Transcatheter edge-to-edge repair (TEER) currently represents a valuable therapeutic option for patients with severe mitral regurgitation (MR) considered at high surgical risk. Besides symptoms and left ventricular (LV) echocardiographic improvements upon TEER, it has been postulated that left atrial (LA) function plays a prognostic role. The aims of our study were to evaluate LA changes after TEER, measured by two-dimensional speckle-tracking echocardiography analysis (2D-STE), their association with atrial fibrillation (AF) occurrence, and relative arrhythmic burden. We considered in a single-center study 109 patients affected by symptomatic severe MR undergoing TEER from February 2015 to April 2022. By 2D-STE, LA reservoir (R_s), conduct (D_s), and contractile (C_s) strains were assessed along with four-chamber emptying fraction (LAEF-4CH) before, 1, 6, and 12 months following TEER. Statistical analysis for comparison among baseline, and follow-ups after TEER was carried out by ANOVA, MANOVA, and linear regression. Successful TEER significantly improved LV dimensions and LA performances, as indicated by all strain components, and LAEF-4CH after 1 year. Strikingly, a significant reduction in arrhythmic burden was observed, since only one case of subclinical AF detected by a previously implanted cardiac electronic device was found in the cohort of sinus rhythm patients (n = 48) undergone TEER; in addition, ventricular rate was reduced in the AF cohort (n = 61) compared to baseline, together with few episodes of nonsustained ventricular tachycardias (5/61, 8.2%) after MR improvement. Overall, TEER was associated with improved cardiac performance, LA function amelioration, and reduced arrhythmic burden.

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Background echocardiography is a helpful tool in patients with suspected pulmonary hypertension (PH). Data derived from echocardiographic examination allow to assign a level of probability of PH by using multiple parameters. Nevertheless, the gold standard for the diagnosis of PH remains the right heart catheterization. The evaluation of PH is important in patients undergoing transcatheter tricuspid valve repair, in fact, many trials excluded those with “severe” pulmonary hypertension. Aim the aim of this study was to examine, in the evaluation of PH, the parameters derived from echocardiographic estimation and cardiac catheterization in patients undergoing TriClip implantation. Methods a retrospective analysis of 4 patients underwent to TriClip implantation in our department was performed. Echocardiography and right heart catheterization data were collected. In the assessment of pulmonary hypertension, the analyzed echocardiographic parameters were: enlarged right ventricle in parasternal long-axis view (>30 mm), flattened interventricular septum leading to “D-shaped LV”, dilated inferior vena cava (>21 mm) with diminished inspiratory collapsibility (<50%), RVOT acceleration time of pulmonary ejection <105 msec, reduced right ventricular fractional area change (<35%), decreased tricuspid annular plane systolic excursion (TAPSE <18mm), TAPSE/sPAP ratio <0.55 mm/mmHg, enlarged right atrial area (>18 cm2), increased systolic peak tricuspid regurgitation velocity (peak TRV>2.8 m/s), estimated systolic pulmonary artery pressure (sPAP). Echocardiographic probability of pulmonary hypertension was defined as high: peak TRV >3.4 m/s or a peak TRV between 2.9-3.4 m/s and the presence of other echo PH sign; intermediate: peak TRV between 2.9-3.4 or peak TRV ≤2.8 m/sec with other echo PH signs; low: peak TRV ≤2.8 m/sec. Pulmonary hypertension, in accordance with guidelines, was defined by a mean pulmonary arterial pressure (mPAP)>20 mmHg at rest. Results the echocardiographic probability of pulmonary hypertension was high in three patients: 2 patients had a peak TRV>3.4 m/s, one patient had peak TRV 2.95 with RVOT AT 55, flattened interventricular septum, dilated inferior vena cava with diminished inspiratory collapsibility, right atrium area >18cm2. In one patient the probability was intermediate (peak TRV 2.40 m/s, RA area >18 cm2 and TAPSE/sPAP ratio <0.55 mm/mmHg). Right heart catheterization confirmed the diagnosis of pulmonary hypertension in two patients with high echocardiographic probability. In the other two patients (one with high probability and one with intermediate probability) there was no PH diagnosis at right heart catheterization. Conclusion in only two out of four patients with intermediate-high probability of PH the diagnosis was confirmed by right catheterization. Therefore, invasive evaluation of pulmonary pressures should be performed in patients with severe tricuspid regurgitation undergoing Triclip implantation.

Introduction The heart is a rare site of tumor metastasis. Although rarely, cardiac metastases may be secondary to a primary intra-abdominal tumor. Aim we report the case of a 60-years-old woman, ante-mortem finding of an isolated cardiac metastasis from cervical carcinoma presented as ACS-NSTE, who was evaluated in our Division of Cardiology. Materials and methods electrocardiogram, transthoracic echocardiography, angioTC, cardiac surgery and histopathologic analysis were performed. Results electrocardiogram showed incomplete right branch block with diffuse negative T waves. On the echocardiogram evidence of a voluminous hypo-isoechoic formation almost completely occupying the cavity of the right ventricule (RV) which appeared dilated and dysfunctional; D-shape aspect of the left ventricule as from the overload of the right sections and with moderate pericardial effusion, mildly reduced ejection fraction (EF50%Q). An urgent Angio-CT was performed and revealed a voluminous solid neoformation with inhomogeneous content and progressive contrast enhancement in the right ventricule. Following admission, the patient's haemodynamic status gradually worsened. Therefore, urgent cardiac surgery was performed. After drainage of abundant serum/haematic effusion, probably neoplastic infiltration of RV was seen. Therefore, given the extension it was decided to perform only multiple biopsies. Histopathological examination revealed moderately differentiated squamous cell carcinoma, as from metastasis from K. cervix. Conclusions there is no standardized therapy for the treatment of cardiac metastases, it is necessary to evaluate on a case-by-case basis. The most important prognostic factors are the obstructive effect of the intracardiac mass and the extent of any pericardial effusion. In fact, they can adversely affect hemodynamic stability.

Background mitral regurgitation (MR) is the second most common valvular heart disease in Europe. In the contest of functional (or secondary) MR recently has emerged a new entity, the atrial functional MR. This form is due to left atrial dilatation, it has no significant degenerative change in mitral valve complex or significant LV systolic disfunction. Conversely the ventricular functional mitral regurgitation (V-FMR) is due to systolic disfunction and left ventricular dilatation. Aim the aim of this study was to evaluate the differences in clinical characteristics and outcomes of patients with AFMR and VFMR treated with Mitraclip. Methods a retrospective analysis collected consecutive patients with functional MR who underwent transcatheter mitral valve repair using Mitraclip system in our division. A total of 161 patients were divided into the following two categories: VFMR (127 patients), defined as EF<40% or EF ≥40% with history of myocardial infarction, and AFMR (34 patients) identified as EF≥50% and LAVi >48 mL/m2. Baseline and clinical characteristics, echocardiographic parameters and 12 months clinical outcomes (overall mortality at 12 months, MACE at 12 months, re-hospitalization for heart failure (HF), re-hospitalization from other causes at 12 months and number of re-hospitalization at 12 months) were analyzed. Results compared to AFMR, patients with VFMR were younger (73 vs 78 years) had a higher man prevalence (72,4% vs 50%), higher rate of: hypercholesterolemia (79,5% vs 67,6%), smokers (14,2% vs 5,9%), diabetes (39,4% vs 20,6%), chronic kidney disease (55,9% vs 47,1%), NT-proBNP mean value (4403,437 pg/ml vs 2063,409 pg/ml), NYHA class ≥III (84.3 vs 52.9%) and lower rate of hypertension (85% vs 97.1%). In AFMR population there was higher prevalence of atrial fibrillation (70.6% vs 45.7%) and tricuspid valve regurgitation ≥2+ (82.3% vs 68,5%). Moreover, in this group, was lower the all-cause mortality rate at 12 months (9.4 vs 22%), MACE at 12 months (4.5 vs 24.5%), re-hospitalization for HF (15.6% vs 33.1%), re-hospitalization from other causes at 12 months (18.8% vs 31.6%) and number of re-hospitalization at 12 months ≥1 (31,3% vs 59.9%). Conclusion our analysis demonstrated that clinical outcomes at 12 months were lower for the AFMR group. These data are consistent with the literature, where AFMR is considered to have a better prognosis than VFMR, and underline the importance of differentiating these two types of population.