Aims The ideal phenotype of patients with functional mitral regurgitation (FMR) who benefit most of transcatheter edge-to-edge repair (TEER) is still unclear. Some studies have suggested that patients with disproportionate FMR may have a better outcome. The purpose of this study is to evaluate the prognostic value of proportionate versus disproportionate FMR, in patients undergoing TEER with MitraClip system. Methods and Results The multicenter observational MITRA-CTV registry includes 200 patients with moderate-severe (3+) to severe (4+) FMR undergoing MitraClip, between March 2013 and June 2021, at three European institutions such as Magna Graecia University of Catanzaro, University of Turin (Italy) and University of Vigo (Spain). Patients were defined as having proportionate or disproportionate FMR if their EROA/LVEDV (left ventricular end diastolic volume) ratio was ≤ or > from the median value (0.15), respectively. The primary endpoint was the composite of death from all causes and rehospitalizations for HF, at 1-year follow-up. The secondary endpoint was composed of the individual components of the primary endpoint and cardiovascular death. Patients with disproportionate FMR had higher EROA (0.47±0.2 cm2 vs 0.27±0.1 cm2) and smaller ventricles (LVEDV: 207 ± ml vs 239 ± 83 ml) than those with proportionate FMR. Procedural success was achieved in 95% of patients. Notably, 30-day residual MR was comparable in patients with disproportionate versus proportionate FMR. There were 4 (2%) deaths during hospitalization, and the median hospital stay after the procedure was 9 days (IQR 7- 9 days). At Kaplan-Meier analysis, an EROA/LVEDV ratio both higher and lower than the median value (0.15) was not associated with an increased incidence of the primary endpoint of death and rehospitalization for HF (HR 1.17 CI 95%[0.72;1.90],p=0.50). The only independent predictors of clinical outcomes at 1 year were: the presence of CKD (HR 4.11 95% CI[1.73;9.75], p=0.0014) and a post TMVR hospital stay >10 days (HR 2.53 95% CI[1.24;5.18],p=0.0111). Conclusion In our study, there were no significant differences in outcome in patients with proportionate versus proportionate FMR undergoing TEER with Mitraclip system.

Background Multivessel disease occurs in approximately half of patients presenting with STEMI and the best management non-culprit lesions is still unclear. The case reported a patient with inferior STEMI, in which the non-culprit lesion has been evaluated with a “full-physiology” approach by a pressure wire. Case Description A 52-year-old woman with a history of hypertension and diabetes was admitted to our center diagnosed with inferior STEMI. Coronary angiography showed a thrombotic occlusion (TIMI 0) of the right coronary artery (culprit lesion) and intermediate stenosis of proximal left anterior descending (LAD). Primary PCI (p-PCI) of the right coronary artery has been performed. After 4 days a stepwise complete physiological approach on the LAD artery has been performed. The physiological study showed a negative discrepancy between FFR - and RFR + with increased index of microvascular resistance (IMR). Discussion The fractional flow reserve (FFR) represents the best-known invasive method for the functional evaluation of intermediate coronary stenosis. Unlike the FFR, the resting flow ratio RFR is a non-hyperemic index that does not require the administration of a vasodilator such as adenosine as does the iwFR. There are many factors that can lead to a negative discrepancy between hyperemic and non-hyperemic indices. In the case presented, the functional values found were: FFR: 0.90 RFR: 0.86 and IMR = 76; CFR = 1.0. The FFR-/ RFR+ disagreement may reflect the attenuating influence of microvascular disease on adenosine-mediated vasodilation. Therefore, we decided to treat the LAD lesion according the RFR value with a DES 3.0×33 mm implantation. Conclusion Myocardial infarction can result in altered microvascular and endothelial dysfunction also in the non-culprit territory. The FFR - / RFR + disagreement may reflect the attenuating influence of microvascular disease on adenosine-mediated vasodilation.

Aims Mitral regurgitation is the second-most frequent VHD in Europe. According to the latest ESC Guidelines, transcatheter edge-to-edge repair (TEER) was included as a treatment option in patients with severe symptomatic MR at high risk for surgery (Class IIb recommendation) for primary MR and a Class IIa recommendation for secondary MR. We sought to investigate predictors of clinical outcome in patients with mitral regurgitation undergoing percutaneous valve repair. Methods and Results The MITRA-UMG study, a single-center registry, retrospectively collected consecutive patients with symptomatic moderate-to-severe or severe MR undergoing MitraClip therapy between March 2012 to October 2021 at Magna Graecia University. Clinical, echocardiographic and procedural data were collected and compared with post procedural outcomes. Procedural success was defined as successful implantation of one or more clip(s) with a post-procedure reduction of MR of 2 + or less at discharge. The primary endpoint was the composite of cardiovascular death or rehospitalization for heart failure. The median follow-up was 456 days (IQR 372–1130 days) with a complete 1-year follow- up in 188 of 200 (97%) patients. A functional aetiology was classified in 75% of patients. Procedural success was obtained in 98% of patients. The composite primary endpoint of cardiovascular death or rehospitalization for HF was met in 77 patients (36%) with cumulative incidences of 7% at 30 days and 25% at 1 year. In the Cox multivariate model, NYHA functional class and left ventricular end-diastolic volume index (LVEDVi), independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan–Meier analysis, a LVEDVi > 92 ml/m2 was associated with an increased incidence of the primary endpoint (HR 3.55, 95%CI [2.03, 6.18], P<0.0001) (Figure). Conclusions In this study, patients presenting with dilatated ventricles (LVEDVi > 92 ml/m2) and advanced heart failure symptoms (NYHA IV) carried the worst prognosis after TEER.

Background The COAPT randomized trial has shown a huge benefit in the survival of patients with heart failure and functional mitral regurgitation treated with Mitraclip. However, patients in COAPT trial were highly selected and the clinical course in real-world patients with and without fulfilment of the trial inclusion criteria is unclear. Methods and Results The present study examined the clinical outcome in consecutive patients (n=146) with symptomatic moderate-to-severe or severe MR of dominant functional etiology undergoing Mitraclip therapy by the presence of the inclusion criteria of the COAPT trial (left ventricular ejection fraction >20%, left ventricular end-systolic dimension <70 mm, non-commissural primary jet, estimated pulmonary artery systolic pressure <70 mmHg, mitral valve orifice area >4 cm2, no prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve or any prior transcatheter mitral valve procedure). The primary endpoint was the composite of all-cause mortality or heart failure hospitalization. Secondary endpoints were the single components of the primary endpoint (heart failure hospitalization, all-cause mortality) and cardiovascular mortality. Among 146 patients who underwent Mitraclip implantation 35.6% fulfilled the inclusion criteria of COAPT. The composite endpoint was significantly less frequent in patients fulfilling the COAPT selection criteria than in those not fulfilling the criteria [HR 0.3851 (0.2266 to 0.6642); p=0.0017] (Figure). Conclusion In this single center study the outcome of patients with functional mitral regurgitation undergoing Mitraclip therapy was significantly worse in patients not fulfilling COAPT inclusion criteria, indicating that these criteria might help identify futility.

Background Despite many therapeutic resources and technological innovations, coronary artery diseases (CAD) yet represent the first cause of death in industrialized countries. In order to improve outcomes in CAD and other chronic diseases, it has been proposed to implement personalized and continuous home-monitoring through digital applications. Currently, dyslipidemias are considered the ideal target condition for the development of such telemedicine approaches. Objectives The main goal is to evaluate the efficacy of a mobile app on the clinical cardiovascular outcomes, by analyzing the adherence to lipid-lowering therapy of dyslipidemic patients, compared to out clinics patients followed under standard work-ups. Materials and methods From March 2022 to September 2022, 15 patients were enrolled who were able to benefit from remote monitoring and 8 patients undergoing outpatient monitoring. The two groups were divided into four categories: 8 ischemic patients to whom the mobile app was recommended admitted with a diagnosis of CAD and undergoing PCI (percutaneous coronary intervention), 4 ischemic patients undergoing outpatient follow-up, 7 not ischemic admitted for other procedure for which remote monitoring was proposed, 4 non-ischemic patients with outpatient procedure. the lipid profile was assessed by mobile application and outpatient visit, respectively. Results In the evaluation between the group of patients who underwent the diagnostic application procedure and the outpatient group, greater adherence to the use of telemedicine was found in patients aged 40-69 years or who could benefit from the help of family members. Lack of information and experience in using the systems and devices was a significant obstacle in 5 percent of patients all over 78 years of age and in the absence of a family member. Given the many logistical and waiting time problems for hospital visits, 57 percent of patients who underwent a medical examination via the app benefited most from using the remote app. Mean LDL values of 97 mg/dL at one month after discharge were found in 66% of patients particularly the subgroup of ischemic patients who, given the strong correlation between atherosclerotic disease and ischemic heart disease, require closer follow-up, with mean LDL values of 95mg/dL found. Conclusions Telemedicine has the potential to improve clinical outcomes in patients with dyslipidemia, although efficacy is influenced by parameters such as age and family support; in the future, telemedicine platforms could be an aid to evaluate new therapeutic opportunities for innovative treatments, such as bempedoic acid. Telemedicine helped patients in understanding the importance of reducing LDL cholesterol.