Mitral valve repair using the MitraClip system was shown to be feasible in patients at high surgical risk primarily determined by an adverse mitral valve morphology and/or severe LV dysfunction.

FMR treatment with the MitraClip in CRT nonresponders was feasible, safe, and demonstrated improved functional class, increased LVEF, and reduced ventricular volumes in about 70% of these study patients.

Background: Guideline-recommended doses of angiotensin-converting-enzyme (ACE) inhibitors/angiotensin-receptor blockers (ARBs) and beta-blockers are similar for men and women with heart failure with reduced ejection fraction (HFrEF), even though there are known sex differences in pharmacokinetics of these drugs. We hypothesized that there may be sex differences in the optimal dose of ACE-inhibitors/ARBs and beta-blockers in patients with HFrEF. Methods: We performed a post-hoc-analysis of BIOSTAT-CHF, a prospective study of HF patients in whom initiation and up-titration of ACE-inhibitors/ARBs and beta-blockers was encouraged by protocol. Findings were validated in an independent cohort (ASIAN-HF) of 3,539 men and 961 women with HFrEF. Findings: Among 1,308 men and 402 women with HFrEF from BIOSTAT-CHF, women were older (74 vs. 70 years, p<0•001), and had lower body weight (72 vs. 85 kg, p<0•001) and height (162 vs. 174 cm, p<0•001) than men, although body mass index did not differ significantly. A similar % of men and women reached guideline-recommended target doses of ACE-inhibitors/ARBs (25 vs. 23%; p=0•61) and beta-blockers (14 vs. 13%; p=0•54). In men, the lowest hazards of death and/or HFhospitalization occurred at 100% of the recommended dose of ACE-inhibitors/ARBs and betablockers, but women showed a ~30% lower risk at only 50% of the recommended doses, with no further decrease in risk at higher dose levels. These sex differences were still present after adjusting for clinical covariates including age and body surface area. In the ASIAN-HF registry, similar patterns were observed for both ACE-inhibitors/ARBs and beta-blockers, with women having a ~30% lower risk at 50% of the recommended doses, with no further benefit at higher dose levels. Interpretation: This study suggests that women with HFrEF may need lower doses of ACEinhibitors/ARBs and beta-blockers as compared with men, and brings into question what true 'optimal medical therapy' is for women versus men.

Aims Our aim was to identify circulating microRNAs (miRNAs) associated with acute heart failure (AHF). Methods and results Plasma miRNA profiling included 137 patients with AHF from 3 different cohorts, 20 with chronic heart failure (CHF), 8 with acute exacerbation of COPD, and 41 healthy controls. Levels of circulating miRNAs were measured using quantitative reverse transcription–polymerase chain reaction (qRT–PCR). Plasma levels of miRNAs in patients with AHF were decreased compared with CHF patients or healthy subjects, whereas no significant changes were observed between acute COPD patients and controls. Fifteen miRNAs found in the discovery phase to differ most significantly between healthy controls and patients with AHF were further investigated in an extended cohort of 100 AHF patients at admission and a separate cohort of 18 AHF patients at different time points. Out of these 15 miRNAs, 12 could be confirmed in an additional AHF validation cohort and 7 passed the Bonferroni correction threshold (miR-18a-5p, miR-26b-5p, miR-27a-3p, miR-30e-5p, miR-106a-5p, miR-199a-3p, and miR-652-3p, all P < 0.00005). A further drop in miRNA levels within 48 h after AHF admission was associated with an increased risk of 180-day mortality in a subset of the identified miRNAs. Conclusions Declining levels of circulating miRNAs were associated with increasing acuity of heart failure. Early in-hospital decreasing miRNA levels were predictive for mortality in a subset of miRNAs in patients with AHF. The discovered miRNA panel may serve as a launch-pad for molecular pathway studies to identify new pharmacological targets and miRNA-based therapies