Isolated TR can be severe and is associated with excess mortality and morbidity, warranting heightened attention to diagnosis and quantitation. Quantitative assessment of TR, particularly ERO measurement, is a powerful independent predictor of outcome, superior to standard qualitative assessment.

et al.. Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years Methods and results. AimsThe MITRA-FR trial showed that among symptomatic patients with severe secondary mitral regurgitation, percutaneous repair did not reduce the risk of death or hospitalization for heart failure at 12 months compared with guideline-directed medical treatment alone.At 37 centres, we randomly assigned 304 symptomatic heart failure patients with severe secondary mitral regurgitation (effective regurgitant orifice area >20 mm 2 or regurgitant volume >30 mL), and left ventricular ejection fraction between 15% and 40% to undergo percutaneous valve repair plus medical treatment (intervention group, n = 152) or medical treatment alone (control group, n = 152). The primary efficacy outcome was the composite of all-cause death and unplanned hospitalization for heart failure at 12 months. At 24 months, all-cause death and unplanned hospitalization for heart failure occurred in 63.8% of patients (97/152) in the intervention group and 67.1% (102/152) in the control group [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.77-1.34]. All-cause *Corresponding author. Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, mortality occurred in 34.9% of patients (53/152) in the intervention group and 34.2% (52/152) in the control group (HR 1.02, 95% CI 0.70-1.50). Unplanned hospitalization for heart failure occurred in 55.9% of patients (85/152) in the intervention group and 61.8% (94/152) in the control group (HR 0.97, 95% CI 0.72-1.

Objectives: To assess non-invasively the acute effects of cardiac resynchronisation therapy (CRT) on functional mitral regurgitation (MR) at rest and during dynamic exercise. Methods: 21 patients with left ventricular (LV) systolic dysfunction and functional MR at rest, treated with CRT, were studied. Each patient performed a symptom-limited maximal exercise with continuous two dimensional Doppler echocardiography twice. The first exercise was performed with CRT; the second exercise was performed without CRT. Mitral regurgitant flow volume (RV), effective regurgitant orifice area (ERO) and LV dP/dt were measured at rest and at peak exercise. Results: CRT mildly reduced resting mitral ERO (mean 8 (SEM 2) v 11 (2) mm 2 without CRT, p = 0.02) and RV (13 (3) v 18 (3) ml without CRT, p = 0.03). CRT attenuated the spontaneous increase in mitral ERO and RV during exercise (1 (1) v 9 (2) mm 2 , p = 0.004 and 1 (1) v 8 (2) ml, p = 0.004, respectively). CRT also significantly increased exercise-induced changes in LV dP/dt (140 (46) v 479 (112) mm Hg/s, p , 0.001). Conclusion: Attenuation of functional MR, induced by an increase in LV contractility during dynamic exercise, may contribute to the beneficial clinical outcome of CRT in patients with chronic heart failure and LV asynchrony. P atients with chronic heart failure (CHF) due to left ventricular (LV) systolic dysfunction commonly develop functional mitral regurgitation (MR) at rest.1 Functional MR may worsen when these patients exercise.2 3 Worsening functional MR during exercise may negatively affect the long-term outcome of patients with CHF by further activating neurohormonal systems.Cardiac resynchronisation therapy (CRT) improves clinical outcome in patients with severe CHF.4 5 The present study was undertaken to assess non-invasively the acute effects of CRT on functional MR at rest and during dynamic exercise. PATIENTS AND METHODS Study populationWe screened 39 patients with CHF, functional MR and CRT. Eighteen of these patients were excluded for poor acoustic window (n = 4), sinus or atrioventricular blocks (n = 5), atrial fibrillation (n = 3), wire displacement (n = 2), orthopaedic limitation (n = 2) and improved LV ejection fraction . 45% (n = 2).The study population comprised the remaining 13 men and eight women (mean age 67 (SEM 2) years) with CHF caused by ischaemic (n = 8) or non-ischaemic dilated cardiomyopathy (LV end diastolic diameter 69 (4) mm, LV end diastolic volume 249 (19) ml) and reduced LV ejection fraction (22 (1)%). These 21 patients had undergone CRT for a mean duration of 2.3 (1.3) months. All patients were in sinus rhythm and before pacemaker implantation had a left bundle branch block (mean QRS interval 175 (16) ms). The devices were programmed in the DDDR mode with the shortest programmable atrioventricular delay (mean 135 (4) ms) to ensure full and permanent biventricular capture. This also provided, by Doppler echocardiography, the longest filling time and optimised LV end diastolic flow before onset of systole. 6 The programmable in...

Nongated multidetector CT can be used to diagnose high-grade shunts through a PFO, with 91% sensitivity and 98% specificity. Thus, PFO detection, in addition to routine CT evaluation of the lungs, could be indicated in patients with unexplained hypoxemia.

Administration of bFGF is associated with important beneficial structural and functional effects in the early stage of experimental atherosclerosis. These results may help us to understand the role of growth factors in atherosclerosis and to anticipate their effects in human arteries.