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Valvular Heart Disease: Challenges and New Opportunities
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Valvular Heart Disease: Challenges and New Opportunities

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 30 December 2024 | Viewed by 4501

Special Issue Editor

Dr. Federico Fortuni

E-Mail Website
Guest Editor
1. Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy
2. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Interests: aortic valve; tricuspid regurgitation; mitral regurgitation; valvular heart disease; echocardiography; cardiac magnetic resonance; cardiac computed tomography; multimodality imaging; cardiovascular imaging; cardiovascular disease; coronary artery disease; atherosclerosis; heart failure; myocardial infarction

Special Issue Information

Dear Colleagues,

We invite you to participate in this Special Issue of JCM, entitled “Valvular Heart Disease: Challenges and New Opportunities”. As is well-known, with the aging of the population, the prevalence of acquired valvular heart disease (VHD) is rapidly growing and, today, it is among the most common causes of cardiovascular morbidity and mortality. Furthermore, VHD may significantly affect the patients’ well-being and reduce their quality of life.

Although several new therapeutical options have been proposed in recent years, there are still important gaps in the understanding of the imaging and clinical parameters that should be considered for optimal patient selection, timing for referral and long-term outcome prediction. With this Special Issue, we seek to provide an overview of the latest advances in the imaging and therapeutic options for patients with VHD with a particular focus on the role of multimodality imaging assessment (including 2D and 3D echocardiography, speckle tracking echocardiography, non-invasive myocardial work assessment, cardiac computed tomography, cardiac magnetic resonance, nuclear imaging and fusion imaging) and imaging markers for risk stratification and outcome prediction in VHD patients. 

We look forward to receiving your submissions to this Special Issue.

Dr. Federico Fortuni
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic valve
  • aortic stenosis
  • aortic regurgitation
  • tricuspid regurgitation
  • mitral regurgitation
  • mitral stenosis
  • valvular heart disease
  • echocardiography
  • cardiac magnetic resonance
  • cardiac computed tomography
  • multimodality imaging
  • cardiovascular imaging

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Published Papers (3 papers)

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Research

14 pages, 1026 KiB  
Article
Early Outcomes of Two Large Mitral Valve Transcatheter Edge-to-Edge Repair Devices—A Propensity Score Matched Multicenter Comparison
by Philipp von Stein, Hendrik Wienemann, Jennifer von Stein, Atsushi Sugiura, Tetsu Tanaka, Refik Kavsur, Can Öztürk, Marcel Weber, Jean Marc Haurand, Patrick Horn, Tobias Kister, Amir Abbas Mahabadi, Niklas Boeder, Tobias Ruf, Muhammed Gerçek, Christoph Mues, Christina Grothusen, Julia Novotny, Ludwig Weckbach, Henning Guthoff, Felix Rudolph, Amin Polzin, Stephan Baldus, Tienush Rassaf, Holger Thiele, Helge Möllmann, Malte Kelm, Volker Rudolph, Ralph Stephan von Bardeleben, Holger Nef, Peter Luedike, Philipp Lurz, Jörg Hausleiter, Roman Pfister and Victor Mauriadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(14), 4187; https://doi.org/10.3390/jcm13144187 - 17 Jul 2024
Viewed by 921
Abstract
Background/Objectives: Previous trials reported comparable results with PASCAL and earlier MitraClip generations. Limited comparative data exist for more contemporary MitraClip generations, particularly the large MitraClip XT(R/W). We aimed to evaluate acute and 30-day outcomes in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) [...] Read more.
Background/Objectives: Previous trials reported comparable results with PASCAL and earlier MitraClip generations. Limited comparative data exist for more contemporary MitraClip generations, particularly the large MitraClip XT(R/W). We aimed to evaluate acute and 30-day outcomes in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) with one of the large devices, either PASCAL P10 or MitraClip XT(R/W) (3rd/4th generation). Methods: A total of 309 PASCAL-treated patients were matched by propensity score to 253 MitraClip-treated patients, resulting in 200 adequately balanced pairs. Procedural, clinical, and echocardiographic outcomes were collected for up to 30 days, including subgroup analysis for mitral regurgitation (MR) etiologies. Results: PASCAL and MitraClip patients were comparable regarding age (80 vs. 79 years), sex (female: 45.5% vs. 50.5%), and MR etiology (degenerative MR: n = 94, functional MR [FMR]: n = 96, mixed MR: n = 10 in each group). Technical success rates were comparable (96.5% vs. 96.0%; p > 0.999). At discharge, the mean gradient was higher (3.3 mmHg vs. 3.0 mmHg; p = 0.038), and the residual mitral valve orifice area was smaller in MitraClip patients (3.0 cm2 vs. 2.3 cm2; p < 0.001). At discharge, the reduction to MR ≤ 2+ was comparable (92.4% vs. 87.8%; p = 0.132). However, reduction to MR ≤ 1+ was more frequently observed in PASCAL patients (67.7% vs. 56.6%; p = 0.029), driven by the FMR subgroup (74.0% vs. 60.0%; p = 0.046). No difference was observed in 30-day mortality (p = 0.204) or reduction in NYHA-FC to ≤II (p > 0.999). Conclusions: Both M-TEER devices exhibited high and comparable rates of technical success and MR reduction to ≤2+. PASCAL may be advantageous in achieving MR reduction to ≤1+ in patients with FMR. Full article
(This article belongs to the Special Issue Valvular Heart Disease: Challenges and New Opportunities)
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13 pages, 1560 KiB  
Article
Changes in Global Longitudinal Strain after TAVI: Additional Prognostic Value over Cardiac Damage in Patients with Severe Aortic Stenosis
by Rinchyenkhand Myagmardorj, Federico Fortuni, Xavier Galloo, Takeru Nabeta, Maria Chiara Meucci, Steele C. Butcher, Frank van der Kley, Jeroen J. Bax and Nina Ajmone Marsan
J. Clin. Med. 2024, 13(13), 3945; https://doi.org/10.3390/jcm13133945 - 5 Jul 2024
Viewed by 1148
Abstract
Background: Previous studies demonstrated the prognostic value of baseline cardiac damage staging as well as left ventricular global longitudinal strain (LVGLS) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the present study was to evaluate the changes in cardiac damage [...] Read more.
Background: Previous studies demonstrated the prognostic value of baseline cardiac damage staging as well as left ventricular global longitudinal strain (LVGLS) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the present study was to evaluate the changes in cardiac damage stage and LVGLS after TAVI and to investigate their prognostic values when integrated into the follow-up assessment. Methods: Patients with severe aortic stenosis undergoing TAVI were hierarchically classified into cardiac damage stages based on echocardiographic criteria before TAVI and at a 6-month follow-up. At the same time, LVGLS was measured. The staging system included stage 0 = no signs of cardiac damage; stage 1 = LV damage; stage 2 = mitral or left atrial damage; stage 3 = pulmonary vasculature or tricuspid damage; and stage 4 = right ventricular damage. The primary endpoint was all-cause mortality. Results: A total of 620 patients were included. At follow-up, LVGLS significantly improved, and the improvement was similar among each baseline cardiac damage stage. Follow-up LVGLS values were divided into quintiles, and each quintile was integrated into the cardiac damage staging, leading to a reclassification of 308 (50%) patients. At the time of a median follow-up at 48 (IQR 31–71) months starting from the 6-month follow-up after TAVI, 262 (38%) patients had died. A multivariable Cox regression model showed that LVGLS-integrated cardiac damage staging at follow-up had an incremental prognostic value over the baseline assessment (HR per 1-stage increase 1.384; 95% CI 1.152–1.663; p < 0.001). Conclusions: The integration of LVGLS with conventional echocardiographic parameters of cardiac damage at a 6-month follow-up after TAVI can improve patient risk-stratification. Full article
(This article belongs to the Special Issue Valvular Heart Disease: Challenges and New Opportunities)
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14 pages, 1510 KiB  
Article
Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement
by Caglayan Demirel, Kseniya Halavina, Kevin Hamzaraj, Johanna Klement, Manar El-Shaer, Rayyan Hemetsberger, Max Paul Winter, Sophia Koschatko, Charlotte Jantsch, Martin Andreas, Christian Loewe, Andreas Kammerlander, Christian Hengstenberg and Philipp E. Bartko
J. Clin. Med. 2024, 13(9), 2698; https://doi.org/10.3390/jcm13092698 - 3 May 2024
Viewed by 1846
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has evolved as first-line therapy for severe aortic valve stenosis (AS), with pre-procedural computed tomography (CT) providing critical anatomical information. While primarily used for anatomical planning, TAVR-CT also offers an opportunity to assess low bone mineral density [...] Read more.
Background: Transcatheter aortic valve replacement (TAVR) has evolved as first-line therapy for severe aortic valve stenosis (AS), with pre-procedural computed tomography (CT) providing critical anatomical information. While primarily used for anatomical planning, TAVR-CT also offers an opportunity to assess low bone mineral density (BMD), a known indicator of frailty. Despite this, the prognostic role of BMD in TAVR patients remains unknown. This study aimed to evaluate BMD on routine TAVR-CT and its impact on long-term survival. Methods: In this retrospective study, 770 consecutive TAVR patients (mean age 80.7 ± 6.7 years, 54.0% males) between November 2015 and March 2022 were included. BMD was measured from a single axial image at the thoracic vertebral level on unenhanced CT scans. Cox regression models assessed the impact of BMD on mortality, and Restricted Cubic Spline models identified potential mortality thresholds. Results: The mean BMD value, as measured on non-contrast CT, was 147.5 ± 5.4 Hounsfield units, demonstrating a noteworthy association with mortality (adjusted hazard ratio per 100 HU decrease: 1.27 [95%CI: 1.01–1.59], p = 0.041). Restricted cubic spline analysis indicated that BMD below 200 HU was linked to a substantial increase in mortality risk. Upon crude Cox regression analysis, every 100 HU decrease was associated with a 32% increase in risk for death (HR 1.32 [95%CI: 1.068–1.65)], p = 0.010). Conclusions: In conclusion, low BMD on TAVR-CT is independently associated with reduced survival, suggesting its potential as a tool for comprehensive frailty assessment and improved risk prediction in TAVR patients. Full article
(This article belongs to the Special Issue Valvular Heart Disease: Challenges and New Opportunities)
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