Search Results (41)

Background: Despite advances in reperfusion therapy, ST-segment elevation myocardial infarction (STEMI) remains associated with substantial morbidity and mortality. Early identification of predictors of adverse outcomes is essential for improving risk stratification. Methods: This retrospective study included 512 STEMI patients who underwent coronary revascularization within 6 h of symptom onset. Clinical, laboratory, angiographic and echocardiographic variables were analyzed. The primary endpoint was in-hospital mortality. Secondary outcomes included reduced left ventricular ejection fraction (LVEF < 40%) and moderate-to-severe ischemic mitral regurgitation (IMR). Independent predictors of in-hospital mortality were identified using multivariable logistic regression, while secondary outcomes were described to characterize the study population. Model performance was evaluated using ROC analysis. Results: In-hospital mortality occurred in 9.4% of patients. Reduced LVEF was present in 26.2%, and IMR in 10.9%. Independent predictors of mortality included LVEF < 40% (OR 5.72, 95% CI 2.77–11.80, p < 0.001), IMR (OR 2.61, 95% CI 1.14–5.97, p = 0.023), lower hemoglobin levels (OR 0.74, 95% CI 0.61–0.91, p = 0.003), and reduced glomerular filtration rate (OR 0.96, 95% CI 0.95–0.98, p < 0.001). The model demonstrated good discrimination (AUC 0.88). Complete revascularization was not independently associated with mortality. Conclusions: Left ventricular dysfunction, IMR, anemia, and renal impairment are strong predictors of in-hospital mortality in STEMI patients. Integrating echocardiographic and laboratory parameters may improve early risk stratification and guide clinical decision-making. Full article

Mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a cornerstone in the management of severe mitral regurgitation, serving as a robust, low-risk alternative to conventional mitral valve surgery. Although thromboembolic risk remains a critical clinical challenge, that varies significantly across the clinical continuum, from pre-procedural substrates to post-procedural management. This review highlights the role of atrial cardiomyopathy in creating a prothrombotic milieu even prior to intervention, while during the procedure, device time emerges as a potentially dominant independent predictor of embolic burden, marking the periprocedural window as the period of peak hazard. Furthermore, this article addresses the notable disparity between the near-universal presence of subclinical ischemic lesions on magnetic resonance imaging and the infrequent incidence of overt neurological deficits. As the post-procedural phase is considered, we discuss the shift from standardized antithrombotic protocols to individualized strategies and the potential role of concomitant left atrial appendage occlusion. Ultimately, integrating these stage-specific clinical and procedural determinants with emerging technologies—like digital twins and artificial intelligence—represents a promising frontier for mitigating embolic risks, optimizing procedural planning and patient safety in the evolving landscape of mitral valve interventions. Full article

Background and Clinical Significance: Mechanical complications and intracavitary thrombus are both recognized causes of clinical deterioration following acute myocardial infarction, yet they require fundamentally different therapeutic approaches. Distinguishing between these entities is critical, as misdiagnosis may lead to unnecessary surgical intervention or delayed anticoagulation with serious consequences. Left ventricular (LV) thrombus typically appears as a well-defined mass; however, atypical and highly mobile morphologies may closely mimic catastrophic post-infarction mechanical complications, creating significant diagnostic uncertainty. This case highlights the pivotal role of contrast-enhanced echocardiography in resolving such ambiguity and guiding appropriate management in a high-stakes clinical setting. Case Presentation: A 60-year-old man presented with acute dyspnea and pulmonary edema ten days after an anterior myocardial infarction treated with percutaneous coronary intervention, complicated by ischemic stroke. Transthoracic echocardiography demonstrated severe LV systolic dysfunction with moderate-to-severe mitral regurgitation and an unexpected, highly mobile, irregular mass protruding into the LV apex. The mass exhibited a shredded, tissue-like appearance, raising urgent concern for post-infarction mechanical complications, including papillary muscle rupture or apical myocardial disruption, and prompting immediate consideration of surgical intervention. Contrast-enhanced echocardiography was performed and revealed a mobile LV apical thrombus. Surgical management was avoided, and systemic anticoagulation was initiated, followed by transition to rivaroxaban in combination with ongoing dual antiplatelet therapy. The patient demonstrated rapid clinical improvement with optimized heart failure treatment and was discharged after four days, with planned follow-up imaging to assess thrombus resolution. Conclusions: Left ventricular thrombus may present with atypical, misleading morphologies that closely resemble life-threatening mechanical complications after myocardial infarction. Full article

Caseous calcification of the mitral annulus (CCMA) is a liquefactive necrosis of mitral annular calcification (MAC). CCMA is rare and usually asymptomatic, has a benign course, and, when incidentally found, can be misdiagnosed as a thrombus, abscess, cardiac tumor or vegetation. Although rarely, CCMA may complicate with rupture, which can lead to ventricular-atrial fistulization, pseudoaneurysm, severe mitral regurgitation (with possible heart failure and atrial fibrillation) and systemic embolism of caseous material (with cerebral ischemic events). A significant increase in CCMA dimensions and an infectious involvement of liquefactive necrosis make CCMA prone to rupture. To date, only case reports and some case series have been published on CCMA, without focusing on the pathophysiological mechanisms responsible for rupture, nor recommendations for prevention and management. However, despite general concerns about surgical treatment of CCMA because of high perioperative risks, most published cases actually underwent successful cardiac surgery. In the present review, we conducted a systematic review of the studies published in the medical literature up to March 2025, reporting cases of CCMA and its complications, as identified through the PubMed database. We analyzed clinical and biological risk factors for CCMA rupture and its diagnostic criteria, focusing on imaging features differentiating mitral annular calcification from uncomplicated CCMA and ruptured CCMA. To this regard, we focused on the key role of multimodality imaging in the achievement of the correct diagnosis. Finally, we propose a management strategy for CCMA, with the aim to fill a gap in this field in the current literature. Full article

Mitral annular disjunction (MAD) is a structural abnormality of the mitral valve increasingly detected with advanced cardiac imaging, particularly cardiac magnetic resonance (CMR). However, the clinical impact of different degrees of disjunction and the lack of standardized measurement criteria remain controversial. This study aimed to describe a series of patients with MAD assessed by CMR and to discuss, in the context of current literature, potential cut-off values that may distinguish physiological from pathological MAD. We retrospectively identified all CMR examinations performed at our institution over a 6-month period in which MAD was visible in at least two cine steady-state free precession (SSFP) projections. For each patient, we recorded MAD extent, presence of mitral valve prolapse/regurgitation, late gadolinium enhancement (LGE) pattern, and main clinical presentation. Nine patients (mean age 57 years; 5 men) were included. Larger MAD distances (>4 mm) were frequently associated with non-ischemic LGE in the basal lateral wall and with valvular abnormalities, whereas smaller disjunctions (≤3 mm) were often observed in patients without significant structural disease. Non-ischemic LGE was present in 6/9 patients, all with MAD > 5 mm. These observations, together with published data, support the hypothesis that small degrees of MAD may represent a frequent anatomical variant, while more extensive disjunction, especially when associated with fibrosis, may indicate a pathological substrate for arrhythmias. Standardized CMR-based criteria and validated MAD cut-off values are needed to improve risk stratification and to incorporate MAD assessment into routine clinical practice. Full article

Introduction: Cardiac sarcoidosis (CS) is a rare but potentially life-threatening manifestation of systemic sarcoidosis, often leading to arrhythmias, conduction abnormalities, or heart failure. Diagnosis is challenging due to nonspecific symptoms and the need for advanced imaging or biopsy. Case Presentation: We describe a 49-year-old man admitted with severe decompensated heart failure (NYHA IV). He had a history of complete heart block treated with pacemaker implantation and subsequent CRT-D upgrade. On admission, echocardiography revealed biventricular dysfunction with severe mitral and tricuspid regurgitation. Cardiac MRI demonstrated extensive non-ischemic late gadolinium enhancement. Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA) and intravenous antibiotics were initiated. Despite diuretics and inotropes, his condition deteriorated. Corticosteroid therapy was started due to high suspicion of sarcoidosis. Endomyocardial biopsy confirmed CS. The patient developed neuropsychiatric complications and, despite urgent listing for heart transplantation, died during hospitalization. Conclusions: This case highlights the diagnostic and therapeutic challenges of CS, the limitations of corticosteroid therapy in advanced disease, and the importance of early recognition with advanced imaging modalities. Full article

Background: Anemia is a common comorbidity in heart failure (HF) and has been associated with adverse clinical consequences. This retrospective, descriptive cohort study examined phenotype-specific differences in anemia severity, clinical presentation, comorbid burden, and in-hospital management across HF subtypes classified by left ventricular ejection fraction (LVEF). Methods: We retrospectively analyzed 443 adult patients hospitalized with concurrent HF and anemia from January 2022 to December 2024. Patients were stratified by LVEF into HFrEF (<40%), HFmrEF (40–49%), and HFpEF (≥50%). All patients included met WHO criteria for anemia. Demographic, clinical, paraclinical, and therapeutic data were extracted, and descriptive statistical methods were used to evaluate intergroup differences. No formal time-to-event analyses (e.g., Kaplan–Meier curves) were performed; instead, exploratory cumulative readmission analyses using fixed follow-up windows were conducted. In-hospital mortality was recorded and stratified by HF phenotype. Results: The cohort comprised 213 (48.0%) HFrEF, 118 (26.6%) HFmrEF, and 112 (25.3%) HFpEF patients. The distribution of anemia severity, management strategies, and comorbidity profiles varied significantly across phenotypes. Severe anemia predominated in the HFmrEF cohort (54.2%), whereas mild anemia was most common in HFpEF (52.1%) and HFrEF (52.1%). Mean hemoglobin concentrations were 8.39 ± 1.79 g/dL (HFmrEF), 9.07 ± 2.47 g/dL (HFpEF), and 8.62 ± 1.94 g/dL (HFrEF). Rates of atrial fibrillation (48.2% in HFpEF), hypertensive ECG changes (63.4% in HFpEF), and ischemic-lesion patterns (>50% in HFrEF) differed by cohort. Echocardiographically, grade III mitral regurgitation and severe pulmonary hypertension each affected 25.4% of HFmrEF patients, whereas HFpEF patients most often exhibited grade II mitral regurgitation (42.9%) and moderate pulmonary hypertension (42.9%). HFrEF patients had severe pulmonary hypertension. Intravenous (IV) iron was the primary treatment modality, with highest utilization in HFmrEF. IV iron use ranged from 69.9% (HFrEF) to 84.8% (HFmrEF), with transfusion rates of 5.6% (HFrEF)–16.1% (HFpEF). Comorbid burdens differed by phenotype: HFrEF was associated with structural heart disease, HFmrEF with vascular and hepatic pathology, and HFpEF with metabolic and degenerative comorbidities. Discharge pharmacotherapy reflected phenotype-specific treatment patterns. Conclusions: This real-world descriptive analysis highlights substantial variation in anemia burden and management across the HF spectrum. While limited to descriptive findings, our analysis highlights the heterogeneity of anemia in HF and describes observed associations across phenotypes, without implying causality. These findings should be interpreted as hypothesis-generating. These findings are observational, exploratory, and cannot establish a causal relationship between intravenous iron use and survival. Full article

Background and Clinical Significance: Congenital malformations of the right atrium are rare. Their clinical presentation varies widely, from the absence of symptoms to sudden death, often being diagnosed incidentally by cardiac imaging. First described in 1955, the right atrial diverticulum is usually characterized as a pouch-like structure originating from the free atrial wall, or right atrial appendage. The prevalence of congenital malformations of the right atrium is unknown because few clinical cases have been reported. Associated complications include arrhythmias, pulmonary thromboembolism, progressive dilatation marked by a high risk of compression and rupture. In these cases, the optimal therapeutic approach is surgical resection. Case Presentation: We present the case of a 58-year-old, hypertensive female with a history of COVID-19 (Coronavirus Disease 2019), who was admitted for persistent dyspnea and chest pain. An electrocardiogram on arrival showed no arrhythmias or ischemic changes, and echocardiography revealed severe systolic dysfunction—a left ventricular ejection fraction (LVEF) of 20%, moderate mitral and tricuspid regurgitations, and a pericardial collection, adjacent to the right atrium, considered to be a localized pericardial effusion. Coronary angiography excluded ischemic etiology and a viral myocarditis was further suspected. Cardiac magnetic resonance imaging (IRM) showed a non-ischemic scar pattern in the interventricular septum, but also detected a well-defined large mass, which communicated with the right atrium through a 20 mm opening, suggestive of a right atrial diverticulum. Contrast echocardiography confirmed the communication between the cavity and the right atrium. A surgical resection of the large diverticulum was performed. Conclusions: The particularity of this case consists in the incidental identification of a rare cardiac malformation in an adult patient. Full article

Functional mitral regurgitation (FMR) is a common condition with significant prognostic implications, primarily driven by left atrial or ventricular remodeling secondary to ischemic or non-ischemic cardiomyopathies. While guideline-directed medical therapy (GDMT) remains the cornerstone of management, reducing mitral regurgitation severity in up to 40–45% of cases, additional interventions are often necessary. In patients where atrial fibrillation (AF) or ventricular dyssynchrony due to abnormal electrical conduction contributes to disease progression, guideline-directed AF management or cardiac resynchronization therapy plays a pivotal role. For those with persistent moderate to severe MR and unresolved symptoms despite optimal GDMT, percutaneous intervention may be warranted, provided specific clinical and echocardiographic criteria are met. This review highlights a precision-medicine approach to patient selection for transcatheter treatment of functional mitral regurgitation (FMR), emphasizing the integration of clinical characteristics with advanced multimodal imaging, including echocardiography, cardiac magnetic resonance, and computed tomography. In anatomically or clinically complex cases, complementary use of these imaging modalities is essential to ensure accurate phenotyping and procedural planning. Once a suitable candidate for percutaneous intervention has been identified, we provide a detailed overview of current transcatheter strategies, with a focus on device selection tailored to anatomical and pathophysiological features. Finally, we discuss emerging technologies and evolving therapeutic paradigms that are shaping the future of individualized FMR management. Full article

Background/Objectives: Anatomical and functional damage of the mitral valve (MV) apparatus in patients with dilated cardiomyopathy (DCM) is secondary to left ventricular (LV) injury, leading to functional mitral regurgitation (FMR). Real-time four-dimensional echocardiography (RT 4DE) is a useful imaging technique in different pathologies, including DCM. Left atrial (LA) strain, as measured by left atrium quantification software, is an accurate technique for evaluating increased filling pressure. The MV has a complex three-dimensional morphology and motion. Four-dimensional echocardiography (4DE) has revolutionized clinical imaging of the mitral valve apparatus. This study aims (1) to characterize the mitral annulus (MA) parameters in patients with DCM and advanced-stage heart failure (HF) according to etiology and (2) to find correlations between left atrial function and MA remodeling in this group of patients, using 4DE quantification software. Methods: A total of 82 patients with DCM and an LV ejection fraction ≤ 40% were recruited. Conventional 2DE and RT 4DE were conducted in DCM patients with a compensated phase of HF before discharge. The measured parameters were left atrial reservoir strain (LASr), annular area (AA), annular perimeter (AP), anteroposterior diameter (A-Pd), posteromedial to anterolateral diameter (PM-ALd), commissural distance (CD), interregional distance (ITD), annular height (AH), nonplanar angle (NPA), tenting height (TH), tenting area (TA), and tenting volume (TV). Results: Measured parameters revealed more advanced damage of LA and MA parameters in ischemic compared to nonischemic etiology. Univariate analysis identified AA, AP, A-Pd, PM-ALd, CD, ITD, TH, TA, and TV (p < 0.0001) as determinants of LASr. Including these parameters in a stepwise multivariate logistic regression, PM-ALd (p = 0.03), TH (p = 0.043), and TV (p = 0.0001) were the best predictors of LAsr in these patients. Conclusions: The results of this study revealed the correlation between LA function depression and MA remodeling in patients with DCM. Full article

Background: Coronary heart disease (CHD) remains the most prevalent pathology within the circulatory system. Among its chronic complications, ischemic mitral valve regurgitation (IMR) is observed in approximately 15% of patients with sustained myocardial ischemia. The presence of this complex valvular defect significantly increases both overall mortality and the incidence of adverse cardiovascular events. Notably, the presence of moderate to severe mitral regurgitation in patients undergoing surgical revascularization has been shown to double the risk of death. Despite the well-established etiology of IMR, data regarding the efficacy of surgical interventions and the determinants of postoperative outcomes remain inconclusive. Methods: The objective of the present study was to evaluate both early and long-term outcomes of surgical treatment of mitral regurgitation in patients undergoing coronary artery bypass grafting (CABG) due to ischemic heart disease. Particular attention was given to the influence of the severity of regurgitation, left ventricular ejection fraction (LVEF), and the dimensions of the left atrium (LA) and left ventricle (LV) on the postoperative prognosis. An additional aim was to identify preoperative risk factors associated with increased postoperative mortality and morbidity. A retrospective analysis was conducted on 421 patients diagnosed with ischemic mitral regurgitation who underwent concomitant mitral valve surgery and CABG. Exclusion criteria included emergent and urgent procedures as well as non-ischemic etiologies of mitral valve dysfunction. Results: The study cohort comprised 34.9% women and 65.1% men, with the mean age of 65.7 years (±7.57). A substantial proportion (76.7%) of patients were aged over 60 years. More than half (51.5%) presented with severe heart failure symptoms, classified as NYHA class III or IV, while over 70% were categorized as CCS class II or III. Among the surgical procedures performed, 344 patients underwent mitral valve repair, and 77 patients required mitral valve replacement. Additionally, 119 individuals underwent concomitant tricuspid valve repair. Short-term survival was significantly affected by the presence of hypertension, prior cerebrovascular events, and chronic kidney disease. In contrast, hypertension and chronic obstructive pulmonary disease were identified as significant predictors of adverse late-term outcomes. Conclusions: Interestingly, neither the preoperative severity of mitral regurgitation nor the echocardiographic measurements of LA and LV dimensions were found to significantly influence surgical outcomes. The perioperative risk, as assessed by the EuroSCORE II (average score: 10.0%), corresponded closely with observed mortality rates following mitral valve repair (9.9%) and replacement (10.4%). Notably, the need for concomitant tricuspid valve surgery was associated with an elevated mortality rate (12.4%). Furthermore, the preoperative echocardiographic evaluation of LA regurgitation severity, as well as LA and LV dimensions, did not exhibit a statistically significant impact on either early or long-term surgical outcomes. However, a reduced LVEF was correlated with increased long-term mortality. The presence of advanced clinical symptoms and the necessity for tricuspid valve repair were independently associated with a poorer late-term prognosis. Importantly, the annual mortality rate observed in the late-term follow-up of patients who underwent surgical treatment of ischemic mitral regurgitation was lower than rates reported in the literature for patients managed conservatively. The EuroSCORE II scale proved to be a reliable and precise tool in predicting surgical risk and outcomes in this patient population. Full article

Secondary mitral regurgitation (sMR) is commonly understood to be secondary to heart failure (HF), left ventricular (LV) dilation, and altered coaptation of the mitral annulus. Three forms of sMR exist: non-ischemic sMR, ischemic sMR, and atrial functional sMR. In the past, there have been limited treatment options for this condition besides medication. Recently, the management of sMR has been revolutionized by the recent advances in percutaneous transcatheter edge-to-edge repair of the mitral valve (m-TEER). However, the major trials investigating this technology have shown that appropriate patient selection is of critical importance to achieve benefit. As such, there is a renewed interest in the accurate diagnosis of sMR. Herein, we review the etiology, management, and diagnosis of sMR in the era m-TEER. Full article

Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, dσ*/dt_max, is load-independent and has been reported to be associated with clinical outcomes in heart failure and aortic stenosis. We aim to assess if dσ*/dt_max could predict adverse outcomes in patients with severe mitral regurgitation (MR). Methodology: We studied dσ*/dt_max in a cohort of 127 patients with isolated severe primary MR and preserved LVEF ≥ 60%. Patients with prior valvular intervention or concurrent valvular disease were excluded. We tested dσ*/dt_max against a composite of adverse outcomes including all-cause mortality, heart failure hospitalization, and mitral valve intervention. Results: The cohort had a mean age of 58 years old and was predominantly male. Of the 127 patients, eight (6.3%) needed subsequent hospitalization for heart failure, while 30 (23.6%) and 11 (8.7%) patients underwent mitral valve repair and replacement, respectively, And 14 (11.0%) passed away. Of the patients (n = 54 (42.5%)) who had an adverse outcome during follow-up, dσ*/dt_max demonstrated an independent association with composite adverse outcome, including its individual components. On ROC analysis, a cut-off of 2.15 s⁻¹ was identified. Based on this cut-off, dσ*/dt_max retained an independent association with composite adverse outcome after adjusting for covariates including age, sex, ischemic heart disease, pulmonary artery systolic pressure, and left ventricular end systolic diameter. Conclusions: In patients with severe primary MR and preserved LVEF, reduced dσ*/dt_max was an independent predictor of adverse outcomes. It can be a useful addition to the armamentarium for assessing patients with severe MR. Full article

Rheumatic heart disease (RHD) and its complications are major health problems worldwide, especially in developing countries, owing to their high prevalence. Mitral stenosis (MS) is one of the most common lesions in RHD, either isolated or in combination with mitral regurgitation, and eventually leads to atrial fibrillation (AF), congestive heart failure, pulmonary hypertension (PH), and other complications, including ischemic stroke or limb ischemia, if not promptly diagnosed and treated. Recent studies have suggested that MS affects the cardiovascular system beyond mere obstructions. The presence of MS in RHD causes significant changes in the cardiovascular system, both upstream and downstream, affecting both the left and right ventricles. Rheumatic MS causes significant structural changes through inflammatory pathways and hemodynamic changes, owing to its obstructive effects. This review aims to discuss the vast changes in the cardiovascular system caused by rheumatic MS. Full article

Background: The optimal surgical management of ischemic mitral regurgitation (IMR)—mitral valve repair (MVr) versus mitral valve replacement (MVR)—remains controversial, with limited evidence on long-term outcomes. This study aimed to compare the outcomes of MVr and MVR in patients with IMR, focusing on survival and recurrence of mitral regurgitation. Additionally, survival was compared based on preoperative characteristics. Methods: A retrospective cohort analysis was conducted at a tertiary referral center and included 759 patients who underwent surgery for IMR between 2009 and 2021. Propensity score matching identified 140 matched pairs. The outcomes assessed included hospital mortality, long-term survival, recurrence of mitral regurgitation, mitral valve reintervention rates, and echocardiographic changes over time. Results: In the matched cohort, no significant differences were observed in hospital mortality (10% for MVr vs. 10.7% for MVR, p > 0.99) or long-term survival (p = 0.534). However, MVr was associated with a higher rate of recurrent moderate or higher mitral regurgitation (29.04% vs. 10.37%, p < 0.001) compared to MVR. The mitral valve reintervention rates did not differ significantly between the groups. Echocardiographic follow-up revealed significant improvements in left ventricular function and dimensions, with no significant differences between the groups. A subgroup analysis revealed no difference in survival according to the age, gender, ejection fraction, EuroSCORE category, or right ventricular function between the MVr and MVR patients. Conclusions: MVr and MVR for IMR yielded comparable survival rates, but MVr was associated with a higher risk of recurrent MR. The efficacy of both surgical approaches across diverse patient populations was comparable, reinforcing the need for individualized decision-making based on other clinical and anatomical considerations. Full article