European heart journal cardiovascular Imaging
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Eur Heart J Cardiovasc Imaging · Jun 2019
Comparative StudyMITRA-FR vs. COAPT: lessons from two trials with diametrically opposed results.
Percutaneous mitral valve repair using the MitraClip device has been proposed to correct secondary mitral regurgitation (MR). Recently, the results of two randomized controlled trials, that is MITRA-FR (Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation) and COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation), assessing the efficacy and safety of MitraClip in patients with systolic heart failure and severe secondary MR were published. A priori, these two trials targeted the same patient populations with the same disease using the same device but the results of these trials were diametrically opposed, MITRA-FR being neutral and COAPT being highly positive with respect to efficacy of the MitraClip procedure. The objectives of this viewpoint are: (i) to highlight not only the similarities but also the differences between MITRA-FR and COAPT, which may explain the strikingly different results and conclusions between these two trials and (ii) to derive from these results, implications with regards to the application of the MitraClip procedure in clinical practice.
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Eur Heart J Cardiovasc Imaging · Jun 2019
Coexistent bicuspid aortic valve and mitral valve prolapse: epidemiology, phenotypic spectrum, and clinical implications.
Bicuspid aortic valve (BAV) and mitral valve prolapse (MVP) are common but the prevalence and significance of coexistent conditions are unknown. This study investigated the prevalence, phenotypic expression, and clinical significance of coexistent MVP-BAV. ⋯ The community prevalence of coexistent MVP-BAV is comparable to MVP-TAV and their most common phenotype is posterior-MVP. However, anterior-MVP is twice as prevalent in MVP-BAV. A large-AML phenotype (LAP-BAV) with predominant BAV regurgitation affects 24% of MVP-BAV patients. An extreme phenotype of anterior-MVP (GAP-BAV) affects 14% of BAV patients; characterized by exceptionally large AML, diminutive PML, high mitral and aortic regurgitation prevalence, and high mitral repair failure rate.
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Eur Heart J Cardiovasc Imaging · Apr 2019
Randomized Controlled Trial Comparative StudyCoronary computed tomography angiography vs. myocardial single photon emission computed tomography in patients with intermediate risk chest pain: a randomized clinical trial for cost-effectiveness comparison based on real-world cost.
To compare the cost-effectiveness of coronary computed tomography angiography (CCTA) vs. myocardial single photon emission computed tomography (SPECT) in patients with stable intermediate risk chest pain. ⋯ CCTA is associated with fewer subsequent ICA with no difference in downstream outcome. CCTA may be more cost-effective than SPECT in Korean patients with stable, intermediate risk chest pain.
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Eur Heart J Cardiovasc Imaging · Apr 2019
Impact of right ventricular dysfunction and end-diastolic pulmonary artery pressure estimated from analysis of tricuspid regurgitant velocity spectrum in patients with preserved ejection fraction.
We aimed to analyse the association between right haemodynamic parameters, right ventricular (RV) dysfunction parameters, and outcomes in patients with preserved ejection fraction (EF). ⋯ TR velocity at pulmonary valve opening time and calculated end-diastolic pulmonary artery pressure are obtainable in most patients, and add prognostic information on top of clinical and routine haemodynamic and diastolic parameters.
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Eur Heart J Cardiovasc Imaging · Apr 2019
University athletes and changes in cardiac geometry: insight from the 2015 Gwangju Summer Universiade.
There is a paucity of data regarding the changes of cardiac geometry in highly trained international and multiracial university athletes. We aimed to investigate the incidence of structural cardiac abnormalities and changes of cardiac geometry in highly trained university athletes. ⋯ A large scale cardiovascular screening programme of the 2015 Summer Universiade demonstrated that abnormal LV geometry is not uncommon (13.2%) and concentric remodelling is the most common pattern of LV geometric change in young trained university athletes. Race, type of sport, and training time are significant predictors of abnormal LV geometry. Structural cardiac abnormalities are common in university athletes even though they are minor abnormalities.