October 2020 at a Glance: Focus on Outcomes, Valve Disease and Patients’ Monitoring

Heart failure (HF) remains a major burden in terms of morbidity and mortality.1 Velagaleti et al.2 investigated the occurrence of subsequent clinical events in 1036 patients with new-onset HF from the Framingham Heart Study. They found that each event was associated with a high risk of recurrence of the same type of event, generating a vicious circle. Data from Danish nationwide registries showed that, compared with new-onset HF, worsening of chronic HF was associated with a higher rate of the composite endpoint including all-cause mortality or HF readmission (hazard ratio 1.37, 95% confidence interval 1.31–1.43).3 In a study by Ishigami et al.,4 incident hospitalization for HF or coronary artery disease resulted in a subsequent decline in renal function in the 2 years after the event, with a faster decline and greater slope change after HF compared with coronary artery disease. In a large database of almost half-million US patients with HF, both prevalent tricuspid regurgitation (TR) and incident TR were independently associated with an increased risk of mortality at a median follow-up of 1.5 years.5 Transcatheter tricuspid valve repair (TTVR) for severe TR was found to be safe and effective in previous studies.6, 7 Kresoja et al.8 analysed a total of 111 patients with isolated TR, treated by TTVR, of whom 71 had HF with preserved ejection fraction (HFpEF) and 40 had HF with reduced ejection fraction (HFrEF). Procedural success did not differ between the two subgroups. HFrEF patients were at higher risk of all-cause death or hospitalization at 12 months and procedural success was associated with improved outcome in HFpEF patients with a relief of symptoms in both cases. Nutritional impairment is common in patients undergoing TTVR and has prognostic implications.9 TTVR may improve nutritional status in some patients with severe TR and this was associated with improvement in quality of life and better outcomes.10 Transcutaneous edge-to-edge mitral valve repair is a treatment option for patients with HF and functional mitral regurgitation (MR).11, 12 Reichart et al.13 showed that patients with residual MR ≤ 1 at discharge and 12-month follow-up had better survival compared to those with higher grades of residual MR. Cardiac amyloidosis (CA) is an underdiagnosed cause of HF.14 Nitsche et al.15 prospectively screened patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Among 191 patients with AS, 8.4% had CA. Voltage/mass ratio and stroke volume index showed a good discriminative power, comparable to cardiac magnetic resonance, to detect CA hypertrophy. CA did not impact survival after TAVR in this cohort. An analysis from the Placement of Aortic Transcatheter Valves (PARTNER) 2 trial and registries showed that recent HF hospitalization was associated with increased mortality at both 30 days and 2 years in AS patients undergoing TAVR. Cardiovascular mortality was the most frequent. Moreover, infective endocarditis at 2 years was more common in the recent HF group.16 Veenis et al.17 evaluated the impact of an aortic valve procedure (replacement or repair) in patients undergoing continuous-flow left ventricular assist device (LVAD) implantation. At multivariate analysis, aortic valve replacement was associated with a poorer outcome. However, this occurred only in patients in whom moderate-to-severe aortic regurgitation was not diagnosed prior to LVAD implantation. There is a growing interest in telemonitoring for HF patients.18 The results of the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF) enrolling 234 New York Heart Association class III patients in Europe are reported. HF hospitalizations decreased by 62% 12 months after implantation. In addition, mean pulmonary artery pressure (PAP) decreased by 5.1 ±7.4 mmHg and both the Kansas City Cardiomyopathy Questionnaire and the 9-item Patients Health Questionnaire scores improved after the device was implanted.19 A study by Almufleh et al.20 evaluated the correlation between haemoconcentration and invasive haemodynamic parameters in patients with HF. In 23 patients undergoing CardioMEMS implantation, changes in haemoglobin were negatively correlated with changes in diastolic PAP. Mullens et al.21 reported the results of the SIRONA study, showing the safety and feasibility of the new Cordella Pulmonary Artery Pressure Sensor and of the comprehensive Cordella Heart Failure System. Mean PAP values were comparable with Swan–Ganz catheter measurements. The Ventricular tachyarrhythmia detection by Implantable loop recording in Patients with Heart Failure and preserved ejection fraction (VIP-HF) study showed that the incidence of ventricular tachyarrhythmias in HF patients with ejection fraction >40% was 0.6 per 100 person-years. Non-sustained ventricular tachyarrhythmias had an incidence of 11.5 per 100 person-years. Five out of 113 patients developed bradyarrhythmias. Overall, 20% of patients were hospitalized for HF and 12% died, mostly due to cardiovascular causes.22

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