Periférne artériové obliterujúce ochorenie (PAOO) sa vyskytuje u diabetikov minimálne 3-krát častejšie ako v nediabetickej populácii a často vedie k invalidizujúcim komplikáciám, ako je amputácia dolnej končatiny. Doteraz bolo vykonaných relatívne málo štúdií zacielených na túto vysoko rizikovú skupinu pacientov. V štúdii STRIDE bolo zaradených 972 diabetikov 2. typu s PAOO štádia Fontaine IIa. Bol testovaný efekt prídavnej liečby semaglutidom v porovnaní s placebom. Primárnym výsledkom bola maximálna prejdená vzdialenosť na bežiacom páse. Pacienti užívajúci semaglutid mali túto vzdialenosť o 13 % väčšiu ako jedinci, ktorí dostávali placebo. Efekt semaglutidu bol veľmi podobný doteraz najviac odporúčanému cilostazolu v tejto indikácii. Na rozdiel od cilostazolu semaglutid v predchádzajúcich štúdiách mal dokázané pozitívne efekty na zníženie kardiovaskulárnej morbidity a mortality, a teda sa javí ako liek prvej voľby na liečbu pacientov s PAOO v klaudikačnom štádiu.

Peripheral artery disease (PAD) occurs at least three times more frequently in patients with diabetes than in the non-diabetic population and often leads to disabling complications such as lower limb amputation. To date, relatively few studies have targeted this high-risk group of patients. The STRIDE study included 972 patients with type 2 diabetes in Fontaine IIa stage of PAD. The effect of add-on treatment with semaglutide was tested in comparison to placebo. The primary outcome was the maximum walking distance on a treadmill. Patients using semaglutide had a 13 % greater walking distance than those receiving placebo. The effect of semaglutide was very similar to cilostazol, which is currently the most recommended treatment for this indication. Unlike cilostazol, semaglutide has demonstrated positive effects in previous studies on reducing cardiovascular morbidity and mortality, and therefore appears to be the most suitable first-line drug for treating patients with claudicant-stage PAOD.

• Keywords
• semaglutid,
• MeSH
• Glucagon-Like Peptide-1 Receptor Agonists * pharmacology   therapeutic use   MeSH
• Diabetes Mellitus, Type 2 * drug therapy   complications   MeSH
• Humans MeSH
• Peripheral Arterial Disease * drug therapy   MeSH
• Randomized Controlled Trials as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Syndróm predĺženého QT intervalu (LQT) a rozvoj komorovej tachykardie typu torsades de pointes (TdP) sú nezanedbateľnou príčinou náhlej srdcovej smrti. LQT je zároveň nezávislým rizikovým faktorom celkovej aj kardiovaskulárnej mortality. Najmä u seniorov často dochádza ku kumulácii faktorov favorizujúcich predĺženie QT intervalu. Cieľom našej práce bolo zistiť rizikový profil pre prolongáciu korigovaného QT intervalu (QTc) u seniorov s náhlym nevysvetleným perhospitalizačným úmrtím. V roku 2018 sme na našom pracovisku identifikovali 20 takých prípadov. Analyzovali sme posledný QT interval pred smrťou a viaceré relevantné rizikové faktory LQT. Predĺženie QTc intervalu bolo veľmi frekventované: v 60 % pacientov a klinicky signifikantné predĺženie > 500 ms v 20 %. Zistili sme istú koreláciu medzi dĺžkou QTc intervalu a hypokalciémiou (p = 0,552; ns), slabšie korelovala klesajúca glykémia (p = 0,382; ns), de facto nekoreloval celkový počet užitých rizikových liečiv (p = 0,134; ns). Každý pacient však užíval aspoň jedno „LQT rizikové“ liečivo a takých liečiv sa v súbore vyskytlo 17. Napriek nepitvanosti a absencii zdokumentovania terminálnej TdP predpokladáme, že viacerí z pacientov mohli zomrieť v dôsledku TdP. V klinickej praxi je relevantné identifikovať predĺženie QTc intervalu a znižovať riziká LQT/TdP.

Long QT syndrome (LQT) and the resulting ventricular tachycardia known as torsades de pointes type (dP) are a significant cause of sudden cardiac death. LQT is also an independent risk factor for all-cause and cardiovascular mortality. Especially in the elderly there is often a cumulation of factors favoring the QT prolongation. The aim of our study was to determine the risk profile for prolongation of the corrected QT interval (QTc) in seniors with sudden unexplained death during hospitalization. In 2018, we identified 20 such cases at our department. We analyzed the last QT interval before death and several relevant risk factors of LQT. Prolongation of the QTc interval was very frequent: in 60% of patients and clinically significant QT prolongation > 500 ms in 20%. We found a certain correlation between the length of the QTc interval and hypocalcemia (p = 0.552; ns), decreasing glycemia was more weakly correlated (p = 0.382; ns), the total number of used risky drugs was not correlated (p = 0.134; ns). However, each patient was taking at least one drug with the LQT risk. In total there were 17 such drugs used by our patients. Despite the lack of autopsy and the absence of documentation of terminal TdP, we assume that several of the patients may have died as a result of TdP. In clinical practice, it is relevant to identify prolongation of the QTc interval and reduce the risks of LQT/TdP.

• MeSH
• Hospitalization MeSH
• Comorbidity MeSH
• Pharmaceutical Preparations classification   MeSH
• Humans MeSH
• Morbidity MeSH
• Death, Sudden * etiology   MeSH
• Drug-Related Side Effects and Adverse Reactions MeSH
• Heart Disease Risk Factors MeSH
• Aged MeSH
• Statistics as Topic MeSH
• Long QT Syndrome * chemically induced   complications   mortality   pathology   MeSH
• Torsades de Pointes complications   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH

Heart failure (HF) is a leading cause of morbidity and mortality, often driven by prolonged exposure to pathological stimuli such as pressure and volume overload. These factors contribute to excessive oxidative stress, adverse cardiac remodeling, and dysregulation of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate (NO-sGC-cGMP) signaling pathway. Given the urgent need for effective treatments, this study investigated the potential of sGC stimulators to mitigate HF progression. We utilized male hypertensive Ren-2 transgenic (TGR) rats and a volume-overload HF model induced by an aortocaval fistula (ACF). Rats received the sGC stimulator BAY 41-8543 (3 mg/kg/day) for 30 weeks, while normotensive Hannover Sprague-Dawley rats served as controls. At the study endpoint (40 weeks of age), left ventricular tissue was analyzed using mass spectrometry, Western blotting, and histological assessment. TGR rats treated with sGC stimulators exhibited a significant increase in key antioxidant proteins (SOD1, CH10, ACSF2, NDUS1, DHE3, GSTM2, and PCCA), suggesting enhanced resistance to oxidative stress. However, sGC stimulator treatment also upregulated extracellular matrix remodeling markers (MMP-2, TGF-β, and SMAD2/3), which are typically associated with fibrosis. Despite this, Masson's trichrome staining revealed reduced collagen deposition in both TGR and TGR-ACF rats receiving sGC stimulators. Notably, all untreated TGR-ACF rats succumbed before the study endpoint, preventing direct assessment of sGC stimulator effects in advanced HF. These findings highlight the therapeutic potential of sGC stimulators in HF, particularly through their antioxidant effects. However, their concurrent influence on fibrosis warrants further investigation to optimize treatment strategies.

• MeSH
• Chronic Disease MeSH
• Fibrosis MeSH
• Cyclic GMP metabolism   MeSH
• Rats MeSH
• Disease Models, Animal MeSH
• Morpholines MeSH
• Oxidative Stress * drug effects   MeSH
• Rats, Sprague-Dawley * MeSH
• Rats, Transgenic MeSH
• Pyridines pharmacology   therapeutic use   MeSH
• Pyrimidines MeSH
• Ventricular Remodeling drug effects   MeSH
• Soluble Guanylyl Cyclase * metabolism   MeSH
• Signal Transduction drug effects   MeSH
• Heart Failure * drug therapy   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

Publikace se zaměřuje na dodržování a nedodržování farmakoterapie kardiovaskulárních nemocí. Určeno odborné veřejnosti.; K dosažení efektu prakticky jakéhokoliv léčebného opatření je potřebná spolupráce pacienta. S rozvojem terapie akutních forem kardiovaskulárních onemocnění přibývá pacientů s chronickými komplikacemi vyžadujícími dlouhodobou farmakoterapii. Velkou rezervou v péči o pacienty je dodržování indikované léčby. Pokud je adherence k léčbě nízká, bude omezený i efekt terapie. Adherence je vedle dostupnosti terapie jedním z faktorů, kde se lze podle Světové zdravotnické organizace v léčbě pacientů nejvíce zlepšit. Adherence k medikaci a její význam je u různých kardiovaskulárních onemocnění značně variabilní. U arteriální hypertenze je testování adherence základní diagnostickou metodou k určení, zda se jedná o hypertenzi rezistentní na terapii, nebo jen pseudorezistentní při non-adherenci k farmakoterapii. Na druhou stranu u srdečního selhání je obvykle zjištěná míra adherence poměrně vysoká a lze se tedy spolehnout na to, že pacienti léky berou a změna pacientova stavu (k dobrému i k horšímu) je ve spojitosti s léčbou. Neméně důležitá je efektivní léčba komorbidit ovlivňujících kardiovaskulární morbiditu a mortalitu (např. syndrom obstrukční spánkové apnoe, chronická obstrukční plicní nemoc a další). Různé metody testování adherence by měly být součástí běžné klinické praxe a každý lékař by měl mít o této problematice alespoň základní přehled. Tato publikace má za cíl seznámit lékaře pečující o pacienty s chronickými kardiovaskulárními onemocněními s konceptem adherence k medikaci obecně. Dále zmiňuje význam, specifika diagnostiky a intervenování non-adherence u konkrétních kardiovaskulárních onemocnění. Kolektiv autorů působí na různých pracovištích vnitřního lékařství v Olomouci a Ostravě. Dohromady přináší pohled specialistů na konkrétní onemocnění i poznatky z vlastní běžné praxe v jednotlivých kazuistikách.

• MeSH
• Medication Adherence MeSH
• Cardiovascular Diseases drug therapy   MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• farmakoterapie
• kardiologie
• NML Publication type
• kolektivní monografie

Chronické onemocnění ledvin (chronic kidney disesase, CKD) je spojeno se zvýšenou morbiditou a mortalitou, zejména z kardiovaskulárních (KV) příčin, a to zejména u osob s diabetes mellitus (DM). Již přítomnost DM zvyšuje KV riziko a potencuje riziko CKD. Proto má vedle kontroly glykemie klinický význam i prevence a léčba CKD, která má zpomalit její progresi. Významný nefroprotektivní účinek nových antidiabetik, konkrétně inhibitorů sodíko-glukózového kotransportéru 2 (sodium-glucose cotransporter 2, SGLT2) a agonistů receptoru pro glukagonu podobný peptid 1 (glucagon-like peptide 1 receptor agonist, GLP-1 RA), byl prokázán vedle jejich účinku na snížení koncentrace glukózy ve velkých KV studiích. Léčba inhibitory SGLT2 podobně jako GLP-1 RA je spojena s nižším rizikem poklesu glomerulární filtrace (glomerular filtration rate, GFR) v průběhu času jak u diabetické, tak nediabetické populace. Podle současných doporučení se inhibitory SGLT2 a/nebo GLP-1 RA doporučují osobám s DM, které mají chronické onemocnění ledvin a/nebo zvýšené KV riziko. Nefroprotektivní vlastnosti však nabízejí i další antidiabetika, o nichž bude v tomto přehledu rovněž pojednáno.

Chronic kidney disease (CKD) is associated with increased morbidity and mortality, especially from cardiovascular (CV) causes, and especially in people with diabetes mellitus (DM). Already presence of DM increases CV risk and potentiates the risk of CKD. Therefore, besides glycemic control, prevention and treatment of CKD to slow its progression are of clinical importance. A significant nephroprotective effect of novel antidiabetic drugs, namely sodium-glucose cotransporter 2 inhibitors (SGLT2) and glucagon-like peptide 1 receptor agonists (GLP-1 RA), has been shown on top of their glucose-lowering effects and was confirmed in cardiovascular outcome trials. Inhibitors SGLT2 treatment, like GLP-1 RA, is associated with a lower risk of glomerular filtration rate (GFR) decline over time in both diabetic and non-diabetic populations. According to current guidelines, inhibitors SGLT2 and/or GLP-1 RA are recommended for people with DM who have CKD and/or increased CV risk. However, other antidiabetic drugs offer nephroprotective properties, which will also be discussed in this review.

• MeSH
• Glucagon-Like Peptide-1 Receptor Agonists pharmacology   therapeutic use   MeSH
• Renal Insufficiency, Chronic * diagnosis   mortality   prevention & control   MeSH
• Diabetes Mellitus diagnosis   prevention & control   MeSH
• Sodium-Glucose Transporter 2 Inhibitors pharmacology   therapeutic use   MeSH
• Hypoglycemic Agents * pharmacology   therapeutic use   MeSH
• Insulin pharmacology   therapeutic use   MeSH
• Diabetes Complications drug therapy   prevention & control   MeSH
• Kidney drug effects   MeSH
• Humans MeSH
• Metformin pharmacology   therapeutic use   MeSH
• Heart Disease Risk Factors MeSH
• Sulfonylurea Compounds pharmacology   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

BACKGROUND: Psychological distress is recognized as an independent risk factor for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with CVDs remains unclear. OBJECTIVE: This meta-analysis aimed to evaluate the effects of eHealth psychological interventions for patients with CVDs. METHODS: Eligible studies were retrieved from 5 databases (Embase, Medline, PubMed, CINAHL, and Cochrane Library), covering the period from database inception to December 2024. Randomized controlled trials (RCTs) investigating the effect of evidence-based psychological eHealth interventions to improve psychosocial well-being and cardiovascular outcomes for people with CVDs were included. The Cochrane Risk of Bias tool (version 2) was used to judge the methodological quality of reviewed studies. RevMan (version 5.3) was used for meta-analysis. RESULTS: A total of 12 RCTs, comprising 2319 participants from 10 countries, were included in the review. The results demonstrated significant alleviation of depressive symptoms for patients receiving psychological eHealth intervention compared to controls (number of paper included in that particular analysis, n=7; standardized mean difference=-0.30, 95% CI -0.47 to -0.14; I2=57%; P<.001). More specifically, in 6 trials where internet-based cognitive behavioral therapy was delivered, a significant alleviation of depressive symptoms was achieved (standardized mean difference=-0.39, 95% CI -0.56 to -0.21; I2=53%; P<.001). There was no significant change in anxiety or quality of life. Synthesis without meta-analysis regarding stress, adverse events, and cardiovascular events showed inconclusive findings. CONCLUSIONS: Psychological eHealth interventions, particularly internet-based cognitive behavioral therapy, can significantly reduce depressive symptoms among patients with CVDs. A multidisciplinary approach is crucial for comprehensively improving psychological and cardiovascular outcomes. Future studies should explore integrating persuasive design features into eHealth and involving mental health professionals for intervention delivery. TRIAL REGISTRATION: PROSPERO CRD42023452276; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452276.

• MeSH
• Depression therapy   MeSH
• Cardiovascular Diseases * psychology   therapy   MeSH
• Cognitive Behavioral Therapy MeSH
• Humans MeSH
• Randomized Controlled Trials as Topic MeSH
• Telemedicine * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Review MeSH
• Systematic Review MeSH

Arteriální hypertenze je jedním z hlavních rizikových faktorů kardiovaskulární morbidity a mortality u dospělých a kardiovaskulárních a renálních onemocnění v dětském věku. doporučení pro diagnostiku a léčbu hypertenze u dětí vychází ze současných doporučení evropské společnosti pro hypertenzi a evropské pediatrické akademie.(1,2) Hypertenze v dětském věku je definována jako opakovaně (alespoň 3×) naměřený krevní tlak ≥ 95. percentilu. pro adolescenty od 16 let je doporučováno používat již dospělá kritéria. Výskyt hypertenze v dětském věku v posledním desetiletí významně stoupl na incidenci 1–4 %. Hypertenze se dělí na primární (esenciální) a sekundární. každé dítě s hypertenzí musí být pečlivě vyšetřeno. Mezi bazální vyšetření, která musí být provedena u všech dětí s hypertenzí, patří vyšetření moči, krve, ultrazvuk ledvin a echokardiografie. Léčba hypertenze spočívá v léčbě základního onemocnění v případech sekundární hypertenze (kauzální), v nefarmakologických opatřeních (redukce nadváhy/obezity, snížení nadměrného příjmu soli a dostatek pohybu) a farmakologické léčbě. u dětí je dnes již povoleno 5 skupin antihypertenziv. lékem první volby u renální hypertenze jsou ace inhibitory. cílem léčby je nejen znormalizovat tk, ale také navodit regresi případných hypertenzních postižení cílových orgánů (hypertrofie levé komory, albuminurie).

Arterial hypertension i sone of the most common risk factor for cardiovascular morbidity and mortality in adults and cardiovascular and kidney diseases in children. these recommendations for diagnosis and treatment of hypertension in children are based on the current recommendations of the european society for Hypertension and the european academy of pediatrics.(1,2) Hypertension in children is defined as repeatedly (at least 3×) blood pressure ≥ 95th percentile. For adolescents aged 16 and over, it is recommended to use the adult criteria. the incidence of hypertension in childhood has risen significantly in the last decade to an incidence of 1-4%. Hypertension is divided into primary (essential) and secondary. every child with hypertension must be carefully examined. Basic tests that must be performed in all children with hypertension include urine and blood tests, kidney ultrasound, and echocardiography. The treatment of hypertension consists in the treatment of the underlying disease in cases of secondary hypertension (causal), in non-pharmacological measures (reduction of overweight/obesity, reduction of excessive salt intake and sufficient exercise) and pharmacological treatment. nowadays, five groups of antihypertensive drugs are allowed for children. ace-inhibitors are the drug of first choice for renal hypertension. the goal of treatment is not only to normalize Bp, but also to induce regression of hypertension-mediated organ damage (left ventricular hypertrophy, albuminuria).

• MeSH
• Antihypertensive Agents pharmacology   therapeutic use   MeSH
• Diet, Sodium-Restricted methods   MeSH
• Child * MeSH
• Weight Loss MeSH
• Hypertension * diagnosis   etiology   drug therapy   MeSH
• Humans MeSH
• Blood Pressure Determination methods   MeSH
• Hypertension, Renal diagnosis   drug therapy   MeSH
• Exercise Therapy methods   MeSH
• Check Tag
• Child * MeSH
• Humans MeSH

Aterosklerotická kardiovaskulární onemocnění (ASKVO) jsou i přes možnosti kardiovaskulární (KV) prevence a snahu ji implementovat nejčastější příčinou morbidity a mortality v rozvinutých zemích. Dyslipidemie, resp. hypercholesterolemie, patří spolu s arteriální hypertenzí, diabetem a nikotinismem k hlavním ovlivnitelným rizikovým faktorům v rámci primární a sekundární prevence ASKVO. I přes významný pokrok ve farmakoterapii těchto chorob, včetně hypercholesterolemie, není dosaženo doporučovaných cílových hladin sérových lipidů až u dvou třetin pacientů. Relativní novinkou mezi hy- polipidemiky je kyselina bempedoová, inhibitor ATP-citrát lyázy. Omezuje endogenní syntézu cholesterolu, a tím snižuje hladinu LDL-cholesterolu, a následně incidenci KV příhod. Tato nová léčba získala příznivé výsledky v klinických studiích, zejm. ve studii CLEAR Outcomes. Kyselina bempedoová má perspektivu zejm. v kombinaci s ezetimibem u statinových intolerantů. Na závěr článku je uveden praktický návod současné možnosti indikace a kritérií úhrady.

Atherosclerotic cardiovascular diseases (ASCVD) remain the most common cause of morbidity and mortality in developed countries, despite the availability of cardiovascular (CV) prevention strategies and efforts to implement them. Dyslipidemia, particularly hypercholesterolemia, along with arterial hypertension, diabetes, and nicotine dependence, are among the main modifiable risk factors in both primary and secondary prevention of ASCVD. Despite significant progress in the pharmacotherapy of these conditions, including hypercholesterolemia, the recommended target serum lipid levels are not achieved in up to two-thirds of patients. A relatively new addition to the lipid-lowering medications is bempedoic acid, an ATP-citrate lyase inhibitor. It limits the endogenous synthesis of cholesterol, thereby reducing LDL-cholesterol levels and subsequently the incidence of CV events. This new treatment has shown favorable results in clinical trials, particularly in the CLEAR Outcomes study. Bempedoic acid holds promise, especially in combination with ezetimibe in statin-intolerant patients. The article concludes with a practical guide on current indications and reimbursement criteria.

• Keywords
• kyselina bempedoová,
• MeSH
• Atherosclerosis prevention & control   MeSH
• Dyslipidemias drug therapy   MeSH
• Hypolipidemic Agents * administration & dosage   pharmacology   therapeutic use   MeSH
• Cardiovascular Diseases prevention & control   MeSH
• Drug Therapy, Combination MeSH
• Cholesterol, LDL drug effects   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH

Miera obezity sa z roka na rok alarmujúco zvyšuje. Je veľmi dobre známe, že (pre)obezita jednak zhoršuje tradičné kardiovaskulárne (KV) rizikové faktory, ale je tiež aj nezávislým KV-rizikovým faktorom, čo následne nepriamo zvyšuje KV-riziko. Mechanizmy, ktoré vedú k rozvoju kardiovaskulárnych ochorení (KVO), sú mnohopočetné a nie úplne pochopené. Dôkazy však spájajú obezitu a chronický subklinický zápal, ktorý uľahčuje rozvoj aterosklerózou podmieneného kardiovaskulárneho ochorenia (ASKVO). Morbiditu a mortalitu na KVO (pre)obezita zvyšuje prostredníctvom priamych a nepriamych mechanizmov. Naopak, redukcia telesnej hmotnosti (TH) je spojená s významnými zdravotnými benefitmi a v súčasnosti máme dôkazy, že výraznejší úbytok TH vedie k výraznejším (nielen) kardiometabolickým benefitom. Manažment jedincov s (pre)obezitou sa v súčasnosti veľmi rýchlo mení vďaka novinkám prichádzajúcim do klinickej praxe. Pokiaľ chceme zlepšiť KV-morbiditu a KV- mortalitu u pacientov s (pre)obezitou, musíme si uvedomiť, že intervencia musí byť včasná, razantná a dlhodobá. Našim cieľom je dosiahnuť nielen bezpečnú, efektívnu a udržateľnú redukciu TH, ktorá bude viesť k zníženiu prevalencie komorbidít súvisiach s obezitou, ale najmä k poklesu KV-morbidity a KV-mortality.

Obesity rates are increasing alarmingly year by year. It is well known that (pre)obesity exacerbates traditional cardiovascular risk factors and is also an independent cardiovascular risk factor, which in turn indirectly increases cardiovascular risk. The mechanisms that lead to the development of cardiovascular disease are multiple and not fully understood. However, evidence links obesity and chronic subclinical inflammation, which facilitates the development of atherosclerotic cardiovascular disease. (Pre)obesity increases morbidity and mortality from cardiovascular disease through direct and indirect mechanisms. Conversely, weight reduction is associated with significant health benefits and we now have evidence that more significant weight loss leads to more significant (not only) cardiometabolic benefits. The management of individuals with (pre)obesity is currently changing very rapidly due to new pharmacotherapies coming into clinical practice. If we want to improve cardiovascular morbidity and mortality in patients with (pre)obesity, we have to realize that the intervention must be early, vigorous and long-term. Our goal is to achieve not only safe, effective and sustainable weight reduction, which will lead to a decrease in the prevalence of obesity related comorbidities, but especially to a decrease in cardiovascular morbidity and mortality.

• MeSH
• Weight Loss drug effects   MeSH
• Cardiovascular Diseases * complications   mortality   physiopathology   therapy   MeSH
• Clinical Studies as Topic MeSH
• Humans MeSH
• Liraglutide administration & dosage   MeSH
• Obesity * drug therapy   complications   MeSH
• Heart Disease Risk Factors MeSH
• Gastric Inhibitory Polypeptide therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

BACKGROUND: Management of recurrent mitral regurgitation (MR) or relevant iatrogenic mitral valve (MV) stenosis after mitral transcatheter edge-to-edge repair (M-TEER) emerges as an increasingly relevant clinical issue. Surgery after M-TEER is associated with higher morbidity and mortality. Electrosurgical leaflet laceration and stabilization of the implant (ELASTA-Clip) followed by transcatheter mitral valve replacement (TMVR) is an innovative, less-invasive treatment option for patients with TEER failure. OBJECTIVES: The authors sought to evaluate the early results of ELASTA-Clip followed by transapical TMVR in patients with symptomatic failed M-TEER (defined as persistent or recurrent MR, or iatrogenic MV stenosis). METHODS: Data from symptomatic patients with failed M-TEER who underwent ELASTA-Clip followed by compassionate use or commercial transapical TMVR using the Abbott Tendyne system were retrospectively collected from 8 tertiary care centers in 4 countries. Safety and efficacy of the procedure were assessed up to 1 year according to Mitral Valve Academic Research Consortium (MVARC) criteria. RESULTS: A total of 22 patients (mean age 77.8 ± 9.2 years, 40.9% [9/22] female) at high surgical risk (EuroSCORE II 8.0 ± 0.4, STS score 7.2% ± 1.1%) with symptomatic residual MR ≥3+ (n = 21) or iatrogenic MV stenosis (n = 1) after failed M-TEER were followed for a median period of 8.5 [Q1-Q3: 2.6-11.6] months. The ELASTA-Clip procedure (90.9% [20/22] transseptal, 9.1% [2/22] transapical) followed by TMVR were successful in all patients (22/22). Technical success according to MVARC was achieved in 21 patients (21/22, 95.4%) without left ventricular outflow tract obstruction or conversion to sternotomy. At 30 days, 3 patients had paravalvular leak progression, ischemic stroke occurred in 3 patients (3/20, 15.0%). Baseline MR (≥3+ in 95.5% [21/22]) was reduced to grade 1+ or less in all patients with durable results in 89.5% (17/19) (P < 0.001). NYHA functional class significantly improved to ≤II in 81.3% (13/16) at discharge (P < 0.001) and 72.2% (13/18) at last follow-up (P < 0.001). At 30 days, all patients (20/20) were alive. Three patients (3/20, 15.0%) were rehospitalized for heart failure (uncontrolled atrial fibrillation in 2 cases) and 1 of them (1/22, 4.5%) underwent a reintervention (valve retensioning). CONCLUSIONS: Transapical TMVR after ELASTA-Clip is a feasible and less invasive option for the management of failed M-TEER that can be performed with acceptable results in a carefully selected patient population. Particular attention is required to avoid paravalvular leakage and measures to minimize the risk of periprocedural cerebrovascular events need to be implemented in future larger-scale prospective studies with longer-term follow-up.

• MeSH
• Time Factors MeSH
• Heart Valve Prosthesis Implantation * instrumentation   adverse effects   MeSH
• Compassionate Use Trials MeSH
• Electrosurgery adverse effects   MeSH
• Iatrogenic Disease MeSH
• Humans MeSH
• Mitral Valve * surgery   diagnostic imaging   physiopathology   MeSH
• Mitral Valve Insufficiency * surgery   diagnostic imaging   physiopathology   etiology   MeSH
• Mitral Valve Stenosis * surgery   diagnostic imaging   physiopathology   etiology   MeSH
• Treatment Failure MeSH
• Recovery of Function MeSH
• Recurrence * MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Heart Valve Prosthesis * MeSH
• Cardiac Catheterization * instrumentation   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH