OAR@UM Collection:

Computed tomography is better than echocardiography in predicting balloon-expandable transcutaneous implantation valve size in a real-world clinical practice single-center study

Sun, 01 Jan 2023 00:00:00 GMT

Title: Computed tomography is better than echocardiography in predicting balloon-expandable transcutaneous implantation valve size in a real-world clinical practice single-center study Authors: Medilek, Karel; Bis, Josef; Polansky, Pavel; Kvasnicka, Tomas; Borg, Alexander; Dusek, Jaroslav; Brtko, Miroslav; Tuna, Martin; Praus, Rudolf; Ballon, Marek; Stasek, Josef; Littnerova, Simona; Parizek, Petr Abstract: Aims: Transcatheter aortic valve replacement (TAVR) has become the standard of care for selected patients with severe aortic stenosis. Multidetector computed tomography (MDCT) and transoesophageal 2D/3D (two-dimensional/three-dimensional) echocardiography (ECHO) are used for aortic annulus (AA) sizing. The aim of this study was to compare the accuracy of AA sizing by ECHO versus MDCT for Edwards Sapien balloon expandable valve in a single center.; Methods and results: Data from 145 consecutive patients with TAVR (Sapien XT or Sapien S3) were analyzed retrospectively. A total of 139 (96%) patients had favorable outcomes after TAVR (at most mild aortic regurgitation and only one valve implanted). The 3D ECHO AA area and area-derived diameter were smaller than the corresponding MDCT parameters (464 ± 99 vs. 479 ± 88 mm2, p < .001, and 24.2 ± 2.7 vs. 25.0 ± 5.5 mm, p = .002, respectively). The 2D ECHO annulus measurement was smaller than both the MDCT and 3D ECHO area-derived diameters (22.6 ± 2.9 vs. 25.0 ± 5.5 mm, p = .013, and 22.6 ± 2.9 vs. 24.2 ± 2.7 mm, p < .001, respectively) but larger than the minor axis diameter of the AA derived from MDCT and 3D ECHO by multiplanar reconstruction (p < .001). The 3D ECHO circumference-derived diameter was also smaller than the MDCT circumference-derived diameter (24.3 ± 2.5 vs. 25.0 ± 2.3, p = .007). The sphericity index by 3D ECHO was smaller than that by MDCT (1.2 ± .1 vs. 1.3 ± .1, p < .001). In up to 1/3 of the patients, 3D ECHO measurements would have predicted different (generally smaller) valve size than was the valve size implanted with favorable result. The concordance of the implanted valve size with the recommended size based on preprocedural MDCT and 3D ECHO AA area was 79.4% versus 61% (p = .001), and for the area-derived diameter, the concordance was 80.1% versus 61.7% (p = .001). 2D ECHO diameter concordance was similar to MDCT (78.7%).; Conclusions: 3D ECHO AA measurements are smaller than MDCT measurements. If 3D ECHO-based parameters alone are used to size the Edwards Sapien balloon expandable valve, then the selected valve size would have been smaller than the valve size implanted with favorable result in 1/3 of the patients. MDCT preprocedural TAVR assessment should be the preferred method over 3D ECHO in routine clinical practice to determine Edwards Sapien valve size.

Letter from Malta

Sun, 01 Jan 2023 00:00:00 GMT

Title: Letter from Malta Authors: Farrugia Jones, Cynthia; Caruana Montalto, Brendan Abstract: 2019 marks the year that the world’s attention shifted to Wuhan China and Coronavirus. Malta, an independent island state with a population of around half a million, used an approach that has been hailed as the best model in pandemic management with policies that ensured an R factor remaining steadily above 1, and allowing the country to plummet towards the bottom of Europe’s pandemic activity.; On 24 January 2020, Maltese Public Health authorities had predicted low exposure as there were no direct flights between Malta and China. However, when the disease spread to Northern Italy it came very close to home. [excerpt]

Do we practice what we preach? Implementation of cardiovascular prevention strategies in 13 European countries between 2011 and 2021 : a statement of the European Association of Preventive Cardiology of the ESC

Mon, 01 Jan 2024 00:00:00 GMT

Title: Do we practice what we preach? Implementation of cardiovascular prevention strategies in 13 European countries between 2011 and 2021 : a statement of the European Association of Preventive Cardiology of the ESC Authors: Kränkel, Nicolle; Scherrenberg, Martijn; Abela, Mark; Shemesh, Elad; Kopylova, Oksana; Babu, Abraham Samuel; Hemat Gaber, Marwa; Śliż, Daniel; Salzwedel, Annett Abstract: The importance of preventive measures and strategies to reduce the burden of cardiovascular risk factors is increasingly recognized, as it impacts upon the incidence, morbidity, and mortality of cardiovascular diseases (CVD). Comprehensive guidelines address this important aspect. Yet, measures described in guidelines need to be implemented in order to be effective. In 2011, a structured report assessed the implementation of the 4th Joint Task Force’s ‘Guidelines on Cardiovascular Disease’ in 13 European countries (Table 1).; We analysed adherence and effects of CVD prevention strategies and measures implemented until 2021. For each of the 13 countries, we addressed:; • guideline implementation strategies, policies, and health system related issues, and; • prevalence of CVD risk factors (Table 1). Description: Supplementary material is available within this record.

Genetic ghosts in the lung : post- COVID fibrosis unveils CTC1 mutation

Thu, 01 Jan 2026 00:00:00 GMT

Title: Genetic ghosts in the lung : post- COVID fibrosis unveils CTC1 mutation Authors: Azzopardi, Christine; Azzopardi, Joelle; Fsadni, Peter; Conti, Luca Abstract: Background: Familial pulmonary fibrosis (FPF) accounts for 10%-20% of idiopathic pulmonary fibrosis cases and is associated with mutations in telomere-related genes, including TERT, TERC, RTEL1, PARN, and, more recently, CTC1. Telomere dysfunction predisposes to progressive fibrotic interstitial lung disease (ILD) and may increase susceptibility to environmental triggers. Emerging evidence suggests that COVID-19 pneumonitis may unmask or accelerate fibrosis in genetically predisposed individuals, though a causal relationship has not been established. We report a case of genetically confirmed FPF due to a likely pathogenic CTC1 mutation presenting with progressive post-COVID pulmonary fibrosis.; Case Presentation: A 59-year-old woman with post-COVID pulmonary fibrosis presented with progressive dyspnea, orthopnea, and functional decline over 6 months. She required long-term oxygen therapy (5 l/min). Family history was significant for two first-degree relatives with usual interstitial pneumonia. Pulmonary function tests showed severe restriction (FVC 48%, diffusing capacity 19%). Imaging evolved from organizing pneumonia during acute COVID-19 to established bilateral fibrotic ILD with traction bronchiectasis and features suggestive of pulmonary hypertension (grade 3), confirmed on right heart catheterization (mean PAP 38 mmHg). Autoimmune workup was largely negative aside from anti-nuclear antibody positivity. Pirfenidone was discontinued due to hepatotoxicity. Genetic testing identified a heterozygous CTC1 variant (c.2518C>T; p.Arg840Trp), classified as likely pathogenic. She was commenced on nintedanib and referred for lung transplantation.; Conclusion: This case highlights the interplay between telomere-related genetic predisposition and viral injury in FPF. COVID-19 may have unmasked or accelerated fibrotic progression in susceptible individuals, though this association remains observational. Early genetic testing, multidisciplinary management, and timely transplant referral are crucial, with careful monitoring for treatment-related and post-transplant complications.