Coronary microvascular obstruction and dysfunction (CMVO) frequently arise following primary percutaneous coronary intervention (PCI), particularly in individuals with myocardial infarction. Despite the restoration of epicardial blood flow, microvascular perfusion might still be compromised, resulting in negative clinical outcomes. CMVO is a complex condition resulting from a combination of ischemia, distal thrombotic embolization, reperfusion injury, and individual susceptibilities such as inflammation and endothelial dysfunction. The pathophysiological features of this condition include microvascular spasm, endothelial swelling, capillary plugging by leukocytes and platelets, and oxidative stress. Traditional angiographic assessments, such as Thrombolysis in Myocardial Infarction (TIMI) flow grade and myocardial blush grade, have limited sensitivity. Cardiac magnetic resonance imaging (CMR) stands as the gold standard for identifying CMVO, while the index of microvascular resistance (IMR) is a promising invasive option. Treatment approaches involve powerful antiplatelet drugs, anticoagulants, and supersaturated oxygen, yet no treatment has been definitively shown to reverse established CMVO. CMVO remains a significant therapeutic challenge in coronary artery disease management. Enhancing the comprehension of its core mechanisms is vital for the development of more effective and personalized treatment strategies.

1. Introduction Scientific knowledge of hypertrophic cardiomyopathy (HCM) has significantly improved in the past decades. A better understanding of its pathogenesis, significant advances in the use of imaging methods, and the more common application of genetic analysis, in addition to a better characterization of the natural history of this myocardial disease, have profoundly reformulated its clinical and prognostic significance. Conversely, these processes were accompanied by the development of new medications addressing molecular mechanisms intrinsically linked to the pathophysiology and pathogenesis [...] 1. Introduction Scientific knowledge of hypertrophic cardiomyopathy (HCM) has significantly improved in the past decades. A better understanding of its pathogenesis, significant advances in the use of imaging methods, and the more common application of genetic analysis, in addition to a better characterization of the natural history of this myocardial disease, have profoundly reformulated its clinical and prognostic significance. Conversely, these processes were accompanied by the development of new medications addressing molecular mechanisms intrinsically linked to the pathophysiology and pathogenesis

1. Introdução O conhecimento médico científico sobre a cardiomiopatia hipertrófica (CMH) recebeu grande avanço nas últimas décadas. O melhor entendimento da sua patogênese, os avanços expressivos no emprego dos métodos de imagem e a aplicação mais corriqueira da análise genética, além da melhor caracterização da história natural dessa doença miocárdica, trouxeram uma profunda reformulação do seu significado clínico e prognóstico. Por outro lado, esses progressos foram acompanhados do desenvolvimento de novas drogas endereçando mecanismos moleculares intrinsecamente ligados à fisiopatogênese da [...] 1. Introdução O conhecimento médico científico sobre a cardiomiopatia hipertrófica (CMH) recebeu grande avanço nas últimas décadas. O melhor entendimento da sua patogênese, os avanços expressivos no emprego dos métodos de imagem e a aplicação mais corriqueira da análise genética, além da melhor caracterização da história natural dessa doença miocárdica, trouxeram uma profunda reformulação do seu significado clínico e prognóstico. Por outro lado, esses progressos foram acompanhados do desenvolvimento de novas drogas endereçando mecanismos moleculares intrinsecamente ligados à fisiopatogênese da

Background: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. Results: In the matched population of n = 5410 patients, the mean age was 81 ± 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0–12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02–1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86–1.37, p = 0.48). Conclusion: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves.

Transfemoral (TF) access is default in transcatheter aortic valve implantation (TAVI). Transaxillary (TAx) access has been shown to be a safe alternative in case of prohibitive iliofemoral anatomy, but whether TAx as preferred access has similar safety and efficacy as TF access is unknown. The aim of this study was to compare outcomes between patients treated with self-expanding devices using TF or TAx route as preferred access in TAVI. A single center cohort of 354 patients treated using TAx as preferred access and a multi-center cohort of 5980 patients treated using TF access were compared. Propensity score matching was used to reduce selection bias and potential confounding. After propensity score matching, each group consisted of 322 patients. Clinical outcomes according to VARC-2 were compared using chi-square test. In 6334 patients undergoing TAVI, mean age was 81.4 ± 7.0 years, 57% was female and median logistic EuroSCORE was 14.7% (IQR 9.5-22.6). In the matched population (age 79.3 ± 7.0, 50% female, logistic EuroSCORE 13.4%, IQR 9.0-21.5), primary outcomes 30-day and one-year all-cause mortality were similar between Tax and TF groups (30 days: 5% versus 6%, p = 0.90; 1 year: 20% versus 16%, p = 0.17). Myocardial infarction was more frequent in patients undergoing Tax TAVI compared with TF (4% versus 1%, p = 0.05), but new permanent pacemakers were less frequently implanted (12% versus 21%, p = 0.001). TAx as preferred access is feasible and safe with outcomes that are comparable to TF access.