Aims: In acute heart failure (AHF), the consequences of impaired left atrial (LA) mechanics are not well understood. We aimed to define the clinical trajectory of LA mechanics by left atrial strain (LAS) analysis. Methods and results: Eighty-five consecutive AHF patients with reduced, mildly reduced, and preserved left ventricular ejection fraction (LVEF) were enrolled in the LAS-AHF trial and underwent LA mechanics analysis by speckle tracking echocardiography. Seventy-seven patients were followed-up (FU) at 6 and 12 months. At hospital admission, discharge, 6 and 12 months post-discharge, LA reservoir function (LAS), LA pump strain, LAVi, LA stiffness, indicators of right ventricular (RV) and left ventricular (LV) function, congestion indexes (B lines, inferior vena cava, X-ray congestion score index), and biomarkers (NT-pro-BNP) were measured. The primary outcome was time to first event of re-hospitalization, worsening HF, or cardiovascular death. From admission to discharge, RV function significantly improved after decongestion, whereas no significant differences were observed in LA dynamics and LV function. In sinus rhythm patients with mild or no mitral regurgitation, decongestion was associated with a significant improvement of LAS and LA pump strain rate during hospitalization. At 12 months, 24 CV events occurred and lack of LAS improvement at 12 months FU emerged as the most powerful predictor followed by NT-pro-BNP. Kaplan–Meier curves showed a better survival for LAS >16%, improvement of LAS > 5%, and an LAS/LAVi ratio >0.25%/mL/m2 compared with lower cut-off values [log-rank: heart rate (HR) 3.5, 95% confidence interval (CI) 1.8–7.3, P = 0.004; log-rank: HR 3.6, 95% CI 2–7.9, P < 0.01; log-rank: HR 3.27, 95% CI 1.4–7.7, P = 0.007]. Conclusion: In AHF of any LVEF, LA dynamics is highly predictive of re-hospitalization and cardiovascular outcome and allows to ease risk-stratification, potentially becoming an early reference target for improving long-term outcome.

Stable coronary artery disease (CAD) has recently been replaced by a new entity described as chronic coronary syndrome (CCS). This new entity has been developed based on a better understanding of the pathogenesis, the clinical characteristics, and the morbi-mortality associated to this condition as part of the dynamic spectrum of CAD. This has significant implications in the clinical management of CCS patients, that ranges from lifestyle adaptation, medical therapy targeting all the elements contributing to CAD progression (i.e., platelet aggregation, coagulation, dyslipidaemia, and systemic inflammation), to invasive strategies (i.e., revascularization). CCS is the most frequent presentation of coronary artery disease which is the first cardiovascular disease worldwide. Medical therapy is the first line therapy for these patients; however, revascularization and especially percutaneous coronary intervention remains beneficial for some of them. European and American guidelines on myocardial revascularization were released in 2018 and 2021, respectively. These guidelines provide different scenarios to help physicians choose the optimal therapy for CCS patients. Recently, several trials focusing on CCS patients have been published. We sought to synthetize the place of revascularization in CCS patients according to the latest guidelines, the lessons learnt from recent trials on revascularization and medical therapy, and future perspectives.

Background: Heavily calcified coronary artery disease presents significant challenges in percutaneous coronary intervention (PCI), often requiring advanced techniques to achieve optimal outcomes. Cutting balloons (CB) have shown potential for plaque modification; however, their effectiveness is limited without standardized protocols.Aims: This study introduces the RODIN‐CUT technique, a novel approach utilizing sequential CB inflations with real‐time intravascular ultrasound (IVUS) guidance. The technique aims to enhance calcified plaque modification, improve stent expansion, and achieve consistent procedural success in heavily calcified coronary lesions.Methodology: A retrospective analysis of three consecutive patients requiring specialized approaches beyond conventional PCI was included at three centers in Belgium. The RODIN‐CUT protocol involved multiple CB inflations at precise lesion segments, followed by immediate IVUS imaging after each inflation to assess plaque modification and guide further therapy. Procedural success was defined as residual stenosis < 30% with TIMI 3 distal flow. The study evaluated the dose‐dependent effects of repeated CB inflations on plaque fracture depth and distribution.Conclusion: The RODIN‐CUT technique demonstrated promising outcomes, achieving procedural success in all cases with enhanced stent expansion and minimal complications. The technique's simplicity, cost‐effectiveness, and reproducibility make it a viable option for treating heavily calcified coronary lesions. Further large‐scale studies are required to validate these findings and establish the RODIN‐CUT technique as a standard approach for complex calcified lesions.

Background: This study investigates the prevalence and prognostic impact of coronary chronic total occlusions (CTO) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Although coronary artery disease (CAD) represents the leading HF etiology in HFmrEF, data about CTO in this population are rare. Methods: All consecutive patients with HFmrEF (ie, left ventricular ejection fraction 41%–49% with signs and/or symptoms of heart failure) undergoing invasive coronary angiography from 2016 to 2022 were included retrospectively. Patients with at least one CTO were compared to patients without CTO, further risk stratification was performed according to the extend of CAD. The primary end point was long‐term all‐cause mortality at 30 months (ie, median follow‐up). Secondary end points comprised of major adverse cardiac and cerebrovascular events (MACCE), HF‐related and cardiac rehospitalization at 30 months. Furthermore, the association of percutaneous coronary intervention (PCI) with long‐term outcomes was investigated. Results: 71% of patients with HFmrEF (1545/2184, primary cohort) underwent invasive coronary angiography. In patients undergoing invasive coronary angiography related to the index hospitalization, CAD was present in 81% (836/1037, final cohort), with a corresponding rate of CTO at 17% (n=141). Coronary CTO was associated with the highest rate of the primary end point (33%) compared with non‐CTO (19%), single‐vessel (12%) and multivessel CAD (21%) in HFmrEF ( P =0.001). Accordingly, HFmrEF patients with CTO had the highest rates of various secondary endpoints, including long‐term MACCE compared to non‐CTO patients (60% versus 32%, P =0.001). Successful CTO‐PCI was associated with improved long‐term survival (21% versus 38%; hazard ratio, 0.49 [95% CI, 0.24–0.99]; P =0.046). Conclusions: Coronary CTO are common in HFmrEF with a significant impact on long‐term prognosis. Registration: URL: https://www.clinicaltrials.gov ; unique identifier: NCT0560339.