Background : Post-cardiac injury syndrome (PCIS) is an inflammatory process that may occur after myocardial infarction, cardiac surgery, percutaneous cardiac interventions or chest trauma. To our knowledge, PCIS following transcatheter mitral valve repair (TMVr) using the MitraClip system has not been reported. Case summary : A 79-year-old female with chronic heart failure and severe mitral regurgitation received TMVr using the MitraClip system. After the procedure she developed elevated inflammatory markers, pericardial and pleural effusion. Cardiac magnetic resonance provided signs of pericardial and pleural inflammation. After initiating an anti-inflammatory therapy with Aspirin and Colchicine, inflammatory markers decreased markedly, pleural and pericardial effusions were regressive, and the patient showed rapid clinical improvement. Discussion : Post-cardiac injury syndrome may occur after TMVr and should be considered as a differential diagnosis in patients developing chest pain, signs of pericarditis with or without pericardial effusion and elevated inflammatory markers.

Handgrip exercise (HG) has been occasionally used as a stress test in echocardiography. The effect of HG on mitral regurgitation (MR) is not well known. This study aims to evaluate this effect and the possible role of HG in the echocardiographic evaluation of MR. 722 patients with MR were included (18% primary, 82% secondary disease). We calculated effective regurgitant orifice area (EROA) and regurgitant volume (RVOL) at rest and during dynamic HG. Increase in MR was defined as any increase in EROA or RVOL. We analyzed the data to identify possible associations between clinical or echocardiographic parameters and the effect of HG on MR. MR increased during dynamic HG in 390 of 722 patients (54%) (∆EROA = 25%, ∆RVOL = 27%). Increase of regurgitation occurred in 66 of 132 patients with primary MR (50%) and in 324 of 580 patients with secondary MR (55%). This increase was associated with larger baseline EROA and RVOL, but it was independent from other clinical or echocardiographic parameters. In secondary MR, dynamic HG led to a reclassification of regurgitation severity from non-severe at rest to severe MR during HG in 104 of 375 patients (28%). There was a significant association between this upgrade in MR classification and higher New York Heart Association (NYHA) class (OR 1.486, 95%-CI 1.138–1.940, p = 0.004). Dynamic HG exercise increases MR in about half of patients independent of the etiology. Dynamic HG may be used to identify symptomatic patients with non-severe secondary MR at rest but severe MR during exercise.

Background: Transcatheter tricuspid valve repair using the edge-to-edge-technique (TEER) has emerged as an alternative therapy in patients with severe tricuspid regurgitation (TR) and high surgical risk. This study aimed to evaluate the feasibility and efficacy of tricuspid valve TEER in patients with cardiac implanted electric devices (CIEDs). Methods: All patients who underwent tricuspid valve TEER at our center were retrospectively included. Patients were classified according to the presence of CIEDs. Procedure success was defined as implantation of at least one clip and the reduction of TR of at least one grade. Procedure success and intrahospital outcome were compared between the two groups. Results: One-hundred and six consecutive patients underwent tricuspid TEER (age 80.1 ± 6.4 years, male = 42; 39.6%). Among them, 25 patients (23.6%, age 80.6 ± 7.3 years, male = 14; 56%) had CIEDs. Patients with CIEDs had a significantly lower left ventricular ejection fraction (LV-EF) compared to those without CIEDs (47.2 ± 15% vs. 56.2 ± 8.2%, p = 0.004, respectively). Moreover, arterial hypertension was more common in patients with CIEDs (96% vs. 79%, p = 0.048). The success of the procedure did not differ between the non-CIED vs. CIED group (93.8% vs. 92%, p = 0.748). Furthermore, the number and position of implanted clips, the duration of the procedure, the post-procedural pressure gradient across the tricuspid valve, and post-procedural TR severity were comparable between both groups. Conclusion: Tricuspid valve TEER is feasible and efficient in patients with CIEDs. The success of the procedure, as well as the intrahospital outcome were comparable between patients with and without CIEDs.

Aims: Lower socio-economic status may delay and even prevent the application of guideline-directed heart failure (HF) therapy for most patients. This study aims to evaluate the feasibility and possible difficulties facing the application of this treatment during the current Syrian conflict. Methods and results: A questionnaire on HF management and feasibility of recommended HF therapy was addressed to physicians practising cardiology in Syria. The questionnaire consisted of 30 questions and focused on the quality of HF management and awareness of recommended drug and device therapy for HF among physicians practising cardiology in Syria. A total of 228 physicians participated in the survey. Awareness of recommended medical and device therapy of HF was very high among participants (98% and 95%, respectively). The majority of participants (>75%) believe that more than half of HF patients do not receive optimal medical HF therapy. Ninety per cent of participants believe that <10% of patients with an appropriate indication for device therapy receive it. More than 75% of participants believe that the cost of medications, alone or in combination with other medical causes, represents the major problem facing the application of optimal HF medical therapy. More than 95% of participants reported that cost alone, or in combination with unavailability, is the primary reason why patients with appropriate indications are not offered device therapy. Conclusions: Despite the high level of awareness of recommended HF therapies among Syrian cardiologists, the majority of HF patients are still undertreated. Financial difficulties and lack of resources are the main causes of this problem.

Introduction: Tricuspid valve regurgitation (TR) is more prevalent among females. Transcatheter tricuspid valve repair (TTVR) using the edge-to-edge technique represents an alternative to surgery in patients with severe TR and high surgical risk. This study aims to investigate sex differences among patients undergoing TTVR. Methods: All patients who underwent TTVR at our center were retrospectively included. We compared baseline characteristics, intra-hospital, and one-year outcomes between males and females. Results: A total of 105 consecutive patients underwent TTVR. Females were more prevalent in the study cohort (n = 63, 60%). Coronary artery disease (CAD) was more evident in males than females (71.4% vs. 47.6%, p = 0.016). Left ventricular ejection fraction (LVEF) was also worse in males (48.8 ± 13.4 vs. 58 ± 6.8, p < 0.001). Other clinical characteristics were similar between both groups. The Success of the procedure (88.1% vs. 95.2%, p = 0.177) and intra-hospital mortality (4.8% vs. 11.1%, p = 0.255) were similar among males and females. At one-year follow-up, mortality was similar between both groups (24.3% vs. 25.9%, p = 0.863). Furthermore, hospitalization due to acute heart failure was also similar between both groups (40.5% vs. 37.5%, p = 0.768), as was a composite endpoint of death or hospitalization. In patients with successful procedures and who survived one year, TR severity was comparable between both groups. Conclusions: In our real-world cohort, more females underwent TTVR than males. No difference was observed in outcomes between males and females at one-year follow-up.