Background: Obstructive sleep apnea is associated with an increased prevalence of cardiovascular disease. The mechanism of these associations is not completely understood. We aimed to investigate the association of the apnea hypopnea index and the degree of airflow limitation with endothelial dysfunction. Methods: This was a single-center prospective study of patients admitted for diagnostic coronary angiography (CAG). Endothelial function was assessed by the non-invasive EndoPAT system by reactive hyperemia index (RHI) and divided into two groups: endothelial dysfunction and normal endothelial function. Sleep apnea signs were detected by WatchPAT measuring the respiratory disturbance index (pRDI), the apnea and hypopnea index (pAHI), and the oxygen desaturation index (ODI). Patients underwent spirometry and body plethysmography. Based on CAG, the severity of coronary artery disease was assessed as follows: no significant coronary artery disease, single-, two- and three-vessel disease. Results: A total of 113 patients were included in the study. Breathing disorders measured by WatchPAT and spirometry were more severe in patients with endothelial dysfunction: pRDI (27.3 vs. 14.8, p = 0.001), pAHI (24.6 vs. 10.3, p < 0.001), ODI (13.7 vs. 5.2, p = 0.002), forced expiratory volume in one second (FEV₁) (81.2 vs. 89, p = 0.05). In a multivariate regression analysis, pAHI and FEV₁ were independent predictors of endothelial dysfunction assessed by RHI. There was no correlation between the severity of coronary artery disease and endothelial dysfunction. Conclusions: Obstructive sleep apnea signs and greater airflow limitation were associated with endothelial dysfunction regardless of the severity of the coronary artery disease.

Background: Tricuspid regurgitation (TR) is a common valvular heart disease that often causes disabling symptoms. Caval valve implantation with the TricValve system is one of the transcatheter treatment options proposed for TR symptom reduction. With this prospective registry, we aim to summarize our early experience with TricValve system implantation. Methods: Registry participants, selected out of patients who were referred for TR treatment but who were not eligible for the transcatheter tricuspid edge-to-edge valve repair (T-TEER), were qualified for the caval valve implantation following a HeartTeam discussion. Results: Four patients (four women; median age 71 years; 67.5–77 years) in whom a one-year follow-up was completed were included in the study. The patients were highly symptomatic in the NYHA class III despite intensive diuretic treatment; all of them were considered a high-mortality risk during conventional cardiac surgery. The TricValve system was successfully implanted in all patients. At 6-month follow-up, we observed a reduction in symptoms in three out of four patients. Up to 12 months, only one patient survived, with a reduction in symptoms of NYHA class II; two patients died because of heart failure; one died due to a progression in neoplastic disease. Conclusions: In highly symptomatic TR patients who were not eligible for the T-TEER and who had a prohibitive risk of cardiac surgery, TricValve implantation led to a reduction in symptoms in a 6-month perspective. Long-term survival was limited mainly by heart failure progression and severe concomitant disorders. Further studies are needed to fully elucidate the role of caval valve implantation in the treatment of TR patients.

Aim: To assess the incremental value of real-time three-dimensional (3D) transesophageal echocardiography (TEE) in visualizing tricuspid valve (TV) anatomy for procedural planning and guidance of transcatheter edge-to-edge repair (TEER) in cases of severe tricuspid regurgitation (TR).Materials and methods: An observational study was conducted on 54 patients with severe TR. The visualization of the TV leaflets during systole was graded semiquantitatively using predefined criteria: 0 points—no visible leaflet border or tissue; 1.25—border only; 2—border and 50% tissue. Each of the three leaflets was evaluated independently in both two-dimensional (2D) and 3D TEE, with a maximum cumulative score of 9. Two thresholds were established: ≥4.5 points as the primary endpoint for adequate visualization for TEER planning and ≥6 points as the secondary endpoint indicating sufficient quality for a detailed morphological assessment.Results: In 3D TEE, 77.8% of patients achieved the primary endpoint, and 68.5% reached the secondary threshold. In comparison, 2D TEE enabled 74.1% and 42.6% of patients to meet these respective thresholds. Although the difference in achieving the primary endpoint was not statistically significant (p = 0.82), 3D TEE significantly outperformed 2D TEE in enabling a detailed morphological evaluation (p = 0.012). No significant differences were noted in the visualization quality of the anterior vs. septal leaflets with 3D TEE (67.4% vs. 65.4%, p = 0.800). For the posterior leaflet, 3D TEE provided superior visualization compared with the 2D TEE (p = 0.0008), while still supporting procedural suitability in a comparable proportion of patients (85.4% vs. 89.8%, p = 0.400). Acoustic shadowing from the interatrial septum and aortic root accounted for 92% of inadequate visualizations.Conclusion: In this observational study, real-time 3D TEE proved feasible for assessing tricuspid valve anatomy and visualization quality in patients with severe TR who were considered for TEER. Compared with 2D TEE, 3D TEE offered an improved visualization of the posterior leaflet and provided adequate image quality for procedural planning in most patients. Moreover, a statistically significant advantage was observed for 3D TEE over 2D TEE in providing image quality sufficient for a detailed morphological evaluation.

Background Tricuspid transcatheter edge-to-edge repair (T-TEER) has become an established therapeutic option for patients with severe tricuspid regurgitation (TR). However, data regarding the qualification process for T-TEER in patients with cardiac implantable electronic devices (CIED) are limited. Methods This retrospective, multicenter study included consecutive patients with severe TR referred between January and December 2024 to six tertiary centers (five in Poland, one in Italy) for T-TEER screening. Echocardiographic assessment followed current recommendations using a five-grade TR severity scale. In CIED carriers, the relationship between the tricuspid valve and the lead was classified as CIED-related (direct interference) or CIED-associated (no causal interaction). Heart teams evaluated all cases, recording qualification status and reasons for disqualification. Results Among 271 patients (mean age 77 ± 9 years, 58.3% female), 113 (41.7%) had a CIED. Compared with non-CIED patients, CIED carriers showed higher rates of diabetes mellitus (35.4% vs. 17.1%), chronic kidney disease (70.8% vs. 54.4%), and previous CABG (13.3% vs. 4.4%), and exhibited lower LV ejection fraction (50.5% vs. 57.0%, all p < 0.05). Overall, 56.5% were qualified for T-TEER, with no significant difference between CIED and non-CIED groups (54.0% vs. 58.3%, p = 0.487). Among CIED patients, 37 (32.7%) had CIED-related TR, characterized by more severe TR (EROA 0.90 vs. 0.60 cm², p = 0.017) but similar qualification rates (59.5% vs. 52.7%, p = 0.500). Conclusions CIED carriers with severe TR represent a more complex and symptomatic population, yet the presence of a CIED does not affect eligibility for T-TEER. The high prevalence of CIED-related TR underscores the growing clinical relevance of this condition and highlights the need for prospective multicenter studies to refine patient selection and treatment strategies.

Comparative Outcomes of Tricuspid-Dedicated Versus Non-Dedicated Devices in Transcatheter Tricuspid Edge-to-Edge Repair - Article abstract #950175