Background: Cardiovascular sequelae after COVID-19 are frequent. However, the predictors for their occurrence are still unknown. In this study, we aimed to assess whether myocardial injury during COVID-19 hospitalization is associated to CV sequelae and death after hospital discharge. Methods: In this prospective observational study, consecutive patients who were admitted for COVID-19 in a metropolitan COVID-19 hub in Italy, between March 2021 and January 2022, with a ≥ 1 assessment of high sensitivity cardiac troponin I (hs-cTnI) were included in the study, if they were alive at hospital discharge. Myocardial injury was defined as elevation hs-cTnI > 99th percentile of the upper reference limit. The incidence of all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE, including cardiovascular death, admission for acute or chronic coronary syndrome, hospitalization for heart failure, and stroke/transient ischemic attack) at follow-up were the primary outcomes. Arrhythmias, inflammatory heart diseases, and/or thrombotic disorders were analyzed as well. Results: Among the 701 COVID-19 survivors (mean age 66.4 ± 14.4 years, 40.2% female), myocardial injury occurred in 75 (10.7%) patients. At a median follow-up of 270 days (IQR 165, 380), all-cause mortality (21.3% vs. 6.1%, p < 0.001), MACCE (25.3% vs. 4.5%, p < 0.001), arrhythmias (9.3% vs. 5.0%, p = 0.034), and inflammatory heart disease (8.0% vs. 1.1%, p < 0.001) were more frequent in patients with myocardial injury compared to those without. At multivariate analysis, myocardial injury (HR 1.95 [95% CI:1.05–3.61]), age (HR 1.09 [95% CI:1.06–1.12]), and chronic kidney disease (HR 2.63 [95% CI:1.33–5.21]) were independent predictors of death. Myocardial injury (HR 3.92 [95% CI:2.07–7.42]), age (HR 1.05 [95% CI:1.02–1.08]), and diabetes (HR 2.35 [95% CI:1.25–4.43]) were independent predictors of MACCE. Conclusion: In COVID-19 survivors, myocardial injury during the hospital stay portends a higher risk of mortality and cardiovascular sequelae and could be considered for the risk stratification of COVID-19 sequelae in patients who are successfully discharged.

Background: Secondary mitral regurgitation is associated with adverse clinical outcomes and cardiac remodeling. While transcatheter edge‐to‐edge repair (TEER) improves symptoms and prognosis in selected patients, its effects on cardiac remodeling remain debated. This systematic review and meta‐analysis aimed to evaluate the impact of TEER on echocardiographic indices of cardiac remodeling. Methods: PubMed, Scopus, and Cochrane Library were used to identify relevant studies assessing echocardiographic changes before and after TEER. Outcomes of interest were left ventricular (LV) ejection fraction, global longitudinal strain, LV end‐diastolic and end‐systolic volumes and LV end‐diastolic and end‐systolic diameter, tricuspid annular plane systolic excursion, pulmonary artery systolic pressure, and left atrial end‐systolic volume. Results: Forty‐two studies (3987 patients) were included. TEER was associated with a significant increase in LV ejection fraction (mean difference [MD], 1.51% [95% CI, 0.47–2.55]), without significant improvement in global longitudinal strain. Significant LV remodeling was observed, with reductions in LV end‐diastolic volume (standardized MD, −0.26 [95% CI, −0.37 to −0.14]), LV end‐systolic volume (standardized MD, −0.21 [95% CI, −0.30 to −0.12]), LV end‐diastolic diameter (MD, −2.35 mm [95% CI, −3.66 to −1.04]) and left ventricular end‐systolic diameter (MD, −2.30 mm [95% CI, −3.86 to −0.74). TEER also improved right ventricular function (tricuspid annular plane systolic excursion [MD, 1.29 mm [95% CI, 0.60–1.97]) and reduced pulmonary artery systolic pressure (MD, −6.75 mm Hg [95% CI, −8.53 to −4.97). No significant improvement in left atrial end‐systolic volume was detected. Conclusions: Available evidence suggests that TEER promotes significant cardiac remodeling in patients with secondary mitral regurgitation.

Superior vena cava (SVC) thrombosis is a rare but potentially life-threatening complication after heart transplantation, particularly in patients with congenital heart disease and complex venous anatomy. A 44-year-old man with cyanotic congenital heart disease and bilateral SVC underwent heart transplantation with systemic venous reconstruction, including right SVC-to-donor SVC anastomosis and left SVC-to-right atrial appendage connection via Dacron graft. Twelve days post-transplant, he developed symptomatic extensive right SVC thrombosis. Given his high surgical risk, endovascular thrombectomy via femoral access was performed using the FlowTriever system. Angiography revealed 2 critical SVC stenoses treated successfully with angioplasty and stent implantation. This case highlights the feasibility and safety of large-bore thrombectomy and venous stenting in a heart transplant recipient with complex congenital anatomy. Endovascular therapy offers a viable, minimally invasive alternative to surgery for post-transplant SVC thrombosis in patients with complex venous anatomy.