Goldberg JF, Bagchi P, Mercado A
… +13 more, Shah KB, Najjar SS, Tchoukina I, Rodrigo ME, Hsu S, Jang M, Kong H, Marboe CC, Berry GJ, Valantine HA, Agbor-Enoh S, Shah P, GRAfT Investigators
Circ Heart Fail
· 2026 May · PMID 41521923
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BACKGROUND: Circulating microRNAs are promising biomarkers of acute cellular rejection (ACR) and antibody-mediated rejection (AMR) in heart transplantation. The study objective was to assess the characteristics and diagn...BACKGROUND: Circulating microRNAs are promising biomarkers of acute cellular rejection (ACR) and antibody-mediated rejection (AMR) in heart transplantation. The study objective was to assess the characteristics and diagnostic performance of previously identified microRNAs and clinical rejection scores (CRS) in distinct blood samples obtained at the time of an endomyocardial biopsy (EMB). METHODS: In the 5-center, prospective, longitudinal cohort study, GRAfT (Genomic Research Alliance for Transplantation), microRNA sequencing was performed on blood samples. The previously identified microRNAs associated with ACR (n=12) and AMR (n=17) were used to fit a logistic regression model to the current cohort, and the scores were scaled from 0 to 100. Diagnostic performance of ACR and AMR microRNA panels was assessed by the area under the receiver-operating characteristic curve. An adjusted Cox proportional hazard model evaluated the effect of CRS on long-term outcomes. RESULTS: In 173 heart transplant recipients (29% female sex, 41% Black race, median follow-up 374 days after transplant), 922 blood samples were sequenced, 720 paired with EMB. Among 14 episodes of ACR, the median ACR CRS was 78 compared with 42 without ACR, <0.001. Among 25 episodes of AMR, median AMR CRS was 75 compared with 53 without AMR, <0.001. The area under the receiver-operating characteristics curve for the CRS was 0.93 for ACR and 0.92 for AMR. Using a CRS threshold of 65, the ACR CRS had 79% sensitivity, 97% specificity, and 100% negative predictive value; the AMR CRS had 84% sensitivity, 86% specificity, and 99% negative predictive value. The ACR and AMR CRS were both <65 in 589 (82%) of the tests. After adjustment, a 10-point increase in CRS was associated with >40% increase in the hazard of the composite outcome: subsequent ACR or AMR by EMB, allograft dysfunction, or death (ACR hazard ratio, 1.42 [95% CI, 1.20-1.69]; <0.001; AMR hazard ratio, 1.45 [95% CI, 1.14-1.86]; =0.003). CONCLUSIONS: Circulating microRNAs reliably identified ACR and AMR on EMB. An elevated microRNA CRS was associated with an increased risk of subsequent rejection, allograft dysfunction, or death. This biomarker, with further validation, can serve as a noninvasive test to screen and diagnose ACR and AMR without the need for an EMB. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02423070.
BACKGROUND: Up-titration of guideline-directed medical therapy (GDMT) is known to enhance left ventricular function in heart failure (HF) with reduced ejection fraction. However, data regarding its effect on right ventri...BACKGROUND: Up-titration of guideline-directed medical therapy (GDMT) is known to enhance left ventricular function in heart failure (HF) with reduced ejection fraction. However, data regarding its effect on right ventricular (RV) function remain sparse. We aimed to assess the impact of GDMT up-titration on the RV, especially RV to pulmonary artery coupling, and its prognostic value in these patients. METHODS: All consecutive patients (n=291) with left ventricular ejection fraction <50% followed for GDMT up-titration in a dedicated HF clinic in a tertiary center from January 2019 to June 2022 with an echocardiography at baseline (before up-titration) and at follow-up (end of up-titration) were included. RESULTS: The median age is 65 (55-74) years; 24% are female. Ischemic cardiomyopathy was the main cause of HF (47%), and left ventricular ejection fraction was 30% (22%-34%). After 2 years, 49 patients (17%) reached the primary end point (all-cause death or hospitalization for acute HF). RV size and function significantly improved after GDMT up-titration (all, <0.001), including RV to pulmonary artery coupling assessed by tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (0.62 versus 0.81 mm/mm Hg; <0.001). Tricuspid annular plane systolic excursion/systolic pulmonary artery pressure <0.65 mm/mm Hg at follow-up remained associated with the primary end point after adjustment with comorbidities (hazard ratio, 5.9 [95% CI, 2.8-12.1]; <0.001), clinical and biological severity (hazard ratio, 6.4 [95% CI, 2.4-17.8]; <0.001), and echocardiography (hazard ratio, 3.6 [95% CI, 1.6-8.4]; =0.002). In addition, tricuspid annular plane systolic excursion/systolic pulmonary artery pressure was associated with an incremental prognostic value (C-index improvement, <0.01), over and above prognostic factors, including left ventricular ejection fraction. CONCLUSIONS: This study highlights the independent and incremental prognostic value of tricuspid annular plane systolic excursion/systolic pulmonary artery pressure in HF with reduced ejection fraction during GDMT up-titration, suggesting to also consider RV to pulmonary artery coupling with echocardiography as a treatment goal.
BACKGROUND: While the immediate goal of cardiopulmonary resuscitation is to achieve return of spontaneous circulation, the patient-centered goal is to minimize neurological injury. Several medications used during cardiac...BACKGROUND: While the immediate goal of cardiopulmonary resuscitation is to achieve return of spontaneous circulation, the patient-centered goal is to minimize neurological injury. Several medications used during cardiac arrest have been associated with poor neurological outcomes. For patients cannulated for veno-arterial extracorporeal membrane oxygenation during cardiac arrest, termed extracorporeal cardiopulmonary resuscitation, the patient-centered impact of these medications has not yet been described. METHODS: We conducted a retrospective Extracorporeal Life Support Organization registry-based analysis. The primary outcome was cerebral performance category (CPC) score at hospital discharge. Cumulative odds models assessed the association between either (1) binary receipt of a medication or (2) the number of epinephrine milligrams given, and CPC score. The model reports the probability of having a score lower than each CPC level. To minimize bias in the receipt of advanced cardiovascular life support drugs, we used inverse probability treatment weights. RESULTS: Antiarrhythmics were associated with better neurological outcomes (amiodarone: CPC ≤ 1 [odds ratio [OR], 1.28 [95% CI, 1.00-1.65]; =0.048] and CPC ≤ 2 [OR, 1.38 [95% CI, 1.06-1.78]; =0.015]; lidocaine: CPC ≤ 1 [OR, 1.69 [95% CI, 1.32-2.17]; <0.001], CPC ≤ 2 [OR, 1.82 [95% CI, 1.39-2.38]; <0.001], CPC ≤ 3 [OR, 1.76 [95% CI, 1.30-2.40]; <0.001]). Intraarrest sodium bicarbonate administration resulted in a lower likelihood of a CPC < 2 to 3 (CPC ≤ 2 [OR, 0.63 [95% CI, 0.49-0.81]; <0.001], CPC ≤ 3 [OR, 0.65 [95% CI, 0.49-0.86]; =0.003]). There was no significant difference in CPC score among adults who received intraarrest calcium. The unweighted cumulative effects model demonstrated a dose-dependent increasing relationship between epinephrine doses and harm for all CPC levels (OR, 0.89-0.94; <0.001 for all). CONCLUSIONS: Our data support that increasing doses of epinephrine and nonantiarrhythmic advanced cardiovascular life support medications both worsen the probability of neurologically intact survival for patients who undergo extracorporeal cardiopulmonary resuscitation.
Damluji AA, Bruce SA, Reeves G
… +6 more, Pastva AM, Bertoni AG, Mentz RJ, Whellan DJ, Kitzman DW, deFilippi CR
Circ Heart Fail
· 2026 Jan · PMID 41500239
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BACKGROUND: Biomarkers in heart failure (HF) provide mechanistic and prognostic insights, but their role in predicting treatment response is less understood. We evaluated whether multiple baseline biomarker profiles from...BACKGROUND: Biomarkers in heart failure (HF) provide mechanistic and prognostic insights, but their role in predicting treatment response is less understood. We evaluated whether multiple baseline biomarker profiles from the REHAB-HF trial (Rehabilitation Therapy in Older Acute Heart Failure Patients) could stratify functional improvement following a 12-week physical rehabilitation intervention (RI). METHODS: Participants ≥60 years hospitalized with heart failure were randomized to a 12-week outpatient RI or attention control. Functional outcomes included changes in the short physical performance battery and 6-minute walk distance. Blood collected at baseline and 12 weeks was analyzed for cardiac (cTnI and cTnT, NT-proBNP [N-terminal pro-brain natriuretic peptide]), renal (creatinine), and inflammatory (CRP [C-reactive protein]) biomarkers. Associations between baseline biomarker levels and 12-week functional gains by treatment group were evaluated using adjusted linear regression models and machine learning-based decision trees. RESULTS: Baseline biomarker data were available for 242 of 349 participants (69%). Using linear regression, higher cTnI and T were associated with greater 12-week gains in the short physical performance battery and 6-minute walk distance, respectively, among RI participants versus attention control (interaction =0.040 and 0.032). In the decision tree, analyses combining all biomarkers, CRP emerged as the primary biomarker for both outcomes. Among participants with CRP ≥9.9 mg/L, RI was associated with a +2.4 point (95% CI, 1.8-3.1) greater increase in the short physical performance battery and a +79 m (95% CI, 50-109) greater increase in 6-minute walk distance compared with attention control. In contrast, for those with CRP <9.9 mg/L, the differential benefit of the RI was limited (+0.8 in short physical performance battery [95% CI, 0.1-1.6]; +30 m in 6-minute walk distance [95% CI, -1.0 to 61]). The biomarker levels (except for creatinine) decreased by 12 weeks posthospitalization, but with no differences based on treatment assignment. CONCLUSIONS: Higher inflammation, measured by CRP, may identify older adults recently hospitalized for heart failure with the greatest functional benefit from a physical RI. Biomarker profiling may predict the benefits of this treatment. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02196038.
Belkin MN, Fudim M, Baratto C
… +10 more, Grinstein J, Hollis I, Ijioma N, Kataria R, Lewis GD, Mak S, Tedford RJ, Thibodeau JT, Yaku H, American Heart Association Fellow-In-Training and Early Career Committee of the Council on Clinical Cardiology
Contemporary hemodynamic testing intersects with many aspects of cardiovascular disease management. There is a growing understanding that accurate diagnosis, phenotyping, and management of cardiogenic shock, heart failur...Contemporary hemodynamic testing intersects with many aspects of cardiovascular disease management. There is a growing understanding that accurate diagnosis, phenotyping, and management of cardiogenic shock, heart failure with preserved ejection fraction, and pulmonary hypertension, and left ventricular assist device support, require both baseline and provocative invasive hemodynamic testing, and often serial measurements. However, there is limited consensus regarding the standardization and interpretation of hemodynamic data. Provocative hemodynamic studies-whether related to volume, drugs, exercise, or device speed-are similarly nonuniform. A frequent limitation to their routine use relates to a lack of concise information regarding provocative study protocols. The aim of this scientific statement is to provide the evidence and rationale underlying best practices for static and provocative right heart catheterization, as well as actionable protocols to standardize their practice. In addition to outlining optimal resting right heart catheterization assessment, indications, and methods for vasodilator challenges to assess pulmonary hypertension reversibility in heart failure, this scientific statement includes discussion on volume challenges, invasive exercise hemodynamic testing, and vasodilator testing for acute pulmonary hypertension. Ramp, reverse-ramp, and exercise studies in patients with left ventricular assist devices are also detailed to help guide care and aid assessment for recovery. The utility and practical application of temporal changes in invasive hemodynamics are covered, from cardiogenic shock to remote patient monitoring. The standardization and advancement of invasive hemodynamic assessment in heart failure represent crucial steps toward optimizing patient outcomes. Continued collaboration across disciplines, enhanced focus on standardization, and investment in emerging technologies are crucial for bridging these gaps and driving innovation.
BACKGROUND: Pregnant women with dilated cardiomyopathy (DCM) face high risks of complications and maternal death due to hemodynamic overload, withdrawal of teratogenic but essential therapies, and limited treatment optio...BACKGROUND: Pregnant women with dilated cardiomyopathy (DCM) face high risks of complications and maternal death due to hemodynamic overload, withdrawal of teratogenic but essential therapies, and limited treatment options during pregnancy. To evaluate maternal and fetal outcomes in women with DCM during pregnancy and up to 12 months postpartum, across different etiologies, and identify predictors of maternal death. METHODS: Prospective cohort of pregnant women with confirmed DCM enrolled in the InCor Pregnancy and Heart Disease Registry. All received standardized cardio-obstetric care. Left ventricular ejection fraction was assessed by echocardiography; brain natriuretic peptide was evaluated when available. Treatment during pregnancy included β-blockers, hydralazine, diuretics, nitrates, enoxaparin, and hospitalization when needed. Guideline-directed therapy was resumed postpartum. Outcomes included maternal (heart failure, arrhythmias, thromboembolism, death) and obstetric/fetal complications. Logistic regression identified predictors of maternal mortality. RESULTS: Among 983 registry patients (2013-2023), 90 had DCM. Causes were peripartum (32), idiopathic (21), myocarditis (15), Chagas disease (11), and others (11). Maternal complications occurred in 51.1% during pregnancy, 36.0% in the early postpartum period (up to 6 weeks after delivery), and 38.6% in the late postpartum period (from 6 weeks to 12 months after delivery). All 9 maternal deaths (10%) occurred postpartum-mostly due to heart failure-at a mean of 8.8±3.1 months. Cesarean section was performed in 75%, with 10% fetal loss and 33.8% prematurity. Mean birth weight was 2606 g. Left ventricular ejection fraction improved from 32% at diagnosis to 39% during pregnancy and 42% at 12 months. Lower left ventricular ejection fraction (odds ratio, 0.87; =0.006) and prior thromboembolism (odds ratio, 15.5; =0.017) were independent predictors of death. CONCLUSIONS: Pregnancy in women with DCM was associated with high morbidity and late mortality. Reduced left ventricular ejection fraction and a history of thromboembolism were independent predictors of maternal death.
Nusrat A, Zhao L, Miao L
… +7 more, Thevasagayampillai S, Lu X, Kandasamy A, Haque MA, Gunaratne PH, Evans SM, Wu M
Circ Heart Fail
· 2026 Feb · PMID 41477684
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BACKGROUND: Left ventricular noncompaction cardiomyopathy (LVNC; OMIM No. 604169) is anatomically characterized by excess trabeculation and deep intertrabecular recesses. It is the third most prevalent pediatric cardiomy...BACKGROUND: Left ventricular noncompaction cardiomyopathy (LVNC; OMIM No. 604169) is anatomically characterized by excess trabeculation and deep intertrabecular recesses. It is the third most prevalent pediatric cardiomyopathy. Despite its clinical significance, the pathogenesis of LVNC remains uncertain. METHODS: We examined Numb expression in epicardial cells (EpiCs) and epicardial-derived cells (EPDCs) using a mCherry::Numb knock-in mouse line; used and inducible to generate epicardium-specific and double knockouts (epicardial double knockout [EDKO]) and inducible EpiC-specific knockout, respectively; monitored EpiCs/EPDCs invasion into the myocardium by lineage tracing; assessed LVNC defects via the ratio of noncompact to compact zone thickness/area; utilized single-nuclei mRNA sequencing and biochemical tools to determine the disrupted molecular mechanisms of EDKOs; and used pharmacological approaches to rescue defects in EDKOs. Cardiac structural and functional changes in adult stages were examined using echocardiography and histochemistry. Sample sizes ranged from 3 to 9 hearts across experiments. RESULTS: Numb is enriched in EpiCs and EPDCs. In EDKO hearts, EPDCs displayed abnormal differentiation, and their migration was arrested at the outer compact zone, resulting in the absence of EPDCs in the inner compact zone and trabeculae. The EDKO hearts displayed LVNC, and inducible EpiC-specific knockouts (induced at embryonic day 10.5) recapitulated the defects. Single-nuclei mRNA sequencing revealed the upregulation of (fibroblast growth factor receptor 1) in epicardium and the downregulation of (fibroblast growth factor) ligands in cardiomyocytes in EDKOs. Exogenous Fgf2 supplementation to pregnant females partially rescued epithelial-mesenchymal transition and compaction defects in EDKO hearts. Female EDKOs survived to adulthood and maintained LVNC. CONCLUSIONS: Ablation of NFPs (Numb family proteins) in EpiCs disrupted the invasion and differentiation of EPDCs and the communication between cardiomyocytes and other cells, and caused LVNC. The epithelial-mesenchymal transition and compaction defects can be partially rescued by exogenous Fgf2 supplementation. Our findings highlight an essential role for the epicardial NFPs-Fgf/Fgfr axis in regulating ventricular compaction.
BACKGROUND: Dilated cardiomyopathy (DCM) is a common cause of heart failure and is associated with substantial morbidity and mortality. However, data on mortality trends and disparities in DCM mortality in the United Sta...BACKGROUND: Dilated cardiomyopathy (DCM) is a common cause of heart failure and is associated with substantial morbidity and mortality. However, data on mortality trends and disparities in DCM mortality in the United States are limited. The objective of this study is to define trends and demographic and regional disparities in DCM-related mortality in the United States. METHODS: Data from the Centers for Disease Control and Prevention Wide-ranging Online Data for epidemiological Research were analyzed from 2004 to 2022 for DCM-related mortality in the US population >15 years. Age-adjusted mortality rates (AAMRs) per 100 000 people and associated annual percent changes were analyzed using Joinpoint regression analysis. Mortality trends were stratified by sex, race and ethnicity, age group, census region, urbanization classification, and state. RESULTS: Between 2004 and 2022, 138 076 DCM-related deaths were reported in the study population. The AAMR decreased from 4.41 in 2004 to 1.98 in 2019 with an average annual percentage change of -5.09 (95% CI, -5.40 to -4.86), after which it increased slightly to 2.22 in 2021. Men consistently had 2- to 2.5-fold higher AAMR compared with women. Non-Hispanic Black people had the highest AAMR. The highest mortality rate during the study period was seen in the older population (age≥75 years). Regionally, the Midwest and South had the highest AAMR in 2004, which was overtaken by the West US after 2010. Rural-urban areas had similar AAMRs for most years. CONCLUSIONS: DCM-related mortality decreased over the past 2 decades, with a slight increase observed during the COVID-19 pandemic. Despite the decreasing trend, sex and racial disparities persisted, with men and Black people having the highest AAMR, whereas regional disparities changed, with the Midwest and South census regions showing an improvement compared with the West of the United States.
Bloomfield GS, Watanabe M, McCallum S
… +19 more, Aberg JA, Awwad A, Campbell TB, Cespedes MS, Chu SM, Currier JS, Diggs MR, Sponseller CA, Fichtenbaum CJ, Lu MT, Malvestutto CD, Pierone G, Rhame F, Tuan J, Zhao S, Zanni MV, Grinspoon SK, Ribaudo HJ, Douglas PS
Circ Heart Fail
· 2026 Apr · PMID 41457980
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BACKGROUND: People with HIV (PWH) may have a higher risk of heart failure (HF) due to traditional and HIV-related factors. Incidence and risk prediction of HF in PWH are not well characterized. We aimed to quantify the r...BACKGROUND: People with HIV (PWH) may have a higher risk of heart failure (HF) due to traditional and HIV-related factors. Incidence and risk prediction of HF in PWH are not well characterized. We aimed to quantify the risk of HF events in a global population of PWH with low-to-moderate estimated atherosclerotic cardiovascular disease risk. METHODS: HF incidence (events/1000 person years) was described overall and by demographic, HIV-specific, and HF factors, including estimated Predicting Risk of Cardiovascular Disease Events 10-year risk of HF. Confirmed HF events included adjudicated HF hospitalization and adverse events identified via a standardized Medical Dictionary for Regulatory Archives HF query. RESULTS: We analyzed 7769 REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) participants from 5 global regions (median, 50 years; 31% female). Over a median follow-up of 5.6 years (interquartile range, 4.3-5.9), HF incidence was higher in women, among Black participants in high-income regions, participants in sub-Saharan Africa, and among those with preexisting hypertension and obesity compared with the absence of these factors. Current and nadir CD4+T-cell count, and HIV-1 RNA level were not related to the incidence of HF events. Median (Q1-Q3) Predicting Risk of Cardiovascular Disease Events HF score was 1.66% (1.01-2.62). HF incidence was 1.65/1000 person-years (95% CI, 1.30-2.09). Expected number of HF events by Predicting Risk of Cardiovascular Disease Events HF (n=73) was consistent with observed (n=67). CONCLUSIONS: Select demographics, clinical factors, and global regions contribute to a higher incidence of HF events among PWH. In PWH, the observed overall number of HF events aligned with the estimated Predicting Risk of Cardiovascular Disease Events HF risk rates.
Van Tassell BW, Golino M, Canada JM
… +29 more, Markley R, Billingsley H, Del Buono MG, Talasaz A, Thomas G, Chiabrando JG, Wohlford G, Dickson V, Kadariya D, Damonte JI, Ho AJ, Sedhai YR, Kontos E, Vecchiè A, West JD, Corna G, Medina de Chazal H, Pinel S, Bressi E, Barron A, Dell M, Mbualungu J, Moroni F, Turlington J, Federmann E, Trankle CR, Carbone S, Arena R, Abbate A
Circ Heart Fail
· 2026 Mar · PMID 41431894
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BACKGROUND: Decompensated heart failure with reduced ejection fraction (HFrEF) is associated with systemic inflammation that predicts unfavorable outcomes. We aimed to determine whether anakinra, an IL-1 (interleukin-1)...BACKGROUND: Decompensated heart failure with reduced ejection fraction (HFrEF) is associated with systemic inflammation that predicts unfavorable outcomes. We aimed to determine whether anakinra, an IL-1 (interleukin-1) blocker, favors inflammation resolution (CRP [C-reactive protein]) and improves peak oxygen consumption (VO) in patients with recently decompensated HFrEF. METHODS: We randomized 102 adult patients recently hospitalized for HFrEF and CRP ≥2 mg/L (2:1) to receive anakinra 100 mg subcutaneously daily (n=68) or placebo for 24 weeks (n=34). The primary end point was the peak VO change at 24 weeks. Data are presented as median (Q1, Q3) or number (%). RESULTS: Of the 102 patients, 84 had primary end point data available (57 treated with anakinra and 27 with placebo). Peak VO increased from 13.0 (10.9, 17.0) to 14.9 (12.0, 18.0) mL·kg⁻·min⁻ (<0.001) in the entire cohort, without significant differences between anakinra and placebo (+1.5 [-0.2, +3.4] and +1.2 [+0.5, +3.9] mL·kg⁻·min⁻, respectively; =0.40; median difference +0.30 mL·kg⁻·min⁻ [95% CI from -1.70 to +0.90]). A significant reduction in CRP levels was seen, with a -76% (-87%, -36%) in anakinra-treated patients and -48% (-77%, +14%) in the placebo group (=0.050 between groups). There were no unexpected treatment-related serious adverse events, and no differences in HFrEF events between groups. CRP<2 mg/L was achieved in 47% and 37% of the anakinra and placebo groups, respectively (=0.48). Patients achieving CRP<2 mg/L had a significantly greater increase in peak VO versus those with CRP≥2 mg/L (+2.6 [+0.7, +4.6] and +1.0 [-0.3, +1.9] mL·kg⁻·min⁻; =0.007) and lower rates of HFrEF-related events (8% and 26%; =0.045). CONCLUSIONS: Patients with recently decompensated HFrEF treated with maximally tolerated medical therapy had a significant improvement in CRP and peak VO. The addition of anakinra had a modest effect on CRP levels and no significant effect on peak VO or other clinically relevant secondary end points. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03797001.
BACKGROUND: In patients with right ventricular (RV) outflow tract stenosis and pulmonary regurgitation (PR), percutaneous pulmonary valve implantation (PPVI) aims to preserve RV and left ventricular (LV) integrity and fu...BACKGROUND: In patients with right ventricular (RV) outflow tract stenosis and pulmonary regurgitation (PR), percutaneous pulmonary valve implantation (PPVI) aims to preserve RV and left ventricular (LV) integrity and function. Our study aimed to assess acute changes in biventricular intrinsic myocardial function occurring with PPVI. METHODS: Twenty patients with RV outflow tract dysfunction (mean±1 SD; age, 23.0±10.9 years; mean peak echocardiographic RV outflow tract gradient, 64±25 mm Hg) underwent PPVI with biventricular assessment of pressure-volume loops using the conductance catheter technique during the same cardiac catheterization. Load-independent parameters of ventricular contractility (ventricular elastance) and ventricular compliance function, as well as pulmonary/systemic arterial elastance and ventriculoarterial coupling, were assessed before and directly after PPVI. Cardiac magnetic resonance for quantification of biventricular volumes, function, and PR was also performed. RESULTS: After PPVI, both RV ventricular elastance (median [interquartile range], 0.26 [0.16-0.83] to 0.19 [0.13-0.42] mm Hg/mL per m; =0.029) and pulmonary systemic arterial elastance (0.32±0.20 to 0.25±0.19 mm Hg/mL per m; <0.001) decreased significantly, while right ventriculoarterial coupling (1.14±0.61 to 1.10±0.59; =0.76) did not change statistically significant. LV ventricular elastance (1.31±0.93 to 1.23±0.72 mm Hg/mL per m; =0.68) and left ventriculoarterial coupling (0.75 [0.51-1.23] to 0.82 [0.53-1.10]; =0.98) were not affected by PPVI although systemic arterial elastance increased significantly (0.83±0.26 to 0.90±0.34 mm Hg/mL per m; =0.032). Both RV (=0.37) and LV (=0.20) compliance showed no significant change after PPVI. Patients with relevant PR (≥25%; n=10) had lower RV ventricular elastance (=0.043) before and higher LV compliance (=0.010) after PPVI compared with patients with minor PR (<25%; n=10), whereas ventriculoarterial coupling was similar between the 2 groups. CONCLUSIONS: Acute reduction of RV overload by PPVI is accompanied by an instantaneous decline in RV contractility with persistent and inefficient ventriculoarterial coupling. The LV adequately adapts to an increase in pre- and post-load with nonsignificant changes in LV intrinsic function and ventriculoarterial coupling. The relevance of these response patterns on long-term biventricular remodeling requires further investigation.