Long-term outcomes of transcatheter mitral valve replacement (TMVR) with balloon-expandable aortic prostheses remain uncertain.
Objectives
The aim of this study was to evaluate long-term clinical and hemodynamic outcomes after TMVR.
Methods
All patients undergoing TMVR at the authors’ center were included. Balloon-expandable transcatheter heart valves were implanted in all cases, usually using a trans-septal approach. The primary outcome was a composite of death or mitral reintervention (surgical or transcatheter replacement or transplantation). Secondary outcomes included mortality, hemodynamic changes, recurrent mitral regurgitation, structural valve deterioration (SVD), and TMVR failure.
Results
A total of 200 patients underwent TMVR: 60.5% (121 of 200) valve-in-valve, 22.5% (45 of 200) valve-in-ring, and 17% (34 of 200) valve–in–mitral annular calcification. The median age was 70 years (Q1-Q3: 52-80 years), and 67% were women (134 of 200). Median follow-up was 3.2 years (Q1-Q3: 1.2-6.8 years). Freedom from death or reintervention at 1, 5, and 8 years was 82% (95% CI: 77%-88%), 48% (95% CI: 40%-56%), and 20% (95% CI: 11%-29%), respectively, with worse outcomes in valve-in-ring and valve–in–mitral annular calcification compared with valve-in-valve (P < 0.01). Mean gradient increased slightly over time (+0.25 ± 0.07 mm Hg/y; P < 0.01), with a modest decrease in effective orifice area (−0.04 cm2/y; P < 0.01). Significant recurrent mitral regurgitation occurred in 5.5% of patients (11 of 200). Seven percent (14 of 200) developed severe SVD after 5.3 (Q1-Q3: 3.5-7.4 years), and 10% (20 of 200) developed TMVR failure after 4.4 (Q1-Q3: 1.8-6.7 years).
Conclusions
TMVR with balloon-expandable aortic prostheses provides favorable long-term outcomes and acceptable durability, with low rates of severe SVD and valve failure.
背景：经导管二尖瓣置换术（TMVR）与球囊扩张主动脉假体的长期预后仍不确定。目的本研究的目的是评估TMVR后的长期临床和血流动力学结果。方法纳入所有在作者中心接受TMVR的患者。所有病例均采用球囊扩张经导管心脏瓣膜植入，通常采用经隔膜入路。主要结局是死亡或二尖瓣再干预（手术或经导管置换术或移植）。次要结局包括死亡率、血流动力学改变、复发性二尖瓣反流、结构性瓣膜恶化（SVD）和TMVR衰竭。结果200例患者行TMVR: 60.5%（200例中121例）瓣内化，22.5%（200例中45例）瓣内环钙化，17%（200例中34例）瓣内环钙化。中位年龄为70岁（Q1-Q3: 52-80岁），其中67%为女性（200人中有134人）。中位随访时间为3.2年（Q1-Q3: 1.2-6.8年）。1年、5年和8年无死亡或再干预的分别为82% （95% CI: 77%-88%）、48% （95% CI: 40%-56%）和20% (95% CI: 11%-29%)，与瓣内瓣相比，瓣内环和二尖瓣内环钙化的结果更差（P < 0.01）。随着时间的推移，平均梯度略有增加（+0.25±0.07 mm Hg/y; P < 0.01），有效孔口面积略有减少（- 0.04 cm2/y; P < 0.01）。5.5%（11 / 200）的患者出现明显的二尖瓣返流。7%（200人中有14人）在5.3年（Q1-Q3: 3.5-7.4年）后出现严重SVD， 10%（200人中有20人）在4.4年（Q1-Q3: 1.8-6.7年）后出现TMVR失败。结论stmvr联合球囊扩张主动脉假体具有良好的远期疗效和可接受的耐久性，严重SVD和瓣膜衰竭发生率低。
{"title":"Long-Term Clinical and Hemodynamic Outcomes of Transcatheter Mitral Valve Replacement","authors":"Nicolas Groshenry MD , Gaspard Suc MD, PhD , Jules Mesnier MD , Clemence Delhomme MD , Audrey Cailliau MD , Eric Brochet MD , Gregory Ducrocq MD, PhD , Reza Farnoud PhD , Linda Bleuze RN , Dominique Himbert MD , Skerdi Haviari MD , Bernard Iung MD, PhD , Marina Urena MD, PhD","doi":"10.1016/j.jcin.2025.09.052","DOIUrl":"10.1016/j.jcin.2025.09.052","url":null,"abstract":"<div><h3>Background</h3><div>Long-term outcomes of transcatheter mitral valve replacement (TMVR) with balloon-expandable aortic prostheses remain uncertain.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate long-term clinical and hemodynamic outcomes after TMVR.</div></div><div><h3>Methods</h3><div>All patients undergoing TMVR at the authors’ center were included. Balloon-expandable transcatheter heart valves were implanted in all cases, usually using a trans-septal approach. The primary outcome was a composite of death or mitral reintervention (surgical or transcatheter replacement or transplantation). Secondary outcomes included mortality, hemodynamic changes, recurrent mitral regurgitation, structural valve deterioration (SVD), and TMVR failure.</div></div><div><h3>Results</h3><div>A total of 200 patients underwent TMVR: 60.5% (121 of 200) valve-in-valve, 22.5% (45 of 200) valve-in-ring, and 17% (34 of 200) valve–in–mitral annular calcification. The median age was 70 years (Q1-Q3: 52-80 years), and 67% were women (134 of 200). Median follow-up was 3.2 years (Q1-Q3: 1.2-6.8 years). Freedom from death or reintervention at 1, 5, and 8 years was 82% (95% CI: 77%-88%), 48% (95% CI: 40%-56%), and 20% (95% CI: 11%-29%), respectively, with worse outcomes in valve-in-ring and valve–in–mitral annular calcification compared with valve-in-valve (<em>P</em> < 0.01). Mean gradient increased slightly over time (+0.25 ± 0.07 mm Hg/y; <em>P</em> < 0.01), with a modest decrease in effective orifice area (−0.04 cm<sup>2</sup>/y; <em>P</em> < 0.01). Significant recurrent mitral regurgitation occurred in 5.5% of patients (11 of 200). Seven percent (14 of 200) developed severe SVD after 5.3 (Q1-Q3: 3.5-7.4 years), and 10% (20 of 200) developed TMVR failure after 4.4 (Q1-Q3: 1.8-6.7 years).</div></div><div><h3>Conclusions</h3><div>TMVR with balloon-expandable aortic prostheses provides favorable long-term outcomes and acceptable durability, with low rates of severe SVD and valve failure.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 2","pages":"Pages 239-251"},"PeriodicalIF":11.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146045044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1016/j.jcin.2025.11.016
Alessandro Sticchi MD , Lukas Stolz MD
{"title":"The Predictive Value of Right Ventricle to Pulmonary Artery Coupling in Valvular Heart Disease","authors":"Alessandro Sticchi MD , Lukas Stolz MD","doi":"10.1016/j.jcin.2025.11.016","DOIUrl":"10.1016/j.jcin.2025.11.016","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 2","pages":"Pages 189-191"},"PeriodicalIF":11.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1016/j.jcin.2025.06.043
Ashish H. Shah MD, MD-Research
{"title":"PFO Closure in Older Adults","authors":"Ashish H. Shah MD, MD-Research","doi":"10.1016/j.jcin.2025.06.043","DOIUrl":"10.1016/j.jcin.2025.06.043","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 2","pages":"Pages 277-278"},"PeriodicalIF":11.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146045187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1016/j.jcin.2025.10.023
Robin Le Ruz MD , Vratika Agarwal MD , Isaac George MD , Jay S. Leb MD , Mark Lebehn MD , Michael Brener MD, MSc , Mahesh V. Madhavan MD , Lauren Ranard MD , Carolina Pinheiro Rezende PA , Joanna Bartkowiak MD , Eun Kyoung Kim MD, PhD , Vivian Ng MD , Torsten P. Vahl MD , Tamim Nazif MD , Martin B. Leon MD , Susheel K. Kodali MD , Rebecca T. Hahn MD
Background
Few studies have evaluated ventricular remodeling following transcatheter tricuspid valve replacement (TTVR) for tricuspid regurgitation.
Objectives
The authors sought to describe biventricular structural and functional changes after TTVR.
Methods
This single-center, retrospective study included all patients undergoing TTVR. Remodeling was evaluated using transthoracic echocardiographic and cardiac computed tomography (CT). CT measurements included: right ventricular (RV) ejection fraction (RVEF), effective RVEF (forward stroke volume [SV]/right ventricular end-diastolic volume [RVEDV]), RV coupling (SV/right ventricular end-systolic volume [RVESV]), septal curvature analysis and average eccentricity index (aEI) of the mid- and distal left ventricle (LV).
Results
Of the 80 TTVR patients included, 87.5% had baseline massive/torrential and 95.9% had ≤mild tricuspid regurgitation post-implantation. Post-TTVR, all transthoracic echocardiographic measures of RV function were reduced (P < 0.001) with an increase in SV and cardiac index (P < 0.001). Paired analysis of 50 patients with pre- and post-CT imaging (performed median of 40 days post-TTVR) showed a 65.3% increase in effective RVEF and 20.3% increase in RV coupling (P < 0.001 for both). RVEDV decreased (138.2 mL/m2 to 59.5 mL/m2; P < 0.001) with increase in LVEDV (49.6 mL/m2 to 57.9 mL/m2; P = 0.001). Septal curvature increased and LV aEI decreased (P < 0.001 for both). Compared with patients with low aEI, patients with baseline greater aEI (≥1.25) showed greater reverse remodeling, lower follow-up NT-proBNP, and greater symptom improvement.
Conclusions
Reduction in RVEDV with increase in LVEDV following TTVR is associated with reduction in LV eccentricity with an increase in forward SV. CT measures of RV function (effective RVEF) and RV coupling (SV/RVESV) both improve following TTVR. Patients with baseline higher LV eccentricity may derive more benefits from TTVR.
{"title":"Cardiac Remodeling After Transcatheter Tricuspid Valve Replacement","authors":"Robin Le Ruz MD , Vratika Agarwal MD , Isaac George MD , Jay S. Leb MD , Mark Lebehn MD , Michael Brener MD, MSc , Mahesh V. Madhavan MD , Lauren Ranard MD , Carolina Pinheiro Rezende PA , Joanna Bartkowiak MD , Eun Kyoung Kim MD, PhD , Vivian Ng MD , Torsten P. Vahl MD , Tamim Nazif MD , Martin B. Leon MD , Susheel K. Kodali MD , Rebecca T. Hahn MD","doi":"10.1016/j.jcin.2025.10.023","DOIUrl":"10.1016/j.jcin.2025.10.023","url":null,"abstract":"<div><h3>Background</h3><div>Few studies have evaluated ventricular remodeling following transcatheter tricuspid valve replacement (TTVR) for tricuspid regurgitation.</div></div><div><h3>Objectives</h3><div>The authors sought to describe biventricular structural and functional changes after TTVR.</div></div><div><h3>Methods</h3><div>This single-center, retrospective study included all patients undergoing TTVR. Remodeling was evaluated using transthoracic echocardiographic and cardiac computed tomography (CT). CT measurements included: right ventricular (RV) ejection fraction (RVEF), effective RVEF (forward stroke volume [SV]/right ventricular end-diastolic volume [RVEDV]), RV coupling (SV/right ventricular end-systolic volume [RVESV]), septal curvature analysis and average eccentricity index (aEI) of the mid- and distal left ventricle (LV).</div></div><div><h3>Results</h3><div>Of the 80 TTVR patients included, 87.5% had baseline massive/torrential and 95.9% had ≤mild tricuspid regurgitation post-implantation. Post-TTVR, all transthoracic echocardiographic measures of RV function were reduced (<em>P</em> < 0.001) with an increase in SV and cardiac index (<em>P</em> < 0.001). Paired analysis of 50 patients with pre- and post-CT imaging (performed median of 40 days post-TTVR) showed a 65.3% increase in effective RVEF and 20.3% increase in RV coupling (<em>P</em> < 0.001 for both). RVEDV decreased (138.2 mL/m<sup>2</sup> to 59.5 mL/m<sup>2</sup>; <em>P</em> < 0.001) with increase in LVEDV (49.6 mL/m<sup>2</sup> to 57.9 mL/m<sup>2</sup>; <em>P</em> = 0.001). Septal curvature increased and LV aEI decreased (<em>P</em> < 0.001 for both). Compared with patients with low aEI, patients with baseline greater aEI (≥1.25) showed greater reverse remodeling, lower follow-up NT-proBNP, and greater symptom improvement.</div></div><div><h3>Conclusions</h3><div>Reduction in RVEDV with increase in LVEDV following TTVR is associated with reduction in LV eccentricity with an increase in forward SV. CT measures of RV function (effective RVEF) and RV coupling (SV/RVESV) both improve following TTVR. Patients with baseline higher LV eccentricity may derive more benefits from TTVR.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 2","pages":"Pages 192-205"},"PeriodicalIF":11.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1016/j.jcin.2025.10.018
Robert Herman MD, PhD , Bryn E. Mumma MD, MAS , Jake D. Hoyne MD , Benjamin L. Cooper MD , Nils P. Johnson MD, MS , Timea Kisova MD , Anthony Demolder MD , Adam Rafajdus MSc , Andrej Iring MSc , Timotej Palus MSc , Marta Belmonte MD , Emanuele Barbato MD, PhD , Suzanne J. Baron MD, MSc , Robert Hatala MD, PhD , Stephen W. Smith MD , H. Pendell Meyers MD , Scott W. Sharkey MD , Jozef Bartunek MD, PhD , Timothy D. Henry MD
Background
Timely reperfusion is critical in reducing mortality in ST-segment elevation myocardial infarction (STEMI). Although electrocardiography-guided cardiac catheterization laboratory (CCL) activation on the basis of first medical contact recognition improves system-level response, diagnostic uncertainty, particularly in atypical presentations, contributes to false positive activations (FPAs) and reperfusion delays.
Objectives
The aim of this study was to evaluate the diagnostic performance and operational impact of artificial intelligence (AI)–based electrocardiographic (ECG) analysis in real-world STEMI triage across a multicenter U.S. registry.
Methods
A total of 1,032 patients with suspected STEMI who triggered emergent CCL activation at 3 geographically diverse percutaneous coronary intervention centers (January 2020 to May 2024) were retrospectively analyzed. Index electrocardiograms underwent standard triage and blinded retrospective AI ECG analysis (Queen of Hearts, PMcardio) trained to detect acute coronary occlusion and benign mimics. The reference standard was an angiographically confirmed culprit lesion with positive enzymes. Diagnostic accuracy, subgroup analyses, and FPA reclassification were compared.
Results
Of 1,032 emergent CCL activations, 601 (58.2%) had confirmed STEMI. The AI ECG model outperformed standard triage, demonstrating higher index ECG sensitivity (553 of 601 [92.0%; 95% CI: 89.7%-94.1%] vs 427 of 601 [71.0%; 95% CI: 67.4%-74.6%]), reducing FPA rates (34 of 431 [7.9%; 95% CI: 6.4%-9.6%] vs 180 of 431 [41.8%; 95% CI: 38.9%-44.7%]), and improving specificity (431 of 531 [81.0%; 95% CI: 77.2%-84.5%] vs 154 of 531 [29.0%; 95% CI: 24.8%-33.4%]) (P < 0.001 for all). The AI ECG model’s area under the receiver-operating characteristic curve was 0.94 (95% CI: 0.92-0.95), maintaining consistent performance across clinically challenging subgroups (eg, atrial fibrillation, bundle branch block, STEMI equivalents). The AI ECG model reclassified 277 of 306 (91%) biomarker-negative FPAs correctly.
Conclusions
AI-based ECG analysis significantly improved STEMI detection, reduced FPAs, and enhanced the recognition of nonconventional presentations. This supports integration of AI-based ECG analysis into acute chest pain pathways.
{"title":"AI-Enabled ECG Analysis Improves Diagnostic Accuracy and Reduces False STEMI Activations","authors":"Robert Herman MD, PhD , Bryn E. Mumma MD, MAS , Jake D. Hoyne MD , Benjamin L. Cooper MD , Nils P. Johnson MD, MS , Timea Kisova MD , Anthony Demolder MD , Adam Rafajdus MSc , Andrej Iring MSc , Timotej Palus MSc , Marta Belmonte MD , Emanuele Barbato MD, PhD , Suzanne J. Baron MD, MSc , Robert Hatala MD, PhD , Stephen W. Smith MD , H. Pendell Meyers MD , Scott W. Sharkey MD , Jozef Bartunek MD, PhD , Timothy D. Henry MD","doi":"10.1016/j.jcin.2025.10.018","DOIUrl":"10.1016/j.jcin.2025.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Timely reperfusion is critical in reducing mortality in ST-segment elevation myocardial infarction (STEMI). Although electrocardiography-guided cardiac catheterization laboratory (CCL) activation on the basis of first medical contact recognition improves system-level response, diagnostic uncertainty, particularly in atypical presentations, contributes to false positive activations (FPAs) and reperfusion delays.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate the diagnostic performance and operational impact of artificial intelligence (AI)–based electrocardiographic (ECG) analysis in real-world STEMI triage across a multicenter U.S. registry.</div></div><div><h3>Methods</h3><div>A total of 1,032 patients with suspected STEMI who triggered emergent CCL activation at 3 geographically diverse percutaneous coronary intervention centers (January 2020 to May 2024) were retrospectively analyzed. Index electrocardiograms underwent standard triage and blinded retrospective AI ECG analysis (Queen of Hearts, PMcardio) trained to detect acute coronary occlusion and benign mimics. The reference standard was an angiographically confirmed culprit lesion with positive enzymes. Diagnostic accuracy, subgroup analyses, and FPA reclassification were compared.</div></div><div><h3>Results</h3><div>Of 1,032 emergent CCL activations, 601 (58.2%) had confirmed STEMI. The AI ECG model outperformed standard triage, demonstrating higher index ECG sensitivity (553 of 601 [92.0%; 95% CI: 89.7%-94.1%] vs 427 of 601 [71.0%; 95% CI: 67.4%-74.6%]), reducing FPA rates (34 of 431 [7.9%; 95% CI: 6.4%-9.6%] vs 180 of 431 [41.8%; 95% CI: 38.9%-44.7%]), and improving specificity (431 of 531 [81.0%; 95% CI: 77.2%-84.5%] vs 154 of 531 [29.0%; 95% CI: 24.8%-33.4%]) (<em>P</em> < 0.001 for all). The AI ECG model’s area under the receiver-operating characteristic curve was 0.94 (95% CI: 0.92-0.95), maintaining consistent performance across clinically challenging subgroups (eg, atrial fibrillation, bundle branch block, STEMI equivalents). The AI ECG model reclassified 277 of 306 (91%) biomarker-negative FPAs correctly.</div></div><div><h3>Conclusions</h3><div>AI-based ECG analysis significantly improved STEMI detection, reduced FPAs, and enhanced the recognition of nonconventional presentations. This supports integration of AI-based ECG analysis into acute chest pain pathways.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 2","pages":"Pages 145-156"},"PeriodicalIF":11.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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