Pub Date : 2025-12-22DOI: 10.1016/j.jcin.2025.09.037
Mohamad Alkhouli MD , Akash Makkar MD , Himanshu Agarwal MD , James V. Freeman MD, MPH, MS , Atman P. Shah MD , Megan Coylewright MD, MPH , Robert Percell MD , Brock Cookman DO, MSA , Jordan A. Anderson PhD , Ryan Gage MS , Christopher R. Ellis MD , Dhanunjaya Lakkireddy MD
Background
Transesophageal echocardiography (TEE) is commonly used to guide left atrial appendage occlusion (LAAO) procedures. Intracardiac echocardiography (ICE) is emerging as an alternative imaging modality with potential advantages over TEE.
Objectives
The aim of this study was to compare outcomes from procedures guided by ICE vs TEE vs both for guidance of Amulet implantation in the EMERGE LAA postapproval study.
Methods
Patients with Amulet implants entered into the National Cardiovascular Data Registry LAAO Registry between August 14, 2021, and December 15, 2023. A safety composite endpoint of all-cause death, ischemic stroke, systemic embolism, or device- or procedure-related events requiring open cardiac surgery or major endovascular intervention through 7 days or hospital discharge was reported. Major adverse events were also reported through 45 days.
Results
A total of 11,848 patients were included in this analysis, with 433 (3.7%) using ICE only, 9,793 (82.6%) TEE only, and 1,622 (13.7%) ICE plus TEE. Median follow-up duration was the same in all groups (45.0 days; Q1-Q3: 45.0-45.0 days). Baseline characteristics were comparable across all groups. Similar rates of implantation success (ICE, 95.0%; TEE, 96.1%; ICE plus TEE, 96.2%; P = 0.324) and clinically relevant closure (≤3-mm peridevice leak) at 45 days (>95% for all groups) were observed. Procedural times were longer in the ICE (104.8 ± 44.7 minutes; median 98.0 minutes; Q1-Q3: 78.0-122.0 minutes) and ICE plus TEE (98.8 ± 46.6 minutes; median 88.5 minutes; Q1-Q3: 71.0-116.0 minutes) groups compared with the TEE group (82.0 ± 39.2 minutes; median 75.0 minutes; Q1-Q3: 57.0-99.0 minutes) (P < 0.001). The safety composite endpoint (ICE, 0.9% [4 of 433]; TEE, 0.9% [93 of 9,793]; ICE plus TEE, 0.7% [11 of 1,622]; OR for ICE vs TEE: 0.97 [95% CI: 0.36-2.66]; OR for ICE vs ICE plus TEE: 1.37 [95% CI: 0.43-4.31]; P = 0.585) and 45-day major adverse event composite (ICE, 7.1% [30 of 433]; TEE, 6.7% [651 of 9,793]; ICE plus TEE, 5.7% [93 of 1,622]; OR for ICE vs TEE: 1.08 [95% CI: 0.75-1.57]; OR for ICE vs ICE plus TEE: 1.27 [95% CI: 0.83-1.93]; P = 0.336) were similar between imaging groups. Procedural times and adverse event rates decreased as operator experience increased in the ICE groups.
Conclusions
In the largest comparison to date, both ICE and TEE are safe and effective for Amulet LAAO guidance, with high acute success and closure rates. ICE was associated with longer procedure times that decreased with operator experience, potentially reflecting a learning curve.
{"title":"Comparative Outcomes of Intracardiac vs Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion","authors":"Mohamad Alkhouli MD , Akash Makkar MD , Himanshu Agarwal MD , James V. Freeman MD, MPH, MS , Atman P. Shah MD , Megan Coylewright MD, MPH , Robert Percell MD , Brock Cookman DO, MSA , Jordan A. Anderson PhD , Ryan Gage MS , Christopher R. Ellis MD , Dhanunjaya Lakkireddy MD","doi":"10.1016/j.jcin.2025.09.037","DOIUrl":"10.1016/j.jcin.2025.09.037","url":null,"abstract":"<div><h3>Background</h3><div>Transesophageal echocardiography (TEE) is commonly used to guide left atrial appendage occlusion (LAAO) procedures. Intracardiac echocardiography (ICE) is emerging as an alternative imaging modality with potential advantages over TEE.</div></div><div><h3>Objectives</h3><div>The aim of this study was to compare outcomes from procedures guided by ICE vs TEE vs both for guidance of Amulet implantation in the EMERGE LAA postapproval study.</div></div><div><h3>Methods</h3><div>Patients with Amulet implants entered into the National Cardiovascular Data Registry LAAO Registry between August 14, 2021, and December 15, 2023. A safety composite endpoint of all-cause death, ischemic stroke, systemic embolism, or device- or procedure-related events requiring open cardiac surgery or major endovascular intervention through 7 days or hospital discharge was reported. Major adverse events were also reported through 45 days.</div></div><div><h3>Results</h3><div>A total of 11,848 patients were included in this analysis, with 433 (3.7%) using ICE only, 9,793 (82.6%) TEE only, and 1,622 (13.7%) ICE plus TEE. Median follow-up duration was the same in all groups (45.0 days; Q1-Q3: 45.0-45.0 days). Baseline characteristics were comparable across all groups. Similar rates of implantation success (ICE, 95.0%; TEE, 96.1%; ICE plus TEE, 96.2%; <em>P</em> = 0.324) and clinically relevant closure (≤3-mm peridevice leak) at 45 days (>95% for all groups) were observed. Procedural times were longer in the ICE (104.8 ± 44.7 minutes; median 98.0 minutes; Q1-Q3: 78.0-122.0 minutes) and ICE plus TEE (98.8 ± 46.6 minutes; median 88.5 minutes; Q1-Q3: 71.0-116.0 minutes) groups compared with the TEE group (82.0 ± 39.2 minutes; median 75.0 minutes; Q1-Q3: 57.0-99.0 minutes) (<em>P</em> < 0.001). The safety composite endpoint (ICE, 0.9% [4 of 433]; TEE, 0.9% [93 of 9,793]; ICE plus TEE, 0.7% [11 of 1,622]; OR for ICE vs TEE: 0.97 [95% CI: 0.36-2.66]; OR for ICE vs ICE plus TEE: 1.37 [95% CI: 0.43-4.31]; <em>P</em> = 0.585) and 45-day major adverse event composite (ICE, 7.1% [30 of 433]; TEE, 6.7% [651 of 9,793]; ICE plus TEE, 5.7% [93 of 1,622]; OR for ICE vs TEE: 1.08 [95% CI: 0.75-1.57]; OR for ICE vs ICE plus TEE: 1.27 [95% CI: 0.83-1.93]; <em>P</em> = 0.336) were similar between imaging groups. Procedural times and adverse event rates decreased as operator experience increased in the ICE groups.</div></div><div><h3>Conclusions</h3><div>In the largest comparison to date, both ICE and TEE are safe and effective for Amulet LAAO guidance, with high acute success and closure rates. ICE was associated with longer procedure times that decreased with operator experience, potentially reflecting a learning curve.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 24","pages":"Pages 3055-3068"},"PeriodicalIF":11.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357614","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 : 2025-12-22DOI: 10.1016/j.jcin.2025.10.030
Matthew Ryan PhD , Alexander G. Truesdell MD , Gavin J. Murphy MD , Saad M. Ezad PhD , Stephen Fremes MD , Alexandra J. Lansky MD , Elmir Omerovic PhD , Stephan Windecker MD , Eric J. Velazquez MD , Mark C. Petrie MBChB , Ajay Kirtane MD , Gregg W. Stone MD , Divaka Perera MD
Ischemic left ventricular dysfunction (iLVD) is the most prevalent cause of heart failure with reduced ejection fraction and is associated with higher mortality than nonischemic cardiomyopathy. Coronary revascularization was once considered routine for patients with iLVD, yet recent randomized trials have questioned this approach. This state-of-the-art review examines the pathophysiology of iLVD, explores the randomized evidence around coronary revascularization, and outlines which patients with iLVD should still be offered coronary artery bypass grafting or percutaneous coronary intervention (PCI). Finally, a step-by-step guide for planning and performing PCI in this population is provided. Attention is given to shared decision-making, nontechnical factors, and considerations for achieving complete revascularization, with a specific focus on upcoming trials of mechanical circulatory support.
{"title":"Revascularization in Ischemic Left Ventricular Dysfunction","authors":"Matthew Ryan PhD , Alexander G. Truesdell MD , Gavin J. Murphy MD , Saad M. Ezad PhD , Stephen Fremes MD , Alexandra J. Lansky MD , Elmir Omerovic PhD , Stephan Windecker MD , Eric J. Velazquez MD , Mark C. Petrie MBChB , Ajay Kirtane MD , Gregg W. Stone MD , Divaka Perera MD","doi":"10.1016/j.jcin.2025.10.030","DOIUrl":"10.1016/j.jcin.2025.10.030","url":null,"abstract":"<div><div>Ischemic left ventricular dysfunction (iLVD) is the most prevalent cause of heart failure with reduced ejection fraction and is associated with higher mortality than nonischemic cardiomyopathy. Coronary revascularization was once considered routine for patients with iLVD, yet recent randomized trials have questioned this approach. This state-of-the-art review examines the pathophysiology of iLVD, explores the randomized evidence around coronary revascularization, and outlines which patients with iLVD should still be offered coronary artery bypass grafting or percutaneous coronary intervention (PCI). Finally, a step-by-step guide for planning and performing PCI in this population is provided. Attention is given to shared decision-making, nontechnical factors, and considerations for achieving complete revascularization, with a specific focus on upcoming trials of mechanical circulatory support.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 24","pages":"Pages 2977-2994"},"PeriodicalIF":11.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373896","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 : 2025-12-22DOI: 10.1016/j.jcin.2025.09.014
Kevin K.W. Olesen MD, PhD , Morten Madsen MSc , Morten Würtz MD, PhD , Troels Thim MD PhD , Martin B. Mortensen MD, PhD , Henrik T. Sørensen MD, DMSci , Michael Maeng MD, PhD
Background
According to international guidelines, patients with angina and no obstructive coronary artery disease (ANOCA) are at elevated risk for adverse clinical events.
Objectives
The aim of this study was to examine 15-year cardiovascular risk in patients with ANOCA referred for coronary angiography because of stable angina pectoris compared with a matched general population cohort without histories of coronary artery disease.
Methods
This cohort study included all patients suspected of having stable angina pectoris and referred for coronary angiography from 2003 to 2021 but who had no or mild coronary artery disease. Myocardial infarction, ischemic stroke, and death outcomes were compared with those in 1:5 age- and sex-matched individuals from the general population without known coronary artery disease. Fifteen-year risk differences were computed, accounting for competing risk for death in the ischemic outcomes. Age- and sex-stratified analyses were performed. The maximum and median follow-up times were 15 and 10.7 years, respectively.
Results
The ANOCA cohort (n = 21,132) and the general population cohort (n = 105,660) had similar 15-year cumulative incidence of myocardial infarction (3.5% vs 3.5%; risk difference [RD]: 0.0%; 95% CI: −0.3% to 0.4%) and higher ischemic stroke risk (3.7% vs 2.9%; RD: 0.8%; 95% CI: 0.5%-1.2%) but slightly lower mortality (25.4% vs 26.4%; RD: −0.9%; 95% CI: −1.8% to −0.1%). Men and older (≥75 years of age) patients had the lowest risks compared with the matched general population cohort.
Conclusions
Patients with ANOCA have a similar risk for myocardial infarction, lower mortality, and a marginally higher risk for ischemic stroke than the general population. Results were age and sex dependent.
背景：根据国际指南，心绞痛且无阻塞性冠状动脉疾病（ANOCA）的患者发生不良临床事件的风险较高。目的：本研究的目的是检查因稳定性心绞痛而转介冠状动脉造影的ANOCA患者15年心血管风险，并与无冠状动脉疾病史的匹配普通人群队列进行比较。方法：该队列研究纳入了2003年至2021年期间所有怀疑患有稳定型心绞痛并转诊进行冠状动脉造影但无或轻度冠状动脉疾病的患者。将心肌梗死、缺血性卒中和死亡结果与没有已知冠状动脉疾病的普通人群中年龄和性别匹配的1:5个体进行比较。计算15年的风险差异，考虑缺血结果中死亡的竞争风险。进行了年龄和性别分层分析。最长随访时间为15年，中位随访时间为10.7年。结果：ANOCA队列（n = 21,132）和普通人群队列（n = 105,660）的15年累积心肌梗死发生率相似（3.5% vs 3.5%；风险差异[RD]: 0.0%; 95% CI: -0.3%至0.4%），缺血性卒中风险较高（3.7% vs 2.9%; RD: 0.8%; 95% CI: 0.5%-1.2%），但死亡率略低（25.4% vs 26.4%; RD: -0.9%; 95% CI: -1.8%至-0.1%）。与匹配的普通人群队列相比，男性和老年（≥75岁）患者的风险最低。结论：与一般人群相比，ANOCA患者心肌梗死风险相似，死亡率较低，缺血性卒中风险略高。结果与年龄和性别有关。
{"title":"15-Year Cardiovascular Risk in Patients With Angina Without Obstructive Coronary Arteries","authors":"Kevin K.W. Olesen MD, PhD , Morten Madsen MSc , Morten Würtz MD, PhD , Troels Thim MD PhD , Martin B. Mortensen MD, PhD , Henrik T. Sørensen MD, DMSci , Michael Maeng MD, PhD","doi":"10.1016/j.jcin.2025.09.014","DOIUrl":"10.1016/j.jcin.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>According to international guidelines, patients with angina and no obstructive coronary artery disease (ANOCA) are at elevated risk for adverse clinical events.</div></div><div><h3>Objectives</h3><div>The aim of this study was to examine 15-year cardiovascular risk in patients with ANOCA referred for coronary angiography because of stable angina pectoris compared with a matched general population cohort without histories of coronary artery disease.</div></div><div><h3>Methods</h3><div>This cohort study included all patients suspected of having stable angina pectoris and referred for coronary angiography from 2003 to 2021 but who had no or mild coronary artery disease. Myocardial infarction, ischemic stroke, and death outcomes were compared with those in 1:5 age- and sex-matched individuals from the general population without known coronary artery disease. Fifteen-year risk differences were computed, accounting for competing risk for death in the ischemic outcomes. Age- and sex-stratified analyses were performed. The maximum and median follow-up times were 15 and 10.7 years, respectively.</div></div><div><h3>Results</h3><div>The ANOCA cohort (n = 21,132) and the general population cohort (n = 105,660) had similar 15-year cumulative incidence of myocardial infarction (3.5% vs 3.5%; risk difference [RD]: 0.0%; 95% CI: −0.3% to 0.4%) and higher ischemic stroke risk (3.7% vs 2.9%; RD: 0.8%; 95% CI: 0.5%-1.2%) but slightly lower mortality (25.4% vs 26.4%; RD: −0.9%; 95% CI: −1.8% to −0.1%). Men and older (≥75 years of age) patients had the lowest risks compared with the matched general population cohort.</div></div><div><h3>Conclusions</h3><div>Patients with ANOCA have a similar risk for myocardial infarction, lower mortality, and a marginally higher risk for ischemic stroke than the general population. Results were age and sex dependent.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 24","pages":"Pages 3009-3020"},"PeriodicalIF":11.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145523605","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 : 2025-12-22DOI: 10.1016/j.jcin.2025.09.031
Luis Eichelmann MD, Taoufik Ouarrak PhD, Steffen Desch MD, Anne Freund MD, Uwe Zeymer MD, Holger Thiele MD
{"title":"Influence of Extracorporeal Life Support on the Causes of Death in Infarct-Related Cardiogenic Shock","authors":"Luis Eichelmann MD, Taoufik Ouarrak PhD, Steffen Desch MD, Anne Freund MD, Uwe Zeymer MD, Holger Thiele MD","doi":"10.1016/j.jcin.2025.09.031","DOIUrl":"10.1016/j.jcin.2025.09.031","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 24","pages":"Pages 3131-3133"},"PeriodicalIF":11.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802271","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 : 2025-12-16DOI: 10.1016/j.jcin.2025.11.019
Timo Nijkamp, Hanae F Namba, Coen K M Boerhout, Joo Myung Lee, Guus A de Waard, Hernán Mejía-Rentería, Masahiro Hoshino, Mauro Echavarria-Pinto, Martijn Meuwissen, Hitoshi Matsuo, Maribel Madera-Cambero, Ashkan Eftekhari, Mohamed A Effat, Rupak Banerjee, Tadashi Murai, Koen Marques, Joon-Hyung Doh, Ji-Hyun Jung, Chang-Wook Nam, Giampaolo Niccoli, Masafumi Nakayama, Nobuhiro Tanaka, Eun-Seok Shin, René van Es, Hester M den Ruijter, Pim van der Harst, Paul Knaapen, Bon-Kwon Koo, Tsunekazu Kakuta, Javier Escaned, Niels van Royen, Evald H Christiansen, Jan J Piek, Peter Damman, Tim P van de Hoef
Background: Advancing age is associated with epicardial atherosclerosis and coronary microvascular dysfunction (CMD), complicating reliable assessment of CMD using coronary flow reserve (CFR). Whether prevalence of functional and structural CMD varies with age remains unclear.
Objectives: The authors sought to evaluate the prevalence of CMD endotypes by age strata and compare CFR with microvascular resistance reserve (MRR) for diagnosis and stratification.
Methods: Data from 1,704 patients (2,283 lesions) with stable angina in the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry) were analyzed, including obstructive (fractional flow reserve ≤0.80) and nonobstructive (fractional flow reserve >0.80) lesions. CMD was classified as no CMD (MRR ≥3.0), functional CMD (MRR <3.0, normal resistance), or structural CMD (MRR <3.0, abnormal resistance). CMD classification was repeated using CFR (<2.5 abnormal). Patients were stratified per age decade: <50, 50-59, 60-69, 70-79, and ≥80 years.
Results: CMD prevalence by MRR was 48.2%, and increased across age strata (37.2% to 78.0%; P < 0.001), driven by structural CMD (10.9% to 40.0%; P < 0.001), while functional CMD prevalence remained unchanged (26.3% to 38.0%; P = 0.220). Age independently predicted functional (OR/y: 1.02; P < 0.001) and structural CMD (OR/y: 1.05; P < 0.001). In obstructive lesions, age predicted structural CMD (OR/y: 1.03; P = 0.0055); in nonobstructive lesions, age predicted functional (OR/y: 1.02; P = 0.0032) and structural CMD (OR/y: 1.06; P < 0.001). Overall CMD prevalence by CFR exceeded MRR across groups (53.3% vs 48.2%; P < 0.001), irrespective of epicardial disease.
Conclusions: Structural CMD increases with age regardless of obstructive CAD, while functional CMD prevalence increases only in nonobstructive CAD. CFR may overestimate CMD in epicardial disease, whereas MRR provides a more consistent assessment regardless of obstructive CAD, underscoring the need for prospective studies on their clinical relevance.
背景：年龄的增长与心外膜动脉粥样硬化和冠状动脉微血管功能障碍（CMD）有关，使冠状动脉血流储备（CFR）对CMD的可靠评估复杂化。功能性和结构性CMD的患病率是否随年龄变化尚不清楚。目的：作者试图评估不同年龄层的CMD内型患病率，并比较CFR和微血管阻力储备（MRR）的诊断和分层。方法：分析ILIAS登记处（包括心绞痛综合征侵入性生理评估登记处）中1704例稳定型心绞痛患者（2283个病灶）的数据，包括梗阻性（分数血流储备≤0.80）和非梗阻性（分数血流储备>0.80）病变。MRR结果：MRR的CMD患病率为48.2%，在不同年龄层呈上升趋势（37.2% ~ 78.0%,P < 0.001），由结构性CMD驱动（10.9% ~ 40.0%,P < 0.001），而功能性CMD患病率保持不变（26.3% ~ 38.0%,P = 0.220）。年龄独立预测功能性CMD （OR/y: 1.02; P < 0.001）和结构性CMD （OR/y: 1.05; P < 0.001）。在梗阻性病变中，年龄预测结构性CMD (OR/y: 1.03; P = 0.0055)；在非梗阻性病变中，年龄预测功能性（OR/y: 1.02; P = 0.0032）和结构性CMD （OR/y: 1.06; P < 0.001）。无论是否患有心外膜疾病，两组间由CFR引起的CMD总体患病率均超过MRR （53.3% vs 48.2%; P < 0.001）。结论：与阻塞性CAD无关，结构性CMD随年龄增加，而功能性CMD仅在非阻塞性CAD中增加。CFR可能高估了心外膜疾病的CMD，而MRR提供了更一致的评估，而不考虑阻塞性CAD，强调需要对其临床相关性进行前瞻性研究。
{"title":"Microvascular Resistance Reserve vs Coronary Flow Reserve to Assess Age-Related Trends in Coronary Microvascular Dysfunction.","authors":"Timo Nijkamp, Hanae F Namba, Coen K M Boerhout, Joo Myung Lee, Guus A de Waard, Hernán Mejía-Rentería, Masahiro Hoshino, Mauro Echavarria-Pinto, Martijn Meuwissen, Hitoshi Matsuo, Maribel Madera-Cambero, Ashkan Eftekhari, Mohamed A Effat, Rupak Banerjee, Tadashi Murai, Koen Marques, Joon-Hyung Doh, Ji-Hyun Jung, Chang-Wook Nam, Giampaolo Niccoli, Masafumi Nakayama, Nobuhiro Tanaka, Eun-Seok Shin, René van Es, Hester M den Ruijter, Pim van der Harst, Paul Knaapen, Bon-Kwon Koo, Tsunekazu Kakuta, Javier Escaned, Niels van Royen, Evald H Christiansen, Jan J Piek, Peter Damman, Tim P van de Hoef","doi":"10.1016/j.jcin.2025.11.019","DOIUrl":"https://doi.org/10.1016/j.jcin.2025.11.019","url":null,"abstract":"<p><strong>Background: </strong>Advancing age is associated with epicardial atherosclerosis and coronary microvascular dysfunction (CMD), complicating reliable assessment of CMD using coronary flow reserve (CFR). Whether prevalence of functional and structural CMD varies with age remains unclear.</p><p><strong>Objectives: </strong>The authors sought to evaluate the prevalence of CMD endotypes by age strata and compare CFR with microvascular resistance reserve (MRR) for diagnosis and stratification.</p><p><strong>Methods: </strong>Data from 1,704 patients (2,283 lesions) with stable angina in the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry) were analyzed, including obstructive (fractional flow reserve ≤0.80) and nonobstructive (fractional flow reserve >0.80) lesions. CMD was classified as no CMD (MRR ≥3.0), functional CMD (MRR <3.0, normal resistance), or structural CMD (MRR <3.0, abnormal resistance). CMD classification was repeated using CFR (<2.5 abnormal). Patients were stratified per age decade: <50, 50-59, 60-69, 70-79, and ≥80 years.</p><p><strong>Results: </strong>CMD prevalence by MRR was 48.2%, and increased across age strata (37.2% to 78.0%; P < 0.001), driven by structural CMD (10.9% to 40.0%; P < 0.001), while functional CMD prevalence remained unchanged (26.3% to 38.0%; P = 0.220). Age independently predicted functional (OR/y: 1.02; P < 0.001) and structural CMD (OR/y: 1.05; P < 0.001). In obstructive lesions, age predicted structural CMD (OR/y: 1.03; P = 0.0055); in nonobstructive lesions, age predicted functional (OR/y: 1.02; P = 0.0032) and structural CMD (OR/y: 1.06; P < 0.001). Overall CMD prevalence by CFR exceeded MRR across groups (53.3% vs 48.2%; P < 0.001), irrespective of epicardial disease.</p><p><strong>Conclusions: </strong>Structural CMD increases with age regardless of obstructive CAD, while functional CMD prevalence increases only in nonobstructive CAD. CFR may overestimate CMD in epicardial disease, whereas MRR provides a more consistent assessment regardless of obstructive CAD, underscoring the need for prospective studies on their clinical relevance.</p>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948679","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}
Background: Angiography-derived index of microcirculatory resistance (angio-IMR) is a reliable measure for assessing coronary microvascular function. However, the prognostic significance of changes in angio-IMR (Δangio-IMR) remains unclear.
Objectives: The aim of this study was to assess the long-term prognostic utility of Δangio-IMR following percutaneous coronary intervention (PCI) in patients with intermediate coronary stenosis.
Methods: A total of 814 vessels with intermediate coronary stenosis that underwent PCI were enrolled from the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial. The primary endpoint was target vessel failure (TVF) during long-term follow-up, defined as a composite of cardiac death, target vessel-related myocardial reinfarction, and target vessel revascularization.
Results: The median Δangio-IMR was 2.02 (Q1-Q3: 0.50-5.00). Using the 75th percentile (Δangio-IMR >5) as the cutoff, 203 vessels were assigned to the high Δangio-IMR group. Vessels with high Δangio-IMR demonstrated a significantly elevated risk for TVF compared with those with low Δangio-IMR (15.62% vs 9.47%; HR: 1.82; 95% CI: 1.15-2.88; P = 0.011). High Δangio-IMR independently predicted TVF (HR: 1.72; 95% CI: 1.04-2.83; P = 0.034). There was a notable interaction effect between Δangio-IMR and post-PCI angio-IMR (P = 0.028). A stratified analysis by post-PCI angio-IMR revealed that vessels with high Δangio-IMR showed a markedly increased TVF risk compared with vessels with low Δangio-IMR in those with post-PCI angio-IMR >25 (26.2% vs 11.9%; HR: 5.18; 95% CI: 1.28-20.94; P = 0.021), whereas no such association was observed in those with post-PCI angio-IMR ≤25 (12.6% vs 9.3%; HR: 1.33; 95% CI: 0.77-2.29; P = 0.305).
Conclusions: An elevated Δangio-IMR correlates with a heightened risk of TVF in vessels with intermediate coronary stenosis underwent PCI. ΔAngio-IMR could be used as a valuable risk stratification indicator, particularly in patients with high post-PCI angio-IMR.
背景：血管造影衍生的微循环阻力指数（angio-IMR）是评估冠状动脉微血管功能的可靠指标。然而，血管imr变化的预后意义尚不清楚（Δangio-IMR）。目的：本研究的目的是评估Δangio-IMR在中度冠状动脉狭窄患者经皮冠状动脉介入治疗（PCI）后的长期预后价值。方法：从flavor（分级血流储备和血管内超声对中度狭窄患者临床结果的影响）试验中招募了814条接受PCI治疗的中度冠状动脉狭窄血管。主要终点是长期随访中的靶血管衰竭（TVF），定义为心源性死亡、靶血管相关性心肌再梗死和靶血管重建术的复合。结果：中位Δangio-IMR为2.02 （Q1-Q3: 0.50-5.00）。以第75百分位（Δangio-IMR bbb50）为分界点，203只血管被分配到高Δangio-IMR组。Δangio-IMR高的血管发生TVF的风险明显高于Δangio-IMR低的血管（15.62% vs 9.47%; HR: 1.82; 95% CI: 1.15-2.88; P = 0.011）。高Δangio-IMR独立预测TVF （HR: 1.72; 95% CI: 1.04-2.83; P = 0.034）。Δangio-IMR与pci后血管imr之间存在显著的交互作用（P = 0.028）。pci后血管imr的分层分析显示，在pci后血管imr为0.25的患者中，Δangio-IMR高的血管与Δangio-IMR低的血管相比，TVF风险明显增加（26.2% vs 11.9%; HR: 5.18; 95% CI: 1.28-20.94; P = 0.021），而在pci后血管imr≤25的患者中，没有观察到这种关联（12.6% vs 9.3%; HR: 1.33; 95% CI: 0.77-2.29; P = 0.305）。结论：Δangio-IMR升高与中度冠状动脉狭窄行PCI的血管TVF风险增加相关。ΔAngio-IMR可以作为一个有价值的风险分层指标，特别是在pci术后血管imr高的患者中。
{"title":"Long-Term Prognostic Impact of Changes in Coronary Angiography-Derived Index of Microcirculatory Resistance Following PCI.","authors":"Yuxuan Zhang, Jiacheng Fang, Zining Chen, Guohui Chen, Jiamu Chen, Ping Lin, Yiyue Zheng, Delong Chen, Xinyi Zhang, Chi Liu, Abuduwufuer Yidilisi, Jiniu Huang, Xinyang Hu, Jinlong Zhang, Seokhun Yang, Jeehoon Kang, Doyeon Hwang, Joo-Yong Hahn, Chang-Wook Nam, Joon-Hyung Doh, Bong-Ki Lee, Weon Kim, Jinyu Huang, Fan Jiang, Hao Zhou, Peng Chen, Lijiang Tang, Wenbing Jiang, Xiaomin Chen, Wenming He, Sung Gyun Ahn, Ung Kim, You-Jeong Ki, Eun-Seok Shin, Seung-Jea Tahk, Jianping Xiang, Bon-Kwon Koo, Jian'an Wang, Jun Jiang","doi":"10.1016/j.jcin.2025.11.010","DOIUrl":"https://doi.org/10.1016/j.jcin.2025.11.010","url":null,"abstract":"<p><strong>Background: </strong>Angiography-derived index of microcirculatory resistance (angio-IMR) is a reliable measure for assessing coronary microvascular function. However, the prognostic significance of changes in angio-IMR (Δangio-IMR) remains unclear.</p><p><strong>Objectives: </strong>The aim of this study was to assess the long-term prognostic utility of Δangio-IMR following percutaneous coronary intervention (PCI) in patients with intermediate coronary stenosis.</p><p><strong>Methods: </strong>A total of 814 vessels with intermediate coronary stenosis that underwent PCI were enrolled from the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial. The primary endpoint was target vessel failure (TVF) during long-term follow-up, defined as a composite of cardiac death, target vessel-related myocardial reinfarction, and target vessel revascularization.</p><p><strong>Results: </strong>The median Δangio-IMR was 2.02 (Q1-Q3: 0.50-5.00). Using the 75th percentile (Δangio-IMR >5) as the cutoff, 203 vessels were assigned to the high Δangio-IMR group. Vessels with high Δangio-IMR demonstrated a significantly elevated risk for TVF compared with those with low Δangio-IMR (15.62% vs 9.47%; HR: 1.82; 95% CI: 1.15-2.88; P = 0.011). High Δangio-IMR independently predicted TVF (HR: 1.72; 95% CI: 1.04-2.83; P = 0.034). There was a notable interaction effect between Δangio-IMR and post-PCI angio-IMR (P = 0.028). A stratified analysis by post-PCI angio-IMR revealed that vessels with high Δangio-IMR showed a markedly increased TVF risk compared with vessels with low Δangio-IMR in those with post-PCI angio-IMR >25 (26.2% vs 11.9%; HR: 5.18; 95% CI: 1.28-20.94; P = 0.021), whereas no such association was observed in those with post-PCI angio-IMR ≤25 (12.6% vs 9.3%; HR: 1.33; 95% CI: 0.77-2.29; P = 0.305).</p><p><strong>Conclusions: </strong>An elevated Δangio-IMR correlates with a heightened risk of TVF in vessels with intermediate coronary stenosis underwent PCI. ΔAngio-IMR could be used as a valuable risk stratification indicator, particularly in patients with high post-PCI angio-IMR.</p>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948681","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 : 2025-12-08DOI: 10.1016/j.jcin.2025.11.016
Alessandro Sticchi, Lukas Stolz
{"title":"The Predictive Value of Right Ventricle to Pulmonary Artery Coupling in Valvular Heart Disease: Three Valves, One Sign.","authors":"Alessandro Sticchi, Lukas Stolz","doi":"10.1016/j.jcin.2025.11.016","DOIUrl":"https://doi.org/10.1016/j.jcin.2025.11.016","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.4,"publicationDate":"2025-12-08","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 : 2025-12-08DOI: 10.1016/j.jcin.2025.09.006
Seokhun Yang MD , Jae Wook Chung MD , Sang-Hyeon Park MD , Jinlong Zhang MD , Keehwan Lee MD , Doyeon Hwang MD , Kyu-Sun Lee MD , Sang-Hoon Na MD , Joon-Hyung Doh MD , Chang-Wook Nam MD , Tae Hyun Kim MD , Eun-Seok Shin MD , Eun Ju Chun MD , Su-Yeon Choi MD , Hyun Kuk Kim MD , Young Joon Hong MD , Hun-Jun Park MD , Song-Yi Kim MD , Mirza Husic MD , Jess Lambrechtsen MD , Bon-Kwon Koo MD
Background
Acute coronary syndrome (ACS) arises from a complex interplay among luminal narrowing, plaque morphology, and hemodynamic environment.
Objectives
The authors aimed to compare the effectiveness of anatomy- and physiology-based ACS risk assessment.
Methods
In this international, multicenter, internal case-control study, 351 ACS patients who underwent coronary computed tomography angiography (CCTA) 1 month to 3 years before the event were analyzed. Lesions were classified as culprit or nonculprit based on invasive coronary angiography at the time of ACS. Core lab CCTA analyses assessed lesion-specific characteristics: stenosis severity, adverse plaque characteristics (APC) (low-attenuation plaque, positive remodeling, spotty calcification, napkin-ring sign), plaque burden at minimum lumen area, and changes in CCTA-derived fractional flow reserve (ΔFFRCT). Diagnostic performance in identifying culprit lesions was compared.
Results
Among 2,451 lesions, 363 (14.8%) became ACS culprits, with a median interval of 375 [95.0-644.5] days. All anatomical and simulated physiological characteristics were independently associated with culprit lesions (all P < 0.001). In identifying ACS culprit lesions, plaque burden ≥70% showed the highest sensitivity of 90.6% (87.2%-93.2%) and ΔFFRCT ≥0.10 had the highest specificity of 88.3% (86.9%-89.6%) %. Predictability was similar between ΔFFRCT and the combined degree of stenosis, the number of APCs, and plaque burden (area under the curve 0.805 [0.782-0.829] vs 0.802 [0.777-0.826]; P = 0.748), with additive discrimination towards each other.
Conclusions
Luminal narrowing, plaque quality and quantity, and local hemodynamics were independent predictors of ACS, offering specificity in physiology and sensitivity in anatomy. A comprehensive assessment of them further refined the risk prediction for future ACS. (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II [EMERALD II]; NCT03591328)
{"title":"Anatomical vs Physiological Lesion Characteristics in Prediction of Acute Coronary Syndrome","authors":"Seokhun Yang MD , Jae Wook Chung MD , Sang-Hyeon Park MD , Jinlong Zhang MD , Keehwan Lee MD , Doyeon Hwang MD , Kyu-Sun Lee MD , Sang-Hoon Na MD , Joon-Hyung Doh MD , Chang-Wook Nam MD , Tae Hyun Kim MD , Eun-Seok Shin MD , Eun Ju Chun MD , Su-Yeon Choi MD , Hyun Kuk Kim MD , Young Joon Hong MD , Hun-Jun Park MD , Song-Yi Kim MD , Mirza Husic MD , Jess Lambrechtsen MD , Bon-Kwon Koo MD","doi":"10.1016/j.jcin.2025.09.006","DOIUrl":"10.1016/j.jcin.2025.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Acute coronary syndrome (ACS) arises from a complex interplay among luminal narrowing, plaque morphology, and hemodynamic environment.</div></div><div><h3>Objectives</h3><div>The authors aimed to compare the effectiveness of anatomy- and physiology-based ACS risk assessment.</div></div><div><h3>Methods</h3><div>In this international, multicenter, internal case-control study, 351 ACS patients who underwent coronary computed tomography angiography (CCTA) 1 month to 3 years before the event were analyzed. Lesions were classified as culprit or nonculprit based on invasive coronary angiography at the time of ACS. Core lab CCTA analyses assessed lesion-specific characteristics: stenosis severity, adverse plaque characteristics (APC) (low-attenuation plaque, positive remodeling, spotty calcification, napkin-ring sign), plaque burden at minimum lumen area, and changes in CCTA-derived fractional flow reserve (ΔFFR<sub>CT</sub>). Diagnostic performance in identifying culprit lesions was compared.</div></div><div><h3>Results</h3><div>Among 2,451 lesions, 363 (14.8%) became ACS culprits, with a median interval of 375 [95.0-644.5] days. All anatomical and simulated physiological characteristics were independently associated with culprit lesions (all <em>P</em> < 0.001). In identifying ACS culprit lesions, plaque burden ≥70% showed the highest sensitivity of 90.6% (87.2%-93.2%) and ΔFFR<sub>CT</sub> ≥0.10 had the highest specificity of 88.3% (86.9%-89.6%) %. Predictability was similar between ΔFFR<sub>CT</sub> and the combined degree of stenosis, the number of APCs, and plaque burden (area under the curve 0.805 [0.782-0.829] vs 0.802 [0.777-0.826]; <em>P</em> = 0.748), with additive discrimination towards each other.</div></div><div><h3>Conclusions</h3><div>Luminal narrowing, plaque quality and quantity, and local hemodynamics were independent predictors of ACS, offering specificity in physiology and sensitivity in anatomy. A comprehensive assessment of them further refined the risk prediction for future ACS. (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II [EMERALD II]; <span><span>NCT03591328</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 23","pages":"Pages 2833-2845"},"PeriodicalIF":11.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697964","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 : 2025-12-08DOI: 10.1016/j.jcin.2025.09.033
Jennifer von Stein MD , Philipp von Stein MD , Roman Pfister MD , Karl-Patrik Kresoja MD , Vera Fortmeier MD , Benedikt Koell MD , Wolfgang Rottbauer MD , Mohammad Kassar MD , Bjoern Goebel MD , Paolo Denti MD , Paul Achouh MD , Tienush Rassaf MD , Manuel Barreiro-Perez MD , Peter Boekstegers MD , Andreas Rück MD , Monika Zdanyte MD , Marianna Adamo MD , Flavien Vincent MD, PhD , Philipp Schlegel MD , Sebastian Rosch MD , Christos Iliadis MD
Background
Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is increasingly used in patients with severe tricuspid regurgitation (TR) at high surgical risk. Long-term outcomes in those with transvalvular cardiac implantable electronic devices (CIEDs) remain insufficiently characterized.
Objectives
The aim of this study was to evaluate procedural and clinical outcomes of T-TEER in patients with CIED leads in a real-world cohort.
Methods
Among 3,025 patients undergoing T-TEER at 26 centers (2016-2024), 851 (28.1%) had transvalvular CIED leads. Residual TR at discharge and follow-up and the composite of all-cause mortality or heart failure hospitalization at 2 years were assessed. CIED function was evaluated preprocedure and postprocedure. Propensity score matching (1:1) was conducted to compare outcomes between patients with and those without CIEDs.
Results
CIED function remained stable, and no lead revision was required. At discharge, TR ≤1+ and ≤2+ was achieved in 39.9% and 79.8%, respectively; at follow-up (median 269 days; Q1-Q3: 63-423 days), TR ≤1+ and ≤2+ persisted in 29.3% and 69.1%. In 385 matched pairs, residual TR, functional status, and 2-year heart failure hospitalization–free survival were comparable between patients with and those without CIEDs (67.1% [95% CI: 62.1%-72.5%] vs 73.6% [95% CI: 68.9%-78.6%]; P = 0.176). CIED presence showed a nonsignificant association with more adverse outcomes (HR: 1.31; 95% CI: 0.99-1.74; P = 0.063) but was not associated with residual TR >2+ (OR: 0.98; 95% CI: 0.70-1.38; P = 0.915). Achieving residual TR ≤2+ conferred significantly better survival irrespective of CIED presence (P < 0.001).
Conclusions
T-TEER is safe and effective in selected patients with transvalvular CIED leads. Effective TR reduction remains prognostically relevant, even in this high-risk real-world population.
背景：三尖瓣经导管边缘到边缘修复（T-TEER）越来越多地应用于严重三尖瓣反流（TR）的高手术风险患者。经瓣膜心脏植入式电子装置（cied）患者的长期预后尚不明确。目的：本研究的目的是评估现实世界队列中CIED导联患者T-TEER的程序和临床结果。方法在26个中心（2016-2024）接受T-TEER治疗的3025例患者中，851例（28.1%）有经瓣CIED导联。评估出院和随访时的剩余TR以及2年全因死亡率或心力衰竭住院的综合情况。在手术前后分别评估CIED功能。倾向评分匹配（1:1）比较有和无cied患者的结果。结果scied功能稳定，无需提前修改。放电时TR≤1+和≤2+分别为39.9%和79.8%；随访（中位269天，Q1-Q3: 63-423天）时，TR≤1+和≤2+的持续率分别为29.3%和69.1%。在385对配对的患者中，有cied和没有cied的患者的剩余TR、功能状态和2年心力衰竭无住院生存率具有可比性（67.1% [95% CI: 62.1%-72.5%] vs 73.6% [95% CI: 68.9%-78.6%]; P = 0.176）。CIED存在与更多不良结局无显著相关性（HR: 1.31; 95% CI: 0.99-1.74; P = 0.063），但与残留的TR bb2.0 +无显著相关性（OR: 0.98; 95% CI: 0.70-1.38; P = 0.915）。无论CIED是否存在，达到残余TR≤2+都能显著提高生存率（P < 0.001）。结论st - teer对经瓣膜CIED导联患者安全有效。即使在现实世界的高风险人群中，有效的TR降低仍然具有预后相关性。
{"title":"Tricuspid Valve Transcatheter Edge-to-Edge Repair in Patients With Cardiac Implantable Electronic Devices","authors":"Jennifer von Stein MD , Philipp von Stein MD , Roman Pfister MD , Karl-Patrik Kresoja MD , Vera Fortmeier MD , Benedikt Koell MD , Wolfgang Rottbauer MD , Mohammad Kassar MD , Bjoern Goebel MD , Paolo Denti MD , Paul Achouh MD , Tienush Rassaf MD , Manuel Barreiro-Perez MD , Peter Boekstegers MD , Andreas Rück MD , Monika Zdanyte MD , Marianna Adamo MD , Flavien Vincent MD, PhD , Philipp Schlegel MD , Sebastian Rosch MD , Christos Iliadis MD","doi":"10.1016/j.jcin.2025.09.033","DOIUrl":"10.1016/j.jcin.2025.09.033","url":null,"abstract":"<div><h3>Background</h3><div>Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is increasingly used in patients with severe tricuspid regurgitation (TR) at high surgical risk. Long-term outcomes in those with transvalvular cardiac implantable electronic devices (CIEDs) remain insufficiently characterized.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate procedural and clinical outcomes of T-TEER in patients with CIED leads in a real-world cohort.</div></div><div><h3>Methods</h3><div>Among 3,025 patients undergoing T-TEER at 26 centers (2016-2024), 851 (28.1%) had transvalvular CIED leads. Residual TR at discharge and follow-up and the composite of all-cause mortality or heart failure hospitalization at 2 years were assessed. CIED function was evaluated preprocedure and postprocedure. Propensity score matching (1:1) was conducted to compare outcomes between patients with and those without CIEDs.</div></div><div><h3>Results</h3><div>CIED function remained stable, and no lead revision was required. At discharge, TR ≤1+ and ≤2+ was achieved in 39.9% and 79.8%, respectively; at follow-up (median 269 days; Q1-Q3: 63-423 days), TR ≤1+ and ≤2+ persisted in 29.3% and 69.1%. In 385 matched pairs, residual TR, functional status, and 2-year heart failure hospitalization–free survival were comparable between patients with and those without CIEDs (67.1% [95% CI: 62.1%-72.5%] vs 73.6% [95% CI: 68.9%-78.6%]; <em>P</em> = 0.176). CIED presence showed a nonsignificant association with more adverse outcomes (HR: 1.31; 95% CI: 0.99-1.74; <em>P</em> = 0.063) but was not associated with residual TR >2+ (OR: 0.98; 95% CI: 0.70-1.38; <em>P</em> = 0.915). Achieving residual TR ≤2+ conferred significantly better survival irrespective of CIED presence (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>T-TEER is safe and effective in selected patients with transvalvular CIED leads. Effective TR reduction remains prognostically relevant, even in this high-risk real-world population.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 23","pages":"Pages 2878-2891"},"PeriodicalIF":11.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357611","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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