Tricuspid regurgitation (TR) is a common condition with prognostic significance, but with limited surgical options. There has been increased interest in the interventional management of TR after three recent clinical trials showing procedural safety and important quality of life gains. Interventional procedures require advanced imaging techniques for characterization of TR etiology, grade, as well as right heart anatomy and function. In this review, we describe the advantages and pitfalls of the main imaging modalities for TR assessment, namely echocardiography, cardiac magnetic resonance and cardiac computed tomography, including major parameters that require attention on the preoperative evaluation as well as recent imaging advances. In addition, we briefly describe the intraprocedural and postprocedural imaging aspect of tricuspid transcatheter interventions.

Tricuspid regurgitation (TR) is a highly prevalent and heterogeneous disease associated with poor outcomes, yet historically undertreated due to limited surgical options and under-recognition. The Tri-FR trial, an investigator-initiated, multicenter randomized controlled study, provides the first European RCT evidence that transcatheter edge-to-edge repair (T-TEER) on top of optimized medical therapy improves quality of life and functional status in elderly, comorbid patients with severe symptomatic TR. With rigorous imaging adjudication, real-world patient selection (mean age 78 years, 64% women, 95% AF), and pragmatic patient-centered endpoints, Tri-FR sets a benchmark for future studies. The trial highlights key challenges in imaging reproducibility, patient profiling, procedural timing, and residual TR grading, while its long-term follow-up will uniquely leverage both onsite reassessment and linkage to the French national health database (SNDS). Together with complementary RCTs and registries, Tri-FR reshapes the management paradigm for TR, emphasizing earlier referral, structured valve networks, and the need to balance repair versus replacement strategies. Still some data are missing for widespread adoption of transcatheter therapies. Recent ESC/EACTS guidelines IIa-A recommendation for T-TEER in severe isolated secondary TR is paving the way.

Aortic stenosis is the most frequent valvular heart disease in industrialized countries, affecting about 10% of individuals aged>75years, with 2-4% presenting severe disease; nearly half of them are asymptomatic. No medical therapy halts aortic stenosis progression, and aortic valve replacement remains the only curative option. Managing asymptomatic patients is challenging because of a persistent risk of sudden death, and the potential for irreversible myocardial damage if intervention is delayed, but also because aortic valve replacement carries procedural risks and long-term prosthesis-related complications. Functional assessment, especially exercise testing, is essential as it can identify a substantial proportion of "falsely asymptomatic" patients who will benefit from timely aortic valve replacement. Accurate assessment of aortic stenosis severity is crucial, with echocardiography as the cornerstone, although additional imaging modalities may be required in selected cases. Modern risk stratification integrates markers of subclinical myocardial dysfunction, haemodynamic compromise and procedural risk. Although observational studies and randomized trials suggest that early aortic valve replacement may reduce adverse events in selected low-risk patients, results are heterogeneous and methodological concerns remain. Meta-analyses have shown reductions in unplanned hospitalizations but no clear survival benefit with early intervention. Current guidelines recommend aortic valve replacement for classical indications, such as symptom onset or reduced ejection fraction, and suggest early aortic valve replacement only in carefully selected asymptomatic patients with low procedural risk. Shared decision-making within a multidisciplinary heart valve team remains essential, taking into account patient preferences, co-morbidities, life expectancy and lifestyle. Close follow-up with regular echocardiography and functional testing is critical to optimize timing and outcomes.

Aortic stenosis (AS) imposes a chronic, progressive pressure overload on the left ventricle. The myocardium responds through a sequence of mechanical and biological processes that initially preserve wall stress and cardiac output but eventually become maladaptive, leading to fibrosis, loss of contractile reserve and clinical heart failure. Integrating myocardial fibrosis assessment and staging frameworks into clinical decision-making may support earlier valve replacement, even before conventional triggers such as symptoms or reduced ejection fraction, to prevent irreversible myocardial damage in patients with severe/significant AS. Advances in imaging biomarkers - including cardiac magnetic resonance-derived late gadolinium enhancement, extracellular volume quantification and strain analysis - allow for more personalized risk stratification and may help identify which patients with asymptomatic severe AS stand to benefit most from earlier intervention. Beyond the valve procedure itself, adjunctive pharmacological strategies, such as antifibrotic therapies, renin-angiotensin system blockade, neprilysin inhibition and metabolic modulators, are being explored to address persistent fibrotic and metabolic remodelling that valve replacement alone cannot reverse. Equally important is the optimal treatment of concomitant cardiovascular comorbidities such as hypertension, coronary artery disease and atrial fibrillation, which may aggravate myocardial remodelling and blunt the benefits of valve replacement if left untreated.

Redo transcatheter aortic valve implantation (TAVI) is increasingly used to treat bioprosthetic valve dysfunction in patients who have undergone TAVI. As TAVI indications continue to expand to include younger patients, it is essential to systematically document redo TAVI procedures to better understand their long-term efficacy and safety. This study aimed to compare outcomes between redo TAVI and first TAVI procedures using a propensity score-matched analysis.

To compare the long-term clinical outcomes, including death, stroke and procedural adverse events, between redo TAVI and first TAVI procedures using a propensity score-matched analysis.

A retrospective analysis was conducted using the TriNetX database, identifying adults (≥18years) with severe aortic stenosis who underwent TAVI (2012-2024). Redo TAVI required an interval of ≥12months. Propensity score matching was performed using all baseline characteristics listed in Table 1, with outcomes assessed over 36months.

After matching, 446 patients were included in each cohort. No statistically significant difference was observed in the annual rates of all-cause death (11.3% vs 8.7%; hazard ratio 1.20, 95% confidence interval 0.86-1.68), ischaemic stroke (hazard ratio 2.07, 95% confidence interval 0.99-4.35) or major bleeding (hazard ratio 1.41, 95% confidence interval 0.99-2.02) between the redo TAVI and first TAVI groups. Pacemaker implantation (hazard ratio 0.25, 95% confidence interval 0.12-0.51), new-onset atrial fibrillation (hazard ratio 0.44, 95% confidence interval 0.24-0.79) and hospitalization for heart failure (hazard ratio 0.64, 95% confidence interval 0.41-0.99) were significantly lower in the redo TAVI group.

No statistically significant difference was observed in all-cause death, ischaemic stroke or major bleeding between the redo TAVI and first TAVI groups. Conversely, redo TAVI was associated with significantly lower rates of permanent pacemaker implantation and heart failure rehospitalization. These findings support the integration of redo TAVI as an essential component within a comprehensive lifetime treatment strategy for managing bioprosthetic aortic valve dysfunction.

Practitioners recommending transcatheter aortic valve implantation (TAVI) currently lack reliable tools to predict periprocedural risk of ischaemic stroke.

We aimed to develop and internally validate a clinical risk score to accurately stratify this risk.

Using data from the nationwide, multicentre FRANCE-TAVI registry, we developed a clinical predictive risk score for 30-day ischaemic stroke post-TAVI using multivariable logistic regression analysis. The model was internally validated through cross-validation techniques.

Among 62,747 patients, 1712 (2.7%) experienced ischaemic stroke within 30 days. Nine clinical predictors were identified: female sex, age >85 years, weight <60kg, symptomatic status, history of stroke or transient ischaemic attack, multiple (i.e. >1) episodes of acute heart failure, severe mobility reduction, diabetes and creatinine clearance <60mL/min. The resulting scoring model demonstrated good accuracy (Brier score 0.18), moderate discrimination (C-index 0.63) and excellent calibration as assessed by calibration plots, calibration-in-the-large and calibration slope. The score categorized patients into low - (90.2% of the population), intermediate - (8.0%) and high-risk (1.8%) groups. Observed stroke rates increased progressively across these groups, from 2.25% in the low-risk group to 6.51% in the intermediate-risk group and 10.10% in the high-risk group.

This newly developed STRAT score is a clinical, practical and effective tool for predicting early ischaemic stroke in patients undergoing TAVI. It was derived and internally validated in the FRANCE-TAVI registry and may help tailor preventive strategies. Further studies are necessary to externally validate this score and evaluate its impact on clinical decision-making.

We conducted a feasibility study to evaluate the feasibility of recruiting patients to examine the effect of near vision glasses in young infants at risk of cerebral visual impairment.

A three-arm, parallel-group, open-label randomised feasibility trial.

Tertiary neonatal intensive care in London, UK.

We included babies born before 29 weeks of gestation or at full term with hypoxic ischaemic encephalopathy. Babies who needed ongoing inpatient care, with established eye anomalies or with very high refractive errors at baseline (<-6.00 dioptres (D) or >±8.00D) were not included. Infants with retinopathy of prematurity were not excluded.

At 8 weeks corrected age, we allocated 18 infants to wear glasses (+3.00D over full cycloplegic refraction) immediately (intervention 1), 18 to wear the same glasses at 16 weeks (intervention 2) and 19 infants were allocated to standard treatment (no glasses).

Recruitment and retention of study participants (primary), compliance wearing glasses, preferential-looking visual acuity (with glasses) and visual function as determined using A Test Battery of Child Development for Examining Functional Vision at 3-month and 6-month age post-term.

Of 70 eligible families, 55 consented and 34 attended baseline assessments, and 28 completed the study. Non-attendance was due mainly to prolonged inpatient stay, infant health and scheduling conflicts. Glasses were worn for similar periods in each group (Intervention 1: median 2 hours/day (95% CI 1 hour to 4 hours); Intervention 2: median 2 hours/day (95% CI 1.5 hours to 3 hours)). Visual acuity improved from baseline to 6 months. Mean (SE) LogMAR (Minimum Angle of Resolution) improvements were standard care: 0.47 (0.45); intervention 1: 0.66 (0.44); intervention 2: 0.37 (0.36). Among the 29 very preterm infants, there were similar findings: standard care: 0.35 (0.35); Intervention 1: 0.67 (0.47); Intervention 2: 0.34 (0.40). As a functional measure, object permanence was present at the following rates by randomised arm: standard care: 29%; whereas intervention 1: 56%; and intervention 2: 44% (OR intervention 1 vs standard care: 3.13 (95% CI 0.38 to 25.57), ie, not statistically significant).

We demonstrate feasibility for a definitive RCT (randomized controlled trial) with good recruitment and retention and observed potential benefits for vision and development following the dispensing of glasses at 8 weeks post-term age compared with untreated controls. We identified methodological modifications to further improve recruitment processes for a future larger study.

ISRCTN14646770; NCT05048550.

Atrial fibrillation (AF), with a prevalence of 1-2%, is the most common cardiac arrhythmia. AF is associated with a fivefold increased risk of cardioembolic events; approximately 20% of all strokes are caused by AF. Pulmonary vein isolation (PVI) has become the first-line treatment for AF. However, PVI cannot eliminate the residual stroke risk. Current guidelines recommend that anticoagulation be continued in this specific group of patients, regardless of the presence or absence of AF. In this large AF population post-PVI, who are considered to be in an earlier stage of AF, it is unknown whether left atrial appendage closure (LAAC) offers an alternative to direct oral anticoagulant (DOAC) therapy.

The trial will be a prospective, randomised, multicentre non-inferiority study comparing two treatment strategies in AF patients after atrial ablation. Patients will be randomly assigned to either percutaneous LAAC (group A) or DOAC treatment (group B) in a 1:1 ratio; both sequential and concomitant planned ablation with or without LAAC are accepted. Randomisation will be conducted using web-based randomisation software. A total of 1012 participants (506 patients per group) will be enrolled. The primary effectiveness measure will be the occurrence of any of the specified events within 24 months after randomisation: stroke/transient ischaemic attack/systemic thromboembolism, cerebral haemorrhage, other major haemorrhages (Bleeding Academic Research Consortium ≥2), cardiovascular mortality and all-cause mortality.

The study was approved by the Ethical Review Board of Shanghai Chest Hospital, China (KS(Y)20287). Written informed consent will be obtained from all participants. The trial will follow the Declaration of Helsinki and Good Clinical Practice. Confidentiality will be maintained with anonymised, securely stored data. Findings will be disseminated through peer-reviewed publications and conferences.

ChiCTR2000036538.

BackgroundThe role of the C-reactive protein-albumin-lymphocyte (CALLY) index in predicting cardiovascular disease prognosis, particularly in the broader population, remains inadequately studied.MethodsData from 22,848 adults, collected between 1999 and 2010, were analyzed in this study. The association between the CALLY index and cardiovascular disease prevalence and mortality was examined using multivariate logistic regression and Cox proportional hazards models. Restricted cubic spline, Kaplan-Meier survival curves, time-dependent receiver operating characteristic curves, and subgroup and interaction tests were employed.ResultsFollowing adjustment for all covariates, a 1-unit rise in the ln CALLY index was correlated with an 11% reduction in cardiovascular disease prevalence (odds ratio = 0.89, 95% confidence interval: 0.85, 0.93) and a 15% decrease in the risk of cardiovascular disease mortality (hazard ratio = 0.85, 95% confidence interval: 0.81, 0.89). Compared with the lowest quartile, patients in the highest quartile of the ln CALLY index exhibited a 33% lower prevalence of cardiovascular disease (odds ratio = 0.67, 95% confidence interval: 0.57, 0.79) and a 39% reduced risk of cardiovascular disease mortality (hazard ratio = 0.61, 95% confidence interval: 0.50, 0.74). The time-dependent receiver operating characteristic curve showed that the ln CALLY index predicted the 1-year cardiovascular disease mortality with an area under the curve of 0.819 (95% confidence interval: 0.753, 0.885).ConclusionsThe CALLY index was significantly inversely associated with cardiovascular disease prevalence and mortality and provided reliable discriminatory capacity in predicting early mortality attributable to cardiovascular disease.

Bleeding and thromboembolism risks are among the key challenges in thoracic surgery. This CME article examines perioperative coagulation and anticoagulation management and provides practical information on anticoagulants, antiplatelet agents, and thrombosis prophylaxis, as well as specific clinical situations.