Secondary prevention is critical for patients with established atherosclerotic cardiovascular diseases (ASCVD). The SMART2 model predicts recurrent ASCVD risk but does not account for psychiatric disorders, socioeconomic deprivation or ethnicity. We aimed to evaluate SMART2 model performance overall and in subgroups defined by these factors.

SMART2 was externally validated using electronic health records of patients aged 40-80 in the Leiden-The Hague region. Patients hospitalised for cardiovascular disease or coronary interventions between 1 January 2010 and 31 December 2021 were included. Model performance was assessed using discrimination (10-year area under ROC curve (AUC)) and calibration (observed/expected (OE) ratios and plots, adjusted for competing risks), both overall and in subgroups defined by three factors: psychiatric history, socioeconomic status (SES) and ethnicity.

Among 15 528 patients (66% male, mean age 65) with established ASCVD, median follow-up was 6.0 years. Recurrent cardiovascular events occurred in 2220 patients, and 1820 had competing events. Overall AUC was 0.63 (95% CI 0.61 to 0.65). OE ratio was 0.96 (95% CI 0.92 to 1.00). The model underestimated risk in patients with low SES (OE 1.09, 95% CI 1.02 to 1.17) and in non-Western patients (OE 1.16, 95% CI 1.02 to 1.31). Calibration was adequate in patients with psychiatric history, but the model was substantially underestimating for patients with multiple vulnerabilities-combinations of low SES, non-Western ethnicity and psychiatric history-with OE ranging from 1.19 to 1.29, depending on the combination.

The SMART2 model is well-calibrated in the general population but underestimates risk, especially in subgroups with multiple vulnerabilities. Patients in these vulnerable subgroups may require intensified monitoring. Clinicians should consider social, ethnic and psychiatric factors when interpreting risk estimates.

The limited literature provides minimal information on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) under different healthcare funding systems, especially in Thailand.

The study aimed to investigate the association between in-hospital clinical outcomes of patients treated with PCI and different types of healthcare funding in Thailand.

The Thai PCI registry is a multicentre, prospective national registry with 39 participating medical centres. Web-based data entry, collected between May 2018 and August 2020, was centrally managed and analysed, providing clinical characteristics, medical management and in-hospital outcomes.

A total of 22 741 patients were analysed and classified into four groups: the Universal Health Coverage Scheme (UC) (63.1%), Government Service Scheme (GS) (26.8%), Social Security Service Scheme (SS) (6.8%) and other payment fund (3.2%). The SS group was younger and predominantly male, whereas cardiovascular risk factors were higher in the GS group. After adjusting for baseline characteristics and management strategies, in-hospital MACE outcomes of ACS patients were significantly higher in patients in the SS (OR=1.81 (1.38, 2.37), p<0.001) and UC group (OR=1.22 (1.04, 1.44), p=0.017) compared with the GS group. Post-procedural myocardial infarction was also higher across all groups. Though differences in all-cause death and cerebrovascular accident/stroke were not statistically significant.

Healthcare funding policies in Thailand significantly associated with disparities in-hospital outcomes of patients undergoing PCI. Patients receiving treatment under the GS scheme demonstrated better clinical outcomes compared to other schemes. These findings highlight the need for policy adjustments aimed at reducing healthcare disparities to improve patient outcomes.

Anticoagulation non-adherence is attributed to myriad factors in patient populations across the world. While direct oral anticoagulants (DOACs) have demonstrated several clinical advantages over other anticoagulant classes, non-adherence persists and the underlying contributors vary by geography.

Outline patient and system level factors involved in DOAC non-adherence in the Bronx.

This retrospective review used all available electronic medical records on patients receiving active DOAC therapy from primary care centres in the Bronx between 2017-2024. Adherent and non-adherent groups were determined by prescription fill status and provider documentation. The two groups were compared by age, gender, race, ethnicity, insurance type, diagnostic indication for DOAC, pharmacy type, employment status, number of comorbidities, number of home medications and primary language. Univariable and multivariable logistic regressions were applied between the groups and categories. P values <0.05 were deemed significant.

The cohort had 938 patients with non-adherence reported in 227 (24.2%) patients. In multivariable logistic regression, non-adherence was more common in younger patients (OR 1.19, CI 1.03 to 1.37, p=0.020) and in males (OR 1.41, CI 1.02 to 1.95, p=0.039). It was also more frequent among patients prescribing from hospital pharmacies (OR 2.70, CI 1.96 to 3.85, p=0.001) and the employed versus retired (OR 1.92, CI 1.09 to 3.57, p=0.032). Non-adherence was borderline significant in Black Non-Hispanics versus White Non-Hispanics (OR 1.75, CI 0.98 to 3.24, p=0.065) and in White Hispanics versus White Non-Hispanics (OR 1.98, CI 0.89 to 4.43, p=0.095). It was also borderline significant in English primary speakers versus Spanish primary speakers (OR 1.64, CI 0.96 to 2.86, p=0.071).

DOAC non-adherence in the Bronx is significantly associated with patient age, gender, employment status and prescribing pharmacy type. Other factors investigated in this study had borderline significant or no significant association and warrant further investigation.

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.