BACKGROUND AND AIMS:The TRISCEND II trial demonstrated superior clinical benefits for patients with ≥severe tricuspid regurgitation (TR) treated with the EVOQUE transcatheter tricuspid valve replacement (TTVR) system plus medical therapy vs medical therapy alone. This work reports 1-year and 18-month outcomes in patients stratified by baseline TR severity. METHODS:The multicentre, prospective TRISCEND II trial enrolled 400 patients with symptomatic, ≥severe TR, and randomized 2:1 to TTVR (n = 267) or control (n = 133). In a post hoc analysis, patients were stratified into severe TR (n = 172) and massive/torrential TR (n = 220) cohorts. Clinical and quality-of-life outcomes were reported at 1 year, with Kaplan-Meier estimates for all-cause mortality and heart failure (HF) hospitalization assessed at 18 months. Study oversight included an independent echocardiographic core laboratory, clinical events committee, and data safety monitoring board. RESULTS:One year after TTVR, TR was ≤mild in 95.2% of severe TR and 95.3% of massive/torrential TR patients. The primary safety and effectiveness endpoint (win ratio) favoured TTVR over control regardless of baseline TR severity: severe {1.64 [95% confidence interval (CI): 1.11, 2.43]} and massive/torrential [2.20 (1.55, 3.14)]. At 18 months, TTVR patients had similar mortality to controls [rate difference: severe 0.2% (-11.6, 11.9), massive/torrential -5.8% (-17.6, 6.0)], whereas HF hospitalization rates favoured TTVR in the massive/torrential cohort [vs control, severe 9.8% (-3.0, 22.7), massive/torrential -15.2% (-28.9, -1.5)]. CONCLUSIONS:Patients with ≥severe TR benefit from TTVR, experiencing improvements in TR severity, functional capacity, and quality of life regardless of baseline TR severity, with a signal for greater benefit in patients with more advanced disease.
Introduction:Physical activity has been associated with improved cardiovascular health outcomes in adults. However, the specific associations between physical activity volume and cardiovascular outcomes in youth athletes are less defined. Methods:This study analyzed data from the HeartBytes National Youth Database, compiled from Simon's Heart. Simon's Heart is a nonprofit organization that includes information from sports pre-participation examinations for adolescents. The dataset encompasses demographics, electrocardiogram (ECG) findings, and exercise-related symptoms. Youth athletes' self-reported weekly physical activity volume was classified into four levels: <2 h, 2-5 h, 5-10 h, and >10 h, with less than 2 h taken as the reference group. Given the physical diMerences among athletes aged 12 to 20, the sample was stratified into middle and high school athlete groups. Logistic regression analysis was performed to evaluate the association between weekly exercise volume and cardiovascular risk factors, controlling for the confounding eMects of age, race, sex, body mass index, and area-level socioeconomic status. Results:Among 7,048 youth athletes (median age 15.1 years; interquartile range: 13.6-16.5), most were male (60.7%) and White (85.5%). Increased weekly exercise volume was associated with lower odds of attention deficit hyperactivity disorder (ADHD), anxiety or depression, and obesity in both middle and high school athletes. Greater exercise volume high school athletes, though these did not reach statistical significance. Greater weekly physical activity volume was associated with lower prevalence of cardiovascular disease risk factors, psychiatric comorbidities, and exertional symptoms in youth athletes. Given the cross-sectional design, causal relationships cannot be established and further studies are needed to clarify the clinical significance of these findings.
Contemporary data of saphenous vein graft (SVGs) use in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) are limited. We examined the frequency, characteristics, and outcomes of SVG use during retrograde CTO PCI. Retrograde CTO PCI cases in the PROGRESS-CTO registry (2017 to 2025) were compared based on SVG versus non-SVG use; non-native targets, arterial grafts, mixed collaterals, and multi-CTO procedures were excluded. Among 4,330 retrograde procedures (4,321 patients), SVGs were used in 545 (12.6%). These patients were older with more comorbidities, higher anatomic complexity and PROGRESS-CTO score, but similar J-CTO score. Procedure time was longer, yet contrast and radiation exposure were lower. A primary retrograde strategy was used more frequently (54.5% vs 36.0%; p <0.001) in the SVG-group. Technical success was higher with SVGs (82.1% vs 78.5%; p = 0.049), while procedural success (79.9% vs 76.7%; p = 0.092) and in-hospital major adverse cardiac events (MACE) (3.3% vs 2.9%; p = 0.6) were similar. SVG collateral use was independently associated with higher technical success (Odds Ratio 1.60, 95% CI 1.24 to 2.09; p <0.001). Pericardiocentesis was less frequent (0.2% vs 1.6%; p = 0.008) and perforation rates were comparable, but mortality and stroke were higher in the SVG group. Among prior-CABG patients, SVG use was associated with higher technical success but also higher in-hospital MACE (3.3% vs 1.3%; p = 0.011). SVG use for retrograde crossing occurred in approximately 1 in 8 overall and 1 in 3 prior-CABG retrograde CTO PCIs. Despite greater clinical and anatomic complexity, SVG use was associated with higher technical success compared with septal/epicardial collaterals.
