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.
Intracoronary (IC) imaging-guided percutaneous coronary intervention (PCI) improves clinical outcomes in patients with high clinical and anatomical risk when compared to interventions guided by angiography alone. Recent Class I recommendations for the use of IC imaging guidance when performing PCI in left main stem or complex lesions may result in a significant uptake as the technology is embraced as standard of care. Routine application of IC imaging will provide interventional cardiologists with a wealth of high-fidelity intracoronary data on plaque composition and distribution. When paired with emerging data regarding the importance of plaque anatomical characteristics, developments in artificial intelligence and computational fluid dynamics, lesion stratification with IC imaging may herald the next paradigm shift in this field. In this review, we will explore this important emerging application of IC imaging to inform morphology-guided PCI, identify high-risk lesions for targeted therapies, and consider the prospects of harnessing automated image interpretation with artificial intelligence technologies to achieve an integrated physiological and morphological assessment. Lesion stratification with IC imaging has the potential to shape the future of interventional cardiology practice to guide therapies within and beyond the confines of the cardiac catheterisation laboratory.
BACKGROUND:Many treatments have been proposed for the treatment of acne vulgaris and acne scarring; however, few data exist regarding the efficacy of botulinum toxin A as a treatment option. OBJECTIVE:To compile all available data on the efficacy and safety of botulinum toxin A as a treatment for acne vulgaris and acne scarring. METHODS:A systematic review of PubMed/MEDLINE, Excerpta Medica Database (EMBASE), Scopus, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials, and Google Scholar databases identified all cases of acne vulgaris and acne scarring treated with botulinum toxin. RESULTS:Four hundred thirty-six patients (218 with acne vulgaris and 218 patients with acne scarring) from 14 manuscripts were included in this review. Results showed overall improvement for up to 3-6 months in the majority of patients based on sebometer readings, fine pore count, and patient satisfaction scores. Acne scarring improved in patients treated with botulinum toxin as a single therapy, as well as in combination with other therapies, with consistently high patient satisfaction scores. CONCLUSIONS:Patients experienced a significant reduction in sebum production, number of acne lesions, and improvement in the appearance of acne scars, indicating a role for botulinum toxin A in the treatment of acne and acne scarring.
BACKGROUND Photon-counting detector-computed tomography (PCD-CT) has emerged as a promising technology, offering improved spatial resolution. OBJECTIVES This study aimed to evaluate the clinical impact and diagnostic performance of PCD-CT vs conventional energy-integrating detector computed tomography (EID-CT) for obstructive coronary artery disease (CAD). METHODS From 2022 to 2023, we retrospectively identified 7,833 consecutive patients who underwent clinically indicated coronary computed tomography angiography (CCTA) at a single center, with either PCD-CT (n = 3,876; NAEOTOM Alpha [Siemens Healthineers]) or EID-CT (n = 3,957; Revolution Apex 256 [GE HealthCare] or Aquilion ONE ViSION 320 [Canon Medical Systems]) scanners. Subsequent invasive coronary angiography (ICA) and percutaneous or surgical revascularization were performed as part of routine clinical care. Among those referred for ICA after coronary CTA, the presence of obstructive CAD in each vessel was determined by coronary CTA (severe stenosis on visual assessment per the Coronary Artery Disease Reporting and Data System) and ICA (>= 50% diameter stenosis on quantitative coronary angiography) in a blinded fashion. The diagnostic performance of EID-CT and PCD-CT was compared by using quantitative coronary angiography as the reference standard. RESULTS Patients who underwent PCD-CT were less frequently referred to subsequent ICA than those undergoing EID-CT (9.9% vs 13.1%; P < 0.001). Among those who underwent ICA, revascularization was more frequently performed in the PCD-CT group than in the EID-CT group (43.4% vs 35.5%; P = 0.02). In the vessel-level analysis (n = 1,686), specificity (98.0% vs 93.0%; P < 0.001), positive predictive value (83.3% vs 63.0%; P = 0.002), and diagnostic accuracy (97.2% vs 92.8%; P < 0.001) were improved by PCD-CT. Sensitivity (90.9% vs 90.7%; P = 0.95) and negative predictive value (98.9% vs 98.7%; P = 0.83) for obstructive CAD were similar between the PCD-CT and EID-CT groups, respectively. CONCLUSIONS PCD-CT exhibited excellent diagnostic performance for detecting obstructive CAD. Compared with patients undergoing conventional EID-CT, fewer patients were referred to ICA after PCD-CT, but those referred were more likely to undergo revascularization. (JACC. 2025;85:339-348) (c) 2025 by the American College of Cardiology Foundation.
