INTRODUCTION:The impact of coexisting left-sided valvular heart disease (VHD) on clinical outcomes following tricuspid valve edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR) remains unclear, particularly under real-world conditions. To evaluate the prevalence and prognostic impact of concomitant left-sided VHD in patients undergoing T-TEER. METHODS:This study included all patients undergoing T-TEER from the European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR; NCT06307262) with complete echocardiographic data on left-sided valve disease. Study endpoints included survival and heart failure hospitalizations (HFH) at 2 years, NYHA functional class, and TR reduction. RESULTS:Among a total of 1647 eligible patients, 95.8%, 35.6%, and 3.8% had ≥mild, moderate, and severe concomitant VHD, respectively. Moderate or higher VHD was associated with a significantly reduced 2-year survival (P < .001) and reduced 2-year HFH-free survival (P = .005). Multivariate regression analysis confirmed ≥ moderate VHD to be an independent predictor of mortality (hazard ratio 1.54, 95% CI 1.21-1.96, P < .001). Despite worse TR and NYHA functional class at baseline in patients with ≥moderate VHD, T-TEER was associated with a significant TR reduction (P < .001) and symptomatic improvement (P < .001). CONCLUSION:Concomitant left-sided VHD is common among patients undergoing T-TEER and is independently associated with worse survival and higher rates of HFH. Nevertheless, T-TEER provides meaningful symptomatic benefit and durable TR reduction in patients with and without VHD burden.

Background and Aims The coexistence of moderate mitral regurgitation (MR) and severe tricuspid regurgitation (TR) is common, yet evidence guiding optimal management remains limited. Transcatheter edge-to-edge repair (TEER) of both valves-performed either sequentially or in combination-has emerged as a potential therapeutic strategy. This study aimed to assess the prognostic impact of moderate MR in patients undergoing tricuspid TEER (T-TEER) for severe TR and to evaluate whether concomitant mitral TEER (M-TEER) improves clinical outcomes. Methods Data from the EuroTR registry (2016-25) were analysed, including patients with severe TR treated with T-TEER. Outcomes were compared between patients with untreated moderate MR and those who underwent concomitant M-TEER using propensity score matching (PSM). The primary endpoint was all-cause mortality at 2 years. Secondary endpoints included New York Heart Association (NYHA) class, 6 min walk distance (6MWD), TR severity, and heart failure rehospitalizations. Results Among 3100 patients, 30% had moderate MR, which was associated with higher 2-year mortality (23% vs 37%, p<0.0001). After PSM, 217 matched patients treated with concomitant M-TEER had greater TR reduction (-1.9 vs -1.6 grades, P = .001), better NYHA improvement, and increased 6MWD at follow-up. Survival was higher in the combined treatment group (87% vs 76% at 1 year; 81% vs 70% at 2 years, P = .005). In a multivariable analysis, moderate MR predicted increased mortality [hazard ratio (HR) 1.81, P = .005), while combined M-TEER predicted better survival (HR 0.46, P < .0001). Conclusions Moderate MR predicts impaired prognosis in patients undergoing T-TEER for treatment of severe TR. Concomitant M-TEER is associated with improved survival and functional outcomes in this population with multivalve disease. These findings are hypothesis-generating and need to be tested in a dedicated randomized controlled trial.

AIMS:Tricuspid regurgitation (TR) frequently coexists with left-sided heart failure (HF). Tricuspid valve transcatheter edge-to-edge repair (T-TEER) has emerged as a treatment for severe TR, yet the prognostic role of coexisting HF phenotypes remains unclear. METHODS AND RESULTS:In the EuroTR registry, we assessed the impact of HF subtypes on 2-year all-cause mortality after T-TEER. Patients were stratified by left ventricular ejection fraction (LVEF) into reduced/mildly reduced (HFmrEF/HFrEF <50%) and preserved (≥50%). Those with preserved LVEF were further divided by pulmonary capillary wedge pressure (PCWP) into HFpEF (>15 mmHg) and non-overt left-sided HF (≤15 mmHg). Among 1,773 patients, 30% had HFmrEF/HFrEF, 44% HFpEF, and 26% non-overt left-sided HF. Procedural success (TR ≤moderate) was highest in non-overt left-sided HF (87%) and lowest in HFmrEF/HFrEF (78%). Symptom burden improved across all groups (p<0.001). Estimated 2-year mortality was 25.0% in HFmrEF/HFrEF, 20.3% in HFpEF, and 13.1% in non-overt left-sided HF. Procedural success was associated with improved outcomes in all groups (p<0.01). Among successfully treated patients, survival was comparable between HFmrEF/HFrEF and HFpEF at 1-year but better in HFpEF at 2-years (p=0.027). Predictors of survival differed by phenotype: right ventricular function for HFmrEF/HFrEF, right-sided pressures for HFpEF, and baseline TR severity for non-overt left-sided HF. CONCLUSION:Consideration of left-sided pathologies in patients with significant TR is important as outcomes and predictors for survival differ. Across HF phenotypes, procedural success is associated with survival but the prognostic impact of TR reduction may unfold over time especially in HFpEF.

Data on the association of previous cardiac surgery (PCS) with outcomes following tricuspid valve transcatheter edge-to-edge repair (T-TEER) are limited. This study aimed to evaluate the impact of PCS on outcomes after T-TEER. This analysis included patients from the EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT0630726) who underwent T-TEER for clinically relevant tricuspid regurgitation (TR) between 2016 and 2024 and had available information on cardiac surgical history. Study endpoints were procedural TR reduction, improvement in NYHA functional class, all-cause mortality, and the composite of death or heart failure hospitalization (HFH) at 2 years. Among 2929 patients, 27.2

BACKGROUND:N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established marker of myocardial stress, yet its prognostic role in tricuspid valve transcatheter edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR) remains unclear. OBJECTIVES:The aim of this study was to evaluate the prognostic value of baseline NT-proBNP and its early postprocedural trajectory after T-TEER. METHODS:Patients undergoing T-TEER with available baseline NT-proBNP measurements in the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) registry were analyzed. NT-proBNP was evaluated continuously and by tertiles, with longitudinal changes assessed when serial measurements were available. Endpoints were the 2-year composite of all-cause mortality or first heart failure hospitalization, changes in NT-proBNP, symptomatic alleviation, and residual TR. RESULTS:In total, 2,282 patients (median age 80 years [Q1-Q3: 76-83 years], 54% women, 86% in NYHA functional class III or IV) with baseline NT-proBNP values (tertile 1, ≤1,674 pg/mL; tertile 2, 1,674-3,743 pg/mL; and tertile 3, >3,743 pg/mL) were included. Higher tertiles were associated with greater comorbidity burden, more advanced biventricular remodeling, and more severe TR. Baseline NT-proBNP was independently associated with the primary endpoint (adjusted HR: 1.62; 95% CI: 1.29-2.04). Residual TR ≤2+ at discharge occurred in 86.3%, 82.9%, and 81.4% across tertiles (P = 0.040), and higher NT-proBNP was associated with a lower likelihood of symptomatic alleviation (adjusted OR per log10 increase: 0.63; 95% CI: 0.48-0.84; P < 0.001). Both baseline NT-proBNP and higher than expected 30-day levels relative to baseline were independently associated with higher subsequent risk for the primary endpoint. CONCLUSIONS:Baseline NT-proBNP was independently associated with 2-year mortality or heart failure hospitalization after T-TEER. Early postprocedural NT-proBNP trajectories provided incremental prognostic information and may identify patients at increased risk.

Background According to the 2025 ESC/EACTS guidelines for the management of valvular heart disease, transcatheter tricuspid valve interventions (TTVI) have received a Class IIa recommendation (Level of Evidence: A) for the treatment of patients with severe symptomatic tricuspid regurgitation. However, in patients with severe left ventricular dysfunction (LVD) or right ventricular dysfunction (RVD) or precapillary pulmonary hypertension (pcPH), optimal medical therapy (OMT) is preferred because of the potential risk for futility. Objectives The aim of this study was to evaluate clinical and symptomatic outcomes in such “OMT candidate” patients. Methods Using data from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), guideline-based thresholds for LVD, RVD, and pcPH were applied to patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER). Patients meeting ≥1 exclusion criterion (“OMT candidates”) were compared with those meeting current recommendations (“TTVI appropriate”) regarding NYHA functional class improvement and 2-year survival free from heart failure hospitalization (HFH). Results Among 1,626 T-TEER patients, 213 (13.1%) met ≥1 exclusion criterion (4.2% of those with LVD, 6.8% of those with RVD, and 3.6% of those with pcPH). Severe LVD, RVD, and pcPH were each associated with significantly lower 1-year HFH-free survival (LVD, 54.6% vs 72.9% [P < 0.001]; RVD, 59.0% vs 73.2% [P = 0.003]; pcPH, 56.2% vs 73.4% [P = 0.021]; median survival follow-up 446 days [Q1-Q3: 192-805 days]). Despite higher NYHA functional class at baseline and follow-up, the rate of ≥1-class improvement was comparable across subgroups (LVD, 51.1% vs 59.4% [P = 0.25]; RVD, 59.7% vs 59.0% [P = 0.90]; pcPH, 51.3% vs 59.4% [P = 0.31]). Overall, “OMT candidates” had lower HFH-free survival than “TTVI-appropriate” patients (58.7% vs 74.3%; P < 0.001) but showed comparable symptomatic relief (≥1 NYHA functional class in 56.2% vs 59.5%; P = 0.68). Conclusions T-TEER may provide symptomatic benefit in selected high-risk patients with severe LVD, RVD, or pcPH. In the absence of randomized evidence, multidisciplinary evaluation at experienced heart valve centers remains essential to balance potential benefit against procedural futility. Further studies are warranted to refine patient selection and optimize outcomes in this challenging cohort.

BACKGROUND:In patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR), NYHA functional class guides assessment, but real-world data on its prognostic value and determinants of symptomatic response remain limited. OBJECTIVES:The objective of the study was to assess the prognostic value of baseline NYHA functional class and identify correlates of NYHA functional class trajectories after T-TEER. METHODS:A total of 3,467 patients from the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT06307262) undergoing T-TEER were analyzed. Baseline NYHA functional class was related to survival and heart failure hospitalization. In patients with paired NYHA functional class assessments, correlates of improvement and worsening were evaluated using prespecified multivariable logistic regression. RESULTS:Among 3,424 patients with available baseline NYHA functional class (43 excluded [1.2%]), the median follow-up was 460 days (IQR: 146-856 days). Kaplan-Meier curves demonstrated separation by baseline NYHA functional class for overall and heart failure hospitalization-free survival (both P < 0.001). Two-year mortality was 28.4% (619/3,424; 95% CI: 26.4%-30.4%). In the complete-case Cox cohort (n = 2,185; 63.8%), higher baseline NYHA functional class was associated with 2-year mortality (HR: 1.8 per 1-class increase; 95% CI: 1.5-2.1; P < 0.001). In 1,974 of 3,424 patients (57.7%) with paired NYHA functional class data, NYHA functional classes I/II increased from 16.4% (323/1,974) to 59.4% (1,173/1,974) at follow-up. Improvement was associated with lower body mass index, higher left ventricular ejection fraction, and less residual TR, whereas worsening was associated with lower tricuspid annular plane systolic excursion/systolic pulmonary artery pressure and more residual TR. CONCLUSIONS:In the large real-world EuroTR cohort, baseline NYHA functional class is a strong, independent predictor of 2-year mortality. Symptom trajectories were associated with body mass index, left ventricular ejection fraction, tricuspid annular plane systolic excursion/systolic pulmonary artery pressure, and residual TR.

AIMS:Infective endocarditis (IE) remains associated with high mortality despite diagnostic & therapeutic advances. The impact of social deprivation (SD), a key determinant of cardiovascular health, remains unclear. We evaluated the influence of SD in IE within a universal healthcare system. METHODS AND RESULTS:1740 IE patient visits from three centers in London (King's College Hospital NHS Foundation Trust, Guy's & St. Thomas' NHS Foundation Trust and Barts Health NHS Trust) between December 2013 and March 2023 were included. SD was measured using the Index of Multiple Deprivation, with patients stratified into High (N = 638), Medium (N = 576) and Low (N = 526) groups. Patient and admission characteristics, diagnostic imaging, clinical management, outcomes and variables influencing mortality were assessed. All-cause mortality at 30 days and 1 year was significantly higher in the High SD group (P = 0.030 and P = 0.004 respectively). The high SD group were more likely to be female (P < 0.001), from Asian (P < 0.001) or Black (P < 0.001) self-reported racial groups and had more co-morbidity, including more people who inject drugs (P < 0.001). The high SD group presented with higher white cell count (P = 0.025), C-reactive protein (P = 0.001) and higher rates of right-sided IE (P = 0.028). A causative organism was established in 77.1% of cases, with no differences between groups. There were significantly lower rates of surgery in the High SD group (P < 0.001), and significantly more patients managed conservatively despite having a surgical indication (P = 0.003). CONCLUSION:These findings suggest that greater co-morbidity, higher inflammatory markers and reduced surgical intervention contribute to higher mortality in socially deprived patients within a universal healthcare system.

BACKGROUND:Risk stratification for tricuspid valve transcatheter edge-to-edge repair (T-TEER) is paramount in the decision-making process to appropriately select patients with severe tricuspid regurgitation. OBJECTIVES:The aim of this study was to develop and validate an artificial intelligence-driven risk score, the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) score, to predict 1-year mortality in patients undergoing T-TEER. METHODS:The EuroTR score was developed using data from the EuroTR registry, comprising 1,225 patients in the derivation cohort and 601 patients in the validation cohort. On the basis of 18 clinical, laboratory, echocardiographic, and hemodynamic parameters, an extreme gradient boosting algorithm was trained and independently validated against established risk models. RESULTS:Among the entire study cohort (N = 1,826), the overall 1-year survival rate was 82.1% (95% CI: 80.1%-84.2%), with no significant differences between the derivation and validation cohorts. The EuroTR score successfully stratified patients into low-risk and high-risk groups for 1-year mortality after T-TEER (HR: 4.26; 95% CI: 2.71-6.67; P < 0.001), and it significantly outperformed established risk scores such as the EuroScore and the TRI-SCORE in the validation cohort. Beyond mortality prediction (Harrell's C index [validation cohort] = 0.741; 95% CI: 0.699-0.783), increasing EuroTR score values were associated with a higher likelihood of a clinically relevant combined endpoint of 1-year mortality, need for heart failure hospitalization, or persistent dyspnea corresponding to NYHA functional class ≥III. The likelihood of poor outcomes increased from 30.6% in patients with the lowest EuroTR scores (EuroTR risk rank <5%) to 85.5% in the highest risk group (EuroTR risk rank ≥95%). The EuroTR score's performance was confirmed in several subgroups (atrial vs nonatrial tricuspid regurgitation, TRILUMINATE-eligible vs TRILUMINATE-noneligible patients, and patients with vs without cardiac implantable electronic device leads). CONCLUSIONS:The EuroTR score offers an easy-to-use, externally validated, accurate risk stratification tool for patients undergoing T-TEER. It supports personalized treatment strategies and the design of future clinical trials, helping optimize patient selection and enhance shared decision-making within multidisciplinary heart teams.

Assessment of left ventricular diastolic function is inherently complex, yet it must be sufficiently simplified for consistent application in clinical practice. Interpretation is challenged by overlapping terminology, load dependence of haemodynamic variables, and the need to integrate multiple echocardiographic parameters that are often discordant. This review presents a simplified, clinically oriented approach to applying contemporary imaging guidelines for diastolic function assessment, with a focus on the 2025 American Society of Echocardiography recommendations. A probabilistic diagnostic framework is emphasized, integrating clinical context, echocardiographic findings, and advanced imaging when appropriate. There are emerging artificial intelligence-based approaches that conceptualize diastolic dysfunction as a latent phenotype, integrating multidimensional imaging and clinical data to improve diagnostic and prognostic assessment beyond traditional stepwise algorithms. The pragmatic approach described in the current review aims to enhance clinical relevance, improve interpretive confidence, and facilitate consistent application of diastolic function assessment in routine practice.

Heart failure (HF) and valvular heart disease (VHD) often coexist and share complex pathophysiological pathways. Traditional management strategies follow a step-by-step approach, prioritizing guideline-directed medical therapy (GDMT) and reserving interventional (surgical or percutaneous) options only in case of persistent symptoms or worsening HF after GDMT. However, greater experience with the use of percutaneous procedures, even in high-risk patients, could support a more integrated approach, which exploits the synergistic effects of medical and interventional therapies to increase the tolerability of one vs the other, thereby improving quality of life and outcomes through their synergic effects. This expert opinion paper summarizes current data and evolving practices in the management of VHD in patients with HF, including secondary mitral regurgitation, aortic stenosis, aortic regurgitation, and tricuspid regurgitation.

Background There are conflicting data on sex differences in patients with aortic stenosis (AS). We aimed to investigate sex differences in management and outcomes across the spectrum of outpatients with AS. Methods Between 2016 and 2017, consecutive all‐comer outpatients with mild (peak aortic velocity=2.5–2.9 m/s), moderate (3–3.9 m/s), or severe (≥4 m/s) native AS were included by 117 cardiologists and followed up for 5 years for aortic valve replacement (AVR) and cause of death. Outcomes were compared by sex using inverse probability of treatment weighting adjustment. Results Among the 2704 patients, 1257 (46.5%) were women. Women were more symptomatic (New York Heart Association class ≥2, 67.7% versus 54.6%; P<0.001) and had a higher proportion of severe AS (17.5% versus 14.3%, P=0.02) at inclusion. During follow‐up (median, 5.0 [interquartile range, 3.4–5.5]) years, 993 AVRs (488 surgical and 505 transcatheter) and 1098 deaths occurred. After inverse probability of treatment weight adjustment, women had better survival (adjusted hazard ratio [HR], 0.81 [95% CI, 0.71–0.93]; P=0.003) but similar cardiovascular death (P=0.99) compared with men. Interestingly, the higher survival in women was observed only in mild AS (adjusted HR, 0.71 [95% CI, 0.56–0.90]; P=0.005). The inverse probability of treatment weight–adjusted cumulative incidence of AVR by AS severity revealed no significant differences between women and men among patients across the AS spectrum. Cumulative incidence of surgical AVR was lower in women than in men (P=0.02). Conclusions Women had a similar referral rate for AVR (versus men), with a lower proportion undergoing SAVR, allowing similar outcomes between women and men with moderate and severe AS. The lower mortality rate in women was restricted to mild AS presentation.

Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) requires multimodality evaluation, including cardiac magnetic resonance (CMR), intracoronary (IC) imaging, and coronary function testing (CFT). However, real-world uptake of these guideline-recommended modalities varies widely. We conducted a global survey to characterize practice variation in MINOCA evaluation and management across demographic characteristics, continents, and economic settings. Methods A 16-item online survey targeting cardiologists and cardiology trainees was distributed globally between August and December 2024. Respondents provided information on demographic characteristics, institutional context, and routine diagnostic and therapeutic strategies for MINOCA. Descriptive statistics, χ2 tests, and multiple regression analysis were used to assess associations. Results A total of 329 cardiology professionals from 6 continents participated (69.6% interventional cardiologists; 45.9% practicing in high-income countries [HIC]). Overall, 64.1% of respondents reported routine statin use and 55.6% reported beta-blocker use in MINOCA management. Advanced diagnostic modalities demonstrated substantial geographic variation. Europe reported the highest use of CMR (80.6%) and CFT (38.9%), whereas IC imaging was most frequently reported in North America (44.1%). Respondents from HIC reported greater routine use of CMR (56.3% vs 31.6%), IC imaging (41.7% vs 28.9%), and CFT (31.1% vs 13.2%) compared with those from lower-income settings (all P < .01). In multivariable analyses, HIC status remained the strongest independent predictor of routine CMR use (odds ratio [OR], 3.95; 95% CI, 2.34-6.68), IC imaging use (OR, 3.01; 95% CI, 1.74-5.20), and CFT use (OR, 2.29; 95% CI, 1.26-4.14). Academic or teaching hospital affiliation was independently associated with higher CMR use (OR, 2.19; 95% CI, 1.07-4.51), while female respondents reported higher odds of CFT use (OR, 1.89; 95% CI, 1.01-3.54). Conclusions Significant global disparities exist in the diagnostic evaluation of MINOCA. After adjustment, economic context emerged as the most consistent determinant of advanced diagnostic modality use. These findings highlight persistent structural barriers to the implementation of guideline-recommended MINOCA evaluation and underscore the need for strategies that expand access to advanced diagnostics and promote standardized evaluation pathways across diverse health care settings.

BACKGROUND:Left ventricular (LV) remodeling in mitral valve prolapse (MVP) may occur disproportionally to mitral regurgitation (MR) severity, especially in patients with Barlow disease. This study hypothesized an underlying MVP cardiomyopathy, potentially driven by ventricular arrhythmias or a genetic substrate. We investigated the determinants of LV remodeling in patients with MVP beyond MR volume load. METHODS:Prospective inclusion of patients with nonsyndromic MVP at 3 centers. Patients were scheduled for cardiac magnetic resonance scans, 24-hour Holter monitoring, and the presence of an underlying cardiomyopathy-associated genetic variant was assessed. Disproportionate LV remodeling was defined as LV end-diastolic volume above the age- and sex-specific upper limit of normal after correction for the total MR volume load, using the following formula: (LV end-diastolic volume-MR volume)/body surface area-LVEDViULN >0. RESULTS:A total of 103 patients with MVP were included (58% males, age 52±17 years). Disproportionate LV remodeling was present in 37% and was more frequent in Barlow disease compared with nonclassic MVP (P=0.067). After correction for age, sex, and MR volume load, Barlow disease phenotypic features like mitral annular dilatation are independently associated with LV dilatation (P<0.001 at multivariable regression analysis for left ventricular end-systolic volume index, R2=0.518). The total volume load (MR volume+prolapse volume) had a stronger correlation with LV remodeling than MR volume alone. In addition, ventricular arrhythmia-particularly ≥3% premature ventricular contractions-was independently associated with increased left ventricular end-systolic volume index even after correction for other classical risk factors (P=0.024, R2=0.518). None of the patients carried a likely pathogenic or pathogenic variant in cardiomyopathy-associated genes. CONCLUSIONS:LV remodeling in MVP is a multifactorial process, where, especially in patients with Barlow disease, the associated mitral annular dilatation and larger prolapse volume drive LV dilatation beyond MR severity. In addition, a burden of ≥3% ventricular ectopy is strongly correlated with LV dilatation and dysfunction. Finally, a monogenic cardiomyopathy substrate appears unlikely.

Tricuspid regurgitation (TR) is a common yet historically neglected condition associated with poor outcomes. Traditionally managed conservatively, TR has recently gained renewed attention, thanks to advances in surgical and transcatheter interventions. Selecting the optimal therapy, however, requires an integrated and systematic approach considering TR aetiology, stage of the disease, comorbidities, operative risk, and anatomical feasibility. This review describes a standardized stepwise work-up for patients with TR from the referral centre to the expert heart valve centre (HVC). It provides practical algorithms and structured protocols covering clinical and biological assessment, multimodality imaging (echocardiography, computed tomography, cardiac magnetic resonance), and invasive haemodynamic evaluation. The document highlights the importance of multidisciplinary collaboration, involving imagers, heart failure specialists, interventional cardiologists, electrophysiologists, and surgeons, in line with the new recommendations of the 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. By harmonizing diagnostic standards and promoting a structured approach to patient assessment within HVCs, this review aims to facilitate timely referral and ensure consistent evaluation and management of patients with this complex and often underestimated condition.

Cardiovascular disease is the leading cause of death in women, yet significant disparities persist in diagnosis, treatment, and research representation. This clinical consensus statement outlines the rationale and framework for establishing women's heart centres (WHCs) in Europe. Women's heart centres are proposed as hub-and-spoke reference networks embedded within existing cardiovascular systems, delivering multidisciplinary, sex-sensitive care across the life course. The document defines referral pathways, operational standards, and core and advanced training competencies in women's cardiovascular health. Key domains include ischaemia/myocardial infarction with non-obstructive coronary arteries, cardio-obstetrics, cardio-oncology, autoimmune disease, mental health, and cardiac rehabilitation. Implementation strategies emphasize scalable models, integration with primary care, telemedicine, quality improvement, and research engagement. Although long-term outcome data remain limited, available evidence suggests improved diagnostic precision, risk factor control, and patient-reported outcomes. Establishing WHC offers a structured approach to reduce inequities and strengthen cardiovascular care for women across Europe.