搜索结果：European heart journal. Cardiovascular Imaging

With the rapid increase in percutaneous left heart interventions, transseptal access to the left atrium has become a widely used procedure. This technique is crucial for electrophysiological procedures, particularly for atrial fibrillation ablation, which is estimated to be performed in more than 250 000 patients per year worldwide, as well as for various structural heart interventions, like percutaneous mitral valve repair. Although transseptal puncture (TSP) is generally considered a simple technique, it is associated with a small risk of potentially life-threatening complications. To ensure a successful and safe procedure, a thorough understanding of TSPs' clinical use, and the anatomy of the interatrial septum-including the fossa ovalis and its anatomical variants-is critical. Since the first fluoroscopy-guided TSP, advancements in echocardiographic imaging have enhanced the precision of the puncture, allowing targeting of specific regions of the fossa ovalis and facilitating difficult procedures. While most TSPs are performed using a Brockenbrough needle and a (steerable) sheath, wide variation in technique exists, and alternative methods have been developed initially aiming for complex cases but now routinely used. Understanding potential complications-such as cardiac tamponade, aortic puncture, and embolism-is essential for prevention, early recognition, and effective management, ultimately improving patients' outcomes. Finally, understanding how to approach specific complex scenarios is crucial for procedural success.

To scope the current European landscape of multi-modality cardiovascular imaging practices in immune-mediated inflammatory diseases (IMIDs). An electronic (e)-survey was distributed to members of the European Association of Cardiovascular Imaging (EACVI) about imaging in cardio-rheumatology. A parallel e-survey focused on the use of coronary computed tomography (CT) for cardiovascular disease (CVD) risk stratification in IMIDs was conducted via the British Society of Cardiovascular Imaging (BSCI). Of the total 111 respondents to the EACVI survey, 92 (82.9%) were consultant-grade physicians and 68 (61.3%) worked in tertiary centres. These individuals had varied experiences in cardio-rheumatology, with limited access to dedicated cardio-rheumatology services and training opportunities. Sixty-nine (62.2%) used coronary CT to guide preventive therapies in IMID patients with borderline risk scores and cardiac symptoms, with a preference for coronary CT angiography over coronary artery calcium scoring alone in this setting. These findings about coronary CT were corroborated in the parallel survey of 54 BSCI members. When using cardiovascular magnetic resonance imaging (CMR) to detect myocardial involvement in IMIDs, 73/111 (67.6%) perceived a need for IMID-specific CMR criteria beyond the current modified Lake Louise criteria for myocarditis. In terms of nuclear imaging, timely access to 18F-fluorodeoxyglucose positron emission tomography imaging was identified as a barrier for diagnosing large-vessel vasculitis, and 61/111 (57%) of responders felt that the development of novel radionuclide tracers should be a future research priority. This European survey highlights the need for dedicated cardio-rheumatology services and specialist training, and further evidence to inform future clinical practice recommendations on multi-modality cardiovascular imaging in IMIDs.

The eye is a recognized source of biomarkers for cardiovascular and neurodegenerative disease risk. Here we characterize the breadth of these associations and identify biological axes that may mediate them. Using UK Biobank data, we developed a multi-omic analysis pipeline integrating physiological, radiomic, metabolomic and genomic information. We trained retinal adversarial autoencoders to represent optical coherence tomography images and color fundus photographs as 256-dimensional embeddings. Retinal adversarial autoencoder-derived embeddings were associated with a range of cardiovascular and neurodegenerative diseases, including ischemic heart disease, cerebrovascular disease, Parkinson's disease and dementia. Examining associations across diverse omics datasets, we provide evidence linking ophthalmic imaging features to neurological and cardiovascular anatomy and function, lipid metabolism and gene sets associated with neurodegenerative pathology. Collectively, our findings show that ophthalmic features reflect complex, multisystem biological processes and reinforce the role of the eye as a composite indicator of systemic health.

BACKGROUND: Oral semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has been shown to reduce major adverse cardiovascular events (MACE) in high-risk individuals with type 2 diabetes in the SOUL trial. Its potential population-level impact in the United States, however, remains unclear. METHODS: We applied SOUL trial eligibility criteria to U.S. adults in the National Health and Nutrition Examination Survey (NHANES, 1988–2018) to estimate the number eligible for oral semaglutide and the projected reduction in cardiovascular events over 4.5 years. MACE—defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke—was the primary outcome. Event rates and hazard ratios were derived from the SOUL trial and applied to weighted NHANES data. RESULTS: An estimated 6.1 million U.S. adults met eligibility criteria for oral semaglutide. Without treatment, 847,598 MACE events were projected, compared to 728,934 with treatment—corresponding to 118,664 events potentially prevented (14% relative reduction; number needed to treat [NNT] = 55). This included 28,430 cardiovascular deaths (NNT = 254), 83,489 nonfatal myocardial infarctions (NNT = 78), and 24,521 nonfatal strokes (NNT = 284). Cardiovascular benefits were consistent across sex, race/ethnicity, and clinical subgroups. At 50% uptake, and assuming a 15.5% discontinuation rate as observed in the SOUL trial, an estimated 59,332 MACE, 14,215 cardiovascular deaths, 41,744 nonfatal myocardial infarctions, and 12,260 nonfatal strokes could be prevented. CONCLUSIONS: Widespread use of oral semaglutide among eligible U.S. adults with type 2 diabetes could substantially reduce cardiovascular events. These findings support its potential as a scalable, population-level cardiometabolic intervention and highlight the need for system-level strategies to enhance access and uptake.

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Bifurcation lesions are among the most challenging in percutaneous coronary intervention (PCI), with outcomes affected by anatomy, side-branch disease, and procedural variability. Existing European definitions and strategies require adaptation for Middle Eastern populations, where diabetes, obesity, and hypertension are highly prevalent and present earlier. The Middle East Bifurcation Club (MEBC), with the National Heart Center, used the Nominal Group Technique to standardize bifurcation PCI terminology, techniques, and treatment pathways tailored to regional demographics. The consensus provides evidence-based recommendations on imaging, provisional and 2-stent strategies, POT, and left main versus non-left main bifurcations, alongside practical algorithms and heart team guidance, highlighting the need for regional outcome data to optimize care.

Left atrial volume index (LAVI) has been recognized as a significant indicator of left heart remodeling and diastolic dysfunction. This study aimed to investigate the association between LAVI assessed by coronary computed tomography angiography (CCTA) and major adverse cardiovascular events (MACEs) in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). This retrospective single-center study enrolled patients with severe AS undergoing TAVR between February 2020 and June 2024. All patients underwent CCTA examination prior to TAVR. Left atrial (LA) volume was automatically quantified from CCTA images, and the LAVI was computed by indexing to body surface area (BSA). Univariate and Firth-penalized Cox proportional hazards regression analyses were used to determine the predictors of MACE. Additionally, restricted cubic spline analysis was performed to explore the relationship between LAVI and MACE. A total of 206 patients (113 males, 93 females; mean age 68.11&#xb1;8.01 years) were included in the final analysis. The incidence of MACE was 13.1% over a median follow-up time of 581 [interquartile range (IQR), 378-990] days. The LAVI was significantly higher in patients with MACE than in those without MACE [70.14 (54.81-84.12) vs. 51.19 (39.67-64.45) mL/m2, P<0.001]. After adjustment for clinical confounders and European System for Cardiac Operative Risk Evaluation (EuroSCORE II), LAVI &#x2265;53.32 mL/m2 [hazard ratio (HR) =4.249, 95% confidence interval (CI): 1.585-11.394, P=0.001] and male sex (HR =2.864, 95% CI: 1.164-7.051, P=0.012) still independently predicted MACE. Restricted cubic spline results showed a nonlinear relationship between LAVI and MACE (P for nonlinearity =0.032). Preprocedural CCTA-derived LAVI may aid risk stratification for MACE after TAVR in severe AS. Male patients warrant closer postprocedural attention.

Computational models of cardiac mechanics can improve diagnosis, surgical planning, and device design; yet their accuracy is limited by the quality of the underlying imaging data used in routine care. Our team recently reported a free-breathing, four-dimensional cardiac magnetic resonance imaging (MRI) protocol (AutoCMR), which provides 30 volumetric frames per cardiac cycle at 1.6mm isotropic resolution. Here, we investigate whether this high spatiotemporal resolution imaging data, along with cuff systolic and diastolic blood pressures (SBP, DBP), improves non-invasive calibration and internal consistency of patient-specific 0D lumped-parameter and 3D finite element (FE) cardiac models. Five adults were imaged with the AutoCMR protocol. Every frame was segmented to obtain left ventricular (LV) and left atrial (LA) volume-time curves. These curves and SBP/DBP calibrated a closed-loop 0D model of LA, LV, and the systemic circulation. To assess the impact on key metrics, the LV elastance up-stroke exponent was varied, while all other calibrated parameters remained fixed. The resulting pressure-volume metrics included end-systolic elastance, effective arterial elastance, ventriculo-arterial coupling, stroke volume, ejection fraction, and stroke work. The calibrated parameters initialized a subject-specific 3D FE LV model. Simulated chamber volumes closely matched MRI, with LV volume root mean square error (RMSE) of 5.55&#xb1;1.13mL with R2=0.951 for 0D; and 7.76&#xb1;1.65mL with R2=0.931 for 3D. Similarly, LA volume RMSE was 3.55&#xb1;2.61mL with R2=0.976 for 0D and 4.32&#xb1;2.64mL with R2=0.973 for 3D. Absolute LV peak-to-cuff systolic pressure target differences averaged 2.81&#xb1;1.91mmHg (0D) and 4.81&#xb1;1.10mmHg (3D), while absolute arterial diastolic pressure target differences were 1.64&#xb1;1.33mmHg (0D) and 1.58&#xb1;1.51mmHg (3D). In baseline-referenced sensitivity analysis, the 30-frame cine constraints kept mid-systolic LV pressure deviations &#x223c;3-4 mmHg, compared to &#x223c;18-25 mmHg when only end-diastolic and end-systolic constraints were used. Thirty-frame 3D cine MRI at 1.6mm isotropic resolution, combined with SBP/DBP, supported non-invasive calibration of 0D lumped parameter and 3D FE models with close in-sample agreement to MRI-derived volumes and cuff-pressure targets. The achieved in-sample agreement indicates that this AutoCMR-based simulation approach has the potential to support patient-specific computational assessments of cardiac function in clinical settings.

The 2021 ESC guidelines on cardiovascular (CV) disease prevention recommend the SMART-REACH lifetime risk model to guide treatment decisions in patients with established atherosclerotic CV disease. The aim was to develop the SMART-REACH2 model for estimating lifetime risk of recurrent CV events and treatment benefits in patients with established atherosclerotic CV disease, with systematic recalibration to the four European and other global risk regions. SMART-REACH2 was derived in 8708 individuals aged 40-90 years with coronary, cerebrovascular, peripheral artery disease and/or abdominal aortic aneurysm from the UCC-SMART cohort. Sex-stratified, cause-specific Cox models for recurrent CV events and non-CV death were fitted using age as timescale and routinely available predictors. Recurrent CV events were defined as a composite of myocardial infarction, stroke, or CV death. Recalibration was based on representative cohorts per risk region. External validation was performed in 2 085 780 patients from 54 countries; model performance was assessed by calibration plots and Harrell's C-statistic. In the derivation cohort, 2057 recurrent CV events occurred over a median follow-up of 8.5 years (25th-75th: 4.3-13.0). In external validation, 307 706 events occurred. The pooled C-statistic was 0.68 (95% confidence interval 0.66-0.69) and ranged from 0.66 (0.64-0.69) for European low-risk region up to 0.72 (0.66-0.78) for Latin America, with adequate calibration across risk regions. Performance was consistent across sexes and CV disease subtypes. Using SMART-REACH2, estimated potential gains in CV disease-free life expectancy for a 50-year-old example patient receiving intensified preventive treatment (15 mmHg systolic blood pressure and 1.0 mmol/L low-density lipoprotein cholesterol reduction) ranged from 2 years in the low-risk region to 4.4 years in the very-high-risk region. The updated SMART-REACH2 model accounts for geographical and sex-specific variations and allows estimation of short-term and lifetime risk of recurrent CV events and treatment benefits, facilitating shared decision-making as recommended by guidelines.

Heart failure with preserved ejection fraction (HFpEF) is more prevalent in women, who often present with earlier onset and greater severity of vascular and endothelial dysfunction. Nitric oxide (NO) is a key contributor to vascular health, and several NO-related metabolites are associated with cardiovascular outcomes. However, it remains unknown whether differences in circulating NO-related metabolite concentrations exist between men and women with HFpEF. In this cross-sectional analysis of a multicentre randomized controlled intervention trial (OptimEx-Clin), plasma concentrations of NO-related amino acids (L-arginine, L-homoarginine (hArg), L-ornithine, L-lysine, L-citrulline), asymmetric and symmetric dimethylarginines (ADMA, SDMA), and functional metabolite ratios were assessed in 171 patients with HFpEF. Analyses were stratified by sex and age, and further adjusted for relevant clinical covariates using multivariable regression models. A principal component analysis (PCA) was performed to explore sex-related metabolite patterns. The comparison of NO-related metabolites in 58 men and 113 women with HFpEF showed significant sex differences for SDMA (&#x3b2;-coefficient [95% CI]; -0.11 [-0.20 to -0.03] &#xb5;mol/L, p&#x2009;=&#x2009;0.010) and hArg (-0.24 [-0.46 to -0.01] &#xb5;mol/L, p&#x2009;=&#x2009;0.043) in unadjusted models; both with lower concentrations in women. While the association with hArg was attenuated after multivariable adjustment, higher SDMA concentrations in men were observed in five out of six tested models. No other significant sex differences were observed neither in single metabolites nor in composite metabolite ratios. The PCA of all measured metabolites did not demonstrate a clear separation between women and men in the overall metabolite profile. In HFpEF, sex-related differences in circulating NO-related metabolites were limited and metabolite-specific, with SDMA showing the most consistent sex-associated difference with higher concentrations in men. The substantial overlap of metabolic profiles between women and men showed no distinct patterns of circulating metabolites linked to endothelial function in patients with HFpEF. ClinicalTrials.gov, TRN: NCT02078947.

Lipoprotein(a) [Lp(a)] is increasingly recognized as an independent and causal risk factor for atherosclerotic cardiovascular (CV) disease including aortic valve stenosis, myocardial infarction, stroke, peripheral arterial disease and CV death. Despite growing global awareness, significant gaps in diagnosis, risk stratification, and management persist in Gulf countries. To develop regionally tailored consensus statements on the clinical management of elevated Lp(a) in Gulf countries using a modified Delphi-based methodology. A multidisciplinary panel, mostly of Gulf-based experts in cardiology, lipidology, and endocrinology evaluated 64 evidence-based statements across six thematic domains, including pathophysiology, risk assessment, therapeutic strategies, and implementation challenges. Consensus was defined by&#xa0;&#x2265;&#xa0;80% agreement, and relevant literature was reviewed to support each statement. Strong consensus supported the inclusion of Lp(a) in routine CV risk assessment, especially for high-risk individuals. The panel endorsed early detection and aggressive management of modifiable risk factors, including LDL-C, apoB, and non-HDL-C. Areas of partial agreement highlighted practical challenges, including variability in insurance coverage and the need for clearer referral pathways, imaging protocols, and outcome-driven treatment guidance and particularly the current unavailability of specific Lp(a) lowering drugs. These expert recommendations provide a pragmatic framework for integrating Lp(a) into CV care pathways in Gulf countries. By aligning practice with emerging evidence, the consensus has the potential to shape national guidelines, inform payer policies, promote regional research on the epidemiology of Lp(a), and support equitable access to future Lp(a)-targeted therapies, ultimately improving long-term CV outcomes in the region.

Adverse left ventricular (LV) remodelling is associated with increased mortality and heart failure following ST-segment elevation myocardial infarction (STEMI). Prior studies on the prognostic value of LV global longitudinal strain (GLS), left atrial (LA) strain, and left atrioventricular coupling index (LACI) are promising, but it remains unclear which CMR-derived functional parameter is optimal. This study aimed to investigate the prognostic significance of atrial and ventricular function parameters to predict early adverse LV remodelling in patients with anterior STEMI. A post-hoc analysis of the EURO-ICE trial was performed, including 200 patients with anterior wall STEMI who underwent cardiovascular magnetic resonance (CMR) at baseline and 3-month follow-up. Predictors of adverse LV remodelling were identified. LV GLS was the strongest predictor, respectively odds ratio (OR) 1.162; 95% confidence interval (CI) 1.060-1.274; p&#xa0;=&#xa0;0.001 and OR 1.155; 95% CI 1.007-1.326; p&#xa0;=&#xa0;0.040. Its significance remained after adjusting for clinical risk factors (OR 1.216; 95% CI 1.096-1.349; p&#xa0;<&#xa0;0.001), but not after adjusting for infarct size and microvascular obstruction (MVO) (OR 1.063; 95% CI 0.959-1.178; p&#xa0;=&#xa0;0.246). LA strain and LACI did not have additional prognostic value. CMR-derived LV GLS is the strongest functional parameter associated with adverse LV remodelling anterior STEMI patients, remaining significant after adjusting for clinical risk factors, but not beyond infarct size and MVO, indicating that its prognostic value is largely mediated by myocardial injury burden. No significant association was found between LA strain or LACI and adverse LV remodelling. LV GLS may add value when contrast agents cannot be used.

Efficient and specific delivery of mRNA to target tissues is critical for maximising therapeutic benefits while minimising off-target effects and systemic toxicity. Systemic administration of mRNA using lipid nanoparticles (LNPs) or extracellular vesicles (EVs) typically leads to predominant accumulation in the liver. We hypothesised that cardiac-specific EVs could promote enhanced relative cardiac enrichment of delivered mRNA compared with non-cardiac EVs or LNPs. In mice, intravenous administration of cardiac progenitor cell-derived EVs (CPC-EVs) achieved the greatest relative cardiac selectivity of modified mRNA encoding vascular endothelial growth factor A (VEGF-A) to the heart, with reduced liver accumulation relative to non-cardiac EVs and LNPs. Cytokine profiling across seven organs revealed that LNP delivery triggered a widespread pro-inflammatory response, whereas CPC-EVs elicited only a localised and limited cytokine activation, suggesting a more favourable safety profile. Furthermore, direct intramyocardial injection of CPC-EVs not only led to efficient mRNA uptake by cardiac tissue and robust VEGF-A protein expression, but also minimal transcriptomic perturbation in the cardiac tissue, as confirmed by RNA-seq. In contrast, LNPs and non-cardiac EVs induced widespread perturbation in the transcriptome of cardiac tissue. Functionally, VEGF-A mRNA delivery via CPC-EVs markedly increased CD31 and &#x3b1;-SMA expression and vessel formation in ex vivo aortic ring assays, confirming enhanced angiogenic potential. Together, these findings support CPC-EVs as a promising platform for achieving enhanced cardiac delivery of mRNA, with reduced liver accumulation, limited off-target transcriptomic perturbation, a more selective cytokine response, and enhanced angiogenic activity in ex vivo assays.

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Purpose To develop a machine learning-based model to identify patients with hypertrophic cardiomyopathy (HCM) at high risk of major adverse cardiac events (MACEs) and key predictors of model performance. Materials and Methods This retrospective cohort study included patients who underwent cardiac MRI for HCM evaluation between September 2015 and December 2022. Cardiac MRI included balanced cine steady-state free precession, native T1 and T2 mapping, and late gadolinium enhancement. MACEs were defined as a composite of cardiovascular death, resuscitated sudden cardiac death, or heart failure hospitalization. A penalized Cox proportional hazards model with elastic net regularization (CoxNet) was developed with 33 clinical, genetic, echocardiography, and cardiac MRI variables. Model training used 200 iterations of stratified subsampling cross-validation (80% training, 20% testing). Performance was evaluated with the Harrell C index and compared with the 2014 European Society of Cardiology sudden cardiac death risk model. Results A total of 604 patients were included (mean age, 52 years &#xb1; 15 [SD]; 417 male patients; median follow-up, 3.0 years [IQR, 1.9-4.2 years]). The CoxNet model demonstrated favorable performance for MACE prediction (C index, 0.75; 95% CI: 0.65, 0.83), similar to the European Society of Cardiology model (C index, 0.67; 95% CI: 0.57, 0.75; P = .07). Key predictors included apical aneurysm, left ventricular end-systolic volume indexed to body surface area, extensive late gadolinium enhancement, native T1 z score, and male sex. Conclusion A machine learning-based model comprising routinely available variables showed strong performance for MACE prediction in HCM. Key variables highlight the impact of cardiac MRI features on risk stratification. Keywords: MRI, Machine Learning, Model Training, Cardiac, Heart, Hyperplasia, Hypertrophy &#xa9; RSNA, 2026 See also commentary by Shiwani in this issue.

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Transcatheter aortic valve implantation (TAVI) is increasingly performed in younger and lower-risk patients. Since many of these patients will outlive their transcatheter heart valve (THV), redo-TAVI procedures are expected to rise in number. Yet, real-world evidence on the procedural safety and efficacy of redo-TAVI remains limited. We aimed to evaluate the 30-day procedural and clinical outcomes of redo-TAVI using the balloon-expandable SAPIEN 3 platform. The ReTAVI registry is a prospective, international study enrolling consecutive patients with a failed aortic THV undergoing redo-TAVI with a balloon-expandable SAPIEN 3 THV. Data were collected across 59 international centres. All imaging was centrally analysed, and major clinical events were adjudicated by an independent committee. &#xe2;&#xa8;A total of 143 patients (median age 84 years; 40.6% female; median Society of Thoracic Surgeons risk score 7.0%) were enrolled. The predominant failing THVs were balloon-expandable SAPIEN 3 (30.1%), self-expanding CoreValve/Evolut (53.1%), and ACURATE (14.0%) platforms. The most common failure mode was isolated regurgitation (48.6%), followed by stenosis (35.2%) and a mixed pathology (16.2%). The replacement valve was successfully implanted in 95.1% of patients, with a 30-day mortality rate of 3.5%. The 30-day stroke and pacemaker implantation rates were 0.7% and 6.3%, respectively. Redo-TAVI significantly improved valve haemodynamics, with mean gradients decreasing overall (&#x394;=-12.0 mmHg), and a more pronounced reduction in stenotic failures (&#x394;=-29.0 mmHg). Coronary obstruction was observed in 1.4% of cases. Redo-TAVI with a balloon-expandable SAPIEN 3 THV platform is a safe and effective reintervention strategy across diverse failed THV types, when guided by the Heart Team, standardised procedural planning, and comprehensive imaging. gov: NCT05601453.

Conventional definitions of adverse left ventricular remodeling (ALVR) following ST-elevation myocardial infarction (STEMI), which are based on longitudinal changes in left ventricular end-diastolic volume index and ejection fraction, have demonstrated limited prognostic value. This study aimed to identify prognostic relevant remodeling phenotypes using a data-driven approach on longitudinal cardiac magnetic resonance (CMR) data. In this prospective longitudinal study, a derivation cohort (n=337) and an independent validation cohort (n=190) of patients with reperfused STEMI were analyzed. Patients underwent CMR at <7 days and 6-month follow-up. Unsupervised clustering algorithm was applied using baseline biventricular, biatrial, and infarct parameters, plus their longitudinal changes. Major adverse cardiovascular events (MACE) included all-cause mortality, recurrent MI, and heart failure. Three reproducible post-MI phenotypes were identified: Low-Risk (n=175), Early Remodeling (n=96, severe acute injury with minimal longitudinal change), and Atrial-dominant Remodeling (n=66, bi-atrial and ventricular enlargement). Phenotype-stratified MACE-free survival differed significantly in both cohorts (derivation P<.001; validation P=.002). In the validation cohort, both Early Remodeling (HR 4.73; 95%CI 1.77-12.64) and Atrial-dominant Remodeling (HR 4.02; 95%CI 1.49-10.88) were associated with elevated MACE risk versus the Low-Risk group; the Atrial-dominant phenotype was further associated with heart failure hospitalization (subdistribution HR: 5.92; 95%CI:1.04-33.56). Adding the derived phenotypes to baseline CMR parameters improved MACE discrimination (C-index 0.755 vs 0.714; &#x394;C 0.041, 95% CI 0.006-0.074), whereas conventional ALVR did not. Three reproducible post-MI remodeling phenotypes were identified, which provides superior risk stratification for MACE over conventional ALVR criteria and insights into post-MI heart failure.

Tricuspid transcatheter edge-to-edge repair alleviates symptoms, but survival benefit remains inconsistent. The authors conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-compliant systematic review and meta-analysis (CRD42024600438) to identify multivariable predictors of procedural success and adverse outcomes. PubMed, Scopus, the Cochrane Library, and Google Scholar were searched (from January 2008 to March 2025) for adjusted predictors of mortality, heart failure hospitalization, major adverse cardiovascular events, and procedural success. Random-effects meta-analysis was performed when &#x2265;2 independent cohorts reported comparable estimates. Fifty-nine studies met the inclusion criteria. Baseline tricuspid regurgitation severity (OR: 2.50; 95% CI: 1.33-4.71), nonanteroseptal jet location (OR: 2.46; 95% CI: 1.08-5.60), and increasing coaptation gap (HR: 1.19 per mm; 95% CI: 1.07-1.33) predicted residual tricuspid regurgitation. Residual tricuspid regurgitation &#x2265;3+ was the only predictor suitable for pooled synthesis across endpoints and was associated with all-cause mortality (HR: 2.19; 95% CI: 1.60-3.00) and major adverse cardiovascular events (HR: 1.84; 95% CI: 1.37-2.48) (I2 = 0%-2%.) Renal dysfunction, impaired right ventricular function and remodeling, pulmonary hypertension, and right ventricular-pulmonary arterial uncoupling reflect advanced disease substrate and demonstrated consistent associations with adverse outcomes. Among surgical risk models, the European System for Cardiac Operative Risk Evaluation II score showed limited discrimination, whereas the TRI-SCORE performed better; tricuspid transcatheter edge-to-edge repair-specific clinical models remain limited, and validated procedural prediction models are emerging. Limited data suggest that an intermediate disease profile may derive the greatest benefit, but this finding is confined to single-registry analyses. Further work is required to define optimal disease-stage thresholds and develop integrated risk models incorporating procedural outcome predictors.