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A Dynamic Right Atrium In Transcatheter Tricuspid Valve Replacement: Friend Or Foe?
No full textIntroduction: Transcatheter tricuspid valve replacement (TTVR) with the Evoque valve (Edwards Lifesciences, USA) is a novel therapeutic approach for treating patients with severe tricuspid regurgitation who are at high surgical risk. Due to the limited mobility of the delivery system, the successful treatment of patients may depend on patient-specific anatomical features. In this study, we evaluated characteristics from pre-procedural cardiac computed tomography (CCT) that may have impacted the success of the procedure. Methods: A retrospective analysis was conducted on fifty patients who had undergone attempted TTVR at a large, high-volume center. All patients had pre-procedural CCT, which was analyzed for volumetric right ventricle (RV) and right atrium (RA) size in systole and diastole, linear metrics of RV function, and annular height. A successful procedure was defined as the deployment of the TTVR without procedural mortality. Results: Among the cohort of the first fifty patients to undergo commercial TTVR, no implant was placed in 10 patients. Among those without procedural success, valve deployment failed in 9 patients, and mortality occurred in 1 patient. A regression model statistical analysis showed no association between lack of procedural success and CT fractional area change (p=0.79), CT RV free wall shortening (p=0.40), CT longitudinal fractional shortening (p=0.84), RA height (p=0.35), or TV annular height (p=0.50). However, a reduced CT-based RA emptying fraction (RA diastole - RA systole / RA diastole) was more likely to be associated with procedural success (p=0.02). Conclusions: Patients with highly dynamic right atrial function undergoing TTVR with the Evoque valve may have a higher rate of procedural failure. This could be related to the variable sizing of the RA and the fixed length of the Evoque delivery catheter. Additionally, the device cannot be retrieved after the unsheathing process begins, and unstable delivery system positioning may hinder depth measurements, leading to decisions to abort the procedure prior to device deployment. Pre-procedural CCT is a cornerstone for planning this highly complex procedure. Further, larger studies are needed to confirm these findings. [Formula presented
TCT-276 Impact of Door to Support Time on Patients with ST-segment Elevation Myocardial Infarction and Cardiogenic Shock
No full textBackground: Use of mechanical circulatory support (MCS) devices has been shown to improve outcomes in patients with ST-segment elevation myocardial infarction and cardiogenic shock (STEMI-CS). We aimed to assess the relationship between door to support (DTS) time and short- and long-term outcomes in these patients. Methods: We combined data from RECOVER III (NCT04136392) and the National Cardiogenic Shock Initiative (NCT03677180), which were single-arm, multicenter studies enrolling patients who underwent revascularization with Impella for STEMI-CS. We compared outcomes of patients based on quartiles (Q) of DTS times. Results: Between 2016 and 2020, 505 patients with STEMI-CS were enrolled across 116 US centers. Median DTS time per quartile was 52, 77, 112, and 217 minutes in Q1 to Q4, respectively. Baseline demographics were similar across DTS quartiles, except there were fewer women in Q1. Patients in Q1 were more likely to present in shock on admission (80.2 vs. 67.4%; p=0.01), have higher pulmonary capillary wedge pressure (30.0 vs. 24.8 mmHg; p=0.02), and have TIMI 0 flow in the infarct-related artery (81.7 vs. 70.9%; p=0.02), compared to patients in Q2-Q4. Patients with shorter DTS time (Q1) had improved survival at 1-year compared to those with longer DTS time (Q2-Q4) (52.8% vs. 39.4%; p\u3c0.02) (Figure). [Formula presented] Conclusion: In a cohort of patients treated early with PCI and Impella, a shorter DTS time (\u3c60 minutes) appeared to be associated with lower 1-year mortality. Larger studies are needed to verify these findings. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arres
TCT-865 Impact of a Standardized Algorithm on Device Selection in Severe Tricuspid Regurgitation
No full textBackground: Repair and replacement options are available for patients with severe tricuspid regurgitation (TR). We describe the determinants and impact of a standardized algorithm on device selection in patients evaluated for severe TR. Methods: From October of 2024 to April of 2025, all patients who were presented for management of severe TR at the heart team meeting were evaluated for device selection according to an institution specific standardized algorithm (Figure 1.) Reasons for ultimate device selection when clinical and anatomic equipoise was established were left to the discretion of the operator. [Formula presented] Results: A total of 93 patients were evaluated during this time. The median age was 76 (IQR; 70-83), 57% (53/93) were women, and 75.2% (70/93) were white. 62.3% (58/93) of patients ultimately underwent transcatheter tricuspid valve intervention (TTVI), 0.04% (4/93) underwent surgery, and 33.3% (31/93) did not undergo treatment. 56.9% (33/58) of those who underwent TTVI were determined to be both clinically and anatomically suitable for either therapy. Of those patients who underwent TTVI, 74.1% (43/58) had TTVR and 25.9% (15/58) had TV-TEER. The most common reason to undergo TTVR was for the perceived decrease in residual TR (65%). The most common reason to undergo TV-TEER was due to the inability to tolerate anti-coagulation. Conclusion: When a standardized algorithm is applied for device selection in patients with severe TR, the majority (56.9%) are determined to be eligible for both treatments. Future research is needed to help identify determinants of success and failure for commercially available devices. Categories: STRUCTURAL: Valvular Disease and Intervention: Tricuspi
TCT-961 Outcomes of Percutaneous Coronary Intervention in Nonagenarians in the United States
No full textBackground: Although Percutaneous Coronary Intervention (PCI) is the cornerstone treatment acute myocardial infarction (AMI), its use in the elderly, specifically nonagenarians patients, is not well studied. This study sought to compare the outcomes and complications of nonagenarian patients who experienced AMI between those who underwent PCI and those who underwent medical treatment only. Methods: We evaluated 301,440 nonagenarian (ages 90−99) patients who presented to the hospital with AMI who were listed in the National Inpatient Sample from 2016 to 2021. AMI was defined according to the ICD-10 Diagnostic Codes. Multivariable logistic regression analysis was used to examine the association of PCI with primary outcomes of mortality and secondary outcomes. The temporal trend of both the incidence of PCI in nonagenarian patients as well as the mortality rate between 2016 and 2021 were expressed as percentages over time. Results: Of the total (n = 301,440) nonagenarian patients with AMI, 33,035 patients underwent PCI while 268,406 did not undergo PCI and rather, just utilized optimized medical therapy (OMT). Of these, 3290 (9.96%) died in the PCI group, and 43580 (16.24%) died in the OMT group. All of the secondary outcomes were significantly different between the PCI and OMT groups. Comparing the two groups, the PCI group was associated with decreased mortality (OR 0.63 [95% CI, 0.58−0.69]; p \u3c 0.001), acute heart failure (OR 0.88 [95% CI, 0.82−0.95] p \u3c 0.001), and AKI (OR 0.75 [95% CI, 0.70−0.79]; p \u3c 0.001), and increased cardiogenic shock (OR 3.06 [95% CI, 2.77−3.38]. The temporal of PCI in nonagenarian patients showed an increase in frequency from about 8.3 in 2016 to about 13.7% in 2021. Furthermore, comparing the mortality between the PCI and OMT groups showed a significant difference with a decreased mortality in the PCI group. Conclusion: Nonagenarian patients experiencing AMI who underwent PCI were associated with a significant mortality decrease compared to those who underwent OMT only. The PCI group was also associated with a significant decrease in multiple secondary complications including acute heart failure, AKI, acute stroke, and an increase in cardiogenic shock. Temporally, we have seen an increase in PCI being used in nonagenarian patients over the interval. Categories: CORONARY: Acute Coronary Syndrome
TCT-1059 Prediction of Patient Radiation Dose During Chronic Total Occlusion Percutaneous Coronary Intervention: A Machine Learning Augmented Analysis
No full textBackground: There is limited information regarding the patient radiation dose during chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). Methods: We evaluated the association of clinical and angiographic characteristics with patient air kerma (AK) radiation dose in 10,806 patients underwent 10,816 CTO PCIs at 51 centers between 2012 and 2025 from an international registry (PROGRESS-CTO). Feature selection was performed with the Random Forest classification algorithm. A generalized linear mixed model (GLMM) with a gamma distribution and random intercept per study center was utilized for the prediction model. Results: The median AK radiation dose was 2.0 (1.1-3.4) Gray. 11% of patients received \u3e5 Gy of AK radiation (high dose). Patients in the high dose group were more likely to be men, higher body mass index (BMI), diabetes, and more complex lesions (J-CTO score: 2.8±1.2 vs. 2.4±1.2, p\u3c0.001). Technical and procedural success were lower and major adverse cardiovascular events were higher in the high dose group. On multivariable GLMM analysis, age, male gender, BMI, diabetes, heart failure, prior CABG, serum creatinine, contrast volume, retrograde crossing strategy, complex lesion characteristics were independently associated with higher radiation dose, whereas interventional collateral presence and intravascular imaging use were associated with lower radiation dose. Substantial center variation was observed, and AK radiation dose has plateaued in recent years. [Formula presented] Conclusion: Several patient and angiographic characteristics were independently associated with AK radiation dose during CTO PCI. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP
TCT-746 Stroke Risk after Left Atrial Appendage Occlusion in Patients with Prior Intracranial Hemorrhage: A Propensity-Matched Analysis
No full textBackground: Patients with atrial fibrillation (AF) and prior intracranial hemorrhage (ICH) present a clinical challenge for stroke prevention. Left atrial appendage occlusion (LAAO) offers an alternative to long-term anticoagulation for the general population patients with AF and contraindications to anticoagulation, but the impact of LAAO on stroke in patients with ICH is unknown. Methods: Using the TriNetX database, we identified patients with AF and prior nontraumatic ICH who underwent LAAO (n=1530) and compared them to matched controls without LAAO (n=1530) using 1:1 propensity score matching. Outcomes assessed were freedom from (1) composite stroke (ischemic or hemorrhagic), (2) recurrent hemorrhagic stroke, and (3) ischemic stroke, over a 5-year period. Kaplan-Meier analysis and Cox proportional hazard models were used to assess time-to-event outcomes. Results: LAAO was associated with significantly lower stroke risk (Figure). Patients with LAAO had lower risks of the composite of ischemic or hemorrhagic stroke (HR 0.41; 95% CI 0.37–0.44; p\u3c0.01; Figure 1A). Individually, recurrent hemorrhagic stroke was less frequent with LAAO (HR 0.52; 95% CI 0.46–0.58; p\u3c0.01; Figure 1B) as was ischemic stroke (HR 0.49; 95% CI 0.43–0.54; p\u3c0.01; Figure 1C). Stroke-free status at 5 years was higher with LAAO than without LAAO across all three endpoints. [Formula presented] Conclusion: In patients with AF and prior ICH, LAAO was associated with significantly reduced risk of both recurrent hemorrhagic and ischemic stroke. These findings support LAAO as a potent stroke prevention strategy in patients with prior ICH. Categories: STRUCTURAL: Left Atrial Appendage Exclusio
TCT-982 Clinical Characteristics and Outcomes of Transcatheter Tricuspid Valve Replacement (TTVR) Patients Stratified by TRISCEND II Trial Eligibility
No full textBackground: Clinical trials like TRISCEND II use strict criteria that exclude many real-world TTVR patients. Those excluded patients often have worse health status and outcomes. We compared characteristics and results between eligible and non-eligible patients in our TTVR cohort. Methods: We analyzed a single-center cohort of 112 patients who underwent TTVR for symptomatic TR, stratified by TRISCEND II eligibility. Baseline demographics and clinical outcomes were compared between eligible (n=51) and non-eligible (n=61) groups. Results: Eligible patients were older (82.2 ± 8.5 vs. 74.6 ± 8.8 years) and had lower BMI. Sex and NYHA class III/IV distribution were similar (female: 68.6% vs. 63.9%; NYHA III/IV: 74.5% vs. 77.0%). Ineligible patients had lower LVEF (51.6% vs. 58.5%) and more frequent prior heart failure hospitalization (83.6% vs. 58.8%). TR severity was comparable when combining severe and torrential grades (60.7% vs. 64.7%). At 30 days, nearly all patients had TR reduced to moderate or less (95.0% vs. 100%). Ineligible patients were more often NYHA class III/IV (31.0% vs. 11.9%) and had lower KCCQ-OS scores (59.1 ± 24.0 vs. 66.1 ± 22.9). Any bleeding event was more frequent in the ineligible group (39.3% vs. 17.6%), while mortality, stroke, reintervention, and pacemaker rates were low and similar. [Formula presented] Conclusion: TRISCEND II–eligible patients had better baseline cardiac function, fewer prior heart failure hospitalizations, and fewer adverse events after TTVR. These findings highlight the need to consider real-world patient complexity when interpreting outcomes to inform both clinical practice and trial design. Categories: STRUCTURAL: Valvular Disease and Intervention: Tricuspi
TCT-581 Renal Sympathetic Denervation as Adjunctive Upstream Therapy during Atrial Fibrillation Ablation: Pooled Analysis of the HFIB and Ultra-HFIB Studies
No full textBackground: During catheter ablation to treat atrial fibrillation (AF), adjunctive renal denervation (RDN) improves AF rhythm control, but these studies included only pts with uncontrolled HTN. The HFIB series of pilot studies addressed whether this antiarrhythmic effect of RDN extends to AF patients with controlled hypertension. Methods: We performed a patient-level pooled analysis of HFIB-1 (n=30) and Ultra-HFIB (n=100): both studies randomized AF pts with HTN history, receiving ≥1 anti-HTN med, to AF ablation alone or AF ablation plus RDN with either an off-the-shelf radiofrequency catheter in HFIB-1 (Celsius Thermocool, JNJ MedTech) or an ultrasound RDN system in Ultra-HFIB (Paradise RDN; Recor Medical). The primary endpoint was freedom from AF recurrence (including atrial flutter/tachycardia) off antiarrhythmic drugs at follow-up (2 yr for HFIB-1, 1yr for Ultra-HFIB). Results: The 130-pt cohort was age 65.3±10, 37% female, 82% paroxysmal AF, baseline BP 139/22 mmHg, with AF ablation in 69 pts and ablation+RDN in 61 pts. RDN reduced AF recurrence (HR 0.61, 95%CI 0.35-1.07, p=0.08; I2=0%). In a mixed-effects model with adjustment for age, sex, and AF type, the pooled HR was similar to the unadjusted analysis (HR 0.66, p=0.16). Pooled change in BP was higher in the RD N group by 1 year. [Formula presented] Conclusion: Adjunctive RDN at the time of AF ablation is associated with reduced arrhythmia recurrence, even among pts with relatively controlled hypertension. A fully powered randomized trial is warranted. Our findings suggest a new avenue for treatment of AF by focusing on the sympathetic / renin-angiotensin-aldosterone axis. Categories: STRUCTURAL: Electrophysiolog
Evaluating noninvasive tests for significant fibrosis in a population-based MASLD cohort: insights from NHANES 2017-2020
No full textBackground and aims: Resmetirom is FDA-approved for metabolic dysfunction-associated steatotic liver disease (MASLD) with signifi cant (F2) to advanced (F3) fibrosis. While current AASLD guidance recommended Vibration-Controlled Transient Elastography for treat ment consideration, limited availability highlights the need for noninvasive tests (NITs) using common laboratory parameters. Most existing NITs were developed in tertiary referral centers and are not optimized for screening significant fibrosis in general populations. This study compares among ALADDIN-F2-Lab, FIB-4, NAFLD Fibrosis Score (NFS), SAFE, and Liver Risk Score for identifying significant fibrosis or higher in a population based cohort. Method: The National Health and Nutrition Examination Survey (NHANES) 2017–2020 database was used. NHANES survey design weights, strata, and clusters ensured nationally representative estimates. Adults (≥ 18 years) with steatotic liver disease (CAP ≥ 248 dB m) and at least one cardiometabolic risk factor were included. Alcohol intake was calculated from survey responses, and patients with alcohol intake ≥ 20 g day for females, ≥ 30 g day for males, viral hepatitis, or missing liver stiffness measurement (LSM) were excluded. Significant fibrosis was defined as LSM ≥ 8 kPa. NITs including ALADDIN-F2-Lab, FIB-4, NFS, SAFE Score, and Liver Risk Score were categorized into low, intermediate, and high-risk groups using published cutoffs. Results: Among 4,022 participants with MASLD, 16.0% (SE 1.4%) had significant fibrosis (≥ 8 kPa). ALADDIN-F2-Lab, FIB-4, and Liver Risk Score classified the majority of participants as low risk, at 80.4%, 74.7%, and 96.1%, respectively, making them suitable for community based screening. Among these, ALADDIN-F2-Lab demonstrated the highest sensitivity (36.5%), followed by FIB-4 (32.5%) and Liver Risk Score (10.2%). NFS displayed a comparable sensitivity (33.8%) but identified only 33.4% as low risk. SAFE Score achieved the highest sensitivity (85.5%) but classified only 30.8% of participants as low risk. For high-risk classification, ALADDIN-F2-Lab (83.7%), FIB-4 (76.1%), NFS (80.9%), and Liver Risk Score (94.2%) demonstrated excellent specificity. ALADDIN-F2-Lab achieved the highest PPV (69.6%) due to fewer patients being classified as high risk. Conclusion: While ALADDIN-F2-Lab demonstrated the highest PPV among NITs for high-risk classification and SAFE achieved superior sensitivity, no NIT showed sufficient sensitivity (\u3c50%) to reliably identify the majority of patients with significant fibrosis (LSM ≥ 8 kPa) in a general population cohort. This highlights the challenge of applying NITs derived from tertiary centers to broader, community-based settings. Reassessing existing cutoffs and optimizing NITs for use in general populations may improve their utility as first-line screening tools for significant fibrosis or higher. Until such adjustments are made, their adoption in clinical practice should be approached with caution
Reducing parenteral support: patient and healthcare professional preferences for potential new short bowel syndrome therapies
No full textRationale: Understanding patient and healthcare provider (HCP) preferences for treatment and outcome attributes in patients with short bowel syndrome (SBS) dependent on parenteral support (PS) can inform management strategies and therapeutic advancements. Methods: A noninterventional, cross-sectional, online survey evaluating potential new treatment and outcome attributes was conducted in the US and Europe in patients with SBS on parenteral support (≥18 years at diagnosis) and HCPs with ≥2 years of SBS experience managing ≥1 patient. Results: Responses were collected from 91 patients and 336 HCPs. Patients’ mean age was 50.4 years (58.2% female; 69.1% White). Patients were on total parenteral nutrition (TPN; 90.1%) and or IV hydration (73.6%) and glucagon-like peptide-2 analog therapy (24.2%); 42.3% of HCPs were physicians. Among patients, outcome attributes rated as very important included minimizing TPN (70.3%), IV hydration nutrition (64.8%), and side effects (68.1%). Most (67.0%) considered a days week TPN decrease meaningful, including a 1–2 days week decrease (33.0%). 63.3% rated minimizing injection frequency as very important. For HCPs, among attributes rated as very important, top priorities were reducing TPN central venous access need related risks (73.5%), hospitalizations (72.8%), and injection frequency (63.4%). Reducing TPN was meaningful to 95.8% of HCPs, including a 1–2 days week decrease (44.3%). Conclusion: Patients highly rated reducing TPN dependence associated risks, with even a 1 day week TPN reduction considered meaningful, and decreasing injection frequency for potential new SBS therapies. HCPs valued reducing central venous access need related risks, hospitalizations, and injection frequency. These findings highlight critical unmet needs in SBS management and the importance of therapies that reduce PS burden and side effects, leading to improved patient outcomes. Disclosure of Interest: S.-M. Jafri Consultant for: Intercept, Ironwood, AbbVie, Gilead, Takeda, and Ipsen, J. Harrison Other: Volunteer for Girls With Guts, V. Kumpf Consultant for: Ironwood, Baxter Healthcare, and Fresenius Kabi, G. Mitchell Other: Employee of Ironwood and may hold shares and or stock options in the company., D. Wolin Other: Full-time employee of RTI Health Solutions, an independent nonprofit research organization, which was retained by Ironwood to conduct the research that is the subject of this abstract. Their compensation is unconnected to the studies on which they work., L. Zografos Other: Full-time employee of RTI Health Solutions, an independent nonprofit research organization, which was retained by Ironwood to conduct the research that is the subject of this abstract. Their compensation is unconnected to the studies on which they work., M. Yang Other: Employee of Ironwood and may hold shares and or stock options in the company., L. Jackson Other: Full-time employee of RTI Health Solutions, an independent nonprofit research organization, which was retained by Ironwood to conduct the research that is the subject of this abstract. Their compensation is unconnected to the studies on which they work., J. Wang Other: Full-time employee of RTI Health Solutions, an independent nonprofit research organization, which was retained by Ironwood to conduct the research that is the subject of this abstract. Their compensation is unconnected to the studies on which they work., J. Henderson Other: Employee of Ironwood and may hold shares and or stock options in the company., M. Boules Other: Employee of Ironwood and may hold shares and or stock options in the company., R. Vemulapalli Other: CME Faculty for Novus Medical Educatio