A tricuspid valve that finally moves hard outcomes

The edition in brief

Four findings for the cardiology desk. TRIC-I-HF randomised 360 patients with symptomatic severe tricuspid regurgitation, mean age 80, to transcatheter repair plus medical therapy or medical therapy alone. The hierarchical primary endpoint favoured repair (win ratio 2.42, 95% CI 1.76-3.33), and freedom from death or heart-failure hospitalisation at three years was 52.4% versus 21.0% (HR 0.40, 95% CI 0.29-0.55). Major adverse events within 30 days were 5.9%. This is the first tricuspid intervention trial to move a hard composite rather than symptoms alone. IDEAL-AF screened 936 patients undergoing first-time ablation for persistent AF and randomised the 209 who had low-voltage zones of 3.0 cm2 or more. Adding individualised low-voltage zone ablation to pulmonary vein isolation raised arrhythmia-free survival off antiarrhythmic drugs at 12 months from 37.4% to 67.6% (difference 30.3%, 95% CI 17.4-43.2), with similar serious adverse events. The result applies to the enriched fifth of patients who have significant scar, not to persistent AF generally. REVEAL tested 124I-evuzamitide PET/CT against adjudicated standard-of-care diagnosis in 170 adults with suspected cardiac amyloidosis: sensitivity 94% (85-98), specificity 86% (77-92). It is a single-group accuracy study in a high-prevalence referral population, and it images amyloid types that bone-tracer scintigraphy misses. SHIELD-MI gave intravenous dexrazoxane around primary PCI in 25 STEMI patients against 25 matched placebo comparators. Intramyocardial haemorrhage volume was lower (2.0% vs 6.3% of LV) and LVEF higher (39.8% vs 34.7%). It is non-randomised, single-centre and phase IIa: a target identified, not a treatment established. In 103,341 Copenhagen adults aged 20 to 100, the relative risk of atherosclerotic disease per 50 mg/dL of Lp(a) was the same at every age (HR 1.12-1.18), while absolute excess risk rose steeply with age.