TAVR for pure aortic regurgitation cut events by two-thirds in a randomised trial

The edition in brief

Today's cardiology edition opens with a meta-analysis of three randomised trials (37,467 adults) of artificial-intelligence ECG screening for low ejection fraction in routine care. Screening raised new diagnoses of an ejection fraction of 50% or less by about a third (RR 1.36, 95% CI 1.12–1.64, I² 0%), with a number needed to screen of 204 and no rise in echo referrals; positive predictive value was only 20–34%. A MESA analysis in JAMA (6 October) found that adding coronary calcium to the PREVENT equations improved prediction only modestly overall (C statistic +0.02) but sorted borderline-risk adults well: 10-year events ran from 1.9% with a score of zero to 14.3% with a score of 300 or more. A small randomised trial in treated hypertension found four weeks of supervised handgrip training lowered awake ambulatory systolic pressure by a few mmHg against controls, while knee-extension training did not. The pearl is how to time aortic regurgitation referral by symptoms and ventricular size. The practice changer is SEASON-AR, an investigator-led trial from 18 Chinese centres: in 210 patients with severe pure aortic regurgitation unsuitable for or declining surgery, transfemoral TAVR plus medical therapy cut the one-year composite of death, disabling stroke or heart failure rehospitalisation from 24.8% to 8.3% (HR 0.31), driven mainly by fewer admissions, at the cost of more early bleeding and pacemakers. The trial was open-label, used one dedicated valve and has one year of follow-up; surgery remains the standard for operable patients.