Journal and News Scan

In the TRISCEND II trial, a total of 400 patients with severe symptomatic tricuspid regurgitation were randomized in a 2:1 ratio to undergo either transcatheter tricuspid valve replacement with medical therapy (valve-replacement group) or medical therapy alone (control group). A total of 267 patients were assigned to the valve replacement group and 133 to the control group. At one-year, tricuspid valve replacement and medical therapy were superior to medical therapy alone, with a win ratio of 2.02 (95 percent confidence interval [CI], 1.56 to 2.62; P<0.001). This was based on a hierarchical composite primary outcome that included death from any cause, implantation of a right ventricular assist device or heart transplantation, post-index tricuspid-valve intervention, hospitalization for heart failure, an improvement of at least 10 points in the Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score, an improvement of at least one New York Heart Association (NYHA) functional class, and an improvement of at least 30 meters on the six-minute walk distance. Patients in the valve replacement group had more wins than the control group with respect to death from any cause (14.8 percent versus 12.5 percent), post-index tricuspid-valve intervention (3.2 percent versus 0.6 percent), and improvements in the KCCQ-OS score (23.1 percent versus 6.0 percent), NYHA class (10.2 percent versus 0.8 percent), and six-minute walk distance (1.1 percent versus 0.9 percent).  

However, the valve replacement group had fewer wins than the control group regarding the annual heart failure hospitalization rate (9.7 percent versus 10.0 percent). Furthermore, severe bleeding occurred in 15.4 percent of the valve replacement group and 5.3 percent of the control group (P=0.003), and new permanent pacemaker implantation was required in 17.4 percent and 2.3 percent, respectively (P<0.001).  

These findings suggest that transcatheter tricuspid valve replacement combined with medical therapy is superior to medical therapy alone in patients with severe tricuspid regurgitation, particular in terms of the primary hierarchical composite outcome, which was primarily driven by improvements in symptoms and quality of life. 

This article provides a consensus-based approach for determining the resectability and optimal management strategies for locally advanced non-small cell lung cancer (NSCLC). The expert panel recommends evaluating resectability through multidisciplinary tumor board (MDT) discussions, with a focus on up-front decisions based on patient operability and tumor biology. It supports neoadjuvant chemoimmunotherapy over adjuvant options for most operable patients without driver mutations, highlighting the increased survival benefits. The guidelines also advise caution with post-induction surgery in patients with extensive or bulky N2 disease, favoring non-surgical treatments unless a multidisciplinary review deems surgery feasible. 
 
This consensus provides evidence-based strategies that integrate modern immunotherapies with surgical options to improve patient outcomes in NSCLC treatment. 

Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis. This study aimed to investigate whether early valve intervention reduces the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. In this trial, asymptomatic patients with severe aortic stenosis and myocardial fibrosis were randomized to undergo early valve intervention with either transcatheter or surgical aortic valve replacement or guideline-directed conservative management. The primary outcome was a composite of all-cause death or unplanned aortic stenosis-related hospitalization in a time-to-first-event intention-to-treat analysis. The trial enrolled 224 eligible patients (mean age, 73 years; 63 women [28 percent]), a subset of the originally planned 356 patients. Surgical aortic valve replacement was performed in 80 patients (75 percent), and transcatheter aortic valve intervention in 26 patients (25 percent). The primary end point occurred in 20 of 113 patients (18 percent) in the early intervention group and 25 of 111 patients (23 percent) in the guideline-directed conservative management group (hazard ratio, 0.79 [95 percent CI, 0.44-1.43]; P = 0.44; between-group difference, -4.82 percent [95 percent CI, -15.31 percent to 5.66 percent]). All-cause death occurred in 16 of 113 patients (14 percent) in the early intervention group and 14 of 111 (13 percent) in the guideline-directed group (hazard ratio, 1.22 [95 percent CI, 0.59-2.51]). Unplanned aortic stenosis-related hospitalization occurred in 7 of 113 patients (6 percent) in the early intervention group and 19 of 111 patients (17 percent) in the guideline-directed group, respectively (hazard ratio, 0.37 [95 percent CI, 0.16-0.88]). The authors concluded that in asymptomatic patients with severe aortic stenosis and myocardial fibrosis, early aortic valve intervention had no demonstrable effect on all-cause death or unplanned aortic stenosis-related hospitalization. 

Neurohormonal modulation and afterload reduction are essential for treating heart failure with reduced ejection fraction (HFrEF). In HFrEF patients with concomitant moderate aortic stenosis (AS), therapy with transcatheter aortic valve replacement (TAVR) may be complementary to guideline-directed medical therapy (GDMT). In this study, the authors sought to determine whether TAVR for moderate AS provides clinical benefits to patients with HFrEF in addition to GDMT.  

Patients were randomized to either TAVR or clinical surveillance with aortic valve replacement upon progression to severe AS. The primary end point was the hierarchical occurrence of: 1) all-cause death, 2) disabling stroke, 3) disease-related hospitalizations and heart failure equivalents, and 4) change from baseline in the Kansas City Cardiomyopathy Questionnaire Overall Summary Score analyzed using the win ratio. A total of 178 patients were randomized to TAVR (n = 89) or clinical surveillance (n = 89). The mean age was 77 years, 20.8 percent were female, and 55.6 percent were in NYHA functional class III or IV. The median follow-up duration was 23 months (Q1-Q3: 12-33 months).  

A total of 38 (43 percent) patients in the clinical surveillance group (of whom 35 had progressed to severe AS) underwent TAVR at a median of 12 months post randomization. TAVR was associated with wins in 47.6 percent of pairs, compared with 36.6 percent in the clinical surveillance group, resulting in a win ratio of 1.31 (95 percent CI: 0.91-1.88; P = 0.14). At one year, TAVR significantly improved the Kansas City Cardiomyopathy Questionnaire Overall Summary Score compared with the clinical surveillance group (12.8 ± 21.9 points versus 3.2 ± 22.8 points; P = 0.018). The authors concluded that TAVR was not superior to AS clinical surveillance for the primary hierarchical composite end point in patients with moderate AS and HFrEF on GDMT.