Masahiko Asami

Background: Transcatheter aortic valve implantation (TAVI) is an established therapy for severe aortic stenosis. Among patients with left ventricular (LV) systolic dysfunction, recovery of LV function after TAVI is heterogeneous, and reliable tools for pre‐procedural risk stratification and patient counseling remain limited. Aims: We sought to identify simple pre‐procedural predictors of complete LV functional recovery after TAVI and to develop a clinically applicable risk score to support patient counseling and post‐procedural management. Methods: We retrospectively analyzed patients with severe aortic stenosis and baseline LV ejection fraction (LVEF) < 40% enrolled in a large multicenter registry in Japan. The primary outcome was complete LVEF normalization (LVEF > 50%) at 1 year after TAVI. Independent predictors were identified using multivariable logistic regression in a derivation cohort, and an exploratory weighted score was constructed. The score was preliminarily assessed in a separate single‐center cohort. Results: The derivation cohort comprised 177 patients (median age 84 years; 44% women), of whom 94 (53%) achieved LVEF normalization. Lower body mass index (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.77–0.95; p = 0.004), higher aortic valve peak velocity (OR 2.45, 95% CI 1.40–4.29; p = 0.002), and smaller LV end‐diastolic diameter (OR 0.93, 95% CI 0.88–0.98; p = 0.020) were independently associated with LVEF normalization. The derived score stratified patients into low‐, intermediate‐, and high‐probability groups (15%, 45%, and 71%, respectively; p < 0.001), with consistent discrimination in the validation cohort. Conclusions: A simple exploratory score incorporating body mass index, transvalvular peak velocity, and LV size was associated with the probability of complete LV functional recovery after TAVI. This pre‐procedural tool may facilitate patient counseling, expectation‐setting, and identification of patients who may require closer heart failure follow‐up after TAVI. It should not be used to determine eligibility for TAVI.

Background: Systemic inflammation is increasingly recognized as an important contributor to cardiovascular outcomes. High‐sensitivity CRP (C‐reactive protein) is an established biomarker, but its prognostic value after mitral transcatheter edge‐to‐edge repair remains unclear. Clinical parameters such as body temperature may also reflect systemic inflammation; however, their prognostic role in this setting is uncertain. We sought to investigate the association between baseline inflammation makers and long‐term outcomes in patients undergoing mitral transcatheter edge‐to‐edge repair. Methods: We analyzed 3511 patients from the OCEAN (Optimized Catheter Valvular Intervention)‐Mitral registry with available CRP, categorized by Centers for Disease Control and Prevention/American Heart Association cutoffs: 3.0 mg/L (n=1307). Body temperature was also assessed as an exploratory inflammatory marker. Results: During a median follow‐up of 13 (interquartile range, 10–26) months, 826 deaths and 911 composite event of cardiovascular death or hospitalization for heart failure were observed. In multivariable models, both CRP and body temperature were associated with higher risk of death (CRP: hazard ratio [HR], 1.98 [95% CI, 1.63–2.40]; and body temperature: HR, 1.49 [95% CI, 1.25–1.78]). Patients with both elevated CRP (>3.0 mg/L) and high temperature (≥37.0 °C) had the highest risk. Sequential Cox analyses showed an incremental value of CRP beyond clinical, laboratory, and echocardiographic variables. The prognostic effect was most pronounced in patients without preprocedural inotrope use. Conclusions: Elevated CRP is an independent and incremental predictor of death and heart failure outcomes after mitral transcatheter edge‐to‐edge repair, with its prognostic impact amplified by higher body temperature. These findings highlight the importance of incorporating systemic inflammation into risk stratification for structural heart interventions. Registration: URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN‐ID: UMIN000023653.

Background: The prognostic value of the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) score in patients undergoing mitral valve transcatheter edge‐to‐edge repair (M‐TEER) remains unclear. This study evaluated the MAGGIC score to predict outcomes after M‐TEER in patients with functional (FMR) or degenerative mitral regurgitation (DMR) and compared its performance with conventional surgical and M‐TEER–specific risk models. Methods: We analyzed 3609 patients (FMR, 71%; DMR, 29%) who underwent M‐TEER in the OCEAN (Optimized Catheter Valvular Intervention)‐Mitral registry. Patients were stratified into MAGGIC score tertiles. The primary outcome was all‐cause death at 1 and 3 years. Secondary outcomes included cardiovascular death. Predictive performance was compared with Society of Thoracic Surgeons score, European System for Cardiac Operative Risk Evaluation II, MitraScore, and COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) score. Results: The median age was 81 years, 55.3% were men, and median MAGGIC score was 30. In the FMR cohort, patients in tertile 3 had higher risks of all‐cause death (1 year: adjusted hazard ratio [HR _adj ], 4.15 [95% CI, 2.34–7.36]; 3 years: HR _adj , 1.83 [95% CI, 1.22–2.77]) and cardiovascular death (1 year: HR _adj , 2.31 [95% CI, 1.56–3.43]; 3 years: HR _adj , 1.61 [95% CI, 1.13–2.31]). In the DMR cohort, tertile 3 was associated with higher all‐cause death (1 year: HR _adj , 2.84 [95% CI, 1.18–6.86]; 3 years: HR _adj , 2.25 [95% CI, 1.07–4.73]) and cardiovascular death at 3 years (HR _adj , 3.49 [95% CI, 1.23–9.84]). The MAGGIC score demonstrated comparable or superior discrimination on the basis of the concordance index. Conclusions: The MAGGIC score independently predicted 1‐ and 3‐year all‐cause death after M‐TEER in both FMR and DMR cohorts and cardiovascular death in the FMR cohort and at 3 years in the DMR cohort. It demonstrated comparable or superior predictive performance to conventional surgical and M‐TEER–specific risk models.