September 2025 | Issue 78
Featured in this issue:
6 Intracoronary imaging Barriers to adoption
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9 DAPT de-escalation
New insight on post-PCI anticoagulation
14 Profile
Dipti Itchhaporia
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Global study shows widening disparity in mitral valve disease outcomes
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AI predicts valvular regurgitation
HYPERTENSION
Blood pressure guidelines bump up recommendation for renal denervation
Degenerative mitral valve disease has doubled in prevalence globally over the last 30 years, and though improvements in surgical techniques and advances in transcatheter technologies have led to improvements in rates of mortality, these have arisen in higher income countries—leading to concern over a global disparity in care for patients with mitral valve disease. hese were among the conclusions of research presented at New York Valves 2025 (25–27 June, New York, USA), following analysis of data from the Global Burden of Disease (GBD) study—a worldwide health programme involving more than 14,000 collaborators from over 200 countries—to determine the extent of degenerative mitral valve disease from 1990 through to 2023. Guido Ascione, a cardiac surgeon and research fellow at the Cardiovascular Research Foundation (CRF) in New York, USA, presented the data which assessed the prevalence of the disease according to population-based cohort studies, population surveys and administrative data from health facilities. For the purposes of the study, degenerative mitral valve disease was defined as an echocardiographic finding of prolapse or myxomatous degeneration of the mitral valve with mitral regurgitation (MR) ≥2, whilst cases of secondary MR, congenital, rheumatic, or those from infectious causes were excluded from the analysis. Mortality estimates were established using information from death certificates including vital registration and autopsy data, and only cases in which degenerative mitral valve disease was the primary cause of death were taken into consideration, with estimates presented as absolute and age-standardised rates, and countries stratified based upon sociodemographic index (SDI) to determine their relative wealth. “Primary MR progressively grew over time; from 1990 to 2023 there was a percentage increase in absolute prevalence of
18 Artificial intelligence
+126%, and in 2023 there were globally 16 million people with primary MR and at least moderate MR,” Ascione said, noting that prevalence was higher in males than in females. Looking at age-standardised rates, Ascione commented that the data pointed to the prevalence of the disease being “actually pretty steady”, suggesting that the main driver of the increase in absolute prevalence can be ascribed to a globally ageing population or a lack of improvement in global diagnostic capabilities (i.e. access to healthcare, screening or echocardiography) over the timespan of the study. “As prevalence increases in age, the rate starts to peak after 60 years of age, and it is the highest in patients that are in between 70 and 74 years,” he detailed. “This means that in 2023, globally there were 11 million people with primary MR that were older than 70 years and four million people were actually older than 80. This has dramatic consequences when
This has dramatic consequences when we think about treatment algorithms for the future”
NEW GUIDELINES FROM THE American College of Cardiology (ACC) and the American Heart Association (AHA) for the prevention and management of high blood pressure have, for the first time, added renal denervation as a treatment option for patients with resistant or uncontrolled hypertension. Published in the Journal of the American College of Cardiology (JACC), Circulation and Hypertension, the guidelines give the therapy a class IIb recommendation for patients with a systolic blood pressure of 140–180mmHg and diastolic blood pressure ≥90mmHg despite four drugs, or in patients with uncontrolled hypertension intolerant to drug escalation. All patients with hypertension who are being considered for renal denervation should be evaluated by a multidisciplinary team with expertise in resistant hypertension and in performing the technique, the guidelines state. Renal denervation is a devicebased treatment in which energy is targeted through a catheter to the renal nerves to modulate the sympathetic signalling between the kidneys and brain to reduce blood pressure. Two devices have been approved by the US Food and Drug Administration (FDA)—the Paradise (Recor Medical) and Symplicity Spyral (Medtronic) systems—following a review of evidence from trials assessing both technologies, evidence that also contributed to the ACC/AHA guideline change. Medtronic’s Symplicity Spyral system is a minimally invasive procedure that delivers radiofrequency energy to Continued on page 2
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