Coronary artery disease (CAD) is a major risk factor for the development of heart failure (HF) with preserved ejection fraction (HFpEF) and is associated with increased mortality. However, an optimal strategy to screen for HFpEF among patients with CAD has not yet been established. The HFpEF-ABA score was introduced to estimate the pretest probability of HFpEF and was shown to predict adverse HF events. This retrospective multicenter cohort study included patients registered in the Clinical Deep Data Accumulation System database who underwent percutaneous coronary intervention from April 2013 to March 2019. Patients with a left ventricular (LV) ejection fraction ≥ 50% and no known history of HF were included. Age, body mass index, and a history of atrial fibrillation were used to calculate the HFpEF-ABA score, and patients were dichotomized at a 50% threshold for descriptive risk stratification. The primary endpoint was a composite of all-cause death and unplanned HF hospitalization. Among 3307 patients, those with high HFpEF-ABA scores were more likely to have hypertension, renal dysfunction, anemia, larger left atrial size, higher LV mass index, and elevated brain natriuretic peptide levels, consistent with an HFpEF phenotype. Over a median follow-up of 721 days, 275 patients experienced the primary endpoint. The HFpEF-ABA score was independently associated with the primary endpoint as both a continuous and a categorical variable (hazard ratio: 1.07 [95% confidence interval: 1.00-1.14], P = 0.043, and 1.37 [1.07-1.76], P = 0.015, respectively). The HFpEF-ABA score identifies CAD patients with an HFpEF phenotype and predicts adverse outcomes.

Patent foramen ovale (PFO) closure is an established treatment for secondary prevention after PFO-related stroke. Traditionally guided by transesophageal echocardiography (TEE) under general anesthesia, the procedure can now be performed using intracardiac echocardiography (ICE) under local anesthesia, supporting a minimalist and potentially outpatient approach. We retrospectively analyzed 205 consecutive patients who underwent ICE-guided PFO closure at Dijon University Hospital between 2018 and 2023. All procedures were performed under local anesthesia, without TEE or anesthesiology support. Procedural success, complications, discharge timing, and patient-reported comfort were evaluated, with clinical follow-up assessing recurrent events. Procedural success was achieved in 100% of patients, with a mean duration of 56 ± 19 min from catheterization laboratory entry to exit. Most patients (94%) were discharged within 24 h of admission, including 44% who underwent the procedure on an outpatient basis. Complications were infrequent (3.4% minor vascular events; one device embolization). Patient comfort was excellent (mean 9.1 ± 1.7/10). At follow-up, no recurrent ischemic events were observed. ICE-guided PFO closure under local anesthesia enables a simplified, anesthesia-free, and highly tolerated procedural pathway. These findings support the adoption of a minimalist interventional approach to streamline PFO management and optimize patient experience. What is already known? What this study adds?

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022 (Ozaki et al. in Cardiovasc Interv Ther 33:178-203, 2018), (Ozaki et al. in Cardiovasc Interv Ther 37:1-34, 2022). Following the publication of the 2023 European Society of Cardiology (ESC) Guidelines for the management of acute coronary syndromes, the CVIT Task Force released another revised version in 2024 (Ozaki et al. in Cardiovasc Interv Ther 39:335-375, 2024). In light of new clinical evidence and technological advances that have emerged since then, the Task Force now proposes an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2026 version.

Right ventricular (RV) function is an established prognostic factor in structural heart disease, but is not routinely incorporated into pre-procedural risk assessment in patients undergoing transcatheter aortic valve implantation (TAVI). This study evaluated the prognostic impact of systolic pulmonary artery pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), and RV–pulmonary artery (PA) coupling (TAPSE/sPAP ratio) in a real-world TAVI population. This retrospective single-center study included 565 consecutive patients (mean age 82.1 ± 5.1 years; 48.7% male) undergoing transfemoral TAVI between 2016 and 2022. All patients received standardized pre-procedural echocardiographic assessment of sPAP, TAPSE, and TAPSE/sPAP. The primary endpoint was all-cause mortality over a mean follow-up of 47.1 ± 22.8 months. Impaired RV–PA coupling – defined as a TAPSE/sPAP < 0.55 mm/mmHg – was identified in 46.5% of patients, elevated sPAP (≥35 mmHg) in 61.2%, and reduced TAPSE (≤18 mm) in 22.3%. Both elevated sPAP and reduced TAPSE/sPAP were significantly associated with increased long-term mortality (p=0.004 and p<0.001, respectively), whereas TAPSE alone was not predictive (p=0.318). Subgroup and interaction analyses showed that the prognostic impact of sPAP and TAPSE/sPAP was greatest in patients aged ≥80 years, in males, and in those with preserved left ventricular ejection fraction and normal stroke volume index (SVi).RV afterload, as reflected by elevated sPAP and impaired RV–PA coupling, is a key driver of post-TAVI mortality, outperforming isolated RV systolic measurements. The TAPSE/sPAP ratio is a robust, integrative marker whose prognostic value is modulated by age, sex and left heart function. These findings support incorporating RV–PA coupling into routine pre-TAVI assessment to improve risk stratification and identify vulnerable patients before intervention

Slender percutaneous coronary intervention (PCI) is a minimally invasive technique that uses smaller catheters, typically 5-French devices, to reduce bleeding complications and eliminate the need for unnecessarily large catheters. While these techniques are highly effective for non-complex lesions, they face inherent challenges, such as limitations in device compatibility and technical constraints. These challenges emphasize the importance of thorough pre-procedural planning to ensure optimal equipment selection and successful procedures. Cardiac computed tomography (CT) addresses these limitations by providing a comprehensive three-dimensional view of the coronary artery anatomy and lesion characteristics. This consensus statement outlines the role of cardiac CT in optimizing slender PCI strategies, emphasizing the importance of detailed anatomical assessments and advanced evaluations of lesion complexity. Cardiac CT enables precise measurements of vessel dimensions, identification of optimal landing zones, and accurate characterization of lesion complexity, including calcified plaque. Thin-slab maximum intensity projection reconstruction provides simultaneous longitudinal and cross-sectional views, comparable with findings of coronary angiography and intravascular imaging, facilitating interventional planning. For complex lesions, CT is essential. It accurately predicts the risk of side branch occlusion in bifurcation lesions, characterizes the distribution of calcification in heavily calcified lesions to aid in device selection, and helps in the appropriate selection of cases for chronic total occlusion lesions based on CT-derived scores and detailed morphological assessments. To systematically apply these principles, a practical pre-procedural checklist for CT-guided planning is proposed. The integration of cardiac CT into the slender PCI workflow extends beyond anatomical assessment to encompass the optimization of resource utilization, potentially enabling interventionists to proceed with appropriately minimally invasive techniques from the outset.