Background Intravascular lithotripsy (IVL) is increasingly used for treatment of coronary artery calcification. This study aimed to evaluate contemporary utilisation patterns, safety and efficacy of IVL in an unselected real-world patient cohort. Methods We included 454 patients undergoing IVL from May 2019 to February 2024 across seven centres in two European countries. Key endpoints included device success, technical success, procedural success, IVL-related complications and major adverse cardiovascular events (MACE) at 1-year follow-up. Results The cohort (mean age 73±9 years, 75% male) had a mean SYNTAX Score of 22.0±13.6. Device, technical and procedural success were achieved in 98%, 91% and 89% of patients, respectively. IVL-related complications occurred in six patients (1%). At 1-year follow-up, MACE was observed in 37 patients (13%). Over time, IVL use increased in patients with acute coronary syndrome (p=0.004) and in combination with intracoronary imaging (p=0.002), while us

Extracorporeal shock wave lithotripsy (ESWL) is standard of care for the treatment of renal calculi. Fracturing large renal calculi using acoustic energy allows them to be safely passed as smaller fragments therefore avoiding surgical treatment. The adaption of ESWL to the vascular space, termed intravascular lithotripsy (IVL), could be said to have a similar goal and has sparked renewed interest in the percutaneous treatment of calcified coronary artery disease (CCAD). The mechanism of action, acoustic waveforms which selectively target calcium, is novel within the vascular space. Yet, crucially, as it is delivered via a balloon platform, it feels familiar. The prospective DISRUPT-CAD trials established IVL’s safety and efficacy in treating CCAD.1 However, as is typical with trials designed for regulatory approval, these studies were conducted in elective patients with restrictive inclusion criteria. IVL penetrance and use in off-label indications has exponentially increased since the

Extracorporeal shock wave lithotripsy (ESWL) is standard of care for the treatment of renal calculi. Fracturing large renal calculi using acoustic energy allows them to be safely passed as smaller fragments therefore avoiding surgical treatment. The adaption of ESWL to the vascular space, termed intravascular lithotripsy (IVL), could be said to have a similar goal and has sparked renewed interest in the percutaneous treatment of calcified coronary artery disease (CCAD). The mechanism of action, acoustic waveforms which selectively target calcium, is novel within the vascular space. Yet, crucially, as it is delivered via a balloon platform, it feels familiar. The prospective DISRUPT-CAD trials established IVL’s safety and efficacy in treating CCAD.1 However, as is typical with trials designed for regulatory approval, these studies were conducted in elective patients with restrictive inclusion criteria. IVL penetrance and use in off-label indications has exponentially increased since the

Degenerative mitral valve disease is common. Up to a quarter of patients with degenerative mitral valve disease may be asymptomatic despite having severe valve regurgitation. Current guideline indications for intervention in asymptomatic patient are centred on left ventricular dimensions and ejection fraction and may include consideration in atrial fibrillation, pulmonary hypertension and those with left atrial dilatation. However, despite intervention according to these recommendations, patients remain at risk of post-operative heart failure and mortality. Newer risk markers have been developed including left ventricular and atrial strain, myocardial fibrosis demonstrated using late gadolinium enhancement, mitral annular disjunction and ventricular arrhythmia burden. Translating newer markers into clinical practice will require integrating and identifying high-risk phenotypes that benefit from early intervention using machine learning techniques and artificial intelligence. Valve repa

Objectives Although financial interactions between physicians and pharmaceutical and medical device companies could be potential conflicts of interest, in certain instances, industry promotion targeted at physicians may facilitate the early adoption of effective, novel care for patients such as sacubitril/valsartan in the USA. This study aims to evaluate associations between industry-sponsored meal payments to physicians and their prescribing patterns for sacubitril/valsartan in the USA. Methods Using the publicly accessible Centers for Medicare and Medicaid Services Medicare Part D database and the Open Payments Database, this study assessed associations between industry-sponsored meal payments to physician prescribers and total amounts of Medicare claims and spending for sacubitril/valsartan between 2015 and 2021. Results Among 220 147 eligible physician prescribers, 60 568 (27.5%) received at least one meal payment related to sacubitril/valsartan from the manufacturer, totaling US$1