From AI to Transcatheter Therapies, Top Valvular Heart Disease Papers of 2025: Viewpoint Highlights

A major highlight of 2025 was the rapid progress in artificial intelligence (AI) for the detection and assessment of VHD. Early identification of structural heart disease remains challenging because of cost and limited access to imaging, and AI-based tools aim to address these gaps. Key developments include:

Artificial Intelligence in VHD

• A deep learning electrocardiography model trained on over one million patient records accurately detected multiple forms of structural heart disease, including moderate to severe VHD, across diverse populations.
• The DELINEATE-regurgitation study analyzed 71,660 echocardiograms with more than one million Doppler videos, showing accurate classification of regurgitation severity, with multiview approaches outperforming single-view methods.
• DELINEATE-MR-Progression introduced an AI-derived score that improved prediction of mitral regurgitation progression beyond traditional clinical measures.

These studies reinforce AI’s expanding role in large-scale screening and risk stratification in VHD.

Management of Asymptomatic Severe Aortic Stenosis (AS)

• A meta-analysis of four randomized controlled trials involving 1,427 patients compared early aortic valve replacement (AVR) or TAVI with clinical surveillance in asymptomatic severe high-gradient AS.
• Early intervention reduced unplanned cardiovascular or heart failure hospitalizations (14.6% vs 31.9%) and stroke (4.5% vs 7.2%), while all-cause and cardiovascular mortality were similar.
• Ongoing trials such as DANAVR and EASY-AS are expected to clarify long-term management strategies.

Transcatheter vs Surgical Treatment in Low-Risk AS

• PARTNER-3 and NOTION-2 demonstrated comparable outcomes between TAVI and surgical AVR at 3–7 years in low-risk patients with tricuspid AS.
• Patients with bicuspid valves showed numerically higher risk with TAVI, though results were not statistically significant.
• Longer follow-up and lifetime management considerations remain essential, particularly in younger patients.

Medical Therapy Post-TAVI

• The DapaTAVI trial showed that dapagliflozin reduced worsening heart failure and hospitalizations compared with standard care in elderly post-TAVI patients, highlighting the value of optimal medical therapy after intervention.

Real-World Outcomes in Mitral Regurgitation (MR)

• The MITRACURE registry revealed late referral patterns, with only 3% of patients receiving early intervention.
• Repair rates were 62% overall and 80% in degenerative MR, with an in-hospital mortality of 4.5%, emphasizing the need for earlier referral.

Transcatheter Mitral Valve Interventions

• Transcatheter edge-to-edge repair (TEER) reduced mortality and heart failure hospitalizations in atrial functional MR, particularly when residual MR was ≤mild.
• The SAPIEN M3 system showed promising outcomes in patients unsuitable for surgery or TEER, with low 30-day mortality (0.7%).

Transcatheter Edge-to-Edge Repair in Tricuspid Regurgitation

• The TRILUMINATE Pivotal trial showed improved quality of life and reduced heart failure hospitalizations with TEER at 2 years, though mortality was unchanged.
• Optimal patient selection remains key to maximizing benefit.

In summary, the top 10 studies of 2025 highlight meaningful advances in AI-driven diagnosis, transcatheter therapies, and optimized medical treatment, offering important insights to improve real-world management of AS, MR, and TR.

Reference:

Baumgartner, H., Iung, B., & Messika-Zeitoun, D. The year in cardiovascular medicine 2025: The top 10 papers in valvular heart disease. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf1088