Journal of the Saudi Heart Association最新文献

{"title":"Racing Against Time: Simultaneous Anterior and Inferior ST-elevation Myocardial Infarction Managed With the Nano-crush Bifurcation Stenting Technique.","authors":"Selim S Sert, Fatih Aksoy","doi":"10.37616/2212-5043.1474","DOIUrl":"https://doi.org/10.37616/2212-5043.1474","url":null,"abstract":"<p><p>We present a rare case of simultaneous anterior and inferior ST-elevation myocardial infarction caused by the acute occlusion of both the right coronary artery and the left anterior descending artery. The culprit LAD lesion involved a true bifurcation, which was successfully treated using the nano-crush stenting technique, achieving complete reperfusion. This case highlights the feasibility of complex bifurcation intervention in a hemodynamically unstable patient with double-vessel STEMI. It underscores the importance of rapid diagnosis, aggressive revascularization, and appropriate stenting strategy in managing multivessel acute myocardial infarction.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 1","pages":"4"},"PeriodicalIF":1.3,"publicationDate":"2026-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Implantable Electronic Device Infections in Saudi Arabia: Incidence, Timing, Causative Organisms, and Outcomes - A Multicenter Study.","authors":"Saad Albogami, Wael Alqarawi, Ahmed Alfagih, Hiatham Alenzi, Mohammad Alshehri, Mossab Aljuaid, Saeed Alqahtani, Norah Alswaidan, Mohammad Alharbi, Norah Alkaltham, Lama Alasmri, Rghd Sadkh, Muna Albashari, Nour Aljumaa, Imad Tleyjeh","doi":"10.37616/2212-5043.1468","DOIUrl":"https://doi.org/10.37616/2212-5043.1468","url":null,"abstract":"<p><strong>Background: </strong>Cardiac implantable electronic devices (CIEDs) substantially improve outcomes in cardiac patients, but device-related infection can negate these benefits. Data on the epidemiology of CIED infections in Saudi Arabia are limited.</p><p><strong>Methods: </strong>We performed a multicenter retrospective cohort study of consecutive patients receiving CIEDs (pacemakers [PPM], implantable cardioverter-defibrillators [ICD], and cardiac resynchronization devices [CRT]) at three tertiary hospitals in Riyadh, Saudi Arabia, from January 2017 through December 2021. Patients were followed for at least one year post-implantation. Data collected included patient demographics, device type (new implant, replacement, revision), infection timing and microbiology, management (device extraction vs conservative treatment), and outcomes.</p><p><strong>Results: </strong>Of 4080 CIED recipients, 114 (2.8 %) developed device infections (incidence 98.8 per 10,000 person-years). CRT-P (cardiac resynchronization therapy pacemaker) devices had the highest infection rate (7.7 %). Revision procedures carried higher infection rates than initial implants or generator replacements (10.0 % vs 2.1 % vs 2.7 %; P < 0.001). The most common pathogens were <i>Staphylococcus aureus</i> (30.1 %), coagulase-negative staphylococci (10.6 %), and <i>Pseudomonas aeruginosa</i> (8.8 %); 38.9 % of infections were culture-negative. Systemic infections and patients managed without device removal had significantly higher mortality (32.3 % vs 8.2 % for systemic vs pocket; 48.4 % vs 12.0 % for no extraction vs extraction; P < 0.001 for both).</p><p><strong>Conclusions: </strong>In this large Saudi cohort, CIED infection occurred in 2.8 % of patients, particularly following revision procedures and in CRT-P recipients. Infections were often culture-negative and associated with substantial mortality, especially in systemic cases or when devices were not removed. These findings highlight the importance of strict infection-prevention protocols, early recognition, and prompt complete device extraction to improve patient outcomes.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"20"},"PeriodicalIF":1.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ruptured Sinus of Valsalva Aneurysm in a Patient With Mixed Connective Tissue Disease: Case Report.","authors":"Kenzo A Wiranata, Pramadya V Mustafiza, Enrico A Budiono","doi":"10.37616/2212-5043.1472","DOIUrl":"https://doi.org/10.37616/2212-5043.1472","url":null,"abstract":"<p><p>Sinus of Valsalva aneurysm is a rare cardiac anomaly, affecting approximately 0.09 % of the population. Its rupture represents a life-threatening event that can rapidly lead to heart failure. We report a 32-year-old woman with mixed connective tissue disease presenting with right-sided heart failure. Echocardiography demonstrated a ruptured right coronary cusp sinus of valsalva aneurysm into the right ventricle with moderate aortic regurgitation. Surgical repair was successfully performed, and histopathology supported an autoimmune-mediated etiology. To our knowledge, this is the first reported case of ruptured sinus of valsalva aneurysm occurring in a patient with autoimmune mixed connective tissue disease.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 1","pages":"3"},"PeriodicalIF":1.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anthracyclines and the Heart: A Double-edged Sword With Therapeutic Hopes.","authors":"Tariq M Alotaibi, Ahmad M Samman, Abdullah A Al Ghamdi, Fisal Salah Alkhamis, Faisal A Alnuwaiser, Abdulrhman A Alabdulgader, Ahmed H Aljizeeri","doi":"10.37616/2212-5043.1475","DOIUrl":"https://doi.org/10.37616/2212-5043.1475","url":null,"abstract":"<p><strong>Background: </strong>Anthracyclines, notably doxorubicin, are potent cytotoxic agents that substantially improved outcomes across numerous malignancies. However, their use is restricted by their cardiotoxicity, a dose-dependent adverse effect that manifests acutely, during treatment, or years post-therapy. It encompasses a spectrum of phenotypes including asymptomatic ventricular dysfunction, heart failure, arrhythmias, and cardiomyopathy, contributing to considerable morbidity and mortality as cancer survival rates improve.</p><p><strong>Objective: </strong>This narrative review summarises current insights into anthracycline-induced cardiotoxicity pathophysiology and evaluates pharmacologic strategies for its prevention and management.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted through August 2025, prioritizing randomised controlled trials, meta-analyses, observational studies, and guideline statements addressing pharmacologic interventions to mitigate anthracycline cardiotoxicity.</p><p><strong>Results: </strong>Anthracycline cardiotoxicity arises from various mechanisms, including oxidative stress, mitochondrial dysfunction, topoisomerase IIβ-induced DNA damage, calcium dysregulation, and reticulum stress. Neurohormonal modulation with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β-blockers has shown modest preservation of left ventricular ejection fraction, especially when initiated early in high-risk patients; spironolactone appears more effective than eplerenone among mineralocorticoid receptor antagonists. Sacubitril/valsartan demonstrates promising superiority in preclinical and early clinical cohorts, though further randomised control trials are ongoing. Metabolic modulators such as metformin and sodium-glucose cotransporter 2 inhibitors exhibit cardio-protectivity via AMPK activation, attenuation of oxidative and inflammatory pathways, but evidence in non-diabetic cancer populations is limited. Statins have shown reduced left ventricular ejection fraction decline and lower cardiotoxicity rates in randomised studies, while dexrazoxane-through iron chelation and topoisomerase IIβ inhibition-remains the only approved agent for anthracycline-induced cardiotoxicity prevention, strongly supported by adult and paediatric data.</p><p><strong>Conclusion: </strong>Several pharmacologic strategies offer potential benefit in limiting anthracycline-induced cardiotoxicity and preserving cardiac function. Tailored, risk-based approaches that incorporate cardioprotective therapies early in anthracycline treatment-guided by biomarkers and imaging-are most promising. Further large-scale randomised studies are required to establish optimal combinations and confirm long-term benefit.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 1","pages":"2"},"PeriodicalIF":1.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Pulmonary Edema Following Minimally Invasive Valve Surgery via Right Thoracotomy: A Word of Caution.","authors":"Ahmed A Arifi, Ahmed M Metwaly, Fayez F Al Mutairi, Bandar Zamzami, Islam Shalaby","doi":"10.37616/2212-5043.1473","DOIUrl":"https://doi.org/10.37616/2212-5043.1473","url":null,"abstract":"<p><p>We report the first case of unilateral pulmonary edema (UPE) in our series of 150 patients undergoing minimally invasive mitral and tricuspid valve surgery via right thoracotomy. A 30-year-old female with rheumatic heart disease developed UPE requiring temporary extracorporeal membrane oxygenation (ECMO) support postoperatively. The patient recovered uneventfully and was discharged on postoperative day 15. This case underscores the importance of recognizing and mitigating UPE in minimally invasive cardiac surgery (MICS).</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 1","pages":"1"},"PeriodicalIF":1.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute STEMI in a Young Adult on Therapeutic Anticoagulation Following Diclofenac Use.","authors":"Naeem Hasanfatta, Naveed Ahmed, Debabrata Dash","doi":"10.37616/2212-5043.1470","DOIUrl":"https://doi.org/10.37616/2212-5043.1470","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndrome (ACS) in young adults is uncommon. The case of a 34-year-old male, post mechanical mitral valve replacement (MVR), who developed anterior ST-elevation myocardial infarction (STEMI) despite therapeutic anticoagulation (INR 3.17), shortly after the initiation of diclofenac, highlights an important clinical scenario.</p><p><strong>Case presentation: </strong>The patient presented with atypical upper back pain and was diagnosed with anterior STEMI. Coronary angiography revealed a 100 % thrombotic occlusion in the mid left anterior descending (LAD) artery. Percutaneous transluminal coronary angioplasty (PTCA) was successfully performed. Importantly, the patient had no history of hypercoagulable states or atherosclerosis and had been compliant with oral anticoagulation therapy. He had been initiated on diclofenac therapy nine days prior to symptom onset.</p><p><strong>Conclusion: </strong>This case highlights the serious thrombotic risks associated with NSAID use, even in patients adequately anticoagulated with acenocoumarol. It underscores the necessity of careful NSAID prescribing and demonstrates that therapeutic INR does not offer protection from platelet-driven thrombotic events.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"18"},"PeriodicalIF":1.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saudi Heart Association Position Statement on Early Detection of Subclinical Atherosclerosis in Clinical Practice.","authors":"Waleed Alhabeeb, Abdulrahaman Almoghairi, Abdulhalim Kinsara, Abdullah T Khoja, Adel Tash, Halia AlShehri, Khalid Al Faraidy, Mohammed A Batais, Mohammed Balghith, Mostafa Alshamiri, Taher Hassan","doi":"10.37616/2212-5043.1455","DOIUrl":"https://doi.org/10.37616/2212-5043.1455","url":null,"abstract":"<p><strong>Background: </strong>Atherosclerosis is the leading underlying cause of cardiovascular disease (CVD), which remains the primary cause of mortality in Saudi Arabia. Saudi patients experience CVD events nearly a decade earlier than their Western counterparts. Given the limitations of traditional risk assessment tools, there is a growing need to detect subclinical atherosclerosis to refine risk stratification and improve primary prevention strategies, particularly in younger and asymptomatic individuals.</p><p><strong>Methods: </strong>The Saudi Heart Association (SHA) developed this position statement through a structured, multistep process that included a comprehensive literature review and two expert panel meetings. Recommendations were formulated based on current evidence, expert consensus, and consideration of population-specific characteristics and healthcare infrastructure in Saudi Arabia. The final recommendations were reviewed by the expert panel to ensure scientific accuracy and relevance to local practice.</p><p><strong>Results and conclusions: </strong>The SHA recommends systematic screening for subclinical atherosclerosis in individuals aged 35 years or older with borderline or intermediate 10-year ASCVD risk (5-20 %). Subclinical atherosclerosis can be assessed using validated non-invasive imaging modalities: coronary artery calcium (CAC) scoring, coronary computed tomography angiography (CCTA), carotid ultrasound, or ankle-brachial index (ABI). CAC scoring is the most validated modality, especially in individuals aged ≥40 years, while CCTA offers the advantage of detecting both calcified and non-calcified plaques. Carotid ultrasound can be advantageous in younger adults, and ABI is useful in older adults. Management should be tailored to disease burden: lifestyle modification is advised for individuals with minimal disease, while moderate-to high-intensity statin therapy is recommended in those with mild or moderate to severe subclinical disease. These recommendations aim to support evidence-based integration of subclinical atherosclerosis screening into routine clinical practice, facilitating earlier interventions and reducing the burden of cardiovascular disease in Saudi Arabia.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"17"},"PeriodicalIF":1.3,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Observational Study on Role of Intraoperative Renal & Muscle Oxygen Saturation on Post-operative Serum Creatinine Level in Patients Undergoing Cardiac Surgery on Cardiopulmonary Bypass.","authors":"Bhakti Banerjee, Haripada Das, Lini Srivastava, Snigdha Pramanik, Diptimay Majumder","doi":"10.37616/2212-5043.1469","DOIUrl":"https://doi.org/10.37616/2212-5043.1469","url":null,"abstract":"<p><strong>Objective: </strong>Near-infrared spectroscopy (NIRS), can be used to monitor renal tissue oxygenation (SrO₂), as well as thenar muscle oxygenation (SmO₂). In this study, we have examined the ability of SrO₂ and SmO₂ in predicting cardiac surgery related change in serum creatinine level (ΔsCr) and explored any correlation between these two parameters.</p><p><strong>Methods: </strong>This study included 55 adult patients (18-60 years), who were scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB), having no pre-existing renal impairment, with skin-to-kidney depth of <4 cm at superior lumbar region which was detected by preoperative ultrasonography examination. NIRS sensors were applied on the superior lumber region to measure SrO₂ and on thenar eminence for SmO₂, preoperatively. ΔsCr was investigated at 24, 48 and 72 hours post-operatively. Relative thresholds of SrO₂ and SmO₂ were quantified using the area-under curve; expressed in % min.</p><p><strong>Results: </strong>Area under the receiver-operating characteristic curve (AUROC) analyses showed SrO₂ decrease >20 % from baseline can significantly predict (AUROC 0.921; p = 0.001) post-operative ΔsCr. SmO₂ decreased 15 % from baseline (AUROC 0.843; p = 0.001) is a better predictor of ΔsCr than its fall >20 % from baseline (AUROC 0.749; p = 0.002). Correlation analysis revealed that the 15 % and >20 % decrease of SmO2 below baseline (Spearman's rho 0.593 and 0.606 respectively) had significant (p = 0.01) positive correlation with decrease of SrO₂ >20 % from baseline.</p><p><strong>Conclusion: </strong>SrO₂ and SmO₂ have significant predictive values for post-cardiac surgery rise in serum creatinine, and there is strong positive correlation between them.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"14"},"PeriodicalIF":1.3,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saudi Heart Association Position Statement on NT-proBNP for Cardiovascular Risk Screening in Asymptomatic Adults With Type 2 Diabetes Mellitus.","authors":"Waleed AlHabeeb, Adel Tash, Abdullah M Abdullah Arabe, Lamya AlZubaidi, Ayman Al Hayek, Mohammed R Al Safi, Malak A Almashali","doi":"10.37616/2212-5043.1466","DOIUrl":"https://doi.org/10.37616/2212-5043.1466","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) is a chronic disease with a rapidly increasing prevalence, posing a significant public health challenge worldwide and in Saudi Arabia. Cardiovascular disease (CVD) is the leading cause of death among patients with T2DM, necessitating early detection and intervention to prevent disease progression. Elevated natriuretic peptide levels, particularly N-terminal pro-B-type natriuretic peptide (NT-proBNP), are promising biomarkers for CVD risk stratification in individuals with T2DM. However, the integration of these biomarkers in clinical management remains limited.</p><p><strong>Methods: </strong>Published evidence and existing guidelines/consensuses related to the use of NT-proBNP for CVD risk stratification in T2DM patients were reviewed and discussed by a multidisciplinary expert panel from Saudi Arabia. The panel also considered the unique characteristics of the local Saudi population, healthcare system, resources, and medical expertise.</p><p><strong>Results and conclusions: </strong>NT-proBNP-based screening holds significant promise for improving CVD outcomes in T2DM patients by identifying at-risk individuals and guiding management approaches. Based on available evidence, the Saudi Heart Association (SHA) developed an evidence-based position statement on the use of NT-proBNP for CVD risk stratification in patients with T2DM who have no established CVD (asymptomatic). The proposed algorithm for NT-proBNP-based screening aims to improve the early identification of at-risk patients with T2DM, inform clinical management decisions, and enhance patient outcomes in Saudi Arabia. The algorithm includes age-adapted thresholds to reduce unnecessary referrals and medical testing. The SHA recognizes the need for further research and local data collection on NT-proBNP-based screening, in addition to clinician training to address the limitations and improve the practical implementation of NT-proBNP screening in routine clinical practice.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"15"},"PeriodicalIF":1.3,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Transcatheter Mitral Valve Repair (MitraClip) Compared to Medical Therapy and Surgery in Patients With Secondary Mitral Regurgitation: A Systematic Review & Pairwise Meta-analysis.","authors":"Salma Younas, Aditya Rana, Mirza F A Beig, Sweta Sahu, Cynthia E Emanemua, Aisha A Reshie, Lamees Kaukab, Dileep Duggineni, S K S S P A Gokavarapu, Padamati Bhavani, Afrasayab Khan, Peter G Fattal","doi":"10.37616/2212-5043.1467","DOIUrl":"https://doi.org/10.37616/2212-5043.1467","url":null,"abstract":"<p><strong>Background: </strong>Secondary mitral regurgitation (SMR) worsens outcomes in heart failure. Transcatheter mitral valve repair (MitraClip/TMVr) is an established alternative for patients who remain symptomatic on guideline-directed medical therapy (GDMT), but comparative efficacy versus GDMT and surgery has been debated.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and Cochrane through February 2025. To avoid double counting, quantitative syntheses used unique randomized controlled trials (RCTs) only; RCT substudies informed qualitative context. Pairwise random-effects meta-analyses compared MitraClip + GDMT vs GDMT and MitraClip vs surgery. Primary outcomes were all-cause mortality and heart-failure hospitalization (HFH). Secondary outcomes included quality of life (Kansas City Cardiomyopathy Questionnaire (KCCQ), MR ≤ 2+, stroke/MI, and major adverse events (MAE). Heterogeneity was explored with I²/τ², leave-one-out, and prespecified sensitivity analyses per Cochrane/JBI guidance.</p><p><strong>Results: </strong>Nineteen studies were included, of which 5 unique Randomized Control Trials (RCTs) (n = 1912 randomized) contributed to pooling. Versus GDMT, MitraClip reduced mortality (RR 0.77, 95 % CI 0.63-0.95; I² = 73 %) and (Heart Failure Hospitalization) HFH (RR 0.76, 0.65-0.89; I² = 90 %), and improved KCCQ (MD + 13.7 points, 6.6-20.7). Including all available comparators across RCTs, mortality remained lower with MitraClip (RR 0.80, 0.65-1.00; p = 0.047; I² = 26 %). Versus surgery, MitraClip had fewer 30-day MAE (Major Adverse events) (RR 0.29, 0.21-0.40; I² = 0 %), with no difference in 1-year mortality and similar MR ≤ 2+ at ~1 year. Stroke/MI were comparable. Procedural success exceeded 96 %; partial clip detachment occurred in 1-2 %.</p><p><strong>Conclusions: </strong>In contemporary RCTs, MitraClip on top of GDMT lowers mortality and HF hospitalizations and improves quality of life in SMR. Compared with surgery, TMVr offers a superior early safety profile with similar MR reduction at ~1 year. These results support Heart-Team use of MitraClip after optimized GDMT in anatomically suitable SMR, while reserving surgery for selected scenarios.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"16"},"PeriodicalIF":1.3,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}