Mixed Cardiogenic-Vasodilatory Shock: Current Insights and Future Directions.

This state-of-the-art review describes the potential etiologies, pathophysiology, and management of mixed shock in the context of a proposed novel classification system. Cardiogenic-vasodilatory shock occurs when cardiogenic shock is complicated by inappropriate vasodilation, impairing compensatory mechanisms, and contributing to worsening shock. Vasodilatory-cardiogenic shock occurs when vasodilatory shock is complicated by myocardial dysfunction, resulting in low cardiac output.

Days at Home After Transcatheter Mitral Valve Repair Versus Medical Therapy Alone in Heart Failure.

Background: Transcatheter edge-to-edge repair of the mitral valve (mTEER) reduced a hierarchical end point that included death and heart failure hospitalization in COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation Trial). However, the magnitude to which mTEER increases the number of days a patient spends at home (DAH) in the first few years after treatment, a patient-centered end point not captured routinely in clinical trials, has not been evaluated. We compared 1- and 2-year DAH among patients with functional mitral regurgitation and heart failure randomized to mTEER plus medical therapy versus medical therapy alone (control) by linking the COAPT trial to comprehensive health care claims data.

Myocarditis in Patients Starting Combination Checkpoint Inhibitor Therapy: Analysis of a Commercial Claims Database.

Background: Immune checkpoint inhibitors have improved the clinical outcomes of several cancers but have also been associated with a greater risk of immune-related adverse effects, especially when combined. The objective of this study was to investigate the incidence of myocarditis in relation to the use of dual concurrent versus single immune checkpoint inhibitors therapies.

Methods And Results: A cohort study was conducted using medical and pharmacy claims data (2011-2022) from a large US commercial insurer.

Multiparametric Assessment of Right Ventricular Dysfunction in Heart Failure: An Analysis From PARAGON-HF.

Background: This study aims to characterize right ventricular dysfunction (RVD) in heart failure (HF) with preserved ejection fraction and understand the cumulative prognostic value of abnormal RV echocardiographic parameters in HF with preserved ejection fraction.

Methods And Results: Data from 809 patients in the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blocker Global Outcomes in HF With Preserved Ejection Fraction) echocardiographic substudy (55% women, mean age 74±8 years) were analyzed. Correlates of RVD (defined as tricuspid annular plane systolic excursion <1.

Clinical Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction and With Reduced Ejection Fraction According to the Prognostic Nutritional Index: Findings From PARADIGM-HF and PARAGON-HF.

Background: The importance of nutritional status is underappreciated in patients with heart failure (HF). This study aimed to describe the range of the prognostic nutrition index (PNI), and the clinical characteristics and outcomes according to PNI, in patients with HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). The primary outcome was the composite of HF hospitalization or cardiovascular death.

Anatomy-centred deep learning improves generalisability and progression prediction in radiographic sacroiliitis detection.

Purpose: To examine whether incorporating anatomy-centred deep learning can improve generalisability and enable prediction of disease progression.

Methods: This retrospective multicentre study included conventional pelvic radiographs of four different patient cohorts focusing on axial spondyloarthritis collected at university and community hospitals. The first cohort, which consisted of 1483 radiographs, was split into training (n=1261) and validation (n=222) sets.

Impact of Implementing a Grossing Tumor-margin Distance Threshold for Frozen Section in Oncologic Lung Surgery.

Intraoperative frozen section (FS) examination of oncologic surgical specimens is frequently performed to ensure complete surgical resection. Data on the gross evaluation of surgical margins are limited. We recently published a study suggesting the use of a macroscopic 2.

Discontinuation of SGLT-2i and GLP-1RA among persons with Type 2 diabetes and atherosclerotic cardiovascular disease treated in US cardiology clinics.

SGLT-2i and GLP-1RA are recommended for persons with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD) but are underused in clinical practice. The COORDINATE-Diabetes randomized clincal trial evaluated a multi-faceted intervention to increase the use of evidence-based therapies for reducing cardiovascular risk among participants with diabetes and atherosclerotic cardiovascular disease. This analysis reports the discontinuation rate of SGLT-2i and GLP-1RA in follow up and summarises the clinician-reported reasons underlying these decisions.

Representation of Women Among Cardiology Grand Rounds Speakers in the United States.

Importance: Women are underrepresented in leadership positions in cardiology. Institutional grand rounds (GR) are platforms through which faculty can gain professional exposure and access to career development opportunities. The gender diversity of invited cardiology GR speakers has not been investigated.

Medical and Surgical Episodes Among Hospital Participants in the Bundled Payments for Care Improvement-Advanced Program.

Importance: Hospital participation in the Bundled Payments for Care Improvement-Advanced (BPCI-A) initiative has been associated with modest savings and stable clinical outcomes overall, but it is unknown whether the program performs differently for medical and surgical or procedural (henceforth, surgical) episodes.

Objective: To assess the association of BPCI-A participation with Medicare spending and clinical outcomes for medical and surgical episodes.

Design, Setting, And Participants: This retrospective difference-in-differences cohort study utilized 100% Medicare fee-for-service inpatient claims for episodes initiated between January 1, 2017, and September 30, 2019, and included 90 days of follow-up.

Severe pulmonary hypertension in chronic obstructive pulmonary disease - From clinical perspective to histological evidence.

Severe pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) is currently defined by an elevated mean pulmonary arterial pressure and strongly elevated pulmonary vascular resistance >5 wood units. Clinically, these patients show a male predominance, and usually present with very severe dyspnea, severe hypoxemia, strongly decreased exercise capacity and poor prognosis, even though the clinical picture is frequently associated with less severe airflow obstruction. Explanted lung samples of patients with COPD and severe PH show severe remodeling of small pulmonary arterioles, predominantly in the intima and media of the vessels.

Transcriptional profile of the rat cardiovascular system at single-cell resolution.

We sought to characterize cellular composition across the cardiovascular system of the healthy Wistar rat, an important model in preclinical cardiovascular research. We performed single-nucleus RNA sequencing (snRNA-seq) in 78 samples in 10 distinct regions, including the four chambers of the heart, ventricular septum, sinoatrial node, atrioventricular node, aorta, pulmonary artery, and pulmonary veins, which produced 505,835 nuclei. We identified 26 distinct cell types and additional subtypes, with different cellular composition across cardiac regions and tissue-specific transcription for each cell type.

Endpoint Selection in Randomized Clinical Trials for Hypertrophic Cardiomyopathy.

Randomized clinical trials (RCTs) for hypertrophic cardiomyopathy (HCM) have long been challenging caused by the condition's rarity, low event rates, and diverse clinical presentations. However, recent advances in targeted therapies have sparked increased interest in HCM research. Despite this, designing effective RCTs remains complex, particularly in identifying clinically meaningful endpoints.

Left Ventricular Dimensions and Clinical Outcomes With a Fully Magnetically Levitated Left Ventricular Assist Device.

Background: Prior analyses have suggested that a smaller left ventricular end-diastolic diameter (LVEDD) is associated with reduced survival following HeartMate 3 left ventricular assist device implantation.

Objectives: In this trial-based comprehensive analysis, the authors sought to examine clinical characteristics and association with the outcome of this specific relationship.

Methods: The authors analyzed the presence of LVEDD <55 mm among 1,921 analyzable HeartMate 3 patients within the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) trial portfolio, on endpoints of overall survival and adverse events at 2 years.

Changes in Blood Eosinophil Counts Predict the Death of Patients With Myocardial Infarction After Hospital Discharge.

Background: Preclinical studies demonstrate a cardioprotective role of eosinophils in acute myocardial infarction. Yet clinical studies show conflicting correlations between blood eosinophil counts and acute myocardial infarction risk and mortality. This study evaluates blood eosinophil counts of patients with acute myocardial infarction at hospital admission (EOS) and discharge (EOS) on all-cause and cardiac mortalities.

Cardiovascular disease burden in the North Africa and Middle East region: an analysis of the global burden of disease study 1990-2021.

Aims: Cardiovascular diseases (CVD) are a leading cause of mortality and morbidity in the North Africa and Middle East (NAME) region. Due to the paucity of research on this issue, we aimed to estimate the burden of CVD and its attributable risk factors in the NAME region.

Methods And Results: Data from the Global Burden of Disease (GBD) were retrieved to estimate the incidence, prevalence, deaths, years of life lost, years lived with disability, disability-adjusted life years (DALYs) for CVD across 21 countries and both sexes.

Inadequate Intensification of LDL-cholesterol lowering therapy after coronary revascularization: Insights from the GOULD registry.

Background: Patients with a history of coronary revascularization are at a higher risk for subsequent cardiovascular events and all-cause mortality. Lowering LDL-cholesterol (LDL-C) levels post-revascularization significantly reduces these risks.

Methods: This analysis compared LDL-C-lowering therapies at baseline and over time among patients with and without prior coronary revascularization in the GOULD registry (a prospective multicenter cohort study).

Effectiveness of Virtual Care Team Guided Management of Hospitalized Patients with HFrEF by Ethnicity.

Background: IMPLEMENT-HF demonstrated a virtual team-based care strategy was safe and improved prescription of guideline directed medical therapy (GDMT) in hospitalized patients with heart failure and reduced ejection fraction (HFrEF). We evaluated differences in efficacy and safety outcomes by ethnicity in IMPLEMENT-HF.

Methods: IMPLEMENT-HF evaluated a provider-facing virtual team-based care strategy vs.

Performance of Clinical Scoring Systems in the Diagnosis of Transthyretin Amyloid Cardiomyopathy in a Diverse Patient Cohort.

Background: Two diagnostic clinical scoring systems, the ATTR-CM Score and the T-AMYLO Score, have been proposed but not validated in diverse populations, despite Black race being an important risk factor for transthyretin amyloid cardiomyopathy (ATTR-CM). The aim of this study was to evaluate their performance in diagnosing ATTR-CM in a diverse patient cohort.

Methods: This retrospective single-center study analyzed patients who underwent a 99mTc-pyrophosphate single photon emission computed tomography scan (Tc-PYP) for workup of suspected ATTR-CM.

Readmission outcomes after acute coronary syndrome among patients with myeloproliferative neoplasms.

Background And Aims: Myeloproliferative neoplasms (MPNs) are associated with arterial thrombosis, including acute coronary syndrome (ACS). Prior studies have suggested similar in-hospital mortality among patients with MPN compared to those without. However, post-ACS outcomes have not been thoroughly evaluated.

Association of Palliative Care Consultation in Patients With Heart Failure With Preserved Ejection Fraction With Symptom Burden and Health Care Use.

Background: Guidelines recommend palliative care (PC) for patients with heart failure. However, little research has been performed assessing the effect of PC consultation in patients with heart failure with preserved ejection fraction (HFpEF).

Objectives: The purpose of this study was to investigate the impact of PC consultation on symptom burden and health care utilization among individuals with HFpEF during the last 3 years of their lives.

Type 2 diabetes genetic risk and incident diabetes across diabetes risk enhancers.

Aims: To evaluate the predictive value of a contemporary type 2 diabetes (T2D) polygenic score (PGS) in detecting incident diabetes across a range of diabetes risk factors.

Materials And Methods: We analysed participants in the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial (ClinicalTrials.gov, number NCT0176463), which compared the efficacy of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab versus placebo in lowering cardiovascular outcomes in participants with stable atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg/dL (1.