Defensive Medicine in an Emergency Department: The Overuse of High-Sensitivity Cardiac Troponin I Testing.

Introduction: Cardiac troponin I is routinely measured in patients with suspected acute coronary syndrome. However, when a high-sensitivity cardiac troponin I (hs-cTnI) test is ordered without a clear clinical indication, unexpectedly elevated levels can lead to unnecessary diagnostic workups and inappropriate management. This study aimed to investigate physicians' rationale for performing hs-cTnI tests in an emergency department (ED).

The Exposome and Cardiovascular Health: Webcast December 12 2024.

This 61-minute webcast features a conversation about "The Exposome and Cardiovascular Health"-the focus of Issue 20.5. Led by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles.

Cardiac MRI Evaluation of Determinants and Prognostic Implications of Right Ventricular Dysfunction in Aortic Regurgitation.

Purpose To investigate the determinants and effect of right ventricular (RV) dysfunction in aortic regurgitation (AR) using cardiac MRI. Materials and Methods This study included patients with moderate or severe AR who were enrolled in the DEBAKEY-CMR registry between January 2009 and June 2020. Patients with previous valve intervention, cardiomyopathy deemed unrelated to AR, severe aortic stenosis, and other confounders were excluded.

Pulmonary Embolism: Webcast June 13 2024.

This 61-minute webcast features a conversation about "Pulmonary Embolism"-the focus of Issue 20.3. Hosted by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles.

Optimal Cerebral Protection Confirmed by Transcranial Doppler During Transcarotid Artery Revascularization.

Transcarotid artery revascularization (TCAR) is a novel method to treat severe stenosis of the carotid artery with minimal embolization. During TCAR, flow reversal system redirects blood from the internal, external, and common carotid arteries into the femoral vein through a filter system to prevent debris and microparticles from entering the cerebral circulation. Transcranial Doppler (TCD) monitoring allows real-time detection of blood flow in the cerebral arteries during the operation and informs the surgeon of flow changes or possible emboli.

Women and the Heart: Webcast April 16 2024.

This 62-minute webcast features a conversation about "Women and the Heart: Gender-Related Differences in Cardiovascular Care"-the focus of Issue 20.2. Led by the issue's editor, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles.

Nuclear respiratory factor-1 (NRF1) induction drives mitochondrial biogenesis and attenuates amyloid beta-induced mitochondrial dysfunction and neurotoxicity.

Mitochondrial dysfunction is an important driver of neurodegeneration and synaptic abnormalities in Alzheimer's disease (AD). Amyloid beta (Aβ) in mitochondria leads to increased reactive oxygen species (ROS) production, resulting in a vicious cycle of oxidative stress in coordination with a defective electron transport chain (ETC), decreasing ATP production. AD neurons exhibit impaired mitochondrial dynamics, evidenced by fusion and fission imbalances, increased fragmentation, and deficient mitochondrial biogenesis, contributing to fewer mitochondria in brains of AD patients.

Nuclear respiratory factor-1 (NRF1) induction as a powerful strategy to deter mitochondrial dysfunction and senescence in mesenchymal stem cells.

Mesenchymal stem cells (MSCs) are promising candidates for regenerative therapies due to their self-renewal and differentiation capabilities. Pathological microenvironments expose MSCs to senescence-inducing factors such as reactive oxygen species (ROS), resulting in MSC functional decline and loss of stemness. Oxidative stress leads to mitochondrial dysfunction, a hallmark of senescence, and is prevalent in aging tissues characterized by elevated ROS levels.

Inclisiran as a siRNA Inhibitor of Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9); Past, Present, and Future.

Reducing low-density lipoprotein cholesterol (LDL-C) levels has been shown to reduce the risk of developing atherosclerotic cardiovascular disease (ASCVD). Statins are the foundation of LDL-C lowering therapy with other non-statin agents used in circumstances where goal LDL-C levels are not reached or owing to intolerance to adverse effects of statins. In 2003, the discovery of the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) system in promoting elevated LDL-C levels led to new avenues of drug development to achieve target LDL-C.

Standardizing social determinants of health data: a proposal for a comprehensive screening tool to address health equity a systematic review.

Social determinants of health (SDoH) significantly impacts health outcomes and disparities. While the Centers for Medicare and Medicaid Services has mandated hospitals to collect standardized SDoH data, existing tools lack key elements. This systematic review identified 78 studies and 20 screening tools addressing various SDoH domains.

GLP-1 Receptor Agonist in Non-obese Patients with Type-2 Diabetes Mellitus and Heart Failure with Preserved Ejection Fraction.

Background: Glucagon like peptide-1 receptor agonists (GLP-1RA) promote weight loss and improve heart failure-related symptoms, quality of life, and functional capacity in patients with obesity and heart failure with preserved ejection fraction (HFpEF). However, their clinical effectiveness in non-obese patients with diabetes and HFpEF is understudied.

Methods: The TriNetX research network was used to identify adult patients (≥18 years) with type 2 diabetes mellitus (T2DM), Heart failure with preserved ejection fraction ((Left ventricular ejection fraction ≥45%), elevated brain natriuretic peptide (≥150pg/mL) or N-terminal pro-B-type natriuretic peptide(≥450pg/mL) and a body mass index (BMI) <30 kg/m2 on or before August 31, 2022.

Sex Differences in Patients Undergoing FFR-Guided PCI or CABG in the FAME 3 Trial.

Background: Outcomes in women after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown.

Objectives: This study sought to evaluate differences in clinical outcomes according to sex after FFR-guided PCI with current generation DES compared with CABG.

Methods: The FAME 3 trial was an investigator-initiated, randomized controlled trial, comparing FFR-guided PCI with current generation DES or CABG in patients with 3-vessel coronary artery disease.

Diuretic efficiency of a single dose of subcutaneous versus oral furosemide after heart failure hospitalization across diuretic resistance strata: A pilot randomized controlled trial.

Aims: Diuretic resistance (DR) in heart failure (HF) is associated with worse outcomes. Furoscix®, a self-administered subcutaneous (sc) furosemide injection administered via on-body infusor, is approved for HF congestion relief. However, its efficacy in patients with DR post-HF hospitalization remains unknown.

Association between Polysocial Risk Score and CVH among Women of Reproductive Age in the SAFE HEART Study: An American Heart Association Research Goes Red Initiative: "Polysocial Risk and Cardiovascular Health in Women of Reproductive Age".

Background: To assess the association between polysocial risk factors and cardiovascular health (CVH) among women of reproductive age.

Methods: Our cross-sectional analysis included women of reproductive age (18-44 years) from community settings and the American Heart Association's Research Goes Red (RGR) registry. Polysocial risk scores (0-14) reflected social disadvantage across domains including socioeconomic stability (education, employment, income, insurance, financial strain), living situation (housing stability, housing quality, marital status, home ownership), food security, transportation, utilities, and interpersonal safety.

Heart Failure and All-Cause Hospitalizations in Patients With Heart Failure: A Meta-Analysis.

Importance: Heart failure (HF) hospitalization is a common end point in HF trials; however, how HF hospitalization is associated with all-cause hospitalization in terms of proportionality, correlation of treatment effects, and concomitant reporting has not been studied.

Objective: To determine the ratio of HF to all-cause hospitalizations, whether reported treatment effects on HF hospitalization are associated with treatment effects on all-cause hospitalization, and how often all-cause hospitalization is reported alongside HF hospitalization.

Data Sources: PubMed was searched from inception to September 2, 2024, for randomized clinical trials (RCTs) of HF treatments using MeSH (medical subject heading) terms and keywords associated with heart failure, ventricular failure, ventricular dysfunction, and cardiac failure, as well as the names of specific journals.

Terbutaline for Management of Relative Bradycardia Post-Orthotopic Heart Transplant: A Single Center Experience.

Background: Vagal nerve denervation during the heart transplant procedure results in higher resting heart rates in these recipients compared to the general population. Relative bradycardia (RB) is a common and often temporary post-operative complication that can be managed with agents like terbutaline; however, little data exist on the efficacy, safety, and necessity of long-term terbutaline use post-heart transplant.

Methods: This was a single-center, retrospective, descriptive study conducted at a large academic medical center investigating oral terbutaline use for RB management in heart transplant recipients.

Cost-effectiveness of TAVI in the United Kingdom: a long-term analysis based on 4-year data from the Evolut Low Risk Trial.

Background: The cost-effectiveness of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) has previously been reported across the spectrum of surgical mortality risk. We present an updated analysis specific to the UK based on 4-year data from the Evolut Low Risk Trial, which showed a maintained numerical survival benefit with TAVI.