BackgroundCHA2DS2-VASc score in cardiac amyloidosis (CA) with atrial fibrillation (AF) is believed to underestimate ischemic stroke risk, necessitating a better predictive model.MethodsData were obtained from the National Readmission Database (NRD). Outcomes between CA-AF and no-CA-AF were compared using multivariate regression analysis to calculate adjusted odds ratios (aORs). AutoScore, an interpretable machine learning framework, was used to develop a stroke risk prediction model, and its predictive accuracy was evaluated with an area under the curve (AUC) using the receiver operating characteristic analysis.ResultsA total of 11,860,804 (CA-AF 22,687 (0.19%) and no-CA-AF 11,838,117) patients were identified from 2015 to 2019. The adjusted odds of mortality (aOR: 1.41 and 1.29), stroke (aOR: 1.78 and 1.74), non-intracranial hemorrhage (aOR: 2.10 and 1.85), and intracranial hemorrhage (aOR: 14.4 and 4.26) were significantly higher in CA-AF compared with non-CA-AF at both index admission and 30 days, respectively. The CHA2DS2-VASc score had a poor discriminative accuracy for stroke at 30 days in CA-AF (AUC 49%, 95% confidence interval (CI): 47 - 51, P = 0.54). The machine learning autoscore integrative model revealed excellent predictive ability of our newly proposed E-CHADS score (end-stage renal disease (ESRD), congestive heart failure (CHF), hypertension (HTN), cancer, dementia, and diabetes mellitus (DM)) for 30-day risk of ischemic stroke in CA-AF (cutoff of 52 points random forest score) with an AUC of 80% (95% CI: 74 - 86).ConclusionsCA with AF carries a high risk of ischemic stroke that is not accurately predicted by the CHA2DS2-VASc score. Our proposed model (E-CHADS) identifies three new variables (ESRD, dementia, and cancer) that have higher discriminative accuracy for ischemic stroke in these patients.

BackgroundTranscatheter aortic valve replacement (TAVR) has emerged as a primary therapeutic option for patients with severe aortic stenosis across all surgical risk categories. Alternative access site (AAS) routes are often used in patients unsuitable for standard transfemoral (TF) approach, though intravascular lithotripsy (IVL) provides novel remedies to traditionally “unsuitable” patients. The objectives of our study were to compare outcomes between AAS TAVR placement and lithotripsy-assisted TF TAVR.MethodsThe authors analyzed 60 patients who underwent TAVR between 2019 and 2022 (41 with alternative access, 19 with lithotripsy) at a single US site. Primary outcomes included procedural success, adverse events at 1 month and 1 year, length of stay, and 3-year mortality.ResultsThe data trended towards higher 1-month adverse outcomes in the alternative access patients compared to TF lithotripsy patients (17.1% (95% confidence interval (CI): 8.5% - 31.3%) vs. 0% (95% CI: 0.0% - 16.8%); P = 0.09), while 1-year adverse outcomes were similar (AAS 12.2% (95% CI: 5.3% - 25.5%) vs. IVL 15.8% (95% CI: 5.5% - 37.6%); P = 0.70), and 3-year mortality (19.5% vs. 21.1%) were similar between groups. Median length of stay was 3 days for both groups.ConclusionsLithotripsy-assisted TF TAVR demonstrated a statistically insignificant trend toward short-term major adverse events with comparable 1-year morbidity and 3-year mortality to alternative access approaches. These findings may support lithotripsy as a viable option for patients with challenging vascular anatomy rather than the more traditional use of AAS in these settings. However, more extensive research is necessary for appropriate statistical power to prove superiority rather than equivocality alone.

BackgroundHypertension is a growing public health concern in India, increasingly interlinked with metabolic disorders such as diabetes and characterized by significant regional and demographic variation. Despite advancements in diagnosis and treatment, control rates remain unsatisfactory. Elevated resting heart rate (HR), an emerging marker of sympathetic overactivity, may offer additional insight into the underlying pathophysiology of Indian hypertensives. The objective of the study was to assess the prevalence of hypertension across India, explore its association with diabetes, elevated HR, and regional variation, and evaluate the potential role of sympathetic overdrive as a common pathophysiological thread.MethodsA nationwide, cross-sectional survey was conducted among 41,370 adults across 31 Indian regions. Data on systolic and diastolic blood pressure, resting HR, diabetes history, age, gender, and region were collected and analyzed to identify patterns of comorbidity and demographic distribution.ResultsOverall hypertension prevalence was 29.8% (95% confidence interval (CI): 29.4 - 30.2), higher among males, 33.2% (95% CI: 32.6 - 33.8) than females, 27.2% (95% CI: 26.6 - 27.8). A notable proportion (14.6%, 95% CI: 14.2 - 15.0) of hypertensives also had diabetes, with this comorbidity more prevalent in males (15.8%, 95% CI: 15.2 - 16.4) than females (13.3%, 95% CI: 12.8 - 13.8). The mean resting HR was 83.9 bpm across all participants, exceeding 80 bpm even among normotensives, and was highest in diabetic hypertensives (85.9 vs. 82.2 bpm in non-diabetics; P < 0.05). Hypertension was more common in older adults, males, and those residing in urbanized or rapidly transitioning regions. Though obesity data were not captured, the strong associations between hypertension, diabetes, and elevated HR point toward underlying metabolic dysfunction and sympathetic overactivity.ConclusionThis large-scale survey reinforces the complex cardiometabolic burden in India and highlights elevated resting HR as a potential surrogate marker of sympathetic overactivity in hypertensives, especially those with diabetes. Regional and demographic disparities underscore the need for integrated, population-specific approaches that go beyond blood pressure control to address the broader spectrum of metabolic and autonomic dysfunction.

BackgroundObtaining commissural alignment in transcatheter aortic valve replacement (TAVR) is important for ensuring coronary access and coronary artery filling, reducing the risk of central leaks, and minimizing leaflet stress. The Evolut FX system has the gold markers placed at the neo-commissures and has demonstrated favorable outcomes. We investigated whether evaluating the orientation of the gold markers in a three-cusp coplanar view (3-CV) after Evolut FX implantation was useful for assessing commissural misalignment (CMA).MethodsBetween April 2023 and December 2024, we included 25 patients who underwent transfemoral TAVR using the Evolut FX for symptomatic severe aortic stenosis. All patients underwent multidetector computed tomography (CT) after TAVR. The native-prosthetic gap (NPG) was defined as the distance between the center of the transcatheter heart valve stent frame and the central gold marker in a 3-CV. We evaluated the association between the NPG and CMA, which was derived from the average misalignment deviation on post-TAVR CT.ResultsThe median age was 84 years, 36% were male, and 8% had coronary artery disease. The implanting view was the cusp overlap view (COV) in 11 patients, the near-COV in 11 patients, and the left anterior oblique view in three patients. Of the 22 patients implanted using the COV or near-COV, the gold markers were positioned at “2 left-1 right” in 17 patients. The average misalignment deviation was 18.0° (commissural alignment: eight patients, mild CMA: 13 patients, moderate CMA: two patients, and severe CMA: two patients) and the median NPG was 0.11. In cases with commissural alignment and mild CMA, NPG showed a significant positive correlation with the average misalignment deviation (r = 0.68, P < 0.01), whereas in cases with moderate and severe CMA, the relationship was inverse (r = -0.38, P = 0.62). Further, in cases with commissural alignment and mild CMA, a clockwise misalignment occurred when the central marker was positioned closer to the non-coronary cusp side, while a counterclockwise misalignment was observed when positioned closer to the left-coronary cusp side.ConclusionsEvaluating the orientation of the gold markers in a 3-CV after Evolut FX implantation is useful for assessing CMA.

BackgroundInterhospital transfer of ST-elevation myocardial infarction (STEMI) patients can lead to greater access to percutaneous coronary intervention (PCI) and reduce mortality. However, it is unclear how the characteristics of the transferring and receiving hospitals impacts mortality of transferred STEMI patients.MethodsIn this retrospective cohort study, we estimated differences in mortality among STEMI patients undergoing interhospital transfer using Kaplan-Meier survival curves and adjusted hazard ratios derived from Cox proportional hazard models.ResultsWe found that partial PCI capability (i.e., retaining some patients while transferring others for PCI) of the transferring hospital and lower quality of the receiving hospital were associated with lower survival.ConclusionsInterhospital transfers driven by factors other than distance and quality can negatively affect patient outcomes.

BackgroundAcute myocardial infarction (AMI) is one of the most severe forms of acute coronary syndrome. During myocardial ischemia, cardiac glycogen is metabolized through glycolysis, which becomes the primary source of ATP. The genetic regulation of glycolysis is well established, yet its contribution to AMI pathogenesis remains poorly understood. This study aimed to use bioinformatics approaches to identify glycolysis-related genes (GRGs) associated with AMI, providing a foundation for their potential applications as molecular markers and therapeutic targets.MethodsGRGs were retrieved from the GeneCards database. Weighted gene co-expression network analysis (WGCNA) was applied to the GSE66360 dataset to identify hub genes, which were validated by the Wilcoxon rank-sum test and the receiver operating characteristic (ROC) curve analysis. Immune cell infiltration and its association with hub gene expression in AMI were further examined using the CIBERSORT algorithm.ResultsAnalysis of the GSE66360 dataset identified 695 differentially expressed genes (DEGs). Gene set enrichment analysis (GSEA) indicated that these genes may contribute to AMI pathogenesis by regulating cellular energy metabolism. Intersecting DEGs with GRGs yielded 31 differentially expressed glycolysis-related genes (DEGRGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses suggested that DEGRGs may influence AMI development by modulating immune cell function and immune response status. Construction of a protein-protein interaction (PPI) network identified seven hub genes, all of which demonstrated diagnostic performance in GSE66360 based on the ROC analysis. Validation in the independent dataset GSE59867 confirmed two hub genes with diagnostic potential. Immune infiltration analysis further revealed that these two hub genes were significantly associated with multiple types of immune cells.ConclusionTwo GRGs, S100A8 and CXCL1, were identified as potential biomarkers and therapeutic targets in AMI. Both genes were associated with immune cell infiltration, suggesting that they may contribute to AMI pathogenesis through immunometabolic regulation. Importantly, combined detection of these hub genes may facilitate early risk stratification and prediction of major adverse cardiac events, offering a new direction for AMI diagnosis and prognosis.

BackgroundN-terminal pro-brain natriuretic peptide (NT-proBNP) is a key biomarker in heart failure (HF) diagnosis and management. This study aimed to evaluate performances of the LumiraDx® NT-proBNP, a point-of-care testing (POCT) device, focusing on imprecision, method comparison, and clinical practicability.MethodsThe LumiraDx® NT-proBNP test was assessed for imprecision across two reagent lots and compared with a reference laboratory method (Cobas e601) using 81 plasma samples. Method concordance was analyzed using Bland-Altman and Passing-Bablok regression. A user satisfaction survey evaluated its practicality in a clinical setting.ResultsFor the first reagent lot, a coefficient of variation (CV) of 2.81% was observed, while for the second reagent lot, the CV was 5.4%. Method comparison revealed strong concordance with the reference method for NT-proBNP values < 1,000 ng/L. However, a significant bias was observed for values > 1,000 ng/L in the first lot, resolved in the second. User satisfaction surveys highlighted ease of use. Additionally, implementing the LumiraDx® NT-proBNP Platform resulted in a significant reduction in turnaround time, with an estimated 49 min saved in result reporting.ConclusionThe LumiraDx® NT-proBNP POCT device demonstrates strong potential for HF management by combining rapid results, user-friendly operation, and sampling versatility. While biases at higher NT-proBNP levels warrant further standardization, this system represents a practical tool for decentralized HF care.

BackgroundTranscatheter closure of secundum atrial septal defects (ASDs) is a widely accepted intervention in adults with left-to-right shunting and right heart volume overload. However, the time course and magnitude of cardiac remodeling and functional improvement after closure remain incompletely defined. This study evaluated serial echocardiographic changes in right heart structure and hemodynamics following ASD closure.MethodsIn this single-center retrospective cohort, adults who underwent transcatheter secundum ASD closure between January 2020 and December 2023 were included. Echocardiography was performed at baseline, immediately post-procedure, at 3 to 6 months, and at 1 year. Parameters included right atrial (RA) area and volume index (RAVI), right ventricular (RV) dimensions, pulmonary valve velocities, RV systolic pressure (RVSP), mean pulmonary artery pressure (mPAP), tricuspid annular plane systolic excursion (TAPSE), and tricuspid regurgitation (TR) severity. Analyses used Wilcoxon signed-rank tests, Chi-square tests, repeated-measures analysis of variance (ANOVA)/multivariate ANOVA (MANOVA), and mixed-effects models.ResultsEighty patients were included (mean age: 42.3 ± 15.0 years; 72.5% female). Immediately after closure, significant reductions were observed in TR Vmax (-20.8 cm/s, P = 0.0005), pulmonary valve Vmax (-32.1 cm/s, P < 0.0001), Vmean (-18.6 cm/s, P < 0.0001), velocity time integral (VTI) (-6.9 cm, P < 0.0001), RA area (-2.6 cm2, P < 0.0001), RAVI (-7.0 mL/m2, P < 0.0001), RVSP (-7.7 mm Hg, P < 0.0001), QP:QS (-0.8, P ≤ 0.0001), and mPAP (-10.0 mm Hg, P = 0.0007). Improvements were sustained at 3 - 6 months (n = 54) and at 1 year (n = 19).ConclusionsTranscatheter ASD closure in adults results in early and sustained improvements in RA and ventricular remodeling, pulmonary pressures, and TR severity. These findings underscore the role of echocardiography in longitudinal surveillance and support timely intervention in patients with significant shunting (QP:QS > 1.5). Larger multicenter studies with extended follow-up and correlation to clinical outcomes are warranted.

An 80-year-old woman with persistent atrial fibrillation was referred to our hospital for evaluation of a left atrial mass. Transthoracic and transesophageal echocardiography revealed a well-defined, sessile, and immobile mass attached to the interatrial septum. Computed tomography (CT) coronary angiography revealed a cardiac tumor fed by two vessels: one from the right coronary artery and one from the left circumflex artery. Based on these findings and cardiac magnetic resonance imaging, the mass was diagnosed as a left atrial myxoma, and excision was performed. Although some atrial myxomas are highly vascular, identification of multiple feeding vessels on CT coronary angiography is rare. Preoperative evaluation of feeding vessels is helpful in distinguishing myxomas from left atrial thrombi, especially in patients with hypercoagulability.

Carney complex is a multiple endocrine neoplasia syndrome, commonly affecting the thyroid, adrenal, and pituitary glands. In addition to endocrine involvement, tumors and myxomas may develop including cardiac myxomas and schwannomas. Approximately 70% of cases result from autosomal dominant germline mutation, with the remaining 30% representing de novo spontaneous mutations. Carney complex remains extremely rare, with only approximately 750 cases reported worldwide since 1985. We present an adolescent with Carney complex who underwent left atrial myxoma resection, followed by bilateral adrenalectomy a few years later. The perioperative implications of Carney complex are presented, previous reports of anesthetic care in these patients reviewed, and options for anesthetic management discussed.