Sentara Healthcare is a not-for-profit healthcare organization serving Virginia and northeastern North Carolina. It is based in Norfolk, Virginia and offers services in 12 acute care hospitals, with 3,739 beds, 853,000 members in its health plan, 10 nursing centers, and three assisted living facilities across the two states. Sentara Healthcare operates its own managed-care plan in Optima Health which covers 450,000 subscribers in the region. It also operates four medical groups.
Predictive biomechanical models of the tricuspid valve require accurate representation of the chordae tendineae, yet subject-specific chordal geometry is difficult to reconstruct from non-invasive imaging. Here, we adopt a framework for generating functionally equivalent synthetic chordae without prior knowledge of in vivo chordal attachments. To this end, we first adapt an anatomy-informed hyperelastic shape-matching method that establishes correspondence between end-diastolic and end-systolic leaflet configurations using chordal-mimicking forces, a rigid contact template, and a Gaussian-smoothed locally corrective pressure field. We then generate synthetic chordal insertion sites using zone-based rejection sampling and calibrate the unloaded length of each chord by combining reaction forces with the chordal stress–stretch relationship. The framework was evaluated using Texas TriValve 1.1, a high-fidelity finite element model of a human tricuspid valve validated against beating-heart echocardiography. We found that shape matching reproduced the target end-systolic geometry with a mean inter-surface distance of 0.29 ± 0.35 mm. Moreover, synthetic chordal insertions faithfully reproduce end-systolic leaflet deformations. We subsequently examined synthetic chordal configurations containing 202, 225, and 450 insertions, informed by measurements from eight explanted human tricuspid valves. Here, increasing insertion number reduced mean inter-surface distance from 0.63 ± 0.52 mm to 0.49 ± 0.44 mm and reduced contact area errors from 3.52% to 0.59%. Across all configurations, mean maximum principal stretch errors in leaflet belly regions remained below 2.4%, while areal strain errors ranged from 0.34% to 10.01%. These results demonstrate that anatomically informed shape matching coupled with stress-based chordal calibration can reproduce tricuspid valve closure without explicit subject-specific chordal geometry. This framework provides a foundation for generating synthetic subvalvular anatomy for future imaging-derived, predictive tricuspid valve models. ### Competing Interest Statement MKR has a speaking agreement with Edwards Lifesciences and LumenexBio. National Heart Lung and Blood Institute, https://ror.org/012pb6c26, R01HL165251, R21HL161832, R21HL17017, F31HL178280, F31HL170754, R01HL184128 American Heart Association, https://ror.org/013kjyp64, 902502, 25IPA1454136
Introduction Advances in cardiovascular precision medicine rely on genetic testing, yet spatiotemporal disparities suggest systemic inequities in access. The Research and Education to Increase Awareness, Genetic INvestigation, and trEatment in Heart Failure (REIMAGINE-HF) investigators sought to integrate temporal, demographic (including race/ethnicity), and geographic proxies to investigate the drivers behind genetic test utilization to evaluate testing of patients for cardiomyopathy and arrhythmia inherited gene variants. Methods We analyzed a dataset of 163,830 unique patients spanning 2015-2024 who received testing from Labcorp Genetics (formerly Invitae). Temporal trends were quantified via the compound annual growth rate (CAGR) and annual variability metrics. The demographic analysis incorporated patients' age-at-testing (categorized into age groups) and clinician-reported race/ethnicity data to determine distributions and potential disparities. Geographic influences were approximated using metropolitan statistical area (MSA) of testing center–based normalization metrics from public datasets. Statistical models, including linear mixed-effects models and age x race and ethnicity interactions, were utilized to assess the combined effects while accounting for geographic variability. Results In this analysis, the CAGR was 35.3% with an urban/rural ratio of 3.2:1 and a peak testing age of 51-70 years (29.3%), (p < 0.001 to p < 0.01). The exponential growth model demonstrated modest predictive power, explaining 56.4% of the variance in testing volumes (p = 0.012327, R-squared: 0.564). The race and ethnicity distributions revealed significant representation imbalances, with White patients constituting the majority (101,223, 61.8%), followed by Black (19,340, 11.8%), Unknown/Other (16,247, 9.9%), Hispanic (12,450, 7.6%), multiple/mixed ethnicity (7,522, 4.6%), and Asian (4,977, 3.0%). The analysis revealed significant year-over-year growth in genetic testing utilization mostly in urban MSAs, demonstrating 3.2 × higher normalized testing rates than rural regions. Conclusions Our integrated spatiotemporal analysis uncovers nuanced disparities, with a higher testing rate for patients >50 years old and a predilection for testing in more urban than rural areas. The juxtaposition of a high urban testing concentration and a distinct age distribution profile underscores the imbalance of genetic screening, suggesting advocacy is essential for targeted strategies to enhance equitable US access to cardiomyopathy and arrhythmia genetic testing.
Introduction Current guidelines recommend genetic testing for all primary cardiomyopathies other than that of ischemic etiology. Given the ease of genetic sampling with saliva or buccal swab testing, and as the care of these patients is highly collaborative and multi-disciplinary, there are multiple opportunities to obtain genetic testing; however, which providers seek genetic testing, and for which indications has not been clearly defined in this population. The Research and Education to Increase Awareness, Genetic INvestigation, and trEatment in Heart Failure (REIMAGINE-HF) consortium therefore sought to examine these characteristics in a large cohort of patients who received cardiac genetic testing from a single diagnostic genetic testing laboratory. Methods We examined de-identified data from individuals who underwent cardiovascular genetic testing from Labcorp Genetics (formerly Invitae) between 2015 - 2024. Clinician provided ICD10 codes as well as ordering clinician specialty were explored in order to provide a descriptive analysis of the landscape of cardiovascular genetic testing. Results A total of 163,830 patients were ordered genetic testing. 48.7% of patients were female, 61.8% clinician reported to be White. 81.3% of all tests were ordered by a physician clinician. Adult Cardiovascular Disease Physician, Clinical Cardiac Electrophysiology Physician, and Advanced Heart Failure & Transplant Cardiology Physician accounted for 30% of all tests ordered. 18% of all tests were ordered by a Clinical Genetics Physician or Genetic Counselor. Pediatric Cardiology Physician and Pediatrics Physician accounted for 17%. The most common ICD10 codes accounting for more than half of all tests were those related to dilated cardiomyopathies (21%), hypertrophic cardiomyopathy (14%), family history of genetic disease or sudden cardiac death (10%), and family history of ischemic heart disease (10%). Conclusion Despite the ease of genetic sampling and current testing, the overwhelming majority of cardiovascular genetic testing are ordered by physicians with a predominance of cardiovascular providers. Despite guideline recommendations that genetic testing be reserved for all primary cardiomyopathies other than that of ischemic etiology, the 3rd most common indication for testing was family history of ischemic heart disease, potentially related to cascade testing. This suggests an opportunity exists for improved multidisciplinary collaboration in genetic testing workflows to prompt up-stream testing by referring non-cardiovascular providers as well as in regard to indication for genetic testing in other cardiomyopathy indications.
Abstract Background Leadless pacemakers (LP) have emerged as an attractive re-implantation option in patients undergoing transvenous lead extraction (TLE) for cardiac implantable electronic device (CIED) infection. However, evidence comparing staged versus concomitant LP implantation strategies remains sparse. Methods The "LEadless pacemaker implantation after device eXtraction – a multIcenter retrospective regiStry (LEXIS)" that included 430 patients from19 centers worldwide who underwent LP implantation following CIED extraction due to infection. LP systems included passive tine (PTF) and active helix fixation (AHF). Indications for extraction were systemic infection, pocket infection, or both. TLE-related complications were classified according to EHRA criteria, and LP implantation complications were recorded. Outcomes were assessed at 1 and 12 months. This subanalysis compares staged versus concomitant LP implantation strategies. Resutls: Among 400 eligible patients, 239 (59.7%) underwent staged and 161 (40.3%) concomitant LP implantation. Baseline characteristics were similar except for more valve dysfunction > grade II (81 vs. 50; p=0.012) and greater pacemaker dependency (87 vs. 103; p=0.028) in the concomitant group. Procedural time was longer with concomitant implantation (75 [40–115] vs. 90 [60–123] min; p=0.006), while rates of incomplete lead removal, systemic infection, and lead vegetation were comparable. Major complications or death did not differ between groups (1.0% vs. 3.0%; p=0.174). Periprocedural mortality, minor complications, ICU admission, and ICU days were similarly distributed. In staged patients, the median interval between TLE and LP implantation was 10 days (IQR 5–17); in the staged procedure, overall complication occured in 3.5% of cases, pericardial effusion occurred in 4 patients (1.4%) and arterial injury in 2 (0.7%). Hospital stay was significantly longer in the staged group, both from admission to discharge (20 [13–28] vs. 8 [3.5–16.3] days; p<0.0001) and from extraction to discharge (14 [8–22] vs. 3 [2–9] days; p<0.0001). Thirty-day mortality was numerically higher with concomitant implantation (10.3% vs. 6.3%), while 12-month mortality was comparable (21.2% vs. 19.2%). Conclusion Early mortality was numerically higher in the concomitant group, although not statistically significant, while 12-month mortality was identical between strategies. This early difference is likely influenced by selection bias, as patients who deteriorate or die around the time of TLE cannot undergo a staged procedure and therefore remain exclusively in the concomitant cohort. Concomitant LP implantation was associated with a substantially shorter hospital stay and allowed patients to undergo only a single procedure, while no significant differences in clinical outcomes were observed. Overall, both staged and concomitant strategies proved safe and feasible in patients undergoing TLE for device infection.
