BACKGROUND:Heart failure with preserved ejection fraction (HFpEF) and tricuspid regurgitation are increasingly recognized as interrelated conditions with overlapping management approaches. CASE SUMMARY:A 69-year-old woman presented with worsening palpitations and exertional dyspnea. Her symptoms, in combination with a preserved ejection fraction and evidence of increased left ventricular filling pressures, were indicative of HFpEF. Echocardiographic examination revealed torrential tricuspid regurgitation. Guideline-directed medical therapy was optimized, resulting in improvement of tricuspid regurgitation severity. DISCUSSION:Recent guidelines for HFpEF management emphasize the use of diuretics for symptom control and the addition of sodium-glucose cotransporter 2 inhibitors and sacubitril-valsartan to improve outcomes. The case underscores the importance of addressing the underlying hemodynamic contributors to tricuspid regurgitation before considering surgical or catheter-based interventions. TAKE-HOME MESSAGES:Guideline-directed medical therapy for HFpEF plays a crucial role in symptom relief, improves outcomes, and may help reduce tricuspid regurgitation severity.

Background The American College of Cardiology (ACC) launched the Clinical Trials Research (CTR) program in 2019 to increase representation of historically underrepresented early-career investigators in cardiovascular research. In 2024, ACC introduced REACH (Research, Equity, and Access for Cardiac Health), a new subcohort within CTR focused on addressing disparities in structural heart disease research and recruitment. This analysis aimed to evaluate the diversity of the 2024-2025 CTR and REACH cohorts and assesses the program’s short-term impact on research engagement, mentorship, and professional development. Methods This was a cross-sectional voluntary survey of 22 items offered to all participants following completion of the program in March 2025. Responses were collected anonymously to ensure confidentiality, with data encrypted during transit and stored securely. Results Among the 2024-2025 ACC CTR cohort, 48 of 51 participants (94.1%) completed the survey, with equal sex distribution (50% women, 50% men) and 25% identifying as Hispanic. Reported short-term outcomes included 52% gaining new mentorship outside their institution, 23% receiving speaking invitations to national meetings, 81% forming new collaborations, and 79% identifying new research opportunities. In the ACC CTR REACH cohort, 60% reported new external mentorship, 40% received national speaking invitations, 60% formed collaborations, and 88% accessed at least 1 new research opportunity. Conclusions The 2024-2025 ACC CTR and REACH programs fostered mentorship, collaboration, and research engagement among early-career investigators while advancing diversity in sex and ethnicity.

Background Guidelines recommend shared decision making when choosing treatment for severe aortic stenosis but implementation has lagged. We assessed the feasibility and impact of a novel decision aid for severe aortic stenosis at point-of-care. Methods This prospective multi-site pilot cohort study included adults with severe aortic stenosis and their clinicians. Patients were referred by their heart team when scheduled to discuss treatment options. Outcomes included shared decision-making processes, communication quality, decision-making confidence, decisional conflict, knowledge, stage of decision making, decision quality, and perceptions of the tool. Patients were assessed at baseline (T0), after using the intervention (T1), and after the clinical encounter (T2); clinicians were assessed at T2. Before the encounter, patients reviewed the intervention, Aortic Valve Improved Treatment Approaches (AVITA), an interactive, online decision aid. AVITA presents options, frames decisions, clarifies patient goals and values, and generates a summary to use with clinicians during the encounter. Results 30 patients (9 women [30.0%]; mean [SD] age 70.4 years [11.0]) and 14 clinicians (4 women [28.6%], 7 cardiothoracic surgeons [50%]) comprised 28 clinical encounters Most patients [85.7%] and clinicians [84.6%] endorsed AVITA. Patients reported AVITA easy to use [89.3%] and helped them choose treatment [95.5%]. Clinicians reported the AVITA summary helped them understand their patients’ values [80.8%] and make values-aligned recommendations [61.5%]. Patient knowledge significantly improved at T1 and T2 (p = 0.004). Decisional conflict, decision-making stage, and decision quality improved at T2 (p = 0.0001, 0.0005, and 0.083, respectively). Most patients [60%] changed treatment preference between T0 and T2. Initial treatment preferences were associated with low knowledge, high decisional conflict, and poor decision quality; final preferences were associated with high knowledge, low conflict, and high quality. Conclusions AVITA was endorsed by patients and clinicians, easy to use, improved shared decision-making quality and helped patients and clinicians arrive at a treatment that reflected patients’ values. Trial registration Trial ID: NCT04755426, Clinicaltrials.gov/ct2/show/NCT04755426.

BACKGROUND:This study investigates the hemodynamics of a dual-orifice mitral valve after mitral valve clip closure (MVCC) in patients with functional and nonfunctional mitral regurgitation (MR). If inflow velocity-time integral (VTi) of both orifices is equal, then the standard continuity equation can be applied to calculate the total mitral valve area (MVA).METHODS AND RESULTS:Adults undergoing MVCC placement were prospectively enrolled. With transesophageal echocardiography (TEE), the vena contracta (VC) of the medial and lateral mitral valve (MV) orifices were determined using color-flow Doppler and dual MV orifice areas were calculated. Valve orifices were classified as large vs small based on VC diameters. Continuous-wave Doppler measurements from both orifices were obtained. Forty-nine patients with severe MR (functional, n = 18) were enrolled. The VTi, mean gradient, peak gradient, and mean velocity of the larger vs smaller orifice were not significantly different, irrespective of MR etiology (P=nonsignificant). There was no difference in these parameters between large and small orifice regardless of MR mechanism (P=nonsignificant). There were no differences in the means of MVA as derived from either large or small VTi-derived and VC-derived areas (P=nonsignificant).CONCLUSIONS:Mitral valve inflow hemodynamics were the same regardless of the size differences between the large and small orifices. Therefore, total MVA can be calculated using the continuity equation in patients irrespective of MR mechanism. This allows for a derivation of total MVA at the time of MVCC placement to evaluate for mitral stenosis.

Hydroxychloroquine (HCQ) cardiomyopathy (CM) usually presents with a hypertrophic or restrictive pattern. We present a patient case of dilated HCQ-CM with normal wall thickness in young woman with systemic lupus erythematosus and end-stage kidney disease. In patients undergoing renal replacement therapy, the daily dose should be lower than recommended by the manufacturer to avoid toxic effects.

The development and administration of mRNA vaccines against SARS-CoV-2 are seeing lower numbers of COVID-19 cases and fatalities among fully vaccinated, immunocompetent adults. We present a case of fatal COVID-19 pneumonia in a heart transplant recipient who had received two doses of mRNA COVID-19 vaccine before the Centers for Disease Control and Prevention had recommended additional doses.

Background Guidelines recommend including the patient’s values and preferences when choosing treatment for severe aortic stenosis (sAS). However, little is known about what matters most to patients as they develop treatment preferences. Our objective was to identify, prioritize, and organize patient-reported goals and features of treatment for sAS. Methods This multi-center mixed-methods study conducted structured focus groups using the nominal group technique to identify patients’ most important treatment goals and features. Patients separately rated and grouped those items using card sorting techniques. Multidimensional scaling and hierarchical cluster analyses generated a cognitive map and clusters. Results 51 adults with sAS and 3 caregivers with experience choosing treatment (age 36–92 years) were included. Participants were referred from multiple health centers across the U.S. and online. Eight nominal group meetings generated 32 unique treatment goals and 46 treatment features, which were grouped into 10 clusters of goals and 11 clusters of features. The most important clusters were: 1) trust in the healthcare team, 2) having good information about options, and 3) long-term outlook. Other clusters addressed the need for and urgency of treatment, being independent and active, overall health, quality of life, family and friends, recovery, homecare, and the process of decision-making. Conclusions These patient-reported items addressed the impact of the treatment decision on the lives of patients and their families from the time of decision-making through recovery, homecare, and beyond. Many attributes had not been previously reported for sAS. The goals and features that patients’ value, and the relative importance that they attach to them, differ from those reported in clinical trials and vary substantially from one individual to another. These findings are being used to design a shared decision-making tool to help patients and their clinicians choose a treatment that aligns with the patients’ priorities. Trial registration ClinicalTrials.gov, Trial ID: NCT04755426 , Trial URL https://clinicaltrials.gov/ct2/show/NCT04755426 .

Recurrent severe primary mitral regurgitation from annuloplasty ring dehiscence is very rare and is associated with adverse outcomes. We present a case where transcatheter edge-to-edge mitral repair with MitraClip was used in high surgical risk patient using a peri-ring approach due to unfavorable anatomy for a conventional intra-ring approach.

Introduction: Angiotensinogen (AGT) is a critical component of the renin-angiotensin-aldosterone system (RAAS) that regulates blood pressure (BP), volume, and electrolyte levels. While physiological effects of AGT are primarily mediated by AGT-derived peptide hormones, effects of AGT independent of these peptides have been described recently in animal models. We sought to determine the relationship between AGT levels, sex, ethnicity, and hypertension (HTN). Methods: We measured baseline plasma AGT levels using an enzyme-linked immunoassay in 5,786 Multiethnic Study of Atherosclerosis (MESA) participants, aged 45 to 84 yrs. We determined the associations between AGT levels and clinical and demographic variables, medication usage, and BP at the first exam. The relationship between prevalent HTN was then determined using adjusted models. Results: Mean AGT levels (log-transformed) were significantly higher in females than males and differed across race/ethnicities with the ordering (from highest to lowest): White, Black, Hispanic, and Chinese adults. The difference between the sexes was greatest in White adults with females having 1.44 times greater levels than males (95% CI: 1.40, 1.48), and lowest in Chinese adults. In males not taking medications targeting RAAS, one SD higher log-AGT was associated with a 2.61 mmHg higher SBP (95% CI: 1.49, 3.80), in females it was associated with 0.97 mmHg higher SBP (95% CI: 0.30, 1.65). Use of RAAS-blocking medications attenuated these associations. In risk factor-adjusted models, higher levels of AGT were associated with higher odds of prevalent HTN. Conclusions: AGT levels differ between race/ethnicities and between the sexes. Higher levels of AGT are associated with higher BP and odds of prevalent HTN. Despite lower levels in males, the association between levels and BP was greater in males. Taken together, the difference in levels and in the association with BP suggests sex-specific regulation and effects of AGT.

Outcomes of acute heart failure hospitalizations are worse during the winter than the rest of the year. Seasonality data are more limited for outcomes in chronic heart failure and the effect of environmental variables is unknown. In this population-level study, we merged 20-year data for 555,324 patients with heart failure from the national Veterans Administration database with data on climate from the National Oceanic and Atmospheric Administration and air pollutants by the Environmental Protection Agency. The outcome was the all-cause mortality rate, stratified by geographical location and each month. The impact of environmental factors was assessed through Pearson's correlation and multiple regression with a family-wise alpha = 0.05. The monthly all-cause mortality was 13.9% higher in the winter than the summer, regardless of gender, age group, and heart failure etiology. Winter season, lower temperatures, and higher concentrations of nitrogen dioxide were associated with a higher mortality rate in multivariate analysis of the overall population. Different environmental factors were associated in regions with similar patterns of temperature and precipitation. The only environmental factor associated with the mortality rate of patients dwelling in large urban centers was the air quality index. In conclusion, the mortality in chronic heart failure exhibits a seasonal pattern, regardless of latitude or climate. In this group of patients, particularly those of male gender, a higher mortality was associated with environmental factors and incorporating these factors in treatment plans and recommendations could have a favorable cost-benefit ratio. (C) 2021 Published by Elsevier Inc.

Aluminum phosphide (ALP) is a pesticide agent and infrequent culprit of accidental poisoning. We present a case of severe reversible cardiomyopathy and left ventricular apical thrombus in a patient who worked as an exterminator and had ALP poisoning.

Congestive heart failure (CHF) affects nearly 6.5 million in the United States and carries significant mortality. Data suggest that there is seasonal variation in the incidence of major cardiovascular events, but it is unknown if this is true of the mortality rate of patients with CHF. We reviewed

Brugada electrocardiographic pattern, or Brugada phenocopy (BrP), can be found in conditions other than Brugada syndrome. We present the case of a 34-year-old woman who was found convulsing at home followed by ventricular tachycardia (VT) cardiac arrest upon arrival to the emergency department. Electrical direct cardioversion led to a return of spontaneous circulation, and she was started on intravenous amiodarone. The patient had four additional episodes of pulseless VT that returned to sinus rhythm with electrical cardioversion. A subsequent electrocardiogram taken in sinus rhythm revealed a right bundle branch block pattern with a coved ST segment elevation and inverted T waves in leads V1 and V2, suggestive of BrP type 1. Further inquiry revealed that an empty bottle of nortriptyline was found at her home. Nortriptyline intoxication was subsequently confirmed by a serum level of 1581 ng/mL. Treatments with intravenous sodium bicarbonate resolved the BrP, and she fully recovered with supportive care. Intoxication with drugs that inhibit cardiac sodium channels, such as nortriptyline, can trigger a BrP in otherwise normal individuals. Nortriptyline and other tricyclic antidepressants (TCAs) are used to treat chronic pain, depression, and other conditions but have dose-related side effects and can lead to fatal overdose. Intoxication by these TCAs should be on the differential when a BrP is observed.

The season of the year affects the incidence of major cardiovascular events and the outcomes of hospitalizations in congestive heart failure (CHF). The factors behind this seasonal variation are largely unknown. We identified a national cohort of 351,022 individuals diagnosed with CHF over the

Due to a limited supply of donor hearts, implantation of left ventricular assist device (LVAD) is getting widely accepted. LVAD implantation comes with multiple adverse effects including pump failure. Pump failure due to outflow graft obstruction is an uncommon complication and often requires open

Patients are avoiding hospitals for fear of contracting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). We are witnessing a re-emergence of rare complications of myocardial infarctions (MI) due to delayed revascularization. Herein, we describe a case of hemorrhagic pericarditis from thrombolytics administered to a patient with late presenting MI. (Level of Difficulty: Beginner.)

Pre-operative optimization of cardiovascular conditions in patients awaiting renal transplantation significantly improves post-transplantation cardiac complications. We describe a case of symptomatic coronary fistula treated with percutaneous coil embolization in a young adult awaiting renal transplantation. (Level of Difficulty: Advanced.)