Background: Inclisiran is a novel innovative therapy for the reduction of low-density lipoprotein cholesterol (LDL-C). However, real-world data about its efficacy are limited. Hypothesis: We hypothesized that inclisiran would significantly reduce LDL-C in patients unable to achieve their target LDL-C goals with conventional therapies. Aims: To investigate the impact of inclisiran on LDL-C levels in a real-world clinical setting at a tertiary cardiovascular center. Methods: We retrospectively analyzed all adult patients at our healthcare network’s cardiovascular clinics who were initiated on inclisiran between December 2021 and May 2024. Baseline patient characteristics, medications, and comorbidities were extracted. Each patient’s lipid profile, including total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides, was collected prior to the initiation of inclisiran, at 6 months, and at 12 months. Results: A total of 380 patients (78% White, 62% female) were included in this study. The mean age was 70 years. The most common comorbidities were coronary artery disease (82%), hypertension (81%), diabetes mellitus (31%), and congestive heart failure (22%). Two hundred nine patients (55%) were on any intensity statin, 174 patients (46%) were on ezetimibe, and 62 patients (16%) were on bempedoic acid during the initiation of inclisiran. Ninety-two patients (24%) were on an alternative PCSK9 inhibitor before switching to inclisiran. At 6 months, there was a 40% reduction in LDL-C, a 35% reduction in HDL-C, a 22% reduction in total cholesterol, and no significant reduction in triglycerides. The reduction was maintained at 12 months. Figure 1 shows the lipid profile at baseline, 6 months, and 12 months. Conclusions: Inclisiran was effective in reducing LDL-C, HDL-C, and total cholesterol by 6 months. This improvement in cholesterol was maintained at 12 months.

BACKGROUND:The Evolut Low Risk trial demonstrated that transcatheter aortic valve replacement (TAVR) was noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke at 2 years. Outcomes at 5 years have not been reported. OBJECTIVES:This study sought to evaluate 5-year clinical and hemodynamic outcomes with TAVR vs surgery in patients from the Evolut Low Risk trial. METHODS:We randomly assigned low-risk patients with severe aortic stenosis to TAVR or surgery. The primary endpoint was a composite of all-cause mortality or disabling stroke. Secondary endpoints included clinical, echocardiographic, and quality-of-life outcomes through 5 years. RESULTS:A total of 1,414 patients underwent an attempted implant (n = 730 TAVR, n = 684 surgery). The mean age was 74 years (range 51-88 years), and women accounted for 35% of patients. At 5 years the Kaplan-Meier estimate for the primary endpoint of all-cause mortality or disabling stroke was 15.5% for the TAVR group and 16.4% for the surgery group (P = 0.47). The Kaplan-Meier estimates in the TAVR and surgery groups for all-cause mortality were 13.5% and 14.9% (P = 0.39) and for disabling stroke were 3.6% and 4.0% (P = 0.57). Cardiovascular mortality was 7.2% in the TAVR group and 9.3% in the surgery group (P = 0.15). Noncardiovascular mortality in the TAVR group was 6.8% and 6.2% in the surgery group (P = 0.73). A site-level vital status sweep was performed for patients who were lost to follow-up or withdrew from the study. With the addition of these patients, the all-cause mortality rate at 5 years for patients undergoing TAVR was 14.7% and for surgery was 15.2% (P = 0.74). Over 5 years, valve reintervention rate was 3.3% for TAVR and 2.5% for surgery (P = 0.44). A sustained improvement in quality of life was observed in both treatment arms with mean Kansas City Cardiomyopathy Questionnaire summary score of 88.3 ± 15.8 in TAVR and 88.5 ± 15.8 in surgery. CONCLUSIONS:At 5 years, patients with severe aortic stenosis who were treated with either TAVR or surgery had comparable rates of all-cause mortality or disabling stroke. Valve durability and performance were excellent in both arms. This midterm evaluation reinforces the position of TAVR as noninferior to surgery in patients with severe aortic stenosis at low surgical risk (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283).

BACKGROUND:Transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis, but data are limited on younger, low-risk patients. This analysis compares outcomes in low-surgical-risk patients aged <75 years receiving TAVR versus surgery. METHODS:The Evolut Low Risk Trial randomized 1414 low-risk patients to treatment with a supra-annular, self-expanding TAVR or surgery. We compared rates of all-cause mortality or disabling stroke, associated clinical outcomes, and bioprosthetic valve performance at 3 years between TAVR and surgery patients aged <75 years. RESULTS:In patients <75 years, 352 were randomized to TAVR and 351 to surgery. Mean age was 69.1±4.0 years (minimum 51 and maximum 74); Society of Thoracic Surgeons Predicted Risk of Mortality was 1.7±0.6%. At 3 years, all-cause mortality or disabling stroke for TAVR was 5.7% and 8.0% for surgery (P=0.241). Although there was no difference between TAVR and surgery in all-cause mortality, the incidence of disabling stroke was lower with TAVR (0.6%) than surgery (2.9%; P=0.019), while surgery was associated with a lower incidence of pacemaker implantation (7.1%) compared with TAVR (21.0%; P<0.001). Valve reintervention rates (TAVR 1.5%, surgery 1.5%, P=0.962) were low in both groups. Valve performance was significantly better with TAVR than surgery with lower mean aortic gradients (P<0.001) and lower rates of severe prosthesis-patient mismatch (P<0.001). Rates of valve thrombosis and endocarditis were similar between groups. There were no significant differences in rates of residual ≥moderate paravalvular regurgitation. CONCLUSIONS:Low-risk patients <75 years treated with supra-annular, self-expanding TAVR had comparable 3-year all-cause mortality and lower disabling stroke compared with patients treated with surgery. There was significantly better valve performance in patients treated with TAVR. REGISTRATION:URL: https://clinicaltrials.gov; Unique identifier: NCT02701283.

•Cardiac fibromas are benign clinical entities that are rarely diagnosed in adulthood.•Echocardiography is considered the first imaging modality used for evaluation.•Multimodality imaging is critical for diagnosis and perioperative intervention.•Management remains largely case by case.•Tumor burden and surgical feasibility guide aggressiveness of management strategy.

Insects are one of the critical reasons why cereal grains and grain products do not retain quality during storage. It is important to identify which pests are present in order to effectively control them. This chapter covers several key aspects of stored grain insects. Key aspects include insect classification, structure, and development; various insects in stored grain and grain products, including both internal and external infestors; ecological and environmental factors affecting stored product insect populations; damage caused by stored product insects; and detection of insect infestation. This chapter builds a solid foundation for subsequent chapters, which will cover control and mitigation aspects, as well as preservation technologies and quality management approaches.

Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in an older generation. We present a unique case of a young woman diagnosed with multivessel CAE in the setting of acute

The association between sleep disordered breathing (SDB) and ventricular arrhythmias (VA) is well established. Limited data is available on the severity of SDB and VA among patients with continuous flow left ventricular assist device (CF-LVAD). Among 230 patients who received CF-LVAD between Jan

HeartWare HVAD log files provide a record of important diagnostics that assist in patient care. We believe that information regarding battery function can inform providers of patient behavior, compliance and future adverse events.

Arrhythmias resulting in internal cardiac defibrillator (ICD) shock are unpredictable, common (15-30%) and lead to increased morbidity and mortality among LVAD supported patients. We sought to evaluate the incidence and temporal implications of appropriate ICD discharge among patients supported with CF-LVAD.

Gastrointestinal bleeding (GIB) after continuous-flow left ventricular assist devices (CF-LVAD) is common (20-40%) and leads to increased morbidity and mortality. Previously we identified chronic obstructive pulmonary disease (COPD) as an independent risk factor for the development of GIB (HR=1.89, 1.10-3.23 P<0.02). This study explores pulmonary function test (PFT) parameters associated with GIB.

Primary cardiac leiomyosarcoma is a rare tumor with poor prognosis. We present a 53-year-old female patient with biatrial leiomyosarcoma with inferior vena cava and coronary sinus involvement who underwent aggressive surgical resection with reconstruction of her left and right atrium and coronary sinus with bovine pericardium followed by adjuvant radiation therapy. She is living well with no recurrence 9 years after diagnosis.

Continuous flow left ventricular assist device (CF-LVAD) therapy is an established lifesaving intervention for patients with advanced heart failure. Quality of life (QOL) and functional capacity improvements have been assessed, however serial measures using validated questionnaires such as Short Form (SF) 36 are sparse. A single-center, retrospective study of all patients supported with CF-LVAD between Jan. 1, 2010 and June 30, 2014 (n=197). One hundred twelve patients underwent pre and serial postoperative assessments of QOL using SF-36 questionnaire at 3-, 6-, 9-, and 12-month intervals. Patient data for SF-36 was further segregated by indication (n=25 for DT and n=87 for BTT) and components of SF-36 (mental and physical scores). Seventy-four percent of the population was men, 86.8% supported with Heartmate 2 (Thoratec, Calif., USA) and 13.2% with HeartWare devices (HeartWare, Mass., USA). DT patients were older (65.7±12.8 vs. 55.9±9.7, p<0.01), and compared with pre-implant, SF-36 scores demonstrated significant improvements at all time points assessed (data not shown). Figure 1 divides the population by indication and component of SF-36 and only physical scores demonstrate statistically significant improvements for both DT and BTT. Mental scores were statistically improved for BTT patients at 3 and 6 months; DT patients showed numeric improvements but the differences did not achieve significance at any time point. CF-LVAD therapy results in significant improvement of QOL as assessed by serial SF-36. Compared with pre-implant, the physical improvements are sustained and statistically significant to 12 months in DT and BTT populations.