BACKGROUND:The coexistence of severe mitral regurgitation (MR) and mild-to-moderate aortic stenosis (AS) presents diagnostic and therapeutic challenges. Limited data exists on outcomes following mitral transcatheter edge-to-edge repair (M-TEER) therapy in this patient population. AIMS:This study is aimed to evaluate clinical outcomes following M-TEER in patients with mild-to-modearte AS compared with those without aortic stenosis. METHODS:A single-center retrospective study was conducted on 238 patients who underwent M-TEER therapy between January 2014 and December 2024. Patients with severe AS, cardiogenic shock, and failed or aborted cases were excluded. We compared patients with mild-to-moderate AS (n = 30) to those without AS (n = 208). PRIMARY OUTCOME:Acute hypoxemic respiratory failure (AHRF) within 24 h (SpO2 ≤ 90% ≥ 30 min or need for O2/NIV/IMV, adjudicated as cardiogenic). SECONDARY OUTCOMES:Post-procedural in-hospital mortality, acute kidney injury, hospital length of stay (LOS), 30-day rate of heart failure hospitalization (HFH), and 30-day rate of all-cause readmission. Multivariable logistic regression was used to identify independent predictors of AHRF, hospital LOS, and 30-day HFH. RESULTS:Following M-TEER, the mild-to-moderate AS group experienced significantly higher rates of AHRF (16.7% vs. 3.8%, p = 0.0142; adjusted OR 4.38, 95% CI 1.36-14.61, p = 0.014). Within the parsimonious adjusted model, AS remained independently associated with AHRF, whereas the other included covariates were not. There was no significant difference in the 30-day rate of all-cause readmission, 30-day rate of HFH, AKI, LOS, or in-hospital mortality between groups. CONCLUSION:In patients undergoing M-TEER, the presence of mild-to-moderate AS is independently associated with an increased risk of early post-procedural AHRF, without differences in other short-term clinical outcomes. Given the single-center retrospective design and the limited number of clinical events, these findings should be considered hypothesis-generating and warrant validation in larger, prospective, multicenter studies.

Background: Chagas cardiomyopathy is a common cause of nonischemic cardiomyopathy in Latin America and often presents with ventricular arrhythmias. With increasing global migration, the prevalence of Chagas cardiomyopathy in non-endemic regions is rising, including the United States. As such, evaluating the etiology of ventricular arrhythmias requires a broad differential. We present the diagnostic work up of a patient presenting with monomorphic ventricular tachycardia (VT), ultimately found to have Chagas cardiomyopathy. Case: A 54-year-old Spanish-speaking male with no past medical history presented after being found unconscious and diaphoretic. Electrocardiogram demonstrated sustained monomorphic VT. After stabilization, transthoracic echocardiography revealed a left ventricular (LV) ejection fraction 30-35% with global hypokinesis and severely dilated LV cavity. Coronary angiography revealed patent coronaries. Further workup with cardiac magnetic resonance imaging demonstrated transmural late gadolinium enhancement in the basal to mid-lateral wall corresponding with hypokinetic myocardium, with a LV thrombus adjacent to the mitral valve and developing apicolateral aneurysm. An 18-fludeoxyglucose positron emission tomography scan was done which showed increased glucose uptake in the dysfunctional mid-lateral to apicolateral and anterolateral myocardium, without extracardiac evidence of sarcoid. Serologic testing was notable for an initially positive Lyme IgM, but confirmatory testing was negative. Further, serologies for Trypanosoma cruzi returned positive. Discussion: Although imaging was initially concerning for cardiac sarcoidosis, it did not meet clinical diagnostic criteria given absence of extracardiac involvement and presence of positive Trypanosoma cruzi titers. Empiric treatment was initiated for suspected Lyme carditis as he endorsed a history of rash resembling erythema migrans prior to presentation but was discontinued once confirmatory testing was negative. He was ultimately diagnosed with Chagas cardiomyopathy, but given his high-risk Rassi score, antiparasitic therapy was deferred and confirmatory testing was not pursued. He was started on guideline-directed medical therapy for cardiomyopathy and anticoagulation for LV thrombus. Amiodarone was initiated for VT, and an automatic implantable cardioverter defibrillator was placed for secondary prevention.

BACKGROUND:Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis in many clinical scenarios, offering several benefits over surgery. However, TAVR has limitations, especially in patients with complex aortic anatomy. TAVR in extremely large annuli (ELA) (>1,000 mm2) is technically challenging with limited data regarding its feasibility. CASE SUMMARY:A 65-year-old man presented in cardiogenic shock from combined severe aortic stenosis and regurgitation in an ELA. His surgical risk was prohibitive, and he underwent successful TAVR with resolution of his cardiogenic shock. DISCUSSION:This is the first reported case of TAVR in an ELA for cardiogenic shock from combined severe aortic stenosis and regurgitation using a balloon-expandable valve. TAKE-HOME MESSAGES:This report highlights the feasibility of TAVR for severe aortic stenosis and aortic regurgitation in ELA complicated by cardiogenic shock. Further research is needed comparing surgical replacement and TAVR for patients with ELA.

Patients with prurigo nodularis (PN) present with pruritus which may lead to sleep disturbances and systemic comorbidities. The objective of our study was to determine the risk of sleep disorders in PN and its association with systemic inflammation and adverse cardiovascular outcomes. We conducted a retrospective population-level cohort using a global health records database to analyze the development of sleep disorders, C-reactive protein (CRP) levels, and risk of cardiovascular disease and mortality in PN compared to controls. PN patients had increased risk of general sleep disorders (RR 1.47, 95

BackgroundAdvances in cancer therapies and improvement in survival of cancer patients have led to a growing number of patients with both cancer and severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has been shown to be a safe and effective treatment option for this patient population. There are established racial disparities in utilization and outcomes of both cancer treatments and TAVR. However, the effect of race on TAVR outcomes in cancer patients has not been studied.ObjectivesThe purpose of this study was to investigate racial disparities in outcomes of TAVR in cancer patients.Methods343 patients with cancer who underwent TAVR at a single center over a 6-year period were included in the study. The primary endpoint was a composite of 1-year mortality, stroke, and bleeding. Secondary outcomes included individual components of the primary endpoint as well as 30-day mortality, structural complications, vascular access complications, and conduction system complications. Outcomes were compared between black and white patients by comparing incidence rates.ResultsBaseline characteristics including age, sex, BMI, medical comorbidities, STS score, and echocardiographic parameters were similar between races, aside from significantly higher rates of CKD (50.0% vs. 26.6%, p = 0.005) and ESRD (18.4% vs. 4.9%, p = 0.005) in black compared to white cancer patients. There was a trend toward worse outcomes in black cancer patients with regard to a composite endpoint of 1-year mortality, stroke, and major bleeding (35.7% vs. 22.6%, p = 0.095), primarily driven by higher 1-year mortality (31.0% vs. 17.6%, p = 0.065). 30-day mortality was twice as high in black cancer patients than in white cancer patients (4.8% vs. 2.3%, p = 0.018).ConclusionsThere is a trend toward worse TAVR outcomes in black cancer patients, with higher periprocedural complication rates and mortality, compared to white cancer patients. Further studies are needed to elucidate the structural, socioeconomic, and biological factors that contribute to racial differences in outcomes.