BACKGROUND:Outflow graft obstruction (OGO) is an increasingly recognized complication of continuous-flow left ventricular assist devices (CF-LVADs), particularly the HeartMate 3. Surgical revision is often high risk, and percutaneous alternatives are emerging. AIMS:To evaluate the feasibility, safety, and outcomes of endovascular stenting for the treatment of LVAD OGO using a multimodality imaging approach. METHODS:We retrospectively reviewed all HeartMate 3 patients undergoing percutaneous treatment of OGO at our institution between September 2023 and April 2025. Clinical presentation, multimodality imaging findings, procedural characteristics, and outcomes were analyzed. RESULTS:Eight patients underwent endovascular intervention. All presented with persistent low-flow alarms and variable syncope or neurologic symptoms. Technical success was achieved in all cases. Median LVAD flow improved from 2.8 L/min pre-intervention to 4.4 L/min post-intervention. Two access-related bleeding complications and one hemothorax occurred, all managed successfully. At a median follow-up of 7 months, no recurrent OGO was observed. CONCLUSIONS:Endovascular stenting guided by multimodality imaging is a feasible and effective alternative to surgical revision for LVAD OGO in selected patients.

Cogan syndrome (CS) is a chronic inflammatory disorder primarily affecting young adults. It is characterized by interstitial keratitis, vestibuloauditory dysfunction, and, rarely, systemic vasculitis and aortitis. In this case report, we present a rare instance of a young male with anterior ST-elevation myocardial infarction in the context of aneurysmal coronary vessels and proximal occlusion of the left anterior descending artery. This case underscores the importance of recognizing cardiac risk factors in the setting of CS, as they can be life-threatening. Regular follow up is necessary, especially for patients showing signs of vasculitis or experiencing cardiac symptoms. A multidisciplinary approach to management can help optimize the prognosis for these complex patients.Learning objectiveComprehend Cogan syndrome (CS): Grasp the clinical manifestations and potential cardiovascular complications of CS. Diagnostic approach in CS: Differentiate cardiac symptoms in CS from typical coronary diseases, emphasizing the role of heart catheterization. Multidisciplinary management: Recognize the importance of integrating rheumatologists, cardiologists, and surgeons for optimal CS patient outcomes.

Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder characterized by thickened heart muscle and dynamic left ventricular outflow tract (LVOT) obstruction. Mavacamten (Camzyos) is a novel therapeutic agent targeting myocardial contractility. This study evaluates the impact of Mavacamten on blood pressure (BP) and other clinical parameters in HOCM patients over a 24-month period. Methods: A retrospective study was conducted on 40 HOCM patients initiated on Mavacamten, with follow-ups at 12 and 24 months. Blood pressure measurements (systolic BP [SBP] and diastolic BP [DBP]) were recorded at baseline, 12 months, and 24 months. Secondary outcomes included changes in LVOT obstruction at rest and with provocation, the New York Heart Association (NYHA) functional class, and left ventricular ejection fraction (LVEF). Results: The study population had a mean age of 67 ± 10 years, with 50% male. Baseline characteristics included a high prevalence of hypertension (78%), dyslipidemia (67%), and atrial fibrillation (31%). At 12 and 24 months, there were no significant changes in SBP (137 ± 18 mmHg to 139 ± 18 mmHg at 12 months, p=0.850, and to 132 ± 17 mmHg at 24 months, p=0.607) or DBP (78 ± 11 mmHg to 80 ± 10 mmHg at 12 months, p=0.409, and to 80 ± 10 mmHg at 24 months, p=0.468). However, significant reductions were observed in LVOT pressure gradients both at rest (48 ± 41 mmHg to 11 ± 15 mmHg at 12 months, p<0.001, and to 8 ± 13 mmHg at 24 months, p<0.001) and with provocation (89 ± 59 mmHg to 27 ± 32 mmHg at 12 months, p<0.001, and to 22 ± 28 mmHg at 24 months, p<0.001). NYHA class improved significantly, with a higher proportion of patients in class I (3% to 21% at 12 months, p=0.031, and to 27% at 24 months, p=0.016) and a reduction in class III patients (50% to 12% at 12 months, p<0.001, and to 10% at 24 months, p=0.002). LVEF decreased from 69 ± 6% to 64 ± 4% at 12 months (p<0.001) and remained at 64 ± 6% at 24 months (p<0.001). Conclusion: Mavacamten use in HOCM patients over 24 months demonstrated stability in blood pressure but significant improvements in LVOT obstruction, NYHA functional class, and a slight decrease in the LVEF.

Left ventricular assist devices serve as a salvage therapy for patients with advanced heart failure. Complications such as thrombosis and obstruction can lead to acute device malfunction, posing significant clinical risks. A multidisciplinary approach is crucial for management. Few cases in the literature have demonstrated the safety and efficacy of percutaneous intervention, which holds significant value due to its less invasive nature and minimal risk of morbidity, especially in high-risk surgical patients.

There is conflicting evidence regarding how torsemide and furosemide differ in their effects on heart failure outcomes. Therefore, we conducted a meta-analysis of randomized controlled trials to compare the therapeutic efficacy of furosemide versus torsemide in the management of heart failure. Methods: MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for studies comparing furosemide to torsemide in heart failure from inception through January 2023. Outcomes of interest included all-cause mortality, hospitalization due to heart failure, and weight change. Results: Our analysis included 10 RCTs comprising 4011 patients, of whom 2019 were treated with furosemide and 1992 patients were treated with torsemide. There was no significant difference between the groups in terms of all-cause mortality (OR 0.99; 95% CI, 0.97-1.02; p = 0.66; I2 = 0.03%); heart failure hospitalization (OR 0.96; 95% CI, 0.87- 1.06; p = 0.38; I2 = 89%) and weight change (mean difference -0.15; 95% CI, -0.82-0.52; p = 0.66; I2 = 94%). Conclusion: Furosemide and torsemide have a similar impact on mortality, hospitalization due to heart failure, and weight change in patients with congestive heart failure

Readmission and emergency room (ER) visits were high regardless of ablation modality.Research has shown additional support and education in early recovery period can mitigate unnecessary encounters with hospital care-providers.Objective: To assess the feasibility of implementing a nurse-led phone call on day-1 after AF ablation and impact on 30-day readmission rates, ER visits and patient-reported satisfaction.Methods: Patients undergoing AF ablation with same-day discharge between July and September 2022 received a day-1 phone-call to assess for post-procedure complications and reinforce education.Participants completed a satisfaction survey, hospital readmission and ER visits were evaluated at 30-days after ablation.Results: Of the 50 participants (median age 65, 36% female), radiofrequency energy was used in 46 (92%) cases with zero reports of peri-procedural complications.Median duration for phone call was 13 minutes (range 4-86) and additional intervention/urgent follow-up by an AF Clinic care-provider based on nurse assessment was required for 9 (18%) participants; complaints of chest pain 4 (45%), arrhythmias 1 (1%), medication adjustment 2 (2.2%) groin site 1 (1%) and other 1 (1%).Participants who completed the satisfaction survey (43, 86%) reported being satisfied with the education provided for postprocedure care, 32 (74%) felt the follow-up call positively prevented them from seeking unnecessary medical attention and 41 (95%) reported improved patient care with the nurse-led phone call on day-1.Preliminary analysis showed ablation related hospital readmission in 2 (4%) and ER visits in 12 (24%) participants within 30-days post procedure.Conclusion: Results demonstrated feasibility of nurse-led day-1 phone call.Patients were satisfied with care received and appreciated education provided to them.Further research exploring 30-day readmission and ER visits is warranted.

Background: Coronary computed tomography angiography (CCTA) allows direct visualization of coronary arteries. As a result of the high accuracy, CCTA has been proposed as an initial step in patients presenting to the emergency department (ED) with acute chest pain to rule out obstructive coronary artery disease (CAD). The effect of the initial CCTA strategy on downstream testing with coronary angiogram and coronary revascularization is yet to be delineated. Objective: To investigate the safety and efficacy of CCTA in patients presenting to the ED with acute chest pain compared to standard of care (SoC). Method: We searched PubMed, Cochrane CENTRAL Register, and ClinicalTrials.gov (inception through July 1st, 2023) for randomized clinical trials evaluating the outcomes of CCTA in acute chest pain. We used a random-effect model to calculate risk ratio (RR) with a 95% confidence interval (CI). The endpoints were all-cause mortality, major adverse cardiac events (MACE), rates of coronary angiography, and length of stay (LOS). Results: A total of 17 studies comprising 9237 patients were included in the analysis. Compared to SoC, the CCTA group had a shorter length of hospitalization (RR -0.3; 95%CI -0.64- -0.13; P = 0.0005). There was no significant difference in all-cause mortality or MACE (RR 0.8; 95%CI 0.45- 1.5; P = 0.52) and (RR -1.00; 95%CI 0.76- 1.3; P = 0.98), respectively. Rates of coronary angiography did not differ between the two groups (RR 0.93; 95%CI 0.61- 1.41; P = 0.96). Conclusion: CCTA is a reliable non-invasive imaging modality that can play a significant role in evaluating acute chest pain in the emergency department and is associated with a decrease in the length of stay without an increase in MACE. There was no increase in downstream coronary angiogram or coronary revascularization in the CCTA group.

A 69-year-old male with a history of prior admissions of heat exhaustion presented with non-specific symptoms including fatigue, diarrhea, and dehydration. The workup revealed a positive legionella urine antigen. He was treated with levofloxacin with symptom resolution within 48 hours.

Background: In vitro studies have shown cannabinoids blocking SARS-CoV-2 cellular entry and affecting replication. There is a paucity of data assessing the effect of cannabis on patients hospitalized with COVID in the USA. The aim of our study was to assess mortality and complication rates in patients hospitalized with COVID stratified by cannabis use.Methods: We used the National Inpatient Sample, the largest all-payer inpatient database with 95% of US hospitalizations from 49 states, to identify all COVID hospitalizations from January 01, 2020, to December 31, 2020. We included all adult patients without missing mortality and gender information. The whole cohort was stratified by cannabis use into two groups (cannabis use disorder (CUD) vs. no CUD). We performed propensity score matching based on multiple patient and hospital characteristics to assess the outcome difference.Results: A total of 1,657,800 hospitalizations were included. Of these, 13,095 (0.79%) were cannabis users and were likely to be male (65.6%) and Black (35%) compared to non-cannabis users. After propensity score matching, the CUD group had lower mortality (2.9% compared to 5.5%, OR 0.43 [CI 0.34 – 0.55] p <0.001). They also had lower rates of non-invasive (2.9% vs. 3.9 p <0.014), invasive mechanical ventilation (9.4% vs. 7.1%, p<0.001) and ECMO use (0.1 vs. 0.3 p <0.014). They also had a lower rate of septic shock (3.1% vs. 4% p<0.03) and lesser GI bleeding (3.3% vs. 2.3% p<0.005) compared to no CUD. The cost of hospitalization in the CUD group was significantly lower. There was no significant difference between the other complications assessed.Conclusion: We found lower mortality rates, lesser need for mechanical ventilation, and reduced hospitalization expenses among cannabis users hospitalized with COVID-19. Further research is required to determine whether cannabinoid is a candidate for the treatment and prevention of COVID-19.

Introduction: Atherosclerotic Cardiovascular disease ( ASCVD) in women remains understudied, under-diagnosed, and under-treated. It is known that traditional risk factors have varied effects on men's vs. women's hearts. However, the current risk stratification tools tend to underestimate or not consider such sex-specific factors. We aimed to investigate the utility of bone mineral density (BMD) with DEXA scoring as a predictor of ASCVD in women. Methods: Patients who underwent DEXA scanning from 2012 to 2014 at multiple centers within our health system were collected and categorized using International Classification of Diseases (ICD) diagnosis codes to identify comorbidities and outcomes. Age, Sex, Race, history of hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), body mass index (BMI), and smoking status were noted. Results: Of the 2,254 patients who underwent DEXA scanning, 1,995 participants were female (88.5%), and 1,929 were white (85.6%) with an average age of 72.8 years. The primary outcome was any ASCVD event (stroke, MI and cardiac death). During the mean follow-up of 9 years, 245 patients (10.8%) experienced ASCVD events. Patients with osteoporosis defined by a T score <-2.5 had higher odds of ASCVD events (OR - 3.82 [2.370-6.172], P<0.0001). Osteopenia was defined by a T score between -1 and -2.5 and was not associated with an increased risk of ASCVD events (OR 1.2 [0.782-1.957] P <0.36). Conclusions: BMD measurement with DEXA scanning may be useful for the stratification and prediction of risk for ASCVD events in women, with no additional economic strain on the healthcare system. Further wide-scale studies are needed to utilize this potentially promising predictor and commonly used diagnostic test. .

Introduction: Acetaminophen-induced hypotension has been reported previously. It is uncertain whether acetaminophen directly impacts blood pressure and heart rate. Hypothesis: The meta-analysis investigates the effects of acetaminophen on the blood pressure and heart rate, and whether there is a dose-response relationship. Methods: This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the effects of acetaminophen on blood pressure and heart rate from inception to February 20, 2022. After screening, 14 clinical trials were included in the analysis. Dichotomous data were pooled as relative risk (RR) and continuous data as mean difference (MD) or standardized mean difference (SMD) using the inverse-variance method. Heterogeneity was assessed using the Cochrane Q test, and its extent was determined by I-square (A value of more than 50% was considered a significant heterogeneity). Results: No statistically significant difference between acetaminophen and control for the overall effect on SBP (MD= -1.52, 95% CI = -4.66 to 1.61, p-value = 0.34) was observed. The findings remained consistent in subgroup analysis by dose, across one gram or less (p-value = 0.54), and more than one gram (p-value = 0.43). Similarly, no statistically significant difference was found for the overall effect on DBP (p-value = 0.61) although we found a statistically significant difference in DBP in the one gram or less subgroup (p-value = 0.02). Finally, we report no statistically significant difference between acetaminophen and control on the MAP (p-value = 0.32) and HR (p-value = 0.18). Conclusions: Acetaminophen has no significant effect on SBP, DBP, MAP, and HR. This effect is consistent with different doses except for a possible increase in DBP after using one gram or less. Further studies are needed to investigate the relevance of this effect.