To characterize clinical profiles of mothers and neonates in Puerto Rico affected by hypertensive disorders of pregnancy and evaluate associated maternal and neonatal outcomes.

We performed a retrospective review of patients seen at the high-risk clinic of the University District Hospital in Puerto Rico (2020-2023). Patients were excluded if they did not deliver a live infant or delivered at an outside hospital. Clinical and demographic data were extracted from medical records and grouped by hypertensive status. Descriptive statistics summarized maternal history, delivery outcomes, and neonatal data. Associations were analyzed using Chi-square, Fisher's exact test, and Wilcoxon-Mann-Whitney tests, with significance set at P ≤ 0.05.

Among 278 mothers, 40.3% (n = 112) had a hypertensive disorder, including chronic hypertension (40%) and preeclampsia (22%). Higher maternal BMI was significantly associated with all hypertensive disorders. Chronic hypertension was strongly associated with preeclampsia, conferring 4.8-fold higher odds (95% CI: 2.36-9.75). Hypertensive disorders were linked to earlier gestational age at delivery but not to increased cesarean delivery rates. Neonates of affected mothers had lower Apgar scores.

Hypertensive disorders were common and associated with higher BMI, increased risk of preeclampsia among patients with chronic hypertension, earlier delivery, and lower neonatal Apgar scores. These findings highlight the need for early identification, targeted management, and strengthened prenatal screening to reduce hypertension-related complications in high-risk populations in Puerto Rico.

ObjectiveTo evaluate the association between early concentrated 8.4% sodium bicarbonate and subsequent in-hospital mortality in patients with cardiogenic shock, severe acidemia, and hyperlactatemia.MethodsWe conducted a retrospective two-hour landmark cohort study using the single-center MIMIC-IV v3.1 database. True time zero was the first time pH ≤7.20 and lactate ≥4 mmol/L were both known within a two-hour pairing window. Patients with pre-time-zero bicarbonate exposure, renal replacement therapy, or diabetic ketoacidosis were excluded. Patients alive and still hospitalized at two hours were classified according to 8.4% sodium bicarbonate administration during the 0- to 2-hour window. Propensity-score overlap weighting was used to balance baseline covariates. The primary outcome was subsequent in-hospital mortality.Results Among 489 landmark patients, 110 received early 8.4% bicarbonate and 379 did not. After overlap weighting, the maximum absolute standardized mean difference was 0.091. Weighted mortality was 80.4% with early bicarbonate versus 70.2% without early treatment, corresponding to a risk difference of 10.2 percentage points (95% CI, -0.1 to 20.4; P=.052) and a risk ratio of 1.145 (95% CI, 1.001-1.310; P=.049). Sensitivity analyses showed broadly consistent point estimates, although confidence intervals and target overlap populations varied.ConclusionsEarly 8.4% sodium bicarbonate did not demonstrate a survival benefit among patients who survived to the two-hour landmark. Estimates were directionally compatible with higher mortality, but residual confounding and statistical uncertainty preclude a causal conclusion of harm.

Hypertension, which affects ≈122.4 million American adults and contributes substantially to preventable deaths and economic burden, represents a major public health challenge. Despite the availability of effective therapeutic interventions, only 20.7% of individuals diagnosed with hypertension achieve optimal blood pressure control, defined as readings <130/80 mm Hg. Disparities persist across racial, ethnic, socioeconomic, and geographic groups, prompting urgent calls to improve hypertension management strategies. In response to these challenges, the American Heart Association has established equitable blood pressure control as a cornerstone priority and adopted a comprehensive socioecologic framework to address barriers to care. This science advisory presents the American Heart Association Blood Pressure Control Logic Model, a visual framework that maps how program resources and activities can lead to desired outcomes and effects through collaborative multisector strategies across health care and community settings. The model delineates how organizational inputs-including staff expertise, data systems, funding resources, and strategic partnerships-are channeled through 4 fundamental intervention strategies to achieve measurable outcomes and population-level effects. These strategies encompass transforming health care environments through research initiatives and policy reform, delivering culturally appropriate educational programs, implementing improvements in clinical care quality, and actively engaging community organizations and workplace environments in health promotion activities. The simultaneous implementation of these strategies aims to achieve equitable health outcomes with reduced risk of cardiovascular events, advancing the American Heart Association's mission to promote longer, healthier lives. This adaptable model provides a framework that can be implemented by other organizations. This science advisory emphasizes the importance of rigorous evaluation and sustained multisector collaboration to effectively manage hypertension and promote cardiovascular health.

Diagnosing internal carotid artery dissection (ICAD) can be challenging even for experienced clinicians, as one of its most specific signs-Horner syndrome (HS)-is often missed during routine neurological examination (NE). This study aimed to evaluate pupillary reactivity in ICAD patients using ultrasound pupillometry (UP) and compare quantitative UP findings with standard NE.

We enrolled 33 consecutive patients with acute ICAD and an age- and sex-matched healthy control group without ocular pathology. HS was assessed at admission using standard NE. UP was performed in both the affected eye (AE) and non-affected eye (NAE), measuring pupillary diameter (PD) and response time (PT) to light stimulus (LS) and ciliospinal reflex (CR). Ultrasound examinations were performed by a single operator, while all offline quantitative measurements were performed by a second investigator blinded to the neurological findings.

UP revealed significantly smaller PDs in the AE compared with the NAE, both at rest and after direct and consensual LS (3.23 ± 0.64 mm vs. 5.12 ± 0.51 mm, p < 0.01). The AE also showed reduced CR response in terms of mydriasis (4.03 ± 2.8% vs. 9.76 ± 3.36%, p < 0.01) and dilation time (2.984 ± 0.278 s vs. 2.071 ± 0.223 s, p < 0.01). Similar differences were observed between the AE and controls. Quantitative pupillary abnormalities were identified by UP in 96.9% of patients, whereas clinical HS was detected by standard NE in 39.4% (p < 0.01).

UP represents a promising Neuro-POCUS application for the objective, quantitative assessment of pupillary dysfunction in acute ICAD and may serve as a valuable adjunct to routine NE.

Pediatric acute myocarditis is a life-threatening condition with nonspecific symptoms that often lead to diagnostic delays. Focused cardiac ultrasound (FoCUS) is used to assess cardiac function in pediatric emergency care; however, reports on its use for acute myocarditis are limited. This study aimed to describe the characteristics of FoCUS used to aid in the diagnosis of acute myocarditis and to assess the concordance of qualitative left ventricular (LV) function assessments between FoCUS and formal echocardiography.

A retrospective chart review was conducted at a single tertiary pediatric emergency department (PED) between March 2020 and December 2025. Patients diagnosed with acute myocarditis who underwent FoCUS were included. Patients diagnosed with acute myocarditis before their PED visit or those who did not undergo FoCUS nor echocardiography performed by a pediatric cardiologist were excluded.

Eleven patients were included in the study. The median age was 8 years, and 36.4% were male. Chest pain and hypotension were the most common indications for FoCUS. FoCUS was performed by novice users and FoCUS experts in seven and four patients, respectively. Parasternal long-axis, parasternal short-axis, apical four-chamber, subxiphoid four-chamber, and subxiphoid inferior vena cava views were obtained in eight, five, two, six, and five patients, respectively. Nine patients had abnormal LV systolic function. Qualitative FoCUS assessment of LV systolic function was concordant with formal echocardiography in all included cases.

This study demonstrated that FoCUS can be a useful adjunctive tool for expediting the diagnosis of acute myocarditis in a PED.

Secundum atrial septal defect (ASD) is one of the most common congenital heart defects encountered in adults. Echocardiography plays a central role in diagnosis, assessment of haemodynamic significance, anatomical characterization, transcatheter closure planning, and follow-up. However, the frequently non-circular geometry of secundum ASD can make accurate anatomical assessment challenging, particularly with single-plane measurements.

This narrative review provides a practical echocardiographic approach to adult secundum ASD, emphasizing the complementary roles of transthoracic echocardiography (TTE), multiplanar two-dimensional transesophageal echocardiography (TEE), color Doppler, and three-dimensional (3D) TEE.

TTE provides initial diagnosis and assessment of physiological consequences, including right-sided chamber remodeling, ventricular function, tricuspid regurgitation, and pulmonary pressure. Multiplanar 2D TEE enables systematic assessment of ASD size, morphology, and surrounding septal rims, while measurements obtained in different planes may reveal substantial differences and highlight the limitations of single-plane sizing. 3D TEE provides an en-face spatial representation of the interatrial septum and complements 2D measurements by defining defect geometry, rim relationships, and suitability for transcatheter closure. Haemodynamic assessment should integrate right ventricular volume overload, shunt magnitude, pulmonary vascular status, and left ventricular disease rather than defect diameter alone. Cardiovascular magnetic resonance or cardiac computed tomography may provide complementary information when echocardiography is insufficient to define pulmonary venous connections, anatomy, or haemodynamics.

A systematic multimodality echocardiographic approach integrates anatomical and physiological information throughout the management of adult secundum ASD. Combining TTE, multiplanar 2D TEE, 3D TEE, and targeted advanced imaging can facilitate individualized assessment and informed transcatheter closure planning.

Heart transplantation is definitive therapy for children with end-stage heart failure. Because donor availability is unpredictable, transplantation occurs overnight or on weekends. Although studies report mixed findings on the association between operative timing and outcomes, pediatric data remain limited. We evaluated the impact of operative timing on pediatric heart transplant outcomes.

We studied pediatric heart transplant recipients (< 18 years) in the United Network for Organ Sharing registry from 2000 to 2018. Transplants were classified by time of day (day: 9 AM-8:59 PM; night: 9 PM-8:59 AM) and day of week (weekday vs. weekend). Primary outcome was survival. Secondary outcomes included graft survival, rejection, retransplantation, and postoperative complications. Survival was analyzed using Kaplan-Meier and log-rank testing. Multivariable Cox regression adjusted for recipient and donor characteristics and pre-transplant support.

Among 6125 recipients, 2930 (47.8%) transplants occurred during the day and 3195 (52.2%) at night; 4408 (72.0%) occurred on weekdays and 1717 (28.0%) on weekends. Kaplan-Meier analysis demonstrated no significant survival difference between daytime and nighttime transplants (p = 0.266) or weekday and weekend transplants (p = 0.210). In multivariable Cox regression, operative timing was not associated with mortality (night vs. day: hazard ratio 0.97, 95% confidence interval 0.89-1.06, p = 0.554; weekend versus weekday: hazard ratio 1.04, 95% confidence interval 0.94-1.15, p = 0.445). Acute rejection prior to discharge and treatment for rejection within 1 year was more frequent in daytime transplants without affecting graft survival.

Operative timing was not associated with patient survival, graft survival, or postoperative outcomes after pediatric heart transplantation.

Management of asymptomatic carotid stenosis (ACS) remains controversial, particularly as contemporary optimal medical therapy (OMT) has evolved beyond the aspirin-based regimens used in earlier trials. We performed a meta-analysis comparing carotid revascularization plus OMT versus OMT alone in patients with ACS.

We searched five databases (PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials [CENTRAL]) from inception to November 2025. Randomized controlled trials comparing carotid revascularization (endarterectomy or stenting) plus OMT versus OMT alone were included. Primary outcomes were 30- to 44-day mortality and stroke. Other outcomes included long-term all-cause mortality, stroke, myocardial infarction, and intracerebral hemorrhage. All statistical analyses were performed in R, and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using either fixed- or random-effects models.

Six trials involving 8276 patients were included. Revascularization significantly increased 30- to 44-day mortality (RR 3.98 [95% CI, 1.53-10.35], p = 0.0046) and stroke risk (RR 4.53 [95% CI, 2.51-8.17], p < 0.0001). However, long-term follow-up demonstrated significant reductions in all-cause mortality (RR 0.80 [95% CI, 0.68-0.93], p = 0.0053) and stroke (RR 0.66 [95% CI, 0.57-0.76], p < 0.0001). No significant differences were observed in myocardial infarction or intracerebral hemorrhage rates.

Carotid revascularization combined with OMT was associated with increased periprocedural risks but lower long-term stroke and mortality in pooled analyses of patients with ACS. These findings should be interpreted cautiously given differences across trials and evolving OMT standards. Patient selection should balance procedural risks against potential long-term benefit, particularly among patients with high-grade stenosis, low periprocedural risk, and access to experienced centers.

To describe the level, content and sources of perceived social support among adults with atrial fibrillation, and to identify clinical, lifestyle and care pathway factors associated with perceived support.

A cross-sectional survey design.

Data were collected through an online survey disseminated across Finland in 2025 via the Finnish Heart Association's website and social media channels among adults with self-reported atrial fibrillation. Perceived social support was measured using the Social Support for Patients with Atrial Fibrillation Instrument, which assesses informational, emotional, and functional support. Data were analysed using descriptive statistics and separate univariate General Linear Model analyses.

Participants reported low-to-moderate informational, emotional, and functional support. Patient education was received primarily from physicians, whereas nurse-delivered education was uncommon, and more than half of participants reported no scheduled follow-up visits. Informational support was strongest for disease consequences and medication information, while support related to treatment options and follow-up monitoring was lower. Emotional support was mainly received from family and friends, while functional support was stronger for self-monitoring than for medication management and structured follow-up. Ablation treatment was consistently associated with lower perceived support across all domains, whereas scheduled follow-up visits were associated with higher emotional support.

Perceived social support among adults with atrial fibrillation was uneven and embedded in the formal care pathway. Support gaps were evident in follow-up, nurse-delivered education, medication management, and practical atrial fibrillation-specific self-management.

Cardiovascular nurses can strengthen atrial fibrillation care by providing structured patient education, emotional support, practical self-management support, and follow-up, particularly after ablation and during long-term care.

This study addresses the limited evidence on perceived social support among adults with atrial fibrillation. The findings suggest that support is unevenly integrated into atrial fibrillation care pathways and that nurse-led education and structured follow-up remain underused. The findings identify opportunities to strengthen atrial fibrillation care.

The study was reported according to the STROBE guideline for cross-sectional studies.

No Patient or Public Contribution.

Background Although diastolic function markers can help predict adverse outcomes in cardiac disease, the prognostic value of cardiac MRI-derived metrics at a population level remains unclear. Purpose To assess the independent and incremental prognostic value of cardiac MRI-derived diastolic function metrics for adverse cardiovascular outcomes in the UK Biobank. Materials and Methods This secondary analysis of the UK Biobank used data from participants enrolled between March 2006 and August 2010. Univariable and multivariable Cox models were used to evaluate the prognostic influence of each diastolic function marker (peak early to peak late mitral filling rate ratio [E/A], peak early diastolic longitudinal strain rate [e'SR], peak early mitral filling rate to peak e'SR ratio [E/e'SR], and maximum left atrial volume [LAV_max]) on adverse outcomes, including heart failure (HF), arrhythmia, and all-cause death. Multivariable models were adjusted for clinical cardiovascular risk factors (age, sex, smoking, body mass index, hypertension, diabetes, and hyperlipidemia) and known prognostic imaging markers (left ventricular [LV] ejection fraction [LVEF], global longitudinal strain [GLS], LV end-diastolic volume index, and LV mass index). Results The cohort included 59 416 individuals (mean age, 65.4 years ± 7.7 [SD]; 30 887 women) with a median follow-up of 6 years. Peak e'SR, E/A, and LAV_max were independently associated with incident HF and arrhythmia, with peak e'SR showing the strongest association (hazard ratio [HR], 0.55 [95% CI: 0.50, 0.61] for HF, 1.37 [95% CI: 1.26, 1.49] for E/e'SR, and 1.28 [95% CI: 1.17, 1.40] for LAV_max; all P < .001). E/e'SR provided incremental value beyond LVEF and GLS. There was no evidence that diastolic markers were associated with incident all-cause death in fully adjusted models. Conclusion Cardiac MRI-derived diastolic function metrics independently predicted HF and arrhythmia in the UK Biobank with incremental value beyond established imaging markers. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Ishida in this issue.