In asymptomatic patients with severe primary mitral regurgitation, surgical referral is based on 2D echocardiographic indices that often identify advanced myocardial injury. Speckle-tracking echocardiography (STE) may detect earlier, reversible dysfunction.This study evaluated whether a novel multichamber STE-based staging system of extra-valvular cardiac damage improves risk stratification in patients with severe degenerative mitral regurgitation undergoing surgery.

A retrospective multicenter cohort study of patients with degenerative mitral regurgitation undergoing surgery: derivation cohort (n = 208; mean age 64 ± 13 years; 59.7% men) and validation cohort (n = 92; mean age 63 ± 12 years; 53.3% men). Receiver-operating characteristic curve analysis identified optimal strain cut-offs associated with adverse outcomes: left ventricular global longitudinal strain (LVGLS) less than 20%, peak atrial longitudinal strain (PALS) less than 25%, and right ventricular free-wall longitudinal strain (RVFWLS) less than 17%. Patients were classified into four stages: Stage 0, no damage; Stage 1, left atrial damage (PALS < 25%); Stage 2, left ventricular damage (LVGLS < 20%); Stage 3, right ventricular damage (RVFWLS < 17%).The STE-based staging system was independently associated with the composite of periprocedural adverse events (mortality, stroke, myocardial infarction, acute kidney injury, life-threatening bleeding or sepsis/wound infection requiring reintervention, complete atrioventricular block requiring pacemaker implantation): odds ratio 1.68 per stage increase (confidence interval 1.24-2.32; P = 0.001). Predictive accuracy was higher compared with clinical and echocardiographic data, with consistent results in the validation cohort.

The multichamber STE staging system provides incremental prognostic information beyond conventional parameters, improving perioperative risk stratification.

Right ventricular to pulmonary artery (RV-PA) coupling has emerged as an important determinant of prognosis in heart failure and pulmonary hypertension. However, its role in patients undergoing catheter ablation of atrial fibrillation remains uncertain. This study investigated changes in RV-PA coupling after ablation and its association with atrial fibrillation recurrence.

In this multicenter prospective study, 118 patients undergoing ablation of atrial fibrillation were evaluated at baseline and after 3 months using comprehensive clinical and echocardiographic assessment. Atrial fibrillation recurrence was assessed at 1-year follow-up.After 3 months, tricuspid annular plane systolic excursion (TAPSE) increased (22.4 ± 4.1 to 24 ± 3.8, P < 0.001), pulmonary artery systolic pressure (PASP) decreased (29.5 ± 6.6 to 27.9 ± 7.7, P = 0.030), and TAPSE/PASP increased (0.81 ± 0.27 to 0.93 ± 0.29, P < 0.001). At 1 year, atrial fibrillation recurrence occurred in 50/118 patients (42%). Restricted cubic spline analysis demonstrated a significant nonlinear association between TAPSE/PASP and AF recurrence (P for nonlinearity = 0.041). Patients in the lowest TAPSE/PASP tertile (<0.67 mm/mmHg) had a higher risk of atrial fibrillation recurrence at 1 year compared with those in the highest (hazard ratio 2.66, 95% confidence interval 1.31-5.45, P = 0.007). Kaplan-Meier analysis confirmed a higher recurrence rate in the lowest tertile (log-rank P = 0.012).

In patients undergoing catheter ablation for atrial fibrillation, RV-PA coupling significantly improved after the procedure. Lower baseline TAPSE/PASP was independently associated with atrial fibrillation recurrence, supporting the role of RV-PA uncoupling as a potential marker for postablation risk stratification.

Despite successful transcatheter aortic valve interventions (TAVIs), a residual risk of heart failure (HF) hospitalization persists.

A total of 37 490 patients from Optum's de-identified Clinformatics Data Mart were included. HF diagnosis was recorded in 21 283 (56.9%) patients during a year before TAVI. One-/two-year risks for a composite of HF hospitalization and mortality were 15.6% [95% confidence interval (CI), 15.2-16.0]/25.4% (95% CI, 24.8-25.9). Post-TAVI, HF medication prescriptions remained low.

HF burden among TAVI recipients is high and HF therapies are underused. Persistent residual risks highlight the need for future clinical trials investigating a role of more aggressive medical management after TAVI.

Metabolic syndrome (MS) is highly prevalent among people living with HIV (PLWH) receiving antiretroviral therapy (ART) and is driven by persistent low-grade inflammation. Hypoxia-inducible factor 1 alpha (HIF-1α) polymorphisms may influence inflammatory pathways underlying MS. This study investigated the association of the rs11549465 HIF-1α polymorphism with inflammatory markers and MS in PLWH receiving ART. We conducted a multicenter case-control study including 116 PLWH treated at two University Clinical Centers in Serbia. Participants were classified according to NCEP ATP III criteria. Genotyping was performed by Real-Time PCR using TaqMan assays. C-reactive protein (CRP) and fibrinogen levels were significantly higher in participants with MS (p < 0.05). ROC analysis demonstrated their potential as biomarkers of MS with cut-off values of 1.85 mg/L for CRP and 2.49 g/L for fibrinogen. Age significantly correlated with CRP and Neutrophil/Lymphocyte ratio (p < 0.05). Elevated CRP and fibrinogen levels were associated with hypertension, hypertriglyceridemia, and other MS-abnormalities (p < 0.05). The HIF-1α rs11549465 CT + TT genotype was associated with higher IL-6 levels among participants with MS (p = 0.026). CRP and fibrinogen may complement existing MS criteria in identifying PLWH at increased risk of cardiovascular disease and diabetes. These findings highlight the role of chronic inflammation and genetic variability in metabolic complications of HIV.

Postoperative nausea and vomiting (PONV) is a common and distressing complication following shoulder arthroscopy. Although hypotension is known to trigger nausea, the specific association between sustained intraoperative hypotension (SIH) during shoulder arthroscopic surgery and PONV has not been well characterized. This retrospective study aimed to investigate whether SIH is independently associated with PONV.

We retrospectively analyzed data from 306 patients who underwent shoulder arthroscopy between March 2018 and January 2024. SIH was defined as a ≥ 20% decrease in mean arterial pressure (MAP) from baseline persisting for at least 60 minutes during the controlled hypotension phase. Univariate logistic regression analysis and multivariate exact logistic regression analysis were performed to identify factors associated with the occurrence of PONV. PONV severity was compared between the SIH and non-SIH groups using the chi-square test.

PONV occurred in 96 patients (31.37%). Univariate logistic regression analysis revealed that females, smoking, history of motion sickness and/or PONV, and SIH were related to the occurrence of PONV (all p < 0.05). Multivariate logistic regression analysis revealed that females (adjusted OR: 3.966, 95% CI: 2.149-7.317, p < 0.001), smoking (adjusted OR: 0.232, 95% CI: 0.107-0.501, p < 0.001), history of motion sickness and/or PONV (adjusted OR: 32.393, 95% CI: 3.801-276.051, p = 0.001), and SIH (adjusted OR: 2.198, 95% CI: 1.289-3.749, p = 0.004) were independently associated with the occurrence of PONV. Additionally, patients with SIH exhibited significantly higher severity grades for both nausea (p = 0.002) and vomiting (p = 0.007).

SIH due to controlled hypotension during shoulder arthroscopic surgery was independently associated with PONV. SIH may serve as a clinically relevant predictor for PONV.

The development of clinical tools to combat extreme heat events (EHEs) is urgently needed. However, the collection, linkage, and application of data and technology required to address the health consequences of EHEs-through individualized decision-making, population-focused interventions, and health system planning-remain in its infancy despite the wealth of data infrastructure in health care systems.

In this paper, we describe a use case for data-intensive system architecture that can enable best practices for addressing EHE-related health risks in older adults with cardiovascular disease (CVD), a population uniquely vulnerable to EHEs.

Descriptions of various data sources integrated into a modular approach are discussed that allows multilevel (ie, individual-level, population-level) evaluation of EHE-related risk. Individual data streams include batched data from personal digital health devices such as wearables, indoor temperature sensors, and electronic medical record data linked through unique identifiers. Data collection, processing, and analysis as well as related challenges (eg, data quality, processing requirements, and health care system attribution) are also discussed. How this data architecture can then address important preclinical, clinical, and related questions are then described, including: (1) which physiological signals (including cardiovascular and sleep measures) may best anticipate EHE-related health care utilization in older adults with CVD; (2) how do heat thresholds that increase EHE-related health care utilization differ by medication use and type, and comorbidities; and (3) how does indoor versus outdoor temperature measures influence these associations-all understudied aspects of EHE risk in older adults.

With considered effort and expertise, a modular data architecture that allows the combination of different elements will enable the development of clinical tools to address EHE-related health risk among older adults with CVD at multilevel scales.

This review summarizes contemporary evidence on transcatheter aortic valve replacement (TAVR) explantation, emphasizing epidemiology, indications, operative challenges, outcomes, risk prediction, and implications for lifetime valve management.

As TAVR expands to younger and lower-risk patients, explantation is becoming an increasingly relevant component of lifetime valve care. Recent systematic reviews, registries, national databases, and center experiences show that TAVR explant is technically complex, frequently requires concomitant procedures, and carries early mortality that exceeds conventional risk predictions. TAVR-in-TAVR is feasible in selected patients with structural valve degeneration but may be limited by infection, small annulus, coronary obstruction risk, or impaired future coronary access. TAVR explant should be considered during index valve selection. Heart Team planning should incorporate durability, coronary access, annular size, redo-TAVR feasibility, and surgical explant complexity, particularly in younger patients.

The 2026 American College of Cardiology/American Heart Association (ACC/AHA) dyslipidemia guideline represents a major shift in secondary prevention of atherosclerotic cardiovascular disease (ASCVD), moving beyond a predominantly low-density lipoprotein cholesterol (LDL-C)-centered model toward earlier, lower, longer, and more individualized lipid-lowering strategies. This review summarizes 10 practice-changing concepts from the guideline with direct relevance to patients with clinical ASCVD.

Despite high-intensity statin therapy, substantial residual cardiovascular risk may persist because of delayed treatment intensification, persistent apolipoprotein B (apoB)-containing lipoprotein burden, elevated lipoprotein(a) [Lp(a)], triglyceride-rich remnants, and high-risk cardiovascular-kidney-metabolic (CKM) comorbidities. Major updates include reintroduction of goal-directed therapy, lower LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) targets, and broader use of non-statin therapies, including ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, bempedoic acid, and inclisiran. In patients with clinical ASCVD at very high risk, LDL-C and non-HDL-C targets of < 55 mg/dL and < 85 mg/dL, respectively, are recommended. The guideline also emphasizes structured lipid monitoring and a systematic approach to statin-attributed muscle symptoms to reduce therapeutic inertia, preserve effective lipid-lowering therapy, and support sustained goal attainment. Collectively, these updates mark a transition toward precision lipidology, emphasizing individualized risk assessment, earlier treatment escalation, structured follow-up, preservation of effective therapy despite treatment-related symptoms, and more comprehensive reduction of residual cardiovascular risk in secondary prevention.

Long waiting times for donor organs in pediatric patients have increased the need for mechanical circulatory support as a bridge to heart transplantation. We report the case of a one-year-old boy with Barth syndrome who presented with cardiogenic shock due to severe biventricular heart failure. Emergency biventricular assist device support using centrifugal pumps was initiated. Under severe pulmonary hypertension and pulmonary regurgitation, the right ventricular assist device outflow was temporarily directed to the left atrium to optimize left ventricular preload. As pulmonary hemodynamics improved, the right ventricular assist device outflow was redirected to the pulmonary artery, allowing evaluation of native pulmonary circulation and subsequent right ventricular assist device weaning. After recovery of end-organ function, the left ventricular assist device was converted to a Berlin Heart EXCOR 76 days after biventricular assist device implantation. The patient remained stable on Berlin Heart EXCOR support for 374 days and subsequently underwent successful heart transplantation. This case highlights the importance of early right ventricular assist device support and strategic management of right ventricular assist device outflow to optimize left ventricular assist device performance in pediatric patients with severe pulmonary hypertension. Such an approach may facilitate successful bridge-to-candidacy and eventual heart transplantation in high-risk pediatric patients.

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant morbidity and mortality, with cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) being the primary contributors to poor outcomes. Magnesium sulfate (MgSO₄) has demonstrated neuroprotective and vasodilatory properties in preclinical models. This study aimed to evaluate the effect of targeted serum magnesium (Mg) maintenance on CV and exploratory clinical outcomes following aSAH. We conducted a prospective, multicenter, single-blind RCT across four neurocritical care units in Korea between 2019 and 2024. A total of 121 aSAH patients were randomized to receive either IV MgSO₄or placebo within six hours of admission. Mg was infused to maintain serum concentrations between 2.0 and 3.0 mg/dL for 14 days. The primary outcome was incidence of CV assessed by transcranial doppler. Secondary outcomes included DCI, ICU and hospital length of stay, modified rankin scale (mRS) at 30 days. There was no significant difference in overall CV incidence; however, the Mg group demonstrated significantly lower mean flow velocity and Lindegaard ratio on days 4-9, indicating reduced vasospasm severity. In exploratory multivariable analyses, a median serum Mg concentration > 2.5 mg/dL during the first 14 hospital days was independently associated with lower risks of CV and DCI. No significant differences were found in mRS scores, ICU and hospital stay, or serious adverse events between groups. Early targeted Mg administration improved TCD-derived hemodynamic markers during the peak vasospasm window; however, it did not significantly reduce CV incidence, DCI, ICU or hospital stay, or 30-day functional outcome.