BACKGROUND: Short sleep duration (<7 h/day) affects one-third of the population, is implicated in morbidity and mortality from coronary heart disease (CHD), and is driven by an interplay of individual, social, and societ...BACKGROUND: Short sleep duration (<7 h/day) affects one-third of the population, is implicated in morbidity and mortality from coronary heart disease (CHD), and is driven by an interplay of individual, social, and societal factors. OBJECTIVE: To review observational and experimental studies that have tested interventions to address short sleep in various clinical presentations (sleep disorders, behaviorally induced short sleep, lack of sleep opportunity) and describe considerations needed for CHD populations. CONCLUSIONS: Few existing interventions have a primary aim to increase sleep duration in individuals with insufficient sleep, and none specifically target individuals with established CHD. Short sleep duration may be modifiable via treatment of insomnia, behavioral sleep extension, and system-level changes to healthcare settings, workplace policies, and communities. With further research on interventions that address diverse phenotypes of short sleep-while assessing long-term cardiometabolic outcomes, patient preferences, and mechanisms-of-action-sleep health could become an important component of CHD secondary prevention.
Although coronary artery bypass grafting (CABG) outcomes are typically highly successful, outpatient evaluation of bypass grafts is an important step. Moreover, the return of myocardial ischemia and acute coronary syndro...Although coronary artery bypass grafting (CABG) outcomes are typically highly successful, outpatient evaluation of bypass grafts is an important step. Moreover, the return of myocardial ischemia and acute coronary syndrome (ACS) events after bypass is not uncommon. Whether due to failure of prior bypass grafts or progression of underlying arteriosclerosis in native coronaries, regularly evaluating if a patient requires intervention (and assessing graft patency vs. closure) is essential. Imaging via cardiac computed tomography angiography (CTA) offers a gold standard anatomical map to facilitate efficiency and accuracy in later invasive coronary angiography (ICA) or surgical re-CABG intervention. This review discusses the utility of CTA as a safe pre and post CABG evaluation tool, in guiding outpatient evaluation of graft patency and roadmapping subsequent reintervention if needed. We seek to ameliorate clinical uncertainties and synthesize growing amounts of research, to help encourage a homogenous approach to post-CABG evaluation. This comprehensive review paper introduces the indications for bypass grafting surgery and transcatheter PCI approaches, details techniques and strategies for bypass surgery, discusses CTA in evaluating post-CABG graft patency, and consolidates research surrounding pre-reintervention CTA in post-CABG patients. Last, this review explores future directions in standardizing post-CABG evaluation guidelines.
Ventricular arrhythmias (VAs) are highly prevalent in patients with advanced heart failure (AHF), a condition characterized by severe signs and symptoms despite conventional HF therapy. The management of VAs in this sett...Ventricular arrhythmias (VAs) are highly prevalent in patients with advanced heart failure (AHF), a condition characterized by severe signs and symptoms despite conventional HF therapy. The management of VAs in this setting remains challenging. Antiarrhythmic drug therapy options are limited and only amiodarone has demonstrated effectiveness in suppressing VA, albeit this agent is associated with a substantial risk of cardiac and noncardiac adverse effects. Catheter ablation is effective for the reduction of VAs in patients with AHF. Identification of patients at high risk for periprocedural hemodynamic decompensation has important implications in terms of procedural planning and improving patient safety and procedural outcomes. Herein, we review the current state of scientific evidence for the management of VA in patients with AHF.
Kwiecinski J, Grodecki K, Pieszko K
… +12 more, Dabrowski M, Chmielak Z, Wojakowski W, Niemierko J, Fijalkowska J, Jagielak D, Ruile P, Schoechlin S, Elzomor H, Slomka P, Witkowski A, Dey D
Prog Cardiovasc Dis
· 2025 · PMID 40268155
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Prediction of outcomes following transcatheter aortic valve replacement (TAVR) is challenging. Considering that in aortic stenosis outcomes are governed by both valve degeneration and myocardial adverse remodeling, we ai...Prediction of outcomes following transcatheter aortic valve replacement (TAVR) is challenging. Considering that in aortic stenosis outcomes are governed by both valve degeneration and myocardial adverse remodeling, we aimed to evaluate machine-learning leveraging pre-procedural computed tomography (CT) for the prediction of 1-year mortality following TAVR. The analysis included data of consecutive patients who underwent TAVR at a high-volume center between January 2017 and January 2022 and was externally validated on unseen data from 3 international sites. Machine learning by extreme gradient boosting was trained and tested using clinical variables, CT-derived volumetric measurements including myocardial mass, and quantitative fibrocalcific aortic valve characteristics measured using standardized software. The EuroScore II and a separate machine learning risk score based exclusively on baseline clinical characteristics served as comparators. The derivation cohort included 631 consecutive patients (48 % men, 80 ± 8 years old, EuroSCORE II 6.5 [4.6-10.3] %). Machine learning was externally validated on data of 596 patients (48 % men, 81 ± 8 years old, EuroSCORE II 5.4 [4.7-8.1] %). In external validation, the machine learning prognostic risk score had an area under the receiver operator curve of 0.79 (0.74-0.84) which was superior to the EuroSCORE 0.59 (0.53-0.66), and the machine learning risk based on clinical data alone 0.64 (0.59-0.69), p < 0.001 for difference. Machine-learning integrating clinical data and CT-derived imaging characteristics was found to predict 1-year all-cause mortality following TAVR significantly better than clinical variables or clinical risk scores alone; and can help identify patients at higher prognostic risk prior to the procedure.
Only 1 in 5 evidence-based interventions make it to routine clinical practice and the evidence generated from clinical research may take 17 years to be implemented. This represents a lost opportunity to improve clinical...Only 1 in 5 evidence-based interventions make it to routine clinical practice and the evidence generated from clinical research may take 17 years to be implemented. This represents a lost opportunity to improve clinical care in healthcare systems. Implementation science refers to the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into real-world clinical settings to positively impact population health. Therefore, implementation roadmaps can be crucial for learning healthcare systems (LHS) to bridge the research-to-practice gap, particularly for cardiovascular disease which remains the leading cause of death in the United States. Implementation models exist, all of which require a thorough understanding of the key phases of implementation for effective healthcare system incorporation and optimization (pre-implementation, implementation, monitoring the implementation, evaluation, sustaining, and scaling-up or de-implementation). This review serves as a call-to-action for involvement of large-scale LHS for cardiovascular implementation science, and provides a roadmap by summarizing various implementation science models, highlighting key implementation phases and discussing successful initiatives to improve the process. We also assess challenges associated with implementation science and provide possible solutions to improve translation of evidence in real-world clinical settings.
Cardioneuroablation (CNA) is an emerging therapy for patients with vasovagal syncope with predominant cardioinhibitory responses. The procedure targets the neuromyocardial connections localized in specific regions of the...Cardioneuroablation (CNA) is an emerging therapy for patients with vasovagal syncope with predominant cardioinhibitory responses. The procedure targets the neuromyocardial connections localized in specific regions of the right and left atrium as well as the adjacent ganglionated plexi (GP) providing parasympathetic innervation to the sinus and atrioventricular nodes. The target regions for CNA can be determined with various techniques, which result in heterogenous procedural approaches and endpoints in different centers specialized in this procedure. In this review we summarize the rationale and details of the procedural approach for three different techniques for CNA, namely: CNA controlled by extra-cardiac vagal stimulation, CNA guided by analysis of fractionated electrograms, and an anatomical approach to CNA.
Ischemic heart disease (IHD) is the leading global cause of death, affecting millions and leading to significant morbidity and mortality. Ischemic cardiomyopathy (ICM), a manifestation of IHD, results in severe left vent...Ischemic heart disease (IHD) is the leading global cause of death, affecting millions and leading to significant morbidity and mortality. Ischemic cardiomyopathy (ICM), a manifestation of IHD, results in severe left ventricular dysfunction due to coronary artery disease and poses a significant challenge due to the complex pathophysiology, variable clinical presentation, and overall poor prognosis. Recent advances in medical therapy, device interventions, and revascularization techniques offer newfound hope in improving ICM patient outcomes. This article reviews the state-of-the-art management approaches for ICM, emphasizing the importance of personalized treatment plans that integrate the various contemporary therapies to address the multiple mechanisms of disease development and progression. A meticulously tailored treatment approach for each individual patient offers the hope of prolonged survival through the synergy of therapies designed to address the different and complex mechanisms that contribute to their disease process.
Zhang RS, Jin L, Falco G
… +10 more, Axman R, Villar-Calle P, Tsay A, Lam MC, Krishnan U, Cheng A, Han Y, Mukherjee M, Weinsaft JW, Kim J
Prog Cardiovasc Dis
· 2025 · PMID 40185178
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BACKGROUND: Right ventricular (RV) performance impacts clinical outcomes across pulmonary hypertension (PH), yet noninvasive tools for early detection and risk stratification are limited. Cardiac MRI (CMR) derived RV to...BACKGROUND: Right ventricular (RV) performance impacts clinical outcomes across pulmonary hypertension (PH), yet noninvasive tools for early detection and risk stratification are limited. Cardiac MRI (CMR) derived RV to left ventricular (LV) volume ratio (RV/LV ratio) provides a relative assessment of RV size by normalizing chamber size to the LV. However, its prognostic utility remains underexplored. In the present study, we investigate the association between the RV/LV ratio and outcomes in patients with PH. METHODS: This prospective study included patients with PH (pulmonary arterial systolic pressure > 35 mmHg by echocardiography or mean pulmonary artery pressure > 20 mmHg on invasive right heart catheterization), who underwent CMR. Abnormal RV/LV ratio cutoff (≥1.27) was applied and further tested using established gradation thresholds. The primary outcome was a composite of all-cause mortality and heart failure hospitalizations. RESULTS: Of 135 patients, 56 (41.5 %) had an abnormal RV/LV ratio. After a mean follow-up of 1.9 ± 1.3 years, 75 patients experienced the primary outcome. Patients with an abnormal RV/LV ratio had higher rates of the primary outcome (64.3 % vs 50.0 %, p = 0.02). After multivariable analysis adjusting for age and CMR indices, abnormal RV/LV ratio was independently associated with the primary outcome (HR 1.81 [95 % CI 1.06-2.97]; p = 0.003). RV/LV ratio added incremental prognostic value over age and traditional RV indices (global χ2 value increasing from 6.7 to 17.4, p = 0.006). CONCLUSIONS: The RV/LV ratio is a simple clinical tool associated with an increased risk of adverse outcomes in PH patients, offering prognostic information beyond traditional RV parameters.
Cardiovascular disease (CVD) represents a significant health crisis, leading to premature morbidity and mortality, that is largely preventable. A decade ago, the World Health Organization formally acknowledged the powerf...Cardiovascular disease (CVD) represents a significant health crisis, leading to premature morbidity and mortality, that is largely preventable. A decade ago, the World Health Organization formally acknowledged the powerful role culture plays in health and well-being, a key factor in preventing CVD, prompting increased attention on how shared values, norms, symbols, ethics and life practices effect the decisions and behaviors of patients, populations and practitioners alike. Cultural contexts affect human behaviors and health outcomes, and the United States (U.S.) is divided between dominant regional cultures. The American Nations model, informed by the work of cultural geographers, historians, and anthropologists, provides an analytical framework for understanding regional cultural contexts within the U.S. This model has been used to demonstrate significant regional differences in health outcomes, wellbeing, lifestyle behaviors, lifespan, and social vulnerability, with communitarian cultures consistently outperforming individualistic cultures across a broad range of phenomena. This model has significant implications for how a nation approaches health and health care, shifting from the traditional, national level one-size-fits-all paradigm to one that considers distinct regional differences based on historical settlement patterns. In this context, the American Nations model can help improve the effectiveness of health interventions by supporting a better understanding of cultural differences and the dominant U.S. cultural landscapes.
What defines a group of individuals as part of a community is broadly interpreted and depends on the context of the group being categorized. For this review, community may be defined as "as a group of people with diverse...What defines a group of individuals as part of a community is broadly interpreted and depends on the context of the group being categorized. For this review, community may be defined as "as a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings". A given community will possess unique cultural attributes, defined by the American Psychological Association as "the values, beliefs, language, rituals, traditions, and other behaviors that are passed from one generation to another within any social group". Unhealthy lifestyle behaviors drive the unacceptably high incidence and prevalence of chronic disease in the United States. Despite well intentioned efforts, society appears to be failing at altering the trajectory of unhealthy lifestyle behaviors, from an individual to population level. Perhaps our oftentimes one size fits all approach to health behavior messaging and counseling is a critical shortcoming. The fact that being more physically active, not smoking and consuming a healthier diet is of great benefit to human physiology and therefore human health outcomes is clear. However, human health behaviors or decisions to make a change in behavior are not driven by physiology but rather a complexly interacting milieu of factors - cultural drivers unique to a community amongst them. Herein, we discuss several community settings where there are opportunities to promote a culture of health living. This review will focus on settings that embody the definitions of community and culture described previously.
Social structures have become focal points in considering how to address the circumstances and conditions under which people live their lives. Yet, the many interactions among multiple factors that make up social and str...Social structures have become focal points in considering how to address the circumstances and conditions under which people live their lives. Yet, the many interactions among multiple factors that make up social and structural determinants are complex, interdependent, interactive, dynamic, and multilevel. This paper introduces an evidence-informed ecological framework that organizes drivers and feedback mechanisms collectively representing a generative force towards population health and well-being. The proposed ecological framework supports explanatory and exploratory considerations for prevention and management of population health and well-being issues. The framework explicitly includes a recognition that successful health and well-being outcomes are often dependent on the presence of social capital and healthy power dynamics. Dominant cultural norm is positioned as an overarching driver in this framework because it shapes the political realities and power dynamics responsible for infrastructure as well as the habits and behaviors of people at both the individual and social levels.