Am J Cardiol
· 2026 Jun · PMID 42264288
·
Publisher ↗
This study evaluated whether embedding diagnostic expectations within prompts biases large language model (LLM) classification of left ventricular ejection fraction (LVEF) from echocardiography reports, and whether a pro...This study evaluated whether embedding diagnostic expectations within prompts biases large language model (LLM) classification of left ventricular ejection fraction (LVEF) from echocardiography reports, and whether a prompt-level mitigation strategy can counteract this effect. GPT-5 was evaluated under 1 baseline, 3 bias-injected, and 1 explicit instruction-based mitigation prompt condition across 1,500 structured reports from a single institution dataset. Bias prompts significantly altered LVEF classifications across all 3 classes, with shifts directionally consistent with the referenced category. The instruction-based mitigation strategy restored overall accuracy near baseline in all 3 conditions. In conclusion, prompt-induced bias poses a meaningful risk to diagnostic classification accuracy; however, prompt-level safeguards may support reliable LLM deployment in clinical settings.
Am J Cardiol
· 2026 Jun · PMID 42264287
·
Publisher ↗
Artificial intelligence (AI) and machine learning (ML) have demonstrated strong diagnostic and prognostic performance across cardiovascular medicine. However, translation into equitable real-world benefit is limited by a...Artificial intelligence (AI) and machine learning (ML) have demonstrated strong diagnostic and prognostic performance across cardiovascular medicine. However, translation into equitable real-world benefit is limited by algorithmic bias, inadequate external validation, and unclear implementation pathways. This State-of-the-Art Review evaluates these challenges using the Total Product Life Cycle (TPLC) framework, encompassing development, validation, regulatory approval, deployment, and post-market surveillance. We synthesize current literature on bias mechanisms, validation strategies, and real-world implementation, and critically assess emerging technical solutions, including federated learning and explainable AI. Bias enters at multiple lifecycle stages through unrepresentative data, flawed labels, measurement variability, and deployment mismatch. Most cardiovascular AI models rely on limited external validation, often lacking geographic or domain generalizability. A 2025 analysis of 691 FDA-cleared AI/ML devices showed 95.5% lacked demographic transparency and only 1.6% had randomized trial evidence. Implementation barriers include dataset shift, regulatory gaps, and inequitable access, with limited prospective outcome data supporting clinical benefit. Current cardiovascular AI deployment is not matched by sufficient evidence for safety, equity, and effectiveness. A TPLC-aligned framework with rigorous validation, demographic transparency, and continuous post-market monitoring is essential to ensure equitable and clinically meaningful integration of AI into cardiovascular care.
Ang SP, Patel D, Chia JE
… +2 more, Lee KS, Shanmugasundaram M
Am J Cardiol
· 2026 Jun · PMID 42264286
·
Publisher ↗
Restoration of epicardial patency with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) does not necessarily translate into adequate tissue-level reperfusion. Adjunct...Restoration of epicardial patency with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) does not necessarily translate into adequate tissue-level reperfusion. Adjunctive intracoronary thrombolysis has been proposed to improve microvascular perfusion, but randomized data remain heterogeneous. This study sought to evaluate the efficacy and safety of adjunctive intracoronary thrombolysis during primary PCI for STEMI. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing adjunctive intracoronary thrombolysis plus primary PCI versus control in patients with STEMI. The primary endpoint was major adverse cardiovascular events (MACE). Secondary endpoints included major bleeding, post-procedural TIMI flow grade 2/3, TIMI myocardial perfusion grade, ST-segment resolution, and corrected TIMI frame count (CTFC). Random-effects models were used to estimate pooled treatment effects. Fifteen RCTs with 2,604 patients were included. Compared with control, adjunctive intracoronary thrombolysis was associated with a significantly lower risk of MACE (risk ratio [RR]: 0.66; 95% confidence interval [CI]: 0.52 to 0.84; p < 0.001). Intracoronary thrombolysis also improved postprocedural TIMI flow grade 2/3 (RR: 1.08; 95% CI: 1.02 to 1.13; p = 0.005), TIMI myocardial perfusion grade (RR: 1.25; 95% CI: 1.08 to 1.43; p = 0.002), and ST-segment resolution (RR: 1.17; 95% CI: 1.10 to 1.25; p < 0.001), and reduced CTFC (mean difference: -4.49 frames; 95% CI: -6.25 to -2.72; p < 0.001). Major bleeding was infrequent and did not differ significantly between groups (OR: 1.40; 95% CI: 0.63 to 3.11). In STEMI patients undergoing primary PCI, adjunctive intracoronary thrombolysis was associated with lower MACE and improved angiographic and electrocardiographic markers of myocardial reperfusion without a significant increase in major bleeding.
Čelutkienė J, Lycholip E, Burneikaitė G
… +13 more, Kalakauskaitė L, Karaliūtė G, Kriukelytė D, Barysienė J, Zuozienė G, Žaliaduonytė D, Kavoliūnienė A, Puronaitė R, Morkvėnienė V, Girčys A, Žilinskas L, Stromberg A, Jaarsma T
Am J Cardiol
· 2026 Jun · PMID 42264285
·
Publisher ↗
Despite clear guideline recommendation to involve heart failure (HF) patients into multidisciplinary programmes (MP), availability of this specialized care remains insufficient throughout European countries. The aim of t...Despite clear guideline recommendation to involve heart failure (HF) patients into multidisciplinary programmes (MP), availability of this specialized care remains insufficient throughout European countries. The aim of this study is to analyse the process of establishment, implementation metrics, and quality indicators (QIs) of heart failure multidisciplinary programme (HF-MP) in Lithuania. We conducted a retrospective analysis of the requisites, steps of initiation and development of HF-MP as a national service reimbursed since 2016. HF-MP is structured as 4 encounters with a specialized HF team during 1 year after HF decompensation. Based on the National Health Insurance Fund (NHIF) administrative data we present the effect of HF-MP intervention on cardiovascular readmissions, survival, and ICD implantations from 2018 to 2022. Aggregated 2018 to 2022 data from the NHIF showed that the odds for 1-year survival were 2.4 to 2.9 times higher in HF-MP cohort compared to usual care (UC), while the chances to survive without readmissions were 1.3 to 1.7 times greater than with UC. Health-related quality of life, index of self-care, and 6-min walk test had improved significantly at the last visit of HF-MP service (p < 0.001). In conclusion, sharing practical experience from HF clinics in Sweden and HF recommendations help to transfer HF multidisciplinary programmes to the national Lithuanian context. The effects of the intervention include reduction of morbidity and early mortality as well as improvement of quality of life of patients with heart failure.
Marschall A, Salamanca J, Cecconi A
… +6 more, Santos B, Vilches L, Gamarra Á, Martí D, Nuñez-Gil IJ, Alfonso F
Am J Cardiol
· 2026 Jun · PMID 42264284
·
Publisher ↗
Takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by transient left ventricular dysfunction and characteristic regional wall motion abnormalities extending beyond a single coronary territory in th...Takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by transient left ventricular dysfunction and characteristic regional wall motion abnormalities extending beyond a single coronary territory in the absence of culprit coronary lesions. Predominantly affecting postmenopausal women, TTS often mimics acute myocardial infarction, with chest pain, dyspnea, electrocardiographic changes, and elevated cardiac biomarkers. Emotional or physical stressors trigger most cases, though one-third occur without identifiable precipitants. Pathophysiology is multifactorial, involving transient catecholamine-mediated cardiotoxicity, coronary microvascular dysfunction, sympathetic hyperactivity, brain-heart axis alterations, and estrogen deficiency, with emerging evidence implicating inflammation and genetic susceptibility. Diagnosis relies on multimodality imaging, including echocardiography, coronary angiography, and cardiac magnetic resonance imaging. Management remains empiric and largely supportive, guided by hemodynamic status and complications, with judicious avoidance of catecholamines. Long-term therapy with beta-blockers ACE inhibitors, ARBs and SGLT2 inhibitors has been proposed to improve prognosis but evidence is observational and limited. TTS is not benign; in-hospital and long-term morbidity and mortality rival those of acute coronary syndromes. Ongoing research is essential to refine risk stratification, elucidate pathophysiology, and develop targeted, evidence-based therapies.
Javaid SS, Hanif M, Paulson S
… +7 more, Anker MS, Chew NWS, Jamil A, Anker SD, DiMaio JM, Butler J, Khan MS
Am J Cardiol
· 2026 Jun · PMID 42264283
·
Publisher ↗
Cancer therapy-related cardiac dysfunction (CTRCD) is becoming more prevalent, while the role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in mitigating CTRCD remains uncertain. We assessed the association be...Cancer therapy-related cardiac dysfunction (CTRCD) is becoming more prevalent, while the role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in mitigating CTRCD remains uncertain. We assessed the association between GLP-1 RA and CTRCD in cancer patients using the TriNetX database (2010 to 2023), identifying adult cancer patients (≥18 years) without prior heart failure (HF) who were receiving cardiotoxic antineoplastic therapy. Patients were stratified into GLP-1 RA-exposed and unexposed groups, and the primary outcome was CTRCD, defined as new-onset HF or intravenous diuretic initiation. Cox proportional hazard models were used to evaluate outcomes at 1 and 3 years. Among 711,091 eligible patients, 21,465 (3.0%) received GLP-1 RAs. After propensity score matching, each cohort included 19,803 patients (mean age: 65.8 ± 12.3 years; 55.8% women), with metastatic cancer and skin cancer being the most common malignancies. GLP-1 RA exposure was associated with a significantly reduced risk of CTRCD at 1 year (HR: 0.49, 95% CI: 0.45 to 0.54, p < 0.01) and 3 years (HR: 0.56, 95% CI: 0.52 to 0.61, p < 0.01), with consistent effects across different cardiotoxic therapies. GLP-1 RA use was also associated with reductions in incident HF, all-cause mortality, myocardial infarction, and atrial fibrillation. In patients with metastatic cancer, similar benefits were observed, including lower risks of CTRCD, all-cause mortality, atrial fibrillation, hospitalizations or emergency room visits, and incident HF. Overall, GLP-1 RA use was associated with a lower risk of CTRCD and cardiovascular events in cancer patients receiving cardiotoxic antineoplastic therapy, including those with metastatic disease.
Am J Cardiol
· 2026 Jun · PMID 42264014
·
Publisher ↗
A 60-year-old woman presented with intermittent chest discomfort for 1 month, which had worsened over the preceding week and was accompanied by progressive dyspnea. Her medical history was notable for hepatitis approxima...A 60-year-old woman presented with intermittent chest discomfort for 1 month, which had worsened over the preceding week and was accompanied by progressive dyspnea. Her medical history was notable for hepatitis approximately 40 years earlier. On admission, physical examination revealed jugular venous distention, cardiomegaly, and bilateral pitting edema of the lower extremities. Laboratory testing showed an NT-proBNP level of 8,272 pg/mL and a d-dimer level of 7,948 ng/mL. Computed tomography pulmonary angiography (CTPA) revealed bilateral thrombi in the main pulmonary arteries. Transthoracic echocardiography showed marked biventricular enlargement (LVEF 20%), 2 mural thrombi in the left ventricle, and a mobile thrombus in the right atrium. Lower extremity venous ultrasonography demonstrated deep vein thrombosis. Genetic testing using a cardiomyopathy gene panel identified a likely pathogenic TTN truncating variant (c.6061C>T, p.Arg2021*), consistent with the patient's phenotype of dilated cardiomyopathy (DCM). In conclusion, this case highlights the complex management of acute pulmonary embolism (PE) complicated by severe heart failure, multisite thrombosis, and acute hepatic congestion, emphasizing the critical need for individualized anticoagulation bridging and early adjunctive mechanical interventions.
Kwaah PA, Mensah SA, Tabot-Ntoung CN
… +5 more, Carboo AK, Hu JR, Tong G, Velazquez EJ, Elissa Altin S
Am J Cardiol
· 2026 Jun · PMID 42264013
·
Publisher ↗
Chronic limb-threatening ischemia (CLTI) represents end-stage peripheral artery disease (PAD) with high mortality and amputation risk. Concomitant heart failure (HF) further worsens prognosis, yet the limb impact of HF g...Chronic limb-threatening ischemia (CLTI) represents end-stage peripheral artery disease (PAD) with high mortality and amputation risk. Concomitant heart failure (HF) further worsens prognosis, yet the limb impact of HF guideline-directed medical therapy (GDMT) on limb outcomes remains uncertain. To evaluate the association between individual HF GDMT classes and major lower-extremity amputation (MLEA) among patients with CLTI and chronic HF, overall and by HF phenotype. Using the TriNetX Analytics Network (2014 to 2024), adults with CLTI ± chronic HF were identified by ICD-10 codes. Propensity-score matching was applied in a 1:1 ratio across cohorts. The primary outcome was time to MLEA (above ankle) at 2 and 5 years, estimated using Cox models. Subgroup analyses were stratified by HF phenotype (HFrEF, HFpEF) based on ICD codes and ejection fraction. A total of 495,943 patients had CLTI only, and 78,349 had concomitant chronic HF; 65,458 pairs were successfully matched. CLTI with chronic HF was associated with a higher risk of MLEA compared with CLTI alone (2-year HR 1.41; 95% CI 1.33 to 1.50; p < 0.01). In CLTI + chronic HF, use of MRAs (HR 0.74; 95% CI 0.65 to 0.84) and SGLT2i (HR 0.65; 95% CI 0.55 to 0.76) was associated with a reduced risk of MLEA, whereas BB use increased the risk (HR 1.88; 95% CI 1.63 to 2.17; p < 0.001). The BB effect was observed in HFpEF (HR 1.47; 95% CI 1.10 to 1.96) but not HFrEF. ACEi, ARBs, and ARNI were neutral except for ARNI in HFrEF, associated with reduced MLEA risk (HR 0.57; 95% CI 0.42 to 0.78). Chronic HF markedly amplifies limb-loss risk in CLTI. MRAs and SGLT2i therapies showed protective limb effects, whereas BBs, particularly in HFpEF, were linked to higher amputation risk. These results underscore the need for phenotype-specific, perfusion-conscious tailoring of HF GDMT in advanced PAD.
Brandon AS, Murphy BS, Nam Y
… +7 more, McClelland RL, Huang S, Hershey MS, Besser LM, Forrester SN, Bancks MP, DeFilippis AP
Am J Cardiol
· 2026 Jun · PMID 42264012
·
Publisher ↗
Peripheral arterial disease (PAD) has many established risk factors, but social determinants of health (SDoH) are increasingly recognized as a cardiovascular disease risk factor. The multi-ethnic study of atherosclerosis...Peripheral arterial disease (PAD) has many established risk factors, but social determinants of health (SDoH) are increasingly recognized as a cardiovascular disease risk factor. The multi-ethnic study of atherosclerosis (MESA) cohort was employed to evaluate if neighborhood-level SDoH, represented by the social deprivation index (SDI), provide additional PAD risk prediction beyond the established risk factors. 5,580 individuals from the MESA cohort had social deprivation index (SDI) scores calculated at the zip code tabulation area (ZCTA) geographic level. Incident PAD, established by an ankle-brachial index (ABI) of < 0.9, was the outcome of interest. Two sets of logistic regression models evaluated the SDI's impact on established PAD risk factors. Black and Hispanic individuals lived in areas with more social deprivation than White and Chinese individuals. With SDI incorporation, age (odds ratio [OR] 1.08 per year, p-value < 0.001), treated diabetes (OR 2.02, p-value 0.002), and both current (OR 3.16, p-value < 0.001) and former (OR 1.43, p-value 0.022) cigarette smoking were significantly associated with incident PAD. After SDI removal, there were no consequential changes in significant associations and ORs. Across all measured risk factors, SDI score incorporation did not significantly modify PAD development. The overall composite SDI score's association with incident PAD was not significant (OR 1.00, p-value 0.437). The SDI's addition to recognized risk factors did not enhance PAD risk prediction. SDI scores had prominent racial/ethnic disparity. In conclusion, the SDI's impact on PAD development is likely upstream to known risk factors, so its incorporation provides no additional risk.
Papazoglou AS, Anastasiou V, Peteinidou E
… +11 more, Daios S, Gogos C, Fardoulis E, Moysidis DV, Karakoulidis G, Karamitsos T, Giannakoulas G, Marsan NA, Bax JJ, Ziakas A, Kamperidis V
Am J Cardiol
· 2026 Jun · PMID 42259442
·
Publisher ↗
In acute heart failure (HF), the response of secondary tricuspid regurgitation (STR) to therapeutic management may indicate reverse right ventricular remodeling and response to treatment. This study sought to explore the...In acute heart failure (HF), the response of secondary tricuspid regurgitation (STR) to therapeutic management may indicate reverse right ventricular remodeling and response to treatment. This study sought to explore the dynamic trends of STR during acute HF hospitalization and their association with outcomes at follow-up. Among 463 acute hospitalized HF patients, 285 had significant STR on admission and were considered for this analysis. All patients underwent echocardiographic assessment on admission and prior to discharge and were divided into 2 groups: (1) significant STR on admission that improved at discharge (improved STR), and (2) significant STR on admission without improvement at discharge (nonimproved STR). The two groups were propensity matched (1:1) for age, gender, chronic HF, chronic atrial fibrillation, chronic kidney disease, and followed for the primary endpoint of all-cause mortality and HF rehospitalization. A total of 192 matched patients were included: 96 with improved STR and 96 with nonimproved STR. Better right ventricular free wall longitudinal strain and higher NT-pro-BNP on admission were independent predictors for STR improvement. After a median follow-up of 6 months (interquartile range 2.3 to 9.8), 90 (46.9%) patients reached the primary endpoint. Patients with nonimproved STR had significantly worse event-free survival rate (37.5%), compared to the improved STR (68.8%). Nonimproved STR was independently associated with the primary endpoint (adjusted hazard ratio 3.51 [95% confidence interval, 2.04 to 6.04]; p < 0.001). Nonimproved STR provided incremental information over a baseline clinical and echocardiographic model and the presence of nonimproved inferior vena cava without respiratory variation, nonimproved left ventricular filling pressures, and nonimproved NT-pro-BNP for association with the primary endpoint. The dynamic trends of STR carry a clinically relevant value in acute HF. Absence of STR improvement during hospitalization indicates poor event-free survival, outperforming conventional markers of response to HF management.
Schaye V, Rajput B, Signoriello L
… +4 more, Burk-Rafel J, Guzman B, Webster T, Sartori DJ
Am J Cardiol
· 2026 Jun · PMID 42259441
·
Publisher ↗
Acute coronary syndrome (ACS) requires prompt treatment, yet management delays are difficult to identify. In this study, we developed a large language model (LLM) system to identify ACS management delays and characterize...Acute coronary syndrome (ACS) requires prompt treatment, yet management delays are difficult to identify. In this study, we developed a large language model (LLM) system to identify ACS management delays and characterized delay cases. Admissions to internal medicine residents at NYU from July 2022 to June 2025 (n = 4,642) were included. Prompts were validated to determine if the resident admission note documented initiation of ACS management and if the initial cardiology consult note documented initiation of ACS management (ground truth) (n = 161 for each). Discordant cases were reviewed by three physicians using a validated tool to confirm management delays. Demographics and key clinical findings of patients with and without delays were compared. The LLM identified management delays with a 52% positive predictive value (n = 35/67). Patients who were older, females, and with preferred language other than English or Spanish were more likely to have a management delay (73.4 ± 15.3 vs 68.5 ± 12.6 years old, p = 0.036, 56.8% vs 34% females, p = 0.014, and 27.0% vs 15.5% other preferred language, p = 0.046, in management delay vs non-management delay cases). The management delay group had longer average time in hours to receiving heparin, aspirin, and cardiac catheterization (56.91 ± 56.78 vs 18.97 ± 13.76, p < 0.001, 13.94 ± 16.64 vs 8.23 ± 9.82, p = 0.005, and 65.12 ± 51.65 vs 39.51 ± 44.19, p = 0.006, respectively in management delay vs non-management delay cases). In conclusion, the LLM-based system we developed to identify ACS management delays can detect cases at scale to inform individual and systems-level interventions to improve quality of ACS care.
Apostolos A, Konstantinou K, Sakalidis A
… +9 more, Kalogeras K, Heng EL, Dalby M, Baltabaeva A, Mirsadraee S, Mittal T, Skondras E, Smith R, Panoulas V
Am J Cardiol
· 2026 Jun · PMID 42229558
·
Publisher ↗
Transaxillary (TAx) access has shown comparable outcomes to transfemoral access in selected studies of transcatheter aortic valve implantation (TAVI). Although TAx-TAVI has mainly been performed via surgical cutdown unde...Transaxillary (TAx) access has shown comparable outcomes to transfemoral access in selected studies of transcatheter aortic valve implantation (TAVI). Although TAx-TAVI has mainly been performed via surgical cutdown under general anesthesia, a fully percutaneous approach under local anesthesia with mild sedation has recently emerged as a less invasive option. We present Balloon-Assisted Transaxillary Artery Closure (BATAC) approach and report our early clinical experience. This observational study included consecutive adult patients with severe aortic stenosis who underwent simplified TAx-TAVI. Procedures were performed via left or right axillary access under ultrasound-guidance. Two ProStyles were predeployed, and the access sheath was progressively upsized over Amplatz Super Stiff wire. During closure, the Armada balloon was inflated at 2 atm via the ipsilateral arterial access at the site of the arteriotomy. With the balloon inflated, the ProStyle suture knots were sequentially advanced one-by-one under fluoroscopic guidance all the way to the arterial wall adjacent to the inflated balloon ensuring no entrapment within the surrounding soft tissue. Twelve patients underwent TAx-TAVI using this technique. Technical success was met in all patients, and device success in 91.7%. There were no in-hospital deaths, cerebrovascular events, major vascular complications, life-threatening bleeding, or need for vascular surgery. One patient developed cardiac tamponade requiring pericardial drainage, without transfusion. One minor access-site bleeding episode was managed conservatively. A simplified percutaneous axillary artery closure strategy following TAx-TAVI was associated with excellent early procedural and clinical outcomes in this small cohort. Larger studies are warranted to validate these findings.
Yu H, Li L, Chen J
… +4 more, Cui L, Song H, Dong S, Chu Y
Am J Cardiol
· 2026 May · PMID 42218955
·
Publisher ↗
Planned rotational atherectomy (RA) has been widely used for severely calcified lesions, but moderate to severe coronary calcified lesions (CCL) are recommended for bailout RA. In this study, we sought to clarify whether...Planned rotational atherectomy (RA) has been widely used for severely calcified lesions, but moderate to severe coronary calcified lesions (CCL) are recommended for bailout RA. In this study, we sought to clarify whether intravascular ultrasound (IVUS)-guided planned RA is superior to cutting balloons (CB) for moderate to severe CCL. Patients with grade Ⅲ CCL were randomly assigned to percutaneous coronary intervention with RA or CB. The primary endpoint was strategy success and the coprimary endpoint was stent expansion. Secondary endpoints included procedural expense and duration, contrast amount, stent thrombosis, and major adverse cardiac events (MACE) at 30 days. A total of 80 patients (65.4 ± 8.0 vs 62.4 ± 11.2 years, p = 0.144) were enrolled, 40 in each group. Prior myocardial infarction was present in 2 (5%) versus 8 (20%) patients, p = 0.043. Strategy success rate was higher with planned RA compared with CB (95% vs 80%, p = 0.043). Stent expansion indices (stent expansion rate >80%, minimal stent area >5.0 mm², and stent asymmetry) were significantly better in the RA group (p <0.05). X-ray dose, contrast amount, and procedural expense were higher in the RA group (p <0.05), but no significant differences in procedural duration or 30-day MACE were observed between groups (p >0.05). In conclusion, IVUS-guided planned RA for grade Ⅲ CCL results in higher strategy success and better stent expansion than CB, with rare procedural complications and few clinical adverse events at 30 days, providing novel insight into pretreatment of moderate to severe CCL.
Enwere C, Mousavi RA, Basera P
… +12 more, Soroa M, Argulian E, Ferrandez-Escarabajal M, Alizadeh L, Herbas F, Dangas GD, Safi L, Khera S, Tang GHL, Sharma SK, Kini AS, Lerakis S
Am J Cardiol
· 2026 Jun · PMID 42218954
·
Publisher ↗
Low-flow aortic stenosis (AS) is a high-risk subgroup of severe AS occurring with either reduced or preserved left ventricular ejection fraction (LVEF). Flow normalization (measured by stroke volume index [SVi]) and LVEF...Low-flow aortic stenosis (AS) is a high-risk subgroup of severe AS occurring with either reduced or preserved left ventricular ejection fraction (LVEF). Flow normalization (measured by stroke volume index [SVi]) and LVEF improvement are associated with improved outcomes after transcatheter aortic valve replacement (TAVR), yet whether these changes occur similarly across subtypes and concordantly remains unclear. To evaluate flow normalization and LVEF improvement across low-flow AS subtypes, assess concordance, and identify predictors. Patients with severe low-flow AS (SVi <35 ml/m²; aortic valve area ≤1 cm²) who underwent TAVR with 1-year echocardiographic follow-up were classified as low-flow, low-gradient (LFLG) AS with reduced LVEF, LFLG AS with preserved LVEF, or low-flow, high-gradient (LFHG) AS. Flow normalization and LVEF improvement ≥5% at 1 year were assessed. Among 174 patients (mean age 79 ± 8 years; 36% female), 18.4% had LFLG with reduced LVEF, 60.9% LFLG with preserved LVEF, and 20.7% LFHG. Flow normalization occurred in 38.5% overall at similar rates across phenotypes respectively (40.6%, 34.9%, and 47.2%; p = 0.407). LVEF improvement ≥5% occurred in 35.6% overall but was most frequent in LFLG with reduced LVEF (65.6%) versus preserved LVEF (29.2%) and LFHG (30.6%; p <0.001). Only 16% showed concordant improvement; 40.8% showed neither. Lower baseline LVEF independently predicted LVEF improvement; no independent predictors of flow normalization were identified. Flow normalization after TAVR occurred at similar rates across low-flow AS subtypes, while LVEF improvement was most frequent in LFLG AS with reduced LVEF. These changes frequently occurred discordantly, though prognostic implications remain unclear.
Pollanen S, Lee AD, McGuinty J
… +3 more, Jeong S, Chronis N, Mukovozov I
Am J Cardiol
· 2026 May · PMID 42214581
·
Publisher ↗
Sternal wound complications following cardiac surgery increase reoperation risk, prolong hospitalization, and complicate postoperative cardiovascular recovery, yet optimal prevention strategies remain poorly defined. We...Sternal wound complications following cardiac surgery increase reoperation risk, prolong hospitalization, and complicate postoperative cardiovascular recovery, yet optimal prevention strategies remain poorly defined. We performed a systematic review with quantitative synthesis of 31 studies enrolling 6,420 adult cardiac surgery patients to evaluate the usefulness of negative pressure wound therapy (NPWT) compared with conventional dressings for preventing and managing poststernotomy wound complications. The pre-specified primary analysis focused on prophylactic NPWT applied over closed sternotomy incisions, since open and closed-incision applications represent fundamentally distinct populations with non-comparable outcomes. Within this primary analysis, prophylactic foam-based closed-incision NPWT (ciNPT) in high-risk sternotomy patients showed the most consistent reduction in surgical site infection, with relative risk estimates of 0.25 to 0.94 across 7 studies enrolling 2,178 patients. Evidence for therapeutic NPWT in established sternal wound infections was directionally favorable but derived exclusively from observational studies. Interstudy heterogeneity precluded robust aggregate pooled conclusions. In conclusion, prophylactic ciNPT may be reasonable to consider in selected high-risk patients pending randomized trial confirmation.
Alexandrou M, Vichos T, Carvalho PEP
… +29 more, Strepkos D, Fath A, Goel M, Williford N, Raj LM, Gorgulu S, Alaswad K, Basir MB, Nakhle A, Frizzell J, Kong JA, Reginelli JP, Garcia-Labbe D, Paradis JM, Nguyen C, Poommipanit P, Young L, Azzalini L, Kearney KE, Ozdemir R, Uluganyan M, Chandwaney RH, Goktekin O, Choi JW, Jefferson B, Mastrodemos O, Rangan BV, Sandoval Y, Brilakis ES
Am J Cardiol
· 2026 May · PMID 42214580
·
Publisher ↗
Contemporary data of saphenous vein graft (SVGs) use in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) are limited. We examined the frequency, characteristics, and outcomes of SVG use d...Contemporary data of saphenous vein graft (SVGs) use in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) are limited. We examined the frequency, characteristics, and outcomes of SVG use during retrograde CTO PCI. Retrograde CTO PCI cases in the PROGRESS-CTO registry (2017 to 2025) were compared based on SVG versus non-SVG use; non-native targets, arterial grafts, mixed collaterals, and multi-CTO procedures were excluded. Among 4,330 retrograde procedures (4,321 patients), SVGs were used in 545 (12.6%). These patients were older with more comorbidities, higher anatomic complexity and PROGRESS-CTO score, but similar J-CTO score. Procedure time was longer, yet contrast and radiation exposure were lower. A primary retrograde strategy was used more frequently (54.5% vs 36.0%; p <0.001) in the SVG-group. Technical success was higher with SVGs (82.1% vs 78.5%; p = 0.049), while procedural success (79.9% vs 76.7%; p = 0.092) and in-hospital major adverse cardiac events (MACE) (3.3% vs 2.9%; p = 0.6) were similar. SVG collateral use was independently associated with higher technical success (Odds Ratio 1.60, 95% CI 1.24 to 2.09; p <0.001). Pericardiocentesis was less frequent (0.2% vs 1.6%; p = 0.008) and perforation rates were comparable, but mortality and stroke were higher in the SVG group. Among prior-CABG patients, SVG use was associated with higher technical success but also higher in-hospital MACE (3.3% vs 1.3%; p = 0.011). SVG use for retrograde crossing occurred in approximately 1 in 8 overall and 1 in 3 prior-CABG retrograde CTO PCIs. Despite greater clinical and anatomic complexity, SVG use was associated with higher technical success compared with septal/epicardial collaterals.