Citations

Advances in plaque imaging have transformed cardiovascular diagnostics through detailed characterization of atherosclerotic plaques beyond traditional stenosis assessment. This review outlines the clinical applications of varying modalities, including dual-layer spectral CT, photon-counting CT, dual-energy CT, and CT-derived fractional flow reserve (CT-FFR). These technologies offer improved spatial resolution, tissue differentiation, and functional assessment of coronary lesions. Additionally, artificial intelligence has emerged as a powerful tool to automate plaque detection, quantify burden, and refine risk prediction. Collectively, these innovations provide a more comprehensive approach to coronary artery disease evaluation and support personalized management strategies.

Myocardial deformation imaging has emerged as a valuable clinical tool for assessing right ventricular (RV) systolic function, providing additional diagnostic and prognostic insights compared to traditional indices of RV function. Two-dimensional speckle-tracking echocardiography is currently the standardized method of choice for measuring RV longitudinal strain (RVLS) in clinical practice. RVLS provides a more sensitive indicator of subtle myocardial dysfunction than conventional parameters for RV function assessment (i.e., tricuspid annular plane systolic excursion, tissue Doppler systolic velocity, fractional area change, or RV ejection fraction), with utility for the risk stratification and surveillance of conditions affecting the right heart. However, accurate interpretation of RVLS requires a comprehensive understanding of RV mechanics, pathology, and loading conditions across various cardiovascular conditions, as well as the effects of image quality and technical aspects of image acquisition and tracking in RV strain measurements. This review provides an updated overview of current practical guidelines for RV strain analysis, current clinical applications, and future directions for its potential use in clinical practice.

Abstract Background/Introduction Access to timely healthcare in disadvantaged areas remains essential to achieving equitable health outcomes, especially in regions facing structural and social vulnerabilities. Purpose To assess wait times for cardiovascular disease consultations in US-Mexico border regions compared to non-border regions among US Veterans. Methods This cross-sectional analysis included all veteran cardiovascular consultations referred through the Veterans Choice Program to community healthcare centers from 2014 to 2020. We obtained the average wait times in days for consultation approval, scheduling, completion, and total wait time from approval to consultation completion. All consultations were classified by county of residence as either within a US-Mexico border region or a non-border region, as per the La Paz Agreement. Multivariable linear regression analyses were performed to evaluate the impact of border status on average wait times. ARIMA modeling was completed to estimate forecasted wait times during the COVID-19 pandemic. Results A total of 485,158 consultations related to outpatient cardiovascular disease were retrieved from the VA Healthcare System. Amongst these, 461,696 of the consultations were placed in non-border regions whereas 23,462 consultations were placed in US-Mexico border regions. The most common consultation requests were made for general cardiology clinic (n=365,227), echocardiography (n=32,017), cardio-pulmonary rehabilitation (n=40,699), and cardiac stress testing (n=16,258). Wait times for cardiovascular disease consultations were not higher in US-Mexico border counties than in non-border regions. For electrophysiology consultations specifically, border counties exhibited significantly shorter total wait times (coeff = -10.81, p=0.008). Additionally, while the COVID-19 pandemic led to increased total wait times in non-border areas (Figure 1), total wait times in border regions remained stable during this period (Figure 2). Conclusions Our findings suggest that US-Mexico border region status does not result in longer wait times for cardiovascular disease consultations, with the exception of shorter wait times for electrophysiology services. This study provides important insights into the unique dynamics of healthcare access in structurally disadvantaged regions, highlighting that wait times are not a significant barrier to cardiovascular care in border areas, and emphasizes the need to consider regional differences in healthcare delivery policies.

Abstract Background Sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) have emerged as a vital component in the management of heart failure (HF), demonstrating significant improvements in cardiac function. However, their impact on outcomes in patients with acute myocardial infarction (AMI) remains poorly characterized. This study aimed to evaluate the long-term outcomes of SGLT2-Is among patients with AMI. Methods We conducted a retrospective cohort study using data from the TriNetX Banner Health Network platform in the United States, including patients aged ≥18 years with AMI identified through ICD-10 codes. Patients were categorized into two cohorts based on SGLT2-I use. Propensity score matching (PSM) was performed to balance baseline demographics, comorbidities (e.g., hypertension, diabetes, chronic kidney disease, heart failure, and hyperlipidemia), and medication use (e.g., heart failure therapies, antiplatelet agents, anticoagulants). Risk ratios (RRs) and 95% confidence intervals (95% CIs) were estimated for the following cardiovascular outcomes: acute HF hospitalizations, stroke, all-cause hospitalizations, recurrent AMI, cardiac arrest, and new-onset atrial fibrillation (AF). Kaplan-Meier analysis was completed to estimate survival probability from all-cause hospitalizations. Results After PSM, 2,440 patients were analyzed (1,220 SGLT2-I users; 1,220 non-users). Both cohorts had similar characteristics without any residual imbalance: mean age 67.7 years in the SGLT2-I group vs. 67.5 years in non-users, and both groups included 85.2% White and 33.6% female patients. Mean follow-up duration was 608 days for SGLT2-I users and 1,013.5 days for non-users. SGLT2-I use was associated with significantly lower rates of all-cause hospitalizations (RR: 0.712; 95% CI: 0.652–0.777), HF-related hospitalizations (RR: 0.878; 95% CI: 0.781–0.987), recurrent AMI (RR: 0.821; 95% CI: 0.703–0.959), and cardiac arrest (RR: 0.500; 95% CI: 0.345–0.725). No significant differences were observed in stroke (RR: 0.909; 95% CI: 0.702–1.178) or new-onset AF (RR: 0.889; 95% CI: 0.782–1.010) between the cohorts. Conclusions SGLT2-Is are associated with improved cardiovascular outcomes in patients with AMI, including reductions in all-cause and HF-related hospitalizations, recurrent AMI, and cardiac arrest. While these findings are hypothesis-generating, they emphasize the need for prospective clinical trials to confirm these results.Kaplan-Meier Analysis.

Abstract Aims Significant advancements have been made in the management of obstructive hypertrophic cardiomyopathy (oHCM), yet the extent of left ventricular outflow tract (LVOT) gradient reduction achieved with commonly used pharmacological therapies [beta-blockers (BBs), calcium channel blockers (CCBs), disopyramide, and cardiac myosin inhibitors (CMIs)] relative to each other is still unclear. Methods and results PubMed and Scopus were searched up to September 2024. Clinical trials or observational studies that assessed the changes associated with BBs, CCBs, disopyramide, or CMIs in LVOT gradient at rest or with provocation in patients with oHCM were included. Mean changes in LVOT gradients were pooled as mean differences (MD) with 95% confidence intervals (CIs) in a random-effects model. Thirty-seven studies, with 44 arms and 1898 patients, were included in the analysis. At the therapeutic class level, pooled analysis showed that disopyramide was associated with the highest reduction in LVOT gradient at rest [MD: −43.5 (95% CI, −51.6 to −35.3)], followed by CMIs [MD: −34.8 (95% CI, −40.6 to −29.0)], BBs [MD: −20.7 (95% CI, −29.4 to −12.0)], and then CCBs [MD: −14.7 (95% CI, −23.3 to −6.1)], inter-action P < 0.01. Within CMIs, mavacamten had a higher effect than aficamten on gradient reduction; among the included BBs, metoprolol showed the highest gradient reduction, while among CCBs, verapamil was the most effective (inter-action P < 0.01). Similar results were observed for provocable LVOT gradients. Conclusion Pharmacological therapies effectively reduced LVOT gradients in oHCM patients to varying degrees, with disopyramide and CMIs showing the highest effect, followed by BBs and CCBs.