Abdominal aortic aneurysm (AAA) care relies on imaging for screening, surveillance, pre-repair planning, and post-repair follow-up, yet both overuse and underuse can harm patients and inflate costs. We performed a narrative synthesis of contemporary guidelines and primary studies to outline a value-based pathway that emphasizes clinical safety, equity, and resource stewardship. Evidence supports an ultrasound-first strategy for unrepaired AAAs, targeted one-time ultrasound screening in at-risk populations, and a single computed tomography angiogram (CTA) before repair to define anatomy and device planning. After endovascular aneurysm repair (EVAR), routine follow-up can be centered on duplex ultrasonography (DUS) ± contrast-enhanced ultrasound (CEUS), reserving CTA/MRA for sac growth, suspected endoleak, or complex repairs. Implementation levers include guideline-embedded order sets, automated capture of incidental AAAs, and operational steps that improve access for disadvantaged patients. In conclusion, a risk-adapted, ultrasound-lean imaging strategy preserves outcomes while lowering cumulative radiation exposure, reducing expenditures, and improving access, thereby advancing value-based cardiovascular care.

Balloon post-dilation (BPD) is used to optimize valve expansion after transcatheter aortic valve implantation (TAVI). However, the clinical impact, particularly between balloon-expandable (BE) and self-expanding (SE) valves, remains unclear.

Nonagenarians, the fastest-growing U.S. age group, face a high burden of Non-ST-Elevation Myocardial Infarction (NSTEMI), yet the utilization and outcomes of percutaneous coronary intervention (PCI) in this population remain poorly understood. The aim of this study was to assess patient characteristics, comorbidities, and in-hospital outcomes in nonagenarians and identify predictors of in-hospital mortality. We analyzed 122,845 hospitalizations with a principal discharge diagnosis of NSTEMI among nonagenarians (2015-2019) using the National Inpatient Sample to compare PCI (8%) versus medical management (92%). Over the study period, there was an 18% reduction in medically managed cases (p=0.04), while PCI utilization increased from 7% to 9% (p=0.03). The medical management cohort had significantly higher Elixhauser comorbidity (EC) scores (p<0.001), 30-day readmission EC scores (p<0.001), in-hospital mortality EC scores (p<0.001), and in-hospital mortality rate (7.9% vs. 4.2%; p<0.001). Mortality predictors differed: mortality in the medical management group was most strongly associated with alcohol abuse, chronic blood loss anemia, and diabetes, whereas mortality in the PCI group correlated most strongly with inotrope/vasopressor use, chronic pulmonary disease, prior transient ischemic attack, and peripheral vascular disease. Despite rising adoption, PCI remains underutilized in nonagenarians. PCI is linked to lower in-hospital mortality. The distinct comorbidity profiles and mortality predictors underscore the need for individualized treatment strategies in this vulnerable elderly population.

Data on the safety and efficacy of transcatheter aortic valve replacement (TAVR) for the treatment of aortic valve stenosis in immunocompromised (IC) patients is scarce, while it represents a valid alternative to surgical AVR in this vulnerable population. This meta-analysis aims to compare the clinical outcomes of TAVR in IC versus non-IC patients. A comprehensive search was conducted across PubMed, EMBASE, and Cochrane Central for randomized controlled trials and observational studies that compared outcomes between IC and non-IC patients undergoing TAVR. Primary outcomes included 1-year all-cause, cardiovascular (CV) and non-CV mortality. Secondary outcomes included new permanent pacemaker implantation (PPI) and major periprocedural complications. 4,478 patients in seven studies (mean age 80.5 years, 7.64% IC) were included in the analysis. As compared with non-IC patients, IC patients exhibited a similar 30-day death rate (Odds Ratio (OR) 1.62; 95% Confidence Interval (CI) 0.68 - 3.98; p=0.297), but significantly higher 1-year all-cause mortality (OR 2.39; 95% CI 1.55 - 3.70; p < 0.001). Notably, IC patients demonstrated a lower risk of CV death (OR 0.24; 95% CI 0.10 - 0.59; p = 0.002) but a higher risk of non-CV death (OR 4.16; 95% CI 1.70 - 10.18; p = 0.002). There was no difference in the rate of new PPI or major periprocedural complications. In conclusion, TAVR is a safe and effective treatment strategy in IC patients, with similar short-term mortality and increased medium-term mortality risk as compared with non-IC patients. (PROSPERO: CRD42024623229).

The clinical impact of transcatheter aortic valve replacement (TAVR) in patients with moderate mixed aortic valve disease (MMAVD)-characterized by the coexistence of moderate aortic stenosis (AS) and aortic regurgitation (AR)-remains unclear, as current evidence primarily focuses on isolated severe AS. This study aimed to compare outcomes of TAVR between patients with MMAVD and those with isolated severe AS. Between January 2019 and June 2024, 848 patients who underwent TAVR at our center were identified for analysis, including 75 with MMAVD and 773 with isolated severe AS. To minimize confounding, 73 MMAVD patients were matched with 264 isolated AS patients using 1:4 propensity score matching for comparative analysis. The primary endpoint was all-cause mortality; secondary endpoints included heart failure rehospitalization, left ventricular (LV) reverse remodeling, and procedural complications. Continuous variables were compared using independent samples t-tests, categorical variables using chi-square or Fisher's exact tests, and survival using Kaplan-Meier curves with log-rank tests. At baseline, MMAVD patients exhibited greater LV dilation (LV end-diastolic diameter [LVEDD]: 56.07±9.04 vs. 50.68±7.70, p<0.001) and hypertrophy (LV mass index [LVMI]: 163.68±50.17 vs. 151.59±44.38, p=0.026). Post-TAVR, MMAVD showed superior reverse remodeling (ΔLVEDD: -7.18±9.75 vs. -2.52±7.64, p<0.001), though LVEF recovery was comparable (ΔLVEF: 5.47±13.98 vs. 6.88±15.20, p=0.52). Survival rates were similar (log-rank p=0.370), but MMAVD had higher 1-year heart failure rehospitalization (5.97% vs. 0.96%, p=0.032). In conclusion, TAVR with self-expandable valves yields comparable survival in MMAVD and isolated AS, with more pronounced reverse remodeling in MMAVD despite advanced baseline disease.

Hydroxychloroquine (HCQ) cardiotoxicity is increasingly recognized, yet progressive conduction system disease remains underappreciated and may represent a lethal phenotype. We report a 67-year-old female on chronic HCQ who developed progressive conduction abnormalities culminating in cardiogenic shock and sudden death despite initial stabilization with isolated atrial pacing. Autopsy revealed extensive sinoatrial and atrioventricular nodal lysosomal toxicity and fibrosis confirming irreversible conduction injury. This case highlights the lysosomal basis of HCQ toxicity and reframes conduction disease as a primary, irreversible manifestation. Vigilant ECG surveillance and early consideration of dual-chamber pacing may prevent catastrophic outcomes in patients on chronic HCQ therapy.

Bicuspid and unicuspid aortic valves represent the most common congenital aortic valve malformations and pose unique challenges in clinical management across the lifespan. These anomalies are associated with progressive valvular dysfunction and aortopathy, often necessitating early intervention. Multiple publications have described life-long management of aortic stenosis (AS), affecting tricuspid valve. This review outlines the embryologic basis, natural history, and clinical spectrum of uni- and bicuspid aortic valve, highlighting diagnostic strategies, surveillance protocols, and surgical - transcatheter interventions. Emphasis is placed on longitudinal care, including transition from pediatric to adult congenital cardiology, multimodality imaging, and timing of surgical or transcatheter interventions. In conclusion, the article aims to provide a framework for evidence-informed, individualized management of these complex valvulo-aortic disorders.

Randomized controlled trials investigating colchicine for secondary prevention of cardiovascular events following acute myocardial infarction (AMI) have yielded conflicting results, and the real-world use and effectiveness of colchicine in this context remains unknown. As such, we sought to evaluate the use of colchicine following AMI in clinical practice and the associated outcomes. We performed a retrospective analysis of patients diagnosed with AMI and longitudinally followed in a large academic health system between 2018 and 2024 to describe the clinical use of colchicine for secondary prevention following AMI, as well as patient-level demographic and clinical characteristics associated with colchicine use. Next, using both multivariable logistic regression models with and without propensity matching, we examined the association between colchicine prescription following AMI and composite cardiovascular outcomes (comprised of recurrent AMI, any revascularization, stroke, and death). Kaplan-Meier Event-free Survival Analysis and Cox Proportional Hazards Models were performed. Of 1,796, 126 (7.0%) were prescribed colchicine after AMI. There was no association between use of colchicine and the composite cardiovascular events in either standard multivariable adjusted (Odds Ratio 1.00, 95% CI 0.66-1.50, p = 0.99) or propensity matched models (0.98, 0.57-1.66, p = 0.93). There was no difference in event-free survival between patients who were prescribed colchicine and those who were not. In summary, we report the first real-world data on the use and effectiveness of colchicine for prevention of cardiovascular events after AMI. Colchicine was infrequently prescribed for this indication and was not associated with lower rates of subsequent cardiovascular events.

Acute coronary syndrome (ACS) significantly impacts global morbidity and mortality, traditionally emphasizing left ventricular (LV) dysfunction. However, the prognostic importance of right ventricular (RV) dysfunction remains underexplored. Cardiac magnetic resonance (CMR), the gold standard for RV assessment, enables precise evaluation of ventricular function and structure. We conducted a retrospective cohort study of 268 patients with ACS who underwent CMR between January 2020 and December 2022 at the National Institute of Cardiology Ignacio Chavez. RV dysfunction was defined as RV ejection fraction (RVEF) <50% by CMR. Multivariate logistic regression identified factors associated with RV dysfunction. RV dysfunction occurred in 170 patients (63.4%). Compared to those without RV dysfunction, patients with RV dysfunction were more likely to be male (84% vs. 70%, p=0.011) and smokers (66% vs. 51%, p=0.017). These patients exhibited reduced LV ejection fraction (39% vs. 44%, p<0.001), higher end-systolic and end-diastolic volumes, and reduced RV fractional area change (42% vs. 45%, p=0.004). BMI (OR 1.13, 95% CI 1.04-1.24, p=0.008) and mitral regurgitation (OR 5.40, 95% CI 1.47-27, p=0.020) were independently associated with RV dysfunction. Although mortality was higher among patients with RV dysfunction (3.5% vs. 1%), it was not statistically significant (p=0.4). In conclusion RV dysfunction is common in ACS and it is independently associated with increased BMI and mitral regurgitation. CMR evaluation of RV function in ACS patients may be considered to enhance clinical outcomes. Future research should explore targeted therapeutic interventions for RV dysfunction.

Diabetes mellitus (DM) is associated with increased coronary calcification and adverse outcomes after percutaneous coronary intervention (PCI), yet the performance of intravascular lithotripsy (IVL) in this high-risk population remains insufficiently defined. This study, conducted within the all-comers BENELUX-IVL registry, evaluated the safety and efficacy of IVL-assisted PCI in patients with and without DM. The primary endpoint was major adverse cardiovascular events (MACE) at 1 and 2 years, defined as cardiovascular death, non-fatal myocardial infarction, or clinically driven target vessel revascularization. Secondary endpoints included procedural outcomes, complications, and all-cause mortality. A total of 574 patients were included, of whom 193 (33.6%) had DM and 381 (66.4%) did not. Procedural (87.0% vs. 89.5%; p = 0.381) and device success (95.3% vs. 97.9%; p = 0.087) were similar between groups. Post-PCI minimum lumen diameter (2.80 ± 0.59 vs. 2.95 ± 0.70 mm; p = 0.027) and area (6.0 [4.80-7.75] vs. 6.6 [4.98-8.90] mm²; p = 0.045) were smaller in patients with DM. Thirty-day MACE was higher among diabetics (3.1% vs. 0.3%; p = 0.007), whereas 1- and 2-year MACE and mortality rates were comparable. Diabetes was not independently associated with mortality (adjusted OR 1.51; p = 0.17). In conclusion, IVL-assisted PCI is safe and effective in diabetic patients, with long-term outcomes comparable to those without diabetes, although the higher early MACE risk, particularly in type 1 DM, warrants careful procedural planning and follow-up.

Thoracic radiation therapy is a cornerstone in the treatment of malignancies such as breast cancer, lung cancer, esophageal cancer, and lymphoma. While its long-term cardiac risks are well known, there is limited data on how prior thoracic irradiation is associated with outcomes in patients hospitalized with acute myocardial infarction (AMI).

Echocardiographic evaluation of Aortic valve stenosis (AS) severity relies on aortic valve area and peak jet velocity. In pursuit of improving accuracy, the transaortic flow rate (FR), defined as the ratio of stroke volume to systolic ejection time, has been introduced. However, its prognostic value in AS patients remains a matter of controversy. This study aims to systematically review the predictive value of FR in AS patients and provide quantitative pooled analysis results where applicable. A systematic search was conducted for observational studies on AS patients published up to July 31, 2025. Studies were included if they assessed the clinical prognostic utility of FR with at least three months of follow-up. Pooled estimates and 95% CI for FR's hazard ratio (HR) in each binary outcome were calculated using a random effects model. Twenty-one studies with 10,895 patients underwent descriptive analysis, and 19 eligible studies were included in the meta-analysis. For predicting all-cause mortality, the pooled HR for low FR measured at rest (cut-off value 200-210 mL/s) was 1.31 (95% CI: 1.03-1.60, I: 66%, p<0.05). For FR measured during stress echocardiography (cut-off value 250 mL/s), the pooled HR was higher at 1.58 (95% CI: 1.20-1.96, I: 0%, p<0.05). However, data in stress echocardiography have been drawn from a smaller number of studies compared to rest FR assessment, and validation in larger studies is warranted. Additionally, every 100 mL/s increase in FR, either at rest or stress, significantly reduced all-cause mortality. In Conclusion, FR is a prognostic marker for all-cause mortality and adverse composite outcomes in AS patients, indicating its potential for risk stratification. Incorporating FR into clinical assessments could help personalize follow-up and monitoring strategies. Systematic Review Registration: PROSPERO (registration number: CRD42023404048).

Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition that occurs in late pregnancy or early postpartum and leads to heart failure with reduced left ventricular ejection fraction (LVEF). A severe complication of PPCM is cardiogenic shock, and its incidence has increased in the recent years. We conducted a retrospective multi-center cohort analysis to evaluate the 180-day clinical outcomes of PPCM complicated by cardiogenic shock (PPCM-CS), with a focus on the role of mechanical circulatory support.

Many individuals transiently reduce their road exposure (kilometers or hours of driving per month) after receiving an implantable cardioverter-defibrillator (ICD). This markedly influences interpretation of monthly crash risks, but very few studies describe real-world road exposure after ICD implantation. We obtained 18 years of population-based health and driving data for drivers undergoing ICD implantation in British Columbia, Canada. We estimated drivers' monthly 'road exposure relative to baseline' (RERB) after ICD implantation (0=complete cessation of driving; 1=road exposure unchanged), using clinical data to infer the duration of compulsory driving restrictions, and using published data to account for incomplete adherence to restrictions and voluntary reductions in road exposure by month since implantation. We then used estimated RERB to calculate exposure-adjusted crash risks. Among 3454 primary prevention ICD recipients, RERB-adjusted crash rate in the first month after implantation was not significantly different than among matched controls (mean recipient RERB=0.29; adjusted incidence rate ratio [aIRR]=2.22, 95%CI 0.72-6.87), but sensitivity analyses suggested that crash rate adjusted for a plausible lower-bound RERB estimate was ∼5-fold higher than among controls. Among 3070 secondary prevention ICD recipients, RERB-adjusted crash rate in the first 6 months after implantation was not significantly different than among matched controls (mean recipient RERB=0.50; aIRR=1.11, 95%CI 0.77-1.61), but sensitivity analyses indicated that crash rate in the first 3 months after implantation adjusted for a plausible lower-bound RERB estimate was ∼2-fold higher than among controls. In conclusion, the substantial transient reductions in road exposure after ICD implantation should inform interpretation of monthly crash risks.

Mortality in male patients with Takotsubo cardiomyopathy appears to be double that of Women. The goal of this study was to determine whether a higher mortality rate is associated with a higher complication rate in male adults. Using ICD-10 codes for Takotsubo cardiomyopathy, we evaluated differences in the occurrence of complications between Men and women. A total of 199,890 patients were diagnosed with Takotsubo cardiomyopathy, comprising 34,770 male and 195,120 female patients. All major complications are significantly higher in men than in women, despite multivariate adjustment for age and cardiovascular risk factors. Cardiogenic Shock: 9.88% vs 5.98% p<0.001, OR: 1.57, 1.43-1.73, Atrial Fibrillation: 23.96% vs 20.12%, p<0.001, OR:1.55, CI 1.45-1.66, Cardiac Arrest: 5.71% vs 2.94%, p<0.001, OR: 1.71, CI 1.51-1.94, Congestive Heart Failure: 39.52% vs 35.18% p <0.001, OR: 1.23, CI:1.16-1.30, Stroke: 7.45% vs 4.94%, p<0.001, OR: 1.51, CI:1.36-1.68). In conclusion, all major cardiovascular complications are higher in men compared to women with a diagnosis of Takotsubo cardiomyopathy, as a plausible explanation for the higher mortality in men.