The American Journal of Cardiology

BackgroundCoronary artery tortuosity (CAT) is often viewed as a benign angiographic finding; however, emerging evidence suggests its potential hemodynamic significance, particularly in non-atherosclerotic cardiomyopathies such as Takotsubo syndrome (TS). ObjectivesThis study aimed to investigate the prevalence and hemodynamic implications of CAT in patients diagnosed with Takotsubo cardiomyopathy (TCM) and to evaluate the association between the severity of tortuosity and myocardial injury mark...

BackgroundScreening for atherosclerosis focuses on identifying Standard Modifiable Risk Factors (SMuRFs), including diabetes, hypertension, hyperlipidaemia, and smoking. PurposeTo compare the extracardiac thoracoabdominal atherosclerotic plaque burden, as measured by computed tomography angiography (CTA), among heart transplant candidates with ischemic or non-ischemic cardiomyopathy (ICM, NICM), and evaluate potential associations between plaque burden and SMuRFs. MethodsThis retrospective stu...

AimsLeft bundle branch block (LBBB) is associated with mechanical dyssynchrony, heterogeneous perfusion, and adverse left ventricular (LV) remodeling. However, not all patients with LBBB develop cardiomyopathy, and dyssynchrony can occur without conduction defects. The role of microvascular dysfunction remains uncertain. We aimed to assess how mechanical dyssynchrony and perfusion heterogeneity relate to LV remodeling and function in patients with and without LBBB. Methods and resultsWe retrosp...

Background: Acute heart failure (AHF) exhibits marked heterogeneity in diastolic hemodynamics, yet comprehensive echocardiographic assessment of diastolic function (DF) and filling pressure (FP) is often infeasible. We evaluated whether artificial intelligence-enabled electrocardiography (AI-ECG) could provide scalable DF grading and FP estimation in hospitalized AHF patients. Methods: We retrospectively studied adults hospitalized for AHF across Mayo Clinic sites (2013-2023) who received 1 dose...

BACKGROUNDPeak oxygen uptake (pVO2) is a strong, independent predictor of adverse cardiovascular outcomes, supporting cardiopulmonary exercise testing as a primary end point assessing efficacy of novel drug therapies in obstructive hypertrophic cardiomyopathy (oHCM) clinical trials. However, characterizing changes in pVO2 that patients perceive as beneficial or meaningful (ie, minimal important difference [MID]) has not been determined. METHODSData from patients with symptomatic oHCM enrolled i...

BackgroundPatients with repaired coarctation of the aorta (CoAo) remain at risk for left ventricular hypertrophy (LVH) even in the absence of hypertension. Alterations in wave reflection and the timing of reflected pressure waves may contribute to ventricular remodeling beyond pressure load alone. MethodsWe performed a cross-sectional analysis of patients with repaired CoAo. Office and ambulatory blood pressure (ABPM), non-invasive central hemodynamics, and echocardiographic indices of left ven...

BackgroundElevated resting heart rate is associated with increased mortality, but the underlying mechanisms remain incompletely understood. Subclinical myocardial injury (SCMI), defined by a Cardiac Infarction/Injury Score (CIIS) [≥]10, represents silent cardiac damage that predicts poor cardiovascular (CV) outcomes and may partially explain this association. MethodsWe analyzed 7,152 participants from NHANES III who underwent ECG recording and were free of cardiovascular disease. Heart rate ...

BackgroundMyocardial 18fluorodeoxyglucose (18FDG)-avidity is frequently seen in patients with genetic cardiomyopathy (CMP), as well as a growing "idiopathic 18FDG-avidity" group of genotype-negative patients who do not clearly have cardiac sarcoidosis (CS). ObjectivesTo determine the prognostic implications of 18FDG-avidity in patients with and without genetic CMP, and the effects of immunosuppression in the latter. MethodsThis multicenter, retrospective study included all patients who were re...

BackgroundAnticoagulants are often less frequently prescribed in elderly patients with atrial fibrillation (AF) because of concerns regarding high bleeding risk, despite their increased susceptibility to embolic stroke and systemic embolization. This study evaluated the impact of the Clinical Frailty Scale (CFS) on clinical outcomes and decision-making for prescribing antithrombotic therapy following left atrial appendage closure (LAAC) in a large contemporary registry. MethodsThe OCEAN-LAAC re...

AimsCardiac myosin inhibitors (CMIs) have emerged as an alternative to septal reduction therapy (SRT) for obstructive hypertrophic cardiomyopathy (oHCM). However, comparative data on the time-trajectory of myocardial functional adaptation after septal myectomy (SM), alcohol septal ablation (ASA), and CMI are lacking. We compared temporal changes in echocardiographic parameters including LV global longitudinal strain (LVGLS) and LA reservoir strain (LASr) across these treatment strategies. Metho...

BackgroundHypertrophic cardiomyopathy (HCM) is a common inherited cardiovascular disease associated with increased risks of heart failure, sudden cardiac death (SCD), and stroke. Over 1,400 pathogenic variants, primarily in MYH7 and MYBPC3, have been identified, yet the prognostic significance of genetics remains unclear. Recent studies suggest genotype-positive (G+) HCM is linked to earlier diagnosis, greater disease severity, and poorer outcomes, necessitating further research to clarify the r...

PurposeDespite strong evidence, real-world adoption of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains suboptimal. The Get With The Guidelines-Heart Failure (GWTG-HF) program was designed to close gaps in care. We evaluated whether hospital participation in GWTG-HF is associated with greater GDMT intensity and improved outcomes. MethodsWe conducted a retrospective analysis (2013-2021) of Medicare beneficiaries with Part A and Part D hos...

BACKGROUNDDilated cardiomyopathy (DCM) presents a highly heterogeneous spectrum, including a familial subset with elevated arrhythmic risk. Traditional demographic and imaging markers, such as late gadolinium enhancement, have been inadequate for identifying high-risk patients before arrhythmic events. Remodelling of the interventricular septum--central to ventricular mechanics and conduction--may offer improved risk stratification. OBJECTIVESTo identify differences in left ventricular (LV) mor...

BackgroundBoth acute myocardial infarction (AMI) and acute myocarditis are characterised by cardiac troponin release as a marker of cardiomyocyte injury. While peak troponin is widely accepted as a surrogate marker for infarct size in AMI, its relationship with myocardial injury in acute myocarditis is unclear. This study aimed to quantify and compare the association between peak high-sensitivity cardiac troponin and cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) exten...

BackgroundGuideline-directed medical therapy (GDMT) has been shown to improve mortality and/or symptoms in heart failure with reduced ejection fraction (HFrEF). Medical devices also play an important role in improved quality of life and overall symptom relief for HFrEF patients. Baroreflex Activation Therapy (BAT) increases parasympathetic nervous system activity by stimulating the carotid baroreceptors, thereby reducing symptoms. Herein, we analyzed the effects of BAT on hospitalization, atrial...

BackgroundPoor adherence to guideline-directed medical therapy (GDMT) in patients with heart failure (HF) with reduced ejection fraction is associated with higher mortality and hospitalization. However, its association with malignant arrhythmias and aborted sudden cardiac death (SCD) remains unclear. This study assessed the association between GDMT adherence and these outcomes in patients with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with a defibrillat...

BackgroundHeart failure (HF) is an increasingly common complication among patients with type 2 diabetes (T2D), yet its early detection remains challenging, especially in those with concomitant chronic kidney disease (CKD). NT-proBNP is a key biomarker for diagnosing and prognosticating HF, but its reference thresholds are influenced by renal function, age, and ethnicity. Current guideline cutoffs, largely derived from Western populations, may not apply to Asian patients. MethodsThis retrospecti...

BackgroundCardiovascular disease (CVD) is the leading cause of pregnancy-related morbidity and mortality in the United States. Several studies have evaluated readmission rates in the general HF population, but in patients with pregnancy-related HF, readmissions have been understudied. This study aims to characterize the 30-day HF readmission patterns in pregnancy-related admissions to identify vulnerable patient populations. MethodsThe National Readmission Database from 2016 to 2021 was used to...

Background and AimsDespite advances in reperfusion and medical therapy, survivors of acute myocardial infarction (AMI) remain at risk for adverse left ventricular remodeling (LVR), a precursor to heart failure. Building on prior work outlining 12-month biomarker trajectories linked to early ventricular dysfunction, we aimed to assess whether these circulating biomarkers predict long-term adverse LVR. MethodsWe prospectively enrolled 155 patients experiencing their first AMI. Clinical, biochemic...

BackgroundPericardial effusion can progress to life-threatening cardiac tamponade when large or rapidly accumulating, yet early diagnosis is frequently delayed without sufficient clinical vigilance. Echocardiography is the gold standard but is not always accessible in emergency or resource-limited settings. Electrocardiographic (ECG) findings, including low QRS voltage and electrical alternans, may prompt clinical suspicion; however, their diagnostic value remains constrained by poor quantitativ...