Invasive epicardial coronary physiologic assessment is increasingly performed to evaluate the hemodynamic significance of intermediate coronary lesions and is recommended by guideline committees. Whereas much of the practice in coronary physiologic assessment is based on evidence, some non-evidence-based traditions and misconceptions persist. The aim of this review is to highlight evidence-based practice in invasive epicardial coronary physiologic assessment and to refute or validate common elements of clinical practice.

Living in neighborhoods with a greater burden of violence is associated with higher cardiovascular disease risk. However, the interpretation of place-based findings is impeded by methodological challenges. To address challenges related to the influence of correlated neighborhood exposures, we utilized a case-crossover design to examine whether patients were more likely to have experienced a violent crime in their neighborhood during the month before their hypertension-related emergency department (ED) visit, compared with control periods 1 year before and after.

Given the large variation in out-of-hospital cardiac arrest (OHCA) survival, the Resuscitation Academy has developed a comprehensive training and mentorship program for emergency medical service (EMS) agencies to improve OHCA care. This study will evaluate whether Resuscitation Academy training is associated with higher OHCA survival at EMS agencies, particularly those with lower OHCA survival.

Cardiovascular disease remains a leading cause of mortality globally, with the adult mammalian heart exhibiting limited regenerative capacity. The chromatin regulatory network plays a crucial role in the dynamic changes in gene expression that orchestrate the regenerative response in the neonatal heart. This study aims to identify key chromatin regulators in neonatal cardiomyocytes and to elucidate their roles in heart regeneration.

The United States is facing a demographic shift as the population of older adults grows rapidly, with the proportion of Americans ≥65 years of age projected to double by 2060. This aging trend will have far-reaching effects on health care systems, especially because aging is a primary risk factor for cardiovascular disease. Age-related cardiovascular changes, such as increased arterial stiffness, endothelial dysfunction, and reduced elasticity, increase the risk for hypertension, atherosclerosis, and other risk factors. Older adults often experience additional complications, including obesity, diabetes, and metabolic diseases, further increasing their cardiovascular risk. Every year, >720 000 Americans experience myocardial infarction or coronary artery disease-related deaths, with older adults disproportionately affected. Individuals ≥75 years of age account for 30% to 40% of all acute coronary syndrome hospitalizations, often presenting with complex coronary disease and associated geriatric syndromes, such as frailty, cognitive impairment, and multimorbidity, complicating revascularization strategies. American College of Cardiology/American Heart Association guidelines for coronary revascularization primarily focus on younger populations, leaving substantial gaps for older adults with geriatric complexities. This scientific statement highlights the need for individualized approaches that consider geriatric syndromes, patient preferences, cognitive function, and life expectancy. This scientific statement outlines key aims: to review age-related cardiovascular changes and geriatric syndromes, provide pragmatic revascularization strategies, and advocate for shared decision-making. Addressing these knowledge gaps is essential for optimizing cardiovascular care for older adults, ensuring that treatment aligns with patient goals and accounts for the unique risks they face.

Missing data in clinical trials remains an ongoing concern. With the expansion of data privacy efforts and the consequent inability to contact trial participants for follow-up, the magnitude and reasons of missing data in clinical trials have shifted. The impact of missing data on a clinical trial results largely depends on the reason why the data are missing. When data are missing at random, the influence on the study's conclusions may be minimal. In contrast, when data are missing not at random, the integrity of the trial results can be compromised. For example, if participants are lost to follow-up or withdraw consent due to adverse reactions or side effects like bleeding, then the remaining participants may disproportionately represent those who can tolerate the therapy or are less frail, leading to biased conclusions regarding the drug's safety and efficacy, a phenomenon referred to as differential censoring. The best strategy is to minimize missing data from the outset of the trial, which includes designing an informed consent form that sets the expectation that and the alternate methods by which outcomes will be tracked even if the participant elects to discontinue study treatment. Likewise, rather than waiting until the end of the study, missing data should be continually and proactively minimized during the trial by offering patients more convenient and infrequent visit strategies or follow-up through relatives or other health care professionals as needed. Also, it is critical to characterize the basis for data missingness so that its impact on trial interpretation can be better assessed. This article provides a roadmap to successfully implement all of these strategies to minimize missing data.

Desmin is a muscle-specific intermediate filament protein crucial for maintaining cardiomyocyte structural integrity, connecting multiprotein complexes and organelles. Although DES mutations are known to cause various (cardio)myopathies, many rare variants remain classified as variants of uncertain significance.

Self-expandable valves are emerging complements to balloon-expandable valves for transcatheter pulmonary valve replacement in dysfunctional right ventricular outflow tracts, though their safety and efficacy remain underexplored. We aim to compare patient characteristics and outcomes of self-expandable valves and balloon-expandable valves in transcatheter pulmonary valve replacement.

Right heart catheterization plays a pivotal role in the preprocedural evaluation of patients considered for transcatheter tricuspid valve edge-to-edge repair. This study aimed to explore the potential impact of hemodynamic parameters obtained through right heart catheterization on patient-centered outcomes.

Background: MODULAR ATP (antitachycardia pacing), a multicenter, international trial, assesses a modular cardiac rhythm management system (mCRM): a subcutaneous implantable cardioverter-defibrillator (S-ICD) in wireless communication with a leadless pacemaker (LP) capable of pace-terminating ventricular tachycardia (VT). Methods: Enrolees had one or more clinical risk factors for VT and did not require chronic pacing. Complications included pre-specified major LP system- and procedure-related complications, and any complication related to the LP, S-ICD, implantation, or study protocol. Survival analysis was performed to identify complication-free rates, therapy delivery, and all-cause mortality. Results: The 297 patients enrolled had an ejection fraction 35±13%, 43% secondary prevention indications, and 59% with prior ventricular arrhythmias (VA). Of 286 patients undergoing LP implantation (100% success), 251 patients completed 12-month follow-up. Mortality rate was 6%, with none related to the implant procedure. Median follow-up duration was 23.4 months (interquartile range: 17.9-28.1). The LP major complication-free rate was 97.2%, exceeding the performance goal. The overall LP+S-ICD system-related complication-free rate was 88.5%. Appropriate tachyarrhythmia-therapy (ATP+shock) rates were 14.4% and appropriate shock rates were 8.5%. Inappropriate total tachyarrhythmia therapy was 9.5% of which 8.5% were shocks. ATP was 67.3% successful in terminating VA episodes and accelerated VAs in 10.1% of episodes. Overall therapy burden (ATP+shock) was 96/100 patient-years of which 44/100 patient-years was for shock delivery. Conclusions: One-year outcomes of the first modular pacing-defibrillator system reveal low system and LP complication rates and good ATP efficacy rates suggesting that the mCRM is a viable alternative to single-chamber ICDs using low-energy pacing capability without the need for transvenous leads.