In the US heart allocation system, when transplant centers submit applications for status exceptions to increase waitlist priority, patients obtain the requested status upgrades immediately while their applications are sent to the regional review boards (RRBs) and reviewed retrospectively. How often transplants occur during this period is unknown.

High intakes of fructose-containing sugars among children and adolescents is implicated in obesity and related comorbidities, including hypertension. However, sugar-sweetened beverages (SSBs), fruit juices, and whole fruit have different nutritional profiles and matrices, which may confer different effects on blood pressure.

Perioperative anemia and red blood cell transfusions are important risk factors for morbidity and mortality in cardiac surgery. Preoperative anemia is common, with up to 50% of patients presenting for cardiac surgery affected. Iron deficiency-the most common and potentially modifiable cause of preoperative anemia-is a major driver of blood transfusions in the cardiac surgical setting, adversely affecting both patient outcomes and resource utilization. Perioperative blood management, a patient-centered approach to blood conservation during cardiac surgery, is a multidisciplinary collaborative effort among anesthesiologists, surgeons, perfusionists, intensivists, and transfusion laboratory teams. Strategies aim to reduce blood loss and transfusions and improve patient outcomes. There has been a recent increase in research related to anemia, iron deficiency, and patient blood management in cardiac surgery. This scientific statement highlights the latest evidence on preoperative anemia assessment and intraoperative blood conservation; discusses considerations for specific patient populations regarding anemia prevalence, treatment, and outcomes; and reviews key challenges and knowledge gaps, with the goal of minimizing the impact of preoperative anemia, intraoperative blood loss, and hemodilution on cardiac surgery outcomes.

Hypertension induces structural and functional damage in multiple organs. Evidence of subclinical damage increases risk of vascular events and death but can be difficult to identify in the clinic. We developed a novel machine learning approach that quantifies current hypertension-associated multiorgan damage, mapping progression from health to advanced disease, in a pseudotemporal manner and predicts organ-specific disease progression trajectories.

Some symptomatic patients manifest pulmonary hypertension (PH), despite normal pulmonary vascular resistance and pulmonary artery wedge pressure-a condition termed unclassified PH. Although hypothesized to reflect increased flow as seen in congenital heart disease, broader clinical implications remain unknown.

Patients with congenital or acquired right ventricular outflow tract dysfunction frequently require pulmonary valve replacement and are exposed to repeated surgical interventions due to prosthetic valve degeneration. The PULSTA self-expanding transcatheter pulmonary valve was designed to address a broad spectrum of native and surgically repaired right ventricular outflow tract anatomies. This study reports the midterm safety, hemodynamic performance, and durability outcomes of the prospective, multinational PULSTA CE approval trial (PULSTA Carpentier Edwards).

Heart failure prevalence is increasing and has a disproportionate burden on older adults. Older adults, however, may encounter unique challenges in accessing and navigating comprehensive disease-modifying, guideline-directed therapies, thus limiting use among those at highest risk of cardiovascular death or worsening heart failure. Care of the older adult with heart failure requires tailored treatment plans to overcome barriers to effective therapies in this population. This scientific statement reviews the literature on care optimization for older adults (≥65 years of age) living with heart failure and highlights strategies for clinicians who aim to deliver patient-centered, evidenced-based heart failure care in the context of common comorbidities seen in older adults. We discuss the consistent treatment effect and safety profiles of guideline-directed therapies for heart failure in older adults and how to manage multimorbidity, polypharmacy, frailty, and social needs using a shared decision-making framework. In consideration of the complexity of heart failure care of the older adult, we highlight a structured framework for therapeutic considerations in the context of benefit-to-risk ratio, multimorbidity, and social needs. We offer practical guidance on the care of older adults with advanced comorbidities who may not have been adequately represented in landmark trials. We also consider implementation strategies, health services interventions, and supportive tools that may foster optimal care in older adults with heart failure. This work is aimed at informing the practice of clinicians and health systems alike to improve outcomes and to reduce the morbidity of heart failure in older adults.

Recent observational studies have suggested that early treatment (<12 hours from diagnosis) of intermediate risk pulmonary embolism (PE) with catheter-based therapies may reduce morbidity and mortality. However, the effect of early versus late mechanical thrombectomy on acute pulmonary hemodynamics and right ventricular mechanics is less well defined.

Cardiopulmonary resuscitation (CPR) by health care responders is often suboptimal during out-of-hospital cardiac arrest (OHCA). Mechanical CPR devices have been promoted as a strategy to improve CPR quality. Whether their use in routine care is associated with improved OHCA survival at emergency medical service (EMS) agencies is unclear.

The assessment of left ventricular diastolic function started with invasive pressure measurements and is currently primarily based on echocardiographic imaging. The current approach to the diagnosis of diastolic function relies on mitral inflow velocities, tissue Doppler early diastolic velocity of the mitral annulus, peak velocity of tricuspid regurgitation, pulmonary vein flow, left atrial size and function, and the noninvasive estimation of right atrial pressure. The recommended algorithm in the 2025 American Society of Echocardiography guidelines for estimation of mean left atrial pressure has been validated in a large multicenter study that included 951 patients. Further, that algorithm has shown incremental value to triaging clinical scores in achieving accurate heart failure with preserved ejection fraction diagnosis, against the invasive gold standard. Newer promising approaches have been developed over the past few years to study left ventricular diastolic function, including shear wave propagation velocity, left atrial conduit volume, and timing of mitral and tricuspid valve opening in the apical 4-chamber view. Artificial intelligence has been applied to this field as a rule-based decision tree algorithm, and as deep-learning neural networks to train models for diagnosing and grading diastolic dysfunction, and for diagnosing heart failure with preserved ejection fraction.

Cardiac aging involves progressive mitochondrial dysfunction, contributing to heart failure. Cardiolipin (CL), essential for mitochondrial function, is increasingly depleted in aging cardiomyocytes, promoting mitochondrial decline. Lysosomal degradation relies on v-ATPase (vacuolar-type H+-ATPase)-mediated acidification, and although lysosomes regulate phospholipid metabolism, their roles in CL homeostasis during aging remains unclear. This study examines whether v-ATPase dysfunction drives age-related cardiac changes by disrupting CL metabolism and mitochondrial function.

Aortic stenosis (AS) is increasingly recognized as a disease of both the valve and the myocardium. Beyond valvular obstruction, many patients with aortic stenosis develop extra-valvular abnormalities, including left ventricular hypertrophy, diastolic dysfunction, and atrial and pulmonary vascular remodeling, which have emerged as major determinants of symptoms and prognosis. These abnormalities share many similarities with heart failure with preserved ejection fraction (HFpEF), a condition that is also prevalent in the same aging population. Emerging data suggest that AS and HFpEF frequently coexist and interact, compounded by shared cardiometabolic risk factors, producing convergent phenotypes that complicate diagnosis and influence treatment response. Residual HFpEF appears to underlie much of the persistent heart failure burden after aortic valve replacement, while even mild AS portends worse outcomes in patients with HFpEF. Recent studies have shown that HFpEF-directed therapies, such as sodium-glucose cotransporter 2 inhibitors, may benefit selected patients with AS. As both conditions increase in prevalence and valve interventions are offered to increasingly complex patients, a clearer understanding of the ways in which AS and HFpEF overlap and interact is essential. This review integrates epidemiological, pathophysiological, and clinical perspectives to synthesize emerging evidence on the AS-HFpEF overlap and outlines implications for diagnosis, prognosis, and management.

Altered cardiac and systemic metabolism is a hallmark of heart failure (HF). In the failing heart, cardiomyocytes develop alterations in substrate preference, mitochondrial oxidative metabolism, and the shuttling of high-energy phosphates from mitochondria to the cytosol that compromise energetic efficiency and contribute to disease progression. At the systemic level, neurohormonal activation plays a dominant role in HF with reduced ejection fraction, whereas HF with preserved ejection fraction is shaped by the clustering of multiple comorbidities, such as diabetes, obesity and hypertension, which disrupt the physiological crosstalk between the heart and metabolically active organs. This review provides a perspective on cardiac metabolism in HF. We delineate the specific alterations in substrate metabolism that characterize HF with reduced ejection fraction versus HF with preserved ejection fraction, examine the impact of interorgan communication on myocardial function, and highlight how the benefits of emerging HF therapies, including sodium-glucose cotransporter 2 inhibitors and GLP-1 receptor agonists, may be mediated, at least in part, through the restoration of metabolic homeostasis.

Arrhythmogenic cardiomyopathy (ACM) is a major cause of sudden cardiac death (SCD) in competitive athletes. We aimed to evaluate the prevalence and characteristics of ACM with the increased awareness of the disease at preparticipation screening after the introduction of the 1994 and 2010 diagnostic criteria.