Familial Hypercholesterolemia: Still an Enigma.

Background: Familial hypercholesterolemia (FH) is a genetic condition characterized by high levels of low-density lipoprotein (LDL) and early atherosclerotic cardiovascular disease.

Case Summary: Our patient was a 61-year-old woman who had been referred to a cardiologist for LDL levels >200 mg/dL for more than a decade. She tested positive for a pathogenic LDLR mutation and was diagnosed with FH.

Mid-Term Outcomes of Balloon-Expandable Aortic Valve-in-Valve Replacement in the United States.

Background: Aortic valve-in-valve (AViV) replacement for is approved for patients with degenerated surgical valves at high or prohibitive surgical risk, mostly on the basis of small series with short-term follow-up.

Objectives: The aim of this study was to analyze the outcomes of AViV therapy using contemporary balloon-expandable valves (BEVs) in a large series with mid-term outcomes.

Methods: BEV AViV patients (June 2015 to December 2023) in the Society for Thoracic Surgeons (STS)/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were propensity matched to native transcatheter aortic valve replacement (TAVR) patients.

Long-Term Follow-Up of Giant Paraesophageal Hernia Repair With Restoration of Normal Anatomy Without Fundoplication.

Background: While some have reported performing gastropexy after paraesophageal hernia repair, the risk for development of severe reflux is being defined. Although we have observed good short-term outcomes after restoration of normal anatomy in patients with predominantly obstructive symptoms, long-term outcomes are unknown.

Methods: Retrospective review of patients without significant reflux (heartburn, regurgitation, pulmonary symptoms) who underwent normal anatomy restoration was performed.

In-Hospital Outcomes and Readmissions in High-Risk Pulmonary Embolism Patients Requiring Extracorporeal Membrane Oxygenation Support.

There are limited data on the use of extracorporeal membrane oxygenation (ECMO) in high-risk pulmonary embolism (PE) patients. We analyzed the use of ECMO in high-risk PE patients (defined as requiring vasopressors, with cardiogenic shock, or cardiac arrest) using the National Readmission Database (2016-2020) to assess the outcomes of in-hospital mortality, hospitalization costs and length of stay (LOS). Among 130,486 patients, 1,685 (1.

Impact of diabetes mellitus type-2 on the outcomes following mitral transcatheter edge-to-edge repair (TEER): A meta-analysis.

Background: Diabetes mellitus (DM) has been linked to unfavorable outcomes in patients undergoing Mitral Transcatheter Edge-to-Edge Repair (TEER). Nevertheless, the literature contains conflicting data. This meta-analysis aimed to assess the impact of DM on outcomes following Mitral TEER.

Prognostic relevance of arrhythmic and QTc burden in takotsubo cardiomyopathy: A systematic review and meta-analysis.

Introduction: Takotsubo cardiomyopathy is characterized by stress-induced systolic dysfunction of the left ventricle that is largely reversible and not related to coronary ischemia. Patients with Takotsubo cardiomyopathy can often develop concurrent arrhythmias and prolonged QTc interval, which have been shown to contribute to significant morbidity and mortality in prior retrospective studies. Hence, we conducted a comprehensive systematic review and meta-analysis to characterize the risk of atrial arrhythmias, life-threatening arrhythmias, and QTc prolongation on clinical outcomes in patients with Takotsubo cardiomyopathy.

Mortality trends related to cardiogenic shock in heart failure patients aged 25 and older across the United States: A study utilizing the CDC WONDER database from 1999 to 2023.

Background: Cardiogenic shock (CS) remains crucial in mortality rates for heart failure (HF) patients. However, contemporary data on long-term mortality trends related to CS are limited. This study investigates demographic patterns and trends in CS mortality among HF patients over 25 years.

Cardiovascular disease risk factors in newly diagnosed rheumatoid arthritis: A retrospective cohort study.

Background And Objectives: Patients with rheumatoid arthritis (RA) face an increased risk of cardiovascular disease (CVD) that traditional risk factors alone cannot fully explain. Chronic inflammation may influence lipid profiles and contribute to this risk. This study evaluates predictors of incident CVD in RA and explores how erythrocyte sedimentation rate (ESR) modifies the relationship between lipid levels and CVD outcomes.

Endovascular therapy in acute ischemic stroke: A six-year national assessment of utilization and outcomes: Outcomes of Endovascular Therapy in Acute Stroke.

Backgrounds: Ischemic stroke is a leading cause of death and disability worldwide. Endovascular treatment (EVT) is recognized as an effective intervention for acute ischemic stroke, but only a small fraction of patients with large vessel occlusion receive it. While EVT adoption has grown in the U.

How much time do internal medicine residents spend on self-directed learning and on which resources: a multi-center study.

Increased clinical demands and newer means of self-directed learning (SDL) necessitate an understanding of how medical residents are supporting their learning. To examine the patterns of SDL engagement among internal medicine residents, their attitudes and behaviors with various resources, and evaluate the relationship between the clinical learning environment (CLE) and the time residents allocate to SDL and types of resources. This cross-sectional study used a systematic questionnaire informed by previous qualitative research on SDL among internal medicine residents.

Socioeconomic Disparities in the Care of for High-Risk Pulmonary Embolism in the United States, 2016 to 2020.

There are limited data on the impact of socioeconomic factors on the management and outcomes of high-risk acute pulmonary embolism (PE). Using the National Inpatient Sample (NIS) from 2016 to 2020, we identified adult (≥18 years) admissions with high-risk PE (defined as PE with one of: cardiogenic shock, vasopressor use, or cardiac arrest). Socioeconomic determinants included sex, race, insurance payer, and economic status.

Arrhythmias and cannabis use: A comprehensive overview.

The increasing prevalence of cannabis use, with an estimated 219 million users globally, underscores the need to examine its potential health impacts. This review focuses on the arrhythmogenic properties of cannabis, particularly considering its active component, tetrahydrocannabinol, and its interactions with the endocannabinoid system. Epidemiological data and multiple studies indicate a significant association between cannabis use and various arrhythmias, particularly atrial fibrillation.

Cardiac Biomarkers in Patients With Asymptomatic Severe Aortic Stenosis: Analysis From the EARLY TAVR Trial.

Background: The EARLY TAVR trial (Evaluation of TAVR Compared to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis) demonstrated that early transcatheter aortic valve replacement (TAVR) intervention was superior to clinical surveillance with delayed TAVR in patients with asymptomatic severe aortic stenosis. Cardiac biomarkers are associated with maladaptive remodeling, symptom onset, and worse outcomes after TAVR. Whether elevated biomarkers identify asymptomatic patients more likely to benefit from early intervention is unknown.

Safety and Efficacy of Inclisiran in Hyperlipidemia: An Updated Meta-Analysis of Randomised Controlled Trials.

Introduction: Inclisiran, a small interfering RNA (siRNA), reduces the levels of low-density lipoproteins (LDL) in the body by preventing the hepatic synthesis of proprotein convertase subtilisin/kexin type 9 (PCSK9). However, there is limited pooled data regarding the efficacy and safety of inclisiran in patients with hypercholesterolemia.

Methods: PubMed/MEDLINE, Embase and the Cochrane Library were searched by investigators from inception till July 2024 to identify randomised controlled trials (RCTs) that investigated inclisiran in patients with hypercholesterolemia.

Revascularization Strategies for Multivessel Disease in Acute Coronary Syndrome: Network Meta-analysis.

Background: The optimal revascularization strategy for patients with acute coronary syndrome (ACS) and multivessel disease (MVD) remains debated. This study compares the efficacy and safety of different revascularization strategies in these patients.

Methods: We included 20 studies comparing staged, complete, and culprit-only (CO) revascularization strategies in patients with ACS and MVD.

Aortic Stenosis With Dynamic Left Ventricular Outflow Obstruction: Diagnostic and Management Challenges-A Case Series.

• Serial stenoses with AS and HCM can pose diagnostic challenges with echocardiography. • Doppler assessment of AS in this situation can overestimate gradients and severity. • Consider TEE and invasive hemodynamics when diagnostic uncertainty remains.

Early Versus Bail-Out Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review And Meta-Analysis.

Left ventricular (LV) unloading has demonstrated favorable outcomes in patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the optimal timing for LV unloading during VA-ECMO remains controversial. PubMed, Embase, and Cochrane were searched for studies comparing early versus bail-out LV unloading in patients undergoing VA-ECMO.

Colchicine for secondary prevention in patients with acute coronary syndrome: A systematic review and meta-analysis.

Background: Despite optimal therapy, coronary artery disease (CAD) remains a significant public health concern worldwide. Studies have increasingly recognized the role of inflammation in atherosclerosis. Colchicine, a potent anti-inflammatory drug commonly used to treat gout, and pericarditis is being evaluated in this study for its safety and efficacy in preventing CAD following an acute coronary syndrome (ACS).

Development of and recovery from acute kidney injury after cardiac surgery: Randomized phase 2 trial of the hepatocyte growth factor mimetic ANG-3777.

Objectives: To investigate the safety and efficacy of ANG-3777, a hepatocyte growth factor mimetic, in mitigating the risk of acute kidney injury (AKI) in patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods: In this double-blind placebo-controlled study (Guard Against Renal Damage [GUARD]), patients were randomized to receive intravenous ANG-3777 2 mg/kg or placebo once daily for 4 days. The primary end point was severity of AKI, measured by mean area under the concentration-time curve on percent increase in serum creatinine from days 2 to 6.

The protean presentations of XK disease (McLeod syndrome): a case series with new observations and updates on previously reported families.

XK disease is a very rare, multi-system disease, which can present with a wide spectrum of symptoms. This disorder can also be identified pre-symptomatically with the incidental detection of serological abnormalities when typing erythrocytes in peripheral blood, or on other routine laboratory testing. Increasing awareness of this disorder and improved access to genetic testing are resulting in increasing identification of affected patients and families.