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Impact of routine repeat echocardiograms in patients hospitalized with acute decompensated heart failure without clear secondary cause
No full textTransthoracic echocardiography (TTE) at the time of acute decompensated heart failure (ADHF) may reveal significant structural and hemodynamic abnormalities that can guide clinical management. However, the impact of routine repeat TTE in uncomplicated ADHF re-admissions is yet to be established. We studied patients with repeat TTE at the time of rehospitalization for ADHF to determine downstream clinical impact. In a single center retrospective study, 410 adult patients with 2 ADHF admissions within 1 year were studied. 185 patients met inclusion criteria. Demographics, key echocardiography parameters and clinical changes were collected between first and second TTE. The study population comprised predominantly of Caucasians (55.7%) and males (53%). Non-ischemic cardiomyopathy was the principal etiology of heart failure. Between first and second TTE, there were no statistically significant changes noted in left ventricular ejection fraction, right ventricular systolic pressure, right atrial pressure, E/e ratio, or diastolic function. Right ventricular function was noted to significantly worsen as seen on the second TTE (p \u3c 0.001). Mitral and aortic regurgitation was noted to be less severe in the repeat TTE group (p = 0.030 and p = 0.047, respectively). The predominant impact of repeat TTE in rehospitalized ADHF patients was medication changes rather than significant interventions, such as advanced imaging or invasive procedures. Our study demonstrates that clinicians should focus on reserving utilization of repeat TTE in uncomplicated ADHF readmissions to those not responding to standard medical optimization including diuresis. Major effect on downstream interventions and new diagnosis is not significantly impacted by repeating TTE
LIMA-LAD Steal Syndrome as a Cause of Post-CABG Angina
No full textBACKGROUND: Coronary steal from unligated side branches of the left internal mammary artery (LIMA) after coronary artery bypass grafting may lead to recurrent angina.
CASE SUMMARY: A 64-year-old man presented with recurrent angina 2 years after coronary artery bypass grafting. Imaging showed perfusion defects in the territory of the left anterior descending artery (LAD). Coronary angiography revealed a large patent LIMA side branch. A percutaneous vascular plug successfully occluded the side branch, with symptom resolution.
DISCUSSION: There is conflicting evidence regarding the diagnosis and treatment of coronary steal syndrome from LIMA graft. Despite the lack of formal guidelines, reversible anterior wall defects on stress testing may help identify patients with clinically significant symptoms.
TAKE-HOME MESSAGES: The side branches of the LIMA when unligated represent a relatively common anatomical variation that could have clinical implications. Large, unligated side branches when accompanied by anterior wall ischemia may indicate a diagnosis of LIMA-LAD steal amenable to percutaneous intervention
Emerging pharmacological strategies in lipoprotein(a) reduction
No full textBACKGROUND: Lipoprotein(a) (Lp(a)) is an low-density lipoprotein (LDL)-like particle whose elevation is considered a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. Currently, there are no published clinical trials showing whether Lp(a) lowering in conjunction with optimal LDL cholesterol control reduces ASCVD risk.
METHODS: Clinicaltrials.gov, an online database for clinical research studies, was used to identify ongoing clinical trials studying targeted Lp(a) lowering pharmacotherapy as of May 2025. Twelve clinical studies met the criteria and were included in this summary.
RESULTS: The three large, multicenter phase 3 outcome trials evaluating clinical cardiovascular disease endpoints of major adverse cardiac event (MACE) are Lp(a)HORIZON (NCT04023552), OCEAN(a) (NCT05581303), and ACCLAIM-Lpa(a) (NCT06292013), which investigate pelacarsen, olpasiran, and lepodisiran, respectively. Other phase 2 and phase 3 trials are also under way.
CONCLUSION: Results from upcoming trials will inform us whether Lp(a) reductions translate to improved cardiovascular clinical outcomes
Safety and Effectiveness of Intracoronary Imaging-Guided PCI in Contemporary Practice: Insights From BMC2
No full textBACKGROUND: Studies suggest percutaneous coronary intervention (PCI) guided by intracoronary imaging (ICI) results in larger balloon/stent diameters and longer stents. Whether this occurs in real-world PCI is poorly understood.
METHODS: De novo PCIs performed at 48 nonfederal Michigan hospitals between July 2019 and June 2022 were evaluated with regression modeling to evaluate associations between ICI-guided PCI and balloon/stent dimensions. The association between ICI-guided PCI and coronary dissection/perforation was assessed using adjusted odds ratios.
RESULTS: ICI was used in 16 777 (22.5%) PCI-treated lesions and increased from 11.2% of cases in July 2019 to 32.1% in June 2022. Compared with angiography alone, the average patient/procedural-adjusted treatment effect of ICI use included: +0.19 mm stent diameter (95% CI +0.16 to +0.22), +0.45 mm maximum balloon diameter (95% CI +0.40 to +0.51), and +3.51 mm stent length (95% CI +2.54 to +4.48). These findings persisted when controlling for the operator. ICI use was associated with a higher risk of dissections (adjusted odds ratio, 2.55 [95% CI, 2.05-3.16]) and perforations (adjusted odds ratio, 2.25 [95% CI, 1.74-2.91]); however, increased use of ICI and larger stent/balloon sizes over the study period (P\u3c 0.001 for trend for both) was not associated with a concomitant increase in rates of dissection or perforation (P=0.78 and P=0.33 for trend, respectively).
CONCLUSIONS: In real-world practice, ICI-guided PCI was associated with larger stent/balloon diameters and longer stents. While ICI use was associated with dissections and perforations, there was no significant increase in the rate of these complications despite significant increases in ICI use and stent/balloon sizes during the study period. Further research is needed to evaluate the association between ICI use and procedural complications
Use of the Ostial Flash balloon in aorto-ostial chronic total occlusion percutaneous coronary intervention
No full textBACKGROUND: The use of the Ostial Flash balloon (Ostial Corporation) has received limited study in aorto-ostial chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI).
METHODS: The authors evaluated the outcomes of Ostial Flash balloon use in a large CTO-PCI registry (PROGRESS-CTO, NCT02061436).
RESULTS: The Ostial Flash balloon was used in 54 of 907 aorto-ostial CTO PCIs in 905 patients (6.0%). The mean patient age was 65.1 ± 10.7 and 80.6% were men, with a high prevalence of diabetes mellitus, hypertension, prior PCI, and prior myocardial infarction. The mean occlusion length was 40.5 ± 25.1 mm, 52.2% had moderate to severe calcification, and the mean Japanese-CTO score was 2.8 ± 1.1. Lesions treated with the Ostial Flash balloon were more frequently located in the right aorto-ostium (79.6% vs 66.0%, P = .002). In the Ostial Flash group, the most common successful CTO crossing technique was antegrade wiring (46.3%), followed by the retrograde approach (40.7%); intravascular imaging was used in 61.1% of cases. Technical success (92.6% vs 87.9%, P = .300) and the incidence of major adverse cardiac events (MACE) (5.6% vs 3.6%, P = .450) was similar in the Ostial Flash vs non-Ostial Flash patients, respectively. In multivariable analysis, PCI of proximal right coronary artery CTOs was independently associated with use of the Ostial Flash balloon (odds ratio 2.2; 95% CI, 1.1-4.8; P = .036).
CONCLUSIONS: The Ostial Flash balloon is infrequently used in aorto-ostial CTO PCI. Although there were no differences in MACE with use of the balloon, randomized controlled trials are needed to determine its effectiveness
Flaring of Protruding Coronary Stents Before Transcatheter Aortic Valve Replacement to Minimize Interaction-A Feasibility Study
No full textBACKGROUND: Protruding coronary artery stents can adversely affect transcatheter aortic valve replacement (TAVR) procedure. Current evidence on the topic is limited.
AIMS: We aim to study the clinical feasibility and safety of flaring of protruding coronary artery stents before TAVR to reduce interaction with transcatheter heart valves.
METHODS: Twenty consecutive patients with 22 protruding coronary stents were optimized with a dual-diameter balloon before TAVR. Procedural success, stent and valve geometry on angiogram, periprocedural and subsequent clinical outcomes as well as valve hemodynamics on echocardiography were evaluated.
RESULTS: Procedural success was achieved in 100% of coronary procedure and TAVR without any major complication directly related to the flaring of stents. There was no coronary artery obstruction after TAVR or visible stent or valve deformity. All valves had normal hemodynamics immediately post-deployment with none having clinically significant aortic insufficiency. One patient had inpatient mortality unrelated to coronary stent optimization. One valve had hemodynamic valve degeneration on follow-up which was unrelated to coronary stent flaring and the patient was asymptomatic.
CONCLUSION: Flaring of protruding coronary stents before TAVR is technically feasible and safe and can potentially minimize stent-valve interaction for during of after TAVR
Characteristics and outcomes of myocardial infarction among burn patients: A nationwide analysis
No full textPURPOSE: To examine the characteristics and outcomes of myocardial infarction (MI) among burn patients.
MATERIALS AND METHODS: The Nationwide Readmissions Database was utilized to identify hospitalizations of patients with burns from 2016 to 2020. The main outcome was the difference in all-cause in-hospital mortality between burn patients with and without MI.
RESULTS: Of 200,130 hospitalizations with burns, 1997 (1 %) developed acute MI. Burn patients with MI were older, more likely to be men, and had a higher prevalence of cardiovascular risk factors. Only burns affecting the trunk and respiratory tract, and those affecting \u3e 20 % of body surface area (BSA), were associated with an increased risk of MI. All-cause in-hospital mortality was higher among patients with MI (18.7 % vs. 3 %, adjusted odds ratio (aOR) 4.59, 95 % confidence interval (CI) 3.66, 5.76). Cardiogenic shock, ventricular tachycardia, and stroke rates were higher among patients with MI. Revascularization was associated with lower in-hospital mortality (aOR 0.33, 95 % CI 0.17, 0.64).
CONCLUSIONS: The incidence of MI in burn patients is low but is associated with high mortality and morbidity. Burns involving the trunk and respiratory tract, and those affecting \u3e 20 % BSA, were associated with an increased risk of MI. Revascularization was associated with lower in-hospital mortality
Analysis of intestinal ostomy content on TikTok: The role of social media in countering fear and stigma
No full textBACKGROUND: Ostomates suffer from multiple comorbidities and social stigma, which can be especially debilitating in young patients. TikTok has become a popular platform for this population to establish a community and gain resources. This study aims to characterize intestinal ostomy videos on TikTok.
METHODS: The top 50 videos for search terms ileostomy, colostomy, ostomy, and stoma were queried on TikTok. Information was compiled regarding the videos\u27 creators, content type, overall sentiment, and viewer engagement.
RESULTS: A total of 113 videos amongst 38 creators garnered 52,021,700 likes and 370,983 comments. Most videos focused on education (45.5%) and personal stories (22.7%). Creators were predominantly young females (82.0%), with minimal input from healthcare professionals (3% of videos). Sixty-nine (61%) of videos had responses with further questions.
CONCLUSIONS: Our study reveals a gap between interest and availability of professional educational material regarding intestinal ostomies. Addressing this deficiency may improve patient acceptance, bystander understanding, and its negative stigma
A Randomized Controlled Trial Using Continuous Glucose Monitoring to Guide Food Choices and Diabetes Self-Care in People with Type 2 Diabetes not Taking Insulin
No full textObjective: Continuous glucose monitoring (CGM) is an effective tool for individuals with type 2 diabetes (T2D) on insulin. This study evaluated the effect of using CGM to reduce hyperglycemia, by focusing on food and lifestyle choices, in people with T2D not taking insulin.
Methods: A 6-month randomized, prospective four-center study was conducted. The primary end point was a within-group reduction in time above range \u3e180 mg/dL (TAR180) at 3 months. Participants were asked not to make diabetes medication changes in the first 3 months. Seventy-two adults not on insulin or sulfonylurea therapy, with glycated hemoglobin (HbA1c) 7.5%-12%, were randomized to use CGM alone (n = 31) or CGM plus a food logging app (n = 41) to aid diabetes management. Participants attended guided education visits. Differences in CGM metrics, HbA1c, and body weight were compared.
Results: The CGM alone group decreased TAR180 from 55% at baseline to 27% at 3 months (P \u3c 0.001) and 21% at 6 months (P \u3c 0.001); the CGM plus food logging app group decreased TAR180 from 53% at baseline to 30% at both 3 and 6 months (P \u3c 0.001 for both). For all participants, time in range (70-180 mg/dL) increased from 46% at baseline to 71% at 3 months (P \u3c 0.001) and to 72% at 6 months (P \u3c 0.001). HbA1c and weight were reduced by 1.3% (P \u3c 0.001) and 7 pounds (lbs.) (P \u3c 0.001) for all participants at 6 months.
Conclusion: People with T2D not taking insulin showed large, clinically significant improvements in CGM metrics and HbA1c when using either CGM alone or with a food logging app. This occurred with a near absence of medication changes in the first 3 months and were therefore likely due to changes in food and/or lifestyle choices
Human Pancreatic Cancer Single-Cell Atlas Reveals Association of CXCL10+ Fibroblasts and Basal Subtype Tumor Cells
No full textPURPOSE: Pancreatic ductal adenocarcinoma (PDAC) patients with tumors enriched for the basal-like molecular subtype exhibit enhanced resistance to standard-of-care treatments and have significantly worse overall survival compared with patients with classic subtype-enriched tumors. It is important to develop genomic resources, enabling identification of novel putative targets in a statistically rigorous manner.
EXPERIMENTAL DESIGN: We compiled a single-cell RNA sequencing (scRNA-seq) atlas of the human pancreas with 229 patient samples aggregated from publicly available raw data. We mapped cell type-specific scRNA-seq gene signatures in bulk RNA-seq (n = 744) and spatial transcriptomics (ST; n = 22) and performed validation using multiplex immunostaining.
RESULTS: Analysis of tumor cells from our scRNA-seq atlas revealed nine distinct populations, two of which aligned with the basal subtype, correlating with worse overall survival in bulk RNA-seq. Deconvolution identified one of the basal populations to be the predominant tumor subtype in nondissociated ST tissues and in vitro tumor cell and patient-derived organoid lines. We discovered a novel enrichment and spatial association of CXCL10+ cancer-associated fibroblasts with basal tumor cells. We identified that besides immune cells, ductal cells also express CXCR3, the receptor for CXCL10, suggesting a relationship between these cell types in the PDAC tumor microenvironment.
CONCLUSIONS: We show that our scRNA-seq atlas (700,000 cells), integrated with ST data, has increased statistical power and is a powerful resource, allowing for expansion of current subtyping paradigms in PDAC. We uncovered a novel signaling niche marked by CXCL10+ cancer-associated fibroblasts and basal tumor cells that could be explored for future targeted therapies