ImportanceDespite the availability of disease-modifying therapies, scalable strategies for heart failure (HF) risk stratification remain elusive. Portable devices capable of recording single-lead electrocardiograms (ECGs) may enable large-scale community-based risk assessment.ObjectiveTo evaluate whether an artificial intelligence (AI) algorithm can predict HF risk from noisy single-lead ECGs.Design

ImportanceAccurate assessment of tricuspid regurgitation (TR) is necessary for identification and risk stratification.ObjectiveTo design a deep learning computer vision workflow for identifying color Doppler echocardiogram videos and characterizing TR severity.Design, Setting, and ParticipantsAn automated deep learning workflow was developed using 47 312 studies (2 079 898 videos) from Cedars-Sinai

This Viewpoint describes the need for more studies on the best timing for dicontinuation of glucagon-like peptide-1 receptor agonists before pregnancy.

This secondary analysis of a randomized clinical trial describes the use of emergency care after self-administration of etripamil by patients experiencing paroxysmal supraventricular tachycardia episodes at home.

ImportanceThe Medicare Shared Savings Program (MSSP) was introduced in 2012 to improve care quality and lower costs to Medicare. Under this program, accountable care organizations (ACOs) assumed responsibility for costs and care quality for a group of Medicare beneficiaries.ObjectiveTo compare changes in quality measures for patients at outpatient cardiology practices before and after their participation

ImportanceThe impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown.ObjectiveTo determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy.Design, Setting, and ParticipantsThis population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice

ImportanceImproving cardiovascular health in rural areas is a national priority in the US. However, little is known about the current state of rural cardiovascular health and the underlying drivers of any rural-urban disparities.ObjectiveTo compare rates of cardiometabolic risk factors and cardiovascular diseases between rural and urban US adults and to evaluate the extent to which health care access

ImportanceHypertension is often underrecognized, leading to preventable morbidity and mortality. Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care.ObjectiveTo determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention

ImportanceThe mode of death in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) remains poorly understood and may vary by EF.ObjectiveTo evaluate the mode of death according to EF and the treatment effect of finerenone on cause-specific mortality in patients with HFmrEF/HFpEF.Design, Setting, and ParticipantsThis was

ImportanceHeart failure (HF) with mildly reduced or preserved ejection fraction and atrial fibrillation (AF) are closely intertwined.ObjectiveTo examine the efficacy and safety of the nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with HF with mildly reduced or preserved ejection fraction according to the absence or presence of AF and the type of AF (paroxysmal vs persistent

ImportanceIn patients with atrial fibrillation (AF), oral anticoagulants (OACs) reduce the risk of stroke.ObjectiveTo investigate if patients with less prior OAC exposure respond differently to a new OAC than patients with more OAC exposure.Design, Setting, and ParticipantsIn this prespecified exploratory subgroup analysis of the Oral Factor 11a Inhibitor Asundexian as Novel Antithrombotic–Atrial Fibrillation

ImportanceDespite statins’ benefit in preventing major adverse cardiovascular events, most patients with an indication for statin therapy are not appropriately treated. Clinicians’ limited time and lack of systematic efforts to address preventive care likely contribute to gaps in statin prescribing.ObjectiveTo determine the effect on statin prescribing of 2 interventions to refer appropriate patients

ImportanceDespite substantial progress in low-density lipoprotein cholesterol (LDL-C)–lowering strategies, residual cardiovascular risk remains. Apolipoprotein C3 (APOC3) has emerged as a novel target for lowering triglycerides. Multiple clinical trials of small-interfering RNA therapeutics targeting APOC3 are currently underway.ObjectiveTo investigate whether genetically predicted lower APOC3 is associated

ImportanceIt is well appreciated that a small yet high-risk subset of patients with atrial fibrillation (AF) develops persistent left atrial appendage (LAA) thrombus despite optimal oral anticoagulation (OAC). In patients with either a heightened risk of bleeding precluding enhanced doses of OAC to dissolve the thrombus, or thromboembolism despite optimal OAC, there are limited nonsurgical options

Importance Outcomes in patients with diabetes after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown. Objectives To investigate the relative treatment effect of PCI vs CABG according to diabetes status with respect to major adverse cardiac and cerebrovascular

ImportanceFood insecurity is associated with prevalent cardiovascular disease (CVD), but studies have been limited to cross-sectional data.ObjectivesTo study whether food insecurity is associated with incident CVD and to determine whether this association varies by sex, education, or race.Design, Setting, and ParticipantsThis prospective cohort study was conducted among US adults without preexisting

An older woman with a history of coronary artery disease presents with dyspnea upon exertion. A transthoracic echocardiogram reveals severe mitral regurgitation, and an electrocardiogram reveals sinus tachycardia with left bundle branch block. What would you do next?

ImportanceExcess body fat plays a pivotal role in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). HU6 is a novel, controlled metabolic accelerator that enhances mitochondrial uncoupling resulting in increased metabolism and fat-specific weight loss.ObjectiveTo assess efficacy and safety of HU6 in reducing body weight, improving peak volume of oxygen consumption (VO2) and

Importance Valsartan has been shown to attenuate phenotypic progression among individuals with early-stage sarcomeric hypertrophic cardiomyopathy (HCM). Myocardial tissue characterization by cardiac magnetic resonance (CMR) imaging may enhance mechanistic insights, but whether valsartan influences these parameters remains uncertain. Objective To evaluate the treatment effects of valsartan on myocardial

ImportancePatients with heart failure (HF) and mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) have a spectrum of risk, and the effect of therapies may vary by risk.ObjectivesTo validate the Prognostic Models for Mortality and Morbidity in HFpEF (PREDICT-HFpEF) in the phase 3 randomized clinical trial Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo

ImportanceTraditional risk factors, enhancing factors, and risk scores help clinicians assess atherosclerotic cardiovascular disease (ASCVD) risk for primary prevention. The latest cholesterol guidelines suggest measuring coronary artery calcium (CAC) score by computed tomography (CT) in those at intermediate risk when there is uncertainty about statin initiation for primary prevention. CAC testing

ImportanceCarotid artery plaque (CAP) is commonly encountered in clinical practice. Presence of CAP predicts future atherosclerotic cardiovascular disease (ASCVD) events; however, CAP prevalence increases with age, and it is unknown how age and sex affect the association of CAP presence and ASCVD risk.ObjectivesTo describe CAP prevalence by age, sex, race, and ethnicity in a multiethnic population

This Viewpoint recommends simultaneous or rapid sequence initiation of combination therapy with 3 specific classes of medication for heart failure with mildly reduced ejection fraction or preserved ejection fraction.

ImportanceWorsening heart failure (HF) is commonly managed in the outpatient setting with adjustments in oral diuretic therapy. The effect of the nonsteroidal mineralocorticoid receptor antagonist finerenone on outpatient worsening HF events in patients with mildly reduced or preserved ejection fraction is unknown.ObjectiveTo evaluate the effect of finerenone on outpatient worsening HF events requiring

This case report describes a saphenous vein graft simulating an intracardiac structure on echocardiography of a patient after coronary revascularization surgery.

Importance Patients with angina and no obstructive coronary artery disease frequently have coronary vasomotor dysfunction as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm, and/or microcirculatory dysfunction. These endotypes can be diagnosed by invasive coronary function testing which has previously shown to be safe in tertiary and expert centers. Objective

ImportanceMyocardial fibrosis in aortic stenosis (AS) may exhibit sex differences. However, its prognostic significance in women with AS remains unclear.ObjectiveTo investigate sex differences in myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) and evaluate its prognostic value in women and men with AS.Design, Setting, and ParticipantsPatients with severe AS who underwent CMR

Importance Filamin C truncating variants (FLNCtv) are a rare cause of cardiomyopathy with heterogeneous phenotypic presentations. Despite a high incidence of life-threatening ventricular arrhythmias and sudden cardiac death (SCD), reliable risk predictors to stratify carriers of FLNCtv are lacking. Objective To determine factors predictive of SCD/major ventricular arrhythmias (MVA) in carriers of FLNCtv

Importance Lipoprotein(a) (Lp[a]) is thought to be the major carrier of oxidized phospholipids (OxPL). OxPL are believed to be a potent driver of inflammation and atherosclerosis. Olpasiran, a small interfering RNA, blocks Lp(a) production by inducing degradation of apolipoprotein(a) messenger RNA. Olpasiran's effects on OxPL and systemic markers of inflammation are not well described. Objective To

This Viewpoint advocates for prompt aortic valve replacement (rather than clinical surveillance) as the default strategy for patients with asymptomatic severe aortic stenosis.

ImportanceThe direct effect of consumption of salt substitutes on recurrent stroke and mortality among patients with stroke remains unclear.ObjectiveTo evaluate the effects of salt substitutes vs regular salt on the incidence of recurrent stroke and mortality among patients with stroke.Design, Setting, and ParticipantsThe Salt Substitute and Stroke Study (SSaSS), an open-label, cluster randomized clinical

ImportanceCardiovascular disease is the leading cause of death in the US. However, it remains unclear how the burden of cardiovascular events in the US compares with that of other high-income countries with distinct health care systems like Denmark, both overall and by income.ObjectiveTo compare cardiovascular hospitalization rates (acute myocardial infarction [MI], heart failure [HF], ischemic stroke)

ImportanceThe advanced ambulatory heart failure (HF) population comprises patients who have progressed beyond the pillars of recommended stage C HF therapies but can still find meaningful life-years ahead. Although these patients are commonly encountered in practice, national databases selectively capture the small groups accepted for heart transplant listing or left ventricular assist devices. The

ImportanceReductions in dietary salt are associated with blood pressure reductions; however, national governments that have passed laws to reduce sodium intake have not measured these laws’ impact.ObjectiveTo determine if South African regulations restricting sodium content in processed foods were associated with reductions in sodium consumption and blood pressure.Design, Setting, and ParticipantsThe

ImportanceHypertension is the primary cardiovascular risk factor in Africa. Recently revised World Health Organization guidelines recommend starting antihypertensive dual therapy; clinical efficacy and tolerability of low-dose triple combination remain unclear.ObjectivesTo compare the effect of 3 treatment strategies on blood pressure control among persons with untreated hypertension in Africa.Design

ImportanceA comprehensive lipid panel is recommended by guidelines to evaluate atherosclerotic cardiovascular disease risk, but uptake is low.ObjectiveTo evaluate whether direct outreach including bulk orders with and without text messaging increases lipid screening rates.Design, Setting, and ParticipantsPragmatic randomized clinical trial conducted from June 6, 2023, to September 6, 2023, at 2 primary

ImportanceNocturnal hypertension while asleep is associated with substantial increases in risk of cardiovascular disease (CVD) and death. Whether hypertension while supine is a risk factor associated with CVD independent of seated hypertension remains unknown.ObjectiveTo investigate the association between supine hypertension and CVD outcomes and by hypertension treatment status.Design, Setting, and

ImportancePatients with transthyretin (ATTR) cardiac amyloid infiltration are increasingly diagnosed at earlier disease stages with no heart failure (HF) symptoms and a wide range of cardiac amyloid infiltration.ObjectiveTo characterize the clinical phenotype and natural history of asymptomatic patients with ATTR cardiac amyloid infiltration.Design, Setting, and ParticipantsThis cohort study analyzed

ImportanceLung ultrasound (LUS) aids in the diagnosis of patients with dyspnea, including those with cardiogenic pulmonary edema, but requires technical proficiency for image acquisition. Previous research has demonstrated the effectiveness of artificial intelligence (AI) in guiding novice users to acquire high-quality cardiac ultrasound images, suggesting its potential for broader use in LUS.ObjectiveTo

ImportanceTreatment to lower high levels of low-density lipoprotein cholesterol (LDL-C) reduces incident coronary artery disease (CAD) risk but modestly increases the risk for incident type 2 diabetes (T2D). The extent to which genetic factors across the cholesterol spectrum are associated with incident T2D is not well understood.ObjectiveTo investigate the association of genetic predisposition to