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Due to the variety of cardiac monitoring devices available after cryptogenic stroke to screen for atrial fibrillation, there is a need to understand the challenges and perceptions of these devices for patients. This article reviews in detail the cardiac monitoring technologies available to screen for atrial fibrillation after cryptogenic stroke/transient ischemic attack, with a focus on what is known regarding patient preferences and compliance in real‐world settings. As the optimal type of device and duration of time to screen for atrial fibrillation after cryptogenic stroke continues to be studied, a shared decision‐making approach that incorporates patient preferences with regard to the monitoring device chosen should be considered. Clinicians should explain to patients the uncertainty about the clinical impact of invasive monitoring, and future studies should aim to qualitatively delineate the viewpoints and comfort levels of patients with stroke regarding the use of implantable versus noninvasive cardiac monitoring.

Introduction: The rate of Alzheimer's disease (AD) for Black Americans (BAs) is 64% higher than for non-Hispanic White Americans (NHWs). Vascular dysfunction may directly contribute to pathologies related to AD and cognitive decline. The purpose of this study is to examine relationships between vascular function and cognition over two years in a diverse cohort of middle-aged adults at-risk for AD. Methods: Cognitively unimpaired, middle-aged (45-65 years) adults with a parental history of AD were enrolled. Vascular function measures (flow-mediated dilation [FMD], EndoPat, pulse wave velocity [PWV], blood pressure [BP]) CSF markers of vascular function (ICAM-1, VCAM-1), and the Benson Complex Figure Test were collected at baseline and year 2. Linear regression analyses accounting for related covariates (age, gender, race, history of hypertension, and APOE ε4) were performed. Results: Participants (N=80) were mostly female (69%), well educated (81% ≥college), 48% ApoEε4 positive, and 34% B/AA. A higher proportion of B/AA had hypertension as compared to NHWs (57% vs 34%, p=.041). Central systolic BP, central mean arterial pressure, and EndoPat augmentation index were higher among BAs at baseline, while FMD was significantly lower at year 2. Increased CSF VCAM-1 was associated with lower FMD over 2 years. Changes in delayed Benson scores were significantly higher among NHWs (median change score 2, 95% CI 0.81-2.6) as compared to BAs (median change score 0, 95% CI -2.0-0.4) with a large effect size (Cohen's d=.823, p

Background: Adverse mental health conditions including depression, posttraumatic stress disorder (PTSD), and anxiety are prevalent among patients who survive myocardial infarctions (MI) and are associated with adverse outcomes. The mechanisms underlying these associations, however, are not well understood. Inflammatory pathways may mediate the cardiovascular outcomes of patients with mental health disorders. We examined the bidirectional association between PTSD symptoms and inflammatory biomarkers in a young/middle-aged post MI population. We further examined how this association may differ between women and men as well as between Black and non-Black individuals. Methods: Participants included individuals with early onset MI between the ages 25 and 60. Mental health scores for depression, PTSD, perceived stress, and anxiety as well as inflammatory biomarkers, interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP), were collected at baseline and at six-month follow up. We examined the bidirectional changes in mental health symptoms and inflammatory biomarkers between baseline and follow-up. Results: Among 244 patients in the study (mean age: 50.8, 48.4% female, 64.3% Black), the geometric means for IL-6 level and hsCRP at rest were 1.7 pg/mL and 2.76 mg/L, respectively. Mental health scores at baseline did not consistently predict changes in inflammatory biomarkers at follow-up. However, baseline levels of both IL-6 and hsCRP were robustly associated with an increase in re-experiencing PTSD symptoms at 6 months: in adjusted linear mixed models, there was a 1.58-point increase in re-experiencing PTSD symptoms per unit of baseline hsCRP (p = 0.01) and 2.59-point increase per unit of baseline IL-6 (p = 0.02). Once the analysis was stratified by race, the association was only noted in Black individuals. Baseline inflammation was not associated with change in any of the other mental health symptom scores. Conclusion: Markers of inflammation are associated with an increase in post-event PTSD symptoms in younger or middle-aged patients who experienced an MI, especially Black patients. These results suggest a mechanistic link between inflammation and the development of PTSD among individuals with cardiovascular disease.

Background Arterial stiffness and earlier wave reflections can increase afterload and impair cardiovascular function. Most prior studies have been performed in patients with preserved left ventricular function. We describe novel measures of pulsatile arterial hemodynamics and their association with clinical outcomes in patients with heart failure with reduced ejection fraction. Methods and Results Participants with heart failure with reduced ejection fraction (n=137, median age 56 years, 49% women, 58% Black) and age‐matched healthy controls (n=124) underwent measurements of large artery stiffness and pulsatile arterial hemodynamics. Carotid‐femoral pulse wave velocity and augmentation index were assessed using radial applanation tonometry. Pressure‐flow analyses derived reflected wave transit time, the systolic pressure–time integral imposed by proximal aortic characteristic impedance, and the pressure–time integral from wave reflection (wasted pressure effort). Cox proportional hazards models defined associations between hemodynamic measures and (1) all‐cause death and (2) a combined end point of left ventricular assist device implant, heart transplant, and death, at 2 years adjusted for race, BNP (B‐type natriuretic peptide), and the Meta‐Analysis Global Group in Chronic Heart Failure Risk Score. Compared with controls, participants with heart failure with reduced ejection fraction exhibited similar carotid‐femoral pulse wave velocity (6.8±1.6 versus 7.0±1.6 m/s, P=0.40) but higher augmentation index normalized to a heart rate of 75 bpm (13±2% versus 22±2%, P