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Background: Despite increasing clinical recognition of atrial functional tricuspid regurgitation (AF-TR), there remains limited literature regarding the characteristics, outcomes, and adverse prognosticators for this valve lesion., Objectives: This study aimed to elucidate clinical and echocardiographic characteristics and outcomes and to develop a novel risk model in a large cohort of patients with significant AF-TR., Methods: Consecutive patients with at least moderate-to-severe AF-TR seen between January 2004 and December 2018 were retrospectively studied. Univariable and multivariable logistic regression (OR) were conducted to determine the risk factors and develop novel risk scores for 1-year all-cause mortality., Results: Among 370 patients with AF-TR (mean age 73.9 ± 15.0 years, 82.2% female; mean follow-up 4.1 ± 3.6 years), 1-year and total mortality occurred in 81 (21.9%) and 219 (59.2%) of patients respectively, with a median survival of 2.5 and 8.5 years for patients with AF-TR effective regurgitant orifice area ≥0.40 and <0.40 cm 2 . Multivariable analyses identified right heart failure (OR: 2.40; 95% CI: 1.31-4.41), lower serum albumin (OR: 0.88; 95% CI: 0.85-0.92), higher right atrial volume indexed (OR: 1.25; 95% CI: 1.04-1.49), lower tricuspid annular plane systolic excursion/right ventricular systolic pressure ratio (OR: 0.82; 95% CI: 0.70-0.95), and higher TR-effective regurgitant orifice area (OR: 1.11; 95% CI: 1.02-1.21) to be independently associated with 1-year mortality, from which a risk model was derived with good discrimination (area under the curve: 0.87)., Conclusions: Patients with AF-TR had poor prognosis especially if tricuspid regurgitation effective regurgitant orifice area was ≥0.40 cm 2 , validating the guidelines threshold for severe tricuspid regurgitation. A novel risk score for 1-year mortality in patients with AF-TR was developed, offering potential utility for risk stratification and treatment guidance; however, external validation is needed., Competing Interests: Funding support and author disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Left ventricular global longitudinal strain (LVGLS) by speckle-tracking transthoracic echocardiography (TTE) is an established measure of left ventricular systolic function with many clinical applications. Strain software has evolved to achieve vendor-neutrality in recent developments, although there is a notable absence of external validation studies. We assessed the normal ranges and associated factors of two-dimensional LVGLS quantification by TomTec, EchoPAC, VVI, and Epsilon contemporary strain software in a healthy cross-sectional cohort., Methods: One hundred healthy subjects undergoing TTE during January-April 2023 at our institution were cross-sectionally recruited, 20 per age-group, 50% were female, and 50% had GE and 50% Philips scans. TomTec version 51.02 (Autostrain LV), EchoPAC version 206 (AFI-LV), VVI version (V.2.00-070730), and Epsilon (5.0.2.11295) were utilized to quantify two-dimensional LVGLS in all patients for comparative and regression analyses., Results: Means and lower limits of normal (95% confidence intervals) of LVGLS were -17.1% (-17.5%, -16.7%) and -14.7% (-15.4%, -14.0%) for TomTec; -17.8% (-18.4%, -17.2%) and -14.4% (-15.3%, -13.5%) for EchoPAC; -16.3% (-16.9%, -15.7%) and -13.0% (-13.9%, -12.1%) for VVI; and -17.0% (-17.6%, -16.4%) and -12.8% (-13.8%, -11.8%) for Epsilon. Factors significantly associated with LVGLS measurements in multivariable regression analyses with their beta-coefficients (95% CI) were female -1.36 (-2.12, -0.59), heart rate (per 10 bpm) with a coefficient of 0.38 (0.10-0.66), left ventricular ejection fraction (per 10%) -1.03 (-1.72, -0.34), and EchoPAC (vs. TomTec) -0.62 (-1.2, 0.0), VVI (vs. TomTec) 0.82 (0.23, 1.41) and Epsilon (vs. TomTec) 0.13 (-0.45, 0.72)., Conclusion: LVGLS measurements were feasible across all four strain software on both GE and Philips scans in this study. Reference ranges to define normal, abnormal, and borderline LVGLS values along with associated factors in healthy patients are reported to enable clinical applications., (© 2025 The Author(s). Echocardiography published by Wiley Periodicals LLC.)

Background: Psoriasis in pregnancy is associated with adverse maternal outcomes. However, there are limited data on this subject., Objectives: The purpose of our study was to investigate the association between psoriasis and related cardiovascular complications during delivery., Methods: The National Inpatient Sample was used to identify hospitalizations for delivery from 2011 to 2020. Propensity score matching was performed to study the association of psoriasis with the primary outcomes of in-hospital medical and obstetric complications., Results: A total of 37,482,206 weighted delivery hospitalizations in women ≥18 years were identified; of which, 23,588 patients had psoriasis. Pregnant patients with psoriasis had a higher incidence of complications during delivery, including preeclampsia/eclampsia, acute kidney injury, pulmonary edema, cardiac arrhythmias, and venous thromboembolism compared to those without psoriasis. In propensity-matched analysis, psoriasis was significantly associated with a higher risk of preeclampsia/eclampsia (OR: 1.25, 95% CI: 1.08 to 1.43, P = 0.002) and cardiac arrhythmias (OR: 1.44, 95% CI: 1.08-1.93, P = 0.012), compared to patients without psoriasis., Conclusions: Delivery hospitalizations in patients with psoriasis are associated with a higher risk of preeclampsia/eclampsia and cardiac arrhythmias., Competing Interests: Funding support and author disclosures Dr Michos reports Advisory Board participation for Amgen, Arrowhead, AstraZeneca, Boehringer Ingelheim, Edwards Life Science, Esperion, Ionis, Lilly, Medtronic, Merck, New Amsterdam, Novartis, Novo Nordisk, and Pfizer. Dr Weber has received scientific advisory board/consulting fees from Novo Nordisk, Kiniksa Pharmaceuticals, BMS, Agepha, and Horizon Therapeutic (now owned by Amgen). Dr Michos is supported by the Amato Fund for Women's Cardiovascular Health research at Johns Hopkins University, as well as an American Heart Association grant 946222. Dr Weber has grants from NHLBIK23 HL159276-01, AHA21CDA851511. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

While multiple scoring systems exist to predict mortality in cardiac surgery, their utility in infective endocarditis (IE) remains uncertain, prompting this study to compare their prognostic accuracy. We conducted a comprehensive review using Ovid Medline, Embase, and Cochrane Central Register of Controlled Trials. Data were pooled using Open-Meta[Analyst] software, and calibration analysis was performed with Review Manager 5.4. Among 620 articles identified, 570 were screened, leading to 15 included studies. Twelve risk scores were analyzed for operative mortality discrimination in IE surgery, with the area under the curve (AUC) ranging from 0.64 to 0.83. Among the IE-specific risk scores, AUCs (95% confidence interval) were highest for ANCLA (Anemia, NYHA class IV, critical state, large intracardiac destruction, surgery on thoracic aorta) 0.838 (0.803-0.873), AEPEI (Association pour l'Etude et la Prevention de l'Endocadite Infectieuse) 0.764 (0.726-0.802), RISK-E (Risk Endocarditis) (0.752 (0.662-0.842) and APORTEI (Análisis de los factores PROnósticos en el Tratamiento quirúrgico de la Endocarditis Infecciosa) 0.750 (0.726-0.774) scores. Regarding traditional risk scores, EuroSCORE II performed at 0.750 (0.725-0.775) but underestimated mortality compared with EuroSCORE I in calibration analysis. In conclusion, EuroSCORE II and several endocarditis-specific scores had moderate discrimination (AUC > 0.75) in predicting mortality after IE surgery., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Coronary artery calcification is an impediment to percutaneous coronary interventions by obstructing the device pathway or stent deployment. To facilitate percutaneous coronary intervention in such complex lesions, high-pressure balloon dilations, atherectomy procedures, and specialty balloons are used but they all come with considerable limitations and periprocedural complications like dissection and perforation. To surpass these disadvantages, intravascular lithotripsy was introduced which acts by delivering high-pressure pulsatile sonic waves circumferentially thereby destroying the calcium deposits. It is a safe and effective treatment modality in treating severe coronary artery calcification and facilitating stent delivery with minimal complications., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Although hyperuricemia is a recognized risk factor for cardiovascular diseases, mixed results have been reported regarding the associations between uric acid-lowering medications and cardiovascular events. This meta-analysis compared the cardiovascular outcomes of different uric acid-lowering medications and placebo., Methods: Following PRISMA guidelines, we searched OVID Medline, Embase, Web of Science, and Cochrane databases to identify potentially relevant articles until December 2023. Studies must be randomized or observational, report cardiovascular and mortality outcomes, and compare uric acid-lowering medications to placebo or each other. Data was analyzed using Revman (version 5.4) software., Results: A total of 3,393 studies were searched, after which 47 studies were included, totaling 3,803,509 patients (28 studies comparing xanthine oxidase inhibitors (XOI) versus placebo, 17 studies comparing allopurinol and febuxostat, and 2 studies comparing XOI and uricosuric agents). Overall mean age was 57.3 years, and females comprised 20.8% of all studies. There were no significant differences between XOI and placebo for cardiovascular outcomes (mortality, myocardial infarction, major adverse cardiovascular events, heart failure, or arrhythmia). There was significant heterogeneity in all these pooled analyses. Comparing Allopurinol to Febuxostat, there was a lower risk of heart failure in febuxostat than allopurinol in 3 RCTs (OR 0.66, 95% CI 0.50-0.89, p = 0.006). Other cardiovascular outcomes were not different. Lastly, when comparing XOI and uricosuric agents, no significant differences in MI rates were evident., Conclusion: XOI was not associated with reduced cardiovascular events compared to placebo. When comparing XOI agents, Febuxostat might reduce the risk of HF, but future studies are required to confirm the findings from the current study., Competing Interests: Declarations. Human and Animal Rights and Informed Consent: Not applicable Conflict of Interests: The authors declare no competing interests. Disclosures: None., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: To outline recent advances in imaging and treatment for recurrent pericarditis (RP)., Recent Findings: Greater understanding of NLRP3 inflammasome activation in the pathogenesis of RP has led to the development of several anti-interleukin (IL-1) agents, and technological advancements have increased the utility of multimodality imaging in RP. Multimodality imaging plays a crucial role in the assessment of RP, with echocardiography serving as the initial imaging modality; cardiac magnetic resonance (CMR) as a pivotal test for diagnosis, grading severity, and surveillance; and cardiac computed tomography (CT) providing complimentary information and assisting operative assessment. Anti-IL-1 agents are now well-established as second line therapy for RP, with recent clinical trials demonstrating their efficacy., Competing Interests: Compliance with Ethical Standards. Competing interests: Author Allan Klein has research grants from Kiniksa Pharmaceuticals and Cardiol Therapeutics, and is on advisory board for Kiniksa Pharmaceuticals, Cardiol Therapeutics and Pfizer. Human and Animal Rights and Informed Consent: No animal or human subjects by the authors were used in this study., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Subaortic stenosis (SAS) is characterized by a fibromuscular membrane located just below the aortic valve, causing fixed outflow tract obstruction. There is a paucity of studies evaluating this condition. This cohort study reviewed the contemporary characteristics and outcomes of SAS in adult patients in a single large referral center., Methods and Results: We retrospectively studied adult patients with SAS evaluated at our center during 2011 to 2022. The primary outcome was all-cause mortality and heart failure hospitalizations during follow-up, with secondary end points including recurrence of SAS and repeat surgery after initial SAS surgery. Among 484 patients with SAS, key characteristics included mean age 55±18 years, 67.5% female, left ventricular outflow tract peak velocity 352±140 cm/s and gradient 57±40 mm Hg, left ventricular ejection fraction 60%±14%, 54.8% had prior SAS surgery, and 45.1% had surgery during follow-up. Over a median follow-up of 5.5 (1.5-12.3) years, 11.5% (n=56) died, 6.8% (n=33) had heart failure hospitalizations, 8.0% (n=39) experienced SAS recurrence, and 14 (5.9%) underwent repeat SAS surgery. Multivariable analyses identified older age per 10-years (hazard ratio [HR], 1.37 [95% CI, 1.12-1.68]) and baseline New York Heart Association class (HR, 2.48 [95% CI, 1.54-3.99]) to be statistically significantly associated with the primary end point; higher body mass index, New York Heart Association class, and peak left ventricular outflow tract gradient were also statistically significantly associated with SAS recurrence and redo surgery., Conclusions: Almost half of patients with SAS had surgery in the past or during follow-up, and a significant minority had mortality or morbidity events during follow-up. Identified prognosticators warrant further research to guide management.

Background: Coronavirus disease 2019 (COVID-19) is known to increase the risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE). However, the incidence, predictors, and outcomes of clinical thrombosis for inpatients with COVID-19 are not well known. This study aimed to enhance our understanding of clinical thrombosis in COVID-19, its associated factors, and mortality outcomes., Method: Hospitalised adult (≥18 years of age) patients with COVID-19 in 2020 were retrospectively identified from the US National Inpatient Sample database. Clinical characteristics, incident VTE, ATE, and in-hospital mortality outcomes were recorded. Multivariable logistic regression was performed to identify clinical factors associated with thrombosis and in-hospital mortality in COVID-19 inpatients., Results: A total of 1,583,135 adult patients with COVID-19 in the year 2020 were identified from the National Inpatient Sample database; patients with thrombosis were 41% females with a mean age of 65.4 (65.1-65.6) years. The incidence of thrombosis was 6.1% (97,185), including VTE at 4.8% (76,125), ATE at 3.0% (47,790), and the in-hospital mortality rate was 13.4% (212,785). Patients with thrombosis were more likely to have respiratory symptoms of COVID-19 (76.7% vs 75%, p<0.001) compared with patients without thrombosis. The main factors associated with overall thrombosis, VTE, and ATE were paralysis, ventilation, solid tumours without metastasis, metastatic cancer, and acute liver failure. Although all thrombosis categories were associated with higher in-hospital mortality for COVID-19 inpatients in univariable analyses (p<0.001), they were not in multivariable analyses-thrombosis (odds ratio [OR] 1.24; 95% confidence interval [CI] 0.90-1.70; p=0.19), VTE (OR 0.70; 95% CI 0.52-1.00; p=0.05), and ATE (OR 1.07; 95% CI 0.92-1.25; p=0.36)., Conclusions: The association of COVID-19 with thrombosis and VTE increases with increasing severity of the COVID-19 disease. Risk stratification of thrombosis is crucial in COVID-19 patients to determine the necessity of thromboprophylaxis., Competing Interests: Conflicts of Interest There are no conflicts of interest to disclose., (Copyright © 2024 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: Takotsubo cardiomyopathy (TC) is an established differential diagnosis of myocardial infarction with non-obstructive coronaries with significant interest but limited data on prognostication. We reviewed the characteristics and in-hospital outcomes and developed a novel risk score for TC., Methods: Using the National Inpatient Sample data from 2016 to 2020, we identified adult patients (≥18 years) with acute coronary syndrome (ACS) and TC. We divided the cohort into ACS with and without TC and retrieved baseline data. Multivariable regression analysis was conducted to identify factors associated with TC diagnosis and adverse outcomes, leading to the development of a risk-scoring system., Results: Among 7 219 004 adult ACS admissions, 78 214 (1.0%) were diagnosed with TC, with a mean age of 68.2 years, 64 526 (82.5%) being female and 5475 (7.0%, compared with 8.4% for other ACS) in-hospital mortality events. Factors significantly associated with TC were female sex (OR 6.78 (95% CI 6.47 to 7.09), p<0.001) and chronic heart failure (OR 1.60 (95% CI 1.54 to 1.66), p<0.001). A novel risk score was developed, including the following parameters: male sex, age >70 years, non-white race, hypertension, hyperlipidemia, history of coronary artery bypass grafting, history of percutaneous coronary intervention, cardiac arrhythmias, renal failure, cardiogenic shock and vasopressor use. The area under curves for in-hospital mortality was 0.716 in the derivation and 0.725 in the validation cohorts., Conclusions: TC remains a high-risk diagnosis in a minority of ACS cases, with mortality rates similar to other ACS causes. Our novel risk score offers a valuable tool for risk stratification in patients with TC, but external validation is needed to confirm its utility., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Our case depicts a challenging diagnosis of catastrophic antiphospholipid syndrome in a young patient with a heterogenous presentation with extensive clinical course, a wide range of investigations, including multimodality imaging, and multidisciplinary expertise, to initiate prompt treatment addressing multiorgan thrombotic injury., Competing Interests: No conflicts of interest for all authors., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Pregnancy in patients with pulmonary hypertension (PH) is associated with a heightened risk of medical complications including right heart failure, pulmonary edema, and arrhythmias. Our study investigated the association between PH and these complications during delivery., Methods and Results: The National Inpatient Sample was used to identify delivery hospitalizations from 2011 to 2020. Multivariable logistic regression was performed to study the association of PH with the primary outcomes of in-hospital medical and obstetric complications. A total of 37 482 207 delivery hospitalizations in women ≥18 years of age were identified, of which 9593 patients had PH. Pregnant patients with PH had higher incidence of complications during delivery including preeclampsia/eclampsia, arrhythmias, and pulmonary edema among others, compared with those without PH. Pregnant patients with PH also had a higher incidence of in-hospital mortality compared with those without PH (0.51% versus 0.007%). In propensity-matched analyses, PH was still significantly associated with a higher risk of in-hospital mortality (odds ratio [OR], 5.02 [95% CI, 1.82-13.90]; P =0.001), pulmonary edema (OR, 9.11 [95% CI, 6.34-13.10]; P <0.001), peripartum cardiomyopathy (OR, 1.85 [95% CI, 1.37-2.50]; P <0.001), venous thromboembolism (OR, 12.60 [95% CI, 6.04-26.10]; P <0.001), cardiac arrhythmias (OR, 6.11 [95% CI, 4.97-7.53]; P <0.001), acute kidney injury (OR, 3.72 [95% CI, 2.86-4.84]; P <0.001), preeclampsia/eclampsia (OR, 2.24 [95% CI, 1.95-2.58]; P <0.001), and acute coronary syndrome (OR, 2.01 [95% CI, 1.06-3.80]; P =0.03), compared with pregnant patients without PH., Conclusions: Delivery hospitalizations in patients with PH are associated with a high risk of mortality, pulmonary edema, peripartum cardiomyopathy, venous thromboembolism, arrhythmias, acute kidney injury, preeclampsia/eclampsia, and acute coronary syndrome.

Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewer of this article have no conflicts of interest.

Objective: Coronary artery bypass grafting (CABG) is an established revascularisation strategy for multivessel and left main coronary artery disease. Although aspirin is routinely recommended for patients with CABG, the optimal antiplatelet regimen after CABG remains unclear. We evaluated the efficacies and risks of different antiplatelet regimens (dual (DAPT) versus single (SAPT), and dual with clopidogrel (DAPT-C) versus dual with ticagrelor or prasugrel (DAPT-T/P)) after CABG., Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and performed a comprehensive literature search using PubMed, Ovid Medline, Ovid Embase and Cochrane Central Register of Controlled Trials. Data were extracted and pooled using random-effects models and Review Manager (V.5.4)., Results: Among the 2970 article abstracts screened, 215 full-text articles were reviewed and 38 studies totaling 77 447 CABG patients were included for analyses. DAPT compared with SAPT was associated with significantly lower all-cause mortality (OR 0.65 with 95% CI 0.50 to 0.86; p=0.002), cardiovascular mortality (OR 0.53, 95% CI 0.33 to 0.84; p=0.008), and major adverse cardiac and cerebrovascular events (MACCE) (OR 0.68, 95% CI 0.51 to 0.91; p=0.01), but higher rates of major (OR 1.30, 95% CI 1.08 to 1.56; p=0.007) and minor bleeding (OR 1.87, 95% CI 1.28 to 2.74; p=0.001) after CABG. DAPT-T/P compared with DAPT-C was associated with significantly lower all-cause (OR 0.43, 95% CI 0.29 to 0.65; p≤0.0001) and cardiovascular mortality (OR 0.44, 95% CI 0.24 to 0.80; p=0.008), and no differences on other cardiovascular or bleeding outcomes after CABG., Conclusion: In patients with CABG, DAPT compared with SAPT and DAPT-T/P compared with DAPT-C were associated with reduction in all-cause and cardiovascular mortality, especially in patients with acute coronary syndrome. Additionally, DAPT was associated with reduction in MACCE, but higher rates of major and minor bleeding. An individualised approach to choosing antiplatelet regimen is necessary for patients with CABG based on ischaemic and bleeding risks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

COronaVIrus Disease-2019 (COVID-19) is associated with a hypercoagulable state. Intracardiac thrombosis is a potentially serious complication but has seldom been evaluated in COVID-19 patients. We assessed the incidence, associated factors, and outcomes of COVID-19 patients with intracardiac thrombosis. In 2020, COVID-19 inpatients were identified from the National Inpatient Sample (NIS) database. Data on clinical characteristics, intracardiac thrombosis, and adverse outcomes were collected. Multivariable logistic regression was used to identify factors associated with intracardiac thrombosis, in-hospital mortality, and morbidities. In 2020, 1,683,785 COVID-19 inpatients (mean age 63.8 years, 32.2% females) were studied. Intracardiac thrombosis occurred in 0.10% (1830) of cases. In-hospital outcomes included 13.2% all-cause mortality, 3.5% cardiovascular mortality, 2.6% cardiac arrest, 4.4% acute coronary syndrome (ACS), 16.1% heart failure, 1.3% stroke, and 28.3% acute kidney injury (AKI). Key factors for intracardiac thrombosis were congestive heart failure history and coagulopathy. Intracardiac thrombosis independently linked to higher risks of all-cause mortality (odds ratio [OR]: 3.32 (2.42-4.54)), cardiovascular mortality (OR: 2.95 (1.96-4.44)), cardiac arrest (OR: 2.04 (1.22-3.43)), ACS (OR: 1.62 (1.17-2.22)), stroke (OR: 3.10 (2.11-4.56)), and AKI (OR: 2.13 (1.68-2.69)), but not heart failure. While rare, intracardiac thrombosis in COVID-19 patients independently raised in-hospital mortality and morbidity risks., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A 40-year-old woman presented with recurrent pericarditis and pericardial effusion while receiving treatment with all-trans retinoic acid and arsenic trioxide for recently diagnosed acute promyelocytic leukemia. She was successfully treated with the interleukin-1 inhibitor rilonacept after experiencing multiple recurrences with triple therapy with aspirin, colchicine, and steroids. ( Level of Difficulty: Advanced. )., Competing Interests: Dr Klein has received research funding from Kiniksa Pharmaceuticals, Ltd; and has served on scientific advisory boards for Kiniksa Pharmaceuticals, Ltd, Swedish Orphan Biovitrum AB, Cardiol Therapeutics, and Pfizer, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2023 The Authors.)

Parasitic constrictive pericarditis is a rare entity. We present a case of a 75-year-old man who presented with dyspnea, ascites, and pedal edema and was found to have constrictive pericarditis on multimodality imaging with positive serology for Strongyloides Stercoralis . Treatment required ivermectin and radical pericardiectomy with significant clinical improvement. ( Level of Difficulty: Intermediate. )., Competing Interests: Dr Klein has received a research grant from Kiniksa Pharmaceuticals and Cardiol Therapeutics; and has served on the scientific advisory board of Kiniksa Pharmaceuticals, Ltd, Cardiol Therapeutics, and Pfizer, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2023 The Authors.)

Guidelines recommend using the CHA₂DS₂-VASc score to determine anticoagulation decisions in atrial fibrillation (AF) patients, including those who undergo pulmonary vein isolation (PVI), however this may not consistently occur in the real-world setting because of other clinical factors. We sought to evaluate the anticoagulation prescription rates patterns in AF patients 1 year PVI at our institution. Consecutive AF patients undergoing PVI in our prospective registry during 2014-2018 who were alive at 1-year post-PVI were studied. Anticoagulation prescription rates at this time-point were adjudicated, and correlated to CHA₂DS₂-VASc score, sex, and heart rhythm status at 1 year. Amongst 4596 patients undergoing PVI, mean age was 64.2 ± 10.0 years, 1328 (28.9%) were female, and based on CHA₂DS₂-VASc score anticoagulation was not indicated, can be considered and indicated in 872 (19.0%), 1183 (25.7%), and 2541 (55.3%) patients, respectively. At 1-year after PVI, 3504 (76.2%) patients were on anticoagulation, and 792 (17.2%) had recurrence of AF. Anticoagulation was continued in over half of AF patients without classic CHA₂DS₂-VASc indication particularly in those with AF recurrence and women, while they were mildly under-prescribed in those with indication, especially for those without AF recurrence and men. In a large real world cohort of patients after PVI, anticoagulation prescription is not solely depending on the CHA₂DS₂-VASc score and sex, but also heart rhythm status and other clinical or imaging factors., (© 2023 Wiley Periodicals LLC.)

Infective endocarditis (IE) remains to be a heterogeneous disease with high morbidity and mortality rates, which can affect native valves, prosthetic valves, and intra-cardiac devices, in addition to causing systemic complications. The combination of clinical, laboratory, and cardiac imaging evaluation is critical for early diagnosis and risk stratification of IE. This can facilitate timely medical and surgical management to improve patient outcomes. Key imaging findings for IE include vegetations, valve perforation, prosthetic valve dehiscence, pseudoaneurysms, abscesses, and fistulae. Transthoracic echocardiography continues to be the first-line imaging modality of choice, while transesophageal echocardiography subsequently provides an improved structural assessment and characterization of lesions to facilitate management decision in IE. Recent advances in other imaging modalities, especially cardiac computed tomography and 18 F-fluorodeox-yglucose positron emission tomography, and to a lesser extent cardiac magnetic resonance imaging and other nuclear imaging techniques, have demonstrated important roles in providing complementary IE diagnostic and prognostic information. This review aims to discuss the individual and integrated utilities of contemporary multi-modality cardiac imaging for the assessment and treatment guidance of IE.

Infective endocarditis is a complex heterogeneous condition involving the infection of the endocardium and heart valves, leading to severe complications, including death. Surgery is often indicated in patients with infective endocarditis but is associated with elevated risk compared with other forms of cardiac surgery. Risk models play an important role in many cardiac surgeries as they can help inform clinicians and patients regarding procedural risk, decision-making to proceed or not, and influence perioperative management; however, they remain under-utilized in the infective endocarditis settings. Another crucial role of such risk models is to assess predicted versus found mortality, thereby allowing an assessment of institutional performance in infective endocarditis surgery. Traditionally, general cardiac surgery risk models such as European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, and Society of Thoracic Surgeon's score have been applied to endocarditis surgery. However, there has been the development of many endocarditis surgery-specific scores over the last decade. This review aims to discuss clinical characteristics and applications of all contemporary risk scores in the setting of surgical treatment of infective endocarditis.

Carcinoid heart disease (CHD) is a rare and potentially lethal manifestation of an advanced carcinoid (neuroendocrine) tumor. The pathophysiology of CHD is related to vasoactive substances secreted by the tumor, of which serotonin is most prominent in the pathophysiology of CHD. Serotonin stimulates fibroblast growth and fibrogenesis, which can lead to cardiac valvular fibrosis. CHD primarily affects right heart valves, causing tricuspid and pulmonic regurgitation and less frequently stenosis of these valves. Left heart valves are usually spared because vasoactive substances such as serotonin are enzymatically inactivated in the lung vasculature. The pathology of CHD is characterized by plaque-like deposition of fibrous tissue on valvular cusps, leaflets, papillary muscles, chordae, and ventricular walls. Symptomatic CHD usually presents between 50 and 70 years of age, initially as dyspnea and fatigue. Echocardiography is the mainstay of imaging and demonstrates thickened right heart valves with limited mobility and regurgitation. Treatment focuses on control of the underlying carcinoid syndrome, targeting subsequent valvular heart disease and managing consequent heart failure. Surgical valve replacement and catheter-directed valve procedures may be effective for selected patients with CHD., (© 2020 S. Karger AG, Basel.)