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This paper describes a case of patient post-TAVI who developed Left Septal Fascicular Block (LSFB) and Right Bundle Branch Block (RBBB). This combination has not been previously reported and must be actively sought out, given the possible increased risk of complete atrioventricular block and sudden cardiac death. RBBB following transcatheter aortic valve replacement is rare and is associated with complete atrioventricular block and permanent pacemaker implantation. LFSB on ECG may be a surrogate maker of diffuse conduction systemic damage following TAVI. Therefore, there should be a low threshold for permanent pacing in patients who develop new RBBB and LSFB post-TAVI., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This research letter evaluates the diagnostic accuracy of three physician groups-pediatric cardiologists, adult congenital heart disease (ACHD) specialists, and general cardiologists-and compares it to the performance of an AI (Artificial Intelligence) LLM model. Based on eight targeted questions in adult congenital heart disease, the analysis highlights significant disparities in correct answer rates, with congenital specialists achieving the highest accuracy and the AI model - the lowest., Competing Interests: All the authors have nothing to disclose. Managing adult congenital heart disease (ACHD) demands specialized knowledge across various cardiology disciplines. GPT 4.0 has already been evaluated in several medical fields for problem solving and showed promising results compared to human physicians [1,2]. This hypothesis generating study explores the diagnostic accuracies of different specialist groups and an AI model (GPT 4.0 and GPT 4o) to explore the utility of AI in clinical decision support in this complex field of cardiac specialty. Human specialist participants included 3 pediatric cardiologists, 3 ACHD specialists, and 3 general cardiologists. All cardiologists had at least 5 years of clinical experience and included experts with significant experience in all groups. Each group responded to the same set of eight standardized hypothetical clinical questions relevant to ACHD. Human participants were able to opt to answer “I don't know” in addition to the options given. The responses were evaluated against a set of predetermined guideline directed answers, with accuracy percentages computed for comparative analysis. Supplement) The current ESC and ACC guidelines on ACHD was inserted into the AI model [3,4]. The results showed that pediatric and ACHD cardiologists performed the best with an accuracy rate of 87.5 % and 83.3 % respectively, followed by general cardiologists with 68.8 %. ChatGPT 4.0 trailed in accuracy rates, providing correct answers to only 50 % of the questions (Fig. 1). The superior performance of congenital specialists reflects their clinical experience in this field. ACHD guidelines are largely based on level of evidence C (expert opinion) and encompass clinical considerations that are often complex [3].The decision-making process is often multidisciplinary and requires a clinical understanding of the underlying congenital heart disease, disease trajectory, patient wishes and acquired medical conditions. The lower performance of ChatGPT suggests a need for enhanced training and AI tuning specifically targeted toward complex medical fields. If it can increase its accuracy in the field, AI could enhance the overall quality of care in the field of adult congenital heart disease and assist in clinical decision-making. Due to the low number of congenital heart specialists worldwide, AI could prove an important clinical assist tool especially in treatment regions where specialists are. However, our results may indicate that at present, the LLM is not ready for “prime time” as a clinical decision support tool in congenital heart diseases and that clinical decisions and therapeutic recommendations in this field should be managed and driven by clinical experts.Fig. 1Correct answers by physician group.Fig. 1, (© 2024 The Authors.)

Objective: To evaluate the association between trimethylamine N-oxide (TMAO) and related metabolites with adverse cardiovascular events in a multiethnic urban primary prevention population., Methods: We performed a case-control study of 361 participants of the Dallas Heart Study, including 88 participants with an incident atherosclerotic cardiovascular disease (ASCVD) event and 273 controls matched for age, sex, and body mass index without an ASCVD event during 12 years of follow-up (January 1, 2000, through December 31, 2015). Plasma levels of TMAO, choline, carnitine, betaine, and butyrobetaine were measured by mass spectrometry. The differential odds for incident ASCVD by metabolite levels between cases and controls were compared by a conditional logistic regression model adjusted for cardiovascular risk factors., Results: Participants with incident ASCVD had higher levels of TMAO and related metabolites compared with those without ASCVD (P<.05 for all). Those with plasma TMAO concentrations in quartile 4 had a more than 2-fold higher odds of ASCVD compared with those in quartile 1 (odds ratio, 2.77 [95% CI, 1.05 to 7.7; P=.04] for hard ASCVD and 2.41 [95% CI, 1.049 to 5.709; P=.04]). Similar trends were seen with the related metabolites choline, betaine, carnitine, and butyrobetaine., Conclusion: Our results suggest that TMAO and related metabolites are independently associated with ASCVD events. Although further studies are needed, measurement of TMAO and related metabolites may have a role in ASCVD risk stratification for primary prevention., (Copyright © 2024 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Background: Permanent pacemaker implantation (PPI) remains one of the main drawbacks of transcatheter aortic valve replacement (TAVR), but scarce data exist on PPI after valve-in-valve (ViV) TAVR, particularly with the use of newer-generation transcatheter heart valves (THVs)., Objectives: The goal of this study was to determine the incidence, factors associated with, and clinical impact of PPI in a large series of ViV-TAVR procedures., Methods: Data were obtained from the multicenter VIVID Registry and included the main baseline and procedural characteristics, in-hospital and late (median follow-up: 13 months [interquartile range: 3 to 41 months]) outcomes analyzed according to the need of periprocedural PPI. All THVs except CoreValve, Cribier-Edwards, Sapien, and Sapien XT were considered to be new-generation THVs., Results: A total of 1,987 patients without prior PPI undergoing ViV-TAVR from 2007 to 2020 were included. Of these, 128 patients (6.4%) had PPI after TAVR, with a significant decrease in the incidence of PPI with the use of new-generation THVs (4.7% vs. 7.4%; p = 0.017), mainly related to a reduced PPI rate with the Evolut R/Pro versus CoreValve (3.7% vs. 9.0%; p = 0.002). There were no significant differences in PPI rates between newer-generation balloon- and self-expanding THVs (6.1% vs. 3.9%; p = 0.18). In the multivariable analysis, older age (odds ratio [OR]: 1.05 for each increase of 1 year; 95% confidence interval [CI]: 1.02 to 1.07; p = 0.001), larger THV size (OR: 1.10; 95% CI: 1.01 to 1.20; p = 0.02), and previous right bundle branch block (OR: 2.04; 95% CI: 1.00 to 4.17; p = 0.05) were associated with an increased risk of PPI. There were no differences in 30-day mortality between the PPI (4.7%) and no-PPI (2.7%) groups (p = 0.19), but PPI patients exhibited a trend toward higher mortality risk at follow-up (hazard ratio: 1.39; 95% CI: 1.02 to 1.91; p = 0.04; p = 0.08 after adjusting for age differences between groups)., Conclusions: In a contemporary large series of ViV-TAVR patients, the rate of periprocedural PPI was relatively low, and its incidence decreased with the use of new-generation THV systems. PPI following ViV-TAVR was associated with a trend toward increased mortality at follow-up., Competing Interests: Funding Support and Author Disclosures Dr. Alperi was supported by a grant from the Fundación Alfonso Martin Escudero (Madrid, Spain). Dr. Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions, and has received institutional research grants from Edwards Lifesciences and Medtronic. Dr. Montorfano is a proctor for Edwards Lifesciences, Abbott, and Boston Scientific. Dr. Adam has received personal fees from Edwards Lifesciences and Boston Scientific; and has received grants and personal fees from Medtronic during the conduct of the study. Dr. Noble has received institutional research grants from Abbott Vascular, Edwards Lifesciences, and Medtronic; and is a proctor for Medtronic. Dr. Erlebach has received fees from Medtronic. Dr. Kempfert has received fees from Medtronic, Edwards Lifesciences, and Abbott. Dr. Pilgrim has received institutional research grants from Biotronik, Boston Scientific, and Edwards Lifesciences; has received speaker fees from Biotronik and Boston Scientific; has received consultancy fees from HighLife SAS (CEC); and has performed proctoring for Medtronic and Boston Scientific. Dr. Kim has received personal fees from, performed proctoring for, and has served on advisory boards for Abbott Vascular, Boston Scientific, Edwards Lifesciences, Meril, Medtronic, and Shockwave Med. Dr. Hildick-Smith has served as a proctor and advisor for Edwards Lifesciences, Boston Scientific, and Medtronic. Dr. Dvir has provided consulting for Edwards Lifesciences, Medtronic, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: There is limited data on the long-term follow-up of patients with myocarditis., Aim: To investigate the long-term follow-up of patients with myocarditis., Material and Methods: We performed a retrospective observational analysis on the clinical long-term outcomes of patients with myocarditis over a 10-year period. The primary outcome was mortality. We identified risk factors for mortality and adverse clinical outcomes. We also compared the characteristics and outcomes of patients presenting with fulminant myocarditis to those presenting with non-fulminant myocarditis., Results: Between May 2004 and December 2014, 203 patients with myocarditis or perimyocarditis were admitted to our center. Most patients were male (87.7%) with a median age at presentation of 33 years (interquartile range: 25.4-38.9). The median follow-up period was 56.9 months (interquartile range 25.3-87.3 months), during which the overall mortality was 4.4% (9 patients). Fifteen patients presented with fulminant myocarditis. After multivariable analysis, older age (HR = 1.11, 95% CI: 1.05-1.16, p < 0.001) and a poorer New York Heart Association (NYHA) function class (HR = 4.6, 95% CI: 1.18-18, p = 0.028) were found to be independently associated with a higher risk of mortality, whereas higher albumin levels at presentation (HR = 0.2, 95% CI: 0.07-0.56, p = 0.002) were associated with decreased mortality. The group presenting with fulminant myocarditis had a more severe course of disease and a higher in-hospital mortality (13.3% vs. 0%, p = 0.005)., Conclusions: The overall prognosis of patients with myocarditis is good - in terms of both survival and recovery without residual left ventricular dysfunction., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2021 Termedia Sp. z o. o.)

An accurate functional assessment of coronary artery stenosis is pivotal in the management and clinical outcomes of patients. The hemodynamic relevance of coronary artery stenoses can be assessed using coronary flow surrogates, namely fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). This review provides an overview of these indexes, their clinical relevance, as well as a review of the literature supporting their use. It also reviews novel image-based FFR (e.g. FFRangio), the evidence showing the accuracy of this technique when compared to conventional wire-based techniques, as well as the clinical implications of non-invasive coronary artery stenosis functional assessments.