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Post-transplant diabetes mellitus (PTDM) is common following heart transplant, impacting greater than 20% of patients with most cases occurring in the first year after transplant. PTDM is associated with multiple negative sequelae including increased post-operative infections, a higher rate of renal failure, and increased mortality. Compared with pre-transplant diabetes mellitus, PTDM has several unique risk factors and immunosuppressive medications play an important role in disease pathophysiology. Newer treatments for hyperglycemia, including glucagon like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors, may counter the mechanisms of immunosuppression-related hyperglycemia making them an appealing treatment option for patients with PTDM. Here, we review the definitions, incidence, risk factors, pathophysiology, clinical outcomes, treatment options, pharmacologic considerations, and future directions in PTDM.

Mitral regurgitation (MR) is one of the common valvular heart diseases and can be broadly categorized as primary or secondary. Primary MR occurs due to abnormalities of the valvular apparatus where surgical repair offers excellent outcomes. In contrast, the underlying degree of left ventricular dysfunction plays a major role in the development of secondary MR. Recently, two randomized controlled trials, the Percutaneous Repair with the MitraClip Device for Severe Functional/ Secondary Mitral Regurgitation (MITRA-FR) and the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT), evaluated the role of transcatheter edge-to-edge repair (TEER) using MitraClip device among heart failure patients with secondary MR and observed contradictory results; this has created a considerable dilemma among clinicians for an appropriate patient selection for the transcatheter mitral valve (MV) therapies. In this review, we highlight several important differences in patient characteristics between the COAPT and MITRA-FR trials that may help explain the differences observed in outcomes. We also reviewed several key clinical, echocardiographic, and procedural characteristics that may guide clinicians in improving patient selection for transcatheter MV therapies for better outcomes.

Supplemental Material, Table_S1 for HeartMate 3 in a ccTGA patient by Daniel Eugene Clark, Tadarro L. Richardson, Ryan D. Byrne, Rachel E. Klausner, Benjamin P. Frischhertz, Sandip K. Zalawadiya, Bret A. Mettler, Matthew R. Danter and Jonathan N. Menachem in World Journal for Pediatric and Congenital Heart Surgery

Background: The implantable loop recorder (ILR) is a cost-effective tool with a high diagnostic yield in the evaluation of unexplained recurrent syncope. The Sleuth ILR (Transoma Medical, St. Paul MN, USA) is a new-generation ILR with wireless transmission capability approved by the Food and Drug Administration. We report the feasibility of achieving appropriate sensing over 1-year follow-up at the traditional midclavicular and alternative inframammary implantation sites without preimplant electrocardiogram (ECG) mapping. Methods and Results: We studied 32 patients with unexplained syncope, aged 58.4±18.44 years, with an ILR implanted at the left midclavicular location (n = 17) or the left inframammary site (n = 15) over 1-year post implant. No preimplant electrocardiogram (ECG) mapping was performed. The highest R-wave amplitudes were observed at the inframammary site, but over the entire follow-up period, amplitudes were not significantly different from those at the midclavicular site. At both sites, R-wave amplitudes at the 6-month follow-up were significantly higher than those measured at 1 week. P-waves were visible in 80–90% of the patients. There was no discernible difference in P-waves (amplitude) relative to implant location. Body mass index, left ventricular ejection fraction, and age did not significantly influence the R-wave amplitude or the ability to discern P-waves. Conclusion: Our findings show that the Sleuth ILR implanted at both the midclavicular and inframammary locations without preimplant ECG mapping achieves acceptable “R” waves. This may simplify implantation procedures and improve patient satisfaction. (PACE 2010; 834–840)

Cardiogenic shock (CS) causes significant morbidity and mortality and such patients can deteriorate rapidly. Temporary left ventricular assist devices (LVADs) are a promising approach to manage these patients. The following is a case series in which patients stabilized with a temporary LVAD for CS improvement were analyzed retrospectively. Between June 2011 and January 2014, 15 patients received temporary devices through an axillary approach (mean age: 53 ± 15, 93% male). Mean survival time was 317.8 ± 359.5 days (range: 6–936 days). During support there were no major bleeding events, infectious complications at the axillary access site, upper extremity edema, or emboli. The most of the patients recovered from CS (93%) were mobilized (67%) and were extubated (73%) while on temporary device support. Median times to extubation, intensive care unit discharge, and discontinuation of inotropic medications were: 1.63, 18, and 15 days, respectively. Four patients recovered to no device support and five received a long-term LVAD, all of whom remain alive. Therefore, implantation of a temporary LVAD through an axillary approach is a promising therapy for improving outcomes in patients needing mechanical circulatory support as a bridge to recovery or a definitive LVAD.

Background: Elevated inflammatory markers, haemostatic factors as well as homocysteine predict cardiovascular disease (CVD) events and mortality. Although racial/ethnic disparities in CVD risk factors and outcomes exist, comparative data on the predictive utility of novel biomarkers for future CVD events in US ethnic groups is limited. Methods: The study comprised 6814 asymptomatic men and women (52.85%), aged 45-84 yrs without prior cardiovascular disease, enrolled in the Multi-Ethnic Study of Atherosclerosis [MESA] obtained from NHLBI Data repository. 6270 asymptomatic men and women [1384 Hispanics, 2409 Caucasians, 753 Chinese and 1724 African Americans] with a host of novel biomarkers drawn were considered for this analysis. The CVD events were defined as ALL CVD events and HARD CVD events per MESA protocol (see Table). Results: A total of 302 all CVD events and 203 hard CVD events were identified during a mean follow up of 4.6 years. We observed significant ethnic differences in the prognostic utility of novel biomarkers for cardiovascular risk assessment, in a large multi-ethnic population of US adults free of clinical cardiovascular disease. While homocysteine emerged as a robust biomarker across racial cohorts, most other biomarkers analyzed predominantly predicted events in Caucasians (see Table). Conclusion: These findings raise serious concern about the prognostic potential or generalizability of risk stratification tools across racial subsets and underscore the need for further ethnicity-specific research in this area.

Introduction: Moderate alcohol intake has been associated with reduced cardiovascular mortality. Red cell distribution width (RDW) is an emerging cardiovascular risk marker, that is increasingly gaining recognition. No prior study has evaluated the association between alcohol intake and RDW. Methods: We evaluated 6,424 nationally representative individuals participating in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2006, free of cardiovascular co-morbidities (including coronary heart disease, diabetes, congestive heart failure, stroke and myocardial infarction) at baseline. RDW was divided into quartiles [Quartile 1 (Q1) ≤12 (reference category), Q2: 12.1-12.5; Q3: 12.6-13; Q4: >13] and alcohol intake was categorized by number of drinks per day [ Results: Mean RDW levels varied inversely with number of drinks per day (12.9 in reference alcohol category versus 12.5 in ≥3 drinks/day, p Conclusion: Moderate alcohol intake [1 to 2 drinks /day] is associated with more favorable levels of RDW. The association appears to be independent of nutritional deficiencies, inflammatory markers and other conventional cardiovascular risk factors. Table 1: Risk of Higher RDW with Increasing Alcohol Intake RDW Categories Alcohol Categories * ≤12 n=1,612 12.1-12.5 n=2,037 12.6-13 n=1,215 >13 n=1,560 1 OR[95% CI] p-value OR [95% CI] p-value OR [95% CI] p-value * 1 1 1 1 1 1 drink/day n=1,510 Model 1 1 0.93 [0.79-1.09] 0.351 0.97 [0.81-1.16] 0.750 0.72 [0.61-0.88] 0.001 Model 2 1 0.96 [0.82-1.13] 0.657 1.01 [0.84-1.21] 0.931 0.76 [0.62-0.93] 0.008 2 drinks/day n=1,212 Model 1 1 1.00 [0.85-1.17] 0.963 0.81 [0.67-0.99] 0.046 0.67 [0.55-0.82] Model 2 1 1.04 [0.88-1.22] 0.669 0.90 [0.74-1.11] 0.336 0.71 [0.56-0.88] 0.002 ≥3 drinks/day Model 1 1 1.00 [0.86-1.17] 0.995 0.85 [0.70-1.02] 0.082 0.86 [0.71-1.03] 0.105 Model 2 1 0.98 [0.84-1.15] 0.826 0.88 [0.72 -1.07]0.193 0.91 [0.74-1.11] 0.346 Model 1: Alcohol Drinks + Sex, Age, systolic blood pressure, anti-hypertensive medications, High Density Lipoprotein cholesterol, total cholesterol, ever smoking and deficiency of nutritional factors (Iron, folic acid and vitamin B 12 ) Model 2: Age, sex, race + body mass index, estimated Glomerular Filtration Rate, high sensitivity C - Reactive Protein, hypertension, hyperlipidemia, ever smoking, mean corpuscular volume, hemoglobin and deficiency of nutritional factors Abbreviations: OR - odds ratio, CI - Confidence Interval, RDW - Red cell Distribution Width. * RDW ≤12 and ‘Zero’ Alcohol drinks/day serve as reference categories for the comparison

Introduction: Metabolic syndrome (MS) is an adverse predictor of cardiovascular outcomes. Recently, waist height ratio (WHtR) is shown to correlate better with future cardiovascular risk factors than other anthropometric measures. We sought to determine whether replacing waist circumference (WC) with WHtR in metabolic syndrome diagnostic criteria per National Cholesterol Education Program (NCEP) guidelines improves predictive accuracy for future cardiovascular disease (CVD) events. Methods: The study cohort consisted of prospectively evaluated 6,702 healthy adults aged 45-84 years enrolled in the Multi-Ethnic Study of Atherosclerosis [MESA] study [Age-: 62±10 years, 47% males, 1473 Hispanics, 2575 Caucasians, 799 Chinese and 1855 African Americans]. Metabolic syndrome (MSwc), at baseline, was defined by NCEP guidelines (n=2,208). Metabolic syndrome (MSwhtr) was redefined using WHtR (≥ 0.5 in both male and females) in place of WC, keeping rest of the components constant as recommended by NCEP (n=2,590). CVD events were defined as All CVD (CVDa) per MESA protocol (See Table ). Unadjusted and adjusted Cox-proportional hazard analysis was performed. Harrell's C-statistics were calculated for the most adjusted models. Results: Total of 319 CVDa events [n=171 (7.44%) in MSwc group and n=190 (7.34%) in MSwhtr group] were identified during a mean follow up of 4.6 years. Results are displayed in the table . Conclusion: Predictive accuracy of MS re-defined with WHtR and MS defined with WC per NCEP criteria is comparable. Risk of CVDa and Metabolic Syndrome Metabolic Syndrome per NCEP guideline [MSwc] Re-defined Metabolic Syndrome with WHtR [MSwhtr] Models HR (95% CI) p-value Models HR (95% CI) p-value 2.45 (1.97-3.06) 0.000 2.43 (1.95-3.05) 0.000 MSwc + X 2.39 (1.91-2.99) 0.000 MSwhtr + X 2.28 (1.82-2.85) 0.000 MSwc + Y 1.97 (1.56-2.49) 0.000 MSwhtr + Y 1.93 (1.53-2.43) 0.000 MSwc + Z 1.89 (1.47-2.44) 0.000 MSwhtr + Z 1.83 (1.43-2.35) 0.000 Harrell's C (MSwc + Z) -: 0.7517 Harrell's C (MSwhtr + Z) -: 0.7531 Abbreviations: HR - Hazard Ratio; CI - Confidence Interval; CVDa - All Cardiovascular Disease events X = Age, Sex, Race Y = X + Hypertension, Use of Hypertension Medications, Total intentional exercise, Total cholesterol, Use of Statins, Smoking [>100 cigarettes ever in life] Z = Y + C-reactive Protein + Serum Insulin level CVDa includes - Myocardial infarction(MI), Resuscitated Cardiac Arrest (RCA), Definite Angina, Probable Angina (if followed by Revascularization), Stroke, Stroke Death, coronary heart disease (CHD) Death, Other Atherosclerotic Death, Other CVD Death.