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Abstract Aims The association between microRNAs (miRNAs) and established cardiac biomarkers is largely unknown. We aimed to measure the association between plasma miRNAs and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), cardiac troponin I, soluble urokinase‐type plasminogen activator receptor (suPAR), and galectin‐3 with cardiac structure and function and clinical outcomes. Methods and results We quantified 32 plasma miRNAs using the FirePlex miRNA assay and measured biomarkers in 139 individuals with symptomatic heart failure (HF). We used principal component (PC) analysis and linear regression to evaluate the association between miRNAs and biomarkers with ventricular size and function by echocardiography and Cox modelling for the incidence of a first composite event of HF hospitalization, heart transplant, left ventricular assist device implant, or death. The mean (standard deviation) age at baseline was 64.3 (12.4) years, 33 (24%) were female, and 122 (88%) were White. A total of 45 events occurred over a median follow‐up of 368 (interquartile range 234, 494) days. Baseline NT‐proBNP (β = −2.0; P = 0.001) and miRNA PC2 (β = 2.6; P = 0.002) were associated with baseline left ventricular ejection fraction. NT‐proBNP (β = 20.6; P = 0.0004), suPAR (β = −39.6; P = 0.005), and PC4 (β = 21.1; P = 0.02) were associated with baseline left ventricular end‐diastolic volumes. NT‐proBNP [hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.28–2.18, P = 0.0002], galectin‐3 (HR 2.02, 95% CI 1.05–3.91, P = 0.036), PC3 (HR 1.75, 95% CI 1.23–2.49, P = 0.002), and PC4 (HR 1.67, 95% CI 1.1–2.52, P = 0.016) were independently associated with incident events. Conclusions Biomarkers and miRNA PCs are associated with cardiac structure and function and incident cardiovascular outcomes. Combining information from miRNAs provides prognostic information beyond biomarkers in HF.

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Aims: The association between microRNAs (miRNAs) and established cardiac biomarkers is largely unknown. We aimed to measure the association between plasma miRNAs and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), cardiac troponin I, soluble urokinase‐type plasminogen activator receptor (suPAR), and galectin‐3 with cardiac structure and function and clinical outcomes. Methods and results: We quantified 32 plasma miRNAs using the FirePlex miRNA assay and measured biomarkers in 139 individuals with symptomatic heart failure (HF). We used principal component (PC) analysis and linear regression to evaluate the association between miRNAs and biomarkers with ventricular size and function by echocardiography and Cox modelling for the incidence of a first composite event of HF hospitalization, heart transplant, left ventricular assist device implant, or death. The mean (standard deviation) age at baseline was 64.3 (12.4) years, 33 (24%) were female, and 122 (88%) were White. A total of 45 events occurred over a median follow‐up of 368 (interquartile range 234, 494) days. Baseline NT‐proBNP (β = −2.0; P = 0.001) and miRNA PC2 (β = 2.6; P = 0.002) were associated with baseline left ventricular ejection fraction. NT‐proBNP (β = 20.6; P = 0.0004), suPAR (β = −39.6; P = 0.005), and PC4 (β = 21.1; P = 0.02) were associated with baseline left ventricular end‐diastolic volumes. NT‐proBNP [hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.28–2.18, P = 0.0002], galectin‐3 (HR 2.02, 95% CI 1.05–3.91, P = 0.036), PC3 (HR 1.75, 95% CI 1.23–2.49, P = 0.002), and PC4 (HR 1.67, 95% CI 1.1–2.52, P = 0.016) were independently associated with incident events. Conclusions: Biomarkers and miRNA PCs are associated with cardiac structure and function and incident cardiovascular outcomes. Combining information from miRNAs provides prognostic information beyond biomarkers in HF. [ABSTRACT FROM AUTHOR]

Abstract Background Transthoracic echocardiograms (TTE) performed and interpreted by cardiology fellows during off-duty hours are critical to patient care, however limited data exist on their interpretive accuracy. Our aims were to determine the discordance rate between TTEs performed and interpreted by cardiology fellows and National Board of Echocardiography certified attending cardiologists and to identify factors associated with discordance. Methods Consecutive on-call TTEs acquired and interpreted by 1st year cardiology fellows over 4.6 years at an academic center were prospectively evaluated by attending cardiologists. Fellow interpretations were classified as concordant or discordant with the attending interpretation. We assessed the association of patient, imaging and fellow characteristics with discordance. Results A total of 777 TTE interpretations (730 patients) were performed/interpreted by 40 first year fellows and overread by 13 attendings. The most common indications were assessment of left ventricular function (40.9%) and pericardial effusion (37.3%). There was a major or minor discordance in 4.1 and 17.4% of studies, respectively with 42.1% of disagreements occurring in assessment of left ventricular size and function. The indication to assess left ventricular function [OR 2.19, 95% CI (1.32, 3.62), P = 0.002 vs. pericardial effusion] and greater duration of echocardiographic image acquisition (OR 1.02, 95% CI 1.01, 1.03, P = 0.004) were independently associated with overall discordance. Conclusions In this large prospective study we found that attending cardiologists disagreed with 1 in 5 fellow TTE interpretations. Standardized tools for evaluation of echocardiograms performed by fellows are needed to ensure quality of training and patient safety.

Simple Summary: Radiation therapy is associated with an increased risk for atherosclerotic cardiovascular disease (ASCVD). Contemporary risk prediction models accurately predict ASCVD in general populations. Whether these models adequately capture ASCVD risk after radiation therapy (RT) is unknown. Our data show that these standard risk scores do not reliably differentiate between those who will and those who will not have an ASCVD event after RT and underestimate the risk for ASCVD among patients receiving RT for HNCA. This study aims to evaluate the efficacy of the Pooled Cohort Equation (PCE), U.S. Preventative Services Task Force (USPSTF), and Framingham Risk Score (FRS) models in predicting ASCVD events among patients receiving radiation therapy (RT) for head and neck cancer (HNCA). From a large cohort of HNCA patients treated with RT, ASCVD events were adjudicated. Observed vs. predicted ASCVD events were compared. We compared rates by statin eligibility status. Regression models and survival analysis were used to identify the relationship between predicted risk and post-RT outcomes. Among the 723 identified patients, 274 (38%) were statin-eligible based on USPSTF criteria, 359 (49%) based on PCE, and 234 (32%) based on FRS. During follow-up, 17% developed an ASCVD, with an event rate of 27 per 1000 person-years, 68% higher than predicted (RR 1.68 (95% CI: 1.02, 2.12), p < 0.001). In multivariable regression, there was no difference in event rates by statin eligibility status (p > 0.05). Post-RT, the observed event rate was higher than the predicted ASCVD risk across all grades of predicted risk (p < 0.05) and the observed risk of an ASCVD event was high even among patients predicted to have a low risk of ASCVD. In conclusion, current ASCVD risk calculators significantly underestimate the risk for ASCVD among patients receiving RT for HNCA. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 69-year-old man with a history of myocardial infarction, ischemic cardiomyopathy, and an implantable cardioverter-defibrillator (ICD), who presented with dyspnea. Topics discussed include his complex medical history, including prior cardiac procedures, recent symptoms of palpitations and fatigue, and the diagnostic workup, including echocardiogram and electrocardiogram, to identify the cause of his dyspnea.

Background: Transthoracic echocardiograms (TTE) performed and interpreted by cardiology fellows during off-duty hours are critical to patient care, however limited data exist on their interpretive accuracy. Our aims were to determine the discordance rate between TTEs performed and interpreted by cardiology fellows and National Board of Echocardiography certified attending cardiologists and to identify factors associated with discordance. Methods: Consecutive on-call TTEs acquired and interpreted by 1st year cardiology fellows over 4.6 years at an academic center were prospectively evaluated by attending cardiologists. Fellow interpretations were classified as concordant or discordant with the attending interpretation. We assessed the association of patient, imaging and fellow characteristics with discordance. Results: A total of 777 TTE interpretations (730 patients) were performed/interpreted by 40 first year fellows and overread by 13 attendings. The most common indications were assessment of left ventricular function (40.9%) and pericardial effusion (37.3%). There was a major or minor discordance in 4.1 and 17.4% of studies, respectively with 42.1% of disagreements occurring in assessment of left ventricular size and function. The indication to assess left ventricular function [OR 2.19, 95% CI (1.32, 3.62), P = 0.002 vs. pericardial effusion] and greater duration of echocardiographic image acquisition (OR 1.02, 95% CI 1.01, 1.03, P = 0.004) were independently associated with overall discordance. Conclusions: In this large prospective study we found that attending cardiologists disagreed with 1 in 5 fellow TTE interpretations. Standardized tools for evaluation of echocardiograms performed by fellows are needed to ensure quality of training and patient safety. [ABSTRACT FROM AUTHOR]

Introduction: Transthoracic echocardiograms (TTEs) performed by cardiology fellows during off-duty hours are critical to patient care, however limited data exist on the interpretive accuracy of TTEs performed by cardiology fellows. Methods: Consecutive on-call TTEs acquired and interpreted by 1st year cardiology fellows over 4.6 years at an academic center were prospectively evaluated by American Board of Echocardiography certified attending cardiologists. Fellow interpretations were classified as concordant or discordant (minor or major) with the attending interpretation. We assessed the association of patient (age, sex, BMI, heart rate, blood pressure, death during the index hospitalization), imaging (study indication, duration and location of TTE acquisition) and fellow (year and month of training and number of on-call TTEs performed) characteristics with discordance in TTE interpretation. Results: A total of 778 TTE interpretations were performed/interpreted by 40 1st year fellows and overread by 13 attendings. The most common TTE indications were left ventricular (LV) function assessment (40.9%) and pericardial effusion (37.4%). There was a major discordance in 4.1% and a minor discordance in 17.1% of studies (Figure). Experienced attendings (>10 years experience) had a greater combined major and minor discordance rate compared to less experienced attendings (25.1% vs. 14.2%, P<0.001, Figure). In a multivariable logistic regression model with random effects for fellows and attendings, LV function assessment [OR 2.18, 95% CI (1.31, 3.61), P=0.003 vs. pericardial effusion] and greater duration of TTE image acquisition (OR 1.02, 95% CI 1.01, 1.03, P=0.003) were significantly associated with discordance. Conclusion: In this prospective study, major discordance with on-call 1st year cardiology fellow TTE interpretation was found in 4.1% of studies. Attending experience, LV function assessment and greater duration of image acquisition were associated with a higher rate of discordance in TTE interpretation between cardiology fellows and attending staff. Standardized tools for evaluation of TTEs performed by fellows are needed and comprehensive LV function assessment should be a main target for fellow education. [ABSTRACT FROM AUTHOR]

Parasitism is only found in eudicotyledonous Angiosperms in all continents and in one Gymnosperm from New Caledonia. At least eleven independent origins of parasitism in Angiosperms have been proposed. The economic importance of parasites is generally considered as negative in connection with dangerous species for agriculture, horticulture and forestry (e.g., Orobanche spp. and Striga spp., Orobanchaceae, Cuscuta spp., Cuscutaceae, and Arceuthobium spp., Viscaceae). But there are a number of species useful as vegetables (Melientha suavis, Opiliaceae), sources for manufacturing cosmetics and soaps (Santalum album, Santalaceae) and fruit trees (Ximenia americana, Ximeniaceae). And there are numerous examples for the use of parasites as medicinal plants, often not yet confirmed by modern medical sciences. In a recent survey, cultivated parasitic plants could be found in Olacaceae (1), Opiliaceae (1), Orobanchaceae (3), Santalaceae (6), Viscaceae (1) and Ximeniaceae (1, number of species in brackets). Among the species listed, there are also some medicinal plants. Most traditional under cultivation is Santalum album from tropical Asia (Santalaceae, hemiparasitic root parasite). An essential oil is extracted from the wood and roots; it is mostly used for oriental perfumes. Though their uses as medicinal plants may be rather old, some species have been taken into cultivation only towards the end of the last century, as Viscum album (Viscaceae, Europe and Asia, hemiparasitic on branches), Cistanche deserticola (China) and Orobanche crenata (Mediterranean, both Orobanchaceae, holoparasitic root parasites). For Euphrasia officinalis (Orobanchaceae, hemiparasitic root parasite) there are reports about cultivation in Europe in the past, but recent experiences are lacking. The cultivation of parasites for medicinal uses is a challenge. But there are new prospects because of developing domestication and cultivation strategies. [ABSTRACT FROM AUTHOR]

Background: Although clinical evidence supports rapid institution of guideline-directed medical therapy (GDMT) for heart failure (HF), in actual practice, there remain large gaps in adherence to guideline recommendations. Recent data support safety and efficacy of rapid GDMT implementation; however, rapid GDMT deployment within a general cardiology environment remains unexplored., Objectives: The purpose of this study was to evaluate the efficacy and safety of a GDMT clinic within a general cardiology practice relative to usual care, the impact on prescription of GDMT, HF symptoms, N-terminal pro-B-type natriuretic peptide concentrations and echocardiographic parameters of remodeling., Methods: Individuals with HF with an abnormal ejection fraction (<50%) referred to the GDMT clinic underwent rapid GDMT titration with close monitoring of clinical data. Rates of GDMT prescription were compared with a matched reference group. Patients underwent echocardiography at baseline and after GDMT clinic completion., Results: A total of 114 persons were treated in GDMT clinic. The mean age was 67.6 ± 14.6 years, and 32 (28%) were women. Among those referred, 100 (87.7%) had no contraindications for 4-drug GDMT. From baseline to clinic completion (median 15.8 weeks [Q1-Q3: 10.7-23.0 weeks]), patients without medication contraindications experienced significant increases in 4-drug GDMT use (from 21% to 88%; P < 0.001); of 4-drug GDMT recipients, 92% received angiotensin receptor neprilysin inhibitor. GDMT clinic participants achieved higher medication doses than those in usual care, with greater achievement of ≥50% target dose of angiotensin receptor neprilysin inhibitor (52% vs 8%), beta-blocker (78% vs 6.2%), mineralocorticoid receptor antagonist (98% vs 15.6%), and sodium-glucose cotransporter 2 inhibitors (92% vs 6.2%). Target doses of all 4 drugs were reached in nearly 1 in 4 participants. HF symptoms improved (94% to 75% NYHA functional class II/III; P < 0.001) and N-terminal pro-B-type natriuretic peptide concentration decreased (median 587 to 534 ng/L; P = 0.03) despite loop diuretic reduction. Additionally, we observed an absolute 6% LVEF increase (from 37% [Q1-Q3: 31%-41%] to 43% [Q1-Q3: 38%-53%]; P < 0.001) and substantial decrease in moderate or severe mitral regurgitation. GDMT titration was well-tolerated., Conclusions: Rapid GDMT implementation via an outpatient GDMT clinic was effective, safe, and associated with improvement in key clinical parameters. The more widespread role of GDMT clinics to improve HF care warrants further study., Competing Interests: Funding Support and Author Disclosures Data analysis supported by an unrestricted grant from Novartis Pharmaceuticals Corporation. Dr Cohen has a board position with Kento Health Inc. Dr Khairnar is an employee of Novartis Pharmaceuticals Corporation. Dr Williamson was an employee of Novartis Pharmaceuticals Corporation at the time that this study was conducted and the analyses were completed. Dr Scott has received research support from the REBIRTH study and HOPE registries; and has received consulting income from Mediflix. Dr Greene has received research support from the Duke University Department of Medicine Chair’s Research Award, American Heart Association, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Pfizer, and Sanofi; has served on advisory boards or as consultant for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Corcept Therapeutics, Corteria Pharmaceuticals, CSL Vifor, Cytokinetics, Eli Lilly, Lexicon, Merck, Novo Nordisk, Otsuka, Roche Diagnostics, Sanofi, scPharmaceuticals, Tricog Health, and Urovant Pharmaceuticals; and has received speaker fees from AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Lexicon, and Roche Diagnostics. Dr Fonarow has consulted for Abbott Laboratories, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Johnson and Johnson, Medtronic, Merck, Novartis, and Pfizer. Dr Januzzi has a board position with Imbria Pharmaceuticals; has received grant support from Abbott, Applied Therapeutics, AstraZeneca, Bristol Myers Squibb, and Novartis Pharmaceuticals, has received consulting income from Abbott Diagnostics, Beckman-Coulter, Jana Care, Janssen, Novartis, Prevencio, Quidel, and Roche Diagnostics; and serves on clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, CVRx, Medtronic, Pfizer, and Roche Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To develop and assess a residual deep learning algorithm to accelerate in vivo cardiac diffusion-tensor MRI (DT-MRI) by reducing the number of averages while preserving image quality and DT-MRI parameters., Materials and Methods: In this prospective study, a denoising convolutional neural network (DnCNN) for DT-MRI was developed; a total of 26 participants, including 20 without obesity (body mass index [BMI] < 30 kg/m 2 ; mean age, 28 years ± 3 [standard deviation]; 11 women) and six with obesity (BMI ≥ 30 kg/m 2 ; mean age, 48 years ± 11; five women), were recruited from June 19, 2019, to July 29, 2020. DT-MRI data were constructed at four averages (4Av), two averages (2Av), and one average (1Av) without and with the application of the DnCNN (4Av DnCNN , 2Av DnCNN , 1Av DnCNN ). All data were compared against the reference DT-MRI data constructed at eight averages (8Av). Image quality, characterized by using the signal-to-noise ratio (SNR) and structural similarity index (SSIM), and the DT-MRI parameters of mean diffusivity (MD), fractional anisotropy (FA), and helix angle transmurality (HAT) were quantified., Results: No differences were found in image quality or DT-MRI parameters between the accelerated 4Av DnCNN DT-MRI and the reference 8Av DT-MRI data for the SNR (29.1 ± 2.7 vs 30.5 ± 2.9), SSIM (0.97 ± 0.01), MD (1.3 µm 2 /msec ± 0.1 vs 1.31 µm 2 /msec ± 0.11), FA (0.32 ± 0.05 vs 0.30 ± 0.04), or HAT (1.10°/% ± 0.13 vs 1.11°/% ± 0.09). The relationship of a higher MD and lower FA and HAT in individuals with obesity compared with individuals without obesity in reference 8Av DT-MRI measurements was retained in 4Av DnCNN and 2Av DnCNN DT-MRI measurements but was not retained in 4Av or 2Av DT-MRI measurements., Conclusion: Cardiac DT-MRI can be performed at an at least twofold-accelerated rate by using DnCNN to preserve image quality and DT-MRI parameter quantification. Keywords: Adults, Cardiac, Obesity, Technology Assessment, MR-Diffusion Tensor Imaging, Heart, Tissue Characterization Supplemental material is available for this article. © RSNA, 2021., Competing Interests: Disclosures of Conflicts of Interest: K.P. disclosed no relevant relationships. M.v.d.B. disclosed no relevant relationships. R.E. disclosed no relevant relationships. S.A.M. disclosed no relevant relationships. A.S. disclosed no relevant relationships. J.K. disclosed no relevant relationships. S.P. disclosed no relevant relationships. T.G.R. disclosed no relevant relationships. C.M. disclosed no relevant relationships. S.D. Activities related to the present article: author’s institution has research funding from the American Heart Association (AHA). Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. D.G. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author is on medical advisory boards for New View Surgical and Boston Scientific; author received consultancy fees from Ethicon, Medtronic, and Boston Scientific. Other relationships: disclosed no relevant relationships. R.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author received consultancy fees from Myokardia, Best Doctors, and Amgen; author’s spouse works at Wolters Kluwer UpToDate; author’s institution has grants/grants pending from AHA and National Institutes of Health (NIH); author has patents for exRNA signatures of cardiac remodeling; author has Pfizer stock and had Gilead stock, which has been sold. Other relationships: disclosed no relevant relationships. D.E.S. Activities related to the present article: author has grant from NIH. Activities not related to the present article author has grants/grants pending from NIH; author’s institution has patents with Mass General Brigham, with no money received. Other relationships: disclosed no relevant relationships. C.N. Activities related to the present article: author’s institution has grant from NIH. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships., (2021 by the Radiological Society of North America, Inc.)

Objective: Adiposity is associated with oxidative stress, inflammation, and glucose intolerance. Previous data suggest that platelet gene expression is associated with key cardiometabolic phenotypes, including body mass index but stable in healthy individuals over time. However, modulation of gene expression in platelets in response to metabolic shifts (eg, weight reduction) is unknown and may be important to defining mechanism. Approach and Results: Platelet RNA sequencing and aggregation were performed from 21 individuals with massive weight loss (>45 kg) following bariatric surgery. Based on RNA sequencing data, we measured the expression of 67 genes from isolated platelet RNA using high-throughput quantitative reverse transcription quantitative PCR in 1864 FHS (Framingham Heart Study) participants. Many transcripts not previously studied in platelets were differentially expressed with bariatric surgical weight loss, appeared specific to platelets (eg, not differentially expressed in leukocytes), and were enriched for a nonalcoholic fatty liver disease pathway. Platelet aggregation studies did not detect alteration in platelet function after significant weight loss. Linear regression models demonstrated several platelet genes modestly associated with cross-sectional cardiometabolic phenotypes, including body mass index. There were no associations between studied transcripts and incident diabetes or cardiovascular end points., Conclusions: In summary, while there is no change in platelet aggregation function after significant weight loss, the human platelet experiences a dramatic transcriptional shift that implicates pathways potentially relevant to improved cardiometabolic risk postweight loss (eg, nonalcoholic fatty liver disease). Further studies are needed to determine the mechanistic importance of these observations.