Search

Groundbreaking strategies for preventive cardiology were showcased at the 2024 American Society for Preventive Cardiology (ASPC) Congress on Cardiovascular Disease (CVD) Prevention held in Salt Lake City, Utah, from August 2nd to 4th, 2024. The event featured 69 moderators and 13 scientific sessions comprised of 98 topics, 36 satellite events, 133 poster presentations, and 27 lifestyle classes. The conference highlighted innovative strategies focused on integrating cardiovascular, kidney, and metabolic health, presenting a cohesive approach for managing complex, interrelated conditions. Pivotal studies have addressed the role of lipid-lowering therapies, the benefits of early statin initiation, and the importance of precision medicine in preventing CVD. The ASPCs emphasis on translating this research into practical clinical tools has the potential to revolutionize preventive care strategies, making strides toward reducing the burden of CVD globally and improving long-term patient outcomes through personalized and early intervention approaches.

Introduction: Inclisiran is a novel drug that employs ribonucleic acid (RNA) interference to lower the levels of the proprotein convertase subtilisin/kexin type 9 (PCSK9) protein. It has demonstrated a significant reduction in LDL cholesterol levels compared to a placebo. We aim to comprehensively evaluate the safety of using Inclisiran in patients with dyslipidemia and ASCVD or an ASCVD risk equivalent. Methods: Four electronic databases, namely, Pubmed/MEDLINE, Web of Science, Embase, and ClinicalTrials.gov, were searched from inception to June 2024 to identify relevant randomized controlled trials (RCTs) comparing safety profiles of Inclisiran and the control group. The outcomes investigated were all-cause mortality, major adverse cardiovascular events (MACEs), injection-site adverse events, new-onset or worsening type 2 diabetes mellitus (T2DM), and nasopharyngitis. The effect estimates of outcomes were assessed using the risk ratio (RR) with a 95% confidence interval (CI). Random-effects meta-analysis was conducted using the restricted maximum likelihood method. Subgroup analysis was performed based on different dosing regimens. Results: The study included 7 RCTs, enrolling 4790 patients (age 63.8 ± 9.7 years, 33.2% females) who received Inclisiran. Compared to the control group, Inclisiran use did not yield a significant effect on all-cause mortality (RR, 0.92; 95% CI, 0.54 to 1.54; I2 = 0%), MACEs (RR, 0.98; 95% CI, 0.82 to 1.17; I2 = 0%), nasopharyngitis (RR, 1.10; 95% CI, 0.83 to 1.45; I2 = 0%), and T2DM (RR, 1.02; 95% CI, 0.85 to 1.21; I2 = 0%). However, Inclisiran use demonstrated a significant increase in injection-site adverse events (RR, 6.50; 95% CI, 3.20 to 13.20; I2 = 29%). Conclusions: Inclisiran use significantly increased injection-site reactions, with no increase in mortality, T2DM, or nasopharyngitis. It demonstrates a generally favorable safety profile, making it a promising option for lipid management in individuals at high cardiovascular risk, such as those with ASCVD or equivalent conditions. While it effectively improves dyslipidemia, decision-makers should be aware of an increased incidence of injection-site reactions, which, though typically mild, warrant consideration in clinical practice. Further trials are required to assess the safety of Inclisiran, particularly the association of the severity of injection-site adverse events over longer treatment durations. [ABSTRACT FROM AUTHOR]

Acute recurrent myopericarditis, characterized by the occurrence of a new myopericarditis event following a symptom‐free interval of 4–6 weeks, is relatively rare lacking definitive guidelines for management. Understanding its prevalence, causes, and optimal management is challenging due to limited data and insufficient guidelines. This case outlines the diagnostic work‐up and different management modalities for recurrent myopericarditis. A 44‐year‐old African American man with a past medical history of myopericarditis a year ago presented with fever and chest pain for 4 days. The patient was found to have elevated troponin, CRP, and ESR; pericardial effusion along with a Coxsackie A virus titer of 1:800, suggestive of Coxsackie A virus–induced recurrent myopericarditis. The patient responded well to colchicine and a tapering dose of ibuprofen, achieving significant resolution in the pericardial effusion. Recurrent myopericarditis caused by Coxsackie A virus is a relatively rare phenomenon. New onset myopericarditis can be caused by various factors such as infections, autoimmune disorders, neoplasms, metabolic issues, trauma, and drugs, with recurrence rates of 15%–50% in pericarditis patients. Coxsackie A virus is an important and rare etiology of recurrent myopericarditis due to its unique immune evasive traits. The treatment modalities guided by definitive guidelines for recurrent pericarditis can be applied in recurrent myopericarditis with significant resolution of symptoms. Although there are no specific guidelines for managing recurrent myopericarditis, using approaches designed for recurrent pericarditis has shown promising results, and the immune evasive nature of Coxsackie A virus underscores the need for further research to improve our understanding and treatment of this condition. [ABSTRACT FROM AUTHOR]

ABSTRACT Atrial and ventricular arrhythmias are common in patients with Infiltrative heart diseases. This review discusses ablative techniques for arrhythmias in amyloidosis, sarcoidosis, hemochromatosis, and glycogen storage disorders, primarily focusing on atrial fibrillation (AF). A thorough literature review was conducted on the MEDLINE database to synthesize current knowledge and propose future research directions. AF is the most common arrhythmia identified in patients with amyloidosis due to cellular infiltration and atrial dilation. While catheter ablation is associated with a significantly lower rate of all‐cause mortality and admission rate, conflicting data exist regarding the higher risk of pericardial effusion, in‐hospital mortality, length of stay, and cost of hospitalization. Cardiac sarcoid predisposes AF due to granulomas, atrial dilation, and scarring. Studies demonstrate encouraging outcomes and low recurrence rates in these patients who undergo ablation for AF, with no difference in complications compared to those without sarcoidosis. AF is the most common arrhythmia in hereditary hemochromatosis (HH), secondary to increased myocardial iron stores and elevated oxidative stress, and is primarily managed by chelation. Scant reports regarding ablation are described for HH and glycogen storage disorders. Catheter ablation is a safe and effective modality for the treatment of AF in infiltrative cardiomyopathy. Future large‐scale trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Estimating and monitoring plant population size is fundamental for ecological research, as well as conservation and restoration programs. High‐resolution imagery has potential to facilitate such estimation and monitoring. However, remotely sensed estimates typically have higher uncertainty than field measurements, risking biased inference on population status.We present a model that accounts for false negative (missed plants) and false positive (misclassified or double‐counted plants) error in counts from high‐resolution imagery via integration with ground data. We apply it to estimate the abundance of a foundational shrub species in post‐wildfire landscapes in the western United States. In these landscapes, plant recruitment is crucial for ecological recovery but locally patchy, motivating the use of spatially extensive measurements from unoccupied aerial systems (UAS). Integrating >16 ha of UAS imagery with >700 georeferenced field plots, we fit our model to generate insights into the prevalence and drivers of observation errors associated with classification algorithms used to distinguish individual plants, relationships between abundance and landscape context, and to generate spatially explicit maps of shrub abundance.Raw counts of plant abundance in high‐resolution imagery resulted in substantial false negative and false positive observation errors. The probability of detecting (p) adult plants (≥0.25 m tall) varied between sites within 0.52 < p̂adult < 0.82, whereas the detection of smaller plants (<0.25 m) was lower, 0.03 < p̂small < 0.3. On average, we estimate that 19% of all detected plants were false positive errors, which varied spatially in relation to topographic predictors. Abundance declined toward the interior of previous wildfires and was positively associated with terrain roughness.Our study demonstrates that integrated models accounting for imperfect detection improve estimates of plant population abundance derived from inherently imperfect UAS imagery. We believe such models will further improve inference on plant population dynamics—relevant to restoration, wildlife habitat and related objectives—and echo previous calls for remote sensing applications to better differentiate between ecological and observational processes. [ABSTRACT FROM AUTHOR]

Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed sequela of acute pulmonary embolism with varied clinical presentation causing significant morbidity among the affected population. There exist important differences in the occurrence, clinical features and diagnosis of CTEPH between men and women, with women carrying a greater predisposition for the disease. Ongoing studies have also pointed out variations among men and women, in the treatment offered and long-term outcomes including mortality. This focused review article highlights important sex-associated differences in multiple aspects of CTEPH including its epidemiology, clinical features, diagnosis, treatment and outcomes as reported in current literature and highlights the need for future research to facilitate a clearer understanding of these differences. Plain Language Summary Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease where blood clots remain stuck in the lungs after a previous clotting episode which leads to high blood pressure in the lung arteries. One interesting aspect is that CTEPH affects men and women differently. Women show different symptoms and may have better survival rates than men, especially if they receive surgery to remove the clots. The reasons for these differences are not fully understood. Diagnosing CTEPH is challenging because its symptoms are similar to other heart and lung conditions, which can cause treatment delays. It is important to consider referring patients with possible CTEPH to specialists early for accurate diagnosis and treatment. Developing new treatments and collecting data will help improve care for these patients. Article highlights Epidemiology Higher prevalence and higher odds of developing Chronic Thromboembolic Pulmonary Hypertension (CTEPH) in women. Older age at diagnosis in women. Clinical features Women reported more symptoms at presentation including chest pain, dizziness. Poorer performance on 6 minute walk test and worse World Health Organization (WHO) functional class in women. No significant difference in pulmonary artery pressures between men and women. Treatment Lower frequency of Pulmonary Endarterectomy (PEA) noted in women. Probability of women receiving PEA decreased with advancing age, a trend not seen in men. Higher proportion of women received medical management alone compared with men. Rates of Balloon Pulmonary Angioplasty (BPA) same across both sexes. Outcomes Without treatment, both women and men with CTEPH typically have a life expectancy of less than three years. Most studies suggest no major differences in long term survival after PEA. Women had lower all-cause mortality in non-operated patients. [ABSTRACT FROM AUTHOR]

A screening method is developed by predicting the strength of verylow- strength (<9 MPa) concrete by the use of the rebound quotient and groove width from two low-energy, direction-independent nondestructive test methods (NDTs)--that is, a Type L rebound hammer and a scratching test--for brick and stone aggregate concrete. It is statistically demonstrated that low-strength concrete (LSC) exhibits a smaller standard deviation because of the low strength of the mortar phase, which ensures reliable LSC screening with any of the aforementioned methods. However, for higher-strength (>9 MPa) concrete classes, due to the increase in standard deviation, the simultaneous use of the two methods is proposed with a conservative approach to estimate the in-place concrete strength during "rapid visual screening" of buildings. Normal distribution curves classify the concrete compressive strength considering NDT boundary values with information on occurrence probability. Field test results are verified with laboratory-based correlations within acceptable statistical significance. [ABSTRACT FROM AUTHOR]

Sepsis-induced cardiomyopathy (SICM) is a life-threatening complication of sepsis characterized by myocardial dysfunction. SICM significantly increases mortality rates in sepsis. Despite its clinical relevance, SICM lacks a unified definition and standardized diagnostic criteria, complicating early identification and treatment. The pathophysiology of SICM is complex and involves a combination of inflammatory mediators, oxidative stress, mitochondrial dysfunction, and dysregulated autonomic responses. Cardiac biomarkers such as B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide, and troponins provide valuable prognostic insights but lack specificity for SICM diagnosis. This article presents the case of a 69-year-old woman who experienced rapid left ventricular dysfunction, initially misattributed to acute coronary syndrome but ultimately diagnosed as SICM. Her condition improved significantly after several days of supportive care, with full recovery of left ventricular function, highlighting the reversible nature of SICM. This article discusses the underlying pathophysiological mechanisms behind SICM, the utility of cardiac biomarkers, and potential therapies addressing specific molecular pathways. Current management of SICM primarily emphasizes supportive care and hemodynamic stabilization. Further research is essential to develop more precise diagnostic tools and effective treatments for this complex and underrecognized condition. Addressing these gaps could significantly reduce treatment delays and improve patient outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Borkowski et al.)

Rheumatic heart disease (RHD) is one of the leading causes of valvular heart disease worldwide and still persists in the USA, particularly among vulnerable populations with limited healthcare. Depending on the risk, severity, and types of valve involvement, treatment includes guideline-directed medical therapy (GDMT) and surgical interventions like valve repair or replacement. Here, we present a unique case of a patient in his late fifties who presented with worsening heart failure symptoms and several heart murmurs. A transthoracic echocardiogram (TTE) revealed moderate to severe mitral regurgitation (MR), aortic regurgitation (AR), and mild aortic stenosis (AS) with a bicuspid aortic valve. However, coronary angiography and right heart catheterization showed no blockages, right ventricular dysfunction, or pulmonary hypertension. Furthermore, no valvular vegetation was noticed on the transesophageal echocardiogram. The patient had a history of acute rheumatic fever (RF) in adolescence and was treated until age 21. Despite potential alternative causes like myocardial infarction or endocarditis, the lack of ischemic findings, negative blood cultures, and absence of valvular vegetation suggested that RHD was the possible cause of his valvular issues. This case highlights the rare occurrence of RHD impacting multiple valves despite proper antibiotic prophylaxis and draws attention to the importance of considering RHD when diagnosing multiple valvular problems, as many patients are identified too late for surgical intervention., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hayee et al.)