ImportanceRecreational and medicinal cannabis legalization has led to increased cannabis use. To understand the consequences for vascular health, we initiated the CANnabis: Does It Damage Endothelium (CANDIDE) study.ObjectiveTo investigate whether cannabis use is associated with vascular endothelial dysfunction.Design, Setting, and ParticipantsIn this cross-sectional study, sex- and age- matched healthy

This case report describes an echocardiography-based diagnosis of left ventricular noncompaction cardiomyopathy in a male patient in his 40s who presented with sudden-onset dyspnea.

ImportancePatients with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) less than 40% who experience LVEF improvement to 40% or higher (HFimpEF) may still face residual risks.ObjectiveTo assess the clinical profiles, risk, and treatment response to finerenone in participants with HFimpEF.Design, Setting, and ParticipantsA total of 6001 patients with HE, LVEF of 40% or higher

This Viewpoint describes the benefits and barriers of conducting cardiovascular disease outcome trials to provide evidence of effectiveness of novel blood pressure (BP)–lowering therapies in reducing hypertension.

ImportancePeripheral artery disease (PAD) is a heritable atherosclerotic condition associated with functional decline and high risk for limb loss. With growing knowledge of the genetic basis for PAD and related risk factors, there is potential opportunity to identify individuals at high risk using polygenic risk scores (PRSs).ObjectiveTo develop a novel integrated, multiancestry polygenic score for

This Viewpoint describes innovations in digital health approaches to cardiovascular care delivery and discusses the need for reimbursement reform to support adoption.

ImportanceFood insecurity is a social risk factor that may be associated with cardiovascular health across the life course.ObjectiveTo evaluate the association of food insecurity in early childhood with cardiovascular health (CVH) in young adulthood and whether associations are modified by participation during childhood in the Supplemental Nutrition Assistance Program (SNAP).Design, Setting, and ParticipantsThe

This case report discusses a diagnosis of right ventricular heart failure secondary to chest tube placement during resternotomy in a male patient aged 73 years.

ImportanceInnate immunity, particularly neutrophil activation, plays a crucial role in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). The potential of calprotectin, a biomarker of neutrophil activation, as a mechanistically informed biomarker for ASCVD in an ethnically diverse population requires further investigation.ObjectiveTo examine the prospective association between circulating

This essay describes a cardiac surgeon’s experience performing surgical septal myectomy for symptomatic obstructive hypertrophic cardiomyopathy during wartime in Ukraine as related during recent interviews with the authors.

ImportanceFluorescence lifetime imaging (FLIm) is a molecular imaging technique used to visualize the biochemical composition of atherosclerosis. Novel dual-modal imaging using optical coherence tomography (OCT)-FLIm has the potential to provide both microstructural and biocompositional information on coronary plaques; however, it needs validation for clinical application.ObjectiveTo investigate the

ImportancePatients with atrial fibrillation (AF), a common morbid arrhythmia, are more likely to carry rare genetic variants associated with inherited cardiomyopathies. Prior studies on rare pathogenic variants in AF relied on small, hospital referral populations, and knowledge on clinical outcomes remains limited.ObjectiveTo evaluate the prevalence and prognostic implications of cardiomyopathy-associated

ImportanceThe use of intravascular imaging for calcified plaque characterization and preparation has been advocated over conventional methods to improve percutaneous coronary intervention (PCI) outcomes, but this approach has never been evaluated.ObjectiveTo determine if optical coherence tomography (OCT) is superior to angiography for calcified lesions PCI guidance.Design, Setting, and ParticipantsThe

This Viewpoint explores how artificial intelligence–assisted point-of-care ultrasound could be used to create coordinated networks of care to improve health care access and delivery in rural communities.

ImportanceMost literature on the association between cardiovascular health (CVH) and incident cardiovascular disease (CVD) and mortality has relied on single midlife measurements. Understanding how cumulative CVH over time influences later-life CVD and mortality may aid early prevention.ObjectiveTo determine whether cumulative CVH, as measured by the American Heart Association Life’s Essential 8 (LE8)

ImportanceHypertension is a primary modifiable risk factor for cardiovascular death and disability. Accurate blood pressure (BP) measurement is essential for the diagnosis and treatment of hypertension. Conventional BP measurement with cuff devices is recommended but difficult for patients to perform due to inconvenience, discomfort, and challenges with appropriate cuff sizing and measurement protocols

ImportanceHypertension is a leading risk factor for cardiovascular diseases and is often undiagnosed. Emergency department (ED) visits serve as critical access points within health care and present a unique opportunity for hypertension screening and intervention.ObjectiveTo evaluate the effectiveness of an Education and mHealth Empowerment (E2) intervention compared with usual care in reducing systolic

ImportanceDespite the availability of disease-modifying therapies, scalable strategies for heart failure (HF) risk stratification remain elusive. Portable devices capable of recording single-lead electrocardiograms (ECGs) may enable large-scale community-based risk assessment.ObjectiveTo evaluate whether an artificial intelligence (AI) algorithm can predict HF risk from noisy single-lead ECGs.Design

ImportanceAccurate assessment of tricuspid regurgitation (TR) is necessary for identification and risk stratification.ObjectiveTo design a deep learning computer vision workflow for identifying color Doppler echocardiogram videos and characterizing TR severity.Design, Setting, and ParticipantsAn automated deep learning workflow was developed using 47 312 studies (2 079 898 videos) from Cedars-Sinai

This Viewpoint describes the need for more studies on the best timing for dicontinuation of glucagon-like peptide-1 receptor agonists before pregnancy.

This secondary analysis of a randomized clinical trial describes the use of emergency care after self-administration of etripamil by patients experiencing paroxysmal supraventricular tachycardia episodes at home.

ImportanceThe Medicare Shared Savings Program (MSSP) was introduced in 2012 to improve care quality and lower costs to Medicare. Under this program, accountable care organizations (ACOs) assumed responsibility for costs and care quality for a group of Medicare beneficiaries.ObjectiveTo compare changes in quality measures for patients at outpatient cardiology practices before and after their participation

ImportanceThe impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown.ObjectiveTo determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy.Design, Setting, and ParticipantsThis population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice

ImportanceImproving cardiovascular health in rural areas is a national priority in the US. However, little is known about the current state of rural cardiovascular health and the underlying drivers of any rural-urban disparities.ObjectiveTo compare rates of cardiometabolic risk factors and cardiovascular diseases between rural and urban US adults and to evaluate the extent to which health care access

ImportanceHypertension is often underrecognized, leading to preventable morbidity and mortality. Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care.ObjectiveTo determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention

ImportanceThe mode of death in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) remains poorly understood and may vary by EF.ObjectiveTo evaluate the mode of death according to EF and the treatment effect of finerenone on cause-specific mortality in patients with HFmrEF/HFpEF.Design, Setting, and ParticipantsThis was

ImportanceHeart failure (HF) with mildly reduced or preserved ejection fraction and atrial fibrillation (AF) are closely intertwined.ObjectiveTo examine the efficacy and safety of the nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with HF with mildly reduced or preserved ejection fraction according to the absence or presence of AF and the type of AF (paroxysmal vs persistent

ImportanceIn patients with atrial fibrillation (AF), oral anticoagulants (OACs) reduce the risk of stroke.ObjectiveTo investigate if patients with less prior OAC exposure respond differently to a new OAC than patients with more OAC exposure.Design, Setting, and ParticipantsIn this prespecified exploratory subgroup analysis of the Oral Factor 11a Inhibitor Asundexian as Novel Antithrombotic–Atrial Fibrillation

ImportanceDespite statins’ benefit in preventing major adverse cardiovascular events, most patients with an indication for statin therapy are not appropriately treated. Clinicians’ limited time and lack of systematic efforts to address preventive care likely contribute to gaps in statin prescribing.ObjectiveTo determine the effect on statin prescribing of 2 interventions to refer appropriate patients

ImportanceDespite substantial progress in low-density lipoprotein cholesterol (LDL-C)–lowering strategies, residual cardiovascular risk remains. Apolipoprotein C3 (APOC3) has emerged as a novel target for lowering triglycerides. Multiple clinical trials of small-interfering RNA therapeutics targeting APOC3 are currently underway.ObjectiveTo investigate whether genetically predicted lower APOC3 is associated

ImportanceIt is well appreciated that a small yet high-risk subset of patients with atrial fibrillation (AF) develops persistent left atrial appendage (LAA) thrombus despite optimal oral anticoagulation (OAC). In patients with either a heightened risk of bleeding precluding enhanced doses of OAC to dissolve the thrombus, or thromboembolism despite optimal OAC, there are limited nonsurgical options

Importance Outcomes in patients with diabetes after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown. Objectives To investigate the relative treatment effect of PCI vs CABG according to diabetes status with respect to major adverse cardiac and cerebrovascular

ImportanceFood insecurity is associated with prevalent cardiovascular disease (CVD), but studies have been limited to cross-sectional data.ObjectivesTo study whether food insecurity is associated with incident CVD and to determine whether this association varies by sex, education, or race.Design, Setting, and ParticipantsThis prospective cohort study was conducted among US adults without preexisting

An older woman with a history of coronary artery disease presents with dyspnea upon exertion. A transthoracic echocardiogram reveals severe mitral regurgitation, and an electrocardiogram reveals sinus tachycardia with left bundle branch block. What would you do next?

ImportanceExcess body fat plays a pivotal role in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). HU6 is a novel, controlled metabolic accelerator that enhances mitochondrial uncoupling resulting in increased metabolism and fat-specific weight loss.ObjectiveTo assess efficacy and safety of HU6 in reducing body weight, improving peak volume of oxygen consumption (VO2) and

Importance Valsartan has been shown to attenuate phenotypic progression among individuals with early-stage sarcomeric hypertrophic cardiomyopathy (HCM). Myocardial tissue characterization by cardiac magnetic resonance (CMR) imaging may enhance mechanistic insights, but whether valsartan influences these parameters remains uncertain. Objective To evaluate the treatment effects of valsartan on myocardial

ImportancePatients with heart failure (HF) and mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) have a spectrum of risk, and the effect of therapies may vary by risk.ObjectivesTo validate the Prognostic Models for Mortality and Morbidity in HFpEF (PREDICT-HFpEF) in the phase 3 randomized clinical trial Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo

ImportanceTraditional risk factors, enhancing factors, and risk scores help clinicians assess atherosclerotic cardiovascular disease (ASCVD) risk for primary prevention. The latest cholesterol guidelines suggest measuring coronary artery calcium (CAC) score by computed tomography (CT) in those at intermediate risk when there is uncertainty about statin initiation for primary prevention. CAC testing

ImportanceCarotid artery plaque (CAP) is commonly encountered in clinical practice. Presence of CAP predicts future atherosclerotic cardiovascular disease (ASCVD) events; however, CAP prevalence increases with age, and it is unknown how age and sex affect the association of CAP presence and ASCVD risk.ObjectivesTo describe CAP prevalence by age, sex, race, and ethnicity in a multiethnic population

This Viewpoint recommends simultaneous or rapid sequence initiation of combination therapy with 3 specific classes of medication for heart failure with mildly reduced ejection fraction or preserved ejection fraction.

ImportanceWorsening heart failure (HF) is commonly managed in the outpatient setting with adjustments in oral diuretic therapy. The effect of the nonsteroidal mineralocorticoid receptor antagonist finerenone on outpatient worsening HF events in patients with mildly reduced or preserved ejection fraction is unknown.ObjectiveTo evaluate the effect of finerenone on outpatient worsening HF events requiring

This case report describes a saphenous vein graft simulating an intracardiac structure on echocardiography of a patient after coronary revascularization surgery.