Waiel Abusnina

Background: The coronavirus disease 2019 (COVID‐19) pandemic introduced a surge in cardiovascular complications, with myocarditis emerging as a concern due to both direct viral effects and rare vaccine‐associated events. Aims: This analysis examines the incidence and outcomes of myocarditis in patients across a large healthcare system in the Washington, DC Metropolitan Area, focusing on periods before, during, and after the COVID‐19 pandemic. Methods: A retrospective cohort study was conducted using electronic health records from the MedStar Health System (2017−2024). Myocarditis cases were identified using ICD‐10 codes, with cases stratified by pre‐ (2017−2019), peri‐ (2020−2022), and post‐COVID‐19 (2023−2024) pandemic periods, as well as by association with COVID‐19 infection and/or vaccination. The overall incidence and inpatient mortality of myocarditis were compared over these eras. Results: This study included 778 myocarditis patients admitted between January 2017 and December 2024, categorized into pre‐COVID‐19 ( n = 207), peri‐COVID‐19 ( n = 370), and post‐COVID‐19 ( n = 201) periods. Total myocarditis incidence surged during the peri‐pandemic period, peaking in 2022, and declined in 2023‐2024. In the post‐pandemic period, total myocarditis remained elevated and higher than in the pre‐pandemic era. During the pandemic and post‐pandemic periods, myocarditis patients were older, included a higher proportion of African American individuals, and had a greater burden of cardiometabolic comorbidities, compared to pre‐pandemic myocarditis hospitalizations. Conclusion: This study demonstrates a marked increase in myocarditis cases during the COVID‐19 pandemic, driven initially by a surge in COVID‐19‐related myocarditis. Notably, total myocarditis cases remained elevated in the post‐pandemic period compared to pre‐pandemic levels. These findings, particularly the increased post‐pandemic myocarditis patients, warrant further investigation into underlying risk factors and long‐term outcomes.

Background: Vascular closure devices (VCDs) are the standard alternative to surgical cutdown for large‐bore arterial access (LBAA) but can lead to complications like bleeding and common femoral artery (CFA) occlusion that require intervention. This manuscript outlines our approach using percutaneous endovascular intervention (PEI) to manage femoral artery occlusion caused by the MANTA (Teleflex, Morrisville, SC), the only collagen plug‐based VCD indicated for LBAA. Methods: Consecutive patients who experienced occlusive complications following MANTA deployment at the conclusion of transcutaneous aortic valve replacement (TAVR) underwent PEI to address occlusion. Clinical and procedural characteristics of the patients, as well as their short‐ and long‐term follow‐up data, were analyzed. Results: A total of 1445 patients underwent TAVR, in whom LBAA was closed with MANTA VCD between August 2017 and July 2024, among whom 34 patients (2.4%) experienced occlusive complications. These patients had a mean age of 79 ± 8 years, and 59% were female. The mean CFA diameter was 7.8 ± 1.1 mm, with mild vessel stenosis present in 41% and calcification in 44% of patients. An 18 French MANTA device was used for closure in 82% of patients. The primary mechanism was plug internalization, which was observed in 88% of our cohort and led to total vessel occlusion in 56% of patients. Bleeding occurred in 38% of patients in association with occlusion. All patients were approached with PEI, achieving an overall procedural success rate of 97%. Lesion crossing was accomplished via an antegrade approach in 71% of patients, with the remaining 29% requiring a retrograde approach. Stenting was the definitive treatment in 85% of patients, with 90% of these involving an oversized VIABAHN (Gore Medical, Newark, DE) self‐expanding stent. One patient experienced profunda artery occlusion after stent placement that required surgery. At 1‐month follow‐up, no vessel occlusions or bleeding were reported. Conclusion: Femoral artery occlusion from MANTA deployment after TAVR can be effectively treated with PEI. Low complication rates at 1 month suggest PEI is safe and reliable, but longer follow‐up is needed to assess long‐term vessel outcomes.

Angina pectoris with non‐obstructive coronary arteries (ANOCA) is a prevalent condition, particularly affecting women, and is often associated with coronary microvascular dysfunction (CMD). CMD, the primary cause of ANOCA, is associated with a diminished quality of life and adverse clinical outcomes. Invasive coronary function testing (CFT) now provides a precise diagnosis of CMD through indices such as coronary flow reserve (CFR) and index of microcirculatory resistance (IMR), assessed using the bolus thermodilution technique. This comprehensive review outlines a systematic approach to evaluating CMD, emphasizing practical steps and troubleshooting strategies to ensure accurate measurements of CFR and IMR. CMD phenotypes, including structural, functional, and compensated CMD, are discussed, along with their distinct pathophysiological mechanisms. Common challenges encountered during CMD testing, such as improper guide or wire positioning, waveform artifacts, and injection errors, are addressed with practical solutions. While continuous thermodilution offers enhanced accuracy, bolus thermodilution remains cost‐effective and widely utilized. Proficiency in the intricacies of CMD testing is crucial for accurate diagnosis and management, ultimately enhancing clinical outcomes for this underrecognized patient population.

Background: Coronary microvascular dysfunction (CMD), which mimics symptoms of obstructive coronary artery disease, has significant prognostic implications. While epicardial adipose tissue normally has a protective role, increased epicardial adipose tissue is associated with inflammation and may contribute to CMD. However, a direct correlation remains unclear. We aimed to investigate this association. Methods and Results: The CMDR (Coronary Microvascular Disease Registry) is a prospective, 2‐center registry that is enrolling patients with angina and nonobstructive coronary artery disease who underwent invasive hemodynamic assessment of the coronary microvasculature. Patients with chest computed tomography within 1 year of CMD evaluation were included. We measured epicardial fat volume (EFV) and calculated the EFV index. Logistic regression analysis was used to investigate the association between EFV and EFV index to CMD. Our study included 130 CMDR patients with associated chest CT; 35 were diagnosed with CMD. The CMD‐negative patients were younger than the CMD‐positive patients (58.52±11.97 versus 63.37±9.56 years; P =0.033), with numerically fewer women (64.2% versus 74.3%; P =0.279). Univariate regression analysis demonstrated a statistically significant association between EFV index and CMD diagnosis (odds ratio, 1.037 [95% CI, 1.014–1.063]; P =0.003), while no significance was observed for EFV (odds ratio, 1.006 [95% CI, 0.995–1.017]; P =0.292). Conclusions: Our results suggest a strong association between EFV index (a significant risk factor) and the presence of CMD. Future studies involving larger cohorts are needed to confirm the association of epicardial adipose tissue with CMD and investigate therapeutic targets to prevent CMD. Registration: URL: https://www.clinicaltrials.gov ; unique identifier: NCT05960474.

Purpose Heart failure (HF) management is well-defined for reduced ejection fraction (HFrEF) but less so for mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF). This meta-analysis evaluates the impact of Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, on cardiovascular and renal outcomes in these patient populations. Methods A systematic search in PubMed and Embase identified randomized controlled trials (RCTs) on Finerenone’s cardiovascular and renal effects. Three RCTs were included—FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF—encompassing 19,027 participants. Primary outcomes included cardiovascular death, HF hospitalization, and renal failure. Secondary outcomes focused on safety and adverse events like acute kidney injury and hyperkalemia. Meta-analyses were performed using hazard ratios (HR), confidence intervals (CI), and Relative Risk (RR). Results Finerenone was associated with a 20% reduction in HF hospitalization risk (HR 0.80, 95% CI: 0.72–0.90) and a 14% reduction in all-cause mortality (RR 0.86, 95% CI: 0.77–0.97). Finerenone did not significantly reduce cardiovascular death (HR 0.91, 95% CI: 0.82–1.01, p = 0.06). Renal failure rates were similar between Finerenone and placebo (RR 1.05, 95% CI: 0.65–1.68). Hyperkalemia incidence was significantly higher with Finerenone, with a RR of 2.31 (95% CI: 1.98–2.69). Conclusion This meta-analysis shows that Finerenone significantly reduces HF hospitalizations and all-cause mortality in patients with chronic kidney disease and heart failure. Further studies are needed to clarify its effects on cardiovascular death and renal failure.

Introduction and importance: Myocardial infarction (MI) can lead to a wide spectrum of mechanical complications. Left ventricular pseudoaneurysm (LVP) is a rare but serious complication of MI. Case presentation: A 69-year-old woman with prior coronary artery bypass grafting and a remote history of inferolateral ST-elevation MI (STEMI) with failure to revascularize the left circumflex artery presented with gangrenous right toes that appeared 2 years after her STEMI. A computed tomography angiogram of the right lower extremity showed arterial occlusion and mild atherosclerotic disease. Echocardiography revealed a pseudoaneurysm with an adherent mural thrombus as the underlying cause of acute limb ischemia. The patient was started on heparin and cardiothoracic surgery was consulted but did not operate as the risk of surgery outweighed the benefit. On hospital day 3, the patient underwent amputation of her gangrenous toes as the tissue was nonviable. The patient remained stable during her hospital stay and was discharged on day 5 on long-term anticoagulation. Clinical discussion: LVPs have a wide spectrum of presentations, from asymptomatic or nonspecific symptoms to thromboembolism with end-organ damage, such as in our case. Therefore, early diagnosis and management are of paramount importance. Our patient’s prior coronary artery bypass grafting most likely helped in forming a fibrous pericardium that sealed the pseudoaneurysm and prevented its rupture. Conclusions: STEMI requires close follow-up, especially in cases where revascularization is not achievable, as the risk of mechanical complications and mortality is high. Physicians should have a high suspicion for LVP in patients with prior MI, given its wide spectrum of presentations.