Chetan Shenoy

BACKGROUND: Clinical genetic evaluation for patients with dilated cardiomyopathy (DCM) is minimally implemented, and models of care are not well defined. To understand current genetic care for DCM, a systematic needs assessment was conducted. METHODS: Principal investigators of the DCM Consortium convened at the Summer Scientific Symposium in July 2025. An electronic needs assessment was conducted among the 24 principal investigators in advance to define current care models by evaluating which genetic evaluation components recommended by the Heart Failure Society of America were conducted, by whom, and the time required for each component. Descriptive statistics were generated to characterize model features. Focus group discussions explored barriers and facilitators to implementing genetic services. RESULTS: Four care models emerged from the principal investigator responses: model 1: Traditional-Synchronous (25%, n=6, requiring the most time per patient); model 2: Traditional-Asynchronous (33%, n=8); model 3: Externally Sourced (17%, n=4); and model 4: Physician/Advanced Practice Provider Conducted (25%, n=6, requiring the least time per patient). All models used genetic testing, whereas other components were implemented variably or not at all. Models 1 (15.7 ± 4.1) and 2 (15.4 ± 3.0) were rated more acceptable than model 4 (9.8 ± 2.9; model 1 versus model 4; P =0.027; model 2 versus model 4; P =0.023). Notably, 88% of principal investigators used genetic information for treatment decisions, including implantable cardioverter defibrillator placement (83%; n=20) and cardiac transplantation (63%; n=15). Major facilitator themes from focus group discussions included having a genetic counselor as part of the heart failure team and developing authoritative standards directing provision of DCM genetic services. Barrier themes included operational challenges, limited personnel, clinician under-recognition, need for new service delivery models, and billing/reimbursement. CONCLUSIONS: DCM genetic care models and components were highly variable across the 24 sites of the DCM Consortium, although all sites discussed similar factors that enable or hinder the implementation of genetic services for DCM. Understanding the basis of practice model variability may provide insight to yield more scalable care approaches.

Background: Clinical genetic evaluation for patients with dilated cardiomyopathy (DCM) is minimally implemented and models of care are not defined. To understand current genetics care for DCM, a systematic needs assessment was conducted. Methods: Principal Investigators (PIs) of the DCM Consortium convened at the Summer Scientific Symposium in July 2025. An electronic needs assessment was collected from the 24 PIs in advance to define current care models by evaluating which Heart Failure Society of America-recommended genetic evaluation components are conducted, by whom, and time required. Descriptive statistics were generated to characterize model features. Focus group discussions explored barriers and facilitators to implementing genetic services. Results: Four care models emerged from the PI responses: 1 – Traditional-Synchronous (25%, n=6, requiring the most time per patient), 2 – Traditional-Asynchronous (33%, n=8), 3 – Externally Sourced (17%, n=4), and 4 – Physician/Advanced Practice Provider Conducted (25%, n=6, requiring the least time per patient). All models used genetic testing, whereas other components were implemented variably or not at all. Models 1 (15.7 ± 4.1) and 2 (15.4 ± 3.0) were rated more acceptable than Model 4 (9.8 ± 2.9; 1 vs 4: p =0.027; 2 vs 4, p =0.023). Notably, 88% of PIs used genetic information for treatment decisions, including ICD placement (83%; n=20) or cardiac transplant (63%; n=15). Major facilitator themes from focus group discussions included having a genetic counselor on the HF team and developing authoritative standards directing provision of DCM genetic services. Barrier themes included operational challenges, limited personnel, clinician under-recognition, need for new service delivery models, and billing/reimbursement. Conclusions: DCM genetic care models and components were highly variable across the 24 sites of the DCM Consortium, even though all sites discussed similar factors that enable or hinder implementing genetic services for DCM. Understanding the basis of practice model variability may provide insight to yield more scalable care approaches. Clinical Perspective: What is new? Four care models to deliver genetic evaluation services for the assessment of dilated cardiomyopathy (DCM) were identified across the 24 sites of the DCM Consortium. Despite universal use of genetic testing and shared barriers and facilitators across sites, substantial variability exists across and within identified model types, and clinical genetic evaluation is not routinely implemented for all patients with DCM. What are the clinical implications? For Heart Failure (HF) centers seeking to implement genetics services for DCM patients and families, the DCM Consortium describes the scaffolding of current care models implemented at HF centers across the US to inform local program development. The incompletely and variably implemented care models highlight the need for a standardized, scalable framework to enhance consistent and equitable integration of clinical genetic evaluation into routine DCM care.

Clinical genetic evaluation of dilated cardiomyopathy (DCM) is implemented variably or not at all. Identifying needs and barriers to genetic evaluations will enable strategies to enhance precision medicine care. Cardiologist investigators of the DCM Consortium from US advanced heart failure/transplant (HF/TX) programs conducted an online survey in June 2024 to collect demographics, training, program characteristics, genetic evaluation practices, and implementation needs for DCM. An in-person discussion followed. Twenty-five cardiologists (28% female, 12% Hispanic, 68% White) participated in the survey and 15 in the discussion; genetics training backgrounds varied greatly. Clinical genetic testing for DCM was conducted at all institutions with annual patient uptake ranging from 5%-70% (median 25%). Thirteen respondents (52%) did not use selection criteria for offering testing in their personal practice whereas others selected patients based on specific clinical and family history data. Eight (32%) ordered testing by themselves, and the remainder had testing managed mostly by a genetic counselor or others with genetic expertise (16/17; 94%). Six themes were distilled from open-ended responses, including access to genetics services, navigating uncertainty, knowledge needs, cost concerns, family-based care barriers, and institutional infrastructure limitations. Following an in-person discussion, four areas were identified for focused effort: improved reimbursement for genetic services, genetic counselor integration with HF/TX teams, improved provider education resources, and more research to find missing heritability and to resolve uncertain results. This needs assessment of the DCM Consortium underscores the implementation challenges in the provision of DCM genetic evaluations in HF/TX programs. Targeted plans to facilitate precision medicine for DCM are needed.

Background and Aims: Implementing societal recommendations for primary prevention implantable cardioverter-defibrillators (ICDs) in cardiac sarcoidosis requires an accurate diagnosis. However, cardiac sarcoidosis diagnostic schemes are inconsistent and often produce conflicting results. This study aimed to compare the discriminative accuracy of cardiovascular magnetic resonance imaging (CMR) phenotyping with the societal recommendations for predicting long-term ventricular arrhythmic outcomes in patients with suspected cardiac sarcoidosis, regardless of their diagnostic status. Methods: This multicentre study included patients with histology-supported sarcoidosis who underwent CMR for suspected cardiac involvement and were ineligible for secondary prevention ICDs. The study outcome was a composite of fatal or life-threatening ventricular arrhythmias. Outcomes were compared based on eligibility for ICDs by societal recommendations and CMR phenotyping. Results: Among 1514 patients, 84 experienced the study outcome during a median follow-up of 4.5 years and a maximum follow-up of 10 years. The high-risk CMR phenotype was associated with higher 5- and 10-year incidences of the outcome (24.0% and 35.0%, respectively) compared with those who met societal recommendations. Patients with low-risk phenotypes had lower incidences (0.7% and 2.6%). Cardiovascular magnetic resonance imaging phenotyping outperformed societal recommendations in discriminative accuracy, with areas under the curve of 0.861 and 0.776 for 5- and 10-year outcomes, respectively. Additionally, CMR phenotyping had the highest adjusted subdistribution hazard ratio (19.8) for the study outcome. Conclusions: In patients with suspected cardiac sarcoidosis, CMR phenotyping showed greater discriminative accuracy than societal recommendations for predicting fatal or life-threatening ventricular arrhythmias, suggesting that it may be more effective at identifying candidates for primary prevention ICDs.

Aims: Systemic sclerosis (SSc) is a rare autoimmune disorder associated with a high risk of cardiovascular diseases. We aimed to determine the long-term prognostic value of left and right ventricular (LV and RV) systolic dysfunction in SSc patients with clinically suspected cardiac disease. Methods and results: We conducted a retrospective cohort study of consecutive adults with SSc who had cardiovascular magnetic resonance (CMR) imaging for suspected cardiac disease. We assessed two CMR measures of LV and RV function, ejection fraction (EF), and feature tracking-derived global longitudinal strain (GLS) and investigated their associations with the long-term incidence of a composite endpoint of death or major adverse cardiac events (MACE). In 151 patients (median age 58 years, 81% women) who had CMR at a median of 3.6 years after diagnosis, the median LVEF was 58.0%, and the median LVGLS was −15.7%. The median RVEF was 57.0%, and the median RVGLS was −16.2%. Over a median follow-up of 4.7 years, 69 patients experienced the composite endpoint of death or MACE. LVGLS was independently associated with the composite endpoint [hazard ratio (HR) 1.08 per 1% worsening; 95% confidence interval (CI) 1.01–1.15; P = 0.018], while LVEF was not. Similarly, RVGLS was independently associated with the composite endpoint (HR 1.08 per 1% worsening; 95% CI 1.01–1.15; P = 0.017), while RVEF was not. Conclusion: In patients with SSc and clinically suspected cardiac disease, worse LVGLS and RVGLS on CMR were independently associated with death or MACE, while LVEF and RVEF were not.

Background: Long COVID is a common complication of infection with severe acute respiratory syndrome coronavirus 2, but the prevalence and predictors of the condition remain poorly characterized. Methods: We prospectively studied adults (≥18 years) with acute coronavirus disease 2019 (COVID-19) presenting to an urban safety net hospital and associated clinics between July 2020 and December 2022. Logistic regression models were used to evaluate the association between baseline demographic, clinical, and laboratory characteristics with long COVID status, defined as symptoms persisting at least 9 months after acute disease. Among unrecovered participants, we describe the prevalence of individual symptoms. Results: We enrolled 222 participants, 162 (73%) of whom had known recovery status by 9 months. Median age was 54 years, half (55%) were female, and the majority of participants (78%) had at least 1 comorbidity at the time of COVID-19 diagnosis. Based on acute illness characteristics, the adjusted odds ratio for long COVID was 3.0 (95% confidence interval [CI], 1.1–8.0) among those with detectable nucleocapsid antigen and 3.6 (95% CI, 1.2–11) for those who required supplemental oxygen. Of the 41% of participants with symptoms persisting at least 9 months, central nervous system and psychological symptoms were most commonly reported, with 57% reporting functional limitations due to their persistent symptoms. Conclusions: The strong association with initial disease suggests a decreasing prevalence of long COVID as acute illnesses become milder. However, many contemporary patients still experience high viral burden with extended viral replication, even after vaccination. Our findings highlight the importance of properly characterizing long COVID as viral evolution shifts acute disease presentation.

Background Clinical genetic evaluation of dilated cardiomyopathy (DCM) is implemented variably or not at all. Identifying needs and barriers to genetic evaluations will enable strategies to enhance precision medicine care. Methods An online survey was conducted in June 2024 among cardiologist investigators of the DCM Consortium from US advanced heart failure/transplant (HF/TX) programs to collect demographics, training, program characteristics, genetic evaluation practices for DCM, and implementation needs. An in-person discussion followed. Results Twenty-five cardiologists (28% female, 12% Hispanic, 68% White) participated in the survey and 15 in the discussion; genetics training backgrounds varied greatly. Clinical genetic testing for DCM was conducted by all programs with annual uptake ranging from 5%-70% (median 25%). Thirteen respondents (52%) did not use selection criteria for testing whereas others selected patients based on specific clinical and family history data. Eight (32%) ordered testing by themselves, and the remainder had testing managed mostly by a genetic counselor or others with genetic expertise (16/17; 94%). Six themes were distilled from open-ended responses regarding thoughts for the future and included access to genetics services, navigating uncertainty, knowledge needs, cost concerns, family-based care barriers, and institutional infrastructure limitations. Following an in-person discussion, four areas were identified for focused effort: improved reimbursement for genetic services, genetic counselor integration with HF/TX teams, improved provider education resources, and more research to find missing heritability and to resolve uncertain results. Conclusions HF/TX programs have implementation challenges in the provision of DCM genetic evaluations; targeted plans to facilitate precision medicine for DCM are needed.