Infective endocarditis (IE) remains to be a heterogeneous disease with high morbidity and mortality rates, which can affect native valves, prosthetic valves, and intra-cardiac devices, in addition to causing systemic complications. The combination of clinical, laboratory, and cardiac imaging evaluation is critical for early diagnosis and risk stratification of IE. This can facilitate timely medical and surgical management to improve patient outcomes. Key imaging findings for IE include vegetations, valve perforation, prosthetic valve dehiscence, pseudoaneurysms, abscesses, and fistulae. Transthoracic echocardiography continues to be the first-line imaging modality of choice, while transesophageal echocardiography subsequently provides an improved structural assessment and characterization of lesions to facilitate management decision in IE. Recent advances in other imaging modalities, especially cardiac computed tomography and ¹⁸F-fluorodeox-yglucose positron emission tomography, and to a lesser extent cardiac magnetic resonance imaging and other nuclear imaging techniques, have demonstrated important roles in providing complementary IE diagnostic and prognostic information. This review aims to discuss the individual and integrated utilities of contemporary multi-modality cardiac imaging for the assessment and treatment guidance of IE.

Background: Subaortic stenosis (SAS) is characterized by a fibromuscular membrane located just below the aortic valve, causing fixed outflow tract obstruction. There is a paucity of studies evaluating this condition. This cohort study reviewed the contemporary characteristics and outcomes of SAS in adult patients in a single large referral center. Methods and Results: We retrospectively studied adult patients with SAS evaluated at our center during 2011 to 2022. The primary outcome was all‐cause mortality and heart failure hospitalizations during follow‐up, with secondary end points including recurrence of SAS and repeat surgery after initial SAS surgery. Among 484 patients with SAS, key characteristics included mean age 55±18 years, 67.5% female, left ventricular outflow tract peak velocity 352±140 cm/s and gradient 57±40 mm Hg, left ventricular ejection fraction 60%±14%, 54.8% had prior SAS surgery, and 45.1% had surgery during follow‐up. Over a median follow‐up of 5.5 (1.5–12.3) years, 11.5% (n=56) died, 6.8% (n=33) had heart failure hospitalizations, 8.0% (n=39) experienced SAS recurrence, and 14 (5.9%) underwent repeat SAS surgery. Multivariable analyses identified older age per 10‐years (hazard ratio [HR], 1.37 [95% CI, 1.12–1.68]) and baseline New York Heart Association class (HR, 2.48 [95% CI, 1.54–3.99]) to be statistically significantly associated with the primary end point; higher body mass index, New York Heart Association class, and peak left ventricular outflow tract gradient were also statistically significantly associated with SAS recurrence and redo surgery. Conclusions: Almost half of patients with SAS had surgery in the past or during follow‐up, and a significant minority had mortality or morbidity events during follow‐up. Identified prognosticators warrant further research to guide management.

Background Takotsubo cardiomyopathy (TC) is an established differential diagnosis of myocardial infarction with non-obstructive coronaries with significant interest but limited data on prognostication. We reviewed the characteristics and in-hospital outcomes and developed a novel risk score for TC. Methods Using the National Inpatient Sample data from 2016 to 2020, we identified adult patients (≥18 years) with acute coronary syndrome (ACS) and TC. We divided the cohort into ACS with and without TC and retrieved baseline data. Multivariable regression analysis was conducted to identify factors associated with TC diagnosis and adverse outcomes, leading to the development of a risk-scoring system. Results Among 7 219 004 adult ACS admissions, 78 214 (1.0%) were diagnosed with TC, with a mean age of 68.2 years, 64 526 (82.5%) being female and 5475 (7.0%, compared with 8.4% for other ACS) in-hospital mortality events. Factors significantly associated with TC were female sex (OR 6.78 (95% CI 6.47 to 7.09), p<0.001) and chronic heart failure (OR 1.60 (95% CI 1.54 to 1.66), p70 years, non-white race, hypertension, hyperlipidemia, history of coronary artery bypass grafting, history of percutaneous coronary intervention, cardiac arrhythmias, renal failure, cardiogenic shock and vasopressor use. The area under curves for in-hospital mortality was 0.716 in the derivation and 0.725 in the validation cohorts. Conclusions TC remains a high-risk diagnosis in a minority of ACS cases, with mortality rates similar to other ACS causes. Our novel risk score offers a valuable tool for risk stratification in patients with TC, but external validation is needed to confirm its utility.

Cardiac iron overload is a rare but important adverse consequence of systemic iron overload, marked by the abnormal accumulation of iron in the myocardium. It is most typically caused by hereditary hemochromatosis (mutations in the HFE gene) or secondary iron overload conditions, such as transfusion-dependent anemias. Excess iron in the myocardium causes oxidative stress, cardiomyocyte damage, and progressive fibrosis, ultimately leading to cardiomyopathy. Clinical manifestations are diverse and may include heart failure, arrhythmias, and restrictive or dilated cardiomyopathy. Given the worsened prognosis with cardiac involvement, timely diagnosis and management are essential to improve clinical outcomes. This review provides a contemporary overview of the cardiovascular complications associated with iron overload, including clinical manifestations, diagnostic approaches, and treatment options.

BACKGROUND: Aortic valve calcium score (AVCa) measured on noncontrast computed tomography (CT) is well-established for grading aortic stenosis (AS) severity. However, thresholds for AVCa measured on contrast CT remain uncertain. We evaluated correlations, associated factors, and severity thresholds of AVCa measured on contrast CT against transthoracic echocardiography (TTE) measures of AS. METHODS: Patients with native AS undergoing transcatheter aortic valve replacement evaluation from 2019 to 2020 who underwent TTE and contrast-enhanced CT were retrospectively studied (n=1035, age 79±9 years, 429 (41.5%) women, 906 (87.5%) severe and 129 (12.5%) moderate AS by TTE). AVCa was measured using the modified Agatston method with the minimum threshold of 4 SD above the mean ascending aorta blood pool Hounsfield units. Receiver-operating characteristics analysis and Youden index were used to define sex-specific optimal AVCa thresholds for identifying severe AS defined by TTE (aortic valve area by continuity equation ≤1.0 cm ² ) in the derivation cohort and assessed when applied to the validation cohort. RESULTS: Mean aortic valve area on TTE was 0.79±0.21 cm ² , while mean AVCa score, volume, and mass were 2152±1102 modified AU, 1853±1592 mm ³ , and 673±485 mg, respectively. Multivariable linear regression identified women to be associated with lower AVCa (β-coefficient, −358), while chronic kidney disease was associated with a higher AVCa (β-coefficient, 171). Optimal severe AS thresholds of ≥1840 modified AU for men and ≥1430 modified AU for women were determined, with area under curve (95% CIs) and sensitivities/specificities of 0.809 (0.749–0.869, 71.3%, 82.2%) for men and 0.822 (0.751–0.892), 73.4%/78.9% for women in the derivation cohort, and 0.830 (0.786–0.875), 75.9%/87.5% for men and 0.780 (0.670–0.890), 77.5%/71.4% for women in the validation cohort. CONCLUSIONS: AVCa by contrast CT is a useful tool for identifying severe AS by TTE, with sex-specific thresholds for severe AS identified. Further studies are necessary to externally validate our findings and evaluate their prognostic significance.

Background: Left ventricular global longitudinal strain (LVGLS) by speckle‐tracking transthoracic echocardiography (TTE) is an established measure of left ventricular systolic function with many clinical applications. Strain software has evolved to achieve vendor‐neutrality in recent developments, although there is a notable absence of external validation studies. We assessed the normal ranges and associated factors of two‐dimensional LVGLS quantification by TomTec, EchoPAC, VVI, and Epsilon contemporary strain software in a healthy cross‐sectional cohort. Methods: One hundred healthy subjects undergoing TTE during January–April 2023 at our institution were cross‐sectionally recruited, 20 per age‐group, 50% were female, and 50% had GE and 50% Philips scans. TomTec version 51.02 (Autostrain LV), EchoPAC version 206 (AFI‐LV), VVI version (V.2.00‐070730), and Epsilon (5.0.2.11295) were utilized to quantify two‐dimensional LVGLS in all patients for comparative and regression analyses. Results: Means and lower limits of normal (95% confidence intervals) of LVGLS were −17.1% (−17.5%, −16.7%) and −14.7% (−15.4%, −14.0%) for TomTec; −17.8% (−18.4%, −17.2%) and −14.4% (−15.3%, −13.5%) for EchoPAC; −16.3% (−16.9%, −15.7%) and −13.0% (−13.9%, −12.1%) for VVI; and −17.0% (−17.6%, −16.4%) and −12.8% (−13.8%, −11.8%) for Epsilon. Factors significantly associated with LVGLS measurements in multivariable regression analyses with their beta‐coefficients (95% CI) were female −1.36 (−2.12, −0.59), heart rate (per 10 bpm) with a coefficient of 0.38 (0.10–0.66), left ventricular ejection fraction (per 10%) −1.03 (−1.72, −0.34), and EchoPAC (vs. TomTec) −0.62 (−1.2, 0.0), VVI (vs. TomTec) 0.82 (0.23, 1.41) and Epsilon (vs. TomTec) 0.13 (−0.45, 0.72). Conclusion: LVGLS measurements were feasible across all four strain software on both GE and Philips scans in this study. Reference ranges to define normal, abnormal, and borderline LVGLS values along with associated factors in healthy patients are reported to enable clinical applications.