Background: In response to the COVID-19 pandemic, social distancing measures such as stay-at-home orders were implemented for all non-essential workers. The consequent disruption in the defined daily work routine has impacted both the quality and duration of sleep. Our aim was to evaluate the quality of sleep in the Indian adult population during the COVID-19 pandemic. Methods: The data were collected between April 17, 2020 and May 24, 2020, and participants were invited openly through social media platforms (Facebook, Twitter, WhatsApp, Instagram). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) Questionnaire. Results: The study population consisted of 808 participants (mean age 30.85 years, 56.7% female). The mean sleep score of the study population was 6.78 ± 3.19 on the PSQI, with a majority (57.2%) of respondents showing 'poor' sleep quality (>5 on PSQI). The mean sleep duration of the study population was found to be 6.9 ± 1.4 h, and sleep latency was 42.64 ± 51.6 min. The PSQI scores were comparable for age, gender, and work status and were not significant. However, a significant association between self-reported mental health and quality of sleep was found (p<0.05). Participants who reported a deterioration in mental health were more likely to have poor sleep quality than those who reported an improvement in their mental health. Conclusions: The results of this study show that poor sleep quality is widely prevalent among the the general population in India during the COVID-19 pandemic.

Transcatheter aortic valve replacement (TAVR) was introduced in 2002 and has become integral in the management of aortic stenosis. As an alternative to surgical aortic valve replacement, it relies heavily on safe access to the aortic annulus for implantation of a valve prosthesis. Throughout its development and in current practice, the transfemoral (TF) arterial route for retrograde valve delivery has been the primary approach. However, this route is not appropriate for all patients, which has led to the development of multiple alternate access options. This review discusses the development of access for TAVR, followed by a thorough discussion of TF access. The commercially available products, preprocedural planning, closure techniques, and procedural complications are all discussed. We also describe the various alternate access routes with particular emphasis on the most recently developed route, transcaval access (TCv), with focus on procedural indications, technical considerations, and comparative outcomes. As TAVR technology, indications, and availability all expand, the knowledge and implementation of safe access are of utmost importance.

Hypertrophic cardiomyopathy (HCM) is a complex and heterogeneous cardiac disorder characterized by cardiac hypertrophy disproportionate to loading stimuli (e.g. hypertension or aortic stenosis). Diagnosing HCM requires a thorough examination of clinical symptoms, with echocardiography as the key initial imaging tool. Multimodality imaging further supports diagnosis, helps assess left ventricular outflow obstruction, and aids in risk stratification for sudden cardiac death. The cornerstone of HCM management remains pharmacological therapy with β-blockers and calcium channel blockers serving as first-line agents to alleviate symptoms and reduce left ventricular outflow tract obstruction. More recently, cardiac myosin inhibitors have revolutionized the treatment paradigm for obstructive HCM. Procedural interventions such as septal reduction therapy are reserved for refractory cases. Genetic testing and risk stratification for sudden cardiac death play a critical role in treatment decisions, guiding further testing in first-degree relatives and ICD implantation in high-risk individuals. Exercise recommendations have evolved based on recent data, challenging traditional restrictions and emphasizing individualized plans.

Cardiac amyloidosis (CA), including transthyretin (ATTR) and light-chain (AL) subtypes, is an underrecognized mimic of heart failure with preserved ejection fraction. While sodium-glucose cotransporter-2 inhibitors (SGLT2i) benefit general heart failure (HF) populations, their role in CA is unclear. This study evaluated the impact of SGLT2i on outcomes in patients with CA. A systematic review and meta-analysis of seven observational studies (N = 13,303) compared patients with CA (AL and ATTR) receiving SGLT2i to matched controls. Outcomes included mortality, HF exacerbations, estimated GFR (eGFR), and NT-proBNP. Random-effects models were used to pool hazard ratios (HRs) and mean differences. In the primary analysis restricted to ATTR-CA, SGLT2i use was associated with lower observed all-cause mortality (the primary outcome; HR 0.71, 95% CI 0.58–0.87, p = 0.001). Among secondary outcomes in the ATTR-CA subgroup, SGLT2i use was associated with reduced NT-proBNP (−414 pg/mL, 95% CI –694 to −134, p = 0.004) and improved eGFR (+4.3 mL/min/1.73 m², 95% CI 1.4 to 7.2, p = 0.004). In a secondary, exploratory any-CA (AL + ATTR combined, 4 studies) analysis, the pooled mortality HR was 0.67 (95% CI 0.50–0.91, p = 0.010); between-study heterogeneity was substantial (I² = 75%), and this combined estimate should not be interpreted as a single class effect across CA subtypes. In this meta-analysis of non-randomized observational studies, SGLT2 inhibitor use was associated with lower observed mortality and improved cardiac biomarkers in CA, with renal benefits most evident in ATTR. Because all included studies were observational and susceptible to confounding by indication, immortal time bias, and survivor bias, these findings are hypothesis-generating and should not be interpreted as evidence of efficacy; randomized trials are needed before treatment recommendations can be made.

Background: Stiff left atrial syndrome (SLAS) is a complication that occurs due to left atrial scarring following procedures such as radiofrequency catheter ablation for atrial fibrillation. Case summary: We present a series of four patients with pre-existing conditions that ultimately were diagnosed as SLAS. In each case, clinical manifestations of SLAS may overlapped with other conditions and required a high index of clinical suspicion and diligent hemodynamic assessment to differentiate it from other concomitant cardiac conditions. Discussion: We aim to highlight key differentiating diagnostic features from overlapping cardiac conditions and to summarize current treatment options for patients with SLAS.