Background/Objectives: The “weekend effect,” characterized by increased mortality and complication rates for weekend hospital admissions, is well documented in myocardial infarction and stroke but has been less thoroughly investigated in acute decompensated heart failure (ADHF). This study evaluates the weekend effect in ADHF using a national cohort. Methods: A retrospective cohort study was conducted using the 2016–2020 Nationwide Inpatient Sample (NIS). Adult ADHF admissions were identified by ICD-10 codes and classified as weekend or weekday admissions. Over 30 variables, including age, sex, and comorbidities, were analyzed. Propensity score matching (1:1) yielded 489,204 patients per group. Univariate and multivariate logistic regression models were used to assess outcomes, adjusting for key covariates. Results: Of 2,131,915 ADHF hospitalizations, 501,076 (23.5%) occurred on weekends. The cohort was 48% female, with a mean age of 72 years (SD ± 12.3). After 1:1 matching, weekend admissions had higher odds of cardiac arrest (aOR: 1.10; 95% CI: 1.06–1.13, p < 0.001), inpatient mortality (aOR: 1.07; 95% CI: 1.05–1.09, p < 0.001), acute kidney injury (AKI; aOR: 1.07; 95% CI: 1.06–1.08, p < 0.001), and acute respiratory failure (ARF; aOR: 1.28; 95% CI: 1.27–1.30, p < 0.001). No significant differences were observed in mechanical circulatory support (MCS) use or length of stay. Conclusions: Weekend ADHF admissions were associated with a higher risk of mortality and complications, which may be attributable to reduced specialist availability or delayed diagnostics. These findings underscore the need for standardized ADHF protocols to ensure equitable care throughout the week.

Pathogenic transthyretin (TTR) variants, such as V142I, demonstrate incomplete, age-dependent penetrance and may be present in patients without clinical transthyretin cardiac amyloidosis cardiomyopathy (ATTR-CM). Distinguishing true ATTR-CM from phenocopies like apical HCM (ApHCM) is critical to guide management. A 61-year-old African-American male with longstanding ApHCM was found to carry the pathogenic TTR V142I variant. Despite genotype positivity, technetium-99m pyrophosphate scintigraphy (H/CL 1.01, visual grade 0) excluded ATTR-CM, and cardiac magnetic resonance imaging confirmed apical-predominant hypertrophy with patchy late gadolinium enhancement consistent with ApHCM. The patient remained stable on medical therapy with ongoing surveillance. This case illustrates genotype-phenotype discordance in TTR carriers and highlights the importance of integrating genetic data with multimodality imaging. Recognition of phenocopies in patients with the TTR gene prevents misdiagnosis and unnecessary therapy and emphasizes the need for longitudinal surveillance in at-risk patients. TTR genotypes can be associated with an HCM phenotype. Clinical and imaging correlation is essential to interpret genetic findings and avoid misdiagnosis.

Background/Objectives: Pulmonary hypertension (PH) is an increasingly recognized complication in patients with end-stage renal disease (ESRD) undergoing hemodialysis, particularly those utilizing arteriovenous fistulas (AVF) or grafts (AVG) for vascular access. The prevalence and clinical impact of PH in this population remain unclear due to methodological heterogeneity and variable diagnostic criteria. This systematic review and meta-analysis aimed to quantify the association between AVF/AVG use and PH prevalence in ESRD patients and to explore sources of heterogeneity. Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted for studies published through 31 December 2024, without language or date restrictions. Eligible studies included adults (≥18 years) with ESRD on dialysis, comparing those with AVF/AVG access to non-AVF/AVG controls (e.g., tunneled dialysis catheters or peritoneal dialysis), and reporting PH prevalence or mean pulmonary artery pressures. Study quality was assessed using the Newcastle–Ottawa Scale, and risk of bias was evaluated. A random-effects meta-analysis calculated pooled odds ratios (OR) for PH prevalence, with heterogeneity assessed by I² and Cochran’s Q. Sensitivity analyses and tests for publication bias (Egger’s and Begg’s) were performed. Secondary analysis compared pooled mean pulmonary artery pressures between groups. Results: Eleven observational studies (1299 dialysis patients) met the inclusion criteria; ten studies (1224 patients) contributed to the quantitative meta-analysis after exclusion of one study with a zero-event control arm. Most studies were small, predominantly cross-sectional, and of moderate methodological quality. The pooled analysis showed a statistically significant association between AVF/AVG use and PH (OR 2.06, 95% CI: 1.69–2.52), with low statistical heterogeneity (I² = 0%). This estimate was sensitive to individual studies: in leave-one-out analysis the association lost statistical significance when the single most influential study was removed indicating that the pooled result is driven in part by a small number of studies rather than being uniformly robust. No statistical evidence of publication bias was detected. Five studies reported continuous pulmonary artery pressures, which were directionally higher in AVF/AVG patients but were not pooled because of extreme heterogeneity (I² = 99.4%). Conclusions: In this synthesis of observational data, AVF/AVG use was associated with higher odds of pulmonary hypertension than non-AVF/AVG access. Because all included studies were observational and the pooled estimate is sensitive to individual influential studies, these findings indicate a possible association rather than a causal effect and should be interpreted with caution. They support the rationale for prospective hemodynamic studies and for evaluating—rather than presuming the benefit of—PH monitoring and individualized access strategies in higher-risk dialysis patients.

Background: Sepsis-associated cardiac dysfunction has historically been characterized as predominantly systolic, yet the burden of heart failure with the preserved ejection fraction (HFpEF) phenotype among patients with heart failure (HF) first documented during sepsis remains poorly defined. Methods: In a single-center retrospective cohort of adults (≥18 years) admitted to a tertiary-care hospital between 1 January 2022 and 31 December 2024, we identified patients whose first sepsis diagnosis (ICD-10) coincided with their first HF diagnosis (ICD-10 I50.x) during the same encounter, with no prior HF in the EHR. Patients were classified by ICD-10 subtype as HFpEF, HFrEF, combined, or unspecified; the unspecified group underwent echocardiographic reclassification when LVEF was documented. Demographics, selected comorbidities, peak inflammatory markers, and unadjusted in-hospital and subsequent-encounter outcomes were compared between HFpEF and HFrEF. Results: Of 924 patients with HF first documented during sepsis, 438 (47.4%) were ICD-10–coded HFpEF and 405 (43.8%) HFrEF. HFpEF patients were older (74.0 vs. 69.2 years; p < 0.001) and more often female (53.0% vs. 37.0%; p < 0.001), with higher prevalence of COPD exacerbation (21.5% vs. 13.1%; p = 0.004) and hypothyroidism (26.3% vs. 17.5%; p = 0.034). HFrEF patients exhibited higher peak lactate (2.88 vs. 2.48 mmol/L; p = 0.009) and procalcitonin (8.52 vs. 7.24 ng/mL; p = 0.011). Unadjusted in-hospital mortality (28.1% vs. 27.7%; p = 0.95), ICU admission (75.8% vs. 74.8%; p = 0.80), and length of stay did not differ. Subsequent encounters were descriptively more frequent after HFpEF (11.0% vs. 6.2%). Conclusions: ICD-10–coded HFpEF and HFrEF occurred at nearly equal frequency among adults with HF first documented during sepsis, challenging the systolic-centric paradigm. Despite distinct demographic and biochemical profiles, unadjusted in-hospital outcomes did not differ. These descriptive findings, limited by administrative-coding-based phenotype classification, the absence of multivariable adjustment, and unmeasured sepsis-severity and comorbidity variables, are hypothesis-generating and support phenotype-aware prospective study of HF arising during sepsis.

Background: Traditional echocardiographic assessment of aortic stenosis (AS) using aortic valve area (AVA) may overestimate severity due to pressure recovery phenomena, while subclinical myocardial dysfunction remains undetected despite preserved ejection fraction. This study evaluated whether energy loss index (ELI)—which accounts for pressure recovery—demonstrates superior correlation with global longitudinal strain (GLS), a marker of subclinical myocardial dysfunction, compared to conventional AVA-based classification in patients with moderate-to-severe AS and preserved left ventricular ejection fraction (LVEF). Methods: This retrospective single-center study analyzed 149 patients with moderate-to-severe AS (AVA < 1.5 cm²) and LVEF > 50% from 2015 to 2019. Among 97 patients with severe AS by AVA (<1.0 cm²), ELI was calculated using the formula ELI = (AVA × Aa)/(Aa − AVA) ÷ BSA, where Aa represents sinotubular junction cross-sectional area. Patients with ELI ≥ 0.6 cm²/m² were reclassified as moderate AS. Spearman correlation assessed relationships between AVA, ELI, and GLS. Multivariable linear regression models determined independent predictors of myocardial dysfunction, adjusting for age, body surface area, hypertension, LVEF, and mean pressure gradient. Results: ELI reclassified 28 of 97 patients (29%) from severe to moderate AS. Reclassified patients had significantly better myocardial function, with less impaired GLS (−15.0 ± 3.9% vs. −12.1 ± 5.0%, p = 0.013) and higher LVEF (60.1 ± 6.2% vs. 56.5 ± 9.1%, p = 0.017) compared to non-reclassified patients. In the overall cohort, ELI demonstrated stronger correlation with GLS than AVA (r = −0.307, p = 0.0003 vs. r = −0.209, p = 0.0115). Critically, among patients with severe AS by AVA criteria, ELI maintained significant correlation with GLS (r = −0.443, p = 0.0003) while AVA showed no correlation (r = −0.144, p = 0.159). In multivariable analysis, ELI independently predicted GLS (β = 5.847, 95% CI: 2.85–8.84, p = 0.0002; adjusted R² = 0.289), whereas AVA did not (β = 2.234, 95% CI: −1.08 to 5.55, p = 0.188; adjusted R² = 0.234). When both parameters were included simultaneously, only ELI remained significant (p = 0.0024). Conclusions: In this retrospective cohort, ELI-based reclassification identified a subgroup of patients with less severe myocardial dysfunction as measured by GLS and LVEF, and ELI demonstrated superior correlation with subclinical myocardial dysfunction compared to AVA. These findings suggest ELI may provide a more physiologically reflective assessment of hemodynamic burden in AS with preserved LVEF. However, the absence of systematic symptom assessment and clinical outcome data represents critical limitations. Prospective studies with standardized symptom evaluation, longitudinal follow-up, and adjudicated clinical endpoints are required to determine whether ELI-based reclassification improves risk stratification and clinical decision-making before this approach can be recommended for routine practice.

Background/Objectives: Atrial fibrillation (AF) is a significant and prevalent cardiovascular complication in end-stage renal disease (ESRD) patients, yet its specific predictors within this population are not well understood. This study aimed to identify the predictors of new-onset AF in ESRD patients undergoing dialysis. Methods: We conducted a retrospective multicenter cohort study within the Northwell Health System, analyzing data from 5326 ESRD patients on dialysis between 2017 and 2019. The mean age was 64.2 ± 13.1 years, with 48.3% females. Multivariable-adjusted logistic regression was used to identify predictors of new-onset AF, the primary outcome. Adjusted odds ratios (ORs) were calculated for potential risk factors. Results: Of the 5326 patients, 1564 (29.4%) developed new-onset AF. Significant predictors included increasing age (OR 1.038 per year, 95% CI 1.032–1.044, p < 0.0001), obesity (BMI > 30 vs. BMI 20–25: OR 1.208, 95% CI 1.026–1.422, p = 0.023), and coronary artery disease (OR 1.678, 95% CI 1.466–1.920, p < 0.0001). African American patients had lower odds of developing AF compared to White patients (OR 0.578, 95% CI 0.494–0.676, p < 0.0001). Hypertension, sex, diabetes, and tobacco use were not significantly associated with AF risk. Conclusions: Age, obesity, and coronary artery disease are significant predictors of new-onset AF in ESRD patients on dialysis. Notable racial disparities exist, with African American patients having a lower risk. These findings may inform targeted prevention strategies and guide future research into the mechanisms underlying AF in ESRD patients.