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.

Background: Antiphospholipid syndrome (APS) predisposes patients to thrombosis and cardiac valve lesions such as Libman-Sacks endocarditis. These vegetations are sterile yet can provide a nidus for infection; the risk of infective endocarditis (IE) and other serious infections in APS patients remains poorly quantified in large populations, representing a knowledge gap. Objective: To quantify the risk of the primary outcome, IE, and secondary outcomes of MRSA sepsis and MSSA sepsis, associated with APS using a large, nationally representative inpatient database. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized patients aged 18–75 with APS were compared to those without APS. Patients with major pre-existing risks for IE or significant confounders (e.g., prosthetic valves, specific congenital/rheumatic heart diseases, ESRD) were excluded. Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: 297,459 patients fitted our inclusion criteria. On multivariate analysis, APS was significantly associated with over double the odds of IE (aOR 2.03; 95% CI 1.22–3.37). Importantly, APS also conferred considerably increased risks of MRSA sepsis (aOR 1.75; 95% CI 1.18–2.58) and MSSA sepsis (aOR 1.86; 95% CI 1.28–2.70). Conclusion: APS emerged as a significant independent risk factor for IE, Methicillin-resistant (MRSA), and Methicillin-sensitive Staphylococcus aureus (MSSA) sepsis. This suggests a broader vulnerability to infection, possibly linked to underlying endothelial dysfunction or immune dysregulation inherent in APS. These findings highlight the critical need for increased clinical suspicion, vigilant monitoring, and potentially tailored prophylactic or treatment approaches for severe infections in patients with APS.

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.

Catheter‐directed intervention (CDI) in patients presenting with pulmonary embolism (PE) is suggested to improve in‐hospital outcomes. We aimed to compare the effect of early versus late initiation of CDI on in‐hospital outcomes. A systematic review and meta‐analysis were conducted according to PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was performed from inception to May 2025. Data extraction was conducted independently by multiple reviewers. Statistical analysis was performed using R software version 4.3.2, and odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were combined using a random‐effects model. Six studies, including 53,472 patients, were included. Early intervention before 24 h significantly reduced mortality (OR 0.61, 95% CI [0.44–0.84]; I ² = 0%). Moreover, Early intervention before 24 h significantly reduced the all‐cause readmission in patients with acute PE (OR = 0.81 (95% CI: [0.73, 0.89]; I² = 0%). There was no significant difference in risk of major bleeding in early vs late intervention (OR = 0.82; 95% CI: [0.48, 1.39]; I² = 69.3%). Also, early intervention before 24 h significantly reduced the length of hospital stay (LOS) (MD = –3.11 days (95% CI: [–4.33, –1.89]; I ² = 0%). This meta‐analysis showed that early CDI, particularly within 24 h of presentation, is associated with a significant reduction in both mortality and all‐cause readmission in patients with acute PE, without increasing the risk of bleeding. These findings support the concept of “time‐is‐myocardium” and reinforce the need for structured protocols that enable early therapeutic intervention. Further randomized controlled trials are needed to confirm these findings and to establish the optimal timing for this potentially life‐saving therapy.

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.

Pulmonary hypertension (PH) is present in over two-thirds of patients who experience heart failure with preserved ejection fraction (HFpEF), and it worsens their prognosis, particularly when combined with right ventricular dysfunction. Effective treatments for HFpEF-related PH are limited. A 70-year-old woman presented with severe exertional dyspnea and hypoxia. Echocardiography revealed a preserved ejection fraction with advanced diastolic dysfunction, as well as severe PH. Right heart catheterization showed pulmonary pressures at systemic levels and elevated left-sided filling pressures. Significant symptom improvement and normalized pulmonary pressures were noted after treatment with sacubitril-valsartan and a sodium-glucose cotransporter 2 (SGLT2) inhibitor. Although sacubitril-valsartan and SGLT2 inhibitors have been proven effective in HFpEF, their specific role in HFpEF-PH remains unclear. This case highlights their potential to improve hemodynamics and symptoms in this challenging patient population. Sacubitril-valsartan and SGLT2 inhibitors may be effective for treating PH in HFpEF; further investigation is warranted.