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During standard cardiovascular magnetic resonance (CMR) the horizontal long‐axis cine image (i.e., 4‐chamber) is captured which includes a cross‐section of the descending aorta. The aortic cross‐section can be used to assess aortic stiffness (distensibility; ∆area/pressure) or circumferential strain (percentage vascular deformation). We examined whether descending aortic strain from traditional CMR is sensitive to age‐ and disease‐related (heart failure with preserved ejection fraction; HFpEF) arteriosclerosis. We recruited 83 participants into three groups: (1) 34 young individuals (age: 22 ± 3 years; body mass index (BMI): 24.3 ± 2.8 kg/m2); (2) 19 older individuals (age: 69 ± 5 years; BMI: 26.9 ± 4.7 kg/m2) and (3) 26 patients with HFpEF (age: 69 ± 6 years; BMI: 35.8 ± 6.1 kg/m2). All participants were studied in the same 3 T scanner (Phillips, Achieva). Descending aortic cross‐sectional area and circumferential strain were measured using cvi42 software. Blood pressure was measured via a brachial oscillometric cuff. Data were compared via ANOVA. All data are reported as means ± standard deviation. Compared to the young group (71 ± 5 mmHg), mean arterial pressure was higher in the older (83 ± 9 mmHg, P < 0.001) and HFpEF groups (86 ± 10 mmHg, P < 0.001). Minimum and maximum aortic areas were greater in the older and HFpEF groups (both, P < 0.01). Peak descending aortic strain (young: 11.4% ± 2.2%; older: 4.8% ± 1.6%; HFpEF 3.8% ± 1.6%) and absolute distension were lower (all, P < 0.02) in the older and HFpEF groups compared to the young. Peak descending aortic strain and strain rates are sensitive to age and may provide a novel assessment of arterial stiffness for longitudinal studies that utilize or have utilized CMR. What is the central question of this study? Assessing aortic stiffness requires prospective planning when done by magnetic resonance imaging (MRI), but is it possible to assess aortic stiffness from standard cardiac MRI? What is the main finding and its importance? Peak strain and systolic and diastolic strain rates of the descending aorta are sensitive to age‐related aortic stiffening, with less variability than conventional measures. The descending aorta captured in the standard four‐chamber view with cardiac MRI can be used to assess aortic stiffness and wall mechanics. These variables represent novel metrics available from every cardiac MRI ever taken.

Sarcoidosis is a multiorgan system granulomatous disease of unknown etiology. It is hypothesized that a combination of environmental, occupational, and/or infectious factors provoke an immunological response in genetically susceptible individuals, resulting in a diversity of manifestations throughout the body. In the United States, cardiac sarcoidosis (CS) is diagnosed in 5% of patients with systemic sarcoidosis, however, autopsy results suggest that cardiac involvement may be present in > 50% of patients. CS is debilitating and significantly decreases quality of life and survival. Currently, there are no gold-standard clinical diagnostic or monitoring criteria for CS. We identified patients with a diagnosis of sarcoidosis who were seen at the Simmons Center from 2007 to 2020 who had a positive finding of CS documented with cardiovascular magnetic resonance (CMR) and/or endomyocardial biopsy as found in the electronic health record. Medical records were independently reviewed for interpretation and diagnostic features of CS including late gadolinium enhancement (LGE) patterns, increased signal on T2-weighted imaging, and non-caseating granulomas, respectively. Extracardiac organ involvement, cardiac manifestations, comorbid conditions, treatment history, and vital status were also abstracted. We identified 44 unique patients with evidence of CS out of 246 CMR reports and 9 endomyocardial biopsy pathology reports. The first eligible case was diagnosed in 2007. The majority of patients (73%) had pulmonary manifestations, followed by hepatic manifestations (23%), cutaneous involvement (23%), and urolithiasis (20%). Heart failure was the most common cardiac manifestation affecting 59% of patients. Of these, 39% had a documented left ventricular ejection fraction of < 50% on CMR. Fifty eight percent of patients had a conduction disease and 44% of patients had documented ventricular arrhythmias. Pharmacotherapy was usually initiated for extracardiac manifestations and 93% of patients had been prescribed prednisone. ICD implantation occurred in 43% of patients. Patients were followed up for a median of 5.4 (IQR: 2.4-8.5) years. The 10-year survival was 70%. In addition to age, cutaneous involvement was associated with an increased risk of death (age-adjusted OR 8.47, 95% CI = 1.11-64.73). CMR is an important tool in the non-invasive diagnosis of CS. The presence of LGE on CMR in a pattern consistent with CS has been shown to be a predictor of mortality and likely contributed to a high proportion of patients undergoing ICD implantation to decrease risk of sudden cardiac death. Additional studies are necessary to develop robust criteria for the diagnosis of CS with CMR, assess the benefit of serial imaging for disease monitoring, and evaluate the effect of immunosuppression on disease progression.

Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients' expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug-drug and drug-food interactions information.

•High intensity and long duration aerobic exercise training increases the risk for left atrial enlargement, an important risk factor for the development of atrial fibrillation.•The effects of chronic aerobic exercise upon left atrial size are amplified in patients with left ventricular hypertrophy and increased LV stiffness.•The effects of these changes on atrial electromechanical properties and atrial fibrosis need further investigation.•Further work is also needed to understand long term effects of habitual aerobic exercise and risk for atrial fibrillation in patients with left ventricular hypertrophy. Habitual aerobic exercise is associated with left atrial (LA) enlargement which may increase risk of atrial fibrillation. Patients with LVH and increased LV stiffness may be more predisposed to LA remodeling due to higher LA pressures during exercise. We tested the hypothesis 1 year of aerobic exercise training would increase LA size to a greater extent in patients with LVH than controls. Adults with LVH (n = 53) enriched for increased cardiac risk and LV stiffness and control (CON) subjects (n = 58) were randomized to 1 year of high intensity aerobic exercise (ex) or yoga control. LA and LV volumes were measured using 3D echo. Of 111 participants, 83 had complete data available (LVH: 18 exercisers, 10 yoga; CON: 29 exercisers, 26 yoga). Baseline LA volume indices were similar between groups (LVH: 19.8 ± 4.4 mL/m2 vs CON: 18.8 ± 4.1 mL/m2; p = 0.33). After 1 year, the effects of exercise (p = 0.003) and LVH (p = 0.001) were each associated with increased LA volume index. More subjects in the LVH/exercise group (33.3%) increased LA size >5 mL/m2 and LA/LV volume ratios >0.1 compared to the other groups (10% LVH/yoga, 3.4% CON/ex, 3.8% CON/yoga; Chi square p = 0.006). In conclusion, 1 year of aerobic training resulted in higher LA volumes in subjects with LVH and LV stiffness compared to healthy subjects. The increase in LA size was greater than changes in LV size suggesting chronic aerobic training in may preferentially affect LA remodeling in subjects with LVH and LV stiffness.

All participants provided written informed consent to participate in the study, which was approved by the institutional review boards at the University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas. [See PDF for image] Fig. 1 A Participant characteristics, B resting supine heart rate (HR), brachial mean arterial pressure (MAP), and muscle sympathetic nerve activity (MSNA) burst frequency (BF) and burst incidence (BI) in patients with heart failure with preserved ejection fraction (HFpEF) taking and not taking (matched HFpEF) sodium–glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide 1 receptor agonists (GLP1ra) In addition to controlling blood glucose, GLP1ra and SGLT2i have been shown to cause weight and fat loss [3] and may contribute to the reduction in sympathetic nerve activity in patients with obesity and HFpEF [11]. [...]GLP1ra/SGLT2i may act directly on the central nervous system by crossing the blood–brain barrier (BBB) [14], leading to the suppression of central sympathetic outflow. [...]we do not have information regarding the duration of treatment and whether participants experienced weight loss.

Background Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and outcomes, the 'obesity paradox', in several diseases. Hypothesis We sought to evaluate whether the obesity paradox is present in patients with left ventricular systolic dysfunction (LVSD) of all etiologies, using all‐cause mortality as the primary endpoint and hospitalization as the secondary endpoint. Methods We conducted a retrospective cohort study of LVSD patients (n = 18 003) seen within the University of Pittsburgh Medical Center network between January 2011 and December 2017. Patients were divided into four BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): <20%, 20–35%, and 35–50%. Results Over a median follow‐up of 2.28 years, higher BMI (mean 28.9 ± 6.8) was associated with better survival for the overall cohort and within LVEF strata (p < .0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and prior myocardial infarction are independent predictors of death. Conclusions Our results support the existence of an obesity paradox impacting all‐cause mortality in patients with LVSD of ischemic and non‐ischemic etiologies even after adjusting for LVEF and comorbidities. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of LVSD is established.