🆕 in OpenSource: Cardiology Can septal myectomy for obstructive HCM be done safely and effectively outside a high-volume center? 97% of high-volume centers are in large metropolitan areas. At LVHN, one surgeon performed 146 septal myectomies from 2006 to 2023 for patients living a median of 27 miles away. Outcomes compared favorably with national series. The authors’ takeaway: at lower-volume centers, concentrating septal myectomy in a single operator may help build and keep expertise, and bring HCM surgery closer to home. opensourcecardiology.org/doi… Free to read, no paywalls @lvhnsm

🆕 in OpenSource: Cardiology An infant with pulmonary vein stenosis gets an Onyx stent. Even at maximal dilation, the stent will eventually be too small for the vessel. Can it be intentionally fractured later? On the bench, Chelsea Miller, MD, and Michael Shorofsky, MD (@mjshorofsky), of the University of Virginia found that 20 of 21 Resolute Onyx and Onyx Frontier stents (2.0–5.0 mm) demonstrated: • Complete fracture on 6–10 mm high-pressure balloons, median pressure 25 atm • Most fractured linearly (16/20). That is the desired pattern, because it allows complete relief of obstruction and straightforward placement of a larger stent • Smaller stents needed higher balloon-to-stent ratios: 3 for 2 mm stents vs 1.8–2 for 5 mm stents • Only one stent, a 3.5 mm, napkin-ringed and never fractured In vivo, the balloon needed for fracture may be too large to inflate safely in a small vessel. The authors stress that serial dilation remains the clinical standard. opensourcecardiology.org/doi… Free to read, no paywalls

Do SGLT inhibitors meet the bar for a geroprotector? Across 13 placebo-controlled trials (90,413 patients), all-cause mortality HR 0.88 (95% CI 0.83–0.94); the authors call SGLTi the most promising candidate geroprotector, and call for a primary-prevention trial in low-risk middle-aged adults to test it. opensourcecardiology.org/doi… @DRJamesOKeefe; @MichaelNassifMD; @AndrewJSauer

🆕 in OpenSource: Cardiology Can IV digoxin loading help get low-output HFrEF patients off inotropes? Cardiac glycosides are the only oral agents with positive inotropic effects. Yet guidelines don't address their use in acutely decompensated HF or cardiogenic shock. Research letter: Hemodynamic Impact with Intravenous Digoxin Loading in Low Output Heart Failure This single-center HF ICU series reviewed 10 consecutive patients with PA catheters and Fick CI <2.2 L/min/m². Each received IV digoxin 0.5 mg, then 0.25 mg at 6 hours and 0.25 mg 6 hours later. Four were on stable dobutamine or milrinone, with the aim of weaning. At 24 hours: • Median cardiac index 1.45 → 2.70 L/min/m² (p=0.002) • All 4 weaned off IV inotropes, with no decrement in CI or SvO₂ • No significant atrial or ventricular tachyarrhythmia or bradyarrhythmia during the ICU stay The authors' read: IV digoxin loading may have contributed to the rapid CI improvement and may help facilitate inotrope weaning. The series is small, mostly young and uncontrolled, and concurrent vasodilators and diuretics also affected the hemodynamics, so a randomized trial is needed. By @maz_hanna, Rajakrishnan Vijayakrishnan, Rodolfo Benatti, @ChonyAlbertMD, @WilsonTangMD, @NutritionHF, Guilherme Oliveira & @rcstarling opensourcecardiology.org/doi… Free to read, no paywalls

🆕CARDIO-TTRansform, the largest treatment trial yet in ATTR-CM (1,432 patients), missed its primary endpoint: rate ratio 0.89 (95% CI 0.73 to 1.09). But baseline stabilizer use modified the effect of eplontersen (P for interaction = .017): • Not on a stabilizer at baseline: RR 0.71 (95% CI 0.54 to 0.93), a nominally 29% lower rate of CV death and recurrent CV events • Already on a stabilizer: RR 1.14 (95% CI 0.85 to 1.53) In a Critical Appraisal, @HamzahAliMD, Andrew A. Girard, and @BrettSperryMD argue this reflects the limited incremental benefit of adding a silencer to a stabilizer, not an ineffective drug. They also unpack why percent TTR knockdown is hard to compare across silencers and reflect on where combination stabilizer and silencer therapy goes from here. opensourcecardiology.org/doi…

CHIP-BCIS3 demonstrated mechanical action without clinical protection. Low LVEF identifies vulnerability, not device responsiveness. Until a prospectively defined physiology-selected subgroup shows net benefit, planned Impella CP should not be routine in CHIP-BCIS3-like patients. @ihtanboga @BrettSperryMD @jtsaxon

The SENTINEL-BVF study Captured debris was noted in all VIV-TAVR with BVF cases, with a higher number of small particles as compared with native valve TAVR. Whether these findings impact clinical stroke rates merits further evaluation. @jtsaxon @chetanhuded @djc795