Mitral regurgitation and tricuspid regurgitation are the most common valvular heart diseases in patients with heart failure and have independent prognostic value. Transcatheter interventions are now available for the treatment of valvular heart disease, and their efficacy and safety have been tested in randomized controlled trials. However, evidence is still limited and sometimes inconclusive because several aspects of these trials limit their interpretation or consistency. These include heterogeneity in the pathogenesis and clinical characteristics of patients, the dynamic nature of secondary atrioventricular valve disease severity, the role of heart failure medications and devices, dependency on procedural results and operators' skills, smaller number of patients enrolled and the power to detect differences in trials, and limitations to use patients' reported outcomes with unblinded study protocols. These specific aspects of trials in patients with atrioventricular valve disease are reviewed in this article with a focus on possible solutions to generate further evidence for the efficacy and safety for transcatheter treatments of atrioventricular valve disease in patients with heart failure.

The transapical beating-heart septal myectomy (TA-BSM) procedure was developed to enhance efficiency and reduce surgical trauma compared with conventional septal myectomy in treating obstructive hypertrophic cardiomyopathy. The current study aimed to delineate a refined TA-BSM surgical technique and summarize the midterm outcomes of the cohort immediately after the learning curve period.

Intravenous adenosine induces stable myocardial hyperemia for coronary microvascular function testing. Iodinated radiographic contrast media induce transient, submaximal hyperemia. We assessed the feasibility, diagnostic value, and potential cost-effectiveness of contrast-derived indices of microvascular function.

The role of cardiac CD (cluster of differentiation) 206+ macrophages in chronic heart failure (HF) is unknown. We examined whether CD206+ macrophages expressing IL (interleukin)-4Rα are key drivers of adverse left ventricular (LV) remodeling in HF.

Chronic coronary disease (CCD) is the leading cause of death in the United States. There is an ongoing imperative to disseminate evidence-based and patient-centered care recommendations that further align the management of patients with CCD to updated evidence-based guidelines. The writing committee developed a comprehensive CCD measure set comprising 10 performance measures and 3 quality measures, the focus of which is to include practical steps to specifically advance care in the CCD population. The measure set begins with an assessment of tobacco use and evidence-based cessation interventions. Also included are topics such as antiplatelet therapy, lipid assessment and low-density lipoprotein cholesterol goals, and guideline-directed management and therapy for hypertension and reduced left ventricular dysfunction in patients with CCD. The measure set concludes with an emphasis on the importance of cardiac rehabilitation referral and patient education, including symptom management and lifestyle modification.

Older adults with concomitant heart failure (HF) and Alzheimer's Disease and Related Dementias (ADRD) are at high risk for adverse outcomes, including health care utilization and mortality. Increasingly, adults with these conditions want to maximize quality of life and days at home (DAH). This study aimed to determine the association between ADRD and DAH following HF hospitalization.

Long-term outcomes and quality of life have been identified as core patient-centered outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO) research. The aim of this study is to investigate the incidence of death or new disability at 12 months after the initiation of VA-ECMO.

Elevated plasma levels of Lp(a) [lipoprotein(a)] are a causal risk factor for coronary heart disease and stroke in European individuals, but the causal relevance of Lp(a) for different stroke types and in East Asian individuals with different Lp(a) genetic architecture is uncertain.

Intersectional genetics is an advanced dual recombinase technology developed to gain more precision in cell fate mapping and gene function analysis in vivo. It relies on overlapping expression patterns of a pair of site-specific DNA recombinases, Cre and Dre, to gain high-resolution targeting of specific cell populations. In this issue of Circulation, Han et al report the application of intersectional genetics to target four SMC subtypes residing in different segments of disease-prone arteries. The innovative new tools generated and the precision targeting results obtained suggest a powerful new experimental approach is available to test the possibility that the regional distribution of vascular disease has a developmental basis in vivo.