The "2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" retires and replaces the "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults."

Ultraprocessed foods and beverages (UPFs) pose a growing public health challenge. Commonly defined by the Nova system, UPFs are industrially processed products made with additives or ingredients not commonly used in home cooking. Although ultraprocessing or extensive processing can lower cost and improve shelf life, convenience, and taste of certain products, high UPF intake is consistently linked to negative health outcomes. Although mechanisms remain unclear, evidence supports food policies that limit UPF intake while avoiding unintended consequences. Identifying high-risk UPF subgroups is essential to balancing nutritional goals with the need for accessible and appealing food options. Most UPFs overlap with foods high in saturated fat, added sugars, and sodium, which are already targets for cardiometabolic risk reduction. Future priorities include uncovering how UPFs specifically affect cardiometabolic health, refining dietary guidance to discourage nutrient-poor UPFs, and clarifying the impact of UPFs with more favorable profiles. This science advisory reviews current evidence on UPFs and their impact on cardiometabolic health and outlines research needs, regulatory reform, and policy changes needed to affect better dietary intake and overall health.

Assessment of left ventricular systolic function is essential for diagnosing and managing cardiac diseases and provides important prognostic information to the treating clinician. However, traditional methods for assessing left ventricular systolic function such as ejection fraction are limited by their reliance on geometric assumptions, subjective reader interpretation, sensitivity to loading conditions and volume, and reflection of a single plane of motion. In addition to interobserver and intraobserver variability and technical confounders, this evaluation is complicated by the complex 3-dimensional organization of the myocardial fibers, which are oriented longitudinally in the subendocardium, transversely in the midmyocardium, and obliquely in the subepicardium. Conversely, 2-dimensional speckle-tracking echocardiography measures left ventricular deformation as myocardial strain in the 3 planes of chamber motion: longitudinal, circumferential, and radial. From a clinical perspective, left ventricular global longitudinal strain offers superior diagnostic and prognostic value across the spectrum of cardiovascular disorders compared with ejection fraction, is highly reproducible, and detects subclinical dysfunction before the ejection fraction declines. Given the expanding clinical utility of speckle-tracking echocardiography and the incremental prognostic and therapeutic value of integrating global longitudinal strain into clinical practice as a potential biomarker, the objectives of this scientific statement are (1) to review the principles and technical aspects of speckle-tracking echocardiography strain imaging; (2) to provide a practical, evidence-based review of the application of speckle-tracking echocardiography in heart failure, cardiomyopathies, ischemic heart disease, valvular disease, and cardio-oncology; (3) to explore the potential utility of speckle-tracking echocardiography in cardiac resynchronization and implantable cardioverter defibrillator therapy; and (4) to outline the future directions of speckle-tracking echocardiography.

Extending cardiovascular disease prevention beyond health care settings is needed to improve population health and to advance health equity. Furthermore, evidence-based practices in community settings leverage assets and strengths (eg, community trust, reach) of organizations and practitioners. Using the Roadmap for Leveraging Implementation Science to Achieve Cardiovascular Health Equity, we conducted a narrative review to determine the scope of studies describing implementation strategies of cardiovascular health evidence-based practices in community settings and to identify bright spots and gaps in what is known about implementing cardiovascular health evidence-based practices in community settings. Evidence for the effect of interventions delivered in community settings to improve cardiovascular health behaviors is emerging in various community settings. Evidence-based practices were identified, selected, and culturally adapted through community engagement, particularly in faith-based and social service/other settings (eg, salons/barbershops). We found several interventions and adaptations aimed at improving outcomes in groups that have historically been excluded by the health care system. The Designing for Dissemination and Sustainability approach supports consideration of contextual factors (eg, alignment of evidence-based practice with the mission, workflow, time, and priorities of the setting) in selecting and adapting evidence-based practices. Development of implementation strategies must engage those who will be asked to implement the intervention and the organization in which it will be implemented. Key research opportunities include high-quality studies that explicitly compare well-specified implementation strategies in various community settings. Taken together, there are bright spots and opportunities for enhanced impact through implementation of evidence-based practices for cardiovascular disease prevention in community settings.

Pulsed field ablation (PFA) has been developed as a largely nonthermal ablation technology with a unique biophysical profile to treat atrial fibrillation. Existing evidence has shown that PFA offers a safe and efficient atrial fibrillation ablation procedure. Among different PFA technologies, the pentaspline FARAPULSE system has been the most extensively used and investigated; however, notable variability exists in workflow, fluoroscopy time, and lesion durability. While innovations such as 3-dimensional electroanatomic mapping systems and intracardiac echocardiography can enhance procedural precision in catheter ablation, fluoroscopy remains the primary imaging modality for guiding pentaspline PFA in many electrophysiology labs worldwide. This is particularly true in centers where limitations in cost, infrastructure, or training may preclude the routine use of advanced imaging technologies. This article summarizes general practical considerations and presents a primarily fluoroscopy-based, refined workflow developed by a group of experts. The goal is to provide a procedural foundation and practical guide for using the pentaspline FARAPULSE PFA system in atrial fibrillation ablation procedures. Developing a fluoroscopy-based practical guide would: (1) Democratize access to PFA technology, enabling safe and effective implementation across a broader range of clinical settings, including those without intracardiac echocardiography or 3-dimensional mapping support; (2) Reduce procedural heterogeneity by offering reproducible best practices; (3) Facilitate meaningful intercenter comparisons of procedural efficacy and safety, aiding in the identification of optimal approaches and improving the quality of clinical data for ongoing research, registries, and real-world performance monitoring of PFA technologies; and (4) Ultimately improve patient outcomes through standardized, accessible, and evidence-based practices.

Efforts to enhance risk stratification in patients with coronary artery disease have driven the pursuit of early detection of rupture-prone plaques-before destabilization and the onset of life-threatening thrombosis-giving rise to the concept of the vulnerable plaque (VP). Invasive diagnostic modalities closely mirror histology and provide instrumental information on VP hallmarks and their prognostic significance. However, limited positive predictive value and invasive nature restrict their use for systematic screening. Noninvasive techniques offer broader application potential, but their specificity and resolution remain inferior to those of invasive techniques. A deeper understanding of the complex interplay between traditional ischemic risk factors, anatomic settings, rheological effects and systemic influences contributing to plaque evolution and rupture has refined our approach to identifying and managing VPs. Systemic therapies have been shown to counteract plaque progression and stabilize VPs by thickening the fibrous cap, decreasing atheroma and necrotic core volumes, and reducing inflammation. In parallel, the hypothesis of sealing and passivating VPs by intravascular imaging-guided preventive stenting is gaining support after the promising results of clinical trials and substantial advances in contemporary device performance and biocompatibility. Upcoming evidence will be instrumental in defining the net benefit of novel diagnostic tools and therapeutic strategies for VPs.

Cardiovascular disease remains the leading cause of death worldwide, calling for the development of novel therapeutics. Over the past 3 decades, substantial investments in human genetic research have unveiled the genetic architecture of cardiovascular disease, offering promising novel therapeutic targets. These discoveries have been instrumental in the development of several cardiovascular drug development programs, such as those targeting proprotein convertase subtilisin/kexin type 9, lipoprotein (a), apo C3, and angiopoietin-like 3. Large-scale resources such as population-based biobanks and data repositories, now enable human genetic data to be leveraged at scale and inform not only target selection, but also clinical drug development. This review highlights the transformative potential of human genetics in cardiovascular drug development, focusing on IL (interleukin)-6 signaling as a case study. Specifically, we discuss how IL-6 signaling was pinpointed as a key causal mediator of atherosclerosis by genetic data, shaping the current development landscape for anti-IL-6 therapeutics in cardiovascular disease. Recent genetic studies employing innovative methodologies have provided key insights into prioritizing indications for clinical testing, informing repurposing strategies, optimizing clinical trial design for population selection, and assessing safety signals. Despite this progress, methodological challenges, such as pleiotropic effects of genetic variants, extrapolation of small genetic associations to large interventional effects, and the predominance of European-derived data, highlight the need for careful interpretation. Continued methodological advances, coupled with the emergence of high-throughput omics data and detailed cardiovascular phenotyping, promise unprecedented opportunities to refine drug discovery and development.

The increasing demand for donor hearts presents both a critical challenge and a significant opportunity for innovation in cardiac transplantation. Advancements in immunosuppressive regimens and genetic engineering have reignited recent interest in xenotransplantation. Notably, 2 human patients have received genetically modified pig hearts under expanded-access authorization. They survived for 40 and 60 days, with xenograft failure preceding death in both cases. Concurrently, decedent studies have focused on monitoring the short-term physiological function of genetically modified cardiac xenografts in legally brain-dead recipients, representing a novel experimental paradigm for preclinical testing to help bridge the gap between nonhuman primate studies and clinical trials. These contemporary achievements build on a large body of exploratory efforts in cardiac xenotransplantation in nonhuman primates. Despite significant progress in overcoming hyperacute rejection, adaptive cellular and humoral immunological barriers remain. This review aims to critically evaluate the current advancements in xenotransplantation, to explore ongoing challenges, and to discuss the future potential of this innovative approach in addressing the growing demand for donor organs in cardiac transplantation.

The postacute sequelae of SARS-CoV-2, also known as Long COVID, may affect 10% to 25% of individuals diagnosed with SARS-CoV-2. More than 100 symptoms have been reported among patients with Long COVID, but almost all patients report severe fatigue, orthostatic intolerance, shortness of breath, and reductions in exercise tolerance. Emerging data suggest that cardiovascular deconditioning plays a major role in the development of this syndrome and that reductions in functional capacity among patients with Long COVID are comparable to reductions seen among individuals with cardiovascular deconditioning resulting from bed rest. Concern has been raised about the use of exercise training as part of the management strategy for patients with Long COVID. However, exercise training appropriately tailored to the patient with cardiovascular deconditioning may be an effective strategy to facilitate improvement in symptoms. This American Heart Association scientific statement provides a concise yet comprehensive overview of mechanisms contributing to development of Long COVID and methods by which exercise training may be applied to this unique patient population to alleviate symptoms and improve quality of life. In addition, methods of reintroducing exercise and return to play among athletes affected by COVID-19 are discussed.

In the landmark WATCHMAN trials, transesophageal echocardiography (TEE) was used to evaluate peri-device leak (PDL) and device-related thrombus (DRT) after percutaneous left atrial appendage closure (LAAC). We aimed to investigate the diagnostic utility of cardiac computed tomography angiography (CCTA) compared with TEE for post-LAAC device surveillance.

Poor diet quality is a leading risk factor for cardiometabolic disease (ie, diabetes and diseases associated with metabolism and inflammation), which is present in about half of American adults. Support has grown for incorporating the provision of healthy food as a complement to or a component of clinical care. Such "Food Is Medicine" programs provide free or subsidized healthy food directly to patients in close coordination with the health care system. In this review, we systematically examined published randomized controlled trials examining Food Is Medicine programs in the United States, categorizing them into different stages of development using the National Institutes of Health Model for Behavioral Intervention Development. This review identified a total of 14 randomized controlled trials of Food Is Medicine interventions in the United States with noncommunicable disease outcomes, more than one-third of which were early-stage smaller-scale trials (stage 1 randomized controlled trials). Broad variations in populations enrolled; intervention design, duration, and intensity; and outcomes precluded many direct comparisons between studies. Randomized controlled trial data were generally consistent with findings in the observational literature, indicating that common Food Is Medicine approaches often positively influence diet quality and food security, which are theorized to be key mediators for clinical outcomes. However, the impact on clinical outcomes was inconsistent and often failed to reach statistical significance. These observations highlight the need for larger, higher-quality Food Is Medicine studies focusing on the measurement of clinical outcomes within well-designed programs and the need for additional randomized controlled trials that more systematically map out the relationship between participation in different types of Food Is Medicine programs and health outcomes.

Intraoperative transesophageal echocardiography is used with increasing frequency in cardiac surgery for monitoring and diagnostic purposes. Recent data have shown the impact of improved outcomes in patients undergoing cardiac surgery and the use of intraoperative transesophageal echocardiography in managing complex surgical decisions. However, specialty society recommendations have not been updated to reflect these trends. This scientific statement reviews the state-of-the-art practice of intraoperative echocardiography, summarizes the association of the use of intraoperative transesophageal echocardiography with enhanced outcomes, and provides specific perioperative and procedural transesophageal echocardiography considerations in the cardiac surgical population.

Alcohol is one of the most commonly consumed substances in the world, exhibiting complex relationships with multiple aspects of cardiovascular health and disease. The majority of the research on the topic is observational and therefore prone to bias and confounding. The available evidence suggests no risk to possible risk reduction when alcohol is consumed in low amounts (such as no more than 1 to 2 drinks a day) in regard to coronary artery disease, stroke, sudden death, and possibly heart failure. The risk associated with consuming 1 to 2 drinks a day on atrial fibrillation remains unknown. More randomized trials of low to moderate alcohol consumption are needed for more definitive conclusions. In stark contrast, heavier alcohol consumption such as binge drinking or consuming on average ≥3 drinks a day is consistently associated with worse outcomes in every cardiovascular disease entity studied. Considering the level of evidence, it remains unknown whether drinking is part of a healthy lifestyle and therefore clinicians should reinforce healthy lifestyle behaviors such as regularly engaging in physical activity, avoiding tobacco use, and maintaining healthy body weight.

The win ratio is a method for analyzing a hierarchical composite outcome. It has been most widely used in randomized clinical trials (RCTs) in cardiovascular disease. We performed a review of cardiovascular RCTs using the win ratio published between January 2022 and July 2024. The aims were to summarize current use and to provide examples to illustrate effective use and communication. We identified 36 eligible RCTs, mainly in heart failure and ischemic heart disease. Intervention was pharmaceutical in 26, a procedure in 7, and treatment strategy in 3 trials. When outcomes were analyzed with both conventional composite end points or hierarchical analysis, the conclusions tended to be similar. The win ratio was often used to combine evidence from event outcomes and quantitative measures together in a hierarchical composite, as was done in 23 RCTs. It was also used to create a clinically more relevant measure in RCTs by recognizing the clinical priorities among event outcomes. Selected example RCTs illustrate how the clarity of win ratio findings can be improved by (1) complementing the win ratio (a relative measure) with the win difference, (2) identifying which components of a hierarchical composite drive the overall results, and (3) clearly prespecifying the outcomes and win ratio analysis to be used. We conclude with a set of recommendations for future use of hierarchical composite outcomes and the win ratio. When used wisely, the win ratio is a valuable tool in the analysis of RCTs.

The pulsatile nature of blood flow and the hydrostatic effect of pulmonary capillary wedge pressure are 2 fundamental, yet often overlooked features of right ventricular-pulmonary arterial interactions in advanced heart failure and cardiogenic shock. These 2 features (above all others) define both the mechanical forces experienced by the pulmonary arteries, and in turn, the vascular afterload imposed by the pulmonary circulation on the right ventricular. For over half a century, it has been assumed that the pulsatile components of the pulmonary circulation exist in predictable and constant proportion to resistive afterload. In other words, that the vascular afterload can be estimated from mean pulmonary arterial pressure and pulmonary vascular resistance alone. While this tenet holds true for most forms of pulmonary hypertension, pulmonary hypertension resulting from the passive transmission of elevated left atrial pressure is a notable exception. In these cases, arterial compliance decreases proportionally more than any increase in pulmonary vascular resistance and is highly dependent upon recruitment and distensibility of the pulmonary circulation. As questions regarding the optimal method to predict right ventricular failure resurface, along with a modern armamentarium of techniques to assess pulsatile pressure-flow relations, it serves as a timely reminder that, in those with normal or near-normal pulmonary arterial pressures, the pulsatile component of pulmonary vascular afterload may account for anywhere between one-quarter and half of the total power of the right ventricular. In this State-of-the-Art Review, we address the role of pulmonary circulation in those with advanced heart failure and cardiogenic shock. Unlike previous discussions on this topic, we set aside considerations of established precapillary disease, focusing specifically on the process by which an acute or chronic elevation of pulmonary capillary wedge pressure results in pulmonary hypertension from left-sided heart failure. In doing so, we create a framework to assess pulmonary vascular afterload in an era of advanced therapeutics and device technologies to treat advanced heart failure and cardiogenic shock.

Persistent thoracic false lumen flow and subsequent aortic expansion are common complications following thoracic endovascular aortic repair for type B aortic dissection, as well as aortic arch replacement with the elephant trunk technique for type A aortic dissection. Although thoracic false lumen-perfused branches are known to contribute to thoracic false lumen backflow, robust imaging evidence is still lacking. This review illustrates how these branches perpetuate thoracic false lumen flow through detailed imaging analysis, emphasizing the critical need for advancing rapid, accurate, and minimally invasive imaging techniques and novel therapeutic devices to address this persistent clinical challenge.

Obtaining informed consent for clinical trial participation in acute myocardial infarction presents unique ethical and logistical challenges because of the patient distress, sedation, and the urgency of treatment. Traditional consent procedures often conflict with the narrow enrollment windows, prompting the use of legally authorized representatives and short- and long-form consent models. Although these approaches enable faster trial enrollment, they may compromise patient autonomy, introduce selection bias, or create postenrollment ethical dilemmas. This review explores the complexities of informed consent in acute myocardial infarction research, evaluating the advantages and limitations of existing strategies, including legally authorized representative consent, 2-step consent processes, and alternatives such as deferred and verbal consent. It also examines international variations in regulatory oversight and presents emerging solutions, such as preemptive consent, opt-out models, electronic platforms, and registry-based trials, to streamline the enrollment without delaying care. Ultimately, consent regulations should be re-evaluated and potentially relaxed to better support timely research. A thoughtful reassessment of consent frameworks is essential to ethically and effectively advance acute myocardial infarction research in time-sensitive settings.

Recent findings emphasize the potential role of invasive hemodynamic assessment in guiding transcatheter mitral and tricuspid valve percutaneous interventions. Right heart catheterization-derived parameters offer insights into hemodynamic changes associated with valvular heart diseases, pulmonary hypertension phenotyping, and right ventricular to pulmonary artery coupling. This might improve prognostic stratification for candidates to transcatheter therapies. This review provides a clinical overview of available data regarding the utility of preoperative right heart catheterization-derived parameters in patients undergoing mitral and tricuspid percutaneous repair or replacement.

Sarcoidosis is characterized by noncaseating granulomatous inflammation that involves the lungs or lymph nodes in 90% of cases. The prevalence of cardiac involvement in patients with sarcoidosis is thought to be between 5% and 25%. However, cardiac sarcoidosis can also present without extracardiac disease (known as clinically isolated cardiac sarcoidosis) or with previously unrecognized extracardiac disease. The principal manifestations of cardiac sarcoidosis are heart failure or left ventricular systolic dysfunction, high-grade atrioventricular nodal disease, or ventricular arrhythmia. Cardiovascular imaging plays a crucial role in making the diagnosis, partly due to the low yield of endomyocardial biopsy in cardiac sarcoidosis. Cardiovascular imaging is also used for risk stratification for ventricular arrhythmia, to identify patients who may benefit from immunosuppressive therapy, and for longitudinal follow-up on and off therapy. It can also be used to identify alternative diagnoses to cardiac sarcoidosis. This review will discuss how to use imaging in the diagnosis and management of patients with suspected or known cardiac sarcoidosis.

Heart valve replacement in children is fraught with long-term morbidity and mortality rates, largely because conventional implants lack the capacity to grow with the child. Partial heart transplantation presents a potential solution by transplanting only specific segments of a donor heart, thereby providing a living and growing heart valve implant. This approach harnesses the full spectrum of cardiac tissues, which, when freshly procured and supported by immunosuppression, can integrate as functional and potentially growth-capable tissue. This state-of-the-art review discusses the history and development of partial heart transplantation, its indications, recent clinical experiences, regulation, and future directions.