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 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.

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.

Fidelity of wound healing after myocardial infarction (MI) is an important determinant of subsequent adverse cardiac remodeling and failure. Macrophages derived from infiltrating Ly6Chi (lymphocyte antigen 6 complex, locus C) blood monocytes are a key component of this healing response; however, the importance of other macrophage populations is unclear.

Deep analgosedation (DAS) or general anesthesia (GA) is mandatory for pulsed-field ablation (PFA) of atrial fibrillation (AF). In contrast to DAS, GA (conventional or total intravenous anesthesia [TIVA]) requires airway management. To find the optimal sedation regimen, this study compared ketamine-remimazolam DAS and propofol-opioid TIVA to propofol-opioid DAS, focusing on sedation-related adverse events.

The PRAETORIAN trial investigated the efficacy and safety of the subcutaneous implantable cardioverter-defibrillator (S-ICD) compared with transvenous ICD (TV-ICD) and showed non-inferiority of the S-ICD with regard to the composite endpoint of device-related complications and inappropriate shocks (IAS) after 49.1 months. Complications associated with transvenous leads are expected to occur after longer follow-up. The PRAETORIAN-XL trial aims to investigate whether the S-ICD is superior to the TV-ICD with respect to device-related complications at 8-year follow-up.

There is sparse high-quality safety and effectiveness data for pulsed field ablation (PFA) of persistent atrial fibrillation (PerAF), where lesions beyond pulmonary vein isolation (PVI) are often placed. Additionally, no large trials have used insertable cardiac monitors (ICMs) for continuous rhythm monitoring post-ablation in PerAF patients, or after PFA in any AF population. In ADVANTAGE AF-Phase 2, PerAF patients underwent PFA for PVI and posterior wall ablation (PWA), and in a sub-cohort, cavotricuspid isthmus (CTI) ablation for typical atrial flutter.

Despite major advances in recent years, the timely detection and prevention of incipient congestion in patients with chronic heart failure remains challenging. Most approaches are either invasive or require the acquisition of additional hardware. Leveraging voice analysis for the purposes of diagnosing, predicting risks, and telemonitoring clinical outcomes of patients with heart failure represents a promising, cost-effective, and convenient alternative compared with hitherto deployed methods. To expand this field, close collaboration of several disciplines of medicine and computer science is an obligatory requirement. The current review aims to lay out the state-of-the-art in this quickly advancing area of research. It elucidates the foundation for voice feature extraction, describes the prospective capabilities of this evolving technology, and outlines the challenges involved in identifying vocal biomarkers both in general and in the context of heart failure.