Clinical
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Cardioprotective Therapy Initiation in Chemotherapy Patients
An international study of patients undergoing cancer chemotherapy or left chest radiation therapy showed that those who showed isolated reductions in echocardiography left ventricular global longitudinal strain but not ejection fraction during follow-up who were randomized to neurohormonal therapy vs. usual care showed better preservation of 12-month cardiac magnetic resonance-determined ejection fraction.
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Prognostic Value of Stress Echocardiography
A UK National Health Service database study of stress echocardiography has shown the degree of ischemia accurately predicts the risk of future cardiovascular events over five years. The same study also showed that a negative test in patients without a history of cardiac disease identifies patients with no more than the expected background risk of an event for patients in this demographic for five years.
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EARLY TAVR Study Reports a Win for TAVR in Asymptomatic Severe AS
In this multicenter, randomized trial comparing transcatheter aortic valve replacement (TAVR) with active surveillance in patients with asymptomatic severe aortic stenosis (AS), early TAVR showed an advantage regarding the composite endpoint of death, stroke, or unplanned hospitalization for cardiovascular causes. This result was driven primarily from the progression to severe symptomatic AS among the surveillance group, with no significant difference in mortality.
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Cardiac and Paracardiac Structure in the SUMMIT Trial
A cardiac magnetic resonance imaging study in a subgroup of the patients in the SUMMIT trial of tirzepatide in patients with heart failure with preserved ejection fraction has demonstrated that patients treated with tirzepatide had reduced left ventricular mass and paracardiac adipose tissue compared to placebo-treated patients, which may partially explain the reduction in heart failure events observed in the main SUMMIT trial.
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A New Treatment for Heart Failure with Preserved Ejection Fraction
A recent randomized, placebo-controlled trial of the long-acting glucagon-like peptide-1 receptor agonist tirzepatide in patients with heart failure with preserved left ventricular ejection fraction who have obesity, diabetes, and one other weight-related comorbidity has shown that tirzepatide not only reduces the symptoms of heart failure, but reduces the incidence of worsening heart failure events.
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Endometrial Cancer: An Update to Classification Using Molecular Features
The classification of endometrial cancer is evolving, transitioning from histological subtypes to molecular profiling. Four key molecular subtypes (POLE ultramutated, MSI unstable, p53 mutant, and NSMP) guide prognosis and treatment. The integration of molecular features into staging highlights their clinical relevance for improving diagnostic accuracy and therapeutic strategies.
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Adverse Outcome Predictors in Pregnancies Complicated by SLE
A prior history of lupus nephritis, active systemic lupus erythematosus (SLE) at conception, secondary antiphospholipid syndrome, and chronic hypertension are critical predictors of adverse pregnancy outcomes in women with SLE.
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Twelve-Month Contraceptive Prescriptions: Do They Make a Difference?
In this national retrospective cohort study of patients on Medicaid, states with 12-month hormonal contraceptive supply policies increased their 12-month dispensing by only 4.39% compared to the pre-policy period. The majority of this increase was contributed by the state of California.
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Individualizing Opioid Prescriptions After Cesarean Delivery
A multicenter, randomized controlled trial of 5,521 participants who underwent uncomplicated cesarean deliveries found that an individualized opioid prescription protocol (IOPP) with shared decision-making was noninferior to a fixed prescription regarding the proportion of participants experiencing moderate to severe pain one week post-discharge, while significantly reducing the number of opioid tablets prescribed at discharge (median of 14 tablets vs. 20 tablets, P < 0.001).
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Does the Physical Exam Help?
You are given the electrocardiogram (ECG) in the figure and told that the patient is a young man in his 20s who presents with acute dyspnea. The physical exam is remarkable for tachypnea, cyanosis, and clubbing of the extremities. How would you interpret the rhythm? Do the noted physical exam findings help in your assessment of the rhythm?