Dr. Joshua F. Grant, DO

Cardiovascular-Kidney-Metabolic Syndrome Stages, Echocardiographic Characteristics, and Heart Failure Risk: ARIC

The AHA CKM syndrome staging framework predicts incident HF. ARIC (n=5646): CKM stage 3 → HR 3.6, stage 4 → HR 8.3 for incident HF over ~9 years. Use it to triage who needs intensified preventive GDMT.

"Heart Stress" as a Pre-HF Stage — NT-proBNP in ARIC and MESA

Age-specific NT-proBNP thresholds define a "heart stress" pre-HF stage. ≥75 (<50 yr), ≥150 (50-74), ≥300 (≥75) — independently associated with incident HF (HR 1.8-2.2) in ARIC/MESA. Supports biomarker-guided prevention.

Advanced Molecular, Metabolic, and Imaging Approaches to Characterizing Right Ventricular Failure: A Scientific Statement From the American Heart Association

Two AHA Scientific Statements published this month: RV failure (cross-cuts PH, HFpEF, LVAD) and pediatric ADHF. Treat as reference documents.

Hospital Tier and Cardiogenic Shock Outcomes in the US

Tiered cardiogenic shock care saves lives. 623K-admission analysis: Level 1 centers had ~16% lower in-hospital mortality than Level 3, with stepwise gradient (aOR 1.33 / 1.44 / 1.63 for Levels 1A / 2 / 3 vs Level 1). Push for transfer to Level 1 in CS.

Aortic Insufficiency and Right Heart Failure After Preoperative Microaxial Flow Device Support — Intermacs Analysis

Preoperative Impella support is associated with substantial post-LVAD aortic insufficiency and RHF. Intermacs PS-matched (n=5942): mAFP → 2-yr AI HR 1.75 vs no tMCS; meaningful RHF signal.

Utility of Direct Fick Cardiac Output in Patients With LVADs

Direct Fick CI (measured VO₂) is the only reliable cardiac output method in LVAD patients. Indirect Fick equations correlate poorly (R 0.25-0.42); only direct Fick predicts the death/HT/HHF composite.

Standardized Reporting in HF Noninvasive Remote Monitoring Trials — "The 6 Rs"

The "6 Rs" framework for HF remote monitoring (Representativeness, Recording, Relay, Review, Response, Recommendations) — multisociety consensus to standardize RPM workflow reporting. Use to scope and audit RPM programs.

Social Determinants of Health, Race, and Sex on Risk for Readmission After Heart Transplantation

In post-HT readmission, education level — not race, sex, or SES tertile — predicts 1-year rehospitalization (HR 1.41). Screen for health literacy pre-transplant.

Screening Strategies for Transthyretin Amyloid Cardiomyopathy — State-of-the-Art Review

ATTR-CM remains substantially underdiagnosed. State-of-the-art review on screening strategies — use EHR-triggered alerts (HFpEF + LVH + carpal tunnel, low-voltage ECG, etc.) and structured risk modeling to identify candidates for PYP imaging and disease-modify…

PRAISE-MR — Angiotensin Receptor Neprilysin Inhibitor in HFpEF and Secondary Mitral Regurgitation

Sacubitril/valsartan signal in HFpEF with atrial functional MR (PRAISE-MR, n=84). Improved exercise mPAP/CO slope, peak VO₂, KCCQ, NT-proBNP. Hypothesis-generating.

Microaxial Flow Pumps in Heart Failure-Related Cardiogenic Shock — State-of-the-Art Review

Practical roadmap for HF-CS device selection in a literature dominated by AMI-CS trials.

Hospital Tier and Cardiogenic Shock Outcomes in the US

Tiered cardiogenic shock care saves lives. 623K-admission analysis: Level 1 centers had ~16% lower in-hospital mortality than Level 3, with stepwise gradient (aOR 1.33 / 1.44 / 1.63 for Levels 1A / 2 / 3 vs Level 1). Push for transfer to Level 1 in CS.

Evaluation and Management of the Child With Acute Decompensated Heart Failure: A Scientific Statement From the American Heart Association

First comprehensive AHA guidance specifically for pediatric ADHF — a population with rising admissions, higher morbidity/mortality than adults, and much greater resource use.

EXCOR Pediatric VAD — Novel Active Driving System, Multicenter Prospective

Donor LV Geometric Remodeling and Hypertrophy — Impact on Acceptance and Recipient Survival

Donor heart geometry matters more than wall thickness alone. 3,647-donor study: hearts rejected for "LVH" usually had normal geometry or concentric remodeling, not true hypertrophy — and none of these patterns predicted 3-yr recipient survival. Could safely ex…

Cardiovascular-Kidney-Metabolic Syndrome Stages, Echocardiographic Characteristics, and Heart Failure Risk: ARIC

The AHA CKM syndrome staging framework predicts incident HF. ARIC (n=5646): CKM stage 3 → HR 3.6, stage 4 → HR 8.3 for incident HF over ~9 years. Use it to triage who needs intensified preventive GDMT.

Cardiac Sarcoidosis — Divergent Diagnostic Philosophies Between Japan and North America

Diagnostic threshold directly drives downstream decisions: when to start immunosuppression, when to place ICD for unexplained LV dysfunction or arrhythmia, when to refer for advanced therapies.

Aortic Insufficiency and Right Heart Failure After Preoperative Microaxial Flow Device Support — Intermacs Analysis

Preoperative Impella support is associated with substantial post-LVAD aortic insufficiency and RHF. Intermacs PS-matched (n=5942): mAFP → 2-yr AI HR 1.75 vs no tMCS; meaningful RHF signal.

Advanced Molecular, Metabolic, and Imaging Approaches to Characterizing Right Ventricular Failure: A Scientific Statement From the American Heart Association

Two AHA Scientific Statements published this month: RV failure (cross-cuts PH, HFpEF, LVAD) and pediatric ADHF. Treat as reference documents.

ANTHEM-HFrEF — Vagal Nerve Stimulation in HFrEF (Pivotal Trial)

VNS for HFrEF: still not supported. ANTHEM-HFrEF pivotal trial terminated early; primary endpoint (CV death / HF hosp) neutral (HR 0.84, p=0.115). Safe and engaging the vagal nerve, but no proven efficacy.

"Heart Stress" as a Pre-HF Stage — NT-proBNP in ARIC and MESA

Age-specific NT-proBNP thresholds define a "heart stress" pre-HF stage. ≥75 (<50 yr), ≥150 (50-74), ≥300 (≥75) — independently associated with incident HF (HR 1.8-2.2) in ARIC/MESA. Supports biomarker-guided prevention.

CADENCE — Sotatercept for Combined Post- and Precapillary PH in HFpEF (Phase 2)

CADENCE — sotatercept is the first positive Phase 2 RCT for Cpc-PH in HFpEF (Group 2 PH). N=164, PVR reduction Δ −1.02 WU vs placebo at 0.3 mg/kg (p=0.004), with simultaneous reductions in mPAP and PAWP. Proof-of-concept; awaiting Phase 3 outcomes.

Refining the Definition of "Low Risk" in PAH — REVEAL 2.0 ≤4

"Refined low-risk" PAH = REVEAL 2.0 score ≤4 (3-year mortality 2.6%, 1-year clinical worsening 6.4%) based on patient-level pooled analysis of 8 PAH RCTs (n=1,925). First risk definition embedding both 3-year mortality and 1-year morbidity, not just 1-year mor…

Hemodynamic Reclassification of CTEPD to CTEPH Under New mPAP >20 mmHg Threshold

The new mPAP >20 mmHg threshold for CTEPH is clinically meaningful. Patients reclassified from CTEPD to CTEPH under the 2022 ESC/ERS definition show abnormal exercise physiology (oxygen desaturation, reduced ventilatory efficiency) — supports active CTEPH work…

RV Adaptation After PEA vs BPA in CTEPH — Multicenter Cardiac MRI Study

Both PEA and BPA achieve RV reverse remodeling proportional to hemodynamic unloading (multicenter cardiac MRI study, n=93). PEA delivers deeper unloading; BPA delivers proportionally similar RV recovery in inoperable patients.

Abbreviated 3-Point Assessment Tool for Detecting PH in Patients With ILD

A simple 3-point PH-ILD screening tool (exam findings, DLCO <40%, supplemental O₂) — score ≥2 has 90% sensitivity, 78% PPV to trigger echo/RHC referral in ILD patients.

Toward a Safe Pathway to Biological Parenthood for Women With PAH

IVF + gestational surrogacy + PGT-M/PGT-A is now a safer biological-parenthood pathway for women with PAH than historically perceived — a defensible alternative to pregnancy (which remains contraindicated).

Specialty Palliative Care to Improve Quality of Life in PAH — RCT

Specialty palliative care did NOT improve HRQOL in PAH in the first RCT (n=62) — limited uptake (58% completion) was the main bottleneck. Keep SPC as an option for selected patients but don't oversell HRQOL benefit.

Sotatercept Improves Small Airway Disease and Hyperinflation in Patients With PH

Suggests sotatercept may have favorable effects on the lung parenchyma/airways in addition to its established PVR-lowering effect — relevant when considering its use in patients with overlapping airway disease.

Seralutinib Phase 2 Circulating Biomarker Substudy in PAH

Track seralutinib closely — second novel mechanism (after sotatercept) reaching Phase 3 in PAH.

SEARCH Algorithm — Identifying Chronic Thromboembolism Phenotypes After Acute PE

SEARCH algorithm formalizes diagnosis of chronic thromboembolism phenotypes after acute PE — only ~12% have any chronic thromboembolic phenotype; most are not classic CTEPH (includes exercise-induced PH, ventilatory-inefficiency phenotype). Very high inter-rea…

Rescue BPA Before Elective PEA + Mitral Valve Plasty in High-Risk Operable CTEPH

Adds a practical bridge option for operable CTEPH patients with severe LV-side pathology who are too sick for combined surgery upfront.

Refining the Definition of "Low Risk" in PAH — REVEAL 2.0 ≤4

"Refined low-risk" PAH = REVEAL 2.0 score ≤4 (3-year mortality 2.6%, 1-year clinical worsening 6.4%) based on patient-level pooled analysis of 8 PAH RCTs (n=1,925). First risk definition embedding both 3-year mortality and 1-year morbidity, not just 1-year mor…

RV Adaptation After PEA vs BPA in CTEPH — Multicenter Cardiac MRI Study

Both PEA and BPA achieve RV reverse remodeling proportional to hemodynamic unloading (multicenter cardiac MRI study, n=93). PEA delivers deeper unloading; BPA delivers proportionally similar RV recovery in inoperable patients.

PVRI India Taskforce Consensus Statement on PAH Management

Useful reference when caring for PAH patients from LMIC backgrounds or training residents who will practice internationally.

Hemodynamic Reclassification of CTEPD to CTEPH Under New mPAP >20 mmHg Threshold

The new mPAP >20 mmHg threshold for CTEPH is clinically meaningful. Patients reclassified from CTEPD to CTEPH under the 2022 ESC/ERS definition show abnormal exercise physiology (oxygen desaturation, reduced ventilatory efficiency) — supports active CTEPH work…

CADENCE — Sotatercept for Combined Post- and Precapillary PH in HFpEF (Phase 2)

CADENCE — sotatercept is the first positive Phase 2 RCT for Cpc-PH in HFpEF (Group 2 PH). N=164, PVR reduction Δ −1.02 WU vs placebo at 0.3 mg/kg (p=0.004), with simultaneous reductions in mPAP and PAWP. Proof-of-concept; awaiting Phase 3 outcomes.

Antidiabetic Medications and Survival in PH Patients With Diabetes — VA Cohort

In PH + diabetes, metformin (HR 0.83) and TZDs (HR 0.84) were associated with lower mortality; insulin with higher mortality in a 41,670-veteran VA cohort. Confounding by indication likely for insulin, but supports robust use of metformin/TZD when safe.

Abbreviated 3-Point Assessment Tool for Detecting PH in Patients With ILD

A simple 3-point PH-ILD screening tool (exam findings, DLCO <40%, supplemental O₂) — score ≥2 has 90% sensitivity, 78% PPV to trigger echo/RHC referral in ILD patients.