Pauley Research Roundup - Summer 2025
A roundup of published research by Pauley faculty from June through August 2025
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Author: Tanner Lambson
June
Examining factors associated with experiencing cardiac arrhythmias in Black and White breast cancer survivors who received anthracyclines or trastuzumab
Pauley researchers: Arnethea Sutton, PhD; Wendy Bottinor MD; Vanessa Sheppard, PhD
Journal: Breast Cancer Research and Treatment
Publication date: June 2025
This study looked at why some women who survive breast cancer develop heart rhythm problems after treatment. Researchers reviewed medical records of 860 women who had received cancer treatment drugs that can affect the heart, such as anthracyclines or trastuzumab. They checked if these women later had arrhythmias (irregular heartbeats) and compared Black and white women, along with other factors like age, weight, high blood pressure, and diabetes. About one-third of the women had arrhythmias after cancer treatment. At first, race seemed linked to these heart problems, but when other health factors were considered, race alone was not a major factor. Instead, certain conditions mattered more: Black women with high blood pressure were much more likely to have arrhythmias than those without it, and White women who were obese were more likely to have arrhythmias than those at a normal weight. Younger Black women were also more likely to have arrhythmias than older Black women. The authors suggest that increased heart health monitoring and management for both Black and white breast cancer survivors with comorbidities like hypertension and obesity may ultimately reduce racial disparities in breast cancer morbidity and mortality.
Postural Orthostatic Tachycardia Syndrome and Orthostatic Hypotension Following Hematopoietic Stem Cell Transplantation
Pauley researchers: Georgia Thomas, MD, PhD; Ben VanTassel, PharmD, BCPS, FFCP
Journal: JACC CardioOncology
Publication date: June 2025
This study, which was funded in part by a Pauley Heart Center Pilot Project Grant, looked at how often two conditions—postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH)—happen in people who get a stem cell transplant for blood cancers. These conditions affect how the heart and blood pressure respond when someone stands up. Researchers followed 46 patients before their transplant and then 30 and 100 days afterward. They measured heart rate, blood pressure, and a chemical called norepinephrine while lying down and after standing for 10 minutes. Before the transplant, only about 4% of patients had POTS and 4% had OH. But 30 days after the transplant, about 26% had POTS and 15% had OH. By 100 days, the numbers dropped to 14% for POTS and 6% for OH, and no new cases appeared. The study shows that these problems are common after stem cell transplants and may be linked to changes in the body’s nervous system and immune response.
High-Density Mapping and Fasciculoventricular Pathways
Pauley researchers: Ken Ellenbogen, MD
Journal: JACC Clinical Electrophysiology
Publication date: June 2025
This report describes three patients who had unusual electrical connections in the heart called fasciculoventricular (FV) pathways. These pathways allow signals to travel from the heart’s conduction system directly to the ventricles, which can cause early activation of the heart muscle. Doctors used high-density mapping to find exactly where these pathways connect. The first patient was a 52-year-old man with palpitations, the second was a 31-year-old woman with a genetic heart condition, and the third was a 21-year-old man treated for a different rhythm problem. In all cases, the FV pathways were located very close to the His bundle, a key part of the heart’s electrical system, about 1 centimeter away. The mapping showed that these pathways start near the His bundle and insert into the basal part of the ventricles. This study is important because it is the first to show detailed maps of these rare pathways, which helps doctors understand where they are and avoid unnecessary treatments.
Differences Between Ischemic and Nonischemic Cardiomyopathy in Heart Failure Related Cardiogenic Shock
Pauley researchers: Michael Kontos, MD
Journal: Journal: Journal of Cardiac Failure
Publication date: June 2025
This study compared two types of heart muscle problems—ischemic cardiomyopathy (ICM), caused by coronary artery disease, that is, blocked heart arteries, and nonischemic cardiomyopathy (NICM), which are heart muscle problems arising from other issues, such as viral infection, drug reactions, autoimmune disease, etc.—in patients who developed cardiogenic shock from heart failure. Researchers looked at data from over 2,400 hospital admissions between 2017 and 2022. They found that patients with ICM were usually older, had more health problems like diabetes and kidney disease, and were more likely to have had a cardiac arrest before arriving at the hospital. Both groups received similar treatments, like medications to help the heart pump and devices for temporary cardiac support, but ICM patients needed breathing machines and kidney treatments more often. People with NICM were more likely to get a heart transplant, while both groups had similar chances of getting a long-term heart pump. Overall, patients with ICM were more likely to die in the hospital—about 33% compared to 22% for NICM—even after adjusting for age and other health issues.
Disparities in diagnosis and outcomes in American patients with transthyretin cardiac amyloidosis
Pauley researchers: Shaimaa Fadl, MD; Cory Trankle, MD
Journal: The International Journal of Cardiovascular Imaging
Publication date: 5 June 2025
This study looked at differences in how African Caribbean (AC) and white patients in the U.S. are diagnosed and treated for a heart condition called transthyretin cardiac amyloidosis (ATTR-CA). Researchers reviewed data from 231 patients who had heart scans and confirmed ATTR-CA. They found that AC patients were more likely to have severe disease when diagnosed, with worse heart function and higher levels of blood markers that show heart stress. AC patients also had more health problems like high blood pressure and diabetes and were less likely to receive treatments that can slow the disease. Over about one year of follow-up, AC patients were much more likely to die or be hospitalized for heart failure compared to white patients (72% vs 33%). Even after adjusting for other factors, race was the strongest predictor of poor outcomes. The study suggests that AC patients face delays in diagnosis and lower treatment rates, which may lead to worse results. Researchers say more work is needed to understand why these differences happen and to create treatment strategies that address the apparent health inequities.
Performance of PREVENT and pooled cohort equations for predicting 10-Year ASCVD risk in the UK Biobank
Pauley researchers: Carolyn Burns, MD; Phillip Duncan, MD; Greg Hundley, MD; Anurag Mehta, MD
Journal: American Journal of Preventive Cardiology
Publication date: June 2025
This study is a comparison of two tools used to predict the chance of a patient having heart problems: the Pooled Cohort Equations (PCE), first published by the American College of Cardiology (ACC) and the American Heart Association (AHA) in 2013 and the newer PREVENT equations published by the AHA in 2023. Researchers looked at data from over 368,000 people in the UK Biobank who did not have heart disease at the start of the study’s ten-year window, and applied PCE and PREVENT to the initial measurements. When compared to what really occurred with the patient, PCE often predicted much higher risk than what was observed, especially for men. PREVENT estimated lower risk and was better matched to real outcomes.
Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with heart failure and mildly reduced left ventricular ejection fraction: Results from International Collaborative LBBAP Study (I-CLAS) Group
Pauley researchers: Ken Ellenbogen, MD
Journal: Heart Rhythm
Publication date: June 2025
This study compared two ways of delivering cardiac resynchronization therapy (CRT) for people with heart failure and a mildly reduced pumping ability of the heart. The two methods were biventricular pacing (BVP), which uses two leads to make the heart beat more evenly, and conduction system pacing (CSP), which targets the heart’s natural electrical pathways. Researchers looked at 1,004 patients treated at 16 hospitals worldwide. They found that CSP patients had shorter procedure times and narrower QRS durations (a measure of the heart’s electrical activity, and a positive outcome) than those with BVP. Both methods improved heart function, but CSP patients had better overall outcomes: fewer died or were hospitalized for heart failure. Patients who received CSP also showed fewer rhythm problems like atrial fibrillation and dangerous ventricular arrhythmias. While both methods helped, CSP appeared to be a safer and more effective form of heart pacing for this group of patients.
Percutaneous repair of biatrial drainage of the right superior vena cava using a covered stent
Pauley researchers: Sangeeta Shah, MD
Journal: International Journal of Cardiology Congenital Heart Disease
Publication date: June 2025
This report describes a rare heart condition where the right superior vena cava (RSVC), a large vein that normally carries blood into the right atrium, drains into both the right and left atria. This can cause low oxygen levels (cyanosis) and increase the risk of stroke or brain infection. Traditionally, fixing this problem requires open-heart surgery, which carries risks. In this case, doctors treated a 45-year-old woman using a less invasive method: placing a covered stent through a catheter to redirect blood flow correctly. Before the procedure, her oxygen levels were low, but after the stent was placed, her oxygen improved to normal and stayed that way for almost three years. She had no complications or heart rhythm problems. This case shows that using a covered stent can be a safe and effective alternative to surgery for this rare condition.
VCU Collaborators: Samuel Casella, MD
Global Practices in Cardiac Imaging for Cardiac Sarcoidosis: A Survey Study of International Experts With Delphi Consensus
Pauley researchers: Jordana Kron, MD
Journal: JACC Cardiovascular Imaging
Publication date: June 2025
This study looked at how doctors around the world use heart imaging to diagnose and manage cardiac sarcoidosis, a condition in which inflammation causes scarring on the heart and can cause dangerous rhythm problems or heart failure. Experts from 13 countries contributed their expertise as to the most effective clinical decision-making pathways for the most effective use of cardiac imaging in the diagnosis and treatment of cardiac sarcoidosis. They agreed that advanced imaging—like cardiac MRI and PET scans—should be used when patients with sarcoidosis develop new heart rhythm issues or signs of heart weakness. However, there was no agreement on how to measure certain imaging details, like the amount of scar tissue or how much improvement on PET scans indicates that treatment is working. Experts also disagreed on how often to repeat scans for follow-up, especially in patients without symptoms. Overall, the study established some clear guidelines but also uncovered many unanswered questions, showing the need for more research to standardize sarcoidosis care.
Influences of age and obesity on heart transplant outcomes
Pauley researchers: Inna Tchoukina, MD; Keyur Shah, MD; Josue Chery, MD; Vigneshwar Kasirajan, MD; Zubair Hashmi, MD
Journal: JTCVS Open
Publication date: June 2025
This study looked at how age and obesity affect survival after heart transplants. Researchers analyzed data from more than 23,000 U.S. patients who received a heart transplant between 2014 and 2023. They divided patients into four groups: normal risk, high-risk age (over 70), high-risk BMI (over 30), and those with both high-risk age and BMI. Results showed that patients who were older or obese had worse survival than normal-risk patients, and those with both risk factors had the lowest survival. After five years, survival was about 80% for normal-risk patients, 77% for older patients, 76% for obese patients, and 67% for those with both risks. Even so, the study found that transplants still provided many benefits for high-risk patients as compared to those patients who remained on the transplant waiting list.
Impact of the Composite Allocation Score on Lung Transplant Waitlist and Posttransplant Outcomes
Pauley researchers: Rachit Shah, MD; Zachary Fitch, MD; Vigneshwar Kasirajan, MD; Zubair Hashmi, MD, FACS, FACC
Journal: Transplantation Direct
Publication date: 27 June 2025
This study looked at what happened after the U.S. switched to a new system, called the Composite Allocation Score (CAS), to allocate donor organs to lung transplant recipients in March 2023. The CAS system was designed to make organ distribution fairer by considering medical urgency, odds of survival, and access, instead of primarily focusing on donor-recipient proximity, as the previous allocation system had done. Researchers analyzed over 6,000 transplants and found that after CAS had been implemented, patients spent less time on the lung transplant waitlist, had lower waitlist death rates, and better survival at six months and one year after transplant. More donor lungs came to recipients from farther away and from donors after circulatory death, but this also meant longer travel and more flights. While access improved for Black patients and those with high antibody levels, challenges remain for people with blood type O and shorter height. Overall, CAS seems to make lung transplants more equitable and successful, but further improvements are needed.
July
Are high school cardiopulmonary resuscitation education mandates working? Insights from a high school survey on CPR knowledge, attitudes, and readiness
Pauley researchers: Ken Ellenbogen, MD
Journal: Heart Rhythm
Publication date: July 2025
This study looked at whether laws that require high school students to learn cardiopulmonary resuscitation (CPR) and how to use an automated external defibrillator (AED) are working. Researchers surveyed nearly 2,400 students from all 50 states. They found that while 86% of students had some CPR training, only about 58% felt confident about using an AED, and just over half remembered how to perform CPR correctly. Most students agreed that learning CPR is important and said refresher courses would help. Many also thought training should continue in college. The results show that even though CPR training is required in most states, many students do not actually undergo the training, and the quality and frequency of training may not be enough to prepare students for real emergencies. The authors suggest improving and standardizing CPR education.
Race Comparisons in Patients With Cardiac Sarcoidosis: Insights From the Cardiac Sarcoidosis Consortium
Pauley researchers: Ken Ellenbogen, MD; Jordana Kron, MD
Journal: Circulation: Arrhythmia and Electrophysiology
Publication date: 25 June 2025
This study looked at differences between Black and white patients with cardiac sarcoidosis, a disease that causes inflammation in the heart. Researchers found that Black patients were diagnosed younger, had weaker heart function, and were more likely to have other health problems like high blood pressure, diabetes, and kidney disease. Despite these challenges, both Black and white patients had similar outcomes, including rates of survival and incidences of major heart events, when treated in specialty centers. The study suggests that while Black patients often begin sarcoidosis treatment with more health issues, equal access to specialized care can lead to similar results for both groups.
Proteomics in Acute Heart Transplant Rejection, on Behalf of the GRAfT Investigators
Pauley researchers: Inna Tchoukina, MD; Keyur Shah, MD
Journal: Transplantation
Publication date: 1 July 2025
This study looked at proteins in the blood of heart transplant patients to understand two types of rejection: acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Researchers analyzed 181 proteins and found that cardiac injury-associated biomarkers were more pronounced in AMR, whereas inflammatory biomarkers were more pronounced in AMR. The study suggests that using proteomics—the comprehensive study of all proteins present in a given biological sample—could improve care for heart transplant patients in the future.
Heart Rate Lowering With Ivabradine and Burden of Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome
Pauley researchers: Georgia Thomas, MD, PhD; Roshanak Markley, MD; Justin Canada, PhD, RCEP; Antonio Abbate, MD
Journal: Journal of Cardiovascular Pharmacology
Publication date: 1 July 2025
Postural orthostatic tachycardia syndrome (POTS) causes a big jump in heart rate when standing, leading to symptoms like dizziness, chest pain, and fatigue. This study looked at whether lowering heart rate with ivabradine, a medicine that slows the heart without lowering blood pressure, could help. Ten patients with severe POTS symptoms took ivabradine for several months. The change in patient heart rate upon standing was reduced from 40 BPM to 15 BPM, and patients’ symptom scores were cut in half, with the biggest improvements in feeling faint and chest pain. These results suggest that the fast heart rate in POTS is not just the body’s way of coping with POTS but rather a main cause of POTS symptoms, and that slowing the heart rate can help to reduce POTS symptoms.
Safety of oral intake prior to cardiac catheterization with minimal to moderate sedation: A systematic review and meta-analysis of randomized controlled trials
Pauley researchers: Zachary Gertz, MD
Journal: American Heart Journal
Publication date: 1 July 2025
Doctors often ask patients to fast before invasive heart procedures, like cardiac catheterization, but this review looked at whether eating or drinking before such procedures is actually unsafe. Researchers analyzed data from eight studies and more than 3,300 patients and found no major differences between fasting and non-fasting groups for serious procedure-related problems like aspiration, low blood sugar, kidney injury, or low blood pressure. No patient in either group needed emergency intubation. Interestingly, fasting might slightly increase the odds a patient would experience nausea and vomiting, while not fasting may increase the odds of kidney injury. Study is needed to confirm either finding. Overall, the study suggests that allowing patients to eat or drink before these procedures may be safe, but more research is needed to confirm.
Complications Leading to Death in Patients Supported by the Impella 5.5: Analysis From the FDA MAUDE Database
Pauley researchers: Inna Tchoukina, MD; Melissa Smallfield, MD; Josue Chery, MD; Zubair Hashmi, MD; Michael Kontos, MD; Keyur Shah, MD; Pengyang Li, MD
Journal: Catheterization and Cardiovascular Interventions
Publication date: July 2025
The Impella 5.5 is a heart pump used to help patients with severe heart failure or shock. This study investigated the causes of reported Impella 5.5-related deaths. Researchers reviewed 43 reports from the FDA database and found that most deaths were linked to problems during the heart pump placement procedure, especially heart perforation caused by incorrect placement or repositioning of the device. Other complications arising from the device included bleeding, valve damage, and device malfunctions like pump failure or blood clots that led to strokes. The study shows that better training for doctors, improved device design, and stronger safety protocols are needed to prevent these serious complications.
Association of Lipoprotein(a) with cardiovascular events among individuals with autoimmune conditions
Pauley researchers: Benjamin Van Tassell, PharmD, BCPS, FCCP, FAHA, ASH-CHC; Dave Dixon, PharmD, FACC, FAHA, FCCP, FNLA, BCACP, CLS ; Greg Hundley, MD; Fadi Salloum, PhD, FAHA, FAPS
Journal: Athlerosclerosis
Publication date: July 2025
This study looked at whether high levels of lipoprotein(a), a type of cholesterol particle, increase the risk of heart problems in people with autoimmune diseases like lupus or rheumatoid arthritis. Using data from over 350,000 people in the UK Biobank, researchers found that both autoimmune conditions and high lipoprotein(a) levels separately raise the risk of major heart events such as heart attack, stroke, or death. People with both risk factors had the highest risk—almost twice as high as those with neither. The study suggests that measuring lipoprotein(a) could help doctors identify patients who need extra care, and future treatments that lower lipoprotein(a) might be especially helpful for people with autoimmune diseases.
Atrioventricular Conduction Disturbances in Patients Undergoing Transcatheter Tricuspid Valve Intervention: A Multidisciplinary Consensus
Pauley researchers: Kenneth Ellenbogen, MD
Journal: JACC: Cardiovascular Interventions
Publication date: 28 July 2025
Tricuspid regurgitation – that is, a leaking tricuspid valve – is typically repaired via cardiac surgery, but newer catheter-based therapies have been used with patients who are considered to be too high-risk for surgery. However, these catheter-based procedures can sometimes cause heart rhythm problems because the tricuspid valve is close to the heart’s electrical system. The risk is highest with valve replacement, where up to 25% of patients may need a pacemaker following the replacement procedure, while valve repair procedures less frequently cause these issues. Patients who already have pacemaker or defibrillator leads face extra challenges, since the leads can interfere with the new valve or become trapped within the valve. The authors suggest careful planning, including imaging, monitoring rhythm changes after the procedure, and considering alternatives like leadless pacemakers. They also call for more research and better device designs to reduce these complications.
Prophylactic left atrial appendage ligation during coronary artery bypass grafting: A propensity score-matched analysis
Pauley researchers: Mohammed Quader, MD
Journal: The Journal of Thoracic and Cardiovascular Surgery
Publication date: July 2025
This study looked at whether tying off the left atrial appendage (a small pouch in the heart where clots often form) during heart bypass surgery helps prevent strokes in patients who hadn’t been diagnosed with atrial fibrillation (a heart rhythm disorder) prior to their surgery. Researchers reviewed more than 16,000 cases and compared patients who had the atrial appendage procedure versus those who didn’t. They found that while the ligation group had more atrial fibrillation after surgery, stayed in intensive care longer, and had higher hospital costs, there was no difference in short-term outcomes like stroke or death. The use of this procedure is increasing, but its benefits for patients without atrial fibrillation remain unclear, and more research is needed to see if it benefits patients in the long run.
Cardiac Magnetic Resonance-based Tissue Characterization for Detection of Transthyretin Cardiac Amyloidosis with Negative or Equivocal Technetium-Pyrophosphate Scan
Pauley researchers: Shaimaa Fadl, MD; Cory Trankle, MD
Journal: JACC: Cardiovascular Imaging
Publication date: 16 July 2025
This study looked at how cardiac MRI that is, cardiac magnetic resonance, or CMR) can help find a heart condition called transthyretin cardiac amyloidosis (ATTR-CA) when a different type of heart scan (Tc-PyP) gives a negative or unclear result. Researchers reviewed patients from four hospitals and found that about 12% of confirmed ATTR-CA cases had negative Tc-PyP scans. They discovered that measuring extracellular volume (ECV) with CMR was very accurate for detecting the disease, even when Tc-PyP was negative. An ECV value of 47% or higher identified these patients with 72% sensitivity and 100% specificity. The findings suggest that if doctors still suspect ATTR-CA after a negative Tc-PyP scan, CMR should be used to confirm the diagnosis,, which could help patients start treatment more quickly.
Early Outcomes of Primary Graft Dysfunction Comparing Donation After Circulatory and Brain Death Heart Transplantation: An Analysis of the UNOS Registry
Pauley researchers: Inna Tchoukina, MD; Keyur Shah, M; Zachary Fitch, MD; Patricia Nicolato, DO; Josue Chery, MD; Mohammed Quader, MD; Vigneshwar Kasirajan, MD; Zubair Hashmi, MD, FACS, FACC
Journal: Clinical Transplantation
Publication date: July 2025
This study looked at heart transplants from donors after circulatory death (DCD) compared to those of donors after brain death (DBD) and focused on a serious problem called primary graft dysfunction (PGD), a condition in which the organ fails to function properly after transplant. Researchers reviewed over 5,000 transplants and found that PGD happened more often in DCD hearts (about 8% vs. 5% at 24 hours), but survival rates at 30 days and 1 year were similar for both groups. Patients with PGD who received DCD hearts often needed extra support like ECMO (a machine that helps the heart and lungs), and using ECMO early seemed to improve survival. The study suggests that while DCD hearts have a higher risk of early problems, these issues can usually be managed, making DCD a safe way to expand the donor pool.
August
Ideal Timing of Coronary Artery Bypass Grafting After Non-ST-Segment Elevation Myocardial Infarction
Pauley researchers: Mohammed Quader, MD
Journal: The Annals of Thoracic Surgery
Publication date: August 2025
This study looked at when it’s best to do heart bypass surgery (CABG) after a type of heart attack called NSTEMI. Researchers reviewed over 10,000 patients and grouped them by timing of their CABG surgery: within 2 days, 3–7 days, or 8–30 days after NSTEMI followed by heart catheterization. They found that surgery done between 3 and 7 days after cardiac catheterization had the lowest risk of death (about 1.8%) and fewer complications compared to the other groups. Waiting longer than 7 days or performing surgery too soon (within 2 days) was linked to higher risks. The study suggests that, when possible, scheduling CABG within 3–7 days after NSTEMI gives patients the best chance for recovery.
Concomitant cryoballoon pulmonary vein and posterior wall isolation in persistent atrial fibrillation: Results from the Left Atrial Posterior Wall Isolation in Conjunction With Pulmonary Vein Isolation Using the Cryoballoon for Treatment of Persistent Atrial Fibrillation (PIVoTAL) IDE trial
Pauley researchers: Kenneth Ellenbogen, MD
Journal: Heart Rhythm
Publication date: 19 August 2025
Pulmonary vein isolation (PVI) is the standard treatment for atrial fibrillation (a heart rhythm disorder). This study tested whether adding posterior wall isolation (PWI) to PVI during cryoballoon ablation helps patients with persistent atrial fibrillation. Researchers compared two groups of patients with persistent atrial fibrillation: one received PVI alone, and the other received PVI plus PWI. Both methods worked well, but the combined approach took longer and required more applications. After 12 months, the recurrence of atrial fibrillation was slightly lower with PVI plus PWI (29% vs 43%), and patients who had PVI plus PWI showed less overall arrhythmia burden and needed fewer antiarrhythmic drugs. Safety was similar for both groups. The results suggest that adding PWI may help reduce persistent AF episodes, but larger studies are needed to confirm this.
Breast Cancer Survivors' Perceptions of Their Cardiovascular Care During Treatment With Anthracyclines or Trastuzumab: A Qualitative Analysis
Pauley researchers: Arnethea Sutton, PhD; Wendy Bottinor, MD, MSCI
Journal: Cancer Medicine
Publication date: August 2025
This study looked at how women who survived breast cancer felt about the heart health care they received while getting certain cancer treatments, such as anthracyclines and trastuzumab, that can harm the heart. Researchers interviewed 17 women—nine white and eight Black—who had breast cancer within the past two years. They asked the women what their doctors told them about heart risks during treatment and what advice they got about staying healthy. Most women remembered getting some heart health information, like warnings about possible heart damage and tips on exercise and diet. Nurses often give this information. Almost all women said they tried healthy habits during treatment, such as eating better or exercising. The study found that white women were more likely to say they had positive experiences with their doctors, while Black women were more likely to mention negative experiences, like feeling rushed or confused by medical terms. Black women also valued having family involved in care discussions. Overall, the study showed that survivors want clear, easy-to-understand information about heart health during cancer treatment. It suggests doctors should improve communication and include culturally sensitive approaches, so all patients feel supported.
Coronary Artery Vasculopathy in a Cohort of Heart Transplant Recipients: A Single Center Experience
Pauley researchers: Richard Cooke, MD
Journal: Catheterization and Cardiovascular Interventions
Publication date: August 2025
This study looked at a problem called coronary artery vasculopathy (CAV), a common condition in heart transplant recipients in which the blood vessels supplying the transplanted heart narrow and eventually become blocked. Researchers reviewed records of 321 patients who had heart transplants at VCU between 2008 and 2021. They wanted to see how often CAV happened, how it related to rejection of the heart, and whether a treatment called PCI (a procedure to open blocked arteries) helped people live longer. They found that 17% of patients developed CAV, usually about 3 years after transplant. People with CAV were more likely to have had strong rejection episodes, and their death rate was higher than those without CAV. Some patients with severe CAV had PCI, and their survival was about the same as patients with milder CAV, suggesting PCI might help improve outcomes.
Reassessing the need for primary prevention implantable cardioverter-defibrillators in contemporary patients with heart failure
Pauley researchers: Kenneth Ellenbogen, MD
Journal: Journal of Cardiac Failure
Publication date: August 2025
Implantable cardioverter-defibrillators (ICDa) can stop dangerous heart rhythms and prevent sudden death in people with certain types of heart failure. For many years, doctors have recommended placing ICDs in patients with heart failure and a weak heart pump, even if they have not previously experience dangeous heart rhythms These guidelines are based on 20-year-old studies that may no longer be applicable today, given recent advances in heart failure medication therapies. ICDs also carry with them inherent risks, such as infection or additional surgeries. The article reviews the existing data on ICD implantation in patients with certain types of heart failure and provides a rationale for future clinical trials on this subject.
Trends of women in cardiovascular disease fellowships 2013-2022
Pauley researchers: Barbara Lawson, MD; Cory Trankle, MD
Journal: American Heart Journal
Publication date: August 2025
This study looked at how many women are training to become heart doctors in the United States. Even though more than half of medical students are women, cardiology still employs far fewer women than men. Researchers used data from 2013 to 2022 to see how many women applied for and started cardiology fellowships. They found that women made up only about 20% to 27% of applicants and 20% to 29% of first-year fellows, though these numbers slowly increased over time. The study also showed that women are especially underrepresented in subspecialties like interventional cardiology and electrophysiology. Overall, work is needed to foster a more diverse and representative workforce within cardiology training programs and the specialty in general.
A call for transparency, improved reporting, and interpretation of trials using surrogate end points in cardiac electrophysiology
Pauley researchers: Jose Huizar, MD; Kenneth Ellenbogen, MD
Journal: Heart Rhythm
Publication date: August 2025
This article explains why scientists need to be more transparent when they administer heart research studies that utilize “surrogate end points.” A surrogate end point is a substitute for a direct measure of how a patient feels, functions, or survives. For example, a surrogate endpoint commonly used is cholesterol, which indicates (but does not guarantee) an increased likelihood of heart disease. This article provides examples of surrogate end points in electrophysiology, discusses the surrogate paradox (which occurs when the treatment has opposite effects on the surrogate and the true end point), and summarizes the challenges and opportunities in using surrogate end points in clinical research.
Contemporary Oral Medication Use and Frequency in Patients with Transthyretin Amyloid Cardiomyopathy
Pauley researchers: Keyur Shah, MD;
Journal: American Journal of Cardiovascular Drugs
Publication date: 1 August 2025
This study looked at people with a heart condition called transthyretin amyloid cardiomyopathy (ATTR-CM). This disease makes the heart stiff and can lead to heart failure, especially in older adults. Many of these patients take several medicines every day for heart problems and other health issues like diabetes. Researchers wanted to see how often these patients take pills and if a new drug called acoramidis, which is taken twice a day, would fit into their routine The study found that adding acoramidis to a patient’s existing daily medication routine would not make treatment burdensome and could work well with existing medication schedules.
Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS)
Pauley researchers: Kenneth Ellenbogen, MD
Journal: Heart Rhythm
Publication date: August 2025
This study compared two ways of helping people with weak hearts: biventricular pacing (BVP) and left bundle branch area pacing (LBBAP). Both methods use special devices to make the heart beat more evenly, which can help patients with heart failure. Researchers looked at over 2,500 patients from 18 hospitals worldwide. They found that LBBAP worked better than BVP in several ways. People with LBBAP had fewer hospital visits for heart failure and fewer problems during other surgeries. Their hearts also pumped more strongly after treatment. The study showed that LBBAP made the heart’s electrical signals more balanced, which helped the heart work better. However, the overall death rate was about the same for both types of treatment The authors say LBBAP looks promising, but bigger studies are needed to confirm these results before changing treatment guidelines.
Treatment With Phosphodiesterase 5 Inhibitors and Long-Term Outcomes in Patients Undergoing Coronary Angiography and Cardiac Catheterization
Pauley researchers: Fadi Salloum, PhD, FAHA, FAPS; Ion Jovin, MD, ScD
Journal: Catheterization and Cardiovascular Interventions
Publication date: August 2025
This study looked at whether medicines called PDE5 inhibitors (often used for erectile dysfunction) affect heart health in people who need a procedure called cardiac catheterization. Researchers studied 4,582 veterans who had this procedure. About 12% of them were taking PDE5 inhibitors prior to their procedure. Researchers then checked if these patients had serious heart problems within a year, like heart attacks, heart failure, or death. At first, the data appeared to show that people on PDE5 inhibitors had fewer heart problems (30% vs 37%). But after adjusting for other factors, the medicines didn’t change the overall risk of major heart problems. However, patients taking PDE5 inhibitors were less likely to die within a year (about half the risk compared to others). The study suggests these drugs don’t harm the heart and might even help it, but more research is needed to be sure.
Impact of donor obesity on outcomes of donation after circulatory death heart transplantation
Pauley researchers: Patricia Nicolato, DO; Zachary Fitch, MD; Mohammed Quader, MD; Josue Chery, MD; Vigneshwar Kasirajan, MD; Zubair Hashmi, MD, FACS, FACC
Journal: The Journal of Thoracic and Cardiovascular Surgery
Publication date: August 2025
This study looked at whether hearts from overweight or obese donors work just as well as hearts from normal weight donors in a type of transplant called donation-after-circulatory-death (DCD). Researchers reviewed 904 heart transplants done in the U.S. between 2019 and 2024. They grouped donors into three categories: normal weight, overweight, and obese. They also compared two ways of collecting the hearts: one called direct procurement and preservation (DPP) and another called normothermic regional perfusion (NRP), which keeps the heart warm and supplied with blood before transplant. The results showed that patients who received hearts from obese donors survived just as well as those who got hearts from normal-weight donors. In fact, when NRP was used, survival was even better for hearts from overweight and obese donors compared to DPP. The study also found that getting a heart that is too small for the recipient can increase the risk of death, but having a bigger heart didn’t cause problems. Overall, the research suggests that hearts from obese donors can be safely transplanted, especially if NRP is utilized.
The atrial neoannulus technique for mitral valve replacement in patients with severe mitral annular calcification
Pauley researchers: Zubair Hashmi, MD; Vigneshwar Kasirajan, MD
Journal: JTCVS Techniques
Publication date: August 2025
This study reports short-term outcomes of a new surgical method for mitral valve replacement (MVR) in patients with severe mitral annular calcification (MAC), a condition that makes the conventional MVR surgery risky due to potential damage to the heart’s structure. The new technique creates a “neoannulus” in the atrial wall to anchor the prosthetic valve, avoiding aggressive calcium removal. Between September 2021 and January 2025, 27 patients underwent this procedure at a tertiary center. The average age was 64 years, and most were women. Many had other health problems such as chronic kidney disease (52%) and diabetes (56%). About 30% had previous heart surgeries. Before surgery, the median mitral valve pressure gradient was 13 mm Hg; after surgery, it dropped to 5 mm Hg, showing improved blood flow. Two patients (7.4%) died in the hospital, and one died later from non-cardiac causes. Minor complications included paravalvular leaks in two patients and one case of left ventricular perforation requiring reoperation. No major issues like annular rupture or severe bleeding occurred. The findings suggest that constructing an atrial neoannulus for valve implantation is technically feasible and provides acceptable short-term results in high-risk patients with severe MAC. Long-term durability remains under evaluation.
