Editorials
The LIMA: A Drug-Eluting Graft and Coronary Flow Shock Absorber
The primary challenge of coronary artery bypass graft (CABG) surgery is the durability of graft patency. Patients with failed grafts experience an overall higher clinical event rate, with graft failure to the left anterior descending territory being the most detrimental.1 Aside from anastomotic technical issues, multiple mechanisms contribute to graft failure. They include patient-related risk profile, graft–coronary artery flow mismatch, target vessel anatomic features, hemodynamic factors, hypercoagulability, and biologic mechanisms involved in plaque formation and atherosclerosis progression.Decreasing Door-to-Diagnosis Time in Cardiac Amyloidosis: A Simple “One-Stop Shop” Approach
Cardiac amyloidosis (CA) remains a challenging disease to detect and to diagnose. Recent advancements in treatment necessitate more rapid diagnosis so that treatment can be initiated as early as possible. In this issue of Mayo Clinic Proceedings, Bézard et al1 report on the real-life evaluation of an algorithm for the diagnosis of CA. The authors propose a “one-stop shop” approach to the diagnosis of CA by performing 4 tests simultaneously at the first day of a visit: serum and urine screening for monoclonal protein (MCP), nuclear cardiac scintigraphy, salivary gland biopsy, and DNA TTR testing.Brave New World: Improving Obesity and Preventing Cardiovascular Disease
For several decades, obesity and type 2 diabetes (T2D) have been rising in tandem so that today, they are worsening global pandemics with debilitating, expensive, and often lethal complications. The prevalence of T2D in the United States has risen more than 10-fold from 2.5 million in 1959 to more than 25 million in 2022.1 During the same time frame, obesity has risen 4-fold, so that now it affects 40% of US adults and is the leading cause of preventable disease and premature mortality. About 90% of people with T2D are overweight or obese, and traditional drugs for T2D, including insulin, sulfonylureas, and thiazolidinediones, cause further weight gain.Almost a Centenarian—Bold, Forward, and Networking
“Unlike in the past, there are now two kinds of people in the world: those who own and run the networks, and those who merely use them.”1Niall FergusonPortopulmonary Hypertension—Rethinking Our Current Approach
Patients with cirrhosis have progressive liver disease with secondary neurohormonal activation resulting in volume overload. This neurohormonal activation is due to “arterial underfilling” from a pathologically decreased systemic vascular resistance (SVR), and this is associated with a reflex increase in cardiac output (CO) to maintain blood pressure.1 When this decrease in blood pressure is sensed by arterial baroreceptors, there is secondary renin-angiotensin-aldosterone activation, which results in renal sodium retention and volume overload despite normal heart function.Health Care for Adults With Cerebral Palsy and Spina Bifida—Must It Be so Difficult?
For children with cerebral palsy and spina bifida (CP/SB), their complex medical needs are often coordinated through a medical home or multidisciplinary clinic setting. In these settings, a care team works to coordinate appointments, follow up on missed appointments, and facilitate communication with and between medical providers and patients. This care coordination is often done through many methods and contact points. Despite this, children with CP/SB may still have unexpected or potentially preventable hospitalizations (PPHs) for urinary tract infection (UTI), pneumonia, pressure wounds, and other illnesses.Trends in Heart Failure Outcomes From a Large, Geographically Diverse Cohort During the COVID-19 Pandemic
The evolving coronavirus disease 2019 (COVID-19) pandemic has presented extraordinary challenges to the health of populations globally. As our understanding of the virus continues to grow at a rapid pace, it has become increasingly clear that the clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection range widely and are in large part dictated by age, underlying comorbidities, and vaccination status. Robust epidemiologic data during the past years have underscored that individuals with chronic health conditions including cardiovascular disease, diabetes mellitus, immunosuppression, tobacco use, and obesity carry a significantly greater risk of falling critically ill with SARS-CoV-2.Explaining Unexplained Hypoglycemia Due To Insulin Analogs
Hypoglycemia is a potentially life-threatening condition that requires urgent medical attention. Most hypoglycemia in patients with diabetes is related to medication use, and recent studies have indicated the contributions of insulin analogs in cases of hypoglycemia.1,2 Even in patients without diabetes, it is important to exclude insulin administration as a cause of hypoglycemia, yet detection of insulin analogs is not straightforward. The small structural changes that result in favorable pharmacokinetics of insulin analogs also affect the detection of analog insulin by immunoassays, culminating in varying results from different commercially available assays.The Imposter Syndrome in Physicians
Imposter syndrome (IS), also known as imposter phenomenon or imposterism, is defined as feelings of uncertainty, inadequacy, and being undeserving of one’s achievements despite evidence to the contrary. Imposter syndrome has 5 subtypes1:Racial Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic: Time for a Solution
Health disparities are a complex and multifactorial construct involving lack of access to health care, differential treatment modalities, and different outcomes for the same disease based on racial or socioeconomic class. Disparity in health care has garnered an increasing amount of attention from health care providers and health policy experts.1 Several studies have elucidated the effect of health care disparity between different socioeconomic and ethnic groups on cardiovascular (CV) outcomes as well as relating to the ongoing SARS-CoV-2 infection (COVID-19) pandemic.Ambulatory Remote Patient Monitoring Beyond COVID-19: Engagement and Sustainment Considerations
Care delivery innovations in response to the COVID-19 pandemic, particularly digital health solutions, have been wide ranging and impactful. The spectrum of such innovations includes, for example, technology-based screening tools, electronic health record–based protocols, rapid provider onboarding and education, clinical decision support and diagnostics, large-scale data collection with real-time dashboards for tracking and surveillance to monitor outcomes and hospital capacity, and rapid adoption and expansion of telehealth services and remote monitoring to improve safe access to health care and to optimize resource utilization.
