JAMA Cardiology

JAMA Cardiology #Review: #BreastCancer is the most common cancer diagnosed in women, and improved survival has increased the importance of long-term #CardiovascularDisease prevention and management across the life course. This Review finds that breast cancer therapies can cause cancer therapy-related cardiac dysfunction as well as QTc prolongation, hypertension, cardiometabolic abnormalities, myocarditis, and venous thromboembolism, making cardiovascular assessment important before, during, and after treatment. https://ja.ma/3RH8Mqr

Among patients with #TransthyretinAmyloidCardiomyopathy, acoramidis attenuated decline in #HeartFailure-related health status vs placebo over 30 months. The least-squares mean difference in Kansas City Cardiomyopathy Questionnaire Overall Summary score was 9.9 points, a clinically meaningful benefit, with differences emerging within 3 months and becoming statistically significant after month 9. https://ja.ma/3TkraWT

Among asymptomatic patients with degenerative #MitralRegurgitation, increasing baseline effective regurgitant orifice area was associated with progressively worse long-term survival under medical therapy in this 25-year follow-up cohort study. Five-year survival among medically treated patients was 88% for effective regurgitant orifice area <20 mm2, 72% for 20-39 mm2, and 55% for >40 mm2, supporting the prognostic value of quantitative baseline severity assessment. https://ja.ma/44TIWTq

💬 Viewpoint by Javid J. Moslehi, MD: Current #CardioOncology practice often groups biologically distinct toxic effects under broad labels such as cancer therapy-related cardiac dysfunction, which may obscure important mechanistic differences between conditions such as anthracycline-induced cardiomyopathy and immune-mediated myocarditis. Broad syndromic labels can promote uniform surveillance and treatment strategies even when the underlying biology differs substantially. #CardioOncology also serves as a reverse translational human laboratory in which cancer therapies reveal critical pathways in cardiovascular biology. Immune checkpoint inhibitor-associated myocarditis illustrates how mechanistic studies can inform targeted immunomodulation and support a more precise framework for prevention and treatment. https://ja.ma/4fr5UY3

🔖 Bookmark now, reference later: Management of #ThyroidCancer increasingly reflects #tumor size, #disease extent, and #molecular profile. This #JAMAReview indicates that observation without surgical resection can be considered for microcarcinomas ≤1 cm, while surgery with or without #RadioactiveIodine is curative in most cases for tumors >1 cm with or without lymph node metastases. For recurrent locoregional disease, #surgical resection is the preferred approach. In metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy, while antiangiogenic multikinase inhibitors and targeted therapies may be used for thyroid cancer that does not respond to radioactive iodine or for tumors with specific #genetic alterations. This treatment framework supports more personalized care, with #therapies directed at alterations including BRAF, RET, NTRK, and MEK in patients with advanced thyroid carcinoma. Save this Review to your citation manager and reference it in future research, presentations, and educational materials: https://ja.ma/4fyUss3

📝 JAMA Cardiology Review: Cardiac dyssynchrony disrupts coordinated atrial and ventricular activation and is linked to impaired function and elevated arrhythmia risk. While biventricular and conduction system pacing have transformed ventricular resynchronization, atrial dyssynchrony—often due to Bachmann bundle conduction delay or nonphysiological pacing—remains underrecognized and may exacerbate arrhythmia and impair diastolic filling. Early data indicate that Bachmann bundle pacing, which directly engages the dominant interatrial conduction pathway, can restore more physiological atrial activation, potentially improving atrioventricular timing and reducing arrhythmia burden. Further studies are needed to define procedural approaches and clarify clinical outcomes for this emerging pacing strategy. https://ja.ma/44JkFiJ

Among patients with asymptomatic severe #AorticStenosis, treadmill stress testing identified AVR indications in approximately 1 in 6 individuals and was associated with no serious adverse events. Despite guideline concordant findings, prompt intervention was not consistently achieved, with 1 in 5 patients remaining untreated at 1 year. This emphasizes not only the value of exercise testing for unmasking symptoms and risk, but also existing clinical gaps in the transition from identification to aortic valve replacement in real-world care. https://ja.ma/4pxduUl

💬 Editorial by Erwan Donal, MD, PhD, Florent Le Ven, MD, PhD, and Laurie Soulat-Dufour, MD, PhD: The management of asymptomatic severe aortic stenosis (#AorticStenosis) is transitioning from a symptom-based approach to earlier, biology- and imaging-informed risk stratification as procedural safety improves and understanding of disease progression deepens. Objective evaluation with exercise testing continues to provide valuable insight, revealing unrecognized symptoms or physiological compromise even in patients who appear asymptomatic. Integrating exercise testing with imaging and biomarkers can identify those at increased risk of myocardial injury before irreversible changes occur, but gaps persist between identification of risk and timely intervention, highlighting a need for improved care pathways and risk assessment strategies. https://ja.ma/4yuuONL

Among adults with #ASCVD, a digitally enabled quality improvement initiative integrating previsit screening, real-time clinical decision support, audit and feedback, and patient engagement tools resulted in significantly greater LDL-C reduction and treatment intensification at 6 months compared with usual care. Statin and ezetimibe combination therapy use was notably higher in intervention clinics, but achievement of guideline LDL-C targets remained incomplete. These findings indicate that digital platforms can support implementation of contemporary lipid management strategies but may need further refinement and improved access to advanced therapies to fully resolve care gaps. https://ja.ma/3T4gprA

Please read the GBD report on IHD deaths in the US and the accompanying editorial by Dr Robert Califf now published in JAMA Cardiology - how do we implement what we know work and curb the surge of obesity and cardiometabolic disease? It's urgent. American Heart Association American College of Cardiology British Heart Foundation The George Institute for Global Health Fondation Leducq Novo Nordisk Foundation Imperial Health Impact Lab DZHK Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. National Heart and Lung Institute, Imperial