Background Whether heart rate upon discharge following hospitalization for heart failure is associated with long‐term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. Methods and Results We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines ® –Heart Failure. Cox proportional‐hazards models were used to estimate the association between discharge heart rate and all‐cause mortality, all‐cause readmission, and the composite outcome of mortality/readmission through 1 year. For SR and AF patients with heart rate ≥75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats‐per‐minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95% CI 1.22 to 1.39; AF: HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95% CI 1.12 to 1.20; AF: HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all‐cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients. Conclusions Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF.

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SUMMARY Background Aortic stiffness and left ventricular (LV) diastolic dysfunction are common and associated with increased morbidity and mortality in systemic lupus erythematosus (SLE). Hypothesis In SLE, aortic stiffness and LV diastolic dysfunction may be associated. Methods This 6-year duration, cross-sectional, and controlled study was conducted in 76 SLE patients (69 women, mean age, 37±12 years) and 26 age-and-sex matched healthy controls. All subjects underwent clinical and laboratory evaluations and transesophageal echocardiography (TEE) to assess LV diastolic function and stiffness of the descending thoracic aorta using the Pressure-Strain Elastic Modulus (PSEM). To validate results using PSEM, aortic strain, stiffness, and distensibility were assessed. Results Patients as compared to controls had higher PSEM (8.14±4.25 versus 5.97±2.31 units, p<0.001) and had lower mitral inflow E/A and septal and lateral mitral annulus tissue Doppler E′/A′ velocity ratios, longer isovolumic relaxation time, lower septal and lateral mitral annulus E′ velocities, and higher mitral E/septal E′ and mitral E/lateral E′ velocity ratios (all p≤0.03), all indicative of LV diastolic dysfunction. In patients, PSEM was correlated with parameters of LV diastolic dysfunction (all p<0.05) and was independently negatively associated with E/A and E′/A′ ratios and E′ velocities and positively associated with E/E′ ratios (p≤0.02 for each parameter and p<0.001 for all parameters as a profile). Aortic strain, stiffness, and distensibility were also worse in patients than in controls (all p<0.05) and were correlated with parameters of LV diastolic dysfunction (all p≤0.03). Conclusion Aortic stiffness is independently associated with LV diastolic dysfunction in young adult patients with SLE.

Bifurcation lesions are frequently encountered in the cath lab [1] and remain a challenge for conventional percutaneous coronary intervention (PCI) techniques. Although provisional stenting remains the default approach for most bifurcation lesions [2-6], the two-stent technique is more appropriate in certain situations. If a two-stent strategy is selected, then final kissing balloon inflation (KBI) should be performed. Adjunctive assessment with intravascular imaging (intravascular ultrasound (IVUS)/optical coherence tomography (OCT)) and physiologic testing (fractional flow reserve, FFR) should be performed liberally. Drug-eluting stents (DES) are typically utilized to reduce the risk of restenosis in bifurcation disease.