Endocarditis guidance rewritten, and a reason to doubt a raised troponin

The edition in brief

Today's cardiology desk opens with the American Heart Association's updated scientific statement on infective endocarditis, replacing guidance written in 2015 — before partial oral antibiotic therapy, non-culture pathogen identification and routine multimodality imaging changed how the disease is diagnosed and treated. A general-population study of 19,499 adults then shows that when cardiac troponin I and T disagree by more than threefold, the raised value usually reflects macrotroponin assay interference rather than myocardial injury: 92.5% of discordant troponin I results were confirmed as macrotroponin complexes, and those participants carried no clear excess cardiovascular risk. A Finnish nationwide registry of 40,986 patients finds ischaemic stroke rates substantially lower in atrial flutter alone than in atrial fibrillation, consistent across CHA2DS2-VA categories, while patients with both arrhythmias sat slightly higher than fibrillation alone. An exploratory analysis from the Multi-Ethnic Study of Atherosclerosis reports that regular aspirin use was associated with less aortic valve calcium and severe aortic stenosis in people with high lipoprotein(a), but not in those with high LDL cholesterol — observational, hypothesis-generating, and not a reason to start aspirin for a valve. A pearl covers the scoring change from CHA2DS2-VASc to CHA2DS2-VA. The edition closes with a meta-analysis of seventeen randomised trials of intravascular ultrasound-guided percutaneous coronary intervention, which found the reduction in cardiac death concentrated almost entirely in East Asian trials, with non-Asian trials neutral — a pre-specified interaction that reframes how the IVUS evidence base should be read before it is applied to a local catheter laboratory.