ABIM Advanced Heart Failure & Transplant Cardiology

According to the 2022 AHA/ACC/HFSA Heart Failure Guideline, which LVEF range defines HFrEF (heart failure with reduced ejection fraction)?

• ALVEF <=30%
• BLVEF <=40%
• CLVEF 41-49%
• DLVEF >=50%

A patient with dyspnea and LVEF 45% on echocardiogram meets which 2022 HF guideline category?

• AHFrEF
• BHFmrEF
• CHFpEF
• DStage A HF

A patient with hypertension and diabetes but no structural heart disease or HF symptoms is classified as which ACC/AHA HF stage?

• AStage A (at risk for HF)
• BStage B (pre-HF)
• CStage C (symptomatic HF)
• DStage D (advanced HF)

Which of the following best describes NYHA functional class III?

• ANo limitation of physical activity
• BSlight limitation; ordinary activity causes symptoms
• CMarked limitation; less than ordinary activity causes symptoms
• DSymptoms at rest

A 62-year-old with HFrEF (LVEF 30%) is on lisinopril 40 mg, carvedilol 25 mg BID, spironolactone 25 mg. Which medication change provides the greatest mortality benefit?

• AIncrease carvedilol to 50 mg BID
• BReplace lisinopril with sacubitril-valsartan (ARNI)
• CAdd digoxin
• DAdd amlodipine

Which of the following beta-blockers is NOT guideline-recommended for HFrEF mortality reduction?

• ACarvedilol
• BMetoprolol succinate
• CBisoprolol
• DMetoprolol tartrate

A patient with HFrEF and diabetes mellitus type 2 has a recent initiation of an SGLT2 inhibitor. Which of the following is TRUE about SGLT2 inhibitors in HFrEF?

• AOnly beneficial if diabetes is present
• BReduce HF hospitalization and CV death regardless of diabetes status
• CContraindicated if eGFR <60 mL/min/1.73 m2
• DShould replace ACEi/ARNI therapy

Which MRA is most likely to cause gynecomastia as an adverse effect?

• ASpironolactone
• BEplerenone
• CFinerenone
• DCanrenone

A patient with HFrEF in sinus rhythm at HR 78 on maximal tolerated carvedilol 25 mg BID remains NYHA III. What is the best next step?

• AAdd digoxin
• BAdd ivabradine
• CReplace carvedilol with metoprolol succinate
• DAdd amiodarone

Which HFrEF therapy has class I indication specifically in self-identified Black patients NYHA III-IV despite optimal GDMT?

• ADigoxin
• BHydralazine plus isosorbide dinitrate
• CAmlodipine
• DRanolazine

Vericiguat, a soluble guanylate cyclase stimulator, is indicated for which HF population?

• AHFpEF with NYHA II
• BHFrEF with recent worsening HF event despite GDMT
• CNewly diagnosed HFrEF
• DCardiogenic shock

Which of the following is now a class I recommendation for HFpEF in the 2023 AHA/ACC/HFSA focused update?

• AACE inhibitor
• BSGLT2 inhibitor
• CDigoxin
• DSildenafil

TOPCAT-Americas subgroup analysis suggested benefit of which therapy in HFpEF?

• ADigoxin
• BSpironolactone
• CIvabradine
• DAmlodipine

Which ARB showed benefit in HF hospitalization in the CHARM-Preserved trial in HFpEF?

• ALosartan
• BCandesartan
• CTelmisartan
• DValsartan

The DOSE trial compared diuretic strategies in acute decompensated HF. What did it show?

• AHigh-dose outperformed low-dose in mortality
• BContinuous infusion superior to bolus for symptom relief
• CNo significant difference between bolus vs infusion or low-dose vs high-dose for primary…
• DCombination of loop plus thiazide reduced mortality

The CARRESS-HF trial compared ultrafiltration to stepped pharmacologic therapy in ADHF with cardiorenal syndrome. The result was:

• AUltrafiltration superior for weight loss and creatinine
• BUltrafiltration inferior — worse creatinine and no weight advantage
• CEquivalent outcomes
• DUltrafiltration reduced mortality by 25%

Which inotrope is a phosphodiesterase-3 inhibitor?

• ADobutamine
• BMilrinone
• CEpinephrine
• DNorepinephrine

Which SCAI shock stage describes a patient with cardiogenic shock who is 'deteriorating' and not responding to initial interventions?

• AStage A (at risk)
• BStage B (beginning)
• CStage C (classic)
• DStage D (deteriorating)

On right heart catheterization in suspected cardiogenic shock, which hemodynamic pattern is classic for 'cold and wet'?

• ACI >2.2, PCWP <18
• BCI <2.2, PCWP <18
• CCI <2.2, PCWP >18
• DCI >2.2, PCWP >18

A 58-year-old with STEMI develops cardiogenic shock refractory to pressors and dobutamine. LVEF is 15%. Which temporary MCS provides the highest cardiac output support (up to 5-5.5 L/min)?

• AIABP
• BImpella 2.5
• CImpella CP
• DImpella 5.5

Harlequin syndrome on peripheral VA-ECMO refers to:

• ASkin mottling from peripheral cannulation
• BDifferential hypoxia — upper body hypoxic from recovering LV ejecting deoxygenated blood…
• CLimb ischemia distal to cannula
• DCannula misplacement in the pulmonary artery

The IABP-SHOCK II trial compared intra-aortic balloon pump vs control in cardiogenic shock from acute MI. The result:

• AIABP reduced 30-day mortality by 25%
• BNo significant mortality difference at 30 days or 12 months
• CIABP increased stroke risk 3-fold
• DIABP improved mortality only in women

Which INTERMACS profile describes a patient with 'critical cardiogenic shock' — crashing and burning?

• AINTERMACS 1
• BINTERMACS 3
• CINTERMACS 5
• DINTERMACS 7

The HeartMate 3 LVAD differs from HeartMate II primarily by:

• APulsatile rather than continuous flow
• BFully magnetically levitated centrifugal rotor vs axial flow
• CPneumatic rather than electrical
• DLarger pump displacement

A patient with a HeartMate 3 LVAD presents with melena and drop in hemoglobin. EGD shows scattered angiodysplasias in the small bowel. The mechanism is:

• AShear-induced cleavage of high-molecular-weight vWF multimers (acquired von Willebrand sy…
• BDirect traumatic hemolysis
• CAntiplatelet-only anticoagulation
• DThrombocytopenia from pump thrombosis

A patient with a HeartMate II LVAD presents with hemoglobinuria, plasma free hemoglobin >40 mg/dL, and LDH 2.5x upper limit of normal. The most likely diagnosis is:

• AGI bleeding
• BPump thrombosis
• CDriveline infection
• DAortic insufficiency

Which complication occurs in up to 25% of LVAD patients over 2 years and can progress to severe AR affecting device unloading?

• AMitral regurgitation
• BAortic insufficiency
• CTricuspid regurgitation
• DPulmonic stenosis

Early RV failure after LVAD implantation is most likely if preoperative:

• ACVP is low and PAPi is high
• BCVP is high, PAPi <1.85, and severe TR is present
• CNormal RV function
• DPulmonary vascular resistance is <2 Wood units

Driveline infection in an LVAD patient is most commonly caused by:

• AMycobacterium tuberculosis
• BStaphylococcus aureus and coagulase-negative staph
• CCandida albicans
• DPseudomonas aeruginosa

A patient is being considered for heart transplantation. Which of the following is an absolute contraindication?

• AAge 68 years
• BDiabetes mellitus with mild retinopathy
• CFixed pulmonary vascular resistance >5 Wood units unresponsive to vasodilator challenge
• DBMI 32 kg/m2

Under the 2018 UNOS adult heart allocation policy, which describes Status 1 (highest priority)?

• AStable outpatient inotrope support
• BIntensive care with IABP alone
• CVA-ECMO, non-dischargeable BiVAD/TAH, or MCS with life-threatening ventricular arrhythmia
• DDurable LVAD at home

Donation after circulatory death (DCD) has expanded heart transplantation using what technology?

• AStatic cold storage
• BTransMedics Organ Care System (OCS) normothermic ex vivo perfusion
• CHypothermic machine perfusion only
• DCryopreservation

Standard maintenance immunosuppression after cardiac transplantation in 2026 most commonly consists of:

• ACyclosporine + azathioprine + prednisone
• BTacrolimus + mycophenolate mofetil + steroid taper
• CSirolimus + azathioprine alone
• DSteroid monotherapy

Which induction agent is a non-depleting IL-2 receptor antagonist?

• ABasiliximab
• BAnti-thymocyte globulin (ATG)
• CAlemtuzumab
• DRituximab

The 2004 revised ISHLT grading for acute cellular rejection (ACR) classifies moderate rejection as:

• A1R
• B2R
• C3R
• DGrade 0

Antibody-mediated rejection (AMR) is graded using which ISHLT system?

• A0R-3R
• BMild/Moderate/Severe
• CpAMR 0, 1(H+), 1(I+), 2, 3
• DISN grade I-IV

Treatment of severe acute cellular rejection (ISHLT 3R) with hemodynamic compromise typically includes:

• AIncreasing tacrolimus dose alone
• BIV pulse methylprednisolone plus ATG
• CObservation and repeat biopsy in 2 weeks
• DStopping all immunosuppression

Non-invasive rejection surveillance with gene expression profiling (AlloMap) is most appropriately used in which setting?

• AImmediately post-transplant (day 0-30)
• BLow-to-moderate risk patients 2 months post-transplant and beyond to rule out moderate/se…
• CTo diagnose AMR
• DFor cardiac allograft vasculopathy screening

Donor-derived cell-free DNA (dd-cfDNA) is useful for detecting:

• AOnly cellular rejection
• BOnly AMR
• CBoth ACR and AMR with high negative predictive value
• DCardiac allograft vasculopathy

Cardiac allograft vasculopathy (CAV) is best detected by:

• AExercise treadmill test
• BResting ECG
• CCoronary angiography with intravascular ultrasound (IVUS)
• DCardiac enzymes

Which pathogen prophylaxis is standard for the first 3-6 months post heart transplant when donor is CMV-positive and recipient is CMV-negative?

• AAcyclovir
• BValganciclovir
• CNystatin
• DTrimethoprim-sulfamethoxazole

Post-transplant lymphoproliferative disorder (PTLD) is most strongly associated with which virus?

• ACMV
• BEBV
• CHepatitis C
• DHPV

Skin cancer (especially squamous cell carcinoma) risk after heart transplant is elevated most strongly by:

• ATacrolimus
• BVoriconazole and cumulative calcineurin inhibitor exposure
• CSteroid taper
• DStatin use

Primary graft dysfunction (PGD) after heart transplant is defined and classified based on:

• AOccurrence within 24 hours of transplant with graft failure not explained by hyperacute r…
• BFailure after 7 days post-op
• CAny rejection episode in the first year
• DCAV within 1 year

The ATTR-ACT trial demonstrated that tafamidis, a TTR stabilizer, in patients with transthyretin amyloid cardiomyopathy (ATTR-CM):

• AHad no effect on outcomes
• BReduced all-cause mortality and CV hospitalizations
• CReversed cardiac amyloid deposits
• DImproved symptoms only in AL amyloidosis

A 72-year-old man has HF with preserved EF, biventricular hypertrophy on echo, low voltage on ECG, and grade 3 pyrophosphate (PYP) uptake. Next best test:

• ASPEP, UPEP, free light chains to rule out AL amyloidosis
• BImmediate tafamidis
• CCardiac MRI only
• DEndomyocardial biopsy

In hypertrophic cardiomyopathy, first-line therapy for symptomatic obstructive HCM (NYHA II-III with LVOT gradient >=50 mmHg) is:

• ADihydropyridine calcium channel blockers
• BNon-vasodilating beta-blocker (e.g., metoprolol) or non-dihydropyridine CCB
• CARNI
• DDigoxin