Int J Cardiol
· 2026 Oct · PMID 42263948
·
Publisher ↗
BACKGROUND: Whether dedicated tertiary heart-failure programmes in low- and middle-income countries can approach guideline-directed medical therapy (GDMT) targets, and whether temporal trends reflect prescribing optimisa...BACKGROUND: Whether dedicated tertiary heart-failure programmes in low- and middle-income countries can approach guideline-directed medical therapy (GDMT) targets, and whether temporal trends reflect prescribing optimisation or case-mix shift, remains unresolved. We characterise four-pillar GDMT adoption in an eastern Indian tertiary centre with systematic robustness testing. METHODS: Repeated cross-sectional analysis in a prospective HFrEF registry (2022-2024 primary cohort, n = 319 patients). Half-yearly adoption assessed by Cochran-Armitage trend tests (Benjamini-Hochberg FDR), MI-adjusted logistic regression (m = 20), and Bayesian regression. Robustness: delta-adjusted MI, tipping-point, FMI, sacubitril-valsartan target-dose, E-value, time-by-diabetes interaction, quarterly ITS at ≥ 8 bins. RESULTS: Four-pillar composite rose from 48.6% (H12022) to 76.3% (H2 2024); MI-adjusted OR per half-year 1.24 (95% CI 1.05-1.47; p = 0.013). SGLT2 inhibitor drove the composite (OR 1.51; 1.22-1.86; p < 0.001); RAAS-i 1.24, MRA 1.11 and beta-blocker 0.98 not significant. Bayesian regression concurred (SGLT2i posterior probability 0.972; four-pillar 0.896). SGLT2i trend was robust to delta-adjusted MI, tipping-point beyond +/- 50 mL/min/1.73 m^2, and unmeasured confounding (E-value point 1.76; CI lower 1.44). Time-by-diabetes interaction was null; sacubitril-valsartan target-dose attainment 20.0%. Quarterly ITS at ≥ 8 bins returned non-significant level and slope changes at every feasible policy event. CONCLUSIONS: Tertiary specialist care approached but did not reach the four-pillar prescription ceiling (76.3%; residual 23.7-percentage-point gap). The SGLT2i trend was robust to MNAR, unmeasured confounding, and diabetes case-mix shift; quarterly ITS at ≥ 8 bins detected no policy-event association. Sacubitril-valsartan target-dose attainment (20.0%), single-centre design, and fragile non-SGLT2i E-values constrain generalisability.
Calomeni P, Abizaid MS, Bernardi F
… +32 more, de Brito FS, Lemos PA, Feres F, Siqueira DA, Costa R, Zukowski C, Sarmento-Leite R, Mangione F, Mangione JA, Thiago LEKS, de Lima VC, Oliveira ADD, Marino MA, Cardoso CJF, Caramori PRA, Tumelero RT, Portela ALF, Prudente ML, Henriques LA, de Freitas Souza FS, Bezerra CG, de Almeida Prado Junior GF, de Freitas LZF, Nogueira EF, Meireles GCX, Pope RB, Guérios ÊE, de Andrade PB, de Moura Santos L, Esteves VBC, Abizaid A, Ribeiro HB
Int J Cardiol
· 2026 Oct · PMID 42251950
·
Publisher ↗
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has become the standard of care for elderly patients with severe aortic stenosis. While valve-in-valve TAVI (ViV-TAVI) offers a less invasive alternative to re...INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has become the standard of care for elderly patients with severe aortic stenosis. While valve-in-valve TAVI (ViV-TAVI) offers a less invasive alternative to redo surgery in patients with degenerated surgical heart valves (SHV), evidence remains limited. METHODS: This is a retrospective study based on a Brazilian clinical registry of TAVI patients between January 2009 and December 2021. We compared ViV-TAVI patients with native aortic valve (NV-TAVI) patients. Temporal trends, procedural, and in-hospital outcomes were evaluated. We performed propensity score matching (PSM) and multivariable regression to adjust comparisons. RESULTS: Among 3194 patients from 25 centers, 135 underwent ViV-TAVI. The ViV volume increased slightly over time in proportion to NV-TAVI. After PSM, there were 127 ViV and 248 NV-TAVI patients. ViV patients had lower device success (71.7% vs. 87.9%; OR 0.35; 95% CI 0.20-0.60; p < 0.01) and permanent pacemaker implantation (4.7% vs. 12.9%; OR 0.35; 95% CI 0.13-0.79; p < 0.01) compared with NV-TAVI. Valve embolization was more frequent in ViV-TAVI (3.9% vs. 0.8%; OR 4.44; 95% CI 1.03-25.59; p = 0.04). Among ViV patients, no difference in embolization risk was detected (OR 1.11; 95% CI 0.18-11.80; p = 0.91) between radiopaque vs. radiolucent SHV. Major vascular complication, major or life-threatening bleeding, stroke, and in-hospital mortality did not differ significantly between groups. CONCLUSION: During the study period, a modest but significant increase was observed in the number of ViV-TAVI procedures. Device success and PPI were lower, and valve embolization was more frequent in ViV-TAVI compared with NV-TAVI. In-hospital safety outcomes did not differ between groups.
Capranzano P, Calabrò P, Musumeci G
… +11 more, Di Mario C, Nicolini E, Mauro C, Trani C, Versaci F, Tomai F, Pepe M, Berti S, Cernetti C, Cirillo P, De Luca L
Int J Cardiol
· 2026 Oct · PMID 42242385
·
Publisher ↗
BACKGROUND: The use of cangrelor in patients with reduced renal function has never been investigated. This post-hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and isc...BACKGROUND: The use of cangrelor in patients with reduced renal function has never been investigated. This post-hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and ischemic outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) and transitioning from cangrelor to any oral P2Y12 inhibitors in clinical practice in subgroups stratified by renal function. METHODS: The patients were stratified according to their Estimated-Glomerular-Filtration-Rate (eGFR) value (<60 [LGFR] vs ≥60 [HGFR] mL/min). Bleeding Academic Research Consortium (BARC)-defined outcomes, Major Adverse Cardiac Events (MACEs), Intraprocedural Thrombotic Events (IPTEs), and other safety parameters were assessed in the two subgroups. RESULTS: Of 770 patients included in this post-hoc analysis, 136 (17.7%) had LGFR. These patients had a higher frequency of comorbidities, including diabetes (34.6% vs. 20.0%, p = 0.0004) and atrial fibrillation (10.3% vs. 2.4%, p = 0.0001) than those HGFR. A higher rate of LGFR patients had NSTEMI (54.4% vs. 44.5%) (p = 0.0350) and a multi-vessel coronary artery disease (67.6%) than HGFR ones (48.3%, p < 0.0001). While rates of bleeding, IPTE, and MACEs were similarly low in LGFR and HGFR patients during the 30-day observation period, a higher proportion of LGFR patients (2.2%) experienced BARC type 3-5 (moderate-severe) bleeding compared to HGFR patients (0.2%; p = 0.0188). The type and frequency of MACEs and adverse events in this fragile population were similar to those observed in the overall patients treated with cangrelor. CONCLUSIONS: These data suggest that the transition from cangrelor to any oral P2Y12 inhibitor is a safe and effective treatment in patients with acute coronary syndrome and reduced renal function undergoing PCI in the setting of routine clinical practice.
Adam R, Neculae G, Bădeliță S
… +14 more, Stassen J, Tjahjadi C, Jercan A, Cremeneanu C, Roșca M, Călin A, Beladan C, Șerban M, Coriu D, Bax J, Băicuș C, Popescu BA, Marsan NA, Jurcuț R
Int J Cardiol
· 2026 Oct · PMID 42242384
·
Publisher ↗
AIMS: We aimed to investigate which parameters of left atrial (LA) structure and function could predict new-onset atrial arrhythmias (NOAA) in patients with CA, aiding in improved follow-up. METHODS AND RESULTS: We prosp...AIMS: We aimed to investigate which parameters of left atrial (LA) structure and function could predict new-onset atrial arrhythmias (NOAA) in patients with CA, aiding in improved follow-up. METHODS AND RESULTS: We prospectively included patients diagnosed with CA, both light chain (AL) and variant transthyretin (ATTRv) with no history of AA. LA mechanical dispersion (LAMD) was defined as the standard deviation of time-to-peak positive strain and reported as percentage from the R-R interval. The primary outcome was NOAA. 93 patients were included (mean age 54.3 ± 9.8, 58% males), and 44 patients (47%) developed NOAA during a median follow up of 11 (3.5-36.0) months. Patients with NOAA had heavier hearts, worse global LV function, more LV longitudinal impairment, larger atria and worse LA function. LA reservoir strain (LASr) was significantly lower and LAMD significantly higher in patients who developed NOAA. In the multivariate analysis adjusting for confounding factors, a lower LAMD was independently associated with higher risk for NOAA (HR: 1.182, 95% CI: 1.033-1.351, p = 0.015). Patients with LAMD>6.6% had a higher risk for NOAA than those with LAMD≤6.6% (P < 0.001). Furthermore, LAMD>6.6% remained an independent predictor for NOAA in both univariate and multivariate analysis. Five models were created and the model based on LA volume was significantly improved by adding LVGLS, RVFWS and LAMD, but it was not significantly improved by adding LASr. CONCLUSION: LAMD is a novel, reproducible and independent predictor of NOAA in patients with CA, being superior and incremental to other imaging predictors.
Cai L, Liang B, Zhou S
… +3 more, Xiao H, Hu Y, Ma H
Int J Cardiol
· 2026 Oct · PMID 42242383
·
Publisher ↗
BACKGROUND: The extent to which achieving multiple metabolic treatment targets confers sustained cardiorenal protection across all stages of cardiovascular - kidney - metabolic (CKM) syndrome remains uncertain. METHODS:...BACKGROUND: The extent to which achieving multiple metabolic treatment targets confers sustained cardiorenal protection across all stages of cardiovascular - kidney - metabolic (CKM) syndrome remains uncertain. METHODS: This multicenter retrospective study used data from the China Renal Data System (CRDS) to investigate the association between achieving multiple metabolic targets (blood pressure, fasting blood glucose, LDL-C control) and cardiorenal outcomes across stages of CKM syndrome. RESULTS: The proportion of patients meeting all three metabolic targets decreased markedly with advancing CKM stage. Kaplan-Meier curves showed increasing risks of cardiovascular-renal events and mortality across higher stages (P < 0.001). After adjustment, higher metabolic scores were linked to lower risks: for cardiovascular-renal outcomes, HR 0.82 (95% CI 0.77-0.87) for score 1, 0.72 (0.68-0.77) for score 2, and 0.65 (0.57-0.73) for score 3. Stratified analysis showed significant risk reduction in early CKM stages but not in advanced stages. Restricted cubic spline models indicated nonlinear associations between LDL-C and both outcomes, and between FBG, systolic BP, and mortality, after full adjustment (all P < 0.05). CONCLUSIONS: The findings underscore the need for stage-specific management strategies in CKM syndrome.
Int J Cardiol
· 2026 Oct · PMID 42208867
·
Publisher ↗
BACKGROUND: There is increasing clinical focus on chronic coronary disease (CCD) yet limited population-level data on CCD epidemiology. We evaluated admission patterns and characteristics of hospitalised CCD patients and...BACKGROUND: There is increasing clinical focus on chronic coronary disease (CCD) yet limited population-level data on CCD epidemiology. We evaluated admission patterns and characteristics of hospitalised CCD patients and assessed the impact of definitions of episodes of care on CCD surveillance. METHODS: We used person-linked hospitalisation data from Western Australia, 2005-2022, to identify CCD (stable angina, ICD-10-AM I20.1-I20.9; chronic ischaemic heart disease, IHD, I25). Baseline episodes and 28-day, 3-month and 6-month duration-specific episodes were created for each subgroup, stratified by recent acute coronary syndrome (ACS). Age-standardised and sex-stratified hospitalisation rates were calculated, with age-adjusted annual changes estimated from Poisson regression models. RESULTS: From 2005 to 2022, 50,384 stable angina and 65,278 chronic IHD baseline episodes were identified. Nearly 10% had a recent ACS admission. Patient characteristics were similar by subgroup, although chronic IHD admissions were predominantly for invasive angiography +/- revascularisation (95% vs stable angina 61%). When 28-day and 3-month episodes were imposed, stable angina counts were 7.0% and 11.6% lower than baseline episodes, with a similar pattern for chronic IHD (9.2% and 14.6% lower). Most patients had ≥1 coronary-related readmission in the 6-months following their CCD admission (68.2%), with >80% for angiography +/- revascularisation. Marginal declines in overall CCD rates were underpinned by reductions in stable angina (-6.1%/year, 95% CI -6.3, -5.9) and increasing chronic IHD (3.3%/year, 95% CI 3.2, 3.5). CONCLUSIONS: Small declines in CCD hospitalisation rates masked differing trends in stable angina and chronic IHD. Differences in patient management indicate that subgroup stratification is needed when using hospitalisation data for CCD.
Nordberg Backelin C, Bobbio E, Bollano E
… +8 more, Rawshani A, Wideqvist M, Björkenstam M, Romeo S, Fu M, Andersson B, Bergh N, Ljungman C
Int J Cardiol
· 2026 Oct · PMID 42208866
·
Publisher ↗
BACKGROUND: Sex-related differences in cardiomyopathy (CMP) may influence clinical presentation, diagnostic evaluation, access to advanced therapies and outcomes. Despite this, women remain substantially underrepresented...BACKGROUND: Sex-related differences in cardiomyopathy (CMP) may influence clinical presentation, diagnostic evaluation, access to advanced therapies and outcomes. Despite this, women remain substantially underrepresented in CMP research. OBJECTIVES: To examine sex differences in distribution, clinical presentation, comorbidities, diagnostic evaluation, advanced therapies and outcomes across CMPs. Further to identify sex-specific predictors of prognosis. METHODS: Adults (≥18 years) with suspected CMPs were prospectively enrolled and diagnosed with arrhythmogenic right heart cardiomyopathy (ARVC), dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), myocarditis, restrictive cardiomyopathy (RCM), or other CMPs. The primary composite outcome included mechanical circulatory support (MCS), heart transplantation (HTx), or death. Age-adjusted Cox regression, and machine-learning survival models identified key outcome predictors. RESULTS: Among 641 patients (mean age 54.4 ± 16.5 years; 72% men) women had lower diastolic blood pressure, lower body mass index and more often endocrine comorbidities (p < 0.008). Women more often presented with fatigue and men with ventricular arrhythmias (p < 0.013). DCM was the most common CMP in both sexes, while HCM was more frequent in women and RCM in men (p < 0.009). Women more often underwent genetic evaluation but no other statistically significant differences in diagnostic assessments were observed. Use of device therapies and outcome did not differ significantly by sex. Gradient-boosted machine analyses identified NTproBNP, right atrial mean pressure and disease duration as the strongest predictors of outcome in both sexes. CONCLUSION: Despite differences in phenotype and presentation no significant differences in outcomes were observed between sexes, indicating that disease severity, not sex, drives prognosis.
BACKGROUND: Epicardial collaterals represent a conduit for retrograde crossing in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but carry higher procedural risk compared with septal or bypass gr...BACKGROUND: Epicardial collaterals represent a conduit for retrograde crossing in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but carry higher procedural risk compared with septal or bypass graft crossing. METHODS: We analyzed 1527 CTO PCI cases attempted via epicardial collaterals between January 2012 and March 2026 from the PROGRESS-CTO multicenter registry (49 centers). Temporal trends were assessed using logistic regression. Technical success, procedural success, and in-hospital major adverse cardiac events (MACE) were evaluated. RESULTS: Mean patient age was 65 ± 10 years; 86.4% were men. Lesion complexity was high (mean J-CTO score 3.16 ± 1.02). Use of the retrograde approach overall and via epicardial collaterals decreased significantly over time (both p < 0.001). Epicardial collateral crossing success increased (p < 0.001), while MACE rates did not change significantly (p = 0.085). Technical and procedural success were 77.0% and 74.4%, respectively. In-hospital MACE occurred in 3.8% of cases. Coronary perforation occurred in 13.8% of procedures and was strongly associated with MACE (15.2% vs. 2.0%, p < 0.001). CONCLUSIONS: In a large contemporary multicenter registry, while use of retrograde CTO PCI via epicardial collaterals declined over time, crossing success improved without a significant increase in complications, suggesting improved case selection and procedural expertise.
Gopal A, Kamrada C, Awad A
… +3 more, Chalhoub M, Basit J, Alraies MC
Int J Cardiol
· 2026 Oct · PMID 42203004
·
Publisher ↗
BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality, and comorbid major depressive disorder (MDD) is linked to worse cardiovascular outcomes. The association bet...BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality, and comorbid major depressive disorder (MDD) is linked to worse cardiovascular outcomes. The association between selective serotonin reuptake inhibitors (SSRIs), first-line therapy for MDD, and clinical outcomes in patients with STEMI remains incompletely defined. METHODS: We performed a retrospective cohort study using the TriNetX Research Network. Adult patients with STEMI and MDD were stratified by SSRI exposure at or prior to the index STEMI event. Propensity score matching was used to balance demographic characteristics, cardiovascular comorbidities, psychiatric conditions, and cardiac medications. Primary outcome was all-cause mortality at 1 month, 1 year, and 3 years. RESULTS: Among 22,427 patients with STEMI and MDD, 18.9% had documented SSRI use at their baseline. After propensity score matching, baseline SSRI use was not associated with recurrent myocardial infarction or ischemic stroke at any time point. Baseline SSRI use was associated with lower all-cause mortality from 30 days to 1 year and 3 years post-STEMI. Baseline SSRI therapy was additionally associated with higher rates of of major bleeding at 3 years post-STEMI and hospital readmission at 1 year post-STEMI. CONCLUSIONS: In this large, propensity-matched cohort of patients with STEMI and MDD, baseline SSRI use was associated with a lower all-cause mortality without higher rates of recurrent myocardial infarction or stroke. These findings suggest an association between SSRI use and favorable mortality outcomes in this population, although residual confounding cannot be ruled out.
BACKGROUND: Elevated lipoprotein(a) [Lp(a)] is a well-established, genetically mediated risk factor for atherosclerotic cardiovascular disease (ASCVD), yet effective therapies targeting Lp(a) remain limited. Glucagon-lik...BACKGROUND: Elevated lipoprotein(a) [Lp(a)] is a well-established, genetically mediated risk factor for atherosclerotic cardiovascular disease (ASCVD), yet effective therapies targeting Lp(a) remain limited. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide cardiometabolic benefits in high-risk populations, but their impact among patients with elevated Lp(a) levels is not well defined. METHODS: We conducted a retrospective cohort study to evaluate cardiovascular outcomes associated with GLP-1RA therapy in adults with Lp(a) >50 mg/dL and comorbid obesity or type 2 diabetes. Patients were categorized into GLP-1RA users versus non-users and matched 1:1 using propensity scores based on demographics, cardiovascular risk factors, and baseline comorbidities. The primary outcome was all-cause mortality; secondary outcomes included major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, and coronary revascularization). Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional hazards models. RESULTS: Among 24,185 eligible patients, 3791 received a GLP-1RA. After matching, 3310 patients remained in each cohort with balanced baseline characteristics. Over a median follow-up of approximately two years, GLP-1RA use was associated with significantly lower all-cause mortality (HR 0.66, 95% CI 0.48-0.90) and reduced MACE (HR 0.68, 95% CI 0.60-0.76). Individual components, including myocardial infarction, ischemic stroke, and cardiovascular death, were also significantly decreased among GLP-1RA users. CONCLUSION: In patients with elevated Lp(a), GLP-1RA therapy was associated with substantial reductions in mortality and cardiovascular events. These findings suggest potential cardioprotective effects of GLP-1RAs in a high-risk population with limited therapeutic options and support further prospective evaluation.
Mauro A, Mascolo R, Bizzi E
… +24 more, Sandini M, Collini V, Caorsi R, La Torre F, Celani C, Cattalini M, Giani T, Del Giudice E, Rigante D, Maggio MC, Trotta L, Pancrazi M, Ceriani E, Berra S, Agozzino F, Mannarino S, Pasquinucci M, Insalaco A, Lubrano R, Simonini G, Gattorno M, Bernardo L, Imazio M, Brucato A
BACKGROUND AND OBJECTIVES: Recurrent pericarditis (RP) guidelines are based on adult studies. We aimed to compare RP in pediatric and adult patients. METHODS: This observational longitudinal multicentric cohort study stu...BACKGROUND AND OBJECTIVES: Recurrent pericarditis (RP) guidelines are based on adult studies. We aimed to compare RP in pediatric and adult patients. METHODS: This observational longitudinal multicentric cohort study studied 442 patients with idiopathic or post-pericardiotomy RP: 133 pediatric (<18 years) and 309 adult (≥18 years) patients. RESULTS: Children showed a male predominance (90 males, 67.7%). Chest pain was most common in children [129/133 (97%) vs. 217/309 (70.2%) p < 0.001], as fever and pleural effusion [85/133 (63.9%) vs. 136/309 (44%), p < 0.05; 68/133 (51.1%) vs. 106/309 (34.3%), p < 0.001], while pericardial effusion occurred with a similar frequency: 99/133 (74.4%) vs. 249/309 (80.6%). Children exhibited a pronounced inflammatory response, with higher neutrophilia (p = 0.031). The clinical course was more favorable with a lower recurrence rate [median (IQR) 0.5 (0.27 to 0.87) vs. 0.87 (0.43 to 1.56) episodes/year, p < 0.001] and a longer disease-free interval, with a median (IQR) of 20.5 (11 to 30.6) months vs. 12.3 (7.4 to 23.6) months (p < 0.001). Glucocorticoid use was more frequent in adults [231/309 (74.8%) vs. 66/133 (49.6%), p < 0.001], as well as colchicine [306/309 (99%) vs. 120/133 (90%), p < 0.001]. Anakinra was more frequently prescribed in pediatric patients [60/133 (45.1%) vs. 73/309 (23.6%), p < 0.001]. Only 5/60 (8.3%) pediatric subjects were able to stop anakinra. Eleven patients (8.3%) had disease onset before 6 years. CONCLUSIONS: Pediatric idiopathic RP exhibits distinct features compared to adult cases, with a more intense inflammatory profile but a more favorable clinical course. IL-1 inhibitors were more commonly used in pediatric subjects.
INTRODUCTION: The Italian pre-participation screening (PPS) protocol includes family and personal medical history, physical examination, and a 12‑lead electrocardiogram (ECG). The aim of this study was to evaluate the pr...INTRODUCTION: The Italian pre-participation screening (PPS) protocol includes family and personal medical history, physical examination, and a 12‑lead electrocardiogram (ECG). The aim of this study was to evaluate the prevalence of selected ECG abnormalities in an unselected athletic population from a multicenter Italian registry, and to assess their association with at-risk cardiovascular conditions. METHODS: This multicenter registry prospectively enrolled 12,758 elite and amateur athletes (62% males; median age 22.5 years, range 14-55 years) undergoing PPS according to the Italian national protocol (COCIS, 2017). ECGs were interpreted according to the International Criteria for Electrocardiographic Interpretation in Athletes, with the addition of selected markers (low QRS voltages, QRS fragmentation, and early repolarization with horizontal or descending ST segment). ECG patterns suggestive of Brugada syndrome and ventricular pre-excitation, although observed, were not included in the analysis. All subjects with ECG abnormalities underwent a second-line diagnostic work-up. RESULTS: A total of 129 abnormal ECGs were identified (1.01%). Among these, 25 athletes (19.3%) were disqualified because of an at-risk cardiovascular condition. CONCLUSION: The prevalence of selected ECG abnormalities in this multicenter registry was lower than that reported in previous studies. However, this finding should be interpreted in the light of the selective ECG criteria adopted. The abnormalities investigated showed a relevant predictive value for identifying at-risk conditions in a real-world, predominantly non-elite population.
AIMS: Takotsubo syndrome is an acute cardiac syndrome that mimics myocardial infarction. Despite its transient nature, substantial early morbidity may occur, while predictors of short-term recovery and adverse in-hospita...AIMS: Takotsubo syndrome is an acute cardiac syndrome that mimics myocardial infarction. Despite its transient nature, substantial early morbidity may occur, while predictors of short-term recovery and adverse in-hospital outcomes remain incompletely characterized. METHODS: We performed a retrospective study of consecutive adults diagnosed with Takotsubo syndrome at a tertiary center between 2011 and 2024. Patients with pre-existing cardiomyopathy or heart failure with reduced ejection fraction were excluded. Clinical, electrocardiographic, echocardiographic, and laboratory data, as well as in-hospital outcomes, were analyzed. Early left ventricular recovery was defined as achieving an ejection fraction ≥50% at discharge. Associations with recovery and major in-hospital complications were evaluated using univariate and exploratory multivariable analyses. RESULTS: A total of 189 patients were included (median age 69 years; 99% women). ST-segment elevation was present in 32%, and QTc prolongation exceeding 20% from baseline occurred in 18%. Median ejection fraction improved from 35% (IQR 30-45%) on admission to 45% (IQR 35-60%) at discharge (p < 0.01). Moderate-to-severe mitral regurgitation declined from 5.8% to 1.6% by discharge. Early left ventricular recovery during hospitalization was observed in only 31% of patients. Shorter QT and PR intervals at discharge were associated with concurrent myocardial recovery. In-hospital arrhythmias occurred in 12%, vasopressor use in 21%, and mechanical support in 1%. Mortality was 2.6% in-hospital and 4.9% at one year. Older age, higher admission troponin levels, prolonged QTc interval, and lower admission LVEF were independently associated with major in-hospital complications. CONCLUSIONS: Takotsubo syndrome is associated with substantial early morbidity and incomplete in-hospital recovery in most patients. These findings reinforce the concept that recovery may be incomplete during the early in-hospital phase and highlight the need for closer monitoring and early risk stratification during the acute phase.
BACKGROUND: Adverse left ventricular (LV) remodelling is associated with increased mortality and heart failure following ST-segment elevation myocardial infarction (STEMI). Prior studies on the prognostic value of LV glo...BACKGROUND: Adverse left ventricular (LV) remodelling is associated with increased mortality and heart failure following ST-segment elevation myocardial infarction (STEMI). Prior studies on the prognostic value of LV global longitudinal strain (GLS), left atrial (LA) strain, and left atrioventricular coupling index (LACI) are promising, but it remains unclear which CMR-derived functional parameter is optimal. This study aimed to investigate the prognostic significance of atrial and ventricular function parameters to predict early adverse LV remodelling in patients with anterior STEMI. METHODS AND RESULTS: A post-hoc analysis of the EURO-ICE trial was performed, including 200 patients with anterior wall STEMI who underwent cardiovascular magnetic resonance (CMR) at baseline and 3-month follow-up. Predictors of adverse LV remodelling were identified. LV GLS was the strongest predictor, respectively odds ratio (OR) 1.162; 95% confidence interval (CI) 1.060-1.274; p = 0.001 and OR 1.155; 95% CI 1.007-1.326; p = 0.040. Its significance remained after adjusting for clinical risk factors (OR 1.216; 95% CI 1.096-1.349; p < 0.001), but not after adjusting for infarct size and microvascular obstruction (MVO) (OR 1.063; 95% CI 0.959-1.178; p = 0.246). LA strain and LACI did not have additional prognostic value. CONCLUSIONS: CMR-derived LV GLS is the strongest functional parameter associated with adverse LV remodelling anterior STEMI patients, remaining significant after adjusting for clinical risk factors, but not beyond infarct size and MVO, indicating that its prognostic value is largely mediated by myocardial injury burden. No significant association was found between LA strain or LACI and adverse LV remodelling. LV GLS may add value when contrast agents cannot be used.
The success of congenital heart surgery and care has created a rapidly expanding population of adults with congenital heart disease. Many individuals who underwent atrial switch procedures for transposition of the great...The success of congenital heart surgery and care has created a rapidly expanding population of adults with congenital heart disease. Many individuals who underwent atrial switch procedures for transposition of the great arteries in infancy have now reached middle adulthood, where excellent early surgical outcomes contrast with the long-term vulnerability of a systemic right ventricle. This article draws on a unique longitudinal narrative centred on an individual first documented as a newborn with transposition of the great arteries in a remarkable 1976 medical documentary. Now followed in adulthood at the same tertiary ACHD centre, his life course illustrates the evolving clinical challenges faced by this generation of patients, including arrhythmia, systemic right ventricular dysfunction, and heart failure. Using this rare historical perspective, we highlight how modifiable lifestyle and psychosocial factors interact with congenital physiology to influence long-term outcomes, and argue for a model of lifelong ACHD care that extends beyond anatomical repair to sustained lifestyle support and prevention.