Takesue Y, Sakakibara K, Kurita H
… +1 more, Nakajima H
Eur Heart J Case Rep
· 2026 Jun · PMID 42370230
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A 66-year-old man with prostate cancer underwent contrast-enhanced computed tomography for cancer staging; the imaging incidentally revealed a 10 mm left ventricular mass. Transthoracic echocardiography demonstrated a hi...A 66-year-old man with prostate cancer underwent contrast-enhanced computed tomography for cancer staging; the imaging incidentally revealed a 10 mm left ventricular mass. Transthoracic echocardiography demonstrated a highly mobile, pedunculated mass attached to a left ventricular false tendon. Cardiac magnetic resonance imaging was insufficient to characterize the tissue because of the extreme mobility of the lesion. Because of the left-sided location, pronounced mobility, and potential embolic risk, the tumour was excised with the attached false tendon via a transmitral approach through a left atriotomy, thereby avoiding a ventriculotomy. Histopathological examination confirmed a papillary fibroelastoma (PFE). This case highlights that PFEs associated with a left ventricular false tendon, although rare, should be considered in the differential diagnosis of highly mobile left ventricular masses; furthermore, a transmitral approach may provide safe access when the tumour is located on the apicoseptal aspect of the left ventricle.
Asvestas D, Charitos D, Sousonis V
… +2 more, Vavouris E, Tzeis S
Eur Heart J Case Rep
· 2026 Jun · PMID 42370229
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BACKGROUND: Postcardiac injury syndrome (PCIS) is an uncommon inflammatory complication after catheter ablation for atrial fibrillation (AF). While pericarditis is well described following thermal ablation, reports after...BACKGROUND: Postcardiac injury syndrome (PCIS) is an uncommon inflammatory complication after catheter ablation for atrial fibrillation (AF). While pericarditis is well described following thermal ablation, reports after pulsed-field ablation (PFA) remain rare. CASE SUMMARY: A 69-year-old man underwent pulmonary vein isolation using PFA for symptomatic paroxysmal AF. Four days later, he developed pleuritic chest pain, fever, and elevated inflammatory markers consistent with acute pericarditis. Despite initial improvement with non-steroidal anti-inflammatory drugs, he developed recurrent moderate-to-large pericardial and bilateral pleural effusions. Corticosteroids combined with colchicine led to resolution; however, relapses occurred during steroid tapering, necessitating more gradual withdrawal. At 12-month follow-up, the patient remained asymptomatic without recurrence of effusion or AF. DISCUSSION: Although PFA is a non-thermal ablation modality, it may be associated with PCIS, warranting further studies to clarify the pathophysiological mechanisms involved.
Oda Y, Yamada T, Usui R
… +2 more, Nogami A, Uno K
Eur Heart J Case Rep
· 2026 Jun · PMID 42370227
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BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI). Although the exact pathophysiological mechanism of SCAD remains unclear, coronary vasospasm has been propose...BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI). Although the exact pathophysiological mechanism of SCAD remains unclear, coronary vasospasm has been proposed as a possible associated or triggering factor. CASE SUMMARY: A 39-year-old woman presented with sudden-onset back pain and ST-segment elevation in leads V1-V6 on electrocardiogram. Emergent coronary angiography (CAG) revealed subtotal occlusion with dissection in the mid left anterior descending artery (LAD), and intravascular ultrasound demonstrated that the dissection extended from the mid portion to the ostium of the LAD. We deployed a drug-eluting stent for the mid-LAD and confirmed reperfusion. After the PCI, she developed recurrent chest pain with transient ST-segment elevation in the inferior leads. Emergent CAG demonstrated diffuse severe stenosis in the distal right coronary artery. Both symptoms and electrocardiographic changes resolved spontaneously; coronary vasospasm was considered the most likely cause. On day 17, follow-up CAG revealed progression of stenosis from mild to severe in the mid to ostial LAD and a new dissecting lesion in the mid right coronary artery. Repeat PCI was performed, and the patient remained stable after discharge. DISCUSSION: There are some SCAD cases that present acute progression or recurrence. The prognostic factor was unknown, while this case would suggest that vasospastic angina pectoris (VSA) might be associated with those events. Consideration of concomitant VSA may be warranted in the clinical management of patients with SCAD.
Trenkpohl VJ, Emelianova M, Rudolph F
… +2 more, Gerçek M, Friedrichs K
Eur Heart J Case Rep
· 2026 Jun · PMID 42370226
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BACKGROUND: Transcatheter mitral valve implantation (TMVI) has emerged as a therapeutic option for high-risk patients with severe mitral regurgitation (MR) who are unsuitable for surgery. The Tendyne system, with its dua...BACKGROUND: Transcatheter mitral valve implantation (TMVI) has emerged as a therapeutic option for high-risk patients with severe mitral regurgitation (MR) who are unsuitable for surgery. The Tendyne system, with its dual-frame design consisting of an atrial cuff and an external frame, has shown promising in complex anatomical settings. However, experience with Tendyne TMVI remains limited in patients with post-surgical MR caused by mitral leaflet perforation and a concomitant mechanical aortic valve prosthesis. CASE SUMMARY: An 80-year-old woman with a prior mechanical aortic valve replacement (St. Jude Medical, 21 mm) for bicuspid aortic stenosis presented with severe mixed MR. At the index operation, a Manouguian aortic root enlargement using a pericardial patch had been performed to prevent prosthesis-patient mismatch. During follow-up, patch dehiscence resulted in perforation of the anterior mitral leaflet, while concomitant annular dilatation generated an additional regurgitant jet, resulting in severe mixed MR. Given the prohibitive risk of redo cardiac surgery (EuroSCORE II 25.24%), the multidisciplinary Heart Team recommended a transcatheter treatment strategy. Following Heart Team evaluation, transapical TMVI with a Tendyne prosthesis (29S LP) was performed. The procedure achieved complete elimination of MR without residual paravalvular leak or interference with the mechanical aortic valve. Notably, the external stent frame of the prosthesis successfully sealed the mitral leaflet perforation, eliminating the need for additional closure devices. DISCUSSION: This case underscores the importance of imaging-guided, multidisciplinary Heart Team planning in optimizing procedural outcomes for patients with challenging post-surgical anatomy. Transcatheter mitral valve implantation might be a feasible option for patients with MR after cardiac surgery at prohibitive surgical risk.
Kawauchi H, Sato T, Fukushima S
… +2 more, Izumi C, Tsukamoto Y
Eur Heart J Case Rep
· 2026 Jun · PMID 42370225
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BACKGROUND: The long-term prognosis of patients supported by durable left ventricular assist devices (LVAD) while receiving immunosuppressive therapy remains unclear. Underlying conditions such as cardiac sarcoidosis, re...BACKGROUND: The long-term prognosis of patients supported by durable left ventricular assist devices (LVAD) while receiving immunosuppressive therapy remains unclear. Underlying conditions such as cardiac sarcoidosis, recurrent myocarditis, or post-organ transplantation may necessitate concomitant immunosuppressive therapy during LVAD support. In particular, patients requiring prolonged immunosuppressive therapy exceeding low-dose corticosteroids represent a clinically challenging population in whom infectious complications and long-term outcomes have not been well characterized. CASE SUMMARY: We retrospectively reviewed 241 consecutive LVAD recipients (HeartMate II and HeartMate 3) at a single centre (2013-24). Five patients (2.1%) required prolonged immunosuppressive therapy exceeding low-dose corticosteroids. Underlying cardiac conditions included myocarditis ( = 3), cardiac sarcoidosis ( = 1), and dilated cardiomyopathy following liver transplantation ( = 1). The mean duration of immunosuppressive therapy during LVAD support was 2.3 years (0.8-4.5 years). One patient developed LVAD-specific infections including driveline infection. Two underwent successful heart transplantation without perioperative complications. One was tapered to low-dose corticosteroid monotherapy due to a non-device-related infection, and two remained stable on LVAD support. DISCUSSION: This case series underscores the complexity of managing LVAD patients requiring extended immunosuppressive therapy and highlights a unique and underreported patient population. Our findings suggest that successful heart transplantation may be achievable in immunosuppressed LVAD patients when supported by vigilant infection surveillance and individualized treatment strategies. This topic is of increasing clinical importance, particularly in regions where DT indications have recently been expanded.
Makizawa Y, Fujiwara A, Fujisawa T
… +2 more, Kusaka Y, Minami T
Eur Heart J Case Rep
· 2026 Jun · PMID 42370224
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BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been widely adopted as a less invasive treatment for aortic stenosis (AS). Although rare, acute ascending aortic dissection associated with TAVI is a life-th...BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been widely adopted as a less invasive treatment for aortic stenosis (AS). Although rare, acute ascending aortic dissection associated with TAVI is a life-threatening complication that necessitates prompt intraoperative diagnosis. This case series reports two cases of acute ascending aortic dissection occurring during TAVI performed under general anaesthesia. CASE SUMMARY: Cases 1 and 2 involved an 87-year-old woman and a 90-year-old man, respectively, both of whom underwent transfemoral TAVI for severe AS. In both cases, procedural difficulty was encountered, including valve pop-up and resistance during device passage. Before overt haemodynamic deterioration became apparent, intraoperative transoesophageal echocardiography revealed an intimal flap and false lumen in the ascending aorta, leading to the diagnosis of acute ascending aortic dissection. Both patients underwent prompt surgical intervention. Case 1 underwent surgical aortic valve replacement (SAVR) and ascending aortic replacement, whereas Case 2 underwent SAVR and total arch replacement. Both patients were discharged ambulatory without neurological sequelae. DISCUSSION: Unlike fluoroscopy and angiography, which provide only intermittent assessment, transoesophageal echocardiography enables continuous intraoperative evaluation and can simultaneously detect findings directly relevant to haemodynamic status, including an intimal flap, false lumen, acute aortic regurgitation, and pericardial effusion. This case series suggests that additional transoesophageal echocardiography assessment prompted by procedural difficulty may contribute to the early diagnosis of serious complications and facilitate prompt conversion to surgical intervention.
Sailer B, Sari-Yavuz S, Biergans S
… +5 more, Verbücheln R, Achauer LC, Rosenberger P, Hardt M, Koeppen M
Eur Heart J Digit Health
· 2026 Jul · PMID 42368708
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AIMS: Perioperative myocardial injury (PMI) is a frequent and often asymptomatic complication after non-cardiac surgery and is associated with increased short- and long-term mortality. Conventional risk scores, such as t...AIMS: Perioperative myocardial injury (PMI) is a frequent and often asymptomatic complication after non-cardiac surgery and is associated with increased short- and long-term mortality. Conventional risk scores, such as the Revised Cardiac Risk Index (RCRI), have limited predictive accuracy and are infrequently used in clinical practice. We aimed to develop and temporally validate an interpretable machine learning model using Explainable Boosting Machines (EBMs) to predict PMI from routine pre-operative data. METHODS AND RESULTS: In this retrospective cohort study at a tertiary care centre in Germany, we included 9323 adult patients undergoing 9824 non-cardiac surgical procedures between 2014 and 2023 who received post-operative high-sensitivity cardiac troponin testing as part of routine care. PMI was defined as a post-operative elevation of high-sensitivity cardiac troponin above the upper reference limit. An EBM was trained on structured pre-operative data from 2014 to 2021 and evaluated in a temporally independent test cohort from 2022 to 2023, with performance compared with logistic regression, random forest, XGBoost, and a modified RCRI. Model discrimination, calibration, and Brier scores were assessed. Feature contributions were examined using internal shape functions and SHAP values. PMI occurred in 2804 procedures (28.5%). The EBM achieved the highest predictive performance (AUROC 0.730, 95% CI 0.720-0.740), outperforming all comparators. Calibration was robust across clinically relevant risk ranges. Key predictors included age, leukocyte count, renal function, potassium, and platelet count. The EBM identified high-risk patients more efficiently than the modified RCRI and ESC guideline-based strategies (Number Needed to Evaluate 3.0 vs. 3.5) and reduced troponin assays by 18.2% in the temporally independent cohort. CONCLUSION: An interpretable machine learning model trained on routine clinical data can accurately predict PMI and outperform existing risk scores. The EBM supports individualized risk stratification and may enhance perioperative decision-making and resource allocation within a guideline-directed testing population. Prospective and external validation is required before clinical implementation.
Eur Heart J Digit Health
· 2026 Jul · PMID 42368707
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Graphical AbstractFor image description, please refer to the figure legend and surrounding text.Graphical AbstractFor image description, please refer to the figure legend and surrounding text.
Walsh MN, Kober L, Sliwa K
… +18 more, Adamo M, Agarwal A, Banerjee A, Bozkurt B, Cikes M, Damasceno A, Desai AS, Michael Felker G, Hogan G, Kinugawa K, Kittleson M, Lam CSP, McDonagh T, Metra M, Mullens W, Ribeiro ALP, Vaughn Y, Vest A
Heart failure (HF) remains a pressing health concern, with rising prevalence globally. Subjectivity and ambiguity in the definition of HF and its antecedent stages have limited research, global surveillance, and preventi...Heart failure (HF) remains a pressing health concern, with rising prevalence globally. Subjectivity and ambiguity in the definition of HF and its antecedent stages have limited research, global surveillance, and prevention programs. To address this, several cardiac societies and foundations convened to standardize the definition of HF in 2021 and designated stage B or pre-HF to identify individuals at risk of developing HF. In subsequent years, substantial progress and changes have been made in aspects of preventing HF, improving HF diagnosis and management, and recognizing the importance of the affected individual's voice. Global differences and disparities in HF are better understood, as are causes and comorbidities leading to differences in care, which are also influenced by access to care. This consensus document presents the Second Universal Definition of Heart Failure, aiming to standardize terminology and facilitate a uniform approach for clinicians, researchers, health systems, and policymakers. In this definition, the classification of HF phenotypes moves away from rigid left ventricular ejection fraction cutoffs, instead grouping HF into reduced, preserved, and improved ejection fraction categories to better reflect clinical realities. A universal classification of HF causes is also proposed. The document also addresses the dynamic trajectories of HF-improvement, remission, and recovery-and highlights the impact of social determinants and geographic variation on HF risk and outcomes. By providing a comprehensive, standardized framework for HF definition and classification, this document seeks to improve prevention, early detection, and management of HF worldwide, ultimately enhancing patient care and advancing global cardiovascular health.
Ky B, Xia C, Ko K
… +14 more, Hyde C, Smith AM, Rhee JW, Tow-Keogh C, Tierney C, Long T, Zhang L, Liu PP, Wilcox NS, Dang V, Armenian SH, Jain M, Mangipudy R, Vaidya VS
BACKGROUND AND AIMS: The objective of this study was to define the relationships between the circulating proteome and metabolome with cardiac structure and function in patients with breast cancer receiving cardiotoxic th...BACKGROUND AND AIMS: The objective of this study was to define the relationships between the circulating proteome and metabolome with cardiac structure and function in patients with breast cancer receiving cardiotoxic therapies. METHODS: Proteomics and metabolomics profiling was performed in a longitudinal, prospective cohort study of breast cancer patients receiving anthracyclines and/or trastuzumab, using the Olink Explore 3072 platform and rapid liquid chromatography-mass spectrometry, respectively. Multivariable linear mixed-effect models evaluated the contemporaneous (same visit) and lagged (subsequent visit) associations between repeated measures of individual proteins or metabolites with quantitative echocardiographic measures of cardiac structure [left ventricular (LV) mass and left atrial volume index] and function [LV ejection fraction (LVEF), longitudinal and circumferential strain, E/e', and ventricular-arterial coupling]. Cox regression and pathway enrichment analyses were conducted for biomarkers demonstrating significant associations with cardiac function. RESULTS: Across 547 breast cancer participants (median age 50 years), 203 unique proteins and 16 unique metabolites were significantly associated with measures of cardiac structure and function in contemporaneous and lagged analyses. Notably, cathepsin C was associated with LVEF [false discovery rate (FDR), P = .017], longitudinal strain (FDR, P = .046), left atrial volume index (FDR, P = .035), and incident cardiac dysfunction, defined by an LVEF decline ≥10% to <50% (hazard ratio .61, 95% confidence interval .41, .90). The 147 proteins associated with cardiac function were enriched in biological processes reflective of protein deubiquitination, protein modification by small protein removal, macromolecule catabolic processes, and global metabolic pathways. Individual metabolites significantly associated with cardiac function (LVEF, longitudinal strain) included n-acetylglutamine, aspartic acid, acetylasparagine, alanyl-alanine, and prolyl-glycine (FDR, P-value < .001), and belonged to amino acids and derivatives and peptides. CONCLUSIONS: These findings provide translational insights into cancer therapy-related cardiac dysfunction and remodelling and identify potential new biomarkers of cardiotoxicity. There is an important need for validation of these findings and a deeper understanding of the biology of these biomarkers.