Eur Heart J Acute Cardiovasc Care
· 2026 Jun · PMID 42345386
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BACKGROUND: In myocardial infarction-related cardiogenic shock, especially in the subgroup of ST-elevation myocardial infarction (STEMI-CS), mechanical circulatory support (MCS) might improve survival. If centers with MC...BACKGROUND: In myocardial infarction-related cardiogenic shock, especially in the subgroup of ST-elevation myocardial infarction (STEMI-CS), mechanical circulatory support (MCS) might improve survival. If centers with MCS availability (MCS centers) have better outcome in STEMI-CS compared to those without MCS availability (non-MCS centers) is unknown. AIM: To analyze the association of the availability of MCS and prognosis in STEMI-CS. METHODS: Secondary analysis of the prospective "Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction" (FITT-STEMI) registry comparing outcome in STEMI-CS treated in MCS and non-MCS centers. Primary endpoint was hospital mortality. RESULTS: Between 2013 and 2022, a total of 5604 patients with STEMI-CS at hospital admission were included (mean age 65.3 years, rate of primary percutaneous coronary intervention (PCI) 86.5%, hospital mortality 44.7%). Of these, 4340/5604 (77.4%) STEMI-CS were treated in MCS centers compared to 1264/5604 (22.6%) in non-MCS centers. Patients in MCS centers were younger (65.1 versus 66.0 years, respectively, p = 0.045), were less-frequently resuscitated in-hospital (31.4% versus 35.1%, respectively, p = 0.013), and had longer contact-to-balloon times (120.7 versus 114.6 minutes, respectively, p = 0.008). Hospital mortality was 44.7% in MCS centers compared to 45.0% in non-MCS centers (OR 0.985, 95%CI 0.869-1.118, p = 0.820). Results remained consistent after adjustment for time trends and center effects (OR 0.936, 95%CI 0.804-1.091, p = 0.397) and after stratification by SCAI shock stage at presentation. After propensity score matching, again hospital mortality was similar in MCS and non-MCS centers (45.8% versus 43.7%, OR 1.070, 95%CI 0.888-1.288, p = 0.478). CONCLUSION: In this large registry of patients with STEMI-CS, hospital survival did not differ between centers with and without MCS availability.
Panaou K, Venema CS, van Bergeijk KH
… +8 more, Hadjicharalambous D, Krikken JA, van der Werf HW, van den Heuvel AFM, Douglas YL, Lipsic E, Voors AA, Wykrzykowska JJ
Eur Heart J Imaging Methods Pract
· 2026 Jul · PMID 42344350
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AIMS: Sex differences in myocardial changes have been identified, but longitudinal investigations in moderate aortic stenosis populations are lacking. The objective of this study was to investigate sex differences in myo...AIMS: Sex differences in myocardial changes have been identified, but longitudinal investigations in moderate aortic stenosis populations are lacking. The objective of this study was to investigate sex differences in myocardial changes in aortic stenosis. METHODS AND RESULTS: We retrospectively collected longitudinal echocardiographic and clinical data of 542 patients with a diagnosis of asymptomatic moderate aortic stenosis. Baseline was defined as the first echocardiogram showing non-severe aortic stenosis.We enrolled 205 (37.8%) females and 337 (62.2%) males, with a median age of 69 years and a median follow-up duration of 6.47 years.Over the course of aortic stenosis, women had higher left ventricular ejection fraction, lower left ventricular mass index, larger relative wall thickness, and more diastolic dysfunction compared to men. Although the prevalence and incidence of concentric hypertrophy did not differ by sex, women developed concentric hypertrophy and diastolic dysfunction at lower mean gradients than men.Incidence and time of symptom occurrence did not differ by sex. Overall, 99 (48%) women and 148 (44%) men developed symptoms, at a median age of 73.4 [64.2;81.0] years and a mean gradient of 39.8 [31.5;47.5] mmHg, which was similar between the sexes. When symptomatic, women more commonly presented with dyspnoea (87.8% vs. 74.8%; = 0.021). Incidence and time from baseline to aortic valve replacement and mortality were similar between men and women. CONCLUSION: Women with aortic stenosis have worse diastolic function, develop concentric hypertrophy and diastolic dysfunction at lower mean gradients, and more often present with dyspnoea. We observed no sex differences in time from baseline to replacement or mortality. SOCIAL MEDIA SUMMARY: Women with moderate aortic stenosis developed concentric hypertrophy at lower mean gradients, had more and earlier diastolic dysfunction, and more often presented with dyspnoea compared to men. No difference was observed in outcomes. #vhdAS #TAVR #WomenInCardiology.
Hasegawa-Tamba S, Sato T, Arai T
… +1 more, Nakano S
Eur Heart J Case Rep
· 2026 Jun · PMID 42344164
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BACKGROUND: Immune checkpoint inhibitors, including nivolumab and ipilimumab, have revolutionized cancer therapy by enhancing immune-mediated antitumour activity. While some cardiovascular immune-related adverse events m...BACKGROUND: Immune checkpoint inhibitors, including nivolumab and ipilimumab, have revolutionized cancer therapy by enhancing immune-mediated antitumour activity. While some cardiovascular immune-related adverse events manifest as various phenotypes, such as myocarditis and pericarditis, pulmonary veno-occlusive disease is a particularly rare complication. CASE SUMMARY: An 80-year-old man with chronic obstructive pulmonary disease, hypertension, and a history of heavy smoking underwent lobectomy for lung cancer. Histopathological examination of pulmonary tissue, including the vasculature, showed no evidence of pulmonary veno-occlusive disease at the time of surgery. Following disease recurrence, he received combination therapy with nivolumab and ipilimumab. Shortly after treatment initiation, he developed respiratory failure and a renal immune-related adverse event, which improved with oral corticosteroid therapy. Ipilimumab was discontinued due to its higher risk of severe immune-related adverse events, and nivolumab monotherapy was continued for 22 months until the 14th cycle, when the patient presented with progressive dyspnoea and severe hypoxaemia. Echocardiography and right heart catheterization confirmed pulmonary hypertension. Pulmonary vasodilator therapy was initiated, but the respiratory failure rapidly progressed, and the patient died on hospital day 53. Autopsy revealed intimal fibrous thickening and smooth muscle proliferation of interlobular pulmonary veins, consistent with pulmonary veno-occlusive disease. DISCUSSION: This case highlights pulmonary veno-occlusive disease as a rare but potentially fatal pulmonary vascular complication associated with immune checkpoint inhibitor therapy. In patients receiving immune checkpoint inhibitors who develop unexplained pulmonary hypertension and severe hypoxaemia, pulmonary veno-occlusive disease should be considered as a differential diagnosis.
Eur Heart J Case Rep
· 2026 Jun · PMID 42344163
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BACKGROUND: Left ventricular outflow tract (LVOT) obstruction is a serious complication of transcatheter mitral valve replacement and mitral valve-in-valve (ViV) procedures. Computed tomography (CT)-based virtual valve i...BACKGROUND: Left ventricular outflow tract (LVOT) obstruction is a serious complication of transcatheter mitral valve replacement and mitral valve-in-valve (ViV) procedures. Computed tomography (CT)-based virtual valve implantation predicts the neo-LVOT area, but it assumes idealized seating and may not fully reflect procedural interaction during double-valve intervention. CASE SUMMARY: A 74-year-old woman with degenerated surgical mitral and aortic bioprostheses presented with NYHA class IV heart failure. Full-cycle ECG-gated 4D-CT identified the minimum predicted neo-LVOT at 43% of the R-R interval (300.9 mm). A one-session transapical double ViV procedure was performed. The aortic ViV was performed first because CT simulation showed that the aortic balloon would expand between the two strut posts of the surgical mitral prosthesis; implanting the mitral valve first could have exposed the newly deployed mitral prosthesis to compression during subsequent aortic balloon expansion. Post-procedural 4D-CT, evaluated using the same workflow and compared at 43%, showed a neo-LVOT area of 280.6 mm, a 20.3 mm reduction, with approximately 1.2 mm asymmetric ventricular protrusion of the mitral prosthesis. Echocardiography showed normal valve-in-valve function and no haemodynamic LVOT obstruction. DISCUSSION: This case demonstrates that CT-based planning correctly identified procedural feasibility, while post-procedural CT revealed measurable geometric variability. The finding remained well above high-risk thresholds and should be interpreted as a hypothesis-generating geometric observation rather than clinically significant obstruction.
Martinsen MH, Højland A, Kvistgaard H
… +1 more, Bork C
Eur Heart J Case Rep
· 2026 Jun · PMID 42344162
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BACKGROUND: Cholesteryl ester storage disease (CESD) is a rare genetic disorder caused by homozygous or compound heterozygous pathogenic variants in the lipase A () gene encoding lysosomal acid lipase (LAL). LAL deficien...BACKGROUND: Cholesteryl ester storage disease (CESD) is a rare genetic disorder caused by homozygous or compound heterozygous pathogenic variants in the lipase A () gene encoding lysosomal acid lipase (LAL). LAL deficiency is characterized by progressive accumulation of cholesteryl esters in hepatocytes and macrophages, ultimately leading to organ damage and potentially hepatic failure. CASE SUMMARY: Here we describe a girl with biochemistry similar to familial hypercholesterolaemia (FH) having a total cholesterol of 9.3 mmol/L, low-density lipoprotein cholesterol of 7.1 mmol/L, triglycerides of 2.7 mmol/L, and alanine transaminase of 354 U/L. Whole genome sequencing found her to be compound heterozygous for NM_000235.4:c.894G>A p.(Gln298=) and NM_000235.4:c.419G>A p.(Trp140*) in the gene, consistent with the diagnosis compound heterozygous CESD. The patient had no clinical signs of cholesterol deposits and no symptoms suggestive of organ damage. DISCUSSION: This case report highlights the difficulties in diagnosing a rare subclinical disease with similarities to FH followed by discussion of current treatment options.
Dorsi M, Deryabin I, Valdeolmillos E
… +2 more, Batteux C, Fournier E
Eur Heart J Case Rep
· 2026 Jun · PMID 42344161
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BACKGROUND: Congenital pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is exceptionally rare, and prenatal diagnosis remains challenging. CASE SUMMARY: We report a rare case of a congenital P-MAIVF di...BACKGROUND: Congenital pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is exceptionally rare, and prenatal diagnosis remains challenging. CASE SUMMARY: We report a rare case of a congenital P-MAIVF diagnosed prenatally. The fetus was closely monitored throughout pregnancy and after birth. Surgical resection was performed at 12 months because of progressive enlargement and concern for fistula formation. The combination of imaging techniques helped in detecting the complication and guiding management. Postoperative outcome was excellent. DISCUSSION: The diagnosis of such a rare congenital anomaly is challenging, and improving its recognition is essential. Multimodality imaging may help in diagnosis, clinical decision-making, and longitudinal follow-up.
Lipošćak G, Kos N, Kordić K
… +2 more, Svetina L, Vinter O
Eur Heart J Case Rep
· 2026 Jun · PMID 42339188
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BACKGROUND: Native aortic valve thrombosis (NAVT) is an uncommon cause of coronary embolism and myocardial infarction. In patients with severe aortic valve disease treated surgically, a post-operative communication betwe...BACKGROUND: Native aortic valve thrombosis (NAVT) is an uncommon cause of coronary embolism and myocardial infarction. In patients with severe aortic valve disease treated surgically, a post-operative communication between the left ventricle and right atrium (i.e. acquired Gerbode defect) is a rare complication. CASE SUMMARY: We report the case of a 67-year-old man with suspected NAVT presenting with myocardial infarction and a post-operative acquired Gerbode defect. Coronary angiography showed a floating thrombus in the left main coronary artery without significant culprit-vessel atherosclerotic disease, suggesting coronary embolism. Multiple aspiration thrombectomies and glycoprotein IIb/IIIa inhibitor therapy were performed. Recurrent chest pain prompted repeat coronary angiography, which confirmed thrombus recurrence and resolution after repeat treatment. Intravascular ultrasound excluded significant culprit-vessel atherosclerotic disease. Aspirated material revealed a subacute thrombus with microcalcifications on histopathological examination. Echocardiography showed severe calcific aortic stenosis, a likely predisposing factor for NAVT. Atrial fibrillation had not been documented during the embolic event or previously and was only detected later during hospitalization, prompting initiation of anticoagulation (CHA2DS2-VASc score 3). Consequently, dual antiplatelet therapy was replaced with apixaban and ticagrelor until surgery. After clinical stabilization, the patient underwent surgical aortic valve replacement. No left atrial appendage thrombus was found intra-operatively after 3 months of anticoagulation. Post-operatively, multimodal imaging identified and quantified an acquired Gerbode defect. Given its haemodynamic insignificance, a conservative approach was adopted. DISCUSSION: This case highlights underreported complications of severe aortic stenosis and its treatment, emphasizing the importance of multimodal imaging in the diagnosis of NAVT and post-operative Gerbode defect.
Hieda Y, Miyatake K, Choe H
… +2 more, Abe K, Inaba Y
Eur Heart J Case Rep
· 2026 Jun · PMID 42339187
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BACKGROUND: Acute pulmonary thromboembolism is a serious complication of total hip arthroplasty that may be asymptomatic, underscoring the importance of early detection. Contrast-enhanced computed tomography is the stand...BACKGROUND: Acute pulmonary thromboembolism is a serious complication of total hip arthroplasty that may be asymptomatic, underscoring the importance of early detection. Contrast-enhanced computed tomography is the standard diagnostic modality; however, its use is limited by its invasiveness, radiation exposure, contrast allergy, and renal dysfunction. Dynamic digital radiography is a novel, minimally invasive imaging technique that enables visualization of pulmonary perfusion without contrast agents. CASE SUMMARY: We report a case of a 58-year-old woman who underwent primary total hip arthroplasty. Post-operatively, the patient remained asymptomatic. One week after total hip arthroplasty, follow-up dynamic digital radiography demonstrated newly developed pulmonary perfusion abnormalities, with marked signal reduction in the right middle and lower lung zones, and a mild reduction in the left upper lung zone. Subsequent contrast-enhanced computed tomography confirmed bilateral pulmonary thromboembolism corresponding to perfusion defects detected using dynamic digital radiography. Anticoagulant therapy completely resolved the thromboembolism. DISCUSSION: This case highlights the potential utility of dynamic digital radiography for early detection of asymptomatic acute pulmonary thromboembolism following total hip arthroplasty.
Deets A, Peters M, Harland D
… +2 more, Crouch J, Richmond R
Eur Heart J Case Rep
· 2026 Jun · PMID 42339186
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BACKGROUND: Left ventricular pseudoaneurysm (LVP) is considered a surgical emergency; however, diagnosis is often delayed owing to its often-insidious presentation. CASE SUMMARY: We present a case of a patient with non-s...BACKGROUND: Left ventricular pseudoaneurysm (LVP) is considered a surgical emergency; however, diagnosis is often delayed owing to its often-insidious presentation. CASE SUMMARY: We present a case of a patient with non-specific symptoms who was found to have a massive LVP. Retrospective review of a transthoracic echocardiogram (TTE) and single photon emission computed tomography (SPECT) with computed tomography (CT) attenuation correction 2 years before this presentation demonstrates a similarly sized LVP that was initially undetected, as it mimicked normal anatomy. DISCUSSION: Common, readily available testing after myocardial infarction, such as TTE and SPECT with CT attenuation correction, are not traditionally utilized for LVP diagnosis because of their low sensitivity. This case demonstrates that these tests may serve a complementary role, providing an opportunity to quickly detect abnormalities and expedite definitive testing. However, cognizance of at-risk patients by cardiac imagers is paramount to increase detection.
Choudhury AR, Valakkada J, Ayyappan A
… +3 more, Alex A, Arunachalam VS, Sharma S
Eur Heart J Case Rep
· 2026 Jun · PMID 42339185
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BACKGROUND: Cor-triatriatum sinistrum (CTS) is a rare congenital heart disease, characterized by a membrane dividing the left atrium into two chambers. Echocardiography is the primary imaging modality. However, computed...BACKGROUND: Cor-triatriatum sinistrum (CTS) is a rare congenital heart disease, characterized by a membrane dividing the left atrium into two chambers. Echocardiography is the primary imaging modality. However, computed tomography and magnetic resonance imaging both play important roles in delineating the anatomy of the condition and also determining the associated anomalies. Although thought to be a disease of childhood, CTS can also present in adulthood with varied clinical manifestations like dyspnea, palpitations, and syncopal attacks. In CTS, the left atrial membrane causes pulmonary venous obstruction and eventual pulmonary arterial hypertension. It is usually associated with membrane fenestrations, which allow some antegrade flow. If not, there are relief valves, such as the ostium secundum atrial septal defect (OS-ASD) and/or the levo-atrial-cardinal vein. CASE SUMMARY: We present three patients with CTS. The first patient is of Type I CTS-presenting with CTS and an OS-ASD, which is acting as a relief valve. The second patient is of Type II CTS with associated levo-atrio-cardinal vein and venovenous shunting. The third patient presented with CTS with partial anomalous pulmonary venous connection (PAPVC)-suggestive of Type III CTS. All the cases were managed surgically with good outcomes. DISCUSSION: CTS, though thought to be a disease of childhood, may present in adults with varied clinical presentations. Imaging plays a crucial role in the diagnosis and delineation of associated anomalies. Management is usually surgical with a good clinical outcome.
Mohammed M, Chou A, Parikh S
… +2 more, DePorre A, McCord J
Eur Heart J Case Rep
· 2026 Jun · PMID 42339184
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BACKGROUND: Transoesophageal echocardiography (TEE) is generally considered a low-risk procedure. However, in patients with severe tricuspid regurgitation (TR) complicated by right ventricular (RV) dysfunction and pulmon...BACKGROUND: Transoesophageal echocardiography (TEE) is generally considered a low-risk procedure. However, in patients with severe tricuspid regurgitation (TR) complicated by right ventricular (RV) dysfunction and pulmonary hypertension (PH), standard procedural sedation can precipitate life-threatening haemodynamic collapse. CASE SUMMARY: An 83-year-old woman with end-stage renal disease, severe PH (95 mmHg), and severe TR underwent a TEE. Shortly after induction with propofol and probe insertion, the patient developed profound systemic hypotension (56/30 mmHg). Real-time TEE imaging revealed acute, severe RV dilatation and a precipitous decline in systolic function. The procedure was immediately aborted, and the patient was stabilized with intravenous phenylephrine and ephedrine. She returned to her haemodynamic baseline within 20 min of procedure termination and probe removal. DISCUSSION: This case highlights the 'triple hit' effect that places patients with RV failure at high risk during sedation: propofol-induced systemic vasodilation, the vagal response to probe insertion, and hypercapnia-induced increases in pulmonary vascular resistance (PVR). For this high-risk phenotype, a 'slow and low' anaesthetic titration, meticulous PVR management, and early consideration of RV-protective vasopressors are essential to prevent catastrophic RV-pulmonary uncoupling.
Androulakis E, Betemariam T, Dweck MR
… +2 more, Friebel R, Petersen SE
Eur Heart J Imaging Methods Pract
· 2026 Jan · PMID 42338486
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AIMS: Cardiovascular magnetic resonance (CMR) is established in guidelines, yet utilization remains inconsistent across Europe and beyond. This study aimed to identify barriers to CMR practice and reporting across Europe...AIMS: Cardiovascular magnetic resonance (CMR) is established in guidelines, yet utilization remains inconsistent across Europe and beyond. This study aimed to identify barriers to CMR practice and reporting across European Society of Cardiology (ESC) member and affiliate countries. METHODS AND RESULTS: This study was conducted between January and September 2025. A sequential exploratory mixed methods design was used, comprising two phases: qualitative interviews and a quantitative survey. Countries were grouped into five ESC subregions (Northern, Western, Southern, and Eastern Europe, and Central Asia/Caucasus) based on the United Nations regional classification system. Quantitative data were analysed using chi-square tests for regional differences. Qualitative responses were synthesized using thematic analysis and integrated through triangulation. Among 283 respondents from 46 countries, inadequate reimbursement (46%), insufficient training (38%), and limited scanner capacity (29%) were the main barriers. Eastern European countries reported four-fold higher training deficits than Northern and Southern Europe (56% vs. 14%, < 0.001). Country-level analyses showed substantial heterogeneity in drivers of limited CMR access, ranging from workforce and efficiency constraints in mature systems to financial and governance restrictions. Qualitative findings enriched these results, identifying structural inefficiencies, interdepartmental barriers, and emerging adaptive strategies such as remote supervision and reading, and regional collaboration networks to support capacity building in resource-limited settings. CONCLUSION: Across ESC member and affiliated countries, CMR delivery remains constrained by infrastructure, training, and reimbursement limitations. Targeted investment in standardized education, harmonized reimbursement frameworks, and collaborative service models is essential to promote equitable and sustainable access to CMR across Europe.
Ayayo SA, Martin GP, Zghebi SS
… +4 more, Taxiarchi VP, Rashid M, Kontopantelis E, Mamas MA
Eur Heart J Acute Cardiovasc Care
· 2026 Jun · PMID 42336354
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BACKGROUND: There is limited data on the long-term transition risks between major bleeding, reinfarction, and death following acute myocardial infarction (AMI). We examined 1-year and 5-year transition risks of major ble...BACKGROUND: There is limited data on the long-term transition risks between major bleeding, reinfarction, and death following acute myocardial infarction (AMI). We examined 1-year and 5-year transition risks of major bleeding, reinfarction and mortality post-AMI. METHODS: We analysed national registry data of AMI patients across England and Wales between 2005-2021. Multistate modelling was used to estimate the transition-specific adjusted incidence rates (IRs) across the three outcomes using a six-state model with nine transitions. FINDINGS: Out of 837,384 patients included, 19.8% had bleeding, 8.1% reinfarction, and 20.6% death as their first event post- AMI admission. Of those with bleeding, 39.4% died while 49.9% of those with reinfarction died. Overall, females had higher rates of transitioning to any of the five states than males. A reference female patient with median age (76.3 years), at 1-year had an IR of 6.7 (95% CI 6.5-6.9) x100PY for AMI admission → bleeding transition, 0.2 (95% CI 0.2-0.2) x100PY for AMI admission → reinfarction, 43.5 (95% CI 41.9-45.2) x100PY for AMI admission → death, 22.2 (95% CI 20.9-23.5) x100PY for bleeding → death, and 41.9 (95% CI 38.1-46.0) x100PY for reinfarction → death. At 5-year, the IRs decreased to 2.1 (95% CI 2.0-2.2) x100PY, 0.04 (95% CI 0.04-0.05) x100PY, 17.5 (95% CI 16.9-18.2) x100PY, 9.7 (95% CI 9.2-10.3) x100PY, and 17.6 (95% CI 16.0-19.4) x100PY respectively.A reference male patient with median age (67.1 years) at 1-year had an IR of 5.2 (95% CI 5.0-5.4) x100PY for AMI admission → bleeding transition, 0.2 (95% CI 0.2-0.2) x100PY for AMI admission→ reinfarction, 23.7 (95% CI 22.8-24.6) x100PY for AMI admission → death, 14.5 (95% CI 13.6-15.4) x100PY for bleeding → death, and 25.9 (95% CI 23.8-28.3) x100PY for reinfarction → death. Similarly, 5-year IRs decreased to 1.6 (95% CI 1.6-1.7) x100PY, 0.04 (95% CI 0.04-0.04) x100PY, 9.5 (95% CI 9.2-9.9) x100PY, 6.3 (95% CI 5.9-6.8) x100PY, and 10.9 (95% CI 10.0-11.9) x100PY respectively. Also, those with diabetes and white patients had higher transition rates than those without diabetes and black patients. CONCLUSION: In this national AMI cohort, 5-year direct death and bleeding events were more frequent than reinfarction, and the highest mortality occurred in women after AMI admission and in men following reinfarction. These transition patterns quantify the substantial absolute risks patients face post-AMI and highlight important sex-specific differences in adverse outcomes.