BACKGROUND: Rheumatoid arthritis (RA)-related physical limitations often hinder sustained physical activity and weight management, thereby amplifying cardiovascular risk through adverse metabolic profiles and chronic inf...BACKGROUND: Rheumatoid arthritis (RA)-related physical limitations often hinder sustained physical activity and weight management, thereby amplifying cardiovascular risk through adverse metabolic profiles and chronic inflammation. We aimed to assess the effectiveness of semaglutide on the risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) in obese adults with type 2 diabetes mellitus (T2DM) and RA in a primary-prevention setting. METHODS: We emulated a target trial using data from the TriNetX US database, including obese adults (aged ≥18 years; BMI ≥30 kg/m2) with T2DM and comorbid RA and no prior history of stroke, heart failure (HF), acute coronary syndrome, or coronary revascularisation. Using a new-user design, we compared patients initiating semaglutide with those initiating non-GLP-1 receptor agonist (GLP-1RA) second-line glucose-lowering therapies. Patients with contraindications to GLP-1RAs were excluded. Propensity-score matching (PS) (1:1) was used to balance baseline covariates. The primary outcome was incident MACCE, defined as a composite of all-cause mortality, myocardial infarction (MI), HF, or stroke. Secondary outcomes included individual MACCE components, HF hospitalisation and disease-modifying antirheumatic drugs (DMARDs) escalation, with Bonferroni correction applied for multiple comparisons. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models over a follow-up of up to 2 years. RESULTS: Between Jan 1, 2014, and Jan 1, 2025, we identified 1,200 and 2,972 patients who initiated semaglutide and non-GLP1RA therapies, respectively, within 3 months of meeting eligibility. After PS matching, 1,017 semaglutide users were compared with 1,017 non-GLP-1RA users (mean age mean age 59.5 vs 59.3 years; women 81.3% vs 81.0%; mean BMI 38.2 vs 38.0 kg/m2; HbA1c, 6.8 vs 7.0%). Semaglutide initiation was associated with a significantly lower risk of incident MACCE compared with non-GLP-1RA therapies (12.7% vs 16.5%; HR, 0.75; 95% CI, 0.60-0.94; P = 0.01). This benefit was driven primarily by a lower risk of incident HF (8.9% vs 12.5%; HR 0.69, 95% CI 0.53-0.91; p=0·007). Semaglutide use was also associated with significantly lower DMARDs escalation (16.6% vs 21.6%; HR, 0.75; 95% CI, 0.60-0.90; P = 0.003. No significant differences were observed in all-cause mortality, MI, or stroke. CONCLUSION: Among obese adults with T2DM and comorbid RA, initiation of semaglutide was associated with a reduced risk of incident MACCE, driven predominantly by a reduction in incident HF, in a primary-prevention setting. Prospective studies are needed to confirm these observations and establish causality.
The conventional paradigm in aortic stenosis (AS) holds that progressive valvular obstruction increases afterload, leading to left ventricular remodelling and dysfunction. However, emerging artificial intelligence (AI)-b...The conventional paradigm in aortic stenosis (AS) holds that progressive valvular obstruction increases afterload, leading to left ventricular remodelling and dysfunction. However, emerging artificial intelligence (AI)-based observational data challenge this sequence. Diastolic dysfunction risk scores, generated without valve imaging, predict future AS even in individuals with aortic sclerosis. This paradox suggests that diastolic dysfunction is not simply a downstream effect but a barometer of a shared upstream pathophysiological state. In this hypothesis, diastolic dysfunction identifies a mechano-inflammatory milieu marked by arterial stiffness, elevated afterload, and disrupted ventriculo-valvular-vascular coupling, which distorts aortic flow and shear stress. This environment promotes structural and functional remodelling in both the myocardium and the aortic valve via shared signalling pathways-yet is more readily detected in the myocardium. By linking AI-based phenotyping with biomechanics and inflammation, this hypothesis challenges current causal hierarchies and proposes a new framework for early risk assessment in calcific AS.
Maestrini V, Gati S, D'Ascenzi F
… +28 more, Almeida AG, Borjesson M, Castelletti S, Cavarretta E, Claessen G, Conte E, Sanz-de la Garza M, Dello Russo A, Dweck MR, Gimelli A, Imazio M, La Gerche A, Leipsic J, Maurovich-Horvat P, Malhotra A, Moon JC, Niederseer D, Nijveldt R, Neglia D, Pantazis A, Perazzolo Marra M, Pugliese F, Vassiliou VS, Sharma S, Petersen SE, Papadakis M, Pelliccia A, Andreini D
The number of individuals engaging in sports continues to rise, and identifying those with cardiac substrates associated with increased risk of exercise-related adverse events is crucial. Athlete evaluation requires a re...The number of individuals engaging in sports continues to rise, and identifying those with cardiac substrates associated with increased risk of exercise-related adverse events is crucial. Athlete evaluation requires a refined diagnostic strategy to distinguish physiological cardiac remodelling from pathology. This joint European Association of Preventive Cardiology/European Association of Cardiovascular Imaging consensus provides a multimodality approach for advanced cardiovascular imaging in sports cardiology. Cardiovascular magnetic resonance, cardiac computed tomography, and nuclear imaging each offer complementary insights into cardiac structure, function, coronary anatomy, tissue characterization, perfusion, and inflammation. When integrated with clinical data and first-line tests, they improve diagnostic precision and risk stratification in scenarios frequently encountered in athletes, including ventricular arrhythmias, cardiomyopathies, congenital coronary anomalies, inflammatory myocardial disease, and coronary artery disease. Standardized protocols tailored to age, training, and clinical indication are essential to ensure reliability and avoid misinterpreting physiological adaptation as disease. The consensus emphasizes responsible reporting, considering performance and legal implications of diagnoses, and recommends second-line imaging when justified. Functional imaging, for ischaemia or inflammation, is central in guiding return-to-play decisions. Persistent evidence gaps include limited normative datasets across athletic subgroups and uncertain significance of subtle tissue abnormalities. Overall, this consensus supports harmonized, safe, and judicious multimodality imaging to protect athletes while preventing unnecessary sport restriction.
D'Ascenzi F, Sanz-de la Garza M, Maestrini V
… +26 more, Cameli M, Dweck MR, Gimelli A, Cavarretta E, Castelletti S, Claessen G, van Craenenbroeck E, Neglia D, Di Salvo G, Donal E, Drezner JA, Eijsvogels TMH, Edvardsen T, Gati S, Halle M, La Gerche A, Guazzi M, Lancellotti P, Niebauer J, Oxborough D, Pieles G, Sitges M, Sharma S, Papadakis M, Andreini D, Pelliccia A
Exercise imaging, particularly exercise stress echocardiography (ESE), has become a pivotal non-invasive tool for evaluating cardiovascular function in athletes and for distinguishing physiological adaptations from patho...Exercise imaging, particularly exercise stress echocardiography (ESE), has become a pivotal non-invasive tool for evaluating cardiovascular function in athletes and for distinguishing physiological adaptations from pathological conditions. This Clinical Consensus Statement by the European Association of Preventive Cardiology and the European Association of Cardiovascular Imaging synthesizes current evidence and provides practical guidance on indications, protocols, and interpretation of exercise imaging modalities in both competitive and recreational athletes. The document emphasizes the role of ESE in assessing cardiac reserve, unmasking concealed cardiomyopathies, and stratifying risk in clinical scenarios such as T-wave inversion, exercise-induced repolarization abnormalities, and extreme ventricular remodelling. Special attention is given to imaging protocols tailored to the athletic population, including dynamic assessment of the right and left ventricles, atria, and valvular function during various exercise modalities, highlighting the importance of the functional evaluation in athletes and active individuals. Additionally, the consensus explores the integration of advanced techniques such as cardiopulmonary exercise testing and exercise cardiac magnetic resonance imaging, highlighting their complementary roles in comprehensive cardiovascular evaluation. The statement advocates for individualized testing strategies that consider sport-specific demands, demographic factors such as body size, sex, ethnicity, and the underlying pathology. It also underscores the importance of exercise imaging in guiding sports eligibility and in tailoring exercise prescription for competitive athletes, as well as for patients willing to participate in recreational sports or exercise programs.
AIM: Benefits of screening coronary artery disease (CAD) using stress perfusion cardiovascular magnetic resonance (CMR) in patients with hypertension without known CAD is not well established. The aim of our study was to...AIM: Benefits of screening coronary artery disease (CAD) using stress perfusion cardiovascular magnetic resonance (CMR) in patients with hypertension without known CAD is not well established. The aim of our study was to assess the long-term prognostic value of vasodilator stress CMR in patients with hypertension without known CAD. METHODS: Between December 2008 and January 2022, all consecutive patients with hypertension without known CAD referred for stress CMR were followed up to the occurrence of major cardiovascular events (MACE), defined as cardiovascular mortality or non-fatal myocardial infarction (MI). Cox regressions were performed to determine the prognostic value of each parameter. RESULTS: Among 2,019 patients (69 ± 12 years; 45% male) with a median follow up of 6.7 (5.9- 8.9) years, 327 had MACE (16%). Patients without ischaemia experienced a lower rate of MACE than those with ischaemia (12 versus 39%, respectively, p < 0.001). Ischaemia and unrecognised MI were both significantly associated with the occurrence of MACE (respectively, HR: 4.1, 99.5%CI: 3.0-5.7 and HR: 3.6, 99.5%CI: 2.6-5.1, both p < 0.001). After adjustment, both the extent of ischaemia and unrecognised MI were independent predictors of MACE (respectively, HR: 1.2, 99.5%CI: 1.2-1.3, and HR: 1.2, 99.5%CI: 1.1-1.3, both p < 0.001). Adding stress CMR parameters improved model discrimination and reclassification, with greatest improvements in stepwise Model (C-statistic improvement: 0.02; net reclassification improvement: 0.50; integrative discrimination index: 0.02; all p < 0.001). CONCLUSION: In patients with hypertension without known CAD, stress CMR is a long-term predictor for the incidence of MACE and offer an incremental prognostic value over traditional predictors.
Lemoine MD, Krug D, Grohmann M
… +2 more, Blanck O, Reissmann B
Eur Heart J Case Rep
· 2026 Jun · PMID 42326041
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BACKGROUND: Electrical storm in patients with structural heart disease is associated with high morbidity and mortality. Catheter ablation is recommended for drug-refractory ventricular tachycardia (VT), but may be contra...BACKGROUND: Electrical storm in patients with structural heart disease is associated with high morbidity and mortality. Catheter ablation is recommended for drug-refractory ventricular tachycardia (VT), but may be contraindicated in the presence of a left ventricular (LV) thrombus due to increased thromboembolic risk. Stereotactic arrhythmia radiotherapy (STAR) has emerged as a non-invasive treatment option for refractory VT. This case highlights the potential role of STAR as a rescue therapy when conventional approaches are not feasible. CASE SUMMARY: An 80-year-old man with advanced ischaemic cardiomyopathy presented after out-of-hospital cardiac arrest due to monomorphic VT. Evaluation revealed severe LV dysfunction (LVEF 15%), an anteroapical LV aneurysm and a newly detected LV thrombus. Catheter ablation was deferred due to embolic risk. Eleven weeks later, the patient was admitted with recurrent VT and developed electrical storm refractory to antiarrhythmic drug therapy, overdrive pacing, and bilateral stellate ganglion blockade. Non-invasive target delineation using contrast-enhanced cardiac computed tomography with scar characterization and ECG-based localization was performed. A single fraction of 25 Gy stereotactic arrhythmia radiotherapy was delivered to the suspected VT substrate. Electrical storm terminated immediately after treatment, and no further VT episodes occurred during hospitalization or during 6 months of follow-up. DISCUSSION: This case demonstrates that stereotactic arrhythmia radiotherapy may provide an effective non-invasive rescue strategy for electrical storm when catheter ablation is contraindicated. Integration of advanced cardiac imaging with ECG-based localization enables target definition in the absence of invasive electroanatomical mapping.
Ünlügenç H, Yıldız BS, Demir E
… +2 more, Tuncer ON, Yavuzgil O
Eur Heart J Case Rep
· 2026 Jun · PMID 42326039
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BACKGROUND: Complete loss of a guidewire during central venous catheterization is a rare but potentially life-threatening complication and is considered a preventable 'never event.' Retained guidewires mostly recognized...BACKGROUND: Complete loss of a guidewire during central venous catheterization is a rare but potentially life-threatening complication and is considered a preventable 'never event.' Retained guidewires mostly recognized during or shortly after the procedure, some may be stay in vascular system for a long time without detection and are associated with wide range of complications including vascular and cardiac chamber perforation. The decision to remove the guidewire through surgical or percutaneous technique should follow an individualized approach based on its location, associated complications, and the patient's clinical condition. CASE SUMMARY: A 61-year-old male presented with sharp chest and epigastric pain, initially raising suspicion of acute coronary syndrome. Chest X-ray and initial echocardiogram were unremarkable. Electrocardiogram findings and serial troponin measurements were inconclusive. During follow-up, the patient developed fever, elevated acute phase reactants, and abdominal tenderness. Given the atypical clinical presentation, emergent coronary angiography was deferred. Abdominal ultrasound showed no acute intra-abdominal pathology. Due to persistent fever and worsening abdominal symptoms, a computed tomography scan was obtained revealing a linear radiopaque object extending from the right femoral vein, perforating right atrium and ascending aorta with associated haemorrhagic pericardial effusion. Emergent surgery was performed, and guidewire was successfully removed. Retrospective imaging showed its unnoticed presence for almost nine years. DISCUSSION: Although guidewire retention is well-documented, delayed diagnosis with major vascular injury is exceedingly rare. Existing literature highlights inadequate supervision and procedural distractions as leading contributors to guidewire retention. This case underscores the long-term risk and severe consequences of retained guidewire.