Kardos A, Yong Q, Kardos B
… +4 more, Garces NS, Burgess E, Chan K, Makris N
Eur Heart J Imaging Methods Pract
· 2026 Jan · PMID 42311830
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AIMS: To develop a ventilation navigator to provide controlled hyperventilation and to assess the feasibility to monitor hypocapnia and respiratory alkalosis in healthy subjects. METHODS AND RESULTS: We developed the Ven...AIMS: To develop a ventilation navigator to provide controlled hyperventilation and to assess the feasibility to monitor hypocapnia and respiratory alkalosis in healthy subjects. METHODS AND RESULTS: We developed the Ventilation Navigator software using C++ and utilizing high-precision timers as an advanced platform for respiratory guidance and control, incorporating adjustable breathing rate, and tidal volume, a session timer for automatic cessation. Its graphical user interface is designed to deliver clear visual cues to the patient, facilitating controlled breathing. We assessed the utility of controlled hyperventilation in five healthy probands using end-tidal CO (ETCO) against capillary CO and pH. We have successfully achieved respiratory alkalosis (pH >7.50) between 70% and 90% of the subjects' baseline ETCO. The linear mixed-effects modelling demonstrated a significant association between ETCO and capillary pH ( = -0.063, SE = 0.008, < 0.001). There was a moderate, clinically relevant agreement between capillary and ETCO with an offset of 0.48 (1.50 - (-0.54)); however, ETCO was significantly associated with capillary CO ( = 0737, SE = 0.115, < 0.001) after accounting for repeated measures within individuals. A strong within-individual associations for ETCO vs. capillary CO as demonstrated (rm = 0.857, 95% confidence interval: 0.628-0.949, < 0.001). CONCLUSION: We developed a ventilation navigator application to deliver a controlled hyperventilation and assess its feasibility to monitor hypocapnia and respiratory alkalosis in healthy subjects. We are proposing this controlled physiological test to be implemented in the routine diagnostic workup to investigate coronary vasoreactivity in patients having angina with non-occlusive coronary artery disease after it has been validated in patients.
Bodanowitz JM, Kochev P, Storek B
… +2 more, Ourani A, Ince H
Eur Heart J Case Rep
· 2026 Jun · PMID 42311615
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BACKGROUND: Severe tricuspid regurgitation (TR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) represents a particularly challenging clinical scenario due to advanced right ventricular dysfunctio...BACKGROUND: Severe tricuspid regurgitation (TR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) represents a particularly challenging clinical scenario due to advanced right ventricular dysfunction, complex device interactions, and high procedural risk. Evidence regarding transcatheter tricuspid valve replacement (TTVR) in ARVC, especially following prior transcatheter annuloplasty procedures such as Cardioband, remains scarce. CASE SUMMARY: We present the first in-man case report of a successful transfemoral TTVR using the EVOQUE™ system in a 69-year-old patient with ARVC, severe TR, heart failure symptoms corresponding to New York Heart Association (NYHA) class IV, prior Cardioband annuloplasty, and an implantable cardioverter-defibrillator (ICD). The patient presented with advanced right heart failure requiring intensive pre-procedural stabilization. TTVR with a 56-mm EVOQUE™ valve resulted in an immediate reduction of TR from grade V to grade 0. The post-procedural course was complicated by severe right heart failure, respiratory insufficiency requiring prolonged mechanical ventilation, ventricular arrhythmias associated with subtherapeutic amiodarone levels, and acute kidney injury requiring temporary renal replacement therapy. Following multidisciplinary intensive care management, the patient stabilized with marked clinical improvement and sustained valve function. DISCUSSION: This case highlights the feasibility of EVOQUE™ TTVR in patients with prior annuloplasty devices and advanced ARVC. It demonstrates the substantial risk of post-procedural right heart failure and complex device interactions, emphasizing that procedural success does not preclude a complicated clinical course. Careful patient selection, procedural planning, and intensive post-procedural management are essential in this high-risk population.
Nguadi J, Ennmer M, Fagouri J
… +2 more, Bouzelmat H, Chaib A
Eur Heart J Case Rep
· 2026 Jun · PMID 42311614
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BACKGROUND: Contrast-induced neurotoxicity (CIN) is a rare complication of iodinated contrast agents, with spinal myoclonus representing an exceptionally uncommon manifestation (<0.01%). To date, no cases have been repor...BACKGROUND: Contrast-induced neurotoxicity (CIN) is a rare complication of iodinated contrast agents, with spinal myoclonus representing an exceptionally uncommon manifestation (<0.01%). To date, no cases have been reported following cardiac resynchronization therapy with defibrillator (CRT-D) implantation. CASE SUMMARY: A 65-year-old man with advanced heart failure (LVEF 28%, NYHA III, QRS 162 ms) underwent successful CRT-D implantation using 50 mL of iopamidol. Four hours post-procedure, he developed sudden, generalized, stimulus-sensitive spinal myoclonus with preserved consciousness. Electroencephalography was normal. Brain and cervical-thoracic spinal MRI on day 3 showed no ischaemic, haemorrhagic, or inflammatory lesions. Serum creatinine remained stable. Intravenous hydration and clonazepam resulted in complete resolution within 72 h, with no neurological sequelae at three-month follow-up (NYHA II, LVEF 38%). DISCUSSION: This represents the first documented case of iodinated contrast-induced spinal myoclonus following CRT-D implantation, occurring with the lowest reported contrast volume (50 mL) and preserved renal function. Normal neuroimaging and rapid reversibility under supportive therapy confirm a functional, non-structural mechanism. This case expands the spectrum of CIN in device-based heart failure therapy and emphasizes the need for heightened clinical awareness during coronary sinus cannulation, even in low-risk patients. Early recognition and simple supportive measures ensure excellent outcomes.
Eur Heart J Case Rep
· 2026 Jun · PMID 42311612
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BACKGROUND: Transfemoral transcatheter aortic valve replacement (TAVR) is challenging in patients with stiff and tortuous anatomy. In the present case, we presented a patient with super-stiff aortic arch (prior history o...BACKGROUND: Transfemoral transcatheter aortic valve replacement (TAVR) is challenging in patients with stiff and tortuous anatomy. In the present case, we presented a patient with super-stiff aortic arch (prior history of aortic arch replacement, stent implantation, and anastomotic fistula plugging) and a summary of strategies for managing such stiff approach. CASE SUMMARY: A 59-year-old man with symptomatic severe aortic stenosis and a super-stiff aortic arch underwent transfemoral TAVR. Techniques including buddy wire, balloon deflection, balloon-assisted tracking, snare assistance, and long sheath use were considered. Balloon-assisted tracking combined with a long sheath ultimately enabled successful TAVR. Supra-annular anchoring was also confirmed in this case. DISCUSSION: For patients with extremely stiff anatomy, multiple techniques may facilitate successful transfemoral TAVR. Furthermore, in bicuspid aortic valve cases, the narrowed supra-annular region can serve as an effective anchoring zone.
Kawahira Y, Kato Y, Miyazaki M
… +2 more, Kuwahara G, Miura S
Eur Heart J Case Rep
· 2026 Jun · PMID 42311611
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BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis (AS), but rare complications can rapidly become life-threatening, particularly in anatomically high-risk pati...BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis (AS), but rare complications can rapidly become life-threatening, particularly in anatomically high-risk patients. CASE SUMMARY: A 94-year-old woman with very severe AS underwent transfemoral TAVR using a self-expanding valve. After transcatheter heart valve implantation, she developed haemodynamic collapse with right coronary artery obstruction and severe mitral regurgitation (MR). At that time, the aetiology of the severe MR could not be clearly identified. Although intra-aortic balloon pump (IABP) was initiated, cardiac arrest occurred, requiring extracorporeal membrane oxygenation (ECMO). Percutaneous coronary intervention was unsuccessful, necessitating conversion to coronary artery bypass grafting. ECMO was discontinued on postoperative Day 1, but recurrent haemodynamic collapse developed under IABP support, revealing left ventricular outflow tract obstruction (LVOTO) and severe MR with systolic anterior motion (SAM). Discontinuing IABP and initiating medical therapy rapidly stabilized haemodynamics. DISCUSSION: This case illustrates the diagnostic and haemodynamic complexity of simultaneous coronary artery obstruction and dynamic LVOTO with SAM-associated MR after TAVR. Because management strategies for these conditions are inherently contradictory, identifying the dominant mechanism of shock can be challenging. Although severe MR was initially attributed to ischaemia secondary to coronary obstruction, retrospective echocardiographic review demonstrated early SAM. Subsequent changes in loading conditions and myocardial contractility unmasked LVOTO. This case emphasizes the importance of repeated echocardiographic assessment and stepwise haemodynamic reassessment when multiple mechanisms of instability coexist after TAVR.
Xue L, Wang W, Zhao Q
… +15 more, Li W, Dong W, Yan S, Zhao X, Li J, Chen R, Li N, He S, Liu C, Zhou P, Chen Y, Song L, Yan H, Liu Z, Zhao H
Eur Heart J Digit Health
· 2026 Jun · PMID 42311439
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AIMS: Predicting long-term mortality after acute myocardial infarction (AMI) remains challenging. We aimed to establish an Artificial Intelligence-based model for predicting long-term all-cause mortality after AMI (the A...AIMS: Predicting long-term mortality after acute myocardial infarction (AMI) remains challenging. We aimed to establish an Artificial Intelligence-based model for predicting long-term all-cause mortality after AMI (the AIMI model). METHODS AND RESULTS: AIMI model was employed by RF (Random forest). Individual predictions were visualized by SHAP plots. AIMI model was compared against existing clinical risk scores using time-dependent ROC (receiver operating characteristic) curves, and Kaplan-Meier (K-M) analyses. External validation was also performed at the same way. Brier scores were calculated in validation cohorts. We consecutively enrolled 4825 AMI patients underwent emergent coronary angiography or PCI procedures within 24 h of symptom onset to train and test the AIMI model and 723 AMI patients for external validation. Model incorporated 15 variables achieved robust performance (C-index = 0.81). As indicated by AUCs in the test set, AIMI model outperformed GRACE and TIMI risk scores across short-, mid- and long-term periods, especially for long-term prediction (1, 3 and 5 years). K-M curves confirmed precise discrimination between low-, median-, and high-risk groups (all < 0.05). External validation confirmed good generalization and robustness for AIMI model (AUCs: 0.88, 0.91, 0.83, 0.75, 0.78 and 0.77 during hospitalization, at 30 days, half-year, 1-year, 2-years and 3-years follow-up; comparisons of K-M curves across three risk groups, all < 0.05). Brier scores demonstrated good individual level performance (internal validation cohort: 0.022; external validation: 0.021). CONCLUSION: The AIMI model surpassed traditional methods for long-term all-cause death prediction after AMI. AI-based model demonstrated potential to enhance risk stratification and guide post-discharge management.
Greco A, Pagani A, Modugno S
… +5 more, Iengo M, Rizzo G, Faverio C, Pedrazzoli P, De Luca L
Eur Heart J Case Rep
· 2026 May · PMID 42311374
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BACKGROUND: Fluoropyrimidines are among the most common chemotherapeutic agents associated with cardiotoxicity, typically presenting as angina due to coronary vasospasm. Severe manifestations such as myocarditis and card...BACKGROUND: Fluoropyrimidines are among the most common chemotherapeutic agents associated with cardiotoxicity, typically presenting as angina due to coronary vasospasm. Severe manifestations such as myocarditis and cardiogenic shock are rare, and rechallenge after cardiotoxicity is generally discouraged. We report a case of acute 5-fluorouracil-induced myocarditis with successful rechallenge after multidisciplinary evaluation. CASE SUMMARY: A 30-year-old man with unresectable rectal adenocarcinoma developed acute cardiotoxicity during the first FOLFOX-6 cycle, presenting with abdominal pain and palpitations. ECG showed atrial fibrillation and ST-segment elevation. Echocardiography revealed severe biventricular dysfunction with elevated cardiac biomarkers. Coronary angiography excluded obstructive disease, and cardiac magnetic resonance confirmed acute myocarditis with diffuse oedema and non-ischaemic late gadolinium enhancement. Guideline-directed heart failure therapy led to rapid functional recovery within days. Following multidisciplinary cardio-oncology assessment, chemotherapy rechallenge under continuous monitoring was performed without recurrence of major adverse events. Subsequent cycles were well tolerated, and follow-up CMR showed preserved ventricular function with residual non-ischaemic LGE. DISCUSSION: This case highlights the importance of early recognition of fluoropyrimidine cardiotoxicity, the role of multidisciplinary cardio-oncology management, and the potential feasibility of rechallenge in carefully selected patients.
Lucas S, Hennart B, de Groote P
… +5 more, Lamblin N, Ridon H, Dupre C, Lionet A, Lemesle G
Eur Heart J Case Rep
· 2026 May · PMID 42311373
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BACKGROUND: Mavacamten has been shown to be efficient in the treatment of obstructive hypertrophic cardiomyopathy (HOCM). However, its use may be associated with toxicity and subsequent adverse events. genotyping is the...BACKGROUND: Mavacamten has been shown to be efficient in the treatment of obstructive hypertrophic cardiomyopathy (HOCM). However, its use may be associated with toxicity and subsequent adverse events. genotyping is therefore recommended to optimize dosing and minimize risks in daily practice. CASE SUMMARY: We report the case of a 39-year-old woman with a history of sleeve gastrectomy and HOCM. She was initiated on mavacamten 5 mg once daily genotyping showed no mutation) because of persistent significant obstruction and dyspnoea (NYHA class II) under nebivolol. Although initial tolerance was good with a reassuring transthoracic echocardiography at 4 months, she experienced a severe cardiogenic shock related to mavacamten overdose in the context of esomeprazole initiation (proton pump inhibitor that strongly interacts with the cytochrome CYP2C19 and CYP3A4) for an oesophageal pyrosis by her general practitioner 8 months later. Notably, the toxicity could be completely overcome by rifampicin initiation (600 mg twice daily for 3 days), which allowed the normalization of the plasma level of mavacamten within a few days and patient recovery. DISCUSSION: The present case highlights that drug interactions in patients with HOCM receiving mavacamten are critical and may lead to a high level of toxicity and severe heart failure events, including cardiogenic shocks. Patient and caregiver information about these potential interactions is highly important. This case also emphasizes that the dosage of mavacamten is now available (and should be used in specific situations) and that mavacamten toxicity can rapidly be overcome by early rifampicin administration, a strong hepatic enzyme inducer.
Eur Heart J Case Rep
· 2026 May · PMID 42311372
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BACKGROUND: Foetal supraventricular tachycardia (SVT) can cause foetal hydrops and demise if untreated. Transplacental therapy often fails in severe SVT with foetal hydrops due to impaired placental drug transfer. In the...BACKGROUND: Foetal supraventricular tachycardia (SVT) can cause foetal hydrops and demise if untreated. Transplacental therapy often fails in severe SVT with foetal hydrops due to impaired placental drug transfer. In the present study, we report the first successful cardioversion of recalcitrant SVT in a hydropic foetus by intracardiac adenosine triphosphate (ATP) administration. CASE SUMMARY: A 34-year-old woman at 28 + 6 weeks of gestation was admitted for persistent foetal tachycardia, subsequently diagnosed as foetal SVT. After combined transplacental therapy with digoxin and sotalol, the foetal tachycardia remained uncontrolled, with progressive hydrops and deteriorating cardiac function. Ultimately, intracardiac ATP administration was performed and achieved successful cardioversion of the foetal SVT. No procedure-related complications occurred. After the procedure, maternal oral digoxin and sotalol were continued to maintain foetal sinus rhythm. DISCUSSION: Intracardiac ATP administration offers a last-resort salvage therapy for terminating recalcitrant SVT with foetal hydrops, which should be reserved for highly selected patients and performed at specialized centres. The larger studies with longer follow-up are needed to validate this procedure's efficacy and safety.
Sato A, Muto Y, Shimizu T
… +2 more, Igarashi T, Takeishi Y
Eur Heart J Case Rep
· 2026 May · PMID 42311371
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BACKGROUND: Acute transcatheter heart valve (THV) dysfunction immediately after transcatheter aortic valve implantation (TAVI) is uncommon but can be catastrophic. Mechanical obstruction by migrated vascular tissue is ex...BACKGROUND: Acute transcatheter heart valve (THV) dysfunction immediately after transcatheter aortic valve implantation (TAVI) is uncommon but can be catastrophic. Mechanical obstruction by migrated vascular tissue is exceptionally rare. CASE SUMMARY: An 80-year-old woman with symptomatic very severe aortic stenosis and high surgical risk underwent transfemoral TAVI with a 23-mm self-expanding Evolut FX valve (Medtronic, Minneapolis, MN, USA). Preprocedural computed tomography showed severe circumferential calcification of the left common iliac artery (CIA) with a preserved lumen (6.8 × 4.9 mm) and a small aortic annulus (area, 244.9 mm; perimeter, 55.9 mm). After valve deployment, invasive haemodynamics showed no reduction in the transvalvular pressure gradient (mean/peak, 58/97 mmHg before vs. 63/98 mmHg after deployment). Transoesophageal echocardiography demonstrated a tubular structure restricting leaflet opening. Balloon post-dilatation resulted in transient echocardiographic improvement but was complicated by balloon rupture, and a mobile intravalvular structure persisted. Emergency surgical conversion was performed. Intraoperatively, a calcified tubular structure with a lumen-like appearance was found on the guidewire and was impinging on the THV leaflets. The THV was explanted, and surgical aortic valve replacement was performed. Histology confirmed calcified vascular intimal tissue, consistent with detachment from the left CIA. The postoperative course was uneventful, and the patient was discharged home. DISCUSSION: In severely calcified iliofemoral access, endarterectomy-like intimal detachment can occur during device passage and, rarely, can migrate into a self-expanding THV, causing acute leaflet opening restriction. Early recognition using multimodality imaging and timely surgical bailout may be life-saving.
Lebbink JS, Smits M, van der Hoeven BL
… +2 more, Schölzel BE, Habets J
Eur Heart J Case Rep
· 2026 May · PMID 42311370
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BACKGROUND: Although rare, dilation of the pulmonary artery, which can be present in patients with pulmonary arterial hypertension (PAH), can cause compression of the left main coronary artery (LMCA), leading to progress...BACKGROUND: Although rare, dilation of the pulmonary artery, which can be present in patients with pulmonary arterial hypertension (PAH), can cause compression of the left main coronary artery (LMCA), leading to progressive dyspnoea, fatigue, syncope, and angina. Over time, this rare complication might lead to acute coronary syndrome. CASE SUMMARY: A 63-year-old White female with a background of systemic hypertension and mild obstructive sleep apnoea was admitted to the emergency unit because of gradually worsening shortness of breath and generalized weakness, without associated anginal symptoms. Blood gas evaluation demonstrated impaired oxygenation, with a partial pressure of oxygen of 6.8 kPa and an oxygen saturation of 87.9%. Transthoracic echocardiography demonstrated marked right ventricular strain along with features consistent with pulmonary arterial hypertension. A CT pulmonary angiographic study showed pronounced enlargement of the pulmonary trunk, measuring 62 mm in diameter. Subsequent coronary angiography combined with intravascular ultrasound identified greater than 50% narrowing of the left main coronary artery due to extrinsic compression, which was corroborated by dynamic CT imaging. The patient underwent IVUS-guided percutaneous revascularization of the left main coronary artery with placement of a drug-eluting stent. One week post-discharge, prior to additional diagnostic evaluation and management of pulmonary arterial hypertension, the patient reported significant symptomatic relief, with functional status improving from New York Heart Association (NYHA) class III to class II. DISCUSSION: This case underscores that extrinsic compression of the LMCA due to pulmonary artery dilatation warrants consideration as a potential aetiology of symptoms, even in the absence of angina.
AIMS: Serum uric acid (SUA) and hyperuricemia have re-emerged as determinants of cardiovascular (CV) risk beyond gout. This review integrates epidemiological, Mendelian randomization (MR), and pharmacological evidence to...AIMS: Serum uric acid (SUA) and hyperuricemia have re-emerged as determinants of cardiovascular (CV) risk beyond gout. This review integrates epidemiological, Mendelian randomization (MR), and pharmacological evidence to define the role of SUA and urate-lowering therapy (ULT) in contemporary cardiovascular pharmacotherapy. METHODS AND RESULTS: We synthesized population-based studies, MR and drug-target MR analyses, and randomized trials of xanthine oxidase inhibitors (XOIs), uricosurics/URAT1 inhibitors, biologic uricases, and CV drugs with urate-modifying effects. Hyperuricemia is prevalent and rising, often closely accompanying obesity, hypertension, diabetes, and chronic kidney disease. Higher SUA correlates with coronary artery disease, heart failure, stroke, cardio-renal-metabolic syndromes, and mortality, with non-linear risk relationships and sex- and age-specific thresholds. MR suggests a modest causal contribution of genetically elevated SUA to blood pressure, coronary disease, and advanced CKD, partly mediated via haemodynamic, renal, and inflammatory pathways. Pharmacologically, XOIs, URAT1 inhibitors, and uricases differ in kinetics and safety profiles. However, large trials and real-world cohorts show no consistent reduction in CV events when ULT is added to guideline-directed therapy in asymptomatic hyperuricemia, stable ischaemic heart disease, chronic heart failure, or chronic kidney disease. Observational data suggest that long-term, adequately dosed XOIs and high cumulative uricosuric exposure may reduce coronary risk. CONCLUSION: SUA is a cardio-renal-metabolic biomarker and a plausible therapeutic target in selected cardio-renal-metabolic phenotypes. However, evidence does not support routine ULT for CV prevention in asymptomatic hyperuricemia. ULT should remain focused on gout and symptomatic hyperuricemia, with phenotype-guided strategies to identify patients most likely to benefit.
BACKGROUND: Apical hypertrophic cardiomyopathies (ApHCM) are characterized by hypertrophy located on the left ventricular (LV) apical segments. Their genetic origin and prognosis are still debated. AIM: We compared the p...BACKGROUND: Apical hypertrophic cardiomyopathies (ApHCM) are characterized by hypertrophy located on the left ventricular (LV) apical segments. Their genetic origin and prognosis are still debated. AIM: We compared the phenotype, genotype and prognosis of ApHCM to non-apical HCM. MATERIALS AND METHODS: 208 consecutive patients from 5 French centres with a phenotype of ApHCM underwent echocardiography, cardiac magnetic resonance, genetic testing and follow-up. They were compared to 419 patients with non-apical HCM. Patients finally diagnosed with Fabry's disease (n=6) and amyloidosis (n=1) were excluded, resulting in 201 ApHCM for comparative analyses. RESULTS: Among the 208 ApHCM patients, genetic analysis was positive in 22.6% of patients, including 6 GLA and 1 TTR mutations. After excluding these latter 7 patients, ApHCM patients had higher LVEF, less LV obstruction (5 vs 23.2%, p<0.001), smaller left atrial volumes (37.9±14.2 vs 47.2±23.8 ml/m2, p<0.001), more impaired GLS (-14.4±4 vs -15.3±4%, p=0.019), more frequent LV aneurysm (10.9 vs 1.4%, p <0.001), and less frequent mutations (20.4 vs 43.4%, p <0.001) than non-apical HCM. During a 5-year follow up, 12 (6%) rhythmic events occurred in the ApHCM group. All of them had a SCD-risk score<4%. Long-term survival was better in ApHCM (p=0.026). CONCLUSION: ApHCM presents with less frequent mutations and better prognosis than non-ApHCM. However, rhythmic complications are frequent in ApHCM but are not predicted by the SCD-risk score. Apical aneurysms are more frequent in apical HCM. Fabry's disease may mimic an apical HCM phenotype and should be ruled out when facing an apical HCM pattern.