Cardiovascular conditions continue to be increasingly common. This narrative review addresses the barriers in managing cardiovascular diseases in primary care settings, including but not limited to disparities in healthc...Cardiovascular conditions continue to be increasingly common. This narrative review addresses the barriers in managing cardiovascular diseases in primary care settings, including but not limited to disparities in healthcare access, asymptomatic or minimally symptomatic nature of many conditions, and nonadherence to treatment. Strategies for early detection, patient education and tailored interventions are discussed across five major cardiovascular diseases.
Myriads of phenomena in inanimate and animate Nature conform to the Fibonacci sequence and Golden rule. Hundred patients, aged 60.39±13.96 SD (28-92) 53 female, who underwent AEM and had ≥1 bout(s) of NSVT and/or NVT, we...Myriads of phenomena in inanimate and animate Nature conform to the Fibonacci sequence and Golden rule. Hundred patients, aged 60.39±13.96 SD (28-92) 53 female, who underwent AEM and had ≥1 bout(s) of NSVT and/or NVT, were analyzed, according to whether the number of beats in these arrhythmias, conformed to the Fibonacci sequence. There was no difference in age, gender, risk factors, and cardiovascular/cerebrovascular pathologies, of the ∼30 %, whose arrhythmias conformed to the Fibonacci sequence, and the remainder 70 %. There is a need to explore the reproducibility of this phenomenon, and its diagnostic and prognostic role in the management of patients.
Cardiac complications in individuals infected with the human immunodeficiency virus (HIV) have been recognized since the 1980s. However, the type of cardiac conditions seen in this population has changed substantially si...Cardiac complications in individuals infected with the human immunodeficiency virus (HIV) have been recognized since the 1980s. However, the type of cardiac conditions seen in this population has changed substantially since the introduction of antiretroviral therapy (ART). Coronary artery disease (CAD) has emerged as a leading cause of morbidity and mortality in HIV positive individuals. HIV and ART have both been linked to the development of CAD through multiple mechanisms. There is limited specific guidance for management of CAD and its risk factors in people with HIV. This literature review explores the pathophysiology and management of CAD in HIV-infected patients, identifying gaps in evidence and areas for future research to address the growing burden of CAD in this patient population.
Patients with Limited English Proficiency (LEP) form a large proportion of the population and experience significant differences in care. A multitude of studies have explored care differences in patients with LEP and car...Patients with Limited English Proficiency (LEP) form a large proportion of the population and experience significant differences in care. A multitude of studies have explored care differences in patients with LEP and cardiovascular disease (CVD). This review covers several key areas in CVD care including coronary artery disease, acute coronary syndrome, heart failure, and several CVD risk factors. While there are no significant differences seen in door to balloon time between LEP and English speakers, important differences exist in coronary artery disease awareness and symptom recognition among LEP patients. Additionally, LEP patients with heart failure experienced higher rates of hospital readmissions and emergency department visits. Mixed evidence exists regarding CVD risk factors control such as diabetes, hypertension, and hyperlipidemia based on language preference. Employing key interventions that target multiple domains in health care delivery can address some of the care disparities seen among LEP patients with CVD.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as transformative therapies in the management of chronic heart failure (HF), offering substantial reductions in mortality and hospitalizations. Beyond their...Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as transformative therapies in the management of chronic heart failure (HF), offering substantial reductions in mortality and hospitalizations. Beyond their initial classification as diuretics, SGLT2i exert a spectrum of cardioprotective effects that extend far beyond renal modulation. By activating autophagic pathways and mimicking a starvation-like state, SGLT2i enhance cellular bioenergetics and mitigate acute injury, potentially underpinning both their immediate and sustained cardiometabolic benefits when administered early in acute care settings. In acute decompensated HF, early initiation of SGLT2i enhances clinical decongestion by increasing diuresis, improving diuretic efficiency, and mitigating diuretic resistance, translating to shorter hospitalizations and reduced readmissions and mortality. In acute myocardial infarction, SGLT2i reduce the incidence of first and total HF hospitalizations, arrhythmic events, adverse cardiac remodelling, and contrast-induced acute kidney injury, while mitigating stent failure and atherosclerotic progression. Furthermore, they demonstrated efficacy in preventing new-onset and recurrent supraventricular and ventricular arrhythmias. However, the evidence remains inconclusive regarding their impact on sudden cardiac death or outcomes following cardiac arrest. In critically ill patients, SGLT2i use is associated with reduced rates of acute kidney injury and the need for renal replacement therapy, with promising implications for the management of sepsis and multi-organ dysfunction. Importantly, adverse effects such as renal impairment, electrolyte disturbances, acid-base imbalances, urinary tract infections, and dysglycemia appear infrequently in this population. This narrative review synthesizes the underlying pathophysiological mechanisms, current clinical evidence, and potential future applications of early SGLT2i therapy in acute care settings, providing insights into their expanding role in contemporary cardiovascular medicine.
Occult asymptomatic myocardial infarction in patients with malignancy (lymphoma), advanced age, and multiple comorbidities may present atypically, complicating the diagnosis of presumed recurrent infarction. We present a...Occult asymptomatic myocardial infarction in patients with malignancy (lymphoma), advanced age, and multiple comorbidities may present atypically, complicating the diagnosis of presumed recurrent infarction. We present a highly complex case of a 66-year-old male with lymphoma and multiple comorbidities who collapsed with diffuse ST-segment elevation on electrocardiography (ECG). The diagnostic challenge required concurrent percutaneous coronary intervention (PCI) and echocardiography to identify the thrombotic occlusions in two coronary vessels. Empirical placement of stents in the right coronary artery and left circumflex artery resolved the acute occlusions, while retrograde imaging revealed a previously undiagnosed anteroapical left ventricular aneurysm. This case underscores the importance of integrating multimodal imaging in oncological patients with atypical cardiovascular presentations.
BACKGROUND: Limited data are available regarding the atrial shunt device (ASD), making it challenging to provide definitive recommendations for patients with heart failure (HF). We conducted a meta-regression analysis to...BACKGROUND: Limited data are available regarding the atrial shunt device (ASD), making it challenging to provide definitive recommendations for patients with heart failure (HF). We conducted a meta-regression analysis to identify individuals who may derive greater benefit from this device. METHODS: We conducted a search across PubMed, EMBASE, and Cochrane databases, including 8 studies for meta-analysis. Estimated endpoints were derived using random-effects proportional meta-analysis. Additionally, meta-regression analysis was performed to elucidate the potential impact of key covariates on these endpoints. RESULTS: A total of 522 patients were included. The pooled analysis revealed an estimated mortality rate of 1.9 % for patients who underwent ASD. Additionally, the proportion of patients who remained in NYHA III to IV was reduced to 22.5 %. Furthermore, there was an improvement of 35.1 meters in the 6-minute walk distance (6MWD) and a 16.2-point improvement in the KCCQ score. Meta-regression analysis indicated that NYHA III to IV status was found to be directly proportional to age (β= 2.799), hypertension (β= 0.782), diabetes (β= 0.951), and atrial fibrillation (β= 0.778). Hypertension and a high level of left ventricular ejection fraction (LVEF) were associated with less improvement in 6MWD and KCCQ score, whereas a higher NT-proBNP level was associated with better improvement in 6MWD and KCCQ score. CONCLUSIONS: ASD emerges as a safe choice for HF patients aiming to alleviate symptoms. Specifically, individuals with reduced EF or elevated NT-proBNP levels, and without concomitant hypertension, diabetes, or atrial fibrillation, appear to achieve more substantial symptom relief.
Mitral valve prolapse (MVP) affects 2-3 % of the population and is generally benign. However, a subgroup presents severe complications such as ventricular arrhythmias and sudden cardiac death (SCD). Arrhythmogenic mitral...Mitral valve prolapse (MVP) affects 2-3 % of the population and is generally benign. However, a subgroup presents severe complications such as ventricular arrhythmias and sudden cardiac death (SCD). Arrhythmogenic mitral valve prolapse (AMVP) combines MVP with frequent or complex ventricular arrhythmias in the absence of other causes. Although SCD in AMVP patients is rare (0.2-0.4 %, annual), it exceeds the general population rate and is associated with specific high arrhythmic risk features, such as mitral annular disjunction (MAD), bileaflet prolapse, Pickelhaube sign, abnormal T waves on the electrocardiogram, and rapid non-sustained ventricular tachycardia. Primary prevention is crucial but challenged by the lack of standardized guidelines. AMVP requires a multidisciplinary and cost-effective evaluation to stratify risk and prevent SCD in a predominantly young and healthy population. The objective of this review is to describe the variables with the highest arrhythmogenic risk in patients with MVP and the possible primary prevention strategies for sudden cardiac death.
BACKGROUND: The heart is a vital organ that pumps blood throughout the body. Its proper functioning is crucial for maintaining overall health, and any malfunction can significantly impact other bodily systems. Recently,...BACKGROUND: The heart is a vital organ that pumps blood throughout the body. Its proper functioning is crucial for maintaining overall health, and any malfunction can significantly impact other bodily systems. Recently, machine learning has emerged as a valuable tool in cardiology, enhancing the prediction and diagnosis of heart diseases. By analyzing clinical data, these algorithms reveal patterns that traditional methods might miss, aiding in early detection and personalized treatment. This study aimed to evaluate the most widely used and accurate supervised machine-learning algorithms for predicting and diagnosing heart disease. METHODS: A systematic analysis was conducted using research articles obtained from six reputable academic databases: Scopus, PubMed, ScienceDirect, Dimensions, ProQuest, and IEEE. The review covers the years from 2013 to 2024. The focus was on the application of various supervised machine-learning algorithms for diagnosing heart disease. RESULT: The study identified twenty-four relevant studies that examined the use of supervised machine learning algorithms for diagnosing and predicting heart disease. Among these, five algorithms were prominent: Decision Trees, Logistic Regression, Naive Bayes, Random Forests, and Artificial Neural Networks. Decision Trees were found to be the most commonly applied and best-performing algorithm, followed by Logistic Regression and Naive Bayes. However, Artificial Neural Networks and Random Forests received less attention despite their potential for high accuracy in certain contexts. CONCLUSION: The research findings highlight important trends in heart disease prediction models using supervised machine learning. By examining these trends, researchers can identify algorithms that improve forecasting accuracy, guiding future research objectives and advancing the effectiveness of heart disease diagnosis.
BACKGROUND: Cardiovascular magnetic resonance (CMR) is a highly valuable tool for evaluating cardiac masses (CM). However, data on its ability to predict patient outcomes remain limited. Therefore, our objective was to a...BACKGROUND: Cardiovascular magnetic resonance (CMR) is a highly valuable tool for evaluating cardiac masses (CM). However, data on its ability to predict patient outcomes remain limited. Therefore, our objective was to assess the accuracy of CMR in determining malignancy, its association with mortality, and its agreement with histopathological analysis. METHODS: This was an observational, retrospective study. We examined patients who underwent CMR due to suspected CM from January 2004 to June 2023 at an university hospital. Patients with suspected infarction-related thrombosis were excluded. Data were collected from electronic medical records. Images were reanalyzed in a blinded manner by two cardiac imaging specialists, documenting predefined imaging characteristics to classify masses as malignant or non-malignant (including cysts, thrombi, and normal variants), leading to a presumptive diagnosis. Mortality rates across groups were compared using survival analysis and Cox regression. In cases with histological confirmation, agreement between the presumptive CMR diagnosis and the final histological diagnosis was evaluated using the Cohen's Kappa coefficient. RESULTS: We identified 75 patients with suspected CM, of which 24 (32 %) were classified as malignant and 51 (68 %) as non-malignant. Imaging variables most strongly associated with malignancy included the presence of multiple masses, involvement of multiple chambers, signs of infiltration, pericardial effusion, perfusion abnormalities, and late gadolinium enhancement. In contrast, mass mobility was associated with a non-malignant diagnosis. The median follow-up was 30 months [IQR 4-67.5]. Malignant masses identified by CMR were associated with higher mortality: (HR: 3.72; 95 % CI: 1.8-7.72, p < 0.001). Histopathological studies were performed in 34 patients (45 %) and compared with the presumptive etiological diagnosis obtained by CMR. The level of agreement was excellent for malignancy (k = 0.88, p < 0.001) and good for etiological diagnosis (k = 0.63, p < 0.001). CONCLUSIONS: Malignancy of a CM, as determined by CMR, was associated with higher mortality. There was good agreement between the presumptive diagnosis by CMR and the histopathological findings.
INTRODUCTION: Patients with acute coronary syndrome (ACS) have concomitant ventricular arrhythmic events (VA). Literature data are conflicting regarding short- and long-term prognosis. International guidelines do not rec...INTRODUCTION: Patients with acute coronary syndrome (ACS) have concomitant ventricular arrhythmic events (VA). Literature data are conflicting regarding short- and long-term prognosis. International guidelines do not recommend defibrillator (ICD) implantation in the first 40 days after a myocardial infarction. However, some patients may have an increased arrhythmic risk and deserve closer monitoring. PURPOSE: The aim of our study was to define the incidence of arrhythmic events in a population of patients admitted for ACS to the Cardiac Intensive Care Unit (CICU) of a tertiary center and to determine the short- and long-term prognosis in patients with arrhythmic onset compared with patients without arrhythmic onset. METHODS: This is a single-center retrospective cohort data analysis of 1587 consecutive patients admitted with a diagnosis of ACS to the CICU of Niguarda Hospital of Milan, from 2014 to 2022. We classified the patients into two groups according to the arrhythmias at presentation: VA (sustained VT or VF) and no-VA. Kaplan-Meier (KM) estimated the probability of remaining event free in the time after ACS and were compared between VA and no-VA groups, using the log-rank test. Cox regression analysis was used to explore the association of specific variables with the occurrence of cardiac events in univariate and multivariate analysis. Statistical analyses were performed with R 42.0 statistical package (R Core Team, Vienna, Austria). RESULTS: Among 1587 ASC patients, 4.6 % had arrhythmic onset (4.0 had a diagnosis of VF and 0.6 % of VT). Patients with VA were significantly younger (63 y. vs 67 y., p = 0.026) and had a lower incidence of cardiovascular risk factors, such as hypertension and dyslipidemia, compared with no-VA group. VA group had a higher risk of arrhythmias during the hospitalization (9.6 % vs 1.3 %, p < 0.001) and had a clinical course characterized by a significantly higher use of mechanical support with intra-aortic balloon pumps (IABP, 35.6 % vs. 6.8 %, p < 0.001) and a greater use of inotropic drugs (34 % vs. 9 %, p < 0.001). We observed in VA group a six-fold increase in-hospital mortality (23 % vs 4 %, p < 0.001), identifying arrhythmic presentation as a marker of worse in-hospital prognosis in patients admitted with ACS. Likewise, mortality at 40 days after the acute event was higher in the VA group than in the no-VA group (22 % vs. 5 %, p < 0.001). Conversely, during a median follow-up of 5.9 years, VA onset did not affect long-term mortality in patients discharged alive. CONCLUSION: In this long-term follow-up retrospective registry involving a large cohort of patients with ACS admitted to the CICU, concomitant VA at admission was found to be linked with an increase in in-hospital arrhythmic complications and in-hospital mortality. The mortality rate at 40 days post-ACS was also notably higher in the VA group. This study underscores the complexity of arrhythmic presentation in ACS patients, emphasizing the critical need for vigilant monitoring throughout their hospitalization and particularly in the initial 6 weeks following the event index. This heightened surveillance is justified by the documented elevated levels of morbidity and mortality during this phase.
INTRODUCTION: The early identification of conditions that lead to increased myocardial wall thickness, such as transthyretin amyloid cardiomyopathy (ATTR-CM), severe aortic stenosis (AS), hypertrophic cardiomyopathy (HCM...INTRODUCTION: The early identification of conditions that lead to increased myocardial wall thickness, such as transthyretin amyloid cardiomyopathy (ATTR-CM), severe aortic stenosis (AS), hypertrophic cardiomyopathy (HCM), and hypertensive heart disease (HHD), is challenging due to overlapping features. Delayed diagnosis can postpone appropriate treatment and worsen prognosis. This study aimed to evaluate the frequency of key electrocardiographic patterns in these conditions, with a specific emphasis on differentiating ATTR-CM from other causes of wall thickening. METHODS: Electrocardiograms (ECGs) from the medical records of 400 patients over 60 years old were analyzed, divided into four groups (ATTR-CM, HCM, HHD, and AS) with confirmed diagnoses and septal thickening (≥12 mm). Specific electrocardiographic patterns, including left ventricular hypertrophy, left atrial enlargement, low voltage, pseudoinfarction, and left ventricular pressure overload, were assessed. Multiple chi-square tests with Bonferroni adjustment were used to detect significant differences between groups. RESULTS: The Sokolow-Lyon criteria was absent in all ATTR-CM cases, compared to 13 % in other conditions (p = 0.001). Additionally, ATTR-CM showed a higher prevalence of low voltage (45 % vs. 18.3 %, p = 0.001) and pseudoinfarction pattern (32 % vs. 22 %, p = 0.007), but a lower prevalence of left atrial enlargement (8 % vs. 30 %, p = 0.005). Absence of the Sokolow criteria was the best predictor of ATTR-CM (sensitivity 100 %, NPV 100 %, PPV 27 %), followed by the presence of low voltage and pseudoinfarction. CONCLUSIONS: Significant differences were observed in the prevalence of electrocardiographic patterns between ATTR-CM and other wall thickening phenotypes. These findings may aid in the early detection and diagnosis of ATTR-CM, allowing for more timely intervention.
Dilated cardiomyopathy (DCM) is a prevalent cardiac disorder affecting 1 in 250-500 individuals, characterized by ventricular dilation and impaired systolic function, leading to heart failure and increased mortality, inc...Dilated cardiomyopathy (DCM) is a prevalent cardiac disorder affecting 1 in 250-500 individuals, characterized by ventricular dilation and impaired systolic function, leading to heart failure and increased mortality, including sudden cardiac death. DCM arises from genetic and environmental factors, such as drug-induced, inflammatory, and viral causes, resulting in diverse yet overlapping phenotypes. Advances in precision medicine are revolutionizing DCM management by leveraging genetic and molecular profiling for tailored diagnostic and therapeutic approaches. This review highlights comprehensive diagnostic evaluations, genetic discoveries, and multi-omics approaches integrating genomic, transcriptomic, proteomic, and metabolomic data to enhance understanding of DCM pathophysiology. Innovative risk stratification methods, including machine learning, are improving predictions of disease progression. Despite these advancements, the current one-size-fits-all management strategy contributes to persistently high morbidity and mortality. Emerging targeted therapies, such as CRISPR/Cas9 genome editing, aetiology-specific interventions, and pharmacogenomics, are reshaping treatment paradigms. Precision medicine holds promise for optimizing DCM diagnosis, treatment, and outcomes, aiming to reduce the burden of this debilitating condition.
This review/viewpoint examines the notion of employing intra-atrial- septal pegs with embedded carbon nanotube fibers as an "artificial Bachman's bundle", for the restoration of interatrial electrical conduction in patie...This review/viewpoint examines the notion of employing intra-atrial- septal pegs with embedded carbon nanotube fibers as an "artificial Bachman's bundle", for the restoration of interatrial electrical conduction in patients with interatrial block with or without history of atrial fibrillation/atrial flutter. It is argued that such restoration of interatrial electrical conduction may prevent the emergence of atrial fibrillation/atrial flutter, or if such conditions have already been experienced, may ameliorate or possibly effectively treat paroxysmal/persistent/permanent atrial fibrillation/atrial flutter. To this effect a detailed protocol for this undertaking in patients is included.
INTRODUCTION/AIM: Stress echocardiography (SE) is a first-line, non-invasive and well-validated technique for the diagnosis and decision making of coronary artery disease (CAD). The introduction of echocardiographic cont...INTRODUCTION/AIM: Stress echocardiography (SE) is a first-line, non-invasive and well-validated technique for the diagnosis and decision making of coronary artery disease (CAD). The introduction of echocardiographic contrast agents, the growing usage of exercise on supine bike as a stressor and the recent technological advances have considerably improved the sensitivity of SE. Despite those advantages, SE remains an operator-dependent technique, and its association with CAD prognosis is based on limited evidence from old studies. Our aim is a) to assess the positive prognostic value of SE in patients with established or suspected CAD and b) to evaluate the relationship between SE findings and invasive coronary angiography (ICA) findings. METHODS: We describe the rationale and design of Amphipolis trial, a prospective, multicentre, self-controlled, open-label trial from 22 labs in Greece and Cyprus. We plan to enrol 390 consecutive adults with a positive SE based on echocardiographic findings, fulfilling specific selection criteria. All participants will undergo ICA within 6 weeks from positive SE. Then, we will be followed up them for at least 12 months for major adverse cardiovascular events (MACE) such as cardiovascular death, acute coronary syndrome (ACS), revascularization interventions (re-stenosis or new cases of myocardial ischemia), or the development of symptoms (angina relapse or new onset). CONCLUSIONS: Amphipolis trial will test the prognostic role of SE, and its implementation in clinical practice along with anatomical findings from ICA.
BACKGROUND: Cardiac sarcoidosis (CS) affects between 5 % to 25 % of systemic sarcoid cases. CS patients may present with heart failure (HF), with ultimate progression to advanced heart failure (AHF) associated with heigh...BACKGROUND: Cardiac sarcoidosis (CS) affects between 5 % to 25 % of systemic sarcoid cases. CS patients may present with heart failure (HF), with ultimate progression to advanced heart failure (AHF) associated with heightened mortality. OBJECTIVES: American guidelines emphasise using the 'I NEED HELP' criteria to identify AHF patients. The European Society of Cardiology (ESC) have alternative AHF diagnostic criteria. Both have demonstrated prognostic value, but their utility in prognosticating CS is unknown. This study aimed to address this. METHODS: 109 patients, with baseline left ventricular ejection fraction (LVEF) <50 %, referred to the Royal Brompton Hospital between 2006 and 2019, were analysed. 48 patients had ≥1 'I NEED HELP' criteria consistent with AHF. Comparisons were made between the AHF and non-AHF CS patients. Sub-analysis was performed between the AHF patients that did or did not meet ESC-AHF criteria. Primary combined outcome measure was all-cause-mortality, urgent orthotopic cardiac transplant or urgent left ventricular assist device insertion. Secondary outcome measure was sustained ventricular tachycardia. RESULTS: The AHF cohort had significantly lower LVEF and higher brain natriuretic peptide values. More AHF CS patients reached combined primary outcome measure (AHF 16/48 [33 %]), than the non-AHF group (8/61 [13 %]), p < 0.019. The AHF group had shorter time to both primary and secondary events on Kaplan-Meier analysis (logrank p < 0.014 and p < 0.040 respectively). Sub-analysis revealed the ESC-AHF group had the poorest prognoses according to both outcome measures. CONCLUSIONS: In this study, both the AHA and ESC-AHF criteria had prognostic value. The ESC-AHF criteria best identifies CS patients with poorest prognoses.
The incidence and prevalence of metabolic syndrome has been increasing globally with no signs of abating. Individuals with metabolic syndrome are at increased risk of multiple comorbidities, including cardiovascular dise...The incidence and prevalence of metabolic syndrome has been increasing globally with no signs of abating. Individuals with metabolic syndrome are at increased risk of multiple comorbidities, including cardiovascular disease and type 2 diabetes mellitus. Studies show that there is a paradoxical relationship in African Americans however, as they experience a higher rate of cardiovascular disease and type 2 diabetes mellitus despite having a lower prevalence of metabolic syndrome when compared to whites. The triglyceride paradox, an unusual phenomenon in which African Americans consistently express a more normal triglyceride status even when having conditions known to be characterized by high triglyceride levels, is believed to account for this paradoxical relationship. In this manuscript, we review the history and pathophysiology of metabolic syndrome while also discussing the importance of the triglyceride paradox in explaining the inverse relationship that exists between metabolic syndrome, cardiovascular disease, and type 2 diabetes mellitus in African Americans. In addition, we advocate for decreasing the triglyceride cutoff value when diagnosing metabolic syndrome in this population to more precisely determine who is at risk for developing type 2 diabetes mellitus and cardiovascular disease.