BACKGROUND: In patients with embolic stroke of undetermined source (ESUS), detecting new-onset atrial fibrillation (AF) is crucial because it leads to treatment change and reduces stroke recurrence and mortality. However...BACKGROUND: In patients with embolic stroke of undetermined source (ESUS), detecting new-onset atrial fibrillation (AF) is crucial because it leads to treatment change and reduces stroke recurrence and mortality. However, the high cost and relatively low AF detection rate of implantable cardiac monitors (ICM) necessitate the identification of predictive factors to better select candidates. This study aimed to identify AF predictors in ESUS patients with left atrial enlargement (LAE) to improve ICM selection. METHODS: We conducted a retrospective observational study with consecutive patients with ESUS and LAE admitted to a tertiary hospital. Echocardiographic, electrocardiographic, and 24-hour Holter electrocardiogram (ECG) findings were collected and analyzed using multivariate logistic regression and cross-validation techniques. Independent predictors were incorporated into a risk model classifying patients into low-, moderate-, and high-risk categories for new-onset AF. RESULTS: A total of 100 patients were included. After an 18-month follow-up period, new-onset AF was detected in 19 patients (20%). Independent predictors included severe LAE (odds ratio [OR] 4.80, 95% confidence interval [CI] 1.32-17.37; p = 0.017), interatrial block (OR 6.22, 95% CI 1.27-30.47; p = 0.024), and atrial tachycardia ≥ 20 beats on 24-hour Holter-ECG (OR 7.62, 95% CI 1.21-47.74; p = 0.03). A predictive risk score (area under the curve [AUC] 0.733; p < 0.001) was developed, classifying patients into low (9.67% risk), moderate (36.6%), and high (100%) risk categories. CONCLUSIONS: Interatrial block (IAB), atrial tachycardia (AT) ≥ 20 beats, and severe LAE are strong new-onset AF predictors in ESUS patients with LAE. A new scoring system effectively stratifies AF risk, optimizing ICM selection.
Ramos-Jovani M, López-Sainz Á, Brufau M
… +12 more, Rodríguez-Arias JJ, Solé E, Quintana E, Farrero M, Castel MA, Caravaca P, Arbelo E, Sandoval E, Pereda D, Castellà M, Sitges M, García-Álvarez A
BACKGROUND: Timely identification of hypertrophic cardiomyopathy (HCM) patients who may require a heart transplant (HT) in the future is crucial. Our study aimed to identify predictive factors associated with the need fo...BACKGROUND: Timely identification of hypertrophic cardiomyopathy (HCM) patients who may require a heart transplant (HT) in the future is crucial. Our study aimed to identify predictive factors associated with the need for HT in HCM patients. METHODS: All patients undergoing HT due to HCM in a tertiary HT hospital from 2003 to 2020 were included and compared - matched 1:4 for similar follow-up time since diagnosis - to a control HCM cohort. Patients' clinical and imaging characteristics at HCM diagnosis and longitudinal data were assessed. RESULTS: 85 patients, 17 who required a HT and 68 HCM control patients from the HCM clinic, were included. At HCM diagnosis, patients who would later require HT had higher NT-proBNP levels (880.5 vs. 86.2 pg/mL), larger left atrium (LA) dimensions (49 vs. 40 mm), and slightly reduced left ventricle (LV) ejection fraction (50 vs. 60%), and showed higher prevalence of atrial fibrillation (AF) (47 vs. 22%). During a median follow-up of 11.6 years, patients subsequently requiring HT developed further worsening functional class and higher incidence of hospital admission for HF and incidence of sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator (ICD) ther-apy (log-rank p < 0.001 in both). This was accompanied by significant LA dilatation (8 vs. 1 mm, p = 0.037) and worsening LV diastolic function. CONCLUSIONS: Left atrium dilatation, AF, elevated NT-proBNP levels, and lower LV ejection fraction at HCM diagnosis should alert about the potential future need for HT. Progressive LA enlargement and worsening diastolic function during follow-up are warning signs that should prompt referral to a HT center.
BACKGROUND: Although a large body of literature describes Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) as having overlapping clinical features and benign outcome measures, they differ signif...BACKGROUND: Although a large body of literature describes Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) as having overlapping clinical features and benign outcome measures, they differ significantly in their pathophysiological mechanisms, demo-graphic profile, and natural history. Herein, we sought to investigate differences in clinical profile and outcomes between patients of these two conditions. METHODS: Following PRISMA guidelines, we compared TTS and SCAD in adult patients regarding epidemiological, clinical, and prognostic features. A systematic search of PubMed, Embase, and Cochrane Library identified eligible studies, with data extracted and quality assessed using the Newcastle-Ottawa scale. Random effects models were applied for statistical analysis, with heterogeneity evaluated by I2 and sensitivity analysis conducted to ensure robustness. RESULTS: Takotsubo syndrome patients presented more often with dyspnea (46.8% vs. 0.9%; p < 0.001), while SCAD patients displayed typical angina (p < 0.001). In-hospital outcomes were worse for TTS patients, with higher mortality (4.4% vs. 0.8%; RR = 7.41, p = 0.001) and major adverse cardiac events (43.3% vs. 5.2%; RR = 8.35, p < 0.001). At one year, TTS patients had higher all-cause mortality (12.5% vs. 0.8%; p < 0.001) and stroke (2.1% vs. 0.6%; RR = 5.08, p = 0.02). CONCLUSIONS: Poorer outcomes are associated with TTS compared to SCAD. SCAD patients demonstrate better prognoses but remain at risk for recurrent ischemic events.
BACKGROUND: Early screening for cardiac light-chain amyloidosis (CA-AL) remains a diagnostic challenge due to its nonspecific clinical features. This study aimed to assess whether the results of routine cardiology examin...BACKGROUND: Early screening for cardiac light-chain amyloidosis (CA-AL) remains a diagnostic challenge due to its nonspecific clinical features. This study aimed to assess whether the results of routine cardiology examinations could predict CA-AL in hospitalized heart failure patients with monoclonal gammopathies. METHODS: After strict filtering, 187 consecutive patients with heart failure and comorbid monoclonal gammopathy were prospectively enrolled from the Department of Cardiology. All patients were referred to the hematologists for further evaluation of suspected cardiac amyloidosis. The cohort consisted of 127 patients with CA-AL, 34 with multiple myeloma (MM), and 26 with monoclonal gammopathy of undetermined significance (MGUS). Comprehensive laboratory and imaging data were systematically collected for each patient. RESULTS: Our results indicated that CA-AL patients exhibited significantly lower left ventricular ejection fractions (EF), proteinuria, and serum creatinine levels, as well as substantially higher cardiac troponin T (cTn-T), free-light chain (FLC) λ, and displayed differences in serum free-light chain (dFLC) levels compared to MM patients. Compared with MM and MGUS patients, CA-AL patients showed consistently increased thicknesses of the interventricular septum and left ventricular posterior wall (LVPW). Univariate and bidirectional logistic regression analysis revealed that thicker LVPW and higher dFLC were significant risk factors for CA-AL. Receiver operating characteristic (ROC) curve analysis demonstrated that the LVPW thickness [area under the curve (AUC) = 0.798, 95% confidence interval (CI) 0.728-0.868] yielded a better AUC than dFLC (AUC = 0.661, 95% CI 0.569-0.754), and combining LVPW with dFLC did not significantly increase diagnostic outcome as compared with LVPW alone. CONCLUSIONS: These findings suggest that LVPW thickness effectively predicts CA-AL in hospitalized heart failure patients with monoclonal gammopathies, thereby providing valuable insights into the diagnostic process for CA-AL.
BACKGROUND: Recently, there has been a resurgence in the incidence of Mycoplasma pneumoniae pneumonia (MPP) among children, but little is known about Mycoplasma pneumoniae (MP) infection in children's hearts. METHODS: Ch...BACKGROUND: Recently, there has been a resurgence in the incidence of Mycoplasma pneumoniae pneumonia (MPP) among children, but little is known about Mycoplasma pneumoniae (MP) infection in children's hearts. METHODS: Children diagnosed with MPP received non-contrast cardiac magnetic resonance (CMR) assessments during hospitalization and at three months following discharge. A control group consisting of healthy children was also included. RESULTS: Children with MPP exhibited significantly decreased left ventricular (LV) ejection fraction (EF), LV cardiac output (CO), LV cardiac index (CI), LV end-diastolic volume (EDV)/body surface area (BSA), LV stroke volume (SV)/BSA, and LV global longitudinal strain (GLS) compared to controls (p < 0.05). The global native T1 and T2 values of the baseline group were higher than those of controls (p < 0.05). The follow-up group showed improvements in LV SV/BSA, LVEF, right ventricle (RV) EF, heart rate (HR), LV GLS, LV global radial strain (GRS), and LV global circumferential strain (GCS) compared to three months prior, but maintained lower LV CI, LV EDV/BSA, LV end-systolic volume (ESV)/BSA, and LV SV/BSA compared to the control group (p < 0.05). CONCLUSIONS: Mycoplasma pneumoniae infection might affect LV function in children. The LVEF and myocardial strain generally show good recovery after three months, although some children may continue to exhibit abnormalities in other cardiac function parameters or imaging signs of cardiac inflammation.
BACKGROUND: Pulsed field ablation (PFA) has emerged as a promising method for pulmonary vein isolation (PVI) due to its myocardial-selective mechanism and a favorable safety profile. Among the available technologies, Far...BACKGROUND: Pulsed field ablation (PFA) has emerged as a promising method for pulmonary vein isolation (PVI) due to its myocardial-selective mechanism and a favorable safety profile. Among the available technologies, Farapulse (Boston Scientific Corporation, Marlborough, USA) and Varipulse (Biosense Webster Inc, New Brunswick, USA) are the two leading PFA systems. However, comparative data regarding their perioperative performance and impact on myocardial injury remain limited. This study aimed to evaluate and compare perioperative outcomes and myocardial injury, assessed by postprocedural troponin I levels, in patients undergoing first-time PVI with the Farapulse or Varipulse system in a real-world clinical setting. METHODS: In this prospective analysis of 50 patients with symptomatic atrial fibrillation (AF) undergoing first-time PVI, Farapulse (n = 25) and Varipulse (n = 25) systems were compared by assessing procedure duration, fluoroscopy time, 12-hour postprocedural troponin I levels, first-pass isolation (FPI) rates, and periprocedural complications (atrial-esophageal fistula, periprocedural stroke, pseudoaneurysm, vascular complications, and AF recurrence before discharge). RESULTS: Farapulse-based procedures were shorter than those performed using the Varipulse system (median duration 50 vs. 55 min; p <0.001) but were associated with longer fluoroscopy times (median, 646 vs.177 s; p <0.001) and higher median troponin levels (15386 vs. 9937 ng/L; p <0.001). No significant differences were observed in FPI (76% vs. 56%; p = 0.23) or complication rates. CONCLUSIONS: In a real-world cohort, Farapulse was associated with shorter procedure times, while Varipulse, aided by 3D mapping, was linked to reduced fluoroscopy exposure and lower troponin release. These findings highlight the need for further studies on long-term outcomes and optimization across different PFA systems.
BACKGROUND: Long-term patency in complex chronic total occlusion percutaneous intervention (CTO-PCI) is often hindered by a high-risk of stent-failure (HR-SF), impacting prognosis. Drug-coated balloon (DCB) angioplasty m...BACKGROUND: Long-term patency in complex chronic total occlusion percutaneous intervention (CTO-PCI) is often hindered by a high-risk of stent-failure (HR-SF), impacting prognosis. Drug-coated balloon (DCB) angioplasty may offer an alternative after successful crossing. We evaluated an invest-to-treat DCB strategy, determined by plaque modification results. METHODS: Patients with CTO wire-crossing and suboptimal lesion profile for stenting were enrolled at Campus Bio-Medico University Hospital of Rome (April-July 2024). After plaque preparation, results were classified as good, suboptimal, or poor based on residual stenosis and thrombolysis in myocardial infarction (TIMI) flow. Poor results received conventional stenting [drug-eluting stent (DES)]. Good results underwent a nine-month follow-up; suboptimal results underwent a three-month angiography. A "redo-DCB" approach was used for persistent suboptimal results within the invest-to-treat strategy. RESULTS: Of 32 CTO-PCIs performed, 29 completed the nine-month follow-up. 11 patients (38%) had poor outflow and required DES (DES-group). The other 18 patients (62%) were managed with DCB alone: six patients (21%) achieved good immediate results (DCB-group), and 12 (41%) were treated as "DCB-investment" due to suboptimal plaque modification (DCB-investment group). At the three-month follow-up, four patients (14%) showed improved angiographic results, while six (21%) had suboptimal outcomes and received redo-DCB after plaque modification; two (7%) of these required DES. At nine-months, 14 patients (48%) were successfully treated with a DCB-only approach. CONCLUSIONS: This prospective study demonstrates that a DCB strategy for CTO patients with HR-SF is feasible and safe. A DCB-only approach resulted in favorable early outcomes for most patients. In the case of suboptimal initial results, the redo-DCB strategy emerged as a promising alternative to extensive stenting.
Heart failure (HF) remains a leading cause of morbidity, mortality, and healthcare utilization worldwide, despite the availability of effective evidence-based therapies. The principal challenge is no longer the absence o...Heart failure (HF) remains a leading cause of morbidity, mortality, and healthcare utilization worldwide, despite the availability of effective evidence-based therapies. The principal challenge is no longer the absence of treatment options but the limited capacity of traditional care models to deliver guidelinedirected medical therapy (GDMT) consistently and at scale. The COVID-19 pandemic exposed the fragility of hospital-centered HF care, highlighting the need for more resilient, patient-centered management strategies. Remote monitoring (RM) has been proposed as a solution, yet its clinical impact has been inconsistent due to fragmented data streams, declining patient adherence, and heavy reliance on continuous human oversight. Artificial intelligence (AI) offers an opportunity to address these limitations by integrating multidimensional clinical data, enabling earlier detection of deterioration, supporting adherence, and prioritizing clinically meaningful interventions. Emerging evidence suggests that AI-assisted workflows can accelerate GDMT optimization and improve surrogate and clinical outcomes when implemented within supervised care pathways. This has led to the concept of next-generation remote monitoring (NGRM), in which AI analyzes longitudinal physiological and behavioral signals to generate context-aware alerts and actionable recommendations while reducing clinical workload. Successful implementation, however, requires rigorous validation, clear governance, integration with clinical workflows, and safeguards for safety, equity, and accountability. When embedded within structured HF care pathways, AI-enabled monitoring may help bridge the persistent gap between evidence and real-world implementation.
PolandAbstractHeart failure (HF) remains the foremost global health problem. Decompensation of chronic HF, char-acterized by exacerbation of symptoms and signs of congestion, reduces functional capacity and quality of li...PolandAbstractHeart failure (HF) remains the foremost global health problem. Decompensation of chronic HF, char-acterized by exacerbation of symptoms and signs of congestion, reduces functional capacity and quality of life, and increases the risk for hospitalizations and mortality. To reduce the HF burden, patients at elevated decompensation risk must be quickly identified. However, reliable, validated risk scores for the prediction of worsening HF are lacking. Therefore, this clinically oriented review aims to outline the clinical factors predisposing for HF decompensation and discuss modern strategies for the non-invasive monitoring of patients with chronic HF, including telemonitoring and artificial intelligence-based tools.
BACKGROUND: Because renal and cardiac function are key to the prognosis of patients with coronary artery disease, we compared three-year clinical outcomes based on the degree of left ventricular ejection fraction (LVEF)...BACKGROUND: Because renal and cardiac function are key to the prognosis of patients with coronary artery disease, we compared three-year clinical outcomes based on the degree of left ventricular ejection fraction (LVEF) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) with or without chronic kidney disease (CKD). METHODS: A total of 4567 patients diagnosed with NSTEMI were enrolled and stratified into CKD (1270 patients) and non-CKD (3297 patients) groups. Each group was further classified into heart failure (HF) with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF) subgroups. The primary outcome was all-cause death. RESULTS: In both the CKD and non-CKD groups, the adjusted rates of all-cause death (both p < 0.001) and cardiac death (CD, both p <0.001) in the HFrEF subgroup were significantly higher than in the HFmrEF and HFpEF subgroups. However, within the CKD group, the all-cause death rate was comparable between the HFmrEF and HFpEF subgroups. In contrast, within the non-CKD group, the rates of all-cause death (p = 0.005) and CD (p = 0.008) were significantly higher in the HFmrEF subgroup compared to the HFpEF subgroup. The increased all-cause death in the CKD group, relative to the non-CKD group, within the HFpEF subgroup contributed to these outcomes. CONCLUSIONS: Regardless of CKD status, the HFrEF subgroup showed higher mortality rates compared with the HFmrEF and HFpEF subgroups. However, the mortality rate differed between the HFmrEF and the HFpEF subgroups in both the CKD and the non-CKD groups.