Hearts, Volume 6, Issue 4 (December 2025) – 10 articles

Background: Serum albumin is a well-known marker of nutritional and inflammatory status and has been associated with adverse outcomes in heart failure (HF). However, its predictive value for length of hospital-stay and short-term mortality in elderly HF patients remains underexplored. Objectives: To investigate the association between serum albumin levels at hospital admission and length of stay, as well as post-admission mortality, in a cohort of elderly patients hospitalized for HF. Methods: We conducted a retrospective analysis of 56 consecutive patients aged ≥65 years admitted for HF. Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), and inflammatory status was measured via C-reactive protein (CRP). Negative binomial regression with robust confidence intervals was employed to evaluate the relationship between serum albumin and length of hospital-stay, adjusting for age, comorbidity burden, and CRP. Cox proportional hazards models were used to assess mortality at 6 months and 1 year, adjusting for age, comorbidity, CRP, and HF subtype, with Kaplan–Meier curves illustrating unadjusted survival differences according to albumin levels and HF subtype. Results: Mean age was 78.6 ± 7.5 years, with 69.6% female patients. Mean serum albumin at admission was 3.58 ± 0.60 g/dL, and mean length of stay was 14.8 ± 10.1 days. Each 1 g/dL increase in albumin was associated with a 32% reduction in length of stay (adjusted IRR = 0.68; 95% CI: 0.54–0.85; p = 0.01), independently by age, inflammatory status and comorbidity. Serum albumin was independently associated with reduced risk of death at 6 months (HR 0.30; 95% CI: 0.11–0.82; p = 0.019) and 1 year (HR = 0.41; 95% CI: 0.17–0.96; p = 0.041). Conclusions: Serum albumin at hospital admission independently predicts length of stay and short-term mortality in elderly patients with HF. Albumin measurement, simple, cheap and universally available biomarker, is helpful for early risk stratification and may guide clinical management in this vulnerable population. Full article

Background: In cardiology, vasoregulation is one of the most important targets of pharmacotherapy. SOMNOtouch™-NIBP (SOMNOmedics AG, Randersacker, Germany) is a cuffless device designed for continuous, non-invasive blood pressure measurements, and it appears to be ready for use in infants and children with congenital heart disease. For infants, minor methodological modifications are required due to their small body size. Methods: Using this device, we demonstrate fluctuations in diastolic blood pressure in three patients: an infant with hypoplastic left heart syndrome after Norwood stage 1 and 2 operations; an infant with Tetralogy of Fallot with heart failure due to pulmonary overcirculation after an aorto-pulmonary shunt implantation; and a 13-year-old girl with chronic cyanosis due to a congenitally corrected transposition of the great arteries (ccTGA) with a ventricular septal defect and pulmonary stenosis. The measurement procedures are completely non-invasive and feasible in an outpatient setting. Results: The results demonstrate strong correlations between blood pressure and oxygen saturation levels as well as heart rate variability. We discuss our results in relation to current concepts of hypoxic pulmonary/systemic vasoconstriction and hypoxemia-related pathways. Conclusions: The cuffless device for continuous, non-invasive blood pressure measurement seems to be useful for infants with and without congenital heart defects who receive pharmacotherapies that modulate vasoregulation. These patients should also be non-invasively monitored for safety reasons and for a better understanding of their pathophysiology. Full article

Heart transplantation is the gold standard in patients with end stage heart failure, offering vastly improved survival, mortality and quality of life. However, hypertension occurring after cardiac transplantation is a serious issue, with the incidence ranging from 50 to 80% of patients. The pathophysiology of the hypertension encompasses a more varied and unique set of causes than those identified in non-organ transplant patients, particularly related to the use of calcineurin inhibitors (CNIs) especially cyclosporine. An in-depth understanding of hypertension after heart transplantation remains a critical issue that necessitates further clarification, due to its deleterious long-term consequence such as impaired graft survival, cardiac allograft vasculopathy (CAV), and overall survival. This article provides a comprehensive review of the prevalence, risk factors, etiology, complications, and management of hypertension after heart transplantation. Full article

Background/Objectives: Cardiovascular disease (CVD) and cerebrovascular disease (CeVD) remain leading causes of death in the United States, with Mississippi consistently reporting some of the nation’s highest mortality rates. Despite earlier national declines, recent evidence suggests stagnation or increases, particularly in high-burden regions. This study examined short-term trends in CVD and CeVD mortality in Mississippi between 2018 and 2022, stratified by age, sex, and race. Methods: Mortality data for adults aged ≥45 years were obtained from the Mississippi Statistically Automated Health Resource System (MSTAHRS). Age-adjusted mortality rates were calculated per 100,000 population and standardized to the 2000 U.S. population. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Analyses were stratified by sex, and within each racial group (White, Black, Other), mortality trends were further examined across age categories (45–54, 55–64, 65–74, 75–84, ≥85 years). Results: Cardiovascular mortality increased significantly among White women in midlife (ages 45–74), while “Other race” men in early midlife and “Other race” women in the oldest age group showed steep increases. Although Black adults did not experience significant changes over time, their mortality rates remained consistently higher than those of White adults. Conclusions: Progress in reducing cardiovascular and cerebrovascular mortality in Mississippi has reversed in several subgroups, particularly midlife White women and smaller racial populations. These findings mirror national stagnation and pandemic-related disruptions, highlighting the urgent need for equity-focused prevention, improved healthcare access, and targeted interventions addressing structural determinants of health. Full article

Tricuspid atresia (TA) is a cyanotic congenital heart defect defined by agenesis of the tricuspid valve and resultant right ventricular hypoplasia, representing 1.4–2.9% of congenital heart disease. Survival depends on interatrial and interventricular shunts that permit systemic and pulmonary blood flow, with staged surgical palliation culminating in the Fontan procedure. While surgical advances have improved long-term outcomes, Fontan circulation remains a delicate physiology characterized by preload dependence, elevated pulmonary vascular resistance, chronic venous hypertension, and a prothrombotic state. These features predispose patients to arrhythmias, lymphatic complications, hepatic congestion, and progressive circulatory failure. For anesthesiologists, perioperative management of TA and Fontan patients is uniquely complex. Anesthetic considerations include meticulous preload optimization, modulation of systemic and pulmonary vascular resistance, and ventilatory strategies that minimize adverse effects on venous return. Additional challenges include the high risk of air embolism, individualized anticoagulation needs, and hemodynamic sensitivity to patient positioning. Preoperative evaluation with echocardiography and electrocardiography provides critical insight into anatomy and physiology, while intraoperative planning must emphasize goal-directed fluid management, careful agent selection, and tailored ventilation. Postoperatively, vigilant monitoring, effective pain control, and prevention of complications are essential. This review synthesizes classification systems, pathophysiology, and the evolution of surgical palliation, while emphasizing anesthetic principles for the perioperative care of patients with TA and Fontan circulation. As survival improves and the population of Fontan patients expands, a nuanced understanding of this physiology is essential for optimizing outcomes across cardiac and non-cardiac surgical settings. Full article

Restrictive cardiomyopathy (RCM) poses a significant challenge in diagnosis, is frequently identified in advanced stages, and has limited therapeutic options, which may lead to adverse cardiovascular outcomes. This narrative review examines the application of artificial intelligence (AI) across key diagnostic modalities and delineates priorities for translational advancement. The discussed diagnostic tools include echocardiography, cardiac magnetic resonance (CMR), electrocardiography (ECG), and electronic health records (EHR). A targeted, non-systematic search of PubMed and Scopus was performed to identify studies focused on model development, validation, or diagnostic accuracy concerning RCM and related infiltrative disorders. The findings suggest that AI can enable earlier detection, standardize imaging protocols, and enhance phenotype-driven management of RCM. Nonetheless, several challenges exist, including limited data access, the absence of external validation, variability across imaging devices and locations, and the imperative for transparent, explainable systems. Key priorities for successful implementation encompass establishing multi-center collaborations, detecting and correcting bias, clinician involvement in deployment, and integrating multimodal data, including imaging, signal data, and -omics. If effectively integrated into clinical practice, AI has the potential to redefine the management of RCM from a condition recognized primarily in its later stages to one characterized by early detection, dynamic risk assessment, and personalized treatment strategies. Full article

Background: Randomized controlled trials (RCTs) are the foundation of evidence-based medicine. However, the rapid pace of technological innovation in cardiovascular surgery and interventional cardiology challenges the traditional RCT framework. Observational studies may hold renewed value in fields where device evolution outpaces the time required to validate clinical outcomes. Methods: This analysis evaluates 270 randomized and non-randomized studies in transcatheter aortic valve implantation (TAVI), one of the most rapidly evolving areas in cardiovascular medicine. The investigation follows two lines: first, mapping the timeline of major RCTs against the introduction of new prosthetic models; second, comparing the prevalence, duration, and role of randomized (R) versus non-randomized (NR) studies. Results: The timeline reveals a persistent misalignment between innovation and validation. New prosthetic models frequently enter the market while RCTs for prior generations are still ongoing. For example, the Sapien 3 valve was approved, while trials on Sapien XT were still enrolling. Similarly, newer Evolut and Acurate models were introduced during ongoing studies of earlier versions, often prompting new studies before existing ones concluded. This leapfrogging effect fragments the evidence base and delays definitive comparisons. In parallel, randomized trials have increased in number and tend to be shorter in duration, reflecting a maturing field. However, non-randomized studies remain crucial for early testing and post-market surveillance. Conclusions: In a field with rapid technological evolution a sort of Zeno’s paradox occurs: long-term validation cannot keep pace with fast innovation, resetting the evidence base with each new model. To overcome this paradox, a paradigm shift in evidence generation is desirable. Future strategies must augment adaptive trial designs, leverage real-world data and use higher-level, advanced analyses to incorporate subjective variables and phenotypic diversity, to reduce confounding factors and speed up data access. Higher-level, integrative evidence analytics could help Achilles walk alongside the tortoise. Full article

Background: Myocardial scar and fibrosis predict adverse cardiac outcomes. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is the reference standard for detection. However, it requires gadolinium-based contrast agents (GBCAs), which may be unsuitable for some patients. Cine balanced steady-state free precession (bSSFP) sequences are universally acquired in routine CMR. They may enable contrast-free scar detection via radiomics analysis. Aim: To systematically review the diagnostic accuracy of cine CMR radiomics for myocardial scar or fibrosis detection. The reference standard is visual or threshold-based LGE. Methods: This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251121699). We searched MEDLINE, Embase, and Cochrane Library up to 8 August 2025. Eligible studies compared cine CMR radiomics with LGE-based assessment in patients with suspected or known scar/fibrosis. Quality was assessed using QUADAS-2 and Radiomics Quality Score (RQS). Results: Five retrospective studies (n = 1484) were included. Two focused on myocardial infarction, two on hypertrophic cardiomyopathy, and one on ischaemic versus dilated cardiomyopathy. Diagnostic performance was good to excellent (AUC 0.74–0.96). Methodological heterogeneity was substantial in reference standards, segmentation, preprocessing, feature selection, and modelling. Only one study used external validation. QUADAS-2 showed high bias risk in patient selection and index test domains. RQS scores were low (30–42%), indicating limited reproducibility and validation. Conclusions: Cine CMR radiomics shows promise as a non-contrast alternative for detecting myocardial scar and fibrosis. However, methodological standardisation, multicentre validation, and prospective studies are needed before clinical adoption. Full article

Background: Heart failure (HF) is common and deadly, affecting over 60 million people worldwide, and it remains a leading cause of hospitalization and post-discharge death. One-year mortality after an acute decompensated HF (ADHF) admission often approaches 40%. Prognostic models are critical for stratifying mortality risk in heart failure (HF) patients. This study compared the performance of the MAGGIC and BCN Bio-HF models in predicting 1-year and 3-year all-cause mortality (ACM) in patients discharged after acute decompensated HF (ADHF). Methods: A retrospective analysis was conducted on 229 patients hospitalized for ADHF at the Clinical University Hospital of Zaragoza. The required variables were extracted from medical records, and ACM risks were calculated using web-based tools. Calibration, discrimination (AUC), and Kaplan–Meier survival analysis and calibration curves assessed risk stratification and alignment with observed outcomes. Reclassification metrics (Net Reclassification Index [NRI], Integrated Discrimination Improvement [IDI]) were used to compare the models’ predictive performances. Results: Both of the models demonstrated robust discrimination for 1-year ACM (AUC: MAGGIC = 0.738, BCN Bio-HF = 0.769) but showed lower performance for 3-year predictions. Calibration was poor, with both models exhibiting significant risk underestimation at the individual level. MAGGIC achieved higher sensitivity (1-year: 0.911; 3-year: 0.685), favoring high-risk patient identification, whereas BCN Bio-HF offered superior specificity (1-year: 0.679; 3-year: 0.746) and a positive prediction value, reducing false positives. BCN Bio-HF showed a significant 12.7% reclassification improvement for 1-year mortality prediction. Conclusions: BCN Bio-HF did not outperform MAGGIC in our cohort. MAGGIC is preferable for the initial high-risk patient identification, requiring more intense short-term follow-up, while BCN Bio-HF’s higher specificity is best-suited to avoid overtreatment. Altogether, the clinical utility of both models was limited in our cohort by severe miscalibration, which may render adequate risk stratification difficult. Full article

Background: Balloon aortic valvuloplasty is a procedure for treating aortic stenosis, as well as being a preliminary step before transcatheter aortic valve implantation. Balloon aortic valvuloplasty requires inserting a balloon catheter into the aortic valve and repeatedly inflating it to widen the narrowed valve. With a wide range of equipment, operators rely on manufacturer data to guide the balloon use during surgery. However, such data can have variations of up to 10%, which can affect the procedures’ efficacy. Methods: In this paper, we report a bench-top proof-of-concept, automated, non-contact optical system that combines a linear delta robot (ROMI) equipped with a bright-field microscopy system, image stitching, and passive autofocusing algorithms to measure the diameters of aortic valvuloplasty balloons inflated using clinically relevant pressures. The system also introduces a laser projection system, enabling the use of passive autofocus algorithms to allow measuring transparent balloons. We evaluate three balloon brands (TRUE Dilatation, Edwards, and Z-MED II) across commonly used sizes and compare the measured diameters with vendor specifications. The developed system allows us to systematically determine the balloons’ diameters with submillimeter-level accuracy. Results: The experimental data shows that the TRUE Dilatation balloon presented the smallest deviations from the manufacturers’ data, even though the 22 and 24 mm balloons exceeded the 1% tolerance by +2.26% (over-inflation) and −1.56% (under-inflation), respectively. The Edwards Lifesciences and Z-MED II balloons presented inflation diameter variations ranging from −5.97% to + 8.81%, which led to a deviation of the specified balloon diameter of 1.76 mm. The standard error value obtained within our measurements revealed that the balloon diameters were consistent despite multiple inflations and were also resilient to repeated inflations up to the rated burst pressure. Conclusions: These results demonstrate the potential of the system presented herein to be adapted for in situ, contactless pre-operative balloon assessment in clinical settings. Full article