Hearts, Volume 7, Issue 1 (March 2026) – 9 articles

Background: Atherosclerotic cardiovascular disease (ASCVD) is one of the most important causes of morbidity worldwide. Registries show an impressive decline in prevalent ASCVD morbidity over the last years. Whether this decline is due to the improvement in treatment options for ASCVD or whether we are also able to prevent first ASCVD events is still unknown. Methods: A nationally representative real-world data longitudinal prescription (LRx) database (IQVIA) was used over a period from 2008 to 2019. All patients ≥20 years were included from the moment they had been prescribed ASCVD medication. The primary outcome was the standardized incidence of first ASCVD events among men and women of different age groups. The secondary outcome of this study was to identify comorbidities in the year 2019. Results: The prescription data on 296.050 individuals were analyzed, and the results indicate the standardized cumulative incidence (%) among women of first ASCVD event prescriptions. This rise in incidence was most pronounced for young women (women 20–39 yr: + 109.46%). The comorbidity analysis indicated that, e.g., thyroid hormones were significantly more often prescribed in the young patients with a first ASCVD event than in those patients without ASCVD events. Conclusions: Prescriptions for the first ASCVD event increased over a period of 12 years among young women. This study suggests that although ASCVD as a whole has decreased over time, this does not seem to be the case for first ASCVD events and that young women are particularly affected. Full article

Background/Objectives: Transcatheter edge-to-edge repair (TEER) has become an established therapeutic option for selected patients with mitral regurgitation (MR). However, primary (degenerative) and secondary (functional) MR represent distinct disease entities, characterized by different pathophysiological mechanisms, clinical trajectories, and determinants of benefit. This review aims to provide an interventional cardiology-oriented synthesis of TEER, emphasizing the fundamental differences between primary and secondary MR and their implications for patient selection, procedural strategy, and outcome interpretation. Methods: A targeted literature search was performed in PubMed and Embase to identify pivotal randomized trials, registries, guideline documents, and high-quality reviews addressing TEER in MR. The available evidence was synthesized narratively, with a focus on mechanistic insights, TEER-specific imaging and procedural endpoints, and clinically relevant outcomes. Results: In primary MR, TEER functions as a valve-centered therapy, with procedural success primarily determined by anatomical suitability and the balance between durable MR reduction and avoidance of elevated transmitral gradients. In secondary MR, TEER should be considered an adjunctive intervention within a comprehensive heart failure strategy, with benefit dependent on patient phenotype, myocardial substrate, optimization of background therapy, and appropriate timing. Emerging phenotypes, such as atrial functional MR, further challenge traditional classification and highlight the need for mechanism-based selection. Across MR subtypes, residual MR and transmitral gradients emerge as key post-procedural endpoints with differential prognostic implications. Conclusions: TEER represents a phenotype-specific intervention rather than a uniform solution for MR. Recognizing the distinct interventional paradigms of primary and secondary MR is essential to optimizing patient selection, procedural decision-making, and clinical outcomes. Full article

We present the case of a 27-year-old woman diagnosed with Löffler’s endomyocarditis complicated by intraventricular thrombus and cerebral infarction. She was treated with prednisolone and anticoagulation therapy; however, tapering of corticosteroids resulted in recurrence of intraventricular thrombosis. Given disease relapse after medication withdrawal, lifelong anticoagulation was indicated. At 29 years of age, she sought pregnancy counseling. Conception was permitted after stabilization of prednisolone dosage, with a planned switch from a vitamin K antagonist to therapeutic-dose unfractionated heparin during pregnancy. Following disease stabilization, she conceived via artificial insemination. Serial echocardiography at 22 and 34 weeks of gestation demonstrated preserved cardiac function without thrombus recurrence. She delivered a healthy infant by emergency cesarean section at 39 weeks of gestation due to fetal distress. No thrombus recurrence was observed postpartum, and she remained clinically stable during 13 months of follow-up. This represents the case of a successful pregnancy in a woman with a history of recurrent intraventricular thrombosis due to Löffler’s endomyocarditis, highlighting the importance of early diagnosis, sustained immunosuppression, individualized anticoagulation, and multidisciplinary preconception planning. Full article

“Pinch-Off Syndrome,” first described by Hinke, is a mechanical complication of totally implantable central venous catheters inserted via subclavian venous access. It occurs when the catheter is compressed between the clavicle and the first rib. Compression can cause transient catheter obstruction and may result in rupture or even complete resection and embolization of the catheter. In this case report, we describe our experience of percutaneous transvenous removal of an embolized port-a-cath fragment within the right heart chambers following a rupture. We used the “retrieval snare” technique and subsequent reimplantation through internal jugular access. The intervention occurred in the same session and involved a multidisciplinary team for a 55-year-old man in need of adjuvant chemotherapy. Full article

Biventricular Takotsubo cardiomyopathy (TCM) is a rare variant characterized by involvement of both the left and right ventricles. This variant is associated with greater hemodynamic instability and longer hospital stays compared to the isolated left ventricular-only variant. We report the case of a 67-year-old female patient who underwent elective resection of a left adrenal adenoma. While her preoperative and intraoperative courses were uneventful, she developed cardiogenic shock postoperatively, necessitating prolonged intensive care unit (ICU) management and vasopressor support. Further evaluation revealed elevated high-sensitivity troponin levels and reduced ejection fraction on echocardiography (30–35%). Hypokinesis was noted in the apical and mid-ventricular segments of both ventricles. A coronary angiogram performed two months prior to admission showed no significant coronary artery disease. Based on these findings, a diagnosis of biventricular TCM was established. The patient was managed supportively and discharged in stable condition with ongoing therapy, including beta-blockers, renin–angiotensin–aldosterone system inhibitors (RAASis), and statins. Follow-up echocardiography showed resolution of regional wall motion abnormalities. Although rare, biventricular TCM is associated with increased severity and a higher risk of complications. Early recognition and timely management are essential to improve outcomes in affected patients. Full article

The role of cardiac implantable electronic devices (CIEDs), including implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices, in patients supported with left ventricular assist devices (LVADs) remains controversial. Although ICDs clearly reduce the risk of sudden cardiac death (SCD) and improve outcomes in advanced heart failure (HF), their benefit in patients with continuous-flow mechanical circulatory support is less certain. Initial small studies involving LVAD patients, particularly those with older pulsatile devices, suggested that ICDs confer a survival benefit during LVAD support. However, more recent evidence has been inconsistent. Some studies show modest protection against arrhythmic death, whereas others show no improvement in overall mortality. Similarly, CRT does not appear to offer significant additional hemodynamic benefits after LVAD implantation, and current evidence does not strongly support its routine continuation. Device-related complications—including lead failure, infection, electromagnetic interference, and inappropriate shocks—are major clinical concerns that can offset potential benefits. Accordingly, current guidelines recommend maintaining pre-existing ICD or CRT devices in LVAD patients but do not endorse the routine implantation of new devices after LVAD placement. The existing evidence highlights the need for a nuanced and individualized approach to CIED therapy in patients with LVAD. Future research should focus on randomized trials, registry-based analyses, and the exploration of novel technologies such as leadless pacing, subcutaneous ICDs, and advanced programming algorithms. Patient-centered outcomes, particularly quality of life and ethical considerations—such as ICD deactivation in end-of-life scenarios—must be considered in decision-making in this evolving field. Full article

Background: This study investigates the impact of engagement with online health platforms (OHPs), perceived treatment effectiveness, and country of residence on patient attitudes toward atrial fibrillation (AF) treatments, mediated by threat perception and behavioral evaluation within an adapted Health Belief Model (HBM). Methods: A cross-sectional survey conducted in June 2024 included 589 members of two professionally curated OHPs: the AFIP Foundation (Amsterdam, The Netherlands) and StopAfib.org (Decatur, United States). Data were analyzed using Structural Equation Modeling (SEM) to examine both direct and indirect relationships among engagement behaviors, perceived treatment effectiveness, country of residence, and patient attitudes toward AF treatments (PAAT). Results: Results indicate that higher engagement (i.e., frequency of OHP visits and time spent on the OHP) positively predicts more favorable PAAT, whereas the number of content types consumed showed no significant mediating effect via threat perception or behavioral evaluation. Conclusions: By increasing awareness of AF and reinforcing the perceived effectiveness of treatments, OHPs can serve as effective tools for patient education and support. From a managerial perspective, these findings provide actionable insights for platform operators and healthcare stakeholders on which engagement factors most effectively enhance patient attitudes toward treatment options. Full article

Mitral annular disjunction (MAD) is a structural abnormality of the mitral valve increasingly detected with advanced cardiac imaging, particularly cardiac magnetic resonance (CMR). However, the clinical impact of different degrees of disjunction and the lack of standardized measurement criteria remain controversial. This study aimed to describe a series of patients with MAD assessed by CMR and to discuss, in the context of current literature, potential cut-off values that may distinguish physiological from pathological MAD. We retrospectively identified all CMR examinations performed at our institution over a 6-month period in which MAD was visible in at least two cine steady-state free precession (SSFP) projections. For each patient, we recorded MAD extent, presence of mitral valve prolapse/regurgitation, late gadolinium enhancement (LGE) pattern, and main clinical presentation. Nine patients (mean age 57 years; 5 men) were included. Larger MAD distances (>4 mm) were frequently associated with non-ischemic LGE in the basal lateral wall and with valvular abnormalities, whereas smaller disjunctions (≤3 mm) were often observed in patients without significant structural disease. Non-ischemic LGE was present in 6/9 patients, all with MAD > 5 mm. These observations, together with published data, support the hypothesis that small degrees of MAD may represent a frequent anatomical variant, while more extensive disjunction, especially when associated with fibrosis, may indicate a pathological substrate for arrhythmias. Standardized CMR-based criteria and validated MAD cut-off values are needed to improve risk stratification and to incorporate MAD assessment into routine clinical practice. Full article

Background: Prosthesis patient mismatch (PPM) is associated with poor outcomes in literature. Prevention of mismatch is crucial in aortic valve replacement, yet there is no current consensus on preventative strategies. Objectives: This study introduces a novel clinical framework, nomenclature, and algorithm for contemporary Heart Team practice, providing a systematic approach for a tailored surgical strategy to anticipate and prevent mismatch. Methods: This was a single-center observational study performing a descriptive analysis of an evolving practice on 100 consecutive patients operated for aortic valve stenosis between 2020 and 2024. A step-by-step No-Mismatch algorithm was designed for the Heart Team to triage, discuss, and decide the surgical strategy prior to the procedure, identifying patients at risk of mismatch, and guiding the surgeon’s plan to prevent PPM and consider a Lifetime Valve Strategy. Results: The algorithm identified 26% of patients at risk of mismatch requiring a No-Mismatch strategy, and 20% at risk of small valve implantation requiring a Lifetime Valve Strategy. This cohort included 51 urgent cases. Valve pathology included 35% congenital, 59% degenerative, 1% rheumatic, and 5% redo operations. Valve implant type: 82% biological, including 29% rapid deployment valve (RDV), and 18% mechanical; 20% of patients required aortic root enlargements (AREs). Pre-, intra-, and post-operative data are presented. Mortality occurred at 1%. All degrees of mismatch were prevented. Conclusions: The surgeon was able to predict mismatch and elected either ARE, RDV, or a mechanical valve as required. Patient selection and a No-Mismatch Heart Team approach are essential to provide a tailored strategy for aortic valve interventions. Full article