Hearts

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

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

Background: Left ventricular myocardial work (MW) derived from non-invasive pressure–strain loops has emerged as a load-adjusted index of contractile performance. Its value for risk stratification in advanced heart failure (HF) remains uncertain. Methods: We retrospectively studied 151 consecutive patients with advanced HF undergoing comprehensive evaluation at our tertiary centre between January 2016 and December 2022. MW parameters—left ventricular global work index (LVGWI), global constructive work (LVGCW), global wasted work (LVGWW) and global work efficiency (LVGWE)—were derived from speckle-tracking echocardiography integrated with brachial blood pressure. Cardiopulmonary exercise testing (CPET), right heart catheterisation (RHC) and biochemical markers were obtained. Patients were stratified according to an LVGWI threshold of 600 mmHg%, identified by receiver operating characteristic (ROC) analysis for predicting the combined end point of cardiovascular mortality or HF hospitalisation. Correlations between MW and traditional indices were assessed, and event-free survival was analysed by Kaplan–Meier curves. Results: LVGWI correlated modestly with pVO₂ (r = 0.35, p = 0.01) and left ventricular ejection fraction (r = 0.42, p < 0.001) and inversely with NT-proBNP (r = −0.30, p = 0.03). LVGWI displayed the largest area under the curve (AUC 0.76 [95% confidence interval 0.65–0.85]) for predicting the combined end point compared with pVO₂ (AUC 0.73) and LVEF (AUC 0.67). Dichotomisation by LVGWI ≤ 600 mmHg% identified a high-risk group (Group A) with worse NYHA class, lower systolic blood pressure and reduced exercise capacity. After a median follow-up of 24 months, Group A exhibited significantly lower event-free survival (log-rank p = 0.02). Multivariable analysis was not performed owing to the limited sample size; therefore, findings should be interpreted with caution. Conclusions: In patients with advanced HF, left ventricular myocardial work, particularly LVGWI, provides incremental prognostic information beyond conventional markers. An LVGWI cut-off of 600 mmHg% derived from ROC analysis identified patients at increased risk of cardiovascular events and may inform timely referral for mechanical circulatory support or transplantation. Larger prospective studies are warranted to confirm these observations and to establish standardised thresholds across vendors. Full article

Background: Congenital heart disease (CHD) is associated with an increased risk of anxiety and depression in adults. However, little is known about the mental health of children and adolescents with CHD. The aim of this study was to assess differences in anxiety and depression symptoms between children and adolescents with CHD and healthy controls. Methods: A total of 232 children and adolescents (age 7–18 years; mean age 13.5 ± 2.7 years, 50.9% female) were enrolled, consisting of 116 patients with CHD and 116 age- and sex-matched healthy controls. Participants were recruited during routine medical examinations at the German Heart Center and Munich schools, respectively. The Beck Anxiety Inventory (BAI) and the Depression Inventory for Youth (BDI-Y) were used to assess anxiety and depression symptoms. Results: The CHD cohort included patients with right heart obstruction (11.2%), left heart obstruction (19.8%), isolated shunts (15.5%), transposition of the great arteries (14.7%), univentricular heart (14.7%), and other defects (24.1%). According to published cut-off values, at least a mild form of anxiety was present in 46.5% CHD patients. However, no significant differences were observed between the CHD group and healthy controls in either the BDI-Y score (CHD: 7.9 ± 7.7 vs. controls: 8.6 ± 8.5; p = 0.569) or the BAI score (CHD: 9.3 ± 8.6 vs. controls: 9.3 ± 10.3; p = 0.429). The complexity of the heart defect was not associated with BAI scores (simple: 5.9 ± 5.7; moderate: 11.1 ± 8.1; complex: 9.3 ± 9.0; p = 0.073) or BDI-Y scores (simple: 7.4 ± 7.5; moderate: 9.0 ± 7.1; complex: 7.0 ± 7.7; p = 0.453). No significant differences in BAI (p = 0.141) or BDI-Y (p = 0.326) scores were found by type of heart defect. Conclusions: Children and adolescents with CHD did not exhibit significantly higher levels of depression or anxiety symptoms compared to healthy controls. Nevertheless, given the increased psychological risk observed in adults with CHD, ongoing mental health monitoring remains important to enable early identification and timely intervention. Further research, particularly through longitudinal studies, is needed to monitor mental health trajectories over time and to identify early predictors of psychological vulnerability in this population. Full article

Background/Objectives: Heart failure (HF) often develops from a prolonged asymptomatic phase where early detection could prevent progression. Pre-heart failure (pre-HF) populations—those with risk factors (Stage A) or subclinical myocardial changes (Stage B)—are critical for intervention. Cardiac magnetic resonance (CMR) with T1 and extracellular volume (ECV) mapping offers a non-invasive approach to detect early myocardial changes in these groups. This systematic review evaluates the role of T1 and ECV mapping in pre-HF populations, focusing on their diagnostic and prognostic utility. Methods: A systematic search of PubMed, EMBASE, and Cochrane was conducted up to April 2025, identifying 17 studies that met inclusion criteria. Data was extracted directly into Excel, and methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) for cohort and cross-sectional studies and AMSTAR-2 for systematic reviews and meta-analyses. A meta-analysis was performed using Review Manager (RevMan) to compare T1 and ECV values between pre-HF and control groups. Results: Studies consistently reported elevated T1 (989.6–1415.41 milliseconds) and ECV (25.7–42.81%) in pre-HF groups compared to controls (T1: 967–1310.63 ms, ECV: 23.5–29.9%). Meta-analysis showed a significant increase in T1 (MD: 27.62 ms, 95% CI: 8.04–47.19, p < 0.006) and ECV (MD: 2.97%, 95% CI: 1.88–4.06, p < 0.00001) in pre-HF groups. RQS scores ranged from 17.2% to 77.8% (mean: 37.9%), and NOS scores ranged from 5 to 8 (mean: 6.2), reflecting variability in study quality. The AMSTAR-2 rating for the systematic review was moderate. Conclusions: T1 and ECV mapping enhance CMR-based detection of early myocardial changes in pre-HF, offering a promising non-invasive approach to predict HF risk. However, variability in study quality, small sample sizes, and methodological inconsistencies limit generalisability. Future research should focus on standardised protocols, prospective designs, and multi-center studies to integrate these techniques into clinical practice, potentially guiding preventive therapies such as SGLT2is and tafamidis. Full article

Background/Objectives: Invasive coronary angiography (ICA) is the gold standard for the diagnosis of coronary artery disease (CAD), with various non-invasive imaging modalities also available. Machine learning (ML) methods are increasingly applied to overcome the limitations of diagnostic imaging by improving accuracy and observer independent performance. Methods: This meta-analysis (PRISMA method) summarizes the evidence for ML-based analyses of coronary imaging data from ICA, coronary computed tomography angiography (CT), and nuclear stress perfusion imaging (SPECT) to predict clinical outcomes and performance for precise diagnosis. We searched for studies from Jan 2012–March 2023. Study-reported c index values and 95% confidence intervals were used. Subgroup analyses separated models by outcome. Combined effect sizes using a random-effects model, test for heterogeneity, and Egger’s test to assess publication bias were considered. Results: In total, 46 studies were included (total subjects = 192,561; events = 31,353), of which 27 had sufficient data. Imaging modalities used were CT (n = 34), ICA (n = 7) and SPECT (n = 5). The most frequent study outcome was detection of stenosis (n = 11). Classic deep neural networks (n = 12) and convolutional neural networks (n = 7) were the most used ML models. Studies aiming to diagnose CAD performed best (0.85; 95% CI: 82, 89); models aiming to predict clinical outcomes performed slightly lower (0.81; 95% CI: 78, 84). The combined c-index was 0.84 (95% CI: 0.81–0.86). Test of heterogeneity showed a high variation among studies (I² = 97.2%). Egger’s test did not indicate publication bias (p = 0.485). Conclusions: The application of ML methods to diagnose CAD and predict clinical outcomes appears promising, although there is lack of standardization across studies. Full article

Background/Objectives: While elevated Lp(a) levels are associated with incident heart failure development, the role of Lp(a) in established heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF) remains unexplored. Methods: We conducted a retrospective analysis of 387 heart failure patients from our institutional database (January 2018–June 2024). Patients were categorized as HFrEF (n = 201) or HFpEF (n = 186) using ICD-10 codes. Categorical variables were compared between heart failure types using the Chi-square test or Fisher’s Exact test, and continuous variables were compared using the two-sample t-test or Wilcoxon rank-sum test, as appropriate. Logistic regression was utilized to assess heart failure type as a function of Lp(a) levels, adjusting for covariates. Spearman correlation assessed relationships between Lp(a) and pro-BNP levels. Results: Despite significant demographic and clinical differences between HFrEF and HFpEF patients, Lp(a) concentrations showed no significant variation between groups. Median Lp(a) levels were 60.9 nmol/dL (IQR: 21.9–136.7) in HFrEF versus 45.0 nmol/dL (IQR: 20.1–109.9) in HFpEF (p = 0.19). After adjusting for demographic and clinical covariates, Lp(a) showed no association with heart failure subtype (OR: 1.001, 95% CI: 0.99–1.004; p = 0.59). Conclusions: Lp(a) levels do not differ significantly between HFrEF and HFpEF phenotypes, suggesting possible shared pathophysiological mechanisms rather than phenotype-specific biomarker properties. These preliminary findings may support unified screening and treatment strategies for elevated Lp(a) across heart failure, pending confirmation in larger studies. Full article