Cardiovascular Medicine doi: 10.3390/cardiovascmed29020016

Authors: Vincenzo Paragliola Emanuele Chiarazzo Andrea Giovanni Parato Marcello Marchetta Stefano Sasso Giuseppe Massimo Sangiorgi Andrea Natale Mario Iannaccone

Percutaneous left atrial appendage occlusion (LAAO) has become an established alternative to long-term oral anticoagulation for stroke prevention in patients with atrial fibrillation, with expanding indications beyond those with absolute contraindications to anticoagulation. Alongside its broader adoption, device-related thrombus (DRT) has emerged as a clinically relevant complication that directly compromises the protective intent of LAAO. This comprehensive narrative review synthesizes contemporary evidence on the incidence, mechanisms, predictors, clinical impact, and management of DRT. DRT is a multifactorial phenomenon that carries an annual incidence ranging from 1.75% to almost 5%, resulting from the interplay between post-implant flow dynamics, device engineering, endothelialization processes, procedural factors, and patient-specific prothrombotic features. Accumulating data from observational registries links DRT to increased risks of ischemic stroke, systemic embolism, major adverse cardiovascular events (MACE), and mortality. Although evidence is growing, optimal management regimens for both the prevention and treatment of DRT remain undefined. Moreover, a lack of standardization also affects diagnosis and imaging surveillance, mainly performed by transesophageal echocardiography or cardiac computed tomography. By integrating mechanistic insights, clinical predictors, device-specific considerations, and therapeutic evidence, this review highlights current knowledge gaps and proposes practical considerations to inform individualized risk stratification, surveillance, and management of DRT in contemporary LAAO practice.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29020015

Authors: Mitko Mladenov Vadim Mitrokhin Stanislav Schileyko Anastasija Rodina Alexandra Zolotareva Valentin Zolotarev Natalia Bocharnikova Dmitry Kaminer Emilija Antova Radoslav Stojchevski Slavica Josifovska Dimiter Avtanski Andre Kamkin Nikola Hadzi-Petrushev

Kv11.1 (hERG1) channels, encoded by KCNH2, mediate the rapid delayed rectifier potassium current (IKr) crucial for cardiac repolarization. Disruptions, via mutations or antiarrhythmic drugs like dofetilide cause severe arrhythmogenic disorders, including Long QT Syndrome Type 2 (LQT2), Brugada Syndrome (BrS), and Torsades de Pointes (TdP). While Kv11.1’s role in channelopathies and drug-induced arrhythmias is established, understanding its complex regulation and therapeutic targeting remains a challenge. This review synthesizes the structural, functional, and regulatory aspects of Kv11.1 channels and their clinical implications. Recent studies using iPSC-derived cardiomyocytes highlight regulation by PI3K/Akt, PKC, and PKA signaling via phosphorylation (Ser283, Ser890) and interactions with proteins like 14-3-3. Beyond electrophysiology, Kv11.1 influences pathological hypertrophy and non-cardiac functions including insulin secretion. Pharmacological efforts focus on activators to shorten action potential duration and suppress TdP, and blockers with overdose risks. Mutation heterogeneity, exemplified by trafficking impairment (G785D) in LQT2 and gain-of-function (R397C) in BrS, complicates precision therapy. Clinically, systematic risk stratification using electrocardiographic parameters and genotype-specific approaches enables personalized management. Beta-blockers remain first-line therapy for LQTS2, while rigorous avoidance of QT-prolonging medications and electrolyte monitoring form the cornerstones of preventive care. Advancing Kv11.1-targeted therapies with approaches like CRISPR-Cas9 and pharmacological chaperones (e.g., lumacaftor) holds promise for personalized treatments, ultimately reducing arrhythmic events and sudden cardiac death.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29020014

Authors: Ferrazzo Giuseppe Giulia Laterra Giampiero Avruscio Carmen Tirrito Sonia Ragazzo Orazio Strazzieri Lorenzo Scalia Giampiero Vizzari Antonio Micari Paolo Mazzone Giovanni Ruscica Giorgio Sacchetta Marco Contarini Marco Barbanti

The use of excimer laser atherectomy (ELA) has significantly evolved from the mid-1990s to the present, showing substantial improvements in both coronary and peripheral artery interventions. Initially associated with suboptimal outcomes due to low-energy settings and limited techniques, advancements such as high-energy delivery, improved catheter designs, contrast injection protocols, and refined procedural approaches have greatly enhanced clinical efficacy. In coronary applications, ELA has become an established technique for treating intracoronary thrombus, under-expanded stents, in-stent restenosis, and heavily calcified lesions, offering favorable procedural and clinical outcomes with low complication rates. The excimer laser operates through photochemical, photothermal, and photomechanical mechanisms, enabling precise plaque ablation with minimal collateral damage. In peripheral interventions, especially in critical limb ischemia (CLI), ELA has emerged as a viable option for complex, non-crossable lesions and in-stent restenosis, demonstrating high technical success, improved patency, and promising limb salvage rates. Multiple clinical trials and registries support the safety and effectiveness of ELA, particularly in high-risk patient populations. This narrative review summarizes current evidence and practical considerations on the use of excimer laser atherectomy in coronary and peripheral interventions.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29020013

Authors: Alim Namitokov Irina Gilevich Olga Malyarevskaya Natalia Iraklionova Karina Karabakhtsieva Dana Namitokova

Background: Sortilin (SORT1), linked to the 1p13.3 coronary risk locus, is implicated in lipid trafficking and atherogenesis; however, clinical studies of circulating SORT1 have produced inconsistent results. We evaluated whether circulating SORT1 is associated with angiographic burden and lesion localization in patients with premature or early clinical debut coronary atherosclerosis. Methods: This single-center, cross-sectional study analyzed a dataset collected from January to May 2023. Participants were classified as coronary atherosclerosis cases if the dataset contained an age of clinical debut of clinically significant atherosclerosis (n = 101). Controls had no recorded debut age and 0% stenosis in all assessed coronary segments (n = 27). Blood was collected in clot activator tubes; serum was stored at −40 °C until analysis. SORT1 (ng/mL) was measured using an Aviscera Bioscience ELISA. Coronary stenoses were recorded as percent diameter stenosis for left main (LM), proximal/mid/distal LAD, proximal/mid/distal LCx, and proximal/mid/distal RCA. Burden metrics included the number of segments with any stenosis (>0%), the number of obstructive segments (≥50%), the number of diseased vessels, and maximum stenosis. The prespecified primary endpoint was obstructive proximal LAD stenosis (≥50%). Nonparametric tests and Spearman correlations were used. Logistic regression evaluated the association between log2-transformed SORT1 and proximal LAD obstruction, adjusted for age, sex, LDL-C, statin use, and smoking/diabetes/hypertension durations. Results: SORT1 was higher in cases than controls (8.60 [2.60–17.10] vs. 2.30 [1.25–10.65] ng/mL; p = 0.0058). Within cases, SORT1 did not correlate with global angiographic burden (any-stenosis segments: ρ = −0.066, p = 0.513; obstructive segments: ρ = −0.060, p = 0.552; diseased vessels: ρ = −0.045, p = 0.652; maximum stenosis: ρ = −0.084, p = 0.403). Obstructive proximal LAD stenosis occurred in 44/101 (43.6%) and was associated with higher SORT1 (12.25 [4.18–17.45] vs. 4.10 [2.20–11.60] ng/mL; p = 0.0093). Each doubling of SORT1 was independently associated with proximal LAD obstruction (adjusted OR 1.48, 95% CI 1.12–1.95; p = 0.005). Conclusions: In this cross-sectional cohort, circulating SORT1 was associated with obstructive proximal LAD stenosis but not with global angiographic burden metrics. These findings are hypothesis-generating and warrant validation in independent cohorts with standardized preanalytics and prospective designs to assess temporal relationships and clinical utility.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010012

Authors: Gamze Yeter Arslan Erkan Baysal

Background: Atrial fibrillation (AF) is frequently encountered in patients presenting with acute coronary syndrome (ACS); however, its clinical significance beyond being a simple rhythm disturbance remains debated. We hypothesized that AF at presentation may be associated with a high-risk clinical profile characterized by hemodynamic instability and increased inflammatory and ischemic activity. Methods: This single-center, retrospective observational study included consecutive adult patients with acute coronary syndrome admitted to a tertiary cardiology center between January 2022 and December 2024. Patients were classified into two groups according to cardiac rhythm at presentation: AF and sinus rhythm. Baseline demographic characteristics, hemodynamic parameters, laboratory biomarkers, validated risk scores, and revascularization strategies were compared between groups. Multivariable logistic regression analysis was performed to evaluate whether AF was independently associated with a high-risk presentation, primarily defined by elevated GRACE risk score, reduced left ventricular ejection fraction, and increased inflammatory markers. Results: A total of 158 patients were included, of whom 50 (31.6%) presented with atrial fibrillation (mean age 71.2 ± 11.4 years, 46% female). Compared with patients in sinus rhythm, those with AF had significantly higher GRACE risk scores, lower left ventricular ejection fraction, faster heart rate, and higher white blood cell counts and peak high-sensitivity troponin levels. These associations remained significant after multivariable adjustment. Patients with AF also showed a numerically higher prevalence of severe angina at presentation. Conclusions: In patients presenting with ACS, atrial fibrillation is associated with a high-risk hemodynamic profile accompanied by increased inflammatory and ischemic activity. Rather than being an incidental finding, AF may represent a clinically relevant marker of acute cardiovascular stress and may contribute to early risk stratification in this setting.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010011

Authors: Firat Erdogan Luca Vercelli Mehdi Madanchi Nicola von Rotz Florim Cuculi Matthias Bossard

Background: Spontaneous recanalized coronary thrombus (SRCT) is an uncommon and often underrecognized coronary pathology that may be angiographically subtle despite having functional significance. Optical coherence tomography (OCT) enables accurate diagnosis and treatment planning. However, optimal treatment strategies remain incompletely defined. Materials and Methods: A 55-year-old man presenting with severe exertional dyspnea, atypical chest pain episodes, and abnormal stress echocardiography underwent invasive coronary assessment with angiography, fractional flow reserve (FFR), and OCT. An SRCT of the left anterior descending artery (LAD) was identified and treated using OCT-guided lesion preparation followed by sirolimus-coated drug-coated-balloon (DCB) angioplasty. Results: Although there was only moderate angiographic disease, a functional assessment confirmed significant ischemia. OCT revealed a characteristic honeycomb morphology. Post-procedural OCT demonstrated satisfactory lumen gain, with preserved vessel integrity. Follow-up imaging showed vessel-healing and late lumen enlargement, and the patient remained asymptomatic. Conclusion: OCT-guided drug-coated-balloon angioplasty may be an effective “leave-nothing-behind” strategy for selected SRCT lesions, highlighting the importance of intracoronary imaging beyond angiography.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010010

Authors: Sangmin Lee Bora Kim Soyeon Kim Soohyun Kim Rahel Kesterke Barbara E. Stähli Alessandro Candreva

Artificial intelligence-based quantitative coronary angiography (AI-QCA) has recently emerged as a promising tool for real-time lesion assessment in cardiology. We aimed to validate a novel AI-QCA software, trained on a Korean dataset, in a European cohort. We analyzed 556 lesions from 252 subjects in two European datasets. The AI-QCA system performed automated vessel segmentation and measurements of minimum lumen diameter, proximal and distal reference diameters, percent diameter stenosis (%DS) and lesion length. The performance of AI-QCA was assessed using both automated and manual frame selection methods, with all measurements validated against expert manual QCA. AI-QCA achieved a lesion detection rate of 86.2% in automated frame selection. AI-QCA and manual QCA showed strong agreement (Pearson’s r > 0.90, R2 > 0.8 for all QCA measurements). For %DS categorization (<50%, 50% to <70%, and ≥70%), 433 lesions were classified into the same category by both methods, with a weighted κ of 0.832 (95% CI, 0.743–0.922). Vessel segmentation achieved a mean DSC of 0.953. This study validated the performance of AI-QCA using a European dataset and demonstrated high lesion detection rate and its strong agreement with manual QCA, which supports its applicability for real-time clinical decision-making during percutaneous coronary intervention.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010009

Authors: Ella Dunsmore Alda Aleksi Debra Bosley Jeffrey Cao Andrew Daly Jonathan Howlett Louis Kolman Lyndsay Litwin Sasha Lupichuk Sudhir Nishtala Roger Y. Tsang Robert J. H. Miller

Background: Cancer and cardiovascular disease are the two leading causes of death in Canada. Although treatments have improved tremendously across the years, interventions such as radiotherapy and chemotherapies are known to have negative impacts on cardiovascular health and can lead to death if not treated in time. Using a retrospective approach, we determined factors associated with cancer therapy-related cardiac dysfunction (CTRCD). Methods: Patients followed through a dedicated Cardio-Oncology clinic with comprehensive screening for CTRCD were identified. CTRCD was defined as a drop in left ventricular ejection fraction of at least 10% to a value lower than 53%. We performed multivariable logistic regression to determine factors associated with CTRCD. Results: In total, 2460 patients with cancer were identified from clinical records—919 had breast cancer, 758 had hematologic malignancies, and 783 had other cancer types. Patients with breast cancer and hematologic malignancies were more likely to experience CTRCD, with odds ratios (ORs) of 2.10 (p = 0.059) and 1.96 (p = 0.047), respectively. Anthracycline and trastuzumab use were independently associated with CTRCD, with ORs of 1.98 (p = 0.002) and 3.19 (p < 0.001), respectively. In hematologic malignancy patients, hypertension (OR = 2.18, p = 0.047) and diabetes (OR = 2.31, p = 0.036) were also significant predictors of CTRCD. Conclusions: We confirmed the importance of anthracycline, trastuzumab, and radiation in the development of CTRCD. However, among patients with hematologic malignancies, traditional cardiovascular risk factors are also associated with CTRCD. This information could help physicians personalize CTRCD surveillance strategies.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010008

Authors: Catarina Gregório Ana Rita Figueiredo Inês Pinto João Ribeiro Susana M. Fernandes Doroteia Silva

Background and Aim: New-onset atrial fibrillation (NOAF) is a common condition in critically ill patients, yet the evidence on optimal NOAF management and outcomes is limited. This study evaluates the impact of management strategies on short- and long-term outcomes in patients who develop NOAF during their intensive care unit (ICU) stay. Methods: A retrospective, single-centre study was conducted of all patients with NOAF admitted in a multidisciplinary ICU between 2020 and 2023. The clinical characteristics and outcomes of the patients were collected. The endpoints included the characterisation of management strategies, short-term outcomes during ICU stays (including atrial fibrillation [AF] recurrence), and long-term outcomes after discharge (including AF recurrence and a composite of death or cardiovascular hospitalisation). Results: A total of 160 patients developed NOAF (mean age 69.5 ± 11.8 years; 63% male). Most had cardiovascular comorbidities and high illness severity, with frequent mechanical ventilation (87%) and vasopressor (89%) use. Rhythm-control strategies—predominantly amiodarone—were associated with lower in-hospital AF recurrence (OR 0.28, p = 0.044) and a numerical reduction in post-discharge recurrence. Anticoagulation was initiated in 45% of patients and continued at discharge in 44%, without major bleeding. ICU and in-hospital mortality were 33% and 43%, respectively. During a median follow-up of 10 (range 0–56) months, post-ICU discharge AF recurrence occurred in 34% of patients initially discharged in sinus rhythm. Anticoagulation at discharge was not associated with recurrence, while rhythm control in the ICU and absence of in-hospital recurrence strongly predicted reduced post-discharge recurrence (p < 0.001). Nine patients required readmission, mainly for heart failure or ischaemic stroke. The composite long-term outcome occurred in 24 patients (27%). Conclusions: Post-ICU discharge AF recurrence after NOAF was common. Early rhythm-control strategies were associated with lower in-hospital and post-discharge AF recurrence, and individualised anticoagulation appeared safe in this observational cohort. These findings support proactive post-ICU monitoring and risk-adapted management strategies.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010007

Authors: Lucia Ilaria Birtolo Antonio Lattanzio Vincenzo Myftari Gianluca Di Pietro Giovanna Manzi Bartolomeo Fabrizio Lovero Margherita Pugliese Annalisa Caputo Gianmarco Scoccia Maria Antonella Zingaropoli Nicola Galea Cristina Chimenti Paolo Severino Viviana Maestrini Massimo Mancone Roberto Badagliacca Guido Antonelli Carmine Dario Vizza

Background: Myocarditis is a potentially life-threatening inflammation of the myocardium that can be triggered by viral infections, including influenza. While corticosteroids have historically been used with caution in viral myocarditis due to concerns over impaired viral clearance, recent insights—particularly those emerging from the COVID-19 pandemic—suggest that early, moderate-dose corticosteroid therapy may offer clinical benefits in selected inflammatory cardiac syndromes. This study aimed to assess the incidence and clinical features, as well as short-term outcomes of influenza-related myocarditis and/or pericarditis. Methods: A retrospective, observational study was conducted, including all consecutive patients diagnosed with acute myocarditis and/or pericarditis between December 2024 and March 2025 who presented with chest pain or dyspnea and had a confirmed Influenza A (H1N1) infection. The diagnostic evaluation included cardiac biomarkers, ECG, TTE, and cardiovascular magnetic resonance (CMR). All patients were monitored during a three-month follow-up period. Results: Of 281 patients with laboratory-confirmed H1N1 infection, six (2%) were diagnosed with myocarditis and/or pericarditis. All patients diagnosed with myocarditis received corticosteroid therapy and an antiviral drug (oseltamivir). CMR confirmed the diagnosis in all cases of inflammatory cardiomyopathy. At 30 days, median LVEF improved from 49% to 58%. No deaths or rehospitalizations were reported. Conclusions: Influenza-related myocarditis and/or pericarditis are relatively uncommon, occurring in approximately 2% of cases. When they occur, they are primarily associated with an uncomplicated clinical course and with favourable short-term outcomes, including a rapid recovery of left ventricular function and the absence of adverse events at three-month follow-up.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010006

Authors: Krishna Patel Chris Sani Asher Gorantla Varshitha T. Panduranga Usaid Raqeeb Adam Budzikowski

Cardiac disturbances are well-recognized in traumatic brain injury (TBI), but most involve supraventricular arrhythmias or repolarization abnormalities, while sinus arrest is rarely reported. We present a case of a 37-year-old man who developed recurrent, prolonged sinus arrest following severe TBI. He arrived intubated for airway protection after an assault, and imaging demonstrated an acute, depressed, comminuted right temporoparietal skull fracture scattered subarachnoid hemorrhage, and bilateral humeral head fractures with posterior shoulder subluxation. After craniotomy and placement of an external ventricular drain (EVD) for intracranial pressure (ICP) monitoring, the patient experienced multiple spontaneous sinus arrest episodes lasting up to 15 s despite normal metabolic, electrolyte, and toxicology evaluations. A transvenous pacemaker (TVP) was inserted to maintain adequate cardiac output and cerebral perfusion. As ICP improved, the sinus arrests resolved and the TVP was removed. This case highlights a rare neurocardiac manifestation of TBI, demonstrating that elevated ICP can precipitate profound conduction disturbances that may require temporary pacing to manage hemodynamics and prevent secondary brain injury.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010005

Authors: Steven S. Coughlin Nikul Parikh Ashley Oh Biplab Datta Marlo Vernon Jennifer Sullivan

Because CKMS was only proposed by the American Heart Association in 2023, there has been a paucity of information about the distribution and determinants of the syndrome across population groups. We reviewed published studies of the prevalence of CKMS in the U.S. and other countries and obtained new estimates of the prevalence of this syndrome among U.S. adults by birth decade and sociodemographic attributes using 2019, 2021, and 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. The results of this study indicate that CKMS is widespread in the general U.S. population, especially among older cohorts born before 1940 and during the 1940s, 1950s, and 1960s. Except for the three younger cohorts, born in the 1980s, 1990s, and 2000 or later, the prevalence of CKMS stage 4 was significantly higher among males than in females. Among those born between the 1950s and 1990s, the prevalence was significantly higher among non-Hispanic Blacks compared to their non-Hispanic white counterparts. Across all birth decades, prevalence of CKMS stage 4 was generally higher among those without a college degree, from a low-income household, and residing in rural areas. These prevalence rate estimates will further our understanding of the burden and unique needs of different population groups in improving cardiovascular–kidney–metabolic health across the life course.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010004

Authors: Matthew Nho Ayushi Mittal Ahmed Abdel-Latif Anand Prakash Singh

Bortezomib is a 26S proteasome inhibitor used to treat multiple myeloma and systemic amyloidosis. While effective in prolonging survival, bortezomib has been increasingly associated with cardiovascular adverse events (CVAEs), including cardiac failure and arrhythmias, yet a comprehensive post-marketing cardiac safety profile remains incompletely defined. We analyzed cardiovascular adverse events reported between May 2003 and May 2025 using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) via the OpenVigil 2.1 platform. Disproportionality analysis was performed using reporting odds ratios (RORs) with 95% confidence intervals (CIs). Among over 9 million drug-related adverse events in FAERS, 552 cardiac events were linked to bortezomib. Several cardiac outcomes, including atrial flutter, left ventricular dysfunction, cardiac failure, cardiomyopathy, atrial fibrillation, right ventricular failure, myocarditis, and supraventricular tachycardia, demonstrated elevated disproportionality signals. Separately, cardiac amyloidosis exhibited the highest disproportionality signal (ROR: 35.58; 95% CI: 28.16–44.95), a finding that reflects underlying disease severity rather than treatment-emergent cardiotoxicity. Cardiac failure accounted for the greatest number of hospitalizations (301) and deaths (208), followed by atrial fibrillation and cardiac amyloidosis. Older adults (≥65 years) and patients with amyloidosis or multiple myeloma were the most vulnerable populations. Overall, bortezomib was associated with serious cardiac adverse events, particularly cardiac failure and atrial arrhythmias, underscoring the need for routine cardiovascular risk assessment and proactive monitoring in high-risk patients.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010003

Authors: Carlos Mestres

This is the summary of the 2023 SGHC Senning Lecture, in which surgical developments and the components of education and training in cardiovascular surgery are discussed. Special emphasis is placed on the problems, challenges, education models, and the dynamics of education and training for the benefit of the trainees and, ultimately, the patients.

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010002

Authors: Peter Matt

What a remarkable first three months it has been for Cardiovascular Medicine! [...]

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010001

Authors: Fulvio Cacciapuoti Angela Iannuzzi Ferdinando Fusco Alessandro De Masi Flavia Casolaro Angelo Sasso

Acute extracardiac conditions can occasionally produce electrocardiographic abnormalities that closely mimic acute coronary occlusion, posing a diagnostic challenge and increasing the risk of unnecessary activation of invasive cardiac pathways. Severe gastrointestinal distension, although uncommon, is a recognized cause of transient ST-segment elevation due to mechanical displacement of the heart, autonomic imbalance, and abrupt changes in ventricular loading conditions. These alterations may be particularly misleading in patients with chronic regional wall motion abnormalities, in whom new ECG changes risk being misinterpreted as recurrent ischemia. We report the case of a 68-year-old man with a history of inferior myocardial infarction who presented with marked abdominal distension secondary to a closed-loop small bowel obstruction. Despite the absence of chest pain, his ECG showed significant anterolateral ST-segment elevation. High-sensitivity troponin I remained negative, and transthoracic echocardiography demonstrated preserved anterior and apical motion, chronic inferior akinesia, and unchanged global longitudinal strain. Following nasogastric decompression, the ST-segment normalized completely within fifteen minutes. Subsequent imaging confirmed a closed-loop volvulus requiring urgent surgical intervention, with full bowel viability preserved. This case underscores the importance of integrating clinical context, biomarkers, and rapid echocardiographic assessment when evaluating ST-segment elevation, helping avoid unnecessary coronary angiography in the presence of extracardiac causes.

Cardiovascular Medicine doi: 10.3390/cardiovascmed28010006

Authors: Selma T. Cook Malica Cook

Long QT associated with pheochromocytoma is rare but clinically significant. A 43-year-old woman presented with palpitations, chest pain, and recurrent syncope. ECG showed ST-segment elevation, while coronary angiography revealed normal arteries but Takotsubo-like left ventricular dysfunction. Hypertension and tachycardia raised suspicion for pheochromocytoma, later confirmed by imaging and biochemical tests. The patient exhibited QT prolongation (QTc 570 ms) in parallel with Takotsubo episodes. Following adrenalectomy, both QT duration and ventricular function normalized. The European Society of Cardiology now classifies pheochromocytoma-induced cardiomyopathy within the Takotsubo spectrum. Early recognition is crucial due to the risk of sudden cardiac death.

Cardiovascular Medicine doi: 10.3390/cardiovascmed28010005

Authors: Oscar Jesus Leal-Ramos Luis Felipe Arias-Ruiz José Miguel Huerta-Velázquez José Pablo Lamoreaux-Aguayo Dalton Butcher Asela Berenice López-Cuellar Karina Iveth Orozco-Jiménez Olivia Torres-Bugarín

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for managing inflammation, but they are associated with gastrointestinal and renal toxicity upon long-term use. Selective cyclooxygenase-2 (COX-2) inhibitors, or coxibs, were developed to avoid these adverse effects while maintaining anti-inflammatory efficacy. However, accumulating evidence indicates that coxibs may increase the risk of cardiovascular complications. This review explores the pathophysiological mechanisms underlying adverse cardiovascular effects in patients treated with COX-2 inhibitors. These mechanisms include an imbalance between prothrombotic and antithrombotic factors, an altered endocannabinoid metabolism, and downregulation of PPARδ, contributing to thrombosis. Additionally, COX-2 inhibition disrupts renal prostaglandin synthesis, particularly PGE2 and prostacyclins, reduces EP4 receptor expression in macrophages, promotes chemotaxis, and elevates arterial pressure via increased iNOS, ADMA, and L-NMMA activity. At the molecular level, genetic polymorphisms, matrix metalloproteinases, signaling cross-talk, and direct cardiomyocyte injury are implicated. Collectively, these alterations promote a prothrombotic state, fluid retention, enhanced vasoconstriction, impaired vasodilation, myocardial injury, cell death, and cardiac fibrosis. Despite these risks, coxibs are often prescribed without adequate cardiovascular assessment, particularly in patients with pre-existing cardiovascular risk factors. Greater awareness of these mechanisms is essential to optimize the benefit–risk ratio in clinical decision-making involving selective COX-2 inhibitors.

Cardiovascular Medicine doi: 10.3390/cardiovascmed28010004

Authors: Ruta Ratyte Mirjam Löffel Christoph Ado Kaiser

Transcatheter aortic valve implantation is rapidly emerging as the leading treatment for severe aortic valve stenosis, especially in elderly and high-risk or inoperable patients. Prosthetic embolism is a rare but serious complication of transcatheter aortic valve replacement. Patients who develop prosthetic embolism are at increased risk of mortality and morbidity. These include stroke and aortic dissection associated with manipulation of the prosthesis in the ascending aorta. Treatment of valve embolisms into the aorta may differ depending on the type of valve; however, it traditionally relies on repositioning the valve to an appropriate position. To date, there are no established pharmaceutical guidelines for the management of patients with valve prosthesis embolization. We present a case report of the implantation of a second aortic valve prosthesis after periprocedural embolization of the first transcatheter valve, resulting in residual floating in the ascending aorta and following treatment with oral anticoagulation as well as single antiplatelet therapy due to the increased risk of thrombogenesis. This case report provides an example of the management of a transcatheter valve embolization with residual floating and highlights the need for further studies to address this issue.

Cardiovascular Medicine doi: 10.3390/cardiovascmed28010003

Authors: Víctor Juan Vera-Ponce Lupita Ana Maria Valladolid-Sandoval Jhosmer Ballena-Caicedo Fiorella E. Zuzunaga-Montoya

Arterial hypertension (HTN) is a global public health problem with three distinct subtypes: isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systodiastolic hypertension (SDH), each with unique clinical implications. This systematic review and meta-analysis aimed to determine the global prevalence of ISH, IDH, and SDH and their variability. Following PRISMA guidelines, a search was conducted in SCOPUS, Web of Science, PubMed, and EMBASE. A random-effects model with the Freeman-Tukey transformation was used for the meta-analysis, and a meta-regression was performed to assess temporal trends. Twenty-seven studies from five continents were included, revealing pooled global prevalence rates of 10.72% for ISH, 5.07% for IDH, and 11.71% for SDH. Extreme heterogeneity was observed (I2 = 100%), reflecting substantial methodological diversity. The meta-regression suggested an increasing trend for ISH over time, while non-significant decreasing trends were observed for IDH and SDH. In conclusion, all three HTN subtypes show clinically relevant prevalences, with ISH and SDH being nearly twice as common as IDH. The high heterogeneity underscores the urgent need for research standardization, and these findings highlight the importance of differentiating subtypes for more effective population-level screening and public health planning.

Cardiovascular Medicine doi: 10.3390/cardiovascmed28010002

Authors: Peter Matt

It is with great pride and enthusiasm that we announce the relaunch of Cardiovascular Medicine, a journal with a longstanding tradition in the Swiss and international cardiology community [...]

Cardiovascular Medicine doi: 10.3390/cardiovascmed28010001

Authors: Carla Aloè

Cardiovascular Medicine was launched in 1998 under the title Kardiovaskuläre Medizin, publishing articles in German, French, and English [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.1239215883

Authors: Peter Matt

The latest issue of Cardiovascular Medicine deals with various topics on cardiovascular diseases, again with a focus on sex-specific subjects [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1379478206

Authors: Flavio Giuseppe Biccirè Lorenz Räber

Over the past few years, large observational trials have confirmed the consistent association between vulnerable plaques identified by intracoronary imaging and major cardiovascular events in patients with coronary artery disease. Lipid-lowering therapies have reduced the occurrence of cardiovascular events in these patients; however, the exact pathophysiological mechanisms behind their clinical benefits have remained underexplored. Intracoronary imaging modalities, including intravascular ultrasonography, near-infrared spectroscopy, and optical coherence tomography have provided fundamental insight into the biological plausibility of these clinical results. Imaging trials employing serial intravascular ultrasonography have suggested that lipid-lowering therapies can either slow disease progression or promote plaque regression, depending on the degree of lipid lowering achieved. More recently, new randomized trials have added significant insights on the additional beneficial effects of achieving very low low-density lipoprotein cholesterol levels on high-risk plaque features, including fibrous cap thickness, lipid accumulation, and inflammatory cell accumulations. This literature review aimed to summarize current evidence on the clinical usefulness of plaque characterization using contemporary intracoronary imaging and the effects of high-intensity lipid-lowering therapies on vulnerable plaque features.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1387770349

Authors: Daniel Wendt Efthymios Deliargyris Stephan Geidel

The incidence of severe bleeding in patients treated with dual antiplatelet therapy, including the new P2Y12 inhibitors or new direct oral anticoagulants, who are undergoing urgent cardiac surgery is very high. Novel strategies, including the removal of antithrombotics via intraoperative hemoadsorption, have shown promising results, which are summarized in this holistic review. Overall, current evidence supports antithrombotic removal via hemoadsorption as a potential new therapy in the management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiopulmonary bypass-assisted cardiac surgery.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1416403729

Authors: Fu Guan Firat Duru Urs Eriksson

The interpretation of the surface electrocardiogram and intracardiac recordings is key for the appropriate diagnosis and interventional treatment of cardiac arrhythmias. This report describes a patient with both a focal atrial tachycardia (AT) and an atypical atrioventricular-nodal reentrant tachycardia that were repeatedly induced and terminated by atrial ectopic beats. Radiofrequency ablation of the slow pathway, as well as targeted ablation of the specific AT focus effectively eliminated both tachycardias.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1443408577

Authors: John Fanourgiakis

Cardiac arrhythmias are a major cause of morbidity and mortality. Cardiac rhythm management devices (CRMDs) are used to diagnose and treat heart rhythm abnormalities. Many prospective randomized trials over the past decade have established the efficacy of CRMD therapy in reducing all-cause mortality and improving the quality of life. The manufacturer of every device provides its longevity in its technical characteristics, which are, as studies show, shorter in practice. Patients are concerned about the replacement procedure due to the risk of the procedure and other socioeconomic reasons. The longer the longevity of the devices, the better for the patients, the payers, the doctors and the health care systems. Given the recently redefined term of health technology assessment on a European level, a new regulatory framework has been proposed. Its intention is that, across different healthcare systems, the upfront costs and the reimbursement costs of these devices should be proportional to their longevity.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1486643913

Authors: Andreas Y. Andreou Elena Leonidou Andreas Tryfonos

We present a challenging case of a patient with an isolated right ventricular myocardial infarction (iRVMI) caused by the spontaneous occlusion of a right ventricular branch mimicking an anterior myocardial infarction on the electrocardiogram. A high index of suspicion is required to diagnose an iRVMI because the electrocardiogram may be misleading.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1514199273

Authors: Andrea Demarchi Lorenzo Greco Francois Regoli Marcello Di Valentino Marco Amoruso Alessandro Felice Chiesa Silvia Pirroni Mauro Foletti Angelo Di Simone Simone Sarzilla Andrea Menafoglio

We present a case of recurrent takotsubo syndrome with contemporary brady- and tachyarrhythmic presentation, a rare clinical pattern for which the correct treatment is still a matter of debate.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1514206641

Authors: Ion Vasiloi Thomas Nestelberger Beat A. Kaufmann Fabien Praz Oliver T. Reuthebuch

Transcatheter mitral valve implantation (TMVI) is used for treating severe mitral valve regurgitation in patients deemed unsuitable for open-heart surgery. However, delays between preoperative workup and therapy can lead to changes in the clinical condition and structural valve findings, necessitating a meticulous reevaluation of diagnostic and therapeutic options. Case Presentation: A 77-year-old woman with severe mitral valve regurgitation and severe comorbidities was referred to our Heart Team and was deemed suitable for TMVI based on the initial evaluation. The echocardiographic finding showed a severe degenerative mitral valve regurgitation with prolapse of the A3 and P3 segments and an eccentric jet directed posteriorly to the atrial roof but without the complete picture of Barlow’s disease. Due to delayed approval by the patient, the therapeutic procedure was postponed. Subsequent echocardiographic reevaluation six months later revealed a hypermobile anterior mitral leaflet resulting from chordal elongation in conjunction with a septal bulge, raising the risk for postoperative left ventricular outflow tract (LVOT) obstruction. To mitigate this risk, TMVI combined with the Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON) was performed. Post-implantation echocardiography revealed a well-functioning mitral valve prosthesis without para- and transvalvular leak, a mean gradient of 3 mm Hg, and no LVOT obstruction. Conclusions: The diagnostic and therapeutic evaluation of TMVI remains intricate and time-consuming, necessitating thorough planning. Prompt performance of the procedure is crucial to prevent unforeseen structural changes that could jeopardize the patient’s outcome. The combination of TMVI with the LAMPOON technique for preventing LVOT obstruction appears feasible and suitable for selected patients.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1514905178

Authors: Catarina Ribeiro Carvalho Marta Catarina Bernardo Ana Baptista Ilídio Moreira

We present the case of a 27-year-old man who was admitted with new-onset acute heart failure. The echocardiogram revealed biventricular dilatation with a severely reduced systolic function. A genetic study identified a truncated variant of the filamin-C (FLNC) gene. Since the systolic function did not improve under heart failure guideline-directed medical therapy, an implantable cardioverter-defibrillator was placed. After two years, the patient is currently being considered for epicardial ventricular tachycardia (VT) ablation due to the failure of appropriate therapies for monomorphic VT despite recovery of the left ventricular (LV) systolic function. Filamin C truncating variants have been recognized as one cause of an overlapping phenotype in dilated and arrhythmogenic cardiomyopathies. These patients typically present with a mildly reduced LV ejection fraction (LVEF), with or without dilatation, and extensive myocardial fibrosis, which heightens the risk of complex ventricular arrhythmias (VAs). Our patient presented a combined phenotype with biventricular dilated cardiomyopathy with a severely reduced LVEF at an unusual young age, as well as an increased incidence of VAs. With this clinical case, we aim to highlight the importance of genetic evaluation in dilated cardiomyopathy, as it can be decisive in its orientation and, consequently, in its prognosis.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1547920225

Authors: Baris Gencer

Based on the growing clinical evidence on the benefit of very low LDL-C levels in combination with the availability of highly effective lipid-lowering therapy (LLT) options [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1566105391

Authors: Andreas Flammer

Dear Readers, Once again, a new issue of the journal has been printed. Every time I read the articles in the CVM journal, I am proud of how diverse, contemporary, and fascinating the field of cardiovascular medicine is [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1317114789

Authors: Bashir Alaour Thomas Pilgrim

Despite an extensive body of literature, there are still many gaps in the evidence surrounding the lifetime management of aortic stenosis (AS) and upstream interventions to prevent or slow down the progression of the disease are yet to be developed. The contemporary shift from simple grading to a more outcome-related staging of AS has ren dered the traditional belief that aortic valve intervention is only indicated in severe symptomatic AS obsolete and opened the debate on the optimal timing for intervention. Transcatheter aortic valve implantation (TAVI) has stood the test of time as a convenient, safe and effective treatment of AS across all risk categories. However, with the expansion of TAVI to younger patients with a longer life expectancy, there has been a gradual shift in focus from periprocedural outcomes to lifetime management, especially in patients who are likely to outlive their first valve prosthesis. In a standard scenario, when choosing the first valve, many actors come to the stage, including out comes and challenges of repeated valve implantations.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1324051349

Authors: Luca Koechlin

Dear Readers, In this issue of Cardiovascular Medicine, Bashir Alaour and Thomas Pilgrim take on the demanding task of summarizing the challenges involved in the management of patients with [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1379434015

Authors: Isabella Sudano

Bempedoic acid is a fairly small molecule acting as a prodrug which is converted into the active compound bempedoyl-CoA in the liver. This active metabolite of bempedoic acid inhibits the enzyme ATP citrate lyase leading to low-density lipoprotein (LDL) reduction. The CLEAR (Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen) Harmony trial showed that bempedoic acid reduced LDL cholesterol (LDL-C) by 12.6–16.5% and the CLEAR Tranquility and Serenity showed a reduction of LDL-C in statin-intolerant patients by a mean of 21% in monotherapy and 38% in combination with ezetimibe. Similar to statins but in contrast to ezetimibe or PCSK9 inhibitors, there was a consistent reduction of high-sensitive C-reactive protein in patients treated with bempedoic acid throughout all those studies. The CLEAR Outcomes trial included patients with established atherosclerotic cardiovascular disease (ASCVD) or a high risk of developing it, a documented intolerance to statin and a LDL ≥2.6 mmol/l despite maximal tolerated lipid-lowering therapy. The study showed that bempedoic acid lowered LDL by 21% and reduced the risk of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke or coronary revascularization (primary composite endpoint) over a median of 3.4 years in statin-intolerant patients. The safety profile showed a slight increase in uric acid, gout and cholelithiasis. Bempedoic acid, used alone or with ezetimibe, is an effective LDL-lowering therapy for patients who do not attain adequate LDL-C control with maximal tolerated statin therapy and in statin-intolerant patients at risk for ASCVD.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1379472814

Authors: Myriam Kaddour Haran Burri

His bundle pacing is the most physiological form of pacing as it replicates the patient’s natural ventricular activation. Its adoption has significantly grown over the last years. However, the technique has several limitations, including suboptimal thresholds. Left bundle branch area pacing has been introduced more recently and has gained much interest as it also delivers physiological pacing but with more favorable electrical parameters. However, there are also several unresolved issues with this technique. This article compares these strategies and highlights their advantages and disadvantages to provide guidance on which technique to select for a specific patient.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1379572570

Authors: Thierry Carrel

Vor einigen Jahren wurde meine damalige Klinik am Inselspital von einer deutschen Beratungs Unternehmung durchleuchtet [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1412183678

Authors: Hari Vivekanantham Guy Amit

We present the case of a young male presenting with a wide complex tachycardia. The diagnostic approach based on the electrocardiogram findings is discussed. The final diagnosis could be made following an adenosine challenge at baseline, underlying the use of this drug for diagnostic purposes even in the absence of ongoing tachycardia.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1412187259

Authors: Abhishek Potnis Sushrut Potwar Uday Jadhav

Takotsubo cardiomyopathy is a type of stress cardiomyopathy that is usually seen in postmenopausal patients and can be triggered by emotional stress, hypoglycemia, hypothyroidism, and surgery. A patient post cardiac surgery can present with multiple complications causing hemodynamic compromise. Hence, takotsubo cardiomyopathy remains a diagnostic dilemma. Here, we present an interesting electrocardiogram (ECG) of the same condition in a patient after mitral valve replacement with normal patent coronaries but presenting with anterolateral massive infarction with shark fin pattern in the ECG.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1455989891

Authors: Otmar Pfister

Fall Der 70-jährige Patient stellte sich 2020 bei uns infolge Pensionierung des behandelnden Kar diologen vor. Er klagte über eine kardiale Leistungseinbusse und ausserdem über Prob- leme mit dem Bewegungsapparat [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1297020794

Authors: Alexander Breitenstein Laurent Roten Tobias Reichlin

Atrial fibrillation (AF) has become the most common arrhythmia worldwide and its incidence is increasing. Treatment strategies for symptomatic patients include stroke prevention, management of cardiovascular comorbidities, and direct treatment of AF itself. With regard to interventional AF treatment, a novel technique called pulsed field ablation has emerged. Large registry data in more than 15,000 patients have demonstrated a high efficacy in reducing the burden of AF with a very high safety. This review provides an overview of the technical aspects of pulsed field ablation and the published clinical data.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1297024900

Authors: Linn Ryberg Norma Balderrábano-Saucedo Argelia Medeiros-Domingo

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a fatal rare inherited cardiac channelopathy. Affected patients are susceptible to develop deadly ventricular arrythmias after physical or emotional stress. The typical arrhythmia presents as bidirectional and/or polymorphic ventricular tachycardias. To illustrate the clinical challenges in properly diagnosing this disease, we report two cases of CPVT together with a brief literature review.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1324052009

Authors: Peter Matt

Are you interested in a new section in Cardio vascular Medicine focusing on cardiac surgery [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1327305240

Authors: Anna Katharina Schmid Victor Voicu Sarah Parejo Franziska M. Jakobs David F. Niedrig Sandro Baumgartner Markus Béchir Stefan Russmann

Dose-dependent statin-related myotoxicity (SRM) is a rare adverse effect of statin treatment. Differences in the pharmacokinetics and interactions with environmental and genetic factors constitute important risk factors for the development of SRM. We present the case of an 82-year-old female patient with severe simvastatin-related myotoxicity and several risk factors of SRM, namely a pharmacokinetic interaction with verapamil, a pharmacogenetic interaction with a SLCO1B1*1/*5 variant, high age, female gender and impaired renal function. A comprehensive evaluation of distinct pharmacokinetic and pharmacogenetic properties of different statins and a pharmacogenetic panel test guided the diagnosis and options for further clinical management. Inspired by this and other similar cases, we developed a pocket card as practical companion for statin prescribing in clinical practice and provide it as an addition to this report.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1338832878

Authors: Peter Laurenz Dietrich Silvan Meier Raban Jeger

Complete heart block (CHB) is a rare complication during left ventriculography. We present a case of transient CHB without ventricular escape rhythm in a patient with an incomplete trifascicular block.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1356564558

Authors: Mevlüt Çelik Maria Nucera Fabio Pregaldini Clarence Pingpoh Thomas Pilgrim Matthias Siepe David Reineke

Background: Dental clearance is routinely performed before cardiac surgery, as it is thought to be essential in reducing postoperative bacteremia and endocarditis. However, there is a lack of evidence supporting this routine. Objectives: This study aimed to investigate the impact of dental clearance on postoperative outcomes after cardiac surgery. Methods: This is a comprehensive review and analysis of relevant studies published between 1 January 1990 and 1 January 2023 in two electronic databases (PubMed and EMBASE). Pooled estimates in terms of relative risk (RR) or standardized mean difference were calculated according to outcome measures. Risk of bias and quality of studies were evaluated. A total of 7040 articles were found through the MEDLINE, EMBASE and Cochrane databases. Five articles were found to be eligible for inclusion in this review. Results: There is no statistically significant benefit of preoperative dental clearance in terms of postoperative outcomes, including all-cause mortality (RR 0.92, 95% Confidence Interval [CI] 0.43–1.97), prosthetic valve endocarditis (RR 1.32, 95% CI 0.51–3.43), postsurgical infection (RR 1.02, 95% CI 0.77–1.36), and length of hospital stay (weighted mean difference 4.00, 95% CI −2.70–10.70). Conclusions: Although the literature emphasizes the importance of preoperative dental clearance, no significant effect was seen with respect to all-cause mortality, infection, endocarditis, and length of hospital stay.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1373944239

Authors: Jessy Steve Masso-Bueso David Jacobo Sánchez-Amaya Oscar Andrés Pérez-Orpinel

The development of prosthetic heart valves has allowed to drastically improve the quality of life and the life expectancy in patients who would otherwise have succumbed to the inevitable course of the disease. While prosthetic heart valves are invaluable resources in therapy, they are not devoid of possible complications, some inherent to the prosthesis itself (structural damage, thrombosis, etc.), others related to the patient (e.g., thrombophilia, non-adherence to medication). The case of a patient is presented whose findings are surprising and show that there is always an exception to the rule.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1220454347

Authors: Jérôme Dällenbach Grégoire Girod Pierre Monney Wongsakorn Luangphiphat Eric Eeckhout

Background: The mortality reduction associated with immediate coronary reperfusion in patients with ST-elevation myocardial infarction is extensively documented. The gap between available knowledge and care delivery is primarily due to lacking coordination between the patient contact points. We postulate that the same applies to non-ST-elevation myocardial infarction (NSTEMI) and that a more consistent care delivery could improve outcomes. Methods: We conducted a single-center retrospective observational study in NSTEMI patients who presented to the emergency department (ED) at our institution between October 2017 and September 2019, covering the last twelve months before implementing our new NSTEMI care pathway (pre-intervention) and the first twelve months thereafter (post-intervention). Primary endpoint was the door-to-cardiology time, i.e., time between ED admission and admission to the cardiology department. Co-primary endpoint was the door-to-needle time, i.e., time between ED admission and initiation of coronary angiography. Secondary endpoints included total hospital stay (time between ED admission and discharge), in-hospital mortality (%), and retrospective misdiagnoses with the coronary angiography showing no or non-relevant coronary lesions (%). Results: 271 consecutive NSTEMI patients were treated during the study period. 112 (41.3%) in the year before and 159 (58.7%) in the year after the NSTEMI care pathway implementation. NSTEMI care pathway led to a significant reduction in median door-to-cardiology time from twelve hours (interquartile range [IQR] 6–24 h) pre-intervention to six hours (IQR 4–9 h) post-intervention (p < 0.0001); a significant reduction in median length of hospital stay from five days (IQR 3–10 days) pre-intervention to three days (IQR 2–7 days) post-intervention (p <0.0001); and a significant reduction of misdiagnoses from 16.96% pre-intervention to 8.81% post-intervention (p = 0.0341). There was no significant change in median door-to-needle time (28 h pre-intervention to 24 h post-intervention, p = 0.0736) nor in in-hospital mortality (0.89% pre-intervention versus 2.52% post-intervention, p = 0.6519). Conclusions: The NSTEMI care pathway significantly reduced door-to-cardiology time, length of hospital stay and number of misdiagnoses. It proved feasible in routine clinical practice and could be implemented on a larger scale.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1243919841

Authors: Tatiana Peer Andreas Müller-Burri

Permanent junctional reciprocating tachycardia (PJRT) is a rare form of atrioventricular reentrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde con duction. The arrhythmia typically presents before adulthood with incessant tachycardia leading to cardiomyopathy and heart failure. We report the case of a woman with tachycardia induced cardiomyopathy due to PJRT detected at the age of 54 years. The patient refused to undergo catheter ablation and was successfully treated with a beta blocker.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1246902814

Authors: Apostolos Tsinaridis Marko Gajic Alessandro Candreva Philipp A. Kaufmann Ronny R. Buechel Barbara E. Stähli Andreas A. Giannopoulos

We present the diagnostic pathway and management of an asymptomatic patient with a solitary, potentially high-risk coronary plaque, utilizing modern and advanced non-invasive and invasive pathophysiological, morphological, and functional assessment. By using coronary computed to mography angiography, computer-based solutions were employed enabling non-invasive under standing of the plaque characteristics and the local and global functional micro-environment. Invasive coronary angiography-based, computational, and wire-free hemodynamic lesion assess ment as well as intracoronary imaging with optical coherence tomography were further utilized, allowing for personalized management and guiding coronary revascularization.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1262905452

Authors: Franz H. Messerli Manuel R. Blum Bernhard Meier

“Professor Meier is nuts!” [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1270682599

Authors: Pratintip Lee Hans-Jürg Beer

Thrombosis remains a significant clinical challenge with potential life-threatening consequences. Despite advancements in anticoagulants, concerns about bleeding and the delicate balance of thrombotic risks persist, especially in patients with specific comorbidities such as renal insufficiency, cirrhosis, and those with medical devices. The search for effective anticoagulant therapies that can prevent thrombotic events while minimizing bleeding risks, has led to the emergence of factor XI (FXI) inhibition as a promising approach. These inhibitors target FXI using different mechanisms of action, routes of administration and durations, offering flexibility for various clinical conditions. Early findings from phase II trials have shown a promising trend of reduced bleeding risks in both venous thrombosis and arterial thromboembolism. The results from these trials, particularly the ongoing phase III trials, will yield valuable insights into the efficacy of FXI inhibitors in preventing thrombosis. Specific patient populations, including individuals with end-stage renal disease and those with mechanical devices or blood exposed to artificial surfaces (commonly referred to as artificial contact surfaces associated thrombosis), alongside patients with conditions like thrombotic antiphospholipid syndrome or sickle cell disease, might experience distinct advantages from the application of FXI inhibitors. Dedicated clinical studies focusing on these patient groups are crucial to establish the effectiveness and safety of FXI inhibitors in their management. Moreover, it is imperative to address the development of effective strategies to reverse the anticoagulant effects of FXI inhibitors, ensuring comprehensive patient management, especially for agents with long half-lives. This review article provides a comprehensive overview of the current understanding and research progress in FXI inhibition for thrombosis prevention.

Cardiovascular Medicine doi: 10.4414/cvm.2024.1282909062

Authors: Etienne Delacrétaz Christian Sticherling

In 1956, at the age of 17, Istvan Babotai fled Hungary, became an electrical engineer and ultimately a pioneering figure of cardi ac pacing in Switzerland [...]

Cardiovascular Medicine doi: 10.4414/cvm.2024.1324050930

Authors: Thomas Lüscher Rakesh Sharma Kshama Wechalekar Vasileios Kouranos

Sarcoidosis is a multisystemic, chronic inflamma tory disorder involving lymph nodes and lungs characterized by a non-caseating [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.1190638221

Authors: Andrea Papa Edira Bekiri Marco Giacchi Gregor Leibundgut

A 67-year-old man with known coronary artery disease was rescued after an out-of-hospital cardiac arrest due to ventricular fibrillation (VF) and admitted to the catheterization laboratory with inferior ST-segment elevation, right bundle branch block and atrial fibrillation on the electrocardiogram. The patient had had an elective percutaneous coronary intervention (PCI) with implantation of a bare metal stent to the dominant mid left circumflex artery three years before and a second PCI with implantation of a drug-eluting stent to the proximal/mid left anterior descending artery at another local institution three months earlier. The prescribed dual antiplatelet therapy was interrupted by the patient right after discharge. Therefore, a stent thrombosis was initially deemed the most probable cause of his clinical presentation (the elephant in the room). Nevertheless, the coronary angiography showed patent stents and the left ventriculography revealed a normal left ventricular function. After excluding aortic dissection and pulmonary embolism, cardiac magnetic resonance imaging showed signs of acute isolated right ventricular myocardial infarction. Upon review of previous angiograms, a small occluded right ventricular branch appeared to be the lesion that triggered the VF.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1216876634

Authors: Nadine Molitor Alexander Breitenstein

Background: Leadless pacemaker therapy was introduced in 2013 to overcome lead- and pocket- related complications in conventional transvenous pacemaker therapy. These leadless devices are self-contained, right ventricular, single-chamber pacemakers, implanted via a femoral percutaneous approach. However, the femoral route is not always possible due to various reasons. The aim of this analysis is to share our first experience using a jugular approach for the implantation procedure. Methods: The first ten patients who underwent leadless pacemaker implantation via the right internal jugular venous route at our center were analyzed prospectively. Follow-up period was three months. Interventional and electrical parameters of the jugular approach were compared with the data of the first 100 patients who underwent a femoral leadless pacemaker implantation at our center (implanted from 2015–2019). Results: Data from ten consecutive patients (mean age 83.3 ± 3.6 years, six males) were collected. All leadless pacemakers were implanted successfully via the internal right jugular vein. Mean procedure time was 31.9 ± 6.4 min with a mean fluoroscopy time of 3.4 ± 2.4 min. The device was positioned at the inferior septum in three patients and midseptal in seven patients. The mean pacing threshold was 0.47 ± 0.14 V at 0.24 ms pulse width with a sensed amplitude of 9.1 ± 3.8 mV. There were no complications during the procedure as well as during the three months follow-up. Pacing parameters remained stable in all patients. Conclusion: The jugular approach seems to be a safe and efficient alternative to the femoral implantation method for currently available leadless pacemakers.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1236103712

Authors: Guido Schüpfer Peter Matt

Digitalization of the healthcare sector is changing its landscape. Artificial intelligence is bound to have a major impact on care providers and their interactions with their patients. As promising as new technologies may be, there will be side effects. New Technologies will place new and higher demands on its users and will require an extremely high level of expertise to check plausibility. Alongside increases in efficiency and effectiveness, the demands on the humans in healthcare will also rise.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1243927837

Authors: Stefano Caselli Lam Dang Kurt Mayer Christine Attenhofer Jost Christoph Scharf

We report unusual manifestations of Lamin mutations (noncompaction, vertical pulmonary vein connection) associated with highly complex atrial arrhythmias, which were not mappable by contact mapping due to unstable reference and activation patterns. The advantages of a novel noncontact mapping technology allowing beat-to-beat analysis of electrical activation in the entire heart chamber simultaneously by localizing electrical charge density (Coulomb/area) are discussed.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1246902735

Authors: Gonca Suna Fu Guan Jonathan Michel Ardan Saguner

A patient with previous transcatheter tricuspid valve-in-valve replacement underwent catheter ablation for symptomatic atrial flutter. An incisional and cavo-tricuspid isthmus (CTI) dependent right atrial flutter was confirmed. Ablation of the critical isthmus at the lateral right atrial wall and CTI ablation sustainably terminated the flutter. This case highlights the feasibility and safety of CTI-dependent atrial flutter ablation after tricuspid valve-in-valve replacement, which has not been reported so far.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1249054251

Authors: Laura Rings Luca Koechlin

What do the special task forces of the Federal Police and heart surgeons have in common [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.1293793614

Authors: Andreas Flammer

Dear readers [...]

Cardiovascular Medicine doi: 10.4414/cvm.2022.02222

Authors: Baudouin Bourlond Jean-Michel Dogné Luis Urbano Oscar Marchetti

Terlipressin is a synthetic analogue of vasopressin recommended as a vasoactive drug with relative specificity for the splanchnic circulation in patients with portal hypertension and bleeding oesophageal varices or hepatorenal syndrome. We report a relapsing terlipressin-induced acute pulmonary oedema in a 59 year-old man with Child B9 alcoholic liver cirrhosis.

Cardiovascular Medicine doi: 10.4414/cvm.2022.02223

Authors: Alexandra-Maria Neagoe David Reineke Attila Kollár Yara Banz Kerstin Wustmann

By our case report, we want to bring to light the necessity of further workup in young patients with syncope, chest pain and dyspnea. A 26-year-old male was admitted due to syncope after complaining of chest pain and breathing difficulties. Transthoracic echocardiography showed cardiac tamponade and pericardiocentesis was performed with removal of hemorrhagic fluid. Cardiac magnetic resonance showed a heterogeneous, highly perfused mass located in the right atrium (RA) with necrotic areas. Histopathology during cardiac surgery determined a high grade angiosarcoma in the RA and R0 margins. Adjuvant chemotherapy was started but a local relapse occurred followed by multiple metastases and death. Haemorrhagic pericardial effusion is highly suspicious of cardiac malignancies and warrants further workup by a multidisciplinary team.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1243787466

Authors: Thomas Lüscher Hans Rickli Michel Zuber

Am 22. Juli 2023 ist der bekannte Schweizer Kardiologe Paul J. E. Erne nach langer Krankheit verstorben […]

Cardiovascular Medicine doi: 10.4414/cvm.2023.1243790698

Authors: Aline Mühl Babken Asatryan Hildegard Tanner

This article provides a condensed but comprehensive summary of the latest knowledge of sex-specific aspects of arrhythmias. Starting with sex-based differences in electrophysiological properties of the heart, it further covers sex- and gender-differences in supraventricular tachycardia, atrial fibrillation, ventricular tachycardia and selected inherited cardiac arrhythmias.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1243822743

Authors: Andreas Andreou

An infrequently diagnosed case of atrial infarction which occurred in conjunction with left ventricular myocardial infarction is presented. Atrial infarction was recognised by the presence of PR segment depression in conjunction with premature atrial complexes. Spatial vector analysis of premature atrial complexes, is highlighted as a means to localise atrial infarction.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1243882557

Authors: Samuel Stempfel Kerstin Wustmann Stéphane Cook Diego Arroyo

We present the case of a 50-year-old woman with a chemotherapeutically treated primary mediastinal lymphoma and circumferential pericardial effusion, whose echocardiogram revealed unusual intrapericardial colour and pulsed-wave Doppler flow signals. Insights on workup and hypotheses are discussed.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1246812107

Authors: Florian Wenzl Simon Kraler Giovanni Camici Thomas Lüscher

Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Emerging data indicates that there are relevant sex-specific differences in the pathobiology, clinical presentation, and management of ACS in women and men. Premenopausal women appear to be largely protected from typical ACS, with women presenting 5 to 10 years later than men. Females tend to experience chest pain or discomfort less frequently and more often present with other associated symptoms, which may contribute to longer prehospital delays and less frequently administered guideline-directed care. Indeed, females are less likely to undergo coronary angiography and percutaneous coronary interventions, and less likely to get a prescription for statins after the acute event. Over the past decades, we made remarkable progress in ACS treatment, reducing short-term mortality from far above 50% to below 10% in both women and men. Novel risk tools for clinical risk assessment such as the machine learning-based GRACE 3.0 risk score may help to further improve the management of female and male non-ST segment elevation ACS patients. In this review, we discuss the role of sex in the diagnosis, management, and outcomes of patients with ACS.

Cardiovascular Medicine doi: 10.4414/cvm.2023.1246945772

Authors: Davide Vece Christian Templin Jelena Rima Ghadri

Acute coronary syndrome (ACS) in women presents unique challenges in terms of pathophysiology, diagnosis and management. Rare forms of ACS, such as takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD), have gained increasing attention in recent years. TTS is characterized by transient left ventricular dysfunction in the absence of epicardial culprit lesions, while SCAD involves separation within layers of the arterial wall of the coronary arteries leading to blood flow disruption and potential myocardial infarction. Despite a different pathogenesis, TTS and SCAD share common features such as a significantly higher prevalence in women and a higher rate of recurrent events compared to traditional ACS. Additionally, both conditions are typically anticipated by emotional or physical stressors and have higher incidence in individuals with neuropsychiatric disorders. These similarities suggest that there could be shared risk factors and pathophysiological mechanisms underlying these conditions, which could inform future research and management strategies. The purpose of this review is to provide a comprehensive clinical overview of TTS and SCAD focusing on various aspects of these conditions including epidemiology, clinical profiles, diagnostic workup, prognosis, and management. By highlighting these key areas, this review aims to increase awareness and understanding of these rare forms of ACS among healthcare professionals leading to improved management and treatment.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02202

Authors: Claudia Siklódy Patrizio Pascale

Syncope is defined as a transient loss of consciousness due to transient cerebral hypoperfusion. It is a frequent cause of consulting in the emergency department, and cardiac arrhythmias play an important role in differential diagnosis. This review article outlines the different arrhythmic causes of syncope and their management, as well as the warning signs that should raise the sus picion of arrhythmia.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02232

Authors: H. Yakup Yakupoglu Tobias Fuchs

Valve interventions in left sided valvular heart disease, mainly such as transcatheter aortic valve implantations (TAVI) and transcatheter edge-to-edge repairs (TEER) have emerged as alternative treatments in symptomatic severe aortic stenosis and severe mitral regurgitation. However, stroke remains a serious concern. The two main causes of embolisation after valve intervention are thrombosis and vegetations. This review summarises the role of all the different tools of cardiac imaging including transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT) and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in the diagnosis and work-up of potential cardiac or aortal sources of embolism associated with valve interventions. TTE provides a more comprehensive understanding of the implanted valve including its location and function. Contrast enhanced echocardiography offers additional value in order to detect left ventricular thrombus. Increased valve gradients can be attributed to patient-prosthesis mismatch, thrombus or pannus on the leaflets. Therefore, echocardiography performed immediately after the procedure, followed by follow-ups 4 weeks post-intervention and then annually is of major importance. In addition to echocardiography, cardiac CT can be highly beneficial for confirming or ruling out an abscess, pseudoaneurysm, fistulae and thrombosis. Nuclear molecular techniques, such as 18F-FDG-PET is another important advanced imaging technique, particularly in the management of infective endocarditis.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02233

Authors: Jan Berg Daniel Hofer Feifan Ouyang Ardan Saguner

We present the case of a 34-year-old man with paroxysmal narrow complex tachycardias. An EP study revealed AVNRT with upper common pathway block. Our case shows a diagnostic ap proach and treatment for this rare scenario in the EP lab.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02235

Authors: Teresa Podstatzky-Lichtenstein Pascal Berdat Lars Englberger

Scimitar syndrome manifesting in adulthood can easily be overlooked owing to mild symptoms. Once diagnosed, operative correction should not be delayed as it can cause severe right heart dysfunction. There are several surgical approaches to recreating normal flow conditions. To identify the best suitable method, one needs to take into account the individual patient’s anatomy.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02236

Authors: Tolga Çimen Nadine Molitor Thomas Wolber Fırat Duru Ardan Saguner

Case Presentation. A 60-year-old man with a history of a right-sided accessory pathway ablated at age 50, presented to a smaller hospital with recurrent palpitations and a regular wide-complex tach ycardia (WCT) (fig. 1) [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02237

Authors: Teodor Serban Diego Mannhart Otmar Pfister Michael Kühne Christian Sticherling Patrick Badertscher

Introduction: The diagnosis and characterisation of intracardiac tumours is challenging. Transoesophageal echocardiographic guided biopsy is an established method to confirm the pathology. Intracardiac echography (ICE) may help to increase the diagnostic outcome of biopsies, particularly in right-sided cardiac masses. Case Report: We report on a 62-year-old patient who presented with recurrent pericardial effusions of unknown origin. Pericardial puncture did not reveal any significant findings. Positron emission tomography-computed tomography revealed a mass in the right atrium. Due to excellent nearfield imaging capacities for right-sided cardiac structures, ICE was used to guide the biopsy. Biopsy was performed safely and demonstrated a primary cardiac angiosarcoma. Conclusion: ICE-guided biopsy can be a reasonable approach, particularly for right-sided structures, allowing a safe, minimally invasive way of diagnosing intracardiac tumours.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02238

Authors: Marcello Di Valentino Tardu Özkartal Andrea Menafoglio François Regoli Stefano Cafarotti

A 38-year-old male smoker with serum LDL-cholesterol of 6.4 mmol/l and a family history of coronary artery disease (father with acute myocardial infarction at the age of 45)[...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02270

Authors: Hans Rickli Micha Maeder

A relevant proportion of patients undergoing percutaneous coronary intervention (PCI) have a high risk of bleeding. The associated individual risk of ischaemia can be differentiated by an app-based approach and helps to determine the duration of intensified antithrombotic therapy.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02279

Authors: Thomas Fishman Vincent Ribordy Serban Puricel Mario Togni Sébastien Doll Diego Arroyo Stéphane Cook

Background: The Lund University Cardiopulmonary Assist System-2/-3 was developed for auto-matic chest compressions during cardiopulmonary resuscitation (mechanical CPR or MCPR) and often allows a patient suffering from cardiac arrest to be taken to the cardiac catheterization room. We report the clinical outcomes of percutaneous coronary interventions (PCI) performed in cardiac arrest patients under automatic MCPR devices. Methods: We retrieved all patients with cardiac arrest who were referred to PCI under MCPR devices from the Cardio-FR database (003-REP-CER-FR) from January 2016 to December 2021. Patients who were hemodynamically stable at the time of coronary examination/intervention (even those who had been resuscitated immediately before) were excluded from the analysis. Baseline patient and procedure characteristics were collected. The primary outcome was the return of spontaneous circulation (ROSC). Results: Of all patients who were on MCPR at the cardiac catheterization room, eleven still required active CPR during coronary examination/intervention and were included in the analysis. Mean age was 67.9 ± 10 years, nine were male. The MCPR device was initiated on average after 8.5 ± 8.1 minutes. All patients had ventricular defibrillation and received an average of 3.4 ± 3.6 shocks and 82% adrenaline boluses. The MCPR was used for an average of 51.1 ± 34.4 minutes. Total resuscitation time was on average 59.6 ± 38.3 minutes. Of the eleven patients, nine underwent ad hoc PCI. ROSC was achieved in four patients after 36.5 ± 49.8 minutes. The survival was 36% (four patients) at 24 hours and 27% (three patients) at three months. Only one of the patients resuscitated for >25 minutes survived. Patients with in-hospital cardiac arrest were associated with shorter ROSC (p <0.01), shorter resuscitation time (p = 0.009) and better survival (p = 0.03) than patients with out-of-hospital cardiac arrest. Conclusions: MCPR allows patients in cardiac arrest to reach the cardiac catheterization room. However, the prognosis is grim with high mortality. Only one patient survived after >25 minutes of mechanical resuscitation.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02289

Authors: Thomas Lüscher

Damals, in tiefer Vergangenheit, ging es gelegentlich wild zu und her [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02267

Authors: Sophie Huegli Antoinette Pechère-Bertschi

Hypertension is the number one killer for women, with a greater burden for women than men and it is an important risk factor for target organ damage. Women are less frequently affected by arterial hypertension than men during their reproductive life, but their risk catches up and exceeds men’s after menopause. There is a knowledge gap about the specificity of arterial hypertension in women due to an under inclusion of women in clinical trials. Hypertensive disorders during pregnancy are a recognised ulterior cardiovascular risk factor and obstetrical history must be part of the evaluation of hypertensive women. Furthermore, efficient cardiovascular prevention must be applied after pregnancies. Both endogenous and exogenous female sex hormones influence the blood pressure (BP) across life course, with specific characteristics relating to pregnancy, lactation, oral contraceptives, menopause, hormones substitution and elderly women. Altogether, effective treatment and control of hypertension ameliorates cardiovascular issues. Concerning medical treatment, due to the lack of data we propose to lower the doses of antihypertensive medications in women, due to increased efficiency and increased risk of secondary effects, most notably for thiazide diuretics and calcium channel blockers.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02272

Authors: Viola Schaefer Denise Hilfiker-Kleiner Corinna Keil

Cardiovascular diseases in pregnancy are increasing, and account for the majority of pregnancy-induced maternal deaths. Among them, hypertensive disorders are the most frequent, affecting 6–8% of all pregnancies. More severe forms, like preeclampsia and HELLP syndrome, represent serious complications and are associated with far-reaching consequences for mother and child, such as stillbirth, peripartum cardiomyopathy, diastolic heart failure, eclampsia and a long-term increased risk for cardiovascular disease. While risk factors such as obesity, smoking, diabetes mellitus, twin pregnancy, multiparity, advanced age of the mother, in-vitro fertilisation (IVF) are well known, the exact pathophysiology of preeclampsia has still not been precisely clarified. Therefore, specific treatment options are limited, also in part due to the challenge of performing clinical trials in pregnant women. The present review provides an overview of the current state of knowledge and summarises treatment strategies and therapy options.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02273

Authors: Paco Estoppey Carole Clair Diane Auderset Jardena Puder

The influence of sex–considered to be the biological differences between women and men– and gender–considered to be sociologically constructed differences based on membership in one of the two sex categories–appears to be particularly important for noncommunicable diseases such as type 2 diabetes (T2D) and obesity. Many T2D risk factors are behavioural and greatly, but not only, influenced by gender-related determinants, making them modifiable factors. In this review, we focus on sex-related biological differences in the prevalence of diabetes and its biological risk factors, such as obesity, fat distribution, metabolic syndrome and glucose homoeostasis, with a particular interest in the influence of menopause and pregnancy. Globally, men have had a higher prevalence of T2D than women with regional, socioeconomic and age-related variations. Overall, women tend to be more protected from cardiometabolic diseases before menopause than men. However, hormonal variation over the course of life, particularly during menopause, modifies these risks. Similarly to T2D, there are differences in the prevalence of obesity between women and men that change during the lifespan. The link between obesity and T2D seems to be stronger in women compared to men. Various hormones have an impact on glycaemic levels and on body fat and their concentrations and effect on metabolic parameters can differ by sex. Understanding and acknowledging sex-related differences in T2D and its risk factors is important to improve health research, lead to better clinical care, more suitable preventive policies and programs for both women and men.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02274

Authors: Alessia Delco Angela Portmann Nidaa Mikail Alexia Rossi Ahmed Haider Susan Bengs Catherine Gebhard

The prevalence of heart failure (HF) is increasing mainly due to population aging. There are important biological (sex) and sociocultural (gender) differences in epidemiology, pathophysiology, phenotype, prognosis and treatment of HF between women and men. While the overall lifetime risk of HF is similar between men and women, women with HF are older, have more comorbidities and a higher incidence of heart failure with preserved ejection fraction (HFpEF) than men. Men instead present a predisposition to the development of heart failure with reduced ejection fraction (HFrEF) due to their higher incidence of coronary artery disease. Sex differences are also notable in the penetrance of genetic cardiomyopathies, HF risk factors as well as in sex-specific conditions such as peripartum cardiomyopathy (PPCM), cancer treatment-induced cardiomyopathy and Takotsubo cardiomyopathy. Although women with HF have a better age-adjusted prognosis than men they experience a worse quality of life. Underpinning current sex disparities in HF, HF treatment is limited by a profound underrepresentation of women in clinical trials, which has resulted in a lesser understanding of disease behaviour in female patients and in treatment guidelines that are predominantly based on male-derived data. In addition, a full understanding of the impact of sociocultural gender on HF management and disease course is lacking. This review outlines the key sex differences with respect to clinical characteristics, pathophysiology and therapeutic responses to HF treatments. Finally, we address existing knowledge gaps in sex-specific mechanisms, optimal drug doses for women and sex-specific criteria for device therapy and heart transplantation.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02275

Authors: Valentina Rossi Anton Oseledchyk Gabriela Kuster

With the continuous improvement of therapies against breast cancer, the long-term onset of cardiovascular disease (CVD) is becoming increasingly relevant for both cardiologists and oncologists. Not only CVD arises from known cardiac side effects of several anti-cancer therapies, but cancer itself seems to promote CVD. On the other hand, there is increasing evidence that CVDs such as myocardial infarction and heart failure predispose to future development of cancer. The fast-developing field of cardio-oncology aims to characterise cancer patients in order to implement effective tools for surveillance and prevention of cardiovascular adverse events and to raise awareness for the increased cancer incidence in patients with CVD. The aim of this review is to highlight cardiovascular side effects and toxicities of some of the most important breast cancer therapies and to provide an overview of what is known on the complex interplay between CVD and breast cancer.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02276

Authors: Thomas Lüscher Rolf Kaiser Stefan Osswald

Albrecht von Haller [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02284

Authors: Thomas Lüscher Andreas Flammer Gabriela Kuster

For many years, cardiovascular disease was considered a male disease.[...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02207

Authors: Fu Guan Firat Duru Ardan Saguner

Although typical atrial flutter and atrial fibrillation are not uncommon in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), there is limited information on atrial tachycardia in this population. A 59-year-old man with a diagnosis of definite ARVC according to the 2010 Task Force Criteria without overt left ventricular involvement presented with recurrent palpitations. The surface 12-lead electrocardiogram raised the suspicion of atrial tachycardia. The patient had no history of cardiac surgery or cardiac ablation. During tachycardia passive activation of the right atrium was visible through invasive electroanatomical mapping indicating a left atrial origin of the tachycardia. High-density mapping of the left atrium confirmed a re-entrant tachycardia with a figure-of-eight activation pattern originating from a small scar in the anterior left atrial wall. Radiofrequency catheter ablation targeting the area of slow conduction in this area terminated the tachycardia and rendered it non-inducible.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02212

Authors: Julie Wacker Maurice Beghetti

Introduction. Children can present at any age with pulmonary hypertension [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02219

Authors: Alexander Breitenstein

Atrial fibrillation (AF) is electrically defined as an uncoordinated[...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02226

Authors: David Faeh

Similar to other developed countries...

Cardiovascular Medicine doi: 10.4414/cvm.2023.02255

Authors: Albana Thartori Francesca Usardi Andrea Menafoglio François Regoli

A 27-year-old pregnant woman (29th week) reported palpitations, dizziness and exertional dysp-noea. The heart rate was 130 bpm at rest, up to 180 bpm during mild exertion, without haemody-namic compromise. The electrocardiogram (ECG) showed atrial tachycardia. An adenosine inter-mittent interruption of the atrial tachycardia was observed. Metoprolol combined with flecainide controlled the ventricular rate to 80–85 bpm followed by conversion to sinus rhythm. The patient stayed asymptomatic until a second pregnancy, when the same atrial tachycardia recurred. Symptoms were controlled by combining metoprolol and flecainide at an earlier stage.

Cardiovascular Medicine doi: 10.4414/cvm.2023.02256

Authors: Fabian Noti Andreas Haeberlin

Introduction. In the past decade, cardiac pacing techniques evolved significantly – resulting in a large vari ety of available approaches that are used to tai lor stimulation individually to the patient’s needs [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02277

Authors: Luca Koechlin Peter Matt

We welcome you to this issue of Cardiovascular Medicine, which once again provides a broad overview of cardiovascular medicine with outstanding review articles in heart failure, electrophysiology, and paediatric cardiology [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02168

Authors: Franziska Hiltpold

The Swiss Heart Foundation is pleased to announce the «W. und L. Rutishauser Fund» [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02220

Authors: Matthias Hermann

Colchicine is an alkaloid extracted from Colchicum plants (Colchicum autumnale, Herbstzeitlose)[...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02229

Authors: Oskar Galuszka Richard Kobza Simon Stämpfli

A 74-year-old male patient presented with malaise, fever, chills, and palpitations for the past five days[...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02266

Authors: Thomas Lüscher

Jede Tätigkeit muss sich heute einer Überprüfung stellen, so auch die For schung [...]

Cardiovascular Medicine doi: 10.4414/cvm.2023.02268

Authors: Peter Matt

Cardiovascular Medicine is one of the most widely read medical journals in Switzerland [...]

Cardiovascular Medicine doi: 10.4414/cvm.2021.02139

Authors: Lukas Padraig O Brien Anthony Buckley Joseph Galvin

A 43-year-old male underwent implantable cardioverter defibrillator (ICD) insertion, 8 months after an out-of-hospital cardiac arrest following acute ST segment-elevation myocardial infarction [...]