Search Results (195)

Objective: This study aimed to evaluate the association between mitral annular calcification (MAC) and ventricular tachycardia (VT) in patients with reduced and mildly reduced ejection fraction and to identify independent predictors of VT. Materials and Methods: A total of 143 patients with heart failure and left ventricular ejection fraction (LVEF) under 50% were included in this retrospective cross-sectional study. Patients were classified into two groups according to the presence of VT. Clinical, biochemical, and echocardiographic variables were compared between groups. Independent predictors of VT were identified using multivariable logistic regression analysis. Results: MAC was significantly more prevalent in the VT group compared with controls (43.6% vs. 17.4%, p < 0.001) and was the strongest independent predictor of VT (OR: 2.74; 95% CI: 1.13–6.65; p = 0.026). Higher inflammatory activity, lower serum albumin levels, increased left atrial volume, renal dysfunction, and elevated diastolic filling pressures were also associated with VT. Conclusion: MAC is a strong and independent predictor of ventricular tachycardia in patients with reduced and mildly reduced ejection fraction. Incorporating MAC into the overall arrhythmic risk profile alongside inflammatory, metabolic, and structural parameters may improve risk stratification in this population. Full article

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease and affects male patients more often than women. Prior studies, however, suggested that women are diagnosed later and at advanced stages of the disease, present with more pronounced symptoms, and experience worse outcomes. Objectives: To investigate sex-specific differences in clinical, laboratory, and comprehensive imaging characteristics in a contemporary cohort of HCM patients from a tertiary referral center in Austria. Methods: We retrospectively analyzed 321 HCM patients enrolled in a prospective registry (2018–2024). All patients underwent a comprehensive baseline evaluation, including medical history, laboratory assessment, transthoracic echocardiography, and cardiac magnetic resonance imaging. Results: At diagnosis, women were significantly older (62 vs. 53 years, p < 0.001) and presented with more advanced functional class (NYHA ≥ II: 80% vs. 49%, p < 0.001). Six-minute walking distance was lower and obstructive HCM was more prevalent in women (425 vs. 505 m, p < 0.001, and 55% vs. 32%, p < 0.001, respectively). Echocardiographic assessment revealed higher diastolic filling pressures (E/E′ 18 vs. 10, p < 0.001), larger indexed atrial volumes (29.5 vs. 26.6 mL/m², p < 0.001), a higher left ventricular ejection fraction (70% vs. 62%, p < 0.001), and a larger indexed interventricular septal thickness in women (10.2 vs. 9.3 mm/m², p = 0.004). Moreover, serum levels of NT-proBNP were significantly higher in women (760 vs. 338 pg/L, p < 0.001). Conclusions: Female patients with HCM were diagnosed at an older age, presented with more advanced symptoms, had higher rates of obstructive physiology, and a phenotype characterized by diastolic dysfunction and elevated biomarkers, closely resembling heart failure with preserved ejection fraction. Recognizing these sex-specific disparities is crucial in improving diagnostic awareness and individualized therapeutic management. Full article

Background/aims: Hypertension (HT) is a modifiable risk factor for the development of cardiovascular disease (CVD) in patients with atrial fibrillation (AF). There are no data on the use of the SCORE2 and SCORE2-OP risk scores used in patients with AF. In our study, we aimed to determine the effect of SCORE2 and SCORE2-OP risk scores on AF recurrence and CVD development after catheter ablation (CA) in AF patients with HT. Methods: This retrospective cohort study included 266 patients (144 men, 122 women, 57.1 ± 11 years) who underwent CA with a diagnosis of paroxysmal AF. Patients were grouped as <5%-5% to <10%-≥10% (Group I-II-III, respectively) according to CVD risk in SCORE2 and SCORE2-OP. The primary endpoint was adverse CVD. The secondary endpoint was AF recurrence. Results: The frequency of CVD and AF recurrence in groups I-II-III was 0(0%)-8(8%)-14(15%) and 9(13%)-17(16%)-23(25%), respectively (p = 0.001 and p = 0.035). Age, systolic blood pressure, presence of CVD risk ≥ 10%, CHA₂DS₂-VA, BUN, and uric acid were found to be higher in those with CVD. In logistic regression analysis, the presence of CVD risk ≥ 10%, CHA₂DS₂-VA and uric acid were found to independently predict the development of CVD (OR = 3.960, 95%CI-1.098–8.508, p = 0.019, OR = 3.257, 95%CI-1.067–7.318, p = 0.015 and OR = 1.967, 95%CI-1.359–2.873, p = 0.001). Triglycerides, CVD risk of ≥10%, and left atrial end-diastolic diameter (LAd) were found to be higher in those with AF recurrence. In regression analysis, the presence of CVD risk ≥ 10% and LAd were found to independently determine the development of AF recurrence (OR = 2.448, 95%CI-0.993–1.023, p = 0.005, OR = 1.217, 95%CI-1.124–1.319). Conclusions: SCORE2 and SCORE2-OP algorithms performed before the procedure in isolated HT patients undergoing ablation for paroxysmal AF can be used to predict AF recurrence and CVD development. The SCORE2 and SCORE2-OP algorithms have been evaluated exclusively in patients with isolated hypertension; therefore, further studies are needed to determine their applicability in the broader atrial fibrillation population. Full article

The left atrial appendage (LAA) is a highly dynamic anatomical structure that plays a key role in left atrial reservoir function, pressure and volume modulation, and endocrine hormone secretion during sinus rhythm. However, its physiological contribution is profoundly altered in atrial fibrillation (AF). Electrical and structural remodeling, impaired contractility, and blood stasis within the LAA collectively transform this functional component into the principal cardiac source of thrombus formation and embolic events in patients with AF. This review focuses on the conceptual continuum from physiological LAA function in sinus rhythm to its pathological transformation in AF and the evolving rationale for progressively more complete (“radical”) anatomical exclusion A variety of strategies, including systemic anticoagulation therapy, percutaneous device-based exclusion, and surgical closure, are currently employed, each with specific indications, limitations, and procedure-related risks. Beyond summarizing available techniques, this review critically synthesizes mechanistic, anatomical, and clinical data to address unresolved controversies regarding patient selection, residual leaks, device-related thrombosis, and post-procedural antithrombotic management. Finally, emerging directions toward minimizing residual foreign material, reducing thrombogenicity, and achieving durable exclusion are discussed, supporting a more personalized and radical approach to stroke prevention in AF. Full article

Cardiac myosin inhibitors have been shown to improve diastolic function in patients with obstructive hypertrophic cardiomyopathy (HCM). Comparative studies to evaluate the diastolic effects of mavacamten versus alcohol septal ablation (ASA) have yet to be examined. In this single-center retrospective analysis, we compared echocardiographic parameters of diastolic function in adult patients with obstructive HCM treated with mavacamten (n = 23) or ASA (n = 22). Baseline imaging was obtained prior to therapy, and follow-up imaging was obtained five months after ASA and or initiation of mavacamten. Left-sided filling pressures (E/e’) improved with both ASA (18.6 versus 15.3, p < 0.001) and mavacamten (17.4 versus 13.5, p = 0.01). Among patients who underwent ASA, mitral annular tissue velocity (e’) was increased at the lateral annulus (6.0 versus 6.1, p = 0.02) with a trend to improvement at the septum (4.0 versus 5.0, p = 0.14). Similarly, among patients treated with mavacamten, septal e’ was increased (6.0 versus 6.7, p < 0.01) and a trended improvement was observed for the lateral e’ (5.7 versus 7.0, p = 0.06). Mavacamten therapy was also associated with an improvement in the LA volume index (45.6 versus 34.5, p < 0.001). Patients treated with ASA were older, more likely to have used tobacco, and had greater limitation in functional status. In this retrospective analysis, ASA and mavacamten were similarly associated with improvements in echocardiographic parameters of diastolic function and left-sided filling pressures, though mavacamten had a more discernible effect on the left-atrial volume index. Larger studies are required to further characterize the relative efficacy of the two therapeutic modalities. Full article

Cirrhotic cardiomyopathy encompasses structural and functional cardiac abnormalities occurring in patients with liver cirrhosis despite the absence of pre-existing heart disease, yet its diagnosis remains challenging. Although echocardiography is the standard diagnostic tool, circulating biomarkers may provide complementary value when imaging findings are inconclusive. This study evaluated the association between N-terminal pro-B-type natriuretic Peptide (NT-proBNP), soluble Suppression of Tumorigenicity 2 (sST2), and diastolic dysfunction in cirrhotic patients without known cardiac disease. We conducted a prospective case–control study including 83 participants (43 patients with non-alcoholic cirrhosis and 40 healthy controls), assessed clinically, biochemically, and echocardiographically between June 2020 and July 2021. Cirrhotic patients showed significantly higher NT-proBNP (94.17 ± 151.36 pg/mL vs. 19.2 ± 5.47 pg/mL, p < 0.001) and sST2 levels (5.4 ± 2.31 ng/mL vs. 2.4 ± 0.99 ng/mL, p < 0.001). NT-proBNP demonstrated limited diagnostic accuracy for diastolic dysfunction (accuracy 52.6%, sensitivity 50%, specificity 60%, AUC 0.51), but it correlated modestly with congestion markers such as left atrial volume and pulmonary artery systolic pressure. A multimarker model combining age, NT-proBNP, and sST2 substantially improved diagnostic performance for diastolic dysfunction (accuracy 75%, sensitivity 77.1%, specificity 71.4%, AUC 0.925). In conclusion, NT-proBNP is associated with diastolic dysfunction but is influenced by cirrhosis congestion status. A combined NT-proBNP and sST2 assessment enhances diagnostic precision and may aid therapeutic decision-making, particularly regarding congestion and diuretic management in cirrhotic patients. Full article

Background: Glycated hemoglobin (HbA1c) is a parameter commonly used in clinical practice to assess glycemic control in patients with diagnosed diabetes. Hyperglycemia is a strong risk factor for developing cardiovascular (CV) disease. Although there is some evidence that this parameter could also help assess CV health in patients without known carbohydrate metabolism disorders, this is not entirely clear. The purpose of this study was to investigate the relationship between HbA1c and selected echocardiographic parameters in patients without diabetes. Methods: This study was a retrospective analysis of data from 59 patients (females: 72.88%) with a mean age of 54.82 ± 17.34 years without any features of acute illness or exacerbation of chronic diseases hospitalized in the Department of Internal Medicine, Angiology and Physical Medicine of the Medical University of Silesia in Katowice (Poland) in the period between June 2022 and May 2024. Only individuals with HbA1c levels and who have undergone transthoracic echocardiography were included in the analysis. Spearman’s rank correlation test was used for statistical analysis, and a multivariate analysis model was then constructed (adjusted for age, sex, body mass index, low-density lipoprotein cholesterol, systolic blood pressure, hypertension, and smoking). Results: In univariate analysis, HbA1c was found to be significantly correlated with selected parameters relating to left ventricular dimensions and mass, left atrial dimensions, right ventricular systolic function, mitral inflow profile parameters, and tissue Doppler echocardiography. Multivariate analysis did not confirm a significant association between HbA1c and the assessed echocardiographic parameters. Conclusions: Although HbA1c significantly correlates with some echocardiographic parameters, the observed relationships are entirely explained by confounding variables. Full article

Objective: In this study, we aimed to determine the most significant risk factors for 5-year mortality in patients with paroxysmal and persistent drug-refractory tachysystolic atrial fibrillation after undergoing atrioventricular node ablation (AVNA) in combination with the implantation of a permanent three-chamber pacemaker with an implantable cardioverter–defibrillator function (CRT-D). Methods: This prospective single-center cohort study included 101 patients with chronic heart failure (mean age 62 ± 15.5 years; 70.3% male) with paroxysmal or persistent drug-refractory atrial fibrillation who underwent atrioventricular node ablation and CRT-D implantation. All patients received optimal medical therapy before and after undergoing the procedure. Predictors of 5-year mortality were assessed using exploratory machine-learning methods, including random forest and Shapley additive explanations. Results: During 5-year follow-up, 13 cardiovascular deaths were recorded. Five key predictors of mortality were identified: left ventricular ejection fraction, 6 min walk distance, mean pulmonary artery pressure, systolic relaxation coefficient, and degree of mitral regurgitation. The exploratory predictive model showed high accuracy (92%) in terms of classifying the outcomes. Conclusions: Atrioventricular node ablation (AVNA) combined with CRT-D was associated with the observed long-term clinical outcomes observed in patients with drug-refractory tachysystolic atrial fibrillation. The exploratory machine learning analysis identified key mortality-associated factors, which may support future efforts in personalized risk stratification and hypothesis generation. The combination of AVNA and CRT-D was associated with the observed long-term outcomes in this real-world cohort. Full article

Chronic kidney disease (CKD) affects nearly 850 million people worldwide, and most patients with kidney failure are treated with kidney replacement therapy. Despite technological progress, venous congestion remains a major determinant of morbidity and mortality, and is often underdetected by conventional tools such as clinical evaluation, weight changes, blood pressure measurement, or bioimpedance. Point-of-care ultrasonography (PoCUS) has transformed this diagnostic landscape by providing real-time, physiology-based insights into both left- and right-sided filling pressures. In dialysis care, multiple or confluent B-lines and subtle pleural irregularities suggest elevated pulmonary capillary wedge pressure, while a dilated inferior vena cava (IVC) with reduced collapsibility and increased portal vein pulsatility indicate elevated right atrial pressures. Integrating these sonographic findings into a multiparametric assessment that also includes clinical assessment, bioimpedance, and biosensor feedback enhances diagnostic sensitivity and refines fluid management. Advanced practice nurses (APNs) trained in PoCUS can perform focused examinations of the lungs, IVC, portal venous system, arteriovenous access, and skeletal muscle, translating ultrasound findings into physiological interpretations that guide individualized ultrafiltration strategies and patient care. Nutritional ultrasound (NUS) further complements congestion assessment by quantifying muscle mass and quality, linking nutritional reserve and functional status with hemodynamic tolerance. The implementation of structured education, competency-based training, and standardized scanning protocols allows nurses to incorporate these techniques safely and reproducibly into daily dialysis workflows. By integrating PoCUS and NUS within interdisciplinary decision-making, nursing practice evolves from procedural to diagnostic, supporting early identification of congestion, protection of vascular access, and detection of malnutrition. This multiparametric, physiology-guided approach exemplifies the concept of precision nursing, where patient evaluation becomes continuous, individualized, and grounded in real-time pathophysiological insight. Full article

Background: Left atrial strain (LAS) derived from speckle-tracking echocardiography (STE) provides a sensitive, load-dependent measure of atrial function and ventricular filling pressures. Data on LAS in paediatric cardiomyopathies are still scarce; therefore, this study aimed to assess LA phasic function in dilated (DCM) and hypertrophic (HCM) cardiomyopathy and to determine its relationship with clinical and echocardiographic indices of disease severity. Methods: We conducted a cross-sectional case–control study that included 84 children (DCM n = 29, HCM n = 29, control n = 26) who underwent comprehensive clinical and echocardiography evaluation, including LAS parameters (reservoir—LASr; conduit—LAScd; and contractile—LASct). Group comparisons were performed using ANOVA or Kruskal–Wallis tests with post hoc adjustments, and correlations were analysed using Pearson’s or Spearman’s coefficients. Multivariable linear and logistic regression models were adjusted for age, body surface area (BSA), heart rate (HR), and blood pressure (BP) percentiles. Results: LASr and LAScd were significantly reduced in both cardiomyopathy groups compared with controls (p < 0.001), following a graded pattern (DCM < HCM < control). In DCM, lower LASr was independently associated with higher left atrial volume index (LAVi) and elevated E/E′ ratio, whereas in HCM, septal hypertrophy (IVSd Z-score) and log NT-proBNP were dominant determinants of impaired LASr. In logistic regression, LASr (OR = 0.93, p = 0.016) and LAScd (OR = 1.21, p = 0.001) independently predicted severe NYHA/Ross functional class after covariate adjustment, while LASct showed no significant association. Conclusions: These findings demonstrate that LA reservoir and conduit strain are markedly impaired in paediatric cardiomyopathy and are strongly linked to structural remodelling and functional limitation, underscoring their value as sensitive non-invasive markers of disease severity. Full article

Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially in elderly or high-risk patients. Objectives: The present study aims to assess the influence of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary systolic arterial pressure (PASP) ratio on clinical outcomes in patients with aortic stenosis undergoing TAVR and offer valuable insights into patient selection and tailored management strategies for individuals undergoing TAVR. Methods: A retrospective analysis was conducted on 100 patients with AS who underwent TAVR, included in two distinct groups based on their median TAPSE/PASP ratio. Results: Patients were divided according to their median TAPSE/PASP ratio into two groups. Those with lower TAPSE/PASP ratios had a higher incidence of post-procedural atrial fibrillation (AF) (48% vs. 28%, p = 0.0404), lower left-ventricular ejection fraction (LVEF) (41.06% vs. 49.50%, p < 0.0001), a more pronounced inflammatory and hematologic response, and longer hospitalization. Receiver-operating characteristic (ROC) analysis demonstrated modest but significant discrimination rather than high sensitivity or specificity for postprocedural arrhythmias, particularly atrial fibrillation. Conclusions: TAPSE/PASP should be regarded as a clinically useful risk-stratification marker in patients with AS undergoing TAVR, enabling the identification of high-risk patients and optimizing peri-procedural management. Full article

Background/Objectives: Advanced heart failure (AdvHF) characterizes patients with impaired functional capacity, severe systolic or diastolic cardiac function, unplanned visits or hospitalizations, raised natriuretic peptides, and increased mortality. Methods: Ninety-five consecutive AdvHF patients followed in a tertiary academic center in Northwestern Greece (2nd Department of Cardiology, University Hospital of Ioannina) were enrolled over a 30-month period. Three distinctive patterns of management were recognized and assessed: intermittent levosimendan administration to 33 patients, intermittent intravenous furosemide administration to 17 patients, and 45 patients were followed up exclusively on an outpatient basis with frequent visits. MAGGIC, SHFM, and BCN-Bio scores were assessed in all patients and mortality was also assessed. Results: Mean age was 73 (±10) years, and 38% were females, 41% had diabetes mellitus, 41% had chronic obstructive pulmonary disease, 59% had coronary artery disease (CAD), 73% had a history of atrial fibrillation, and 82.1% had a cardiac device implanted. The median duration of follow-up was 24 months (IQ range 14, 30). The 12-month and 30-month mortality rates were 19% and 49%, respectively. Higher rates of 1-year mortality were observed in the levosimendan group (30%). The median 12-month mortality of the three scores was comparable to the actual mortality, but their prognostic value was not satisfactory (AUC < 0.540 and p > 0.05 for all), while they performed better for 30-month mortality (AUC < 0.756 and p > 0.05 for all). In the current study, mortality at 12 months was associated with decreasing diastolic blood pressure (DBP) and sodium levels; the presence of CAD (p < 0.05 for all) and mortality at 30 months was associated with decreasing systolic blood pressure, as well as DBP and left ventricle ejection fraction, but also with the presence of CAD and the use of renin–angiotensin–aldosterone system blockers. Logistic regression-based models incorporating these factors have a greater diagnostic accuracy (AUC = 0.824 and 0.817 for 12 and 30 months, respectively; p < 0.001 for both). Conclusions: AdvHF patients represent a complex population requiring close follow-up and novel strategies to improve survival. Larger studies are needed to refine and update predictive scores in this population. Full article

Background: Pulmonary hypertension is common in left-sided heart valve disease, with historical studies reporting mortality rates up to 31% in severe cases undergoing mitral valve surgery. This study evaluates the impact of severe pulmonary hypertension on outcomes of mechanical mitral valve replacement with posterior leaflet preservation by comparing results with patients having mild-to-moderate pulmonary hypertension. Methods: Prospective analysis of 86 patients with mitral valve disease undergoing mechanical valve replacement with posterior leaflet preservation from March 2015 to September 2016 was conducted. Patients were stratified by pulmonary artery pressure: severe (≥60 mmHg, n = 19) versus mild–moderate (35–59 mmHg, n = 67). Primary outcomes included mortality, complications, and functional recovery at 1, 6, and 12 months. Results: The cohort included 67 patients (77.9%) with mild–moderate pulmonary hypertension and 19 patients (22.1%) with severe pulmonary hypertension. Severe pulmonary hypertension patients demonstrated higher NYHA functional class (73.7% class III vs. 46.2%, p = 0.03), larger left atrial diameter (56.3 ± 9.8 vs. 49.5 ± 6.7 mm, p = 0.01), and higher mean pressure gradients (14.4 ± 5.3 vs. 11.3 ± 5.0 mmHg, p = 0.025). Mortality was 5.3% in the severe group versus 0% in the mild–moderate group (p = 0.331). Patients with severe pulmonary hypertension required longer ICU stays (6.3 ± 3.7 vs. 4.7 ± 2.2 days, p = 0.024) but showed no significant differences in ventilation time, reoperation rates, or major complications. At the 12-month follow-up, both groups achieved equivalent outcomes in pulmonary artery pressures, left ventricular function, and cardiac dimensions. Conclusion: In this study with a relatively small sample size, severe pulmonary hypertension was associated with significantly longer intensive care unit stay but not with higher mortality compared to mild–moderate pulmonary hypertension, with both groups attaining comparable functional and hemodynamic parameters at 12 months after mechanical mitral valve replacement with posterior leaflet preservation. Full article

Pressure overload in non-treated or resistant hypertension (HTN) increases the risk of heart failure (HF) as well as the occurrence of fatal ventricular arrhythmias and stroke-provoking atrial fibrillation (AF), while perturbed connexin-43 (Cx43) and Cx40 might be involved. In addition, kidney dysfunction may facilitate hemodynamic volume overload and congestive HF. We investigated the impact of volume overload on Cx43 and Cx40 in right and left heart atria of hypertensive pressure overloaded Ren-2 transgenic (TGR) strain and normotensive Hannover Sprague Dawley (HSD) rats, as well as the efficacy of renin–angiotensin blockade with trandolapril and losartan. Key novel findings revealed lower levels of Cx43 and Cx40 proteins in left as well as right heart atria in pressure overloaded hypertensive rats compared to normotensive rats. There was a significant decrease in Cx43 and Cx40 proteins due to volume overload in both atria of normotensive as well as hypertensive rats. Treatment with trandolapril increased Cx43 and Cx40 levels in right and left heart atria of normotensive as well as hypertensive volume overloaded rats. While losartan increased Cx43 and did not affect Cx40 in left and right heart atria of volume overloaded rats. Findings of this study point out that right heart atria of normotensive as well as hypertensive rats are more susceptible to volume overload comparing to the left heart atria. Trandolapril attenuated pro-arrhythmic downregulation of Cx43 and Cx40 in atria of volume overloaded normotensive as well as hypertensive rats. This fact as well as examining AF inducibility requires further investigation. Full article

The relationship of diabetes mellitus (DM) with cardiovascular mortality and morbidity has been widely established. Diabetic cardiomyopathy (DBCM) has been increasingly recognized as the development of cardiac dysfunction accompanied by heart failure (HF) symptoms in the absence of obvious causes like coronary artery disease (CAD), hypertension (HTN) or valvular diseases. The objective of this review is to critically appraise the role of echocardiography in the diagnosis and prognostic stratification of DBCM. Echocardiography remains the first-line imaging modality due to its availability, repeatability, non-invasive nature and ability to assess structural and functional changes. Classical echocardiographic indices such as left ventricular hypertrophy and systolic and diastolic dysfunction assessment provide valuable information but they lack sensitivity, often remaining normal until advanced stages of DBCM. Recently developed echocardiographic modalities, including strain imaging, myocardial work indices and left atrial strain, may allow for earlier detection of subclinical myocardial dysfunction, having important prognostic implications. However, these advanced modalities require high imaging quality, expertise and standardization, being subject to technical and physio-logical limitations. Stress echocardiography, particularly exercise-based protocols, is an increasingly recognized, valuable tool for unmasking exertional abnormalities in filling pressures, myocardial reserve and pulmonary pressures that are not evident at rest. Until now, stress echocardiography requires validation in large cohorts to assess its prognostic power. This review highlights the importance of timely recognition of DBCM, underscores the advantages and disadvantages of current echocardiographic approaches and outlines future perspectives in multimodality imaging to improve patient outcomes. Full article