Search Results (754)

Cardiac arrest is a way of demise of patients who are affected by heart failure (HF), being more frequent in those with HF with a reduced left ventricular ejection fraction (HFrEF), and is, as such, responsible for 30–50% of cardiac death. Specific data on the risk of sudden cardiac death (SCD) related to HF with a preserved ejection fraction (HFpEF) and HF with a mildly reduced ejection fraction (HFmrEF) are lacking, as well as data regarding ventricular arrhythmias in this population. Considering the 0.3% person/year incidence rate of investigator-reported ventricular tachycardia (VT) and ventricular fibrillation (VF), the rate of SCD in the analyzed population seems to be 1.3% per year. Age, gender, history of diabetes and myocardial infarction, left bundle branch block (LBBB) on electrocardiogram (ECG), and a natural logarithm of N-terminal pro B-type natriuretic peptide (NT-proBNP), identified a subgroup of HFpEF patients with a higher risk (5-year cumulative incidence of 11%) of sudden death (SD). In HFpEF patients, both glifozins and finerenone did not demonstrate a beneficial effect on SCD incidence in comparison to placebo. A significantly lower rate of SCD emerged in patients who were treated with dapaglifozin (10 vs. 26 pts) among patients with HF with an improved ejection fraction (HFimpEF), who were defined as patients with a previous left ventricular ejection fraction (LVEF) < 40%. Promising methods discussed include cardiac magnetic resonance, myocardial scintigraphy, genetic assessment, and electrophysiologic studies for predicting SCD in those patients. In conclusion, arrhythmic SCD in HFpEF patients should not be considered merely as an effect of VT/VF; bradyarrhythmia is probably more frequent and dangerous. The effects of drugs in preventing SCD in HFpEF have not been demonstrated yet. Full article

Background: Pediatric out-of-hospital cardiac arrest (OHCA) is rare and associated with poor outcomes. Evidence from physician-staffed EMS systems remains limited. This study aimed to describe the incidence, presenting rhythms, EMS response intervals, and outcomes of pediatric OHCA, and to describe incidence, presenting rhythms, EMS response intervals, and prehospital outcomes in a local physician-staffed EMS system. Methods: We conducted a retrospective study of all pediatric (0–17 years) OHCA cases managed by the ASL Lecce physician-staffed EMS (southern Italy) between 2013 and 2025. Data were abstracted from standardized records. Variables included demographics, initial rhythm, EMS response intervals, temporal patterns, and return of spontaneous circulation (ROSC). The primary outcome was ROSC during prehospital care. Results: Twenty-seven cases were identified, corresponding to a cumulative incidence of 22.9 per 100,000 children over the study period (annualized incidence 1.73 per 100,000 children-year). Mean age was 11.9 ± 5.5 years (median 15); 59% were male. Initial rhythms were asystole in 81% and ventricular fibrillation (VF) in 19%; no pulseless ventricular tachycardia (pVT) or pulseless electrical activity (PEA) were recorded. Five patients had shockable rhythms, with seven shocks delivered overall. Mean time intervals were: event-to-call 1.0 ± 0.6 min, call-to-arrival 10.3 ± 4.1 min, event-to-arrival 11.3 ± 4.4 min. Arrests clustered during daytime (63%) and summer (41%). ROSC occurred in three patients (11%), two with VF and one with asystole; all arrests with ROSC were daytime events. In descriptive comparisons, ROSC cases showed a shorter call-to-arrival interval (T1–T2), whereas no consistent pattern was observed across all prehospital time intervals. Conclusions: Pediatric OHCA in this Italian physician-staffed EMS was infrequent, usually presented with asystole, and rarely achieved ROSC. Shockable rhythms were associated with better outcomes. Given the small sample size, findings related to response times should be interpreted with caution. System preparedness should include pediatric-specific training, early defibrillation access, and multicenter registries to improve care and track outcomes. Full article

Acute myocardial infarction (AMI) with reduced or preserved left ventricular ejection fraction (LVEF) is associated with distinct prognoses and differing risk factor profiles. However, the use of new-onset atrial fibrillation (NOAF) burden in risk stratification of AMI patients, particularly across LVEF subgroups, remains unclear. We analyzed consecutive AMI patients without prior AF who developed their first in-hospital AF episode between 2014 and 2022. The patients were stratified by LVEF (AMIrEF: <40%; AMIpEF: ≥40%) and AF burden (>10.87% vs. ≤10.87%). The primary endpoint was a major adverse cardiovascular event (MACE), including cardiovascular death and heart failure hospitalization. Among 644 patients with LVEF data, 178 (27.6%) were AMIrEF and 466 (72.4%) were AMIpEF; 248 (38.5%) had a high AF burden. Over a median follow-up time of 4.2 years, the MACE incidence was 18.9 and 23.0 per 100 person-years in low- and high-burden AMIrEF patients, and 7.2 and 17.5 in AMIpEF patients, respectively. After multivariable adjustment, a high NOAF burden was significantly associated with increased MACE in AMIpEF patients [hazard ratio (HR): 2.63, 95% confidence interval (CI): 1.82–3.79], but not in AMIrEF patients [HR: 1.29, 95% CI: 0.79–2.10]. Propensity-matched analysis yielded concordant results [AMIrEF: 1.15 (0.69–1.90); AMIpEF: 2.45 (1.75–3.45)]. In conclusion, a high NOAF burden is strongly associated with adverse long-term cardiovascular outcomes in AMIpEF patients, highlighting its potential utility for risk stratification in this population. Full article

Tricuspid regurgitation (TR) is a prevalent cardiovascular disorder with significant clinical impact. TR is frequently silent and underdiagnosed and is estimated to impact over 70 million people globally. Characterized by retrograde blood flow from the right ventricle into the right atrium due to incomplete valve closure, TR leads to right heart dilation, systemic congestion, and eventually right-sided heart failure. Importantly, TR may contribute to the onset of atrial fibrillation (AF), the most common sustained arrhythmia, affecting approximately 59 million individuals worldwide. Despite its growing clinical importance, the pathophysiology of TR remains incompletely understood, and current animal models of TR, based on direct valve manipulation, limit translational applicability. We present a novel, minimally invasive porcine model of TR established via femoral/jugular vein catheterization with deployment of an inferior vena cava (IVC) filter. The filter partially impedes tricuspid valve closure, inducing TR without valvular injury. Validation was achieved through multimodal imaging, including fluoroscopy, echocardiography, and electrocardiography, confirming hallmark features of TR, including right atrial and ventricular enlargement and arrhythmic activity. This model provides a reproducible, minimally invasive platform for studying selected features of TR progression. Its minimally invasive nature and preservation of native valvular structure make it a useful preclinical platform for mechanistic and translational research. Full article

Background and Clinical Significance: Patients with a left ventricular assist device (LVAD) are at risk of ventricular arrhythmias, which are generally hemodynamically tolerated if they occur. In such cases, patients may experience painful implantable cardioverter-defibrillator (ICD) shocks. Case Presentation: A 71-year-old patient with a history of dilated cardiomyopathy caused by a phospholamban (PLN) gain-of-function mutation, with a primary prevention ICD and an LVAD, presented with multiple ICD shocks which she experienced as painful and traumatic. She was found to have ongoing ventricular fibrillation with apparent hemodynamic stability. Conversion to sinus rhythm was achieved through intravenous administration of antiarrhythmic drugs followed by external defibrillation using stacked shocks. Due to the traumatic nature of the shocks, the shock function of the ICD was turned off. Nearly two months later, the patient presented for a second time and was again found to have ventricular fibrillation which had been present for at least six weeks. Conversion to sinus rhythm was unsuccessful and the patient was discharged to her home with an advanced care plan and her LVAD was deactivated. The patient died two months later. Conclusions: Patients with an LVAD can remain hemodynamically stable for prolonged periods of time during ventricular arrhythmias. ICD shocks are therefore mostly experienced as painful and even traumatic. Therefore, the routine use of ICD shock therapy in patients with an LVAD should be reconsidered. Adjustment of ICD programming to higher rates and longer detection may be warranted. Further investigation is warranted regarding a switch to devices with an alarm function rather than therapies for tachyarrhythmias. Full article

Background: Perioperative cardiovascular risk assessment remains challenging in non-cardiac surgery, particularly in older patients and those with multiple comorbidities. Traditional models rely largely on clinical history and may not fully reflect current cardiovascular functional status. This study aimed to derive and assess the apparent performance of a new composite score, PERFORM-CV, integrating clinical, laboratory, and echocardiographic data. Methods: We conducted a prospective two-center cohort study including 503 non-cardiac surgical patients with cardiovascular comorbidity. The Revised Cardiac Risk Index (Lee/RCRI) and the AUB-HAS2 index were calculated according to their original published definitions as raw point totals ranging from 0 to 6; without additional normalization. The PERFORM-CV score was derived from univariable and multivariable analyses, with continuous predictors dichotomized using ROC-derived thresholds. Results: Emergency admission, chronic heart failure, and elevated serum creatinine remained independently associated with in-hospital mortality. Lower left ventricular ejection fraction, lower mitral annular plane systolic excursion (MAPSE), lower hemoglobin, and atrial fibrillation also contributed to the final composite score. ROC analysis showed good discrimination for PERFORM-CV (AUC 0.852; 95% CI 0.806–0.897; p < 0.001), comparable to Lee/RCRI (AUC 0.860; 95% CI 0.818–0.901; p < 0.001) and higher than AUB-HAS2 (AUC 0.779; 95% CI 0.731–0.826; p < 0.001). Conclusions: PERFORM-CV showed good apparent discrimination in the derivation cohort and may complement established bedside risk tools by incorporating echocardiographic and laboratory data. The ROC-derived thresholds should be interpreted as data-driven derivation cut-offs; resampling-based internal validation and external validation are required before broader clinical use. Full article

Introduction: The prevalence of maternal arrhythmias is increasing with advanced maternal age. Current evidence regarding the association between maternal arrhythmias and pregnancy outcomes remains inconsistent. This meta-analysis aimed to define the associations between adverse pregnancy outcomes and specific maternal arrhythmias. Methods: We conducted a systematic review and meta-analysis using the PRISMA guidelines. We searched MEDLINE, Scopus, and Cochrane on the 4th of November 2025 for cohort and case–control studies comparing pregnant women with cardiac arrhythmias to those without. Primary outcomes included preeclampsia, stillbirth, preterm delivery, and small-for-gestational-age (SGA) neonates. Data were pooled using random-effects models with subgroup analyses by arrhythmia type. Results: Nineteen studies were included. Maternal arrhythmias were associated with a significantly increased risk of preeclampsia (RR = 1.46, 95% CI [1.10, 1.93]), preterm delivery (RR = 1.39, 95% CI [1.12, 1.72]), and stillbirth (RR = 2.09, 95% CI [1.11, 3.91]). Ventricular tachycardia/fibrillation was linked to the most severe outcomes, including a four-fold increase in stillbirth (RR = 4.20, 95% CI [3.75, 4.71]) and a fifteen-fold increase in neonatal death (RR = 15.47, 95% CI [3.45, 69.45]). Supraventricular tachycardia was independently associated with preeclampsia (aRR = 1.14, 95% CI [1.04, 1.24]), preterm delivery (aRR = 1.76, 95% CI [1.39, 2.23]), and SGA neonates (aRR = 5.93, 95% CI [1.23, 28.55]). Risks were notably higher in the general population compared to women with known heart disease, supporting an “unmasking” of occult vulnerability. Conclusions: Maternal arrhythmias are associated with distinct fetal risks beyond maternal hemodynamics. Ventricular tachycardia was associated with severe outcomes, likely reflecting acute compromise, while supraventricular tachycardia was linked to signs of chronic vascular dysfunction. These findings suggest arrhythmias as possible sentinels for placental insufficiency, necessitating enhanced surveillance. Full article

Background/Objectives: Acute coronary syndromes (ACS) encompass a spectrum of clinical entities from unstable angina to non–ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI), all associated with significant morbidity and mortality. Inflammation plays a central role in the pathophysiology of ACS, contributing to atherosclerotic plaque destabilization, myocardial injury, and adverse clinical outcomes. Inflammatory biomarkers, together with N-terminal pro–B-type natriuretic peptide (NT-proBNP), are increasingly used for risk stratification, yet their prognostic value across different ACS presentations remains unclear. This study aimed to assess the prognostic value of inflammatory status in patients with acute coronary syndromes in a single-center cohort. Methods: This prospective observational study included 100 consecutive patients with ACS and elevated inflammatory biomarkers, enrolled in 2024–2025 at a tertiary cardiovascular center. Inflammatory status was assessed by using C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII); NT-proBNP was also measured. The primary endpoint was in-hospital MACE, defined as cardiovascular death, recurrent myocardial infarction, stroke, urgent coronary revascularization, or acute heart failure requiring escalation of therapy. Multivariable logistic regression and ROC analyses were performed. Results: Among the 100 ACS patients, half experienced in-hospital MACE. Compared with those without events, patients with MACE were older (p = 0.003) and had higher inflammatory biomarkers—CRP (p < 0.001; strongest association), NLR (p = 0.030), and SII (p = 0.042)—as well as higher NT-proBNP (p = 0.002). Patients with MACE also showed reduced renal function (p < 0.001) and lower left ventricular systolic function, reflected by reduced LVEF (p = 0.001), indicating concomitant renal impairment and ventricular dysfunction. Hypertension was more prevalent in the MACE group (p = 0.028), and new-onset atrial fibrillation was significantly more common among these patients (p < 0.001). In multivariable analysis, LVEF emerged as an independent predictor of short-term outcomes (OR 0.934 per 1% increase; p = 0.047). Conclusions: Inflammatory activation appears closely linked to the occurrence of in-hospital adverse events in patients with acute coronary syndromes. While left ventricular ejection fraction remained an independent determinant of short-term outcomes, inflammatory biomarkers may provide complementary insight into the inflammatory burden accompanying ACS. Full article

Background/Objectives: SGLT2 inhibitors (SGLT2i) became a cornerstone of heart failure with preserved ejection fraction (HFpEF) pharmacotherapy in the recent years However, their actual influence on pulmonary veins isolation (PVI) efficacy in this population remains unclear. The aim of the study was to evaluate an impact of SGLT2i on one-year first-time PVI efficacy and clinical course of patients with HFpEF and atrial fibrillation (AF). Methods: This is a single-center retrospective study including 105 HFpEF and AF individuals, who underwent the first-time PVI (51 (48.6%) males; mean age at PVI: 65.2 ± 9.5 years). 53 patients treated with SGLT2i (hospitalized for PVI since 2023) and 52 patients without such a treatment (2020-mid-2023) were assessed according to the clinical presentation and hard endpoints. The primary endpoint was arrhythmia recurrence rate. The secondary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCE). Results: SGLT2i therapy was associated with greater symptom reduction after PVI (90.6% vs. 62.7%; p < 0.001). There was a statistical trend toward reduced all-cause mortality in SGLT2i (0% vs. 5.8%; p = 0.076). Although overall AF recurrence rates were similar between subgroups, Kaplan–Meier analysis showed a non-significant trend toward lower recurrence in the SGLT2i group (p = 0.096). The analysis did not reveal significant differences in terms of cardiovascular hospitalizations, stroke/transient ischemic attack (TIA) and MACCE incidence between the subgroups. Non-vitamin K antagonist oral anticoagulants (NOACs) administration was associated with a lower risk of AF recurrence (OR 0.27; 95% CI 0.096 to 0.77; p = 0.014). MACCE occurrence was predicted by higher CHA₂DS₂-VA (Congestive heart failure, Hypertension, Age ≥ 75, Diabetes, Stroke, Vascular disease, Age 65–74) (OR 5.63; 95% CI 1.57–20.12; p = 0.008), lower left ventricular ejection fraction (LVEF) (OR 0.74; 95% CI 0.57–0.99; p = 0.028) and (vitamin K antagonists) VKA use (OR 97.44; 95% CI 3.2–2962.57; p = 0.009). Conclusions: SGLT2i pharmacotherapy in the study population was linked to higher efficacy in symptom reduction, with a probability of AF recurrence and all-cause mortality reduction, which may suggest a potential beneficial role of SGLT2i in this cohort. Full article

Background: Atrial fibrillation (AF) frequently coexists with heart failure (HF) and worsens clinical outcomes. However, factors associated with AF in HF with preserved (HFpEF) and mildly reduced ejection fraction (HFmrEF) remain poorly defined. This study aimed to identify clinical, laboratory, and echocardiographic determinants of AF in these HF phenotypes. Methods: This retrospective single-center observational study included 700 consecutive patients with HF hospitalized between January 2018 and December 2023. The median age was 74 years (IQR 66–80). Women predominated in the cohort (55.3% vs. 44.7%, p < 0.001). Based on echocardiographically assessed left ventricular ejection fraction, patients were stratified into groups with preserved (≥50%), mildly reduced (41–49%), and reduced (≤40%) ejection fraction. Determinants of AF were evaluated using univariate and multivariate logistic regression analyses, and model discrimination was assessed using ROC analysis. Results: Strongest determinants of AF in our patients with HFpEF and HFmrEF were left atrial size (OR 1.114 per mm increase; 95% CI 1.054–1.177; p < 0.001), moderate and severe tricuspid regurgitation (OR 4.092; 95% CI 1.977–8.466; p < 0.001 and OR 6.957; 95% CI 2.482–19.499; p < 0.001), male gender (OR 1.680; 95% CI 1.076–2.621; p = 0.022) and advanced age (OR 1.070 per year; 95% CI 1.032–1.109; p < 0.001). Conclusions: In patients with HFpEF and HFmrEF, AF is strongly associated with atrial remodeling, with left atrial enlargement as the key structural determinant. The identified associations may contribute to an improved understanding of AF in HFpEF and HFmrEF; however, their potential role in risk stratification requires validation in prospective studies. Full article

Background: Left atrial appendage closure (LAAC) is an established alternative to oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation who are at high risk of thromboembolic events or bleeding complications. Methods: In this single-center retrospective study, we analyzed 70 consecutive patients who underwent successful LAAC with the Watchman™ device between 2012 and 2024. Acute procedural outcomes, long-term thromboembolic and bleeding events, transfusion requirements and mortality were evaluated. Mean follow-up duration was 1210 days. Results: Procedural success was achieved in 98.6% of cases with a low periprocedural complication rate. Ischemic stroke/transient ischemic attack occurred in 2.8% of patients; no hemorrhagic strokes or stroke-related deaths were observed. LAAC resulted in a significant reduction in both the number (144 vs. 56 events; 2.36 vs. 1.55 events per patient, p < 0.05) and severity of bleeding events. Nonetheless, 42.9% of patients required bleeding-related hospitalization after implantation, predominantly within the first 6 months during dual antiplatelet therapy. Overall mortality was 40% with a 12% yearly mortality rate; heart failure and infections were leading causes of death. Pre- and postprocedural transfusion requirements were independently associated with a six-fold increase in mortality risk (HR = 5.97). Conventional risk scores (CHA₂DS₂-VASc, HAS-BLED) failed to predict transfusion needs; atrial enlargement, right ventricular dysfunction, smoking and alcohol consumption were associated with higher risk. Conclusions: LAAC is a safe and effective alternative to long-term anticoagulation, significantly reducing bleeding burden without increasing thromboembolic mortality. Persistent postprocedural bleeding remains a major determinant of long-term prognosis, underscoring the need for individualized, multidisciplinary post-implant management. Full article

Background and Clinical Significance: Acetazolamide is routinely used post-cataract surgery to prevent intraocular pressure (IOP) spikes. Rare non-cardiogenic pulmonary edema (NCPE) cases highlight its risks in elderly comorbid patients. This report details acetazolamide-induced NCPE and provides a review of current evidence from the literature. Case Presentation: A 74-year-old male with chronic kidney disease, atrial fibrillation, and aortic aneurysm repair received 250 mg oral acetazolamide post-cataract extraction. Clinical, imaging, and lab data were documented during Intensive Care Unit (ICU) stay. PubMed/Google Scholar review identified similar cases. Within 30 min, severe hypoxemia with SpO₂ (peripheral oxygen saturation) of 77%, accompanied by tachypnea and hypertension, necessitated endotracheal intubation. Echocardiography showed preserved left ventricular (LV) function; computed tomography (CT) confirmed bilateral alveolar opacities without cardiomegaly or embolism, indicating permeability-mediated NCPE. Lung-protective mechanical ventilation and vasopressor therapy resulted in hemodynamic and respiratory stabilization. On day 4, ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii resolved with targeted antibiotic therapy. The patient made a full recovery following ICU discharge. To date, nine prior cases have been reported, alongside 31 entries in EudraVigilance reflecting a 19.4% mortality rate. Conclusions: Rapid-onset NCPE from acetazolamide involves endothelial injury, distinct from cardiogenic pulmonary edema. Early recognition, drug cessation, and admission to the intensive care unit (ICU) are vital components of therapeutic intervention. Risk stratification and pharmacovigilance are recommended for perioperative safety. Full article

Background/Objectives: There are significant gaps in knowledge regarding the heterogeneity of heart failure (HF) phenotypes, particularly among patients with preserved left ventricular ejection fraction (HFpEF). Our aim was to identify phenotypes within the hospitalized North-Eastern Romanian HFpEF cohort and their impact on short-term outcomes. Methods and Results: We derived a cluster model from 924 patients with HFpEF hospitalized over an 18-month interval in the Internal Medicine II Department of the “Sf. Spiridon” Emergency Clinical County Hospital in Iași, Romania. The median age of the patients was 74 years [range 30–101], 59.8% were women, and the most frequent comorbidities were arterial hypertension (93.2%), valvular heart disease (68.7%), atherosclerotic cardiovascular disease (ASCVD, 64.6%) and atrial fibrillation (43%). Statistical analysis identified five distinct phenotypes: cluster 1 (21.6% of patients) consisted of normal-weight patients with valvular disease predominance; cluster 2 (18.2%) described a severe cardiometabolic phenotype; cluster 3 (19.6%) defined a young, hypertensive, and atherosclerotic phenotype; cluster 4 (21.26%) described a hypertensive–atrial fibrillation phenotype; and cluster 5 (18.9%) included elderly, hypertensive non-diabetic patients with severe vascular burden (ASCVD 100%). Conclusions: This study defines five distinct phenotypes within the HFpEF population in our region which differ in terms of clinical characteristics and heart failure pharmacological therapy. These results confirm the significant heterogeneity of HFpEF. The identified phenotypes were not associated with significant differences in composite short-term outcomes, including in-hospital mortality and 30-day rehospitalization for heart failure. Full article

Takotsubo cardiomyopathy (TCM) is characterized by contractile impairment of the left ventricular apex and excessive contraction of the base of the heart, resulting in transient cardiac dysfunction. Here, we report a case of an implantable cardioverter defibrillator (ICD) that was activated for ventricular fibrillation (VF) caused by TCM one day after removal of maxillomandibular exostoses. The patient was a 53-year-old female who underwent removal of maxillomandibular exostoses in the mid-palate area, bilateral molars of the maxilla, and bilateral mandibular premolars under general anesthesia. Because the patient had a history of VF, an ICD was implanted. Removal was performed without any problems, but VF occurred on the following day, and the ICD was frequently required. Ultrasound examination suggested contractile impairment of the ventricular apex and excessive contraction of the base. Examinations led to a diagnosis of TCM using the Mayo Clinic diagnostic criteria. VF was resolved by administration of amiodarone hydrochloride. The wound in the oral cavity healed favorably, and the patient was discharged from hospital on day 33 without further occurrence of VF. This case highlights important perioperative risk assessment and anesthesia considerations for oral and maxillofacial surgeons managing medically compromised patients undergoing oral surgery. Full article

Background: Visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) are increasingly recognized as relevant contributors to cardiometabolic alterations and subclinical myocardial dysfunction, independently of overall obesity. Their pathogenic role extends beyond simple fat accumulation, encompassing inflammatory activation, lipotoxicity, and altered myocardial metabolism. Objective: This narrative review synthesizes current evidence on the relationships between VAT/EAT and myocardial strain parameters, with emphasis on subclinical cardiovascular risk detection and nutritional interventions. Methods: We conducted a comprehensive review of studies published between 2003–2025, focusing on imaging-based assessments of adipose tissue distribution and strain parameters using echocardiography, computed tomography, and cardiac magnetic resonance. Results: Increased EAT and, to a lesser extent, VAT showed significant associations with impaired global longitudinal strain (GLS) across imaging-based studies. In patients with type 2 diabetes, VAT mediated a substantial proportion of the association between insulin resistance and left ventricular dysfunction. Mediterranean diet adherence was associated with lower epicardial adipose tissue burden, while higher EAT was associated with persistent atrial fibrillation among patients with atrial fibrillation undergoing catheter ablation. Speckle-tracking echocardiography consistently showed superior prognostic value compared to ejection fraction for detecting subclinical dysfunction. Conclusions: VAT and EAT represent important mechanistic links between body composition and early myocardial dysfunction, identifiable through advanced strain imaging before clinical disease becomes apparent. These findings support the integration of multimodal cardiac imaging and nutritional interventions into cardiovascular prevention strategies, providing novel opportunities for early risk stratification and personalized treatment approaches. Full article