Outlet septum ventricular septal defects (VSDs) are notably more prevalent in North-Eastern India and often associated with aortic valve prolapse, leading to a need for surgical intervention. While surgical methods remain the conventional approach, there is an opportunity to explore the effectiveness of transcatheter closure techniques. This study aimed to assess the effectiveness and follow-up of transcatheter closure for outlet and outlet muscular type VSDs using three distinct devices: Amplatzer ADO II, KONAR MF VSD Occluder, and Cocoon VSD Occluder. This Descriptive study with follow-up observation up to 1 year was conducted at Health City Hospital in Guwahati, India, from March 2023 to November 2025, involving 21 patients who met the criteria for inclusion. Among the 21 patients, transcatheter closure was successfully achieved in 16 individuals, resulting in a success rate of 76.2%. The mean diameter of the VSDs was 3.8 mm, with 66.6% of the cases showing pre-existing aortic valve prolapse. Closure attempts were unsuccessful in five patients, who subsequently received surgical intervention. In the successful cases, the Amplatzer ADO II was implanted in 7 patients (43.7%), the KONAR MFO in 8 patients (50%), and the Cocoon VSD occluder in 1 patient (6.3%). Seven patients exhibited mild intra-device residual shunts, and 37.5% (6/16) experienced a transient increase in aortic regurgitation (AR) after 24 hours post-procedure. Importantly, follow-up after one year showed static or non-progression of pre-existing AR, with worsening of AR (moderate severity) observed only in one patient, and the majority of residual shunts resolved. No major complications like outflow obstruction or device embolization were reported in the present study. The results indicate that transcatheter closure of outlet and outlet muscular type VSDs is a promising option for selected patients, yielding positive short- to mid-term outcomes. Further long-term follow-up will enhance our understanding of the procedure's safety and efficacy, paving the way for broader application of this technique in clinical practice.
Cancer treatments such as chemotherapy and radiotherapy significantly impact the cardiovascular system. While cardiac toxicity is well characterized, the effects on the aorta, the body's largest artery, remain less understood. Given that aortic weakening may lead to life-threatening conditions such as aneurysm formation and rupture, understanding these effects is crucial for improving long-term vascular health in cancer survivors. This narrative review synthesizes findings from six selected studies comprising clinical investigations and reviews. It examines the impact of radiotherapy, chemotherapy, cancer-related systemic factors, and incidental aortic findings from radiotherapy planning computed tomography scans, analysing their roles in aortic pathology progression or stabilization. In this narrative review of six selected studies, radiotherapy was consistently associated with slower aneurysm expansion (~ 1.1 mm/year vs. 2.7 mm/year), suggesting a paradox wherein radiation-induced fibrosis and modulation of inflammatory processes may stabilize the aortic wall. Chemotherapy showed no significant effect on aneurysm growth, with rates comparable between treated patients and controls (~ 2.3 vs. 2.4 mm/year). Cancer-induced sarcopenia and inflammation contributed to adverse aortic remodelling within one year. Additionally, a high prevalence (9.3%) of thoracic aortic dilatation was identified via opportunistic screening on radiotherapy planning CTs, emphasizing an opportunity for earlier detection and intervention. The complex interplay between cancer therapies and aortic biology reveals a potentially counterintuitive stabilization of aortic pathology following radiotherapy, in contrast to the neutral effects of chemotherapy and the deleterious influence of cancer-related systemic changes. Radiotherapy planning CT offers an underutilized avenue for vascular screening. Future prospective studies are essential to disentangle these paradoxes and translate mechanistic insights into strategies that protect vascular integrity while optimizing cancer treatment outcomes.
The burden of premature atherosclerotic cardiovascular disease (ASCVD) in Egypt remains disproportionately high, and current international dyslipidemia guidelines have proven insufficient in achieving target lipid levels in the local population. This underscores the necessity for a context-specific national guideline. The 2025 Egyptian Guidelines for the Management of Dyslipidemia were developed through a structured consensus process led by an expert panel of cardiologists, endocrinologists, and representatives from national medical societies. The methodology included two rounds of blind voting followed by a consensus meeting to ensure rigorous evaluation. The guidelines emphasize the importance of early detection of dyslipidemia through systematic screening programs and prioritize lifestyle interventions as the cornerstone of management. A novel "extreme-risk" category was introduced to identify patients requiring intensified lipid-lowering strategies, including early initiation of combination pharmacotherapy. Additionally, the recommendations highlight the critical role of ongoing monitoring and follow-up to sustain long-term lipid control and reduce cardiovascular risk. The current guidelines provide a simplified, yet evidence-based framework tailored to the Egyptian population, aiming to optimize dyslipidemia management, reduce ASCVD-related complications, and improve overall cardiovascular outcomes.
Atrial fibrillation and flutter (AFF) are two of the most common cardiac tachyarrhythmias. The burden of AFF is increasing globally, with a particularly rapid increase in the Eastern Mediterranean region (EMR) due to economic and lifestyle changes. Despite extensive research on AFF, regional variations remain understudied. To analyze the burden and risk factors for AFF in the EMR using the Global Burden of Disease (GBD). Systematic analysis. Data from the GBD 2021 were used to evaluate the incidence, prevalence, disability-adjusted life years (DALYs), and deaths associated with AFF stratified by age, sex, and sociodemographic index (SDI) from 1990 to 2021. In addition, deaths and DALYs of AFF attributable to risk factors were estimated. Accompanying 95% uncertainty intervals (UIs) were provided to reflect the combination of data and estimates, and findings were presented as absolute counts and age-standardized rates. From 1990 to 2021, the absolute number of incidence and prevalence of AFF in the EMR increased by 161.9% (from 64362.4 [48684.7-85763.7] in 1990 to 168555.0 [129706.9-220844.2] in 2021) and 162.4% (from 617721.6 [482076.0-807810.5] in 1990 to 1620763.1 [1270893.6-2108347.5] in 2021), respectively. From 1990 to 2021, the EMR revealed significant increases in the age-standardized incidence (3.0%, 95% UI 1.1-4.8) and prevalence (4.6%, 2.9-6.3) of AFF, with women experiencing greater increases than men did. The burden of AFF increased across all ages, with the incidence increasing by 161.9% and the prevalence increasing by 162.4%. From 2019 to 2021, the age-standardized rates of incidence, prevalence, DALYs, and deaths remained stable, with no significant changes. High systolic blood pressure was the leading risk factor, contributing to 25.5 age-standardized DALYs per 100,000 in 2021, whereas a high body mass index showed the largest increase in the attributable burden. Compared with low-SDI nations, high-SDI countries presented higher prevalence and incidence rates but lower death rates. Age-specific analysis revealed a sharp increase in the AFF burden with age, particularly among women aged 95+ years. The burden of AFF in the EMR increased from 1990 to 2021, with increasing incidence, DALY, and death rates. High systolic blood pressure and high body mass index are key contributors to these conditions. These findings underscore the need for public health interventions, including improved hypertension and obesity management, lifestyle modifications, and early detection strategies.
Atrial fibrillation (AF) is the most common arrhythmias. Other than pharmacotherapy, catheter ablation is preferred especially for symptomatic paroxysmal AF or persistent AF. However, recurrence of atrial fibrillation following catheter ablation can occur due to several factors. Hyperthyroidism is known as a factor in atrial fibrillation pathogenesis but its role in AF recurrence following ablation is not known yet. Therefore, we aimed to assess the recurrence risk after catheter ablation in patients with a history of hyperthyroidism. Systematic searching was performed through three databases: MEDLINE, EMBASE, and SCOPUS for studies reporting the recurrence of AF (hazard ratio) following catheter ablation in patients with a history of hyperthyroidism. The risk of bias assessment of included studies was performed using quality in prognosis studies (QUIPS). Meta-analysis (random effect model and inverse variance) was conducted using RevMan software version 5.4. Four studies involving 837 subjects were included. Pooled analysis shows a higher risk of recurrence of atrial fibrillation following catheter ablation in patients with history of hyperthyroidism (HR 1.86 [CI 95% 1.26-2.75]; I2 38%). Subgroup analysis showed patients with amiodarone-induced hyperthyroidism (AIH) had a higher risk of atrial fibrillation recurrence (HR 2.31; CI 95% 1.49-3.58; I2 0%) compared to non-AIH. However, two studies on AIH showed moderate risk of bias. History of hyperthyroidism was found as the risk of recurrence of atrial fibrillation after a single ablation procedure. Patients with amiodarone-induced hyperthyroidism have a higher recurrence risk. Further studies with larger participants are needed for subgroup analysis on specific parameters of the ablation.
Heart failure (HF) affects millions of individuals worldwide and shows an increasing trend, constituting a serious public health issue. Considerable attention has been paid to the screening, diagnosis, risk prediction, treatment, and prognosis of HF. Although many guidelines for the management of HF have been proposed in recent years, the efficacy of evidence-based treatments seems to vary among patients. Therefore, the era of "one-size-fits-all" approaches is drawing to a close, and the concepts of precision medicine and individualized medicine are gradually taking root. Artificial intelligence (AI) is an emerging discipline in the rapidly growing field of computer science. It has now become deeply involved in all aspects of cardiovascular disease research, with particular relevance to HF, though its translation into clinical practice is yet to be fully realized. Although the use of AI in cardiovascular disease (CVD) and HF patient care, as well as cardiac resynchronization therapy (CRT), has been extensively discussed, a discussion from the standpoint of all aspects of HF clinical process is lacking. This review provides a comprehensive overview of the use of AI in HF in specific scenarios, including patient diagnosis, subtyping, prognostic assessment, pre- and post-treatment evaluation, and telecare. It also presents the prospects and challenges for the development of AI in the field of HF, with the expectation that a mature AI diagnosis and treatment system adapted to clinical practice will be developed in the future through in-depth research and validation. This review summarizes the application of AI in various links of HF management from diagnosis to telecare, and analyzes its current application limitations, existing challenges and future research directions, aiming to provide a reference for the subsequent clinical transformation and research optimization of AI in the HF field.
Ischaemic heart disease (IHD) is a leading cause of mortality and morbidity globally. Coronary angioplasty has a vital role in treating coronary artery disease. However, this is associated with a small risk of serious side effects, including contrast-induced nephropathy, vascular complications and arrhythmia. Contrast-induced nephropathy (CIN) is a serious and common complication of coronary angioplasty that can lead to renal failure and major adverse cardiac and renal outcomes. We conducted a systematic review and meta-analysis by searching multiple databases, including PubMed, Scopus, Embase, Google Scholar, and ScienceDirect, as well as other sources. The inclusion and exclusion criteria are described in detail later in this article. Two independent reviewers performed the literature search in September 2024 and identified 282 articles. The study was conducted following the population, intervention, comparator, and outcome (PICO) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 17 studies were included in the final analysis after applying the inclusion and exclusion criteria. The exclusion criteria were guidelines, case reports, qualitative research, and letters to the editor, commentaries, conference proceedings, gray literature, opinions, policy papers, and case series. Articles published after 2010 were included in this meta-analysis, and data analysis was performed using Rayyan statistical software. This study demonstrated that nicorandil was associated with protective effects against CIN. The total number of patients in the Nicorandil and placebo groups were 3836 and 3858 respectively. The occurrence of CIN was 5.14% in the nicorandil group, compared with 13.15% in the control group. This study also confirmed the dose-dependent effect of nicorandil on CIN. Among 662 patients enrolled in three studies, 3,9% in the double dose (DD) group presented with CIN, compared with 8,4% in the standard dose (SD) group. The occurrence of MACE was 5.7% in the Nicorandil group and 8.2% in the control group. However, there was no statistically significant protective effect against major adverse cardiovascular events (MACE) or major adverse kidney events (MAKE). Only a few studies measured the impact on MAKE, and the findings may not be truly representative of its effects. This study demonstrated the renoprotective effects of nicorandil in preventing CIN in patients undergoing coronary angioplasty, and this relationship was also evident from the double-dose response. Further larger size randomised controlled trials are recommended to assess the efficacy of nicorandil in preventing CIN in patients undergoing coronary angioplasty.
Heart failure (HF) is a major cardiovascular disease (CVD) with high morbidity and mortality. Research on the effect of electroacupuncture (EA) on the quality of life (QoL) of HF patients with reduced ejection fraction (HFrEF) remains limited. This study aims to determine the role of combining EA with conventional treatment in improving QoL for patients with HFrEF. This single-blind, randomized controlled trial employed a pre- and post-test design at the Heart Failure and Acupuncture Clinics of UNS Hospital, Indonesia. Thirty-four participants participated, with random assignment to either an intervention or a control group. While the intervention group received pharmacological therapy combined with electroacupuncture, the control group received only pharmacological therapy. All pharmacological treatments were administered according to cardiologists' prescriptions in alignment with the 2021 European Society of Cardiology guidelines. In the intervention group, participants underwent 32 EA sessions conducted by a medical acupuncture specialist, delivered twice weekly for 30 min per session. The primary outcomes were: (1) Change in Left Ventricular Ejection Fraction (LVEF); (2) Change in six-minute walk distance; and (3) Change in Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23) score, measured before and after the intervention period. The combination of pharmacological therapy and EA produced a significant increase in the mean of LVEF by 14.07 ± 5.67%, an improvement in mean 6MWD by 348.82 ± 61.23 m, and an increase in mean KCCQ-23 score to 34.94 ± 5.99. Statistically significant differences were observed between the intervention and control groups for all measured outcomes (p < 0.05). The combination of conventional treatment and EA significantly improves quality of life in patients with HFrEF, representing a promising adjuvant therapy for heart failure.
Hypertension (HTN) and dyslipidemia are major risk factors for cardiovascular diseases. Recently, researchers have investigated the potential benefits of combining multiple medications in one bill to improve their metabolic and cardiovascular efficacy. We investigated a treatment approach that combines two antihypertensive medications with one statin. We aim to assess the safety and effectiveness of a triple therapy regimen consisting of angiotensin receptor blockers (ARBs) combined with amlodipine/rosuvastatin. We compared this triple therapy to dual therapy involving either ARBs/amlodipine or ARBs/rosuvastatin in patients with HTN and dyslipidemia. We conducted systematic search in the following databases: Medline, Web of Science, Scopus, and Cochrane Library until August 2024. The main outcomes assessed were the variations in mean systolic blood pressure (mSBP), mean diastolic blood pressure (mDBP), and the percentage changes in LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) following an eight-week treatment period. Our analysis included seven randomized controlled trials (RCTs) which enrolled 1074 patients. Triple therapy revealed a significant reduction in mSBP (mean difference (MD): -4.06, 95% C.I. [-7.97: -0.15], p-value = 0.04), mDBP (MD: -5.45, 95% C.I. [-7.96: -2.93], p-value = < 0.0001), and LDL-C (MD: -50.10, 95% C.I. [-55.55: -44.64], p-value = < 0.001) compared to ARBs/amlodipine. Triple therapy significantly decreased mSBP (MD: -12.28, 95% C.I. [- 16.68: -7.88], p-value = < 0.001) and mDBP levels (MD: -6.48, 95% C.I. [-10.95: -2.01], p-value = 0.005) compared with ARBs plus rosuvastatin. There was no significant difference in secondary outcomes, including total adverse events, cerebrovascular adverse events, and adverse drug reactions. Triple therapy has greater effectiveness in decreasing blood pressure in hypertensive patients with dyslipidemia compared to treatments involving ARBs combined with amlodipine or ARBs with rosuvastatin. Additionally, Triple therapy significantly improved lipid profiles compared to the ARB/amlodipine group. Our study lays the groundwork for developing a single-pill, triple-combination therapy. Further RCTs are necessary to confirm our findings.
Coronary stent dislodgement is a rare complication of percutaneous coronary interventions with potentially serious clinical sequelae. There are several scenarios for the dislodgement and various techniques to deal with this complication. A dislodged stent migrating retrogradely over a guiding catheter and retrieved with a snare system has never been reported. We present the first reported case of a dislodged coronary stent passing over a guiding catheter which was successfully retrieved with a snare system. A 76-year-old patient with unstable angina was admitted for a coronary angiography. It revealed in-stent restenosis in the mid portion of the left anterior descending artery (LAD) and within the ostium of the left main coronary artery (LM). Following an uncomplicated PCI of the LAD and during subsequent stent deployment in the LM, the balloon with a mounted stent popped out to the aorta. After the balloon had been pulled back, the stent migrated over the guiding catheter. Consequently, another longer stent was successfully implanted into the LM, and afterwards the dislodged stent was snared and retrieved using an ipsilateral femoral access. The patient was discharged after two days of uneventful hospital stay. The case report demonstrates an unusual course of stent dislodgement passing over a guiding catheter which was successfully retrieved with a snare technique. It underscores the importance of optimal lesion preparation and meticulous vigilance when implanting short stents into LM.
A free-floating thrombus in the ascending aorta is a rare but clinically significant condition that can cause cerebral and peripheral arterial embolism. Preoperative differentiation from primary aortic tumors, particularly intimal sarcoma, remains challenging even with positron emission tomography-computed tomography (PET-CT). Optimal treatment strategies have not been established. A 49-year-old man presented to our emergency department with acute right lower extremity ischemia. Contrast-enhanced computed tomography revealed acute occlusion of the right common femoral artery, and emergent thrombectomy was performed on the same day. He had experienced a cryptogenic cerebral infarction two months earlier; although echocardiography had shown no intracardiac thrombus, he had been managed with anticoagulation alone. To identify the source of recurrent embolism, contrast-enhanced computed tomography from the neck to the pelvis was performed, revealing a pedunculated mass in the ascending aorta. PET-CT showed no abnormal uptake. On hospital day 10, ascending aortic replacement with a prosthetic graft was performed. Intraoperative epi-aortic echocardiography was used to identify the thrombus location and determine a safe cross-clamp site, thereby avoiding deep hypothermic circulatory arrest. The mass was resected together with a ring-shaped segment of the aortic wall at its attachment site to prevent local recurrence. Pathological examination confirmed an organizing thrombus without neoplastic features. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. At 5-year follow-up, no recurrent embolic events or new thrombus formation has been observed. In patients with a pedunculated free-floating thrombus in the ascending aorta presenting with recurrent systemic embolism, early surgical intervention, including graft replacement, is a reasonable therapeutic option. Graft replacement enables complete excision of the attachment site for recurrence prevention and provides a definitive histopathological diagnosis. However, further accumulation of cases is needed to establish optimal management strategies for this rare condition.
Congenitally corrected transposition of the great arteries (ccTGA) is an uncommon congenital heart defect involving both atrioventricular (AV) and ventriculoarterial (VA) discordance. This condition is further complicated by additional anomalies such as a hypoplastic pulmonary valve, ventricular septal defect (VSD), and dextroversion. These abnormalities may contribute to an increased risk of heart failure and cardiogenic shock, making early detection and appropriate intervention essential for better patient outcomes. A 16-year-old female presented with progressive shortness of breath, cyanosis, recurrent episodes of syncope, and exertional palpitations. Upon admission, the patient exhibited severe hypoxia, tachycardia, and hypotension, consistent with cardiogenic shock. She was NYHA grade IV at the time of presentation.Imaging studies, including chest X-ray and echocardiography, GLS- strain imaging and cardiac MRI confirmed the diagnosis of ccTGA with AV and VA discordance, a left-sided aortic arch, subaortic VSD, a hypoplastic pulmonary valve, and left sided morphologic right ventricular systolic dysfunction. Blood investigations indicated polycythemia and signs of congestive hepatopathy. The patient was initially stabilized with inotropic support using norepinephrine (0.05-0.5 mcg/kg/min), along with diuretics and ACE inhibitors. Over the course of seven days, her condition improved significantly, allowing for the withdrawal of inotropic support. She was subsequently referred for surgical evaluation, with potential options including the double-switch procedure or VSD closure, depending on the extent of structural and functional abnormalities. Our patient underwent double switch procedure despite having RV dysfunction and improved significantly over a period of 3 months. This case underscores the significance of prompt recognition and aggressive management in complex congenital heart conditions like ccTGA. Cases of symptomatic ccTGA in adolescence are exceptionally rare, highlighting the importance of a multidisciplinary approach in optimizing patient care and surgical planning.
Only a limited number of studies have reported on TOF with absent pulmonary valve (APV). Similarly, while cases of TOF with absent pulmonary artery (PA) have been documented, case reports describing TOF with both APV and absent PA are extremely rare. The present study investiged the case of a 1-year-old girl born at term with no initial clinical or physical signs of cyanosis. A subtle additional heart murmur detected during routine examination prompted referral to a cardiologist. Subsequent echocardiography and computed tomography (CT) angiography confirmed TOF with APV and absence of the left pulmonary artery (LPA). The patient later underwent corrective surgery, including pulmonary valve reconstruction and pulmonary artery plication. Although TOF is a common cyanotic congenital heart disease, certain variants of TOF, such as TOF with APV and absent LPA, may present without the typical cyanotic or respiratory symptoms. Therefore, even the slightest additional heart murmur should be thoroughly investigated. While clinical examination, arterial oxygenation, and echocardiography are essential, definitive diagnosis and precise anatomical characterization ultimately require CT angiography.
The supply of donor hearts has fallen short of the increasing demand. This widening gap has led to a crisis marked by long waiting times and high mortality rates among those on waiting lists. This study aimed to compare the echocardiographic data of individuals whose hearts were eligible for transplant. This retrospective, cross-sectional study investigated all eligible brain-death cases conducted at Sina Hospital in Tehran, Iran. Based on echocardiographic data, patients were evaluated for heart donation (59 hearts that were deemed eligible vs. 39 hearts that were non-eligible for donation). The study used a custom checklist based on transthoracic echocardiography data. Data were analyzed using SPSS 18 software. A P < 0.05 was considered statistically significant. The average age of the cases was 29.28 ± 10.59 years. Gender was not significantly associated with transplant eligibility (P = 0.46). In contrast, the cause of brain death was a significant factor (P = 0.04). There were statistically significant differences between the cause of brain death and left ventricular ejection fraction (LVEF) (F = 3.14, η² = 0.094, P = 0.029). No significant relationship was found between the cause of brain death and regional wall motion abnormality (RWMA) or pulmonary artery systolic pressure (PASP). Borderline cases should undergo reevaluation using repeat transthoracic echocardiogram or echocardiographic assessments of heart function with inotropic medications to increase the pool of potential heart donors due to limited organ donor options.
The incompetence of the tricuspid valve (TV) may predispose to unfavorable results of Fontan palliation in patients with single right ventricle (RV). This study aims to reveal the effect of TV intervention in patients with single RV on long-term outcomes after Fontan completion. A single-center retrospective cohort study was conducted with patients who underwent Fontan completion from 1985 to 2017. There was a total of 678 patients with single RV. A total of 128 patients (18.8%) underwent TV intervention at any stage (TVI group); 30 of them (23.4%) underwent repeat TV surgery (repeat TVI subgroup). The control group comprises 550 patients (81.2%) who had no TV surgery regardless of the degree of TR (non TVI group). The median follow-up was 8.8 (± 7.6) years. Overall transplant- and Fontan takedown-free survival was 62.5% (95% CI 59.2%-64.9%) at 20 years. The repeat TVI group had significantly lower transplant and takedown-free survival rates (Non TVI 76.5% vs. Single TVI 75.3% vs. repeat TVI 56.0% at 15 years, P = 0.02). The younger age at Fontan (1.12 [95% CI 1.02-1.22], p = 0.019), repeat TVI (3.33 [95% CI 1.57-7.04], p = 0.002), TV intervention after Fontan (6.14 [95% CI 2.60-14.50], p < 0.001), significant ventricular dysfunction before Fontan (3.12 [95% CI 1.12-8.30], p = 0.028) and any concomitant procedure at Fontan (1.98 [95% CI 1.16-3.37], p = 0.013) were the significant risk factors for transplant and takedown free- survival. Repeat TV intervention during the Fontan was associated with inferior outcomesin patients with morphologic systemic RV. Successful TV intervention could provide comparable long-term survival outcomes to non-TV intervention patients.
Coronary artery anomalies (CAAs) are rare congenital abnormalities involving the origin, course, or structure of coronary arteries. While often incidental, some variants have clinical and procedural implications. With the increasing use of computed tomography coronary angiography (CTCA), more anomalies are being detected, yet large-scale data from India remain limited. To evaluate the prevalence, anatomical patterns, and clinical relevance of CAAs over a 12-year period using CTCA at a high-volume tertiary cardiac center in India. In this retrospective study, 20,243 consecutive patients undergoing multidetector CTCA between January 2011 and October 2023 were analyzed. Coronary anomalies were categorized into myocardial bridging (MB) and non-MB types based on Angelini's classification. Each scan was independently reviewed by both a radiologist and a cardiologist. Coronary artery anomalies (CAAs) were identified in 1513 patients (overall prevalence 7.5%), largely driven by myocardial bridging (MB). When MB was excluded, the prevalence of non-bridging anomalies was 0.9% (n = 183), including both isolated and combined cases. Isolated myocardial bridging was the most common finding, identified in 1330 patients (87.9%), predominantly involving the mid-segment of the left anterior descending artery. Isolated non-bridging anomalies were observed in 171 patients, while 12 patients had combined MB and non-MB anomalies. Among non-bridging anomalies, the most frequent included anomalous right coronary artery origin from the left sinus with an interarterial course (26.9%), retroaortic left circumflex artery (9.9%), separate origins of the LAD and LCX (8.8%), and high take-off anomalies (7.6%). Most anomalies were classified according to Angelini's framework, with a small subset remaining unclassified due to atypical anatomical presentations. This 12-year retrospective cross-sectional study represents one of the largest single-center CTCA-based datasets on coronary artery anomalies (CAAs) globally. The findings highlight the utility of CTCA in detecting and characterizing both benign and potentially significant anomalies. The anatomical insights derived from this cohort have direct clinical relevance, aiding interventional cardiologists in procedural planning and risk stratification. Future multicenter studies are warranted to further refine diagnostic algorithms and management strategies across diverse populations.
Takotsubo cardiomyopathy (TC) is a cardiomyopathy characterized by temporary ventricular dysfunction, often resembling myocardial infarction. The association between ischemic stroke and TC remains unclear, with unknown true incidence. The objective of this study is to assess the incidence of ischemic stroke in TC patients and its risk factors. We carried out a comprehensive search of PUBMED, Google Scholar, PROQUEST, and ScienceDirect databases from their inception to February 2026. Studies reporting the incidence of ischemic stroke in TC patients were included. The quality of studies was evaluated utilizing the Joanna Briggs Institute Critical Appraisal Tools. Statistical analyses were performed using Review Manager and RStudio. This study included six studies with 35,573 participants (841 had ischemic stroke and 34,732 did not). The pooled incidence of ischemic stroke was 4% (95% CI 0.01-0.06; I2 = 91%). The incidence of all-cause mortality was 36% (95% I 0.02-0.71, I2 = 81%) in TC patients with ischemic stroke, significantly higher than the 3.12% (95%CI:0.01-0.05, I2 = 37%) observed in TC patients without stroke. The mortality risk was higher in TC patients with ischemic stroke (OR7.57; 95% CI 2.70-21.22). Age (MD: 3.04; 95% CI 0.74-5.34), sex (OR0.64; 95% CI 0.53-0.77), diabetes (OR1.73; 95% CI 1.00-3.00), and atrial fibrillation (OR1.87; 95% CI 1.28-2.72) were significantly related to the incidence of ischemic stroke. However, smoking and hypertension showed no significant association with ischemic stroke. Ischemic stroke in TC patients correlates with an increased mortality rate and is associated with age, sex, and comorbidities, including diabetes and atrial fibrillation. Additional research is necessary to evaluate the possible advantages of anticoagulant therapy in TC patients.
Objective. A retrospective case-control study was conducted to explore the risk factors of late failure of arteriovenous fistula in hemodialysis patients. Methods. A total of 95 hemodialysis patients treated in our hospital from January 2018 to January 2021 were included. The HE staining results of late failure of arteriovenous fistula in hemodialysis patients were observed. The general data and laboratory indexes of the patients were recorded by using a questionnaire survey, hospital case system, and hemodialysis record. According to the functional status of internal fistula, the patients were divided into two groups: failure group ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>n</a:mi> <a:mo>=</a:mo> <a:mn>35</a:mn> </a:math> ) and patency group ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>n</c:mi> <c:mo>=</c:mo> <c:mn>60</c:mn> </c:math> ). SPSS22.0 software was employed for statistical analysis, and the relevant data of the two groups were compared. The independent sample <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>t</e:mi> </e:math> -test was employed for the comparison of variance between groups, and the <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:msup> <g:mrow> <g:mi>χ</g:mi> </g:mrow> <g:mrow> <g:mn>2</g:mn> </g:mrow> </g:msup> </g:math> test was employed for counting data. Logistic multivariate regression was employed to analyze the risk factors of late loss of power in autologous arteriovenous fistula (AVF). Results. (1) Late failure of arteriovenous fistula in hemodialysis patients: the results of HE staining showed the following: (1) histological changes of venous intima: 100% of the patients had varying degrees of intimal hyperplasia, mainly eccentric hyperplasia, resulting in luminal stenosis, and annular uniform intimal hyperplasia in some patients, and (2) histological changes of venous media: 81.6% of the patients had venous media lesions, which were mainly in two cases; one was media smooth muscle hyperplasia with fibrous tissue hyperplasia, and the other was smooth muscle compression when intimal hyperplasia was serious, resulting in smooth muscle fiber rupture, disarrangement, focal necrosis, atrophy, and thinning, and some smooth muscle stroma showed vitreous degeneration and myxoid degeneration. A few cases showed multifocal neutrophil, lymphocyte, and plasma cell infiltration. (2) First of all, we surveyed the general data, and there were significant differences in age, history of diabetes, history of hypertension, and uric acid nephropathy ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo><</i:mo> <i:mn>0.05</i:mn> </i:math> ). There was no significant difference in sex, body mass index, smoking history, polycystic kidney disease, chronic glomerulonephritis, and obstructive nephropathy between the two groups ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>P</k:mi> <k:mo>></k:mo> <k:mn>0.05</k:mn> </k:math> ). Secondly, we compared the levels of hemoglobin, eosinophils, platelet count, and hematocrit. The levels of hemoglobin, eosinophils, and hematocrit in the failure group were higher, and the platelet count was lower compared to that of the unobstructed group ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>P</m:mi> <m:mo><</m:mo> <m:mn>0.05</m:mn> </m:math> ). Furthermore, the calcium and phosphorus product and the level of C-reactive protein (CRP) in the failure group were higher, while the levels of fibrinogen and INR in the unobstructed group were lower. The levels of plasma protein, alkaline phosphatase, and cholesterol were higher in the failure group, while the level of triglyceride was lower in the failure group ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>P</o:mi> <o:mo><</o:mo> <o:mn>0.05</o:mn> </o:math> ). Finally, logistic regression analysis showed that age, hemoglobin, hematocrit, and calcium-phosphorus product were the risk factors for late failure of arteriovenous fistula in hemodialysis patients ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>P</q:mi> <q:mo><</q:mo> <q:mn>0.05</q:mn> </q:math> ). There exhibited no significant correlation between diabetes, hypertension, uric acid nephropathy, eosinophil, CRP, fibrinogen, INR, plasma protein, alkaline phosphatase, cholesterol, triglyceride, and late failure of arteriovenous fistula in hemodialysis patients. Conclusion. Age, hemoglobin, hematocrit, and calcium-phosphorus product are independent risk factors for late failure of arteriovenous fistula in hemodialysis patients. The hemoglobin, eosinophil, platelet count, and hematocele in hemodialysis patients with late failure of arteriovenous fistula were higher. The indexes related to biochemistry, blood coagulation, and nutrition were significantly different from those without late failure of arteriovenous fistula. Thus, the risk of late failure of arteriovenous fistula can be predicted.
Atrial septal defect secundum (ASDs) is one of the congenital heart diseases that is common in adults and frequently associated with volume overload and functional impairment of the right heart. Percutaneous device closure has become the preferred treatment because of its efficacy and lower complication rates. While right heart remodeling post-closure is well established, the effects on left atrial (LA) function, especially phasic components involving reservoir, conduit, and contraction strain, remain less understood. Two-dimensional speckle tracking echocardiography (2D STE) enables early and sensitive detection of LA functional changes. This retrospective cohort study included adult patients (aged 18–65 years) with ASDs who underwent percutaneous device closure between December 2022 and October 2023 at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Echocardiographic evaluations, including LA strain analysis (LASr, LAScd, LASc), were performed pre-closure, within 6 months (1st semester), and between ≥ 6–12 months (2nd semester) post-device closure. Patients with significant valvular disease, persistent arrhythmias, or suboptimal acoustic windows were excluded. Statistical analysis was conducted using repeated measures ANOVA or Friedman tests with Bonferroni correction. A total of 21 patients (mean age 40.86 ± 14.74 years; 76% female) were included. LA reservoir strain (LASr) significantly declined in the 1st semester post-device closure compared to baseline (p = 0.003) and showed partial recovery by the 2nd semester (p = 0.016 vs. baseline). LA conduit strain (LAScd) and contraction strain (LASc) also significantly decreased in the 1st semester (p = 0.030 and p = 0.025, respectively), while LASc did not significantly improve at the 2nd semester follow-up. No significant changes were observed in LA geometry. Interobserver agreement for all strain measurements was excellent (ICC ≥ 0.99). LA functional impairment was observed in the 1st semester after percutaneous device closure, marked by a noticeable decline in all strains of the LA (LASr, LAScd, and LASc). Partial recovery of LASr was observed at one year, whereas LASc did not show significant improvement after the initial reduction. These findings highlight that the LA strain may be a sensitive marker for predicting the development of LA dysfunction post-device closure follow-up.
Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients. This single-centre prospective cohort study was conducted at SMS Medical College, Jaipur, India, over 12 months (March 2024-March 2025). A total of 368 patients with baseline (pre-PCI) thrombocytopenia who underwent elective or emergency PCI while on DAPT were enrolled. DAPT comprised aspirin plus a P2Y12 inhibitor: clopidogrel in 317 patients (86.1%), ticagrelor in 48 (13.0%), and prasugrel in 3 (0.8%), with the choice based on clinician discretion; the distribution did not differ significantly across thrombocytopenia grades (p = 0.204). DAPT was generally maintained for 6-12 months per institutional protocol, without a standardized de-escalation strategy. Thrombocytopenia was classified based on pre-procedural platelet counts as mild (100,000-150,000/mm³; n = 237, 64.4%), moderate (50,000-100,000/mm³; n = 104, 28.2%), or severe (30,000-50,000/mm³; n = 27, 7.3%). The primary outcomes were major adverse cardiovascular events (MACE), defined as a composite of total death, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization due to heart failure; and bleeding events assessed using Bleeding Academic Research Consortium (BARC) criteria. Secondary outcomes included in-hospital mortality, stent thrombosis, target vessel revascularization, and post-PCI MI. Follow-up was conducted at 1, 2, and 6 months post-PCI. Multivariate logistic regression was used to adjust for confounders across three sequential models (demographics; clinical variables; procedural outcomes). Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89-2.81) and bleeding (HR: 2.88, CI: 2.37-3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01). Moderate and severe thrombocytopenia are independently associated with increased risks of bleeding and cardiovascular events in patients on DAPT post-PCI. These observational findings support the incorporation of thrombocytopenia severity into existing risk stratification frameworks; however, as this study did not evaluate alternative management strategies, prospective randomized trials are needed to determine whether modified antiplatelet regimens can improve outcomes in this high-risk population.