ObjectiveTo evaluate the predictive value of LA strain parameters and LASI for AF recurrence following electrical CV, and to compare them to conventional echocardiographic, biochemical, and clinical markers.MethodsIn this prospective, observational pilot study, 31 patients with persistent AF underwent electrical CV and were followed for six months. Echocardiographic evaluation included LA reservoir, conduit, and contractile strain, left atrial stiffness index, left atrial volume index (LAVI), left atrial appendage (LAA) morphology, left ventricular ejection fraction (LVEF), right atrial (RA) area, and right ventricular systolic pressure (RVSP). AF recurrence was assessed at three and six months.ResultsAt three months post-CV, LA reservoir, conduit, and contractile strain values were significantly negatively associated with AF recurrence (p < 0.001), while LASI and E/E' ratios were positively associated (p < 0.001). At six months, only contractile strain retained prognostic significance (p = 0.008). LVEF showed a positive correlation with recurrence at six months (p = 0.003), potentially reflecting the role of diastolic dysfunction.ConclusionLA strain parameters and LASI are valuable tools for predicting AF recurrence after CV, particularly in the early post-procedural period. Contractile strain may serve as a more reliable long-term predictor, emphasizing the importance of longitudinal atrial function assessment in rhythm outcome prediction. However, given the small sample size and single-center design, these results should be considered hypothesis-generating, requiring validation in larger studies.

Over the past decade, stress echocardiography has evolved from a test for assessing epicardial artery stenosis to a comprehensive functional test, targeting multiple cardiovascular parameters. The new approach includes several structured steps: (a) evaluating regional wall motion abnormalities to detect epicardial artery stenosis or vasospasm; (b) assessing pulmonary congestion and diastolic function via B-lines with lung ultrasound; (c) gauging preload and contractile reserve with volumetric echocardiography; (d) measuring coronary microvascular reserve using Doppler-based coronary flow velocity in the middistal left anterior descending artery; and (e) determining cardiac sympathetic reserve by tracking heart rate reserve on an ECG. This evolution was supported extensively by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), which played a key role in five areas: (1) developing the initial, curiosity-driven project; (2) disseminating protocols and results at national and international conferences, supporting logistic infrastructure and publication expenses; (3) establishing a digital platform (customized Redcap) for data entry and storage; (4) facilitating patient recruitment across 19 Italian centers; and (5) offering formal endorsement through six presidencies, adding credibility and reach beyond any single institution. The protocol quickly advanced from concept to high-impact publications, earning inclusion in 2024 specialty guidelines. Initially Italian-led, the study now includes 50 centers across 20 countries (e.g. USA and China). Beyond the 50 peer-reviewed papers published in 2016–2024, this study offers a novel, sustainable approach to cardiac stress testing, providing more information at lower costs, with zero radiation and minimal environmental impact. SIECVI’s endorsement was instrumental in amplifying the study’s rigor and outreach.

Introduction/Objective. Introduction/Objective Following the failure of the single-wire technique in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), two principal anterograde escalation strategies are commonly employed: the parallel-wire technique and antegrade wire escalation (AWE). Despite their widespread use, comparative data on the procedural characteristics and long-term clinical outcomes of these strategies remain scarce. This study aims to compare the procedural parameters and long-term outcomes of the parallel-wire and AWE techniques after single-wire failure in CTO PCI. Methods. This retrospective, single-center study included patients who underwent successful CTO PCI between January 2018 and December 2023 using either the parallel-wire or AWE technique following single-wire failure. The primary endpoint was a composite of cardiac death, myocardial infarction, stroke, or target vessel revascularization (TVR). Secondary outcomes included procedure duration, fluoroscopy time, contrast volume, and total radiation dose. Median follow-up duration was 1222 days (IQR 580-1969 days). Results. Among 270 CTO PCI procedures, 112 (41.5%) required escalation: 90with AWE and 22 with the parallel-wire technique. Baseline clinical and angiographic characteristics were comparable. The primary composite outcome occurred in 14.4% of the parallel-wire group and 9.1% of the AWE group (p = 0.73). No significant differences were observed in individual clinical events. Procedure duration was longer (95.5 ? 43.6 vs. 77.0 ? 30.7 min; p = 0.064) and contrast volume higher (336.4 ? 113.3 vs. 271.6 ? 90.6 mL; p = 0.014) in the AWE group, with similar fluoroscopy time and radiation dose. No clinically or ?ngiographically significant complications occurred during the periprocedural period. Conclusion. Both AWE and parallel-wire techniques demonstrate comparable safety and efficacy following single-wire failure in CTO PCI. While procedural efficiency slightly favored the parallel-wire strategy, overall outcomes support either approach, pending further prospective validation.

Introduction. When considering revascularization modalities, for patients with stable presentation, with appropriate coronary anatomy suitable for both PCI and CABG and low predicted surgical mortality, the recommendations are specifically focused on patients with main stem stenosis. In these cases, patients should be individually assessed according to the complexity of the anatomical disease, as determined by the anatomical SYNTAX score. In the last few years, the results of four randomized studies have been published comparing PCI with newer-generation DES and CABG in patients with left-main stenosis. The latest 2024 ESC guidelines for the management of chronic coronary syndromes recommend CABG over PCI when the anatomical SYNTAX score exceeds 22, as indicated by recent trials. The aim of this study was to examine whether the indications for CABG or PCI, as determined by the well-informed intuitive judgment of PCI operators in everyday clinical practice, align with the treatment recommendations outlined in the recently published ESC guidelines. Methods. Between January 1, 2023, and December 31, 2023, patients were recruited from the University Clinical Centre of the Republic of Srpska in Banja Luka, Bosnia and Herzegovina, utilizing the hospital information system. The study included consecutive patients diagnosed with significant unprotected left main coronary artery disease (≥50% diameter stenosis) confirmed through angiography, who did not exhibit major hemodynamic instability and received PCI at our facility. Patients were divided into two groups, based on the anatomical SYNTAX score i.e. those with SYNTAX ≤ 22 and those with SYNTAX > 22. Results. Following inclusion criteria, a total number of 38 patients were included in the analysis. The included patients had either previously diagnosed coronary artery disease or a high suspicion of coronary artery disease. The majority of the participants were male, with an average age of 65.6 years, with the youngest participant being 31 years old and the oldest 83 years old. A large majority of both sexes suffered from arterial hypertension, dyslipidemia, and type 2 diabetes. Participants in whom SYNTAX score was ≤ 22 were younger (p=0.049) and had less complex coronary artery disease i.e. fewer MEDINA 1,1,1 (p< 0.001) with less stents implanted (p=0.040). Over the course of one year of follow-up, three patients passed away, two of whom had a SYNTAX score exceeding 22. Additionally, two patients were lost to follow-up. Conclusion. The present study demonstrates that an intuitive decision-making process by experienced interventional cardiologists for choosing the optimal myocardial revascularization method for the individual patient with left main stenosis led to a discordance of the definitely chosen methods vs. the recommended method based on the SYNTAX score and ESC guidelines. This discordance between the recommended and the finally performed revascularization strategy led to a higher shortterm mortality.

Medical professionals have a responsibility to inform the public about contemporary research on alcohol consumption. Earlier health recommendations focused primarily on the link between alcohol and cardiovascular diseases. Over time, these guidelines have expanded to consider the broader impact of alcohol on all-cause morbidity and mortality. Unlike the tobacco industry, which remains profitable but faces strict regulations on marketing and lobbying, the alcohol industry benefits from fewer regulations. This allows alcohol manufacturers to freely promote their products and influence both federal and state policies. Clear emphasis on the importance of ceasing alcohol consumption is crucial, particularly in primary and secondary prevention efforts. Keywords: cardiovascular diseases, alcoholics, prevention.

Atrial cardiomyopathy is closely associated with atrial fibrillation (AF), and some patients exhibit no dysfunction at rest but demonstrate evident changes in left atrial (LA) function and LA volume during exercise. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF). A prospective cohort of 1055 patients in SR was enrolled across 12 centers. The main study cohort was divided into two groups: the modeling group (n = 513) and the verification group (n = 542). All patients underwent ESE, which included B-lines, LA volume index (LAVi), and LA strain of the reservoir phase (LASr). Age, resting and stress LAVi and LASr, and B-lines were identified as a combination of detectors for PAF in both groups. In the entire cohort, aside from resting and stress LAVi and LASr, additional parameters differentiating PAF and non-PAF patients were the presence of systemic hypertension, exercise E/e’ > 7, worse right ventricle (RV) contraction during exercise (∆ tricuspid annular plane systolic excursion < 5 mm), a lower left ventricular contractile reserve (< 1.6), and a reduced chronotropic reserve (heart rate reserve < 1.64). The composite score, summing all 9 items, yielded a score of > 4 as the best sensitivity (79%) and specificity (65%). ESE can complement rest echocardiography in the identification of previous PAF in patients with SR through the evaluation of LA functional reservoir and volume reserve, LV chronotropic, diastolic, and systolic reserve, and RV contractile reserve. A scoring system predicting the probability of PAF. The score was computed using the cutoff values as in the illustration. The score >4 demonstrated a sensitivity of 79% and a specificity of 65% of PAF.

of