Heart failure with preserved ejection fraction (HFpEF) is more prevalent in women, whereas heart failure with reduced ejection fraction (HFrEF) predominates in men. Despite these well-established epidemiological differences, sex-specific alterations in vascular function in heart failure (HF) remain poorly characterised. This systematic review, using a narrative synthesis approach, evaluated sex-related differences in vascular function in individuals with HF. The review was prospectively registered with PROSPERO (CRD42024617745). MEDLINE and CINAHL were searched from inception to 26th November 2024 for studies reporting sex-stratified measures of arterial stiffness among individuals with HF. Nine studies met the eligibility criteria for inclusion (n = 2820; men: n = 1390, women: n = 1430). Of the included studies, 78% were characterised as HFpEF. Compared with men, women exhibited a higher pulsatile arterial load and lower arterial compliance. Representative findings from individual studies showed that women exhibited a higher augmentation index (28.9 ± 13.7% vs 21.7 ± 11.9%, p < 0.001) and augmentation pressure (19.1 ± 12.4 vs 13.7 ± 10.1 mmHg, p = 0.003). Body mass index (BMI) showed variable relationships with arterial stiffness indices, including positive associations with pulse wave velocity (r = 0.24, p < 0.01), central pulse pressure (r = 0.33, p < 0.001), and augmentation index (r = 0.23, p = 0.01), but an inverse relationship was found with cardio-ankle vascular index (r = −0.204, p < 0.001). Importantly, sex differences in HFpEF remained significant after adjustment for BMI. Women with HF exhibit higher pulsatile arterial load and reduced arterial compliance compared with men, which remain after adjustment for BMI. Sex-specific vascular dysfunction contributes to HF pathophysiology and supports the need for sex-informed assessment.

Background: Bartonella henselae infection has been associated with a broad spectrum of neurological and autonomic manifestations, although its impact on autonomic nervous system function remains insufficiently characterized, and the aim of this study was to evaluate autonomic function in patients with polymorphic symptoms and Bartonella henselae IgM seroreactivity. Methods: In this cross-sectional study, 75 patients were compared with 75 age- and sex-matched healthy controls, and all participants underwent cardiovascular autonomic reflex testing, short-term (5 min) and long-term (24 h) heart rate variability analysis, and 24 h ambulatory blood pressure monitoring, while head-up tilt testing was performed in the Bartonella group. Results: Abnormal autonomic reflex tests were significantly more frequent in the Bartonella IgM-seroreactive group, particularly those reflecting parasympathetic function, while heart rate variability analysis demonstrated reduced high-frequency components and lower long-term variability indices, and head-up tilt testing revealed heterogeneous hemodynamic responses including orthostatic hypotension and pronounced blood pressure variability, with ambulatory monitoring additionally showing higher nighttime blood pressure values and reduced nocturnal dipping. Conclusions: These findings indicate a consistent pattern of autonomic imbalance characterized predominantly by parasympathetic impairment and altered blood pressure regulation in patients with Bartonella henselae IgM seroreactivity, although further studies are required to clarify underlying mechanisms and clinical implications.

Background/Objectives: Hypertrophic cardiomyopathy (HCM) is a complex myocardial disease in which structural remodeling extends beyond conventional parameters such as maximal wall thickness (MWT). This study aimed to evaluate isoperimetric analysis as a geometry-based approach for characterizing left ventricular (LV) morphology and to compare its performance with fractal analysis in distinguishing HCM from non-HCM subjects. Methods: This retrospective study included 120 subjects (60 HCM and 60 controls) who underwent clinically indicated CMR. Endocardial contours were delineated on short-axis cine images at end-diastole. The isoperimetric index (IPI), cavity-corrected IPI (CC-IPI), and fractal dimension (FD) were calculated. Group comparisons, correlations, and receiver operating characteristic analyses were performed. Results: Patients with HCM showed significantly higher IPI and CC-IPI values than controls (p < 0.001), including in sex-stratified analyses. IPI and CC-IPI correlated strongly with MWT (r = 0.867) and LV mass index (r = 0.807 and 0.803, respectively), moderately with native T1 (r = 0.567), and weakly with end-diastolic volume index (r = 0.256 and 0.253, respectively) and stroke volume (r = 0.237 and 0.229, respectively). No association was observed with late gadolinium enhancement. IPI and CC-IPI showed a strong linear correlation (R2 = 0.997), with both indices demonstrating high discriminatory performance (AUC = 1.00). Conclusions: HCM is associated with notable alterations in LV endocardial geometry beyond myocardial hypertrophy alone. IPI and CC-IPI provide simple, size-normalized, and physiologically interpretable morphologic descriptors that complement conventional CMR parameters and FD-based contour complexity analysis.

This case study proposes a multi-stage deep learning-based system for an automated inventory analysis of stent boxes cabinets in angiography rooms. The proposed pipeline integrates cabinet image segmentation, vendor classification, detection of region-of-interest (ROI) with numerical features, and character recognition enabling extraction of stent boxes’ attribute triples (vendor, diameter, length). Experimental results show that the system achieves high performance across individual stages: mAP@0.5 of 0.995 in box segmentation task, top-1 accuracy of 99.3% in the stent vendor classification and mAP@0.5 of 0.991 in ROI detection. The overall F1 score at the system level for stent box attribute triples is 0.811. The error analysis indicates that system performance is strongly influenced by camera-to-cabinet distance determining the scale of segmented ROI, and can be improved to F1=0.984 by partial standardization of image acquisition step.

Left ventricular free-wall rupture (LVFWR) is a rare but often fatal complication of acute myocardial infarction (AMI). While typically requiring emergency surgical intervention, spontaneous healing is exceptionally uncommon. This case is noteworthy for the spontaneous resolution of a left ventricular rupture in a hemodynamically stable patient, successfully managed with multimodality imaging and selective surgical revascularization. A 66-year-old white European male with a history of hypertension and smoking presented with non-ST elevation myocardial infarction (NSTEMI) and was managed conservatively. Transthoracic echocardiography showed preserved left ventricular ejection fraction (55%) with lateral wall hypokinesia. The patient was discharged with a recommendation for coronary angiography. 1 month later, he was re-admitted for recurrent chest pain and dynamic electrocardiographic changes. Imaging revealed a rupture of the lateral left ventricular wall, confirmed by multidetector computed tomography (MDCT) and cardiac magnetic resonance (CMR), which showed a thrombus encased in fibrous tissue at the rupture site, along with minimal pericardial effusion. Despite the presence of a contained rupture, the patient remained hemodynamically stable. He underwent urgent coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) to the left anterior descending artery. Intraoperatively, no rupture was evident apart from localized discoloration of the affected myocardium. The postoperative course was uneventful. 5 months later, follow-up CMR demonstrated regression of the thrombus and further fibrous remodeling, with restored myocardial integrity and an improved ejection fraction of 51%. Two years post-intervention, the patient remains asymptomatic with stable cardiac function. This case illustrates that not all LVFWRs result in catastrophic outcomes. In selected patients with subacute, contained ruptures, spontaneous healing is possible under close surveillance and guided by advanced imaging. Cardiac CT and CMR were pivotal in characterizing the rupture, confirming myocardial stability, and informing treatment strategy. While surgery remains the standard of care, conservative management may be considered in hemodynamically stable patients, provided careful monitoring and multidisciplinary evaluation are ensured. This case underscores the critical role of multimodality imaging in assessing mechanical complications of AMI and supports the potential for individualized therapeutic approaches.

Background/Objectives: Aortic stenosis is associated with autonomic nervous system (ANS) imbalance, while diabetes mellitus is a major contributor to cardiac autonomic neuropathy. Their coexistence may result in more pronounced autonomic dysfunction not fully captured by conventional assessment. This study aimed to compare ANS function in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), according to diabetes status. Methods: This cross-sectional study included 74 patients with severe aortic stenosis referred for TAVR, including 21 patients with diabetes mellitus. Autonomic function was evaluated using non-invasive ECG-based analysis, incorporating short-term and 24 h Holter-derived heart rate variability (HRV), nonlinear Poincaré plot indices, and deceleration and acceleration capacity. Ambulatory blood pressure monitoring and standard clinical and echocardiographic assessment were performed. Results: Patients with diabetes mellitus demonstrated significantly lower long-term HRV parameters and reduced nonlinear Poincaré plot indices compared with non-diabetic patients, indicating altered autonomic modulation. Short-term HRV showed similar trends without statistical significance. Echocardiographic severity of aortic stenosis and left ventricular systolic function were comparable between groups. Conclusions: Autonomic dysfunction appears to be more pronounced in patients with severe aortic stenosis and diabetes mellitus, predominantly affecting parasympathetic modulation. ECG-derived autonomic parameters may offer complementary insight into ANS involvement in this population and warrant further investigation.

Background/Objectives: Heart rate variability (HRV) is a non-invasive marker of autonomic nervous system function with established prognostic value after acute coronary syndrome (ACS). The clinical relevance of temporal changes in short-term HRV remains insufficiently defined. This study evaluated short-term HRV dynamics and their association with mortality after ACS. Methods: This retrospective–prospective study included 230 patients with acute myocardial infarction. Five-minute resting ECG recordings were obtained on day 1 and day 21. Time- and frequency-domain HRV parameters were analyzed, and delta values were calculated. The primary endpoint was overall mortality. Survival was assessed using Kaplan–Meier analysis and Cox regression. Results: Patients who died during follow-up had lower HRV values on day 21 and more pronounced declines in selected parameters. In multivariable analysis, decreased ΔLF and shorter RR intervals independently predicted overall mortality. Conclusions: Short-term HRV provides a practical bedside assessment of autonomic function after ACS. Unfavorable temporal changes likely reflect persistent autonomic imbalance and may offer additional prognostic insight. Larger contemporary studies are needed to confirm these findings.

OBJECTIVES Aortic stenosis (AS) is the most common valvular heart disease, with transcatheter aortic valve implantation (TAVI) now preferred for select severe cases. This study evaluated the early safety and performance of the new Myval Octacor Transcatheter Heart Valve (THV) (Meril Life Sciences), for which limited clinical data exist. METHODS The authors retrospectively analyzed 43 consecutive patients with severe AS who underwent TAVI using the Myval Octacor THV at a tertiary cardiac center. Primary outcomes included all-cause mortality, stroke, major vascular complications, conduction abnormalities, new pacemaker implantation, paravalvular leak, and valve failure at 30 days follow-up. RESULTS The median age was 81 years (IQR: 7), and 22 patients (51.2%) were female. Coronary artery disease was present in 24 (55.8%). Technical success rate was 100%. Mean pressure gradient decreased significantly post-procedure (55 mm Hg [IQR: 24] vs 5 mm Hg [IQR: 2]; P ≤ .001). No in-hospital deaths occurred. Two patients (4.7%) received permanent pacemakers during hospitalization, and 3 (7.0%) required pacemakers within a week because of conduction issues. Two patients (4.7%) experienced Bleeding Academic Research Consortium Type 3a bleeding. At 30 days, 42 patients remained in follow-up (98%), with 55% improved to New York Heart Association Class I. No vascular complications, stroke, acute kidney injury, valve thrombosis, or endocarditis occurred. One patient had valve failure from a significant paravalvular leak and 1 noncardiac death occurred 2 weeks post-discharge. CONCLUSIONS Early outcomes suggest that the Myval Octacor THV is a safe and effective option for TAVI in severe AS; however, larger studies with longer follow-up are required.

Background/Objectives. Ebstein’s anomaly (EA), which accounts for fewer than 1% of congenital heart diseases, and atrioventricular canal defect (AVCD), present in approximately 4–5% of cases, exceptionally coexist, with this combination observed in fewer than 0.5% of patients with AVCD. We aim to report the oldest documented case of a 45-year-old female with the exceptionally rare combination of complete AVCD, EA, and right ventricular hypoplasia and to provide a concise review of these anomalies. Case presentation. Diagnosed in early childhood with a complete AVCD, pulmonary stenosis, and right ventricular (RV) hypoplasia, the patient underwent palliative surgical intervention with a modified Blalock–Taussig shunt at the age of 10 but did not receive subsequent regular follow-up. Over the ensuing 35 years, she remained largely untreated until presentation at 45 years of age with progressive exertional dyspnea, central cyanosis, and palpitations, corresponding to NYHA class III. Comprehensive multimodal imaging, including transthoracic echocardiography and cardiac magnetic resonance, revealed a complete AVCD with moderate-to-severe mitral regurgitation secondary to an anterior mitral leaflet cleft, severe tricuspid regurgitation, RV hypoplasia, and hallmark features of EA. Given the complex cardiac anatomy and the elevated surgical risk, the patient was considered inoperable, and a strategy of conservative management with multidisciplinary follow-up was implemented. Conclusions. This case highlights the exceptional longevity of a patient with the rare coexistence of complete AVCD, EA, and RV hypoplasia, surviving 45 years from diagnosis despite limited early intervention. It underscores the importance of lifelong follow-up in complex congenital heart disease and illustrates the role of multimodal imaging in assessing anatomy and guiding management when surgical options are high-risk or not feasible.

Background and Objectives: Diabetes mellitus (DM) is a major risk factor for cardiovascular diseases (CVD), including acute myocardial infarction (MI), and is frequently associated with cardiac autonomic neuropathy (CAN). Post-MI autonomic dysfunction contributes to adverse outcomes, but data on prognostic markers in diabetic patients remain limited. This study aimed to (1) compare autonomic nervous system (ANS) function between patients with MI and DM (MI/DM), MI without DM, and DM without MI; (2) assess differences in MI/DM patients based on survival status; and (3) identify prognostic factors for all-cause mortality in diabetic patients following MI. Materials and Methods: This retrospective–prospective study included 375 patients: 93 MI/DM, 229 MI, and 53 DM. MI patients were treated with fibrinolytic or conservative therapy. All participants underwent cardiovascular reflex tests (CARTs) and 24 h Holter ECG with heart rate variability (HRV) analysis; DM patients without MI were tested in an outpatient setting. The primary endpoint was all-cause mortality during a median follow-up of 38 months. Univariable and multivariable Cox regression analyses were performed to determine mortality predictors. Results: Autonomic dysfunction was prevalent in all groups, with MI/DM patients showing the most pronounced impairment, particularly in parasympathetic function. MI/DM patients had significantly lower SDNN values and higher prevalence of definite parasympathetic dysfunction than other groups. In the MI/DM group, abnormal Valsalva maneuver (VM) was more frequent among non-survivors. Multivariable analysis identified abnormal VM and NSTEMI as predictors of overall mortality. Conclusions: Diabetic patients after MI exhibit the most severe autonomic impairment, predominantly parasympathetic, which may contribute to their increased cardiovascular risk. In this high-risk group, abnormal VM and NSTEMI presentations independently predict long-term mortality. Assessment of autonomic function, particularly VM, may provide valuable prognostic information and aid in risk stratification.