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.

Lung ultrasound (LUS) is a valuable, non-invasive tool for detecting pulmonary congestion in patients with acute heart failure (AHF), with a higher sensitivity relative to physical examination. However, the association between LUS-detected pulmonary congestion and cardiovascular outcomes in patients with ST-segment elevation (STEMI) is not well established. This systematic review and meta-analysis evaluated cardiovascular outcomes in patients with STEMI and congested (wet) or non-congested (dry) lungs by LUS. We searched PubMed, Embase, and Cochrane databases, and conference abstracts for clinical trials evaluating LUS-congestion (LUS+) versus non-LUS-congestion (LUS-) in patients with STEMI. Risk ratios (RRs) and hazard ratios (HR) with 95%CIs were pooled using R software under random-effects models. We also calculated LUS sensitivity, specificity, and area under the curves (AUCs) for the prediction of in-hospital mortality and cardiogenic shock. We included five studies with 1,454 patients. The mean age was 60 to 65 years; 1,066 (73.3%) were male, and 451 (31%) had congested lungs (LUS+). Patients with congestion on LUS had a significantly higher risk of the composite endpoint of death, heart failure, acute coronary syndrome, and cardiogenic shock (HR 4.00; 95%CI 2.12-7.54; p<0.01; Figure 1A). There was also a higher risk of in-hospital mortality (RR 5.09; 95%CI 2.25-11.49; p<0.001; Figure 1B) and cardiogenic shock (RR 5.01; 95%CI 2.47-10.17; p<0.001; Figure 1C) compared to patients with non-congested lungs. Reinfarction was similar between groups (p=0.08; Figure 1D). LUS had high diagnostic accuracy for in-hospital mortality (SROC-AUC: 0.82) and cardiogenic shock (SROC-AUC: 0.77); a high sensitivity (0.84; 95%CI 0.49-0.97; Figure 2A), and moderate specificity (0.78; 95%CI 0.67-0.87; Figure 2A) for in-hospital mortality; and moderate sensitivity (0.75; 95%CI 0.42-0.93; Figure 2B) and specificity (0.76; 95% CI 0.61-0.87; Figure 2B) for cardiogenic shock. Congested lungs on LUS are significantly associated with a higher risk of in-hospital mortality and cardiogenic shock in patients with STEMI. Moreover, LUS has a high AUC for identifying in-hospital mortality and cardiogenic shock in this patient population. Figure 1 Figure 2

INTRODUCTION: AI-based EKG has shown good accuracy for diagnosing heart failure. However, due to the heterogeneity of studies regarding cutoff points, its precision for specifically detecting heart failure with reduced ejection fraction (LVEF <40%) is not yet well established. Research question: What it is the sensitivity and specificity of artificial-based electrocardiogram to diagnose heart failure with low ejection fraction(cut-off of 40%) Aims: We conducted a meta-analysis and systematic review to evaluate the accuracy of artificial intelligence electrocardiograms in predicting an ejection fraction below 40%. METHODS: We searched PubMed, Embase and Cochrane Library for studies evaluating the performance of AI EKGs in diagnosing HFrEF. We computed true positives, true negatives, false positives and false negatives events to estimate pooled sensitivity, specificity and area under the curve, using R software version 4.3.1, under a random-effects model. RESULTS: We identified 8 studies,including 136151 patients with a paired artificial intelligence enabled electrocardiogram with an echocardiography. 9349(6.8%) patients had an ejection fraction below 40% according to the echocardiogram. The AI-ECG data yielded areas under the receiver operator of, sensitivity of 0.861(0.815-0.897), and specificity of 0.874(0.834-0.905) , and area under the curve of 0.929(0.876-0.949). Mean/median age ranged from 60±9 to 67.8±14.4 years. CONCLUSIONS: In this systematic review and meta-analysis, the use of electrocardiogram-based artificial intelligence models demonstrated high sensitivity and specificity for the diagnosis of heart failure with an ejection fraction below 40%

Background: Cyclophosphamide is an alkylating agent of the nitrogen mustard class that has become standard of care for graft-versus-host disease prophylaxis after hematopoietic stem cell transplantation. Although its cardiac toxicity in conditioning regimens is well-documented, data on cardiac events after administration of post-transplant cyclophosphamide (PT-Cy) administration remains limited. Research Question: Is PT-Cy associated with a higher incidence of cardiac adverse events compared with no PT-Cy? Aims: We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing PT-Cy versus no PT-Cy in patients with hematological disorders who received hematopoietic stem cell transplantation. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing PT-Cy versus no PT-Cy in patients with hematological conditions who received hematopoietic stem cell transplantation. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1, under a random-effects model. Heterogeneity was assessed using I2 statistics. Results: We included four studies, all of which were retrospective, with 1,546 patients, of whom 826 (53%) received PT-Cy. Age ranged from 18 to 77 years, and 840 (54%) were male. A total of 1549 allogeneic transplants were performed, primarily for malignant hematological conditions. The conditioning regimens used were myeloablative (52%), reduced intensity (33%), non-myeloablative (8%), and sequential (7%). The most common cardiac events in patients receiving PT-Cy were heart failure (28%) and cardiomyopathy (27%), followed by arrhythmias (25%), pericarditis/pericardial effusion (14%) and acute coronary syndrome (5%). The incidence of adverse cardiac events was significantly higher in patients who received PT-Cy compared with those who did not receive PT-Cy (RR 2.05; 95% CI 1.36, 3.10; p<0.001; I 2 =44%). Conclusion: These findings suggest that PT-Cy is associated with a higher incidence of adverse cardiac events, the most common of which is heart failure/cardiomyopathy.

Introduction: The efficacy and safety of use and impact of pulmonary artery catheter (PAC) in patients with cardiogenic shock (CS) treated with Impella remains unclear. The use of PAC in conjunction with Impella for patients with CS might be associated with improved clinical outcomes and increased safety compared to the use of Impella alone. We aimed to perform a systematic review and meta-analysis comparing Impella with versus without PAC for patients with CS. Methods: We systematically searched PubMed, Embase, and Cochrane databases for studies comparing PAC use in patients with CS treated with Impella. We pooled odds ratios (OR) with 95% confidence intervals (CI) applying random-effects model. We used R version 4.3.2 for statistical analyses. Results: We included two observational studies comprising 11,463 patients, of whom 6,058 (53%) had PAC. Compared with no PAC, the use of PAC was associated with a significantly lower in short-term mortality rates (37% vs. 42%; OR 0.83; 95% CI 0.77-0.90; p<0.01; Figure 1A). There was no significant difference in the incidence of arrhythmias 59% vs. 63%; OR 1.14; 95% CI 0.92-1.41 p=0.44; Figure 1B) or renal complications between groups (47% vs. 50%; OR 1.08; 95% CI 1.00-1.17; p=0.06; Figure 1C). Conclusions: In patients with CS, adjunctive PAC to Impella is associated with lower mortality rates, but no significant difference in arrhythmias and renal complications. Randomized controlled trials are warranted to further validate this results.

Background: Bruton Tyrosine Kinase inhibitors (BTKi) are targeted therapies that have demonstrated promising results in the treatment of hematological malignancies; however, they are associated with adverse cardiac events. Direct comparisons of the cardiotoxic profile between old-generation and new-generation BTKi are limited. Research Question: Are novel BTKi associated with a lower incidence of cardiac adverse events compared with ibrutinib? Aims: We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing new-generation BTKi versus ibrutinib in patients with hematological malignancies. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing any new-generation BTKi with ibrutinib in patients with hematological malignancies. Outcomes included 1) risk of cardiac events; 2) atrial fibrillation (AF); 3) rate of treatment discontinuations due to AF; and 4) hypertension. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analysis was performed using R software 4.3.1, under a random-effects model. Heterogeneity was assessed using I 2 statistics. Results: We included four randomized controlled trials with 1905 patients, of whom 957 (50%) received new-generation BTKi. Age ranged from 28 to 90 years, with 1337 (70%) male patients. Prior lines of systemic therapy ranged from none to 12. Overall cardiac events were significantly lower in patients who received novel BTKi compared with those who received ibrutinib (RR 0.75; 95% CI 0.63 to 0.90; p=0.002; I 2 =0%; Fig.1A). New-generation BTKis were associated with a statistically significant reduction in the risk of AF (RR 0.48; 95% 0.35 to 0.64; p<0.001; I2=0% Fig.1B) and treatment discontinuation due to AF (RR 0.07; 95% CI 0.01 to 0.34; p=0.001; I 2 =0%), compared with ibrutinib. However, there was no statistically significant reduction in the risk of hypertension with novel BTKi relative to ibrutinib (RR 0.58; 95% CI 0.34 to 1.01; p=0.053; I 2 =81%). Conclusion: Our findings suggest that treatment with new-generation BTKi is associated with a significant reduction in the risk of cardiac events, AF, and AF-related treatment discontinuation compared with the old-generation BTKi.

ABSTRACT Background: The triglyceride/high-density lipoprotein (TG/HDL) ratio emerges as a promising marker for cardiovascular risk. However, the relationship between overall serum lipid levels and hemorrhagic stroke (HS) remains uncertain. Therefore, our study aims to explore the association between this novel index and mortality in HS patients. Methods: Utilizing a retrospective-prospective framework from January 2020 to August 2023, we scrutinized data from 104 hospitalized patients diagnosed with HS, with particular attention to their medical backgrounds and lipid profiles. Results: Age (odds ratio [OR], 1.078; 95% confidence interval [CI], 1.032–1.125; P = 0.001), atrial fibrillation (OR, 0.237; 95% CI, 0.074–0.760; P = 0.015), glucose level (OR, 1.121; 95% CI, 1.007–1.247; P = 0.037), and TG/HDL index (OR, 0.368; 95% CI, 0.173–0.863; P = 0.020) emerged as independent predictors for in-hospital mortality, as determined by both univariable and multivariable logistic regression analyses. Conclusion: Our results add weight to the growing evidence backing the utility of the TG/HDL index in assessing cardiovascular risk among HS patients. They emphasize the necessity of adopting a comprehensive risk assessment and management strategy that incorporates both traditional markers and novel indicators.

In this case report, we describe the diagnostic modality of sinus of Valsalva aneurysm (SOVA) in combination with congenital cardiac defect, aortic valve involvement, and conduction abnormality in a 19-year-old patient. Aim of article was to understand the importance of clinicians being cautious about SOVA presenting in young patients, despite cases being rare, and that SOVA requires a thorough SOVA diagnostic approach. We further provide a review of literature highlighting and comparing the treatment options for both unruptured and ruptured SOVAs. The patient presented for examination due to tachycardia and palpitations. A murmur was heard, and the patient was found to have an atrioventricular nodal reentry tachycardia. Echocardiographic evaluation, magnetic resonance imaging, and computed tomography angiography confirmed an aneurysmally dilated aortic root, aortic regurgitation, and ventricular septal defect. Surgical intervention was indicated; however, the patient refused to undergo surgery.

BACKGROUND: Left atrial strain (LAS) analysis represents a newer non-invasive, sensitive and specific technique for assessing left atrial (LA) function and early detection of its deformation and dysfunction. However, its applicability in mitral regurgitation (MR) in pediatric population remains unexplored, raising pertinent questions regarding its potential role in evaluating the severity and progression of the disease. OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on LA remodeling and function. METHODS: The study included 100 participants. Patients with primary and secondary chronic MR lasting at least 5 years fit our inclusion criteria. The exclusion criteria from the study were: patients with functional mitral regurgitation due to primary cardiomyopathies, patients with artificial mitral valve, patients with MR who had previously undergone surgery due to obstructive lesions of the left heart (aortic stenosis, coarctation of the aorta), patients with significant atrial rhythm disorders (atrial fibrillation, atrial flutter). The echocardiographic recordings were conducted by two different cardiologists. Outcome data was reported as mean and standard deviation (SD) or median and interquartile range (Q1–Q3). RESULTS: The study included 100 participants, of whom 50 had MR and the remaining 50 were without MR. The average age of all participants was 15.8 ± 1.2 years, with a gender distribution of 37 males and 63 females. There was a significant difference in the values of LA volume index (LAVI), which were higher in patients with MR ( p = 0.0001), S/D ratio (and parameters S and D; p = 0.001, p = 0.0001, p = 0.013), mitral annulus radius ( p = 0.0001), E/A ratio ( p = 0.0001), as well as septal e’ (m/s), lateral e’ (m/s), and average E/e’ ratio, along with the values of TV peak gradient and LV global longitudinal strain (%). There was no significant difference in LA strain parameters, nor in LA stiffness index (LASI). CONCLUSION: Our findings revealed significant differences in several echocardiographic parameters in pediatric patients with MR relative to those without MR, providing insight into the multifaceted cardiac structural and functional effects of MR in this vulnerable population.

BACKGROUND: Left atrial stiffness index (LASI), defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e’) to peak atrial strain, reflects reduced left atrial (LA) compliance and represents an emerging marker that can be used for noninvasive measurement of fibrosis of LA in patients with mitral regurgitation (MR). OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on the remodeling and function of the LA, quantified through strain parameters and diastolic function. METHODS: The study included fifty patients ( n = 50) diagnosed with primary and secondary chronic MR lasting at least 5 years. The echocardiographic recordings were performed by a third party, two cardiologists actively engaged in echocardiography on a daily basis. RESULTS: Older participants had higher values of the LASI ( r = 0.467, p = 0.001). Participants with higher LASI values had a smaller LA reservoir ( r = 0.784, p = 0.0001) and smaller LA conduit values ( r = - 0.374, p = 0.00). Participants with higher LASI values had a larger LA diameter ( r = 0.444, p -value= 0.001) and higher average E/e’ ratio ( r = 0.718, p = 0.0001). There was a significant difference ( p = 0.04) in the LASI among participants based on the MR jet area ( < 20.85% ⩾ 20.85%), LASI was higher in participants with an area greater than 20.85%. Differences in other parameters such as LA reservoir, LA conduit, LA contractile were not statistically significant. CONCLUSION: Increased LA stiffness is associated with diminished atrial compliance and reservoir capacity, and LASI has a potential to as an early marker for assessing disease severity and progression in pediatric MR.

Background: Peripheral arterial disease (PAD) is highly prevalent and has a well-known association with diabetes. It is still unknown if diabetes worsens clinical outcomes after lower extremity revascularization (LER). Research question: What is the impact of diabetes on clinical outcomes in patients with PAD undergoing LER. Goals: In this meta-analysis, we assessed the effect of diabetes on mortality, major limb amputation, and major adverse cardiovascular events (MACE) in patients with PAD following endovascular or open LER during the perioperative period and within 30 days of follow-up. Methods: We performed a systematic search of PubMed, Embase, and Cochrane databases to December 2023, including studies that compared the clinical outcomes of patients with diabetes and without diabetes following LER procedure. Review Manager 5.4 was used for statistical analysis. I 2 statistics were used to examine heterogeneity. A random-effects model was applied to all analyses. Results: Of the 3,810 articles screened, five observational studies with 55,444 patients were included. A total of 51.13 % had diabetes. There was no significant association between diabetes and mortality (RR 0.96; 95 % confidence interval (CI) 0.74 - 1.26; I 2 = 69%; P = 0.79; Figure 1A). However, diabetes was associated with a significantly increased risk of major limb amputation by 50% (RR 1.50; 95 % CI 1.03 - 2.21; I 2 = 94%; P = 0.04; Figure 1B), and an 18% significantly higher risk of experiencing MACE (RR 1.18; 95 % CI 1.08 - 1.29; I 2 = 0%; P = 0.0005; Figure 1C). Conclusion: Our findings suggest that diabetes is associated with an increased risk of major amputation and MACE but not with mortality in patients following LER.