Adaptation to volume overload in mitral regurgitation (MR) decreases left ventricular (LV) chamber stiffness. Compromised diastolic function in MR may contribute to clinical decompensation. Aim of the study was to evaluate the effect of MR etiology on the noninvasively estimated LV stiffness both at rest (R) and supine exercise ergometry (Ex) and to interrogate potential implications for the outcome. One hundred forty three asymptomatic subjects with moderate to severe MR (pts), followed up on valve clinic in a tertiary center (age 56±14), were referred for Ex. Fifty-three had myxomatous substrate (Myx), 57 fibroelastic deficiency (FD), 19 functional LV MR (LVfn) and 14 functional atrial MR (ATRfn). Cardiac events (independent decision for surgery, NYHA worsening) during a follow up of 34±25 months occurred in 24 pts. The following parameters (mean±SD) were estimated at R/Ex: Biplane LV enddiastolic volume (LVEDvol), ejection fraction, stroke volume, longitudinal strain, systolic tricuspid pressure gradient (TRPG), transmitral E/e, LV stiffness as the ratio E/e/LVEDvol (mL-1). The slope meanTRPG/cardiac output (CO) was estimated using R/Ex points. At R, LV stiffness was greater (thus implying decreased compliance) in ATRfn (0.21±0.16 vs 0.09±0.06 Myx/p<0.001, 0.12±0.06 FD/p=0.005, 0.12±0.09 LVfn/p=0.03). During Ex, LVFn and ATRfn had similar stiffness (0.19±0.08 vs 0.16±0.09) and both continued to be greater than Myx(0.10±0.06,p<0.001/=0.006 respectively). ATRfn remained also grater at Ex to FD (0.16±0.09, p=0.02). LV stiffness at Ex was related inversely with strain (r=-0.23 p=0.01). The meanTRpG/CO was related with LV stiffness both at R (r=0.4, p=0.001) and Ex (r=0.70, p=0.001) (figure 1). The relationship was also significant for separate analysis of Myx, FD and ATRfn. Pts with outcome events had decreased LV stiffness both at R (0.098±0.06 vs 0.13±0.06 p<0.04) and at Ex (0.11±0.08 vs 0.14±0.08, p<0.04). ROC analysis for outcome provided similar cut off for LV stiffness at R /Ex (=0.08 with area under curve 0.79/0.91,p=0.002/0.001, sensitivity: 73%/90%, specificity: 83%/83% respectively). Kaplan-Meier analysis using either LV stiffness R or Ex, predicted better outcome for values >0.08 mL-1 (R/Ex: log rank =3.6/6. p=0.05/0.01) overall. The evidence was more specific in the pts not increasing TRPG during Ex >55mmHg. The analysis remained with similar outcome when it was applied only in the degenerative/organic MR (R: log rank=3.3, p=0.05 figure 2). LV stiffness differs according to the underlying pathophysiology in asymptomatic moderate to severe MR. Noninvasive evaluation of LV stiffness either at R or Ex may provide an independent contribution for the mid-term risk stratification in both organic and functional MR.
Sex-related differences in outcomes after catheter ablation for atrial fibrillation (AF) remain incompletely understood, particularly regarding long-term arrhythmia recurrence and procedural safety. Current guidelines do not provide sex-specific recommendations. This systematic review and meta-analysis aimed to evaluate sex-based differences in efficacy, safety, and long-term outcomes following AF catheter ablation. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines and the Cochrane Handbook, with prospective registration in PROSPERO (CRD420251168422). PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2025. Only studies adjusting for baseline differences using propensity score–based methods were included. Risk ratios (RRs) with 95
Background:Previous studies provided conflicting evidence of benefit of beta-blockers (BBs) in preventing vasovagal syncope (VVS), with possible benefit in older adults, leading to North American guidelines accepting BBs as a reasonable but weak option in patients aged ≥ 42 years with VVS (class IIb). In the Prevention of Vasovagal Syncope Trial 5 (POST 5), we conducted a randomized clinical trial of metoprolol in the prevention of VVS in patients aged ≥ 40 years. Methods:Patients aged ≥ 40 years with ≥ 1 syncopal spell in the prior year and ≥ -2 points for the Calgary Syncope Symptom Score were randomized to receive either metoprolol or matching placebo for 12 months. Patient-level meta-analysis of patients with age ≥ 40 years was done for randomized controlled trials (RCTs) studying the effect of BBs in VVS. Results:A total of 51 patients (age 64 ± 11 years, 59% female) were included in POST 5 (26 metoprolol, 25 placebo). Treatment arms were balanced in demographic and clinical characteristics. Eight patients (31%) in the metoprolol arm and 10 (40%) in the placebo arm experienced syncope during a median follow-up period of 12 months (P = 0.69). In the pooled analysis of 173 patients from 4 RCTs, 29 of 85 patients on BB (34%) and 30 of 88 patients (34%) on placebo had at least one syncope recurrence (odds ratio 0.99, 95% confidence interval 0.43, 2.29). Conclusion:BBs showed no effect on reducing syncope recurrence in older patients with VVS. These results may inform practice guidelines by removing their recommendations for using BBs in this specific context. Clinical Trial Registration:NCT02123056.
Background: Channelopathies represent a heterogeneous group of rare inherited cardiac diseases associated with life-threatening arrhythmias. Our knowledge of their epidemiology in childhood is limited. The aim of this study is to evaluate the epidemiology of pediatric channelopathies on a Mediterranean island (Crete, Greece). Methods: Retrospective study of children < 18 years followed in the Regional Tertiary Pediatric Cardiology Unit during a 24-year period (2002-2025) and meeting the disease-specific diagnostic criteria. Results: A total of 43 children (32 families) were enrolled, corresponding to an average annual incidence of 1.43 (95% C.I.: 1.03-1.92) and a cumulative prevalence of 31.1 (95% C.I.: 22.1-42.5) cases per 100, 000 children, with significant regional incidence differences. Long QT syndrome (n = 38) was predominant; rare cases of Brugada syndrome (n = 3) and Catecholaminergic polymorphic tachycardia (n = 2) were recorded. The diagnosis was based on symptomatic presentation (n = 15, 35%), while asymptomatic patients (n = 28, 65%) were diagnosed during cascade family screening (n = 22, 51%) and preparticipation screening (n = 6, 14%). They represented the first diagnosis within affected families (index cases) in 21/43 (49%) of cases. Genetic testing was performed in 35/43 (81%) channelopathy cases and it was positive in 33/43 (77%) of them, specifically in 30 out of 38 (79%) LQT cases with a genotype of LQT2 in 15 (39%), LQT1 in 10 (26%), LQT3 in one (3%) and LQT5 in two (5%) cases. Conclusions: The incidence of pediatric channelopathies on the Mediterranean island of Crete seems comparable to that reported in the literature, with regional clusters of significantly increased incidence. Further study of the epidemiology of pediatric channelopathies is needed, to document any regional or ethnic differences and for the best design of large-scale screening programs.
