Background: Remote magnetic navigation (RMN) enables precise three-dimensional catheter control with stable contact force, potentially enhancing safety and lesion quality. Previous studies demonstrated reduced radiation exposure and comparable efficacy to manual navigation, primarily in paroxysmal atrial fibrillation (pxAF). Evidence in persistent AF (perAF), particularly advanced stages, remains scarce. This study presents the first very long-term outcomes of RMN-guided ablation in perAF.Methods: 383 patients were retrospectively analyzed (mean age 62.6 ± 9.1 years; 85.4% perAF, 14.6% pxAF) who underwent RMN-guided pulmonary vein isolation (PVI) with additional linear lesions as indicated (2009–2019). The cohort represented advanced atrial disease (85.4% persistent AF) with elevated CHA2DS2-VASc scores and frequent atrial tachyarrhythmias (AT); 96 repeat RMN procedures were additionally analyzed. Long-term success was defined as freedom from AF or AT recurrence beyond a 3-month blanking period. Survival and predictors were assessed using Kaplan–Meier and multivariable analyses.Results: AF-free survival after the initial RMN procedure was 61.1%, 43.4%, 33.0%, 23.7%, and 18.0% at 12, 24, 36, 48, and 60 months, respectively. Freedom from any AT declined from 52.5% at 12 months to 11.5% at 60 months. Early recurrence during the blanking period strongly predicted long-term failure. Mean fluoroscopy and procedure times were 9.1 ± 10.1 minutes and 276 ± 84 minutes. Severe complications occurred in 5.0%.Conclusion: Advanced persistent AF, RMN-guided ablation achieves modest long-term arrhythmia control with low complication rates. Early post-procedural AT recurrence is the strongest prognostic marker. RMN remains a feasible strategy for complex AF ablation and warrants further evaluation in high-risk populations.
Introduction and objectives: Although elevated natriuretic peptide levels form part of the universal definition of heart failure, values of echocardiographic parameters indicating congestion have not yet been defined. Our research aims to demonstrate the correlation between different echocardiographic parameters and NT-proBNP levels ≥300 pg/mL, the diagnostic threshold for heart failure in decompensated and hospitalized patients.Methods: We performed a retrospective observational analysis of echocardiographic parameters and NT-proBNP levels from patients admitted to the cardiology inpatient unit of a tertiary hospital in Madrid, Spain, with a suspected diagnosis of decompensated heart failure during 18 months. Results: A total of 134 patients (68 female) were included. LV thickness, E/E’ lat, E/E’ med, E/E’ average, S-wave, E-wave, and IVC diameter were significantly associated with NT-proBNP levels ≥300 pg/ml. In contrast, LVEF, A-wave, and TAPSE were negatively correlated with NT-proBNP levels ≥300 pg/ml. E/E’ ratio >15 was found to be significantly related to NT-proBNP ≥300 pg/ml (p = 0.007), with a positive predictive value of 95%. The model with the highest predictive power for NT-proBNP levels of ≥300 pg/ml included LA diameter, A1, E/E’ mean, S-wave, LV thickness, and LVEF ((AUC 0.88 (0.81 – 0.94)).Conclusion: Our research presents an accurate model that uses echocardiographic parameters to predict NT-proBNP ≥300 pg/ml, a diagnostic criterion for heart failure. Strong predictors of NT-proBNP ≥300 pg/ml included LA diameter, A-wave, E/E’ mean, S-wave, LV thickness, and LVEF. Our research defines echocardiographic parameters suggestive of cardiogenic pulmonary or systemic congestion that apply to the complete phenotypical spectrum of heart failure.
Pericardial effusion is a rare but potentially fatal adverse effect reported with apixaban, dabigatran, edoxaban, and rivaroxaban (direct oral anticoagulants). We report three cases of pericardial effusion that occurred at a single institution with two patients requiring urgent pericardiocentesis. All patients took a direct oral anticoagulant with a p-glycoprotein inhibitor or a combined p-glycoprotein and CYP3A4 inhibitor. Our patients had underlying conditions predisposing them to developing pericardial effusion.
Objective: Study the association between anti-ischemic chemoprophylaxis (ACE inhibitor, statin, and antiplatelet agent) and the reduced risk of the occurrence of silent myocardial ischemia in hypertensive diabetic subjects. Methodology: This was an observational, retrospective, prospective case-control study conducted from January 1 to November 30, 2018. It involved 94 patients distributed into 47 cases and 47 controls following the result of the exercise stress test performed in the cardiology department of Yalgado Ouédraogo Teaching Hospital in Ouagadougou, Burkina Faso. Results: The average age of the cases was 55.98 ± 8.6 years against 56.11 ± 7.57 years for the controls; the sex ratio was in favor of women in both groups. Anti-ischemic chemoprophylaxis was found in 25% of cases and 15% of controls. The assessment of the cardiovascular risk showed a high cardiovascular risk level in 34% of cases, against to 35% of controls; an intermediate risk level in 34% of cases, against 41% in controls. Risk factors such as age, dyslipidemia, smoking, and hyperuricemia were not associated with silent myocardial ischemia. Multivariate analysis revealed an association (odds ratio = 0.29; p = 0.048) between chemoprophylaxis and reduction of 71% of the risk of silent myocardial ischemia. Conclusion: Our work highlights the importance of pharmacological treatment of hypertensive diabetic patients as a primary cardiovascular prevention.
At presentation, the PaO2/FiO2 ratio was 92 with SpO2 82% on high‑flow nasal cannula 15 L/min at FiO2 0.80. Ultrasound‑guided 14‑Fr pigtail decompression (right 5th intercostal space, anterior axillary line) at T0 evacuated ~220 mL air with scant blood‑tinged fluid; oxygenation improved to a PaO2/FiO2 of 308 within 12 minutes (PaO2/FiO2 308 on 3 L nasal cannula; A–a gradient 528 → 112 mmHg), and induction proceeded at T+30 minutes with ORIF commencing at T+90 minutes the same day. Background: Hypoxemia before fracture fixation in polytrauma often derives from reversible thoracic causes. We report a case in which unilateral radiographic lung decompensation with low oxygen saturation was rapidly reversed by targeted pigtail decompression, enabling safe anesthesia and definitive fixation. Case: A patient with bilateral open distal femur fractures (right Gustilo‑Anderson II, left I) developed acute hypoxemia with unilateral alveolar opacity on chest radiography. Ultrasound‑guided 14‑Fr pigtail decompression immediately improved oxygenation and radiographic aeration, allowing timely ORIF. Outcome: Postoperative recovery was uneventful; long‑leg follow‑up radiographs confirmed bony healing. Interpretation: When low SpO2 coexists with a unilateral pattern, clinicians should not be constrained by the prior of bilateral pulmonary edema. Rapid, targeted pleural decompression (pigtail) can eliminate a reversible pleural barrier within minutes and open an anesthetic window for fracture fixation. Mechanistically, hyperacute decompensation may reflect a convergence of pleural tension‑related shunt, re‑expansion lung injury, negative‑pressure/airway factors, and fat‑embolism‑related pulmonary vascular responses. Design: Case report with focused literature review.
Background: Routine chest radiography (CXR) is inexpensive and ubiquitous. Beyond categorical reads, classical CXR metrics—CTR, VPW, and a lung transparency index (LTI)—encode hemodynamic and pulmonary information. We present CXR‑Hemo, a math‑first framework and deployable API that converts these metrics together with bedside physiology (SpO2, ABG/VBG, MAP) into calibrated probabilities linked to clinical decision thresholds via decision‑curve analysis (DCA). Methods: We formalize a constrained logistic risk function with monotonic feature effects and a reader‑in‑the‑loop design. Image metrics are computed automatically from standardized definitions: CTR from transverse diameters; VPW from mediastinal landmarks with projection‑aware scaling (millimeters via DICOM PixelSpacing); and LTI from normalized lung‑mask intensity. Physiologic inputs include SpO2, ABG/VBG surrogates, lactate, and MAP. Post‑hoc probability calibration uses isotonic regression or temperature scaling with reliability curves and Brier score auditing. Clinical utility is summarized across 0.2–0.6 thresholds using DCA. We expose three JSON endpoints—/cxr/metrics, /physio/ingest, and /risk/hemo—to return calibrated risk, attention weights, and net‑benefit snapshots. Findings (analytical demonstration): We provide calibration diagnostics and DCA curves using simulated data to illustrate threshold‑linked interpretation, accompanied by a schematic depicting dual encoders, a modality gate α, a constrained logistic head, and post‑hoc calibration to produce an actionable probability. Interpretation: By explicitly foregrounding calibration and DCA, CXR‑Hemo links probabilities to threshold‑anchored actions and can avert discretionary CT in risk ranges where model‑guided net benefit exceeds ‘CT‑for‑all’ [1,2]. Given the large dose differential between CXR and chest CT in adults (≈0.1 mSv vs. several mSv), the framework has the potential to reduce population radiation exposure while maintaining clinical safety [3,4]. CXR‑Hemo reframes routine CXR and basic gases as a probabilistic, interpretable sensor for hemodynamic risk. By foregrounding calibration and DCA, the approach links probabilities to actions, enabling a transparent, threshold‑aware tool suitable for resource‑variable emergency care.
Introduction/Objective: Identify the factors associated with poor blood pressure control in hypertensive patients followed up in the cardiology outpatient consultation unit of CHU-YO. Methodology: This was a two-month cross-sectional study with a descriptive and analytical focus. Results: A total of 288 hypertensive patients were included in the study. 137 cases had poor blood pressure control, representing 47.57% of the total. In terms of sociodemographic characteristics, females dominated at 67.4% with a sex ratio of 0.48, and the average age was 60.2 ± 13.9 years. Cardiovascular risk factors were dominated by dyslipidemia, which accounted for 53.5%. The average of cases with a previous history of hypertension was 7.1 ± 5.1 years. In terms of treatment, fixed dual therapy was predominant with a rate of 57.3%. In multivariate analysis, urban residence, the presence of acute complications, and poor treatment adherence were associated with poor blood pressure control. Conclusion: This study highlights the key factors contributing to poor blood pressure in hypertensive patients, such as life in urban settings, complications such as strokes, and poor treatment adherence, emphasizing the importance of holistic management.
Background: The stress-induced hyperglycemic ratio (SHR) is an index that reflects the imbalance between acute stress-induced glucose fluctuations and baseline glucose metabolism levels. Currently, there are few studies on the SHR index and its prognostic significance in heart failure (HF) patients undergoing invasive mechanical ventilation. This study aimed to investigate the relationship of SHR with the risk of death in HF patients requiring invasive ventilation. Methods: Conduct a retrospective cohort study based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Include adult heart failure patients who received invasive ventilation and divide them into quartile groups according to the level of the Systemic Heart Rate (SHR). The primary endpoints of the observation are the 30-day all-cause mortality rate and the all-cause mortality rate in the Intensive Care Unit (ICU), while the secondary endpoints are the 365-day all-cause mortality rate and the all-cause mortality rate during hospitalization. The Kaplan-Meier curve is used to compare the survival outcomes between groups. A Cox proportional hazards regression model that adjusts for demographic characteristics, underlying diseases, and the severity of critical illnesses is employed to evaluate the relationship between SHR and the mortality rate. The Restricted Cubic Spline (RCS) is utilized to test the nonlinear association between the two, and subgroup analysis is carried out to verify the consistency of the results across different groups. Results: Among the 1,038 eligible patients, the mean age was 68.50 years (range: 59.46 - 77.48 years), and 639 (61.56%) of them were male. The Kaplan-Meier curve showed that the higher the SHR index, the higher the risk of all-cause mortality in patients at 30 days (log-rank test, p = 0.011) and in the ICU (log-rank test, p = 0.0029). An increase in SHR was independently associated with an increased risk of 30-day and ICU mortality. Compared with the second quartile group Q2, the 30-day mortality rate in the group with the highest SHR was significantly higher (HR = 1.59, 95% CI 1.08, 2.33), and the ICU mortality rate in the group with the highest SHR was significantly higher (HR = 1.86, 95% CI 1.10, 3.14). The restricted cubic spline analysis showed a non-linear dose-response relationship between SHR and 30-day all-cause mortality (p for non-linearity < 0.05), and the risk of 30-day and ICU all-cause mortality gradually increased with the increase of the SHR index. The risks of 30-day and all-cause mortality in the ICU gradually increased. The results of the subgroup analysis confirmed that it remained stable in the subgroup of patients with Coronary Heart Disease (CHD). Conclusion: In critically ill heart failure (HF) patients receiving invasive ventilation, a higher stress hyperglycemia ratio (SHR) index is significantly associated with an increased risk of 30-day and all-cause mortality in the intensive care unit (ICU). Meanwhile, the SHR index is an independent predictor of mortality in critically ill HF patients who require invasive ventilation.
Retracing the evolution of Mineralocorticoid Receptors (MR) obliges us to take an instructive as well as fascinating leap back in time. This journey teaches us that the relationship between MRs and what we consider their natural ligand, aldosterone, has not always been an exclusive one. MRs operated for a very long time in the oceans and, in any case, in an aquatic environment, stimulated by ligands other than aldosterone, and exercising functions that we still do not know well but which were certainly different from those they currently perform in terrestrial vertebrates, where they maintain normal sodium and body fluids. The history of MRs was initially intertwined with that of female sexual hormones, in particular with progesterone, which was one of the first agonists for MRs, before becoming, with the transition to the terrestrial environment, an important antagonist. This initial intertwining could be the cause of the sexual dimorphism that can be glimpsed when these receptors are overstimulated, as emerges from many experimental studies and some clinical data and/or when antagonistic drugs for these receptors are studied. This must be taken into account in the planning of clinical studies, especially randomized controlled trials, in which the presence of the two sexes must always be well balanced and in the interpretation of the results which must always be performed being well aware of the gender of participants. This does not always happen, however.
Introduction: Behçet’s disease is a rare, systemic, inflammatory condition that primarily affects young adults. It is characterized by a variety of clinical manifestations. However, neurological and cardiac presentations remain uncommon and often delayed in diagnosis. This disease can lead to severe complications, such as ischemic strokes and myocarditis, highlighting the systemic and complex nature of the condition. Case presentation: A 27-year-old patient was hospitalized after experiencing an ischemic stroke and myocarditis, which revealed Behçet’s disease. He had a history of oral and cutaneous ulcers, without a prior diagnosis of Behçet. Upon admission, brain imaging confirmed an ischemic stroke, and echocardiography and cardiac MRI showed acute myocarditis. Biological tests confirmed elevated systemic inflammation, which guided the treatment plan. The initial treatment included corticosteroids, immunosuppressors (azathioprine), and cardioprotective therapy. The patient showed significant clinical improvements, although mild deficits persist. Discussion: Myocarditis in Behçet’s disease is a rare but severe manifestation resulting from inflammation of the heart walls, often associated with other systemic vascular involvement. Although less common than oral or cutaneous ulcers, myocarditis can lead to acute heart dysfunction and even heart failure if not treated promptly. It is generally caused by an excessive inflammatory response, often associated with immune system activation, which affects the coronary circulation and damages the cardiac muscle. Treatment for myocarditis in this context relies on high-dose corticosteroids to control inflammation, followed by long-term immunosuppressive medications like azathioprine. While the initial treatment often leads to a rapid improvement in cardiac function, the risk of long-term complications, such as dilated cardiomyopathy or heart failure, remains high. Close follow-up is therefore essential to prevent these complications and optimize the long-term cardiac prognosis of patients with this rare disease. Conclusion: The progression of myocarditis in Behçet’s disease can be favorable if diagnosed and treated early, with significant improvement in cardiac function achieved through the use of corticosteroids and immunosuppressive therapy. However, the long-term prognosis remains uncertain due to the risk of chronic cardiac complications, such as dilated cardiomyopathy or heart failure.
Dyspepsia refers to acute, chronic, or recurrent pain or discomfort centered in the upper abdomen. An international committee of clinical investigators (Rome III Committee) has defined Dyspepsia as Epigastric pain or Burning, early satiety, or postprandial fullness Dyspepsia occurs in 15 % of the Adult population and accounts for 3% of general medical office visits. The descriptive study was carried out in Eastern Afghanistan, Afghan Momand Medical Complex & Research Center, Department of Gastroenterology, during the years 2023-2024. To know the Clinico-Endoscopy of Dyspepsia, for patients who present with investigated Dyspepsia to Gastroenterological OPD & IPD. The study result showed, there were a total of patients 467, and of these patients 230 were Male and 237 were Female. According to the Age, 45 patients were under Age <20, 219 patients were between the ages 21-40 years, 130 patients were between ages 41-60 years and 73 patients were over 60 years of Age. However according to the presentation, 357 patients had Dyspepsia, 59 patients had Dysphagia, 13 patients had Chronic Liver Diseases & Screened for Varices, 3 patients presented after Acid ingestion, 2 patients had Anemia, 11 patients had persistent vomiting and 22 patients had suspected GI-Bleeding. Furthermore in Esophageal findings from a total of 467 patients 34 patients had Esophageal Candidacies, 6 patients had Esophageal Narrowing, 25 patients had Esophageal Growth, 71 patients had Hiatus Hernia, 180 patients had LA Grade A Esophagitis, 21 patients had LA Grade B Esophagitis, 6 patients had LA Grade C Esophagitis, 3 patient had LA Grade D Esophagitis. 16 patients had Lax Lower Esophageal Sphincter, 9 Patients had High-Risk Esophageal Varices, 3 patients had Small Esophageal Varices and 150 patients had Normal Esophagus and in Gastric findings from total all above patients, 4 patients had Antral Gastritis, 50 patients had Corpus Gastritis, 1 patient had Fundal Gastritis, 4 patients had Nodular Gastritis, 199 patients had Pan-Gastritis, 108 patients have Severe Pan Erosive Gastritis, 23 patient had Gastric Erosions, 6 patients had PHG (Portal Hypertensive Gastropathy), 3 Patients had Fundal Varices, 5 patients had Gastric Polyps, 5 patients had Gastric Growth, 2 patients had Pyloric Stenosis, 8 patients stomach not seen due to Esophageal Growth, 67 patients stomach were normal. In the present study there were Duodenal findings from a total of the above patients 48 had Duodenitis, 2 patients had Duodenal Polyps, 2 patients had duodenal ulcers, 1 patient had Duodenopathy, 2 patients had Duodenopathy, 2 patients Duodenum not seen due to Pyloric Stenosis and 413 patients Duodenum were normal. Regarding the habits in our study in which a total of 467 patients were examined 135 of the above patients had snuff habits, 103 patients had smoking habits, 2 patients were Heroin addicts and 227 of the total patients didn’t have any habits (the majority of them were using spicy food, overfeeding, drinking of nonalcoholic beverages, fatty foods, NSAIDs ...) and the higher incidence of Dyspepsia was in Female patients, Also with the age between 21-40 years (43%) patients, Also the higher incidence of Dysphagia 47% were in patients with Age >60 years, the Endoscopy showed that 83% patients had Gastritis also higher incidence regarding the habits 29% had snuff habit and 22% had a smoking habit.
Cardiac arrhythmias are frequent complications of the consumption of toxic substances, including cannabis, which can be fatal. We report in this case a patient who developed a cardiac arrhythmia-type focal atrial tachycardia a few moments after the consumption of an important dose of cannabis but which reduced spontaneously and without having administered any medication or an external electric shock. All the rest of the etiological assessment of this arrhythmia was negative and the arrhythmia was linked to the consumption of cannabis which is known to cause these complications.
Background: Atherosclerosis is a disease characterized by the deposition of lipids on the inner walls of blood vessels. Diabetes is a significant risk factor for atherosclerosis. C-reactive protein (CRP) is a marker of systemic inflammation and an independent risk factor for cardiovascular disease (CVD). This study aimed to investigate the relationship between serum CRP levels and the severity of coronary artery disease in diabetic patients. Materials and methods: This cross-sectional analytical study was conducted on 185 diabetic patients referred for coronary angiography based on non-invasive test indications. A checklist was used to collect demographic data, blood pressure readings, and duration of diabetes was completed, and CRP testing was performed for each patient. Coronary angiographic data were also collected, including the type and severity of involved vessels reported by two cardiologists. Results: There was a statistically significant relationship between serum CRP level and severity of coronary artery disease (p = 0.009). Additionally, there was a significant relationship between the duration of diabetes and the severity of coronary artery disease (p – value = 0.006). Conclusion: We found a significant relationship between serum CRP levels and the severity of coronary artery stenosis and between the duration of diabetes and the severity of coronary artery stenosis.
In this paper, we aimed to report the use of Merit Wrapsody® for popliteal artery aneurysms. We describe a case series involving 5 patients submitted to endovascular repair with Merit Wrapsody® for popliteal artery aneurysms. Merit Wrapsody® is a flexible self-expanding endoprosthesis indicated for use in hemodialysis patients for the treatment of stenosis or occlusion within the dialysis outflow circuit of an Arteriovenous (AV) fistula or AV graft, consisting of Nitinol, ePTFE, PTFE structure. In a case series communication, we aimed to describe the feasibility of a PTFE-lined stent for percutaneous treatment of conditions other than AV fistula obstruction. We report the successful use of Wrapsody® to percutaneously treat popliteal artery aneurysms. This case series illustrates the feasibility of the “off-label” use of self-expanded Wrapsody endoprosthesis to percutaneously treat arterial pathology conditions, especially popliteal artery aneurysms with satisfactory and excellent results.
Cardiac rhythm is fundamental to cardiovascular health, ensuring synchronized electrical impulses that maintain effective heartbeats and blood circulation. Central to this process are electrolytes—sodium, potassium, calcium, magnesium, and chloride—which regulate the generation and propagation of action potentials across cardiac cell membranes. Each electrolyte plays a distinct role in cardiac electrophysiology: sodium drives rapid depolarization, potassium facilitates repolarization, calcium modulates contraction, magnesium stabilizes ion channels, and chloride maintains ionic balance. Electrolyte imbalances, such as hyperkalemia, hypokalemia, hypernatremia, and hypocalcemia, are critical contributors to arrhythmias, contractility issues, and cardiomyopathies. For instance, hyperkalemia actually depresses the upstroke of the action potential by partially depolarizing the resting membrane (inactivating Na+ channels), slowing impulse conduction. Similarly, hypercalcemia shortens action potential duration, while hypocalcemia compromises cardiac contractility. Clinically, maintaining electrolyte homeostasis is critical to mitigating arrhythmic risk and improving outcomes in conditions such as atrial fibrillation and heart failure. Advances in therapeutic interventions, including electrolyte supplementation, ion channel modulators, and precision medicine approaches, offer new opportunities for improving cardiac care. Furthermore, understanding the interplay between electrolytes, myocardial ultrastructure, and systemic comorbidities like hypertension and diabetes is critical for developing targeted therapies. This review highlights the pivotal roles of electrolytes in maintaining cardiac rhythm and provides insights into their clinical and therapeutic implications for managing electrolyte-driven cardiac diseases.
Introduction: The term “Cardiorenal Syndrome” [CRS] is widely used to make reference to the vast array of interrelated, bidirectional interactions between heart-kidney derangements. Objective: In the present manuscript, a brief description of CRS-related operational definitions and physiopathological mechanisms will be made, in order to better describe the therapeutic benefits of the use of ECOS in CRS patients, including achieving euvolemic state via ultrafiltration, inflammatory pathways regulation via hemadsorption and ECMO-provided hemodynamic support. Discussion: Even when there is a high heterogenicity among cardiorenal syndrome clinical scenarios, common physiopathological pathways have been described, including neurohormonal adaptations, and hemodynamic changes, right ventricle dysfunction, oxidative stress and proinflammatory pathways. Therapeutic benefits of the use of ECOS in CRS patients, include achieving euvolemic state via ultrafiltration, regulation of inflammatory pathways via hemoadsorption and ECMO-provided hemodynamic support. Conclusion: Extracorporeal organ support represents a valuable therapeutic strategy for patients with cardiorenal syndrome. In the years to come, the potential of ECOS as an inflection point in the natural history of disease to prevent the development of organ failure, prevent single organ failure becoming a multiorgan failure, prevent chronic organ failure development and achieving full recovery will be among the most important subjects within the research agenda.
Case presentation: We describe the youngest successful cavotricupsid isthmus cryoablation in a 16-month-old toddler with small atrial septal defect whose medical management was complicated by intrinsic atrioventricular nodal conduction disease and recurrent atrial flutter. Methods: Zero fluoroscopy electrophysiology study performed. Cavotricuspid isthmus proved to be “in” circuit with entrainment. Line of block was achieved with termination of atrial flutter using 2 minutes cryolesions. Results: The patient underwent successful cryoablation at 9 kg, without recurrence. Conclusion: Cavotricuspid isthmus ablation using cryoablation resulted in no recurrence of atrial flutter for at least 1 year of follow up. Ablation offers a less invasive alternative to pacemaker implantation in toddlers with coexisting conduction disease, limiting medical management options.
