Abstract Background Takayasu arteritis is a rare, chronic vasculitis affecting large arteries, primarily the aorta and its principal branches. The illness frequently presents with non-specific systemic symptoms, leading to a postponed diagnosis. Dysphagia resulting from aortic involvement is a rare manifestation and may resemble other cardiovascular or gastrointestinal disorders. Case presentation We report a 45-year-old Iranian woman with a one-year history of exertional dyspnoea, intermittent dysphagia for solid food, and diffuse musculoskeletal pain with morning stiffness. Initial evaluation showed elevated inflammatory markers, moderate aortic regurgitation, and aneurysmal dilation of the ascending aorta and aortic arch, and infective endocarditis was initially suspected. After serial negative blood cultures and resolution of a suspicious valvular finding on repeat transoesophageal echocardiography, upper gastrointestinal endoscopy and endoscopic ultrasonography localised her dysphagia to extrinsic oesophageal compression by the dilated thoracic aorta. Computed tomography angiography confirmed a non-dissecting aneurysm of the ascending aorta and arch, and whole-body ¹⁸F-FDG PET demonstrated markedly increased metabolic activity along the thoracic aorta and its supra-aortic branches, consistent with active large-vessel vasculitis. After systematic exclusion of infective and other inflammatory mimics, a clinical diagnosis of Takayasu arteritis was made. Conclusion This case illustrates an uncommon presentation of Takayasu arteritis with dysphagia produced by extrinsic oesophageal compression from thoracic aortic aneurysmal dilatation. Constitutional symptoms, elevated inflammatory markers, and unexplained cardiovascular findings should prompt evaluation for large-vessel vasculitis. Early multimodal imaging and a systematic approach to excluding infective and other inflammatory mimics are essential for accurate diagnosis and timely treatment.
Abstract Background Anomalies of coronary artery origin are uncommon congenital variants that may pose a challenge to selective engagement at invasive coronary angiography (CAG). Although their prevalence and anatomical spectrum are well described, prospective data on the diagnostic and guide catheter utilisation to engage each anomaly subtype, procedural implications and on the access strategy adopted in current radial-first practice, remain limited. Methods We prospectively enrolled 1,850 consecutive adults undergoing invasive CAG, with or without percutaneous coronary intervention (PCI). Anomalies of origin were defined by the modified Angelini classification; intrinsic anomalies and anomalies of termination were excluded. Baseline, angiographic, procedural data - including diagnostic and guide catheter use by subtype; and access strategy were compared between anomaly and non-anomaly groups. Results An anomaly of origin was identified in 85 of 1,850 patients (4.59%; 95% CI 3.71–5.63%); under a restricted definition that excluded two anatomical variants not consistently classified as anomalies in earlier invasive-angiography series, prevalence was 1.30% (95% CI 0.83–1.92%). The commonest anomaly was ectopic (high or anterior) right coronary artery (RCA) origin from the right coronary cusp ( n = 47; 55.3%), followed by separate ostia of left anterior descending (LAD) and left circumflex (LCx) arteries ( n = 14; 16.5%) and anomalous LCx from the right coronary cusp or RCA ( n = 14; 16.5%). PCI was performed in 52 of 85 anomaly patients (61.2%). Radial access was attempted in 67 patients: 53 (79.1%) completed radially, 14 (20.9%) required crossover to femoral; and 18 were attempted femorally. Anomaly patients required more diagnostic catheters per case (2.20 vs. 1.23), with the greatest burden in crossover cases (3.14 vs. 1.17 catheters); more access crossover (16.5% vs. 5.0%) and more guide catheter changes (44.2% vs. 6.5%; all p < 0.001),. No significant difference in major procedural complications was observed (4.7% vs. 2.7%; p = 0.43); however the study was not powered for rare procedural events.
Abstract Background The electromechanical window (EMW), defined as the difference between mechanical and electrical systole, is an emerging marker of arrhythmic risk and ventricular dysfunction. Although cardiac resynchronization therapy (CRT) improves mechanical synchrony, the influence of different pacing strategies on EMW is not well established. This study compared the effects of conventional biventricular (BiV) pacing and left bundle branch area pacing (LBBAP) on EMW, reverse remodeling, CRT response, and arrhythmic burden. Methods In this prospective, observational study, 80 patients with left ventricular ejection fraction (LVEF) ≤ 35% undergoing CRT received BiV pacing ( n = 40) or LBBAP ( n = 40). Echocardiography with simultaneous electrocardiography was performed at baseline and 6 months. The primary endpoint was change in EMW. Results At 6 months, LBBAP was associated with greater QRS narrowing (42 ± 15 vs. 28 ± 13 ms, p < 0.001) and EMW normalization (− 38 ± 22 to − 5 ± 18 ms vs. − 36 ± 20 to − 18 ± 19 ms; p = 0.003). Improvements in LVEF, global longitudinal strain, and left ventricular end-systolic volume were also greater with LBBAP. EMW improvement correlated with reverse remodeling and QRS narrowing. Baseline EMW predicted CRT response (AUC 0.71), while persistent EMW negativity was associated with a higher incidence of non-sustained ventricular tachycardia (45% vs. 18%, p = 0.01). Conclusions LBBAP was associated with greater EMW normalization, improved reverse remodeling, and a lower arrhythmic burden than BiV pacing. EMW may represent an integrative marker of CRT response and residual arrhythmic risk. These findings are hypothesis-generating and require validation in larger multicenter randomized studies.
Abstract Background Pulmonary embolism (PE) remains a complex clinical challenge with significant morbidity and mortality. Despite significant advancements in diagnosis and management, as well as the availability of recent guidelines, disparities in their implementation persist due to socioeconomic factors and other barriers. The study aims to assess the degree of implementation of guidelines in the diagnosis and management of PE. Results Among 8,648 patients presenting to the National Heart Institute emergency department, 200 were diagnosed with acute PE, accounting for 2.3% of ED visits during the study period. The mean age was 56.7 ± 9.8 years, with 58% being female. Dyspnea was the most common symptom, occurring in 64% of cases, while bed rest for > 3 days was the most frequent risk factor (32%). Computed tomography pulmonary angiography (CTPA) confirmed PE in 95.5% of cases. Risk stratification classified 80% as low to intermediate-low risk, 13% as intermediate-high risk, and 6% as high-risk. Unfractionated heparin monotherapy was initiated in 63% of patients, while only 8.5% were discharged on direct oral anticoagulants (DOACs). Mortality was 3%, including 1% due to life-threatening bleeding. There was notable overuse of D-dimer testing, underutilization of ventilation–perfusion (V/Q) scans, limited prescription of DOACs, and absence of interventional therapies in eligible patients. Conclusions This study highlights critical gaps in adherence to PE management guidelines, influenced by physician discretion, socioeconomic constraints, and diagnostic inconsistencies. Strengthening outpatient care pathways, refining risk stratification practices, and ensuring consistent guideline implementation are key priorities to optimize outcomes.
Abstract Background Delayed coronary stent-related inflammatory complications following percutaneous coronary intervention (PCI) are exceptionally rare, and chronic cutaneous fistulization years after stent implantation has only rarely been described. Such indolent presentations may mimic superficial chest wall infections, making diagnosis challenging. Multimodality imaging is essential for accurate diagnosis and surgical planning. Case presentation A 53-year-old man with type 2 diabetes mellitus and ischemic heart disease underwent right coronary artery (RCA) stenting in 2018. He presented with recurrent intermittent fever and a persistent draining xiphisternal sinus for seven months following incision and drainage of a presumed chest wall abscess. Ultrasonography demonstrated a localized subcutaneous collection. Contrast-enhanced computed tomography and CT coronary angiography (CTCA) revealed a fractured, chronically occluded RCA stent with extensive peri-stent inflammatory soft tissue extending into the pericardium, diaphragm, and subdiaphragmatic region. Cardiac magnetic resonance imaging confirmed transdiaphragmatic inflammatory extension and a fistulous tract communicating with the overlying skin. Transesophageal echocardiography was not performed because transthoracic echocardiography and cross-sectional imaging adequately delineated the lesion and showed no evidence of endocarditis. Following preoperative and perioperative antibiotic therapy, the patient underwent surgical excision of the fractured stent, chronic fibro-inflammatory tissue, and sinus tract. Intraoperative cultures and GeneXpert testing were negative, possibly reflecting prior prolonged antibiotic therapy. The postoperative course was uneventful, with complete wound healing, resolution of fever, and follow-up transthoracic echocardiography demonstrating no pericardial collection or valvular vegetations. Conclusions This case highlights an exceptionally rare delayed culture-negative chronic peri-stent inflammatory fistulizing process associated with RCA stent fracture presenting nearly seven years after PCI. It emphasizes the importance of maintaining a high index of suspicion in patients with persistent chest wall sinuses after coronary intervention and demonstrates the complementary role of CTCA and cardiac magnetic resonance imaging in defining disease extent and guiding successful surgical management.
Transcatheter closure of patent ductus arteriosus (PDA) and ventricular septal defect (VSD) is performed using various occluder devices. We aim to compare the use of KONAR-Multifunctional Occluder (KONAR-MFO) and Amplatzer occluders (ADO-I, ADO-II) for closure of PDAs and VSDs. This is a retrospective study on patients who underwent transcatheter PDA or VSD closure between June 2023 and October 2025. Patients were categorized according to the occlusion device and the underlying defect. Data were analysed comprehensively. The study included 173 patients; 116 (67.1
Previous research has shown that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have cardioprotective effects. However, their efficacy in acute myocardial infarction (AMI) is not yet well established. We conducted a systematic review and meta-analyses to assess the impact of GLP-1 RAs in AMI. We systematically searched major databases for studies in patients with ST-elevation (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). These included MEDLINE (accessed via PubMed), Excerpta Medica dataBASE (Embase), Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Google Scholar from their inception through February 2026. PRISMA guidelines were used to conduct this review. Both randomized controlled trials (RCTs) and observational studies were included in the systematic review. However, only RCTs were included in the meta-analyses. The primary outcome was infarct size relative to the area at risk (AAR). Secondary outcomes included major adverse cardiovascular events (MACE) and safety outcomes (nausea, hypoglycemia, pancreatitis). The Cochrane Risk of Bias 2 (RoB 2) tool and Newcastle-Ottawa Scale (NOS) were used to assess risk of bias. We included eight studies with a total of 1,483 participants. GLP-1 RAs led to a smaller infarct size indexed to the AAR compared with placebo. The mean reduction was 10.14
Abstract Background Antiplatelet therapy remains a cornerstone of the management of acute (ACS) and chronic coronary syndromes (CCS). The 2025 European Society of Cardiology (ESC) Congress presented several pivotal Hot-Line trials that challenge established paradigms regarding dual antiplatelet therapy (DAPT) duration, agent selection, and risk-based personalization. Purpose This national advisory statement synthesizes the clinical value and implications of 11 major antiplatelet trials presented at ESC 2025 and provides evidence-aligned, context-specific recommendations for cardiovascular practice in Egypt. Methods A structured review of ESC 2025 Hot-Line antiplatelet trials was conducted. Evidence was appraised using a predefined grading framework, and national consensus was achieved through a multi-institutional expert panel using modified Delphi methodology. Recommendations were assigned Class of Recommendation and Level of Evidence according to ESC/ACC standards. Results The trials addressed antiplatelet therapy in six clinical pathways: ACS, primary PCI in STEMI, cardiogenic shock, post-CABG, complex PCI, and chronic coronary syndrome requiring oral anticoagulation. Key findings include: (1) selective use of shortened DAPT in stabilized ACS; (2) a potential role for P2Y12 monotherapy after 1 month in low-risk, fully revascularized MI; (3) lack of benefit from ultra-early aspirin withdrawal; (4) no superiority of twice-daily aspirin in high-risk ACS; (5) twice-daily clopidogrel for 1 month as a possible alternative to ticagrelor in resource-limited STEMI settings; (6) superior platelet inhibition with intravenous cangrelor in cardiogenic shock without proven clinical superiority; (7) emerging evidence supporting shorter DAPT or aspirin monotherapy after CABG; (8) score-guided DAPT duration in complex PCI; and (9) confirmation that aspirin should not be added to oral anticoagulation in stable coronary disease. Conclusion The Egyptian Society of Cardiology supports a more individualized, risk-based approach to antiplatelet therapy, emphasizing ischemic–bleeding balance, stent technology, revascularization completeness, and national resource considerations. Recommendations should be interpreted cautiously given the preliminary nature of some ESC 2025 data.
Ischemic stroke, including transient ischemic attack, exhibits seasonal variation, and the association between winter exposure and ischemic stroke risk in patients with nonvalvular atrial fibrillation (NVAF) has not been fully characterized at the population level. We investigated the association of winter exposure with ischemic stroke risk in Japanese patients with NVAF within a CHADS₂-based risk framework. We analyzed nationwide Japanese insurance claims data (2014–2022) to identify patients ≥ 60 years with newly diagnosed NVAF and subsequently conducted Poisson regression analyses. The outcome was hospitalization for ischemic stroke. Among 389,314 patients (median age 80 years), 24,576 (6.3
Dynamic Coronary Roadmap (DCR) is a novel software providing a motion-compensated, real-time overlay of coronary arteries to assist PCI device navigation with a single contrast injection. This meta-analysis evaluated the effectiveness and safety of DCR. We searched PubMed, Scopus, Web of Science, Cochrane Library, and Embase from inception to May 5, 2024. Outcomes were pooled as risk ratios (RR) or mean differences (MD) with 95
BACKGROUND:Middle aortic syndrome (MAS) is a rare clinical condition in children that is associated with a significant risk of morbidity and mortality. Delayed diagnosis and inadequate treatment can lead to severe complications, resulting in life-threatening consequences. CASE PRESENTATION:In this paper, we present two cases involving two 10-year-old Saudi girls diagnosed with MAS who presented with systemic hypertension. Echocardiography demonstrated a patent aortic arch; however, it showed abnormal diastolic flow in the descending aorta, which facilitated the diagnosis of MAS. CONCLUSIONS:Even when a paediatric patient shows no symptoms, health care workers should not record unreliable blood pressure readings. These blood pressure readings may indicate the onset of a disease that, if left untreated, could have catastrophic consequences. This report emphasises the rarity and clinical importance of MAS in the paediatric population, aiming to enhance early diagnosis and improve management strategies. Moreover, these findings underscore the critical role of echocardiography in diagnosing MAS.
Abstract Background New evidence suggests a relatively high prevalence of occult cardiac amyloidosis (CA) among patients with aortic stenosis (AS). While transcatheter aortic valve replacement (TAVR) is an established treatment for AS, the impact of concomitant CA on long-term outcomes remains unclear. We conducted a systematic review and meta-analysis to evaluate survival and procedural outcomes of TAVR in AS patients with and without CA. Methods PubMed, Scopus, Web of Science, Google Scholar, and the Cochrane Library were searched through 21 April 2026. Studies comparing outcomes of TAVR in patients with and without CA and reporting Kaplan–Meier survival curves were included. Individual patient survival data were extracted from Kaplan–Meier curves and reconstructed for pooled analysis. Secondary outcomes were analyzed using random-effects meta-analysis. Results Seven studies including 2747 patients were analyzed. In the primary analysis, which included both definitive and probability-based definitions of CA, CA was associated with increased all-cause mortality following TAVR (HR: 1.58; 95% CI 1.23, 2.03; P < 0.001). However, in a sensitivity analysis restricted to studies with confirmed CA, this association was no longer significant (HR: 1.32, 95% CI 0.84, 2.07, P = 0.226). There were no significant differences in pacemaker implantation (OR: 1.33; 95% CI 0.69, 2.56; P = 0.40) or more than mild aortic regurgitation (OR: 0.96; 95% CI 0.25, 3.78; P = 0.96). Conclusion The association between CA mortality after TAVR in AS patients is highly dependent on how CA is defined. While analyses including screening-based cohorts suggest increased risk, this was not observed in analyses of studies with confirmed CA. These findings highlight the impact of differing diagnostic approaches in CA and underscore the need for future studies to use standardized criteria and prospective designs to clarify the independent prognostic role of confirmed CA.
Abstract Background Atrial arrhythmias are a frequent and clinically significant complication in left ventricular assist device (LVAD)–supported patients, with the potential to impair right ventricular (RV) function, compromise device hemodynamics, and reduce quality of life. While atrial fibrillation (AF) has received considerable attention in this population, the distinct hemodynamic impact of typical cavotricuspid isthmus (CTI)–dependent atrial flutter and the role of catheter-based rhythm control remain poorly characterized. Case presentation A 60-year-old male with non-ischemic cardiomyopathy who underwent HeartMate 3 LVAD implantation as a bridge to transplantation developed typical CTI-dependent atrial flutter refractory to medical therapy, associated with marked deterioration in RV systolic function (TAPSE: 1.2 → 0.82 cm; Sm: 6.9 → 5.3 cm/s) and adverse LVAD hemodynamics. Electrical cardioversion had been attempted but failed to maintain sinus rhythm. Electrophysiological study using three-dimensional electroanatomic mapping (CARTO system, Biosense Webster) confirmed counterclockwise CTI-dependent atrial flutter. Radiofrequency (RF) ablation of the cavotricuspid isthmus achieved bidirectional conduction block and restored sinus rhythm. The procedure was performed under uninterrupted therapeutic anticoagulation with warfarin. Results At one-month follow-up, RV systolic function improved substantially (TAPSE: 0.82 → 1.19 cm; Sm: 5.3 → 6.5 cm/s), with concurrent normalization of LVAD hemodynamic parameters and complete resolution of palpitations and dyspnea. Conclusions Catheter ablation of CTI-dependent atrial flutter in a carefully selected LVAD-supported patient yielded significant improvement in RV function, device hemodynamics, and quality of life (QoL), underscoring the potential role of rhythm control in this population.
Abstract Background Transradial access is widely used for coronary angiography and percutaneous coronary intervention (PCI); however, complications such as radial artery spasm, perforation, and occlusion remain clinically relevant. Jahanzeb’s Coronary Catheter Rolling Technique (JCRT) is a novel method designed to improve catheter navigation and reduce vascular trauma. Objective To evaluate the feasibility, safety and clinical outcomes of JCRT compared with the conventional radial catheterization technique. Methods In this prospective, non-randomized comparative study 4,697 patients undergoing elective coronary angiography or PCI via radial access were included. Patients were allocated to JCRT (n = 1,519) or the standard technique (n = 3,178). Primary endpoints were arterial perforation and radial artery occlusion. Secondary endpoints included major bleeding, radial artery spasm, thrombosis, and patient and physician satisfaction. Outcomes were analyzed using odds ratios (OR) with 95% confidence intervals (CI) and multivariable logistic regression was performed. Results JCRT was associated with a significantly lower overall complication rate (7.6% vs. 11.0%; OR: 0.66, 95% CI 0.52–0.92; p = 0.037). Significant reductions were observed in major bleeding (4.3% vs. 7.1%; OR: 0.58, 95% CI 0.42–0.81; p = 0.024), radial artery spasm (2.1% vs. 4.9%; OR: 0.41, 95% CI 0.27–0.63; p = 0.011), arterial perforation (1.6% vs. 3.8%; OR: 0.41, 95% CI 0.24–0.71; p = 0.032), and radial artery occlusion (2.8% vs. 6.3%; OR: 0.43, 95% CI 0.29–0.63; p = 0.006). On multivariable analysis, JCRT remained associated with reduced complications after adjustment (adjusted OR: 0.69, 95% CI: 0.51–0.93; p = 0.021). Patient and physician satisfaction scores were significantly higher with JCRT (p < 0.001). Conclusion JCRT is a feasible and safe technique associated with reduced vascular complications and improved satisfaction. Further multicenter randomized studies are warranted to confirm these findings.
Abstract Background The optimal long-term strategy for coronary bifurcation PCI remains debated. Earlier meta-analyses limited to long-term data suggested better outcomes with a provisional approach versus routine two-stent techniques. Methods We conducted an updated, comprehensive meta-analysis of randomized controlled trials comparing provisional versus two-stent strategies. MEDLINE, Embase, and the Cochrane Library were searched through September 2025. Fifteen RCTs (n = 6978) met inclusion criteria. Using Stata 16.1, random-effects (DerSimonian–Laird) risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for prespecified outcomes. Results Relative risks (95% CIs) for provisional vs two-stent were: all-cause mortality 0.97 (0.72–1.30); cardiovascular mortality 0.98 (0.68–1.40); myocardial infarction 0.86 (0.62–1.19); target lesion revascularization 1.07 (0.80–1.44); stent thrombosis 1.36 (0.81–2.29); and MACE 1.27 (0.81–1.99). Across endpoints, pooled estimates did not show statistically significant differences between strategies. Conclusion In this updated synthesis of randomized trials, the available evidence did not demonstrate clear superiority of either provisional or two-stent strategies for major clinical outcomes. Unlike prior long-term-only analyses, we did not observe higher mortality or myocardial infarction with two-stent approaches. Technique selection should remain individualized according to lesion anatomy, procedural complexity, and operator expertise. These findings should not be interpreted as proof of equivalence or non-inferiority. Trial registration CRD420251167534.
Abstract Background Mitral regurgitation (MR), one of the most common valvular heart diseases, poses ongoing challenges in risk stratification and timely intervention. Traditional diagnostic approaches, suffer from interobserver variability. Artificial intelligence (AI) has recently gained traction in cardiology to augment clinical precision. This article reviews the use of AI in the diagnosis, severity assessment, and prognostication of MR, with a focus on performance metrics. Methods The search was conducted in PubMed, Embase, and MEDLINE on May 9, 2025. Studies were eligible if they applied AI to MR-related tasks using imaging, ECG, or clinical data. Data extraction focused on dataset characteristics, model architectures, and performance. Results A total of eleven studies, comprising 80,915 patients, were included. Among the included studies, six utilized echocardiographic data, two electrocardiography, two clinical biomarkers or structured datasets, and one chest radiography. Algorithms included convolutional neural networks, support vector machines, and ensemble models. Reported AUCs ranged from 0.74 to 0.94. Models based on color Doppler or 3D geometrical mitral features achieved the highest discriminatory performance. Only a minority of studies incorporated external validation or reported clinically actionable thresholds such as PPV. ECG-based models demonstrated high scalability but lower sensitivity. Studies integrating multimodal data yielded promising results. Conclusion AI models, especially those trained on echocardiographic imaging, demonstrate strong potential for improving MR evaluation. However, widespread clinical adoption is limited by lack of external validation, and inconsistent outcome reporting. Future work should emphasize model interpretability, multicenter validation, and head-to-head comparisons with expert assessment to bridge the translational gap.
Abstract Background Heart failure with preserved ejection fraction (HFpEF) remains difficult to manage because conventional therapies often provide limited symptom relief and do not adequately address exercise-related congestion. Right greater splanchnic nerve (GSN) ablation has emerged as a potential therapeutic approach by modulating splanchnic venous capacitance. However, current evidence is limited and includes both uncontrolled and randomized studies. Methods We performed a systematic review and meta-analysis of studies evaluating right GSN ablation in HFpEF. Searches were conducted in PubMed, Scopus, and Embase in December 2024. Randomized and non-randomized studies were included. Continuous outcomes were pooled as mean differences (MDs) with 95% confidence intervals (CIs). Sensitivity analyses excluding the randomized controlled trial (RCT) were performed for selected outcomes. Analyses based on uncontrolled studies and converted median/interquartile range data were considered exploratory. Results The most consistent findings were observed in functional and exercise-related hemodynamic outcomes. Six-minute walk distance improved at both 6 and 12 months, and KCCQ overall score showed improvement, although with substantial heterogeneity. Provocative hemodynamic measures, including 20 W and peak pulmonary capillary wedge pressure, were reduced at 1 month, whereas resting hemodynamic measures showed no clear pooled benefit. NT-proBNP, renal indices, blood pressure, heart rate, and left ventricular ejection fraction were largely unchanged. Overall, randomized sham-controlled evidence did not demonstrate a clear comparative benefit. Conclusions Right GSN ablation may improve selected exercise-related hemodynamic, functional, and patient-reported outcomes in HFpEF, but the current evidence base is driven mainly by small uncontrolled studies. Randomized evidence remains neutral, and further sham-controlled trials are required.
Abstract Introduction Percutaneous coronary intervention (PCI) is an important treatment for coronary artery disease, and coronary dominance may influence procedural risk. PCI to a left-sided posterior descending artery (L-PDA) occurs in the setting of left-dominant coronary anatomy and may involve greater anatomical complexity and a larger myocardial territory at risk than PCI to a right-sided PDA (R-PDA). We performed a retrospective analysis of a statewide registry to compare the characteristics and outcomes of R-PDA and L-PDA PCI. Methods The Victorian Cardiac Outcomes Registry is a state-wide quality registry with all PCI capable centres in Victoria, Australia contributing. We undertook a retrospective analysis of patients undergoing PCI for L-PDA and R-PDA lesions between 2013 and 2022. Results 2,880 patients were included over the 10-year study period, with 2,282 (79.2%) undergoing R-PDA PCI and 598 (20.8%) undergoing L-PDA PCI. Patient characteristics between groups were of similar age (66.3 years in both groups), gender (17.9% vs. 14.5%; p = 0.06) and had comparable rates of comorbidities including diabetes (25.8% vs. 24.9%; p = 0.66). There was no significant difference between groups with respect to 30-day mortality (1.1% vs. 0.5%; p = 0.21). 30-day MACE was also comparable (2.2% both groups; p = 0.93). Conclusions Data from a large contemporary cohort did not find any association between coronary dominance and clinical outcomes when undertaking PDA PCI.
Abstract Background Infective endocarditis carries high mortality in hemodialysis patients, particularly when caused by methicillin‑resistant Staphylococcus aureus. Concomitant fungemia further worsens prognosis but remains rare. Case summary A 52‑year‑old woman with type 2 diabetes mellitus and stage V chronic kidney disease on thrice‑weekly hemodialysis presented with atypical chest pain, fatigue, night sweats, and splinter hemorrhages. She was afebrile. Transthoracic echocardiography showed preserved left‑ventricular ejection fraction and grade II mitral/tricuspid regurgitation; transesophageal echocardiography revealed a 0.7 × 2.1 cm pedunculated vegetation on the septal leaflet of the tricuspid valve. Three sets of peripheral and catheter blood cultures were drawn, and empiric renally adjusted daptomycin plus gentamicin were started. On day 3, C‑reactive protein had fallen. Cultures grew methicillin‑resistant Staphylococcus aureus in two peripheral sets and in the tunneled catheter, and Candida tropicalis in one peripheral set. The infected catheter was removed and a brachio‑axillary graft was placed. Gentamicin was discontinued; daptomycin was continued for six weeks. Voriconazole was administered for 21 days, ending 14 days after negative fungal cultures. Follow‑up echocardiography at week 6 showed complete resolution of the vegetation. The patient remained asymptomatic at three‑month follow‑up. Conclusion In immunocompromised hemodialysis patients, dual bacterial‑fungal bloodstream infections can occur, yet not every positive fungal culture indicates endocardial involvement. Serial cultures, prompt removal of infected hardware, and targeted antimicrobial therapy can achieve cure without surgery even in the presence of sizable vegetations.
