Background: Pericoronary adipose tissue (PCAT) radiomics on coronary computed tomography angiography (CCTA) may capture inflammatory and structural information beyond conventional attenuation measures. We assessed whether PCAT radiomics predicts future coronary events or quantifies plaque progression. Methods: PubMed/MEDLINE, Embase, and Web of Science were searched from inception to 29 August 2025. Eligible studies included adults undergoing CCTA with quantitative PCAT, or anatomically equivalent coronary perivascular adipose tissue (PVAT), radiomics, and longitudinal clinical or serial-CCTA outcomes. Findings were synthesised narratively because no common estimand supported meta-analysis. Methodological quality was assessed using QUADAS-2 and the Radiomics Quality Score (RQS). Results: Eleven full-text studies, representing at least 6307 participants were included; one study also analysed 127 plaques in 97 patients, and one reported a separate 202-person model-development sample whose overlap with its 1575-person cohort evaluation was not quantified. Eight studies evaluated coronary clinical events, and three evaluated plaque progression. Seven clinical-event studies reported better discrimination for radiomics-based or integrated models than at least one conventional comparator, although calibration and clinical-utility reporting were inconsistent. Two studies included clearly independent external validation. QUADAS-2 identified high patient-selection risk in 4/11 studies; RQSs ranged from 10/36 to 15/36 (mean: 12.5/36). Conclusions: PCAT radiomics shows preliminary prognostic potential, but confidence in the evidence is low because of retrospective designs, heterogeneous outcomes and workflows, restricted geographic sampling, and limited independent external validation. Current evidence is insufficient for routine clinical decision-making. Prospective multicentre validation with standardised acquisition, analysis, reporting, and clinically consistent endpoints is required.
Semaglutide, a recombinant DNA-derived long-acting GLP-1 receptor agonist, has emerged as a key player for patients with or without T2DM and obesity. It exerts pleiotropic effects by modulating glycemic regulation and energy homeostasis. Mechanistically, it stimulates glucose-dependent insulin secretion and suppresses glucagon while enhancing satiety through POMC/NPY modulation in the arcuate nucleus and delaying gastric emptying. Beyond its metabolic utility, semaglutide is cardioprotective, leveraging the PI3K/Akt and eNOS pathways to improve vasodilation, reduce reactive oxygen species (ROS), and stabilize atherosclerotic plaques by inhibiting pro-inflammatory cytokines like TNF-α. While it improves cardiac output via PKA-mediated inotropy, potential cardiotoxicity, including resting tachycardia and autonomic-driven arrhythmias, requires clinical vigilance, particularly regarding electrolyte imbalances in heart failure patients. Ultimately, its robust vasculoprotective profile reinforces its potential as a cornerstone in cardiovascular pharmacotherapy. Further research is needed to better understand the effects of semaglutide on cardiac function and pathologies as it advances as a cardiac drug. This review discusses multiple molecular targets of semaglutide on the heart.
Background: Traditional intraoperative sizing for sutureless aortic valves, such as the Corcym Perceval Plus (CPP), often relies on subjective tactile feedback, which can lead to excessive over-sizing. Significant over-sizing is associated with complications like increased trans-prosthetic gradients, valve thrombosis, and conduction disturbances requiring permanent pacemakers. This study aims to develop an AI-driven predictive recommendation system using Multidetector Computed Tomography (MDCT) data to optimize valve sizing and improve patient outcomes. Methods: Data were collected from 380 consecutive patients who underwent aortic valve replacement with a CPP prosthesis between 2011 and 2026. Two machine learning models were trained using preoperative MDCT features, including annular area, perimeter, and diameters. The first model predicted “normal” clinical labels, while the second used “penalized” labels adjusted for postoperative hemodynamic performance to discourage over-sizing. The dataset was split into training (80%) and testing (20%) subsets. Results: The mean patient age was 77.6 years. The model using normal labels achieved an overall accuracy of 91.84% (68.75% on the test set). The penalized label model showed improved performance with an overall accuracy of 92.89% (72.16% on the test set). MDCT provided highly reproducible objective metrics superior to echocardiography for calculating optimal sizing. Conclusions: The AI-driven recommendation system proves to be a reliable and reproducible tool for preoperative planning. By transitioning from subjective tactile assessment to predictive modeling, surgeons can better select valve sizes that minimize complications, particularly in minimally invasive approaches.
Background/Objectives: Twiddler’s syndrome is an uncommon but clinically important complication of implantable cardiac devices, in which generator rotation within the pocket results in lead torsion, lead retraction, and device malfunction. Recurrence can necessitate repeated surgical intervention and may be preventable through early risk identification and procedural strategies. Methods: We describe a single-centre case series of three female patients with pacemaker-associated Twiddler’s syndrome. Clinical presentation, timing of lead retraction, management strategies (including pocket location and fixation approach), recurrence, and follow-up outcomes were reviewed. Results: All patients were older women and developed symptomatic device failure early after implantation, with radiographic confirmation of lead retraction and coiling occurring within three weeks in all cases. Recurrence was observed when enhanced preventive measures were not employed. Notably, in one patient, recurrence occurred after an initial revision in a second prepectoral pocket, prompting subsequent reimplantation in a subpectoral location with reinforced fixation and structured patient and family counselling, after which no further recurrence occurred at one year. In the remaining cases, revision with reinforced generator fixation and counselling was associated with stable lead position and satisfactory device function during follow-up. Conclusions: Twiddler’s syndrome most commonly presents in the first weeks following implantation. Proactive identification of at-risk patients and consideration of reinforced fixation and pocket strategies at the index procedure may reduce recurrence and avoid repeat interventions.
We describe the case of a 26-year-old man who presented with acute chest pain and was found to have single-vessel coronary occlusion most consistent with probable paradoxical embolism. Coronary angiography demonstrated complete occlusion of the ramus intermedius artery. Aspiration thrombectomy restored flow without stent implantation. Intravascular ultrasound showed no plaque rupture, atherosclerosis, or coronary dissection, supporting but not definitively confirming an embolic etiology. Transthoracic and transesophageal echocardiography subsequently identified a large patent foramen ovale with bidirectional shunting. Lower-extremity Doppler studies and an extensive hypercoagulable evaluation were negative. The patient later underwent successful percutaneous closure of the patent foramen ovale. This case highlights probable paradoxical coronary embolism as a rare cause of acute myocardial infarction in a young patient without significant atherosclerotic disease and underscores the value of multimodality imaging in supporting the diagnosis and guiding management.
Background: Obesity and metabolic syndrome (MS) often co-exist; however, these conditions can exist independently as metabolically healthy obesity (MHO) and as metabolic obesity (MO). Methods: We investigated the association between metabolic status and body weight and risk of obstructive angiographic coronary artery disease (CAD), long-term major adverse cardiovascular events (MACEs), and all-cause mortality in women with signs/symptoms of ischemic heart disease (IHD) enrolled in the original cohort of the Women’s Ischemia Syndrome Evaluation (WISE) study (1997–2001) followed for mortality for a median of 8.6 years (range: 0–11.3 years). Normal weight (NW) was defined as a body mass index (BMI) < 25 kg/m2, overweight (OW) was defined as a BMI of 25–29 kg/m2, obesity (O) was defined as ≥30 kg/m2. MS was defined according to the NCEP ATP III Harmonized definition, metabolically healthy (MHO) was defined as obesity in the absence of MS, and MO was defined as MS in NW individuals. Results: 503 women were evaluated including 20.7% MH-NW, 14.7% MH-OW, 8.5% MHO, 6.2% MO, 21.9% MS-OW, 28.0% MS-O. Compared to MH-NW (reference), MHO was associated with a lower risk of MACEs (aHR 0.50; 95% CI 0.29, 0.85, p = 0.011) and mortality (aHR 0.50; 95% CI 0.27, 0.95, p = 0.035). MO was associated with higher odds of obstructive CAD (aOR 2.10; 95% CI 1.33, 3.33, p = 0.002) and a higher risk of MACEs (aHR 1.67, 95% CI 1.07, 2.59, p = 0.023). Conclusions: In women with suspected IHD, compared with MH-NW, MHO was associated with a lower risk of MACEs and mortality, whereas MO had higher odds of obstructive CAD and a greater MACE risk. These findings challenge simplistic BMI-based risk paradigms and emphasize the benefits of using metabolic status assessment over weight alone.
Cardiovascular disease is traditionally interpreted through macrocirculatory parameters such as cardiac output, vascular resistance, and epicardial coronary anatomy. However, clinical outcomes frequently diverge from predictions based solely on these indices, particularly in syndromes such as heart failure with preserved ejection fraction (HFpEF), cardiogenic shock, and sepsis-associated myocardial dysfunction. Increasing evidence suggests that the integrity of the microvascular–immune interface plays a central role in determining tissue perfusion and cardiovascular resilience. This review proposes a staged framework of cardiovascular decompensation centered on progressive failure of this interface. In Stage 1, chronic cardiometabolic and inflammatory stress produces a primed but compensated microvascular state characterized by endothelial activation, glycocalyx vulnerability, pericyte remodeling, platelet sensitization, and reduced lymphatic reserve. Perfusion is preserved at rest, but vasodilatory reserve and microvascular stability are reduced, narrowing the effective perfusion window under physiologic stress. In Stage 2, acute insults such as infection, ischemia, or neurohumoral activation precipitate threshold instability within the microcirculation. Perfusion becomes governed by the arterial pressure–critical closing pressure (Pa − Pcrit) relationship rather than traditional arterial–venous gradients. As this window narrows, segmental capillary derecruitment and heterogeneous flow emerge, producing loss of hemodynamic coherence in which systemic blood pressure and cardiac output may appear preserved despite impaired tissue perfusion. In Stage 3, inflammatory amplification and immunothrombotic processes consolidate microvascular dysfunction. Pericyte contraction, endothelial injury, cytokine escalation, and neutrophil extracellular trap formation promote platelet–fibrin deposition and capillary obstruction, transforming reversible conductance failure into structural microvascular impairment. This framework provides a unifying physiologic lens for diverse cardiovascular syndromes, including Type 2 myocardial infarction, HFpEF decompensation, and cardiogenic shock. It also suggests that therapeutic efficacy may depend less on macrocirculatory normalization alone and more on preserving microvascular integrity before immunothrombotic consolidation occurs. Although this model remains hypothesis-generating, it highlights the microvascular–immune interface as a central determinant of cardiovascular stability and a potential target for future precision hemodynamic and immunomodulatory strategies.
Background: Regular physical activity induces physiological cardiac remodeling (“athlete’s heart”), which may overlap with pathological hypertrophy. Regional echocardiographic and electrocardiographic data among young African adults are limited. This study evaluated how graded physical activity relates to cardiac structure and function among university students in Ghana. Methods: In this comparative cross-sectional study, 174 apparently healthy students aged 18–30 years were categorized into four physical activity groups in the preceding six months: level 1, no regular exercise (n = 29, 16.7%); level 2, <30 min/day of exercise (n = 41, 23.6%); level 3, 30 to 60 min/day of moderate exercise (n = 29, 16.7%); and level 4, >1 h/day of vigorous exercise (n = 75, 43.1%). Anthropometry, blood pressure, 12-lead electrocardiography, and comprehensive transthoracic echocardiography were obtained. Cardiac indices were compared across activity levels using the Kruskal–Wallis or Welch’s ANOVA test, with post hoc comparisons and regression analyses performed where appropriate. Results: Participants were predominantly male (56.3%), with a mean age of 22.3 ± 3.50 years, BMI of 23.0 ± 4.39 kg/m2, systolic blood pressure of 118 ± 13.0 mmHg, diastolic blood pressure of 71.3 ± 9.11 mmHg, and heart rate of 66.9 ± 10.9 bpm. Compared with sedentary participants, those in level 4 had a higher IVSd (9.87 ± 1.61 vs. 8.17 ± 1.47 mm, p < 0.001), LVIDd (43.6 ± 6.96 vs. 40.2 ± 3.58 mm, p = 0.002), LVPWd (10.1 ± 1.95 vs. 8.91 ± 1.60 mm, p = 0.003), and LVM (54.6 ± 7.45 vs. 47.1 ± 6.57 g, p < 0.001). EDV and ESV also increased with activity (90.1 ± 24.8 vs. 69.7 ± 17.8 mL, p < 0.001; 32.4 ± 12.8 vs. 25.6 ± 6.52 mL, p = 0.023). Systolic function was preserved across groups, with an EF of 59.3 ± 4.86% in level 4 vs. 58.3 ± 5.34% in level 1 (p = 0.707). Level 4 participants had a higher SV (57.6 ± 16.7 vs. 46.3 ± 10.4 mL, p = 0.003), CO (3.83 ± 1.17 vs. 3.05 ± 0.70 L/min, p = 0.022), and CI (2.19 ± 0.66 vs. 1.77 ± 0.37 L/min/m2, p = 0.015). Bradycardia was most frequent in level 4 (35.8% vs. 18.2% in level 1, p = 0.041), and PR interval was longer in participants exercising ≥30 min/day than in those exercising <30 min/day (166 ± 23.2 vs. 162 ± 21.8 ms, p = 0.031). Conclusions: In young African university students, greater physical activity was associated with mild physiological remodeling, including a higher left ventricular wall thickness, cavity size, and mass, while systolic and diastolic indices remained preserved. The mean values in the most active group were 9.87 mm IVSd and 10.1 mm LVPWd with preserved EF, supporting activity-related adaptation rather than overt pathological hypertrophy and highlighting the need for population-specific cardiovascular interpretation.
Background/Objectives: Intraoperative methadone has emerged as a significant pharmacological strategy in cardiac surgery to improve postoperative analgesic outcomes and reduce the reliance on rescue short-action opioids. This review aims to synthesize evidence regarding the safety and efficacy of intravenous methadone compared to other strategies for postoperative pain control in adult and pediatric cardiac surgeries. Methods: This narrative review relied on electronic searches in PubMed, Web of Science, Cochrane Library, and EMBASE up to January 2026. From 199 articles retrieved, 41 were included, focusing on analgesic efficacy, safety, pharmacokinetic variations during cardiopulmonary bypass (CPB), and cost-effectiveness. Results: The implementation of methadone results in up to 70% reduction in postoperative opioid requirements. Patients experience significantly lower pain scores from 24 to 72 h and improvement in satisfaction regarding pain management. In pediatric populations (neonates and children), the use of methadone leads to a significant reduction in opioid needs and a high rate of extubation in the operating room. Pharmacokinetically, a 48% drop in methadone concentration occurs during CPB due to hemodilution and sequestration. Safety data confirms that intraoperative use does not prolong mechanical ventilation; however, doses exceeding 0.25 mg/kg are linked to an increased incidence of delirium. Economically, methadone can be cost-effective, resulting in savings of up to $6355 per patient. Conclusions: Intraoperative methadone improves postoperative analgesia, opioid consumption, patient satisfaction, and costs after cardiac surgery. Its opioid-sparing effects make it particularly attractive for ERAS protocols, although vigilance against dose-related delirium and QT prolongation remains essential. Further research, especially in pediatrics, is needed to refine dosages and safety protocols.
Background: Cardiomyopathy is a major cause of morbidity and mortality in Duchenne muscular dystrophy (DMD). We evaluated whether N-terminal pro–brain natriuretic peptide (NT-proBNP) identifies severe systolic dysfunction and assessed its diagnostic performance. Methods: Male patients with genetically confirmed DMD and established cardiomyopathy were included if NT-proBNP measurement and echocardiographic ejection fraction (EF) were available within one month. Severe systolic dysfunction was defined as EF < 40%. Clinical, cardiac, and respiratory variables were analysed. ROC analysis with bootstrap validation and exploratory logistic regressions was performed. Results: NT-proBNP levels were significantly higher in patients with EF < 40% (median 843 vs. 81 pg/mL). A cut-off >200 pg/mL identified severe systolic dysfunction with 90.5% sensitivity and 90.9% specificity (AUC 0.96, 95% CI 0.88–1.00). During 24 months of follow-up, five deaths occurred. NT-proBNP showed moderate discrimination for mortality (AUC 0.79) and was associated with mortality in exploratory analysis. Conclusions: NT-proBNP was associated with severe systolic dysfunction in Duchenne cardiomyopathy and may complement imaging. Prospective validation is warranted.
Background: Unhealthy alcohol use may lead to arrhythmia and cardiomyopathy, but its impact on sudden death is not well understood. Objective: To investigate the association of unhealthy alcohol use with sudden death. Methods: We conducted a case-control study in Wake County, a large (~1 million inhabitants), diverse county in North Carolina. We screened and adjudicated victims of sudden, unexpected, out-of-hospital deaths in adults aged 18–64 years reported by emergency medical services between 2013 and 2015. We randomly selected sex- and age-matched control patients from a university health system from the same county and time period. Characteristics of sudden death victims and controls were ascertained via standardized chart reviews. Unhealthy alcohol use was identified via chart review and was defined as any evidence of excessive alcohol use, such as it being stated in the social history or medical history, alcohol abuse being listed as a possible contributor to death, or alcohol-related diagnoses. We used logistic regression to estimate odds ratios (ORs) for the association of unhealthy alcohol use and sudden death, adjusting for age, sex, race, and other psychiatric diagnoses, including depression, anxiety, schizophrenia, bipolar disorder, and substance use disorders other than tobacco and alcohol. We also calculated the E-value to estimate the impact of any unmeasured confounders. Results: We identified 399 sudden death victims, of whom 374 (94%) had alcohol use data available. Among these 374 included victims, 256 (68%) were male, and 239 (62%) were White, with a median age at death of 55 years (IQR 48, 60). The demographic characteristics of the 1114 matched controls were similar to those of sudden death victims. Unhealthy alcohol use was present in 115 (31%) sudden death victims and 27 (2%) controls. In analyses adjusted for demographics only, unhealthy alcohol use was associated with a higher incidence of sudden death, with an OR of 17.5 (95% CI 11.4, 27.8). When further adjusted for other psychiatric diagnoses, the OR was 11.2 (95% CI 7.1, 18.0). The calculated E-value was 21.8, meaning an unmeasured confounder would need to be associated with both unhealthy alcohol use and sudden death by 21.8-fold to explain away the observed OR. Conclusions: Unhealthy alcohol use was strongly associated with higher sudden death risk in working-age adults. Our calculated E-value indicates it is unlikely that any unmeasured confounders alone would account for the observed association. Our findings suggest that interventions to reduce unhealthy alcohol use may be an effective strategy to prevent sudden death in working-age adults.
Biventricular Takotsubo cardiomyopathy (TCM) is a rare variant characterized by involvement of both the left and right ventricles. This variant is associated with greater hemodynamic instability and longer hospital stays compared to the isolated left ventricular-only variant. We report the case of a 67-year-old female patient who underwent elective resection of a left adrenal adenoma. While her preoperative and intraoperative courses were uneventful, she developed cardiogenic shock postoperatively, necessitating prolonged intensive care unit (ICU) management and vasopressor support. Further evaluation revealed elevated high-sensitivity troponin levels and reduced ejection fraction on echocardiography (30–35%). Hypokinesis was noted in the apical and mid-ventricular segments of both ventricles. A coronary angiogram performed two months prior to admission showed no significant coronary artery disease. Based on these findings, a diagnosis of biventricular TCM was established. The patient was managed supportively and discharged in stable condition with ongoing therapy, including beta-blockers, renin–angiotensin–aldosterone system inhibitors (RAASis), and statins. Follow-up echocardiography showed resolution of regional wall motion abnormalities. Although rare, biventricular TCM is associated with increased severity and a higher risk of complications. Early recognition and timely management are essential to improve outcomes in affected patients.
“Pinch-Off Syndrome,” first described by Hinke, is a mechanical complication of totally implantable central venous catheters inserted via subclavian venous access. It occurs when the catheter is compressed between the clavicle and the first rib. Compression can cause transient catheter obstruction and may result in rupture or even complete resection and embolization of the catheter. In this case report, we describe our experience of percutaneous transvenous removal of an embolized port-a-cath fragment within the right heart chambers following a rupture. We used the “retrieval snare” technique and subsequent reimplantation through internal jugular access. The intervention occurred in the same session and involved a multidisciplinary team for a 55-year-old man in need of adjuvant chemotherapy.
We present the case of a 27-year-old woman diagnosed with Löffler’s endomyocarditis complicated by intraventricular thrombus and cerebral infarction. She was treated with prednisolone and anticoagulation therapy; however, tapering of corticosteroids resulted in recurrence of intraventricular thrombosis. Given disease relapse after medication withdrawal, lifelong anticoagulation was indicated. At 29 years of age, she sought pregnancy counseling. Conception was permitted after stabilization of prednisolone dosage, with a planned switch from a vitamin K antagonist to therapeutic-dose unfractionated heparin during pregnancy. Following disease stabilization, she conceived via artificial insemination. Serial echocardiography at 22 and 34 weeks of gestation demonstrated preserved cardiac function without thrombus recurrence. She delivered a healthy infant by emergency cesarean section at 39 weeks of gestation due to fetal distress. No thrombus recurrence was observed postpartum, and she remained clinically stable during 13 months of follow-up. This represents the case of a successful pregnancy in a woman with a history of recurrent intraventricular thrombosis due to Löffler’s endomyocarditis, highlighting the importance of early diagnosis, sustained immunosuppression, individualized anticoagulation, and multidisciplinary preconception planning.
Background: Left ventriculo-arterial coupling (VAC) integrates the interaction between left ventricular contractility and the arterial system, representing a key determinant of cardiovascular efficiency. In rapidly changing hemodynamic states such as septic or cardiogenic shock, conventional indices of pressure or flow alone may be misleading. VAC provides a unified physiological framework to assess global cardiovascular performance and guide therapy. Objective: To review the physiological foundations, bedside assessment, and therapeutic applications of VAC in critically ill patients with rapidly fluctuating circulatory conditions. Methods and Content: The article revisits the underlying principles of VAC, expressed as the ratio between arterial elastance (Ea) and end-systolic elastance (Ees), and discusses their derivation from the pressure–volume relationship. Practical echocardiographic methods for bedside estimation, including the non-invasive single-beat approach, are outlined with illustrative figures. The review further examines how VAC patterns evolve in sepsis, cardiogenic shock, and heart failure and how this integrative index clarifies paradoxical responses to vasoactive and inotropic therapies. Specific therapeutic phenotypes are proposed according to Ea/Ees profiles, providing a structured approach to optimise coupling and restore circulatory efficiency. Summary: VAC offers a physiology-based perspective on cardiovascular performance, enabling clinicians to interpret complex hemodynamic changes beyond traditional measures of ejection fraction or mean arterial pressure. Its dynamic tracking may refine the assessment of therapeutic trajectories and improve bedside decision-making. Conclusions: By integrating ventricular and arterial function into a single measure, VAC bridges cardiovascular physiology and clinical practice. Its incorporation into routine critical care monitoring could enhance individualised hemodynamic management and serve as a foundation for future outcome-driven studies. Methodology: This narrative review was conducted using a structured literature search to ensure comprehensive coverage of contemporary evidence regarding ventriculo-arterial coupling (VAC) in critical care and shock states. A systematic search of PubMed/MEDLINE, Embase, and Scopus databases was performed from database inception through October 2025. The following key search terms were used: “ventriculo-arterial coupling”; “arterial elastance”; “end-systolic elastance”; “Ea/Ees”; “pressure–volume loops”; “septic shock”; “cardiogenic shock”; “critical care echocardiography”; “point-of-care ultrasound”; “mechanical circulatory support”. Reference lists of relevant articles, review papers, and consensus documents were also manually screened to identify additional pertinent studies. Only English-language publications were included. Both seminal foundational studies and recent contemporary investigations were reviewed to provide historical context and up-to-date clinical applicability.
Background: Atherosclerotic cardiovascular disease (ASCVD) is one of the most important causes of morbidity worldwide. Registries show an impressive decline in prevalent ASCVD morbidity over the last years. Whether this decline is due to the improvement in treatment options for ASCVD or whether we are also able to prevent first ASCVD events is still unknown. Methods: A nationally representative real-world data longitudinal prescription (LRx) database (IQVIA) was used over a period from 2008 to 2019. All patients ≥20 years were included from the moment they had been prescribed ASCVD medication. The primary outcome was the standardized incidence of first ASCVD events among men and women of different age groups. The secondary outcome of this study was to identify comorbidities in the year 2019. Results: The prescription data on 296.050 individuals were analyzed, and the results indicate the standardized cumulative incidence (%) among women of first ASCVD event prescriptions. This rise in incidence was most pronounced for young women (women 20–39 yr: + 109.46%). The comorbidity analysis indicated that, e.g., thyroid hormones were significantly more often prescribed in the young patients with a first ASCVD event than in those patients without ASCVD events. Conclusions: Prescriptions for the first ASCVD event increased over a period of 12 years among young women. This study suggests that although ASCVD as a whole has decreased over time, this does not seem to be the case for first ASCVD events and that young women are particularly affected.
Background: This study investigates the impact of engagement with online health platforms (OHPs), perceived treatment effectiveness, and country of residence on patient attitudes toward atrial fibrillation (AF) treatments, mediated by threat perception and behavioral evaluation within an adapted Health Belief Model (HBM). Methods: A cross-sectional survey conducted in June 2024 included 589 members of two professionally curated OHPs: the AFIP Foundation (Amsterdam, The Netherlands) and StopAfib.org (Decatur, United States). Data were analyzed using Structural Equation Modeling (SEM) to examine both direct and indirect relationships among engagement behaviors, perceived treatment effectiveness, country of residence, and patient attitudes toward AF treatments (PAAT). Results: Results indicate that higher engagement (i.e., frequency of OHP visits and time spent on the OHP) positively predicts more favorable PAAT, whereas the number of content types consumed showed no significant mediating effect via threat perception or behavioral evaluation. Conclusions: By increasing awareness of AF and reinforcing the perceived effectiveness of treatments, OHPs can serve as effective tools for patient education and support. From a managerial perspective, these findings provide actionable insights for platform operators and healthcare stakeholders on which engagement factors most effectively enhance patient attitudes toward treatment options.
Background/Objectives: Transcatheter edge-to-edge repair (TEER) has become an established therapeutic option for selected patients with mitral regurgitation (MR). However, primary (degenerative) and secondary (functional) MR represent distinct disease entities, characterized by different pathophysiological mechanisms, clinical trajectories, and determinants of benefit. This review aims to provide an interventional cardiology-oriented synthesis of TEER, emphasizing the fundamental differences between primary and secondary MR and their implications for patient selection, procedural strategy, and outcome interpretation. Methods: A targeted literature search was performed in PubMed and Embase to identify pivotal randomized trials, registries, guideline documents, and high-quality reviews addressing TEER in MR. The available evidence was synthesized narratively, with a focus on mechanistic insights, TEER-specific imaging and procedural endpoints, and clinically relevant outcomes. Results: In primary MR, TEER functions as a valve-centered therapy, with procedural success primarily determined by anatomical suitability and the balance between durable MR reduction and avoidance of elevated transmitral gradients. In secondary MR, TEER should be considered an adjunctive intervention within a comprehensive heart failure strategy, with benefit dependent on patient phenotype, myocardial substrate, optimization of background therapy, and appropriate timing. Emerging phenotypes, such as atrial functional MR, further challenge traditional classification and highlight the need for mechanism-based selection. Across MR subtypes, residual MR and transmitral gradients emerge as key post-procedural endpoints with differential prognostic implications. Conclusions: TEER represents a phenotype-specific intervention rather than a uniform solution for MR. Recognizing the distinct interventional paradigms of primary and secondary MR is essential to optimizing patient selection, procedural decision-making, and clinical outcomes.
The role of cardiac implantable electronic devices (CIEDs), including implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices, in patients supported with left ventricular assist devices (LVADs) remains controversial. Although ICDs clearly reduce the risk of sudden cardiac death (SCD) and improve outcomes in advanced heart failure (HF), their benefit in patients with continuous-flow mechanical circulatory support is less certain. Initial small studies involving LVAD patients, particularly those with older pulsatile devices, suggested that ICDs confer a survival benefit during LVAD support. However, more recent evidence has been inconsistent. Some studies show modest protection against arrhythmic death, whereas others show no improvement in overall mortality. Similarly, CRT does not appear to offer significant additional hemodynamic benefits after LVAD implantation, and current evidence does not strongly support its routine continuation. Device-related complications—including lead failure, infection, electromagnetic interference, and inappropriate shocks—are major clinical concerns that can offset potential benefits. Accordingly, current guidelines recommend maintaining pre-existing ICD or CRT devices in LVAD patients but do not endorse the routine implantation of new devices after LVAD placement. The existing evidence highlights the need for a nuanced and individualized approach to CIED therapy in patients with LVAD. Future research should focus on randomized trials, registry-based analyses, and the exploration of novel technologies such as leadless pacing, subcutaneous ICDs, and advanced programming algorithms. Patient-centered outcomes, particularly quality of life and ethical considerations—such as ICD deactivation in end-of-life scenarios—must be considered in decision-making in this evolving field.
