In connective tissue diseases (CTD), myocardial T2 elevation is a frequent CMR finding, yet whether it translates into myocardial injury remains uncertain. We compared T2 and late gadolinium enhancement (LGE) between CTD-associated myocardial involvement and acute suspected viral myocarditis, a clinical model in which inflammatory activity and structural injury commonly co-occur in the acute phase, to assess whether the association between myocardial inflammatory activity and structural injury differs between disease contexts. Patients from two prospective institutional registries were included. Active myocardial inflammation was defined using a study-specific CMR definition based on the T2 component of the updated Lake Louise Criteria, requiring T2 elevation ≥ 40 ms, applied identically in both groups. Inflammatory activity was quantified by myocardial T2 mapping and structural injury by LGE. A total of 181 patients were included (CTD n = 44; viral myocarditis n = 137). CTD patients were predominantly female (75
Background Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI). Sex-related disparities in AMI-CS have been reported, but findings vary across cohorts. Objectives The authors examined the clinical characteristics and in-hospital outcomes of consecutive women and men with AMI-CS. Methods The ALKK coronary angiography (CAG) registry prospectively enrolled consecutive CAG and percutaneous coronary interventions (PCI) across 51 participating hospitals in Germany. Results Between January 2009 and December 2020, a total of 4204 patients undergoing CAG for suspected AMI-CS were included. Women (30.5%, n = 1281) were on average 6 years older (74.3 vs. 68.0 years, P < .001) and had more comorbidities. They less frequently had significant coronary artery disease (CAD), 82.3% vs. 90.3%, P < .001. No significant sex differences in the recommendation for revascularization (PCI or CABG) among patients with significant CAD after adjustment for age (92.4% vs. 91.3%, adjusted OR: 1.3; 95% CI: 0.99-1.72) were observed. There were no sex differences in hospital mortality after adjustment for age, particularly in the PCI group, age-adjusted OR: 1.06; 95% CI: 0.90-1.25, multivariable adjusted OR: 1.09; 95% CI: 0.92-1.28. Conclusions In this large, contemporary registry, women with early CAG for AMI-CS were older than men and had more comorbidities. Significant CAD was less frequently diagnosed in women with suspected AMI-CS. After adjustment for age, there were neither sex differences in revascularization strategies nor in hospital mortality after PCI for AMI-CS. These results question previous reports about undertreatment and higher mortality of AMI-CS in women.
While primary mitral valve regurgitation (PMR) results from structural abnormalities of the mitral valve leaflets, secondary mitral valve regurgitation (SMR) arises from either mitral annular dilatation (atrial type, aSMR) or left ventricle remodelling (ventricular type, vSMR) in the absence of intrinsic leaflet disease. Although SMR is considered the most common cause of clinically relevant mitral regurgitation (MR), population-based data on its prevalence, subtype distribution, and clinical profiles are lacking. We aimed to determine the prevalence of PMR and SMR and to characterize PMR, aSMR, and vSMR in the general population. We analyzed the first 10,000 participants of the population-based Hamburg City Health Study enrolled 2016–2019; 8543 echocardiographic examinations were available. Mitral valve morphology and function were independently assessed by two investigators. PMR was defined by the presence of intrinsic leaflet pathology, whereas SMR was classified as ventricular when left ventricular ejection fraction was less than 50
Takotsubo syndrome has long been deemed a benign condition following sudden emotional stress. While current mechanisms explaining the acute cardiac dysfunction are not fully understood, current evidence suggests certain takotsubo populations are at higher risk of adverse course. Acute neurologic emergencies commonly precede the takotsubo syndrome and new insights into the role of the brain–heart axis and central autonomic regions driving excess sympathetic activation have come about. This multicenter analysis included 595 patients admitted between January 2013 and December 2024 with takotsubo syndrome across 13 German tertiary care centers. The aim of this study was to (I) assess whether acute brain pathology influences severity of cardiac dysfunction differently in comparison to other nonneurologic forms of physical or emotional stress, (II) investigate short-term recovery of cardiac function, and (III) improve identification of vulnerable patients susceptible to critical in-hospital course. Marginal odds ratios were estimated for cardiac complications of takotsubo syndrome across trigger groups using generalized estimating equations. Multivariable mixed-effects logistic regression models were fit to analyze the association between prespecified variables for short-term recovery of wall motion and systolic abnormalities as well as critical in-hospital course. Acute neurologic emergencies (47.5
Abnormal liver biochemistry is common in acute decompensated heart failure (ADHF), yet most studies evaluate individual markers rather than clinically meaningful patterns of hepatic involvement. We examined whether cardiohepatic injury phenotypes derived from routine liver tests identify distinct short-term prognostic profiles in patients hospitalized with ADHF. In this retrospective cohort study, we included consecutive adults hospitalized with ADHF between December 2006 and 2017. Using peak in-hospital values of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total bilirubin, patients were classified into four phenotypes: no hepatic injury, hepatocellular injury, cholestatic injury, or combined injury. Associations with in-hospital mortality were evaluated using multivariable logistic regression. Post-discharge outcomes (30-day mortality, readmission, and their composite) were analyzed using Cox and Fine–Gray models. Among 8332 ADHF admissions, 6792 (81.5
