Background: Lipoprotein(a) (Lp(a)) is a genetically determined lipid particle associated with atherosclerotic cardiovascular disease. Despite growing evidence supporting the clinical relevance of Lp(a) in cardiovascular risk stratification and the emergence of potential therapies targeting elevated Lp(a) levels, Lp(a) testing remains underutilized, with reported rates below 20-30%. This study aims to explore Lp(a) levels in the Lebanese population and their association with the vascular and metabolic burden of diseases. Methods: We conducted a retrospective observational study of patients who underwent Lp(a) level testing at the American University of Beirut Medical Center between 2010 and 2023. Data were extracted using the EPIC electronic medical record system, and statistical analyses were performed using IBM SPSS Statistics Version 28. Results: This study included 456 patients; the mean age was 50 ± 13, and the mean Lp(a) level was 25 ± 28 mg/dL. Mean Lp(a) was higher in females than in males (28 ± 32 mg/dL versus 23 ± 25 mg/dL), and 25.9%, 12.9%, and 7.6% of the population had Lp(a) levels ≥ 30, ≥50, and ≥70 mg/dL respectively. Logistic regression analysis showed no significant association between Lp(a) levels and cardiovascular factors including dyslipidemia, hypertension, coronary artery disease, previous coronary artery bypass graft, and previous myocardial infarction. Similarly, no significant correlation was found between Lp(a) and LDL, HDL, total cholesterol, triglyceride, and HbA1c. Subgroup analysis showed a significant relationship between Lp(a) levels > 50 mg/dL and atrial fibrillation. Conclusions: This study explores the distribution of Lp(a) levels in a Middle Eastern tertiary-care population and provides population-specific descriptive data, addressing an important gap in the existing literature.

BACKGROUND:Cardiovascular disease (CVD) is the leading global cause of mortality and disproportionately affects low- and middle-income countries (LMICs). Although screening is essential for prevention and early detection, its effectiveness and implementation in LMICs remain unclear. OBJECTIVES:The objective of the study was to evaluate the diagnostic performance, detection yield, and linkage-to-care outcomes of CVD and major cardiometabolic risk-factor screening programs in LMICs. METHODS:We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO, CRD420251241426). Databases were searched through November 2025. Observational and interventional studies assessing cardiovascular or major cardiometabolic screening programs in LMICs were included. Primary outcomes were detection rates and linkage to care. Secondary outcomes included risk-factor control, cardiovascular events, mortality, and cost-effectiveness. Owing to heterogeneity, results were synthesized narratively. RESULTS:Seventeen studies from Asia, sub-Saharan Africa, and Latin America were included. Screening approaches comprised risk-prediction models, point-of-care testing, community health worker-led programs, and mobile health platforms. Diagnostic performance ranged from area under the curve 0.64 to 0.91. Locally adapted risk models generally outperformed imported scores, whereas simplified tools showed acceptable discrimination. Screening identified a substantial burden of undiagnosed disease, with up to 55% meeting hypertension criteria and approximately 40% classified as high risk for diabetes. However, considerable attrition occurred across the care cascade, with preventive service uptake ranging from 15% to 58% and confirmatory testing as low as 22%. Community health worker-led programs demonstrated >90% sensitivity and specificity compared with clinician assessment. CONCLUSIONS:CVD screening programs in LMICs can effectively identify unmet cardiometabolic risk, but weak linkage to care limits impact. Strengthening integrated screening-to-treatment pathways is essential to improve outcomes.

BACKGROUND:Evidence, largely observational, has been mixed on whether conduction system pacing (CSP) improves outcomes over conventional right ventricular pacing (RVP). This meta-analysis compared the efficacy and safety of CSP vs RVP in randomised controlled trials (RCTs) of patients with preserved or mildly reduced left ventricular ejection fraction (LVEF) who require permanent pacing. METHODS:We analysed RCTs comparing different CSP modalities with RVP. Databases were searched through February 24, 2026. Outcomes were pooled using random-effects models for risk ratios (RRs) and mean differences (MDs). RESULTS:Fifteen RCTs (n = 1466; mean baseline left ventricular ejection fraction (LVEF) = 59.4 ± 7.0%) showed lower pacing-induced cardiomyopathy (PICM) with CSP vs RVP (4.6% vs 16.2%; RR 0.34, 95% CI 0.19-0.60) and lower heart failure hospitalisation (HFH) (3.3% vs 9.1%; RR 0.34, 95% CI 0.17-0.70), with no difference in all-cause mortality. CSP shortened paced QRS duration (MD -30.10 ms, 95% CI -35.46 to -24.74 ms) and improved LVEF (MD +2.96%, 95% CI 1.18%-4.73%), but had lower pacing success (93.6% vs 99.5%; RR 0.95, 95% CI 0.91-0.99) and worse procedural metrics (procedure time MD +32.44 min, 95% CI 21.22-43.67 min; fluoroscopy time MD +5.27 min, 95% CI 3.89-6.65 min; radiation dose MD +24.91 mGy, 95% CI 10.27-39.55 mGy). CONCLUSIONS:In RCTs of predominantly preserved or mildly reduced LVEF requiring permanent pacing, CSP reduced PICM and HFH and preserved left ventricular function more effectively than RVP, but with longer procedural and fluoroscopy times. CSP is a reasonable preventive strategy when substantial ventricular pacing is anticipated in this population.

Sudden cardiac arrest is a major cause of sudden cardiac death (SCD) in youth, including athletes and nonathletes. In Lebanon, the survival rate after out-of-hospital cardiac arrest in individuals <35 years old is only 16.7%. We aim to assess the knowledge, attitudes, and practices of primary care physicians in Lebanon regarding screening for SCD risk factors in youth. A cross-sectional survey was distributed to general practitioners, pediatricians, and family medicine physicians across Lebanon. The questionnaire, based on American Heart Association guidelines, assessed physician knowledge, attitudes, and practices toward screening for SCD in athletes and nonathletes. Sixty-eight physicians completed the survey (49% male; 68% >50 years old; 53% general practitioners (GPs), 32% pediatricians, 15% family doctors). Family doctors had the highest mean knowledge score (1.9), followed by GPs (1.56). Attitude assessment showed that 70% of family physicians, 58.3% of GPs, and 59.1% of pediatricians believed there is sufficient screening for SCD risk factors in young adults. Practice assessment using American Heart Association criteria showed mean scores of 12.4 for family doctors and pediatricians and 10.9 for GPs. While awareness and knowledge of SCD among Lebanese primary care physicians are moderate, they are not consistently translated into clinical practice. These findings underscore the need for targeted education, implementation of standardized screening protocols, and further research to address this gap.

The effect of advanced age on outcomes after catheter ablation for atrial fibrillation (AF) remains uncertain. This systematic review and meta-analysis compared long-term efficacy and safety between elderly and non-elderly patients using time-to-event reconstruction. A comprehensive search of PubMed, Scopus, Embase, and Web of Science was conducted for comparative studies up to January 2026. The primary outcome was AF recurrence. Secondary outcomes included mortality, stroke, and procedural complications. Pairwise meta-analysis estimated risk ratios (RR), and individual patient-level time-to-event data were reconstructed from Kaplan–Meier curves to calculate hazard ratios (HR). Twenty-eight studies involving 22,921 patients were included in the analysis. Elderly patients had a significantly higher risk of AF recurrence compared with non-elderly patients (RR 1.174, 95

ABSTRACT:Sinus tachycardia is common after heart transplantation (HTx) and may worsen graft function through increased oxygen demand and remodeling. Ivabradine, a selective If channel inhibitor, lowers heart rate (HR) independently of sympathetic activity. This meta-analysis evaluates its efficacy and safety versus standard care in HTx recipients. A comprehensive search of PubMed, Embase, WoS, Scopus, and Cochrane was conducted through September 2025. Eligible studies included randomized and nonrandomized comparative trials. Data were pooled with a random-effects model to estimate mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes. Six studies, including 852 adult HTx recipients, were included. Ivabradine consistently reduced HR across all time points. Statistical significance was reached at 24 months (MD -16.82 bpm; P = 0.04) and 36 months (MD -12.94 bpm; P = 0.04). A significant reduction was observed in left ventricular mass index (MD -11.10 g/m 2 ; 95% confidence interval -17.15 to -5.06; P < 0.05; I^2 = 0%). While left ventricular mass (LVM) and left ventricular ejection fraction (LVEF) showed trends toward improvement at the final follow-up (MD = -11.23 for LVM and +2.94% for LVEF), neither reached statistical significance ( P = 0.06 and P = 0.48, respectively). No significant differences were found between the ivabradine and control groups regarding all-cause mortality (RR 1.16 at the final follow-up; P = 0.90), graft rejection (RR 1.14; P = 0.87), or systolic blood pressure (MD 0.50 mm Hg; P = 0.83). Ivabradine lowers HR after HTx but shows no clear benefit on mortality, rejection, or ejection fraction. It does not significantly affect blood pressure, supporting its tolerability, particularly when beta-blockers are not tolerated.

We aim to compare the impact of left atrial appendage closure vs. medical therapy on clinical outcomes in patients with atrial fibrillation, focusing on key clinical outcomes relevant to thromboembolic prevention. We conducted a PRISMA-guided systematic review and meta-analysis of studies comparing LAAC with medical therapy in AF adults. PubMed, Embase, Scopus, ClinicalTrial. gov, and Cochrane Library were searched from inception to March 2026. Outcomes included all-cause mortality, any stroke, ischemic stroke, hemorrhagic stroke, major bleeding, systemic embolism and cardiac death. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Reconstructed individual patient-level survival data from published Kaplan-Meier curves were used for time-to-event analyses. Trial sequential analysis (TSA) assessed the conclusiveness of cumulative evidence. Six randomized controlled trials involving 7004 patients were included. LAAC demonstrated comparable outcomes to medical therapy for all-cause mortality, any stroke, major bleeding, systemic embolism, and cardiac death. There was a non-significant trend toward increased ischemic stroke and reduced hemorrhagic stroke with LAAC. Reconstructed time-to-event analyses showed similar cumulative incidence of stroke and bleeding outcomes over follow-up. TSA demonstrated that the required information size was not reached for any major endpoint, indicating that current evidence remains underpowered and additional randomized trials are needed. LAAC provides similar overall efficacy and safety compared with medical therapy for stroke prevention in AF but should currently remain reserved for selected patients rather than replacing oral anticoagulation broadly. Further adequately powered trials with longer follow-up are required.

Cardiomyopathy refers to a spectrum of diseases affecting the heart, impairing the organ’s ability to effectively pump blood to the rest of the body. The notion encompasses a wide array of conditions, including dilated, hypertrophic, and restrictive cardiomyopathy (RCM) among many others. RCM is the least common and least understood subtype of cardiomyopathies. It is characterized by ventricular stiffening and diastolic dysfunction, eventually leading to pulmonary and circulatory congestion. Symptoms such as dyspnea and exercise intolerance develop gradually, often culminating in fatal arrhythmias and heart failure, thus eventually requiring cardiac transplantation as the only currently available curative option. RCM can be classified as primary or secondary, and the etiology of RCM falls under three main categories: genetic, nonheritable, and idiopathic. While recent research has significantly advanced our knowledge of RCM, its genetic basis remains poorly understood. This review focuses on the pathophysiology, clinical manifestation, prognosis and diagnosis, molecular genetics, and management of RCM including related challenges. Through critically examining new genetic insights, novel diagnostic strategies, and gaps in the treatment approaches, this review provides a valuable resource for cardiologists and molecular geneticists to further understand this intricate group of cardiac disorders.

Atrial fibrillation (AFib) is a common arrhythmia that is associated with increased stroke and mortality risk. It requires early and accurate detection for improved patient healthcare support. This study explores the application of vision-enabled large language models (LLMs)—specifically Llama-3.2-11B-Vision-Instruct and Qwen2-VL-7B-Instruct —for AFib and sinus rhythm detection using ECG images. We designed structured prompts to simulate clinical reasoning, evaluate rhythm features, and elicit model confidence. Models were tested on a curated PTB-XL subset under both full 12-lead and dual-lead (Lead II + V1) configurations. Results show that while Llama achieves higher diagnostic accuracy, especially with Chain-of-Thought prompting (up to 97% for AFib), both models struggle with consistent feature-level interpretation, particularly for sinus rhythm. Our findings underscore both the promise and current limitations of LLMs in ECG-based diagnosis. Bridging the gap between AI-generated outputs and clinical standards will require fine-tuning on ECG-specific data, robust prompting strategies, and hybrid approaches that integrate signal-level reasoning for improved interpretability and reliability in real-world settings.

Heart failure is a progressive condition with increased morbidity and mortality. There are several treatment options for heart failure, and these include medications, device therapy (cardiac resynchronization therapy, implantable cardioverter defibrillator), and left-ventricular assist devices (LVADs). The usage of LVADs in patients with end-stage heart failure has increased, especially following the introduction of second-generation LVADs with improved mechanics and hemodynamics. LVADs were initially used as a "bridge-to-transplantation." They were later found to reverse the molecular transformations that take place in the cardiomyocytes in patients with heart failure, eventually leading to partial or complete recovery in a subset of patients. And so, LVADs started being used as destination therapy. However, although most patients with heart failure who receive LVAD therapy show reverse remodeling, only a minority of them achieve partial recovery, and an even smaller minority achieve complete recovery. Therefore, several underlying mechanisms that contribute to reverse remodeling and recovery following LVAD therapy are probably still unknown and need further elucidation. In this review, we will then talk about how LVAD implantation contributes to reverse cardiac remodeling by affecting the microenvironment, and several intracellular processes and signaling pathways.

Resting sinus tachycardia is frequently encountered in cancer patients. It affects a wide variety of cancer patients and is associated with distressing symptoms. Cancer-associated resting sinus tachycardia varies in its underlying mechanism. It can stem from the tumor burden or the side effects of chemotherapy/radiotherapy, or it can be secondary to paraneoplastic syndrome or the sequalae of cancer itself (infection, anemia, thrombosis, etc.). The clinical significance of resting sinus tachycardia extends beyond mere symptomatology, as it can potentially indicate severe complications which may facilitate or exacerbate a new or underlying cardiovascular dysfunction. Therefore, this necessitates thorough diagnostic tools to discern the underlying cause and tailor appropriate management strategies, whether pharmacological, non-pharmacological, or conservative. While resting sinus tachycardia has been extensively investigated in the context of cardiovascular disease, its underlying etiology, clinical implication, prognostic value, and treatment options remain vague in the context of cancer. This review aims to explore the topic of resting sinus tachycardia in cancer patients through delving deeper into its underlying mechanism, presenting the current evidence on its effect on cancer-independent cardiovascular and all-cause mortality, as well as providing some insight into the currently available treatment options. It will also propose therapeutic interventions and strategies aimed at optimizing cancer patient care. Lastly, it will highlight research gaps which need to be addressed further, as future research is needed to refine the diagnostic criteria, develop targeted therapies, find alternative cardioprotective/cardio-neutral chemotherapy options, and establish evidence-based guidelines to improve outcomes in this vulnerable patient population.