Background: Sarcoidosis is a multisystem disorder characterized by non-caseating granulomas in various organs. While cardiac sarcoidosis (CS) is clinically rare, it has significant implications, including heart failure, ventricular arrhythmias, and sudden cardiac death. Speckle-tracking echocardiography has emerged as a promising tool for detecting subclinical myocardial dysfunction, which is cost-efficient and readily available. This meta-analysis aims to evaluate differences in functional echocardiographic parameters between patients with CS and extracardiac sarcoidosis (ECS) to improve early recognition and management. Methods: A comprehensive search of major bibliographic databases was conducted to identify studies up to December 2024. Mean differences (MDs) with 95% CIs were pooled using the inverse-variance random-effect model. Results: Seven studies with 478 patients with sarcoidosis (CS: 159 and ECS: 319) were included. Patients with CS had a significant reduction in left ventricular global longitudinal strain (MD: −2.73; 95% CI: −4.09, −1.38; p < 0.0001) and tricuspid annular plane systolic excursion (MD: −0.59; 95% CI: −1.12, −0.05; p = 0.03) compared to patients with ECS. No significant differences in the LV global circumferential strain, interventricular septum thickness, left ventricular ejection fraction, E/A ratio, E/E’ ratio, LV end-diastolic diameter, and LV end-systolic diameter were noted. Conclusions: LV GLS and TAPSE are promising parameters for the early detection of cardiac involvement in sarcoidosis, with significant prognostic implications. Although STE provides a cost-effective and accessible alternative to CMR and FDG-PET, further research is needed to standardize its use and validate diagnostic cut-offs.

The interplay between HDL-C and LDL levels are closely intertwined with the cardiovascular system. High-Density Lipoprotein Cholesterol (HDL-C) is a well-known biomarker traditionally being interpreted as higher the HDL-C levels, minimal the risk of adverse cardiovascular disease (CVD) outcomes. However, recent research has unveiled a more complex relationship between HDL-C levels and cardiovascular outcomes, including genetic influences and potential risks associated with extremely high HDL-C levels. Intriguingly, extremely high HDL-C levels have been linked to unexpected cardiovascular risks. Up To date research suggests that individuals with genetically linked ultra-high HDL-C levels may depict an increased susceptibility to CVD, challenging the conventional realm that higher HDL-C is always beneficial. The mechanisms underlying this mystery are not fully understood but may involve HDL particle functionality and composition. In a nutshell, the relationship between HDL-C levels and cardiovascular outcomes is multifactorial. While low HDL-C remains a recognized risk factor for CVD, the genetic determinants of HDL-C levels add complexity to this association. Furthermore, extremely high HDL-C levels may not exhibit the expected protective benefits and may even pose unprecedented cardiovascular risks. A comprehensive understanding of these dynamics is essential for advancing our knowledge of CVD risk assessment and developing targeted therapeutic interventions. Further studies are needed to unravel the intricacies of HDL-C's role in cardiovascular health and disease.

Aortic dissection (AD) is a catastrophic life-threatening cardiovascular emergency with a 1-2% per hour mortality rate post-diagnosis, characterized physiologically by the separation of aortic wall layers. AD initially presents as intense pain that can then radiate to the back, arms, neck, or jaw along with neurological deficits like difficulty in speaking, and unilateral weakness in some patients. This spectrum of clinical features associated with AD is often confused with acute myocardial infarction, hence leading to a delay in AD diagnosis. Cardiac and vascular biomarkers are structural proteins and microRNAs circulating in the bloodstream that correlate to tissue damage and their levels become detectable even before symptom onset. Timely diagnosis of AD using biomarkers, in combination with advanced imaging diagnostics, will significantly improve prognosis by allowing earlier vascular interventions. This comprehensive review aims to investigate emerging biomarkers in the diagnosis of AD, as well as provide future directives for creating advanced diagnostic tools and imaging techniques.

Background Patients with complex valvular heart disease (VHD) should be evaluated by a multidisciplinary heart team (HT). In low- and middle-income countries, referral practices are more variable, permitting any physician to refer patients directly to a cardiac surgeon without prior formal evaluation by a cardiologist with expertise in VHD. Objectives The goal of the study was to examine the demographics of VHD patients seen in a large heart valve center in a low- and middle-income country and to assess the impact of the multidisciplinary HT in patients referred for valve surgery. Methods Over a 20-month period, all patients with VHD seen in the National Institute of Cardiovascular Diseases (Karachi, Pakistan) outpatient cardiovascular surgery clinic were referred to the heart valve center and assessed by a multidisciplinary HT. The multidisciplinary HT developed individualized plans for each patient. Results A total of 2,003 patients (52.8% female, mean age: 43.9 ± 14.4 years) were enrolled. Rheumatic heart disease was identified as the predominant cause of mitral valve disease, whereas bicuspid valve was the most common cause of significant aortic stenosis. All patients had been referred for valve surgery. Based on the HT’s evaluation, 1,521 patients (76%) were deemed suitable for surgery, 335 patients (17%) were recommended for medical therapy, and 147 patients (7%) were considered candidates for transcatheter treatments. Notably, the HT reclassified the management strategies for 24% of the patients, all of whom had initially been referred for surgical intervention. Conclusions The integration of collaborative decision-making through a multidisciplinary HT led to individualized and tailored treatment strategies, with a significant proportion of patients receiving alternative interventions or medical management instead of surgery.

Recently, Drs Damani, Usman, and Samiullah composed a letter to the editor in reference to our published article entitled “Short-term Prognostic Value of Heart Failure Diagnosis in a Contemporary Cohort of Patients With Adult Congenital Heart Disease.” 1 Maessen L. de Meester P. Troost E. et al. Short-term prognostic value of heart failure diagnosis in a contemporary cohort of patients with adult congenital heart disease. Can J Cardiol. 2023; 39: 292-301 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Our study primarily aimed to assess the supplementary prognostic value of a heart failure diagnosis concerning anatomic complexity and physiologic stage in people with congenital heart disease. However, they recommended the inclusion of gender disparity, lifestyle, and other factors in the analysis. 2 Damani R, Usman M, Samiullah FNU. Bridging the gap: considering gender disparity, lifestyle, and other factors in predicting the outcomes of ACHD—insights from Maessen et al.’s study. Can J Cardiol 2024;xxxxx. Google Scholar In our response, we concurred that addressing the queries raised in their letter would necessitate further research and strengthened collaborations between institutions and countries. 3 Van de Bruaene A, Budts W, Moons P. Reply to Damani et al.—bridging the gap: considering gender disparity, lifestyle, and other factors in predicting the outcomes of ACHD. Can J Cardiol 2024;xxxxx. Google Scholar Reply to Damani et al.—Bridging the Gap: Considering Gender Disparity, Lifestyle, and Other Factors in Predicting the Outcomes of ACHDCanadian Journal of CardiologyPreviewWe thank Drs Damani, Usman, and Samiullah for their interest in our study on the value of a heart failure diagnosis in adult patients with congenital heart disease (ACHD). The main purpose of the study was to evaluate the added prognostic value of a heart failure diagnosis (relative to anatomic complexity and physiological stage), which helps to stratify risk and determine the intensity of follow-up.1 We acknowledge that gender disparity, socioeconomic status, and health behaviour has received limited attention, although it represents a key part of our interaction with patients. Full-Text PDF Short-term Prognostic Value of Heart Failure Diagnosis in a Contemporary Cohort of Patients With Adult Congenital Heart DiseaseCanadian Journal of CardiologyVol. 39Issue 3PreviewHeart failure (HF) is the primary cause of premature death in adult congenital heart disease (ACHD). This study aimed to describe the impact of a HF diagnosis on short-term prognosis and to investigate the added prognostic value of an HF diagnosis to the ACHD Anatomic and Physiologic classification (ACHD-AP). Full-Text PDF Bridging the Gap: Considering Gender Disparity, Lifestyle, and Other Factors in Predicting the Outcomes of ACHD—Insights From Maessen et al.Canadian Journal of CardiologyPreviewThe research article by Maessen et al.,1 "Short-Term Prognostic Value of Heart Failure Diagnosis in a Contemporary Cohort of Patients With Adult Congenital Heart Disease," piqued our inquiry and interest. Contributing to the expanding field of adult congenital heart disease (ACHD) research, the authors should be commended for their diligence in conducting such a remarkable study with a substantial sample size. The ultimate conclusion of this study is that patients with ACHD and heart failure (HF) have an increased risk of death, requiring heart transplants or ventricular-assist devices (VADs). Full-Text PDF Reply to Moon et al.—Concerns About the Use of Artificial Intelligence in Composing Letters to the EditorsCanadian Journal of CardiologyPreviewWe properly reviewed the letter by Van de Bruaene et al., “Reply to Damani et al.—Bridging the Gap: Considering Gender Disparity, Lifestyle, and Other Factors in Predicting the Outcomes of ACHD.”1 We appreciate the efforts made by the authors in furthering the scientific pursuit by acknowledging and providing all the important data missing in the original article.2 Reporting such data can be crucial for a better understanding of health problems associated with adult congenital heart disease (ACHD). Full-Text PDF