Romanian Journal of Cardiology Feed

Clinical profile, anatomical variations, and short-term clinical outcomes in patients with chronic lower limb ischemia

Sat, 26 Sep 2026 00:00:00 GMT

BackgroundPeripheral artery disease is a critical manifestation of systemic atherosclerosis, yet clinical data regarding its anatomical patterns and short-term prognosis within the Indian subcontinent remain limited. Understanding these variations is essential for optimizing secondary prevention and intervention strategies. This study aimed to characterize the clinical profile, anatomical disease patterns, and three-month outcomes of patients with newly diagnosed lower extremity peripheral artery disease in a specialized Indian tertiary care setting.MethodsWe conducted a prospective, hospital-based observational study of 400 consecutive patients with newly diagnosed infrarenal peripheral artery disease and symptoms for more than 14 days at a major cardiology research center in Western India. Subjects were followed for 3 months to evaluate all-cause mortality, major adverse cardiovascular events (MACE), and revascularization requirements.ResultsThe cohort showed a marked male predominance (88.0%). Advanced presentations were common; 70.6% of patients were classified in Rutherford categories Three and Five. Anatomically, the femoropopliteal segment was the most affected (70.3%), and 54.7% of angiographically staged cases demonstrated complex TASC II category D lesions. At three months, all-cause mortality was 13.8%. Multivariable analysis identified serum creatinine (OR: 2.260, p=0.016), C-reactive protein (OR: 1.012, p<0.001), and established CAD (OR: 4.667, p<0.001) as independent predictors of mortality, while gangrene at presentation was the most potent predictor of amputation (OR: 52.75, p < 0.001).ConclusionPatients with peripheral artery disease in this setting present with high anatomical complexity and face significant short-term risks of mortality and revascularization. Aggressive management of metabolic, renal, and cardiac factors may be associated with improved survival in this high-risk population. These findings are limited to early (three-month) outcomes and should not be extrapolated to longer-term prognosis.

A CRUSADE-adjusted prospective cohort analysis of heparin dosing velocity, multivariable mediation and iatrogenic haemorrhage in acute coronary syndromes

Wed, 23 Sep 2026 00:00:00 GMT

BackgroundThe activated partial thromboplastin time (aPTT) is the most widely used assay for monitoring continuous intravenous unfractionated heparin (UFH) in acute coronary syndromes (ACS), yet acute-phase reactants – particularly C-reactive protein (CRP) – can artefactually shorten clotting times by inducing Factor VIII and fibrinogen elevation. This phenomenon, which we term ‘aPTT Blindness’, prompts clinicians to escalate UFH doses in pursuit of a falsely shortened therapeutic target, creating a dose escalation cascade that may disproportionately expose low-weight patients to iatrogenic haemorrhage. No prior study has employed multivariable mediation analysis to quantify the proportion of CRP-associated bleeding risk that operates through this aPTT-mediated pathway, nor has any study used CRUSADE risk score adjustment to isolate protocol-attributable excess bleeding from baseline patient frailty.MethodsWe conducted a CRUSADE-adjusted prospective cohort study of 1600 consecutive adult patients with ACS (STEMI, NSTEMI, and high-risk unstable angina) who received continuous intravenous UFH, with data collected from admission through a 5-day observation window. The cohort was stratified by body weight (<65 kg, 65–85 kg, >85 kg) and CRP quartile. The primary safety end-point was major bleeding classified as BARC type 3 through 5. Inverse probability of treatment weighting balanced baseline covariates, and Fine-Gray sub-distribution hazard regression handled in-hospital death as a competing risk. A multivariable mediation analysis (Baron and Kenny framework, bootstrapped with 5000 replications) was performed to decompose the total effect of CRP on bleeding into direct and aPTT-mediated indirect effects. CRUSADE bleeding risk scores were calculated for each patient; the difference between observed and CRUSADE-predicted bleeding rates was defined as protocol-attributable excess risk.ResultsThe overall BARC 3–5 bleeding rate was 6.8%, with the lowest weight group (<65 kg) experiencing an 11.4% incidence compared with 2.8% in the highest weight group (>85 kg). After CRUSADE adjustment, the excess bleeding attributable to the aPTT-chasing protocol in low-weight patients with pseudo-resistance was 4.5 percentage points (observed 11.4% vs CRUSADE-predicted 6.9%). The multivariable mediation analysis demonstrated that 47.3% (95% confidence interval [CI] 38.2%–56.8%) of the CRP-to-bleeding association was mediated through the aPTT pathway (indirect effect OR 1.20; 95% CI 1.11–1.30; p < 0.001). The interaction between high CRP (>24 mg/L) and low body weight yielded a sub-distribution hazard ratio of 2.94 (95% CI 2.08–4.15; p < 0.001) for major bleeding.Nearly half of the CRP-associated bleeding risk in ACS is mediated through aPTT artefact – what we term CRP-driven ‘aPTT Blindness’. Even after accounting for baseline bleeding risk with the CRUSADE score, low-weight patients on aPTT-guided titration nomograms still experience a clinically meaningful excess of protocol-attributable haemorrhage. The interaction between high CRP and low body weight (SHR 2.94) was the strongest single predictor of major bleeding. These results suggest that aPTT-guided monitoring may be particularly problematic in patients with raised inflammatory markers or low body weight and support the need for comparative trials evaluating alternative monitoring strategies.

Cannabis consumption and myocardial infarction: A report of two cases

Sat, 19 Sep 2026 00:00:00 GMT

BackgroundCannabis is the most widely consumed illicit substance in northern Morocco. An increasing body of literature relates acute cannabis use with major cardiovascular events, particularly acute myocardial infarction (AMI), in young adults without traditional coronary artery disease risk factors.Case presentationWe report two cases of young men who developed ST-elevation myocardial infarction (STEMI) following active cannabis consumption. Case 1: a 29-year-old male who presented with atypical epigastric symptoms, developed cardiorespiratory arrest shortly after electrocardiogram (ECG) acquisition and died; post-mortem examination confirmed recent myocardial necrosis, although the causal link to cannabis remains presumptive in the absence of toxicological confirmation. Case 2: a 31-year-old male with combined cannabis and cocaine use who presented with a 7-hr history of epigastric pain; coronary angiography demonstrated multi-segment coronary thrombosis of the left anterior descending artery (LAD) without spasm or dissection, successfully managed by percutaneous coronary intervention (PCI).ConclusionsThese cases suggest that cannabis consumption may be a trigger for AMI, even in young adults without traditional cardiovascular risk factors. Coronary thrombosis was documented in Case 2, potentially aggravated by polydrug use. Atypical presentations, such as epigastric pain, should prompt active exclusion of AMI in young cannabis users. Larger prospective studies are needed to characterise the incidence, mechanisms and optimal management of cannabis-associated AMI in a better way.

Association of atherogenic index and mean platelet volume with coronary slow flow phenomenon

Sat, 19 Sep 2026 00:00:00 GMT

BackgroundCoronary slow flow phenomenon is defined by delayed opacification of the coronary arteries in the absence of significant stenotic lesions in the epicardial vessels. This study investigated the association between atherogenic index and mean platelet volume (MPV) in patients with coronary slow flow.MethodsThis retrospective analysis was conducted by reviewing the medical records of patients who underwent coronary angiography at Erzurum City Hospital. Individuals diagnosed with coronary slow flow constituted the study group, whereas patients with normal coronary flow were included as the control group. Coronary perfusion was evaluated using the TIMI frame count method. The atherogenic index was derived from triglyceride and HDL cholesterol concentrations, and MPV was obtained from routine complete blood count measurements.ResultsPatients with coronary slow flow exhibited significantly higher atherogenic index and MPV values compared to the control group. Furthermore, a statistically significant positive correlation was found between TIMI frame count and both atherogenic index and MPV.ConclusionThese results suggest a relationship between atherogenic index, MPV and coronary slow flow phenomenon. These routinely available biomarkers may have potential clinical utility and may contribute to a better understanding of the underlying pathophysiological mechanisms.

Predictors of no-reflow phenomenon in patients with type 2 diabetes mellitus undergoing elective percutaneous coronary intervention: The emerging role of the triglyceride–glucose index

Sat, 19 Sep 2026 00:00:00 GMT

ObjectiveTo determine the prevalence and predictors of the no-reflow phenomenon in patients with type 2 diabetes mellitus (T2DM) undergoing elective percutaneous coronary intervention and to evaluate the predictive value of the triglyceride–glucose (TyG) index.MethodsThis prospective observational cohort study included 137 patients with T2DM scheduled for elective percutaneous coronary intervention at two tertiary centres. Patients were classified according to postprocedural Thrombolysis in Myocardial Infarction flow grade into normal reflow and no-reflow groups. Clinical, laboratory, echocardiographic, angiographic and procedural variables were compared. Receiver operating characteristic curve analysis and multivariable logistic regression were performed to assess predictive performance and independent predictors.ResultsThe no-reflow phenomenon occurred in 13 patients (9.5%). Patients with no-reflow had a significantly longer diabetes duration, higher fasting blood glucose, random blood glucose, glycated haemoglobin, low-density lipoprotein cholesterol, triglyceride and TyG index values, and lower left ventricular ejection fraction compared with patients with normal reflow. Severe coronary stenosis and pre-dilatation were significantly more frequent in the no-reflow group. The TyG index demonstrated the highest predictive performance for no-reflow (area under the curve [AUC] = 0.870, 95% confidence interval [CI]: 0.753–0.987, p < 0.001). A TyG cutoff value of approximately 9.01 yielded 76.9% sensitivity and 89.5% specificity. Multivariable logistic regression identified the TyG index as an independent predictor of no-reflow (odds ratio [OR] = 2.05 per 0.1-unit increase, 95% CI 1.26–3.32, p = 0.004), together with duration of diabetes and reduced ejection fraction.ConclusionsNo-reflow occurred in approximately 1 in 10 diabetic patients undergoing elective percutaneous coronary intervention. The TyG index is a simple, inexpensive and effective marker for preprocedural risk stratification.

Vericiguat for post-myocardial infarction heart failure prevention: From molecular mechanisms to clinical translation

Sat, 19 Sep 2026 00:00:00 GMT

Myocardial infarction (MI) remains a major cause of morbidity and mortality, largely due to the development of heart failure (HF). More molecular mechanisms should be investigated concerning the pathophysiology of HF after MI since current therapies for reperfusion and clinical guidelines in medicine cannot solve the problem. The regulation of the signalling pathway involving nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate is responsible for the stability of the cardiovascular system. This pathway works properly in healthy individuals but gets disrupted in MI, causing adverse consequences. Vericiguat acts as an orally administered soluble guanylate cyclase stimulator that restores the levels of cyclic guanosine monophosphate to counteract pathological events leading to HF. Numerous pre-clinical and clinical investigations into vericiguat have shown the capacity of early administration to prevent HF following MI, especially in patients who are at risk of having continued myocardial stress. Moreover, combination approaches using vericiguat alongside current cardioprotective modalities have proven to be promising in yielding better outcomes. The current review is therefore designed to give an insight into various aspects relating to heart with special attention being paid to the role of vericiguat as a disease-modifying agent for prevention of post-MI myocardial HF.

From devices to mechanisms: Towards a structural approach to plaque preparation

Sat, 19 Sep 2026 00:00:00 GMT

Coronary artery calcification remains a major challenge in percutaneous coronary intervention, impairing device delivery, vessel expansion, and clinical outcomes. Despite the availability of multiple calcium-modifying technologies, optimal treatment strategies remain unclear, and the results according to device type are difficult to interpret, as they are influenced by numerous confounding variables.This limitation reflects a predominantly device-centered approach, where plaque preparation is viewed as a preliminary step rather than a central determinant of procedural success. We propose a shift toward a structural and mechanistic understanding of lesion treatment, in which the objective is plaque transformation rather than simple lumen enlargement.This review summarizes current calcium-modifying strategies and emphasizes the importance of procedural technique, iterative device use, and intravascular imaging for real-time assessment. We introduce an integrated framework in which plaque preparation is considered a dynamic and measurable process, guiding both device selection and therapeutic strategy.By moving from a device-based to a mechanism-based approach, this paradigm aims to improve procedural coherence and better balance efficacy and safety in complex percutaneous coronary intervention.

Arterial hypertension in Romania: A national call for action through prevention, diagnosis, treatment and adherence

Wed, 12 Aug 2026 00:00:00 GMT

Arterial hypertension (HTN) represents the leading cause of cardiovascular mortality in Romania, with a rising prevalence estimated at over 45% among the adult population. Despite some progress in recent years, blood pressure control remains suboptimal, highlighting the urgent need for national intervention. This article proposes an integrated action plan, structured around four key pillars – prevention, diagnosis, treatment and adherence, to significantly improve HTN management in Romania. Drawing on recent national and international epidemiological data, as well as successful models implemented in other countries, the authors outline a set of feasible, evidence-based measures that can be progressively and sustainably implemented. These include population-wide nutritional and behavioural interventions, reorganised screening programmes, establishment of digital registries, standardised treatment protocols with fixed-dose combinations, integration of telemedicine and development of digital tools to improve long-term adherence. In addition, the proposed framework explicitly addresses several Romania-specific implementation gaps. A coordinated implementation of this framework could help achieve blood pressure control rates approaching 70% by 2030, thereby reducing the national cardiovascular burden. Consequently, HTN may become a more manageable condition on a national scale, with long-term positive impact on public health.

Acute myocardial infarction in desmoplakin cardiomyopathy: beyond a ‘hot phase’

Wed, 12 Aug 2026 00:00:00 GMT

IntroductionDesmoplakin (DSP) cardiomyopathy is a rare disease, a particular form of arrhythmogenic cardiomyopathy, with a high risk of life-threatening arrhythmia and heart failure.Case presentationA 53-year-old man presented to the emergency department with palpitations. He had no significant medical history, and his family history was unremarkable. The electrocardiogram revealed ventricular tachycardia with left bundle branch block morphology and inferior axis. Following cardioversion, sinus rhythm revealed first-degree AV block and T wave inversion in precordial leads. Echocardiography revealed biventricular dysfunction and right ventricular (RV) dilation, with impaired RV strain and regional kinesis abnormalities. Coronary angiography was normal. Cardiac magnetic resonance (CMR) showed late-gadolinium enhancement in a ring-like pattern, with septal sparring. Genetic testing was positive for the DSP variant, and the diagnosis of DSP cardiomyopathy was established. An implantable cardioverter-defibrillator was placed in secondary prevention, and subsequently, ventricular tachycardia ablation was performed due to repeated arrhythmia. Three years later, the patient presented with a myocardial infarction without ST elevation. Coronary angiography revealed critical stenosis of the circumflex artery, which was treated by implantation of a drug-eluting stent. Family screening revealed DSP cardiomyopathy in his daughter, who had subclinical findings on CMR.ConclusionWhile DSP cardiomyopathy is a complex disease and patients can sometimes present with myocarditis-like episodes, coronary angiography should always be performed in a patient presenting with acute coronary syndrome.

Efficacy of an mHealth-guided tailored physical activity intervention on exercise tolerance and sedentary behaviour in ischaemic heart disease: A prospective cohort study

Fri, 07 Aug 2026 00:00:00 GMT

BackgroundIschaemic heart disease (IHD) remains a preeminent cause of global mortality [6]. The progressive nature of coronary atherosclerosis necessitates nuanced clinical interventions involving structured physical activity [7]. This study investigates the complex intersection of residential living conditions, baseline cardiovascular pathophysiology and the efficacy of an individualised, mobile health (mHealth)-guided physical activity program among patients diagnosed with IHD [8,13].Materials and MethodsThis prospective cohort study was conducted at the Tashkent State Medical University clinic, enrolling 183 patients (98 men, 85 women; mean age 64.2 ± 5.1 years) diagnosed with stable exertion angina pectoris (functional class II-III). Patients were categorised into urban (n = 89) and rural (n = 94) cohorts. Subjective baseline activity was assessed using the ODA-23+ questionnaire and daily diaries, while objective exercise tolerance was evaluated via cycle ergometry [3,5]. Following baseline assessments, patients were prescribed a tailored exercise regimen managed via the ‘HealthRunApp’ and followed up at 6 months [30–32].ResultsAt baseline, arterial hypertension was highly prevalent (84.3% urban, 80.8% rural). Daily diaries revealed profound sedentarism; urban men averaged 11.4 ± 1.8 hr of sleep per day, while rural women averaged 5.7 ± 0.7 hr of television viewing. Subjective assessments demonstrated massive overestimation of physical condition: 64.7% of rural men self-rated their activity as medium to high [10,29]. However, objective cycle ergometry revealed that 80% of urban patients possessed low or very low exercise tolerance. Following the 6-month mHealth intervention, cycle ergometry duration significantly increased (p < 0.001), total work volume improved dramatically across all cohorts (p < 0.01) and ischaemic indicators significantly decreased (p < 0.001).ConclusionWhile a severe baseline disconnect exists between self-perceived health literacy and objective physiological tolerance among IHD patients, the introduction of a tailored, continuously monitored mHealth cardiac rehabilitation programme successfully combats hypodynamia, safely improves exercise tolerance and enhances objective motor activity across both urban and rural demographics [6,27,29,34].

One-year mortality in patients with pulmonary hypertension undergoing TAVI: a systematic review and descriptive meta-analysis

Fri, 07 Aug 2026 00:00:00 GMT

BackgroundPulmonary hypertension (PH) is a frequent comorbidity in severe aortic stenosis (AS) and is associated with poorer outcomes following transcatheter aortic valve implantation (TAVI). This study aims to provide a descriptive synthesis of 1-year allcause mortality rates among TAVI recipients with pre-existing PH.ObjectivesTo characterise 1-year all-cause mortality rates in patients with PH undergoing TAVI, to assess the impact of study quality on reported mortality and to explore sources of heterogeneity in reported outcomes.DesignSystematic review and descriptive meta-analysis.Data SourcesMEDLINE, Embase, Scopus, Web of Science and Cochrane CENTRAL were searched from inception to 18 September 2024, without language restrictions.Eligibility CriteriaObservational cohorts reporting ≥1-year mortality after TAVI in patients with PH defined by echocardiography or right-heart catheterisation. Systematic reviews were included for qualitative synthesis only.Data Extraction and SynthesisTwo reviewers independently extracted the data and assessed the quality (Newcastle–Ottawa Scale [NOS]). A random-effects meta-analysis with logit transformation was used to pool 1-year mortality estimates from observational cohorts. Heterogeneity was quantified by I2; subgroup and sensitivity analyses were performed, stratified by study quality and PH definition.ResultsEleven observational cohorts (N = 10,665 patients) were included in the quantitative synthesis. Pooled 1-year mortality was 24.5% (95% CI 20.0%–29.6%; I2 = 96.7%). High-quality studies (NOS ≥ 8) showed 23.7%, while moderate-quality (NOS 6–7) showed 26.2%. Substantial heterogeneity was observed, influenced by variations in PH definition and measurement modality. Systematic reviews (n = 6) provided additional qualitative context on the association between PH and TAVI outcomes.ConclusionsPatients with PH undergoing TAVI exhibit high 1-year mortality rates, with approximately one in four dying within a year. Marked heterogeneity underscores differences in PH definitions and measurement. Standardised PH assessment and righ theart phenotyping are essential for improved risk stratification and patient selection, and to enable more robust prognostic studies in the future.

Coxiella burnetii pulmonary conduit endocarditis in a child with complex congenital heart disease: a case report

Fri, 07 Aug 2026 00:00:00 GMT

BackgroundCoxiella burnetii is a well-recognized cause of culture-negative endocarditis in patients with prosthetic cardiac material. In pediatric populations, diagnosis is uncommon and frequently delayed, particularly in the presence of immunological abnormalities that may impair serological responses.Case presentationWe present a case of Coxiella burnetii endocarditis in an 11-year-old boy with complex congenital heart disease and multiple prior cardiac surgical interventions who developed chronic systemic manifestations associated with prosthetic conduit infection. He was first evaluated at our center at nine years of age, presenting with a two-year history of low-grade fever, hepatomegaly, hypoalbuminemia, hypogammaglobulinemia, peripheral edema, and progressive right-sided heart failure. His medical history was notable for splenectomy performed for severe unexplained splenomegaly with hypersplenism. Extensive investigations failed to identify an infectious etiology. Echocardiography demonstrated severe conduit stenosis without vegetations. Two years later, during hybrid surgical replacement of the stenotic conduit, fluorescence in situ hybridization of the explanted Contegra conduit detected Coxiella burnetii, while blood PCR and serology were initially negative. Following conduit replacement and initiation of doxycycline-hydroxychloroquine therapy, the patient showed rapid clinical improvement, with resolution of systemic manifestations and normalization of protein and immunoglobulin levels. Seroconversion with high phase I and II IgG titers occurred after three months of therapy.ConclusionsIn pediatric patients with congenital heart disease and prosthetic cardiac material, Coxiella burnetii infection may present with prolonged systemic manifestations. Despite negative initial serology, tissue-based detection from explanted material can establish the diagnosis when conventional investigations fail, and may support the initiation of targeted long-term antimicrobial therapy.

Risk profile and prognosis of myocardial infarction in young adults: A comparative study

Wed, 08 Jul 2026 00:00:00 GMT

Myocardial infarction in young adults is increasingly recognised as a distinct clinical entity, with limited data from North African populations. This study aimed to compare risk profiles and outcomes of ST-segment elevation myocardial infarction (STEMI) between young and older patients.MethodsWe conducted a retrospective comparative study including patients who experienced a first STEMI. Patients were stratified into two groups based on an age of 50 years. All data were analysed from medical records, and follow-up was a minimum of 12 months. The primary endpoint was cardiovascular mortality, and the secondary endpoint included a composite of non-fatal myocardial infarction, hospitalisation for acute heart failure and stent thrombosis or restenosis.ResultsAmong 206 patients included, younger patients had higher rates of smoking (84.9% vs 60%, p < 0.05), chronic heavy alcohol use (30.2% vs 7%, p < 0.05) and family history of coronary artery disease (22.6% vs 7%, p < 0.05). Cardiovascular mortality was higher in older patients (11% vs 0.9%, p < 0.01), whereas the incidence of cardiovascular events was similar between the two groups (25.5% vs 26%, p = 0.96).ConclusionYoung STEMI patients have a significant risk of adverse outcomes despite distinct risk profiles, warranting targeted strategies.

Management of severe symptomatic aortic stenosis and concomitant large abdominal aortic aneurysm in high-risk patients: Review of literature and case series

Tue, 30 Jun 2026 00:00:00 GMT

BackgroundTranscatheter aortic valve replacement (TAVR) has become the traditional standard of care for patients with severe symptomatic aortic stenosis (AS) at high surgical risk, but recently it has been increasingly used for treating patients with intermediate as well as low operative risk. Endovascular aneurysm repair (EVAR) is generally the first-line strategy for treating abdominal aortic aneurysms (AAAs) particularly for infrarenal AAAs meeting the anatomical necessary criteria. The association between AS and AAA is increasing due to the increased life expectancy. Only a limited number of combined TAVR and EVAR procedures have been reported in the literature, each utilizing different strategies and device choices tailored to individual patient anatomy and risk profiles. In the absence of clear clinical guidelines, several challenges remain in identifying the optimal management approach for patients with both severe AS and AAA.ObjectiveThis paper explores the current trends in the treatment of patients with severe symptomatic AS and concomitant large infrarenal AAA, particularly in those at high surgical risk. We present two representative cases managed with a combined TAVR and EVAR approach, highlighting the procedural advantages and risks and decision-making challenges. The implementation of this innovative, minimally invasive strategy may in some cases significantly reduce both hospitalization time and periprocedural complications.ConclusionWith growing clinical experience, this combined approach may evolve into a standard of care for carefully selected high-risk individuals.

Global myocardial work efficiency provides incremental prognostic value in STEMI patients undergoing PCI

Tue, 30 Jun 2026 00:00:00 GMT

ObjectivesEchocardiographic parameters such as left ventricular ejection fraction (LVEF) and global longitudinal strain are commonly used for risk stratification in patients with acute ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, their prognostic accuracy is influenced by loading conditions. We aimed to evaluate whether myocardial work (MW), accounting for afterload, offers prognostic value beyond conventional echocardiographic parameters.MethodsWe prospectively enrolled 215 STEMI patients (mean age 61±10 years) who underwent PCI within 12 hours of symptom onset and early echocardiography. Patients were followed for major adverse events (MAE), defined as all-cause mortality, unplanned cardiovascular hospitalization, ventricular arrhythmias, or stroke.ResultsDuring a median follow-up of 7 months (interquartile range 5-15), 40 patients experienced MAE. Among echocardiographic parameters, global work efficiency (GWE) was the only variable significantly different between patients with and without events. In univariable analysis, hypertension, peak value of creatine-kinase isoform-MB, and MW parameters (global work index, global constructive work, and GWE) were significantly associated with outcomes. In multivariable Cox regression, each 5% decrease in GWE was associated with a 16.5% increased risk of MAE (HR = 0.835, 95%CI = 0.693 – 0.985, p = 0.03). Sequential Cox models showed that adding LVEF to a baseline clinical model (age, Killip class, glomerular filtration rate) provided minimal improvement, whereas inclusion of GWE significantly enhanced model performance (likelihood ratio X2=4.90, p =0.02).ConclusionsIn STEMI patients undergoing PCI, GWE independently predicts MAE and provides incremental prognostic information beyond clinical and echocardiographic parameters. Incorporating GWE into risk assessment may improve identification of high-risk patients for targeted post-infarction management.

Right atrial and ventricular strain in heart failure with preserved ejection fraction: Correlation with N-terminal pro-brain natriuretic peptide

Tue, 30 Jun 2026 00:00:00 GMT

BackgroundRight ventricular (RV) dysfunction is frequently observed in heart failure with preserved ejection fraction (HFpEF). N-terminal pro-brain natriuretic peptide (NT-proBNP) is a neurohormone released in response to ventricular strain with elevated serum levels supporting the diagnosis of HFpEF and RV dysfunction.ObjectivesTo evaluate the relationship between right ventricular and right atrial (RA) strain assessed by speckle-tracking echocardiography (STE) and serum NT-proBNP levels in patients with HFpEF.MethodsThis single-center, prospective case-control study included 39 HFpEF patients and 20 age-and sex-matched healthy controls. RA and RV function were assessed by 2D transthoracic echocardiography and speckle-tracking strain (STE), with RV GLS calculated from a six-segment model. Strain values are reported as absolute numbers, and serum NT-proBNP was measured by ELISA.ResultsThe HFpEF group showed significantly impaired RV global longitudinal strain (16.79 ± 3.96% vs. 25.35 ± 1.89% for the controls) and RA strain (20.94 ± 8.78% vs. 39.95 ± 2.03% for the controls), with p < 0.001 for both. Serum NT-proBNP levels were markedly higher in HFpEF patients (610 ± 15.6 pg/mL vs. 103 ± 7 pg/mL for controls, p < 0.001), with a diagnostic cutoff of 383 pg/mL achieving 96% sensitivity and 94% specificity. NT-proBNP was strongly inversely correlated with RV GLS (r = –0.737) and RA strain (r = –0.739), with p < 0.001 for both.ConclusionsRight ventricular and right atrial dysfunction assessed by STE is prevalent in HFpEF and correlates strongly with NT-proBNP levels. These findings support the combined use of right heart strain parameters and NT-proBNP for improved assessment and risk stratification in HFpEF.

Heart failure hospitalization in Romania – A national multiannual study based on administrative dataset collection

Tue, 30 Jun 2026 00:00:00 GMT

BackgroundHeart failure (HF) is a leading cause of hospitalization and mortality worldwide, with a substantial burden in Central and Eastern Europe. Romania lacks long-term national HF registries, making real-world administrative data an important source of epidemiological evidence.MethodsWe conducted a retrospective national study, using aggregated DRG reimbursement data reported by all public and private hospitals in Romania, between 2017 and 2022. HF hospitalizations were identified using ICD-10 codes (I50.x, I11.0). Key indicators included annual “HF hospital cases” and “HF patients”. Age distribution, length of stay, in-hospital mortality, and readmission frequency were collected for annual HF cohorts, with comparisons between pre-pandemic and COVID-19 pandemic periods.ResultsHF accounted for up to 14% of all “hospital cases”, with 550,000–590,000 annual HF episodes before the pandemic, declining by ~45% during COVID-19 pandemic. Approximately 1.4 hospitalization episodes per heart failure patient were recorded annually. Mean age was 70.1 (+/- 10) years and most hospitalized patients were ≥65 years old, although nearly 30% were <65 years. Mean length of stay was 6.7 days. In-hospital mortality for heart failure was consistently double that of all hospitalizations (4% vs. 2% pre-pandemic, increasing to 8-9% during the pandemic). One-year readmissions were very frequent, with >20% HF-related readmissions.ConclusionsHF represents a major and persistent burden on the Romanian medical system, characterized by high mortality and readmission rates. These findings underscore the need for improved post-discharge management and national strategies to optimize HF care.

Curve or crease: comparative pain and healing profiles in submammary and transaxillary thoracotomy for MICS-MVR

Tue, 30 Jun 2026 00:00:00 GMT

ObjectiveSubmammary lateral thoracotomy and transaxillary thoracotomy are two common approaches for minimally invasive mitral valve replacement (MICS-MVR). However, their impact on postoperative pain, wound healing, and cosmetic outcomes remains underexplored.MethodsIn this prospective cohort study, 80 patients undergoing elective MICS-MVR were assigned to submammary (n = 40) or transaxillary (n = 40) thoracotomy. Pain was assessed using the visual analogue scale (VAS) at defined postoperative intervals. Opioid use, wound healing (Southampton grade, ASEPSIS score), scar quality (patient and observer scar assessment scale, POSAS), and cosmetic satisfaction were recorded.Resultsaseline characteristics were comparable. At 24 hours, VAS scores were lower in the transaxillary group (5.1 ± 1.0) versus submammary (6.3 ± 1.2; p < 0.001). Opioid use over 72 hours was also less with transaxillary (38 ± 10 mg vs. 46 ± 12 mg; p = 0.002). Wound healing at day seven was similar (grade I-II in 92.5% vs. 85%; p = 0.32). Minor wound complications occurred in three and five patients, respectively; none developed deep infections. At three months, POSAS scores favored the submammary approach (14.2 ± 3.5 vs. 17.8 ± 4.2; p < 0.001), with higher cosmetic satisfaction (4.6 ± 0.5 vs. 4.2 ± 0.6; p = 0.004).ConclusionsTransaxillary thoracotomy in MICS-MVR reduced early postoperative pain and opioid use, whereas submammary thoracotomy yielded better long-term scar appearance and cosmetic satisfaction. Both approaches had similar wound healing profiles; thus, surgical choice may be guided by patient priorities.

The great mimicker: Multimodality imaging in cardiac sarcoidosis

Tue, 30 Jun 2026 00:00:00 GMT

Cardiac sarcoidosis is a granulomatous inflammatory disease that can mimic genetic cardiomyopathies, making diagnosis challenging, particularly in young patients with preserved ventricular function. Multimodality imaging is essential for identifying myocardial inflammation, assessing fibrosis, and stratifying arrhythmic risk.We present the case of a 32-year-old female athlete evaluated for exertional syncope and initially suspected of having a genetic cardiomyopathy. Hybrid 18F-FDG PET–CMR demonstrated intense heterogeneous myocardial FDG uptake co-localizing with areas of late gadolinium enhancement (LGE), consistent with active inflammatory cardiomyopathy. Endomyocardial biopsy confirmed cardiac sarcoidosis. Following immunosuppressive therapy, inflammatory activity resolved, while myocardial fibrosis persisted.This case highlights the value of hybrid PET–CMR in differentiating inflammatory from genetic cardiomyopathies, guiding biopsy, and refining sudden cardiac death risk assessment, even in patients with preserved left ventricular ejection fraction.

The heart failure burden: What national administrative data reveal about an unseen epidemic

Thu, 11 Jun 2026 00:00:00 GMT