Fetal Supraventricular Tachycardia: What Do We Know up to This Day?

Fetal tachyarrhythmias, particularly supraventricular tachycardia (SVT) and atrial flutter (AFL), pose significant clinical challenges, especially when complicated by hydrops fetalis. This article provides a comprehensive review of the tachyarrhythmia types, the diagnostic modalities applied, and the therapeutic strategies followed in fetal tachyarrhythmias. Diagnostic techniques such as M-mode echocardiography and fetal magnetocardiography (fMCG) are highlighted for their capacity to provide real-time, high-quality assessments of fetal cardiac rhythms.

Pathophysiology of endothelial dysfunction in Fontan circulation: from bench to bedside and back again.

The Fontan procedure is a definitive surgical approach for complex cardiac malformations, redirecting systemic venous blood into the pulmonary circulation through a staged repair that separates systemic and pulmonary venous returns in the absence of a subpulmonary ventricle. The ensuing unique hemodynamic conditions compromise the endothelial function both in the pulmonary and the systemic circulation. The underlying pathophysiological mechanisms, although distinct within each vascular bed, are interrelated and may collectively contribute to progressive end-organ dysfunction, ultimately accounting for the significant morbidity burden in Fontan patients.

Clinical characteristics and outcomes of patients with acute myocardial Infarction without standard modifiable risk factors (SMuRFs).

Background: The etiology as well as the prevalence of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear, especially in European populations. Simultaneously, evidence suggests that SMuRF-less patients may experience worse short-term outcomes after AMI.

Methods: The "Beyond-SMuRFs" prospective observational study (NCT05535582) included 1011 consecutive patients with AMI in Greece, who underwent coronary angiography and had available data on clinical, laboratory and imaging parameters.

Acute myocardial infarction in patients without standard modifiable risk factors -A state-of-the-art review.

Acute myocardial infarction (AMI) in patients without standard modifiable risk factors (SMuRFs) is an increasingly recognized clinical entity. Traditionally, AMI has been closely associated with SMuRFs: hypertension, diabetes, dyslipidemia, and smoking. However, a subset of patients experience AMI without any of these established risk factors, posing diagnostic and therapeutic challenges.

Prognostic Role of Right Atrial Reservoir Strain in Acute Heart Failure.

Background: Right atrial (RA) dysfunction might indicate an advanced stage of heart failure (HF). The prognostic role of RA dysfunction, assessed according to RA reservoir strain (RArS), in hospitalized acute HF patients remains undetermined.

Methods: All consecutive patients hospitalized for acute HF were prospectively enrolled and had speckle-tracking echocardiography at discharge.

Lipoprotein(a) and aortic stenosis: Practical insights.

Aims: The role of Lp(a) in cardiovascular diseases is increasingly recognized, with high Lp(a) levels shown to be associated with worse outcomes. In this review, we aim to summarize the literature and the current research status regarding AS and Lp(a) with a comprehensive approach, in order to inform basic and clinical scientists with the most up-to-date data and insights.

Data Synthesis: Lp(a) is significantly involved in the pathogenesis of aortic stenosis (AS), with the interplay between AS and Lp(a) being documented in observational studies and a causal association being proposed based on genetic studies.

Impact of Intradialytic Weight Gain on Left Ventricular Function and Characteristics in Hemodialysis Patients.

Background: Pulmonary circulation is particularly overloaded in hemodialysis patients with high interdialytic weight gain (IDWG), as evidenced by deterioration in right ventricular function indices. This study aimed to evaluate the impact of the degree of fluid accumulation on left ventricular (LV) systolic and diastolic function and sizing characteristics.

Methods: This is a post hoc analysis of a cross-over study in 41 hemodialysis patients.

Poor Mental Health Status as a Risk Factor and Prognosticator in SMuRF-Less Acute Myocardial Infarction.

The etiology of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear. Simultaneously, evidence suggests that mental health status (MHS) contributes to the pathogenesis of AMI and worsens its outcomes. This analysis of the prospective "Beyond-SMuRFs" (NCT05535582) study included 650 consecutive patients with AMI who had available data on self-reported MHS before AMI, calculated by the SF36-Questionnaire mental component summary (MCS).

AI-Quantitative CT Coronary Plaque Features Associate With a Higher Relative Risk in Women: CONFIRM2 Registry.

Background: Coronary plaque features are imaging biomarkers of cardiovascular risk, but less is known about sex-specific patterns in their prognostic value. This study aimed to define sex differences in the coronary atherosclerotic phenotypes assessed by artificial intelligence-based quantitative computed tomography (AI-QCT) and the associated risk of major adverse cardiovascular events (MACEs).

Methods: Global multicenter registry including symptomatic patients with suspicion of coronary artery disease referred for coronary computed tomography angiography.

Transthyretin Amyloid Cardiomyopathy: Current Diagnostic Approach and Risk Stratification with Multimodality Imaging.

Amyloidosis is an infiltrative disease that may cause cardiomyopathy if the precursor protein that misfolds and forms the amyloid is transthyretic or plasma abnormal light chains. Transthyretin amyloid cardiomyopathy has to be diagnosed timely and accurately since there are specific treatment options to support the patients. Multimodality imaging including electrocardiography, echocardiography with strain imaging and cardiac magnetic resonance applying late gadolinium enhancement imaging, native T1 mapping and extracellular volume, raise a high suspicion of the disease and bone scintigraphy set the diagnosis even without the need of biopsy.

Diagnosing Heart Failure with Preserved Ejection Fraction in Obese Patients.

Obesity is a current pandemic that sets all affected individuals at risk of heart failure (HF), and the majority of them will develop the clinical syndrome of HF with preserved ejection fraction (HFpEF). The diagnosis of HFpEF is challenging as it is based on the detection of subtle functional and structural remodeling of the heart that leads to diastolic dysfunction with increased left ventricular (LV) filling pressures and raised natriuretic peptides (NPs). The accurate diagnosis of HFpEF is even more challenging in patients who are obese, since the echocardiographic imaging quality may be suboptimal, the parameters for the evaluation of cardiac structure are indexed to the body surface area (BSA) and thus may underestimate the severity of the remodeling, and the NPs in patients who are obese have a lower normal threshold.

Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation.

Background: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in this demographic.

Methods: This post hoc analysis of the MISOAC-AF trial focused on hospitalized AF patients aged ≥ 75 years prescribed OAC at discharge.

Prognostic Implications of Guideline-Directed Medical Therapy for Heart Failure in Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis.

Randomized evidence on the role of heart failure guideline-directed medical therapy for patients with functional mitral regurgitation (FMR) is lacking. The present meta-analysis sought to investigate the prognostic impact of different pharmacotherapy categories recommended in heart failure on subjects with FMR. A systematic literature review was conducted to identify studies reporting the association of renin angiotensin system inhibitors (RASi), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA) with outcomes in FMR.

Blood pressure variability in CKD patients with and without nocturnal hypertension.

Nocturnal hypertension is highly prevalent in patients with chronic kidney disease (CKD) and represents a strong predictor of cardiovascular events. Increased blood pressure variability (BPV) is also independently associated with cardiovascular events in these patients. Differences in short-term BPV indices between CKD patients with and without nocturnal hypertension have not been previously studied.

Treatment of radial artery occlusion after transradial coronary catheterization: a review of the literature and proposed treatment algorithm.

The transradial artery has been established as the default access site for most coronary catheterization procedures with fewer access-related and bleeding complications, rapid hemostasis, early ambulation of the patient, and reduction in all-cause mortality compared with transfemoral access. However, radial artery occlusion (RAO) remains the most frequent complication of coronary catheterization procedures performed via transradial artery access. The purpose of our review was to conduct detailed literature research and summarize all the available treatment strategies for RAO, given the lack of a standardized treatment protocol in the literature.

Endothelial dysfunction in adults with congenital heart disease: A systematic review and meta-analysis.

Background: Adults with congenital heart disease (ACHD) can face a lifelong risk of premature cardiovascular events. Endothelial dysfunction and arterial stiffness may be some of the key mechanisms involved. Early identification of endothelial damage in ACHD could be crucial to mitigate the adverse events.

Could SGLT2 inhibitors improve outcomes in patients with heart failure and significant valvular heart disease? Need for action.

Delivering valvular intervention for all eligible patients with valvular heart disease (VHD) in a timely manner remains a challenge. Therefore, a high number of patients with heart failure (HF) and VHD receive pharmacotherapy while awaiting intervention or as destination therapy if they are deemed inoperable. The sodium-glucose co-transporter-2 inhibitors (SGLT2i) are recommended with a class I indication for patients with chronic HF throughout the spectrum of left ventricular ejection fraction.

Atherosclerotic Risk Factor Prevalence in Adults With Congenital Heart Disease: A Meta-Analysis.

Background: The risk of atherosclerotic cardiovascular disease (ASCVD) in adults with congenital heart disease (ACHD) is comparable to that of the general population and is driven by traditional ASCVD risk factors.

Objectives: The aim of the study was to estimate the prevalence of traditional ASCVD risk factors (hypertension, dyslipidemia, diabetes mellitus [DM], obesity, smoking, and physical inactivity) in ACHD and compare it with the general population.

Methods: A systematic literature search was conducted up to May 15, 2024, to identify studies (with or without control group) reporting the prevalence of ASCVD risk factors in ACHD.

The many faces of SCN5A pathogenic variants: from channelopathy to cardiomyopathy.

The SCN5A gene encodes the alpha subunit of the cardiac sodium channel, which plays a fundamental role in the generation and propagation of the action potential in the heart muscle. During the past years our knowledge concerning the function of the cardiac sodium channel and the diseases caused by mutations of the SCN5A gene has grown. Although initially SCN5A pathogenic variants were mainly associated with channelopathies, increasing recent evidence suggests an association with structural heart disease in the form of heart muscle disease.

Atrial Functional Mitral Regurgitation: From Diagnosis to Current Interventional Therapies.

Mitral regurgitation (MR) is one of the most common valvular pathologies worldwide, contributing to the morbidity and mortality of several cardiovascular pathologies, including heart failure (HF). Novel transcatheter treatment for MR has given the opportunity for a safe and feasible alternative, to surgery, in order to repair the valve and improve patient outcomes. However, after the results of early transcatheter edge-to-edge repair (TEER) trials, it has become evident that subcategorizing the mitral regurgitation etiology and the left ventricular function, in patients due to undergo TEER, is of the essence, in order to predict responsiveness to treatment and select the most appropriate patient phenotype.

Direct Oral Anticoagulants Versus Vitamin K Antagonists for the Management of Left Ventricular Thrombus After Myocardial Infarction: A Meta-Analysis.

Left ventricular (LV) thrombus formation remains a post-acute myocardial infarction (AMI) complication even in the modern era of early reperfusion. The optimal anticoagulation regimen in this clinical scenario is poorly defined. The present meta-analysis sought to investigate the efficacy and safety profile of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) for the management of LV thrombus after AMI.