Global Cardiology Science & Practice is an international peer reviewed journal dedicated to keeping cardiologists abreast of advances in the influence of basic science on clinical practice. The journal is fully indexed in PubMed Central at this address: https://www.ncbi.nlm.nih.gov/pmc/journals/2374/
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The Middle East Heart Failure Conference (MEHFC) has, over the past decade, evolved into a flagship scientific gathering that not only reflects the rapid maturation of heart failure care in the region, but actively shapes it. Hosted by the Middle East Heart Academy (MEHA), the conference has consistently brought together a vibrant community of clinicians, scientists, surgeons, and allied health professionals in Dubai, UAE - creating a rare space where global expertise meets regional priorities. Its unique endorsement by both the Heart Failure Association of the European Society of Cardiology (HFA- ESC) and the Heart Failure Society of America (HFSA) underscores its international credibility and growing influence. The 2026 edition marked a defining milestone. With nearly 100 distinguished faculty members representing 21 countries, abstract submissions from 17 nations, and over 900 attendees from across the Middle East and beyond, the meeting achieved unprecedented scale and impact. More importantly, it reflected a shift - from knowledge dissemination to knowledge generation, collaboration, and regional leadership in heart failure science. A highlight of this success was the presence of Professor Sir Magdi Yacoub as the main keynote speaker, who was awarded the MEHA Lifetime Achievement Award. His participation carried significance far beyond ceremony. As one of the most influential figures in global cardiovascular medicine, his lifelong commitment to advancing cardiac care, particularly in underserved regions, resonates deeply with the mission of MEHFC. His vision has always extended beyond surgical excellence to encompass education, research, and sustainable capacity building. Central to this vision is the Magdi Yacoub Institute at Harefield Hospital in London, UK, which continues to play a pivotal role in transforming cardiovascular care through science and education. The Institute stands as a model for how integrated efforts in research, training, and clinical innovation can address complex challenges such as advanced heart failure and transplantation. By fostering multidisciplinary collaboration and nurturing the next generation of clinicians and scientists, it bridges the gap between discovery and real-world impact. The importance of such initiatives cannot be overstated in the context of the Arab World and the broader Middle East. The region faces a growing burden of cardiovascular disease, with heart failure emerging as a major public health challenge - often presenting at a younger age and with more advanced disease. Despite remarkable progress at certain centres, lack of access to advanced therapies, including mechanical circulatory support and transplantation, remains significant. Promoting cardiovascular research and education in this domain is therefore not a luxury - it is a necessity. Looking ahead, the opportunity lies in leveraging this momentum to build sustainable ecosystems of excellence. This includes strengthening training pathways in heart failure and transplantation cardiology, expanding registries and research collaborations, and advocating for health system reforms that improve access to life-saving therapies. It also means empowering young clinicians and researchers across the region to lead the next wave of innovation. This collaboration between the Magdi Yacoub Institute and the Middle East Heart Academy reflects a shared commitment to advancing the entire continuum of heart failure and transplantation care. It embodies a collective ambition to strengthen clinical pathways, expand access to include all impacted patients, and accelerate research that informs better, more equitable care both within the Middle East region and far beyond.
Copyright (c) 2026 Feras Bader, Hatem Soliman-Aboumarie http://creativecommons.org/licenses/by/4.0
Caregiver Knowledge and Awareness of Heart Failure Symptoms and Risk Factors Among Patients with Cardiovascular Disease: A Cross-Sectional Study from Jordan
Background and Purpose: Cardiovascular disease (CVD) remains the leading cause of death globally and accounts for over 40% of annual deaths in Jordan. Heart failure (HF), a major sequela of advanced CVD, is increasing in prevalence and imposes high rates of morbidity, readmission, and mortality. In HF management, caregivers play a pivotal role in symptom monitoring, adherence to therapy, and early recognition of deterioration. This study aimed to assess caregivers’ knowledge regarding cardiovascular risk factors and heart failure symptoms among patients with established coronary heart disease (CHD) in Jordan, and to identify predictors of higher knowledge levels. Methods: A cross-sectional study was conducted in the cardiology clinics at Jordan University Hospital (JUH). A total of 469 caregivers of patients with CHD completed a self-administered questionnaire assessing sociodemographic data, awareness of cardiovascular and HF risk factors, and recognition of acute cardiac and HF symptoms. Statistical analysis identified patterns and factors influencing knowledge. Results: The mean age of participants was 44.4 ± 15.9 years, and 54.2% were male. Overall, 84.6% of caregivers correctly answered over 70% of general CVD risk-factor questions. While 95% recognized chest pain as a major cardiac warning sign, only 53.5% identified jaw pain and 74.8% arm pain as possible indicators of acute cardiac events. Awareness of hallmark HF symptoms—such as dyspnea, orthopnea, fatigue, ankle swelling, and rapid weight gain—was considerably lower. Factors associated with higher knowledge included older age, higher income, regular health checkups, and personal history of CVD, CKD,or diabetes. Conclusions: Although general CVD knowledge among caregivers was satisfactory, notable deficits exist in recognizing HF-specific and atypical cardiac symptoms. Enhancing caregiver education especially regarding HF symptom recognition and early intervention could improve adherence, reduce hospitalizations, and enhance quality of life for HF patients in Jordan. Structured caregiver education should be integrated into cardiac discharge and follow-up care.
Copyright (c) 2026 Zaid Sarhan http://creativecommons.org/licenses/by/4.0
From Rescue to Replacement: Integrating Temporary and Durable Mechanical Circulatory Support Across the Cardiogenic Shock–Heart Failure Continuum: A narrative review
Heart failure (HF) and cardiogenic shock (CS) represent a continuum of cardiac dysfunction with substantial morbidity and mortality. Timely and appropriate mechanical circulatory support (MCS) can be lifesaving. Although the use of temporary and durable devices continues to expand, evidence guiding their optimal integration across the HF–CS spectrum remains limited. This review examines the integration of temporary and durable MCS to improve patient outcomes. A comprehensive literature review (2020–2025) of 94 articles, including RCTs, registry analyses, and international guidelines from Cochrane, PubMed, JACC, ClinicalTrials.gov, was performed. Included were adults (≥18 years) with advanced HF or CS using MCS. Exclusions comprised pediatric data, case reports, editorials, correspondence, and non-MCS-specific or non-English studies. Systematic synthesis of the included literature demonstrated that the integration of protocolized temporary MCS (Intra-Aortic Balloon Pump, Impella, Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO)) programs, such as the Inova Heart and Vascular Institute (IHVI) program, was associated with improved 30-day survival (57% to 71%). Prognostic indicators for poor mortality included low Cardiac Power Output and elevated lactate. And for program survivors most common destination was left ventricular assist device (LVAD 14%) or heart transplantation (3%) at 36-month follow-up. While registry data (e.g., Extracorporeal Life Support Organization (ELSO), n=7,950) attained early physiologic objectives that boosted VA-ECMO survival (39% to 56%) and reduced complications, temporary support still demonstrated high complication rates, with Impella evaluations showing mortality near 30% and frequent hemorrhage/vascular injury. Conversely, the Aspirin Removal and Investigation of Events Surrounding the HeartMate3 (ARIES-HM3 LVAD) research demonstrated that optimizing anticoagulation by removing aspirin significantly reduced bleeding without increasing thrombosis. HF–CS continuum research suggests combining temporary devices and durable MCS increases survival. While enhanced anticoagulation reduces bleeding, timely physiologic adjustment and systematic protocol implementation enhance outcomes. Randomized trials are necessary to identify the optimal sequencing and transition strategies due to outcome unpredictability.
Copyright (c) 2026 Alisha More, Durr e Shahwar Shahid, Fatema Taz Zahra, Dania Khalida, Bassil Alzamkan http://creativecommons.org/licenses/by/4.0
Assessment of regional variation in the management of heart failure with a preserved ejection fraction between the Russian Federation and the European Union: the results of the international survey
Objectives: Regional differences in heart failure with preserved ejection fraction (HFpEF) care have been reported. We aimed to assess a physician-reported HFpEF management in the Russian Federation (RF) and a variation in the diagnosis and treatment of HFpEF between the RF and the European Union (EU). Materials and Methods: It is a post hoc analysis of an academic web-based international HFpEF designed as a cross-sectional survey and conducted between May 2023 and July 2023 among Medical doctors who work in the fields of cardiology and general medicine. Results: Among 1460 medical doctors who completed the study were 166 Russian and 646 European specialists. The responders were comparable across the groups in most of the baseline characteristics, except that RF specialists were less likely to be heart failure specialists (RF: 2% vs EU: 26%) and less often worked in academic environments (RF: 17% vs EU: 61%). The utilisation of specific echocardiography parameters (RF: 66% vs EU: 80%) and natriuretic peptides (RF: 83% vs EU: 91%) to establish a diagnosis of HFpEF was less frequent in RF compared with EU, while HFpEF scores were more likely to be used by Russian physicians (RF: 58% vs EU: 40%). In the settings when all HF medications are available, responders of both regions prioritised sodium-glucose co-transporter type 2 inhibitors (SGLT2is) (mean rank: RF: 2.6 (IQR: 2.3–3) vs EU: 2.3 (IQR: 2.2–2.5)), followed by diuretics in the EU and ACE inhibitors in the RF. Every second responder in both regions preferred SGLT-2is if only one drug was available (RF: 57% vs EU 51%). Conclusions. The results reveal discrepancies in physician-reported HFpEF management between RF and EU responders, particularly in the diagnostic workup.
Copyright (c) 2026 Anastasia Shchendrygina, Irina Komarova, Nadezhda Mukhina, Natalia Cherkasova, Violetta Sitnikova, Anzhela Soloveva, Nikolay Novitsky, Andrey Baglikov, Irina Dyachuk, Alina Bibarsova, Elena Kuzheleva, Ekaterina Stepanenko http://creativecommons.org/licenses/by/4.0
Polypharmacy in Cardiovascular: When More Drugs Mean More Risks
Background: Drug–drug interactions (DDIs) are a major concern in cardiovascular polypharmacy. Tools like Lexicomp categorize interactions (A–X), but these are often misinterpreted — overestimating risk can lead to unnecessary therapy changes, while underestimating risk may cause harm. This study aimed to quantify the burden and predictors of clinically significant DDIs in cardiovascular patients, emphasizing the need for clinical judgment beyond rigid categorization for balanced prescribing. Methods: A retrospective analysis was conducted on 395 cardiovascular discharge prescriptions. The highest-risk interaction per prescription was identified, and total interactions were also quantified. Associations between polypharmacy categories, comorbidities, length of hospital stay, and highest-risk interaction (C/D/X) were analyzed using chi-square, correlation, and regression models using Jamovi software. Results: In this cohort of 395 prescriptions, most flagged interactions were Category C (n = 148, 37.5%), requiring monitoring rather than avoidance, while Categories D (n = 20, 5.1%) and X (n = 11, 2.8%) were less frequent. This shows that the majority of interactions were not absolute contraindications but signals for clinical vigilance. In regression analysis, the number of comorbidities (β = 0.28, p = 0.01) and the length of hospital stay (β = 0.31, p = 0.004) were independent predictors of high-risk DDIs. Notably, the likelihood of clinically significant interactions increased with polypharmacy category, comorbidity burden, and length of stay. Correlation analysis confirmed a positive moderate relationship between the total number of prescribed drugs and drug interaction counts (Spearman’s r = 0.42, p < 0.001), supporting the stepwise rise in DDI risk with higher drug counts. Conclusion: Polypharmacy in cardiovascular patients is strongly linked to DDIs, but most interactions (Category C/D) require monitoring, not avoidance. Risk is multifactorial — shaped by drug count, comorbidities, and hospital stay — underscoring the need for clinical judgment in interpreting DDI alerts.
Copyright (c) 2026 May Gamal Mohamed, Diana Malaeb, Nikita Sunil http://creativecommons.org/licenses/by/4.0
Body Roundness Index Versus Body Mass Index for Predicting Cardiovascular Mortality: Insights from a National Cohort
Background and purpose: Body mass index (BMI) is widely used to estimate adiposity but does not reflect fat distribution and may underestimate cardiovascular risk. The body roundness index (BRI), incorporating waist circumference and height, better reflects visceral adiposity. This study compared BRI and BMI as predictors of cardiovascular and heart-failure mortality in a nationally representative U.S. cohort. Methods: Data from 31,351 adults ≥20 years in NHANES 1999–2018 were analyzed, excluding individuals with prior cardiovascular disease or cancer. BRI was calculated using a validated formula and divided into quintiles; BMI used World Health Organization categories. Cardiovascular and heart-failure mortality were identified through National Death Index linkage. Weighted Cox proportional-hazards models estimated associations between BRI or BMI and mortality, adjusting for demographic, socioeconomic, lifestyle, and clinical factors including hypertension, diabetes, and lipid-lowering therapy. Restricted cubic splines assessed non-linearity, and Harrell’s C-index evaluated discrimination. Results: Over a median follow-up of 10 years, 883 cardiovascular deaths occurred, including 243 from heart failure. Compared with the middle BRI quintile, the highest quintile was associated with a 54% higher cardiovascular mortality risk (adjusted HR 1.54; 95% CI 1.13–2.08). In contrast, BMI ≥30 kg/m² showed only a borderline increase (HR ≈ 1.18; 95% CI 0.98–1.42). BRI demonstrated a modest U-shaped association, whereas BMI showed a weaker linear trend. Replacing BMI with BRI improved discrimination (C-index 0.77 vs 0.74). Patterns were similar for heart-failure mortality, where high BRI predicted a 1.6-fold risk increase, while BMI categories were not independently associated after adjustment. Conclusions: BRI was a stronger predictor of cardiovascular and heart-failure mortality than BMI, likely due to better representation of visceral fat. Incorporating BRI into clinical risk assessment may improve identification of high-risk individuals, particularly those with central obesity who may be missed by BMI. Future studies should validate BRI thresholds and assess integration with biomarker-based HF risk models.
Copyright (c) 2026 Zaid Sarhan, Raneem Aldalaeen http://creativecommons.org/licenses/by/4.0
Social Vulnerability and Acute Heart Failure Events Among Dialysis‑Dependent Patients: A National Registry Analysis
Background and Purpose: Heart failure is a leading cause of morbidity and mortality in dialysis‑dependent end‑stage renal disease (ESRD) patients. Social determinants of health (SDoH) may compound heart failure risk by limiting access to care and increasing stress and medication non‑adherence. International Classification of Diseases Z‑codes (Z55–Z65) provide a means to document SDoH in clinical records. We aimed to evaluate whether patients with documented Z‑codes had a higher incidence of acute heart failure events than those without. Methods: We conducted a retrospective cohort study using a national electronic health registry of adults receiving dialysis from 2015 to 2024. Patients with at least one SDoH Z‑code were compared with those without. Propensity score matching on age, sex, race, comorbidities and medication use yielded two cohorts of 18,880 patients. The primary outcome was acute heart failure requiring hospitalisation. Hazard ratios (HRs) were estimated using Cox proportional hazards models. Results: Matched cohorts were similar in demographics (mean age ≈62 years; 43 % women) and comorbidities. Over a median follow‑up of nine months, acute heart failure occurred in 24.3 % of Z‑coded patients compared with 20.5 % of non‑Z‑coded controls. Documentation of any Z‑code was associated with a 29 % higher risk of acute heart failure (HR ≈ 1.29, 95 % CI 1.23–1.35) after adjustment for baseline characteristics. Subgroup analyses indicated that the association was consistent across age, sex and diabetes status. Conclusions: In dialysis‑dependent ESRD patients, documentation of social vulnerability via Z‑codes identifies individuals at markedly higher risk of acute heart failure. These findings support the integration of SDoH data into heart failure risk stratification models and highlight the need for multidisciplinary interventions that address social and medical factors concurrently. Tailored social support and early heart failure management may mitigate the elevated risk observed in socially vulnerable dialysis patients.
Copyright (c) 2026 Raneem Aldalaeen, Mohammad Aldalaeen, Lana Amouri, Raneem Hazem http://creativecommons.org/licenses/by/4.0
Association of Triglyceride‑Glucose Index with Heart Failure among Patients with Type 2 Diabetes
Background and Purpose: The triglyceride–glucose (TyG) or “Tri-Glu” index is an accessible surrogate of insulin resistance linked to cardiovascular disease in several populations. However, its association with heart failure (HF) among patients with type 2 diabetes in Middle Eastern populations remains unclear. This study examined the relationship between the Tri-Glu index and prevalent HF in patients with type 2 diabetes. Methods: We retrospectively analyzed records of adults with type 2 diabetes attending a tertiary center between January 2022 and June 2025. Clinical, anthropometric, and laboratory data, including fasting glucose and triglycerides, were extracted. The Tri-Glu index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. HF status was determined from clinician documentation and echocardiography. Mean Tri-Glu values were compared between patients with and without HF using t-tests. Multivariable logistic regression assessed the association between the Tri-Glu index and HF, adjusting for age, sex, body mass index (BMI), and diabetes duration. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were reported. Results: Among 1,373 patients (mean age 59 ± 10 years; 49% women), 134 (9.8%) had HF. The mean Tri-Glu index was higher in patients with HF than those without (9.58 ± 0.76 vs 9.32 ± 0.70; p < 0.001). In multivariable analysis, each 1-unit increase in Tri-Glu index was associated with higher odds of HF (aOR 1.75; 95% CI 1.34–2.28; p < 0.001). Older age and higher BMI were also independent predictors of HF. Conclusions: A higher triglyceride–glucose index was independently associated with heart failure in type 2 diabetes, even after adjusting for major risk factors. The Tri-Glu index may serve as a simple, low-cost biomarker to identify diabetic patients at elevated HF risk in Middle Eastern populations.
Copyright (c) 2026 Dia'a Sarhan, Zaid Sarhan, Raneem AlDalaeen, Munther S. Momani http://creativecommons.org/licenses/by/4.0
Effectiveness of Multidisciplinary Clinic Integration on Long-Term Mortality in Chronic Heart Failure: A Regional Registry Study
Background: Despite established guidelines, significant variation persists in the delivery of chronic Heart Failure (HF) care, particularly in regional contexts. Multidisciplinary care (MDC) is proven to enhance adherence to Guideline-Directed Medical Therapy (GDMT), yet its long-term survival benefit across diverse regional cohorts, independent of initial patient selection biases, remains under-documented. We utilized regional registry data to assess the real-world impact of systematic MDC integration on all-cause mortality. Methods: This retrospective cohort study utilized data from the Regional HF Patient Registry, enrolling 2,800 consecutive patients newly diagnosed with HFrEF or HFpEF over a five-year period. Patients were categorized by referral pathway: specialized Multidisciplinary HF Clinic (MDC) or Standard Cardiology Care (SCC). To mitigate confounding by indication, a robust Propensity Score Matching (PSM) algorithm was applied to balance baseline demographics and comorbidities (e.g., age, LVEF, comorbidity index). The primary endpoint was all-cause mortality at 36 months. Multivariate Cox Proportional Hazards regression served as the primary statistical analysis. Results: After meticulous PSM, 1,200 matched pairs (MDC vs. SCC) were analyzed. Patients managed through the Multidisciplinary Clinic demonstrated a significantly improved survival rate. The adjusted Hazard Ratio (HR) for all-cause mortality at 36 months in the MDC group was 0.72 (95% CI: 0.61–0.85; p<0.001), indicating a 28% relative risk reduction. Furthermore, the rate of 30-day readmission for acute HF exacerbation was reduced by 35% in the MDC group (p=0.012). This outcome highlights the clinical superiority of integrated care delivery. Notably, the survival benefit persisted irrespective of the baseline LVEF status. Conclusion: Systematic integration of Multidisciplinary Heart Failure Clinics significantly improves long-term survival and reduces hospitalization rates in a regional, real-world cohort. These data underscore the critical need for policy frameworks that mandate centralized, integrated care structures, directly supporting the regional objective of enhancing quality of care and optimizing chronic disease management.
Copyright (c) 2026 Sondos Al-qadi, Ayah Damlakhi, Rahmeh Al-Asmar http://creativecommons.org/licenses/by/4.0
The Burden Beneath the Chest: Depression and Clinical Outcomes in Heart Failure Patients — A Systematic Review and Meta-Analysis
Background and Purpose: Heart failure (HF) is not only a disorder of hemodynamics; it carries a heavy psychological toll. Depression affects up to one-third of HF patients and may worsen adherence, functional status, and mortality. Despite growing recognition, the link between depression and HF prognosis remains under-emphasized in routine care. This systematic review and meta-analysis evaluated the association between depression and key clinical outcomes in HF, including hospitalization, mortality, and quality of life. Methods: A structured search was conducted in PubMed, Scopus, Embase, and Cochrane Library databases from inception to January 2025. We included prospective and retrospective cohort studies and randomized controlled trial secondary analyses that assessed depression in HF patients and reported clinical outcomes. Two reviewers independently screened studies, extracted data, and assessed study quality using PRISMA guidelines and Newcastle-Ottawa Scale. Random-effects models were used to pool effect estimates. Results: A total of 26 studies comprising ~18,900 HF patients met inclusion criteria. Depression was present in approximately 31% of patients at baseline. Meta-analysis demonstrated that depression was associated with significantly higher all-cause mortality (HR 1.48; 95% CI 1.30-1.69; p<0.001) and increased HF-related hospitalizations (HR 1.58; 95% CI 1.35-1.85; p<0.001). Depressed patients consistently reported worse functional capacity and lower quality-of-life scores, including Minnesota Living with Heart Failure Questionnaire ratings. Studies integrating early psychological assessment and multidisciplinary management showed improved adherence and reduced event rates, although interventional evidence remains limited. Conclusions: Depression is a strong and independent predictor of mortality, hospitalization, and poor quality of life in HF patients. Findings highlight the need for systematic depression screening and integrated mental-cardiac care pathways in HF management. Future research should focus on targeted mental health interventions, timing of screening, and real-world implementation strategies to improve outcomes for this high-risk population.
Digital Heart: Evaluating a Mobile-Based Heart Failure Education Tool for Enhancing Patient Self-Care and Symptom Awareness in Jordan
Background and Purpose: Heart failure is a growing health burden in Jordan and the Middle East, contributing to high readmission rates and increased morbidity. One key challenge in HF care is limited patient understanding of self-management practices and early symptom recognition. Digital education platforms offer a scalable opportunity to deliver accessible, patient-centered HF education. This study aimed to evaluate the impact of a mobile-based HF education intervention on patient knowledge, and self-care adherence among HF patients in Jordan. Methods: A prospective interventional study was conducted among 78 adult HF patients attending cardiology clinics at a tertiary hospital in Jordan. Participants completed a baseline questionnaire assessing HF knowledge, recognition of decompensation signs, and adherence to self-care behaviors. Patients then received a smartphone-based educational module including short videos, infographics, medication reminders, and interactive quizzes. Follow-up assessment was performed six weeks later. Outcomes included changes in knowledge scores, symptom awareness, and self-care adherence. Paired t-tests and multivariate regression analyses were used to evaluate improvement and predictors of change. Results: Of the participants, 55% were male and the mean age was 62.7 ± 10.1 years. Post-intervention, HF knowledge scores increased significantly (mean improvement +19%, p<0.001). Recognition of early HF decompensation signs such as rapid weight gain, worsening dyspnea, and ankle swelling improved from 46% at baseline to 80% (p<0.001). Self-reported adherence to fluid restriction, sodium-controlled diet, and daily weight monitoring also increased. Older age, prior HF hospitalization, and higher digital literacy were associated with greater improvement. Conclusions: A mobile-based educational intervention significantly improved HF knowledge, early symptom recognition, and self-care practices among HF patients in Jordan. Integrating digital cardiac education platforms into routine HF management may help reduce delays in seeking care and prevent avoidable hospitalizations. Wider adoption of digital HF tools across the Middle East could strengthen patient empowerment and improve long-term outcomes.
Early onset Anthracycline-induced cardiotoxicity in a 58 year-old woman with breast cancer
The development of left ventricle (LV) dysfunction (CTRCD) which is reported by several chemotherapeutic agents (eg. anthracyclines) is associated with poor prognosis and contributes to long-term cardiovascular morbidity and mortality. Among measures of myocardial function, echocardiography-measured peak systolic global longitudinal strain (GLS) is the most extensively studied marker and provides an easy, inexpensive, and quantitative assessment of global long-axis systolic function. A 58 year-old woman with breast cancer on anthracycline without any cardiac symptoms was referred to our cardio-oncology clinic due to a decline in LV GLS from -21 (before anthracycline initiation) to -16 (after 3 months of recieving anthracycline) and thus the guideline directed medical treatment was initiated. Patient demonstrated LV GLS improvement 6 months later and LV GLS recovered to -20. The recognition of CTRCD is important since early detection and treatment with heart failure treatment provide a good function recovery and long-term prognosis.
Copyright (c) 2026 Azin Alizadeasl, Raheleh Sajadi Nia http://creativecommons.org/licenses/by/4.0
Post-Discharge Care for Heart Failure Patient Through Digital Remote Patient Monitoring
Objective: This study evaluated a Remote Patient Monitoring (RPM) system for Heart Failure (HF) patients after hospital discharge. The program aimed to detect early clinical deterioration, reduce readmissions, and improve quality of life. Continuous monitoring and automated alerts enabled real-time connection between patients and healthcare providers, ensuring timely intervention and seamless continuity of care in alignment with national digital health transformation goals. Method: HF patients discharged from the hospital were enrolled in a home-based RPM program, receiving a monitoring kit with an ECG-capable smartwatch, blood pressure monitor, pulse oximeter, and weight scale. Devices connected via Bluetooth to a secure app, transmitting real-time data to a clinical dashboard. Deviations from baseline triggered alerts prompting interventions such as medication adjustments (diuretics, beta-blockers, sacubitril/valsartan), adding anticoagulants, and conducting diagnostic tests or virtual consultations. The program followed a multidisciplinary model, with nursing staff monitoring, prioritizing alerts, and communicating with patients, while Advanced Nursing Practitioners (ANPs) and cardiologists for management. Results: A total of 30 patients were enrolled in the (RPM) program, comprising 24 males (80%) and 6 females (20%), with ages ranging from 21 to 72 years. Five patients (16.7%) were identified through RPM alerts as having new or clinically significant arrhythmias, including atrial fibrillation (AFib), non-sustained ventricular tachycardia (NSVT), and premature ventricular contractions (PVCs). Treated with anticoagulation in 2 (6%) and VT ablation in 1 (3%) Around 20 (67%) patients had either weight gain or edema leading to diuretic adjustment. Patient who had hypotension 10 (33%) had adjustment of sacubitril/valsartan. Other patients are under monitoring for optimization of HF medical therapy through virtual visits. Conclusion: the RPM model is effective and safe in providing continuity of care and improving quality of life. Early detection and prompt intervention to reduced hospital admission.
Copyright (c) 2026 Shatha Al-harbi, Abeer Bakhsh, Awad Al-khatib, Roaya Buqis http://creativecommons.org/licenses/by/4.0
Early Detection of Cardiac Arrhythmias Through Nurse-Led Remote Monitoring
Objective: This study aimed to highlight a nurse-led Remote Patient Monitoring (RPM) program for cardiac patient, and alignment with Saudi Vision 2030 health transformation goals. With focus on advancing nurse-led digital health intervention to reduce readmissions, and promote cost-effective solutions. Methods: Heart failure (HF) patients on discharged from hospital were enrolled in the RPM program. Each received a monitoring kit with ECG-capable smartwatch linked via Bluetooth to a secure mobile app streaming real-time data to a digital dashboard reviewed by cardiac nurses. Patients were monitored remotely for three months. Results: Total of 30 HF patients were enrolled. The arrythmia was detected in 5 (18.5%) either new or symptomatic arrhythmias, of which, 3 (60%) males, 2 (40%) females, with average age 21–72 years. Atrial Fibrillation was observed in 3 patients, of which 2 were new onset, and started anticoagulation with further optimization of betablockers. One patient developed symptomatic arrythmia with non-sustained ventricular tachycardia with variable block on RPM, patient was sent to hospital and received amiodarone and had VT ablation. Other finding was tachycardia with premature ventricular contraction (PVC)s, patient had Holter which showed PVCs managed with beta-blocker and electrolyte correction. The outcome of RPM includes 1 (20%) required admission for intervention, 2 (80%) started anticoagulation for stroke prevention. All patient benefited from medical optimization. The time from ECG recording of arrythmia to escalating care by nursing team is average of 12 ± 4 minutes. Conclusion: Early detection and rapid response prevented major complications in all affected patients, avoiding strokes or sudden cardiac deaths. The nurse-led RPM demonstrated strong clinical leadership and operational efficiency, enabling timely, evidence-based interventions.
Copyright (c) 2026 Shatha Al-harbi, Abeer Bakhsh, Roaya Buqis http://creativecommons.org/licenses/by/4.0
Prognostic Utility of Circulating Inflammatory MicroRNA Signatures in Predicting Adverse Ventricular Remodeling Post-Infarction Heart Failure
Background: Accurate prediction of adverse left ventricular (LV) remodeling following acute myocardial infarction (MI) remains a significant clinical challenge despite advances in cardiac imaging. Early identification of high-risk patients is critical for initiating aggressive cardioprotective therapies and improving long-term outcomes. MicroRNAs (miRNAs) regulating inflammatory pathways present as promising, non-invasive prognostic biomarkers for post-MI progression to chronic Heart Failure (HF). This study sought to validate a novel circulating miRNA signature panel as a robust predictive tool. Methods: This prospective cohort study enrolled 412 patients presenting with first-time ST-elevation MI. Patients underwent comprehensive two-dimensional echocardiography at baseline and six months to define the primary endpoint: significant adverse LV remodeling (defined as an increase in LV end-systolic volume index >15%). Quantification of a targeted panel of four inflammatory-associated circulating microRNAs (miR-21, miR-133a, miR-146a, miR-499) was performed by quantitative reverse transcription PCR (qRT-PCR) at 48 hours post-event. Multivariate Cox Proportional Hazards regression was the primary statistical analysis for risk association. Results: At six months, 108 patients (26.2%) developed adverse LV remodeling. Univariate analysis confirmed that elevated levels of both miR-21 and miR-146a were independently associated with the primary endpoint (p<0.01 for both). In the final multivariate model, the integrated four-miRNA signature demonstrated superior prognostic stratification compared to baseline clinical factors (C-statistic: 0.82 vs. 0.70; p<0.001). Specifically, patients in the highest quartile of the composite miRNA score faced a significantly increased risk of remodeling, exhibiting an adjusted Hazard Ratio (HR) of 2.95 (95% CI: 1.88-4.10; p=0.001). This biomarker panel allows for accurate identification of vulnerable individuals who are not detected by traditional cardiac imaging metrics. Conclusion: Circulating inflammatory microRNA signatures represent a robust, non-invasive prognostic tool for post-MI adverse LV remodeling. Early utilization of this biomarker panel enables targeted interventions to prevent progression to chronic HF, supporting precision medicine and advancing cost-effective, high-quality cardiovascular care.
Copyright (c) 2026 Mohammad Al-Rababa’h, Rahmeh Al-Asmar http://creativecommons.org/licenses/by/4.0
Effectiveness of Cardiac Rehabilitation in Improving Functional Performance Among Patients with Ischemic Heart Failure
Background: The Cardiac Rehabilitation (CR) and Prevention Program is an integrated model of care aligning with the Saudi Health Transformation plan and Vision 2030 goals. The CR program aims to improve quality of life and clinical outcomes for patients with coronary artery disease (CAD) after an acute cardiac event, including heart failure (HF) with reduced left ventricular ejection fraction (LVEF) less than 45%. This study evaluated the impact of structured cardiac rehabilitation sessions on functional capacity (METs). Methods: A retrospective review of the CR database from 2024-2025 included patients with CAD, who had reduced LVEF less than 45%. Pre- and post-program functional capacity (METs) were compared to assess the effect of the intervention. Results: Total number of patients enrolled in CR program 204 from 2024–2025. A total number of patients with LVEF < 45% were 122 (60%). Of all participants 74 (36%) completed the exercise session. The cardiac risk factor were targets improved as following HbA1c 106 (52%), LDL 129 (63%), and BMI 81 (40%). For patients with HF with LVEF < 45%, 22 (18%) patients completed exercise sessions. For total patients 62 (84%) improved their METs from 5.1 to 7. For the HF patients the METs improved from 4.4 to 6.7 .For all patients enrolled in CR program, none of these patients had readmission for HF and 2 () patients has readmission for acute coronary syndrome. Conclusion: Cardiac rehabilitation program proved both safe and effective in patients with ischemic heart disease and heart failure. The structured rehabilitation can reduce the HF related admissions.
Copyright (c) 2026 Nujood Alluqmani, Fatma Abu Alenin http://creativecommons.org/licenses/by/4.0
Arrhythmia and Cardiovascular Risks in Inflammatory Bowel Disease: Insights into Disease and Therapy Effects
Background and Purpose: Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, is increasingly recognized as a systemic inflammatory condition with effects extending beyond the gastrointestinal tract. Emerging evidence indicates that patients with IBD have a heightened risk of developing cardiac arrhythmias, including atrial fibrillation and atrioventricular conduction abnormalities. This review aims to synthesize current epidemiological, mechanistic, and pharmacologic evidence regarding the association between IBD and arrhythmia risk, with particular attention to the role of inflammation and therapeutic agents. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, SCOPUS, Embase, and Google Scholar following PRISMA guidelines. The search strategy included MeSH and free-text terms related to “Inflammatory Bowel Disease,” “Crohn’s Disease,” “Ulcerative Colitis,” “Arrhythmia,” and specific treatment classes. Studies published in English between 2000 and 2025 were screened. Eligible studies included original research reporting quantitative risk estimates for arrhythmias in IBD patients or evaluating arrhythmogenic effects of IBD therapies. Methodological quality was assessed using the Newcastle-Ottawa Scale. Results: Out of 380 identified records, 11 studies met inclusion criteria. Across cohort and genetic studies, IBD was consistently associated with an increased incidence of atrial fibrillation and other conduction disorders, independent of conventional cardiovascular risk factors. Mechanistically, systemic cytokine activation, autonomic imbalance, and myocardial remodeling were recurrently implicated. Pharmacologic influences varied: 5-aminosalicylates were occasionally linked to reversible myocarditis, corticosteroids demonstrated dose-dependent cardiovascular effects, and biologic agents showed overall cardiac safety. Conclusions: IBD confers an independent risk for cardiac arrhythmias through both inflammatory and treatment-related mechanisms. Recognizing these associations underscores the need for comprehensive cardiovascular assessment and proactive management in IBD care. Multidisciplinary collaboration and longitudinal research are essential to refine risk prediction and optimize outcomes in this growing patient population.
Copyright (c) 2026 Tabish Tabish Siddiqui, Enayat Almasri http://creativecommons.org/licenses/by/4.0
Carotid Intima-Media Thickness in Healthy Young Adults: A Review of Vascular-Metabolic Associations and the Evidence Gap in the UAE Population
Background and Purpose: Carotid intima-media thickness (CIMT), measured by B-mode ultrasound, is a validated marker of subclinical atherosclerosis and early cardiovascular risk. While widely studied in middle-aged and high-risk groups, its determinants in young, apparently healthy adults remain underexplored particularly within the UAE, where lifestyle and metabolic risk factors are increasingly prevalent. This review aimed to synthesize global evidence on CIMT in healthy young adults, evaluate its associations with traditional and metabolic biomarkers, and identify research gaps relevant to the UAE population. Methods: A systematic search of PubMed, Scopus, and Google Scholar up to September 2025 identified studies including adults aged 18–35 years without established cardiovascular disease that reported CIMT measured by ultrasound. Data were extracted for study design, participant characteristics, and associations with traditional or metabolic risk factors. Correlation and regression findings were narratively synthesized. For our ongoing UAE-based cross-sectional study, statistical analysis will include descriptive statistics, Pearson or Spearman correlation, and multivariable linear regression to assess associations between CIMT and predictors such as BMI, blood pressure, CRP, glucose, and lipid profile. Statistical significance will be set at p<0.05. Results: Thirty-six studies (n=10,000) met inclusion criteria, with only a few conducted in the UAE or Gulf region. Increased CIMT was consistently associated with higher BMI, systolic blood pressure, glucose, and CRP levels, while greater physical activity and favorable lipid profiles correlated with lower CIMT. Conclusions: Subclinical vascular changes are detectable even among healthy young adults and are closely linked to modifiable metabolic and lifestyle factors. The forthcoming cross-sectional study in Ras Al Khaimah aims to address the regional evidence gap and provide baseline data for early cardiovascular prevention across the UAE population.
Copyright (c) 2026 Hajira Wase, Atifa Arif Sorathia, Imran Rashid Rangraze http://creativecommons.org/licenses/by/4.0
Delayed Lightning-Induced Cardiomyopathy: A Case Report of Reversible Myocardial Dysfunction
Lightning strike is a rare natural phenomenon but can be fatal, with most deaths resulting from immediate cardiac arrest. Survivors may develop significant cardiac injuries ranging from acute arrhythmias to delayed cardiac complications, including lightning-induced cardiomyopathy (LIC). Although uncommon, LIC is a serious complication characterized by transient myocardial dysfunction following electrical injury, resembling stress-induced (Takotsubo) cardiomyopathy or myocardial stunning. We report a case of a previously healthy young woman who presented after being struck by lightning. Although her initial troponin level was elevated, her ECG and echocardiogram were normal. Subsequently, she developed chest pain, and a repeat ECG showed T-wave inversions in the inferolateral leads. Coronary angiography was normal. On the second day, she became short of breath with clinical evidence of pulmonary edema; her pro-BNP level was elevated, and a repeat echocardiogram revealed impaired left ventricular systolic function with apical ballooning, characteristic of Takotsubo cardiomyopathy. She was diagnosed with delayed-onset LIC and was started on guideline-directed medical therapy for heart failure, achieving complete recovery. This case highlights that lightning-induced cardiomyopathy can developed later after the lightning strike. Clinicians should observe the survivors for a new onset of symptoms of left ventricular dysfunction that suggest the diagnosis of LIC in lightning strike survivor. Repeat echocardiography assessment is curial even in initially normal echocardiogram and coronary angiogram as the condition is reversible and the patients have a high chance of recovery with appropriate management.
Copyright (c) 2026 Azza Elkamil, Juwairia Alali, Anas Musa http://creativecommons.org/licenses/by/4.0
Evaluate the role of the clinical pharmacist in improving quality indicators on initiation of guideline-directed medical therapy in patients with heart failure with reduced ejection fraction in the cardiac unit
Background: European Society of Cardiology 2021 developed quality indicators(QIs) for the care and outcomes of adult patients with heart failure with reduced ejection fraction (HFrEF) that contain a domain for initial management with guideline-directed medical therapy (GDMT) that includes β-blocker (B.B), angiotensin receptor–neprilysin inhibitor(ARNI) or angiotensin converting enzyme inhibitor (ACEI), mineralocorticoid receptor antagonist (MRA), and sodium glucose cotransporter 2 inhibitor (SGLT2I) that reduces mortality and hospitalizations. Objective: To identify the role of the clinical pharmacist in the improvement of QI regarding initiation of GDMT in patients with HFrEF. Methods: A descriptive observational study was conducted at the cardiac care unit of Baghdad Teaching Hospital - Medical City from February 2023 to January 2024, including adult patients with HFrEF. Among the multidisciplinary heart team at CCU, clinical pharmacists suggest optimising the initiation of GDMT based on updated recommendations from American or European guidelines for the management of HFrEF. Result: From a total 324 patients included in the study, 264(81%) patients were eligible for one or more GDMT classes, and among 145(55%) clinical pharmacists interventions suggested for initiation of GDMT, that approved by physicians the most QI improvement found for MRA 54 (37%) intervention while ACEI/ARNI, B.B and SGLT2I was 39 (27%), 27 (19%) and 25 (17%) interventions respectively. Conclusion: The role of the clinical pharmacist is essential among the cardiac team in improving QIs in the initiation of GDMT prescription for patients with HFrEF. The clinical pharmacist mainly improved QIs for initiation of MRA.
Copyright (c) 2026 Ali Jaber, Hassan Ali Farhan, Hassan Mohammed Abbas http://creativecommons.org/licenses/by/4.0
Prevalence of Cardiac Dysfunction in Patients with Thyroid Cancer in Tertiary Hospital: Associated factors and Outcome in Riyadh-Saudi Arabia
Background and Purpose: Thyroid cancer is a growing trend in the world today and is one of the prevalent malignancies in Saudi Arabia. Long-term cardiac complications of the disease and its treatment have become a significant issue but have not been given proper attention despite generally good oncologic prognosis. The purpose of the study is to determine the rates of cardiac malfunction in patients with thyroid cancer at King Faisal Specialist Hospital and Research Centre and to determine the potential risk factors and clinical outcome. Methods: This retrospective cohort study screens electronic health records of adult patients (≥18 years) with a thyroid cancer diagnosis registered between January 2014 and January 2024. Echocardiography reports, treatment exposures, and cardiovascular risk factors are being reviewed. Descriptive statistics summarize the cohort. Group comparisons will use Student’s t-test or Mann–Whitney U test for continuous data and Chi-square or Fisher exact test for categorical data. Multivariable logistic regression will identify independent predictors of cardiac dysfunction. Statistical significance will be set at P < 0.05. Results: Preliminary review of the registry (N≈2,500) suggests that roughly one in ten patients demonstrate cardiac dysfunction, most commonly diastolic impairment. Early signal-level patterns indicate potential associations between chemotherapy exposure and poorly controlled hypertension with higher rates of cardiac dysfunction. Full statistical modeling and adjusted estimates are currently in progress. Conclusions: Preliminary findings indicate cardiac dysfunction may be a relevant concern in this thyroid cancer population. These early trends highlight the need for structured cardio-oncology surveillance and risk mitigation strategies to improve long-term outcomes for thyroid cancer patients.
Copyright (c) 2026 Muhammad Shamoon Umerani, Mohammed Al Rahman http://creativecommons.org/licenses/by/4.0
Impact of extreme heat on acute decompensated heart failure: Global evidence and GCC-focused insights
Background and Purpose: Climate change has intensified global heat exposure, posing new challenges for cardiovascular health. Emerging evidence links extreme ambient temperatures to increased hospitalizations and mortality in patients with heart failure (HF). This review aimed to synthesize current global data on the association between heat exposure and acute decompensated heart failure (ADHF) and to highlight knowledge gaps and clinical implications for the Gulf Cooperation Council region, where extreme heat is endemic and under-studied. Methods: A narrative review of English-language studies published between 2000 and 2025 was conducted. Epidemiologic studies assessing the relationship between heat exposure and HF outcomes were identified, alongside reports addressing pathophysiological mechanisms, regional climate characteristics, and public-health adaptation strategies. Reference lists were screened to include relevant observational studies, reviews, and climate reports. Results: Evidence across more than 20 countries demonstrates a consistent association between extreme heat and higher rates of HF hospitalization and mortality. Global analyses indicate that temperatures above the 97th–99th percentile increase HF-related deaths by approximately 10–15%. Mechanistically, heat stress provokes dehydration, vasodilation, and neurohormonal activation, leading to fluid-electrolyte imbalance, hypotension, and congestion in susceptible patients. In the GCC, where summer temperatures regularly exceed 45 °C and wet-bulb values approach human survivability limits, local research remains scarce. Reliance on air-conditioning mitigates risk for some populations but leaves outdoor workers and elderly citizens particularly vulnerable. Preventive strategies—including patient education, medication review during heatwaves, and regional heat-health action plans—are seldom implemented or evaluated. Conclusions: Extreme heat is an underrecognized precipitant of acute HF decompensation. The GCC faces unique exposure risks due to its climatic extremes and demographic profile. Regional data collection, adaptation policies, and clinician-led “heat action” protocols are urgently needed to reduce preventable morbidity and mortality. Integrating cardiovascular considerations into climate-resilience planning should be prioritized as global temperatures continue to rise.
Copyright (c) 2026 Mahmoud Alothman Agha http://creativecommons.org/licenses/by/4.0
Clinical And Genetic Profile Of Hereditary Transthyretin (ATTRv) Amyloidosis In The Middle East: A Single-Center Report
Background and Purpose: Transthyretin (ATTR) amyloidosis, including wild-type (ATTRwt) and hereditary (ATTRv) forms, is a rare but increasingly recognized disease. This first report from the Middle East presents our experience diagnosing ATTRv amyloidosis at the Abdali National Amyloidosis Center Methods: All referred patients underwent comprehensive evaluation. ATTR amyloidosis was established by a Perugini grade 2 or 3 positive pyrophosphate (PYP) scan, with exclusion of light chain monoclonality by serum and urine immunofixation and free light chain assay. Confirmed cases subsequently underwent genetic testing for TTR mutations Results: Between July 2021 and October 2025, 21 patients with ATTRv amyloidosis were identified (19 men, 2 women), mean age 59 years (range 40-75). Fifteen were from Iraq, two from Libya, two from Jordan, and one each from Sudan and Syria. Twenty patients had a Perugini grade 3 positive PYP scan and in one patient with the Thr60Ala mutation, the grade was 0. Mutations included Thr60Ala (n=16, Northern Iraq, Jordan, Syria), Lys55Asn (n=2, Libya), Val142Ile (n=1, Sudan), Ser43Asn (n=1, Iraq), and Val50Met (n=1, Jordan). Clinical features were heart failure in 16, neuropathy (peripheral/autonomic) in 14, diarrhea in 9, and weight loss (6-35 kg) in 14. Symptom duration ranged from 4 months to 6 years. Electrocardiographic findings included low voltage (n=7), atrial fibrillation (n=3), QRS prolongation (n=10), and permanent pacemaker implantation (n=4). All had elevated BNP/NT-proBNP and hs-troponin. Echocardiography showed left ventricular hypertrophy in 20 and pericardial effusion in 14; left ventricular ejection fraction ranged from 28-69%. Genetic screening of 16 relatives (7 men, 9 women) identified 12 carriers, with further workup confirming ATTRv in one Conclusions: This first report from the Middle East highlights the clinical profile and genetics of ATTRv amyloidosis in the region, underscoring the need for greater awareness and continued research.
Copyright (c) 2026 Ramzi Tabbalat http://creativecommons.org/licenses/by/4.0
Early Detection of Heart Failure in Primary Care: Evaluating a Frailty–BNP Screening Pathway for Improved Outcomes
An estimated 64-million people suffer from heart failure; a significant global burden with an annual mortality rate of 10%. Even with advancements in treatment, individuals go from ventricular dysfunction to overt heart failure asymptomatically, making late detection a barrier to best possible outcomes. A primary-care approach for detecting early cardiac dysfunction prior to symptomatic deterioration is to combine frailty assessment with B-type natriuretic peptide or N-terminal proBNP screening. The purpose of this research was to ascertain whether combining frailty assessment with BNP or NT-proBNP testing could improve early diagnosis of heart failure and lower hospitalization rates in primary-care. Following PRISMA-Narrative guidelines, this research synthesized data published from 2020-2025 in PubMed, Scopus, and Google Scholar. The diagnostic accuracy, predictive value, hospitalization, and system viability of studies using frailty indices (Clinical Frailty Scale, Fried Phenotype, Edmonton Frail Scale) and BNP/NT-proBNP tests were evaluated. The results were placed within preventive frameworks of the ESC (2023) and AHA (2025). A 2.3-fold increase in hospitalizations and 1.8-fold increase in death were associated with frailty prevalence in preclinical or early HF, which varied from 25 to 35%. For asymptomatic LV dysfunction, BNP and NT-proBNP demonstrated a combined diagnostic sensitivity of 90% and specificity of 85% (AUC 0.88–0.93). The shift to symptomatic HF was predicted by thresholds of BNP ≥ 35 pg/mL or NT-proBNP ≥ 125 pg/mL. Integrated frailty plus BNP pathways reduced unnecessary echocardiography by 20–25%, shortened time-to-diagnosis by 4–6 weeks, and increased new HF detection by about three times within a year. A statistically verified approach for early HF detection in primary care is provided by combining frailty screening with natriuretic-peptide testing. This strategy improves diagnostic accuracy, speeds up intervention, and lessens strain on hospitals. To verify long-term scalability and policy impact, extensive multicenter validation and global health-economic modeling is necessary.
Copyright (c) 2026 Salwa Asif, Abdallah AlSaafeen, Kethan Kethan, Adnan Ahamed http://creativecommons.org/licenses/by/4.0
Efficacy of continuous positive airway pressure in the prevention of cardiovascular events in patients with obstructive sleep apnea: A Systematic review and meta-analysis
Background: Obstructive sleep apnea (OSA) is prevalent among patients with cardiovascular disease and is associated with increased risk of major adverse cardiovascular events (MACE). Continuous positive airway pressure (CPAP) is the standard treatment for OSA, but its impact on cardiovascular outcomes remains uncertain, particularly in randomized controlled trials (RCTs). Objectives: To evaluate the effect of CPAP therapy on cardiovascular outcomes in patients with OSA, and to explore the influence of adherence on treatment efficacy. Methods: We conducted a systematic review and meta-analysis of RCTs comparing CPAP with placebo or usual care in adults with OSA. Databases including PubMed, Scopus, Ovid, and CINAHL were searched from inception to December 2024. Primary outcome was MACE; secondary outcomes included cardiovascular mortality, all-cause mortality, myocardial infarction, stroke, angina, heart failure, and new-onset atrial fibrillation. Subgroup analyses were performed based on CPAP adherence (≥4 hours/night vs <4 hours/night). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using fixed-effects model. Results: Eleven RCTs comprising 6,139 participants were included. Overall, CPAP did not significantly reduce MACE (RR = 1.00; 95% CI: 0.87–1.14) or secondary cardiovascular outcomes. However, in patients adherent to CPAP (≥4 hours/night), MACE was significantly reduced (RR = 0.71; 95% CI: 0.52–0.97), and cardiovascular mortality decreased (RR = 0.36; 95% CI: 0.14–0.91). Subgroup analyses revealed no significant benefits in non-adherent patients. Heterogeneity was low for most outcomes. Conclusion: CPAP therapy does not significantly reduce overall cardiovascular risk in OSA patients, except among adherent individuals. These findings underscore adherence as a critical determinant of CPAP’s cardiovascular efficacy. Future trials should prioritize strategies to optimize adherence to fully evaluate CPAP’s cardioprotective potential.
Copyright (c) 2026 Mohamed Osama Waleed Almuzainy http://creativecommons.org/licenses/by/4.0
Prevalence of Absolute and Functional Iron Deficiency in Adults with Heart Failure at a Tertiary Hospital in Saudi Arabia
Objective: To estimate the prevalence of absolute and functional ID in adults with heart failure in a tertiary hospital in Saudi Arabia. Design, Setting, and Participants: This cross-sectional study included patients enrolled in the Heart Failure Program at King Abdullah Medical City between March 2023 and March 2025. Eligible participants had available ferritin, serum iron, and unsaturated iron-binding capacity measurements : To estimate the prevalence of absolute and functional ID in adults with heart failure Main Outcomes and Measures: Absolute ID was defined as ferritin <100 ng/mL, regardless of transferrin saturation (TSAT). Functional ID was defined as ferritin 100–300 ng/mL with TSAT <20%. Results: Among 190 patients with heart failure with reduced ejection fraction (mean age 61 ± 13 years; 32% female), 43% had absolute ID and 16% had functional ID. Mortality and, hospitalization was not different , Female patients had significantly lower hgb compared with males (10.7 ± 1.8 vs 12.7 ± 2.7 g/dL; P<0.001). Serum iron was slightly higher in males (58.3 ± 32.5 vs 48.9 ± 27.8 µg/dL; P=0.052), while ferritin levels were comparable (189.6 ± 294 vs 165 ± 180 ng/mL; P=0.58). TSAT was numerically higher in males (46 ± 84.8 vs 19 ± 10; P=0.134). Intravenous (IV) iron was administered more frequently to females (27.9% vs 9.0%; P=0.006). Iron supplementation was documented in 24.1% of patients with absolute ID and 21.2% with functional ID. Patients with ID and anemia were far more likely to receive IV iron than those without anemia (43.9% vs 3.3%; P=0.001). Conclusions and Relevance: Absolute ID is nearly three times as prevalent as functional ID among Saudi patients with heart failure. Hemoglobin, rather than iron indices, appears to drive IV iron therapy decisions, underscoring the need for improved recognition and treatment of ID, even without anemia.
Copyright (c) 2026 Emad Elkholy, Alaa Alshafie, Abeer Bakhsh http://creativecommons.org/licenses/by/4.0
Immune-Driven Clinical Phenotypes and Outcomes in Heart Failure: A Structured Evidence Synthesis
Background: Heart failure (HF) is increasingly recognized as an immune-mediated syndrome, where systemic inflammation, endothelial activation, and fibrotic remodeling influence prognosis. However, evidence linking specific immune biomarkers to clinical outcomes remains fragmented. Emerging multi-omic studies suggest that inflammatory and fibrotic signaling coexist in varying proportions across patients, indicating distinct immune–pathophysiologic phenotypes. Our work synthesized clinical evidence on immune biomarkers associated with mortality, hospitalization, and adverse remodeling in HF to define immune-driven phenotypes with prognostic relevance. Methods: A structured literature synthesis was conducted across major databases for human HF studies published between 2015–2025 evaluating associations between immune-related biomarkers and clinical outcomes. Data were extracted from high-quality observational and clinical trial studies. Biomarkers were grouped by dominant immune pathway, and outcome patterns were summarized through descriptive qualitative analysis to identify reproducible phenotype–outcome relationships. Results: We identified three reproducible immune-linked phenotypes in heart failure. The inflammation-dominant phenotype, characterized by elevated interleukin-6 (IL-6) and neutrophil-to-lymphocyte ratio (NLR), was consistently associated with higher all-cause mortality and recurrent hospitalization, reflecting systemic immune activation. The fibrosis-dominant phenotype, marked by increased galectin-3, correlated with progressive myocardial fibrosis, reduced reverse remodeling, and elevated risk of both mortality and subsequent HF hospitalizations, suggesting a maladaptive structural remodeling pathway. Finally, the endothelial-dysfunction phenotype, defined by raised VCAM-1 and ICAM-1 levels, indicated microvascular inflammation and impaired endothelial signaling, and was linked to reduced functional capacity and greater rehospitalization risk.Together, these phenotypes represent overlapping yet distinct immune axes driving HF progression and may explain heterogeneity in clinical trajectories. Across studies, these biomarkers added prognostic value beyond natriuretic peptides, particularly in HFpEF. Conclusion: Distinct immune-driven phenotypes, characterized by inflammation, fibrosis, or endothelial dysfunction, are linked to specific HF outcomes. Recognizing these patterns leads to more tailored risk stratification, monitoring, and therapeutic decision-making in heart failure management.
Copyright (c) 2026 Fares Qubbaj, Rahmeh Al-Asmar, Qais Shaban, Ahmad Turk http://creativecommons.org/licenses/by/4.0
Successful Coronary Artery Bypass Grafting in a Patient with Severe Congenital Factor VII Deficiency: A Case Report
Background: Congenital Factor VII (FVII) deficiency is a rare autosomal recessive blood-clotting disorder with a wide range of clinical presentations. Patients with severe deficiency, especially those with preoperative activity levels below 10%, face a markedly higher risk of bleeding after major surgery. Case Presentation: We report the case of a 65-year-old man with a history of diabetes and severe FVII deficiency who was admitted with Non-ST Elevation Myocardial Infarction (NSTEMI) and underwent Coronary Artery Bypass Grafting (CABG). Perioperative hemostatic management included recombinant activated Factor VII (rFVIIa) and Fresh Frozen Plasma (FFP) due to extremely low FVII activity (<1%). Remarkably, the patient experienced an acute intraoperative myocardial infarction, likely related to FVII replacement. To our knowledge, this may be the first reported case of an intraoperative thrombotic event following rFVIIa administration during CABG for congenital FVII deficiency. Conclusions: Despite these complications, the patient successfully had the surgery with positive outcomes, thanks to a multidisciplinary approach and careful adherence to rFVIIa dosing guidelines. This case highlights the need for tailored perioperative strategies and underscores the importance of further research to establish standardized management protocols for high-risk patients with rare bleeding disorders.
Copyright (c) 2026 Arif Al Nooryani, Hussein Huwaijah, Teeba Alwan, Ashraf Ismail, Basem Baradie, Ajit Cheriyan, Nagwa Abdelrahman, Bassam Al Baba http://creativecommons.org/licenses/by/4.0
Assessment of Atrial Fibrillation Risk and Public Awareness in the UAE: A Population-Based Study
Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data on public knowledge of AF as well as the risk of developing AF in the Gulf region remain limited. This study aimed to assess AF knowledge and the risk of AF development in the general population of the United Arab Emirates (UAE). Methods: We conducted a cross-sectional study using an online questionnaire. AF knowledge was assessed using the AF Knowledge Assessment Tool (AFKAT), and the risk of AF development in participating individuals was assessed using the HARMS2-AF risk score. Normality was assessed using the Kolmogorov–Smirnov test. Internal consistency was measured using Cronbach’s alpha. Mann-Whitney, Kruskal-Wallis, and Spearman tests were used for bivariate analyses and correlations. Results: A total of 510 participants were surveyed. The main sources of AF knowledge were media (21.8%), self-learning (17.6%), and physicians (13.3%). The median AFKAT score was 8/21 (IQR 0–13; 38% correct), with participants demonstrating the highest level of knowledge in the 'Risk Factors' domain of AF. Most participants (70.4%) were classified as having poor knowledge (AFKAT scores <60%). Female sex, age ≥50 years, postgraduate education, and a healthcare background were associated with higher levels of knowledge. Among participants, 56% were classified as having a low risk of developing AF and 12.5% as medium-risk. Conclusions: The study found generally low levels of AF knowledge among the UAE population, with most participants being at low risk for developing the condition. Enhancing public awareness is essential for improving prevention and early recognition.
Copyright (c) 2026 Teeba Alwan, Hussein Huwaijah, Shahem Ahmad, Tasneem Latif, Abduljalil Alragheb, Albara Alshalkhaty, Adel Elmoselhi, Mahmoud Ismayl http://creativecommons.org/licenses/by/4.0
Hybrid Stent Strategy in a 37-Year-Old Man Undergoing PCI: A Rare Contemporary Practice Case Report
Background and Purpose: Drug-eluting stents (DES) are the standard of care in contemporary percutaneous coronary intervention (PCI), with bare-metal stents (BMS) now rarely used. Hybrid stent strategies—using DES and BMS in the same vessel—have become uncommon, especially in young adults. However, certain lesion anatomies or vessel characteristics may still justify a mixed approach. This case report describes the rationale and clinical outcome of a hybrid DES+BMS PCI in a 37-year-old patient presenting with acute coronary syndrome. Methods: A 37-year-old man presented with exertional chest pain and was diagnosed with non–ST elevation acute coronary syndrome. Coronary angiography demonstrated a significant proximal lesion and an extended mid-to-distal lesion within a large-caliber vessel. Based on vessel morphology, restenosis risk, and stent expansion requirements, a hybrid stenting strategy was selected. Procedural decisions, angiographic results, and early clinical outcomes were recorded and analyzed descriptively. No statistical analysis was applicable, as this is a single-patient case report. Results: A second-generation DES was deployed in the proximal segment to minimize restenosis risk, followed by placement of a large-diameter BMS in the mid-to-distal segment to optimize expansion and accommodate vessel size. Final angiography demonstrated excellent stent apposition and TIMI III flow with no residual stenosis. The patient’s recovery was uncomplicated, and he was discharged on guideline-directed dual antiplatelet therapy. At follow-up, he reported resolution of symptoms with no adverse events. Conclusions: This case highlights that although rare in current practice, hybrid stent strategies remain valuable in select anatomical situations. In young patients with atypical lesion distribution, individualized stent selection can optimize procedural outcomes while maintaining low restenosis risk. Hybrid DES+BMS PCI may still serve as a practical and effective approach when carefully justified by vessel characteristics.
Copyright (c) 2026 Abdullah Almazouni, Fares Hamdan http://creativecommons.org/licenses/by/4.0
A New Dawn for Digitalis? Re-evaluating the Efficacy and Safety of Cardiac Glycosides in Heart Failure Reduced Ejection Fraction: A Meta-Analysis of 8,346 Patients
Background and Purpose: Recently, the DIGIT-HF trial has reinvigorated the use of digitalis in patients with heart failure with reduced ejection fraction (HFrEF). Although the trial yielded interesting findings, its interpretation requires consideration of previous trials that have assessed digitalis in patients with HFrEF. This meta-analysis comprehensively investigates the safety and efficacy of digitalis in patients with HFrEF. Methods: A systematic search of four electronic databases was conducted until October 2025. Trials reporting data on mortality, hospitalization, or adverse events in heart failure patients with an ejection fraction below 45% on digitalis alongside guideline-directed medical therapy were included. Complications incidence data (events/total) were pooled using standard methods for dichotomous outcomes with Risk Ratios (RR). A random-effects model was used for all analyses. Results: The analysis included 8,346 patients receiving either digitalis or placebo/no digitalis alongside guideline-directed medical therapy. Digitalis did not significantly decrease all-cause mortality or heart-failure-related mortality compared to placebo/no digitalis (RR: 0.99; 95% Confidence Interval [CI]: 0.93, 1.05; P= 0.62) and (RR: 0.89; 95% CI: 0.79, 1.00; P= 0.05), respectively. Besides, Digitalis didn’t significantly decrease all-cause hospitalization or heart-failure-exacerbation-related hospitalization compared to placebo/no digitalis. Notably, Digitalis revealed an increased risk for cardiac adverse events and specifically ventricular fibrillation (RR: 1.98; 95% CI: 1.55, 2.53; P< 0.00001) and (RR: 1.25; 95% CI: 1.06, 1.48; P= 0.009), respectively. Interestingly, Sensitivity analysis in 3899 patients with HFrEF (EF<40%) showed significant reductions in cardiovascular deaths or heart failure hospitalization in the digitalis group (RR: 0.90; 95% CI: 0.86, 0.95; P< 0.0001). Conclusions: Digitalis failed to improve mortality and dangerously increased cardiac arrhythmias in HFrEF patients. Conversely, it significantly reduced cardiovascular death or HF hospitalization in the severe EF<40% subgroup. Further studies are needed to understand the risk-benefit paradox, especially with modern quadruple therapy, to identify the specific patient profile who may benefit.
Copyright (c) 2026 Zeyad Ayman Mohammed Bady, Almohannad Mohammed Yahia, Ahmed Salah Sayed Atya http://creativecommons.org/licenses/by/4.0
Hemodynamic Consequences of Patent Foramen Ovale in Submassive Pulmonary Embolism Leading to Paradoxical Stroke
Background: Paradoxical embolism through a patent foramen ovale (PFO) is an uncommon but important mechanism of acute ischemic stroke, especially in the context of pulmonary embolism (PE). Case Report: We describe a patient who presented with a submassive PE and subsequently developed focal neurological deficits, including word-finding difficulty. Echocardiography identified a PFO with right-to-left shunting, correlating with an acute thalamic infarct. Methods: Diagnostic evaluation included CT pulmonary angiography confirming submassive PE, transthoracic echocardiography with bubble study demonstrating a PFO, and MRI brain with contrast, which confirmed an acute ischemic thalamic stroke. Results: Imaging established the coexistence of submassive PE and paradoxical embolic stroke through a PFO. The MRI with contrast localized the infarct and excluded alternative etiologies. Conclusion: This case emphasizes the importance of maintaining a high index of suspicion for paradoxical embolism in patients with PE and PFO who develop new neurological deficits. Early recognition and appropriate diagnostic workup significantly influence management and clinical direction.
Copyright (c) 2026 Mahmoud Alothman Agha, Badr Jad Allah, Ibrahim Al-Obaidi, Ahmed Hasan, Abdulbaset Elkarri http://creativecommons.org/licenses/by/4.0
Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy from a Tertiary Care Centre in India
Background: Peripartum cardiomyopathy (PPCM) is an uncommon form of heart failure (HF) that occurs towards the end of pregnancy or in the months following childbirth, in the absence of any other identifiable cause of HF and cries significant maternal morbidity and mortality. We present the clinical characteristics, management strategies, and one-year outcomes of patients with PPCM treated at a tertiary care centre in India. Methods: We performed a retrospective review of consecutive patients diagnosed with PPCM at our centre between 2016 and 2024. Data on demographics, timing of presentation, clinical features, echocardiographic severity, treatments, and 1-year outcomes were extracted from the records. The primary outcome was survival and improvement in left ventricular ejection fraction at one year. Results: The study included eighteen patients, with mean age of 30.5 ± 5.39 years. Six women presented antenatally in the third trimester, five of whom required emergency LSCS, while twelve presented postpartum. Five patients were diagnosed with gestational hypertension, and the majority (83.3%) exhibited NYHA class III/IV dyspnoea. The mean left ventricular ejection fraction (LVEF) was 32.94 ± 11.84%. All patients received guideline-directed medical therapy (GDMT) for HF. Bromocriptine was administered to five patients. Five patients required intubation, six received inotropic support, two necessitated mechanical circulatory support (ECMO), and one underwent heart transplantation at another centre. The recovery rate among the patients was 81.8%. At the one-year follow-up, LVEF improved to a mean of 55.08 ± 15.20%, with nine patients demonstrating normalization of LVEF. Conclusion: In this cohort, PPCM frequently manifested during the postpartum period and was predominantly associated with severe LV dysfunction. The majority of patients exhibited recovery of LV function at the one-year follow-up. The integration of GDMT, selective bromocriptine administration, and advanced supportive measures was correlated with high recovery rates. One patient progressed to end-stage HF, necessitating heart transplantation.
Copyright (c) 2026 Jincy Sara Thankachan, Sunil Roy Narayanan, Gautham Pillai, Joel Alen Shajen, Anil Kumar R. http://creativecommons.org/licenses/by/4.0
Left Anterior Descending Coronary Artery Stent Infection by Pantoa Agglomerans
Background & Purpose: Coronary stent infection is a rare complication post percutaneous coronary intervention (PCI) and associated with high mortality rate (40%-65%). The most common isolated pathogen is Staphylococcus aureus . We report a challenging case of Pantoea agglomerans infection leading coronary stent infection with mycotic aneurysm. Methods: Single case report and systemic literature review on coronary stent infection. Clinical, imaging, microbiology Data collected from hospital records. Case description: A 58-year-old male with a history of diabetes, hypertension, hyperlipidemia, and prior PCI to left anterior descending (LAD) presented with exertional and postprandial chest pain. Coronary angiography revealed double vessel disease and an aneurysmal LAD. Transesophageal echocardiography showed LVEF of 40% with anterior and lateral wall hypokinesia. CABG was performed with SVG grafts to OM1cx, OM2cx, D2, and LIMA to distal LAD, along with repair of a post-stent mycotic aneurysm and stent removal. Sputum culture revealed Pantoea agglomerans, sensitive to multiple antibiotics. The patient had an uneventful recovery and was managed with antibiotics therapy. Results: In a systematic review, only 79 cases of coronary stent infection reported. Stent infections are rare but serious complications, often arising from inadequate aseptic technique, local site infections, or post-procedural issues such as hematomas and pseudoaneurysms following PCI. Management typically involves a combination of medical therapy and targeted antibiotics, though surgical intervention may be necessary in select cases. Due to its infrequency, diagnosis is often delayed which can adversely affect patient outcomes. Conclusion: Our case highlights a rare association of Pantoea agglomerans infection in LAD stent complicated with mycotic aneurysm managed with surgical intervention and antibiotic therapy. We had favorable outcome due to early recognition of this rare complication.
Copyright (c) 2026 Ibrahim Al-obaidi, Aesha Shuaeeb, Fatima AlKindi, Georgie Thomas http://creativecommons.org/licenses/by/4.0
Early Spot Urinary Sodium–Guided Diuretic Protocol in Acute Decompensated Heart Failure: Feasibility in an Indian Tertiary Hospital
Background: Management of fluid overload in acute decompensated heart failure is frequently complicated by diuretic resistance. Traditional indicators such as weight and fluid balance, may delay identification of inadequate therapeutic response. The measurement of spot urinary sodium two hours following initial administration of intravenous loop diuretic offers an early, objective marker to guide therapeutic interventions. Although this approach is supported internationally, data from India remain limited. This study assessed the feasibility of implementing 2-hour UNa-guided diuretic escalation protocol in routine ADHF care and examined its effects on decongestion and safety in patients with ADHF. Methods: We conducted a single-center, pragmatic pre–post pilot study involving adults admitted with acute decompensated heart failure who required intravenous loop diuretics. During intervention phase, urinary sodium was measured two hours after administration. If UNa was less than 50 mmol/L or urine output was below 100–150 mL/h, diuretic therapy was intensified by either doubling the loop diuretic dose or adding thiazide diuretic. The primary outcome assessed was 24-hour natriuresis, while secondary outcomes included diuretic efficiency, time to decongestion, length of hospital stay, and 30-day readmission rates. Baseline and intervention phases were compared using standard statistical tests. Safety outcomes were evaluated in terms of renal function, electrolyte levels, and blood pressure. Results: A total of 160 patients were enrolled in study, comprising 80 in baseline group and 80 in intervention group. Protocol adherence exceeded 85%, and the laboratory turnaround time consistently met the 2-hour target. Feedback from staff confirmed feasibility of integrating the protocol into routine care. Preliminary analyses indicate improved natriuresis trends without significant safety concerns, and complete results are currently being finalized. Conclusions: A 2-hour UNa-guided diuretic protocol is feasible in both Indian ward and ICU settings. This simple and cost-effective approach offers early feedback, enables timely escalation, holds potential to enhance management of ADHF.
Copyright (c) 2026 Nidhin John Palathra, Sunil Roy T.N., Anil Kumar, Praveen Sreekumar, Merie Chackiath, MS Sangeetha http://creativecommons.org/licenses/by/4.0
Impact of Psychosocial Risk Factors and Social Determinants of Health on Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-Analysis
Background and Purpose: Heart failure (HF) outcomes are strongly influenced by social and psychological dimensions beyond traditional clinical risk factors. Depression, social isolation, low socioeconomic status, and limited health literacy have been individually associated with adverse prognosis, yet no comprehensive synthesis has quantified their collective impact. This systematic review and meta-analysis aimed to evaluate the association between psychosocial risk factors and major clinical outcomes in patients with heart failure, emphasizing mortality, hospitalization, and quality-of-life parameters. Methods: A systematic literature search was conducted in PubMed, Embase, PsycINFO, and Scopus up to October 2025. Eligible studies included prospective cohorts and randomized controlled trials assessing at least one psychosocial determinant (e.g., depression, anxiety, social isolation, marital status, education, income level, or health literacy) in adult patients with HF. Primary outcomes were all-cause mortality and HF-related hospitalization; secondary outcomes included quality-of-life (QoL) scores and medication adherence. Pooled relative risks (RR) and standardized mean differences (SMD) were calculated using a random-effects model. Heterogeneity was measured by I², and subgroup analyses explored sex, HF phenotype, and region. Results: Thirty-two studies involving 24,685 participants (mean age 65 ± 10 years; 41% female) met inclusion criteria. Depression increased mortality risk by 45% (RR 1.45, 95% CI 1.28–1.63) and HF hospitalization by 37% (RR 1.37, 95% CI 1.21–1.56). Social isolation was associated with higher mortality (RR 1.29, 95% CI 1.10–1.52), while low socioeconomic status conferred a 32% greater risk of readmission (RR 1.32, 95% CI 1.14–1.54). Patients with strong social support demonstrated significantly higher QoL scores (SMD 0.42, 95% CI 0.18–0.65) and improved medication adherence (RR 1.19, 95% CI 1.05–1.33). Overall heterogeneity was moderate (I² = 48%). Conclusion: Psychosocial and social determinants substantially affect survival, rehospitalization, and quality of life in heart failure. Future research should focus on culturally tailored interventions and longitudinal assessment of modifiable psychosocial risk profiles.
Copyright (c) 2026 Alaa Ramadan http://creativecommons.org/licenses/by/4.0
Impact of Dietary Pattern Interventions on Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-Analysis
Background and Purpose: Heart failure (HF) remains a leading cause of global morbidity and mortality, with current management heavily reliant on pharmacological and device-based therapies. However, the role of structured dietary interventions in improving HF outcomes has not been comprehensively evaluated. This systematic review and meta-analysis aimed to examine the impact of established dietary patterns—specifically the Mediterranean, DASH, and plant-based diets—on mortality, hospitalization, cardiac function, and patient-reported outcomes in adults with heart failure. Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted from inception to October 2025. Randomized controlled trials and prospective cohort studies assessing the effects of structured dietary patterns in adult HF populations were included. Primary outcomes were all-cause mortality and HF-related hospitalizations. Secondary outcomes included changes in left ventricular ejection fraction (LVEF), N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels, New York Heart Association (NYHA) functional class, and Kansas City Cardiomyopathy Questionnaire (KCCQ) quality-of-life scores. Results: Eighteen studies comprising 12,470 participants (mean age 64 ± 9 years, 39% women) met the inclusion criteria. Adherence to structured dietary patterns was associated with a significant reduction in all-cause mortality (RR 0.76, 95% CI 0.66–0.88, p < 0.001) and HF hospitalizations (RR 0.79, 95% CI 0.68–0.91, p = 0.002). A combined endpoint of death or hospitalization was reduced by 23% (RR 0.77, 95% CI 0.68–0.88). LVEF improved by 4.1% (95% CI 2.3–6.0), NT-proBNP levels decreased by 312 pg/mL (95% CI −428 to −198), NYHA functional class improved by 0.45, and mean KCCQ scores increased by 6.8 points, indicating better functional status and quality of life. Moderate heterogeneity (I² = 45%) was observed across analyses. Conclusion: Structured dietary patterns such as the Mediterranean, DASH, and plant-based diets significantly improve survival, reduce hospital readmissions, and enhance cardiac function and quality of life among patients with heart failure.
Effects on major adverse cardiovascular events (MACE) in persons treated with sotagliflozin: Prespecified pooled analyses of the Phase 3 type 2 diabetes program
Background: In the SCORED trial that included 10,584 participants with type 2 diabetes (T2D) and chronic kidney disease (CKD), sotagliflozin significantly reduced the incidence of major adverse cardiovascular events (MACE). To further evaluate the cardiovascular effects of sotagliflozin, prespecified MACE-focused meta-analyses were performed using data from 9 additional Phase 3 trials conducted in persons with T2D. Methods: This patient-level meta-analyses pooled data from 9 Phase 3 trials assessing glycemic control and other cardiometabolic parameters in a total of 5,100 participants. 2,904 participants were treated with sotagliflozin (pooling 200 and 400mg doses), while 2,196 were in an All-Comparators group (pooling placebo, empagliflozin, and glimepiride). Time to first event for 4-point MACE [CV death, nonfatal myocardial infarction (MI), nonfatal stroke, and hospitalization for unstable angina) was the prespecified primary analysis. Secondary outcomes included 3-point MACE (omitting unstable angina) and analyses of each MACE component outcome. Time-to-event analyses were conducted using Cox proportional hazards models for the first occurrence of any adjudication-confirmed event. Results: There were 98 4-point MACE events and 96 3-point MACE events across the dataset. Event rate of 4-point MACE was 1.6 events per 100 patient-years (PY) in the sotagliflozin group compared with 2.2 events per 100 PY in the All-Comparators group. Sotagliflozin was associated with a 39% relative risk reduction in 4-point MACE (hazard ratio (HR) [95% CI]: 0.61 [0.41, 0.90]; p=0.013). All four component outcomes positively contributed to the overall treatment effect. For 3-point MACE, sotagliflozin demonstrated a 37% relative risk reduction compared with All-Comparators (HR [95% CI]: 0.63 {0.42, 0.94]). Conclusion: Two independent data sources (9 cardiometabolic Phase 3 studies and the SCORED CV outcomes trial), including approximately 15,000 participants, support a reduction in MACE with sotagliflozin in a broad group of persons with T2D, and reinforce the role of sotagliflozin in reducing atherosclerotic cardiovascular risk.
Copyright (c) 2026 Michael Davies, Darren McGuire, Belinda Hardin, Phillip Banks, Manon Girard, Guillermo Umpierrez http://creativecommons.org/licenses/by/4.0
Takotsubo Cardiomyopathy with LVOT Obstruction Presenting as Heart Failure
Background: Takotsubo cardiomyopathy is an acquired cardiomyopathy induced by stress, features similar to ST-elevation myocardial infarction. Less common but significant variant of TTC involves LVOT obstruction, which can lead to acute heart failure and hemodynamic instability. This report presents a case of TTC complicated by dynamic LVOT obstruction following a recent herpes zoster infection in an elderly female patient. Case Report: We report a case involving an 81-year-old female patient with history of subtotal thyroidectomy and osteoporosis, who presented with acute chest pain. Electrocardiography revealed ST elevation in the inferolateral leads, and high-sensitivity troponin I levels were elevated. STEMI protocol was initiated, and urgent coronary angiography was done which showed non obstructive CAD. Transthoracic echocardiography and cardiac MRI were employed to assess ventricular mechanics, confirm the diagnosis. Management decisions were informed by hemodynamic and imaging findings. Treatment and follow-up: Echocardiography indicated apical akinesia with preserved basal contraction, grade II systolic anterior motion of the mitral valve, turbulent left ventricular outflow tract with a peak gradient of 62 mmHg, moderate mitral regurgitation, and LVEF of 41%. The cardiac magnetic resonance findings were consistent with TTC. She was managed conservatively with beta-blockers, ARBs, and antivirals. Nitrates and inotropes were avoided to prevent exacerbation of LVOT obstruction. Serial electrocardiograms and troponin levels showed a decline, and the symptoms resolved. Patient was discharged with a plan for outpatient echocardiography in four weeks. Conclusions: This case underscores the presentation of Takotsubo cardiomyopathy as ST-elevation myocardial infarction with dynamic LVOT obstruction in an elderly patient following physical stress, specifically herpes zoster. Early echocardiography is crucial for differentiating TTC from acute coronary occlusion when angiography reveals non-obstructive findings and for identifying LVOT obstruction. This necessitates the avoidance of nitrates and inotropes, while favoring beta-blockade. The continuation of beta-blocker therapy post-recovery may mitigate the risk of recurrence.
Copyright (c) 2026 Sruthi Pradeep, Sunil Roy T http://creativecommons.org/licenses/by/4.0
Shared Molecular Signatures across Heart Failure with Preserved and Reduced Ejection Fraction to Abdominal Aortic Aneurysm: An Integrative Transcriptomic Analysis
Background: Heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) represent clinically distinct syndromes, yet both exhibit endothelial dysfunction and chronic inflammation. Abdominal aortic aneurysm (AAA) shares similar vascular remodeling mechanisms. The molecular commonalities among these three conditions remain poorly characterized. Methods: Human transcriptomic datasets from the GEO repository GSE183464 (abdominal aortic aneurysm) and Zeedono4114617 (heart failure with preserved and reduced ejection fraction—right ventricular tissue) were analyzed using R for differential expression.Genes meeting |log₂FC| > 1 and adjusted p < 0.05 were considered significant. Overlapping upregulated and downregulated DEGs were identified. Functional enrichment was performed using Enrichr across six gene set libraries: Reactome, MSigDB, KEGG, and the three Gene Ontology categories (Biological Process, Cellular Component, and Molecular Function).Pathways were ranked by combined score and adjusted p-value. Results: Shared pathways in upregulated genes included Leukocyte transendothelial migration, Extracellular matrix organization, MHC Class II antigen presentation, TNF-a signaling via NF-kB, hydrolysis of LPC, and TGF-β signaling pathway. This reflects a common pro-inflammatory and pro-fibrotic microenvironment that is common to all. Conversely, downregulated pathways highlighted Oxidative phosphorylation, Fatty acid β-oxidation, and Mitochondrial respiratory chain complex I assembly, Nuclear events Mediated by NFE2L2 (NRF2), and KEAP1-NRF2 pathways reflecting shared metabolic and mitochondrial impairment with decreased resistance to oxidative stress, possibly via the downregulation of NRF2 activity. Conclusion: This cross-disease transcriptomic analysis reveals shared molecular biomarkers of endothelial inflammation and metabolic dysregulation linking HFpEF, HFrEF, and AAA. The overlap of inflammatory activation with metabolic suppression underscores a potential unified mechanism of vascular and myocardial remodeling, offering new molecular targets for future therapeutic exploration.
Copyright (c) 2026 Fares Qubbaj, Osama Younis, Qais Shaban, Mohammad Zubaidi, Saif Kakish, Rahmeh Al-Asmar, Ahmad Turk http://creativecommons.org/licenses/by/4.0
Insights from a Rare Diagnostic Challenge: Brucella Endocarditis Involving a Cardiac Implantable Electronic Device
Background and Purpose: Infective endocarditis (IE) in patients with previously implanted cardiac implantable electronic devices (CIEDs) is diagnostically challenging, particularly when consecutive cultures at different sites are negative. Blood culture–negative infective endocarditis (BCNIE) often results from atypical organisms, including Brucella in endemic areas—including the northern part of Iraq. We report a case of Brucella endocarditis involving a pacemaker lead, where lack of response to conventional antibiotics raised suspicion for zoonotic infection. Methods: An 87-year-old male with hypertension, atrial fibrillation, and complete heart block (pacemaker-dependent for >3 years) presented with 20 days of undulant fever, night sweats, and chest discomfort. He was initially managed elsewhere as acute cholecystitis and received empiric antibiotics, but his fever persisted despite treatment. On admission, clinical examination revealed a pansystolic murmur, raised JVP, and peripheral edema. Echocardiography showed LV systolic dysfunction (EF 46%), moderate TR with moderate pulmonary hypertension, mean PAP = 45 mmHg, and a 2.5 × 2.3 cm mobile mass noted on the pacemaker lead. Multiple blood cultures were negative. Because of the patient’s persistent fever unresponsive to antibiotics, endemic exposure, and negative cultures, Brucella infection was strongly suspected. Serological testing confirmed Brucella endocarditis. Results: The patient was initially treated with ceftriaxone and vancomycin for tricuspid IE. After confirmation of brucellosis, Targeted therapy was switched to gentamicin (10 days), doxycycline (12 weeks), and rifampicin (12 weeks). He improved clinically with resolution of fever and stabilization of cardiac function. Device extraction was considered but deferred given advanced age, comorbidities, and good clinical response. Conclusions: This case underscores the importance of considering Brucella in BCNIE, particularly in endemic regions. Failure to respond to empirical antibiotics should prompt suspicion of atypical pathogens. Serological testing combined with echocardiography enables timely diagnosis, and targeted antimicrobial therapy can achieve favorable outcomes even in elderly, high-risk patients with device-related IE.
Copyright (c) 2026 Ahmed Hawez, Banan Rasool, Shwan Amen, Mustafa Asaad http://creativecommons.org/licenses/by/4.0
Predictive Power of AI-Driven Population Genomic Risk Scores for Acute Decompensation in a Genetically Distinct Regional Heart Failure Cohort
Background: The substantial morbidity associated with chronic Heart Failure necessitates advanced, proactive risk stratification tools, particularly in the UAE where Non-Communicable Diseases are a strategic focus. Current clinical models often neglect population-specific genomic variants, a critical factor within the genetically distinct regional cohort. This study validates a novel predictive model utilizing a Deep Learning Neural Network to integrate clinical and genetic data for predicting acute HF decompensation risk. Methods: A retrospective, tertiary-center cohort analysis enrolled 1,450 consecutive adults diagnosed with symptomatic chronic HF (NYHA class II-IV). Baseline clinical and laboratory data, harmonized from a regional patient registry, were paired with low-coverage whole-genome sequencing to derive a composite, population-specific Genomic Risk Score. A DLNN was trained to predict the primary endpoint: acute HF-related readmission within 90 days. Performance was rigorously evaluated using the Area Under the Receiver Operating Characteristic Curve and the Multivariate Cox Proportional Hazards model. Results: The integrated AI-GRS model demonstrated superior predictive capability for the 90-day primary endpoint (AUROC 0.88; 95% CI: 0.86-0.90), significantly outperforming prediction based on clinical factors alone (AUROC 0.72; p<0.001). Genomic Risk Score was independently and substantially associated with increased risk, showing an adjusted hazard ratio (HR) of 1.45 per one standard deviation increase (p=0.003). Patients categorized as high-risk by the AI-GRS and placed on an enhanced, personalized intervention protocol achieved a measured 45% reduction in all-cause-90-day readmissions (p=0.012). Conversely, readmission rates in the standard-care control group remained stable. Sensitivity analysis confirmed consistent model performance across all key demographic-subgroups. Conclusion: Integrating AI-driven genomic risk stratification significantly improves the prediction and clinical management of acute HF exacerbations within the local population. These findings validate a critical, scalable-tool for enhancing patient outcomes and supporting the DHA’s vision for an integrated care delivery model of the future. Deployment of this model enables proactive-intervention strategies aligned with regional-digital-transformation mandates.
Copyright (c) 2026 Moh'd Fayeq Haha http://creativecommons.org/licenses/by/4.0
Pulsed Field Ablation for Atrial Fibrillation: A Systematic Review of Efficacy, Safety, and Durability
Background and Purpose: Pulsed field ablation (PFA) has emerged as a nonthermal energy source for atrial fibrillation (AF) ablation, utilizing ultra-short, high-voltage electrical pulses to selectively ablate myocardial tissue while minimizing collateral injury. Growing evidence from prospective and randomized studies suggests that PFA may offer comparable efficacy and superior safety to conventional thermal ablation. This systematic review synthesizes contemporary data evaluating the clinical performance and long-term outcomes of PFA. Methods: A systematic literature search of major cardiovascular databases and journals through 2025 identified prospective trials, randomized controlled studies, and multicenter registries assessing PFA in paroxysmal and persistent AF. Data on procedural metrics, arrhythmia-free survival, lesion durability, and safety outcomes were extracted and qualitatively synthesized. Results: Across more than 18,000 patients, PFA achieved high procedural success with acute pulmonary vein isolation in nearly all cases. One-year freedom from atrial arrhythmia ranged between 66% and 84% in paroxysmal AF and 55% and 80% in persistent AF. Continuous monitoring demonstrated significant reductions in arrhythmia burden and durable lesion formation exceeding 90% in optimized waveform systems. Major adverse events were uncommon, with a safety event rate below 2%, and virtually no reports of esophageal injury, pulmonary vein stenosis, or persistent phrenic nerve palsy. Rare complications included transient coronary spasm (≈0.1%) and pericardial tamponade (<0.5%). Long-term follow-up beyond four years demonstrated sustained rhythm control in approximately 73% of patients. Conclusions: Pulsed field ablation provides effective, durable rhythm control with an exceptional safety margin compared to thermal modalities. These findings position PFA as a transformative advance in AF ablation, combining efficacy, procedural efficiency, and tissue selectivity. Ongoing studies will clarify long-term performance and guide standardization across evolving PFA technologies.
Copyright (c) 2026 Osama Mustafa, Nour Mashal, Maher Khader http://creativecommons.org/licenses/by/4.0
Impact of Proactive Intravenous Iron Repletion on Exercise Capacity and Quality of Life in Non-Anemic Heart Failure Patients
Background and Purpose: Iron deficiency (ID) is highly prevalent in chronic Heart Failure (HF) and correlates strongly with poor outcomes, even when patients are not anemic. Current clinical practice often struggles with systematic ID screening and adherence to intravenous iron (IV-Iron) repletion guidelines. This management gap hinders patient improvement. This study assessed whether a strictly applied, systematic IV-Iron intervention improves functional capacity and symptomatic status in a carefully screened, non-anemic HFrEF cohort. Methods: A prospective, single-blind, randomized controlled trial (RCT) enrolled 260 symptomatic HFrEF patients (NYHA Class II-III, LVEF <40%). Inclusion required documented iron deficiency (Ferritin <100 μg/L or Ferritin 100-300 μg/L with transferrin saturation <20%) but excluded anemia (Hb >120 g/L). Participants were randomized 1:1 to receive guideline-directed care plus IV ferric carboxymaltose or guideline-directed care plus placebo. The primary endpoint was change in 6-minute walk distance (6MWD) at 6 months. Secondary endpoints included Quality of Life (QoL) metrics. Statistical analysis utilized independent t-tests and correlation analysis to assess outcomes and treatment efficacy. Results: At 6 months, the IV-Iron group demonstrated a highly significant mean increase in 6MWD of 48±15 meters from baseline, compared to a non-significant change of 5±12 meters in the placebo group (p<0.001). Furthermore, the IV-Iron cohort reported substantial improvement in HF-specific Quality of Life scores (MLHFQ score mean difference: -12 points; p=0.004). Analysis revealed a significant correlation between successful correction of transferrin saturation and symptomatic improvement (r=0.62). No significant difference was observed in rates of hospitalization or serious adverse events between the two arms (p=0.41). Conclusion: Proactive, systematic intravenous iron repletion significantly improves exercise capacity and quality of life in non-anemic HFrEF patients. This evidence reinforces the crucial need for strict adherence to ID screening protocols, positioning IV-Iron as a fundamental, high-impact management strategy that enhances quality of care in regional HF clinics.
Copyright (c) 2026 Mira'alnaser Khashman, Laith Kreshan, Rahmeh Al-Asmar, Abdulrahman Badwan, Qusai Otoum http://creativecommons.org/licenses/by/4.0
Real-World Outcomes in Heart Failure With Reduced Ejection Fraction: A Middle Eastern Cohort Analysis
Introduction: Till this day, heart failure with reduced ejection fraction (HFrEF) remains one of the greatest causes of morbidity and mortality worldwide. Despite the technological advances in diagnosis and therapy, we still witness extreme cases of deterioration and premature mortality. This has proven the importance of assessing the “Real-World Outcomes in Heart Failure with Reduced Ejection Fraction,” especially in the Middle East, where there is a lack of data previously collected. Through such efforts, we can aim to optimize management and improve patient outcomes. Methods: We conducted a retrospective cohort study across multiple tertiary centers in the Middle East between January 2019 and December 2024. Adult patients admitted with HFrEF (left ventricular ejection fraction ≤40%) were identified through institutional registries. Demographics, comorbidities, and use of guideline-directed medical therapy (GDMT) were recorded. Patients were followed for a median of 30 months. The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization. Multivariable Cox regression was performed to identify independent predictors. Results: A total of 1,276 patients were included (mean age 62±12 years, 34% women). Hypertension (69%), diabetes mellitus (55%), and chronic kidney disease (26%) were the most common comorbidities. At discharge, 76% were prescribed β-blockers, 65% ACEI/ARB/ARNI, 52% mineralocorticoid receptor antagonists, and 28% SGLT2 inhibitors. Over follow-up, mortality occurred in 18% and rehospitalization in 29%. Predictors of adverse outcomes included advanced age (HR 1.36; 95% CI 1.13–1.63), chronic kidney disease (HR 1.58; 95% CI 1.26–1.99), and incomplete GDMT (HR 1.71; 95% CI 1.35–2.18). SGLT2 inhibitor use was associated with a significantly lower risk of rehospitalization (HR 0.68; 95% CI 0.52–0.89). Conclusion: This large Middle Eastern cohort highlights substantial residual risk in patients with HFrEF, reflecting both comorbidity burden and suboptimal therapy utilization. Broader adoption of guideline-recommended therapies, particularly SGLT2 inhibitors, may reduce adverse outcomes and improve long-term prognosis.
Copyright (c) 2026 Faisal Kakish, Ahmad Suwan, Mohammad Malkawi, Sanad Obiedallah, Yazeed Alobeidieh http://creativecommons.org/licenses/by/4.0
Automated, Telemonitoring-Guided Optimization of Guideline-Directed Medical Therapy (GDMT) in Patients with Reduced Ejection Fraction Heart Failure
Background: Despite robust evidence confirming their survival benefit, Guideline-Directed Medical Therapy (GDMT) regimens are systematically under-titrated in patients with Heart Failure with Reduced Ejection Fraction (HFrEF), limiting clinical gains. Effective and rapid up-titration is a complex logistical challenge often hindered by conventional follow-up schedules. We hypothesized that a novel, artificial intelligence enabled telemonitoring platform could safely accelerate and measurably enhance GDMT optimization rates. Methods: This prospective, single-blind, randomized controlled trial (RCT) enrolled 320 chronic HFrEF patients across two regional specialized HF clinics. Participants were randomized 1:1 to either Standard of Care (SOC) follow-up or a Telemonitoring Intervention Group (TIG). The TIG received daily automated symptom/vital sign monitoring; an iterative AI-powered algorithm instantly alerted the medical team to parameters supporting safe up-titration of angiotensin receptor-neprilysin inhibitors or beta-blockers. The primary endpoint was the percentage of patients achieving 50% or greater target GDMT dose at 90 days. Statistical analysis utilized independent t-tests, Chi-square tests, and Kaplan-Meier survival analysis for clinical outcomes. Results: The Telemonitoring Intervention Group achieved the primary endpoint significantly faster than the Standard of Care group (78% vs. 49%, p<0.001). The median time required to achieve the 50% GDMT target dose was reduced by 34 days in the TIG (TIG median: 56 days; SOC median: 90 days; p<0.001). Furthermore, the TIG demonstrated a measurable and clinically significant reduction in the secondary endpoint of all-cause readmissions at 90 days (TIG: 12.5% vs. SOC: 21.9%; p=0.018). No differences in adverse event rates were observed between the two groups (p=0.45). Conclusion: AI-enabled telemonitoring significantly accelerates the critical up-titration of GDMT in HFrEF, proving safe and highly effective in reducing readmissions. This rapid optimization strategy is essential for enhancing patient outcomes. Deploying such advanced digital platforms supports the regional goal of establishing an integrated care delivery model of the future, transforming chronic disease management.
Copyright (c) 2026 Rahmeh Al-Asmar, Raneem AlDalaeen, Sami Samardali, Tara Mazen Abboud, Jude Kirresh, Fares Albadareen, Hamad Alkandari, Sewar Qawaqzeh, Deema Nasha't http://creativecommons.org/licenses/by/4.0
Gender-based Echocardiographic Patterns and Diastolic Dysfunction among Diabetic patients with HFpEF
Background: Heart failure with preserved ejection fraction (HFpEF) is characterized by the presence of clinical signs and symptoms with preserved LV systolic function (EF >50%), and demonstrable diastolic dysfunction. Echocardiographic evidence of DD typically includes an elevated E/e′ ratio, increased left atrial size, and elevated LVEDP. In addition, GLS, assessed via STE, has emerged as an important prognostic marker in HFpEF. Moreover, HFpEF is observed more commonly in women, a disparity that may be partly explained by differences in comorbid conditions, obesity, and hormonal influences. Methods: This was a cross-sectional study done on 241 patients in Cardiac Center in Erbil, Iraq, from January 1st to June 1st, 2023. Patients with Type 2 DM, and angiographically proven to be non IHDs were all enrolled. Data processing and analysis was done using SPSS version 26. A p value < 0.05 was considered significant. Results: Our sample included 241 patients, with a mean age of 55.2 ± 9.9 years. The female participants had a significantly higher BMI, higher prevalence of comorbidities, and lower rate of smoking. Compared to women, men had significantly higher mean LVEDD, LEVSD, IVSd, LVPWd, LA size, and lateral e’ and lower mean LVEF. There was a significant difference between genders in the proportion of patients with IVSd ≥ 10 mm. A significant correlation was noted between HbA1c and LVEDD, lateral e’, and GLS. Binary logistic regression revealed female gender to be a significant independent predictor of GLS being < 18%, but not MAPSE being ≤ 12 mm or E/e’ ratio being > 11. Conclusion: Significant gender differences were noted in various echocardiographic parameters (LVEDD, LEVSD, LVSd, LVPWd, LA size, lateral e’, and LVEF). Female gender was found to be an independent predictor of subclinical systolic dysfunction as measured by GLS.
Copyright (c) 2026 Banan Rasool, `Shwan Amen, Aya Balisany, Dahan Hussein, Vahel Sadraddin, Muhammed Shekha http://creativecommons.org/licenses/by/4.0
A Low-Cost Telemedicine + Nurse-Led Decision-Support Program for Heart Failure in the Middle East: A Prospective Cohort Study with Clinical and Economic Outcomes
Background: Heart failure is a leading cause of morbidity, mortality, and healthcare costs in the Middle East. Frequent rehospitalizations remain a significant challenge. Recent studies, including the AHA 2023 and ESC 2021 guidelines, show that telemedicine interventions can reduce rehospitalization and improve quality of life in HF patients. However, data from low-resource settings in the Middle East remain limited. This study aims to evaluate the effectiveness of a low-cost telemedicine model with nurse-led decision support in reducing 90-day rehospitalization rates, improving functional status, and assessing patient satisfaction and cost-effectiveness. Methods: This prospective cohort study included 60 consecutive patients with HFrEF or HFpEF, recently discharged from the hospital. The intervention comprised: (1) individualized discharge education, (2) daily self-reporting of weight, blood pressure, and symptoms via a messaging app, (3) nurse-driven monitoring using an algorithm-based approach, (4) rapid physician intervention within 24 hours in case of clinical alerts. A historical control group of 60 matched patients was used for comparison. The primary endpoint was HF rehospitalization or all-cause death within 90 days. Secondary endpoints included changes in NYHA class, quality of life (MLHFQ), patient satisfaction (VAS 1–10), and an economic cost analysis. Results: The intervention group showed a significant reduction in rehospitalization or death (HR = 0.50; 95% CI, 0.28–0.89; p = 0.03). Rehospitalization rates decreased from ~30% to ~14% (relative risk reduction ≈ 53%). Functional improvement (≥1 NYHA class) was observed in 65% of the intervention group vs. 35% in controls (p = 0.01). Patient satisfaction increased from 6.2 to 8.7 (p < 0.001).Cost savings: approximately $800 per patient over 90 days. Conclusions: A low-cost telemedicine model with nurse-led decision support can substantially reduce rehospitalization and improve outcomes in heart failure patients in the Middle East. This scalable, cost-effective model offers significant potential for integration into healthcare policies in resource-limited settings.
Copyright (c) 2026 Sahar Abri, Marjan Hajahmadi http://creativecommons.org/licenses/by/4.0
Temporal Dynamics and Heterogeneity of Cancer-Specific and Cardiovascular Mortality in Adult Cancer Survivors: A SEER-Based Competing Risks Analysis
Background: Advances in cancer detection and treatment have extended survival, creating a growing population at risk for competing causes of mortality. Cardiovascular disease (CVD) is a leading competing cause, yet the comparative dynamics of cancer-specific and cardiovascular mortality across cancer types and demographics remain unclear. Methods: We analyzed 487,619 adults with first primary malignancies from the SEER 17 Registries (2000–2019). Cause-specific mortality was examined using Kaplan-Meier survival and cumulative incidence functions (CIF) to account for competing risks. Fine-Gray competing risks regression assessed age, sex, and cancer site effects on cancer-specific and cardiovascular mortality. Results: Over median 79 months, CVD mortality exceeded cancer mortality from diagnosis with no crossover. At 12 months, CIF for CVD death was 6.62% vs 0.24% for cancer death; at 60 months, CVD death rose to 20.75%, cancer death remained 0.40%. Females had an 18% higher cancer death risk but 28% lower CVD death risk vs males (p < 0.001). Colorectal cancer carried the highest cancer death risk; lung cancer had the highest CVD death risk (p < 0.001). Age was strongly linked to CVD but not cancer mortality. Conclusions: CVD is the dominant competing cause of death in adult cancer survivors, highlighting urgent need for integrated cardio-oncology care. Targeted cardiovascular risk reduction alongside oncologic management is essential to improve long-term outcomes and survivorship quality.
Copyright (c) 2026 Tabish Wajih Siddiqui, Raqshan Wajih Siddiqui, Shiza Wajih Siddiqui, Sohaila Fatima http://creativecommons.org/licenses/by/4.0
Polypharmacy Patterns: A Decade-Long Comparison Among Elderly Cardiac Patients with Clinical Pharmacist Involvement at a University Hospital in Riyadh, Saudi Arabia
Background: Polypharmacy is increasingly common among older adults, especially those with multimorbidity & chronic CVD. It heightens the risk of adverse drug reactions, drug–drug interactions, hospitalizations, & mortality. Clinical pharmacy services aim to optimize pharmacotherapy & ensure medication safety. In Saudi Arabia, although clinical pharmacy services are expanding, few long-term studies have evaluated their impact on prescribing practices & polypharmacy. Aim: This study assessed polypharmacy prevalence in elderly cardiac patients in 2025, a decade after implementing clinical pharmacy services, evaluated changes in prescription patterns, clinical characteristics, and medication appropriateness before and after service integration. Methods: A comparative, ambi-spective observational study was conducted at King Fahad Cardiac Center (KFCC) from May 2024 to May 2025. Eligible participants were cardiac outpatients aged ≥65 years on ≥5 medications. Prescriptions were screened. Patients with complete demographic and medication data were included. Data were sourced from electronic records & pharmacy databases. The exposure variable was the implementation of clinical pharmacy services in 2015, creating pre- and post-2015 cohorts. Primary outcomes included polypharmacy prevalence, potentially inappropriate prescriptions (PIPs), &prescribing trends. Statistical analyses were performed using chi-square and t-tests (p<0.05). Results: Out of 1,174 prescriptions analysed, 88.9% were post-2015. Post-intervention,patients had fewer comorbidities, &prescriptions for those >80 years declined (p<0.05). Cardiovascular drugs remained the most prescribed. Polypharmacy slightly increased post-2015, but PIPs remained low and stable. Prescription volumes rose significantly after 2015, peaking in 2018. Temporal shifts included higher workloads on Saturday & Sundays and a prescription peak in March. Conclusions: Clinical pharmacy services were associated with improved prescribing practices and reduced comorbidity burden. Despite a slight rise in polypharmacy, PIPs remained minimal, highlighting the role of clinical pharmacists in promoting safe and effective medication use in elderly cardiac patients.
Copyright (c) 2026 Fakhr Alayoubi, Mostafa Q Al Shamiri, Fayez Elshaer http://creativecommons.org/licenses/by/4.0
Quantitative Assessment of Myocardial Work Index (MWI) as a Predictor of Early Response to SGLT2 Inhibitors in Heart Failure
Background and Purpose: The rapid adoption of SGLT2 inhibitors (SGLT2i) in Heart Failure (HF) management necessitates precise, early imaging biomarkers to predict therapeutic response. Current methods relying on ejection fraction are often delayed and insensitive to immediate myocardial changes. Myocardial Work Index (MWI), derived from non-invasive pressure-strain loops, offers a sensitive, quantitative measure of cardiac energy efficiency, potentially identifying early responders to SGLT2i-associated myocardial benefit. Methods: A prospective cohort study enrolled 210 HFrEF patients initiating SGLT2i therapy. All participants underwent comprehensive echocardiography, including assessment of MWI and Global Longitudinal Strain (GLS), at baseline and 90 days. Early positive response was defined as a composite endpoint: reduction in NT-proBNP >30% and improvement in NYHA class at 90 days. A multivariate logistic regression analysis was performed to determine the independent predictive capacity of baseline MWI for the primary endpoint. Results: At 90 days, 137 patients (65%) were classified as early responders. Baseline MWI was significantly lower in non-responders compared to responders (1250 mmHg% vs. 1580 mmHg%; p<0.001). The multivariate logistic regression confirmed that a baseline MWI threshold of <1300 mmHg% was the single strongest independent predictor of non-response (Adjusted Odds Ratio: 4.10; 95% CI: 2.85-5.90; p<0.001). This threshold demonstrated 85% sensitivity and 82% specificity for identifying therapeutic failure. In contrast, baseline LVEF was not predictive (p=0.45). This precise imaging metric allows for timely adjustment of Guideline-Directed Medical Therapy (GDMT). Conclusion: Baseline Myocardial Work Index, obtained non-invasively, offers a powerful, early predictive biomarker for SGLT2i therapeutic response in HFrEF. This quantitative imaging strategy enables personalized pharmacological management and resource optimization, supporting the regional mandate for utilizing advanced diagnostic innovation to drive high-quality outcomes in cardiovascular health.
Copyright (c) 2026 Nour Mashal, Osama Mustafa, Rahmeh Al-Asmar http://creativecommons.org/licenses/by/4.0
Efficacy and Safety of Sacubitril/Valsartan Versus Enalapril in the Treatment of Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
Background and Purpose: Heart failure with reduced ejection fraction (HFrEF) continues to cause significant global morbidity and mortality. With sacubitril/valsartan now recommended as first-line therapy in guidelines, this review aimed to evaluate its safety and efficacy compared to enalapril in HFrEF patients. Methodology: We systematically searched PubMed, Scopus, Ovid, Cochrane Library, and ProQuest databases through December 2024. Eligible studies were randomized controlled trials (RCTs) or observational studies comparing sacubitril/valsartan versus enalapril among patients diagnosed with HFrEF. The risk ratios (RR) and mean differences (MDs) with 95% confidence interval (CI) were computed and p-value < 0.05 was considered as a level of significance. Statistical analyses were performed using RevMan. Results and Discussions: This study included 10 RCTs and 2 prospective cohort studies with 11,765 patients. Sacubitril/valsartan significantly reduced all-cause mortality (RR 0.85, P = 0.0006), cardiovascular mortality (RR 0.81, P < 0.0001), and heart failure rehospitalization (RR 0.68, P = 0.006) compared to enalapril. Hypotension was more frequent with sacubitril/valsartan (RR 1.54, P < 0.00001), while no significant differences were found for hyperkalemia, angioedema, worsening renal function, or left ventricular ejection fraction (LVEF). Sacubitril/valsartan was associated with lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (MD -427.50, P = 0.009) and better Kansas City Cardiomyopathy Questionnaire (KCCQ) scores (MD 1.64, P < 0.00001). Sensitivity analyses confirmed result robustness and resolved heterogeneity in outcomes. These findings indicate that sacubitril/valsartan improves survival, quality of life, and biomarkers in HFrEF, consistent with guideline recommendations for early use. The higher risk of hypotension underscores the importance of careful patient selection and monitoring, but the overall safety profile remains comparable to enalapril, supporting sacubitril/valsartan as a more effective option. Conclusions: Sacubitril/valsartan demonstrates superior efficacy over enalapril in key clinical and patient-reported outcomes. Further research is needed to investigate its long-term safety and effectiveness across diverse patient populations.
Copyright (c) 2026 Rayan Aljubeh, Saif Almuzainy, Mohamed Lemine, Majed Bseiso, Khaled Kadro, Abdullah Metawa, Rizwan Qaisar http://creativecommons.org/licenses/by/4.0
Severe Dengue Fever Complicated by Myocarditis Presenting as ST-Elevation Myocardial Infarction: A Case Report with Atypical Features
Background: Dengue fever, a mosquito-borne viral illness, can rarely present with cardiac complications that mimic acute myocardial infarction. This case highlights the diagnostic challenge of dengue myocarditis presenting with ST segment elevation (STE) on electrocardiography (ECG). Case Presentation: A 28 year old male presented with fever, chest pain, and dyspnea. Initial ECG showed inferior ST elevation and diffuse ST depression, highly suggestive of ST elevation myocardial infarction (STEMI). Echocardiography revealed preserved biventricular function without regional wall motion abnormalities. Emergent coronary angiography demonstrated normal coronary arteries. Laboratory testing confirmed acute dengue infection via positive PCR and serology (IgM/IgG), along with significant thrombocytopenia (57,000/μL) and elevated cardiac enzymes (peak Troponin I 8.5 ng/mL). The ST segment elevations resolved spontaneously within 24 hours, supporting a final diagnosis of acute dengue myocarditis. Conclusion: This case underscores the critical importance of considering dengue myocarditis in differential diagnosis of STEMI in endemic regions, particularly in young, febrile patients without coronary risk factors. Accurate recognition prevents unnecessary interventions like thrombolysis and guides appropriate supportive management.
Copyright (c) 2026 Hesham Ahmed http://creativecommons.org/licenses/by/4.0
Machine Learning-Based Risk Stratification for Predicting Hospital Readmissions in Heart Failure Patients: A Multi-Center Retrospective Study
Background: Heart failure remains a leading cause of hospitalization and rehospitalization worldwide. Traditional risk scores, though useful, often fail to capture the complex interplay of clinical, laboratory, and imaging data that influence patient outcomes. Machine learning (ML) techniques have emerged as promising tools to improve risk prediction and guide individualized care strategies. Methods: We conducted a retrospective analysis of 3,200 heart failure patients admitted across three tertiary hospitals in the Middle East between 2019 and 2024. Clinical variables (demographics, comorbidities, medications), laboratory parameters, echocardiographic findings, and electronic health record (EHR) data were included. Several supervised ML models (random forest, XGBoost, logistic regression) were trained and validated to predict 30-day readmission. Model performance was compared using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and calibration metrics. Results: The XGBoost model outperformed traditional logistic regression and random forest (AUC 0.84 vs. 0.71 and 0.78, respectively). Important predictors identified included serum sodium, NT-proBNP, prior hospitalizations, and medication adherence patterns extracted from EHR. The model demonstrated good calibration across risk strata, with a sensitivity of 82% and specificity of 76% in the validation cohort. Conclusion: ML-based models provide more accurate prediction of 30-day readmissions compared with conventional risk scores in heart failure. By integrating routinely available clinical and EHR data, these tools may enable early identification of high-risk patients, inform discharge planning, and ultimately reduce healthcare burden. Future work will focus on prospective validation and embedding ML models into clinical decision support systems.
Copyright (c) 2026 Rahmeh Al-Asmar http://creativecommons.org/licenses/by/4.0
Concurrent Diabetic Ketoacidosis and NSTEMI: A Complex Cardiometabolic Emergency
We report the case of a 51-year-old male with type 2 diabetes mellitus, hypertension, and dyslipidemia, who presented with a two-day history of central chest pain radiating to the left arm, associated with nausea, vomiting, exertional dyspnea, and orthopnea. On examination, he was hypotensive, tachycardic, and clinically dehydrated. Initial investigations revealed sinus tachycardia with ST-segment depression in leads V4, V5 and V6 on ECG, severe hyperglycemia (glucose 20.1 mmol/L), ketonemia (>7 mmol/L), and high anion gap metabolic acidosis (pH 7.06, bicarbonate 9 mmol/L), confirming DKA. Management was initiated with intravenous fluid resuscitation and insulin infusion. Troponin T was elevated at 56.2 ng/L, raising concern for NSTEMI. The cardiology team recommended conservative management with dual antiplatelet therapy, statins, beta-blockers, ACE inhibitors, and low molecular weight heparin. The patient required non-invasive ventilation in the ICU due to oxygen desaturation and pulmonary congestion. Serial troponins peaked at 429 ng/L. Coronary angiography revealed multi-vessel coronary artery disease. Transthoracic echocardiography showed regional wall motion abnormalities with an ejection fraction(EF) of 40-45%. The patient subsequently underwent coronary artery bypass grafting (CABG) at an external center and has since shown favorable recovery. This case underscores the rare but clinically significant presentation of NSTEMI-induced DKA. The systemic inflammatory state and catecholamine surge during myocardial infarction may precipitate metabolic decompensation in diabetics. Co-management requires a careful balance between aggressive fluid resuscitation for DKA and the risk of exacerbating cardiac dysfunction. Early recognition, multidisciplinary coordination, and risk stratification are essential for optimizing outcomes.
Copyright (c) 2026 Ridha Umar, Kinza Moin, Zahra Amini http://creativecommons.org/licenses/by/4.0
Complete Heart Block: A Rare Initial Presentation of Epstein-Barr Virus-Induced Myocarditis
Myocarditis, a rare but serious condition often caused by viral infections, rarely manifests with cardiac involvement in healthy individuals infected with Epstein-Barr virus (EBV). We present a case of a 51-year-old diabetic presenting with exertional dyspnoea, pleuritic chest pain, and intermittent fever. Investigations revealed elevated C-reactive protein (CRP), brain natriuretic peptide (BNP), high sensitive troponin, creatine kinase (CK) levels, and complete heart block on ECG. Echocardiography showed reduced ejection fraction and cardiac MRI confirmed myocarditis. Epstein-Barr virus was confirmed as the underlying cause. He was treated with prednisone, acyclovir, and a permanent pacemaker. Due to serious complications associated with myocarditis such as acute heart failure and arrhythmias, it is imperative to emphasize the importance of early recognition and timely intervention of atypical presentations.
Copyright (c) 2026 Ridha Umar, Kinza Moin, Tarab Iqbal, Resshme Sudha, Thiagarajan Jaiganesh http://creativecommons.org/licenses/by/4.0
Earlier Is Better: In-Hospital vs Early Post-Discharge Initiation of SGLT2 Inhibitors in Acute Heart Failure—Updated Random-Effects Meta-analysis With Continuous Time-to-Start Meta-regression
Background & Purpose: SGLT2 inhibitors (SGLT2i) benefit AHF, but the optimal timing for initiation is unclear. We performed an updated meta-analysis and a continuous meta-regression by days-to-start (admission→randomization/first dose) to test whether earlier initiation confers greater short-term benefit. Methods: PRISMA-conformant search (MEDLINE/EMBASE/Cochrane, inception–Aug 2025). Inclusion: RCTs initiating SGLT2i during AHF hospitalization or ≤7 days post-discharge, reporting 60–90-day clinical outcomes. Primary outcome: composite of HF hospitalization and/or death within 60–90 days. Secondary: total HF events, KCCQ change, safety (AKI, hypotension, ketoacidosis/UTI). Random-effects (REML with Hartung-Knapp). Meta-regression modeled log-risk ratio vs days-to-start (trial-level medians). Small-study bias: Egger’s test; risk of bias: RoB-2. Results: We included EMPULSE (in-hospital, median day ~3), EMPA-RESPONSE-AHF (in-hospital pilot), SOLOIST-WHF (pre/early post-discharge), and DICTATE-AHF (in-hospital dapagliflozin); total n≈2,100. The pooled 60–90-day composite favored SGLT2i (RR ≈0.83; 95% CI ≈0.73–0.95; low heterogeneity), consistent with contemporary reviews. Meta-regression showed a significant timing effect: for each day of delay, treatment effect attenuated (β for log RR +0.05/day, p≈0.03), implying ~5% relative loss of benefit per day. Safety was neutral (no excess AKI, hypotension, or ketoacidosis). Findings were robust in leave-one-out analyses and when restricting to strictly in-hospital starts. Conclusions: Across modern AHF RCTs, starting SGLT2i before discharge is associated with fewer 60–90-day events, and earlier initiation yields greater benefit on a continuous time scale. These data justify protocolized in-hospital starts as a high-value pharmacotherapy strategy for AHF pathways.
Copyright (c) 2026 Arif Albulushi, Mohammed El Hadad http://creativecommons.org/licenses/by/4.0
Dual-Biomarker Navigation Clinic (NT-proBNP + hs-Troponin) Accelerates GDMT Up-Titration and Lowers 6-Month Events in HFrEF/HFmrEF: A Pragmatic Program from Oman
Background & Purpose: Single-biomarker follow-up can miss actionable risk in heart failure (HF). We implemented a Dual-Biomarker Navigation Clinic (DBNC) using point-of-care NT-proBNP and hs-troponin to trigger same-day guideline-directed medical therapy (GDMT) up-titration with pharmacist follow-up. Methods: Prospective cohort with 1:1 propensity-matched usual-care controls. Inclusion: symptomatic HFrEF/HFmrEF (LVEF ≤50%), outpatient NT-proBNP ≥600 pg/mL or rising ≥30% within 3 months. DBNC protocol: POC NT-proBNP + hs-cTn at visit; algorithmic triggers for ARNI/SGLT2i/MRA/β-blocker up-titration; WhatsApp reminders; nurse calls at 2 and 4 weeks. Primary endpoint: 6-month composite (HF hospitalization or all-cause death). Secondary: achieving ≥½-target doses by 90 days, adherence (proportion of days covered [PDC] ≥80% at 90 days), biomarker % change at ~90 days. Adjusted Cox/logistic models controlled for age, sex, EF, eGFR, NYHA class, ischemic etiology. Results: n=404 (DBNC 202; matched usual care 202), age 62±11, 35% female, LVEF 34±8%. By 90 days, DBNC vs usual care: ARNI ≥½-target 56% vs 34% (aOR 2.55, 95%CI 1.72–3.80); β-blocker ≥½-target 69% vs 50% (aOR 2.12, 1.43–3.15); MRA ≥½-target 61% vs 45% (aOR 1.92, 1.28–2.89); PDC ≥80% 66% vs 52% (aOR 1.76, 1.19–2.61). Biomarkers: NT-proBNP −29% vs −18% (p=0.012); hs-cTn −8% vs −2% (p=0.045). The 6-month composite occurred in 17% vs 25%; adjusted HR 0.68 (95%CI 0.48–0.96; p=0.028). Hypotension (5.0% vs 5.4%) and AKI KDIGO≥2 (3.7% vs 3.5%) were similar. Conclusions: A pragmatic dual-biomarker clinic tied to immediate, protocolized titration accelerated GDMT, improved adherence, reduced NT-proBNP and hs-troponin, and lowered 6-month events without added safety risk. This model is implementable in regional HF services without sST2 availability.
Copyright (c) 2026 Arif Albulushi, Gamal Aly http://creativecommons.org/licenses/by/4.0
Same-Day FAST-HF CMR + Biomarker & Adherence Pathway: Faster Decisions, Higher GDMT Uptake, and Fewer 90-Day Events in a Middle East Single-Center Cohort
Background & Purpose: Access delays worsen HF outcomes. We implemented an integrated, same-day pathway combining 10-minute FAST-HF CMR (single-shot cine, dark-blood PSIR-LGE, native T1), point-of-care NT-proBNP/hs-troponin, and a pharmacist-led adherence bundle (protocolized GDMT orders, WhatsApp reinforcement, refill tracking). Methods: Interrupted time-series with inverse probability of treatment weighting (IPTW). Adults referred for HF aetiologic assessment; exclusions: cardiogenic shock, eGFR <20 mL/min/1.73m², active myocarditis requiring admission. Pre vs Post (two 24-week epochs, seasonal match). Primary: 90-day composite (all-cause death or HF readmission). Secondary: referral-to-report time, time-to-decision, GDMT initiation at discharge, adherence (PDC ≥80% at 90 days), 30-day NT-proBNP change. Safety: AKI (KDIGO ≥2), ED revisits. Results: N=620 referrals (298 pre; 322 post), age 63±12, 37% female, LVEF 36±9%. Access improved: referral-to-report 5.0→1.8 days (p<0.001), time-to-decision 13→4 days (p<0.001), same-day diagnosis 9%→61%. Throughput 21→33 scans/week (p<0.001). NT-proBNP reduction at ~30 days −16% vs −29% (p=0.011). GDMT at discharge increased: SGLT2i 49%→73% (IPTW aOR 2.39, 95%CI 1.72–3.35), MRA 44%→62% (aOR 1.94, 1.40–2.70). Adherence improved (PDC ≥80%: 52%→68%; aOR 1.88, 1.34–2.64). Primary endpoint: 22%→15%; aHR 0.71 (95%CI 0.54–0.95, p=0.019). Safety unchanged (AKI ≥2 3.1% vs 3.4%, p=0.82; ED revisits similar). Conclusions: A same-day imaging–biomarker–adherence pathway anchored by FAST-HF CMR is feasible and associated with faster diagnosis, higher GDMT uptake, better adherence, improved NT-proBNP, and fewer 90-day events, without safety trade-offs.
Copyright (c) 2026 Arif Albulushi http://creativecommons.org/licenses/by/4.0
A Comprehensive Review and Pooled Analysis of Clinical Results for Normothermic Ex-Vivo Machine Perfusion for Donation-after-Circulatory-Death Heart Transplantation
Background and Objective: Donation-after-circulatory-death (DCD) hearts are now used more often thanks to normothermic ex-vivo machine perfusion (NMP), which allows for prolonged preservation and real-time functional assessment. There is still a lack of comparative outcome data, despite recent ISHLT and ACC/AHA guidelines to the contrary. Compared to traditional donation-after-brain-death (DBD), this review examined the early and intermediate results of adult DCD-NMP heart transplantation. Methods: A PRISMA-2020 systematic review included research from MEDLINE, Embase, CENTRAL, and Scopus (January 2020–June 2025). The review compared DCD-NMP to DBD hearts, focusing on studies reporting results at least 30 days post-transplantation. The ROBINS-I tool was used to assess bias risk. Pooled risk ratios (RRs) were calculated using a random-effects model (DerSimonian–Laird) with Hartung-Knapp adjustment, and heterogeneity was measured by I2. Publication bias was examined in at least 10 studies. Results: There were twelve multicenter observational cohorts (1,268 DCD-NMP; 9,442 DBD). Lower 1-year mortality (7.4% vs. 10.2%; RR 0.75, 95% CI 0.59–0.96; I² = 16%) and 5-year mortality (RR 0.72, 95% CI 0.54–0.97; I² = 21%) were associated with DCD-NMP. The DCD-NMP group experienced a significant reduction in ischemic time, averaging 51 minutes (95% CI –68 to –34; I² = 48%), and a lower incidence of primary graft dysfunction (9.7% vs. 14.2%; RR 0.68, 95% CI 0.51–0.91). No significant adverse events linked to the device were observed, and rates of acute rejection after one year were similar across groups (RR 1.02, 95% CI 0.81–1.28; I² = 0%). Funnel plots for 1-year mortality showed no evidence of publication bias. Conclusions: Compared to DBD transplantation, NMP-assisted DCD heart transplantation shows similar or better survival rates, a shorter ischemic period, and less graft dysfunction, all without increasing rejection or device-related complications. To enable broader adoption, more cost-effectiveness studies and prospective trials are needed.
Copyright (c) 2026 Muhammad Farhan http://creativecommons.org/licenses/by/4.0
The Role of Serum Magnesium Levels in the Prevention and Management of Cardiac Arrhythmias
Background and Purpose: Hypomagnesemia has been strongly implicated in the pathogenesis of cardiac arrhythmias due to its role in myocardial excitability and membrane stabilization. Serum magnesium acts as a natural calcium antagonist, and its deficiency promotes afterdepolarizations and increased automaticity in cardiac myocytes, predisposing to both atrial and ventricular arrhythmias. This abstract aims to summarize current evidence regarding the preventive and therapeutic significance of optimal magnesium levels in arrhythmia management. Methods: A synthesis of cross-sectional, cohort, and interventional studies published between 2008 and 2024 was performed. Data from community-based studies, including the Atherosclerosis Risk in Communities (ARIC) and the Chronic Renal Insufficiency Cohort (CRIC), were analyzed alongside randomized clinical trials evaluating magnesium supplementation in coronary artery bypass surgery and heart failure patients. Results: Low serum magnesium levels (<0.75 mmol/L) were consistently associated with a higher risk of atrial fibrillation and premature ventricular contractions. Magnesium repletion reduced proarrhythmic risk in conditions such as acute myocardial infarction, heart failure, and postoperative cardiac surgery, though findings varied depending on baseline magnesium status and duration of supplementation. Meta-analyses indicated that maintaining magnesium within the mid-normal range was associated with reduced incidence of sudden cardiac death and arrhythmic events. Conclusions: Adequate serum magnesium levels play a protective role in cardiac electrophysiology and may serve as both a preventive and adjunctive therapeutic factor in arrhythmia management. While supplementation benefits specific high-risk populations, its preventive effects in the general population require further large-scale, randomized trials. Monitoring and correcting magnesium deficiency should therefore be an integral component of cardiovascular risk management.
Copyright (c) 2026 Raqshan Wajih Siddiqui, Tabish Wajih Siddiqui, Shiza Wajih Siddiqui, Syed Muhammad Hayyan Nishat, Sohaila Fatima http://creativecommons.org/licenses/by/4.0
Utilization of guideline‑directed medical therapy for heart failure with reduced ejection fraction: a retrospective chart review in a teaching hospital
Background and Purpose: Guideline‑directed medical therapy improves outcomes in heart failure with reduced ejection fraction, yet uptake is often suboptimal. We evaluated real‑world use of guideline‑directed therapy among adults hospitalized for decompensated heart failure in a tertiary teaching hospital and explored patient factors associated with under‑prescribing. Methods: This retrospective review included consecutive adults with stable HFrEF (left ventricular ejection fraction ≤40 %) admitted to the cardiology service between January 2024 and April 2025. Under supervision, medical students extracted demographic data, comorbidities and discharge prescriptions from electronic records. Guideline therapy comprised any renin–angiotensin system inhibitor, beta‑blocker, mineralocorticoid receptor antagonist and sodium–glucose co‑transporter 2 inhibitor. We calculated prescription rates for each drug class and the proportion receiving all four therapies. Logistic regression examined associations between under‑prescribing and age, sex, low blood pressure, renal impairment and comorbidities. Results: We reviewed 198 admissions (mean age 60 years; 30 % female). Prescription rates were 83 % for renin–angiotensin system inhibitors, 92 % for beta‑blockers, 56 % for mineralocorticoid receptor antagonists and 48 % for sodium–glucose co‑transporter 2 inhibitors. Only 38 % of patients received all four therapies. In multivariate analysis, moderate renal impairment (estimated glomerular filtration rate <45 mL min⁻¹ 1.73 m⁻²) predicted omission of renin–angiotensin system inhibitors (adjusted odds ratio 3.1). Systolic blood pressure <100 mmHg predicted non‑prescription of beta‑blockers (adjusted odds ratio 2.4). Age, sex and other comorbidities were not associated with under‑prescribing. Reasons for withholding drugs were rarely documented. Conclusions: Less than half of HFrEF patients at this teaching hospital received the full combination of evidence‑based therapies. Concerns about renal function and hypotension contributed to under‑prescribing. Structured heart failure management pathways, improved documentation and educational initiatives may enhance adherence to guideline‑directed therapy in similar settings in practice.
Copyright (c) 2026 Esraa Abusaleem, Raneem AlDalaeen, Suhaila Bashir, Sewar Qawaqzeh, Rahma AlKharabsheh http://creativecommons.org/licenses/by/4.0
Database Analysis of the valvular affection in 4782 Echocardiographic examinations for patients with Rheumatic heart disease (RHD) at the Echocardiography Lab. Cairo University Hospitals
Background: RHD is widely prevalent in developing countries all over the world. Database analysis of 4782 Transthoracic Echocardiographic examinations (TTE) for patients with (RHD) at the echo Lab was performed to study specifically the change of pattern in patients with RHD as regards detailed anatomical description of the valvular affection, detailed description of the associated functional abnormalities including valvular stenosis and incompetence and finally the prevalence of complications. Patients and Methods: The study population consisted of 4782 TTE for patients with RHD at the echo-lab at Cairo University Hospitals. Statistical analysis was performed. Results: 60.7 % of RHD patients were females (2906 TTE) and 39.3 % of RHD patients were males (1876 TTE). Mitral stenosis due to RHD was the most common valvular pathology due to RHD (87 % of RHD). Isolated Mitral stenosis due to RHD was (55.7 % of patients having MS due to RHD) Combined Mitral stenosis & regurgitation due to RHD was noticed in (44.3 % of patients having MS due to RHD) Aortic valve disease (AVD) due to RHD was (50.6 % of RHD patients) Aortic stenosis due to RHD was the diagnosis in (59.19 % of patients having AVD due to RHD) Aortic regurgitation due to RHD was the diagnosis in (40.81 % of patients having AVD due to RHD) Organic tricuspid valve disease (TVD) due to RHD was the diagnosis in (21.5 % of RHD patients) (TR 20.5 % & TS 1.0 % of RHD patients) Conclusion: Echo is the current gold standard for accurately identifying and quantifying the type and severity of valvular involvement in RHD. Mitral stenosis due to RHD was the most common valvular pathology due to RHD.
Copyright (c) 2026 Walid Atout http://creativecommons.org/licenses/by/4.0
Delayed Adolescent Presentation of Uhl’s Anomaly Presenting as Pericardial Effusion: A Case Report
Background and Significance: Uhl’s anomaly, a rare congenital cardiac disease, is characterized by the partial or complete absence of the right ventricular myocardium, leading to progressive right-sided heart failure. Although typically diagnosed in infancy, late-onset presentations are rare and could be misdiagnosed as Ebstein’s anomaly or arrhythmogenic right ventricular dysplasia (ARVD), resulting in delayed and potentially life-threatening diagnoses. Case Summary: We present a case of a 15-year-old adolescent who initially presented with persistent jaundice following hepatitis A infection. Investigations revealed cardiomegaly and pericardial effusion, prompting further evaluation. Multimodal imaging revealed severe right ventricular dilation, paradoxical septal motion, and near-total absence of myocardium in the right ventricle, confirming Uhl’s anomaly. Over the next five years, the patient developed progressive fatigue, ascites, and right-sided heart failure. He was listed on the heart transplant list and managed conservatively with diuretics, beta blockers, spironolactone, and an implantable cardiac defibrillator. However, his condition deteriorated, progressing to cardiac cirrhosis, refractory ascites, and recurrent predominantly right-sided heart decompensations. Ultimately, he suffered an out-of-hospital cardiac arrest and was pronounced deceased at the age of 21. Conclusion and Discussion: This case highlights the diagnostic challenges of adolescent-onset Uhl’s anomaly and emphasizes the need to consider this diagnosis in young patients with isolated right ventricular dysfunction. Early utilization of cardiac MRI and timely referral for transplantation may improve outcomes in this rare but life-threatening condition.
Copyright (c) 2026 Ruba Aweer, Noor Aweer, Anwar Joudeh, Pravesh Jaguari http://creativecommons.org/licenses/by/4.0
Real-World Outcomes of Sacubitril/Valsartan in Heart Failure with Reduced Ejection Fraction
Background: Sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor (ARNI), is a foundational therapy for heart failure with reduced ejection fraction (HFrEF), proven in randomized trials to reduce mortality and hospitalizations. However, translating these results into real-world clinical practice requires evaluation in broader, less selected patient populations. This study assessed the real-world effectiveness and safety of sacubitril/valsartan in patients with HFrEF, focusing on mortality, rehospitalization, functional improvement, and tolerability. Methods: We conducted a retrospective cohort analysis of approximately 5,400 patients with HFrEF initiated on sacubitril/valsartan between 2016 and 2023. Data were collected from linked electronic health records and national registries, including baseline demographics, NYHA functional class, and laboratory parameters. The primary endpoints were all-cause mortality and heart failure–related hospitalizations, while secondary outcomes included changes in NYHA class and treatment-emergent adverse events such as renal dysfunction, hyperkalemia, and hypotension. Each patient’s outcomes after ARNI initiation were compared with their pre-treatment period, with subgroup analyses performed in older adults (≥75 years) and those with advanced functional limitation (NYHA III/IV). Results: Over a mean follow-up of more than five years, initiation of sacubitril/valsartan was associated with significant clinical improvement. NYHA functional class improved markedly from baseline (p<0.0001), and the rate of cardiovascular and HF hospitalizations declined by more than 26% compared to the pre-ARNI period. These benefits were consistent across subgroups, including elderly patients and those with advanced disease. Importantly, all-cause mortality remained stable, with no signal of excess risk in high-risk subgroups. The treatment demonstrated good tolerability, as serious adverse events such as hypotension, renal impairment, or hyperkalemia were infrequent and aligned with the established safety profile of ARNI therapy. Conclusion: This large real-world analysis reinforces the clinical value of sacubitril/valsartan in HFrEF, demonstrating sustained functional improvement, reduced hospitalizations, and favorable safety outcomes, supporting its continued integration into guideline-directed care.
Copyright (c) 2026 Rashed Al-Marmouri http://creativecommons.org/licenses/by/4.0
Efficacy of SGLT2 Inhibitor Therapy in Middle Eastern Patients with Heart Failure
Heart failure (HF) remains a leading cause of morbidity and mortality worldwide. Contemporary management increasingly relies on disease-modifying pharmacotherapies, including angiotensin receptor–neprilysin inhibitors (ARNIs) and sodium–glucose cotransporter-2 (SGLT2) inhibitors, both now considered essential components of guideline-directed therapy. This study aimed to evaluate the real-world clinical impact of adding the SGLT2 inhibitor dapagliflozin to optimized medical therapy in a Middle Eastern population with chronic HFrEF. In this multicenter, prospective, randomized trial, 400 ambulatory patients with NYHA class II–IV HF and left ventricular ejection fraction ≤40% were enrolled and assigned 1:1 to receive dapagliflozin (10 mg daily) or placebo, in addition to standard therapy consisting of ARNI/ACEi/ARB, beta-blockers, and mineralocorticoid receptor antagonists as tolerated. The primary endpoint was the time to first occurrence of cardiovascular (CV) death or HF hospitalization. Secondary outcomes included changes in NYHA class, six-minute walk distance (6MWD), and renal function at 12 months. Safety was closely monitored, and the study adhered to CONSORT guidelines. The two groups were well matched at baseline, with a mean age of 62 ± 11 years, 65% male, and a mean LVEF of 32%. At 12 months, the composite endpoint occurred in 15% of dapagliflozin-treated patients versus 24% of placebo (hazard ratio 0.60; 95% CI 0.43–0.84; p<0.01), representing a 40% relative risk reduction. This benefit was mainly driven by fewer HF hospitalizations (10% vs 18%; p<0.01), while CV mortality trended lower (5% vs 8%; p=0.08). Functional outcomes improved significantly with dapagliflozin, including greater NYHA class improvement (45% vs 28%; p=0.02) and longer 6MWD gains (+35 m vs +10 m; p=0.03). Renal decline was attenuated (–2 vs –6 mL/min/1.73 m²; p=0.04). Adverse events, including hypotension and electrolyte disturbances, were similar across groups. Dapagliflozin added to standard therapy reduced HF events and improved function in Middle Eastern HFrEF patients, supporting SGLT2 inhibitor use.
Copyright (c) 2026 Bashar Quteishat http://creativecommons.org/licenses/by/4.0
Remote Patient Monitoring in Heart Failure
Background: Heart failure (HF) remains a major public health burden, accounting for approximately one million hospitalizations annually in the United States, with nearly 20% of patients readmitted within 30 days. Remote patient monitoring (RPM), using connected devices and telehealth platforms, has emerged as a promising approach to detect early signs of decompensation, improve adherence to guideline-directed therapy, and reduce recurrent hospitalizations. Recent large-scale trials and real-world studies have evaluated RPM’s effects on clinical outcomes, patient-reported quality of life, and mortality. Methods: We reviewed recent data from randomized and real-world studies examining the impact of RPM on HF management. The MONITOR-HF trial (Lancet 2023) enrolled approximately 340 patients with NYHA class III HF, comparing implantable pulmonary-artery pressure–guided management with usual care. The E-INH trial (JACC HF 2023) evaluated a nurse-coordinated, telephone-based RPM program in 1,022 post-discharge patients with reduced ejection fraction, extending follow-up to ten years. Additionally, a prospective ACO cohort (2021–2022) implemented a short-term home RPM program using daily vital sign and symptom tracking in high-risk HF patients after discharge. Results: In MONITOR-HF, RPM significantly reduced HF events compared with standard care (hazard ratio [HR] 0.56; p=0.0053) and improved health-related quality of life, reflected by a mean 12-month KCCQ improvement of seven points versus controls. E-INH found no early reduction in death or hospitalization but demonstrated lower all-cause mortality at five and ten years (HR 0.82 and 0.83, respectively). The ACO registry showed a non-significant reduction in 6-month readmissions yet revealed markedly lower short-term mortality (6.4% vs 17%). Across studies, adherence to monitoring varied, with engagement declining over time, emphasizing the need for structured support strategies. Conclusion: Collectively, evidence supports RPM as an effective adjunct to guideline-based HF management, improving quality of life, reducing hospitalizations, and potentially lowering long-term mortality when sustained adherence is achieved.
Copyright (c) 2026 Mohammad Abu Zalam http://creativecommons.org/licenses/by/4.0
Efficacy and Safety of Mavacamten in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Background and Purpose: Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease marked by sarcomeric hypercontractility, diastolic dysfunction, and, frequently, dynamic left-ventricular outflow tract (LVOT) obstruction. Mavacamten, a selective cardiac myosin inhibitor, directly targets excessive contractility and may improve functional capacity and quality of life. This meta-analysis quantitatively evaluated the efficacy and safety of mavacamten across randomized controlled trials in obstructive and non-obstructive HCM. Methods: Electronic databases were searched for phase II–III randomized trials of mavacamten in adults with HCM. Data were pooled using random-effects meta-analysis (DerSimonian–Laird method). Continuous outcomes were expressed as standardized mean differences (SMDs) and categorical outcomes as odds ratios (ORs), each with 95% confidence intervals (CIs). Heterogeneity was assessed using I² and τ² statistics. Subgroup analyses were performed by disease phenotype. Results: Five trials (n = 1,022) met inclusion criteria. Mavacamten significantly improved peak VO₂ versus placebo (SMD 0.33; 95% CI 0.09–0.57; P = 0.007), with greater benefit in obstructive HCM (SMD 0.49) than non-obstructive disease (SMD 0.20). Functional improvement (≥1 NYHA class) was more frequent with mavacamten (OR 2.51; 95% CI 1.08–5.86; P = 0.03), driven by the obstructive subgroup (OR 4.59). Quality-of-life scores (KCCQ-CSS) improved modestly overall (SMD 0.33; P = 0.04), and post-exercise LVOT gradient decreased markedly (SMD −1.07; P < 0.00001). Any adverse event was more common with mavacamten (OR 1.84; P = 0.02), but serious events and mortality were comparable to placebo. Conclusions: Mavacamten provides meaningful improvements in exercise capacity, symptoms, and LVOT hemodynamics, particularly in obstructive HCM, with an acceptable safety profile. These findings support its role as a disease-specific therapy targeting sarcomeric hypercontractility in hypertrophic cardiomyopathy.
Copyright (c) 2026 Ahmad Alazzam, Omar Almajdoubeh, Mus'ab Mustafa, Ahmad Barakat, Loay Abuhamdan, Aws Alsboul http://creativecommons.org/licenses/by/4.0
Sex-Based Differences in Clinical Outcomes Among Heart Failure Patients Treated With SGLT2 Inhibitors: Insights From a Multicenter Cohort Study
Background: Sodium–glucose cotransporter-2 inhibitors (SGLT2i) have emerged as a cornerstone in heart failure (HF) management across the spectrum of ejection fraction. However, evidence regarding potential sex-based differences in treatment response remains limited, particularly in real-world cohorts. Methods: We conducted a retrospective cohort study including consecutive adult patients hospitalized with heart failure between 2019 and 2024 across five tertiary centers. Eligible patients initiated SGLT2i therapy (empagliflozin, dapagliflozin, or canagliflozin) within 90 days of index admission. Propensity score matching (1:1) was applied to balance baseline characteristics between men and women. The primary endpoint was all-cause mortality at two years. Secondary endpoints included heart failure rehospitalization, composite cardiovascular outcomes, and renal function trajectories. Kaplan–Meier survival analyses and multivariable Cox proportional hazards models were used to assess outcomes. Results: A total of 4,286 patients were included (mean age 64 ± 12 years; 41% women). After matching, 1,512 men and 1,512 women were analyzed. Women demonstrated a significantly lower risk of all-cause mortality at two years compared to men (HR 0.78, 95% CI 0.65–0.92, p = 0.004). The reduction in HF rehospitalization was also more pronounced in women (HR 0.81, 95% CI 0.70–0.94, p = 0.006). No sex-based differences were observed in renal function decline. Sensitivity analyses across HF subtypes (HFrEF, HFpEF) yielded consistent findings. Conclusion: In this large multicenter cohort, women with heart failure treated with SGLT2 inhibitors exhibited more favorable long-term outcomes compared to men, driven primarily by lower rates of mortality and rehospitalization. These results highlight the importance of sex-specific considerations in contemporary HF therapy and support tailored treatment strategies to optimize outcomes.
Copyright (c) 2026 Raneem Aldalaeen, Rahmeh Al-Asmar, Enjood Mhairat, Esraa Abusaleem, Suhaila Bashir, Deema Nasha’t, Dima Alajouz, Dua’ Younes http://creativecommons.org/licenses/by/4.0
Racial Disparities in Heart Failure Outcomes Among Patients With Hypertensive Retinopathy: A Multicenter Real-World Analysis
Background: Hypertensive retinopathy is a microvascular manifestation of chronic hypertension and a prognostic marker for systemic cardiovascular damage. However, the relationship between hypertensive retinopathy and heart failure outcomes across racial groups remains poorly understood. Objective: To evaluate racial disparities in the incidence of acute heart failure among patients with hypertensive retinopathy using a large multicenter electronic health record network. Methods: A retrospective cohort study was conducted using the TriNetX Research Network (2010–2021). Adult patients with diagnoses of hypertension and hypertensive retinopathy were identified and stratified by race (Black vs. White). Propensity score matching (1:1) was performed across 34 covariates, including comorbidities, medications, and laboratory parameters. The primary outcome was acute heart failure (new-onset or acute-on-chronic), analyzed over 3 years of follow-up using Cox proportional hazards models. Results: After matching, 49,114 patients (mean age 68.7 years; 61.2% female) were included. Black patients had a higher incidence of acute heart failure compared with White patients (10.9% vs. 9.7%; HR 1.125, 95% CI 1.064–1.189). Black individuals also exhibited higher rates of related adverse outcomes, including cardiac arrest (HR 1.45) and ventricular tachycardia (HR 1.30). These findings persisted despite balanced baseline characteristics, suggesting underlying racial disparities in heart failure risk among patients with hypertensive retinopathy. Conclusions: Among individuals with hypertensive retinopathy, Black patients experienced a significantly higher risk of heart failure compared to White patients. This highlights the prognostic value of hypertensive retinopathy as a marker of subclinical cardiac dysfunction and underscores the need for targeted prevention strategies addressing racial inequities in heart failure care.
Copyright (c) 2026 Dema Staitieh, Rima Omari, Rahmeh Al-Asmar http://creativecommons.org/licenses/by/4.0
Early Quadruple Therapy in HFrEF: A Systematic Review and Pooled Analysis of Mortality and Hospital Utilisation Versus ≤Triple Therapy
Background and Purpose: Despite advances in guideline-directed medical therapy (GDMT), heart failure with reduced ejection fraction (HFrEF) remains a major cause of morbidity and mortality. The 2021 ESC and 2022 AHA/ACC/HFSA guidelines recommend early initiation of quadruple therapy (ARNI, β-blocker, MRA, SGLT2i). However, evidence comparing early quadruple therapy with conventional triple therapy (ACEi/ARB/ARNI + β-blocker + MRA) in real-world settings remains limited. This study aimed to evaluate the impact of early quadruple GDMT on clinical outcomes in HFrEF. Methods: We conducted a systematic review and pooled analysis following PRISMA 2020 guidelines. MEDLINE, Embase, CENTRAL, and Web of Science were searched (Jan 2014–Mar 2025). Eligible studies compared early quadruple therapy (initiated ≤4 weeks of diagnosis) with ≤triple therapy in adult HFrEF patients, reporting outcomes ≥90 days. Risk of bias was assessed using ROB2/ROBINS-I. Random-effects (DerSimonian–Laird) and fixed-effect models were used; heterogeneity assessed via I² statistic. Results: Two observational studies (n = 2,584) were included. Early quadruple therapy significantly reduced the 30-day composite of all-cause mortality/readmission (RR 0.73, 95% CI 0.55–0.97; I² = 0%), in-hospital mortality (RR 0.29, 95% CI 0.15–0.56), and hospital stay duration (mean difference –2.6 days). Twelve-month HF-related admissions were lower with quadruple therapy (RR 0.51, p = 0.02). There was no significant increase in hypotension, hyperkalaemia, or acute kidney injury. Sensitivity analyses confirmed result robustness. Conclusions: Early initiation of quadruple therapy in HFrEF is associated with significant reductions in short-term mortality, readmissions, and hospital utilisation, without increased adverse effects. While promising, these findings are based on two moderate-risk, non-randomised studies. Larger prospective trials are needed to validate these outcomes and support widespread implementation. Keywords: HFrEF, quadruple therapy, SGLT2i, guideline-directed therapy, outcomes, systematic review
Myocardial Infarction with Non Obstructive Coronary Atherosclerosis: A Rare Case
Background: Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is a syndrome with different causes, characterized by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography. Cardiovascular Magnetic Resonance imaging (CMR) is increasingly used in cardiology to complement the diagnostic work-up of patients with cardiovascular disease, including MINOCA. The case below illustrates the clinical role of CMR in patients with acute coronary syndrome and unobstructed coronary arteries, and its usefulness in reaching the final diagnosis. It also highlights the possible link between aortic bioprosthetic valves as a source of emboli leading to MINOCA. Case Presentation: Here we describe an interesting case of a 29 year old male known to have bioprosthetic aortic valve replacement who presented with chest pain suggestive of the acute coronary syndrome, with rising troponin levels but having a normal coronary angiography and a cardiac magnetic resonance imaging showing revealed hypokinesia and thinning of the basal to mid lateral wall of the left ventricle and edema of the basal to mid lateral wall. Given the Cardiac MRI findings the patient was diagnosed with MINOCA. He was treated with aspirin bisoprolol and atorvastatin in the hospital setting. Discussion: CMR plays an important role in the confirmation of MINOCA. It provides a unique opportunity to noninvasively characterize heart tissue. Consequently, it has a crucial role to complement the diagnostic workup of patients with cardiovascular disease and to screen for the underlying cause. This case posed a challenge to establish an underlying cause for the myocardial infarction. Conclusion: This case illustrates the increasing clinical role of cardiac magnetic resonance imaging in modern cardiology and its ability to detect a final diagnosis in patients with MINOCA and also raise the possibility of recurrent embolic phenomena to the epicardial vessels from bioprosthetic valves, which might be challenging to prove.
Copyright (c) 2026 Mousa Abughoush, Safa Almohdar, Thamer Samha http://creativecommons.org/licenses/by/4.0
Transformation of Heart Failure Care in Oman: Impact of Multidisciplinary Advanced Heart Failure Clinic on Patient Outcomes
Background: Heart failure (HF) is a significant burden in Oman. The HF clinic at the Royal Hospital, established in 2014, was initially managed by one cardiologist and later by two in 2021. Limited resources, late referrals, and the absence of a dedicated advanced HF team led to suboptimal outcomes, with high re-admissions and poor survival. In early 2024, two advanced HF and transplant cardiologists joined, improving the service. Objective: To evaluate the impact of the enhanced HF service on patient outcomes, focusing on survival, re-admission, and management strategies. Methods: A retrospective cohort study included all HF patients attending the clinic from 2014–2023. Data from the pre-enhancement period (2014–2023) were compared with post-enhancement (2024). Demographics, clinical characteristics, and outcomes were analysed using SPSS v22. Kaplan-Meier survival analysis assessed survival rates. Adherence to guideline-directed medical therapy (GDMT) was evaluated. Significance was set at p < 0.05. Results: In 2014–2023, 2,940 patient visits were recorded (average 15/day; 55% ischemic cardiomyopathy; mean age 65; 60% male). Outcomes included: Re-admissions: 45% One-year survival: 60% GDMT adherence: 40% In 2024, following service enhancement: Re-admissions: 30% (p = 0.02) One-year survival: 75% (p = 0.01) GDMT adherence: 70% (p = 0.03) Mean age: 64; 58% male 50% improved NYHA class (p = 0.02) Quality of life improved (MLHFQ, p = 0.03) Reduced exacerbations in patients with comorbidities (p = 0.04) Kaplan-Meier analysis confirmed improved survival (log-rank p = 0.01). Conclusion: Enhancement of the HF clinic through the addition of advanced HF cardiologists and a multidisciplinary approach significantly improved outcomes. Dedicated HF programs, early referral, and team-based care are vital to sustain these gains.
Copyright (c) 2026 Duaa Alsinani http://creativecommons.org/licenses/by/4.0
A Blind Spot In The Heart: Eustachian Valve Complicating Atrial Septal Defect Closure
Background and purpose: The Eustachian valve (EV) is a remnant of fetal circulation that directs inferior vena caval blood toward the foramen ovale. Persistence of a prominent EV in adulthood may alter intracardiac flow dynamics, potentially facilitating right-to-left shunting in the presence of an atrial septal defect (ASD) or patent foramen ovale (PFO), and thus contributing to hypoxemia. Methods: A 10-year-old female with a known secundum ASD presented with a six-month history of exertional dyspnea and fatigue. Physical examination revealed an oxygen saturation of 87% on room air. ECG and chest X-ray were unremarkable. Transthoracic echocardiography (TTE) demonstrated a 14 mm ASD with preserved biventricular function. A transesophageal echocardiography (TEE)-guided percutaneous closure was planned; however, the patient developed significant desaturation and hemodynamic instability during the procedure, prompting its abortion. Subsequent TEE revealed an 18 mm ASD with a prominent EV producing bidirectional shunting. Results: A repeat closure via the right internal jugular vein was undertaken using a 20 mm Amplatzer device. Post-procedure, oxygen saturation improved from 84% to 96%, indicating effective shunt elimination. Conclusion: While transcatheter ASD closure is typically safe, unrecognized EV can pose procedural challenges and precipitate desaturation events. In this case, guidewire entrapment by the EV likely caused transient inferior vena cava obstruction and right-to-left shunting. Therefore, in patients presenting with unexplained hypoxemia or atypical shunting patterns, pre-procedural TEE assessment is essential to identify EV or other anatomical variants, ensuring safe and successful intervention.
Copyright (c) 2026 Osama Mustafa, Kais Al Balbissi, Nour Mashal http://creativecommons.org/licenses/by/4.0
Right Coronary Artery–Right Atrial Fistula with Left-to-Right Shunt: A Rare Case Managed by Surgical Closure
Background and purpose: Coronary artery fistula (CAF) is a rare congenital anomaly, with an estimated prevalence of 0.002% in the general population and accounting for approximately 14% of all coronary artery anomalies. While many cases remain asymptomatic and are incidentally discovered, others can present with nonspecific symptoms or lead to serious complications such as myocardial ischemia, heart failure, pulmonary hypertension, or aneurysmal dilatation. Recognizing and managing hemodynamically significant fistulas early is crucial to prevent long-term cardiopulmonary consequences. Methods: A 54-year-old female presented with a 10-month history of exertional dyspnea, palpitations, and intermittent chest pain. Her past medical history was unremarkable. Electrocardiography revealed normal sinus rhythm, and cardiac biomarkers were within normal limits. Transthoracic echocardiography demonstrated preserved left ventricular function, elevated right ventricular systolic pressure (RVSP) of 55 mmHg, and a Qp/Qs ratio of 1.6, consistent with a left-to-right shunt. Further evaluation with computed tomography angiography identified a right coronary artery fistula draining into the right atrium. Coronary angiography confirmed the anatomy and guided multidisciplinary discussion on management options, including percutaneous versus surgical closure. Results: Given the size of the fistula and its hemodynamic impact, surgical closure was selected as the definitive treatment. The procedure was successfully performed without complications. At two-month follow-up, the patient reported complete resolution of symptoms. Repeat echocardiography showed a reduction in RVSP to 30 mmHg, with no residual shunt or recurrence. Conclusion: This case underscores the importance of early detection and timely surgical intervention in coronary artery fistulas with significant shunting. Left untreated, such lesions may result in progressive right heart failure or irreversible pulmonary hypertension. Surgical closure remains an effective and durable solution in preventing these complications.
Copyright (c) 2026 Nour `Mashal, Kais Al Balbissi, Osama Mustafa http://creativecommons.org/licenses/by/4.0
A Rare Triple Coronary and Pulmonary Artery Fistula Involving the RCA and LAD: Successful Coil Embolization with Long Term Resolution
Background and purpose: Coronary artery fistulas are uncommon congenital anomalies, found in approximately 0.9% of the population. While many remain clinically silent, complex fistulas may produce ischemia, heart failure, or arrhythmic complications. We present a rare case of a right coronary artery (RCA)–pulmonary artery (PA) fistula with an additional branch to the left anterior descending artery (LAD), successfully managed with transcatheter coil embolization and documented long-term resolution. Methods: A 24-year-old male with an eight-year history of exertional dyspnea, chest pain, and palpitations was evaluated. Electrocardiography showed normal sinus rhythm, and echocardiography revealed preserved left ventricular ejection fraction (60%). Coronary computed tomography angiography demonstrated abnormal communication between the RCA, PA, and LAD systems. Results: Coronary angiography confirmed a large RCA-originating fistula crossing anterosuperior to the right ventricular outflow tract and draining into the main PA trunk, with a secondary branch to the LAD causing ischemia via coronary steal. Using an Amplatz Left 1 guiding catheter and BMW wire, three detachable coils were deployed, achieving complete occlusion. The patient was discharged on dual antiplatelet therapy and remained asymptomatic at one- and six-month follow-ups, with CT angiography confirming durable closure and no residual shunt. Conclusion: Triple-communication coronary-pulmonary fistulas involving both RCA and LAD are exceptionally rare, with only isolated cases reported. This case highlights the feasibility and long-term efficacy of coil embolization in managing anatomically complex coronary-pulmonary connections and underscores the importance of individualized catheter strategies for optimal outcomes.
Copyright (c) 2026 Nour Mashal, Kais Al Balbissi, Osama Mustafa http://creativecommons.org/licenses/by/4.0
Heart On The Flip Side: Navigating Bilateral Duct Stenting In A Rare Congenital Anomaly
Background: Situs inversus with isolated levocardia is rare and often associated with severe congenital heart disease. When combined with pulmonary atresia and bilateral patent ductus arteriosus, it presents an even more complex case. Methods: An 11-day-old full-term male (3.6 kg), presented with central cyanosis and an oxygen saturation of 66%. Echocardiography and CT angiogram (CTA) revealed situs inversus with isolated levocardia, double outlet right ventricle with pulmonary atresia, non-confluent pulmonary arteries, a hypoplastic left ventricle, and a large ventricular septal defect (VSD). The left pulmonary artery was supplied by a PDA from the aortic arch, while the right was supplied by a PDA from the brachiocephalic artery. Additionally, there was total anomalous pulmonary venous return, with pulmonary veins draining into the right atrium and the superior vena cava into the left atrium. Upon arrival, the patient developed desaturation and was started on PGE1 infusion. Results: Bilateral ductal stenting via axillary access was done to maintain pulmonary blood flow. Post-procedure, oxygen saturation improved to 85%, and an echocardiogram showed good PDA flow. The patient was discharged in stable condition with plans for follow-up. Conclusion: This case presents a rare combination of congenital anomalies. Bilateral ductal stenting stabilized the patient and delayed high-risk surgery, highlighting the importance of early intervention in managing complex congenital heart disease.
Predictive Utility of Remote Pacing Diagnostics in Identifying Non-Responders to Cardiac Resynchronization Therapy (CRT)
Background: Despite its proven efficacy, a significant fraction of patients receiving Cardiac Resynchronization Therapy (CRT) remains non-responsive, severely compromising prognosis. Early identification of these non-responders is crucial, but conventional follow-up schedules often delay necessary optimization and therapeutic adjustments. We investigated whether data derived from continuous remote device monitoring (RDM) could provide the necessary granularity to predict CRT non-response significantly earlier than standard clinical metrics. Methods: A prospective cohort study enrolled 285 chronic Heart Failure patients with HFrEF and wide QRS complex receiving an implanted CRT device across three regional specialized clinics. All patients underwent continuous RDM, recording pacing percentage (Vp%), atrial fibrillation (AF) burden, and right ventricular (RV) lead impedance stability. The primary endpoint was defined as clinical non-response (failure to achieve a 10% increase in LVEF or reduction in NYHA class) at six months. Univariate and subsequent multivariate Kaplan-Meier survival analysis was employed to assess time-to-non-response prediction. Results: Clinical non-response was observed in 28% (N=80) of the cohort. RDM data analysis revealed that a drop in Vp% below 92% combined with a 2-fold increase in daily AF burden within the first 60 days post-implant was independently associated with non-response. The multivariate model demonstrated that this combined RDM metric predicted non-response with a sensitivity of 88% and specificity of 79%, significantly exceeding the predictive power of baseline clinical or echocardiographic factors alone (p<0.001). Furthermore, the RDM signature identified eventual non-responders a median of 95 days earlier than standard clinical assessment, allowing for timely therapeutic adjustments. Conclusion: Integrating these precise metrics into clinical workflows facilitates proactive, personalized device management, drastically shortening the time to necessary intervention. This strategy aligns perfectly with the regional goal of establishing advanced, data-led risk and disease detection, enhancing the Quality of Care in complex HF management.
Copyright (c) 2026 Abrar Omari, Lana Omari, Rima Omari http://creativecommons.org/licenses/by/4.0
Geospatial Risk Mapping and Predictive Modeling of Incident Heart Failure in an Urbanized Regional Cohort: An Epidemiological Study
Background: The global rise in incident Heart Failure (HF) is inextricably linked to accelerating urbanization, demanding sophisticated primary prevention tools that integrate clinical risk with environmental determinants. Traditional risk stratification models often fail to account for the local impact of factors like air quality, temperature variation, and noise pollution, which are increasingly recognized as non-traditional cardiovascular stressors. This investigation sought to develop a comprehensive predictive model using geographically indexed data to identify asymptomatic individuals at the highest risk of new-onset HF within the next three years. Methods: This large-scale retrospective cohort study analyzed electronic health records (EHR) from 15,000 asymptomatic, non-HF adults over a 5-year period. Patient data were geocoded and linked with high-resolution, time-variant regional environmental exposure metrics (e.g., particulate matter, thermal fluctuation). A Random Forest survival model was trained on the combined clinical, demographic, and geocoded environmental features to predict the primary endpoint: incident, de novo diagnosis of HF (HFrEF or HFpEF). Model performance was evaluated using the concordance statistic (C-statistic) and Relative Risk Quotient (RRQ). Results: The integrated Geospatial-Clinical Risk Score (GCRS) model demonstrated excellent discrimination for predicting incident HF (C-statistic: 0.86; 95% CI: 0.83–0.89), significantly improving upon clinical factors alone (C-statistic: 0.73; p<0.001). Feature importance analysis confirmed that average daily exposure to ambient fine particulate matter (PM 2.5) was the third strongest predictor of incident HF, surpassed only by age and baseline hypertension. Individuals classified in the highest risk quartile by the GCRS exhibited an adjusted Relative Risk Quotient of 3.1 for developing HF over the study period (p<0.001). The study identified precise urban micro-environments responsible for a disproportionate burden of incident cases. Conclusion: This methodology facilitates the strategic allocation of public health resources and supports the critical regional objective of advancing advanced risk and disease detection to enhance the integrated care delivery model.
Copyright (c) 2026 Lana Omari, Abrar Omari, Rima Omari http://creativecommons.org/licenses/by/4.0