Global Cardiology Science & Practice最新文献

{"title":"Combined heart and liver transplantation for homozygous familial hypercholesterolaemia: 35-year post-operative outcomes.","authors":"Rona Jalandari, Fatima Omar, Fawzi Lazem, Mahmoud Barbir","doi":"10.21542/gcsp.2026.38","DOIUrl":"10.21542/gcsp.2026.38","url":null,"abstract":"<p><p>Combined heart-liver transplantation (CHLT) is an exceptionally rare multi-organ procedure undertaken in patients with concurrent end-stage cardiac and hepatic disease, or in those with inherited metabolic disorders-most notably homozygous familial hypercholesterolaemia (HoFH)-in which defective hepatic LDL receptor (LDL-R) function drives progressive and otherwise irreversible cardiovascular injury. We report a 35-year follow-up of a female patient who underwent simultaneous orthotopic cardiac and liver transplantation on 13 September 1990 for HoFH complicated by severe ischaemic cardiomyopathy and aortic valve stenosis. Pre-operative serum low-density lipoprotein cholesterol (LDL-C) was 13 mmol/L, refractory to all pharmacological interventions available at the time. Transplantation produced immediate normalisation of LDL-C to 2.1 mmol/L, reflecting instantaneous restoration of donor hepatic LDL-R function-consistent with the landmark observations reported by Bilheimer, Goldstein, Brown, and Starzl^1, 2. This normalisation has been broadly maintained across three and a half decades of follow-up. Lipid-lowering therapy was commenced post-operatively to augment the normalised lipid profile, and dramatic regression of tendon xanthomata was documented within six months of transplantation¹¹. Cardiac graft function has remained preserved, with ejection fraction (EF) of 64-68% on recent echocardiography and no inducible ischaemia on sequential myocardial perfusion scintigraphy (MPS) in May 2025. Progressive cardiac allograft vasculopathy (CAV) has been identified on coronary CT angiography (CTCA) in 2024 but without haemodynamic consequence. Rejection burden across 35 years has been remarkably low-comprising a mild episode at three weeks post-transplant and a single biopsy-confirmed Grade 1R episode in 2013-consistent with the hepatic immunological privilege hypothesis first elaborated by Calne and subsequently substantiated in combined organ transplantation literature^3, 4. The dominant long-term complication has been end-stage renal failure secondary to calcineurin inhibitor (CNI) nephropathy-a well-recognised sequela of long-term CNI exposure²⁷-necessitating haemodialysis via arteriovenous fistula. More recently, the patient sustained a low-impact femoral fracture reflecting steroid-associated osteoporosis, with subsequent prolonged hospitalisation, deconditioning, rotator cuff tear, and bilateral upper limb neuromuscular symptoms under active investigation. This case contributes exceptional 35-year outcome data in a field where long-term follow-up beyond ten to fifteen years remains sparse.</p>","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202638"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized totally endoscopic non-robotic mitral valve repair for degenerative mitral regurgitation: early single-center outcomes in 84 patients.","authors":"Phan Quang Thuan, Pham Tran Viet Chuong, Cao Dang Khang, Nguyen Hoang Dinh","doi":"10.21542/gcsp.2026.30","DOIUrl":"10.21542/gcsp.2026.30","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate early clinical and echocardiographic outcomes of totally endoscopic, non-robotic mitral valve repair for degenerative mitral regurgitation using a standardized DCT approach (double-port; camera and main working port in the same intercostal space; skin incision <3 cm), and to propose operational criteria for \"totally endoscopic\" mitral surgery. <b>Methods:</b> In this single-center observational study, 84 consecutive patients with severe degenerative mitral regurgitation meeting 2021 ESC/EACTS surgical criteria underwent totally endoscopic non-robotic repair with three-dimensional visualization between July 2023 and January 2026. The technique used a primary skin incision ≤3 cm with no rib spreading in all cases. Clinical and echocardiographic outcomes within 30 days were assessed. <b>Results:</b> Repair was successful in all 84 patients (100%), without conversion to sternotomy or replacement. All underwent ring annuloplasty; neochordal implantation was performed in 69 (82.1%). Mean incision length was 2.9 ± 0.3 cm. Mean cardiopulmonary bypass and cross-clamp times were 163.3 ± 50.5 and 112.1 ± 37.5 minutes, respectively. There was no 30-day mortality. Major complications each occurred in 1 patient (1.2%): re-exploration for bleeding, intracranial hemorrhage, and femoral artery occlusion. Median intensive care unit and hospital stays were 2 (IQR 2-3) and 10 (IQR 9-14) days. Echocardiography showed no residual regurgitation ≥ moderate and preserved ventricular function in all patients. <b>Conclusions:</b> Standardized totally endoscopic non-robotic mitral valve repair using the DCT approach was feasible and reproducible, achieving a 100% repair rate with favorable early outcomes. Given the single-center design and short follow-up, these should be interpreted as feasibility data.</p>","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202630"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In reply: acute intraventricular obstruction as a complementary trigger of takotsubo cardiomyopathy in endurance athletes.","authors":"Husam Katib, Ngoc Thai Kieu, Sabeeh Islam","doi":"10.21542/gcsp.2026.37","DOIUrl":"10.21542/gcsp.2026.37","url":null,"abstract":"","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202637"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven-day mortality and its predictors among patients with acute coronary syndrome in southwestern Ethiopia: a prospective cohort study.","authors":"Elsah Tegene Asefa, Melese Mekonnen Kassa, Alemayehu Abebe Guji, Kedir Negesso Tukeni","doi":"10.21542/gcsp.2026.32","DOIUrl":"10.21542/gcsp.2026.32","url":null,"abstract":"<p><p><b>Background:</b> Acute coronary syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality worldwide, with particularly poor outcomes in low-resource settings. Contemporary prospective data on short-term outcomes and their predictors remain scarce in Ethiopia. This study aimed to describe the clinical characteristics of patients with ACS, determine seven-day mortality, and identify independent predictors of seven-day mortality at Jimma University Medical Center, Southwest Ethiopia. <b>Methods:</b> A prospective hospital-based cohort study was conducted among 200 consecutive adult patients admitted with ACS between September 2024 and September 2025. Sociodemographic, clinical, laboratory, electrocardiographic, echocardiographic, treatment, and outcome data were collected using a structured case report form. Seven-day mortality was the primary outcome. Kaplan-Meier analysis was used to estimate survival probabilities, and bivariable and multivariable logistic regression analyses were performed to identify independent predictors of seven-day mortality. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) are reported, and statistical significance was defined as <i>p</i> < 0.05. <b>Results:</b> Among the 200 participants, 75.5% were male and 61.5% were urban residents. The median age was 58 years (interquartile range [IQR], 48-68 years). ST-segment elevation myocardial infarction was the predominant ACS subtype (78.0%), followed by non-ST-segment elevation myocardial infarction (11.5%) and unstable angina (10.5%). Overall, 60 patients (30.0%) died within seven days of admission. After adjustment for potential confounders, diabetes mellitus (AOR, 17.93; 95% CI [3.44-93.42]; <i>p</i> = 0.001), advancing age (AOR, 1.23 per year; 95% CI [1.11-1.38]; <i>p</i> < 0.001), higher baseline troponin concentration (AOR, 1.41 ng/mL; 95% CI [1.19-1.67]; <i>p</i> < 0.001), and Killip class IV at presentation (AOR, 69.50; 95% CI [4.54-1065.01]; <i>p</i> = 0.002) were independently associated with increased odds of seven-day mortality. <b>Conclusion:</b> Seven-day mortality among patients with ACS at Jimma University Medical Center was substantial. Advancing age, diabetes mellitus, elevated baseline troponin, and Killip class IV independently predicted seven-day mortality. These findings underscore the importance of early risk stratification, prompt recognition of hemodynamic compromise, and timely implementation of evidence-based management strategies to improve short-term outcomes in resource-limited settings.</p>","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202632"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond hypertrophy: four-chamber myocardial involvement in ATTR cardiac amyloidosis diagnosed by multimodality imaging.","authors":"Sridevi Chigullapalli, Ajitkumar Jadhav, Susheel Kumar Malani, Sravanth Gandavarapu","doi":"10.21542/gcsp.2026.31","DOIUrl":"10.21542/gcsp.2026.31","url":null,"abstract":"<p><p><b>Background:</b> Cardiac amyloidosis results from the deposition of amyloid fibrils in the myocardial extracellular matrix, leading to restrictive cardiomyopathy and heart failure. Diagnosis has traditionally been challenging owing to non-specific clinical features and reliance on endomyocardial biopsy. Advances in cardiovascular imaging have, however, improved early detection. <b>Case summary:</b> We present a 74-year-old man with progressive dyspnea on exertion and bilateral pedal edema of three months' duration. Cardiac amyloidosis was suspected on the basis of discordance between electrocardiographic and echocardiographic findings, and was confirmed using global longitudinal strain (GLS), cardiac magnetic resonance imaging (CMR), and bone scintigraphy. <b>Conclusion:</b> This case underscores the importance of recognizing cardiac amyloidosis as an underdiagnosed cause of heart failure. Modern imaging modalities facilitate non-invasive, early diagnosis, often obviating the need for biopsy. Early identification is crucial, as emerging therapies offer the potential to modify disease progression and improve outcomes in a condition once considered incurable.</p>","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202631"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fully biodegradable versus nitinol occluder devices for transcatheter patent foramen ovale closure: a systematic review.","authors":"Abdulbari Alsaeed, Ahmad R Al-Qudimat, Mohammed Qintar, Raed M Al-Zoubi, Rufaidah H Alameen, Osama Mohamad","doi":"10.21542/gcsp.2026.34","DOIUrl":"10.21542/gcsp.2026.34","url":null,"abstract":"<p><p><b>Background:</b> The optimal device platform for transcatheter patent foramen ovale (PFO) closure remains uncertain. Permanent nitinol occluders are widely used, but concerns persist regarding long-term foreign-body exposure and device-related complications. Fully biodegradable occluders have been developed to provide temporary septal support during endothelialization before gradual resorption, with the intended benefit accruing only after the device has resorbed. <b>Methods:</b> We systematically searched Medline, PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and trial registries through 17 February 2026. Eligible studies were randomized or comparative observational studies of patients aged 16 years or older undergoing PFO closure with biodegradable or bioresorbable versus nitinol or metallic occluders. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using RoB 2 for randomized evidence and ROBINS-I for non-randomized evidence. Because of clinical and methodological heterogeneity, findings were synthesized narratively. <b>Results:</b> Three comparative studies were included-one randomized trial and two retrospective cohorts-comprising 481 analyzed participants. Procedural success was high with both device types. Residual shunt generally decreased over time, with no clear advantage for either platform. Serious adverse events, device thrombosis, embolization or detachment, and atrial arrhythmias were uncommon, though event counts were small. Two of the three studies were migraine-specific cohorts, and the randomized trial enrolled a mixed-indication population in which treatment-resistant migraine was the most common single indication; the available evidence therefore reflects device-platform performance predominantly in migraine populations. No study followed participants substantially beyond the expected biodegradation window. <b>Conclusion:</b> Current evidence suggests similar short- to mid-term performance of biodegradable and nitinol occluders, but certainty is low to very low, and no study yet assesses the post-resorption period in which any advantage of a biodegradable platform would be expected to emerge. Larger multicenter studies with standardized imaging, rhythm monitoring, and follow-up extending beyond biodegradation are needed. Because two of the three studies were migraine-specific and event counts were small, these findings should not be extrapolated to stroke-prevention populations, and the absence of observed between-device differences should not be interpreted as equivalence.</p>","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202634"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is FH a curable disease?","authors":"Nabil G Seidah","doi":"10.21542/gcsp.2026.39","DOIUrl":"10.21542/gcsp.2026.39","url":null,"abstract":"","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202639"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute intraventricular obstruction: an underrecognized trigger of takotsubo cardiomyopathy in athletes in the setting of endurance activities.","authors":"Kenan Yalta, Muhammet Gurdogan, Yekta Gurlertop","doi":"10.21542/gcsp.2026.33","DOIUrl":"10.21542/gcsp.2026.33","url":null,"abstract":"","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202633"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-based differences in myocardial perfusion imaging among diabetic Egyptian patients:a retrospective registry study.","authors":"Ahmed Ibrahim El-Desoky Khalil, Osama Mohamed Mohamed Alzebak, Amr Adel Alsayed, Hazem Mohamed Mansour","doi":"10.21542/gcsp.2026.35","DOIUrl":"10.21542/gcsp.2026.35","url":null,"abstract":"<p><p><b>Background:</b> Diabetes mellitus (DM) markedly increases the risk of coronary artery disease (CAD), and myocardial perfusion imaging (MPI) is a key noninvasive tool for risk stratification. Sex-based differences in presentation, referral patterns, and diagnostic accuracy of MPI remain understudied, particularly in Middle Eastern populations with a high prevalence of diabetes. This study evaluated sex-based differences in the indications, results, appropriateness, and diagnostic accuracy of MPI among diabetic Egyptian patients. <b>Methods:</b> This retrospective observational registry study included 1,000 diabetic adults (648 men, 352 women) who underwent gated SPECT-MPI at our university hospitals. Demographic data, risk factors, ECG findings, stress modalities, MPI results, coronary angiography data, and appropriate use criteria (AUC) were analyzed. <b>Results:</b> Men were older than women (59.6 ± 8.0 vs. 57.0 ± 9.4 years, <i>p</i> < 0.001). Hypertension was more prevalent in women (84.1% vs. 67.6%, <i>p</i> < 0.001), whereas smoking was more common in men (30.4% vs. 0.3%, <i>p</i> < 0.001). Positive MPI results were more frequent in men (77.0% vs. 43.2%, <i>p</i> < 0.001), as were appropriate indications (79.3% vs. 53.4%, <i>p</i> < 0.001); inappropriate and uncertain indications were correspondingly more common in women. Reversible perfusion defects did not differ significantly by sex (23.6% in women vs. 21.2% in men, <i>p</i> = 0.523), whereas fixed defects were more prevalent in men (17.0% vs. 7.8%, <i>p</i> < 0.001). MPI accuracy relative to coronary angiography did not differ significantly between the sexes (91.7% in men vs. 86.3% in women, <i>p</i> = 0.103). <b>Conclusion:</b> Substantial sex-based disparities exist in MPI referral patterns, test positivity, and appropriateness among diabetic Egyptians. Women are more likely to receive inappropriate referrals and to have a lower positive diagnostic yield, underscoring the need for sex-sensitive clinical protocols.</p>","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202635"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The silent storm: Quinine-induced Torsade de Pointes unmasking a latent KCNH2 variant.","authors":"Humberto Morais, Miguel Vicente, Catarina David, Fidel Manuel Caceres-Loriga","doi":"10.21542/gcsp.2026.36","DOIUrl":"10.21542/gcsp.2026.36","url":null,"abstract":"<p><p>Quinine, a <i>Cinchona</i> alkaloid and a cornerstone of malaria therapy in resource-limited settings, produces predominant sodium-channel blockade alongside modest inhibition of the rapid delayed-rectifier potassium current (IKr). Although generally safe at the population level, even modest IKr blockade can precipitate life-threatening Torsade de Pointes (TdP) in patients with severely impaired repolarization reserve. We report an 8-year-old boy with severe <i>Plasmodium falciparum</i> malaria who, on the third day of intravenous quinine, developed profound QTc prolongation (730 ms) followed by recurrent TdP. This arose from the convergence of quinine-induced IKr inhibition, hypokalaemia (K 2.9 mmol/L), and an underlying pathogenic KCNH2 variant, which together exhausted repolarization reserve. Although initially haemodynamically stable, the patient's extreme electrical instability proved a sentinel event, prompting identification of latent Long QT Syndrome type 2 (LQT2). The case highlights the importance of ECG monitoring and electrolyte correction during quinine therapy. It illustrates how drug-induced arrhythmia can represent the phenotypic unmasking of diminished repolarization reserve, in which a pharmacological trigger exposes a silent genetic substrate-here necessitating lifelong beta-blocker therapy and family cascade screening to prevent sudden cardiac death.</p>","PeriodicalId":12669,"journal":{"name":"Global Cardiology Science & Practice","volume":"2026 4","pages":"e202636"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}