Journal of the Saudi Heart Association最新文献

{"title":"Position Statement by the Saudi Heart Failure Working Group of the Saudi Heart Association on the Management of Advanced Heart Failure in Saudi Arabia.","authors":"Ibrahim Jelaidan, Abeer Bakhsh, Ammar G Chaudhary, Ebtisam Alkhattaby, Fahmi AlKaf, Feras Khaliel, Ismail Raslan, Mohammed Alreshidan, Mosaad Alhussein, Waleed Alhabeeb","doi":"10.37616/2212-5043.1509","DOIUrl":"10.37616/2212-5043.1509","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a leading cause of morbidity and mortality in Saudi Arabia. Despite remarkable progress in guideline-directed medical therapy, a significant proportion of patients progress to advanced HF and require evaluation for heart transplantation or mechanical circulatory support (MCS). In response to this growing burden, the Saudi Heart Association (SHA) developed recommendations to guide identification, timely referral, and optimal management of candidates for advanced HF therapies in Saudi Arabia.</p><p><strong>Methods: </strong>A multidisciplinary panel of 10 HF experts from Saudi Arabia convened for a series of structured virtual meetings to review local and international evidence. The panel integrated Saudi-specific clinical practice patterns and healthcare considerations into the deliberation process. Consensus was achieved through discussion and majority agreement. Recommendations were formulated using the SHA methodology, supported by a comprehensive literature review of published evidence.</p><p><strong>Results and conclusions: </strong>The SHA consensus establishes a structured, comprehensive framework for recognizing advanced HF, optimizing guideline-directed therapy, and determining candidacy for heart transplantation or MCS in tertiary and quaternary centers in Saudi Arabia. The document emphasizes timely prognostic stratification using clinical indicators and standardized tools such as INTERMACS and SCAI classifications. Referral pathways and multidisciplinary coordination are delineated to facilitate efficient evaluation and timely intervention. These recommendations aim to minimize delays in referral, expand access to advanced HF therapies and improve patient outcomes across Saudi Arabia.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"21"},"PeriodicalIF":1.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228226","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":"Personalizing Modern Heart Failure Therapy in HFrEF: Bridging Evidence, Clinical Practice, and Future Perspectives.","authors":"Ehsan Shahverdi, Amin Shahverdi, Sendooran Shahi, Carsten Schneider, Mathias Lange, Shadi Kamali","doi":"10.37616/2212-5043.1513","DOIUrl":"https://doi.org/10.37616/2212-5043.1513","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with reduced ejection fraction (HFrEF) remains a major cause of morbidity, mortality, and healthcare utilization worldwide despite substantial therapeutic advances. Over the past three decades, randomized clinical trials have established four foundational pharmacologic pillars of guideline-directed medical therapy (GDMT): renin-angiotensin system inhibition or angiotensin receptor-neprilysin inhibition, evidence-based beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. However, real-world implementation of these therapies remains suboptimal.</p><p><strong>Objectives: </strong>To provide a contemporary state-of-the-art review of current evidence supporting GDMT in HFrEF, examine unresolved challenges in sequencing and optimization, and propose a practical phenotype-based framework to support individualized treatment decisions.</p><p><strong>Methods: </strong>A structured narrative review was conducted using PubMed/MEDLINE, Embase, and Google Scholar to identify relevant publications from January 2000 to February 2026. Priority was given to randomized controlled trials, international guidelines, meta-analyses, and high-quality observational registries addressing GDMT initiation, sequencing, tolerability, and implementation.</p><p><strong>Results: </strong>Robust evidence supports early and combined use of the four foundational GDMT classes, with substantial reductions in mortality and heart failure hospitalization. Emerging data favor rapid initiation of multiple therapies followed by structured uptitration rather than prolonged sequential strategies. Nevertheless, important barriers persist, including hypotension, renal dysfunction, hyperkalemia, frailty, polypharmacy, therapeutic inertia, and inequitable access to medications. Current guidelines provide limited practical direction regarding treatment prioritization in complex clinical phenotypes. A phenotype-based decision framework may facilitate earlier, safer, and more individualized implementation of GDMT in routine practice.</p><p><strong>Conclusions: </strong>The principal challenge in modern HFrEF management is no longer the absence of effective therapies, but failure to deliver proven therapies rapidly, comprehensively, and sustainably. Future progress may depend less on development of new drug classes and more on optimizing implementation of currently available life-saving treatments through phenotype-informed and patient-centered strategies.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"22"},"PeriodicalIF":1.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758485","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":"Depression and Anxiety in Pulmonary Hypertension Associated With Congenital Heart Disease: Pathophysiology and Clinical Implications of the Heart-Brain Axis.","authors":"Nicodemus N Triatmojo, Valerinna Y S Putri","doi":"10.37616/2212-5043.1498","DOIUrl":"https://doi.org/10.37616/2212-5043.1498","url":null,"abstract":"<p><p>Pulmonary hypertension associated with congenital heart disease or PH-CHD is an increasingly prevalent disorder in modern cardiology. It is characterized by progressive pulmonary vascular remodeling, chronic right ventricular (RV) pressure overload, and abnormal cardiopulmonary hemodynamic. Due to advances in congenital cardiology and treatments for pulmonary hypertension, survival rates have increased. As a result, the focus has switched to long-term functional status and quality of life. Depression and anxiety are currently recognized as prevalent and clinically significant manifestations in PH-CHD; nonetheless, they remain underdiagnosed and undertreated within cardiovascular care frameworks. More study shows the disease's severity or symptom count cannot explain PH-CHD patients' psychological distress. Instead, it shows a chronic heart disease-induced pathogenic process. The heart-brain axis underlines this idea. Chronic pulmonary vascular disease and RV failure induce neurohormonal activation, autonomic instability, systemic inflammation, hypoxia, and inadequate cerebral perfusion, which affect brain structure and emotion regulation. This brief review gathers evidence of objective cardiovascular dysfunction linked to depression and anxiety in PH-CHD, and investigates into the molecular pathways that connect the heart and brain. The ideas of psychological distress as a factor associated with chronic cardiovascular disease requires a more extensive interdisciplinary approach, which may ultimately affect favorable patient outcomes and long-term prognosis.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"18"},"PeriodicalIF":1.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761221","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":"Prevalence of Cerebrovascular Disease in Patients with Coronary Artery Disease After Pharmacological Stress Test.","authors":"Eman M Abdelfattah, Muhammad S Muhammad Hagrass, Khalid A Elkhashab, Sameh E Sadek, Hassan M Ebeid, Lamya O A Salih, Najah M Al-Amri, Mostafa S Mostafa, Haytham S Ghareeb","doi":"10.37616/2212-5043.1511","DOIUrl":"https://doi.org/10.37616/2212-5043.1511","url":null,"abstract":"<p><strong>Objectives: </strong>Coronary artery disease (CAD) and cerebrovascular disease (CVD) share common atherosclerotic pathways. However, the clinical significance of headache absence during stress testing remains unexplored. We investigated whether the absence of headache during pharmacological stress testing reflects the presence of subtle cerebrovascular atherosclerosis detectable by transcranial Doppler ultrasonography (TCD).</p><p><strong>Methods: </strong>This cross-sectional study enrolled 225 patients with CAD undergoing pharmacological stress testing with TCD and myocardial perfusion imaging (MPI) at centers in Egypt (Cardiology Department, Fayoum University). Patients were stratified by headache status during stress testing. Multivariate logistic regression and receiver-operating characteristic (ROC) analysis identified independent predictors of abnormal TCD findings.</p><p><strong>Results: </strong>The cohort comprised 123 patients without headache (mean age 59.0 ± 6.8 years) and 102 with headache (mean age 56.5 ± 4.5 years). TCD abnormalities were significantly more prevalent in patients without headache (81.3% vs 27.5%, p < 0.0001). On univariate analysis, age (p < 0.001), hypertension (p = 0.014), and positive MPI (trend, p = 0.191) were associated with abnormal TCD. After adjustment for between-cohort heterogeneity, multivariate analysis confirmed the absence of headache as the strongest independent predictor of TCD abnormality (adjusted odds ratio [aOR] = 0.09, 95% confidence interval [CI]: 0.04-0.19; 91% risk reduction; p < 0.001). Age was the only cardiovascular risk factor that retained independent significance (aOR = 1.09 per year; 95% CI: 1.03-1.16; p = 0.005). The full predictive model achieved excellent discrimination (area under the ROC curve (AUC) = 0.833; 95% CI: 0.780-0.884), with sensitivity of 68.0%, specificity of 86.6%, and positive predictive value (PPV) of 87.0%.</p><p><strong>Conclusions: </strong>This is the first evidence of a paradoxical association in pharmacological stress testing: absence of Headache is strongly associated with advanced subclinical cerebrovascular disease. This finding challenges the conventional interpretation of stress-test symptomatology and suggests new strategies for identifying high-risk CAD patients with silent cerebrovascular atherosclerosis who warrant aggressive preventive therapy. The utility of stress-induced symptom (Headache) profiles for risk stratification warrants prospective validation.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"19"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759917","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":"Efficacy of Sirolimus Versus Paclitaxel-Coated Balloons for Coronary Revascularization: An Updated Meta-Analysis with GRADE Assessment.","authors":"Matthew A Wijayanto, Christopher D Tristan, Erlangga M Kynaya, Annisa A Rahma, Putri S Harimurti, Arwin S Mangkuanom, Amir A Alkatiri, Doni Firman, Bambang B Siswanto","doi":"10.37616/2212-5043.1508","DOIUrl":"10.37616/2212-5043.1508","url":null,"abstract":"<p><p>Drug-coated balloons are an emerging strategy for coronary revascularization. Despite their increasing use, the comparative efficacy of sirolimus-versus paclitaxel-coated balloons (SCB vs PCB) remains uncertain. This updated meta-analysis evaluated clinical and angiographic outcomes of SCB and PCB in percutaneous coronary intervention (PCI). A comprehensive search of PubMed, Scopus, and ScienceDirect was performed on August 28, 2025. Studies directly comparing SCB and PCB were included. The primary endpoint was target lesion failure (TLF), which was defined as cardiac death, target vessel myocardial infarction (TVMI), or target lesion revascularization (TLR). On follow-up angiography, secondary endpoints consisted of minimal lumen diameter (MLD), late lumen loss (LLL), and diameter stenosis. Pairwise meta-analyses, subgroup analyses, and sensitivity analyses were performed. The certainty of evidence was evaluated with GRADE. Thirteen studies with 5947 patients (4097 SCB and 1850 PCB) were analyzed. SCB and PCB showed no significant differences in TLF (RR 1.10, 95% CI 0.84 to 1.44), cardiac death (RR 1.19, 95% CI 0.56 to 2.53), TLR (RR 1.12, 95% CI 0.91 to 1.37), and TVMI (RR 1.82, 95% CI 0.58 to 5.72). Subgroup analyses by lesion type and study design were consistent. Angiographic outcomes were comparable between groups, except for smaller insegment MLD with SCB (MD -0.10 mm, 95% CI -0.18 to -0.02; p = 0.01), although this finding was not robust in sensitivity analysis. Certainty of evidence was moderate for clinical outcomes and low to moderate for angiographic outcomes, primarily downgraded due to imprecision and inconsistency. In conclusion, SCB and PCB demonstrated comparable efficacy in PCI, with no significant differences in clinical and angiographic endpoints, irrespective of lesion types.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"17"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604328","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":"Determinants of Early Mortality After Congenital Heart Surgery: A 7-Year Single-center Experience in Saudi Arabia.","authors":"Saud A Bahaidarah, Jowana M Aljinaid, Amal A Alzahrani, Jana M Banjer, Lujain A Kofiyah, Nesmah A Noaman, Rahaf A Badkook, Raghad A Aljabri, Raghad S Alghamdi, Renad M Alamoudi, Sarah S Bawazir, Gaser A Abdelmohsen","doi":"10.37616/2212-5043.1506","DOIUrl":"10.37616/2212-5043.1506","url":null,"abstract":"<p><strong>Objectives: </strong>To determine predictors of early mortality among pediatric patients undergoing congenital heart surgery at a tertiary care center in Saudi Arabia.</p><p><strong>Methods: </strong>This retrospective cohort study included 955 pediatric patients who underwent congenital heart surgery at King Abdulaziz University Hospital, Jeddah, between January 2017 and December 2023. Demographic, clinical, operative, and postoperative variables were collected.</p><p><strong>Results: </strong>Overall mortality was 4.9%. Mortality was higher among neonates and infants and among patients with RACHS categories 4-6. Non-survivors had longer cardiopulmonary bypass times and more frequent delayed chest closure. Postoperative complications, including the need for extracorporeal membrane oxygenation (ECMO), depressed cardiac function, acute kidney injury, central nervous system (CNS) insult, infection, and prolonged mechanical ventilation and intensive care unit (ICU) stay, were strongly associated with mortality. In multivariate analysis, independent predictors of mortality were prolonged ICU stay, longer postoperative mechanical ventilation, postoperative ECMO support, and postoperative CNS insult.</p><p><strong>Conclusion: </strong>Early mortality was comparable to international benchmarks. Postoperative physiological deterioration, particularly ECMO requirement, neurological injury, prolonged ventilation, and extended ICU stay, was independently associated with death, underscoring the importance of early detection and targeted perioperative management.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"15"},"PeriodicalIF":1.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604317","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":"Intraoperative Tissue Oxygenation and Postoperative Creatinine Rise: Interpreting the Microcirculatory Context.","authors":"Bedirhan B Bayıcı, Fatih Kızılyel","doi":"10.37616/2212-5043.1494","DOIUrl":"10.37616/2212-5043.1494","url":null,"abstract":"","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"13"},"PeriodicalIF":1.4,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604403","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":"Comments on the Letter - Intraoperative Tissue Oxygenation and Postoperative Creatinine Rise: Interpreting the Microcirculatory Context.","authors":"Bhakti Banerjee, Haripada Das, Lini Srivastava, Snigdha Pramanik, Diptimay Majumder","doi":"10.37616/2212-5043.1495","DOIUrl":"10.37616/2212-5043.1495","url":null,"abstract":"","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"14"},"PeriodicalIF":1.4,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604349","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":"Intermittent Fasting in Chronic Heart Failure: A Systematic Review of Safety and Physiological Outcomes.","authors":"Zulrahman Erlangga, Prenali D Sattwika","doi":"10.37616/2212-5043.1503","DOIUrl":"10.37616/2212-5043.1503","url":null,"abstract":"<p><strong>Background and objectives: </strong>Interest in intermittent fasting regimens has expanded substantially due to its reported metabolic effects. However, whether such dietary patterns are safe for individuals living with chronic heart failure remains unclear. This issue is particularly relevant for patients who fast for religious observance, including Ramadan. We therefore performed a systematic review to evaluate the clinical safety and physiological implications of intermittent fasting regimens in stable heart failure populations.</p><p><strong>Methods: </strong>The review protocol adhered to established reporting standards for systematic reviews. Multiple electronic databases were systematically searched from inception through December 2025 to identify studies evaluating intermittent fasting regimens in adults with chronic heart failure. Both randomized and observational designs were considered eligible. Key outcomes included clinical deterioration, cardiovascular events, New York Heart Association functional status, left ventricular systolic performance, and natriuretic peptide levels. Where data allowed, pooled analyses were conducted; otherwise, findings were summarized narratively.</p><p><strong>Results: </strong>Five observational studies fulfilled inclusion criteria, three of which provided comparable data for quantitative synthesis, comprising 1345 participants. Across studies, fasting was not associated with increased rates of heart failure decompensation, major cardiovascular events, or mortality relative to non-fasting periods. Functional status remained generally stable, with a tendency toward improved symptom classification among fasting participants. Measures of systolic function and natriuretic peptides showed no clinically meaningful worsening.</p><p><strong>Conclusion: </strong>In clinically stable individuals with chronic heart failure, intermittent fasting regimens, including Ramadan fasting, were not linked to short-term adverse clinical outcomes based on currently available observational evidence.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"11"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352303","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":"Right Ventricular-Pulmonary Artery Coupling Predicts Early Myocardial Strain Improvement in SGLT2 Inhibitor-Treated HFrEF.","authors":"Mohammad A Hammad, Ramy M Elgamal, Arwa M Abouelkhir, Osama A Elshaer, Mohamed S Fahmy, Reda N Dawoud, Reda Biomy, Mohamed K Salama","doi":"10.37616/2212-5043.1504","DOIUrl":"10.37616/2212-5043.1504","url":null,"abstract":"<p><strong>Background: </strong>While sodium-glucose cotransporter-2 (SGLT2) inhibitors clearly benefit left ventricular recovery in heart failure with reduced ejection fraction (HFrEF), their rapid effects on right ventricular (RV) function remain poorly characterized. This prospective observational study investigated the timeline and markers of biventricular changes shortly after SGLT2 inhibitor initiation.</p><p><strong>Methods: </strong>In this prospective observational study, 50 adults with HFrEF (LVEF <40%) on optimal guideline-directed therapy underwent baseline and 3-month assessments after SGLT2 inhibitor initiation. Clinical parameters, functional capacity, and comprehensive echocardiography-including speckle-tracking-were evaluated.</p><p><strong>Results: </strong>After 3 months, NT-proBNP levels decreased significantly (1116.5 vs 913.5 pg/mL, P < 0.001). Improvements were observed in LV systolic function (LVEF 28.88 vs 30.32%, P = 0.001; LV-GLS -16.35% vs -17.70%, P = 0.001) and RV performance (RVEF 37.76 vs 39.40%, P = 0.002; RVFWS -16.8% vs -18.3%, P = 0.003). These changes were accompanied by gains in functional capacity (6MWT 291.4 ± 31.6 m vs 324.0 ± 36.8 m, P < 0.001) and quality of life (KCCQ-12 44.22 ± 7.88 vs 49.70 ± 8.19, P < 0.001). Improvement in RVFWS correlated strongly with changes in LV-GLS (r = 0.62, P < 0.001), 6MWT (r = -0.67, P < 0.001), and KCCQ-12 (r = -0.62, P < 0.001). Multivariable linear regression identified baseline NT-proBNP (β = 0.253, P = 0.032), ischemic etiology (β = 0.217, P = 0.044), and the TAPSE/PASP ratio (β = -0.510, P < 0.001) as independent predictors of RV strain improvement (model R² = 0.546). ROC analysis demonstrated that a baseline TAPSE/PASP ratio ≥0.39 predicted RV functional response (AUC 0.84; sensitivity 76%, specificity 84%).</p><p><strong>Conclusions: </strong>In this prospective observational study without a control group, SGLT2 inhibitor initiation was associated with coordinated biventricular improvements within three months in HFrEF patients. The baseline TAPSE/PASP ratio may serve as a useful non-invasive predictor of early RV functional recovery. These preliminary findings require confirmation in larger controlled studies.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"38 2","pages":"9"},"PeriodicalIF":1.4,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265213","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}