The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology最新文献

{"title":"Takayasu arteritis presenting with dysphagia and morning stiffness: a diagnostic challenge in a middle-aged woman.","authors":"Niloofar Najafi, Seyedeh Tahereh Faezi, Hakimeh Sadeghian, Khashayar Danandeh","doi":"10.1186/s43044-026-00774-z","DOIUrl":"https://doi.org/10.1186/s43044-026-00774-z","url":null,"abstract":"<p><strong>Background: </strong>Takayasu arteritis is a rare, chronic vasculitis affecting large arteries, primarily the aorta and its principal branches. The illness frequently presents with non-specific systemic symptoms, leading to a postponed diagnosis. Dysphagia resulting from aortic involvement is a rare manifestation and may resemble other cardiovascular or gastrointestinal disorders.</p><p><strong>Case presentation: </strong>We report a 45-year-old Iranian woman with a one-year history of exertional dyspnoea, intermittent dysphagia for solid food, and diffuse musculoskeletal pain with morning stiffness. Initial evaluation showed elevated inflammatory markers, moderate aortic regurgitation, and aneurysmal dilation of the ascending aorta and aortic arch, and infective endocarditis was initially suspected. After serial negative blood cultures and resolution of a suspicious valvular finding on repeat transoesophageal echocardiography, upper gastrointestinal endoscopy and endoscopic ultrasonography localised her dysphagia to extrinsic oesophageal compression by the dilated thoracic aorta. Computed tomography angiography confirmed a non-dissecting aneurysm of the ascending aorta and arch, and whole-body ¹⁸F-FDG PET demonstrated markedly increased metabolic activity along the thoracic aorta and its supra-aortic branches, consistent with active large-vessel vasculitis. After systematic exclusion of infective and other inflammatory mimics, a clinical diagnosis of Takayasu arteritis was made.</p><p><strong>Conclusion: </strong>This case illustrates an uncommon presentation of Takayasu arteritis with dysphagia produced by extrinsic oesophageal compression from thoracic aortic aneurysmal dilatation. Constitutional symptoms, elevated inflammatory markers, and unexplained cardiovascular findings should prompt evaluation for large-vessel vasculitis. Early multimodal imaging and a systematic approach to excluding infective and other inflammatory mimics are essential for accurate diagnosis and timely treatment.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalies of coronary artery origin at invasive angiography: a prospective study of prevalence, catheter utilisation, access strategy and procedural implications.","authors":"Qayoom Yousuf, Aamir Rashid, Sameer Purra, Imran Hafeez, Bilal Syed, Aadil Amin Shah","doi":"10.1186/s43044-026-00773-0","DOIUrl":"10.1186/s43044-026-00773-0","url":null,"abstract":"<p><strong>Background: </strong>Anomalies of coronary artery origin are uncommon congenital variants that may pose a challenge to selective engagement at invasive coronary angiography (CAG). Although their prevalence and anatomical spectrum are well described, prospective data on the diagnostic and guide catheter utilisation to engage each anomaly subtype, procedural implications and on the access strategy adopted in current radial-first practice, remain limited.</p><p><strong>Methods: </strong>We prospectively enrolled 1,850 consecutive adults undergoing invasive CAG, with or without percutaneous coronary intervention (PCI). Anomalies of origin were defined by the modified Angelini classification; intrinsic anomalies and anomalies of termination were excluded. Baseline, angiographic, procedural data - including diagnostic and guide catheter use by subtype; and access strategy were compared between anomaly and non-anomaly groups.</p><p><strong>Results: </strong>An anomaly of origin was identified in 85 of 1,850 patients (4.59%; 95% CI 3.71-5.63%); under a restricted definition that excluded two anatomical variants not consistently classified as anomalies in earlier invasive-angiography series, prevalence was 1.30% (95% CI 0.83-1.92%). The commonest anomaly was ectopic (high or anterior) right coronary artery (RCA) origin from the right coronary cusp (n = 47; 55.3%), followed by separate ostia of left anterior descending (LAD) and left circumflex (LCx) arteries (n = 14; 16.5%) and anomalous LCx from the right coronary cusp or RCA (n = 14; 16.5%). PCI was performed in 52 of 85 anomaly patients (61.2%). Radial access was attempted in 67 patients: 53 (79.1%) completed radially, 14 (20.9%) required crossover to femoral; and 18 were attempted femorally. Anomaly patients required more diagnostic catheters per case (2.20 vs. 1.23), with the greatest burden in crossover cases (3.14 vs. 1.17 catheters); more access crossover (16.5% vs. 5.0%) and more guide catheter changes (44.2% vs. 6.5%; all p < 0.001),. No significant difference in major procedural complications was observed (4.7% vs. 2.7%; p = 0.43); however the study was not powered for rare procedural events.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702748","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":"Electromechanical window as an integrative marker of remodeling and arrhythmic risk in biventricular vs. left bundle branch area pacing.","authors":"Arvind Kumar, Tania Bansal, Salil Jaura","doi":"10.1186/s43044-026-00772-1","DOIUrl":"10.1186/s43044-026-00772-1","url":null,"abstract":"<p><strong>Background: </strong>The electromechanical window (EMW), defined as the difference between mechanical and electrical systole, is an emerging marker of arrhythmic risk and ventricular dysfunction. Although cardiac resynchronization therapy (CRT) improves mechanical synchrony, the influence of different pacing strategies on EMW is not well established. This study compared the effects of conventional biventricular (BiV) pacing and left bundle branch area pacing (LBBAP) on EMW, reverse remodeling, CRT response, and arrhythmic burden.</p><p><strong>Methods: </strong>In this prospective, observational study, 80 patients with left ventricular ejection fraction (LVEF) ≤ 35% undergoing CRT received BiV pacing (n = 40) or LBBAP (n = 40). Echocardiography with simultaneous electrocardiography was performed at baseline and 6 months. The primary endpoint was change in EMW.</p><p><strong>Results: </strong>At 6 months, LBBAP was associated with greater QRS narrowing (42 ± 15 vs. 28 ± 13 ms, p < 0.001) and EMW normalization (- 38 ± 22 to - 5 ± 18 ms vs. - 36 ± 20 to - 18 ± 19 ms; p = 0.003). Improvements in LVEF, global longitudinal strain, and left ventricular end-systolic volume were also greater with LBBAP. EMW improvement correlated with reverse remodeling and QRS narrowing. Baseline EMW predicted CRT response (AUC 0.71), while persistent EMW negativity was associated with a higher incidence of non-sustained ventricular tachycardia (45% vs. 18%, p = 0.01).</p><p><strong>Conclusions: </strong>LBBAP was associated with greater EMW normalization, improved reverse remodeling, and a lower arrhythmic burden than BiV pacing. EMW may represent an integrative marker of CRT response and residual arrhythmic risk. These findings are hypothesis-generating and require validation in larger multicenter randomized studies.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681418","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":"Predictors of atrial fibrillation recurrence after catheter ablation: a systematic review.","authors":"Muhanned Faisal Towfig, Mohamed Salah Khalil Salih, Omer Yahia Elhadi Suliman, Mugtaba Ahmed, Selma Ali, Moiad Faisal Suliman Tawfig, Fatima Salah Khalil Salih","doi":"10.1186/s43044-026-00765-0","DOIUrl":"10.1186/s43044-026-00765-0","url":null,"abstract":"<p><strong>Background: </strong>Recurrence of atrial fibrillation (AF) following catheter ablation is a major clinical problem, and there is considerable variability in patient outcomes. The identification of reliable predictors of AF recurrence is critical in developing patient management strategies.</p><p><strong>Objective: </strong>To systematically identify and synthesize evidence on independent predictors of atrial fibrillation recurrence following catheter ablation derived from multivariable prognostic models.</p><p><strong>Methods: </strong>A systematic review was carried out following the PRISMA 2020 guidelines. A comprehensive search was done using PubMed, PubMed Central, Google Scholar, CORE, and DOAJ. Studies were filtered based on the keywords entered with a publication date ranging from January 2016 to January 2026. The tool used for bias assessment was ROBINS-I. Due to the heterogeneity of the data, the results were synthesized narratively, and descriptive statistics were used to measure study characteristics. Conversely, the certainty of the evidence was assessed using the GRADE approach.</p><p><strong>Results: </strong>Out of the identified 24,083 records, after removing the duplicates, 6817 studies were screened, followed by the collection of 148 full-text articles, and finally, 21 studies were selected for the synthesis after meeting all the inclusion criteria. Advanced age, persistent AF phenotype, increased left atrial size, elevated left atrial pressure, renal dysfunction, frailty, and metabolic abnormalities emerged as the most consistent predictors of AF recurrence. Structural and clinical predictors demonstrated high-certainty evidence. Several biomarkers, including soluble ST2, trimethylamine N-oxide, B-type natriuretic peptide, and insulin resistance indices, were independently associated with AF recurrence, although the certainty of evidence was moderate. Machine learning and radiomics-based models demonstrated promising predictive performance but were limited by insufficient external validation and reduced interpretability.</p><p><strong>Conclusion: </strong>Atrial fibrillation recurrence after catheter ablation seems to result from the interaction between atrial remodeling, metabolic and inflammation dysfunction, and patients' clinical features. Conventional predictors based on clinical and structural information seem to be the most robust indicators in terms of prognosis, while novel predictors such as biomarkers and machine-learning approaches require further external validation to be utilized in practice.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623142","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":"Assessment of adherence to acute pulmonary embolism management guidelines: a single-centre registry.","authors":"Hesham Salah Eldin Taha, Noha Hassanein, Heba Mostafa Kamal, Mirna Mamdouh Shaker, Mohamed Osama, Nouran Hisham","doi":"10.1186/s43044-026-00771-2","DOIUrl":"10.1186/s43044-026-00771-2","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) remains a complex clinical challenge with significant morbidity and mortality. Despite significant advancements in diagnosis and management, as well as the availability of recent guidelines, disparities in their implementation persist due to socioeconomic factors and other barriers. The study aims to assess the degree of implementation of guidelines in the diagnosis and management of PE.</p><p><strong>Results: </strong>Among 8,648 patients presenting to the National Heart Institute emergency department, 200 were diagnosed with acute PE, accounting for 2.3% of ED visits during the study period. The mean age was 56.7 ± 9.8 years, with 58% being female. Dyspnea was the most common symptom, occurring in 64% of cases, while bed rest for > 3 days was the most frequent risk factor (32%). Computed tomography pulmonary angiography (CTPA) confirmed PE in 95.5% of cases. Risk stratification classified 80% as low to intermediate-low risk, 13% as intermediate-high risk, and 6% as high-risk. Unfractionated heparin monotherapy was initiated in 63% of patients, while only 8.5% were discharged on direct oral anticoagulants (DOACs). Mortality was 3%, including 1% due to life-threatening bleeding. There was notable overuse of D-dimer testing, underutilization of ventilation-perfusion (V/Q) scans, limited prescription of DOACs, and absence of interventional therapies in eligible patients.</p><p><strong>Conclusions: </strong>This study highlights critical gaps in adherence to PE management guidelines, influenced by physician discretion, socioeconomic constraints, and diagnostic inconsistencies. Strengthening outpatient care pathways, refining risk stratification practices, and ensuring consistent guideline implementation are key priorities to optimize outcomes.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594932","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":"Chronic draining xiphisternal fistula associated with fractured right coronary artery stent and transdiaphragmatic inflammatory extension: a multimodality imaging and surgical correlation.","authors":"Zakiur Rehman Ansari, Zainul Abedein Hamdulay, Azizullah Khan, Sanjesh Jain, Meher Hamdulay","doi":"10.1186/s43044-026-00770-3","DOIUrl":"10.1186/s43044-026-00770-3","url":null,"abstract":"<p><strong>Background: </strong>Delayed coronary stent-related inflammatory complications following percutaneous coronary intervention (PCI) are exceptionally rare, and chronic cutaneous fistulization years after stent implantation has only rarely been described. Such indolent presentations may mimic superficial chest wall infections, making diagnosis challenging. Multimodality imaging is essential for accurate diagnosis and surgical planning.</p><p><strong>Case presentation: </strong>A 53-year-old man with type 2 diabetes mellitus and ischemic heart disease underwent right coronary artery (RCA) stenting in 2018. He presented with recurrent intermittent fever and a persistent draining xiphisternal sinus for seven months following incision and drainage of a presumed chest wall abscess. Ultrasonography demonstrated a localized subcutaneous collection. Contrast-enhanced computed tomography and CT coronary angiography (CTCA) revealed a fractured, chronically occluded RCA stent with extensive peri-stent inflammatory soft tissue extending into the pericardium, diaphragm, and subdiaphragmatic region. Cardiac magnetic resonance imaging confirmed transdiaphragmatic inflammatory extension and a fistulous tract communicating with the overlying skin. Transesophageal echocardiography was not performed because transthoracic echocardiography and cross-sectional imaging adequately delineated the lesion and showed no evidence of endocarditis. Following preoperative and perioperative antibiotic therapy, the patient underwent surgical excision of the fractured stent, chronic fibro-inflammatory tissue, and sinus tract. Intraoperative cultures and GeneXpert testing were negative, possibly reflecting prior prolonged antibiotic therapy. The postoperative course was uneventful, with complete wound healing, resolution of fever, and follow-up transthoracic echocardiography demonstrating no pericardial collection or valvular vegetations.</p><p><strong>Conclusions: </strong>This case highlights an exceptionally rare delayed culture-negative chronic peri-stent inflammatory fistulizing process associated with RCA stent fracture presenting nearly seven years after PCI. It emphasizes the importance of maintaining a high index of suspicion in patients with persistent chest wall sinuses after coronary intervention and demonstrates the complementary role of CTCA and cardiac magnetic resonance imaging in defining disease extent and guiding successful surgical management.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581542","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":"Comparison of KONAR-multifunctional occluder and Amplatzer occluders in transcatheter closure of patent arterial ducts and ventricular septal defects.","authors":"Fatma Aboalsoud Taha, Marwa Desoky Abohamar, Raghda Ghonimy Elsheikh, Nouran Mostafa Mansour","doi":"10.1186/s43044-026-00768-x","DOIUrl":"10.1186/s43044-026-00768-x","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter closure of patent ductus arteriosus (PDA) and ventricular septal defect (VSD) is performed using various occluder devices.</p><p><strong>Objective: </strong>We aim to compare the use of KONAR-Multifunctional Occluder (KONAR-MFO) and Amplatzer occluders (ADO-I, ADO-II) for closure of PDAs and VSDs.</p><p><strong>Methods: </strong>This is a retrospective study on patients who underwent transcatheter PDA or VSD closure between June 2023 and October 2025. Patients were categorized according to the occlusion device and the underlying defect. Data were analysed comprehensively.</p><p><strong>Results: </strong>The study included 173 patients; 116 (67.1%) and 57 (32.9%) underwent PDA and VSD closure, respectively, using 99 ADO-I, 53 KONAR-MFO, and 21 ADO-II devices. The KONAR-MFO was used in smaller, younger patients, and the ADO-I in heavier, older patients (p < 0.05). The ADO-I was used for PDA type-A (40.4%), type-E (12.1%), type-C and D (9.1% for each), as well as perimembranous and muscular VSDs (13.1% each). The KONAR-MFO was used for peri-membranous VSDs (47.2%), Gerbode-type VSDs (5.7%), and PDA type-B (14.1%). The ADO-II was employed for PDA type-E (57.1%) and type-C (42.9%), without use in VSDs. The KONAR-MFO and ADO-II devices showed the shortest procedural and fluoroscopy times with the lowest contrast use, owing to single-access deployment without arteriovenous loop formation. Freedom from all types of complications was 73.9%, 71.1%, and 66.7% for KONAR-MFO, ADO-I, and ADO-II, respectively. In ADO-I, residual shunt, device embolization, and complete heart block occurred in 2.0% each. In KONAR-MFO, left pulmonary artery (LPA) stenosis and mild aortic regurgitation were observed in 3.8% each, while residual shunt and device embolization were observed in 1.9%. ADO-II was associated with the highest residual shunt and device embolization, both occurring at 9.5%.</p><p><strong>Conclusions: </strong>ADO-I was used to close PDA and VSD, with longer procedural times. KONAR-MFO offered useful applications across complex VSDs with safety profiles in smaller, younger patients. ADO-II was preferred for tubular and elongated PDAs.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551657","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":"Egyptian Society of Cardiology national advisory statement revisiting antiplatelet therapy: insights from E. S. C. 2025 hot-line trials.","authors":"Sameh Shaheen, Khaled Shokry, Islam Shawky, Hamza Kabil, Gamela Nasr, Mohamad Abd Elghany, Moustafa Mokarrab, Yasser Abd Elhady, Basem Zareef, Haitham Soliman, Mohamad Zahran, Magdy Abd Elhameed","doi":"10.1186/s43044-026-00769-w","DOIUrl":"10.1186/s43044-026-00769-w","url":null,"abstract":"<p><strong>Background: </strong>Antiplatelet therapy remains a cornerstone of the management of acute (ACS) and chronic coronary syndromes (CCS). The 2025 European Society of Cardiology (ESC) Congress presented several pivotal Hot-Line trials that challenge established paradigms regarding dual antiplatelet therapy (DAPT) duration, agent selection, and risk-based personalization.</p><p><strong>Purpose: </strong>This national advisory statement synthesizes the clinical value and implications of 11 major antiplatelet trials presented at ESC 2025 and provides evidence-aligned, context-specific recommendations for cardiovascular practice in Egypt.</p><p><strong>Methods: </strong>A structured review of ESC 2025 Hot-Line antiplatelet trials was conducted. Evidence was appraised using a predefined grading framework, and national consensus was achieved through a multi-institutional expert panel using modified Delphi methodology. Recommendations were assigned Class of Recommendation and Level of Evidence according to ESC/ACC standards.</p><p><strong>Results: </strong>The trials addressed antiplatelet therapy in six clinical pathways: ACS, primary PCI in STEMI, cardiogenic shock, post-CABG, complex PCI, and chronic coronary syndrome requiring oral anticoagulation. Key findings include: (1) selective use of shortened DAPT in stabilized ACS; (2) a potential role for P2Y12 monotherapy after 1 month in low-risk, fully revascularized MI; (3) lack of benefit from ultra-early aspirin withdrawal; (4) no superiority of twice-daily aspirin in high-risk ACS; (5) twice-daily clopidogrel for 1 month as a possible alternative to ticagrelor in resource-limited STEMI settings; (6) superior platelet inhibition with intravenous cangrelor in cardiogenic shock without proven clinical superiority; (7) emerging evidence supporting shorter DAPT or aspirin monotherapy after CABG; (8) score-guided DAPT duration in complex PCI; and (9) confirmation that aspirin should not be added to oral anticoagulation in stable coronary disease.</p><p><strong>Conclusion: </strong>The Egyptian Society of Cardiology supports a more individualized, risk-based approach to antiplatelet therapy, emphasizing ischemic-bleeding balance, stent technology, revascularization completeness, and national resource considerations. Recommendations should be interpreted cautiously given the preliminary nature of some ESC 2025 data.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13388613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537861","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":"A systematic review and meta-analyses of glucagon-like peptide-1 receptor agonists in acute myocardial infarction.","authors":"Jasmin Kaur Bhullar, Amol Bahekar","doi":"10.1186/s43044-026-00767-y","DOIUrl":"10.1186/s43044-026-00767-y","url":null,"abstract":"<p><strong>Background: </strong>Previous research has shown that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have cardioprotective effects. However, their efficacy in acute myocardial infarction (AMI) is not yet well established. We conducted a systematic review and meta-analyses to assess the impact of GLP-1 RAs in AMI.</p><p><strong>Methods: </strong>We systematically searched major databases for studies in patients with ST-elevation (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). These included MEDLINE (accessed via PubMed), Excerpta Medica dataBASE (Embase), Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Google Scholar from their inception through February 2026. PRISMA guidelines were used to conduct this review. Both randomized controlled trials (RCTs) and observational studies were included in the systematic review. However, only RCTs were included in the meta-analyses. The primary outcome was infarct size relative to the area at risk (AAR). Secondary outcomes included major adverse cardiovascular events (MACE) and safety outcomes (nausea, hypoglycemia, pancreatitis). The Cochrane Risk of Bias 2 (RoB 2) tool and Newcastle-Ottawa Scale (NOS) were used to assess risk of bias.</p><p><strong>Results: </strong>We included eight studies with a total of 1,483 participants. GLP-1 RAs led to a smaller infarct size indexed to the AAR compared with placebo. The mean reduction was 10.14% points (95% confidence interval [CI]: -14.11--6.17; P < 0.001). The primary infarct-size analysis was based on only three RCTs. GLP-1 RAs led to an improvement in the left ventricular ejection fraction (LVEF). The absolute mean improvement was 2.93% points (95% CI: 0.18-5.67; P < 0.05). Subgroup analyses were conducted to explore the findings in greater detail. They revealed that liraglutide was associated with an even higher absolute increase in LVEF. The absolute mean improvement was 5.32% points (95% CI: 3.49-7.15; P < 0.01). Nausea was more frequent in the treatment group, while hypoglycemia and pancreatitis were not significantly increased. Limitations included relatively small sample sizes in the individual studies, short follow-up periods, and variability in study designs.</p><p><strong>Conclusions: </strong>In patients with AMI, GLP-1 RAs reduce relative infarct size and improve LVEF. No clear safety signal was detected in the available short-term trial data, except for increased nausea. These results indicate that GLP-1 RAs could be beneficial as an additional treatment in AMI.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13388624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537798","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":"Association of winter exposure with ischemic stroke risk in nonvalvular atrial fibrillation within a CHADS₂-based risk framework: a nationwide Japanese administrative claims database study.","authors":"Ryusuke Sakuma, Shuko Nojiri, Takuya Uematsu, Masashi Nagao, Muneaki Ishijima, Yuji Nishizaki","doi":"10.1186/s43044-026-00766-z","DOIUrl":"10.1186/s43044-026-00766-z","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke, including transient ischemic attack, exhibits seasonal variation, and the association between winter exposure and ischemic stroke risk in patients with nonvalvular atrial fibrillation (NVAF) has not been fully characterized at the population level. We investigated the association of winter exposure with ischemic stroke risk in Japanese patients with NVAF within a CHADS₂-based risk framework.</p><p><strong>Results: </strong>We analyzed nationwide Japanese insurance claims data (2014-2022) to identify patients ≥ 60 years with newly diagnosed NVAF and subsequently conducted Poisson regression analyses. The outcome was hospitalization for ischemic stroke. Among 389,314 patients (median age 80 years), 24,576 (6.3%) had ischemic stroke. The incidence rate peaked in winter (December-February), reaching 35.0 per 1,000 person-years, the highest among all seasons. In a Poisson regression model adjusted for CHADS₂ components, with winter treated as a binary exposure, winter remained independently associated with ischemic stroke risk (adjusted incidence rate ratio 1.06, 95% CI 1.03-1.09). Adding winter exposure to the CHADS₂ framework improved model fit but resulted in only negligible improvement in discrimination (AUC 0.690 vs. 0.691). In interaction analyses with CHADS₂ components, the association between winter exposure and ischemic stroke risk was stronger in patients without prior ischemic stroke than in those with prior ischemic stroke (p = 0.033).</p><p><strong>Conclusions: </strong>In patients with NVAF, winter exposure was associated with a modest increase in ischemic stroke risk at the population level. The stronger association observed among patients without prior ischemic stroke may support seasonal risk awareness and population-level risk communication in the primary prevention setting.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474700","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}