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

{"title":"Stent fracture and embolization: an unusual late complication of neonatal coarctation of aorta stenting with bioresorbable vascular scaffold.","authors":"Qayoom Yousuf, Aamir Rashid, Sameer Purra, Syed Bilal, Mehraj Khan","doi":"10.1186/s43044-026-00778-9","DOIUrl":"10.1186/s43044-026-00778-9","url":null,"abstract":"<p><strong>Background: </strong>Critical neonatal coarctation of the aorta (CoA) may present with cardiogenic shock and severe ventricular dysfunction, rendering immediate surgical repair high risk. In such situations, transcatheter interventions may be used as a temporary stabilizing strategy.</p><p><strong>Case presentation: </strong>A 10-day-old male neonate with critical CoA presented in cardiogenic shock and severe left ventricular dysfunction. Balloon angioplasty resulted in only transient improvement due to elastic recoil, necessitating rescue implantation of a bioresorbable vascular scaffold. This led to rapid haemodynamic stabilization and recovery of ventricular function. Follow-up computed tomography angiography revealed late scaffold fracture with distal embolization to the proximal abdominal aorta. The child remained clinically stable and subsequently underwent successful elective surgical repair.</p><p><strong>Conclusion: </strong>Although bioresorbable vascular scaffolds can provide short-term haemodynamic stabilization in critically ill neonates with CoA, their use is limited by mechanical vulnerability in the neonatal aorta, as illustrated by late scaffold fracture in this case. Their role should therefore be highly selective, with close imaging surveillance and early definitive surgical correction.</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":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972654","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":"Identification and reporting of heart failure with preserved ejection fraction in Sub-Saharan Africa: a scoping review of diagnostic approaches, echocardiographic assessment, and evidence gaps.","authors":"Faith Adedayo Adejumo, Samuel Gbolagunte Olaniyan, Temilade Patience Adejumo, Sandra Kikelomo Odunaro, Humuani Ajibola Oba, Boluwatife Juwon Falope, Olanike Elizabeth Kasali, Oluwayimika Oluwatobi Obielodan, Nicholas Aderinto","doi":"10.1186/s43044-026-00779-8","DOIUrl":"10.1186/s43044-026-00779-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a major heart failure phenotype globally; however, its diagnosis is complex and is recommended to require integrated assessment of clinical features, echocardiographic abnormalities, and biomarkers. In Sub-Saharan Africa (SSA), where diagnostic resources are limited, HFpEF identification may rely on simplified approaches, potentially leading to under-recognition and heterogeneity in reporting. This review evaluates how HFpEF is identified and reported in SSA, with emphasis on diagnostic approaches, echocardiographic characterization, and biomarker use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A scoping review of observational studies reporting heart failure with left ventricular ejection fraction (LVEF) data in Sub-Saharan Africa (SSA) was conducted using predefined eligibility criteria and reported in accordance with PRISMA-ScR. PubMed, Google Scholar, Web of Science, and African Journals Online (AJOL) were searched for relevant studies published in English from database inception to May 2026. Data were extracted on HFpEF definitions, echocardiographic parameters, biomarker use, and diagnostic approaches and frameworks used during the respective study periods. Contemporary HFpEF diagnostic frameworks, including HFA-PEFF and H₂FPEF, were considered separately when interpreting the compatibility of reported phenotyping approaches with current diagnostic concepts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;10 observational studies involving 3,821 patients with heart failure, published between 2009 and 2024, were included. Studies were conducted in South Africa, Nigeria, Senegal, Côte d'Ivoire, Cameroon, and Tanzania, with two multicountry Sub-Saharan African registries also represented. HFpEF definitions were inconsistent, with most studies relying primarily on LVEF ≥ 50% without application of structured diagnostic algorithms. Only two studies reported dedicated HFpEF cohorts, while the remainder identified HFpEF as a subgroup within broader heart failure populations. Echocardiographic reporting was highly variable; left ventricular hypertrophy and left atrial enlargement were the most frequently reported structural abnormalities, but diastolic function parameters were inconsistently assessed, and formal grading was rare. Natriuretic peptides were infrequently measured and seldom integrated into diagnostic classification. No study applied contemporary multiparametric diagnostic frameworks such as HFA-PEFF or H₂FPEF scoring systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;HFpEF in SSA is predominantly identified using simplified ejection fraction-based criteria, with limited integration of echocardiographic diastolic assessment and biomarker data. This results in heterogeneous and potentially non-standardized phenotyping across studies, limiting comparability and accurate disease estimation. Strengthening diagnostic standardization through structured echocar","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":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972659","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":"Clinical and procedural outcomes of ostial left anterior descending artery intervention with or without crossover to left-main.","authors":"Mohamed Sayed, Yasutsugu Shiono, Doaa A Fouad, Ahmed Abdel-Galeel, Rikuya Tanaka, Shin Murakami, Satoshi Hata, Keisuke Yamamoto, Keiya Komatsu, Yuta Takano, Yoshinori Asae, Hiroki Emori, Akira Taruya, Masahiro Takahata, Teruaki Wada, Shingo Ota, Yuichi Ozaki, Manabu Kashiwagi, Akio Kuroi, Takashi Yamano, Hironori Kitabata, Atsushi Tanaka, Aly Tohamy","doi":"10.1186/s43044-026-00777-w","DOIUrl":"10.1186/s43044-026-00777-w","url":null,"abstract":"<p><strong>Background: </strong>It remains debated whether just ostial stenting (JOS) or crossover stenting (COS) is optimal for isolated ostial lesions of the left anterior descending (LAD) artery, and available comparative data on intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) remains limited. We aim to compare clinical outcomes between the strategies and identify determinants of strategy selection.</p><p><strong>Methods and results: </strong>This retrospective study included 172 patients with isolated ostial LAD lesions who underwent IVI-guided PCI with either JOS (n = 112) or COS (n = 60) between 2018 and 2025. The primary endpoint was two-year major adverse cardiac events (MACEs), defined as all-cause mortality, myocardial infarction, and any revascularization. MACE rates did not differ significantly in both strategies (23% vs.17%; adjusted hazard ratio: 0.74; 95% confidence interval [CI]: 0.37-1.49; P = 0.40). LAD diameter on angiography (odds ratio [OR] 2.04, 95% CI 1.03-4.05, P = 0.040) and LAD proximal reference area measured by IVI (OR 1.26, 95% CI 1.02-1.55, P = 0.033) were independently associated with selecting JOS over COS. Optimal minimum stent areas (MSA) were achieved in most cases in both groups (89% vs. 98%, P = 0.032).</p><p><strong>Conclusions: </strong>Under IVI-guided PCI, clinical outcomes showed no significant difference between JOS and COS, and LAD anatomy determined the strategy. These findings support individualized, anatomy-driven technique selection and IVI-guided procedural optimization for ostial LAD lesions.</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":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964019","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":"Transient ST-segment elevation following coronary artery bypass grafting in a patient with immune thrombocytopenia treated with romiplostim: a case report.","authors":"Zakiur Rehman Ansari, Zainul Abedein Hamdulay, Azizullah Khan, Sanjesh Jain, Meher Hamdulay, Aziz Kothawala","doi":"10.1186/s43044-026-00776-x","DOIUrl":"10.1186/s43044-026-00776-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;ST-segment elevation following coronary artery bypass grafting (CABG) is a clinically important postoperative finding that may indicate perioperative myocardial infarction, early graft failure, or acute coronary compromise. However, non-ischemic postoperative processes may produce similar electrocardiographic abnormalities, creating diagnostic uncertainty, particularly in clinically stable patients. Patients with immune thrombocytopenia (ITP) undergoing cardiac surgery present an additional therapeutic challenge because of the competing risks of bleeding and thrombosis. Thrombopoietin receptor agonists (TPO-RAs), such as romiplostim, may be used to increase platelet counts before invasive procedures, but their use requires careful assessment in patients with concomitant cardiovascular disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;A 47-year-old man with chronic ITP and multivessel coronary artery disease underwent elective CABG following preoperative administration of romiplostim for platelet optimization. Forty-eight hours after receiving romiplostim, his platelet count increased from 57 × 10⁹/L to 125 × 10⁹/L. Four-vessel CABG was performed, with a pedicled left internal mammary artery (LIMA) grafted to the left anterior descending artery (LAD) and a right internal mammary artery (RIMA) used as a Y-graft arising from the LIMA and directed sequentially to the diagonal branch, ramus intermedius, and posterior descending artery (PDA). The operation was initially attempted off-pump but was converted to cardiopulmonary bypass because of challenging coronary anatomy and inadequate target-vessel exposure. On postoperative day one, routine electrocardiography demonstrated new ST-segment elevation in leads II, III, and aVF, accompanied by PR-segment depression. A pericardial friction rub was documented. The patient remained clinically asymptomatic and hemodynamically stable. Transthoracic echocardiography showed preserved left ventricular systolic function without new regional wall motion abnormalities or pericardial effusion. High-sensitivity cardiac troponin I (hs-cTnI) was 0.9 ng/mL on postoperative day one and declined to 0.3 ng/mL on postoperative day three (laboratory reference range, 0-0.6 ng/mL). C-reactive protein and erythrocyte sedimentation rate were elevated to 120 mg/L and 68 mm/h, respectively; preoperative inflammatory marker values were unavailable.Given the absence of clinical or echocardiographic evidence of ongoing ischemia, declining cardiac biomarkers, preserved ventricular function, and the additional procedural bleeding risk associated with ITP, immediate coronary angiography was deferred. The patient was managed with close monitoring, aspirin, prophylactic low-molecular-weight heparin, indomethacin, and intravenous nicorandil during the initial assessment. The ST-segment elevation resolved by postoperative day three without clinical evidence of ongoing myocardial ischemia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conc","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":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932077","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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898608","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":"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}