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

{"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}

{"title":"Efficacy of multipoint versus conventional biventricular pacing in CRT: systematic review and meta-analysis of randomized trials.","authors":"Tasneem Zanati Saeed, Ahmed Elkhouly, Waseem Emara, Nada Gamil, Imad Samman Tahhan, Bashar Abu-Mallouh, Rawan Fawzy, Basel Mohamed, Ahmed Adel Mohamed, Ahmed M Gazer","doi":"10.1186/s43044-026-00761-4","DOIUrl":"10.1186/s43044-026-00761-4","url":null,"abstract":"<p><strong>Background: </strong>MultiPoint Pacing (MPP) may enhance the clinical and echocardiographic response to Cardiac Resynchronization Therapy (CRT), but randomized evidence remains inconsistent. The objective of this study is to compare the efficacy and safety of MPP versus conventional biventricular (BiV) pacing in patients with heart failure and reduced ejection fraction.</p><p><strong>Methods: </strong>We conducted a PROSPERO-registered (CRD420251033856) systematic review and meta-analysis of randomized controlled trials evaluating MPP versus BiV pacing. Outcomes included LVESV reduction, LVEF improvement, clinical response rate, super-response rate, and conversion to non-responder. Data were synthesized using random-effects models, and certainty was assessed with GRADE.</p><p><strong>Results: </strong>Six RCTs (n = 1,766) were included. MPP significantly improved LVEF (MD 5.16%, 95% CI 3.17-7.15; P < 0.0001), clinical response rate (RR 1.35, 95% CI 1.18-1.55; P < 0.0001), and super-response rate (RR 1.54, 95% CI 1.15-2.06; P = 0.004). The pooled LVESV analysis showed a nominally significant benefit with MPP, but this was accompanied by substantial heterogeneity and a prediction interval crossing zero, limiting confidence in a universal effect; the benefit appeared more consistent in CRT-naïve patients. No significant improvement was observed in non-responder conversion (RR 0.99). Overall certainty ranged from very low to moderate.</p><p><strong>Conclusion: </strong>Multipoint pacing is associated with signals of improved left ventricular reverse remodeling and higher clinical response rates compared with conventional biventricular pacing. However, the high heterogeneity and a 95% prediction interval crossing zero for LVESV reduction indicate that this effect is not consistent across all populations. MPP provides clinically meaningful benefits primarily in selected patient subgroups-particularly in CRT-naïve and responder populations-rather than serving as a universal rescue strategy for established non-responders.</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":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414241","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":"From inflammation to inheritance: rethinking myocarditis as the first signal of desmosomal cardiomyopathy.","authors":"Antoine Fakhry AbdelMassih, Anna Carinina Sankari, George Mallouka, Haya Sameh Ahmad Hattab, Jumana Abutaleb, Meera Albalooshi, Reem Abukhater, Shirin Khan","doi":"10.1186/s43044-026-00764-1","DOIUrl":"10.1186/s43044-026-00764-1","url":null,"abstract":"<p><strong>Background: </strong>Acute myocarditis has traditionally been regarded as an acquired inflammatory disorder of the myocardium, most commonly triggered by viral infection or immune-mediated injury. However, emerging evidence suggests that in a substantial subset of patients, myocarditis may represent the initial clinical manifestation of an underlying genetic cardiomyopathy rather than a purely inflammatory disease. Recent advances in molecular genetics, cardiac magnetic resonance (CMR) imaging, and translational pathology have highlighted a growing overlap between myocarditis and inherited cardiomyopathies, particularly those associated with desmosomal dysfunction.</p><p><strong>Main body: </strong>Variants in desmosomal genes-most commonly involving desmoplakin (DSP), plakophilin-2 (PKP2), and desmoglein-2 (DSG2)-have increasingly been reported in patients presenting with myocarditis-like syndromes characterized by chest pain, troponin elevation, and CMR findings fulfilling the Lake Louise criteria. Observational and registry studies suggest that some of these patients subsequently experience recurrent episodes of myocardial injury, ventricular arrhythmias, and progressive fibrotic or fibrofatty myocardial remodeling, eventually developing phenotypic features consistent with arrhythmogenic cardiomyopathy (ACM). ACM is used throughout this review as an inclusive umbrella term encompassing classical arrhythmogenic right ventricular cardiomyopathy (ARVC) as well as biventricular and left-dominant variants. Experimental and translational studies further suggest mechanistic links between desmosomal dysfunction and myocardial inflammation, including DAMP-mediated innate immune activation and the generation of anti-desmoglein-2 (anti-DSG2) autoantibodies. While these observations support a possible role for autoimmunity, the causal contribution of these autoantibodies to myocardial injury and disease progression remains incompletely established and constitutes a proposed rather than confirmed model.</p><p><strong>Conclusion: </strong>The emerging relationship between myocarditis and desmosomal cardiomyopathy challenges the traditional distinction between inflammatory and genetic myocardial disease. Integrating genetic testing, advanced CMR imaging, arrhythmic surveillance, and emerging immunological biomarkers may facilitate earlier recognition of genetically mediated cardiomyopathy presenting as myocarditis-like episodes. Further prospective and mechanistic studies are needed to establish causality and evaluate therapeutic implications.</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":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392784","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":"Dynamic coronary roadmap-guided versus traditional percutaneous coronary intervention techniques in contrast medium volume reduction: a systematic review and meta-analysis.","authors":"Amjad Almansi, Shahd Alqato, Lama Hossam Taher, Abdelrahman M Elettreby, Suhel F Batarseh, Nada Mostafa Al-Dardery, Zina Otmani, Salem Elshenawy, Mohamed Abouzid","doi":"10.1186/s43044-026-00763-2","DOIUrl":"10.1186/s43044-026-00763-2","url":null,"abstract":"<p><strong>Background: </strong>Dynamic Coronary Roadmap (DCR) is a novel software providing a motion-compensated, real-time overlay of coronary arteries to assist PCI device navigation with a single contrast injection. This meta-analysis evaluated the effectiveness and safety of DCR.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, Web of Science, Cochrane Library, and Embase from inception to May 5, 2024. Outcomes were pooled as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) using random-effects models. PROSPERO registration: CRD42024553689.</p><p><strong>Results: </strong>Eight studies (two RCTs, six observational; 1,512 patients) were included. DCR-guided PCI significantly reduced contrast media volume (MD =  - 45.82 mL, 95% CI - 68.33 to - 23.30; P < 0.001; I² = 97%), air kerma (MD =  - 283.09 mGy, 95% CI - 474.47 to - 91.70; P = 0.004; I² = 99%), dose area product (MD =  - 6.85 Gy/cm², 95% CI - 10.48 to - 3.22; P = 0.0002; I² = 82%), radiation duration (MD =  - 2.79 min, 95% CI - 4.59 to - 0.98; P = 0.002; I² = 94%), and procedural duration (MD =  - 3.51 min, 95% CI - 6.69 to - 0.32; P = 0.03; I² = 0%). No significant differences were found in procedural success (RR = 1.00; 95% CI 0.99-1.01; I² = 0%) or acute kidney injury incidence (RR = 0.40; 95% CI 0.15-1.08; I² = 0%). Risk of bias was mixed for RCTs (low to high risk across domains) and moderate to high for observational studies, with most scoring ≥ 7 on the Newcastle-Ottawa Scale.</p><p><strong>Conclusion: </strong>DCR-guided PCI was associated with reductions in contrast use and radiation metrics without compromising procedural success; however, the overall certainty of evidence is low due to study design limitations, risk of bias, and substantial heterogeneity, warranting cautious interpretation.</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":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364505","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":"Impact of cardiac amyloidosis on survival in aortic stenosis patients undergoing TAVR: a systematic review and reconstructed time-to-event meta-analysis.","authors":"Omar Almaadawy, Naydeen Mostafa, Ahmed Elbataa, Belal Mohamed Hamed, Menna Sarhan, Eman Mohyeldin, Omar Kamel, Amar Asad, Buseyna Dahik, Mohamed Ismael Elnady, Muhammad Ashraf Husain, Ahmed Elshahat, Ahmed Mansour, Christian Eskander, Mustafa Ahmed","doi":"10.1186/s43044-026-00762-3","DOIUrl":"10.1186/s43044-026-00762-3","url":null,"abstract":"<p><strong>Background: </strong>New evidence suggests a relatively high prevalence of occult cardiac amyloidosis (CA) among patients with aortic stenosis (AS). While transcatheter aortic valve replacement (TAVR) is an established treatment for AS, the impact of concomitant CA on long-term outcomes remains unclear. We conducted a systematic review and meta-analysis to evaluate survival and procedural outcomes of TAVR in AS patients with and without CA.</p><p><strong>Methods: </strong>PubMed, Scopus, Web of Science, Google Scholar, and the Cochrane Library were searched through 21 April 2026. Studies comparing outcomes of TAVR in patients with and without CA and reporting Kaplan-Meier survival curves were included. Individual patient survival data were extracted from Kaplan-Meier curves and reconstructed for pooled analysis. Secondary outcomes were analyzed using random-effects meta-analysis.</p><p><strong>Results: </strong>Seven studies including 2747 patients were analyzed. In the primary analysis, which included both definitive and probability-based definitions of CA, CA was associated with increased all-cause mortality following TAVR (HR: 1.58; 95% CI 1.23, 2.03; P < 0.001). However, in a sensitivity analysis restricted to studies with confirmed CA, this association was no longer significant (HR: 1.32, 95% CI 0.84, 2.07, P = 0.226). There were no significant differences in pacemaker implantation (OR: 1.33; 95% CI 0.69, 2.56; P = 0.40) or more than mild aortic regurgitation (OR: 0.96; 95% CI 0.25, 3.78; P = 0.96).</p><p><strong>Conclusion: </strong>The association between CA mortality after TAVR in AS patients is highly dependent on how CA is defined. While analyses including screening-based cohorts suggest increased risk, this was not observed in analyses of studies with confirmed CA. These findings highlight the impact of differing diagnostic approaches in CA and underscore the need for future studies to use standardized criteria and prospective designs to clarify the independent prognostic role of confirmed CA.</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":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310792","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":"Mid-aortic syndrome in two Saudi children with refractory hypertension: a case report.","authors":"Osama Alrusayni, Yazeed Saleh Alahmed, Yasser Ahmad Bhat, Raghad Abdulaziz Alhojailan, Raghad Husain Alkhalifah, Insha Banday, Fahad Alhabshan","doi":"10.1186/s43044-026-00758-z","DOIUrl":"10.1186/s43044-026-00758-z","url":null,"abstract":"<p><strong>Background: </strong>Middle aortic syndrome (MAS) is a rare clinical condition in children that is associated with a significant risk of morbidity and mortality. Delayed diagnosis and inadequate treatment can lead to severe complications, resulting in life-threatening consequences.</p><p><strong>Case presentation: </strong>In this paper, we present two cases involving two 10-year-old Saudi girls diagnosed with MAS who presented with systemic hypertension. Echocardiography demonstrated a patent aortic arch; however, it showed abnormal diastolic flow in the descending aorta, which facilitated the diagnosis of MAS.</p><p><strong>Conclusions: </strong>Even when a paediatric patient shows no symptoms, health care workers should not record unreliable blood pressure readings. These blood pressure readings may indicate the onset of a disease that, if left untreated, could have catastrophic consequences. This report emphasises the rarity and clinical importance of MAS in the paediatric population, aiming to enhance early diagnosis and improve management strategies. Moreover, these findings underscore the critical role of echocardiography in diagnosing MAS.</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":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310623","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":"Catheter ablation of typical atrial flutter in a patient with left ventricular assist device support: a case report.","authors":"Azmican Kaya, Murat Karaçam, Tezel Kovancı, Seda Tanyeri Uzel, Abdülkadir Uslu","doi":"10.1186/s43044-026-00760-5","DOIUrl":"10.1186/s43044-026-00760-5","url":null,"abstract":"<p><strong>Background: </strong>Atrial arrhythmias are a frequent and clinically significant complication in left ventricular assist device (LVAD)-supported patients, with the potential to impair right ventricular (RV) function, compromise device hemodynamics, and reduce quality of life. While atrial fibrillation (AF) has received considerable attention in this population, the distinct hemodynamic impact of typical cavotricuspid isthmus (CTI)-dependent atrial flutter and the role of catheter-based rhythm control remain poorly characterized.</p><p><strong>Case presentation: </strong>A 60-year-old male with non-ischemic cardiomyopathy who underwent HeartMate 3 LVAD implantation as a bridge to transplantation developed typical CTI-dependent atrial flutter refractory to medical therapy, associated with marked deterioration in RV systolic function (TAPSE: 1.2 → 0.82 cm; Sm: 6.9 → 5.3 cm/s) and adverse LVAD hemodynamics. Electrical cardioversion had been attempted but failed to maintain sinus rhythm. Electrophysiological study using three-dimensional electroanatomic mapping (CARTO system, Biosense Webster) confirmed counterclockwise CTI-dependent atrial flutter. Radiofrequency (RF) ablation of the cavotricuspid isthmus achieved bidirectional conduction block and restored sinus rhythm. The procedure was performed under uninterrupted therapeutic anticoagulation with warfarin.</p><p><strong>Results: </strong>At one-month follow-up, RV systolic function improved substantially (TAPSE: 0.82 → 1.19 cm; Sm: 5.3 → 6.5 cm/s), with concurrent normalization of LVAD hemodynamic parameters and complete resolution of palpitations and dyspnea.</p><p><strong>Conclusions: </strong>Catheter ablation of CTI-dependent atrial flutter in a carefully selected LVAD-supported patient yielded significant improvement in RV function, device hemodynamics, and quality of life (QoL), underscoring the potential role of rhythm control in this population.</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":"2026-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13283945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297699","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}