Cardiology Commons^™

Association Between Echocardiographic Epicardial Adipose Tissue Thickness And Atrial Fibrillation In A Single-Centre Pakistani Cohort, Ateeb Mahmood Khan, Fateh Ali Tipoo Sultan, Aiman Sultan, Adeel Khoja

Journal of the Saudi Heart Association

Objectives: To assess the association between echocardiographic epicardial adipose tissue (EAT) thickness and atrial fibrillation (AF) in a single-centre Pakistani cohort of patients referred for transthoracic echocardiography (TTE).

Methods: Patients referred for TTE at Aga Khan University Hospital (AKUH), Karachi, were prospectively enrolled over a six-month period (1 September 2024 – 28 February 2025) using a convenience sampling approach; nearly all patients referred for TTE with AF during this period were captured, while patients in sinus rhythm were enrolled by convenience sampling alongside them, in order to ensure an adequate number of AF cases for comparison. EAT was measured in …

Cardiac Marker Levels In Patients With Sickle Cell Disease During Emergency Room Visits: A Retrospective Study, Adel F. Al-Marzouki, Osman Radhwi, Nadine Alharbi, Sondos Jar, Weam Bajunaid, Abdulaziz Alzahrani, Majed Alhuzali, Sultan Aljuaid, Naif Abdulaziz Meighrbl

Journal of the Saudi Heart Association

Background: Millions of people worldwide suffer from a genetic hemoglobinopathy known as sickle cell disease (SCD). It is a long-term condition marked by progressive multiorgan failure. Among SCD patients, cardiovascular complications are the main leading cause of death. Cardiovascular complications raise cardiac markers levels as well as sickle cell vaso-occlusive crisis (VOC). This makes it challenging to determine the source. This research aims to identify the association between cardiac markers and myocardial infarction in SCD patients at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia.

Material and Method: This retrospective study was conducted from June 2022 to March 2023. …

Recognizing Coronary Artery Disease In Women, Krista Ohmie Pa-C, Cck, Aacc

Lynchburg Journal of Medical Science

The purpose of this review is to identify sex-specific factors in the prevention, diagnosis, and treatment of cardiovascular disease in women as it continues to be the number one cause of their mortality. A search of the literature was conducted using PubMed as well as resources from the American College of Cardiology and the American Heart Association with multiple articles identified for use. The risk of cardiovascular disease in women is affected by traditional risk factors such as hypertension and diabetes, but is compounded by length of estrogen exposure, pregnancy, and higher rates of systemic inflammation. Systemic barriers such as …

Primary Treatment Of Congenital Aortic Stenosis In Infants: A Comparative Analysis Of Balloon Aortic Valvuloplasty And Surgical Aortic Commissurotomy, Kayumov Arabbek Ravshanovich, Sinelnikov Yuriy Semenovich, Amansakhatova Ekaterina Nazarovna, Nalimov Konstantin Aleksandrovich, Roseykin Evgeniy Vladimirovich, Manukian Serezha Nersesovich, Soynov Ilya Aleksandrovich

Journal of the Saudi Heart Association

Objective

To compare the efficacy and safety of balloon aortic valvuloplasty (BAV) and surgical aortic commissurotomy (SAC) as primary treatment strategies for congenital aortic stenosis in infants during the first year of life.

Methods

This retrospective two-center cohort study included 89 infants with congenital aortic stenosis treated between April 2015 and June 2025 at two tertiary centers. Patients were divided according to the initial intervention: BAV (n = 39) and SAC (n = 50). The primary endpoint was any repeat intervention on the aortic valve. Secondary endpoints included hospital and late mortality, recurrent hemodynamically significant aortic stenosis, and clinically significant …

Continuous Pacing During Lbbap With A Lumenless Lead: A Simplified, Zero-Cost Sliding-Contact Technique, Leonardo Marinaccio

Journal of the Saudi Heart Association

Left bundle branch pacing with lumenless leads usually requires disconnecting pacing cables during rotation, creating an electrical blind spot during septal advancement. We describe the "sliding-contact" technique, a zero-cost modification enabling continuous real-time monitoring. Retracting the rubber shroud of a standard sterile alligator pacing clip reduces jaw tension, allowing unrestricted lead pin rotation while preserving electrical continuity. In 42 consecutive cases, LBBAP was successfully performed without complications. Beat-to-beat feedback on QRS morphology, impedance, and injury current was maintained throughout rotation, improving procedural precision and safety without specialized equipment.

Inferior Vena Cava–Left Atrial Connection Hidden Beneath Large Secundum Defect. A Case Report, Alisia Yuana Putri, Muhammad Surya Tiyantara

Journal of the Saudi Heart Association

Inferior vena cava (IVC) drainage into left atrium is an exceptionally rare congenital anomaly and may remain unrecognized when associated with a large atrial septal defect (ASD). A 35-year-old-man presented with progressive exertional dyspnea and fatigue. Transthoracic echocardiography, transesophageal echocardiography, and cardiac catheterization demonstrated a large secundum ASD with severe septal malalignment, while systemic venous drainage was interpreted as normal. During surgical ASD repair, an unexpected IVC-to-left atrium connection was identified and redirected to right atrium. Careful assessment of IVC inflow is essential in patients with large malaligned ASD despite normal oxygen saturation.

Complete Atrioventricular Block Revealing Late-Onset Cardiac Fabry Disease: Diagnostic Role Of Native T1 Mapping, Nouhaila Bentama, Lamyae Bakamel, Jalal Tagueniti, Fatiha Ait Yahya, Brahim Meftout

Journal of the Saudi Heart Association

A 63-year-old man presented with symptomatic complete atrioventricular block requiring urgent pacemaker implantation. Evaluation revealed non-obstructive left ventricular hypertrophy with normal coronary arteries. Cardiac magnetic resonance showed diffusely reduced native T1 values and inferolateral late gadolinium enhancement, suggesting Fabry cardiomyopathy; amyloidosis was excluded by bone scintigraphy. Diagnosis was confirmed by markedly reduced alpha-galactosidase A activity, elevated lyso-Gb3, and a pathogenic hemizygous GLA variant (p.Asn215Ser). Enzyme replacement therapy with agalsidase beta was initiated, with early stabilization of myocardial deformation and septal thickness. This case highlights native T1 mapping as a key diagnostic biomarker in unexplained left ventricular hypertrophy.

Comment On “Advancing Lipid Management: Saudi Heart Association Position Statement On Pcsk9-Targeted Therapies In The Primary And Secondary Prevention Of Cardiovascular Disease”, Ali Faris Altebainawi

Journal of the Saudi Heart Association

No abstract provided.

Modified Frozen Elephant Trunk Repair For Aortic Coarctation With Segmental Post-Stenotic Aneurysms, Pham Quoc Dat, Ma Nguyen Thai Hoang, Dang Van Phuc, Ta Dinh Do, Ngo Phi Long

Journal of the Saudi Heart Association

Aortic coarctation can be complicated by descending thoracic aortic aneurysms in adults. A 31-year-old man presented with exertional chest pain radiating to the back. Preoperative evaluation showed a 27-mmHg arm-leg systolic pressure gradient, echocardiographic coarctation with a 10-mm narrowest diameter and 25-mmHg gradient, and computed tomography showing two segmental post-stenotic aneurysms, the largest measuring 62 mm. He underwent one-stage modified frozen elephant trunk repair using a Medtronic thoracic stent graft sutured to a surgical graft. The postoperative gradient decreased to 5 mmHg, with stable 9-month follow-up.

Recommendations For Preparticipation Cardiovascular Screening For Athletes In Saudi Arabia: A Consensus Statement From The National Heart Center, Saudi Heart Rhythm Society, And National Center For Sudden Death, Alwaleed Aljohar, Bandar S. Al-Ghamdi, Abdulrahman Y. Sabbagh, Fahad Almehmadi, Fayez Bokhari, Naeem Alshoaibi, Yahya Alhebaishi, Wael Alqarawi

Journal of the Saudi Heart Association

Vigorous sports participation provides substantial physical and psychological benefits but may be accompanied by a small risk of sudden cardiac arrest and death in individuals with previously unrecognized cardiovascular disease. Preparticipation cardiovascular screening aims to identify athletes at increased risk, facilitate appropriate evaluation and management, and promote safe participation in sport. Despite growing international experience, no national recommendations have previously existed for Saudi Arabia. Recognizing the rapid expansion of organized sports participation driven by Saudi Vision 2030, an expert panel convened to develop consensus recommendations for the implementation of a nationwide preparticipation cardiovascular screening program. A comprehensive review of contemporary …

Sex-Based Disparities In Artificial Intelligence For Cardiovascular Disease: A Scoping Review, Maurgan Lee, Tarek Atasi, Michael Mclellan, Yodit Beru, Jason Booza

Population, Patient, Physician and Professionalism Projects

No abstract provided.

Hubungan Kadar Fibroblast Growth Factor-23 Dalam Serum Dengan Hipertrofi Ventrikel Kiri Dan Fraksi Ejeksi Ventrikel Kiri Pada Pasien Hemodialisis Di Rumah Sakit Cipto Mangunkusumo, Ester Morina Silalahi Ester, Maruhum Bonar Marbun, Eka Ginanjar, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Fibroblast growth factor-23 (FGF-23) is a marker that indicates the process of bone mineral disorders in chronic kidney disease dialysis. An elevated FGF-23 causes a remodeling process that contributes to the development of left ventricle hypertrophy (LVH) and the still controversial direct decline of left ventricle ejection fraction (LVEF) among hemodialysis patients. This study aimed to seek out the connection between FGF-23 levels in serum with left ventricle hypertrophy and left ventricle ejection fraction among regular hemodialysis patients.

Methods. A cross-sectional study was conducted to 111 regular hemodialysis patients for twice a week in Cipto Mangunkusumo Hospital …

Reversible Microvascular Ischemia With St-Segment Elevation: An Underrecognized Manifestation Of Antibody-Mediated Rejection In Cardiac Allograft Recipients, Jonathan Ahn, Justin Daneshrad, Liset Stoletniy, Dmitry Abramov

The VAD Journal

Electrocardiographic manifestations of cardiac allograft rejection are often subtle, and stress-induced ST-segment elevation associated with antibody-mediated rejection (AMR) is rarely reported. We describe a 34-year-old heart transplant recipient with progressive exertional angina, nonobstructive coronary disease on angiography, and exercise-induced ST-segment elevation in lead augmented vector right, high-lateral leads I, and augmented voltage left, along with diffuse ST-segment depressions, hypotension, and transient ventricular tachycardia. Concurrent emergence of complement-binding donor-specific antibodies with high mean fluorescence intensity raised concern for AMR, prompting treatment with corticosteroids, plasma exchange, and intravenous immunoglobulin despite the absence of biopsy confirmation. After therapy, symptoms, exercise-induced ischemic electrocardiographic abnormalities, …

Wolff-Parkinson-White Pattern: Recognition Of Ventricular Pre-Excitation And Risk Stratification, Devi Parvathy Jyothi Ramachandran Nair, Badri Aryal

Transformative Medicine

Background: Wolff-Parkinson-White (WPW) pattern is characterized by ventricular pre-excitation through an accessory atrioventricular pathway. Although often asymptomatic, some pathways carry a risk of tachyarrhythmia and sudden cardiac death.

Case Description: A 45-year-old man with hypertension, polysubstance use, and bipolar disorder presented with altered mental status following suspected substance intoxication. His course was complicated by hypoxic respiratory failure requiring intubation and a large right basal ganglia hemorrhage requiring surgical evacuation. During hospitalization, an abnormal ECG prompted Cardiology consultation. The ECG demonstrated sinus rhythm with a short PR interval, delta wave, and widened QRS complex, consistent with ventricular pre-excitation. He had …

Is My Child's Heart Murmur Dangerous?, Bob Underwood, Mahmoud Jaara, Pezad Doctor

Pediatrics in Practice: A CME Podcast

Is my child's heart murmur dangerous or just harmless? Heart murmurs and when they matter — Pezad Doctor, MD, Pediatric Cardiology at Children's Mercy - Pediatrics in Practice - CME, and Mahmoud Jaara, MD, pediatric cardiology fellow at Children's Mercy - Pediatrics in Practice - CME, explain how to tell innocent murmurs (soft, systolic, short, position‑dependent) from concerning ones, which symptoms and family history raise concern, and what to expect at a cardiology visit (exam, oxygen saturation, pulses).

Click here to stream the podcast episode.

Transportability Of An Artificial Intelligence Electrocardiography Model For Structural Heart Disease: External Validation And Recalibration Of Echonext-Mini In Mimic-Iv, Emmanuel Otabor, Abdulraheem Hassan, Ayoyimika Okunlola, Justin Lam, Laith Alomari, Michael Hamilton

Einstein Health Papers

AIMS: Structural heart disease is often underdiagnosed, and echocardiography is limited by access and referral thresholds. Artificial intelligence electrocardiography (AI-ECG) may identify echocardiographically defined structural heart disease. EchoNext-Mini is a released AI-ECG model, accompanied by a benchmark dataset, that detects a composite structural heart disease outcome and component conditions from 12-lead electrocardiogram waveforms together with age, sex, and electrocardiographic measurements. We assessed its transportability and recalibration.

METHODS AND RESULTS: We linked electrocardiograms from MIMIC-IV to subsequent transthoracic echocardiograms, including adults whose electrocardiogram preceded an eligible echocardiogram within one year, one per patient. Labels were mapped to structured echocardiographic fields using …

Evaluation Of Radial Artery Anatomy With Various Anatomical Variants In Patients Undergoing Transradial Q1 Catheterization, Nisarg Desai, Sharadkumar Jain, Kunal Parwani, Pooja Vyas, Yaqub Sidatar

Journal of the Saudi Heart Association

Objectives: This study aimed to determine the incidence of radial artery anomalies in a large cohort of patients undergoing TRA and to evaluate their specific impact as predictors of procedural failure and access site complications.                                                                                  

  Methods: This prospective, observational, single-center study enrolled 1000 consecutive patients undergoing coronary angiography or intervention via TRA between 2022 and 2024. Radial artery anatomy was assessed using retrograde radial arteriography immediately following sheath insertion. Anatomical variants were categorized into high bifurcation (origin proximal to the cubital fossa), Radial artery loops (full 360-degree curvature), Tortuosity (curve of more than 45 degrees in the vessel), Narrow calliber, …

"Re-Evaluation Of Radial Artery Anatomy With Anatomical Variants In Patients Undergoing Transradial Catheterization, Eman Aslam, Eman Zahra, Maryam Amjad

Journal of the Saudi Heart Association

No abstract provided.

Strengthening The Evidence Base For Pediatric Cardiac Ct: Statistical And Technological Considerations, Faizan Faisal

Journal of the Saudi Heart Association

No abstract provided.

Comments On The Letter: Strengthening The Evidence Base For Pediatric Cardiac Computed Tomography: Statistical And Technological Considerations, Lamia Ghazi Jamjoom, Razan Kamal Daghistani

Journal of the Saudi Heart Association

No abstract provided.

Diagnostic Accuracy Of Quantitative Coronary Analysis As Compared With Instantaneous Wave-Free Ratio In Intermediate Coronary Lesions: A Prospective Vessel-Level Study, Tamer Mosaad Ragab, Khaled Ahmed Alkhashab, Mohamed Zaki Hussain, Ibrahim Mohammed Nosseir, Marwa Salah Sayed, Waleed Khaled Ali Salem

Journal of the Saudi Heart Association

Background: Instantaneous wave-free ratio (IFR) represents a new vasodilator-free innovative approach which is considered as a gold standard for functional assessment of the hemodynamic significance of intermediate coronary stenoses. Although relatively safe, iFR is still an invasive procedure that has its potential hazards, complications and cost. Two-dimensional quantitative coronary analysis (2D-QCA) is a non-invasive technique that has emerged robustly as an excellent and attractive tool for delineating coronary anatomy.

Aims: To assess the ability of two-dimensional quantitative coronary analysis (2D-QCA) to guide decision-making for quantification of severity of intermediate coronary stenoses (40–80% diameter stenosis) in each of the three main …

The American Society Of Extracorporeal Technology Standards And Guidelines For Pediatric And Congenital Perfusion Practice: 2025 Update☆., Molly Elisabeth Oldeen, Carrie Whittaker Striker, Ronald Angona, Dafne Andrea Chianella, Chelsea Capone, Ashley B Walczak, Thomas Klein

Heart and Vascular Articles

Background: In 2019, the American Society of ExtraCorporeal Technology (AmSECT) approved the inaugural Standards and Guidelines for Pediatric and Congenital Perfusion Practice. These standards and guidelines were created with the intent of periodic revision to ensure continued alignment with evolving best practices. In 2023, an AmSECT subcommittee initiated this review in consideration of current literature and contemporary clinical practices.

Methods: The subcommittee, consisting of pediatric and congenital perfusionists, conducted a systematic literature review assessing each standard and guideline to determine if current evidence supports elevation of guidelines to standards, incorporation of new guidelines or standards, or whether existing standards and …

Pharmacogenetics In Pediatric Cardiology., Adenike Adenikinju, Jonathan B. Wagner, Mollie Walton

Manuscripts, Articles, Book Chapters and Other Papers

Children with congenital and acquired heart disease frequently require complex and prolonged pharmacotherapy, often involving off-label cardiovascular medications with narrow therapeutic ranges. Consequently, variability in drug response and medication-related adverse events remains a significant clinical challenge in pediatric cardiology. Pharmacogenetics provides a framework to individualize drug selection and dosing by incorporating genetic variability alongside established clinical and developmental factors. This review outlines the current clinical utility and emerging role of pharmacogenetics in pediatric cardiology, emphasizing applications most relevant to day-to-day patient care. Established pharmacogenetic associations with direct implications for pediatric cardiac practice include gene-drug pairs involving tacrolimus (CYP3A5), …

Retrieval Strategies For Embolized Left Atrial Appendage Closure Devices, Usama Sadiq, Muneeba Ali, Stacey Damito, Maxwell Ambrosino, Muhammad Sabri, Muhammad Ahmad Sadiq, Muhammad Hamza Sadiq, Richard Kovach, Sheena Rastogi, Muhammad Raza

Abington Jefferson Health Papers

BACKGROUND: Device embolization (DE) is a rare but potentially life-threatening complication of left atrial appendage occlusion (LAAO). As landmark trials broaden the eligible population for LAAO, operator preparedness for DE management becomes increasingly critical.

CASE SUMMARY: We present 4 cases of LAAO DE managed with distinct retrieval strategies: 1) open surgical retrieval with concurrent AtriClip ligation for an endothelialized left atrial device; 2) sequential transseptal then retrograde arterial snaring for intraprocedural migration to the abdominal aorta; 3) transseptal retrieval using a dedicated ONO system with cerebral embolic protection for partial left atrial dislodgment; and 4) retrograde large-bore arterial retrieval for …

Valvular Heart Failure Is A Distinct Heart Transplant Phenotype With Comparable Adjusted Survival To Other Heart Failure Etiologies, Devon Kelley, Varun Kathawate, Joyce Ho, Andrew Belec, Takahiro Tashima, Kazuhiro Ueno, Jessica Dominic, Pavan Atluri

Division of Cardiology Faculty Papers

PURPOSE: Valvular heart failure (VHF) accounts for 1-5% of heart transplant listings. Comparative outcomes relative to other heart failure etiologies remain poorly characterized. This study defines the VHF phenotype and compares waitlist and transplant outcomes to other heart failure recipients.

METHODS: This retrospective cohort study uses the UNOS thoracic transplant database to analyze adult, first-time, heart-only listings with a diagnosis of heart disease. Patients were grouped by diagnosis as VHF or non-VHF. The primary outcome was waitlist events; post-transplant survival and outcomes were secondary analyses. Subgroup analysis was performed in the post-2018 allocation era.

RESULTS: VHF recipients were older (55.3 …

Optimizing Heart Failure-Specific Disease Management Programs And Patient Care In Saudi Arabia: A Saudi Heart Association Position Statement, Abeer Bakhsh, Fakhr Al Ayoubi, Fayez Elshaer, Hanan B. Albackr, Hanin A. Bogari, Ibrahim Jelaidan, Ismail Raslan, Kamal Al Ghalayini, Maryam Alqaseer, Waleed Alhabeeb

Journal of the Saudi Heart Association

Background: Heart failure (HF) represents a major and growing health burden in Saudi Arabia, with high morbidity, frequent hospitalizations, and substantial system-level costs. Despite advances in guideline-directed medical therapy, gaps in diagnosis, care coordination, and longitudinal management persist. Structured, multidisciplinary heart failure–specific disease management programs (HF-DMPs) have been shown to improve outcomes and healthcare efficiency, yet their implementation remains inconsistent across the Kingdom.

Methods: The Saudi Heart Association (SHA) convened a multidisciplinary expert panel to develop a national position statement on HF-DMPs. Recommendations were formulated through structured consensus, informed by a comprehensive review of international guidelines, clinical trials, real-world evidence, …

Redo-Transcatheter Aortic Valve Replacement With Self-Expanding Valves: A U.S. Registry Analysis., Toby Rogers, Vinayak N Bapat, Stanley J Chetcuti, Harold L Dauerman, John K Forrest, Sachin S Goel, Kendra J Grubb, Wah Wah Htun, Rishi Puri, Michael J Reardon, Gilbert H L Tang, Amit N Vora, Steven J Yakubov, Ruth Eisenberg, Guilherme F Attizzani

Heart and Vascular Articles

BACKGROUND: Redo-transcatheter aortic valve replacement (TAVR) for failed transcatheter heart valves is expected to increase, but data on outcomes with self-expanding valves remain limited.

OBJECTIVES: The aims of this study were to evaluate procedural, clinical, and quality-of-life outcomes following redo-TAVR using self-expanding Evolut valves and to compare these outcomes with those among a contemporary native TAVR cohort.

METHODS: Outcomes after redo-TAVR with Evolut R, Evolut PRO, and Evolut PRO+ valves in the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were analyzed and compared with outcomes after native-valve TAVR using the same valve platform during the …

Hidden Infarctions: Understanding And Managing Myocardial Infarction With Non-Obstructive Coronary Arteries Through A Multimodal Lens, Catalina Esquivel

Lynchburg Journal of Medical Science

Myocardial infarction with non-obstructive coronary arteries (MINOCA) accounts for 5–15% of myocardial infarctions and disproportionately affects women and minority populations. It is defined by clinical evidence of myocardial ischemia with

2026 Focused Update Of The Saudi Heart Association Guidelines On Best Practices In The Management Of Chronic Coronary Syndromes, Owayed Alshammeri, Halia Alshehri, Shukri Alsaif, Mirvat Alasnag, Fatema Qaddoura, Fahad Alqahtani, Yosra Abdulahad A Turkistani, Walid Alharbi, Adel Tash, Mohammad Alshehri, Khalid Al Faraidy, Waleed Alhabeeb

Journal of the Saudi Heart Association

Background: Chronic coronary syndromes (CCS) continue to impose a substantial clinical and economic burden in Saudi Arabia. Since publication of the 2022 Saudi Heart Association (SHA) CCS guidelines, important advances have emerged in diagnosis, pharmacotherapy, cardiometabolic risk reduction, antiplatelet management, and revascularization. This 2026 focused update selectively revises and clarifies key recommendations to reflect these advances within the Saudi context.

Methods: A multidisciplinary SHA expert panel conducted a structured review of randomized trials, meta-analyses, and relevant international guidance published since 2022. Updates were restricted to areas with substantive new evidence or evolving clinical practice. Recommendations were formulated through expert consensus …

Double-Port Totally Endoscopic Mitral Valve Replacement Through A Prosthesis-Sized Working Incision With Posterior Subvalvular Preservation, Cao Dang Khang, Tran Duc Quang, Phan Quang Thuan, Vuong Ngoc Minh, Pham Tran Viet Chuong, Nguyen Hoang Dinh

Journal of the Saudi Heart Association

Objective: To evaluate the feasibility and early outcomes of totally endoscopic non-robotic mitral valve replacement using a double-port DCT approach with posterior subvalvular preservation.

Methods: In this single-center retrospective observational study, 76 consecutive patients underwent totally endoscopic non-robotic mitral valve replacement between November 2023 and December 2025. The DCT approach was defined by exclusive endoscopic visualization, no rib spreading, a camera port and prosthesis-sized working incision placed in the same intercostal space, and thoracoscopic intracardiac instrumentation. Posterior ventricular-annular continuity was preserved whenever feasible by posterior leaflet preservation, native chordal preservation, or artificial chordal reimplantation after leaflet resection. Outcomes were reported …