Cardiology Commons^™

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 <50% coronary stenosis on angiography and carries morbidity and mortality comparable to obstructive coronary artery disease–related MI. This narrative review summarizes current diagnostic and management strategies for MINOCA, with emphasis on prognostic assessment using multimodal cardiac imaging and blood biomarkers. A review of key evidence and guidelines was conducted to evaluate established diagnostic approaches and treatments for common etiologies, including plaque disruption, coronary vasospasm, microvascular dysfunction, and spontaneous coronary artery dissection. Early use of cardiac magnetic resonance imaging, optical coherence tomography, and intravascular ultrasound improves diagnostic accuracy and facilitates the identification of underlying mechanisms. However, treatment remains highly individualized due to heterogeneity in etiology and limited evidence guiding therapy. Prognosis varies by cause but is consistently associated with significant long-term cardiovascular risk. Key challenges include diagnostic variability, delayed imaging, and a lack of standardized treatment protocols. Future priorities include randomized trials of mechanism-directed therapies and the development of standardized diagnostic algorithms incorporating functional testing and advanced imaging. Recognition of MINOCA as a distinct clinical entity and early, mechanism-based evaluation are essential to improving outcomes in this diverse, historically underrecognized population.

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 …

Saudi Heart Association Scientific Statement On Cardiovascular–Kidney–Liver-Metabolic (Cklm) Syndrome, Waleed Alhabeeb, Abdulhalim J. Kinsara, Ahmed Mitwalli, Ali A. Alshehri, Faisal Aba-Alkhail, Ismail Raslan, Khalid Aljohani, Mohammed Arafah, Muthana Sahlawi, Saud Alsifri, Suleiman M. Kharabsheh

Journal of the Saudi Heart Association

Background: Cardiovascular, kidney, metabolic, and liver diseases are closely interconnected and frequently coexist. While the cardiovascular–kidney–metabolic (CKM) framework provides a unified model, increasing evidence supports a central role for hepatic disease, particularly metabolic dysfunction–associated steatotic liver disease (MASLD), in this continuum. The Saudi Heart Association (SHA) therefore aimed to introduce the cardiovascular–kidney–liver–metabolic (CKLM) syndrome as an expanded framework and provide expert guidance on its pathophysiology, staging, screening, and management, with relevance to the Saudi population.

Methods: A multidisciplinary expert panel convened under the auspices of the SHA conducted a comprehensive, non-systematic literature review and developed consensus-based recommendations through iterative discussion …

Simulating Pacemakers And Heartbeat Recovery Through Mathematical Modeling, Thomas Estrada, Jayla Edwards

Discovery Day - Daytona Beach

Title: Simulating Pacemakers and Heartbeat Recovery Through Mathematical Modeling   This study utilizes the Fitzhugh-Nagumo model to simulate cardiac electrical activity and the regulatory role of pacemakers through ordinary differential equations (ODEs). By defining the rate of change for membrane voltage, 𝑑𝑣/dt, and a recovery variable, 𝑑𝑤/dt, the model captures the heart's excitability and resting states. Central to the analysis is the stimulus current parameter, which represents the "kick" provided by a pacemaker to correct flatline conditions or weak heartbeats. Using Euler’s method for numerical integration, the research compares unstable cardiac rhythms against corrected periodic oscillations. Additionally, the project implements vector …

High-Flow Nasal Cannula Oxygen Therapy Versus Standard Oxygen Therapy On Perioperative Outcomes In Patients Undergoing Transcatheter Aortic Valve Replacement, Kirsten B. Whiteside, Jacqueline M. Case

Graduate Theses, Dissertations, and Capstones

Abstract 

Background and Purpose: Transcatheter aortic valve replacement (TAVR) is increasingly performed under monitored anesthesia care (MAC) to facilitate faster recovery and reduce complications associated with general anesthesia. Standard oxygen therapy (SOT) may be insufficient in maintaining adequate oxygenation in this high-risk population. High-flow nasal cannula (HFNC) therapy has emerged as a potential alternative. This literature review evaluates the effects of HFNC compared with SOT on perioperative outcomes in patients undergoing TAVR under MAC. 

Methods: A comprehensive review of the literature was conducted to identify studies evaluating HFNC versus SOT during TAVR procedures performed under MAC. Six studies met inclusion …

An Assessment Of The Multidisciplinary Approach To Fetal Echocardiography Education, Riley Allen

Masters Projects

With congenital heart disease (CHD) being the most common birth defect, there is a growing demand for utilization of fetal echocardiography (FE). In clinical practice FE requires an interdisciplinary approach to performance and patient care, and integration of techniques from both the obstetric and pediatric cardiac areas of medicine. While practitioners align on the need for an interdisciplinary approach to practice and the specific methods of performance, there is little consensus on how to comprehensively educate the sonography workforce. Literature has identified gaps in both the obstetric and pediatric cardiac sonographer education bases, predominantly focusing on the lack of specific …

Extracorporeal Rescue In Massive Pulmonary Embolism: A Case Of Chronic Thromboembolic Pulmonary Hypertension Unveiled, Kenzo Ramos, Kari Gorder

Journal of Shock and Hemodynamics

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare yet curable cause of pulmonary hypertension from unresolved pulmonary emboli. We present the case of a 48-year-old man with progressive dyspnea and leg swelling, who was found to have bilateral pulmonary emboli with right heart strain. He developed cardiac arrest during thrombectomy, requiring emergent veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Further evaluation revealed acute emboli superimposed on CTEPH. After incomplete thrombectomy and persistent instability, he underwent successful pulmonary endarterectomy with ECMO decannulation, leading to recovery of right ventricular function and discharge in stable condition. This case illustrates that previously unrecognized CTEPH may …

Personalizing Modern Heart Failure Therapy In Hfref: Bridging Evidence, Clinical Practice, And Future Perspectives, Ehsan Shahverdi, Amin Shahverdi, Sendooran Shahi, Carsten Schneider, Mathias Lange, Shadi Kamali

Journal of the Saudi Heart Association

Background

Heart failure with reduced ejection fraction (HFrEF) remains a major cause of morbidity, mortality, and healthcare utilization worldwide despite substantial therapeutic advances. Over the past three decades, randomized clinical trials have established four foundational pharmacologic pillars of guideline-directed medical therapy (GDMT): renin–angiotensin system inhibition or angiotensin receptor–neprilysin inhibition, evidence-based beta-blockers, mineralocorticoid receptor antagonists, and sodium–glucose cotransporter 2 inhibitors. However, real-world implementation of these therapies remains suboptimal.

Objectives

To provide a contemporary state-of-the-art review of current evidence supporting GDMT in HFrEF, examine unresolved challenges in sequencing and optimization, and propose a practical phenotype-based framework to support individualized treatment decisions

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Candida Albicans Purulent Pericarditis Complicated By Cardiac Tamponade In A Critically Ill Burn Patient: A Case Report, Mutaz Althobaiti, Abdulrahman Alqahtani, Faisal Alanazi, Mohammad S. Alotaibi, Ibrahim Bahabri, Shikah Alsuwaid, Turki Almutairi, Fawaz Almutairi

Journal of the Saudi Heart Association

Candida pericarditis is a rare, life-threatening complication of invasive candidiasis, associated with high mortality.

We report this case of a young woman with 60% body surface area burn, multidrug-resistant polymicrobial sepsis, and multiorgan failure who developed Candida albicans pericarditis complicated by cardiac tamponade. Despite urgent pericardiocentesis and escalation of antifungal therapy, she ultimately progressed to refractory shock and multiorgan failure.

This case illustrates the diagnostic challenge and therapeutic limitations of fungal pericarditis in critically ill host, and underscores the importance of maintaining a high index of suspicion in burn patients with multisite Candida colonization and prolonged antibiotic exposure.

Neural-Immune-Cardiovascular Axis: From Mechanistic Crosstalk To Therapeutic Targets In Cardiovascular Disease, Junkang Cheng, Shuang Gao, Haowei Zhang, Wei Gao, Zeyuan Mei, Xiaoling Liu, Jocelyn Gao, Chenghu Guo, Guipeng An

Student Papers, Posters & Projects

The neural-immune-cardiovascular axis represents an emerging and highly integrated physiological and pathophysiological concept, describing a complex bidirectional communication network between the nervous, immune, and vascular systems. This review systematically examines the pivotal role of this axis in maintaining cardiovascular homeostasis and in the pathogenesis of cardiovascular diseases. We first provide an overview of the fundamental signaling pathways between the components of this axis. Subsequently, we delve into the specific crosstalk mechanisms within the axis in the context of major cardiovascular conditions, including atherosclerosis, hypertension, and heart failure. A central focus is placed on critically evaluating the potential therapeutic targets and …

Position Statement By The Saudi Heart Failure Working Group Of The Saudi Heart Association On The Management Of Advanced Heart Failure In Saudi Arabia, Ibrahim Jelaidan, Abeer Bakhsh, Ammar G. Chaudhary, Ebtisam Alkhattaby, Fahmi Alkaf, Feras Khaliel, Ismail Raslan, Mohammed Alreshidan, Mosaad Alhussein, Waleed Alhabeeb

Journal of the Saudi Heart Association

Background: Heart failure (HF) is a leading cause of morbidity and mortality in Saudi Arabia. Despite remarkable progress in guideline-directed medical therapy, a significant proportion of patients progress to advanced HF and require evaluation for heart transplantation or mechanical circulatory support (MCS). In response to this growing burden, the Saudi Heart Association (SHA) developed recommendations to guide identification, timely referral, and optimal management of candidates for advanced HF therapies in Saudi Arabia.

Methods: A multidisciplinary panel of 10 HF experts from Saudi Arabia convened for a series of structured virtual meetings to review local and international evidence. The panel integrated …

Left Atrial Appendage Mimicking Coronary Aneurysm And Thrombus On Echocardiography In A Child With Kawasaki Disease, Anhar Ali Baeshen, Riad Abouzahr, Jameel Alata

Journal of the Saudi Heart Association

Background: The left atrial appendage (LAA) is an embryologically distinct structure with anatomical features that may mimic pathological findings on echocardiography. In Kawasaki disease, this resemblance can cause diagnostic confusion with coronary artery aneurysm or thrombus.

Clinical presentation: A 7-year-old boy presented with fever lasting more than five days and cervical lymphadenopathy following a viral illness. Kawasaki disease was suspected. Transthoracic echocardiography suggested an abnormality of the left coronary artery with possible thrombus, and the patient was started on aspirin, clopidogrel, and apixaban. Coronary computed tomography angiography demonstrated normal coronary origins, course, and caliber, confirming the suspected lesion to be …

Correlation Between Aortic Valve Area Measured By Cardiac Computed Tomography And Transthoracic Echocardiography In Patients With Aortic Stenosis, Shehroz Sultan, Neeraj Joshi, Ali Haider Awan, Shabana Kauser, Hafsa Malik Aulakh, Bilal Ghafoor, Muhammad Ammar Ajmal, Abida Perveen, Jahanzeb Malik

Journal of Community Hospital Internal Medicine Perspectives

Background: Accurate assessment of aortic valve area (AVA) is essential for determining the severity of aortic stenosis (AS) and guiding clinical management. Transthoracic echocardiography (TTE) is the standard first-line imaging modality, while cardiac computed tomography (CT) provides direct anatomical planimetry and may offer complementary information in selected patients.

Objective: To evaluate the correlation and agreement between CT-derived and TTE-derived AVA measurements and to examine their association with clinical outcomes in patients with AS.

Methods: This single-center retrospective cohort study included 1,857 consecutive adults with moderate to severe AS who underwent both TTE and cardiac CT at the Rawalpindi Institute of …

Clinical Characteristics, Microbiology, And In-Hospital Outcomes Of Infective Endocarditis At A Tertiary Cardiac Center In Saudi Arabia: A Retrospective Cohort Study, Hussain M. Alhassan, Zainab A. Al Hubail, Zahra Maruf Alshakhs, Sireen Omar Takrouni, Fatimah Alawi Al Hussain, Hussain Abdullah Alqahtani, Ammar Ahmed Binammar, Beenish Mukhtar, Muhammad Azam Shah

Journal of the Saudi Heart Association

Background: Infective endocarditis (IE) carries high morbidity and mortality, and its epidemiology in Saudi Arabia reflects a transition in which rheumatic and prosthetic valve disease coexist. Contemporary single-center data describing the clinical profile, microbiology, and in-hospital outcomes of IE in this setting remain limited.

Methods: We conducted a retrospective cohort study at a tertiary cardiac center in Riyadh, Saudi Arabia, including 102 patients with IE diagnosed between October 2020 and December 2024, classified using the modified Duke criteria. Variables were analyzed descriptively. Proportions are reported with 95% confidence intervals (CI; Wilson method) against the number of patients with available data, …

Premature Ventricular Contractions As A Result Of Subacute Myocarditis In A Professional Football Player, Charlotte Pirquet, Daniel Underberg, Brian Osler, Derek Schwabe-Warf, David Shipon

Department of Medicine Faculty Papers

BACKGROUND: Return-to-play (RTP) decisions for professional athletes with arrhythmias are challenging, particularly when the diagnosis is uncertain.

CASE SUMMARY: A 33-year-old professional football player presented for RTP evaluation of premature ventricular contractions (PVCs) and atypical chest pain. Work-up was significant for fragmented R waves and PVCs on electrocardiogram as well as late gadolinium enhancement on cardiac magnetic resonance imaging. Positron emission tomography scan was normal. These findings suggested possible subacute myocarditis. He elected to rest for 2 to 3 months and was treated with guideline-directed medical therapy. Risk stratification highlighted increased risks associated with late gadolinium enhancement and incomplete genetic …

Prevalence Of Cerebrovascular Disease In Patients With Coronary Artery Disease After Pharmacological Stress Test, Eman Mahmoud Abdelfattah, Muhammad Salem Muhammad Hagrass, Khalid Ahmed Elkhashab, Sameh Emil, Hassan Mohamed Ebeid, Lamya Salih, Najah Makhbout Al-Amri, Mostafa Sayed, Haytham Soliman Ghareeb

Journal of the Saudi Heart Association

Objectives: Coronary artery disease (CAD) and cerebrovascular disease (CVD) share common atherosclerotic pathways. However, the clinical significance of headache absence during stress testing remains unexplored. We investigated whether the absence of headache during pharmacological stress testing reflects the presence of subtle cerebrovascular atherosclerosis detectable by transcranial Doppler ultrasonography (TCD).

Methods: This cross-sectional study enrolled 225 patients with CAD undergoing pharmacological stress testing with TCD and myocardial perfusion imaging (MPI) at centers in Egypt (Cardiology Department, Fayoum University). Patients were stratified by headache status during stress testing. Multivariate logistic regression and receiver-operating characteristic (ROC) analysis identified independent predictors of abnormal TCD …

Depression And Anxiety In Pulmonary Hypertension Associated With Congenital Heart Disease: Pathophysiology And Clinical Implications Of The Heart–Brain Axis, Nicodemus N. Triatmojo, Valerinna Y.S. Putri

Journal of the Saudi Heart Association

Pulmonary hypertension associated with congenital heart disease or PH-CHD is an increasingly prevalent disorder in modern cardiology. It is characterized by progressive pulmonary vascular remodeling, chronic right ventricular (RV) pressure overload, and abnormal cardiopulmonary hemodynamic. Due to advances in congenital cardiology and treatments for pulmonary hypertension, survival rates have increased. As a result, the focus has switched to long-term functional status and quality of life. Depression and anxiety are currently recognized as prevalent and clinically significant manifestations in PH-CHD; nonetheless, they remain underdiagnosed and undertreated within cardiovascular care frameworks.

More study shows the disease's severity or symptom count cannot explain …