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WORLD HOSPITAL DIRECTORY
Cardiology Medical European Heart Journal - current issue
<span class="paragraphSection">The European Society of Cardiology (ESC) introduced evidence-based clinical practice guidelines in the field of cardiovascular medicine more than 30 years ago.<sup><a href="#ehaf102-B1" class="reflinks">1</a>,<a href="#ehaf102-B2" class="reflinks">2</a></sup> European Society of Cardiology Guidelines have proved invaluable to inform healthcare providers and patients with the goal of improving cardiovascular care and advancing implementation of established therapies.</span>
<span class="paragraphSection">EuroEcho-Imaging is the world’s leading echocardiography congress and the flagship event of the European Association of Cardiovascular Imaging (EACVI). EuroEcho-Imaging 2024 was held in Berlin (Germany) from 11 to 13 December 2024 and marked the 24th edition of the EuroEcho-Imaging congress after its inaugural edition in Prague, in 1997. The EuroEcho-Imaging congress has become established over the years, first as the major annual conference of the European Society of Cardiology (ESC)’s Working Groups on Echocardiography (founded in 1978), then of the European Association of Echocardiography (EAE, created in 2003), and currently of the EACVI (established in 2013), the ESC branch dedicated to all cardiovascular imaging modalities.</span>
<span class="paragraphSection">It is with deep sadness that we pay tribute to Professor Ioanna Andreadou, who passed away on the night of 13 January 2025 at the age of 59. Ioanna was born in Athens, Greece. The unexpected and tragic news of Professor Ioanna Andreadou’s passing has deeply shocked us all—her relatives, friends, colleagues, and students, reflecting the countless lives she touched with her warmth and bright personality. Our deepest condolences and heartfelt support go out to her family, her friends, and loved ones during this profoundly difficult time.</span>
<span class="paragraphSection"><strong>This commentary refers to ‘Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis of clinical trials’, by A. Oraii <span style="font-style:italic;">et al</span>., <a href="https://doi.org/10.1093/eurheartj/ehad811">https://doi.org/10.1093/eurheartj/ehad811</a> and the discussion piece ‘Double counting in meta-analyses: a statistical complication in cardiovascular medicine trials’, by S. Mehta and E.C. Martinez, <a href="https://doi.org/10.1093/eurheartj/ehaf086">https://doi.org/10.1093/eurheartj/ehaf086</a>.</strong></span>
<span class="paragraphSection"><strong>This commentary refers to ‘Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis of clinical trials’, by A. Oraii <span style="font-style:italic;">et al.</span>, <a href="https://doi.org/10.1093/eurheartj/ehad811">https://doi.org/10.1093/eurheartj/ehad811</a> and the discussion piece ‘Systematic review and meta-analysis of cardiovascular outcome trials: importance of <span style="font-style:italic;">post hoc</span> studies’, by A. Oraii <span style="font-style:italic;">et al.</span>, <a href="https://doi.org/10.1093/eurheartj/ehaf089">https://doi.org/10.1093/eurheartj/ehaf089</a>.</strong></span>
<span class="paragraphSection">A 13-year-old girl was admitted for post-exercise syncope, and transthoracic echocardiography (TTE) revealed anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA). Coronary angiography confirmed a tortuous and dilated right coronary artery (RCA) with extensive collaterals supplying the LCA, which drained into the pulmonary artery (PA) <span style="font-style:italic;">Panels A–D</span>).</span>
<span class="paragraphSection">A male infant, prenatally diagnosed with complete transposition of the great arteries and a ventricular septal defect, was born at 38 weeks’ gestation. Coronary artery evaluation revealed both the right (RCA) and the left coronary arteries (LCA) originating from the posterior sinus (sinus 2) with separate ostia. The LCA coursed between the aorta and pulmonary artery, corresponding to Shaher type 5A<sup><a href="#ehaf092-B1" class="reflinks">1</a></sup> (<span style="font-style:italic;">Panel A1-2</span>); therefore intramural LCA complication was considered highly possible, making the arterial switch operation (ASO) challenging. The patient developed necrotizing enterocolitis while awaiting the ASO and died at 38 days old despite intensive management.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>It remains unknown whether the brain glymphatic system, which is driven by the heartbeat-driven pulsation of arteries and is responsible for cerebral waste clearance, is impaired in atrial fibrillation (AF) and mediates cognitive dysfunction related to AF. The aim of this study was to assess brain glymphatic alterations in AF, their role in cognitive function, and whether catheter ablation can improve glymphatic activity.<div class="boxTitle">Methods</div>In this case-control and prospective before–and–after study, patients with AF and healthy controls (HCs) were enrolled. Participants underwent brain magnetic resonance imaging and a comprehensive neuropsychological battery. Glymphatic activity was quantified by diffusion tensor image analysis along the perivascular space (DTI-ALPS) index. Magnetic resonance imaging was repeated after surgery in patients who underwent ablation.<div class="boxTitle">Results</div>Overall, 87 patients with AF and 44 HCs were enrolled. Compared with HCs, patients with AF had a lower ALPS index (<span style="font-style:italic;">P</span> = .016). Nonparoxysmal AF patients showed lower ALPS index than both HCs (<span style="font-style:italic;">P</span> = .002) and paroxysmal AF patients (<span style="font-style:italic;">P</span> = .044). A lower ALPS index was associated with worse scores of Trail Making Test, Digit Symbol Substitution Test, Digit Span Test, and Stroop Colour and Word Test (all <span style="font-style:italic;">P</span> < .05). Mediation analyses revealed that glymphatic activity was a mediator between AF and cognitive decline. Among the 50 patients who underwent ablation therapy, DTI-ALPS index was improved after surgery (<span style="font-style:italic;">P</span> = .015).<div class="boxTitle">Conclusions</div>Brain glymphatic function measured by DTI-ALPS index was impaired in patients with AF, mediates the association between AF and cognitive decline, and was improved after ablation therapy.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>Life-threatening arrhythmias are a well-established consequence of reduced cardiac sodium current (<span style="font-style:italic;">I</span><sub>Na</sub>). Gene therapy approaches to increase <span style="font-style:italic;">I</span><sub>Na</sub> have demonstrated potential benefits to prevent arrhythmias. However, the development of such therapies is hampered by the large size of sodium channels. In this study, <span style="font-style:italic;">SCN10A-short</span> (<span style="font-style:italic;">S10s</span>), a short transcript encoding the carboxy-terminal domain of the human neuronal sodium channel, was evaluated as a gene therapy target to increase <span style="font-style:italic;">I</span><sub>Na</sub> and prevent arrhythmias.<div class="boxTitle">Methods</div>Adeno-associated viral vector overexpressing <span style="font-style:italic;">S10s</span> was injected into wild type and <span style="font-style:italic;">Scn5a</span>-haploinsufficient mice on which patch-clamp studies, optical mapping, electrocardiogram analyses, and ischaemia reperfusion were performed. <span style="font-style:italic;">In vitro</span> and <span style="font-style:italic;">in silico</span> studies were conducted to further explore the effect of <span style="font-style:italic;">S10s</span> gene therapy in the context of human hearts.<div class="boxTitle">Results</div>Cardiac <span style="font-style:italic;">S10s</span> overexpression increased cellular <span style="font-style:italic;">I</span><sub>Na</sub>, maximal action potential upstroke velocity, and action potential amplitude in <span style="font-style:italic;">Scn5a</span>-haploinsufficient cardiomyocytes. <span style="font-style:italic;">S10s</span> gene therapy rescues conduction slowing in <span style="font-style:italic;">Scn5a</span>-haploinsufficient mice and prevented ventricular tachycardia induced by ischaemia-reperfusion in wild type mice. <span style="font-style:italic;">S10s</span> overexpression increased maximal action potential upstroke velocity in human inducible pluripotent stem cell-derived cardiomyocytes and prevented inducible arrhythmias in simulated human heart models.<div class="boxTitle">Conclusions</div><span style="font-style:italic;">S10s</span> gene therapy may be effective to treat cardiac conduction abnormalities and associated arrhythmias.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>No-touch saphenous vein harvesting may enhance graft patency and improve clinical outcomes after coronary artery bypass grafting (CABG).<div class="boxTitle">Methods</div>In this registry-based, randomized trial, patients undergoing CABG were randomly assigned to no-touch or conventional harvesting. The primary composite outcome was the proportion of patients with occluded/stenosed >50% vein graft on coronary computed tomography angiography, or who underwent percutaneous coronary intervention to a vein graft, or died. Secondary outcomes included clinical outcomes and leg wound complications.<div class="boxTitle">Results</div>A total of 902 patients were enrolled with a mean total number of distal vein anastomoses of 2.0 (SD 0.87). The primary endpoint occurred in 90/454 (19.8%) of patients randomized to no-touch and in 107/446 (24.0%) of patients randomized to the conventional technique [difference, −4.3 percentage points; 95% confidence interval (CI) −10.1–1.6; <span style="font-style:italic;">P</span> = .15] at a mean follow-up time of 3.5 (SD 0.1) years. The composite of death, myocardial infarction, or repeat revascularization at 4.4 (SD 1.3) years occurred in 57/454 (12.6%) and 44/446 (9.9%) in the no-touch and conventional groups, respectively (hazard ratio 1.3; 95% CI, 0.87–1.93). Leg wound complications were more common in patients assigned to no-touch harvesting at 3 months [107/433 (24.7%) vs. 59/427 (13.8%); difference, 10.9 percentage points; 95% CI 5.7–16.1]. At 2 years, 189/381 (49.6%) vs. 91/361 (25.2%) had remaining leg symptoms (difference, 24.4 percentage points; 95% CI 17.7–31.1).<div class="boxTitle">Conclusions</div>No-touch vein graft harvesting for CABG was not superior to conventional open harvesting in reducing vein graft failure or clinical events after CABG but increased leg wound complications. The primary outcome requires cautious interpretation due to a lower-than-expected number of primary events.</span>
<span class="paragraphSection"><strong>This comment refers to ‘TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and complex or multivessel coronary disease (TCW): an international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial’, which was published in <span style="font-style:italic;">The Lancet</span>. <a href="https://doi.org/10.1016/S0140-6736(24)02100-7">https://doi.org/10.1016/S0140-6736(24)02100-7</a>.</strong></span>
<span class="paragraphSection">This is a correction to: Luca Saba, Riccardo Cau, Rocco Vergallo, M Eline Kooi, Daniel Staub, Gavino Faa, Terenzio Congiu, George Ntaios, Bruce A Wasserman, John Benson, Valentina Nardi, Rika Kawakami, Giuseppe Lanzino, Renu Virmani, Peter Libby, Carotid artery atherosclerosis: mechanisms of instability and clinical implications, <span style="font-style:italic;">European Heart Journal</span>, 2025, ehae933, <a href="https://doi.org/10.1093/eurheartj/ehae933">https://doi.org/10.1093/eurheartj/ehae933</a></span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>A longer time to alive hospital discharge following infrarenal abdominal aortic aneurysm (AAA) repair is associated with reduced patient satisfaction and increased length of stay, hospital-acquired deconditioning, infection, and costs. This study investigated sex-specific differences in, and drivers of, the rate of alive hospital discharge.<div class="boxTitle">Methods</div>Examination of UK National Vascular Registry (UK NVR), 2014–19, and Swedish National Patient Registry (SE NPR) elective AAA patients, 2010–18, for endovascular (EVAR) or open aneurysm repair (OAR). Cox models assessed sex-specific difference in the rate of alive hospital discharge, adjusting for co-morbidity, anatomy, standard of care, post-operative complications, and year, with in-hospital death as the competing risk.<div class="boxTitle">Results</div>A total of 29 751 AAA repairs (UK NVR: EVAR 12 518:1532; OAR 6803:837; SE NPR: EVAR 4234:792; OAR 2638:497, men:women) were assessed. For EVAR, the unadjusted rate of alive hospital discharge was ∼25% lower for women [UK NVR: hazard ratio (HR) 0.75 (0.71–0.80), <span style="font-style:italic;">P</span> < .001; SE NPR: HR 0.75 (0.69–0.81), <span style="font-style:italic;">P</span> < .001]. Following adjustment, the sex-specific HR narrowed but remained significant [UK NVR: HR 0.83 (0.79–0.88), <span style="font-style:italic;">P</span> < .001; SE NPR: HR 0.83 (0.76–0.89), <span style="font-style:italic;">P</span> < .001]. For OAR, the rate of alive hospital discharge was 23%–27% lower for women [UK NVR: HR 0.73 (0.67–0.78), <span style="font-style:italic;">P</span> < .001; SE NPR: HR 0.77 (0.70–0.85), <span style="font-style:italic;">P</span> < .001]. Following adjustment, the sex-specific HR narrowed [UK NVR: HR 0.82 (0.76–0.88), <span style="font-style:italic;">P</span> < .001; SE NPR: HR 0.79 (0.72–0.88), <span style="font-style:italic;">P</span> < .001] but remained significant.<div class="boxTitle">Conclusions</div>Women have a 25% lower rate of alive discharge after aortic surgery, despite adjustment for pre/peri- and post-operative parameters. Efforts to increase the rate of alive hospital discharge for women should be sought.</span>
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