Cardiology and Angiology: An International Journal

Reversible Severe Heart Failure in Corticosteroid-Refractory Cardiac Sarcoidosis: The Crucial Role of 18F-FDG PET/CT in MRI-Negative Disease

Mon, 01 Jun 2026 00:00:00 +0000

Background: Cardiac involvement significantly impacts the prognosis of sarcoidosis. While conduction abnormalities represent the classic presentation, inaugural acute heart failure with severe left ventricular dysfunction is a less common and diagnostically challenging phenotype that can closely mimic idiopathic dilated cardiomyopathy. Furthermore, diagnosing cardiac sarcoidosis (CS) can be complex when initial advanced imaging yields false-negative results.

Case Presentation: A 43-year-old female with a history of cutaneous sarcoidosis, maintained on chronic oral corticosteroids, presented with rapidly progressive heart failure (New York Heart Association class III). Transthoracic echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of 26%. Her clinical course was notably complicated by an episode of paroxysmal atrial fibrillation and a subsequent transient ischemic attack (TIA). Cardiac magnetic resonance (CMR) imaging was non-contributory, showing no evidence of edema or late gadolinium enhancement. However, due to high clinical suspicion, an 18F-FDG PET/CT was performed, revealing intense, multifocal myocardial uptake indicative of active granulomatous inflammation. Recognising the corticosteroid-refractory nature of her flare-up, she was treated with intravenous corticosteroid pulses, followed by the early introduction of methotrexate as a steroid-sparing agent, optimised guideline-directed medical therapy (GDMT) for heart failure, and therapeutic anticoagulation with apixaban. At one year, the patient was completely asymptomatic with a full normalisation of her ejection fraction to 52%.

Conclusion: This case highlights that a normal CMR does not exclude active cardiac sarcoidosis, especially in the early inflammatory stages, reinforcing the critical diagnostic value of 18F-FDG PET/CT. Additionally, it demonstrates that severe, corticosteroid-refractory ventricular dysfunction can achieve complete functional reversibility through the early and synergistic use of methotrexate and GDMT.

Profile of Rhythm Disturbances and Predictive Factors of Sudden Death in Sarcomeric Hypertrophic Cardiomyopathy: A Retrospective Study of 30 Patients

Sat, 23 May 2026 00:00:00 +0000

Introduction: Sarcomeric hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease. Its prognosis is primarily determined by the risk of ventricular arrhythmias and sudden cardiac death (SCD). This study aimed to describe the rhythm profile of patients with sarcomeric HCM, to identify clinical and paraclinical predictors of arrhythmias, and to assess the risk of SCD using the European Society of Cardiology (ESC) risk stratification score.

Materials and Methods: This retrospective descriptive study included 30 patients with sarcomeric HCM followed in an electrophysiology department between July 2021 and December 2025. All included patients underwent a complete clinical examination, a surface electrocardiogram (ECG), a 24- to 48-hour Holter ECG recording, a transthoracic echocardiogram, and, for 20 of them, cardiac magnetic resonance (CMR) imaging. The 5-year risk of SCD was calculated using the ESC online risk score.

Results: The mean age of the patients was 46 ± 29 years, with a male-to-female ratio of 2.7. Atrial fibrillation (AF) was the most frequent arrhythmia, affecting 20% of patients (16% of whom presented with a paroxysmal form). Premature ventricular contractions (PVCs) were observed in 90% of patients on Holter monitoring, while only one patient (3.3%) presented with non-sustained ventricular tachycardia (NSVT). Regarding the SCD risk score, 73% of patients were classified as low risk (<4%), 10% as intermediate risk (4–6%), and 17% as high risk (≥6%). Five patients underwent implantable cardioverter-defibrillator (ICD) implantation for primary prevention. Notably, no thromboembolic complications or deaths were recorded during the 4-year follow-up period.

Conclusion: In our series, atrial fibrillation was the most frequent arrhythmia in patients with sarcomeric HCM. The ESC 2014 score proved to be an effective tool for stratifying the risk of SCD. ICD implantation in high-risk patients was well tolerated and may improve prognosis.

Cardiac Structural and Functional Alterations in End-stage Renal Disease : An Echocardiographic Study

Fri, 29 May 2026 00:00:00 +0000

Background: Cardiovascular disease accounts for approximately 45% of all-cause mortality in hemodialysis patients — a risk 10 to 20 times higher than in the general population. Despite the critical role of echocardiography in characterizing this cardiac burden, systematic echocardiographic data from local dialysis centers remain scarce.

Objectives: The study aims to provide a comprehensive echocardiographic characterization of end-stage of chronic kidney disease (CKD) patients on maintenance hemodialysis. We assessed left ventricular (LV) geometry, systolic function, diastolic function, and the prevalence and severity of valvular disease.

Methods : Single-center cross-sectional study of 78 consecutive adults with end stage renal disease (ESRD) on maintenance hemodialysis (≥ 3 months) at the Echocardiography Department of University Hospital Mohamed VI, Marrakesh, from May 2024 to May 2025. All examinations followed the 2015 ASE/EACVI chamber quantification guidelines. Diastolic function was formally graded in 49 patients in sinus rhythm without significant mitral disease, using the 2016 ASE/EACVI four-variable algorithm.

Results : Mean age 56.3 ± 12.8 years; 59.0% male. LV hypertrophy was found in 74.4%, predominantly concentric (56.4%). Only 7 patients (9.0%) had completely normal LV geometry. Reduced LV ejection fraction (EF < 50%) was present in 30.8%, with severely reduced EF (< 35%) in 12.8%. Among 49 formally evaluable patients, diastolic dysfunction was identified in 77.6%: Grade I in 32.7%, Grade II in 28.6%, Grade III in 16.3%. valvular abnormalities were found in 61.5%; moderate-to-severe aortic stenosis in 7.7%; moderate-to-severe mitral regurgitation in 15.4%; and non-rheumatic mitral stenosis in 6.4%. Elevated estimated pulmonary artery systolic pressure (> 35 mmHg) was present in 43.6%.

Conclusions : End-stage CKD patients on hemodialysis carry a severe, multidimensional cardiac burden. These findings support the implementation of routine, protocol-driven echocardiographic evaluation at dialysis initiation and at regular intervals thereafter.

Immediate Procedural Results of Superior Mesenteric Artery Angioplasty: An Observational Single-Center Study from India

Avinash Gutte, Dixit Varma, Snehal Kose, Abin Jose — Fri, 03 Jul 2026 00:00:00 +0000

Background: Superior mesenteric artery occlusive disease is an important cause of chronic mesenteric ischaemia and is increasingly managed with endovascular techniques. However, regional data describing procedural outcomes remain limited. This study assessed the technical success and immediate angiographic results of superior mesenteric artery angioplasty, with or without stent placement, at a tertiary care centre in India.

Materials and methods: This retrospective observational case series included consecutive adult patients who underwent attempted endovascular revascularisation for symptomatic superior mesenteric artery atherosclerotic stenosis between November 2019 and October 2025. Eligible patients had symptoms compatible with chronic mesenteric ischaemia and imaging-confirmed stenosis of 70% or greater on computed tomography angiography or digital subtraction angiography. Data were extracted from institutional records. Technical success was defined as successful wire traversal, deployment of the intended device where applicable, and restoration of antegrade flow. Immediate angiographic improvement was defined as improved distal branch opacification or peripheral blush on completion angiography. Descriptive statistics were used.

Results: Seventeen patients underwent attempted superior mesenteric artery angioplasty. The mean age was 57.2 ± 13.2 years, and 11 patients were male. Technical success was achieved in 13 of 17 cases. Four procedures were abandoned because the guidewire could not cross heavily calcified occlusions. Among the successful cases, 11 patients underwent angioplasty with stent placement, one underwent angioplasty alone, and one received thrombolytic therapy after angioplasty. Immediate angiographic improvement was documented in all technically successful procedures. No intraoperative complications were recorded.

Conclusion: In this single-centre retrospective series, superior mesenteric artery angioplasty, most commonly with stent placement, was technically feasible and associated with favourable immediate angiographic results. The findings should be interpreted cautiously because of the small sample size, retrospective design, and absence of long-term clinical or imaging follow-up.

Myocardial Infarction in Young People: A Retrospective Study of 15 Cases

Fri, 03 Jul 2026 00:00:00 +0000

Aims: This study aimed to describe the epidemiological, clinical and angiographic characteristics of patients aged under 45 years who were hospitalised for myocardial infarction and to highlight the characteristics of MI in young people compared with older people.

Study Design: A descriptive retrospective study.

Place and Duration of Study: Department of Cardiology, Mohammed VI University Hospital of Marrakech, Morocco, between January 2023 and December 2025.

Methodology: Fifteen patients (13 men and 2 women; age range: 26-45 years) hospitalised for myocardial infarction were included. All included patients underwent an assessment focusing on cardiovascular risk factors, disease history and mode of presentation, electrocardiographic, echocardiographic and angiographic findings, and short- and medium-term follow-up.

Results: There was a male predominance, with a mean age of 41 years. Smoking was the most prevalent cardiovascular risk factor, being present in 67% of the study population. MI was the inaugural presentation in 86% of cases, chest pain was typical in 93% of patients, and the anterior territory predominated, representing 73% of MI cases. Echocardiography showed moderate left ventricular systolic dysfunction in two-thirds of the patients. Coronary angiography revealed a predominance of single-vessel coronary artery disease. Regarding prognosis, a favourable course was observed in the majority of patients, with one death reported.

Conclusion: The main characteristics of myocardial infarction in young people appear to be male predominance, a high prevalence of smoking, an inaugural mode of presentation, typical chest pain, anterior territory predominance, a high frequency of single-vessel coronary artery disease, and a favourable short- and mid-term prognosis.

Impact of Acute Rheumatic Fever on the Type and Severity of Valvular Lesions: Experience of the Cardiology and Cardiovascular Surgery Departments of Avicenne Military Hospital of Marrakech

Sat, 11 Jul 2026 00:00:00 +0000

Background: Acute rheumatic fever remains an important cause of acquired valvular heart disease where rheumatic heart disease persists in practice, with possible long-term consequences including severe valvular involvement, chamber remodelling, rhythm disturbances, and surgery.

Objective: This study described the impact of acute rheumatic fever on the type and severity of valvular lesions among patients managed for valvular heart disease at Avicenne Military Hospital and assessed post-operative outcomes after valve surgery.

Methods: This retrospective descriptive and analytical study included 106 adult patients with valvular disease documented by transthoracic echocardiography and managed in the Departments of Cardiology and Cardiovascular Surgery. Demographic, clinical, electrocardiographic, echocardiographic, and surgical data were analysed according to rheumatic or non-rheumatic aetiology.

Results: The mean age was 57.4 ± 12.3 years, and 71 patients were male. Rheumatic aetiology was identified in 52 patients (49.1%). Polyvalvular disease was observed in 46 patients, atrial dilation in 84 patients, and atrial fibrillation in 40 cases among patients with arrhythmias. Severe or very severe lesions were more frequent in the rheumatic group. Surgery was performed in 58 patients, with mechanical mitral valve replacement being the most frequent procedure. Early complications included atrial fibrillation, acute cardiac failure, pericardial effusion, infection, thromboembolic events, renal failure, bleeding requiring re-exploration, and complete atrioventricular block. Four operated patients died in hospital.

Conclusion: Rheumatic aetiology was the leading cause of valvular disease and was associated with clinically important severity, polyvalvular involvement, atrial remodelling, and frequent surgical management. The findings support prevention, early diagnosis, structured follow-up, and careful post-operative monitoring.

Innovations in Drug-Coated Balloons and Stentless Coronary Interventions: Evaluating the Evidence, Limitations, and Future Prospects in De-Novo Lesion Management

Mon, 13 Jul 2026 00:00:00 +0000

Coronary artery disease (CAD) remains a major cause of morbidity and mortality, and percutaneous coronary intervention (PCI) is central to the management of obstructive coronary disease. Although drug-eluting stents (DESs) have reduced restenosis and repeat revascularisation, their permanent metallic structure is associated with persistent concerns, including chronic vascular inflammation, impaired vasomotion, delayed healing, neoatherosclerosis, stent thrombosis and difficulties during future revascularisation. Drug-coated balloons (DCBs) provide a stentless approach by delivering an antiproliferative agent to the vessel wall during balloon inflation without leaving a permanent scaffold. This narrative review evaluates the evidence, limitations and future prospects of DCB-based coronary intervention for de novo coronary artery lesions. Contemporary randomised trials, systematic reviews, meta-analyses, pooled analyses and expert reviews were examined, with emphasis on clinical outcomes, angiographic findings, lesion preparation, device-related considerations and long-term safety. The reviewed evidence indicates that DCBs can achieve clinical and angiographic outcomes broadly comparable to those of DESs in appropriately selected patients, particularly in small-vessel coronary artery disease. Three-year and longer-term analyses also suggest similar rates of major adverse cardiovascular events, target lesion revascularisation and cardiac mortality in selected populations. Emerging evidence supports possible use in selected large-vessel lesions, although this indication is less established. The principal advantage of DCB therapy is its leave-nothing-behind strategy, which preserves native vessel architecture and avoids complications related to permanent implants. However, outcomes depend strongly on adequate lesion preparation, careful patient selection and device-specific performance. Current evidence supports DCB-based stentless intervention as a maturing revascularisation strategy for selected de novo lesions, while further standardised trials are required to define its role in complex anatomy and acute coronary syndromes.