Abstract: Background: T1 mapping has become a valuable technique in cardiac magnetic resonance imaging (CMR) for evaluating myocardial tissue properties. However, its quantitative accuracy remains limited by noise-related variability. Super-resolution deep learning-based reconstruction (SR-DLR) has shown potential in enhancing image quality across various MRI applications, yet its effectiveness in myocardial T1 mapping has not been thoroughly investigated. This study aimed to evaluate the impact of SR-DLR on noise reduction and measurement consistency in myocardial T1 mapping. Methods: This single-center retrospective observational study included 36 patients who underwent CMR between July and December 2023. T1 mapping was performed using a modified Look-Locker inversion recovery (MOLLI) sequence before and after contrast administration. Images were reconstructed with and without SR-DLR using identical scan data. Phantom studies using seven homemade phantoms with different Gd-DOTA dilution ratios were also conducted. Quantitative evaluation included mean T1 values, standard deviation (SD), and coefficient of variation (CV). Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement. Results: SR-DLR had no significant effect on mean native or post-contrast T1 values, but significantly reduced SD and CV in both patient and phantom studies. SD decreased from 42.1 to 29.7 ms (native) and 17.9 to 12.8 ms (post-contrast), and CV also improved. ICCs indicated excellent inter-observer reproducibility (native: 0.822; post-contrast: 0.955). Conclusions: SR-DLR effectively reduces measurement variability while preserving T1 accuracy, enhancing the reliability of myocardial T1 mapping in both clinical and research settings.

Abstract: Background/Objectives: Pacing treatment of bradyarrhythmias is both to reduce symptoms and to prevent syncope and sudden cardiac death. The aim of our study was to analyze left bundle branch area pacing (LBBAP) in the prevention of new-onset AF and the improvement of echocardiographic parameters in patients with mildly reduced left ventricular ejection fraction (LVEF) compared to patients with bradyarrhythmias but preserved LVEF who underwent mid-septal right ventricular pacing. Methods: This research was structured as a retrospective observational cohort study that included 186 patients with LBBAP and 186 patients with RVP, enrolled for 3 years until March 2024 with a follow-up time of 1 year. The primary endpoint of our study was new-onset atrial fibrillation after pacemaker implantation. The secondary endpoint was the improvement of echocardiographic parameters. Results: We observed in the LBBAP group a mean QRS complex duration of 108.7±8.83 ms (after pacemaker implantation), compared to a much longer duration in the RVP group (143.8±9.851 ms, p=0.0001). At 1 year follow-up, 22 (11.82%) patients in the RVP group were diagnosed with new-onset atrial fibrillation, compared to 6 (3.22%) patients out of 186 included in the LBBAP group (p=0.0017). Regarding LVEF, at follow-up, RVP patients had a decrease in LVEF compared to those in the LBBAP group who had an improved LVEF (54.54±3.77%, p=0.0001). Conclusions: LBBAP both prevents the onset of atrial fibrillation and improves echocardiographic parameters, especially left ventricular ejection fraction, thus contributing to significantly reducing the risk of developing/worsening advanced heart failure through pacing-induced cardiomyopathy.

Abstract: Background and Objectives: Contrasting indications exist across official guidelines regarding the administration of short-term (4 weeks) oral anticoagulation (OAC) after acute cardioversion (CV), i.e. <12-48 hours of atrial fibrillation (AF), in patients at low thromboembolic risk (CHA₂DS₂-VA= 0). The Authors sought to understand real-world clinical preferences in the setting of short-term OAC after acute CV and to which extent AF guidelines translate into clinical practice. Materials and Methods: Six different AF guidelines were evaluated regarding the recommendation for, and scientific evidence justifying short-term OAC in this specific setting. Following review, an international questionnaire was developed and circulated among physicians working in the fields of cardiology, internal medicine, intensive care unit, geriatrics, and emergency medicine at 17 centres in Italy, France and Canada. Results: A total of 78 responses were obtained. Younger physicians and cardiologists appeared to administer OAC more frequently compared to older physicians or those working in other specialties (95% CI Fisher’s exact test p= 0.049 and 0.029, respectively). Significant differences were observed in the use of periprocedural imaging, with transoesophageal echocardiogram (TOE) prior to CV being performed more often in Europe vs Canada (p=0.006) and in long-term rhythm control, with first-line PVI being offered more frequently by European cardiologists (p= 0.013). No statistically significant association was found with regard to guideline adherence for OAC administration (p=0.120). Conclusions: The real-world antithrombotic management of low-risk (CHA₂DS₂-VA=0), acutely cardioverted AF patients varies significantly amongst healthcare systems. Reducing the time limit to safely not prescribe OAC to < 12 hours, caring for local access to direct oral anticoagulants (DOACs) and regional stroke risk profiles and actively preventing haemorrhage in patients receiving short-term OAC could all limit CV-related complications in this low-risk population.

Abstract: Aortic stenosis (AS) is a prevalent valvular heart disease, especially among older adults, and is associated with high morbidity and mortality. Left ventricular mass (LVM) in-creases in response to pressure overload in AS. However, excessive LVM is associated with adverse outcomes. The prognostic implications of LVM, particularly potential sex-specific effects on mortality, remain unclear. We conducted a retrospective sin-gle-center cohort study of 531 outpatients with symptomatic but stable severe AS awaiting valve intervention between April 2020 and February 2024. None had prior valve procedures. Baseline clinical and echocardiographic data were collected, and pa-tients were followed for a mean of 2.67 years. The cohort included 283 men and 248 women (mean age 74.7 years). During follow-up, 165 patients (31.1%) died, with 86% of deaths due to cardiovascular causes. Deceased patients had lower left ventricular ejec-tion fraction (LVEF) and higher LVM index (LVMi) than survivors. Multivariate analysis showed that LVMi and atrial fibrillation (AF) were independent predictors of mortality. In women, LVMi, LVEF, and AF were independently associated with death, while no such predictors were identified in men. In conclusion, elevated LVMi was inde-pendently associated with increased mortality in patients with severe AS, particularly among women.

Abstract: Heart failure (HF) remains a major global health challenge, driven by multifactorial pathophysiological processes such as systemic congestion, endothelial dysfunction, and inflammation. While natriuretic peptides are well-established biomarkers for diagnosing and monitoring HF, they do not fully capture the complexity of vascular involvement. CD146, also known as melanoma cell adhesion molecule (MCAM), is a transmembrane glycoprotein primarily expressed on endothelial cells and involved in cell adhesion, vascular permeability, and angiogenesis. Its soluble form (sCD146), released in response to multiple pathophysiological stimuli, including venous and arterial endothelial stretch, oxidative stress, and inflammatory cytokine activation, has emerged as a promising biomarker reflecting both hemodynamic congestion and systemic endothelial stress. This review synthesizes current knowledge on the structure, regulation, and release mechanisms of CD146 and explores its clinical utility in HF. Elevated sCD146 levels have been associated with echocardiographic and radiological indicators of congestion, as well as with adverse outcomes. While promising, its application is limited by variability, lack of standardization, and confounding elevations in non-cardiac conditions, including malignancy.

Abstract: Cardiac arrest (CA) is a hemostatic state only reversible via dynamics intracardiac action potentials implementing hemorheological-biochemical reactions of adequate blood volumes (BV). Undeniably exclusive electrophysiological processes that began since intrauterine life remain compromised by cardiopulmonary resuscitation (CPR). Failure of CPR to adapt these hemostatic-electrophysiological conditions as well as human cardiotorsal anatomy, and thoracic biomechanics results in a staggering number of CA mortalities worldwide. Except for mechanical circulatory support (MCS), CPR induces a pointless back-and-forth mode of perfusion that worsens the stalled metabolism. Since the heart and respiratory pump, the main generators of endothelial shear stress (ESS) that control organs microcirculation, thereby metabolism, no longer function. Accordingly, we propose ESS-induced meditators as a potential solution in CA, mechanically with pulsatile MCSs providing rapid circulatory flow restoration (CFR), regardless of return of spontaneous circulation (ROSC). And manually with a novel technique of cardiac massage inducing snaping atrial wall shear stress with adequate BV, promoting a less-traumatic ROSC. Our goal is to evaluate the therapeutic proposal through an in-depth analysis that could change the fierce strain in evolving current CPR doctrine, thus improving the dismal outcomes of CA victims.

Abstract: Background: The inflammatory response is critically important in ST-segment elevation myocardial infarction (STEMI). Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), which are novel inflammatory biomarkers, have been linked to determining outcomes in various diseases. The aim of the current study was to examine the relation of the SII index and SIRI with contrast-induced acute kidney injury (CI-AKI) in elderly subjects with (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Methods: All patients diagnosed with STEMI between November 2020 and September 2024 were screened, and patients aged over 70 were retrospectively analyzed in the present study. The patients were divided into 2 groups according to CI-AKI development. SII and SIRI were calculated based on peripheral blood counts. A receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of SII and SIRI in predicting CI-AKI. Additionally, multivariable logistic regression models were employed to investigate the associations between inflammatory indices and the incidence of CI-AKI in elderly patients with STEMI. Results: A total of 263 participants were included (mean age 77,67±6,20, 56% women). Both SII and SIRI were higher in the CI-AKI group than in the non-CI-AKI group (3252±2257, 1097±991 p< .001 for SII; 12,1±4,54, 4,86±2,42 p< .006 for SIRI). In the receiver operating characteristic analysis, SII and SIRI showed the highest area under curve (AUC) compared with other inflammatory parameters. The AUC of SII and SIRI were 0.903 and 0.867, the sensitivity and specificity were 80.1% and 84.4%, 77.5% and 81.0% respectively (p< .001, p< .001). In multivariate logistic regression analysis, SII (odds ratio (OR): OR: 1.114, 95% CI: 1.050–1.183, p = .001), and SIRI (OR: 1.23, 95% CI: 1.057–1.433, p = .008) were associated with CI-AKI. Conclusions: SII and SIRI were found to be important markers for predicting post-procedural CI-AKI in elderly patients with STEMI.

Abstract: Objective: To evaluate early and midterm outcomes of cryopreserved aortic homograft implantation in pediatric patients undergoing aortic valve and root replacement. Methods: A retrospective analysis was conducted on 36 pediatric patients aged 2 to 7 years who underwent cryopreserved aortic homograft implantation between January 2016 and December 2024. Indications included complex congenital aortic valve disease, annular hypoplasia, failed Ross procedure, and infective endocarditis. Standard root replacement technique was used under moderate hypothermic cardiopulmonary bypass. Postoperative outcomes were analyzed, including early complications, mortality, echocardiographic parameters, and long-term graft performance. Statistical analysis included chi-square, Mann–Whitney U test, and Spearman correlation. Results: There was no 30-day mortality. One patient (2.8%) experienced late mortality at year 3, and two patients (5.6%) underwent reoperation at years 4 and 7 due to root aneurysm and severe regurgitation, respectively. Early postoperative echocardiography showed satisfactory hemodynamic performance with a mean gradient of 8.4 ± 3.2 mmHg. At 5-year follow-up, 92.9% of grafts maintained normal function. Conclusion: Cryopreserved homografts provide a safe and effective option for pediatric aortic valve replacement in the early and midterm period. However, potential late complications such as structural degeneration or root dilation necessitate long-term surveillance. Advances in decellularized grafts may improve future durability and integration.

Abstract: Background/Objectives: Water and alcohol extracts of Epilobium have gained attention due to the high concentration of its bioactive compounds and associated health benefits. This review aimed to evaluate the effects of Epilobium parviflorum Shreb. (Onagraceae) preparations on vasculature in the light of its medical application on human health over the last five years. Materials and Methods: A literature search of databases such as PubMed/Medline, Scopus, and Google Scholar for original articles published between March 2000 and March 2025 was undertaken. The keywords used were: “aortic rings”, “ellagitannins”, “Epilobium”, “hypotension”, “oenothein B”, “Onagraceae”, “systolic blood pressure”, “vasorelaxation”, “willow herb”. Only one study was found, and this was discussed in this review. Results: Herb of E. parviflorum Shreb. is used as a remedy in folk medicine with a variety of therapeutic properties, including its preventive effects and ability to relieve symptoms in patients with benign prostate hyperplasia, prostatitis, and cancer. Other properties include kidney and urinary tract diseases, skin infections and antibacterial properties. E. parviflorum contains bioactive compounds such as oenothein B, quercetin-3-O-glucuronide and myricetin-3-O-rhamnoside. In a low dose they contribute to the reduction of oxidative stress due to their antioxidant and immunostimulant effects, positively reducing inflammation that causes certain conditions. At higher concentrations Epilobium generates reactive oxygen species that stimulate the body’s defense mechanisms against a variety of cancers. Conclusions: Although the potential application of E. parviflorum in metabolic disorders was not extensively studied before, its antioxidant and anti-inflammatory properties are well documented, which suggests potential pathways for future research and therapeutic development of preparations to benefit vascular health.

Abstract: Background/Objectives. The study aims to observe and compare the real-world total costs of hospitalization in patients with chronic heart failure (CHF) and metabolic syndrome (MetS) from an upper-middle-income European country. Methods. Data were electronically retrieved from three different internal medicine departments of university hospitals in Bucharest, Romania, including all admissions from December 2023 to June 2024. Collected data included demographics, cost of hospitalization (€), and discharge diagnoses (ICD10 codes, used to calculate the Charleston comorbidity index - CCI and to define a MetS surrogate definition). Results. Database query retrieved 4732 hospitalizations (median duration of 4 days; median cost of 1002€) of unique patients (53.9% women, average age of 68.7 years), of whom 48.0% had CHF and 11.0% classified as MetS. Compared to men, women were significantly older, with significantly higher prevalence of CHF, but similar median hospitalization duration and costs. Compared to patients without CHF or MetS, those with CHF or MetS were significantly older, with more comorbidities (CCI) and with higher median hospitalization duration, total cost and cost/day of hospitalization. The total cost of hospitalization increases steadily from a minimum in patients without CHF or Met to a maximum in patients with both conditions. Conclusions. CHF is highly prevalent among patients admitted to internal medicine wards and it is more prevalent among hospitalized women, without significant hospitalization cost differences compared to men. CHF and MetS incrementally increased the total costs of hospitalization in a DRG-based reimbursement systems.

Abstract: Background: Diabetic patients tend to have complex coronary artery disease (CAD). Understanding their procedural risk may help guiding treatment strategies. Syntax and British Cardiovascular Intervention Society) Jeopardy Score (BCIS-JS) have been used to define complex CAD but not compared in diabetic patients. Methods: This is a retrospective analysis of prospectively collected data of consecutive patients who underwent complex percutaneous coronary intervention (PCI) and were deemed unsuitable for surgical revascularization. Both syntax and BCIS-JS were calculated by experienced operators who were blinded to patient’s outcome. The primary endpoint was all-cause mortality at 12 months. Results: Of 452 patients included in the study, diabetes was present in 35% patients. There was a modest relationship between BCIS-JS and syntax score (Spearman r= 0.44, P< 0.001) and this relationship was even weaker in patients with diabetes (Spearman r= 0.32, P< 0.001). The primary endpoint was comparable in the non-diabetic group irrespective of the used score (syntax or BCIS-JS) to define complex CAD. In contrast, there was a differential prognostic outcome in the diabetic group, whereby the primary endpoint was more frequently reported in diabetic patients with high versus low syntax score [HR 4.96, 95% CI (1.44- 17.03), P= 0.011] but not when BCIS-JS was used. Conclusions: There was a modest relationship between BCIS-JS and syntax score. Unlike, BCIS-JS, syntax score identified patients who are at increased risk of death in diabetic patients. Both scoring system did not effectively differentiate mortality risk in non-diabetic patients. Future research is needed to confirm this study’s findings.

Abstract: Background. Deep vein thrombosis (DVT) is an important component of venous thromboembolism and can lead to pulmonary embolism with high morbidity and mortality. Anticoagulant therapy alone (ACA) and catheter-mediated thrombolysis (CDT) are commonly used strategies for the management of DVT. Although CDT has been reported to be effective in reducing the risk of postthrombotic syndrome (PTS), it remains unclear in which patient groups it should be preferred due to the risk of bleeding.Methods. This retrospective study included 175 patients diagnosed with DVT between 2015 and 2024 (98 ACA, 77 CDT). Patients with a diagnosis of proximal DVT, aged ≥18 years and with at least 30 days of follow-up data were included. The primary endpoint was 30-day mortality and secondary endpoints were length of hospitalization, pulmonary embolism and bleeding complications. Results. The CDT group was superior to ACA in thrombus clearance rates, especially in iliac vein thrombosis (97.7% vs. 78%, p=0.003). Clinical symptoms improved faster in the CDT group, but total hospitalization was longer. There were no significant differences in bleeding complications and mortality rates between the two groups.Conclusion. The optimal approach to DVT treatment should be based on the patient's individual risk factors. Although CDT provides a higher thrombus clearance rate, especially in iliac vein thrombosis, it may not be suitable for all patients. Future large-scale studies will contribute to a better understanding of the long-term outcomes of interventional therapies.

Abstract: Background Durable mechanical circulatory support (DMCS) infections remain a serious challenge. Ventricular assist device (VAD)-specific driveline infections (DLIs) are the most common type; however, no consensus exists on their surgical management. We aimed to define the incidence, risk factors, and microbiology of DLIs and discuss surgical treatment modalities. Methods We retrospectively reviewed 90 patients who underwent left or biventricular ventricular assist device (LVAD or BiVAD) implantation with HeartMate 2 (Abbott), HeartWare HVAD (Medtronic), HeartMate 3 (Abbott) in a single center between March 01, 2011, and May 30, 2023. Results DLIs were detected in 20 (%21.5) patients in the follow-up. The mean duration of VAD support was 561.1±833.2 days (1-4124 days), while 1277.9±621.6 days in the DLI group. Extended duration of VAD support was associated with higher incidence rates of late-onset DLIs (p< 0.05). Younger age and lower plasma albumin levels were independent predictive factors for the risk of DLI with a hazard ratio of 9.77 (95% CI: 1.3 – 74.5) and 10.55 (95% CI: 1.40 – 79.35), respectively. Removal of the biofilm with velour and DL relocation through the rectus muscle combined with vacuum-assisted strategies (VAC) was performed in 9 patients. One patient developed recurrent infection, and another patient with deep DLI subsequently received a heart transplant. No patient underwent device exchange for intractable DLIs. Conclusions Our results suggest that DLIs are common infectious complications after VAD implantation, which endanger patient autonomy, impair quality of life and overall survival. DL relocation through rectus muscles and VAC strategies have a role in controlling DLIs.

Abstract: Background/Objectives: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogenous clinical entity which differs in pathophysiology, treatment, and prognosis from myocardial infarction with obstructive coronary artery disease (MI-CAD) and MINOCA mimickers, such as myocarditis or Takotsubo syndrome. This study aimed to compare the clinical characteristics, imaging findings, management strategies, and long-term outcomes of patients with true MINOCA, MI-CAD, and MINOCA mimickers. Methods: This retrospective cohort study included 1596 patients hospitalized with acute myocardial infarction (AMI) between 2012 and 2024 at a tertiary university hospital. Patients were classified as having true MINOCA, MI-CAD, or MINOCA mimickers based on coronary angiography and advanced cardiac imaging. Data included clinical and laboratory variables, echocardiography, cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA). All-cause mortality was analyzed using Cox regression. Results: Of 1596 AMI patients, 7.0% had true MINOCA, 85.1% had MI-CAD, and 8.0% had MINOCA mimickers. Mimicker patients were significantly younger and had fewer cardiovascular risk factors. True MINOCA was more frequent in females and associated with preserved left ventricular ejection fraction and lower high-sensitivity troponin T levels compared to MI-CAD. CMR and CCTA identified the underlying etiology in over 70% of MINOCA and mimicker patients, with high-risk plaque features observed in 42.9% of CCTA scans. Long-term all-cause mortality in MINOCA was similar to MI-CAD (32.1% vs. 30.9%, p = 0.76) and significantly higher than in mimickers (5.9%, p < 0.001). Conclusions: True MINOCA is a distinct clinical entity with diagnostic and prognostic implications. Its comparable mortality to MI-CAD highlights the need for accurate diagnosis and targeted secondary prevention strategies.

Abstract: (1) Background: Early-onset atrial fibrillation (AF) exhibits distinct clinical and genetic profiles compared to AF in older adults. The increasing detection of AF among younger patients—often in the absence of traditional risk factors—has raised interest in the genetic determinants underlying the condition; this review aims to synthesize current evidence on the genetic architecture of early-onset AF, assess the clinical utility of genetic testing, and discuss future directions for integrating genetic insights into personalized management strategies (2) Methods: We conducted a comprehensive analysis of recent studies, including genome-wide association studies and targeted sequencing efforts, that examined rare pathogenic variants and polygenic risk scores in early-onset AF. The review also considers emerging data on atrial cardiomyopathy and evaluates current guideline recommendations for genetic testing; (3) Results: Data indicate that rare variants, particularly in genes such as TTN, LMNA, and KCNQ1, play a significant role in early-onset AF, with evidence suggesting an association between these mutations and adverse clinical outcomes. Polygenic risk scores further complement traditional risk factors, providing a more nuanced risk stratification. Despite these advances, challenges remain in the interpretation of variants of uncertain significance, cost-effectiveness, and the need for interdisciplinary collaboration in clinical implementation; (4) Conclusions: Integrating genetic evaluation into the diagnostic and management framework of early-onset AF holds promise for improved risk stratification and personalized therapy. Future large-scale, multi-ethnic studies and ongoing refinement of genetic risk models are essential to overcome current limitations and enhance the clinical applicability of genetic testing in this rapidly evolving field.

Abstract: Infective endocarditis continues to represent a challenge for healthcare systems, requiring careful management and resources. It appears that there may have been something of a shift, in recent years, from Streptococcus sp a to Staphylococcus sp and Enterococcus sp as the primary pathogens of concern. This shift is of concern as it is associated with Staphylococcus Aureus which has a high virulence rate and a tendency to form a biofilm, meaning that non-surgical therapy may not be effective. It is imperative to deliberate on the likelihood of platelet blood clot formation, which may be accompanied by bacterial infestation and the development of a biofilm. An endocarditis lesion is believed to comprise primarily a fibrin and platelet blood clot infested with bacteria, which adheres to the cardiac valves. Consequently, infective endocarditis serves as a paradigm of immunothrombosis that has developed in an unfavorable manner. The concept of immunothrombosis involves a multifacetered interaction among the coagulation system, innate immunity, and the function of coagulation in isolating and eliminating invasive pathogens. However, in the context of infective endocarditis, immunothrombosis unintentionally establishes an optimal environment that is conducive to bacteria proliferation. The process of immunothrombosis functions to impede the host immune system, thus enabling bacterial proliferation in a manner that is largely uninhibited. The coagulation system plays a pivotal role in the progression of this condition at each stage. It has been demonstrated that the coagulation system plays a pivotal role in the initial adhesion of bacteria to the leaflets, the subsequent proliferation and maturation of vegetations, and the development of complications such as embolization and valve dysfunction. Furthermore, the primary etiological agent of infective endocarditis, Staphylococcus aureus, has been demonstrated to manipulate immunothrombosis, thriving within the fibrin-rich milieu of an endocarditis vegetation. Given its central role in infective endocarditis, the coagulation system emerges as an attractive therapeutic target for this deadly disease. However, it is crucial to exercise caution, as the use of antithrombotic agents in patients with endocarditis frequently accompanies an elevated bleeding risk.

Abstract: Hypertension disorders of pregnancy affect almost 10% of pregnancies. Most hypertensive disorders associated with pregnancy, including chronic hypertension and gestational hypertension, often persist into the postpartum period. Thus, many breastfeeding mothers require ongoing antihypertensive treatment with antihypertensive medications while nursing. This highlights the importance of understanding the efficacy, safety, and potential adverse effects of antihypertensive therapy in breastfeeding mothers. Unfortunately, research in this area is limited, and references in clinical guidelines remain sparse. Our review aims to provide a comprehensive summary of the current knowledge on antihypertensive medications during breastfeeding, drawing from available research and evidence-based guidelines. This article discusses all groups of antihypertensive drugs, presenting societies' recommendations and available clinical data. Based on the available literature, calcium channel blockers (nifedipine as the first choice) and diuretics and beta-blockers (labetalol, metoprolol, propranolol) appear to be the drugs of choice. Our review highlights the need for further research to evaluate the long-term safety of antihypertensive medications during breastfeeding, improve clinical guidelines, and ensure optimal treatment for nursing mothers.

Abstract: Thoracic Aortic Aneurysms are life-threatening vascular conditions linked to inherited disorders such as Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, and Familial Thoracic Aortic Aneurysms and Dissections. While traditionally associated with extracellular matrix and contractile defects in vascular smooth muscle cells, emerging evidence suggests a key role for mitochondrial dysfunction. Here, we show that overexpression of ACTA2R179H and TGFBR2G357W in murine aortic VSMCs reduces Mitochondrial Transcription Factor A (Tfam) expression, decreases mitochondrial DNA (mtDNA) content, and impairs oxidative phosphorylation, shifting metabolism toward glycolysis. Notably, nicotinamide riboside, a NAD+ precursor, restores mitochondrial respiration, increases Tfam and mtDNA levels, and promotes a contractile phenotype by enhancing actin polymerization and reducing matrix metalloproteinase activity. These findings identify mitochondrial dysfunction as a shared feature in hereditary Thoracic Aortic Aneurysm, not only in Marfan syndrome but also in other genetic forms and highlight mitochondrial boosters as a potential therapeutic strategies.

Abstract: Background and Clinical Significance: Scimitar Syndrome is a rare congenital cardio-pulmonary anomaly characterized by partial anomalous pulmonary venous return, often requiring early surgical correction. It may coexist with other congenital or acquired cardiovascular anomalies, including valvular diseases such as mitral regurgitation. When this intervention is combined with mitral valve annuloplasty, the proximity to the atrioventricular node may predispose patients to late-onset conduction disturbances. Case Presentation: We describe the case of a 53-year-old male who developed paroxysmal atrial fibrillation, atrial flutter, and intermittent second-degree AV block decades after un-dergoing surgical correction of Scimitar Syndrome with concomitant mitral annuloplasty. Multimodal echocardiographic evaluation revealed preserved left atrial volume, normal intra-atrial conduction time, mildly reduced strain, and maintained atrial synchrony. The patient was treated with direct oral anticoagulants, beta-blockers and underwent im-plantation of a ventricular leadless pacemaker. Conclusions: This case highlights the role of atrial function imaging in guiding rhythm management and procedural choices in surgically-corrected congenital heart disease.

Abstract: Background: Several mitochondrial abnormalities such as defective energy production, depletion of energy stores, Ca²⁺-accumulation, generation of reactive oxygen species and impaired intracellular signaling are associated with cardiac dysfunction during the development of different heart diseases. Methods: A narrative review was compiled by a search for applicable literature in MEDLINE via PubMed. Results: Mitochondria generate ATP through the processes of electron transport and oxidative phosphorylation, which is used as energy for cardiac contractile function. Mitochondria in fact are the key subcellular organelle for the regulation of intracellular Ca²⁺ concentration and are considered to serve as a buffer to maintain Ca²⁺ homeostasis in cardiomyocytes. However, during the development of heart disease, excessive accumulation of intracellular Ca²⁺ results in mitochondria Ca²⁺-overload, which, in turn, impairs mitochondrial energy production and induces cardiac dysfunction. Mitochondria also generate reactive oxygen species (ROS), including superoxide and hydroxyl radicals as well as H₂O₂, a well-known oxidant that promotes lipid peroxidation and subsequent disturbance of Ca²⁺ homeostasis, cellular damage and death. Conclusion: Oxidative stress plays a critical role in mitochondrial disruption during the pathogenesis of different cardiac pathologies.