Background: Cardiac magnetic resonance (cMRI) is often used to diagnose acute myocarditis (AM). It is also performed after 6 months to monitor myocardial involvement. However, the clinical and predictive relevance of the 6-month cMRI is uncertain. Objective: We used cMRI to assess the morphology and heart function of patients with AM, the correlation between left ventricular remodeling and biomarkers of heart dysfunction and myocardial fibrosis, and the involvement of myocardial fibrosis initially and 6 months after the acute episode. Materials and methods: We conducted a prospective study of 90 patients with the clinical suspicion of AM, where cMRI was performed within the first week after symptom onset and repeated after 6 months. Results: Non-ischemic late gadolinium enhancement (LGE) was present in 88 (97.7%) patients and mainly involved the septum and inferior wall. cMRI at 6 months was associated with significantly reduced abnormalities of segmental kinetics (p < 0.001), myocardial edema (p < 0.001), presence of LGE (p < 0.05) and LGE mass (p < 0.01), native T1 mapping (p < 0.001), and presence of pericardial collection (p ≤ 0.001). At 6 months, signs of myocardial edema appeared in 34.4% of patients, and a complete cure (absence of edema and LGE) was found in 8.8% of patients. LGE disappeared in 15.2% of patients, and the mean number of myocardial segments involved decreased from 46% to 30%, remaining unchanged in 13% of patients. Patients with LGE without edema had a more severe prognostic condition than those with persistent edema. Patients with increased LGE extension on the control cMRI had a worse prognosis than those with modified or low LGE. The most significant independent predictive parameters for major cardiovascular events (MACEs) were LGE mass (adjusted OR = 1.27 [1.11–1.99], p < 0.001), myocardial edema (OR = 1.70 [1.14–209.3], p < 0.001), and prolonged native T1 (OR = 0.97 [0.88–3.06], p < 0.001). The mid-wall model of LGE and the presence of edema-free LGE were MACE-independent predictors. Conclusions: LGE, myocardial edema, and prolonged native T1 were predictors of MACEs. LGE does not necessarily mean constituted fibrosis in the presence of edema and may disappear over time. LGE without edema could represent fibrosis, whereas the persistence of edema represents active inflammation and could be associated with the residual chance of complete recovery. cMRI should be performed in all patients with AM at 6 months to evaluate progress and prognosis.

This study investigates the distribution of hyperhomocysteinemia and cardiovascular metabolic syndrome (SM) among participants, shedding light on their prevalence and co-occurrence within the study cohort. Through an analysis of demographic characteristics and health parameters, including age, gender, and body mass index (BMI), alongside nutritional data, correlations between these factors and health risks are explored. Results reveal a notable prevalence of hyperhomocysteinemia, with 45.3% of participants exhibiting this condition. Furthermore, 31.4% of the cohort does not present hyperhomocysteinemia or SM, while 23.3% shows SM without hyperhomocysteinemia. The study underscores gender-specific dietary recommendations due to significant variations in nutrient intake patterns. Additionally, inverse correlations between health risks like obesity, hypertension, and hypercholesterolemia and nutrient requirements highlight the need for tailored dietary interventions. Age-related changes in nutrient needs and the positive correlation between physical activity levels and certain nutrient demands further emphasize the importance of personalized dietary strategies. Variations in nutrient intake by gender, inverse correlations with health risks, and age-related changes underscore the need for tailored dietary strategies. These findings provide valuable insights for healthcare professionals in developing targeted nutritional interventions to mitigate disease risk and promote overall health and well-being.

Cardiac magnetic resonance (cMRI) imaging has recently become essential in cardiology. cMRI is widely recognized as the most reliable imaging technique for assessing the size and performance of the right ventricle. It allows for objective and functional cardiac tissue evaluations. Early in disease progression, cardiac structure and activity decrease subclinically. Late-phase clinically visible signs have been associated with less favourable outcomes. Subclinical alterations ought to be recognized for rapid evaluations and accurate treatment. An increasing amount of evidence supports cMRI deformation parameter quantification. Strain imaging enables cardiologists to assess heart function beyond traditional measurements. Prognostic information for cardiovascular disease patients is obtained through the right ventricle (RV) strain, including information primarily about the left ventricle (LV). Right atrial (RA) function evaluations using RA strain have been promising in recent studies. Therefore, this narrative review aims to present an overview of the data that are currently available for assessing right myocardial strain and biomechanics using cMRI.

Background: The prognostic significance of right heart remodeling (RHR) in patients with secondary tricuspid regurgitation (STR) who do not meet guideline‐based indications for tricuspid valve surgery remains uncertain. We evaluated whether advanced markers of RHR are associated with outcomes in medically managed patients with significant STR. Methods: We retrospectively included 755 patients with significant STR (age 75±12 years). Patients were stratified into 3 groups: Group 1, no current surgical indication (n=519); Group 2, meeting Class I/IIa guideline criteria (n=144); and Group 3, deemed inoperable (n=92). RHR markers included right atrial volume index, right ventricular end‐diastolic volume index, forward stroke volume/right ventricular end‐systolic volume ratio, and effective right ventricular ejection fraction. The primary end point was a composite of all‐cause mortality or heart failure hospitalization. Results: Group 1 patients had less severe STR and less advanced right ventricular remodeling than Groups 2 and 3. Over a median follow‐up of 24 months (interquartile range, 11–34), 330 primary events occurred; 64 patients underwent tricuspid valve intervention. In Group 1, 30‐month event‐free survival was 71±4% with no RHR markers, 65±3% with 1 or 2 markers, and 33±9% with ≥3 markers (adjusted hazard ratio [aHR], 2.76 [95% CI, 1.74–4.37]; P <0.001). Patients in Group 1 with ≥3 RHR markers had event rates comparable to Group 2 (aHR, 2.79 [95% CI, 1.94–4.02]; P <0.001) and Group 3 (aHR, 4.08 [95% CI, 2.73–6.09]; P <0.001). Conclusions: Among patients with significant STR without surgical indications, ≥3 markers of RHR identify a high‐risk phenotype with outcomes similar to those meeting surgical criteria or considered inoperable.

Objectives: The presence of a bicuspid aortic valve (BAV) is known to alter transvalvular flow and increase shear stress on the ascending aorta, contributing to alterations in aortic geometry and the progression of BAV-related aortopathy. The purpose of the current study was to characterize aortic flow abnormalities and their associations with aortic geometry and ventricular mechanics using cardiac magnetic resonance imaging (CMR). Methods: In this prospective cross-sectional study, 56 young adults with CMR-confirmed BAV and 56 age- and sex-matched healthy volunteers underwent standardized CMR. Biventricular volumes and function, LV global longitudinal strain (LV-GLS), LV torsional mechanics, ascending aortic geometry, pulse-wave velocity, aortic distensibility, and two-dimensional phase-contrast-derived forward and backward flow parameters were quantified. Associations between myocardial mechanics and haemodynamic variables were assessed using correlation analyses and multivariable linear regression. Results: Compared with healthy controls, patients with BAV exhibited preserved LV ejection fraction but impaired LV-GLS, reduced LV torsion, increased aortic stiffness, and a significantly greater backward-flow burden despite similar net aortic flow (all p < 0.001). Higher peak backward-to-forward flow-rate ratios were associated with less negative LV-GLS (p = 0.006), whereas greater aortic regurgitant volume was also associated with impaired longitudinal deformation (p = 0.001). In multivariable analysis, LV-GLS and aortic regurgitant volume remained associated with the peak backward-to-forward flow-rate ratio within the specified model, whereas ascending-aortic dimensions were not. The final model explained 52% of the variability in backward-flow burden. Conclusions: CMR identified a subclinical ventricular-aortic phenotype in young adults with BAV characterized by altered LV mechanics, increased aortic stiffness, and greater relative backward-flow burden despite preserved conventional LV systolic function. The association between backward-flow burden and LV longitudinal mechanics suggests that these abnormalities may represent interrelated manifestations of BAV disease; however, their temporal and causal relationships cannot be established from this cross-sectional study.

Background/Objectives: Bicuspid aortic valve (BAV) is frequently associated with valvular dysfunction and aortic remodeling. This exploratory study examined cross-sectional associations between circulating extracellular matrix-related biomarkers and concurrent echocardiographic characteristics in children with BAV. Methods: We included 43 pediatric participants—26 with BAV and 17 with tricuspid aortic valves (TAV). All participants underwent clinical assessment, transthoracic echocardiography, and serum biomarker quantification at the same study visit. MMP-2, MMP-9, TIMP-1, and TGF-β1 were measured using ELISA. Biomarker levels were compared between the BAV and TAV groups and, within the BAV group, according to the presence of concurrent aortopathy, aortic stenosis, and aortic regurgitation. Results: MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio were higher in the BAV group than in the TAV comparison group. Within the BAV cohort, none of the investigated biomarkers differed significantly between participants with and without aortopathy. TGF-β1 was higher in BAV patients with aortic stenosis, whereas the MMP-9/TIMP-1 ratio showed a borderline difference according to aortic regurgitation status; these subgroup findings are exploratory and limited by small sample size and multiple comparisons. Conclusions: In this selected pediatric cohort, circulating MMP-9 and TIMP-1 levels differed between children with BAV and the TAV comparison group. However, none of the investigated biomarkers differed significantly between BAV patients with and without aortopathy. These cross-sectional findings describe exploratory associations with the BAV phenotype but do not establish diagnostic, predictive, or prognostic utility. Larger longitudinal studies including the broader clinical spectrum of BAV and independent validation cohorts are required.