Background: Coronary artery calcification is a predictor of adverse outcomes after percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) is a promising tool for the treatment of calcified lesions. The aim of this study was to assess the effectiveness and safety of IVL. Methods: A single-center observational study of PCI procedure, with assessment of the outcomes of patients undergoing PCI using IVL, was performed. Angiographic procedural success was used as the primary effectiveness endpoint. The primary safety endpoint was defined as a composite of cardiac death, myocardial infarction and target vessel revascularization within 30 days. Results: A total of 111 patients were included. Indications for PCI spanned the spectrum of chronic (53.2%) and acute coronary syndromes (43%). Lesion preparation before IVL was performed with non-compliant (42%), cutting or OPN (14.4%) balloons and with atherectomy techniques in 11% of procedures. Intravascular imaging was used in 21.6% of procedures. The primary effectiveness endpoint was achieved in 100% and the primary safety endpoint in 3.6% of procedures. Peri-procedural complications were minimal and successfully resolved. Conclusions: IVL was an effective and safe technique for the treatment of calcified coronary lesions. These findings contribute to the growing body of evidence supporting the use of IVL in the management of these challenging scenarios.

Invasive coronary physiology is underused and carries risks/costs. Artificial Intelligence (AI) might enable non-invasive physiology from invasive coronary angiography (CAG), possibly outperforming humans, but has seldom been explored, especially for instantaneous wave-free Ratio (iFR). We aimed to develop binary iFR lesion classification AI models and compare them with human performance. single-center retrospective study of patients undergoing CAG and iFR. A validated encoder-decoder convolutional neural network (CNN) performed segmentation. Manual annotation of target vessel and pressure sensor location on a segmented telediastolic frame followed. Three AI models classified lesions as positive (≤ 0.89) or negative (> 0.89). Model 1 uses preprocessed vessel diameters with a transformer. Models 2/3 are EfficientNet-B5 CNNs using concatenated angiography and segmentation - Model 3 employs class-frequency-weighted Cross-Entropy Loss. Previous findings demonstrated Model 3’s superiority for left anterior descending (LAD) and Model 1’s for circumflex (Cx)/right coronary artery (RCA) - they were therefore unified into a vessel-based model. Ten-fold patient-level cross-validation enabled full sample training/testing. Three experienced operators performed binary iFR classification using single frames of raw/segmented images. Comparison metrics were accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Across 250 measurements, AI accuracy was 72%, PPV 48%, NPV 90%, sensitivity 77%, and specificity 71%. Human accuracy ranged from 54 to 74%. NPV was high for the Cx/RCA (AI: 96/98%; operators: 94/97%), but AI significantly outperformed humans in the LAD (78% vs. 60–64%). An AI model capable of binary iFR lesions classification mildly outperformed interventional cardiologists, supporting further validation studies.

The differential diagnosis of aneurysmal dilation of the ventricular wall includes aneurysm, pseudoaneurysm, and diverticulum. Aneurysm and pseudoaneurysm are associated with myocardial ischemia, whereas diverticulum is a congenital anomaly. These conditions can be differentiated using transthoracic echocardiography, and accurate differentiation is crucial because pseudoaneurysms carry a high risk of rupture and require urgent surgical intervention. We describe 3 cases of left ventricular outpouchings with distinct etiologies and clinical implications. The first case involved a true inferior wall aneurysm with thrombus in a patient presenting with heart failure, which was successfully managed with surgical resection. The second case featured multiple pseudoaneurysms and a ventricular septal defect after anterior myocardial infarction complicated by cardiogenic shock, requiring veno-arterial extracorporeal membrane oxygenation, revascularization, and surgical repair. The third case was an incidental finding of a large inferolateral diverticulum in a minimally symptomatic patient. These cases illustrate the diverse presentations of left ventricular outpouchings and underscore the importance of accurate diagnosis and tailored management strategies.

To assess long-term outcomes of acute myocarditis (AM). Prospective, single-center observational study including patients admitted with AM between 2007 and 2022, followed at a tertiary cardiology center. Follow-up (FUP) included annual clinical evaluations, treadmill testing, Holter and echocardiography. Statistical analysis was performed using Chi-square test and Cox regression. We included 158 patients, 12.7% female, with a mean age of 32 ± 12 years. Most presented with chest pain (94.3%). Severe complications, including cardiogenic shock or arrhythmic storm, occurred in 3.6%. Upon admission, the mean left ventricle ejection fraction (LVEF) was 57%. Out of the 140 patients who underwent cardiac magnetic resonance imaging (CMR), myocardial oedema and late gadolinium enhancement (LGE) were present in 47.8% and 88.5%, respectively. During a mean FUP time of 6±4,3 years, 13,3% patients were readmitted, 80,9% of them due to recurrent myocarditis. Only one patient with LVEF <50% at admission did not recover at FUP. No patients exhibited significant arrhythmias during Holter monitoring or treadmill stress tests. Six patients died at FUP. Three patients had experienced fulminant myocarditis (FM) at index admission; two of them died due to CV causes. There was a statistically significant association between death and fulminant presentation during index admission (p<0,001). AM in adults typically followed a benign course with favorable short- and long-term outcomes. In contrast, a small but significant subset with FM had a markedly poorer prognosis, with severe recurrences frequently proving fatal. Clinical presentation was the sole determinant of prognosis, prompting consideration of whether patients with milder cases truly require extended FUP.

Cardiac metastases from colorectal cancer are exceedingly rare and pose significant diagnostic challenges, particularly in the absence of disseminated disease. A 55-year-old man with ulcerative colitis and previously treated rectal adenocarcinoma presented with rising carcinoembryonic antigen levels during surveillance. Colonoscopy excluded local recurrence. Multimodality imaging identified a right ventricular mass, with cardiac magnetic resonance revealing a 36 × 48 mm lesion arising from the right ventricular free wall with endoluminal growth and late enhancement. In the absence of extracardiac disease, intracardiac echocardiography-guided endomyocardial biopsy confirmed metastatic colorectal adenocarcinoma. Endomyocardial biopsy remains the gold standard for definitive etiological diagnosis of intracardiac masses and is generally safe when performed in experienced centers. Multimodality imaging and operator expertise are essential for accurate diagnosis of high-risk intracardiac masses.

Background/Objectives: Fabry disease (FD) is a rare X-linked disease caused by the deficient activity of the enzyme α-galactosidase A. Cardiac involvement is particularly critical, often determining the disease prognosis. Epidemiological data on FD in Portugal are limited and inconsistent, highlighting the need for targeted screening. The F-CHECK study aimed to determine the prevalence of FD through the systematic screening of a Portuguese cohort of patients with unexplained cardiomyopathies. Methods: This multicenter observational study (NCT05409846) assessed the prevalence and clinical characteristics of FD in a Portuguese cohort (n = 409) of patients from 10 central hospitals who presented with unexplained cardiomyopathies, including idiopathic hypertrophic cardiomyopathy (HCM), left ventricular hypertrophy, dilated-phase HCM, and dilated cardiomyopathy with late gadolinium enhancement in the inferolateral segment. Screening was performed using dried blood spot assays to measure α-galactosidase A activity and/or by GLA gene sequencing in whole-blood samples. Results: FD was diagnosed in 14 patients, corresponding to a prevalence of 3.4%. FD diagnosis was significantly associated with systemic manifestations such as acroparesthesias (p = 0.027) and angiokeratomas (p = 0.003), as well as an increased risk of prior arrhythmic events (p = 0.021) and cerebrovascular disease (p = 0.016). Most FD patients (57%) presented a non-founder mutation in the GLA gene; however, they were pathogenically relevant. Conclusions: The observed 3.4% prevalence highlights the importance of systematic FD screening among Portuguese patients with unexplained cardiomyopathy, extending beyond classic hypertrophic presentations to dilated forms. Specific clinical signs, electrocardiogram findings, and cardiac imaging features can serve as valuable indicators to guide targeted genetic testing for FD.