Background: Aortic coarctation (CoA) is a congenital heart disease affecting 5–8% of patients, with long-term complications persisting despite successful correction. Stress echocardiography (SE) is increasingly used for evaluating cardiac function under stress, yet its role in repaired CoA remains under-explored. Objective: This study aimed to assess the predictive value of SE and myocardial strain in repaired CoA patients with a history of hypertension without significant gradients or with borderline gradients at rest. Methods: Between June 2020 and March 2024, we enrolled 35 consecutive CoA patients with successful repairs and either a history of hypertension or borderline Doppler gradients. Baseline and peak exercise echocardiographic measurements, including left ventricular mass index (LVMi) and global longitudinal strain (LVGLS), were recorded. Patients were followed for up to 4 years. Results: At baseline, the positive SE group had higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to the negative SE group. The positive SE group also exhibited significantly higher basal and peak trans-isthmic gradients. Positive SE was found in 45.7% of patients, with 68.7% of these requiring re-intervention during follow-up. A peak trans-isthmic gradient > 61 mmHg during exercise predicted recoarctation with 100% sensitivity and 71% specificity (AUC = 0.836, p < 0.004). Conclusions: SE identifies at-risk patients post-CoA repair, aiding in early intervention. A peak trans-isthmic gradient > 61 mmHg during exercise is a strong predictor of recoarctation. These findings support incorporating SE into routine follow-up protocols for CoA patients, particularly those with a history of hypertension and borderline gradients, to improve long-term outcomes and quality of life.

Obesity complicates assessment after repair of tetralogy of Fallot (rTOF) because it can influence symptoms, exercise performance, ventricular remodeling, and the normalization of ventricular measurements. This narrative review examines the direct rTOF evidence, almost all observational, and its implications for pulmonary valve replacement (PVR) decision-making. Obesity is present in approximately 15–20% of patients (12–26% across the cohorts reviewed). In studies using absolute, height-indexed, or ideal-BSA-indexed volumes, obesity was associated with larger biventricular volumes and lower ventricular ejection fractions, and the RV volume association persisted after adjustment for PR in one study. These findings have implications for the interpretation of cardiac findings in patients with moderate-to-severe PR after rTOF. Decisions are best made by integrating all findings, with extra attention to patients with obesity. We propose an integrated assessment of symptoms, rhythms, exercise findings, and ventricular measurements.

Background: Obesity and unhealthy dietary habits are among the leading modifiable determinants of cardiovascular disease, acting through biological mechanisms that extend far beyond excess body weight. Adipose tissue dysfunction, chronic low-grade inflammation, oxidative stress, endothelial impairment, mitochondrial dysfunction, and gut microbiota dysbiosis contribute to the development and progression of cardiometabolic disease. Consequently, nutrition should be regarded as a key biological modulator of cardiovascular risk, capable of influencing multiple interconnected metabolic and molecular pathways. Methods: This narrative review provides a critical and translational overview of the current evidence linking diet, obesity, and cardiovascular disease. We critically evaluated epidemiological studies, landmark randomized controlled trials, prospective cohort studies, meta-analyses, international guidelines, and relevant mechanistic investigations to examine the impact of major dietary patterns, obesity-related immunometabolic alterations, and emerging precision nutrition strategies on cardiovascular prevention and management. Results: Among currently available dietary models, the Mediterranean diet has one of the most extensive randomized evidence bases for cardiovascular prevention, including trials demonstrating reductions in major adverse cardiovascular events and other clinically relevant cardiovascular outcomes. Other healthy dietary patterns, including the Dietary Approaches to Stop Hypertension (DASH), healthy plant-based, and Nordic diets, consistently improve intermediate cardiometabolic outcomes, although evidence for hard cardiovascular endpoints is less robust. Conversely, Western dietary patterns characterized by high consumption of ultra-processed foods are associated with visceral adiposity, insulin resistance, vascular inflammation, mitochondrial dysfunction, endothelial injury, and increased cardiovascular risk. Conclusions: Contemporary evidence supports nutrition as a cornerstone of cardiovascular prevention and obesity management, with benefits may extend beyond weight reduction through modulation of key biological pathways involved in cardiometabolic disease.