A 35-year-old female presented to our emergency department with clinical signs of acute heart failure. Clinical workup identified severe right heart (RH) dilation and dysfunction with a crossing membrane structure in the right atrium. Right heart catheterization confirmed high output heart failure (HOHF), pulmonary hypertension (PH), and left-to-right blood shunting followed by the documentation of multiple liver and pulmonary arteriovenous malformations (AVMs). Hereditary Hemorrhagic Telangiectasia (HHT) diagnosis was made according to clinical criteria and was established as the cause of HOHF because of chronic volume overload from systemic to pulmonary shunts. With this illustrative case, we aim to discuss the broad spectrum of clinical manifestations of HHT and the unusual phenotype of HOHF secondary to HHT. This case also highlights the broad diagnosis of atrial echocardiographic abnormalities and cardiac structural distortion secondary to high output that can be misleading at imaging evaluation.

Endomyocardial fibrosis (EMF) is the most common cause of restrictive cardiomyopathy in Africa and South America. We present a case of a 55-year-old man who experienced an anterior myocardial infarction due to thrombotic occlusion of the left anterior descending artery. Multimodality imaging revealed left ventricular (LV) apical obliteration, apical thrombus, and subendocardial fibrosis, without significant systolic dysfunction, consistent with EMF. EMF should be suspected in patients presenting with heart failure symptoms because of restrictive physiology and/or thrombotic manifestations with typical echocardiographic findings. Cardiac magnetic resonance imaging can provide valuable information regarding typical scar patterns. Similar features can be observed in other forms of cardiopathy, including apical hypertrophic cardiomyopathy, LV thrombosis, excessive LV trabeculation, and Ebstein anomaly.

Background: Patients with non-ST-segment elevation myocardial infarction (NSTEMI) are frequently admitted to intensive care or monitored settings despite heterogeneous risk of ICU-requiring complications. We developed NSTEMI-CARE, a calibrated multilayer decision-support algorithm for early hospital level-of-care assignment. Methods: We conducted a retrospective cohort study of consecutive patients with NSTEMI and angiographically confirmed obstructive coronary artery disease admitted between 1 July 2017 and 31 December 2020 to a cardiovascular referral center in Bogotá, Colombia. The primary outcome was a composite of ICU-requiring complications. Candidate machine-learning models were evaluated for discrimination and calibration. The selected probabilistic model was integrated with predefined clinical triggers and a Gray-Zone decision rule to generate a binary recommendation for general ward versus ICU/monitored care. Results: Among 981 patients, 155 (15.8%) experienced the primary outcome. The isotonic-calibrated HistGradientBoosting model achieved an AUC of 0.821, average precision of 0.618, and Brier score of 0.092 during five-fold out-of-fold internal validation. The final algorithm assigned 464 patients (47.3%) to general ward care and 517 (52.7%) to ICU/monitored care. The observed event rate among ward-assigned patients was 3.9%. Sensitivity was 88.4%, specificity 54.0%, positive predictive value 26.5%, and negative predictive value 96.1%. In secondary comparative analysis, NSTEMI-CARE showed greater discrimination than ACTION-ICU (AUC 0.821 vs. 0.645; p < 0.001). Conclusions: NSTEMI-CARE identified a substantial subgroup potentially suitable for general ward management while maintaining a high negative predictive value. By integrating calibrated risk estimation with explicit clinical decision rules, the algorithm provides a clinically interpretable framework for early level-of-care assignment in NSTEMI. External and prospective validation is required before clinical implementation.

La enfermedad de Castleman comprende un grupo de trastornos linfoproliferativos con características clínicas y comportamientos variables, la variante multicéntrica se ha asociado con infección por virus del Herpes tipo 8, un patógeno que predispone a otras patologías malignas como el sarcoma de Kaposi y el linfoma de cavidad, especialmente en pacientes con compromiso de la inmunidad. Presentamos el caso de un paciente con infección por VIH estadío 3, sarcoma de Kaposi con compromiso visceral, y evidencia de pancitopenia e infección por Herpes virus tipo 8, llegando al diagnóstico de enfermedad de Castleman multicéntrica y compromiso por sarcoma de Kaposi diseminado.

Background: Chagas cardiomyopathy (CC) is a major cause of cardiac morbidity and mortality in Latin America. The disease presents with varying degrees of myocardial involvement, posing a significant clinical challenge. Multimodal imaging plays a crucial role in patient assessment and management; however, the role of cardiac magnetic resonance (CMR) imaging in this context remains under investigation. Objective: To evaluate the association between CMR-derived parameters and the occurrence of adverse outcomes in patients with CC. Methods: Patients with CC underwent comprehensive CMR evaluation using a 1.5-T scanner. Imaging assessments included biventricular volumes, left ventricle ejection fraction (LVEF), right ventricle ejection fraction (RVEF) and late gadolinium enhancement (LGE) for scar analysis. Follow-up data were collected to assess a primary composite outcome comprising all-cause mortality, cardiovascular hospitalization, ischemic stroke, and heart transplantation. All-cause mortality was analyzed as a secondary outcome. Results: A total of 133 patients were included [median age 64 years, 71 (53.4%) female]. The mean LVEF was 43.3% ± 15%. LV scar was detected in 97% of patients. Myocardial edema, LV aneurysm, and LV thrombus were observed in 21.1%, 21.1%, and 12.8% of patients, respectively. The primary composite outcome occurred in 63 patients (47.4%). In multivariable analysis, age, subendocardial LV scarring, and extensive LV scar (≥6 segments with LGE) were independently associated with the primary outcome. Only age was independently associated with all-cause mortality. Conclusions: In patients with CC, subendocardial LV scarring and extensive myocardial fibrosis (≥6 segments with LGE) were independently associated with adverse clinical outcomes. These CMR-derived parameters may serve as valuable prognostic indicators in this high-risk population.