2026-03-30
Nisarg Desai et al.
Objectives: This study aimed to determine the incidence of radial artery anomalies in a large cohort of patients undergoing TRA and to evaluate their specific impact as predictors of procedural failure and access site complications. Methods: This prospective, observational, single-center study enrolled 1000 consecutive patients undergoing coronary angiography or intervention via TRA between 2022 and 2024. Radial artery anatomy was assessed using retrograde radial arteriography immediately following sheath insertion. Anatomical variants were categorized into high bifurcation (origin proximal to the cubital fossa), Radial artery loops (full 360-degree curvature), Tortuosity (curve of more than 45 degrees in the vessel), Narrow calliber, Spasm, and Ulnar absent. Procedural success was defined by completion of the procedure via the initial radial access site. Binary logistic regression was used to identify independent predictors of procedural failure (crossover to alternate access). Results: Radial artery anomalies were observed in 9.3% (n=93) of the total cohort. High bifurcation (4.7%) was the most common variant, followed by loops (2.3%) and tortuosity (1.5%). Overall procedural success via the initial radial site was 93.8%. The presence of an anatomical anomaly was a highly significant independent predictor of procedural failure/crossover (Odds Ratio [OR]: 8.16; 95% CI: 4.29 to 15.52; PpP=0.001) and older age (OR: 1.03; P =0.005) also predicted failure. Conclusion: Radial artery variants, particularly loops, are significant predictors of procedural crossover but remain rare (~2%) and are successfully negotiated in nearly two-thirds of cases. These findings do not support routine upfront radial angiography, which increases radiation exposure and costs without meaningfully improving success rates. Instead, a selective angiographic approach is recommended for challenging cases. While distal radial access (dTRA) is a promising alternative, its adoption is tempered by a steeper learning curve and smaller vessel calibers.
2026-03-26
Alya J. Al Hashmi et al.
Primary cardiac fibromas are rare benign tumors that may carry arrhythmic risk. We report a case of cardiac fibroma that was incidentally detected in an 18-year-old athlete with echocardiography and MRI during routine pre-championship screening. Following multidisciplinary heart team discussion and shared decision-making, surgical excision was performed due to potential arrhythmic risk in the setting of high-intensity athletic activity.
2026-03-09
Ali Alakhfash et al.
Atrial septal defects are common congenital heart anomalies and may coexist with rare systemic venous abnormalities. We describe a one-year-old female with a large secundum atrial septal defect and an unusual retrocardiac innominate vein. Transthoracic echocardiography suggested a persistent left superior vena cava, but the innominate vein was absent from its usual location and the coronary sinus was not dilated. Cardiac CT angiography demonstrated a retrocardiac innominate vein draining into the azygos system and subsequently to the right atrium. Surgical atrial septal defect closure was successful. Recognition of this anomaly is essential for accurate diagnosis and procedural planning.
2026-02-20
Nazlı Dilek Çolak et al.
Objectives: Carbohydrate antigen 125 (CA125) is associated with different cardiovascular conditions. This study aimed to determine CA125 levels in patients with acute coronary syndrome (ACS) and the potential relationship between major adverse cardiac events (MACE) in the short-term following. Methods: This prospective cohort study was conducted in a coronary care unit between May and November 2022. Plasma CA125 levels were measured only once upon hospital admission. Patients were followed for six months. All-cause mortality, recurrent acute coronary syndrome, requirement for revascularization, decompensated heart failure, cardiogenic pulmonary edema, atrial fibrillation, and stroke were recorded as MACE. Results: A total of 127 patients were included in this study. The mean left ventricular ejection fraction (LVEF) was 50.5%. The median plasma CA125 level was 14.6 KU/L. There was a, significant positive relationship between CA125 and high-sensitivity cardiac troponin (hs-cTn) (r = 0.315, p Conclusions: Plasma CA125 levels were correlated with the pro-BNP and hs-cTn, established ACS biomarkers. An additional notable finding was the weak correlation with LVEF. Elevated plasma CA125 levels might be used to identify patients with ACS who are at higher risk of MACE at six months.
2026-02-19
Praveen Shukla et al.
Objective: Use of vascular closure devices (VCDs) for femoral artery puncture site hemostasis has increased but their safety and efficacy have remained unclear. This study was designed to compare safety and efficacy of Obtura, Angioseal, and Proglide VCD to manual compression (MC) and also between for femoral artery haemostasis. Methods: This was prospective, randomized controlled study where patients were randomly assigned on 1:1:1:1 basis. Primary endpoints were time to hemostasis (TTH) and ambulation time (AT) while secondary endpoints were deployment success, device related adverse events and technical success rate. ANOVA and Tukey HSD was conducted to draw significant difference between individual strategies. P Results: Total of 1,000 patients (250 in each arm) who underwent transfemoral intervention at LPS Institute of Cardiology, Kanpur, India between January 2025 and March 2025 were evaluated. Sheath size, common femoral artery diameter and device size did not differ significantly across all the groups. Mean TTH was shortest for Angioseal (1.30 minutes) followed by Obtura (2.58 minutes), Perclose (3.97 minutes), and MC (17.61 minutes). Similarly, mean AT was shortest for Angio-Seal (123.06 minutes) followed by Perclose ProGlide (162.56 minutes), Obtura (185.42 minutes) and MC (743.23 minutes). Technical success in Angio-Seal, Obtura and Perclose ProGlide were 99.1%, 97.4% and 94.6% respectively. No access site complications (re-bleeding, infection, arteriovenous fistula, and transient access site nerve injury) were noted. There were 2(0.8%), 5(2%), 7(3.2%) and 12(4.8%) cases of haematoma in Angio-Seal, Obtura, Perclose ProGlide and MC arm respectively. There were 2(0.8%), 2(0.8%), and 4(1.6%) case of arterial pseudoaneurysm Obtura, Perclose ProGlide and MC arm respectively while none in Angio-Seal arm. Conclusion - Vascular closure devices showed significantly faster haemostasis and shorter ambulation time compared to manual compression highlighting their clinical efficiency and Angio-Seal was superior safety and efficacy over Obtura and Perclose ProGlide.
2026-02-13
Tariq Majed Alotaibi et al.
Background: Anthracyclines, notably doxorubicin, are potent cytotoxic agents that substantially improved outcomes across numerous malignancies. However, their use is restricted by their cardiotoxicity, a dose-dependent adverse effect that manifests acutely, during treatment, or years post-therapy. It encompasses a spectrum of phenotypes including asymptomatic ventricular dysfunction, heart failure, arrhythmias, and cardiomyopathy, contributing to considerable morbidity and mortality as cancer survival rates improve. Objective: This narrative review summarises current insights into anthracycline-induced cardiotoxicity pathophysiology and evaluates pharmacologic strategies for its prevention and management. Methods: A comprehensive literature search was conducted through August 2025, prioritizing randomised controlled trials, meta-analyses, observational studies, and guideline statements addressing pharmacologic interventions to mitigate anthracycline cardiotoxicity. Results: Anthracycline cardiotoxicity arises from various mechanisms, including oxidative stress, mitochondrial dysfunction, topoisomerase IIβ–induced DNA damage, calcium dysregulation, and reticulum stress. Neurohormonal modulation with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and βeta-blockers has shown modest preservation of left ventricular ejection fraction, especially when initiated early in high-risk patients; spironolactone appears more effective than eplerenone among mineralocorticoid receptor antagonists. Sacubitril/valsartan demonstrates promising superiority in preclinical and early clinical cohorts, though further randomised data are awaited. Metabolic modulators such as metformin and sodium-glucose cotransporter 2 inhibitors exhibit cardio-protectivity via AMPK activation, attenuation of oxidative and inflammatory pathways, but evidence in non-diabetic cancer populations is limited. Statins have shown reduced left ventricular ejection fraction decline and lower cardiotoxicity rates in randomised studies, while dexrazoxane—through iron chelation and topoisomerase IIβ inhibition—remains the only approved agent for anthracycline-induced cardiotoxicity prevention, strongly supported by adult and paediatric data. Conclusion: Several pharmacologic strategies offer potential benefit in limiting anthracycline-induced cardiotoxicity and preserving cardiac function. Tailored, risk-based approaches that incorporate cardioprotective therapies early in anthracycline treatment—guided by biomarkers and imaging—are most promising. Further large-scale randomised studies are required to establish optimal combinations and confirm long-term benefit.
2025-12-22
Waleed AlHabeeb et al.
Background: Type 2 diabetes mellitus (DM) is a chronic disease with a rapidly increasing prevalence, posing a significant public health challenge worldwide and in Saudi Arabia. Cardiovascular disease (CVD) is the leading cause of death among patients with T2DM, necessitating early detection and intervention to prevent disease progression. Elevated natriuretic peptide levels, particularly N-terminal pro–B-type natriuretic peptide (NT-proBNP), are promising biomarkers for CVD risk stratification in individuals with T2DM. However, the integration of these biomarkers in clinical management remains limited. Methods: Published evidence and existing guidelines/consensuses related to the use of NT-proBNP for CVD risk stratification in T2DM patients were reviewed and discussed by a multidisciplinary expert panel from Saudi Arabia. The panel also considered the unique characteristics of the local Saudi population, healthcare system, resources, and medical expertise. Results and conclusions: NT-proBNP-based screening holds significant promise for improving CVD outcomes in T2DM patients by identifying at-risk individuals and guiding management approaches. Based on available evidence, the Saudi Heart Association (SHA) developed an evidence-based position statement on the use of NT-proBNP for CVD risk stratification in patients with T2DM who have no established CVD (asymptomatic). The proposed algorithm for NT-proBNP-based screening aims to improve the early identification of at-risk patients with T2DM, inform clinical management decisions, and enhance patient outcomes in Saudi Arabia. The algorithm includes age-adapted thresholds to reduce unnecessary referrals and medical testing. The SHA recognizes the need for further research and local data collection on NT-proBNP-based screening, in addition to clinician training to address the limitations and improve the practical implementation of NT-proBNP screening in routine clinical practice.