Heba Wassif

Background: Loeffler endocarditis is a rare form of cardiomyopathy caused by eosinophilic infiltration of the endocardium with endomyocardial fibrosis and thrombus formation. It carries significant risk for systemic thromboembolism. This case describes the successful medical management of a massive left ventricular thrombus and highlights the role of cardiac magnetic resonance (CMR) in this condition. Case Summary: A 54-year-old female with eosinophilic granulomatosis with polyangiitis with a heart murmur underwent an echocardiogram showing dilated cardiomyopathy with left ventricular ejection fraction (LVEF) of 39%. Follow-up CMR showed apical predominant endomyocardial fibrosis with a large apical thrombus consistent with Loeffler endocarditis. The clinical course was complicated by direct oral anticoagulant (DOAC) failure and intolerance of immunosuppression, requiring warfarin and biologic (mepolizumab) therapy. The patient has remained free of systemic thromboembolic events while on immunosuppression and systemic anticoagulation. Discussion: There is limited data on the management of Loeffler endocarditis. The widespread availability of cardiac magnetic resonance (CMR) can allow for early diagnosis of cardiac involvement in eosinophilic and other inflammatory conditions. Despite common cardiac involvement in eosinophilic diseases, there are no universal screening guidelines for echocardiography or CMR. Anticoagulation in the setting of Loeffler endocarditis is based on guidelines and retrospective studies demonstrating safety of DOAC. If cardiac involvement is suspected in eosinophilic diseases, early CMR can allow for detection and prevention of complications from Loeffler endocarditis.

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Arteriovenous access-related heart failure (ARHF) is a critical yet underrecognized complication in ESKD patients on hemodialysis. Heart failure is highly prevalent among patients with ESKD and is often characterized as uremic cardiomyopathy. In this setting, the increased hemodynamic load imposed by a functioning hemodialysis access circuit can further aggravate the underlying myocardial pathology, potentially precipitating high-output heart failure. Vascular access accounts for 23% of high-output heart failure cases, carrying a 58% five-year mortality rate. Despite its prevalence, ARHF remains underdiagnosed and mismanaged due to a lack of established societal guidelines. This narrative review aims to delineate the complex pathophysiology of ARHF, highlight current diagnostic challenges, identify existing gaps in evidence, and suggest potential methods to enhance its management. Hemodynamic changes are investigated, including increased cardiac output, cardiac remodeling, pulmonary hypertension, and arterial stiffening, alongside non-hemodynamic factors. Diagnostic modalities, including history and physical exam, laboratory cardiac biomarkers, transthoracic echocardiography, vascular duplex ultrasound, magnetic resonance imaging and right heart catheterization are discussed. Management strategies, encompassing preoperative prevention and risk stratification, medical therapies, surgical interventions (e.g., banding), and surveillance protocols, are also outlined. This comprehensive review addresses current evidence gaps and provides clinical guidance to improve ARHF recognition, diagnosis, and management.

Background: Upper gastrointestinal bleeding is a severe postoperative complication after coronary artery bypass grafting. We aimed to identify the incidence, predictors, and outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) readmissions within 30 days after coronary artery bypass grafting from a nationwide database. Methods: The Nationwide Readmission Database 2016 to 2020 was queried to identify patients who had isolated coronary artery bypass grafting and were readmitted with NVUGIB in 30 days. International Classification of Diseases , Tenth Revision , Clinical Modification ( ICD‐10‐CM ) and Procedure Coding System codes were used to identify the cohort. As the Nationwide Readmission Database is an anonymous public database, the study was exempt from the institutional review board. The analysis was conducted using Stata 17 (StataCorp LLC, College Station, TX). Results: Of 801 221 patients who underwent isolated coronary artery bypass grafting, 784 280 were discharged alive. Within 30 days, of the 5180 patients who were readmitted with a diagnosis of NVUGIB, the mortality rate was 5.4%. Compared with nonreadmitted patients, patients with NVUGIB had a lower proportion of women (25.4% versus 31.2%, P P P P 65 years) (HR, 1.25 [95% CI, 1.01–1.53]; P =0.04). Female sex (odds ratio, 2.01 [95% CI, 1.28–3.17]; P =0.002) was strongly associated with death. Early (≤24 hours) esophagogastroduodenoscopy had better mortality outcomes (odds ratio, 0.23 [95% CI, 0.09–0.53]; P <0.001). Conclusions: NVUGIB readmissions after coronary artery bypass grafting are linked to significant morbidity and death. Early esophagogastroduodenoscopy is associated with improved outcomes, emphasizing its role in management.

Background: Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), has been associated with elevated cardiovascular risks. However, the impact of IBD on outcomes following percutaneous coronary intervention (PCI) remains underexplored. We aimed to evaluate the clinical and procedural outcomes of PCI in patients with concurrent IBD. Methods: This study utilized the National Readmission Database from 2016 to 2020 to evaluate outcomes such as all-cause mortality and post-PCI complications, including various cardiovascular and gastrointestinal (GI) complications in IBD patients undergoing PCI. Patients with concurrent IBD and PCI were compared to non-IBD controls via multivariable logistic regression. Results: On propensity-score-matching analysis, IBD patients undergoing PCI had a higher prevalence of GI complications, including acute liver failure (Odds ratio (OR) 1.48, 95% confidence interval (CI) 1.13–1.93, p = 0.004), mesenteric ischemia (OR 5.34, 95% CI 1.56–18.40, p = 0.007), and need for blood transfusion (OR 1.74, 95% CI 1.46–2.08, p < 0.001). There was also a higher rate of cardiac complications (OR 1.31, 95% CI 1.05–1.64, p = 0.017). No significant difference in all-cause mortality (OR 0.86, 95% CI 0.72–1.04, p = 0.113) was observed. Conclusions: IBD patients undergoing PCI face increased GI and cardiovascular complications without a significant mortality difference. These findings highlight the complex interplay between systemic inflammation, vascular integrity, and procedural outcomes in IBD patients.

Purpose of Review: To provide an overview of the diagnosis and updated therapeutic approach to autoimmune pericarditis. Recent Findings: Subtypes of autoimmune pericarditis may benefit from IL-1 inhibition and future phenotyping based on clinical presentation, biomarkers, and imaging may aid in guiding future therapeutic approaches. Summary: Autoimmune pericarditis is a unique phenotype of pericarditis for which there is scarce data. The clinical spectrum of pericardial involvement associated with autoimmune disorders varies in acuity, recurrence, severity, and symptomatic presentation. There is a pathophysiologic distinction that separates autoimmune and autoinflammatory pericarditis from other pericarditis presentations. This review explores the state of the art in diagnosis and therapeutic management.

High-output heart failure can be a complication of having an arteriovenous fistula (or graft) for hemodialysis access. This review details the pathophysiology, diagnosis, and management of this serious but underdiagnosed condition.

Background: ECGs are a primary assessment of cardiac structure and function. Alignment of their findings with cardiac imaging is not well defined. This study investigates the correlation of left atrial enlargement and left ventricular hypertrophy (LVH) found on ECG with transthoracic echocardiogram and cardiac magnetic resonance imaging (CMR) findings. Methods: This is a single‐center retrospective study of 1000 patients. It included patients with positive ECG criteria for left atrial enlargement or left ventricular hypertrophy (LVH) with transthoracic echocardiograms done within the same month. CMR data were included if within 6 months of the ECG. Receiver operator curves and area under the curves (AUC) were calculated based on whether ECG findings were confirmed on either imaging. Results: Left atrial enlargement ECG criteria best correlating with transthoracic echocardiograms were p‐wave duration of 120+ ms in lead II (AUC, 0.81 [95% CI, 0.79–0.83]; P value P value P value P valueP P value<0.0001). CMR data corroborated this pattern. LAE and LVH criteria with the highest AUC were least represented by patients. Conclusions: ECG criteria for left atrial enlargement and LVH correlated poorly with both transthoracic echocardiograms and CMR. Updating current waveform criteria may improve diagnostic accuracy of ECGs.