Asian Journal of Research in Cardiovascular Diseases

Transient Ventricular Dysfunction after Tachycardia-induced Cardiomyopathy: Implications for Timing of Rhythm Control and Device Therapy

Adu Agyen Kwame, Aminu Dogondaji Ahmad — Tue, 14 Apr 2026 00:00:00 +0000

Tachycardia-induced cardiomyopathy (TIC) is a reversible form of ventricular dysfunction resulting from sustained or recurrent tachyarrhythmias, often presenting as dilated cardiomyopathy with reduced left ventricular ejection fraction. This study provides a narrative synthesis of current evidence on the recovery of ventricular function following rhythm control and its implications for the timing of device therapy. A comprehensive review of published literature was conducted, focusing on pathophysiology, clinical outcomes, and management strategies in TIC. The findings consistently demonstrate that effective control of the underlying arrhythmia, particularly through early rhythm control or catheter ablation, leads to significant improvement or normalisation of ventricular function in most patients. Recovery may begin within weeks but often requires several months for full restoration, depending on the duration and severity of tachycardia. However, a subset of patients may experience incomplete recovery due to irreversible myocardial remodelling or underlying structural heart disease. Recurrence of tachyarrhythmias is associated with rapid deterioration of ventricular function, highlighting the importance of sustained rhythm control. Importantly, the transient nature of ventricular dysfunction in TIC has significant implications for device therapy, as early implantation of implantable cardioverter-defibrillators or cardiac resynchronisation therapy may be unnecessary in many cases. A strategy of deferring device therapy until reassessment after rhythm control is therefore recommended. In conclusion, early recognition and timely rhythm management are critical to optimising outcomes in TIC, while individualised decision-making is essential to avoid unnecessary interventions.

Serum Adiponectin and Metabolic Alterations in HIV Patients on HAART: Evidence from Rivers State University Teaching Hospital

Prince Ohaka Thankgod, Brown Holy, Ebirien-Agana Samuel Bartimaeus — Fri, 02 Jan 2026 00:00:00 +0000

Background: Alterations in adiponectin levels among HIV-infected individuals receiving highly active antiretroviral therapy (HAART) have been associated with cardiometabolic risk. However, adiponectin and metabolic parameters among people living with HIV on HAART remain insufficiently investigated.

Aim: To evaluate adiponectin concentrations and some selected metabolic indices associated with obesity and lipid metabolism among HIV-positive individuals on HAART at the Rivers State University Teaching Hospital, Port Harcourt.

Materials and Methods: This cross-sectional study recruited 50 HIV-infected adults on HAART and 39 apparently healthy HIV-negative controls. Demographic data were obtained using a structured questionnaire. Anthropometric and blood pressure measurements were determined using standard procedures. Serum adiponectin was measured by enzyme-linked immunosorbent assay (ELISA), fasting glucose by the glucose oxidase method and lipid profile parameters enzymatically, with low-density lipoprotein cholesterol calculated using the Friedewald equation. Derived cardiometabolic indices were computed using standard formulae. Data were analyzed using SPSS version 26, with statistical significance set at p < .05.

Results: There were no significant differences (p > .05) between HIV-infected individuals on HAART and HIV-negative controls in adiponectin, fasting glucose, lipid profile parameters, or most cardiometabolic indices. However, lipid accumulation product (LAP) (50.282±16.93 vs 46.35±19.37), visceral adiposity index (VAI) (0.92 ± 0.40 vs. 0.76 ± 0.93), body roundness index (BRI) (8.72 ± 0.69 vs. 6.66 ± 0.70), and weight-adjusted waist index (WWI) (8.30 ± 0.51 vs. 5.55 ± 0.51) were significantly higher (p < 0.05) among HIV-infected individuals on HAART compared with HIV-negative controls.

Conclusion: Adiponectin levels and most metabolic paramaters did not differ significantly between HIV-infected individuals on HAART and HIV-negative controls. Nonetheless, elevated adiposity-related indices (LAP, VAI, BRI, and WWI) among HIV subjects on HAART suggest a potential subclinical cardiometabolic risk. Routine monitoring of these indices in HIV care is recommended, and larger population-based studies in Port Harcourt are warranted to further elucidate these findings.

Implementation of a Team‑Based Care Model for Multi‑Morbidity (Hypertension + Diabetes + Dyslipidaemia) in Nigerian Primary Care: Outcomes on Quality and Cost

AbAbolore Aminat Ajakaye, Pelumi M. Adereti, Onome Olajide, Abiola O. Ojo — Mon, 09 Feb 2026 00:00:00 +0000

Background: Multi-morbidity involving hypertension, diabetes, and dyslipidaemia is increasing in Nigeria and poses significant challenges for fragmented, physician-centered primary care systems. Team-based care models may improve clinical outcomes and reduce costs, but evidence from low- and middle-income settings remains limited. This study evaluated the implementation of a team-based care model for managing cardiometabolic multi-morbidity in Nigerian primary care and assessed its impact on quality of care and healthcare costs.

Methods: A prospective implementation study was conducted in selected primary healthcare facilities, where multidisciplinary teams comprising physicians, nurses, pharmacists, and community health workers delivered coordinated care using standardized treatment protocols, patient education, and follow-up systems. Clinical outcomes (blood pressure, glycaemic control, and lipid levels), process indicators (guideline adherence, visit frequency, and patient satisfaction), and direct healthcare costs were measured at baseline and after 12 months of implementation.

Results: The team-based care model was associated with significant improvements in clinical outcomes, including increased proportions of patients achieving target blood pressure, HbA1c, and LDL-cholesterol levels. Adherence to clinical guidelines and patient retention in care improved, while unplanned hospital visits decreased. Cost analysis demonstrated a reduction in per-patient annual healthcare expenditures driven by fewer complications and hospitalizations, despite modest increases in primary care service utilization.

Conclusion: Implementing a team-based care model for cardiometabolic multi-morbidity in Nigerian primary care settings improved quality of care and was cost-saving over one year. Scaling up multidisciplinary, protocol-driven care may strengthen chronic disease management and enhance health system efficiency in resource-limited settings.

Trends, Care Cascade Gaps and Projected Burden of Hypertension in Rivers State, Nigeria (2015–2034)

Nduye Christie Tobin Briggs — Wed, 01 Apr 2026 00:00:00 +0000

Background: Hypertension is the leading modifiable risk factor for cardiovascular morbidity and mortality globally, with a rising burden in sub-Saharan Africa. This study assessed ten-year trends in hypertension prevalence, awareness, treatment, and control in Rivers State, Nigeria, and projected future burden to 2034.

Methods: A retrospective trend analysis was conducted using routinely collected health facility records, state surveillance reports, and population-based survey data from 2015 to 2024. Data from 156 health facilities across all 23 Local Government Areas were analysed, comprising 2,847,693 adult encounters. Hypertension was defined as blood pressure ≥140/90 mmHg or as current use of antihypertensive medication. Data analysis was conducted with SPSS version 27. Temporal trends were assessed using joinpoint regression, with projection modelling (2025-2034) using AutoRegressive Integrated Moving Average and population-based methods under three scenarios.

Results: Hypertension prevalence increased from 24.8% (95% CI: 24.1-25.5) in 2015 to 33.7% (95% CI: 32.9-34.5) in 2024 (Average Annual Per cent Change: 3.2%; p<0.001). Prevalence was higher among males (35.2% versus 30.1%), urban residents (35.8% versus 29.2%), and increased with age. Awareness improved modestly from 26.3% to 34.8% (p<0.001), treatment from 18.4% to 24.7% (p<0.001), and control among treated individuals from 12.1% to 14.3% (p=0.03). Only 3.5% of all hypertensives achieved blood pressure control in 2024. Projections indicate the number of adults with hypertension will increase by 47-55% to 2.78-2.94 million by 2034, with uncontrolled cases rising from 1.82 million to 2.68 million.

Conclusion: Hypertension burden in Rivers State is high, accelerating, and projected to increase substantially. Profound gaps in awareness, treatment, and control leave most hypertensives at risk for preventable complications. Urgent health system strengthening and population-level prevention strategies are needed.

Prevalence and Pattern of Dyslipidemia among HIV Patients Receiving HAART in a Nigerian Tertiary Hospital

Tarila Ngowari Aleruchi-Didia, Helen Waribo, Onengiyeofori Ibama — Mon, 18 May 2026 00:00:00 +0000

Background: Dyslipidemia is a recognized metabolic complication among people living with HIV receiving highly active antiretroviral therapy (HAART). As survival improves with long-term antiretroviral treatment, lipid abnormalities are becoming increasingly important contributors to cardiovascular disease risk. This study assessed the prevalence and pattern of dyslipidemia among HIV patients receiving HAART at a Nigerian tertiary hospital and compared lipid parameters with HIV-negative controls.

Methods: This cross-sectional analytical study was conducted at Rivers State University Teaching Hospital, Port Harcourt, Nigeria. A total of 150 adults were recruited consecutively, comprising 90 HIV-positive patients receiving HAART and 60 apparently healthy HIV-negative controls. Serum lipid parameters, including total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-HDL cholesterol, were measured using standard enzymatic techniques. Dyslipidaemia was defined according to established clinical threshold values. Statistical comparisons were performed using independent samples t-tests and chi-square tests, with a p-value of < 0.05 considered statistically significant.

Results: Overall dyslipidemia was observed in 85.7% of HIV-positive participants receiving HAART. Hypercholesterolemia and low HDL-C were the most prevalent abnormalities, each occurring in 42.9% of participants, while elevated LDL-C was observed in 14.3%. No cases of hypertriglyceridemia were identified. Comparative analysis demonstrated significantly higher mean total cholesterol, LDL-C, and non-HDL-C levels, as well as significantly lower HDL-C levels, among HIV-positive participants compared with controls (p < 0.05). Overall dyslipidemia was also significantly more prevalent among HIV-positive participants.

Conclusion: Dyslipidemia was highly prevalent among HIV patients receiving HAART, highlighting the need for routine lipid monitoring and integrated metabolic assessment in HIV care programs.

In vivo Assessment of the Antihypertensive Effect of Schrankia leptocarpa (Mimosoideae) in Wistar Rats

Tue, 09 Jun 2026 00:00:00 +0000

Background: Hypertension is a serious public health problem. The ethnobotanical studies revealed the use of numerous medicinal plants in beninese pharmacopeia of which Schrankia leptocarpa for the hypertension treatment.

Aims: The study aims to characterize the phytochemical profile of the hydroalcoholic extract of Schrankia leptocarpa and to evaluate its antihypertensive potential in L-NAME-induced hypertensive rats.

Methodology: Hydroalcoholic extraction of the plant was performed and the chemical groups were determined by thin-layer chromatography (TLC). The study involved 40 Wistar rats, divided into four groups of 10 animals each. Hypertension was induced by administering L-NAME (20 mg/kg) for 7 consecutive days. From day 8 onwards, treatments were administered for 7 days (D8 to D14): Schrankia leptocarpa extract (200 and 500 mg/kg) or Captopril (100 mg/kg), while the control groups received distilled water. The animal’s blood pressure was measured by carotid catheterisation under thiopental anaesthesia using a Spacelabs monitor. The toxicological profile of the extracts was determined according to the guidelines of the Organization for Economic Cooperation and Development (OECD). The results were analyzed using analysis of variance (ANOVA) with a p-value of 0.05.

Results: Alkaloids, flavonoids, coumarins, tannins, saponins, and traces of anthracene derivatives were found to be present in the extract. Administration of the extract at a dose of 2000 mg/kg body weight showed no signs of toxicity in Wistar rats. This study showed that L-NAME increased mean arterial pressure to 168.4 mmHg in rats. Treatment with the hydroalcoholic extract of Schrankia leptocarpa significantly reduced it to 140.5 mmHg (−27.9 mmHg), while captopril lowered it to 145.5 mmHg (−22.9 mmHg).

Conclusion: The hydroalcoholic extract of Schrankia leptocarpa showed significant antihypertensive effects in L-NAME-induced rats, supporting its potential for developing improved traditional therapies against hypertension.

Effect of a WhatsApp-Based Educational Intervention on Knowledge of Hypertension, Medication Adherence, and Self-Care Management among Hypertensive Patients in Teaching Hospitals in Ogun State, Nigeria: A Quasi-Experimental Study

Ssempebwa Kato Daniel, Asonye C. Christian, Nwosu Ihouma — Sat, 27 Jun 2026 00:00:00 +0000

Aim: This study assessed the effect of a structured WhatsApp-based educational intervention on knowledge of hypertension, medication adherence, and self-care management among patients with hypertension attending teaching hospitals in Ogun State, Nigeria.

Study Design: A two-arm hospital-cluster quasi-experimental design was used, with intervention and control groups. Ogun State has two registered teaching hospitals, according to the current registration records of the State Ministry of Health.

Place and Duration of Study: The study was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, and Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria, between January and March 2026.

Methodology: A total of 126 adult patients with uncontrolled hypertension were recruited, with 63 participants in each group. The intervention group received an eight-week structured WhatsApp-based educational programme in addition to usual care, while the control group received usual care only. The intervention included daily educational messages, infographics, short videos, voice notes, quizzes, and moderated question-and-answer sessions. Data were collected using a structured questionnaire that assessed knowledge of hypertension, medication adherence, and self-care management. Blood pressure was measured using an automated digital blood pressure monitor. Data were analysed using descriptive statistics, paired t-tests, independent t-tests, and effect-size estimation.

Results: The intervention group showed improvements in hypertension knowledge, medication adherence, self-care management, and blood pressure after the intervention. Knowledge scores increased from 6.3 to 11.0, medication adherence scores increased from 4.5 to 7.2, and self-care management scores increased from 60.3 to 82.6. Systolic and diastolic blood pressure decreased from 148.5/92.3 mmHg to 132.4/83.1 mmHg. The control group showed smaller and statistically non-significant changes. Most participants in the intervention group reported high acceptability of the WhatsApp-based programme.

Conclusion: The structured WhatsApp-based educational intervention was associated with improved knowledge, medication adherence, self-care management, and blood pressure outcomes among hypertensive patients in the study setting. Further studies using larger randomised designs and longer follow-up are recommended.

Occupational Health Hazards: Biomonitoring of Oxidative, Inflammatory and Cardiovascular Stress Markers in Female Market Traders

Harrison Ogheneochuko Eruotor, Wisdom Tochukwu Shedrack, Ncholas Asiwe — Tue, 14 Jul 2026 00:00:00 +0000

Market activities may release toxic substances into the environment and adversely affect traders' health. This study assessed oxidative stress, inflammatory and cardiac stress markers among female market traders. Serum samples from market traders (Group 1, n = 20) and non-market women (Group 2, n = 20) were analysed. Unpaired t-test results (mean ± SEM) showed significantly lower catalase (CAT) levels in Group 1 than in Group 2 (26.83 ± 5.63 vs. 54.33 ± 7.88; p = 0.01), with significantly higher nitric oxide (NO) (25.35 ± 2.15 vs. 11.80 ± 1.37; p < 0.01), C-reactive protein (CRP) (28.30 ± 5.90 vs. 7.10 ± 0.78; p = 0.02), NT-proBNP (179.20 ± 30.01 vs. 61.10 ± 8.99; p = 0.01), myoglobin (97.92 ± 10.47 vs. 54.98 ± 13.82; p = 0.02) and soluble ST2 (sST2) (73.00 ± 5.20 vs. 30.24 ± 7.44; p < 0.01). Non-significant differences were observed for superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6), cardiac troponin I (cTnI), cardiac troponin T (cTnT) and CK-MB. Pearson correlation analysis between biomarker levels and exposure duration in Group 1 was significant only for sST2 (r = 0.66, p < 0.01). These findings indicate measurable alterations in oxidative, inflammatory and cardiovascular stress markers among female market traders compared with controls, suggesting the need for further occupational health assessment.

The Zebrafish (Danio rerio) Embryo as a Model for Developmental and Cardiovascular Toxicity: Principles, Mechanisms and Applications

Thu, 19 Mar 2026 00:00:00 +0000

Background: Embryonic zebrafish (Danio rerio) has emerged as a leading vertebrate model in developmental biology and cardiovascular toxicology. It effectively bridges the gap between high-throughput in vitro assays and mammalian in vivo systems, enabling efficient evaluation of drugs and chemical-induced cardiotoxicity and developments.

Key Advantages: The model offer approximately 70 percent genetic similarity to humans, conserved cardiovascular physiology (including a distinct QT interval), rapid external embryonic development, optical transparency for live imaging, small size, and high fecundity. A unique strength is that embryos with severe cardiac defects survive via passive oxygen diffusion, permitting detailed phenotypic analysis of otherwise lethal cardiac malformations unlike in mammalian models.

Screening Applications and Phenotypic Endpoints: Zebrafish embryos enable cost-effective, large-scale screening of drugs and environmental toxins (greatly surpassing rodent throughput). They facilitate detection of structural cardiotoxicity (e.g. Pericardial edema, heart looping defects) and functional cardiotoxicity (e.g. Bradycardia, reduced cardiac output), including effects without overt morphological alterations.

Chemical Sensitivity and Mechanistic Features: The model is highly sensitive to diverse chemical classes, including tyrosine kinase inhibitors, immunosuppressants (e.g. Cyclosporine A), antibiotics (e.g. Ciprofloxacin), and fungicides (e.g. Iprodione, thiram). Environmental factors such as pH modulate toxicity and uptake of ionizable compounds. Conserved pathways include oxidative stress and p53-mediated apoptosis, with compound-specific molecular signatures (e.g. Cyclosporine A inhibits Wnt signalling; ciprofloxacin disrupts calcium signalling).

Experimental capabilities: The zebrafish embryo supports pathway-specific rescue experiments (e.g., Wnt activators, antioxidants) and high-throughput screening of cardioprotective agents.

Conclusion and Impact: Overall, the embryonic zebrafish model plays a pivotal role in elucidating early cardiac developmental defects, reducing attrition risks during drug discovery, and establishing safety thresholds for environmental chemicals.

Epidemiological Profile of Takotsubo Syndrome: A Review

Nabil Laktib, Selma Saidi, Najat Mouine, Zouhair Lakhal, Aatif Benyass — Mon, 22 Jun 2026 00:00:00 +0000

Background: Takotsubo syndrome is an acute and usually reversible form of myocardial dysfunction that often resembles acute coronary syndrome. Its epidemiological profile has become increasingly relevant as diagnostic awareness and access to cardiac imaging have improved.

Objective: This literature review describes the epidemiological profile of Takotsubo syndrome, with emphasis on incidence, demographic characteristics, risk factors, triggers, clinical phenotypes, prognosis, recurrence, and remaining gaps in knowledge.

Methods: A narrative literature review was conducted using PubMed, Scopus, and Google Scholar. Studies published mainly between 2000 and 2026 were considered. Priority was given to major registries, observational studies, systematic reviews, meta-analyses, and consensus documents relevant to epidemiology and clinical outcomes.

Results: Takotsubo syndrome accounts for approximately 1-3% of suspected acute coronary syndrome presentations and occurs predominantly in postmenopausal women, who represent about 80-90% of reported cases. The typical age range is 60-75 years. Emotional stressors are classically associated with the syndrome; however, physical triggers, including acute neurological events, infection, surgery, trauma, respiratory failure, malignancy, and critical illness, are increasingly recognised and are linked to less favourable outcomes. Psychiatric and neurological disorders are frequent comorbidities, supporting the relevance of brain-heart interactions. Although left ventricular systolic function usually recovers, acute complications may include heart failure, cardiogenic shock, arrhythmias, thromboembolism, recurrence, and death. Recurrence is reported in approximately 5-10% of patients during follow-up. Increased reporting during the COVID-19 pandemic further illustrates the potential influence of psychological stress, systemic illness, and inflammatory mechanisms.

Conclusion: Takotsubo syndrome is clinically important and probably underdiagnosed. Its epidemiology is characterised by female predominance, older age, stress-related triggers, heterogeneous clinical severity, and limited data from low- and middle-income regions, particularly African populations.

Current Evidence, Challenges and Future Directions Associated with Teaching Electrocardiogram Interpretation to Medical Students

Nabil Laktib, Selma Saidi, Najat Mouine, Zouhair Lakhal, Benyass Aatif — Sat, 11 Jul 2026 00:00:00 +0000

The electrocardiogram (ECG) remains one of the most universally applied diagnostic tools in clinical medicine, yet a substantial body of evidence demonstrates that ECG interpretation competency among medical graduates is persistently and widely inadequate. This critical review examines the current state of ECG education in undergraduate medical curricula, synthesising peer-reviewed evidence published predominantly between 2003 and 2024. The review appraises both traditional and technology-enhanced teaching modalities, explores the cognitive frameworks that underpin ECG literacy, and evaluates the validity and reliability of existing assessment approaches. Evidence indicates that conventional lecture-based instruction, whilst foundational, is insufficient on its own to develop or sustain competent interpretation skills. Technology-enhanced methods—including e-learning platforms, virtual patient simulations, mobile applications, and gamified learning environments—have demonstrated measurable gains in accuracy and confidence, particularly when combined with deliberate practice and structured feedback. Artificial intelligence is emerging not only as a clinical adjunct to ECG interpretation but also as a potential educational instrument capable of personalising learning and illuminating diagnostic reasoning patterns. Significant challenges persist, including marked variability in curriculum design, inadequate time allocation, the theory-to-practice gap, and motivational barriers among students. Assessment frameworks are often poorly aligned with the applied, clinical nature of ECG competency, over-relying on decontextualised recall-based formats. This review synthesises available evidence to propose a framework for more coherent, standardised, and learner-centred ECG education, and identifies research priorities including the development of validated competency benchmarks, the integration of spaced and adaptive learning technologies, and the adoption of interprofessional approaches to cardiac rhythm training.

Modern Strategies and Innovations in the Reperfusion Therapy of Acute Myocardial Infarction: A Systematic Review

AbAbolore Aminat Ajakaye, Pelumi M. Adereti, Chibuike A. Ojiego — Fri, 06 Feb 2026 00:00:00 +0000

Acute myocardial infarction (AMI) remains a leading cause of global morbidity and mortality, with timely reperfusion therapy forming the cornerstone of contemporary management. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for ST-segment elevation myocardial infarction (STEMI), demonstrating relative reductions in short-term mortality, reinfarction, and stroke of approximately 20–30% compared with fibrinolysis when performed promptly in high-volume centers. Over the past two decades, system-level initiatives aimed at reducing door-to-balloon (D2B) time have successfully decreased median treatment delays to below 90 minutes in many regions; however, contemporary registry and trial data indicate that incremental reductions in D2B time beyond this threshold are not consistently associated with proportional improvements in survival. Instead, total ischemic time—particularly pre-hospital delay—has emerged as a stronger determinant of infarct size, left ventricular dysfunction, and long-term outcomes. Evolving reperfusion strategies now emphasize complete revascularization in multivessel disease, intravascular imaging–guided PCI, and selective use of mechanical circulatory support in high-risk presentations, each associated with reductions in recurrent ischemic events and heart failure hospitalization in recent randomized trials. Advances in adjunctive pharmacotherapy, including potent P2Y12 inhibitors, optimized anticoagulation strategies, and targeted intracoronary therapies, have further improved thrombus resolution and microvascular perfusion. In parallel, regional STEMI networks and digital health technologies have demonstrated meaningful reductions in first medical contact–to-device time and treatment delays. This narrative review synthesizes contemporary quantitative evidence on modern reperfusion strategies, re-examines the clinical relevance of D2B metrics in the current era, and highlights emerging pharmacologic and system-based innovations aimed at optimizing reperfusion efficacy and improving both short- and long-term outcomes in patients with AMI.

Chronotherapy in Hypertension: A Systematic Review and Meta-Analysis Comparing Asian and Non-Asian Populations on the Effects of Antihypertensive Dosing Time, Ambulatory Blood Pressure and Cardiovascular Outcomes

Gabriel Angelo S.E. Molina, Ninfa Marie G. Señoron, Michael Anthony A. dela Cruz — Tue, 07 Apr 2026 00:00:00 +0000

Background: Hypertension is a major global health burden and a leading cause of cardiovascular morbidity and mortality. Despite effective antihypertensive therapies, optimal blood pressure (BP) control remains inadequate worldwide (Kario et al., 2019). Circadian variations influence BP, and insufficient nocturnal decline (“nondipping”) increases cardiovascular risk. Chronotherapy, the timed administration of antihypertensive medication, may enhance 24-hour BP control and clinical outcomes.

Objective: To evaluate the effects of morning versus bedtime antihypertensive medication dosing on ambulatory BP parameters and major adverse cardiovascular events (MACE).

Methods: A systematic literature search was conducted in PubMed, Google Scholar, HERDIN, and Cochrane Library, yielding 1,246 records. After duplicate removal and relevance screening, 86 full-text articles were assessed for eligibility. Seventy-one studies were excluded mainly for non-randomized designs, incomplete data, or absence of direct comparison between bedtime and morning dosing. Ultimately, 11 randomized controlled trials (RCTs) fulfilled the inclusion criteria and were included in the meta-analysis.

Results: Bedtime dosing resulted in significantly greater reductions in 24-hour and nighttime systolic BP (approximately 2–3 mmHg) than morning dosing. Subgroup analyses showed enhanced BP-lowering effects among Asian populations, potentially reflecting genetic and circadian influences.

Conclusion: Bedtime administration of antihypertensive medications is a safe and feasible chronotherapeutic approach that improves nocturnal BP control, especially in patients with nondipping or nocturnal hypertension. Although major cardiovascular benefits remain unconfirmed, this strategy supports personalized hypertension management and warrants validation in larger outcome trials.

Graded Impairment and Pattern Evolution of Global Longitudinal Strain in Coronary Artery Disease: A Systematic Review of Anatomical Complexity

C. C. Sekarsari, A. F. Rahimah — Wed, 03 Jun 2026 00:00:00 +0000

Background & Aims: Global longitudinal strain (GLS) derived from two-dimensional speckle-tracking echocardiography is increasingly recognized as a sensitive marker of subclinical myocardial dysfunction. Its relationship to the anatomical extent and distribution of coronary artery disease (CAD), however, remains incompletely synthesized. This review aims to evaluate differences in resting GLS according to coronary vessel involvement and to characterize regional versus diffuse strain patterns across varying degrees of CAD severity.

Methodology: A systematic search of PubMed, Cochrane Library, and ScienceDirect was conducted. Studies were included if they assessed resting GLS in adults with angiographically confirmed CAD and stratified disease by vessel count or anatomical complexity. Qualitative synthesis was performed due to methodological heterogeneity.

Results: Twelve observational studies met inclusion criteria. Across vessel-count classifications, GLS progressively declined from normal coronary arteries to single-, double-, triple-vessel, and left main disease. Similar inverse associations were observed between GLS magnitude and SYNTAX score. In single-vessel disease, strain reduction tended to localize to affected territories, whereas multivessel involvement was associated with more diffuse longitudinal impairment despite preserved ejection fraction. Longitudinal strain reflects cumulative subendocardial ischemic burden and demonstrates a dose–response relationship with coronary disease extent. The transition from regional to diffuse dysfunction may represent a functional signature of increasing anatomical involvement.

Conclusion: Resting GLS is closely associated with coronary artery disease burden and distribution, supporting its role as a noninvasive marker of ischemic severity.

Severe Aortic Stenosis in a Patient With Transthyretin Cardiac Amyloidosis: A Case Report

Wed, 25 Feb 2026 00:00:00 +0000

Transthyretin amyloidosis (ATTR) is a condition in which amyloid fibrils derived from transthyretin accumulate in tissues, which may result from hereditary factors or the ageing process. Heart problems are often observed, resulting in restrictive cardiomyopathy, causing heart failure and electrical conduction abnormalities.Aortic stenosis is the most common form of valve disease in older people. Recent research has revealed a significant link between ATTR amyloidosis, particularly the wild-type form, and severe aortic stenosis, with important implications for diagnosis, prognosis and treatment options.

In this article, we report the case of an elderly patient with severe aortic stenosis and significant left ventricular hypertrophy. Transthoracic echocardiography revealed a cockade appearance of the global lateral strain, and cardiovascular magnetic resonance imaging showed diffuse late gadolinium enhancement in both ventricles, suggesting cardiac amyloidosis. Bone scintigraphy revealed intense myocardial uptake (Perugini grade 3), confirming transthyretin cardiac amyloidosis. The patient was treated with transcatheter aortic valve implantation and started tafamidis therapy with good result.

Right-Sided Tricuspid Infective Endocarditis Caused by Streptococcus Pneumoniae in a Patient with a Long-Standing Implantable Venous Port: A Rare Case Report

Fri, 27 Feb 2026 00:00:00 +0000

Background: Right-sided infective endocarditis (IE) is uncommon, accounting for only 5–10% of cases, and is typically associated with intravenous drug use or intracardiac devices. Streptococcus pneumoniae has become a rare cause of IE, especially on the tricuspid valve. Early diagnosis remains challenging due to nonspecific clinical features and frequent respiratory presentations.

Case Presentation: We report a 47-year-old male with a history of chronic lymphocytic leukemia in remission, who presented with prolonged fever and dyspnea while carrying an unused implantable venous chamber. Transthoracic echocardiography revealed a large mobile vegetation on the tricuspid valve with severe regurgitation, and blood cultures isolated Streptococcus pneumoniae. Targeted intravenous antibiotic therapy (ceftriaxone and gentamicin), combined with removal of the intravascular device, resulted in rapid clinical improvement and complete recovery.

Conclusion: This case highlights a rare presentation of pneumococcal right-sided IE in the absence of classic risk factors. It underscores the importance of considering right-sided IE in persistent fever and supports early device removal and targeted antimicrobial therapy to optimize outcomes.

A Pseudotumoral Lesion of the Mitral Annulus: Diagnostic Approach and Clinical Implications

Sat, 21 Mar 2026 00:00:00 +0000

Background: Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification characterized by liquefaction necrosis within chronically calcified annular tissue. Its pseudotumoral appearance may mimic cardiac tumors or infective processes, creating significant diagnostic challenges.

Case Presentation: An 81-year-old female patient was referred for preoperative cardiac assessment in advance of elective hip arthroplasty. She was asymptomatic and classified as New York Heart Association (NYHA) functional class I. Transthoracic echocardiography demonstrated a well-circumscribed mass measuring 23 × 20 mm situated at the posterior mitral annulus, accompanied by mild mitral stenosis, with a mitral valve area of 1.9 cm² and a mean transvalvular gradient of 5 mmHg. Left ventricular systolic function was preserved. Cardiac magnetic resonance imaging demonstrated a hypointense lesion with peripheral late gadolinium enhancement, while computed tomography confirmed a hypodense mass with peripheral calcifications, consistent with caseous degeneration. Laboratory findings were unremarkable. A conservative approach was adopted. The patient underwent orthopaedic surgery without complications, and six-month follow-up echocardiography showed stable findings.

Conclusion: CCMA should be included in the differential diagnosis of mitral annular masses in elderly individuals. The use of multimodality imaging is integral to accurate diagnosis and is essential in avoiding unwarranted surgical intervention.

Valve Destruction and Fatal Acute Aortic Regurgitation in Staphylococcal Infective Endocarditis: A Case Report

Wed, 01 Apr 2026 00:00:00 +0000

Background: Infective endocarditis remains a life-threatening disease with significant morbidity and mortality. Acute aortic regurgitation is among the most severe complications of infective endocarditis and results from rapid destruction of the aortic valve apparatus. This condition frequently leads to acute heart failure and requires urgent surgical intervention.

Case presentation: We report the case of a 58-year-old woman with no prior history of cardiovascular disease who was admitted for native aortic valve infective endocarditis caused by Staphylococcus haemolyticus. Transthoracic echocardiography revealed severe acute aortic regurgitation with preserved left ventricular systolic function. Transesophageal echocardiography demonstrated extensive destruction of the aortic cusps with loss of leaflet coaptation and massive regurgitation. Blood cultures confirmed Staphylococcus haemolyticus infection. Despite prompt initiation of targeted intravenous antibiotic therapy and intensive medical management, the patient developed progressive renal failure and acute decompensated heart failure. Urgent surgical aortic valve replacement was indicated; however, the patient experienced rapid hemodynamic deterioration and died before surgical intervention could be performed.

Conclusion: This case illustrates the fulminant course of staphylococcal infective endocarditis complicated by acute aortic regurgitation. Early recognition of severe valvular destruction and immediate referral for surgical management are essential to improve survival in this life-threatening condition.

From Inflammation to Constriction: Tuberculous Pericarditis in a Young Postpartum Woman

A. El Bouazizi, F. Essadqui, L. Afendi, M. Khachab, M. Haboub — Thu, 02 Apr 2026 00:00:00 +0000

Tuberculous pericarditis remains a major cause of pericardial disease in endemic regions and continues to be associated with significant morbidity and mortality. Constrictive pericarditis represents one of its most severe complications and results from progressive pericardial inflammation leading to fibrosis, thickening, and impaired ventricular filling. We report the case of a 23-year-old pregnant woman who presented with febrile dyspnea and systemic inflammatory syndrome, whose clinical course was complicated by preterm labor and intrauterine fetal demise. Multimodal imaging revealed pericardial thickening, moderate pericardial effusion, respiratory variation of ventricular inflow velocities consistent with ventricular interdependence, and associated pleuropulmonary and lymph node involvement. Pleural fluid analysis demonstrated a lymphocyte-predominant exudate highly suggestive of tuberculous etiology in an endemic setting. Anti-tuberculous therapy combined with adjunctive corticosteroids was initiated promptly. This case highlights the diagnostic challenges of tuberculous constrictive pericarditis, particularly in young pregnant patients, and emphasizes the importance of early recognition of reversible inflammatory constriction to prevent progression toward irreversible fibrotic disease requiring pericardiectomy.

Massive Ascending Aortic Dilation in a Patient with Marfan Syndrome: A Case Report

D. Bennani, M. Bouziane, L. Afendi, B. Lahkim, A. Drighil — Thu, 28 May 2026 00:00:00 +0000

Aortic complications in Marfan syndrome can be life-threatening, yet this case uniquely illustrates the catastrophic consequences of delayed diagnosis in a young patient. We report a 21-year-old man with a family history of Marfan syndrome who presented with acute dyspnea and tearing chest pain. Clinical examination revealed a systemic score ≥7, including arachnodactyly, pectus carinatum, thoracolumbar scoliosis, pes planus, and characteristic facial features. Transthoracic echocardiography demonstrated a massive ascending aortic aneurysm (sinuses of Valsalva up to 84 mm), an intimal flap consistent with Stanford type A aortic dissection, severe aortic regurgitation (regurgitant volume 72 mL), severe left ventricular dysfunction (LVEF 24%), and severe tricuspid regurgitation. Computed tomography confirmed the aortic aneurysm and dissection. Urgent Bentall procedure with tricuspid annuloplasty was recommended, but the clinical outcome was rapidly fatal within hours of diagnosis. To our knowledge, this degree of ascending aortic dilation (>80 mm) in such a young adult, combined with multi-valvular involvement and acute dissection, represents one of the most extreme presentations of Marfan syndrome reported. This case underscores the critical importance of early diagnosis and regular echocardiographic surveillance in patients with heritable connective tissue disorders.

Subcapsular Liver Hematoma Following Tenecteplase Thrombolysis for ST-Segment Elevation Myocardial Infarction: A Case Report

M. Makhloufi, Y. Lahmouz, O. Belcadi, Z. Lakhal, N. Mouine, A. Benyass — Tue, 14 Jul 2026 00:00:00 +0000

Subcapsular hepatic haematoma is an uncommon and potentially serious bleeding complication following systemic thrombolytic therapy. Although rare, it may occur even in the absence of trauma and can present with non-specific abdominal symptoms, making diagnosis challenging in the post-thrombolysis setting. We report the case of a 62-year-old male smoker who presented with an inferior ST-segment elevation myocardial infarction complicated by ventricular fibrillation shortly after admission. Following successful defibrillation and stabilisation, the patient received 50 mg of tenecteplase within 4 hours and 30 minutes of symptom onset, in addition to dual antiplatelet therapy and anticoagulation. Coronary angiography performed the following day revealed triple-vessel coronary artery disease, and coronary artery bypass grafting was planned. Seventy-two hours later, the patient developed abdominal pain associated with abdominal and upper limb ecchymosis while remaining haemodynamically stable. Laboratory tests showed stable haemoglobin levels with elevated liver enzymes and cholestasis. Abdominal ultrasonography revealed a large hyperechoic hepatic lesion, and computed tomography confirmed a subcapsular haematoma of the right hepatic lobe (segments VI, VII, and VIII), measuring 45.8 mm in axial diameter, with compression of the bile ducts and no evidence of intestinal perforation. There was no history of abdominal trauma. Anticoagulation was discontinued, and the patient was managed conservatively with close clinical and radiological monitoring. Follow-up CT after seven days demonstrated a reduction in haematoma size. This case highlights the importance of considering subcapsular hepatic haematoma in patients who develop abdominal pain after thrombolytic therapy, even in the absence of haemodynamic instability or a substantial decrease in haemoglobin. Early recognition and appropriate imaging are essential to ensure timely diagnosis and guide conservative management in selected stable patients.