Introduction : Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have evolved from glucose-lowering medications for diabetes into foundational cardiometabolic therapies, supported by robust evidence of cardiovascular protection from major clinical trials.1 Their dual capacity to reduce hyperglycemia and promote substantial weight loss is particularly relevant in regions like Iran and the Middle East, where the prevalence of obesity (∼25%), overweight (∼60%), and diabetes (∼10%) is rising rapidly; regional diabetes prevalence is projected to increase by more than 80% by 2050.
By enhancing glucose-dependent insulin secretion, suppressing glucagon release and appetite, lowering blood pressure, improving lipid profiles, and exerting anti-inflammatory vascular effects, GLP-1 RAs such as liraglutide, semaglutide, and dulaglutide offer a comprehensive strategy for mitigating the intertwined risks of metabolic and cardiovascular disease.

Background: Right-sided infective endocarditis (IE) is uncommon. Furthermore, Streptococcus agalactiae (S agalactiae) rarely causes IE, with only 2% to 9% of bacteremia cases manifesting as endocarditis.
Case Presentation: A 30-year-old Lebanese woman presented to the emergency department with high-grade fever and chills. Blood tests were obtained, urinalysis showed leukocytes, and treatment for urinary tract infection was initiated. The patient was hospitalized 3 days later and transferred to the ICU. Echocardiography revealed severe right-sided cardiomegaly, flail tricuspid leaflets with ruptured chordae, and a large coaptation defect. She was diagnosed with right-sided IE due to S agalactiae and underwent tricuspid valve replacement. Unfortunately, the patient died from acute decompensated heart failure.
Conclusion: This case represents an unusual instance of right-sided IE due to S agalactiae in Lebanon, for which definitive treatment guidance remains limited.

Background: Adopting healthy nutritional behavior among patients with heart failure (HF) plays a crucial role in controlling disease symptoms. Developing effective interventions requires identifying significant determinants of nutritional behavior using theoretical frameworks from behavioral sciences and validated instruments. This study aimed to develop and validate tools to assess the determinants of nutritional behavior in patients with HF based on the Theory of Planned Behavior (TPB).
Methods: A preliminary instrument with four subscales was developed based on the TPB. An instrument for measuring the nutritional behavior of patients with HF was also created. Face and content validity were assessed using qualitative and quantitative methods. The factor structure of the TPB instrument was examined using exploratory factor analysis (EFA) in a sample of 330 patients with HF. Instrument reliability was also evaluated.
Results: During face and content validity assessment, 13 items were removed from the TPB instrument, and 14 items were modified across both instruments. The EFA revealed that the 12 items measuring TPB variables loaded onto four distinct subscales: behavioral intention, attitude, perceived behavioral control, and subjective norms. The Kaiser-Meyer-Olkin measure and Bartlett test of sphericity were acceptable. These factors accounted for 87.03% of the total variance. All TPB subscales demonstrated acceptable internal consistency, as measured by Cronbach’s α. Both instruments showed satisfactory intraclass correlation coefficients.
Conclusion: The developed instruments are valid and reliable tools for assessing the determinants of nutritional behavior in patients with HF based on the TPB. They can be used for needs assessment and to develop educational interventions for this population.

Background and Objectives: Atrial fibrillation (AF) is the most prevalent persistent arrhythmia and imposes a substantial burden on public health and society. Given prior evidence linking psychological factors with AF, this study was conducted to investigate the association between perceived stress and arrhythmia.
Methods: In this case-control study, participants were recruited from the Outpatient Clinic of Rajaie Cardiovascular, Medical, and Research Center in Tehran, Iran, between May 2021 and September 2021 according to eligibility criteria. Data were collected through face-to-face interviews by trained research nurses using standardized checklists. Stress levels were assessed with the Perceived Stress Scale (PSS). Data were analyzed with SPSS, version 22.
Results: A total of 155 cases with arrhythmia and 144 controls were enrolled. In the case group, the mean age was 53.99 years (±14.23), with 100 males (64.5%) and 55 females (35.5%). In the control group, the mean age was 48.53 years (±13.59), with 73 males (50.7%) and 71 females (49.3%). The mean perceived stress score was 30.6 in cases and 25.07 in controls (P<0.001). Stress-related symptoms, including palpitation and chest discomfort, were more common in patients with arrhythmia than in healthy controls (P=0.015 and P<0.001, respectively). In multivariate logistic regression analysis, the risk of arrhythmia was independently associated with sex, diabetes mellitus, dyslipidemia, cardiomyopathy, concentration difficulty, chest discomfort, and stress score.
Interpretation and Conclusions: The findings demonstrate that AF is significantly associated with psychological stress and higher perceived stress scores. Interventions aimed at reducing stress in individuals at high risk of developing AF may be beneficial.

Introduction: Echocardiographic planimetry is the primary and most available modality for diagnosing rheumatic mitral stenosis (MS). Nonetheless, this approach is highly reliant on the examiner’s technique. Echocardiographic evaluation of MS should also include assessment of right ventricular (RV) function because of its prognostic role. We hypothesized that the assessment of RV function via speckle-tracking echocardiography could also have a diagnostic role in determining MS severity.
Methods: This cross-sectional study included 47 patients with a typical diagnosis of rheumatic MS. Echocardiographic data were recorded and evaluated offline by an expert cardiologist. We measured right ventricular global longitudinal strain (RVGLS), right ventricular free-wall longitudinal strain (RVFWLS), mitral valve area (MVA) using 2D planimetry, and other conventional parameters of MS severity. Data were analyzed and visualized utilizing SPSS version 26 (IBM Corp) and Python 3.10.6 (Python Software Foundation).
Results: Our analysis showed that both RVGLS (R=–0.598; P<0.05) and RVFWLS (R=–0.620; P<0.05) were significantly correlated with MVA. The mean RVGLS values in patients with severe and progressive MS were –14.44±4.36 and –18.12±3.25, respectively (P=0.017). The mean RVFWLS values also demonstrated a significant difference between these two groups (–6.3±4.7 vs–20.8±3.2; P=0.005). The area under the curve (AUC) for RVGLS and RVFWLS in detecting severe MS was 0.75 (95% CI, 0.64 to 0.86) and 0.78 (95% CI, 0.66 to 0.90), respectively.
Conclusion: RVGLS and RVFWLS significantly correlate with MVA and may serve as tools to assess the severity of rheumatic MS in daily clinical practice. These strain parameters have high sensitivity for ruling out severe MS during routine echocardiographic evaluation.

Background: Nephrotic syndrome (NS) in children is a chronic glomerular disorder that, beyond its renal implications, poses a significant risk for cardiovascular complications. Early vascular alterations, such as increased aortic stiffness, may signal subclinical cardiovascular dysfunction with long-term consequences.
Objective: This study aimed to evaluate aortic stiffness in children with idiopathic NS compared with age and sex-matched healthy controls using noninvasive echocardiographic indices.
Methods: A case-control study was conducted at Ali Asghar Pediatric Hospital from 2023 through 2024. Eighty-seven children with idiopathic NS and 87 healthy controls underwent M-mode echocardiographic assessment of the ascending aorta. Aortic systolic and diastolic diameters, along with systolic and diastolic blood pressure (SBP and DBP, respectively), were used to calculate stiffness indices: aortic strain, distensibility, stiffness index β, and pressure-strain elastic modulus (PSEM). Data were analyzed using SPSS version 23 (IBM), and a P value below 0.05 was considered statistically significant for all analyses.
Results: Children with NS had significantly higher SBP and DBP, reduced aortic strain (9.62% vs 14.77%), decreased aortic distensibility (0.0050 vs 0.0085), and elevated stiffness index β and PSEM values (P<0.001 for all). No significant sex distribution differences were noted. Responders to treatment showed better renal function and lower BP but did not differ significantly in vascular stiffness measures. Positive correlations were found between stiffness parameters and proteinuria, serum creatinine, and anthropometric indices.
Conclusion: Children with NS exhibited early signs of aortic stiffening, even during clinical remission. These findings support the incorporation of cardiovascular surveillance into the long-term management of NS to identify at-risk children and initiate early interventions.

Background: Heart failure remains a global health challenge, necessitating a deeper understanding of factors affecting mortality and quality of life. Given the paucity of studies investigating the relationship between serum albumin levels and outcomes in patients with chronic heart failure, particularly their quality of life, we conducted this study.
Methods: This prospective study evaluated demographic information, laboratory findings, and ejection fraction (EF) in hospitalized patients with ischemic and non-ischemic heart failure. Patients with an EF of less than 50% were included as having heart failure. Serum albumin levels were measured. Patients completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) during hospitalization and were followed up for six months after discharge.
Results: A total of 102 individuals were included in this study. Among them, 59.8% had a history of chronic heart failure. There was a weak but significant inverse relationship between serum albumin level and the MLHFQ index (r=−0.263; P=0.018). There was no significant difference in serum albumin level or MLHFQ index between deceased and surviving patients (P=0.816 and P=0.12, respectively).
Conclusion: This study indicates that serum albumin levels were weakly associated with quality of life in patients with heart failure with reduced EF, as assessed by the MLHFQ. Nonetheless, serum albumin levels did not predict short-term mortality over the 6-month follow-up period.

Objective: This review evaluates the efficacy of semaglutide in reducing cardiac hypertrophy and enhancing cardiac function in mouse studies.
Methods: A literature search was conducted using databases such as PubMed, Google Scholar, SpringerLink, Cochrane, Nature, JACC, and ScienceDirect. Keywords included “semaglutide,” “cardiac remodeling,” “heart failure,” “heart failure with preserved ejection fraction (HFpEF),” and “cardiac hypertrophy.” Studies involving male and female mice that discussed the effects of semaglutide on hypertrophy, oxidative stress, inflammatory markers, and cardiac remodeling were included. Data were extracted using the PICO framework.
Results: Semaglutide consistently led to reductions in body weight, fat mass, tissue-specific inflammation, apoptosis, and oxidative stress in mice. It significantly alleviated cardiac hypertrophy, as evidenced by decreased heart weight and left ventricular mass, and improved cardiac output through enhanced cellular architecture. Inflammatory markers such as tumor necrosis factor α, interleukin 6, and atrial natriuretic peptide were notably reduced. Fibrosis was significantly attenuated at both molecular and histological levels, with decreased collagen deposition and lower markers such as collagen 1a1 and collagen 3a1. Oxidative stress markers NADPH oxidase 2 and malondialdehyde were reduced, accompanied by increased antioxidant enzymes, including superoxide dismutase and catalase. Additionally, semaglutide reduced apoptosis, evidenced by lower levels of Bcl-2-associated X protein (BAX) and slightly decreased caspase-3.
Conclusion: The results demonstrate the significant potential of semaglutide for managing cardiac remodeling. Semaglutide showed considerable cardioprotective effects through the regulation of hypertrophy, oxidative stress, inflammation, apoptosis, fibrosis, and lipid metabolism. These benefits suggest its viability as a promising therapeutic agent for cardiac disorders. Nonetheless, more clinical trials, particularly in humans, are required to validate these findings and determine appropriate dosing.

Background: Congenital heart disease (CHD) is a leading cause of morbidity and mortality in children requiring surgical intervention. Accurate prediction of postoperative mortality remains challenging because of the limitations of traditional risk stratification systems. Artificial intelligence (AI) has emerged as a promising tool for enhancing predictive accuracy in this field.
Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of AI in predicting postoperative mortality in patients with CHD.
Methods: Following the PRISMA guidelines, we systematically searched four databases for relevant studies published up to July 16, 2024. Studies with retrospective, prospective, or cross-sectional designs that evaluated AI-based models for predicting mortality after CHD surgery were eligible for inclusion. Data were extracted, and study quality was assessed using the PROBAST tool. Pooled estimates for sensitivity, specificity, and the area under the curve (AUC) were calculated.
Results: Six studies involving 42,536 patients and evaluating 11 distinct AI models were included. The meta-analysis yielded a pooled AUC of 0.90 (95% CI, 0.88 to 0.93), with a pooled sensitivity of 0.43 (95% CI, 0.23 to 0.65) and a pooled specificity of 0.96 (95% CI, 0.92 to 0.98). Subgroup analysis revealed that the Extreme Gradient Boosting (AUC, 0.93) and Gradient Boosting Machine (AUC, 0.91) models had the highest predictive performance. All included studies were judged to have a low risk of bias.
Conclusion: The Extreme Gradient Boosting and Gradient Boosting Machine models demonstrate high specificity and promising accuracy for predicting postoperative mortality in patients with CHD, outperforming traditional scoring systems. Further multicenter, prospective studies are needed to enhance generalizability and support clinical implementation.