BackgroundThe prevalence of coarctation of the aorta is 4/10,000, accounting for 8% of congenital heart diseases. Accurate prenatal diagnosis of coarctation of the aorta is still difficult.Case presentationThis article tracks and reports two cases of false coarctation of the aorta diagnosed by different hospitals until their postnatal outcomes. It discusses in detail the possible causes of misdiagnosis during prenatal care. It provides an in-depth analysis of the differential diagnosis between redundant foramen ovale flap and coarctation of the aorta.ConclusionsAssist in prenatal diagnosis of coarctation of the aorta.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12947-025-00352-4.

Cardioembolism is one of the most frequent and clinically severe mechanisms underlying ischemic stroke, accounting for a substantial proportion of global morbidity and mortality. Despite declining age-adjusted mortality rates in high-income countries, the absolute number of strokes continues to increase, largely driven by population ageing and the rising prevalence of cardiovascular comorbidities. Timely identification of cardiac sources of embolism is therefore essential to optimize secondary prevention and improve long-term neurological outcomes. The range of potential cardiac substrates is wide and includes atrial fibrillation, native and prosthetic valvular disease, left ventricular thrombus, aortic arch atheroma, intracardiac masses, and right-to-left shunts such as patent foramen ovale. Echocardiography represents the cornerstone of the diagnostic work-up in patients with suspected cardioembolic events. Transthoracic echocardiography provides rapid, non-invasive evaluation of cardiac morphology and global function, while transesophageal echocardiography offers superior visualization of high-risk structures, particularly the left atrial appendage, prosthetic valves, and the thoracic aorta. Advances in three-dimensional imaging and Doppler technology have further improved the ability to delineate complex anatomy and hemodynamic abnormalities with high accuracy. Although additional imaging modalities such as cardiac computed tomography and cardiac magnetic resonance may offer complementary anatomical or tissue-characterization data in selected cases, their use should be individualized and reserved for scenarios in which echocardiographic assessment is insufficient to fully characterize a suspected embolic source. Cardioembolic stroke continues to represent a major clinical and socioeconomic burden worldwide. While progress in cardiac imaging has substantially improved the detection and characterization of embolic substrates, diagnostic strategies must extend beyond imaging alone. A truly effective and cost-efficient work-up requires integration of clinical information—including patient age, cardiovascular risk profile, predisposing infectious conditions, and overall clinical presentation—to guide appropriate use of diagnostic resources. Incorporating these variables enables more personalized selection of imaging modalities, avoids unnecessary tests, accelerates diagnosis, and ultimately supports more targeted preventive strategies. Strengthening this clinically driven, patient-specific approach is essential to reducing the global impact of embolic stroke and improving cerebrovascular outcomes. scenario-based diagnostic approach to cardioembolic stroke, guiding tailored imaging strategies and targeted preventive therapy according to patient clinical profile.

Left atrial (LA) volume and strain parameters have been associated with cardiovascular outcomes in several cardiac pathologies, yet their role in predicting major adverse cardiovascular events (MACE) in kidney transplant (KT) recipients has not been explored. We retrospectively reviewed the records of adult KT recipients from our institution (2015-2024). We utilized baseline echocardiograms routinely acquired during KT workup to measure LA volumetrics and strain. MACE was the study's primary endpoint, defined as cardiovascular death, nonfatal myocardial infarction, stroke, major arrhythmias or heart failure hospitalization. Logistic regression, Kaplan-Meier and Cox proportional hazards regression were performed to evaluate the association between LA parameters and MACE. Of 518 patients who underwent kidney transplant, 377 were in sinus rhythm with an acceptable quality echocardiogram (male, 56.7%; mean age 53.7 ± 13.1 years). Over a median follow up duration of 5.3 ± 2.3 years from KT, 82 patients reached the study endpoint. Kaplan-Meier analysis showed significantly lower MACE-free survival in patients with abnormal LA strain. After adjusting for confounding variables in the Cox Proportional Hazards model, of all LA parameters, lower LAScd (HR 0.94, 95% CI 0.89-0.98, p = 0.003), and LASr (HR 0.97, 95% CI 0.94-0.995, p = 0.02) were independently associated with MACE. In this retrospective single center study, LA strain parameters particularly LASr and LAScd were independently associated with MACE after KT. LA strain might have a role in risk stratification in this population.

In patients with mitral regurgitation (MR), cardiac remodeling by two-dimensional (2D) echocardiography is variable and less suitable for individualized risk assessment. We evaluated whether three-dimensional (3D) peak LA reservoir strain (LASr) and stiffness improve risk prediction in primary MR. In the prospective 3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation (3D-PRIME) study, 110 patients with moderate or greater primary MR underwent 2D/3D echocardiographic assessment of LASr and LA stiffness (i.e. (mitral E-wave/ annular e’ velocity)/ LASr). The primary outcome was a composite of death, heart failure worsening and mitral valve intervention. During 24 [17–26] months follow-up, the primary outcome occurred in 59 patients. In multivariable Cox analyses, low 3D LASr (HR 2.1, 95% CI 1.1–4.3) and increased 3D LA stiffness (HR 3.5, 95% CI 1.6–7.4) predicted higher risk of adverse events after adjustment for left ventricular (LV) global longitudinal strain (GLS), MR severity, LV end-systolic volume and maximum LA volume (p < 0.05). In likelihood ratio tests, 3D LASr or LA stiffness (but not the corresponding 2D indices) increased the predictive value of a model including LV GLS and current indications for intervention in primary MR (χ2 -increase from 58 to 63 / 70, p < 0.05). In moderate or greater primary MR, impaired LA function by 3D echocardiography is associated with higher risk of disease progression towards death, worsening heart failure and mitral valve intervention. Our findings lay the groundwork for future multicenter studies to explore the value of routine assessment of 3D LA remodeling in the follow-up of patients with primary MR. 3D LA strain and stiffness and clinical outcomes in primary MR

Cardiovascular events caused by atherosclerotic plaque are the leading causes of death worldwide. The change in pericoronary adipose tissue (PCAT) and epicardial adipose tissue (EAT) can dynamically reflect the inflammation activity of coronary artery, playing an important role in the development of cardiovascular diseases (CVDs). Recently, PCAT and EAT have been used to assess the atheromatous plaque from its formation and development to rupture, which are of great clinical value in predicting the risk of adverse cardiovascular events, as well as in evaluating the efficacy of cardiovascular drugs. Numerous literature have also reported that evaluating the pathophysiological changes of PCAT and EAT can be performed by non-invasive imaging techniques such as ultrasound, CT, MRI and PET-CT. This review mainly aimed to summarize the PCAT and EAT -related anatomy and physiological function and its correlation with cardiovascular risk by imaging examinations, providing a valuable clinical guidance for early diagnosis and prognostic evaluation of cardiovascular events.

Left atrial (LA) remodeling and dysfunction are increasingly recognized as important contributors to outcomes in heart failure; however, their prognostic and functional relevance in advanced heart failure (AHF) remains insufficiently defined. This study evaluated the prognostic and functional significance of echocardiographic LA indices in AHF. Between 2021 and 2023, 194 patients with left ventricular ejection fraction ≤ 25% were included. All patients were referred to our tertiary cardiovascular center for evaluation of advanced therapeutic options [left ventricular assist device (LVAD) or heart transplantation] and underwent echocardiography, right heart catheterization, and cardiopulmonary exercise testing (CPET). Kaplan–Meier and Cox regression analyses were used to assess the prognostic impact of LA strain and mechanical indices on the composite endpoint of all-cause death, LVAD implantation, or heart transplantation. Correlations with CPET parameters were examined to evaluate functional relevance. Patients with impaired LA reservoir strain (LASr < 8.35%) exhibited more advanced atrial remodeling, higher filling pressures, worse ventricular function, and reduced exercise capacity. During a median follow-up of 461 days, adverse outcomes occurred more frequently in the lower LASr group (35.1% vs. 14.4%, p = 0.002). Both LASr and LA minimum volume index (LAVImin) independently predicted the composite endpoint and provided incremental prognostic value. LASr, LA ejection fraction (LAEF), and LA expansion index (LAEI) showed positive associations with peak VO₂ (all p < 0.001), indicating an association between atrial mechanics and exercise performance. In patients with AHF, LASr and LAVImin are independently associated with adverse clinical outcomes and reduced exercise tolerance. Incorporation of LA functional assessment into routine evaluation may help improve risk stratification and support clinical decision-making in this high-risk population.