Sex differences in out-of-hospital cardiac arrest (OHCA) have been studied in adults but remain poorly explored in younger populations. We aimed to assess sex differences in OHCA across age groups to provide a comprehensive overview. All OHCA occurring between May 2011 and December 2018 in Paris and its suburbs were analysed. Primary outcomes included sex differences in OHCA characteristics and survival to hospital discharge across three age groups: paediatric patients (28 days-18years), young adults (18-35 years) and older adults (≥35 years). Secondary outcomes included aetiology and 1-month survival. Logistic regression was used to identify factors associated with OHCA in females versus males. Among 18 767 OHCA cases, 6185 (33.0%) were females, 360 (1.92%) were paediatric patients, 1240 (6.61%) young adults and 17 167 (91.5%) older adults.In paediatric patient, male were older (6.00 vs 2.78 years, p=0.029) and had shorter no-flow times (5.00 vs 10.0 min, p=0.007). Among young adults, OHCA in males occurred more often in public areas (61.9% vs 35.3%, p<0.001) and during sport (6.47% vs 1.53%, p<0.001); females had shorter no-flow time (3.00 vs 5.00 min, p=0.035). In older adults, males were younger (64.3 vs 71.8 years, p<0.001), more shocked (40.2% vs 23.7%, p<0.001) and more commonly managed with amiodarone (16.5% vs 8.11%, p<0.001). OHCA in males occurred more often in public areas (33.9% vs 19.8%, p<0.001) and during sport (1.94% vs 0.30%, p<0.001).After adjustment, females underwent coronary angiography less often (OR (95% CI) 0.54 (0.46 to 0.64)). Survival to hospital discharge was lower in females across all age groups, reaching statistical significance in older adults (6.23% vs 9.37%, p<0.001). Sex differences in OHCA characteristics and outcomes were observed across all age groups and became more pronounced with increasing age, consistently indicating a better prognosis for males.

Allergic vasospastic angina (also referred to as Kounis syndrome) is an under-recognised subtype of vasospastic angina in which coronary artery spasm is precipitated by an allergen. This study evaluates the clinical characteristics, mechanisms and management of this intriguing angina subtype. A systematic review of reported cases of allergic vasospastic angina from 1992 to 2022 was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Each case report was then analysed for patient characteristics, presenting signs/symptoms and both cardiac and allergic investigations. A systematic review of 393 allergic vasospastic angina case reports revealed a median age of 53 years (64% males), 46% had one or more cardiovascular risk factors with 32% having an atopic history. Most patients presented with an acute coronary syndrome (ST-elevation myocardial infarct in 71%) following exposure to a wide array of precipitating allergens (55% prescription medications), with multiple potential allergic mechanisms including immunoglobulin-E (IgE)-mediated mast cell degranulation, eosinophil-mediated allergic response and other non-IgE mediated mast cell activation pathways. Allergic vasospastic angina is an important and under-recognised vasospastic angina subtype, often presenting as an acute coronary syndrome. Diagnosis of this disorder is important since management differs to conventional vasospastic angina with the potential of allergen avoidance and use of allergic response modulating therapies.

Cardiac resynchronisation therapy (CRT) is a key treatment for heart failure (HF) in acquired heart disease, but its benefits in adults with congenital heart disease and a systemic right ventricle (sRV) remain unclear. This study aimed to assess whether CRT improves outcomes in patients with sRV. This is an international, retrospective study including patients >18 years from 33 centres with transposition of the great arteries (TGA) following atrial switch operation and congenitally corrected TGA. The primary endpoint included overall survival and survival free from HF. The secondary endpoint was a composite of death, hospitalisation for HF, heart transplant, mechanical support and ventricular tachycardia/implantable cardioverter-defibrillator therapies. We identified 105 out of 1721 patients (3.5%) who underwent CRT. Median follow-up after CRT implant was 4.6 (1.6-8) years. QRS improvement was limited to those with previous pacing (167±35 vs 154±28 ms; p=0.002). Following CRT, there was no significant change in B-type natriuretic peptide values, peak VO2 and tricuspid regurgitation severity by echocardiography. CRT complications occurred in 10 (9.5%), though they were usually minor. Patients with CRT were propensity-matched to controls according to age, sex, anatomy, presence of complex disease, previous HF and sRV dysfunction at baseline. At univariable analysis, CRT (HR 4.39-95%, CI 1.6 to 11.9; p=0.003), older age and moderate-to-severe sRV dysfunction at baseline were predictive of death, while CRT (HR 3-95%, CI 1.3 to 7; p=0.01) and sRV dysfunction were associated with HF admission. By multivariable analysis, CRT (HR 8.8-95%, CI 2.9 to 26.6; p=0.0001) and age (HR 1.1%-95%, CI 1.01 to 1.15; p<0.0001) were independently associated with poorer outcome. In this retrospective study in the largest population thus far described with an sRV, CRT implant was not associated with improved survival, even after controlling for key confounders.

Cannabis consumption has increased among young adults, but its long-term cardiovascular impact remains unclear. This study assessed the association between cannabis use at admission for acute coronary syndrome (ACS) and long-term prognosis. A retrospective, single-centre cohort included patients under the age of 45 years admitted for ACS between 1 January 2010 and 1 March 2025, all of whom reported current tobacco use at admission. Based on urinary testing at admission, patients were classified as cannabis users or non-users. The primary endpoint was major adverse cardiovascular events (MACE), a composite of death, stroke, recurrent myocardial infarction, arrhythmia or heart failure-related events. A propensity-weighted analysis adjusted for socioeconomic and cardiovascular risk factors was conducted. Weighted survival curves were plotted, and a Cox model truncated at 6 years was used to estimate the HR for MACE associated with cannabis use. Among 188 included patients, 77 (41.0%) were cannabis users and 111 (59.0%) non-users. The median follow-up was 2.93 (0.45-5.53) years. Weighted Kaplan-Meier curves differed significantly (Fleming-Harrington p=0.002), with a higher cumulative incidence of MACE among cannabis users. In the inverse probability of treatment weighting Cox model, cannabis use was associated with a higher hazard of MACE (HR 2.52, 95% CI 1.05 to 6.02; p=0.04). Cannabis users also had higher peak troponin levels, higher leucocyte counts and a greater use of postprocedural anticoagulation (all p<0.05). Cannabis use in young adults with ACS was associated with a 2.5-fold higher hazard of MACE over 6 years, highlighting the need to take cannabis use into account in cardiovascular care pathways.

Cardiovascular adaptation to pregnancy is more marked in twin than singleton pregnancies and may result in a higher rate of adverse cardiac events in women with heart disease. The objective was to test the hypothesis that women with heart disease and a twin pregnancy have a higher rate of adverse cardiac events. Registry Of Pregnancy And Cardiac disease (ROPAC) is a prospective (2007-2018), global registry of pregnant women with heart disease. Pregnancy outcomes in twin (n=96) were compared with 5643 women with singleton pregnancies. At baseline, twin mothers were older (32.1 vs 29.5 years, p<0.001) and had fewer prior cardiac interventions (43% vs 55.5%, p=0.02). Cardiac diagnosis, New York Heart Association class, modified WHO class, country of origin, prior hypertension, diabetes mellitus, atrial fibrillation and signs of heart failure were similar. The risk of heart failure was significantly higher in twin pregnancies, with 24/96 developing heart failure vs 631/5643 singleton (25 vs 11.2%, p<0.001), but there were no differences in maternal mortality, arrhythmia, endocarditis, thrombosis, dissection, acute coronary syndrome or hospital admission for cardiac reasons. Multivariable analysis of the whole ROPAC population showed that twin pregnancy was a risk factor for heart failure, and that within the twin pregnancies, cardiomyopathy and prior heart failure were risk factors for development of heart failure. Women with valvular or congenital heart disease experienced heart failure during pregnancy, but those with cardiomyopathy experienced it during the peripartum period. Obstetric outcomes were worse in twins. Women with heart disease and a twin pregnancy have twice the risk of heart failure, particularly in those with a prior diagnosis of cardiomyopathy.

Pericarditis is typically diagnosed on the basis of clinical criteria (chest pain, pericardial rub, ECG changes and pericardial effusion). However, the diagnosis can be challenging as these findings are often transient. We evaluated the clinical utility of cardiac magnetic resonance (CMR) in the diagnosis of pericarditis. Consecutive patients referred for the evaluation of pericarditis by CMR between 2010 and 2024 to a tertiary hospital in Sydney, Australia, were retrospectively screened. Patients were stratified according to the presence (CMR-pos) or absence (CMR-neg) of pericardial late gadolinium enhancement (LGE) and analysed for differences in clinical patterns, C reactive protein (CRP), troponin and imaging findings. Among 2530 patients referred for CMR, 88 patients (age 39 years (IQR 24-52), 37% female) were identified as referrals for pericarditis/myopericarditis. 43/88 (49%) patients had CMR-proven pericarditis and 45/88 (51%) did not. Among CMR-pos patients, 13/43 (30%) did not meet 2015 ESC diagnostic criteria. Conversely, 24/45 (47%) CMR-neg patients met criteria for a clinical diagnosis. CRP and pericardial effusion were associated with positive scans and more severe pericardial disease (CRP 178 mg/L (IQR 98-253) and 88% had pericardial effusion in moderate/severe pericardial LGE vs 35 mg/L (IQR 7-63) and 19% in minimal/mild, p<0.05 for both). CRP level demonstrated moderate predictive value for identifying CMR-pos scans with a sensitivity of 56% and a specificity of 84% for CRP levels above 50 mg/L. CMR-pos patients not meeting clinical criteria tended to have more subacute and non-idiopathic disease despite similar levels of pericardial LGE when compared with those with clinically apparent pericarditis. CMR reliably identifies pericardial inflammation in patients not meeting clinical criteria and excludes significant inflammation in a large proportion of patients with an initial clinical diagnosis. CRP level and the presence of pericardial effusion may help identify patients who are likely to have CMR evidence of pericarditis.