Current Cardiology Reports最新文献

Purpose of review: The goal of this review is to evaluate the evolving role of triglycerides (TGs) and TG-rich lipoproteins (TRLs) in cardiovascular disease (CVD) risk and prevention. We examine the mechanistic rationale, genetic and epidemiological evidence, and therapeutic potential of targeting TGs in residual risk reduction, particularly in high-risk populations.

Recent findings: Emerging data from Mendelian randomization studies and large clinical cohorts support a causal link between elevated remnant lipoproteins and atherosclerotic CVD, in which apolipoprotein B may be the principal driver. Although traditional triglyceride-lowering agents have produced mixed results on cardiovascular outcomes, emerging therapies-such as ApoC-III and ANGPTL3 inhibitors-show robust lipid-lowering effects, while selective PPAR modulators have thus far not demonstrated cardiovascular benefit. However, outcome data remain limited. Residual CVD risk persists despite aggressive LDL-C reduction, especially in patients with diabetes, metabolic syndrome, or chronic kidney disease. Selective TG-lowering strategies targeting TRLs-especially those that decrease apolipoprotein B-may provide clinical benefit in high-risk phenotypes. Ongoing trials will clarify whether these promising agents confer meaningful cardiovascular protection and warrant integration into future guidelines.

Purpose of review: A borderline small left ventricle (LV), in which the LV is underdeveloped but not diminutive, represents an ongoing area of research and a challenge in clinical management. In this paper, the authors aimed to review the definition of borderline LV and recruitment strategies with a focus on hybrid, and wholly transcatheter approaches, to achieve the goal of two ventricle circulation.

Recent findings: Hampered by a lack of consensus definition; historically, patients with borderline LV were managed with single-ventricle palliation. However, due to the suboptimal long-term outcomes with single-ventricle palliation, many programs have adopted strategies to promote LV growth with the goal of achieving two-ventricle circulation with different outcomes. Initially dominated by surgical staging, there is growing evidence to support the use of hybrid or entirely transcatheter techniques to achieve first stage palliation in patients with borderline LV. Regardless of technique used (surgical and/or transcatheter), recruiting the LV into a successful biventricular circulation typically requires multiple interventions aimed at improving blood flow through the left heart structures and increasing LV volume loading in an effort to promote LV remodeling. Scoring systems can be helpful tools in determining the candidacy for LV recruitment strategy; however, the optimal scoring system has yet to be established.

Purpose of review: The purpose of this review is to provide an updated overview of mesenchymal stem cell (MSC)-based regenerative therapies in atherosclerosis. We aim to explore the mechanisms, recent advancements, and challenges associated with MSC applications in treating atherosclerosis.

Recent findings: Recent studies highlight the potential of MSCs in modulating inflammation, promoting vascular repair, and reducing plaque formation in atherosclerosis. Novel approaches, such as hypoxia-conditioned MSCs and combination therapies with biomaterials, have shown promising results in preclinical models. This review concludes that MSC-based therapies hold significant promise for treating atherosclerosis, but further clinical trials are needed to validate their safety and efficacy. Future research should focus on optimizing MSC delivery methods and understanding long-term outcomes.

Purpose of review: Leadless pacemakers (LPMs) are an established alternative to transvenous pacing systems for the treatment of bradyarrhythmias. This review outlines the evolution of LPMs, summarizes available safety and efficacy data, and highlights future development for leadless systems and the challenges that lie ahead.

Recent findings: Data from prospective cohort studies, large patient registries, and meta-analyses demonstrate high implantation success rates and fewer long-term complications with LPMs when compared to transvenous systems. Recent advances in leadless systems include dual-chamber devices capable of atrial and ventricular synchronous pacing and LPMs integrated with subcutaneous defibrillators. Future directions for leadless systems include leadless cardiac resynchronization therapy and leadless conduction system pacing. However, unresolved issues remain, including management of device end of life. LPMs are transforming cardiac pacing by reducing complications frequently observed with transvenous systems. Continued technological refinement and long-term clinical evaluation will guide broader adoption and optimize outcomes.

Purpose of review: While excess adiposity is a known risk factor for incident heart failure ( HF), once the condition is established, observational data suggest that increased body mass index (BMI) may confer a survival advantage. This paradox has emphasized the underlying roles of cardiorespiratory fitness (CRF), and body composition, particularly lean mass (LM), in influencing clinical outcomes.

Recent findings: In this review, we explore the multifaceted nature of the obesity paradox in HF, with a focus on emerging anti-obesity incretin-mimetic therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. These agents have demonstrated remarkable efficacy in weight reduction and favorable cardiovascular profiles in patients with HF with preserved ejection fraction (EF), yet their use in other HF populations, such as HF with reduced EF, raises important clinical questions and the urgent need for future research. Concerns include the potential for LM loss, implications for sarcopenic obesity, and the uncertain impact of weight loss on outcomes in patients who may not benefit from weight loss. We also highlight the need to assess therapeutic outcomes beyond BMI, incorporating measures of CRF, such as peak oxygen consumption (VO₂ peak), quality of life, and functional capacity, using tools such as the 6-minute walk test. Barriers to implementation, including cost, provider hesitation, insurance restrictions, and patient level challenges are also reviewed. Finally, we call for future research using contemporary cohorts and advanced phenotyping to reevaluate the obesity paradox in the context of modern pharmacologic interventions. As obesity treatment continues to evolve, a patient-centered, individualized approach that integrates body composition, functional status, and comorbid conditions will be essential in optimizing care for individuals with HF.

Purpose of review: This review examines the impact of incretin-based therapies and related incretin therapies on skeletal muscle health during pharmacologic weight loss. It explores the extent to which lean mass reduction contributes to total weight loss and highlights strategies to preserve muscle as a determinant of cardiovascular resilience.

Recent findings: Emerging data indicate that 25-40% of incretin-based therapies-induced weight loss derives from loss of lean mass, with skeletal muscle being a key component. Although incretin-based therapies may improve the quality of skeletal muscle by reducing muscle fat infiltration, its function and strength remain underexplored. Exercise, adequate protein intake, and creatine supplementation mitigate these effects, whereas novel adjuncts such as myostatin/activin inhibitors and selective androgen receptor modulators show promise in early trials. Preserving muscle during incretin-based pharmacotherapy weight reduction is key to sustain long-term metabolic and cardiovascular benefits. Future trials should assess body composition, functional outcomes, and integrate muscle-preserving co-therapies into obesity management.

Background: Multi-society expert consensus statements on catheter-based left atrial appendage occlusion (LAAO) suggest transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) for pre-procedural planning. However, evidence comparing the outcomes of adding CCTA to TEE on procedural success is limited.

Objective: Perform a systematic review and meta-analysis to determine the impact of adding CCTA to TEE for pre-procedural planning in patients undergoing LAAO.

Methods: We systematically searched Cochrane, Embase, and Medline for observational studies and randomized controlled trials (RCTs) comparing the addition of CCTA vs. TEE alone. The primary endpoint was procedural success. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.

Results: Systematic review identified four studies for meta-analysis, three RCTs and one observational study, including a total of 824 patients, of whom 496 (60.2%) underwent additional CCTA. In the pooled analysis, procedural success was higher with added CCTA (RR 1.10; 95% CI 1.01-1.19; p = 0.022; I²=52%). A subgroup analysis of only RCTs confirmed these findings with a slightly higher magnitude of effect and lower heterogeneity (RR 1.15; 95% CI: 1.06-1.25; I² = 0%).

Purpose of review: This review summarizes the emerging role of ultra-low temperature cryoablation (ULTC) in ventricular tachycardia (VT) ablation. It outlines the limitations of conventional techniques such as radiofrequency (RF) ablation and explores the current clinical data supporting ULTC's deeper lesion formation, safety, and efficacy.

Recent findings: ULTC delivers cryothermal energy at -140 to -150 °C via a specialized catheter in a freeze-thaw-freeze sequence, achieving lesion depths ≥ 10 mm. Clinical studies report > 90% acute success, > 60% VT-free survival, and > 80% freedom from implantable cardioverter defibrillator (ICD) shocks at 6 months, with sustained effectiveness at 1-year follow-up. The approach is effective across both ischemic and non-ischemic cardiomyopathy without the need for adjunctive interventions. Ongoing preclinical work with augmented ULTC systems shows encouraging results. ULTC offers a promising new strategy in VT ablation by creating durable, transmural lesions. Further randomized trials are warranted to confirm its long-term clinical benefits and safety.

Purpose of the review: To understand the growth of the adults with congenital heart disease (ACHD) population and ACHD work force needs in the United States, and to consider solutions to provide access for this population.

Recent findings: The ACHD population is growing rapidly and is outpacing current efforts to improve access and delivery of ACHD care.  Achieving adequate access for the ACHD population will require a multipronged approach, including training more ACHD cardiologists and advanced practice providers, expanding use of telehealth, increasing collaboration between larger tertiary ACHD care centers and smaller ACHD clinics and cardiology practices, and reimagining care models and pay structures.