Current Cardiology Reports最新文献

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.

Purpose of review: To summarize and provide insight into the role of exercise rehabilitation for heart failure, cardiomyopathies and associated conditions. We provide an overview of the evolution of exercise training from "bed rest" to current guidelines and highlight emerging approaches.

Recent findings: Exercise training appears to be safe and provide benefits for patients with heart failure. Emerging evidence also suggests potential benefit in hypertrophic cardiomyopathy as well as angina with non-obstructive coronary arteries, though more data are needed for widespread implementation. Given appropriate precautions and clinical assessments, exercise is a unifying therapy across most heart failure conditions regardless of ejection fraction. Exercise training appears to be safe, and beneficial in terms of improvements in functional capacity and health-related quality of life. Larger controlled trials are needed to better examine the impact of exercise on hard clinical endpoints such as HF hospitalizations (likely beneficial) and cardiovascular mortality.

Purpose of review: Titin-related cardiomyopathy (TTN CMP) is the most prevalent genetic cause of dilated cardiomyopathy (DCM), yet its clinical variability and incomplete penetrance challenge risk stratification and therapeutic management. This review aims to summarize recent insights into the genetic, molecular, and clinical aspects of TTN-CMP, emphasizing its heterogeneity and the implications for diagnosis, prognosis, and treatment.

Recent findings: TTN truncating variants (TTNtv) are associated with DCM but are also present in asymptomatic individuals, complicating their interpretation. Emerging evidence suggests that both haploinsufficiency and toxic gain-of-function mechanisms may underlie disease expression, influenced by variant location and expression. Patient-derived iPSC models and advanced imaging studies have elucidated pathophysiological mechanisms and highlighted promising therapeutic targets. Clinically, TTN-CMP shows relatively high rates of left ventricular reverse remodeling and variable arrhythmic burden, with male sex and environmental stressors influencing outcomes. TTN-CMP spans a broad phenotypic spectrum, ranging from asymptomatic carriers to end-stage heart failure. While standard heart failure therapies are often effective, precision management remains limited. Improved clinical, genetics and molecular understanding, together with novel experimental models, provide promising new tools for precise disease assessment and targeted therapeutic interventions.

Purpose of review: This review aims to provide a comprehensive overview of mavacamten in the management of obstructive hypertrophic cardiomyopathy (oHCM), from its molecular mechanism of action to clinical trial outcomes and real-world application. It explores the efficacy, safety, and practical considerations of mavacamten use, while highlighting evolving indications and future directions.

Recent findings: Randomized trials have shown that mavacamten significantly reduces left ventricular outflow tract gradients, improves symptoms and exercise capacity, and induces structural reverse remodeling with a favorable safety profile. Real-world data confirm these benefits in broader patient populations. Pharmacogenetic variability, titration protocols, and cost-effectiveness analyses have further refined its clinical use. Mavacamten represents a paradigm shift in oHCM treatment by targeting disease at its sarcomeric origin. Its integration into routine care is expanding, supported by real-world evidence. Ongoing studies will clarify its role in non-obstructive HCM, heart failure with preserved ejection fraction, pediatric populations, and early-stage disease.

Purpose of review: This review aims to provide a comprehensive contemporary overview regarding the clinical perspectives, multi-modality imaging evaluation, treatments and outcomes of subaortic stenosis (SAS).

Recent findings: SAS remains an important condition making up a significant minority of patients with progressive fixed left ventricular ouflow tract obstruction. Echocardiography remains the first-line imaging modality to diagnose SAS, evaluate severity of obstruction along with cardiac chamber and valvular function. Transesophageal echocardiography, cardiac computed tomography and cardiac magnetic resonance have adjunctive roles to help delineate SAS anatomy, functional implications and pre-operative planning. A variety of surgical techniques have been developed for SAS with significant obstruction often with symptoms, with excellent contemporary outcomes, though recurrence rates remain significant particularly in younger patients and those with complex anatomical features that may need repeat surgeries. Multi-disciplinary approach to management is necessary to improve clinical outcomes, including multi-modality imaging for diagnosis, risk stratification, treatment guidance and close surveillance, along with meticulous surgery by experienced surgeons, are necessary to improve clinical outcomes for SAS.

Purpose of the review: To describe recent advances in knowledge of familial hypercholesterolemia (FH).

Recent findings: There has been a significant advance in understanding the natural history, risk stratification, and therapy of FH. Heterozygous FH affects approximately 1 in every 310 individuals worldwide and is associated with an increased risk of premature atherosclerotic cardiovascular disease (ASCVD). Early diagnosis is crucial and relies on clinical criteria and/or genetic testing. Timely initiation of treatment in childhood is imperative, as cumulative exposure to elevated LDL-cholesterol is directly correlated with the onset and progression of ASCVD. Several ASCVD risk prediction models have been developed specifically for adults with FH. Coronary artery calcium scoring is a valuable adjunct to cardiovascular risk stratification in this population. Pharmacological management of FH typically involves statins and ezetimibe, as well as PCSK9 inhibitors. In the elderly, therapeutic strategies must account for age-related factors, such as frailty and comorbidities.

Purpose of review: Accurate, timely quantification of cardiac function is central to the diagnosis, management, and monitoring of cardiovascular disease. This review synthesizes recent advances in artificial intelligence (AI) applications across the major data modalities used in cardiovascular medicine, spanning electrocardiography (ECG), echocardiography, cardiac CT/MRI, and clinical text in electronic health records (EHR).

Recent findings: State-of-the-art deep learning algorithms now enable highly accurate assessment of cardiac disease across a range of modalities. These models excel in detecting subclinical cardiovascular disease, occult disease etiologies, and ventricular dysfunction that may elude conventional interpretation. Recent randomized controlled trials demonstrate that AI models can match or even outperform clinicians in identifying myocardial infarction from ECGs, occult atrial fibrillation from sinus rhythm ECGs, and in quantifying left ventricular ejection fraction from echocardiography. Concurrently, the emergence of foundation models and multimodal architectures is accelerating label-efficient learning, enabling automated report generation, and facilitating scalable population-level screening across diverse clinical settings. AI is poised to transition from proof-of-concept to indispensable clinical partner in cardiology. Robust multicenter validation, open-source code transparency, and prospective trials are essential to confirm generalizability and to quantify patient-level benefit. As foundation models mature and multimodal learning becomes routine, AI will enable scalable screening, precision phenotyping, and more equitable cardiovascular care-particularly in resource-limited settings-while allowing clinicians to refocus on patient-centered practice.

Purpose of review: Mitral regurgitation is a common and heterogeneous valve disease, with its prevalence increasing due to aging populations. This review aims to provide a comprehensive overview of the roles of transthoracic (TTE) and transesophageal echocardiography (TEE) in the evaluation of mitral regurgitation (MR).

Recent findings: MR encompasses a spectrum of pathologies, ranging from degenerative leaflet prolapse to functional regurgitation caused by left ventricular remodeling. Accurate assessment of regurgitation is challenging and requires a multiparametric, comprehensive approach. TTE remains the primary imaging modality used to evaluate mitral valve structure, determine the severity of regurgitation, and related hemodynamic effects. TEE provides higher-resolution imaging for more detailed anatomical assessment, particularly valuable in surgical planning and transcatheter mitral procedures. The introduction of 3D echocardiography has further improved mitral valve imaging, allowing accurate preprocedural assessment and real-time guidance during structural interventions. Both TTE and TEE play essential and complementary roles in the thorough evaluation of MR. A multiparametric approach ensures accurate characterization of the regurgitation severity.