Current Cardiology Reports最新文献

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.

Purpose of the review: Epicardial adipose tissue (EAT), the visceral fat of the heart, is highly inflammatory fat depot with pro-inflammatory transcriptome and proteosome. EAT contributes to the development and progression of coronary artery disease (CAD) and atrial fibrillation (AF) through multifactorial inflammatory pathways. However, the paradigm linking EAT inflammation and cardiovascular risk was recently reevaluated.

Recent findings: EAT inflammation may be also necessary process for adipose tissue remodeling and expansion to accommodate excess lipids. EAT inflammation may be also considered an adaptive response of adipose tissue to the effects of glucagon-like peptide-1 receptor (GLP-1Rs) and glucose-dependent insulinotropic polypeptide (GIP) analogs. The presence of GLP-1 (GLP-1R) and GIP receptors (GIP-R) suggest direct interaction of these agents with EAT. EAT GLP-1R and GIP-R activation can induce a beneficial balance between increased adipogenesis and reduced ectopic fat accumulation. Cardiovascular effects of liraglutide, semaglutide and tirzepatide can be mediated by EAT inflammation.

Purpose of review: Wearable cardioverter-defibrillators (WCDs) offer a non-invasive, temporary safeguard against sudden cardiac death in patients with transient high-risk conditions, but real-world prescribing is highly variable due to inconsistent evidence of benefit. This review examines current WCD evidence and guideline recommendations, highlighting recent clinical findings, international guideline discrepancies, health economic data, and controversies underlying heterogeneous prescribing practices.

Recent findings: Observational studies and meta-analyses show that WCDs effectively terminate malignant arrhythmias and that arrhythmic death during WCD use is rare (~ 0.7% over 3 months). Approximately 5% of patients receive appropriate WCD shocks within 3 months. However, the VEST randomized trial did not demonstrate a significant reduction in arrhythmic mortality, likely due in part to low patient adherence (median 18 h/day). Post-hoc analyses of VEST suggested potential mortality reduction with better compliance. Reflecting the evidence gap, U.S. guidelines (2017) granted WCD a Class IIa/IIb role in several transient high-risk scenarios, whereas recent European guidelines (2021-2022) are more restrictive after VEST's neutral results. Modeling studies indicate WCD use can be cost-effective in select high-risk populations, but the device's high cost ($3,734/month; ~$223k per shock) raises concerns for broader use. WCD prescribing remains highly heterogeneous worldwide due to divergent guidelines, uncertain mortality benefit, and variable patient selection. While WCDs are generally safe and can bridge patients during reversible risk periods, definitive survival benefit is unproven. Ongoing debates about appropriate patient selection and cost-effectiveness underscore the need for further trials and unified guidance. In the meantime, health policy should encourage prudent, case-by-case use of WCDs focused on those most likely to benefit.

Purpose of review: To summarize the key features of vulnerable plaques identified by intracoronary and non-invasive imaging and explore how anti-atherosclerotic therapies contribute to plaque regression and stabilization.

Recent findings: Compared with high-dose statin therapy, intensive lipid-lowering with proprotein convertase subtilisin/kexin type 9 inhibitors achieves lower low-density lipoprotein cholesterol (LDL-C) levels and results in greater plaque regression and fibrous cap thickening. Recent data suggest that preventive intervention for functionally non-significant but high-risk plaques may reduce clinical events, and this strategy is now being further evaluated in randomized controlled trials. Detecting and treating vulnerable plaques is essential for improving the prognosis of patients with coronary artery disease. The extent of plaque volume reduction and fibrous cap thickening appears closely associated with on-treatment LDL-C levels. Anti-inflammatory therapies may provide additional stabilizing effects. Preventive treatment of high-risk, non-obstructive lesions and the use of non-invasive imaging to identify vulnerable plaques and high-risk individuals are promising strategies warranting further research.

Purpose of review: To summarize the recent literature examining the degree of overlap among atrial fibrillation (AF), heart failure (HF), and left atrial (LA) dysfunction, the prognostic relevance of finding a second condition in one of the other disease states, and the treatment effects for one condition on the secondary entities.

Recent findings: If one condition (AF, HF, or LA dysfunction) is present, there are very high prevalences of a second condition demonstrated across several cohorts. Additionally, the presence of a second condition consistently has a negative impact on prognosis. Treatment effects for AF or HF tend to show bidirectional benefit, whereas data is limited toward impacts on LA dysfunction. Patients with AF, HF, or LA dysfunction often have more than one of these conditions (either clinically manifest or occult), which may influence prognosis. Established treatment pathways for AF or HF tend to show benefits in the second condition, whereas there is limited data to determine effects on LA dysfunction, or whether LA dysfunction may be directly targeted for therapy.

Purpose of review: To provide clinicians with a concise introduction of microplastics potential role as a cardiovascular risk factor.

Recent findings: Microplastics have been identified in human cardiovascular tissues. In vitro and animal-based studies associate microplastics presence with increased oxidative stress, endothelial dysfunction, platelet aggregation disruption, and low-grade inflammation. Small human studies report associations between intraplaque or circulating microplastics and cardiovascular outcomes. However, these signals are associative, method-dependent, and vulnerable to exposure misclassification, co-pollutant confounding, contamination, and heterogeneous analytics. Microplastics are pervasive and biologically plausible as a cardiovascular risk factor, supported by growing in-vitro evidence and incipient human association studies. Cohesive population-level measures to curb MP pollution should be embedded within policies addressing broader environmental cardiovascular risk factors. For clinicians, it remains premature to recommend personal-level mitigation strategies, and MPs are best regarded as an emerging exposure within the patient's exposome that warrants awareness and further rigorous studies.

Purpose of review: This paper examines how digital health technologies can either reduce or exacerbate disparities in cardiovascular disease outcomes. It explores the role of the digital divide defined as a multifactorial phenomenon encompassing unequal access to internet connectivity, digital devices, and digital literacy, often driven by socioeconomic status, geography, age, education, language, and disability in shaping access to telehealth, remote monitoring, and patient engagement tools, with a focus on strategies for equitable implementation.

Recent findings: Digital health interventions have improved patient outcomes by enhancing accessibility and adherence to care. However, challenges such as limited technology access, low digital literacy, and systemic biases contribute to persistent disparities, particularly among marginalized populations. Emerging strategies, including community-based digital literacy programs, policy reforms, and inclusive design approaches, show promise in addressing these gaps. While digital health has the potential to bridge gaps in cardiovascular care, ensuring equity requires intentional design and policy interventions. Addressing barriers to access and digital literacy is critical to maximizing the benefits of these innovations for all patient populations.

Purpose of review: This review examines the growing role of extended reality (XR) (including virtual, augmented, and mixed reality) in the care of patients with congenital heart disease (CHD), with a focus on its use in patient education, trainee instruction, and procedural planning.

Recent findings: XR has demonstrated early success in improving patient and family understanding, enhancing trainee comprehension of cardiac anatomy, and aiding in surgical and transcatheter procedural planning for patients with complex cardiac anatomy. Studies demonstrate that XR improves visualization of 3D spatial relationships, increases confidence amongst providers and learners, and facilitates more informed preprocedural decision-making. XR addresses longstanding limitations of 2D imaging by providing interactive, patient-specific 3D environments. While most studies in this area are small and exploratory, they consistently underscore the clinical and educational value of XR in CHD care. XR is well-positioned to become a powerful tool across the continuum of CHD management.

Purpose of review: Ultrasound-targeted microbubble cavitation (UTMC) has emerged as a transformative non-invasive technology in diagnostic imaging, therapy, and targeted gene and drug delivery. As UTMC advances toward clinical translation, understanding its impact on fundamental cellular functions is essential.

Recent findings: Recent studies on UTMC have provided insights into its effects on biological processes. These include transient membrane opening and resealing (sonoporation), calcium ion (Ca²⁺) influx, generation of free radicals, nitric oxide synthesis, cytoskeletal remodeling, inter-endothelial gap formation, gene expression changes, and neuroinflammation. This review explores the mechanisms underlying UTMC, with a focus on ultrasound-targeted microbubble cavitation and its bioeffects on cellular function. We examine the molecular processes induced by cavitation, including sonoporation and Ca²⁺ influx, and highlight their effects on key biological processes.

Introduction: Energy drinks are widely marketed to enhance alertness and performance, making them a rapidly growing industry valued at $73.99 billion. These beverages typically contain caffeine and other stimulants, but their consumption has raised concerns about potential cardiovascular risks, including arrhythmias, tachycardia, and hypertension, particularly among young adults. While moderate caffeine intake may offer health benefits, excessive consumption of energy drinks has been linked to increased cardiovascular risks. This systematic review aims to explore the cardiovascular effects of energy drink consumption, identify knowledge gaps, and guide clinicians in making recommendations.

Methods: A comprehensive literature search was conducted across multiple databases, including CENTRAL, CINAHL, MEDLINE, PubMed, and others. Studies were screened for those involving energy drink consumption and cardiovascular outcomes such as heart rate, blood pressure, and ECG changes. After screening abstracts, full-text articles were reviewed based on inclusion criteria: participants aged 13+, energy drink consumption, and relevant cardiovascular endpoints.

Results: A total of 1,444 references were screened, resulting in 37 studies with 1,597 participants (mean age 22.6). Red Bull and Monster were the most studied brands. Results showed significant cardiovascular effects, including increased heart rate (60.9%), systolic blood pressure (53.8%), diastolic blood pressure (61.5%), and QTc interval prolongation (63.2%). Other ECG changes, such as PR interval and T-wave alterations, were observed in 57.9% of studies.

Conclusion: This review highlights the cardiovascular risks of energy drinks, including increased heart rate, blood pressure, and QTc prolongation. Future research should focus on at-risk groups and long-term effects.