Current Cardiology Reports最新文献

Purpose of review: This review aims to evaluate current diagnostic and therapeutic strategies for postpericardiotomy syndrome (PPS), with a focus on the evolving role of multimodality imaging, including echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance imaging (CMR). The review also explores the potential benefits of advanced imaging in improving the accuracy and management of PPS.

Recent findings: PPS, a common complication following cardiac surgery, presents with pleuritic chest pain, fever, and pericardial or pleural effusion. Traditional diagnostic methods like echocardiography and X-ray are increasingly supplemented by advanced imaging modalities such as CCT and CMR. These tools allow for better visualization of pericardial inflammation and effusion, aiding in diagnosis and guiding treatment. Colchicine and NSAIDs remain the most effective treatments for PPS, while the role of corticosteroids remains uncertain. Biological treatments have shown promising results in managing recurrent pericarditis. This review presents a proposed algorithm for the diagnosis and management of PPS, drawing on our institutional experience. Multimodality imaging is emerging as an essential tool in diagnosing and managing PPS. It enhances diagnostic precision, informs treatment strategies, and provides prognostic insights. As imaging technology advances, integrating these modalities into PPS care has the potential to improve patient outcomes.

Purpose of review: This review assesses the outcomes of coronary interventions in patients with liver cirrhosis and coronary artery disease (CAD), focusing on the clinical challenges posed by cirrhosis-related hemodynamic and coagulopathic changes. It highlights essential considerations for managing these patients, who have an increased risk of adverse events during coronary procedures.

Recent findings: Recent studies have shown that patients with liver cirrhosis undergoing PCI experience significantly higher mortality rates compared to non-cirrhotic patients, particularly in the context of STEMI and NSTEMI. Coagulopathy and thrombocytopenia increase the risk of bleeding and vascular complications during interventions. Radial access has been suggested as a safer alternative to femoral access in these patients due to reduced bleeding complications. Additionally, contrast-induced nephropathy (CIN) is a prevalent risk, with cirrhotic patients demonstrating higher rates of acute kidney injury post-PCI. Preventive strategies such as minimizing contrast exposure and utilizing intravascular ultrasound (IVUS) are recommended. Managing CAD in cirrhotic patients requires careful consideration of their unique pathophysiological state. Higher in-hospital mortality, bleeding risks, and vascular complications necessitate tailored procedural strategies, such as radial access and contrast minimization. The balance between thrombotic and bleeding risks is critical in decision-making, with IVUS and hydration strategies being promising approaches. Further research is required to optimize treatment protocols and improve long-term outcomes for this high-risk population.

Purpose of review: The present review aims to address systemic sclerosis (SSc)-associated myocardial disease, a significant cause of morbidity and mortality, by examining the mechanisms of inflammation, microvascular dysfunction, and fibrosis that drive cardiac involvement. The objective is to elucidate critical risk factors and explore advanced diagnostic tools for early detection, enhancing patient outcomes by identifying those at highest risk.

Recent findings: Recent studies underscore the importance of specific autoantibody profiles, disease duration, and cardiovascular comorbidities as key risk factors for severe cardiac manifestations in SSc. Additionally, advanced imaging techniques and biomarker analyses have emerged as pivotal tools for early identification and risk stratification. These innovations enable clinicians to detect subclinical myocardial involvement, potentially averting progression to symptomatic disease. SSc-associated myocardial disease remains challenging to predict, yet novel imaging modalities and biomarker-guided strategies offer a promising pathway for early diagnosis and targeted intervention. Integrating these approaches may enable more effective early detection and screening strategies as well as mitigation of disease progression, ultimately enhancing clinical outcomes for patients with SSc at-risk for adverse clinical outcomes.

Background: Although hyperuricemia is a recognized risk factor for cardiovascular diseases, mixed results have been reported regarding the associations between uric acid-lowering medications and cardiovascular events. This meta-analysis compared the cardiovascular outcomes of different uric acid-lowering medications and placebo.

Methods: Following PRISMA guidelines, we searched OVID Medline, Embase, Web of Science, and Cochrane databases to identify potentially relevant articles until December 2023. Studies must be randomized or observational, report cardiovascular and mortality outcomes, and compare uric acid-lowering medications to placebo or each other. Data was analyzed using Revman (version 5.4) software.

Results: A total of 3,393 studies were searched, after which 47 studies were included, totaling 3,803,509 patients (28 studies comparing xanthine oxidase inhibitors (XOI) versus placebo, 17 studies comparing allopurinol and febuxostat, and 2 studies comparing XOI and uricosuric agents). Overall mean age was 57.3 years, and females comprised 20.8% of all studies. There were no significant differences between XOI and placebo for cardiovascular outcomes (mortality, myocardial infarction, major adverse cardiovascular events, heart failure, or arrhythmia). There was significant heterogeneity in all these pooled analyses. Comparing Allopurinol to Febuxostat, there was a lower risk of heart failure in febuxostat than allopurinol in 3 RCTs (OR 0.66, 95% CI 0.50-0.89, p = 0.006). Other cardiovascular outcomes were not different. Lastly, when comparing XOI and uricosuric agents, no significant differences in MI rates were evident.

Conclusion: XOI was not associated with reduced cardiovascular events compared to placebo. When comparing XOI agents, Febuxostat might reduce the risk of HF, but future studies are required to confirm the findings from the current study.

Purpose of review: This article summarizes findings seen in various cardiomyopathies on myocardial perfusion imaging (MPI) with positron emission tomography (PET).

Recent findings: MPI is the cornerstone for evaluation of coronary ischemia, and technological advancements have yielded improved imaging quality and reduction in radiation exposure, particularly with PET. Multi-specialty guidelines and appropriate use criteria provide guidance on utilization of PET MPI in various scenarios related to evaluation of chest pain, new onset cardiomyopathy, and other scenarios where coronary ischemia should be assessed. Various non-ischemic cardiomyopathies such as septal and apical hypertrophic cardiomyopathy, amyloidosis, sarcoidosis, takotsubo, and dilated cardiomyopathy have typical imaging findings on PET MPI and can be identified if these patterns are understood. It is essential to recognize specific imaging patterns in non-ischemic cardiomyopathies which may aide in diagnosis. Ultimately, multimodality imaging, including echocardiography and cardiac magnetic resonance, complement PET MPI in diagnosing and guiding treatment options for these conditions.

Purpose of review: To summarise current international clinical outcomes from donation after circulatory death heart transplantation (DCD-HT); discuss procurement strategies, their impact on outcomes and overall organ procurement; and identify novel approaches and future areas for research in DCD-HT.

Recent findings: Globally, DCD-HT survival outcomes (regardless of procurement strategy) are comparable to heart transplantation from brain dead donors (BDD). Experience with normothermic machine perfusion sees improvement in rates of primary graft dysfunction. Techniques have evolved to reduce cold ischaemic exposure to directly procured DCD hearts, though controlled periods of cold ischaemia can likely be tolerated. There is interest in hypothermic machine perfusion (HMP) for directly procured DCD hearts, with promising early results. Survival outcomes are firmly established to be equivalent between BDD and DCD-HT. Procurement strategy (direct procurement vs. regional perfusion) remains a source of debate. Methods to improve allograft warm ischaemic tolerance are of interest and will be key to the uptake of HMP for directly procured DCD hearts.

Purpose of review: To survey recent progress in the application of implantable and wearable sensors to detection and management of cardiac arrhythmias.

Recent findings: Sensor-enabled strategies are critical for the detection, prediction and management of arrhythmias. In the last several years, great innovation has occurred in the types of devices (implanted and wearable) that are available and the data they collect. The integration of artificial intelligence solutions into sensor-enabled strategies has set the stage for a new generation of smart devices that augment the human clinician. Smart devices enhanced by new sensor technologies and Artificial Intelligence (AI) algorithms promise to reshape the care of cardiac arrhythmias.

Purpose of review: Despite growing evidence supporting the diagnostic utility of coronary computed tomographic angiography (CCTA) for anatomical assessment of coronary artery disease (CAD), its is underutilized in peri-procedural planning especially in the acute setting.

Recent findings: Incorporation of flow reserve measurement techniques into CCTA has expanded its sensitivity and specificity for obstructive disease, and continued improvement in CCTA technology permits more accurate cross-sectional plaque characterization. CCTA has the potential to constitute the mainstay of pre-procedural planning for patients with CAD, who are being considered for percutaneous coronary intervention , reducing their ad hoc nature while facilitating equipment selection and improving catheterization lab safety and throughput. Future studies are needed to compare the cost and benefits of more frequent use of routine pre-procedural CCTA prior to coronary angiography and intervention.

Purpose of the review: Successful catheter ablation of ventricular arrhythmias depends on identifying the critical tissues that sustain the arrhythmia. Increasingly, the intramural space is being recognized as an important source of idiopathic and reentrant ventricular arrhythmias, representing a common cause of ablation failure. A systematic approach to mapping and ablating these arrhythmias is key to optimize outcomes.

Recent findings: Intramural ventricular arrhythmias are common in certain anatomical locations such as the left ventricular ostium or the interventricular septum. In these cases, mapping of the septal coronary veins provides an opportunity to explore the intramural compartment of the septum to perform activation mapping, entrainment and/or pace mapping. When an intramural arrhythmia is identified, ablation may require radiofrequency application from multiple sites, prolonged lesions, or special ablation techniques such as bipolar ablation or transvenous ethanol injection. Identification of intramural ventricular arrhythmias depends on comprehensive mapping that should include the coronary venous system, and ablation often requires advanced techniques. This paper provides a guide on when to suspect an intramural ventricular arrhythmia in the electrophysiology laboratory and how to approach mapping and ablation in these challenging cases.

Purpose of review: The present review aims to summarize current evidence, explore underlying mechanisms, and help guide clinicians regarding statin therapy and diabetes risk in primary prevention.

Recent findings: The observational and genetic epidemiology, as well as evidence from randomized controlled trials and meta-analyses, illustrate a modest, dose-dependent increase in risk of diabetes from statin therapy. Risk of new onset diabetes from statins appears to be greatest in those near the diagnostic threshold for diabetes or with diabetes risk factors prior to statin initiation. The risk of incident diabetes is vastly offset by the cardiovascular protection offered from statin therapy and should not deter guideline recommended statin initiation in primary prevention.