Current Cardiology Reports最新文献

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.

Purpose of review: This review summarizes current 2D and 3D echocardiographic techniques for evaluating right heart structure and function in pulmonary hypertension (PH), emphasizing their diagnostic, prognostic, and monitoring roles. It also highlights the emerging role of myocardial strain imaging and right atrial (RA) assessment in comprehensive right heart evaluation.

Recent findings: Recent guidelines support a multiparametric echocardiographic approach, integrating structural, functional, and hemodynamic parameters to characterize right ventricular (RV) remodeling in PH. Advanced modalities such as 3D echocardiography and speckle-tracking strain imaging enhance evaluation of RV and RA function and may enable earlier detection of dysfunction and improved risk stratification. Established 2D echocardiographic guidelines provide a strong foundation for PH assessment. Incorporating 3D RV imaging and RA/RV strain builds on these standards, improving diagnostic precision and clinical relevance. Standardization and broader adoption of these tools will be essential to optimize patient outcomes and support future PH research.

Purpose of review: This review aims to provide an updated overview of the clinical management of heart failure and comorbidities in transthyretin amyloid cardiomyopathy (ATTR-CM). We sought to address key unanswered questions and current uncertainties regarding treatment response, prognosis, and optimization of care in this complex population.

Recent findings: Once considered rare, ATTR-CM is now increasingly recognized due to greater awareness and the possibility of non-invasive diagnosis. Patients are often identified at earlier stages, with lower mortality than historically observed. Disease-modifying therapies with proven efficacy in randomized trials are now available, yet many patients experience disease progression. In real-world practice, ATTR-CM patients are typically older and have multiple cardiac and extracardiac comorbidities, often representing exclusion criteria of clinical trials, which may influence treatment response and efficacy. Modern management of ATTR-CM should integrate heart failure treatment with tailored approaches to comorbidity care. Earlier diagnosis, real-world evidence, and strategies for patients outside trial populations will be essential to improve prognosis and guide future research.

Purpose of review: This paper aims to clarify the mechanism of action of Cardiac Contractility Modulation in heart failure treatment, synthesize key clinical evidence supporting the combination of Cardiac Contractility Modulation and implantable cardioverter-defibrillators for managing heart failure with reduced ejection fraction, and explore potential challenges and future applications pertaining to this combined therapy.

Recent findings: Recent studies indicate that cardiac contractility modulation therapy improves ventricular function without elevating myocardial oxygen consumption, promotes recovery of diastolic and systolic function, augments myocardial contractility, and exhibits substantial efficacy in drug-refractory chronic heart failure. Additionally, cardiac contractility modulation markedly improves left ventricular function, reduces hospitalization frequency, and enhances quality of life in patients with heart failure with reduced ejection fraction and a QRS duration of 120-149 ms. It may also serve as a pivotal strategy to arrest progression of heart failure with preserved ejection fraction. Combining implantable cardioverter-defibrillators with cardiac contractility modulation addresses a critical gap in the clinical management of patients with heart failure with reduced ejection fraction. These individuals meet criteria for left ventricular assist devices but are ineligible for cardiac resynchronization therapy and fail to derive long-term survival benefits from implantable cardioverter-defibrillator monotherapy. This review demonstrates that combining cardiac contractility modulation and implantable cardioverter-defibrillators shows potential for improving outcomes in specific populations with heart failure with reduced ejection fraction by addressing limitations of single-therapy approaches. A key implication is that this combined strategy may offer a valuable therapeutic option for patients underserved by current guidelines. However, further rigorous clinical investigations are needed to fully establish its long-term efficacy, safety, and optimal patient selection criteria. These findings highlight the need for future research to refine the application of this combined therapy and expand its evidence base, which may inform future treatment guidelines for heart failure with reduced ejection fraction.

Purpose of review: Postoperative atrial fibrillation (POAF) and post pericardiotomy syndrome (PPS) are among the most common complications following cardiac surgery. This review explores their incidence, clinical features, risk factors, and shared inflammatory mechanisms. It also examines prevention and management strategies, with a focus on the relationship between PPS and POAF and remaining gaps in understanding.

Recent findings: Pericardial inflammation and innate immune activation are central to the development of both POAF and PPS. Surgical trauma initiates cascades involving cytokines, oxidative stress, and atrial remodeling. PPS has been associated with a higher risk of atrial fibrillation in the early postoperative period. Although current prediction models do not provide optimal discrimination, several preventive strategies, including preoperative medications and surgical options, have been shown to reduce the risk of these complications. However, varying definitions and diagnostic criteria limit comparability across studies, and long-term data are scarce. POAF and PPS are associated with significant morbidity, including longer hospital stays, readmissions, and cardiovascular complications. Identifying high-risk patients is essential to guide early interventions. The overlap in pathophysiology suggests PPS may trigger POAF, but causality remains unconfirmed. Future research should focus on clarifying their relationship, assessing the durability of preventive strategies, and establishing standardized diagnostic criteria to reduce heterogeneity and improve clinical decision-making.

Purpose of review: The relationship between positive affect (PA) and heart rate variability (HRV) has attracted considerable interest due to its potential implications for emotion regulation and cardiovascular health. This systematic review synthesizes current literature on the association between PA and HRV, considering resting-state, stress-reactivity and recovery contexts, as well as variations in PA conceptualization.

Recent findings: A total of 36 studies (N = 5501) were included, spanning experimental, ambulatory, cross-sectional, and mixed designs. Elevated PA was most often associated with higher vagally mediated HRV, measured as RMSSD or high-frequency (HF) power, but results varied by context. Resting-state and trait-like PA measures showed the most consistent positive associations. In stress-induction paradigms, effects depended on the stress phase and arousal level of PA, with RMSSD emerging as a more consistent index than other HRV metrics. In real-life settings, aggregated activated PA was linked to higher RMSSD, while momentary activated PA was linked to lower RMSSD, suggesting short-term allostatic adjustments. Findings for other HRV metrics, such as LF/HF ratio, LF-HRV, and SDNN, were mixed. Overall, this review highlights the complex interplay between PA and cardiac autonomic regulation and provides directions for future research, which should aim for greater methodological consistency and clarify the temporal dynamics of the PA-HRV relationship.

Purpose of review: To discuss the optimal timing of staged chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndromes (ACS), multiple CTOs and after a CTO modification procedure.

Recent findings: In patients with acute coronary syndromes CTO PCI should be performed as part of a complete revascularization strategy within a few weeks or months from the initial presentation. In patients who undergo CTO modification procedures, such as subintimal tracking and re-entry (STAR) earlier re-intervention (within 1-2 months) is better than later re-intervention. Staged intervention is preferred in most patients who need PCI of more than one CTO to minimize the risk of complications. The optimal timing of CTO intervention as part of a complete revascularization strategy remains unknown, as does the optimal timing of repeat intervention after a CTO modification procedure, though earlier is likely better than later in both cases. PCI of more than one CTO in the same patient should also be staged for safety reasons.

Purpose of review: The Fontan procedure, a palliative surgery for single-ventricle congenital heart disease, often leads to multisystem complications. Elevated bile acids and reduced vitamin D3 levels, frequently observed in this population, may share a harmful bidirectional relationship. This review examines their interplay and therapeutic relevance.

Recent findings: Fontan-associated liver disease and potential gut dysbiosis contribute to altered bile acid metabolism, with elevated circulating secondary bile acids impairing cardiovascular, hepatic, musculoskeletal, and immune functions. Recent evidence suggests that bile acid accumulation hinders vitamin D absorption and metabolism. In turn, vitamin D deficiency exacerbates systemic inflammation and fibrosis while reducing bile acid detoxification via diminished vitamin D receptor signaling. The dysregulation of bile acid and vitamin D pathways may create a vicious cycle driving Fontan-associated multisystem dysfunction. Interventions targeting this axis-such as vitamin D supplementation and bile acid modulation-may offer novel strategies to mitigate organ injury and improve long-term outcomes in this high-risk population.