Current Cardiology Reviews最新文献

Introduction: International guidelines recommend intravenous (IV) iron replacement in patients with heart failure (HF) with reduced or mildly reduced ejection fraction (HFrEF or HFmrEF) and iron deficiency (ID). IV iron therapy remains underutilised despite growing evidence of its positive impact on hospitalisation rates, quality of life, and symptom control in HF. In this study, we aimed to explore the prevalence of ID and adherence to guideline-directed medical therapy (GDMT) for ID in HF patients.

Methods: It was a retrospective observational study performed at a tertiary hospital in Oman. All HF patients admitted between March 2022 and February 2024 were included. ID was defined as serum ferritin less than 100 μg/L or serum ferritin 100-299 μg/L with transferrin saturation (TSAT) of less than 20%. Patients in intensive care units, pregnant women, and those with HF with preserved LVEF (HFpEF) were excluded.

Results: Only 26% (n=97) of 376 patients with HFrEF/HFmrEF were screened for ID, and about half of them (n=52) were found to be iron deficient. ID was tested more often in patients with anemia compared to those without anemia (33.9% vs. 10.7%, p < 0.001). IV iron in the form of iron carboxymaltose (FCM) was administered in 19% of ID patients, but only 15% received the recommended dose of 1000 mg FCM. There was no statistically significant difference in patient demographics or comorbidities between patients with or without ID.

Conclusion: Among 376 HF patients screened for ID, almost half were iron deficient. However, the compliance rate of IV FCM therapy remained quite low. Low screening rates and limited adherence to GDMT underscore the need for standardized hospital protocols for the management of ID in HF patients.

Introduction: Multivalvular cardiac disease has been associated with increased mortality and morbidity as compared to isolated valve disease. The treatment of choice for combined degenerative aortic and mitral stenotic disease is considered to be double valve surgery, but it is associated with poorer outcomes when compared to isolated valve surgical correction, especially in high-risk populations. There is considerable interest in utilizing transcatheter therapies in multivalvular disease. The prevalence and outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) with concomitant mitral stenosis (MS) have not been studied extensively. Currently, there are no specific recommendations or guidelines for managing these patients.

Methods: A search of PubMed and Cochrane databases was performed for studies and metaanalyses of patients undergoing TAVR for severe AS with concomitant MS.

Results: Our research demonstrates that most patients undergoing TAVR for severe AS with concomitant mitral valve stenosis tend to be elderly with degenerative valve disease. Short-term outcomes, such as postoperative hospital stay, as well as long-term outcomes, such as 1-year mortality, are worse in TAVR with severe MS. TAVR in mild to moderate MS shows no significant differences in outcomes compared with TAVR for isolated severe AS.

Discussion: Most studies have shown that in subjects undergoing TAVR with concomitant MS, severe MS is associated with worse outcomes, while mild to moderate MS shows no significant difference compared with the absence of MS. Limitations of our study are mainly related to the small number of high-quality clinical trials examining TAVR in patients with combined AS and MS.

Conclusion: With the aging population, TAVR has been a more attractive option for the treatment of severe symptomatic AS. The optimal treatment of patients with AS along with MS is not clear. Thus, further research is needed in this field.

Introduction: Emerging scientific evidence supports the essential role of inflammation as one of the factors in the development of hypertension. The immune system plays a crucial role in the body's defense mechanism and in promoting tissue regeneration after injury. When the immune system overreacts to an insult or injury, collateral damage can result in hypertension.

Methods: A comprehensive literature search was conducted to collect and analyse articles related to the role of the adaptive immune system, particularly T cells and their cytokines. It was conducted in scientific databases, including PubMed, ScienceDirect, and Google Scholar, to identify relevant articles published between 2000 and 2024, ensuring an up-to-date collection of scientific evidence. The following keywords and Medical Subject Headings (MeSH terms) were used: hypertension, immune system, T cells, cytokines, IL-10, TNF-α, IL-17, IFN-γ, and renal inflammation. These keywords helped capture both basic mechanisms and clinical findings relevant to the immune-mediated mechanism of hypertension. Only peer-reviewed original research articles and review articles in English were included. Preference was given to articles focused on cytokine synthesis, expression, release, and their signalling pathways, as well as hypertension- related target organ damage, especially in the kidney and blood vessels. All the articles were thoroughly analysed to extract information on the involvement of T cell-derived cytokines in promoting immune activation, monocyte infiltration, sodium retention, vascular dysfunction, and endothelial impairment, which all contribute to the pathogenesis of hypertension.

Results: According to the reference articles, TNF-α, IL-17, and IFN-γ stimulate vascular inflammation, sodium retention, endothelial dysfunction, and renal inflammation.

Discussion: The roles of T cells and the associated cytokines in regulating blood pressure are thoroughly discussed. It can activate oxidative stress and result in renal sodium imbalance, as well as interaction with the RAAS system and oxidative stress pathway, culminating in the exacerbation of blood pressure.

Conclusion: It is concluded that cytokines play a significant role in the development of hypertension, and targeting them might be a plausible pharmacological intervention for managing blood pressure.

Background: Pulsed field ablation (PFA) minimizes the risk of esophageal injury, pulmonary vein stenosis, and permanent phrenic nerve damage. However, when PFA is applied near coronary arteries, it has been associated with the induction of coronary vasospasm, which is typically asymptomatic but occasionally results in ventricular arrhythmias. Pre-treatment strategy with intravenous nitroglycerin can significantly reduce the occurrence of this complication.

Case presentation: A 79-year-old male with cavotricuspid isthmus (CTI)-dependent atrial flutter and atrial fibrillation underwent catheter ablation after antiarrhythmic therapy failure. Following pulmonary vein and posterior wall isolation using a novel variable-loop biphasic circular pulsed field ablation (PFA) catheter integrated with a 3D mapping system (VARIPULSE catheter, CARTO mapping system, Johnson and Johnson, USA), CTI ablation was performed with the same system. Twenty-one applications resulted in sinus rhythm restoration and confirmed bidirectional block, with no complications.

Conclusion: To our knowledge, this is the first real-world reported case of CTI-dependent atrial flutter successfully treated with the mapping-integrated PFA system, with clinical and rhythm follow-up extending to 6 months. Further studies are needed to assess its role in non-pulmonary vein ablation.

Introduction: Sex-based differences in outcomes among patients with heart failure with reduced ejection fraction (HFrEF) treated with sodium-glucose cotransporter 2 inhibitors (SGLT2is) remain underexplored. This study aimed to evaluate sex-specific differences in cardiovascular outcomes in patients with HFrEF receiving SGLT2 inhibitors alongside guidelinedirected medical therapy (GDMT).

Methods: We conducted a retrospective cohort study using the TriNetX global research network. Adults with HFrEF treated with SGLT2is and GDMT were stratified by sex. Propensity score matching (PSM) was used to balance baseline demographics, comorbidities, medications, and laboratory data. Primary outcomes were all-cause mortality and acute heart failure (HF) events; secondary outcomes included hospitalizations, arrhythmias, renal outcomes, and advanced therapies.

Results: After PSM, 17,408 male and 17,408 female patients were analyzed. Male patients had lower odds of acute HF events (aOR: 0.949; 95% CI: 0.909-0.991), all-cause hospitalizations (aOR: 0.933; 95% CI: 0.895-0.973), and renal failure (aOR: 0.915; 95% CI: 0.870-0.962). No significant differences were observed in all-cause mortality (aOR: 1.003; 95% CI: 0.926-1.087) or heart transplantation, although LVAD use was more frequent in males (aOR: 1.416; 95% CI: 1.053-1.905).

Discussion: The findings highlighted potential sex-based disparities in outcomes for patients with HFrEF on SGLT2is. Differential prescribing patterns, comorbidity burden, or timing of therapy initiation may contribute to observed differences.

Conclusion: Among HFrEF patients treated with SGLT2is, males experienced lower risks of HF events, hospitalizations, and renal failure compared to females, despite similar mortality. Further research is needed to understand and address sex-specific disparities in HFrEF management.

Introduction: This mini-review aims to investigate the shared pathophysiological mechanisms linking psoriasis to cardiovascular disease (CVD), with a particular emphasis on electrocardiographic and echocardiographic alterations in individuals affected by psoriasis.

Methods: A comprehensive search of PubMed and Google Scholar was conducted for studies published between January 1980 and June 2025. The search included clinical trials, observational studies, reviews, and meta-analyses.

Results: The pathogenesis of psoriasis shares several key features with CVD, particularly systemic inflammation and endothelial dysfunction. Psoriasis patients frequently exhibit electrocardiographic abnormalities, such as arrhythmias, including atrial fibrillation (AF), and structural heart changes, such as left ventricular diastolic dysfunction. These cardiovascular changes are often observed even in the absence of clinically evident heart disease.

Discussion: Psoriasis significantly contributes to cardiovascular risk, even in patients without manifest CVD. Chronic inflammation, endothelial dysfunction, and metabolic disturbances are key factors contributing to the increased cardiovascular risk observed in these individuals. Furthermore, the presence of psoriatic arthritis may exacerbate these associations, highlighting the multifaceted nature of the disease.

Conclusion: Early detection and management of cardiovascular alterations in patients with psoriasis are essential for mitigating their long-term cardiovascular burden. Targeting shared inflammatory pathways holds promise as a therapeutic approach to improve both dermatological and cardiovascular health in this patient population.

Introduction: Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors are a class of antidiabetic drugs that have demonstrated cardiovascular risk improvement in patients with heart failure. Current evidence suggests that they can also reduce mortality, hospitalization, and renal disease progression. In this study, we aimed to evaluate the cardiac reverse remodeling potential of SGLT2 inhibitors in nondiabetic heart failure patients with reduced ejection fraction (HFrEF).

Method: We systematically searched various databases, including Web of Science, Pub- Med/Medline, Scopus, Cochrane, and ProQuest. After screening, five randomized controlled trials were retrieved from the initial search (8442 citations).

Results: The meta-analysis revealed statistically significant and positive effects of SGLT2 inhibitors on left ventricular mass and function, cardiac matrix and cells, and cardiopulmonary fitness.

Discussion: SGLT2 inhibitor users experienced a reduction in left ventricular (LV) mass (mean difference (MD): -20.06 grams, confidence interval (CI) 95%: -24.94 to -10.18, p-value< 0.01), LV mass index (MD: -9.79 g/m2, CI 95%: -13.47 to -6.11, p-value < 0.01), LV end diastolic volume (MD: -17.42 ml, CI 95%: -29.00 to -5.83, p-value < 0.01), and LV end systolic volume (MD: -17.30 ml, CI 95%: -34.35 to -0.25, p-value: 0.05). Correspondingly, cardiac extracellular volume (MD: -1.47, CI 95%: -2.49 to -0.46, p-value < 0.01), cardiac cellular volume (MD: - 7.74, CI 95%: -12.30 to -3.19, p-value< 0.01), and cardiac matrix volume (MD: -5.33 ml, CI 95%: -8.33 to -2.33, p-value< 0.01) significantly decreased. Markers of cardiorespiratory fitness, including maximal oxygen consumption (VO2) (MD: 1.58 ml/kg/min, CI 95%: 0.60 to 2.55, pvalue< 0.01) and the minute ventilation (VE)/carbon dioxide consumption (VCO2) slope (MD: - 1.64, CI 95%: -3.18 to -0.09, p-value: 0.04), also improved. Moreover, LV ejection fraction indicated a statistically and clinically negligible rise (MD: 2.97 %, CI 95%: -0.24 to 6.19, p-value: 0.07).

Conclusion: The meta-analysis supports the potential role of SGLT2 inhibitors in enhancing LV function and reducing LV mass in HFrEF patients. These drugs can benefit HFrEF patients by improving pulmonary function and oxygenation. Treatment with SGLT2 inhibitors may be effective for outcomes associated with pulmonary and left ventricular function.

Introduction/objective: This systematic review and meta-analysis compares percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) as revascularization strategies for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD).

Methods: A comprehensive search of PubMed, Embase, and CENTRAL was conducted, with a pre-registered study protocol registered on PROSPERO (ID: CRD42024496529). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of allcause mortality, myocardial infarction (MI), stroke, or ischemia-driven revascularization. Secondary endpoints included each component of MACCE and 30-day all-cause mortality.

Results: Seven studies were analyzed, including five cohort studies and two subanalyses of randomized clinical trials, encompassing 3,475 patients. PCI was associated with a higher incidence of MACCE (hazard ratio [HR]: 1.50; 95% confidence interval [CI] 1.26-1.79), driven by allcause mortality (HR: 1.38; 95% CI 1.07-1.78), MI (HR: 1.75; 95% CI 1.17-2.62), and ischemiadriven revascularization (HR: 3.22; 95% CI 2.10-4.93). There were no differences in stroke rates (HR: 0.70; 95% CI 0.40-1.22) or 30-day all-cause mortality (odds ratio [OR]: 0.92; 95% CI 0.35-2.41).

Discussion: While previous studies have reported conflicting evidence regarding the noninferiority of PCI to CABG in patients with LMCAD, our pooled analysis demonstrates an increased incidence of MACCE in the PCI group, primarily driven by higher rates of all-cause mortality, myocardial infarction, and ischemia-driven revascularization. The findings suggest that CKD may play a role in clinical outcomes comparable to diabetes in multivessel disease and should be a key factor in revascularization decisions.

Conclusion: CABG is associated with superior long-term outcomes compared to PCI in patients with LMCAD and CKD. However, dedicated randomized controlled trials stratified by CKD stage are essential to guide optimal treatment strategies in this high-risk population.

Heart Failure (HF) is a prevalent medical illness worldwide that affects millions and is a substantial economic burden. Its epidemiological impact is on the rise due to factors such as the ageing of the population, increasing rates of diabetes and hypertension, and better survival post-myocardial infarction. Some limitations in HF management include diagnostic challenges, sudden progression of the disease, and rising rates of readmission. Continuous monitoring and limited therapeutic interventions add further complexity to care. Artificial Intelligence(AI) is essential in health care and has provided solutions for improving HF management. Techniques like machine learning and deep learning enhance clinical decision-making and patient care. AI helps physicians diagnose HF more precisely through the analysis of imaging and electrocardiograms. Additionally, the patients' risk is calculated using various AI algorithms to develop personalized treatments for each individual. AI will help healthcare providers identify problems early and select appropriate therapies, leading to better outcomes. Further areas for improvement include enhanced data integration, predictive accuracy, patient engagement, data privacy and ethics, as well as integration with clinical workflows. AI technologies will continue to evolve in managing and treating HF; ongoing exploration and development are crucial for its optimization. This review outlines the current progress and potential of AI in the future to ensure better patient care and healthcare practices.

Introduction: Pompe disease, a rare autosomal recessive lysosomal storage disorder, results from mutations in the GAA gene that lead to deficient acid alpha-glucosidase activity and glycogen accumulation in various tissues.

Methods: This review employs the diagnostic approach to the disease, encompassing enzymatic assays and molecular genetics, with a focus on genotype-phenotype correlations and regionspecific mutations.

Results: Over 500 mutations in the GAA gene, including missense, nonsense, insertions, deletions, and splicing defects, contribute to varying levels of enzyme deficiency, accounting for the diverse clinical manifestations of Pompe disease.

Discussion: Current therapies, including Enzyme replacement therapy (ERT), are the cornerstone treatments for Pompe disease, utilizing recombinant human alpha-glucosidase to restore enzyme activity and reduce glycogen accumulation in lysosomes. While ERT significantly improves survival, cardiomyopathy, and respiratory function, its limited uptake in skeletal muscle and immunogenicity pose challenges. Innovations include immune tolerance protocols and nextgeneration enzymes to enhance skeletal muscle delivery. Gene therapy emerges as a promising alternative, leveraging viral vectors to deliver functional GAA genes, thereby enabling sustained endogenous enzyme production and addressing limitations of ERT. Preclinical and early-phase trials demonstrate efficacy, reduced immunogenicity, and enhanced skeletal muscle uptake; however, challenges, such as vector immunogenicity and cost, remain. Thus, genetic counseling is essential for family planning and managing emotional and psychosocial challenges related to this disease.

Conclusion: This article highlights advances and challenges in the diagnosis, management, and treatment of Pompe disease, providing a comprehensive resource for clinicians and researchers.