Expert Review of Cardiovascular Therapy最新文献

Introduction: The presence of acute hypertension-mediated organ damage (HMOD) makes the difference between hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). In the case of unrecognized ('false negative') acute HMOD, a misclassification ensues: the diagnosis is HTN-U instead of HTN-E, and the treatment of these patients is inadequate.

Areas covered: This review aims to investigate the presence of undiagnosed acute HMODs in the hypertension (HTN) guidelines, to analyze the significance of the undiagnosed acute HMODs, and to evaluate the gaps in the knowledge on the topic. The following databases were searched: Scopus, PubMed, Cambridge, Oxford Journals, Springer, Science Direct, SAGE, Wiley, and Google Scholar.

Expert opinion: There is insufficient awareness of the problem of unrecognized ('false negative') acute HMODs in clinical practice. HTN-Es have poor prognosis, with high risk of cardiovascular events and even death. Acute HMODs are prerequisite for the diagnosis of HTN-E, and it can be expected that undetected HMODs have even worse outcome. Therefore, undetected (false - negative) acute HMODs are worth of accepting and studying.

Introduction: Coronary artery disease (CAD) is a major global cause of morbidity and mortality. Percutaneous coronary intervention (PCI) is central to its management, and optimal stent deployment is critical. This systematic review evaluates the efficacy and clinical outcomes associated with enhanced stent visualization (ESV) systems - X-ray-based fluoroscopic tools such as StentBoost and CLEARstent - in PCI.

Methods: A systematic literature search of PubMed, PubMed Central, and Cochrane Library was conducted according to PRISMA guidelines. Inclusion criteria comprised all study types evaluating ESV use in PCI, excluding case reports and non-English articles. Study quality was assessed using Newcastle-Ottawa tool.

Results: Twelve studies involving ESV were included. ESV improved detection of stent expansion and deployment versus standard angiography and showed strong agreement with OCT and IVUS. ESV-guided PCI was associated with reduced rates of major adverse cardiac events (MACE), particularly in long-term follow-up. Radiation exposure was modestly increased but deemed acceptable.

Conclusions: ESV systems enhance stent deployment accuracy and clinical outcomes in PCI, offering a cost-effective and accessible alternative to OCT and IVUS. Evidence supports routine integration of ESV in PCI workflows, although further large-scale trials are warranted.

Registration: PROSPERO identifier is CRD420251020834.

Introduction: Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis, yet conduction disturbances remain the most common complication. Permanent pacemaker implantation (PPI), while often necessary, may negatively impact long-term outcomes and increase healthcare burden. Identifying patients at risk of PPI and optimizing post-TAVI rhythm management is therefore of critical importance.

Areas covered: This Special Report reviews key predictors of conduction disturbances after TAVI, including baseline electrocardiographic features (e.g. right bundle branch block), anatomical parameters (e.g. short membranous septum), and procedural factors (e.g. valve type and implantation depth) identified by literature review. Dynamic post-procedural changes in PR interval and QRS duration are discussed as triggers for further monitoring or electrophysiological testing. The report synthesizes findings from recent multicenter studies, guideline recommendations, and emerging tools such as ECG ambulatory monitoring using artificial intelligence and the MIDAS implantation technique.

Expert opinion: Reducing unnecessary PPI requires an individualized, risk-adapted approach that integrates imaging, ECG, and procedural planning. Dynamic post-TAVI monitoring and selective use of electrophysiological studies may help avoid overtreatment. As TAVI expands to younger and lower-risk populations, refining conduction management will be essential to optimize patient outcomes and healthcare resource utilization.

Introduction: The Fontan procedure and its modifications have dramatically transformed prognosis in individuals with single ventricle physiology, yet long-term outcomes remain challenging due to the high incidence of short and long-term complications. Common issues include arrhythmias, heart failure, Fontan-associated liver disease and an increasing need for reintervention or transplantation, all of which substantially impact on patients' quality of life and longevity. As this population ages, late cardiac and extracardiac complications are common, which underscores the need for ongoing monitoring and comprehensive multidisciplinary care aimed at early and effective management.

Areas covered: This review summarizes current evidence on the long-term outcomes after Fontan-type surgery. It describes the unique pathophysiology of the Fontan circuit, and critically evaluates incidence, severity, and management strategies for common cardiac and extracardiac complications, focusing on established clinical practice and recent advances. The review also highlights the value of continued specialist multidisciplinary care.

Expert opinion: Emerging research supports the potential of novel medical therapies and devices to further improve outcomes, yet optimal care remains grounded in multidisciplinary management rather than experimental approaches. Continued research is vital to support clinical guidelines and improve the quality of life and outcomes of individuals living with a Fontan-type circulation.

Introduction: Patients with chronic kidney disease (CKD) have a significantly elevated risk of coronary artery disease. The relationship between CAD and CKD is multifaceted involving complex physiological mechanisms that result in increased inflammation, oxidative stress, and lipid abnormalities. Medical therapy and interventions in these comorbid conditions are highly complex, as they must ideally address both cardiovascular risk reduction and renal protection.

Areas covered: This literature review provides an overview of the epidemiology, unique pathophysiology, clinical presentation, and management of CAD in patients with CKD. We searched PubMed and Web of Science databases from inception to November 2025 to gather evidence-based recommendations regarding CAD in CKD. We also discuss the challenges of medical and revascularization therapy that arise in patients with concurrent CAD and CKD, including providing insight into outcome differences in percutaneous coronary intervention compared to coronary artery bypass grafting.

Expert opinion: CAD in CKD remains sub-optimally treated due to provider hesitancy, poor risk stratification tools, and limited dedicated trials. New medical therapies show potential. Future advances may include CKD-specific CAD calculators, contrast-free imaging, artificial intelligence driven treatment models, and expanded guideline-based use, though real-world implementation will require overcoming cost and education barriers.

Introduction: Thirst is a common yet underrecognized symptom in patients with heart failure (HF), exerting a significant impact on disease management, treatment adherence, and quality of life (QoL). Approximately 65-75% of patients with HF report moderate to severe thirst, particularly in advanced stages of the disease or under strict fluid restrictions contributing to psychological distress, social isolation, and diminished well-being.

Areas covered: This systematic review explores the pathophysiology, clinical consequences, and management of thirst in HF. A literature search of PubMed, Embase, Scopus, and Web of Science (2015-2025) identified studies addressing thirst prevalence, neurohormonal and electrolyte mechanisms, and therapeutic interventions. Severe thirst has been associated with poor adherence to fluid restriction, increased psychological distress, and a 40% higher risk of hospital readmission within six months of discharge. Patient-centered strategies, such as structured education and follow-up programs, have been shown to improve adherence and reduce thirst burden.

Expert opinion: Despite its clinical importance, thirst remains underaddressed in HF care, with fewer than 20% of studies evaluating it as an outcome. The development of standardized assessment tools, implementation of long-term intervention studies, and incorporation of thirst management into routine HF care are essential steps toward improving patient outcomes and QoL.

Introduction: Acute pulmonary embolism (PE) is a cardiovascular life-threatening condition associated with significant morbidity and mortality worldwide. Hemodynamic instability is a critical determinant of outcomes in PE, underscoring the need for precise risk stratification and management.

Areas covered: This review highlights the importance of understanding key hemodynamic parameters in the pathophysiology of PE, emphasizing the role of advanced assessments such as diastolic blood pressure and mean arterial pressure in refining risk stratification.

Expert opinion: These parameters may offer a more comprehensive evaluation of cardiac function and perfusion, particularly in intermediate-risk patients where subtle hemodynamic compromise may not be evident with traditional measures. By integrating these advanced assessments into risk models, clinicians can develop personalized therapeutic strategies tailored to individual patient needs, ultimately enhancing hemodynamic outcomes and improving the effectiveness of PE management.

Introduction: In the last decade, technological advancements in procedural devices and techniques as the increasing recognition of the prognostic relevance of bleeding after percutaneous coronary intervention (PCI) paved the way forward to the investigation of different modulation strategies of dual antiplatelet therapy (DAPT) intensity and duration.

Areas covered: The present review provides an update overview on DAPT modulation strategies with a specific focus in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS) patients undergoing PCI stratified by the presence of high bleeding risk (HBR) features. We searched PubMed (MEDLINE), Web of Science and Cochrane Library databases from inception to August 2025 using combinations of appropriate keywords.

Expert opinion: Current evidence supports a shift in the post-PCI antithrombotic paradigm toward early aspirin discontinuation and transitioning to P2Y₁₂ inhibitor monotherapy, particularly in patients with HBR. While there is increasing evidence for ticagrelor monotherapy in patients with ACS, clopidogrel-based strategies may be considered in selected patients, particularly those with CCS and/or or low thrombotic risk. A patient-centered, tailored approach should remain key to guide the selection and duration of antiplatelet therapy after PCI.

Introduction: Conduction system pacing (CSP) is redefining management of patients requiring permanent pacing by offering a more physiologic alternative to subpulmonary ventricular pacing and conventional cardiac resynchronization therapy (CRT). While most evidence stems from acquired heart disease, CSP is gaining traction in congenital heart disease, where traditional pacing can exacerbate dyssynchrony and lead to long-term ventricular dysfunction.

Areas covered: This review examines the role of CSP in congenital heart disease, focusing on anatomical variability of the atrioventricular conduction system and lesion-specific challenges affecting lead placement. It synthesizes early data on the feasibility and safety of His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) across a range of congenital lesions. Technological advances, including CT-based conduction mapping, electroanatomic mapping, and intracardiac echocardiography, enable anatomy-guided implantation strategies. Advances in delivery tools are expanding CSP use in anatomically complex settings. Despite encouraging early results, long-term data are limited, and randomized trials are lacking.

Expert opinion: CSP holds the potential to become the default physiologic pacing strategy in congenital heart disease. With advancing tools and operator experience, lesion-specific and hybrid CSP - CRT techniques may optimize outcomes. Key priorities include refining patient selection, defining preventive indications, and developing guidelines to support broader adoption.