Expert Review of Cardiovascular Therapy最新文献

Introduction: Peripartum cardiomyopathy (PPCM) is a severe condition with nonspecific symptoms and limited diagnostic biomarkers. Conventional markers such as BNP and NT-proBNP lack specificity, complicating differentiation from other cardiac disorders.

Areas covered: We conducted a comprehensive literature search in PubMed, Scopus, and Web of Science for studies published between January 2000 and August 2025 using keywords related to PPCM and biomarkers. Recent advances highlight novel markers in prolactin-mediated and angiogenic pathways. Cathepsin D shows therapeutic potential, while miR-146a offers an alternative to bromocriptine without lactation suppression. The sFlt-1/PlGF ratio aids in distinguishing PPCM from preeclampsia, though postpartum variability limits its utility. Emerging candidates such as VEGF, PlGF, adiponectin (ADIPOQ), and QSOX1 reflect diverse mechanisms, and heat shock proteins may modulate biomarker activity.

Expert opinion: Multi-marker strategies are essential to address PPCM heterogeneity and improve diagnostic accuracy. Future research should validate these biomarkers, refine diagnostic tools, and explore therapeutic applications to transform PPCM management and outcomes.

Objectives: This systematic review and meta-analysis focused on summarizing and quantitatively estimating the pooled adherence rates to clinical guideline recommendations for anticoagulation therapy in patients with AF receiving treatment in Ethiopian hospitals.

Methods: The Systematic literature search was conducted in PubMed, Cochrane Library, Africa-specific databases (African Index Medicus, and African Journals Online), and Google Scholar. Data were extracted in a structured format prepared using Microsoft Excel. The extracted data were exported to R software Version 4.3.0 for analysis. The I2 test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI). Based on the test result, a random-effects meta-analysis model was used to estimate pooled effect adherence rate to the international guideline in antithrombotic therapy.

Results: The review included a total of 6 primary studies with the pooled adherence rate to guidelines in antithrombotic therapy use in patients diagnosed with AF who are at high risk for thromboembolic events and eligible for oral anticoagulants was found to be 55% (95% CI: 33% to 77%).

Conclusion: Guideline adherence for oral antithrombotic therapy was low (55%), leaving many high-risk patients vulnerable. Multifaceted interventions, including coordinated care and pharmacist involvement, are needed to improve adherence.

Introduction: Mitral regurgitation (MR) is a progressive valvular heart disease (VHD) with significant morbidity and mortality, particularly in older adults. Current guidelines rely primarily on symptom status and LV function to guide intervention, which may underestimate disease severity, especially in asymptomatic patients.

Areas covered: A comprehensive literature search was conducted in PubMed/Medline, Scopus and EMBASE databases for articles until March 2025. This review discusses MR severity grading and introduces the concept of extra-mitral cardiac damage staging, adapted from models used in aortic stenosis. It highlights the application of this staging to both primary and secondary MR, detailing how structural and functional deterioration beyond the mitral valve, such as involvement of the LV, left atrium, pulmonary vasculature, and right ventricle, correlates with outcomes.

Expert opinion: Cardiac damage staging offers a practical, echocardiography-based tool for personalized risk assessment. It allows for the earlier identification of high-risk patients and may shift intervention timing, especially for transcatheter therapies. Despite some variability in staging definitions, its integration into clinical practice could enhance patient stratification and management. Future research should aim to standardize criteria and assess its role in prospective trials, advancing the field toward precision care in VHD.

Background: Non-dipper blood pressure (BP) patterns are associated with increased cardiovascular risk, but their relationship to coronary artery disease (CAD) complexity remains unclear. This study evaluated whether a non-dipper BP profile is linked to greater CAD burden in hypertensive patients using SYNTAX Scores (SS) I and II.

Research design and methods: A total of 381 hypertensive patients undergoing elective coronary angiography were prospectively enrolled. All underwent 24-hour ambulatory BP monitoring (ABPM) and were categorized as dipper or non-dipper. CAD burden was assessed using SS I and II. ROC analysis and multivariate logistic regression were performed.

Results: Non-dippers had significantly higher SS I (14.24 ± 8.47 vs. 9.81 ± 5.24) and SS II (28.64 ± 9.64 vs. 22.30 ± 6.57) than dippers (p < 0.001). SS II had greater predictive value (AUC: 0.704). Non-dipper status (OR: 20.1), diabetes, lower eGFR, and higher platelet count were independently associated with high SS, while age, gender, and high-sensitivity C-reactive protein (hs-CRP) were not.

Conclusions: Non-dipper BP was independently associated with greater anatomical and clinical CAD complexity. Integrating ABPM and SS may enhance cardiovascular risk stratification and inform individualized preventive strategies in hypertensive patients.

Introduction: Atherosclerosis, the primary cause of coronary artery disease (CAD), progresses through subclinical, chronic, and acute phases, culminating in acute myocardial infarction (AMI). Historically viewed as a lipid-driven disorder, it is now recognized as an inflammatory disease. Despite achieving optimal low-density lipoprotein cholesterol reduction, many patients experience residual cardiovascular risk, largely attributed to persistent inflammation.

Areas covered: A comprehensive literature search has been performed on PubMed, Web of Science and Cochrane, up to July 2025, with no significant restrictions. The review explores the role of inflammation in plaque progression and destabilization, discusses emerging biomarkers for risk stratification, and summarizes current and investigational anti-inflammatory therapies. Special attention is given to the evolving understanding of acute versus chronic post-AMI inflammation and how this distinction may guide therapeutic strategies.

Expert opinion: Anti-inflammatory therapy has reshaped the landscape of cardiovascular prevention, yet challenges remain in patient selection, timing, and target identification. Novel imaging techniques and artificial intelligence-driven risk models offer promising avenues for personalized therapy. Future efforts should focus on precision-based approaches that target detrimental immune activation while preserving reparative processes, ensuring maximal clinical benefit.

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in elderly patients. Antiarrhythmic drugs (AADs) are often required for rate/rhythm control and to improve AF-related symptoms. There is limited evidence on the effectiveness and safety of AADs in elderly AF patients.

Areas covered: This narrative review focuses on the use of AADs in elderly AF patients, summarizing the different physiology, pharmacokinetics, and pharmacodynamics in the older age. Furthermore, the evidence from clinical studies on AADs pointing up data on safety and effectiveness in the elderly was summarized.

Expert opinion: Although AADs represent a cornerstone for symptom relief in patients with AF, these drugs did not show a clinical net benefit compared to rate control, with a potentially increased risk of complications and hospitalizations. Considering also the different pharmacokinetics and the concomitant comorbidities and treatments that characterize older patients, the administration of these drugs should be reserved for selected patients with a high burden of AF-related symptoms.

Introduction: Catheter ablation has traditionally been performed using thermal modalities, which, despite being effective, remain associated with potentially severe complications such as pulmonary vein stenosis and atrioesophageal fistula. Pulsed field ablation (PFA), a non-thermal technique based on irreversible electroporation, has emerged as a promising alternative, with the potential to maintain the efficacy of thermal energies while minimizing collateral damage to surrounding structures.

Areas covered: This review discusses the safety and efficacy of PFA for atrial fibrillation (AF) ablation. We analyzed the latest clinical evidence on PFA lesion durability and effectiveness, integrating insights from our clinical experience and workflow. The safety profile of PFA is critically examined, highlighting its advantages in reducing complications while addressing emerging PFA-specific adverse effects such as hemolysis and coronary vasospasm.

Expert opinion: PFA promises to overcome the safety limitations encountered during AF ablation with thermal modalities. This may permit earlier referrals, treatment of more complex patients, and adoption of a more individualized, extensive ablation approach. Despite this, PFA still requires technological and workflow optimization due to challenges in lesion durability, real-time lesion assessment, and emerging concerns about energy-specific side effects. These issues require operator awareness and are expected to be addressed with second-generation PFA systems.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality, with elevated low-density lipoprotein cholesterol (LDL-C) established as a primary causal factor. Despite foundational therapies, many high-risk patients fail to achieve optimal LDL-C targets.

Areas covered: This review examines established LDL-C lowering agents (statins and ezetimibe), detailing their mechanisms and limitations, including statin intolerance and residual cardiovascular risk. We provide a comprehensive analysis of novel therapeutic options, including proprotein convertase subtilisin/kexin type 9 (PCSK9) modulators (monoclonal antibodies, small interfering RNA, and emerging oral agents), ATP-citrate lyase inhibitors (bempedoic acid), angiopoietin-like protein 3 (ANGPTL3) inhibitors, and pioneering gene-editing technologies. We discuss mechanisms of action, pivotal efficacy data (LDL-C reduction and plaque modification), safety profiles, and key findings from major cardiovascular outcome trials.

Expert opinion: Novel LDL-C lowering therapies represent a paradigm shift, offering unprecedented efficacy in reducing LDL-C and mitigating ASCVD risk. However, significant challenges remain, including cost-effectiveness concerns, the need for long-term safety data, profound global disparities in access, and persistent clinical inertia that impedes real-world implementation even in well-resourced healthcare systems. Future research should prioritize personalized lipid management, combination strategies, and development of durable, cost-effective solutions to reduce the residual ASCVD burden.