Expert Review of Cardiovascular Therapy最新文献

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.

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.