Expert Review of Cardiovascular Therapy最新文献

Introduction: Life expectancy is rising globally, leading to an expected increase in age-related cardiovascular diseases. Managing cardiovascular disease in older adults is particularly challenging, as these patients often face multimorbidity, polypharmacy, and increased frailty, factors independently associated with poor prognosis and a higher risk of iatrogenic complications.

Areas covered: Atrial fibrillation (AF) is the most common tachyarrhythmia worldwide, with its prevalence projected to reach 15.9 million in the U.S. by 2050 and 17.9 million in Europe by 2060, driven by the progressive aging of the population. AF patients are at high risk of thromboembolism, and oral anticoagulant (OAC) therapy remains the cornerstone of stroke prevention. However, older AF patients often have multiple comorbidities that elevate bleeding risk, making the net clinical benefit of OAC therapy uncertain.

Expert opinion: This review aims to outline strategies for balancing ischemic and hemorrhagic risks in this vulnerable population, following the integrated and holistic management pathway, an evidence-based approach proven to improve outcomes in complex and frail AF patients.

Background: Heart transplant (HTx) in dystrophy patients has been shown to have a similar survival to cardiomyopathy from other causes, but postoperative rehabilitation remains an issue. This study aimed to review and analyze the reports in the literature to determine whether pre- and post-transplant functional status along with wheelchair dependence in dystrophy patients can influence post-HTx outcomes.

Research design and methods: Relevant databases were queried for all case reports and case series regarding HTx in patients with dystrophy-associated cardiomyopathy published in the literature. Clinical data were extracted and tabulated. Patient survival was stratified according to preoperative and postoperative functional status, and Kaplan-Meier survival analysis was performed.

Results: We identified 22 studies yielding 36 patients with muscular dystrophy who underwent HTx. At baseline, there were three patients who were wheelchair dependent, and 22 patients had a diminished functional status preoperatively. Overall survival did not differ significantly between patients with normal baseline functional status and those with diminished functional status, either before or after transplantation.

Conclusions: Although no significant survival difference was found, diminished functional status, both pre- and post-transplant, appear to be associated with worse survival, highlighting its importance in transplant decision-making.

Introduction: Cangrelor is the only parenteral P2Y₁₂ receptor antagonist currently recommended for the prevention of periprocedural thrombotic complications in P2Y₁₂ inhibitor-naïve patients undergoing percutaneous coronary intervention (PCI).

Areas covered: This review provides a comprehensive analysis of the pharmacological properties and administration strategies of cangrelor in PCI, summarizes the latest evidence from clinical trials and real-world studies, and discusses potential future directions for its application in clinical practice. Literature search was conducted using PubMed up to May 2025.

Expert opinion: Cangrelor provides rapid platelet inhibition following an intravenous bolus, and its short half-life ensures predictable pharmacokinetic profile, facilitating perioperative management. The CHAMPION program demonstrated that cangrelor significantly reduces early ischemic events, including myocardial infarction and stent thrombosis, compared with clopidogrel in patients undergoing PCI. Since its approval, several clinical trials and observational studies have further evaluated the efficacy and safety of cangrelor and its optimal use. The adoption of cangrelor in catheterization laboratories worldwide remains inconsistent, with misuse being frequently reported. Drug-related costs along with concerns surrounding drug interaction when switching to oral P2Y₁₂ inhibitors, limited safety data in high-risk populations and lack of evidence on the comparison against ticagrelor or prasugrel may contribute to its restricted utilization in clinical practice.

Introduction: Ebstein anomaly (EA) is a rare congenital heart defect with a broad spectrum of severity - both anatomically and clinically. Treatment options have evolved and hence the rationale for this review.

Areas covered: This manuscript reviews all of the current literature including the recent expert consensus document that describes the updated diagnostic and treatment strategies. A citation search in PubMed, Embase, Scopus, and Web of Science was performed using key words related to EA. The search was restricted to the English language and the years 1990 to present.

Expert opinion: The expert commentary is a summary of the 2 most recent expert consensus documents and also pros and fit pitfalls based on the authors institutional experience which is the largest in the world.

Background: Compliance of prescriptions with treatment guidelines (CPTG) after an acute coronary syndrome (ACS) is poorly studied. We studied CPTG index levels in ERICO cohort over three years and its association with long-term mortality.

Research design and methods: We analyzed data from 961 ERICO participants who were discharged after an ACS event. Medication information was obtained at discharge, 30 days 180 days, and yearly after the index event. The CPTG index was defined as the proportion of evidence-based medications for post-ACS care (anti-platelets, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, and statins), a patient's prescription had. We verified the association between CPTG index and survival using adjusted Cox regression.

Results: The median age was 62 years, and 41% were female. At 30 days, the proportion of individuals with CPTG index = 1.0 decreased to the lowest values observed (23.4%), followed by a partial recovery (40.1% at 180 days). CPTG index was significantly associated with better survival (Hazard Ratio for a 0.1-point increase: 0.92; 95% confidence interval:0.87-0.96).

Conclusions: The CPTG index was significantly associated with long-term survival. The expressive drop in CPTG index values 30 days after discharge suggests that targeted actions might be necessary to ensure timely healthcare access in this population.

Introduction: To perform a systematic review and meta-analysis to compare the safety, early and late mortality, morbidity and long-term function of the tricuspid valve (TV) following tricuspid transcatheter edge-to-edge repair (T-TEER) compared to surgical tricuspid valve (TV) repair/replacement (TVR) for tricuspid regurgitation (TR).

Methods: This review investigates through two different databases for original studies that evaluated patients with TR who underwent either T-TEER or TVR was until December 2024. The outcomes of interest were safety, morbidity, mortality and long-term function following T-TEER vs TVR.

Results: We identified three retrospective observational studies, including a total of 1612 patients with TR. Short-term (OR, 0.36; 95% CI, 0.13-1.04; p = 0.06) and long-term mortality was similar between T-TEER and TVR. There was a lower risk of acute kidney injury (AKI) (OR, 0.31; 95% CI, 0.23-0.43; p < 0.00001) and permanent pacemaker implantation (PPI) (OR, 0.19; 95% CI, 0.10-0.35; p < 0.00001) with T-TEER, while there was no significant difference in terms of stroke events (OR, 1.17; 95% CI, 0.68-2.01; p = 0.58) and risk of bleeding (OR, 0.81; 95% CI, 0.45-1.44; p = 0.47) compared to TVR.

Conclusions: In conclusion, T-TEER appears to have a comparable safety profile to TVR with a lower risk of AKI and PPI. However, these findings are based on limited observational data and should be interpreted as hypothesis-generating rather than conclusive.

Registration: This systematic review and meta-analysis was prospectively registered on the international prospective register of systematic reviews (PROSPERO; CRD42024622555).

Introduction: Hypercholesterolemia and other dyslipidemias are common risk factors for cardiovascular diseases (CVD) and development of atherosclerosis. International guidelines recommend LDL-C, non-HDL-C and apoB under some conditions for clinical use in evaluating risk of CVD. In part 1 of this review newer risk factor data for apoA-1, and the apoB/apoA-1 ratio is presented for cardiovascular, cerebrovascular, diabetes and other CVD manifestations of atherosclerosis. Compared to conventional lipids, these apolipoproteins add strong clinical risk information for these CVD disorders and for a range of other diseases.

Areas covered: Prospective studies, reviews, meta-analyses, case control, nested-case and therapeutic studies are analyzed. Searches were conducted with Google and in PubMed, and CVD journals for peer-reviewed publications. In part 2 of this review newer risk factor data for apoA-1, and the apoB/apoA-1 ratio is presented for atherosclerotic plaques, HDL-C versus apoA-1, inflammatory diseases, cancer, and metastases.

Expert opinion: Associations between apoB, apoA-1 and especially the apoB/apoA-1 ratio and development of atherosclerosis related risk of multiple CVD diseases have been documented world-wide. This data indicates that the balance, i.e. the ratio between the atherogenic apoB and the protective apoA-1, significantly improves risk evaluation and prediction of CVD, hence calling for an update of guidelines.