Future cardiology最新文献

Sjögren's disease (SjD) is a systemic autoimmune disease primarily affecting exocrine glands, but increasingly recognized for its association with elevated cardiovascular risk. Chronic inflammation, immune dysregulation, and metabolic disturbances contribute to this burden. To summarize the mechanisms linking SjD to cardiovascular disease (CVD) and propose evidence-based strategies for risk assessment and management, we reviewed the current literature on immune-mediated vascular dysfunction, autoantibody profiles, dyslipidemia, hypertension, insulin resistance, and lifestyle factors in SjD. It also evaluates pharmacologic and non-pharmacologic interventions. SjD patients exhibit both traditional and disease-specific cardiovascular risk factors. Autoantibody positivity (anti-Ro/SSA and anti-La/SSB) correlates with increased risk of thrombotic events. Systemic inflammation and endothelial dysfunction are central to pathogenesis. Statins, ACE inhibitors, and metformin show promise in mitigating risk. Lifestyle interventions, including Mediterranean diet and aerobic exercise, offer additional benefits. Thus, cardiovascular risk management should be an integral part of SjD care. A multidisciplinary approach combining clinical evaluation, targeted therapies, and lifestyle modification is essential to reduce morbidity and improve outcomes.

Mitral regurgitation (MR) is among the most common heart conditions. Untreated, severe MR may result in adverse cardiac remodeling, atrial fibrillation (AF), and heart failure. A 45-year-old male with a history of AF presented with heart failure symptoms. Transesophageal echocardiogram revealed a myxomatous mitral valve with anterior leaflet prolapse, severe MR, and massively dilated left atrium (LA). A computerized tomography scan found severe LA dilation up to 17.8 cm. The patient underwent mitral valve replacement, tricuspid valve repair, and LA reduction. MR is known to result in LA dilation due to increased LA volume and pressure. While large LA sizes have been reported, they are often related to congenital conditions and rarely grow to the size identified in this case. AF and LA dilation both predict adverse outcomes, increasing the risk of thrombus formation in such a large chamber.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence expected to double by 2060. This is due to aging populations and increasing rates of obesity, hypertension, and diabetes. It is often asymptomatic and can go undetected which will intensify the risk of serious complications such as ischemic stroke, heart failure, and cognitive decline. Early detection through opportunistic and systematic screening is essential for anticoagulation therapy, which can reduce stroke risk by 65%. AF arises from disorganized atrial electrical activity that is frequently originating in the pulmonary veins, and is sustained by a complex interplay of electrical, structural, and autonomic factors. Lifestyle and dietary habits play a significant role in AF risk and progression with obesity, and alcohol consumption linked to increased risk, while heart-healthy diets and weight control can alleviate symptoms and reduce recurrence. Additionally, genetic predisposition contributes to AF, particularly in early-onset cases. Genome-wide studies have identified over 100 associated loci, highlighting the value of personalized approaches in diagnosis and treatment. This paper explores the epidemiology, pathophysiology, and modifiable risk factors of AF with a dedicated focus on the precision medicine approach by highlighting personalized strategies for early detection and targeted management despite current clinical challenges.

A 36-year-old man with marked eosinophilia presented with fatigue and dyspnea. Echocardiography revealed biventricular apical thickening and thrombi, confirmed by contrast imaging. Cardiac magnetic resonance demonstrated global systolic dysfunction,myocardial edema, and subendocardial late gadolinium enhancement, consistent with early-thrombotic-stage Loeffler endocarditis. Bone marrow biopsy identified a FIP1L1-PDGFRA fusion, confirming myeloproliferative hypereosinophilic syndrome. High-dose corticosteroids followed by imatinib induced hematologic and cardiac improvement, with complete thrombus resolution at follow-up. Τhis case illustrates that the integration of advanced multimodal imaging with targeted genetic analysis can reliably establish the diagnosis of Loeffler endocarditis, obviating the need for invasive histopathological confirmation in appropriately selected patients.

Atrial fibrillation (AF) and coronary artery disease (CAD) frequently coexist due to shared risk factors such as obesity and diabetes. The interrelationship between these diseases carries important therapeutic implications, given the fact that both AF and CAD are associated with an increased risk for cardiovascular events such as stroke, myocardial infarction, heart failure and cardiovascular mortality. In this review, we elucidate our current understanding of the epidemiological and pathophysiological links between AF and CAD, with particular focus on the impact of obesity, diabetes and systemic inflammation as common drivers. We discuss the implications for patient management, including antithrombotic therapy, lifestyle modifications and metabolic risk reduction. Beyond antithrombotic therapy, we highlight the importance of rate and rhythm control strategies in case of coexisting of AF and CAD. Novel pharmacological approaches for patients with CAD and type 2 diabetes, such as GLP-1 receptor agonist and SGLT2 inhibitors, provide additional cardiometabolic benefits by reducing the risk of major adverse cardiovascular events. Finally we propose a framework for integrated management of AF and CAD that aligns with contemporary guidelines and emerging evidence. This holistic approach, including metabolic risk factor modification, represents a paradigm shift in the care of patients with both AF and CAD.

Background: Patients with aortic stenosis have a high mortality risk treatable by transcatheter aortic valve replacement (TAVR). We conducted a network meta-analysis to compare the efficacy and safety of transcatheter aortic valves in aortic stenosis patients.

Methods: A systematic search of PubMed, Embase, and Cochrane was conducted. Randomized controlled trials (RCTs) that included adult patients with aortic stenosis undergoing TAVR, which compared clinical efficacy and safety between any of the transcatheter aortic valves, were included. Random effects meta-analysis was employed.

Results: A total of 4687 patients from 9 RCTs were included. Sapien XT had a significantly higher risk of stroke compared to Sapien 3 RR = 31.38 (95% CI: 1.12 to 876, p = 0.043), while other devices showed no significant differences. Evolut had a significantly increased risk of permanent pacemaker placement compared to Sapien 3 RR = 1.36 (95% CI: 1.07-1.74, p = 0.013). No significant differences were observed between valves for any of the other analyzed outcomes.

Conclusion: While most TAVR devices showed comparable safety profiles, Evolut was associated with increased pacemaker implantation risk. The higher stroke risk with Sapien XT should be interpreted with caution.

Protocol registration: This review was registered with PROSPERO (CRD42024563628).

Cardiac amyloidosis (CA) can result in a restrictive cardiomyopathy, and heart transplantation (HT) remains the gold standard treatment for patients with end-stage heart failure secondary to amyloid cardiomyopathy. Although HT was historically contraindicated due to inferior outcomes, survival following HT in patients with CA has significantly improved over recent decades; and outcomes are now similar to those of patients undergoing HT for non-amyloid indications. This improvement has been driven largely by advances in screening for appropriate patient selection and improvement in therapeutic strategies for both immunoglobulin light-chain (AL) and transthyretin (ATTR) amyloidosis. Future directions in HT for CA will hinge on continued optimization of patient selection and refining post-transplant management of extracardiac manifestations.

Background: The link between birth weight and heart failure risk remains inconclusive. This study evaluates the relationship between birth weight categories and heart failure incidence in adults.

Methods: A systematic search was done on PubMed, Scopus, and Cochrane up to June 2024 included observational studies on adults Birth weight was categorized as low (0.9-3.38 kg), normal (3.38-4.00 kg), and high (≥4.00 kg). Heart failure incidence was analyzed using pooled hazard ratios (HR) with a random-effects model (95% CI).

Results: A total of four studies with 302,363 adults, with an average follow-up of 20.7 years, were included. Among participants, 3978 heart failure cases were identified, and 9.46% also had hypertension as a risk factor. In the pooled analysis of multivariate studies, individuals with low birth weight was associated with a 26% higher risk of heart failure (HR 1.26, 95% CI [1.17, 1.36], I² = 2%, p < 0.00001), compared to those with normal birth weight. In contrast, high birth weight did not show asignificant association with heart failure risk (HR 1.13, 95% CI [0.99, 1.29], I² = 20%, p = 0.08). Sensitivity analysis excluding a male-only study also showed no significant results (p > 0.05). No publication bias was found based on funnel plot assessment.

Conclusions: Low birth weight is significantly associated with an increased risk of heart failure, highlighting the importance of recognizing birth weight history for early prevention efforts.Protocol Registration: https://www.crd.york.ac.uk/prospero identifier is CRD42024570800.

The Superior cavopulmonary connection (SCPC) is typically the second stage of the single ventricle palliation. There are modifiable factors that have a complex interplay in determining outcomes such as mortality or hospital length of stay. There is no clear consensus on the timing of SCPC as this involves a critical balance between the timing of operation and the length of the high-risk interstage period. Younger age has not been associated with reduced transplant-free survival but has been associated with longer hospital length of stay. Another critical decision is for children with viral respiratory infections; a patient with a symptomatic viral respiratory infection may need to be delayed for weeks but this extends time in the interstage. While age is an important consideration, weight-for-age-Z-score and rate of weight gain are also critical factors in reduced transplant-free survival with those poor weight gain. Atrioventricular valve regurgitation, pulmonary artery obstruction and arch obstruction can all impact outcomes of SCPC. A systematic approach to pre-operative evaluation can identify these residual lesions to individualize the approach and optimize outcomes of single ventricle palliation.