Future cardiology最新文献

Left ventricular thrombus (LVT) is an uncommon but potentially devastating complication of Takotsubo syndrome (TTS). Although its incidence is relatively low, the associated risk of embolic events, including stroke and systemic infarctions, warrants special attention. This review synthesizes the available evidence on LVT in TTS, from the first case reported in the literature to data from mechanistic studies and large international registries. Incidence, pathophysiology, clinical predictors, diagnostic tools, management strategies, and clinical outcomes will be addressed. While LVT typically resolves with anticoagulation within weeks, its occurrence is strongly associated with acute complications. Identification of high-risk patients remains key to optimizing monitoring and prevention. Standardized risk scores and prospective studies are needed to better define preventive and therapeutic strategies in this uniquely challenging population.

In this review of right ventricular (RV) preload, we discuss RV physiology, assessment of RV preload, and optimization of RV preload in the setting of acute RV failure. Early recognition and ongoing reassessment of invasive or noninvasive hemodynamics are critical to the management of acute RV failure. Central venous pressure (CVP) estimates RV preload but should not be the sole parameter guiding management. A comprehensive approach that integrates multiple hemodynamic indices should be considered to guide the resuscitative process in acute RV failure.

As renal handling of chloride (Cl) and bicarbonate (HCO₃) under different cardiac states would affect the acid-base balance and subsequently influence respiratory function, cardio-renal-pulmonary interactions can be predicted in heart failure (HF) pathophysiology, but have not yet been confirmed. We report a 93-year-old male HF patient taking diuretics who presented with mild body fluid retention, elevated b-type natriuretic peptide (BNP), and hypercapnia during a hospital stay. To improve the hypercapnia and correct metabolic alkalosis, he was given oral acetazolamide (250 mg/day). Peripheral venous blood tests before and after 1 month on acetazolamide showed that his body weight (39.8 to 36.8 kg) and BNP level (348 to 158 pg/mL) decreased. Arterial blood gas analysis showed that his blood pH (7.41 to 7.37) and PaO₂ (91 to 95 mmHg) increased, and PaCO₂ (59.7 to 37.8 mmHg), HCO₃ (36.7 to 21.3 mmol/L) and base excess (11.5 to -3.1 mmol/L) decreased. These observations indicated that acetazolamide treatment reduced the cardiac burden and enhanced pulmonary ventilation possibly by stimulating the brain's respiratory center. This case highlights a new clinical HF entity of pathophysiologic cardio-renal pulmonary syndrome as a pathologic spectrum defined by cardio-pulmonary interactions linked to kidney function through renal modulation of the acid-base balance.

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.

Tricuspid regurgitation (TR) is a common yet underrecognized valvular disease associated with significant morbidity and mortality. Recent advances in transcatheter therapies, namely transcatheter edge-to-edge repair (T-TEER) with the TriClip device (Abbott) and transcatheter tricuspid valve replacement (TTVR) with the EVOQUE device (Edwards Lifesciences), offer promising alternatives to surgery for severe symptomatic TR. This review compares both approaches with a focus on safety, procedural considerations, and clinical outcomes. Treating TR remains uniquely challenging due to the anatomical complexity of the valve, frequent lead interference, and common coexistence of RV dysfunction, atrial fibrillation, and pulmonary hypertension. Many affected patients are elderly and frail, rendering them poor surgical candidates. Optimal treatment requires individualized decision-making guided by detailed imaging and assessment of RV function and valvular anatomy. Both therapies achieve significant TR reduction, yet each carries distinct risks: TTVR is associated with higher rates of pacemaker implantation, bleeding, and RV failure, while T-TEER may lead to single leaflet device attachment (SLDA), leaflet injury, or residual TR. Careful patient selection is essential. Despite encouraging short-term outcomes, long-term data are needed to determine survival benefit and durability. Further studies are warranted to refine technique and optimize candidate selection.

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.

Functional mitral regurgitation (FMR), secondary to left ventricle and mitral annulus dilation, is a frequent and prognostically adverse complication of heart failure. Several different transcatheter approaches were developed as therapeutic options in high-risk patients. Among them, the Carillon® Mitral Contour System, which offers a minimally invasive, trans- coronary-venous approach to indirect annuloplasty that reduces annular dimensions and improves leaflet coaptation without the need for transseptal access or manipulation of the mitral valve apparatus. A key advantage of Carillon lies in its extracardiac, leaflet-sparing mechanism. By acting from the lumen of coronary sinus and great cardiac vein, the device preserves the possibility of future interventions such as transcatheter edge-to-edge repair, direct annuloplasty, or even valve replacement, while still allowing successful placement of left ventricular pacing leads for cardiac resynchronization therapy. The current article provides the Carillon device characteristics and technical aspects of implantation procedure. The paper is an overview of the clinical studies and real-world registries conducted on the Carillon device, and the effectiveness of this treatment for functional mitral regurgitation. We also discuss possible future perspectives of the Carillon device applications like treating patients with mild FMR, in combination with other treatment modalities, approaches or atrial form of FMR.