Future cardiology最新文献

Longer life expectancy and advancements in coronary artery disease management have improved life expectancy and survival, increasing the prevalence of chronic coronary syndromes (CCS). Angina is a common symptom in patients with CCS but remains underdiagnosed and undertreated. Contemporary guidelines provide detailed information on diagnosing and treating angina based on evidence and expert consensus; however, their extensive nature may hinder uptake by non-specialists. This review presents a practical approach to diagnosing stable angina, followed by the three pillars of CCS management: 1) healthy lifestyle including appropriate exercise, diet, and avoiding toxic habits; 2) optimal medical therapy, including treatment recommended to prevent cardiovascular events and drugs for the control of myocardial ischemia and angina tailored to the patient's comorbidities; and 3) myocardial revascularization when indicated. This approach may be useful for practicing physicians but is not intended to substitute more detailed and authoritative documents. Checklists are proposed to help focus patient-physician interactions and make follow-up visits more efficient. This approach seeks to increase the proportion of correct angina diagnoses and patients receiving evidence-based treatments, emphasizing the importance of patient education, managing residual angina, and reducing cardiovascular risk. We include reference to the recently published 2024 ESC guidelines on chronic coronary syndromes.

Aortic dissections are classified as Stanford Type A and B based on site of intimal dissection. Management of Type B dissections is guided by risk stratification. Complicated and high-risk Type B aortic dissections are managed either using endovascular or open surgical repair. Uncomplicated Type B dissections are managed medically. The role of the patency of the false lumen and the presence of reentry tears in the dissecting membrane are still contested. Here, we describe two cases of descending aortic dissections with varying anatomical features in the setting of cocaine use and uncontrolled hypertension. The first case uniquely had a triple lumen dissection with two true lumens, while the second case had two distal tears. Both patients initially had signs of reduced end organ perfusion that resolved with control of comorbid conditions. After multidisciplinary discussions, the decision was made to continue with anti-impulse treatment. Due to the radiological and biochemical absence of evidence of end organ injury even while visceral organs were supplied by the false lumen, our multidisciplinary team preferred conservative management with anti-impulse therapy. This serves as a demonstration of individualized management of Type B aortic dissection in patients with multiple comorbidities using carefully analyzed radiographic and biochemical evidence.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. In view of the close correlation between the functions of the body, which cannot be examined in a piecemeal manner but as an integrated system, a holistic approach allows for a comprehensive assessment of the patient. Our study aims to (i) examine the connection between CVD and cognitive deficits; (ii) examine the presence of anxiety and depression; (iii) evaluate the presence of dysphagia, pneumophonic coordination disorders, respiratory and sleep disorders; (iv) analyze the impact of CVD on the caregiver; and (v) evaluate the effectiveness of psychoeducational intervention. At least 218 patients will participate in the survey. At T0, they will undergo neuropsychological, psychological and associated clinical condition assessment through standardized tests. In addition, at least one psychoeducation meeting will be held. After 6 months (T1), the same tests will be repeated, and the effectiveness of psychoeducation will be evaluated. Assessment of associated disorders will provide a comprehensive view of the patient. In addition, it will be observed how psychoeducational intervention can make changes on general well-being. Comprehensive, multi-step observation allows for identification of risk factors, tailoring of treatment, and prevention of future complications.Clinical Trial Registration: registered on Clinicaltrials.gov (ID: NCT06413823).

Obesity and heart failure are interlaced global epidemics, each contributing to significant morbidity and mortality. Obesity is not only a risk-factor for heart failure, but also complicates its management, by distinctive pathophysiological mechanisms and cumulative comorbidities, requiring tailored treatment plan. To present current treatment options for heart failure in individuals with overweight/obesity, emphasizing available pharmacological therapies, non-pharmacological strategies, and the management of related comorbidities. We conducted a comprehensive literature review regarding the results of heart failure treatments in individuals with overweight/obesity, including cornerstone interventions as well as emerging therapeutic options. Specific drug classes, including angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, have demonstrated consistent efficacy in heart failure irrespective of body mass index, while diuretics remain a key for fluid management. Glucagon-like peptide-1 receptor agonists have shown promising results in improving relevant outcomes and warrant further research. Non-pharmacological approaches, including weight-loss strategies and lifestyle modifications, have shown to improve symptoms, exercise tolerance and quality of life. Managing heart failure in individuals with overweight/obesity requires a multidisciplinary, individualized approach integrating pharmacological and non-pharmacological options. Emerging therapies and preventive strategies arise to address the unique challenges in this population and provide improved outcomes.

Introduction: A phenomenon known as the obesity paradox has been reported in patients with heart failure (HF). The goal of this study is to characterize this observation in systolic (SHF) and diastolic (DHF) HF.

Methods and results: We used the National Inpatient Sample (NIS) database for 2016-2020. We evaluated mortality based on body weight. A total of 7,364,023 with SHF and 10,064,223 with DHF were found in the NIS database. All-cause inpatient mortality was lowest in overweight followed by obesity and morbid obesity, whereas mortality was highest in cachexia for SHF and DHF (mortality: overweight 2.56%, obese 3.12%, morbidly obese 3.70%, normal weight 5.60%, and cachexia 15.22%; p < 0.001) and DHF patients (mortality: overweight 2.08%, obese 2.43%, morbidly obese 2.93%, normal weight 4.58%, and cachexia 14.25%; p < 0.001). This relationship remains similar after multivariate analysis (SHF patients: overweight OR: 0.49 (0.41-0.58), obesity OR: 0.64 (0.62-0.66), morbid obesity OR: 0.85 (0.83-0.88), and cachexia OR: 2.78 (2.67-2.90); p < 0.001; DHF patients: overweight OR: 0.47 (0.40-0.56), obesity OR: 0.61 (0.59-0.63), morbid obesity OR: 0.83 (0.81-0.85), and cachexia OR: 3.09 (2.96-3.23); p < 0.001).

Conclusions: All-cause inpatient mortality in SHF and DHF is lowest in overweight populations followed by obese and morbidly obese populations, whereas cachexia has the highest mortality.

Cardioneuroablation is a treatment option for patients with recurrent vasovagal syncope (VVS). Ablation targets of parasympathetic ganglionated plexi (GP) adjacent to the right and left atrial walls and distal endocardial inputs of these GP can be identified both by their anatomical localization and by intracardiac mapping of fragmented electrogram signals. In this case of a successful cardioneuroablation of a 22-year-old patient suffering from recurrent VVS, a new algorithm for automatic mapping of fragmented signals (CARTO Elevate Module, Biosense Webster) was used to identify areas of GP. In this first experience, automatic tags of fragmented signals were matching well with anatomically guided ablation points. This new tool for automatic identification of fragmented signals may facilitate and improve cardioneuroablation procedures.

Introduction: Nonbacterial thrombotic endocarditis (NBTE) involves vegetations on heart valves without active bloodstream infection. The AngioVac device, a vacuum-based aspiration system commonly used for infective endocarditis, has potential in managing NBTE, particularly in patients unsuitable for surgery. This study systematically reviews the literature to evaluate AngioVac's effectiveness in reducing vegetations in NBTE.

Methods: A systematic literature review was conducted using PubMed, Embase, Cochrane, and Web of Science databases through February 2024. Primary outcome was procedural success, defined as a ≥ 50% reduction in vegetation size on transesophageal echocardiogram. Secondary outcomes included in-hospital mortality, hospital stay length, and procedural complications.

Results: Out of 38 identified articles, 4 case reports met inclusion criteria. Patients were male with a median age of 60 years, and NBTE was associated with conditions such as lung adenocarcinoma, end-stage renal disease, and antiphospholipid syndrome. The mitral valve was the most commonly affected site. AngioVac achieved 100% procedural success, with no complications or in-hospital mortality. The average hospital stay was 2 days. Follow-up revealed one patient alive at 2 months, one deceased at 3 months and no data for two patients.

Conclusion: AngioVac is a promising tool for safely reducing vegetations in NBTE, especially for high-risk surgical candidates.The study design and protocol are registered with PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42024505295).