Future cardiology最新文献

Transcatheter aortic valve replacement has rapidly expanded from high-risk populations to younger patients with aortic stenosis. This shift raises important questions about valve durability, reintervention strategies, and long-term outcomes compared with surgical aortic valve replacement. Younger patients often present with unique anatomical challenges, including bicuspid aortic valves, and are expected to outlive their first valve prosthesis, making lifetime management a central concern. While new valve technologies show promise, long-term data remain limited. Careful patient selection, shared decision-making, and ongoing prospective studies are essential to guide the role of TAVR in this population.

Background: Many patients remain functionally limited after transcatheter aortic valve replacement (TAVR) despite successful correction of aortic stenosis. Exercise-based cardiac rehabilitation (EBCR) is effective in other cardiac populations, but its benefits after TAVR remain uncertain. This study evaluated the impact of EBCR on functional capacity, cardiac function, quality of life, and safety outcomes in post-TAVR patients.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) published through February 2025 was conducted using major databases. Outcomes were pooled using mean differences or risk ratios with 95% confidence intervals.

Results: Six RCTs with 272 patients were included. No significant difference was found between EBCR and usual care for peak VO₂ change (MD: 1.46, 95% CI: [-0.16 to 3.08], p = 0.076) and six-minute walk distance (6MWD) change (MD: 18.72, 95% CI: [-2.24 to 39.68], p = 0.08). Similarly, no significant difference was observed between EBCR and usual care for left ventricular ejection fraction (LVEF) change (MD: 1.31, 95% CI: [-2.06 to 4.69], p = 0.45), and aortic valve orifice area change (AVOA) (MD: -0.03, 95% CI: [-0.24 to 0.18], p = 0.78).

Conclusion: EBCR did not significantly improve outcomes after TAVR; however, near-significant trends in functional capacity warrant further large-scale investigation.

Protocol registration: PROSPERO ID CRD420250652719.

Transthyretin (TTR) amyloid cardiomyopathy (ATTR-CM) is a progressive, often fatal disease. TTR stabilizers bind directly to TTR, inhibiting tetramer dissociation and the resulting amyloidogenic process. This comprehensive review synthesizes clinical outcomes data from the ATTRibute-CM study program, including primary analyses, prespecified sensitivity studies, and open-label extension (OLE) follow-up, to characterize the clinical profile of acoramidis, an oral TTR stabilizer approved for ATTR-CM treatment. In clinical trials, acoramidis demonstrated consistent clinical benefits, with statistically significant reductions in the composite of all-cause mortality or first cardiovascular-related hospitalization evident within 3 months and sustained through 30 months. Prespecified analyses confirmed treatment robustness. Efficacy was maintained regardless of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds (≥500 pg/mL, ≥750 pg/mL, and ≥1000 pg/mL), was unaffected by concomitant tafamidis use, and was similar in high-risk participants with stage 4 chronic kidney disease (CKD), who are typically excluded from clinical trials. OLE studies through 42 months showed sustained benefits with no new safety concerns. Results demonstrate robust clinical benefits of acoramidis across diverse ATTR-CM populations and across NYHA classes and NAC stages, independent of NT-proBNP thresholds, concomitant tafamidis use, or high-risk CKD. An ongoing prevention study in asymptomatic ATTR-CM gene-mutation carriers may further expand its therapeutic range for ATTR management.

Background: Echocardiography after myocardial infarction (MI) provides clinically useful information through assessment of regional wall motion abnormalities, but interpretation requires expertise and remains subject to observer variability. Artificial intelligence (AI) shows promise in automatic interpretation, but it is unclear how explainability affects human-AI collaborative performance.

Methods: A ResNet18-LSTM model was trained to classify normal vs MI on 127 apical four chamber (A4C) and 120 apical two chamber (A2C) echocardiogram videos from the HMC-QU dataset. Gradient-weighted Class Activation Mapping (Grad-CAM provided visual explanations. Eight cardiology trainees compared diagnostic performance across three conditions: (a) echo clips alone, (b) echo clips with AI predictions, and (c) echo clips with AI predictions plus Grad-CAM explanations.

Results: The AI models demonstrated strong discriminative performance with AUCs of 0.9429 (A2C) and 0.9250 (A4C). AI alone achieved 80.0% accuracy versus 77.0% for clinicians alone. Surprisingly, combining AI with human judgment did not improve performance, and introducing visual explanations reduced accuracy to 72% and specificity from 93.8% to 83.8% (p = 0.046).

Conclusion: While AI models can effectively detect MI on echocardiographic videos, current explainability techniques may misalign with clinical reasoning, potentially impairing diagnostic performance. Future integration requires AI visual explanation strategies that complement clinician expertise.

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.

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.