Future cardiology最新文献

Background: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.

Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.

Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024).

Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.

Protocol registration: PROSPERO: CRD42024618027.

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.

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.

In patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER), atrial fibrillation is a common comorbidity. While oral anticoagulation is the mainstay of stroke prevention therapy in most patients with atrial fibrillation, patients undergoing M-TEER might have a unique opportunity to undergo concomitant left atrial appendage occlusion (LAAO). LAAO is an alternative to oral anticoagulation that reduces the long-term risk of stroke and major bleeding, but it comes with upfront peri-procedural risk. M-TEER and LAAO share numerous procedural characteristics including large-bore venous access, transseptal puncture, general anesthesia, and real-time imaging of the left atrium with echocardiography. Therefore, performing concomitant LAAO at the time of M-TEER might be an attractive option for patients to lessen the cumulative peri-procedural risk, repeated anesthetic, and hospital visits from separate procedures. With rapidly evolving device technologies and an increasing evidence base for LAAO use, there is still limited data evaluating the safety and feasibility of concomitant M-TEER and LAAO. This up-to-date narrative review on concomitant M-TEER and LAAO aims to summarize the current body of literature, review practical procedural considerations, and review the unmet research questions limiting the widespread adoption of this concomitant intervention.

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.

Pregnancy in patients with prosthetic heart valves presents complex challenges requiring multidisciplinary care and individualized decision-making. While bioprosthetic valves are often preferred in women of childbearing age to avoid anticoagulation-related fetal risks, these valves are susceptible to structural degeneration potentially accelerated by the physiologic demands of pregnancy. Conversely, mechanical valves offer durability but necessitate lifelong anticoagulation, posing substantial risks of valve thrombosis, fetal hemorrhage, and warfarin embryopathy. The Ross operation, which can be considered for individuals with advanced aortic valve disease, is an appealing option yet is offered only in highly specialized centers. In this review, we present contemporary data on maternal and fetal outcomes, valve function, and anticoagulation strategies in pregnant patients with mechanical and bioprosthetic heart valves. We highlight geographical and knowledge gaps regarding type of valve utilization, optimal anticoagulation in pregnancy, durability of modern valve designs, and long-term reoperation risk. Future research priorities include uniform global approach with improved access to contemporary surgical and medical solutions in low- and middle-income countries, safety of direct oral anticoagulants, improved surveillance of valve function during pregnancy, and comparative studies of bioprosthetic valve models. By consolidating evolving evidence, we aim to support informed decision-making and multidisciplinary management for this high-risk patient population.

A 71-year-old black male with a history of hypertension, dyslipidemia, type 2 diabetes, history of bladder cancer status-post resection now in remission, history of multiple transient ischemic attacks, and coronary artery disease (CAD) presented with non-exertional substernal chest pain radiating to the left arm, accompanied by shortness of breath and nausea. Initial evaluation revealed elevated troponins and nonspecific electrocardiogram changes, consistent with non-ST elevation myocardial infarction. Coronary angiography demonstrated severe multivessel disease, including critical left main stenosis. Post-procedurally, the patient developed anoxic brain injury, likely due to a hypoxic event, leading to acute hydrocephalus and transtentorial herniation. Despite aggressive management, the patient experienced progressive neurologic decline, necessitating palliative care consultation. This case highlights the complexities of managing severe CAD in high-risk patients and the devastating consequences of peri-procedural complications.

Background: Patients on maintenance hemodialysis (HD) face high cardiovascular (CV) mortality risk. Although electrocardiograms (ECGs) are routinely performed, the prognostic significance of chronic ECG abnormalities in predicting mortality among HD patients remains unclear.

Methods: We retrospectively analyzed patients with kidney failure receiving maintenance HD at a single center between January 2000 and March 2022. ECGs obtained within two years of the end of follow-up were independently reviewed by two physicians. Multivariable logistic regression was used to identify predictors of mortality, integrating clinical and ECG parameters. Model performance was assessed using calibration and discrimination statistics.

Results: Of 291 records, 149 were included (mean age 67.1 ± 13.2 years; 64.4% male; median dialysis vintage 47 months [IQR 25-87]). Common comorbidities included hypertension (90%), diabetes (54.4%), and coronary artery disease (42.4%). Frequent ECG findings were ST depression (33.8%), left axis deviation (32.9%), and poor R-wave progression (26.4%), with sinus rhythm in 94%. Overall mortality was 55%, including31.7% sudden cardiac deaths. The final model showed good calibration and excellent discrimination (AUC 0.80 ± 0.04, P < 0.001).

Conclusion: ECG abnormalities enhance mortality risk prediction in HD patients and should be validated in larger prospective cohorts.

Introduction: The aim of this article is to compare the long-term efficacy of Thoracic Endovascular Aortic Repair (TEVAR) versus Optimal Medical Therapy (OMT) in reducing mortality among adult patients with uncomplicated Stanford type B aortic dissection (uSTBAD).

Methods: An electronic search of PubMed, Cochrane Central and Google Scholar was conducted for studies comparing TEVAR with OMT for mortality in adult patients with uSTBAD. Relevant outcomes, including mortality, aortic rupture, re-intervention, retrograde type A dissection, myocardial infarction and stroke were analyzed and presented as risk ratios (RRs) along with their 95% confidence intervals (95% CI). A p-value of less than 0.05 was considered significant in all cases. All statistical analysis was conducted using Review Manager.

Results: A total of 12 studies were included (n = 25,605). Meta-analysis favored TEVAR over OMT for all-cause mortality (RR = 0.57, 95% CI: [0.43-0.76]; P < 0.01). However, there was no significant difference considering the morbidity, which included endovascular re-intervention (RR = 0.76, 95%CI: [0.46-1.28]; P = 0.30), aortic rupture (RR = 0.38; 95%CI: [0.14-1.05]; P = 0.06), retrograde type A dissection (RR = 1.00; 95%CI: [0.78-1.28]; P = 1.00), myocardial infarction (RR = 0.85; 95% CI: [0.51-1.42]; P = 0.53). However, a significant increase in risk of stroke in TEVAR group was observed (RR = 1.56; 95%CI: [1.30-1.89]; P < 0.01).

Conclusion: We report that while there were similar morbidity outcomes for uSTBAD treated with TEVAR and OMT, overall mortality was significantly improved with TEVAR. Further large-scale studies are needed to elucidate the differences in outcomes between the two treatment options.

Protocol registration: https://www.crd.york.ac.uk/prospero identifier is CRD42024566452.