Future cardiology最新文献

Left atrial appendage closure (LAAC) during cardiac surgery is a pivotal strategy for stroke prevention in atrial fibrillation (AF), gaining recognition in guidelines (Class I AHA 2023, Class IIa ESC 2024). This review identifies critical challenges and proposes solutions for optimizing outcomes. Challenges 1) Patient Selection: Significant controversy exists regarding extending LAAC to high-stroke-risk patients without documented AF ;(CHA₂DS₂-VASc ≥2), where 50% of post-cardiac surgery strokes occur, creating an evidence-practice gap. Conflicting meta-analyses exist (Baudo et al. vs. Kowalewski et al.). 2) Technique Standardization: Marked heterogeneity in surgical techniques (suture, excision, stapling) and lack of standardized protocols lead to highly variable success rates (0%-100%), unlike standardized clipping (AtriClip®; > 93% success). 3)Post-procedural Management: Unresolved debates persist on optimal post-surgical antithrombotic regimens and the standalone efficacy of LAAC vs. anticoagulation. Solutions 1) Ongoing RCTs (LeAAPS, LAA-CLOSURE, LAACS-2) aim to define LAAC efficacy in non-AF populations. 2) Implement evidence-based standardized operating procedures (SOPs) for each technique, prioritizing validated clipping devices. Promote unified imaging criteria (transesophageal echocardiography(TEE) intra-operation, Cardiac Computed Tomography Angiography(CCTA) follow-up) per AHA 2023 guidelines. 3) The LAA-CLIP trial is evaluating thoracoscopic clipping vs. DOACs, potentially supporting anticoagulation simplification post-LAAC. Addressing these challenges through standardization and targeted trials is crucial for maximizing LAAC efficacy.

Introduction: Left ventricular assist devices have been demonstrated to improve both quality of life and improve survival in patients with end-stage heart failure. Ideal speed setting of these devices is necessary to provide adequate left ventricular unloading while not disadvantaging the right heart. This highlights the potential utility of speed titration studies.

Methods: PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature databases were searched for: (LVAD) OR (Left Ventricular Assist Device) OR (VAD) OR (Ventricular Assist Device) AND (Speed Optimization) OR (Ramp Study) from inception to April 2025.

Results: 22 studies with 749 total patients were included, 45% of whom had a Heart Mate 3. Outcomes of interest included mortality, readmission, RV function, speed change at conclusion of the study, and quality of life. Only 1 out of 22 studies reported all 5 outcomes, with 64% reporting 2 or fewer outcomes of interest.

Conclusion: There exists limited data on speed optimization in the HM3, and that which has been reported lacks a standardization regarding method of evaluation as well as outcomes reporting. Prospective studies, with a standard method of speed optimization and more detailed outcomes reporting, are necessary in order to define best practices.

Elevated blood pressure is one of the most important risk factors for cardiovascular disease (CVD). Despite blood pressure being historically measured in the supine position prior to the 20th century, current clinical guidelines are primarily based on seated measurements. Emerging evidence suggests that hypertension in the supine position may be equally or more strongly associated with cardiovascular risk and mortality than seated hypertension. However, there is no standardized protocol or diagnostic criteria to evaluate supine hypertension (SH) in the general population. Moreover, if SH is detected, clinical recommendations for its treatment remain unclear. In this review, we synthesized the literature on SH by conducting a MEDLINE search of publications from 2024 to 2025 and offer recommendations for the assessment, interpretation, and treatment of SH in the outpatient setting. In addition, we identify gaps in evidence and opportunities for future research to advance our understanding of this underappreciated and yet potent risk factor for cardiovascular disease.

Inflammatory bowel disease (IBD) has emerged as a significant risk factor for cardiovascular disease (CVD). Despite shared pathophysiological mechanisms including chronic inflammation, immune dysregulation, and endothelial dysfunction, the relationship between IBD and cardiovascular outcomes remains incompletely characterized. This review provides updated evidence on the association between IBD and major cardiovascular events (ischemic heart diseases, stroke, and heart failure), examining epidemiological findings, underlying mechanisms, and the impact of therapeutic interventions on cardiovascular risk. These findings support the need for cardiovascular risk stratification in IBD management and highlight the importance of achieving sustained remission while considering the cardiovascular effects of therapeutic interventions.

We present the case of a 21-year-old male with chest pain, malaise, and fever, who was initially diagnosed with suspected acute myocarditis. The patient exhibited elevated cardiac troponin levels, occasional premature ventricular complexes, and right ventricular dilation, raising concerns about arrhythmogenic cardiomyopathy. Cardiac magnetic resonance (CMR) imaging showed myocardial edema and subepicardial enhancement in the basal anterolateral segment, confirming myocarditis, but also revealed severe dilation of the right chambers. Advanced imaging sequences identified a previously unrecognized inferior sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return. This finding led to a significant left-to-right shunt and surgical correction was performed. SVASD, a rare congenital anomaly, often remains undiagnosed due to its subtle clinical presentation and limitations of standard imaging techniques. This case highlights the importance of tailored CMR acquisition protocols, which revealed a congenital heart defect in our patient despite an initial focus on myocarditis. The adjustment in diagnostic approach significantly altered the patient's management and may have improved his long-term prognosis.

Background: Acute Myocardial Infarction (AMI) necessitates timely treatment to improve outcomes. Identifying treatment delays across different South Asian countries can aid in formulating policies to reduce these delays. Objectives: To estimate the average treatment delay in AMI patients in South Asia and identify contributing factors.

Methods: Using the CoCoPop framework (Condition, Context, Population), studies were reviewed on AMI treatment delays in South Asia from 2000 to 2022. Databases searched included PubMed Central, Embase and Google Scholar. Eligible studies were cross-sectional and analytical that reported exact delay times, excluding knowledge, attitude, practice studies, narrative reviews, and case reports.

Results: The search yielded 2954 records, with 42 studies meeting the inclusion criteria. The pooled median prehospital delay was 531 minutes (95% CI: 366-769 minutes). The pooled mean door-to-ECG time was 9.18 minutes (95% CI: 2.52-15.84 minutes). The door-to-needle and door to balloon time among STEMI patients were 37.95 (95% CI: 30.11-45.78 minutes) minutes and 62.92 minutes (95% CI: 45.28-80.56 minutes), respectively with significant heterogeneity. Factors associated with delays included old age, female gender, low literacy, ignorance, financial constraints, and rural location.

Conclusion: Significant treatment delays for AMI patients in South Asia are identified, with socio-economic and logistical barriers contributing to these delays.