Future cardiology最新文献

Despite advancements in treatment, cancer and cardiovascular disease remain the leading causes of morbidity and mortality in developed nations. Cancer therapies have led to improved cancer-specific outcomes at the potential risk of cardiotoxicity. Additionally, basic and translational research have demonstrated a common shared pathophysiology of cancer and cardiovascular disease. Recent clinical research has suggested a potential role of repurposing cancer and cardiovascular medications for the treatment of each other. This narrative review aims to review and examine current literature of repurposing cancer and cardiovascular drugs via exploitation of off-target effects to benefit each condition. A better understanding of underlying pathophysiologic effects of these off-target mechanisms of action may aid in identifying novel therapeutics for both cancer and cardiovascular disease.

Background: Data on outcomes of surgical pulmonary valve replacement or repair (SPVR/SPVr) in patients with heart failure (HF) are limited. We aimed to assess the safety and complications of SPVR/SPVr in this population.

Methods: Adults (≥18 years) who underwent SPVR/SPVr between 2018-2021 were identified from the National Inpatient Sample. Patients were stratified by HF status. In-hospital outcomes included mortality, cardiac arrest, cardiogenic shock, mechanical ventilation (MV), vasopressor use, heart block, permanent pacemaker (PPM), ECMO, bleeding, and acute kidney injury (AKI). Propensity score matching was performed to adjust for comorbidities, hospital factors, income, and elective status. Logistic regression was used to assess associations between HF and outcomes.

Results: There were 4595 SPVR/SPVr; the median age was 35 (26-52). Patients with heart failure had an increased risk of mortality, odds ratio (OR) 3.42 (95% confidence interval [CI] 1.19-6.12); p-value < 0.0001, heart block 1.75 (1.45-2.13); < 0.0001, bleeding 1.31 (1.12-1.52); 0.0005, AKI 1.35 (1.12-1.61); 0.001, vasopressor use 1.33 (1.08-1.65); 0.007, cardiogenic shock 2.34 (1.87-2.93); < 0.0001, MV 1.45 (1.09-1.94); 0.01, in-hospital cardiac arrest 2.29 (1.35-3.91); 0.002, ECMO 2.23 (1.43-3.45); 0.0003. No significant difference in PPM 1.51 (0.85-2.67); 0.1.

Conclusion: Heart failure is associated with worse in-hospital outcomes following surgical pulmonic valve replacement or repair. Preoperative optimization and considering earlier surgical intervention may improve outcomes in this high-risk population.

Tumor necrosis factor-alpha (TNF-α) inhibitors and other biologics used for autoimmune diseases are associated with low-grade immunosuppression. Treatment with these and the presence of prosthetic mechanical cardiac valves both increase the risk of infective endocarditis (IE). However, evidence on the risk of prosthetic valve endocarditis (PVE) among patients treated with TNF-α inhibitors is limited. This study reports a 41-year-old man with a prosthetic aortic valve who was on treatment with golimumab and presented with low-grade fevers and positive blood cultures for Staphylococcus epidermidis. Transesophageal echocardiogram revealed vegetations adjacent to the valve sewing ring and an inflammatory phlegmon in the right atrium, leading to a diagnosis of prosthetic valve endocarditis. The patient was referred to a higher level of care center and underwent urgent surgical intervention. The study highlights that TNF-α inhibitors and other biologics may increase the risk of prosthetic heart valve endocarditis and the importance of early imaging for diagnosis.

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.