Future cardiology最新文献

Aficamten is a novel cardiac myosin inhibitor that has completed a Phase III trial for the treatment of obstructive hypertrophic cardiomyopathy (HCM). Aficamten was developed to optimize pharmacokinetic properties and clinical tolerability relative to its predecessor, mavacamten. Mechanistically, aficamten decreases myocardial contractility by way of reducing cardiac myosin ATPase activity and the number of active actin-myosin cross bridges during the cardiac cycle. Clinically, aficamten improves cardiac hemodynamics and biomarker profiles while promoting favorable cardiac remodeling, augmenting exercise tolerance and improving overall health status. Observed systolic dysfunction was infrequent, mild, reversible, and not associated with serious adverse events. Collectively, the available data suggests that aficamten is a well-tolerated drug that shows strong clinical efficacy across a wide array of clinical parameters. In this review, we provide a comprehensive description of the pharmacology, clinical efficacy, and tolerability of aficamten.

Xenotransplantation is a promising advancement in the field of transplantation that could eliminate deaths on the waitlist and provide an unlimited supply of on-demand organs for those in need of this life-saving therapy. The results of preclinical studies in orthotopic heart xenotransplantation have shown that non-human primate models can consistently survive 9 months post-transplant. However, early clinical results in orthotopic heart xenotransplantation have been subpar compared to traditional orthotopic heart transplantation as the longest surviving patient survived for 60 days with a complicated postoperative course. Partial heart xenotransplantation could serve as an earlier clinical use case of xenotransplantation products due to the many advantages of the neonate and infant population for xenotransplantation as well as the unique immunogenicity of heart valves which is significantly lower than that of whole hearts. The adoption of partial heart xenotransplantation would allow more children to realize the benefits of a valve that tolerates somatic growth without the need for serial reoperation.

Introduction: High-sensitivity C-reactive protein (hsCRP) is a biomarker of systemic inflammation (SI) and its elevated level is considered a risk-enhancing factor for cardiovascular disease in primary prevention. This study aimed to understand opinions of US clinicians using hsCRP testing in the management of patients with atherosclerotic cardiovascular disease (ASCVD) with or without chronic kidney disease (CKD).

Materials & methods: Clinicians who ordered hsCRP testing with evaluation of patient-level data were surveyed, between June 2023-August 2023. Endpoints included self-identified drivers and barriers to hsCRP testing and assessment of posttest actions following SI recognition.

Results: Common factors perceived to prevent hsCRP testing were a lack of evidence showing improvements in patient cardiovascular outcomes after addressing SI in ASCVD and CKD (50%), and lack of proven efficacy of hsCRP testing (33%). Barriers to hsCRP testing included cost, insurance coverage and patient refusal. The most common reason for not considering SI in clinical decision-making was that it would not affect management of ASCVD. After the first hsCRP testing, an average reduction of hsCRP level is observed, but not lower than 2 mg/L.

Conclusions: In this limited study sample, perceived limitations of hsCRP testing included insufficient evidence of improved cardiovascular outcomes in patients with ASCVD.

Transcatheter aortic valve replacement (TAVR) represents a minimally invasive alternative for the treatment of severe symptomatic aortic stenosis and is increasingly adopted in younger and lower-risk patients. A support guidewire placed in the left ventricle is required in all TAVR procedures, and rapid ventricular pacing is frequently used to ensure valve implant stability. Also, recent studies showed a correlation between post-TAVR hemodynamic gradients and clinical outcomes, underscoring the importance of accurate invasive measurements. The SavvyWire™ (Opsens Medical) is a novel support guidewire designed for TAVR procedures that integrates left ventricular pacing and invasive pressure measurement capabilities, enabling continuous hemodynamic monitoring and simplifying the procedure. This review outlines the SavvyWire's™ design features and summarizes clinical evidence supporting its use in TAVR procedures.

Background: Acute heart failure (AHF) is leading cause of hospitalization and mortality. Empagliflozin, a Sodium Glucose Co-transporter 2 inhibitor (SGLT-2i), has demonstrated benefits in HFrEF and HFpEF, but its role in AHF remains under-explored.

Objective: Assess safety and efficacy of empagliflozin in AHF.

Methods: A systematic review and meta-analysis adhering to PRISMA 2020 guidelines was conducted. A search on 25 February 2025, identified Phase IIb and III randomized controlled trials (RCTs) involving adults with AHF from databases like Medline®, Cochrane CENTRAL, Embase, and ClinicalTrials.gov. Outcomes included all-cause mortality, HF rehospitalization, cardiovascular deaths, and serious adverse events. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with I2 and Cochrane Q-statistic.

Results: Three RCTs (n = 824) were included. Empagliflozin reduced all-cause mortality (OR: 0.47, 95% CI: 0.29-0.78, p = 0.004) and cardiovascular death (OR: 0.56, 95% CI: 0.38-0.82, p = 0.003) compared to placebo. It also lowered serious adverse events risk (OR: 0.62, 95% CI: 0.44-0.87, p = 0.005) without significantly increasing adverse effects such as acute kidney injury, diabetic ketoacidosis, hypotension, or urinary tract infections. Sensitivity analyses confirmed these findings.

Conclusion: Empagliflozin reduces mortality in AHF with a favorable safety profile, highlighting need for further trials.

Aim: Validating an operational algorithm for identifying ventricular arrhythmia and sudden cardiac arrest (VA/SCA) in electronic health record (EHR) data may be useful to minimize measurement bias in studies characterizing real-world VA/SCA risk; however, validation studies require an appropriate reference standard. We aimed to assess if adequate information is documented in unstructured clinical notes of a large EHR database to serve as a reference standard for future validation studies of VA/SCA.

Methods: Twenty potential VA/SCA events were randomly selected from unstructured clinical notes of a large EHR database, TriNetX Dataworks - USA. These notes were reviewed to assess if key clinical elements were documented to confirm the occurrence of VA/SCA and describe their clinical features. These included explicit documentation of an acute event, electrocardiogram (ECG) findings, urgent medical interventions, and other elements.

Results: Explicit documentation of an acute event was recorded for 17 patients (85.0%) and ECG findings were documented for 15 patients (75.0%). Generally, unstructured clinical notes also contained information about signs and symptoms, care setting, medical interventions administered, and event resolution.

Conclusions: The unstructured clinical notes of a large EHR database contained the information necessary to serve as a reference standard for validation studies of a VA/SCA operational algorithm in EHR data.

Background: ST-segment elevation myocardial infarction (STEMI) is responsible for high morbidity and mortality rates globally. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) remains the cornerstone treatment for patients with STEMI, the use of angiotensin-receptor neprilysin inhibitors (ARNIs) may offer better outcomes than ACEIs. This meta-analysis compares the efficacy and safety of ARNIs versus ACEIs in patients with STEMI.

Methods: Randomized controlled trials (RCTs) were pooled from PubMed and Cochrane databases. A random-effects model calculated risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs).

Results: Five trials (n = 4,915) were included. ARNIs significantly reduced major adverse cardiovascular events (MACE) (RR: 0.66, 95% CI [0.50, 0.86]; p = 0.002) and hospitalizations for heart failure (HHF) (RR: 0.67, 95% CI [0.49, 0.92]; p = 0.01). ARNIs also improved left ventricular ejection fraction (LVEF) (WMD: 2.60, 95% CI[1.53, 3.68]; p < 0.00001) and lowered NT-proBNP levels (WMD: -268.89, 95% CI[-422.35, -115.42]; p = 0.0006). No significant differences were observed in recurrent myocardial infarction, cardiovascular death, or safety outcomes - except for hypotension, which was significantly more common with ARNI use.

Conclusions: ARNI therapy reduces MACE, HHF, and NT-proBNP levels and improves LVEF in patients with STEMI without increasing safety risks, except for hypotension. Further RCTs are needed to confirm these findings.