Current Treatment Options in Cardiovascular Medicine最新文献

Purpose of review: The purpose of this work is to review the role of drug-coated balloons (DCBs) in contemporary coronary artery disease (CAD) management by focusing on its clinical indications and technical considerations, supported by updated insights from the International DCB Consensus Group.

Recent findings: While percutaneous coronary intervention (PCI) and drug-eluting stents were initially the standard treatment for CAD, limitations such in-stent stenosis, neoatherosclerosis, and increased bleeding led to the development of the novel DCBs. These DCBs have become well established in treating various clinical cases such as in-stent restenosis, de-novo small-vessel disease, bifurcation lesions, large-vessel disease, high bleeding risk, acute coronary syndromes, and diabetes mellitus.

Summary: For optimal DCB outcomes, functional assessments, careful lesion preparation, and patient selection are crucial for effective drug delivery and reduced complications. Ongoing innovations in drug formulations, balloon design, and delivery mechanisms, along with further trials, will expand DCBs' impact in CAD treatment.

Purpose of review: A critical evaluation of contemporary literature regarding the role of big data, artificial intelligence, and digital technologies in precision cardio-oncology care and survivorship, emphasizing innovative and groundbreaking endeavors.

Recent findings: Artificial intelligence (AI) algorithm models can automate the risk assessment process and augment current subjective clinical decision tools. AI, particularly machine learning (ML), can identify medically significant patterns in large data sets. Machine learning in cardio-oncology care has great potential in screening, diagnosis, monitoring, and managing cancer therapy-related cardiovascular complications. To this end, large-scale imaging data and clinical information are being leveraged in training efficient AI algorithms that may lead to effective clinical tools for caring for this vulnerable population. Telemedicine may benefit cardio-oncology patients by enhancing healthcare delivery through lowering costs, improving quality, and personalizing care. Similarly, the utilization of wearable biosensors and mobile health technology for remote monitoring holds the potential to improve cardio-oncology outcomes through early intervention and deeper clinical insight. Investigations are ongoing regarding the application of digital health tools such as telemedicine and remote monitoring devices in enhancing the functional status and recovery of cancer patients, particularly those with limited access to centralized services, by increasing physical activity levels and providing access to rehabilitation services.

Summary: In recent years, advances in cancer survival have increased the prevalence of patients experiencing cancer therapy-related cardiovascular complications. Traditional cardio-oncology risk categorization largely relies on basic clinical features and physician assessment, necessitating advancements in machine learning to create objective prediction models using diverse data sources. Healthcare disparities may be perpetuated through AI algorithms in digital health technologies. In turn, this may have a detrimental effect on minority populations by limiting resource allocation. Several AI-powered innovative health tools could be leveraged to bridge the digital divide and improve access to equitable care.

Purpose of review: Photoacoustic imaging (PAI) has emerged as a promising non-ionizing modality that leverages optical absorption contrast to provide both anatomical and functional insights into vascular health. This review examines recent advances in PAI technologies applied to the diagnosis, assessment, and management of peripheral arterial disease (PAD). The goal is to evaluate how emerging PAI techniques address current diagnostic limitations and to identify opportunities for clinical integration.

Recent findings: Recent studies have demonstrated the potential of PAI to capture high-resolution, dynamic images of peripheral vasculature, quantify oxygen saturation and regional blood volume, and assess microvascular health. Technological innovations, including single-shot volumetric imaging, all-optical scanners, and multimodal systems, have expanded PAI's clinical utility.

Summary: Emerging PAI systems show promise for complementing traditional imaging by providing functional insights into microvascular health. Continued technological development and validation through large-scale studies are essential for establishing PAI's clinical role in PAD diagnosis and management.

Purpose of review: To provide the most up-to-date clinical evidence of intracoronary optical coherence tomography (OCT), and clinical implications to guide future imaging research in cardiology.

Recent findings: Intracoronary OCT has demonstrated advanced system performance and high reproducibility in analyzing atherosclerotic lesions. It is an attractive tool due to its capability for functional classification and superior imaging resolution, enabling precise and reliable tissue assessments. Compared to traditional angiography, OCT has been associated with improved long-term clinical outcomes and serves as an effective tool for optimizing stent selection and post-intervention evaluation. The development of OCT variations and the combination of various intravascular imaging modalities further enhance its diagnostic capabilities, allowing a comprehensive assessment of complex vulnerable lesions and improving risk stratification for patients.

Summary: Current and evolving system development presents a hopeful path for treating coronary artery disease by addressing the challenges of the intracoronary OCT technique. Future studies focusing on utilizing OCT system extensions, integrated multimodality imaging systems, and Artificial Intelligence (AI) derived image analysis will improve clinical endpoints and streamline the process.

Purpose of review: This article offers a comprehensive review of the literature on imaging predictors of response to transcatheter interventions for secondary mitral regurgitation (SMR).

Recent findings: Recent advancements in percutaneous valve therapies have broadened treatment options for high-risk patients with SMR. While recent studies have demonstrated significant reduction in all-cause mortality and hospitalizations with transcatheter edge-to-edge repair (TEER), significant controversy remains. This review highlights the central role of multi-modality imaging to guide therapeutic decision making for optimal treatment response and long-term outcomes.

Summary: Several echocardiographic, computerized tomography (CT) and cardiac magnetic resonance (CMR) imaging parameters are central to identifying optimal conditions for transcatheter therapies. Imaging features have become key predictors of outcomes following transcatheter interventions for secondary mitral regurgitation and provide important risk stratification to guide therapeutic decision making and shared decision making.

Purpose of the review: The need for treatments and specialists to manage complications that adults with congenital heart disease experience with heart failure is pressing. Research in this field is limited by small sample sizes with broad patient heterogeneity.

Recent findings: The mainstays of heart failure treatment include goal-directed medical therapies, electrophysiology interventions, mechanical circulatory support, and transplant. Although these therapies have been studied in the adult populations in the more traditional left-sided heart failure, data is limited in the use of these therapies in adults with congenital heart disease.

Summary: Collaborative guidance is needed to advance the management and care of the fast-growing population of adults with congenital heart disease.

Purpose of review: The goals of this review are to summarize the current literature regarding metabolic abnormalities in heart failure and propose therapies that can induce metabolic reprogramming to benefit the diseased heart.

Recent findings: Analysis of cardiac and skeletal muscle metabolism in heart failure has revealed several abnormalities including lower PCr/ATP ratio (indicating diminished myocardial energy reserves), altered substrate utilization, and mitochondrial abnormalities. Several advances in both non-invasive and invasive methods to studying cardiac metabolism have allowed recent key contributions to the field. Promising therapeutic strategies include shifting towards increased utilization of ketones and fatty acids, targeting mitochondrial biogenesis and function, and activation of genes that promote metabolic remodeling. Several current therapies lead to metabolic reprogramming, including both drug and device-based therapies such as cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs).

Summary: Strategies to induce metabolic reprogramming in the diseased heart need further study. Future research should address differences in metabolic abnormalities in HFrEF and HFpEF, methods to study metabolic responses to therapies, and impact of metabolic reprogramming on clinical outcomes in heart failure.

Purpose of review: This review explores current advancements in drug discovery for promoting cardiomyocyte proliferation and highlights key challenges in translating these findings to clinical applications.

Recent findings: High-throughput screening platforms, including phenotypic assays using stem cell-derived or neonatal cardiomyocytes, have identified candidate compounds that modulate proliferative signaling pathways. Computational modeling and omics analysis have enabled mechanistic insights and supported the development of targeted drug discovery strategies. Emerging approaches are increasingly incorporating orthogonal screening and cross-species validation to improve translational potential.

Summary: While no therapy has yet fully translated beyond pre-clinical models, significant progress has been made in identifying candidate drugs that stimulate cardiomyocyte proliferation in animal models. Translating these findings into effective therapies requires a rigorous foundation in basic research to clarify the molecular mechanisms of cardiac repair and guide drug development.

Purpose of review: To provide an overview of the latest evidence-based treatment strategies for acute heart failure (HF), with a significant focus on recent clinical trials and their associated implications within clinical practice.

Recent findings: Recent studies have highlighted the effectiveness of urine sodium-guided decongestion, segmental nephron blockade, disease-modifying therapies, and the use of maintenance diuretics. These approaches have demonstrated significant improvements in patient outcomes, including better decongestion, reduced hospital admissions, and improved survival rates.

Summary: The findings suggest a multifaceted, evidence-based approach is necessary for the effective management of acute HF. Implementing urine sodium-guided decongestion and segmental nephron blockade can enhance diuretic efficiency while disease-modifying therapies improve long-term outcomes. Maintenance diuretics play a crucial role in preventing recurrent hospitalizations.

Purpose of review: In recent years, several pre-clinical studies have demonstrated the therapeutic potential of stem cell-derived exosomes in the treatment of cardiovascular disease (CVD). Here, we evaluate their potential as biomarkers for the detection and monitoring of CVD, with a particular focus on pediatric heart disease.

Recent findings: Exosomes isolated from stem cell sources, including mesenchymal stem cells (MSCs) and pluripotent stem cells (PSCs), benefit cardiovascular function, inflammatory responses, and angiogenesis in injured and diseased hearts. These exosomes carry a variety of cargo, such as proteins, lipids, and nucleic acids. However, the majority contain non-coding RNA molecules.

Summary: Review of the existing literature for several non-coding RNAs and their relationship to CVD suggests that exosomes containing microRNAs (miRNAs) can serve as promising biomarkers for CVD due to their presence in circulation, ease of isolation, and therapeutic potential. These biomarkers are especially promising as screening and diagnostic tools for the early detection of pediatric and congenital heart disease.