Current Problems in Cardiology最新文献

Background: Increasing recognition of takotsubo syndrome (TTS) is being realized since its formal description in 1990/1991 with information provided in case reports, patient series, and multinational registries. The present study aimed at gathering all the patient reports published in the world literature in 2024 to evaluate possible changes in the diagnosis and management of TTS, as compared with TTS registries.

Methods: All the patients with TTS and granular data published in PubMed in response to the MeSH term "takotsubo" in 2024 were scrutinized with data tabulated pertaining to 85+ variables, and compared with the corresponding data deriving from the latest published reports of the InterTak, RETAKO, and GEIST TTS registries.

Results: The present study comprised 246 patients aged 58.2 ± 20.3, with 41 (16.7%) being male, reported from 51 countries, and were characterized by comparison with the 8,288 patients from the 3 registries, by lower rates of risk factors for CAD and cancer, very high comorbidity burden (86.2%), "physical stress"-triggered TTS (69.5% vs. 47.5%, 28.%, 35.5%, for the 3 registries, correspondingly, P = 0.00001), and higher rates of cardiogenic shock (20.7% vs 8.5%, 10.5%, and 8.1%, P = 0.00001), in-hospital mortality (6.9% vs 5.5%, 2.3%, P = 0.00001), and recurrence of TTS (7.3% vs 3.2%, P = 0.02).

Conclusions: The patients with TTS published in the world literature in 2024 comprise a younger group revealing lower risks for CAD and cancer, and higher rates of comorbidity, "physical stress"-triggered TTS, in-hospital complications, mortality, and TTS recurrence, as compared to patients published heretofore.

Background: Anthracycline-induced cardiotoxicity is a major cause of morbidity in breast cancer survivors. Although left ventricular ejection fraction (LVEF) is the gold standard for monitoring cardiac function, it is often considered a late and insensitive marker of myocardial damage. New methods have emerged: global longitudinal strain (GLS) and cardiac magnetic resonance (CMR) derived parameters as potentially superior tools for detecting subclinical dysfunction. This study aimed to systematically compare the diagnostic accuracy and temporal sensitivity of GLS, LVEF, and CMR índices in the early detection of chemotherapy-induced cardiotoxicity.

Methods: A systematic review and meta-analysis of clinical studies was conducted to evaluate the outcomes and technical accuracy of the main methods for assessing cardiac function in breast cancer patients undergoing chemotherapy, using the PubMed, Web of Science, and Scopus databases. Twenty-nine studies were included in the systematic review and meta-analysis.

Results: The meta-analysis revealed a distinct temporal dissociation between methods. GLS detected a significant absolute reduction of 1.81% (95% CI: 1.14 - 2.49; z = 5.25, p < .001) as early as 1-3 months after treatment initiation. In contrast, LVEF showed a significant reduction of 3.59% only at mid-term follow-up (4-6 months), typically remaining within the range of clinical normality (>50%). The HSROC analysis for GLS (10 studies) demonstrated robust diagnostic performance, with an Area Under the Curve (AUC) of 0.818, a pooled sensitivity of 74.6% (95% CI: 64.8%-82.4%), and a specificity of 76.3% (95% CI: 68.2%-82.9%).

Conclusion: Comparative analysis of data from our meta-analyses supports the recommendation of Global Longitudinal Strain (GLS) as the preferred method for screening for cardiotoxicity, over isolated assessment by Left Ventricular Ejection Fraction (LVEF).

Background: Diuretic resistance remains a major challenge in acute decompensated heart failure (ADHF). Urinary sodium (UNa) concentration provides an early marker of loop diuretic responsiveness, yet its clinical utility remains uncertain.

Methods: We conducted a systematic review and meta-analysis (PROSPERO ID: CRD420251175306). PubMed, Embase, Scopus, and CENTRAL were searched from database inception to October 1, 2025, for studies evaluating UNa-guided diuretic titration in hospitalized ADHF patients. Primary outcomes were 24- and 48-hour diuresis and natriuresis; secondary outcomes included congestion relief, renal function, length of stay, rehospitalization, and mortality. Data were pooled using random-effects models. Heterogeneity was assessed using I² and χ² statistics. Analyses were performed with the R software (version 4.4.3, meta package). Certainty of evidence was rated using the GRADE framework.

Results: Five studies were included (three RCTs, two observational cohorts). UNa-guided therapy significantly increased 24- and 48-hour diuresis (MD = 0.59,95%CI [0.30-0.87] L; MD = 0.70 [0.37-1.03] L) and natriuresis (MD = 88 [52-124] mmol; MD = 138 [69-206] mmol; all P < 0.001). No significant differences were observed in mortality (RR = 0.99 [0.60-1.63]), rehospitalization (RR = 0.90 [0.57-1.41]), renal dysfunction, or length of stay. Safety outcomes, including hypotension, hypokalemia, and renal worsening, were similar (all P > 0.05). Certainty of evidence was moderate for natriuresis/diuresis and low for clinical outcomes.

Conclusions: UNa-guided diuretic therapy enhances short-term natriuresis and diuresis without increasing adverse events but shows no proven impact on mortality, rehospitalization, or renal outcomes. Larger studies are needed to confirm its long-term benefit and feasibility.