Pub Date : 2026-01-19DOI: 10.1016/j.cpcardiol.2026.103263
Yongda Zhu, Shun Gao Prof, Qingquan Liu, Chunjian Shen Dr.
Background
Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF); however, early diagnosis remains challenging.
Objective
From the perspective of cardiovascular physicians, this review systematically elucidates the ocular manifestations of ATTR, explores their clinical significance as early diagnostic clues, and proposes an integrated diagnostic pathway incorporating ophthalmologic assessment.
Content
This article focuses on the pathophysiological mechanisms and recognition criteria of characteristic ocular signs, including vitreous amyloidosis and secondary glaucoma, and constructs a multidisciplinary diagnostic workflow integrating cardiac imaging, ophthalmologic "red flags," and molecular diagnostic techniques.
Conclusions
Incorporating ocular manifestations into routine cardiovascular history-taking and systematic evaluation holds significant clinical value for improving early ATTR-CM diagnosis rates and patient outcomes. Active promotion of cardiovascular-ophthalmology-neurology multidisciplinary collaboration is warranted.
{"title":"Ocular manifestations of transthyretin amyloidosis and their diagnostic value in cardiology: A comprehensive review","authors":"Yongda Zhu, Shun Gao Prof, Qingquan Liu, Chunjian Shen Dr.","doi":"10.1016/j.cpcardiol.2026.103263","DOIUrl":"10.1016/j.cpcardiol.2026.103263","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF); however, early diagnosis remains challenging.</div></div><div><h3>Objective</h3><div>From the perspective of cardiovascular physicians, this review systematically elucidates the ocular manifestations of ATTR, explores their clinical significance as early diagnostic clues, and proposes an integrated diagnostic pathway incorporating ophthalmologic assessment.</div></div><div><h3>Content</h3><div>This article focuses on the pathophysiological mechanisms and recognition criteria of characteristic ocular signs, including vitreous amyloidosis and secondary glaucoma, and constructs a multidisciplinary diagnostic workflow integrating cardiac imaging, ophthalmologic \"red flags,\" and molecular diagnostic techniques.</div></div><div><h3>Conclusions</h3><div>Incorporating ocular manifestations into routine cardiovascular history-taking and systematic evaluation holds significant clinical value for improving early ATTR-CM diagnosis rates and patient outcomes. Active promotion of cardiovascular-ophthalmology-neurology multidisciplinary collaboration is warranted.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 4","pages":"Article 103263"},"PeriodicalIF":3.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transthyretin-mediated (ATTR) and immunoglobulin light-chain (AL) cardiac amyloidosis causes progressive myocardial dysfunction and poor prognosis. Disease-specific therapies in ATTR and anti-clonal therapies in AL cardiac amyloidosis may modify disease, but treatment-induced changes in prognostic cardiac imaging markers remain incompletely defined.
We systematically searched PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and EMBASE for studies reporting treatment-associated changes in global longitudinal strain (GLS), left ventricular (LV) wall thickness, and extracellular volume (ECV) assessed by echocardiography or cardiac magnetic resonance. Random-effects meta-analyses pooled mean changes.
Seventeen studies met inclusion criteria. In ATTR cardiac amyloidosis, therapy with silencers or RNA-depleting agents was associated with improved GLS (pooled mean difference [MD] -0.97 %, 95 % CI -1.27 to -0.68) and reduced LV wall thickness (MD -0.72 mm, 95 % CI -1.26 to -0.17) versus no therapy, while ECV showed no significant change (MD -1.93 %, 95 % CI -15.27 to 11.41). In AL amyloidosis, complete hematologic response was linked to greater improvement than non-response in GLS (MD -1.19 %, 95 % CI -2.20 to -0.17) and LV wall thickness (MD -0.87 mm, 95 % CI -1.31 to -0.43). NMA in ATTR cardiac amyloidosis showed that patisiran (MD -1.04 %, 95 % CI -1.56 to -0.52), tafamidis (-0.91 %, -1.40 to -0.41), and vutrisiran (-0.90 %, -1.75 to -0.05) improved GLS versus placebo, compared to acoramidis.
Disease-directed therapy in ATTR and hematologic response in AL cardiac amyloidosis are associated with preservation or improvement of GLS and LV wall thickness, supporting their use as surrogate endpoints for treatment monitoring.
转甲状腺素介导（ATTR）和免疫球蛋白轻链（AL）心脏淀粉样变性导致进行性心肌功能障碍和不良预后。ATTR的疾病特异性治疗和AL心脏淀粉样变性的抗克隆治疗可能会改变疾病，但治疗引起的预后心脏成像标志物的改变仍然不完全明确。我们系统地检索了PubMed/MEDLINE、Scopus、CINAHL、Web of Science和EMBASE，以获取通过超声心动图或心脏磁共振评估的总体纵向应变（GLS）、左室（LV）壁厚和细胞外体积（ECV）与治疗相关变化的研究报告。随机效应荟萃分析汇总了平均变化。17项研究符合纳入标准。在ATTR型心脏淀粉样变性中，与不治疗相比，使用消声器或rna消耗药物治疗可改善GLS（合并平均差[MD] -0.97%, 95% CI -1.27至-0.68）和降低左室壁厚（MD -0.72 mm, 95% CI -1.26至-0.17），而ECV无显著变化（MD -1.93%, 95% CI -15.27至11.41）。在AL淀粉样变性中，完全血液学反应与GLS （MD -1.19%, 95% CI -2.20至-0.17）和左室壁厚（MD -0.87 mm, 95% CI -1.31至-0.43）的改善相关。ATTR型心脏淀粉样变性的NMA显示，与安慰剂相比，帕西兰（MD -1.04%, 95% CI -1.56至-0.52）、他法米底斯（-0.91%,-1.40至-0.41）和乌特里西兰（-0.90%,-1.75至-0.05）改善GLS。ATTR的疾病导向治疗和AL心脏淀粉样变性的血液学反应与GLS和左室壁厚的保存或改善有关，支持它们作为治疗监测的替代终点。
{"title":"Impact of disease-modifying therapies on imaging parameters in cardiac amyloidosis: A systematic review and meta-analysis","authors":"Alexandros Briasoulis MD PhD , Georgios Georgiopoulos, Christos Kourek MD PhD, MD PhD , Raphael Patras MD, Niki Lama MD PhD, Foteini Theodorakakou MD, Nikolaos Tepetes MD, Georgios Zervas MD, Emmanuil Androulakis MD PhD, Efstathios Kastritis MD PhD, Kimon Stamatelopoulos","doi":"10.1016/j.cpcardiol.2026.103265","DOIUrl":"10.1016/j.cpcardiol.2026.103265","url":null,"abstract":"<div><div>Transthyretin-mediated (ATTR) and immunoglobulin light-chain (AL) cardiac amyloidosis causes progressive myocardial dysfunction and poor prognosis. Disease-specific therapies in ATTR and anti-clonal therapies in AL cardiac amyloidosis may modify disease, but treatment-induced changes in prognostic cardiac imaging markers remain incompletely defined.</div><div>We systematically searched PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and EMBASE for studies reporting treatment-associated changes in global longitudinal strain (GLS), left ventricular (LV) wall thickness, and extracellular volume (ECV) assessed by echocardiography or cardiac magnetic resonance. Random-effects meta-analyses pooled mean changes.</div><div>Seventeen studies met inclusion criteria. In ATTR cardiac amyloidosis, therapy with silencers or RNA-depleting agents was associated with improved GLS (pooled mean difference [MD] -0.97 %, 95 % CI -1.27 to -0.68) and reduced LV wall thickness (MD -0.72 mm, 95 % CI -1.26 to -0.17) versus no therapy, while ECV showed no significant change (MD -1.93 %, 95 % CI -15.27 to 11.41). In AL amyloidosis, complete hematologic response was linked to greater improvement than non-response in GLS (MD -1.19 %, 95 % CI -2.20 to -0.17) and LV wall thickness (MD -0.87 mm, 95 % CI -1.31 to -0.43). NMA in ATTR cardiac amyloidosis showed that patisiran (MD -1.04 %, 95 % CI -1.56 to -0.52), tafamidis (-0.91 %, -1.40 to -0.41), and vutrisiran (-0.90 %, -1.75 to -0.05) improved GLS versus placebo, compared to acoramidis.</div><div>Disease-directed therapy in ATTR and hematologic response in AL cardiac amyloidosis are associated with preservation or improvement of GLS and LV wall thickness, supporting their use as surrogate endpoints for treatment monitoring.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 4","pages":"Article 103265"},"PeriodicalIF":3.3,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.cpcardiol.2026.103271
Rogelio Robledo-Nolasco M.D. , Elias Noel Andrade-Cuellar M.D. , Juan Carlos Solis-Gómez M.D, M.Sc. , Saul Yair Guillot-Castillo M.D. , Jose Javier Ik Yahalcab Zamora-Diaz M.D., M.Sc. , Ivan Alejandro Elizalde-Uribe M.D. , Rocio Aceves-Millan M.D. , Andrea Paulina Maldonado-Tenesaca M.D. , Maria Alejandra Monroy-Jimenez M.D. , Kevin Josué Acevedo-Gómez M.D. , Freddy Javier Medina-Santos M.D.
Background
Left bundle branch block (LBBB) is a frequent complication after transcatheter aortic valve replacement (TAVR), altering ventricular activation and challenging ECG interpretation. This study sought to establish novel electrocardiographic criteria to define the electrical position of the heart (EPH) before and after LBBB post-TAVR.
Methods
In this single-center, retrospective study, 439 TAVR patients (2018–2023) were screened; 74 developed new LBBB. Patients with pre- and post-TAVR ECGs, without pacemaker, infiltrative disease, or baseline conduction disorders, were included. ECGs were analyzed for QRS duration, electrical axes (AQRS, AT), and patterns of concordance/discordance in leads II/III and aVL/aVF. EPH was categorized as intermediate (IEP), horizontal (HEP), or vertical (VEP) by AQRS. Morphology in leads I, aVL, V5, and V6 was also assessed.
Results
Among 74 patients with LBBB, 36 (48.6%) had IEP, 32 (43.2%) HEP, and 6 (8.1%) VEP. In patients without LBBB, AQRS averaged 50°±15° in IEP and –10°±20° in HEP (p < 0.0001). With LBBB, AQRS shifted to –20°±25° in IEP and –60°±30° in HEP (p < 0.0001). Positive concordance in II/III and aVL/aVF identified IEP, whereas positive discordance indicated HEP. In LBBB, negative concordance in II/III with positive discordance in aVL/aVF defined HEP, while positive discordance in II/III with positive concordance in aVL/aVF characterized IEP.
Conclusion
Novel ECG criteria enable reliable classification of cardiac electrical position in both baseline and post-TAVR LBBB. Leftward axis deviation with LBBB often reflects intrinsic EPH rather than new pathology, enhancing interpretation and clinical decision-making.
{"title":"Novel electrocardiographic criteria to determine the electrical position of the heart in baseline rhythm and in Post-TAVR left bundle branch block","authors":"Rogelio Robledo-Nolasco M.D. , Elias Noel Andrade-Cuellar M.D. , Juan Carlos Solis-Gómez M.D, M.Sc. , Saul Yair Guillot-Castillo M.D. , Jose Javier Ik Yahalcab Zamora-Diaz M.D., M.Sc. , Ivan Alejandro Elizalde-Uribe M.D. , Rocio Aceves-Millan M.D. , Andrea Paulina Maldonado-Tenesaca M.D. , Maria Alejandra Monroy-Jimenez M.D. , Kevin Josué Acevedo-Gómez M.D. , Freddy Javier Medina-Santos M.D.","doi":"10.1016/j.cpcardiol.2026.103271","DOIUrl":"10.1016/j.cpcardiol.2026.103271","url":null,"abstract":"<div><h3>Background</h3><div>Left bundle branch block (LBBB) is a frequent complication after transcatheter aortic valve replacement (TAVR), altering ventricular activation and challenging ECG interpretation. This study sought to establish novel electrocardiographic criteria to define the electrical position of the heart (EPH) before and after LBBB post-TAVR.</div></div><div><h3>Methods</h3><div>In this single-center, retrospective study, 439 TAVR patients (2018–2023) were screened; 74 developed new LBBB. Patients with pre- and post-TAVR ECGs, without pacemaker, infiltrative disease, or baseline conduction disorders, were included. ECGs were analyzed for QRS duration, electrical axes (AQRS, AT), and patterns of concordance/discordance in leads II/III and aVL/aVF. EPH was categorized as intermediate (IEP), horizontal (HEP), or vertical (VEP) by AQRS. Morphology in leads I, aVL, V5, and V6 was also assessed.</div></div><div><h3>Results</h3><div>Among 74 patients with LBBB, 36 (48.6%) had IEP, 32 (43.2%) HEP, and 6 (8.1%) VEP. In patients without LBBB, AQRS averaged 50°±15° in IEP and –10°±20° in HEP (<em>p</em> < 0.0001). With LBBB, AQRS shifted to –20°±25° in IEP and –60°±30° in HEP (<em>p</em> < 0.0001). Positive concordance in II/III and aVL/aVF identified IEP, whereas positive discordance indicated HEP. In LBBB, negative concordance in II/III with positive discordance in aVL/aVF defined HEP, while positive discordance in II/III with positive concordance in aVL/aVF characterized IEP.</div></div><div><h3>Conclusion</h3><div>Novel ECG criteria enable reliable classification of cardiac electrical position in both baseline and post-TAVR LBBB. Leftward axis deviation with LBBB often reflects intrinsic EPH rather than new pathology, enhancing interpretation and clinical decision-making.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 4","pages":"Article 103271"},"PeriodicalIF":3.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.cpcardiol.2026.103270
Shayan Raeisi Dehkordi , Isabella Tso , Shyla Gupta , Andres Felipe Miranda Arboleda MD , Juan Farina , Norberto Bornancini , Amin Meghdadi , Diego Xavier Chango Azanza , Kiera Liblik , Sebastian García-Zamora , Adrian Baranchuk MD, FACC, FRCPC, FCCS, FSIAC F-ISHNE
Neglected Tropical Diseases (NTDs) are a group of infectious conditions primarily affecting tropical and subtropical geographies, where the climate supports the spread of these pathogens. While traditionally uncommon in Europe, rising migration from endemic areas has led to an increasing presence of these diseases across the continent. Immigration patterns from various parts of the world were analyzed by referencing the Eurostat database. The four regions with the most significant inflow of immigrants were identified, and the NTDs in each of these areas were determined. These regions include Africa, Asia, Latin America, and the Middle East. This paper examines the cardiovascular manifestations of NTDs now emerging in Europe and highlights the diagnostic challenges they pose to the healthcare system.
{"title":"Cardiovascular impact of neglected tropical diseases and their emergence in Europe due to new immigration patterns","authors":"Shayan Raeisi Dehkordi , Isabella Tso , Shyla Gupta , Andres Felipe Miranda Arboleda MD , Juan Farina , Norberto Bornancini , Amin Meghdadi , Diego Xavier Chango Azanza , Kiera Liblik , Sebastian García-Zamora , Adrian Baranchuk MD, FACC, FRCPC, FCCS, FSIAC F-ISHNE","doi":"10.1016/j.cpcardiol.2026.103270","DOIUrl":"10.1016/j.cpcardiol.2026.103270","url":null,"abstract":"<div><div>Neglected Tropical Diseases (NTDs) are a group of infectious conditions primarily affecting tropical and subtropical geographies, where the climate supports the spread of these pathogens. While traditionally uncommon in Europe, rising migration from endemic areas has led to an increasing presence of these diseases across the continent. Immigration patterns from various parts of the world were analyzed by referencing the Eurostat database. The four regions with the most significant inflow of immigrants were identified, and the NTDs in each of these areas were determined. These regions include Africa, Asia, Latin America, and the Middle East. This paper examines the cardiovascular manifestations of NTDs now emerging in Europe and highlights the diagnostic challenges they pose to the healthcare system.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 4","pages":"Article 103270"},"PeriodicalIF":3.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.1016/j.cpcardiol.2026.103268
Lucrecia María Burgos, Lucila María Carosella, Rocío Consuelo Baro Vila, María Antonella De Bortoli, Damian Jesus Malano, Mirta Diez
In heart failure with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF), a smaller left ventricular end-diastolic diameter (LVEDD) has been associated with lower stroke volume and functional capacity. However, its association with clinical outcomes remains unexplored. We evaluated the prognostic impact of small LV in patients hospitalized with acute HFpEF. We performed a single-center retrospective analysis of a prospectively collected cohort of patients admitted for acute heart failure (AHF) with LVEF >40%. Small LV was defined according to ASE guidelines. The primary outcome was in-hospital mortality; secondary outcomes included worsening renal function and need for inodilators. Among 369 patients, 82 (22.2%) had a small LV. These patients had fewer traditional comorbidities but more amyloid cardiomyopathy and lower systolic blood pressure. In-hospital mortality was significantly higher in the small LV group (12.2% vs 3.5%, p = 0.002). In multivariable analysis, small LV was independently associated with mortality (adjusted OR 7.15). These findings suggest that in HFpEF or HFmrEF, small LV represents a high-risk phenotype.
在轻度降低（HFmrEF）或保留射血分数（HFpEF）的心力衰竭中，较小的左室舒张末期直径（LVEDD）与较低的卒中容量和功能容量相关。然而，其与临床结果的关系仍未被探索。我们评估了小左室对急性HFpEF住院患者预后的影响。我们对一组前瞻性收集的LVEF为40%的急性心力衰竭（AHF）患者进行了单中心回顾性分析。根据ASE指南定义小LV。主要结局是住院死亡率；次要结局包括肾功能恶化和需要抗扩张剂。在369例患者中，82例（22.2%）的左室较小。这些患者的传统合并症较少，但淀粉样心肌病较多，收缩压较低。小左室组的住院死亡率明显更高（12.2% vs 3.5%, p = 0.002）。在多变量分析中，较小的左室与死亡率独立相关（调整OR为7.15）。这些发现表明，在HFpEF或HFmrEF中，小LV代表高风险表型。
{"title":"Small left ventricle identifies a high-risk phenotype in patients hospitalized for heart failure with preserved or mildly reduced ejection fraction","authors":"Lucrecia María Burgos, Lucila María Carosella, Rocío Consuelo Baro Vila, María Antonella De Bortoli, Damian Jesus Malano, Mirta Diez","doi":"10.1016/j.cpcardiol.2026.103268","DOIUrl":"10.1016/j.cpcardiol.2026.103268","url":null,"abstract":"<div><div>In heart failure with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF), a smaller left ventricular end-diastolic diameter (LVEDD) has been associated with lower stroke volume and functional capacity. However, its association with clinical outcomes remains unexplored. We evaluated the prognostic impact of small LV in patients hospitalized with acute HFpEF. We performed a single-center retrospective analysis of a prospectively collected cohort of patients admitted for acute heart failure (AHF) with LVEF >40%. Small LV was defined according to ASE guidelines. The primary outcome was in-hospital mortality; secondary outcomes included worsening renal function and need for inodilators. Among 369 patients, 82 (22.2%) had a small LV. These patients had fewer traditional comorbidities but more amyloid cardiomyopathy and lower systolic blood pressure. In-hospital mortality was significantly higher in the small LV group (12.2% vs 3.5%, <em>p</em> = 0.002). In multivariable analysis, small LV was independently associated with mortality (adjusted OR 7.15). These findings suggest that in HFpEF or HFmrEF, small LV represents a high-risk phenotype.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 4","pages":"Article 103268"},"PeriodicalIF":3.3,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.cpcardiol.2026.103266
Tala Al Saleh MD , Yusuf Kamran Qadeer MD , Bing Yue MD , Maurizio Pieroni MD, PhD , Karim El Hachem MD , Fabiano de Oliveira Poswar MD, MSc, PhD , Roberto Giugliani MD , Irfan Vardarli MD , Eric Wallace MD , Chayakrit Krittanawong MD, FACC
Fabry disease (FD) is an X-linked lysosomal storage disease that results in the accumulation of glycosphingolipids, such as globotriaosylceramide (Gb3) in a variety of cells. FD most prominently involves cardiac, nervous, and renal tissue, with cardiac complications representing the most common cause of death. Fabry disease has a prevalence ranging between 1:8454 to 1:117,000 among men. The higher prevalence included patients with the A143T mutation, which was shown to be a non-disease causing variant. Due to its rarity, and wide array of phenotypic presentations, especially in women, FD is often misdiagnosed. Advances in echocardiographic techniques and magnetic resonance imaging can play a crucial role in raising suspicion for Fabry disease and identifying early Fabry cardiomyopathy. Identification of end-organ involvement can, in turn, permit treatment initiation in patients who did not previously qualify for advanced therapies and in screened family members who are still too early in the disease process to manifest specific symptoms.
{"title":"Fabry disease cardiomyopathy: A practical guide for cardiologists","authors":"Tala Al Saleh MD , Yusuf Kamran Qadeer MD , Bing Yue MD , Maurizio Pieroni MD, PhD , Karim El Hachem MD , Fabiano de Oliveira Poswar MD, MSc, PhD , Roberto Giugliani MD , Irfan Vardarli MD , Eric Wallace MD , Chayakrit Krittanawong MD, FACC","doi":"10.1016/j.cpcardiol.2026.103266","DOIUrl":"10.1016/j.cpcardiol.2026.103266","url":null,"abstract":"<div><div>Fabry disease (FD) is an X-linked lysosomal storage disease that results in the accumulation of glycosphingolipids, such as globotriaosylceramide (Gb3) in a variety of cells. FD most prominently involves cardiac, nervous, and renal tissue, with cardiac complications representing the most common cause of death. Fabry disease has a prevalence ranging between 1:8454 to 1:117,000 among men. The higher prevalence included patients with the A143T mutation, which was shown to be a non-disease causing variant. Due to its rarity, and wide array of phenotypic presentations, especially in women, FD is often misdiagnosed. Advances in echocardiographic techniques and magnetic resonance imaging can play a crucial role in raising suspicion for Fabry disease and identifying early Fabry cardiomyopathy. Identification of end-organ involvement can, in turn, permit treatment initiation in patients who did not previously qualify for advanced therapies and in screened family members who are still too early in the disease process to manifest specific symptoms.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 4","pages":"Article 103266"},"PeriodicalIF":3.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.cpcardiol.2026.103261
Joseph S Spindler, Robert J Henning
The global burden of atherosclerotic cardiovascular disease has risen from 271 million people in 1990 to more than 600 million people in 2023. Atherosclerotic vascular disease results not only from lipid accumulation within the arterial walls but also from acute and chronic inflammatory changes in response to arterial endothelial injury. Inflammation together with cytokines, chemokines, and acute-phase reactants play a pivotal role in atherosclerotic vascular plaque formation, progression, rupture, and thrombogenesis that lead to an acute coronary syndrome (ACS) or stroke. In addition, individuals who have previously sustained an ACS frequently have evidence of residual arterial inflammation as indicated by increased blood concentrations of the inflammatory biomarker C-reactive protein (CRP). As a consequence, chronic arterial inflammatory disease contributes to more than 15% of all global deaths from myocardial infarction, cerebral vascular events (transient ischemic attacks or strokes), and peripheral vascular disease. This Review Article discusses the important mechanisms by which inflammation contributes to the initiation and progression of coronary artery atherosclerosis, the biologic measurements which indicate arterial inflammation in individuals, the diagnostic techniques useful in the detection of arterial inflammation and atherosclerosis, and the clinical studies that have been performed and are currently being performed to limit the contributions of acute and chronic inflammation to the morbidity and mortality from coronary artery atherosclerosis.
{"title":"THE CRITICAL ROLE OF INFLAMMATION IN ATHEROSCLEROTIC CORONARY ARTERY HEART DISEASE.","authors":"Joseph S Spindler, Robert J Henning","doi":"10.1016/j.cpcardiol.2026.103261","DOIUrl":"https://doi.org/10.1016/j.cpcardiol.2026.103261","url":null,"abstract":"<p><p>The global burden of atherosclerotic cardiovascular disease has risen from 271 million people in 1990 to more than 600 million people in 2023. Atherosclerotic vascular disease results not only from lipid accumulation within the arterial walls but also from acute and chronic inflammatory changes in response to arterial endothelial injury. Inflammation together with cytokines, chemokines, and acute-phase reactants play a pivotal role in atherosclerotic vascular plaque formation, progression, rupture, and thrombogenesis that lead to an acute coronary syndrome (ACS) or stroke. In addition, individuals who have previously sustained an ACS frequently have evidence of residual arterial inflammation as indicated by increased blood concentrations of the inflammatory biomarker C-reactive protein (CRP). As a consequence, chronic arterial inflammatory disease contributes to more than 15% of all global deaths from myocardial infarction, cerebral vascular events (transient ischemic attacks or strokes), and peripheral vascular disease. This Review Article discusses the important mechanisms by which inflammation contributes to the initiation and progression of coronary artery atherosclerosis, the biologic measurements which indicate arterial inflammation in individuals, the diagnostic techniques useful in the detection of arterial inflammation and atherosclerosis, and the clinical studies that have been performed and are currently being performed to limit the contributions of acute and chronic inflammation to the morbidity and mortality from coronary artery atherosclerosis.</p>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":" ","pages":"103261"},"PeriodicalIF":3.3,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.cpcardiol.2026.103259
Maria Eduarda M. Vigilato , Eduardo R. de Victo , William R. Tebar , Stefany C.B. Silva , Isabella I. Sampaio , Lucas A. Benetello , Gerson Ferrari , Luiz Carlos M. Vanderlei , Diego G.D. Christofaro
Background
Arterial stiffness, reflected by pulse wave velocity (PWV), is an important cardiovascular risk marker. Physical activity (PA) may reduce arterial stiffness, but the most beneficial intensity remains unclear. The objective this study was to analyze the relationship between different intensities of PA and arterial stiffness in adults and to verify whether these relationships are independent of sex, age, and socioeconomic status.
Methods
A total of 185 participants (104 women) were included in this study. Arterial stiffness was assessed using PWV, measured by a non-invasive oscillometric device (Arteriograph AOP). Three consecutive measurements were performed (with one-minute intervals), and the device provided the final PWV value. PA intensity (light, moderate, and vigorous) was objectively measured using an ActiGraph GT3X accelerometer. The associations between PWV and PA intensities were examined using Pearson’s correlation and linear regression models, with the crude model and subsequently adding sex, age, and socioeconomic status, to estimate the magnitude of these associations.
Results
An inverse relationship was found between PWV and vigorous-intensity PA in the unadjusted model (β = –0.007; 95 % CI: –0.011, –0.002; p = 0.006). This association remained significant after adjustment for sex (β = –0.006; 95 % CI: –0.010, –0.001; p = 0.010), but lost significance after additional adjustment for age (β = –0.001; 95 % CI: –0.004, 0.001; p = 0.323). No associations were observed between PWV and light or moderate PA.
Conclusion
PWV was inversely associated with vigorous-intensity PA; however, but age appears to exert a strong influence on this relationship.
脉波速度（PWV）反映的血管刚度是重要的心血管危险指标。体育活动（PA）可能降低动脉僵硬，但最有益的强度尚不清楚。本研究的目的是分析成人不同强度PA与动脉僵硬度之间的关系，并验证这些关系是否与性别、年龄和社会经济地位无关。方法共纳入185例受试者，其中女性104例。采用无创动脉示波仪（Arteriograph AOP）测量PWV，评估动脉硬度。连续进行三次测量（间隔一分钟），该装置提供最终的PWV值。使用ActiGraph GT3X加速度计客观测量PA强度（轻度、中度和剧烈）。使用Pearson相关和线性回归模型检验PWV和PA强度之间的关联，使用粗糙模型，随后添加性别、年龄和社会经济地位，以估计这些关联的程度。结果在未调整的模型中，PWV与剧烈PA呈负相关（β = -0.007; 95% CI: -0.011, -0.002; p = 0.006）。在调整性别后，这种相关性仍然显著（β = -0.006; 95% CI: -0.010, -0.001; p = 0.010），但在额外调整年龄后，这种相关性失去了显著性（β = -0.001; 95% CI: -0.004, 0.001; p = 0.323）。PWV与轻度或中度PA之间没有关联。结论pwv与高强度PA呈负相关；然而，年龄似乎对这种关系有很大的影响。
{"title":"Analysis of the relationship between different intensities of physical activity and pulse wave velocity in adults: an epidemiological study","authors":"Maria Eduarda M. Vigilato , Eduardo R. de Victo , William R. Tebar , Stefany C.B. Silva , Isabella I. Sampaio , Lucas A. Benetello , Gerson Ferrari , Luiz Carlos M. Vanderlei , Diego G.D. Christofaro","doi":"10.1016/j.cpcardiol.2026.103259","DOIUrl":"10.1016/j.cpcardiol.2026.103259","url":null,"abstract":"<div><h3>Background</h3><div>Arterial stiffness, reflected by pulse wave velocity (PWV), is an important cardiovascular risk marker. Physical activity (PA) may reduce arterial stiffness, but the most beneficial intensity remains unclear. The objective this study was to analyze the relationship between different intensities of PA and arterial stiffness in adults and to verify whether these relationships are independent of sex, age, and socioeconomic status.</div></div><div><h3>Methods</h3><div>A total of 185 participants (104 women) were included in this study. Arterial stiffness was assessed using PWV, measured by a non-invasive oscillometric device (Arteriograph AOP). Three consecutive measurements were performed (with one-minute intervals), and the device provided the final PWV value. PA intensity (light, moderate, and vigorous) was objectively measured using an ActiGraph GT3X accelerometer. The associations between PWV and PA intensities were examined using Pearson’s correlation and linear regression models, with the crude model and subsequently adding sex, age, and socioeconomic status, to estimate the magnitude of these associations.</div></div><div><h3>Results</h3><div>An inverse relationship was found between PWV and vigorous-intensity PA in the unadjusted model (β = –0.007; 95 % CI: –0.011, –0.002; p = 0.006). This association remained significant after adjustment for sex (β = –0.006; 95 % CI: –0.010, –0.001; p = 0.010), but lost significance after additional adjustment for age (β = –0.001; 95 % CI: –0.004, 0.001; p = 0.323). No associations were observed between PWV and light or moderate PA.</div></div><div><h3>Conclusion</h3><div>PWV was inversely associated with vigorous-intensity PA; however, but age appears to exert a strong influence on this relationship.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 4","pages":"Article 103259"},"PeriodicalIF":3.3,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.cpcardiol.2026.103262
Cristhian E. Scatularo MD, MTSAC , Gardenia L Chango Acurio MD , Luciano Battioni MD, MTSAC , Analía Guazzone MD , Hugo O. Grancelli MD, MTSAC
Introduction
The natriuresis measurement is useful to diagnose diuretic resistance (DR) and adjust furosemide doses in acute heart failure (AHF) hospitalized patients, but the utility of urinary chloride is unknown.
Objectives
To correlate the urine chloride at admission (UCLA) in AHF patients with the development of DR and cardiovascular (CV) events at the 180-day outpatient follow-up.
Methodology
A prospective study included patients hospitalized for AHF, without shock, creatinine >2.5 mg/dL or mechanical respiratory support at admission. They received 40 mg of intravenous furosemide at admission, UCLA was measured, and diuretic treatment was based on a protocol. DR was defined as the requirement for furosemide ≥240 mg/day, sequential nephron diuretic blocked (SNB), hypertonic saline serum, or renal replacement therapy.
Results
116 patients were included, 51% were men, UCLA was 105 meq/L, and DR was developed in 17% of patients. The UCLA was associated with the development of DR (p 0.0001; AUC ROC curve 0.81; cut-off point 96 meq/L). UCLA <96 meq/L was associated with persistent congestion (p 0.01), furosemide ≥240 mg/day use (p 0.004), worsening of AHF (p 0.002) and renal function (p 0.02), use of SNB (p 0.001) and inotropic drugs (p 0.007), a longer hospital stay (p 0.02) and a higher CV death (p 0.05). At 180-day follow-up, UCLA <96 meq/L was associated with AHF readmissions (p 0.002).
Conclusion
In AHF hospitalized patients, low UCLA was associated with DR, persistent congestion, need for more aggressive decongestion strategies, worse in-hospital clinical outcomes and more AHF hospitalizations at 6 months.
{"title":"Urinary chlorine at hospital admission as a predictor of diuretic resistance and clinical evolution in acute heart failure","authors":"Cristhian E. Scatularo MD, MTSAC , Gardenia L Chango Acurio MD , Luciano Battioni MD, MTSAC , Analía Guazzone MD , Hugo O. Grancelli MD, MTSAC","doi":"10.1016/j.cpcardiol.2026.103262","DOIUrl":"10.1016/j.cpcardiol.2026.103262","url":null,"abstract":"<div><h3>Introduction</h3><div>The natriuresis measurement is useful to diagnose diuretic resistance (DR) and adjust furosemide doses in acute heart failure (AHF) hospitalized patients, but the utility of urinary chloride is unknown.</div></div><div><h3>Objectives</h3><div>To correlate the urine chloride at admission (UCLA) in AHF patients with the development of DR and cardiovascular (CV) events at the 180-day outpatient follow-up.</div></div><div><h3>Methodology</h3><div>A prospective study included patients hospitalized for AHF, without shock, creatinine >2.5 mg/dL or mechanical respiratory support at admission. They received 40 mg of intravenous furosemide at admission, UCLA was measured, and diuretic treatment was based on a protocol. DR was defined as the requirement for furosemide ≥240 mg/day, sequential nephron diuretic blocked (SNB), hypertonic saline serum, or renal replacement therapy.</div></div><div><h3>Results</h3><div>116 patients were included, 51% were men, UCLA was 105 meq/L, and DR was developed in 17% of patients. The UCLA was associated with the development of DR (p 0.0001; AUC ROC curve 0.81; cut-off point 96 meq/L). UCLA <96 meq/L was associated with persistent congestion (p 0.01), furosemide ≥240 mg/day use (p 0.004), worsening of AHF (p 0.002) and renal function (p 0.02), use of SNB (p 0.001) and inotropic drugs (p 0.007), a longer hospital stay (p 0.02) and a higher CV death (p 0.05). At 180-day follow-up, UCLA <96 meq/L was associated with AHF readmissions (p 0.002).</div></div><div><h3>Conclusion</h3><div>In AHF hospitalized patients, low UCLA was associated with DR, persistent congestion, need for more aggressive decongestion strategies, worse in-hospital clinical outcomes and more AHF hospitalizations at 6 months.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 4","pages":"Article 103262"},"PeriodicalIF":3.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Infective endocarditis after transcatheter aortic valve implantation (TAVI-IE) is an uncommon but severe complication associated with substantial morbidity and mortality. Therapeutic strategies vary widely, since invasive management is often precluded by prohibitive risk and conservative medical therapy may be linked to poorer outcomes. Therefore, we aimed to compare outcomes between conservative and invasive management in patients with TAVI-IE.
Methods: A systematic search of PubMed, Scopus, and Web of Science identified comparative studies evaluating conservative versus invasive treatment in TAVI-IE. The primary endpoints were all-cause in-hospital and 1-year mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was quantified with I², publication bias was assessed with Egger's test, and sensitivity analyses (leave-one-out, GOSH plots) were performed.
Results: The search yielded 2,551 records; 15 studies met inclusion criteria for data extraction and meta-analysis. No significant differences were observed between conservative and invasive strategies for in-hospital mortality (RR 0.99, 95% CI 0.80-1.24, p=0.96; I²=0% with p=0.67) or 1-year mortality (RR 1.03, 95% CI 0.84-1.26; p=0.81; I²=11.4% with p=0.33). There was no evidence of publication bias (Egger's test: in-hospital, p=0.07; 1-year, p=0.54). Results were robust in sensitivity analyses.
Conclusions: In patients with TAVI-IE, conservative and invasive treatments were associated with comparable in-hospital and 1-year mortality. These findings support individualized, multidisciplinary decision-making rather than presuming a uniform advantage of either approach.
背景：经导管主动脉瓣植入术后感染性心内膜炎（TAVI-IE）是一种罕见但严重的并发症，具有很高的发病率和死亡率。治疗策略差异很大，因为侵入性治疗往往被禁止性风险所排除，保守的药物治疗可能与较差的结果有关。因此，我们的目的是比较TAVI-IE患者的保守治疗和侵入性治疗的结果。方法：对PubMed、Scopus和Web of Science进行系统检索，确定了评估TAVI-IE中保守治疗与侵入性治疗的比较研究。主要终点是院内全因死亡率和1年死亡率。采用随机效应模型计算合并风险比（rr）和95%置信区间（ci）。异质性用I²量化，发表偏倚用Egger检验评估，并进行敏感性分析（留一图，GOSH图）。结果：搜索得到2551条记录；15项研究符合数据提取和荟萃分析的纳入标准。在院内死亡率（RR 0.99, 95% CI 0.80-1.24, p=0.96; I²=0%,p=0.67）或1年死亡率（RR 1.03, 95% CI 0.84-1.26; p=0.81; I²=11.4%,p=0.33）方面，保守策略与有创策略无显著差异。没有发表偏倚的证据（Egger检验：住院，p=0.07； 1年，p=0.54）。结果在敏感性分析中是稳健的。结论：在TAVI-IE患者中，保守和侵入性治疗与相当的住院死亡率和1年死亡率相关。这些发现支持个性化的、多学科的决策，而不是假设任何一种方法都有统一的优势。
{"title":"Invasive versus conservative management in infective endocarditis after transcatheter aortic valve implantation: A systematic review and meta-analysis.","authors":"Panagiotis Theofilis, Kyriakos Dimitriadis, Nikolaos Pyrpyris, Paschalis Karakasis, Eirini Dri, Eirini Beneki, Aikaterini Vordoni, Panagiotis Tsioufis, Maria Chatzi, Evangelos Oikonomou, Konstantinos Aznaouridis, Konstantinos Tsioufis","doi":"10.1016/j.cpcardiol.2026.103264","DOIUrl":"https://doi.org/10.1016/j.cpcardiol.2026.103264","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis after transcatheter aortic valve implantation (TAVI-IE) is an uncommon but severe complication associated with substantial morbidity and mortality. Therapeutic strategies vary widely, since invasive management is often precluded by prohibitive risk and conservative medical therapy may be linked to poorer outcomes. Therefore, we aimed to compare outcomes between conservative and invasive management in patients with TAVI-IE.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, and Web of Science identified comparative studies evaluating conservative versus invasive treatment in TAVI-IE. The primary endpoints were all-cause in-hospital and 1-year mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was quantified with I², publication bias was assessed with Egger's test, and sensitivity analyses (leave-one-out, GOSH plots) were performed.</p><p><strong>Results: </strong>The search yielded 2,551 records; 15 studies met inclusion criteria for data extraction and meta-analysis. No significant differences were observed between conservative and invasive strategies for in-hospital mortality (RR 0.99, 95% CI 0.80-1.24, p=0.96; I²=0% with p=0.67) or 1-year mortality (RR 1.03, 95% CI 0.84-1.26; p=0.81; I²=11.4% with p=0.33). There was no evidence of publication bias (Egger's test: in-hospital, p=0.07; 1-year, p=0.54). Results were robust in sensitivity analyses.</p><p><strong>Conclusions: </strong>In patients with TAVI-IE, conservative and invasive treatments were associated with comparable in-hospital and 1-year mortality. These findings support individualized, multidisciplinary decision-making rather than presuming a uniform advantage of either approach.</p>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":" ","pages":"103264"},"PeriodicalIF":3.3,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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