Pub Date : 2025-10-28DOI: 10.1016/j.cpcardiol.2025.103206
Dina Abushanab , Daoud Al-Badriyeh , Rawan F. Al Froukh , Rasha Kaddoura , Mohammed Abdelaal , Clara Marquina , Jazeel Abdulmajeed , Palli Valapila Abdulrouf , Shaban Mohamed , Zanfina Ademi
Background
Cardiovascular diseases (CVD) are a great public health challenge in Qatar, with significant impacts on long-term population health and societal costs.
Objective
We aimed to forecast the health and economic burden of the CVD in Qatar from 2024 to 2033, from both healthcare and societal perspective.
Methods
A validated two-stage dynamic model was structured, spanning a 10-year period and targeting individuals aged 40-79. The CVD incidents (i.e., myocardial infarction [MI], stroke) were estimated using the 2013 Pooled Cohort Equation, while recurrent events were obtained from the global REACH registry. The model outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total direct costs, and total productivity loss costs. Utility and cost inputs were derived from published sources. Outcomes were discounted at a rate of 3 % per annum. Calibration and validation were performed to ensure model accuracy. A multivariate sensitivity analysis was also conducted.
Results
By 2033, there will be 271,260 non-fatal MI events (95 % confidence interval [CI] 271,249-271,277), 258,892 non-fatal strokes (95 %CI 258,858-259,094), and 20,413 CVD deaths (95 %CI 20,405-20,429). The cumulative years of life lived and QALYs were 13,806,845 (95 % CI 13,802,149-13,811,541) and 10,655,665 (95 %CI 10,652,720-10,658,611), respectively. The direct costs were QAR71.14 (95 %CI QAR70.62-71.66) billion, and the productivity loss costs were estimated to surpass QAR108.12 (95 %CI QAR106.88-109.36) billion. The exchange rates used were based on 2024 values (1QAR=0.27US$).
Conclusions
This study offers valuable insights into the projected burden of CVD in Qatar, highlighting the need for effective preventive strategies to reduce risk.
{"title":"The next decade of cardiovascular disease burden in Qatar, a gulf cooperation council country: Projections from 2024 to 2033","authors":"Dina Abushanab , Daoud Al-Badriyeh , Rawan F. Al Froukh , Rasha Kaddoura , Mohammed Abdelaal , Clara Marquina , Jazeel Abdulmajeed , Palli Valapila Abdulrouf , Shaban Mohamed , Zanfina Ademi","doi":"10.1016/j.cpcardiol.2025.103206","DOIUrl":"10.1016/j.cpcardiol.2025.103206","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular diseases (CVD) are a great public health challenge in Qatar, with significant impacts on long-term population health and societal costs.</div></div><div><h3>Objective</h3><div>We aimed to forecast the health and economic burden of the CVD in Qatar from 2024 to 2033, from both healthcare and societal perspective.</div></div><div><h3>Methods</h3><div>A validated two-stage dynamic model was structured, spanning a 10-year period and targeting individuals aged 40-79. The CVD incidents (i.e., myocardial infarction [MI], stroke) were estimated using the 2013 Pooled Cohort Equation, while recurrent events were obtained from the global REACH registry. The model outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total direct costs, and total productivity loss costs. Utility and cost inputs were derived from published sources. Outcomes were discounted at a rate of 3 % per annum. Calibration and validation were performed to ensure model accuracy. A multivariate sensitivity analysis was also conducted.</div></div><div><h3>Results</h3><div>By 2033, there will be 271,260 non-fatal MI events (95 % confidence interval [CI] 271,249-271,277), 258,892 non-fatal strokes (95 %CI 258,858-259,094), and 20,413 CVD deaths (95 %CI 20,405-20,429). The cumulative years of life lived and QALYs were 13,806,845 (95 % CI 13,802,149-13,811,541) and 10,655,665 (95 %CI 10,652,720-10,658,611), respectively. The direct costs were QAR71.14 (95 %CI QAR70.62-71.66) billion, and the productivity loss costs were estimated to surpass QAR108.12 (95 %CI QAR106.88-109.36) billion. The exchange rates used were based on 2024 values (1QAR=0.27US$).</div></div><div><h3>Conclusions</h3><div>This study offers valuable insights into the projected burden of CVD in Qatar, highlighting the need for effective preventive strategies to reduce risk.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 1","pages":"Article 103206"},"PeriodicalIF":3.3,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410514","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 : 2025-10-28DOI: 10.1016/j.cpcardiol.2025.103205
Andrea Grillo , Sandro Lepidi , Massimo Puato
Atherosclerotic renal artery stenosis (ARAS) represents a common manifestation of systemic atherosclerosis and remains an underrecognized cause of secondary hypertension, chronic kidney disease, and cardiovascular morbidity. Although often clinically silent, progressive narrowing of the renal artery may result in renovascular hypertension, ischemic nephropathy, or cardiac destabilization syndromes such as recurrent pulmonary edema. The pathophysiology of ARAS extends beyond simple flow limitation, involving renin–angiotensin–aldosterone system activation, oxidative stress, microvascular rarefaction, and parenchymal fibrosis, thereby explaining the limited reversibility of renal damage after revascularization.
Over the past decades, management strategies have evolved considerably. While initial enthusiasm for surgical or endovascular revascularization was supported by observational reports of improved blood pressure and renal function, randomized controlled trials—including ASTRAL and CORAL—failed to demonstrate a consistent benefit of stenting over optimal medical therapy in unselected patients. These findings have shifted current practice toward medical therapy as the cornerstone of management, integrating renin–angiotensin system inhibitors, statins, antiplatelet agents, and, more recently, SGLT2 inhibitors.
Nevertheless, accumulating evidence indicates that specific high-risk subsets—patients with resistant hypertension, recurrent pulmonary edema, or progressive ischemic nephropathy—may derive meaningful clinical benefit from timely revascularization. In the post-CORAL era, the central challenge is therefore accurate patient selection to identify the small group in whom revascularization remains appropriate, leveraging advanced imaging, physiological indices, and risk stratification.
{"title":"Atherosclerotic renal artery stenosis in the post-CORAL Trial Era. A narrative review","authors":"Andrea Grillo , Sandro Lepidi , Massimo Puato","doi":"10.1016/j.cpcardiol.2025.103205","DOIUrl":"10.1016/j.cpcardiol.2025.103205","url":null,"abstract":"<div><div>Atherosclerotic renal artery stenosis (ARAS) represents a common manifestation of systemic atherosclerosis and remains an underrecognized cause of secondary hypertension, chronic kidney disease, and cardiovascular morbidity. Although often clinically silent, progressive narrowing of the renal artery may result in renovascular hypertension, ischemic nephropathy, or cardiac destabilization syndromes such as recurrent pulmonary edema. The pathophysiology of ARAS extends beyond simple flow limitation, involving renin–angiotensin–aldosterone system activation, oxidative stress, microvascular rarefaction, and parenchymal fibrosis, thereby explaining the limited reversibility of renal damage after revascularization.</div><div>Over the past decades, management strategies have evolved considerably. While initial enthusiasm for surgical or endovascular revascularization was supported by observational reports of improved blood pressure and renal function, randomized controlled trials—including ASTRAL and CORAL—failed to demonstrate a consistent benefit of stenting over optimal medical therapy in unselected patients. These findings have shifted current practice toward medical therapy as the cornerstone of management, integrating renin–angiotensin system inhibitors, statins, antiplatelet agents, and, more recently, SGLT2 inhibitors.</div><div>Nevertheless, accumulating evidence indicates that specific high-risk subsets—patients with resistant hypertension, recurrent pulmonary edema, or progressive ischemic nephropathy—may derive meaningful clinical benefit from timely revascularization. In the post-CORAL era, the central challenge is therefore accurate patient selection to identify the small group in whom revascularization remains appropriate, leveraging advanced imaging, physiological indices, and risk stratification.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 1","pages":"Article 103205"},"PeriodicalIF":3.3,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410471","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 : 2025-10-19DOI: 10.1016/j.cpcardiol.2025.103193
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. , Rocio Aceves-Millan M.D. , Andrea Paulina Maldonado-Tenesaca M.D. , Maria Alejandra Monroy-Jimenez M.D. , Ivan Alejandro Elizalde-Uribe M.D. , Daniel Torres Peynado , Rodrigo Bonilla-Figueroa M.D. , Kevin Josué Acevedo-Gómez M.D.
Background
Progressive atrial myopathy marked by fibrotic remodelling drives the transition from paroxysmal to persistent atrial fibrillation (AF), yet the temporal dynamics of fibrosis within persistent AF remain poorly defined.
Objective
To quantify dense scar and borderline fibrotic zones using high-density electro-anatomic mapping (HD-EAM) in patients with persistent AF, and to compare fibrotic burden between early persistent (>7 days–<3 months) and persistent (≥3 months–<1 year) AF.
Methods
Retrospectively analysed 78 consecutive patients (59 ± 15 years, 59 % men) undergoing first-time pulmonary vein isolation for persistent AF. Atrial voltage maps (CARTO 3 CONFIDENSE™) acquired in sinus rhythm classified tissue as healthy (>0.5 mV), borderline (0.3–0.5 mV), or dense scar (<0.2 mV). Echocardiographic left atrial diameter (LAD) and volume (LAV) were compared with mapping data. The primary endpoint was dense scar point count; secondary endpoints included AF/atrial tachycardia recurrence and correlation between imaging modalities.
Results
Twenty-two patients had early persistent and 56 persistent AF. Mapping resolution was similar (5 193 ± 459 vs 5 399 ± 601 points, p = 0.83). Dense scar points were significantly higher in persistent AF (2 807 ± 336 vs 1 634 ± 236; p < 0.001). LAD and LAV from HD-EAM correlated moderately with echocardiography (r = 0.45 and 0.48; both p < 0.01) but did not differ between groups. After 7.2 ± 3.7 months, recurrence occurred in 16 % of persistent versus 8 % of early persistent AF (p = 0.11).
Conclusions
Fibrotic burden increases markedly after three months of uninterrupted AF despite stable atrial size. HD-EAM enables intra-procedural quantification of atrial myopathy and may guide personalised ablation strategies.
{"title":"Atrial myopathy in persistent atrial fibrillation: Three-dimensional quantification of atrial fibrosis by high-density electro-anatomic mapping and its association with arrhythmia duration","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. , Rocio Aceves-Millan M.D. , Andrea Paulina Maldonado-Tenesaca M.D. , Maria Alejandra Monroy-Jimenez M.D. , Ivan Alejandro Elizalde-Uribe M.D. , Daniel Torres Peynado , Rodrigo Bonilla-Figueroa M.D. , Kevin Josué Acevedo-Gómez M.D.","doi":"10.1016/j.cpcardiol.2025.103193","DOIUrl":"10.1016/j.cpcardiol.2025.103193","url":null,"abstract":"<div><h3>Background</h3><div>Progressive atrial myopathy marked by fibrotic remodelling drives the transition from paroxysmal to persistent atrial fibrillation (AF), yet the temporal dynamics of fibrosis within persistent AF remain poorly defined.</div></div><div><h3>Objective</h3><div>To quantify dense scar and borderline fibrotic zones using high-density electro-anatomic mapping (HD-EAM) in patients with persistent AF, and to compare fibrotic burden between early persistent (>7 days–<3 months) and persistent (≥3 months–<1 year) AF.</div></div><div><h3>Methods</h3><div>Retrospectively analysed 78 consecutive patients (59 ± 15 years, 59 % men) undergoing first-time pulmonary vein isolation for persistent AF. Atrial voltage maps (CARTO 3 CONFIDENSE™) acquired in sinus rhythm classified tissue as healthy (>0.5 mV), borderline (0.3–0.5 mV), or dense scar (<0.2 mV). Echocardiographic left atrial diameter (LAD) and volume (LAV) were compared with mapping data. The primary endpoint was dense scar point count; secondary endpoints included AF/atrial tachycardia recurrence and correlation between imaging modalities.</div></div><div><h3>Results</h3><div>Twenty-two patients had early persistent and 56 persistent AF. Mapping resolution was similar (5 193 ± 459 vs 5 399 ± 601 points, <em>p</em> = 0.83). Dense scar points were significantly higher in persistent AF (2 807 ± 336 vs 1 634 ± 236; <em>p</em> < 0.001). LAD and LAV from HD-EAM correlated moderately with echocardiography (r = 0.45 and 0.48; both <em>p</em> < 0.01) but did not differ between groups. After 7.2 ± 3.7 months, recurrence occurred in 16 % of persistent versus 8 % of early persistent AF (<em>p</em> = 0.11).</div></div><div><h3>Conclusions</h3><div>Fibrotic burden increases markedly after three months of uninterrupted AF despite stable atrial size. HD-EAM enables intra-procedural quantification of atrial myopathy and may guide personalised ablation strategies.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 1","pages":"Article 103193"},"PeriodicalIF":3.3,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349924","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 : 2025-10-10DOI: 10.1016/j.cpcardiol.2025.103192
Antonios A. Argyris , Alena Shantsila , D. Gareth Beevers , Eduard Shantsila , Gregory Υ.Η. Lip
Background
Malignant phase hypertension (MHT) is a severe form of hypertension with high morbidity and mortality; data on the association of visit-to-visit blood pressure (BP) variability and outcomes are lacking. Given that such high BP variability has been associated with poorer outcomes in the general hypertensive population, our aim was to examine the prognostic role of visit-to-visit BP variability with cardiovascular disease and mortality in this high risk MHT population.
Methods
Data from the West Birmingham MHT Registry were analyzed. We calculated quartiles of visit-to-visit BP variability and used Kaplan-Meier curves and Cox proportional hazard models to examine the association of BP variability with incidence of outcomes.
Results
A total of 339 patients (age 48 ± 13 years, 65 % male) were included, with a median follow-up 11 years (IQR 3-18). On Kaplan-Meier analyses, subjects in the highest variability quartiles had significantly lower risk of cardiovascular disease, all-cause mortality and all-cause mortality/dialysis than patients in the lower quartiles (log rank p < 0.001). In Cox proportional hazard models, higher systolic BP variability was associated with lower incidence of all outcomes [HR (95 % CI): 0.266 (0.128-0.552) for higher vs lower quartile for all-cause mortality]. Higher diastolic BP variability was associated with lower risk of mortality outcomes [HR (95 % CI): 0.236 (0.107-0.519)]. This effect was attenuated in the subgroup with better BP control at follow-up.
Conclusions
Higher visit-to-visit BP variability was associated with lower prevalence of cardiovascular disease and mortality in a MHT population. Given the extremely high initial BP of MHT patients, the high BP variability reflects likely better BP control in the follow up visits, re-emphasizing the crucial role of early and rapid control of BP in this high-risk population.
{"title":"An apparent paradox in visit-to-visit blood pressure variability and adverse outcomes in malignant hypertension patients: The West Birmingham malignant hypertension registry","authors":"Antonios A. Argyris , Alena Shantsila , D. Gareth Beevers , Eduard Shantsila , Gregory Υ.Η. Lip","doi":"10.1016/j.cpcardiol.2025.103192","DOIUrl":"10.1016/j.cpcardiol.2025.103192","url":null,"abstract":"<div><h3>Background</h3><div>Malignant phase hypertension (MHT) is a severe form of hypertension with high morbidity and mortality; data on the association of visit-to-visit blood pressure (BP) variability and outcomes are lacking. Given that such high BP variability has been associated with poorer outcomes in the general hypertensive population, our aim was to examine the prognostic role of visit-to-visit BP variability with cardiovascular disease and mortality in this high risk MHT population.</div></div><div><h3>Methods</h3><div>Data from the West Birmingham MHT Registry were analyzed. We calculated quartiles of visit-to-visit BP variability and used Kaplan-Meier curves and Cox proportional hazard models to examine the association of BP variability with incidence of outcomes.</div></div><div><h3>Results</h3><div>A total of 339 patients (age 48 ± 13 years, 65 % male) were included, with a median follow-up 11 years (IQR 3-18). On Kaplan-Meier analyses, subjects in the highest variability quartiles had significantly lower risk of cardiovascular disease, all-cause mortality and all-cause mortality/dialysis than patients in the lower quartiles (log rank <em>p</em> < 0.001). In Cox proportional hazard models, higher systolic BP variability was associated with lower incidence of all outcomes [HR (95 % CI): 0.266 (0.128-0.552) for higher vs lower quartile for all-cause mortality]. Higher diastolic BP variability was associated with lower risk of mortality outcomes [HR (95 % CI): 0.236 (0.107-0.519)]. This effect was attenuated in the subgroup with better BP control at follow-up.</div></div><div><h3>Conclusions</h3><div>Higher visit-to-visit BP variability was associated with lower prevalence of cardiovascular disease and mortality in a MHT population. Given the extremely high initial BP of MHT patients, the high BP variability reflects likely better BP control in the follow up visits, re-emphasizing the crucial role of early and rapid control of BP in this high-risk population.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103192"},"PeriodicalIF":3.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281669","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 : 2025-10-10DOI: 10.1016/j.cpcardiol.2025.103191
Abdulhakim M. Alhazmi , Arif Albulushi
Background
Postpartum hypertension is a leading driver of emergency visits and readmissions within 6 weeks of delivery, yet optimal therapy must balance BP control with lactation safety.
Objective
To synthesize contemporary evidence (Jan 2015–Aug 2025) on postpartum antihypertensives with emphasis on breastfeeding compatibility, treatment thresholds/targets, and maternal–infant outcomes. Data Sources: PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov/ICTRP, and guideline repositories (AHA/ACOG/NICE), plus LactMed and UK Specialist Pharmacy Service (SPS). Eligibility: RCTs, comparative cohorts/case–control studies, and ≥10-patient case series reporting postpartum outcomes or lactation data.
Results
First-line postpartum agents compatible with breastfeeding in term, healthy infants are dihydropyridine calcium-channel blockers (nifedipine, amlodipine), ACE inhibitors (enalapril), and labetalol. Multiple large cohorts associate nifedipine (at discharge) with lower hypertension-related readmissions than labetalol. Small RCTs show signals for enalapril-related cardiac reverse remodeling and physician-optimized self-monitoring improving 9-month BP and cardiac structure. Severe BP ≥160/110 mmHg warrants urgent treatment (IV labetalol or hydralazine; oral IR nifedipine if no IV), while persistent ≥150/100 mmHg merits/continues oral therapy titrated toward ≤140/90 mmHg in clinic (≈≤135/85 mmHg at home). Early review within 3–10 days (≤72 h after severe disease) and remote/home BP programs reduce unplanned care.
Conclusions
For lactating patients, nifedipine ER/amlodipine, enalapril, and labetalol are appropriate first-line choices; real-world data favor nifedipine for lowering readmissions. Scaling home BP monitoring with early follow-up improves outcomes. Large pragmatic RCTs comparing step-care strategies and tracking infant outcomes remain a priority.
背景：产后高血压是分娩6周内急诊和再入院的主要原因，但最佳治疗必须平衡血压控制和哺乳安全。目的：综合当代（2015年1月- 2025年8月）关于产后降压的证据，重点关注母乳喂养适应性、治疗阈值/目标和母婴结局。数据来源：PubMed/MEDLINE， Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov/ICTRP，指南库（AHA/ACOG/NICE），以及LactMed和UK Specialist Pharmacy Service （SPS）。入选条件：随机对照试验、比较队列/病例对照研究，以及≥10例报告产后结局或哺乳期数据的病例系列。结果：适合于足月龄健康婴儿母乳喂养的一线产后药物为二氢吡啶类钙通道阻滞剂（硝苯地平、氨氯地平）、ACE抑制剂（依那普利）和拉贝他洛尔。多个大型队列将硝苯地平（出院时）与拉贝他洛尔相比，高血压相关的再入院率更低。小型随机对照试验显示依那普利相关的心脏反向重构和医生优化的自我监测改善了9个月血压和心脏结构。严重的血压≥160/110 mmHg需要紧急治疗（静脉注射拉贝他洛尔或肼嗪，如果没有静脉注射则口服硝苯地平），而持续≥150/100 mmHg需要/继续口服治疗，在临床滴定到≤140/90 mmHg（≈≤135/85 mmHg在家中）。早期复查3-10天（严重疾病发生后≤72小时）和远程/家庭BP方案可减少计划外护理。结论：对于哺乳期患者，硝苯地平ER/氨氯地平、依那普利、拉贝他洛尔是合适的一线选择；实际数据支持硝苯地平降低再入院率。家庭血压监测与早期随访可改善预后。比较继步护理策略和跟踪婴儿结果的大型实用随机对照试验仍然是优先考虑的。
{"title":"Targeted antihypertensive therapy after hypertensive pregnancy: Lactation-safe choices, treatment thresholds, and outcomes (2015–2025)","authors":"Abdulhakim M. Alhazmi , Arif Albulushi","doi":"10.1016/j.cpcardiol.2025.103191","DOIUrl":"10.1016/j.cpcardiol.2025.103191","url":null,"abstract":"<div><h3>Background</h3><div>Postpartum hypertension is a leading driver of emergency visits and readmissions within 6 weeks of delivery, yet optimal therapy must balance BP control with lactation safety.</div></div><div><h3>Objective</h3><div>To synthesize contemporary evidence (Jan 2015–Aug 2025) on postpartum antihypertensives with emphasis on breastfeeding compatibility, treatment thresholds/targets, and maternal–infant outcomes. Data Sources: PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov/ICTRP, and guideline repositories (AHA/ACOG/NICE), plus LactMed and UK Specialist Pharmacy Service (SPS). Eligibility: RCTs, comparative cohorts/case–control studies, and ≥10-patient case series reporting postpartum outcomes or lactation data.</div></div><div><h3>Results</h3><div>First-line postpartum agents compatible with breastfeeding in term, healthy infants are dihydropyridine calcium-channel blockers (nifedipine, amlodipine), ACE inhibitors (enalapril), and labetalol. Multiple large cohorts associate nifedipine (at discharge) with lower hypertension-related readmissions than labetalol. Small RCTs show signals for enalapril-related cardiac reverse remodeling and physician-optimized self-monitoring improving 9-month BP and cardiac structure. Severe BP ≥160/110 mmHg warrants urgent treatment (IV labetalol or hydralazine; oral IR nifedipine if no IV), while persistent ≥150/100 mmHg merits/continues oral therapy titrated toward ≤140/90 mmHg in clinic (≈≤135/85 mmHg at home). Early review within 3–10 days (≤72 h after severe disease) and remote/home BP programs reduce unplanned care.</div></div><div><h3>Conclusions</h3><div>For lactating patients, nifedipine ER/amlodipine, enalapril, and labetalol are appropriate first-line choices; real-world data favor nifedipine for lowering readmissions. Scaling home BP monitoring with early follow-up improves outcomes. Large pragmatic RCTs comparing step-care strategies and tracking infant outcomes remain a priority.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103191"},"PeriodicalIF":3.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281699","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 : 2025-10-10DOI: 10.1016/j.cpcardiol.2025.103189
Jumana Algheffari , Abdel Rahman Salameh , Lina Adil , Aamir Hameed , Kurdo Araz
Background
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome with limited treatment options to improve long-term outcomes such as quality of life, exercise capacity, and mortality. Neuromodulation-based therapies have emerged as potential interventions to address autonomic dysregulation in HFpEF. This review discusses the long-term efficacy and safety of four key neuromodulation therapies: Renal Denervation (RDN), Baroreceptor Activation Therapy (BAT), Vagus Nerve Stimulation (VNS), and Greater Splanchnic Nerve (GSN) Ablation. Each therapy shows promise, but variability exists in terms of patient outcomes, procedural risks, and long-term durability. This paper evaluates the pros and cons of each approach, focusing on their potential to improve clinical outcomes in diverse HFpEF phenotypes.
Objective
To summarise and critically assess the role of neuromodulation-based devices in managing HFpEF, including their mechanisms, efficacy, and impact on patient outcomes.
Methods
We reviewed clinical trials and studies involving neuromodulation therapies for HFpEF, focusing on VNS, RDN, BAT, and GSN. The review includes randomised controlled trials and feasibility studies assessing various endpoints such as functional status, QoL, exercise capacity, and adverse events.
Results
Neuromodulation therapies show potential in improving symptoms and QoL for HFpEF patients. The ANTHEM-HFpEF trial demonstrated VNS's efficacy in enhancing functional status and autonomic tone, although cardiac mechanical function showed minimal change. RSD trials, including RDT-PEF and UNLOAD-HFpEF, indicated mixed results with some improvements in symptoms and cardiac function, though limitations like sample size and device effectiveness persist. BAT, through the BAROSTIM NEO System, has shown promise in reducing sympathetic activity and improving heart failure symptoms. The GSN ablation trials indicated significant reductions in pulmonary capillary wedge pressure (PCWP) and improved exercise capacity, though further large-scale studies are needed to confirm these findings.
Conclusions
Neuromodulation-based device interventions represent a promising frontier in HFpEF management, offering potential improvements in symptoms, QoL, and functional status. However, the variability in trial outcomes and the need for further research underscore the necessity for continued investigation to fully establish the efficacy and safety of these therapies.
{"title":"The role of neuromodulation in heart failure with preserved ejection fraction","authors":"Jumana Algheffari , Abdel Rahman Salameh , Lina Adil , Aamir Hameed , Kurdo Araz","doi":"10.1016/j.cpcardiol.2025.103189","DOIUrl":"10.1016/j.cpcardiol.2025.103189","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome with limited treatment options to improve long-term outcomes such as quality of life, exercise capacity, and mortality. Neuromodulation-based therapies have emerged as potential interventions to address autonomic dysregulation in HFpEF. This review discusses the long-term efficacy and safety of four key neuromodulation therapies: Renal Denervation (RDN), Baroreceptor Activation Therapy (BAT), Vagus Nerve Stimulation (VNS), and Greater Splanchnic Nerve (GSN) Ablation. Each therapy shows promise, but variability exists in terms of patient outcomes, procedural risks, and long-term durability. This paper evaluates the pros and cons of each approach, focusing on their potential to improve clinical outcomes in diverse HFpEF phenotypes.</div></div><div><h3>Objective</h3><div>To summarise and critically assess the role of neuromodulation-based devices in managing HFpEF, including their mechanisms, efficacy, and impact on patient outcomes.</div></div><div><h3>Methods</h3><div>We reviewed clinical trials and studies involving neuromodulation therapies for HFpEF, focusing on VNS, RDN, BAT, and GSN. The review includes randomised controlled trials and feasibility studies assessing various endpoints such as functional status, QoL, exercise capacity, and adverse events.</div></div><div><h3>Results</h3><div>Neuromodulation therapies show potential in improving symptoms and QoL for HFpEF patients. The ANTHEM-HFpEF trial demonstrated VNS's efficacy in enhancing functional status and autonomic tone, although cardiac mechanical function showed minimal change. RSD trials, including RDT-PEF and UNLOAD-HFpEF, indicated mixed results with some improvements in symptoms and cardiac function, though limitations like sample size and device effectiveness persist. BAT, through the BAROSTIM NEO System, has shown promise in reducing sympathetic activity and improving heart failure symptoms. The GSN ablation trials indicated significant reductions in pulmonary capillary wedge pressure (PCWP) and improved exercise capacity, though further large-scale studies are needed to confirm these findings.</div></div><div><h3>Conclusions</h3><div>Neuromodulation-based device interventions represent a promising frontier in HFpEF management, offering potential improvements in symptoms, QoL, and functional status. However, the variability in trial outcomes and the need for further research underscore the necessity for continued investigation to fully establish the efficacy and safety of these therapies.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103189"},"PeriodicalIF":3.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281656","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}
Left ventricular assist devices (LVADs) serve as lifesaving support for patients with advanced heart failure but are prone to infectious complications. The timing of these infections may play a crucial role in determining clinical outcomes. This study examines the differences between early (≤18 months) and late (>18 months) LVAD infections.
Methods
In this retrospective cohort study, 105 LVAD patient charts were reviewed, and 50 patients identified to have LVAD-related infections. These patients were categorized based on the timing of infection: early (≤18 months post-implantation) and late (>18 months). Variables analyzed included patient demographics, infection type, microbial etiology, post-implantation complications, treatment course, relapse rates, and survival outcomes.
Results
Early infections were associated with more severe LVAD infections, including higher rates of bacteremia and candidemia. It was also linked to infection with more aggressive pathogens, higher prevalence of Staphylococcus aureus in early infections (45 % vs. 26 %), a higher relapse rate (80 % vs. 63 %) (p = 0.029), and a shorter time to relapse. Among those with relapses, bacteremia was predominantly associated with the recurrence. Furthermore, early infections resulted in higher mortality (25.8 % vs. 15.7 %) and a shorter mean survival time (2.3 vs. 4 years).
Conclusions
Early LVAD infections are associated with higher relapse rates and worse clinical outcomes compared to late infections. These findings suggest that closer monitoring, more aggressive early interventions, and tailored antimicrobial strategies may improve patient outcomes in the early post-implantation period. Prospective studies are needed to validate these observations and guide infection prevention strategies in LVAD patients.
{"title":"A race against time: The impact of timing of first post-implantation LVAD infection and patient outcomes","authors":"Andrew Takla MD , Omofolarin Babayale MD , Basil Verghese MD , Soidjon Khodjaev MD , Maryrose Laguio-Vila MD","doi":"10.1016/j.cpcardiol.2025.103188","DOIUrl":"10.1016/j.cpcardiol.2025.103188","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist devices (LVADs) serve as lifesaving support for patients with advanced heart failure but are prone to infectious complications. The timing of these infections may play a crucial role in determining clinical outcomes. This study examines the differences between early (≤18 months) and late (>18 months) LVAD infections.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, 105 LVAD patient charts were reviewed, and 50 patients identified to have LVAD-related infections. These patients were categorized based on the timing of infection: early (≤18 months post-implantation) and late (>18 months). Variables analyzed included patient demographics, infection type, microbial etiology, post-implantation complications, treatment course, relapse rates, and survival outcomes.</div></div><div><h3>Results</h3><div>Early infections were associated with more severe LVAD infections, including higher rates of bacteremia and candidemia. It was also linked to infection with more aggressive pathogens, higher prevalence of Staphylococcus aureus in early infections (45 % vs. 26 %), a higher relapse rate (80 % vs. 63 %) (<em>p</em> = 0.029), and a shorter time to relapse. Among those with relapses, bacteremia was predominantly associated with the recurrence. Furthermore, early infections resulted in higher mortality (25.8 % vs. 15.7 %) and a shorter mean survival time (2.3 vs. 4 years).</div></div><div><h3>Conclusions</h3><div>Early LVAD infections are associated with higher relapse rates and worse clinical outcomes compared to late infections. These findings suggest that closer monitoring, more aggressive early interventions, and tailored antimicrobial strategies may improve patient outcomes in the early post-implantation period. Prospective studies are needed to validate these observations and guide infection prevention strategies in LVAD patients.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103188"},"PeriodicalIF":3.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281662","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 : 2025-10-10DOI: 10.1016/j.cpcardiol.2025.103190
Sneha Annie Sebastian MD , Harshan Atwal MD , Tanesh Ayyalu MD , Martha Gulati MD, MS
<div><h3>Background</h3><div>Maternal mortality is at an all-time high in the U.S., with maternal cardiac disease being the leading cause of death. Cardio-obstetrics is a collaborative, multidisciplinary approach to maternal care, bringing together experts from maternal-fetal medicine, cardiology, and other specialties. This study investigates the impact of cardio-obstetrics team care on maternal outcomes, focusing on how this integrated model can improve the health and well-being of pregnant women with cardiovascular disease (CVD).</div></div><div><h3>Methods</h3><div>We conducted a systematic review by searching MEDLINE, Web of Science, Scopus, and Cochrane up to March 5, 2025. Statistical analysis was performed using RevMan 5.4, with an inverse variance random effects model to calculate risk ratios (RR) for dichotomous outcomes. Heterogeneity was assessed using the Higgins I² test. The study protocol is registered in PROSPERO (CRD420251010149).</div></div><div><h3>Results</h3><div>We identified six observational studies evaluating cardio-obstetrics team care, including a total of 1,109 pregnant women with CVD, with a mean age of 30.8 years. Most participants had a CARPREG II score > 2, indicating high risk for adverse maternal cardiovascular outcomes. The average gestational age at delivery was 38 weeks, with arrhythmias being the most common cardiovascular condition, followed by congenital and valvular heart disease. Pooled analysis revealed a statistically significant reduction in the 30-day postpartum readmission rate for pregnant women with CVD receiving cardio-obstetrics care compared to standard care (RR 0.29, 95 % CI: 0.13–0.64, <em>p</em> = 0.002, I² = 0 %) with no observed heterogeneity. There was also a significant decrease in postpartum arrhythmias (RR 0.07, 95 % CI: 0.04–0.12, <em>p</em> < 0.001, I² = 0 %). However, no significant difference in maternal mortality was found between the two groups (RR 0.74, 95 % CI: 0.14–3.93, <em>p</em> = 0.72, I² = 0 %).</div></div><div><h3>Conclusion</h3><div>Maternal outcomes with cardio-obstetrics team care in pregnant women with CVD were promising, indicating the potential of this integrated care model when compared with standard care. These results emphasize the need for further research to explore its long-term benefits. Standard care data were approximated using national averages due to the lack of direct comparison data, which should be considered when interpreting the results.</div></div><div><h3>Lay Summary</h3><div>Heart disease is the leading cause of death during pregnancy in the U.S. This study looked at whether having a specialized cardio-obstetrics team made up of doctors from different specialties working together improves outcomes for pregnant women with heart disease. Six studies with >1,100 women found that women cared for by these cardio-obstetrics teams had fewer hospital readmissions and fewer heart rhythm problems after delivery, though death rates were not differen
背景：在美国，孕产妇死亡率处于历史最高水平，孕产妇心脏病是导致死亡的主要原因。心产科学是一种协作性的、多学科的孕产妇护理方法，汇集了母胎医学、心脏病学和其他专业的专家。本研究探讨了心产团队护理对产妇结局的影响，重点探讨了这种综合模式如何改善患有心血管疾病（CVD）的孕妇的健康和福祉。方法：通过检索MEDLINE、Web of Science、Scopus和Cochrane进行系统综述，检索时间截止到2025年3月5日。采用RevMan 5.4进行统计学分析，采用逆方差随机效应模型计算二分类结果的风险比（RR）。采用Higgins I²检验评估异质性。研究方案已在PROSPERO注册（CRD420251010149）。结果：我们确定了6项评估心产团队护理的观察性研究，包括1109名患有心血管疾病的孕妇，平均年龄为30.8岁。大多数参与者的CARPREG II评分为bb0.2，表明产妇心血管不良结局的风险很高。分娩时的平均胎龄为38周，心律失常是最常见的心血管疾病，其次是先天性和瓣膜性心脏病。合并分析显示，与标准治疗相比，心血管疾病孕妇接受心产护理后30天再入院率有统计学意义的降低（RR 0.29, 95% CI: 0.13-0.64, p = 0.002,I² = 0%），未观察到异质性。产后心律失常发生率也显著降低（RR 0.07, 95% CI: 0.04 ~ 0.12, p < 0.001, I² = 0%）。然而，两组产妇死亡率无显著差异（RR 0.74, 95% CI: 0.14-3.93, p = 0.72,I² = 0%）。结论：与标准护理相比，心产团队护理的CVD孕妇的产妇结局很有希望，表明这种综合护理模式的潜力。这些结果强调需要进一步研究以探索其长期效益。由于缺乏直接比较数据，标准护理数据使用全国平均数据进行近似，在解释结果时应考虑到这一点。总结：心脏病是美国怀孕期间死亡的主要原因。这项研究着眼于由不同专业的医生组成的专门的心脏产科团队是否能改善患有心脏病的孕妇的预后。对1100多名妇女进行的六项研究发现，由这些心脏产科团队护理的妇女在分娩后再入院和心律问题较少，尽管死亡率没有什么不同。
{"title":"Impact of cardio-obstetrics care on maternal outcomes in pregnant women with heart disease: A systematic review and meta-analysis","authors":"Sneha Annie Sebastian MD , Harshan Atwal MD , Tanesh Ayyalu MD , Martha Gulati MD, MS","doi":"10.1016/j.cpcardiol.2025.103190","DOIUrl":"10.1016/j.cpcardiol.2025.103190","url":null,"abstract":"<div><h3>Background</h3><div>Maternal mortality is at an all-time high in the U.S., with maternal cardiac disease being the leading cause of death. Cardio-obstetrics is a collaborative, multidisciplinary approach to maternal care, bringing together experts from maternal-fetal medicine, cardiology, and other specialties. This study investigates the impact of cardio-obstetrics team care on maternal outcomes, focusing on how this integrated model can improve the health and well-being of pregnant women with cardiovascular disease (CVD).</div></div><div><h3>Methods</h3><div>We conducted a systematic review by searching MEDLINE, Web of Science, Scopus, and Cochrane up to March 5, 2025. Statistical analysis was performed using RevMan 5.4, with an inverse variance random effects model to calculate risk ratios (RR) for dichotomous outcomes. Heterogeneity was assessed using the Higgins I² test. The study protocol is registered in PROSPERO (CRD420251010149).</div></div><div><h3>Results</h3><div>We identified six observational studies evaluating cardio-obstetrics team care, including a total of 1,109 pregnant women with CVD, with a mean age of 30.8 years. Most participants had a CARPREG II score > 2, indicating high risk for adverse maternal cardiovascular outcomes. The average gestational age at delivery was 38 weeks, with arrhythmias being the most common cardiovascular condition, followed by congenital and valvular heart disease. Pooled analysis revealed a statistically significant reduction in the 30-day postpartum readmission rate for pregnant women with CVD receiving cardio-obstetrics care compared to standard care (RR 0.29, 95 % CI: 0.13–0.64, <em>p</em> = 0.002, I² = 0 %) with no observed heterogeneity. There was also a significant decrease in postpartum arrhythmias (RR 0.07, 95 % CI: 0.04–0.12, <em>p</em> < 0.001, I² = 0 %). However, no significant difference in maternal mortality was found between the two groups (RR 0.74, 95 % CI: 0.14–3.93, <em>p</em> = 0.72, I² = 0 %).</div></div><div><h3>Conclusion</h3><div>Maternal outcomes with cardio-obstetrics team care in pregnant women with CVD were promising, indicating the potential of this integrated care model when compared with standard care. These results emphasize the need for further research to explore its long-term benefits. Standard care data were approximated using national averages due to the lack of direct comparison data, which should be considered when interpreting the results.</div></div><div><h3>Lay Summary</h3><div>Heart disease is the leading cause of death during pregnancy in the U.S. This study looked at whether having a specialized cardio-obstetrics team made up of doctors from different specialties working together improves outcomes for pregnant women with heart disease. Six studies with >1,100 women found that women cared for by these cardio-obstetrics teams had fewer hospital readmissions and fewer heart rhythm problems after delivery, though death rates were not differen","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103190"},"PeriodicalIF":3.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281625","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 : 2025-10-01Epub Date: 2025-08-05DOI: 10.1016/j.cpcardiol.2025.103149
Paschalis Karakasis, Panagiotis Theofilis, Panayotis K Vlachakis, Anastasios Apostolos, Nikias Milaras, Nikolaos Ktenopoulos, Konstantinos Grigoriou, Aleksandra Klisic, Efstratios Karagiannidis, Barbara Fyntanidou, Dimitrios Patoulias, Antonios P Antoniadis, Nikolaos Fragakis
Cardiac fibrosis is a key pathological substrate that drives diastolic dysfunction, arrhythmogenesis, and heart failure progression across a spectrum of cardiometabolic disorders. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed for glucose lowering, have demonstrated pleiotropic effects on myocardial structure, notably attenuating fibrotic remodeling. Experimental models of diabetes, hypertension, ischemia, and cardiotoxicity consistently show that SGLT2 inhibitors mitigate interstitial and perivascular fibrosis through modulation of oxidative stress, mitochondrial function, autophagy, and canonical profibrotic signaling cascades, including TGF-β/Smad, STAT3, and mTOR. These actions are largely preserved in non-diabetic settings and appear to extend beyond hemodynamic or glycemic benefits. Clinical data, including cardiac magnetic resonance-based assessments, support the notion of diffuse fibrosis regression, particularly in heart failure with preserved ejection fraction and diabetic cardiomyopathy. Moreover, reductions in serum collagen biomarkers and improvements in myocardial energetics further substantiate their antifibrotic capacity. Nonetheless, fibrosis-specific endpoints remain underrepresented in major cardiovascular outcome trials, and histological validation in human tissue is lacking. Integrating artificial intelligence-driven fibrosis quantification, spatial transcriptomics, and high-resolution imaging may refine phenotyping and enable precision antifibrotic therapy. Whether fibrosis regression translates into durable clinical benefit remains an open question. This review comprehensively synthesizes the mechanistic, translational, and clinical evidence supporting the role of SGLT2 inhibitors as modulators of cardiac fibrosis across diverse cardiovascular disease states.
{"title":"SGLT2 inhibitors and cardiac fibrosis: A comprehensive review.","authors":"Paschalis Karakasis, Panagiotis Theofilis, Panayotis K Vlachakis, Anastasios Apostolos, Nikias Milaras, Nikolaos Ktenopoulos, Konstantinos Grigoriou, Aleksandra Klisic, Efstratios Karagiannidis, Barbara Fyntanidou, Dimitrios Patoulias, Antonios P Antoniadis, Nikolaos Fragakis","doi":"10.1016/j.cpcardiol.2025.103149","DOIUrl":"10.1016/j.cpcardiol.2025.103149","url":null,"abstract":"<p><p>Cardiac fibrosis is a key pathological substrate that drives diastolic dysfunction, arrhythmogenesis, and heart failure progression across a spectrum of cardiometabolic disorders. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed for glucose lowering, have demonstrated pleiotropic effects on myocardial structure, notably attenuating fibrotic remodeling. Experimental models of diabetes, hypertension, ischemia, and cardiotoxicity consistently show that SGLT2 inhibitors mitigate interstitial and perivascular fibrosis through modulation of oxidative stress, mitochondrial function, autophagy, and canonical profibrotic signaling cascades, including TGF-β/Smad, STAT3, and mTOR. These actions are largely preserved in non-diabetic settings and appear to extend beyond hemodynamic or glycemic benefits. Clinical data, including cardiac magnetic resonance-based assessments, support the notion of diffuse fibrosis regression, particularly in heart failure with preserved ejection fraction and diabetic cardiomyopathy. Moreover, reductions in serum collagen biomarkers and improvements in myocardial energetics further substantiate their antifibrotic capacity. Nonetheless, fibrosis-specific endpoints remain underrepresented in major cardiovascular outcome trials, and histological validation in human tissue is lacking. Integrating artificial intelligence-driven fibrosis quantification, spatial transcriptomics, and high-resolution imaging may refine phenotyping and enable precision antifibrotic therapy. Whether fibrosis regression translates into durable clinical benefit remains an open question. This review comprehensively synthesizes the mechanistic, translational, and clinical evidence supporting the role of SGLT2 inhibitors as modulators of cardiac fibrosis across diverse cardiovascular disease states.</p>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":" ","pages":"103149"},"PeriodicalIF":3.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796053","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 : 2025-10-01Epub Date: 2025-08-05DOI: 10.1016/j.cpcardiol.2025.103147
Mansimran Singh Dulay, Rishi Patel, Winston Banya, Dharani Yogasivam, Ramey Assaf, Nahal Raza, Andrew Morley-Smith, Fernando Riesgo-Gil, Owais Dar
Background: Orthotopic Cardiac Transplantation (OCTx) improves survival in advanced heart failure. Currently, a tool in United Kingdom from NHS Blood and Transplant (NHSBT) helps predict likelihood of OCTx from waitlist. However, it does not use predictive variables such as age, or Human Leukocyte Antibody (HLA%). We aimed to develop OCTx predictive models incorporating known prognostic variables at 3-, 6-, 9- and 12-months.
Methods: All patients who were urgent-listed for OCTx at Harefield Hospital between 2014 and 2018 (n = 125) were analysed. Variables included age, gender, blood group (BG), midline sternotomy, ventricular assist device (VAD), body mass index (BMI) and HLA%. Multivariable logistic regression models were constructed following internal validation per timepoint. A separate validation dataset was collected using 52 patients transplanted between 2019 and 2023, to compare model effectiveness against the current NHSBT tool.
Results: At 3-months, variables included were age, gender, sternotomy, BG O and HLA%=0, with model area under curve (AUC) of 0.74 (0.66-0.83 95 % confidence interval [CI]). 6-month model included variables age, gender, BG O, sternotomy, BMI and HLA%=0, model AUC of 0.80 (0.72-0.89 95 % CI). 9-month model used age, BG O, VAD, BMI and HLA%=0, giving an AUC of 0.80 (0.71-0.89 95 % CI). The final 12-month model included midline sternotomy, BMI and HLA%=0 and HLA%=1-24, with AUC 0.78 (0.68-0.88 95 % CI). Our predictive models recorded an 85 % win-ratio compared to the NHSBT tool.
Conclusion: We were able to develop models to predict urgent OCTx, with greater accuracy than the currently available tool. Multicentre external validation would help enable its wider implementation.
{"title":"Developing a tool to predict the likelihood of undergoing orthotopic cardiac transplant from the urgent waitlist - a single centre UK experience.","authors":"Mansimran Singh Dulay, Rishi Patel, Winston Banya, Dharani Yogasivam, Ramey Assaf, Nahal Raza, Andrew Morley-Smith, Fernando Riesgo-Gil, Owais Dar","doi":"10.1016/j.cpcardiol.2025.103147","DOIUrl":"10.1016/j.cpcardiol.2025.103147","url":null,"abstract":"<p><strong>Background: </strong>Orthotopic Cardiac Transplantation (OCTx) improves survival in advanced heart failure. Currently, a tool in United Kingdom from NHS Blood and Transplant (NHSBT) helps predict likelihood of OCTx from waitlist. However, it does not use predictive variables such as age, or Human Leukocyte Antibody (HLA%). We aimed to develop OCTx predictive models incorporating known prognostic variables at 3-, 6-, 9- and 12-months.</p><p><strong>Methods: </strong>All patients who were urgent-listed for OCTx at Harefield Hospital between 2014 and 2018 (n = 125) were analysed. Variables included age, gender, blood group (BG), midline sternotomy, ventricular assist device (VAD), body mass index (BMI) and HLA%. Multivariable logistic regression models were constructed following internal validation per timepoint. A separate validation dataset was collected using 52 patients transplanted between 2019 and 2023, to compare model effectiveness against the current NHSBT tool.</p><p><strong>Results: </strong>At 3-months, variables included were age, gender, sternotomy, BG O and HLA%=0, with model area under curve (AUC) of 0.74 (0.66-0.83 95 % confidence interval [CI]). 6-month model included variables age, gender, BG O, sternotomy, BMI and HLA%=0, model AUC of 0.80 (0.72-0.89 95 % CI). 9-month model used age, BG O, VAD, BMI and HLA%=0, giving an AUC of 0.80 (0.71-0.89 95 % CI). The final 12-month model included midline sternotomy, BMI and HLA%=0 and HLA%=1-24, with AUC 0.78 (0.68-0.88 95 % CI). Our predictive models recorded an 85 % win-ratio compared to the NHSBT tool.</p><p><strong>Conclusion: </strong>We were able to develop models to predict urgent OCTx, with greater accuracy than the currently available tool. Multicentre external validation would help enable its wider implementation.</p>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":" ","pages":"103147"},"PeriodicalIF":3.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796049","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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