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":"2025-12-01","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 : 2025-12-01Epub 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":"2025-12-01","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}
Initially developed for the treatment of type 2 diabetes mellitus (T2DM), SGLT2 inhibitors have increasingly been recognized for their substantial cardiovascular, renal, and metabolic benefits. This study undertakes a systematic bibliometric analysis to delineate research trends, quantify advancements, and identify influential studies on SGLT2 inhibitors and cardiovascular outcomes.
Methods
A comprehensive literature search was performed using the Scopus database, resulting in 10,211 documents up to the search date. Both original research articles and reviews (narrative and systematic) were included. Quantitative metrics such as publication count, citation analysis, and authorship were employed. Network visualization tools (e.g., VOSviewer) and bibliometric software (R Studio with bibliometrix packages) were used to analyze collaboration networks, keyword co-occurrence, and thematic clustering.
Results
The analysis revealed a significant upward trend in publication volume, with a notable peak in recent years, indicating a heightened interest in the topic among scientists. The United States and selected European institutions emerged as major contributors, with prominent authors and funding sources influencing the research output. Thematic analysis highlighted a focus on cardiovascular diseases, heart failure, renal outcomes, and mechanistic studies of SGLT2 inhibitor action. Notably, landmark randomized controlled trials have reported significant reductions in cardiovascular mortality, heart failure hospitalizations, and progression of kidney disease.
Conclusion
This study underscores the transformative impact of SGLT2 inhibitors on cardiovascular therapy. The analytical framework highlights the expansion of the field, and the integration of translational research.
{"title":"Knowledge mapping of SGLT2-inhibitors and cardiovascular outcomes: A bibliometric analysis","authors":"Aysa Rezabakhsh , Hadis Iraji , Ashot Avagimyan , Elena Aghajanova , Zinaida Jndoyan , Lilia Mirzoyan , Waseem Hassan , Solomon Habtemariam , Anne Meddahi-Pellé , Graciela Pavon-Djavid , Abolfazl Barzegri","doi":"10.1016/j.cpcardiol.2025.103171","DOIUrl":"10.1016/j.cpcardiol.2025.103171","url":null,"abstract":"<div><h3>Introduction</h3><div>Initially developed for the treatment of type 2 diabetes mellitus (T2DM), SGLT2 inhibitors have increasingly been recognized for their substantial cardiovascular, renal, and metabolic benefits. This study undertakes a systematic bibliometric analysis to delineate research trends, quantify advancements, and identify influential studies on SGLT2 inhibitors and cardiovascular outcomes.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed using the Scopus database, resulting in 10,211 documents up to the search date. Both original research articles and reviews (narrative and systematic) were included. Quantitative metrics such as publication count, citation analysis, and authorship were employed. Network visualization tools (e.g., VOSviewer) and bibliometric software (R Studio with bibliometrix packages) were used to analyze collaboration networks, keyword co-occurrence, and thematic clustering.</div></div><div><h3>Results</h3><div>The analysis revealed a significant upward trend in publication volume, with a notable peak in recent years, indicating a heightened interest in the topic among scientists. The United States and selected European institutions emerged as major contributors, with prominent authors and funding sources influencing the research output. Thematic analysis highlighted a focus on cardiovascular diseases, heart failure, renal outcomes, and mechanistic studies of SGLT2 inhibitor action. Notably, landmark randomized controlled trials have reported significant reductions in cardiovascular mortality, heart failure hospitalizations, and progression of kidney disease.</div></div><div><h3>Conclusion</h3><div>This study underscores the transformative impact of SGLT2 inhibitors on cardiovascular therapy. The analytical framework highlights the expansion of the field, and the integration of translational research.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103171"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056183","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 : 2025-11-01Epub Date: 2025-07-01DOI: 10.1016/j.cpcardiol.2025.103120
Mohammed Khanjary MSc, Shokoh Varaei PhD, Haitham Ibrahim Faris PhD
{"title":"Effect of implementation of follow-up care model on self-management in patient with chronic heart failure disease","authors":"Mohammed Khanjary MSc, Shokoh Varaei PhD, Haitham Ibrahim Faris PhD","doi":"10.1016/j.cpcardiol.2025.103120","DOIUrl":"10.1016/j.cpcardiol.2025.103120","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 11","pages":"Article 103120"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561922","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 : 2025-11-01Epub Date: 2025-07-31DOI: 10.1016/j.cpcardiol.2025.103131
Alberto Piserra López Fernández de Heredia , Martín Ruiz Ortiz , Javier Torres Llergo , Magdalena Carrillo Bailen , María Sánchez de Castro , Margarita Fernández de la Mata , Arancha Díaz Exposito , Alejandro I Pérez Cabeza , Mónica Delgado Ortega , María García Fortes , Inmaculada Fernández Valenzuela , Marinela Chaparro Muñoz , Alicia Rodríguez Fernández , Ana María Rodríguez Almodóvar , Inara Alarcón de la Lastra Cubiles , Fátima Esteban Martínez , Francisco Javier Capote Huelva , José Javier Sánchez Fernandez , Dolores Mesa Rubio , Working Groups of Atrial Fibrillation and Cardio-Onco-Hematology of the Andalusian Society of Cardiology
{"title":"Corrigendum to “Clinical profile and cardiovascular events in patients with atrial fibrillation and hematologic malignancies with recent initiation of targeted therapy: real-life data from CANAC-FA registry” [Current Problems in Cardiology 50(2025):102974]","authors":"Alberto Piserra López Fernández de Heredia , Martín Ruiz Ortiz , Javier Torres Llergo , Magdalena Carrillo Bailen , María Sánchez de Castro , Margarita Fernández de la Mata , Arancha Díaz Exposito , Alejandro I Pérez Cabeza , Mónica Delgado Ortega , María García Fortes , Inmaculada Fernández Valenzuela , Marinela Chaparro Muñoz , Alicia Rodríguez Fernández , Ana María Rodríguez Almodóvar , Inara Alarcón de la Lastra Cubiles , Fátima Esteban Martínez , Francisco Javier Capote Huelva , José Javier Sánchez Fernandez , Dolores Mesa Rubio , Working Groups of Atrial Fibrillation and Cardio-Onco-Hematology of the Andalusian Society of Cardiology","doi":"10.1016/j.cpcardiol.2025.103131","DOIUrl":"10.1016/j.cpcardiol.2025.103131","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 11","pages":"Article 103131"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765780","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 : 2025-11-01Epub Date: 2025-09-03DOI: 10.1016/j.cpcardiol.2025.103170
Yuxi Jin , Mohammed Alissa , Ahmed Ezzat Ahmed , Amin A. Al-Doaiss , Naif Asiri , Yasser Assiri , Shahid Ullah Khan Phd , Munir Ullah Khan , Samuel Joseph
Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) represent interconnected metabolic disorders with multifaceted etiology, demonstrating bidirectional relationships and pronounced associations with cardiovascular diseases (CVDs). Despite extensive research, significant knowledge gaps persist regarding the temporal progression of these comorbidities, optimal screening strategies for high-risk populations, and personalized therapeutic approaches targeting the hepatic-cardiac-metabolic axis simultaneously. Current literature lacks a comprehensive analysis of phenotypic heterogeneity within NAFLD-T2DM-CVD clusters and fails to address sex-specific and ethnic variations in disease progression patterns adequately. A systematic literature search was conducted across PubMed, Medline, Embase, Web of Science, and Google Scholar databases from inception to June 2024, employing various combinations of terms including NAFLD, NASH, T2DM, and CVDs, with emphasis on identifying mechanistic pathways, epidemiological trends, and therapeutic innovations. This review identifies novel pathophysiological mechanisms linking hepatic steatosis, insulin resistance, and cardiovascular dysfunction, including previously underexplored roles of gut microbiome dysbiosis, advanced glycation end products, and epigenetic modifications. Emerging evidence suggests distinct molecular signatures that could facilitate precision medicine approaches. The intricate interplay between diabetes, hepatic dysfunction, and cardiovascular complications represents a global health challenge requiring integrated management strategies. Future research should prioritize developing biomarker-guided therapeutic algorithms, investigating sex-specific treatment responses, and establishing standardized protocols for concurrent NAFLD-T2DM-CVD management to optimize clinical outcomes and reduce healthcare burden.
非酒精性脂肪性肝病（NAFLD）和2型糖尿病（T2DM）是具有多方面病因的相互关联的代谢性疾病，与心血管疾病（cvd）表现出双向关系和明显的相关性。尽管进行了广泛的研究，但关于这些合并症的时间进展，高危人群的最佳筛查策略以及同时针对肝-心-代谢轴的个性化治疗方法，仍然存在重大的知识空白。目前的文献缺乏对NAFLD-T2DM-CVD集群表型异质性的全面分析，未能充分解决疾病进展模式的性别特异性和种族差异。系统地检索了PubMed、Medline、Embase、Web of Science和谷歌Scholar数据库，检索时间从成立到2024年6月，检索了包括NAFLD、NASH、T2DM和cvd在内的各种术语组合，重点是确定机制途径、流行病学趋势和治疗创新。本综述确定了与肝脂肪变性、胰岛素抵抗和心血管功能障碍相关的新的病理生理机制，包括以前未被充分探索的肠道微生物群失调、晚期糖基化终产物和表观遗传修饰的作用。新出现的证据表明，不同的分子特征可以促进精准医疗方法。糖尿病、肝功能障碍和心血管并发症之间错综复杂的相互作用是一项全球健康挑战，需要综合管理策略。未来的研究应优先开发生物标志物引导的治疗算法，调查性别特异性治疗反应，并建立NAFLD-T2DM-CVD并发管理的标准化方案，以优化临床结果并减轻医疗负担。
{"title":"The triadic relationship between nonalcoholic fatty liver disease, type 2 diabetes, and cardiovascular disease: From molecular mechanisms to clinical management","authors":"Yuxi Jin , Mohammed Alissa , Ahmed Ezzat Ahmed , Amin A. Al-Doaiss , Naif Asiri , Yasser Assiri , Shahid Ullah Khan Phd , Munir Ullah Khan , Samuel Joseph","doi":"10.1016/j.cpcardiol.2025.103170","DOIUrl":"10.1016/j.cpcardiol.2025.103170","url":null,"abstract":"<div><div>Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) represent interconnected metabolic disorders with multifaceted etiology, demonstrating bidirectional relationships and pronounced associations with cardiovascular diseases (CVDs). Despite extensive research, significant knowledge gaps persist regarding the temporal progression of these comorbidities, optimal screening strategies for high-risk populations, and personalized therapeutic approaches targeting the hepatic-cardiac-metabolic axis simultaneously. Current literature lacks a comprehensive analysis of phenotypic heterogeneity within NAFLD-T2DM-CVD clusters and fails to address sex-specific and ethnic variations in disease progression patterns adequately. A systematic literature search was conducted across PubMed, Medline, Embase, Web of Science, and Google Scholar databases from inception to June 2024, employing various combinations of terms including NAFLD, NASH, T2DM, and CVDs, with emphasis on identifying mechanistic pathways, epidemiological trends, and therapeutic innovations. This review identifies novel pathophysiological mechanisms linking hepatic steatosis, insulin resistance, and cardiovascular dysfunction, including previously underexplored roles of gut microbiome dysbiosis, advanced glycation end products, and epigenetic modifications. Emerging evidence suggests distinct molecular signatures that could facilitate precision medicine approaches. The intricate interplay between diabetes, hepatic dysfunction, and cardiovascular complications represents a global health challenge requiring integrated management strategies. Future research should prioritize developing biomarker-guided therapeutic algorithms, investigating sex-specific treatment responses, and establishing standardized protocols for concurrent NAFLD-T2DM-CVD management to optimize clinical outcomes and reduce healthcare burden.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 11","pages":"Article 103170"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006870","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 : 2025-11-01Epub Date: 2025-08-20DOI: 10.1016/j.cpcardiol.2025.103154
Alonzo Armani Prata , Ana Carolina Covre Coan , Megan Coylewright MD, MPH , Julia Marques Fernandes , Eric Shih Katsuyama MD , Christian Ken Fukunaga , Gabriel Scarpioni Barbosa , Pedro Gabriel Scardini , Gioli-Pereira Luciana MD, PhD
Background
The clinical effect of an iatrogenic interatrial shunt in heart failure with preserved ejection fraction (HFpEF) was based on observational data, wherein decompression of the pressure-overloaded left atrium improved symptoms and hemodynamics. However, the identification of a specific patient population that may benefit remains unclear.
Methods
We searched for randomized controlled trials (RCTs) that compared the creation of interatrial shunts versus a sham procedure in patients with HFpEF. The primary outcomes of interest were HF events and Cardiovascular (CV) mortality.
Results
Three RCTs were included, encompassing 966 patients, of which 479 (49.5%) were in the interatrial shunt group. The mean age of the participants was 73.2 years, with an average LVEF of 58.7%. Of the 479 patients undergoing interatrial shunt placement, 69% had exercise hemodynamics to assist in selection for therapy. Interatrial shunt therapy in the selected patients showed a trend towards an increased risk of HF events (RR:1.29;95%CI:0.98-1.70;p=0.069) and CV death (RR:2.30;95%CI:0.94-5.59;p=0.067), compared with the sham procedure.
Conclusion
In this meta-analysis of patients with HFpEF, interatrial shunt therapy showed a trend towards an increased risk of HF events and CV mortality compared with the sham procedure, with no significant improvement in MACE, quality of life, or rates of MI and stroke/TIA. These findings raise concerns about interatrial shunt therapy for the broader HFpEF population and highlight the need for better patient selection.
{"title":"Interatrial shunt devices in heart failure with preserved ejection fraction: A meta-analysis of randomized trials","authors":"Alonzo Armani Prata , Ana Carolina Covre Coan , Megan Coylewright MD, MPH , Julia Marques Fernandes , Eric Shih Katsuyama MD , Christian Ken Fukunaga , Gabriel Scarpioni Barbosa , Pedro Gabriel Scardini , Gioli-Pereira Luciana MD, PhD","doi":"10.1016/j.cpcardiol.2025.103154","DOIUrl":"10.1016/j.cpcardiol.2025.103154","url":null,"abstract":"<div><h3>Background</h3><div>The clinical effect of an iatrogenic interatrial shunt in heart failure with preserved ejection fraction (HFpEF) was based on observational data, wherein decompression of the pressure-overloaded left atrium improved symptoms and hemodynamics. However, the identification of a specific patient population that may benefit remains unclear.</div></div><div><h3>Methods</h3><div>We searched for randomized controlled trials (RCTs) that compared the creation of interatrial shunts versus a sham procedure in patients with HFpEF. The primary outcomes of interest were HF events and Cardiovascular (CV) mortality.</div></div><div><h3>Results</h3><div>Three RCTs were included, encompassing 966 patients, of which 479 (49.5%) were in the interatrial shunt group. The mean age of the participants was 73.2 years, with an average LVEF of 58.7%. Of the 479 patients undergoing interatrial shunt placement, 69% had exercise hemodynamics to assist in selection for therapy. Interatrial shunt therapy in the selected patients showed a trend towards an increased risk of HF events (RR:1.29;95%CI:0.98-1.70;p=0.069) and CV death (RR:2.30;95%CI:0.94-5.59;p=0.067), compared with the sham procedure.</div></div><div><h3>Conclusion</h3><div>In this meta-analysis of patients with HFpEF, interatrial shunt therapy showed a trend towards an increased risk of HF events and CV mortality compared with the sham procedure, with no significant improvement in MACE, quality of life, or rates of MI and stroke/TIA. These findings raise concerns about interatrial shunt therapy for the broader HFpEF population and highlight the need for better patient selection.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 11","pages":"Article 103154"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977631","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 : 2025-11-01Epub Date: 2025-09-10DOI: 10.1016/j.cpcardiol.2025.103174
Guido Vannoni MD, Carlos D. Labadet MD, Giuliana Caminotti MD, Bárbara Zambudio MD, Juan M. Fiamengo Tch, Lucas N. Campana MD, María V. Vannoni MD, Gerardo M. Marambio MD, Jorge A. Lax MD, Juan A. Gagliardi MD, PhD
Introduction
Complete left bundle branch block (LBBB) is associated with increased risk of cardiovascular events. The value of extreme deviation of the QRS axis to the left (LAD) in the context of LBBB is controversial.
Objective
To evaluate whether LAD (-45°) in patients with LBBB is a marker of systolic dysfunction and ventricular remodeling.
Material and methods
Cross-sectional cohort study including 102 patients with LBBB who underwent echocardiography to assess left ventricular (LV) diameters, wall thickness and ejection fraction (EF).
Results
Mean age was 67.9 ± 13 years. 48 % were women. 80.4 % met Strauss criteria for LBBB and 28.4 % had LAD. The LAD group showed lower EF (32.2 ± 12 % vs. 46.7 ± 17 %, p = 0.00009) and higher LV end-diastolic diameter index (34.8 ± 9 vs. 30.9 ± 6, p = 0.011). LAD had 45 % sensitivity, 88 % specificity, positive predictive value of 0.79 and negative predictive value of 0.62 for identifying reduced EF. Cardiomyopathy diagnosis was more frequent in the LAD group (93.1 % vs. 61.6 %; p = 0.0016). LV hypertrophy prevalence was similar between groups, but LAD patients had higher prevalence of eccentric LV hypertrophy.
Conclusion
In LBBB, LAD (-45°) identifies patients with worse systolic function, greater degree of LV dilatation, and more eccentric hypertrophy. Additionally, cardiomyopathy prevalence was higher in this population.
{"title":"Value of extreme left axis deviation in patients with complete left bundle branch block","authors":"Guido Vannoni MD, Carlos D. Labadet MD, Giuliana Caminotti MD, Bárbara Zambudio MD, Juan M. Fiamengo Tch, Lucas N. Campana MD, María V. Vannoni MD, Gerardo M. Marambio MD, Jorge A. Lax MD, Juan A. Gagliardi MD, PhD","doi":"10.1016/j.cpcardiol.2025.103174","DOIUrl":"10.1016/j.cpcardiol.2025.103174","url":null,"abstract":"<div><h3>Introduction</h3><div>Complete left bundle branch block (LBBB) is associated with increased risk of cardiovascular events. The value of extreme deviation of the QRS axis to the left (LAD) in the context of LBBB is controversial.</div></div><div><h3>Objective</h3><div>To evaluate whether LAD (-45°) in patients with LBBB is a marker of systolic dysfunction and ventricular remodeling.</div></div><div><h3>Material and methods</h3><div>Cross-sectional cohort study including 102 patients with LBBB who underwent echocardiography to assess left ventricular (LV) diameters, wall thickness and ejection fraction (EF).</div></div><div><h3>Results</h3><div>Mean age was 67.9 ± 13 years. 48 % were women. 80.4 % met Strauss criteria for LBBB and 28.4 % had LAD. The LAD group showed lower EF (32.2 ± 12 % vs. 46.7 ± 17 %, p = 0.00009) and higher LV end-diastolic diameter index (34.8 ± 9 vs. 30.9 ± 6, p = 0.011). LAD had 45 % sensitivity, 88 % specificity, positive predictive value of 0.79 and negative predictive value of 0.62 for identifying reduced EF. Cardiomyopathy diagnosis was more frequent in the LAD group (93.1 % vs. 61.6 %; p = 0.0016). LV hypertrophy prevalence was similar between groups, but LAD patients had higher prevalence of eccentric LV hypertrophy.</div></div><div><h3>Conclusion</h3><div>In LBBB, LAD (-45°) identifies patients with worse systolic function, greater degree of LV dilatation, and more eccentric hypertrophy. Additionally, cardiomyopathy prevalence was higher in this population.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 11","pages":"Article 103174"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056169","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 : 2025-11-01Epub Date: 2025-09-03DOI: 10.1016/j.cpcardiol.2025.103168
Rio Putra Pamungkas MD , Laras Pratiwi MD , Henry Sutanto MD, MSc, PhD
HER2-targeted therapies have dramatically improved outcomes for patients with HER2-positive breast cancer, but their potential for cardiotoxicity remains a critical clinical concern. Early trials reported high rates of cardiac dysfunction, particularly with concomitant anthracycline use, prompting the development of intensive cardiac monitoring strategies. However, emerging evidence suggests that most cardiotoxic events are asymptomatic, reversible, and rarely require permanent treatment discontinuation, particularly with newer agents such as antibody–drug conjugates. Clinical determinants include baseline left ventricular dysfunction, age, comorbidities, and combination chemotherapy, while biomarkers and advanced imaging are promising tools for early detection. Mechanistically, HER2 inhibition disrupts cardiomyocyte survival pathways and mitochondrial function, but the relationship between these changes and clinically meaningful heart failure remains incompletely defined. Recent studies, including SAFE-HEaRt, demonstrate that HER2 therapy can often be safely continued under cardio-oncology supervision with appropriate cardioprotective interventions. Nevertheless, gaps persist in risk stratification, long-term surveillance, and the integration of biomarkers and imaging into routine practice. This article critically examines the pathophysiology, clinical risk factors, and management of HER2 therapy-induced cardiotoxicity, ultimately arguing that with proper monitoring and multidisciplinary care, cardiotoxicity should not preclude optimal oncologic treatment.
{"title":"HER2-targeted therapies and cardiotoxicity: From major concern to manageable risk","authors":"Rio Putra Pamungkas MD , Laras Pratiwi MD , Henry Sutanto MD, MSc, PhD","doi":"10.1016/j.cpcardiol.2025.103168","DOIUrl":"10.1016/j.cpcardiol.2025.103168","url":null,"abstract":"<div><div>HER2-targeted therapies have dramatically improved outcomes for patients with HER2-positive breast cancer, but their potential for cardiotoxicity remains a critical clinical concern. Early trials reported high rates of cardiac dysfunction, particularly with concomitant anthracycline use, prompting the development of intensive cardiac monitoring strategies. However, emerging evidence suggests that most cardiotoxic events are asymptomatic, reversible, and rarely require permanent treatment discontinuation, particularly with newer agents such as antibody–drug conjugates. Clinical determinants include baseline left ventricular dysfunction, age, comorbidities, and combination chemotherapy, while biomarkers and advanced imaging are promising tools for early detection. Mechanistically, HER2 inhibition disrupts cardiomyocyte survival pathways and mitochondrial function, but the relationship between these changes and clinically meaningful heart failure remains incompletely defined. Recent studies, including SAFE-HEaRt, demonstrate that HER2 therapy can often be safely continued under cardio-oncology supervision with appropriate cardioprotective interventions. Nevertheless, gaps persist in risk stratification, long-term surveillance, and the integration of biomarkers and imaging into routine practice. This article critically examines the pathophysiology, clinical risk factors, and management of HER2 therapy-induced cardiotoxicity, ultimately arguing that with proper monitoring and multidisciplinary care, cardiotoxicity should not preclude optimal oncologic treatment.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 11","pages":"Article 103168"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006889","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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