Trends in Cardiovascular Medicine最新文献

In symptomatic patients with obstructive hypertrophic cardiomyopathy, the management of left ventricular outflow tract obstruction remains the central therapeutic challenge. Despite recent advances in pharmacologic therapy, septal reduction therapy continues to represent the gold standard for relieving obstruction. Among available techniques, transaortic septal myectomy and percutaneous alcohol septal ablation are the most widely practiced and well-established procedures. In recent years, novel techniques employing alternative approaches or energy sources have emerged, including transapical beating-heart septal myectomy, transcatheter septal myotomy, percutaneous intramyocardial septal radiofrequency ablation, transcatheter endocardial septal radiofrequency ablation, and stereotactic septal radio ablation. These procedures share a common mechanistic principle-thinning the hypertrophied basal interventricular septum to mitigate systolic anterior motion of the mitral valve and thereby reduce obstruction. Preliminary studies have demonstrated promising efficacy and procedural safety, suggesting that some of these new modalities may be valuable adjuncts or potential alternatives to conventional therapies. Nonetheless, long-term, multicenter, and prospective data are necessary to establish their durability, safety, and clinical outcomes before broad clinical implementation.

Radiofrequency (RFA) and cryoballoon (CBA) catheter ablation are the primary thermal ablation techniques used for catheter-based ablation of atrial fibrillation (AF). Recently, pulsed field ablation (PFA), which is a nonthermal ablation technique, has been studied; however, it is unclear if PFA can improve atrial arrhythmia freedom compared to thermal ablation. A meta-analysis of randomized controlled trials comparing PFA to thermal ablation techniques (RFA and/or CBA) was conducted. The primary outcome was atrial arrhythmia freedom. The secondary outcome was a composite of serious adverse events as defined by each trial. Cumulative odds ratios (OR) and 95% confidence intervals (CI) were calculated for each treatment type. Three trials were identified that included 1,237 participants (PFA = 622, Thermal = 615). The mean age (± standard deviation) was 64.3 (±9.0) years, and 32.6% of all patients were female. All trials had a follow-up time of 12 months. PFA was not significantly associated with an increase in atrial arrhythmia freedom (OR 1.19; 95% CI 0.85 to 1.65; p = 0.31; I²=31.1) or serious adverse events (OR 1.25; 95% CI 0.48 to 3.26; p=0.64; I²=0.00). There was no evidence of effect modification on either endpoint when subgrouping by arrhythmia detection methods (continuous monitoring vs. Holter monitoring) or atrial fibrillation type (paroxysmal vs. persistent). For patients undergoing catheter ablation for AF, there is no significant improvement in atrial arrhythmia freedom with PFA compared to thermal ablation techniques. Additionally, the incidence of adverse events was similar across the two groups.

Pacemaker implantation rates are increasing worldwide, raising concerns about pacing-induced cardiomyopathy a complication of chronic right ventricular pacing (RVP). Pacing-induced cardiomyopathy results in adverse remodeling leading to left ventricular dysfunction and heart failure. pacing-induced cardiomyopathy treatment includes cardiac resynchronization therapy (CRT) and cardiac physiologic pacing upgrades, while preventative strategies include de novo implantation of CRT or cardiac physiologic pacing. Identification of patients who may be suitable for de novo CRT/cardiac physiologic pacing due to high risk for developing pacing-induced cardiomyopathy remains challenging, in part due to limited assessment of patient characteristics. A narrative review of pertinent literature was conducted to examine the definitions, pathophysiology, prevalence, risk factors, novel screening tools, and treatment options for pacing-induced cardiomyopathy in adult populations. Accurate assessment of pacing-induced cardiomyopathy prevalence is limited by center-to-center variability, as well as a variety of lead implantation sites and pacing options. Effective risk stratification, facilitated by a thorough collection and analysis of notable risk factors for pacing-induced cardiomyopathy, can help identify patients that may benefit from early use of cardiac physiologic pacing or CRT to prevent pathologic remodeling.

Artificial intelligence (AI) offers new opportunities in cardio-oncology for early detection, risk stratification, and personalized management of cardiovascular complications in cancer patients. By leveraging data from electronic health records, blood biomarkers, imaging tests such as echocardiography, electrocardiograms, and wearables, AI models can facilitate prediction, detection and response to treatment of cardiovascular disease entities, pre-existing and developing as a consequence of cancer therapy. Specific to the latter, referred to as cardiotoxicity, widespread adoption has been hindered by the limited availability of large datasets for model training, insufficient external validation, and challenges in integrating AI tools into routine clinical workflows. Future progress will depend on advancements in AI technologies, rigorous multi-center validation, development of explainable models, and seamless integration into clinical practice. Barriers, not only from a systems perspective, but also from a provider and most importantly from a patient perspective will need to be addressed for successful implementation. With a broad multidisciplinary perspective and patient focus, AI can advance cardio-oncology care and improve outcomes for patients with cancer.

Atrial fibrillation (AF) increases the risk of stroke and cognitive decline. While anticoagulation with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) prevents stroke, their role in reducing dementia risk in patients with AF remains unclear. To evaluate the effect of anticoagulation therapy on dementia incidence in patients with AF, comparing DOACs versus VKAs. We systematically reviewed PubMed, Scopus, Web of Science, Embase, and Cochrane. Systematic reviews and meta-analyses evaluating the effects of anticoagulation therapies on dementia were included. A total of 11 systematic reviews and meta-analyses were included in this umbrella review. Findings from 6 systematic reviews showed that OAC use was associated with a reduced risk of incident dementia in patients with AF, with effect estimates (RR/HR) ranging from 0.46 [0.28-0.78] to 0.79 [0.67-0.93]. For DOACs versus VKAs, most studies found a lower risk of dementia with DOACs, with effect sizes ranging from HR: 0.51 [0.37-0.71] to RR: 0.88 [0.82-0.94]. However, two studies found no significant difference between DOACs and warfarin in dementia risk (OR: 0.65 [0.34-1.25] and RR: 0.91 [0.75-1.12], respectively). Anticoagulation therapy, particularly with DOACs, may help reduce the risk of dementia in AF patients. The evidence remains of moderate to low certainty, and further high-quality, long-term randomized controlled trials are needed to confirm these findings and explore the neuroprotective mechanisms of OACs.

Parkinson's disease (PD) is a synucleinopathy best known for its motor symptoms, but emerging research shows it also impacts the cardiovascular system. In this paper, we explore the association between PD and cardiovascular disease (CVD), reviewing six key categories: cardiac dysautonomia, coronary artery disease, arrhythmias, cardiomyopathy, heart valve disease, and heart failure. We also discuss risk factors, epidemiology, and overlapping pathophysiology. Cardiac dysautonomia is the most frequently reported cardiovascular issue in PD and includes orthostatic hypotension, postprandial hypotension, supine hypertension, and nocturnal non-dipping blood pressure. PD also appears to be positively associated with coronary artery disease. Early-stage PD is linked to atrial fibrillation, but overall, there is no consistent increase in arrhythmias outside of certain PD medications. Structural and functional cardiac changes such as left ventricular hypertrophy and diastolic dysfunction have also been reported in PD, which may predispose to heart failure and cardiomyopathy. Dopamine agonists pergolide and cabergoline are associated with valve regurgitation, but this seems to be drug-related rather than caused by PD. Shared risk factors like aging, male sex, diabetes, and inflammation help explain the PD-CVD connection. However, some CVD risk factors like high LDL and smoking are associated with lower PD risk. Autonomic dysfunction, impaired lipid and glucose metabolism, and chronic inflammation may all contribute to disease overlap. Our review consolidates existing research to highlight the importance of recognizing cardiovascular manifestations in PD, which may present before motor symptoms. This has important implications for earlier diagnosis, better screening, and more effective management of PD.

The 2025 European Society of Cardiology (ESC) guidelines and the 2024-2025 American College of Cardiology (ACC) consensus documents redefine the management of myocarditis and pericarditis, with notable convergence, yet key differences. Both emphasize early, accurate diagnosis, particularly through cardiac magnetic resonance (CMR), which now often supersedes immediate biopsy in stable, uncomplicated cases of acute myocarditis. The ESC introduces a unified "inflammatory myopericardial syndrome" (IMPS) framework encompassing myocarditis, pericarditis, and overlap syndromes, while the ACC provides separate pathways, including a novel four-stage clinical classification of myocarditis. Therapeutically, both endorse non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine for pericarditis and myopericarditis, and heart failure-directed therapy for myocarditis, while reserving immunosuppression for select cases. Importantly, interleukin-1 (IL-1) blockade has emerged as a pivotal therapy in recurrent pericarditis, receiving a Class I recommendation in ESC guidelines and strong endorsement in ACC guidance. Prognostic assessment focuses on identifying high-risk features and structured follow-up with imaging and biomarkers. Divergences in terminology, staging, and diagnostic thresholds underscore opportunities for further harmonization. The ESC and ACC documents align in a patient-tailored, evidence-informed approach to management.