Trends in Cardiovascular Medicine最新文献

Suicide left ventricle (SLV) is a rare but potentially catastrophic complication of surgical or transcatheter aortic valve replacement, characterized by acute hemodynamic collapse after relief of aortic stenosis. Abrupt reduction in left ventricular afterload unmasks dynamic intracavitary obstruction driven by adverse ventricular geometry, hypercontractility, and impaired filling, resulting in a low-cardiac output state. Although increasingly recognized, SLV remains a rare yet potentially fatal condition that continues to pose diagnostic and therapeutic challenges. This review synthesizes available evidence on the mechanistic basis of SLV presents an operational framework for recognition, highlighting key clinical and echocardiographic features associated with susceptibility to this complication. We discuss a practical, physiology-guided management approach, including pharmacologic modulation, pacing strategies, septal reduction approaches, and selective use of mechanical circulatory support. Improved awareness and coordinated multidisciplinary care may help mitigate morbidity and optimize outcomes for this severe condition.

Cardiogenic shock (CS) remains a major clinical challenge, with persistently high short-term mortality despite advances in reperfusion therapy, pharmacological support, and mechanical circulatory support. This review reassesses the conceptual evolution of CS and examines why hemodynamic-centric diagnostic and therapeutic strategies have failed to yield meaningful improvements in outcomes. Historically, CS has been defined by cardiac-oriented macrocirculatory compromise, and contemporary definitions and staging systems have improved risk stratification but remain largely hemodynamics-focused and primarily validated in intensive care settings. Increasing evidence indicates that inflammatory activation, microcirculatory dysfunction, endothelial injury, and metabolic derangements are central determinants of shock progression and organ failure. Integrating multimodal diagnostic approaches-including bedside assessment of microcirculation and inflammation, omics-based phenotyping, advanced echocardiographic techniques, and artificial intelligence-assisted risk stratification-may enable earlier recognition, more precise classification, and improved risk stratification across the continuum of care. Reframing cardiogenic shock as a dynamic, multisystem disorder supports a shift from hemodynamic-centric paradigms toward multimodal precision care, with important implications for clinical management and future trial design.

Stretch-Induced Syncope is an uncommon form of situational syncope triggered by stretching upper-back, neck, and shoulder muscles. A review of 133 publications in PubMed, Embase, Scopus, Web of Science, Scielo, and Google Scholar, using search terms such as "stretch syncope," "syncope with stretch," and "stretch-induced syncope," identified 12 studies describing 30 patient cases (ages 5-26). Stretch-induced syncope episodes were triggered by neck hyperextension and upper-back stretching, producing brief loss of consciousness. Early reports attributed these events to vertebral artery compression or carotid baroreceptor stimulation. However, recent data from simulated stretch testing demonstrate a pronounced vasodepressor response with diminished compensatory tachycardia compared to the heart rate increment during an active standing maneuver in the same patient; these findings are best accounted for by a neural reflex-mediated mechanism rather than mechanical vascular obstruction. Diagnosis is best achieved through careful history taking in the clinic and symptom reproduction with simultaneous video-EEG and beat-by-beat blood pressure monitoring during autonomic testing. No pharmacologic therapy has proven effective; patient education and avoidance of provoking maneuvers remain the mainstays of management. Greater awareness of stretch-induced syncope may prevent misdiagnosis, reduce unnecessary testing, and guide future investigation into the autonomic mechanisms of this reflex.