Trends in Cardiovascular Medicine最新文献

Modern cancer therapies, particularly immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs), have markedly improved cancer outcomes through more selective tumor targeting. However, as survivorship increases, there is growing recognition of long-term treatment-related complications, including a range of cardiometabolic disturbances. These include hyperglycemia, dyslipidemia and accelerated atherosclerosis, thyroid dysfunction and adrenal insufficiency, which significantly elevate long-term cardiovascular and metabolic risk in cancer survivors. The cardiometabolic sequelae of ICIs and TKIs are often under-recognised and under-monitored, despite their potential to contribute to serious morbidity. The mechanisms underpinning these toxicities are diverse and agent-specific, involving immune-mediated endocrine disruption, insulin resistance, and altered lipid metabolism. Current guideline recommendations remain limited across different therapeutic classes and clinical scenarios. In this review, we synthesise available evidence regarding the prevalence, mechanisms, and clinical management of cardiometabolic complications associated with ICIs and TKIs. We highlight key gaps in monitoring and therapeutic guidance and advocate for a multidisciplinary approach to early detection and management. Greater awareness and standardised care pathways will be essential to prevent avoidable complications and optimise long-term health in cancer survivors.

Tricuspid regurgitation (TR) in advanced heart failure (HF) is associated with poor prognosis, functional decline, and increased morbidity. This systematic review synthesizes current evidence of transcatheter device tricuspid transcatheter approaches in advanced HF patients. A comprehensive search of PubMed, Embase, Scopus, CINAHL, and the Cochrane Library identified studies evaluating transcatheter procedures for moderate-to-severe TR in advanced HF, and reporting procedural outcomes, survival, and functional measures. A total of 37 studies encompassing approximately 2,372 patients were included, spanning edge-to-edge repair systems (TriClip, PASCAL), annuloplasty devices (Cardioband, Trialign, TriCinch), transcatheter valve replacement (Evoque, LuX-Valve, NaviGate, Intrepid), heterotopic caval valve implantation (TricValve, Tricento), and leaflet spacers (FORMA). Most patients were in NYHA class III-IV with high surgical risk scores. Across techniques, procedural success rates were high, with consistent reductions in TR severity and improvements in NYHA class, 6-minute walk distance, and quality-of-life scores. Edge-to-edge repair was the most frequently studied, showing favorable safety and symptom improvement. Mortality rates varied, with limited long-term follow-up data. Transcatheter interventions for TR in advanced HF offer promising improvements in symptoms, functional status, and quality of life. Given patient and anatomical heterogeneity, an individualized approach is essential.

Acute coronary syndrome (ACS) includes ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA), which occur predominantly due to atherothrombosis with varying degrees of acute occlusion of coronary vasculature. Coronary angiogram and subsequent percutaneous coronary intervention (PCI) are central to management of acute coronary occlusions; however, the timing of coronary angiogram varies significantly across these pathologies based on current guidelines. The STEMI criteria are electrocardiographic features utilized to rapidly triage patients to catheterization laboratories, because these criteria are felt to be specific for acute coronary occlusion of culprit coronary vessels. Patients who do not fulfill STEMI criteria are triaged as NSTEMIs with delayed coronary reperfusion strategies. A significant proportion of patients with NSTEMI ACS are found to have acute coronary occlusion (ACO) of coronary vessels. Some NSTEMI patterns on electrocardiogram that are considered specific for acute coronary occlusion myocardial infarction (ACOMI) have been aptly labeled "STEMI-equivalents" and are thus recognized as high-risk features in expert statements but, as of yet, not formally adopted in guidelines. Here, we review the current literature on ACOMI in NSTEMI ACS and the "STEMI Equivalents". We discuss the potential role for additional studies, revised diagnostic criteria, and predictive tools to better stratify patients with NSTEMI ACS for urgent versus delayed reperfusion.