Trends in Cardiovascular Medicine最新文献

Active and passive tobacco exposure during childhood and adolescence represents a critical preventable risk factor for premature cardiovascular disease. Tobacco smoking in early life poses an elevated risk of endothelial dysfunction, vascular alteration, and irregular heart rhythm, which may lead to thrombosis. Smoking may temporarily raise cardiac output, enhance heart rate, augment cardiac contractility, and increase cardiac filling due to systemic venoconstriction. Emerging studies have shown that smoking is an independent driver of ventricular hypertrophy in the young population, as a crucial factor in cardiovascular risk progression. This narrative review provides up-to-date evidence regarding epidemiology, risk factors, and clinical implications of active and passive childhood tobacco exposure on a growing heart. Long-term prospective relationships between tobacco use and structural and functional heart alterations were discussed, and strategies to reduce smoking interest in the young population were also highlighted. Finally, this review re-engages interest in a sensational topic that cannot be wished away like a bad dream and recommends strategic actions to take to save the youth's heart.

Dilated cardiomyopathy (DCM) is an underrecognized yet potentially reversible cardiac complication of primary aldosteronism (PA), the most prevalent cause of secondary hypertension. Beyond its well-established hypertensive and profibrotic effects, chronic aldosterone excess exerts direct myocardial toxicity, driving progressive left ventricular remodeling. This remodeling follows a characteristic trajectory, evolving from concentric remodeling to eccentric hypertrophy with diastolic dysfunction, and ultimately culminating in overt systolic impairment. Importantly, these pathological changes result from mechanisms extending beyond mere pressure overload, including mineralocorticoid receptor overactivation, inflammation, oxidative stress, and myocardial fibrosis. This state-of-the-art review integrates current epidemiological data, mechanistic insights, and therapeutic outcomes from both clinical and experimental studies on PA-related DCM. We critically assess the pathophysiological cascade linking aldosterone excess to adverse cardiac remodeling and evaluate the comparative impact of adrenalectomy and mineralocorticoid receptor antagonists on myocardial recovery. Special emphasis is placed on diagnostic challenges, clinical implications, and the importance of early recognition. By consolidating available evidence and highlighting key knowledge gaps, this review aims to inform clinical decision-making and stimulate future research in the emerging field of endocrine cardiomyopathy.

Left ventricular thrombus is a relatively common and serious complication in patients with left ventricular systolic dysfunction, resulting in an increased risk of embolic events such as ischemic stroke and contributing to higher mortality rates. Current clinical guidelines recommend anticoagulation therapy for 3 to 6 months in patients with left ventricular thrombus; however, the evidence supporting this approach primarily derives from small-scale randomized trials or retrospective observation studies, which limit the generalizability of findings across diverse patient populations. Several critical aspects of left ventricular thrombus identification and management remain inadequately studied, and these areas include optimal time and detection imaging methods, anticoagulation strategies (treatment of choice and optimal duration), and the need for periodic re-evaluation. This review consolidates the current evidence, identifies gaps in left ventricular thrombus management, and proposes individualized strategies that consider factors like left ventricular function and bleeding risks.

Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death, but their function poses a significant challenge in palliative care, where goals shift from life prolongation to comfort. A substantial percentage of patients receive painful, futile shocks in their final days, causing significant distress. This review synthesizes evidence on the impact of these shocks and underscores the gap between clinical practice and patient-centered care. Key barriers to timely ICD deactivation include clinician discomfort, patient misconceptions, and systemic flaws like fragmented care and absent institutional protocols. Although a robust ethical framework founded on patient autonomy supports deactivation in certain circumstances, its principles are poorly implemented. This review argues for a paradigm shift towards proactive, interdisciplinary care, calling for structured communication, routine advance care planning, and the integration of palliative cardiology models to ensure this life-saving technology does not compromise a dignified death.

Plaque erosion is the second most common cause of acute coronary syndromes. It occurs in the absence of fibrous cap rupture, and typically shows luminal thrombi in direct contact with an intimal surface that lacks endothelial cells (ECs) but is enriched in smooth muscle cells and proteoglycan matrix. First described almost thirty years ago, plaque erosion accounts for an increasing fraction of acute coronary syndromes, but its frequency decreases with age in both men and women. Although a higher prevalence of erosion in women was suggested based on early observations, this has not been clearly borne out in more recent studies. The pathogenesis of plaque erosion is largely unknown; nevertheless, potential etiologic factors include disturbed flow and altered endothelial shear stress, elements of the innate and adaptive immune systems, hyaluronan and Toll-like receptor 2 signaling, activation of the NRF2 transcription factor, matrix metallopeptidase-mediated disruption of EC-extracellular matrix interactions, and distinct thrombotic mechanisms. While several of these factors are also linked to plaque rupture, existing evidence suggests that the biology of plaque erosion is substantially different from that of rupture; therefore, a deeper understanding of the molecular basis of coronary thrombosis associated with plaque erosion may guide the development of biomarkers and specific preventive or therapeutic strategies for acute coronary syndromes with intact fibrous cap. Such progress would pave the way for personalized care of these patients.

Cardio-obstetrics is a growing subspecialty focused on the prevention, diagnosis, and management of high-risk pregnancies in women with cardiac disease, a condition affecting 1-4 % of pregnancies and a leading cause of indirect maternal mortality in developed countries. The prevalence of maternal cardiac disease is rising as a result of increasing maternal age, obesity, comorbidities, and improved survival of individuals with congenital heart disease. Artificial intelligence (AI) is increasingly used in cardiology to enhance early diagnosis, risk stratification, and treatment planning, offering promising tools to support the diagnostic and therapeutic complexities of maternal cardiac disease. This review explores current applications of AI in cardio-obstetrics and highlights potential opportunities and barriers to its future integration in clinical care.