Trends in Cardiovascular Medicine最新文献

Aortic aneurysm is a leading cause of death across the world. Many victicms carry it without knowing. Ruputre of aortic aneurysms leads to devastating sudden death. This brings trauma to families and our society. Based upon sound results out of several cohort studies, US Preventative Services Task Force (USPST) crafted the 1st nationwide abdominal aorta aneurysm (AAA) screening program in 2005. It was renewed and expanded in each of the subsequent revisions in 2014 and 2019. UK and Sweden estalished their own programs as well. Since then, a significant decline in AAA prevalence and mortality has been observed. Two decades into the practice, the state of the art on diagonstics, surgical approaches, and pharmacological options have drastically changed. Patients previously ineligible for treatment or inconclusive on diagnostics now have valid options. The screening program is on the verge for a bold expansion. In this review, we summarize the chroncles leading to the inception of the screening programs, progress in interpretation after implementation including gains, gaps and controversies, advents of new technologies and approaches, new fronts facing us, as well as priorities to be addressed in future phases. Particularly, screening asssys with a clinically tested biomarker, tetrahydrobiopterin (H₄B), enables unpresended accessibility, consistency and throughput to accommodate the needs of a larger population. Furthermore, patients with AAAs at size below the eligibility threhold for surgical intervention (e.g., < 5.5 cm) can be treated with novel oral medications. Confronting factors such as changing demographics and COVID-19 aftermath are putting up new challenges. Nevertheless, running a program at national scale demands both unwavering commitment and agile fine-tuning. Technical innovation will be an indispensable chapter of its continued success. The burden of aortic aneurysm-led sudden death is too heavy for any family and the society to bear; it is time to step up our resolve with additional capacities as discussed in the present review.

Location-based disparities in cardiovascular health are multifaceted and deeply intertwined with historical, environmental, socioeconomic, and healthcare access factors. This scoping review explores the associations between residential locations and cardiovascular disease (CVD). We reviewed articles that describe environmental influences, socioeconomic determinants, healthcare access challenges, and societal influences in the location-specific development of CVD. We describe some of the social determinants within geographical and neighborhood-level contexts that drive CVD inequality and explore potential future directions for addressing these disparities.

Takotsubo syndrome (TTS) is a condition of acute ventricular dysfunction mainly in aging women that is frequently precipitated by episodes of physical or emotional stress. The association with negative emotional triggers such as fear, grief, or interpersonal conflicts was observed soon after the first description of TTS three decades ago and led to the popular term "broken heart syndrome". However, more recent research shows that TTS can also be provoked by pleasant emotions in some patients, referred to as "happy heart syndrome". This review will discuss the role of stressful triggers in patients with TTS and their impact on the course of the disease with a particular focus on characteristic features of happy heart syndrome.

Atrial fibrillation (AF) is a complex condition caused by various underlying pathophysiological disorders and is the most common heart arrhythmia worldwide, affecting 2 % of the European population. This prevalence increases with age, imposing significant financial, economic, and human burdens. In Europe, stroke is the second leading cause of death and the primary cause of disability, with numbers expected to rise due to ageing and improved survival rates. Functional recovery from AF-related stroke is often unsatisfactory, leading to prolonged hospital stays, severe disability, and high mortality. Despite advances in AF and stroke research, the full pathophysiological and management issues between AF and stroke increasingly need innovative approaches such as artificial intelligence (AI) and machine learning (ML). Current risk assessment tools focus on static risk factors, neglecting the dynamic nature of risk influenced by acute illness, ageing, and comorbidities. Incorporating biomarkers and automated ECG analysis could enhance pathophysiological understanding. This paper highlights the need for personalised, integrative approaches in AF and stroke management, emphasising the potential of AI and ML to improve risk prediction, treatment personalisation, and rehabilitation outcomes. Further research is essential to optimise care and reduce the burden of AF and stroke on patients and healthcare systems.

Left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure, providing mechanical circulatory support for patients awaiting heart transplantation or as destination therapy. However, patients on LVAD support are susceptible to a range of emergency medical conditions that require prompt recognition, intervention, and multidisciplinary management. This review paper aims to provide an algorithmic approach and a field guide on the diagnosis and management of emergency medical conditions in LVAD patients, including LVAD alarms, gastrointestinal bleeding, cerebrovascular accidents, pump thrombosis and obstruction, unresponsiveness, and electrical shock by the defibrillator. By understanding the mechanisms, clinical presentation, diagnostic evaluation, and therapeutic strategies associated with these conditions, healthcare providers can improve patient outcomes and optimize LVAD care.

Cardiovascular disease remains a major contributor to maternal morbidity and mortality in the United States. Cardio Obstetrics is a nascent field for which most cardiovascular clinicians have not received any formal training. This has resulted in knowledge and care gaps. In this review we provide principles to guide the care for the evaluation and management of pregnancy capable individuals, which should be considered the standard knowledge for all clinicians.

Unexplained sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in the young remains a critical issue for clinicians, researchers, patients and their family members. In this review, we explore the current status of SCA and SCD evaluation in the young, including recent monogenic and polygenic disease discoveries, advancements in cardiac imaging and our growing understanding of the role of the Purkinje system in triggering life threatening and even fatal ventricular arrhythmias. Yet, despite these advancements, over a third of SCA and SCD among individuals with seemingly structurally normal hearts remain unexplained. We explore the future role of artificial intelligence, novel biomarkers, multimodality cardiac imaging, genetic discoveries, as well as wearable devices and sensors in closing this current gap. With the overarching framework provided in this review, we envision a future in which collaboration among patients, clinicians, researchers, innovators, and policy makers culminates in our ability to diagnose, predict, and ultimately prevent SCA and SCD in the young.