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.

The background for this review includes negative emotions-including anger, sadness, and chronic stress-that are biologically active contributors to atherothrombosis but remain under-integrated in prevention. The objective is to synthesize epidemiologic, mechanistic, and interventional evidence linking emotional dysregulation to the pathogenesis and acute expression of ASCVD, and to contextualize effect sizes alongside traditional risk factors. The methods include a narrative review of large cohorts and case-crossover studies, neural and immunologic mechanisms (amygdala-bone marrow-arterial axis), and trials of β-blockers, SSRIs, cognitive behavioral therapy (CBT), mindfulness, and endothelial function responses to provoked emotions. We found that depressive symptoms and trait anger confer ∼30-50 % higher incident MI risk; intense anger outbursts transiently raise MI risk up to ∼8-9 ×, and bereavement up to ∼20 × within 24 h. Stress-evoked amygdalar activity predicts myelopoiesis, arterial inflammation, and events. Mechanisms include HPA axis activation, IL-6/NLRP3 signaling, eNOS uncoupling, and catecholamine-driven platelet activation. Interventions such as β-blockers, SSRIs, CBT, and mindfulness improve vascular/inflammatory markers and may reduce event susceptibility. We conclude that emotions are causal drivers of atherothrombosis and acute coronary events. Incorporating emotion metrics, inflammatory biomarkers, and targeted behavioral/pharmacologic strategies into preventive cardiology can close residual risk gaps.

Numerous controversies still exist in the diagnosis and management of valvular heart disease, for example, the benefit of treating moderate aortic stenosis (AS) or asymptomatic, severe AS and the appropriate selection criteria for transcatheter edge-to-edge mitral valve repair. While numerous imaging parameters have been linked to the risk of sudden cardiac death in mitral valve prolapse, their relative merits are unknown and this is a challenging population to risk-stratify. No large, randomized data exist to guide selection of patients for transcatheter repair of tricuspid regurgitation or valve intervention in severe pulmonary regurgitation. Multimodality cardiac imaging provides unique insights into these important questions.

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.