Current Opinion in Cardiology最新文献

Purpose of review: This review discusses current research (between July 2024 and January 2026) on sleep disorders and cardiovascular disease, highlighting underlying biological processes, clinical outcomes, and therapeutic strategies.

Recent findings: More than a billion adults worldwide are affected by sleep disorders that significantly increase heart disease risk. Obstructive sleep apnoea (OSA) is increasingly recognised as an independent predictor of major cardiovascular complications, with nocturnal hypoxaemia emerging as a critical marker for risk stratification. Continuous positive airway pressure (CPAP) may decrease cardiovascular complications in selected high-risk patients with OSA. In addition, irregular sleep patterns and insufficient sleep duration are associated with arrhythmias and cardiac failure. Sleep disruption contributes to adverse cardiac remodelling through mechanisms involving oxidative stress and autonomic dysfunction. Genetic studies further support a direct causal relationship between OSA and coronary heart disease. Sleep has been added by the American Heart Association to its Life's Essential 8 framework, emphasising its role in cardiovascular health.

Summary: Sleep disorders represent a modifiable cardiovascular risk factor that warrants systematic assessment and targeted management. Optimal sleep health encompasses sufficient duration, appropriate timing, and regularity. Treatment of sleep disorders-particularly OSA with CPAP therapy in carefully selected high-risk populations-can confer cardiovascular benefits.

Purpose of review: Cardiovascular disease is a leading cause of morbidity and mortality among patients with cancer, yet individual risk is highly heterogeneous. This review examines cardiometabolic vulnerability as a unifying framework linking baseline cardiometabolic risk factors with cancer therapy-related cardiovascular injury and discusses emerging pharmacologic and lifestyle interventions for cardiovascular risk mitigation.

Recent findings: Epidemiologic and mechanistic studies demonstrate that obesity, insulin resistance, dyslipidemia, and hypertension, often exacerbated by cancer therapies, amplify systemic inflammation, neurohormonal activation, endothelial dysfunction, and metabolic inflexibility. These disturbances interact with specific anticancer treatments, including anthracyclines, HER2-targeted agents, VEGF pathway inhibitors, endocrine therapies, and immune checkpoint inhibitors, increasing susceptibility to diverse cardiovascular toxicities. Emerging evidence supports multimodal preventive strategies integrating pharmacologic interventions targeting neurohormonal, metabolic, and inflammatory pathways with lifestyle modifications, though optimal approaches require further validation in cancer populations.

Summary: Cardiometabolic vulnerability provides a framework to understand heterogeneous cardiovascular risk in cancer patients. Integrating cardiometabolic profiling with therapy-specific risk assessment may improve prevention strategies in cardio-oncology. Continued research is needed to refine risk stratification and inform personalized approaches for this growing population.

Purpose of review: The 2025 ESC/EACTS Guidelines for valvular heart disease introduce substantial changes in timing and modality of intervention, making a focused appraisal of their surgical implications highly relevant for contemporary cardiac practice.

Recent findings: The guidelines formalize imaging-based staging of cardiac damage, lower thresholds for intervention in aortic stenosis and primary mitral regurgitation, and refine age- and risk-stratified allocation of surgery vs. transcatheter therapies across aortic, mitral, and tricuspid disease. They expand indications for transcatheter aortic valve implantation, mitral and tricuspid transcatheter edge-to-edge repair, and transcatheter valve replacement in carefully selected high-risk patients, while strengthening the role of durable surgical valve repair, complex aortic and multivalve procedures, and lifetime valve management strategies. Organizationally, they define and emphasize the importance of Heart Valve Centres and volume-outcome relationships.

Summary: These guideline recommendations reflect upon contemporary evidence to support thoughtful decision making, encourage earlier intervention, and reinforce the central role of cardiac surgery and cardiology partnerships in achieving best patient outcomes through Heart Valve Centres. Cardiac surgeons should continue advance excellence in valve repair and reconstructive surgery and embrace the complementary role of transcatheter valve therapies.

Purpose of review: The aim of this study is to provide an updated overview on exercise training as an optimal strategy for preventing and treating cardiometabolic complications.

Recent findings: Physical inactivity is recognized as one of the most significant, modifiable risk factors for cardiovascular disease (CVD), the leading cause of mortality worldwide. Despite well established guidelines, nearly one-third of adults fail to meet recommended activity levels. Physical inactivity is associated with increased risk of CVD and cardiometabolic complications including coronary artery disease, heart failure, hypertension, stroke, obesity, type 2 diabetes, and dyslipidemia. Home exercise prescriptions and supervised exercise training programs including aerobic ± resistance training have been shown to modify risk and treat cardiometabolic disease. This includes positive effects on glycemic control, obesity, stroke, hypertension, heart failure, and primary and secondary prevention of atherosclerotic CVD. The cardioprotective effects of exercise training programs appear to be multifactorial, mediated through specific structural and functional cardiovascular adaptations, and systemic effects including improved lipid metabolism, enhanced mitochondrial efficiency, and attenuation of systemic inflammation.

Summary: In this review, we summarize recent evidence for various exercise training programs in preventing and managing cardiometabolic disease and explore the physiologic mechanisms underlying their cardiovascular benefits.

Purpose of review: To synthesize current evidence supporting intentional weight reduction as a cardiometabolic strategy for treating and preventing heart failure (HF) across the ejection-fraction spectrum, examine the influence of baseline obesity on treatment effects of established HF therapies, and highlight key knowledge gaps and future research directions.

Recent findings: Visceral adipose tissue, central obesity, and dysfunctional adipose mass are linked to the development and progression of HF with preserved ejection fraction (HFpEF). Recent trials show that incretin-based therapies (semaglutide, tirzepatide) improve exercise capacity, symptoms, and quality of life in HFpEF, and potentially reduce HF events. Patients with higher degrees of obesity may derive greater benefit from incretin-based therapies and other guideline-directed therapies, including mineralocorticoid receptor antagonists (MRA), sodium-glucose transport 2 (SGLT2) inhibitors, and angiotensin receptor-neprilysin inhibitor (ARNI). While observational studies suggest intentional weight loss may lower HF risk, randomized trials of antiobesity medications have yet to further clarify this potential benefit.

Summary: Weight loss is currently recommended as an optimal strategy for individuals with obesity and HFpEF, given consistent benefits for exercise capacity, functional status, and quality of life, with a potential for reducing clinical events. Intentional weight loss impact in HFrEF and its role in primary HF prevention remains uncertain. Large, well designed cardiovascular outcome trials of intentional weight-loss interventions in populations with obesity and HF, or obesity and elevated HF risk, are needed to establish clinical efficacy and better define individuals who benefit from those interventions across the spectrum of ejection fraction.

Purpose of review: Mechanical prosthetic heart valves have been implanted for decades, but have seen declining utilization in modern cardiac surgery. We aim to explore recent literature on the risks and benefits of mechanical prostheses.

Recent findings: The desire of patients to avoid anticoagulation and good performance of bioprosthetic valves appears to have driven a decline in the percentage of mechanical valve use, with mechanical valves now accounting for <20% of aortic and mitral prosthetic implants. However, modern mechanical valves exhibit excellent hemodynamics and durability. Modern bioprosthetic surgical valves are durable, but still experience structural valve deterioration (SVD), especially in younger patients. Transcatheter aortic valve replacement (TAVR) valves are a special case of bioprostheses in which long-term valve durability remains unclear, but presumably will have similar SVD rates to surgical bioprostheses. The true durability of TAVR-in-surgical aortic valve replacement (SAVR) remains unproven and the promise of this for younger patients is without significant data. Moreover, though bleeding risks due to anticoagulation are real and warfarin alternatives elusive, lower INR targets for mechanical valves may be a safe and promising approach. In keeping with the data on the tradeoffs of SVD and anticoagulation, multiple well conducted retrospective studies have confirmed age cutoffs below which patients have a mortality benefit from mechanical valves.

Summary: Mechanical valves are associated with improved survival in younger patients with excellent hemodynamics and may be underutilized.

Purpose of review: Infective endocarditis (IE) remains a prevalent and high-risk condition despite advances in cardiac care. Increasing attention has been directed toward sex-based differences in physiological presentation, disease progression, and surgical management. This review synthesizes evidence on sex-specific differences in IE, with an emphasis on diagnosis, risk factors, disease manifestations, medical management, surgical intervention, and postoperative outcomes.

Recent findings: While the incidence of IE is more than twice as high in men, women consistently experience worse outcomes. Women present at an older age, with greater comorbidity burden and greater delays in surgical referral. Postoperatively, women are at higher risk of complications - including embolic events, extended ventilation time, and intensive care unit stays - and have significantly higher short-term mortality. Long-term survival is comparable between sexes, suggesting disparities largely influence short-term outcomes.

Summary: Awareness of sex-specific differences in risk factors, clinical presentation, intervention bias, complications, and outcomes of IE is essential for optimizing management and equitable care. Further research into sex-based pathophysiology, comorbidity management, and tailored perioperative strategies is critical to advancing patient-centered treatment and optimizing clinical outcomes.

Purpose of review: National databases reveal increased application of the surgical robot to facilitate mitral valve repair. Single-center and multiinstitutional studies confirm that excellent results are achievable with robotic mitral valve repair. However, not all patients with degenerative mitral valve disease are appropriate candidates for robotic mitral valve repair.

Recent findings: With increased experience, surgeons have successfully applied the surgical robot to perform mitral valve repair in conjunction with concomitant procedures. Concurrently, selection criteria have expanded, enabling more patients to enjoy the benefits of a less invasive approach. A small group of patient-related and anatomic factors are best managed via a standard sternal approach.

Summary: Approaching 15% of all mitral valve repairs for degenerative disease, robotic mitral valve repair has reached an inflection point in its growth. Well tolerated application of this technology requires understanding of both its advantages and its limitations.

Purpose of review: Tumours involving cardiac valves pose complex diagnostic and therapeutic challenges. In this review, we use three theoretical cases as a foundation to explore diagnostic workup, therapeutic interventions, and follow-up for both benign and malignant tumours of the heart valves.

Recent findings: While the differential for valvular masses is broad, the most common valvular tumours are benign. Multimodal imaging, usually beginning with echocardiography, and tissue sampling where feasible, are the core tenants of diagnostic workup. Highly mobile lesions on a stalk that are isolated to the valve are likely to be papillary fibroelastomas. However, malignancy should be considered in cases of immobile lesions with unclear boundaries. Based on available data, left sided benign tumours involving valves should be excised promptly given the safety and efficacy of operative approaches and the risk of embolization. For suspected malignancy, biopsy should be organized and a centre of excellence should be consulted. Given that recurrence is possible for benign lesions, and is effectively certain for malignant lesions, a lifelong follow-up plan is crucial.

Summary: Current treatment paradigms for valvular tumours described herein are based entirely from anecdotal and retrospective data. Future standardization and optimization of treatment protocols depend on the systematic gathering of long-term prospective data.

Purpose of review: Technical progress in noninvasive medical imaging continues to enhance diagnosis and intervention, with three-dimensional (3D) imaging emerging as a significant advancement over traditional methods. While 3D visualization is widely used to evaluate a living heart, precise measurement from such images remains challenging. This review describes a new technique named isosurface geometric measurement on volume-rendered images (IMVR), which facilitates accurate 3D measurement of complex cardiovascular anatomy.

Recent findings: Direct volume rendering provides clear visualization and tissue identification, but the lack of exact spatial boundaries inherently makes measurement of any anatomical feature difficult. However, by superimposing a surface-rendered polygonal mesh (representing isosurface geometry) onto a variably transparent volume image of the heart, IMVR enables significantly easier and more accurate 3D measurement. This technique demonstrates versatility across various cardiovascular, anatomical, and clinical applications, including preinterventional assessment and planning for structural heart diseases, notably expanding 3D imaging's utility toward precision medicine and personalized treatment.

Summary: This review article summarizes recent advances in cardiac imaging, highlighting an efficient IMVR technique, which combines volume-rendered images with superimposed surface-rendered image to facilitate accurate 3D measurements of cardiac anatomical features.