US cardiology最新文献

[This corrects the article DOI: 10.15420/usc.2025.19.s1.].

Heart failure (HF) affects 6 million people in the US, and type 2 diabetes (T2D) is a significant risk factor for HF. Since 2008, regulatory agencies have required cardiovascular safety trials for new T2D therapies, and these have consistently demonstrated the cardiovascular benefits of glucose-lowering drugs. Sodium-glucose cotransporter inhibitors (SGLTi) and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs)/glucose-dependent insulinotropic polypeptide (GIP) reduce major adverse cardiovascular events and deaths, regardless of diabetes status, and improve cardiorespiratory fitness. SGLTis, such as dapagliflozin and empagliflozin, benefit patients with reduced and preserved ejection fraction, significantly reducing HF hospitalizations and cardiovascular deaths. The DAPA-HF and EMPEROR-Reduced trials showed dapagliflozin and empagliflozin reduce worsening HF or cardiovascular death by 26%. GLP-1 RAs such as semaglutide and the dual GLP-1/GIP receptor agonist tirzepatide improve clinical symptoms, HF hospitalizations, major adverse cardiovascular events, exercise capacity, and quality of life in patients with HF. However, these agents have side effects that must be considered. This review examines the role and efficacy of SGLTis and GLP-1 RAs in established HF.

Patients with atherosclerotic cardiovascular disease (ASCVD), such as those with a history of MI or stroke, are at high risk for morbidity and mortality associated with future cardiovascular events. Ideal management of these patients requires a multifactorial strategy for risk factor mitigation and prevention of additional cardiovascular events. Traditional management of secondary prevention patients involves lipid-lowering with statins, blood pressure control, and anti-platelet treatment. Several additional targets have been identified to optimize the secondary prevention of ASCVD, such as further lipid control, inflammation management, lifestyle and weight optimization, strict diabetes control, use of β-blockers, use of renin-angiotensin-aldosterone system inhibitors, vaccinations, and additional considerations of anti-thrombotic therapies. This review will describe the interventions associated with these targets, as well as the relevant research and indications for these therapies.

Amyloidosis is caused by extracellular deposition of amyloid protein in various organs and tissues. Light-chain amyloidosis is the most common systemic amyloidosis, whereas transthyretin amyloid cardiomyopathy is emerging as the underdiagnosed variant, especially in the elderly. Cardiac MRI and technetium-99m-pyrophosphate scintigraphy are specific non-invasive modalities that have simplified the diagnostic accuracy of cardiac amyloidosis. Identifying the type of amyloidosis is of paramount importance, given the differences in management protocols. Increased left-ventricular wall thickness and diastolic dysfunction are the most easily detectable manifestations of cardiac amyloidosis. Atrial involvement is early in both light-chain and transthyretin amyloidosis and is associated with high risk of arrhythmias and thromboembolic events. We report a case of wild-type transthyretin amyloid cardiomyopathy with predominant involvement of the right atrium and patchy involvement of the right and left ventricles.

With the increasing use of imaging for screening and diagnostic purposes, particularly coronary CT angiography, the number of adult patients diagnosed with anomalous origin of the coronary arteries (AOCA) has risen significantly. While current guidelines offer a general framework for managing and treating AOCA, patients present with diverse anomalies, symptoms, and clinical presentations, making broad recommendations less universally applicable. Notably, a wide range of treatment options exists, but there is no clear consensus on the best intervention strategy. Presented here are three cases of AOCA emphasizing the anatomical variations, clinical presentations, and the utility of coronary CT angiography in delineating anatomy and identifying high-risk features.

The care of the cardio-obstetric population in the cardiac intensive care unit is challenging due to limited data in this patient population. Optimal care requires a broad multidisciplinary team of experts such that both maternal and fetal health are fully supported. A deep understanding of the interplay between the hemodynamics of pregnancy and the clinical manifestations of varied cardiac disease states is essential. The assessment, diagnostic testing, and treatment of patients who are pregnant require special consideration, especially as teams consider pharmacological and invasive therapies. Complex ethical decisions often arise and therapies may be limited by federal and state policy, which adds an additional layer of complexity. This review serves as an introductory guide to cardio-obstetric care in the cardiac intensive care unit.

Inflammation and dyslipidemia are central to the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). While lipid-lowering therapies are the cornerstone of ASCVD prevention and treatment, there are other emerging targets, including inflammation (which has been dubbed the 'residual inflammatory risk'), that can be addressed after LDL cholesterol thresholds have been reached. Research over the past 20 years has identified C-reactive protein (CRP) as a key marker of inflammation with atherosclerosis. The association of more sensitive measures of CRP (high- sensitivity C-reactive protein [hsCRP]) with ASCVD risk in epidemiological studies has also led to its incorporation as a risk enhancer in primary prevention guidelines and its incorporation into risk stratification tools. While there are no formal recommendations related to measurement of hsCRP in secondary prevention, consideration should be given to an individualized approach that addresses inflammatory risk in those with major adverse cardiovascular events, despite maximal lipid-lowering therapy and well-controlled LDL cholesterol levels. The aim of this review is to discuss the role of inflammation in ASCVD, the use of hsCRP as a tool to assess residual inflammatory risk to target upstream pathways such as glucose intolerance and obesity, and to consider use of additional anti-inflammatory medications for ASCVD risk reduction. The authors provide clinical context around when to measure hsCRP in clinical practice and how to address residual inflammatory risk in ASCVD.

With the dawn of advanced technological and digital resources, medical education has changed. Learners are now able to learn, share, and communicate medical knowledge through online discussion forums, blogs, videos, podcasts, infographics, virtual communities, social media platforms, and collaborative author groups. Navigating these digital education modalities can be challenging, with each platform presenting unique challenges and opportunities. Digital educators need to learn how to navigate this uncertain territory, equipped with a skillset applicable to all digital spaces. This article explores the key components of a digital educator's skillset by examining the core foundations of learning theory, creation of digital education materials, and virtual communities of practice.

Background: There is a surprising lack of research surrounding effective teaching and learning methodologies in cardiology, especially in invasive coronary angiography (ICA). Therefore, a survey study was designed to assess perceived gaps in education in trainees' interpretation of ICA and available resources.

Methods: A 20-question survey was distributed via an online survey platform disseminated through a CardioNerds email newsletter and social media. The intended audience included medical trainees and medical students through to subspecialty fellows.

Results: The survey received 144 responses and 36% (n=52) said they anticipated working in interventional cardiology in future. Most participants (n=108; 77%) recorded more than 4 weeks of in-person experience in the cardiac catheterization laboratory per year; 35% (n=49) spent 4-12 weeks per year and 31% (n=44) spent 13-24 weeks per year. Most participants felt moderately or less comfortable interpreting coronary angiography. The most used resource was on-the-job training (n=102; 73%), followed by online resources (n=84; 60%) and textbooks (n=54; 39%). Over half of participants agreed that this knowledge might have changed or might still have the potential to change their career choice.

Conclusion: The results suggest that most students/trainees use on-the-job training to learn ICA, most were not comfortable interpreting ICA independently, and a better understanding of ICA might affect a student or trainee's choice of specialty. These results imply a need not only for dedicated educational time, but also for the creation of modern learning resources.