Progress in cardiovascular diseases最新文献

Aims: Data on cardiac myosin inhibitors (CMIs) in obstructive hypertrophic cardiomyopathy (oHCM) are rapidly emerging. This systematic review and meta-analysis evaluated the efficacy and safety of CMIs in randomized placebo-controlled trials.

Methods: Phase 3 randomized placebo-controlled trials published up to 22-Apr-2025 were included. Outcomes extracted included symptoms, cardiopulmonary exercise testing (CPET), biomarkers, transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR), and safety data. Frequentist (common/fixed effect, random) and Bayesian meta-analyses were performed using trial-level data to pool estimates of effects.

Results: Four randomized placebo-controlled trials involving 726 patients with oHCM were included (444 mavacamten/placebo, 282 aficamten/placebo). Trial follow-up durations ranged from 16 to 30 weeks. In common/fixed effects meta-analyses, CMIs were associated with a greater proportion achieving ≥1 NYHA improvement [difference 36 % (95 % CI 29, 43)] and an increase in KCCQ-CSS [8.4 (6.6, 10.2) points] versus placebo. CMIs significantly improved several CPET parameters including increased peak oxygen consumption [1.6 (1.0, 2.1) mL/kg/min] and reduced VE/VCO₂ [-2.0 (-2.7, -1.3)]. CMIs significantly reduced NT-proBNP [-79 % (-81 %, -77 %)] and hs-cTnI [-50 % (-54 %, -46 %)]. CMIs led to significant reductions in resting LVOT-G [-40 (-45, -35) mmHg] and favourable cardiac remodelling in other TTE and CMR parameters. Although CMIs increased the likelihood of LVEF <50 %, consistent with its known mechanism of action, none of these patients developed heart failure. No significant differences were seen in safety outcomes.

Conclusions: Mavacamten and aficamten significantly improve symptoms, enhance exercise performance, improve cardiac biomarkers, reduce LVOT obstruction, and promote favourable cardiac remodelling. These findings suggest a class effect of CMIs.

Prospero registration: CRD42024582096.

Mast cells have emerged as pivotal regulators of cardiovascular physiology and pathology, influencing key processes including fibrosis, angiogenesis, tissue regeneration, and atherosclerosis. This review synthesizes findings from 110 studies to delineate the multifaceted roles of mast cells across these domains. Historically associated with allergic responses, growing evidence now underscores their substantial contribution to the progression of cardiovascular diseases. In fibrotic remodeling, mast cells facilitate extracellular matrix deposition and fibroblast activation through the release of pro-fibrotic mediators such as tryptase and chymase. In the context of angiogenesis, mast cells enhance endothelial proliferation and vascular permeability, predominantly through VEGF-driven signaling pathways. Although the role of mast cells in cardiac regeneration remains underexplored, current evidence suggests a context-dependent function in modulating stem cell dynamics and inflammatory microenvironments. Additionally, mast cells can participate in the pathogenesis of atherosclerosis by promoting lipid accumulation, vascular inflammation, and plaque destabilization. Collectively, these findings highlight mast cells as integral components of cardiovascular disease mechanisms. Therapeutic targeting of mast cell-derived mediators and signaling pathways, through stabilizers, enzyme inhibitors, or selective modulators, represents an avenue worthy of investigation for clinical intervention. Future studies should refine these strategies, aiming to mitigate mast cell-driven pathogenesis while preserving their physiological roles in tissue homeostasis and immune defense.

Objective: Aortic dissection presents significant variations in incidence, treatment, and outcomes based on demographic and clinical factors. This study leverages official databases to elucidate the epidemiological trends of aortic dissection and related syndromes in Spain while examining demographic, clinical, and economic variables.

Methods: A Python-based workflow refined and classified data from the Spanish hospital database (2016-2021) of patients with aortic dissection, crosslinking age, sex, management, and resource use. The study examined sex- and age-specific differences, quantified treatment modalities in relation to outcomes such as procedure choice and in-hospital case fatality, and assessed hospitalization and intervention costs to evaluate the economic burden.

Results: Findings from 9587 cases reveal persistently high case-fatality (∼20 %) despite advancements in diagnosis and highlight disparities in care. Case-fatality was significantly higher in females (29.3 %) than in males (22.4 %), with diagnoses occurring at an older age in females compared to males (70.4 vs. 65.5 years). Open surgery remains as the predominant strategy across all analyzed aortic locations despite the medical and economic advantages of percutaneous intervention, although the database's limitation in recording cases according to the Stanford classification hinders the ability to criticize the treatment selection.

Conclusion: Clinical data highlight the need for innovative medical and technological solutions. Moreover, transitioning to a new data system could enhance epidemiological reliability and improve patient management.

Background: Cardiomyopathies encompass a heterogeneous group of myocardial diseases with variable clinical manifestations and prognoses. Despite their complexity and association with high-risk outcomes, malpractice claims related to cardiomyopathies have not been well-characterized.

Objective: To characterize medicolegal claims associated with non-ischemic cardiomyopathies in the United States and identify common clinical and systemic contributors to liability.

Methods: A retrospective review of U.S. malpractice and negligence claims from inception to 2025 was conducted using Westlaw, vLex, and a sports cardiology litigation database. Included cases involved a diagnosis or clinical suspicion of cardiomyopathy directly linked to a legal claim. Case frequency, location, demographics, allegations, defendant profiles, and outcomes/awards were identified for all eligible cases.

Results: Of 421 cases reviewed, 63 (15 %) met inclusion criteria, spanning 1990-2025 with 1.8 cases/year. Hypertrophic (38 %) and dilated (31 %) cardiomyopathies were the most frequently litigated subtypes. Sudden cardiac arrest/death occurred in 79 % of cases. Leading allegations were failure to diagnose cardiomyopathy (37 %), inappropriate treatment (27 %) and communication failures (19 %). Non-cardiology providers, particularly primary care, were the most frequently named defendants (83 %), while cardiologists were implicated in 29 % of cases. Incarcerated individuals accounted for 16 % of cases. Most outcomes favored defendants (54 %), while 13 % resulted in plaintiff-favorable verdicts or settlements, with awards ranging from $100,000-$21,568,710 ($200,999 - $28,039,323 adjusted for inflation).

Conclusion: While rare, malpractice claims related to cardiomyopathies are often associated with preventable failures in diagnosis, treatment and communication. These findings underscore the need for improved provider education, standardized diagnostic pathways, and clinical decision support tools to mitigate liability and enhance patient safety.

Coronary computed tomography angiography (CCTA) has emerged as a pivotal tool in the non-invasive evaluation of coronary artery disease (CAD). Recent advancements in imaging techniques, quantitative plaque assessment methods, assessment of coronary physiology, and perivascular coronary inflammation have propelled CCTA to the forefront of CAD management, enabling precise risk stratification, disease monitoring, and evaluation of treatment response. However, challenges persist, including the need for cardiovascular outcomes data for therapy modifications based on CCTA findings and the lack of standardized quantitative plaque assessment techniques to establish universal guidelines for treatment strategies. This review explores the current utilization of CCTA in clinical practice, highlighting its clinical impact and discussing challenges and opportunities for future development. By addressing these nuances, CCTA holds promise for revolutionizing coronary imaging and improving CAD management in the years to come. Ultimately, the goal is to provide precise risk stratification, optimize medical therapy, and improve cardiovascular outcomes while ensuring cost-effectiveness for healthcare systems.