Cardiology in Review最新文献

This study aims to present the current evidence on the antihypertensive and cardioprotective properties of potassium. Increased potassium intake has been associated with antihypertensive and cardioprotective effects demonstrated by many studies, but its supplementation is infrequent in many countries and not frequently recommended by scientific societies. Hypertension is very common and a major risk factor for cardiovascular disease, heart failure, chronic kidney disease, strokes, and death, but it is poorly controlled, especially in developing countries. The causes for this are multiple and one of them could be the low potassium supplementation or lack of it. A review of the literature revealed that potassium supplementation decreases blood pressure, cardiovascular disease, heart failure, chronic kidney disease, strokes, and death. However, its intake is low and not recommended by several societal blood pressure treatment guidelines with the worldwide potassium intake to be quite low. This is happening despite the fact that potassium supplementation is very easy through potassium salt supplements and from the intake of fruits and vegetables rich in potassium content. Therefore, potassium intake should be recommended by physicians to their hypertensive patients, since its benefits significantly outweigh its risks.

Radiation therapy is a widely used treatment for cancer, but it can have detrimental effects on the heart, leading to radiotherapy-induced cardiotoxicity. This condition has become an area of increasing concern, especially as cancer treatments continue to evolve. This review aims to explore the recent literature on radiotherapy-induced cardiotoxicity, focusing on the latest research published. The goal is to identify recent advances in understandings of the underlying mechanisms of damage, risk factors, screening modalities, risk stratification, and novel treatment strategies for mitigating radiotherapy-induced cardiotoxicity. A narrative literature review of PubMed articles from the last 3 years was conducted to gather recent research on radiotherapy-induced cardiotoxicity including keywords such as "cardiac complications," "cardiotoxicity," "radiotherapy," and "radiation." This review identifies advances in understanding the mechanisms of cardiac damage, particularly the roles of humoral immunity and endothelial dysfunction. Recent studies have also highlighted key risk factors, including radiation dose, genetic predispositions, underlying cardiovascular conditions, and lifestyle factors. Additionally, the review emphasizes the need for enhanced surveillance and early detection of cardiotoxicity following radiation therapy, proposing a combined approach involving both imaging techniques and biomarker monitoring for more accurate assessment. Novel imaging methods and emerging biomarkers are being explored for their potential in improving detection and risk stratification. This review article also outlines the national guidelines and clinical recommendations for the prevention and management of radiotherapy-related cardiotoxicity. Despite these advancements, there remain significant gaps in understanding the full range of factors contributing to radiotherapy-induced cardiotoxicity, including the genetic contribution and the interaction between radiotherapy and other cancer treatments with regard to their contributions to cardiotoxicity. Additionally, further research is indicated to further elucidate the mechanisms of damage and the significance of biomarker changes relating to cardiotoxicity. Overall, this review underscores the importance of ongoing research to mitigate the cardiovascular risks associated with radiotherapy.

Vasomotor symptoms (VMS), such as hot flashes and night sweats, are experienced by over 80% of women during menopause and can significantly impair quality of life. While hormone replacement therapy (HRT) is the gold standard for managing VMS, concerns over its association with breast cancer, cardiovascular disease (CVD), and thromboembolic events have led to increasing interest in nonhormonal alternatives. This review explores the efficacy and cardiovascular safety of nonhormonal treatments for VMS. Given the heightened risk of CVD in postmenopausal women due to estrogen deficiency, the ideal nonhormonal therapy should not only alleviate VMS but also mitigate cardiovascular risks. Various nonhormonal options, including lifestyle modifications, acupuncture, cognitive behavioral therapy, and pharmacological agents such as SSRIs/SNRIs, gabapentin, clonidine, and the emerging class of neurokinin-3 receptor antagonists, are examined. Clinical trials demonstrate that SSRIs (eg, paroxetine) and SNRIs (eg, venlafaxine) provide significant VMS relief, particularly for women who are unable to use HRT. Neurokinin-3 receptor antagonists, such as fezolinetant, show promising results in reducing hot flashes without affecting cardiovascular health. While more research is needed to further assess long-term outcomes, nonhormonal therapies present a viable and safer alternative for managing VMS, especially for women at risk for cardiovascular complications.

Cardiovascular disease (CVD) has remained the leading cause of death among adults for more than one hundred years. With persistently suboptimal outcomes and a profound economic burden on our healthcare system, there is growing interest in alternative treatment approaches for CVD. One such approach is Tongxinluo (TXL) capsules, a Traditional Chinese Medicine (TCM). TXL is commonly used in China and offers a potentially safe, efficacious, and cost-effective treatment option. To address the limited awareness of TXL in the United States, this narrative review will provide a broad overview of its composition, pharmacological mechanisms, and clinical applications.

Diabetic individuals of reproductive age face higher risks of poor pregnancy outcomes and abnormal fetal development. Approximately 4.5% of women of reproductive age have diabetes, with non-Hispanic Black women having the highest prevalence of 15%. Research on the impact of paternal diabetes on offspring cardiac anomalies is limited, but it may interact with metabolic syndrome to increase long-term health risks. Infants of diabetic parents are more likely to develop cyanotic and acyanotic heart defects, hypertrophic cardiomyopathy, and subsequently other cardiovascular issues. Fetal hyperinsulinemia, caused by maternal hyperglycemia, contributes to these conditions through oxidative stress, impaired heart development, and cardiac remodeling. Long-term risks include diabetes, arrhythmias, pulmonary hypertension, heart failure, and early-onset cardiovascular disease. Treatment options are limited, often requiring surgery for severe conditions. Prevention focuses on tight glycemic control, a balanced diet, avoiding teratogens (nicotine, alcohol, or drugs), and using technology like continuous glucose monitors and insulin pumps, along with pregnancy screening and monitoring protocols. Understanding the effects of parental diabetes on offspring's cardiac health is crucial for early intervention, prevention, and improved maternal-fetal care, ultimately reducing the burden of congenital heart defects and long-term cardiovascular complications.

Patient-centered health care (PCC) is a framework of clinical care focused on the patient's individual health care needs. In particular, it emphasizes the development of a partnership between the patient, physician, and healthcare workers to actively involve and empower the patient in their health care decisions. Additionally, PCC goals include ensuring access to care, emotional support, engaging patient support systems, physical comfort, and continuity of care. Technology also provides a platform to engage patients and their families in their care and can be a useful tool to gauge their level of interest, knowledge, and motivations to adequately educate them on the many factors that contribute to their disease, including diet, exercise, medication adherence, psychological support, and early symptom detection. In this article, we summarize the importance of technology in promoting PCC in cardiac rehabilitation and the impact technology may have on the different aspects of patient and physician relationships. Modern technological devices including smartphones, tablets, wearables, and other internet-enabled devices have been shown to help patient-staff communication, cater to patients' individual needs, increase access to health care, and implement aspects of PCC domains.

Mitral annular disjunction (MAD) is the atrial displacement of the mitral valve (MV) hinge point, especially along the posterior mitral leaflet, which leads to inhomogeneous blood flow into the left ventricle, causing chronic fibrotic changes, malignant arrhythmias, and even sudden cardiac arrest. Some studies suggest that MAD is a part of normal heart morphology; however, the origin is still controversial. MAD commonly occurs with MV prolapse and myxomatous degenerative MV disease. In almost 20% of cases, MAD can occur independently as well. The prevalence of MAD in normal hearts varies from 8.6% to 96%, depending on the imaging modality and the cutoff used to define MAD. Transthoracic echocardiography is often the initial screening test, but the low sensitivity of transthoracic echocardiography to identify MAD makes it easy to miss the diagnosis altogether. More advanced imaging, especially cardiac MRI, is the gold standard for diagnosing MAD and risk stratification. MAD is an independent predictor of malignant arrhythmia. Among patients with MAD, risk stratification is based on the age at diagnosis, previous syncopal attacks, premature ventricular contractions, papillary muscle fibrosis, and longitudinal disjunction distance. Most asymptomatic patients are managed conservatively; however, radiofrequency ablation should be considered in patients with high-risk or symptomatic MAD due to the risk of ventricular arrhythmias and sudden cardiac death.

Thrombi in the left atrial appendage (LAA) are an important cause of systemic thromboembolism in patients with atrial fibrillation. The gold standard for the diagnosis of LAA thrombi is a transesophageal echocardiogram, although cardiac multidetector computed tomography, intracardiac echocardiogram, and cardiac magnetic resonance imaging are alternative diagnostic imaging modalities. When an LAA thrombus is diagnosed, effective anticoagulation is recommended for at least 3 weeks or until thrombus resolution is confirmed on repeat transesophageal echocardiogram. Recent prospective research shows the efficacy of nonvitamin K oral anticoagulants in the treatment of LAA thrombus, which offers a promising alternative to vitamin K antagonists. As an alternative approach, left atrial aspiration thrombectomy has been described in case reports, though there is limited evidence comparing its efficacy to anticoagulation alone.

Antiphospholipid syndrome is a rare, autoimmune thrombophilia defined by vascular thrombosis and pregnancy morbidity, in the setting of documented persistent antiphospholipid antibodies including the lupus anticoagulant, anticardiolipin antibodies, or anti-β2 glycoprotein I antibodies. The presence of antiphospholipid antibodies can be completely asymptomatic, or they can lead to clinical manifestations as severe as catastrophic antiphospholipid syndrome, which involves widespread coagulopathy over a very short period of time. The degree of risk associated with antiphospholipid syndrome depends on the characteristics of the antiphospholipid antibody profile and on the presence of additional thrombotic risk factors. The current standard treatment for unprovoked thrombosis is long-term warfarin. Treatment to prevent recurrent obstetric complications is low-dose aspirin and prophylactic heparin in pregnant patients. The use of direct oral anticoagulants in patients with antiphospholipid syndrome is still being debated. Their use is generally contraindicated, especially in high-risk patients, such as those with all 3 antiphospholipid antibodies present, but they may potentially be of some use in some low-risk patients.