Cardiology in Review最新文献

Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and mortality worldwide, yet blood pressure control rates remain suboptimal despite the availability of effective therapies. Contemporary guidelines increasingly recommend early use of combination therapy, recognizing that most patients require multiple agents to achieve target blood pressure. Widaplik, a recently Food and Drug Administration-approved fixed-dose, single-pill triple combination of telmisartan, amlodipine, and indapamide, represents the first triple therapy approved for initial treatment of hypertension in adults likely to need multidrug therapy. This review summarizes the pharmacologic rationale for low-dose triple therapy, highlighting complementary mechanisms targeting the renin-angiotensin-aldosterone system, vascular resistance, and sodium retention. We examine evidence from pivotal phase 3 trials demonstrating rapid, sustained blood pressure reductions, higher control rates compared with dual therapy, and favorable tolerability. We also discuss safety considerations, practical limitations, and gaps in evidence, including long-term cardiovascular outcomes. Widaplik represents a paradigm shift toward simplified, early combination therapy aimed at improving hypertension control and reducing cardiovascular risk.

Coronary microvascular dysfunction (CMD) is increasingly recognized as a central mechanism underlying myocardial ischemia, heart failure with preserved ejection fraction, and adverse cardiovascular outcomes in patients with and without obstructive coronary artery disease. The coronary microcirculation plays a critical role in regulating myocardial perfusion through tightly coordinated myogenic, metabolic, and endothelial pathways. Disruption of these mechanisms results in impaired vasodilatory capacity, abnormal coronary flow reserve, and microvascular ischemia. This review summarizes the anatomy and physiology of coronary microcirculation and examines the pathophysiologic mechanisms driving CMD, including endothelial dysfunction, structural remodeling, inflammation, and neurohormonal dysregulation. Contemporary diagnostic strategies are reviewed, with emphasis on invasive coronary function testing and advanced noninvasive imaging modalities such as positron emission tomography and cardiac magnetic resonance imaging. The clinical implications of CMD across diverse disease states, including ischemia with nonobstructive coronary arteries, heart failure, and cardiomyopathies, are discussed. Finally, current therapeutic approaches, prognostic considerations, and emerging research directions aimed at improving diagnosis and targeted treatment of CMD are highlighted.

Venous thromboembolism (VTE) is a leading cause of cardiovascular morbidity and mortality. Evidence directly comparing direct oral anticoagulants (DOACs) with placebo for extended anticoagulation is limited. We conducted this systematic review and meta-analysis following Preferred Reporting Items for Systematic Review and Meta-Analyses and Cochrane guidelines. We identified randomized controlled trials that compared DOACs with placebo for extended VTE therapy in PubMed, Cochrane Library, and ClinicalTrials.gov up to October 2025. We calculated pooled risk ratios (RR) with 95% confidence intervals (CI) using a random-effects model. We assessed risk of bias using the Cochrane tool and evaluated certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Four randomized controlled trials (n = 5621) met the inclusion criteria. DOACs significantly reduced all-cause mortality (RR, 0.38; 95% CI, 0.19-0.76; P = 0.006) and VTE recurrence (RR, 0.17; 95% CI, 0.12-0.24; P < 0.0001). DOACs did not significantly increase the incidence of major bleeding compared to placebo (RR, 1.84; 95% CI, 0.33-10.21; P = 0.48), but they increased clinically relevant nonmajor bleeding (RR, 3.13; 95% CI, 2.23-4.39; P < 0.0001). Extended DOAC therapy reduces VTE recurrence and mortality, with no significant increase in major bleeding but a higher risk of clinically relevant nonmajor bleeding. Patients at low bleeding risk benefit most from carefully selected long-term DOAC use.

The choice of vascular access in percutaneous coronary intervention (PCI) significantly influences procedural safety and patient outcomes. While the transradial approach (TRA) is established as superior in acute coronary syndromes, its efficacy and safety in chronic coronary syndromes (CCS) undergoing elective PCI remain less clearly defined. This meta-analysis aimed to compare the TRA versus the transfemoral approach exclusively in patients with CCS. A systematic search of PubMed, Embase, and Cochrane Library was conducted from inception to September 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Randomized controlled trials and observational studies comparing the TRA and transfemoral approach in CCS were included. Primary outcomes were 30-day mortality, major adverse cardiovascular events, and major bleeding. Secondary outcomes included myocardial infarction, stroke, blood transfusion, procedural success, hospital stay, and access-site surgery. Data were pooled using a random-effects model, and certainty of evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluations framework. Seven studies met the inclusion criteria. TRA significantly reduced major bleeding risk (risk ratio, 0.41; P < 0.0001) and the need for blood transfusion (risk ratio, 0.36; P = 0.0003). No significant differences were observed in 30-day mortality (P = 0.84), major adverse cardiovascular events (P = 0.25), myocardial infarction (P = 0.40), stroke (P = 0.13), or procedural success (P = 0.30). Heterogeneity was low for most outcomes. In patients with CCS undergoing elective PCI, the TRA significantly reduces bleeding and transfusion risk without compromising procedural success or major cardiovascular outcomes. These findings reinforce TRA as the preferred access site even in stable, low-risk populations, supporting its broader adoption in contemporary practice.

This updated meta-analysis set out to investigate the effect of nurse-led telecoaching on anxiety, depression, heart failure knowledge, self-care, and quality of life among patients suffering from heart failure. We systematically searched PubMed, the Cochrane Library, Scopus, and Web of Science up to June 10, 2025, to find randomized controlled trials evaluating the effect of nurse-led telecoaching on anxiety, depression, heart failure knowledge, self-care, and quality of life among patients suffering from heart failure. We adopted a random-effects model to pool data and employed the revised RoB2 tool to determine the risk of bias. In total, 19 studies with 2917 participants were included in this meta-analysis. We found that despite some improvements compared to usual care, nurse-led telecoaching did not significantly change the heart failure knowledge of patients [standardized mean difference (SMD) 2.09, 95% confidence interval (CI) (-0.01-4.18), I2 = 99.41%], depression [SMD -0.27, 95% CI (-0.59-0.04), I2 = 78.21%], anxiety [SMD -0.06, 95% CI (-0.22-0.10), I2 = 0.00%], self-care [SMD 0.12, 95% CI (-0.67-0.91), I2 = 98.45%], and quality of life [SMD -0.33, 95% CI (-0.82-0.17), I2 = 96.53%] scores among patients with heart failure. Despite some degrees of improvement, nurse-led telecoaching did not significantly improve the heart failure knowledge, anxiety, depression, self-care, and quality of life of those suffering from heart failure.

Heart transplantation represents the definitive therapeutic intervention and gold standard treatment for patients with end-stage heart failure that remains refractory to medical management and advanced treatment modalities. The process of identifying appropriate candidates for transplantation requires comprehensive, multifaceted, and continuously evolving evaluation protocols before formal listing on the transplant waiting list. The scarcity of suitable donor organs, coupled with significant wait list mortality, perioperative risks, post-transplant complications, and the imperative to optimize allocation of this limited resource, creates a complex landscape where specific indications and contraindications to listing must be carefully defined and applied. Historically, transplant eligibility criteria were characterized by rigid, categorical exclusions. However, as both the art and science of heart transplantation have progressively advanced, the traditional contraindications to being listed for heart transplant have undergone substantial modification. Contemporary practice increasingly emphasizes individualized risk assessment rather than absolute exclusionary thresholds, recognizing that many historically prohibitive factors may be modifiable through appropriate bridging strategies, medical optimization, and support interventions. In this review, we highlight and analyze the specific ways in which transplant eligibility criteria have evolved across multiple domains including age and frailty assessment, obesity and metabolic factors, infectious disease considerations, hemodynamic parameters, oncologic history, and psychosocial determinants. Furthermore, we critically discuss the broad implications of these shifting paradigms for clinical practice, ethical considerations regarding equitable organ allocation, healthcare resource utilization, and future research priorities to maximize both individual patient benefit and collective societal utility of this scarce and life-saving therapeutic resource.

Shock is a life-threatening state of circulatory failure characterized by inadequate tissue oxygen delivery and cellular hypoxia. Lactate has emerged as a central biomarker in the diagnosis, risk stratification, and management of shock, yet its interpretation is complex and context dependent. Although traditionally viewed as a marker of anaerobic metabolism and tissue hypoperfusion, hyperlactatemia in distributive shock, particularly sepsis, frequently reflects multifactorial mechanisms, including increased aerobic glycolysis, adrenergic stimulation, mitochondrial dysfunction, and impaired hepatic clearance. This review examines the pathophysiology and classification of shock, the biochemical basis of lactate production and clearance, and the prognostic significance of both static lactate levels and lactate kinetics. We synthesize evidence supporting lactate as a robust prognostic marker while highlighting limitations of lactate-targeted resuscitation strategies. Emerging data favor multimodal approaches integrating lactate trends with complementary perfusion markers such as capillary refill time and central venous oxygen saturation. Lactate should be interpreted as one component of a comprehensive physiological assessment rather than an isolated therapeutic target.

Coronary artery spasm (CAS) is a dynamic vasomotor disorder characterized by transient, intense constriction of epicardial coronary arteries, leading to myocardial ischemia in patients with and without obstructive coronary artery disease. CAS plays a central role in vasospastic angina, ischemia with nonobstructive coronary arteries and myocardial infarction with nonobstructive coronary arteries, malignant arrhythmias, and sudden cardiac death. Its pathophysiology is multifactorial, involving endothelial dysfunction, vascular smooth muscle hyperreactivity, inflammation, oxidative stress, autonomic imbalance, and genetic susceptibility, with notable ethnic and sex-related differences. Diagnosis relies on integration of clinical features, electrocardiographic changes, and invasive coronary provocation testing using acetylcholine or ergonovine, supported by advanced imaging and functional assessment when microvascular involvement is suspected. Management is centered on calcium channel blockers and nitrates, aggressive risk factor modification, particularly smoking cessation, and individualized strategies for refractory or high-risk patients. Improved recognition and standardized diagnostic pathways are essential to optimize outcomes and reduce life-threatening complications associated with CAS.

Lymphedema is a common condition often resulting from cancer treatment, among other causes, and poses significant impacts on the patient's quality of life. Given the lack of curative treatments for lymphedema as well as its detrimental and prevalent nature, much growth is needed in the medical understanding and management of this condition. This review seeks to explore the recent literature on lymphedema, focusing on the most novel research. The aim is to identify the latest research on etiology, diagnosis and monitoring, risk factors, prevention, and treatment of lymphedema. A narrative literature review of PubMed articles from the last 3 years was conducted to gather recent advances in lymphedema. With the understanding of the role of inflammation in lymphedema development, the causes of lymphedema are being better understood. Despite still lacking a diagnostic gold standard, multiple assessment tools are in use, and researchers are actively refining optimal methods for diagnosing and monitoring lymphedema. Personal, demographic, cancer-related, and cancer treatment-related risk factors have also been clarified and can help clinicians identify high-risk patients and support early surveillance and intervention. Research on preventive as well as conservative, surgical, pharmacological, and alternative treatment strategies has shown promising results, although more work is required to identify optimal therapeutic strategies. Overall, this review highlights the importance of ongoing research for lymphedema understanding and management.

Hypertrophic cardiomyopathy (HCM), the most common genetic cardiac disease, remains underdiagnosed most of the time due to overlapping echocardiographic characteristics and subjective interpretations. This systematic review and meta-analysis aimed to assess the diagnostic performance of artificial intelligence (AI)-assisted echocardiography interpretations for identifying HCM and to explore factors contributing to variability and validity. After a comprehensive search through various databases, eligible studies reporting diagnostic metrics such as sensitivity, specificity, or area under the curve (AUC) were included into our analyses. Data were pooled using a bivariate random-effects model, and heterogeneity was quantified with the I2 statistic. Twenty-five studies were included into our meta-analysis. The pooled AUC for AI-based echocardiographic detection of HCM was 0.93 [95% confidence interval (CI), 0.90-0.95]. After trim-and-fill correction, the pooled AUC increased to 0.96 (95% CI, 0.93-0.97). Overall sensitivity and specificity were 0.89 (95% CI, 0.83-0.93) and 0.87 (95% CI, 0.76-0.94), respectively. Meta-regression revealed that convolutional neural network, support vector machine, and ensemble learning algorithms exhibited variable performance, with convolutional neural network-based models favoring higher sensitivity. We demonstrated that AI-based models evaluating echocardiographic data could be an accurate diagnostic tool for HCM. This highlights the potential of recent advancements to improve clinical decision-making.