Cardiology in Review最新文献

The vascular endothelium and its endothelial glycocalyx contribute to the protection of the endothelial cells from exposure to high levels of sodium and help these structures maintain normal function by regulating vascular permeability due to its buffering effect. The endothelial glycocalyx has negative surface charges that bind sodium and limit sodium entry into cells and the interstitial space. High sodium levels can disrupt this barrier and allow the movement of sodium into cells and extravascular fluid. This can generate reactive oxygen species that inhibit nitric oxide production. This leads to vasospasm and increases intravascular pressures. Overtime vascular remodeling occurs, and this changes the anatomy of blood vessels, their intrinsic stiffness, and their response to vasodilators and results in hypertension. Patients with increased salt sensitivity are potentially at more risk for this sequence of events. Studies on the degradation of the glycocalyx provide insight into the pathogenesis of clinical disorders with vascular involvement, but there is limited information available in the context of higher concentrations of sodium. Data on higher intake of sodium and the imbalance between nitric oxide and reactive oxygen species have been obtained in experimental studies and provide insights into possible outcomes in humans. The current western diet with sodium intake above recommended levels has led to the assessment of sodium sensitivity, which has been used in different populations and could become a practical tool to evaluate patients. This would potentially allow more focused recommendations regarding salt intake. This review will consider the structure of the vascular endothelium, its components, the effect of sodium on it, and the use of the salt blood test mini.

Congenital heart disease (CHD) is the most common congenital anomaly in newborns. Advances in catheter and surgical techniques led to the majority of these patients surviving into adulthood, leading to evolving challenges due to the emergence of long-term complications such as arrhythmias. Interventional electrophysiology (EP) has had remarkable advances over the last few decades, and various techniques and devices have been explored to treat adult patients with CHD. This comprehensive review aims to summarize findings from recent studies exploring advances in the use of interventional electrophysiology to manage adult patients with CHD. While pacemaker therapy has some indications in adults with CHD, various long-term consequences include pacing-induced cardiomyopathy and complications requiring reintervention. Cardiac resynchronization therapy has shown promising results in some studies to treat CHD patients with heart failure, although further research to clarify guidelines is encouraged. Implantable cardiac defibrillators have demonstrated clear benefits in CHD patients and are indicated for primary prevention of sudden cardiac death, although selection criteria for secondary prevention of sudden cardiac death are uncertain. Catheter ablation has also been used for various atrial and ventricular arrhythmias in patients with CHD with high success rates, although the likelihood of success depends on patient characteristics and the type of arrhythmia, and multidisciplinary assessment is encouraged to improve the chance of successful therapy.

Recent advancements in artificial intelligence (AI) have revolutionized the diagnosis, risk assessment, and treatment of heart failure (HF). AI models have demonstrated superior performance in distinguishing healthy individuals from those at risk of congestive HF by analyzing heart rate variability data. In addition, AI clinical decision support systems exhibit high concordance rates with HF experts, enhancing diagnostic precision. For HF with reduced as well as preserved ejection fraction, AI-powered algorithms help detect subtle irregularities in electrocardiograms and other related predictors. AI also aids in predicting HF risk in diabetic patients, using complex data patterns to enhance understanding and management. Moreover, AI technologies help forecast HF-related hospital admissions, enabling timely interventions to reduce readmission rates and improve patient outcomes. Continued innovation and research are crucial to address challenges related to data privacy and ethical considerations and ensure responsible implementation in healthcare.

Severe mental illness (SMI) encompasses depression, bipolar disorder, and schizophrenia which affect the daily quality of life. While it has a significant impact on their social life, it is also supposedly linked with various comorbidities, of which, cardiovascular disease (CVD) is the most frequently reported. Various biological, behavioral, and genetic mechanisms are thought to play a role: hypothalamic-pituitary-adrenal axis, autonomic nervous system dysregulation, inflammation, and psychotropic medications. Lack of exercise, low-fiber diet, smoking, substance abuse, and failure of medicine compliance also strongly contribute to the increased risk for CVD-related death. The understanding of the complex relationship between CVD and SMI would thus play a significant role in decreasing the incidence of CVD-related morbidity and mortality. This article aims to review and explain the hypothesized increased risk of CVD events in patients with SMI.

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by proliferative remodeling and obliterative narrowing of the pulmonary vasculature. While outcomes have improved with existing treatments targeting 3 main pathways, there remains a critical need for novel therapies that address different and novel mechanisms of PAH. Sotatercept, recently Food and Drug Administration (FDA) approved, is a groundbreaking fusion protein that binds to activin and growth differentiation factors, rebalancing antiproliferative and pro-proliferative signals to reverse remodeling in both the pulmonary vasculature and the right ventricle. This review highlights current evidence exploring the safety and efficacy of sotatercept in the 2 landmark trials, phase 2 Pulmonary Arterial Hypertension and Sotatercept Trial and Research and phase 3 Sotatercept Treatment in Expansion of Long-term Learning and Assessment in PAH trial, which were instrumental in securing FDA approval for adult PAH patients with WHO functional class II or III symptoms already receiving background pulmonary hypertension therapy. Overall, sotatercept represents a landmark advancement in PAH treatment, offering hope for patients and the potential to delay or avoid lung transplantation. Importantly, this marks the beginning of an era of targeted therapies aimed at reverse remodeling in PAH while improving outcomes.

Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) play a vital role in managing and preventing cardiovascular disease, particularly in elderly populations who face elevated risks for atherosclerosis and related conditions. This review delves into the mechanisms of statin action, emphasizing their impact on low-density lipoprotein cholesterol levels, anti-inflammatory properties, and potential genetic factors influencing efficacy and drug tolerability. Consideration is given to statin intolerance and management strategies, drug interactions, and guidelines for primary and secondary prevention of cardiovascular events. Patient-centered care and shared decision-making are highlighted as essential for effective therapy in elderly patients. This review also addresses the importance of personalized approaches in the context of genetic markers such as SLCO1B1 polymorphisms, optimizing patient outcomes and minimizing adverse effects. Finally, emerging areas of research are discussed, underscoring the need for further studies on the cognitive impact of statins and newer lipid-lowering agents. This analysis serves to inform clinical practice by balancing statins' cardiovascular benefits against potential risks, aiming for a tailored approach in managing elderly patients with cardiovascular concerns.

Although metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed nonalcoholic fatty liver disease, has become the most common chronic liver disorder, its complex pathophysiology has not been fully elucidated up to date. A correlation between elevated sympathetic activation and MASLD has been highlighted in recent preclinical and clinical studies. Furthermore, increased sympathetic activity has been associated with the main mechanisms involved in MASLD, such as lipid accumulation in the liver, insulin resistance, and metabolic dysregulation, while it has been also correlated with the progression of MASLD, leading to liver fibrosis. Preclinical studies demonstrated that therapies which ameliorate the activation of the sympathetic nervous system, such as renal and liver sympathetic denervation, reduce hepatic insulin resistance, decrease hepatic glucose production, and reverse hepatic steatosis in high-fat-diet models. However, data from clinical trials regarding the effect of renal denervation on metabolic parameters are conflicting, since several trials reported a favorable effect, while other trials stated no significant difference, with the profound limitation of the lack of originally designed denervation trials in this setting. Thus, a thorough review of the role of the sympathetic nervous system in the pathophysiology of MASLD, as well as the results of recent sympathetic denervation studies and trials regarding metabolic regulation and MASLD treatment would be of great importance.

Iloprost is a synthetic long-acting prostacyclin-analog drug used to treat various vascular diseases. The Federal Drug Administration approved the drug in 2004 for pulmonary arterial hypertension, and it has since been shown to be helpful in other vascular conditions such as scleroderma and Raynaud phenomenon. The Federal Drug Administration has now approved the use of iloprost for severe frostbite. This review summarizes the pharmacologic properties of iloprost, its clinical applications, and potential therapeutic benefits in vascular conditions.

Thromboembolism is a significant complication after the Fontan procedure because of endothelial dysfunction, abnormal blood flow, and hypercoagulability. This is the reason why it is recommended for these patients to receive thromboprophylaxis. The aim of our study was to compare the efficacy and safety of antiplatelets versus anticoagulants in patients with a history of a Fontan procedure. A systematic literature review was performed on the electronic databases PubMed, Cochrane, and Scopus, and the grey literature for retrieving studies comparing antiplatelets with anticoagulants and/or no medication on patients with Fontan circulation. We used the random effect model for synthesizing the data. A total of 26 and 20 studies were included in the qualitative and quantitative analysis, respectively. No difference was observed between antiplatelets and anticoagulants in the rate of thromboembolic events [odds ratio (OR), 1.47; 95% confidence interval (CI), 0.66-3.26]. Anticoagulants were more effective than no medication for thromboprophylaxis (OR, 0.17; 95% CI, 0.05-0.61), while comparison between antiplatelets and no medication showed no difference in thromboembolic episodes (OR, 0.25; 95% CI, 0.06-1.09). Antiplatelets were safer than anticoagulants with regards to any bleeding episodes (OR, 0.57; 95% CI, 0.34-0.95). In conclusion, no difference could be found between antiplatelets and anticoagulants in terms of efficacy. However, antiplatelets seem to be safer, as they are responsible for fewer bleeding events. Additional randomized controlled trials are needed to produce robust results.

Red meat is the muscle meat of mammals like beef, lamb, and pork that is red due to the abundance of myoglobin pigment and becomes even darker when cooked. The global average per capita consumption of meat and the total amount of meat consumed is rising, and there has been a particularly marked increase in the global consumption of chicken and pork. The consumption of red meat has always been a contentious issue, with data suggesting benefits in terms of nutritional value and at the same time linking its consumption to major health disorders such as endocrine abnormalities, gastrointestinal issues, cancers, and cardiovascular diseases (CVDs). Despite being normalized by major food franchises, red meat consumption may lead to adverse cardiovascular outcomes such as atherosclerosis, ischemic heart disease, stroke, and cardiac failure. Given the evidence that indicates the consumption of red and processed meat as a risk factor for cardiovascular diseases and all-cause mortality, it is important to review the effects of red meat on the risk of cardiovascular diseases.