Cardiology in Review最新文献

The therapeutic landscape for obesity and type 2 diabetes mellitus (T2DM) is being reshaped by glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Orforglipron (LY3502970) represents a significant evolution in this class. Given the limitations of injectable GLP-1 RAs and the administration constraints of oral semaglutide, orforglipron offers a major convenience advantage: it is a small molecule with ~79% oral bioavailability that requires no food or water restrictions. Mechanistically, it acts by stimulating cyclic adenosine monophosphate without inducing β-arrestin recruitment, thus potentially limiting receptor desensitization and tachyphylaxis. Phase 3 trials demonstrated potent, dose-dependent efficacy. In the ACHIEVE-3 head-to-head trial (T2DM), orforglipron 36 mg proved superior to oral semaglutide 14 mg, delivering significantly greater reductions in hemoglobin A1c (-2.2% vs -1.4%) and body weight (-9.2% vs -5.3%). In the ATTAIN-2 trial (obesity and T2DM), the same dose achieved 10.5% mean weight loss. The safety profile is consistent with the GLP-1 RA class, dominated by manageable gastrointestinal events mitigated by slow dose escalation. A nondose-dependent heart rate increase and a small signal for mild pancreatitis were observed. A class-specific concern exists regarding increased ventricular arrhythmia risk in patients with heart failure with reduced ejection fraction treated with conventional GLP-1 RAs.

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce heart failure (HF)-associated admissions; however, the data on patients with aortic stenosis following transcatheter aortic valve replacement (TAVR) is limited. This systematic review and meta-analysis compares clinical outcomes in patients with and without SGLT2i following TAVR. Major electronic databases were systematically searched through April 2025 for studies evaluating SGLT2i following TAVR. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. A P value of ≤0.05 was considered statistically significant. Two studies with 1534 patients undergoing TAVR (679: SGLT2i; 855: no SGLT2i) were included. SGLT2i therapy led to a significant reduction in HF hospitalization (RR: 0.56; 95% CI: 0.32-0.99; P = 0.05); however, no differences in all-cause (RR: 0.48; 95% CI: 0.13-1.72; P = 0.26) and cardiovascular mortality (RR: 0.53; 95% CI: 0.19-1.48; P = 0.22) were noted. SGLT2i are associated with a statistically and clinically significant reduction in HF hospitalization; however, no reduction in mortality was observed following TAVR. Further randomized controlled trials are warranted to support future guideline recommendations regarding SGLT2i following TAVR.

Inherited cardiac diseases, including cardiomyopathies and channelopathies, are major contributors to morbidity and sudden cardiac death. Conditions such as long QT syndrome, hypertrophic cardiomyopathy, and dilated cardiomyopathy result from mutations in genes like KCNQ1, KCNH2, and MYBPCF3. X-linked disorders such as danon (lysosomal-associated membrane protein 2) and fabry (generalized lymphatic anomaly) also cause systemic cardiomyopathy. The genetic and phenotypic variability of these disorders highlights the importance of reviewing current diagnostic and treatment strategies. A thorough review of over 40 peer-reviewed articles published between 2010 and 2025 was performed. These included clinical studies, preclinical research, and reviews focusing on genetic mechanisms, disease models, and gene-editing techniques in inherited cardiac conditions. Selected sources emphasized relevance to molecular pathology, therapeutic options, ethical or regulatory issues, minimization, and graft survival. While PSC-CMs and gene editing hold promising therapeutic potential, translating these approaches into human treatments requires improved delivery methods, extensive safety testing, and long-term evaluation. Genome-editing and iPSC technologies are powerful tools for understanding and treating inherited cardiac diseases. Somatic gene editing is generally feasible, whereas germline modifications face ethical and legal obstacles.

Initially developed as antihyperglycemic agents, sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated therapeutic efficacy at every level of the cardiovascular disease spectrum. Multiple cardiovascular outcome trials have shown that SGLT2 inhibitors significantly reduce hospitalizations for heart failure as well as major adverse events. SGLT2 inhibitors have demonstrated remarkable advantages in lowering the risk of heart failure, even in individuals without diabetes, including those with heart failure. The exact mechanisms by which SGLT2 inhibitors provide cardiovascular protection are still unknown despite their widespread usage, indicating the need for more research. SGLT2 inhibitors have transformed the treatment of cardiovascular disease, providing substantial therapeutic promise for a wide range of patients. They are anticipated to become more and more important in the prevention and management of cardiovascular disease.

Despite similar burdens of aortic stenosis (AS) in men and women, management guidelines have historically focused on older, male populations. Age and sex differences contribute to variances in symptomatology and postprocedural outcomes. This review aims to evaluate strategies for lifelong management of AS in young women, specifically during childbearing age and pregnancy, and in women with failed bioprosthetic valves. Advanced surgical options such as the Ross and Ozaki Procedures, in addition to transcatheter aortic valve repair (TAVR) and traditional surgical aortic valve repair (SAVR), are viable options for young women with AS. However, valve durability and reintervention rates for each procedure remain major factors that affect decision-making. Maternal and fetal complications are of paramount concern when treating pregnant patients. Effects of altered uterine-placental blood flow and the risk of intraprocedural fetal irradiation should be considered when choosing an intervention for these patients, and efforts should be made to minimize risks to both mother and fetus. Current options for young women with failed bioprosthesis include redo-SAVR, TAVR in SAVR, TAVR in TAVR, and redo-SAVR after TAVR. These options are often associated with high rates of procedural complications and pitfalls compared to initial intervention in young women. No single treatment modality emerges as the best option for young women with AS. Ultimately, care should be tailored to each young woman by considering their clinical condition, reproductive goals, personal preferences, and associated comorbidities.

Sodium-glucose cotransporter-2 inhibitors improve kidney and cardiovascular outcomes through proximal tubular effects that produce osmotic diuresis, modest natriuresis, and restoration of tubuloglomerular feedback. These actions may address key elements of the pathophysiology of cirrhosis, including sodium and water retention, dilutional hyponatremia, and renal hemodynamic instability. This narrative review summarizes preclinical data, pharmacokinetic studies in hepatic impairment, and emerging clinical evidence on the use of sodium-glucose cotransporter-2 inhibitors in cirrhosis. Across case reports and small series, initiation of therapy has been associated with reduced ascites burden and fewer paracenteses in diuretic-refractory disease. A randomized, placebo-controlled trial in recurrent ascites demonstrated improved ascites control with dapagliflozin, although higher rates of infection and acute kidney injury were observed. Early safety and pharmacokinetic studies of empagliflozin in advanced chronic liver disease suggest acceptable short-term tolerability without the need for routine dose adjustment solely for hepatic impairment. Observational cohorts report fewer liver-related events and hospitalizations among treated patients, but confounding cannot be excluded. Empagliflozin increased serum sodium in randomized trials of syndrome of inappropriate antidiuresis, supporting a plausible mechanism for correcting dilutional hyponatremia in cirrhosis. Preclinical findings regarding portal hypertension and encephalopathy are mixed and appear model-dependent.

Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, with South Asians carrying a disproportionate burden. Compared to other ethnic groups, South Asians experience a decade earlier onset of atherosclerotic cardiovascular disease, often before age 60, and have higher rates of ischemic heart disease and stroke. This elevated risk reflects a complex interaction of biological, environmental, and sociocultural factors that are not fully accounted for by existing research models. This review summarizes current evidence on the epidemiology, pathophysiology, and risk factors contributing to the atherosclerotic cardiovascular disease risk in South Asians. Key risk factors include hypertension, diabetes, dyslipidemia, central obesity, and dietary patterns high in refined carbohydrates and saturated fats. Nontraditional factors-such as elevated pro-inflammatory biomarkers and epigenetic programming-may further accelerate atherosclerosis in this population. Despite progress in reducing mortality, underrepresentation in cardiovascular research and limited access to preventive care continue to hinder effective management. Culturally tailored prevention programs and earlier screening, combined with advancements in research, are critical to improving outcomes. Collaborative efforts across research and clinical practice are needed to reduce the burden and create effective interventions.

Idiopathic cardiomyopathy in children is a rare but severe condition that demonstrates high morbidity and mortality. Pediatric cardiomyopathy is etiologically multifaceted, with many presentations involving de novo genetic mutations or undiagnosed metabolic conditions, but these are not definitive, which complicates diagnosis and treatment. This review explores the limitations in identifying the etiology of pediatric idiopathic cardiomyopathy and examines the impact of these challenges on the development of targeted, pediatric therapies to improve current outcomes. A literature review was conducted, analyzing current information from clinical trials, cohort studies, and specialist consensus statements focused on pediatric cardiomyopathy etiology, treatment, and outcomes. The majority of treatments are adapted from adult studies, which show limited effectiveness in children. The absence of a standardized classification system, insufficient pharmacologic evidence, and scarce pediatric-specific trials contribute to poor prognosis and generalized treatment practices. Advancing pediatric cardiomyopathy care requires precision medicine frameworks, substantial databases on genotype-phenotype, and clinical trials developed specifically for pediatric patients. Increasing attention to pediatric research and targeted treatment strategies is crucial to improving survival and outcomes from current strategies.

Patients with a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR) face a high risk of prosthesis-patient mismatch and adverse outcomes. The 2 most studied valve types, balloon-expandable valves (BEVs) and self-expanding valves (SEVs), differ in structure and deployment, potentially impacting outcomes in this subgroup. To compare the hemodynamic and clinical outcomes of BEVs versus SEVs in SAA patients undergoing TAVR. A systematic search of major databases through March 2025 identified randomized controlled trials and propensity score matching studies comparing BEVs and SEVs. Pooled analyses were conducted using a random-effects model to derive mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) in R (version 4.4.1). Thirteen studies (n = 4582; BEV: 2290; SEV: 2292) were included. BEVs were associated with smaller indexed effective orifice area (iEOA) (MD: -0.15 cm²/m²), higher mean (MD: 4.92 mm Hg) and peak (MD: 4.78 mm Hg) transvalvular gradients, and higher overall (OR: 2.64) and severe (OR: 2.72) prosthesis-patient mismatch rates. However, BEVs had a significantly lower risk of permanent pacemaker implantation (OR: 0.62). No significant differences were found in mortality, stroke, bleeding, acute kidney injury, paravalvular leak, myocardial infarction, vascular complications, or heart failure hospitalization. BEVs and SEVs demonstrate comparable mortality in SAA patients undergoing TAVR. SEVs offer superior hemodynamic outcomes, while BEVs reduce pacemaker need. Prosthetic valve selection should be individualized based on anatomy, clinical profile, and procedural factors. Future randomized trials with long-term follow-up are warranted to inform optimal device selection in this population.

Heart failure (HF) in patients with chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality. This study delineates national trends and predicts HF-related mortality among COPD patients utilizing US death certificate data from 1999 to 2024, with projections extending to 2030. We extracted mortality data from the CDC WONDER database (1999-2024) for adults aged ≥25 years with HF and COPD listed on death certificates. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population and stratified by sex, race/ethnicity, region, and urbanization. Trends were analyzed using Joinpoint regression, and forecasts were generated using autoregressive integrated moving average models. Between 1999 and 2024, 1,445,877 COPD-related HF deaths occurred. Overall, AAMR declined from 1999-2012 [annual percent change (APC) = -0.80%, 95% confidence interval (CI): -1.21 to -0.44], then increased from 2012-2021 (APC = +3.12%, 95% CI: 2.59-4.42), followed by a post-2021 decline (APC = -1.46%, 95% CI: -4.46 to -0.59). Projections indicate AAMR will increase from 21.29 in 2025 to 22.25 in 2030. Regional variation was notable, with the Midwest having the highest AAMR (27.9) and the Northeast having the lowest (19.5). Rural areas exhibited markedly higher mortality (AAMR = 32.7) compared to urban areas (AAMR = 21.9). The mortality rate associated with HF among US adults diagnosed with COPD experienced a significant increase after 2012, reaching its peak around 2021. Projections indicate that AAMRs are likely to either escalate or stabilize through 2030, especially within vulnerable subpopulations.