Clinical Medicine Insights. Cardiology最新文献

{"title":"Rheumatic Heart Disease in Pregnancy in Sub-Saharan Africa: A Case Series Emphasizing Gaps in Access to Definitive Care.","authors":"Pearson Mwemezi, Gissela B Nyakunga, Alex F Lwiza, Simon C Peter, Hendrina Lazarus, Hellen Kyilyosudu, Beatrice Kabuka, Abid M Sadiq","doi":"10.1177/11795468261479407","DOIUrl":"https://doi.org/10.1177/11795468261479407","url":null,"abstract":"<p><p>Rheumatic heart disease (RHD) remains a major cause of maternal cardiovascular morbidity and mortality in low-resource settings, particularly among women of reproductive age. Physiological changes during pregnancy can unmask previously undiagnosed disease or precipitate decompensation in those with established valvular lesions. We present a case series of three women with RHD during pregnancy and the early postpartum period, highlighting the burden, clinical presentation, and management challenge in a resource-limited setting. All patients presented with advanced disease, including severe mitral stenosis, atrial fibrillation, and heart failure, with one case complicated by multivalvular involvement and reduced left ventricular function. Management focused on hemodynamic stabilization using diuretics, rate control, anticoagulation, and multidisciplinary care. Definitive interventions such as percutaneous balloon mitral valvotomy or valve replacement were indicated but deferred due to limited availability and financial constraints. All three mothers were clinically stabilized and remained alive at short-term follow-up, although one preterm neonate died from respiratory distress syndrome and Case 3 required readmission because of medication nonadherence. This series underscores the persistent burden of RHD in pregnancy in sub-Saharan Africa and highlights critical gaps in access to definitive cardiac interventions and anticoagulation monitoring. Strengthening health systems, improving access to specialized cardiac care, and implementing preventive strategies are essential to reduce morbidity and mortality associated with RHD in pregnancy in resource-limited settings.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261479407"},"PeriodicalIF":2.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Chronic Risk Meets Acute Strain: Sudden Cardiac Death and Cardiovascular Vulnerability in Firefighters.","authors":"Ibrahim Mortada, Ebrahim Adel Elkolaly, Aaron W Lee, Dalton Buckingham, Diann Gaalema, Mostafa Shalaby, Michael C Boyars, Thomas A Blackwell, Hani Jneid","doi":"10.1177/11795468261479323","DOIUrl":"10.1177/11795468261479323","url":null,"abstract":"<p><p>Cardiovascular disease remains the leading cause of line-of-duty mortality among firefighters. Sudden cardiac death occurs disproportionately during emergency operations, particularly fire suppression, suggesting an interaction between occupational stressors and underlying cardiovascular vulnerability. This narrative review integrates epidemiologic, mechanistic, and clinical data from observational studies, systematic reviews, and contemporary cardiovascular guidelines. A structured literature search of PubMed and Google Scholar identified studies addressing cardiovascular disease, sudden cardiac death, occupational stress, and autonomic regulation in firefighters. Autopsy and case-control data indicate that most duty-related sudden cardiac deaths occur in the presence of underlying coronary atherosclerosis. Firefighters exhibit a high prevalence of cardiovascular risk factors, including hypertension (10%-44%), obesity (14%-60%), dyslipidemia (20%-56%), and metabolic syndrome (∼22%); these rates exceed those reported in age-matched general-population samples. Emergency operations are associated with marked sympathetic activation, hemodynamic stress, and circadian perturbation, which may promote plaque destabilization, myocardial ischemia, and ventricular arrhythmia. Additionally, occupational stress and sleep disturbance are linked to autonomic imbalance, potentially increasing arrhythmic susceptibility. Sudden cardiac death in firefighters reflects the interaction between baseline cardiometabolic risk and intermittent high-intensity physiologic stress rather than a distinct occupational disease entity. Early risk identification, guideline-directed therapy, and recognition of occupational stressors are central to cardiovascular risk reduction in this population.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261479323"},"PeriodicalIF":2.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148719837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overlap of Frailty and Depression and Its Association With Cardiovascular Disease: A Population-Based Study.","authors":"Diego Armando Pérez Covo, Cristian Orlando Porras Bueno, Diego Alejandro Ortega Gomez, Sofía Rodríguez Urrego, Ana Sofía Trujillo Henao, Andres Felipe Camargo Abello, Catalina Arbelaez Hoyos, Fabian Gil, Rodrigo Castro Paris, Edward Andres Cáceres Méndez, Ángel Alberto García Peña","doi":"10.1177/11795468261475707","DOIUrl":"10.1177/11795468261475707","url":null,"abstract":"<p><strong>Background: </strong>Depression and frailty are prevalent geriatric syndromes. Their co-occurrence may define a phenotype of heightened cardiovascular disease (CVD). In Latin America the joint association of these syndromes with CVD has not been previously characterised.</p><p><strong>Objective: </strong>To evaluate the association between the overlap of depression and frailty and the prevalence of CVD in older adults.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using data from the 2015 SABE Colombia study. Adults aged ≥60 years with complete information on depression, frailty, and history of acute myocardial infarction or stroke defined as CVD were included. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using bivariate and multivariate log-binomial regression models.</p><p><strong>Results: </strong>18,973 participants were analysed (mean age 69.3 ± 7.1 years; 56% women). The prevalence of depression, frailty, and CVD was 57.3%, 3.5%, and 15.4%, respectively. In bivariate analyses, depression (PR 1.83, 95% CI 1.51-2.23), prefrailty (PR 1.61, 95% CI 1.50-1.73), and frailty (PR 2.91, 95% CI 2.57-3.28) were associated with CVD. In multivariate model, the overlap of depression and frailty demonstrated the strongest association with CVD (PR 4.86; 95% CI 3.37-7.01), exceeding that of depression with prefrailty and each condition individually. This association persisted after adjustment for traditional cardiovascular risk factors (PR 2.05, 95% CI 1.05-3.97).</p><p><strong>Conclusion: </strong>In older adults, the overlap of depression and frailty remained associated with a higher prevalence of CVD after adjustment for traditional cardiovascular risk factors. Although the association was attenuated after adjustment, the coexistence of both conditions remained associated with increased cardiovascular burden.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261475707"},"PeriodicalIF":2.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13434886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Men Fare Worse: Understanding Gender Disparities in Systemic Sclerosis-Associated Pulmonary Hypertension.","authors":"Francesca Coppi, Gianluca Pagnoni, Ashraf Nassar, Marco de Pinto, Amelia Spinella, Stefania Cerri, Valentina Selleri, Daniela Aschieri, Anna Vittoria Mattioli, Giuseppe Boriani, Francesco Fedele, Dilia Giuggioli, Marcello Pinti","doi":"10.1177/11795468251396355","DOIUrl":"10.1177/11795468251396355","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates gender disparities in clinical outcomes among patients with systemic sclerosis (SSc)-associated pulmonary arterial hypertension (PAH), focusing on cardiovascular events, right ventricular function, and survival.</p><p><strong>Introduction: </strong>PAH is a severe and life-threatening complication of SSc, with male patients often experiencing worse outcomes despite its higher prevalence in women. Comparative data on gender differences in this population remain limited.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study including 61 patients with SSc-associated PAH (52 women, 9 men), confirmed by right heart catheterization. Clinical, serological, pulmonary, and echocardiographic data were analyzed. Differences between sexes in cardiovascular events, right ventricular dilation, and survival were evaluated using appropriate statistical methods.</p><p><strong>Results: </strong>Male patients had a significantly higher incidence of cardiovascular events (median: 2.00 vs 1.00 in women; <i>P</i> = .031) and a greater prevalence of right ventricular dilation (100.00% vs 44.23%; <i>P</i> = .002). Kaplan-Meier analysis demonstrated reduced cardiovascular event-free survival (<i>P</i> = .001) and overall survival (<i>P</i> = .014) in men. Although mortality was higher in men (88.89%) than in women (57.69%), the difference was not statistically significant (<i>P</i> = .134).</p><p><strong>Conclusion: </strong>Men with SSc-associated PAH experience worse clinical outcomes, including more frequent cardiovascular events and reduced survival. The absence of estrogen's protective effects and the adverse influence of testosterone on cardiac remodeling may contribute to these disparities. These findings highlight the importance of early gender-specific risk stratification and the need for tailored therapeutic strategies to improve outcomes in this high-risk group.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468251396355"},"PeriodicalIF":2.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter-2 Inhibitors Following Acute Myocardial Infarction in Patients Without Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials.","authors":"Muhammad Ahmed, Muhammad Hamza Shuja, Shajia Shakil, Huzaifa Ul Haque Ansari, Firzah Shakil, Muhammad Abdullah Naveed, Syed Atta Ur Rehman, Narmeen Shaikh, Syed Hassaan Ali, Haya Waseem Ansari, Faiza Sajid, Mustafa Murtaza, Muhammad Usman, Biruk Demisse Ayalew","doi":"10.1177/11795468261469143","DOIUrl":"10.1177/11795468261469143","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose transporter 2 (SGLT2) inhibitors have shown significant cardiovascular benefits in heart failure (HF) patients with diabetes mellitus or chronic kidney disease. However, their safety and efficacy in non-diabetic patients without HF presenting with acute myocardial infarction (AMI) remain understudied.</p><p><strong>Methods: </strong>Databases including MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov were queried through August 2025 to identify randomized controlled trials (RCTs). Data were pooled using a random-effects model using risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Five RCTs involving 9,135 patients (SGLT2i: 4,581 and placebo: 4,554) were included. On pooled analysis, SGLT2 inhibitors were associated with significantly reduced first HF hospitalization (RR: 0.74, p=0.02), improved LVEF (MD: 2.08; p=0.002), and reduced NT-proBNP levels (MD: 12.81; p < 0.0001). No significant differences were noted in all-cause mortality and the composite of first HF hospitalization with all-cause mortality.</p><p><strong>Conclusion: </strong>In non-diabetic patients without HF, SGLT2 inhibitors significantly reduce the first HF hospitalization and improve LVEF following AMI. The findings of this meta-analysis suggest that future research should evaluate the cardiovascular benefits of SGLT2 inhibitors in this patient population.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261469143"},"PeriodicalIF":2.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Implantable Left Ventricular Assist Devices for Destination Therapy: A Peruvian Health Technology Assessment.","authors":"Carlos J Toro-Huamanchumo, Andrea M Rivera-Santillán, Carolay Z Vasquez-Quispe, Julissa E Venancio-Huerta, Lucy J Gendrau-Castillo, Verónica Peralta, Maribel M Castro-Reyes, José A Zavala-Loayza","doi":"10.1177/11795468261433692","DOIUrl":"10.1177/11795468261433692","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the efficacy and safety of the HeartMate 3 (HM3) left ventricular assist device (LVAD) as a destination therapy (DT) for patients with end-stage heart failure (HF) ineligible for transplantation, from a Peruvian healthcare perspective.</p><p><strong>Methods: </strong>A health technology assessment (HTA) was conducted, which included a systematic review of clinical effectiveness and safety, complemented by a critical appraisal of relevant evidence. Searches were performed in 3 databases, complemented by manual searches in HTA organizations and clinical practice guidelines (CPGs) repositories. The search included CPGs, HTAs, randomized clinical trials (RCTs), and high-quality observational studies evaluating LVADs for DT. Cost-effectiveness analyses and device costs specific to the Peruvian context were also reviewed.</p><p><strong>Results: </strong>All the CPGs supported the use of the HM3 LVAD, emphasizing its significant survival benefits demonstrated in primary studies. The HM3 showed a 5-year survival rate exceeding 50%, compared to 25% at 1 year and 8% at 2 years with optimal medical therapy (OMT). Functional and quality of life outcomes also improved significantly. However, common adverse events included bleeding and infections. Cost-effectiveness analyses from high-income settings indicated that the HM3 exceeded conventional willingness-to-pay thresholds but highlighted its critical clinical benefits for high-risk patients with no alternative therapies.</p><p><strong>Conclusion: </strong>The HM3 LVAD offers significant survival and quality of life improvements for patients with end-stage HF ineligible for transplantation. Despite challenges in cost-effectiveness, the adoption of the HM3 as DT in Peru is justified to address a critical unmet clinical need, provided robust medical device surveillance is implemented.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261433692"},"PeriodicalIF":2.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Analysis of Heparin-Binding Protein (HBP) and Serum Amyloid a Protein (SAA) Versus Interleukin 6 (IL-6), C-Reactive Protein (CRP), and Procalcitonin (PCT) During Both the Acute Postoperative Period and Recovery at Three Months From Non-emergent Cardiac Surgery.","authors":"Krzysztof Laudanski, Ahmed Sayed Ahmed, Mohamed A Mahmoud, Hossam Gad, Benjamin R E Harris, Ryan Smith, Dandan Zhu, Abdelhamed Elgazar, Anil Vasishta, Gajic Ognjen, Daniel A Diedrich, Juan Crestanello","doi":"10.1177/11795468261462607","DOIUrl":"10.1177/11795468261462607","url":null,"abstract":"<p><p>Variability in novel inflammatory markers (HBP and SAA) post-surgery could indicate ongoing perioperative inflammation. This pilot cohort study collected blood from 99 patients undergoing elective cardiac surgery at baseline, 24 hours, 7 days, and 3 months post-surgery. Inflammatory markers (HBP, SAA, PCT, CRP, IL-6) were measured with a point-of-care device. Demographic and clinical data were extracted from health records. Serum SAA increased significantly in the acute postoperative phase (M_e[IQR];SAA_baseline=81.1[87] vs SAA_24hr=232.65[88.02];U[72]=2343,p<0.0001), remained elevated at 7 days (Me_7d=252.6[88.56];U[57]=1484,p<0.0001) and were still more pronounced than baseline at t_3m (Me_3m=118.44[101.52];U[38]=448,p=0.0008). HBP showed a significant rise at seven days (HBP_baseline=45[26;89] vs HBP_7d=121[69.75;224.5]; U[56]=805,p<0.0001) then returned to near baseline by t_3m(Me_3m=32.5[15.75;98.5]). Traditional inflammatory markers PCT, CRP, and IL-6 demonstrated a rapid increase at t_24h and plateaued at t_7d. None of the biomarkers showed variability at baseline or postoperatively with preoperative status or postoperative complications. Cluster analysis of the inflammatory markers at 24 hours (t_24h) identified distinct subgroups. Cluster #1-patients with a modest increase in all markers; Cluster#2 characterized with a robust increase in IL-6; Cluster #3 showed increase in CRP and decline in HBP; Cluster #4 showed a modest increase in IL-6 and decline in HBP; Cluster #5 represented a decline in both CRP and SAA. Patients in these clusters differ with respect to age, pre-existing peripheral artery disease, and borderline differences in perioperative acetaminophen use. SAA and HBP remain elevated longer than IL-6, CRP, and PCT after surgery, suggesting that inflammation may persist beyond 3 months.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261462607"},"PeriodicalIF":2.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Evaluation of Guideline-Directed Treatments in Patients With Obstructive Hypertrophic Cardiomyopathy in Germany.","authors":"Farbod Sedaghat-Hamedani, Carla Zema, Michael Schultze, Tarcyane Barata Garcia, Nils Kossack, Ervant J Maksabedian Hernandez, Tobias Bluhmki, Taryn Krause, Johanna Schmoelders, Benjamin Meder","doi":"10.1177/11795468261455390","DOIUrl":"10.1177/11795468261455390","url":null,"abstract":"<p><strong>Background: </strong>Obstructive hypertrophic cardiomyopathy (HCM) is defined by left ventricular hypertrophy with outflow tract obstruction. Despite clear guideline-directed medical therapy recommendations from the European Society of Cardiology (ESC), it remains unclear whether real-world treatment aligns with these guidelines. This study evaluates adherence to ESC guidance in Germany, focusing on pharmacological and invasive therapies and identifying gaps in real-world care for patients with obstructive HCM.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted using the WIG2 Benchmark database, containing administrative claims data from German statutory health insurers. Patients aged ≥18 years who received an International Classification of Diseases (ICD)-coded diagnosis of HCM between 2012 and 2018 were included. Treatment alignment was assessed against ESC guidelines on HCM.</p><p><strong>Results: </strong>Of 6793 patients with an HCM diagnosis, 1141 had obstructive HCM. Mean age was 59.7 years and 62% were male. Following initial HCM consultation, 18% received beta-blocker (BB) monotherapy and 12% received calcium channel blocker (CCB) monotherapy, in accordance with ESC guidelines. However, 43% of treatment combinations were not aligned with the ESC guidelines, including use of contraindicated dihydropyridine CCBs and vasodilating BBs, and 22% of patients did not receive any HCM-related pharmacological treatment. Overall, only 57% of the prescribed treatments were consistent with ESC guidelines for obstructive HCM management.</p><p><strong>Conclusions: </strong>This study reveals substantial gaps in alignment with the ESC guidelines for obstructive HCM management in Germany, underscoring the need for enhanced clinician education on existing therapies. Greater uptake of guideline-directed medical therapy is critical to improving patient well-being, functional status and outcomes.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261455390"},"PeriodicalIF":2.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current State of Computed Tomography Derived Fractional Flow Reserve (FFR-CT) and Its Diagnostic Advantages.","authors":"Ibrahim Mortada, Dalton Buckingham, Aaron W Lee, Esosa Odigie-Okon, Mostafa Shalaby, Afaq Motiwala, Amer Abdulla, Michael C Boyars, Thomas A Blackwell, Hani Jneid","doi":"10.1177/11795468261464355","DOIUrl":"10.1177/11795468261464355","url":null,"abstract":"<p><p>Coronary computed tomography angiography (CCTA) is widely used for noninvasive evaluation of coronary artery disease (CAD) and is highly sensitive for detecting anatomic coronary stenosis with a high negative predictive value. However, CCTA is limited in its ability to determine the physiological significance of lesions, resulting in reduced specificity and disagreement with invasive coronary angiography in a substantial proportion of cases. Fractional Flow Reserve derived from CCTA (FFR-CT) was developed to address this anatomic-physiologic discordance by providing noninvasive, lesion-specific functional assessment of ischemia. This narrative review summarizes the current state of FFR-CT technology, its diagnostic performance relative to CCTA alone and invasive FFR, and its evolving role in contemporary CAD evaluation. Across prospective trials and meta-analyses, FFR-CT consistently improves diagnostic accuracy for ischemia-producing lesions, driven primarily by gains in specificity, with favorable agreement to invasive FFR at clinically relevant thresholds. Advances in computational modeling and machine learning have substantially reduced processing times, improving feasibility and workflow integration. Clinical studies demonstrate that incorporation of FFR-CT following CCTA improves selection for invasive coronary angiography, reduces unnecessary diagnostic catheterization, and provides prognostic information beyond anatomic disease burden alone. Important limitations remain, including dependence on CCTA image quality, reduced reliability in heavily calcified or complex coronary anatomy, and uncertainty near ischemic thresholds, necessitating careful interpretation within the clinical context. When applied selectively after high-quality CCTA, FFR-CT offers a robust noninvasive surrogate for invasive coronary physiology and supports a more targeted, physiology-guided diagnostic pathway for patients with suspected CAD.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261464355"},"PeriodicalIF":2.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirzepatide and the Cardiovascular Continuum: Metabolic, Cardiorenal and Heart Failure Evidence.","authors":"Antonio Lm Parlati, Luca Martini, Ermanno Nardi, Raffaele Carluccio, Luca Ep Parlati, Cristina Madaudo, Pasquale Perrone Filardi","doi":"10.1177/11795468261460202","DOIUrl":"10.1177/11795468261460202","url":null,"abstract":"<p><p>Tirzepatide is a first-in-class, once-weekly dual GIP and GLP-1 receptor agonist approved for type 2 diabetes and obesity. Given the tight link between hyperglycemia, adiposity, and cardiovascular disease, tirzepatide has rapidly gained interest as a broader cardiometabolic intervention. This narrative review summarizes mechanistic rationale and clinical evidence on cardiovascular risk-factor modification, cardiorenal signals, and outcome data. Across the SURPASS program in type 2 diabetes, tirzepatide produces large, dose-dependent reductions in HbA1c and substantial weight loss, with consistent benefits versus active comparators. In obesity, the SURMOUNT trials showed marked and durable weight reduction over long follow-up, with clinically relevant improvements in waist circumference, blood pressure, triglycerides, and inflammatory biomarkers. Beyond weight and glycaemia, available data suggest favorable effects on lipids, ambulatory blood pressure, inflammatory markers, and kidney-related endpoints in exploratory analyses. Tirzepatide also improves obstructive sleep apnea severity in adults with obesity. Regarding cardiovascular outcomes, SURPASS-CVOT supports cardiovascular safety by demonstrating noninferiority versus dulaglutide for 3-point major adverse cardiovascular events in patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD). In obesity-related HFpEF, SUMMIT shows reductions in worsening heart failure (HF) events and improvements in health status, supporting a phenotype-specific role in HF. Overall, tirzepatide is emerging as a key therapeutic option for integrated cardiometabolic risk reduction, with ongoing research needed to define its incremental benefit versus established GLP-1 receptor agonists, long-term effectiveness in routine care, and optimal positioning across HF phenotypes.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261460202"},"PeriodicalIF":2.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}