Current Cardiology Reports最新文献

{"title":"Hot Phases Cardiomyopathy: Pathophysiology, Diagnostic Challenges, and Emerging Therapies.","authors":"Giulia Bassetto, Federico Angriman, Carola Pio Loco Detto Gava, Alessia Paldino, Maria Perotto, Luca Bordignon, Marta Gigli, Matteo Dal Ferro, Laura Massa, Alessandro Altinier, Antonio De Luca, Gianfranco Sinagra, Marco Merlo","doi":"10.1007/s11886-024-02168-6","DOIUrl":"10.1007/s11886-024-02168-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hot phases are a challenging clinical presentation in arrhythmogenic cardiomyopathy (ACM), marked by acute chest pain and elevated cardiac troponins in the absence of obstructive coronary disease. These episodes manifest as myocarditis and primarily affect young patients, contributing to a heightened risk of life-threatening arrhythmias and potential disease progression. This review aims to synthesize recent research on the pathophysiology, diagnostic challenges, and therapeutic management of hot phases in ACM.</p><p><strong>Recent findings: </strong>Hot phases have been linked to genetic mutations, particularly in desmosomal proteins such as Desmoplakin (DSP). Diagnostic challenges include differentiating hot phases from isolated acute myocarditis, through identification of red flags and a multimodal approach, including CMR, FDG-PET, endomyocardial biopsy and genetic testing. Emerging therapies, such as immunosuppressive and anti-inflammatory treatments, show promise in managing hot-phase episodes. Hot phases in ACM present a significant risk for arrhythmias and disease progression, necessitating a comprehensive diagnostic and therapeutic management. A multimodal diagnostic approach is essential for accurate diagnosis, but further research is needed to refine these strategies and improve prognosis for affected patients.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"11"},"PeriodicalIF":3.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Ventricle Function: The Role of the Forgotten Chamber in Mitral Valve Surgery.","authors":"Beatrice Bacchi, Andrea Stefanini, Giulia Elena Mandoli, Federica Lorusso, Gianmarco Toto, Maria Concetta Pastore, Francesco Cabrucci, Massimo Bonacchi, Matteo Cameli, Gianluigi Bisleri","doi":"10.1007/s11886-024-02151-1","DOIUrl":"10.1007/s11886-024-02151-1","url":null,"abstract":"<p><strong>Background: </strong>Referred to as the \"forgotten chamber,\" the right ventricle (RV) is now widely acknowledged as a significant factor, particularly in certain cardiovascular pathologies. Despite historically being undervalued in comparison to the left ventricle, the RV function is deemed crucial in determining patient outcomes following mitral valve (MV) surgery. In the context of MV surgery, it is important to note that the RV is highly susceptible to dysfunction before, during, and after the surgical procedure. This vulnerability is also partly compounded by a lack of precise preoperative assessment, appropriate intraoperative management, and sufficient postoperative care for the RV. Moreover, it is notable that the current preoperative risk-score evaluation does not encompass considerations for the RV.</p><p><strong>Observations: </strong>Sophisticated assessment methodologies, including echocardiography, cardiac magnetic resonance imaging, and invasive hemodynamic procedures, play a pivotal role in accurately evaluating the RV function in patients undergoing MV surgery. These methodologies offer invaluable insights into the extent of RV dysfunction both pre- and postoperatively. By furnishing precise measurements of RV performance, these techniques contribute to risk stratification, guide perioperative management, and may enhance surgical outcomes. Their integration into routine clinical practice is essential for optimizing patient care in the context of MV surgery.</p><p><strong>Conclusions: </strong>This review highlights the importance of evaluating the RV before surgery, ensuring proper perioperative care, and utilizing advanced imaging to monitor RV function in order to predict the outcomes. The goal is to enhance surgical outcomes by thoroughly assessing and supporting RV function during the surgical process.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"13"},"PeriodicalIF":3.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desmoplakin Cardiomyopathy: Role of Inflammation and Potential Role of Disease-Modifying Therapies.","authors":"Alessio Gasperetti, Richard T Carrick, Steven Muller, Brittney Murray, Luigi Adamo, Barbara Bauce, Elizabeth McNally, Adam Helms","doi":"10.1007/s11886-024-02183-7","DOIUrl":"10.1007/s11886-024-02183-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize the available data on the use of immunosuppression therapies for the management of hot phases of disease and recurrent myocarditis in patients with desmoplakin cardiomyopathy (DSP-CMP).</p><p><strong>Recent findings: </strong>Occurrence of myocarditis episodes has been associated with worsening of outcomes in DSP-CMP. Multiple case reports and small case series have described potential benefit in using anti-inflammatory and immunosuppressive medications for the treatment of those episodes. Recently published translational data has shown a clear link between DSP variants and a propensity to inflammation. The presence of acute myocarditis episodes have been clearly demonstrated as a manifestation of DSP-CMP. These episodes are marked by myocardial inflammation and subsequent fibrosis, and, moreover, contribute to a heightened future risk of subsequent arrhythmias and heart failure. Identifying optimal strategies to prevent and/or interrupt myocardial inflammation is therefore a critical priority of patients with DSP-CMP.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"12"},"PeriodicalIF":3.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory Heart Disease in Multisystem Inflammatory Syndrome.","authors":"Giulia La Vecchia, Marco Giuseppe Del Buono, Aldo Bonaventura, Alessandra Vecchiè, Francesco Moroni, Tommaso Sanna, Antonio Abbate","doi":"10.1007/s11886-024-02173-9","DOIUrl":"10.1007/s11886-024-02173-9","url":null,"abstract":"<p><strong>Purposeof the review: </strong>In this review article, we aim to provide an overview of the pathophysiology, the clinical features, the therapeutic management and prognosis of patients affected by Multisystemic inflammatory syndrome (MIS) with cardiac involvement, focusing on myocarditis and pericarditis.</p><p><strong>Recent findings: </strong>MIS is a multiorgan hyperinflammatory condition due to a cytokine storm following (within 4-12 weeks) SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection. First described in children, it also affects young adults without comorbidities, predominantly males with highly heterogeneous clinical manifestations, including cardiac involvement. Pericardial and myocardial involvement are prevalent among patients affected by MIS leading to different clinical manifestations including myocarditis with arrhythmias, acute heart failure and cardiogenic shock that significantly affect the patient's prognosis. The heterogeneity of its clinical features and the significant overlap with other hyperinflammatory diseases make the diagnosis particularly challenging. Moreover, the evidence on the efficacy of pharmacological treatments targeting the hyperinflammatory response is scarce, as well as data on long-term prognosis.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"10"},"PeriodicalIF":3.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learnings from Implementation Strategies to Improve Lipid Management.","authors":"Nick S R Lan, Ruofei Trophy Chen, Girish Dwivedi, Gerald F Watts, Stephen J Nicholls, Adam J Nelson","doi":"10.1007/s11886-024-02174-8","DOIUrl":"10.1007/s11886-024-02174-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Lowering low-density lipoprotein (LDL)-cholesterol reduces cardiovascular risk. International lipid management guidelines recommend LDL-cholesterol goals or thresholds for initiating lipid-lowering therapy. However, contemporary real-world studies have shown that many high- and very high-risk patients are not attaining LDL-cholesterol goals and are not receiving intensive lipid-lowering therapies. In this review, recent examples of implementation strategies for optimising lipid management are discussed.</p><p><strong>Recent findings: </strong>Implementation studies are heterogenous in their strategies and design. At the clinician level, multidisciplinary team-based care (including multidisciplinary lipid clinics), pharmacist- or nurse-led interventions, decision-support algorithms or protocols, and educational initiatives have shown potential to improve lipid management. Various strategies to improve patient adherence to lipid-lowering therapies have demonstrated at least short-term efficacy, including education, shared decision-making, behavioural support and nudges. Electronic health records can be leveraged at low cost to identify patients requiring initiation or intensification of lipid-lowering therapies, but the optimal method of integrating automated alerts or nudges to influence decision-making requires further research. Moreover, telehealth and remote care delivery models can improve access to healthcare and facilitate lipid-lowering. Multifaceted strategies with a systematic approach to targeting clinician, patient and system related factors can be successful in improving lipid management. Future implementation research should evaluate longer-term outcomes and follow implementation science theories, models and/or frameworks at all stages. By doing so, ongoing implementation studies will help researchers better understand the impact, sustainability and scalability of strategies, and where barriers and facilitators to lipid management may exist in other contexts.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"9"},"PeriodicalIF":3.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Prioritization of Heart Transplantation Candidates for Optimal Clinical Outcomes: A Narrative Review.","authors":"Phan Quang Thuan, Cao Dang Khang, Nguyen Hoang Dinh","doi":"10.1007/s11886-024-02150-2","DOIUrl":"10.1007/s11886-024-02150-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review evaluates the limitations of current heart transplantation allocation models, which prioritize medical urgency and waitlist time but fail to adequately predict long-term post-transplant outcomes. It aims to identify advanced metrics that can strengthen the prioritization framework while addressing persistent racial, geographic, and socioeconomic inequities in access to transplantation.</p><p><strong>Recent findings: </strong>Recent research indicates that incorporating frailty, nutritional status, immunological compatibility, and pulmonary hemodynamics into allocation frameworks can enhance the prediction of transplant outcomes. The growing use of mechanical circulatory support (MCS) as a bridge to transplantation provides stabilization for critically ill patients; however, disparities in access persist. Studies continue to emphasize the barriers faced by minority and pediatric populations, highlighting the need for expanded donor networks and improved matching criteria. This review highlights the necessity of shifting transplantation prioritization toward multidimensional candidate evaluations that consider both clinical complexity and long-term outcomes. Policy reforms aimed at addressing healthcare disparities and optimizing donor utilization are crucial for improving patient outcomes. Future research should focus on assessing the effectiveness of advanced allocation models, such as continuous distribution frameworks, to promote equitable and sustainable transplantation systems.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"8"},"PeriodicalIF":3.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Caval Implantation for Severe Tricuspid Regurgitation.","authors":"Vincent Chen, Omar Abdul-Jawad Altisent, Rishi Puri","doi":"10.1007/s11886-024-02190-8","DOIUrl":"10.1007/s11886-024-02190-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>We describe the evolution of caval valve implantation (CAVI) as a treatment for severe symptomatic tricuspid regurgitation (TR) in the high surgical risk patient.</p><p><strong>Recent findings: </strong>Surgical treatment of severe TR is often limited by the high surgical risk of the patients who tend to develop severe secondary TR. Coaptation, annuloplasty, and orthotopic replacement strategies are all limited by annular and leaflet geometry, prior valve repair, and the presence of cardiac implantable device leads. CAVI appears to be a treatment strategy for severe symptomatic TR that improves functional capacity and quality of life while also reducing edema and ascites and improving cardiac output. Chronic kidney disease is a common comorbidity of patients with severe TR; zero-contrast CAVI has been described. Severe TR is undertreated, yet common in the elderly structural heart disease population. The evolution of CAVI as a viable treatment for severe TR underscores the deleterious systemic contribution of backwards flow to morbidity and mortality. There are good safety and efficacy outcomes from registry data using the TricValve platform. Randomized controlled trials for CAVI versus medical therapy for severe TR are ongoing.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"7"},"PeriodicalIF":3.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Myocarditis Research: Evaluating Animal Models for Enhanced Pathophysiological Insights.","authors":"Yanzhe Xu, Yixing Tan, Zhonghui Peng, Meiyu Liu, Bi Zhang, Ke Wei","doi":"10.1007/s11886-024-02182-8","DOIUrl":"10.1007/s11886-024-02182-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to assess the current landscape of animal models used in myocarditis research, with a focus on understanding their utility in uncovering the pathophysiology of the disease. The goal is to evaluate these models' strengths and weaknesses and propose optimizations to make them more relevant and reliable for both mechanistic studies and therapeutic interventions in myocarditis.</p><p><strong>Recent findings: </strong>Recent studies have primarily utilized animal models, particularly viral and autoimmune myocarditis models, to study disease mechanisms. Coxsackievirus remains the most common virus used in viral myocarditis models, offering high success rates but limited applicability to human cases due to differences in infection patterns. Autoimmune myocarditis models, often involving humanized mice, have made strides in mimicking human immune responses but still face challenges in accuracy and clinical relevance. COVID-19 has introduced new avenues for research, especially concerning vaccine-induced myocarditis, although findings remain preliminary. Animal models remain crucial for myocarditis research, but each comes with distinct challenges. Viral models excel in success rate but suffer from partial relevance to human conditions. Autoimmune models are useful in immunological studies, though costly and less replicable. Vaccine-associated models are closely related to modern clinical conditions, but lack theoretical support and therefore lack reliability. Optimizing these models could improve our understanding of myocarditis and lead to more effective treatments. Future research should aim to refine these models to better simulate human conditions and enhance their clinical applicability, ultimately advancing the diagnosis and treatment of myocarditis.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"6"},"PeriodicalIF":3.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis-Associated Cardiomyopathy: Long-Term Prognosis, Management, and Guideline-Directed Medical Therapy.","authors":"Steven M Hollenberg","doi":"10.1007/s11886-024-02175-7","DOIUrl":"10.1007/s11886-024-02175-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>To explore the definitions of sepsis-induced cardiomyopathy and how that impacts interpretation of the available data and considerations of long-term prognosis and management.</p><p><strong>Recent findings: </strong>The field of sepsis-induced cardiomyopathy has been hampered by lack of consensus about its proper definition, with a great deal of heterogeneity in clinical trial data in both individual studies and meta-analyses and consequent disparity of estimates of incidence, prognosis, and clinical significance. New diagnostic techniques, while potentially shedding light on pathophysiology, have only exacerbated these challenges. There are few persuasive data to suggest that decreased ejection fraction consequent to sepsis-induced cardiomyopathy merits a treatment strategy different from other causes, except that improvement may be more likely inasmuch as the classic description includes reversibility over 7 to 10 days. For persistent cardiac dysfunction after sepsis, whether pre-existing or newly diagnosed, institution and titration of guideline-directed medical therapy for HFrEF seems to be the most logical strategy. Armed with a clear understanding of what parameters of cardiac function are most important, clinicians can develop therapeutic strategies that make sense and calibrate them according to the clinical response.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"5"},"PeriodicalIF":3.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk and Protective Factors of Poor Clinical Outcomes in Heart Failure with Improved Ejection Fraction Population: A Systematic Review and Meta-Analysis.","authors":"Wilbert Huang, Apridya Nurhafizah, Alvin Frederich, Alya Roosrahima Khairunnisa, Capella Kezia, Muhammad Irfan Fathoni, Sean Samban, Samuel Flindy","doi":"10.1007/s11886-024-02180-w","DOIUrl":"https://doi.org/10.1007/s11886-024-02180-w","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure with improved ejection fraction (HFimpEF) patients could still develop adverse outcomes despite EF improvement. This study evaluates the risk and protective factors of poor clinical outcomes in HFimpEF patients.</p><p><strong>Methods: </strong>Systematic searching was done to include studies that evaluate the risks of developing poor outcomes in HFimpEF patients. HFimpEF is defined as improvement of 5-10% EF within 6-12 months or normalization of EF > 40%. Poor clinical outcome is defined as a composite of all-cause mortality, cardiovascular events, HF rehospitalization, and requirement of LVAD/ transplant. Odds ratios of outcome are pooled with random effects model. A subgroup analysis of multivariate analysis-only studies was also conducted.</p><p><strong>Results: </strong>32 studies comprising 10,740 HFimpEF patients are included. Poor clinical outcomes followed up for approximately 3 years, are seen in 18.9% of HFimpEF patients. Twelve statistically significant factors that increase the risk of outcome are found. Among them, anemia (OR 7.69, CI 3.48-16.99, I² 0%) and baseline NT pro-BNP (OR 3.25) are the two most important predictors. Other significant risk factors are increasing age, ischemic heart disease, NYHA III/IV, diabetes mellitus, atrial fibrillation, dyslipidemia, cerebrovascular disease, hypertension, use of diuretics, and baseline LVEDD. Alternately, protective factors of poor clinical outcome are regression of left atrial diameter (LAD) (OR 0.33, CI: 0.18-0.61, p 0.0003, I² 0%), use beta-blockers, SGLT- 2 inhibitors, and baseline LVEF level (OR 0.60, 0.78, 0.90, respectively).</p><p><strong>Conclusion: </strong>HFimpEF patients are not fully recovered and patient stratification based on risk and protective factors is recommended.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":"27 1","pages":"4"},"PeriodicalIF":3.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}