Expert Review of Cardiovascular Therapy最新文献

{"title":"How can clinicians help to facilitate more equitable cardiovascular healthcare?","authors":"Itamar S Santos","doi":"10.1080/14779072.2025.2522219","DOIUrl":"10.1080/14779072.2025.2522219","url":null,"abstract":"","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"1-3"},"PeriodicalIF":1.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant systemic thrombolytic therapy with tissue plasminogen activator for acute pulmonary embolism: a systematic review and meta-analysis.","authors":"Hafiz Muhammad Ehsan Arshad, Hassan Shahzad, Muhammad Zain Raza, Musab Maqsood, Sanam Altaf, Minahil Fatima, Ali Ahmad Nadeem, Muhammad Omais","doi":"10.1080/14779072.2025.2520826","DOIUrl":"10.1080/14779072.2025.2520826","url":null,"abstract":"<p><strong>Introduction: </strong>The standard therapy for acute low- and intermediate-risk pulmonary embolism (PE) is anticoagulation, while concomitant systemic thrombolysis is reserved only for high-risk patients. Studies reporting thrombolysis in the former categories have yielded mixed results.</p><p><strong>Methods: </strong>Two databases and two trial registers were searched for randomized- and non-randomized trials. The Mantel-Haenszel method, along with a fixed-effect model, was used for analysing dichotomous outcomes.</p><p><strong>Results: </strong>Sixteen trials were included. Concomitant use of tPA analogues resulted in lower all-cause mortality (OR = 0.53;95%-CI:0.32-0.89;<i>p</i> = 0.02), PE recurrence (OR = 0.47;95%-CI:0.24-0.90; <i>p</i> = 0.01) and, treatment-escalations (OR = 0.39;95%-CI:0.25-0.61;<i>p</i> < 0.00001) while causing a higher incidence of major- (OR = 2.84;95%-CI:1.82-4.43; <i>p</i> < 0.00001) and minor-bleeding (OR = 4.31;95%-CI:3.26-5.71;<i>p</i> < 0.00001). Subgroup analysis based on the type of tPA used showed similar results except for the significantly lower major-bleeding with alteplase compared to tenecteplase (<i>p</i> = 0.003) and a lower incidence of bleeding events with low dosage while maintaining relatively similar treatment efficacy.</p><p><strong>Conclusions: </strong>Systemic thrombolysis significantly reduced all-cause mortality, PE recurrence, and treatment escalations but increased major and minor bleeding risk, with low-dose alteplase causing fewer bleeding complications compared to full-dose therapy/tenecteplase. Although the included trials showcased substantial sample-sizes and standardized dosing protocols, their baseline imbalances introduced potential confounding bias. Notably, mortality reduction lost statistical-significance upon excluding non-randomized trials and trials with baseline imbalances.</p><p><strong>Registration: </strong>This paper was registered on PROSPERO (CRD42024553660).</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"1-15"},"PeriodicalIF":1.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the prevention and diagnosis gap: how can we innovate early coronary heart disease identification in women with female-specific risk factors?","authors":"Eva Sinha, Simone Marschner, Anushriya Pant, Sarah Zaman","doi":"10.1080/14779072.2025.2523929","DOIUrl":"10.1080/14779072.2025.2523929","url":null,"abstract":"","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"1-3"},"PeriodicalIF":1.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiogram indicators of right ventricular dilation in repaired tetralogy of Fallot patients.","authors":"Uchina Hiya, Tomoyuki Kabutoya, Yasushi Imai, Kana Kubota, Kenta Fujimura, Akiko Yokomizo, Mitsuru Seki, Kazuomi Kario","doi":"10.1080/14779072.2025.2524566","DOIUrl":"https://doi.org/10.1080/14779072.2025.2524566","url":null,"abstract":"<p><strong>Background: </strong>Patients with surgically repaired tetralogy of Fallot (rTOF) often develop chronic pulmonary regurgitation (PR), necessitating pulmonary valve replacement (PVR). While cardiac MRI is crucial for PVR timing, its availability is limited. This study evaluates electrocardiographic (ECG) findings - specifically the R-wave amplitude in lead V1 (V1R) and the sum of the R-wave amplitude in lead V1 and the deepest S-wave amplitude in lead V5 or V6 (V1R + V5S or V6S) - as predictors of cardiac MRI findings.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 35 rTOF patients (mean age 34 ± 9 years; 60% male) who underwent cardiac MRI from 2019 to 2022, assessing correlations between ECG parameters (V1R, V1R + V5S or V6S, and QRS duration) and MRI findings (RVESVI and RVEDVI).</p><p><strong>Results: </strong>V1R showed significant correlation with RVESVI (<i>r</i> = 0.486, <i>p</i> = 0.003) and was notably higher in patients with RVESVI ≥80 mL/m². A V1R cutoff of 20 mm identified RVESVI ≥80 mL/m² with 67% sensitivity and 77% specificity.</p><p><strong>Conclusions: </strong>V1R on ECG may help predict the need for cardiac MRI, aiding in the timely PVR planning for rTOF patients.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding risk assessment tools in patients with atrial fibrillation taking anticoagulants: a comparative review and clinical implications.","authors":"Chia Siang Kow, Feng Chen, Shawn Leong Kai Jie, Kai Yuan Tham, Li Ann Yeoh, Ze Ming Chew, Wen Jie Peh, Kaeshaelya Thiruchelvam","doi":"10.1080/14779072.2025.2523920","DOIUrl":"https://doi.org/10.1080/14779072.2025.2523920","url":null,"abstract":"<p><strong>Introduction: </strong>Bleeding risk assessment plays a critical role in anticoagulation management for atrial fibrillation (AF), to balance stroke prevention with risk of major hemorrhage. Traditional bleeding risk models, such as HAS-BLED, ORBIT, and ATRIA, offer valuable insights but have limitations in predictive accuracy and clinical applicability. Recent advances in risk stratification have introduced novel models integrating biomarkers, genetic data, and artificial intelligence (AI)-driven algorithms to improve precision and individualized patient care.</p><p><strong>Areas covered: </strong>This review evaluates strengths and limitations of established bleeding risk assessment tools and explores emerging trends in predictive modeling. It discusses novel risk stratification models- DOAC Score, GARFIELD-AF, and HEMORR₂HAGES, which incorporate renal function markers, hematologic parameters, and genetic polymorphisms to enhance predictive accuracy. Integration of machine learning and digital health tools, such as the Universal Clinician Device (UCD) and the mAFA-II mobile application, was also examined for their role in improving anticoagulation safety and adherence.</p><p><strong>Expert opinion: </strong>The future of bleeding risk assessment lies in AI-driven, real-time risk prediction models adapting to dynamic patient profiles. Enhanced integration of digital health solutions and learning health systems will minimize adverse events while optimizing stroke prevention. Future research should prioritize the validation and standardization of these novel tools.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining major adverse cardiovascular event risk of beta-blocker discontinuation after acute coronary syndromes.","authors":"Nicolas Johner, Baris Gencer","doi":"10.1080/14779072.2025.2520828","DOIUrl":"10.1080/14779072.2025.2520828","url":null,"abstract":"<p><strong>Introduction: </strong>Beta-blocker therapy reduced mortality and cardiovascular events following acute coronary syndromes (ACS) in the pre-reperfusion era. In the contemporary era of early mechanical reperfusion and modern secondary prevention, the benefit of beta-blockers after ACS without reduced left ventricular ejection fraction (LVEF) has been questioned. This review was based on PubMed database searches from inception to January 2025.</p><p><strong>Areas covered: </strong>The recent REDUCE-AMI and ABYSS trials were the first adequately powered contemporary randomized trials evaluating beta-blockers after ACS without reduced LVEF. Contemporary observational evidence is also discussed. Implications for different LVEF categories (41-49% versus ≥ 50%), ACS subtypes, beta-blocker therapy duration, optimal dose, and interaction with other secondary prevention therapies are addressed.</p><p><strong>Expert opinion: </strong>We estimate that there is sufficient evidence to abandon routine beta-blocker prescription in post-ACS patients with preserved LVEF ≥ 50%. Beta-blocker prescription should be individualized with shared decision-making, balancing the risk of cardiovascular event against potential benefits of deprescription. Factors favoring beta-blocker discontinuation include adverse effects, polypharmacy, >1-3 years of stability post-ACS, and specific comorbidities (e.g. heart failure with preserved LVEF). Factors favoring beta-blocker prescription/continuation (besides established indications such as LVEF ≤ 40%, arrhythmias, angina, and refractory hypertension) include good tolerance, LVEF 41-49%, and non-adherence to other secondary prevention therapies.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"1-15"},"PeriodicalIF":1.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence: a promising tool for the clinical cardiologist.","authors":"Carlos Escobar, Lorenzo Facila, Rafael Vidal-Pérez, Alberto Pinedo Lapeña, David Vivas, Ana García Martín, Sergio Manzano Fernández, Eva Gonzalez Caballero, Vivencio Barrios, Román Freixa-Pamias","doi":"10.1080/14779072.2025.2520830","DOIUrl":"10.1080/14779072.2025.2520830","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence (AI) has emerged as a revolutionary technology that is changing clinical practice, including management of patients with cardiovascular diseases.</p><p><strong>Areas covered: </strong>From a clinical practice perspective, this manuscript reviews the impact of AI on the management of cardiovascular diseases, and current challenges and opportunities. For this purpose, a systematic search was conducted on PubMed (MEDLINE), using the MeSH terms [Artificial intelligence] + [Cardiology] + [Cardiovascular] up to February 2025. Original data from clinical trials, observational studies and reviews of interest were reviewed.</p><p><strong>Expert opinion: </strong>Cardiovascular diseases remain the first cause of morbidity, disability, and death worldwide, mainly owing to late diagnosis, insufficient control of cardiovascular risk factors, and poor use of guideline-recommended therapies. Moreover, the high prevalence of cardiac disease increases stress on the health system, which is already overloaded, challenging its capacity to provide quality patient care. AI-based algorithms may assist clinicians by promoting personalized medicine, improving efficiency, and better anticipating outcomes. Although some AI-based technical solutions are currently implemented, most will be ready for use in the coming years. Nonetheless, many challenges, barriers, and ethical concerns remain, and the effective implementation of AI in routine practice will take some time. In this context, it seems necessary to increase medical knowledge of how AI works, its impact on cardiovascular diseases, and its potential translation to clinical practice.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"1-15"},"PeriodicalIF":1.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding endothelial dysfunction in kidney transplantation: assessment techniques, existing evidence, and research needs.","authors":"Fotini Iatridi, Eleni Karkamani, Marieta P Theodorakopoulou, Pantelis Sarafidis","doi":"10.1080/14779072.2025.2520832","DOIUrl":"10.1080/14779072.2025.2520832","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney transplant recipients (KTRs) have substantially lower risk for cardiovascular events compared to dialysis, but it remains significantly higher than in the general population due to the synergistic action of traditional and nontraditional factors. Among them, endothelial dysfunction is suggested to be involved pathogenetically in cardiovascular and renal disease progression, with its improvement being another potential benefit of transplantation.</p><p><strong>Areas covered: </strong>VOP was the first technique to be used, followed by several functional methods, most commonly FMD. Over the years, several biomarkers of endothelial dysfunction have been used to assess microvascular function. The totality of evidence in KTRs suggests the improvement of endothelial dysfunction after transplantation, but with several gaps in knowledge, including rarity of studies using novel, more accurate techniques. This review presents the current functional methods and biomarkers used to evaluate microvascular and endothelial function in KTRs, discussing the existing evidence on their changes after transplantation and their associations with comorbidities and outcomes in this population. A comprehensive literature search was conducted in PubMed and Scopus for articles published until December 2024.</p><p><strong>Expert opinion: </strong>Novel methods assessing endothelial function offer a comprehensive, real-time evaluation of microvascular function and should be more widely used to enhance our understanding in this area.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"1-18"},"PeriodicalIF":1.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The overlooked cardiovascular burden of type 1 diabetes: from atherosclerosis to myocardial infarction.","authors":"Jenyfer María Fuentes-Mendoza, Roger Gonzales-Valdivieso, Marcio Concepción-Zavaleta, Maicol Augusto Cortez Sandoval","doi":"10.1080/14779072.2025.2522223","DOIUrl":"10.1080/14779072.2025.2522223","url":null,"abstract":"","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"1-3"},"PeriodicalIF":1.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding risk assessment tools in acute myocardial infarction: a comparative review and clinical implications.","authors":"Kaeshaelya Thiruchelvam, Jonathan Than Chun Xin, Win Kit Law, Lyn Feng Lee, Xuen Bei Liew, Ji Le Lim, Olivia Sim Hui Min, Zhi Qi Tan, Chia Siang Kow","doi":"10.1080/14779072.2025.2520827","DOIUrl":"https://doi.org/10.1080/14779072.2025.2520827","url":null,"abstract":"<p><strong>Introduction: </strong>Bleeding risk stratification tools are essential for optimizing ischemic protection while minimizing bleeding complications, particularly in patients undergoing percutaneous coronary intervention (PCI) or dual antiplatelet therapy (DAPT).</p><p><strong>Areas covered: </strong>A structured search of PubMed, Scopus, and Web of Science was conducted for studies published from January 2005 to December 2024. This review evaluates traditional and novel bleeding risk models in MI management. Established tools like CRUSADE, ACUITY-HORIZONS, ACTION, and PRECISE-DAPT aid in predicting in-hospital and early post-discharge bleeding but have limitations in long-term risk assessment and adapting to modern PCI techniques. Emerging models - SWEDEHEART, ARC-HBR, BLEED-MI, CREDO-KYOTO, and BleeMACS - offer enhanced risk stratification by incorporating broader clinical variables and long-term bleeding predictors, improving their applicability to contemporary MI management.</p><p><strong>Expert opinion: </strong>Despite advancements, current models exhibit moderate predictive accuracy (c-statistics 0.70-0.80) and rely on static baseline factors, limiting real-time applicability. They also fail to integrate ischemic risk assessment, creating challenges in balancing thrombotic and bleeding risks. Future research should focus on AI-driven dynamic risk models, broader validation across diverse populations, and integrating bleeding and ischemic risk stratification into a unified framework. Embedding these tools into electronic health records (EHRs) will enhance clinical decision-making and improve patient outcomes.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}