Pablo Díez-Villanueva, César Jiménez-Méndez, Pedro Cepas-Guillén, Lidia Vilches, Fernando Rivero, Héctor García-Pardo, Juan Sanchís, Albert Ariza, Fernando Alfonso
{"title":"Personalized management and decision-making for non-ST-segment elevation acute coronary syndrome in vulnerable populations.","authors":"Pablo Díez-Villanueva, César Jiménez-Méndez, Pedro Cepas-Guillén, Lidia Vilches, Fernando Rivero, Héctor García-Pardo, Juan Sanchís, Albert Ariza, Fernando Alfonso","doi":"10.1080/14779072.2025.2583939","DOIUrl":"10.1080/14779072.2025.2583939","url":null,"abstract":"<p><strong>Introduction: </strong>Acute coronary syndromes (ACS) remain the leading cause of mortality in developed countries, particularly affecting older adults. Managing vulnerable patients - particularly those who are frail or have significant comorbidities such as anemia or chronic kidney disease (CKD) - is challenging due to the lack of evidence-based guidelines tailored to this group.</p><p><strong>Areas covered: </strong>This review explores the management of non-ST-elevation acute coronary syndrome (NST-ACS) with a focus on antithrombotic therapy, invasive strategies, and cardiac rehabilitation (CR). Special attention is given to patients with frailty, atrial fibrillation (AF), and CKD, recognizing their complexity. For this purpose, studies specifically addressing the management of elderly patients with NST-ACS were reviewed.</p><p><strong>Expert opinion: </strong>Optimal management of elderly patients with NSTE-ACS requires a personalized approach. Antithrombotic therapy should be individualized, avoiding rigid guidelines. Less potent antiplatelet agents (e.g. clopidogrel) combined with direct oral anticoagulants (DOACs) offer improved safety in patients with AF. Early invasive strategies can reduce adverse events but may carry procedural risks in frail individuals. Systematic comprehensive geriatric assessment (CGA) should guide decision-making; and multidisciplinary care is essential to improving outcomes. Home-based or hybrid CR programs still need to be widely implemented and the integration of caregivers into them can enhance outcomes.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"809-820"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437684","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}
Michele Di Leo, Nicolò Vasumini, Angelo Maida, Tommaso Manaresi, Marco Basile, Francesco Angeli, Matteo Armillotta, Marcello Casuso Alvarez, Leonardo Luca Bavuso, Rebecca Belà, Jessica Salerno, Damiano Fedele, Lisa Canton, Sara Amicone, Roberto Carletti, Elisa Gardini, Luca Bergamaschi, Carmine Pizzi
{"title":"Cardiac magnetic resonance imaging in myocardial infarction with non-obstructive coronary arteries (MINOCA): current and evolving perspectives.","authors":"Michele Di Leo, Nicolò Vasumini, Angelo Maida, Tommaso Manaresi, Marco Basile, Francesco Angeli, Matteo Armillotta, Marcello Casuso Alvarez, Leonardo Luca Bavuso, Rebecca Belà, Jessica Salerno, Damiano Fedele, Lisa Canton, Sara Amicone, Roberto Carletti, Elisa Gardini, Luca Bergamaschi, Carmine Pizzi","doi":"10.1080/14779072.2025.2577397","DOIUrl":"10.1080/14779072.2025.2577397","url":null,"abstract":"<p><strong>Introduction: </strong>Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) represents a diagnostic challenge, requiring the exclusion of non-ischemic causes such as myocarditis, Takotsubo syndrome, and cardiomyopathies. Cardiac magnetic resonance (CMR) plays a pivotal role in differentiating MINOCA from these conditions by providing detailed tissue characterization to identify inflammation, edema, and fibrosis. This review explores the expanding role of CMR in diagnosing, reclassifying, and managing MINOCA, emphasizing its ability to guide treatment, improve prognosis, and aid risk stratification by identifying underlying causes.</p><p><strong>Areas covered: </strong>This narrative review discusses recent advancements in CMR protocols for suspected MINOCA, its role in distinguishing ischemic from non-ischemic causes of acute myocardial injury, and its emerging utility in risk stratification and personalized therapy. Relevant articles were searched in PubMed, Scopus, and Cochrane databases up to February 2025.</p><p><strong>Expert opinion: </strong>CMR is the noninvasive gold standard for diagnosing MINOCA. Its emerging role in evaluating coronary microcirculation, along with integrated approaches using coronary computed tomography, will further enhance the noninvasive assessment of MINOCA, in particular determining potential coronary and non-coronary etiologies.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"765-775"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307388","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":"Myocardial injury biomarkers and their assays: advances, insights, and future directions.","authors":"Samuel McGrath, Bashir Alaour, Michael Marber","doi":"10.1080/14779072.2025.2586669","DOIUrl":"10.1080/14779072.2025.2586669","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac Troponin (cTn) is fundamental to the diagnosis of myocardial injury. High sensitivity cTn assays have transformed acute cardiac care by shifting the focus toward rapid rule-out of myocardial infarction, allowing the early identification and safe discharge of low-risk patients. However, cTn proteins and their assays have limitations.</p><p><strong>Areas covered: </strong>The review summarizes cTn as a biomarker of myocardial injury, high-sensitivity cTn assay performance, and their combined impact on chest pain pathways. It explores Cardiac Myosin-Binding Protein C (cMyC) and discusses the evidence behind its use as an alternative biomarker. Studies available on Pubmed were analyzed using keywords cTn, cMyC, myocardial infarction, triage, chest pain and assay. The second half of this review explores the proteolysis of both these biomarkers, and how this information could be used in clinical practice.</p><p><strong>Expert opinion: </strong>Both hs-cTn and hs-cMyC assays have shown equivalent diagnostic performance in the rule-out of myocardial infarction. Unfortunately, both are also plagued by the similar liabilities: decreased specificity for Type 1 AMI, and an inability to distinguish between types of myocardial injury. Proteolysis of each biomarker differs according to underlying pathology. Novel assays that quantify distinct forms could enhance patient triage.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"855-866"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476937","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":"Undetected acute hypertension-mediated organ damage: a very important but insufficiently recognized problem.","authors":"Goran Koraćević, Milovan Stojanović","doi":"10.1080/14779072.2025.2591328","DOIUrl":"10.1080/14779072.2025.2591328","url":null,"abstract":"<p><strong>Introduction: </strong>The presence of acute hypertension-mediated organ damage (HMOD) makes the difference between hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). In the case of unrecognized ('false negative') acute HMOD, a misclassification ensues: the diagnosis is HTN-U instead of HTN-E, and the treatment of these patients is inadequate.</p><p><strong>Areas covered: </strong>This review aims to investigate the presence of undiagnosed acute HMODs in the hypertension (HTN) guidelines, to analyze the significance of the undiagnosed acute HMODs, and to evaluate the gaps in the knowledge on the topic. The following databases were searched: Scopus, PubMed, Cambridge, Oxford Journals, Springer, Science Direct, SAGE, Wiley, and Google Scholar.</p><p><strong>Expert opinion: </strong>There is insufficient awareness of the problem of unrecognized ('false negative') acute HMODs in clinical practice. HTN-Es have poor prognosis, with high risk of cardiovascular events and even death. Acute HMODs are prerequisite for the diagnosis of HTN-E, and it can be expected that undetected HMODs have even worse outcome. Therefore, undetected (false - negative) acute HMODs are worth of accepting and studying.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"841-853"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548800","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}
Vibhootee Sant Bakshsingh, Shawmendra S Bundhoo, Majd B Protty
{"title":"The role of enhanced stent visualization imaging in percutaneous coronary intervention: a systematic review of efficacy and clinical outcomes.","authors":"Vibhootee Sant Bakshsingh, Shawmendra S Bundhoo, Majd B Protty","doi":"10.1080/14779072.2025.2574262","DOIUrl":"10.1080/14779072.2025.2574262","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery disease (CAD) is a major global cause of morbidity and mortality. Percutaneous coronary intervention (PCI) is central to its management, and optimal stent deployment is critical. This systematic review evaluates the efficacy and clinical outcomes associated with enhanced stent visualization (ESV) systems - X-ray-based fluoroscopic tools such as StentBoost and CLEARstent - in PCI.</p><p><strong>Methods: </strong>A systematic literature search of PubMed, PubMed Central, and Cochrane Library was conducted according to PRISMA guidelines. Inclusion criteria comprised all study types evaluating ESV use in PCI, excluding case reports and non-English articles. Study quality was assessed using Newcastle-Ottawa tool.</p><p><strong>Results: </strong>Twelve studies involving ESV were included. ESV improved detection of stent expansion and deployment versus standard angiography and showed strong agreement with OCT and IVUS. ESV-guided PCI was associated with reduced rates of major adverse cardiac events (MACE), particularly in long-term follow-up. Radiation exposure was modestly increased but deemed acceptable.</p><p><strong>Conclusions: </strong>ESV systems enhance stent deployment accuracy and clinical outcomes in PCI, offering a cost-effective and accessible alternative to OCT and IVUS. Evidence supports routine integration of ESV in PCI workflows, although further large-scale trials are warranted.</p><p><strong>Registration: </strong>PROSPERO identifier is CRD420251020834.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"915-921"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274172","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":"Fixing the rhythm in transcatheter aortic valve implantation patients: can we reduce the need for permanent pacemaker implantation?","authors":"Teodor Serban, Andrea Papa, Patrick Badertscher","doi":"10.1080/14779072.2025.2591793","DOIUrl":"10.1080/14779072.2025.2591793","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis, yet conduction disturbances remain the most common complication. Permanent pacemaker implantation (PPI), while often necessary, may negatively impact long-term outcomes and increase healthcare burden. Identifying patients at risk of PPI and optimizing post-TAVI rhythm management is therefore of critical importance.</p><p><strong>Areas covered: </strong>This Special Report reviews key predictors of conduction disturbances after TAVI, including baseline electrocardiographic features (e.g. right bundle branch block), anatomical parameters (e.g. short membranous septum), and procedural factors (e.g. valve type and implantation depth) identified by literature review. Dynamic post-procedural changes in PR interval and QRS duration are discussed as triggers for further monitoring or electrophysiological testing. The report synthesizes findings from recent multicenter studies, guideline recommendations, and emerging tools such as ECG ambulatory monitoring using artificial intelligence and the MIDAS implantation technique.</p><p><strong>Expert opinion: </strong>Reducing unnecessary PPI requires an individualized, risk-adapted approach that integrates imaging, ECG, and procedural planning. Dynamic post-TAVI monitoring and selective use of electrophysiological studies may help avoid overtreatment. As TAVI expands to younger and lower-risk populations, refining conduction management will be essential to optimize patient outcomes and healthcare resource utilization.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"785-791"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534304","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}
Massimo A Padalino, Giuseppe Imperatore, Domenico Crea, Biagio Castaldi, Jürgen Hörer, Bart Meyns, Claudia Montanaro, Eva Sames Dolzer, George Sarris, Tomaso Bottio, Andrew Constantine, Konstantinos Dimopoulos
{"title":"An assessment of Fontan procedure outcomes and how we can reduce post-Fontan complications.","authors":"Massimo A Padalino, Giuseppe Imperatore, Domenico Crea, Biagio Castaldi, Jürgen Hörer, Bart Meyns, Claudia Montanaro, Eva Sames Dolzer, George Sarris, Tomaso Bottio, Andrew Constantine, Konstantinos Dimopoulos","doi":"10.1080/14779072.2025.2591333","DOIUrl":"10.1080/14779072.2025.2591333","url":null,"abstract":"<p><strong>Introduction: </strong>The Fontan procedure and its modifications have dramatically transformed prognosis in individuals with single ventricle physiology, yet long-term outcomes remain challenging due to the high incidence of short and long-term complications. Common issues include arrhythmias, heart failure, Fontan-associated liver disease and an increasing need for reintervention or transplantation, all of which substantially impact on patients' quality of life and longevity. As this population ages, late cardiac and extracardiac complications are common, which underscores the need for ongoing monitoring and comprehensive multidisciplinary care aimed at early and effective management.</p><p><strong>Areas covered: </strong>This review summarizes current evidence on the long-term outcomes after Fontan-type surgery. It describes the unique pathophysiology of the Fontan circuit, and critically evaluates incidence, severity, and management strategies for common cardiac and extracardiac complications, focusing on established clinical practice and recent advances. The review also highlights the value of continued specialist multidisciplinary care.</p><p><strong>Expert opinion: </strong>Emerging research supports the potential of novel medical therapies and devices to further improve outcomes, yet optimal care remains grounded in multidisciplinary management rather than experimental approaches. Continued research is vital to support clinical guidelines and improve the quality of life and outcomes of individuals living with a Fontan-type circulation.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"883-902"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145539477","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":"Diagnosis and treatment of coronary artery disease in patients with chronic kidney disease.","authors":"Rohan Dod, Harika Yadav, Ion S Jovin","doi":"10.1080/14779072.2025.2597772","DOIUrl":"10.1080/14779072.2025.2597772","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic kidney disease (CKD) have a significantly elevated risk of coronary artery disease. The relationship between CAD and CKD is multifaceted involving complex physiological mechanisms that result in increased inflammation, oxidative stress, and lipid abnormalities. Medical therapy and interventions in these comorbid conditions are highly complex, as they must ideally address both cardiovascular risk reduction and renal protection.</p><p><strong>Areas covered: </strong>This literature review provides an overview of the epidemiology, unique pathophysiology, clinical presentation, and management of CAD in patients with CKD. We searched PubMed and Web of Science databases from inception to November 2025 to gather evidence-based recommendations regarding CAD in CKD. We also discuss the challenges of medical and revascularization therapy that arise in patients with concurrent CAD and CKD, including providing insight into outcome differences in percutaneous coronary intervention compared to coronary artery bypass grafting.</p><p><strong>Expert opinion: </strong>CAD in CKD remains sub-optimally treated due to provider hesitancy, poor risk stratification tools, and limited dedicated trials. New medical therapies show potential. Future advances may include CKD-specific CAD calculators, contrast-free imaging, artificial intelligence driven treatment models, and expanded guideline-based use, though real-world implementation will require overcoming cost and education barriers.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"867-881"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647872","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":"Thirst in heart failure: a neglected symptom with profound implications for patient management and quality of life.","authors":"Razieh Parizad, Juniali Hatwal, Ajit Brar, Akash Batta, Rupak Desai, Bishav Mohan","doi":"10.1080/14779072.2025.2577405","DOIUrl":"10.1080/14779072.2025.2577405","url":null,"abstract":"<p><strong>Introduction: </strong>Thirst is a common yet underrecognized symptom in patients with heart failure (HF), exerting a significant impact on disease management, treatment adherence, and quality of life (QoL). Approximately 65-75% of patients with HF report moderate to severe thirst, particularly in advanced stages of the disease or under strict fluid restrictions contributing to psychological distress, social isolation, and diminished well-being.</p><p><strong>Areas covered: </strong>This systematic review explores the pathophysiology, clinical consequences, and management of thirst in HF. A literature search of PubMed, Embase, Scopus, and Web of Science (2015-2025) identified studies addressing thirst prevalence, neurohormonal and electrolyte mechanisms, and therapeutic interventions. Severe thirst has been associated with poor adherence to fluid restriction, increased psychological distress, and a 40% higher risk of hospital readmission within six months of discharge. Patient-centered strategies, such as structured education and follow-up programs, have been shown to improve adherence and reduce thirst burden.</p><p><strong>Expert opinion: </strong>Despite its clinical importance, thirst remains underaddressed in HF care, with fewer than 20% of studies evaluating it as an outcome. The development of standardized assessment tools, implementation of long-term intervention studies, and incorporation of thirst management into routine HF care are essential steps toward improving patient outcomes and QoL.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"793-807"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312760","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":"How important is measuring hemodynamic parameters for risk stratification in acute pulmonary embolism patients?","authors":"Marco Zuin","doi":"10.1080/14779072.2025.2583946","DOIUrl":"10.1080/14779072.2025.2583946","url":null,"abstract":"<p><strong>Introduction: </strong>Acute pulmonary embolism (PE) is a cardiovascular life-threatening condition associated with significant morbidity and mortality worldwide. Hemodynamic instability is a critical determinant of outcomes in PE, underscoring the need for precise risk stratification and management.</p><p><strong>Areas covered: </strong>This review highlights the importance of understanding key hemodynamic parameters in the pathophysiology of PE, emphasizing the role of advanced assessments such as diastolic blood pressure and mean arterial pressure in refining risk stratification.</p><p><strong>Expert opinion: </strong>These parameters may offer a more comprehensive evaluation of cardiac function and perfusion, particularly in intermediate-risk patients where subtle hemodynamic compromise may not be evident with traditional measures. By integrating these advanced assessments into risk models, clinicians can develop personalized therapeutic strategies tailored to individual patient needs, ultimately enhancing hemodynamic outcomes and improving the effectiveness of PE management.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"777-784"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426683","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}