Reviews in cardiovascular medicine最新文献

{"title":"The Role of Iron and Other Micronutrients in Arterial Stiffness: Univariable and Multivariable Mendelian Randomization.","authors":"Weishen Qiao, Qi Liu, Hongyu Ding, Gang Wang, Yufei Sun, Zhibo Yao, Xingtao Huang, Xuedong Wang, Chao Fu, Jingbo Hou","doi":"10.31083/RCM27920","DOIUrl":"10.31083/RCM27920","url":null,"abstract":"<p><strong>Background: </strong>Prior research on the relationship between iron status and arterial stiffness is limited, with causality still unclear. However, understanding these connections is crucial for improving the prevention and management of arterial stiffness. Therefore, this study aimed to examine the impact of iron status and other micronutrients on arterial stiffness risk using Mendelian randomization (MR) approaches.</p><p><strong>Methods: </strong>MR was performed utilizing genome-wide association studies (GWAS) data from European populations to investigate the causal link between various nutrients (iron, etc.) and arterial stiffness index. We selected the random-effects inverse-variance weighting (IVW) approach for the primary analysis and conducted numerous sensitivity tests to ensure accuracy.</p><p><strong>Results: </strong>This study found a causal effect of genetically predicted high levels of serum iron (β = 0.069, 95% confidence interval (CI) [0.031 to 0.107], <i>p</i> _FDR = 1.87 × 10^-3) [false discovery rate, FDR], ferritin (β = 0.143, 95% CI [0.050 to 0.235], <i>p</i> _FDR = 8.28 × 10^-3), and transferrin saturation (β = 0.053, 95% CI [0.025 to 0.080], <i>p</i> _FDR = 1.29 × 10^-3) on arterial stiffness index. There was no evidence of reverse causality. Associations derived from multivariate MR analyses remained significant after adjusting for potential confounders. Zinc and carotene levels may be inversely linked with arterial stiffness.</p><p><strong>Conclusions: </strong>This study provides a genetic basis for the causal relationship between elevated iron status and increased arterial stiffness, suggesting the important role of micronutrients in the disease process.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"27920"},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of Ambulatory Blood Pressure Monitoring during Pregnancy: A Path Toward Risk Stratification Improvement and Management of Hypertensive Disorders.","authors":"Yiwen Fang, Lushu Zuo, Jingge Li, Huihua Shi, Ruimin Zhang, Cha Han, Lijuan Lv, Xin Zhou","doi":"10.31083/RCM27235","DOIUrl":"10.31083/RCM27235","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy (HDP) pose substantial risks to both maternal and fetal health, thereby highlighting the need for precise and comprehensive blood pressure (BP) monitoring methods. Ambulatory blood pressure monitoring (ABPM) offers advantages over traditional office BP measurements by enabling continuous 24-hour assessment, thus capturing circadian BP variations, including nocturnal and morning hypertension, which are often missed when BP is measured in a medical office. This capacity for detailed monitoring allows ABPM to identify specific BP phenotypes, such as normotension, white-coat hypertension, masked hypertension, and sustained hypertension. Each of these phenotypes has unique implications for risk stratification, which helps to identify high-risk pregnancies early and potentially improve outcomes through more targeted interventions. Despite these advantages, three key challenges have limited the widespread adoption of ABPM during pregnancy. First, the complex dynamics in BP variations throughout gestation are influenced by physiological adaptations, such as uterine artery remodeling, which lowers BP before 20 weeks and increases mean arterial pressure after 20 weeks to support fetal growth. Second, adaptive changes in the maternal arterial system alter vascular mechanical properties, complicating accurate BP assessments. Third, diagnostic thresholds specific to pregnancy that are directly linked to adverse pregnancy outcomes are lacking. Therefore, this review addresses the role of ABPM in managing HDP, examining BP dynamics and the suitability of monitoring devices, and ongoing efforts to develop diagnostic thresholds tailored to pregnancy. By exploring these aspects, this review underscores the importance of ABPM in advancing more precise, effective strategies for HDP management and multidisciplinary management programs for pregnant women to enhance clinical decision-making and maternal-fetal outcomes.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"27235"},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Imaging Depth: A Pilot Study About 2D vs. 4D Echocardiography for Tricuspid Valve Evaluation.","authors":"Giuseppe Santarpino, Giovanni Taverna, Vincenzo Calabrese, Flavia Coviello, Giancarlo Trimarchi, Olimpia Trio, Corrado Fiore, Giuseppe Andò, Giuseppe Nasso, Giuseppe Speziale","doi":"10.31083/RCM41556","DOIUrl":"10.31083/RCM41556","url":null,"abstract":"<p><strong>Background: </strong>The tricuspid valve (TV) is a complex three-dimensional (3D) anatomical structure; however, current guidelines recommend tricuspid annulus (TA) measurements to be performed with two-dimensional (2D) echocardiography. The aim of this study was to compare TV measurements obtained with 2D and four-dimensional (4D) echocardiography for surgical planning.</p><p><strong>Methods: </strong>All echocardiographic data of patients referred to our center for TV assessment were collected. Multimodality imaging data were reviewed, including 2D transthoracic echocardiography (TTE) integrated with information from 3D TTE. Measurements were also compared with those obtained using the 4D Auto Tricuspid Valve Quantification (TVQ) tool.</p><p><strong>Results: </strong>Overall, 11 patients (median age 72 [66-78] years, 18% female) were included in the study. Mild, moderate and severe tricuspid regurgitation (TR) was present in 6, 3 and 2 patients, respectively. Systolic pulmonary artery pressure was 35 ± 8 mmHg, inferior vena cava diameter 21 ± 4 mm, right atrial area 25 ± 9 cm², 4D ejection fraction 45 ± 7%, 4D fractional area change 40 ± 6%, and tricuspid annular plane systolic excursion 21 [15-25] mm. 2D/4D right ventricular-basal diameter (RVD1) was significantly different (<i>p</i> < 0.005). Similarly, 2D/4D right ventricular diameter measured at the level of the left ventricular papillary muscles (RVD2) was significantly different (<i>p</i> < 0.012), as well as 2D/4D tricuspid annular diameter (<i>p</i> = 0.020). Despite these differences, a strong correlation between variables was observed (Spearman correlation coefficient >0.824). In evaluating the correlation between TR severity and analyzed variables, RVD1 was related to TR severity both at 2D and 4D echocardiography. Conversely, RVD2 and TA diameter were significantly associated with TR severity only at 4D echocardiography.</p><p><strong>Conclusions: </strong>Our results suggest that specific patient subsets could benefit more from TA measurements using the 4D Auto TVQ tool to help identify the mechanisms responsible for TR, including candidates for left-sided valve surgery and patients in whom the indication for TV repair is unclear.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"41556"},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specificity and Areas of Usage of Cardiovascular Prediction Models Among Athletes-State-of-the-art Review.","authors":"Tomasz Chomiuk, Przemysław Kasiak, Artur Mamcarz, Daniel Śliż","doi":"10.31083/RCM37493","DOIUrl":"10.31083/RCM37493","url":null,"abstract":"<p><p>Cardiovascular diseases are a leading cause of mortality worldwide. Physical activity is linked with a reduced prevalence of cardiovascular diseases. However, excessive over-volume of training could negatively increase the risk of cardiovascular diseases. Prediction models are usually derived to facilitate decision-making and may be used to precisely adjust the intensity of physical activity and stratify individual exercise capacity. Incorporating prediction models and knowledge of risk factors of cardiovascular diseases allows for the accurate determination of risk groups among athletes. Due to the growing popularity of amateur physical activity, as well as the high demands for professional athletes, taking care of their health and providing precise pre-participation recommendations, return-to-play guidelines or training intensity is a significant challenge for physicians and fitness practitioners. Athletes with confirmed or suspected cardiovascular disease should be guided to perform training in carefully adjusted safe zones. Indirect prediction algorithms are feasible and easy-to-apply methods of individual cardiovascular disease risk estimation. Current knowledge about the usage of clinical forecasting scores among athletic cohorts is limited and numerous controversies emerged. The purpose of this review is to summarize the practical applications of the most common prediction models for maximal oxygen uptake, cardiac arrhythmias, hypertension, atherosclerosis, and cardiomyopathies among athletes. We primarily focused on endurance disciplines with additional insight into strength training. The secondary aim was to discuss their relationships in the context of the clinical management of athletes and highlights key understudied areas for future research.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"37493"},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Lipoprotein(a) with Major Adverse Cardiovascular Events after Acute Myocardial Infarction: A Meta-Analysis of Cohort Studies.","authors":"Huiruo Liu, Liangshan Wang, Hong Wang, Xing Hao, Zhongtao Du, Chenglong Li, Xiaotong Hou","doi":"10.31083/RCM27376","DOIUrl":"10.31083/RCM27376","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence suggesting a link between lipoprotein(a) (Lp(a)) and the occurrence of acute myocardial infarction (AMI), the relationship regarding prognoses related to AMI remains unclear. This meta-analysis was conducted to summarize the association between Lp(a) and the risks of major adverse cardiovascular events (MACEs) among populations surviving AMI.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, MEDLINE, and Cochrane Library databases until February 14, 2024. Cohort studies reporting multivariate-adjusted hazard ratios (HRs) for the correlation of Lp(a) with MACEs in AMI populations were identified. The Lp(a) level was analyzed using categorical and continuous variables. Subgroup analyses were conducted based on gender, type of AMI, diabetic and hypertensive status. Publication bias was assessed using funnel plots. A random-effect model was utilized to pool the results.</p><p><strong>Results: </strong>In total, 23 cohorts comprising 30,027 individuals were recruited. In comparison to those categorized with the lowest serum Lp(a), individuals in the highest category showed higher risks of MACEs after AMI (HR: 1.05, 95% confidence interval (CI): 1.01-1.09, <i>p</i> = 0.006). Similar findings were exhibited when Lp(a) was analyzed as a continuous variable (HR: 1.14, 95% CI: 1.02-1.26, <i>p</i> = 0.02). Subgroup analyses indicated that this correlation persisted significantly among females (HR: 1.23, <i>p</i> = 0.005), diabetes mellitus (DM) (HR: 1.39, <i>p</i> = 0.01), hypertension (HR: 1.36, <i>p</i> < 0.00001), ST-segment elevation myocardial infarction (STEMI) (HR: 1.03, <i>p</i> = 0.04), non-STEMI (HR: 1.40, <i>p</i> = 0.03), and long-term (>1 year) MACE (HR: 1.41, <i>p</i> = 0.0006) subgroups.</p><p><strong>Conclusions: </strong>Higher Lp(a) levels might be an independent indicator for MACE risks after AMI, especially among female populations with DM and/or hypertension, and more suitable for evaluating long-term MACEs.</p><p><strong>The prospero registration: </strong>CRD42024511985, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024511985.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"27376"},"PeriodicalIF":1.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Hemoglobin and Iron Deficiency on Mortality in Patients with Acute Myocardial Infarction in Intensive Care Units: A Retrospective Study from MIMIC-IV.","authors":"Fangyuan Luo, Zhe Wang, Tong Gao, Baofu Wang, Yijie Gao, Mengru Liu, Hong Jiang, Xianlun Li","doi":"10.31083/RCM28261","DOIUrl":"10.31083/RCM28261","url":null,"abstract":"<p><strong>Background: </strong>Anemia and iron deficiency (ID) are common in patients with acute myocardial infarction (AMI), especially those in intensive care units (ICU). This study investigated the impact of hemoglobin (Hb) and ID on the short-term mortality of critically ill patients with AMI.</p><p><strong>Methods: </strong>Overall 992 AMI patients with their first ICU admission were included in this analysis. ID was defined as serum ferritin <100 ng/mL or transferrin saturation (TSAT) <20%. Patients were categorized into four groups according to their Hb concentrations and the presence of ID. Kaplan-Meier survival analysis was used to assess differences in all-cause mortality between the different groups, and Cox regression models to identify risk factors for all-cause mortality.</p><p><strong>Results: </strong>Anemia was present in 89.5% of patients, while 65.9% suffered from ID. Patients in the group with Hb <9 g/dL and without ID were the youngest, yet they exhibited the highest severity scores. The Kaplan-Meier analysis showed that this group had a higher rate of all-cause mortality compared to the other three groups (Log-rank test <i>p =</i> 0.005). Moreover, multivariate Cox regression analysis revealed that Hb <9 g/dL and no ID was associated with a higher risk of all-cause mortality at 120 days (hazard ratio 1.512, 95% confidence interval 1.031-2.217, <i>p =</i> 0.034) when compared to the reference group (Hb ≥9 g/dL and no ID). Additionally, multivariate Cox regression analysis showed that lower Hb was linked to increased rates of all-cause mortality at 30, 60, 90, and 120 days. Elevated levels of ferritin and TSAT were also associated with increased all-cause mortality at 60, 90, and 120 days. Compared to patients without ID, those with ID had a decreased risk of all-cause mortality at 60, 90, and 120 days.</p><p><strong>Conclusions: </strong>Anemia and ID were prevalent in ICU patients with AMI. Patients with Hb <9 g/dL and without ID showed higher 120-day all-cause mortality. Additionally, lower Hb, elevated ferritin, and increased TSAT levels were identified as significant risk factors for short-term all-cause mortality in these patients.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"28261"},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tricuspid Regurgitation: A Comprehensive Review of Clinical, Imaging and Therapy.","authors":"Frank F Seghatol-Eslami, Kan Liu","doi":"10.31083/RCM28173","DOIUrl":"10.31083/RCM28173","url":null,"abstract":"<p><p>Once considered the \"forgotten valve and ventricle\", the tricuspid valve and right ventricle are now recognized as critical structures with significant clinical and prognostic implications. Growing evidence has highlighted that tricuspid regurgitation (TR) and right heart failure are not merely secondary phenomena that resolve following the treatment of left-sided heart disease. Instead, TR and right heart failure contribute to adverse outcomes and increased mortality if left untreated. This paradigm shift has fueled extensive clinical research, leading to a deeper understanding of the pathophysiology of TR and right ventricular (RV) dysfunction. Additionally, advancements in cardiovascular imaging have facilitated early detection, risk stratification, and innovative therapeutic approaches for TR and right heart failure. This article explores the evolving landscape of tricuspid valve disease, emphasizing the importance of early recognition and the role of emerging imaging technologies in improving patient outcomes. Thanks to progress in imaging technology, especially echocardiography, as well as cardiac magnetic resonance and cardiac computer tomography, enhanced studies can be conducted on the tricuspid valve pathology to delineate the various mechanisms involved in TR and RV dysfunction and offer patients a tailored medical, as well as surgical and transcatheter therapies. These unparalleled technological advances would not be possible without the hard work of physicians, scientists, surgeons, interventional cardiologists, and echocardiographers worldwide, despite the many challenges they experience daily and in every procedure. Many patients with TR present at an advanced stage of disease progression, often with severe regurgitation and clinical manifestations associated with poor outcomes. Additionally, a significant proportion of these patients have either undergone previous open-heart surgery for left-sided valvular disease or are considered high-risk surgical candidates due to multiple comorbid conditions. In recent years, transcatheter therapy has emerged as a viable alternative for this high-risk population, offering a less invasive option for those previously deemed \"inoperable\". This breakthrough has transformed the therapeutic landscape for valvular heart disease, particularly for TR, providing new hope and improved outcomes for patients who were once left with limited treatment options.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"28173"},"PeriodicalIF":1.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Independent Risk Factors of Non-Resolution Mural Thrombus in ST-Segment Elevation Myocardial Infarction Patients with Left Ventricular Aneurysms.","authors":"Meng Wang, Mengwan Li, Wenheng Liu, Jian Li, Dan Chen, Ziqing Wang, Qilong Guo, Shouling Mi, Junhua Ge","doi":"10.31083/RCM28222","DOIUrl":"10.31083/RCM28222","url":null,"abstract":"<p><strong>Background: </strong>The clinical prognosis of ST-elevation myocardial infarction (STEMI) patients with mural thrombus in left ventricular aneurysm (MTLVA) remains poor; moreover, the risk factors associated with the non-resolution (persistent or recurrent) of MTLVA are not well understood. This study aimed to identify independent risk factors for MTLVA non-resolution.</p><p><strong>Methods: </strong>A total of 133 STEMI patients (mean age 62 ± 11 years, 80.5% male) with MTLVA, admitted to our department between 2014 and 2022, were included in this retrospective analysis. Patients were categorized into two groups: resolution (n = 59) and non-resolution [persistent (n = 72) or recurrent (n = 2) MTLVA; n = 74]. The median follow-up duration was 25 months, during which adverse events were monitored, including stroke, re-revascularization, major bleeding, systemic embolism, and cardiac death.</p><p><strong>Results: </strong>The prevalence of non-resolution was 55.6%. Non-resolution was significantly associated with elevated lipoprotein (a) [Lp(a)] levels (>270 mg/L, hazard ratios (HR) 2.270, <i>p</i> = 0.003), larger left ventricular aneurysm (LVA) area (>4.5 cm², HR 4.038, <i>p</i> < 0.001), and greater mural thrombus (MT) area (>2.2 cm², HR 2.40, <i>p</i> = 0.002), independent of other risk factors, such as hypercholesterolemia and left circumflex artery (LCX)-related STEMI. Baseline left ventricular ejection fraction (LVEF) was lower in the non-resolution group (41.7% vs. 45.7%, <i>p</i> = 0.008). During follow-up, the LVEF remained lower in the non-resolution group and increased in the resolution group. The composite of adverse events was significantly higher in the non-resolution group (28.4% vs. 8.5%, <i>p</i> = 0.003), including stroke (<i>p</i> = 0.025) and systemic embolism (<i>p</i> = 0.034).</p><p><strong>Conclusions: </strong>Independent risk factors for thrombus non-resolution in STEMI patients with MTLVA include elevated Lp(a), larger LVA and MT areas. These factors contribute to thrombus persistence and are associated with worse clinical outcomes. However, further studies are needed to assess targeted management strategies for high-risk patients.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"28222"},"PeriodicalIF":1.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Restless Nights, Stressed Hearts\": The Link Between Sleep Disorders and Takotsubo Syndrome-A Comprehensive Review.","authors":"Ioannis Alevroudis, Magda Petridou, Agni Sakkou, Serafeim-Chrysovalantis Kotoulas, Sotirios Matzolas, Panagiotis Roumelis, Maria Stougianni, Eleni Massa, Eleni Mouloudi","doi":"10.31083/RCM28244","DOIUrl":"10.31083/RCM28244","url":null,"abstract":"<p><p>Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy or \"broken heart syndrome\", is characterized by transient left ventricular dysfunction, often triggered by emotional or physical stress. Emerging evidence suggests that sleep-disordered breathing (SDB) and sleep disruption may play a significant role in the pathophysiology and exacerbation of TTS. This review explores the influence of conditions such as obstructive sleep apnea (OSA), insomnia, and other sleep disturbances on the onset and progression of TTS. SDB, particularly OSA, is marked by repetitive episodes of upper airway obstruction during sleep, leading to intermittent hypoxia and increased sympathetic nervous system activity. These physiological changes can trigger or exacerbate TTS by promoting myocardial stress and impairing autonomic regulation. Insomnia and other forms of sleep disruption also contribute to heightened sympathetic activity and elevated stress hormone levels, which may precipitate TTS in susceptible individuals. Thus, this review synthesizes current research on the mechanisms linking sleep disturbances to TTS, highlighting the impact of nocturnal hypoxia, sleep fragmentation, and autonomic dysregulation. Moreover, this review discusses the clinical implications of these findings, emphasizing the need to screen and manage sleep disorders in patients with or at risk of TTS. Addressing sleep disturbances through therapeutic interventions may reduce the incidence and recurrence of TTS, offering a novel approach to managing this condition. In conclusion, this review underscores the importance of recognizing and treating SDB and sleep disruption as potential contributors to Takotsubo syndrome. Future research should focus on elucidating the precise mechanisms involved and determining effective strategies for integrating sleep management into the care of patients with TTS.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"28244"},"PeriodicalIF":1.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Regulation in Atrial Cardiomyopathy.","authors":"Si-Ming Tao, Man Yang","doi":"10.31083/RCM26897","DOIUrl":"10.31083/RCM26897","url":null,"abstract":"<p><p>Clinical observations have shown that cases of stroke or thromboembolism are not uncommon even in the absence of atrial fibrillation, suggesting that atrial fibrillation is a delayed marker of atrial thrombus formation. Atrial cardiomyopathy (ACM) is a pathophysiological concept characterized by atrial substrate and functional abnormalities closely associated with atrial myopathy, atrial enlargement, and impaired ventricular diastolic function. It is an independent factor for thromboembolic stroke, increasing the risk of serious complications such as atrial fibrillation, heart failure, and sudden cardiac death. ACM is likely to be a potential cause of embolic stroke, especially cryptogenic stroke, and early identification of patients at high thromboembolic risk is essential to guide anticoagulation therapy. Although the pathogenesis of ACM has not been fully elucidated, prospective mechanism-based studies have revealed the important role of activated cardiac immune cells along with inflammatory responses, oxidative stress, and other factors in its progression. Exploring the role of immune regulation in the pathogenesis of ACM provides new insights into the underlying mechanisms of cerebrovascular events of cardiac thromboembolic origin. This review summarizes the mechanisms by which immune regulation is involved in the progression of ACM and provides useful insights for future clinical diagnosis and treatment.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"26897"},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}