Reviews in cardiovascular medicine最新文献

{"title":"Effect of Intracoronary Recombinant Human Prourokinase on Myocardial Perfusion and Clinical Outcomes in STEMI Patients Undergoing Primary PCI: A Randomized Controlled Trial.","authors":"Chonghuai Gu, Xin Hu, Haihong Liu, Rui Qiao, Xuejun Xiang, Haiyan Chen, Xin Zhao","doi":"10.31083/RCM39580","DOIUrl":"10.31083/RCM39580","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate whether intracoronary administration of recombinant human prourokinase (rhPro-UK) improves coronary blood flow, attenuates post-reperfusion inflammatory responses, and enhances clinical outcomes in patients with acute myocardial infarction.</p><p><strong>Methods: </strong>In this prospective, single-blind, randomized, controlled clinical trial, 136 ST-segment elevation myocardial infarction (STEMI) patients undergoing emergency percutaneous coronary intervention (PCI) at Anqing Municipal Hospital (August 2021-June 2023) were randomized 1:1:1 to intracoronary rhPro-UK (n = 44), tirofiban (n = 44), or saline groups (n = 48). Perioperative serum levels of creatine kinase-MB (CK-MB), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), and soluble suppression of tumorigenicity-2 (sST2) were measured. Serum sST2 was re-evaluated at 1 month (28 ± 7 days) post-PCI. Major adverse cardiovascular events (MACE) were assessed via clinic visits or telephone follow-up at 12 months.</p><p><strong>Results: </strong>The cohort had a mean age of 60.6 ± 11.5 years and was predominantly male (89.0%). At 12 months, the rhPro-UK group had the lowest MACE incidence (log-rank <i>p</i> = 0.039). Multivariable Cox regression confirmed reduced MACE risk in the rhPro-UK group (hazard ratio [HR] 0.22, 95% confidence interval [CI]: 0.05-0.99, <i>p</i> = 0.049). The final intra- and postoperative corrected TIMI frame count (cTFC) results demonstrated that both the tirofiban group and the rhPro-UK group exhibited superior efficacy in alleviating the slow/no-reflow phenomenon compared with the saline control group. At 48 hours post-PCI, rhPro-UK significantly reduced CK-MB and hs-cTnT levels compared to saline (<i>p</i> < 0.05). Both rhPro-UK and tirofiban groups exhibited lower IL-6, IL-8, and TNF-α levels at 24, 48, and 72 hours (<i>p</i> < 0.05). At 1-month follow-up, sST2 levels were markedly reduced in the rhPro-UK group (12.9 ± 3.3 pg/mL) versus tirofiban (18.7 ± 4.9 pg/mL) and saline (24.4 ± 15.7 pg/mL) (<i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>Intracoronary rhPro-UK administration during emergency PCI in STEMI patients reduces post-reperfusion inflammation and fibrosis, limits infarct size, and improves clinical outcomes.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR; http://www.chictr.org.cn; Identifier: ChiCTR2100047095).</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"39580"},"PeriodicalIF":2.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888409","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":"Analysis of Risk Factors and Development of a Diagnostic Model for Ischemia in Patients With Nonobstructive Coronary Artery Disease Based on Positron Emission Tomography/Computed Tomography.","authors":"Rui Jing, Wei Zhu, Yanmin Zhou, Jinglin Sun, Huan Luo, Ruijuan Fan, Ning Yang, Maoti Wei, Yuming Li","doi":"10.31083/RCM48741","DOIUrl":"10.31083/RCM48741","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This study aimed to identify search for clinical indicators of ischemia with no obstructive coronary arteries (INOCA) and to develop a preliminary diagnostic and predictive model to identify high-risk patients in clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;(1) We retrospectively reviewed patients admitted to the hospital for chest pain or related symptoms who were clinically suspected of having angina pectoris. Patients who received complete nuclear coronary flow reserve (CFR) measurements obtained by positron emission tomography/computed tomography (PET/CT) quantitative coronary artery assessment, had undergone coronary angiography, and had no obstructive coronary lesions were selected as study subjects. Based on the CFR results, patients with a minimum CFR &lt;2.0 were classified as the INOCA group (diagnosed group), and those with a minimum CFR ≥2.5 were classified as the non-INOCA group (control group). Clinical indicators were compared between the two groups. A multiple logistic regression analysis was performed to identify high-risk factors and to establish an INOCA diagnostic model. Additionally, a random forest INOCA diagnostic model based on decision trees was constructed using machine learning methods. (2) An independent cohort of patients meeting the same inclusion criteria as in Method (1) was used for external validation and evaluation of the previously established multiple logistic regression and random forest models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;(1) During the model development phase, the results of the multiple logistic regression analysis indicated that smoking history, standard deviation of normal R-R interval (SDNN), low-density lipoprotein-cholesterol (LDL-C), hematocrit (HCT), and monocyte absolute value (MONO#) may be associated with the risk of INOCA. The preliminary logistic regression model, with internal validation and receiver operating characteristic (ROC) curve analysis, demonstrated moderate discrimination (area under the curve (AUC) = 0.70; 95% confidence interval (CI): 0.66-0.74; sensitivity = 79.80%; specificity = 54.12%). Calibration curve and decision curve analysis (DCA) suggested good predictive accuracy and clinical net benefit. (2) Using machine learning, a random forest model was constructed based on four features (SDNN, LDL-C, age, MONO#). Internal validation with ROC analysis showed excellent discrimination (AUC = 0.92; 95% CI: 0.89-0.95; sensitivity = 84.0%; specificity = 82.3%). (3) During the external validation phase, the logistic regression model showed limited performance (AUC = 0.59; 95% CI: 0.50-0.68; sensitivity = 58.92%; specificity = 58.24%), and the calibration curve and DCA curve showed only average model performance. In contrast, external validation of the random forest model yielded better discrimination (AUC = 0.71; 95% CI: 0.63-0.79; sensitivity = 84.5%; specificity = 53.0%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;(1) Decreases in resting and stress left ","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"48741"},"PeriodicalIF":2.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888210","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":"Baseline Serum Potassium Within the Normal Range Is Independently Associated With One-Year Myocardial Strain Recovery in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Study.","authors":"Shancheng Wang, Jinhua Zhang, Yu Zhang, Ding Wang, Xianping Meng, Junwei Xu, Wei Xing","doi":"10.31083/RCM48335","DOIUrl":"10.31083/RCM48335","url":null,"abstract":"<p><strong>Background: </strong>While serum potassium abnormalities predict mortality in acute myocardial infarction, whether potassium levels within the normal range influence long-term myocardial functional recovery remains unknown. Therefore, this study aimed to investigate the association between baseline potassium levels and 1-year cardiac magnetic resonance (CMR)-derived global longitudinal strain in patients with ST-segment elevation myocardial infarction (STEMI).</p><p><strong>Methods: </strong>This retrospective cohort study enrolled 120 consecutive patients with STEMI (mean age 52.4 ± 12.6 years, 94.2% male) who underwent primary percutaneous coronary intervention (PCI) and completed 1-year CMR follow-up. Baseline electrolyte levels, including potassium, sodium, chloride, magnesium, ionized calcium, and phosphorus, were measured before the intervention. The primary outcome was 1-year absolute global longitudinal strain (abs_GLS) assessed by CMR feature tracking. Analysis of covariance (ANCOVA) was used to evaluate associations between electrolyte levels and myocardial strain after adjustment for baseline abs_GLS and 16 clinical covariates, including discharge medications.</p><p><strong>Results: </strong>Baseline potassium averaged 3.92 ± 0.26 mmol/L, with 90% of values ranging from 3.42 to 4.39 mmol/L. After adjustment for baseline abs_GLS and 16 clinical covariates, potassium was the only electrolyte significantly associated with 1-year abs_GLS in the prespecified primary model. Each 1-SD increase in potassium (0.26 mmol/L) was associated with a 0.782 percentage-point higher 1-year abs_GLS (95% CI: 0.042-1.521, <i>p</i> = 0.041). Categorical analysis showed a nonsignificant trend across potassium tertiles (T1 [<3.82 mmol/L]: 10.3%; T2 [3.82-4.02 mmol/L]: 11.6%; T3 [>4.02 mmol/L]: 12.0%; <i>p</i> for trend = 0.159), with the highest tertile exhibiting a 1.7-percentage-point higher adjusted abs_GLS than the lowest tertile.</p><p><strong>Conclusions: </strong>Among patients with STEMI treated with primary PCI, baseline serum potassium, even within the normal range, is independently associated with 1-year myocardial strain recovery, with a trend toward superior outcomes at higher-normal levels. These findings suggest that potassium may serve as a readily available prognostic biomarker for risk stratification; nonetheless, randomized trials are warranted to investigate whether targeted optimization of potassium can improve post-infarction cardiac recovery.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"48335"},"PeriodicalIF":2.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888372","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":"Inflammation and Immune Mechanisms in Atherosclerosis.","authors":"Zihao Wan, Xu Xu, Guofu Zhu","doi":"10.31083/RCM49118","DOIUrl":"10.31083/RCM49118","url":null,"abstract":"<p><p>Cardiovascular diseases (CVDs) are the leading cause of death and disability worldwide, and atherosclerosis (AS) is a major underlying pathology. This review systematically examines the interplay between inflammation and immunity in AS. Disease initiation involves endothelial injury, formation of oxidized low-density lipoprotein (ox-LDL), and innate immune responses, including monocyte and macrophage infiltration and dendritic cell (DC) activation. Macrophages polarize to a proinflammatory M1 phenotype, phagocytose lipids to form foam cells, and release inflammatory mediators such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α), thereby exacerbating plaque inflammation. DCs serve as a crucial link between innate and adaptive immunity by presenting antigens to CD4⁺ T cells. T helper 1 (Th1) cells facilitate inflammation through interferon-γ (IFN-γ), whereas regulatory T cells (Tregs) exert protective, anti-inflammatory effects. B cells have dual functions: B1 cells secrete immunoglobulin M (IgM) and provide protection, while B2 cells typically contribute to disease progression. In advanced lesions, immune cells cluster within the arterial wall to form arterial tertiary lymphoid organs (ATLOs), and the identification of neuro-immune-cardiovascular interfaces (NICIs) underscores the involvement of the nervous system. Chronic inflammation results in the thinning of the fibrous cap, thereby heightening the risk of plaque rupture and acute clinical events. Current therapies primarily target inflammatory pathways, including statins, colchicine, and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), whereas future strategies may focus on directly targeting immune cells.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"49118"},"PeriodicalIF":2.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888558","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 Role of PoCUS in the Diagnosis and Early Monitoring of Cardiogenic Shock in the Emergency Department: A Narrative Review.","authors":"Laura Giovenali, Emanuele Guerrieri, Lorenzo Falsetti, Silvia Santini, Giulia Pierdomenico, Vincenzo Zaccone, Giovanna Viticchi, Gianluca Moroncini","doi":"10.31083/RCM50103","DOIUrl":"10.31083/RCM50103","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is the most serious heart failure manifestation, characterised by a significant risk of morbidity and mortality despite improving diagnosis and treatment: early recognition and accurate hemodynamic phenotypization are crucial to improve its poor prognosis. Recently, point-of-care ultrasound (PoCUS) has evolved as a key method in emergency settings for fast shock assessment. Evidence indicates that PoCUS improves the clinician's diagnostic accuracy by identifying ventricular dysfunction, valvular disease, complications of myocardial infarction, loading conditions, and systemic congestion. Multiorgan protocols that combine cardiac, pulmonary, and vascular assessments enable differentiation among cardiogenic, obstructive, hypovolemic, and distributive shock. Echocardiographic parameters-including ventricular function, volume indices, and dynamic measures such as stroke volume and cardiac output-can guide fluid management, vasoactive therapy, and circulatory support. Limitations include operator dependence and potential imaging challenges due to patient factors. When combined with clinical and laboratory data, PoCUS is a fundamental tool for early CS assessment. With this paper, we aimed to describe the role of PoCUS in the differential diagnosis of undifferentiated shock, confirming or ruling out CS, assessing CS prognosis, guiding appropriate treatment and enabling hemodynamic monitoring. Integrating PoCUS elements with validated classifications, such as the Society for Cardiovascular Angiography and Interventions (SCAI) CS stages, can be useful for improving CS management. This review highlights validated PoCUS markers, practical PoCUS applications within the SCAI framework, and areas for further research, emphasising the increasing role of PoCUS in personalised, physiology-guided management of CS in the emergency department.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"50103"},"PeriodicalIF":2.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888311","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":"Stent Undersizing and Malapposition: Mechanical Causes of Acute and Late Stent Failure.","authors":"Fotios Toulgaridis, Nikolaos Tsiamis, Dimitrios Afendoulis, Flora Tsakirian, Sotirios Kotoulas, Christo Kole, Ioannis Andreou","doi":"10.31083/RCM52926","DOIUrl":"10.31083/RCM52926","url":null,"abstract":"<p><p>Stent undersizing and malapposition are critical mechanical failures in contemporary percutaneous coronary intervention (PCI). These deficiencies create a substrate for both immediate and delayed complications, including acute stent thrombosis, delayed healing, and late stent restenosis. Despite technological advances, angiography often fails to detect clinically relevant malapposition, leading to a systematic underestimation of its prevalence and clinical impact. This review evaluates the mechanisms underlying stent undersizing and malapposition, the associated pathophysiological consequences, and the pivotal role of intracoronary imaging (ICI) in optimizing stent deployment and improving clinical outcomes. Key definitions include stent underexpansion, defined as an expansion index <0.8; malapposition refers to a physical gap between stent struts and the vessel wall. Malapposition triggers a cascade of disturbed flow, low shear stress, and endothelial dysfunction, in part through inhibition of the MER proto-oncogene tyrosine kinase receptor (MerTK), thereby promoting a prothrombotic and proinflammatory environment. Inadequate deployment is established as the primary mechanism for early thrombotic events, with underexpansion observed in 44.4% of stent thrombosis cases. ICI-guided PCI consistently demonstrates improved stent expansion and better clinical outcomes compared with angiography-alone strategies. Optical coherence tomography (OCT) offers superior resolution for detecting acute malapposition, whereas intravascular ultrasound (IVUS) provides more accurate vessel sizing in large or heavily calcified vessels. Consequently, a fundamental shift toward a \"mechanism-based PCI strategy\" is required, emphasizing that optimal stent sizing and deployment should be guided by ICI, rather than by angiographic endpoints alone. Wider adoption of imaging, specialized training in ICI for interventionalists, and the implementation of standardized definitions of malapposition are essential to minimize stent failure and achieve mechanistic excellence in coronary intervention.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"52926"},"PeriodicalIF":2.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888295","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":"Targeting Inflammation in Atherosclerosis: Mechanistic Rationale, Clinical Trials, and Regulatory Considerations.","authors":"Lazar Mandinov, Chris A Learn","doi":"10.31083/RCM52626","DOIUrl":"10.31083/RCM52626","url":null,"abstract":"<p><p>Atherosclerosis remains the leading cause of global mortality, most commonly manifesting as ischemic heart disease, stroke, and peripheral arterial disease. Although age-adjusted cardiovascular mortality has declined in many developed nations, the global burden of atherosclerotic disease continues to rise due to population aging and growth. This narrative review examines the evolving understanding of atherosclerosis, which has shifted from a predominantly lipid-centric model to a chronic inflammatory disease. Atherosclerosis is initiated by the retention and modification of apolipoprotein B-containing lipoproteins within the arterial wall and propagated by innate and adaptive immune responses, alongside the development of new treatment strategies. Central to this process is activation of the NLRP3 inflammasome and downstream IL-1β-IL-6 signaling and pyroptotic cell death, which amplify vascular inflammation and promote plaque progression and instability. Clinical evidence demonstrates that targeting inflammation, independent of lipid lowering, reduces cardiovascular events, as exemplified by agents such as canakinumab and colchicine. Consequently, the therapeutic landscape is rapidly evolving, with ongoing efforts to refine cytokine-targeted approaches (e.g., IL-6 inhibition), develop selective NLRP3 inhibitors, and advance innovative modalities including cell-based interventions. These strategies aim to provide more durable, precise, and potentially disease-modifying or even curative approaches. However, challenges related to safety, the high cost of biologic agents, and optimal patient selection have limited widespread implementation. A major barrier remains the lack of sensitive and specific biomarkers to identify patients with active vascular inflammation, complicating trial design and therapeutic targeting. In addition to circulating markers such as high-sensitivity C-reactive protein (hsCRP) and IL-6, emerging insights highlight the liver as a central hub linking inflammation and thrombosis through complement and coagulation pathways, offering potential avenues for developing novel biomarkers. Despite promising advances, clinical translation faces persistent challenges, including increased infection risk, inadequate biomarkers for patient selection, cost constraints, and regulatory and payer requirements for hard clinical endpoints. Precision medicine approaches, drug repurposing, and innovative delivery systems may help accelerate development. Ultimately, the management of atherosclerosis is shifting toward a multifaceted approach that integrates lipid-lowering, inflammation resolution, and genetic correction to achieve durable cardiovascular protection.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"52626"},"PeriodicalIF":2.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888301","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":"Navigating the Coronary Landscape: Towards Establishing Intracoronary Optical Coherence Tomography in Research and Clinical Practice.","authors":"Antonios Karanasos, Periklis Davlouros","doi":"10.31083/RCM52708","DOIUrl":"10.31083/RCM52708","url":null,"abstract":"","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"52708"},"PeriodicalIF":2.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887200","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":"Mitral Regurgitation in Contemporary Practice: From Diagnosis to Management.","authors":"Carlo Gaspardone, Paolo Costa, Giuseppe Barone, Rosaria Sofia, Riccardo Mager, Francesca Braccischi, Riccardo Mazza, Marianna Adamo, Francesco Maisano, Cosmo Godino, Marco Metra, Gabriele Fragasso","doi":"10.31083/RCM49149","DOIUrl":"10.31083/RCM49149","url":null,"abstract":"<p><p>Mitral regurgitation (MR) is the most prevalent valvular heart disease in developed countries, affecting approximately 1 in 50 individuals in the general population and about 1 in 10 individuals older than 75 years. Despite its frequency, MR remains a complex clinical challenge due to its heterogeneous etiology, variable natural history, and evolving therapeutic landscape. The 2025 ESC/EACTS guidelines have introduced a paradigm shift, transitioning from a purely morphological classification to a mechanism-based framework that distinguishes primary, ventricular secondary, and atrial secondary MR. This review provides a comprehensive overview of contemporary MR management. We discuss the updated classification system and the associated implications for risk stratification, emphasizing how the underlying mechanism of MR influences prognosis and guides treatment selection. The diagnostics section addresses multimodality imaging strategies, detailing the complementary roles of echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) in assessing severity, characterizing anatomy, and planning interventions. The management section addresses optimization of medical therapy, surgical techniques (repair versus replacement, including conventional and minimally invasive approaches), and transcatheter interventions, with particular focus on mitral transcatheter edge-to-edge repair (M-TEER) and emerging transcatheter mitral valve replacement technologies. We propose an integrated, stepwise management algorithm that incorporates early risk markers, including natriuretic peptides, to guide the timing of intervention before irreversible myocardial damage occurs. The critical role of multidisciplinary heart valve teams (HVTs) in individualizing treatment decisions is highlighted throughout. Early recognition of MR and timely intervention are paramount to prevent progression to irreversible left ventricular dysfunction and heart failure. The mechanism-based classification enables more precise patient phenotyping and treatment tailoring. Transcatheter therapies have expanded therapeutic options for high-risk surgical patients, although careful patient selection remains essential. Natriuretic peptides have emerged as valuable biomarkers for identifying candidates who may benefit from earlier intervention. Contemporary MR management requires the integration of advanced imaging, mechanism-based classification, and collaborative decision-making within HVTs. As therapeutic options continue to expand, optimal outcomes depend on matching the right intervention to the right patient at the right time.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"49149"},"PeriodicalIF":2.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888515","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":"MMT: A Potential Mechanism of Myocardial Fibrosis - Regulation of the TGF-β1/Smad3 Pathway and Prospects for Targeted Therapy.","authors":"Ming-Rui Zou, Kang Huang, Shuai-Shuai Zhao, Bo Wu, Xin Hong, Xue-Liang Zhou","doi":"10.31083/RCM49154","DOIUrl":"10.31083/RCM49154","url":null,"abstract":"<p><p>Macrophage-Myofibroblast Transition (MMT) is a process in which macrophages, under the influence of specific factors such as transforming growth factor-beta 1 (TGF-β1) within a fibrotic microenvironment, gradually lose their original immune phenotype and acquire the biological characteristics of myofibroblasts. This transition involves changes in cell morphology, protein expression, and function, representing an important mechanism in the development and progression of tissue fibrosis. The TGF-β1/Smad3 signaling pathway, as a central regulator of fibrosis, plays a key role in MMT by modulating cell proliferation, differentiation, and the synthesis and degradation of extracellular matrix. Recent studies have identified MMT as a newly recognized form of phenotypic switching that contributes significantly to fibrosis in multiple organs, including the heart, lungs, liver, and kidneys. Experimental evidence has confirmed that the TGF-β1/Smad3 pathway directly regulates critical steps in MMT, thereby promoting the progression of fibrosis. However, the specific molecular targets and detailed mechanisms underlying this regulation remain incompletely understood and require further investigation. Elucidating the regulatory network of this pathway may offer new strategies for early intervention and targeted therapy in clinical diseases with fibrosis. However, direct evidence for MMT in human myocardial fibrosis remains limited, and its relative contribution compared to other sources of myofibroblasts requires further elucidation.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"49154"},"PeriodicalIF":2.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887183","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}