Current Problems in Cardiology最新文献

{"title":"Comparative analysis of electrocardiographic patterns of ventricular hypertrophy in cardiac amyloidosis and other cardiomyopathies","authors":"Juan Pablo Costabel,&nbsp;Ramiro Espinosa,&nbsp;Ana Spaccavento,&nbsp;Franco Nicolas Ballari,&nbsp;Marcia Cortés,&nbsp;Diego Gabriel Conde,&nbsp;Pablo Fernando Elissamburu","doi":"10.1016/j.cpcardiol.2025.103074","DOIUrl":"10.1016/j.cpcardiol.2025.103074","url":null,"abstract":"<div><h3>Introduction</h3><div>The early identification of conditions that lead to increased myocardial wall thickness, such as transthyretin amyloid cardiomyopathy (ATTR-CM), severe aortic stenosis (AS), hypertrophic cardiomyopathy (HCM), and hypertensive heart disease (HHD), is challenging due to overlapping features. Delayed diagnosis can postpone appropriate treatment and worsen prognosis. This study aimed to evaluate the frequency of key electrocardiographic patterns in these conditions, with a specific emphasis on differentiating ATTR-CM from other causes of wall thickening.</div></div><div><h3>Methods</h3><div>Electrocardiograms (ECGs) from the medical records of 400 patients over 60 years old were analyzed, divided into four groups (ATTR-CM, HCM, HHD, and AS) with confirmed diagnoses and septal thickening (≥12 mm). Specific electrocardiographic patterns, including left ventricular hypertrophy, left atrial enlargement, low voltage, pseudoinfarction, and left ventricular pressure overload, were assessed. Multiple chi-square tests with Bonferroni adjustment were used to detect significant differences between groups.</div></div><div><h3>Results</h3><div>The Sokolow-Lyon criteria was absent in all ATTR-CM cases, compared to 13 % in other conditions (p = 0.001). Additionally, ATTR-CM showed a higher prevalence of low voltage (45 % vs. 18.3 %, p = 0.001) and pseudoinfarction pattern (32 % vs. 22 %, p = 0.007), but a lower prevalence of left atrial enlargement (8 % vs. 30 %, p = 0.005). Absence of the Sokolow criteria was the best predictor of ATTR-CM (sensitivity 100 %, NPV 100 %, PPV 27 %), followed by the presence of low voltage and pseudoinfarction.</div></div><div><h3>Conclusions</h3><div>Significant differences were observed in the prevalence of electrocardiographic patterns between ATTR-CM and other wall thickening phenotypes. These findings may aid in the early detection and diagnosis of ATTR-CM, allowing for more timely intervention.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 7","pages":"Article 103074"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision medicine applications in dilated cardiomyopathy: Advancing personalized care","authors":"Elina Khattab ,&nbsp;Michael M Myrianthefs ,&nbsp;Stefanos Sakellaropoulos ,&nbsp;Kyriakos Alexandrou ,&nbsp;Andreas Mitsis MD, MSc, PhD(c)","doi":"10.1016/j.cpcardiol.2025.103076","DOIUrl":"10.1016/j.cpcardiol.2025.103076","url":null,"abstract":"<div><div>Dilated cardiomyopathy (DCM) is a prevalent cardiac disorder affecting 1 in 250–500 individuals, characterized by ventricular dilation and impaired systolic function, leading to heart failure and increased mortality, including sudden cardiac death. DCM arises from genetic and environmental factors, such as drug-induced, inflammatory, and viral causes, resulting in diverse yet overlapping phenotypes. Advances in precision medicine are revolutionizing DCM management by leveraging genetic and molecular profiling for tailored diagnostic and therapeutic approaches. This review highlights comprehensive diagnostic evaluations, genetic discoveries, and multi-omics approaches integrating genomic, transcriptomic, proteomic, and metabolomic data to enhance understanding of DCM pathophysiology. Innovative risk stratification methods, including machine learning, are improving predictions of disease progression. Despite these advancements, the current one-size-fits-all management strategy contributes to persistently high morbidity and mortality. Emerging targeted therapies, such as CRISPR/Cas9 genome editing, aetiology-specific interventions, and pharmacogenomics, are reshaping treatment paradigms. Precision medicine holds promise for optimizing DCM diagnosis, treatment, and outcomes, aiming to reduce the burden of this debilitating condition.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 7","pages":"Article 103076"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic value of positive stress echocardiography and its relationship with invasive coronary angiography: Rationale and design of the multicenter stress echo trial – AMPHIPOLIS","authors":"Nikolaos PE Kadoglou ,&nbsp;Constantinos H. Papadopoulos ,&nbsp;Vasilios Sahpekidis ,&nbsp;Konstantinos G. Papadopoulos ,&nbsp;Nearchos Kassinos ,&nbsp;Anastasios Theodosis-Georgilas","doi":"10.1016/j.cpcardiol.2025.103075","DOIUrl":"10.1016/j.cpcardiol.2025.103075","url":null,"abstract":"<div><div>Introduction/aim: Stress echocardiography (SE) is a first-line, non-invasive and well-validated technique for the diagnosis and decision making of coronary artery disease (CAD). The introduction of echocardiographic contrast agents, the growing usage of exercise on supine bike as a stressor and the recent technological advances have considerably improved the sensitivity of SE. Despite those advantages, SE remains an operator-dependent technique, and its association with CAD prognosis is based on limited evidence from old studies. Our aim is a) to assess the positive prognostic value of SE in patients with established or suspected CAD and b) to evaluate the relationship between SE findings and invasive coronary angiography (ICA) findings.</div><div>Methods: We describe the rationale and design of Amphipolis trial, a prospective, multicentre, self-controlled, open-label trial from 22 labs in Greece and Cyprus. We plan to enrol 390 consecutive adults with a positive SE based on echocardiographic findings, fulfilling specific selection criteria. All participants will undergo ICA within 6 weeks from positive SE. Then, we will be followed up them for at least 12 months for major adverse cardiovascular events (MACE) such as cardiovascular death, acute coronary syndrome (ACS), revascularization interventions (re-stenosis or new cases of myocardial ischemia), or the development of symptoms (angina relapse or new onset).</div><div>Conclusions: Amphipolis trial will test the prognostic role of SE, and its implementation in clinical practice along with anatomical findings from ICA.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 8","pages":"Article 103075"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and outcomes of acute myocardial infarction with arrhythmic onset: A retrospective cohort study","authors":"Marisa Varrenti ,&nbsp;Giorgio Solfanelli ,&nbsp;Davide Bernasconi ,&nbsp;Matteo Regazzetti ,&nbsp;Michele Galasso ,&nbsp;Alberto Preda ,&nbsp;Marco Carbonaro ,&nbsp;Matteo Baroni ,&nbsp;Lorenzo Gigli ,&nbsp;Fabrizio Guarracini ,&nbsp;Sara Vargiu ,&nbsp;Giulia Colombo ,&nbsp;Giovanni Tavecchia ,&nbsp;Giovanna Viola ,&nbsp;Luca Villanova ,&nbsp;Jacopo Oreglia ,&nbsp;Cristina Giannattasio ,&nbsp;Fabrizio Oliva ,&nbsp;Patrizio Mazzone ,&nbsp;Alice Sacco","doi":"10.1016/j.cpcardiol.2025.103077","DOIUrl":"10.1016/j.cpcardiol.2025.103077","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with acute coronary syndrome (ACS) have concomitant ventricular arrhythmic events (VA). Literature data are conflicting regarding short- and long-term prognosis. International guidelines do not recommend defibrillator (ICD) implantation in the first 40 days after a myocardial infarction. However, some patients may have an increased arrhythmic risk and deserve closer monitoring.</div></div><div><h3>Purpose</h3><div>The aim of our study was to define the incidence of arrhythmic events in a population of patients admitted for ACS to the Cardiac Intensive Care Unit (CICU) of a tertiary center and to determine the short- and long-term prognosis in patients with arrhythmic onset compared with patients without arrhythmic onset.</div></div><div><h3>Methods</h3><div>This is a single-center retrospective cohort data analysis of 1587 consecutive patients admitted with a diagnosis of ACS to the CICU of Niguarda Hospital of Milan, from 2014 to 2022. We classified the patients into two groups according to the arrhythmias at presentation: VA (sustained VT or VF) and no-VA. Kaplan–Meier (KM) estimated the probability of remaining event free in the time after ACS and were compared between VA and no-VA groups, using the log-rank test. Cox regression analysis was used to explore the association of specific variables with the occurrence of cardiac events in univariate and multivariate analysis. Statistical analyses were performed with R 42.0 statistical package (R Core Team, Vienna, Austria).</div></div><div><h3>Results</h3><div>Among 1587 ASC patients, 4.6 % had arrhythmic onset (4.0 had a diagnosis of VF and 0.6 % of VT). Patients with VA were significantly younger (63 y. vs 67 y., p = 0.026) and had a lower incidence of cardiovascular risk factors, such as hypertension and dyslipidemia, compared with no-VA group. VA group had a higher risk of arrhythmias during the hospitalization (9.6 % vs 1.3 %, p &lt; 0.001) and had a clinical course characterized by a significantly higher use of mechanical support with intra-aortic balloon pumps (IABP, 35.6 % vs. 6.8 %, p &lt; 0.001) and a greater use of inotropic drugs (34 % vs. 9 %, p &lt; 0.001). We observed in VA group a six-fold increase in-hospital mortality (23 % vs 4 %, p &lt; 0.001), identifying arrhythmic presentation as a marker of worse in-hospital prognosis in patients admitted with ACS. Likewise, mortality at 40 days after the acute event was higher in the VA group than in the no-VA group (22 % vs. 5 %, p &lt; 0.001). Conversely, during a median follow-up of 5.9 years, VA onset did not affect long-term mortality in patients discharged alive.</div></div><div><h3>Conclusion</h3><div>In this long-term follow-up retrospective registry involving a large cohort of patients with ACS admitted to the CICU, concomitant VA at admission was found to be linked with an increase in in-hospital arrhythmic complications and in-hospital mortality. The mortality rate at 40 days post-ACS was ","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 8","pages":"Article 103077"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon nanotube fibers to restore interatrial conduction in patients for prevention/management of atrial fibrillation","authors":"John E. Madias MD, FACC, FAHA","doi":"10.1016/j.cpcardiol.2025.103072","DOIUrl":"10.1016/j.cpcardiol.2025.103072","url":null,"abstract":"<div><div>This review/viewpoint examines the notion of employing intra-atrial- septal pegs with embedded carbon nanotube fibers as an “artificial Bachman’s bundle”, for the restoration of interatrial electrical conduction in patients with interatrial block with or without history of atrial fibrillation/atrial flutter. It is argued that such restoration of interatrial electrical conduction may prevent the emergence of atrial fibrillation/atrial flutter, or if such conditions have already been experienced, may ameliorate or possibly effectively treat paroxysmal/persistent/permanent atrial fibrillation/atrial flutter. To this effect a detailed protocol for this undertaking in patients is included.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 7","pages":"Article 103072"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The blind spot in cardiotoxicity: Reassessing right ventricular dysfunction in the era of SGLT2 inhibitors","authors":"Paschalis Karakasis MD, MSc (PhD candidate)","doi":"10.1016/j.cpcardiol.2025.103073","DOIUrl":"10.1016/j.cpcardiol.2025.103073","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 7","pages":"Article 103073"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calculated leads and smarter ECGs: Time to reconsider V3?","authors":"Mario J. Mc Loughlin MD ,&nbsp;Pedro Brugada MD","doi":"10.1016/j.cpcardiol.2025.103071","DOIUrl":"10.1016/j.cpcardiol.2025.103071","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 7","pages":"Article 103071"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing prognostic outcomes in cardiac sarcoidosis with advanced heart failure: How do current guidelines fare?","authors":"Mansimran Singh Dulay MRCP ,&nbsp;Raheel Ahmed MRCP ,&nbsp;Wilfred Ifeanyi Umeojiako MRCP ,&nbsp;Kshama Wechalekar DNB ,&nbsp;John Arun Baksi FRCP PhD ,&nbsp;Rajdeep Khattar FRCP FACC ,&nbsp;Athol Umfrey Wells MD PhD ,&nbsp;Vasilis Kouranos MD PhD ,&nbsp;Owais Dar MRCP MD(Res) ,&nbsp;Rakesh Sharma MRCP PhD","doi":"10.1016/j.cpcardiol.2025.103068","DOIUrl":"10.1016/j.cpcardiol.2025.103068","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac sarcoidosis (CS) affects between 5 % to 25 % of systemic sarcoid cases. CS patients may present with heart failure (HF), with ultimate progression to advanced heart failure (AHF) associated with heightened mortality.</div></div><div><h3>Objectives</h3><div>American guidelines emphasise using the ‘I NEED HELP’ criteria to identify AHF patients. The European Society of Cardiology (ESC) have alternative AHF diagnostic criteria. Both have demonstrated prognostic value, but their utility in prognosticating CS is unknown. This study aimed to address this.</div></div><div><h3>Methods</h3><div>109 patients, with baseline left ventricular ejection fraction (LVEF) &lt;50 %, referred to the Royal Brompton Hospital between 2006 and 2019, were analysed. 48 patients had ≥1 ‘I NEED HELP’ criteria consistent with AHF. Comparisons were made between the AHF and non-AHF CS patients. Sub-analysis was performed between the AHF patients that did or did not meet ESC-AHF criteria. Primary combined outcome measure was all-cause-mortality, urgent orthotopic cardiac transplant or urgent left ventricular assist device insertion. Secondary outcome measure was sustained ventricular tachycardia.</div></div><div><h3>Results</h3><div>The AHF cohort had significantly lower LVEF and higher brain natriuretic peptide values. More AHF CS patients reached combined primary outcome measure (AHF 16/48 [33 %]), than the non-AHF group (8/61 [13 %]), <em>p</em> &lt; 0.019. The AHF group had shorter time to both primary and secondary events on Kaplan-Meier analysis (logrank <em>p</em> &lt; 0.014 and <em>p</em> &lt; 0.040 respectively). Sub-analysis revealed the ESC-AHF group had the poorest prognoses according to both outcome measures.</div></div><div><h3>Conclusions</h3><div>In this study, both the AHA and ESC-AHF criteria had prognostic value. The ESC-AHF criteria best identifies CS patients with poorest prognoses.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 7","pages":"Article 103068"},"PeriodicalIF":3.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing the triglyceride diagnostic criteria of metabolic syndrome for African Americans","authors":"Christopher M. Stevens BS ,&nbsp;Christopher Schmoutz PhD ,&nbsp;Rajini Yatavelli MD","doi":"10.1016/j.cpcardiol.2025.103069","DOIUrl":"10.1016/j.cpcardiol.2025.103069","url":null,"abstract":"<div><div>The incidence and prevalence of metabolic syndrome has been increasing globally with no signs of abating. Individuals with metabolic syndrome are at increased risk of multiple comorbidities, including cardiovascular disease and type 2 diabetes mellitus. Studies show that there is a paradoxical relationship in African Americans however, as they experience a higher rate of cardiovascular disease and type 2 diabetes mellitus despite having a lower prevalence of metabolic syndrome when compared to whites. The triglyceride paradox, an unusual phenomenon in which African Americans consistently express a more normal triglyceride status even when having conditions known to be characterized by high triglyceride levels, is believed to account for this paradoxical relationship. In this manuscript, we review the history and pathophysiology of metabolic syndrome while also discussing the importance of the triglyceride paradox in explaining the inverse relationship that exists between metabolic syndrome, cardiovascular disease, and type 2 diabetes mellitus in African Americans. In addition, we advocate for decreasing the triglyceride cutoff value when diagnosing metabolic syndrome in this population to more precisely determine who is at risk for developing type 2 diabetes mellitus and cardiovascular disease.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 7","pages":"Article 103069"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for Readers","authors":"","doi":"10.1016/S0146-2806(25)00083-0","DOIUrl":"10.1016/S0146-2806(25)00083-0","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 6","pages":"Article 103061"},"PeriodicalIF":3.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}