Trends in Cardiovascular Medicine最新文献

{"title":"The role of vitamin D in pulmonary arterial hypertension: From vascular biology to patient outcomes.","authors":"Andrea Gulino, Sandra Ghelardoni, Letizia Mattii, Enza Polizzi, Anna Vittoria Mattioli, Rosalinda Madonna","doi":"10.1016/j.tcm.2026.10.004","DOIUrl":"10.1016/j.tcm.2026.10.004","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disease characterized by endothelial dysfunction, excessive vasoconstriction, vascular remodeling, and right ventricular failure. In recent years, vitamin D (VitD) has emerged as a potential modulator of several biological pathways implicated in PAH pathobiology. Beyond its classical role in calcium and phosphate homeostasis, VitD exerts pleiotropic effects through activation of the VitD receptor, which is expressed in pulmonary artery endothelial cells and smooth muscle cells. Experimental evidence indicates that VitD signaling is associated with the regulation of key mechanisms involved in PAH, including endothelial nitric oxide production, prostacyclin and endothelin pathways, Endothelial-to-Mesenchymal Transition, smooth muscle cell proliferation, inflammation, oxidative stress, mitochondrial dysfunction, and extracellular matrix remodeling. Studies conducted in experimental pulmonary hypertension models, including models with PAH-like vascular remodeling, have reported associations between VitD restoration and improved pulmonary hemodynamics, right ventricular function, endothelial function, and pulmonary vascular remodeling. However, these models do not fully recapitulate human Group 1 PAH and therefore their findings should be interpreted cautiously. Clinical studies have demonstrated a high prevalence of VitD deficiency among patients with PAH, although several studies have included heterogeneous pH populations, and lower circulating 25-hydroxyvitamin D levels have been associated with worse functional class, reduced exercise capacity, more severe hemodynamic impairment, right ventricular dysfunction, and poorer survival. However, clinical evidence regarding the benefits of VitD supplementation remains limited and is mainly derived from small observational studies and uncontrolled interventions. This narrative review summarizes the current experimental and clinical evidence linking VitD to PAH pathobiology and patient outcomes, highlighting potential mechanistic pathways and discussing the opportunities and challenges for future therapeutic strategies. Although available data support a biologically plausible association between VitD/VitD receptor signaling and pulmonary vascular homeostasis, adequately powered randomized controlled trials are required to determine whether correction of VitD deficiency is associated with improved clinical outcomes in PAH.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric myocarditis from risk recognition to evidence based treatment.","authors":"Bibhuti B Das","doi":"10.1016/j.tcm.2026.10.003","DOIUrl":"10.1016/j.tcm.2026.10.003","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven years is not a lifetime: long-term TAVR outcomes in an era of expanding indications.","authors":"Xander Jacquemyn, Derek Serna-Gallegos","doi":"10.1016/j.tcm.2026.10.001","DOIUrl":"10.1016/j.tcm.2026.10.001","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric acute myocarditis: current evidence and practical recommendations.","authors":"Sara Mori, Giacomo Veronese, Ezio Bonanomi, Rachele Adorisio, Franziska Seidel, Scott Auerbach, Giuseppe Limongelli, Ferran Gran Ipiña, Francesca Raimondi, Enrico Ammirati","doi":"10.1016/j.tcm.2026.10.002","DOIUrl":"10.1016/j.tcm.2026.10.002","url":null,"abstract":"<p><p>Acute myocarditis (AM) in children and adolescents remains a diagnostic and therapeutic challenge because of its heterogeneous presentation, overlap with dilated cardiomyopathy, and potential for fulminant deterioration, with approximately 5.9% risk of early mortality. We performed a narrative review integrating contemporary guidelines, consensus documents, and weighted analyses from systematically selected large pediatric cohorts to summarize current evidence on epidemiology, diagnosis, risk stratification, and treatment. Pediatric AM shows a male predominance and a bimodal age distribution. Early recognition is often difficult because initial manifestations may be non-specific and the differential diagnosis varies across age groups. Younger children more often present with dilated phenotypes and prominent gastrointestinal symptoms, frequently reflecting low cardiac output and systemic congestion, whereas adolescents may present with an uncomplicated phenotype characterized by chest pain and regional wall motion abnormalities. Severe disease remains a relevant burden, with fulminant myocarditis accounting for approximately one quarter of cases and carrying markedly higher mortality. Initial evaluation should therefore focus on early risk stratification, integrating clinical severity, biomarkers, electrocardiogram, echocardiography, and etiological testing. This approach may help identify high-risk viral phenotypes associated with enteroviruses or parvovirus B19, while also recognizing systemic inflammatory syndromes such as multisystem inflammatory syndrome in children, which may mimic AM but usually responds to timely immunomodulatory treatment. We propose a practical risk-based strategy that classifies patients into low-, intermediate-, and high-risk groups to guide monitoring, referral, cardiac magnetic resonance, endomyocardial biopsy, and therapy. High-risk patients require early referral to tertiary centers with pediatric intensive care, cardiac surgery, and temporary mechanical circulatory support availability. Treatment should be individualized according to risk, ranging from supportive care to mechanical circulatory support, transplant evaluation, and selected immunomodulation. Prospective registries and randomized trials are needed to validate risk-based pathways and define evidence-based therapies.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The non-culprit lesion in myocardial infarction: Treat now, treat later, or not at all?","authors":"Akshay Bagai, Michael E Farkouh","doi":"10.1016/j.tcm.2026.09.003","DOIUrl":"10.1016/j.tcm.2026.09.003","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of left atrial appendage occlusion versus oral anticoagulation for stroke prevention in non-valvular atrial fibrillation: do meta-analyses sharpen blurred images?","authors":"April Slee, Brian Olshansky, Bharat K Kantharia","doi":"10.1016/j.tcm.2026.09.004","DOIUrl":"10.1016/j.tcm.2026.09.004","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous left atrial appendage occlusion versus oral anticoagulation in nonvalvular atrial fibrillation.","authors":"Ameer Odeh, Abdalhakim Shubietah, Mohammad Riyad Salah, Jena Itraish, Tianze Jiao, Andrew J Foy, John Mandrola, Mohammed Ruzieh","doi":"10.1016/j.tcm.2026.09.002","DOIUrl":"10.1016/j.tcm.2026.09.002","url":null,"abstract":"<p><p>Percutaneous left atrial appendage occlusion (pLAAO) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation, yet no individual trial has been powered to detect meaningful differences in ischemic stroke or systemic embolism. We evaluated the comparative efficacy and safety of pLAAO vs OAC in nonvalvular atrial fibrillation using pooled analysis of randomized controlled trials. We searched PubMed, Embase, and Cochrane Central through April 3, 2026. Risk ratios were pooled using a random-effects model. Bayesian and trial sequential analyses were performed to assess non-inferiority using a prespecified margin of RR = 1.40, and power of available evidence. The primary efficacy endpoint was ischemic stroke or systemic embolism; primary safety endpoints were major bleeding and hemorrhagic stroke. Seven RCTs enrolling 7353 patients were included. Compared with OAC, pLAAO was associated with significantly more ischemic stroke or systemic embolism (3.3% vs 2.0%; RR 1.48, 95% CI 1.06-2.07). Hemorrhagic stroke was numerically lower with pLAAO but non-significant (0.6% vs 0.9%; RR 0.65, 95% CI 0.39 - 1.07). Major bleeding did not differ (8.3% vs 8.1%; RR 0.98, 95% CI 0.84-1.15). Bayesian analysis yielded a posterior probability of non-inferiority of 45.3%, failing the prespecified margin. Trial sequential analysis confirmed insufficient evidence to establish non-inferiority, and the major bleeding Z-curve entered the futility zone. Compared with OAC, pLAAO was not non-inferior for the outcome of ischemic stroke or systemic embolism, and did not significantly reduce major bleeding, though hemorrhagic stroke was numerically lower with pLAAO.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ECG as a window into the injured brain.","authors":"Charltien Long, Olujimi A Ajijola","doi":"10.1016/j.tcm.2026.09.001","DOIUrl":"10.1016/j.tcm.2026.09.001","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary artery calcification: Let the calcium shape the strategy.","authors":"Pietro Scicchitano, Ivano Barnaba","doi":"10.1016/j.tcm.2026.08.012","DOIUrl":"10.1016/j.tcm.2026.08.012","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate versus staged complete revascularization in patients presenting with acute myocardial infarction and multivessel coronary artery disease: A meta-analysis with time-to-event analysis.","authors":"Abdelrahman Hafez, Ahmed Abdelaziz, Muhammad Desouky, Ahmed Nazmy, Ahmed Sobhy, Mohammed Tarek Hasan, Ahmed Elshahat, Ahmed Mansour, Mohammed Sabri Hassanin, Ahmed Wahdan Kasem, Mohamed Abdelfatah Abdallah Abdellatif, Hanaa Elsayed, Karim Atta, Elena Ivanovna Gorshenina, Vasily Ivanovich Davydkin, Carl J Lavie","doi":"10.1016/j.tcm.2026.08.011","DOIUrl":"10.1016/j.tcm.2026.08.011","url":null,"abstract":"<p><p>Current guidelines recommend complete revascularization for patients with multivessel disease (MVD) presenting with acute myocardial infarction (AMI); however, the optimal timing of complete revascularization remains debated. We aimed to compare the outcomes of immediate versus staged complete revascularization in this population. Following PRISMA and Cochrane methodological standards, we systematically searched electronic databases from inception to March 2026 to identify randomized controlled trials (RCTs) comparing immediate versus staged complete revascularization in AMI patients with MVD. The primary outcomes were major adverse cardiac events (MACE) and all-cause mortality, assessed using reconstructed individual patient data (IPD) derived from published Kaplan-Meier curves. Secondary outcomes included cardiovascular disease (CVD) mortality and unplanned repeat revascularization. Hazard ratios (HRs) were pooled using random-effects Cox regression models. Thirteen RCTs including 8247 patients (3855 [46.7%] immediate complete revascularization; 4392 [53.3%] staged complete revascularization) were analyzed. There were no significant differences between strategies in the risks of MACE (HR, 0.88; 95% CI, 0.76-1.01; p = 0.08), all-cause mortality (HR, 1.30; 95% CI, 0.91-1.86; p = 0.10), or CVD mortality (HR, 1.64; 95% CI, 0.96-2.78; p = 0.07). Immediate complete revascularization complete revascularization was associated with a significantly lower 4-year risk of unplanned repeat revascularization (HR, 0.44; 95% CI, 0.30-0.64; p < 0.001). In patients with AMI and multivessel disease, immediate and staged complete revascularization yielded similar overall estimates for MACE and mortality, although clinically meaningful differences, particularly for mortality, cannot be excluded. Immediate complete revascularization significantly reduced the risk of repeat revascularization.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}