Trends in Cardiovascular Medicine最新文献

{"title":"Etiology-Specific Survival and Reoperation Trends Following Surgical Mitral Valve Repair and Replacement: A Meta-Analysis of Reconstructed Time-to-Event Data.","authors":"Mohammed Al-Tawil, Serge Sicouri, Yoshiyuki Yamashita, Basel Ramlawi","doi":"10.1016/j.tcm.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.tcm.2025.06.002","url":null,"abstract":"<p><p>Current American and European guidelines recommend mitral valve repair (MVr) over replacement (MVR) whenever feasible. However, these recommendations are primarily based on data from patients with degenerative mitral regurgitation (DMR), whereas evidence supporting MVr in other etiologies, such as infective endocarditis (IE) or ischemic mitral regurgitation (IMR), remains less conclusive. We systematically searched for and identified studies published after 2000 that compared MVr and MVR in patients with specific mitral valve disease etiologies, including DMR, IE, IMR, and rheumatic heart disease (RHD). A total of 61 records (10 DMR, 21 IE, 18 IMR, and 12 RHD) of 59 studies published between 2005 and 2024, were included. MVr consistently demonstrated superior survival compared to MVR in DMR and IE patients. Parametric time-varying hazard ratios revealed a sustained survival benefit of MVr in DMR and IE, whereas in IMR and RHD, the survival advantage was transient-lasting only up to six months and 2.7 years postoperatively, respectively-after which survival hazards between MVr and MVR became comparable. This was further corroborated by the results of a two-year landmark and the propensity-matched subgroup analyses. In DMR, MVr was associated with lower reoperation rates compared to MVR; however, in IE, IMR, and RHD, MVr was associated with significantly higher reoperation rates compared to MVR. Our study supports current guidelines favoring MVr over MVR, demonstrating sustained survival benefits in DMR. In IE-specific MR, MVr also showed consistent benefits over MVR, demonstrating that MVr should be prioritized when feasible. However, in IMR and RHD, there was no notable survival advantage of MVr over MVR, with higher reoperation rates observed with MVr. These findings highlight the need for etiology-specific and individualized surgical planning.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295354","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":"Inflammasome and ventricular arrhythmogenesis: pathogenic interplay and potential targets on the horizon.","authors":"Maria Lucia Narducci, Cristina Conte, Alessandro Telesca, Giovanna Liuzzo, Massimo Imazio","doi":"10.1016/j.tcm.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.tcm.2025.05.006","url":null,"abstract":"<p><p>Life-threatening ventricular arrhythmias (VAs) pose a significant challenge in clinical management due to their impact on mortality, particularly the risk of sudden cardiac death, which remains a concern despite the use of only partially effective anti-arrhythmic drugs and repeated catheterablation. There is also a need for more precise risk stratification tools for implantable cardioverter defibrillators (ICD). Sustained ventricular tachycardia (VT) most commonly occurs in patients with a history of myocardial infarction (MI) or non ischemic cardiomyopathy characterized by fibrotic ventricular scars, which can be identified as areas of late gadolinium enhancement (LGE) through cardiac magnetic resonance or as low-voltage areas via three-dimensional electroanatomic mapping. Both the presence and extent of cardiac fibrosis are linked to ventricular arrhythmogenesis and the risk of sudden death. Fibrosis contributes to VAs for several reasons; primarily, it causes structural remodelling that alters the myocardial architecture and promotes reentry circuits. On this regard, increasing evidence highlights the role of inflammation mediated by the NLR family pyrin domain containing 3 (NLRP3) inflammasome as a key factor in scar development, cardiac electrical instability, and disease progression. Secondly, systemic and local sympathetic hyperactivity significantly contribute to electrical instability. The interplay between inflammation, cardiac fibrosis and sympathetic hyperactivity has been neglected for a long time. However, a deep insight in the pathogenesis of VAs is warranted in order to develop new and tailored pharmacological strategies. Therefore, the NLRP3 inflammasome pathway, autonomic imbalance, and early stage of myocardial fibrosis may represent promising therapeutic targets for mitigating adverse ventricular remodeling and the burden of VAs. On this basis of multiple evidence, inflammation plays a role of trigger in a hypothetical Coumel's triangle of arrhythmogenesis for the pathogenesis of VAs, where the ventricular substrate is represented by cardiac fibrosis, and the favoring modulating factor is provided by sympathetic hyperactivity.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295355","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":"Editorial Commentary: Finerenone as an additional therapeutic strategy in heart failure: finerenone in heart failure.","authors":"Bianca Larroux, Aldo Bonaventura","doi":"10.1016/j.tcm.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.tcm.2025.06.001","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250771","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":"Cardiac neuromodulation to treat ventricular arrhythmias.","authors":"Saori Asada, Hiroshi Morita","doi":"10.1016/j.tcm.2025.05.007","DOIUrl":"10.1016/j.tcm.2025.05.007","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250770","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 cardiorespiratory fitness gap.","authors":"Barbara Cifra, Robert M Hamilton","doi":"10.1016/j.tcm.2025.05.004","DOIUrl":"10.1016/j.tcm.2025.05.004","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200698","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":"Managing angina across the spectrum of non-acute myocardial ischaemic syndromes.","authors":"Kevin Cheng, Ranil de Silva","doi":"10.1016/j.tcm.2025.05.005","DOIUrl":"10.1016/j.tcm.2025.05.005","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152429","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":"A data-driven approach to guide the role of percutaneous catheter-based therapies in congenital heart disease.","authors":"Dinesh K Kalra","doi":"10.1016/j.tcm.2025.05.003","DOIUrl":"10.1016/j.tcm.2025.05.003","url":null,"abstract":"","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121170","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 role of finerenone in heart failure.","authors":"Hassan Ismahel, Kieran F Docherty","doi":"10.1016/j.tcm.2025.05.002","DOIUrl":"10.1016/j.tcm.2025.05.002","url":null,"abstract":"<p><p>Heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) represents approximately half of all HF cases, yet therapeutic options are limited. Mineralocorticoid receptor (MR) overactivation by aldosterone has long been recognized as a key driver of vascular inflammation, cardiac fibrosis, and cardiac hypertrophy, pathophysiological processes integral to the development and progression of HFmrEF/HFpEF. The non-steroidal MRA finerenone has been developed with a distinct pharmacological profile: potent and selective MR blockade with a reduced risk of off-target hormone-related side effects. Large, multicenter randomized placebo-controlled trials in chronic kidney disease and type 2 diabetes patients (FIDELIO-DKD, FIGARO-DKD) first highlighted finerenone's cardiorenal benefits, including a reduction in death from cardiovascular causes and hospitalization for HF. More recently, the FINEARTS-HF trial extended this evidence to patients with HFmrEF/HFpEF, demonstrating a significant reduction in the risk of worsening HF events and death from cardiovascular causes. Ongoing studies, such as REDEFINE-HF, CONFIRMATION-HF, and FINALITY-HF, will examine the potential role of finerenone in HF across a broad spectrum of ejection fractions and different clinical settings. This review synthesizes the evolving evidence supporting the role of finerenone as a new option in the management of HF.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095694","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":"Premature ventricular complexes and non-sustained ventricular tachycardia in older women.","authors":"Isaac C Bohart, Sofia E Gomez, Marco V Perez","doi":"10.1016/j.tcm.2025.04.007","DOIUrl":"10.1016/j.tcm.2025.04.007","url":null,"abstract":"<p><p>While ventricular ectopy is common across broad populations and becomes even more prevalent with age, this topic has been largely understudied, particularly among women. Recent data have revealed that the prevalence of frequent ventricular ectopy among older women is higher than expected. Furthermore, older women are more likely to experience symptomatic arrhythmias and palpitations resulting in cardiac monitoring and the detection of ectopy. Incidental ventricular ectopy, namely premature ventricular complexes (PVCs) and non-sustained ventricular tachycardia (NSVT), is being identified more frequently across both sexes due to recent expansion of cardiac monitoring, often for atrial fibrillation screening. Definitions and clinically relevant thresholds of frequent ventricular ectopy vary widely across clinical studies and society guidelines. As a result, the diagnosis and management of frequent ventricular ectopy is challenging. Given the consequences of frequent PVCs and NSVT, namely incident cardiomyopathy and associated morbidity and mortality, further characterization of these entities and consensus on diagnostics and therapeutics is needed to guide providers in caring for an aging population. This review seeks to synthesize the literature on the prevalence and clinical significance of ventricular ectopy, while also proposing novel, evidence-based diagnostic and treatment algorithms. A special focus will be placed on postmenopausal women in an effort to tackle existing sex disparities and highlight unique insights relevant to the clinical care of this understudied population.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087029","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":"Cardiac neuromodulation for ventricular arrhythmias: Current state and future perspectives. A comprehensive review.","authors":"Pierre Groussin, Donovan Decaudin, Melvyn Dezecot, Thomas Marc, Nathalie Behar, Dominique Pavin, Christophe Leclercq, Philippe Mabo, Karim Benali, RaphaëlP Martins","doi":"10.1016/j.tcm.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.tcm.2025.05.001","url":null,"abstract":"<p><p>Electrical storm represents an urgent challenge in electrophysiology. Despite the use of antiarrhythmic medications and catheter ablation, refractory ventricular arrhythmias may persist, prompting the use of neuromodulation. This approach has evolved over the years, facing initial challenges owing to the intricacies of the autonomic nervous system. Animal studies have significantly enhanced our understanding of this system, paving the way for human studies on sympathetic modulation, which gained momentum in the early 2000s and expanded notably in cardiology in the 2010s. Presently, a variety of techniques coexist and offer diverse alternatives. Additionally, there are promising avenues for development that are primarily explored in animal models. This review aims to shed light on the diverse approaches currently available in this field.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081958","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}