Hellenic Journal of Cardiology最新文献

{"title":"The journey to improving stroke risk stratification for patients with carotid artery stenosis: from medical management to revascularization","authors":"Ioanna Gianopoulos ,&nbsp;Stella S. Daskalopoulou","doi":"10.1016/j.hjc.2025.08.002","DOIUrl":"10.1016/j.hjc.2025.08.002","url":null,"abstract":"<div><div>Ischemic strokes remain a leading cause of mortality and morbidity worldwide. Carotid artery stenosis is a major risk factor for ischemic strokes. Although traditional carotid revascularization procedures are based on carotid stenosis, it has been increasingly recognized that plaque composition plays an important role in plaque rupture and stroke occurrence. Our narrative review aims to present the evidence related to 1) carotid atherosclerosis and plaque composition contributors to stroke and 2) medical management and revascularization of patients with carotid artery stenosis for stroke prevention. For patients with severe carotid atherosclerosis, critical treatment modalities include best medical therapy and revascularization, specifically, carotid endarterectomy (CEA) or carotid artery stenting (CAS) for symptomatic and asymptomatic individuals, according to stenosis guidelines (≥50% and ≥70% stenosis, respectively). Landmark randomized controlled trials (RCTs) showcased the clinical value of surgery in reducing future stroke outcomes for asymptomatic and symptomatic populations. Along with the latest advancements in medical therapy, results from modern RCTs are providing much needed evidence regarding the net benefits in revascularization for stroke risk reduction, namely, in asymptomatic populations. Evidence suggests that carotid artery stenosis, the primary metric for CEA or CAS eligibility is not always consistent with the degree of plaque instability. We emphasize the importance of combining plaque instability and carotid stenosis assessments to better classify at-risk patients. Along with integrations of interventions with modern medical treatment, novel findings from RCTs and consideration of stenosis and plaque instability will ultimately help improve individualized care leading to effective prevention of ischemic strokes.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"88 ","pages":"Pages 73-86"},"PeriodicalIF":3.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819024","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":"Dual nature of mitral annular disjunction: normal variation or pathological precursor?","authors":"Agata Krawczyk-Ożóg ,&nbsp;Mateusz K. Hołda","doi":"10.1016/j.hjc.2025.08.005","DOIUrl":"10.1016/j.hjc.2025.08.005","url":null,"abstract":"<div><div>The concept of mitral annular disjunction (MAD) has garnered significant attention due to its potential clinical implications. MAD refers to a spatial displacement of the hinge point of the mitral valve leaflets. Initially described over 150 years ago, MAD has evolved from being an anatomical curiosity to a potential marker of pathological processes, especially in the context of mitral valve prolapse and arrhythmic syndromes. Two distinct types of MAD can be identified: atrial (a-MAD), characterized by annular displacement toward the left atrium, and ventricular (v-MAD), characterized by annular displacement toward the left ventricle. The prevalence of a-MAD varies based on the patient population studied, the imaging techniques employed, and the specific definition of a-MAD used and ranges from 7.2%–8.7%–96.0%. The prevalence of v-MAD is approximately 25%. It is critical to note that disjunction is non-uniformly distributed around the circumference of the junction supporting the mural leaflet of the valve and is also present in the commissural areas, interspersed with alternating segments of tissue that do not exhibit disjunction. Clinically, a-MAD may be associated with mitral valve prolapse, ventricular arrhythmias, and sudden cardiac death, underscoring its importance in risk stratification and management. V-MAD, although less studied, raises intriguing possibilities about its role in mitral valve dynamics and its possible contribution to pathological processes. Through a detailed review of existing literature and clinical observations, this article seeks to elucidate the spectrum of MAD’s presentations, its diagnostic challenges, and its potential impact on patient outcomes.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"88 ","pages":"Pages 87-96"},"PeriodicalIF":3.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985304","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":"Renin-angiotensin system inhibitors and non-ST-elevation myocardial infarction outcomes based on left ventricular ejection fraction","authors":"Yong Hoon Kim ,&nbsp;Ae-Young Her ,&nbsp;Seung-Woon Rha ,&nbsp;Cheol Ung Choi ,&nbsp;Byoung Geol Choi ,&nbsp;Soohyung Park ,&nbsp;Dong Oh Kang ,&nbsp;Se Yeon Choi ,&nbsp;Jinah Cha ,&nbsp;Su Jin Hyun ,&nbsp;Jung Rae Cho ,&nbsp;Min-Woong Kim ,&nbsp;Ji Young Park ,&nbsp;Sang-Ho Park ,&nbsp;Myung Ho Jeong","doi":"10.1016/j.hjc.2024.08.007","DOIUrl":"10.1016/j.hjc.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><div>We assessed left ventricular ejection fraction (LVEF) to compare the effects of renin–angiotensin system inhibitors (RASI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI).</div></div><div><h3>Methods</h3><div>We categorized 4558 patients with NSTEMI as either RASI users (3752 patients) or non-users (806 patients). The 3-year patient-oriented composite outcome (POCO), which included all-cause death, recurrent myocardial infarction, any repeat revascularization, or hospitalization for heart failure (HF), was the primary outcome. To compare clinical outcomes, a multivariable-adjusted hazard ratio (aHR) was calculated after performing multicollinearity tests on all significant confounding variables (P &lt; 0.05).</div></div><div><h3>Results</h3><div>Among RASI users, the aHRs for POCO, all-cause death, and cardiac death were significantly higher in the HF with reduced EF (HFrEF) subgroup than in the HF with mildly reduced EF (HFmrEF) (1.610, 2.120, and 2.489; P &lt; 0.001, &lt;0.001, and &lt;0.001; respectively) and HF with preserved EF (HFpEF) (2.234, 3.920, and 5.215; P &lt; 0.001, &lt;0.001, and &lt;0.001; respectively) subgroups. The aHRs for these variables were significantly higher in the HFmrEF subgroup than the HFpEF subgroup (1.416, 1.843, and 2.172, respectively). Among RASI non-users, the aHRs for these variables were significantly higher in the HFrEF subgroup than the HFmrEF (2.573, 3.172, and 3.762, respectively) and HFpEF (2.425, 3.805, and 4.178, respectively) subgroups. In three LVEF subgroups, RASI users exhibited lower aHRs for POCO and all-cause death than RASI non-users.</div></div><div><h3>Conclusion</h3><div>In the RASI users group, the aHRs for POCO and mortality were highest in the HFrEF subgroup, intermediate in the HFmrEF subgroup, and lowest in the HFpEF subgroup.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"88 ","pages":"Pages 21-35"},"PeriodicalIF":3.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996971","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":"Humanistic values of the physician in the era of artificial intelligence","authors":"Konstantinos Dean Boudoulas ,&nbsp;Konstantinos Marmagkiolis ,&nbsp;Filippos Triposkiadis ,&nbsp;Harisios Boudoulas","doi":"10.1016/j.hjc.2025.04.005","DOIUrl":"10.1016/j.hjc.2025.04.005","url":null,"abstract":"<div><div>Artificial intelligence (AI) has recently been introduced into clinical practice with the potential to revolutionize medicine. AI will provide the physician with unlimited power, which is almost impossible to foresee at present. In addition, AI can be used for the development of pharmacologic agents and antibodies with unprecedented accuracy and speed. AI will assist the physician in defining individuals at high risk for developing a certain disease and, in turn, provide appropriate care to delay or prevent the disease. Using vast information related to a certain disease, the physician will be able to apply individualized care in contrast to the current approach based on guidelines where “one size fits all.” With prevention and individualized care, the cost of health care will decrease, human suffering will diminish, and overall mortality will decline. However, in this endless evolution of medicine, the role of the physician remains constant, which is to maintain the health of a human being. In addition to diagnosis and management, the physician should apply common sense, courage, and compassion when dealing with the difficulties of human life that may escape machines. Humanistic values, among others, are basic for the caring physician. Thus, the humanistic approach to the patient and the divine vocation of the physician should never be forgotten and should be based on a solid ethical foundation. The greatest challenge for physicians and medical leadership in the 21st century will not be living with and adapting to changing technology, but determining the proper balance between clinical wisdom and evolving technology.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"88 ","pages":"Pages 109-111"},"PeriodicalIF":3.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060780","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":"Association of neutrophil extracellular traps burden with clinical and angiographic characteristics in patients with ST-elevation myocardial infarction","authors":"Nikolaos Stalikas ,&nbsp;Sofia-Eleni Tzorakoleftheraki ,&nbsp;Efstratios Karagiannidis ,&nbsp;Matthaios Didagelos ,&nbsp;Antonios Ziakas ,&nbsp;Vasileios Kamperidis ,&nbsp;George Giannakoulas ,&nbsp;Vasileios Vassilikos ,&nbsp;Triantafyllia Koletsa ,&nbsp;George Giannopoulos","doi":"10.1016/j.hjc.2024.09.001","DOIUrl":"10.1016/j.hjc.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>The precise triggers for atherosclerotic plaque rupture and the underlying pathophysiology of coronary thrombogenesis remain elusive. Polymorphonuclear neutrophils, particularly their formation of neutrophil extracellular traps (NETs), have garnered attention in the context of coronary atherothrombosis. This study sought to explore the association of NETs burden with clinical and angiographic characteristics in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) and thrombus aspiration (TA).</div></div><div><h3>Methods</h3><div>For this study, 336 consecutive STEMI patients undergoing pPCI were considered for TA. Aspirated thrombi underwent histological analysis and NETs quantification via immunohistochemistry. Potential associations of clinical variables and angiographic outcomes with NETs burden were assessed.</div></div><div><h3>Results</h3><div>Manual TA was selectively performed in 72 cases with increased thrombotic burden, and 60 thrombi were suitable for analysis and included in the current study. Most thrombi specimens displayed lytic features (63%), and almost three out of four were identified as white thrombi. Increased NETs burden was significantly associated with prolonged pain-to-balloon time (&gt;300 min), OR = 10.29 (95% CI 2.11–42.22, p = 0.001), and stress-induced hyperglycemia OR = 6.58 (95% CI 1.23–52.63, p &lt; 0.01) after multivariate regression analysis. Additionally, distal embolization, and left ventricular ejection fraction ≤40% were more frequent among patients with an elevated NETs burden OR = 16.9 (95% CI 4.23–44.52, p &lt; 0.01) and OR = 3.2 (95% CI 1.05–12.1, p = 0.05), respectively.</div></div><div><h3>Conclusion</h3><div>Elevated NETs burden in STEMI thrombi may be due to delayed reperfusion and stress-induced hyperglycemia, and it is associated with an increased risk of distal embolization and lower left ventricular ejection fraction. Further research is needed to elucidate the role of NETs as a potential therapeutic target in acute atherothrombosis.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"88 ","pages":"Pages 49-56"},"PeriodicalIF":3.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156751","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 history of Naxos disease: pioneering innovation and collaboration with limited means","authors":"Adalena Tsatsopoulou","doi":"10.1016/j.hjc.2025.04.001","DOIUrl":"10.1016/j.hjc.2025.04.001","url":null,"abstract":"","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"88 ","pages":"Pages 104-108"},"PeriodicalIF":3.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042973","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":"Myocardial inflammation after elective percutaneous coronary intervention","authors":"Ioannis Merinopoulos ,&nbsp;U. Bhalraam ,&nbsp;Bahman Kasmai ,&nbsp;David Hewson ,&nbsp;Richard Greenwood ,&nbsp;Simon C. Eccleshall ,&nbsp;James Smith ,&nbsp;Vasiliki Tsampasian ,&nbsp;Vassilios Vassiliou","doi":"10.1016/j.hjc.2024.06.010","DOIUrl":"10.1016/j.hjc.2024.06.010","url":null,"abstract":"<div><h3>Objective</h3><div>It is well established that inflammation plays a central role in the sequelae of percutaneous coronary intervention (PCI). Most of the studies to date have focused on the inflammatory reaction affecting the vessel wall after angioplasty. However, there are data to suggest that the main foci of inflammation are in fact in the myocardium beyond the vessel wall. The main aim of our study was to investigate the myocardial inflammation after elective, uncomplicated angioplasty with cardiovascular magnetic resonance (CMR) enhanced by ultrasmall superparamagnetic particles of iron oxide (USPIO) and also blood biomarkers. This is the first study to report such findings after elective angioplasty.</div></div><div><h3>Methods</h3><div>We assessed patients undergoing elective angioplasty for stable angina with USPIO-enhanced CMR two weeks after the procedure and compared the results with those of healthy volunteers who constituted the control group. We excluded patients with previous myocardial infarction, previous PCI, or any significant inflammatory condition. All patients also underwent blood biomarker testing at baseline (pre-PCI), 4 h, and two weeks later.</div></div><div><h3>Results</h3><div>A total of five patients and three controls were scanned. There was a small absolute increase, although statistically insignificant, in R2∗ values in the PCI area compared with either remote myocardium from the same patient (PCI area [left anterior descending artery (LAD)] vs remote myocardium [circumflex area]: 19.3 ± 10.8 vs 9.2 ± 7.9, p = 0.1) or healthy myocardium from healthy volunteers (PCI area [LAD] vs healthy myocardium [LAD]: 19.3 ± 10.8 vs 12.2 ± 4.0, p = 0.2). PTX3 and IL-6 were the only biomarkers that changed significantly from baseline to 4 h and 2 weeks. Both biomarkers peaked at 4 h.</div></div><div><h3>Conclusion</h3><div>We used USPIO-enhanced CMR for the first time to assess myocardial inflammation after elective, uncomplicated PCI. We have demonstrated a small numerical increase in inflammation, which was not statistically significant. This study opens the way for future studies to use this method as a means to target inflammation.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"87 ","pages":"Pages 4-12"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499685","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":"Implementation of a cardiogenic shock team in a tertiary academic center","authors":"Grigoris V. Karamasis ,&nbsp;Effie Polyzogopoulou ,&nbsp;Charalampos Varlamos ,&nbsp;Frantzeska Frantzeskaki ,&nbsp;Vassiliki-Maria Dragona ,&nbsp;Antonios Boultadakis ,&nbsp;Vasiliki Bistola ,&nbsp;Katerina Fountoulaki ,&nbsp;Christos Pappas ,&nbsp;Fotios Kolokathis ,&nbsp;Dionysios Pavlopoulos ,&nbsp;Ioannis K. Toumpoulis ,&nbsp;Vasilios D. Kollias ,&nbsp;Dimitrios Farmakis ,&nbsp;Loukianos S. Rallidis ,&nbsp;Dimitrios C. Angouras ,&nbsp;Iraklis Tsangaris ,&nbsp;John T. Parissis ,&nbsp;Gerasimos Filippatos","doi":"10.1016/j.hjc.2024.06.011","DOIUrl":"10.1016/j.hjc.2024.06.011","url":null,"abstract":"<div><h3>Objective</h3><div>Observational studies have shown that the management of patients with cardiogenic shock (CS) by dedicated multidisciplinary teams improves clinical outcomes. Nevertheless, these studies reflect a specific organizational setting with most patients being transferred from referring hospitals, hospitalized in cardiac intensive care units (ICU), or treated with mechanical circulatory support (MCS) devices. The purpose of this study was to document the organization and outcomes of a CS team offering acute care in an all-comer population.</div></div><div><h3>Methods</h3><div>A CS team was developed in a large academic tertiary institution. The team consisted of emergency care physicians, critical care cardiologists, interventional cardiologists, cardiac surgeons, ICU physicians, and heart failure specialists and was supported by a predefined operating protocol, a dedicated communication platform, and regular team meetings.</div></div><div><h3>Results</h3><div>Over 12 months, 70 CS patients (69 ± 13 years old, 67% males) were included. Acute myocardial infarction (AMI-CS) was the most common cause (64%); 31% of the patients presented post-resuscitated cardiac arrest and 56% needed invasive mechanical ventilation (IMV). Coronary angiography was performed in 70% and 53% had percutaneous coronary intervention. MCS was used in 10% and 6% were referred for urgent cardiac surgery. The in-hospital mortality in our center was 40% with 39% of the patients dying within 24 h from presentation. Overall, 76% of the live patients were discharged home.</div></div><div><h3>Conclusion</h3><div>Across an all-comer population, AMI was the most common cause of CS. A significant number of patients presented post-cardiac arrest, and the majority required IMV. Mortality was high with a significant number dying within hours of presentation.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"87 ","pages":"Pages 62-70"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535990","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":"Nationwide mortality trends from 2001 to 2020 in Greece: health policy implications under the scope of aging societies","authors":"Maria Nikolaou ,&nbsp;Nikolaos Theodorakis ,&nbsp;Georgios Feretzakis ,&nbsp;Georgia Vamvakou ,&nbsp;Christos Hitas ,&nbsp;Sofia Kalantzi ,&nbsp;Aikaterini Spyridaki ,&nbsp;Anastasios Apostolos ,&nbsp;Vassilios S. Verykios ,&nbsp;Konstantinos Toutouzas","doi":"10.1016/j.hjc.2024.08.009","DOIUrl":"10.1016/j.hjc.2024.08.009","url":null,"abstract":"<div><h3>Objective</h3><div>This nationwide study aims to analyze mortality trends for all individual causes in Greece from 2001 to 2020, with a specific focus on 2020, a year influenced by the COVID-19 pandemic. As Greece is the fastest-aging country in Europe, the study’s findings can be generalized to other aging societies, guiding the reevaluation of global health policies.</div></div><div><h3>Methods</h3><div>Data on the population and the number of deaths were retrieved from the Hellenic Statistical Authority. We calculated age-standardized mortality rates (ASMR) and cause-specific mortality rates by sex in three age groups (0–64, 65–79, and 80+ years) from 2001 to 2020. Proportional mortality rates for 2020 were determined. Statistical analysis used generalized linear models with Python Programming Language.</div></div><div><h3>Results</h3><div>From 2001 to 2020, the ASMR of cardiovascular diseases (CVD) decreased by 42.7% (p &lt; 0.0001), with declines in most sub-causes, except for hypertensive diseases, which increased by 2.8-fold (p &lt; 0.0001). In 2020, the proportional mortality rates of the three leading causes were 34.9% for CVD, 23.5% for neoplasms, and 9.6% for respiratory diseases (RD). In 2020, CVD were the leading cause of death among individuals aged 80+ years (39.3%), while neoplasms were the leading cause among those aged 0–79 years (37.7%). Among cardiovascular sub-causes, cerebrovascular diseases were predominant in the 80+ year age group (30.3%), while ischemic heart diseases were most prevalent among those aged 0–79 years (up to 60.0%).</div></div><div><h3>Conclusions</h3><div>The global phenomenon of population aging necessitates a reframing of health policies in our aging societies, focusing on diseases with either a high mortality burden, such as CVD, neoplasms, and RD, or those experiencing increasing trends, such as hypertensive diseases.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"87 ","pages":"Pages 13-28"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114944","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":"Navigating the silence: reconsidering treatment paradigms in asymptomatic severe aortic stenosis","authors":"Konstantinos Karampinos ,&nbsp;Nikolaos Ktenopoulos ,&nbsp;Anastasios Apostolos ,&nbsp;Leonidas Koliastasis ,&nbsp;Ioannis Kachrimanidis ,&nbsp;Panayotis Vlachakis ,&nbsp;Odysseas Katsaros ,&nbsp;Sotirios Tsalamandris ,&nbsp;Antonios Karanasos ,&nbsp;Maria Drakopoulou ,&nbsp;Andreas Synetos ,&nbsp;George Latsios ,&nbsp;Konstantinos Tsioufis ,&nbsp;Konstantinos Toutouzas","doi":"10.1016/j.hjc.2025.06.004","DOIUrl":"10.1016/j.hjc.2025.06.004","url":null,"abstract":"<div><div>Aortic stenosis (AS) remains the leading valvular heart disease worldwide, affecting up to 5% of older adults and posing a significant risk if left untreated. The evolution of transcatheter aortic valve replacement (TAVR) and its expanding indications for symptomatic patients with severe AS, coupled with the evolving understanding of the pathophysiology and natural history of AS, have heightened the focus on asymptomatic patients with severe AS. Although current clinical practice guidelines recommend aortic valve replacement (AVR) therapy in asymptomatic severe aortic stenosis (ASAS) only in specific clinical settings, recent studies have challenged traditional treatment paradigms, advocating for a more individualized strategy, particularly for patients exhibiting high-risk characteristics. In this review, we provide an in-depth analysis of ASAS, focusing on the intricacies of its clinical management, novel risk-stratification modalities, and predictors of symptom onset and disease progression. We also determine the role of echocardiography in assessing AS severity, highlighting inconsistencies in diagnostic criteria and the need for supplementary testing. Evolving and recently published randomized controlled trials—namely EARLY-TAVR, EVoLVeD, and TAVR-UNLOAD—randomizing asymptomatic patients to early intervention or a watchful waiting strategy provide significant evidence that has the potential to change treatment paradigms, lower the threshold for intervention, and pave the way for more individualized management strategies in ASAS.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"87 ","pages":"Pages 101-120"},"PeriodicalIF":3.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328402","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}