Current Opinion in Cardiology最新文献

{"title":"Cardiac sarcoidosis; update for the heart failure specialist.","authors":"David H Birnie","doi":"10.1097/HCO.0000000000001200","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001200","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review presents contemporary data on epidemiology, common presentations, investigations and diagnostic algorithms, treatment and prognosis. It particularly focuses on topics of most relevance to heart failure specialists, including what left ventricle (LV) function changes can be expected after treatment and outcomes to all standard and advanced heart failure therapies.</p><p><strong>Recent findings: </strong>Around 5% of sarcoidosis patients have clinically manifest cardiac sarcoidosis (CS), presenting with significant arrhythmias (such as conduction disturbances and ventricular arrhythmias) or newly developed unexplained heart failure. These cardiac symptoms (including sudden cardiac death) may be the initial manifestations of CS. While cardiac magnetic resonance imaging (CMR) is the preferred method for identifying fibrosis in the myocardium, FDG-positron emission tomography (FDG-PET) helps in identifying active inflammation within the myocardium and aids in managing immunosuppressive treatment. The concept of isolated CS is much debated. However very importantly, recent data have shown that some patients diagnosed with 'clinically and imaging isolated CS' are subsequently found to have genetic cardiomyopathy. The management of CS involves a comprehensive approach including medications for immunosuppression, all standard heart failure medication and, in high-risk patient's implantable cardioverter defibrillators (ICDs). In CS patients with terminal heart failure who do not respond to medical and surgical interventions, heart transplantation and ventricular assist devices should be considered. Long-term results after transplantation are generally favorable and comparable to non-CS patients. The degree of left ventricular dysfunction remains a crucial prognostic factor in CS cases. Outcomes for CS have very significantly improved, over the last two decades due to earlier diagnosis, advanced heart failure treatments, and the strategic use of ICD therapy.</p><p><strong>Summary: </strong>Outcomes for CS have significantly improved, over the last two decades due to earlier diagnosis, advanced heart failure treatments, and the strategic use of ICD therapy.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetics, manifestations, and management of catecholaminergic polymorphic ventricular tachycardia.","authors":"Shubh Desai, Oliver M Moore, Xander H T Wehrens","doi":"10.1097/HCO.0000000000001202","DOIUrl":"10.1097/HCO.0000000000001202","url":null,"abstract":"<p><strong>Purpose of review: </strong>Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a devastating heritable channelopathy that can lead to sudden cardiac death in children and young adults. This review aims to explore genetics, the cardiac and extracardiac manifestations of mutations associated with CPVT, and the challenges involved with managing phenotypically variable variants.</p><p><strong>Recent findings: </strong>The understanding of the genetics and mechanisms of CPVT continues to grow with recent discoveries including alternative splicing of cardiac TRDN and calmodulin gene variants. Additionally, there is an increasing recognition of the extra-cardiac manifestations such as epilepsy, neurodevelopmental delay, and glucose homeostasis abnormalities in RyR2 variant carriers. Advances in precision medicine, including the development of iPSC-derived cardiomyocytes, are valuable models for developing targeted therapeutics.</p><p><strong>Summary: </strong>CPVT remains a complex disorder with cardiac and neurological manifestations impacting management. Early genetic testing and personalized treatment, including beta-blockers, flecainide, and ICDs, is important in improving outcomes. Ongoing research into the mechanism of each mutation will help in developing more effective, personalized therapeutics.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New therapies to treat cardiac amyloidosis.","authors":"Olives Nguyen, Daniel Kamna, Ahmad Masri","doi":"10.1097/HCO.0000000000001198","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001198","url":null,"abstract":"<p><strong>Purpose of review: </strong>Review advancements in therapies for transthyretin (ATTR-CM) and immunoglobulin light chain (AL-CM) cardiac amyloidosis.</p><p><strong>Recent findings: </strong>In ATTR-CM, tafamidis remains the cornerstone therapy, with Food and Drug Administration (FDA) approval for over 5 years. Acoramidis, another transthyretin stabilizer, has very recently been FDA-approved following positive results in the ATTRibute-CM trial. Vutrisiran, a transthyretin gene silencer, demonstrated efficacy in the HELIOS-B trial and awaits FDA review. Eplontersen's CARDIO-TTRansform trial, the largest ATTR-CM study to date, is expected to report by late 2025. Innovative approaches such as NTLA-2001 (a CRISPR-Cas9 therapy) and fibril depleters like ALXN2220 and coramitug are advancing in clinical trials. In AL-CM, daratumumab, cyclophosphamide, bortezomib, and dexamethasone (Dara-CyBorD) has established itself as the standard of care. Novel antiplasma cell therapies include CAR-T cells and bispecific antibodies (teclistimab) and fibril depleters. Birtamimab improved survival in advanced AL-CM during the VITAL trial and is under investigation in AFFIRM-AL. Anselamimab is in phase III CARES trials, whereas AT-02 undergoes early-phase testing for ATTR-CM and AL-CM.</p><p><strong>Summary: </strong>The therapeutic landscape for ATTR-CM and AL-CM is rapidly evolving, driven by novel therapies targeting diverse mechanisms. Ongoing clinical trials promise to further refine the standard of care and improve outcomes for patients with cardiac amyloidosis.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment options to break the cycle of recurrent pericarditis.","authors":"Ajit B Raisinghani, Sushil Allen Luis","doi":"10.1097/HCO.0000000000001201","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001201","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides a contemporary, evidence-based update on the pathophysiological mechanisms and rapidly evolving therapeutic options for recurrent pericarditis.</p><p><strong>Recent findings: </strong>Recent studies have elucidated the pathogenesis of recurrent pericarditis, identifying autoinflammation as a key mechanism and interleukin-1 (IL-1) as a central modulator of the inflammatory cascade. Multiple clinical trials have investigated novel therapeutic approaches, particularly focusing on IL-1 inhibition. The recent FDA approval of IL-1 pathway blockade for recurrent pericarditis has revolutionized treatment, offering patients significantly improved quality of life and symptom management.</p><p><strong>Summary: </strong>The enhanced understanding of the autoinflammatory nature of recurrent pericarditis, coupled with groundbreaking advances in targeted therapies, has transformed the treatment landscape for affected patients. The emergence of IL-1 inhibitors as an effective therapeutic option promises substantial improvements in clinical outcomes and patient well being. Clinicians must familiarize themselves with these new treatments, their efficacy, and potential limitations to optimize patient care and guide therapeutic decision-making in this challenging condition.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and multimodal approaches to right-sided cardiac tumours.","authors":"Shubh K Patel, Nitish K Dhingra, Robert J Cusimano","doi":"10.1097/HCO.0000000000001197","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001197","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiac tumours present significant clinical challenges due to their wide differential, complex anatomical and physiological implications, as well as the potential for widespread invasion in the case of malignancies. This review synthesizes recent findings surrounding the diagnosis and management of specifically right-sided cardiac tumours, with a particular focus on surgical resection and reconstructive techniques.</p><p><strong>Recent findings: </strong>Management of cardiac tumours can be categorized into three key phases. First: early and accurate diagnosis is critical for improving outcomes, especially in malignancies. Advances in imaging modalities like MRI, CT, PET-CT, and biopsy techniques enhance diagnostic accuracy. Second: surgical resection is a cornerstone treatment for both benign and malignant right-sided cardiac tumours. Surgery is often curative for benign tumours, while for malignant tumours, R0 resection (complete microscopic removal) in appropriate candidates correlates with better survival. Third: managing cardiac malignancies necessitates a multidisciplinary approach, integrating additional therapies such as chemotherapy, radiation, and emerging immunotherapies tailored to patient and tumour characteristics.</p><p><strong>Summary: </strong>Managing right-sided cardiac tumours demands interdisciplinary expertise. Standardized protocols are limited by the rarity of cases and insufficient high-quality data. International collaboration and sharing of experiences through prospective registries and clinical studies are essential to advancing knowledge and improving patient outcomes.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic mitral valve surgery: evolving history, techniques, and training paths.","authors":"Irsa Hasan, Andrea Amabile, Derrick Y Tam","doi":"10.1097/HCO.0000000000001194","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001194","url":null,"abstract":"<p><strong>Purpose of review: </strong>Over the past 25 years, robotic-assisted mitral valve surgery has gained significant recognition because of its potential to minimize patient trauma and improve clinical outcomes. This field has evolved from early efforts in minimally invasive mitral procedures to more refined and technically sophisticated approaches, driven by the need for smaller incisions and reduced recovery times.</p><p><strong>Recent findings: </strong>This review will delve into the historical evolution of robotic-assisted mitral valve surgery, detailing the technical advancements that have shaped current practices and outlining the essential training pathways for a career as robotic mitral valve surgeon.</p><p><strong>Summary: </strong>The development of robotic systems has marked a turning point, offering surgeons greater precision and dexterity, crucial adjuncts in complex mitral valve repairs.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrographic flow mapping of atrial fibrillation.","authors":"Steven Castellano, Melissa H Kong","doi":"10.1097/HCO.0000000000001182","DOIUrl":"10.1097/HCO.0000000000001182","url":null,"abstract":"<p><strong>Purpose of review: </strong>A low ceiling of efficacy exists for the treatment of persistent atrial fibrillation via pulmonary vein isolation without adjunctive ablations, which is likely because they do not target an individual patient's specific underlying disease mechanisms. Electrographic flow (EGF) mapping is the first system that reliably displays wavefront propagation through the atria. It is a promising tool for localizing sources of atrial fibrillation, guiding targeted ablation, and visualizing conduction through the atrial substrate.</p><p><strong>Recent findings: </strong>We describe EGF mapping with emphasis on contemporary studies examining map reproducibility and use cases in the preclinical and clinical environment. Animal experiments demonstrated that maps were interpretable across increasingly complex rhythms with pacing during spontaneously persistent atrial fibrillation reliably simulating EGF sources. The FLOW-AF randomized controlled trial showed that source ablation improved outcomes and that EGF map properties may be used to phenotype patients based on their atrial fibrillation mechanisms and recurrence likelihoods.</p><p><strong>Summary: </strong>Targeted ablation strategies balance the risks of insufficiently ablating atrial fibrillation triggers with exacerbating disease through additional scar formation. EGF mapping leverages spatiotemporal relationships in voltage to localize sources and quantify substrate health. Further research is needed to optimize phenotyping and treatment efforts.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"8-14"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373618","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":"Cardiovascular disease in South Asian immigrants facing adverse socioeconomic circumstances: challenges and opportunities for enhanced management.","authors":"Carolina C Pappalettere, Marc Llagostera, Joan Vime-Jubany, Miguel Cainzos-Achirica","doi":"10.1097/HCO.0000000000001187","DOIUrl":"10.1097/HCO.0000000000001187","url":null,"abstract":"<p><strong>Purpose of review: </strong>To describe the challenges that health professionals often face when attempting to provide optimal primary and secondary prevention care of atherosclerotic cardiovascular disease (ASCVD) to South Asian immigrant patients who face adverse socioeconomic factors, such as many of the South Asian men and women who live in Catalonia, and to present a number of constructive approaches that can help minimize those barriers.</p><p><strong>Recent findings: </strong>The challenges include limited health literacy, frequent language barriers, cultural factors that limit the relevance of standard lifestyle advice, financial barriers, limited access to preventive care, racism, and other barriers. Approaches that can help minimize them and enhance the quality of secondary cardiovascular preventive care in this group include empathy, using support from cultural mediators, enhanced proficiency using readily available translation programs, approaches that minimize financial barriers and simplify treatment regimes, and provision of more culturally competent lifestyle advice, among others.</p><p><strong>Summary: </strong>We hope that the notions included in this review will help physicians and healthcare system managers around the world become more aware and culturally competent when treating South Asian patients with ASCVD. The ongoing Pul-Cat and other studies will illuminate the most effective steps moving forward.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"40 1","pages":"42-49"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial introductions.","authors":"","doi":"10.1097/HCO.0000000000001191","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001191","url":null,"abstract":"","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"40 1","pages":"v-vi"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ablation options for sub-epicardially located ventricular substrates responsible for ventricular tachycardia: where is it all headed?","authors":"Jason S Sperling, Pasquale Santangeli","doi":"10.1097/HCO.0000000000001184","DOIUrl":"10.1097/HCO.0000000000001184","url":null,"abstract":"<p><strong>Purpose of review: </strong>Patients with nonischemic and ischemic cardiomyopathy (NICM and ICM) exhibit re-entrant tachycardias related to scar tissue in subepicardial, in addition to typical subendocardial locations. Control of ventricular arrhythmias related to these targets has remained elusive despite advances in mapping and ablation technology.</p><p><strong>Recent findings: </strong>Percutaneous epicardial ablation is the standard after failed endocardial ventricular ablation, but recurrence rates are disappointing. Pulsed-field energy has been associated with coronary artery spasm and therefore may be less suitable for epicardial ablation. Commercially available energy sources, including pulsed-field, have limited depths of myocardial penetration when applied epicardially. Lateral volumetric thermal spreading of ablation injury is associated with decreasing depth of ablation and is difficult to control. A new cryoablation technology based on liquid helium and developed specifically for epicardial work may be able to overcome these limitations.</p><p><strong>Summary: </strong>Ablation strategies that can improve lesion formation in subepicardial ventricular myocardium may improve outcomes of ablation in nonsubendocardial NICM and ICM targets.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}