Current Opinion in Cardiology最新文献

{"title":"Diagnostic performance and clinical impact of photon-counting detector computed tomography in coronary artery disease.","authors":"Roosha Parikh, Doosup Shin, Ziad A Ali, Omar K Khalique","doi":"10.1097/HCO.0000000000001339","DOIUrl":"10.1097/HCO.0000000000001339","url":null,"abstract":"<p><strong>Purpose of review: </strong>Photon-counting detector computed tomography (PCD-CT) is an emerging technology that addresses key limitations of conventional coronary CT angiography, including calcium blooming, stent-related artifacts, and limited spatial resolution. This review summarizes recent evidence regarding the diagnostic performance and clinical impact of PCD-CT in the evaluation of coronary artery disease (CAD) and discusses its potential role in contemporary cardiovascular imaging.</p><p><strong>Recent findings: </strong>Recent studies demonstrate that PCD-CT provides superior spatial resolution, improved contrast-to-noise ratio, and reduced blooming artifacts compared with conventional energy-integrating detector CT. Clinical investigations have shown improved diagnostic accuracy for detecting obstructive CAD, particularly in patients with heavy coronary calcification, older patients and coronary stents. Large observational studies report higher specificity, improved positive predictive value, fewer indeterminate examinations, reduced invasive coronary angiography referrals, and greater revascularization yield. Emerging applications include advanced plaque characterization, extracellular volume quantification, and ultra-low-dose radiation and contrast imaging.</p><p><strong>Summary: </strong>Current evidence suggests that PCD-CT represents a transformative advancement in noninvasive coronary imaging. Beyond improving diagnostic accuracy, PCD-CT may enhance clinical decision-making, reduce unnecessary downstream testing, and expand the role of CT in comprehensive cardiovascular assessment. Future multicenter outcome studies and standardized imaging protocols will be essential to establish its long-term clinical and economic value.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"575-583"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834888","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":"Advancements in wearable technology for heart failure patients.","authors":"George Perlman, Janie Leroux, Abhinav Sharma","doi":"10.1097/HCO.0000000000001326","DOIUrl":"10.1097/HCO.0000000000001326","url":null,"abstract":"<p><strong>Purpose of review: </strong>While pharmacologic and device therapies have improved heart failure care in recent decades, age-adjusted rehospitalization rates remain largely stable. While the adoption of many implanted devices shown to reduce heart failure hospitalizations has been slow due to their invasive nature and limited insurance coverage, wearable devices such as smartwatches are noninvasive and increasingly accessible for the general population. In this review, we discuss novel developments in clinical applications of wearable devices for heart failure.</p><p><strong>Recent findings: </strong>While no wearable is currently recommended for heart failure monitoring or screening, recent studies have shown promising preliminary results that suggest wearables may be used to screen for prevalent heart failure, monitor congestion levels, predict acute exacerbation events, and evaluate response to interventions. We highlight research on smartwatch-based prediction of acute exacerbations and screening for heart failure, and patch-based pulmonary capillary wedge pressure estimation.</p><p><strong>Summary: </strong>This review aims to serve as a primer for healthcare providers and researchers on advances for use of wearable devices in patients with heart failure. If properly validated and implemented, wearables offer potential to improve quality of life and self-efficacy of patients with heart failure while reducing their hospitalization risk.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"483-490"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370981","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":"Contemporary medical management of left ventricular assist device patients: integrating sex-specific perspectives.","authors":"Adhya Mehta, Ersilia M DeFilippis, Palak Shah","doi":"10.1097/HCO.0000000000001327","DOIUrl":"10.1097/HCO.0000000000001327","url":null,"abstract":"<p><strong>Purpose of review: </strong>Durable left ventricular assist devices (LVADs) have become a cornerstone in the management of advanced heart failure, improving patient survival and quality of life. Long-term survival on LVAD support is approaching a decade, but women are less likely to be referred for implantation, remain underrepresented in LVAD trials, and experience a distinct adverse event profile. With longer periods on support, optimized medical management after LVAD has become increasingly important. It has been increasingly recognized that as hemocompatibility-related adverse events (HRAEs) have been reduced with current generation devices, hemodynamic-related adverse events (HDREs), including aortic insufficiency and heart failure, contribute significantly to patient morbidity after LVAD. This review summarizes contemporary advances in the medical management of these patients, integrating recent trials, professional society guidelines, emerging evidence, and highlighting sex-specific perspectives.</p><p><strong>Recent findings: </strong>Recent literature highlights the burden of persistent congestion and heart failure after LVAD implantation, highlighting the importance of hemodynamic optimization, including individualized speed selection and blood pressure management, to mitigate HDREs. Evidence continues to support guideline-directed medical therapy to promote reverse remodeling and reduce morbidity, though utilization remains suboptimal. Advances in antithrombotic therapy, especially the reduced use of aspirin, are reshaping practice and further reducing gastrointestinal bleeding rates. Growing attention to reproductive health, including contraception counseling, pregnancy management, and medication safety, reflects an evolving recognition of sex-specific needs in LVAD care.</p><p><strong>Summary: </strong>Persistent knowledge gaps, particularly regarding sex-specific management, highlight the need for inclusive, prospective research to inform evidence-based guidelines for the growing population of patients on chronic LVAD support.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"474-482"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399937","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":"Viability testing for guiding revascularization in ischemic cardiomyopathy.","authors":"Kevin Y Li, Nitish K Dhingra, Raumil Patel, Sanjog Kalra, Alireza Rabi","doi":"10.1097/HCO.0000000000001329","DOIUrl":"10.1097/HCO.0000000000001329","url":null,"abstract":"<p><strong>Purpose of review: </strong>Myocardial viability testing has traditionally been used to guide revascularization decisions in ischemic cardiomyopathy on the assumption that identifying dysfunctional but viable myocardium predicts functional recovery and improved survival following revascularization. Recent trials have challenged this assumption, highlighting the need to re-evaluate the clinical role of viability testing in the context of contemporary revascularization strategies and modern guideline-directed medical therapy.</p><p><strong>Recent findings: </strong>The STICH trial and its extended follow-up demonstrated that CABG improves long-term survival independently of viability status and independently of whether ejection fraction improves, challenging the mechanistic assumption of viability-guided revascularization. REVIVED-BCIS2 showed that PCI may not improve survival benefit, even in patients selected with demonstrated viability. A prespecified imaging substudy of REVIVED identified scar burden, rather than the presence of viable myocardium, as the strongest independent predictor of adverse outcomes, reframing the prognostic question from the detection of viable tissue toward the quantification of irreversible myocardial loss.</p><p><strong>Summary: </strong>Viability should be reconceptualized as a continuous spectrum rather than a binary construct. Scar quantification, particularly through late gadolinium enhancement cardiac magnetic resonance (CMR), may offer greater prognostic utility than viability detection alone. A prospective randomized trial integrating contemporary imaging with modern guideline-directed medical therapy is needed to resolve the clinical role of viability-guided revascularization.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"452-458"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399993","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":"Optimizing conduits and intraoperative graft quality in coronary artery bypass graft surgery.","authors":"Hamnah Majeed, Marc Pelletier","doi":"10.1097/HCO.0000000000001304","DOIUrl":"10.1097/HCO.0000000000001304","url":null,"abstract":"<p><strong>Purpose of review: </strong>Optimization of conduits and intraoperative graft assessment remain central determinants of long-term success in coronary artery bypass grafting (CABG). This review is timely, given the recent publication of randomized data refining conduit selection, harvesting strategies, and modalities for physiologic graft verification.</p><p><strong>Recent findings: </strong>Over the past year, accumulating randomized and registry-based evidence has strengthened support for multi-arterial revascularization, while clarifying the risks and benefits of certain arterial grafting and associated techniques. Parallel investigations have emphasized atraumatic great saphenous vein (GSV) harvesting and no-touch techniques, to mitigate endothelial injury and enhance patency. Intraoperative graft assessment has increasingly shifted toward routine use of objective physiologic tools, particularly transit-time flow measurement (TTFM) with adjunctive Doppler/ultrasound or fluorescence angiography, and emerging data refining quantitative thresholds and quality benchmarks.</p><p><strong>Summary: </strong>Contemporary evidence underscores that durable surgical revascularization depends on integrated biologic, technical, and physiologic optimization. Standardizing conduit selection, minimizing conduit injury, and adopting routine intraoperative graft assessment may reduce early technical failure and improve long-term graft performance. Ongoing trials and implementation research will determine how best to translate these advances into consistent, high-quality CABG practice.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"445-451"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935488","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":"Coronary physiology and intravascular imaging in surgical and percutaneous revascularization.","authors":"Adham Elsherbini, Shubh K Patel, Tina B Marvasti, Meena Verma, Syed M Ali Hassan, Derrick Y Tam, Stephen Fremes, Terrence M Yau","doi":"10.1097/HCO.0000000000001321","DOIUrl":"10.1097/HCO.0000000000001321","url":null,"abstract":"<p><strong>Purpose of review: </strong>Coronary angiography remains the principal imaging modality guiding coronary revascularization, but it provides only an anatomic representation of disease and does not reliably identify lesion-specific ischemia. This review summarizes contemporary evidence on coronary physiology and intravascular imaging in percutaneous and surgical revascularization.</p><p><strong>Recent findings: </strong>Physiology-guided percutaneous coronary intervention (PCI) improves clinical outcomes by refining lesion selection and supporting safe deferral of nonflow-limiting stenoses. Fractional flow reserve and instantaneous wave-free ratio are supported by long-term randomized data, while angiography-derived quantitative flow ratio has shown favorable outcomes compared with angiography-guided PCI, although equivalence to pressure-wire-based strategies remains unsettled. In parallel, intravascular ultrasound and optical coherence tomography enhance procedural optimization by improving stent sizing, expansion, and detection of mechanical complications, with the strongest benefit observed in anatomically complex lesions. Postprocedural physiologic testing frequently reveals residual ischemia despite acceptable angiographic results. In coronary bypass surgery, physiologic assessment may refine target selection and clarify mechanisms of competitive flow, and postoperative quantitative flow ratio has been explored in assessing functional completeness; however, consistent improvement in clinical outcomes has not been demonstrated.</p><p><strong>Summary: </strong>Current evidence strongly supports integration of coronary physiology and intravascular imaging in PCI, whereas their role in coronary artery bypass grafting remains investigational.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"422-435"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213624","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":"Role of nutritional interventions to reduce cardiometabolic disease burden in the community.","authors":"Sandra López-Arana, Miguel Ángel Rincón-Cervera, Isabel Pereyra-González","doi":"10.1097/HCO.0000000000001319","DOIUrl":"10.1097/HCO.0000000000001319","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiovascular disease (CVD) is the leading global cause of death and disability, with most disability-adjusted life-years linked to modifiable risk factors. Nutrition is a scalable intervention that influences multiple cardiometabolic pathways. This review is timely because recent scientific statements and global policy frameworks highlight the need to prioritize dietary strategies in community settings to reduce CVD burden and promote equity.</p><p><strong>Recent findings: </strong>Community-based nutritional interventions in urban settings, neighborhoods and workplaces effectively reach underserved populations by leveraging trust and cultural relevance. Dietary patterns such as the Mediterranean and DASH diets have demonstrated improvements in blood pressure, lipid profiles, and inflammation. New approaches, including intermittent fasting and the EAT-Lancet reference diet, broaden prevention options. Policy actions such as taxes, nutrition labeling, and healthier procurement standards are recognized by the WHO as cost-effective measures.</p><p><strong>Summary: </strong>Community-based nutritional interventions reduce cardiometabolic risk and promote equity. Strategies include fiscal policies, healthier food environments, education, digital tools, and \"Food Is Medicine\" programs. Their success relies on cultural adaptation and stakeholder engagement. Evidence supports their capacity to shift norms, improve diets, and sustain long-term reductions in CVD burden.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"499-506"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213646","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":"Advances in artificial intelligence for the evaluation of mitral regurgitation.","authors":"Agostina A Sanchez, Anita Sadeghpour, Federico M Asch","doi":"10.1097/HCO.0000000000001317","DOIUrl":"10.1097/HCO.0000000000001317","url":null,"abstract":"<p><strong>Purpose of review: </strong>The diagnostic evaluation of mitral regurgitation (MR) is complex, time-intensive, and prone to significant interobserver variability. This review examines the current evidence on artificial intelligence (AI) applications across the full MR diagnostic pathway, from pre-imaging screening to advanced multimodality imaging, and explores future directions for clinical integration.</p><p><strong>Recent findings: </strong>AI-enabled digital stethoscopes and deep learning-based electrocardiographic models provide scalable upstream strategies for early detection and population-level risk stratification, although they currently function as enrichment tools rather than standalone diagnostics. In echocardiography, AI has demonstrated strong performance for automated valve segmentation, Doppler analysis, severity grading, and phenotypic classification. In cardiac magnetic resonance, AI enables automated valve tracking, ventricular segmentation, and tissue characterization, although dedicated algorithms for direct MR quantification remain under development. Beyond automation, AI-driven approaches have identified clinically meaningful phenotypes linking valvular dysfunction and cardiac remodeling with myocardial fibrosis and increased cardiovascular risk.</p><p><strong>Summary: </strong>AI holds significant promise to improve reproducibility, consistency, and clinical integration of MR assessment. Widespread implementation, however, requires prospective validation, standardized acquisition protocols, improved model interpretability and, most importantly, proper regulations driven by a culture of safety.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"407-413"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260719","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":"Rebooting blood vessel repair: implications of the SEMA-VR CardioLink-15 trial.","authors":"Raj Verma, Meena Verma, Brady Park, Hwee Teoh, Adrian Quan, Kim A Connelly, David A Hess","doi":"10.1097/HCO.0000000000001323","DOIUrl":"10.1097/HCO.0000000000001323","url":null,"abstract":"<p><strong>Purpose of review: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce major adverse cardiovascular events (MACE), heart failure, and mortality through undetermined mechanisms independent of glycemic control. This review examines emerging evidence that GLP-1RAs overcome vascular regenerative cell exhaustion (VRCE), a pathological depletion of bone marrow-derived progenitor cells that mediate vessel repair.</p><p><strong>Recent findings: </strong>VRCE, the progressive loss of circulating progenitor cells that mediate vessel regeneration, has recently emerged as an underappreciated driver of MACE risk in individuals living with type 2 diabetes (T2D), obesity or atherosclerotic cardiovascular disease. In a recent randomized translational trial of semaglutide vs. usual care, SEMA-VR CardioLink-15 provided the direct evidence that 6-month semaglutide administration could reverse VRCE profile associated with longstanding cardiometabolic disease (34.8% increase in VR myeloid progenitor cells, 66.2% expansion of endothelial precursor cells). Semaglutide additionally reduced circulating granulocyte content and suppressed pro-inflammatory TNF and interleukin family cytokines in sera.</p><p><strong>Summary: </strong>GLP-1RAs can restore bone marrow progenitor cell output towards a more vessel regenerative profile. Reversal of VRCE may partially explain early event curve separation in cardiovascular outcome trials with multiple GLP-1RAs. Therefore, circulating VR cell content could serve as a measure of compromised vascular regenerative capacity and elevated cardiovascular disease risk.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"459-466"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371035","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":"Contemporary evidence for multiarterial grafting in coronary artery bypass surgery.","authors":"Calvin Sun, Grace S Lee, Stephen E Fremes","doi":"10.1097/HCO.0000000000001318","DOIUrl":"10.1097/HCO.0000000000001318","url":null,"abstract":"<p><strong>Purpose of review: </strong>Observational data suggests that multiarterial grafting (MAG) is associated with improved long-term outcomes for coronary artery bypass grafting (CABG), yet adoption remains low due to limited randomized evidence. This review synthesizes contemporary evidence comparing MAG with single arterial grafting (SAG), highlighting recent observational studies and ongoing randomized trials.</p><p><strong>Recent findings: </strong>Large registry-based analyses consistently demonstrate a 15-25% relative reduction in long-term mortality and adverse cardiovascular events with MAG compared with SAG. However, randomized evidence is unclear; the Arterial Revascularization Trial (ART) showed no significant survival difference but possessed important methodological limitations. In contrast, randomized data support radial artery use over saphenous vein grafts as a second conduit. The ongoing randomized comparison of the clinical outcome of single vs. multiple arterial grafts (ROMA) trial is expected to provide definitive evidence.</p><p><strong>Summary: </strong>MAG is supported by observational data, but uncertainty persists due to limited randomized evidence and variability in clinical adoption. The results of ROMA will clarify the role of MAG and help determine whether this should become the default strategy for CABG in select patients.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"414-421"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581334","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}