Current Opinion in Cardiology最新文献

{"title":"Artificial intelligence for left ventricular strain.","authors":"Bjørnar Grenne, Andreas Østvik, Håvard Dalen, Lasse Løvstakken","doi":"10.1097/HCO.0000000000001302","DOIUrl":"10.1097/HCO.0000000000001302","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review recent advances in artificial intelligence (AI) for left ventricular (LV) strain echocardiography, with emphasis on studies published during the preceding 18 months, and to assess current evidence for measurement performance, workflow integration, emerging AI-based approaches, disease-specific applications and barriers to widespread clinical adoption.</p><p><strong>Recent findings: </strong>The most mature evidence relates to automated global longitudinal strain (GLS) measurement, where recent studies show high feasibility, improved reproducibility and reduced operator dependence compared with conventional analysis. AI-based tools have also moved beyond retrospective post-processing towards real-time acquisition support and workflow integration, with evidence of shorter analysis time and more standardized image acquisition. Emerging approaches suggest a shift from single-task GLS automation towards multitask and phenotyping-oriented models in which strain is integrated with broader echocardiographic interpretation. Disease-specific applications are most studied in acute ischaemic heart disease and cardio-oncology, where AI-based strain has shown promise for risk stratification, surveillance and clinical triage. However, agreement with conventional methods remains imperfect and varies substantially across models, decision thresholds are uncertain, and prospective evidence for improved clinical outcomes is still limited.</p><p><strong>Summary: </strong>AI for LV strain is evolving from single-task automated measurement towards broader support for reproducibility, workflow integration and clinical interpretation. Current priorities are robust external validation, transparent reporting of feasibility and unsuccessful analyses, and prospective evaluation of clinical utility and workflow impact in routine practice, with clinician oversight as a critical component of safe implementation.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"377-383"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935490","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":"Artificial intelligence for right ventricular assessment: current evidence and future directions.","authors":"Xin Tan, Jarrett Fowler, Meng Li, Ashrith Guha","doi":"10.1097/HCO.0000000000001320","DOIUrl":"10.1097/HCO.0000000000001320","url":null,"abstract":"<p><strong>Purpose of review: </strong>Right ventricular size and function are vital to risk stratification in pulmonary hypertension, valvular disease, and congenital heart disease, yet right ventricular assessment remains technically demanding and subject to interpreter variability. This review aims to synthesize the rapidly expanding evidence on the application of artificial intelligence to RV structural and functional assessment across echocardiography, cardiac magnetic resonance (CMR), and computed tomography.</p><p><strong>Recent findings: </strong>Artificial intelligence has demonstrated accuracy approaching interobserver variability for automated right ventricular segmentation and chamber quantification across imaging modalities. Functional applications include artificial intelligence derived fractional area change, tricuspid annular plane systolic excursion, free-wall strain, and ejection fraction estimation compared against CMR. Emerging applications address right ventricular-pulmonary artery coupling and hemodynamic phenotyping through afterload-aware, physiology-centered models.</p><p><strong>Summary: </strong>Current artificial intelligence tools can standardize and accelerate established right ventricular measurements, with the strongest performance in echocardiographic segmentation, annular tracking, and ejection fraction surrogates. Translation into clinical practice will require robust external validation across disease phenotypes, hybrid artificial intelligence workflows that loop in humans, and prospective studies that display measurable impact on clinical efficiency and patient outcomes.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"400-406"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213622","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":"Minimally invasive approaches to coronary artery bypass grafting: techniques, current evidence, and future directions.","authors":"Syed M Ali Hassan, Mohamed Maatallah, Shubh Patel, Meena Verma, Piroze Davierwala","doi":"10.1097/HCO.0000000000001322","DOIUrl":"10.1097/HCO.0000000000001322","url":null,"abstract":"<p><strong>Purpose of review: </strong>Conventional coronary artery bypass grafting (CABG) is most commonly performed via median sternotomy, an approach that can be associated with postoperative pain, sternal wound complications, and prolonged recovery. Over the past two decades, multiple minimally invasive coronary surgery strategies have been developed, offering sternotomy-sparing alternatives that may reduce surgical trauma and accelerate recovery in appropriately selected patients. This review summarizes contemporary minimally invasive strategies, focusing on their procedural steps, patient selection, clinical outcomes, and evolving role in contemporary coronary revascularization.</p><p><strong>Recent findings: </strong>Contemporary techniques include minimally invasive direct coronary artery bypass (MIDCAB), endoscopic/robotic-assisted coronary artery bypass, totally endoscopic coronary artery bypass (TECAB), and hybrid coronary revascularization (HCR), which combines CABG with percutaneous coronary intervention (PCI). Available evidence, largely from observational series and experienced centers, supports favorable graft patency and recovery profiles; however, comparative long-term data remain limited for multivessel and robotic approaches. Owing to their inherent technical complexity, steep learning curves, and high costs of robotic platforms, widespread adoption of MI-CABG has remained limited.</p><p><strong>Summary: </strong>MI-CABG offers an important sternotomy-sparing option for selected patients with coronary artery disease. Wider adoption will depend on careful patient selection, structured training, multidisciplinary Heart Team decision-making, and stronger comparative evidence defining which patients benefit most.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"436-444"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260710","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":"An integrative approach to patient selection for mitral transcatheter edge-to-edge repair in secondary mitral regurgitation.","authors":"Marc Brusosa, Eduardo Flores-Umanzor, Eric Horlick","doi":"10.1097/HCO.0000000000001330","DOIUrl":"10.1097/HCO.0000000000001330","url":null,"abstract":"<p><strong>Purpose of review: </strong>Secondary mitral regurgitation (SMR) remains a major contributor to symptoms and hospitalizations in heart failure, despite guideline-directed medical therapy (GDMT). This review synthesizes current evidence and proposes a structured framework for identifying patients most likely to benefit from mitral transcatheter edge-to-edge repair (M-TEER), integrating data from randomized clinical trials, proportionality concepts, and multimodality imaging.</p><p><strong>Recent findings: </strong>Divergent results in MITRA-FR and COAPT mainly reflect differences in echocardiographic selection and left-ventricular remodeling, which means SMR severity should be judged relative to ventricular size and regurgitant burden. Contemporary trials such as RESHAPE-HF2 and MATTERHORN broaden the evidence and support M-TEER in selected patients and as a safer alternative to surgery in some operable cohorts. Beyond effective regurgitant orifice area, regurgitant volume and regurgitant fraction better capture MR load. Cardiac magnetic resonance refines quantification when echocardiography is discordant or limited. Right-ventricular dysfunction and pulmonary vascular involvement are key modifiers of prognosis and expected benefit.</p><p><strong>Summary: </strong>Optimal candidate selection requires a structured, integrative evaluation: confirm clinically meaningful SMR despite GDMT, ensure anatomic suitability, quantify severity with a multiparametric echo approach supplemented by CMR when indicated, and incorporate ventricular-atrial-pulmonary coupling. This physiology-based strategy moves beyond single thresholds to identify patients most likely to achieve meaningful clinical benefit.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"491-498"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378236","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":"The role of artificial intelligence in the diagnosis of pericardial constriction.","authors":"Kevin Lipat, Tyler Booth, Partho P Sengupta","doi":"10.1097/HCO.0000000000001325","DOIUrl":"10.1097/HCO.0000000000001325","url":null,"abstract":"<p><strong>Purpose of review: </strong>Constrictive pericarditis is a complex disease whose distinction from clinical mimickers remains challenging yet critically important. Diagnosis frequently requires integration of findings across multiple imaging modalities. Artificial intelligence (AI) applications in cardiac imaging are rapidly evolving and may play an increasingly important role in the diagnosis of constrictive pericarditis.</p><p><strong>Recent findings: </strong>Most established evidence supporting AI in diagnosis of constrictive pericarditis involves machine learning and deep learning applied to echocardiography, particularly for differentiating constrictive pericarditis from restrictive cardiomyopathy. Newer approaches incorporate multiple echocardiographic views and emphasize model generalizability. Emerging applications span cardiac computed tomography (CT)-for automated pericardial thickening and calcification quantification-large language models (LLMs) in cardiac magnetic resonance interpretation, and deep learning electrocardiogram analysis.</p><p><strong>Summary: </strong>Applications of AI for diagnosis of constrictive pericarditis are being studied across multiple imaging modalities, but remain in early stages of development. Emerging AI concepts, including multimodal LLMs and foundation models leveraging transfer learning, show promise for further advances and eventual meaningful implementation. Cardiac CT, though underrepresented in the current AI literature for constrictive pericarditis, represents an important target for future investigation given its established role in surgical planning.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"393-399"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665136","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":"Artificial intelligence for the assessment of diastolic function.","authors":"Teresa S M Tsang, Darwin F Yeung","doi":"10.1097/HCO.0000000000001324","DOIUrl":"10.1097/HCO.0000000000001324","url":null,"abstract":"<p><strong>Purpose of review: </strong>Assessment of left ventricular diastolic function remains one of the most challenging aspects of echocardiography. Artificial intelligence (AI) has emerged as a transformative tool capable of automating data acquisition, analysis, and interpretation. This review summarizes recent advances in the use of AI to facilitate diastolic function assessment.</p><p><strong>Recent findings: </strong>An increasing number of studies have shown the potential for AI-based models to equal or exceed expert-guideline approaches for evaluating diastolic function while improving reproducibility and workflow. Recent trends include the use of more deep learning techniques, reliance on fewer input variables, validation with relevant clinical outcomes, and shift in diastolic function classification from a categorical grading system to a more continuous probabilistic score.</p><p><strong>Summary: </strong>Current guideline-based approaches integrate multiple Doppler, structural, and hemodynamic variables to classify diastolic function. Although these algorithms have improved standardization, they remain limited by interobserver variability, discordant parameters, indeterminate classifications, incomplete datasets, and reduced applicability in complex clinical settings. Machine learning and deep learning approaches can integrate multidimensional echocardiographic features, electrocardiographic signals, and clinical variables to identify latent physiologic patterns beyond conventional rule-based algorithms. Future work will focus on addressing limitations of AI including explainability, generalizability, regulatory considerations, and integration into clinical workflows.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"384-392"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581258","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":"Superficial intercostal plane blocks for post-sternotomy pain control rationale and design for the EPOCH CardioLink-10 randomized clinical trial.","authors":"Nitish K Dhingra, Fallon Dennis, Syed Mohammad Ali Hassan, Adrian Quan, Hwee Teoh, Kyle Chin, Michael J Ricci, John D Tran, Jason Li, Raj Verma, Fábio de Vasconcelos Papa, Youngseo Lee, Ashton P Chang, Jesus Igualada, Juan F Morales, Juan P Ghiringhelli, Kendra L Derry, Thomas George, Amine Mazine, Ori D Rotstein, Corey Adams, Richard C Cook, Ansar Hassan, Atul David Nagpal, Terrence M Yau, Jessica D Spence, Korey Sutherland, Pawel M Martinka, Christopher D Noss, James L Dougherty, Pieter de Jager, Alexander J Gregory, Rakesh C Arora, Subodh Verma, Ahmad Alli, Cyril David Mazer","doi":"10.1097/HCO.0000000000001298","DOIUrl":"10.1097/HCO.0000000000001298","url":null,"abstract":"<p><strong>Purpose of the trial: </strong>Inadequate pain control following cardiac surgery remains a significant clinical and socioeconomic burden. Superficial parasternal intercostal plane (SPIP) blocks are not widely utilized for reducing pain and opioid consumption post-cardiac surgery because the available evidence is weak and inconsistent.</p><p><strong>Methods: </strong>The double-blind, placebo-controlled, multicenter EPOCH CardioLink-10 trial was designed to evaluate how continuous bilateral SPIP blocks affect opioid consumption and recovery-related endpoints among individuals who have undergone cardiac surgery via median sternotomy. Participants from four Canadian sites are randomized to receive either 0.2% ropivacaine or placebo (0.9% sodium chloride) for 48-h following bilateral catheter insertion into the SPIP. The primary outcome is cumulative postoperative opioid use (morphine milligram equivalents) up to 72-hours post-catheter insertion. Secondary endpoints include median pain scores and the incidence of delirium over the 72-hours post-catheter insertion; cumulative postoperative opioid use up to hospital discharge; and participant-reported quality of recovery 24-96 h post-surgery.</p><p><strong>Summary: </strong>EPOCH CardioLink-10 is to date the largest randomized controlled trial to evaluate an Enhanced Recovery After Surgery (ERAS) intervention among individuals who are recuperating from cardiac surgery with median sternotomy. Its overarching goal is to obtain robust data to improve clinical care and inform on post-cardiac surgery pain management guidelines.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"467-473"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018979","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":"Resistant hypertension, hyperaldosteronism, and the emerging understanding of hypercortisolism.","authors":"Daniel Einhorn, Christian Mende, Richard J Auchus","doi":"10.1097/HCO.0000000000001315","DOIUrl":"10.1097/HCO.0000000000001315","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article reviews the evolving landscape and high prevalence of hyperaldosteronism and hypercortisolism, two previously under-recognized disorders for which cardiologists should have a high index of suspicion when managing patients with resistant hypertension.</p><p><strong>Recent findings: </strong>Resistant hypertension is estimated to occur in approximately 10-20% of people with hypertension, or 10 million people in the United States, and is associated with substantially increased cardiovascular morbidity and mortality. Hyperaldosteronism, previously considered a rare disease, has been shown to be a relatively common cause of hypertension and is a multisystem disease associated with a significantly higher risk of multiple comorbid conditions, including resistant hypertension. Likewise, endogenous hypercortisolism, once considered a rare disease, is now known to have a higher prevalence than previously estimated and is associated with a wide spectrum of clinical and biochemical presentations, including resistant hypertension, that result from prolonged exposure to excess cortisol activity. However, despite the prevalence and negative clinical consequences of hyperaldosteronism and hypercortisolism, screening rates remain low.</p><p><strong>Summary: </strong>Cardiologists are well positioned to provide timely screening for both hyperaldosteronism and hypercortisolism. To optimize clinical outcomes, patients with these endocrine causes of resistant hypertension require aldosterone-directed and/or cortisol-directed therapy in addition to therapy for hypertension.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"244-250"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935536","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":"Liver lesions in Fontan-associated liver disease: current challenges and future directions.","authors":"Pranay Singh, Amit Nair, Juliet A Emamaullee","doi":"10.1097/HCO.0000000000001296","DOIUrl":"10.1097/HCO.0000000000001296","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hepatic lesions develop in nearly half of the Fontan population, yet clinicians lack tools to distinguish benign lesions from malignancy, including hepatocellular carcinoma (HCC). Standard Liver Imaging Reporting and Data System (LI-RADS) criteria are not applicable to Fontan-associated liver disease (FALD). To address this critical diagnostic gap, risk-stratified surveillance approaches have been proposed.</p><p><strong>Recent findings: </strong>We review the spectrum of hepatic lesions in FALD, emphasizing the diagnostic challenge in distinguishing benign from malignant nodules. Noninvasive fibrosis assessment, including transient elastography, is discussed for risk stratification, though liver biopsy remains the only reliable tool for characterizing suspicious lesions. HCC in FALD demonstrates distinct features and carries poor prognosis primarily due to presentation with advanced disease. Despite treatment modalities, outcomes remain suboptimal, with most therapies limited by cardiac comorbidities, abnormal hemodynamics, and advanced FALD.</p><p><strong>Summary: </strong>The optimal surveillance and diagnostic strategy for hepatic lesions in patients with FALD remains undefined. Multimodal assessment, multidisciplinary care, and a low threshold for biopsy are essential. Liver biopsy remains the only reliable method for characterizing suspicious lesions and staging fibrosis severity in the context of FALD. FALD-specific diagnostic criteria and evidence-based surveillance protocols are urgently needed to guide early detection and improve outcomes.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"304-311"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581994","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":"Aldosterone synthase inhibition in hypertension: an evolving therapeutic strategy.","authors":"Radwan Alkhatib, Taha Hatab, Luke J Laffin","doi":"10.1097/HCO.0000000000001291","DOIUrl":"10.1097/HCO.0000000000001291","url":null,"abstract":"<p><strong>Purpose of review: </strong>Despite widespread use of renin-angiotensin-aldosterone system blockade, resistant and uncontrolled hypertension remain common, highlighting the need for novel therapeutic strategies. Growing recognition of aldosterone excess as a central driver of vascular, cardiac, and kidney injury has renewed interest in targeting this pathway. Recent advances in highly-selective aldosterone synthase inhibition (ASI) suggest this is a clinically viable approach.</p><p><strong>Recent findings: </strong>ASIs, including baxdrostat and lorundrostat, demonstrate consistent blood pressure reductions of approximately 8-12 mmHg when administered in addition to standard antihypertensive therapy across phase 2 and phase 3 trials. These drugs may overcome limitations of mineralocorticoid receptor antagonists by suppressing aldosterone production upstream, mitigating aldosterone escape, and reducing adverse effects. There may also be benefits among patients with chronic kidney disease, primary aldosteronism, and heart failure with preserved ejection fraction, supporting a broader cardiorenal role.</p><p><strong>Summary: </strong>Aldosterone synthase inhibition represents an advance in hypertension therapeutics. If ongoing and future outcome-driven trials confirm cardiovascular and renal benefit, ASIs may reshape treatment algorithms, complement existing renin-angiotensin-aldosterone-based strategies, and enable more precise targeting of aldosterone-mediated disease.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"236-243"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516819","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}