The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology最新文献

{"title":"Value of three-dimensional imaging in tricuspid valve stenosis: a case series.","authors":"Mahmoud Abdelnabi, Abdallah Almaghraby, Ramzi Ibrahim, Hoda Abdelgawad","doi":"10.1186/s43044-025-00672-w","DOIUrl":"https://doi.org/10.1186/s43044-025-00672-w","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic tricuspid stenosis (TS) is a rare and easily missed clinical finding until late stages. Two-dimensional echocardiography (2DE) can assess the leaflet thickening and transvalvular gradients, which may be misleading in the presence of significant TR. Moreover, it lacks en face views of the tricuspid valve (TV), making the diagnosis of TS challenging. Meanwhile, three-dimensional echocardiography (3DE) effectively visualizes commissural fusion and sub-valvular thickening, enabling accurate tracing of the orifice area.</p><p><strong>Case presentation: </strong>The authors present a case series discussing rheumatic and non-rheumatic TV stenosis to emphasize the role of 3DE in identifying the key findings in rheumatic stenotic TV and distinguishing them from other non-rheumatic etiologies.</p><p><strong>Conclusions: </strong>This case series demonstrated that 2DE has limitations in diagnosing TV stenosis, whereas 3DE provides a clear view of features such as commissural fusion and chordal thickening. Therefore, 3DE is essential in addition to 2DE for improved imaging of TV diseases, allowing accurate tracing of the orifice area, regardless of regurgitation.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"76"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A report study of successful surgical treatment of an aorto-left ventricular tunnel in a 5-year-old boy: differential diagnosis from other congenital heart diseases with similar clinical symptoms.","authors":"Alireza Yaghoubi Golverdi, Amirhossein Jalali, Mohammad Mahdavi, Seyed Salaheddin Nabavi, Mahmoud Ganjifard, Maryam Bahramian, Mozhgan Bahramian, Seyed Shervin Shafiei","doi":"10.1186/s43044-025-00668-6","DOIUrl":"10.1186/s43044-025-00668-6","url":null,"abstract":"<p><strong>Background: </strong>Aorto-left ventricular tunnel (ALVT) is a rare congenital anomaly. In this condition, the aorto-ventricular tunnel is a congenital extracardiac channel that connects the ascending aorta to the left ventricle above the sinotubular junction.</p><p><strong>Case presentation: </strong>A 5-year-old boy presented with fatigue during physical activity, leading to visiting a pediatric specialist. Upon examination, a continuous murmur, predominantly diastolic, was detected. Suspecting aortic insufficiency, the patient was referred for further evaluation. Transthoracic echocardiography revealed a congenital ALVT.</p><p><strong>Conclusion: </strong>Although congenital ALVT is a rare congenital heart disease, its clinical symptoms may overlap with other congenital heart diseases, such as tetralogy of Fallot without pulmonary stenosis and patent ductus arteriosus. Differential diagnosis, such as the absence of a wide pulse pressure, can be helpful in distinguishing between these conditions.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"75"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study.","authors":"Ömer Selim Selim Unat, Pervin Korkmaz, Akın Çinkooğlu, Özge Can, Elton Soydan, Selen Bayraktaroğlu, Gürsel Çok, Recep Savaş, Funda Karbek Akarca, Sanem Nalbantgil, Celal Çinar, Mehmet Uyar, Kubilay Demirağ, Tahir Yağdi, Çağatay Engin, Münevver Erdinç, Feza Bacakoğlu","doi":"10.1186/s43044-025-00669-5","DOIUrl":"10.1186/s43044-025-00669-5","url":null,"abstract":"<p><strong>Background and aim: </strong>The use of thrombolytics in intermediate-high risk pulmonary embolism (PE) remains controversial. This study evaluated the efficacy and safety of half-dose alteplase compared to anticoagulation with LMWH in this group.</p><p><strong>Material and methods: </strong>Patients treated with thrombolytics (50 mg alteplase) after the establishment of EGEPET (2.10.2018) formed the prospective group, while the retrospective group included patients treated with LMWH (enoxaparin) before EGEPET. Primary outcomes were one-month and one-year mortality. Secondary outcomes were vital sign changes after thrombolysis, hemorrhagic events, recurrence of embolism, chronic pulmonary thromboembolism (CPTE), and chronic thromboembolic pulmonary hypertension (CTEPH).</p><p><strong>Results: </strong>Thrombolytic group (n = 59) and anticoagulation group (n = 38) were similar in age, comorbidities, and vital signs, except for higher pulse rates in the thrombolytic group. In the thrombolytic group, PaO₂/FiO₂ ratio significantly improved [330 (270-380) to 417 (351-447), p < 0.001], and pulse rate decreased [116 (105-127) to 91 (80-104), p < 0.001]. In the anticoagulation group, oxygenation showed no significant change, but pulse rate improved. No major bleeding occurred in either group. One-month mortality was 6.7% in the thrombolytic group and 15.8% in the anticoagulation group (p = 0.18). One-year mortality was 13.7% and 26.3%, respectively (p = 0.17). Advanced age (> 67) (OR: 8.82, %95 CI 1.54 - 50.53 p = 0.014) and elevated second-day pulse > 94/min (OR 7.61, 95% CI 1.33-43.49, p = 0.022) were independent predictors of one-month mortality in the multivariate analysis.</p><p><strong>Conclusion: </strong>Thrombolytic therapy significantly improved oxygenation and clinical findings without major complications. Although mortality rates were lower in the thrombolytic group, the difference was not statistically significant. These results should be interpreted with caution, and larger prospective studies are needed to confirm the clinical efficacy and safety of thrombolytic therapy in this patient population.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"74"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12297098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-powered advancements in atrial fibrillation diagnostics: a systematic review.","authors":"Sofia Khaja, Kevin Baijoo, Reza Aziz","doi":"10.1186/s43044-025-00670-y","DOIUrl":"10.1186/s43044-025-00670-y","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases remain one of the leading causes of mortality worldwide, with atrial fibrillation emerging as a clinically significant arrhythmia. The increasing prevalence of atrial fibrillation calls for advanced diagnostic tools for accurate detection to reduce adverse consequences, such as stroke and heart failure. Cardiovascular advancements in artificial intelligence have improved the detection and management of atrial fibrillation.</p><p><strong>Objective: </strong>This review examines recent advancements in atrial fibrillation detection using artificial intelligence-driven tools-such as wearables, neural networks, and machine learning-and highlights their clinical relevance, limitations, and potential to transform cardiovascular care.</p><p><strong>Methodology: </strong>A systematic review was conducted using PubMed, IEEE Xplore, and ScienceDirect to identify peer-reviewed studies between 2020 and 2024. Original clinical studies using artificial intelligence were included for the diagnosis of atrial fibrillation. Studies on conditions other than atrial fibrillation or incomplete data were excluded. Factors analyzed across all studies included diagnostic application, key findings, clinical implications, and limitations of artificial intelligence approaches.</p><p><strong>Results: </strong>This review evaluated 11 studies on artificial intelligence-enhanced tools for atrial fibrillation diagnostics. Neural networks showed the highest diagnostic accuracy, outperforming clinicians in retrospective electrocardiogram analyses (80% vs. 75%). Wearable artificial intelligence-integrated devices, such as electrocardiogram wristbands, offer the highest accessibility and real-time monitoring, with sensitivities exceeding 94%, although they are limited by single-lead input and patient compliance. Machine learning models, including random forest and XGBoost, showed moderate performance (AUROC 0.74-0.89) with strengths in risk prediction and stratification. Key challenges included limited generalizability, small-sample sizes, and varying model accuracy.</p><p><strong>Conclusions: </strong>This review highlights the potential of artificial intelligence to improve atrial fibrillation diagnostics through wearable technologies, neural networks, and machine learning. While these tools often outperform traditional methods, real-world use is limited by small, retrospective studies and a lack of validation. Future work should focus on equity, transparency, and expanding artificial intelligence use beyond atrial fibrillation diagnosis, with collaboration needed to ensure safe, effective clinical integration.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"73"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of administration of Del Nido cardioplegia solution containing vitamin C on myocardial protection and clinical outcomes in patients undergoing coronary artery bypass graft surgery.","authors":"Farshad Jalili Shahandashti, Mohammadhadi Mozayan, Leyla Abdolkarimi, Faranak Kargar, Amene Ghanbari, Saeid Heidarinia, Mohammad Ziae Totonchi Ghorbani, Seyed Salaheddin Nabavi, Seyyed Ebrahim Hosseini Zargaz","doi":"10.1186/s43044-025-00641-3","DOIUrl":"10.1186/s43044-025-00641-3","url":null,"abstract":"<p><strong>Background: </strong>A main concern during cardiac surgery is the protection of the heart. Myocardial ischemia tends to increase the generation of reactive oxygen species. Based on its oxidation-reduction potentials, vitamin C is the most powerful antioxidant to counteract the effects of free radicals. This reason made the researcher to perform this study with the goal to determine and evaluate the effect of on perioperative clinical outcomes and laboratory criteria of coronary artery bypass grafting (CABG) cases.</p><p><strong>Methods: </strong>This randomized clinical trial (RCT) was done in 2022 at Rajaie Cardiovascular Medical and Research Center. Following obtaining permission from the ethics committee, 62 CABG patients were randomly allocated to two groups and were included in the study. The control group received routine Del Nido cardioplegia solution while vitamin C group received Del Nido cardioplegia solution containing 3gr of vitamin C. In this study, demographic information and variants like hemodynamic, blood, and FFP transfusion were evaluated and compared. Data were analyzed by two-way repeated measures ANOVA.</p><p><strong>Results: </strong>According to the findings, diastolic blood pressure (DBP) in the vitamin C group was lower, which was significant across both groups (P < 0.05); however, these alterations were in the normal range. The groups showed no significant difference in other parameters like fresh frozen plasma (FFP) transfusion in the intensive care unit (ICU) and return to baseline heart rate (P > 0.05). Also, the average cardiac arrest time (average time to cardiac arrest from the time of cardioplegia injection) in the controls was significantly higher compared to the intervention group (P = 0.028).The data indicate that for CK-MB, the group effect is not statistically significant, while the effect of time and the interaction effect of group and time are significant. For troponin, the group effect and the interaction effect are not significant, although the effect of time is significant. Therefore, adding vitamin C to the cardioplegia solution does not significantly affect troponin.</p><p><strong>Conclusion: </strong>One of the factors that contribute to myocardial protection is the reduction in the time to achieve cardiac arrest. In the group that received vitamin C, this time was reduced; therefore, it can be concluded that in this group, the risk of damage due to lack of blood flow and oxygen to the cardiac tissue is lower.</p><p><strong>Clinical trial number: </strong>This study is a randomized clinical trial (RCT).</p><p><strong>Irctid: </strong>IRCT20220716055477N1.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"72"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial adipose tissue in type 1 diabetes mellitus: a systematic review and meta-analysis.","authors":"Basavaraj G Sooragonda, Vanshika Karnwal, Vikneswaran Gunaseelan, Ameya Joshi, Kaushik Biswas, Mohan T Shenoy, Rakesh Anbazhagan","doi":"10.1186/s43044-025-00666-8","DOIUrl":"10.1186/s43044-025-00666-8","url":null,"abstract":"<p><strong>Background: </strong>Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot surrounding the myocardium and evidence suggests its potential role in the development of cardiovascular complications in type 1 diabetes mellitus (T1DM). This systematic review and meta-analysis aimed to: (1) quantify EAT measurements (thickness and volume) in patients with T1DM, and (2) compare EAT measurements between T1DM patients and healthy controls.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted using a systematic search strategy to identify studies that measured EAT thickness or volume in T1DM patients in PubMed, Embase, Cochrane Library, Web of Science, and CINAHL. Studies were included if they: (1) involved patients with T1DM, (2) reported EAT measurements using imaging techniques, and (3) were published in English. Case reports and reviews were excluded. Two independent reviewers performed study selection, data extraction, and quality assessment. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Statistical heterogeneity was assessed using I² statistics. Meta-analysis was performed using a random effect model.</p><p><strong>Results: </strong>A total of nine studies involving 285 and 233 participants measuring thickness and volume with T1DM were included. The pooled mean EAT thickness was 5.81 mm (95%CI: 4.30, 7.32 mm), and the pooled mean EAT volume was 56.84cm³ (95%CI: 34.05, 79.63cm³). Significant heterogeneity was observed between the volume and thickness of EAT among people with T1DM (I² = 99% for volume and 95% for thickness). Subgroup analysis revealed a mean difference of 2.12 mm (95%CI: 0.82, 3.43 mm) in EAT thickness between T1DM and control groups.</p><p><strong>Conclusions: </strong>Our findings indicate increased EAT measurements in T1DM patients compared to healthy individuals, suggesting EAT's potential involvement in T1DM-related cardiovascular issues.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"71"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of extracorporeal membrane oxygenation (ECMO) in congenital heart diseases: a systematic review.","authors":"Muhammad Shaheer Bin Faheem, Ahmed Ali Khan, Shamikha Cheema, Muzamil Akhtar, Danish Ali Ashraf","doi":"10.1186/s43044-025-00667-7","DOIUrl":"10.1186/s43044-025-00667-7","url":null,"abstract":"<p><strong>Background: </strong>Congenital heart diseases (CHDs) represent a significant healthcare challenge with incidence rates of 17.9 per 1000 live births. Extracorporeal membrane oxygenation (ECMO) has become an invaluable therapeutic option providing essential aid to support both cardiac as well as pulmonary failure.</p><p><strong>Methods: </strong>A systematic search was performed using PubMed, Embase, and Scopus from 2000 till date. Observational studies involving pediatric patients with CHD undergoing cardiac surgery using ECMO were included. The main outcomes were to determine short-term mortality, weaning off ECMO, complications, hospital and ICU length of stay, and indications for ECMO. Assessment of the risk of bias of included studies was done by Newcastle-Ottawa scale.</p><p><strong>Results: </strong>24 retrospective observational studies, encompassing 1,658 patients, were ultimately included in our review. The overall incidence of mortality across these studies was 45.2%. Successful weaning from ECMO was achieved in 73.9% of patients. The most frequently reported complications included bleeding, which affected 42.9% of patients, renal failure in 42.5%, and sepsis in 27.5%. The mean duration of hospital stay was 47.8 ± 41.1 days, while the mean length of stay in the ICU was 33.4 ± 32.6 days.</p><p><strong>Conclusions: </strong>ECMO benefits pediatric heart patients but comes with risks like bleeding and high mortality. Percutaneous techniques can reduce complications; more research on minimally invasive approaches is needed.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"70"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VSD device closure in situs inversus with dextrocardia: technical challenges and solutions: a case report.","authors":"Abhimanyu Uppal, Bhushan Shah, Rambabu Sharma, Ashok Garg","doi":"10.1186/s43044-025-00665-9","DOIUrl":"10.1186/s43044-025-00665-9","url":null,"abstract":"<p><strong>Background: </strong>Situs inversus with dextrocardia (SI-DC) is rarely associated with congenital heart defects. Traditionally, ventricular septal defect (VSD) in such patients has been managed surgically. Percutaneous VSD device closure in SI-DC, albeit a suitable alternative, has been seldom reported. The present report describes the unique challenges of mirror-image cardiac anatomy and suggests technical modifications for successful percutaneous closure. A 4-year-old boy, previously diagnosed with SI-DC and a moderate-size perimembranous VSD, presented with a history of poor weight gain and dyspnea. A 2D echocardiogram indicated that the septal defect was suitable for device closure. The procedure was adapted to account for the altered cardiac anatomy by adjusting the fluoroscopic angles and wire-torquing maneuvers. A Konar-multifunction occluder device MFO® 7-5mm was successfully deployed via retrograde approach without complications utilizing hemodynamic and echocardiographic guidance. No excess contrast volume or fluoroscopic radiation dose was used during the procedure due to meticulous pre-procedure planning.</p><p><strong>Conclusion: </strong>VSD device closure in atypical scenarios like SI-DC is both safe and feasible with thorough pre-procedure planning tailored to the \"mirror image\" cardiac anatomy.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"69"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Every great story seems to begin with a snake: a case report of large right atrial thrombus encountered during MitraClip procedure.","authors":"Antonio Totaro, Vincenzo Ienco, Chiara Galluccio, Vincenzo Sacra, Antonio Pierro, Nicola Testa, Gianluca Testa, Cosimo Sacra","doi":"10.1186/s43044-025-00661-z","DOIUrl":"10.1186/s43044-025-00661-z","url":null,"abstract":"<p><strong>Background: </strong>TEER has revolutionized mitral regurgitation treatment, addressing clinical burden in aging patients. However, thrombotic complications may still occur.</p><p><strong>Case presentation: </strong>An 83-year-old man with severe mitral regurgitation underwent a MitraClip procedure. A large molding thrombus was observed during the procedure, despite a targeted ACT. To prevent cerebral embolization, two carotid filters were placed. The procedure was successfully completed, and mitral regurgitation was reduced. The patient was stable during the procedure, with no evidence of pulmonary or cerebral embolism.</p><p><strong>Conclusions: </strong>The case highlights the importance of close observation and multidisciplinary decision-making in managing acute thrombus during TEER. Further research is needed to establish the potential role of cerebral protection devices and the effect of anticoagulation procedures on thrombus formation.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"67"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular risk management beyond statins: review of new therapies available in Italy.","authors":"Maurizio Capuozzo, Alessandro Ottaiano, Claudia Cinque, Stefania Farace, Francesco Ferrara","doi":"10.1186/s43044-025-00660-0","DOIUrl":"10.1186/s43044-025-00660-0","url":null,"abstract":"<p><strong>Background: </strong>Statins remain foundational in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). However, despite optimal statin therapy, a significant residual risk of ASCVD persists, highlighting the need for novel lipid-lowering strategies targeting both low-density lipoprotein cholesterol (LDL-C) and other atherogenic lipoproteins. Over the last decade, a new generation of pharmacological agents has been developed to enhance dyslipidemia management beyond traditional statins.</p><p><strong>Main body: </strong>Bempedoic acid, a prodrug activated in the liver, inhibits ATP-citrate lyase (ACLY), an enzyme upstream of HMG-CoA reductase in the cholesterol synthesis pathway. This action reduces hepatic cholesterol synthesis and simultaneously upregulates LDL receptor expression, promoting enhanced LDL-C clearance. These dual actions provide a statin-independent approach to LDL-C reduction, particularly beneficial for patients with statin intolerance. In addition, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, including monoclonal antibodies and siRNA-based therapies, have shown robust LDL-C-lowering effects by preventing LDL receptor degradation, leading to a significant reduction in cardiovascular risk. Other innovative lipid-modifying approaches include antisense oligonucleotides targeting apolipoprotein C3, angiopoietin-like protein 3, and lipoprotein(a) [Lp(a)]-such as pelacarsen and olpasiran-which demonstrate promising results in addressing genetically driven dyslipidemias. Additionally, strategies aimed at enhancing apolipoprotein A1 and promoting high-density lipoprotein functionality are under investigation, although clinical validation remains ongoing.</p><p><strong>Conclusion: </strong>This review underscores the evolving landscape of lipid-lowering therapies, with emphasis on agents acting through novel mechanisms beyond statin pathways. Bempedoic acid, by inhibiting ACLY and increasing LDL receptor expression, represents a safe and effective option for reducing LDL-C, especially in statin-intolerant individuals. PCSK9 inhibitors further expand therapeutic options by augmenting LDL receptor recycling and clearance. The integration of these agents into clinical practice may help mitigate residual cardiovascular risk and personalize treatment strategies in dyslipidemia management.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"77 1","pages":"68"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}