European cardiologyPub Date : 2025-09-15eCollection Date: 2025-01-01DOI: 10.15420/ecr.2025.28
Armin Arbab-Zadeh, Michelle Graham, Hector M Garcia-Garcia, Gb John Mancini, William S Weintraub, William E Boden
{"title":"Left Main Disease: The Last Frontier for Medical Therapy in Stable Coronary Artery Disease?","authors":"Armin Arbab-Zadeh, Michelle Graham, Hector M Garcia-Garcia, Gb John Mancini, William S Weintraub, William E Boden","doi":"10.15420/ecr.2025.28","DOIUrl":"10.15420/ecr.2025.28","url":null,"abstract":"<p><p>Patients with stable coronary artery disease (CAD) involving ≥50% stenosis in the left main coronary artery almost invariably undergo revascularisation. However, there is lack of evidence from contemporary randomised controlled clinical trials (RCTs) supporting the superiority of this approach versus an initial strategy of intensive, multifaceted optimal medical therapy (OMT) directed at dyslipidaemic, hypertensive, thrombotic, metabolic and ischaemic targets. Current clinical practice guidelines still base their recommendations on small subsets of RCTs conducted in the 1970s and early 1980s. Given the lack of survival benefit among patients with stable, multi-vessel coronary artery disease who do versus those do not undergo routine revascularisation in the era of advanced OMT, the question arises whether the current treatment recommendations for left main disease are valid. This issue is of considerable importance; while significant left main disease is found in only 8-10% of diagnostic invasive angiography cases, it is a disease entity associated with a high risk of adverse clinical events and extensive resource use. This article discusses clinical trials data as well as challenges to address this question in the contemporary era. It highlights the complexities of trial planning and execution as it relates to both feasibility and equipoise, study design, choice of trial endpoints and duration of follow-up. The authors conclude there is a compelling need for an RCT to test the hypothesis that the current practice of routine revascularisation for all patients with LMD is superior to an initial strategy of multifaceted OMT with selective use of revascularisation.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e24"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208648","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}
European cardiologyPub Date : 2025-09-09eCollection Date: 2025-01-01DOI: 10.15420/ecr.2025.26
Giulia Tamburrini, Celia de Cobos García, Teresa López-Fernández
{"title":"Advances in Cardioprotection Strategies: Focusing on Breast Cancer and Beyond Through Novel Biomarkers and Pharmacological Approaches.","authors":"Giulia Tamburrini, Celia de Cobos García, Teresa López-Fernández","doi":"10.15420/ecr.2025.26","DOIUrl":"10.15420/ecr.2025.26","url":null,"abstract":"<p><p>Recent improvements in cancer treatments have significantly improved patient survival rates, which has drawn attention to cardiovascular complications that may arise after using oncological therapies. These complications can seriously affect quality of life and long-term outcomes, sometimes leading to the need for modification or discontinuation of cancer treatment. This highlights the urgent need for effective cardioprotective strategies to prevent and mitigate clinical and subclinical cardiotoxicity, as well as reducing acute and chronic cardiac damage. In this review, we critically evaluate the cardiac biomarkers used in clinical practice for early detection and monitoring of cardiotoxicity, focusing on N-terminal pro-B-type natriuretic peptide and troponins due to their established predictive value. We also explore emerging biomarkers that may improve cardiovascular risk assessment in cancer patients. On the pharmacological front, β-blockers, angiotensin-converting enzyme inhibitors and sodium-glucose cotransporter 2 inhibitors show potential for mitigating cardiotoxicity, although evidence from randomised trials remains mixed. Non-pharmacological approaches are also discussed, and the aim is to integrate comprehensive cardiovascular prevention into oncology care.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e23"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208658","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}
European cardiologyPub Date : 2025-08-13eCollection Date: 2025-01-01DOI: 10.15420/ecr.2024.51
Daniel Murphy, Debasish Banerjee
{"title":"Cardiac Troponins in Kidney Disease.","authors":"Daniel Murphy, Debasish Banerjee","doi":"10.15420/ecr.2024.51","DOIUrl":"10.15420/ecr.2024.51","url":null,"abstract":"<p><p>Cardiovascular disease is a major cause of morbidity and mortality in individuals with kidney disease. In recent years, biomarkers such as cardiac troponins have become indispensable to the diagnosis and prognosis of cardiac disease, such as MI and heart failure. However, these biomarkers behave differently in the general population compared with people with kidney disease, who may have higher baseline levels and reactions to acute disturbance due to a combination of reduced renal clearance of biomarker molecules and increased production due to concurrent cardiovascular disease and cardiorenal syndrome. Three decades of research into cardiac biomarkers have produced a range of literature investigating their applications in different patient groups and healthcare settings. This review explores the evidence surrounding measurement and interpretation of cardiac troponin levels in people who have chronic kidney disease, and have had dialysis and/or kidney transplantation, with reference to baseline levels and changes over time, their relationship to incident cardiovascular morbidity and mortality, and their application in acute settings.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e22"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994832","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}
European cardiologyPub Date : 2025-08-13eCollection Date: 2025-01-01DOI: 10.15420/ecr.2024.37
Shirley Siang Ning Tan, Wei Hong Lai, Lee Len Tiong, Lawrence Anchah, Edmund Ui Hang Sim, Alan Yean Yip Fong
{"title":"Systematic Scoping on Point-of-care Monitoring of Direct Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation: Current Status and Future Perspectives in Malaysia.","authors":"Shirley Siang Ning Tan, Wei Hong Lai, Lee Len Tiong, Lawrence Anchah, Edmund Ui Hang Sim, Alan Yean Yip Fong","doi":"10.15420/ecr.2024.37","DOIUrl":"10.15420/ecr.2024.37","url":null,"abstract":"<p><p>This review explores the use of point-of-care (POC) monitoring of direct oral anticoagulants (DOACs) in patients with non-valvular AF globally and in Malaysia. As patent protection measures for innovative medicines come to an end, and generic alternatives become available, we expect a greater uptake of DOACs than warfarin by patients due to cost advantages. However, the anticoagulation effect of DOACs has been shown to vary from patient to patient and is associated with thrombotic and bleeding risks. Despite the availability of laboratory technology, including at POC, that can monitor the pharmacological effects of DOACs, it has not achieved any substantial traction in clinical use to date. Future efforts should focus on establishing the therapeutic window or 'sweet spot' of DOAC therapy for the POC assays and ensuring adherence before implementation of POC monitoring. This is crucial for the tailoring of anticoagulation therapy, potentially reducing overall healthcare costs and improving patient health outcomes.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e21"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994835","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}
European cardiologyPub Date : 2025-06-30eCollection Date: 2025-01-01DOI: 10.15420/ecr.2024.52
Antonio Zaza, Marcella Rocchetti
{"title":"Development of Small-molecule SERCA2a Stimulators: A Novel Class of Ino-lusitropic Agents.","authors":"Antonio Zaza, Marcella Rocchetti","doi":"10.15420/ecr.2024.52","DOIUrl":"10.15420/ecr.2024.52","url":null,"abstract":"<p><p>Long-term use of modulators of myocardial function has been scaled down because of the partially detrimental effects of currently available agents. Nonetheless, inotropy and lusitropy remain unmet needs in the treatment of chronic heart failure (HF). This underlies the interest in SERCA2a stimulation, a novel approach. This short review describes the identification of SERCA2a stimulating activity in istaroxime, an inotropic compound characterised by its minimal proarrhythmic effects despite its multiple targets, and the development of its derivatives into a novel class of ino-lusitropic agents. The benefits achieved with istaroxime derivatives (versus istaroxime) consist of their selectivity for SERCA2a stimulation and pharmacokinetics suitable for chronic oral administration. Considering the role of SERCA2a depression in HF and the accompanying electrical instability, selective restoration of SERCA2a function provides an appealing approach to HF therapy. Beneficial effects of SERCA2a stimulation by istaroxime have also been recently described in non-cardiac tissues, thus suggesting even broader and unexpected indications for this new class of agents.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e20"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651648","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":"Same-day Discharge Following Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomised Controlled Trials.","authors":"Ngoc Huy Nguyen, Thanh Ngoc Le, Hoai Thi Thu Nguyen, Tuan Minh Pham, Dung Viet Nguyen","doi":"10.15420/ecr.2025.21","DOIUrl":"10.15420/ecr.2025.21","url":null,"abstract":"<p><strong>Background: </strong>Over the past decade, significant advancements in percutaneous coronary intervention (PCI) have substantially reduced periprocedural complications. These developments have also made same-day discharge (SDD) following PCI increasingly feasible. This study aims to provide the most up-to-date evidence on the safety of SDD through a synthesis of randomised controlled trial (RCT) results.</p><p><strong>Methods: </strong>We systematically searched the PubMed, Embase, Cochrane Library and ClinicalTrials.gov databases for RCTs comparing the safety of SDD versus overnight stay (ONS) following PCI. Meta-analyses were conducted using a random effects model.</p><p><strong>Results: </strong>A total of 14 RCTs comprising 3,215 patients (1,608 in the SDD group and 1,607 in the ONS group), primarily with chronic coronary syndrome or low-risk acute coronary syndrome, were included. Our meta-analysis demonstrated that SDD is as safe as ONS, as indicated by the comparable risks of adverse events, including major adverse cardiovascular events (pooled RR 0.76; 95% CI [0.46-1.27]), major bleeding (pooled RR 1.29; 95% CI [0.50-3.37]), vascular complications related to the access site (pooled RR 1.06; 95% CI [0.78-1.45]), rehospitalisation (pooled RR 1.15; 95% CI [0.79-1.68]) and unplanned hospital visits (pooled RR 1.02; 95% CI [0.73-1.42]) within 30 days post-PCI. The results remained robust, regardless of access site, timing of discharge or clinical presentation (all p for interaction >0.05).</p><p><strong>Conclusion: </strong>This up-to-date meta-analysis provides strong evidence supporting the safety of SDD compared with ONS after PCI. Further well-designed RCTs involving high-risk acute coronary syndrome patients are warranted to further clarify the safety of the SDD strategy in this population.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e19"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556201","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}
European cardiologyPub Date : 2025-06-12eCollection Date: 2025-01-01DOI: 10.15420/ecr.2024.30
Federica Piani, Lorenzo Annesi, Claudio Borghi
{"title":"New Insights into Uric Acid Metabolism in the Pathophysiology of Ischaemic Heart Disease.","authors":"Federica Piani, Lorenzo Annesi, Claudio Borghi","doi":"10.15420/ecr.2024.30","DOIUrl":"10.15420/ecr.2024.30","url":null,"abstract":"<p><p>The role of hyperuricaemia as an independent cardiovascular risk factor remains controversial and subject to debate. Nonetheless, multiple studies have highlighted the central role of uric acid (UA) in conditions such as hypertension, metabolic syndrome, heart failure and coronary artery disease. Various mechanisms have been proposed to explain UA's involvement in cardiovascular diseases, including through UA-induced oxidative stress, systemic inflammation, endothelial dysfunction and activation of the renin-angiotensin-aldosterone system (RAAS). Asymptomatic hyperuricaemia has been proposed as an independent risk factor for ischaemic heart disease. Nonetheless, the positive impact of urate-lowering therapies on reducing cardiovascular risk still needs to be thoroughly confirmed through large randomised controlled studies.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e18"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487557","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":"Oral P2Y<sub>12</sub> Inhibitors: Victims or Perpetrators? A Focused Review on Pharmacokinetic, Clinically Relevant Drug Interactions.","authors":"Elisabetta Bigagli, Jacopo Angelini, Alessandro Mugelli, Bianca Rocca","doi":"10.15420/ecr.2025.12","DOIUrl":"10.15420/ecr.2025.12","url":null,"abstract":"<p><p>Pharmacokinetic-based drug-drug interactions (DDI) largely contribute to therapeutic failures by decreasing a drug's safety or efficacy. In particular, clinically relevant DDIs generate major changes in plasma concentrations of the 'victim' drug exerted by the 'perpetrator' drug, which interferes with different pharmacokinetic steps. Polypharmacy significantly contributes to clinically relevant DDIs, but is unavoidable for complex patients, such as those with acute or chronic cardiovascular diseases with comorbidities. Oral P2Y<sub>12</sub> inhibitors, namely clopidogrel, prasugrel and ticagrelor, are recommended for dual or single (clopidogrel) antiplatelet therapy following acute and chronic cardiovascular diseases, respectively, and urgent or elective percutaneous coronary interventions. Thus, an oral P2Y<sub>12</sub> agent is often part of a necessary polypharmacy in patients with cardiovascular diseases. The authors critically review pharmacokinetic-related clinically relevant DDIs involving oral P2Y<sub>12</sub> inhibitors, focusing on underlying mechanisms, which may reduce safety and effectiveness. Based on significant differences in pharmacokinetic and biotransformation, clopidogrel and ticagrelor are exposed to clinically relevant DDIs as victim or perpetrator drugs, while prasugrel is less susceptible to DDIs.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e17"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487558","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}
European cardiologyPub Date : 2025-06-02eCollection Date: 2025-01-01DOI: 10.15420/ecr.2025.20
Gaetano Antonio Lanza
{"title":"The Role of ECG Exercise Stress Testing in the Assessment of Patients with Suspected Coronary Artery Disease.","authors":"Gaetano Antonio Lanza","doi":"10.15420/ecr.2025.20","DOIUrl":"10.15420/ecr.2025.20","url":null,"abstract":"","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e16"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287583","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}
European cardiologyPub Date : 2025-05-14eCollection Date: 2025-01-01DOI: 10.15420/ecr.2024.62
Joshua M Stolker, Philippe G Steg, Roberta Rossini, Dorairaj Prabhakaran, Lale Tokgözoğlu, Naveed Sattar
{"title":"Could Acute COVID-19 Infection Ignite Thrombotic Risk?","authors":"Joshua M Stolker, Philippe G Steg, Roberta Rossini, Dorairaj Prabhakaran, Lale Tokgözoğlu, Naveed Sattar","doi":"10.15420/ecr.2024.62","DOIUrl":"10.15420/ecr.2024.62","url":null,"abstract":"<p><p>With the growing body of evidence of the ischaemic and thrombotic risks associated with recent COVID-19 infection, this expert commentary reviews the data on the cardiovascular risk implications of COVID-19 and considers potential management approaches for these patients. The authors' opinions were gauged against a global healthcare professional survey to measure current levels of agreement, lending support to their validity. While the need for ongoing research to improve the understanding of this disease is appreciated, the authors recognise that there is the potential to transform management approaches to reduce the health impact of COVID-19 infection among high-risk patients, especially those with established cardiovascular disease.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":"20 ","pages":"e14"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210548","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}