Cardiology and Therapy最新文献

{"title":"ACO-SWITCH: Rationale and Design of a Phase 4 Study Evaluating Serum Transthyretin in ATTR-CM After Switching from Tafamidis to Acoramidis.","authors":"Roman Pfister, Lars Michel, Marcel Schulze, Kai Vogtländer, Antonio Ciaccia, Martin Merz, Christian Hengstenberg","doi":"10.1007/s40119-026-00466-4","DOIUrl":"10.1007/s40119-026-00466-4","url":null,"abstract":"<p><strong>Introduction: </strong>Acoramidis is a novel oral transthyretin (TTR) stabilizer approved for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM) based on the phase 3 ATTRibute-CM study (ClinicalTrials.gov identifier, NCT03860935). As the ATTR-CM therapy landscape evolves, there is a growing need to evaluate changes in disease markers and treatment response in patients who switch therapies.</p><p><strong>Methods: </strong>ACO-SWITCH (NCT07298044) is an ongoing, prospective, open-label, multicenter, single-arm, interventional phase 4 study designed to evaluate the effects of switching from tafamidis to acoramidis in 50 adults with variant or wild-type ATTR-CM diagnosis within the past 24 months. Participants will have used tafamidis for ≥ 3 months prior to study start and after a 21-day screening period, will switch to a 6-month acoramidis treatment period. Data will be collected at weekly visits during the first month of acoramidis treatment, after 3 months, at the end of treatment, and 30 days after the end of treatment.</p><p><strong>Planned outcomes: </strong>The primary endpoint is the change in serum TTR (sTTR) level from baseline to month 6 or time of premature treatment discontinuation, measured using immunoturbidimetry and analyzed using the one-sided paired Wilcoxon signed-rank test. Secondary endpoints include sTTR levels at different time points; changes from baseline to month 6 in cardiovascular (N-terminal pro-B-type natriuretic peptide, high-sensitivity troponin T, and retinol-binding protein 4), kidney (estimated glomerular filtration rate, creatinine, cystatin C, urinary albumin-to-creatinine ratio), and thyroid (thyroid-stimulating hormone) biomarkers; echocardiographic results; 6-minute walking distance; the Kansas City Cardiomyopathy Questionnaire overall summary score; the EuroQol 5-dimension 5-level index score; and adverse events. Statistical analyses for secondary endpoints will be explorative and descriptive. Descriptive analysis will be carried out using summary statistics for categorical and continuous data.</p><p><strong>Conclusions: </strong>ACO-SWITCH is a prospective study in adults with ATTR-CM. The study will determine the effects of switching treatment from tafamidis to acoramidis, with a particular focus on sTTR levels. ACO-SWITCH aims to provide evidence to support clinical decision-making and guide optimal management in patients with ATTR-CM. Graphical Abstract available for this article.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov identifier, NCT07298044.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"529-542"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788455","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":"Advanced Cardiac Imaging Techniques for Detection of Myocardial Ischemia in Children with Coronary Artery Abnormalities.","authors":"Justin B Jin, Jason L Williams, Siew May Wang, Simon Lee","doi":"10.1007/s40119-026-00469-1","DOIUrl":"10.1007/s40119-026-00469-1","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery disease in children arises from a diverse group of non-atherosclerotic conditions that may result in myocardial ischemia, ventricular dysfunction, and sudden cardiac death. Important etiologies include post-inflammatory vasculopathy following Kawasaki disease, transplant-related cardiac allograft vasculopathy, congenital coronary anomalies such as anomalous aortic origin of a coronary artery, and complications after coronary reimplantation during congenital heart surgery. The detection of myocardial ischemia in children is uniquely challenging, as symptoms are frequently absent or atypical, and traditional screening tools such as resting electrocardiography and transthoracic echocardiography lack sufficient sensitivity.</p><p><strong>Methods: </strong>A narrative review was performed of the literature on non-invasive myocardial ischemia evaluation in pediatric patients with acquired and congenital coronary artery disease, focusing on Kawasaki disease, congenital coronary anomalies, cardiac allograft vasculopathy, and postoperative conditions involving coronary artery manipulation. PubMed and Google Scholar were searched and supplemented by reference lists and guideline documents. Original studies, reviews, consensus statements, and society guidelines were qualitatively synthesized by disease category and imaging modality, with emphasis on diagnostic performance, clinical applications, safety considerations, limitations, and evidence gaps.</p><p><strong>Results: </strong>Multimodality imaging plays a central role in the evaluation of pediatric coronary pathology. Stress echocardiography provides a widely available, radiation-free method for detecting inducible regional wall motion abnormalities but requires specialized expertise. Stress perfusion cardiac magnetic resonance imaging offers comprehensive assessment of ventricular function, myocardial perfusion, and scar tissue without ionizing radiation and is increasingly incorporated into surveillance strategies. Nuclear perfusion imaging remains a well-established technique but is used less frequently due to radiation exposure and modest specificity in some populations. Coronary computed tomography angiography provides high-resolution anatomic characterization of coronary origin, course, and luminal patency and is particularly valuable in congenital coronary anomalies and postsurgical coronary assessment.</p><p><strong>Conclusions: </strong>Optimal evaluation of pediatric coronary disease requires the integration of anatomic and functional imaging tailored to the underlying pathology and patient characteristics. Despite advances in multimodality imaging, pediatric-specific data remain limited, and many diagnostic thresholds are extrapolated from adult populations. Further multicenter studies are needed to refine risk stratification and establish evidence-based surveillance strategies for children at risk of myocardial ischemia.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"439-462"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683387","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":"Concomitant Versus Staged Percutaneous Cervicocerebral Artery Revascularization with Coronary Artery Bypass Grafting.","authors":"Jinwei Zhang, Liaoming He, Chenzhen Xu, Chuanjie Yue, Song Wang, Peng Sun, Hao Cui, Changwei Ren, Yongqiang Lai","doi":"10.1007/s40119-026-00465-5","DOIUrl":"10.1007/s40119-026-00465-5","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal strategy and timing for percutaneous cervicocerebral artery revascularization (PCAR) combined with coronary artery bypass grafting (CABG) remain uncertain in patients with severe carotid or vertebral artery stenosis.</p><p><strong>Methods: </strong>We retrospectively analyzed adults undergoing concomitant or staged PCAR-CABG at Beijing Anzhen Hospital from January 2011 to December 2025. The primary endpoint was perioperative death or stroke. Strategies were compared using Firth penalized logistic regression. In the staged cohort, restricted cubic splines and interval-based analyses assessed the association between interprocedural interval and outcomes.</p><p><strong>Results: </strong>Among 801 patients, 57 (7.1%) underwent concomitant and 744 (92.9%) underwent staged intervention; the median interprocedural interval was 30 days (interquartile range, 9-46). PCAR was performed for severe vertebral stenosis in 221 (27.6%), severe carotid stenosis in 474 (59.2%), and both in 106 (13.2%). Perioperative death or stroke occurred in one patient (1.8%) in the concomitant group and 37 patients (5.0%) in the staged group. Concomitant intervention was not significantly associated with the primary endpoint after adjustment (adjusted odds ratio (OR) 0.43; 95% confidence interval (CI), 0.05-1.76; P = 0.280). Exploratory analyses suggested decreasing risk with longer intervals, although no significant nonlinear association was identified. The 1-7-day staged group had the highest estimated odds relative to the concomitant group (adjusted OR, 4.89; 95% CI, 1.04-48.30; P = 0.044).</p><p><strong>Conclusions: </strong>Perioperative death or stroke did not differ significantly between concomitant and staged PCAR-CABG. However, the limited number of events precludes conclusions regarding equivalence. Interval-specific findings were exploratory and require confirmation in adequately powered prospective multicenter studies.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"339-350"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688590","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":"Burden of Systemic Inflammation Among Individuals with Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease in Northern China.","authors":"Hongye Ren, Magnus Fugger, Ying Wang, Zewei Shen, Chengyu Liu, Yawei Hao, Xin Zhou, Hangkuan Liu, Zirui Zhou, Ruoya Chen, Mei Yang","doi":"10.1007/s40119-026-00467-3","DOIUrl":"10.1007/s40119-026-00467-3","url":null,"abstract":"<p><strong>Introduction: </strong>Atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) represent major public health challenges that contribute substantially to morbidity, mortality, and healthcare expenditures worldwide. Systemic inflammation (SI) has been recognized as a key pathophysiological mechanism underlying disease progression in both conditions; however, real-world evidence regarding its prevalence and associated clinical and economic impact remains limited, particularly in China.</p><p><strong>Methods: </strong>A cross-sectional analysis estimated the prevalence of ASCVD, CKD, and SI, alongside a retrospective cohort study evaluating clinical and economic burden associated with SI among patients with coexisting ASCVD and CKD, using data from Tianjin Health and Medical Data Platform (THMDP). SI was defined as C-reactive protein (CRP) or high-sensitivity CRP (hsCRP) ≥ 2 mg/L after excluding values attributable to acute events. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) for major adverse cardiovascular events (MACE) and all-cause mortality.</p><p><strong>Results: </strong>Between 2020 and 2023, ASCVD prevalence increased from 16.7% to 24.3%, with CKD affecting 12-13% of these patients. Among patients with ASCVD-CKD and eligible CRP/hsCRP testing, about 56% had SI, and the proportion remained stable over time. The cohort study included 39,760 patients with SI and 16,225 without. SI was associated with significantly higher risk of 3-point MACE (HR 1.42, 95% CI 1.38-1.47), expanded MACE (HR 1.28, 95% CI 1.24-1.31), and all-cause mortality (HR 2.59, 95% CI 2.4-2.8). Patients with SI also experienced greater CKD progression, higher dialysis rates, more frequent hospitalizations, and higher medical costs.</p><p><strong>Conclusions: </strong>SI is highly prevalent among patients with ASCVD and CKD in northern China and is strongly associated with worse clinical outcomes and greater healthcare burden. These findings underscore the unmet need for strategies targeting SI to improve prognosis and reduce clinical burden in this high-risk population.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"351-363"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705536","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":"Repurposing Empagliflozin for Duchenne Muscular Dystrophy-Associated Cardiomyopathy: Protocol for a Pharmacokinetics, Safety and Proof-of-Concept Trial in Children.","authors":"Sebastiano A G Lava, Craig Laurence, Janet Mallory, Oscar Della Pasqua, Alessandro Di Deo, Chet Villa, Sean Lang, Michael Quail, Michael Burch","doi":"10.1007/s40119-026-00456-6","DOIUrl":"10.1007/s40119-026-00456-6","url":null,"abstract":"<p><strong>Introduction: </strong>Duchenne muscular dystrophy (DMD) is a life-limiting disease characterized by progressive muscle wasting of skeletal and cardiac myocytes. Nowadays, heart failure is the principal cause of death. Current treatment is still unsatisfactory. Empagliflozin has shown excellent results in adults with heart failure, and is licensed for adolescents > 10 years of age with type 2 diabetes mellitus. In an effort to repurpose empagliflozin for DMD-associated cardiomyopathy, we aim to describe its pharmacokinetic behaviour in this population, assess ease-of-swallow, monitor safety, explore efficacy and screen efficacy markers.</p><p><strong>Methods: </strong>This is a single-arm, single-centre, open-label phase 2a trial in children and adolescents aged 6 to ≤ 18 years with DMD-associated cardiomyopathy. Participants (n = 12) will take empagliflozin 10 mg once daily for 6 months, with a whole-day stay at visit 1 for the evaluation of pharmacokinetics, and follow-up visits at 1 week, 6 weeks, 3 months and 6 months. On top of acceptability (ease-of-swallow), which will be assessed at visit 1, further secondary endpoints include safety and efficacy clinical (e.g. heart rate, blood pressure), biochemical (e.g. NT-proBNP, haemoglobin, uric acid, electrolytes, renal function), imaging (echocardiography, cardiac magnetic resonance) and bioimpedance (intra- and extracellular fluid volume) parameters.</p><p><strong>Planned outcomes: </strong>Characterization of primary and secondary pharmacokinetic parameters will allow one to define the dose range for children and adolescents with DMD-associated cardiomyopathy, informing both current compassionate care and the design of future efficacy trials. Additionally, this trial will enable the identification of efficacy markers to be used as endpoints in future efficacy trials and in clinical practice.</p><p><strong>Trial registration number: </strong>NCT06643442, ISRCTN 12497973, IRAS number 1009946.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"503-514"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136613","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":"Concordance of Large Language Model Recommendations with Multidisciplinary Heart Team Decisions in Coronary Revascularization and Aortic Valve Intervention: A Systematic Review and Pooled Analysis.","authors":"Armaun D Rouhi, Shreyas V Menon, Yazid K Ghanem, Jason J Han","doi":"10.1007/s40119-026-00453-9","DOIUrl":"10.1007/s40119-026-00453-9","url":null,"abstract":"<p><strong>Introduction: </strong>The multidisciplinary heart team (HT) remains the cornerstone of decision-making for complex cardiovascular disease. Large language models (LLMs) and other generative artificial intelligence models have recently emerged as potential decision support tools across diverse clinical settings. We sought to synthesize current evidence and quantitatively estimate concordance between LLM recommendations and HT decisions.</p><p><strong>Methods: </strong>A literature search was performed using PubMed, Scopus, and Web of Science for primary studies published between November 2022 and February 2026 that evaluated recommendations by LLMs against multidisciplinary HT decisions. Studies reporting overall agreement were included for quantitative pooling. Random-effects meta-analysis was performed to determine proportion of agreement.</p><p><strong>Results: </strong>Four retrospective concordance studies were included regarding decision-making in coronary revascularization and aortic valve intervention. LLM-HT concordance ranged from 65% to 82% for coronary revascularization and was 77% for aortic valve intervention. In random-effects meta-analysis, the pooled agreement between LLM recommendations and HT decisions was 0.73 (95% CI 0.60-0.83) with substantial heterogeneity. Discordance stemmed from LLM reliance on outdated trial evidence and limited transparency regarding utilized data, with misclassifications observed in cases of octogenarians with aortic stenosis. Detailed prompts generally improved accuracy and reliability of LLM recommendations.</p><p><strong>Conclusion: </strong>These preliminary findings suggest LLMs may have potential as adjunctive decision support tools for multidisciplinary HTs. There remains potential for misclassification when patient-specific factors and conflicting guidelines complicate decision-making. Further prospective evaluation across diverse LLMs is essential before clinical deployment can be recommended.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"393-406"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947279","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":"Transthyretin Amyloid Cardiomyopathy in Women: Epidemiology, Diagnostic Delay, and Clinical Implications.","authors":"Avni Madhani, Bhavya Ancha, Kevin M Alexander, Joban Vaishnav","doi":"10.1007/s40119-026-00463-7","DOIUrl":"10.1007/s40119-026-00463-7","url":null,"abstract":"<p><p>Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed cause of heart failure, resulting from the deposition of misfolded transthyretin protein in the myocardium. While historically considered to be a male-predominant disease, an increasing number of studies have shown that ATTR-CM may be under-recognized in women, likely due to differences in disease presentation compared with men. Notably, left ventricular wall thickness ≥ 12 mm is frequently used as a marker for ATTR-CM workup; however, women with ATTR-CM often have a lower left ventricular wall thickness than men and may not meet this threshold despite significant myocardial involvement. Moreover, hormonal differences between male and female patients may result in distinct cardiac phenotypes. Socioeconomic factors disproportionately impacting women, such as increased caregiving burden, symptom dismissal, and fewer financial resources, are likely additional contributing factors. As a result, diagnostic delays up to several years have been noted in women. Improving the diagnosis of ATTR-CM in women requires a multifactorial approach, including reforming screening guidelines to reflect sex-specific differences in disease presentation and increasing awareness of ATTR-CM in the community. Furthermore, given the historical underrepresentation of women in clinical studies on ATTR-CM, further investigation is necessary to better understand the prevalence, treatment efficacy, and outcomes of ATTR-CM in women.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"463-479"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705569","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":"Real-World Analysis of the Association Between Systemic Inflammation, Cardiovascular Events, and Economic Burden Among Patients with Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease.","authors":"Chi Nguyen, Radha Ryali, Jeffrey R Skaar, Wing Chow, Carey Robar, Allegra Kaufman, Weilong Li, Binita Shah","doi":"10.1007/s40119-026-00459-3","DOIUrl":"10.1007/s40119-026-00459-3","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with atherosclerotic cardiovascular disease (ASCVD) and systemic inflammation (SI) or chronic kidney disease (CKD) have poorer outcomes than those without SI or CKD. This study evaluated the impact of both SI and CKD on major adverse cardiovascular events (MACE), healthcare costs, and healthcare resource utilization (HCRU) in patients with ASCVD.</p><p><strong>Methods: </strong>This retrospective cohort study examined the association between SI and revised MACE, healthcare costs, and HCRU among adult patients with ASCVD from the Komodo Healthcare Map®. CKD stage 3-4 was determined from claims or laboratory data. SI was defined as ≥ 1 high-sensitivity C-reactive protein (hsCRP) value of 2-10 mg/l (without SI, all hsCRP values < 2 mg/l). The primary endpoint, revised MACE, was defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality.</p><p><strong>Results: </strong>Of 74,884 patients with ASCVD and ≥ 1 eligible hsCRP value, 8.5% had CKD stage 3-4, and 49.2% had SI. Patients with SI had a higher comorbidity index and a greater prevalence of obesity, hypertension, and type 2 diabetes than those without SI. Compared with patients with ASCVD without CKD or SI, SI alone was associated with a 24% higher risk (hazard ratio [HR] 1.24; 95% CI 1.15-1.34), CKD stage 3-4 with a 33% higher risk (HR 1.33; 95% CI 1.16-1.51), and both SI and CKD stage 3-4 with a 62% higher risk (HR 1.62; 95% CI 1.45-1.82) of revised MACE. In patients with ASCVD without CKD, total healthcare costs were $18,002 PPPY with SI vs. $15,070 PPPY without SI. In patients with ASCVD with CKD stage 3-4, costs were $26,089 PPPY with SI vs. $20,753 PPPY without SI. Across groups, SI was associated with higher HCRU.</p><p><strong>Conclusions: </strong>SI is associated with increased risk of MACE and higher total healthcare costs and HCRU in patients with ASCVD with or without CKD.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"319-338"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653160","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":"Cardiogenic Shock Centers and Protocols for Acute Cardiovascular Care: Bridging the Gap Between Spoke and Hub Sites.","authors":"Chirag Mehta, Sahas Chandragiri, Carl Atallah, Heena Asnani, Aryan Mehta, Brian Welling, Colleen McCarthy, Alexander Sweeting, Howard A Cooper, Srihari S Naidu, J Dawn Abbott, Saraschandra Vallabhajosyula","doi":"10.1007/s40119-026-00454-8","DOIUrl":"10.1007/s40119-026-00454-8","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is a syndrome of low cardiac output associated with high inpatient morbidity and mortality. Studies have supported the early transfer of patients with CS from spoke sites to the nearest regional hub center, forming the basis for the \"hub-and-spoke\" model. Contemporary CS algorithms revolve around invasive hemodynamic monitoring and temporary mechanical circulatory support guided by a multidisciplinary CS team. However, these protocols have limited applicability to the majority of spoke sites due to the limitations of resources, equipment, and personnel, further contributing to inequities in CS care. In this review, we seek to provide a blueprint for a generalizable approach to CS, an algorithm for intrahospital care escalation based on CS severity, and an example protocol detailing stabilization and monitoring strategies, independent of multidisciplinary CS teams.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"377-391"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926752","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":"Utilization Patterns and Barriers to Sodium-Glucose Cotransporter-2 Inhibitor Prescription in Patients with Heart Failure: Real-World Evidence from Saudi Arabia.","authors":"Lama Alfehaid, Omar Alkhezi, Riyadh Alrayes, Abdulmajeed Alsuwaylihi, Ahmed Alharbi, Battal Aldosari, Hisham Badreldin","doi":"10.1007/s40119-026-00458-4","DOIUrl":"10.1007/s40119-026-00458-4","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as foundational therapy for patients with heart failure (HF) across all ejection fractions; however, real-world adoption remains inconsistent, and data from Middle Eastern health systems are limited. This study aimed to assess real-world utilization of SGLT2i among patients with HF in Saudi Arabia and to identify clinical factors associated with prescribing and outcomes.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study of adult patients with HF receiving longitudinal care at tertiary cardiac centers between January 2016 and December 2024 in Saudi Arabia. HF phenotypes included reduced, mildly reduced, preserved, and improved ejection fraction. The primary outcome was SGLT2i use during follow-up. Multivariable logistic regression identified factors associated with prescribing. Exploratory outcomes included HF hospitalization and all-cause mortality.</p><p><strong>Results: </strong>Among 1081 patients with HF (median age 66 years [IQR 56-76]; 50.8% women), 626 (57.9%) received an SGLT2i. Utilization uptake increased over time but was lower in HF with preserved versus reduced ejection fraction (adjusted odds ratio [aOR] 0.30; 95% CI 0.20-0.43). Diabetes mellitus (aOR 2.29; 95% CI 1.60-3.29) and greater baseline guideline-directed medical therapy optimization (aOR per additional class 1.31; 95% CI 1.13-1.51) were independently associated with use, whereas advanced chronic kidney disease (eGFR < 30 ml/min/1.73 m²) was associated with lower prescribing (aOR 0.26; 95% CI 0.15-0.44). Exploratory analyses suggested lower rates of HF hospitalization and all-cause mortality among SGLT2i users; however, these findings are associative and should be interpreted cautiously.</p><p><strong>Conclusions: </strong>In this real-world cohort, SGLT2i use was heterogeneous and influenced by HF phenotype, renal function, comorbidity burden, and baseline therapy, highlighting persistent gaps in evidence-based HF care.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"281-299"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249394","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}