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Topic Review
Mechanism of Action and Effects of Sodium-Glucose Cotransporter
Heart failure (HF) is an extremely complex, multifactorial, progressive clinical condition, characterized by cardiac function impairment secondary to a structural and/or functional heart abnormality. Sodium-glucose cotransporter (SGLT2i) was the first class of glucose-lowering drugs able to reduce cardiovascular events in diabetic and non-diabetic patients with HF.
  • 675
  • 12 Jan 2023
Topic Review
Biomarkers of Atrial Fibrillation Recurrence
Atrial fibrillation (AF) is associated with atrial remodeling, cardiac dysfunction, and poor clinical outcomes. External direct electrical cardioversion is a well-developed urgent treatment strategy for patients presenting with recent-onset AF.
  • 675
  • 25 May 2023
Topic Review
OSA and Cardiac Arrhythmias
Sleep apnea is a highly prevalent disorder among patients with all forms of cardiovascular disease. Decades of data from several large prospective patient registries have revealed that sleep apnea—in particular, obstructive sleep apnea (OSA)—is practically endemic in cardiology clinics and cardiac inpatient wards across the globe. OSA has been closely associated with prevalent and incident hypertension, ischemic heart disease, heart failure, stroke, and all forms of cardiac rhythm disturbance. Additionally, central sleep apnea (CSA) or combined OSA and CSA often affects patients with heart failure and stroke. Sleep apnea and cardiovascular disease are so intertwined with respect to their epidemiology and shared pathophysiology that one can think of them as being two components of a global, multi-system metabolic syndrome driven largely by obesity.
  • 673
  • 23 Sep 2021
Topic Review
Zebrafish Models of Fibrotic Disease
Zebrafish models of fibrotic disease include, among others, cardiovascular disease models, liver disease models (categorized into Alcoholic Liver Diseases (ALD) and Non-Alcoholic Liver Disease (NALD)), and chronic pancreatitis models.
  • 671
  • 20 Jan 2022
Topic Review
Consanguinity and Congenital Heart Disease Susceptibility
Congenital heart disease (CHD) encompasses a wide range of structural defects of the heart and, in many cases, the factors that predispose an individual to disease are not well understood, highlighting the remarkable complexity of CHD etiology. Evidence of familial aggregation of CHD has been demonstrated in different communities and for different cardiac lesions. Consanguinity, particularly among first cousins, is an added risk factor for these families, particularly in societies where it is considered a common cultural practice, as confirmed in previous studies conducted in Saudi Arabia and other countries.
  • 671
  • 24 Feb 2022
Topic Review
Coronary No-Reflow after Primary Percutaneous Coronary Intervention
Coronary no-reflow (CNR) is a frequent phenomenon that develops in patients with ST-segment elevation myocardial infarction (STEMI) following reperfusion therapy. CNR is highly dynamic, develops gradually (over hours) and persists for days to weeks after reperfusion. Microvascular obstruction (MVO) developing as a consequence of myocardial ischemia, distal embolization and reperfusion-related injury is the main pathophysiological mechanism of CNR. The frequency of CNR or MVO after primary PCI differs widely depending on the sensitivity of the tools used for diagnosis and timing of examination. Coronary angiography is readily available and most convenient to diagnose CNR but it is highly conservative and underestimates the true frequency of CNR. Cardiac magnetic resonance (CMR) imaging is the most sensitive method to diagnose MVO and CNR that provides information on the presence, localization and extent of MVO. CMR imaging detects intramyocardial hemorrhage and accurately estimates the infarct size. MVO and CNR markedly negate the benefits of reperfusion therapy and contribute to poor clinical outcomes including adverse remodeling of left ventricle, worsening or new congestive heart failure and reduced survival.
  • 671
  • 01 Sep 2023
Topic Review
Dysfunctional High-Density Lipoproteins in T2DM
High density lipoproteins (HDLs) are commonly known for their anti‑atherogenic properties that include functions such as the promotion of cholesterol efflux and reverse cholesterol transport, as well as antioxidant and anti‑inflammatory activities. However, because of some chronic inflammatory diseases, such as type 2 diabetes mellitus (T2DM), significant changes occur in HDLs in terms of both structure and composition. These alterations lead to the loss of HDLs’ physiological functions, to transformation into dysfunctional lipoproteins, and to increased risk of cardiovascular disease (CVD).
  • 670
  • 05 Jul 2021
Topic Review
Factor XI/XIa Inhibition in Cardio- and Cerebrovascular Disease
Factor XI (FXI) is one promising target. Existing direct oral anticoagulants (DOACs) have improved treatment options compared to the classic heparins and vitamin K antagonists (VKA), but the bleeding risks associated with their use are substantial enough to expand the focus onto the development of their antidotes. Early indications are that FXI-directed strategies could offer similar protection against thrombotic events as DOACs, but with the added benefit of lower bleeding risk. Furthermore, the spectrum of modalities for FXI inhibition presents a range of options in both types of administration and duration of effect. With the possibility of once- or twice-monthly injections, some FXI-directed agents could also improve treatment compliance compared to current therapies. Altogether, FXIa inhibitors could be a therapeutic option in a broad spectrum of clinical scenarios. 
  • 670
  • 19 Dec 2022
Topic Review
Association between Atrial Fibrillation and Adenosinergic System
Atrial fibrillation (AF) is a multifactorial sustained cardiac arrhythmia, and it is now considered a real worldwide public health issue. Despite the substantial progress that has been made in the detection and management of AF, the underlying molecular mechanisms associated with the onset of atrial fibrillation and its progression remain still unclear. Among these molecular mechanisms, the implication of the adenosinergic system in AF has increased, since the accumulation of experimental data suggests that the increase in the adenosine blood level and the remodeling expression of the adenosine receptors might be part of the AF pathophysiology. Unfortunately, the adenosinergic system still has a Janus face in cardiac arrythmias, since adenosine can have both antiarrhythmic or proarrhythmic actions, along with adenosine receptors, which can lead to either profibrotic or antifibrotic effects.
  • 669
  • 01 Dec 2022
Topic Review
RBM20
The RBM20 gene encodes the muscle-specific splicing factor RNA-binding motif 20, a regulator of heart-specific alternative splicing. Nearly 40 potentially deleterious variants in RBM20 have been reported in the last ten years, being found to be associated with highly arrhythmogenic events in familial dilated cardiomyopathy. Frequently, malignant arrhythmias can be a primary manifestation of disease. The early recognition of arrhythmic genotypes is crucial in avoiding lethal episodes, as it may have an impact on the adoption of personalized preventive measures.
  • 669
  • 29 Mar 2021
Topic Review
Multimodality Imaging in Detection Women's Ischemic Heart Disease
Cardiovascular disease is the leading cause of death and disability, accounting for approximately one in three deaths worldwide. It is the leading cause of death in the United States; coronary artery disease (CAD) and ischemic heart disease (IHD) remain the leading causes of death attributable to cardiovascular disease in men and women. The incidence of atherosclerotic cardiovascular disease is increasing due to an increase in cardiac risk factors such as obesity, diabetes, and hypercholesterolemia in addition to an aging population. However, age-adjusted mortality rates are decreasing, likely due to improved medical therapies allowing patients to live longer with IHD. Although cardiovascular disease is more common in men, women with CAD have a worse short and long-term prognosis. In addition, women with symptoms of angina or who have had an abnormal cardiac stress test are less likely to be referred for additional diagnostic testing and initiated on guideline directed medical therapies.
  • 668
  • 31 Oct 2022
Topic Review
Atrial Fibrillation Pathogenesis
Electrical remodeling lies on impaired calcium handling, enhanced inwardly rectifying potassium currents, and gap junction perturbations. In addition, a wide array of profibrotic stimuli activates fibroblast to an increased extracellular matrix turnover via various intermediaries. Concomitant dysregulation of the autonomic nervous system and the humoral function of increased epicardial adipose tissue (EAT) are established mediators in the pathophysiology of AF. Local atrial lymphomononuclear cells infiltrate and increased inflammasome activity accelerate and perpetuate arrhythmia substrate. Finally, impaired intracellular protein metabolism, excessive oxidative stress, and mitochondrial dysfunction deplete atrial cardiomyocyte ATP and promote arrhythmogenesis. 
  • 666
  • 09 Oct 2021
Topic Review
Consequences of COVID-19
Mitochondria are clustered around the replication sites of several viruses and decrease the supply routes for energy and metabolites, resulting in increased viral progeny viruses. In a viral infection, viruses generate cellular stress, which causes mitochondrial redistribution.
  • 665
  • 19 Aug 2021
Topic Review
Acute Coronary Syndromes and Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) induces a process of systemic inflammation, sharing common ground with acute coronary syndromes (ACS). Growing evidence points towards a possible association between IBD and an increased risk of ACS.
  • 665
  • 15 Dec 2021
Topic Review
Inherited Arrhythmogenic Syndromes
Inherited arrhythmogenic syndromes are the primary cause of unexpected lethal cardiac episodes in young people. It is possible that the first sign of the condition may be sudden death. Inherited arrhythmogenic syndromes are caused by genetic defects that may be analyzed using different technical approaches. A genetic alteration may be used as a marker of risk for families who carry the genetic alterations. Therefore, the early identification of the responsible genetic defect may help the adoption of preventive therapeutic measures focused on reducing the risk of lethal arrhythmias.
  • 664
  • 13 Nov 2020
Topic Review
Endothelial Dysfunction and Arterial Stiffness under Cardiovascular Risk
Pathophysiological conditions such as endothelial dysfunction and arterial stiffness, characterized by low nitric oxide bioavailability, deficient endothelium-dependent vasodilation and heart effort, predispose individuals to atherosclerotic lesions and cardiac events. Nitrate (NO3−), L-arginine, L-citrulline and potassium (K+) can mitigate arterial dysfunction and stiffness by intensifying NO bioavailability. Dietary compounds such as L-arginine, L-citrulline, NO3− and K+ exert vasoactive effects as demonstrated in clinical interventions by noninvasive flow-mediated vasodilation (FMD) and pulse-wave velocity (PWV) prognostic techniques.
  • 664
  • 07 Jun 2023
Topic Review
Small Interfering RNA in Inhibition of PCSK-9
Dyslipidemia is listed among important cardiovascular disease risk factors. Treating lipid disorders is difficult, and achieving desirable levels of LDL-cholesterol (LDL-C) is essential in both the secondary and primary prevention of cardiovascular disease. Statins became the basis of lipid-lowering therapy. Nevertheless, these drugs are often insufficient due to their side effects and restrictive criteria for achieving the recommended LDL-C values. Even the addition of other drugs, i.e., ezetimibe, does not help one achieve the target LDL-C. The discovery of proprotein convertase subtilisin/kexin type 9 (PCSK9) discovery has triggered intensive research on a new class of protein-based drugs. The protein PCSK9 is located mainly in hepatocytes and is involved in the metabolism of LDL-C. In the beginning, antibodies against the PCSK9 protein, such as evolocumab, were invented. The next step was inclisiran. Inclisiran is a small interfering RNA (siRNA) that inhibits the expression of PCSK9 by binding specifically to the mRNA precursor of PCSK9 protein and causing its degradation.
  • 663
  • 02 Feb 2023
Topic Review
Antithrombotic Therapy with Acute Coronary Syndromes
Cardiovascular disease constitutes one of the leading causes of death worldwide. The incidence of acute coronary syndromes (ACS) is especially high in the elderly, who constitute up to one-third of patients. Age also associates with an increased risk of recurrent ischemic events and death. Antithrombotic therapy represents the main component of treatment in the setting of ACS. The focus is on antiplatelet therapy, but balancing the benefit in terms of reducing ischemic events with the bleeding risk is still complicated. In combination with aspirin, oral P2Y12 receptor inhibitors (clopidogrel, prasugrel, and ticagrelor) have been widely implemented as a first-line treatment strategy in patients with ACS and those undergoing percutaneous coronary intervention (PCI). However, the management of ACS in the elderly has turned out to be challenging, since compared with clopidogrel, prasugrel and ticagrelor involve an increased risk of bleeding, potentially offsetting their ischemic clinical benefit among more vulnerable patients.
  • 662
  • 07 Jun 2022
Topic Review Video
Cardiac Power Hemodynamic Measurements in Cardiovascular Conditions
Despite numerous advancements in prevention, diagnosis and treatment, cardiovascular disease has remained the leading cause of mortality globally for the past. Part of the explanation for this trend is persistent difficulty in determining the severity of cardiac conditions in order to allow for the deployment of prompt therapies.  In heart failure (HF) patients showing cardiac power index (CPI) and cardiac power output (CPO) as valuable tools to assess cardiac function in the acute setting; and, additionally, CPO was found to be an essential tool in patients with critical cardiac illness (CCI), as the literature showed that CPO was statistically correlated with mortality. Cardiac power and the derived measures obtained from this relatively easily obtained variable can allow for essential estimations of prognostic outcomes in cardiac patients.
  • 660
  • 07 Dec 2022
Topic Review
Endothelial Cell Metabolism
EC (Endothelial Cell) metabolism is confined to glucose, FAs, and amino acids (AAs), the three major substrates for adenosine triphosphate (ATP) production and biomass production in ECs, which have been widely studied and summarized.
  • 658
  • 01 Feb 2023
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