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Topic Review Peer Reviewed
COVID-19 and Coronary Heart Disease
Coronary heart disease (CHD) is the leading cause of mortality worldwide. One of the main contributions of mortality and morbidity in CHD patients is acute myocardial infarction (AMI), which is the result of abrupt occlusion of an epicardial coronary artery due to a sudden rupture of atherosclerotic plaque, causing myocardial ischemia. In the initial stage of myocardial ischemia, lack of oxygen and nutrient supply results in biochemical and metabolic changes within the myocardium. Depletion of oxygen switches the aerobic cellular metabolism to anaerobic metabolism and impairs the oxidative phosphorylation pathway eventually leading to cardiomyocyte death. Several studies suggest an interlink between COVID-19 and ischemic heart disease. An increased ACE2 receptor expression in the myocardium may partly contribute to the myocardial injuries that are observed in patients affected by SARS-CoV-2. Furthermore, pre-existing cardiovascular disease, in conjunction with an aggravated inflammatory response which causes an up-regulation in pro-inflammatory cytokines. Moreover, patients with atherosclerosis are observed to be more prone to ischemic attacks when affected by COVID-19, due to hypercoagulation in the blood as well as elevated pro-inflammatory markers.
  • 1.1K
  • 13 Apr 2022
Topic Review
Treatment of Transthyretin Amyloid Cardiomyopathy
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressively debilitating, rare disease associated with high mortality. ATTR-CM occurs when TTR amyloid protein builds up in the myocardium along with different organs, most commonly the peripheral and the autonomic nervous systems. Managing the cardiac complications with standard heart failure medications is difficult due to the challenge to maintain a balance between the high filling pressure associated with restricted ventricular volume and the low cardiac output. To date, tafamidis is the only agent approved for ATTR-CM treatment.
  • 1.1K
  • 06 May 2022
Topic Review
Iron Supplementation in Heart Failure
Iron deficiency is a significant comorbidity of heart failure (HF), defined as the inability of the myocardium to provide sufficient blood flow. However, iron deficiency remains insufficiently detected. Iron-deficiency anemia, defined as a decrease in hemoglobin caused by iron deficiency, is a late consequence of iron deficiency, and the symptoms of iron deficiency, which are not specific, are often confused with those of HF or comorbidities. HF patients with iron deficiency are often rehospitalized and present reduced survival. The correction of iron deficiency in HF patients is associated with improved functional capacity, quality of life, and rehospitalization rates. Because of the inflammation associated with chronic HF, which complicates the picture of nutritional deficiency, only the parenteral route can bypass the tissue sequestration of iron and the inhibition of intestinal iron absorption. Given the negative impact of iron deficiency on HF progression, the frequency and financial implications of rehospitalizations due to decompensation episodes, and the efficacy of this supplementation, screening for this frequent comorbidity should be part of routine testing in all HF patients.
  • 1.1K
  • 18 Aug 2022
Topic Review
Cardiovascular Morbidities in Adults Born Preterm
Advances in perinatal and neonatal care have led to improved survival of preterm infants into adulthood. However, the shift in focus to long-term health in adults born preterm requires a clear understanding of the impact of prematurity on developing organ systems and the development of adult-oriented disease. A less well-recognized area of risk for surviving preterm infants is their cardiometabolic health. Epidemiologic evidence has linked preterm birth to the development of systemic hypertension, type 2 diabetes, metabolic syndrome, heart failure, and ischemic heart disease. Of more significant concern is that the risk of cardiometabolic disorders is higher in adults born preterm compared to full-term infants. 
  • 1.1K
  • 20 Dec 2022
Topic Review
Ultrathin-Strut Stents
Studies have shown a lower risk of very late stent thrombosis with developing second-generation DESs with biocompatible and biodegradable polymers or without polymers altogether. In addition, research has indicated that thinner struts are associated with a reduced risk of intrastent restenosis and angiographic and clinical results. A drug-eluting stents (DES) with ultrathin struts (strut thickness of 70 µm) is more flexible, facilitates better tracking, and is more crossable than a conventional second-generation DES. The question is whether ultrathin eluting drug stents suit all kinds of lesions. 
  • 1.1K
  • 15 May 2023
Topic Review
Pulmonary Artery Banding for Dilated Cardiomyopathy in Children
Current treatment paradigms for end-stage dilated cardiomyopathy (DCM) in children include heart transplantation and mechanical support devices. However, waitlist mortality, shortage of smaller donors, time-limited durability of grafts, and thrombo-hemorrhagic events affect long-term outcomes. Moreover, both these options are noncurative and cannot preserve the native heart function. Pulmonary artery banding (PAB) has been reinvented as a possible “regenerative surgery” to retrain the decompensated left ventricle in children with DCM. The rationale is to promote positive ventricular–ventricular interactions that result in recovery of left ventricular function in one out of two children, allowing transplantation delisting.
  • 1.1K
  • 27 Sep 2022
Topic Review
Cardiac-Targeting Peptide
Despite significant strides in prevention, diagnosis, and treatment, cardiovascular diseases remain the number one cause of mortality in the United States, with rates climbing at an alarming rate in the developing world. Targeted delivery of therapeutics to the heart has been a lofty goal to achieve with strategies ranging from direct intra-cardiac or intra-pericardial delivery, intra-coronary infusion, to adenoviral, lentiviral, and adeno-associated viral vectors which have preference, if not complete cardio-selectivity, for cardiac tissue. Cell-penetrating peptides (CPP) are 5–30-amino-acid-long peptides that are able to breach cell membrane barriers while carrying cargoes up to several times their size, in an intact functional form. Identified nearly three decades ago, the first of these CPPs came from the HIV coat protein transactivator of transcription. Although a highly efficient CPP, its clinical utility is limited by its robust ability to cross any cell membrane barrier, including crossing the blood–brain barrier and transducing neuronal tissue non-specifically.
  • 1.1K
  • 01 Dec 2023
Topic Review
Transcription Control of Liver Development
During liver organogenesis, cellular transcriptional profiles are constantly reshaped by the action of hepatic transcriptional regulators, including FoxA1-3, GATA4/6, HNF1α/β, HNF4α, HNF6, OC-2, C/EBPα/β, Hex, and Prox1. These factors are crucial for the activation of hepatic genes. The initial opening of highly condensed chromatin is executed by a special class of transcription factors known as pioneer factors. This is followed by the progressive recruitment of chromatin modifiers and the stable or transient binding of other transcription factors, which lead to the gradual deposition of activating histone modifications and the broadening of active chromatin domains. The resulting permissive chromatin state facilitates the assembly of the pre-initiation complex (PIC) and promotes transcriptional initiation.
  • 1.1K
  • 27 Aug 2021
Topic Review
Non-Calcified Coronary Artery Plaque on Coronary CT Angiogram
Coronary artery disease (CAD) is associated with increased mortality and morbidity and remains a great healthcare concern. Early detection of coronary artery plaque before its progression to calcification can allow early interventions towards regression. This will eventually translate into a lower incidence of future cardiovascular (CV) events. Dedicated and focused outcome-based research is highly indicated in this area to assess if there is utility of coronary computed tomography angiography (CCTA) in symptomatic and asymptomatic patients with zero or minimum coronary artery calcium score of zero (CACS). CCTA can be performed with minimal possible radiation exposure.
  • 1.1K
  • 16 Oct 2023
Topic Review
Heart Disease and Metabolic Steatosis
The liver-heart axis is a growing field of interest owing to rising evidence of complex bidirectional interplay between the two organs. Recent data suggest non-alcoholic fatty liver disease (NAFLD) has a significant, independent association with a wide spectrum of structural and functional cardiac diseases, and seems to worsen cardiovascular disease (CVD) prognosis.
  • 1.1K
  • 28 Apr 2021
Topic Review
Feasibility of Catheter Ablation of Atypical Atrial Flutters
Atypical atrial flutters (AAFL) are difficult-to-manage atrial arrhythmias, yet potentially amenable to effective radiofrequency catheter ablation (CA). However, data on CA feasibility are only sparingly reported in the literature in different clinical settings, such as AAFL related to surgical correction of congenital heart disease.
  • 1.1K
  • 02 Sep 2022
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.
  • 1.0K
  • 23 Sep 2021
Topic Review
Advanced Monitoring Technologies
Heart failure (HF) is characterized by a progressive course of disease accompanied by recurrent exacerbations leading to high hospitalization and rehospitalization rates, which account for a substantial part of the disease load. Among the elderly, acute decompensated heart failure (ADHF) is the leading cause of hospitalization. The 30-day rehospitalization rate following the first admission to the hospital for HF exacerbation is 22–29.4%, which is the most common amongst all other etiologies.
  • 1.0K
  • 29 Oct 2021
Topic Review
Haemoptysis
Pulmonary arterial hypertension (PAH) is a rare, heterogeneous disease of the pulmonary vasculature, haemodynamically defined by a mean pulmonary arterial pressure (mPAP) >20 mmHg, a normal pulmonary artery wedge pressure ≤15 mmHg and elevated pulmonary vascular resistance ≥3 Wood units. Congenital heart disease (CHD) is frequently complicated by PAH, including four individual groups with shared features; Eisenmenger syndrome (ES), congenital systemic to pulmonary shunts, PAH associated with coincidental or small defects, and PAH encountered in patients with repaired congenital defects. Spontaneous bleeding events are common in PAH-CHD and usually minor and self-limiting (e.g., dental bleeding, epistaxis, easy bruising, menorrhagia). Haemoptysis is one of the most perilous major bleeding manifestations in the clinical course of PAH-CHD and can be life-threatening. 
  • 1.0K
  • 18 Feb 2022
Topic Review
Antiplatelet for Older Patients with Acute Coronary Syndromes
Patients ≥ 75 years of age account for about one third of hospitalizations for acute coronary syndromes (ACS). Since the European Society of Cardiology guidelines recommend that older ACS patients use the same diagnostic and interventional strategies used by the younger ones, most elderly patients are currently treated invasively. Therefore, an appropriate dual antiplatelet therapy (DAPT) is indicated as part of the secondary prevention strategy to be implemented in such patients. The choice of the composition and duration of DAPT should be tailored on an individual basis, after careful assessment of the thrombotic and bleeding risk of each patient. Advanced age is a main risk factor for bleeding. Data show that in patients of high bleeding risk short DAPT (1 to 3 months) is associated with decreased bleeding complications and similar thrombotic events, as compared to standard 12-month DAPT. Clopidogrel seems the preferable P2Y12 inhibitor, due to a better safety profile than ticagrelor. When the bleeding risk is associated with a high thrombotic risk (a circumstance present in about two thirds of older ACS patients) it is important to tailor the treatment by taking into account the fact that the thrombotic risk is high during the first months after the index event and then wanes gradually over time, whereas the bleeding risk remains constant. 
  • 1.0K
  • 21 Apr 2023
Topic Review
Osteopontin in Pulmonary Hypertension
Pulmonary hypertension (PH) is a pathological condition with multifactorial etiology, which is characterized by elevated pulmonary arterial pressure and pulmonary vascular remodeling. Accumulating clinical evidence suggests that circulating osteopontin may serve as a biomarker of PH progression, severity, and prognosis, as well as an indicator of maladaptive right ventricular remodeling and dysfunction. Osteopontin modulates a plethora of cellular processes within the pulmonary vasculature, including cell proliferation, migration, apoptosis, extracellular matrix synthesis, and inflammation via binding to various receptors such as integrins and CD44.
  • 1.0K
  • 18 May 2023
Topic Review
Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction
“Post-acute sequelae of SARS-CoV-2 infection” (PASC), otherwise referred to as “long COVID” or “long-haul COVID”, refers to persistent and prolonged effects after acute COVID-19 and describes the persistence of symptoms or development of sequelae beyond 3 weeks from the onset of acute symptoms of SARS-CoV-2 infection. Symptoms commonly experienced by PASC patients include fatigue, palpitations, chest pain, dyspnea, reduced exercise tolerance, and “brain fog”. Additionally, symptoms of orthostatic intolerance and syncope suggest the involvement of the autonomic nervous system.
  • 1.0K
  • 15 Feb 2022
Topic Review
Marathon-Induced Cardiac Fatigue
There is a clear impact of marathon on skeletal muscle and myocardium structure. 
  • 1.0K
  • 02 Sep 2021
Topic Review
Cardiopulmonary Exercise Testing in Hypertrophic Cardiomyopathy
In contrast to standard exercise testing and stress echoes, which are limited due to the ECG changes and wall motion abnormalities that characterize this condition, CPET allows for the assessment of the complex pathophysiology and severity of the disease, its mechanisms of functional limitation, and its risk stratification. It is useful tool to evaluate the risk for sudden cardiac death and select patients for cardiac resynchronization therapy (CRT), cardiac transplantation, or mechanical circulatory support, especially when symptomatology and functional status are uncertain. It may help in differentiating HCM from other forms of cardiac hypertrophy, such as athletes’ heart. Finally, it is used to guide and monitor therapy as well as for exercise prescription. It may be considered every 2 years in clinically stable patients or every year in patients with worsening symptoms. Although performed only in specialized centers, CPET combined with echocardiography (i.e., CPET imaging) and invasive CPET are more informative and provide a better assessment of cardiac functional status, left ventricular outflow tract obstruction, and diastolic dysfunction during exercise in patients with HCM.
  • 1.0K
  • 27 Jul 2023
Topic Review
Pulmonary Atresia with Ventricular Septal Defect
Pulmonary atresia with ventricular septal defect (PA/VSD) is the extreme form of Fallot's tetralogy in which pulmonary blood flow is ensured from systemic blood flow sources. In the presence of Major Aorto-Pulmonary Collateral Arteries (MAPCAs), the disease assumes the greatest complexity due to the variable pulmonary perfusion patterns, of which MAPCAs are an important, although not the only source. True pulmonary arteries may have varying degrees of hypoplasia, be absent and, more rarely, discontinuous, with unilateral pulmonary perfusion provided by the arterial duct and contralateral by MAPCAs. The variability of the pulmonary perfusion pattern is a determining factor in the complexity of patients with PA/VSD/MAPCAs and the consequent diversity of their surgical management.
  • 1.0K
  • 12 Apr 2022
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