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Topic Review
Endothelial Ion Channel Therapy-Targets for Pulmonary Arterial Hypertension
Endothelial cells (ECs) form a multifunctional signal-transducing surface that performs diverse tasks depending on its localization in the vessel tree. A diverse variety of ion channels is expressed in the plasma and organelle membranes that control the function of these cells. Pulmonary arterial hypertension (PAH) is a severe disease characterized by vascular remodeling in pulmonary arteries attributable to persistent vasoconstriction, proliferation, inflammation, and in situ thrombosis.  Ion channels play a crucial role in the pathophysiology of the disease and can be carefully considered as new therapeutic targets relevant for PAH.
  • 578
  • 08 Apr 2022
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.
  • 577
  • 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.
  • 576
  • 28 Apr 2021
Topic Review
Percutaneous Mitral Valve Repair
Severe mitral valve regurgitation (MR) carries a significant burden both in prognosis and quality of life of patients, as well as on healthcare systems, with high rates of hospitalization for heart failure. While mitral valve surgery constitutes the first-line treatment option for primary MR in suitable patients, surgical treatment for secondary severe MR remains controversial, with a substantial lack of evidence on a survival benefit. In recent decades, percutaneous mitral valve repair has emerged as an alternative treatment for patients deemed not suitable for surgery. Among several devices under development or evaluation, the MitraClip system is the most widespread and is supported by the strongest evidence. While the role of MitraClip in patients with chronic primary MR who are not deemed suitable for surgery is well established, with consistent data showing improvement in both prognosis and quality of life, MitraClip treatment in secondary MR is a rapidly evolving field. Two recent randomized clinical trials generated apparently controversial results but actually provided an interesting pathophysiologic frame that could help discerning patients who will benefit from the procedure versus patients who will not. In this review, we will discuss current treatment options for mitral regurgitation, focusing on percutaneous mitral valve repair with the MitraClip system.
  • 575
  • 08 Mar 2021
Topic Review
Diagnosis of Pulmonary Embolism during Pregnancy
Many of the symptoms and signs reported in almost 50% of women during physiological pregnancy, such as shortness of breath or lower limb oedema—especially as pregnancy advances through the third trimester—may suggest the possibility of a pulmonary embolism (PE) and/or deep vein thrombosis (DVT).
  • 575
  • 29 Aug 2022
Topic Review
Omega-3 Polyunsaturated Fatty Acids on Cardiovascular Health
High consumption of polyunsaturated fatty acids (PU FAs), specifically omega-3 FAs (Ω3FAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), results in low plasma cholesterol levels and minimal coronary heart disease (CHD). Furthermore, as elevated triglycerides (TGs) appear to be a causal factor for atherosclerotic cardiovascular diseases (CVD)(ASCVD) and possibly for premature all-cause mortality, more so when they are associated with genetic variants, PUFAs can reduce TG levels by decreasing lipoproteins with high amounts of TGs, such as very-low-density lipoproteins, intermediate-density lipoproteins, chylomicrons, and their remnants.
  • 575
  • 20 Dec 2022
Topic Review
Dysuricemia
The importance of uric acid, the final metabolite of purines excreted by the kidneys and intestines, was not previously recognized, except for its role in forming crystals in the joints and causing gout. Uric acid is not a biologically inactive substance and may exert a wide range of effects, including antioxidant, neurostimulatory, proinflammatory, and innate immune activities. 
  • 575
  • 08 Jun 2023
Topic Review
Epigenetic Modifications, Elderly Cardiovascular Disease
The rate of aging has increased globally during recent decades and has led to a rising burden of age-related diseases such as cardiovascular disease (CVD). At the molecular level, epigenetic modifications have been shown recently to alter gene expression during the life course and impair cellular function. In this regard, several CVD risk factors, such as lifestyle and environmental factors, have emerged as key factors in epigenetic modifications within the cardiovascular system.
  • 574
  • 30 Sep 2021
Topic Review
Secretoneurin as a Novel Biomarker of Cardiovascular Episodes
Secretoneurin (SN) is a 33 amino-acid evolutionary conserved neuropeptide from the chromogranin peptide family. SN’s main effects may be cardioprotective and are believed to be mediated through its inhibition of calmodulin-dependent kinase II (CaMKII), which influences intracellular calcium handling. SN inhibition of CaMKII suppresses calcium leakage from the sarcoplasmic reticulum through the ryanodine receptor. This action may reduce the risk of ventricular arrhythmias and calcium-dependent remodelling in heart failure. SN is also involved in reducing the intracellular reactive oxygen species concentration, modulating the immune response, and regulating the cell cycle, including apoptosis. SN can predict mortality in different disease states, beyond the classical risk factors and markers of myocardial injury. Plasma SN levels are elevated soon after an arrhythmogenic episode. In summary, SN is a novel biomarker with potential in cardiovascular medicine, and probably beyond.
  • 573
  • 20 Dec 2022
Topic Review
Transcatheter Tricuspid Valve Interventions
Tricuspid regurgitation (TR) is a common valvular pathology, estimated to affect 1.6 million people in the United States alone. Even though guidelines recommend either medical therapy or surgical treatment for TR, the misconception of TR as a benign disease along with the high mortality rates of surgical intervention led to undertreating this disease and commonly describing it as a “forgotten” valve.
  • 572
  • 07 Jul 2023
Topic Review
History of Automated Electrocardiogram Interpretation
The most recent development in the field of automated electrocardiogram (ECG) analysis has been the use of artificial intelligence (AI), including a variety of machine learning techniques to aid interpretation. One of the authors (PWM) was involved in the use of neural networks in the early 1990s but at that time, use of a simple neural network did not prove to be of any great advantage in ECG interpretation compared to the use of more basic, straightforward diagnostic criteria.  This entry describes the development of automated ECG interpretation since its beginnings in Washington DC around 1960 up until the present.
  • 571
  • 15 Feb 2023
Topic Review
Bilberry Supplementation on Metabolic and Cardiovascular Disease Risk
Bilberry (Vaccinium myrtillus L.) is one of the richest natural sources of anthocyanins which give berries their red/purple/blue coloration. Anthocyanins are powerful antioxidants and are reported to play an important role in the prevention of metabolic disease and CVD as well as cancer and other conditions. 
  • 569
  • 15 Jul 2022
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. 
  • 568
  • 18 Feb 2022
Topic Review
Sudden Unexplained Death
Sudden unexplained death (SUD) is a fatal event that encompasses several heart disorders which lead to abrupt and unpredicted death. Normally, the victim has no known history of heart disease. In adult population (16–64 years) the SUD rate is 11/100,000 per year, while, in the young population (<16 years of age), it is 7.5/100,000. Please note that sudden unexplained death is sometimes used as a synonym of sudden unexpected death but some authors use this term to specifically indicate sudden deaths in which both autopsy and toxicology testing are negative. 
  • 567
  • 05 May 2021
Topic Review
CPET in Patients with HCM
We aim to review and analyze the available data from the literature on the value of Cardiopulmonary Exercise Test (CPET) in HCM. 
  • 567
  • 03 Jun 2021
Topic Review
Vascular Endothelium in Cardiovascular Diseases
The vascular endothelium plays a vital role during embryogenesis and aging and is a cell monolayer that lines the blood vessels. The immune system recognizes the endothelium as its own. Therefore, an abnormality of the endothelium exposes the tissues to the immune system and provokes inflammation and vascular diseases such as atherosclerosis. Its secretory role allows it to release vasoconstrictors and vasorelaxants as well as cardio-modulatory factors that maintain the proper functioning of the circulatory system. The sealing of the monolayer provided by adhesion molecules plays an important role in cardiovascular physiology and pathology.
  • 566
  • 01 Feb 2023
Topic Review
Dystrophin-Deficient Cardiomyopathy
Dystrophin-deficient cardiomyopathy (DDC) is currently the leading cause of death in patients with dystrophinopathies. Targeting myocardial fibrosis (MF) has become a major therapeutic goal in order to prevent the occurrence of DDC. 
  • 565
  • 18 Jan 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.
  • 565
  • 02 Sep 2022
Topic Review
Physical Activity in Polluted Air and Cardiovascular Health
Both exposure to higher levels of polluted air and physical inactivity are crucial risk factors for the development and progression of major noncommunicable diseases and, in particular, of cardiovascular disease. While regular physical activity is well known to improve general health, it may also increase the uptake and deposit of air pollutants in the lungs/airways and circulation, due to increased breathing frequency and minute ventilation, thus increasing the risk of cardiovascular disease.
  • 564
  • 17 Nov 2021
Topic Review
Broad Electrocardiogram Syndromes Spectrum
Electrocardiogram (ECG) still remains a very useful diagnostic method in modern cardiology. Its broad availability, noninvasiveness and good sensitivity explain why it plays a capital role in the very beginning of the process of diagnosis for every patient, with or without cardiac-related complaints. For the practitioner, good training in ECG interpretation is mandatory. Sometimes, the ECG trace reveals particular aspects that may cause confusion and complicate decision-making. Several less common situations underlying the general context and ECG features are presented. The syndromes studied have a high pathological significance and may range from acute emergencies that call for a rapid therapeutical response to chronic syndromes that require prolonged observation, monitoring and risk stratification.
  • 564
  • 30 Dec 2022
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