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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. 
  • 975
  • 05 May 2021
Topic Review
Endocarditis
Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate.
  • 974
  • 02 Feb 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.
  • 974
  • 27 Jul 2023
Topic Review
Cardiac Implantable Electronic Device Infection
Infection is the most feared complication in patients with cardiac implantable electronic devices (CIED), with an incidence of 1–3% during the lifetime and a mortality rate of up to 27.5% at three years. Different strategies have been proposed to prevent infections. Strategies of proven efficacy include appropriate procedure timing, management of antithrombotic therapy, patient preparation, surgical technique, and adequate wound care. However, the most important defense against CIED infection (and the most studied in more than 40 years of clinical trials) is systemic antibiotic prophylaxis. In short, preoperative administration of antibiotics is clearly beneficial and represents the standard of care for all patients, recommended by international consensus, mostly with drugs covering Staphylococcus aureus species, such as beta-lactams or glycopeptides.
  • 973
  • 24 Nov 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.
  • 973
  • 20 Dec 2022
Topic Review
Thrombocytopenia and impaired platelet function
Thrombocytopenia and impaired platelet function are known as intrinsic drawbacks of cardiac surgery and extracorporeal life supports (ECLS). A number of different factors influence platelet count and function including the inflammatory response to a cardiopulmonary bypass (CPB) or to ECLS, hemodilution, hypothermia, mechanical damage and preoperative treatment with platelet-inhibiting agents. Moreover, although underestimated, heparin-induced thrombocytopenia is still a hiccup in the perioperative management of cardiac surgical and, above all, ECLS patients. Moreover, recent investigations have highlighted how platelet disorders also affect patients undergoing biological prosthesis implantation. Though many hypotheses have been suggested, the mechanism underlying thrombocytopenia and platelet disorders is still to be cleared. This narrative review aims to offer clinicians a summary of their major causes in the cardiac surgery setting. 
  • 972
  • 08 Mar 2021
Topic Review
Micro-CT in Pulmonary Diseases Diagnosis
Micro-computed tomography (micro-CT) is a promising novel medical imaging modality that allows for non-destructive volumetric imaging of surgical tissue specimens at high spatial resolution. 
  • 969
  • 02 Nov 2022
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.
  • 964
  • 18 May 2023
Topic Review
Cardiac Computed Tomography Radiomics
Radiomics, via the extraction of quantitative information from conventional radiologic images, can identify imperceptible imaging biomarkers that can advance the characterization of coronary plaques and the surrounding adipose tissue. Such an approach can unravel the underlying pathophysiology of atherosclerosis which has the potential to aid diagnostic, prognostic and, therapeutic decision making. Several studies have demonstrated that radiomic analysis can characterize coronary atherosclerotic plaques with a level of accuracy comparable, if not superior, to current conventional qualitative and quantitative image analysis. While there are many milestones still to be reached before radiomics can be integrated into current clinical practice, such techniques hold great promise for improving the imaging phenotyping of coronary artery disease.
  • 963
  • 22 Sep 2021
Topic Review
Angina in 2022
Cardiovascular disease is the leading cause of death worldwide and ischemic heart disease is responsible for approximately half of these deaths. Angina is the main symptom of ischemic heart disease; mirroring a mismatch between oxygen supply and demand.
  • 961
  • 30 Nov 2022
Topic Review
Fractalkine in Cardiovascular Disease
Fractalkine (FKN, CX3CL1) is a unique chemokine, present as a transmembrane protein on the endothelium, or following cleavage as a soluble ligand, attracting leukocyte subsets expressing the corresponding receptor CX3CR1.  Fractalkine receptor CX3CR1 is associated with microvascular obstruction (MVO) in patients undergoing primary PCI. Moreover, inhibition of CX3CR1 with an allosteric small molecule antagonist (KAND567) in the rat MI model reduces acute infarct size, inflammation, and intramyocardial haemorrhage (IMH). 
  • 960
  • 03 Aug 2023
Topic Review
Collagen fibers in Mitral Valve
Collagen fibers are essential structural components of mitral valve leaflets, their tension apparatus (chordae tendineae), and the associated papillary muscles. Excess or lack of collagen fibers in the extracellular matrix (ECM) in any of these structures can adversely affect mitral valve function. The organization of collagen fibers provides a sophisticated framework that allows for unidirectional blood flow during the precise opening and closing of this vital heart valve. Although numerous ECM molecules are essential for the differentiation, growth, and homeostasis of the mitral valve (e.g., elastic fibers, glycoproteins, and glycans), collagen fibers are key to mitral valve integrity. Besides the inert structural components of the tissues, collagen fibers are dynamic structures that drive outside-to-inside cell signaling, which informs valvular interstitial cells (VICs) present within the tissue environment.
  • 958
  • 01 Sep 2021
Topic Review
Biomarkers in Pulmonary Arterial Hypertension
Pulmonary arterial hypertension (PAH) is a severe medical condition characterized by elevated pulmonary vascular resistance (PVR), right ventricular (RV) failure, and death in the absence of appropriate treatment. The progression and prognosis are strictly related to the etiology, biochemical parameters, and treatment response. The gold-standard test remains right-sided heart catheterization, but dynamic monitoring of systolic pressure in the pulmonary artery is performed using echocardiography. 
  • 957
  • 14 Dec 2022
Topic Review
COVID-19 Pandemic for Cardiovascular Diseases in Italy
Coronavirus disease 2019 (COVID-19) has been responsible for an epidemic of devastating proportion, and it has represented a challenge for worldwide healthcare systems with the need of resources reallocation in order to face epidemic spread. Italy was one of the hardest hit countries by COVID-19, and the Italian government adopted strict rules to contain the spread of the COVID-19 pandemic, such as national lockdown and home quarantine; moreover, the Italian healthcare system had to rapidly re-organize the diagnostic and therapeutic pathways, with a reallocation of health resources and hospital beds, in order to manage COVID-19 patients. 
  • 957
  • 13 Jan 2023
Topic Review
Echocardiography in Pulmonary Arterial Hypertension
Pulmonary arterial hypertension (PAH) is a rare, progressive disease with a poor prognosis. The pathophysiologic model is mainly characterized by an afterload mismatch in which an increased right ventricle afterload, driven by increased pulmonary vascular resistance (PVR), leads to right heart failure. International guidelines recommend optimization of treatment based on regular risk assessments to achieve or maintain a low-risk status. Current risk scores are based on a multi-modality approach, including demographic, clinical, functional, exercise, laboratory, and hemodynamic parameters, which lack significant echocardiographic parameters. The originality of echocardiography relies on the opportunity to assess in a non-invasive way a physiologically meaningful combination of easy to measure variables tightly related to right ventricle adaptation/maladaptation to increased afterload, the main determinant of a patient’s prognosis. Echo-derived morphological and functional parameters have been investigated in PAH, proving to have prognostic relevance. Different therapeutic strategies proved to have different effects in reducing PVR. An upfront combination of drugs, including a parenteral prostacyclin, has shown to be associated with right heart reverse remodeling in a greater proportion of patients than other treatment strategies as a function of PVR reduction. Adding echocardiographic data to current risk scores would allow better identification of right ventricle (RV)  adaptation in PAH patients' follow-up. This additional information would allow better stratification of the patient, leading to optimized and personalized therapeutic management.
  • 956
  • 18 Feb 2021
Topic Review
Fatty Acid Binding Protein 3 in Cardiovascular Diseases
Fatty acid binding proteins (FABPs) are proteins found in the cytosol that contribute to disorders related to the cardiovascular system, including atherosclerosis and metabolic syndrome. Functionally, FABPs serve as intracellular lipid chaperones, interacting with hydrophobic ligands and mediating their transportation to sites of lipid metabolism.
  • 953
  • 14 Oct 2022
Topic Review
Fabry Disease
Fabry disease (FD) is a lysosomal storage disorder, depending on defects in alpha-galactosidase A (GAL) activity. At the clinical level, FD shows a high phenotype variability. Cardiovascular dysfunction is often recurrent or, in some cases, is the sole symptom (cardiac variant) representing the leading cause of death in Fabry patients. Cardiac dysfunction is dependent on globotriaosylceramide (Gb3) accumulation in the heart but several other mechanisms are involved, such as inflammation and mitochondrial dysfunction, that could become useful targets for therapeutics.
  • 952
  • 22 Sep 2021
Topic Review
MicroRNAs in Valvular Heart Diseases
microRNAs (miRNAs) have been documented to be regulators of valvular diseases pathogenesis, diagnostic biomarkers, and therapeutical targets. They in fact play stimulatory or inhibitory roles in mitral valve prolapse development, aortic leaflet fusion, and calcification pathways. Tissue expression assessment and comparison between physiological and pathological phenotypes of different disease entities, including mitral valve prolapse and mitral chordae tendineae rupture, emerged as the best strategies to address miRNAs over or under-representation and thus, their impact on pathogeneses. miRNAs can also be targeted by several molecules. Inhibitors such as antisense oligonucleotides and sponge vectors are under investigation. Furthermore, to increase miRNAs activity miRNA mimics, miRNA expression vectors, and small molecules have been developed.
  • 951
  • 23 Nov 2021
Topic Review
The Popeye Domain Containing Gene Family
The Popeye domain containing (POPDC) genes encode a novel class of  3',5'-cyclic adenosine monophosphate (cAMP) effector proteins, which are localized to the plasma membrane. Mutations of POPDC genes have been associated with cardiac and skeletal muscle disease. However POPDC genes also play a role as tumor suppressor by interacting with proteins involved in cell migration, cell signaling and cell cycle control.
  • 951
  • 08 Dec 2021
Topic Review
Gut Microbiota Interacts with HFpEF
Heart failure with preserved ejection fraction (HFpEF) is a disease for which there is no definite and effective treatment, and the number of patients is more than 50% of heart failure (HF) patients. Gut microbiota (GMB) is a general term for a group of microbiota living in humans’ intestinal tracts, which has been proved to be related to cardiovascular diseases, including HFpEF. In HFpEF patients, the composition of GMB is significantly changed, and there has been a tendency toward dysbacteriosis. Metabolites of GMB, such as trimethylamine N-oxide (TMAO), short-chain fatty acids (SCFAs) and bile acids (BAs) mediate various pathophysiological mechanisms of HFpEF. GMB is a crucial influential factor in inflammation, which is considered to be one of the main causes of HFpEF. The role of GMB in its important comorbidity—metabolic syndrome—also mediates HFpEF. Moreover, HF would aggravate intestinal barrier impairment and microbial translocation, further promoting the disease progression. In view of these mechanisms, drugs targeting GMB may be one of the effective ways to treat HFpEF. 
  • 951
  • 20 Feb 2023
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