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Topic Review
Oral and Parenteral P2Y12 Inhibitor Antiplatelet Agents
Dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and an inhibitor of the platelet P2Y12 receptor for ADP, remains among the most investigated treatments in cardiovascular medicine. While a substantial amount of research initially stemmed from the observations of late and very late stent thrombosis events in the first-generation drug-eluting stent (DES) era, DAPT has been recently transitioning from a purely stent-related to a more systemic secondary prevention strategy. Oral and parenteral platelet P2Y12 inhibitors are currently available for clinical use. The latter have been shown to be extremely suitable in drug-naïve patients with acute coronary syndrome (ACS), mainly because oral P2Y12 inhibitors are associated with delayed efficacy in patients with STEMI and because pre-treatment with P2Y12 inhibitors is discouraged in NSTE-ACS, and in patients with recent DES implantation and in need of urgent cardiac and non-cardiac surgery. More definitive evidence is needed, however, about optimal switching strategies between parenteral and oral P2Y12 inhibitors and about newer potent subcutaneous agents that are being developed for the pre-hospital setting.
  • 528
  • 12 Apr 2023
Topic Review
Factors Affecting the Lipoprotein(a) Levels
Lipoprotein(a) is a variant of LDL-C, distinguished by the covalent binding of ApoB100 to a unique glycoprotein called apolipoprotein(a) via a disulfide thioester bond.
  • 527
  • 01 Apr 2024
Topic Review
Cost-Effectiveness of Cardiac Magnetic Resonance Imaging
The utilization of cardiac magnetic resonance (CMR) in cardiac imaging became possible with fast acquisition techniques and improved imaging quality, allowing adequate assessment of cardiac function and morphology with a high degree of accuracy and precision. CMR is hailed as the single most important procedure that could revolutionize the standard of care. However, given the relatively long duration of CMR examination, its costs, and multiple limiting patient factors including patient comfort and safety, other diagnostic alternatives with lower cost and shorter turn-around times are typically preferred to attain preliminary information. The cost of CMR is an essential factor for its appropriate utilization and the just allocation of healthcare resources due to cost being a barrier to entry in community settings. In this regard, a cost-effectiveness analysis of CMR can shed light on its diagnostic and prognostic utility.
  • 526
  • 03 Nov 2022
Topic Review
LCZ696 in Patients with Hypertension
Hypertension is a well-known and modifiable risk factor for cardiovascular disease worldwide. However, the management of hypertension remains suboptimal throughout the world. LCZ696 (Sacubitril/valsartan) was approved for the treatment of heart failure. Several randomized control trials showed that LCZ696 achieved the target blood pressure control without significant adverse fffects. This meta-analysis including randomized control trials to precisely determine the effectiveness and safety of LCZ696 for the treatment of high aterial pressure.  
  • 525
  • 09 Jul 2021
Topic Review
Cardiorenal Crosstalk in Patients with Heart Failure
Worsening renal function is associated with poor outcomes in heart failure and often accompanies the initiation and up-titration of guidelines-directed heart failure therapy.
  • 525
  • 29 Jun 2022
Topic Review
Glycocalyx–Sodium Interaction in Vascular Endothelium
The glycocalyx generally covers almost all cellular surfaces, where it participates in mediating cell-surface interactions with the extracellular matrix as well as with intracellular signaling molecules. The endothelial glycocalyx that covers the luminal surface mediates the interactions of endothelial cells with materials flowing in the circulating blood, including blood cells. Cardiovascular diseases (CVD) remain a major cause of morbidity and mortality around the world. The cardiovascular risk factors start by causing endothelial cell dysfunction associated with destruction or irregular maintenance of the glycocalyx, which may culminate into a full-blown cardiovascular disease. The endothelial glycocalyx plays a crucial role in shielding the cell from excessive exposure and absorption of excessive salt, which can potentially cause damage to the endothelial cells and underlying tissues of the blood vessels.
  • 524
  • 26 Jun 2023
Topic Review
Therapy of Cardiac-Atrial-Appendage-Stem-Cells and Pyridoxamine
Myocardial infarction (MI) occurs when the coronary blood supply is interrupted. As a consequence, cardiomyocytes are irreversibly damaged and lost. Unfortunately, current therapies for MI are unable to prevent progression towards heart failure. As the renewal rate of cardiomyocytes is minimal, the optimal treatment should achieve effective cardiac regeneration, possibly with stem cells transplantation. In that context, our research group identified the cardiac atrial appendage stem cells (CASCs) as a new cellular therapy. However, CASCs are transplanted into a hostile environment, with elevated levels of advanced glycation end products (AGEs), which may affect their regenerative potential. In this study, we hypothesize that pyridoxamine (PM), a vitamin B6 derivative, could further enhance the regenerative capacities of CASCs transplanted after MI by reducing AGEs’ formation. Methods and Results: MI was induced in rats by ligation of the left anterior descending artery. Animals were assigned to either no therapy (MI), CASCs transplantation (MI + CASCs), or CASCs transplantation supplemented with PM treatment (MI + CASCs + PM). Four weeks post-surgery, global cardiac function and infarct size were improved upon CASCs transplantation. Interstitial collagen deposition, evaluated on cryosections, was decreased in the MI animals transplanted with CASCs. Contractile properties of resident left ventricular cardiomyocytes were assessed by unloaded cell shortening. CASCs transplantation prevented cardiomyocyte shortening deterioration. Even if PM significantly reduced cardiac levels of AGEs, cardiac outcome was not further improved. Conclusion: Limiting AGEs’ formation with PM during an ischemic injury in vivo did not further enhance the improved cardiac phenotype obtained with CASCs transplantation. Whether AGEs play an important deleterious role in the setting of stem cell therapy after MI warrants further examination. 
  • 524
  • 04 Sep 2021
Topic Review
Renin–Angiotensin–Aldosterone System and Immunomodulation
The renin–angiotensin system (RAS) has long been considered the pinnacle of homeostasis in cardiovascular physiology. Its main function involves regulation of blood pressure, via direct and indirect means, through electrolyte balance, and trophic and vasomotor functions. While historically associated with these basic functions, the role of inflammation in cardiovascular diseases has been more and more described, and a critical role of RAS in inflammation regulation has been suggested.
  • 523
  • 05 Aug 2021
Topic Review
Vasospasm in Fluoropyrimidine-Induced Ischemic Heart Disease
Cardiovascular diseases and cancer are the leading cause of morbidity and mortality globally. Cardiotoxicity from chemotherapeutic agents results in substantial morbidity and mortality in cancer survivors and patients with active cancer. Cardiotoxicity induced by 5-fluorouracil (5-FU) has been well established, yet its incidence, mechanisms, and manifestation remain poorly defined. Ischemia secondary to coronary artery vasospasm is thought to be the most frequent cardiotoxic effect of 5-FU. The available evidence of 5-FU-induced epicardial coronary artery spasm and coronary microvascular dysfunction suggests that endothelial dysfunction or primary vascular smooth muscle dysfunction (an endothelial-independent mechanism) are the possible contributing factors to this form of cardiotoxicity. In patients with 5-FU-related coronary artery vasospasm, termination of chemotherapy and administration of nitrates or calcium channel blockers may improve ischemic symptoms. However, there are variable results after administration of nitrates or calcium channel blockers in patients treated with 5-FU presumed to have myocardial ischemia, suggesting mechanisms other than impaired vasodilatory response. 
  • 523
  • 22 Apr 2022
Topic Review
Myocardium Infarction
Myocardium Infarction (MI) is one of the foremost cardiovascular diseases (CVDs) causing death worldwide, and its case numbers are expected to continuously increase in the coming years. Pharmacological interventions have not been at the forefront in ameliorating MI-related morbidity and mortality. Stem cell-based tissue engineering approaches have been extensively explored for their regenerative potential in the infarcted myocardium. Recent studies on microfluidic devices employing stem cells under laboratory set-up have revealed meticulous events pertaining to the pathophysiology of MI occurring at the infarcted site. This discovery also underpins the appropriate conditions in the niche for differentiating stem cells into mature cardiomyocyte-like cells and leads to engineering of the scaffold via mimicking of native cardiac physiological conditions. However, the mode of stem cell-loaded engineered scaffolds delivered to the site of infarction is still a challenging mission, and yet to be translated to the clinical setting.
  • 523
  • 23 Oct 2021
Topic Review
Fibrinogen and Atherosclerotic Cardiovascular Diseases
Atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease, cerebrovascular disease, and peripheral arterial disease, represent a significant cause of premature death worldwide. Biomarkers, the evaluation of which would allow the detection of ASCVD at the earliest stage of development, are intensively sought. Moreover, from a clinical point of view, a valuable biomarker should also enable the assessment of the patient’s prognosis. It has been known for many years that the concentration of fibrinogen in plasma increases, inter alia, in patients with ASCVD. On the one hand, an increased plasma fibrinogen concentration may be the cause of the development of atherosclerotic lesions (increased risk of atherothrombosis); on the other hand, it may be a biomarker of ASCVD, as it is an acute phase protein. In addition, a number of genetic polymorphisms and post-translational modifications of fibrinogen were demonstrated that may contribute to the risk of ASCVD.
  • 522
  • 14 Feb 2022
Topic Review
Tetrahydrocurcumin-Related Vascular Protection
Tetrahydrocurcumin (THC), one of the major metabolites of Curcumin (CUR), possesses several CUR-like pharmacological effects; however, its mechanisms of action are largely unknown. The effects of THC on angiogenesis in CaSki xenografted mice and the expression of vascular endothelial growth factor (VEGF) are well documented. On the other hand, as an anti-inflammatory and antioxidant compound, THC is involved in enhancing homocysteine-induced mitochondrial remodeling in brain endothelial cells. The experimental evidence regarding the mechanism of mitochondrial dysfunction during cerebral ischemic/reperfusion injury and the therapeutic potential of THC to alleviate mitochondrial cerebral dysmorphic dysfunction patterns is also scrutinized and explored. Overall, the studies on different animal models of disease suggest that THC can be used as a dietary supplement to protect against cardiovascular changes caused by various factors (such as heavy metal overload, oxidative stress, and carcinogenesis). 
  • 520
  • 16 Aug 2022
Topic Review
Therapies for Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world, with an estimated prevalence of 2 to 4%. It is defined as supraventricular tachyarrhythmia with uncoordinated atrial electrical activation, which results in chaotic and irregular activation of atrial pacemaker cells and thus ineffective mechanical contraction of the atrial chambers.
  • 520
  • 11 Jan 2023
Topic Review
Congenital Heart Disease
The use of next-generation sequencing has provided new insights into the causes and mechanisms of congenital heart disease (CHD). Examinations of the whole exome sequence have detected detrimental gene variations modifying single or contiguous nucleotides, which are characterised as pathogenic based on statistical assessments of families and correlations with congenital heart disease, elevated expression during heart development, and reductions in harmful protein-coding mutations in the general population.
  • 520
  • 19 Feb 2024
Topic Review
Human Cardiac Muscle Patches in Cardiac Tissue Engineering
Tissue engineering has paved the way for the development of artificial human cardiac muscle patches (hCMPs) and cardiac tissue analogs, especially for treating Myocardial infarction (MI), often by increasing its regenerative abilities.
  • 519
  • 01 Dec 2022
Topic Review
Extracellular Vesicles in Patients with Atrial Fibrillation
Extracellular vesicles are particles released from cells and delimited by a lipid bilayer. They have been widely studied, including extensive investigation in cardiovascular diseases. The content presented here focuses on their role in atrial fibrillation. 
  • 519
  • 01 Sep 2022
Topic Review
Fatty Acids for Cardiovascular Disorders
Data are discussed regarding the roles of the most relevant fatty acids, such as myristic (C14:0), palmitic (C16:0), stearic (C18:0), palmitoleic (C16:1), oleic (C18:1), linoleic (C18:2), α-linolenic (C18:3, ω-3), γ-linolenic (C18:3, ω-6), arachidonic (C20:4), eicosapentaenoic (C20:5), docosahexaenoic (C22:6), and docosapentaenoic (C22:5) acid. The accumulated knowledge has expanded the understanding of the involvement of fatty acids in metabolic processes, thereby enabling the transition from basic exploratory studies to practical issues of application of these biomolecules to CVD treatment. In the future, these findings are expected to facilitate the interpretation and prognosis of changes in metabolic lipid aberrations in CVD.
  • 517
  • 31 Aug 2020
Topic Review
Congenital Heart Defects in Newborns
Congenital heart disease is a group of pathologies characterized by structural malformations of the heart or great vessels. These alterations occur during the embryonic period and are the most frequently observed severe congenital malformations, the main cause of neonatal mortality due to malformation, and the second most frequent congenital malformations overall after malformations of the central nervous system. The severity of different types of congenital heart disease varies depending on the combination of associated anatomical defects. The causes of these malformations are usually considered multifactorial, but genetic variants play a key role. Currently, use of high-throughput genetic technologies allows identification of pathogenic aneuploidies, deletions/duplications of large segments, as well as rare single nucleotide variants. The high incidence of congenital heart disease as well as the associated complications makes it necessary to establish a diagnosis as early as possible to adopt the most appropriate measures in a personalized approach. In this review, we provide an exhaustive update of the genetic bases of the most frequent congenital heart diseases as well as other syndromes associated with congenital heart defects, and how genetic data can be translated to clinical practice in a personalized approach. 
  • 517
  • 28 Jun 2021
Topic Review
Telemedicine in Cardiovascular Diseases
Telehealth and telemedicine, if properly used, may offer advantages for both patients and health professionals. As per the World Health Organization (WHO), telemedicine can be defined as “the delivery of medical services, where distance is a basic factor, by all medical care experts utilizing information and communication technologies (ICT) for the exchanging of adequate information for the treatment, diagnosis and avoidance of illness and wounds, exploration and assessment, and for the proceeding with instruction of medical care suppliers, in the purpose of strengthening individuals health and their networks”. Telemedicine includes the protected transmission of clinical information and data, by voice, text, images, or other forms required for the diagnosis, treatment, and patient follow up.
  • 517
  • 02 Aug 2021
Topic Review
Chronic Thoracic Aortic Dissection
Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. 
  • 516
  • 31 Oct 2022
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