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Topic Review
The Electrocardiogram in Reflex Syncope
The baseline electrocardiogram (ECG) is less informative in neurally mediated syncope (NMS) than in arrhythmic syncope. However, some of the ECG patterns present in NMS can have diagnostic and prognostic value in such patients. This work reviews known ECG findings related to the cardioinhibitory reflex, as well as recently studied ECG patterns present in patients with NMS, such as the isolated very low QRS voltage.
  • 933
  • 26 Aug 2021
Topic Review
Heart Failure after Cardiac Surgery
Heart disease requires a surgical approach sometimes. Cardiac-surgery patients develop heart failure associated with ischemia induced during extracorporeal circulation. This complication could be decreased with anesthetic drugs. The cardioprotective effects of halogenated agents are based on pre- and postconditioning (sevoflurane, desflurane, or isoflurane) compared to intravenous hypnotics (propofol). 
  • 933
  • 22 Feb 2022
Topic Review
Traditional and Novel Biomarkers for Coronary Microvascular Dysfunction
Coronary microvascular dysfunction (CMD) is related to a broad variety of clinical scenarios in which cardiac microvasculature is morphologically and functionally affected, and it is associated with impaired responses to vasoactive stimuli. Although the prevalence of CMD involves about half of all patients with chronic coronary syndromes and more than 20% of those with acute coronary syndrome, the diagnosis of CMD is often missed, leading to the underestimation of its clinical importance. The established and validated techniques for the measurement of coronary microvascular function are invasive and expensive. An ideal method to assess endothelial dysfunction should be accurate, non-invasive, cost-effective and accessible. There are varieties of biomarkers available, potentially involved in microvascular disease, but none have been extensively validated in this heterogeneous clinical population. The investigation of potential biomarkers linked to microvascular dysfunction might improve the assessment of the diagnosis, risk stratification, disease progression and therapy response. 
  • 932
  • 26 Apr 2022
Topic Review
Biomarkers of Diagnosis of Acute Cardiorenal Syndrome
An increasing number of patients have suffered from combined heart and kidney dysfunction largely known as cardiorenal syndrome (CRS). A panel of new biomarkers (in plasma and/or urine) and artificial intelligence support systems could aid in the early identification of CRS patients at risk of developing adverse outcomes.
  • 930
  • 03 Jul 2023
Topic Review
Percutaneous Coronary Intervention of Chronic Total Occlusion
Percutaneous coronary intervention of chronic total occlusion (CTO PCI) is a challenging procedure with high complication rates and, as not yet fully understood long-term clinical benefits. Ischemic symptom relief in patients with high ischemic burden is to date the only established clinical indication to undergo CTO PCI, supported by randomized controlled trials.
  • 929
  • 10 Jan 2023
Topic Review
Sympathetic–Vascular Interactions
Sympathetic–vascular interactions means that the sympathetic nervous system plays a pivotal role in the short- and long-term regulation of different cardiovascular functions. In recent decades, increasing evidence has demonstrated that sympathetic neural influences are involved not only in the vasomotor modulation of small resistance arteries but also in the control of large arteries. Sympathetic activity and vascular function, which are key factors in the pathophysiology and prognosis of cardiovascular disease, are linked by a close relationship. Evidence from experimental studies indicates that the sympathetic nervous system is critically influenced, at the central and also at the peripheral level, by the most relevant factors regulating vascular function, namely nitric oxide, reactive oxygen species and endothelin. Additionally, there is evidence of a reciprocal influence between endothelial function and sympathetic mechanisms. 
  • 927
  • 03 Sep 2021
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.
  • 926
  • 03 Nov 2022
Topic Review
Echocardiographic Markers for Arrhythmias and Cardiac Magnetic Resonance
Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. 
  • 925
  • 09 May 2022
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.
  • 925
  • 12 Apr 2023
Topic Review
Segmental Disharmony
In very rare circumstances, individuals can be found in whom, when the atrial chambers are in their expected position, and the cavities of the atrial chambers are in continuity with their morphologically appropriate or inappropriate ventricles, the ventricular topology is incongruent with the connections present.
  • 924
  • 27 May 2022
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.
  • 923
  • 07 Jun 2022
Topic Review
Dual Antiplatelet Therapy after Coronary Stenting
Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 receptor inhibitor, is the cornerstone of post-percutaneous coronary intervention treatment to prevent stent thrombosis and reduce the risk of adverse cardiovascular events.
  • 923
  • 22 Nov 2023
Topic Review
Metabolic Approaches for Treatment of Dilated Cardiomyopathy
In dilated cardiomyopathy (DCM), where the heart muscle becomes stretched and thin, heart failure (HF) occurs, and the cardiomyocytes suffer from an energetic inefficiency caused by an abnormal cardiac metabolism. Although underappreciated as a potential therapeutic target, the optimal metabolic milieu of a failing heart is still largely unknown and subject to debate. Because glucose naturally has a lower P/O ratio (the ATP yield per oxygen atom), the previous studies using this strategy to increase glucose oxidation have produced some intriguing findings. In reality, the vast majority of small-scale pilot trials using trimetazidine, ranolazine, perhexiline, and etomoxir have demonstrated enhanced left ventricular (LV) function and, in some circumstances, myocardial energetics in chronic ischemic and non-ischemic HF with a reduced ejection fraction (EF).
  • 922
  • 26 Jul 2023
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.
  • 919
  • 08 Apr 2022
Topic Review
Monomeric C-Reactive Protein in Atherosclerotic Cardiovascular Disease
C-reactive protein (CRP) is the final product of the interleukin (IL)-1β/IL-6/CRP axis. Its monomeric form can be produced at sites of local inflammation through the dissociation of pentameric CRP and, to some extent, local synthesis. Monomeric CRP (mCRP) has a distinct proinflammatory profile. In vitro and animal-model studies have suggested a role for mCRP in: platelet activation, adhesion, and aggregation; endothelial activation; leukocyte recruitment and polarization; foam-cell formation; and neovascularization. mCRP has been shown to deposit in atherosclerotic plaques and damaged tissues.
  • 918
  • 01 Feb 2023
Topic Review
Strategies Targeting Mitochondrial Metabolism to Improve Cardiac Function
Heart failure (HF) is a condition in which heart function is insufficient to meet the body’s oxygen demand. It is not a specific cardiac disorder but rather a clinical syndrome characterized by increased intracardiac pressure and/ or reduced cardiac output resulting from diverse cardiac abnormalities. Therefore, HF may be the common end stage of numerous cardiovascular diseases, such as coronary artery disease, hypertension, cardiomyopathies, heart valve disease or a combination of these.
  • 918
  • 04 May 2023
Topic Review
Classification and Hemodynamic Definitions of Pulmonary Hypertension
Pulmonary hypertension (PH) refers to a pathologic elevation of the mean pulmonary artery pressure (mPAP) and is associated with increased morbidity and mortality in a wide range of medical conditions. These conditions are classified according to similarities in pathophysiology and management in addition to their invasive hemodynamic profiles. The 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension present the newest clinical classification system and includes significant updates to the hemodynamic definitions. Pulmonary hypertension is now hemodynamically defined as an mPAP > 20 mmHg, reduced from the previous threshold of ≥25 mmHg, due to important insights from both normative and prognostic data. Pulmonary vascular resistance has been extended into the definition of pre-capillary pulmonary hypertension, with an updated threshold of >2 Wood Units (WU), to help differentiate pulmonary vascular disease from other causes of increased mPAP. Exercise pulmonary hypertension has been reintroduced into the hemodynamic definitions and is defined by an mPAP/cardiac output slope of >3 mmHg/L/min between rest and exercise. While these new hemodynamic thresholds will have a significant impact on the diagnosis of pulmonary hypertension, no evidence-based treatments are available for patients with mPAP between 21–24 mmHg and/or PVR between 2–3 WU or with exercise PH. 
  • 918
  • 21 Mar 2024
Topic Review
RhoA Signaling in Immune Cell/Cardiac
One of the key proteins involved in stress-mediated cardiomyocyte signal transduction is a small GTPase RhoA. Importantly, the regulation of RhoA activation is critical for effective immune cell response and is being considered as one of the potential therapeutic targets in many immune-cell-mediated inflammatory diseases.
  • 917
  • 27 Jul 2021
Topic Review
Myocarditis
Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious agents. It can lead to serious short-term and long-term sequalae, such as sudden cardiac death or dilated cardiomyopathy. Due to its heterogenous clinical presentation and disease course, challenging diagnosis and limited evidence for prognostic stratification, myocarditis poses a great challenge to clinicians. As it stands, the pathogenesis and etiology of myocarditis is only partially understood.
  • 916
  • 25 Jun 2023
Topic Review
High-Density Lipoproteins-Based Nanomedicine in Cardiovascular Disease
High-density lipoproteins (HDL) are complex endogenous nanoparticles involved in important functions such as reverse cholesterol transport and immunomodulatory activities, ensuring metabolic homeostasis and vascular health. The ability of HDL to interact with a plethora of immune cells and structural cells places it in the centre of numerous disease pathophysiologies. With a better understanding of the properties of synthetic and reconstituted HDL formulations and an increase in preclinical research, several HDL based nanoformulations have been tested in clinical trials.
  • 913
  • 09 Jun 2023
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