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Topic Review
Environment, Gut Microbiota, and CAD
Gut microbiota has been shown to affect the cardiovascular system through different mechanisms, representing a potentially modifiable risk factor for atherosclerosis. This opens new perspectives on therapeutic and preventive strategies for coronary artery disease (CAD). Gut microbiota strongly varies depending on several environmental and lifestyle factors, such as pollution and diet, and maintains a symbiotic relationship with the gut mucosa, with substantial metabolic, immunological, and gut protective functions in the healthy individual.
  • 923
  • 23 Jun 2021
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.
  • 923
  • 27 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.
  • 923
  • 12 Apr 2023
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.
  • 918
  • 07 Jun 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. 
  • 917
  • 09 May 2022
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).
  • 917
  • 26 Jul 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. 
  • 915
  • 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.
  • 915
  • 03 Nov 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.
  • 915
  • 03 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.
  • 913
  • 08 Apr 2022
Topic Review
Management of Postoperative Chylothorax after Paediatric Cardiac Surgery
Chylothorax refers to the accumulation of lymphatic fluid in the pleural space. Its presence in the neonatal and pediatric population has been associated with numerous conditions, mainly chest trauma, thoracic surgery, extracorporeal membrane oxygenation and primary or metastatic malignancy, particularly lymphoma.
  • 910
  • 12 May 2022
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.
  • 910
  • 04 May 2023
Topic Review
Endothelial Dysfunction Due to Diabetes and/or Insulin Resistance
Endothelial dysfunction is not only involved in the development and progression of cardiovascular disease (CVD), but is also associated with the progression of CKD. In patients with type 2 diabetes, hyperglycemia, insulin resistance, hyperinsulinemia and dyslipidemia induce the development of endothelial dysfunction.
  • 909
  • 13 Jun 2023
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.
  • 909
  • 20 Dec 2022
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.
  • 908
  • 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.
  • 907
  • 25 Jun 2023
Topic Review
β-Blockers in Heart Failure
Cardiac β-receptor dysfunction in HFrEF is characterized by a reduced β1-receptor density and by the uncoupling of β1- and β2-receptors from the membrane G proteins, resulting in their functional desensitization. This mechanism is mediated by increased G protein-coupled receptor kinase 2 activity, resulting in reduced cardiac β-receptor density and reactivity, with consequent reduced cardiac inotropic reserve. In addition, catecholamines themselves are cardiotoxic, contributing to myocardial damage.
  • 904
  • 02 Sep 2021
Topic Review
Mediators Connecting Cardiovascular Disease and Cancer
Cardiovascular (CV) diseases and cancer are two of the most common causes of death worldwide.  The pathophysiological overlap between cancer and CV disease is expressed at different levels, including inflammation, oxidative stress, neuro-hormonal activation, clonal hematopoesis and circulating factors. Traditionally, the interest was to find predictors for CV toxicity associated with antineoplastic treatment and to identify these patients in whom chemotherapy would represent a heavy burden. The relationship between cancer and CV diseases is no longer unidirectional. Extracellular vesicles (EVs) could be among the most important biomarkers as they play a decisive role in early identification and determining the CV risk for cancer patients receiving specific treatment for this disease. The preclinical evidence on the bilateral connection between cancer and cardiovascular disease (especially early cardiac changes) through some specific mediators such as EVs  will be discussed here.
  • 904
  • 21 Feb 2023
Topic Review
Constraints in Clinical Cardiology
The integration of genetic and molecular components of a disease produces interacting networks, modules and phenotypes with clinical applications in complex cardiovascular entities. With the holistic principle of systems biology, some of the features of complexity and natural progression of cardiac diseases are approached and explained. Two important interrelated holistic concepts of systems biology are described; the emerging field of personalized medicine and the constraint-based thinking with downward causation. Constraints in cardiovascular diseases embrace three scientific fields related to clinical cardiology: biological and medical constraints; constraints due to limitations of current technology; and constraints of general resources for better medical coverage. Systems healthcare and personalized medicine are connected to the related scientific fields of: ethics and legal status; data integration; taxonomic revisions; policy decisions; and organization of human genomic data. 
  • 902
  • 27 May 2021
Topic Review
G-Proteins in Cardiovascular Diseases
G-proteins are a family of specialized proteins that can bind to nucleotides, i.e., guanosine triphosphate (GTP) and guanosine diphosphate (GDP); thus, they are also known as guanine nucleotide-binding proteins. G-proteins are either composed of a single subunit (monomeric) or multiple subunits (heterotrimeric). G-proteins and their receptors are extensively expressed in the cardiovascular system and are involved in the pathophysiology of cardiovascular diseases. Much of the G-protein signaling is mediated by several signaling effectors, such as adenylyl cyclase (AC), Ras homology (Rho), cell division cycle 42 (cdc42), phospholipase C (PLC), and SRC, which contribute to various diverse cellular processes.
  • 902
  • 10 Jan 2023
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