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Topic Review
Long-Term Proton Pump Inhibitor Use on Cardiovascular Health
Proton pump inhibitors (PPIs) are one of the most prescribed classes of drugs worldwide as a first-line treatment of acid-related disorders. Although adverse effects are rare and rapidly reversible after a short exposure, concerns have been recently raised about a greater toxicity on cardiovascular health after a longer exposure, especially when combined with clopidogrel. Besides, the availability of over-the-counter PPIs and a potential rebound acid hypersecretion after stopping PPI therapy would have led to a significant amount of off-label PPI use, with up to 65% of prescriptions having no appropriate indication, and a global cost exceeding $25 billion per year in the United States.
  • 503
  • 20 Jul 2022
Topic Review
IR and Atherosclerosis in T2DM with CAD
Type 2 diabetes mellitus (T2DM) is characterized by impaired insulin secretion on a background of insulin resistance (IR). IR and T2DM are associated with atherosclerotic coronary artery disease (CAD). The mechanisms of IR and atherosclerosis are known to share similar genetic and environmental roots.
  • 503
  • 29 Mar 2023
Topic Review
Diagnostic Evaluation of Pulmonary Hypertension
Pulmonary hypertension (PH) is a disorder involving a heterogeneous group of medical conditions encompassing several cardiopulmonary illnesses.
  • 503
  • 05 Dec 2023
Topic Review
Cardiac Remodeling and Dysfunction in Primary Aldosteronism
Speckle tracking echocardiography is a novel technique to quantify cardiac function and deformation. It has been applied in a series of cardiovascular diseases for the evaluation of early cardiac impairment. Cardiac damage usually occurs earlier in patients with primary aldosteronism than those with primary hypertension, probably because aldosterone hypersecretion is more commonly observed in the former than the latter patients.
  • 502
  • 02 Mar 2022
Topic Review
Alterations in Vascular Chloride Channels and Transporters
Blood pressure is determined by cardiac output and systemic vascular resistance, and mediators that induce vasoconstriction will increase systemic vascular resistance and thus elevate blood pressure. While peripheral vascular resistance reflects a complex interaction of multiple factors, vascular ion channels and transporters play important roles in the regulation of vascular tone by modulating the membrane potential of vascular cells. In vascular smooth muscle cells, chloride ions (Cl−) are a type of anions accumulated by anion exchangers and the anion–proton cotransporter system, and efflux of Cl− through Cl− channels depolarizes the membrane and thereby triggers vasoconstriction. Among these Cl− regulatory pathways, emerging evidence suggests that upregulation of the Ca2+-activated Cl− channel TMEM16A in the vasculature contributes to the increased vascular contractility and elevated blood pressure in hypertension. A robust accumulation of intracellular Cl− in vascular smooth muscle cells through the increased activity of Na+–K+–2Cl− cotransporter 1 (NKCC1) during hypertension has also been reported. Thus, the enhanced activity of both TMEM16A and NKCC1 could act additively and sequentially to increase vascular contractility and hence blood pressure in hypertension.
  • 501
  • 22 Sep 2022
Topic Review
Role of Thyroid Hormone in COVID-19
Tissue hypoxia is one of the main pathophysiologic mechanisms in sepsis and particularly in COVID-19. Microvascular dysfunction, endothelialitis and alterations in red blood cell hemorheology are all implicated in severe COVID-19 hypoxia and multiorgan dysfunction. Tissue hypoxia results in tissue injury and remodeling with re-emergence of fetal programming via hypoxia-inducible factor-1α (HIF-1a)-dependent and -independent pathways. In this context, thyroid hormone (TH), a critical regulator of organ maturation, may be of relevance in preventing fetal-like hypoxia-induced remodeling in COVID-19 sepsis. Acute triiodothyronine (T3) treatment can prevent cardiac remodeling and improve recovery of function in clinical settings of hypoxic injury as acute myocardial infarction and by-pass cardiac surgery. Furthermore, T3 administration prevents tissue hypoxia in experimental sepsis. On the basis of this evidence, the use of T3 treatment was proposed for ICU (Intensive Care Unit) COVID-19 patients (Thy-Support, NCT04348513).
  • 500
  • 08 Jul 2022
Topic Review
Sphingolipids in Cardiovascular Diseases
Cardiovascular diseases (CVDs) are the leading cause of death and illness in Europe and worldwide, responsible for a staggering 47% of deaths in Europe. There has been increasing evidence pointing to bioactive sphingolipids as drivers of CVDs. Among them, most studies place emphasis on the cardiovascular effect of ceramides and sphingosine-1-phosphate (S1P), reporting correlation between their aberrant expression and CVD risk factors. 
  • 500
  • 16 Jan 2023
Topic Review
Triglyceride/High-Density Lipoprotein Cholesterol Ratio in Metabolic Syndrome
Increased plasma triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) levels have been associated with metabolic syndrome (MetS) and cardiovascular disease (CVD), and their ratio, TG/HDL-C, has been proposed as a novel biomarker for predicting the risk of both clinical entities.
  • 500
  • 17 Mar 2023
Topic Review
Cardiomyopathies: An Overview
Cardiomyopathies are a heterogeneous group of pathologies characterized by structural and functional alterations of the heart. 
  • 499
  • 30 Nov 2021
Topic Review
Aspirin Therapy, Cognitive Impairment, and Dementia
Dementia is associated with a greater burden of cardiovascular risk factors. There is a significant vascular contribution to dementia, and aspirin may play a role in targeting this vascular dysregulation via its anti-inflammatory and antiplatelet effects. Aspirin has effects on the primary prevention of cognitive impairment and various subtypes of dementia, as well as its role in cognitive decline in certain subsets of patients, including those with cerebral small vessel disease (CVSD), coronary heart disease (CHD), and gender differences. Overall, the benefits of aspirin in preventing dementia and cognitive decline remain inconclusive. The majority of cohort studies investigating aspirin’s role in preventing cognitive decline or dementia looked promising, but this was not supported in most randomised controlled trials.
  • 499
  • 01 Mar 2023
Topic Review
Genetic Mutations Associated Myocardial Bridges
Myocardial bridging (MB) is a congenital coronary artery anomaly that has limited molecular disease state characterization. Though a large portion of individuals may be asymptomatic, the myocardial ischemia caused by this anomaly can lead to angina, acute coronary syndrome, coronary artery disease, and sudden cardiac death in patients.
  • 499
  • 11 Mar 2024
Topic Review
Total Endovascular Aortic Arch Repair
Aortic arch surgery is one of the most complex procedures in cardiac surgery. The gold-standard therapy for the treatment of aortic arch pathologies (including penetrating ulcers, intramural hematoma, aneurysms and pseudoaneurysms) remains open surgery performed under Cardiopulmonary Bypass (CPB) with hypothermic circulatory arrest and selective cerebral perfusion.
  • 498
  • 18 Mar 2022
Topic Review
Left Ventricle Unloading in VA ECMO
Impressively increasing availability of mechanical circulatory/cardiac support systems (MCSs) worldwide, together with the deepening of the knowledge of critical care medical practitioners, has inevitably led to the discussion about further improvements of intensive care associated to MCS. An appealing topic of the left ventricle (LV) overload related to VA ECMO support endangering myocardial recovery is being widely discussed within the scientific community. Unloading of LV leads to the reduction in LV end-diastolic pressure, reduction in pressure in the left atrium, and decrease in the LV thrombus formation risk. Consequently, better conditions for myocardial recovery, with comfortable filling pressures and a better oxygen delivery/demand ratio, are achieved. The combination of VA ECMO and Impella device, also called ECPELLA, seems to be a promising strategy that may bring the improvement of CS mortality rates.
  • 498
  • 07 Oct 2023
Topic Review
Cardiovascular Nuclear Imaging in Cardiac Amyloidosis
Nuclear imaging is a generic term for several imaging techniques. They all make use of small amounts of radioactive tracers administered to gain information about organs and tissues and represent an additional pillar in the diagnosis of CA. Nuclear imaging is not about functional, but more about structural assessment. While scintigraphy is two-dimensional or planar, positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are three-dimensional.
  • 497
  • 13 May 2022
Topic Review
Antiplatelet for Older Patients with Acute Coronary Syndromes
Patients ≥ 75 years of age account for about one third of hospitalizations for acute coronary syndromes (ACS). Since the European Society of Cardiology guidelines recommend that older ACS patients use the same diagnostic and interventional strategies used by the younger ones, most elderly patients are currently treated invasively. Therefore, an appropriate dual antiplatelet therapy (DAPT) is indicated as part of the secondary prevention strategy to be implemented in such patients. The choice of the composition and duration of DAPT should be tailored on an individual basis, after careful assessment of the thrombotic and bleeding risk of each patient. Advanced age is a main risk factor for bleeding. Data show that in patients of high bleeding risk short DAPT (1 to 3 months) is associated with decreased bleeding complications and similar thrombotic events, as compared to standard 12-month DAPT. Clopidogrel seems the preferable P2Y12 inhibitor, due to a better safety profile than ticagrelor. When the bleeding risk is associated with a high thrombotic risk (a circumstance present in about two thirds of older ACS patients) it is important to tailor the treatment by taking into account the fact that the thrombotic risk is high during the first months after the index event and then wanes gradually over time, whereas the bleeding risk remains constant. 
  • 496
  • 21 Apr 2023
Topic Review
Diagnosis of Heart Failure in Patients after COVID-19
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It can lead to myocardial damage. Heart failure (HF) is a significant global health concern and is characterized as a clinical syndrome with symptoms caused by structural and/or functional abnormalities of the heart, confirmed by elevated natriuretic peptide levels and evidence of pulmonary or systemic congestion. The relationship between COVID-19 and heart failure is complex. SARS-CoV-2 can cause cardiac damage through the activation of pro-inflammatory cytokines. Understanding the interactions between the disease and viruses is crucial for optimal patient care. However, the validity of screening for cardiovascular complications after COVID-19 remains unconfirmed, and individualized diagnosis procedures are necessary based on the patient's clinical symptoms.
  • 496
  • 19 Jun 2023
Topic Review
Redo-TAVR
Within the last two decades, transcatheter aortic valve replacement (TAVR) has transformed the treatment strategy for symptomatic severe aortic stenosis (AS), representing a less invasive alternative to traditional open-chest surgery. With time, advances in device features, imaging planning, and implantation techniques have contributed to an improvement in safety as well as a reduction in procedural complications. This has led to the expansion of TAVR to lower-risk patients, where TAVR has shown favorable outcomes compared to surgical aortic valve replacement (SAVR). As TAVR expands to younger and lower-risk patients with longer life expectancies, the need for reintervention for failing transcatheter heart valves is expected to increase. Redo-TAVR has gained increasing relevance in the lifetime management of AS as one of the treatment strategies available for structural valve dysfunction (SVD).
  • 494
  • 28 Jul 2023
Topic Review
Artificial Intelligence in Identifying Disease States
Echocardiography is an integral part of the diagnosis and management of cardiovascular disease. The use and application of artificial intelligence (AI) is a rapidly expanding field in medicine to improve consistency and reduce interobserver variability. AI can be successfully applied to echocardiography in addressing variance during image acquisition and interpretation. Furthermore, AI and machine learning can aid in the diagnosis and management of cardiovascular disease. In the realm of echocardiography, accurate interpretation is largely dependent on the subjective knowledge of the operator. Echocardiography is burdened by the high dependence on the level of experience of the operator, to a greater extent than other imaging modalities like computed tomography, nuclear imaging, and magnetic resonance imaging. AI technologies offer new opportunities for echocardiography to produce accurate, automated, and more consistent interpretations. 
  • 492
  • 01 Mar 2023
Topic Review
Cardiovascular Disease in T1DM
Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1DM) patients, and cardiovascular risk (CVR) remains high even in T1DM patients with good metabolic control.
  • 491
  • 22 Sep 2021
Topic Review
Roles of MicroRNAs in Veterinary Cardiology
MicroRNAs are promising novel biomarkers for the diagnosis and prognosis of cardiovascular diseases. These molecules are defined as a class of short-sequence non-coding RNAs that influence the expression of numerous genes. Each miRNA is a short sequence of non-coding RNA that influences countless genes’ expression and, thereby, contributes to several physiological pathways and diseases. It has been demonstrated that miRNAs participate in the development of many cardiovascular diseases (CVDs). The growing understanding of cardiac biology contributed to recognising specific abnormal microRNA expression when diseases are present, which makes them potential biomarkers and therapeutical targets.
  • 491
  • 04 Nov 2022
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