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Topic Review
Imaging Cardiovascular in Chronic Kidney Disease
Chronic kidney disease (CKD) patients have a higher risk of developing early cardiovascular disease (CVD). Although vascular calcification (VC) is one of the strongest predictors of CVD risk, its diagnosis among the CKD population remains a serious clinical challenge. Imaging methods, henceforward referred to as imaging biomarkers, have played a crucial role in the diagnosis of VC, with important insights into cardiovascular risk. One of the reasons that may explain the struggle for accurate VC diagnosis in CKD patients is that the calcification characteristics change alongside renal deterioration and CKD progression. Novel circulating biomarkers like Fetuin-a, Matrix Gla Protein (MGP) and Gla Rich Protein (GRP), representing a more direct and unique reflection of the molecular dynamics involved in VC mechanisms, could complement VC clinical diagnostic and add value to patient care.
  • 749
  • 30 Dec 2022
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. 
  • 748
  • 04 Sep 2021
Topic Review
Pathophysiology and Mortality with Peripheral Artery Disease
There are a number of devastating complications associated with peripheral artery disease, including limb amputations and acute limb ischemia. In coronary atherosclerosis, thrombosis is often precipitated by rupture or erosion of fibrous caps around atheromatous plaques, which leads to acute coronary syndrome.
  • 746
  • 13 Jun 2023
Topic Review
Management of Metabolic Syndrome
Metabolic syndrome (MS) is a growing disorder affecting thousands of people worldwide, especially in industrialised countries, increasing mortality. Oxidative stress, hyperglycaemia, insulin resistance, inflammation, dysbiosis, abdominal obesity, atherogenic dyslipidaemia and hypertension are important factors linked to MS clusters of different pathologies, such as diabesity, cardiovascular diseases and neurological disorders. All biochemical changes observed in MS, such as dysregulation in the glucose and lipid metabolism, immune response, endothelial cell function and intestinal microbiota, promote pathological bridges between metabolic syndrome, diabesity and cardiovascular and neurodegenerative disorders. 
  • 745
  • 15 Dec 2023
Topic Review
Genetic Predisposition and Inflammatory Inhibitors in COVID-19
Genetic predisposition, as in other inflammatory diseases, might be responsible for alterations in the clinical course of COVID-19 patients through polymorphisms in crucial genes such as ACE2 and MHC class I. Components of the immune response to the virus appear to be primarily related to disease severity, whereas genes related to the binding of the ACE2 cell surface—the entry point for SARS-CoV-2—during the early stages of infection appear to be largely responsible for the varying susceptibility to SARS-CoV-2. Inflammatory inhibitors are at the forefront of pharmacological management in COVID-19, although their potential has not been fully elucidated till now. The above mentioned would have a potentially large impact on targeted medicines and, more critically, vaccine development.
  • 744
  • 17 Feb 2022
Topic Review
The Right Ventricle in COVID-19 Patients
Cardiac involvement has been described during the course of SARS-CoV-2 disease (COVID-19), with different manifestations. Several series have reported only increased cardiac troponin without ventricular dysfunction, others the acute development of left or right ventricular dysfunction, and others myocarditis. 
  • 743
  • 11 May 2022
Topic Review
Cardiovascular Calcification
Cardiac calcifications are generally asymptomatic findings frequently encountered on routine echocardiographic examination or CT scanning. The sites affected most often are the aortic valve (prevalence about 24%) and the mitral annulus (prevalence 8- 15%). The recognition of even small calcium deposits on valves and other cardiac structures is clinically relevant, both as a marker of systemic atherosclerosis and as a predictor of future cardiovascular events. The detection of cardiac calcifications by ultrasound is a promising tool for identifying subclinical atherosclerosis and thus improving risk stratification in asymptomatic subjects.
  • 741
  • 28 Apr 2021
Topic Review
Endothelial Dysfunction in COVID-19
The endothelium is considered a real organ, with its own defined structure capable of guaranteeing vascular homeostasis through several functions.
  • 737
  • 29 Apr 2022
Topic Review
Dipeptidyl Amino-Peptidase 3 (DPP3) in Cardiogenic Shock
Dipeptidyl amino-peptidase 3 (DPP3) is an aminopeptidase that is released into circulation upon cell death. DPP3 is involved in the degradation of angiotensins, enkephalines, and endomorphines. It has been shown that circulating DPP3 (cDPP3) plasma concentration increases in cardiogenic shock (CS) patients and correlates with high mortality risk. Cardiogenic shock is a life-threatening syndrome associated with organ hypoperfusion. One of the common causes of CS is acute myocardial infarction (AMI).
  • 737
  • 10 Nov 2023
Topic Review
Acute Rheumatic Fever and Rheumatic Heart Disease
Group A Streptococcus (GAS) causes superficial and invasive infections and immune mediated post-infectious sequalae (including acute rheumatic fever/rheumatic heart disease). Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are important determinants of global cardiovascular morbidity and mortality. ARF is a multiorgan inflammatory disease that is triggered by GAS infection that activates the innate immune system. In susceptible hosts the response against GAS elicits autoimmune reactions targeting the heart, joints, brain, skin, and subcutaneous tissue. Repeated episodes of ARF—undetected, subclinical, or diagnosed—may progressively lead to RHD, unless prevented by periodic administration of penicillin. The modified Duckett Jones criteria with stratification by population risk remains relevant for the diagnosis of ARF and includes subclinical carditis detected by echocardiography as a major criterion. Chronic RHD is defined by valve regurgitation and/or stenosis that presents with complications such as arrhythmias, systemic embolism, infective endocarditis, pulmonary hypertension, heart failure, and death.
  • 735
  • 07 Jul 2022
Topic Review
Role of Cardiovascular Imaging in Risk Assessment
Cardiovascular imaging is progressively assuming an increasingly pivotal role, playing a crucial part in enhancing the meticulous categorization of individuals according to their risk profiles, thus enabling the customization of precise therapeutic strategies for patients with increased cardiovascular risks. Optimal risk assessment for primary prevention remains highly challenging.
  • 735
  • 30 Aug 2023
Topic Review
Management of Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome with multiple underlying mechanisms and comorbidities that leads to a variety of clinical phenotypes. The identification and characterization of these phenotypes are essential for better understanding the precise pathophysiology of HFpEF, identifying appropriate treatment strategies, and improving patient outcomes.
  • 734
  • 13 Jul 2023
Topic Review
Long Non-Coding Ribonucleic Acids Implicated in Plaque Instability
Long non-coding RNAs (lncRNAs) represent an important class of molecules that are implicated in epigenetic control of numerous cellular processes. Atherosclerotic plaque represents a dynamic environment where the interplay between various cell types, including endothelial cells, immune cells, and VSMCs, governs the plaque phenotype and its vulnerability. The specific roles of nuclear lncRNAs in regulating gene expression and cellular processes associated with plaque instability, providing a comprehensive understanding of their contributions to the pathogenesis of atherosclerosis.
  • 733
  • 26 Jul 2023
Topic Review
Transcatheter Mitral Valve Replacement
The transcatheter mitral valve replacement (TMVR) is performed through the implantation of either an aortic or mitral transcatheter heart valve (THV) in the mitral position. Although not specifically designed for the mitral position, the aortic THV has been successfully employed in patients with failed bioprostheses (mitral valve-in-valve (MViV)), failed prosthetic rings and bands (mitral valve-in-ring (MViR)) and native calcified valves (valve in mitral annular calcification (ViMAC)). On the other hand, newer TMVR devices with mitral THVs have primarily been used for native noncalcified mitral valves. 
  • 732
  • 26 Jul 2023
Topic Review
Coronary Computed Tomography Angiography
The use of coronary computed tomography angiography (CCTA) in the setting of stable coronary artery disease is highly recommended for low-risk patients. High-risk patients, such as symptomatic subjects with prior revascularization, are suggested to be investigated with noninvasive functional tests or invasive coronary angiography.
  • 732
  • 31 Jan 2024
Topic Review
Artery Stenosis and Vasospastic Angina
Vasospastic angina (VA) is caused by focal or diffuse spasm of an epicardial coronary artery, resulting in severe obstruction of the coronary artery lumen and myocardial ischemia. Vasospasm can occur in an angiographically normal coronary artery, but may also occur at the site of an existing organic atherosclerotic stenosis. Stable atherosclerotic plaques are rarely fatal, but can interfere with coronary blood flow and lead to stable angina. However, it has been suggested that vasospasm is associated with endothelial damage and subsequent atheroma rupture. Considering that acute coronary syndrome (ACS) is almost always caused by luminal thrombus or sudden plaque rupture applied to organic atherosclerotic plaques, coronary vasospasm can induce the rupture of a stable atheroma, which could lead to myocardial infarction and sudden cardiac death.
  • 730
  • 08 Nov 2021
Topic Review
Cardioprotective Strategies from Cardiotoxicity in Cancer Patients
Cardiotoxicity is a significant complication of chemotherapeutic agents in cancer patients. Cardiovascular incidents including LV dysfunction, heart failure (HF), severe arrhythmias, arterial hypertension, and death are associated with high morbidity and mortality. Risk stratification of cancer patients prior to initiation of chemotherapy is crucial, especially in high-risk patients for cardiotoxicity. The early identification and management of potential risk factors for cardiovascular side effects seems to contribute to the prevention or minimization of cardiotoxicity. Screening of cancer patients includes biomarkers such as cTnI and natriuretic peptide and imaging measurements such as LV function, global longitudinal strain, and cardiac MRI. Cardioprotective strategies for either primary or secondary prevention include medical therapy such as ACE inhibitors, ARBs, b-blockers, aldosterone antagonists, statins and dexrazoxane, physical therapy, and reduction of chemotherapeutic dosages. However, data regarding dosages, duration of medical therapy, and potential interactions with chemotherapeutic agents are still limited. Collaboration among oncologists, cardiologists, and cardio-oncologists could establish management cardioprotective strategies and approved follow-up protocols in patients with cancer receiving chemotherapy.
  • 728
  • 25 Aug 2022
Topic Review
Moderator Band-Related Arrhythmias
The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. Premature ventricular complexes originating within the Purkinje network have been implicated in the genesis of life-threatening arrhythmias. However, right Purkinje network arrhythmias have been much less reported in the literature compared to the left counterpart. The MB has unique anatomical and electrophysiological properties, which may account for its arrhythmogenicity and may be responsible for a significant portion of idiopathic ventricular fibrillation.
  • 728
  • 25 Apr 2023
Topic Review
The Ketogenic Effect of SGLT-2 Inhibitors
Sodium–glucose cotransporter-2 (SGLT-2) inhibitors, also called gliflozins or flozins, are a class of drugs that have been increasingly used in the management of type 2 diabetes mellitus (T2DM) due to their glucose-lowering, cardiovascular (CV), and renal positive effects. 
  • 728
  • 23 Nov 2023
Topic Review
SGLT2i in Diabetes, Cardiovascular Disease, and Kidney Disease
Sodium glucose cotransporter 2 inhibitor (SGLT2i) is a class of drugs that were originally intended for decreasing blood glucose in diabetes. However, recent trials have shown that there are other beneficial effects. Recent major SGLT2i landmark trials have demonstrated benefits for cardiovascular disease (reduce major adverse cardiovascular events (heart attack, stroke, cardiovascular death), hospitalization for heart failure, all-cause death), and renal disease (delay the onset of dialysis) regardless of diabetic status. 
  • 727
  • 17 Mar 2023
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