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Topic Review
Cholesteryl Ester Transfer Protein Inhibition Reduces Cardiovascular Events
Cholesteryl ester transfer protein (CETP) is a glycoprotein synthesized in the liver that is present in all primates (including humans), rabbits and hamsters. The CETP molecule has a boomerang shape, with a tunnel that forms between spaces at each end for binding cholesteryl esters and triglycerides (TG). It is responsible for the exchange of TG from very low-density lipoprotein (VLDL) particles with cholesteryl esters from high-density lipoprotein (HDL) particles and low-density lipoprotein (LDL) particles. The net effect of this exchange is to enrich VLDL and LDL particles with cholesteryl esters and deplete them of TG while simultaneously enriching HDL particles with TG and depleting them of cholesteryl esters.
  • 697
  • 01 Sep 2022
Topic Review
Utility of Genetic Testing in Patients with ATTR-CM
Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly diagnosed condition. Although wild-type transthyretin amyloidosis (ATTRwt) is the most common ATTR-CM, hereditary transthyretin amyloidosis (ATTRv) may also occur. Genetic testing for transthyretin pathogenic variants is recommended for patients with a confirmed clinical diagnosis of ATTR-CM. In fact, confirmation of this autosomal dominant pathogenic variant prompts genetic counselling and allows early identification of affected relatives. Additionally, in the presence of an ATTR-CM-associated polyneuropathy, specific drugs targeting transthyretin can be used.
  • 697
  • 09 Jan 2024
Topic Review
NLRP3 Inflammasome in Vascular Disease and Pharmacological Opportunities
The NLRP3 inflammasome is a multiprotein complex that assembles to engage the innate immune defense by processing the maturation of pro-inflammatory cytokines IL-1β and IL-18. Substantial evidence has positioned the NLRP3 inflammasome at the center of vascular disease progression, with a particular significance in the context of aging and the low-grade chronic inflammation associated (inflammaging). Therefore, pharmacological blockade of the NLRP3 inflammasome and its end products has arisen as an extremely promising tool to battle vascular disease. 
  • 695
  • 16 Feb 2022
Topic Review
Inflammation in Heart Failure
Chronic heart failure is a terminal point of a vast majority of cardiac or extracardiac causes affecting around 1–2% of the global population and more than 10% of the people above the age of 65. Inflammation is persistently associated with chronic diseases, contributing in many cases to the progression of disease. Even in a low inflammatory state, past studies raised the question of whether inflammation is a constant condition, or if it is, rather, triggered in different amounts, according to the phenotype of heart failure. 
  • 695
  • 20 Dec 2023
Topic Review
Comorbid Sepsis and Cardiogenic Shock
Septic shock management in the cardiac intensive care unit (CICU) is challenging due to the complex interaction of pathophysiology between vasodilatory and cardiogenic shock, complicating how to optimally deploy fluid resuscitation, vasopressors, and mechanical circulatory support devices.
  • 693
  • 26 Oct 2023
Topic Review
Calcium in Arrhythmogenic Cardiomyopathy
Arrhythmogenic cardiomyopathy (ACM) is an inherited heart disease characterized by sudden death in young people and featured by fibro-adipose myocardium replacement, malignant arrhythmias, and heart failure. The Ca2+ toolkit is heavily remodeled in cardiomyocytes derived from a mouse model of ACM defective of the desmosomal protein plakophilin-2. Furthermore, ACM-related mutations were found in genes encoding for proteins involved in excitation‒contraction coupling, e.g., type 2 ryanodine receptor and phospholamban. 
  • 691
  • 15 Nov 2021
Topic Review
Hydrogen Sulfide in Plaque Stability
Hydrogen sulfide (H2S) is an identified and recognized gasotransmitter after nitric oxide and carbon oxide. Atherosclerosis is one of most prevalent cardiovascular diseases worldwide, characterized as chronic inflammation and lipid accumulation in the large arteries. Atherosclerotic plaque rupture or erosion causes the formation of thrombosis or blood clot, resulting in acute events, such as myocardial infraction, or ischemic stroke, contributing to a major mortality rate in the case of human diseases.
  • 691
  • 23 Dec 2022
Topic Review
Telomere Length and Coronary Artery Disease
Coronary artery disease (CAD) is a multifactorial disease with a high prevalence, particularly in developing countries. The investigation of telomeres as a potential tool for the early detection of the atherosclerotic disease seems to be a promising method. Telomeres are repetitive DNA sequences located at the extremities of chromosomes that maintain genetic stability. Telomere length (TL) has been associated with several human disorders and diseases while its attrition rate varies significantly in the population. The rate of TL shortening ranges between 20 and 50 bp and is affected by factors such as the end-replication phenomenon, oxidative stress, and other DNA-damaging agents.
  • 691
  • 27 Feb 2023
Topic Review
Molecular Therapies in Cardiovascular Diseases
Small interfering RNA (siRNA) represents a novel, fascinating therapeutic strategy that allows for selective reduction in the production of a specific protein through RNA interference. In the cardiovascular (CV) field, several siRNAs have been developed in the last decade. Inclisiran has been shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) circulating levels with a reassuring safety profile, also in older patients, by hampering proprotein convertase subtilisin/kexin type 9 (PCSK9) production. Olpasiran, directed against apolipoprotein(a) mRNA, prevents the assembly of lipoprotein(a) [Lp(a)] particles, a lipoprotein linked to an increased risk of ischemic CV disease and heart valve damage. Patisiran, binding transthyretin (TTR) mRNA, has demonstrated an ability to improve heart failure and polyneuropathy in patients with TTR amyloidosis, even in older patients with wild-type form. Zilebesiran, designed to reduce angiotensinogen secretion, significantly decreases systolic and diastolic blood pressure (BP).
  • 691
  • 15 Jan 2024
Topic Review
Antithrombotic Therapy in Polyvascular Disease
Patients presenting with atherosclerosis involving more than one vascular bed, such as those with peripheral artery disease (PAD) and concomitant coronary artery disease (CAD), constitute a particularly vulnerable group characterized by enhanced residual long-term risk for major adverse cardiac events (MACE), as well as major adverse limb events (MALE). Antithrombotic therapy is the mainstay of secondary prevention in both patients with PAD or CAD; however, the optimal intensity of such therapy is still a topic of debate, particularly in the post-acute and long-term setting.
  • 689
  • 31 Aug 2023
Topic Review
Decoys in Cardiovascular Diseases Therapeutic
Cardiovascular disease (CVD) is the main cause of global death, highlighting the fact that conventional therapeutic approaches for the treatment of CVD patients are insufficient, and there is a need to develop new therapeutic approaches. In recent years, decoy technology, decoy oligodeoxynucleotides (ODN), and decoy peptides show promising results for the future treatment of CVDs. Decoy ODN inhibits transcription by binding to the transcriptional factor, while decoy peptide neutralizes receptors by binding to the ligands.
  • 689
  • 25 Sep 2023
Topic Review
The Mitochondrial Dysfunction in Atherosclerosis
Atherosclerosis is a multifactorial inflammatory pathology that involves metabolic processes. Improvements in therapy have drastically reduced the prognosis of cardiovascular disease. Nevertheless, a significant residual risk is still relevant, and is related to unmet therapeutic targets. Endothelial dysfunction and lipid infiltration are the primary causes of atherosclerotic plaque progression. In this contest, mitochondrial dysfunction can affect arterial wall cells, in particular macrophages, smooth muscle cells, lymphocytes, and endothelial cells, causing an increase in reactive oxygen species (ROS), leading to oxidative stress, chronic inflammation, and intracellular lipid deposition. 
  • 686
  • 31 Jan 2023
Topic Review
Cardiovascular Diseases and Exosomes
Cardiovascular diseases (CVDs) are widely recognized as the leading cause of mortality worldwide. Despite the advances in clinical management over the past decades, the underlying pathological mechanisms remain largely unknown. Exosomes have drawn the attention of researchers for their relevance in intercellular communication under both physiological and pathological conditions. These vesicles are suggested as complementary prospective biomarkers of CVDs; however, the role of exosomes in CVDs is still not fully elucidated.
  • 683
  • 25 Feb 2021
Topic Review
Blood-Based Biomarkers in Pulmonary Hypertension
Pulmonary hypertension (PH) is a serious hemodynamic condition, characterized by increased pulmonary vascular resistance (PVR), leading to right heart failure (HF) and death when not properly treated. The prognosis of PH depends on etiology, hemodynamic and biochemical parameters, as well as on response to specific treatment.
  • 683
  • 26 Jan 2022
Topic Review
Renal Denervation in the Management of Heart Failure
Norepinephrine (NE) spillover in the kidneys is associated with a worse prognosis. Since the kidneys constitute an integral part of the sympathetic activation feedback loop between the brain, the heart, the vasculature, and the kidneys, the therapies targeting this afferent loop may provide a novel and promising target in the management of patients with heart failure. Renal denervation has evolved from surgical denervation to transcatheter-based technology. This latter technique is a minimally invasive, catheter-based procedure that ablates both the afferent and efferent renal sympathetic nerves. Various catheter-based technologies exist today, including radiofrequency ablation, ultrasound thermal ablation, and chemical ablation utilizing alcohol. Renal denervation has been predominantly studied as a tool for the management of resistant hypertension. 
  • 683
  • 01 Aug 2022
Topic Review
4D-Flow Imaging in Aortic Valve Disease
The development of abnormal blood flow has been demonstrated to be due to a variety of pathological causes, such as atherosclerotic plaque or valvular disease. Traditionally, cardiovascular magnetic resonance imaging (MRI) has provided high-quality imaging of the heart with its surrounding structures. 4D-flow imaging is an advanced cardiac MR imaging technique that allows fluid hemodynamics to be measured non-invasively in patients. As a growing field in radiology, its adaptation and clinical use remain underutilized. 
  • 683
  • 21 Jun 2023
Topic Review
Clinical Applications of Cardiac Scintigraphy with Bone Tracers
Radionuclide bone scintigraphy is the cornerstone of an imaging-based algorithm for accurate non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). In patients with heart failure and suggestive echocardiographic and/or cardiac magnetic resonance imaging findings, the positive predictive value of Perugini grade 2 or 3 myocardial uptake on a radionuclide bone scan approaches 100% for the diagnosis of ATTR-CA as long as there is no biochemical evidence of a clonal dyscrasia. The technetium-labelled tracers that are currently validated for non-invasive diagnosis of ATTR-CA include pyrophosphate (99mTc-PYP); hydroxymethylene diphosphonate (99mTc-HMDP); and 3,3-diphosphono-1,2-propanodicarboxylate (99mTc-DPD). Although nuclear scintigraphy has transformed the contemporary diagnostic approach to ATTR-CA, a number of grey areas remains, including the mechanism for binding tracers to the infiltrated heart, differences in the kinetics and distribution of these radiotracers, differences in protocols of image acquisition worldwide, the clinical significance of extra-cardiac uptake, and the use of this technique for prognostic stratification, monitoring disease progression and assessing the response to disease-modifying treatments.
  • 683
  • 21 Dec 2023
Topic Review
Cardiovascular Risk Prediction Parameters in Rheumatic Diseases
Multiple imaging techniques, such as ECG, ultrasound, and cIMT, as well as biomarkers like osteoprotegerin cytokine receptor and angiopoietin-2, can be beneficial in both CV risk prediction and in early subclinical diagnosis. Physical exercise is an essential non-pharmacological intervention that can maintain the health of the cardiovascular system and, additionally, influence the underlying disease. Lipid-lowering drugs (methotrexate from the non-biologic DMARDs family as well as biologic DMARDs such as anti-TNF) were all associated with a lower CV risk; however, anti-TNF medication can decrease cardiac compliance and promote heart failure in patients with previously diagnosed chronic HF. Although they achieved success rates in reducing inflammation, glucocorticoids, NSAIDs, and COX-2 inhibitors were correlated with an increased risk of CVD. When taking all of the aforementioned points into consideration, there appears to be a dire need to establish and implement CVD risk stratification models in rheumatic patients. 
  • 681
  • 07 Mar 2022
Topic Review
Mechanisms of Hyperglycaemia-Induced Vascular Damage
Coronary artery disease (CAD) remains one of the most important causes of morbidity and mortality worldwide, and revascularization through percutaneous coronary interventions (PCI) significantly improves survival. In this setting, poor glycaemic control, regardless of diabetes, has been associated with increased incidence of peri-procedural and long-term complications and worse prognosis. Novel antidiabetic agents have represented a paradigm shift in managing patients with diabetes and cardiovascular diseases.
  • 680
  • 15 Jul 2022
Topic Review
Cardioplegic Solution with an Understanding of a Cardiochannelopathy
Cardiac surgeries have been improved by accompanying developing cardioplegia solutions. However, the cardioplegia application presents an ongoing challenge with a view of a sufficiently restored cardiac function.
  • 680
  • 15 Dec 2022
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