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Topic Review
Proprotein Convertase Subtilisin/Kexin Type 9 and Infections
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is the last discovered member of the family of proprotein convertases (PCs), mainly synthetized in hepatic cells. This serine protease plays a pivotal role in the reduction of the number of low-density lipoprotein receptors (LDLRs) on the surface of hepatocytes, which leads to an increase in the level of cholesterol in the blood. 
  • 393
  • 02 Apr 2022
Topic Review
Management of Dyslipidemia
Dyslipidemia, especially a circulating non-optimal level of cholesterol, is one of the most important risk factors for atherosclerotic cardiovascular disease (ASCVD), which accounts for the most deaths worldwide. Maintaining a healthy level of blood cholesterol is an important prevention strategy for ASCVD, through lifestyle intervention or cholesterol-lowering therapy. 
  • 393
  • 14 Nov 2022
Topic Review
Systemic Sclerosis-Related Pulmonary Arterial Hypertension
Systemic sclerosis (SSc)-related pulmonary arterial hypertension (SSc-PAH) is a leading cause of mortality in SSc. The extent of peripheral microvasculopathy assessed through nailfold capillaroscopy might correlate with the presence of PAH in SSc patients. 
  • 391
  • 17 May 2021
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. 
  • 390
  • 01 Aug 2022
Topic Review
The Role of Nutrition in Cardiovascular Damage
The cardiovascular system is a well-known target of antineoplastic treatments, including anthracyclines, chest radiotherapy and new molecules, such as tyrosine kinase inhibitors. Researchers investigated nutritional changes in children with cancer from the diagnosis to the end of treatment and dietary habits in cancer survivors. At diagnosis, children with cancer may present variable degrees of malnutrition, potentially affecting drug tolerability and prognosis. 
  • 390
  • 31 Aug 2023
Topic Review
Postoperative Myocardial Infarction after Non-Cardiac Surgery
In patients undergoing major non-cardiac surgery, perioperative myocardial infarction (PMI) is a threatened complication. Every year, not less than 300 million non-cardiac surgery interventions are performed in the world. Perioperative mortality after non-cardiac surgery is estimated at 2% in patients over 45 years of age. Cardiovascular events account for half of these deaths, and most are due to perioperative myocardial infarction (MINS). The diagnosis of postoperative myocardial infarction, before the introduction of cardiac biomarkers, was based on symptoms and electrocardiographic changes and its incidence was largely underestimated. The incidence of MINS when a standard troponin assay is used ranges between 8 and 19% but increases to 20–30% with high-sensitivity troponin assays. Higher troponin values suggesting myocardial injury, both with or without a definite diagnosis of myocardial infarction, are associated with an increase in 30-day and 1-year mortality. 
  • 388
  • 20 Mar 2024
Topic Review
Vericiguat in Heart Failure
Despite advances in heart failure (HF) management, the risk of death and hospitalizations remains high in the long term. HF is characterized by endothelial dysfunction, inflammation and increased oxidative stress, due to a reduction in the activity of the nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) signaling pathway. All these factors contribute to direct damage at the myocardial, vascular and renal level. Vericiguat restores the deficiency in this signaling pathway, through stimulation and activation of sGC, aiming to increase cGMP levels, with a reduction in HF-related oxidative stress and endothelial dysfunction. 
  • 387
  • 14 Oct 2022
Topic Review
Relationship between Inflammation and Vasospastic Angina
Coronary artery spasm (CAS) is a dynamic coronary stenosis causing vasospastic angina (VSA). However, VSA is a potentially lethal medical condition with multiple presentations, including sudden cardiac death. Mounting evidence supports the relation of local or systemic inflammation to VSA.
  • 386
  • 20 Mar 2023
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.
  • 386
  • 25 Jun 2023
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. 
  • 386
  • 21 Jun 2023
Topic Review
Diet and Exercise Impacts on Metabolic Diseases
Epigenetic reprogramming predicts the long-term functional health effects of health-related metabolic disease. This epigenetic reprogramming is activated by exogenous or endogenous insults, leading to altered healthy and different disease states. The epigenetic and environmental changes involve a roadmap of epigenetic networking, such as dietary components and exercise on epigenetic imprinting and restoring epigenome patterns laid down during embryonic development, which are paramount to establishing youthful cell type and health.
  • 385
  • 24 Feb 2023
Topic Review
Propranolol in Rare Vascular Diseases
Rare Diseases (RD) are defined by their prevalence in less than 5 in 10,000 of the general population. Considered individually, each RD may seem insignificant, but together they add up to more than 7000 different diseases. Research in RD is not attractive for pharmaceutical companies since it is unlikely to recover development costs for medicines aimed to small numbers of patients. Since most of these diseases are life threatening, this fact underscores the urgent need for treatments. Drug repurposing consists of identifying new uses for approved drugs outside the scope of the original medical indication. It is an alternative option in drug development and represents a viable and risk-managed strategy to develop for RDs. In 2008, the “off label” therapeutic benefits of propranolol were described in the benign tumor Infantile Hemangioma. Propranolol, initially prescribed for high blood pressure, irregular heart rate, essential tremor, and anxiety, has shown increasing evidence of its antiangiogenic, pro-apoptotic, vasoconstrictor and anti-inflammatory properties in different RDs, including vascular or oncological pathologies.
  • 384
  • 25 Apr 2022
Topic Review
Antithrombotic Therapy in Patients with AF Undergoing PCI
The antithrombotic management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) poses numerous challenges. Triple antithrombotic therapy (TAT), which combines dual antiplatelet therapy (DAPT) with oral anticoagulation (OAC), provides anti-ischemic protection but increases the risk of bleeding. Therefore, TAT is generally limited to a short phase (1 week) after PCI, followed by aspirin withdrawal and continuation of 6–12 months of dual antithrombotic therapy (DAT), comprising OAC plus clopidogrel, followed by OAC alone.
  • 384
  • 27 Dec 2023
Topic Review
Aortic Stiffness as a Risk Factor for Multimorbidity
Multimorbidity, the coexistence of multiple health conditions in an individual, has emerged as one of the greatest challenges facing health services, and this crisis is partly driven by the aging population. Aging is associated with increased aortic stiffness (AoStiff), which in turn is linked with several morbidities frequently affecting and having disastrous consequences for the elderly. These include hypertension, ischemic heart disease, heart failure, atrial fibrillation, chronic kidney disease, anemia, ischemic stroke, and dementia. Two or more of these disorders (multimorbidity) often coexist in the same elderly patient and the specific multimorbidity pattern depends on several factors including sex, ethnicity, common morbidity routes, morbidity interactions, and genomics.
  • 383
  • 15 Jun 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.
  • 383
  • 13 Jul 2023
Topic Review
Interplay of Angiotensin Peptides, Vasopressin, and Insulin
In each vascular bed, the blood flow depends on perfusion pressure, the rheologic properties of the blood, the structural and functional properties of the vascular wall, and the action of vasoconstrictory and vasodilatory factors produced locally or inflowing from the systemic circulation. The fundamental role of the heart in the maintenance of blood circulation requires the particularly precise regulation of the coronary blood flow (CBF). Rhythmic contractions of the heart exert direct mechanical effects on the coronary vessels that are associated with the production of metabolic factors in the cardiac myocytes and the smooth muscle cells of coronary vessels. 
  • 383
  • 29 Jan 2024
Topic Review
Vital Echocardiographic Data Prior to Ventricular Arrhythmia Ablation
Ventricular arrhythmias (VA) are a major cause of sudden cardiac death (SCD). Echocardiography is the first widely available imaging tool which guides VA management strategies. Along with other invasive and noninvasive imaging techniques, it provides essential information for identification of VA substrate such as differentiation between ischemic and non-ischemic etiology and identification of structural heart disease. Both classic as well as novel echocardiographic techniques such as left ventricular strain measurement and mechanical dispersion assessment provide prognostic information and assist in risk stratification. Furthermore, intracardiac echocardiography may have an adjunctive role for the VA ablation by providing real-time visualization of cardiac structures, continuous monitoring of catheter location and early recognition of procedural complications.
  • 383
  • 21 Oct 2022
Topic Review
Cardioprotective Mechanisms against Reperfusion Injury in AMI
Ischemia/reperfusion injury is a process associated with cardiologic interventions, such as percutaneous coronary angioplasty after an acute myocardial infarction. Blood flow restoration causes a quick burst of reactive oxygen species (ROS), which generates multiple organelle damage, leading to the activation of cell death pathways. Therefore, the intervention contributes to a greater necrotic zone, thus increasing the risk of cardiovascular complications. A major cardiovascular ROS source in this setting is the activation of multiple NADPH oxidases, which could result via the occupancy of type 1 angiotensin II receptors (AT1R); hence, the renin angiotensin system (RAS) is associated with the generation of ROS during reperfusion.
  • 382
  • 28 Dec 2022
Topic Review
Epidemiology and Pathophysiology of Spontaneous Coronary Artery Dissection
Spontaneous Coronary Artery Dissection (SCAD) refers to the spontaneous separation of the layers of the vessel wall caused by intramural hemorrhage, with or without an intimal tear. This condition is not associated with trauma, atherosclerosis or iatrogenic causes and may be an expression of an underlying systemic arterial disease, namely, fibromuscular dysplasia. 
  • 382
  • 30 Dec 2022
Topic Review
Cardiovascular Effects of Apelins
In-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is 5–6%. Consequently, it is necessary to develop fundamentally novel drugs capable of reducing mortality in patients with acute myocardial infarction. Apelins could be the prototype for such drugs. Chronic administration of apelins mitigates adverse myocardial remodeling in animals with myocardial infarction or pressure overload. The cardioprotective effect of apelins is accompanied by blockage of the MPT pore, GSK-3β, and the activation of PI3-kinase, Akt, ERK1/2, NO-synthase, superoxide dismutase, glutathione peroxidase, matrix metalloproteinase, the epidermal growth factor receptor, Src kinase, the mitoKATP channel, guanylyl cyclase, phospholipase C, protein kinase C, the Na+/H+ exchanger, and the Na+/Ca2+ exchanger. The cardioprotective effect of apelins is associated with the inhibition of apoptosis and ferroptosis.
  • 382
  • 05 May 2023
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