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Topic Review
Heart Failure with Reduced Ejection Fraction
Heart failure with reduced ejection fraction (HFrEF) is considered a major health care problem with frequent decompensations, high hospitalization and mortality rates. In severe heart failure (HF), the symptoms are refractory to medical treatment and require advanced therapeutic strategies. Early recognition of HF sub- and decompensation is the cornerstone of the timely treatment intensification and, therefore, improvement in the prognosis. Echocardiography is the gold standard for the assessment of systolic and diastolic functions. It allows one to obtain accurate and non-invasive measurements of the ventricular function in HF.
  • 656
  • 16 Aug 2023
Topic Review
Pathophysiology of Inflammation in Peripheral Artery Disease
Inflammation has a critical role in the development and progression of atherosclerosis. On the molecular level, inflammatory pathways negatively impact endothelial barrier properties and thus, tissue homeostasis. Conformational changes and destruction of the glycocalyx further promote pro-inflammatory pathways also contributing to pro-coagulability and a prothrombotic state. In addition, changes in the extracellular matrix composition lead to (peri-)vascular remodelling and alterations of the vessel wall, e.g., aneurysm formation. Moreover, progressive fibrosis leads to reduced tissue perfusion due to loss of functional capillaries.
  • 656
  • 07 Sep 2023
Topic Review
Kounis Syndrome
Kounis syndrome (KS) is an acute coronary syndrome triggered by allergic or hypersensitivity reactions. Incidence rates vary, with studies reporting 19.4 per 100.000 among all admissions and 3.4% among allergy patients. The pathophysiology of this syndrome involves a complex interplay between allergic reactions and the cardiovascular system. Mast cell activation, histamine release, leukotrienes, cytokines, and platelet activation can contribute to coronary events. Three types of classification systems (allergic angina, allergic myocardial infarction, allergic stent thrombosis) aid in categorizing presentations. The diagnosis of KS relies on clinical presentation, laboratory findings, and imaging. Postmortem assessment of KS is based on the integration of circumstantial data, autopsy, and histological findings. Biochemical and immunohistochemical analyses also contribute to postmortem diagnosis. In conclusion, a combined, multidisciplinary approach should be used to ease the diagnostic process, which is crucial for forensic practitioners in confirming KS occurrence.
  • 656
  • 09 Jan 2024
Topic Review
Pharmacological Approaches for Managing Hypercholesterolemia
Hypercholesterolemia plays a crucial role in the formation of lipid plaques, particularly with elevated low-density lipoprotein (LDL-C) levels, which are linked to increased risks of cardiovascular disease, cerebrovascular disease, and peripheral arterial disease. Controlling blood cholesterol values, specifically reducing LDL-C, is widely recognized as a key modifiable risk factor for decreasing the morbidity and mortality associated with cardiovascular diseases. Historically, statins, by inhibiting the enzyme β-hydroxy β-methylglutaryl-coenzyme A (HMG)-CoA reductase, have been among the most effective drugs.
  • 653
  • 26 Feb 2024
Topic Review
COVID-19 Diagnosis and Coronary Artery Thrombosis
Coronavirus disease 2019 is characterized by its severe respiratory effects. Data early on indicated an increased risk of mortality in patients with cardiovascular comorbidities. Early reports highlighted the multisystem inflammatory syndrome, cytokine storm, and thromboembolic events as part of the disease processes. The role of neutrophil extracellular traps (NETs) is explored in the pathogenesis of the disease. The structure and anatomy of the virus are pivotal to its virulence in comparison to other α and β Coronaviridae (HCoV-229E, HCoV-OC43, HCoV-229E, HCoV-NL63, HCoV-OC43, and HCoV-HKU1).  In particular, the host interaction and response may explain the variability of severity in patients. Angio tensin-converting enzyme 2 (ACE2) activation may be implicated in the cardiovascular and throm bogenic potential of the disease. The virus may also have direct effects on the endothelial lining affecting hemostasis and resulting in thrombosis through several mechanisms. 
  • 652
  • 18 Apr 2022
Topic Review
Viral Myocarditis
Viral infections are the most frequently reported etiological factors of acute myocarditis, presumed even in cases where the viral pathogen cannot be detected, or when it could act as a trigger for a secondary reaction. No consensus exists regarding the necessary investigations to confirm infectious causes. Coronary artery disease and congenital or acquired structural deformities are routinely investigated, but dysfunction induced by toxic substances, collagen vascular diseases, postpartum cardiomyopathy and myocardial infarction with non-obstructed coronary arteries are just a few of the examples that occasionally can cause misdiagnosis, especially in patients having a coincidental history of a recent viral illness. The COVID-19 pandemic brought attention to viral myocarditis and problems with its diagnostics.
  • 652
  • 16 Sep 2022
Topic Review
Heart Transplant Surgeon Workforce between 2000 and 2020
Though diversity among cardiothoracic surgeons performing pediatric and adult heart transplantations (HTxs) has increased over the past years, the majority of the field remains male and White. This is particularly striking when compared with the composition of the United States population (49.2% male, 60.1% White in 2019). These findings are particularly important, given that prior studies have identified sex and racial disparities in access and outcomes following HTx among adult patients, and that racial concordance between physicians and patients improves patient outcomes in settings of known racial disparities. These results demonstrate the need for further research to analyze the causes of sex and racial disparities and initiate more effective efforts to increase diversity of the workforce.
  • 650
  • 07 Apr 2022
Topic Review
Cellular Mechanisms Mediating Exercise-Induced Protection
Anthracyclines such as doxorubicin are widely used chemotherapy drugs. A common side effect of anthracycline therapy is cardiotoxicity, which can compromise heart function and lead to dilated cardiomyopathy and heart failure. Dexrazoxane and heart failure medications (i.e., beta blockers and drugs targeting the renin–angiotensin system) are prescribed for the primary prevention of cancer therapy-related cardiotoxicity and for the management of cardiac dysfunction and symptoms if they arise during chemotherapy. Exercise is a cardioprotective stimulus that has recently been shown to improve heart function and prevent functional disability in breast cancer patients undergoing anthracycline chemotherapy. Evidence from preclinical studies supports the use of exercise training to prevent or attenuate the damaging effects of anthracyclines on the cardiovascular system.
  • 650
  • 25 May 2023
Topic Review
Off-Target Effects of P2Y12 Receptor Inhibitors
Ischemic heart disease holds the foremost position as the primary contributor to mortality from cardiovascular disease (CVD). Furthermore, it constitutes the predominant underlying cause of heart failure on a global scale. Diverging from other tissues, the myocardium demonstrates a markedly limited ability to regenerate in the aftermath of injuries. Consequently, necrotic cardiomyocytes are replaced by fibrotic scar tissue in the cardiac repair process, which can lead to an adverse cardiac remodeling. Different cell types, including fibroblasts and macrophages, are involved in this process and play a pivotal role by releasing a wide array of mediators (i.e., cytokines) that regulate the activation of multiple molecular pathways, such as the Wnt/β-catenin pathway, involved in cardiac fibrosis. For this reason, the modulation of these pathways might be effective in promoting the replacement of fibrosis in reactive tissue. Dual antiplatelet therapy (DAPT), consisting of the combination of a platelet P2Y12 receptor inhibitor and aspirin, is the cornerstone of treatment for patients with acute coronary syndromes (ACS) requiring percutaneous coronary interventions (PCI). P2Y12 receptor activation, a platelet purinergic receptor for adenosine 5′-diphosphate (ADP), significantly contributes to the arterial thrombosis process. 
  • 650
  • 28 Feb 2024
Topic Review
Veno-Arterial Extracorporeal Membrane Oxygenation
Mortality in infarct-related cardiogenic shock (CS) remains high, reaching 40–50%. In refractory CS, active mechanical circulatory support devices including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are rapidly evolving. However, supporting evidence of VAECMO therapy in infarct-related CS is low. The basics of VA-ECMO therapy, current evidence, ongoing trials, patient selection and potential complications warrant focus.
  • 649
  • 12 Apr 2022
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. 
  • 648
  • 02 Apr 2022
Topic Review
Clinical Applications of 3D Printing in Cardiovascular Disease
3D printing has shown great promise in many medical applications covering a spectrum of areas, depending on the location, type and severity of pathologies. Whereas in the field of cardiovascular disease, in particular, congenital heart disease, the clinical value of 3D printing focuses on education of medical students or junior doctors or residents, improves physician-patient communication and increases confidence of cardiologists or cardiac surgeons in dealing with complex cardiac conditions. 3D printing is useful to develop medical devices in the treatment of aortic or valvular diseases.
  • 648
  • 22 Feb 2023
Topic Review
Mitochondrial Integrity in Right Heart Failure Development
Molecular processes underlying right ventricular (RV) dysfunction (RVD) and right heart failure (RHF) need to be understood to develop tailored therapies for the abatement of mortality of a growing patient population. Today, the armament to combat RHF is poor, despite the advancing identification of pathomechanistic processes. Mitochondrial dysfunction implying diminished energy yield, the enhanced release of reactive oxygen species, and inefficient substrate metabolism emerges as a potentially significant cardiomyocyte subcellular protagonist in RHF development. Dependent on the course of the disease, mitochondrial biogenesis, substrate utilization, redox balance, and oxidative phosphorylation are affected.
  • 648
  • 20 Jul 2023
Topic Review
Surgical Challenges in Infective Endocarditis
Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial.
  • 647
  • 20 Feb 2024
Topic Review
Current Management for PAH-CHD
Current management of patients with congenital heart disease has increased their survival into adulthood. This is accompanied by potential cardiac complications, including pulmonary hypertension associated with congenital heart disease (PAH-CHD). PAH-CHD constitutes a challenging subgroup of pulmonary hypertension and requires expert management to improve quality of life and prognosis. Novel agents have shown a significant improvement in morbidity and mortality in patients with pulmonary arterial hypertension.
  • 646
  • 03 Jan 2024
Topic Review
Management of Hypertension in Diabetic Kidney Disease
Hypertension is a critical component of cardiovascular disease progression in patients with chronic kidney disease, and specifically diabetic kidney disease (DKD). Causation versus correlation remains up for debate, but what has been confirmed is the delay of DKD progression when hypertension is controlled or moved to guideline drive ranges.
  • 645
  • 13 Nov 2023
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.
  • 642
  • 21 Oct 2022
Topic Review
MSC Exosomal miRNAs in Heart Repair
Mesenchymal stem cell (MSC)-based therapy is one of the most promising modalities for cardiac repair. Accumulated evidence suggests that the therapeutic value of MSCs is mainly attributable to exosomes. MSC-derived exosomes (MSC-Exos) replicate the beneficial effects of MSCs by regulating various cellular responses and signaling pathways implicated in cardiac regeneration and repair. miRNAs constitute an important fraction of exosome content and are key contributors to the biological function of MSC-Exo.
  • 642
  • 21 Dec 2023
Topic Review
Myocardial Mechanics in Left Ventricular Noncompaction Cardiomyopathy
Left ventricular (LV) non-compaction (LVNC) is a rare genetic cardiomyopathy due to abnormal intra-uterine arrest of compaction of the myocardial fibers during endomyocardial embryogenesis. Due to the partial or complete absence of LV compaction, the structure of the LV wall shows characteristic abnormalities, including a thin compacted epicardium and a thick non-compacted endocardium with prominent trabeculations and deep intertrabecular recesses. LVNC is frequently associated with chronic heart failure, life-threatening ventricular arrhythmias, and systemic embolic events. 
  • 642
  • 01 Mar 2024
Topic Review
Postoperative Intensive Care Management of Aortic Repair
Vascular surgery patients have multiple comorbidities and are at high risk for perioperative complications. Aortic repair surgery has greatly evolved, with an increasing predominance of endovascular techniques (EVAR). The incidence of cardiac complications is significantly reduced with endovascular repair, but high-risk patients require postoperative ST-segment monitoring. Open aortic repair may portend a prohibitive risk of respiratory complications that could be a contraindication for surgery. This risk is greatly reduced in the case of an endovascular approach, and general anesthesia should be avoided whenever possible in the case of endovascular repair. Preoperative renal function and postoperative kidney injury are powerful determinants of short- and long-term outcome, so that preoperative risk stratification and secondary prevention are critical tasks. Intraoperative renal protection with selective renal and distal aortic perfusion is essential during open repair. EVAR has lower rates of postoperative renal failure compared to open repair, with approximately half the risk for acute kidney injury (AKI) and one-third of the risk of hemodialysis requirement. Spinal cord ischemia used to be the most distinctive and feared complication of aortic repair. The risk has significantly decreased since the beginning of aortic surgery, with advances in surgical technique and spinal protection protocols, and is lower with endovascular repair. Endovascular repair avoids extensive aortic dissection and aortic cross-clamping and is generally associated with reduced blood loss and less coagulopathy.
  • 641
  • 16 Sep 2022
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