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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.
  • 648
  • 07 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.
  • 647
  • 16 Sep 2022
Topic Review
General Considerations Regarding Heart Failure Treatment and Strategies
Since the prevalence of heart failure (HF) increases with age, HF is now one of the most common reasons for the hospitalization of elderly people. Although the treatment strategies and overall outcomes of HF patients have improved over time, hospitalization and mortality rates remain elevated, especially in developed countries where populations are aging.
  • 646
  • 27 May 2022
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.
  • 645
  • 09 Jan 2024
Topic Review
Temporary Right-Ventricular Assist Devices
Acute right-sided heart failure (RHF) is a complex clinical syndrome, with a wide range of clinical presentations, associated with increased mortality and morbidity, but about which there is a scarcity of evidence-based literature. A temporary right-ventricular assist device (t-RVAD) is a potential treatment option for selected patients with severe right-ventricular dysfunction as a bridge-to-recovery or as a permanent solution.
  • 644
  • 22 Feb 2022
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.
  • 644
  • 20 Jul 2023
Topic Review
Stable Coronary Artery Disease
Coronary revascularization is one of the most studied treatment modalities in cardiology; however, there is no consensus among experts about its indications in patients with stable coronary artery disease (SCAD). 
  • 643
  • 12 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.
  • 643
  • 20 Feb 2024
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. 
  • 642
  • 02 Apr 2022
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.
  • 642
  • 12 Apr 2022
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.
  • 642
  • 13 Nov 2023
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.
  • 640
  • 03 Jan 2024
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.
  • 639
  • 25 May 2023
Topic Review
Obesity-Related Atrial Fibrillation
Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased morbidity and mortality. The mechanisms underlying AF are complex and multifactorial. In addition to overall hemodynamic changes due to increased body weight, excess adiposity raises systemic inflammation and oxidative stress, which lead to adverse atrial remodeling. This remodeling includes atrial fibrosis, atrial dilation, decreased electrical conduction between atrial myocytes, and altered ionic currents, making atrial tissue more vulnerable to both the initiation and maintenance of AF. However, much remains to be learned about the mechanistic links between obesity and AF. 
  • 637
  • 06 Oct 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.
  • 635
  • 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.
  • 635
  • 21 Dec 2023
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. 
  • 634
  • 30 Dec 2022
Topic Review
Radiotherapy in Breast Cancer-Induced Cardiovascular Toxicity
The number of patients diagnosed with breast cancer and cardiovascular disease is continuously rising. Treatment options for breast cancer have greatly evolved, but radiotherapy (RT) still has a key role in it. Despite many advances in RT techniques, cardiotoxicity is one of the most important side effects. 
  • 634
  • 09 Aug 2023
Topic Review
Cardiovascular Health of People with Severe Mental Illness
In Australia and internationally, adults with SMI such as schizophrenia, schizoaffective disorder, and bipolar disorder are at increased risk of early death due to physical health problems. Cardiovascular diseases (CVD), type 2 diabetes, nutritional and metabolic diseases, and obesity and smoking-related cancers are some of these potentially preventable chronic conditions that are frequently observed and disproportionately found among people with SMI compared with non-SMI populations. This mental–physical health interface has multiple adverse impacts for the person in their daily life, and also appears to generate greater difficulty in the person’s healthcare management.
  • 632
  • 11 Feb 2022
Topic Review
Invasive Techniques for Intermediate Coronary Lesions Assessment
Intravascular ultrasound has been used for many years in the assessment of intermediate coronary lesions. This technique uses a piezoelectric transducer that produces ultrasound signals allowing the assessment of the vessel wall and characterizing the atherosclerotic lesions, eliminating the disadvantages of angiography and FFR/iFR. Its main indications in the American College of Cardiology guideline as class IIa recommendation are the assessment of angiographically intermediate stenosis of the LMCA or the mechanisms of stent failure (thrombosis or restenosis) as well as guidance of coronary stent implantation, especially in LMCA or complex coronary artery disease.
  • 632
  • 30 Jun 2022
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