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Topic Review
Paraoxonase 1 and Its Implications in Various Diseases
Paraoxonase enzymes have a protective role due to their ability to contribute to antioxidant and anti-inflammatory pathways, especially paraoxonase 1 (PON1). PON1 is diminished in infectious diseases, it can be used as a marker, and it can lead to lower protection against the microorganism; therefore, it can play a part in the development of antibiotic resistance.
  • 585
  • 21 Mar 2024
Topic Review
Facilitation of hERG Activation by Its Blocker
Modulation of the human Ether-à-go-go-Related Gene (hERG) channel, a crucial voltage-gated potassium channel in the repolarization of action potentials in ventricular myocytes of the heart, has significant implications on cardiac electrophysiology and can be either antiarrhythmic or proarrhythmic. For example, hERG channel blockade is a leading cause of long QT syndrome and potentially life-threatening arrhythmias, such as torsades de pointes. Conversely, hERG channel blockade is the mechanism of action of Class III antiarrhythmic agents in terminating ventricular tachycardia and fibrillation. In recent years, it has been recognized that less proarrhythmic hERG blockers with clinical potential or Class III antiarrhythmic agents exhibit, in addition to their hERG-blocking activity, a second action that facilitates the voltage-dependent activation of the hERG channel. This facilitation is believed to reduce the proarrhythmic potential by supporting the final repolarizing of action potentials.
  • 585
  • 27 Nov 2023
Topic Review
Cardiac Imaging
Cardiac magnetic resonance imaging emerged as the most definitive modality, offering real-time detection, comprehensive assessment of cardiac function, the ability to detect early myocardial changes, and superior detection of cardiotoxicity when compared to the other imaging modalities. 
  • 583
  • 19 Dec 2023
Topic Review
Role of Exercise Stress Echocardiography in Pulmonary Hypertension
Pulmonary hypertension (PH) is a pathophysiological disorder that may involve various clinical conditions and may be associated with numerous respiratory and/or cardiovascular diseases. Exercise echocardiography can unmask exercise PH, detect the early stages of left ventricular diastolic dysfunction, and, therefore, differentiate between pre- and post-capillary PH. Regardless of the underlying aetiology, a developed PH is associated with increased mortality. Parameters of overt right ventricle (RV) dysfunction, including RV dilation, reduced RV ejection fraction, and elevated right-sided filling pressures, are detectable with resting echocardiography and are associated with worse outcome. 
  • 582
  • 28 Jun 2023
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.
  • 582
  • 21 Dec 2023
Topic Review
Microbial Modulation of Bile Acid in Cardiovascular Disease
Bile acids represent a class of cholesterol derivatives that is essential for intestinal absorption of lipids and fat-soluble vitamins, plays an important role in cholesterol turnover and, as more recently discovered, acts as a group of signaling molecules that exerts hormonal functions throughout the body.
  • 581
  • 28 Apr 2023
Topic Review
mTORC1 and SGLT2 Inhibitors for Diabetic Cardiomyopathy
Diabetic cardiomyopathy is a critical diabetes-mediated co-morbidity characterized by cardiac dysfunction and heart failure, without predisposing hypertensive or atherosclerotic conditions. Metabolic insulin resistance, promoting hyperglycemia and hyperlipidemia, is the primary cause of diabetes-related disorders, but ambiguous tissue-specific insulin sensitivity has shed light on the importance of identifying a unified target paradigm for both the glycemic and non-glycemic context of type 2 diabetes (T2D). Several studies have indicated hyperactivation of the mammalian target of rapamycin (mTOR), specifically complex 1 (mTORC1), as a critical mediator of T2D pathophysiology by promoting insulin resistance, hyperlipidemia, inflammation, vasoconstriction, and stress. Moreover, mTORC1 inhibitors like rapamycin and their analogs have shown significant benefits in diabetes and related cardiac dysfunction. Recently, FDA-approved anti-hyperglycemic sodium–glucose co-transporter 2 inhibitors (SGLT2is) have gained therapeutic popularity for T2D and diabetic cardiomyopathy, even acknowledging the absence of SGLT2 channels in the heart. Recent studies have proposed SGLT2-independent drug mechanisms to ascertain their cardioprotective benefits by regulating sodium homeostasis and mimicking energy deprivation.
  • 581
  • 24 Oct 2023
Topic Review
Hypoxia in Cardiovascular Diseases
Heart valve diseases are a major contributor to cardiovascular morbidity and mortality worldwide. They affect more than 13% of the population aged over 75 years old and occur when any type of the four heart valves (tricuspid, pulmonic, mitral, and aortic valves) is damaged. Calcific aortic valve disease (CAVD) is defined as a slowly progressing condition that ranges from mild valve aortic sclerosis to severe calcifying aortic valve stenosis. This progression manifests in approximately 2% of individuals over 65 years old annually.
  • 577
  • 20 Jul 2023
Topic Review
Leadless Ventricular Pacemaker
Conventional transvenous pacemakers (TPMs) have been the cornerstone of the treatment of bradyarrhythmias. With technological advances in device miniaturization, communication, and battery longevity, leadless pacemakers (LPMs) have emerged as an alternative to TPMs to eliminate the complications associated with leads and subcutaneous pockets.
  • 576
  • 16 Jun 2023
Topic Review
Surgical Left Atrial Appendage Occlusion
Atrial fibrillation (AF) is the most common arrhythmia worldwide. It is estimated to affect 2–4% of the adult population, and its prevalence increases with advancing age. Given the aging population, AF is expected to become even more prevalent in the coming years. Ischemic stroke and systemic embolism are the most significant risks associated with AF, leading to increased morbidity and mortality. Therefore, thromboembolism prevention is the cornerstone of managing AF.
  • 574
  • 06 Sep 2023
Topic Review
Myocarditis-like Episodes in Patients with Arrhythmogenic Cardiomyopathy
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined myocardial disease, characterized by myocytes necrosis with fibrofatty substitution and ventricular arrhythmias that can even lead to sudden cardiac death. The presence of inflammatory cell infiltrates in endomyocardial biopsies or in autoptic specimens of ACM patients has been reported, suggesting a possible role of inflammation in the pathophysiology of the disease. Furthermore, chest pain episodes accompanied by electrocardiographic changes and troponin release have been observed and defined as the “hot-phase” phenomenon.
  • 572
  • 19 Oct 2022
Topic Review
LVAD as Bridge to Remission from Advanced HF
Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of patients. 
  • 572
  • 27 Jul 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. 
  • 568
  • 31 Aug 2023
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.
  • 568
  • 22 Feb 2023
Topic Review
Signaling Mechanism of Remote Postconditioning of the Heart
Acute myocardial infarction (AMI) remains the leading cause of mortality in the world, highlighting an urgent need for the development of novel, more effective approaches for the treatment of AMI. Remote postconditioning (RPost) of the heart could be a useful approach. It was demonstrated that RPost triggers infarct size reduction, improves contractile function of the heart in reperfusion, mitigates apoptosis, and stimulates autophagy in animals with coronary artery occlusion and reperfusion. Endogenous opioid peptides and adenosine could be involved in RPost. It was found that kinases and NO-synthase participate in RPost. KATP channels, MPT pore, and STAT3 could be hypothetical end-effectors of RPost. 
  • 566
  • 21 Jun 2023
Topic Review
Possible Mechanisms of Atrial Fibrillation in Athletes
Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, and it is an enormous burden worldwide because of its high morbidity, disability and mortality. It is generally acknowledged that physical activity (PA) is strongly associated with a significant reduction in the risk of cardiovascular (CV) disease and all-cause mortality. Moreover, it has been observed that moderate and regular physical activity has the potential to reduce the risk of AF, in addition to improving overall well-being.
  • 566
  • 31 May 2023
Topic Review
Na-Cl Cotransporter Regulation
The pathogenesis of hypertension in chronic kidney disease (CKD) is complex, and its occurrence and development are affected by many factors. Sodium-imbalance-increased sympathetic nervous system (SNS) activity and changes in the renin-angiotensin system (RAAS) are some of the key pathogenic mechanisms. An important target of these mechanisms is Na-Cl cotransporter (NCC). NCC activity is highly regulated by a complex signaling network, and these kinases appear to be sensitive to changes in hormonal and physiological environments.
  • 565
  • 09 Jan 2023
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.
  • 564
  • 16 Sep 2022
Topic Review
AT1/AT2 Receptor Equilibrium in the Renin Angiotensin System
The AT1 receptor has mainly been associated with the pathological effects of the renin-angiotensin system (RAS) (e.g., hypertension, heart and kidney diseases), and constitutes a major therapeutic target. In contrast, the AT2 receptor is presented as the protective arm of this RAS, and its targeting via specific agonists is mainly used to counteract the effects of the AT1 receptor. The discovery of a local RAS has highlighted the importance of the balance between AT1/AT2 receptors at the tissue level. Disruption of this balance is suggested to be detrimental. The fine tuning of this balance is not limited to the regulation of the level of expression of these two receptors. Other mechanisms still largely unexplored, such as S-nitrosation of the AT1 receptor, homo- and heterodimerization, and the use of AT1 receptor-biased agonists, may significantly contribute to and/or interfere with the settings of this AT1/AT2 equilibrium.
  • 562
  • 30 Aug 2023
Topic Review
Treatment of Obstructive Hypertrophic Cardiomyopathy
Left ventricular outflow obstruction (LVOTO) and diastolic dysfunction are the main pathophysiological characteristics of hypertrophic cardiomyopathy (HCM)LVOTO, may be identified in more than half of HCM patients and represents an important determinant of symptoms and a predictor of worse prognosis.  Treatment of LVOTO is indicated in patients with lifestyle-limiting symptoms only. Negative inotropic and chronotropic medications are indicated as the first-line therapy. If patients remain symptomatic, or remain in the presence of side effects, surgery is suggested only when performed in experienced centers.
  • 561
  • 30 May 2023
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