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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.
  • 308
  • 09 Jan 2024
Topic Review
Paediatric Restrictive Cardiomyopathy
Restrictive cardiomyopathy (RCM) is characterized by restrictive ventricular pathophysiology determined by increased myocardial stiffness. While suspicion of RCM is initially raised by clinical evaluation and supported by electrocardiographic and echocardiographic findings, invasive hemodynamic evaluation is often required for diagnosis and management of patients during follow-up. RCM is commonly associated with a poor prognosis and a high incidence of heart failure, and PH is reported in paediatric patients with RCM. Only a few therapies are available for specific RCM aetiologies. Early referral to centres for advanced heart failure treatment is often necessary.
  • 307
  • 02 Jan 2024
Topic Review
Pulsed Field Ablation in Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with high morbidity and mortality. AF treatment is guided by a patient–provider risk–benefit discussion regarding drug versus ablation or combination. Thermal ablation has a high rate of adverse events compared to pulsed field ablation (PFA). The success rate of PVI by PFA is high, and major adverse events are low. PFA is found to decrease the recurrence of atrial arrhythmia compared to thermal ablation. Substantial randomized controlled trials (RCTs) are needed to validate the efficacy and safety of PFA over conventional methods.
  • 306
  • 25 Apr 2023
Topic Review
Cardiac Implantable Electronic Devices Infections
The use of increasingly complex cardiac implantable electronic devices (CIEDs) has increased exponentially. One of the most serious complications in terms of mortality, morbidity and financial burden is represented by infections involving these devices. They may affect only the generator pocket or be generalised with lead-related endocarditis. Modifiable and non-modifiable risk factors have been identified and they can be associated with patient or procedure characteristics or with the type of CIED. Pocket and systemic infections require a precise evaluation and a specialised treatment which in most cases involves the removal of all the components of the device and a personalised antimicrobial therapy. CIED retention is usually limited to cases where infection is unlikely or is limited to the skin incision site. Optimal re-implantation timing depends on the type of infection and on the results of microbiological tests. Preventive strategies, in the end, include antibiotic prophylaxis before CIED implantation, the possibility to use antibacterial envelopes and the prevention of hematomas. 
  • 302
  • 24 Oct 2022
Topic Review
Infective Endocarditis during Pregnancy
The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams.
  • 302
  • 16 May 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.
  • 301
  • 28 Apr 2023
Topic Review
Prosthesis–Patient Mismatch
Prosthesis–patient mismatch (PPM) is defined as implanting a prosthetic that is insufficiently sized for the patient receiving it. PPM leads to high residual transvalvular gradients post-aortic valve replacement and consequently results in left ventricular dysfunction, morbidity and mortality in both the short and long term.
  • 301
  • 11 Sep 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.
  • 300
  • 07 Sep 2023
Topic Review
Benefits of Prehabilitation before Complex Aortic Surgery
The term “complex aortic disease” encompasses juxta/pararenal aortic and thoraco-abdominal aneurysms, chronic aortic dissection and occlusive aorto-iliac pathology. Although endovascular surgery has been increasingly favored, open aortic surgery (OAS) remains a durable option, but by necessity involves extensive surgical approaches and aortic cross-clamping and requires a trained multidisciplinary team. The physiological stress of OAS in a fragile and comorbid patient group mandates thoughtful preoperative risk assessment and the implementation of measures dedicated to improving outcomes. Cardiac and pulmonary complications are one of the most frequent adverse events following major OAS and their incidences are correlated to the patient’s functional status and previous comorbidities. Prehabilitation should be considered in patients with risk factors for pulmonary complications including advanced age, previous chronic obstructive pulmonary disease, and congestive heart failure with the aid of pulmonary function tests. It should also be combined with other measures to improve postoperative course and be included in the more general concept of enhanced recovery after surgery (ERAS).
  • 299
  • 08 Jun 2023
Topic Review
Aortic and Visceral Aneurysms
Aortic and visceral aneurysms affect large arterial vessels, including the thoracic and abdominal aorta, as well as visceral arterial branches, such as the splenic, hepatic, and mesenteric arteries, respectively. 
  • 299
  • 20 Sep 2023
Topic Review
Pro-Inflammatory Cytokines in the Pathogenesis of Cardiovascular Disease
With cardiovascular disease (CVD) being a primary source of global morbidity and mortality, it is crucial that we understand the molecular pathophysiological mechanisms at play. Recently, numerous pro-inflammatory cytokines have been linked to several different CVDs, which are now often considered an adversely pro-inflammatory state. These cytokines most notably include interleukin-6 (IL-6),tumor necrosis factor (TNF)α, and the interleukin-1 (IL-1) family, amongst others. Not only does inflammation have intricate and complex interactions with pathophysiological processes such as oxidative stress and calcium mishandling, but it also plays a role in the balance between tissue repair and destruction.
  • 299
  • 26 Jan 2024
Topic Review
Diagnosis and Management of Cancer in Children
It is disheartening for parents to discover that their children have long-term cardiac dysfunction after being cured of life-threatening childhood cancers. As the number of childhood cancer survivors increases, early and late oncology-therapy-related cardiovascular complications continue to rise. It is essential to understand that cardiotoxicity in childhood cancer survivors is persistent and progressive. A child’s cancer experience extends throughout his or her lifetime, and ongoing care for long-term survivors is recognized as an essential part of the cancer care continuum. Initially, there was a lack of recognition of late cardiotoxicities related to cancer therapy. In 1984, pioneers like Dr. Lipshultz and others published anecdotal case reports of late cardiotoxicities in children and adolescents exposed to chemotherapy, including some who ended up with heart transplantation. At that time, cardiac tests for cancer survivors were denied by insurance companies because they did not meet appropriate use criteria. Since then, cardio-oncology has been an emerging field of cardiology that focuses on the early detection of cancer therapy-related cardiac dysfunction occurring during and after oncological treatment. 
  • 297
  • 30 Jan 2023
Topic Review
Relationship between Obesity and Cardiovascular Disease
Obesity is defined when the body mass index (BMI) exceeds a value of 30 kg/m2. It is implicated in slowing improved life expectancy and increasing cardiovascular (CV) risk.
  • 296
  • 11 Aug 2023
Topic Review
Biomarkers of Invasive Imaging for Carotid Plaque Vulnerability
Carotid artery disease has traditionally been assessed based on the degree of luminal narrowing. However, this approach, which solely relies on carotid stenosis, is being questioned with regard to modern risk stratification approaches. Guidelines have introduced the concept of the “vulnerable plaque,” emphasizing specific features such as thin fibrous caps, large lipid cores, intraplaque hemorrhage, plaque rupture, macrophage infiltration, and neovascularization.
  • 296
  • 21 Aug 2023
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.
  • 295
  • 26 Feb 2024
Topic Review
Long-Term Mechanical Circulatory Support Devices
Cardiovascular disease (CVD) includes a range of disorders that affect the myocardium and/or the vascular system. It stands as the number one cause of death worldwide, accounting for one-third of all deaths. The prevalence of CVD contributes to the rise in healthcare costs, which is attributed to increased rates of hospitalisation, primary care usage and prescription medication. Heart failure (HF) is a common clinical syndrome caused by functional and structural abnormalities of the heart, imposing a burden of disability, reduced quality of life and increased mortality rate. Durable mechanical circulatory support (MCS) devices have become progressively more common as a long-term therapeutic option. Many patients are initially deemed eligible for MCS device implantation as a bridge to transplant but face the harsh reality of limited organ availability. 
  • 292
  • 07 Mar 2024
Topic Review
Hypertensive Heart Failure
Hypertension (HTN) is the leading cause of cardiovascular disease and premature death worldwide, which largely surpasses other important factors of mortality such as smoking and metabolic diseases. HTN is the most important risk factor for heart failure (HF) development, with recent evidence indicating that HTN is present in 76% of incident HF cases, and the lifetime risk of HF is almost twice as high in people with HTN as in those with normal blood pressure (BP).
  • 292
  • 09 Nov 2023
Topic Review
Pharmacometabolomics of Lipid-Lowering Therapies
Lipid-lowering therapies are widely used to prevent the development of atherosclerotic cardiovascular disease (ASCVD) and related mortality worldwide. “Omics” technologies have been successfully applied to investigate the mechanisms of action of these drugs, their pleiotropic effects, and their side effects, aiming to identify novel targets for future personalized medicine with an improvement of the efficacy and safety associated with the treatment. Pharmacometabolomics is a branch of metabolomics that is focused on the study of drug effects on metabolic pathways that are implicated in the variation of response to the treatment considering also the influences from a specific disease, environment, and concomitant pharmacological therapies. The integration of pharmacometabolomics data with the information obtained from the other “omics” approaches could help in the comprehension of the biological mechanisms underlying the use of lipid-lowering drugs in view of defining a precision medicine to improve the efficacy and reduce the side effects associated with the treatment.
  • 291
  • 22 Feb 2023
Topic Review
Origins of Circulating Triglyceride-Rich Lipoproteins
The role of triglyceride-rich lipoproteins (TRLs) and their remnants in atherosclerosis has come to the forefront in the past decade. Triglycerides (TGs) stand as markers of the remnants of the catabolism of TRLs that tend to contain twice as much cholesterol as compared to LDL. The accumulation of circulating TRLs and their partially lipolyzed derivatives, known as “remnants”, is caused mainly by ineffective triglyceride catabolism. These cholesterol-enriched remnant particles are hypothesized to contribute to atherogenesis. 
  • 291
  • 10 Jul 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.
  • 289
  • 06 Sep 2023
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