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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.
  • 605
  • 30 May 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.
  • 603
  • 24 Oct 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.
  • 602
  • 31 May 2023
Topic Review
Lipid-Lowering Therapy of Post-Acute Coronary Syndrome
It has been consistently demonstrated that circulating lipids and particularly low-density lipoprotein cholesterol (LDL-C) play a significant role in the development of coronary artery disease (CAD). Several trials have been focused on the reduction of LDL-C values in order to interfere with atherothrombotic progression. Importantly, for patients who experience acute coronary syndrome (ACS), there is a 20% likelihood of cardiovascular (CV) event recurrence within the two years following the index event. 
  • 602
  • 21 Aug 2023
Topic Review
Molecular Imaging in Infective Endocarditis
Infective endocarditis (IE) is a growing epidemiological challenge. Appropriate diagnosis remains difficult due to heterogenous etiopathogenesis and clinical presentation. The disease may be followed by increased mortality and numerous diverse complications.
  • 600
  • 19 Jul 2023
Topic Review
Association of Obstructive Sleep Apnea with Hypertension
Hypertension (HT) is a worldwide public health issue and an essential risk factor for cardiovascular and cerebrovascular diseases. Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of apnea and hypopnea as a consequence of partial or complete obstruction of the upper airways due to anatomic and/or functional disturbances.
  • 597
  • 06 Jul 2023
Topic Review
Aortic Elasticity and Cardiovascular Risk Stratification
Cardiovascular risk stratification is a cornerstone of preventive cardiology, aiming to identify individuals at a higher risk for adverse events. In line with this, aortic elastic properties have gained recognition as crucial indicators of vascular health and predictors of cardiovascular outcomes.
  • 596
  • 08 Mar 2024
Topic Review
HMG-CoA Reductase Inhibitors for Dyslipidemia Treatment
Dyslipidemia plays a fundamental role in the development and progression of atherosclerosis. Current guidelines for treating dyslipidemia focus on low-density lipoprotein–cholesterol (LDL-C). Despite advances in the pharmacotherapy of atherosclerosis, the most successful agents used to treat this disease—statins—remain insufficient in the primary or secondary prevention of acute myocardial infarction. Advancing therapy for hypercholesterolemia with emerging new drugs, either as monotherapy or in combination, is expected to improve cardiovascular outcomes. 
  • 596
  • 01 Mar 2024
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. 
  • 595
  • 28 Jun 2023
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.
  • 595
  • 30 Aug 2023
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. 
  • 595
  • 31 Aug 2023
Topic Review
Biomechanics of Transcatheter Aortic Valve Implant
Transcatheter aortic valve implantation (TAVI) has grown exponentially within the cardiology and cardiac surgical spheres. It has now become a routine approach for treating aortic stenosis. Several concerns have been raised about TAVI in comparison to conventional surgical aortic valve replacement (SAVR). The primary concerns regard the longevity of the valves. Several factors have been identified which may predict poor outcomes following TAVI. To this end, the lesser-used finite element analysis (FEA) was used to quantify the properties of calcifications which affect TAVI valves. This method can also be used in conjunction with other integrated software to ascertain the functionality of these valves. Other imaging modalities such as multi-detector row computed tomography (MDCT) are now widely available, which can accurately size aortic valve annuli. This may help reduce the incidence of paravalvular leaks and regurgitation which may necessitate further intervention.
  • 593
  • 26 Sep 2022
Topic Review
Myostatin and the Heart
Myostatin (growth differentiation factor 8) is a member of the transforming growth factor-β superfamily. It is secreted mostly by skeletal muscles, although small amounts of myostatin are produced by the myocardium and the adipose tissue as well. Myostatin binds to activin IIB membrane receptors to activate the downstream intracellular canonical Smad2/Smad3 pathway, and additionally acts on non-Smad (non-canonical) pathways. Studies on transgenic animals have shown that overexpression of myostatin reduces the heart mass, whereas removal of myostatin has an opposite effect. 
  • 591
  • 20 Dec 2023
Topic Review
Calcium Handling in Inherited Cardiac Diseases
Calcium (Ca2+) is the major mediator of cardiac contractile function. It plays a key role in regulating excitation–contraction coupling and modulating the systolic and diastolic phases. Defective handling of intracellular Ca2+ can cause different types of cardiac dysfunction. Thus, the remodeling of Ca2+ handling has been proposed to be a part of the pathological mechanism leading to electrical and structural heart diseases. Indeed, to ensure appropriate electrical cardiac conduction and contraction, Ca2+ levels are regulated by several Ca2+-related proteins.
  • 590
  • 16 Feb 2023
Topic Review
C-Reactive Protein as Inflammatory Marker in Cardiovascular Disease
C-reactive protein (CRP) is an inflammatory molecule that has demonstrated value as a predictive marker for cardiovascular risk assessment, both independently and in conjunction with other parameters. It has been incorporated into risk assessment algorithms, enhancing risk prediction and guiding therapeutic decisions. Pharmacological interventions with anti-inflammatory properties, such as statins, glucagon-like peptide-1 agonists, and interleukin-1 inhibitors, have shown promising effects in reducing both cardiovascular risks and CRP levels.
  • 590
  • 05 Sep 2023
Topic Review
The Roles of Periodontal Bacteria in Atherosclerosis
Atherosclerosis (AS) is an inflammatory vascular disease that constitutes a major underlying cause of cardiovascular diseases (CVD) and stroke. Infection is a contributing risk factor for AS. Epidemiological evidence has implicated individuals afflicted by periodontitis displaying an increased susceptibility to AS and CVD. 
  • 587
  • 06 Oct 2023
Topic Review
Control of LDL Level with LDLR Pathway
Since the discovery of the LDL receptor in 1973 by Brown and Goldstein as a causative protein in hypercholesterolemia, tremendous amounts of effort have gone into finding ways to manage high LDL cholesterol in familial hypercholesterolemic (HoFH and HeFH) individuals with loss-of-function mutations in the LDL receptor (LDLR) gene. Statins proved to be the first blockbuster drug, helping both HoFH and HeFH individuals by inhibiting the cholesterol synthesis pathway rate-limiting enzyme HMG-CoA reductase and inducing the LDL receptor. However, statins could not achieve the therapeutic goal of LDL. Other therapies targeting LDLR include PCSK9, which lowers LDLR by promoting LDLR degradation. Inducible degrader of LDLR (IDOL) also controls the LDLR protein, but an IDOL-based therapy is yet to be developed. Among the LDLR-independent pathways, such as angiopoietin-like 3 (ANGPTL3), apolipoprotein (apo) B, apoC-III and CETP, only ANGPTL3 offers the advantage of treating both HoFH and HeFH patients and showing relatively better preclinical and clinical efficacy in animal models and hypercholesterolemic individuals, respectively.
  • 585
  • 03 Jul 2023
Topic Review
Risk Factors for Stroke in Chronic Kidney Disease
Patients with chronic kidney disease (CKD) have a higher risk ofboth ischemic and hemorrhagic stroke. This association appears to be partly independent from the higher prevalence of established risk factors for stroke in patients with CKD, including hypertension and atrial fibrillation.
  • 585
  • 06 Sep 2023
Topic Review
CT Application in Structural Heart Diseases
Computed tomography (CT) scanning has recently assumed a first-pillar role in the preoperative planning of patients undergoing transcatheter structural heart procedures (e.g., transcatheter aortic valve implantation, TAVI; MitraClip; Triclip; left atrial appendage occlusion, LAAO). A careful preprocedural assessment is crucial for achieving the best possible result, and, currently, CT represents the paramount technique to obtain morphological data on cardiac and vessel structures, thus allowing to choose the most appropriate vascular approach, the type and size of devices, and all the required steps to meet procedural expectations. The image reconstruction accuracy also provides information to predict potential complications such as misplacements and leakages. 
  • 584
  • 22 May 2023
Topic Review
Intrastent Restenosis
Restenosis refers to the narrowing of a blood vessel’s diameter following an angioplasty procedure. Intrastent restenosis (ISR) is a challenging medical problem. A meta-analysis showed that percutaneous coronary intervention (PCI) for ISR is associated with a higher incidence of adverse cardiac events than PCI for de novo lesions. This happens especially because of a higher incidence of risk-adjusted major adverse cardiac events compared with PCI for de novo lesions at a median of ≈30 months.
  • 584
  • 16 Feb 2024
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