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Topic Review
Congestion in Heart Failure
Annual heart failure hospitalizations exceed 1 million in both the United States and Europe, and more than 90% are due to symptoms and signs of fluid overload. Additionally, up to one in four patients (24%) are readmitted within 30 days, and one in two patients (50%) are readmitted within 6 months. Acute decompensated heart failure (ADHF) remains the leading cause of hospitalization in patients > 65 years old and has the highest rate of 30-day rehospitalization among all medical conditions. Recurrent fluid overload in heart failure has been associated with worse outcomes independently of age and renal function. Deranged hemodynamics, neurohormonal activation, excessive tubular sodium reabsorption, inflammation, oxidative stress, and nephrotoxic medications are important drivers of harmful cardiorenal interactions in patients with heart failure. Central venous pressure elevation is rapidly transmitted to the renal veins, causing increased interstitial and tubular hydrostatic pressure, which decreases net glomerular filtration. Venous congestion itself can produce endothelial activation, the up-regulation of inflammatory cytokines, hepatic dysfunction, and intestinal villi ischemia. Thus, the foremost goal in managing acutely decompensated heart failure is to effectively resolve fluid overload.
  • 513
  • 10 Jan 2024
Topic Review
Anti-Arrhythmic Effects of Heart Failure Guideline-Directed Medical Therapy
Sudden cardiac death (SCD) accounts for a substantial proportion of mortality in heart failure with reduced ejection fraction (HFrEF), frequently triggered by ventricular arrhythmias (VA). Guideline-directed medical therapy (GDMT) for HFrEF is founded on a cornerstone of four distinct classes of medications: beta-blockers (BB), renin-angiotensin-aldosterone system (RAAS) inhibitors, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i).
  • 510
  • 08 Mar 2024
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. 
  • 509
  • 24 Oct 2022
Topic Review
Biomarkers for Predicting Clinical Outcomes in Heart Disease
Cardiovascular disease is most frequently caused by the development and progression of atherosclerosis. When coronary arteries are afflicted, and the stenoses caused by atherosclerotic plaques are severe enough, the metabolic supply-and-offer balance is disturbed, leading to myocardial ischemia. If atherosclerotic plaques become unstable and local thrombosis develops, a myocardial infarction occurs. Sometimes, myocardial ischemia and infarction may result in significant and irreversible heart failure. To prevent severe complications, such as acute coronary syndromes and ischemia-related heart failure, extensive efforts have been made for developing biomarkers that would help identify patients at increased risk for cardiovascular events.
  • 508
  • 30 Jan 2023
Topic Review
Risk Factors and Cellular Differences in Heart Failure
Patients with heart failure are conventionally stratified into phenotypic groups based on their ejection fraction. The aim of this stratification is to improve disease management with a more targeted therapeutic approach. A further subdivision based on patient gender is justified. It is recognized that women are underrepresented in randomized controlled clinical trials, resulting in limited clinical and molecular differentiation between males and females. However, many observational studies show that the onset, development, and clinical course of the disease may substantially differ between the two sexes. 
  • 506
  • 27 Nov 2023
Topic Review
General Effects of Elevated Blood Pressure on Vasculature
Vascular dysfunction and vascular remodeling are caused by chronically elevated systemic arterial blood pressure (BP), and can be associated with changes in all vessel layers, from the endothelium to the perivascular adipose tissue (PVAT). In HHD, large artery alterations are characterized by increased proximal artery enlargement, arterial wall thickness, the elongation and widening of the aortic arch, and increased arterial stiffness. Small artery alterations are characterized by eutrophic remodeling (defined as increased media-to-lumen ratio with unchanged total wall tissue), increased arterial stiffness, and microvascular rarefaction. It is considered that the progressive course of HHD leads to a reduction in the microcirculatory network, and many bioactive molecules, such as angiotensin-II (Ang-II), endothelin-1 (ET-1), aldosterone, catecholamines, and metalloproteinases (MMP) have an impact on vascular remodeling, particularly because of their capacity to increase oxidative stress and to impair nitric oxide (NO) activity in the vascular wall.
  • 505
  • 31 Jan 2024
Topic Review
Stress Echo in Asymptomatic Aortic Stenosis
Rest and stress echocardiography (SE) plays a pivotal role in the evaluation of valvular heart disease. The use of SE is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms. In aortic stenosis (AS), rest echocardiographic analysis is a stepwise approach that begins with the evaluation of aortic valve morphology and proceeds to the measurement of the transvalvular aortic gradient and aortic valve area (AVA) using continuity equations or planimetry. 
  • 499
  • 26 May 2023
Topic Review
Systemic Lupus Erythematosus and Arterial Hypertension
Systemic lupus erythematosus (SLE) is a multifactorial disorder with contributions from hormones, genetics, and the environment, predominantly affecting young women. Cardiovascular disease is the primary cause of mortality in SLE, and hypertension is more prevalent among SLE patients.
  • 489
  • 06 Dec 2023
Topic Review
Multimodality Imaging Diagnosis in Infective Endocarditis
Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices.
  • 484
  • 11 Jan 2024
Topic Review
Cardiac Drugs in ACHD-Related Heart Failure
Pharmacotherapy in adult CHD (ACHD) is largely supportive and is used to manage complications such as arrhythmias, heart failure (HF), and pulmonary hypertension in addition to interventional or surgical procedures.
  • 481
  • 12 May 2023
Topic Review
Physiological Roles of TRPM4 in the Heart
The transient receptor potential melastatin 4 (TRPM4) channel is a non-selective cation channel that activates in response to increased intracellular Ca2+ levels but does not allow Ca2+ to pass through directly. It plays a crucial role in regulating diverse cellular functions associated with intracellular Ca2+ homeostasis/dynamics. TRPM4 is widely expressed in the heart and is involved in various physiological and pathological processes therein. Specifically, it has a significant impact on the electrical activity of cardiomyocytes by depolarizing the membrane, presumably via Na+ loading. 
  • 477
  • 25 Jul 2023
Topic Review
Drug-Coated Balloons
Drug-coated balloons (DCB) are a well-established option for treating in-stent restenosis endorsed by European Guidelines on myocardial revascularization. However, in recent years, a strategy of “leaving nothing behind” with DCB in de novo coronary stenosis has emerged as an appealing approach.
  • 477
  • 12 Mar 2024
Topic Review
Targeting Collagen Pathways as an HFpEF Therapeutic Strategy
Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical syndrome, and the prevalence is expected to increase in the coming years. This condition poses a burden to the global health care system as the number of patients affected by this condition is constantly increasing due to a rising average lifespan. The absence of validated drugs effective in reducing hospitalization rates and mortality may reflect the impossibility of applying a one size fits all approach as in HFrEF, heading for a personalized approach. Available evidence demonstrated the link between collagen quantity and quality alterations, and cardiac remodeling. In the context of fibrosis, collagen cross-linking is strictly involved, displaying two types of mechanisms: enzymatic and non-enzymatic. In the murine model, enzymatic inhibition of fibrosis-inducing protease-activated receptor-1 (PAR1) and transforming growth factor (TGF)-β signaling appeared to reduce cardiac fibrosis. On the other hand, in the case of non-enzymatic cross-linking, sodium glucose co-transporter type 2 inhibitors (SGLT2is), appeared to counteract the deposition of advanced glycation end-products (AGEs), which in turn contributed to ventricular remodeling.
  • 476
  • 04 Jan 2024
Topic Review
Role of Genetics in Heart Failure Patients Management
The relevance of genetics in cardiovascular diseases has expanded, especially in the context of cardiomyopathies. Its relevance extends to the management of patients diagnosed with heart failure (HF), given its capacity to provide invaluable insights into the etiology of cardiomyopathies and identify individuals at a heightened risk of poor outcomes. Notably, the identification of an etiological genetic variant necessitates a comprehensive evaluation of the family lineage of the affected patients. In the future, these genetic variants hold potential as therapeutic targets with the capability to modify gene expression.
  • 474
  • 30 Oct 2023
Topic Review
Correlation of NETs to Atherosclerosis and Implication
Neutrophil extracellular traps (NETs) have attracted much attention recently, beyond elemental host immunity, due to their fundamental implication in a variety of pathologic conditions and widespread impactful diseases. Atherosclerotic cardiovascular disease (ASCVD) is one of them, and a major cause of mortality and disability worldwide. Consequently, years of basic and clinical research were dedicated to shedding light on every possible pathophysiologic mechanism that could be used as an effective prevention and treatment tool to ameliorate its burden. This led to the development of complex and prevention protocols and regimens that are now widely used, with lipid-lowering treatment being the current cornerstone; however, this is not adequate to alleviate the residual cardiovascular risk, which remains prominent. 
  • 474
  • 05 Mar 2024
Topic Review
Natural Antioxidant in Myocardial Infarction/Ischemic Stroke Injury Treatment
Natural antioxidants are present in low concentrations within cells. They reduce free radicals to provide a protection system against vascular diseases. They have a strong potential to inhibit oxidative stress (OS), lipid peroxidation and the oxidation of breakdown products. Natural antioxidants can function either individually or synergistically to remove free radicals generated during oxidative metabolism, thus maintaining the redox balance.
  • 473
  • 23 Oct 2023
Topic Review
Glucagon-Like Peptide-1 Receptor Agonists in Atherosclerosis
Atherosclerosis is a chronic inflammatory disease characterized by lipid and inflammatory cell deposits in the inner layer of large- and medium-sized elastic and muscular arteries. Diabetes mellitus (DM) significantly increases the risk of cardiovascular diseases and the overall and cardiovascular mortality, and it is a pro-atherogenic factor that induces atherosclerosis development and/or accelerates its progression through a multifactorial process. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a new class of drugs, belonging to the armamentarium to fight type 2 DM, that have shown robust reductions in atherosclerotic events and all-cause mortality in all studies.
  • 467
  • 04 Mar 2024
Topic Review
Novel MRI Tools for Hypertrophic Cardiomyopathy Risk Stratification
Hypertrophic cardiomyopathy (HCM) is a common genetic disorder with a well described risk of sudden cardiac death; however, risk stratification has remained a challenge. Recently, novel parameters in cardiac magnetic resonance imaging (CMR) have shown promise in helping to improve upon current risk stratification paradigms. 
  • 466
  • 28 Feb 2024
Topic Review
Four-Dimensional Flow Echocardiography in Congenital Heart Disease
Blood speckle tracking echocardiography (BSTE) is a new, promising 4D flow ultrafast non-focal plane imaging technique. BSTE is highly feasible, fast, and easy for visualization of normal/abnormal flow patterns in healthy children and in those with congenital heart disease (CHD). BSTE allows for visualization and basic 2D measures of normal/abnormal vortices forming the ventricles and in the main vessel. Left ventricular vortex characteristics and aortic flow patterns have been described both in healthy children and in those with CHD.
  • 464
  • 31 Jan 2024
Topic Review
Cardiovascular Computed Tomography in Cardiovascular Disease Diagnosis
The recent emergence of photon-counting computed tomography (CT) has further enhanced CT performance in clinical applications, providing improved spatial and contrast resolution. CT-derived fractional flow reserve is superior to standard CT-based anatomical assessment for the detection of lesion-specific myocardial ischemia. CT-derived 3D-printed patient-specific models are also superior to standard CT, offering advantages in terms of educational value, surgical planning, and the simulation of cardiovascular disease treatment, as well as enhancing doctor–patient communication. Three-dimensional visualization tools including virtual reality, augmented reality, and mixed reality are further advancing the clinical value of cardiovascular CT in cardiovascular disease.
  • 463
  • 24 Jan 2024
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