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Topic Review
Epicardial Adipose Tissue
The epicardial adipose tissue (EAT) is a metabolically active organ recently associated with heart failure and atrial fibrillation and classified as an independent risk factor for subclinical coronary artery disease. Some evidence suggests as the assessment of EAT using coronary artery calcium (CAC) might represent an additional tool to quantify patients’ cardiovascular risk.
  • 909
  • 28 Dec 2022
Topic Review
Artificial Intelligence (AI)-Empowered Echocardiography Interpretation
Echocardiography (Echo), a widely available, noninvasive, and portable bedside imaging tool, is the most frequently used imaging modality in assessing cardiac anatomy and function in clinical practice. Artificial-intelligence-empowered echo (AI-Echo) can potentially reduce inter-interpreter variability and indeterminate assessment and improve the detection of unique conditions as well as the management of various cardiac disorders.
  • 904
  • 28 Apr 2021
Topic Review
Saliva biomarkers for Heart Failure
Heart Failure (HF) is a clinical syndrome characterized by symptoms such as dyspnoea or fatigue on exertion or at rest, and clinical signs (i.e. lower extremity oedema, elevated jugular venous pressure, pulmonary crackles, etc.) caused by a structural and/or functional cardiac abnormality, ultimately leading to reduced cardiac output. Despite advances in the knowledge on HF, decisions on diagnosis and treatment of HF remain challenging. In everyday clinical practice, biomarkers such as plasma natriuretic peptides such as brain natriuretic peptide (BNP) and N-terminal fragment BNP (NT-proBNP), play an important role in HF diagnosis, therapy monitoring and risk stratification, while many other serum biomarkers have also been studied without definite evidence on how to use them in clinical practice. Biomarkers that could be measured in other biological fluids other than blood, easily and non-invasively, and outside the hospital setting, have attracted research interest. During the last years, saliva has emerged as a body fluid for this purpose.  This review assessed the potential role of salivary biomarkers in diagnosis and progression monitoring of patients with HF. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.
  • 904
  • 19 May 2021
Topic Review
Role of NADPH Oxidases in Pathologies
Nicotinamide adenine dinucleotide phosphate oxidases (NADPH oxidases, NOX), were discovered in immune cells, such as neutrophils and macrophages, in the 1970s. Upon phagocytosis of pathogens, the enzymatic complex is activated and triggers O2− production in an “oxidative burst” that acts to kill pathogens. Over time, enzymes with a similar function located in various tissues have been identified and subsequently grouped into the NOX family of enzymes. The mitochondrial electron transport chain was soon demonstrated as another source of O2− due to a “leaky” electron transport system, its O2− scavenged by superoxide dismutase (SOD) into H2O2.
  • 902
  • 29 Jun 2022
Topic Review
Bedside Ultrasound for Hemodynamic Monitoring in CICU
Thanks to the advances in medical therapy and assist devices, the management of patients hospitalized in cardiac intensive care unit (CICU) is becoming increasingly challenging. In fact, Patients in the cardiac intensive care unit are frequently characterized by dynamic and variable diseases, which may evolve into several clinical phenotypes based on underlying etiology and its complexity. Therefore, the use of noninvasive tools in order to provide a personalized approach to these patients, according to their phenotype, may help to optimize the therapeutic strategies towards the underlying etiology. Echocardiography is the most reliable and feasible bedside method to assess cardiac function repeatedly, assisting clinicians not only in characterizing hemodynamic disorders, but also in helping to guide interventions and monitor response to therapies. Beyond basic echocardiographic parameters, its application has been expanded with the introduction of new tools such as lung ultrasound (LUS), the Venous Excess UltraSound (VexUS) grading system, and the assessment of pulmonary hypertension, which is fundamental to guide oxygen therapy. 
  • 902
  • 05 Jan 2023
Topic Review
Hypertension and Arrhythmias
Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in patients already at risk of ischemic and/or haemorrhagic stroke and, consequently, disability and death.
  • 897
  • 25 Apr 2022
Topic Review
Current Management Strategies for Neurogenic Hypertension
Hypertension is a significant risk factor for renal impairment, other cardiovascular diseases, diabetes mellitus, and multiple end-organ damages. Nevertheless, a large pool of recent studies affirms a relatively higher incidence of sympathetic nerve activity (SNA) (as indicated by high levels of norepinephrine and plasma catecholamines) in hypertension unresponsive to conventional treatment, which is also referred to as resistance hypertension or neurogenic hypertension (NH). This strong association between an increase in SNA and elevated blood pressure (BP) forms the basis of NH: a form of hypertension mainly driven by a sympathetic mechanism. The complex nature of NH makes curative treatment difficult. Therefore, the current therapeutic approach to tackling NH aims at bringing BP under control to prevent any cardiovascular events and associated end-organ damage. In addition, surgical procedures that have been explored for NH management interfere with the sympathetic influence on cardiac function. Although several surgical approaches were adopted, only a few progresses toward preclinical stages and still lead to inconclusive outcomes. Both therapeutic and surgical approaches that have been implemented for the management of NH will be briefly discussed.
  • 897
  • 20 Feb 2023
Topic Review
Antioxidants in Arrhythmia Treatment
Antioxidants are substances that can prevent damage to cells caused by free radicals. Production of reactive oxygen species and the presence of oxidative stress play an important role in cardiac arrhythmias.
  • 895
  • 15 Jun 2022
Topic Review
Management of Acute Coronary Syndrome in Cancer Patients
Cancer patients have an increased risk of cardiovascular disease and, notably, a significant prevalence of acute coronary syndrome (ACS). It has been shown that an elevated presence of cardiovascular risk factors in this setting leads to an interaction between these two conditions, influencing their therapeutic strategies and contributing to higher mortality. 
  • 892
  • 28 Nov 2022
Topic Review
Macrophages as Potential Therapeutic Targets in Cardiovascular Disease
Cardiovascular disease (CVD) is one of the greatest public health concerns and is the leading cause of morbidity and mortality in the United States and worldwide. CVD is a broad yet complex term referring to numerous heart and vascular conditions, all with varying pathologies. Macrophages are one of the key factors in the development of these conditions. Macrophages play diverse roles in the maintenance of cardiovascular homeostasis, and an imbalance of these mechanisms contributes to the development of CVD.
  • 891
  • 15 Jul 2022
Topic Review
Monocytes in Chronic Heart Failure
A long-term condition known as chronic heart failure (CHF) is an ongoing difficulty of the heart in pumping blood enriched in oxygen and required nutrients around the body’s tissues. CHF pathogenesis is associated with various causes, and inflammation is one of the most important factors promoting the condition. In addition, monocytes, a group of cells present in the blood and infiltrating tissues, are known to participate in both pro- and anti-inflammatory processes and thus affect myocardial remodeling over time.
  • 890
  • 14 Feb 2022
Topic Review
Renin–Angiotensin-System-Induced Cardiac Remodelling
The renin–angiotensin system (RAS) indicates its central role in the pathogenesis of cardiovascular remodelling via both hemodynamic alterations and direct growth and the proliferation effects of angiotensin II or aldosterone resulting in the hypertrophy of cardiomyocytes, the proliferation of fibroblasts, and inflammatory immune cell activation. 
  • 887
  • 18 May 2021
Topic Review
ECG Signs in Cardiac Resynchronization Therapy Response Prediction
Cardiac resynchronization therapy (CRT) is a cornerstone therapeutic opportunity for selected patients with heart failure. For optimal patient selection, no other method has been proven to be more effective than the 12-lead ECG, and hence ECG characteristics are extensively researched. The evaluation of particular ECG signs before the implantation may improve selection and, consequently, clinical outcomes. The definition of a true left bundle branch block (LBBB) seems to be the best starting point with which to select patients for CRT. Although there are no universally accepted definitions of LBBB, using the classical LBBB criteria, some ECG parameters are associated with CRT response. In patients with non-true LBBB or non-LBBB, further ECG predictors of response and non-response could be analyzed, such as QRS fractionation, signs of residual left bundle branch conduction, S-waves in V6, intrinsicoid deflection, or non-invasive estimates of Q-LV which are described in newer publications. 
  • 885
  • 20 Nov 2023
Topic Review
Computer Modeling of the Heart
Computer modeling of the electrophysiology of the heart has undergone significant progress. A healthy heart can be modeled starting from the ion channels via the spread of a depolarization wave on a realistic geometry of the human heart up to the potentials on the body surface and the ECG.
  • 884
  • 25 Aug 2021
Topic Review
Statin Residual Cardiovascular Disease Risk
Several randomized, double blind, placebo-controlled trials (RCTs) have demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering by using statins, including high-doses of strong statins, reduced the development of cardiovascular disease (CVD). However, among the eight RCTs which investigated the effect of statins vs. placebos on the development of CVD, 56–79% of patients had the residual CVD risk after the trials. In three RCTs which investigated the effect of a high dose vs. a usual dose of statins on the development of CVD, 78–87% of patients in the high-dose statin arms still had the CVD residual risk after the trials. An analysis of the characteristics of patients in the RCTs suggests that elevated triglyceride (TG) and reduced high-density lipoprotein cholesterol (HDL-C), the existence of obesity/insulin resistance, and diabetes may be important metabolic factors which determine the statin residual CVD risk. 
  • 881
  • 06 Apr 2022
Topic Review
Cardiogenic Shock Complicating Acute Myocardial Infarction
Cardiogenic shock complicating acute myocardial infarction is a complex clinical condition associated with dismal prognosis. Routine early target vessel revascularization remains the most effective treatment to substantially improve outcomes, but mortality remains high. Temporary circulatory support devices have emerged with the aim to enhance cardiac unloading and improve end-organ perfusion.
  • 881
  • 21 Sep 2022
Topic Review
Myocardial Infarction with Non-Obstructive Coronary Arteries
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of conditions that include both atherosclerotic (coronary plaque disruption) and non-atherosclerotic (spontaneous coronary artery dissection, coronary artery spasm, coronary artery embolism, coronary microvascular dysfunction, and supply–demand mismatch) causes resulting in myocardial damage that is not due to obstructive coronary artery disease. Failure to identify the underlying cause may result in inadequate and inappropriate therapy in these patients.
  • 875
  • 20 Oct 2022
Topic Review
Primary Cilia in Acquired Heart Disease
Primary cilia are non-motile plasma membrane extrusions that display a variety of receptors and mechanosensors. Loss of function results in ciliopathies, which have been strongly linked with congenital heart disease, as well as abnormal development and function of most organ systems. 
  • 874
  • 24 Mar 2022
Topic Review
Definition of Hypertension and Establishment of Treatment Targets
Hypertension is the most frequent chronic and non-communicable disease all over the world, with about 1.5 billion affected individuals worldwide. Its impact is currently growing, particularly in low-income countries. Even in high-income countries, hypertension remains largely underdiagnosed and undertreated, with consequent low rates of blood pressure (BP) control.
  • 873
  • 21 Mar 2022
Topic Review
Cardiac Arrest
Cardiac arrest (CA) is a frequent cause of death and a major public health issue. To date, conventional cardiopulmonary resuscitation (CPR) is the only efficient method of resuscitation available that positively impacts prognosis. Extracorporeal membrane oxygenation (ECMO) is a complex and costly technique that requires technical expertise. It is not considered standard of care in all hospitals and should be applied only in high-volume facilities. ECMO combined with CPR is known as ECPR (extracorporeal cardiopulmonary resuscitation) and permits hemodynamic and respiratory stabilization of patients with CA refractory to conventional CPR. This technique allows the parallel treatment of the underlying etiology of CA while maintaining organ perfusion. However, current evidence does not support the routine use of ECPR in all patients with refractory CA. Therefore, an appropriate selection of patients who may benefit from this procedure is key. Reducing the duration of low blood flow by means of performing high-quality CPR and promoting access to ECPR, may improve the survival rate of the patients presenting with refractory CA. Indeed, patients who benefit from ECPR seem to carry better neurological outcomes.
  • 872
  • 25 Feb 2021
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