BACKGROUND: Colchicine, an anti-inflammatory agent, has been demonstrated to reduce adverse cardiovascular events in coronary artery disease (CAD) patients. Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) provide card...BACKGROUND: Colchicine, an anti-inflammatory agent, has been demonstrated to reduce adverse cardiovascular events in coronary artery disease (CAD) patients. Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) provide cardiovascular prevention beyond glycemic control including anti-inflammatory effect, and reduced heart failure risk. Given their complementary mechanisms, combining colchicine and SGLT2i may offer synergistic benefits in CAD patients with T2DM, yet the incremental effects of this combination remain underexplored. OBJECTIVE: This study aimed to assess the comparative effectiveness of combination therapy of SGLT2i with colchicine vs colchicine alone among patients with CAD and T2DM. METHODS: The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years of age from January 2015 to June 2024. Patients were categorized into two groups: one with a combination therapy of colchicine and SGLT2i and a control group with colchicine alone. Individuals were matched based on CVD risk factors and medications. After propensity score matching, Risk ratios (RR) were used to compare outcomes over follow-up periods of 6 months and 1 year. RESULTS: After 1:1 propensity score matching, the study cohort comprised 12,235 patients on colchicine and SGLT2i and 12,235 patients in the control group. The study population had a mean age of 71.5 ± 16.7 years. PSM analysis showed that combination therapy of colchicine and SGLT2i in CAD patients was associated with significantly lower risk of major adverse CVD events (MACE) after 6 month (RR, 0.70 (95 %CI 0.61-0.80), p < 0.01), after 1 year (RR, 0.78 (95 %CI 0.70-0.87), p < 0.01), all-cause mortality (ACM) after 6 month (RR, 0.50 (95 %CI 0.43-0.57), P < 0.01), after 1 year (RR, 0.57 (95 %CI 0.51-0.63), p < 0.01), heart failure excacerbation (HFE) after 6 month (RR, 0.80 (95 % CI 0.69-0.93), p < 0.01), after 1 year (RR, 0.81 (95 % CI 0.72-0.92), p < 0.01), and atrial fibrillation (AF) after 6 month (RR, 0.76 (95 %CI 0.63-0.91), p < 0.01) when compared with colchicine alone. However, the risks of ischemic stroke, acute myocardial infarction (AMI) and hemorrhagic stroke were comparable between the colchicine and SGLT2i groups and the colchicine alone group. CONCLUSION: This study suggests that SGLT2i use along with colchicine was associated with significantly lower risk of mortality, MACE, and HFE among CAD patients in comparison to colchicine alone.
Imaging of cardiovascular disease is undergoing profound growth and transformation as conventional imaging modalities are increasingly being augmented with molecular functional imaging with the desire to accelerate more...Imaging of cardiovascular disease is undergoing profound growth and transformation as conventional imaging modalities are increasingly being augmented with molecular functional imaging with the desire to accelerate more specific diagnosis, better quantify disease burden and prognosis, and ultimately provide more effective treatments and measures of success. Positron emission tomography (PET) with novel tracers can now target and image many molecular markers of various cardiovascular diseases, providing insight into changes in myocardial perfusion, fibrosis, metabolism, innervation, tissue repair, and inflammation that often proceeds irreversible structural changes and offers the opportunity for earlier and more targeted intervention via conventional therapy and theranostics concepts. Further, continued technologic advances in PET scanner technology and processing/quantification software (including artificial intelligence) further advances the utility of novel PET radiotracers by allowing for improved image quality and quantification, while reducing acquisition times and doses. While the future is exciting, much work needs to be done to identify and translate the most promising radiotracers to address the many unmet imaging needs of clinical cardiovascular practice.
The prevalence of heart failure (HF) in developed countries has reached epidemic proportions and continues to rise. Despite therapeutic advances, HF remains associated with significant morbidity and mortality and thus co...The prevalence of heart failure (HF) in developed countries has reached epidemic proportions and continues to rise. Despite therapeutic advances, HF remains associated with significant morbidity and mortality and thus constitutes a major public health problem that necessitates new treatment options. Cell therapy is a potential new approach to improve outcomes in HF that was first introduced two decades ago and has evolved significantly since then. Although the mechanism of action remains unclear and pivotal, large-scale trials have not been performed, numerous studies have demonstrated the safety of using various cell products in patients with HF, and several randomized, double-blind, Phase II or III trials have shown beneficial effects of cell therapy, particularly with mesenchymal stromal cells (MSCs), on clinical outcomes in ischemic and nonischemic cardiomyopathy, after administration of a single dose of cells. These potential efficacy signals, coupled with the robust record of safety, provide a solid rationale for pursuing further studies that will conclusively evaluate efficacy. New cell types, such as induced pluripotent cell-derived myocytes, and new strategies, such as repeated doses and intravenous delivery, are being tested in ongoing trials. In contrast, embryonic stem cells are unlikely to become a clinical therapy. Rigorous, well-designed, large clinical trials have the potential to pave the way for cell therapy to become a useful treatment option for patients with HF. This review summarizes the conceptual and clinical progress made in our understanding of cell therapy for HF, particularly over the past decade, and explores future horizons for the application of this treatment in HF.
BACKGROUND: Emerging evidence suggests that the Fit-Fat Index (FFI), which combines measures of fitness and fatness, may offer a more accurate assessment of cardiometabolic risk than either component alone. We aimed to i...BACKGROUND: Emerging evidence suggests that the Fit-Fat Index (FFI), which combines measures of fitness and fatness, may offer a more accurate assessment of cardiometabolic risk than either component alone. We aimed to investigate the prospective associations of cardiorespiratory fitness (CRF), fatness indices, and FFI variants with the risk of sudden cardiac death (SCD), and to evaluate their utility in SCD risk prediction. METHODS: Baseline assessments of CRF (measured using a respiratory gas exchange analyzer during exercise testing) and fatness indices (body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)) were conducted in 1662 men aged 42-61 years. FFI variants (FFI, FFI, and FFI) were calculated by dividing CRF by each corresponding fatness measure. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were estimated using Cox regression, and improvements in risk prediction were assessed using measures of discrimination and reclassification. RESULTS: Over a median follow-up of 28.3 years, 172 SCDs occurred. After adjustment for confounders and potential mediators, each 1 SD increase in CRF and FFI variants was associated with a significantly lower risk of SCD: HRs (95 % CI) were 0.68 (0.56-0.82) for CRF, 0.65 (0.53-0.79) for FFI, 0.66 (0.54-0.81) for FFI, and 0.65 (0.53-0.80) for FFI. BMI and WHtR, but not WHR, remained associated with SCD after full adjustment. CRF and all FFI variants significantly improved model fit, net reclassification, and discrimination (p < .001 for all). CONCLUSIONS: Higher levels of CRF and FFI variants were robustly associated with lower SCD risk and offered comparable improvements in prediction. These findings support their potential utility in clinical and research settings for SCD risk stratification.
Pande S, Varzideh F, Gambardella J
… +10 more, Jankauskas SS, Cerasuolo FA, Spinelli L, Kansakar U, De Luca A, Kurland IJ, Sidoli S, Iaccarino G, Sadoshima J, Santulli G
Prog Cardiovasc Dis
· 2025 · PMID 40840785
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Fabry disease or Anderson-Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A (GLA), leading to systemic accumulation of globotriaosyl-ceramide (Gb3). Initially described i...Fabry disease or Anderson-Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A (GLA), leading to systemic accumulation of globotriaosyl-ceramide (Gb3). Initially described in 1898 as a dermatological condition, Fabry disease is now recognized as a progressive multisystem disorder with significant cardiac involvement. Cardiomyopathy in Fabry disease arises from Gb3 accumulation in cardiac tissue, resulting in fibrosis, left ventricular hypertrophy (LVH), diastolic dysfunction, and heart failure. The deacylated derivative, lysoGb3, serves as a biomarker of cardiac involvement. Diagnosis relies on enzyme assays, genetic testing, and advanced cardiac imaging modalities like echocardiography and cardiac MRI. Management strategies are centered around enzyme replacement therapy, and prognosis varies due to phenotypic heterogeneity and severity of disease progression. Psychological and social burdens further complicate patient care. However, underdiagnosis remains a concerning issue, particularly in individuals with unexplained cardiomyopathies. Early recognition through increased clinical awareness and genetic screening is crucial for timely intervention. Ongoing research is essential to develop new therapies targeting the genetic and metabolic roots of the disease. This systematic review comprehensively examines current evidence regarding the mechanisms, diagnosis, treatment, and prognosis of cardiomyopathy associated with Fabry disease, providing insights that may enhance clinical practice and guide future research initiatives.
Ischemic cardiomyopathy (ICM) is a leading cause of heart failure globally. Myocardial viability testing aims to identify dysfunctional but potentially reversible myocardium in patients with ICM. This review examines the...Ischemic cardiomyopathy (ICM) is a leading cause of heart failure globally. Myocardial viability testing aims to identify dysfunctional but potentially reversible myocardium in patients with ICM. This review examines the clinical application and diagnostic performance of radionuclide imaging techniques including thallium-201 (Tl) and technetium-99 m (Tc) single positron emission tomography (SPECT), and flourine-18-flourodeoxyglucose (F-FDG) positron emission tomography (PET) for assessing myocardial viability. TI SPECT assesses viability via active myocardial uptake and delayed redistribution but is limited by prolonged protocols and suboptimal image quality. Tc-labeled agents (sestamibi and tetrofosmin) offer improved spatial resolution, shorter half-life, and higher photon energy, enabling faster imaging and better image quality. When combined with nitrate augmentation or gated imaging, Tc SPECT enhances detection of viable but under perfused myocardium. F-FDG PET is considered the gold standard modality for viability assessment due to its superior sensitivity, image quality and quantitative capabilities for myocardial blood flow. While observational studies associate viability with improved outcomes after revascularization, randomized trials have yielded mixed results. However, contemporary guidelines continue to support viability testing in selected high-risk patients. Emerging technologies including novel PET tracers, artificial intelligence, and hybrid imaging may further improve diagnostic accuracy and clinical utility of radionuclide viability testing. Radionuclide imaging remains a valuable tool in assessing myocardial viability in ICM. While PET offers superior diagnostic accuracy, SPECT remains widely used given its accessibility. Future studies incorporating modern imaging technologies and contemporary heart failure therapies are needed to clarify the role of viability testing in guiding revascularization strategies.
Cardiac sarcoidosis (CS) is an infiltrative cardiomyopathy characterized by non-caseating granulomatous inflammation that results in significant morbidity and mortality. It has become increasingly recognized over the pas...Cardiac sarcoidosis (CS) is an infiltrative cardiomyopathy characterized by non-caseating granulomatous inflammation that results in significant morbidity and mortality. It has become increasingly recognized over the past several decades; however, diagnosis remains challenging due to its heterogeneous nature and limited diagnostic yield of endomyocardial biopsy. As such, there has been increasing reliance on advanced cardiac imaging to aid in the diagnosis and management of CS. Fluorodeoxyglucose positron emission tomography (FDG-PET) has emerged as the most robust imaging modality and remains the preferred method for assessing active inflammation, treatment response, and surveillance. Nevertheless, it requires meticulous patient preparation and image acquisition to ensure optimal imaging and interpretation. This article aims to provide a comprehensive review of the various imaging modalities used for the diagnosis of CS, with a particular focus on the intricacies of FDG-PET, including the latest advancements in patient preparation and study interpretation. Other future directions for the diagnosis and management of CS will also be discussed.
Hypertrophic cardiomyopathy (HCM) is increasingly recognized as a condition involving not only the left ventricle but also the left atrium (LA). In this issue of Progress in Cardiovascular Diseases, Di Napoli et al. prov...Hypertrophic cardiomyopathy (HCM) is increasingly recognized as a condition involving not only the left ventricle but also the left atrium (LA). In this issue of Progress in Cardiovascular Diseases, Di Napoli et al. provide compelling evidence that longitudinal trajectories of LA remodeling offer stronger prognostic value for atrial fibrillation (AF), and sudden cardiac death (SCD) in patients with HCM than do static measurements. Using group-based trajectory modeling in a 35-year cohort, the authors identified three distinct phenotypes of LA enlargement. The most adverse phenotype was associated with a 9.3-fold increased risk of AF and a 3.6-fold increased risk of SCD. These findings support dynamic rather than static risk assessment strategies. This editorial explores the methodological and clinical implications of these insights, situating LA remodeling at the forefront of contemporary HCM management.
INTRODUCTION: Pregnancy induces significant metabolic changes, including altered lipid profiles, yet the role of lipoprotein(a) [Lp(a)] remains unclear. While Lp(a) levels rise during pregnancy and may be linked to compl...INTRODUCTION: Pregnancy induces significant metabolic changes, including altered lipid profiles, yet the role of lipoprotein(a) [Lp(a)] remains unclear. While Lp(a) levels rise during pregnancy and may be linked to complications like pre-eclampsia and gestational diabetes, existing studies show inconsistent findings. This meta-analysis aims to investigate Lp(a) levels in normal and high-risk pregnancy and its associated outcomes. METHODS: This meta-analysis followed PRISMA guidelines, systematically searching PubMed, Scopus, Web of Science, and Embase for studies comparing Lp(a) levels in normal pregnant vs. non-pregnant women, or high-risk vs. normal pregnancies. Data extraction, quality assessment, and statistical analysis were performed independently by two reviewers. Heterogeneity was assessed using I statistics, with sensitivity analyses and GRADE evaluating evidence certainty. RESULTS: Forty-one studies were included (31 meta-analyzed), predominantly small cross-sectional studies. Compared with non-pregnant women, Lp(a) levels were modestly higher in healthy pregnancy (MD = 5.02 mg/dL, p = 0.01; very low-certainty evidence - GRADE). In women with pre-eclampsia, Lp(a) levels were significantly elevated compared to normotensive pregnancies (MD = 11.92 mg/dL, 95 % CI: 7.68 to 16.16, p < 0.00001; very low-certainty evidence - GRADE). Subgroup analyses demonstrated that this association was consistent across different assay methods and was also observed in both early-onset (≤34 weeks; MD = 12.91 mg/dL) and late-onset (>34 weeks; MD = 10.60 mg/dL) pre-eclampsia. No significant difference was observed in women with gestational diabetes (MD = -8.85 mg/dL, p = 0.39; very low-certainty- GRADE). CONCLUSION: This meta-analysis found higher Lp(a) levels in pregnancy, especially in pre-eclampsia, but not in gestational diabetes. While these findings suggest a possible link between Lp(a) and hypertensive pregnancy complications, further studies are needed to confirm clinical relevance and establish predictive utility.
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive and life-threatening condition characterized by the deposition of misfolded transthyretin (TTR) protein in the myocardium, leading to restrictive cardiomyop...Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive and life-threatening condition characterized by the deposition of misfolded transthyretin (TTR) protein in the myocardium, leading to restrictive cardiomyopathy and heart failure. Given its high mortality rate and historically limited therapeutic options, there is a growing need for effective treatments. Current therapeutic strategies focus on reducing the production of TTR using RNA-targeted therapies and stabilizing the native TTR tetramer to prevent misfolding and aggregation. In recent years, emerging therapies-including monoclonal antibodies aimed at promoting amyloid clearance and gene-editing techniques designed to eliminate pathogenic TTR expression-have demonstrated encouraging results in early-phase studies. However, several challenges persist, including delays in diagnosis, variability in clinical response, and limited long-term outcome data. Early detection, timely initiation of treatment, and a personalized approach based on disease stage and genotype are critical to improving prognosis. Ongoing clinical trials are expected to provide further insight into the durability, safety, and broader applicability of these novel therapies, potentially reshaping the treatment landscape for ATTR-CM.
The treatment for atrial fibrillation has evolved significantly over time. Previously, medication management was the mainstay of treatment. As we have developed more robust technologies and modalities for catheter ablati...The treatment for atrial fibrillation has evolved significantly over time. Previously, medication management was the mainstay of treatment. As we have developed more robust technologies and modalities for catheter ablation, these treatment recommendations have changed. Catheter ablation is a safe and effective strategy for treating atrial fibrillation that is now considered first-line therapy in some patient populations. In this review, we discuss historical perspectives regarding the treatment and management of atrial fibrillation. We review the literature on studies investigating catheter ablation as first-line therapy, including the impact of catheter ablation on arrhythmia recurrence, cardiovascular outcomes, and healthcare utilization. Finally, we discuss future directions for the management of atrial fibrillation as the technology for catheter ablation continues to grow and progress.
Colivicchi F, Di Fusco SA, Gil Ad V
… +21 more, Castelletti S, Pollarolo L, Canale ML, Giubilato S, Rossini R, Oliva S, Tedeschi A, Greco A, Intravaia MR, Veneziano FA, Clavario P, Bilato C, Corda M, Geraci G, Iacovoni A, Navazio A, Nardi F, Gabrielli D, Grimaldi M, Oliva F, Cardiovascular Disease Prevention Area of the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), in collaboration with Cardio-oncology ANMCO Area and Management Quality ANMCO Area
Despite a decline in global smoking prevalence over recent decades, cigarette smoking remains one of the main modifiable risk factors for cardiovascular disease. The cardiovascular benefits of smoking cessation are well...Despite a decline in global smoking prevalence over recent decades, cigarette smoking remains one of the main modifiable risk factors for cardiovascular disease. The cardiovascular benefits of smoking cessation are well established; however, quitting smoking remains a major challenge. In this review, we aim to highlight useful tools to support smokers in their cessation journey. These include brief counseling, cognitive and behavioral interventions, and pharmacological therapies (e.g. nicotine replacement therapy, bupropion, varenicline). We also discuss evidence regarding eHealth-based interventions and the potential impact of e-cigarettes on smoking cessation. Finally, we focus on the role of public health interventions in promoting smoking cessation.
Atrial Fibrillation, dementia, and obesity are prevalent and interconnected pathologic states with significant morbidity and mortality and increasing global incidence. This review examines the current literature regardin...Atrial Fibrillation, dementia, and obesity are prevalent and interconnected pathologic states with significant morbidity and mortality and increasing global incidence. This review examines the current literature regarding the known and hypothesized relationships between these three conditions, their risk factors, and treatment strategies. We aim to highlight a stepwise and potentially causative interplay between them. As all three states become increasingly common in clinical practice, a detailed understanding of their multifactorial and multimodal relationship becomes critical for effective multidisciplinary care. Appropriate treatment of each is likely to reduce the burden of all three.