Cardiology In Review[JOURNAL]
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200 papers
Endoscopic Versus Open Radial Artery Harvesting in Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Balach R, Khalid A, Qadri FH … +6 more , Zafar A, Ahmed M, Rahman MF, Daniyal SM, Ahmad A, Musani MH
Cardiol Rev · 2026 Jun · PMID 42308352 · Publisher ↗
The radial artery is a commonly used conduit in coronary artery bypass grafting (CABG) due to its favorable long-term patency. However, conventional open radial artery harvesting (ORAH) is associated with wound and neuro...
The radial artery is a commonly used conduit in coronary artery bypass grafting (CABG) due to its favorable long-term patency. However, conventional open radial artery harvesting (ORAH) is associated with wound and neurological morbidity. Endoscopic radial artery harvesting (ERAH) has emerged as a minimally invasive alternative, but its comparative safety and efficacy remain uncertain. PubMed, ScienceDirect, and the Cochrane Library were systematically searched from inception to January 2026 for randomized controlled trials comparing ERAH with ORAH in patients undergoing CABG. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Primary outcomes included wound infection, overall wound complications, and neurological complications. Secondary outcomes included graft patency, hematoma, neurological deficit, stenosis, occlusion, and mortality. Eight randomized controlled trials involving 914 patients were included. ERAH was associated with a significantly lower risk of overall wound complications (RR: 0.51; 95% CI, 0.32-0.79; P = 0.003), hematoma (RR: 0.24; 95% CI, 0.07-0.78; P = 0.02), and neurological deficits (RR: 0.47; 95% CI, 0.36-0.62; P < 0.0001) compared with ORAH. No significant differences were observed in wound infection, overall neurological complications, graft patency, stenosis, occlusion, or mortality. ERAH reduces wound complications, hematoma, and neurological deficits without compromising graft patency or increasing mortality, supporting its use as a safe minimally invasive alternative to ORAH in CABG. Registration: PROSPERO (CRD420261333569).
Glucagon-Like Peptide-1 Receptor Agonists in Cardiovascular Disease: Redefining Therapy Through Cardiometabolic Substrate Modification.
Ramadan A, Aglan A, Salama B … +4 more , Abdalla M, Fath A, Frishman WH, Aronow WS
Cardiol Rev · 2026 Jun · PMID 42307757 · Publisher ↗
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have moved from the margins of diabetes care to the center of cardiovascular medicine. Although initially developed as glucose-lowering agents, their most important cl...
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have moved from the margins of diabetes care to the center of cardiovascular medicine. Although initially developed as glucose-lowering agents, their most important clinical effects arise from broader actions on body weight, vascular biology, inflammation, and metabolic stress. Randomized trials have established that several GLP-1RAs reduce major adverse cardiovascular events and mortality in patients with type 2 diabetes and, more recently, in individuals with overweight or obesity and established cardiovascular disease without diabetes. However, their cardiovascular effects are not uniform across syndromes. The clearest benefit is observed in atherosclerotic disease, whereas their role in heart failure is phenotype-specific and largely confined to obesity-associated heart failure with preserved ejection fraction. Emerging data suggest that GLP-1RAs may also influence arrhythmic risk and outcomes in selected populations, although these observations remain hypothesis-generating. Together, these findings support a unifying concept: GLP-1RAs function as cardiometabolic substrate-modifying therapies, acting through effects on weight, inflammation, vascular biology, myocardial energetics, and autonomic regulation. This framework provides a coherent explanation for their heterogeneous clinical profile and supports a phenotype-directed approach to their use in contemporary cardiovascular care.
Ischemia-Modified Albumin: Review of a Novel Cardiac Biomarker and Its Clinical Applications in Cardiovascular Disease.
Furqan MS, Frishman WH, Aronow WS
Cardiol Rev · 2026 Jun · PMID 42302744 · Publisher ↗
Ischemia-modified albumin (IMA) is a structurally altered form of human serum albumin produced within minutes of myocardial ischemia, well before the onset of irreversible cell injury detectable by cardiac troponin. Meas...
Ischemia-modified albumin (IMA) is a structurally altered form of human serum albumin produced within minutes of myocardial ischemia, well before the onset of irreversible cell injury detectable by cardiac troponin. Measured via the albumin cobalt-binding assay-the first Food and Drug Administration-approved serum marker for cardiac ischemia-IMA has been extensively investigated as an adjunct to electrocardiography and troponin for the early evaluation of acute chest pain in the emergency department. When used as part of a triple-test strategy combining IMA, troponin, and electrocardiogram, sensitivities exceeding 90-95% for acute coronary syndrome (ACS) exclusion have been reported, with 2 meta-analyses confirming significantly elevated IMA concentrations across ACS subtypes. Beyond diagnosis, IMA carries independent prognostic significance: elevated levels predict adverse outcomes at 1 year after acute myocardial infarction and correlate with the presence of critical coronary artery stenosis on angiography. IMA is not endorsed by current American College of Cardiology/American Heart Association guidelines for ACS evaluation, largely because of its low specificity and marked elevation in noncardiac conditions including pulmonary embolism, stroke, and heart failure. This review examines clinical evidence for IMA in cardiovascular disease, critically appraises its diagnostic limitations, and discusses its potential role as a complementary biomarker of ischemia-without-necrosis in the era of high-sensitivity troponin.
Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Postablation Atrial Fibrillation Recurrence: A Systematic Review and Meta-Analysis.
Adnan Y, Thirupathy U, Abouayana A … +12 more , Elsammani A, Deiab AT, Abdelrahman MAG, Hussein MJA, Ali MU, Nawaz M, Basu S, Natesan TA, Ahmad A, Abouayana AEA, Ali SM, Volucke G
Cardiol Rev · 2026 Jun · PMID 42302741 · Publisher ↗
Postablation atrial fibrillation (AF) recurrence remains an important clinical challenge. Recent evidence suggests sodium-glucose cotransporter 2 inhibitors (SGLT2i) may reduce AF recurrence, but comprehensive data are l...
Postablation atrial fibrillation (AF) recurrence remains an important clinical challenge. Recent evidence suggests sodium-glucose cotransporter 2 inhibitors (SGLT2i) may reduce AF recurrence, but comprehensive data are limited. Electronic databases were systematically searched to identify studies evaluating clinical outcomes in patients with AF undergoing catheter ablation who received SGLT2i compared with those not receiving SGLT2i therapy. The primary outcome of interest was AF recurrence. Secondary outcomes included all-cause mortality and rehospitalization. Pooled effect estimates were calculated using random-effects models. The meta-analysis included 14 studies comprising 20,996 patients. Mean patient age was 65.9 ± 8.1 years, and mean follow-up duration was 16.4 months. SGLT2i therapy was associated with a significantly reduced risk of postablation AF recurrence compared to control (risk ratios [RRs]: 0.65, 95% confidence intervals [CIs], 0.58-0.72, P < 0.0001). Secondary outcomes demonstrated reductions in all-cause mortality (RR: 0.67, 95% CI, 0.49-0.93, P = 0.01) and rehospitalizations (RR: 0.80, 95% CI, 0.72-0.88, P < 0.0001). Moderate heterogeneity was observed for the primary outcome (I2 = 47.6%), but subgroup analyses showed no significant interaction by study design (P = 0.83). SGLT2i therapy is associated with a substantial reduction in postablation AF recurrence and improved cardiovascular outcomes. However, the evidence is predominantly observational; large-scale randomized controlled trials are needed to confirm these benefits and refine clinical guidelines.
Chocolate and Cardiovascular Disease.
Manolis AA, Manolis TA, Vouliotis A … +1 more , Manolis AS
Cardiol Rev · 2026 Jun · PMID 42298350 · Publisher ↗
Moderate dark chocolate consumption may serve as a possible adjunct strategy to diminish cardiometabolic and cardiovascular (CV) risks due to its physiological and potential CV and general health effects, such as the reg...
Moderate dark chocolate consumption may serve as a possible adjunct strategy to diminish cardiometabolic and cardiovascular (CV) risks due to its physiological and potential CV and general health effects, such as the regulation of blood pressure, insulin levels, vascular functions, oxidation processes, prebiotic effects, glucose homeostasis, lipid metabolism, and a reduction in the risk of CV disease and mortality. Chocolate, particularly dark chocolate, is known for its antioxidant properties, ascribed to its content of cocoa flavonoids that promote CV health. Enriching chocolate with phytosterols, known to be effective in reducing cholesterol levels, has the potential to further enhance its CV benefits. Such an enrichment provides a palatable and cost-effective means of delivering these beneficial compounds to the body, improves its nutritional profile and functional properties, and also renders it a potential dietary supplement for cholesterol management. Also, chocolate is an energy-dense food rich in bioactive compounds such as polyphenols, amino acids, and alkaloids. Studies have demonstrated certain benefits of moderate consumption via the reduction of oxidative and inflammatory burden, possible improvement of cognitive function, and maintenance of diversity in gut microbiota. Based on the data herein presented, chocolate may constitute an important part of a CV healthy diet when used in moderation. Nevertheless, further translational and epidemiologic studies are needed to corroborate current results, assess other possible effects, and provide guidance on how best to employ chocolate in the daily diet in terms of quantity, type, and time.
Improving Heart Failure Outcomes Through Telehomecare: A Comprehensive Review of Technologies in Practice.
Canizares M, Hale G
Cardiol Rev · 2026 Jun · PMID 42298340 · Publisher ↗
This project evaluated telehomecare technologies in the management of heart failure, with a focus on comparing invasive and noninvasive devices and impact on clinical outcomes, hospitalizations, and patient self-manageme...
This project evaluated telehomecare technologies in the management of heart failure, with a focus on comparing invasive and noninvasive devices and impact on clinical outcomes, hospitalizations, and patient self-management. A literature review was conducted using PubMed to identify studies published in adults between 2015 and 2024 that examined telehomecare and telemonitoring interventions in heart failure. Search terms included telehealth, telehomecare, telemonitoring, and heart failure. Eligible studies included randomized controlled trials, observational studies, systematic reviews, and meta-analyses evaluating both invasive and noninvasive technologies. Across the reviewed studies, several invasive and noninvasive telehomecare interventions were identified that were associated with improvements in clinical and patient-centered outcomes. Remote monitoring enabled earlier detection of clinical deterioration, reduced all-cause and heart failure-related hospitalizations, and enhanced patient engagement and self-management. Benefits were greatest when monitoring tools were used consistently, integrated into structured care programs, and supported by timely clinical follow-up. Telehomecare represents an effective and patient-centered approach to heart failure management. Invasive monitoring devices provide strong evidence and benefits for high-risk patients through continuous physiologic assessment, while noninvasive tools offer accessible solutions for daily monitoring and self-management. When incorporated into coordinated care models, telehomecare improves outcomes and reduces the burden of heart failure.
Olezarsen for Hypertriglyceridemia: A New Therapy Update with Systematic Review and Meta-Analysis.
Khan N, Shahid H, Choudhry HHA … +15 more , Irshad M, Shaikh HA, Shahid S, Afridi FN, Mian SM, Mateen L, Khan H, Shereen M, Majeed E, Javaid M, Hassan S, Bashir S, Khan MM, Abdullah A, Bacha Z
Cardiol Rev · 2026 Jun · PMID 42298338 · Publisher ↗
Hypertriglyceridemia is a frequently seen lipid disorder. It is linked to a higher risk of cardiovascular diseases and adds a significant burden on healthcare systems. Olezarsen, a novel antisense therapy targeting apoli...
Hypertriglyceridemia is a frequently seen lipid disorder. It is linked to a higher risk of cardiovascular diseases and adds a significant burden on healthcare systems. Olezarsen, a novel antisense therapy targeting apolipoprotein C-III, offers effective triglyceride reduction with the convenience of infrequent dosing. This meta-analysis evaluates the safety and efficacy of olezarsen in hypertriglyceridemia to guide clinical decision-making. A comprehensive literature search across major databases identified randomized control trials comparing olezarsen with usual care in patients with hypertriglyceridemia. Data extraction and bias assessment were conducted independently, using RoB 2.0 and the GRADE framework. A meta-analysis was performed using RevMan 5.4.1, applying random effects models and assessing heterogeneity with the I2 statistic. Eight randomized controlled trials were included. Olezarsen significantly reduced triglycerides (MD -58.57, 95% CI -63.10 to -54.04; I2 = 13%) and apolipoprotein C-III (MD -69.81, 95% CI -75.77 to -63.84; I2 = 56%). Significant improvements were also observed in apolipoprotein B, nonhigh-density lipoprotein cholesterol, and achievement of TAG targets (<150 mg/dL). There was no increase in overall or serious adverse events, although injection-site reactions, liver enzyme elevations, and treatment discontinuation were higher with olezarsen. Olezarsen significantly improves TAG levels and atherogenic lipid parameters in patients with hypertriglyceridemia, demonstrating robust efficacy across multiple outcomes. It maintains an overall favorable safety profile, supporting its role as a promising therapeutic option, although monitoring for liver enzymes and injection-site reactions is warranted.
Efficacy and Safety of Catheter Ablation in Atrial Fibrillation With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis.
Bai A, Kumar H, Niazi RK … +1 more , Heema S
Cardiol Rev · 2026 Jun · PMID 42298326 · Publisher ↗
The aim is to evaluate the impact of catheter ablation (CA) versus medical therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF), focusing on mortality, heart failure...
The aim is to evaluate the impact of catheter ablation (CA) versus medical therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF), focusing on mortality, heart failure (HF) hospitalizations, and left ventricular ejection fraction (LVEF). We conducted a systematic review and meta-analysis of 11 randomized controlled trials and randomized controlled trial-derived studies comparing CA with medical therapy for AF patients with HFrEF. Databases including PubMed, Embase, and Cochrane Library were searched up to December 2025. Outcomes included all-cause mortality, HF hospitalizations, change in LVEF, AF recurrence, and quality of life. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate certainty. A total of 11 studies comprising over 2100 patients were included. CA significantly reduced all-cause mortality [risk ratio = 0.61, 95% confidence interval (CI): 0.45-0.83] and HF hospitalizations (risk ratio = 0.68, 95% CI: 0.50-0.91). LVEF improved by a mean of 6.4% (95% CI: 4.2-8.7) in the ablation group. AF recurrence and quality of life also favored CA. Sensitivity analyses confirmed the robustness of findings. In patients with HFrEF and AF, CA significantly improves survival, reduces HF hospitalizations, and enhances cardiac function, supporting its role as a disease-modifying therapy.
Single Coronary Artery: A Comprehensive Review.
Zhang J, Yuan M
Cardiol Rev · 2026 Jun · PMID 42296394 · Publisher ↗
Single coronary artery (SCA) is a rare congenital coronary anomaly. This condition may lead to myocardial ischemia, angina pectoris, and even sudden cardiac death. Generally speaking, if there are no other heart abnormal...
Single coronary artery (SCA) is a rare congenital coronary anomaly. This condition may lead to myocardial ischemia, angina pectoris, and even sudden cardiac death. Generally speaking, if there are no other heart abnormalities, a SCA can be entirely asymptomatic. However, it may also pose a serious threat to health and survival. A thorough understanding of its anatomical and clinical characteristics is essential for accurate diagnosis and risk assessment. Medical imaging plays an important role in the diagnosis of a SCA. Precise imaging not only enables identification of the anomaly subtype but also allows comprehensive evaluation of coronary anatomy, myocardial perfusion, and concomitant lesions, thereby providing critical guidance for clinical decision-making. From echocardiography and conventional coronary angiography to noninvasive modalities such as computed tomography angiography and magnetic resonance angiography, each imaging technique has distinct clinical applications. Based on current literature, this review focuses on recent advances in SCA, systematically summarizing its clinical and anatomical characteristics, major classification systems, imaging diagnosis, clinical implications, and high-risk patterns, with the aim of providing a reference for precise diagnosis and therapeutic strategies.
Adipose Tissue Memory and Why Patients Regain Weight after Weight Loss: Understanding the Immunologic Basis for Recurrent Cardiovascular Risk.
Sami N, Parikh MA, Mihatov N … +3 more , Schwartzman ML, Frishman WH, Peterson SJ
Cardiol Rev · 2026 Jun · PMID 42296333 · Publisher ↗
Weight loss remains one of the primary strategies for reducing cardiometabolic risk, particularly with the advent of glucagon-like peptide-1 receptor agonists, which have been demonstrated to induce significant weight lo...
Weight loss remains one of the primary strategies for reducing cardiometabolic risk, particularly with the advent of glucagon-like peptide-1 receptor agonists, which have been demonstrated to induce significant weight loss. Recent evidence suggests, however, that weight loss does not completely normalize the underlying biology of obesity. When weight loss medications are discontinued, patients may regain lost weight along with an increase in cardiometabolic disease risk, indicating that these medications may contribute to transiently altering the phenotype of obesity, but do not produce long-term remission. Adipose tissue is increasingly recognized as an active organ regulating systemic inflammation and metabolic homeostasis. In obesity, adipose tissue becomes inflamed through the activation of innate and adaptive immune pathways. This response has a lasting effect on the immune system. T cells in adipose tissue develop memory-like qualities via epigenetic and transcriptional reprogramming and can persist after weight loss, ready for rapid activation upon renewed metabolic stress. These immunologic memory effects drive repeated weight gain, progressive metabolic dysfunction, and ongoing cardiovascular risk. An immune process is working alongside the endocrine and metabolic adjustments that facilitate energy conservation and fat regain. The repetitive cycles of weight loss and regain further amplify these responses, leading to greater inflammation. Memory T-cell populations are maintained primarily through the CD70-CD27 axis; therefore, targeting this axis may be an effective approach to developing therapies that modify immune memory and achieve long-term cardiometabolic remission when combined with weight loss.
Comparable Assessment of Perioperative and Postoperative Outcomes in Open Versus Endoscopic Radial Artery Harvest for Patients Undergoing CABG: A Systematic Review and Meta-Analysis.
Meghwar S, Parvez A, Abbasi SUAM … +7 more , Fatima M, Kumar D, Lohano G, Hashmi MUH, Jabeen L, Sahil F, Singh K
Cardiol Rev · 2026 Jun · PMID 42277585 · Publisher ↗
Coronary artery bypass grafting (CABG) is the standard treatment for multivessel coronary disease. The radial artery (RA) is commonly used because of its good long-term outcomes. RA can be harvested using either endoscop...
Coronary artery bypass grafting (CABG) is the standard treatment for multivessel coronary disease. The radial artery (RA) is commonly used because of its good long-term outcomes. RA can be harvested using either endoscopic or open techniques, but the optimal method remains unclear. This systematic review and meta-analysis compares outcomes between both approaches in CABG procedures. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Embase, Cochrane Library, and Scopus were searched up to January 2026 for randomized controlled trials comparing endoscopic versus open RA harvesting in CABG. Data were analyzed using a random-effects model in R (version 4.5.2), with risk of bias 2 used for bias assessment. Outcomes assessed included wound and neurological complications, along with graft patency, mortality, and reoperation. Pooled analysis showed a significant reduction in wound infections (risk ratio, 0.58; P = 0.03) and neurological complications (risk ratio, 0.47; P < 0.0001) with endoscopic compared with conventional open harvesting, with consistent results across various follow-up periods. Graft patency showed similar results in both groups (P = 0.49), with no significant differences in reoperation (P = 0.33), in-hospital/30-day mortality (P = 0.47), or length of hospital stay (P = 0.16). However, endoscopic harvesting showed a significant increase in harvest time compared with open harvesting (mean difference, 11.44 minutes; P = 0.04), with no significant differences in aortic clamp time (P = 0.96). Endoscopic RA harvesting in CABG surgery showed significantly reduced wound infections and neurological complications without affecting graft patency or short-term outcomes.
Right Ventricular Remodeling in Repaired Tetralogy of Fallot: Imaging, Arrhythmia Risk, and Timing of Pulmonary Valve Replacement.
Fatima H, Akram MB, Sher A … +4 more , Rana MA, Nawaz Z, Masood MA, Fatima M
Cardiol Rev · 2026 Jun · PMID 42277580 · Publisher ↗
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and advances in surgical repair have enabled survival into adulthood for most patients. However, long-term survival after repair is frequent...
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and advances in surgical repair have enabled survival into adulthood for most patients. However, long-term survival after repair is frequently complicated by progressive right ventricular (RV) remodeling driven by chronic pulmonary regurgitation, residual RV outflow tract obstruction, myocardial fibrosis, and electromechanical dyssynchrony. RV remodeling in repaired TOF (rTOF) is a dynamic process characterized by RV dilatation, altered geometry, declining systolic and diastolic function, interventricular interaction, and arrhythmogenic substrate formation. These structural and electrophysiologic changes underpin the late burden of ventricular arrhythmias, heart failure, and sudden cardiac death in this population. Multimodality imaging has become central to surveillance and risk stratification, with echocardiography providing longitudinal bedside assessment, cardiovascular magnetic resonance serving as the reference standard for RV volumes and tissue characterization, computed tomography aiding procedural planning, and emerging deformation imaging refining subclinical functional assessment. Pulmonary valve replacement (PVR), whether surgical or transcatheter, remains the principal intervention to reduce pulmonary regurgitation and mitigate RV volume overload, yet the optimal timing of intervention remains controversial. Delayed PVR risks irreversible RV dysfunction and arrhythmia progression, whereas premature intervention may expose patients to additional valve-related reinterventions over a patient's lifetime, emphasizing the importance of optimizing long-term procedural durability. This narrative review synthesizes contemporary evidence on the mechanisms and phenotypes of RV remodeling in rTOF, the role of multimodality imaging in defining adverse remodeling, the relationship between RV structural change and arrhythmia risk, and current concepts guiding the timing of PVR. A precision-based framework integrating imaging, electrophysiology, and clinical trajectory is proposed to optimize longitudinal management in this growing adult congenital population.
Exosome Therapy: A Novel Investigational Approach in Acute Myocardial Infarction.
Joshi A, Gupta R, Sangdup T … +2 more , Jacob J, Aggarwal A
Cardiol Rev · 2026 Jun · PMID 42277569 · Publisher ↗
Despite major advances in reperfusion therapy and pharmacological management, acute myocardial infarction (AMI) remains one of the leading causes of mortality and morbidity worldwide. Conventional treatment strategies pr...
Despite major advances in reperfusion therapy and pharmacological management, acute myocardial infarction (AMI) remains one of the leading causes of mortality and morbidity worldwide. Conventional treatment strategies primarily focus on restoring coronary blood flow to ischemic myocardium; however, their ability to regenerate damaged cardiac tissue remains limited. In recent years, exosomes have emerged as a promising cell-free therapeutic approach for cardiac repair following AMI. Exosomes are nanosized extracellular vesicles secreted by various cell types that carry diverse bioactive molecules, including microRNAs, proteins, lipids, and signaling factors, which mediate intercellular communication and regulate multiple biological processes involved in myocardial healing. Emerging experimental and preclinical evidence suggests that exosome-based therapy may attenuate inflammation, reduce cardiomyocyte apoptosis, enhance angiogenesis, modulate immune responses, and promote myocardial regeneration following ischemic injury. Compared with conventional stem cell therapy, exosomes offer several advantages, including lower immunogenicity, reduced risk of tumorigenicity, improved stability, and easier storage and handling. Furthermore, engineered exosomes and targeted delivery systems are being investigated to enhance therapeutic specificity and efficacy in cardiovascular diseases. In addition to their therapeutic potential, circulating exosomes are also being explored as diagnostic and prognostic biomarkers for the early detection and monitoring of AMI. This review highlights the biological characteristics of exosomes, their mechanisms of action in myocardial repair, current experimental and clinical evidence, and future perspectives of exosome-based therapeutics in the management of AMI.
Blood Culture-Negative Infective Endocarditis: A Review.
Kaushik S, Borck J, Flatow E … +2 more , Frishman WH, Aronow WS
Cardiol Rev · 2026 Jun · PMID 42271556 · Publisher ↗
Blood culture-negative infective endocarditis (BCNIE) represents a diagnostically challenging subset of infective endocarditis in which routine blood cultures remain negative despite fulfillment of Duke-ISCVID diagnostic...
Blood culture-negative infective endocarditis (BCNIE) represents a diagnostically challenging subset of infective endocarditis in which routine blood cultures remain negative despite fulfillment of Duke-ISCVID diagnostic criteria. BCNIE arises primarily from prior antibiotic exposure, infection with fastidious or nonculturable organisms, or noninfectious conditions that mimic endocarditis. Common fastidious pathogens include Coxiella burnetii, Bartonella species, Brucella species, Tropheryma whipplei, fungi, and nutritionally variant streptococci. Because delayed pathogen identification may postpone targeted therapy, BCNIE is associated with increased diagnostic complexity and substantial morbidity and mortality. Modern evaluation relies on a multimodal strategy integrating serologic testing, prolonged culture incubation, histopathology, advanced molecular diagnostics, and multimodality imaging. Emerging molecular techniques, including 16S/18S polymerase chain reaction and metagenomic next-generation sequencing, have significantly improved microbiologic yield, particularly from excised valve tissue, and are now incorporated into updated Duke-ISCVID criteria. Echocardiography remains central to diagnosis, while cardiac computer tomography and 18 fluoro-2-deoxy-D-glucose positron emission tomography/computer tomography provide complementary value in prosthetic valve disease and detection of periannular complications. Management requires empiric antimicrobial therapy followed by organism-directed treatment once a pathogen is identified, with surgery frequently necessary for heart failure, uncontrolled infection, fungal disease, or structural complications. Multidisciplinary endocarditis teams are increasingly recognized as essential to optimizing outcomes in this complex disease process.
Multivessel Spontaneous Coronary Artery Dissection With Cardiogenic Shock: A Systematic Review.
Kovatsenko E, Battisha A
Cardiol Rev · 2026 Jun · PMID 42269022 · Publisher ↗
Spontaneous coronary artery dissections (SCAD) are characterized by tears of nonatherosclerotic etiology within coronary vessels. This clinical entity promotes intravascular hematoma formation, which can compress the art...
Spontaneous coronary artery dissections (SCAD) are characterized by tears of nonatherosclerotic etiology within coronary vessels. This clinical entity promotes intravascular hematoma formation, which can compress the arterial lumen and obstruct coronary blood flow. Subsequent limitations in coronary perfusion facilitate an environment within the myocardium conducive to acute coronary syndrome and cardiogenic shock from relative hemodynamic perturbation. Although SCAD has been reported in the literature, there is a dearth of literature reporting the management of multivessel SCAD, with no official guidelines available for reference. We present a systematic review of the clinical management of multivessel SCAD within the context of subsequent cardiogenic shock in hopes of generating a dialogue to reach cogent approaches to minimize morbidity and mortality in multivessel SCAD management.
Gastrointestinal Endoscopic Interventions During Antithrombotic Therapy: A Comprehensive Review of Bleeding Risk and Periprocedural Management.
Alkasabrah O, Maniyar P, Ibrahim EA … +6 more , Ibrahim S, Eldesouki MH, Chaudhry MQ, Agrawal SP, Frishman WH, Aronow WS
Cardiol Rev · 2026 Jun · PMID 42269020 · Publisher ↗
The increasing use of antiplatelet and anticoagulant therapy has made periprocedural management a central issue in patients undergoing diagnostic and therapeutic endoscopy. Upper endoscopy and colonoscopy are commonly pe...
The increasing use of antiplatelet and anticoagulant therapy has made periprocedural management a central issue in patients undergoing diagnostic and therapeutic endoscopy. Upper endoscopy and colonoscopy are commonly performed in patients receiving aspirin, P2Y12 receptor inhibitors, warfarin, or direct oral anticoagulants, and the clinical decision to continue, interrupt, or bridge therapy requires balancing procedure-related bleeding against thromboembolic risk. Diagnostic esophagogastroduodenoscopy and colonoscopy with mucosal biopsy are generally low-risk procedures and can usually be performed without interruption of most antithrombotic agents. In contrast, colonoscopic polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, and other advanced therapeutic interventions carry a higher delayed bleeding risk, particularly in patients receiving anticoagulants or multiple antithrombotic drugs. Current society guidelines generally support continuation of aspirin, temporary interruption of P2Y12 receptor inhibitors for elective high-risk procedures when thrombotic risk permits, brief interruption of direct oral anticoagulants for high-risk interventions, and avoidance of routine heparin bridging except in selected patients with very high thromboembolic risk. Evidence from randomized trials, cohort studies, and meta-analyses supports cold snare polypectomy as a bleeding-sparing technique for small colorectal polyps, especially in anticoagulated patients.
Interpreting Coronary Perfusion Endpoints: A Multidimensional Framework for Physiologic and Clinical Integration.
Manglik A, Qu Y
Cardiol Rev · 2026 Jun · PMID 42269017 · Publisher ↗
Third-generation β-blockers such as carvedilol and nebivolol exhibit vasodilatory properties mediated through α1-adrenergic antagonism and nitric oxide-related pathways, respectively. Although these mechanisms are well s...
Third-generation β-blockers such as carvedilol and nebivolol exhibit vasodilatory properties mediated through α1-adrenergic antagonism and nitric oxide-related pathways, respectively. Although these mechanisms are well supported by receptor-level and ex vivo data, their translation into definitive human vascular effects remains incompletely defined. Human interventional studies have primarily relied on composite perfusion endpoints, including coronary flow reserve, which are influenced by heart rate, myocardial oxygen demand, perfusion pressure, and extravascular compression. Consequently, changes in these indices reflect integrated hemodynamic effects, limiting mechanistic specificity. Existing literature has largely characterized these endpoints individually or in relation to clinical outcomes, with less emphasis on interpretation of underlying physiologic mechanisms. This review proposes a structured, context-dependent framework in which coronary flow reserve, the index of microcirculatory resistance, an invasive measure of minimal microvascular resistance, and microvascular resistance reserve, a metric of vasodilatory reserve utilization, are interpreted in combination to contextualize dominant physiologic contributors across disease states. Although precise mechanistic attribution remains limited in vivo, this hypothesis-generating approach may provide a more coherent basis for interpreting perfusion-based endpoints. When applied in appropriate clinical contexts, it may improve characterization of pharmacologic vascular effects and inform future studies aimed at distinguishing intrinsic microvascular responses from systemic influences.
Early Aspirin Discontinuation Postacute Coronary Syndrome: A New Approach to Postmyocardial Infarction Management.
Greenberg T, Kusayev J, Frishman WH … +1 more , Aronow WS
Cardiol Rev · 2026 Jun · PMID 42269016 · Publisher ↗
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor for 12 months has long been the official guideline for patients with acute coronary syndrome treated with percutaneous coronary intervention. There have been r...
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor for 12 months has long been the official guideline for patients with acute coronary syndrome treated with percutaneous coronary intervention. There have been recent trials and analyses looking at modifying this recommendation due to the fact that although it reduces risk for thrombosis, it increases risk for major bleeding events. This literature review synthesizes those studies and evaluates whether discontinuing aspirin and moving to P2Y12 monotherapy can reduce bleeding without increasing ischemic events, as well as the optimal time to do so. The evidence discussed demonstrated that aspirin discontinuation generally reduced bleeding compared with continued dual antiplatelet therapy, while cardiovascular outcomes were not clearly increased in selected patients. These findings are strongest for lower-risk acute coronary syndrome patients while myocardial infarction-specific evidence is more limited and requires more investigation. Overall, discontinuing aspirin at either 3 or 1 month postpercutaneous coronary intervention appears to be a promising strategy to reduce bleeding risk while maintaining protection against thrombotic or cardiovascular events. However, timing needs to be individualized based on the bleeding and ischemic risk of the patient.
Cardiac Myxoma: From Pathogenesis to Management.
Tusongjiang Y, Cui H
Cardiol Rev · 2026 Jun · PMID 42269015 · Publisher ↗
Cardiac myxoma is the most common primary benign cardiac neoplasm. Despite its benign histologic nature, its unique anatomical location and potential for embolization can lead to severe clinical consequences. This articl...
Cardiac myxoma is the most common primary benign cardiac neoplasm. Despite its benign histologic nature, its unique anatomical location and potential for embolization can lead to severe clinical consequences. This article reviews the epidemiological characteristics, pathological features, and molecular genetic mechanisms of cardiac myxoma-particularly mutations in the PRKAR1A gene (encoding the type 1α regulatory subunit of cyclic adenosine monophosphate-dependent protein kinase A) and the stem cell origin hypothesis. Furthermore, it discusses clinical presentation, multimodal imaging, diagnostic approaches, and recent advances in surgical management. While improvements in imaging technology and a deeper understanding of molecular mechanisms have significantly enhanced early diagnosis and personalized treatment, long-term follow-up remains a critical component of clinical management, particularly for familial cases.
Burden and Predictors of 30- and 90-Day Readmission in Patients With Aortic Dissection: A Nationwide Retrospective Analysis.
Jamil A, Aisha E, Furqan M … +10 more , Akram MH, Khan S, Hasan A, Ali SM, Khatab A, Bughio SA, Areeb MA, Zafar A, Ali MW, Murtaza M
Cardiol Rev · 2026 Jun · PMID 42269011 · Publisher ↗
Aortic dissection (AD) is a life-threatening emergency, with type A requiring surgery and type B generally managed medically. This retrospective cohort study analyzed 30- and 90-day readmission rates using data from the...
Aortic dissection (AD) is a life-threatening emergency, with type A requiring surgery and type B generally managed medically. This retrospective cohort study analyzed 30- and 90-day readmission rates using data from the 2016-2017 Nationwide Readmissions Database. Adult patients (≥18 years) with a principal diagnosis of AD were identified by International Classification of Diseases-10th Revision-Clinical Modification codes. Outcomes included 30- and 90-day all-cause readmissions, mortality, length of stay, charges, and causes of readmission. Among 26,477 index admissions, in-hospital mortality was 12.70%. Of the 23,117 survivors, and 11.92% were readmitted within 30 days. Among 21,421 index admissions, in-hospital mortality was 12.57%, and 14.92% were readmitted within 30 days. Readmitted patients were younger and more likely to be insured by Medicaid or Medicare; chronic pulmonary disease and renal failure were the strongest comorbidity signals. In regression models, Medicaid (odds ratio [OR] 1.23-1.36) and Medicare (OR 1.20-1.29), as well as chronic pulmonary disease (OR 1.29-1.34) and renal failure (OR 1.32-1.36), were independently associated with increased risk of readmission. At the same time, older age was associated with a slight reduction (OR 0.99 per year). Hospital factors, sex, and most other comorbidities were not significant. Readmission stays averaged about 6 days, with charges ranging from $99,000 to $106,000. In-hospital mortality was 3%, which is lower than the index mortality rate. Readmissions after AD are frequent and resource-intensive, particularly within 90 days. Extending follow-up and focusing on high-risk groups, such as Medicaid/Medicare patients and those with pulmonary or renal disease, may help reduce this burden.
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