Cardiology In Review[JOURNAL]
Sun
200 papers
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Pre-Existing Permanent Pacemaker or Implantable Cardioverter-Defibrillator: A Nationwide Propensity-Matched Analysis.
Abomohsen M, Mohamed AE, Elkasaby MH … +8 more , Alkuwaiti MA, Hamed BM, Alghzawi HM, Rifai M, Bakr HM, Almakadma AH, Frishman WH, Aronow WS
Cardiol Rev · 2026 Jun · PMID 42219558 · Publisher ↗
Patients with severe aortic stenosis and a pre-existing permanent pacemaker (PPM) or implantable cardioverter-defibrillator represent a distinct subgroup in whom the usual pacemaker disadvantage of transcatheter aortic v...
Patients with severe aortic stenosis and a pre-existing permanent pacemaker (PPM) or implantable cardioverter-defibrillator represent a distinct subgroup in whom the usual pacemaker disadvantage of transcatheter aortic valve replacement (TAVR) is largely neutralized. We used the National Inpatient Sample 2016-2022 to compare isolated TAVR versus surgical aortic valve replacement (SAVR) in adults with aortic stenosis and pre-existing PPM/implantable cardioverter-defibrillator. After exclusions, 8776 hospitalizations were identified (8141 TAVR; 635 SAVR), and 501 well-balanced propensity-matched pairs were formed. The primary outcome was in-hospital all-cause mortality; secondary outcomes included major adverse cardiovascular and cerebrovascular events, procedural complications, length of stay, and discharge disposition. In the matched cohort, in-hospital mortality was lower after TAVR than SAVR (0.80% vs 2.59%; matched odds ratio 0.31, 95% confidence interval, 0.10-0.94; P = 0.049). TAVR was also associated with a lower major adverse cardiovascular and cerebrovascular events, stroke/transient ischemic attack, acute kidney injury, major bleeding/transfusion, cardiogenic shock, respiratory failure, lead revision, nonroutine discharge, and shorter length of stay, without excess new-pacemaker procedures. These findings support TAVR as a favorable strategy in selected patients already carrying cardiac rhythm devices.
Cardiovascular Effects and Clinical Outcomes Associated With Electronic Cigarette Use: A Narrative Review.
Furhang D, Frishman WH, Aronow WS
Cardiol Rev · 2026 May · PMID 42192250 · Publisher ↗
Electronic cigarette use has increased substantially over the past decade, especially among adolescents and young adults. Although e-cigarettes are often viewed as safer than combustible cigarettes, their cardiovascular...
Electronic cigarette use has increased substantially over the past decade, especially among adolescents and young adults. Although e-cigarettes are often viewed as safer than combustible cigarettes, their cardiovascular effects remain incompletely understood. This review explores the current literature on e-cigarette use and cardiovascular health, focusing on mechanisms of injury and clinical cardiovascular outcomes. E-cigarette aerosols contain nicotine, solvents, flavoring agents, carbonyl compounds, volatile organic compounds, and metals that may contribute to cardiovascular toxicity. Experimental studies show that e-cigarette exposure can cause sympathetic activation, increased heart rate and blood pressure, endothelial dysfunction, oxidative stress, inflammation, platelet activation, thrombogenesis, and increased vascular stiffness. These findings suggest several pathways by which e-cigarettes may contribute to cardiovascular disease. However, evidence linking e-cigarette use to clinical cardiovascular outcomes is less definitive. Observational studies have reported associations with myocardial infarction, stroke, and composite cardiovascular disease outcomes, but these findings are limited by cross-sectional study designs, reverse causation, and confounding by combustible cigarette use. Longitudinal studies have not consistently shown an independent association between exclusive e-cigarette use and incident cardiovascular events. Overall, e-cigarettes are not physiologically inert, but further prospective studies are needed to clarify their long-term cardiovascular risk.
Pre-emptive and Prophylactic Strategies to Prevent Cardiovascular and Neurotoxicity in Chimeric Antigen Receptor T-Cell Therapy: The Role of Tocilizumab, Anakinra, and Cytokine-Targeted Interventions.
Thukral J, Sindhwani N, Khan K … +9 more , Moudgil P, Singla R, Garg K, Shah RK, Kaur H, Thukral N, Agrawal SP, Frishman WH, Aronow WS
Cardiol Rev · 2026 May · PMID 42190079 · Publisher ↗
Chimeric antigen receptor T-cell therapy has revolutionized the treatment of hematological malignancies but is associated with significant immune-mediated toxicities, particularly cytokine release syndrome and immune eff...
Chimeric antigen receptor T-cell therapy has revolutionized the treatment of hematological malignancies but is associated with significant immune-mediated toxicities, particularly cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, driven by an exaggerated inflammatory response involving cytokines such as interleukin (IL)-6, IL-1, and tumor necrosis factor-alpha. These processes contribute to endothelial dysfunction and a spectrum of cardiovascular complications, including hypotension, arrhythmias, myocardial dysfunction, and heart failure. The underlying pathophysiology involves complex interactions between immune activation and vascular injury, often progressing rapidly and necessitating early recognition. Contemporary management is shifting from reactive treatment to proactive strategies, emphasizing early risk stratification using clinical parameters, biomarkers, and imaging, alongside timely intervention with cytokine-directed therapies such as IL-6 and IL-1 inhibitors. Integration of cardiology within multidisciplinary care teams is essential for optimizing outcomes through tailored monitoring and management of cardiovascular complications. As chimeric antigen receptor T-cell therapy expands to broader and higher-risk populations, including those with pre-existing cardiovascular disease, a structured cardio-oncology approach and further prospective research are critical to improving safety and long-term outcomes.
Cirrhotic Cardiomyopathy: Pathophysiology, Diagnosis, and Clinical Management.
Alkasabrah O, Garg V, Ibrahim S … +7 more , Serhan A, Khalaf A, Patel H, Patel R, Agrawal SP, Frishman WH, Aronow WS
Cardiol Rev · 2026 May · PMID 42190078 · Publisher ↗
Cirrhotic cardiomyopathy (CCM) is a syndrome of cardiac structural, functional, and electrophysiologic abnormalities arising in the setting of cirrhosis in the absence of preexisting primary heart disease. Its defining f...
Cirrhotic cardiomyopathy (CCM) is a syndrome of cardiac structural, functional, and electrophysiologic abnormalities arising in the setting of cirrhosis in the absence of preexisting primary heart disease. Its defining feature is not overt resting heart failure but an impairment of cardiac reserve: resting left ventricular ejection fraction is typically preserved or supranormal owing to the low-afterload, hyperdynamic state driven by splanchnic vasodilation and portal hypertension, yet contractile and chronotropic responses to stress are blunted. Over the past 2 decades, conceptualization of CCM has broadened from a purely "stress-unmasked systolic dysfunction" paradigm to a multidomain phenotype encompassing subclinical systolic dysfunction detectable by speckle-tracking global longitudinal strain, diastolic dysfunction defined by contemporary multi-parameter echocardiographic algorithms, QTc prolongation and other repolarization disturbances, and chronotropic incompetence-all superimposed on a background of neurohormonal activation and systemic inflammation. Diagnostic frameworks have evolved from the 2005 World Congress of Gastroenterology "Montreal" proposal to the 2019 CCM Consortium criteria, which integrate modern diastolic algorithms and global longitudinal strain to improve detection and reproducibility. Pooled prevalence approaches 50% across cirrhotic populations, though estimates vary substantially by criteria set, disease severity, and testing modality.
Cardiac Arrhythmias Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.
Moudgil P, Thukral J, Ratol HK … +6 more , Dhawan A, Sindhwani N, Moudgil S, Verma A, Frishman WH, Aronow WS
Cardiol Rev · 2026 May · PMID 42190077 · Publisher ↗
Immune checkpoint inhibitors (ICIs) are increasingly associated with cardiovascular immune-related adverse events, including arrhythmias, though their incidence remains incompletely defined. PubMed/MEDLINE and Google Sch...
Immune checkpoint inhibitors (ICIs) are increasingly associated with cardiovascular immune-related adverse events, including arrhythmias, though their incidence remains incompletely defined. PubMed/MEDLINE and Google Scholar were systematically searched from inception to February 2026 for studies reporting arrhythmia outcomes in patients receiving ICIs. A random-effects meta-analysis of proportions was performed. Twenty-two studies were included, of which 13 studies comprising 31,542 patients were included in the quantitative synthesis. The pooled incidence of arrhythmias was 6.89% [95% confidence interval (CI): 4.4-9.4%; I2 = 99.07%]. Subgroup analyses demonstrated an incidence of atrial fibrillation of 6.8% (95% CI: 0.0-15.3%; I2 = 95.3%) and conduction disorders of 1.44% (95% CI: 0.0-3.07%; I2 = 88.5%). ICIs are associated with a measurable burden of arrhythmias, particularly atrial fibrillation. However, substantial heterogeneity limits precision, highlighting the need for prospective studies with standardized monitoring strategies.
The Role of Glucagon-Like Peptide-1 Receptor Agonists in Mediating Myocardial Resilience in Cardiac Surgery.
Venkatesan A, Martin A, Katragadda N … +4 more , Tsui S, Otten M, Lee R, Sharma G
Cardiol Rev · 2026 May · PMID 42190075 · Publisher ↗
The use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has expanded rapidly for the management of diabetes and obesity. However, beyond glycemic control, GLP-1RAs have demonstrated consistent cardiometabolic ben...
The use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has expanded rapidly for the management of diabetes and obesity. However, beyond glycemic control, GLP-1RAs have demonstrated consistent cardiometabolic benefits, including reductions in major adverse cardiovascular events, mediated through anti-inflammatory, endothelial, and metabolic mechanisms. Cardiac surgery induces a profound physiological stress response characterized by systemic inflammation, ischemia-reperfusion injury, endothelial dysfunction, and metabolic derangements. Despite this strong mechanistic overlap, the role of GLP-1RAs in the perioperative cardiac surgical setting remains incompletely understood. This review endeavors to synthesize current mechanistic and clinical evidence and evaluate the potential role of GLP-1RAs in enhancing myocardial resilience during cardiac surgery. GLP-1 signaling targets multiple pathways implicated in perioperative myocardial injury. GLP-1RAs reduce epicardial adipose tissue activity and inflammatory cytokine signaling associated with postoperative atrial fibrillation. In ischemia-reperfusion injury, GLP-1 signaling reduces oxidative stress, inflammation, and cardiomyocyte cell death. Additionally, these agents improve endothelial function through nitric oxide-mediated vasodilation and modulation of mitogen-activated protein kinases signaling, suggesting a role in mitigating cardiopulmonary bypass-associated microvascular dysfunction. GLP-1RAs also enhance perioperative metabolic stability by improving glycemic control and reducing insulin requirements. However, perioperative use is complicated by the associated risk of delayed gastric emptying and aspiration risk. GLP-1RAs demonstrate strong biological plausibility for improving myocardial resilience during cardiac surgery. However, clinical evidence in surgical patients remains limited, and definitive benefit has not been fully established. Prospective, cardiac-surgery-specific studies are needed to determine whether mechanistic advantages translate into measurable improvements perioperatively and in the long term.
Partial Oral Antibiotic Therapy in Infective Endocarditis: Evidence, Patient Selection, and Practical Implementation.
Khatami S, Faghihi M, Talebi-Taher M … +1 more , Yousefifard M
Cardiol Rev · 2026 May · PMID 42157360 · Publisher ↗
Infective endocarditis (IE) is a life-threatening infection traditionally treated with 4-6 weeks of intravenous (IV) antibiotics. Emerging data, including the Partial Oral versus Intravenous Antibiotic Treatment of Endoc...
Infective endocarditis (IE) is a life-threatening infection traditionally treated with 4-6 weeks of intravenous (IV) antibiotics. Emerging data, including the Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis trial and recent meta-analyses, suggest that selected clinically stable patients can safely transition early to oral regimens, but practical guidance on implementation is limited. We conducted a comprehensive narrative review of randomized trials, observational studies, ongoing clinical trials, meta-analyses, and contemporary guidelines addressing partial oral antibiotic therapy in adult IE. Evidence consistently shows that after at least 10 days of effective IV treatment, patients who are afebrile, hemodynamically stable, have negative blood cultures, and no uncontrolled infection on imaging can be transitioned to dual oral regimens with high bioavailability and pathogen-directed activity. In this population, oral step-down therapy yields similar rates of death, relapse, embolic events, and unplanned cardiac surgery compared with prolonged IV therapy, while substantially reducing hospital length of stay and line-related complications. Data in people who inject drugs, those with multidrug-resistant pathogens, or severe heart failure remain limited, and robust pharmacokinetic validation of some oral β-lactam-based combinations is still needed. Overall, partial oral antibiotic therapy represents a safe, evidence-based, and stewardship-aligned strategy for many patients with left-sided native or prosthetic valve IE when applied within structured protocols and strict selection criteria.
Multimodality Imaging in Inflammatory Cardiac Disease.
Mahmood A, Ramesh J, Patel DS … +5 more , Naseem M, Shah RK, Pate H, Frishman WH, Aronow WS
Cardiol Rev · 2026 May · PMID 42157359 · Publisher ↗
Inflammatory cardiac diseases-including myocarditis, cardiac sarcoidosis (CS), infective endocarditis (IE), and pericarditis-have varied causes but share the need for precise diagnosis and management. Multimodality imagi...
Inflammatory cardiac diseases-including myocarditis, cardiac sarcoidosis (CS), infective endocarditis (IE), and pericarditis-have varied causes but share the need for precise diagnosis and management. Multimodality imaging is central: echocardiography (transthoracic echocardiography/transesophageal echocardiography) is universally first-line (especially for IE and pericardial effusion), while cardiac magnetic resonance imaging (MRI) provides gold-standard tissue characterization for myocarditis, CS, and pericardial inflammation. Computed tomography (CT) complements by delineating anatomy (eg valves, abscesses, pericardial calcification). Fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) (and PET/MR) identifies active inflammation (metabolic uptake) in CS, myocarditis, and prosthetic IE but requires specialized patient preparation. Recent advances-updated Lake Louise Criteria incorporating T1/T2 mapping, PET suppression protocols, and hybrid imaging-have improved sensitivity and guided therapy. Each modality's strengths (eg echo's portability, MRI's tissue detail, PET's inflammation sensitivity) and limitations (eg echo's operator dependence, MRI contraindications, PET's false positives) must be understood. Here we review definitions, epidemiology, pathophysiology, and modality-specific applications; we compare diagnostic performance and provide practical algorithms, reporting standards, prognostic insights, and research gaps.
Impact of Statin Therapy on Mortality and Cardiovascular Outcomes in End-Stage Renal Disease: A Systematic Review and Meta-Analysis.
Mohammed AS, Takagi MA, Yasmeen U … +5 more , Desai R, Ramaiyah S, Vasudeva R, Parmar G, Gupta K
Cardiol Rev · 2026 May · PMID 42157355 · Publisher ↗
Cardiovascular disease (CVD) is the leading cause of death among patients with end-stage renal disease (ESRD). The majority of the randomized controlled trials (RCTs) evaluating statin therapy in patients with dialysis d...
Cardiovascular disease (CVD) is the leading cause of death among patients with end-stage renal disease (ESRD). The majority of the randomized controlled trials (RCTs) evaluating statin therapy in patients with dialysis did not show statistically significant mortality benefit. In contrast, recent observational studies have consistently demonstrated improvement in mortality. Although the benefits of statin in this population remain controversial, there is also ambiguity regarding the benefit of statin therapy in patients with dialysis and established atherosclerotic cardiovascular disease (ASCVD). A systematic review and meta-analysis was conducted to evaluate the effects of statin therapy in patients with ESRD using the PubMed and Google Scholar databases. Our objective was to assess all-cause and cardiovascular mortality in mixed ESRD populations (with and without ASCVD), as well as in patients with ESRD and established ASCVD. A total of 396,163 patients in 28 studies were included. Overall, statin therapy significantly reduced all-cause mortality [hazard ratios (HR) = 0.75; 95% confidence intervals (CI, 0.68-0.83)] and cardiovascular mortality (HR = 0.75; 95% [CI, 0.60-0.94]). The majority of the benefits were associated with observational data whereas RCTs did not show any mortality benefits. Among patients with ESRD and established ASCVD in observational studies, statin therapy was associated with reduced all-cause mortality (HR = 0.84; 95% [CI, 0.74-0.95]), but there were little or no cardiovascular mortality benefits. There was substantial heterogeneity amongst the studies. In conclusion, real-world data demonstrated the beneficial role of statins in the ESRD population. These findings are hypothesis-generating and highlight the need for prospective trials focused on patients with ESRD and established ASCVD.
Percutaneous Coronary Intervention Outcomes in Patients With Inflammatory Bowel Disease: A Comprehensive Review of Pathophysiology, Clinical Prognosis, and Management Strategies.
Jajja FA, Fnu V, Alkasabrah O … +6 more , Ramesh J, Chaudhry MQ, Patel R, Patel R, Frishman WH, Aronow WS
Cardiol Rev · 2026 May · PMID 42157339 · Publisher ↗
Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, is being increasingly recognized as a systemic inflammatory condition with a link to accelerated atherosclerosis and increased cardiovasc...
Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, is being increasingly recognized as a systemic inflammatory condition with a link to accelerated atherosclerosis and increased cardiovascular risk. Patients with inflammatory bowel disease are often younger and have fewer classical risk factors for coronary artery disease at the time of percutaneous coronary intervention, but there is an increasing body of evidence for an increased risk of adverse outcomes following the procedure. This review discusses the pathophysiologic connections between chronic intestinal inflammation and coronary artery disease, with special reference to endothelial dysfunction, hypercoagulability, immune activation, and the loss of the intestinal-vascular barrier in relation to unstable plaques and impaired vascular healing. A comprehensive review of the current literature, including cohort studies and pathophysiological research, was undertaken to assess the risk of short- and long-term outcomes following percutaneous coronary intervention in this group of patients. The current evidence clearly indicates that there is a 30-40% relative risk increase of major adverse cardiovascular events, including myocardial infarction and heart failure, in the short to long term compared to controls. The challenges in management include the difficulty in balancing dual antiplatelet therapy with increased gastrointestinal bleeding risk and the cardiovascular consequences of immunosuppressive therapy.
Cerebral Embolic Protection During Transcatheter Aortic Valve Implantation: A Meta-Analysis, Meta-Regression, and Trial Sequential Analysis.
Naeem F, Qamar U, Burhan M … +13 more , Shehada W, Balbaa E, Gadelmawla AF, Tabassum S, Husnain A, Naeem N, Hanif M, Bhat V, Muthukumar L, Eltawansy S, Kalra A, Daggubati R, Sattar Y
Cardiol Rev · 2026 May · PMID 42157241 · Publisher ↗
Stroke is a serious complication of transcatheter aortic valve implantation (TAVI). Cerebral embolic protection devices (CEPDs) were developed to reduce periprocedural embolization; however, their clinical efficacy remai...
Stroke is a serious complication of transcatheter aortic valve implantation (TAVI). Cerebral embolic protection devices (CEPDs) were developed to reduce periprocedural embolization; however, their clinical efficacy remains uncertain. We conducted a systematic review and meta-analysis of 8 randomized controlled trials including 11,775 patients undergoing TAVI with or without CEPDs. Primary outcomes included stroke (any, disabling, non-disabling), new ischemic lesions, and cognitive decline assessed by the Montreal Cognitive Assessment and National Institutes of Health Stroke Scale. Secondary outcomes included mortality, bleeding, vascular complications, and acute kidney injury. Data were pooled using a random-effects model, reporting risk ratios (RRs) or mean differences with corresponding 95% confidence intervals (CIs). Subgroup, meta-regression, and trial sequential analyses were performed. CEPDs did not significantly reduce any stroke (RR: 0.92, 95% CI [0.74-1.15], P = 0.48), disabling stroke (RR: 0.80, 95% CI [0.57-1.12], P = 0.19), or non-disabling stroke (RR: 1.08, 95% CI [0.79-1.46], P = 0.64). No significant differences were observed in ischemic lesion count, National Institutes of Health Stroke Scale worsening, or Montreal Cognitive Assessment decline. The Sentinel device showed a marginal reduction in ischemic lesion count without clinical benefit. Sentinel use was associated with increased major vascular complications (RR: 1.42, 95% CI [1.01-2.01], P = 0.046), and sensitivity analysis demonstrated higher acute kidney injury with CEPDs (RR: 1.38, 95% CI [1.01-1.88], P = 0.04). Trial sequential analyses suggested futility for most outcomes. While CEPDs capture embolic debris, they do not significantly reduce stroke or cognitive decline after TAVI, limiting support for routine use. Future efforts should focus on improved device design and identifying high-risk subgroups.
Impact of Chronic Antiplatelet Therapy on Clinical Outcomes of First-Time ST-Elevation Myocardial Infarction.
Malhotra A, Ahmed M, Beck JM … +6 more , Annabi J, Sanchez B, Douglas K, Frishman WH, Aronow WS, Lanier GM
Cardiol Rev · 2026 May · PMID 42153731 · Publisher ↗
ST-elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality in the United States. A retrospective cross-sectional study was conducted using the National Inpatient Sample database (2015-2022)....
ST-elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality in the United States. A retrospective cross-sectional study was conducted using the National Inpatient Sample database (2015-2022). We included patients ≥18 years-old hospitalized with STEMI and without history of myocardial infarction. Outcomes included inpatient mortality, routine discharge, complications, comorbidities, and treatment modalities in patients on chronic antiplatelet therapy (cAPT). Propensity score-based inverse probability of treatment weighting adjusted for confounding factors. Multivariable logistic regression estimated adjusted odds ratios and 95% confidence intervals. Among 1,070,085 first-time STEMI hospitalizations, 236,085 (22.1%) involved patients receiving cAPT. The median age of these patients was 66 years (interquartile range: 57-75) and 74,120 (31.4%) were women. Patients on cAPT had significantly higher odds of treatment with coronary artery bypass graft (adjusted odds ratios: 1.86, 95% confidence intervals [1.77-1.97], P < 0.001) and percutaneous coronary intervention (1.04 [1.01-1.07], P = 0.010). cAPT was also significantly associated with reduced bleeding (0.831 [0.789-0.876], P < 0.001), mural thrombus (0.703 [0.587-0.841], P < 0.001), and acute heart failure (0.889 [0.859-0.921], P < 0.001), without increased risk of any complication. Following inverse probability of treatment weighting, cAPT was associated with significantly lower inpatient mortality (0.562 [0.534-0.591], P < 0.001) and higher routine discharge (1.38 [1.34-1.43], P < 0.001). cAPT was associated with significantly improved inpatient outcomes among STEMI hospitalizations.
Risk Factors for Acute Kidney Injury After Surgery for Stanford Type A Aortic Dissection: A Systematic Review and Meta-Analysis.
Yang F, Kang H, Wang Y … +1 more , Hu H
Cardiol Rev · 2026 May · PMID 42153640 · Publisher ↗
This systematic review and meta-analysis aimed to evaluate risk factors for acute kidney injury (AKI) after surgery for Stanford type A aortic dissection. We searched Web of Science, PubMed, Embase, Proquest, Cochrane Li...
This systematic review and meta-analysis aimed to evaluate risk factors for acute kidney injury (AKI) after surgery for Stanford type A aortic dissection. We searched Web of Science, PubMed, Embase, Proquest, Cochrane Library, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and Chinese Biomedical Literature databases from inception to January 2026. A total of 58 case-control studies were included, assessed using the Newcastle-Ottawa Scale. Meta-analysis identified numerous significant perioperative factors. Key demographic and preoperative risk factors included age, body mass index, hypertension history, preoperative renal insufficiency, elevated cystatin C, lactate, serum creatinine, white blood cell count, and renal malperfusion, while a higher left ventricular ejection fraction was protective. Intraoperative factors such as prolonged cardiopulmonary bypass time, increased red blood cell transfusion, and total aortic arch replacement increased AKI risk, whereas higher intraoperative urine output was protective. Postoperatively, prolonged mechanical ventilation and acute respiratory insufficiency were also high-risk factors. In conclusion, multiple preoperative, intraoperative, and postoperative factors significantly influence AKI risk following Stanford type A aortic dissection surgery. Comprehensive perioperative assessment of these factors may help clinicians implement targeted management to reduce AKI incidence and improve patient outcomes.
Frailty, Sarcopenia, and Functional Decline After CAR-T Therapy: The Case for Structured Rehabilitation.
Thukral J, Moudgil P, Sindhwani N … +8 more , Kudrat F, Rohewal J, Kaur J, Shah RK, Kaur H, Thukral N, Frishman WH, Aronow WS
Cardiol Rev · 2026 May · PMID 42150100 · Publisher ↗
Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment landscape of relapsed or refractory hematologic malignancies, offering unprecedented response rates and durable remissions in diseases suc...
Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment landscape of relapsed or refractory hematologic malignancies, offering unprecedented response rates and durable remissions in diseases such as B-cell acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and multiple myeloma. By genetically engineering autologous T cells to recognize tumor-associated antigens, CAR-T therapy enables targeted immune-mediated cytotoxicity against malignant cells. Although early clinical experience has largely focused on acute toxicities including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome improving survival has shifted attention toward the long-term health status of survivors. As the population of CAR-T recipients grows, a broader survivorship framework that incorporates functional outcomes and quality of life has become increasingly important. Emerging evidence suggests that frailty, sarcopenia, and progressive functional decline represent underrecognized complications in patients recovering from CAR-T therapy. These impairments may result from multiple converging factors including systemic inflammation, prior intensive chemotherapy, prolonged hospitalization, corticosteroid exposure, and physical inactivity during treatment. Such changes may have important cardiovascular implications, including reduced cardiorespiratory fitness, impaired exercise tolerance, and increased vulnerability to cardiovascular morbidity. Despite these risks, structured rehabilitation programs remain poorly integrated into CAR-T survivorship care.
Machine Learning in Nonischemic Cardiomyopathy: Phenotyping, Mechanism Discovery, and Clinical Applications.
Quansah K, Anderson E, Kwon E … +1 more , Kwon C
Cardiol Rev · 2026 May · PMID 42150097 · Full text
Nonischemic cardiomyopathy (NICM) refers to a heterogeneous group of myocardial disorders whose shared phenotypes complicate diagnosis and risk stratification. This complexity has driven growing interest in computational...
Nonischemic cardiomyopathy (NICM) refers to a heterogeneous group of myocardial disorders whose shared phenotypes complicate diagnosis and risk stratification. This complexity has driven growing interest in computational approaches that can integrate high-dimensional data and capture patterns not evident through conventional analyses. In this review, we synthesize studies, published between 2020 and 2026, that apply machine learning and deep learning models to NICMs across 3 interconnected domains: phenotype classification, mechanism discovery, and clinical decision support. We find that imaging and electrocardiography-based models help improve subtype discrimination, arrhythmia detection, and early disease identification; genomic and multiomics approaches advance variant interpretation and biomarker discovery; and emerging multimodal frameworks extend these efforts toward outcome prediction and individualized management. Challenges remain in generalizability, interpretability, and prospective validation, as well as in integrating modalities into patient-level risk models. Continued development of multimodal and longitudinal approaches will be essential for translating these advances into precision care for NICM.
High-Sensitivity Cardiac Troponin in Hypertrophic Cardiomyopathy: Diagnostic Insights and Future Directions.
Hassan A, Mizori R, Malik A … +3 more , Kundur SP, Ijaz M, Sivalokanathan S
Cardiol Rev · 2026 May · PMID 42139454 · Publisher ↗
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, yet challenges remain in assessing disease severity and phenotypic heterogeneity. High-sensitivity cardiac troponin (hs-cTn) has emerged as...
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, yet challenges remain in assessing disease severity and phenotypic heterogeneity. High-sensitivity cardiac troponin (hs-cTn) has emerged as a potential biomarker of myocardial stress in nonischemic cardiomyopathies. Through an evaluation of observational cohort, mechanistic, and longitudinal studies, this narrative review synthesizes the current evidence on the role of cardiac troponin in HCM, including its pathophysiological basis, patterns of elevation, associations with imaging and clinical outcomes, and potential clinical applications. Across multiple cohorts, approximately one-quarter to one-half of patients with HCM demonstrated elevated hs-cTn concentrations at rest, even in the absence of acute coronary syndromes, consistent with chronic low-grade myocardial injury. Troponin elevation consistently correlated with markers of disease severity, including greater left ventricular hypertrophy, myocardial fibrosis on cardiac magnetic resonance imaging, elevated filling pressures, reduced exercise capacity, and arrhythmic burden. Exercise- or stress-related troponin rises have also been reported, particularly in higher-risk phenotypes and in the presence of myocardial edema. Recent trials of cardiac myosin inhibitors show troponin levels decline with disease-modifying therapy, supporting hs-cTn as a biologically responsive marker of active myocardial injury. Although hs-cTn lacks disease specificity and is not a standalone diagnostic or prognostic tool, it may provide useful adjunctive information when interpreted alongside imaging and clinical findings. Prospective studies with serial measurement, standardized assays, and integration with risk models are needed to define its role in risk stratification and clinical management.
Therapeutic Impact of Cardiac Glycosides (Digoxin and Digitoxin) in Heart Failure With Reduced Ejection Fraction: A Systematic Review.
Jerical C, Ahmed E, Asifa S … +7 more , Ariba S, Jabeen L, Meghwar S, Shahani S, Naveed M, Ghouse MA, Eltawansy S
Cardiol Rev · 2026 May · PMID 42132739 · Publisher ↗
Heart failure (HF) is a major cause of hospitalization and mortality worldwide. Cardiac glycosides, particularly digoxin and digitoxin, are used in patients with HF with reduced ejection fraction (HFrEF) who are symptoma...
Heart failure (HF) is a major cause of hospitalization and mortality worldwide. Cardiac glycosides, particularly digoxin and digitoxin, are used in patients with HF with reduced ejection fraction (HFrEF) who are symptomatic despite guideline-directed therapy. However, their comparative effectiveness and safety remain unclear. This systematic review aims to compare the therapeutic effect of digoxin and digitoxin in patients with HFrEF. PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov were searched using predefined keywords related to cardiac glycosides and HFrEF to identify randomized controlled trials (RCTs). Eligible studies enrolled adults with HFrEF (left ventricular ejection fraction ≤ 40%) receiving digoxin or digitoxin versus placebo and reported mortality or hospitalization outcomes. Due to heterogeneity and the identification of only 2 eligible RCTs, a qualitative synthesis was performed. From 646 screened records, 2 RCTs involving 8012 patients were included. Neither digoxin nor digitoxin reduced all-cause mortality [Digitalis Investigation Group: 34.8% vs 35.1%, risk ratio (RR) 0.99; Digitoxin to Improve Outcomes in Patients with Advanced Chronic Heart Failure: 27.2% vs 29.5%, hazard ratio (HR) 0.86] or cardiovascular mortality (Digitalis Investigation Group: 29.9% vs 29.5%, RR 1.01; Digitoxin to Improve Outcomes in Patients with Advanced Chronic Heart Failure: 20.4% vs 22.4%, HR 0.87). HF-specific mortality showed no significant difference. Digoxin significantly reduced cardiovascular hospitalizations (49.9% vs 54.4%, RR 0.87) and HF hospitalizations (26.8% vs 34.7%, RR 0.72), while digitoxin similarly lowered HF hospitalization risk (28.1% vs 30.4%, HR 0.85). Both agents reduced the composite of HF death or hospitalization (digoxin: RR 0.85, P < 0.001; digitoxin: HR 0.82, P = 0.03). Cardiac glycosides do not reduce all-cause mortality in patients with HFrEF; however, digoxin significantly lowered hospitalizations for worsening HF. Both digoxin and digitoxin reduced the composite of mortality and HF hospitalization.
Metabolic Dysfunction-Associated Steatotic Liver Disease and Cardiovascular Disease: Shared Mechanisms and Therapeutic Opportunities.
Basta D, Al Refaei A, Msinjili L … +2 more , Frishman WH, Lebovics E
Cardiol Rev · 2026 May · PMID 42121355 · Publisher ↗
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects ~25-30% of adults worldwide and is increasingly recognized as a systemic cardiometabolic disorder rather than an isolated liver condition. While MA...
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects ~25-30% of adults worldwide and is increasingly recognized as a systemic cardiometabolic disorder rather than an isolated liver condition. While MASLD can progress to advanced fibrosis and cirrhosis, cardiovascular disease (CVD) is the leading cause of morbidity and mortality in this population, surpassing liver-related deaths. Beyond shared risk factors such as obesity, insulin resistance, and type 2 diabetes, MASLD is independently linked to atherosclerotic CVD, heart failure-particularly heart failure with preserved ejection fraction-and atrial arrhythmias through mechanisms including lipotoxicity, chronic inflammation, endothelial dysfunction, and atherogenic dyslipidemia. This review summarizes evidence connecting MASLD pathobiology with CVD and evaluates emerging pharmacologic strategies that target metabolic dysfunction with relevance to both hepatic and cardiovascular outcomes. We highlight 3 mechanistically complementary therapeutic classes: thyroid hormone receptor-β agonists, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors. Thyroid hormone receptor-β agonism (resmetirom) improves hepatic lipid handling, steatosis, and fibrosis while lowering apolipoprotein B-containing lipoproteins, though cardiovascular outcomes data remain pending. Glucagon-like peptide-1 receptor agonists reduce weight, improve insulin sensitivity, and lower major adverse cardiovascular events. Sodium-glucose cotransporter-2 inhibitors provide strong protection against heart failure and chronic kidney disease while improving metabolic and hepatic parameters. Together, these therapies reinforce MASLD as a cardiovascular-relevant metabolic disease and support integrated cardiometabolic approaches to reduce CVD risk.
A Review of Atrial Fibrillation and Sepsis-Related Mortality Among Adults in the United States.
Thirupathy U, Warsi T, Sajnani P … +12 more , Bhimineni DP, Agarwal T, Joseph KV, Aboukhater N, Mesmar A, Sheikh AN, Behary Paray N, Shahzad M, Mohsin M, Elzain Hassan EI, Baig M, Shahid F
Cardiol Rev · 2026 May · PMID 42121289 · Publisher ↗
Atrial fibrillation (AF) is a common cardiac arrhythmia associated with increased morbidity and mortality, particularly in critically ill patients. Sepsis further exacerbates this risk, contributing to adverse cardiovasc...
Atrial fibrillation (AF) is a common cardiac arrhythmia associated with increased morbidity and mortality, particularly in critically ill patients. Sepsis further exacerbates this risk, contributing to adverse cardiovascular outcomes. This study aims to analyze AF-related mortality trends in sepsis patients in the United States from 1999 to 2023. Trends in AF- and sepsis-related mortality among adults aged ≥25 years from 1999 to 2023 were analyzed using the Centers for Disease Control and Prevention Wide-Ranging ONline Data for Epidemiologic Research database. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated. From 1999 to 2023, a total of 241,127 deaths related to AF and sepsis occurred among adults in the United States. The AAMR rose sharply from 2.02 in 1999 to 5.60 in 2018 (APC: 5.53; 95% confidence interval: 4.78-6.03), followed by a further increase to 7.87 in 2021 (APC: 12.63; 95% confidence interval: 8.33-14.96). After 2021, the AAMR remained stable through 2023. In 2023, males (8.54) averaged a considerably higher AAMR than females (6.05). Among racial groups, the highest AAMR in 2023 was reported in the non-Hispanic (NH) White group (7.57), followed by the NH Black group (7.09), the Hispanics and Latinos (5.18), and the NH Others group at 4.45. Rural areas (3.87) averaged a significantly higher AAMR than urban areas (3.80). AF-related mortality in sepsis patients has risen significantly over the past 2 decades, with notable disparities. The sharp increase in AAMR highlights the need for targeted interventions to mitigate mortality risks in high-risk populations.
Melatonin and the Cardiovascular System.
Manolis AA, Manolis TA, Vouliotis A … +1 more , Manolis AS
Cardiol Rev · 2026 May · PMID 42121279 · Publisher ↗
Melatonin (N-acetyl-5-methoxytryptamine) is a neuroendocrine hormone primarily secreted by the pineal gland and also produced in extrapineal tissues such as the retina, lymphocytes, and the cardiovascular (CV) system. Th...
Melatonin (N-acetyl-5-methoxytryptamine) is a neuroendocrine hormone primarily secreted by the pineal gland and also produced in extrapineal tissues such as the retina, lymphocytes, and the cardiovascular (CV) system. This hormone possesses amphiphilic properties, allowing it to penetrate most biological barriers and exert its effects at the subcellular level; it plays an important role in controlling the body's response to circadian rhythms and adjusting to internal and external environmental cues. It also has antioxidant, anti-inflammatory, and antiaging properties. Melatonin's secretion is controlled by daily and seasonal environmental light cycles. Its production is strictly occurs during the night and is inhibited by light. Besides these chronobiotic actions, this hormone possesses vasoactive properties mediated by the plasma membrane melatonin receptors (MT1/MT2) and ion channels expressed in the CV system. The responses triggered by melatonin in the CV system vary depending on the vascular bed analyzed and hormone concentration. Also, MT1 receptors likely mediate vasoconstrictor effects, whereas MT2 receptors mediate vasorelaxant effects. Furthermore, there is a gap in the literature, as very few studies have addressed the effects of circadian variations on the expression of these receptors, pointing to an important area for further investigation. In summary, melatonin is a robust antioxidant agent and free radical scavenger, guarding cells from oxidative damage. Within its wide spectrum of diverse physiological roles, such as maintaining the functional integrity of endothelial cells, thus averting atherosclerosis, a major contributor to CVD, melatonin exhibits antioxidant and free radical scavenging properties, potentially ameliorating cardiometabolic disorders, and, as herein detailed, it has a unique adjunctive therapeutic potential for managing various CVDs via several mechanisms by which melatonin interacts with the CV system. All these issues are herein reviewed, the results of relevant meta-analyses are tabulated and discussed, and the actions and influences of melatonin on the CV system are detailed and pictorially illustrated.
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