Cardiology In Review[JOURNAL]
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200 papers
Global Longitudinal Strain as a Surveillance Tool in Hematologic Cancer-Related Cardiotoxicity.
Thukral J, Moudgil P, Sindhwani N … +9 more , Makkar S, Kaur J, Mann A, Shah RK, Kaur H, Agrawal SP, Thukral N, Frishman WH, Aronow WS
Cardiol Rev · 2026 May · PMID 42087293 · Publisher ↗
Advances in the treatment of hematologic malignancies have significantly improved survival, leading to an increasing burden of cancer therapy-related cardiac dysfunction (CTRCD). Early detection of cardiotoxicity is crit...
Advances in the treatment of hematologic malignancies have significantly improved survival, leading to an increasing burden of cancer therapy-related cardiac dysfunction (CTRCD). Early detection of cardiotoxicity is critical, as conventional measures such as left ventricular ejection fraction often identify myocardial injury only after irreversible damage has occurred. Global longitudinal strain (GLS), derived from speckle-tracking echocardiography, has emerged as a sensitive and reproducible tool for detecting subclinical myocardial dysfunction. This review summarizes the role of GLS in the surveillance of cardiotoxicity in patients with hematologic malignancies. We discuss the pathophysiological basis of chemotherapy-induced myocardial injury, including oxidative stress, mitochondrial dysfunction, and inflammatory mechanisms. Evidence supporting GLS as a predictive and monitoring tool is examined across baseline risk stratification, treatment-related changes, and long-term outcomes. GLS consistently demonstrates earlier detection of myocardial dysfunction compared with left ventricular ejection fraction and provides prognostic value in diverse therapeutic settings, including anthracycline-based chemotherapy, hematopoietic stem cell transplantation, and novel immune-based therapies. The integration of GLS into cardio-oncology practice, particularly in combination with cardiac biomarkers, enhances early detection and risk stratification. Despite limitations such as intervendor variability and lack of standardized thresholds, GLS is increasingly incorporated into guideline-recommended surveillance strategies.
The Cardiopulmonary Complications of Vaping.
Milshteyn A, Del Rio V, Treihaft AM … +5 more , Weingarten JA, Saleh AG, Minkin R, Frishman WH, Peterson SJ
Cardiol Rev · 2026 May · PMID 42071277 · Publisher ↗
Electronic cigarettes, also known as e-cigarettes or vapes, have risen in popularity recently, especially among teenagers and young adults, because many believe they are safer than regular cigarettes. However, research h...
Electronic cigarettes, also known as e-cigarettes or vapes, have risen in popularity recently, especially among teenagers and young adults, because many believe they are safer than regular cigarettes. However, research has shown that the use of e-cigarettes can still lead to significant pulmonary and cardiovascular risks. E-liquids usually contain propylene glycol, vegetable glycerin, nicotine, flavorings, and sometimes tetrahydrocannabinol or other additives. When these ingredients are heated, they can produce harmful chemicals such as reactive aldehydes and other toxins that cause inflammation and other long-term effects. Studies have found a positive correlation between the use of e-cigarettes and oxidative stress, inflammation, and endothelial damage. Research has also linked vaping to an increase of reactive oxygen species in the blood of people like those of traditional tobacco smokers. The 2019-2020 outbreak of e-cigarette or vaping-associated lung injury, which was strongly connected to the unregulated presence of tetrahydrocannabinol and vitamin E acetate, highlighted the serious risks of these products. Our aim is to examine the health and economic burdens posed by e-cigarette use and challenge the idea that they are a "safer" alternative to traditional tobacco smoking.
Low Albumin, Heavy Hearts: Role of Hypoalbuminemia in Infiltrative Cardiomyopathies: A Narrative Review.
Memon RR, Ikkurthy N, Jumani MM … +2 more , Rizvi SF, Kumar V
Cardiol Rev · 2026 Apr · PMID 42059934 · Publisher ↗
Infiltrative cardiomyopathies, a subset of restrictive cardiomyopathies, are rare but clinically essential disorders often lead to heart failure, which is a major global health issue. Although interest in these condition...
Infiltrative cardiomyopathies, a subset of restrictive cardiomyopathies, are rare but clinically essential disorders often lead to heart failure, which is a major global health issue. Although interest in these conditions is growing, they remain poorly understood due to their low occurrence, vague clinical signs, and frequent underreporting. Advances in diagnosis have been made through multimodal imaging techniques-including cardiac magnetic resonance, nuclear imaging, and computed tomography-as well as genetic testing and new biomarkers for amyloidosis. However, a universal biomarker that applies across the entire range of infiltrative cardiomyopathies has yet to be identified. This review discusses albumin, a vital regulator of physiological balance, as a promising biomarker candidate. In this narrative review, we explore disease mechanisms, identify knowledge gaps in research, and suggest new connections to direct future studies and enhance diagnostic accuracy.
Mitral Annular Calcification.
Oprysko C, Prabhakar C, Berman L … +5 more , Staroselsky M, Fishkin T, Hai O, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 42059910 · Publisher ↗
Mitral annular calcification (MAC) is a chronic degenerative process strongly associated with aging that predominantly affects the posterior mitral annulus. Its pathogenesis is linked to traditional cardiovascular risk f...
Mitral annular calcification (MAC) is a chronic degenerative process strongly associated with aging that predominantly affects the posterior mitral annulus. Its pathogenesis is linked to traditional cardiovascular risk factors that increase mechanical stress and inflammation, promoting pathological cellular differentiation within the annulus. MAC prevalence in the general population is approximately 8-15%, with 8% of affected patients developing clinically significant valvular disease, defined as mitral stenosis or moderate or greater mitral regurgitation. Patients with MAC are at higher risk of cardiovascular mortality and complications, including the development of atrial fibrillation, the development of conduction disorders, and often have signs of coronary or systemic atherosclerosis. Transthoracic echocardiogram remains the first-line imaging modality for the diagnosis of MAC, while cardiac-gated computed tomography is valuable for quantifying severity and progression while also guiding procedural planning. Though management is often conservative, in patients who have clinically significant valvular dysfunction, MAC can present a challenge when planning valvular interventions, and a multidisciplinary approach is often required.
Myeloproliferative Neoplasms, Clonal Thrombosis, and Vascular Disease: Can Cardiology Learn from Hematology?
Thukral J, Khangurra SK, Ghaie M … +7 more , Kaur M, Moudgil P, Shah R, Kaur H, Thukral N, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 42059892 · Publisher ↗
Philadelphia-negative myeloproliferative neoplasms (MPNs), encompassing polycythemia vera, essential thrombocythemia, and primary myelofibrosis, represent a group of chronic clonal hematopoietic disorders characterized b...
Philadelphia-negative myeloproliferative neoplasms (MPNs), encompassing polycythemia vera, essential thrombocythemia, and primary myelofibrosis, represent a group of chronic clonal hematopoietic disorders characterized by excessive proliferation of myeloid lineages and with a propensity for arterial and venous thrombosis. These disorders provide a unique human model of inflammation-driven, clone-mediated vascular disease with mechanistic insights highly relevant to cardiovascular medicine. The interplay of elevated hematocrit, leukocytosis, activated platelets, neutrophil extracellular traps, endothelial dysfunction, and chronic cytokine elevation creates a multifaceted prothrombotic state. Randomized evidence, such as the CYTO-PV (cytoreductive therapy in polycythemia vera) trial, demonstrates that correcting hematocrit meaningfully reduces major cardiovascular and thrombotic events. Discoveries like Janus Kinase 2 valine-to phenylalanine substitution on position 617-mutated clones, altered platelet biology, and NETosis inform evolving concepts in coronary artery disease, microvascular ischemia, and inflammatory thrombosis. This review synthesizes thrombosis biology in MPNs with actionable implications for cardiologists. Key lessons include the importance of clonal hematopoiesis as a cardiovascular risk factor, the role of inflammation and hematologic dysregulation in accelerating atherothrombosis, and the therapeutic relevance of antiplatelet optimization, hematocrit control, cytoreductive therapy, and anti-inflammatory interventions. The review also outlines diagnostic situations in cardiology where MPNs should be suspected, proposes opportunities for improved risk stratification, and identifies research priorities bridging the 2 specialties.
Metformin as a Cardioprotective Agent: New Life for an Old Drug?
Duran R, Parikh MA, Mihatov N … +3 more , Kothari M, Frishman WH, Peterson SJ
Cardiol Rev · 2026 Apr · PMID 42048623 · Publisher ↗
Despite metformin's established role in treating patients with diabetes, its exact mechanism of action remains unclear. Does metformin possess additional mechanisms of action in addition to its glucose-lowering effect? A...
Despite metformin's established role in treating patients with diabetes, its exact mechanism of action remains unclear. Does metformin possess additional mechanisms of action in addition to its glucose-lowering effect? Although medications such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists have become increasingly popular among diabetic patients, clinical research on the benefits of metformin beyond its antiglycemic effects continues to emerge. Given the higher incidence of heart disease amongst diabetic patients, its cardioprotective actions are of particular interest. Recent evidence suggests that metformin exerts cardioprotective effects. In this review, we will explore how metformin's cardioprotective effects alleviate cardiac remodeling, hypertrophy, and fibrosis.
Transplant Allograft Markers of Rejection for Heart, Liver, and Kidney Transplantation: A Review.
Mushannen M, Weisberg IS, Ramasubbu K … +3 more , Parikh MA, Frishman WH, Peterson SJ
Cardiol Rev · 2026 Apr · PMID 42048616 · Publisher ↗
Every year, the incidence of heart, liver, and kidney transplants rises. This is due to robust transplant networks, improvements in procurement strategies, and advances in surgical techniques. However, long-term transpla...
Every year, the incidence of heart, liver, and kidney transplants rises. This is due to robust transplant networks, improvements in procurement strategies, and advances in surgical techniques. However, long-term transplant rejection monitoring and diagnosis continue to rely on biopsy confirmation. We review the latest updates on biomarkers of transplant rejection. These include donor-specific antibodies, which are now routinely in use, and cell-free DNA and microRNA, which are still being tested for their diagnostic efficacy. This review aims to serve as a reference tool for providers as the field continues to evolve and improve outcomes in transplant care.
Partial Anomalous Pulmonary Venous Return in Adults: Beyond Anatomy: A Cardiologist's Guide.
Khalid M, Khalid N, Shahid T … +6 more , Akhtar S, Akram MB, Sabah NU, Nawaz K, Saadat S, Tariq D
Cardiol Rev · 2026 Apr · PMID 42020941 · Publisher ↗
Partial anomalous pulmonary venous return (PAPVR) is a congenital cardiovascular malformation in which one or more pulmonary veins drain abnormally into the right atrium or systemic venous circulation, producing a pretri...
Partial anomalous pulmonary venous return (PAPVR) is a congenital cardiovascular malformation in which one or more pulmonary veins drain abnormally into the right atrium or systemic venous circulation, producing a pretricuspid left-to-right shunt. In anatomic terms, this condition is more precisely described as a partial anomalous pulmonary venous connection, whereas PAPVR refers to the physiological consequence of anomalous venous drainage. Historically, these anomalies were most often diagnosed during childhood; however, with increasing use of cross-sectional imaging modalities such as cardiac computed tomography and cardiovascular magnetic resonance, the condition is increasingly identified in adults. Adult presentations are heterogeneous, ranging from incidental imaging findings to clinically significant disease characterized by right ventricular volume overload, atrial arrhythmias, and pulmonary arterial hypertension. Recognition of PAPVR/partial anomalous pulmonary venous connection in adults remains clinically important, as delayed diagnosis may allow progressive right-sided cardiac remodeling and pulmonary vascular changes. This narrative review aims to move beyond classic anatomical descriptions and provide a clinically oriented overview of PAPVR in adults. We summarize the embryologic basis, anatomic variants, epidemiology, clinical manifestations, and hemodynamic consequences of this condition. Particular emphasis is placed on multimodality imaging-including transthoracic echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance-for accurate diagnosis and procedural planning. The review also discusses hemodynamic evaluation with right-heart catheterization, risk assessment for pulmonary hypertension, and indications for intervention. Management strategies are reviewed in detail, including surgical techniques such as intracardiac baffling, single-patch and 2-patch repairs, and the Warden procedure, as well as the evolving role of transcatheter and hybrid approaches in carefully selected adult patients. Special clinical scenarios-including late presentation, pregnancy, and coexisting pulmonary hypertension-are also addressed. By integrating diagnostic, therapeutic, and longitudinal follow-up perspectives, this review provides a practical framework for the evaluation and management of adults with PAPVR in modern cardiology practice.
Distal Versus Conventional Transradial Access in Patients With ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis.
Daniyal SM, Tabish S, Baig BM … +8 more , Khalid A, Rasool A, Asifa S, Abdul Samad Z, Gul I, Burhan M, Ashraf S, Greene SJ
Cardiol Rev · 2026 Apr · PMID 42020939 · Publisher ↗
The distal radial access (DRA) is emerging as an alternative to conventional transradial access (TRA) for coronary procedures, potentially reducing vascular complications. This meta-analysis aims to compare the efficacy...
The distal radial access (DRA) is emerging as an alternative to conventional transradial access (TRA) for coronary procedures, potentially reducing vascular complications. This meta-analysis aims to compare the efficacy and safety of DRA versus TRA specifically in patients with ST-elevation myocardial infarction (STEMI). We systematically searched PubMed, Cochrane, Scopus, and Embase for randomized or observational studies comparing DRA and TRA in STEMI patients undergoing coronary angiography or percutaneous coronary intervention. Data were pooled using a random-effects model and reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Subgroup analyses were performed based on study design. Analysis included 6 studies (n = 1330), out of which 3 were randomized controlled trials. DRA was associated with a significant reduction in the risk of radial artery occlusion [RR, 0.23; (95% CI, 0.11-0.51); P < 0.01]. However, time to reperfusion was significantly longer with DRA [mean differences, +3.25 min, (95% CI, 0.93-5.57); P < 0.01]. A nonsignificant trend favored DRA for reduced hematoma risk [RR, 0.59; (95% CI, 0.33-1.06); P = 0.077]. No significant differences were found in puncture failure rates [RR, 0.99; (95% CI, 0.34-2.84); P = 0.980] or cannulation success [RR, 0.99; (95% CI, 0.94-1.04); P = 0.594]. In patients with STEMI, DRA was associated with significantly lower risk of radial artery occlusion, with a potential trend towards fewer hematomas, and without compromising puncture success or cannulation rates. The associated 3.25-minute delay in reperfusion is small relative to the ≤90-minute door-to-balloon target and is unlikely to compromise guideline adherence.
Cardiovascular Dysautonomia and Sudden Cardiac Death in Parkinson's Disease: Emerging Clinical Insights and Implications for Care.
Fisher K, Haji S, Rudmann E … +6 more , Danisi F, Lisk J, Ravikumar V, Frishman W, Hirani R, Etienne M
Cardiol Rev · 2026 Apr · PMID 42020934 · Publisher ↗
Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide. In addition to its cardinal motor features-bradykinesia rigidity and resting tremor-PD is frequently preceded by mild subclinical c...
Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide. In addition to its cardinal motor features-bradykinesia rigidity and resting tremor-PD is frequently preceded by mild subclinical cardiac autonomic dysfunction such as reduced heart rate variability, constipation and reduced metaiodobenzylguanidine uptake with more severe autonomic failure such as neurogenic orthostatic hypotension and urogenital failure occurring later in the disease. Beyond the substantial morbidity associated with advanced disease, individuals with PD have a 1.617-fold increased risk of all-cause mortality compared with the general population, with cardiovascular disease representing a major contributor to this excess risk. The relationship between cardiovascular autonomic dysfunction and mortality in PD has been widely investigated, though important gaps remain. This review synthesizes current evidence on cardiovascular autonomic manifestations of PD, discusses implications for clinical management, and highlights cardiovascular dysautonomia as a priority area for future mechanistic and therapeutic research.
Dextrocardia: Understanding Complex Anatomy to Treat This Disorder.
Sami N, Mulchan J, Parikh MA … +3 more , Mihatov N, Frishman WH, Peterson SJ
Cardiol Rev · 2026 Apr · PMID 42018743 · Publisher ↗
Dextrocardia occurs in approximately 1 in 10,000 live births and is frequently dismissed as an incidental anatomic variant, particularly when accompanied by situs inversus totalis and a structurally normal heart. Ultimat...
Dextrocardia occurs in approximately 1 in 10,000 live births and is frequently dismissed as an incidental anatomic variant, particularly when accompanied by situs inversus totalis and a structurally normal heart. Ultimately, dextrocardia reflects a disruption of embryonic left-right axis determination. While situs inversus totalis is often associated with relatively low rates of congenital heart disease, dextrocardia with situs solitus or situs ambiguus is more likely to occur with complex structural abnormalities. Such congenital conditions include single-ventricle physiology, which can require surgical correction and result in Fontan circulation or anomalous venous connections. Chronic conditions further complicate this disease, such as hemodynamic compromise from pulmonary hypertension. These anatomic differences affect multiple aspects of cardiovascular care. In electrocardiography, the mirror-image orientation of the heart can result in abnormal electrocardiogram that may indicate ischemia when none is present; lead adjustment is needed to mitigate this. In interventional cardiology, modifications must be made during coronary angiography or percutaneous coronary intervention, namely, reversal of catheter direction and proper interpretation of fluoroscopic views. Cardiac surgery presents similar issues because the cannulation strategy, operative exposure, and graft orientation must all account for the heart's reversed position. Dextrocardia is a fascinating problem in which a single embryologic misstep can ripple through everything from the interpretation of a 12-lead electrocardiogram to planning a transplant operation. Managing these patients requires recognizing the mirror-image arrangement and adjusting diagnostic and procedural strategies. Once the spatial inversion clicks into place, the rest is familiar ground.
Postmyocardial Infarction Depression as a Modifiable Secondary Prevention Risk Factor.
Arun AJ, Abraham E, Baig M … +2 more , Arun AJ, Frishman WH
Cardiol Rev · 2026 Apr · PMID 42008443 · Publisher ↗
Major depressive disorder is a common and clinically consequential complication following myocardial infarction (MI), affecting approximately one-quarter of patients and occurring at substantially higher rates than in th...
Major depressive disorder is a common and clinically consequential complication following myocardial infarction (MI), affecting approximately one-quarter of patients and occurring at substantially higher rates than in the general population. Beyond its prevalence, post-MI depression independently predicts all-cause mortality, recurrent ischemic events, and hospital readmission, with risk proportional to symptom severity and persistence. Emerging evidence supports a bidirectional brain-heart axis linking depression to adverse cardiovascular outcomes through autonomic dysregulation, systemic inflammation, endothelial dysfunction, platelet activation, metabolic disturbance, and impaired health behaviors. Treatment of post-MI depression consistently improves depressive symptoms and quality of life. Selective serotonin reuptake inhibitors appear safe in appropriately selected cardiac patients, and signals of long-term cardiovascular benefit have been observed in some trials. However, randomized evidence demonstrating definitive reductions in mortality or major adverse cardiovascular events remains limited. Persistent and untreated depression is consistently associated with the worst outcomes, suggesting that durable remission may be necessary to influence long-term prognosis. Cardiac rehabilitation provides a critical interface between mental health and cardiovascular recovery, yet depression impairs rehabilitation participation while rehabilitation itself reduces depressive symptoms and improves survival. Integrating longitudinal depression screening, stepped-care treatment pathways, and collaborative care models into established secondary prevention frameworks may enhance both psychological and cardiovascular outcomes. Reframing post-MI depression as a modifiable secondary prevention risk factor supports its systematic incorporation into comprehensive cardiovascular care.
Clinical Presentations, Comorbidities, and Diagnostic Approaches in Sinus Venosus Atrial Septal Defect: A Literature Review.
Bsat D, Safi D, Abdul Khalek J … +2 more , El Rassi I, Arabi M
Cardiol Rev · 2026 Apr · PMID 42008425 · Publisher ↗
Sinus venosus atrial septal defect is a rare congenital heart defect that is frequently associated with partial anomalous pulmonary venous return (PAPVR). This defect is categorized into 2 types: superior vena cava (SVC)...
Sinus venosus atrial septal defect is a rare congenital heart defect that is frequently associated with partial anomalous pulmonary venous return (PAPVR). This defect is categorized into 2 types: superior vena cava (SVC) type and inferior vena cava type, with the SVC type being more common. The condition results in abnormal left-to-right shunting of blood, leading to right heart dilation and increased pulmonary blood flow. A comprehensive literature search was performed using PubMed, MEDLINE Ovid, and Embase, focusing on studies involving patients with sinus venosus atrial septal defect, with or without PAPVR, published in English. Data were collected on patient demographics, the type of sinus venosus atrial septal defect, comorbidities, diagnostic imaging methods, and treatment outcomes. The search aimed to gather information on the clinical presentations, diagnostic challenges, and treatment options for this congenital defect. Sinus venosus atrial septal defect accounts for 5-10% of all atrial septal defects. Most cases involve the SVC type, which is often associated with PAPVR. Patients commonly present with symptoms such as dyspnea, fatigue, palpitations, and exercise intolerance. Comorbidities such as Lutembacher syndrome, cor triatriatum dexter, and pulmonary hypertension were observed. Diagnostic methods included transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance imaging, and computed tomography angiography, with transesophageal echocardiography being the most sensitive. Sinus venosus atrial septal defect is a clinically significant condition that can lead to serious complications like atrial arrhythmias and pulmonary hypertension. Early diagnosis using advanced imaging techniques and surgery is essential for preventing long-term morbidity.
Cardiovascular Safety of Parkinson's Disease Therapies: A Comprehensive Review.
Qian B, Munjal R, Haselkorn R … +8 more , Mckay L, Lu K, Hirani R, Lisk JP, Karp A, Ravikumar V, Frishman WH, Etienne M
Cardiol Rev · 2026 Apr · PMID 41992395 · Publisher ↗
Parkinson's disease (PD) is a neurodegenerative disorder characterized by progressive motor dysfunction and a host of additional systemic manifestations. PD is managed via a broad range of pharmacological and procedural...
Parkinson's disease (PD) is a neurodegenerative disorder characterized by progressive motor dysfunction and a host of additional systemic manifestations. PD is managed via a broad range of pharmacological and procedural treatments aimed at ameliorating motor and nonmotor symptoms. As PD occurs with a high prevalence of cardiac comorbidities, investigation and awareness of the cardiac safety of this range of treatments are essential. This review aims to synthesize current consensus on the cardiotoxic risk associated with the most prevalent treatments for PD, including levodopa, catechol-O-methyltransferase inhibitors, dopamine agonists, monoamine oxidase inhibitors, deep brain stimulation, and electroconvulsive therapy. This systematic literature review was performed via PubMed and Google Scholar by using predefined, relevant terms such as "Parkinson's," "cardiotoxicities," and "treatment," and synthesizing information drawn from studies selected based on methodologic rigor, generalizability, relevance, and quality of data related specifically to cardiovascular outcomes. Agents including levodopa, ergot-based dopamine agonists, entacapone, and selegiline have been found to be associated with cardiotoxic side effects, including orthostatic hypotension, arrhythmias, and valvular abnormalities, while agents such as safinamide, non-ergot-based dopamine agonists, and opicapone show minimal evidence of cardiotoxicity. Procedural treatments such as electroconvulsive therapy and deep brain stimulation appear to convey minimal cardiac risk, though typical perioperative vigilance is still necessary for high-risk patients. Collectively, evidence supports individualized tailoring of PD treatment based on cardiac risk profiles of patients and underscores the need for additional research attention to better elucidate the mechanisms underlying these cardiotoxic effects.
Antiphospholipid Syndrome and Cardiovascular Disease.
Naseem M, Ramesh J, Mahmood A … +4 more , Kothari K, Memon FZ, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41992296 · Publisher ↗
Antiphospholipid syndrome (APS) is an acquired systemic autoimmune thrombo-inflammatory disorder characterized by venous, arterial, and microvascular thrombosis and/or pregnancy morbidity in the setting of persistent ant...
Antiphospholipid syndrome (APS) is an acquired systemic autoimmune thrombo-inflammatory disorder characterized by venous, arterial, and microvascular thrombosis and/or pregnancy morbidity in the setting of persistent antiphospholipid antibodies. Cardiovascular disease in APS extends well beyond classic thrombosis and includes ischemic stroke, myocardial infarction, venous thromboembolism, valvular heart disease, pulmonary embolism, accelerated atherosclerosis, and microvascular ischemic injury. Mechanistically, APS is increasingly understood as a disorder of immunothrombosis, in which antiphospholipid antibodies-particularly anti-β2-glycoprotein I antibodies-promote endothelial dysfunction, tissue factor expression, platelet activation, complement amplification, and neutrophil extracellular trap formation. In parallel, oxidized low-density lipoprotein-β2-glycoprotein I immune complexes may link autoimmunity with plaque formation and atherothrombosis. Clinical cardiovascular risk is shaped not only by antibody profile, including lupus anticoagulant positivity, double/triple positivity, and high titers, but also by traditional atherosclerotic risk factors, systemic lupus erythematosus, hematologic manifestations, and prior thrombotic phenotype. Recent advances in classification, particularly the 2023 American College of Rheumatology/European League Against Rheumatism criteria, better capture macrovascular, microvascular, and valvular domains relevant to cardiovascular practice, although classification should not substitute for diagnosis. For secondary prevention, vitamin K antagonist therapy remains the cornerstone of thrombotic APS management. Randomized trials of direct oral anticoagulants have demonstrated excess recurrent thrombosis, especially arterial events, in high-risk APS.
Childhood Obesity, Medications, and Surgeries.
Raghav S, Frishman WH
Cardiol Rev · 2026 Apr · PMID 41986930 · Publisher ↗
The obesity pandemic continues to increase in prevalence in children and adolescents, with its increase outpacing the rate of adult obesity; the human developmental index, body mass index, and family income all display a...
The obesity pandemic continues to increase in prevalence in children and adolescents, with its increase outpacing the rate of adult obesity; the human developmental index, body mass index, and family income all display associations to childhood obesity. There are numerous adverse complications of childhood obesity, including cardiovascular, endocrine, and gastrointestinal manifestations. Obesity is thought to be an interaction of several different factors, such as leptin, proopiomelanocortin, glucose uptake in adipocytes, melanocortin receptor 4, protein convertase 1/3, brain-derived neurotrophic factor, fat-mass and obesity-associated gene, melanocortin receptor 4, tumor necrosis factor, interleukin-6, and long noncoding RNA. Epigenetic regulation, the unique gut microbiome role in contributing to obesity, environmental factors, and the social context of a child can precipitation of childhood obesity. In this review, we hope to explore the different medications for obesity, orlistat, glucagon-like peptide-1 agonists, liraglutide, semaglutide, exenatide, setmelanotide, metreleptin, naltrexone, lorcaserin, phentermine, metformin, fluoxetine, lisdexamfetamine, and zonisamide, while also reviewing surgeries such as the Roux-en-Y gastric bypass, laparoscopic or vertical sleeve gastrectomy, and adjustable gastric banding.
Exosomes and Extracellular Vesicles in CAR-T Cell Therapy: Emerging Mediators and Biomarkers of Cardiac Injury.
Thukral J, Moudgil P, Sindhwani N … +9 more , Mann A, Makkar S, Kaur J, Shah RK, Kaur H, Thukral N, Agrawal SP, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41986929 · Publisher ↗
Chimeric antigen receptor T-cell (CAR-T) therapy has transformed outcomes in hematologic malignancies but is frequently complicated by cardiovascular toxicity, most notably in the setting of cytokine release syndrome. Wh...
Chimeric antigen receptor T-cell (CAR-T) therapy has transformed outcomes in hematologic malignancies but is frequently complicated by cardiovascular toxicity, most notably in the setting of cytokine release syndrome. While systemic inflammation, endothelial activation, and myocardial stress have been implicated, the mechanistic links between immune activation and cardiac injury remain incompletely understood. Exosomes and other extracellular vesicles (EVs) have emerged as critical mediators of intercellular communication during immune responses, carrying bioactive cargo including cytokines, microRNAs, proteins, and lipids that can modulate cardiovascular function. In the context of CAR-T therapy, EVs derived from activated T-cells, tumor cells, and injured endothelium may amplify inflammatory signaling, promote endothelial dysfunction, and contribute directly to myocardial injury. Importantly, EVs are detectable in peripheral blood and exhibit dynamic changes in concentration and cargo during CAR-T-associated toxicities, positioning them as promising biomarkers for early detection, risk stratification, and prognostication of cardiac injury. This review synthesizes current evidence on the biogenesis, functional roles, and cardiovascular effects of exosomes and EVs in CAR-T therapy, highlighting their potential as mechanistic mediators and translational biomarkers. We also discuss existing knowledge gaps, technical challenges in EV characterization, and future directions for integrating EV-based diagnostics into cardio-oncology practice.
Upstream Antiplatelet Therapy in ST-Segment Elevation Myocardial Infarction: What Zalunfiban Adds to the Glycoprotein IIb/IIIa Story.
Ji T, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41986924 · Publisher ↗
Zalunfiban is a next-generation glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor developed through a novel molecular design that enables rapid, potent, and reversible platelet inhibition following single-dose subcutaneous ad...
Zalunfiban is a next-generation glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor developed through a novel molecular design that enables rapid, potent, and reversible platelet inhibition following single-dose subcutaneous administration. This pharmacologic profile creates an opportunity for very early antiplatelet therapy at first medical contact in patients with ST-segment elevation myocardial infarction. Historical experience with intravenous GPIIb/IIIa inhibitors has demonstrated that clinical benefit is highly dependent on early administration; however, routine prehospital use has been limited by logistical complexity and safety concerns. Recent clinical trials suggest that zalunfiban may overcome these barriers while preserving the mechanistic advantages of upstream platelet inhibition. This review summarizes the mechanism of action, pharmacokinetic and pharmacodynamic properties, clinical efficacy, and safety profile of zalunfiban, and discusses its potential role within contemporary ST-segment elevation myocardial infarction care pathways.
Geniculate Artery Embolization: A Concise Review.
Mohamad T, Dwaik HA, Abbasi L … +3 more , Darwiche A, Zeabari S, Chowdhury M
Cardiol Rev · 2026 Apr · PMID 41986919 · Publisher ↗
Osteoarthritis (OA) is one of the most prevalent causes of chronic disability worldwide, yet current therapeutic options often provide incomplete or short-lived relief, particularly for patients who are not surgical cand...
Osteoarthritis (OA) is one of the most prevalent causes of chronic disability worldwide, yet current therapeutic options often provide incomplete or short-lived relief, particularly for patients who are not surgical candidates. Genicular artery embolization (GAE) has emerged as a minimally invasive endovascular therapy that directly targets synovial inflammation and abnormal neovascularization, both key drivers of OA pain. Over the past decade, prospective studies and early randomized trials have demonstrated meaningful improvements in pain, function, and quality of life following GAE, with durability of effect extending up to 2 years in selected patients. Imaging studies consistently support reductions in synovial volume and vascularity without evidence of cartilage injury, while safety data confirm a low rate of mostly minor, self-limited complications. Patient selection, embolic material choice, and technical considerations remain important factors influencing outcomes. This review synthesizes current clinical, imaging, and anatomical evidence on GAE, highlighting its role as a promising mechanism-based therapy that bridges the gap between conservative management and surgical intervention in knee OA.
Raynaud's Disease: Review of Current Literature.
Venkatesh V, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41986912 · Publisher ↗
Raynaud's disease (RD), also referred to as Raynaud's phenomenon (RP) or Raynaud's syndrome, is a vasospastic condition characterized by episodic, reversible constriction of the peripheral digital arteries and cutaneous...
Raynaud's disease (RD), also referred to as Raynaud's phenomenon (RP) or Raynaud's syndrome, is a vasospastic condition characterized by episodic, reversible constriction of the peripheral digital arteries and cutaneous arterioles in response to cold temperature and/or emotional stress. The condition is classified into 2 forms. The first being primary RD, which occurs in the absence of any identifiable underlying condition, and then secondary RP, which develops in the setting of a systemic disease, most commonly connective tissue disorders such as systemic sclerosis, systemic lupus erythematosus, and Sjogren's syndrome. Primary RD is considerably more prevalent and generally follows a benign course, whereas secondary RP carries a significant risk of ischemic digital complications, including ulceration, gangrene, and permanent tissue loss. The clinical hallmark of RD is the characteristic triphasic color change of the digits, progressing from pallor to cyanosis to erythema, reflecting the sequential phases of vasospasm, deoxygenation, and reactive hyperemia. Diagnosis is largely clinical, supported by a thorough history and physical examination, serologic autoantibody testing, and nailfold capillaroscopy, which serves as the gold standard for differentiating primary from secondary disease.
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