Cardiology In Review[JOURNAL]
Sun
200 papers
The Changing Pulse of a Region: Ischemic Heart Disease and Its Drivers in the Asia-Pacific, 1990-2021.
Adrejiya P, Bhatt V, Khushalani S … +7 more , Rohatgi S, Shah D, Raval M, Pravin Agrawal S, Patel D, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41986909 · Publisher ↗
Ischemic heart disease remains the leading cause of cardiovascular mortality globally, yet the burden in Southeast Asia, East Asia, and Oceania has followed a distinct trajectory that contrasts with global trends. Despit...
Ischemic heart disease remains the leading cause of cardiovascular mortality globally, yet the burden in Southeast Asia, East Asia, and Oceania has followed a distinct trajectory that contrasts with global trends. Despite declining age-standardized rates reported in higher-income regions, these areas continue to experience rising absolute prevalence, mortality, and disability-adjusted life years, reflecting the combined effects of population aging, rapid urbanization, and persistent metabolic and environmental risk factors. Smaller nations and lower-resource settings, including Timor-Leste, the Maldives, Papua New Guinea, Indonesia, and parts of China, have experienced the steepest increases, highlighting widening regional disparities. Air pollution has emerged as a particularly important contributor to ischemic heart disease mortality, emphasizing the growing influence of environmental exposures alongside traditional cardiometabolic determinants such as hypertension, diabetes, hypercholesterolemia, and tobacco use. The increasing burden in these regions underscores the need for tailored, region-specific strategies that integrate public health, environmental, and cardiovascular prevention priorities. Early identification and management of modifiable risk factors, improvements in air quality, and expanded access to acute and preventive cardiac care are essential to curb future disease burden. Understanding the interplay between demographic shifts, environmental challenges, and persistent metabolic risks is critical for guiding policy and clinical interventions, particularly in lower-resource countries, and may offer a roadmap for mitigating emerging disparities and preventing avoidable cardiovascular deaths across diverse populations.
Barriers to Electrocardiographic Monitoring Practice Among Nurses: A Scoping Review.
Giusti ACBS, Medeiros KS, Chiavone FBT … +3 more , Silva WPD, Cornélio ME, Gallani MCBJ
Cardiol Rev · 2026 Apr · PMID 41968402 · Publisher ↗
Despite the evidence of the importance of a good use of the electrocardiographic monitoring (ECG-M) to safe and quality patient care, best practices on ECG-M seem to remain a problem for nurses. The aim of this study was...
Despite the evidence of the importance of a good use of the electrocardiographic monitoring (ECG-M) to safe and quality patient care, best practices on ECG-M seem to remain a problem for nurses. The aim of this study was to identify and map the barriers faced by the nursing team in performing ECG-M, as well as the strategies to overcome them. Scoping review according to the recommendations of the Joanna Briggs Institute Manual. The databases used were: Medline, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHAL), Latin American and Caribbean Literature in Health Sciences (LILACS), Scopus, and Cochrane. The keywords "Electrocardiography," "Hemodynamic Monitoring," "Nursing," and "Nursing Team" and associated terms were used to find articles published from January 2014 to December 2022, without language restriction. An iterative team approach enabled screening, data selection, and extraction studies that were mapped. Twenty-nine articles were selected and analyzed, and the main barriers were a lack of knowledge and/or skills, as well as difficulty in retaining capacity after an educational intervention. Barriers to adequate cardiac monitoring were related to knowledge and interpretation of ECG-M data, as well as technical aspects related to monitoring. Continuing education strategies, establishment of institutional protocols, and customization of monitoring parameters have been shown to be effective in implementing best practices for ECM.
Stereotactic Arrhythmia Radioablation: An Emerging Technique for the Treatment of Ventricular Tachycardia.
Comuzzi A, Candelora A, Madaffari A … +6 more , Angheben C, Maines M, Laurente M, Catanzariti D, Del Greco M, Peruzza F
Cardiol Rev · 2026 Apr · PMID 41952103 · Publisher ↗
Ventricular tachycardia (VT) in patients with structural heart disease is a significant cause of both morbidity and mortality. Current treatment options for VT include the implantation of implantable cardioverter-defibri...
Ventricular tachycardia (VT) in patients with structural heart disease is a significant cause of both morbidity and mortality. Current treatment options for VT include the implantation of implantable cardioverter-defibrillators, anti-arrhythmic medications, and catheter ablation. Although implantable cardioverter-defibrillators can terminate arrhythmias by delivering shocks, they do not address the underlying cause and may even contribute to recurrence or cause discomfort for the patient. Anti-arrhythmic drugs may reduce the frequency of VT episodes but are often associated with various side effects. Catheter ablation can effectively eliminate the arrhythmogenic substrate, but it is an invasive procedure and not always successful. Recent studies have investigated stereotactic arrhythmia radioablation as a potential alternative, offering a less invasive, effective, and well-tolerated treatment by using photons, protons, and carbon ions to target and destroy arrhythmic tissue externally. This review aims to examine the current evidence and potential clinical applications of stereotactic arrhythmia radioablation.
The Effectiveness of Polypills for Primary and Secondary Prevention of Major Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis.
Mirhosseini SA, Azami P, Mirzaei A … +8 more , Zooravar D, Yaghoobi N, Arman A, Ranjbar M, Hosseinpour A, Shams F, Elhagh A, Attar A
Cardiol Rev · 2026 Apr · PMID 41952094 · Publisher ↗
Recent evidence shows that polypills reduce major adverse cardiovascular events (MACE) compared with standard care, though many studies mix primary and secondary prevention populations, limiting clarity on subgroup effec...
Recent evidence shows that polypills reduce major adverse cardiovascular events (MACE) compared with standard care, though many studies mix primary and secondary prevention populations, limiting clarity on subgroup effects. The impact of polypills on individual MACE components also remains unclear. This study assessed the effectiveness of polypills in preventing MACE and its components-cardiovascular mortality, coronary artery event (CAE), stroke, and heart failure-across primary, secondary, and mixed populations. Secondary outcomes included predefined MACE, all-cause mortality, coronary intervention, and peripheral vascular disease. We systematically searched PubMed, Scopus, and Web of Science for randomized controlled trials and cohort studies comparing polypills with usual care, monocomponent therapy, or placebo. Polypills were defined as fixed combinations of at least 2 of the following: aspirin, an antihypertensive agent, and a statin. Eighteen studies (15 randomized controlled trials, 3 cohorts; N = 32,425) were included. No significant reduction in MACE was observed in primary or mixed prevention groups, but polypills significantly reduced MACE in secondary prevention (risk ratio [RR]: 0.80, 95% confidence interval [CI]: 0.70-0.92). Predefined MACE was also reduced (RR: 0.79, 95% CI: 0.68-0.91), particularly in primary and secondary prevention. Cardiovascular mortality (RR: 0.69, 95% CI: 0.55-0.87) and CAE (RR: 0.77, 95% CI: 0.62-0.96) were significantly reduced, especially in secondary prevention. No significant effects were observed for stroke, heart failure, peripheral vascular disease, or all-cause mortality. Overall, polypills effectively reduce MACE in secondary prevention, mainly through reductions in cardiovascular mortality and CAE. Further work is needed to refine risk stratification and optimize polypill use in primary prevention.
Lactation Safety in Peripartum Cardiomyopathy.
Khalid H, Kim A, Lau T … +4 more , Parikh MA, Ramasubbu K, Frishman WH, Peterson SJ
Cardiol Rev · 2026 Apr · PMID 41952076 · Publisher ↗
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure that occurs toward the end of pregnancy or in the months following delivery. It is characterized by left ventricular systo...
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure that occurs toward the end of pregnancy or in the months following delivery. It is characterized by left ventricular systolic dysfunction in women without preexisting structural heart disease. Despite increasing recognition, the pathophysiology of PPCM remains incompletely understood. Accumulating experimental and clinical evidence supports a central role for hormonal dysregulation in disease development, particularly involving prolactin (PRL). During late pregnancy and the postpartum period, heightened oxidative stress promotes cleavage of full-length PRL into a 16-kDa fragment with potent antiangiogenic, proinflammatory, and proapoptotic properties. While total circulating PRL levels are elevated in PPCM, it is the generation of the 16-kDa PRL fragment, rather than absolute PRL concentration, that appears to be most strongly linked to disease severity and progression. The recognition of this mechanism has provided a framework for targeted therapeutic strategies. As many women choose to breastfeed, there are concerns about the safety of breastfeeding in PPCM. This review summarizes the experimental and clinical evidence related to elevated PRL levels, particularly the cleaved 16-kDa PRL fragment's contribution to disease development, with emphasis on lactation safety in PPCM.
Acute Care Outcomes and 30-Day Readmission Among Patients With Peripheral Artery Disease Hospitalized for Acute Heart Failure: A Retrospective Cohort Study.
Ascandar N, Chinniah C, Ekram J … +3 more , Sreenivasan SS, Milford B, Ali R
Cardiol Rev · 2026 Apr · PMID 41945872 · Publisher ↗
Peripheral artery disease (PAD) commonly coexists with acute heart failure (HF), yet the short-term prognostic implications of PAD severity during HF hospitalization are uncertain. Using nationally representative data, w...
Peripheral artery disease (PAD) commonly coexists with acute heart failure (HF), yet the short-term prognostic implications of PAD severity during HF hospitalization are uncertain. Using nationally representative data, we queried all adult (≥18 years) index admissions with a primary diagnosis of acute HF. Cohorts were stratified into 3 groups according to PAD presence and severity using the Rutherford classification. Patients with Rutherford categories 0-3 were classified as PAD, those with categories 4-6 as critical limb ischemia (CLI), and all remaining cohorts without PAD comprised the non-PAD group. Compared with non-PAD, PAD was associated with higher adjusted odds of mortality [adjusted odds ratio (aOR), 1.10; 95% confidence interval (CI), 1.03-1.18], acute kidney injury (AKI) (aOR, 1.15; 95% CI, 1.12-1.18), cardiogenic shock (aOR, 1.13; 95% CI, 1.03-1.23), nonhome discharge (aOR, 1.15; 95% CI, 1.11-1.18), all-cause 30-day readmission (aOR, 1.21; 95% CI, 1.18-1.25), and HF readmission (aOR, 1.28; 95% CI, 1.21-1.35), as well as modestly longer length of stay by +0.39 days and higher hospitalization costs by +$500. CLI conferred markedly higher odds of mortality (aOR, 2.77; 95% CI, 2.06-3.73), cardiogenic shock (aOR, 2.31; 95% CI, 1.65-3.24), AKI (aOR, 1.41; 95% CI, 1.21-1.65), AKI requiring dialysis (aOR, 4.55; 95% CI, 2.19-9.47), and all-cause 30-day readmission (aOR, 1.59; 95% CI, 1.33-1.90), with substantially greater length of stay by +5.07 days and hospitalization costs by +$19,700. In acute HF admissions, increasing PAD severity is linked with progressively worse in-hospital outcomes and greater resource utilization, supporting early multidisciplinary inpatient management and intensified postdischarge planning for patients with PAD, particularly CLI.
Caffeine and Cardiovascular Outcomes: Current Evidence and Clinical Perspectives.
Neshat N, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41945865 · Publisher ↗
Caffeine is among the most widely consumed bioactive compounds worldwide and remains a target of cardiovascular counseling despite heterogeneous evidence across mechanistic, interventional, and epidemiologic studies. At...
Caffeine is among the most widely consumed bioactive compounds worldwide and remains a target of cardiovascular counseling despite heterogeneous evidence across mechanistic, interventional, and epidemiologic studies. At dietary doses, caffeine acts as a competitive antagonist of adenosine receptors, influencing autonomic tone, vascular resistance, and myocardial electrophysiology. Acute exposure can produce increases in blood pressure, alterations in sympathetic activity, and changes in ventricular ectopy, whereas habitual coffee consumption is associated in cohort studies with neutral or modestly favorable cardiovascular outcomes, including lower risks of cardiovascular mortality, heart failure, and stroke at moderate intake levels. Evidence from randomized and observational studies does not support a consistent proarrhythmic effect of habitual coffee consumption, and recent clinical trials challenge recommendations for caffeine restriction in conditions such as atrial fibrillation. Importantly, caffeine exposure is heterogeneous: energy drinks and concentrated caffeine products demonstrate more consistent electrophysiologic and hemodynamic effects, including QTc prolongation and sustained blood pressure elevation, suggesting a distinct risk profile compared with coffee or tea. Genetic variability in caffeine metabolism and differences in exposure patterns further modify individual responses. Overall, current evidence supports a dose-, source-, and patient-specific framework for interpreting caffeine exposure in cardiovascular medicine rather than universal restriction.
Prevalence and Factors Associated With Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction: A Meta-Analysis and Meta-Regression.
Tristan CD, Wijayanto MA, Kynaya EM … +7 more , Budiono EA, Huang W, Myrtha R, Irnizarifka I, Dinarti LK, Siswanto BB, Muliawan HS
Cardiol Rev · 2026 Apr · PMID 41945854 · Publisher ↗
Pulmonary hypertension (PH) is one of the unfavorable clinical turning points in the natural history of heart failure with preserved ejection fraction (HFpEF). However, as it is identified as an independent predictor of...
Pulmonary hypertension (PH) is one of the unfavorable clinical turning points in the natural history of heart failure with preserved ejection fraction (HFpEF). However, as it is identified as an independent predictor of worse prognosis, its true prevalence is uncertain. This review aims to investigate the pooled prevalence, associated risk factors, and characteristics of patients with PH-HFpEF. Systematic searches of 3 databases (PubMed, ScienceDirect, and Scopus) with citation searching were conducted. Studies conducting direct surveillance using echocardiography or catheterization for estimating the prevalence of PH-HFpEF patients (left ventricular ejection fraction ≥50%) were included. The Newcastle-Ottawa scale was used for quality assessment. RStudio was used for statistical analysis. This review comprises 11 studies (n = 1838 patients) that met the eligibility criteria. The pooled prevalence of PH-HFpEF was 0.63 (95% CI, 0.52-0.74). This value was robust based on leave-one-out and cumulative sample sensitivity analysis. Meta-regression revealed a significant relationship between PH prevalence and several associated factors, including history of coronary artery disease (β = 0.50; P < 0.0001), baseline female sex (β = 0.49; P < 0.0001), hypertension (β = 0.49; P < 0.0001), and diabetes (β = 0.46; P < 0.0001). Meta-analyses of echocardiography characteristics revealed that patients with PH-HFpEF have significantly worse diastolic function and more advanced left atrial remodeling compared to those without PH. In conclusion, PH was present in over half of HFpEF patients at baseline, with a history of coronary artery disease, female sex, hypertension, and diabetes significantly associated with greater susceptibility, emphasizing risk-based screening across these HFpEF phenotypes.
Intraoperative Transesophageal Echocardiography in Cardiac Surgery: Clinical Applications, Decision-Making, and Impact on Outcomes.
Kalçik M, Bayam E, Özkan M
Cardiol Rev · 2026 Apr · PMID 41945851 · Publisher ↗
Intraoperative transesophageal echocardiography (TEE) has become a central component of modern cardiac surgery by providing real-time, high-resolution assessment of cardiac anatomy and physiology throughout the periopera...
Intraoperative transesophageal echocardiography (TEE) has become a central component of modern cardiac surgery by providing real-time, high-resolution assessment of cardiac anatomy and physiology throughout the perioperative period. Beyond its traditional diagnostic role, intraoperative TEE directly influences surgical and anesthetic decision-making by enabling immediate detection of unexpected pathology, residual lesions, and hemodynamic instability. Accumulating evidence demonstrates that TEE-guided intraoperative assessment frequently leads to modification of surgical strategy or anesthetic management, particularly in valve surgery, aortic procedures, and complex congenital heart disease repair. In valve surgery, intraoperative TEE serves as a critical quality control tool by verifying repair adequacy and identifying residual regurgitation, which has been associated with impaired mid- and long-term durability. In aortic surgery, TEE provides rapid bedside evaluation of aortic pathology and repair adequacy, supporting timely intraoperative decision-making in high-risk settings. Additionally, intraoperative TEE plays a pivotal role in perioperative hemodynamic monitoring by allowing direct assessment of ventricular filling, contractility, and right ventricular function, thereby guiding fluid therapy, pharmacologic support, and mechanical circulatory assistance. Although limitations such as operator dependency, practice variability, and a predominance of observational data persist, the cumulative literature supports routine integration of intraoperative TEE into contemporary cardiac surgical practice. Ongoing advances in three-dimensional imaging, artificial intelligence-assisted analysis, and protocol standardization are expected to further enhance the clinical utility and reproducibility of intraoperative TEE in evolving surgical and hybrid procedures.
Sacubitril/Valsartan Versus Enalapril in Chagas Cardiomyopathy With Heart Failure: A Systematic Review and Meta-Analysis.
AlSejari NY, Gadelmawla AF, Alfehaid A … +9 more , AlMutairi OT, Taqi M, Alibrahim AA, AlOmar H, AlShammari MT, Alharran AM, Alsubaiei AA, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41941460 · Publisher ↗
Chagas cardiomyopathy represents a distinct and understudied etiology of heart failure with reduced ejection fraction (HFrEF). This meta-analysis aims to compare the efficacy and safety of sacubitril/valsartan versus ena...
Chagas cardiomyopathy represents a distinct and understudied etiology of heart failure with reduced ejection fraction (HFrEF). This meta-analysis aims to compare the efficacy and safety of sacubitril/valsartan versus enalapril in the treatment of patients with HFrEF due to Chagas cardiomyopathy with a total of 1225 patients (615 in the sacubitril/valsartan group and 610 in the enalapril group). There were no statistically significant differences between sacubitril/valsartan and enalapril in hospitalization for heart failure [risk ratios (RR) = 0.93; 95% confidence intervals (CI), 0.74-1.16; P = 0.53], cardiovascular mortality (RR = 0.91; 95% CI, 0.73-1.12; P = 0.37), or all-cause mortality (RR = 0.96; 95% CI, 0.79-1.17; P = 0.69). Heterogeneity was low across all efficacy outcomes (I2 = 0-4.1%). Similarly, we found no significant differences in safety outcomes, including symptomatic hypotension (RR = 1.14; 95% CI, 0.94-1.39), kidney dysfunction (RR = 1.08; 95% CI, 0.84-1.39), or hyperkalemia (RR = 1.26; 95% CI, 0.37-4.32). Our results indicated that sacubitril/valsartan has comparable efficacy to enalapril with no significant differences in hospitalization for heart failure, cardiovascular mortality, or all-cause mortality in patients with HFrEF secondary to Chagas cardiomyopathy.
Cancer-Associated Takotsubo Syndrome: An Emerging Intersection of Cardio-Oncology.
Thukral J, Moudgil P, Sindhwani N … +8 more , Garg V, Grover D, Kaur H, Shah RK, Kaur H, Thukral N, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41941451 · Publisher ↗
Takotsubo syndrome (TTS) is an acute stress-induced cardiomyopathy that mimics acute coronary syndrome and is recognized in patients with malignancy. Outcomes analyses and contemporary cardio-oncology reviews further emp...
Takotsubo syndrome (TTS) is an acute stress-induced cardiomyopathy that mimics acute coronary syndrome and is recognized in patients with malignancy. Outcomes analyses and contemporary cardio-oncology reviews further emphasize malignancy as a clinically meaningful modifier of TTS risk, phenotype, and prognosis. Cancer patients represent a uniquely vulnerable population due to the combined effects of emotional stress, systemic inflammation, autonomic imbalance, and exposure to potentially cardiotoxic therapies. Targeted anticancer agents that perturb vascular homeostasis (eg, vascular endothelial growth factor-pathway inhibition) also contribute to endothelial dysfunction, hypertension, thromboinflammation, and myocardial stress-mechanisms that plausibly lower the threshold for stress cardiomyopathy in susceptible patients. Evidence suggests that TTS in the oncology setting is associated with higher complication rates, increased mortality, and complex diagnostic and management challenges compared with noncancer populations. Large-scale database studies and propensity-matched real-world analyses reinforce the need for cancer-specific risk stratification and tailored cardiovascular management pathways. Moreover, cancer-associated TTS often occurs at critical junctures, including at diagnosis, during active treatment, or in the perioperative period, and may reflect underlying disease severity or physiological frailty. This review explores the epidemiology, pathophysiological mechanisms, and clinical presentation of TTS in patients with cancer, with particular emphasis on neurohormonal activation, inflammatory pathways, endothelial dysfunction, and treatment-related triggers.
Artificial Intelligence-Enabled Prediction of Reversible Versus Irreversible Chemotherapy-Induced Myocardial Injury: Toward Precision Cardio-Oncology.
Adrejiya P, Neshat N, Patel A … +4 more , Shah V, Patel N, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41941437 · Publisher ↗
Cancer therapy-related cardiac dysfunction remains a major cause of morbidity among cancer survivors and may interrupt life-saving oncologic therapy or lead to chronic heart failure. Conventional surveillance relies larg...
Cancer therapy-related cardiac dysfunction remains a major cause of morbidity among cancer survivors and may interrupt life-saving oncologic therapy or lead to chronic heart failure. Conventional surveillance relies largely on serial assessment of left ventricular ejection fraction, which often detects myocardial injury only after significant and sometimes irreversible remodeling has occurred. A major unmet need in cardio-oncology is early differentiation of reversible myocardial dysfunction from permanent structural injury. Artificial intelligence can integrate multimodal clinical data, including electronic health records, echocardiographic strain, cardiac magnetic resonance tissue characterization, circulating biomarkers, genomic susceptibility profiles, and wearable-derived physiologic signals, to predict not only cardiotoxicity risk but also recovery likelihood. Early machine learning and deep learning models show improved sensitivity for identifying subclinical dysfunction compared with conventional threshold-based surveillance. Temporal trajectory modeling may further distinguish transient myocardial stunning from fibrosis-mediated cardiomyopathy, enabling earlier risk-guided interventions such as cardioprotective therapy, oncologic regimen adjustment, or intensified surveillance. Despite promising results, current evidence remains limited by single-center datasets, inadequate prospective validation, and challenges in model interpretability and clinical deployment. This narrative review summarizes contemporary artificial intelligence applications in cardio-oncology, proposes a staged framework for predicting myocardial injury reversibility, and highlights priorities for future translational research.
Optimal Timing and Duration of Beta-Blocker Therapy for Preventing Postoperative Atrial Fibrillation: A Literature Review.
Abouzid MR, Nwaukwa C
Cardiol Rev · 2026 May-Jun 01 · PMID 41931013 · Publisher ↗
This literature review explores the intricate landscape of postoperative atrial fibrillation (POAF), a common complication that arises following heart surgery. The analysis highlights the significant risks associated wit...
This literature review explores the intricate landscape of postoperative atrial fibrillation (POAF), a common complication that arises following heart surgery. The analysis highlights the significant risks associated with POAF, including stroke, extended hospital stay, and increased healthcare costs. POAF, together with its transient character, indicates an augmented susceptibility to atrial fibrillation in the long run. Despite extensive research on preventive measures, such as beta-blocker medication, uncertainties remain regarding the optimal timing and duration of beta-blocker therapy for preventing POAF. The existing evidence suggests that starting beta-blocker treatment early, ideally within the first 24-48 hours after surgery, may be effective in reducing the occurrence of POAF. Nevertheless, there is a noticeable absence of agreement regarding the optimal length of this therapy. Conflicting viewpoints arise, with certain research calling for brief therapies, while others propose the possible benefits linked to extended treatment. This review highlights the urgent requirement for more research to precisely adjust guidelines, taking into account patient-specific factors and considering the consequences for long-term results. The call to action entails a request for the implementation of uniform definitions, the conduct of prospective randomized controlled trials, and the utilization of larger sample sizes in future investigations. These characteristics are considered critical in providing the medical community with strong evidence, which is crucial for making well-informed therapeutic decisions.
Clonal Cytopenias of Undetermined Significance and Cardiovascular Disease: Inflammatory Mechanisms, Risk Stratification, and Clinical Outcomes.
Thukral J, Moudgil P, Sindhwani N … +8 more , Khan K, Singla R, Garg K, Shah RK, Kaur H, Thukral N, Frishman WH, Aronow WS
Cardiol Rev · 2026 Apr · PMID 41928365 · Publisher ↗
Clonal cytopenia of undetermined significance (CCUS) is defined by persistent, unexplained cytopenias accompanied by somatic mutations characteristic of clonal hematopoiesis, in the absence of morphologic criteria for my...
Clonal cytopenia of undetermined significance (CCUS) is defined by persistent, unexplained cytopenias accompanied by somatic mutations characteristic of clonal hematopoiesis, in the absence of morphologic criteria for myeloid malignancy. While traditionally viewed as a hematologic precursor state, emerging evidence indicates that CCUS represents a systemic inflammatory disorder with important cardiovascular relevance. Mutant myeloid clones associated with CCUS promote chronic low-grade inflammation, dysregulated cytokine signaling, and inflammasome activation, processes that contribute to endothelial dysfunction, accelerated atherosclerosis, and adverse myocardial remodeling. In parallel, anemia and other cytopenias commonly observed in CCUS independently exacerbate cardiovascular stress by increasing myocardial oxygen demand, worsening heart failure outcomes, and complicating antithrombotic and invasive management in patients with coronary artery disease. CCUS frequently overlaps with aging-related syndromes such as frailty and multimorbidity, further amplifying cardiovascular risk and influencing prognosis. As molecular testing becomes increasingly integrated into clinical practice, cardiologists will encounter CCUS with greater frequency across a range of cardiovascular settings. This review synthesizes contemporary evidence linking CCUS to cardiovascular disease, highlights mechanisms relevant to cardiology, and outlines practical considerations for cardiovascular risk assessment and interdisciplinary management, while identifying key gaps for future cardio-hematology research.
Genetically Modified Foods: Have They Reduced Cardiovascular Risk?
Kaiser ME, Farmer BM, Parikh MA … +4 more , Turitto G, Minkin R, Frishman WH, Peterson SJ
Cardiol Rev · 2026 Apr · PMID 41923146 · Publisher ↗
Genetically modified organisms (GMOs) have been the subject of much debate due to their potential impact on human health, and in particular cardiovascular disease (CVD), the leading contributor to death worldwide. Althou...
Genetically modified organisms (GMOs) have been the subject of much debate due to their potential impact on human health, and in particular cardiovascular disease (CVD), the leading contributor to death worldwide. Although GMOs are used to improve agricultural properties, emerging nutritional engineering focuses on modifying food composition to produce foods high in polyunsaturated fatty acids, with the potential to correct an imbalance between omega-6 and omega-3 fatty acids and decrease the associated centrality of CVD; and evaluated GMO safety, plant-based diets, biofortified crops, and omega-6/omega-3 ratios. This review evaluated both the positive (protective) and harmful (adverse) associations of GMO consumption to provide a more balanced perspective on the safety/benefit relationship. GMO foods have been found by regulatory bodies to be no less safe than equivalent conventional foods for human health and potential adverse effects. Nutritional biofortification holds great potential because it involves creating crops with higher levels of omega-3 fatty acids, which have been shown to reduce inflammation and improve lipid profiles. Plant-based diets incorporating such enhancements are associated with lower CVD incidence and mortality. GMO food products do not increase the risk of CVD unless they involve ultraprocessed foods combined with GMOs, while also providing pathways to optimally improve the diet to lower CVD risk, mainly by balancing polyunsaturated fatty acids. Overall, the risk is not in GMO foods but remains in the overall diet.
Sacubitril/Valsartan Versus Enalapril in Chagas Cardiomyopathy With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis.
Daniyal SM, Tabish S, Burhan M … +8 more , Noor A, Jalal AA, Khalid A, Muhammad Sharjeel S, Gul I, Siddiqui MH, Ashraf DA, Hassan IN
Cardiol Rev · 2026 Apr · PMID 41923142 · Publisher ↗
Chagas cardiomyopathy is a leading cause of heart failure (HF) with reduced ejection fraction (HFrEF) in endemic regions, yet patients with this distinct etiology have been underrepresented in pivotal HF trials. This cre...
Chagas cardiomyopathy is a leading cause of heart failure (HF) with reduced ejection fraction (HFrEF) in endemic regions, yet patients with this distinct etiology have been underrepresented in pivotal HF trials. This creates significant uncertainty regarding the efficacy of guideline-directed therapies, including sacubitril-valsartan, in this population. PubMed, Cochrane (CENTRAL), Scopus, and Embase were searched from inception to December 17, 2025, for randomized controlled trials comparing sacubitril-valsartan to enalapril in patients with HFrEF due to Chagas cardiomyopathy. Primary outcomes were the composite endpoint of cardiovascular mortality or HF hospitalization, all-cause mortality, and individual components of the composite endpoint. Secondary outcomes included the percentage change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and adverse events. Three randomized controlled trials (n = 1225) patients were included. Sacubitril-valsartan did not significantly reduce the risk of the primary composite endpoint (risk ratio: 0.92; 95% confidence interval [CI]: 0.81-1.05; P = 0.216) or all-cause mortality (risk ratio: 0.96; 95% CI: 0.79-1.17; P = 0.691) compared to enalapril. However, it resulted in a significantly greater reduction in NT-proBNP levels (mean difference: -31.00%; 95% CI: -51.40 to -10.60; P < 0.01). The risks of renal dysfunction, symptomatic hypotension, and hyperkalemia were comparable between the 2 treatments. In patients with HFrEF due to Chagas cardiomyopathy, sacubitril-valsartan did not significantly improve hard clinical outcomes compared to enalapril but was associated with a substantially greater reduction in NT-proBNP and a similar safety profile. These findings underscore the unique pathophysiology of this disease and highlight the critical need for large, long-term outcome trials specifically powered for this neglected population.
Lymphedema: The Overlooked Cardiovascular Disorder-Mechanisms, Manifestations, and Management.
Whitford T, Wasserstein DH, Whiteson H … +1 more , Frishman WH
Cardiol Rev · 2026 Apr · PMID 41923138 · Publisher ↗
Lymphedema, a chronic disorder resulting from impaired lymphatic drainage, is increasingly recognized for its significant relevance to cardiovascular medicine. Its fundamental role in regulating systemic fluid homeostasi...
Lymphedema, a chronic disorder resulting from impaired lymphatic drainage, is increasingly recognized for its significant relevance to cardiovascular medicine. Its fundamental role in regulating systemic fluid homeostasis and inflammation positions it as a key factor in the pathophysiology of many cardiovascular conditions. This review aims to summarize the fundamental mechanisms of lymphatic dysfunction, elucidate its direct cardiovascular implications, and outline current and emerging management strategies. The content is tailored for a cardiology-focused audience to bridge the gap between peripheral lymphatic medicine and mainstream cardiovascular practice. Lymphatic dysfunction contributes to a cascade of pathological changes, including systemic and interstitial fluid overload, chronic inflammation, progressive tissue fibrosis, and adipose deposition. There is a critical, reciprocal relationship between lymphatic failure and cardiovascular conditions. Specifically, lymphatic dysfunction can exacerbate heart failure and impair postmyocardial infarction recovery, while conditions such as chronic venous disease and right heart failure directly overload and damage the lymphatic system, creating a vicious cycle of fluid accumulation. Lymphedema is an underrecognized systemic vascular condition, not merely a peripheral disorder of swelling. Integrating lymphatic assessment into routine cardiovascular practice could be beneficial for accurately diagnosing fluid overload states and mitigating the systemic inflammatory consequences of lymphatic failure. Early diagnosis and multidisciplinary management are crucial for improving outcomes in patients with cardiovascular disease.
Immune Checkpoint Inhibitor-Associated Myocarditis: Current Understanding of Clinical Presentation and Management.
Thukral J, Moudgil P, Rohewal J … +8 more , Kudrat F, Kaur J, Sindhwani N, Shah RK, Kaur H, Thukral N, Frishman WH, Aronow WS
Cardiol Rev · 2026 Mar · PMID 41913310 · Publisher ↗
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape of multiple malignancies but are increasingly associated with immune-related cardiovascular toxicities. Among these, ICI-associated myocarditis...
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape of multiple malignancies but are increasingly associated with immune-related cardiovascular toxicities. Among these, ICI-associated myocarditis is rare yet represents the most severe and life-threatening cardiac adverse event, characterized by early onset, malignant arrhythmias, conduction disturbances, acute heart failure, and high mortality. As ICIs are increasingly administered across earlier disease stages, prolonged durations, and combination regimens, the clinical burden of myocarditis is expected to rise. Pathogenesis is driven by dysregulated T-cell-mediated immune activation, loss of peripheral tolerance, and shared tumor-cardiac antigens, with heightened risk observed in patients receiving dual immune checkpoint blockade. Diagnosis remains challenging due to nonspecific symptoms, frequent preservation of left ventricular function, and limited sensitivity of early cardiac imaging, necessitating a multimodal approach integrating cardiac biomarkers, electrocardiography, advanced imaging, and selective endomyocardial biopsy. Early recognition and prompt initiation of high-dose corticosteroids are central to management and are associated with improved outcomes, while steroid-refractory cases may require targeted immunomodulatory therapies. Decisions regarding ICI rechallenge remain complex and must balance oncologic benefit against the risk of recurrent cardiac injury. Optimal care in this high-risk population.
Metabolic Dysfunction-Associated Steatotic Liver Disease and Atherosclerotic Cardiovascular Disease: Shared Pathophysiology, Biomarkers, and Emerging Therapeutic Strategies.
Drogy MS, Minto ST, Frishman WH
Cardiol Rev · 2026 Mar · PMID 41913294 · Publisher ↗
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is increasingly recognized as an important cardiovascular risk modifier. Cardiovascular disease is t...
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is increasingly recognized as an important cardiovascular risk modifier. Cardiovascular disease is the leading cause of mortality among individuals with MASLD, reflecting shared pathophysiologic mechanisms with atherosclerotic cardiovascular disease. These include insulin resistance, lipotoxicity, oxidative stress, chronic inflammation, endothelial dysfunction, and progressive fibrogenesis, which contribute to both hepatic disease progression and atherosclerotic plaque development. Noninvasive biomarkers and imaging modalities provide complementary tools for integrated risk assessment. Serum measures of insulin resistance, atherogenic dyslipidemia, inflammation, and composite fibrosis scores are associated with both liver disease severity and cardiovascular risk. Vibration-controlled transient elastography enables noninvasive assessment of hepatic fibrosis and steatosis, while coronary artery calcium scoring is a robust predictor of subclinical atherosclerosis and cardiovascular events. Increasing evidence demonstrates a positive association between hepatic fibrosis severity and coronary artery calcium burden, supporting combined hepatic and cardiovascular evaluation in patients with MASLD. Therapeutic strategies targeting shared cardiometabolic pathways offer a potential dual benefit. Lifestyle modification remains foundational for improving hepatic disease activity and reducing cardiovascular risk. Statins are safe in MASLD and provide established cardiovascular protection. Glucagon-like peptide-1 receptor agonists and other emerging metabolic therapies demonstrate promise in improving liver disease activity while favorably modifying cardiometabolic risk factors. Recognition of MASLD as a systemic cardiometabolic disorder has important implications for cardiovascular risk stratification and multidisciplinary care.
Mitral Annular Calcification and Coronary Artery Disease: Associations and Prognostic Implications: An Up-to-Date Review.
Bazoukis G, Papadatos SS, Andreakis E … +4 more , Roy E, Jomeh AAE, Liu T, Tse G
Cardiol Rev · 2026 Mar · PMID 41913272 · Publisher ↗
Mitral annular calcification (MAC) is a common, degenerative calcific process of the mitral valve annulus readily identified on echocardiography and classifiable by extent as mild, moderate, or severe. Epidemiologic and...
Mitral annular calcification (MAC) is a common, degenerative calcific process of the mitral valve annulus readily identified on echocardiography and classifiable by extent as mild, moderate, or severe. Epidemiologic and registry data link MAC to older age, metabolic risk factors, female sex, and markers of cardiac remodeling. MAC is associated with impaired coronary microvascular function, suggesting endothelial dysfunction as a mechanistic bridge to coronary artery disease (CAD). Multiple imaging- and angiography-based studies report a consistent association between MAC and prevalent, severe, or multivessel obstructive CAD across diverse populations, including older adults, younger patients undergoing simultaneous echocardiography and angiography, patients with dilated cardiomyopathy, and those with end-stage renal disease or on dialysis. Some cohorts find that MAC independently predicts myocardial ischemia and adverse cardiovascular events. Computed tomography studies generally corroborate a link between MAC and coronary calcification and plaque burden, and the combined presence of MAC and aortic valve calcification denotes a particularly high-risk coronary phenotype with more calcified/mixed and potentially vulnerable plaques. However, studies show that the crude association between MAC and CAD is attenuated after adjustment for age and other confounders, and some analyses find no independent relation to angiographic severity or complexity. Overall, MAC appears to be a useful adjunctive marker of systemic atherosclerosis and higher coronary risk rather than definitive proof of obstructive CAD; its presence on imaging should prompt consideration of further coronary evaluation in appropriate clinical contexts.
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