Current Problems In Cardiology[JOURNAL]
Sun
200 papers
Mechanisms and targets of vascular natural aging from a systems biology perspective.
Ma X, Zhou S, Zhu Q
Curr Probl Cardiol · 2026 Mar · PMID 41318012 · Publisher ↗
BACKGROUND: Vascular aging is a fundamental biological process underlying many age-related cardiovascular diseases. Although traditional risk factors have been widely studied, vascular dysfunction progresses with aging e...
BACKGROUND: Vascular aging is a fundamental biological process underlying many age-related cardiovascular diseases. Although traditional risk factors have been widely studied, vascular dysfunction progresses with aging even in individuals without classic risk factors. Current studies often focus on individual organs or single-cell types and pathways, resulting in limited understanding of the multidimensional mechanisms of vascular aging. METHODS: We systematically retrieved "vascular aging" transcriptomic datasets from the Gene Expression Omnibus (GEO) database. Five datasets meeting strict inclusion criteria for physiological vascular aging were selected. Differentially expressed genes (DEGs) between young and aged groups were identified using linear modeling and batch correction. Functional enrichment analyses, including GO, KEGG, and GSEA, were performed to elucidate biological processes and signaling pathways. Protein-protein interaction (PPI) networks were constructed, hub genes identified using CytoHubba, and regulatory networks (miRNA, lncRNA, transcription factors) were analyzed. Potential drug-gene interactions were evaluated through enrichment and molecular docking. RESULTS: A total of 21 aging-related DEGs were identified, mainly enriched in biological processes related to immune regulation and cell cycle activity. Four hub genes-PPARG, IRF7, VCAN, and SDC1-were identified as central regulators. GSEA revealed activation of interferon signaling, inflammatory response, p53, and KRAS pathways in aged vasculature, while young vasculature was enriched in E2F, MYC, and oxidative phosphorylation pathways. Drug enrichment analysis indicated that Heparan sulfate exhibited strong binding potential to VCAN and may represent a promising anti-aging candidate. CONCLUSIONS: This systems biology study reveals key molecular mechanisms and targets in natural vascular aging. VCAN and associated inflammatory and metabolic pathways may play pivotal roles in age-associated vascular dysfunction, providing a foundation for targeted anti-aging interventions and personalized medicine strategies.
Psychological health in a modified life's Crucial 9 score: Association with all-cause mortality and comparison with LE8.
Diaz-Toro F, Pedrero V, Nazar G … +5 more , Reyes-Molina D, Concha-Cisternas Y, Lanuza F, Celis-Morales C, Petermann-Rocha F
Curr Probl Cardiol · 2026 Mar · PMID 41318011 · Publisher ↗
BACKGROUND: The inclusion of Psychological Health in the Life's Essential 8 (LE8) may improve its predictive validity and contribute to a more equitable assessment of mortality by better accounting for this crucial compo...
BACKGROUND: The inclusion of Psychological Health in the Life's Essential 8 (LE8) may improve its predictive validity and contribute to a more equitable assessment of mortality by better accounting for this crucial component. Therefore, this study aimed i) to assess the longitudinal association between a modified version of Life's Crucial 9 (LC9) score and all-cause mortality in the Chilean population and ii) to examine whether adding psychological health to the original LE8 framework might enhance its predictive ability. METHOD: We included 3,546 participants aged ≥15 from the Chilean National Health Survey 2016-2017. Mortality was ascertained through linkage with the Chilean Civil Registry and Identification. A modified version of the LC9 score was created and divided into quartiles. The modified version was calculated from nine health and behavioral components, incorporating a Psychological Health variable (composite of depression and social integration). The association between LC9 and all-cause mortality was examined using crude Kaplan-Meier survival curves and Cox proportional hazard models adjusted for sociodemographic and lifestyle factors. Non-linear associations were explored using restricted cubic splines. Predictive performance of LC9 was further compared with LE8 using model fit criteria (AIC, BIC) and discrimination measures (C-statistics, ROC-AUC). FINDINGS: Over a median follow-up of 5 years, 169 participants (4.8 %) died from any cause. Survival curves showed lower survival probabilities among individuals in the lowest LC9 quartile than to those in higher quartiles (log-rank <0.001). Compared with participants in Q1, those in Q4 had a 49 % lower risk of all-cause mortality after full adjustment for confounders (HR: 0.51; 95 % CI: 0.31-0.82). When comparing indices, LC9 (C-statistics= 0.854 (95 % CI: 0.842-0.866) provided marginally better model fit than LE8 (C-statistics= 0.851 (95 % CI: 0.839-0.864), but their overall predictive performance for mortality was similar. INTERPRETATION: Higher LC9 scores were associated with lower all-cause mortality. The incorporation of Psychological Health measures may slightly improve the prediction of the models.
Effects of concurrent training on atrial fibrillation burden, fitness and physical activity after pulmonary vein isolation: Study protocol for a randomized controlled trial.
Echevarría-Polo M, Hernández-Vicente A, Vadillo-Martín P … +10 more , Sanchis-Gomar F, Melero-Polo J, Cabrera-Ramos M, Montilla-Padilla I, Rucco A, Martínez JP, Laguna P, Pueyo E, Ramos-Maqueda J, Garatachea N
Curr Probl Cardiol · 2026 Mar · PMID 41318010 · Publisher ↗
BACKGROUND: Pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF), but many patients remain inactive after the procedure for fear of AF recurrence. Evidence supports moderate exercise to i...
BACKGROUND: Pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF), but many patients remain inactive after the procedure for fear of AF recurrence. Evidence supports moderate exercise to improve outcomes of this procedure; however, there are no clear guidelines for returning to physical exercise after PVI. We aim to evaluate the effects of a combined endurance and resistance training (CT) intervention on cardiac function, physical fitness, activity levels, body composition, quality of life, and AF burden after PVI. METHODS AND RESULTS: We will conduct a randomized controlled trial with 68 participants, approximately 15 months after PVI, randomized 1:1 to a CT or control group. The CT program consists of supervised training sessions combining moderate-intensity endurance and resistance work three times a week for 12 weeks. Outcomes will be assessed at three time points: at baseline, after the intervention, and after 12 weeks of follow-up, including echocardiographic and electrocardiographic parameters, fitness tests, physical activity monitoring, body composition, health-related quality of life, and AF burden monitored by an implantable cardiac Holter. We expect that CT intervention will improve cardiac function, increase physical fitness and activity levels, optimize body composition, and improve quality of life without recurrence of AF. CONCLUSIONS: This protocol is the first to examine the effects of return to exercise training in AF patients after PVI using objective monitoring tools. The simplicity and scalability of the intervention support its safe integration into clinical practice to promote physical activity and improve patient outcomes after PVI.
Left atrial volume measured by Cardiac CT as an independent predictor of atrial fibrillation recurrence following catheter ablation.
Tonso S, Saccomani F, Castaño B … +7 more , Del Castillo S, Amrein ME, Fernandez Villar G, Maid G, Perez de Arenaza D, Falconi M, Pizarro R
Curr Probl Cardiol · 2026 Feb · PMID 41308964 · Publisher ↗
BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and is associated with increased risk of stroke, heart failure, and dementia. Catheter ablation is an established treatment, particul...
BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and is associated with increased risk of stroke, heart failure, and dementia. Catheter ablation is an established treatment, particularly effective in patients with symptomatic paroxysmal AF. However, recurrence rates remain high (30-50 %) and are influenced by factors including AF type, left atrial (LA) volume, comorbidities, and procedural expertise. This study aimed to evaluate the association between LA volume measured by cardiac computed tomography (CT) and AF recurrence. METHODS: We conducted a retrospective observational study including patients who underwent AF ablation and prior cardiac CT for pulmonary vein mapping between 2018 and 2021 at a high-complexity center in Buenos Aires, Argentina. Patients with prior ablation, follow-up <12 months, or missing CT were excluded. LA volume was measured automatically excluding the appendage and pulmonary veins, and indexed to body surface area. Recurrence beyond the 3-month blanking period was assessed. Patients were categorized into tertiles based on LA volume. Kaplan-Meier survival and Cox regression analyses were performed. RESULTS: A total of 145 patients were included (mean age 60.2 ± 11.3 years; 24.8 % women; 53.7 % with hypertension). AF was paroxysmal in 66.2 %. Mean LA volume was significantly higher in the recurrence group (142.8 ± 42.5 mL vs. 112.7 ± 29.2 mL; p < 0.001). Recurrence occurred in 26.5 %, 46 %, and 71.7 % across increasing volume tertiles. LA volume in the upper tertile was independently associated with recurrence (HR 1.83; 95 % CI 1.05-3.2; p = 0.03). CONCLUSIONS: CT-derived LA volume was independently associated with AF recurrence following catheter ablation.
Assessing outcomes in a cardiac sarcoid cohort with implantable loop recorders - a tertiary United Kingdom study.
Dulay MS, Ahmed R, Kouranos V … +1 more , Sharma R
Curr Probl Cardiol · 2026 Feb · PMID 41308963 · Publisher ↗
INTRODUCTION: Cardiac sarcoidosis (CS) entails the inflammatory cardiac involvement of systemic sarcoid. Development of myocardial fibrosis can cause sustained ventricular arrhythmia (sVA), alongside high grade atriovent...
INTRODUCTION: Cardiac sarcoidosis (CS) entails the inflammatory cardiac involvement of systemic sarcoid. Development of myocardial fibrosis can cause sustained ventricular arrhythmia (sVA), alongside high grade atrioventricular (hgAVB). In those patients who do not meet current international guidelines for implantable cardiac devices, implantable loop recorders (ILR) could be a feasible long term monitoring option. With only one current study in the literature, we sought to retrospectively assess outcomes in CS patients who underwent ILR insertion at Royal Brompton Hospital (RBH), the largest tertiary CS centre in the United Kingdom. METHODS: CS patients who underwent ILR insertion between 2014 and 2024 at RBH were identified. Only patients with multidisciplinary team meeting (MDT) diagnoses were included. Outcome measures assessed for included need for new implantable cardiac device, non-sustained ventricular tachycardia (NSVT), sVA, hgAVB, newly inserted ICD/CRT-D shock, all-cause-mortality and heart failure hospitalisation. RESULTS: A total of 47 patients were identified with a median follow up of 2.79 years. There were 10 patients (21%) who sustained an adverse event, with 9 (19%) undergoing a new cardiac device implantation, 5 (11%) demonstrating NSVT, 5 (11%) demonstrating hgAVB and sVA noted in 4 (8.5%) patients. Those patients who sustained an event were compared with patients who did not; overall, only hypertension was significantly more prevalent in the event positive group. CONCLUSION: In conclusion, this study has demonstrated that ILR insertion may be a useful long term surveillance tool in those CS patients who do not meet conventional device insertion criteria. Larger studies are prudent to clarify our findings.
External validation of a predictive model for diagnosing transthyretin cardiac amyloidosis in suspected cases.
Carretero M, Decotto S, Pieklo G … +3 more , Brulc EB, Aguirre MA, Posadas-Martínez ML
Curr Probl Cardiol · 2026 Feb · PMID 41308962 · Publisher ↗
Abstract loading — click title to view on PubMed.
Physiological and metabolic predictors of adverse outcomes one year after coronary intervention: A two-tiered approach.
Chen Y, Zhong J, Li B … +6 more , Hong R, Chen H, Chen L, Yan Y, Luo Y, Chen Q
Curr Probl Cardiol · 2026 Mar · PMID 41297649 · Publisher ↗
BACKGROUND: Residual ischemia and metabolic dysregulation remain determinants of long-term prognosis after percutaneous coronary intervention (PCI). We investigated the prognostic impact of the three-vessel quantitative...
BACKGROUND: Residual ischemia and metabolic dysregulation remain determinants of long-term prognosis after percutaneous coronary intervention (PCI). We investigated the prognostic impact of the three-vessel quantitative flow ratio (3V-QFR) and the triglyceride-glucose (TyG) index in this population. METHODS: A total of 546 patients who underwent repeat angiography one year after PCI were followed for four years. Restricted cubic spline analysis was used to determine risk thresholds for both 3V-QFR and TyG. The primary endpoint was major adverse cardiac events (MACEs). RESULTS: The optimal cutoffs for predicting MACEs were 2.44 for 3V-QFR and 8.75 for TyG. Patients with 3V-QFR < 2.44 experienced significantly higher adverse event rates. Among patients with 3V-QFR ≥ 2.44, TyG ≥ 8.75 was independently associated with increased MACEs (adjusted HR 1.51, 95 % CI 1.04-2.05), mainly driven by ischemia-driven revascularization. No such association was observed in patients with 3V-QFR < 2.44. CONCLUSIONS: 3V-QFR < 2.44 reflects residual functional ischemia and portends poor prognosis after PCI. In patients with complete functional revascularization, a high TyG index indicates elevated metabolic risk. A combined physiological-metabolic assessment provides improved risk stratification for long-term secondary prevention.
Reducing carbon emissions through remote patient interview: A quality improvement initiative.
Al-Shahwani IMF, Nawwar DA
Curr Probl Cardiol · 2026 Feb · PMID 41297648 · Publisher ↗
BACKGROUND: Healthcare contributes approximately 4-5 % of the United Kingdom's total greenhouse gas emissions, with patient and visitor travel responsible for up to 14 % of this footprint. Implementing telehealth in outp...
BACKGROUND: Healthcare contributes approximately 4-5 % of the United Kingdom's total greenhouse gas emissions, with patient and visitor travel responsible for up to 14 % of this footprint. Implementing telehealth in outpatient care offers potential to reduce travel-related emissions while maintaining high-quality care. OBJECTIVE: To evaluate the environmental impact and feasibility of replacing routine in-person cardiothoracic outpatient consultations with video appointments at a tertiary cardiothoracic center in Scotland. METHODS: This prospective quality improvement initiative converted 50 routine cardiothoracic outpatient appointments to virtual consultations using the NHS-endorsed Near Me video platform between January and April 2025. Round-trip distances from patient postcodes to hospital were estimated using standard geocoding tools. Carbon dioxide (CO₂) emissions avoided were calculated using the UK Government's BEIS conversion factor of 211.2 g/mile for average petrol vehicles. Patient satisfaction and technical feasibility were evaluated through post-consultation surveys. RESULTS: Substituting 50 face-to-face appointments with Near Me video consultations avoided a total of 3,014.4 miles of patient travel, corresponding to approximately 636.7 kg of CO₂ emissions. No consultations required rescheduling due to technical difficulties. Patient satisfaction ratings were high, particularly for convenience and quality of interaction. Extrapolated to 1,000 patients annually, this model could prevent approximately 12.7 tones of CO₂ emissions. CONCLUSIONS: Replacing in-person cardiothoracic consultations with telehealth is feasible, well accepted by patients, and environmentally beneficial. Scaling this approach across high-volume outpatient services supports the NHS's commitment to net-zero emissions while preserving care quality and efficiency.
GLP1-RAs: long-term use versus discontinuation events of an emerging therapy for obesity and cardiovascular diseases.
Salerno ENM, Fumarulo I, Garramone B … +4 more , Vaccarella M, Ierardi C, Burzotta F, Aspromonte N
Curr Probl Cardiol · 2026 Feb · PMID 41297647 · Publisher ↗
Obesity is a highly prevalent chronic disease strongly associated with cardiometabolic complications, including type 2 diabetes, hypertension, heart failure and other cardiovascular diseases. The growing understanding of...
Obesity is a highly prevalent chronic disease strongly associated with cardiometabolic complications, including type 2 diabetes, hypertension, heart failure and other cardiovascular diseases. The growing understanding of these interrelationships has fundamentally changed clinical approaches to their management. In this context, a new class of agents, the glucagon-like peptide-1 receptor agonists (GLP-1 RAs), has gained increasing importance in patient care, supported by relevant scientific evidence that made them a first-line therapeutic option in various clinical settings. Nevertheless, in clinical practice, there is still concern about their long-term use and the potential risk of adverse effects. As a consequence, GLP1-RAs are often prescribed only for limited periods and discontinued once weight reduction has been achieved. The aim of this review is to examine the clinical effects and main indications of GLP-1 RAs and to compare the risk of long-term adverse outcomes associated with their use versus the risks related to their discontinuation.
Twiddler-, Reel-, and Ratchet-syndrome: an alternative approach to address the underlying mechanism of complication in cardiac implantable electronic devices.
Stadlbauer C, Stadlbauer A, Wiesner S … +5 more , Ücer E, Jungbauer C, Schmid C, Schopka S, Keyser A
Curr Probl Cardiol · 2026 Feb · PMID 41297646 · Publisher ↗
The circumstances leading to the origins of "Twiddler", "Reel", and "Ratchet" in patients with cardiac implantable electronic devices (CIED) have not yet been fully determined. This retrospective study was performed to a...
The circumstances leading to the origins of "Twiddler", "Reel", and "Ratchet" in patients with cardiac implantable electronic devices (CIED) have not yet been fully determined. This retrospective study was performed to address different mechanisms that lead to impairment of implanted leads within the context of "Twiddler", "Reel", and "Ratchet". From 2004 and 2023, 5966 patients underwent CIED procedures at our institution. 31 patients with lead impairment by rotation were identified with evidence of pulse generator mobility, lead dislodgement with retraction and / or associated coiling of the lead(s) radiographically or intraoperatively. A review of the literature from 1963 to 2024 identified 216 cases from 165 publications. In less than half of our patients lead retraction could be attested, and a minority of patients had clinical symptoms attributable to lead impairment by rotation. Psychiatric comorbidities and patients´ manipulation could not be ascertained. Thorough follow-up of all patients with CIEDs appears mandatory. Precise implantation techniques from the outset may limit lead impairment by rotation.
The GLP-1 RA Era - A positive disruptor to the ecological framework of population health.
Pronk NP, Arena R, Woodard C
Curr Probl Cardiol · 2026 Jan · PMID 41242439 · Publisher ↗
Abstract loading — click title to view on PubMed.
In situ pulmonary arterial thrombosis in pulmonary arterial hypertension: Diagnostic differentiation, imaging criteria, and management-A narrative review with an institutional case-series snapshot.
Bravo-Vásquez MJ, Cueto-Robledo G, Roldan-Valadez E … +5 more , Navarro-Vergara DI, Graniel-Palafox LE, Ruiz-Ruiz J, Gonzalez-Stoylov N, Garcia-Luna EM
Curr Probl Cardiol · 2026 Jan · PMID 41242438 · Publisher ↗
BACKGROUND: Pulmonary arterial hypertension (PAH) creates a prothrombotic environment that may result in in situ pulmonary arterial thrombosis (PAT), a subtype that can resemble pulmonary embolism and chronic thromboembo...
BACKGROUND: Pulmonary arterial hypertension (PAH) creates a prothrombotic environment that may result in in situ pulmonary arterial thrombosis (PAT), a subtype that can resemble pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH) but requires different management. METHODS: We conducted a narrative review of epidemiology, mechanisms, diagnostic differentiation, imaging (CT pulmonary angiography [CTPA], ventilation-perfusion [V/Q] scanning, echocardiography), and treatment of in situ PAT, and incorporated an institutional retrospective series (screened 2020-2025). RESULTS: In situ PAT typically appears on CTPA as central or wall-adherent thrombi within markedly dilated proximal pulmonary arteries, often without stenosis. Early V/Q scanning is useful to rule out CTEPH; non-segmental or mottled perfusion favors Group 1 PAH. Caliber metrics (PA diameter, PA/Ao) and RV strain indices (RV/LV, TAPSE) support but do not by themselves establish the diagnosis. Of 364 PAH patients screened, 7 (1.9 %) met imaging criteria for in situ PAT; mean age 42 years, 71 % female, 43 % congenital heart disease. All had PA ≥30 mm and RV/LV ≥1; 71 % had aneurysmal PA ≥40 mm; 71 % had negative DVT Doppler. Functional and hemodynamic impairment was substantial. CONCLUSIONS: A stepwise workflow-DVT assessment, V/Q to exclude CTEPH, and targeted CTPA morphology interpreted with hemodynamics-facilitates accurate classification of in situ PAT and avoids misdirected CTEPH interventions. Therapy should begin with PAH-targeted treatment; anticoagulation should be individualized according to phenotype, bleeding risk, and clinical course.
Efficacy of GLP-1 receptor agonists in obese patients with heart failure with preserved ejection fraction: A systematic review and meta-analysis of randomized trials and propensity score-matched cohorts.
Caldeira Gaelzer G, Armani Prata A, Gustavo Rizzolli L … +2 more , Mendes Afonso L, Lenci Marques G
Curr Probl Cardiol · 2026 Jan · PMID 41173128 · Publisher ↗
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) remains a major clinical challenge, particularly among obese individuals. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally indicated for...
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) remains a major clinical challenge, particularly among obese individuals. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally indicated for type 2 diabetes, have demonstrated potential cardiovascular benefits, including weight loss and anti-inflammatory effects. However, their efficacy in HFpEF remains uncertain. We conducted a systematic review and meta-analysis to evaluate the effects of GLP-1 RAs in obese patients with HFpEF. METHODS: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) and propensity score-matched cohort studies comparing GLP-1 RAs with placebo or standard care in obese HFpEF populations. The primary endpoints of this meta-analysis were as follows: (1) any HF event; (2) Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS); and (3) Six-minute walk test (6MWT) distance. A random-effects model was used to pool effect estimates. RESULTS: Five studies (4 RCTs, 1 propensity-matched cohort) comprising 5,561 patients met inclusion criteria. GLP-1 RAs significantly reduced HF events (HR: 0.50; 95 % CI: 0.36-0.70; p < 0.0001; I² = 29.5 %). Treatment was also associated with improvements in KCCQ-CSS (MD: 7.38 points; 95 % CI: 5.51-9.26; p < 0.0001; I² = 0 %), 6MWT distance (MD: 17.60 m; 95 % CI: 11.86-23.35; p < 0.0001; I² = 0 %) and weight loss (MD: -9.56 kg; 95 % CI: -12.71 to -6.41; p < 0.0001; I² = 95 %). Trends toward reduced CV and all-cause mortality were observed, though not statistically significant. CONCLUSION: GLP-1 RAs are associated with reductions in HF events and meaningful improvements in quality of life and functional capacity in obese patients with HFpEF. These findings highlight their potential as a therapeutic strategy in this high-risk population.
Atherosclerotic renal artery stenosis in the post-CORAL Trial Era. A narrative review.
Grillo A, Lepidi S, Puato M
Curr Probl Cardiol · 2026 Jan · PMID 41167516 · Publisher ↗
Atherosclerotic renal artery stenosis (ARAS) represents a common manifestation of systemic atherosclerosis and remains an underrecognized cause of secondary hypertension, chronic kidney disease, and cardiovascular morbid...
Atherosclerotic renal artery stenosis (ARAS) represents a common manifestation of systemic atherosclerosis and remains an underrecognized cause of secondary hypertension, chronic kidney disease, and cardiovascular morbidity. Although often clinically silent, progressive narrowing of the renal artery may result in renovascular hypertension, ischemic nephropathy, or cardiac destabilization syndromes such as recurrent pulmonary edema. The pathophysiology of ARAS extends beyond simple flow limitation, involving renin-angiotensin-aldosterone system activation, oxidative stress, microvascular rarefaction, and parenchymal fibrosis, thereby explaining the limited reversibility of renal damage after revascularization. Over the past decades, management strategies have evolved considerably. While initial enthusiasm for surgical or endovascular revascularization was supported by observational reports of improved blood pressure and renal function, randomized controlled trials-including ASTRAL and CORAL-failed to demonstrate a consistent benefit of stenting over optimal medical therapy in unselected patients. These findings have shifted current practice toward medical therapy as the cornerstone of management, integrating renin-angiotensin system inhibitors, statins, antiplatelet agents, and, more recently, SGLT2 inhibitors. Nevertheless, accumulating evidence indicates that specific high-risk subsets-patients with resistant hypertension, recurrent pulmonary edema, or progressive ischemic nephropathy-may derive meaningful clinical benefit from timely revascularization. In the post-CORAL era, the central challenge is therefore accurate patient selection to identify the small group in whom revascularization remains appropriate, leveraging advanced imaging, physiological indices, and risk stratification.
The next decade of cardiovascular disease burden in Qatar, a gulf cooperation council country: Projections from 2024 to 2033.
Abushanab D, Al-Badriyeh D, Froukh RFA … +7 more , Kaddoura R, Abdelaal M, Marquina C, Abdulmajeed J, Abdulrouf PV, Mohamed S, Ademi Z
Curr Probl Cardiol · 2026 Jan · PMID 41167515 · Publisher ↗
BACKGROUND: Cardiovascular diseases (CVD) are a great public health challenge in Qatar, with significant impacts on long-term population health and societal costs. OBJECTIVE: We aimed to forecast the health and economic...
BACKGROUND: Cardiovascular diseases (CVD) are a great public health challenge in Qatar, with significant impacts on long-term population health and societal costs. OBJECTIVE: We aimed to forecast the health and economic burden of the CVD in Qatar from 2024 to 2033, from both healthcare and societal perspective. METHODS: A validated two-stage dynamic model was structured, spanning a 10-year period and targeting individuals aged 40-79. The CVD incidents (i.e., myocardial infarction [MI], stroke) were estimated using the 2013 Pooled Cohort Equation, while recurrent events were obtained from the global REACH registry. The model outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total direct costs, and total productivity loss costs. Utility and cost inputs were derived from published sources. Outcomes were discounted at a rate of 3 % per annum. Calibration and validation were performed to ensure model accuracy. A multivariate sensitivity analysis was also conducted. RESULTS: By 2033, there will be 271,260 non-fatal MI events (95 % confidence interval [CI] 271,249-271,277), 258,892 non-fatal strokes (95 %CI 258,858-259,094), and 20,413 CVD deaths (95 %CI 20,405-20,429). The cumulative years of life lived and QALYs were 13,806,845 (95 % CI 13,802,149-13,811,541) and 10,655,665 (95 %CI 10,652,720-10,658,611), respectively. The direct costs were QAR71.14 (95 %CI QAR70.62-71.66) billion, and the productivity loss costs were estimated to surpass QAR108.12 (95 %CI QAR106.88-109.36) billion. The exchange rates used were based on 2024 values (1QAR=0.27US$). CONCLUSIONS: This study offers valuable insights into the projected burden of CVD in Qatar, highlighting the need for effective preventive strategies to reduce risk.
Atrial myopathy in persistent atrial fibrillation: Three-dimensional quantification of atrial fibrosis by high-density electro-anatomic mapping and its association with arrhythmia duration.
Robledo-Nolasco R, Andrade-Cuellar EN, Solis-Gómez JC … +9 more , Guillot-Castillo SY, Zamora-Diaz JJIY, Aceves-Millan R, Maldonado-Tenesaca AP, Monroy-Jimenez MA, Elizalde-Uribe IA, Peynado DT, Bonilla-Figueroa R, Acevedo-Gómez KJ
Curr Probl Cardiol · 2026 Jan · PMID 41120065 · Publisher ↗
BACKGROUND: Progressive atrial myopathy marked by fibrotic remodelling drives the transition from paroxysmal to persistent atrial fibrillation (AF), yet the temporal dynamics of fibrosis within persistent AF remain poorl...
BACKGROUND: Progressive atrial myopathy marked by fibrotic remodelling drives the transition from paroxysmal to persistent atrial fibrillation (AF), yet the temporal dynamics of fibrosis within persistent AF remain poorly defined. OBJECTIVE: To quantify dense scar and borderline fibrotic zones using high-density electro-anatomic mapping (HD-EAM) in patients with persistent AF, and to compare fibrotic burden between early persistent (>7 days-<3 months) and persistent (≥3 months-<1 year) AF. METHODS: Retrospectively analysed 78 consecutive patients (59 ± 15 years, 59 % men) undergoing first-time pulmonary vein isolation for persistent AF. Atrial voltage maps (CARTO 3 CONFIDENSE™) acquired in sinus rhythm classified tissue as healthy (>0.5 mV), borderline (0.3-0.5 mV), or dense scar (<0.2 mV). Echocardiographic left atrial diameter (LAD) and volume (LAV) were compared with mapping data. The primary endpoint was dense scar point count; secondary endpoints included AF/atrial tachycardia recurrence and correlation between imaging modalities. RESULTS: Twenty-two patients had early persistent and 56 persistent AF. Mapping resolution was similar (5 193 ± 459 vs 5 399 ± 601 points, p = 0.83). Dense scar points were significantly higher in persistent AF (2 807 ± 336 vs 1 634 ± 236; p < 0.001). LAD and LAV from HD-EAM correlated moderately with echocardiography (r = 0.45 and 0.48; both p < 0.01) but did not differ between groups. After 7.2 ± 3.7 months, recurrence occurred in 16 % of persistent versus 8 % of early persistent AF (p = 0.11). CONCLUSIONS: Fibrotic burden increases markedly after three months of uninterrupted AF despite stable atrial size. HD-EAM enables intra-procedural quantification of atrial myopathy and may guide personalised ablation strategies.
Impact of cardio-obstetrics care on maternal outcomes in pregnant women with heart disease: A systematic review and meta-analysis.
Sebastian SA, Atwal H, Ayyalu T … +1 more , Gulati M
Curr Probl Cardiol · 2025 Dec · PMID 41077108 · Publisher ↗
BACKGROUND: Maternal mortality is at an all-time high in the U.S., with maternal cardiac disease being the leading cause of death. Cardio-obstetrics is a collaborative, multidisciplinary approach to maternal care, bringi...
BACKGROUND: Maternal mortality is at an all-time high in the U.S., with maternal cardiac disease being the leading cause of death. Cardio-obstetrics is a collaborative, multidisciplinary approach to maternal care, bringing together experts from maternal-fetal medicine, cardiology, and other specialties. This study investigates the impact of cardio-obstetrics team care on maternal outcomes, focusing on how this integrated model can improve the health and well-being of pregnant women with cardiovascular disease (CVD). METHODS: We conducted a systematic review by searching MEDLINE, Web of Science, Scopus, and Cochrane up to March 5, 2025. Statistical analysis was performed using RevMan 5.4, with an inverse variance random effects model to calculate risk ratios (RR) for dichotomous outcomes. Heterogeneity was assessed using the Higgins I² test. The study protocol is registered in PROSPERO (CRD420251010149). RESULTS: We identified six observational studies evaluating cardio-obstetrics team care, including a total of 1,109 pregnant women with CVD, with a mean age of 30.8 years. Most participants had a CARPREG II score > 2, indicating high risk for adverse maternal cardiovascular outcomes. The average gestational age at delivery was 38 weeks, with arrhythmias being the most common cardiovascular condition, followed by congenital and valvular heart disease. Pooled analysis revealed a statistically significant reduction in the 30-day postpartum readmission rate for pregnant women with CVD receiving cardio-obstetrics care compared to standard care (RR 0.29, 95 % CI: 0.13-0.64, p = 0.002, I² = 0 %) with no observed heterogeneity. There was also a significant decrease in postpartum arrhythmias (RR 0.07, 95 % CI: 0.04-0.12, p < 0.001, I² = 0 %). However, no significant difference in maternal mortality was found between the two groups (RR 0.74, 95 % CI: 0.14-3.93, p = 0.72, I² = 0 %). CONCLUSION: Maternal outcomes with cardio-obstetrics team care in pregnant women with CVD were promising, indicating the potential of this integrated care model when compared with standard care. These results emphasize the need for further research to explore its long-term benefits. Standard care data were approximated using national averages due to the lack of direct comparison data, which should be considered when interpreting the results. LAY SUMMARY: Heart disease is the leading cause of death during pregnancy in the U.S. This study looked at whether having a specialized cardio-obstetrics team made up of doctors from different specialties working together improves outcomes for pregnant women with heart disease. Six studies with >1,100 women found that women cared for by these cardio-obstetrics teams had fewer hospital readmissions and fewer heart rhythm problems after delivery, though death rates were not different.
Targeted antihypertensive therapy after hypertensive pregnancy: Lactation-safe choices, treatment thresholds, and outcomes (2015-2025).
Alhazmi AM, Albulushi A
Curr Probl Cardiol · 2025 Dec · PMID 41077107 · Publisher ↗
BACKGROUND: Postpartum hypertension is a leading driver of emergency visits and readmissions within 6 weeks of delivery, yet optimal therapy must balance BP control with lactation safety. OBJECTIVE: To synthesize contemp...
BACKGROUND: Postpartum hypertension is a leading driver of emergency visits and readmissions within 6 weeks of delivery, yet optimal therapy must balance BP control with lactation safety. OBJECTIVE: To synthesize contemporary evidence (Jan 2015-Aug 2025) on postpartum antihypertensives with emphasis on breastfeeding compatibility, treatment thresholds/targets, and maternal-infant outcomes. DATA SOURCES: PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov/ICTRP, and guideline repositories (AHA/ACOG/NICE), plus LactMed and UK Specialist Pharmacy Service (SPS). Eligibility: RCTs, comparative cohorts/case-control studies, and ≥10-patient case series reporting postpartum outcomes or lactation data. RESULTS: First-line postpartum agents compatible with breastfeeding in term, healthy infants are dihydropyridine calcium-channel blockers (nifedipine, amlodipine), ACE inhibitors (enalapril), and labetalol. Multiple large cohorts associate nifedipine (at discharge) with lower hypertension-related readmissions than labetalol. Small RCTs show signals for enalapril-related cardiac reverse remodeling and physician-optimized self-monitoring improving 9-month BP and cardiac structure. Severe BP ≥160/110 mmHg warrants urgent treatment (IV labetalol or hydralazine; oral IR nifedipine if no IV), while persistent ≥150/100 mmHg merits/continues oral therapy titrated toward ≤140/90 mmHg in clinic (≈≤135/85 mmHg at home). Early review within 3-10 days (≤72 h after severe disease) and remote/home BP programs reduce unplanned care. CONCLUSIONS: For lactating patients, nifedipine ER/amlodipine, enalapril, and labetalol are appropriate first-line choices; real-world data favor nifedipine for lowering readmissions. Scaling home BP monitoring with early follow-up improves outcomes. Large pragmatic RCTs comparing step-care strategies and tracking infant outcomes remain a priority.
An apparent paradox in visit-to-visit blood pressure variability and adverse outcomes in malignant hypertension patients: The West Birmingham malignant hypertension registry.
Argyris AA, Shantsila A, Beevers DG … +2 more , Shantsila E, Lip GΥΗ
Curr Probl Cardiol · 2025 Dec · PMID 41077106 · Publisher ↗
BACKGROUND: Malignant phase hypertension (MHT) is a severe form of hypertension with high morbidity and mortality; data on the association of visit-to-visit blood pressure (BP) variability and outcomes are lacking. Given...
BACKGROUND: Malignant phase hypertension (MHT) is a severe form of hypertension with high morbidity and mortality; data on the association of visit-to-visit blood pressure (BP) variability and outcomes are lacking. Given that such high BP variability has been associated with poorer outcomes in the general hypertensive population, our aim was to examine the prognostic role of visit-to-visit BP variability with cardiovascular disease and mortality in this high risk MHT population. METHODS: Data from the West Birmingham MHT Registry were analyzed. We calculated quartiles of visit-to-visit BP variability and used Kaplan-Meier curves and Cox proportional hazard models to examine the association of BP variability with incidence of outcomes. RESULTS: A total of 339 patients (age 48 ± 13 years, 65 % male) were included, with a median follow-up 11 years (IQR 3-18). On Kaplan-Meier analyses, subjects in the highest variability quartiles had significantly lower risk of cardiovascular disease, all-cause mortality and all-cause mortality/dialysis than patients in the lower quartiles (log rank p < 0.001). In Cox proportional hazard models, higher systolic BP variability was associated with lower incidence of all outcomes [HR (95 % CI): 0.266 (0.128-0.552) for higher vs lower quartile for all-cause mortality]. Higher diastolic BP variability was associated with lower risk of mortality outcomes [HR (95 % CI): 0.236 (0.107-0.519)]. This effect was attenuated in the subgroup with better BP control at follow-up. CONCLUSIONS: Higher visit-to-visit BP variability was associated with lower prevalence of cardiovascular disease and mortality in a MHT population. Given the extremely high initial BP of MHT patients, the high BP variability reflects likely better BP control in the follow up visits, re-emphasizing the crucial role of early and rapid control of BP in this high-risk population.
The role of neuromodulation in heart failure with preserved ejection fraction.
Algheffari J, Salameh AR, Adil L … +2 more , Hameed A, Araz K
Curr Probl Cardiol · 2025 Dec · PMID 41077105 · Publisher ↗
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome with limited treatment options to improve long-term outcomes such as quality of life, exercise capacity, and mortality. Neuromodul...
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome with limited treatment options to improve long-term outcomes such as quality of life, exercise capacity, and mortality. Neuromodulation-based therapies have emerged as potential interventions to address autonomic dysregulation in HFpEF. This review discusses the long-term efficacy and safety of four key neuromodulation therapies: Renal Denervation (RDN), Baroreceptor Activation Therapy (BAT), Vagus Nerve Stimulation (VNS), and Greater Splanchnic Nerve (GSN) Ablation. Each therapy shows promise, but variability exists in terms of patient outcomes, procedural risks, and long-term durability. This paper evaluates the pros and cons of each approach, focusing on their potential to improve clinical outcomes in diverse HFpEF phenotypes. OBJECTIVE: To summarise and critically assess the role of neuromodulation-based devices in managing HFpEF, including their mechanisms, efficacy, and impact on patient outcomes. METHODS: We reviewed clinical trials and studies involving neuromodulation therapies for HFpEF, focusing on VNS, RDN, BAT, and GSN. The review includes randomised controlled trials and feasibility studies assessing various endpoints such as functional status, QoL, exercise capacity, and adverse events. RESULTS: Neuromodulation therapies show potential in improving symptoms and QoL for HFpEF patients. The ANTHEM-HFpEF trial demonstrated VNS's efficacy in enhancing functional status and autonomic tone, although cardiac mechanical function showed minimal change. RSD trials, including RDT-PEF and UNLOAD-HFpEF, indicated mixed results with some improvements in symptoms and cardiac function, though limitations like sample size and device effectiveness persist. BAT, through the BAROSTIM NEO System, has shown promise in reducing sympathetic activity and improving heart failure symptoms. The GSN ablation trials indicated significant reductions in pulmonary capillary wedge pressure (PCWP) and improved exercise capacity, though further large-scale studies are needed to confirm these findings. CONCLUSIONS: Neuromodulation-based device interventions represent a promising frontier in HFpEF management, offering potential improvements in symptoms, QoL, and functional status. However, the variability in trial outcomes and the need for further research underscore the necessity for continued investigation to fully establish the efficacy and safety of these therapies.
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