Sarswat N, Ambardekar AV, Alexander KM
… +10 more, Cuddy SA, Stern L, Poulsen SH, Tschöpe C, Sekijima Y, Sheikh FH, Griffin JM, Judge DP, Gillmore J, Masri A
Future Cardiol
· 2026 Feb · PMID 41656575
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Transthyretin (TTR) amyloid cardiomyopathy (ATTR-CM) is a progressive, often fatal disease. TTR stabilizers bind directly to TTR, inhibiting tetramer dissociation and the resulting amyloidogenic process. This comprehensi...Transthyretin (TTR) amyloid cardiomyopathy (ATTR-CM) is a progressive, often fatal disease. TTR stabilizers bind directly to TTR, inhibiting tetramer dissociation and the resulting amyloidogenic process. This comprehensive review synthesizes clinical outcomes data from the ATTRibute-CM study program, including primary analyses, prespecified sensitivity studies, and open-label extension (OLE) follow-up, to characterize the clinical profile of acoramidis, an oral TTR stabilizer approved for ATTR-CM treatment. In clinical trials, acoramidis demonstrated consistent clinical benefits, with statistically significant reductions in the composite of all-cause mortality or first cardiovascular-related hospitalization evident within 3 months and sustained through 30 months. Prespecified analyses confirmed treatment robustness. Efficacy was maintained regardless of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds (≥500 pg/mL, ≥750 pg/mL, and ≥1000 pg/mL), was unaffected by concomitant tafamidis use, and was similar in high-risk participants with stage 4 chronic kidney disease (CKD), who are typically excluded from clinical trials. OLE studies through 42 months showed sustained benefits with no new safety concerns. Results demonstrate robust clinical benefits of acoramidis across diverse ATTR-CM populations and across NYHA classes and NAC stages, independent of NT-proBNP thresholds, concomitant tafamidis use, or high-risk CKD. An ongoing prevention study in asymptomatic ATTR-CM gene-mutation carriers may further expand its therapeutic range for ATTR management.
Khan U, Ali J, Khan MH
… +10 more, Abdelgalil MS, Majeed Z, Naveed MA, Amin AM, Nawaz A, Abuelazm M, Turkmani M, Aamir M, Vyas AV, Dani S
Future Cardiol
· 2026 Mar · PMID 41637115
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BACKGROUND: Older adults with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) are often undertreated invasively due to concerns about risks and comorbidities, despite potential benefits. Their limited inclusion i...BACKGROUND: Older adults with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) are often undertreated invasively due to concerns about risks and comorbidities, despite potential benefits. Their limited inclusion in clinical trials leaves a gap in evidence-based management. This meta-analysis compared invasive versus conservative strategies in elderly NSTEMI patients. METHODS: A systematic search was conducted across PubMed, CENTRAL, Web of Science, Scopus, and Embase through December 2024. Pooled results were reported using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes with 95% confidence intervals (CI). RESULTS: A total of 11 randomized controlled trials involving 4114 patients were included. Invasive treatment significantly reduced the composite of all-cause mortality and non-fatal MI (RR: 0.82; 95% CI: 0.68-0.99; = 0.04) and MI alone (RR: 0.68; 95% CI: 0.56-0.84; = 0.0003). There was no significant difference in all-cause mortality (RR: 1.04; 95% CI: 0.92-1.16; = 0.55) or cardiovascular death (RR: 0.96; 95% CI: 0.78-1.18; P = 0.67). Invasive strategy significantly lowered the need for revascularization (RR: 0.29; 95% CI: 0.21-0.40; < 0.0001). CONCLUSION: In NSTEMI patients aged ≥70, invasive management reduces the risk of MI and revascularization without increasing mortality risk. More elderly-focused trials are warranted. PROTOCOL REGISTRATION: https://www.crd.york.ac.uk/prospero identifier is CRD42025633157.
Khan U, Abdelgalil MS, Khan MH
… +7 more, Ali J, Majeed Z, Amin AM, Nawaz A, Younas HMW, Abuelazm M, Aamir M
Future Cardiol
· 2026 Feb · PMID 41630560
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BACKGROUND: Many patients remain functionally limited after transcatheter aortic valve replacement (TAVR) despite successful correction of aortic stenosis. Exercise-based cardiac rehabilitation (EBCR) is effective in oth...BACKGROUND: Many patients remain functionally limited after transcatheter aortic valve replacement (TAVR) despite successful correction of aortic stenosis. Exercise-based cardiac rehabilitation (EBCR) is effective in other cardiac populations, but its benefits after TAVR remain uncertain. This study evaluated the impact of EBCR on functional capacity, cardiac function, quality of life, and safety outcomes in post-TAVR patients. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) published through February 2025 was conducted using major databases. Outcomes were pooled using mean differences or risk ratios with 95% confidence intervals. RESULTS: Six RCTs with 272 patients were included. No significant difference was found between EBCR and usual care for peak VO change (MD: 1.46, 95% CI: [-0.16 to 3.08], = 0.076) and six-minute walk distance (6MWD) change (MD: 18.72, 95% CI: [-2.24 to 39.68], = 0.08). Similarly, no significant difference was observed between EBCR and usual care for left ventricular ejection fraction (LVEF) change (MD: 1.31, 95% CI: [-2.06 to 4.69], = 0.45), and aortic valve orifice area change (AVOA) (MD: -0.03, 95% CI: [-0.24 to 0.18], = 0.78). CONCLUSION: EBCR did not significantly improve outcomes after TAVR; however, near-significant trends in functional capacity warrant further large-scale investigation. PROTOCOL REGISTRATION: PROSPERO ID CRD420250652719.
Ratti C, Malaguti M, De Mitri G
… +1 more, D'Aniello E
Future Cardiol
· 2026 Mar · PMID 41607371
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Consumer wearables are increasingly used to document palpitations, but their algorithms are almost exclusively validated for atrial fibrillation (AF). We report a 70-year-old man with recurrent palpitations, no prior car...Consumer wearables are increasingly used to document palpitations, but their algorithms are almost exclusively validated for atrial fibrillation (AF). We report a 70-year-old man with recurrent palpitations, no prior cardiovascular history, and controlled hypertension. A single-lead Apple Watch ECG classified sinus rhythm at 75 bpm, while a same-day 12-lead ECG revealed typical atrial flutter with sawtooth waves and regular atrioventricular conduction. After adequate anticoagulation, the patient underwent successful electrical cardioversion with 120 J and remains in stable sinus rhythm. This case highlights that AF-validated smartwatch algorithms may miss other supraventricular arrhythmias, particularly with regular ventricular response. Smartwatches can aid AF screening and symptom capture, but persistent symptoms require confirmation with standard 12-lead ECG. Future work should prioritize algorithm refinement and rigorous, post-market validation beyond AF to ensure that consumer devices transition from wellness tools to clinically reliable instruments for arrhythmia management.
Khan A, Islam I, Mannakkara N
… +9 more, Noakes D, Mansour A, Davies L, Marcolin C, Aquilina A, Dignazi F, Parsons S, King A, Day TG
Future Cardiol
· 2026 Mar · PMID 41590988
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BACKGROUND: Echocardiography after myocardial infarction (MI) provides clinically useful information through assessment of regional wall motion abnormalities, but interpretation requires expertise and remains subject to...BACKGROUND: Echocardiography after myocardial infarction (MI) provides clinically useful information through assessment of regional wall motion abnormalities, but interpretation requires expertise and remains subject to observer variability. Artificial intelligence (AI) shows promise in automatic interpretation, but it is unclear how explainability affects human-AI collaborative performance. METHODS: A ResNet18-LSTM model was trained to classify normal vs MI on 127 apical four chamber (A4C) and 120 apical two chamber (A2C) echocardiogram videos from the HMC-QU dataset. Gradient-weighted Class Activation Mapping (Grad-CAM provided visual explanations. Eight cardiology trainees compared diagnostic performance across three conditions: (a) echo clips alone, (b) echo clips with AI predictions, and (c) echo clips with AI predictions plus Grad-CAM explanations. RESULTS: The AI models demonstrated strong discriminative performance with AUCs of 0.9429 (A2C) and 0.9250 (A4C). AI alone achieved 80.0% accuracy versus 77.0% for clinicians alone. Surprisingly, combining AI with human judgment did not improve performance, and introducing visual explanations reduced accuracy to 72% and specificity from 93.8% to 83.8% (p = 0.046). CONCLUSION: While AI models can effectively detect MI on echocardiographic videos, current explainability techniques may misalign with clinical reasoning, potentially impairing diagnostic performance. Future integration requires AI visual explanation strategies that complement clinician expertise.
Future Cardiol
· 2026 Feb · PMID 41574707
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Transcatheter aortic valve replacement has rapidly expanded from high-risk populations to younger patients with aortic stenosis. This shift raises important questions about valve durability, reintervention strategies, an...Transcatheter aortic valve replacement has rapidly expanded from high-risk populations to younger patients with aortic stenosis. This shift raises important questions about valve durability, reintervention strategies, and long-term outcomes compared with surgical aortic valve replacement. Younger patients often present with unique anatomical challenges, including bicuspid aortic valves, and are expected to outlive their first valve prosthesis, making lifetime management a central concern. While new valve technologies show promise, long-term data remain limited. Careful patient selection, shared decision-making, and ongoing prospective studies are essential to guide the role of TAVR in this population.
Salamanca J, Vilches L, Gamarra Á
… +1 more, Alfonso F
Future Cardiol
· 2026 Feb · PMID 41532344
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Left ventricular thrombus (LVT) is an uncommon but potentially devastating complication of Takotsubo syndrome (TTS). Although its incidence is relatively low, the associated risk of embolic events, including stroke and s...Left ventricular thrombus (LVT) is an uncommon but potentially devastating complication of Takotsubo syndrome (TTS). Although its incidence is relatively low, the associated risk of embolic events, including stroke and systemic infarctions, warrants special attention. This review synthesizes the available evidence on LVT in TTS, from the first case reported in the literature to data from mechanistic studies and large international registries. Incidence, pathophysiology, clinical predictors, diagnostic tools, management strategies, and clinical outcomes will be addressed. While LVT typically resolves with anticoagulation within weeks, its occurrence is strongly associated with acute complications. Identification of high-risk patients remains key to optimizing monitoring and prevention. Standardized risk scores and prospective studies are needed to better define preventive and therapeutic strategies in this uniquely challenging population.
Future Cardiol
· 2026 Mar · PMID 41521027
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In this review of right ventricular (RV) preload, we discuss RV physiology, assessment of RV preload, and optimization of RV preload in the setting of acute RV failure. Early recognition and ongoing reassessment of invas...In this review of right ventricular (RV) preload, we discuss RV physiology, assessment of RV preload, and optimization of RV preload in the setting of acute RV failure. Early recognition and ongoing reassessment of invasive or noninvasive hemodynamics are critical to the management of acute RV failure. Central venous pressure (CVP) estimates RV preload but should not be the sole parameter guiding management. A comprehensive approach that integrates multiple hemodynamic indices should be considered to guide the resuscitative process in acute RV failure.
Future Cardiol
· 2026 Feb · PMID 41486676
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As renal handling of chloride (Cl) and bicarbonate (HCO) under different cardiac states would affect the acid-base balance and subsequently influence respiratory function, cardio-renal-pulmonary interactions can be predi...As renal handling of chloride (Cl) and bicarbonate (HCO) under different cardiac states would affect the acid-base balance and subsequently influence respiratory function, cardio-renal-pulmonary interactions can be predicted in heart failure (HF) pathophysiology, but have not yet been confirmed. We report a 93-year-old male HF patient taking diuretics who presented with mild body fluid retention, elevated b-type natriuretic peptide (BNP), and hypercapnia during a hospital stay. To improve the hypercapnia and correct metabolic alkalosis, he was given oral acetazolamide (250 mg/day). Peripheral venous blood tests before and after 1 month on acetazolamide showed that his body weight (39.8 to 36.8 kg) and BNP level (348 to 158 pg/mL) decreased. Arterial blood gas analysis showed that his blood pH (7.41 to 7.37) and PaO (91 to 95 mmHg) increased, and PaCO (59.7 to 37.8 mmHg), HCO (36.7 to 21.3 mmol/L) and base excess (11.5 to -3.1 mmol/L) decreased. These observations indicated that acetazolamide treatment reduced the cardiac burden and enhanced pulmonary ventilation possibly by stimulating the brain's respiratory center. This case highlights a new clinical HF entity of pathophysiologic cardio-renal pulmonary syndrome as a pathologic spectrum defined by cardio-pulmonary interactions linked to kidney function through renal modulation of the acid-base balance.
Liu X, Xu T, Sang W
… +6 more, Li Z, Yang X, Wang Y, Zhou X, Jiang H, Yu L
Future Cardiol
· 2026 Feb · PMID 41451621
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Coronary artery disease (CAD) remains one of the leading causes of death worldwide, making precise risk stratification essential for personalized medicine. Hyperspectral imaging (HSI) has emerged as a novel noninvasive m...Coronary artery disease (CAD) remains one of the leading causes of death worldwide, making precise risk stratification essential for personalized medicine. Hyperspectral imaging (HSI) has emerged as a novel noninvasive medical imaging technology with significant potential in CAD detection and risk stratification. Previous reviews focusing on machine learning (ML) in CAD have predominantly centered on traditional imaging modalities or broadly explored the applications of ML in CAD. By exclusively focusing on the synergistic potential of HSI and ML, this review aims to advance CAD diagnosis and risk stratification. It systematically summarizes the current application, core technical advantages, and unresolved challenges of HSI in CAD diagnosis. By integrating HSI with ML, we propose a novel noninvasive diagnostic framework capable of extracting CAD-related biomarkers from superficial body features. Although challenges remain in data standardization, model generalizability, and clinical translation, this integrated approach holds great promise for advancing precision cardiology.
Kałmucki P, Owsik K, Baszko A
… +1 more, Siminiak T
Future Cardiol
· 2026 Jan · PMID 41436392
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Functional mitral regurgitation (FMR), secondary to left ventricle and mitral annulus dilation, is a frequent and prognostically adverse complication of heart failure. Several different transcatheter approaches were deve...Functional mitral regurgitation (FMR), secondary to left ventricle and mitral annulus dilation, is a frequent and prognostically adverse complication of heart failure. Several different transcatheter approaches were developed as therapeutic options in high-risk patients. Among them, the Carillon® Mitral Contour System, which offers a minimally invasive, trans- coronary-venous approach to indirect annuloplasty that reduces annular dimensions and improves leaflet coaptation without the need for transseptal access or manipulation of the mitral valve apparatus. A key advantage of Carillon lies in its extracardiac, leaflet-sparing mechanism. By acting from the lumen of coronary sinus and great cardiac vein, the device preserves the possibility of future interventions such as transcatheter edge-to-edge repair, direct annuloplasty, or even valve replacement, while still allowing successful placement of left ventricular pacing leads for cardiac resynchronization therapy. The current article provides the Carillon device characteristics and technical aspects of implantation procedure. The paper is an overview of the clinical studies and real-world registries conducted on the Carillon device, and the effectiveness of this treatment for functional mitral regurgitation. We also discuss possible future perspectives of the Carillon device applications like treating patients with mild FMR, in combination with other treatment modalities, approaches or atrial form of FMR.
Future Cardiol
· 2026 Feb · PMID 41416395
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Sjögren's disease (SjD) is a systemic autoimmune disease primarily affecting exocrine glands, but increasingly recognized for its association with elevated cardiovascular risk. Chronic inflammation, immune dysregulation,...Sjögren's disease (SjD) is a systemic autoimmune disease primarily affecting exocrine glands, but increasingly recognized for its association with elevated cardiovascular risk. Chronic inflammation, immune dysregulation, and metabolic disturbances contribute to this burden. To summarize the mechanisms linking SjD to cardiovascular disease (CVD) and propose evidence-based strategies for risk assessment and management, we reviewed the current literature on immune-mediated vascular dysfunction, autoantibody profiles, dyslipidemia, hypertension, insulin resistance, and lifestyle factors in SjD. It also evaluates pharmacologic and non-pharmacologic interventions. SjD patients exhibit both traditional and disease-specific cardiovascular risk factors. Autoantibody positivity (anti-Ro/SSA and anti-La/SSB) correlates with increased risk of thrombotic events. Systemic inflammation and endothelial dysfunction are central to pathogenesis. Statins, ACE inhibitors, and metformin show promise in mitigating risk. Lifestyle interventions, including Mediterranean diet and aerobic exercise, offer additional benefits. Thus, cardiovascular risk management should be an integral part of SjD care. A multidisciplinary approach combining clinical evaluation, targeted therapies, and lifestyle modification is essential to reduce morbidity and improve outcomes.
Future Cardiol
· 2026 Jan · PMID 41412578
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Mitral regurgitation (MR) is among the most common heart conditions. Untreated, severe MR may result in adverse cardiac remodeling, atrial fibrillation (AF), and heart failure. A 45-year-old male with a history of AF pre...Mitral regurgitation (MR) is among the most common heart conditions. Untreated, severe MR may result in adverse cardiac remodeling, atrial fibrillation (AF), and heart failure. A 45-year-old male with a history of AF presented with heart failure symptoms. Transesophageal echocardiogram revealed a myxomatous mitral valve with anterior leaflet prolapse, severe MR, and massively dilated left atrium (LA). A computerized tomography scan found severe LA dilation up to 17.8 cm. The patient underwent mitral valve replacement, tricuspid valve repair, and LA reduction. MR is known to result in LA dilation due to increased LA volume and pressure. While large LA sizes have been reported, they are often related to congenital conditions and rarely grow to the size identified in this case. AF and LA dilation both predict adverse outcomes, increasing the risk of thrombus formation in such a large chamber.
Future Cardiol
· 2026 Feb · PMID 41410542
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Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence expected to double by 2060. This is due to aging populations and increasing rates of obesity, hypertension, and diabetes. It is often asym...Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence expected to double by 2060. This is due to aging populations and increasing rates of obesity, hypertension, and diabetes. It is often asymptomatic and can go undetected which will intensify the risk of serious complications such as ischemic stroke, heart failure, and cognitive decline. Early detection through opportunistic and systematic screening is essential for anticoagulation therapy, which can reduce stroke risk by 65%. AF arises from disorganized atrial electrical activity that is frequently originating in the pulmonary veins, and is sustained by a complex interplay of electrical, structural, and autonomic factors. Lifestyle and dietary habits play a significant role in AF risk and progression with obesity, and alcohol consumption linked to increased risk, while heart-healthy diets and weight control can alleviate symptoms and reduce recurrence. Additionally, genetic predisposition contributes to AF, particularly in early-onset cases. Genome-wide studies have identified over 100 associated loci, highlighting the value of personalized approaches in diagnosis and treatment. This paper explores the epidemiology, pathophysiology, and modifiable risk factors of AF with a dedicated focus on the precision medicine approach by highlighting personalized strategies for early detection and targeted management despite current clinical challenges.
Malikides O, Papazachariou A, Anagnostakis G
… +4 more, Koutalas E, Petousis S, Zacharis E, Simantirakis E
Future Cardiol
· 2026 Jan · PMID 41403213
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A 36-year-old man with marked eosinophilia presented with fatigue and dyspnea. Echocardiography revealed biventricular apical thickening and thrombi, confirmed by contrast imaging. Cardiac magnetic resonance demonstrated...A 36-year-old man with marked eosinophilia presented with fatigue and dyspnea. Echocardiography revealed biventricular apical thickening and thrombi, confirmed by contrast imaging. Cardiac magnetic resonance demonstrated global systolic dysfunction,myocardial edema, and subendocardial late gadolinium enhancement, consistent with early-thrombotic-stage Loeffler endocarditis. Bone marrow biopsy identified a FIP1L1-PDGFRA fusion, confirming myeloproliferative hypereosinophilic syndrome. High-dose corticosteroids followed by imatinib induced hematologic and cardiac improvement, with complete thrombus resolution at follow-up. Τhis case illustrates that the integration of advanced multimodal imaging with targeted genetic analysis can reliably establish the diagnosis of Loeffler endocarditis, obviating the need for invasive histopathological confirmation in appropriately selected patients.
Voorhout LJ, Verburg A, Pisters R
… +2 more, Ten Berg JM, Hemels MEW
Future Cardiol
· 2026 Jan · PMID 41389033
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Atrial fibrillation (AF) and coronary artery disease (CAD) frequently coexist due to shared risk factors such as obesity and diabetes. The interrelationship between these diseases carries important therapeutic implicatio...Atrial fibrillation (AF) and coronary artery disease (CAD) frequently coexist due to shared risk factors such as obesity and diabetes. The interrelationship between these diseases carries important therapeutic implications, given the fact that both AF and CAD are associated with an increased risk for cardiovascular events such as stroke, myocardial infarction, heart failure and cardiovascular mortality. In this review, we elucidate our current understanding of the epidemiological and pathophysiological links between AF and CAD, with particular focus on the impact of obesity, diabetes and systemic inflammation as common drivers. We discuss the implications for patient management, including antithrombotic therapy, lifestyle modifications and metabolic risk reduction. Beyond antithrombotic therapy, we highlight the importance of rate and rhythm control strategies in case of coexisting of AF and CAD. Novel pharmacological approaches for patients with CAD and type 2 diabetes, such as GLP-1 receptor agonist and SGLT2 inhibitors, provide additional cardiometabolic benefits by reducing the risk of major adverse cardiovascular events. Finally we propose a framework for integrated management of AF and CAD that aligns with contemporary guidelines and emerging evidence. This holistic approach, including metabolic risk factor modification, represents a paradigm shift in the care of patients with both AF and CAD.
Adnan M, Ahmed Usman M, Akhtar M
… +8 more, Hameed H, Hussain Bakhtiari MI, Hamza M, Zaheer W, Shoaib I, Saleem A, Basit J, Alraies MC
Future Cardiol
· 2025 Dec · PMID 41384949
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BACKGROUND: Patients with aortic stenosis have a high mortality risk treatable by transcatheter aortic valve replacement (TAVR). We conducted a network meta-analysis to compare the efficacy and safety of transcatheter ao...BACKGROUND: Patients with aortic stenosis have a high mortality risk treatable by transcatheter aortic valve replacement (TAVR). We conducted a network meta-analysis to compare the efficacy and safety of transcatheter aortic valves in aortic stenosis patients. METHODS: A systematic search of PubMed, Embase, and Cochrane was conducted. Randomized controlled trials (RCTs) that included adult patients with aortic stenosis undergoing TAVR, which compared clinical efficacy and safety between any of the transcatheter aortic valves, were included. Random effects meta-analysis was employed. RESULTS: A total of 4687 patients from 9 RCTs were included. Sapien XT had a significantly higher risk of stroke compared to Sapien 3 RR = 31.38 (95% CI: 1.12 to 876, = 0.043), while other devices showed no significant differences. Evolut had a significantly increased risk of permanent pacemaker placement compared to Sapien 3 RR = 1.36 (95% CI: 1.07-1.74, = 0.013). No significant differences were observed between valves for any of the other analyzed outcomes. CONCLUSION: While most TAVR devices showed comparable safety profiles, Evolut was associated with increased pacemaker implantation risk. The higher stroke risk with Sapien XT should be interpreted with caution. PROTOCOL REGISTRATION: This review was registered with PROSPERO (CRD42024563628).
Future Cardiol
· 2026 Jan · PMID 41358627
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Cardiac amyloidosis (CA) can result in a restrictive cardiomyopathy, and heart transplantation (HT) remains the gold standard treatment for patients with end-stage heart failure secondary to amyloid cardiomyopathy. Altho...Cardiac amyloidosis (CA) can result in a restrictive cardiomyopathy, and heart transplantation (HT) remains the gold standard treatment for patients with end-stage heart failure secondary to amyloid cardiomyopathy. Although HT was historically contraindicated due to inferior outcomes, survival following HT in patients with CA has significantly improved over recent decades; and outcomes are now similar to those of patients undergoing HT for non-amyloid indications. This improvement has been driven largely by advances in screening for appropriate patient selection and improvement in therapeutic strategies for both immunoglobulin light-chain (AL) and transthyretin (ATTR) amyloidosis. Future directions in HT for CA will hinge on continued optimization of patient selection and refining post-transplant management of extracardiac manifestations.