Future Cardiol
· 2025 Nov · PMID 40988576
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INTRODUCTION: Left ventricular assist devices have been demonstrated to improve both quality of life and improve survival in patients with end-stage heart failure. Ideal speed setting of these devices is necessary to pro...INTRODUCTION: Left ventricular assist devices have been demonstrated to improve both quality of life and improve survival in patients with end-stage heart failure. Ideal speed setting of these devices is necessary to provide adequate left ventricular unloading while not disadvantaging the right heart. This highlights the potential utility of speed titration studies. METHODS: PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature databases were searched for: (LVAD) OR (Left Ventricular Assist Device) OR (VAD) OR (Ventricular Assist Device) AND (Speed Optimization) OR (Ramp Study) from inception to April 2025. RESULTS: 22 studies with 749 total patients were included, 45% of whom had a Heart Mate 3. Outcomes of interest included mortality, readmission, RV function, speed change at conclusion of the study, and quality of life. Only 1 out of 22 studies reported all 5 outcomes, with 64% reporting 2 or fewer outcomes of interest. CONCLUSION: There exists limited data on speed optimization in the HM3, and that which has been reported lacks a standardization regarding method of evaluation as well as outcomes reporting. Prospective studies, with a standard method of speed optimization and more detailed outcomes reporting, are necessary in order to define best practices.
Future Cardiol
· 2025 Nov · PMID 40985184
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BACKGROUND: The triglyceride - glucose (TyG) index is a surrogate of insulin resistance and may predict vascular risk. We evaluated whether baseline TyG is associated with incident stroke and all-cause mortality in adult...BACKGROUND: The triglyceride - glucose (TyG) index is a surrogate of insulin resistance and may predict vascular risk. We evaluated whether baseline TyG is associated with incident stroke and all-cause mortality in adults with diabetes. METHODS: We analyzed 10,000 UK Biobank participants with diabetes and no baseline cardiovascular disease. TyG was calculated from fasting triglycerides and glucose and categorized into quartiles. Outcomes (stroke; all-cause mortality) were ascertained via hospital and death registries. Cox models estimated hazard ratios (HRs) adjusting for demographic, lifestyle, and clinical covariates. RESULTS: Over a median 12.8 years, 620 strokes and 688 deaths occurred. Compared with Q1, Q4 had higher risks of stroke (HR 1.45, 95% CI 1.18-1.80) and mortality (HR 1.42, 95% CI 1.17-1.73). Each 1-SD higher TyG was associated with ~ 19% higher stroke risk (HR 1.19, 95% CI 1.07-1.32) and ~ 16% higher mortality risk (HR 1.16, 95% CI 1.05-1.29). Associations were consistent across age, sex, and BMI subgroups and robust in sensitivity analyses, including extended adjustment. CONCLUSIONS: Higher TyG is independently associated with increased risks of stroke and all-cause mortality among individuals with diabetes. As an inexpensive measure derived from routine tests, TyG may aid risk stratification and inform targeted prevention in this high-risk population.
Santobuono VE, Falagario A, Giovannico L
… +10 more, Basile P, Carella MC, Memeo R, Fischetti G, Mazzone F, Monitillo F, Santoro D, Bottio T, Ciccone MM, Guaricci AI
Future Cardiol
· 2025 Dec · PMID 40957675
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The ongoing global shortage of donor hearts dictates the need for innovative solutions to enlarge the donor pool and to reduce mortality of patients on the waiting list. The extended-heart-transplantation-criteria premis...The ongoing global shortage of donor hearts dictates the need for innovative solutions to enlarge the donor pool and to reduce mortality of patients on the waiting list. The extended-heart-transplantation-criteria premise is to match patients who fall outside traditional eligibility criteria with donor hearts that have high risk features. In our case, the donor experienced ventricular fibrillation episodes. Given the idiopathic arrhythmogenic substrate of the transplanted heart, we decided to protect the receiver with a subcutaneous implantable cardioverter defibrillator in the short-term post heart transplantation. It represents the first experience worldwide in this specific setting of sudden cardiac death.
Future Cardiol
· 2025 Dec · PMID 40931803
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A 71-year-old black male with a history of hypertension, dyslipidemia, type 2 diabetes, history of bladder cancer status-post resection now in remission, history of multiple transient ischemic attacks, and coronary arter...A 71-year-old black male with a history of hypertension, dyslipidemia, type 2 diabetes, history of bladder cancer status-post resection now in remission, history of multiple transient ischemic attacks, and coronary artery disease (CAD) presented with non-exertional substernal chest pain radiating to the left arm, accompanied by shortness of breath and nausea. Initial evaluation revealed elevated troponins and nonspecific electrocardiogram changes, consistent with non-ST elevation myocardial infarction. Coronary angiography demonstrated severe multivessel disease, including critical left main stenosis. Post-procedurally, the patient developed anoxic brain injury, likely due to a hypoxic event, leading to acute hydrocephalus and transtentorial herniation. Despite aggressive management, the patient experienced progressive neurologic decline, necessitating palliative care consultation. This case highlights the complexities of managing severe CAD in high-risk patients and the devastating consequences of peri-procedural complications.
Qazi SU, Zaide DB, Fatima U
… +8 more, Nayyab D, Hijab N, Bajaj S, Majid F, Nezami MS, Mansoor M, Nabi R, Farhan SA
Future Cardiol
· 2025 Dec · PMID 40923587
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INTRODUCTION: The aim of this article is to compare the long-term efficacy of Thoracic Endovascular Aortic Repair (TEVAR) versus Optimal Medical Therapy (OMT) in reducing mortality among adult patients with uncomplicated...INTRODUCTION: The aim of this article is to compare the long-term efficacy of Thoracic Endovascular Aortic Repair (TEVAR) versus Optimal Medical Therapy (OMT) in reducing mortality among adult patients with uncomplicated Stanford type B aortic dissection (uSTBAD). METHODS: An electronic search of PubMed, Cochrane Central and Google Scholar was conducted for studies comparing TEVAR with OMT for mortality in adult patients with uSTBAD. Relevant outcomes, including mortality, aortic rupture, re-intervention, retrograde type A dissection, myocardial infarction and stroke were analyzed and presented as risk ratios (RRs) along with their 95% confidence intervals (95% CI). A p-value of less than 0.05 was considered significant in all cases. All statistical analysis was conducted using Review Manager. RESULTS: A total of 12 studies were included (n = 25,605). Meta-analysis favored TEVAR over OMT for all-cause mortality (RR = 0.57, 95% CI: [0.43-0.76]; P < 0.01). However, there was no significant difference considering the morbidity, which included endovascular re-intervention (RR = 0.76, 95%CI: [0.46-1.28]; P = 0.30), aortic rupture (RR = 0.38; 95%CI: [0.14-1.05]; P = 0.06), retrograde type A dissection (RR = 1.00; 95%CI: [0.78-1.28]; P = 1.00), myocardial infarction (RR = 0.85; 95% CI: [0.51-1.42]; P = 0.53). However, a significant increase in risk of stroke in TEVAR group was observed (RR = 1.56; 95%CI: [1.30-1.89]; P < 0.01). CONCLUSION: We report that while there were similar morbidity outcomes for uSTBAD treated with TEVAR and OMT, overall mortality was significantly improved with TEVAR. Further large-scale studies are needed to elucidate the differences in outcomes between the two treatment options. PROTOCOL REGISTRATION: https://www.crd.york.ac.uk/prospero identifier is CRD42024566452.
Hullon D, Saraireh THA, Obaidi GA
… +5 more, Mirza H, Fediunina VA, Oskouyan Z, Al-Sudani N, Tawallbeh MA
Future Cardiol
· 2025 Dec · PMID 40904321
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INTRODUCTION: Wilson's disease (WD) is a rare autosomal recessive disorder caused by ATP7B gene mutations, leading to systemic copper accumulation. This systematic review examines the cardiac manifestations of WD and aim...INTRODUCTION: Wilson's disease (WD) is a rare autosomal recessive disorder caused by ATP7B gene mutations, leading to systemic copper accumulation. This systematic review examines the cardiac manifestations of WD and aims to summarize key diagnostic and therapeutic findings from available studies. METHODS: We conducted a systematic review of 21 studies using databases such as PubMed and Scopus. Studies were selected based on relevance to WD and cardiac involvement. Data extraction focused on diagnostic methods, outcomes, and treatments. Risk of bias and methodological quality were assessed qualitatively. RESULTS: A total of 21 studies were included. Cardiac complications included arrhythmias, myocardial fibrosis, and diastolic dysfunction. Oxidative stress and mitochondrial dysfunction were identified as key pathological mechanisms. Cardiac MRI was highlighted as a valuable diagnostic tool. While chelation remains the cornerstone therapy, gene therapy and liver transplantation are considered for advanced cases. CONCLUSIONS: This review underscores the importance of early cardiac assessment in WD patients. New diagnostic tools and emerging therapies show promise, though evidence remains limited by small sample sizes. Further longitudinal studies are needed to inform clinical guidelines. PROTOCOL REGISTRATION: www.crd.york.ac.uk/prospero identifier is CRD420251107174.
Zimmermann SK, Farhat K, Zaman S
… +6 more, Wang FM, Hirpara SY, Markovitz RS, Hu JR, Beach PA, Juraschek SP
Future Cardiol
· 2025 Nov · PMID 40904320
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Elevated blood pressure is one of the most important risk factors for cardiovascular disease (CVD). Despite blood pressure being historically measured in the supine position prior to the 20th century, current clinical gu...Elevated blood pressure is one of the most important risk factors for cardiovascular disease (CVD). Despite blood pressure being historically measured in the supine position prior to the 20th century, current clinical guidelines are primarily based on seated measurements. Emerging evidence suggests that hypertension in the supine position may be equally or more strongly associated with cardiovascular risk and mortality than seated hypertension. However, there is no standardized protocol or diagnostic criteria to evaluate supine hypertension (SH) in the general population. Moreover, if SH is detected, clinical recommendations for its treatment remain unclear. In this review, we synthesized the literature on SH by conducting a MEDLINE search of publications from 2024 to 2025 and offer recommendations for the assessment, interpretation, and treatment of SH in the outpatient setting. In addition, we identify gaps in evidence and opportunities for future research to advance our understanding of this underappreciated and yet potent risk factor for cardiovascular disease.
Agarwal R, Yakkali S, Gonzales-Uribe A
… +5 more, Lebovics N, Morgan RJ, Leiderman E, Galloway A, Lerner DJ
Future Cardiol
· 2025 Dec · PMID 40889134
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Tumor necrosis factor-alpha (TNF-α) inhibitors and other biologics used for autoimmune diseases are associated with low-grade immunosuppression. Treatment with these and the presence of prosthetic mechanical cardiac valv...Tumor necrosis factor-alpha (TNF-α) inhibitors and other biologics used for autoimmune diseases are associated with low-grade immunosuppression. Treatment with these and the presence of prosthetic mechanical cardiac valves both increase the risk of infective endocarditis (IE). However, evidence on the risk of prosthetic valve endocarditis (PVE) among patients treated with TNF-α inhibitors is limited. This study reports a 41-year-old man with a prosthetic aortic valve who was on treatment with golimumab and presented with low-grade fevers and positive blood cultures for . Transesophageal echocardiogram revealed vegetations adjacent to the valve sewing ring and an inflammatory phlegmon in the right atrium, leading to a diagnosis of prosthetic valve endocarditis. The patient was referred to a higher level of care center and underwent urgent surgical intervention. The study highlights that TNF-α inhibitors and other biologics may increase the risk of prosthetic heart valve endocarditis and the importance of early imaging for diagnosis.
Goren LR, Ding X, Jones-O'Connor M
… +1 more, Zakaria S
Future Cardiol
· 2025 Dec · PMID 40884756
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Cardiogenic shock (CS) is a complex condition characterized by insufficient cardiac output, tissue hypoperfusion, and life-threatening organ failure. In this review, we describe the definition, pathophysiology, classific...Cardiogenic shock (CS) is a complex condition characterized by insufficient cardiac output, tissue hypoperfusion, and life-threatening organ failure. In this review, we describe the definition, pathophysiology, classification, and approach to management in CS. We highlight recent advances in understanding the phenotypic heterogeneity and classification of CS. Then, we describe the limited, evidence-based, therapeutic approaches demonstrating survival benefit, including emergent revascularization of the culprit vessel in acute myocardial infarction related CS, and the use of a microaxial flow pumps in those with ST-segment elevation myocardial infarctions and CS. We also detail the limited evidence for other interventions, including medical therapies and other mechanical circulatory support (MCS) devices. Importantly, we highlight the current gaps in evidence and key ongoing trials that might inform the management of clinicians caring for patients with CS.
Shafiq A, Salar A, Husainy B
… +5 more, Kidess GG, Parrikh K, Basit J, Al Jaroudi W, Alraies MC
Future Cardiol
· 2025 Dec · PMID 40856605
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The role of echocardiography is critical in the diagnostic evaluation and management of ischemic stroke, especially cryptogenic stroke, in which the cause is unknown. About 15-30% of ischemic strokes are caused by cardio...The role of echocardiography is critical in the diagnostic evaluation and management of ischemic stroke, especially cryptogenic stroke, in which the cause is unknown. About 15-30% of ischemic strokes are caused by cardiogenic embolism, making cardiac imaging a critical component of evaluation. Guidelines from the American Heart Association and the American College of Cardiology highlight the importance of echocardiography and mobile cardiac telemetry or implantable loop recorders to identify possible sources of cardiac embolism and monitor for atrial fibrillation, thus guiding secondary prevention.Transthoracic echocardiography (TTE) is widely used as an initial tool to assess cardiac structure and function, detect intracardiac thrombi, and evaluate valvular abnormalities. Transesophageal echocardiography (TEE), as well as cardiac CT and MRI, offer enhanced visualization of certain cardiac structures, identifying embolic sources not readily visible on TTE, such as left atrial appendage thrombi and patent foramen ovale (PFO).The comprehensive diagnostic approach for cryptogenic stroke (CS) includes brain imaging (CT or MRI), neurovascular imaging, electrocardiography (ECG), and vascular ultrasound.Echocardiography plays a crucial role in assessing left atrial and ventricular thrombi, valvular disease, and aortic plaques. Additionally, advancements in echocardiography, such as real-time three-dimensional imaging, are emphasized for their potential to enhance stroke prevention and management strategies.
Future Cardiol
· 2025 Nov · PMID 40851541
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BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, with rising hospitalization rates and high comorbidity burden, yet the impact of cardiovascular comorbidities (CVC) on mortalit...BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, with rising hospitalization rates and high comorbidity burden, yet the impact of cardiovascular comorbidities (CVC) on mortality among hospitalized HCM patients remains poorly defined. METHODS: Queried the 2016 to 2020 National Inpatient Sample (NIS) to identify hospitalizations with diagnosed HCM. RESULTS: Among 278,995 HCM hospitalizations (mean age 64.3 ± 18.4 years; 55.7% female), in-hospital mortality rose from 16.4% to 22.9% throughout the study. Cardiac arrest (41.00%), tamponade (13.70%), and ST-segment elevation myocardial infarction (STEMI) (10.20%) had the highest mortality rates. Atrial fibrillation (AF) (42.10%), heart failure with preserved ejection fraction (HFpEF) (28.10%), and cardiorenal syndrome (16.60%) were the most prevalent comorbidities. Predictors of case-fatality included increasing age (aOR: 1.02, 95% CI: 1.02-1.03, p < 0.0001), Asian/Pacific Islander race (aOR: 1.70, 95% CI: 1.10-2.40, p = 0.007), CVA (aOR: 2.30, 95% CI: 1.70-3.06, p < 0.0001), NSTEMI (aOR: 1.80, 95% CI: 1.30-2.40, p < 0.0001), cardiorenal syndrome (aOR: 1.40, 95% CI: 1.20-1.80, p < 0.001), and cardiac arrest (aOR: 26.60, 95% CI: 20.90-33.90, p < 0.001). CONCLUSION: Mortality rate among hospitalized HCM patients has shown a mild upward trend and is driven by age, race, NSTEMI, and cardiorenal syndrome.
Solomon L, Dwivedi G, Boon E
… +2 more, Thomas M, Lan NSR
Future Cardiol
· 2025 Dec · PMID 40844021
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Anderson-Fabry disease (AFD) is a rare, X-linked, lysosomal storage disorder caused by the absence or deficiency of alpha-galactosidase A activity, leading to the progressive accumulation of sphingolipids in multiple org...Anderson-Fabry disease (AFD) is a rare, X-linked, lysosomal storage disorder caused by the absence or deficiency of alpha-galactosidase A activity, leading to the progressive accumulation of sphingolipids in multiple organ systems, including the heart. Cardiac involvement accounts for > 50% of AFD-related mortality and is a primary determinant of disease prognosis. AFD cardiomyopathy is heterogenous with key features that include left ventricular hypertrophy, conduction disturbances, myocardial fibrosis and valvular disease. Early diagnosis and treatment are crucial to prevent progressive and irreversible myocardial damage. Electrocardiography and echocardiography are effective and inexpensive first-line modalities to detect abnormalities that suggest cardiac involvement in patients with AFD. However, cardiovascular magnetic resonance imaging (CMR) can provide a more comprehensive assessment of myocardial tissue characteristics and cardiac structure and function. Recent studies have strengthened the role of T1 mapping, myocardial strain and late gadolinium enhancement using CMR in the assessment of patients with AFD. Whilst CMR is less widely available than electrocardiography and echocardiography, it has the potential to improve the diagnosis, monitoring and prognostication of patients with AFD. In the future, advanced CMR techniques may further refine risk stratification, guide therapeutic decisions and facilitate earlier interventions that can ultimately improve patient outcomes.
Future Cardiol
· 2025 Dec · PMID 40817750
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Pregnancy in patients with prosthetic heart valves presents complex challenges requiring multidisciplinary care and individualized decision-making. While bioprosthetic valves are often preferred in women of childbearing...Pregnancy in patients with prosthetic heart valves presents complex challenges requiring multidisciplinary care and individualized decision-making. While bioprosthetic valves are often preferred in women of childbearing age to avoid anticoagulation-related fetal risks, these valves are susceptible to structural degeneration potentially accelerated by the physiologic demands of pregnancy. Conversely, mechanical valves offer durability but necessitate lifelong anticoagulation, posing substantial risks of valve thrombosis, fetal hemorrhage, and warfarin embryopathy. The Ross operation, which can be considered for individuals with advanced aortic valve disease, is an appealing option yet is offered only in highly specialized centers. In this review, we present contemporary data on maternal and fetal outcomes, valve function, and anticoagulation strategies in pregnant patients with mechanical and bioprosthetic heart valves. We highlight geographical and knowledge gaps regarding type of valve utilization, optimal anticoagulation in pregnancy, durability of modern valve designs, and long-term reoperation risk. Future research priorities include uniform global approach with improved access to contemporary surgical and medical solutions in low- and middle-income countries, safety of direct oral anticoagulants, improved surveillance of valve function during pregnancy, and comparative studies of bioprosthetic valve models. By consolidating evolving evidence, we aim to support informed decision-making and multidisciplinary management for this high-risk patient population.
Daise MA, Maule G, Ismail M
… +4 more, Alqudah Q, Mojaddedi S, Obeidat O, Ismail K
Future Cardiol
· 2025 Dec · PMID 40811051
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Atrial cardiomyopathy (ACM) is an underrecognized cardiac entity marked by structural, contractile, or electrophysiological changes in the atria, yet it lacks established clinical diagnostic criteria and management guide...Atrial cardiomyopathy (ACM) is an underrecognized cardiac entity marked by structural, contractile, or electrophysiological changes in the atria, yet it lacks established clinical diagnostic criteria and management guidelines. These alterations - driven by molecular, mechanical, and genetic factors - lead to atrial remodeling and contribute to arrhythmogenesis, thromboembolic complications, and the progression of heart failure. Despite recent advances in imaging, biomarkers, and histopathological classifications, the pathophysiology of ACM remains complex and multifactorial, involving processes such as inflammation, oxidative stress, and genetic predisposition. This review synthesizes current knowledge on ACM, including its classification, pathophysiologic mechanisms, and clinical relevance in atrial fibrillation, ischemic stroke, and heart failure with preserved ejection fraction (HFpEF). We also explore emerging diagnostic tools and biomarkers that may aid in risk stratification and therapeutic decision-making. Ultimately, we aim to underscore the clinical significance of ACM and advocate for the development of standardized diagnostic frameworks and personalized treatment strategies to improve patient outcomes.
Ramamurthy D, Panda M, Rangappa M
… +6 more, Kannan S, Kundapur R, Rajeshwari S, Subbiah P, Aggarwal P, Aggarwal S
Future Cardiol
· 2025 Nov · PMID 40808578
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BACKGROUND: Acute Myocardial Infarction (AMI) necessitates timely treatment to improve outcomes. Identifying treatment delays across different South Asian countries can aid in formulating policies to reduce these delays....BACKGROUND: Acute Myocardial Infarction (AMI) necessitates timely treatment to improve outcomes. Identifying treatment delays across different South Asian countries can aid in formulating policies to reduce these delays. Objectives: To estimate the average treatment delay in AMI patients in South Asia and identify contributing factors. METHODS: Using the CoCoPop framework (Condition, Context, Population), studies were reviewed on AMI treatment delays in South Asia from 2000 to 2022. Databases searched included PubMed Central, Embase and Google Scholar. Eligible studies were cross-sectional and analytical that reported exact delay times, excluding knowledge, attitude, practice studies, narrative reviews, and case reports. RESULTS: The search yielded 2954 records, with 42 studies meeting the inclusion criteria. The pooled median prehospital delay was 531 minutes (95% CI: 366-769 minutes). The pooled mean door-to-ECG time was 9.18 minutes (95% CI: 2.52-15.84 minutes). The door-to-needle and door to balloon time among STEMI patients were 37.95 (95% CI: 30.11-45.78 minutes) minutes and 62.92 minutes (95% CI: 45.28-80.56 minutes), respectively with significant heterogeneity. Factors associated with delays included old age, female gender, low literacy, ignorance, financial constraints, and rural location. CONCLUSION: Significant treatment delays for AMI patients in South Asia are identified, with socio-economic and logistical barriers contributing to these delays.
Szulik M, Mykieta K, Millan N
… +1 more, Suchodolski A
Future Cardiol
· 2025 Nov · PMID 40785394
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Postpartum cardiomyopathy (PPCM) is a rising research interest in idiopathic cardiomyopathy with heart failure secondary to systolic dysfunction of the left ventricle, diagnosed when no other origin can be established. A...Postpartum cardiomyopathy (PPCM) is a rising research interest in idiopathic cardiomyopathy with heart failure secondary to systolic dysfunction of the left ventricle, diagnosed when no other origin can be established. As the diagnostic possibilities progress, the frequency of PPCM rises, becoming challenging even for the multidisciplinary team. This case goes beyond the rigid definition of PPCM, as it is hard to say with certainty if the PPCM was "only" initial syndrome, or final diagnosis. Two elements of the treatment procedure should be highlighted as crucial for a patient's recovery: effective control of VT and finding the proper anticoagulant therapy (heparin alternative).