Hajj J, Kassab J, Zalaquett Z
… +2 more, Harb SC, Kapadia SR
Future Cardiol
· 2026 Jan · PMID 40779241
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Tricuspid regurgitation (TR) is a common yet underrecognized valvular disease associated with significant morbidity and mortality. Recent advances in transcatheter therapies, namely transcatheter edge-to-edge repair (T-T...Tricuspid regurgitation (TR) is a common yet underrecognized valvular disease associated with significant morbidity and mortality. Recent advances in transcatheter therapies, namely transcatheter edge-to-edge repair (T-TEER) with the TriClip device (Abbott) and transcatheter tricuspid valve replacement (TTVR) with the EVOQUE device (Edwards Lifesciences), offer promising alternatives to surgery for severe symptomatic TR. This review compares both approaches with a focus on safety, procedural considerations, and clinical outcomes. Treating TR remains uniquely challenging due to the anatomical complexity of the valve, frequent lead interference, and common coexistence of RV dysfunction, atrial fibrillation, and pulmonary hypertension. Many affected patients are elderly and frail, rendering them poor surgical candidates. Optimal treatment requires individualized decision-making guided by detailed imaging and assessment of RV function and valvular anatomy. Both therapies achieve significant TR reduction, yet each carries distinct risks: TTVR is associated with higher rates of pacemaker implantation, bleeding, and RV failure, while T-TEER may lead to single leaflet device attachment (SLDA), leaflet injury, or residual TR. Careful patient selection is essential. Despite encouraging short-term outcomes, long-term data are needed to determine survival benefit and durability. Further studies are warranted to refine technique and optimize candidate selection.
Prosperi-Porta G, Al-Abcha A, Simard T
… +2 more, Hibbert B, Abdel-Razek O
Future Cardiol
· 2026 Jan · PMID 40757898
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In patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER), atrial fibrillation is a common comorbidity. While oral anticoagulation is the mainstay of stroke prevention therapy in most patients with a...In patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER), atrial fibrillation is a common comorbidity. While oral anticoagulation is the mainstay of stroke prevention therapy in most patients with atrial fibrillation, patients undergoing M-TEER might have a unique opportunity to undergo concomitant left atrial appendage occlusion (LAAO). LAAO is an alternative to oral anticoagulation that reduces the long-term risk of stroke and major bleeding, but it comes with upfront peri-procedural risk. M-TEER and LAAO share numerous procedural characteristics including large-bore venous access, transseptal puncture, general anesthesia, and real-time imaging of the left atrium with echocardiography. Therefore, performing concomitant LAAO at the time of M-TEER might be an attractive option for patients to lessen the cumulative peri-procedural risk, repeated anesthetic, and hospital visits from separate procedures. With rapidly evolving device technologies and an increasing evidence base for LAAO use, there is still limited data evaluating the safety and feasibility of concomitant M-TEER and LAAO. This up-to-date narrative review on concomitant M-TEER and LAAO aims to summarize the current body of literature, review practical procedural considerations, and review the unmet research questions limiting the widespread adoption of this concomitant intervention.
Bertolín-Boronat C, Baettig E, Torondel S
… +6 more, Santas E, Bodi V, Merenciano-González H, Gil J, Sanchis J, Marcos-Garcés V
Future Cardiol
· 2025 Nov · PMID 40728502
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We present the case of a 21-year-old male with chest pain, malaise, and fever, who was initially diagnosed with suspected acute myocarditis. The patient exhibited elevated cardiac troponin levels, occasional premature ve...We present the case of a 21-year-old male with chest pain, malaise, and fever, who was initially diagnosed with suspected acute myocarditis. The patient exhibited elevated cardiac troponin levels, occasional premature ventricular complexes, and right ventricular dilation, raising concerns about arrhythmogenic cardiomyopathy. Cardiac magnetic resonance (CMR) imaging showed myocardial edema and subepicardial enhancement in the basal anterolateral segment, confirming myocarditis, but also revealed severe dilation of the right chambers. Advanced imaging sequences identified a previously unrecognized inferior sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return. This finding led to a significant left-to-right shunt and surgical correction was performed. SVASD, a rare congenital anomaly, often remains undiagnosed due to its subtle clinical presentation and limitations of standard imaging techniques. This case highlights the importance of tailored CMR acquisition protocols, which revealed a congenital heart defect in our patient despite an initial focus on myocarditis. The adjustment in diagnostic approach significantly altered the patient's management and may have improved his long-term prognosis.
Thayapran KG, Nabrzyski RJ, Longino AA
… +1 more, Gill EA
Future Cardiol
· 2025 Aug · PMID 40728266
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Bedside assessment of venous congestion is key to managing hospitalized adults with cardiovascular disease and guiding fluid management to achieve euvolemia. Current methods include physical examination, radiographic ima...Bedside assessment of venous congestion is key to managing hospitalized adults with cardiovascular disease and guiding fluid management to achieve euvolemia. Current methods include physical examination, radiographic imaging, and point-of-care ultrasound (POCUS) of the inferior vena cava (IVC). While accessible, physical exam and IVC measurements are prone to errors and variability. Right heart catheterization (RHC), considered the gold standard, is invasive, costly, and often unavailable. A novel ultrasound technique, Venous Excess Ultrasound (VExUS), offers a noninvasive alternative for assessing venous congestion by characterizing the IVC and hepatic, portal, and intrarenal veins. Rapidly evolving literature on VExUS has created controversy and uncertainty around its application to patients with cardiovascular disease. This review summarizes the utility of the VExUS scoring system as a bedside tool for assessing venous congestion in adults with cardiovascular disease. It will discuss the methodology of VExUS, its performance compared to traditional IVC measurements and RHC, and its applications in various cardiovascular conditions including acute decompensated heart failure (ADHF), acute coronary syndromes (ACS), tricuspid regurgitation (TR), cardiorenal syndromes (CRS), cardiogenic shock (CS), and patients undergoing cardiac surgery.
Namjouyan K, Tangsrivimol JA, Rizwan A
… +7 more, Riaz I, Escobar J, Khawaja M, Virk HH, Alam M, Dardik A, Krittanawong C
Future Cardiol
· 2026 Jun · PMID 40696787
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Carotid artery stenosis (CS) is a critical diagnosis linked to ischemic stroke, a leading cause of morbidity and mortality, affecting about 4% of the general population. Risk factors for CS include age, hypertension, dys...Carotid artery stenosis (CS) is a critical diagnosis linked to ischemic stroke, a leading cause of morbidity and mortality, affecting about 4% of the general population. Risk factors for CS include age, hypertension, dyslipidemia, diabetes, and smoking, with poly vascular disease seen in 45% of patients with known atherosclerotic disease. Early recognition and management of CS are crucial to prevent stroke by utilizing imaging modalities like Duplex ultrasound (DUS). Management of CS involves complex decision-making that balances the risks and benefits of intervention against the developing diagnostic and therapeutic modalities. This narrative review aims to review and examine the current guidelines for clinicians' approach to CS.
Taha HI, Shubietah A, Al Zoubi BM
… +8 more, Elgendy MS, Mansour HR, Abdulkader A, Ghazal AM, Shamis N, Abuelazm M, Turkmani M, Mentz RJ
Future Cardiol
· 2026 Jan · PMID 40689605
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BACKGROUND: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompen...BACKGROUND: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF. METHODS: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used. RESULTS: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; = 0.024). CONCLUSION: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk. PROTOCOL REGISTRATION:PROSPERO: CRD42024618027.
Raza A, Kalpina F, Rehmat M
… +6 more, Alamgir E, Zeeshan E, Ahmad M, Ikram M, Turkmani M, Khan U
Future Cardiol
· 2025 Aug · PMID 40685979
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BACKGROUND: Aortic Stenosis (AS) is a valvular heart disease. Hypertension accelerates stenosis, increasing morbidity and mortality. This study investigates mortality trends in US older adults with AS and hypertension fr...BACKGROUND: Aortic Stenosis (AS) is a valvular heart disease. Hypertension accelerates stenosis, increasing morbidity and mortality. This study investigates mortality trends in US older adults with AS and hypertension from 1999 to 2020. METHODS: Using the CDC WONDER database, age-adjusted mortality rates (AAMRs) per 100,000 individuals aged 65+ with AS and hypertension were analyzed. Changes in AAMRs were examined through annual percent change (APC) and average APC (AAPC) using Joinpoint regression. RESULTS: From 1999 to 2020, hypertension caused 99,250 deaths in AS patients in the US, demonstrating an increasing trend (AAPC: 5.51%). Males had higher AAMRs (11.51) than females (9.99). Non-Hispanic (NH) white people (11.32) had the highest AAMRs, followed by Hispanic (7.37), NH Black people (7.27), and NH Asians (6.12). Regionally, the West showed the highest AAMR (13.3), followed by the Midwest (11.38), the Northeast (10.62), and the South (8.53). The states with the highest AAMRs were Vermont and Oregon, while Alabama and Georgia had the lowest. Non-metropolitan areas (11.19) experienced higher mortality than metropolitan areas (10.49). CONCLUSION: We report increasing mortality rates in patients with AS and hypertension, especially in males, NH white people, and the West. Target healthcare measures are needed to address the rising mortality.
Leal MA, Sheldon T, Escalante K
… +5 more, Holm M, Galarneau M, Rosemas S, Stromberg K, Piccini JP
Future Cardiol
· 2025 Aug · PMID 40671373
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BACKGROUND: Leadless ventricular pacemakers have been developed for single chamber VVIR and AV synchronous pacing applications. AIM: To assess the device longevity impact of battery/electronics enhancements of next-gener...BACKGROUND: Leadless ventricular pacemakers have been developed for single chamber VVIR and AV synchronous pacing applications. AIM: To assess the device longevity impact of battery/electronics enhancements of next-generation Micra leadless pacemakers, Micra VR2 and AV2, compared to Micra VR and AV. METHODS: Real-world pacing data gathered from the Micra IDE study, Medtronic's CareLink database, and historical pacemaker patient survival data from Medtronic's Device Registry were used to project device longevity and estimate the proportion of patients requiring lifetime device replacements. RESULTS: Based on data from 644 patients, the median projected longevity of Micra VR was 12.3 years and Micra VR2 was 16.7 years, with 91% of patients requiring a single VR2 device over their lifetime. Based on data from 999 patients, the median projected longevity of Micra AV was 10.8 years and Micra AV2 was 15.6 years, with 80% of patients requiring one AV2 device. The longevity improvements with Micra VR2 projected 8 fewer device replacements would be required across 100 patients. Similarly, 15 devices would be avoided when considering Micra AV versus AV2. CONCLUSIONS: Modeling of the Micra leadless pacemakers projected meaningful improvements in device longevity and an increase in the number of patients served with a single device.
Future Cardiol
· 2025 Aug · PMID 40662686
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With a significant impact on morbidity and mortality rates worldwide, arrhythmias are a growing global health concern. The most common sustained arrhythmia, atrial fibrillation (AF), affects approximately 2% of the gener...With a significant impact on morbidity and mortality rates worldwide, arrhythmias are a growing global health concern. The most common sustained arrhythmia, atrial fibrillation (AF), affects approximately 2% of the general population, with its prevalence increasing with age. Although significant advancements have been made in non-pharmacological therapies, such as catheter ablation and implantable devices, the basis of arrhythmia management remains antiarrhythmic drugs (AADs). Yet the development of safer and more effective AADs has not kept pace with the increasing burden of arrhythmias. This article aims to briefly explore the current landscape of antiarrhythmic treatment, emerging pharmacological targets, and the potential for innovative drug therapies to reshape clinical practice.
Future Cardiol
· 2025 Aug · PMID 40650957
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Systemic light-chain (AL) amyloidosis is a rare clonal plasma cell disorder characterized by the production of abnormal immunoglobulin free light-chains that misfold into amyloid fibrils and deposit in the extracellular...Systemic light-chain (AL) amyloidosis is a rare clonal plasma cell disorder characterized by the production of abnormal immunoglobulin free light-chains that misfold into amyloid fibrils and deposit in the extracellular matrix of tissues. Despite being a multisystemic disease process, the presence and severity of cardiac involvement remains the main determinant of prognosis. Improved understanding of the underlying pathophysiology has resulted in transformative changes in both diagnostics and treatment. Improvements in multimodality cardiac imaging have enabled accurate diagnosis, facilitated rapid initiation of treatment and allowed the direct visualization changes in the myocardial substrate in response to chemotherapy. Significant progress has also been made through leveraging treatments that directly target the underlying abnormal plasma cell clone responsible the production of the amyloidogenic immunoglobulin free light-chains. Current treatment options successfully target amyloid production, but novel anti-amyloid therapies seek to target amyloid fibrils that have already deposited in the organs and facilitate their removal through an immune-mediated degradation process are at advanced stages of development. These treatments have the potential to induce disease regression by depleting amyloid deposits and if successful will represent a significant step forward in the treatment of systemic AL amyloidosis, especially for patients with advanced cardiac disease.
Maekawa Y, Ikeda Y, Torigoe M
… +4 more, Shimoura K, Suo S, Takeda R, Kitaoka H
Future Cardiol
· 2025 Aug · PMID 40641461
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AIM: To identify factors affecting the health-related quality of life (HR-QOL) of symptomatic patients with hypertrophic cardiomyopathy (HCM) using qualitative interviews exploring patients' experiences and perceptions....AIM: To identify factors affecting the health-related quality of life (HR-QOL) of symptomatic patients with hypertrophic cardiomyopathy (HCM) using qualitative interviews exploring patients' experiences and perceptions. PATIENTS & METHODS: This cross-sectional observational study was conducted using qualitative web-based or telephone interviews. Adult patients with HCM in Japan who were experiencing burden because of HCM were included. In-depth interviews were conducted using a semi-structured interview guide. The data were analyzed using a thematic analysis approach. RESULTS: Nineteen patients completed the interview. Ten HR-QOL-related themes were identified. Many patients were unaware that they had HCM symptoms, either no longer noticing them following life adjustments or attributing them to factors other than HCM. HCM affected multiple life aspects, including work, family, and social life. Patients resisted disclosing their disease to others and strongly resisted invasive treatment. Patients highly trusted their physicians but were reluctant to discuss their mental burdens and daily life challenges with them. CONCLUSIONS: This first qualitative study of HR-QOL in patients with HCM in Japan suggests that deeper physician - patient communication is needed to understand patient burden and needs, as patients have difficulty discussing their burdens with physicians and may lack awareness of HCM symptoms. CLINICAL TRIAL REGISTRATION: NCT06181617 (ClinicalTrials.gov).
Wu Q, Ye H, Zhou Z
… +3 more, Zhang M, Sun X, Wang Q
Future Cardiol
· 2025 Aug · PMID 40641351
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Right ventricular (RV) function is the primary determinant of survival in connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). A "double hit" hypothesis suggests that RV suffers not only from p...Right ventricular (RV) function is the primary determinant of survival in connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). A "double hit" hypothesis suggests that RV suffers not only from pressure overload common to all PAH but also from direct insults related to the underlying systemic autoimmunity and inflammation. This likely drives distinct maladaptive remodeling (fibrosis, inflammation) and contributes to the poorer prognosis observed in CTD-PAH compared to idiopathic PAH (IPAH).Comprehensive, multi-modal RV assessment - integrating clinical evaluation, biomarkers, echocardiography, cardiac MRI, and right heart catheterization - is crucial for prognosis and monitoring therapy. RV size, function, and tissue characteristics are key indicators.Current management involves PAH-targeted therapies to reduce RV afterload, optimal CTD control, and supportive care. However, CTD-PAH often shows attenuated treatment responses and worse outcomes, emphasizing the need for therapies directly addressing RV maladaptation. Future research priorities include understanding specific RV injury mechanisms in CTD, refining assessment tools, and developing novel RV-directed strategies. Optimizing outcomes requires a deep understanding of RV pathobiology within the CTD context and integrated, multidisciplinary care.
Future Cardiol
· 2025 Nov · PMID 40624950
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Cardiovascular-kidney-metabolic (CKM) syndrome represents a complex interaction between cardiovascular (CV) disease, chronic kidney disease (CKD), and metabolic risk factors. Non-steroidal mineralocorticoid receptor anta...Cardiovascular-kidney-metabolic (CKM) syndrome represents a complex interaction between cardiovascular (CV) disease, chronic kidney disease (CKD), and metabolic risk factors. Non-steroidal mineralocorticoid receptor antagonists (ns-MRAs) are an emerging therapy showing promise in improving CKM syndrome outcomes. A recent large randomized trial, the FINEARTS-HF study, demonstrated a 16% reduction in the composite endpoint of worsening heart failure (HF) and CV death in patients with mildly reduced and preserved ejection fraction after a median 32-month follow-up. Additionally, two pivotal randomized studies demonstrated the efficacy of finerenone in CKD with diabetes patients. The FIDELIO-DKD trial showed a reduction in the renal composite outcome, including kidney failure and related death, over 2.6 years. Similarly, the FIGARO-DKD trial demonstrated a reduction in composite CV outcomes, including CV death, myocardial infarction, stroke, or HF hospitalization, after a median follow-up of 3.4 years. Evidence from in vitro and in vivo studies suggests that finerenone attenuates cardiac and kidney injury by reducing fibrosis, apoptotic cell death, oxidative stress, and endothelial dysfunction. Despite these advances, further research is necessary to evaluate the efficacy of ns-MRAs in specific CKM subpopulations, including HF with reduced ejection fraction and CKD without diabetes, to expand their indications and improve outcomes for CKM syndrome patients.
Future Cardiol
· 2025 Aug · PMID 40614137
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BACKGROUND: Cardiovascular diseases (CVDs) remain the leading cause of mortality globally, with mitochondrial dysfunction playing a key role in their pathogenesis. SIRT3 (Sirtuin 3), a mitochondrial deacetylase, has emer...BACKGROUND: Cardiovascular diseases (CVDs) remain the leading cause of mortality globally, with mitochondrial dysfunction playing a key role in their pathogenesis. SIRT3 (Sirtuin 3), a mitochondrial deacetylase, has emerged as a critical regulator of mitochondrial function and oxidative stress, with evidence linking its reduction to the progression of CVDs. This meta-analysis aimed to evaluate the association between SIRT3 levels and CVDs in order to elucidate its role in CVD pathogenesis and its potential as a biomarker. METHODS: A systematic search of MEDLINE and Embase databases was conducted up to August 2024, adhering to PRISMA guidelines. Observational studies evaluating SIRT3 levels in human patients with CVDs as compared to healthy controls were included. RESULTS: 8 studies comprising 397 participants were included in this meta-analysis. Overall, SIRT3 levels were found to be significantly lower in individuals with CVDs compared to healthy controls (SMD: 1.08, 95% CI: 0.495-1.662, = 0.0032). The reduction in SIRT3 levels was most pronounced in hypertension (SMD: 1.82) and dilated cardiomyopathy (SMD: 1.08). CONCLUSION: This meta-analysis provides compelling evidence of gsignificantly reduced SIRT3 levels in CVD patients, highlighting its critical role in cardiovascular diseases. These findings underscore the potential of SIRT3 as a biomarker and therapeutic target in CVDs.
Future Cardiol
· 2025 Aug · PMID 40611429
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Heart Failure is a prevalent disease with significant impacts on morbidity and mortality. Heart failure patients have a large volume of healthcare data which is digitized and can be collated. Artificial intelligence (AI)...Heart Failure is a prevalent disease with significant impacts on morbidity and mortality. Heart failure patients have a large volume of healthcare data which is digitized and can be collated. Artificial intelligence (AI) can then be used to assess the data for underlying patterns. AI systems can be trained to analyze readily available data, such as ECGs and heart sounds, and assess likelihood of heart failure. AI can also risk stratify heart failure patients by analyzing available healthcare data. AI can allow rapid assignment of heart failure patients to specific groups via automated echo analysis, but can also provide information regarding novel imaging bio-markers that may be more useful than left ventricular ejection fraction, such as first phase ejection fraction. AI can be used to assess patients' suitability for existing drugs, whilst also enabling development of novel drugs for known or newly discovered drug targets. Heart Failure as a field, with its multi-modal data set and variability in outcomes, will greatly benefit from the expansion and improvement of AI technology over the next 20 years.
Naqvi SM, Naqvi SY, Hashim HT
… +4 more, Shabu A, Akbar K, Nief AH, Tawfick W
Future Cardiol
· 2025 Jul · PMID 40555981
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BACKGROUND: Peripheral arterial disease (PAD) is a condition whereby the peripheral arteries of the body, and particularly the lower limbs, experience atherosclerosis resulting in narrowing of the peripheral arteries. Th...BACKGROUND: Peripheral arterial disease (PAD) is a condition whereby the peripheral arteries of the body, and particularly the lower limbs, experience atherosclerosis resulting in narrowing of the peripheral arteries. This largely preventable condition is a major cause of cardiovascular morbidity and mortality, affecting over 230 million people worldwide. METHODOLOGY: We conducted a systematic search for randomized control trials on four databases: Medline, CINAHL, PubMed, and Embase. We compared the outcomes of anticoagulation therapy with standard care following PRISMA standards. RESULTS: 10,051 studies were identified, and through titles and abstract screening followed by full text screening, five studies involving 14,463 individuals were included. One study compared rivaroxaban with dose adjusted warfarin. Two studies compared a combination of rivaroxaban and low dose aspirin with antiplatelet therapy. These three demonstrated a reduction in major adverse cardiovascular events (MACE) and Major adverse limb events (MALE) when combined with Aspirin. However, they noted increased bleeding risk. CONCLUSION: Newer-generation direct oral anticoagulants in combination with antiplatelet therapy, may improve cardiovascular outcomes and reduce limb-related complications in patients with PAD. Further randomized controlled trials (RCTs) are needed to determine optimal dosing before guideline implementation.