Future Cardiol
· 2025 Jul · PMID 40552429
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Xenotransplantation is a promising advancement in the field of transplantation that could eliminate deaths on the waitlist and provide an unlimited supply of on-demand organs for those in need of this life-saving therapy...Xenotransplantation is a promising advancement in the field of transplantation that could eliminate deaths on the waitlist and provide an unlimited supply of on-demand organs for those in need of this life-saving therapy. The results of preclinical studies in orthotopic heart xenotransplantation have shown that non-human primate models can consistently survive 9 months post-transplant. However, early clinical results in orthotopic heart xenotransplantation have been subpar compared to traditional orthotopic heart transplantation as the longest surviving patient survived for 60 days with a complicated postoperative course. Partial heart xenotransplantation could serve as an earlier clinical use case of xenotransplantation products due to the many advantages of the neonate and infant population for xenotransplantation as well as the unique immunogenicity of heart valves which is significantly lower than that of whole hearts. The adoption of partial heart xenotransplantation would allow more children to realize the benefits of a valve that tolerates somatic growth without the need for serial reoperation.
Future Cardiol
· 2025 Jul · PMID 40530507
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Aficamten is a novel cardiac myosin inhibitor that has completed a Phase III trial for the treatment of obstructive hypertrophic cardiomyopathy (HCM). Aficamten was developed to optimize pharmacokinetic properties and cl...Aficamten is a novel cardiac myosin inhibitor that has completed a Phase III trial for the treatment of obstructive hypertrophic cardiomyopathy (HCM). Aficamten was developed to optimize pharmacokinetic properties and clinical tolerability relative to its predecessor, mavacamten. Mechanistically, aficamten decreases myocardial contractility by way of reducing cardiac myosin ATPase activity and the number of active actin-myosin cross bridges during the cardiac cycle. Clinically, aficamten improves cardiac hemodynamics and biomarker profiles while promoting favorable cardiac remodeling, augmenting exercise tolerance and improving overall health status. Observed systolic dysfunction was infrequent, mild, reversible, and not associated with serious adverse events. Collectively, the available data suggests that aficamten is a well-tolerated drug that shows strong clinical efficacy across a wide array of clinical parameters. In this review, we provide a comprehensive description of the pharmacology, clinical efficacy, and tolerability of aficamten.
Andreka J, Malik FT, Khandaker M
… +6 more, Uddin K, Kayum A, Maaroufi A, Prunea D, Ruzsa Z, Toth GG
Future Cardiol
· 2025 Jul · PMID 40476636
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BACKGROUND: Left main (LM) percutaneous coronary intervention (PCI) remains a major interventional challenge, with outcomes influenced by various patient- and procedure-related factors. OBJECTIVES: To analyze procedural...BACKGROUND: Left main (LM) percutaneous coronary intervention (PCI) remains a major interventional challenge, with outcomes influenced by various patient- and procedure-related factors. OBJECTIVES: To analyze procedural characteristics and outcomes of patients who underwent LM PCI over a 15-year period in a single center. METHODS: We retrospectively analyzed data from all consecutive patients who underwent LM PCI between 2006 and 2022. Procedural details, with a focus on stenting technique, were collected. Primary outcome was all-cause mortality at 1 year. RESULTS: In total 3494 patients were included. The majority (67%) presented with chronic coronary syndrome. Seventy-seven percent of all patients (n = 2690) underwent PCI by single stent (SS) strategy and 23% (n = 804) by double stent (DS) strategy. One-year mortality was significantly lower in SS cases compared to DS (3.5% vs. 5.1%, HR 0.64, 95% CI 0.43-0.96). Intravascular imaging was used in 17% of the cases but showed no significant difference in one-year mortality compared to angio-guided PCI (4.8% vs. 3.7%; HR 1.11, 95% CI 0.71-1.73). CONCLUSIONS: In real-world LM PCI practice, patients for whom a provisional single-stent strategy was feasible had better outcomes than those requiring a double-stent approach.
Future Cardiol
· 2025 Jul · PMID 40459962
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INTRODUCTION: High-sensitivity C-reactive protein (hsCRP) is a biomarker of systemic inflammation (SI) and its elevated level is considered a risk-enhancing factor for cardiovascular disease in primary prevention. This s...INTRODUCTION: High-sensitivity C-reactive protein (hsCRP) is a biomarker of systemic inflammation (SI) and its elevated level is considered a risk-enhancing factor for cardiovascular disease in primary prevention. This study aimed to understand opinions of US clinicians using hsCRP testing in the management of patients with atherosclerotic cardiovascular disease (ASCVD) with or without chronic kidney disease (CKD). MATERIALS & METHODS: Clinicians who ordered hsCRP testing with evaluation of patient-level data were surveyed, between June 2023-August 2023. Endpoints included self-identified drivers and barriers to hsCRP testing and assessment of posttest actions following SI recognition. RESULTS: Common factors perceived to prevent hsCRP testing were a lack of evidence showing improvements in patient cardiovascular outcomes after addressing SI in ASCVD and CKD (50%), and lack of proven efficacy of hsCRP testing (33%). Barriers to hsCRP testing included cost, insurance coverage and patient refusal. The most common reason for not considering SI in clinical decision-making was that it would not affect management of ASCVD. After the first hsCRP testing, an average reduction of hsCRP level is observed, but not lower than 2 mg/L. CONCLUSIONS: In this limited study sample, perceived limitations of hsCRP testing included insufficient evidence of improved cardiovascular outcomes in patients with ASCVD.
Future Cardiol
· 2025 Jul · PMID 40458885
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Recent trials underscore the cardiovascular (CV), renal, and metabolic benefits of semaglutide in individuals with and without type 2 diabetes (T2D). In T2D, semaglutide enhances glycemic control, reduces major adverse C...Recent trials underscore the cardiovascular (CV), renal, and metabolic benefits of semaglutide in individuals with and without type 2 diabetes (T2D). In T2D, semaglutide enhances glycemic control, reduces major adverse CV events (MACE), and slows chronic kidney disease (CKD) progression. The SUSTAIN-6 trial demonstrated a 26% MACE reduction (HR 0.74; 95% CI: 0.58-0.95; = 0.02) in high CV-risk patients with T2D using semaglutide (0.5 or 1.0 mg weekly). Similarly, the FLOW trial showed a 24% reduction in major kidney disease events (HR 0.76; 95% CI: 0.66-0.88; = 0.002) with weekly 1.0 mg semaglutide in individuals with T2D with CKD. Beyond T2D, the SELECT trial highlighted semaglutide's efficacy in reducing MACE by 20% (HR 0.80; 95% CI: 0.72-0.90; < 0.001) and slowing kidney function loss in overweight or obese individuals with preexisting CV disease using 2.4 mg weekly. Additionally, semaglutide alleviates heart failure symptoms and reduces hospitalizations in obese individuals regardless of T2D status. These findings underscore semaglutide's role in improving kidney, CV, and survival outcomes among high-risk patients. This review highlights the cardio-kidney-metabolic benefits of semaglutide in individuals with and without T2D to inform cardiologists about its potential to enhance patient care.
Future Cardiol
· 2025 Jun · PMID 40458840
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Hypertrophic cardiomyopathy is a heterogenous genetic condition caused by myocyte disarray with varying degrees of interstitial fibrosis. Traditional management strategies focused on symptom mitigation and sudden cardiac...Hypertrophic cardiomyopathy is a heterogenous genetic condition caused by myocyte disarray with varying degrees of interstitial fibrosis. Traditional management strategies focused on symptom mitigation and sudden cardiac death prevention among high-risk patients. The only disease-modifying treatments have historically been septal reduction therapy or heart transplantation. However, cardiac myosin inhibitors have emerged as promising novel pharmacotherapies. Emerging evidence indicates that cardiac myosin inhibitors as well as surgical myectomy result in not only symptomatic benefit and reduction in left ventricular outflow tract obstruction, but also positive cardiac remodeling including reduction in left ventricular mass and maximum wall thickness, improved left ventricular diastolic parameters, reduced left atrial volumes, and improved left atrial strain. The long-term durability and clinical significance of these findings require further study. In this article, we will review the existing evidence of favorable reverse remodeling conferred by cardiac myosin inhibitors and surgical myectomy.
Future Cardiol
· 2025 Jun · PMID 40444722
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Coronary kinking represents an underrecognized diagnosis which typically arises as a complication of invasive cardiovascular procedures but may also be non-iatrogenic and nonatheromatous. Determining the etiology of coro...Coronary kinking represents an underrecognized diagnosis which typically arises as a complication of invasive cardiovascular procedures but may also be non-iatrogenic and nonatheromatous. Determining the etiology of coronary kinking poses a diagnostic dilemma with limited guidance in the medical literature. A stenotic lesion on invasive coronary angiography (ICA) may be attributable to intrinsic causes, such as atherosclerosis, fibromuscular dysplasia, coronary vasospasm, spontaneous coronary artery dissection, coronary kinks, and severe tortuosity, or extrinsic causes such as myocardial bridging. Lesions that appear angiographically atypical can be further elucidated with intracoronary imaging using intravascular ultrasound (IVUS) or optical coherence tomography (OCT), which help distinguish coronary kinks from other mimicking etiologies. Coronary kinks have the potential to cause ischemia, arrhythmia, and other structural complications, underscoring the importance of early and accurate detection. In this review, we summarize and appraise published data on coronary kinks. We also share a diagnostic schema on how to investigate coronary kinks with noninvasive and invasive techniques.
Ahmed A, Sohail MU, Saad M
… +9 more, Naveed Z, Arshad MS, Jawed A, Musheer A, Paracha AA, Siddiqi AK, Paryani NS, Shahid I, Memon MM
Future Cardiol
· 2025 Jun · PMID 40418165
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BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is responsible for high morbidity and mortality rates globally. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) remains the cornerstone...BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is responsible for high morbidity and mortality rates globally. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) remains the cornerstone treatment for patients with STEMI, the use of angiotensin-receptor neprilysin inhibitors (ARNIs) may offer better outcomes than ACEIs. This meta-analysis compares the efficacy and safety of ARNIs versus ACEIs in patients with STEMI. METHODS: Randomized controlled trials (RCTs) were pooled from PubMed and Cochrane databases. A random-effects model calculated risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). RESULTS: Five trials ( = 4,915) were included. ARNIs significantly reduced major adverse cardiovascular events (MACE) (RR: 0.66, 95% CI [0.50, 0.86]; = 0.002) and hospitalizations for heart failure (HHF) (RR: 0.67, 95% CI [0.49, 0.92]; = 0.01). ARNIs also improved left ventricular ejection fraction (LVEF) (WMD: 2.60, 95% CI[1.53, 3.68]; < 0.00001) and lowered NT-proBNP levels (WMD: -268.89, 95% CI[-422.35, -115.42]; = 0.0006). No significant differences were observed in recurrent myocardial infarction, cardiovascular death, or safety outcomes - except for hypotension, which was significantly more common with ARNI use. CONCLUSIONS: ARNI therapy reduces MACE, HHF, and NT-proBNP levels and improves LVEF in patients with STEMI without increasing safety risks, except for hypotension. Further RCTs are needed to confirm these findings.
Future Cardiol
· 2025 Jun · PMID 40417940
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Transcatheter aortic valve replacement (TAVR) represents a minimally invasive alternative for the treatment of severe symptomatic aortic stenosis and is increasingly adopted in younger and lower-risk patients. A support...Transcatheter aortic valve replacement (TAVR) represents a minimally invasive alternative for the treatment of severe symptomatic aortic stenosis and is increasingly adopted in younger and lower-risk patients. A support guidewire placed in the left ventricle is required in all TAVR procedures, and rapid ventricular pacing is frequently used to ensure valve implant stability. Also, recent studies showed a correlation between post-TAVR hemodynamic gradients and clinical outcomes, underscoring the importance of accurate invasive measurements. The SavvyWire™ (Opsens Medical) is a novel support guidewire designed for TAVR procedures that integrates left ventricular pacing and invasive pressure measurement capabilities, enabling continuous hemodynamic monitoring and simplifying the procedure. This review outlines the SavvyWire's™ design features and summarizes clinical evidence supporting its use in TAVR procedures.
Hashim HT, Osama M, Khan MH
… +9 more, Khan S, Rehman N, Ghuraibawi M, Ali MA, Ur Rehman W, Raja HAA, Khan Z, Hassan MB, Madhi ZSA
Future Cardiol
· 2025 Jun · PMID 40402862
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BACKGROUND: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic heart disease leading to obstructive hypertrophy. Radiofrequency ablation (RFA) is a minimally invasive alternative to traditional treatments. This...BACKGROUND: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic heart disease leading to obstructive hypertrophy. Radiofrequency ablation (RFA) is a minimally invasive alternative to traditional treatments. This review evaluates RFA's effectiveness and safety for HOCM. METHODS: A systematic review and meta-analysis were performed on studies from PubMed, Cochrane, and clinicaltrials.gov up to August 2024. Studies comparing RFA outcomes before and after the procedure were included. Data were analyzed through Revman software, using random-effects models. The funnel plots and Egger test were used for publication bias. Subgroup analysis and sensitivity analysis were also performed. RESULTS: This meta-analysis included 16 cohort studies and 2 case series, encompassing 727 patients with ages ranging from 10.4 to 62 years. The studies were conducted in various countries, including China, the USA, Germany, the UK, India, and Brazil. The analysis revealed significant improvements following radiofrequency ablation (RFA): the LVOT gradient at rest was reduced by MD -58.2 (CI: -71.2 to -56.93, < 0.00001), and the provoked gradient decreased by MD -81.05 (CI: -97.67 to -64.42, < 0.00001). CONCLUSION: RFA effectively reduces both LVOT gradients at rest and provoked, improves NYHA functional class, and decreases septal size in HOCM patients.
Gargaro A, Biancalana G, Botto GL
… +1 more, Brignole M
Future Cardiol
· 2025 Jun · PMID 40388576
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Sinus bradycardia, sinoatrial block, sinus arrest, and bradycardia-tachycardia syndrome are manifestations of intermittent or persistent sinus node dysfunctions (SNDs). SND is classified as intrinsic, when related to an...Sinus bradycardia, sinoatrial block, sinus arrest, and bradycardia-tachycardia syndrome are manifestations of intermittent or persistent sinus node dysfunctions (SNDs). SND is classified as intrinsic, when related to an anatomic disease of sinoatrial cells, or extrinsic, when bradycardia is caused by inappropriate vagal outflow. Chronotropic incompetence is often associated with SND, especially in elderly patients. When symptoms are related to SND, pacemaker implantation is the recommended therapy, and rate-adaptive pacing modes are often preferred in cases of chronotropic incompetence. Closed-Loop Stimulation (CLS) is a rate-adaptive system based on continuous evaluation of contractility and contraction speed through the analysis of right-ventricular unipolar impedance trends during the systole of each cardiac cycle. An increase in contractility or contraction speed modifies the impedance trends, to which the CLS algorithm responds by adapting the pacing rate, and thereby heart rate and cardiac output. Therefore, CLS is integrated into the autonomic mechanisms of cardiac output regulation. This feature has drawn interest in the use of CLS in several forms of SND, from the treatment of intrinsic bradycardias to the prevention of vasovagal syncope and device-detected atrial fibrillation. We will examine the working principle of CLS and review the results of recent clinical investigations.
Abdi S, Nazeri I, Mandegar MH
… +6 more, Geraiely B, Soleimani H, Mahalleh M, Agahi S, Abdi A, Larti F
Future Cardiol
· 2025 Jun · PMID 40388257
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The 2021 ESC/EACTS guidelines recommend percutaneous approaches for failing bioprostheses. These methods are less invasive, resulting in shorter recovery times and fewer complications. Valve-in-valve (ViV) procedures off...The 2021 ESC/EACTS guidelines recommend percutaneous approaches for failing bioprostheses. These methods are less invasive, resulting in shorter recovery times and fewer complications. Valve-in-valve (ViV) procedures offer a promising solution, although simultaneous transcatheter replacement of two valves (double ViV) still needs to be standard and primarily documented through case reports. This case series presents the initial outcomes of two patients who underwent simultaneous double transcatheter heart valve implantation, exploring the feasibility of this approach in the elderly. As the demand for bioprosthetic valves grows, innovative strategies like double ViV may provide valuable solutions to address valve degeneration and enhance patient outcomes.
Dhopeshwarkar N, Dharmani C, Fofah O
… +4 more, Tu N, Khan N, Kou TD, Chan KA
Future Cardiol
· 2025 Jun · PMID 40383962
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AIM: Validating an operational algorithm for identifying ventricular arrhythmia and sudden cardiac arrest (VA/SCA) in electronic health record (EHR) data may be useful to minimize measurement bias in studies characterizi...AIM: Validating an operational algorithm for identifying ventricular arrhythmia and sudden cardiac arrest (VA/SCA) in electronic health record (EHR) data may be useful to minimize measurement bias in studies characterizing real-world VA/SCA risk; however, validation studies require an appropriate reference standard. We aimed to assess if adequate information is documented in unstructured clinical notes of a large EHR database to serve as a reference standard for future validation studies of VA/SCA. METHODS: Twenty potential VA/SCA events were randomly selected from unstructured clinical notes of a large EHR database, TriNetX Dataworks - USA. These notes were reviewed to assess if key clinical elements were documented to confirm the occurrence of VA/SCA and describe their clinical features. These included explicit documentation of an acute event, electrocardiogram (ECG) findings, urgent medical interventions, and other elements. RESULTS: Explicit documentation of an acute event was recorded for 17 patients (85.0%) and ECG findings were documented for 15 patients (75.0%). Generally, unstructured clinical notes also contained information about signs and symptoms, care setting, medical interventions administered, and event resolution. CONCLUSIONS: The unstructured clinical notes of a large EHR database contained the information necessary to serve as a reference standard for validation studies of a VA/SCA operational algorithm in EHR data.