Current Opinion In Cardiology[JOURNAL]
Sun
200 papers
Climate change and cardiovascular risk.
Ang SP, Chia JE
Curr Opin Cardiol · 2025 Jul · PMID 39998494 · Publisher ↗
PURPOSE OF REVIEW: This review explores the complex relationship between climate change and cardiovascular health. It examines the mechanisms through which climate change impacts cardiovascular risk, highlights recent fi...
PURPOSE OF REVIEW: This review explores the complex relationship between climate change and cardiovascular health. It examines the mechanisms through which climate change impacts cardiovascular risk, highlights recent findings on regional trends, and discusses mitigation strategies. RECENT FINDINGS: Climate change significantly contributes to cardiovascular morbidity and mortality through mechanisms such as temperature extremes, air pollution, and food insecurity. Heatwaves increase risks of dehydration, electrolyte imbalance, and acute cardiovascular events, while cold spells exacerbate myocardial stress and pollution-related cardiovascular risks. Air pollution, including fine particulate matter (PM2.5), induces systemic inflammation, endothelial dysfunction, and atherosclerosis. Emerging data highlight regional variations, with urbanization exacerbating risks in Asia-Pacific and Middle Eastern populations, while extreme heat and cold challenge resilience in Europe and Latin America. Studies also link socioeconomic stress from climate-induced displacement and resource shortages to chronic cardiovascular conditions. Notably, urban greening and air quality regulations demonstrate potential for reducing cardiovascular risks. SUMMARY: Climate change amplifies cardiovascular risks through diverse mechanisms, disproportionately affecting vulnerable populations. Targeted strategies, including public health campaigns, sustainable urban planning, and technological innovations, can mitigate these risks. Advances in generative artificial intelligence and big data analytics offer opportunities to tailor interventions and enhance predictive modeling. A multidisciplinary approach integrating public health, environmental science, and clinical expertise is critical to addressing these challenges. Urgent action is required to mitigate the long-term cardiovascular impacts of climate change and foster resilient health systems globally.
Near infrared spectroscopy in the pediatric cardiac intensive care unit: accurately interpreting the data.
Iliopoulos I, Flores S, Loomba R
Curr Opin Cardiol · 2025 Jul · PMID 39998488 · Publisher ↗
PURPOSE OF REVIEW: Near infrared spectroscopy (NIRS) has been increasingly adopted as standard monitoring in postoperative care of pediatric cardiac patients. Several reports have established its association with both ma...
PURPOSE OF REVIEW: Near infrared spectroscopy (NIRS) has been increasingly adopted as standard monitoring in postoperative care of pediatric cardiac patients. Several reports have established its association with both markers of perfusion and adverse outcomes. The correlation with markers of perfusion is not strong and exhibits wide limit of agreement, making the determination of critical thresholds and its integration in treatment algorithms challenging. RECENT FINDINGS: A growing body of literature support the use of NIRS for hemodynamic monitoring in pediatric cardiac patients. Recent reports corroborate prior findings of weak to moderate correlation of NIRS with markers of global and regional perfusion and confirm its association with adverse outcomes. The challenge of lack of treatment thresholds remains, limiting clinical utility. Evidence of improvement of outcomes with the use of NIRS remains limited. SUMMARY: NIRS is a useful monitor of regional and global perfusion and can inform management decisions but cannot be used as the sole decision-making tool. Large, randomized studies are needed to define its use as decision making tool and facilitate its integration in treatment algorithms.
Mitigating heart failure risk in patients with diabetes and chronic kidney disease.
Kowalczyk NS, Prochaska M
Curr Opin Cardiol · 2025 May · PMID 39998480 · Publisher ↗
PURPOSE OF REVIEW: Patients with chronic kidney disease and diabetes are at high risk of cardiovascular disease, including heart failure. Risk mitigation requires a comprehensive approach with lifestyle modifications, bl...
PURPOSE OF REVIEW: Patients with chronic kidney disease and diabetes are at high risk of cardiovascular disease, including heart failure. Risk mitigation requires a comprehensive approach with lifestyle modifications, blood pressure management, renin-angiotensin blockade, and sodium-glucose cotransporter 2 inhibitors. Recent trials have shown that nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) should also be components of this approach. This review will discuss the comprehensive approach to mitigating risk in these high-risk patients and highlight the recent trials of ns-MRAs and GLP-1 RA. RECENT FINDINGS: In recent years, large, randomized controlled trials of ns-MRA and GLP-1 RA have shown benefit in kidney and cardiovascular outcomes for patients with chronic kidney disease and diabetes. SUMMARY: The substantial benefits and overall favorable safety profiles for ns-MRA and GLP-1 RA in patients with chronic kidney disease and diabetes demonstrate that these medications should be considered as a part of a comprehensive approach to cardiovascular risk reduction in this high-risk population. Future studies should consider different combination therapies and guide how and when to initiate these therapies.
RNA therapeutics in cardiovascular medicine.
Damase TR, Cooke JP
Curr Opin Cardiol · 2025 May · PMID 39998478 · Full text
PURPOSE OF REVIEW: RNA therapeutics came to global attention when mRNA-based vaccines provided an answer to the SARS-CoV-2 pandemic. The immense significance of this development notwithstanding, it is important to note t...
PURPOSE OF REVIEW: RNA therapeutics came to global attention when mRNA-based vaccines provided an answer to the SARS-CoV-2 pandemic. The immense significance of this development notwithstanding, it is important to note that almost a decade prior to the pandemic, RNA drugs had made important inroads toward the amelioration of disease. The first class of RNA therapies to be introduced into clinical use were the antisense oligomers and siRNA drugs which generally induce a therapeutic effect by acting to brake or to modulate mRNA expression. RNA therapeutics is quickly becoming the fourth pillar of pharmacotherapy, and will have broad applications, including for the treatment of cardiovascular disease. RECENT FINDINGS: The United States (US) Food and Drug Administration (FDA) has approved several antisense oligomers (ASOs) and siRNA-based drugs to treat disorders associated with cardiovascular disease. In addition, multiple RNA-based drugs are in clinical trials to assess their safety and efficacy in patients with cardiovascular disorders, such as Zodasiran, a siRNA therapy that targets angiopoietin-like protein 3 (ANGPTL3) to reduce LDL cholesterol. SUMMARY: Because of limitless sequence choice; speed of design; and relative ease of synthesis, RNA drugs will be rapidly developed, will have broad applications, and will be generated at lower cost than other drug types. This review aims to highlight RNA therapies for cardiovascular diseases that are approved, and those that are under clinical evaluation.
Advances in device-based therapies for cardiorenal syndrome.
Esposito ML, Moore R
Curr Opin Cardiol · 2025 May · PMID 39998466 · Publisher ↗
PURPOSE OF REVIEW: Diuretic resistance presents a harrowing obstacle in patients with decompensated heart failure and cardiac-driven cardiorenal syndrome. This conundrum not only presents clinical decision-making challen...
PURPOSE OF REVIEW: Diuretic resistance presents a harrowing obstacle in patients with decompensated heart failure and cardiac-driven cardiorenal syndrome. This conundrum not only presents clinical decision-making challenges but also portends worse outcomes for these patients. The development of device-based therapies to provide support in these cases is an attractive alternative therapeutic option. This review will describe the growing evidence supporting developments in device-based therapies for cardiorenal syndrome in patients with heart failure. RECENT FINDINGS: We describe multiple emerging technologies in this space, each classified according to its mechanism of action. 'Pushers' are devices that increase blood flow and perfusion pressure to the renal arteries. 'Pullers' reduce renal afterload by decreasing pressure in the renal veins, and 'fluid shifters' decongest the interstitium through the lymphatic system. SUMMARY: While early results from small clinical studies piloting these devices are promising, randomized controlled trials are needed to fully evaluate their utility in patients with heart failure. In the future, these devices may work synergistically with pharmacologic therapy to reduce average inpatient length of stay, hospitalization rates, and potentially improve mortality.
Advances in the management of obesity and heart failure: latest evidence from clinical trials.
Costa TA, Harrington JL
Curr Opin Cardiol · 2025 May · PMID 39998461 · Publisher ↗
PURPOSE OF REVIEW: Obesity is an important risk factor for heart failure with preserved ejection fraction (HFpEF). In patients who already have HFpEF, obesity contributes to high symptom burden and increased risk for hea...
PURPOSE OF REVIEW: Obesity is an important risk factor for heart failure with preserved ejection fraction (HFpEF). In patients who already have HFpEF, obesity contributes to high symptom burden and increased risk for heart failure (HF) hospitalization. This review examines the latest clinical trials assessing the efficacy of pharmacological interventions in the treatment of obesity-related HFpEF. RECENT FINDINGS: Recent results from randomized clinical trials (RCTs) suggest that incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) (e.g., semaglutide) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs (e.g., tirzepatide), can improve quality of life, exercise tolerance, and markers of HF severity while promoting weight loss in patients with obesity and HFpEF. Some evidence also suggests that these therapies may reduce risk for HF hospitalizations. Additionally, exploratory analyses of the nonsteroidal mineralocorticoid receptor antagonist finerenone has been associated with reduced cardiovascular mortality and total worsening HF events across all body mass index (BMI) levels, with greater benefits observed in patients with higher BMIs. SUMMARY: Antiobesity medications such as semaglutide and tirzepatide may represent important treatment options for patients with obesity-related HFpEF. Additional evidence suggests that certain other HF medications may have increased efficacy in patients with obesity.
Cardiac sarcoidosis; update for the heart failure specialist.
Birnie DH
Curr Opin Cardiol · 2025 Mar · PMID 39882981 · Publisher ↗
PURPOSE OF REVIEW: This review presents contemporary data on epidemiology, common presentations, investigations and diagnostic algorithms, treatment and prognosis. It particularly focuses on topics of most relevance to h...
PURPOSE OF REVIEW: This review presents contemporary data on epidemiology, common presentations, investigations and diagnostic algorithms, treatment and prognosis. It particularly focuses on topics of most relevance to heart failure specialists, including what left ventricle (LV) function changes can be expected after treatment and outcomes to all standard and advanced heart failure therapies. RECENT FINDINGS: Around 5% of sarcoidosis patients have clinically manifest cardiac sarcoidosis (CS), presenting with significant arrhythmias (such as conduction disturbances and ventricular arrhythmias) or newly developed unexplained heart failure. These cardiac symptoms (including sudden cardiac death) may be the initial manifestations of CS. While cardiac magnetic resonance imaging (CMR) is the preferred method for identifying fibrosis in the myocardium, FDG-positron emission tomography (FDG-PET) helps in identifying active inflammation within the myocardium and aids in managing immunosuppressive treatment. The concept of isolated CS is much debated. However very importantly, recent data have shown that some patients diagnosed with 'clinically and imaging isolated CS' are subsequently found to have genetic cardiomyopathy. The management of CS involves a comprehensive approach including medications for immunosuppression, all standard heart failure medication and, in high-risk patient's implantable cardioverter defibrillators (ICDs). In CS patients with terminal heart failure who do not respond to medical and surgical interventions, heart transplantation and ventricular assist devices should be considered. Long-term results after transplantation are generally favorable and comparable to non-CS patients. The degree of left ventricular dysfunction remains a crucial prognostic factor in CS cases. Outcomes for CS have very significantly improved, over the last two decades due to earlier diagnosis, advanced heart failure treatments, and the strategic use of ICD therapy. SUMMARY: Outcomes for CS have significantly improved, over the last two decades due to earlier diagnosis, advanced heart failure treatments, and the strategic use of ICD therapy.
Genetics, manifestations, and management of catecholaminergic polymorphic ventricular tachycardia.
Desai S, Moore OM, Wehrens XHT
Curr Opin Cardiol · 2025 May · PMID 39835466 · Full text
PURPOSE OF REVIEW: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a devastating heritable channelopathy that can lead to sudden cardiac death in children and young adults. This review aims to explore gen...
PURPOSE OF REVIEW: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a devastating heritable channelopathy that can lead to sudden cardiac death in children and young adults. This review aims to explore genetics, the cardiac and extracardiac manifestations of mutations associated with CPVT, and the challenges involved with managing phenotypically variable variants. RECENT FINDINGS: The understanding of the genetics and mechanisms of CPVT continues to grow with recent discoveries including alternative splicing of cardiac TRDN and calmodulin gene variants. Additionally, there is an increasing recognition of the extra-cardiac manifestations such as epilepsy, neurodevelopmental delay, and glucose homeostasis abnormalities in RyR2 variant carriers. Advances in precision medicine, including the development of iPSC-derived cardiomyocytes, are valuable models for developing targeted therapeutics. SUMMARY: CPVT remains a complex disorder with cardiac and neurological manifestations impacting management. Early genetic testing and personalized treatment, including beta-blockers, flecainide, and ICDs, is important in improving outcomes. Ongoing research into the mechanism of each mutation will help in developing more effective, personalized therapeutics.
New therapies to treat cardiac amyloidosis.
Nguyen O, Kamna D, Masri A
Curr Opin Cardiol · 2025 Mar · PMID 39819772 · Full text
PURPOSE OF REVIEW: Review advancements in therapies for transthyretin (ATTR-CM) and immunoglobulin light chain (AL-CM) cardiac amyloidosis. RECENT FINDINGS: In ATTR-CM, tafamidis remains the cornerstone therapy, with Foo...
PURPOSE OF REVIEW: Review advancements in therapies for transthyretin (ATTR-CM) and immunoglobulin light chain (AL-CM) cardiac amyloidosis. RECENT FINDINGS: In ATTR-CM, tafamidis remains the cornerstone therapy, with Food and Drug Administration (FDA) approval for over 5 years. Acoramidis, another transthyretin stabilizer, has very recently been FDA-approved following positive results in the ATTRibute-CM trial. Vutrisiran, a transthyretin gene silencer, demonstrated efficacy in the HELIOS-B trial and awaits FDA review. Eplontersen's CARDIO-TTRansform trial, the largest ATTR-CM study to date, is expected to report by late 2025. Innovative approaches such as NTLA-2001 (a CRISPR-Cas9 therapy) and fibril depleters like ALXN2220 and coramitug are advancing in clinical trials. In AL-CM, daratumumab, cyclophosphamide, bortezomib, and dexamethasone (Dara-CyBorD) has established itself as the standard of care. Novel antiplasma cell therapies include CAR-T cells and bispecific antibodies (teclistimab) and fibril depleters. Birtamimab improved survival in advanced AL-CM during the VITAL trial and is under investigation in AFFIRM-AL. Anselamimab is in phase III CARES trials, whereas AT-02 undergoes early-phase testing for ATTR-CM and AL-CM. SUMMARY: The therapeutic landscape for ATTR-CM and AL-CM is rapidly evolving, driven by novel therapies targeting diverse mechanisms. Ongoing clinical trials promise to further refine the standard of care and improve outcomes for patients with cardiac amyloidosis.
Treatment options to break the cycle of recurrent pericarditis.
Raisinghani AB, Luis SA
Curr Opin Cardiol · 2025 Mar · PMID 39819644 · Publisher ↗
PURPOSE OF REVIEW: This review provides a contemporary, evidence-based update on the pathophysiological mechanisms and rapidly evolving therapeutic options for recurrent pericarditis. RECENT FINDINGS: Recent studies have...
PURPOSE OF REVIEW: This review provides a contemporary, evidence-based update on the pathophysiological mechanisms and rapidly evolving therapeutic options for recurrent pericarditis. RECENT FINDINGS: Recent studies have elucidated the pathogenesis of recurrent pericarditis, identifying autoinflammation as a key mechanism and interleukin-1 (IL-1) as a central modulator of the inflammatory cascade. Multiple clinical trials have investigated novel therapeutic approaches, particularly focusing on IL-1 inhibition. The recent FDA approval of IL-1 pathway blockade for recurrent pericarditis has revolutionized treatment, offering patients significantly improved quality of life and symptom management. SUMMARY: The enhanced understanding of the autoinflammatory nature of recurrent pericarditis, coupled with groundbreaking advances in targeted therapies, has transformed the treatment landscape for affected patients. The emergence of IL-1 inhibitors as an effective therapeutic option promises substantial improvements in clinical outcomes and patient well being. Clinicians must familiarize themselves with these new treatments, their efficacy, and potential limitations to optimize patient care and guide therapeutic decision-making in this challenging condition.
Surgical and multimodal approaches to right-sided cardiac tumours.
Patel SK, Dhingra NK, Cusimano RJ
Curr Opin Cardiol · 2025 Mar · PMID 39786180 · Publisher ↗
PURPOSE OF REVIEW: Cardiac tumours present significant clinical challenges due to their wide differential, complex anatomical and physiological implications, as well as the potential for widespread invasion in the case o...
PURPOSE OF REVIEW: Cardiac tumours present significant clinical challenges due to their wide differential, complex anatomical and physiological implications, as well as the potential for widespread invasion in the case of malignancies. This review synthesizes recent findings surrounding the diagnosis and management of specifically right-sided cardiac tumours, with a particular focus on surgical resection and reconstructive techniques. RECENT FINDINGS: Management of cardiac tumours can be categorized into three key phases. First: early and accurate diagnosis is critical for improving outcomes, especially in malignancies. Advances in imaging modalities like MRI, CT, PET-CT, and biopsy techniques enhance diagnostic accuracy. Second: surgical resection is a cornerstone treatment for both benign and malignant right-sided cardiac tumours. Surgery is often curative for benign tumours, while for malignant tumours, R0 resection (complete microscopic removal) in appropriate candidates correlates with better survival. Third: managing cardiac malignancies necessitates a multidisciplinary approach, integrating additional therapies such as chemotherapy, radiation, and emerging immunotherapies tailored to patient and tumour characteristics. SUMMARY: Managing right-sided cardiac tumours demands interdisciplinary expertise. Standardized protocols are limited by the rarity of cases and insufficient high-quality data. International collaboration and sharing of experiences through prospective registries and clinical studies are essential to advancing knowledge and improving patient outcomes.
Robotic mitral valve surgery: evolving history, techniques, and training paths.
Hasan I, Amabile A, Tam DY
Curr Opin Cardiol · 2025 Mar · PMID 39785856 · Publisher ↗
PURPOSE OF REVIEW: Over the past 25 years, robotic-assisted mitral valve surgery has gained significant recognition because of its potential to minimize patient trauma and improve clinical outcomes. This field has evolve...
PURPOSE OF REVIEW: Over the past 25 years, robotic-assisted mitral valve surgery has gained significant recognition because of its potential to minimize patient trauma and improve clinical outcomes. This field has evolved from early efforts in minimally invasive mitral procedures to more refined and technically sophisticated approaches, driven by the need for smaller incisions and reduced recovery times. RECENT FINDINGS: This review will delve into the historical evolution of robotic-assisted mitral valve surgery, detailing the technical advancements that have shaped current practices and outlining the essential training pathways for a career as robotic mitral valve surgeon. SUMMARY: The development of robotic systems has marked a turning point, offering surgeons greater precision and dexterity, crucial adjuncts in complex mitral valve repairs.
When should the tricuspid valve be repaired during mitral valve repair?
An KR, Nwajei E, Chu MWA
Curr Opin Cardiol · 2025 Mar · PMID 39749816 · Publisher ↗
PURPOSE OF REVIEW: Management of tricuspid regurgitation and annular dilation during mitral valve repair remains controversial. We review the latest evidence on indications to repair the tricuspid valve during mitral val...
PURPOSE OF REVIEW: Management of tricuspid regurgitation and annular dilation during mitral valve repair remains controversial. We review the latest evidence on indications to repair the tricuspid valve during mitral valve repair and discuss surgical strategies and complications. RECENT FINDINGS: Concomitant tricuspid valve repair of moderate tricuspid regurgitation is effective in reducing tricuspid regurgitation progression at 2 years, but has not shown benefit to late survival, quality of life, or functional benefit, and is associated with increased permanent pacemaker implantation (PPM) rates, which is associated with reduced late survival. Progression of less than moderate tricuspid regurgitation with annular dilation alone is uncommon, obviating the need for concomitant repair. SUMMARY: Repairing concomitant moderate tricuspid regurgitation at the time of mitral repair reduces tricuspid regurgitation progression at 2 years, at the cost of a higher PPM implantation rate. However, repairing less than moderate tricuspid regurgitation for annular dilation alone has not been shown to reduce tricuspid regurgitation progression, bringing current guideline recommendations surrounding repair for annular dilation into question. Longer-term follow-up data, at 5 years, will shed further light on this topic.
Promoting gender diversity and ergonomic equity in the cardiac surgery operating room.
Altin E, Majeed H, Verma R … +2 more , Paterson E, Yanagawa B
Curr Opin Cardiol · 2025 Mar · PMID 39749812 · Publisher ↗
PURPOSE OF REVIEW: The operating room (OR) infrastructure and equipment such as gloves, were historically designed at a time when most surgeons were male. Today, there are increasing numbers of females in the OR and we s...
PURPOSE OF REVIEW: The operating room (OR) infrastructure and equipment such as gloves, were historically designed at a time when most surgeons were male. Today, there are increasing numbers of females in the OR and we should ensure that there is not a disproportionate risk of ergonomic stress and risk of work-related injuries. This review provides a perspective on the representation of female cardiac surgeons globally and examines the unique ergonomic challenges they may face. RECENT FINDINGS: Female cardiac surgeons represent approximately 17% of practitioners in our sample of cardiac surgery centers, underscoring significant underrepresentation. Female cardiac surgeons report higher incidences of work-related musculoskeletal injuries and ergonomic challenges compared to their male colleagues. This could negatively impact their physical health and performance. Studies further highlight the inadequacy of standardized surgical tools and workstations in accommodating sex-specific anthropometry, contributing to the disproportionate strain experienced by female surgeons. SUMMARY: To mitigate gender disparities in cardiac surgery, there is a need to optimize OR infrastructure and surgical instrumentation to accommodate sex-based anatomical differences. Implementing ergonomic solutions, such as adjustable workstations and gender-specific surgical tools, could reduce musculoskeletal injuries and improve overall surgeon performance. Addressing these disparities represents a critical step toward fostering an equitable and inclusive surgical workforce, enhancing both the health and career longevity of female cardiac surgeons.
Cardiovascular disease in South Asian immigrants facing adverse socioeconomic circumstances: challenges and opportunities for enhanced management.
Pappalettere CC, Llagostera M, Vime-Jubany J … +1 more , Cainzos-Achirica M
Curr Opin Cardiol · 2025 Jan · PMID 39633560 · Publisher ↗
PURPOSE OF REVIEW: To describe the challenges that health professionals often face when attempting to provide optimal primary and secondary prevention care of atherosclerotic cardiovascular disease (ASCVD) to South Asian...
PURPOSE OF REVIEW: To describe the challenges that health professionals often face when attempting to provide optimal primary and secondary prevention care of atherosclerotic cardiovascular disease (ASCVD) to South Asian immigrant patients who face adverse socioeconomic factors, such as many of the South Asian men and women who live in Catalonia, and to present a number of constructive approaches that can help minimize those barriers. RECENT FINDINGS: The challenges include limited health literacy, frequent language barriers, cultural factors that limit the relevance of standard lifestyle advice, financial barriers, limited access to preventive care, racism, and other barriers. Approaches that can help minimize them and enhance the quality of secondary cardiovascular preventive care in this group include empathy, using support from cultural mediators, enhanced proficiency using readily available translation programs, approaches that minimize financial barriers and simplify treatment regimes, and provision of more culturally competent lifestyle advice, among others. SUMMARY: We hope that the notions included in this review will help physicians and healthcare system managers around the world become more aware and culturally competent when treating South Asian patients with ASCVD. The ongoing Pul-Cat and other studies will illuminate the most effective steps moving forward.
Coronary artery injury in pulsed field ablation.
Higuchi S, Gerstenfeld EP
Curr Opin Cardiol · 2025 Jan · PMID 39633559 · Publisher ↗
PURPOSE OF REVIEW: Although pulsed field ablation (PFA) has emerged as an innovative nonthermal catheter ablation modality, recent reports raise concerns about its potential impact on nearby coronary arteries. This revie...
PURPOSE OF REVIEW: Although pulsed field ablation (PFA) has emerged as an innovative nonthermal catheter ablation modality, recent reports raise concerns about its potential impact on nearby coronary arteries. This review provides a comprehensive overview of the current understanding and future directions regarding the effects of PFA on or near coronary arteries. RECENT FINDINGS: Clinical studies have demonstrated the risks of acute transient vasospasm after delivery of PFA, especially with ablation of structures in proximity to the coronary arteries, such as the cavotricuspid and mitral isthmuses. The clinical incidence has been reported to be approximately 0.14%, according to the largest multicenter registry. Nitroglycerin pretreatment has been demonstrated to mitigate vasospastic events. However, early preclinical models indicate that chronic neointimal hyperplasia, tunica media fibrosis and mild coronary artery narrowing may occur, suggesting long-term coronary injury after delivering PFA near coronary arteries. SUMMARY: Despite reducing collateral tissue damage compared with thermal methods, PFA near coronary arteries may require careful procedural planning and proactive use of nitroglycerin to reduce coronary vasospasm. Further research is essential to elucidate the mechanisms underlying PFA-induced coronary spasm, optimize catheter design and placement, and assess the long-term coronary health implications.
Cardiac selectivity in pulsed field ablation.
Meng F, Jin S, Liu N
Curr Opin Cardiol · 2025 Jan · PMID 39611738 · Full text
PURPOSE OF REVIEW: This review examines the selective cardiac injury induced by pulsed electric fields during atrial fibrillation ablation. It consolidates findings from both preclinical and clinical studies on cardiac s...
PURPOSE OF REVIEW: This review examines the selective cardiac injury induced by pulsed electric fields during atrial fibrillation ablation. It consolidates findings from both preclinical and clinical studies on cardiac selectivity and explores the potential mechanisms behind this selectivity. RECENT FINDINGS: Preclinical studies indicate that pulsed electric fields cause significantly more myocardial injury compared with other tissues. Clinical studies have similarly shown that complication rates for pulsed field ablation are notably lower than those for radiofrequency and cryoballoon ablation. SUMMARY: Pulsed field ablation demonstrates a notable selectivity for myocardial injury, likely because of the unique functional and metabolic characteristics of cardiomyocytes. This review delves into the underlying principles of cardiac selectivity and proposes future directions for improving this selectivity. It is important to note that while pulsed field ablation shows promise, its cardiac selectivity is not absolute, as some complications still occur, necessitating further research.
Current trends and challenges in infective endocarditis.
Patel SK, Hassan SMA, Côté M … +2 more , Leis B, Yanagawa B
Curr Opin Cardiol · 2025 Mar · PMID 39513568 · Publisher ↗
PURPOSE OF REVIEW: Infective endocarditis (IE) is a complex disease with increasing global incidence. This review explores recent trends in IE infection patterns, including healthcare-associated IE (HAIE), drug-use-assoc...
PURPOSE OF REVIEW: Infective endocarditis (IE) is a complex disease with increasing global incidence. This review explores recent trends in IE infection patterns, including healthcare-associated IE (HAIE), drug-use-associated IE (DUA-IE), multidrug-resistant organisms (MDROs), and challenges in managing prosthetic valve and device-related infections. RECENT FINDINGS: Staphylococcus aureus has emerged as the leading cause of IE, especially in HAIE and DUA-IE cases. Increasingly prevalent MDROs, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, pose further clinical challenges. Advances in molecular diagnostics have improved the detection of culture-negative endocarditis. The introduction of the AngioVAC percutaneous aspiration device promises to change the management of right and possibly some left sided IE. Multidisciplinary team management and early surgery have demonstrated improved outcomes including partnerships with psychiatry and addictions services for those with intravenous DUA-IE. SUMMARY: IE presents significant diagnostic and therapeutic challenges due to evolving infection patterns, MDROs, and HAIE. Early diagnosis using advanced imaging, appropriate early antimicrobial therapy, and multidisciplinary care, including timely surgery, are critical for optimizing patient outcomes.
Beyond the Agatston calcium score: role of calcium density and other calcified plaque markers for cardiovascular disease prediction.
Razavi AC, Whelton SP, Blumenthal RS … +2 more , Blaha MJ, Dzaye O
Curr Opin Cardiol · 2025 Jan · PMID 39445716 · Full text
PURPOSE OF REVIEW: To review the current evidence and highlight future strategies regarding consideration of coronary artery calcium (CAC) density in cardiovascular disease (CVD) risk stratification. RECENT FINDINGS: Exp...
PURPOSE OF REVIEW: To review the current evidence and highlight future strategies regarding consideration of coronary artery calcium (CAC) density in cardiovascular disease (CVD) risk stratification. RECENT FINDINGS: Expressed as the product of plaque area and a peak calcium density weighting factor, the Agatston method is the gold-standard for measuring CAC on noncontrast cardiac computed tomography. Over the last decade, observational data have suggested that calcium density is inversely associated with CVD events and confers additional prognostic information independent of traditional risk factors and Agatston CAC scores. Specific density measures have been assessed including peak calcium density, mean CAC density, and CAC area-density discordance. Beyond calcium density, the number of affected arteries and regional distribution of CAC which may be correlated with CAC density have also improved the predictive utility of the Agatston score. SUMMARY: Calcium density is inversely associated with CVD risk after considering plaque area and/or volume. Calcium markers including density, vessel involvement, and regional distribution confer additional prognostic information for the prediction of incident CVD among those with prevalent subclinical atherosclerosis. A future area of study includes calcium radiomics ('calcium-omics') and whether the artificial intelligence-derived automated measurement of calcium markers beyond the Agatston score may be of value in CVD risk stratification among individuals with early to advanced subclinical atherosclerosis.
Advancements in automated external and wearable cardiac defibrillators.
Aldaas OM, Birgersdotter-Green U
Curr Opin Cardiol · 2025 Jan · PMID 39445709 · Publisher ↗
PURPOSE OF REVIEW: Survival statistics for out-of-hospital cardiac arrests remain unsatisfactory. Prompt defibrillation of shockable rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia, is cru...
PURPOSE OF REVIEW: Survival statistics for out-of-hospital cardiac arrests remain unsatisfactory. Prompt defibrillation of shockable rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia, is crucial for improving survival. Automated external defibrillators (AEDs) and wearable cardiac defibrillators (WCDs) seek to improve the survival rates following out-of-hospital cardiac arrests. We aim to review the indications, utility, advancements, and limitations of AEDs and WCDs, as well as their role in contemporary and future clinical practice. RECENT FINDINGS: Recent advancements in these technologies, such as smartphone applications and drone delivery of AEDs and less inappropriate shocks and decreased size of WCDs, have increased their ubiquity and efficacy. However, implementation of this technology remains limited due to lack of resources and suboptimal patient adherence. SUMMARY: Out of hospital cardiac arrests continue to pose a significant public health challenge. Advancements in AEDs and WCDs aim to facilitate prompt defibrillation of shockable rhythms with the goal of improving survival rates. However, they remain underutilized due to limited resources and suboptimal patient adherence. As these technologies continue to evolve to become smaller, lighter and more affordable, their utilization and accessibility are expected to improve.
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