Reviews In Cardiovascular Medicine[JOURNAL]
Sun
200 papers
Bridging the Gap in AL and ATTR Cardiac Amyloidosis: Integrating Histopathology, Biomarkers, and Multimodal Imaging for Subtype-Specific Diagnosis.
Ali K, Awad MK, Majeed H … +5 more , Amer MS, Alayyat A, Ali AE, Ali A, Abuzaid AS
Rev Cardiovasc Med · 2026 Jan · PMID 41659097 · Full text
Cardiac amyloidosis (CA) represents an increasingly recognized but historically underdiagnosed cause of restrictive cardiomyopathy and heart failure. CA is now understood to be more prevalent, particularly in older adult...
Cardiac amyloidosis (CA) represents an increasingly recognized but historically underdiagnosed cause of restrictive cardiomyopathy and heart failure. CA is now understood to be more prevalent, particularly in older adults, as advancements in imaging and biomarker technologies have improved detection. The disease results from the misfolding of precursor proteins, primarily immunoglobulin light chains (in light chain (AL) amyloidosis) or transthyretin (in transthyretin (ATTR) amyloidosis), into insoluble fibrils that deposit in myocardial tissue. These deposits cause structural and functional cardiac impairment through both physical infiltration and cytotoxic mechanisms, leading to diastolic dysfunction, arrhythmias, and progressive heart failure. Understanding the molecular basis of amyloid formation and deposition has revealed subtype-specific mechanisms of toxicity and tissue tropism, highlighting the central role of protein instability, proteolytic cleavage, and oxidative stress in disease progression. Furthermore, increasing awareness of phenotypic variability and sex- or ethnicity-based diagnostic disparities has called for earlier recognition and differentiation of CA subtypes. Diagnostic precision is enhanced by a multimodal approach incorporating histopathology, biomarker staging, and advanced imaging techniques such as echocardiography, cardiac magnetic resonance, and nuclear scintigraphy. This review addresses our contemporary understanding of the molecular mechanisms, pathophysiologic cascade, and diagnostic evolution of AL and ATTR CA, emphasizing clinical progress. By delineating the biological mechanisms and tools for early identification, this paper aims to strengthen the framework for diagnosing and managing a disease that was once overlooked but is now at the forefront of modern cardiovascular medicine.
Composition and Influence of Fibrogenic Niche in Myocardial Fibrosis.
Wang X, Fan L, Yuan Q … +4 more , Luo Y, Cheng Z, Chen Y, Gong C
Rev Cardiovasc Med · 2026 Jan · PMID 41659096 · Full text
Myocardial fibrosis represents the initial stage of cardiac failure and is characterized by the accumulation of extracellular matrix proteins. The fibrogenic niche provides a unique microenvironment for myocardial fibros...
Myocardial fibrosis represents the initial stage of cardiac failure and is characterized by the accumulation of extracellular matrix proteins. The fibrogenic niche provides a unique microenvironment for myocardial fibrosis and consists primarily of extracellular matrix proteins, various types of cardiac resident cells, inflammatory cells, extracellular vesicles, and soluble factors. Meanwhile, the composition and contents of this microenvironment undergo dynamic changes during the repair of damaged tissues. Several studies have demonstrated that the fibrogenic niche plays a key role in the activation of fibroblasts, the development of inflammation, and the onset of microvascular dysfunction. Studying the fibrogenic niche has emerged as a new method to clarify the mechanisms involved in myocardial fibrosis, and can potentially facilitate the early diagnosis and individualized medical treatment for the disease.
Resistant Hypertension: Integration of Novel Agents and Interventional Approaches in Clinical Practice.
Arriola-Montenegro J, Chaponan-Lavalle A, Nombera-Aznaran N … +10 more , Abdalla M, Bizer B, Mohan A, Muñoz Verdugo IA, Zardoost P, Ordaya-Gonzales K, Villarreal Rizzo A, Rios-Garcia W, Yip LKY, Gonzalez Suarez ML
Rev Cardiovasc Med · 2026 Jan · PMID 41659095 · Full text
Resistant hypertension (RH) is a high-risk phenotype characterized by blood pressure readings ≥130/80 mmHg despite maximally tolerated therapy with three antihypertensive agents, including a diuretic, or controlled blood...
Resistant hypertension (RH) is a high-risk phenotype characterized by blood pressure readings ≥130/80 mmHg despite maximally tolerated therapy with three antihypertensive agents, including a diuretic, or controlled blood pressure requiring four or more medications. The diagnosis of RH requires a structured evaluation that confirms accurate blood pressure measurement, excludes pseudoresistance-particularly nonadherence and white coat hypertension-and identifies secondary causes such as obstructive sleep apnea, primary aldosteronism, renovascular disease, pheochromocytoma, and Cushing syndrome. RH arises from overlapping mechanisms, including activation of the renin-angiotensin-aldosterone system (RAAS), sympathetic overactivity, arterial stiffness, volume expansion, and immune-mediated pathways. Management begins with lifestyle modification and optimized triple therapy, followed by mineralocorticoid receptor antagonists as the preferred fourth-line treatment. Emerging pharmacological options, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, endothelin receptor antagonists, aldosterone synthase inhibitors, and angiotensin receptor and neprilysin inhibitors (ARNIs), offer additional therapeutic potential; meanwhile, device-based interventions, including renal denervation and baroreflex activation therapy, have shown sustained blood pressure reductions in selected patients. Future directions highlight precision medicine, digital health technologies, and artificial intelligence as methods to improve diagnosis, guide individualized therapy, and enhance long-term blood pressure control.
4D-Flow Cardiac Magnetic Resonance Imaging: An 8-Year Clinical Practice Review.
Urmeneta Ulloa J, Martínez de Vega V, Molina Borao I … +4 more , Álvarez Vázquez A, López Alcolea J, Recio Rodríguez M, Cabrera JÁ
Rev Cardiovasc Med · 2026 Jan · PMID 41659094 · Full text
Four-dimensional (4D) flow cardiac magnetic resonance (CMR) is an advanced imaging modality that enables comprehensive qualitative and quantitative assessment of blood flow in the three spatial dimensions plus time. This...
Four-dimensional (4D) flow cardiac magnetic resonance (CMR) is an advanced imaging modality that enables comprehensive qualitative and quantitative assessment of blood flow in the three spatial dimensions plus time. This technique is more accurate, reproducible, and easier to interpret visually than conventional two-dimensional phase-contrast techniques. In this narrative review, we synthesize our clinical experience-including practical insights from representative cases from routine practice-with published research to describe the technical foundations, clinical applications, advantages, and limitations of this technique. We discuss the technical aspects, including spatial and temporal resolution, velocity encoding, contrast administration, workflow requirements, and post-processing software, and their influence on diagnostic performance. Thus, 4D-flow CMR imaging can accurately assess cardiac shunts through advanced visualization of pathlines and streamlines, providing direct quantification of pulmonary flow: systemic flow ratios, blood flow volumes, and complex hemodynamic patterns in congenital heart disease (CHD). Moreover, 4D-flow CMR imaging provides robust characterization of valvular and aortic disease through dynamic flow analysis and quantitative hemodynamic metrics. Overall, 4D flow CMR imaging is a powerful, noninvasive diagnostic tool that can greatly enhance clinical decision-making. The growing body of evidence supports the use of 4D-flow CMR imaging in routine clinical practice, particularly for evaluating CHD and valvular and aortic disorders.
Bile Acids: The Contribution of the Gut Microbiota to Atherosclerosis.
Xu L, Yang H, He C … +5 more , Zhang H, Jiang Z, Zhang Y, Luan K, Hu H
Rev Cardiovasc Med · 2026 Jan · PMID 41659093 · Full text
Emerging evidence has implicated the gut microbiota in the pathogenesis and progression of numerous cardiovascular diseases. Atherosclerosis is a major pathological process that leads to many severe cardiovascular compli...
Emerging evidence has implicated the gut microbiota in the pathogenesis and progression of numerous cardiovascular diseases. Atherosclerosis is a major pathological process that leads to many severe cardiovascular complications. Meanwhile, atherosclerosis patients may experience local and systemic inflammatory responses, with structural changes in the intestinal microbiota and increased mucosal permeability. Currently, the role of gut microbiota-derived metabolites in atherosclerosis pathology is of great concern. Relevant findings have highlighted the potential direct or indirect impacts of gut microbiota on the metabolic health of the host via the production of various metabolites. Thus, this review places an emphasis on bile acids (BAs), metabolites derived from and regulated by the gut microbiota. BAs can delay the pathological processes associated with atherosclerosis, underscoring the significance of these metabolites as an early marker for disease progression risk. In addition, we explore the potential of BA-related gut metabolites as novel therapeutic targets for atherosclerosis, and propose several promising directions for future research.
Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Acute Kidney Injury Post Off-Pump Coronary Artery Bypass Grafting: A Retrospective Cohort Study and Meta-Analysis.
Zhou X, Pan Y, Hua K … +1 more , Yang X
Rev Cardiovasc Med · 2026 Jan · PMID 41659092 · Full text
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a novel class of oral antihyperglycemic medications prescribed for type 2 diabetes mellitus, play a beneficial role in slowing the progression of heart failu...
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a novel class of oral antihyperglycemic medications prescribed for type 2 diabetes mellitus, play a beneficial role in slowing the progression of heart failure. However, debate persists regarding the potential link of these inhibitors to acute kidney injury (AKI) in specific clinical conditions. METHODS: This study was a retrospective analysis of consecutive patients receiving off-pump coronary artery bypass grafting (OPCABG) at our institution between January 2018 and July 2023. A group of patients who had been administered SGLT2 inhibitors was systematically compared with non-users in a 1:3 ratio using propensity score matching. The principal endpoint was postoperative AKI after OPCABG. In addition, we performed a comprehensive meta-analysis of the associations between SGLT2 inhibitor therapy and AKI risk. The analytical approach combined institutional data with aggregated findings from existing literature. RESULTS: The analysis encompassed 403 patients who administered SGLT2 inhibitors and 1209 non-users. AKI developed in 54 cases (13.4%) post-OPCABG among individuals who received SGLT2 inhibitors, compared to 373 cases (30.9%) in the control cohort. Statistical analysis demonstrated significantly reduced AKI prevalence in the SGLT2 inhibitor cohort compared to non-users ( < 0.001). The meta-analysis results confirmed a protective association between SGLT2 inhibitor therapy and AKI risk reduction (odds ratio (OR) = 0.525, 95% confidence interval (CI) 0.437-0.631; < 0.001). CONCLUSION: In this study, SGLT2 inhibitor administration was associated with a decreased incidence of postoperative AKI in OPCABG patients. CLINICAL TRIAL REGISTRATION: NCT05888168, https://clinicaltrials.gov/study/NCT05888168?cond=NCT05888168&rank=1.
Reference Values for Myocardial Strain by Cardiac Magnetic Resonance Feature Tracking: Insights From Healthy Volunteers and Heart Failure Patients Using Caas MR.
Weiss KJ, Ching S, Doeblin P … +13 more , Carrión-Sánchez I, Carrizosa K, Tanacli R, Werhahn S, Veit J, Beyer RE, Mittmann N, Stehning C, Vogel G, Düngen HD, Blum M, Hashemi D, Kelle S
Rev Cardiovasc Med · 2026 Jan · PMID 41659091 · Full text
BACKGROUND: Magnetic resonance imaging (MRI) allows for the assessment of myocardial strain and identification of heart failure (HF) patients with reduced (HFrEF), mildly reduced (HFmrEF), or preserved (HFpEF) left ventr...
BACKGROUND: Magnetic resonance imaging (MRI) allows for the assessment of myocardial strain and identification of heart failure (HF) patients with reduced (HFrEF), mildly reduced (HFmrEF), or preserved (HFpEF) left ventricular ejection fraction (LVEF). The cardiovascular angiographic analysis system magnetic resonance (Caas MR) strain (Pie Medical Imaging) has recently been implemented in the IntelliSpace Portal Suite (Philips Healthcare) to assess the global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS). However, standard values for this software across different HF entities, as well as normal values, have yet to be established. Thus, this study aimed to establish reference values for the GLS, GCS, and GRS using the Caas MR strain in healthy individuals and HF patients, to assess the ability of these parameters to differentiate between HF subtypes, and to compare CAAS-derived strain values with those obtained using CVI42 software. METHODS: Using a 1.5 T Philips Achieva scanner, we analyzed 19 healthy volunteers and 56 HF patients (HFpEF, n = 19; HFmrEF, n = 20; and HFrEF, n = 17) using the feature tracking post-processing software Caas MR Strain. GLS, GCS, and GRS were quantified using 4-chamber-view, 2-chamber-view, and short-axis (SAX) cine images. All volunteers and patients were evaluated by CVI42 to analyze inter-vendor reliability with a validated software. RESULTS: Mean GLS, GCS, and GRS by Caas MR Strain were significantly different for healthy volunteers compared to HF patients (GLS -15.8 ± 1.9% vs. -11.7 ± 3.0%, < 0.001; GCS -17.0 ± 2.6% vs. -11.4 ± 3.3%, < 0.001; GRS 27.3 ± 6.2% vs. 14.5 ± 5.5%, < 0.001). The upper limit of the 99% confidence interval for healthy volunteers was -14.6% for GLS, -15.3% for GCS and the lower limit of the 99% CI for GRS was 23.1%. GLS, GRS, and GCS by Caas MR Strain were significantly different among HF entities ( < 0.001). Intervendor comparison showed very good agreement for GLS and GRS between Caas MR Strain and CVI42 (GLS = 0.86, < 0.001; GCS = 0.83, < 0.001; GRS = 0.76, < 0.001). CONCLUSION: Magnetic resonance imaging assessment of left ventricular myocardial strain using Caas MR Strain software reliably identifies HF patients. Discrimination between the different HF entities is potentially feasible by GLS, GCS, and GRS. Intervendor agreement was most robust for GLS and GCS, but less robust for GRS. For practical clinical use, we propose cut-off values for GLS above -15%, GCS above -15%, and GRS below 23% to define pathological findings.
Association Between Glucagon-Like Peptide-1 Receptor Agonists and Major Adverse Cardiovascular Outcomes Based on Race and Sex Among Patients With and Without Diabetes Mellitus: A Meta-Analysis of Nine Randomized Controlled Trials.
Jaiswal V, Mashkoor Y, Borra V … +6 more , Gera A, Patel N, Jitta SR, Nasir YM, Sharma P, Mattumpuram J
Rev Cardiovasc Med · 2026 Jan · PMID 41659090 · Full text
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been shown to reduce major adverse cardiovascular events (MACEs) in patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risk. Howev...
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been shown to reduce major adverse cardiovascular events (MACEs) in patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risk. However, the efficacy of GLP-1 RAs on the outcomes of MACEs across different racial and sex groups among patients with and without T2DM remains underexplored. Thus, this study aimed to evaluate the association between GLP-1 RAs and MACEs in patients with and without T2DM based on race and sex. METHODS: We conducted a systematic literature search on the PubMed and Scopus databases, as well as ClinicalTrials.gov, for relevant randomized controlled trials (RCTs) from inception to July 5, 2025. Trials were eligible for inclusion if the included adults (≥18 years) had been randomized to a GLP-1 RA versus placebo group, and MACEs were reported as an outcome. Trials combining GLP-1 RAs with other investigational glucose-lowering agents were excluded. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effect model, and a -value of <0.05 was considered statistically significant. RESULTS: Nine RCTs involving 81,266 patients were included in the analysis. The mean age of patients was 65 years. Compared with the placebo, GLP-1 RAs significantly reduced the risk of MACEs in males (RR, 0.82; 95% CI: 0.77-0.86; < 0.001) and females (RR, 0.81; 95% CI: 0.75-0.88; < 0.001). Meanwhile, across racial groups, GLP-1 RAs significantly reduced the risk of MACEs in Caucasian patients (RR, 0.87; 95% CI: 0.79-0.96; < 0.001) compared with placebo. However, no significant difference was observed for the risk of MACEs in Black patients (RR, 1.05; 95% CI: 0.72-1.53; = 0.80) when comparing GLP-1 RAs with placebo. CONCLUSION: This meta-analysis demonstrates that GLP-1 RAs significantly reduce the risk of MACEs in both males and females, as well as across various racial groups in patients with or without T2DM. However, the lack of significant benefit in Black patients suggests potential racial disparities in the enrollment and efficacy of GLP-1 RAs for cardiovascular outcomes.
Beyond Diabetes: A Review of Emerging Indications for Glucagon-Like Peptide-1 Receptor Agonists.
West L, Patolia H, Chapman B … +4 more , Laffin L, Vest AR, Sauer AJ, Martyn T
Rev Cardiovasc Med · 2026 Jan · PMID 41659089 · Full text
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for glycemic control in type 2 diabetes, have emerged as transformative agents with broad therapeutic applications across multiple organ systems...
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for glycemic control in type 2 diabetes, have emerged as transformative agents with broad therapeutic applications across multiple organ systems. This review explores the expanding role of GLP-1 RAs in managing cardiometabolic diseases, including obesity, heart failure (particularly with preserved ejection fraction), chronic kidney disease (CKD), and metabolic dysfunction-associated steatotic liver disease (MASLD). Robust clinical trial data support the efficacy of GLP-1 RAs in promoting weight loss, improving cardiovascular outcomes, and preserving renal function, with additional trials underway to further strengthen and expand the evidence base. Despite the growing utility of GLP-1 RAs, challenges related to cost, access, adherence, and implementation persist, particularly for indications beyond diabetes. However, innovations such as oral formulations and combination therapies may help improve accessibility and sustained use. As clinical guidelines evolve, targeted integration of GLP-1 RAs into care models may transform the prevention and treatment landscape for complex, chronic diseases.
Targeting the Sarcomere: Myosin Inhibitors as the Revolutionary Game Changer in Hypertrophic Cardiomyopathy.
Sedaghat-Hamedani F, Kayvanpour E, Meder B
Rev Cardiovasc Med · 2026 Jan · PMID 41659088 · Full text
Hypertrophic cardiomyopathy (HCM) represents the most common inherited cardiac disease and a leading cause of heart failure, arrhythmias, and sudden cardiac death in young individuals. For decades, management of HCM has...
Hypertrophic cardiomyopathy (HCM) represents the most common inherited cardiac disease and a leading cause of heart failure, arrhythmias, and sudden cardiac death in young individuals. For decades, management of HCM has relied on symptom control with β-blockers, calcium channel blockers, disopyramide, or invasive septal reduction in advanced cases. The identification of pathogenic sarcomere variants and the recognition of hypercontractility as a central disease mechanism have paved the way for cardiac myosin inhibitors (CMIs), the first truly disease-specific pharmacological therapy for HCM. Indeed, CMIs represent a revolutionary therapeutic paradigm that redefines the standard of care by translating molecular discovery into clinical application. This review provides a guide to the mechanistic basis of sarcomere modulation, summarizes the clinical evidence for mavacamten and aficamten, and critically evaluates the evolving roles of both medications in obstructive and non-obstructive HCM.
Current Advances in Epidemiology, Diagnosis, and Management of TAVR-Associated Infective Endocarditis: A Narrative Review.
Li Z, Lin D, Fan J … +3 more , Miao J, Pan W, Zhou D
Rev Cardiovasc Med · 2026 Jan · PMID 41659087 · Full text
With ongoing technological advancements and device innovations, transcatheter aortic valve replacement (TAVR) has become a well-established therapeutic approach for managing aortic stenosis and regurgitation. As indicati...
With ongoing technological advancements and device innovations, transcatheter aortic valve replacement (TAVR) has become a well-established therapeutic approach for managing aortic stenosis and regurgitation. As indications for TAVR expand, particularly into younger patient populations, the incidence of TAVR-associated infective endocarditis (TAVR-IE) has concurrently increased. Although the reported incidence of TAVR-IE remains relatively low (0.3%-2.0% per 100 patient-years), its clinical outcomes are notably poor, with mortality rates considerably higher than those observed in general infective endocarditis (IE). Moreover, the microbiological profile of TAVR-IE differs distinctly from surgical aortic valve replacement-associated IE (SAVR-IE), predominantly involving spp., , and coagulase-negative staphylococci. This review systematically summarizes the epidemiology, diagnosis, microbial etiology, prevention strategies, clinical prognosis, and management approaches for TAVR-IE, providing clinical insights and identifying key areas for future research.
From Last Resort to Standard of Care: The Evolution and Future of Transcatheter Aortic Valve Implantation.
Lee O, Osman A, Shum-Tim D
Rev Cardiovasc Med · 2026 Jan · PMID 41659086 · Full text
Transcatheter aortic valve implantation (TAVI) has evolved from an experimental, last-resort procedure in 2002 to a first-line therapy for aortic stenosis; moreover, the 2025 ESC/EACTS (European Society of Cardiology/Eur...
Transcatheter aortic valve implantation (TAVI) has evolved from an experimental, last-resort procedure in 2002 to a first-line therapy for aortic stenosis; moreover, the 2025 ESC/EACTS (European Society of Cardiology/European Association for Cardiothoracic Surgeons) guidelines marked a paradigm shift beyond traditional risk stratification toward earlier intervention and broader patient selection. Current evidence demonstrates the non-inferiority or superiority of TAVI to surgical aortic valve replacement across all risk categories, with the guidelines now recommending TAVI for patients aged ≥70 years and formally endorsing early intervention in asymptomatic severe stenosis when procedural risk is low. Meanwhile, critical challenges persist despite large-scale systematic reviews demonstrating significant mortality reduction following TAVI, including paravalvular leak rates of 10-25% compared to near-zero rates with surgery, and subclinical leaflet thrombosis affecting up to 30% of patients with unclear optimal management strategies. Moreover, the expansion toward younger populations exposes critical knowledge gaps, including unknown long-term durability beyond 10 years, structural valve degeneration rates of 4.8-13.3% at 5-7 years, and complex reintervention scenarios with reported mortality rates of 17.1% for surgical TAVI explantation. Thus, this review synthesizes contemporary evidence within the framework of the 2025 guidelines while examining unique aspects, including the pathophysiology of subclinical leaflet thrombosis, polymeric heart valve technologies as next-generation solutions, and the critical durability questions that will determine the role of TAVI in younger patients. Next-generation polymeric valves utilizing materials such as polyhedral oligomeric silsesquioxanes-polycarbonate urethane (POSS-PCU), poly(styrene-b-isobutylene-b-styrene) (SIBS), and siloxane polyurethane-urea have shown promising preclinical results in terms of enhanced durability and reduced thrombogenicity, although comprehensive clinical validation remains necessary. As TAVI practice evolves under new guideline recommendations emphasizing early intervention and simplified antithrombotic management, this thorough analysis can provide essential context for understanding both current capabilities and future directions in transcatheter valve therapy.
Caspase Recruitment Domain Family Member 8: A Favorable Target in the Pathogenesis of Atherosclerosis.
Tian D, Liu L, Zeng GG … +7 more , He J, Liu H, Ma D, Yang Z, Ma X, Cao Y, Xu C
Rev Cardiovasc Med · 2026 Jan · PMID 41659085 · Full text
Atherosclerosis, a lipid-driven chronic inflammatory disease, is the primary pathological basis of cardiovascular diseases, characterized by endothelial injury, lipid deposition, immune cell infiltration, and chronic inf...
Atherosclerosis, a lipid-driven chronic inflammatory disease, is the primary pathological basis of cardiovascular diseases, characterized by endothelial injury, lipid deposition, immune cell infiltration, and chronic inflammation. The NOD-like Receptor Pyrin Domain-Containing 3 () inflammasome has emerged as a crucial mediator of inflammation in atherosclerosis, with caspase recruitment domain family member 8 (CARD8) acting as a key regulatory component. Indeed, CARD8, a member of the caspase recruitment domain family, regulates immune responses by modulating inflammasome activity, particularly NLRP3. Recent studies suggest that CARD8 influences various aspects of atherosclerotic development, including lipid accumulation, oxidative stress, vascular inflammation, smooth muscle cell proliferation, and plaque instability. Thus, this review summarizes the latest findings on the role of CARD8 in the pathogenesis of atherosclerosis, with a focus on the regulatory effects of this component on immune cells and inflammatory pathways. We also discuss the potential of targeting CARD8 as a therapeutic strategy for atherosclerosis, exploring the current preclinical and clinical evidence.
Repair of Partial and Transitional Atrioventricular Septal Defects: Mid-term Outcomes in a Single-center Cohort.
Chen Z, Li Y, Xie W … +7 more , Chen T, Qiu H, Li X, Liu X, Chen J, Zhang Y, Wen S
Rev Cardiovasc Med · 2026 Jan · PMID 41659084 · Full text
BACKGROUND: Surgical repair of partial and transitional atrioventricular septal defects (AVSDs) aims to achieve optimal outcomes with minimal need for reintervention. This study aimed to evaluate the mid-term outcomes of...
BACKGROUND: Surgical repair of partial and transitional atrioventricular septal defects (AVSDs) aims to achieve optimal outcomes with minimal need for reintervention. This study aimed to evaluate the mid-term outcomes of AVSD repair in both pediatric and adult populations. METHODS: We retrospectively reviewed all patients who underwent surgical repair for partial or transitional AVSDs at our center between January 2019 and December 2022. Key outcomes, including mortality, reoperation, and atrioventricular valve (AVV) repair strategies, were assessed during follow-up. RESULTS: A total of 136 patients were included (partial AVSD, n = 100; transitional AVSD, n = 36), with a median follow-up of 50.5 months. The median hospital stay was 14 days. No early or late deaths occurred. Reoperation was required in four patients (2.9%); all reoperations included left atrioventricular valve (LAVV) reoperation. However, reoperation rates did not differ significantly between AVSD subtypes ( = 1.000) or age groups ( = 0.177). The incidence of moderate or greater LAVV regurgitation showed no significant difference between patients with and without ring annuloplasty, either postoperatively or at the final follow-up (both = 1.000). CONCLUSIONS: Surgical repair of partial and transitional AVSDs results in excellent mid-term survival and a low reoperation rate across both pediatric and adult patients. Continued refinement of AVV repair strategies remains essential to reduce the risk of LAVV reintervention and prevent left ventricular outflow tract obstruction. Long-term follow-up is warranted to improve the evaluation of the durability of techniques such as suture annuloplasty and ring annuloplasty.
Epicardial Ventricular Tachycardia Ablation: A Contemporary Review of Indications, Techniques, and Practical Approaches for Challenging Substrates.
Kuroda M, Hiroshima K, Ando K
Rev Cardiovasc Med · 2026 Jan · PMID 41659083 · Full text
Epicardial ablation is an increasingly important treatment for refractory ventricular tachycardia (VT), particularly in nonischemic cardiomyopathy or when the substrate is epicardial or mid-myocardial. This review provid...
Epicardial ablation is an increasingly important treatment for refractory ventricular tachycardia (VT), particularly in nonischemic cardiomyopathy or when the substrate is epicardial or mid-myocardial. This review provides an overview of the pathophysiology and disease-specific characteristics of VT substrates, with a particular focus on epicardial involvement and indications based on electrocardiographic, imaging, and clinical findings. We present advanced substrate-mapping strategies, including functional and high-resolution approaches, and practical examples of three-dimensional mapping using the CARTO™ (Biosense Webster, Diamond Bar, CA, USA) and EnSite™ (Abbott, Abbott Park, IL, USA) systems to overcome the known limitations of conventional mapping techniques. In the latter part of the review, we discuss the technical aspects of epicardial access, as well as the clinical challenges and strategies for challenging scenarios, such as bipolar ablation and ablation after prior cardiac surgery, supported by practical examples from our institution. We also highlight future perspectives. These insights are expected to contribute to the optimization of treatment strategies for refractory epicardial VT and to support the development of more precise and durable patient care.
Three-Dimensional Perspectives on Inflammatory Regulation in Coronary Atherosclerosis: Integrated Mechanisms of Endothelial Priming, Lipid Metabolism, and Cytokine Synergy.
Liu M, Mo DG, Bai JX … +2 more , Han QF, Yao HC
Rev Cardiovasc Med · 2026 Jan · PMID 41659082 · Full text
Atherosclerosis, a leading cause of global mortality, is a chronic inflammatory disease driven by a vicious cycle of endothelial dysfunction, dysregulated lipid metabolism, and persistent inflammation. This review examin...
Atherosclerosis, a leading cause of global mortality, is a chronic inflammatory disease driven by a vicious cycle of endothelial dysfunction, dysregulated lipid metabolism, and persistent inflammation. This review examines the mechanisms through which diverse triggers initiate the cycle. We discuss key cellular and molecular events, such as the detrimental phenotypic switching of vascular smooth muscle cells. We also describe the processes through which various upstream signals converge on core inflammatory hubs, such as the Toll-like receptor 4 (TLR4)/nuclear factor-κB (NF-κB) pathway and the nucleotide-binding oligomerization domain, leucine-rich repeat-containing family, pyrin domain-containing-3 (NLRP3) inflammasome. By integrating these established mechanisms with recent findings on novel regulators, including the chemokine hemofiltrate CC chemokine 1 (HCC-1) and cell surface glycoRNA, this review identifies several potential new biomarkers. Overall, this review aimed to provide a comprehensive understanding of the pathogenesis of atherosclerosis, informing future research and the development of targeted interventions.
Effect of Cardiac Myosin Inhibitors on Echocardiographic Features of Cardiac Structure and Function in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis.
Lu Y, Zhu Y, Tian Z
Rev Cardiovasc Med · 2026 Jan · PMID 41659081 · Full text
BACKGROUND: Recent advancements have introduced novel cardiac myosin inhibitors (CMIs) that have demonstrated significant efficacy in treating hypertrophic cardiomyopathy (HCM). This meta-analysis aimed to clarify the cu...
BACKGROUND: Recent advancements have introduced novel cardiac myosin inhibitors (CMIs) that have demonstrated significant efficacy in treating hypertrophic cardiomyopathy (HCM). This meta-analysis aimed to clarify the current understanding of the impact of CMIs on echocardiographic cardiac structure and function in patients with HCM. METHODS: A comprehensive search of the PubMed, Cochrane Library, and Embase databases was conducted from inception until September 14, 2025. The studies reporting the impact of CMIs on echocardiographic cardiac structure and function in HCM patients were included. RESULTS: Ultimately, this meta-analysis included 10 studies: five randomized controlled trials (RCTs), three echocardiographic sub-studies derived from RCTs, and two long-term cohort studies. A total of 938 patients were enrolled in these studies. This meta-analysis revealed that CMIs significantly reduce interventricular septum thickness (mean difference (MD): -1.77, 95% confidence interval (CI): -3.30 to -0.23; = 0.0240). CMIs were also shown to significantly reduce left ventricular mass index (MD: -18.15, 95% CI: -32.65 to -3.65; = 0.0141). Moreover, the pooled results demonstrated that administering CMIs can significantly reduce left ventricular ejection fraction (MD: -3.22, 95% CI: -5.60 to -0.85; = 0.0078). CMIs also significantly improved echocardiographic parameters of left ventricular diastolic function, such as the left atrial volume index (MD: -5.75, 95% CI: -7.87 to -3.64; < 0.0001) and septal E/e' ratio (MD: -3.80, 95% CI: -4.74 to -2.87; < 0.0001). However, the results did not reveal an association between CMIs and the risk of atrial arrhythmias (risk ratio (RR): 0.98, 95% CI: 0.33 to 2.94; = 0.9689). CONCLUSIONS: CMIs have shown great efficacy in improving left ventricular structure and diastolic function in HCM patients. Additionally, CMIs can reduce left ventricular ejection fraction. However, the impact of CMIs on the risk of atrial arrhythmias remains unclear. THE PROSPERO REGISTRATION: CRD420251243904, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251243904.
Association Between Plasma Fibrinogen Level and the Risk of Myocardial Infarction With Non-Obstructive Coronary Arteries: A Retrospective Observational Study.
Li D, Jing Z, Ding J … +1 more , Xue Z
Rev Cardiovasc Med · 2026 Jan · PMID 41659080 · Full text
BACKGROUND: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity with an unclear pathophysiological basis. Fibrinogen is a key coagulation factor and inflammato...
BACKGROUND: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity with an unclear pathophysiological basis. Fibrinogen is a key coagulation factor and inflammatory marker that has been associated with atherosclerotic burden in myocardial infarction (MI). However, the role of fibrinogen in MINOCA remains to be established. Therefore, this study aimed to investigate the association between plasma fibrinogen levels and the occurrence of MINOCA, and to evaluate the potential value of fibrinogen assessment in clinical characterization and early identification. METHODS: This retrospective study initially screened 1759 patients diagnosed with acute myocardial infarction (AMI) who underwent coronary angiography. A total of 287 patients were analyzed after applying the inclusion and exclusion criteria: 87 with MINOCA and 200 with the MI alongside obstructive coronary artery disease (MI-CAD). A logistic regression analysis was used to assess the association between fibrinogen levels and MINOCA, with subgroup and interaction analyses performed. Receiver operating characteristic (ROC) and restricted cubic spline (RCS) analyses were conducted as supplementary evaluations. RESULTS: Fibrinogen levels were significantly lower in the MINOCA group compared to the MI-CAD group ( = 0.005). Lower fibrinogen levels were independently associated with increased odds of MINOCA in the multivariate analysis (odds ratio (OR): 0.654, 95% confidence interval (CI): 0.483-0.885; = 0.006). Quartile analysis revealed a significant inverse trend between fibrinogen levels and risk of MINOCA ( for trend = 0.006), which was further confirmed by a consistent dose-response relationship in the spline analysis ( for overall = 0.035; for nonlinear = 0.590). The association remained robust across several subgroups. Fibrinogen alone showed a limited discriminative ability (area under the curve (AUC) = 0.605, 95% CI: 0.534-0.675; = 0.005). CONCLUSIONS: Lower plasma fibrinogen levels were independently associated with the occurrence of MINOCA, suggesting a potential role in its pathophysiology and the early identification of this condition. Fibrinogen alone has limited discriminative utility; however, fibrinogen may contribute to multi-marker approaches for determining and managing MINOCA patients.
Proteoglycans as Biomarkers of Medial Degeneration in Acute Stanford Type A Aortic Dissection.
Bagaber G, Song W, Fu G … +5 more , Hu K, Wang Z, Hu Y, Wei L, Chen J
Rev Cardiovasc Med · 2025 Dec · PMID 41524075 · Full text
Acute Stanford type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency that demands prompt and accurate diagnosis due to a high associated mortality. Although imaging remains the diagnostic gold s...
Acute Stanford type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency that demands prompt and accurate diagnosis due to a high associated mortality. Although imaging remains the diagnostic gold standard, the limited accessibility and time sensitivity of this technique underscore the need for reliable serum biomarkers. D-dimer is the most widely used biomarker, offering high sensitivity; however, the limited specificity of using D-dimer has prompted a search for novel biomarkers with greater diagnostic precision. Interestingly, proteoglycans (PGs) are essential constituents of the extracellular matrix (ECM) and have emerged as promising candidates for ATAAD, as PGs are released into the circulation during medial degradation, a defining histological feature of ATAAD. Moreover, emerging evidence suggests that specific PGs exhibit favorable specificity and stability, potentially enabling distinction between ATAAD and other acute cardiovascular syndromes. Additionally, in contrast to D-dimer, which is rapidly cleared within 8 hours, certain PGs, such as aggrecan, remain stable for up to 72 hours, offering an advantage for detecting ATAAD in patients presenting beyond the early acute phase. This review summarizes the potential of aortic PGs as biomarkers of medial degeneration and circulating PGs as serum diagnostic markers of ATAAD. Future research is warranted to establish PGs as clinically reliable biomarkers, with the potential to enhance current diagnostic frameworks and support an earlier, more accurate identification of ATAAD.
Comparison of European vs American High Blood Pressure Guidelines-A Transoceanic Journey.
Grassi G
Rev Cardiovasc Med · 2025 Dec · PMID 41524074 · Full text
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