Reviews In Cardiovascular Medicine[JOURNAL]
Sun
200 papers
Heart Transplant Outcomes in Chemotherapy-Induced vs. Non-Ischemic-Dilated Cardiomyopathy: Pediatric and Adult Recipients in the Ventricular Assist Device Era.
Das BB, Lirette S, Choudhry S … +1 more , Perumal G
Rev Cardiovasc Med · 2026 Apr · PMID 42110168 · Full text
BACKGROUND: Chemotherapy-induced dilated cardiomyopathy (CIDCM) has become an increasingly recognized indication for heart transplantation (HT) among cancer survivors with end-stage heart failure (HF). Advances in cardio...
BACKGROUND: Chemotherapy-induced dilated cardiomyopathy (CIDCM) has become an increasingly recognized indication for heart transplantation (HT) among cancer survivors with end-stage heart failure (HF). Advances in cardio-oncology practices, mechanical circulatory support, and refined immunosuppression strategies have improved outcomes; however, comparative data with non-ischemic dilated cardiomyopathy (NIDCM) in the modern ventricular assist device (VAD) era remain limited. Therefore, this study primarily aimed to compare post-transplant outcomes between CIDCM and NIDCM within pediatric and adult cohorts in the VAD era. METHODS: Data from the United Network for Organ Sharing (UNOS) registry were used to retrospectively analyze first-time orthotopic HT recipients between January 2010 and March 2023, with follow-up through March 2024. CIDCM was defined using the UNOS diagnosis codes "dilated myopathy-adriamycin" or "dilated myopathy-cancer", whereas NIDCM included idiopathic, familial, myocarditis-related, and other specific DCM subtypes. Primary outcomes were post-HT survival, treated allograft rejection, and new or recurrent malignancy. RESULTS: Among 28,813 recipients, 527 had CIDCM (52 pediatric, 475 adults). Pediatric survival was comparable between groups (1-, 5-, and 10-year survival: 0.92, 0.86, 0.76 vs. 0.95, 0.82, 0.68; = 0.951). Adults with CIDCM showed superior survival (0.92, 0.82, and 0.68 vs. 0.91, 0.79, and 0.59; = 0.018; hazard ratio (HR) 0.78 (0.64-0.96)) and lower rejection rates (0.03 vs. 0.04 events/person-year; = 0.0027), with similar incidence of post-HT malignancy. Older age, female sex, and minority race were associated with reduced survival. In pediatric recipients, age >10 years and Ebstein Bar Virus (EBV) seronegativity were associated with post-HT malignancy; in adults, age ≥50 years was predictive. CONCLUSIONS: HT in CIDCM achieves durable survival and safety comparable to NIDCM. These results support expanding HT eligibility and multidisciplinary evaluation for cancer survivors with advanced HF in the contemporary era.
Value of Thromboelastography as a Predictor of Postoperative Acute Respiratory Distress Syndrome in Patients With Acute Type A Aortic Dissection.
Wang X, Ye K, Chen X … +4 more , Guo Y, You B, Qiu Z, Wu Q
Rev Cardiovasc Med · 2026 Apr · PMID 42110167 · Full text
BACKGROUND: This study aimed to evaluate the effectiveness of thromboelastography (TEG) in predicting postoperative acute respiratory distress syndrome (ARDS) in patients with acute type A aortic dissection (ATAAD). METH...
BACKGROUND: This study aimed to evaluate the effectiveness of thromboelastography (TEG) in predicting postoperative acute respiratory distress syndrome (ARDS) in patients with acute type A aortic dissection (ATAAD). METHODS: This retrospective cohort study included 350 consecutive patients with ATAAD who underwent emergency total aortic arch replacement surgery at our institution. Patients were divided into ARDS and non-ARDS groups based on the postoperative development of ARDS. Perioperative data were collected and compared between groups. RESULTS: Overall, 56/350 (16.0%) patients developed postoperative ARDS, of whom four required reintubation and four progressed to respiratory failure. Although 30-day mortality was similar between the ARDS and non-ARDS groups (8.9% vs. 4.1%; = 0.227), postoperative complications were more complex and severe in the ARDS group. Indeed, this group had longer ventilator use ( = 0.009), a higher incidence of severe pneumonia ( = 0.026), longer intensive care stays ( = 0.019), and more frequent respiratory failure ( = 0.096) and multiple organ failure ( = 0.040). Multivariate analysis identified preoperative clot angle (odds ratio (OR) 4.421, 95% confidence interval (CI) 1.922-8.743; < 0.001), fibrinogen level (OR 4.473, 95% CI 2.678-9.399; < 0.001), maximum amplitude (MA) (OR 4.552, 95% CI 2.089-8.947; < 0.001), cardiopulmonary bypass time (OR 2.796, 95% CI 1.166-6.705; = 0.021), and intraoperative plasma transfusion (OR 4.057, 95% CI 1.700-9.046; = 0.004) as independent predictors of postoperative ARDS. The optimal cut-off values for preoperative fibrinogen level, clot angle, and platelet function (MA) on the receiver operating characteristic (ROC) curve analysis were 2.65 μg/mL, 59.4 degrees, and 64.1 mm, respectively, with corresponding areas under the curve of 0.744, 0.781, and 0.807 (all < 0.001). CONCLUSION: Preoperative fibrinogen, clot angle, and MA may be useful predictors of postoperative ARDS in patients with ATAAD. TEG enables rapid preoperative assessment of coagulation system status, guiding fibrinogen supplementation and blood transfusion strategies to reduce the incidence of postoperative ARDS and shorten the duration of postoperative mechanical ventilation. Thus, TEG may be a valuable tool for real-time monitoring and improving postoperative outcomes in this population.
When Sleep and Rhythm Collide: Amiodarone, Obstructive Sleep Apnoea, and Sinus Rhythm Maintenance After Cardioversion.
Foong KW, Elkammash A, McKenzie D
Rev Cardiovasc Med · 2026 Apr · PMID 42110166 · Full text
BACKGROUND: Recurrence of atrial fibrillation (AF) and atrial flutter (AFL) after direct current cardioversion (DCCV) remains a common problem. Several predictors of recurrence have been identified in observational studi...
BACKGROUND: Recurrence of atrial fibrillation (AF) and atrial flutter (AFL) after direct current cardioversion (DCCV) remains a common problem. Several predictors of recurrence have been identified in observational studies. Current guidelines recommend considering amiodarone as an adjunct in patients at high risk of AF/AFL recurrence. However, data in the available literature on the effectiveness of amiodarone in restoring and maintaining sinus rhythm (SR) are sparse. METHODS: This observational cross-sectional study analysed retrospective data from 193 patients who underwent elective DCCV for AF/AFL at a single UK cardiac centre, with follow-up at 6 weeks and 12 months. Baseline patient characteristics, including demographic data, echocardiographic findings, co-morbidities, and SR maintenance rate, were compared between patients treated with amiodarone and those without. Multivariate logistic regression was performed to identify parameters associated with DCCV failure. RESULTS: A total of 13.0% of the study population were started on amiodarone before DCCV. Those on amiodarone were more likely to have had a previous failed DCCV (60.0% vs. 21.4%; < 0.001), AF/AFL duration of at least 12 months (84.0% vs. 53.0%; = 0.003), a left ventricular ejection fraction (LVEF) of less than 40% (32.0% vs. 14.3%; = 0.03), and a diagnosis of coronary artery disease (CAD) (32.0% vs. 13.7%; = 0.02). Treatment with amiodarone was not associated with an increased rate of SR restoration at the time of DCCV (96.0% vs. 92.3%; = 0.50). However, amiodarone treatment was associated with SR maintenance at 6 weeks (92.0% vs. 54.8%; < 0.001) and at 12 months (60.0% vs. 26.8%; < 0.001). Multivariate logistic regression analysis identified obstructive sleep apnoea (OSA) as the only parameter associated with DCCV failure (adjusted odds ratio (OR) 10.5; 95% confidence interval (CI) 2.5-53.5; = 0.005). There was an increased risk of peri-procedural bradyarrhythmia with amiodarone therapy (adjusted OR 8.85; 95% CI 1.84-42.7; = 0.007). CONCLUSIONS: Amiodarone treatment is associated with maintenance of SR following elective DCCV for AF/AFL. This effect is observed even in patients with risk factors for recurrence, including previous failed DCCV, longer AF/AFL duration, and reduced LVEF. OSA is an independent predictor of DCCV failure; further research is required to delineate the role of early adjunctive amiodarone therapy in these patients.
Correlation Between Fat Attenuation Index and Major Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis.
Tan Y, Wang Y, Zhao B … +2 more , Jiang Y, Chen K
Rev Cardiovasc Med · 2026 Apr · PMID 42110165 · Full text
BACKGROUND: Numerous previous studies have examined the relationship between the fat attenuation index (FAI) and major adverse cardiovascular events (MACE), reporting inconsistent findings. METHODS: We conducted a system...
BACKGROUND: Numerous previous studies have examined the relationship between the fat attenuation index (FAI) and major adverse cardiovascular events (MACE), reporting inconsistent findings. METHODS: We conducted a systematic search of four databases (PubMed, Embase, Web of Science, and the Cochrane Library) for cohort, case-control, and cross-sectional studies evaluating the association between FAI and MACE incidence. The outcomes were defined as the correlations between MACE and FAI, including total FAI, FAI of the right coronary artery (RCA), FAI of the left circumflex coronary artery (LCX), and FAI of the left anterior descending (LAD) artery. FAI was analyzed both as a continuous and categorical indicator. Two researchers determined the final inclusion of the literature based on the inclusion and exclusion criteria and completed the data extraction. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). RevMan 5.4 was used to conduct heterogeneity tests, perform statistical pooling, and generate forest plots. Hazard ratios (HRs) were used to estimate the association between FAI and MACE risk. STATA16.0 (StataCorp LLC, College Station, TX, USA) was used to generate funnel plots, and the Egger test was applied to evaluate publication bias. RESULTS: A total of 22 studies involving 10,224 participants were included: 17 cohort studies, 1 cross-sectional study, and 4 case-control studies. The meta-analysis results suggested that there was a significant correlation between MACE and total FAI (FAI as a categorical variable: HR = 2.77, 95% confidence interval (CI) = 2.22-3.46; < 0.00001; FAI as a continuous variable: HR = 1.15, 95% CI = 1.05-1.26; = 0.003). There was also a significant association between MACE risk and FAI for the RCA (FAI as a categorical variable: HR = 2.10, 95% CI = 1.58-2.79; < 0.00001; FAI as a continuous variable: HR = 1.06, 95% CI = 1.04-1.08; < 0.00001), a significant correlation between the risk of MACE and FAI for the LAD (FAI as a categorical variable: HR = 2.76, 95% CI = 1.93-3.97; < 0.00001; FAI as a continuous variable: HR = 1.09, 95% CI = 1.06-1.11; < 0.00001), a significant correlation between the risk of MACE and FAI for the LCX branch (FAI as a categorical variable: HR = 2.68, 95% CI = 1.24-5.80; = 0.01; FAI as a continuous variable: HR = 1.07, 95% CI = 1.05-1.10; < 0.00001). Meanwhile, individuals with elevated FAI levels had a significantly increased risk of developing MACE. CONCLUSION: The results of this meta-analysis show a significant association between FAI and MACE. Higher FAI values are associated with significantly higher risks of MACE. These results suggest that FAI may serve as an imaging indicator for predicting the risk of MACE. PROSPERO REGISTRATION: CRD420250652674, https://www.crd.york.ac.uk/PROSPERO/view/CRD420250652674.
Effects of Maximal Fat Oxidation Exercise Training for Body Composition and Cardiovascular Risk Factors on College Students With Obesity.
Yang J, Zhu H, Sun F … +1 more , Pei Z
Rev Cardiovasc Med · 2026 Apr · PMID 42110164 · Full text
BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of mortality among various diseases in China, with both the incidence and mortality rates associated with CVD continuing to rise. Obesity, as a key risk...
BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of mortality among various diseases in China, with both the incidence and mortality rates associated with CVD continuing to rise. Obesity, as a key risk factor for CVD, exacerbates the disease burden. Concurrently, the rates of overweight and obese individuals among Chinese college students have been increasing annually. Maximal fat oxidation (FATmax)-intensity training, which precisely identifies the optimal exercise intensity for fat oxidation, can effectively improve cardiorespiratory function, regulate metabolic levels, and reduce the risk of chronic diseases. Thus, this study aimed to investigate the effects of FATmax-intensity exercise on cardiovascular disease risk factors in obese college students and to explore the associated underlying mechanisms. METHODS: A longitudinal single-group pre-post experimental design was adopted, with a 12-week intervention conducted on 24 obese college students. Measurements and comparisons of body composition, biochemical indicators, blood parameters, cardiorespiratory function, oxidative stress-related indicators, and immunoinflammatory cytokines were performed before and after the intervention. RESULTS: The results demonstrated that FATmax-intensity training significantly reduced the body weight, body mass index (BMI), body fat percentage, waist-to-hip ratio, abdominal adipose tissue, subcutaneous fat, resting heart rate, endothelin-1 (ET-1), C-X-C chemokine receptor 1 (CXCR1), CXCR2, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-gamma (IFN-γ) and interleukin-33 (IL-33) ( < 0.05) values in participants, while significantly increasing peak oxygen uptake (peak VO), anaerobic threshold, the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), maximal mid-expiratory flow (MMEF), endothelial nitric oxide synthase (eNOS), and vascular endothelial growth factor (VEGF) ( < 0.05). CONCLUSIONS: These findings provide preliminary evidence that applying FATmax-intensity exercise improves body composition, oxidative stress indicators, immunomodulatory anti-inflammatory function, and reduces cardiovascular disease risk in young obese populations, thereby providing the foundation for further research on the effects of FATmax-intensity exercise on other cardiovascular risk factors and potential mechanisms.
Exhaled Volatile Organic Compounds in Ischemic Cardiomyocytes: Signatures of Oxidative Stress!
Marzoog BA, Kopylov P
Rev Cardiovasc Med · 2026 Apr · PMID 42110163 · Full text
Volatile organic compounds (VOCs) reflect the homeostatic state of an organism, including that of cardiomyocytes. Ongoing alterations in cardiac muscle tissue can be detected as VOCs in exhaled breath. Traditionally, agi...
Volatile organic compounds (VOCs) reflect the homeostatic state of an organism, including that of cardiomyocytes. Ongoing alterations in cardiac muscle tissue can be detected as VOCs in exhaled breath. Traditionally, aging and the presence of atherosclerosis in the coronary arteries are associated with the development of ischemic heart disease (IHD). Pathophysiologically, IHD is characterized by an imbalance between the demand for and supply of oxygen and nutrients to cardiomyocytes. This imbalance favors oxidative stress over the antioxidant defense system, leading to the accumulation of reactive oxygen species (ROS) in cardiomyocytes. The molecular mechanisms of IHD involve the peroxidation of lipids, proteins, and nucleotides in cellular and intercellular components, particularly mitochondrial membranes. The products of peroxidation are released into the circulation and eventually reach the pulmonary circulation, where these products are exhaled as VOCs. This suggests that changes in exhaled VOCs in patients with IHD likely arise from oxidative stress within cardiomyocytes.
Pericardial Inflammatory Mediators in Patients Undergoing Cardiac Surgery: Towards a Biomarker-Informed Clinical Practice.
Blackledge M, Chatha HN, Fernández González AL … +3 more , Abu-Omar Y, Elsherbini A, El Diasty M
Rev Cardiovasc Med · 2026 Apr · PMID 42110162 · Full text
Postoperative atrial fibrillation, heart failure, and pericardial effusion remain frequent complications after cardiac surgery. Pericardial fluid is a localized inflammatory compartment in close contact with the myocardi...
Postoperative atrial fibrillation, heart failure, and pericardial effusion remain frequent complications after cardiac surgery. Pericardial fluid is a localized inflammatory compartment in close contact with the myocardium and may provide information that complements systemic biomarkers. This narrative review summarizes inflammatory mediators identified in pericardial fluid after cardiac surgery and their associations with postoperative outcomes. We discuss potential mechanistic links between pericardial inflammation and pericardial fluid markers, as well as practical limitations related to sampling, timing, and standardization. Although pericardial fluid biomarkers may augment existing clinical risk models, prospective studies are needed to determine their incremental value and clarify their role in perioperative management.
A Novel ApoB/ApoA1 Ratio-Integrated Nomogram to Predict Cardiogenic Shock After Acute Myocardial Infarction.
Zhang X, Chen L, Tian N … +2 more , Qin H, Bao L
Rev Cardiovasc Med · 2026 Apr · PMID 42110161 · Full text
BACKGROUND: Despite advances in treatment, cardiogenic shock (CS) remains a highly lethal complication of acute myocardial infarction (AMI), with mortality rates still exceeding 40%. Early identification of high-risk pat...
BACKGROUND: Despite advances in treatment, cardiogenic shock (CS) remains a highly lethal complication of acute myocardial infarction (AMI), with mortality rates still exceeding 40%. Early identification of high-risk patients is critical, yet existing risk-stratification tools lack precision, particularly in integrating novel biomarkers such as the apolipoprotein B/A1 (ApoB/ApoA1) ratio, which reflects atherogenic lipid imbalance and has shown predictive value in cardiovascular disease. METHODS: This retrospective cohort study included patients admitted with an acute coronary syndrome between December 2022 and July 2025. RESULTS: Using the least absolute shrinkage and selection operator (LASSO) regression, a predictive nomogram was developed incorporating eight independent predictors: heart rate, respiratory rate, systolic blood pressure, white blood cell count, D-dimer, albumin, glucose, and the ApoB/ApoA1 ratio. The model demonstrated strong discriminatory performance, with an area under the curve (AUC) of 0.839 in the training cohort and 0.832 in the validation cohort. Calibration and decision curve analyses further supported the clinical utility of the nomogram. CONCLUSIONS: The inclusion of the ApoB/ApoA1 ratio, a marker associated with endothelial dysfunction, plaque instability, and metabolic dysregulation, adds significant prognostic value beyond conventional parameters. This nomogram provides a practical tool for early risk stratification, potentially guiding timely interventions and improving outcomes in high-risk patients with AMI.
Extreme Weather Events, Air Pollution, and Cardiovascular Health: Mechanisms and Challenges.
Xu S, Li R, Li J … +3 more , Zheng Z, Luo Y, Gao J
Rev Cardiovasc Med · 2026 Apr · PMID 42110160 · Full text
Extreme weather events and air pollution are becoming increasingly frequent and severe, posing complex challenges to human health. Although the adverse effects of these environmental stressors on cardiovascular disease a...
Extreme weather events and air pollution are becoming increasingly frequent and severe, posing complex challenges to human health. Although the adverse effects of these environmental stressors on cardiovascular disease are widely acknowledged, the underlying mechanisms remain incompletely understood. This review examines these mechanisms from a physiological perspective, considering both pathways that act directly on the heart and those mediated through non-cardiac organs. Airborne particulate pollutants from dust storms, wildfires, and haze days can pass through the respiratory system and reach the heart, resulting in cardiac injury. Meanwhile, extreme weather events, including heatwaves, cold spells, hurricanes, and even earthquakes, can increase cardiovascular disease risk by affecting traditional risk factors, autonomic nervous system responses, oxidative stress, inflammation, coagulation disturbances, and behavioral factors. Hence, by providing a comprehensive overview, this review aims to enhance our understanding of the cardiovascular risks associated with climate hazards.
Association Between Vericiguat and Clinical Outcomes Across Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Nasir YM, Yasmeen J, Shama N … +7 more , Ang SP, Doshi NA, Deb N, Hamsakutty H, Haris S, Jaiswal V, Mattumpuram J
Rev Cardiovasc Med · 2026 Apr · PMID 42110159 · Full text
BACKGROUND: Heart failure (HF) remains a major global health burden, with mortality continuing to rise despite therapeutic advances. Vericiguat, a soluble guanylate cyclase stimulator, has demonstrated potential benefit...
BACKGROUND: Heart failure (HF) remains a major global health burden, with mortality continuing to rise despite therapeutic advances. Vericiguat, a soluble guanylate cyclase stimulator, has demonstrated potential benefit in patients with worsening HF with reduced ejection fraction (HFrEF), although results across randomized trials have been inconsistent. METHODS: We conducted a systematic literature search across PubMed, Scopus, and ClinicalTrials.gov for relevant articles from inception through September 30th, 2025. Outcomes were reported as pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Statistical significance was defined as a 95% confidence interval not crossing 1.0 with a two-tailed -value < 0.05. RESULTS: Five randomized controlled trials (RCTs) with 12,877 patients (6857 in the vericiguat group and 6020 in the placebo group) were included. Vericiguat demonstrated a borderline but non-significant reduction in composite outcome of cardiovascular death (CVD) or hospitalization for HF (OR 0.92, 95% CI 0.85-1.00; = 0.05), hospitalization for HF (OR 0.93, 95% CI 0.85-1.02; = 0.14), and all-cause mortality (ACM) (OR 0.91, 95% CI 0.81-1.01; = 0.07). CONCLUSION: The findings of this study suggest that Vericiguat, when added to guideline-directed medical therapy in patients with heart failure, was associated with a borderline, non-significant reduction in the risk of the composite outcome of cardiovascular death or heart failure hospitalization, as well as all-cause mortality. Further large-scale randomized trials are warranted to better define its clinical benefit.
A New Paradigm for Atrial Fibrillation Ablation in Obesity Focusing on Substrate Remodeling and Patient-Centered Outcomes.
Cao Y, Gong A, Li Z … +6 more , Li F, Hu X, Ren B, Li W, Zhou Y, Zeng R
Rev Cardiovasc Med · 2026 Apr · PMID 42110158 · Full text
The obesity and atrial fibrillation (AF) epidemics are inextricably linked and continue to increase worldwide, posing significant global health burdens. Epidemiological evidence has revealed that obesity is a powerful, i...
The obesity and atrial fibrillation (AF) epidemics are inextricably linked and continue to increase worldwide, posing significant global health burdens. Epidemiological evidence has revealed that obesity is a powerful, independent, and modifiable risk factor for AF. Obesity directly creates a proarrhythmic substrate through a triad of synergistic pathways: chronic hemodynamic overload that induces left atrial enlargement, local paracrine and inflammatory effects of dysfunctional epicardial adipose tissue (EAT), and systemic inflammation and oxidative stress, which collectively promote atrial fibrosis and electrical remodeling. Catheter ablation remains a cornerstone of rhythm control; however, the efficacy of this procedure is often compromised in patients with obesity, creating a "high-recurrence-high-benefit" paradox in which this patient group achieves the greatest improvements in quality of life despite higher rates of arrhythmia recurrence. Recent large-scale data have further refined this paradox, identifying a distinct "efficacy cliff" among patients categorized as severely obese (body mass index ≥35 kg/m). Furthermore, emerging concepts are reshaping therapeutic strategies. Novel technologies, such as pulsed field ablation, with an enhanced safety profile, can mitigate the "insulation effect" of EAT; however, these concepts cannot fully overcome this effect without complementary strategic adjustments. Concurrently, recent evidence has suggested that ablation may act as a "biological substrate modification" by reducing the volume of local EAT. These findings support a paradigm shift in therapeutic strategy, moving beyond the singular endpoint of arrhythmia elimination toward a comprehensive approach that applies substrate modification guided by dynamic, spatiotemporally discrete mapping, with the primary endpoints of success shifting to dual endpoints encompassing a reduction in AF burden and an improvement in the quality of life of patients. Overall, this review aimed to discuss the pathophysiological nexus between obesity and AF, critically evaluate the challenges and technological advancements in catheter ablation for this population, and propose an integrated management pathway centered on substrate reversal and quality of life.
DNA Methylation and Fetal Programming of Cardiovascular Disease: From Congenital Heart Diseases to Adult Cardiovascular Dysfunction.
Chen Z, Qiu M, Li Y … +5 more , Xie W, Chen T, Qiu H, Zhang Y, Wen S
Rev Cardiovasc Med · 2026 Apr · PMID 42110157 · Full text
DNA methylation, the most extensively studied epigenetic mechanism, acts as a critical interface between maternal environmental influences and fetal cardiovascular development. During embryogenesis, tightly orchestrated...
DNA methylation, the most extensively studied epigenetic mechanism, acts as a critical interface between maternal environmental influences and fetal cardiovascular development. During embryogenesis, tightly orchestrated methylation remodeling regulates the transcriptional networks required for cardiogenesis, including chamber septation, valve formation, and myocardial maturation. Disruption of these methylation patterns contributes to congenital heart disease (CHD), with distinct methylation signatures identified in tetralogy of Fallot, double-outlet right ventricle, bicuspid aortic valve, and coarctation of the aorta. Maternal exposures, including smoking, alcohol intake, folic acid status, hypertension, diabetes, and hyperlipidemia, modify fetal DNA methylation in placental, myocardial, and cord blood tissues. These alterations affect key developmental pathways, including Wnt, Notch, and mitogen-activated protein kinase signaling, as well as genes that regulate oxidative stress, thereby increasing the risk of structural defects and predisposing offspring to long-term cardiovascular vulnerability. Epigenetic reprogramming in adverse intrauterine environments has been linked to hypertension, pulmonary vascular disease, atherosclerosis, and ischemia-sensitive phenotypes in later life, supporting a continuum from fetal life to adult cardiovascular dysfunction. Unlike genetic mutations, DNA methylation is dynamic and reversible, highlighting the potential of this modification as a biomarker of early risk and a target for preventive strategies. Optimizing maternal health, ensuring appropriate folate intake, and reducing harmful exposures may help preserve normal methylation landscapes and improve offspring cardiovascular outcomes. Advances in high-resolution epigenomic profiling, including single-cell methylation technologies, now enable delineation of cell-specific trajectories that connect CHD with adult cardiovascular disease and may inform precision interventions aimed at modifying pathogenic epigenetic states. Thus, understanding the role of DNA methylation in fetal programming can clarify the developmental origins of CHD and adult cardiovascular disorders, and lay the foundation for cardiovascular prevention strategies that extend from preconception through the earliest stages of life.
Focus on Baseline LDL-C and Patient Risk, Not Drug Type: A Perspective on Alirocumab vs Evolocumab.
Sabouret P, Giamundo DM, Mamas M
Rev Cardiovasc Med · 2026 Apr · PMID 42110156 · Full text
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Supra-Annular Self-Expanding Versus Intra-Annular Balloon-Expandable Transcatheter Aortic Valve Implantation: A Meta-Analysis of Valve-Related Outcomes.
Ali M, Paraskevi T, Omari M … +3 more , Farag M, Kuzemczak M, Alkhalil M
Rev Cardiovasc Med · 2026 Apr · PMID 42110155 · Full text
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. The two most widely used platforms are either balloon-expandable intra-annular valve (BEV, Edwards) or se...
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. The two most widely used platforms are either balloon-expandable intra-annular valve (BEV, Edwards) or self-expanding supra-annular valve (SEV) from Medtronic. Comparative data related to clinical and sub-clinical valve thrombosis are limited. The aim of this study-level meta-analysis is to evaluate its incidence and whether this translates into any difference in clinical outcomes. METHODS: Electronic databases were searched from inception through to October 2025 to identify randomised clinical trials of patients receiving either platform. Rates of clinical and subclinical valve thrombosis were identified and compared between the two groups. RESULTS: In five randomized controlled trials including 1877 patients, the risk of clinical and sub-clinical valve thrombosis was relatively low in both groups. There was a significant 81% reduction in clinical valve thrombosis in patients undergoing SEV compared to BEV [0.4% vs. 2.1%; rate ratio (RR) 0.19, 95% confidence interval (CI) (0.04 to 0.86), = 0.03]. Similarly, the risk of sub-clinical valve thrombosis was significantly lower in the SEV group [0.6% vs. 3.6%; RR 0.22, 95% CI (0.07 to 0.65), = 0.006]. This difference was not translated into increased risk of stroke, valve re-intervention, or death. CONCLUSION: Patients undergoing TAVI using SEV compared to BEV have a lower risk of clinical and sub-clinical valve thrombosis in randomized trials, which is largely influenced by small annulus anatomy. Larger studies with longer term follow-up or using a dedicated imaging protocol may provide better insights into the clinical sequelae of this phenomenon.
A Comment on "Combination of the Fibrosis-4 Index and Carbohydrate Antigen 125 to Predict Morbidity and Mortality in Acute Heart Failure".
Tatar S, Yavuz YE, Sahin AT
Rev Cardiovasc Med · 2026 Apr · PMID 42110154 · Full text
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Increased Vascular Endothelial Growth Factor Receptor 2 Levels Are Associated With a Higher Occurrence of Coronary Artery Disease in Patients With Obstructive Sleep Apnea.
Zhu J, Wu D, Chen S … +3 more , Pan Y, Jiao X, Fu G
Rev Cardiovasc Med · 2026 Apr · PMID 42110153 · Full text
BACKGROUND: Obstructive sleep apnea (OSA) has become a vital risk factor for coronary artery disease (CAD). Vascular endothelial growth factor receptor 2 (VEGFR2) participates in the mediation of atherosclerosis, the mai...
BACKGROUND: Obstructive sleep apnea (OSA) has become a vital risk factor for coronary artery disease (CAD). Vascular endothelial growth factor receptor 2 (VEGFR2) participates in the mediation of atherosclerosis, the main underlying pathophysiological basis of CAD, by promoting angiogenesis and inflammation. Chronic intermittent hypoxia, a characteristic of OSA, can induce VEGFR2 expression. Therefore, this study aimed to examine the association between circulating VEGFR2 levels and CAD in OSA patients, an association that has not been well explored in previous research. METHODS: This cross-sectional study involved 453 Chinese adults: 345 with OSA and CAD and 108 with OSA alone. The Gensini and SYNTAX scores were used to evaluate the severity of CAD. An enzyme-linked immunosorbent assay (ELISA) was used to measure circulating VEGFR2 levels. Multivariate logistic regression analyses were used to explore the association between the circulating VEGFR2 levels and CAD and also to determine the independent associations. Multivariate linear regression analysis was used to determine the relationship between VEGFR2 levels and the severity of CAD. RESULTS: Patients with OSA and CAD demonstrated remarkably higher circulating VEGFR2 levels compared with those patients with OSA alone (median interquartile range (IQR): CAD 10.9 (8.26-14.6) vs. non-CAD 8.25 (5.87-10.3) ng/mL; * < 0.05). After confounding factors were adjusted, the circulating VEGFR2 level exhibited an independent association with CAD (odds ratio (OR) = 1.17, 95% confidence interval (CI) 1.09-1.27; < 0.001). Furthermore, we confirmed a positive association between VEGFR2 levels and CAD severity in Chinese patients with OSA. CONCLUSIONS: In Chinese patients with OSA, those with CAD exhibited higher circulating VEGFR2 levels than those without CAD. Increased VEGFR2 levels were independently associated with the presence and severity of CAD, suggesting a potential role of VEGFR2 as a biomarker for vascular endothelial dysfunction.
Advances in Epicardial Access for Ventricular Tachycardia Ablation: From Historical Techniques to Carbon Dioxide Insufflation.
Higuchi K, Sroubek J, Lee J … +1 more , Santangeli P
Rev Cardiovasc Med · 2026 Apr · PMID 42110152 · Full text
Epicardial access is often required for effective catheter ablation of ventricular tachycardia (VT) originating from the epicardium, especially in patients with non-ischemic cardiomyopathy, arrhythmogenic right ventricul...
Epicardial access is often required for effective catheter ablation of ventricular tachycardia (VT) originating from the epicardium, especially in patients with non-ischemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (ARVC), and cardiac sarcoidosis. Traditional subxiphoid access using large-bore needles remains effective but carries substantial procedural risks, including right ventricular (RV) puncture, coronary artery injury, and injury to intra-abdominal organs. These risks are amplified in patients with prior cardiac surgery, obesity, and distorted anatomy. To mitigate these challenges, several technical advancements have been introduced, including the needle-in-needle (micropuncture) technique and the SAFER approach using RV angiography during apnea. However, these methods do not fully overcome the inherent limitation of minimal separation between the pericardial layers at the time of pericardial puncture. Carbon dioxide (CO) insufflation into the pericardial space is a recently developed technique that can temporarily separate the parietal and visceral pericardium for safer epicardial access. Coronary venous exit for CO has demonstrated safety and efficacy, as confirmed in the multicenter Epi-CO Registry. Further advances include the use of radiofrequency (RF)-assisted trans-right atrial appendage (RAA) perforation for CO insufflation. In this comprehensive review, the advancement of epicardial access is discussed from the early era to contemporary techniques, especially regarding CO insufflation, including its pitfalls and the future direction of this technique.
Conduction Abnormalities After Transcatheter Aortic Valve Replacement: Comprehensive Review of Current Literature, Guidelines, and Clinical Practices.
Namjouyan K, Yeckley M, Bitton N … +3 more , Marcus M, Eaton C, Jhand A
Rev Cardiovasc Med · 2026 Apr · PMID 42110151 · Full text
Transcatheter aortic valve replacement (TAVR) offers a minimally invasive alternative to traditional surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis. Notably, TAVR was once reserved f...
Transcatheter aortic valve replacement (TAVR) offers a minimally invasive alternative to traditional surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis. Notably, TAVR was once reserved for patients at high surgical risk but is now a viable option even for those at low surgical risk. Despite the widespread adoption and favorable outcomes of TAVR, this technique presents several challenges, including conduction disturbances such as new-onset left bundle branch block (LBBB) and high-grade atrioventricular (AV) block, which may require permanent pacemaker (PPM) implantation. These complications arise from the close anatomical relationship between the aortic valve and the cardiac conduction system and are influenced by factors such as valve design, implantation depth, and individual anatomical variations. This review aims to explore the structural and physiological intricacies of the aortic valve and conduction system. Additionally, this review explores pre-procedural risk stratification, monitoring protocols, and emerging strategies to mitigate these complications and enhance procedural safety and long-term patient outcomes.
The Role of Glutathione Peroxidase 4 in Atherosclerosis: Role and Therapeutic Potential.
Guo Z, Wei X, Gu T … +2 more , Guo H, Hua S
Rev Cardiovasc Med · 2026 Apr · PMID 42110150 · Full text
Atherosclerosis, characterized by abnormal lipid metabolism and inflammation, constitutes the fundamental pathological basis for the development of cardiovascular lesions. Ferroptosis, a recently discovered novel form of...
Atherosclerosis, characterized by abnormal lipid metabolism and inflammation, constitutes the fundamental pathological basis for the development of cardiovascular lesions. Ferroptosis, a recently discovered novel form of cell death, is linked to disturbances in iron metabolism and lipid peroxidation; meanwhile, an association with various cardiovascular diseases, including heart failure, myocardial infarction, and atherosclerosis, has also been confirmed. Glutathione peroxidase 4 (GPX4) is an important component of the antioxidant system that plays a key role in maintaining iron homeostasis and inhibiting ferroptosis. Ferroptosis triggered by GPX4 inactivation can also further activate pyroptosis pathways by releasing proinflammatory signals, thereby collectively exacerbating inflammation and the progression of atherosclerotic plaques. Therefore, further investigations into the function of GPX4 in atherosclerosis may facilitate the development of novel diagnostic and therapeutic approaches, as well as drug development targets for the prevention and prognosis of related cardiovascular diseases. Moreover, the activation of GPX4 or the supplementation with its coenzyme, glutathione (GSH), may emerge as a promising new therapeutic strategy. This review summarizes the structure and function of GPX4 and the role of this enzyme in iron toxicity and atherosclerosis.
An Overview of the Diagnostic and Treatment Strategies for Aortic Disease.
Xu J, Wang F, Wang K … +1 more , Zhang S
Rev Cardiovasc Med · 2026 Apr · PMID 42110149 · Full text
The aorta, a vital conduit that transports oxygenated blood from the heart to the systemic circulation, is characterized by intricate architecture and heterogeneous embryological origins. Recently, the aorta has been con...
The aorta, a vital conduit that transports oxygenated blood from the heart to the systemic circulation, is characterized by intricate architecture and heterogeneous embryological origins. Recently, the aorta has been conceptualized as a functionally integrated "aortic organ", providing a comprehensive framework that supports the systematic evaluation, management, and long-term surveillance of aortic pathologies. Aortic disease primarily encompasses acute aortic syndromes and chronic aneurysmal disorders, which are often characterized by asymptomatic onset and rapid clinical progression, posing a significant risk of mortality in the absence of prompt diagnosis and intervention. This review provides a systematic overview of the classification, epidemiological features, diagnostic approaches, and therapeutic advances in aortic diseases. Moreover, this review outlines current indications, technical considerations, and clinical outcomes associated with various treatment strategies. Finally, this review identifies key directions for future research, including standardizing diagnostic classifications, refining risk-stratification models, and advancing comprehensive endovascular therapies, with the ultimate goal of enhancing lifelong patient management and improving clinical outcomes.
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