Reviews In Cardiovascular Medicine[JOURNAL]
Sun
200 papers
The Impact of Early In-Hospital Use of SGLT2 Inhibitors on Outcomes in Patients With Acute Heart Failure: An Updated Systematic Review and Meta-Analysis.
Deng Y, Ma Y, Li H … +1 more , Zhu L
Rev Cardiovasc Med · 2026 Mar · PMID 41923732 · Full text
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, employed as antidiabetic agents, have been shown to effectively improve the prognosis of patients with chronic and stable heart failure, chronic kidney disea...
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, employed as antidiabetic agents, have been shown to effectively improve the prognosis of patients with chronic and stable heart failure, chronic kidney disease, and diabetes in the context of cardiovascular-renal-endocrine integrated management. However, the safety and clinical benefits of the early application of SGLT2 inhibitors in hospitalized patients with acute heart failure remain controversial. This study aimed to evaluate the safety and prognostic impact of early SGLT2 inhibitor therapy in patients with acute heart failure. METHODS: A systematic literature search of the PubMed, Web of Science, and Cochrane Library databases was conducted to identify studies on the use of SGLT2 inhibitors in acute heart failure. Two researchers independently screened studies, extracted data, and assessed the risk of bias in the included studies. The meta-analysis was performed using STATA 16.0 software (StataCorp, College Station, TX, USA). RESULTS: A total of 23 studies involving 47,291 patients with acute heart failure were included in this analysis (10 randomized controlled trials and 13 observational studies). Early use of SGLT2 inhibitors in hospitalized patients with acute heart failure was associated with a reduction in the incidence of composite events in the short term (relative risk (RR) = 0.64, 95% confidence interval (CI) (0.56, 0.74)), all-cause mortality (RR = 0.72, 95% CI (0.60, 0.86)), and heart failure rehospitalization rates (RR= 0.77, 95% CI (0.63, 0.87)); however, the early use of SGLT2i did not improve the incidence of cardiogenic death (RR = 0.74, 95% CI (0.51, 1.08)). Additionally, the early administration of SGLT2 inhibitors significantly reduced the incidence of cardiogenic mortality (RR = 0.77, 95% CI (0.60, 1.0); = 0.045), as well as decreasing heart failure rehospitalization rates (RR = 0.77, 95% CI (0.70, 0.86)) and all-cause mortality (RR = 0.49, 95% CI (0.41, 0.60)), without increasing the incidence of adverse drug reactions such as acute kidney injury, urinary tract infections, diabetic ketoacidosis, hypoglycemia, or hypotension. CONCLUSION: Early in-hospital use of SGLT2 inhibitors can safely and effectively reduce the incidence of all-cause mortality, cardiogenic rehospitalization, and composite events in acute heart failure patients in both the short term and over one year.
Hematuria Management in Patients on Antiplatelet Medications After Acute Coronary Syndrome: A Review of the Current Evidence and Recommendations.
Loufopoulos I, Kapriniotis K, Fyntanidou B … +5 more , Apostolopoulou A, Nasoufidou A, Stachteas P, Karagiannidis E, Papaefstathiou E
Rev Cardiovasc Med · 2026 Mar · PMID 41923731 · Full text
Hematuria is a frequent urological presentation, particularly in patients with significant cardiovascular comorbidities who receive dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS). Managing hematuria...
Hematuria is a frequent urological presentation, particularly in patients with significant cardiovascular comorbidities who receive dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS). Managing hematuria in this high-risk population poses a unique clinical challenge, requiring a careful balance between thrombotic and bleeding risks. This review summarizes current evidence and provides practical recommendations for the multidisciplinary management of hematuria in patients on antiplatelet medications following ACS. Relevant literature and international guideline recommendations from urology, cardiology, and emergency medicine were reviewed, focusing on diagnostic evaluation, hemodynamic assessment, modification of antiplatelet therapy, surgical considerations, and reversal strategies. The management pathway begins with a prompt assessment of hemodynamic stability, hematuria severity, and underlying cause. Conservative measures include catheterization, bladder irrigation, and correction of coagulation disorders. The diagnostic evaluation should not be delayed, as up to 24% of cases of visible hematuria in this population are due to malignancy. Antiplatelet management depends on bleeding severity and thrombotic risk: mild bleeding generally allows continuation of DAPT; moderate bleeding may warrant temporary cessation of aspirin; severe bleeding often requires de-escalation to monotherapy; life-threatening bleeding necessitates immediate discontinuation of all antiplatelets. Interventional options-ranging from endoscopic clot evacuation to selective arterial embolisation-should be tailored to the stability and cardiovascular risk of the patient. Resumption of antiplatelet therapy should occur as early as clinically feasible, ideally within 48 hours, with de-escalated regimens considered for patients with a high bleeding risk. Hematuria in post-ACS patients on antiplatelets requires an individualized, multidisciplinary approach to optimize hemostasis without compromising cardiovascular protection. Early diagnosis of underlying urological pathology is essential, and both bleeding severity and ischemic risk should guide antiplatelet modification therapy. Evidence supports early specialist involvement, adherence to structured risk-adapted protocols, and judicious use of conservative or interventional measures to improve outcomes.
Evolution of Clinical Indications for Mitral Valve Transcatheter Edge-to-Edge Repair.
Iglesias-Otero C, Echarte-Morales J, González-Fernández D … +2 more , Íñiguez-Romo A, Estévez-Loureiro R
Rev Cardiovasc Med · 2026 Mar · PMID 41923730 · Full text
Mitral valve transcatheter edge-to-edge repair (M-TEER) has evolved from a highly specialized intervention to an essential treatment option for patients with severe mitral regurgitation (MR) who are unsuitable candidates...
Mitral valve transcatheter edge-to-edge repair (M-TEER) has evolved from a highly specialized intervention to an essential treatment option for patients with severe mitral regurgitation (MR) who are unsuitable candidates for surgery. Moreover, current guidelines support the use of M-TEER in both secondary MR and selected cases of primary MR. In addition to these established indications, data from clinical trials and registries indicate that M-TEER is associated with improved short-term outcomes compared with conservative therapy in acute MR after myocardial infarction, and is beneficial in more complex scenarios, such as advanced heart failure, hypertrophic obstructive cardiomyopathy, and mitral annulus calcification. Meanwhile, combined strategies, such as repairing the mitral and tricuspid valves simultaneously, adding M-TEER to transcatheter aortic valve replacement, or performing this procedure alongside left atrial appendage closure, are gaining ground as practical ways to address the broader needs of these high-risk patients. More recently, M-TEER has been used in patients with moderate MR, as this stage is now recognized to be associated with adverse outcomes. Overall, current evidence supports M-TEER as a safe and versatile therapy across an expanding range of clinical scenarios. Nonetheless, ongoing studies will help further clarify long-term outcomes and refine patient selection.
Combined Effect of Low-Density Lipoprotein Cholesterol and Homocysteine on Major Adverse Cardiovascular Events in Coronary Heart Disease: A Retrospective Cohort Study.
Zhu B, Luo X, Wu P … +8 more , Ma Y, Wu B, Yan R, Ma T, Yang J, Wang Z, Cong G, Jia S
Rev Cardiovasc Med · 2026 Mar · PMID 41923729 · Full text
BACKGROUND: Residual cardiovascular risk remains substantial despite aggressive low-density lipoprotein cholesterol (LDL-C) lowering in coronary heart disease (CHD). Consequently, this elevated risk has spurred the searc...
BACKGROUND: Residual cardiovascular risk remains substantial despite aggressive low-density lipoprotein cholesterol (LDL-C) lowering in coronary heart disease (CHD). Consequently, this elevated risk has spurred the search for non-lipid targets, such as homocysteine (HCY). However, the combined effect of HCY with LDL-C and the overall potential for combined risk stratification remain unclear. METHODS: This retrospective cohort study included patients with CHD confirmed by coronary angiography or computed tomography angiography at the General Hospital of Ningxia Medical University between January 2019 and December 2021. Participants were stratified by baseline LDL-C levels (<1.8 vs. ≥1.8 mmol/L) and HCY (<15 vs. ≥15 μmol/L). Major adverse cardiovascular events (MACEs) were employed as the primary endpoint, defined as a composite of all-cause death, stroke, non-fatal myocardial infarction, or unplanned revascularization. RESULTS: A total of 744 MACEs were recorded during the 25-month follow-up. Elevated levels of LDL-C (adjusted hazard ratio (aHR) = 1.38, 95% confidence interval (CI): 1.09-1.73) and HCY (aHR = 1.47, 95% CI: 1.19-1.81) were independently associated with a higher risk of MACEs. The risk was synergistic when both factors were elevated, as patients in the high LDL-C and high HCY group had a significantly increased risk (aHR = 1.97, 95% CI: 1.34-2.90) compared to the reference group with low levels. CONCLUSION: LDL-C and HCY are independent predictors of MACEs in patients with CHD, and the combined use of these indices improves risk stratification. Thus, integrating these indices into clinical practice could improve personalized management strategies and outcomes in this high-risk population.
Barriers to Participation and Adherence in Cardiac Rehabilitation Programmes: A Scoping Review of Recent Evidence from Industrialized and Developing Countries.
Latir A, Hafiz E, Suhaimi A
Rev Cardiovasc Med · 2026 Mar · PMID 41923728 · Full text
Participation and adherence to cardiac rehabilitation (CR) remain low worldwide; meanwhile, differences in barriers between industrialized and developing countries have not been well synthesized. A scoping review was con...
Participation and adherence to cardiac rehabilitation (CR) remain low worldwide; meanwhile, differences in barriers between industrialized and developing countries have not been well synthesized. A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to map recent evidence (2014-2025) on barriers to CR participation and adherence in industrialized and developing settings. Searches conducted in major databases identified 538 records, of which 19 met the inclusion criteria for thematic analysis. Participation in CR ranged from 12.3% to 81% in industrialized countries and from 5% to 70% in developing settings, while adherence ranged from 70.8% to 90.3% and from 20.4% to 71.3%, respectively. Reported barriers can be clustered into patient-level beliefs and perceptions, logistical and work-related constraints, comorbidities and health status, socioeconomic and demographic factors, psychological characteristics, and health-system and environmental limitations. A wide variation in CR utilization persists globally, with distinct patterns of barriers across industrialized and developing contexts. These findings highlight the need for setting-specific strategies to improve CR participation and adherence.
Lipoprotein(a) as a Risk Factor for Recurrent Acute Coronary Syndrome and Unplanned Revascularization in Fractional Flow Reserve-Negative Lesions.
Zhao Y, Luo J, Xu K … +2 more , Li Y, Han Y
Rev Cardiovasc Med · 2026 Mar · PMID 41923727 · Full text
BACKGROUND: This study aimed to explore the association between serum lipoprotein(a) [Lp(a)] levels and recurrent acute coronary syndrome (ACS) and revascularization of target lesions in patients with ACS who showed no f...
BACKGROUND: This study aimed to explore the association between serum lipoprotein(a) [Lp(a)] levels and recurrent acute coronary syndrome (ACS) and revascularization of target lesions in patients with ACS who showed no functional ischemia on fractional flow reserve (FFR) testing during coronary angiography (CAG). METHODS: The retrospective observational study was conducted at the General Hospital of Northern Theater Command and included 513 patients with new ACS recruited from 23 February 2016 to 6 November 2023 and followed up. These patients underwent CAG examination and were found to have at least one coronary artery with moderate or greater stenosis, and also underwent FFR measurement with FFR value >0.80. Patients experienced recurrent ACS and underwent unplanned revascularization were defined as the revascularization group, while patients did not experience recurrent ACS and undergo unplanned revascularization were assigned to the no revascularization group. The study employed propensity score matching (PSM) and receiver operating characteristic (ROC) curve analysis to evaluate the correlation between serum Lp(a) and recurrent ACS and unplanned revascularization in target lesion with FFR value >0.80. RESULTS: Serum Lp(a) levels were higher in female patients. There were no statistically significant differences in the basic clinical characteristics, medication use, laboratory test results or ejection fraction values between the two groups. During a average follow-up of 6.5 years, 119 patients (23.2%) experienced recurrent ACS and unplanned revascularization in the target lesion. The level of serum Lp(a) in the patients that underwent unplanned revascularization was significantly higher than in the group that did not undergo repeated revascularization (65.80 mmol/L vs. 60.57 mmol/L, = 0.034). CONCLUSION: Serum Lp(a) is an independent risk factor for recurrent ACS and unplanned revascularization in patients with ACS and FFR negative plaque.
Intelligent Decision Support for Transcatheter Aortic Valve Replacement: Machine Learning Spans From Anatomical Assessment to Dynamic Risk Modeling.
Hu X, Xie P, Li Y
Rev Cardiovasc Med · 2026 Mar · PMID 41923726 · Full text
This study aimed to investigate the application of machine learning (ML) in transcatheter aortic valve replacement (TAVR) and to demonstrate that, owing to the unique strengths of ML, this field outperforms conventional...
This study aimed to investigate the application of machine learning (ML) in transcatheter aortic valve replacement (TAVR) and to demonstrate that, owing to the unique strengths of ML, this field outperforms conventional approaches in both preoperative assessment and postoperative prediction of TAVR. Nonetheless, TAVR is the preferred treatment option for medium- and high-risk patients with aortic stenosis, a common valvular disease, because of the associated minimally invasive nature and rapid recovery. However, challenges remain in preoperative evaluation and in predicting postoperative complications. Thus, ML technology offers innovative solutions for these challenges. This study provides an overview of current ML applications in TAVR and evaluates the associated benefits in measuring preoperative anatomical parameters and predicting postoperative complications. Indeed, the superiority of ML models for preoperative planning can be assessed by comparing ML model-derived data with measurements from senior and junior observers across various aortic root anatomical parameters. Additionally, this review discusses the challenges of applying ML in TAVR, including data acquisition, privacy protection, and model generalizability. The ongoing advancement of artificial intelligence (AI) technologies, particularly the integration of explainable AI and federated learning, is expected to enhance the accuracy and personalization of preoperative planning and postoperative prediction for TAVR. This progress will facilitate broader application of these technologies, ultimately benefiting a wider patient population.
Advances in Non-Invasive Myocardial Stiffness Assessment and Clinical Applications in Hypertrophic Cardiomyopathy.
Gao Y, Qi N, Gao H … +2 more , Deng Y, Liu Y
Rev Cardiovasc Med · 2026 Mar · PMID 41923725 · Full text
Myocardial stiffness is a central determinant of diastolic dysfunction and clinical outcomes in hypertrophic cardiomyopathy; however, a non-invasive evaluation of myocardial stiffness remains challenging. Emerging techni...
Myocardial stiffness is a central determinant of diastolic dysfunction and clinical outcomes in hypertrophic cardiomyopathy; however, a non-invasive evaluation of myocardial stiffness remains challenging. Emerging techniques, such as elastography, offer direct, non-invasive quantification of myocardial stiffness, providing critical insights beyond conventional indirect surrogates. This review summarizes the principles, validation, and clinical evidence for current non-invasive techniques for assessing myocardial stiffness. We further discuss the clinical applications of these techniques in hypertrophic cardiomyopathy, including diagnostic refinement, fibrosis detection, risk stratification, and treatment monitoring, as well as the challenges and future directions required for broader clinical translation. Ultimately, the non-invasive assessment of myocardial stiffness holds promise for transforming patient management to phenotyping and therapeutic decision-making through a more precise, mechanism-based approach.
Vascular Protection of Poly(ADP-ribose) Polymerase Inhibitors in the Combination Therapy With Vascular Endothelial Growth Factor Signaling Pathway Inhibitors.
Ma J, Li C, Wang W … +6 more , Fan X, Wei T, Ma X, Wang Y, Feng C, Yu J
Rev Cardiovasc Med · 2026 Mar · PMID 41923724 · Full text
The Poly(ADP-ribose) polymerase (PARP) family comprises seventeen members that catalyze poly- or mono- adenosine diphosphate (ADP)-ribosylation, a pivotal post-translational modification regulating a wide array of cellul...
The Poly(ADP-ribose) polymerase (PARP) family comprises seventeen members that catalyze poly- or mono- adenosine diphosphate (ADP)-ribosylation, a pivotal post-translational modification regulating a wide array of cellular processes, including deoxyribonucleic acid (DNA) repair, apoptosis, protein synthesis, cellular proliferation, and responses to oxidative stress. PARP inhibitors (PARPIs) exhibit selective cytotoxicity in cancers with breast cancer susceptibility gene () mutations or defects in homologous recombination. Activation of PARP, indicated by increased poly(ADP-ribose) (PAR) accumulation, is implicated in various disease states such as ischemia-reperfusion injury, vascular disorders, and diabetic complications. Clinically, PARPIs, in combination with anti-angiogenic therapies, not only show efficacy as monotherapies in epithelial ovarian cancer but also mitigate hypertension induced by anti-angiogenic agents. This review consolidates recent advancements in understanding the dual therapeutic potential of PARP inhibition, encompassing both antineoplastic and cardioprotective effects.
Outcome Comparisons of Direct Coverage Versus Fenestration for an Isolated Left Vertebral Artery in Zone 2 TEVAR: A Retrospective Study.
Pu Z, Fang K, Lu J … +6 more , Zhang Y, Zhao J, Fan B, Liu Y, Luo M, Shu C
Rev Cardiovasc Med · 2026 Mar · PMID 41923723 · Full text
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) in Zone 2 frequently necessitates coverage of the isolated left vertebral artery (ILVA), a congenital vascular anomaly, to ensure adequate proximal sealing. However...
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) in Zone 2 frequently necessitates coverage of the isolated left vertebral artery (ILVA), a congenital vascular anomaly, to ensure adequate proximal sealing. However, the clinical requirement of ILVA revascularization remains uncertain. Thus, this study aimed to compare the outcomes between ILVA coverage and fenestration during Zone 2 TEVAR. METHODS: We retrospectively analyzed the clinical records of patients with ILVA who underwent Zone 2 TEVAR between September 2010 and August 2023. Patients were divided into two groups: Coverage Group (n = 23) and Fenestration Group (n = 33). Baseline characteristics, surgical outcomes, and changes in left and right vertebral artery diameters pre- and postoperatively were compared. Continuous variables were compared using Student's -test or Mann-Whitney U test, depending on the distribution. Categorical variables were analyzed using the chi-square test or Fisher's exact test. RESULTS: The overall cohort had a mean age of 54.48 ± 10.31 years, with 89.29% of participants male and a mean body mass index (BMI) of 25.88 ± 3.5 kg/m. The Fenestration Group was significantly older than the Coverage Group (56.82 ± 8.78 vs. 51.13 ± 11.56; = 0.04). Technical success of the TEVAR was achieved in both groups in 98.21% of cases, with no perioperative mortality. Simultaneous left subclavian artery stenting was performed more frequently in the Fenestration Group (57.58% vs. 21.74%; = 0.008). At discharge, patients in the Coverage Group demonstrated a significantly greater reduction in left vertebral artery diameter compared with the Fenestration Group (13.64% [5.52%, 22.4%] vs. 0 [-3.29%, 5.13%]; < 0.001). The incidence of vertebral artery diameter reduction was significantly higher in the Coverage Group compared with the Fenestration Group (39.13% vs. 6.06%; < 0.01). Follow-up computed tomography angiography demonstrated a greater reduction in left vertebral artery diameter in the Coverage Group (52.94% vs. 14.29%; = 0.020), while occlusion rates were comparable between groups (29.41% vs. 4.76%; = 0.070). CONCLUSIONS: Fenestration is associated with a lower incidence of postoperative ILVA diameter reduction compared with direct coverage during Zone 2 TEVAR. These findings highlight the potential benefit of ILVA revascularization and underscore the need for further validation in larger studies.
Three-Dimensional Echocardiographic Evaluation of Rheumatic Tricuspid Valve Disease: A Prospective Single-Center Cohort Study.
Abdelnabi M, Almaghraby A, Gamal M … +2 more , Abdel-Hay MA, Abdelgawad H
Rev Cardiovasc Med · 2026 Mar · PMID 41923722 · Full text
BACKGROUND: Rheumatic heart disease (RHD) remains a prevalent cause of valvular heart pathology worldwide, especially in younger populations of low- and middle-income countries. Tricuspid valve (TV) involvement in RHD is...
BACKGROUND: Rheumatic heart disease (RHD) remains a prevalent cause of valvular heart pathology worldwide, especially in younger populations of low- and middle-income countries. Tricuspid valve (TV) involvement in RHD is usually secondary to left-sided valvular lesions and is often underdiagnosed, since two-dimensional echocardiography (2DE) has limited ability to visualize the complex tricuspid anatomy. Compared with 2DE, three-dimensional echocardiography (3DE) provides an en face visualization of the tricuspid valve, enabling direct planimetric measurements and detailed commissural assessment, and offers advantages for evaluating complex valvular heart disease (VHD). Thus, this study aimed to assess baseline characteristics and valvular morphology in patients with rheumatic tricuspid valve disease using 3DE. METHODS: A prospective cohort single-center study conducted between April 2022 and April 2023 included 34 patients with rheumatic TV involvement. Baseline demographics, morphological features, and hemodynamic parameters were assessed using transthoracic 3DE. RESULTS: The mean age of included patients was 45.5 ± 9.1 years, and 88.2% were female. Most patients had associated left-sided valvular involvement (mitral or combined mitral and aortic). Commissural fusion (50%), leaflet thickening (82.4%), restricted mobility (85.3%), and coaptation loss (58.8%) were predominantly noted. The mean diastolic TV gradient was 3.9 ± 3.4 mmHg, planimetry area 3.3 ± 1.7 cm, and estimated pulmonary artery systolic pressure 43.3 ± 19.5 mmHg. Mean right ventricular (RV) global longitudinal strain was -23.6 ± 6.1%. CONCLUSION: Rheumatic TV involvement is characterized by commissural fusion, leaflet thickening, and coaptation loss, highlighting the diagnostic value of 3DE in identifying morphological patterns that may guide intervention planning.
Pathways of Care for Patients Who Undergo Primary Percutaneous Coronary Intervention for STEMI: A Review of "" vs. "" Clinical Scenarios.
Kwok CS, Potluri R, Sarma J … +2 more , Bainey KR, Borovac JA
Rev Cardiovasc Med · 2026 Mar · PMID 41923721 · Full text
Care processes and outcomes for patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remain heterogeneous. A "patient pathway" framework-defined as t...
Care processes and outcomes for patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remain heterogeneous. A "patient pathway" framework-defined as the sequence of clinically relevant events from symptom onset through diagnosis, reperfusion, and early recovery-can help identify real-world points of failure and opportunities for system-level improvement. In this narrative review, we contrast an "ideal" STEMI pathway with the pathways commonly observed in routine practice for patients treated with primary PCI, and we contextualize deviations from best practice from patient, clinician, health service, and societal perspectives. From the patient's perspective, the priority is rapid symptom recognition and seeking care; however, delays are frequent, particularly in individuals with mild, atypical, or non-classical presentations, prolonging total ischemic time and increasing myocardial injury. Clinicians aim to diagnose STEMI promptly and initiate evidence-based therapy and reperfusion without delay, yet diagnostic uncertainty and competing differentials can contribute to missed or late diagnoses. Health systems seek to provide timely, efficient, and cost-effective emergency revascularization, but performance is influenced by pre-hospital logistics, triage, catheterization laboratory availability, and inter-hospital transfer processes. At the societal level, STEMI imposes substantial mortality, morbidity, and economic burden through premature death and disability. We synthesize evidence on delays to revascularization, misdiagnosis, populations at risk for atypical presentation, and pragmatic interventions to improve care. We conclude that pathway-based analyses offer a structured approach to defining desirable STEMI care trajectories and to reducing missed opportunities for better outcomes.
Myocardial Revascularization in 2025: A Clinical Perspective on the Evolution of Technologies, Strategic Decision-Making, and Future Horizons.
Sharma V, Ahuja K
Rev Cardiovasc Med · 2026 Mar · PMID 41923720 · Full text
Coronary artery disease remains the leading cause of death worldwide, causing the field of myocardial revascularization to evolve rapidly. This review synthesizes current evidence and emerging trends, providing clinician...
Coronary artery disease remains the leading cause of death worldwide, causing the field of myocardial revascularization to evolve rapidly. This review synthesizes current evidence and emerging trends, providing clinicians with practical guidelines to support decision-making in practice. Current drug-eluting stents have attained excellent safety profiles, with restenosis rates below 3%. Percutaneous treatment of complex lesions is now routinely feasible, with success rates of 90-95% in experienced institutions. Surgical revascularization remains the standard of care for complex multivessel disease, and total arterial grafting provides a strong long-term survival advantage. Nonetheless, emerging technologies, such as artificial intelligence (AI)-guided interventions, robotic interventions, and precision medicine strategies, have the potential to overcome current limitations and extend advanced therapies to high-risk patients. The optimal revascularization plan increasingly depends on integrating anatomical complexity, physiological significance, patient-specific features, and institution-specific expertise. Heart team-based decision-making is now a necessity, particularly in difficult cases where hybrid strategies might offer particular advantages. Over the coming decade, the extensive use of AI-assisted procedural planning, the broader adoption of minimally invasive treatments, and the establishment of prescription-based personalized medicine protocols are likely to be observed. Success will depend on addressing current challenges, including health disparities, delayed complications, and increasing heterogeneity in the patient population.
The Impact of Single-Dose Alirocumab on Efficacy and Safety After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction: A Single-Center Retrospective Real-World Study.
Wang P, Wang H, Yan D … +1 more , Zhang Z
Rev Cardiovasc Med · 2026 Mar · PMID 41923719 · Full text
BACKGROUND: Residual inflammation and persistent lipid abnormalities substantially increase the risk of adverse clinical outcomes in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronar...
BACKGROUND: Residual inflammation and persistent lipid abnormalities substantially increase the risk of adverse clinical outcomes in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI). Although proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to improve cardiovascular outcomes, the efficacy, safety, and prognosis of these inhibitors when administered as a single dose after PPCI in real-world practice remain unclear. METHOD: A retrospective study of patients with acute ST-segment elevation myocardial infarction (STEMI) admitted between May 2023 and May 2024. Patients were assigned to an alirocumab group or a conventional treatment group based on whether a single dose of alirocumab was administered within 6 hours of PPCI. Baseline differences between groups were balanced using 1:1 propensity score matching (PSM). The occurrence of major adverse cardiovascular events (MACEs) at 12 months post-procedure was applied as the primary endpoint. Secondary endpoints included lipid profiles, inflammatory markers, cardiac function, quality-of-life changes, and safety outcomes. RESULTS: A non-significant downward trend in the incidence of MACEs at 12 months post-PPCI was observed in the alirocumab group compared with the conventional treatment group (log-rank = 0.242). A single dose of alirocumab significantly reduced low-density lipoprotein cholesterol (LDL-C) at 1 month ( = 0.011) and attenuated inflammation markers at 24 hours postoperatively. At 12 months, the alirocumab group showed improved cardiac function with significantly reduced left ventricular end-systolic volume (LVESV, = 0.009) and modest but statistically significant improvement in quality of life ( = 0.012), primarily driven by enhanced physical activity ( < 0.001), alongside reduced insecurity ( < 0.001). No increased incidence of adverse events was observed ( > 0.05). CONCLUSIONS: This study demonstrated that a single dose of alirocumab in STEMI patients undergoing PPCI was associated with significant improvement in LDL-C levels, attenuation of early postoperative inflammation, and a favorable trend toward improved cardiac function and quality of life, while maintaining an acceptable safety profile.
Regarding: "Exercise Stress Echocardiography Predicts Adverse Cardiovascular Events in Hypertrophic Cardiomyopathy: A 5-Year Prospective Study".
Su Y, Peng Q, Yin L … +1 more , Li C
Rev Cardiovasc Med · 2026 Mar · PMID 41923718 · Full text
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Effects of Fluoroquinolones on Aortic Aneurysm or Dissection Processes: A Systematic Review and Meta-Analysis.
Wu ZY, Yang Y, Li ZL … +4 more , Zhao WX, Chen ZG, Diao YP, Li YJ
Rev Cardiovasc Med · 2026 Mar · PMID 41923717 · Full text
BACKGROUND: This systematic review/meta-analysis investigated the risks of fluoroquinolones (FQs) for aortic aneurysms (thoracic/abdominal) and Stanford A/B dissections. METHODS: We searched EMBASE, Ovid, PubMed, Web of...
BACKGROUND: This systematic review/meta-analysis investigated the risks of fluoroquinolones (FQs) for aortic aneurysms (thoracic/abdominal) and Stanford A/B dissections. METHODS: We searched EMBASE, Ovid, PubMed, Web of Science, and Scopus databases in February 2024. Eligible observational studies were those that presented adjusted risk estimates for aortic aneurysm or dissection (AAD) incidence, aortic-specific mortality, or all-cause mortality in FQ-treated versus untreated unexposed populations. RESULTS: A total of 13 studies were included (36,224,419 participants), eight of which were cohort studies, two were nested case-control studies, and three were case-crossover designs. FQ exposure was associated with significantly elevated AAD risk within 30 days (relative risk (RR) = 3.40, 95% confidence interval (CI) = [2.72, 4.24]; heterogeneity: = 41.5%, = 0.11) and 60 days (RR = 3.53, 95% CI = [2.78, 4.49]; heterogeneity: = 87.0%, < 0.0001). The analysis also revealed a higher all-cause mortality risk for FQs versus non-exposed controls (odds ratio (OR) = 1.44, 95% CI = [1.08, 1.93]; heterogeneity: = 0%, = 0.80). Subgroup analysis demonstrated comparable aortic dissection (AD) and aortic aneurysm (AA) risks, except for a significantly increased AA risk at 30 days (RR = 9.13, 95% CI = [6.05, 13.78]; heterogeneity: = 68.7%, = 0.07) and 60 days (OR = 1.69, 95% CI = [1.27, 2.26]; heterogeneity: = 52%, = 0.10). CONCLUSION: This meta-analysis found a significant association between FQ use and short-term AAD risk. These results suggest that clinicians should weigh the risks of AAD before prescribing FQs, especially in patients with aortic vulnerability or pre-existing aortic pathology, considering alternative treatments when feasible. THE PROSPERO REGISTRATION: CRD42024509853 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024509853).
Association Between Neutrophil-to-Lymphocyte Ratio and Mortality Risk Among Patients With Hyperlipidemia Across Different Glycemic Status: A Longitudinal Cohort Study From NHANES 1999-2018.
Zhou Q, Chen Y, Ju H … +1 more , Zhao X
Rev Cardiovasc Med · 2026 Mar · PMID 41923716 · Full text
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) has been linked as a marker of systemic inflammation to adverse outcomes in various metabolic diseases. However, the association of the NLR with mortality risk among p...
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) has been linked as a marker of systemic inflammation to adverse outcomes in various metabolic diseases. However, the association of the NLR with mortality risk among patients with hyperlipidemia remains inconclusive. Thus, this research aimed to investigate whether the NLR is associated with mortality risk among individuals with hyperlipidemia and to examine how glycemic status influences this relationship. METHODS: Weighted Cox regression, restricted cubic splines (RCS), and subgroup analyses were employed to evaluate the association between the NLR and mortality risk in patients with hyperlipidemia. Time-dependent receiver operating characteristic (ROC) analysis was conducted to assess the predictive accuracy for mortality risk. RESULTS: In Model 3, individuals in the highest NLR quartile had a 40% higher risk of all-cause mortality (95% confidence interval (CI): 1.19-1.65; for trend <0.001) and an 86% higher risk of cardiovascular mortality (95% CI: 1.28-2.68; for trend <0.001) compared with those in the lowest quartile. Time-dependent ROC analysis confirmed the superior performance of the NLR in predicting cardiovascular mortality risk. A significant interaction between the NLR and diabetes mellitus (DM) was observed for both all-cause and cardiovascular mortality in the subgroup analyses. Given this finding, we further examined the association between the NLR and mortality, stratified by glycemic status. The results indicated that the association between the NLR and mortality was stronger among individuals with DM. CONCLUSIONS: An elevated NLR is closely associated with an increased risk of mortality among individuals with hyperlipidemia, and the presence of DM significantly strengthens this association.
Integrating Genetic Counseling in Cardiology Clinics: From Guidelines to Practice.
Sanoudou D, Vakrou S, Frogoudaki A
Rev Cardiovasc Med · 2026 Mar · PMID 41923715 · Full text
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Dynamic Strain Imaging in Hypertrophic Cardiomyopathy: Refining Risk Stratification Beyond Conventional Metrics.
Cheng W
Rev Cardiovasc Med · 2026 Mar · PMID 41923714 · Full text
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Advancements and Applications of Artificial Intelligence in Hypertrophic Cardiomyopathy: A Comprehensive Review.
Ma H, Li J, Ta S … +3 more , Yu L, Ruan F, Liu L
Rev Cardiovasc Med · 2026 Mar · PMID 41923713 · Full text
Hypertrophic cardiomyopathy (HCM) is a common cardiovascular disease and one of the leading causes of exercise-induced sudden cardiac death in adolescents. HCM presents complex diagnostic, prognostic, and management chal...
Hypertrophic cardiomyopathy (HCM) is a common cardiovascular disease and one of the leading causes of exercise-induced sudden cardiac death in adolescents. HCM presents complex diagnostic, prognostic, and management challenges due to the phenotypic heterogeneity and clinical course. Artificial intelligence (AI), machine learning (ML), and deep learning (DL) technologies are expected to transform the roles of echocardiography, electrocardiography (ECG), and cardiac magnetic resonance (CMR) imaging in the clinical management of HCM. AI methods can fully integrate clinical and imaging data to enable a comprehensive assessment of the risk profile of a patient. However, challenges remain, such as insufficient data standardization across multiple sources, limited model interpretability, and data privacy issues. Despite these challenges, AI-based approaches have the potential to revolutionize the management of HCM by providing timely, accurate diagnoses and personalized treatment strategies based on individual patient risk profiles. This review systematically examines the current landscape of AI applications in HCM data analytics, with a focus on methodological advancements and clinical implementations. Furthermore, this review aims to facilitate the transition from experience-based to data-driven paradigms in HCM diagnosis, thereby advancing precision medicine and individualized patient management.
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