Reviews In Cardiovascular Medicine[JOURNAL]
Sun
200 papers
The Extent and Phenotype of Coronary Artery Disease in Diabetes and Prediabetes: Insights From Imaging Studies and Potential Therapeutic Implications.
Gurgoglione FL, Navacchi R, Ristagno A … +15 more , Benatti G, Solinas E, Tadonio I, Denegri A, Donelli D, Magnani G, Torlai Triglia L, Bianconcini M, Barocelli F, Covani M, De Gregorio M, Dei Cas A, Bonadonna RC, Vignali L, Niccoli G
Rev Cardiovasc Med · 2026 Feb · PMID 41789328 · Full text
Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder that is associated with a markedly increased risk of coronary artery disease (CAD) and cardiovascular (CV) mortality compared with the general population. P...
Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder that is associated with a markedly increased risk of coronary artery disease (CAD) and cardiovascular (CV) mortality compared with the general population. Prediabetes, a heterogeneous intermediate glycemic state defined by impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), and/or glycated hemoglobin (HbA1c) levels between 5.7% and 6.4%, is likewise associated with a significantly higher CV risk than normoglycemia. Over the past decade, both overall CAD burden and specific plaque morphologic features have been established as robust predictors of future adverse CV events using invasive and non-invasive coronary imaging modalities. More recently, growing evidence has highlighted the influence of glycemic abnormalities on the extent, progression, and phenotype of CAD, underscoring the interplay between metabolic dysfunction and atherosclerotic vulnerability. Therefore, this review aims to (i) elucidate the pathophysiological mechanisms linking T2DM and prediabetes with atherogenesis, (ii) summarize findings from coronary imaging studies in these populations, and (iii) evaluate therapeutic strategies designed to promote plaque stabilization and regression.
Revolutionization of the Leadless Pacemaker Implantation: Hemodynamic Verification Slashes Vascular Complications.
Zhang X, Jiang L, Xu Y … +1 more , Liu X
Rev Cardiovasc Med · 2026 Feb · PMID 41789327 · Full text
BACKGROUND: The procedure of implanting a Micra leadless pacemaker (Medtronic PLC, Dublin, Ireland) via transfemoral venous access carries the risk of vascular complications. Our study examined whether Liu's hemodynamic...
BACKGROUND: The procedure of implanting a Micra leadless pacemaker (Medtronic PLC, Dublin, Ireland) via transfemoral venous access carries the risk of vascular complications. Our study examined whether Liu's hemodynamic verification technique, a basic bedside evaluation of flow and pulsatility through the sheath side port before dilator advancement, minimizes vascular complications in Micra implantation. METHODS: We conducted a retrospective analysis of 465 consecutive Micra implantations performed at the Department of Cardiology, West China Hospital of Sichuan University, from December 2019 to November 2023. Participants were categorized into two groups: Group A (n = 389), which employed pre-dilation hemodynamic verification with sheath blood flow analysis (Liu's method), and Group B (n = 76), which used standard vascular access. The groups were compared based on demographics, procedural specifics, and vascular complications. RESULTS: Compared with the standard puncture method, Liu's technique was linked to a much lower incidence of vascular complications (0.5% vs. 3.9%; < 0.05). No major vascular complications necessitating surgical or endovascular treatment occurred in Group A (0% vs. 2.63%; < 0.01). The method allowed quick identification of accidental arterial entry and immediate corrective actions without requiring extra specialized tools. No increase in procedure duration or complications related to the Micra device was observed. CONCLUSION: In this single-center retrospective study of 465 consecutive Micra implantations, Liu's method for hemodynamic verification significantly reduced the rate of vascular complications and completely prevented major vascular events compared with traditional femoral venipuncture. The technique is straightforward, economical, easy to learn, and could be a viable option when ultrasound guidance is not accessible.
Multi-Omics Mechanisms of Trimethylamine Oxide and Cardiovascular Disease: A Review.
Yu H, Li F
Rev Cardiovasc Med · 2026 Feb · PMID 41789326 · Full text
Cardiovascular diseases (CVDs) rank among the most prevalent conditions globally, encompassing coronary heart disease, hypertension, cardiomyopathy, and heart failure. The global prevalence of CVD continues to rise despi...
Cardiovascular diseases (CVDs) rank among the most prevalent conditions globally, encompassing coronary heart disease, hypertension, cardiomyopathy, and heart failure. The global prevalence of CVD continues to rise despite available therapies such as interventional procedures and pharmacotherapy, which remain associated with high rates of recurrence and mortality. In recent years, with a deepening understanding of the human gut microbiome, researchers have discovered that gut microbiota and their metabolites play a significant role in the development and progression of cardiovascular diseases. Among these, trimethylamine N-oxide (TMAO), a major metabolite of gut microbiota, has garnered extensive attention. Thus, this review leverages a multi-omics perspective to compare the commonalities and differences in TMAO-related mechanisms across various cardiovascular diseases. Moreover, this review aims to construct a TMAO-driven pathogenic network and critically evaluate the translational potential of this metabolite as a disease biomarker and therapeutic target, alongside current challenges.
Targeting Tumor Necrosis Factor-α Mitigates Glucose Fluctuation-Induced Aortic Valve Fibrosis: Insights From Diabetic Rat Models.
Chen YJ, Chen HP, Zhang CY … +4 more , Rong XS, Li KL, Xiao F, Wang RX
Rev Cardiovasc Med · 2026 Feb · PMID 41789325 · Full text
BACKGROUND: Calcific aortic valve disease (CAVD) is a progressive condition characterized by inflammation and fibrous calcification remodeling, with aortic valve fibrosis (AVF) representing the associated subclinical pha...
BACKGROUND: Calcific aortic valve disease (CAVD) is a progressive condition characterized by inflammation and fibrous calcification remodeling, with aortic valve fibrosis (AVF) representing the associated subclinical phase. Early intervention with oral medication during the AVF stage may prevent and slow the development and progression of CAVD. Previous studies have demonstrated that individuals with diabetes are at an elevated risk of CAVD and also experience a significantly higher incidence of aortic valve stenosis, which rapidly advances from mild to severe stages. Significantly, the adverse effects of glucose fluctuations (GFs) on cardiovascular diseases exceed those associated with persistent hyperglycemia. Nonetheless, the mechanisms through which GFs contribute to AVF, the early stage of CAVD, remain inadequately understood. Consequently, this study aimed to investigate the inflammatory mechanisms underlying AVF induction in response to fluctuations in glucose levels. METHODS: Diabetic rat models were established through intraperitoneal injection of streptozotocin (STZ). GFs in these diabetic rats were managed by alternating between a Western diet and periods of fasting. Infliximab was administered to inhibit inflammation mediated by tumor necrosis factor-alpha (TNF-α). For the study, echocardiographic assessments of the aortic valve and left ventricular function were conducted on the diabetic rats after eight weeks. Aortic valves from various groups of rats were dissected to test fibrosis, extracellular matrix remodeling, and variations in inflammatory factors, which were examined using hematoxylin and eosin (HE) staining, modified Movat-Russell pentachrome staining, and immunohistochemical staining, respectively. For the study, porcine valvular interstitial cell (VIC) cultures were used to establish GF-induced fibrosis, thereby elucidating the underlying inflammatory mechanisms. RESULTS: Our study demonstrated that GFs exacerbate AVF and dysfunction in diabetic patients. This is characterized by increased peak blood flow velocity and peak cross-valve gradient of the aortic valve. Furthermore, we observed intensified TNF-α-mediated inflammatory responses, characterized by the upregulation of T lymphocytes and macrophages, as well as activation of the Janus kinase 1 (JAK1)/signal transducer and activator of transcription 3 (STAT3) pathway. Notably, these pathological processes were ameliorated by the administration of infliximab, resulting in the downregulation of fibrotic and inflammatory markers, as well as improved echocardiographic indices. Our research findings indicate that TNF-α-mediated inflammation exacerbates fibrotic aortic valve processes through GFs, which are mediated by the JAK1/STAT3 signaling pathway. CONCLUSIONS: Targeting TNF-α may serve as a potential therapeutic target to mitigate the progression of inflammation-induced aortic valve damage and fibrosis.
The Impact of Dual Antiplatelet Therapy Guided by Platelet Function Testing on the Prognosis of Patients With Dual High-Risk Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.
Lei M, Li Y, Wang J … +5 more , Sun X, Li C, Wang X, Zhao Z, Xue Z
Rev Cardiovasc Med · 2026 Feb · PMID 41789324 · Full text
BACKGROUND: To investigate the effect of dual antiplatelet therapy (DAPT) guided by platelet function testing (PFT) on the prognosis of patients with acute coronary syndrome (ACS) at a high risk for ischemia and bleeding...
BACKGROUND: To investigate the effect of dual antiplatelet therapy (DAPT) guided by platelet function testing (PFT) on the prognosis of patients with acute coronary syndrome (ACS) at a high risk for ischemia and bleeding who underwent percutaneous coronary intervention (PCI). METHODS: A retrospective analysis was conducted on 1816 patients with ACS and a dual high risk who underwent PCI at a single center from March 2017 to November 2022. Patients were stratified into the guided DAPT group (n = 712) and standard DAPT group (n = 1104) according to whether the patient received PFT. All patients received oral DAPT for a duration of 12 months post-PCI. The deadline for the endpoint was within 12 months of receiving PCI. The primary endpoint was the number of net clinical adverse events (NACEs) that occurred during follow-up, including the composite endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding, as defined by the bleeding academic research consortium (BARC) (type 3 or greater). RESULTS: Compared with the standard DAPT group, the guided DAPT group exhibited a lower incidence of NACEs (4.8% vs. 8.7%; = 0.001), MACCEs (3.9% vs. 6.7%; = 0.017), cardiac death (0.4% vs 1.5%; = 0.038), and stroke (0.6% vs. 2.5%; = 0.005) during follow-up. Cox regression analysis revealed that the incidence of NACEs (hazard ratio (HR): 0.543, 95% confidence interval (CI): 0.363-0.812; = 0.003), MACCEs (HR: 0.570, 95% CI: 0.364-0.893; = 0.014), cardiac death (HR: 0.249, 95% CI: 0.072-0.866; = 0.029), and stroke (HR: 0.174, 95% CI: 0.060-0.501; = 0.001) in the guided DAPT group was 0.543, 0.570, 0.249, and 0.174 times, respectively, that in the standard DAPT group. CONCLUSION: For patients with ACS who are at high risk in the East Asian population, the primary recommendation is to use PFT to guide DAPT within 12 months after PCI, which can reduce the incidence of NACEs, primarily by lowering the rate of MACCEs.
Employment of the Ascending Aortic Volume as a Predictor of Adverse Outcomes in Patients With Bicuspid Aortic Valve Disease.
Li H, Hu Y, Yuan H … +2 more , Chen T, Zhuang J
Rev Cardiovasc Med · 2026 Feb · PMID 41789323 · Full text
BACKGROUND: A bicuspid aortic valve (BAV) is a common congenital heart disease. The primary treatment for this condition involves the surgical replacement of both the aortic valve and the ascending aorta, typically throu...
BACKGROUND: A bicuspid aortic valve (BAV) is a common congenital heart disease. The primary treatment for this condition involves the surgical replacement of both the aortic valve and the ascending aorta, typically through the Bentall procedure. Traditionally, the timing of surgery in patients with BAV and aortic dilation is based on the maximum ascending aortic diameter. However, numerous patients who experienced adverse outcomes did not fulfil the established surgical criteria, highlighting the necessity for new predictive factors to guide surgical decisions more effectively. Thus, this study aimed to identify alternative parameters in patients with BAV that could serve as early indicators of surgical intervention and to establish clear threshold values. METHODS: A retrospective analysis was conducted among 101 patients diagnosed with BAV at our institution between January 2004 and December 2023 who underwent follow-up computed tomography angiography. Demographic and clinical data were collected, focusing on the influence of ascending aortic volume on adverse outcomes, measured from the aortic annulus to the origin of the brachiocephalic artery. RESULTS: The average ascending aortic volume, length, and diameter were 99,496.51 mm, 90.94 mm, and 38.79 mm, respectively. Logistic regression analysis identified that only ascending aortic volume ( = 0.0338) and volume-to-height ratio ( = 0.0331) were significantly associated with adverse outcomes. In a multiple logistic regression model, the volume-height index (VHI) was independently associated with adverse outcomes (odds ratio (OR) 1.0008, 95% confidence interval (CI) 1.00023-1.00182; = 0.048). Receiver operating characteristic (ROC) analysis determined the optimal cutoff value for the VHI as 66,340.5 mm/m (area under the curve (AUC) = 0.797, 95% CI 0.676-0.896). The Kaplan-Meier curve showed that the event-free survival rate of patients with a VHI >66,340.5 mm/m was consistently lower than that of the low VHI group; The difference between the two groups was statistically significant (log rank < 0.0001). CONCLUSION: The VHI is a strong predictor of adverse outcomes in patients with a BAV and can guide surgical intervention decisions.
Electrocardiogram P-Wave Dispersion and New-Onset Atrial Fibrillation: A Nested Case-Control Study.
Wu C, Ma Y, Yang P … +2 more , Li Y, Xu M
Rev Cardiovasc Med · 2026 Feb · PMID 41789322 · Full text
BACKGROUND: This study aimed to investigate the association between electrocardiogram (ECG) P-wave dispersion (Pd) in sinus rhythm and the risk of new-onset atrial fibrillation (NAF) within one year, to identify high-ris...
BACKGROUND: This study aimed to investigate the association between electrocardiogram (ECG) P-wave dispersion (Pd) in sinus rhythm and the risk of new-onset atrial fibrillation (NAF) within one year, to identify high-risk individuals earlier and improve clinical outcomes. METHODS: (1) This retrospective nested case-control study included patients diagnosed with NAF at Changzhou First People's Hospital between July 2022 and June 2023. Cases were defined as individuals without a previous atrial fibrillation (AF) diagnosis who developed NAF regardless of symptom status. Controls were matched 1:3 by age and sex from individuals with sinus rhythm during the same period. (2) Using the date of the NAF diagnosis as the index date, then ECGs, echocardiographic data, laboratory tests, and basic clinical characteristics in the sinus rhythm were collected via the electronic medical record system for all subjects within one year post-index date. (3) Differences in ECG parameters, echocardiographic parameters, blood biological indicators, and basic clinical characteristics in the sinus rhythm were compared between the two groups. (4) Conditional logistic regression models were used to evaluate the association between relevant ECG indicators and NAF, with curve fitting performed using generalized additive models (GAMs). RESULTS: (1) A total of 824 participants were enrolled, including 206 NAF cases and 618 matched controls. (2) A comparison between groups identified significantly higher diastolic blood pressure, glycated hemoglobin A1c, serum creatinine, P-wave duration, Pd, and left atrial diameter in the NAF group than the control group; meanwhile, uric acid, total cholesterol, high-density lipoprotein, and low-density lipoprotein were significantly lower (all < 0.05). (3) In fully adjusted conditional logistic regression models, increased Pd was independently associated with a higher risk of NAF within one year (odds ratio (OR): 1.149; 95% confidence interval (CI): 1.099-1.202; < 0.001). Curve fitting demonstrated a positive correlation between Pd and the risk of NAF. CONCLUSIONS: ECG Pd in the sinus rhythm was independently and positively associated with the risk of NAF within one year.
Proximal Anchoring Technique: A Novel Technique to Prevent Coronary Stent Longitudinal Deformation.
Zhang S, Gong Y, Zhang Y … +2 more , Sun D, Li Y
Rev Cardiovasc Med · 2026 Feb · PMID 41789321 · Full text
BACKGROUND: Precise coronary stent implantation is crucial for ostial and partial bifurcation lesions during percutaneous coronary intervention (PCI). Conventional post-dilation coronary stent implantation often causes l...
BACKGROUND: Precise coronary stent implantation is crucial for ostial and partial bifurcation lesions during percutaneous coronary intervention (PCI). Conventional post-dilation coronary stent implantation often causes longitudinal stent deformation (LSD); meanwhile, even a small area of protrusion into the proximal main branch (MB) can lead to severe problems. This study aimed to introduce a novel post-dilation technique, the proximal anchoring technique (PAT), and evaluate the associated feasibility and efficacy in achieving precise stent implantation and preventing LSD. METHODS: This bench study was performed in a tapered silicon vessel model, in which 3.5 × 28 mm-sized everolimus-eluting stents (Xience Xpedition™; Abbot, USA) were deployed at a nominal pressure. Post-dilation was conducted using two different strategies: the proximal anchor followed by distal post-dilation group (PAT group) and the conventional post-dilation group (dilation from distal to proximal) (D-P group). After each step, the subsequent changes in stent length were measured by optical coherence tomography (OCT). Additionally, three clinical PCI cases in which PAT and conventional post-dilation were employed are presented. RESULTS: The longitudinal elongation of stents was significantly increased in the D-P group compared with the PAT group ( < 0.001). The OCT measurements showed that the stents were elongated during every step of the procedure in the D-P group (29.35 ± 0.10 mm vs. 29.65 ± 0.10 mm; = 0.0054), but only slightly elongated in the first step of the post-dilation in the PAT group (28.73 ± 0.12 mm vs. 28.87 ± 0.12 mm; = 0.2262). CONCLUSIONS: We present a novel technique, PAT, to assist in more precise coronary stent implantation by preventing LSD for partial ostial and bifurcation lesions during PCI.
Associations Between Controlling Nutritional Status and Allostatic Load With Heart Failure Across Different Depressive States: A Cross-Sectional Study Using NHANES 2005-2018 Data.
Li L, Zhai Y, Liu A … +1 more , Su J
Rev Cardiovasc Med · 2026 Feb · PMID 41789320 · Full text
BACKGROUND: The controlling nutritional status (CONUT) and allostatic load (AL) indices indicate significant correlations with heart failure (HF). Given that depressive status associated with metabolic dysregulation may...
BACKGROUND: The controlling nutritional status (CONUT) and allostatic load (AL) indices indicate significant correlations with heart failure (HF). Given that depressive status associated with metabolic dysregulation may influence these associations, this research aimed to explore whether depressive status modulates the associations between these two indices and HF. METHODS: Data were analyzed from 4632 participants aged ≥20 years in the National Health and Nutrition Examination Survey (NHANES), 2005-2018. After applying weighting (WTINT2YR) to the included data, samples with missing data and those without weighted processing were excluded. Binary logistic regression analysis was then employed to investigate the relationships between CONUT, AL, and HF. Subgroup analysis was performed with depressive status as a stratifying factor, and a restricted cubic spline (RCS) model was used to investigate the presence of linear or non-linear relationships between the two clinical indices and HF. Receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were employed to evaluate the predictive performance of the different models for HF. RESULTS: Both CONUT and AL were positively correlated with HF in Model 1 (CONUT: odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.25-1.63, < 0.001; AL: OR = 1.23, 95% CI: 1.14-1.32, < 0.001) and Model 2 (CONUT: OR = 1.29, 95% CI: 1.12-1.48, < 0.001; AL: OR = 1.14, 95% CI: 1.05-1.24, = 0.002). Depressive status was shown to moderate the positive association between CONUT and HF ( for interaction = 0.035). AL was associated with HF in the depressive subgroup (area under the curve (AUC) = 0.6048, 95% CI: 0.5162-0.6934), indicating limited predictive performance of the model. The NRI and IDI values revealed no significant difference in the predictive performance of CONUT and AL in Model 4. CONCLUSIONS: The CONUT and AL indices demonstrated positive associations with HF in the general population. Depressive status is a moderating factor that attenuates the association between CONUT and HF. Meanwhile, CONUT and AL are not effective predictors of HF risk under conditions of depressive status. Therefore, screening for depressive status in individuals with high CONUT and AL indices is important for predicting HF.
Coronary Microvascular Dysfunction in Cardiomyopathies: Insights on Clinical and Prognostic Roles.
Giacobbe F, Meynet P, Balducci M … +18 more , Capoccia S, Cimino RA, Morena A, Dalu A, D'Ascenzo F, De Filippo O, Novarese F, Bruno F, Raineri C, Conrotto F, Sakalidis A, Omedé P, Giannino G, Angelini F, Bocchino PP, Dusi V, Porto I, De Ferrari GM
Rev Cardiovasc Med · 2026 Feb · PMID 41789319 · Full text
Coronary microvascular dysfunction (CMD) is a key driver of ischemia and prognosis across several non-ischemic cardiomyopathies. This review summarizes the main tools for diagnosing microvascular dysfunction and availabl...
Coronary microvascular dysfunction (CMD) is a key driver of ischemia and prognosis across several non-ischemic cardiomyopathies. This review summarizes the main tools for diagnosing microvascular dysfunction and available evidence on CMD incidence and the prognostic role in patients with cardiomyopathies. In dilated cardiomyopathy, CMD is associated with reduced myocardial blood flow, greater fibrosis, adverse remodeling, and worse outcomes. In hypertrophic cardiomyopathy, CMD is highly prevalent and multifactorial (arteriolar remodeling, reduced capillary density, extravascular compression, diastolic dysfunction, and/or left ventricular (LV) outflow obstruction), correlating with fibrosis, heart failure, and arrhythmias/sudden death. In Takotsubo syndrome, CMD appears acute and reversible, with microvascular spasms as a predominant mechanism and plausible pathophysiologic basis of the event. In arrhythmogenic right ventricular cardiomyopathy, preliminary data show a blunted hyperemic response and autonomic abnormalities that may impair microvascular vasodilation. In infiltrative and storage diseases (amyloidosis and Anderson-Fabry disease), CMD is often early, preceding hypertrophy/fibrosis, and contributes to symptoms, contractile dysfunction, and adverse outcomes; in sarcoidosis, microvascular inflammation reduces coronary flow reserve (CFR) and is associated with events. Targeted therapies remain limited; optimization of risk factors and drugs that modulate endothelial/metabolic function (statins, angiotensin converting enzyme (ACE) inhibitors, vasodilating β-blockers, calcium channel blockers, sodium glucose cotransporter 2 (SGLT2) inhibitors) yielded variable signals; device-based and nonpharmacologic strategies are under investigation. In conclusion, integrating microcirculatory assessment improves risk stratification and may furnish future therapeutic targets across cardiomyopathies.
Bradycardia, Hyperkalemia, Renal Dysfunction, and Hypoglycemia in Guideline-Directed Medical Therapy for Heart Failure: When to Tolerate and When to Worry.
Bellicini MG
Rev Cardiovasc Med · 2026 Feb · PMID 41789318 · Full text
A paradox persists in contemporary heart failure (HF) care, whereby the therapies most clearly proven to save the most lives are also those most frequently interrupted, often for reasons that are more physiological than...
A paradox persists in contemporary heart failure (HF) care, whereby the therapies most clearly proven to save the most lives are also those most frequently interrupted, often for reasons that are more physiological than pathological. Indeed, during HF medical therapy bradycardia, modest increases in creatinine or potassium levels, mild reductions in blood pressure, and concern regarding hypoglycemia are frequently perceived as dangerous adverse effects of drugs therapy, leading to premature dose reductions or discontinuation. However, when interpreted within their pharmacological and physiological context, these findings more often reflect predictable, dose-related drug effects rather than true toxicity. In the absence of predisposing conditions, such changes are typically modest in magnitude and unlikely to progress to clinically relevant pathological alterations. Recognizing these signals as expected manifestations of effective therapy, rather than harmful events, allows clinicians to maintain evidence-based drugs at target or near-target doses and to fully realize the mortality reduction associated with comprehensive guideline-directed medical therapy (GDMT).
The Lipoprotein(a) Implementation Gap: Bridging Evidence and Clinical Practice.
Yang HS, Yoon S, Hur M
Rev Cardiovasc Med · 2026 Feb · PMID 41789317 · Full text
Lipoprotein(a) [Lp(a)] represents one of cardiovascular medicine's most profound implementation gaps: a genetically determined risk factor affecting 1.5 billion people worldwide, yet historically underutilized in clinica...
Lipoprotein(a) [Lp(a)] represents one of cardiovascular medicine's most profound implementation gaps: a genetically determined risk factor affecting 1.5 billion people worldwide, yet historically underutilized in clinical practice despite overwhelming evidence of its importance. This review examines the transformation of Lp(a) from an untreatable genetic burden to a promising therapeutic target through four interconnected perspectives. First, we document the implementation gap, where, despite affecting 20% of the global population, screening remains below 1%. The evolution from selective screening (2018 American College of Cardiology/American Heart Association (ACC/AHA)) to universal measurement (2024 National Lipid Association (NLA) Class I recommendation) reflects growing recognition, yet persistent barriers, including reimbursement challenges, provider knowledge gaps, and laboratory standardization issues, perpetuate underutilization. Second, we synthesize evidence establishing Lp(a)'s dual nature as both a biomarker and a causal factor. Observational studies demonstrate markedly increased cardiovascular risk with elevated Lp(a), while Mendelian randomization confirms causal relationships with coronary heart disease, large-artery stroke, peripheral artery disease, and aortic stenosis, with differential effects on stroke subtypes and non-atherosclerotic outcomes. Third, we examine the transformation from genetic determinism to pharmacological tractability. Despite 70-90% heritability, novel RNA-targeted therapies achieve unprecedented 80-95% reductions, with phase 3 cardiovascular outcome trials (completing 2026-2029) poised to determine whether dramatic Lp(a) lowering translates to clinical benefit. Finally, we provide a practical management algorithm bridging current evidence-based risk stratification with emerging therapies, stratifying patients by Lp(a) levels with corresponding interventions. The Lp(a) story exemplifies how genetic insights and technological innovation can transform immutable disease aspects into treatable conditions, offering a paradigm for precision cardiovascular medicine while highlighting the urgent need to close the gap between scientific knowledge and clinical implementation.
Cardiovascular Protective Effects and Mechanisms of Action of Cacao: A Comprehensive Review.
Lee YG, Choi HK, Hwang JT
Rev Cardiovasc Med · 2026 Feb · PMID 41789316 · Full text
Cacao, the primary raw material for chocolate and certain beverages, is widely cultivated in the Americas and Asia. Furthermore, various components of cacao, including phenolic compounds, have been shown to be effective...
Cacao, the primary raw material for chocolate and certain beverages, is widely cultivated in the Americas and Asia. Furthermore, various components of cacao, including phenolic compounds, have been shown to be effective in preventing numerous diseases. Notably, cacao is particularly effective in preventing cardiovascular diseases (CVDs) by regulating various biomarkers and signaling pathways. The functionality of cacao has been reported in multiple and studies and clinical trials, thereby further confirming its efficacy. However, comprehensive reviews on the recently reported preventive effects of cacao on CVDs and the related mechanisms , , and in clinical trials remain limited. Thus, this review aimed to provide an overview of the latest research results on the effects of cacao on the prevention of CVDs and on biomarkers associated with these mechanisms. Cacao shows significant potential to prevent and mitigate CVDs, with promising findings that could shape the future of cardiovascular health and functional plant innovation. However, to fully harness the potential of cacao, future research must focus on standardizing bioactive compound content, assessing bioavailability and metabolic pathways, and establishing dose-response relationships across diverse populations.
Precision Monitoring Strategies for Chemotherapy-Induced Cardiotoxicity: A Review of Molecular Indicators for Early Detection and Risk Stratification.
Kong Y, He R, He H … +4 more , Liao L, Wu C, Chen X, Peng X
Rev Cardiovasc Med · 2026 Feb · PMID 41789315 · Full text
Chemotherapy-induced cardiotoxicity (CIC) is an increasingly recognized complication in cancer survivors, particularly with anthracyclines, human epidermal growth factor receptor 2 (HER2) inhibitors, vascular endothelial...
Chemotherapy-induced cardiotoxicity (CIC) is an increasingly recognized complication in cancer survivors, particularly with anthracyclines, human epidermal growth factor receptor 2 (HER2) inhibitors, vascular endothelial growth factor (VEGF) inhibitors, and immune checkpoint inhibitors. CIC may present acutely, chronically, or as a delayed condition, with phenotypes ranging from asymptomatic myocardial dysfunction to heart failure, arrhythmias, and myocarditis. This narrative review aimed to summarize the latest evidence on the pathogenesis of CIC and evaluate traditional and emerging biomarkers for early detection and risk stratification. We comprehensively reviewed the literature related to the pathogenesis and biomarkers of CIC, focusing on studies that examined oxidative stress, DNA damage, mitochondrial dysfunction, inflammation, and immune activation. The five most frequently reported mechanisms in CIC toxicity were oxidative stress, DNA damage, mitochondrial dysfunction, inflammation, and immune activation. Traditional biomarkers, such as cardiac troponin and natriuretic peptides, have been shown to aid in early detection; however, these biomarkers are limited by specificity and timing. Emerging biomarkers, including inflammatory cytokines, fibrosis-related proteins, extracellular vesicles, and non-coding RNAs, demonstrate greater sensitivity and potential for earlier risk stratification. However, study heterogeneity and limited validation across populations hinder clinical translation. Thus, integrating biomarkers with imaging modalities and standardized protocols may enhance personalized surveillance of CIC toxicity. Large prospective studies and standardized frameworks are essential. Hence, a multiparametric approach combining molecular, functional, and computational tools may define future precision monitoring for CIC toxicity.
Beneficial Effects of Canagliflozin in Heart Failure Associated With Cardiac and Surgical Procedures.
Dong Y, Zhou F, Chi L … +1 more , Mu J
Rev Cardiovasc Med · 2026 Feb · PMID 41789314 · Full text
Heart failure is a significant complication following cardiac surgery. While sodium-glucose co-transporter-2 (SGLT2) inhibitors show established benefits in chronic heart failure, their specific role in the perioperative...
Heart failure is a significant complication following cardiac surgery. While sodium-glucose co-transporter-2 (SGLT2) inhibitors show established benefits in chronic heart failure, their specific role in the perioperative setting remains poorly defined. This review aims to consolidate the current evidence on the beneficial effects and underlying mechanisms of canagliflozin in managing heart failure associated with cardiac surgery. A narrative review of relevant preclinical animal studies and clinical trials was conducted to integrate and summarize the existing data. The evidence demonstrates that canagliflozin confers cardiovascular protection through multifaceted mechanisms, including improved metabolic regulation, favorable hemodynamic effects, and potent anti-inflammatory and anti-fibrotic actions. These mechanisms are highly relevant to mitigating key pathophysiological insults in the perioperative period. While current clinical data are limited to observational studies, they suggest promising benefits for canagliflozin in reducing postoperative cardiovascular complications. Canagliflozin shows considerable potential as a therapeutic agent for patients with heart failure related to cardiac surgery. However, definitive evidence from large-scale, multicenter randomized controlled trials is warranted to confirm its efficacy and safety, and to optimize perioperative management strategies.
Optimization of Distal Radial Access Into Clinical Routine Practice Through Ultrasound Guidance: A Review and Technical Guide.
Ungureanu C, Colletti G, Haine S … +1 more , Sgueglia GA
Rev Cardiovasc Med · 2026 Feb · PMID 41789313 · Full text
Distal radial access (DRA) has emerged as a preferred approach in cardiac and peripheral vascular catheterization, offering distinct advantages over traditional access methods. However, DRA is inherently more challenging...
Distal radial access (DRA) has emerged as a preferred approach in cardiac and peripheral vascular catheterization, offering distinct advantages over traditional access methods. However, DRA is inherently more challenging due to the smaller diameter, sharper angulation, and greater anatomical variability of the vessels, which collectively increase the risk of puncture failure and the need for crossover to alternative vascular access. Thus, ultrasound guidance has become increasingly important. Unlike the conventional transradial approach, where ultrasound guidance remains optional, the use of ultrasound guidance in DRA could offer additional benefits, including potentially improved success rates and a reduced risk of damage to surrounding anatomical structures. This review highlights the essential role of vascular ultrasound in DRA and presents a detailed, step-by-step guide that integrates sonographic and anatomical techniques. Therefore, by promoting technical precision and ensuring safer vascular access, this approach aims to optimize the success and safety of catheterization procedures and foster the widespread adoption of DRA in clinical practice.
A Novel Risk Score Based on Lipid-Related Biomarkers for Acute Coronary Syndromes: A Multicenter Machine Learning Study.
Wan J, Luo Y, Li Y … +8 more , Cai S, He T, Chen Z, Yan F, Hu Y, Zhou Z, Wang Q, Lu Z
Rev Cardiovasc Med · 2026 Feb · PMID 41789312 · Full text
BACKGROUND: This study aimed to develop and test an explainable machine learning (ML) predictive model based on lipid-related biomarkers to predict acute coronary syndrome (ACS) in hospitalized patients. METHODS: A total...
BACKGROUND: This study aimed to develop and test an explainable machine learning (ML) predictive model based on lipid-related biomarkers to predict acute coronary syndrome (ACS) in hospitalized patients. METHODS: A total of 10,127 consecutive hospitalized patients at three large hospitals were retrospectively studied between 2022 and 2024. ACS incidence was recorded as the primary outcome. Eight ML models were used to calculate the risk of ACS during hospitalization and to distribute patients into low-, intermediate-, and high-risk groups. RESULTS: All patients were randomly divided into a 70% training set (n = 7088) and a 30% test set (n = 3039). ACS occurred in 1119 (15.8%) and 461 (15.2%) patients, respectively. The Light Gradient Boosting Machine (LightGBM) exhibited the best predictive performance (area under the curve, 0.829) for ACS in the training set. The final model, which included the top 10 features from the LightGBM model, including lipid-related markers and clinical features, achieved a C-index of 0.781 on the test set and demonstrated a significant ability to stratify patients into low-, intermediate-, and high-risk groups. CONCLUSION: We constructed a risk-stratification model based on lipid-related biomarkers derived from ML models to predict ACS in hospitalized patients, which could assist in identifying patients with high discriminatory capacity.
Association of Thyroid Function With Restenosis and Long-Term Outcomes After Drug-Coated Balloon Angioplasty in Euthyroid Patients With Coronary Heart Disease.
Duan Y, Xu C, Zhao Q … +4 more , Gu J, Zhang J, Zhuo Y, Zhang H
Rev Cardiovasc Med · 2026 Feb · PMID 41789311 · Full text
BACKGROUND: The role of euthyroid hormone levels in clinical outcomes after drug-coated balloon (DCB) angioplasty in patients with coronary heart disease (CHD) remains unclear. Thus, this study aimed to explore the relat...
BACKGROUND: The role of euthyroid hormone levels in clinical outcomes after drug-coated balloon (DCB) angioplasty in patients with coronary heart disease (CHD) remains unclear. Thus, this study aimed to explore the relationship between thyroid function and the risk of restenosis at one year, as well as the prognosis over five years in euthyroid patients with CHD following DCB angioplasty. METHODS: This prospective study evaluated 189 euthyroid CHD patients who underwent successful DCB angioplasty. Coronary angiographic follow-up was performed 9-12 months post-procedure to assess the status of target lesions, with restenosis defined as ≥50% reduction in luminal diameter. All patients underwent five-year clinical follow-ups, during which major adverse cardiovascular events (MACEs) were recorded. RESULTS: Following angiographic follow-ups, patients were categorized into two groups: those with restenosis (n = 66) and those without (n = 123). At baseline and during the follow-up, the restenosis group demonstrated significantly higher levels of thyroid-stimulating hormone (TSH), lymphocytes, hemoglobin A1c (HbA1c), lipoprotein(a), and platelet count, along with lower free triiodothyronine (FT3) levels. Multivariable logistic regression analysis revealed that the TSH levels both at the baseline (odds ratio (OR) 1.607, 95% confidence interval (CI) 1.238-2.085, < 0.001) and angiographic follow-up (OR 2.970, 95% CI 2.000-4.411, < 0.001) were independently associated with an increased risk of post-DCB restenosis. Furthermore, patients in the high TSH tertile had a 90% increased risk of MACEs during the 5-year follow-up period (hazard ratio (HR) 1.922, 95% CI 1.343-2.750, < 0.001) compared with those in the low TSH tertile. CONCLUSIONS: A high-normal TSH level within the euthyroid range was strongly associated with an increased 1-year restenosis risk and decreased 5-year MACE-free survival following DCB angioplasty in CHD patients.
Clinical Efficacy of In-Line Mechanical Insufflation-Exsufflation in Patients with Invasive Mechanical Ventilation After Cardiopulmonary Bypass.
Han D, Li C, Jia M … +3 more , Wang H, Wang L, Hou X
Rev Cardiovasc Med · 2026 Jan · PMID 41659119 · Full text
BACKGROUND: This study aimed to evaluate the clinical efficacy of in-line mechanical insufflation-exsufflation (IL-MIE) in airway secretion management in patients receiving invasive mechanical ventilation after cardiopul...
BACKGROUND: This study aimed to evaluate the clinical efficacy of in-line mechanical insufflation-exsufflation (IL-MIE) in airway secretion management in patients receiving invasive mechanical ventilation after cardiopulmonary bypass (CPB). METHODS: A total of 56 patients who underwent CPB and required invasive mechanical ventilation in the Cardiac Surgery Intensive Care Unit of Beijing Anzhen Hospital, Capital Medical University, between July 2015 and July 2020, were enrolled and divided into an IL-MIE group (n = 28) and a conventional suction (CS) group (n = 28). The IL-MIE group received automated secretion clearance every 30 min for 8 h, supplemented with CS as needed, whereas the CS group received standard CS treatment. General patient data, respiratory and hemodynamic parameters, ventilator settings, CS frequency, mechanical ventilation duration, and intensive care unit (ICU) length of stay were recorded during the 8 h intervention. RESULTS: At 4 h and 8 h, the IL-MIE group exhibited significantly higher arterial oxygen partial pressure, oxygenation index, and static compliance and low plateau pressure ( < 0.05). Heart rate was significantly lower in the IL-MIE group at 4 h ((99.21 ± 13.87) vs. (89.32 ± 10.66); < 0.01) and 8 h ((96.71 ± 14.47) vs. (89.61 ± 9.34); = 0.033). The IL-MIE group required fewer CS interventions (0 (0, 1) vs. 4 (3, 4); < 0.01) and had a shorter duration of mechanical ventilation (20 (16.75, 22) vs. 24 (18.75, 26.5); = 0.029) than those in the CS group. CONCLUSIONS: By mimicking physiological airway clearance, IL-MIE significantly improves oxygenation and lung compliance, reduces the duration of mechanical ventilation, and maintains hemodynamic stability during respiratory management in patients after CPB.
Cardiac Sarcoidosis: Pathophysiology and Diagnostic-Therapeutic Processes.
Antonaci S, Ismibayli Z, De Martino S … +3 more , De Santis GA, Salame K, Russo M
Rev Cardiovasc Med · 2026 Jan · PMID 41659118 · Full text
Sarcoidosis is a rare inflammatory disorder of unknown etiology, characterized by the formation of non-caseating granulomas in affected organs. Additionally, sarcoidosis typically involves multiple systems, with the lung...
Sarcoidosis is a rare inflammatory disorder of unknown etiology, characterized by the formation of non-caseating granulomas in affected organs. Additionally, sarcoidosis typically involves multiple systems, with the lungs and thoracic lymph nodes being most commonly affected. While many cases are self-limited and resolve spontaneously, cardiac involvement, although relatively uncommon, can be particularly severe. Indeed, cardiac sarcoidosis may lead to life-threatening arrhythmias, severe heart failure, or sudden cardiac death, significantly impacting prognosis. Meanwhile, the heterogeneity of presentation and disease course can make diagnosis and treatment challenging. An endomyocardial biopsy (EMB) is considered the gold standard for diagnosing cardiac sarcoidosis (CS); despite its high specificity, the sensitivity of this technique is low owing to the often focal and patchy cardiac involvement in sarcoidosis. New imaging techniques, such as fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and cardiac magnetic resonance (CMR) imaging, can provide valuable information for the accurate diagnosis of CS and can be useful for evaluating treatment response and prognosis. Immunosuppressive treatments, particularly corticosteroids, are considered the cornerstone of therapy for CS. However, randomized clinical trials are lacking, and treatment decisions are based on cohort studies and consensus opinions. Moreover, the optimal strategy for determining when to initiate, how long to continue, and what dosage to use for immunosuppressive therapy remains uncertain.
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