Cardiology In Review[JOURNAL]
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200 papers
Immunometabolism in Cardiovascular Disease: Linking Metabolic Reprogramming to Inflammation, Atherothrombosis, and Clinical Outcomes.
Rani S, Aimen Gillani S, Naseer R … +4 more , Khalid M, Fatima A, Akram MB, Dilshad A
Cardiol Rev · 2026 Jul · PMID 42400267 · Publisher ↗
Cardiovascular disease remains the leading global cause of death, and a major part of its residual risk is now understood to be inflammatory rather than purely lipid-driven. Immunometabolism provides the missing link bet...
Cardiovascular disease remains the leading global cause of death, and a major part of its residual risk is now understood to be inflammatory rather than purely lipid-driven. Immunometabolism provides the missing link between metabolic stress and immune activation: excess lipids, hyperglycemia, and tissue hypoxia reprogram immune and vascular cells toward glycolysis, altered glutamine use, mitochondrial dysfunction, and durable epigenetic memory. In atherosclerosis, this metabolic shift fuels endothelial dysfunction, macrophage foam-cell formation, cytokine release, defective efferocytosis, and plaque instability. The concept extends beyond the plaque itself through trained immunity, in which monocytes and bone marrow progenitors retain a pro-inflammatory memory that can persist after the original trigger has passed. This helps explain why myocardial infarction, diabetes, and hyperlipidemia can leave a long inflammatory imprint on the vasculature. Immunometabolism also contributes to thromboinflammation, where activated platelets, neutrophils, and extracellular traps reinforce clot formation and amplify arterial injury. In heart failure, postischemic remodeling and chronic congestion are accompanied by immune-cell and cardiomyocyte metabolic remodeling that sustains inflammation, fibrosis, and adverse ventricular remodeling. Clinical trials targeting inflammation, especially canakinumab and low-dose colchicine, have shown that suppressing inflammatory pathways can reduce cardiovascular events, supporting the translational value of this biology. A clearer understanding of immunometabolic circuits may enable better risk stratification, biomarker-guided therapy, and new treatments that simultaneously stabilize plaques, reduce thrombosis, and improve postinfarction healing.
Cardiotoxicity of Antibody-Drug Conjugates in HER2-Positive Cancer: Beyond Left Ventricular Ejection Fraction Decline.
Agrawal SP, Lussier A, Thukral J … +6 more , Gopu SS, Ramesh J, Kale M, Ponnusamy V, Frishman WH, Aronow WS
Cardiol Rev · 2026 Jul · PMID 42390039 · Publisher ↗
Human epidermal growth factor receptor 2-targeted antibody-drug conjugates-ado-trastuzumab emtansine and trastuzumab deruxtecan-have transformed the treatment of human epidermal growth factor receptor 2-positive breast c...
Human epidermal growth factor receptor 2-targeted antibody-drug conjugates-ado-trastuzumab emtansine and trastuzumab deruxtecan-have transformed the treatment of human epidermal growth factor receptor 2-positive breast cancer. Because their antibody backbone derives from trastuzumab, which is associated with reversible left ventricular (LV) dysfunction, cardiovascular safety remains clinically relevant. In pivotal randomized trials, symptomatic heart failure was rare, and clinically significant declines in LV ejection fraction (LVEF) were uncommon: LV dysfunction occurred in roughly 0.4-1.8% of ado-trastuzumab emtansine-treated patients and approximately 2.7-4.6% of trastuzumab deruxtecan-treated patients, almost always asymptomatic and frequently reversible. However, these reassuring estimates derive from populations selected for normal baseline LVEF and limited cardiovascular comorbidity, with short follow-up and endpoints anchored to LVEF. Reliance on serial LVEF alone may underestimate cardiovascular injury, because LVEF is insensitive to early, subclinical dysfunction. Global longitudinal strain and cardiac biomarkers (troponins and natriuretic peptides) detect myocardial changes earlier and are endorsed by contemporary cardio-oncology guidelines, although prospective validation specific to antibody-drug conjugates is lacking, and strain-guided management has not improved long-term outcomes. We examine why LVEF-only surveillance is incomplete and outline a risk-stratified, multimodal monitoring framework grounded in current guidelines.
Celiac Disease and Cardiovascular Disease: Epidemiology, Mechanisms, and Clinical Challenges.
Silverman J, Somogyi D, Charlat M … +2 more , Wruble A, Frishman W
Cardiol Rev · 2026 Jul · PMID 42389993 · Publisher ↗
Celiac disease (CD), a chronic immune-mediated enteropathy triggered by gluten ingestion, is increasingly recognized as a systemic disorder with significant extraintestinal manifestations, including effects on the cardio...
Celiac disease (CD), a chronic immune-mediated enteropathy triggered by gluten ingestion, is increasingly recognized as a systemic disorder with significant extraintestinal manifestations, including effects on the cardiovascular system. This review synthesizes recent epidemiological evidence demonstrating that individuals with CD face a modest but statistically significant increase in cardiovascular disease risk, including ischemic heart disease, myocardial infarction, and venous thromboembolism, despite a lower prevalence of traditional risk factors such as obesity, hypertension, and smoking. This so-called "risk factor paradox" underscores the significance of nontraditional, disease-specific mechanisms, including chronic systemic inflammation, immune dysregulation, nutritional deficiencies, and the metabolic consequences of a gluten-free diet. Emerging data also highlight the early onset of nontraditional cardiovascular risk in pediatric CD populations and the reversibility of some cardiac manifestations, such as arrhythmias and cardiomyopathy, with strict gluten-free diet adherence. Clinical recommendations now emphasize annual cardiovascular screening, comprehensive nutritional assessment, and multidisciplinary management in patients with CD. However, significant research gaps remain, including the need for CD-specific risk prediction tools, randomized trials on dietary quality, and greater understanding of genetic and autoimmune contributions to cardiovascular disease in CD. Addressing these gaps is essential for optimizing prevention and management strategies in this growing patient population.
Valve-Specific Comparative Effectiveness of Direct Oral Anticoagulants Versus Vitamin K Antagonists After Surgical Valve Procedures in Atrial Fibrillation: A Systematic Review and Meta-Analysis.
Gamarra-Valverde NN, Loaiza SP, Asif M … +8 more , Silva R, Melo G, Dandamudi M, Delgado D, Batista PG, Chilon J, Giorgi JM, Barbagelata A
Cardiol Rev · 2026 Jul · PMID 42385141 · Publisher ↗
Anticoagulation after left-sided bioprosthetic valve replacement or mitral valve repair in patients with atrial fibrillation (AF) remains uncertain, as decisions must balance prevention of thromboembolism against bleedin...
Anticoagulation after left-sided bioprosthetic valve replacement or mitral valve repair in patients with atrial fibrillation (AF) remains uncertain, as decisions must balance prevention of thromboembolism against bleeding risk in a heterogeneous postoperative population. Although vitamin K antagonists (VKAs) have long been the standard of care, expanding real-world use of direct oral anticoagulants (DOACs) has created an urgent need to define their comparative effectiveness and safety in this setting. We performed a systematic review and meta-analysis of randomized and observational studies comparing DOACs with VKAs in patients with AF after surgical left-sided bioprosthetic valve replacement or mitral valve repair. The primary outcome was ischemic stroke; secondary outcomes included composite thromboembolic events, major bleeding, and all-cause mortality. Pooled risk ratios were estimated using random-effects models, with prespecified subgroup and sensitivity analyses to explore clinical heterogeneity. Fourteen studies including 15,877 patients met inclusion criteria. Compared with VKAs, DOACs were associated with a lower observed risk of ischemic stroke, although this finding was largely driven by patients with aortic bioprosthetic valves. Across analyses, heterogeneity was moderate, and no significant differences were observed for composite thromboembolic events, major bleeding, or all-cause mortality. These findings suggest that DOACs may be a reasonable alternative to VKAs in selected patients with AF after surgical valve intervention. However, the dependence of treatment effect on valve type underscores that left-sided valve populations should not be treated as clinically interchangeable. Anticoagulation decisions should be individualized, integrating valve position, surgical substrate, thromboembolic risk, bleeding risk, and the strength of available evidence.
Growing Heart Valves in Congenital Cardiac Surgery: Mechanisms and Considerations for Tissue-Engineered Heart Valves, Noncryopreserved Homografts, and Partial Heart Transplantation.
Lee DS, Alexander V, Vogel A … +1 more , Rajab TK
Cardiol Rev · 2026 Jul · PMID 42385140 · Publisher ↗
Heart valve abnormalities are present in 30% of congenital heart defects. Additionally, there are acquired conditions like rheumatic heart disease. They often require surgery, and in complex cases, valve replacement beco...
Heart valve abnormalities are present in 30% of congenital heart defects. Additionally, there are acquired conditions like rheumatic heart disease. They often require surgery, and in complex cases, valve replacement becomes unavoidable. The current valve replacement options, either mechanical, bioprosthetic, homografts, or autografts, lack key properties for pediatric patient needs: availability, durability, and the ability to grow. Our goal is to review 2 clinically relevant innovations: tissue-engineered heart valves (TEHVs) and partial heart transplantation (PHT). We conducted searches in electronic databases covering the past 25 years using the terms "partial heart transplantation," "tissue-engineered heart valves," and their combinations. Decellularized pulmonary homografts outperform cryopreserved homografts and bovine jugular vein conduits in pulmonary valve replacement, showing less stenosis and no infective endocarditis. The European Clinical Study for the Application of Regenerative Heart Valves trial confirmed decellularized pulmonary homograft safety, demonstrating 97.5% freedom from explantation at 5 years. Decellularized aortic homografts showed excellent 97.8% 5-year survival and low endocarditis rates, though increases in transvalvular gradient and regurgitation occurred. Partial heart transplantation uses living valves from donor hearts and accommodates somatic growth. Postoperative immunosuppression in PHT is required but may be limited, as children and valve tissues may possess immune privilege, as evidenced by limited valve injury even in failed orthotopic heart transplants. In a pilot study of 19 infants, with a median follow-up of 26 weeks, increases in annular diameter and leaflet length were observed. Both PHT and TEHVs are promising valve replacement options. While PHT provides a growth-adaptive capability, TEHVs hold the potential for off-the-shelf solutions with minimal immunogenicity.
Implementation Gaps and Limitations of Statin Therapy in Young Adults: Bridging Guideline Recommendations and Real-World Practice.
Annabi C, Frishman WH
Cardiol Rev · 2026 Jul · PMID 42383793 · Publisher ↗
Atherosclerosis is a progressive inflammatory process involving the arteries of the body that is driven by cumulative exposure to low-density lipoprotein cholesterol and other lipoprotein particles. Although clinical man...
Atherosclerosis is a progressive inflammatory process involving the arteries of the body that is driven by cumulative exposure to low-density lipoprotein cholesterol and other lipoprotein particles. Although clinical manifestations typically occur later in life, the atherosclerotic process can begin decades earlier if lipid levels are not well controlled. Despite this, current prevention strategies do not adequately account for young adults at elevated lifetime cardiovascular risk. This review examined multiple studies evaluating statin use in young adults and found that many high-risk individuals are not identified or treated under current approaches. The studies demonstrate that 2013 and 2018 American College of Cardiology and American Heart Association guidelines excluded a substantial proportion of young adults who experienced myocardial infarction and may have benefited from therapy prior to their event. In addition to this, statin therapy remains underutilized even in individuals who meet guideline-based criteria. Recent guideline updates in 2026 have emphasized cumulative lifetime exposure to atherogenic lipoproteins and expanded consideration of statin therapy to younger populations, reflecting an important shift toward earlier identification and prevention of cardiovascular risk. This review examines contemporary evidence regarding statin therapy in young adults, identifies barriers to treatment, and discusses potential strategies to improve early cardiovascular prevention.
Cardiovascular Manifestations of Epilepsy.
Vazquez Z, Dyce C, Samous S … +11 more , Tsirelman K, Tiwari P, Carson E, Steinthal H, Pandit M, Goldblatt A, Karp A, Gitlevich T, H Frishman W, Hirani R, Etienne M
Cardiol Rev · 2026 Jul · PMID 42383778 · Publisher ↗
A connection between epilepsy and cardiovascular health has long been proposed due to the higher prevalence of cardiovascular pathologies like heart disease, sudden cardiac death, and atherosclerosis among epilepsy patie...
A connection between epilepsy and cardiovascular health has long been proposed due to the higher prevalence of cardiovascular pathologies like heart disease, sudden cardiac death, and atherosclerosis among epilepsy patients. However, the directionality of this relationship and the underlying factor(s) have yet to be fully understood. Cerebrovascular dysfunction, ictal myocardial strain, and side effects of antiseizure medications have all been suggested to cause cardiovascular manifestations of epileptic disease and may present avenues for reduction of morbidity and mortality in epilepsy. In this review, we will discuss known cardiovascular pathologies associated with epilepsy, their potential etiologies, and implications for the treatment of epilepsy patients.
Finerenone and Cardiorenal Outcomes: A Narrative Review.
Fernandes W, Tasneem S, Latif F … +10 more , El Soussi Y, Saji A, Jani A, Fuqaha F, Mohammed RUH, Mejia Leiva D, Iliasov M, Binny V, Kiyani M, Khan AS
Cardiol Rev · 2026 Jun · PMID 42366486 · Publisher ↗
Finerenone is a nonsteroidal mineralocorticoid receptor antagonist that has demonstrated cardiorenal benefits in patients with chronic kidney disease (CKD) associated with type 2 diabetes. CKD affects up to 40% of patien...
Finerenone is a nonsteroidal mineralocorticoid receptor antagonist that has demonstrated cardiorenal benefits in patients with chronic kidney disease (CKD) associated with type 2 diabetes. CKD affects up to 40% of patients with type 2 diabetes and is associated with substantial cardiovascular morbidity and mortality. Despite renin-angiotensin system inhibitors and sodium-glucose cotransporter-2 inhibitor therapy, many patients experience worsening kidney function and cardiovascular events. This narrative review summarizes evidence published between 2014 and 2025, including Mineralocorticoid Receptor Antagonist Tolerability Study-Diabetic Nephropathy, Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease, Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease, pooled analysis of FIDELIO-DKD and FIGARO-DKD, and Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure, and relevant real-world studies. Finerenone provides organ protection by reducing mineralocorticoid receptor-mediated inflammation and fibrosis, offering benefits beyond blood pressure and glycemic control. Clinical trials have shown an approximate 30% drop in urine albumin-to-creatinine ratio within the first months of treatment, with a slower long-term decline in kidney function. The pooled analyses indicate a 23% reduction in serious kidney outcomes and a 14% reduction in major cardiovascular events compared with placebo, in patients receiving background angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy. Although hyperkalemia was more frequent with finerenone than placebo, discontinuation was uncommon under trial-based monitoring protocols. Overall, finerenone is an important addition to cardiorenal risk reduction in CKD associated with type 2 diabetes, although direct randomized endpoint comparisons with spironolactone or eplerenone remain lacking. Hyperkalemia risk should be interpreted in the context of trial eligibility criteria and structured potassium monitoring.
Role of Polypeptide Procalcitonin in Cardiac and Microvascular Injury in Sepsis, Myocardial Ischemia/Reperfusion, Cardiac Arrest, Mixed Shock, and Stress.
Maslov LN, Popov SV, Mukhomedzyanov AV … +6 more , Slidnevskaya AS, Latonov VR, Naryzhnaya NV, Gorbunov AS, Ma H, Ilinykh PA
Cardiol Rev · 2026 Jun · PMID 42361208 · Publisher ↗
High mortality in patients with sepsis, acute myocardial infarction (AMI), cardiac arrest (CA), and Takotsubo syndrome (TS) is the main problem of modern medicine. Polypeptide procalcitonin is synthesized and secreted by...
High mortality in patients with sepsis, acute myocardial infarction (AMI), cardiac arrest (CA), and Takotsubo syndrome (TS) is the main problem of modern medicine. Polypeptide procalcitonin is synthesized and secreted by different cells and tissues. Septic shock (SS), cardiogenic shock (CS), CA, CoronavIrus disease 2019, and TS significantly increase circulating procalcitonin levels. Lipopolysaccharide stimulates the production of procalcitonin through the activation of toll-like receptor-4 and transcription factor nuclear factor of κ light polypeptide gene enhancer in B-cells. Procalcitonin activates the calcitonin gene-related peptide receptor in endothelial cells and an unknown receptor. Procalcitonin causes lung microvessel injury, apoptosis, and pyroptosis of endothelial cells. Procalcitonin antibodies increase survival in animals with sepsis. Exogenous procalcitonin exacerbates sepsis in animals. Procalcitonin is involved in the pathogenesis of SS, CS, and death after CA, and stress-induced cardiac injury. An increase in circulating procalcitonin levels is associated with acute heart failure, but not microvascular injury or intramyocardial hemorrhage in patients with AMI. An increase in circulating procalcitonin levels is a predictor of mortality after SS, CS, and CA. The elevation in the procalcitonin level indicates a worsening of the course of pneumonia. Mixed CS is observed in patients with AMI and TS and is often associated with sepsis and systemic inflammatory response. Hence, calcitonin gene-related peptide receptor antagonists and procalcitonin monoclonal antibody may become the basis for the development of drugs for the treatment of SS, CS, TS, and prevention of death after CA.
Do Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict In-Hospital and Long-Term Mortality in Endocarditis Patients?: A Systematic Review and Meta-Analysis.
Assayed A, Aburumman S, Altahhan AH … +7 more , Salih ARF, Ramos-Vega KW, Gruhonjic H, Minasyan A, Fabian D, Ledonio C, Prashad R
Cardiol Rev · 2026 Jun · PMID 42361207 · Publisher ↗
Infective endocarditis (IE) remains a severe condition associated with significant in-hospital and long-term mortality despite advances in antimicrobial therapy and surgical management, highlighting the need for simple a...
Infective endocarditis (IE) remains a severe condition associated with significant in-hospital and long-term mortality despite advances in antimicrobial therapy and surgical management, highlighting the need for simple and reliable prognostic markers. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), derived from routine complete blood counts, have emerged as accessible inflammatory indices with potential prognostic value in cardiovascular and infectious diseases. We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate the ability of admission NLR and PLR to predict mortality in adult patients with IE. A comprehensive search of PubMed, MEDLINE, the Cochrane Library, CINAHL, and Web of Science through May 2024 identified 7 eligible observational studies comprising 847 patients. Random-effects meta-analysis using restricted maximum likelihood estimation with Hartung-Knapp adjustment demonstrated that NLR levels were consistently higher among nonsurvivors than survivors, yielding a pooled standardized mean difference of 1.25 (95% CI -0.13 to 2.63), although statistical significance was not achieved and substantial heterogeneity was observed (I2 = 94.5%). Diagnostic accuracy analysis demonstrated good prognostic performance of NLR for in-hospital mortality, with a pooled area under the curve of 0.85 (95% CI 0.57-1.00; P = 0.002) and no observed heterogeneity. Optimal NLR cutoff values ranged from approximately 5.5 to 9.8 across studies. Evidence regarding PLR was limited and inconsistent, preventing definitive conclusions regarding its prognostic utility. Overall, admission NLR appears to be an inexpensive, reproducible biomarker with good discriminative ability for predicting mortality in IE, although larger prospective multicenter studies are required to validate these findings and clarify the role of PLR in risk stratification.
Pacing for Pressure: The Clinical Efficacy of AVIM Therapy in Hypertension Management.
Vyas H, Fishkin T, Frishman WH … +1 more , Aronow WS
Cardiol Rev · 2026 Jun · PMID 42361206 · Publisher ↗
Resistant hypertension affects approximately 10-15% of hypertensive patients despite optimized pharmacologic therapy, necessitating novel interventions. Atrioventricular Interval Modulation (AVIM) therapy is an emerging...
Resistant hypertension affects approximately 10-15% of hypertensive patients despite optimized pharmacologic therapy, necessitating novel interventions. Atrioventricular Interval Modulation (AVIM) therapy is an emerging device-based approach that utilizes dual-chamber pacemakers to simultaneously address standard pacing indications and uncontrolled blood pressure. Unlike conventional pacing, AVIM leverages continuous cycles of short atrioventricular delays to effectively reduce ventricular preload and arterial afterload. These short delays are strategically interspersed with native-like, longer atrioventricular intervals that generate intermittent, higher-pressure pulses. This cyclical asymmetry tricks the body's baroreflex, successfully suppressing compensatory sympathetic vasoconstriction and lowering total peripheral resistance. Pilot trials (MODERATO I and II) demonstrate significant, durable reductions in ambulatory systolic blood pressure while maintaining cardiac contractility and energy efficiency. Furthermore, integrating AVIM with modern conduction system pacing, specifically left bundle branch area pacing, has refined the therapy. Left bundle branch area pacing-AVIM preserves native-like electrical synchrony and substantially outperforms traditional right ventricular pacing, achieving systolic blood pressure reductions of up to 24.1 mm Hg. The therapy also demonstrates rapid, restorative benefits for patients with concurrent diastolic dysfunction, promoting favorable reverse left ventricular remodeling. Ultimately, AVIM presents a continuous, nonpharmacological alternative for managing hypertension, circumventing the pervasive challenges of polypharmacy and medication nonadherence.
Venopulmonary Extracorporeal Membrane Oxygenation: Overview, Applications, and Current Evidence.
Dhalani M, Johnson J, Allam H … +3 more , Banker H, Jain P, Jain R
Cardiol Rev · 2026 Jun · PMID 42361204 · Publisher ↗
Extracorporeal membrane oxygenation (ECMO) has become an essential supportive therapy for patients with severe respiratory and/or cardiac failure. While conventional configurations such as veno-venous and veno-arterial E...
Extracorporeal membrane oxygenation (ECMO) has become an essential supportive therapy for patients with severe respiratory and/or cardiac failure. While conventional configurations such as veno-venous and veno-arterial ECMO have well-established roles, they are limited by important physiological trade-offs, particularly in patients with concomitant right ventricular dysfunction. Venopulmonary ECMO (VP ECMO) has emerged as a distinct and increasingly utilized configuration designed to provide right ventricular unloading while preserving physiologic pulmonary circulation and enabling extracorporeal gas exchange. By draining venous blood and returning it directly to the pulmonary artery, VP ECMO bypasses the failing right ventricle, reduces venous congestion, improves pulmonary hemodynamics, and supports gas exchange without the systemic complications associated with veno-arterial-ECMO. This review summarizes the physiological principles underlying VP ECMO, outlines cannulation strategies and configurations, and discusses clinical indications with an emphasis on patient phenotyping. Particular attention is given to its role in acute right ventricular failure, acute respiratory distress syndrome with right ventricular dysfunction, postleft ventricular assist device right heart failure, and as a bridge to lung transplantation. Emerging clinical evidence suggests that VP ECMO may improve hemodynamic stability, facilitate early mobilization, and enhance survival in carefully selected patients. However, data remain largely limited to observational studies and case series. Further prospective studies are required to refine patient selection, optimize timing, and define standardized management strategies for VP ECMO.
Women in Heart Failure With Preserved Ejection Fraction Clinical Trials: Bridging the Gap Between Trial Enrollment and Real-World Disease Burden.
Ganthan RR, Rotatori F
Cardiol Rev · 2026 Jun · PMID 42335097 · Publisher ↗
Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure cases and disproportionately affects women, who represent the majority of patients in real-world populations. De...
Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure cases and disproportionately affects women, who represent the majority of patients in real-world populations. Despite this, the representation of women in contemporary HFpEF clinical trials remains variable. In this narrative review, we examine sex distribution across major randomized trials, including TOPCAT, PARAGON-HF, EMPEROR-Preserved, and DELIVER, and compare these findings with real-world epidemiology. Women comprised approximately 44-52% of participants across trials, demonstrating modest discordance with real-world cohorts in which women often account for 50-70% of HFpEF patients. Although female enrollment in HFpEF trials has improved substantially compared with historical cardiovascular studies, important questions remain regarding the extent to which enrolled populations adequately reflect female-predominant HFpEF phenotypes, including obesity-associated HFpEF, microvascular dysfunction, and advanced multimorbidity. While some studies, particularly PARAGON-HF, suggested a potential greater treatment benefit among women, sex-specific analyses were frequently underpowered and inconsistently reported. More recent trials of sodium-glucose cotransporter-2 inhibitors demonstrated consistent benefits across sexes without clear evidence of differential effect. Differences in trial eligibility criteria, including natriuretic peptide thresholds, renal function requirements, and left ventricular ejection fraction cutoffs, may further influence the representation of women and the generalizability of trial findings. These findings raise important considerations regarding external validity and generalizability of trial-derived therapies. Greater emphasis on representative enrollment and prospective evaluation of sex-specific outcomes will be essential to advancing equitable and evidence-based care in HFpEF.
Pulmonary Hypertension and Kidney Disease: A Review of a High-Risk Patient Population.
Tobi Y, Buffer SW, Grullon G … +6 more , Shlimon N, Simkovic SJ, Saha S, Frishman WH, Aronow WS, Lanier GM
Cardiol Rev · 2026 Jun · PMID 42335018 · Publisher ↗
Pulmonary hypertension (PH) is a multifaceted disease driven by increased pulmonary vascular resistance and right ventricular afterload, eventually progressing to right-sided heart failure and a high mortality rate. Kidn...
Pulmonary hypertension (PH) is a multifaceted disease driven by increased pulmonary vascular resistance and right ventricular afterload, eventually progressing to right-sided heart failure and a high mortality rate. Kidney dysfunction, a common comorbidity in patients with PH, complicates treatment and impacts prognosis. In this literature review, we seek to broadly explore this coincidence of diseases, primarily focusing on chronic kidney disease (CKD) developing after a primary diagnosis of pulmonary arterial hypertension (PAH). We discuss prevalence, pathophysiologic mechanisms of disease, management of disease including the use of primary PAH therapies in the setting of renal disease, as well as background therapy for kidney disease and PAH comorbidities. This paper further seeks to evaluate associated comorbid conditions such as anemia and iron deficiency. We performed a literature search of several online medical databases, with a primary focus on Pubmed, to explore the findings of multiple systematic reviews and meta-analyses, clinical trials, and preclinical studies using animal models, among others. We found that while there is generally a good amount of consensus data for PH, CKD, and PH in the setting of preexisting CKD, little has been published regarding the specific focus of patients developing kidney dysfunction in the setting of PH.
Comparative Efficacy and Safety of Ticagrelor and Prasugrel in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Clinical Trials.
Shafiq SB, Razzak MJ, Ahmed M … +10 more , Khan GT, Siddiqi AM, Bilal AR, Tariq Mansoor K, Sohaib A, Khan MA, Majid M, Ahmed T, Abbasi M, Waqas SA
Cardiol Rev · 2026 Jun · PMID 42332387 · Publisher ↗
Acute coronary syndrome remains a prominent cause of morbidity and mortality worldwide despite advances in percutaneous coronary intervention and pharmaceuticals. As such, the discovery and implementation of novel and sa...
Acute coronary syndrome remains a prominent cause of morbidity and mortality worldwide despite advances in percutaneous coronary intervention and pharmaceuticals. As such, the discovery and implementation of novel and safe preventative measures like ticagrelor and prasugrel need to be studied and their safety profiles compared. For this purpose, we compiled 3 randomized controlled trials and 1 post hoc study from PubMed, Web of Science, and Cochrane Central after thorough screening, in this meta-analysis. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death, myocardial infarction, composite ischemic events, stent thrombosis, stroke, and bleeding events. Prasugrel and ticagrelor demonstrated similar efficacy and safety in patients with acute coronary syndrome undergoing percutaneous coronary intervention. These findings support an individualized approach to P2Y12 inhibitor selection based on patient characteristics, contraindications, tolerability, and adherence considerations rather than a preference for either agent.
Sirolimus-Coated Versus Paclitaxel-Coated Balloons in the Treatment of Coronary Artery Lesions: A Systematic Review and Meta-Analysis.
Moftah AW, Mohamed AA, Solah IA … +9 more , Lasheen MM, Al Freijat T, Abdrabo MF, Salah A, Abusalah B, Al-Azzawi OM, Ghawanmeh EM, Hegazy A, Hemida MF
Cardiol Rev · 2026 Jun · PMID 42328884 · Publisher ↗
Coronary artery lesions are either de novo lesions, where the arterial lumen is narrowed for the first time, or in-stent restenosis, where re-narrowing of a previously stented arterial segment occurs. Sirolimus-coated ba...
Coronary artery lesions are either de novo lesions, where the arterial lumen is narrowed for the first time, or in-stent restenosis, where re-narrowing of a previously stented arterial segment occurs. Sirolimus-coated balloons (SCBs) and paclitaxel-coated balloons (PCBs) are drug-coated balloons used in percutaneous coronary interventions to prevent restenosis without leaving a permanent implant. We conducted a systematic review and meta-analysis comparing SCBs versus PCBs for the treatment of coronary artery lesions, including de novo lesions and in-stent restenosis. Major databases were searched through September 2025. Pooled analyses were performed using random-effects models to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Ten studies involving 5246 patients (SCBs: n = 2964; PCBs: n = 2282) were included. Safety outcomes showed no significant differences in all-cause mortality (RR: 1.39, 95% CI, 0.50-3.89, P = 0.53), cardiac death (RR: 1.21, 95% CI, 0.50-2.92, P = 0.67), or myocardial infarction (RR: 0.98, 95% CI, 0.59-1.64, P = 0.95). Efficacy outcomes were similarly equivalent for target lesion failure (RR: 1.13, 95% CI, 0.85-1.50, P = 0.39), target lesion revascularization (RR: 1.23, 95% CI, 0.98-1.55, P = 0.068), major adverse cardiac events (RR: 1.14, 95% CI, 0.91-1.43, P = 0.27), and binary restenosis (RR: 1.18, 95% CI, 0.63-2.20, P = 0.61). None of the interventions (SCBs or PCBs) demonstrated superiority in terms of efficacy or safety for the treatment of coronary artery lesions. Therefore, device selection should be guided by lesion characteristics and overall clinical context.
Leadless Pacemaker in Bradyarrhythmia After Transcatheter Aortic Valve Replacement: A Meta-Analysis.
Pajareya P, Chuanchai W, Laohasurayotin K … +5 more , Siranart N, Phutinart S, Tokavanich N, Prasitlumkum N, Chokesuwattanaskul R
Cardiol Rev · 2026 Jun · PMID 42315247 · Publisher ↗
Leadless pacemaker (LPM) offers a favorable safety profile for bradyarrhythmia, especially in patients at high risk for infection from transvenous pacemaker (TPM). However, its use for bradyarrhythmia after transcatheter...
Leadless pacemaker (LPM) offers a favorable safety profile for bradyarrhythmia, especially in patients at high risk for infection from transvenous pacemaker (TPM). However, its use for bradyarrhythmia after transcatheter aortic valve replacement (TAVR) remains unexplored. We conducted a systematic search from the inception of PubMed to November 2025. Eligible studies included adults who received a pacemaker after TAVR. Primary endpoints were overall complications and device-related complications. Secondary endpoints included all-cause mortality, device-related mortality, hospitalization for heart failure, procedure time, fluoroscopy time, and length of stay after pacemaker implantation. We included a total of 11 studies involving 11,750 patients who underwent TAVR (1243 with LPM and 10,507 with TPM). None of the patients in the LPM group experienced device-related complications, with significantly lower rates compared to the TPM group [adjusted hazard ratio (aHR) 0.35, 95% confidence interval (CI): 0.13-0.97; I2 = 0%]. Similarly, no device-related mortality was observed in the LPM group. All-cause mortality and hospitalization for heart failure were comparable between the LPM and TPM groups (aHR 1.02, 95% CI, 0.05-20.68; I2 = 25% and aHR 0.87, 95% CI, 0.24-3.17; I2 = 0%, respectively). The feasibility of LPM was also similar to TPM in terms of procedural time (MD -28.66 minutes, 95% CI, -92.36 to 35.03; I2 = 11%), fluoroscopy time (MD -1.36 minutes, 95% CI, -6.30 to 3.59; I2 = 0%), and length of stay (MD -0.53 days, 95% CI, -1.33 to 0.27; I2 = 6%). In conclusion, LPM could serve as a first-line pacing strategy in bradyarrhythmia post-TAVR due to its safer profile with comparable efficacy and feasibility to TPM.
Discontinuation of Oral Anticoagulants After Successful Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis.
Tahir M, Naveed MA, Khan MH … +8 more , Qureshi S, Rani S, Bilal AR, Talib A, Uddin MS, Bin Shafiq S, Mithani AA, Waqas SA
Cardiol Rev · 2026 Jun · PMID 42315246 · Publisher ↗
The optimal duration of oral anticoagulation (OAC) after successful atrial fibrillation (AF) ablation remains uncertain. We performed an updated meta-analysis comparing postablation OAC continuation (ON-OAC) versus disco...
The optimal duration of oral anticoagulation (OAC) after successful atrial fibrillation (AF) ablation remains uncertain. We performed an updated meta-analysis comparing postablation OAC continuation (ON-OAC) versus discontinuation (OFF-OAC). A systematic search of MEDLINE, Scopus, and Cochrane CENTRAL was performed from inception until March 2026. We included randomized controlled trials and cohort studies evaluating patients receiving ≥3 months of OAC after AF ablation. Primary outcome was thromboembolism; secondary outcomes were major bleeding, all-cause mortality, and AF recurrence. Random-effect models pooled the effect estimates. Twenty-nine studies (n = 153,352) were included. OFF-OAC did not significantly alter thromboembolism risk [odds ratio (OR): 0.91; 95% confidence interval (CI), 0.64-1.30; P = 0.60], all-cause mortality (OR: 0.67; 95% CI, 0.44-1.02; P = 0.06), or AF recurrence. OFF-OAC significantly reduced major bleeding risk (OR: 0.34; 95% CI, 0.23-0.49; P < 0.00001). Subgroup analysis showed significant effect modification by OAC type, region, and antiplatelet switch. Discontinuation of warfarin (OR: 0.13; 95% CI, 0.05-0.39) or warfarin/nonvitamin K antagonist oral anticoagulants (OR: 0.43; 95% CI, 0.31-0.61) reduced major bleeding (P = 0.04). Greater bleeding risk reduction was observed in non-Asian cohorts (OR: 0.12; 95% CI, 0.04-0.35) versus Asian (OR: 0.45; 95% CI, 0.31-0.64; P = 0.02). Patients switched to antiplatelet therapy also showed lower bleeding risk (OR: 0.18; 95% CI, 0.08-0.39) compared with those not switched (OR: 0.44; 95% CI, 0.28-0.71; P = 0.05). Discontinuation of OAC after AF ablation significantly reduces major bleeding without increasing thromboembolic or mortality risk in appropriately selected patients. Individualized risk stratification is essential to guide postablation anticoagulation decisions.
Native Aortic and Mitral Valve Endocarditis Caused by Brucella: A Rare Case Report and Systematic Review.
Abulimiti K, Yiming N, Zou Q … +3 more , Waili A, Chen D, Zhang W
Cardiol Rev · 2026 Jun · PMID 42308361 · Publisher ↗
Brucella endocarditis (BE) is a rare but life-threatening complication of brucellosis, associated with an extremely high mortality rate. Among BE cases, aortic and mitral valve involvement remains poorly characterized du...
Brucella endocarditis (BE) is a rare but life-threatening complication of brucellosis, associated with an extremely high mortality rate. Among BE cases, aortic and mitral valve involvement remains poorly characterized due to complex pathophysiology and diagnostic and management challenges.This article describes a 52-year-old male admitted with persistent, intermittent fever and fatigue. Endocarditis of the native aortic and mitral valves caused by Brucella was confirmed via echocardiography and serological testing, with a mitral valve abscess as an additional complication. After combined antibiotic therapy and surgery, the patient recovered well, was discharged in stable condition, and remained healthy during a 1-year follow-up. The key to improving the prognosis of patients with BE lies in the integration of early diagnosis and timely intervention. This requires the establishment of a standardized clinical pathway that incorporates antibiotic-based infection control and timely surgical management, the initiation of early interventions for high-risk complications, and the implementation of a multidisciplinary team approach to optimize treatment outcomes while preserving organ function.
Efficacy and Safety of Combination Pharmacotherapies With Standard Diuretic Therapy in Acute Heart Failure: A Systematic Review and Meta-Analysis.
Leaman A, Liu L, Alashqar MT … +1 more , Nahata MC
Cardiol Rev · 2026 Jun · PMID 42308354 · Publisher ↗
Many patients hospitalized with acute heart failure (AHF) do not respond adequately to initial intravenous loop diuretic therapy, and residual congestion at discharge is associated with adverse outcomes. We conducted a s...
Many patients hospitalized with acute heart failure (AHF) do not respond adequately to initial intravenous loop diuretic therapy, and residual congestion at discharge is associated with adverse outcomes. We conducted a systematic review and meta-analysis of randomized controlled trials comparing loop diuretics alone versus loop diuretics in combination with add-on pharmacotherapy in adults hospitalized with AHF. PubMed, Embase, and CENTRAL were searched from inception to May 7, 2025. Efficacy outcomes included mortality, hospital readmission, hospital length of stay (LOS), change in body weight, and urine output (UO). Safety outcomes included worsening renal function, worsening heart failure (WHF), hypokalemia, and serious adverse events. Twenty-four randomized studies were identified, with 22 included in the meta-analysis. Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduced mortality [risk ratio (RR), 0.60 (95% confidence interval [CI], 0.38-0.94)], WHF [RR, 0.64 (95% CI, 0.43-0.96)], serious adverse events [RR, 0.74 (95% CI, 0.60-0.92)], and body weight [mean difference (MD), -1.05 (95% CI, -1.97 to -0.13) kg]. Tolvaptan was associated with greater weight reduction [MD, -0.98 (95% CI, -1.25 to -0.70) kg] and increased UO [MD, 1.15 (95% CI, 0.16-2.14) L]. Add-on hydrochlorothiazide (HCTZ) increased UO [MD, 0.95 (95% CI, 0.47-1.43) L] and decreased LOS [MD, -1.38 (95% CI, -2.40 to -0.36) days] but increased the risk of worsening renal function [RR, 2.03 (95% CI, 1.10-3.74)] and hypokalemia [RR, 2.31 (95% CI, 1.51-3.52)]. Overall, the combination with SGLT2 inhibitors, tolvaptan, and HCTZ improved surrogate markers of decongestion in AHF. SGLT2 inhibitors were associated with reduced mortality and WHF, whereas HCTZ shortened hospital LOS but increased the risk of renal dysfunction and hypokalemia.
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