Current Problems In Cardiology[JOURNAL]
Sun
200 papers
Implantable cardioverter-defibrillator in cardiac sarcoidosis: A propensity-score matched analysis.
Yeap G, Jain H, Patel N … +10 more , Zeeshan N, Jain J, Sokhal BS, Jha M, Shafiq SB, Bailey K, Gonna H, Chahal A, Costa RBDP, Ahmed R
Curr Probl Cardiol · 2026 Jun · PMID 42379543 · Publisher ↗
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) are used in cardiac sarcoidosis (CS) to prevent sudden cardiac death, but real-world effectiveness remains uncertain and is vulnerable to treatment-selection bia...
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) are used in cardiac sarcoidosis (CS) to prevent sudden cardiac death, but real-world effectiveness remains uncertain and is vulnerable to treatment-selection bias. METHODS: We performed a retrospective cohort study using the TriNetX Global Collaborative Network (157 healthcare organisations). Adults (≥18 years) with CS (ICD-10-CM D86.85; 2005-2025) were stratified by ICD implantation. Cohorts were balanced using 1:1 propensity-score matching (caliper 0.1 SD) across demographic, comorbidity, laboratory, and medication variables. The primary endpoint was a composite of all-cause mortality, heart failure exacerbation, cardiac transplantation, and ventricular arrhythmia. Secondary endpoints included heart failure diagnosis, all-cause rehospitalisation, acute myocardial infarction, and ischaemic stroke. Outcomes are reported as risk ratios (RR) with 95% confidence intervals (CI). RESULTS: A total of 4554 matched patients were analysed (2277 per cohort) over a median follow-up of 2.7 years. ICD use was associated with lower all-cause mortality (RR 0.83, 95% CI 0.71-0.96) and lower cardiac transplantation (RR 0.66, 95% CI 0.49-0.90). Heart failure exacerbation (RR 1.06, 95% CI 1.00-1.12) and ventricular arrhythmia (RR 1.70, 95% CI 1.59-1.81) were higher in ICD recipients. ICD recipients also had higher risks of heart failure diagnosis (RR 1.11, 95% CI 1.07-1.16) and rehospitalisation (RR 1.18, 95% CI 1.13-1.24). CONCLUSIONS: In a large propensity-matched real-world CS cohort, ICD implantation was associated with lower mortality and transplantation. However, these findings occurred alongside higher morbidity and healthcare utilization signals and must be interpreted cautiously due to the potential for selection bias and differential surveillance.
Arterial Stiffness in Heart Failure with Preserved Ejection Fraction: is this a new Predisposing Factor?
Kalesi AE, Papanastasiou C, Alexandrou K … +3 more , Khattab E, Patsourakos N, Kadoglou NPE
Curr Probl Cardiol · 2026 Jun · PMID 42364704 · Publisher ↗
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome characterized by diastolic dysfunction (DD), impaired left ventricular relaxation and elevated left ventricular filling pressure...
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome characterized by diastolic dysfunction (DD), impaired left ventricular relaxation and elevated left ventricular filling pressures (LVFP), with limited disease-modifying therapeutic options. Emerging evidence implicates the association between arterial stiffness and the development of HFpEF. This review aims to summarize current evidence on the relationship between arterial stiffness and HFpEF and to explore its potential implications for risk stratification and future therapies. Structural and functional vascular changes increase pulsatile afterload and disrupt ventricular-arterial coupling (VAC), leading to myocardial hypertrophy, fibrosis and DD. Arterial stiffening is closely associated with common HFpEF comorbidities including hypertension, diabetes mellitus, obesity and atrial fibrillation, reflecting shared mechanisms such as endothelial dysfunction and systemic inflammation. Several non-invasive indices of arterial stiffness correlate with DD, reduced exercise capacity and adverse clinical outcomes, underscoring their potential prognostic value. Additionally, emerging indices that integrate vascular and myocardial mechanics, providing a more comprehensive assessment of VAC, may offer incremental value in risk stratification. Although arterial stiffness represents a promising therapeutic target in HFpEF, it remains uncertain whether the reduction of arterial stiffness after pharmacological therapies translates into improved VAC and clinical outcomes. We need new insights into the interplay between arterial stiffness and HFpEF and novel therapeutic strategies should be tested.
The future of cardiovascular training: Bridging global disparities and building a hybrid model for equity in care.
Alhmouz MM, AbuHalimeh BJ
Curr Probl Cardiol · 2026 Jun · PMID 42364703 · Publisher ↗
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Disparities in healthcare access and treatment outcomes for patients with chronic limb-threatening ischemia.
Odugbemi O, Obasi-Eze S, Joseph F … +7 more , Joseph S, Nnadi E, Ibude OC, Alagbo HO, Agwuegbo CC, Akinfenwa S, Bob-Manuel T
Curr Probl Cardiol · 2026 Jun · PMID 42362132 · Publisher ↗
BACKGROUND: Chronic limb-threatening ischemia (CLTI) is clinically identified by the presence of a severe form of peripheral arterial disease that significantly affects the patient's quality of life. Despite improvements...
BACKGROUND: Chronic limb-threatening ischemia (CLTI) is clinically identified by the presence of a severe form of peripheral arterial disease that significantly affects the patient's quality of life. Despite improvements in medical and surgical interventions, social disparities in health care access remain a major determinant in clinical outcomes. This study uniquely examines disparities in revascularization, limb loss, and cardiovascular outcomes across multiple racial groups using a large national inpatient database. HYPOTHESIS: We aim to explore the association between social determinants of health and hospital outcomes in CLTI among different socioeconomic groups. METHODS: We queried the National Inpatient Sample (NIS) database from 2016 to 2021. ICD-10 codes were used to identify and compare interventions, including surgical bypass, endovascular interventions, and non-traumatic amputation, across socioeconomic groups. Major adverse limb events (MALE) and major adverse cardiovascular and cerebrovascular events (MACCE) were compared during the period of hospitalization. Multivariate regression adjusted for hypertension, diabetes, and hyperlipidemia. The trends of utilizing revascularization and amputation were examined over the six years. RESULTS: The study reveals a rising prevalence of CLTI over the 6-year period. Surgical bypass and amputation rates have declined, while endovascular repair is increasingly utilized. There were 405,370 admissions; Caucasians comprised 63%, Blacks 21.9%, Hispanics 12.4%, and Asians 1.9%. Major comorbidities including hyperlipidemia, hypertension, cigarette use, and diabetes were similarly distributed across racial groups. Despite comparable risk profiles, significant disparities in treatment and outcomes were observed. Surgical bypass and endovascular revascularization were utilized more frequently among Caucasians, while amputation rates were disproportionately highest among Black and Hispanic patients. On multivariate analysis, Black patients were 18% less likely to undergo surgical bypass (aOR 0.82, 95% CI: 0.7-0.8, p < 0.001). Black and Hispanic patients were significantly more likely to undergo amputation (aOR 1.24, p < 0.001 and aOR 1.18, p < 0.001, respectively). Asian patients had 30% higher odds of in-hospital mortality (aOR 1.30, p < 0.001). Black patients also demonstrated significantly higher rates of cardiac and ventricular arrhythmias (p < 0.001). These findings persisted after adjustment for hypertension, diabetes, and hyperlipidemia, implicating social determinants of health as key drivers of disparate outcomes. CONCLUSION: Black and Hispanic patients with CLTI face disproportionately higher amputation rates and adverse outcomes despite similar comorbidity burdens, reflecting inequities in access to limb-salvage interventions. Targeted strategies including improved access to vascular specialty care and policy interventions for underserved communities are essential for achieving equitable CLTI management.
Diagnostic and prognostic value of coronary computed tomography angiography and high-risk plaque assessment in acute coronary syndrome.
Miceli AL, Iroulart JM, Domenech P … +4 more , Fanilla ME, Del Castillo S, Pizarro R, Falconi ML
Curr Probl Cardiol · 2026 Jun · PMID 42362131 · Publisher ↗
Coronary computed tomography angiography (CCTA) has become a key noninvasive imaging modality for the assessment of coronary artery disease and is increasingly used in patients presenting with acute chest pain. Beyond th...
Coronary computed tomography angiography (CCTA) has become a key noninvasive imaging modality for the assessment of coronary artery disease and is increasingly used in patients presenting with acute chest pain. Beyond the evaluation of coronary stenosis, CCTA enables characterization of atherosclerotic plaque composition, identification of high-risk plaque features, and assessment of non-coronary causes of chest pain. The potential use of CCTA as a means of improving patient selection for invasive coronary angiography has attracted considerable interest in the evaluation of acute coronary syndromes (ACS). This review discusses the available evidence regarding its diagnostic and prognostic value in this setting, with particular emphasis on high-risk plaque assessment and emerging CT-based technologies. Randomized trials have shown that CCTA safely facilitates early discharge and reduces hospital length of stay in selected low-risk patients presenting with acute chest pain. However, studies involving intermediate- and high-risk populations have demonstrated adequate diagnostic performance but limited impact on clinical outcomes, resource utilization, and cost-effectiveness when compared with contemporary standard care. CCTA-derived high-risk plaque features, including positive remodeling, low-attenuation plaque, spotty calcifications, and the napkin-ring sign, provide incremental prognostic information beyond stenosis severity and traditional cardiovascular risk factors. Emerging technologies such as CT-derived fractional flow reserve, fat attenuation index, and photon-counting detector CT may further expand the diagnostic and prognostic capabilities of coronary CT imaging. Current evidence supports CCTA as a valuable tool for coronary assessment and cardiovascular risk stratification, although its routine implementation as a systematic strategy in ACS has not yet demonstrated meaningful clinical benefit.
Prognostic value of albuminuria in heart failure with preserved ejection fraction: A systematic review.
Barbagelata L, Masson W, Decotto S … +3 more , Diez GR, Lillo E, Pizarro R
Curr Probl Cardiol · 2026 Jun · PMID 42362130 · Publisher ↗
BACKGROUND AND AIM: Albuminuria has emerged as a potential marker of cardiorenal and microvascular dysfunction in heart failure with preserved ejection fraction (HFpEF). We conducted a systematic review to evaluate its p...
BACKGROUND AND AIM: Albuminuria has emerged as a potential marker of cardiorenal and microvascular dysfunction in heart failure with preserved ejection fraction (HFpEF). We conducted a systematic review to evaluate its prognostic significance in this population. METHODS: A systematic search of PubMed, Embase, and Scopus was performed according to PRISMA recommendations. Studies evaluating albuminuria, proteinuria, or related urinary biomarkers in adults with HFpEF and reporting clinical outcomes were included. RESULTS: Fourteen studies were identified, including post hoc analyses of randomized trials and observational cohorts. Albuminuria was consistently associated with higher risks of mortality, heart failure hospitalization, and adverse cardiovascular outcomes. Several studies also demonstrated associations with incident HFpEF, myocardial remodeling, and cardiorenal dysfunction. The prognostic value of albuminuria was independent of renal function and was observed across different methods of urinary protein assessment. CONCLUSION: Albuminuria is a robust marker of adverse prognosis in HFpEF and may reflect underlying cardiorenal and microvascular dysfunction. Its routine assessment could improve risk stratification and facilitate identification of high-risk phenotypes.
Atherosclerosis as an evolutionary mismatch disease: from ancestral biology to cardiometabolic vulnerability.
Botto F, Garcia-Zamora S, Bottaro F
Curr Probl Cardiol · 2026 Jun · PMID 42362129 · Publisher ↗
A middle-aged patient with no cardiovascular history, modest cholesterol levels, and a normal stress test may already have extensive subclinical atherosclerosis across multiple vascular territories. Large imaging cohorts...
A middle-aged patient with no cardiovascular history, modest cholesterol levels, and a normal stress test may already have extensive subclinical atherosclerosis across multiple vascular territories. Large imaging cohorts have shown that this scenario is far more common than conventional risk stratification would predict. Understanding why requires looking further back than conventional risk scores allow. Atherosclerosis is routinely framed as a disease acquired in adulthood through modifiable risk factors. That framing is clinically useful but biologically incomplete. Arterial lesions are detectable in children; vascular calcifications consistent with atherosclerosis appear in mummified remains from populations thousands of years old; and subsistence communities living closer to ancestral ecologies show extraordinarily low coronary burden despite high infectious loads. The conclusion is consistent: susceptibility to atherosclerosis is intrinsic to human biology. Modern environments activate and sustain it. This narrative review argues that atherosclerosis is best understood as the long-term vascular consequence of a mismatch between biological systems shaped under intermittent metabolic stress and environments that now impose chronic, unrelenting activation of those same pathways. That mismatch deepened across two major historical transitions (agricultural and industrial) and was amplified further by developmental programming established before birth. Insulin resistance, dyslipidaemia, endothelial dysfunction, sustained sympathetic activation, circadian disruption, and exposure to tobacco and air pollutants are not isolated modern risk factors; they are converging expressions of biology operating outside the context in which it evolved. Framed this way, prevention should shift from late event prediction toward earlier trajectory modification, addressing the conditions that accelerate atherogenesis long before conventional risk thresholds are crossed.
Beyond troponin: emerging biomarker strategies to differentiate type 1 from type 2 myocardial infarction.
Saraullo S, Palermi A, Ricci F … +5 more , Di Marco M, Furia N, Mattioli AV, Gallina S, Renda G
Curr Probl Cardiol · 2026 Jun · PMID 42362128 · Publisher ↗
The widespread adoption of high-sensitivity cardiac troponin (hs-cTn) assays has markedly improved the detection of myocardial injury, but at the cost of reduced specificity for atherothrombotic type 1 myocardial infarct...
The widespread adoption of high-sensitivity cardiac troponin (hs-cTn) assays has markedly improved the detection of myocardial injury, but at the cost of reduced specificity for atherothrombotic type 1 myocardial infarction (T1MI). Therefore, troponin-positive presentations increasingly reflect heterogeneous conditions, including supply-demand mismatch-related type 2 myocardial infarction (T2MI) and acute or chronic non-ischemic myocardial injury, creating major diagnostic and therapeutic challenges in time-sensitive clinical pathways. Because the current distinction between T1MI and T2MI largely relies on clinical context and expert adjudication, there is growing interest in circulating biomarkers that could refine etiologic classification, support early triage decisions, and improve risk stratification. In this narrative review, we synthesize contemporary evidence on established and emerging biomarker strategies aimed at discriminating T1MI from T2MI, including troponin kinetics and ratios, cardiac myosin-binding protein C, biomarkers of hemodynamic and neurohormonal stress (e.g., copeptin, natriuretic peptides, MR-proANP), markers of endothelial and microvascular dysfunction (e.g., MR-proADM, CT-proET1, GDF-15), biomarkers of plaque activation, thrombosis, and proteomic/metabolomic signatures. Overall, single biomarkers provide only modest separation between T1MI and T2MI, whereas performance improves when biomarkers are integrated into multivariable clinical models or pragmatic multimarker combinations that capture the biological contrast between focal coronary injury and systemic stress. We conclude by proposing a practical framework for clinico-biomolecular phenotyping and highlighting the key requirements for clinical translation linked to actionable management pathways. Future studies should prioritize head-to-head comparisons in rigorously adjudicated cohorts and evaluate whether biomarker-guided pathways can safely reduce unnecessary invasive coronary angiography while preserving timely reperfusion in patients with atherothrombotic T1MI.
Takotsubo syndrome: Comparison of data from the 2024 world literature and the 2016-2018 InterTak registry subgroup.
Madias JE
Curr Probl Cardiol · 2026 Jun · PMID 42362127 · Publisher ↗
A comparison of data on patients with takotsubo syndrome (TTS), from the World literature (WL) 2024 with the InterTalk 2016-2018 registry subgroup showed a much younger population of patients suffering TTS triggered by p...
A comparison of data on patients with takotsubo syndrome (TTS), from the World literature (WL) 2024 with the InterTalk 2016-2018 registry subgroup showed a much younger population of patients suffering TTS triggered by physical stresses, with a high rate of neurological and other comorbidities in the former. While the rates of hypertension and hypercholesterolemia, and prescription of β-blockers, ACE-inhibitors/Angiotensin blockers, and aspirin at discharge were higher in InterTAK, resuscitation, cardiogenic shock, mechanical support, and thrombus formation was higher in WL.
Evolving paradigms in cardiovascular pharmacology: advances and clinical significance.
Pandey R, Singh P
Curr Probl Cardiol · 2026 Jun · PMID 42362126 · Publisher ↗
Cardiovascular disease is the leading cause of morbidity and mortality among both the elderly and the young, making cardiovascular drugs the most commonly prescribed medications for these populations. Cardiovascular cond...
Cardiovascular disease is the leading cause of morbidity and mortality among both the elderly and the young, making cardiovascular drugs the most commonly prescribed medications for these populations. Cardiovascular conditions such as arrhythmias, coronary artery disease, hyperlipidemia, heart failure, and arterial hypertension are managed with these drugs. Over the past few decades, significant advances have been made in developing cardiovascular medications to prevent and treat various diseases. This review provides a comprehensive overview of recent advances in cardiovascular drug therapy, focusing on several key drugs and their pharmacokinetics and pharmacodynamics, including absorption, excretion, metabolism, and distribution. It highlights the mechanisms of action, routes of administration, side effects, and clinical implications of essential cardiovascular drugs, such as diuretics, angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin II receptor blockers (ARBs), calcium channel blockers, and Digoxin. Additionally, the paper discusses the use of nanoscience and nanoparticles in the effective treatment of cardiovascular diseases, highlighting their role in reducing side effects and improving prognosis. Nanoparticles are gaining significant attention for the treatment of cardiovascular conditions due to their greater sensitivity and specificity. Reports indicate that nanotechnology or nanoscience can effectively treat over 50% of cardiovascular conditions.
Psychopharmacological treatment of patients with heart failure: A narrative review of antidepressants and anxiolytics.
Pilarski B, Suchodolski A, Florek S … +2 more , Szulik M, Pudlo R
Curr Probl Cardiol · 2026 Jun · PMID 42259462 · Publisher ↗
Heart failure (HF) commonly coexists with psychiatric disorders, particularly depression and anxiety, which significantly worsen prognosis and complicate treatment. Approximately 25 million Europeans suffer from anxiety...
Heart failure (HF) commonly coexists with psychiatric disorders, particularly depression and anxiety, which significantly worsen prognosis and complicate treatment. Approximately 25 million Europeans suffer from anxiety disorders and 21 million from depression, while clinically significant depression affects up to 21.5% of patients with chronic HF. Because both cardiovascular and psychotropic medications may influence haemodynamic stability, electrolyte balance, and cardiac conduction, pharmacotherapy in this population requires careful monitoring and an interdisciplinary treatment approach. To analyse the available scientific literature on the use of psychopharmacotherapy in patients with HF who present with co-occurring depressive and/or anxiety disorders, and to formulate practical clinical guidance for physicians managing these patients. This narrative review was based on a targeted literature search conducted in PubMed/MEDLINE, Scopus, and Google Scholar, including publications from 1984 to 2025, with emphasis on recent evidence and clinical guidelines. Priority was given to systematic reviews, meta-analyses, randomised clinical trials, and studies addressing cardiovascular safety and drug interactions in psychopharmacotherapy. This review summarises major drug classes used in HF and in the treatment of depression and anxiety, drawing on clinical and experimental studies with emphasis on relevant pharmacological mechanisms. It highlights risk patterns, supports the selection of safer therapeutic combinations, and outlines monitoring strategies that may reduce adverse events. A safe pharmacological approach requires avoiding agents with high interaction potential (paroxetine, fluoxetine, tricyclic antidepressants) and preferentially using agents with a more favourable safety profile (sertraline, escitalopram, mirtazapine). Key findings, including recommended monitoring considerations and therapeutic implications, are summarised in Tables 1 and 2.
Clinical outcomes in patients with hypertension and renal artery stenosis across age categories.
Seri A, Hussain B, Aggarwal V … +4 more , Mamas MA, Lichaa H, Alraies MC, Paul TK
Curr Probl Cardiol · 2026 Jun · PMID 42248492 · Publisher ↗
INTRODUCTION: Renal artery stenosis (RAS) is a common cause of secondary hypertension (HTN) and chronic kidney disease (CKD). Studies have suggested that the prevalence of RAS increases with age. Data comparing the outco...
INTRODUCTION: Renal artery stenosis (RAS) is a common cause of secondary hypertension (HTN) and chronic kidney disease (CKD). Studies have suggested that the prevalence of RAS increases with age. Data comparing the outcomes of RAS and concurrent HTN in different age groups is very limited. We investigated the clinical outcomes of RAS in hypertensive patients (RAS-HTN) and in different age categories. METHODS: National Inpatient Sample 2016-2020 was used to extract data with ICD-10 codes (International Classification of Diseases- Tenth Revision) for patients hospitalized with primary diagnosis of HTN and concurrent diagnosis of RAS. A multivariable logistic regression model was used to analyze the association between RAS and clinical outcomes in <30 years, 30-55 years, and >55 years age cohorts. RESULTS: Among 5,647,220 nationwide admissions with primary diagnosis of HTN, a total of 39,235 were found to have RAS. Among RAS-HTN patients, 0.97% were <30 years, 11.9% were 30-55 years, and 87.13% were >55 years old. RAS-HTN was significantly associated with congestive heart failure (CHF) and pulmonary edema among all age groups. RAS-HTN had the strongest association with CHF in >55 years cohort (OR 4.89, CI 4.62-5.16, p < 0.001), followed by 30-55 (OR 3.56, CI 3.06-4.1, p < 0.001) and <30 (OR 3.45, CI 1.78-6.73, p < 0.001) years cohorts. RAS-HTN had strongest association with pulmonary edema in <30 years cohort (OR 3.82, CI 1.1-13.3, p = 0.035) followed by >55 (OR 1.87, CI 1.57-2.2, p ≤ 0.001) and 30-55 (OR 1.74, CI 1.09-2.78, p = 0.02) years cohorts. Furthermore, RAS-HTN had significant association with ischemic heart disease (IHD) and arrhythmia in >55 years cohort (OR 2.73, CI 2.59-2.89, p < 0.001 vs OR 1.26, CI 1.19-1.33, p < 0.001 respectively) and 30-55 years cohort (OR 2.35, CI 2-2.74. p < 0.001 vs OR 1.27, CI 1.04-1.55, p = 0.017 respectively). There was no association observed for RAS-HTN with IHD and arrhythmia in the <30 years cohort. CONCLUSION: The proportion of patients with RAS-HTN increased with increasing age and 11.9% were between 30 and 55 years. The observed stronger association of increased CHF and pulmonary edema in patients < 30 years of age emphasizes the need for early screening for RAS in patients with resistant hypertension in this age group.
Lipid-lowering therapy in acute coronary syndrome: Limitations of the stepwise approach and rationale for a 'strike early, strike strong' strategy.
Rossi B, Masson W
Curr Probl Cardiol · 2026 Jun · PMID 42242334 · Publisher ↗
Acute coronary syndrome (ACS) is associated with a markedly increased risk of recurrent cardiovascular events, particularly during the early post-event period, which is characterized by persistent inflammation, endotheli...
Acute coronary syndrome (ACS) is associated with a markedly increased risk of recurrent cardiovascular events, particularly during the early post-event period, which is characterized by persistent inflammation, endothelial dysfunction, plaque vulnerability, and ongoing thrombotic activation. Extensive evidence has demonstrated a strong relationship between cumulative exposure to low-density lipoprotein cholesterol (LDL-C) and the development and progression of atherosclerosis, while randomized clinical trials have consistently shown that LDL-C reduction is associated with proportional reductions in cardiovascular risk. In addition, current guidelines recommend intensive LDL-C targets in patients with recent ACS. Despite the availability of highly effective lipid-lowering therapies, a substantial proportion of patients fail to achieve recommended LDL-C goals in routine clinical practice. This gap may be partially explained by the limitations of the traditional stepwise ("step-up") treatment strategy, in which lipid-lowering therapy is progressively intensified during outpatient follow-up. Each step of this process represents a potential point of failure involving patient-, physician-, and healthcare system-related factors, potentially delaying optimal lipid control during the period of greatest vulnerability. In response to these challenges, an alternative "strike early, strike strong" approach has emerged, advocating for earlier and more intensive lipid-lowering therapy during the index hospitalization. This review critically examines whether the traditional stepwise strategy remains adequate in ACS management or whether current evidence supports a paradigm shift toward early combination lipid-lowering therapy.
Determinants of cardiorespiratory fitness after successfully reperfused ST-elevation myocardial infarction.
Hogwood AC, Smarż K, Golino M … +16 more , Tysarowski M, Canada JM, Zaborska B, Dziekan-Wisławska K, Zioło J, West JD, Jaxa-Chamiec T, Kontos E, Barron AM, Mbualungu J, Marchetta M, Lopez R, Moroni F, Arena R, Tassell BV, Abbate A
Curr Probl Cardiol · 2026 Jun · PMID 42242333 · Full text
BACKGROUND: Modern treatment of ST-elevation myocardial infarction (STEMI), emphasizing prompt reperfusion, has improved clinical outcomes by preserving cardiac function. Despite this, cardiorespiratory fitness remains i...
BACKGROUND: Modern treatment of ST-elevation myocardial infarction (STEMI), emphasizing prompt reperfusion, has improved clinical outcomes by preserving cardiac function. Despite this, cardiorespiratory fitness remains impaired. The purpose of this study was to assess determinants of cardiorespiratory fitness in patients with reperfused STEMI and preserved cardiac function. METHODS: We prospectively collected data from two patient cohorts with reperfused STEMI who underwent cardiopulmonary exercise testing on either a semi-supine cycle ergometer (Cohort 1) or treadmill (Cohort 2). Peak oxygen consumption (VO) was measured as mL·kg·min and as percent-predicted. Cardiac reserve was measured with Doppler echocardiography using heart rate (HR), stroke volume (SV), and cardiac output (CO) before and at peak exercise. Arterial-venous oxygen difference (a-v Odiff) was calculated using the Fick equation. RESULTS: We included ninety-five patients (58 [51-65] years, 34% female) tested 41 [37-45] days after STEMI (Cohort 1: n = 39; Cohort 2: n = 56). Resting LVEF was 55 [50-59] %, with 2 (2%) having <40%. E' velocity was 8.8 [7.3-10.5] and E/e' was 7.6 [6.5-9.2]. Peak VO was 20.0 [16.3-22.9] mL·kg·min, and 74 (78%) and 24 (25%) patients had reduced peak VO at <80% and <60% of predicted, respectively. A significant positive correlation was observed between peak VO and peak CO (R = 0.42, p = 0.0001), SV (R = 0.24, p = 0.02), HR (R = 0.36, p = 0.006), and a-v Odiff (R = 0.49, p < 0.0001). Peak HR and SV were each independent predictors of peak VO using multivariate analyses (all p < 0.01). CONCLUSION: Cardiorespiratory fitness remains impaired after successfully reperfused recent STEMI, despite rather preserved resting cardiac function. Cardiac and peripheral reserve partially explain the impairments, and preserving these may improve fitness after STEMI.
Multimodal artificial intelligence for early detection and precision management of inflammatory and infiltrative cardiomyopathies.
Adrejiya P, Alkhatib DA, Aljaroudi W
Curr Probl Cardiol · 2026 May · PMID 42155787 · Publisher ↗
BACKGROUND: Inflammatory and infiltrative cardiomyopathies, including cardiac sarcoidosis, transthyretin amyloidosis, and autoimmune myocarditis, are frequently underrecognized until advanced myocardial dysfunction devel...
BACKGROUND: Inflammatory and infiltrative cardiomyopathies, including cardiac sarcoidosis, transthyretin amyloidosis, and autoimmune myocarditis, are frequently underrecognized until advanced myocardial dysfunction develops. Conventional diagnosis of inflammatory and infiltrative cardiomyopathies depends on multimodality imaging and clinical integration, yet interpretation remains complex and delayed. AI (Artificial Intelligence) can improve diagnostic suspicion, tissue-based phenotyping, and risk-directed triage by integrating ECG, echocardiography, cardiac magnetic (CMR), positron emission tomography (PET)/scintigraphy, biomarkers, and Electronic Health Record (EHR) features. METHODS: This narrative review synthesizes contemporary evidence (2018-2026) regarding multimodality imaging and emerging AI approaches for early detection and risk-directed management of inflammatory and infiltrative cardiomyopathies. We emphasize mechanistic integration across electrocardiography, echocardiography, CMR, PET, nuclear scintigraphy, and EHR-derived phenotypes. RESULTS: Traditional functional assessment incompletely captures subclinical myocardial inflammation, interstitial expansion, and arrhythmogenic substrate. Multimodal AI platforms enable weak-signal fusion across imaging, electrophysiologic, and laboratory domains, identifying subvisual patterns not discernible through conventional interpretation. Disease-specific AI applications demonstrate promise in detecting occult cardiac sarcoidosis prior to overt clinical manifestation, differentiating amyloid phenotypes and expediting nonbiopsy diagnosis, and stratifying myocarditis trajectories. Importantly, AI-derived phenotypes may refine biopsy targeting, optimize immunosuppression timing, enhance arrhythmic risk stratification, and guide heart failure therapy escalation. CONCLUSIONS: Transitioning from conventional functional assessment to multimodal, AI-supported phenotyping represents a paradigm shift in the evaluation of inflammatory and infiltrative cardiomyopathies. Carefully validated and clinically integrated AI tools have the potential to enable earlier diagnosis, individualized therapy, and improved cardiovascular outcomes.
Comparative efficacy of baroreflex activation therapy, cardiac contractility modulation, and cardiac resynchronization therapy in heart failure with reduced ejection fraction: a systematic review and network meta-analysis of randomized controlled trials.
Basu-Ray I, Daniel RA, Ajoy Saha S … +11 more , Thota AN, Ramineni A, Jamalpuri D, Baiden I, Patel J, Meza M, Veeramachaneni R, Shrestha R, Deniz Ayar U, Qi Y, Fraga C
Curr Probl Cardiol · 2026 May · PMID 42144029 · Publisher ↗
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) remains a major global health burden despite advances in guideline-directed medical therapy (GDMT). Device-based therapies-including baroreflex activation...
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) remains a major global health burden despite advances in guideline-directed medical therapy (GDMT). Device-based therapies-including baroreflex activation therapy (BAT), cardiac contractility modulation (CCM), and cardiac resynchronization therapy (CRT)-target distinct autonomic, contractile, and electrical mechanisms. However, their comparative effectiveness across structural, functional, and clinical outcomes remains uncertain. METHODS: We performed a systematic review and network meta-analysis of randomized controlled trials in accordance with PRISMA-NMA guidelines (PROSPERO CRD420251087472). PubMed, Embase, Scopus, and Google Scholar were searched for trials enrolling adults with HFrEF and left ventricular ejection fraction (LVEF) ≤40%. Random-effects frequentist models were used, with GDMT as the reference comparator. Outcomes included change in LVEF, health-related quality of life (HRQoL), exercise capacity, New York Heart Association (NYHA) functional class, heart failure-related hospitalization, and all-cause mortality. Treatment rankings were estimated using the surface under the cumulative ranking curve (SUCRA). RESULTS: Nineteen trials involving 10,125 participants were included. BAT ranked highest for improvement in LVEF, HRQoL, six-minute walk distance, and NYHA class. CRT demonstrated the greatest improvement in peak oxygen consumption, whereas CCM ranked best for reducing heart failure-related hospitalization. None of the device therapies significantly reduced all-cause mortality. Between-study heterogeneity was low to moderate, and sensitivity analyses confirmed the robustness of the findings. CONCLUSIONS: BAT, CCM, and CRT provide complementary benefits beyond GDMT, supporting a phenotype-guided approach to device therapy in patients with HFrEF.
Obesity and cardiovascular risk in down syndrome: Challenges and updated management.
Lumb A, Levillard B, Rios V … +9 more , Al-Rawi R, Abdrabou M, Gupta K, Esfandiari H, Hasheminia A, Garagiola ML, Bornancini N, Porcille R, Baranchuk A
Curr Probl Cardiol · 2026 May · PMID 42142642 · Publisher ↗
Down syndrome (DS) or trisomy 21 is a genetic condition presenting with intellectual disabilities, distinctive phenotypic features, and multisystem involvement. As life expectancy in individuals with DS increases, obesit...
Down syndrome (DS) or trisomy 21 is a genetic condition presenting with intellectual disabilities, distinctive phenotypic features, and multisystem involvement. As life expectancy in individuals with DS increases, obesity has emerged as a significant and growing clinical concern. Although obesity is highly prevalent among DS patients, its contribution in shaping cardiovascular risk has not been comprehensively synthesized in the existing literature. Studies published between January 2000 and March 2026 were identified through searches of PubMed and ScienceDirect, supplemented by manual screening of reference lists. In total, 65 studies met the inclusion criteria. Evidence indicates that individuals with DS commonly exhibit increased central adiposity, altered metabolic and adipokine profiles, adverse lipid abnormalities, sedentary behavior, and a higher prevalence of sleep apnea, all of which may contribute to downstream cardiometabolic and cardiovascular strain. However, findings on insulin resistance remain varied, and much of the available evidence is cross-sectional and based on intermediate risk markers rather than on longitudinal cardiovascular outcomes. Overall, the current literature supports obesity in DS as a clinically relevant and probable amplifier of cardiovascular risk. Early, targeted strategies centred on nutrition, physical activity, and caregiver-supported interventions may help mitigate long-term burden. Although DS-specific longitudinal and interventional studies remain needed.
Endothelial cell metabolic reprogramming and pulmonary hypertension: Research progress and therapeutic potential.
Zhu R, Liu X, Shen Y … +2 more , Zhu S, Shao L
Curr Probl Cardiol · 2026 May · PMID 42107513 · Publisher ↗
Pulmonary hypertension (PH) is a progressive and life-threatening cardiovascular disorder characterized by elevated pulmonary arterial pressure and pulmonary vasculature remodeling. Accumulating evidence highlights that...
Pulmonary hypertension (PH) is a progressive and life-threatening cardiovascular disorder characterized by elevated pulmonary arterial pressure and pulmonary vasculature remodeling. Accumulating evidence highlights that metabolic reprogramming in pulmonary arterial endothelial cells (PAECs) as a fundamental driver of PH initiation and progression. This metabolic shift involves a transition to a hyper-glycolytic state, disordered fatty acid oxidation, and increased glutaminolysis, which contributes significantly to the pathogenesis of PH. Oxidative stress and mitochondrial dysfunction triggered by metabolic alterations in PAECs, establishing a self-reinforcing cycle of damage that disrupts vascular homeostasis. Furthermore, metabolic reprogramming drives PAECs heterogeneity, leading to the emergence of pathogenic subpopulations, including pro-inflammatory ECs, senescent ECs, and mesenchymal-like ECs via endothelial-to-mesenchymal transition (EndoMT). In addition to intrinsic changes, metabolically dysregulated ECs initiate aberrant intercellular crosstalk with smooth muscle cells, immune cells, and fibroblasts through the secretion of cytokines, lactate, and extracellular vesicles, ultimately accelerating vascular structural remodeling. In this review, we discussed the feasibility of targeting the metabolic drivers, such as inhibiting glycolysis, restoring mitochondrial function, or modulating amino acid metabolism in ECs, which have shown potential in preclinical and early clinical studies to alleviated PH. This offers new perspectives for the development of novel therapeutic strategies for PH.
Sociodemographic factors associated with major adverse cardiovascular events in the Ñuble Region in Chile: An ecological study.
Araneda J, Celis-Dooner J, Celis A … +1 more , Petermann-Rocha F
Curr Probl Cardiol · 2026 May · PMID 42107512 · Publisher ↗
BACKGROUND: Cardiovascular diseases are the leading cause of death globally. In Chile, the Ñuble Region shows the highest national Cardiovascular diseases mortality rate, highlighting the need for local analyses. Major a...
BACKGROUND: Cardiovascular diseases are the leading cause of death globally. In Chile, the Ñuble Region shows the highest national Cardiovascular diseases mortality rate, highlighting the need for local analyses. Major adverse cardiovascular events, including myocardial infarction, stroke, and heart failure, are key indicators of cardiovascular risk. This study aimed to identify sociodemographic factors associated with Major adverse cardiovascular events rates across Ñuble's 21 municipalities from 2011 to 2021. METHODS: This ecological study used hospital discharge data, calculating Major adverse cardiovascular events rates per 1,000 inhabitants weighted by the public health-insured population. Variables included rurality, health expenditures, and municipal health contributions. Statistical analyses involved Spearman correlation, forward selection regression, and multvariate modeling using SAS 9.4. RESULTS: There were 20,063 Major adverse cardiovascular events discharges, with a mean rate of 4.85 per 1,000. Health expenditure (ρ = -0.30), rurality (ρ = -0.15), and municipal contribution (ρ = -0.17) were inversely correlated with MACE rates (p < 0.05). In multivariate analysis (R² = 0.699), these remained significant. CONCLUSION: Greater rurality, higher health spending, and increased municipal investment were associated with lower Major adverse cardiovascular events rates. These findings emphasize the importance of local health investment in reducing cardiovascular risk.
Cardio-oncology and functional outcomes: Top contributors, and content analysis of the global research literature (1974-2025).
Albasheer O, Mahfouz MS, Ali S … +7 more , Ahmed AE, Muqri M, Ali NA, Madkhali T, Nogdalla M, Ibrahim W, Nogdalla MM
Curr Probl Cardiol · 2026 Sep · PMID 42034219 · Publisher ↗
This bibliometric analysis examined global research on cardio-oncology, cardiotoxicity, cancer survivorship, and functional outcomes using Scopus-indexed publications (1974-2025). The results demonstrate exponential grow...
This bibliometric analysis examined global research on cardio-oncology, cardiotoxicity, cancer survivorship, and functional outcomes using Scopus-indexed publications (1974-2025). The results demonstrate exponential growth in output, particularly after 2000, reaching a peak in 2024. Among authors, Cardinale, D. led with 16 publications, followed by Lipshultz, S.E. (14) and Guha, A. (12). The most productive institutions included The University of Texas MD Anderson Cancer Center (60), and Harvard Medical School (48). At the country level, the United States dominated output (919 publications), followed by Italy (313) and the United Kingdom (241). Analysis of the top 100 most cited publications (1987-2024) showed a a mean citation rate of 115.3 per document. Co-word dynamics revealed an evolution from chemotherapy-centered toxicity (e.g., doxorubicin) toward integrated frameworks involving cardiovascular outcomes, mechanistic pathways such as oxidative stress, and survivorship concerns. The formal emergence of "cardio-oncology" after 2018 marked consolidation of the field. Content analysis of the top 50 publications highlighted anthracycline-induced cardiotoxicity, biomarker and imaging-based early detection, and multidisciplinary care models. Key mechanisms included oxidative stress, mitochondrial dysfunction, and ferroptosis, while disparities in socioeconomic and demographic factors were increasingly recognized. Overall, the evidence indicates a shift toward integrated, patient-centered strategies balancing cancer control with preservation of cardiovascular and functional health.
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