All Articles

Federico Virgili^1*, Tommaso Rossi²

¹Department of Medical Surgical Science and Translational Medicine, Sapienza-University of Rome, Radiology Unit-Sant’Andrea University Hospital, 00189 Rome, Italy.

²Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155 Sapienza, Rome, 00161, Italy.

Gonzalo Martínez de las Cuevas^1,2*

¹ Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

²Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Spain

Heart failure with reduced ejection fraction (HFrEF) is highly prevalent among elderly patients, who frequently present with multimorbidity and frailty and are therefore at very high risk of hospitalization and mortality. Despite strong evidence supporting guideline-directed medical therapy (GDMT), therapeutic optimization remains suboptimal in this population, largely due to concerns regarding tolerability and comorbidities.

Emerging real-world data suggest that the early post-discharge period may represent a critical “window of opportunity” for therapeutic optimization in elderly patients with HFrEF. In this very high-risk population, early initiation and structured titration of disease-modifying therapies may confer substantial absolute benefits, potentially greater than those observed in lower-risk profiles, although this hypothesis requires further investigation.

This mini-review summarizes current evidence on GDMT implementation in elderly patients with HFrEF, with a focus on real-world experience, barriers to optimization, and the prognostic relevance of reducing heart failure hospitalizations. Unresolved controversies regarding patient selection, frailty, and outcome prioritization are discussed. Overall, available evidence suggests that age alone should not preclude therapeutic optimization and that structured, individualized approaches during this early phase may improve outcomes in elderly patients with HFrEF.

Hannah Stillman¹, Ehsan Rahimy^2,3, Prithvi Mruthyunjaya², Karen Wai^2*

¹Division of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, RI, USA

²Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA

³Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA, USA

Introduction: Retinal vein occlusion (RVO) is a condition in which one of the veins supplying the retina is occluded, causing acute vision changes. This event is often a signal of underlying cardiovascular disease and increases the risk for future adverse cardiovascular events.

Aim & method: This mini-review aims to provide an overview of pertinent studies investigating the relationship between RVO and increased risk of cardiovascular events and mortality, as well as treatments proposed to mitigate this risk.

Results: Pubmed database was searched for studies on RVO and risk of cardiovascular and mortality. 41 studies met criteria for inclusion. Following RVO, there was found to be a consistently elevated risk for myocardial infarction and cerebrovascular event, highest in the first year. There was also a mildly increased risk post-RVO for deep vein thrombosis and atrial fibrillation, but not for pulmonary embolism. Recent studies have also suggested that there is an increased risk for all-cause mortality after RVO. Central RVO may be more strongly associated with cardiovascular events as compared to branch RVO. To mitigate cardiovascular morbidity and mortality, treatment has been aimed at preventing atherosclerosis. Statin therapy post-RVO was found to significantly decrease cardiovascular risk.

Conclusion: While the relationship between RVO and cardiovascular disease has yet to be fully elucidated, evidence indicates that RVO is a strong predictor for future cardiovascular events, particularly acute myocardial infarction and cerebrovascular event. Ophthalmologists should work closely with primary care physicians and cardiologists following RVO to ensure proper risk assessment and treatment. These preventative interventions could reduce mortality and morbidity after RVOs.

Maho Kakemizu-Watanabe, Atsuko Hara, Masakazu Hayashida^*

Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan

Background: Cerebral tissue oxygen saturation monitoring using near-infrared spectroscopy (NIRS) is widely employed during cardiac surgery. Although NIRS devices are approved for monitoring cerebral oxygenation, they are not licensed for prognostic purposes. Nevertheless, multiple studies have demonstrated significant associations between baseline cerebral NIRS values measured before anesthesia induction and postoperative mortality after cardiac and noncardiac surgery in adults, suggesting a potential role for baseline NIRS values in mortality risk prediction. This narrative review summarizes current evidence regarding the association between baseline cerebral NIRS values and postoperative mortality, focusing primarily on adult cardiac and noncardiac surgery and exclusively on mortality rather than composite morbidity endpoints.

Methods: A comprehensive PubMed search was conducted to identify studies investigating the relationship between cerebral NIRS values and postoperative mortality in adult surgical patients.

Results: Six studies evaluating adult cardiac surgery patients and three studies involving adult noncardiac surgery patients were identified. All studies but one demonstrated a significant association between low baseline cerebral NIRS values recorded before anesthesia induction and increased postoperative mortality. These findings suggest that baseline NIRS values reflect underlying cardiac functional reserve and systemic oxygen delivery capacity. Emerging evidence also suggests potential inter-device differences in mortality prediction performance among commonly used NIRS technologies.

Conclusions: Baseline cerebral NIRS values may serve as convenient, useful predictors of postoperative mortality. This review highlights the mechanistic basis of this association and discusses potential differences in prognostic performance among NIRS devices, underscoring the need for further large-scale comparative studies.

Arnav Mana¹, Susan X. Zhao, MD^2*

¹Los Gatos High School, Los Gatos, CA, USA

²Santa Clara Valley Medical Center, San Jose, CA, USA

Despite significant advances in cardiopulmonary resuscitation (CPR) and post-cardiac arrest care, out-of-hospital cardiac arrest (OHCA) remains a major public health problem, with high rates of death and severe long-term neurological impairment among survivors. This systematic review addresses the current methods in predicting poor neurological outcomes in comatose OHCA survivors, including both pre- and post hospital factors, neurophysiological tests, neurological exam, biomarkers, and neuroimaging. A multimodality, multidisciplinary approach incorporating these factors as well as the OCHA survivors and their surrogate decision makers’ values is proposed (WEMuV) to guide neuroprognostication and counseling. The review also identifies emerging technologies such as artificial intelligence and machine learning as promising innovations that could integrate and automate complex patient data analysis to provide more accurate, personalized risk assessments and improve outcomes in OHCA patients.

Liudmila Iamukova¹

¹School of Pharmacy, University of California San Diego, La Jolla, United States

Cardiovascular diseases remain the leading cause of mortality worldwide, with limited capacity for myocardial regeneration following injury. Regenerative strategies, including autologous and allogeneic cell-based therapies, gene therapy, and tissue constructs, are being investigated as potential approaches to restore cardiac function. We searched ClinicalTrials.gov on August 16, 2025, using the terms “heart regeneration”, restricting to interventional trials in phases 1-3. Trials unrelated to cardiac regeneration were excluded. Study characteristics were analyzed by condition, intervention type, phase, geographic distribution, sponsor, age group, and enrollment size. For completed studies, associated publications were reviewed to summarize efficacy and safety outcomes. Of 41 identified trials, 23 met inclusion criteria. Most were early-phase studies (11 phase 1, 9 phase 2, 3 phase 3). Myocardial infarction was the most common target (9 trials), followed by heart failure (8), coronary artery disease (5), and congenital heart disease (1). Autologous strategies predominated, though several allogeneic stem cell and gene therapy trials were also represented. The United States (6 trials) and Spain (5) were the leading contributors, followed by Germany (3), the Republic of Korea (3), and Poland (2). Enrollment ranged from 6 to 420 participants. Publications from completed trials demonstrated consistent safety but variable efficacy in improving left ventricular function and infarct size. Clinical research into cardiac regeneration remains dominated by small, early-phase, investigator-led studies, with limited large-scale, industry-driven development. While feasibility and safety have been established, efficacy signals remain inconsistent, underscoring the need for larger trials to clarify therapeutic benefit.

Tetiana Poliakova¹ and Cheryl L. Wellington^1*

¹Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada, V6T 1Z3

Alzheimer’s disease (AD) remains a leading cause of dementia worldwide, with complex pathophysiology involving amyloid deposition and tau pathology that precedes cognitive decline. Cardiovascular risk factors, including hypertension, type II diabetes, and dyslipidemia, are recognized as modifiable risk factors of AD, especially during midlife, underscoring the close interplay between AD and vascular contributions to cognitive impairment and dementia (VCID). Anti-amyloid immunotherapies offer potential for disease modification; however, they can transiently increase cerebral amyloid angiopathy (CAA), which may lead to serious and potentially fatal adverse effects known as amyloid-related imaging abnormalities (ARIA). These risks are particularly elevated in apolipoprotein E4 (APOE4) carriers, the major genetic risk factor for late-onset AD, underscoring the urgent need for improved safety measures and patient stratification strategies. Notably, the vascular pathways implicated in ARIA may overlap with mechanisms of amyloid clearance influenced by lipid metabolism. The objective of this study is to review how lipoproteins, including low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), influence amyloid clearance and vascular health, and discuss how cholesteryl ester transfer protein (CETP), a key regulator of lipoprotein exchange, has emerged as a potential therapeutic target in dementia. In addition to effectively lowering LDL-C and increasing HDL-C, the CETP inhibitor obicetrapib has recently shown promising results in slowing progression of a key AD biomarker, p-tau-217, over 12-month of treatment in patients with atherosclerotic cardiovascular disease, with more pronounced effects in APOE4 carriers. This minireview thus highlights the intersection of cardiovascular and neurodegenerative pathways and supports further exploration of lipid-modulating therapies in AD and VCID.

Stefan Duschek¹, Rainer Schandry² & Gustavo A. Reyes del Paso³

¹UMIT Tirol – University of Medical Sciences and Technology, Hall in Tirol, Austria

²University of Munich, Germany

³University of Jaén, Spain

In addition to physical complaints like fatigue, reduced drive, dizziness, and cold limbs, chronic low blood pressure (hypotension) is associated with cognitive impairments and negative mood states. This review is concerned with autonomic and hemodynamic factors implicated in the origin of chronic hypotension and associated symptoms. There is strong evidence of reduced stroke volume and cardiac output, and prolonged pre-ejection period, at rest, during mental challenge and during sleep, indicating reduced myocardial contractility due to low beta-adrenergic drive in chronic hypotension. While studies investigating parasympathetic cardiac control and alpha-adrenergic vascular influences revealed inconsistent results, increased sensitivity of the cardiac baroreflex is well-supported in chronic hypotension. Moreover, cardiovascular stress reactivity is reduced. Low myocardial contractility constitutes the main factor in the manifestation of chronic hypotension; increased responsiveness of the baroreflex may play an additional role. Diminished cardiac output leads to insufficient blood supply of the organism and symptoms like low skin temperature and cold limbs; moreover, low beta-adrenergic activity is involved in hypotension-related mood impairments. Deficits in systemic hemodynamics are partly transferred to brain perfusion, expressed as lower cerebral blood flow at rest and impaired blood flow adjustment during cognitive activity in chronic hypotension. Blunted cardiovascular reactivity reflects reduced autonomic flexibility, limiting the adaptive resources of the organism.

Kayo Sugiyama^1*, Hirotaka Watanuki¹, Masato Tochii¹, Katsuhiko Matsuyama¹

¹Department of Cardiac Surgery, Aichi Medical University Hospital

      1 - 1  Yazako Karimata, Nagakute, Aichi, 480-1195, Japan

Purpose: To evaluate the clinical background and postoperative outcomes of patients with infective endocarditis in the aortic valve position and discuss the appropriate approach in the era of minimum invasive cardiac surgery.

Methods: We evaluated the preoperative background, intraoperative procedure, and postoperative outcomes of infective endocarditis in the aortic valve including 13 patients at our hospital. The right lateral mini-thoracotomy approach was introduced in six patients with localized infectious changes in the aortic valve.

Results: All surgical treatment were performed successfully, and there were no mortality or cardiac events related to recurrent infection. The right lateral mini-thoracotomy approach was completed safely; however, ventricular diverticulum was detected in multidetector computed tomography after surgery.

Conclusions: Infective endocarditis in the aortic valve was appropriately treated, and the postoperative course was favorable. The right lateral mini-thoracotomy approach is feasible, but it should be selected carefully only for cases with localized infection in the aortic valve.

Aima Mustafa Bhatti¹, Khawaja Husnain Haider²

¹Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts 02215

²Department of Basic Sciences, Sulaiman AlRajhi University, AlQaseem, Kingdom of Saudi Arabia

Mesenchymal stem cells (MSCs) are rapidly emerging as living biodrugs with significant potential in regenerative medicine, particularly cardiovascular applications. The recent FDA approval of the first allogenic MSC-based product, Ryoncil (remestemcel-L-rknd), for steroid-refractory acute graft vs. host disease (GvHD), underscores their safety and effectiveness. This paves the way for MSCs to be a safe and effective innovative treatment strategy for acute and chronic ischemic heart disease and cardiomyopathy. Preclinical experiments and translational study data have shown that MSCs have the potential to improve cardiac pump function significantly, opening up a promising avenue for further research. This mini-review explores the promising potential of MSCs as a living drug, offering hope for patients with cardiovascular pathologies.

Niti Dalal¹, Aabha Divya²

¹Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA

²Division of Cardiothoracic Surgery, Department of Surgery, Tulane School of Medicine, New Orleans, LA

Patients undergoing pulmonary endarterectomy surgery require lifelong anticoagulation to prevent thromboembolic complications. However, spontaneous retroperitoneal hemorrhage (SRH) represents a rare but severe complication of long-term anticoagulation. There are controversies regarding the optimal timing and strategy for resuming anticoagulation. This review explores the current evidence on long-term anticoagulation management following spontaneous retroperitoneal hemorrhage. This review aims to analyze risks, diagnostic tests, therapeutic approaches, and clinical outcomes. We refer to a case report of SRH following pulmonary thromboembolectomy surgery, and we discuss conservative and interventional management strategies for the management of long-term anticoagulation after significant bleeding complications such as SRH.

Zhuang Lu^1#, Jing Liu^2#, Tangjia Cui¹, Yehua Lu¹, Zhongwei Bao¹, Qiuming He³, Yaming Yan^1*

¹Kangqiao Community Health Center, Shanghai 201319, China

²Department of Microbiology and Immunity, The College of Medical Technology, Shanghai University of Medicine & Health Sciences, Shanghai 201318, P.R. China

³Ruzhou Renai Hospital, Henan 467500, China
^#These authors contributed equally to this work

Objective: This study aimed to examine the effects of low-dose statins on blood pressure in individuals diagnosed with prehypertension and borderline elevated blood lipids.

Methods: From January 2020 to June 2021, a cohort of 150 patients with prehypertension and borderline elevated blood lipids was recruited from the Kangqiao Community Health Service Center, Pudong New Area, Shanghai. Participants were randomly divided into an experimental group and a control group, each comprising 75 patients. Both groups received standard lifestyle interventions. Additionally, the experimental group was treated with low-dose statins, while the control group was given with placebo. The treatment duration was three months. Blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), blood lipids (total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)), vascular endothelial function (nitric oxide (NO), endothelin-1 (ET-1), flow-mediated dilation (FMD)), and carotid intima-media thickness (IMT) were measured. These parameters were assessed at baseline, one month into treatment, and at the end of the three-month treatment period. Subsequently, patients were followed for two years to evaluate the incidence of hypertension.

Results: Both SBP and DBP showed a progressive decrease from baseline to three months in both the experimental group and control group, with the experimental group experiencing a more significant reduction. Statistically significant differences were observed between the two groups, over time, and in group-by-time interactions (P < 0.05). Similarly, reductions in TC, TG, and LDL-C were more pronounced in the experimental group, with significant differences between the two groups, time points, and group-by-time interactions (P < 0.05). Improvements in NO and FMD levels and reductions in ET-1 levels were more marked in the experimental group, with statistically significant differences (P < 0.05). IMT reduction was also more notable in the experimental group, with significant differences between groups, over time, and in group-by-time interactions (P < 0.05). After two years of follow-up, the experimental group had a lower prevalence of hypertension compared to the control group (P <0.05).

Conclusion: Low-dose statin therapy could effectively lower blood pressure and blood lipid levels, enhance vascular endothelial function, delay arteriosclerosis progression, and reduce the incidence of hypertension in patients with prehypertension and borderline elevated blood lipids.

Antonio Coca

School of Health and Life Sciences, Universitat Abat Oliba CEU, CEU Universities, Barcelona, Spain

Mohammed Yunus Khan^1*, Sadanand Shetty², Abraham Oomman³, Peeyush Jain⁴, Kumar Gaurav⁵

¹Global Generics India, Dr. Reddy’s Laboratories, India

²Dr. D.Y. Patil Medical College, India

³Apollo Heart Institute, Apollo Hospitals, India

⁴Department of Preventive and Rehabilitative Cardiology with Fortis Escorts Heart Institute, India

⁵Global Generics India, Dr. Reddy’s Laboratories, India

High blood pressure is considered one of the major risk factors for heart disease. In addition to evidence of low heart disease and death with adequate control of blood pressure, antihypertensive treatment is still less effective in clinical practice. It is well documented that there is a decrease in cardiovascular events, such as stroke and MI, with potent therapies to combat high blood pressure. This, however, is generally believed to be the result of a phase. This review paper includes and focuses on evidence from clinical trials in support of amlodipine as a first-line anti-hypertensive agent, showing how its unique properties can provide better cardiovascular protection compared to other antihypertensive agents to prevent stroke and cardiovascular disease. Evidence from the many randomized controlled trials presented below shows that amlodipine has excellent efficacy and safety, as a first-rate anti-hypertensive agent not only to control BP but also to safely improve patient outcomes. Patients treated with this drug have benefited as they have fewer hospitals and lower rates of recovery. Its unique mechanism of action leads to a reduction in the development of atherosclerosis. In addition, amlodipine with effective BP control for 24 hours may also be helpful as an adjunct to the treatment of patients with renal impairment by reducing the progression of end-stage renal disease.

Lauren Johnston, Maria Boumpouli, Asimina Kazakidi^*

^*Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK

Congenital heart disease, which affects more than one million newborns globally each year, contributes to an increased risk of cardiovascular disease and ultimately reduced life expectancy. Computational fluid dynamics (CFD) enables detailed, non-invasive characterization of complex physiological pressure and flow fields, thus improving our understanding of congenital heart disease hemodynamics.

In recent years, this has driven clinical decision-making, surgical planning, and the evaluation of innovative surgical techniques. In this mini review, CFD methods applied to the study of congenital abnormalities, with a focus on the aorta and pulmonary bifurcation, are discussed. The clinical relevance and future directions of CFD modelling are also reviewed.

Yuling He¹, Jingjing Wang¹, Lingdong Kong¹, Bo Jia¹, Yujia Chi¹, Xiaoyu Zhai¹, Han Jin², Ziping Wang¹*

¹Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, China

²Department of Cardiology, Peking University First Hospital, China

Background: Cardiac and pericardial metastasis in small cell lung cancer (SCLC) is more common than estimated, but there are a few related studies in the literature. This study aims to raise the attention of such clinical circumstances.

Methods: We analyzed the clinical data of 62 SCLC patients with arrhythmia and confirmed eleven cases of SCLC with cardiac and/or pericardial metastasis by cytology or imaging diagnosis. Survival analysis was performed by the Kaplan-Meier method.

Results: Among 11 patients, 6 had pericardial involvement, 10 had mediastinal lymph node metastasis, and 8 had hilar lymph node metastasis. The most common type of electrocardiogram (ECG) abnormality was supraventricular arrhythmias (10/11). Complete imaging data were obtained in 7 patients through whole treatment after diagnosed with cardiac metastasis. Among them, 5 patients achieved partial response, and 2 of them achieved improvements in ECG abnormality. In the two remaining patients, advances in imaging diagnosis were identified after treatment, and new abnormalities were found in their ECG. The median overall survival time of the 11 patients was 11 months.

Conclusions: Cardiac and pericardial metastasis of SCLC can present different types of arrhythmia, and the ECG may change after treatment. Clinicians should take this condition into consideration, and aggressive treatment may achieve significant remission. 

Yanyi Tian^1,4,5, Wei Tian^2,4,5, Ting Li³, Jingman Xu^1,4,5*

¹Heart Institute, School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China

²Analysis and Test Center, North China University of Science and Technology, Tangshan, Hebei, China

³College of Foreign Language, North China University of Science and Technology, Tangshan, Hebei, China

⁴Hebei Province Key Laboratory of Organ Fibrosis, Tangshan, Hebei, China

⁵International Scientific and Technological Cooperation Base of Geriatrics Medicine, Tangshan, Hebei, China

César Del Castillo Gordillo^1,2*, Mario Alfaro Diaz¹

¹Cardiovascular center, San Borja Arriaran Hospital, Santiago, Chile

²Cardiovascular center, DIPRECA Hospital, Santiago, Chile

Akanksha Agrawal¹*, Deepanshu Jain², Jefferson Baer¹, Michael McDaniel¹

¹Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

²Center for Interventional Endoscopy, AdventHealth, Orlando, FL, USA

Coronavirus Disease 2019 (COVID-19) is a primary respiratory illness with various cardiac manifestations. This case describes a patient presenting as acute myocardial infarction (AMI) with cardiogenic shock and acute hypoxic respiratory failure secondary to COVID-19 complicated by acute embolic stroke.

Elizabeth Tolmie, Grace M Lindsay*, Philip Belcher

College of Nursing, Umm Al-Qura University Makkah, Kingdom of Saudi Arabia

Background: Survival after myocardial infarction (MI) is improving leading to increasing numbers of people dealing with heart health recovery, readjustment and re-investment in their future wellbeing and that of their family. Cardiac Rehabilitation (CR) aims to improve outcome by ensuring patients adopt recommended health maintenance strategies. This study explored the health maintenance needs of adults one to three years after an MI. The theoretical framework guiding the study was Leventhal’s Self Regulation Model. Data from the completion of different measures of health and illness representation are presented and the potential for measuring current health status and their explanatory factors is illuminated.

Aims: To identify the longer-term health needs of adults who have suffered an acute MI.

Methods: A mixed method design was used to explore respondents’ illness representations and the factors believed to be impacting on their longer-term health and health behaviour. A sample of 73 adults completed 3 questionnaires to assess their illness perceptions, mood and quality of life (QoL) 1 to 3 years after discharge from hospital. A sub-sample (n=30) participated in an interview, underwent a brief clinical assessment, and completed a small task. Data analysis used StatsDirect and Nudist 5.

Results: One to three years post-discharge, Personal and Treatment control belief scores of 22.6 ± 4.3 and 17.6 ± 4.3 respectively were strong, but perceived consequences high (20.6 ± 4.9). Many respondents were experiencing low energy (92%), breathlessness (67%) and chest pain (53%), and many reported a sense of loss that affected their ability to sustain health and positive health behaviour. Those with the poorest attendance at CR had poorer QoL, anxiety, and depression scores, and women had poorer outcomes than men in many of the indices assessed (p<0.05). Initial compliance with prescribed drug regimens and lifestyle recommendations (self-report) was not maintained.

Conclusion: This preliminary study supports the notion that there is a largely unmet and persistent health need among adults diagnosed with MI, and that more consideration needs to be paid to its longer-term effects and the needs of women. Combining surveys with interview methods and tools such as the PRISM+ provide an opportunity to understand the complexity of patients’ health evaluation.

Prasanna Karthik Suthakaran¹, Jasima Nilofer², Kothai Gnanamoorthy³, Mohammed Idhrees⁴*

¹Professor, Department of General Medicine, Saveetha Medical College Hospital, Chennai, India

²Department of Pathology, Sree Balaji Medical College and Hospital, Chrompet, Chennai

³Associate Professor, Department of General Medicine, ESIC Medical College and PGIMSR, India

⁴Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India

Peripartum cardiomyopathy is a idiopathy cardiomyopathy associated with heart failure towards the end of pregnancy or in the postpartum period. Various mechanisms like myocarditis, autoimmune response to pregnancy, viral infections, selenium deficiency, oxidative stress and prolonged tocolysis have been proposed as the etiology. The most common presentation is acute heart failure occurring usually within a few weeks after delivery with patients developing exertional breathlessness, orthopnea and paroxysmal nocturnal dyspnea. Cardiac Magnetic Resonance Imaging is useful in accurate measurement of chamber volumes and global and segmental myocardial function. The gold standard test for diagnosis of peripartum cardiomyopathy is Endomyocardial biopsy with the histological Dallas criteria. Most of these postpartum patients are managed medically. The risk of peripartum cardiomyopathy increases with increasing parity and outcomes in subsequent pregnancies was poor.

François M.A. Paris¹*, Gillian J. Jessurun², Rutger L. Anthonio², Massimo A. Mariani³

¹House officer cardiology, Department of Cardiology, Treant Zorggroep Scheper Ziekenhuis Emmen, The Netherlands

²Intervention cardiologist, Department of Cardiology, Treant Zorggroep Scheper Ziekenhuis Emmen, The Netherlands

³Cardiothoracic surgeon Heart, Center University Medical Center Groningen, The Netherlands

One of the most important causes of death in Western society, following cancer, is myocardial infarction (MI). Although acute MI occurs at an older age, the incidence of acute MI in younger adults has increased.

Essentially, treatment of acute MI is reperfusion therapy, which should preferably be performed within 12 hours of onset of the symptoms. Time is imperative and shorter intervals between symptoms an reperfusion leads to lower mortality. Conversely, a longer interval results in higher mortality, more mechanical complications and morbidity.

At our institution, located in the middle of a thinly populated rural area, patients used to be treated with thrombolysis until 2005. The nearest centers for percutaneous coronary interventions (PCI) and cardiothoracic surgery, had a travelling distance of 60 minutes. Since the introduction of interventional cardiology in the province of Drenthe, we managed to reduce the symptom to needle time.

Recently, we have been confronted with the COVID-19 pandemic, led to an increase in patient’s and doctor’s delay. This unfolded new challenges in treating acute MI.

This overview addresses the general clinical approach of acute MI and highlights the diagnostic approach and treatment options of both premature atherosclerosis and non-atherosclerotic causes of MI from our clinical perspective. We would like to argue that a personalized clinical approach remains of utmost importance in each patient treated by protocolized medicine.

Eliezer J. Tassone*, Cesare Tripolino, Gaetano Morabito, Placido Grillo, Bindo Missiroli

Department of Cardiac Surgery, Cardiology Unit, Sant’Anna Hospital-Catanzaro, Italy

The presence of coronary calcification is a hard challenge for the interventional cardiologist, as it is associated with incomplete stent expansion and frequently stent failure. In recent years, innovative techniques have been developed to treat coronary calcific lesions such as rotational atherectomy. However, many of them are burdened with an increased procedural risk. Recently, a new technique called “Shockwave Coronary Lithoplasty System”, also called lithotripsy, has been introduced in order to treat calcific coronary lesions with greater safety. Shockwave procedure allows treating the most calcific coronary lesions with simplicity and safety. This system employs the sound waves, similar to that used for treating kidney stones, in order to crush the calcific lesions. In this minireview, we explain the characteristics of the method and we provide a description of the technique in detail on the basis of the preliminary experience of the first cases. In particular, we will demonstrate that this technique is more effective and safer than traditional techniques employing atherectomy, also providing for the first time a therapeutic chance for the treatment of under-expanded stents in many clinical contexts.

Houria Daimi¹, Diego Franco²*

¹Biochemistry and Molecular Biology Laboratory, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia

²Department of Experimental Biology University of Jaen, Spain

In the human heart, the action potential (AP) is initiated and maintained thanks to a fast-activating fast-inactivating Na⁺ current carried by Nav1.5 channels. The pivotal physiological role of Nav1.5 in the heart is reflected by the important consequences of its coding SCN5A gene mutations. These mutations may lead to an impaired functional expression (including expression level, subcellular localization, trafficking, and/or current density), and are generally correlated with severe cardiac rhythm disorders such as Long QT (LQT) and Brugada syndrome (BrS). In BrS, loss of function mutations in SCN5A account for 35-40% of clinically affected patients and around 400 mutations in the SCN5A gene were identified in probands with BrS. Emerging electrophysiological techniques such as patch clamp along with transgenic animal technologies improved our understanding of the pathogenic mechanisms underlying BrS due to SCN5A variants. However, despite significant advances in defining the pathophysiology of Nav1.5, the molecular mechanisms underlying its regulation and contribution to the disease are poorly understood. It is well established that functional expression of Nav1.5 may be under modulation by post-transcriptional regulators, defining thus its transcript levels in the cell and also the penetrance on its associated diseases. Recently, non-coding RNA (ncRNAs) molecules have been identified as key transcriptional regulators of SCN5A expression in the heart. The present mini-review provides a summary of the role of ncRNAs, especially microRNAs (miRNAs), in the regulation of SCN5A. It mainly focuses on their role in the BrS context and discusses the recent updates and the major gaps still to be elucidated.

Abbreviations

AP: Action potential; LQT: Long QT; BrS: Brugada syndrome; ncRNAs: non-coding RNA; miRNAs: microRNAs; lncRNAs: long non coding RNAs; 3′UTR: 3′ untranslated region; SNPs: Single-nucleotide polymorphisms.

Luis Graca Santos*, Rita Ribeiro Carvalho, Sara Fernandes, Joao Morais

Department of Cardiology, Leiria Hospital Centre, Leiria, Portugal

Noncompaction cardiomyopathy is a heterogeneous and complex entity characterized by hypertrabeculation, typically of the left ventricle. Uncertainties regarding pathogenesis, classification as primary genetic or unclassified cardiomyopathy, diagnostic criteria, and risk stratification have contributed to fuel the discussion surrounding this disorder. Meanwhile, noncompaction phenotype is thought to be the morphological expression of different underlying pathophysiological mechanisms, genetics, and pathologies. Recent studies suggest that distinguishing genetic from nongenetic causes allows risk stratification and may support clinical management and counselling of patients and their relatives. Additionally, advanced cardiac imaging techniques have demonstrated a complementary role in outcome prediction. The purpose of this review is to provide a brief comprehensive review of this controversial entity.