Acute Pulmonary Embolism in the Cardiometabolic Patient
Antonio Maria Labate1, Provvidenza Villari2
1ASST Franciacorta, UOSD Diabetologia, Viale Mazzini 4, 25032 Chiari, Italy
2ASST Garda, Specialistica Ambulatoriale, Branca Diabetologia, Località Montecroce, 25015 Desenzano del Garda, Italy
Background: Acute pulmonary embolism (PE) remains one of the most clinically relevant manifestations of venous thromboembolism and continues to pose important diagnostic and prognostic challenges. In routine practice, however, PE is still often considered separately from the broader framework of cardiometabolic disease.
Methods & Scope: This mini-review discusses acute PE in the cardiometabolic patient, focusing on the intersection between obesity, visceral adiposity, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease (MASLD).
Results: Current evidence suggests that obesity, particularly central and visceral adiposity, represents the most consistent cardiometabolic determinant of venous thromboembolic risk, through mechanisms involving chronic low-grade inflammation, endothelial dysfunction, impaired fibrinolysis, and procoagulant imbalance. Type 2 diabetes appears to play a more nuanced role, acting less as an isolated driver and more as a marker of clustered metabolic vulnerability, especially in the presence of poor glycemic control, renal impairment, and long disease duration. MASLD may further amplify thrombo-inflammatory susceptibility through the liver’s central role in coagulation and fibrinolytic pathways.
Conclusion: In this setting, PE may be more difficult to recognize because symptoms frequently overlap with those of obesity, heart failure, respiratory disease, and general functional limitation. A more integrated cardiometabolic perspective may improve diagnostic vigilance, risk interpretation, and post-event clinical management.
DOI: 10.29245/2578-3025/2026/2.1249 View / Download PdfGender Affirming Hormone Therapy and Potential Effects on Myocardium, Ventricular Morphology, and Cardiac Function: A Literature Review
Alyssa Ahern, DO1, Hossam Albeyoumi, M.B.B.C.H1, Stephanie Saucier, MD2
1University of Connecticut, Department of Internal Medicine
2Hartford Healthcare, Department of Cardiology
Introduction: Approximately 1.4 million adults in the United States identify as transgender, about half of whom are treated with gender-affirming hormone therapy (GAHT). Transgender individuals experience increased cardiovascular risk, which may be partly related to GAHT. However, GAHT’s effects on cardiac morphology and function are not well understood. The role of echocardiography in assessing these potential effects remains unclear.
Methods: A literature review was conducted using four major databases with keywords relevant to transgender and cardiovascular health. Articles were screened for relevance based on titles, and selected abstracts were reviewed for the initial inclusion criterion: (1) GAHT and potential effects on cardiovascular health. Remaining articles were read in full and eliminated or stratified based on research themes: (a) GAHT’s effect on cardiac myocardium, (b) effects on ventricular morphology or function, or (c) the role of echocardiography in evaluating GAHT-related cardiac changes.
Results: 960 articles were initially identified, of which 214 distinct abstracts were reviewed, and 85 publications were read in full. 9 articles contained information regarding at least one of the three research themes. Reviewed data suggest GAHT may affect myocardial mass, end diastolic volume, and diastolic function in transgender men. Transgender women may have increased LVEF during exercise. Few studies used echocardiography to evaluate these changes.
Conclusion: GAHT may increase cardiovascular risk in transgender individuals, though underlying mechanisms remain unclear. Few articles evaluate GAHT’s effect on cardiac structure and function, though current data suggest possible cardiac effects. The use of echocardiography to assess GAHT-related cardiac changes remains underexplored.
DOI: 10.29245/2578-3025/2026/2.1239 View / Download PdfTherapeutic Apheresis for Homozygous Familial Hypercholesterolemia Turns 50
Claudia Stefanutti
1Department of Molecular Medicine, Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Regional Centre for Rare Diseases, Immunohematology and Transfusion Medicine, Umberto I Hospital, "Sapienza" University of Rome, Viale del Policlinico 155, Rome, 00161, Italy.
Familial hypercholesterolemia (FH) is a genetic autosomal dominant metabolic disorder that is characterized by elevated plasma and lipoprotein levels, such as low-density lipoprotein cholesterol (LDL-C) that carry atherogenic lipids in plasma. There are two forms of FH: Heterozygous Familial Hypercholesterolemia (HeFH), a relatively frequent genetic disorder affecting roughly 1 in 200–300 people worldwide, causing high LDL-C and early atherosclerotic cardiovascular disease (ASCVD). Homozygous Familial Hypercholesterolemia (HoFH) is a rare, severe form occurring in 1 in 160,000 to 1,000,000 people. Early diagnosis and lifelong treatment are essential for patients with FH to reduce the risk of developing cardiovascular disease early in life, increase life expectancy, and improve quality of life. This mini review offers a targeted historical and clinical review of the 5-decade development of extracorporeal treatment methods, especially Lipoprotein Apheresis (LA), in the treatment of HoFH. Besides the overview of its proven efficacy, safety, and pleiotropic activity, the review briefly describes the modern role of LA and new lipid-lowering treatments and their role in the remaining patient groups.
DOI: 10.29245/2578-3025/2026/2.1247 View / Download PdfEvaluating Beta Blocker use in Acute Pericarditis Beyond Anti-Inflammatories: A Retrospective Cohort Study
Aarushi Kalra1*, Henry L.Colorado 1, Fardeen Faiz 2, Ioannis Parastatidis 2
1Northeast Georgia Medical Center, Gainesville, GA, USA
2Georgia Heart Institute, Gainesville, GA, USA
Background: Pericarditis accounts for approximately 5% of chest pain visits in the emergency department. Standard therapy includes NSAIDs, colchicine, and corticosteroids; however, recurrence and readmissions remain common despite treatment. Few European studies suggest that beta blockers may decrease symptoms and arrhythmia burden; however, the role of beta blockers in acute pericarditis outcomes is limited.
Objective: We sought to examine whether beta blockers influence the clinical outcomes of acute pericarditis.
Methods: We performed a retrospective cohort chart review which analyzed adult patients in the Northeast Georgia Health System diagnosed with pericarditis between 2018 and 2024. A total of 435 patients were included: 155 were not on beta blockers (no BB) and 280 were on beta blockers (BB). Primary outcomes included length of stay (LOS), 365-day cardiovascular and all-cause hospital and emergency department readmissions.
Results: Based on the results, mean length of stay did not differ between the BB group and the no BB group (4.0 vs 3.0 days, p=0.228). At 1-year, cardiovascular readmissions occurred in 35/280 (12.5%) for the BB group versus 16/155 (10.3%) for the no-BB group (p=0.69). Similar nonsignificant differences were observed for all-cause hospital and ED readmissions. Since arrhythmia events were infrequent, no formal statistical analysis was performed.
Conclusions: In our cohort, beta-blocker use in acute pericarditis was not significantly associated with reduction in LOS or readmission rates. While European data suggests potential benefits, our results do not confirm a clear advantage. Further trials are necessary to define whether beta blockers have a role in pericarditis management.
DOI: 10.29245/2578-3025/2026/2.1245 View / Download Pdf