Current Treatment Options in Cardiovascular Medicine最新文献

Purpose of review: Supervised-exercise therapy (SET) is a cornerstone intervention for management of peripheral artery disease (PAD) and is associated with improvement in ambulatory functional status. Despite strong evidence supporting the benefits of SET, accessibility and adherence remains a challenge, underling its full clinical potential. Home-based exercise therapy (HBET) has emerged as more accessible alternative to SET. This paper reviews the benefits of exercise in PAD, explores the role of home-based exercise therapy in the management of PAD, and describes the essential components of HBET in contemporary clinical practice.

Recent findings: HBET programs have demonstrated similar improvements in ambulatory function, including walking distance and pain-free walking distance, as established SET regimens. Recent clinical trials and meta-analysis have established HBET as a reasonable alternative to SET, as reflected in the latest multi-societal clinical guidelines.

Summary: Functional and quality of life improvements with HBET parallel those with SET and outperform routine exercise education. Successful HBET should include both monitoring and behavioral intervention components to improve adherence and long-term symptomatic improvements. Providers should tailor HBET to the individual patient's needs and limitations. Ongoing research aims to understand the optimal platform to deliver HBET programs to a wide range of patients with symptomatic PAD.

Purpose of review: This review aims to detail recent research and guidelines that have changed the approach to exercise and sport participation in the pediatric hypertrophic cardiomyopathy (HCM) population.

Recent findings: Recent studies, including the landmark LIVE-HCM cohort, demonstrated that vigorous exercise was not associated with death, implantable cardiac defibrillator (ICD) shock, resuscitated cardiac arrest, or arrhythmic syncope in patients with HCM. Furthermore, there is increasing evidence that restriction from physical activity (PA) has negative consequences for the cardiovascular health and emotional well-being of children with HCM. This has influenced guidelines that promote individualized risk assessment and shared decision-making (SDM), rather than uniform restriction, in children with HCM who wish to participate in both recreational and competitive athletics.

Summary: The relationship between PA and cardiac events in children and adults with HCM is more nuanced than once believed, and the negative consequences of uniform PA restrictions have become increasingly clear. Guided by recent prospective cohort studies, the approach to adolescents and young adults with HCM is changing, now emphasizing the role of individualized risk assessment and SDM.

Purpose of review: Photoacoustic and ultrasound imaging together resolve vascular structure, wall biomechanics, blood flow, oxygenation, and tissue composition without ionizing radiation or iodinated contrast. This review summarizes what each modality can now measure in patients and asks which of these measurements are close enough to clinical use to inform cardiovascular management decisions.

Recent findings: Recent advances have expanded photoacoustic imaging toward faster, higher-resolution functional vascular phenotyping, including clinically relevant biomarkers and co-registered ultrasound imaging. Ultrafast and super-resolution ultrasound now quantify vascular biomechanics, hemodynamics, and microvasculature, with ultrasound localization microscopy entering clinical studies. Wearable ultrasound has also been validated for blood-pressure monitoring across diverse care settings, alongside increasingly quantitative feature extraction.

Summary: Ultrasound and photoacoustic imaging provide complementary vascular information: ultrasound offers depth, speed, and continuous access, while photoacoustic imaging adds compositional and oxygenation contrast. Despite limitations in quantitative accuracy, imaging depth, and system standardization, emerging patient studies now span super-resolution vascular mapping, functional biomarkers, and wearable monitoring. Their integration offers a potential route toward continuous, operator-independent vascular phenotyping for clinical decision-making.

Purpose of review: Congenital heart defects (CHDs) arise from disruption of precisely orchestrated developmental programs that coordinate cardiac lineage specification, morphogenesis, maturation, and tissue remodeling. This review highlights recent advances in experimental systems used to connect CHD-associated genes and variants to developmental mechanisms.

Recent findings: In vivo mouse and vertebrate studies have refined models of early cardiogenic mesoderm formation, heart-field allocation, valve development, outflow tract morphogenesis, epicardial-myocardial interactions, and ventricular compaction. Parallel work on postnatal cardiac maturation highlights how RNA processing, metabolic remodeling, immune signaling, and non-myocyte populations influence cardiomyocyte maturation and regenerative competence, with implications for long-term outcomes in CHD survivors. Human pluripotent stem cell models provide complementary platforms for investigating gene functions: two-dimensional differentiation enables scalable, temporally controlled analysis of lineage commitment and cell-autonomous phenotypes, whereas organoids and other three-dimensional models introduce spatial organization, multicellular interactions, and tissue-level readouts. Genome editing, CRISPR screening, base and prime editing, regulatory-element assays, and inducible protein-depletion systems now allow increasingly precise and high-throughput characterization of coding and noncoding variants.

Summary: Together, these advances are enabling a transition in CHD research from descriptive genomics to integrated, multi-model approaches that connect genetic variation to gene function, developmental mechanisms, and disease phenotypes.

Purpose of review: Cardiac vascular remodeling is central to cardiovascular development, injury, and regeneration, yet it remains difficult to resolve in three dimensions within the living, beating heart. This review critically evaluates emerging light-sheet fluorescence microscopy (LSFM) strategies for zebrafish cardiac vascular studies, distinguishes directly demonstrated cardiac applications from transferable methods established in other tissues, and defines quantitative endpoints needed for rigorous treatment-response assessment.

Recent findings: Cardiac-gated and four-dimensional LSFM, hybrid light-field/light-sheet imaging, multiscale acquisition, automated segmentation, and deep-learning-assisted reconstruction have enabled cardiac-cycle-resolved visualization of myocardial motion, intracardiac flow, endothelial migration, vascular remodeling, and regenerative responses. However, the evidence base is uneven: several approaches are validated directly in the zebrafish heart, whereas others remain enabling technologies whose cardiac microvascular utility is inferred from noncardiac applications.

Summary: LSFM can serve as a powerful discovery platform when fluorescent reporters, motion synchronization, quantitative analysis, and biological validation are integrated prospectively. The field now requires standardized acquisition and reporting, explicit separation of measured and model-derived endpoints, validation of AI-assisted reconstructions, and coordinated confirmation in mammalian or human cardiovascular models.

Purpose of review: The purpose of this work is to review the role of drug-coated balloons (DCBs) in contemporary coronary artery disease (CAD) management by focusing on its clinical indications and technical considerations, supported by updated insights from the International DCB Consensus Group.

Recent findings: While percutaneous coronary intervention (PCI) and drug-eluting stents were initially the standard treatment for CAD, limitations such in-stent stenosis, neoatherosclerosis, and increased bleeding led to the development of the novel DCBs. These DCBs have become well established in treating various clinical cases such as in-stent restenosis, de-novo small-vessel disease, bifurcation lesions, large-vessel disease, high bleeding risk, acute coronary syndromes, and diabetes mellitus.

Summary: For optimal DCB outcomes, functional assessments, careful lesion preparation, and patient selection are crucial for effective drug delivery and reduced complications. Ongoing innovations in drug formulations, balloon design, and delivery mechanisms, along with further trials, will expand DCBs' impact in CAD treatment.

Purpose of review: A critical evaluation of contemporary literature regarding the role of big data, artificial intelligence, and digital technologies in precision cardio-oncology care and survivorship, emphasizing innovative and groundbreaking endeavors.

Recent findings: Artificial intelligence (AI) algorithm models can automate the risk assessment process and augment current subjective clinical decision tools. AI, particularly machine learning (ML), can identify medically significant patterns in large data sets. Machine learning in cardio-oncology care has great potential in screening, diagnosis, monitoring, and managing cancer therapy-related cardiovascular complications. To this end, large-scale imaging data and clinical information are being leveraged in training efficient AI algorithms that may lead to effective clinical tools for caring for this vulnerable population. Telemedicine may benefit cardio-oncology patients by enhancing healthcare delivery through lowering costs, improving quality, and personalizing care. Similarly, the utilization of wearable biosensors and mobile health technology for remote monitoring holds the potential to improve cardio-oncology outcomes through early intervention and deeper clinical insight. Investigations are ongoing regarding the application of digital health tools such as telemedicine and remote monitoring devices in enhancing the functional status and recovery of cancer patients, particularly those with limited access to centralized services, by increasing physical activity levels and providing access to rehabilitation services.

Summary: In recent years, advances in cancer survival have increased the prevalence of patients experiencing cancer therapy-related cardiovascular complications. Traditional cardio-oncology risk categorization largely relies on basic clinical features and physician assessment, necessitating advancements in machine learning to create objective prediction models using diverse data sources. Healthcare disparities may be perpetuated through AI algorithms in digital health technologies. In turn, this may have a detrimental effect on minority populations by limiting resource allocation. Several AI-powered innovative health tools could be leveraged to bridge the digital divide and improve access to equitable care.

Purpose of review: Photoacoustic imaging (PAI) has emerged as a promising non-ionizing modality that leverages optical absorption contrast to provide both anatomical and functional insights into vascular health. This review examines recent advances in PAI technologies applied to the diagnosis, assessment, and management of peripheral arterial disease (PAD). The goal is to evaluate how emerging PAI techniques address current diagnostic limitations and to identify opportunities for clinical integration.

Recent findings: Recent studies have demonstrated the potential of PAI to capture high-resolution, dynamic images of peripheral vasculature, quantify oxygen saturation and regional blood volume, and assess microvascular health. Technological innovations, including single-shot volumetric imaging, all-optical scanners, and multimodal systems, have expanded PAI's clinical utility.

Summary: Emerging PAI systems show promise for complementing traditional imaging by providing functional insights into microvascular health. Continued technological development and validation through large-scale studies are essential for establishing PAI's clinical role in PAD diagnosis and management.

Purpose of review: To provide the most up-to-date clinical evidence of intracoronary optical coherence tomography (OCT), and clinical implications to guide future imaging research in cardiology.

Recent findings: Intracoronary OCT has demonstrated advanced system performance and high reproducibility in analyzing atherosclerotic lesions. It is an attractive tool due to its capability for functional classification and superior imaging resolution, enabling precise and reliable tissue assessments. Compared to traditional angiography, OCT has been associated with improved long-term clinical outcomes and serves as an effective tool for optimizing stent selection and post-intervention evaluation. The development of OCT variations and the combination of various intravascular imaging modalities further enhance its diagnostic capabilities, allowing a comprehensive assessment of complex vulnerable lesions and improving risk stratification for patients.

Summary: Current and evolving system development presents a hopeful path for treating coronary artery disease by addressing the challenges of the intracoronary OCT technique. Future studies focusing on utilizing OCT system extensions, integrated multimodality imaging systems, and Artificial Intelligence (AI) derived image analysis will improve clinical endpoints and streamline the process.

Purpose of review: This article offers a comprehensive review of the literature on imaging predictors of response to transcatheter interventions for secondary mitral regurgitation (SMR).

Recent findings: Recent advancements in percutaneous valve therapies have broadened treatment options for high-risk patients with SMR. While recent studies have demonstrated significant reduction in all-cause mortality and hospitalizations with transcatheter edge-to-edge repair (TEER), significant controversy remains. This review highlights the central role of multi-modality imaging to guide therapeutic decision making for optimal treatment response and long-term outcomes.

Summary: Several echocardiographic, computerized tomography (CT) and cardiac magnetic resonance (CMR) imaging parameters are central to identifying optimal conditions for transcatheter therapies. Imaging features have become key predictors of outcomes following transcatheter interventions for secondary mitral regurgitation and provide important risk stratification to guide therapeutic decision making and shared decision making.