Current Cardiology Reviews - Volume 20, Issue 6, 2024

Fractional flow reserve computed tomography (FFRCT) is a novel imaging modality. It utilizes computational fluid dynamics analysis of coronary blood flow obtained from CCTA images to estimate the decrease in pressure across coronary stenosis during the maximum hyperemia.

The FFRCT can serve as a valuable tool in the assessment of coronary artery disease (CAD). This non-invasive option can be used as an alternative to the invasive fractional Flow Reserve (FFR) evaluation, which is presently considered the gold standard for evaluating the physiological significance of coronary stenoses. It can help in several clinical situations, including Assessment of Acute and stable chest pain, virtual planning for coronary stenting, and treatment decision-making.

Although FFRCT has demonstrated potential clinical applications as a non-invasive imaging technique, it is also crucial to acknowledge its limitations in clinical practice. As a result, it is imperative to meticulously evaluate the advantages and drawbacks of FFRCT individually and contemplate its application in combination with other diagnostic examinations and clinical data.

Developing a novel risk score for accurate assessment of cardiovascular disease (CVD) morbidity and mortality is an urgent need in terms of early prevention and diagnosis and, thereafter, management, particularly of ischemic heart disease. The currently used scores for the evaluation of cardiovascular disease based on the classical risk factors suffer from severe limitations, including inaccurate predictive values. Therefore, we suggest adding a novel non-classical risk factor, including the level of specific exhaled volatile organic compounds that are associated with ischemic heart disease, to the SCORE2 and SCORE2-OP algorithms. Adding these non-classical risk factors can be used together with the classical risk factors (gender, smoking, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes mellitus, arterial hypertension, ethnicity, etc.) to develop a new algorithm and further program to be used widely.

Over the past decades, there has been a notable increase in the risk of Cardiovascular Disease (CVD), even among younger individuals. Policymakers and the health community have revised CVD prevention programs to include younger people in order to take these new circumstances into account. A variety of CVD risk assessment tools have been developed in the past years with the aim of identifying potential CVD candidates at the population level; however, they can hardly discriminate against younger individuals at high risk of CVD.Therefore, in addition to the traditional 10-year CVD risk assessment, lifetime CVD risk assessment has recently been recommended by the American Heart Association/American College of Cardiology and the European Society of Cardiology prevention guidelines, particularly for young individuals. Methodologically, the benefits of these lifetime prediction models are the incorporation of left truncation observed in survival curves and the risk of competing events which are not considered equivalent in the common survival analysis. Thus, lifetime risk data are easily understandable and can be utilized as a risk communication tool for Public Health surveillance. However, given the peculiarities behind these estimates, structural harmonization should be conducted in order to create a sex-, race-specific tool that is sensitive to accurately identifying individuals who are at high risk of CVD. In this review manuscript, we present the most commonly used lifetime CVD risk tools, elucidate several methodological and critical points, their limitations, and the rationale behind their integration into everyday clinical practice.

There is debate on the best treatment for significant stenoses of the left main (LM) coronary artery. The available evidence is based on four randomized trials, which were either performed specifically to assess patients with LM disease (EXCEL, NOBLE, PRECOMBAT) or had a significant fraction of patients with this disease pattern (SYNTAX). A meta-analysis revealed no difference in periprocedural and 5-year mortality but demonstrated a significant reduction of spontaneous myocardial infarction (MI) with CABG. Furthermore, the recently published SWEDEHEART registry data have shown survival advantage and fewer MACCE with CABG for LM disease after adjustment. In general, patients with more severe coronary artery disease (CAD) appear to have a survival advantage with CABG both over PCI and medical therapy (independent of the presence or absence of LM stenosis), which is always associated with a reduction of spontaneous MI in the CABG arm. Since the nomenclature of LM disease does not automatically reflect the complexity of CAD, we review the nature of LM disease in this article. We mechanistically assess the treatment effects of PCI and CABG for patients with LM disease, which is rarely isolated, often distal, and mostly associated with varying degrees of single and multi-vessel disease. We conclude that in patients with isolated LM shaft lesions and associated diseases of low complexity, the risk of spontaneous MI is lower, and PCI may achieve similar long-term outcomes compared to CABG. Thus, heart teams are essential for selecting the best treatment option and should focus on assessing infarction risk in chronic CAD.

Cardiac amyloidosis (CA) is an infiltrative disease characterized by the deposition of misfolded proteins in cardiac interstitial tissue. Interest towards studying this pathology has been growing in the last decade, as new epidemiological insights have revealed that it is not as uncommon as previously believed. Likewise, advances in non-invasive diagnostic approaches and the identification of molecules that modify its long-term progression, even in terms of mortality, have also bolstered interest in CA. Despite this global panorama, in Venezuela, limitations remain regarding the diagnosis of CA, partly associated with a lack of knowledge of the disease. Therefore, additional efforts are necessary for clinical cardiologists to hone their diagnostic skills regarding this disease, as opportune identification is an essential step for its effective management.

Ischemic heart disease (IHD) is a pathology of global interest because it is widespread and has high morbidity and mortality. IHD pathophysiology involves local and systemic changes, including lipidomic, proteomic, and inflammasome changes in serum plasma. The modulation in these metabolites is viable in the pre-IHD, during the IHD period, and after management of IHD in all forms, including lifestyle changes and pharmacological and surgical interventions. Therefore, these biochemical markers (metabolite changes; lipidome, inflammasome, proteome) can be used for early prevention, treatment strategy, assessment of the patient's response to the treatment, diagnosis, and determination of prognosis. Lipidomic changes are associated with the severity of inflammation and disorder in the lipidome component, and correlation is related to disturbance of inflammasome components. Main inflammasome biomarkers that are associated with coronary artery disease progression include IL‐1β, Nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3), and caspase‐1. Meanwhile, the main lipidome biomarkers related to coronary artery disease development involve plasmalogen lipids, lysophosphatidylethanolamine (LPE), and phosphatidylethanolamine (PE). The hypothesis of this paper is that the changes in the volatile organic compounds associated with inflammasome and lipidome changes in patients with coronary artery disease are various and depend on the severity and risk factor for death from cardiovascular disease in the time span of 10 years. In this paper, we explore the potential origin and pathway in which the lipidome and or inflammasome molecules could be excreted in the exhaled air in the form of volatile organic compounds (VOCs).

Female carriers of Duchenne Muscular Dystrophy (DMD) carry a heterozygous pathogenic variant in the dystrophin gene and can transmit pathogenic variants to their offspring. DMD is an X-linked recessive disease that affects up to 19.8 in every 100,000 male births. Those carriers with symptoms can be referred to as women with dystrophinopathy. Even among asymptomatic carriers, cardiac involvement can be verified in between 2.5% and 75% through echocardiography. The most commonly affected wall of the left ventricle is the inferolateral, with myocardial fibrosis detected by cardiac nuclear resonance. Therefore, screening is recommended for these women carriers due to the risk of cardiomyopathy. There is a lack of longitudinal studies on the evolution of these carriers. In this article, data on clinical presentation, cardiac assessment for female patients with dystrophinopathy and DMD carriers, and approaches for these patients are discussed.