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After 40 years of spectacular technological innovation, catheter ablation has become central to the treatment of cardiac arrhythmias, revolutionizing patient care but with no consideration for environmental sustainability. With climate change being the biggest threat to humanity, all stakeholders urgently need to promote more virtuous and circular practices in the catheterization laboratory.
Immune checkpoint inhibitors (ICIs) have become a pillar of cancer therapy. The cardiovascular complications of ICIs extend beyond myocarditis and can involve any component of the cardiovascular system, including the pericardium, coronary arteries and conduction system. Clinicians caring for patients treated with ICIs must be vigilant for the cardiovascular complications of these therapies, which might portend a poor prognosis.
In this Review, Noseda and colleagues provide an overview of the technical challenges in the experimental design of single-cell and single-nucleus transcriptomics studies, and describe novel findings derived from transcriptomics studies for each major cardiac cell type in both health and disease, and from development to adulthood.
While there is understandable excitement about the development of new cardiovascular drugs, an unmet and equally important need is to perform new clinical trials of old drugs, including to determine their longer-term effects and if and when they should be discontinued after years of use. New trials of old drugs can inform clinical practice and are much needed.
In this Review, Gatsiou and Stellos summarize the current knowledge on RNA modifications in cardiovascular health and disease, discussing their effect on cardiovascular biology and function, and the potential for development and application of epitranscriptome-based prognostic, diagnostic and therapeutic tools for cardiovascular disease.
Cytotoxic CD8+ T cells specific for the cardiac protein α-myosin heavy chain have a key role in immune-checkpoint-inhibitor-associated myocarditis, according to a study published in Nature.
In patients with paroxysmal, untreated atrial fibrillation (AF), first-line cryoballoon ablation is associated with a lower incidence of persistent AF compared with antiarrhythmic drug therapy, according to the 3-year follow-up data from the EARLY-AF trial.
In patients with chronic limb-threatening ischaemia who had an adequate conduit for vein bypass, bypass surgery is associated with fewer adverse events or deaths than an endovascular procedure, according to findings from the BEST-CLI trial.
The IRONMAN trial adds further support to the known benefits of intravenous iron therapy in patients with heart failure (HF) with reduced ejection fraction and iron deficiency, but narrowly misses the primary end point of hospitalization for HF and cardiovascular death.
Pemafibrate, a selective PPARα modulator, lowers plasma triglyceride levels but does not reduce the rate of major adverse cardiovascular events in patients already treated with optimal statin therapy, according to data from the PROMINENT trial.
Olpasiran, a small interfering RNA (siRNA) that reduces lipoprotein(a) (Lp(a)) production in the liver, administered every 12 weeks induces a pronounced and sustained decrease in the plasma levels of Lp(a) in patients with established atherosclerotic cardiovascular disease, according to findings from the OCEAN(a)-DOSE trial.
Some clinical observations suggest that female patients are more susceptible to myocarditis induced by immune-checkpoint-inhibitor therapies. A new study recapitulates this female predisposition in mice and provides mechanistic and biological plausibility, and suggests that hormone therapy could help to treat myocarditis by promoting the expression of MANF, a protein related to the unfolded protein response.
Alternative strategies for defibrillation improve outcomes in patients with refractory ventricular fibrillation, according to findings from the DOSE VF trial.
Screening for atrial fibrillation in high-risk populations could contribute to the prevention of cardioembolic stroke. Randomized trials of atrial fibrillation screening are directionally favourable but underpowered for stroke risk assessment; nevertheless, meta-analysis results are encouraging. Consumer-facing wearable devices can detect unknown atrial fibrillation at scale, although they are mostly used by individuals at low risk of stroke.
A growing body of evidence suggests that the mechanical functions of cardiac fibroblasts are an active and necessary component of myocardial growth and homeostasis. In this Review, Van Linthout and colleagues describe cell mechanosensation as a regulator of cardiac maturation and disease, and summarize the evidence showing that remodelling of the cardiac extracellular matrix, as a result of disease, can induce changes in the mechanical properties of the myocardium.
