Therapeutic Advances in Cardiovascular Disease

Graphical Abstract

Combined torsemide-spironolactone tablet shows benefits for heart failure patients in India

The RESTORE-HF study evaluated the effectiveness of a tablet that combines torsemide and spironolactone in treating heart failure in people in India. Around 1752 patients took the medicine for 3 weeks. On average, they lost about 2.41 kg, their breathing and activity improved, and their swelling went down. About 22.11% patients had no swelling by the end. Side effects were very mild and uncommon. Most doctors and patients reported that the treatment was effective and easy to tolerate.

Structural heart disease (SHD) encompasses a wide range of congenital and acquired cardiac abnormalities, increasingly treated with transcatheter interventions. Echocardiography plays a crucial role in optimising these procedures, providing high-resolution imaging for pre-procedural planning, real-time guidance and post-intervention assessment. The shift from two-dimensional to advanced three/four-dimensional (3D/4D) echocardiography has significantly enhanced the visualisation of complex cardiac structures, improving procedural success and patient safety. The purpose of this review article is to provide an overview of the vital role of echocardiography in key structural heart interventions, including mitral transcatheter edge-to-edge repair, transcatheter aortic valve replacement, paravalvular leak closure, left atrial appendage occlusion and atrial septal defect closure. It highlights the integration of 3D/4D imaging and advanced Doppler techniques in refining procedural precision, optimising decision-making, and improving patient outcomes. The evolving field of interventional echocardiography continues to shape SHD management, making more minimally invasive treatments available to patients.

The first 24-hour negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study

The first 24-hour negative fluid balance is correlated to lower 28-day mortality. Acute kidney injury progression should be cautioned in the first 24-hour negative fluid balance. Lower fluid output and more fluid input may prevent acute kidney injury incidence. The first 24-hour net output mainly contributes to the mediation effect.

Cardiovascular imaging (CVI) provides an essential and accurate assessment of cardiac anatomy, function, and prognosis, thereby guiding management planning in long-term illnesses. It plays an essential role in modern cardiology in Iraq, where the adoption of advanced CVI technologies has enhanced diagnostic precision and patient care. However, there are some limitations that may interrupt the specialized improvement process, including a shortage of specialized personnel, limited infrastructure, and economic barriers. To address these challenges, the Iraqi Council of Cardiology established a nationally accredited CVI fellowship program in 2019. The key feature to initiate the program is the deliberate integration of diversity, particularly gender and geographic representation, into the training framework. This approach yielded a significantly high participation of women in CVI compared to other cardiology subspecialties in Iraq, which eventually reflected a special regional trend and productive response to workforce gaps. Also, geographic diversity has widened access to expertise across governorates, supporting equitable healthcare delivery. Regardless of these advances, marked progress needs continued investment in infrastructure and alignment with international standards. Furthermore, expanding and strengthening research capacity and fostering international collaborations will be critical to advance the whole process. The Iraqi CVI program has illustrated the framework of policy, training, and workforce planning that will overcome systemic limitations and contribute to the advancement of equitable cardiovascular care in resource-limited settings.

This article describes the need of diversity as a vital role in the cardiovascular imaging program in Iraq and not just an addition to the cardiology specialty

In this review, we have showed the requirements and the methods to improve the Cardiovascular Imaging (CVI) program diversity and progression in Iraq. Also, the review highlights the growing importance of CVI in diagnosing, treating, and managing cardiovascular diseases (CVD), especially in Iraq, where limited resources and infrastructure pose challenges. It focuses on the role of CVI in improving healthcare efficiency, guiding interventions, and reducing unnecessary procedures while addressing gender and geographic diversity in the field. Efforts to enhance training, international collaboration, and infrastructure are crucial for advancing CVI in Iraq. The review also discusses barriers faced by women in cardiology globally and highlights Iraq’s progress in empowering women through CVI fellowship programs. Future directions focus on expanding access, education, and research to optimize cardiac care.

Severe burn injuries result in a massive systemic inflammatory and hypermetabolic response, often disrupting multiple organ systems, including the cardiovascular system. Cardiac troponins are frequently elevated in burn patients, but the interpretation of these elevations is hardly straightforward. Sometimes, elevated troponin means type 1 myocardial infarction (MI) due to an acute coronary event, but it might also reflect type 2 MI due to an imbalance between body oxygen demand and supply, or even non-ischemic myocardial injury from things like overwhelming inflammation, sepsis, or direct thermal effects on the heart itself. This narrative review explores the prevalence, underlying pathophysiological mechanisms, diagnostic challenges, and prognostic implications of troponin elevation in burn patients. We discussed the limitations of applying conventional MI diagnostic criteria in this unique population. The role of electrocardiographic and echocardiographic assessment, as well as the potential utility of high-sensitivity troponin assays, is also discussed. Understanding of how burn pathophysiology relates to myocardial injury is essential for accurate diagnosis, improved management, and better outcomes in this highly vulnerable group of patients.

Detecting heart attacks in burn patients using different tools

Burn injuries affect different organs in the body due to inflammation, and one of them is the heart. When the heart is injured, a protein called troponin increases, which could indicate a heart attack. In this review, we learn about using troponins and another machine called echocardiogram to detect if a burn patient is suffering from a heart injury or possibly a heart attack. We learn the mechanism behind the increase of troponins, how often the increase occurs, what does it mean if troponins increase, and problems we face trying to detect if an increase has occurred. Understanding this is important as it we are able to find gaps in our knowledge and create better tools to diagnose them to help burn patients.

The National Cardiothoracic Centre at the Korle Bu Teaching Hospital stands as a premier institution for cardiothoracic surgery in Ghana and West Africa. Established in 1989 under the leadership of Prof. Kwabena Frimpong-Boateng, the Centre recently celebrated 35 years of advancing modern cardiothoracic surgery in Ghana. The Centre also serves as an accredited training hub for cardiothoracic surgeons, critical care nurses and other allied health professionals in the West African sub-region. Over the past 35 years, the Centre has undertaken 14,981 surgeries and other cardiac procedures for Ghanaians and other African countries. The centre has also locally trained a total of 30 cardiothoracic surgeons for Ghana, Nigeria and Ethiopia, and has recently commenced training its first surgeon for the Gambia. Among the Centres’ challenges are infrastructural deficit, limited health financing, human resource deficit and technological gaps. This narrative review highlights the Centre’s 35 years of existence, its contributions to the cardiothoracic surgical landscape in West Africa, challenges and its future directions.

Comparing two types of drug-coated balloons in coronary artery disease: a two-year real-world study

Coronary artery disease is one of the leading causes of heart problems worldwide. It occurs when the blood vessels supplying the heart become narrowed or blocked. One common treatment is a procedure called percutaneous coronary intervention (PCI), which helps restore blood flow. Traditionally, small metal tubes called stents are placed in the artery to keep it open. However, stents remain permanently in the body and may lead to long-term complications in some patients. Drug-coated balloons (DCBs) are a newer treatment option. They deliver medication directly to the artery wall during a short inflation and do not leave any permanent device behind. In this study, we evaluated the outcomes of 92 patients who were treated with DCBs and followed for two years. We compared two commonly used types of drug-coated balloons: one coated with paclitaxel and the other with sirolimus. Overall, the results showed that DCB treatment was safe and effective. Most patients experienced improvement in their symptoms, such as chest pain. The rates of repeat narrowing of the artery and major heart-related events were relatively low. Patients with diabetes had slightly higher event rates, but the differences were not statistically significant. We also found that larger artery size was associated with a higher chance of the artery narrowing again after treatment. This finding suggests that the size and characteristics of the artery may influence how well the treatment works. In summary, drug-coated balloon therapy appears to be a safe and effective option for selected patients with coronary artery disease. Further studies with larger patient groups are needed to better understand which patients benefit the most from this treatment.

Evaluating Physicians’ adherence to prescribe life-saving drugs for patients who have heart failure in public hospitals in Ethiopia

Introduction: Medications with disease modifying ability prolongs survival in patients with heart failure with contractility problem. However, different countries implement usage of these medications differently, and many patients are still not accessing them.

Aim: To find out what percentage of people are on the medicines and why these medicines are not often given to those eligible patients.

Methods: A retrospective review of patients’ charts and patient interview were employed to quantify usage of these lifesaving heart failure medications between 25th September to 25th November 2022. Global guideline adherence score was used to assess adherence to these lifesaving medications prescription. We looked at the information using a statistical tool to see Physicians’ guideline adherence and what factors prevent them from doing so. Physician interview was then conducted to know the reasons why the low prescription to these medications. By using software, we sorted out similar comments raised during physicians’ interviews together to group related reasons together.

Results: 341 patients were included in the quantitative study. Adherence to prescribe these lifesaving drugs was good in 37.5% (128 out of 341) of the patients. Patient parameters including female gender, unable to read and write primary education were negative contributory factors for Physicians’ good adherence. Absence of comorbid illnesses were positive predictors. System, patient, and physician-related factors were reported as barriers to prescribe the medications.

Conclusion: Nearly one-fourth of eligible patients were on <50% of medications recommended by guidelines. Female gender, educational level, and comorbid illnesses were the contributory factors to low prescription of lifesaving medications. System, patient, and physician-related reasons for low prescription were identified. Multipronged interventions are required to address those adherence barriers.

Pulmonary artery aneurysms (PAAs) are a rare pathology with potentially devastating consequences. In this case series, we describe two cases of clinically isolated pulmonary arteritis and concisely review the literature surrounding this new clinical entity. Two Caucasian women, aged 65 and 73, were referred to our cardiovascular surgery center with incidental PAAs, both growing to over 65 mm in main pulmonary artery diameter. Both participants underwent serial thoracic CT-angiograms to monitor the pulmonary artery aneurysms. Both pulmonary artery aneurysms showed an interval increase in diameter, so they were repaired surgically. The main pulmonary artery was excised in both cases and replaced with a synthetic graft. No pre- or postoperative corticosteroids were administered. Neither of our patients had systemic symptoms of giant cell arteritis or elevated inflammatory markers. In both cases, only the main pulmonary artery was replaced to minimize surgical complexity and risk; however, the left pulmonary artery of one patient began to further dilate 5 years postoperatively. Currently, no reintervention is planned. These cases represent mounting evidence for the existence of clinically isolated pulmonary arteritis leading to a pulmonary artery aneurysm. This entity is analogous to clinically isolated aortitis and may represent a subclinical smoldering vasculitis. These rare aneurysms can progress over time and require surgical intervention. In the absence of guidelines for pulmonary artery aneurysm intervention, the present cases will serve to guide further management of this rare disease.

Clinically isolated inflammation of the pulmonary artery

Isolated inflammation of the pulmonary artery (large blood vessel that supplies the lung) has not been well described. We describe two cases which were initially followed with repeat imaging and eventually grew to be larger and subsequently underwent surgery. There are no guideline recommendations for management of this rare condition. These cases with similar features may be used to guide management of additional cases.

Transthyretin (TTR) amyloid cardiomyopathy occurs when stable TTR, normally a 4-protein tetramer, becomes misfolded and aggregates to form amyloid fibrils that accumulate in the heart. Progressive accumulation causes cardiomyopathy, leading to arrhythmia and heart failure. Acoramidis is a high-affinity TTR stabilizer (⩾90%) evaluated in the ATTRibute-CM clinical trial. In this podcast discussion, Dr Mathew Maurer and Dr Adam Castaño provide insights into their recent analysis of prognostic implications of acoramidis-mediated changes to serum TTR (sTTR) in 557 patients and the associated implications for all-cause mortality. For the patients included in this analysis, acoramidis fully mediated a sharp and significant early rise in sTTR levels (mean 9.1 mg/dL) by day 28, sustained through month 30. Incremental changes (+5 mg/dL) in sTTR were associated with a 31.6% lower odds of mortality through month 30. This evidence strongly supports a direct association between early, sustained sTTR increases with acoramidis treatment and survival.

Acoramidis rapidly increases serum TTR concentrations, which is associated with improved survival

Proteins are biological machines in living things. A protein called transthyretin, abbreviated as “TTR,” normally flows in blood to move certain chemicals from one place to another. For normal function, 4 copies of TTR need to be folded together in a specific way. If TTR becomes unfolded or folds the wrong way, it will clump with other TTR proteins. These clumps stick to organ tissues and build up over time. As the sticky clumps grow, they prevent the organs from working properly. When this happens in the heart, it can lead to a weakened heart muscle and eventually death. Acoramidis is a drug that keeps the 4 copies of TTR together and folded correctly. In this medical study, doctors looked at the amount of TTR in the blood of 557 people with misfolded TTR. They found treatment with acoramidis quickly increased the amount of TTR in blood, which lowered the risk of death by more than one-fourth.

Infographic

This case report describes a rare case of a giant right atrial aneurysm (RAA) in a 7-month-old male infant admitted to Children’s Hospital Affiliated to Zhengzhou University in July 2025. A RAA was detected during a physical examination at 2 months of age with no clinical symptoms present. Follow-up reexamination at 7 months of age revealed progressive enlargement of the RAA, and the infant thus underwent aneurysm resection plus atrial septal defect repair under cardiopulmonary bypass. Postoperative histopathological examination confirmed the diagnosis of RAA. On the second postoperative day, the infant developed neurological complications including lethargy, skew deviation, mild hemiplegia, and focal epilepsy. The hospital immediately implemented a multimodal intervention strategy involving mannitol for dehydration, glucocorticoids for anti-inflammation, antiepileptic medication, and strict fluid management. The infant achieved near-complete recovery of neurological function at discharge on the 21st postoperative day, with significant improvement in brain abnormalities on follow-up at 1 month postoperatively. This case highlights cytotoxic cerebral edema, a rare postoperative neurological complication following RAA resection in children, and emphasizes the importance of early identification and multimodal treatment for such complications, providing valuable clinical evidence for the perioperative management of pediatric cardiac surgery.

Cerebral swelling after heart surgery for a large heart artery bulge in a young baby

We describe a 7-month-old baby who had surgery to fix a large, rare bulge in the wall of the right upper heart chamber. The surgery went well, but two days later the baby became sleepy, had weak movement on one side of the body, and brief seizures. Brain scans showed swelling inside brain cells, a rare complication after heart surgery with a heart-lung bypass machine. We treated the baby with medicines to reduce brain swelling, control seizures, and limit fluid intake. After about three weeks, the baby recovered almost completely and went home. At one-month follow-up, brain swelling was much better, and the baby had no lasting weakness or seizures. This case shows that babies can have rare but serious brain swelling after this type of heart surgery. Close watching and quick, combined treatment can help babies recover well. Doctors should look for early signs of brain problems after infant heart surgery.

Artificial intelligence (AI) and machine learning are rapidly transforming cardiac electrophysiology, offering new avenues for diagnosing, managing, and treating cardiac arrhythmias. These technologies leverage diverse data sources, including clinical records, imaging, and electrical waveforms, to support decision-making and optimize outcomes, particularly in procedures such as cardiac ablation. This scoping review explores the evolving role of AI in cardiology, emphasizing its applications in diagnostics, predictive analytics, and procedural innovations. It also examines the collaborative dynamics of interdisciplinary teams, highlighting how professionals, such as electrophysiologists, computer scientists, clinicians, nurses, perfusionists, and technologists, contribute to identifying and solving key challenges in the field. The integration of AI into cardiology is not only enhancing diagnostic precision and patient outcomes but also streamlining healthcare delivery. As technological capabilities expand, AI is poised to play an increasingly central role in preventive cardiology, enabling more accurate risk assessments, earlier interventions, and the promotion of healthier lifestyles. However, the successful implementation of AI requires thoughtful coordination across disciplines and a clear understanding of its limitations and ethical considerations. This review underscores the importance of fostering interdisciplinary collaboration and aligning AI innovations with clinical needs. It also identifies barriers to adoption and proposes strategies for integrating AI tools into routine practice. Ultimately, the findings aim to guide stakeholders, including researchers, clinicians, and policymakers, in advancing the development and application of AI systems in cardiology. By doing so, the healthcare community can move toward reducing the global burden of cardiovascular disease and improving population health. The insights presented here, after a review of 142 studies, offer a roadmap for future research and clinical integration, ensuring that AI continues to serve as a catalyst for innovation and excellence in cardiac care.

Plain language summary

Artificial intelligence for cardiology: from diagnosis to management

This review paper explores the integration of artificial intelligence (AI) in cardiology, focusing on its applications in diagnosis, risk assessment, monitoring, and treatment. We discuss advancements in AI-driven diagnostic tools, predictive models for risk stratification, wearable devices for real-time monitoring, and personalized treatment plans. Ethical considerations, data privacy concerns, and technical challenges associated with AI implementation in clinical practice are also addressed.

Graphical abstract:

Artificial intelligence applications in cardiac care.