Current Cardiology Reviews - Volume 21, Issue 4, 2025

Anthracycline-based chemotherapy, such as Doxorubicin (DOX), often induces cardiotoxicity in cancer patients, which compromises their health and quality of life.

This study aimed to verify the effects of exercise concomitant with prolonged administration of DOX on improving cardiotoxicity.

A systematic literature search in MedLine, PubMed, Web of Science, and Scopus databases was performed from inception until November 2023, strictly following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Preclinical randomized controlled trials related to exercise, cardiotoxicity, and DOX were included.

Eight studies were included in the systematic review and 7 were selected for meta-analysis. By evaluating the Fractional Shortening (FS), it was possible to verify that exercise as complementary therapy provided a cardioprotective effect when compared to DOX combined with sedentary behavior (heterogeneity: I² = 53%; tau² = 0.19; p = 0.03; overall effect: z = 2.69; p < 0.01). However, no additional benefits were observed for the Left Ventricular Ejection Fraction (LVEF) (heterogeneity: I² = 82%; tau² = 1.43; p < 0.01; overall effect: z = 1.42; p = 0.15).

The included studies demonstrated exercise to have a cardioprotective effect on rodents, mainly on FS. However, there is a lack of high-level evidence to guide exercise prescription in clinical practice to improve cardiotoxicity associated with DOX administration.

Pulmonary embolism (PE) associated with hemodynamic compromise, termed high-risk or massive acute PE (MAPE), is associated with increased morbidity and mortality. Despite advancements in procedural techniques and an increase in the availability of advanced therapies, the outcomes associated with high-risk PE remain poor. Here, we review the literature surrounding the use of Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO), primarily as a bridging therapy, in patients presenting with high-risk pulmonary embolism.

We conducted a systematic review and meta-analysis utilizing PubMed/MEDLINE from database inception until March 2024. The terms “high-risk PE”, “massive PE” and “MAPE” were paired with “VA-ECMO”, “bridge therapy” and “solo therapy” along with related terms to find and analyze relevant studies. The primary outcome assessed was in-hospital mortality.

Most comparative studies involved assessing VA-ECMO's utility as solo therapy vs as a bridge to advanced therapy. Out of the data involving VA-ECMO as solo therapy, most showed definite survival benefit in subset of populations with VA-ECMO's role being varied by age and cardiac arrest presence. A portion of studies were notable for finding no difference in outcomes; however no major retrospective determined negative effect of VA-ECMO. In head-to-head studies as a bridge, studies from multiple centers highlighted VA-ECMO's role in stabilizing and improving survival in massive PE prior to systemic or catheter directed thrombolysis. Follow-up studies were limited, however one retrospective showed 30-day mortality of 31% and the 1-year mortality of 54% post PERT call. Follow-up echocardiograms performed on survivors between 30-365 days from Pulmonary Embolism Response Team (PERT) activation interestingly all had normal Right Ventricular (RV) size and function with mild to no tricuspid regurgitation.

Most major literature supports the use of VA-ECMO as either solo therapy or a bridge to advanced therapy in MAPE with additional shock or cardiac arrest. However, further studies are needed to develop society guidelines for regular initiation in cases of MAPE.

Non-bacterial Thrombotic Endocarditis (NBTE) is a rare condition characterized by aseptic vegetations of the heart valves, predisposing to valvular dysfunction and end-organ infarction. Lung Cancer (LC) is amongst the most common malignancies associated with NBTE.

PubMed/MEDLINE was searched from database inception until January 2024, pairing Non-bacterial Thrombotic Endocarditis (NBTE) and related terms with “Lung Cancer (LC)”. Reports were included if patients had both NBTE and lung cancer. The risk of bias was assessed using Mixed Methods Analysis Testing (MMAT).

32 patients with an average age of 59y +/- 11.6 were included from 31 peer-reviewed publications, with significant findings as below:

• The majority (47%) of patients were admitted with stroke.

• The most commonly affected valve was aortic (51%), followed by mitral (43%), and tricuspid (5%).

• At diagnosis of NBTE, 86% of patients had stage IV cancer.

• Multi-organ infarct was common (61%), with the brain most often affected (40%).

• Treatment of NBTE included antibiotics (86%), anticoagulation (50%), and cardiac surgery (6%).

• Treatment of LC included traditional chemotherapy (30.7%), radiation (16%), tyrosine kinase inhibitors (11.5%), lobectomy (6%), and immunotherapy (3.8%).

• Overall mortality rate was 77%.

• Mortality rate was 38% in patients treated with chemotherapy and 91% in patients who did not receive chemotherapy.

• Mortality rate stratified by anticoagulant: unfractionated heparin (85.7%), DOAC (75%), and LMWH (20%).

High clinical suspicion for NBTE in patients presenting with LC and thromboembolic phenomena can lead to changes in treatment and improved clinical outcomes.

The usage of doxorubicin (DOX), an antineoplastic drug that is frequently used for the cure of cancer, is restricted to maximal doses due to its cardiac toxicity. Reactive oxygen species produced by DOX result in lipid peroxidation and organ failure, ultimately resulting in cardiomyopathy. Due to its high polyphenol content, virgin rice bran oil (VRBO) is a diet nutritional supplement with a strong antioxidant. This study aimed to assess the potential defense of VRBO against DOX-induced cardiotoxicity.

VRBO and DOX injections were administered to thirty male Wistar rats for 42 days after being randomly assigned to five groups.

The study demonstrated the cardioprotective effects of VRBO against doxorubicin (DOX)-induced cardiotoxicity. VRBO (0.71 and 1.42 ml/kg) significantly improved the heart-to-body weight ratio, reduced elevated serum CK-MB and LDH levels by 18.4% and 52.7%, respectively, and increased HDL by 43.1%. ECG parameters also improved, with reductions in QT interval (19%), ST interval (28%), and QRS complex (15%). VRBO enhanced systolic blood pressure (up to 21%) and heart rate (7.1%). Antioxidant markers showed notable recovery, with MDA levels reduced by 66.1%, while GSH, SOD, and catalase levels increased by 129.4%, 158.2%, and 84.8%, respectively.

A cardioprotective benefit was found at middle and higher VRBO dosages. In order to demonstrate the effectiveness of VRBO as a cardioprotective medication, further research on dosage response and bioavailability is required.

At a critical juncture in the ongoing fight against cardiovascular disease (CVD), healthcare professionals are striving for more informed and expedited decision-making. Artificial intelligence (AI) promises to be a guiding light in this endeavor. The diagnosis of coronary artery disease has now become non-invasive and convenient, while wearable devices excel at promptly detecting life-threatening arrhythmias and treatments for heart failure.

This study aimed to highlight the applications of AI in cardiology with a particular focus on arrhythmias and its potential impact on healthcare for all through careful implementation and constant research efforts.

An extensive search strategy was implemented. The search was conducted in renowned electronic medical databases, including Medline, PubMed, Cochrane Library, and Google Scholar. Artificial Intelligence, cardiovascular diseases, arrhythmias, machine learning, and convolutional neural networks in cardiology were used as keywords for the search strategy.

A total of 6876 records were retrieved from different electronic databases. Duplicates (N = 1356) were removed, resulting in 5520 records for screening. Based on predefined inclusion and exclusion criteria, 4683 articles were excluded. Following the full-text screening of the remaining 837 articles, a further 637 were excluded. Ultimately, 200 studies were included in this review.

AI represents not just a development but a cutting-edge force propelling the next evolution of cardiology. With its capacity to make precise predictions, facilitate non-invasive diagnosis, and personalize therapies, AI holds the potential to save lives and enhance healthcare quality on a global scale.

Metabolic reprogramming is critical in cardiovascular disease (CVD) research, affecting a variety of diseases such as myocardial damage, coronary heart disease, and atherosclerosis, and has also emerged as a therapeutic target. This study conducts a bibliometric analysis of the past 24 years to identify trends and hotspots in CVD metabolism, aiming to guide future research and inform policy.

This study analyzes publications from January 1, 2000, to October 10, 2024, using the Web of Science Core Collection database. Tools like CiteSpace, VOSviewer, and SCImago Graphica were used for co-authorship, keyword, citation, and journal visualizations. Dual-map overlays and annual publication trends were examined to uncover hotspots, trends, and the progression of metabolic reprogramming in CVD.

This study analyzed 765 articles and reviews from 66 countries. The USA had the most publications, with the University of Milan being the most productive institution. Després, JP's team in Italy, published the most papers. The International Journal of Molecular Sciences had the highest publication count, while Cardiovascular Diabetology had the greatest citation impact. Recent research has mainly focused on the role of immune cell substrate metabolism in CVD.

This study reveals the development trend and research characteristics of CVD metabolic reprogramming over the past 24 years, from the early focus on disease risk factors to the recent exploration of the transformation of immune cell metabolism. In the future, targeting immune cell metabolism will drive CVD therapy forward.