PURPOSE OF REVIEW:Residual inflammatory risk remains an important driver of recurrent vascular events despite contemporary lipid-lowering and antithrombotic therapies. Low-dose colchicine is the first widely available anti-inflammatory therapy to be incorporated into contemporary guidelines for secondary prevention in coronary artery disease. This review summarizes contemporary evidence on the efficacy and safety of low-dose colchicine for secondary prevention. RECENT FINDINGS:Large randomized trials have demonstrated that colchicine reduces recurrent ischemic events in patients with chronic coronary disease and after myocardial infarction. Recent trials in acute myocardial infarction and stroke populations, however, have produced heterogeneous results. Nevertheless, contemporary meta-analyses consistently demonstrate reductions in major adverse cardiovascular events (MACE), driven mainly by fewer myocardial infarctions, strokes, and coronary revascularizations. Safety data are reassuring, with no consistent excess in serious infection, cancer, pneumonia, or noncardiovascular death, although gastrointestinal intolerance remains the most common adverse effect. SUMMARY:Low-dose colchicine has established residual inflammation as an actionable target in secondary prevention of vascular events in patients with chronic coronary disease or recent myocardial infarction. Ongoing trials will clarify colchicine's role across broader vascular indications. Future work should also focus on implementing the use of colchicine for prevention of clinical events in patients with coronary artery disease in clinical practice.
PURPOSE OF REVIEW:Nonobstructive coronary artery disease (NOCA) is now frequently detected by coronary CT angiography (CCTA), but the term compresses biologically distinct patterns into a single anatomic label. This review examines how CT-derived markers can reorganize NOCA around plaque burden, inflammatory activity, clinical expression, and temporal change. RECENT FINDINGS:Recent work distinguishes three related but distinct tasks in NOCA: identify disease, stratify risk, and define phenotypes that may inform future prevention strategies. CCTA addresses the atherosclerotic and prognostic dimensions by quantifying plaque burden, plaque composition, and high-risk features; CT-derived inflammatory and cardiometabolic markers may further identify active vascular and metabolic phenotypes. In symptomatic patients, CCTA and fractional flow reserve CT can evaluate epicardial anatomy and lesion-specific hemodynamic significance, but normal or nonobstructive findings do not exclude coronary microvascular dysfunction or vasospasm. In asymptomatic patients, coronary artery calcium and CCTA can reveal subclinical atherosclerosis and refine preventive risk assessment. Serial imaging and intervention studies suggest that adverse plaque phenotypes can stabilize or change with intensive prevention, but outcome-proven CCTA-guided treatment algorithms are still lacking. SUMMARY:CCTA is evolving into a multidimensional phenotyping tool for NOCA. Its immediate value is refined risk stratification; whether these markers will improve outcomes remains unproven and should be tested prospectively.
PURPOSE OF REVIEW:Of patients undergoing coronary artery bypass grafting (CABG), 10-20% have preexisting atrial fibrillation (AF), which remains undertreated at the time of surgery. With rapidly evolving data, interest and enthusiasm for concomitant surgical management of AF have grown concurrently. This review summarizes the contemporary evidence, techniques, and approaches for surgical management of AF in patients undergoing CABG and proposes tailored operative strategies for these patients at the time of surgery. RECENT FINDINGS:Concomitant surgical management of AF at the time of CABG is underutilized, with only 30-40% of eligible patients receiving concomitant AF treatment. Surgeons can offer a spectrum of options to concurrently treat AF, from left atrial appendage occlusion (LAAO) to a full biatrial Cox-maze iteration without significant additional perioperative risk. Contemporary large-scale observational analyses suggest concomitant surgical ablation improves rhythm outcomes and is associated with improved survival, and lower risk of stroke long-term. SUMMARY:Concomitant LAAO is essential. Ablation techniques can be tailored based on the patient's burden of AF, clinical complexity, and surgeon expertise. A robust randomized trial is needed to convince clinicians to expand adoption.
PURPOSE OF REVIEW:Antithrombotic therapy for patients with atrial fibrillation (AF) after acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) requires balancing prevention of stroke and coronary events against bleeding. Recent recurrent-event and patient-centered analyses of AUGUSTUS make this review timely by reframing treatment benefit beyond first events. RECENT FINDINGS:Four dedicated trials support dual antithrombotic therapy with direct oral anticoagulants (DOAC) plus P2Y 12 inhibitor and early aspirin withdrawal to reduce bleeding without significant increase in ischemic events. However, aspirin-free strategies differ by anticoagulation indication: in patients without anticoagulation, very early aspirin withdrawal after ACS or PCI may increase the risk of coronary events, whereas in patients with AF receiving anticoagulation, oral anticoagulation may assume the early antithrombotic role of aspirin. AUGUSTUS showed that apixaban and placebo each reduced bleeding compared with vitamin K antagonist and aspirin. The recent total-event analyses further showed lower cumulative bleeding with apixaban than with vitamin K antagonist, and substantially greater cumulative bleeding with randomized aspirin than with placebo, along with similar total ischemic events and hospitalizations. SUMMARY:For patients with AF after ACS or PCI, DOAC-based dual antithrombotic therapy provides the most favorable cumulative safety-efficacy balance. Future research should focus on the timing of aspirin discontinuation and validate recurrent-event endpoints.
PURPOSE OF REVIEW:Coronary artery bypass grafting (CABG) improves prognosis in advanced coronary artery disease but does not halt native-vessel atherosclerosis or prevent graft failure. This review summarizes key advances in secondary prevention after CABG, emphasizing contemporary evidence, treatment shortcomings, and practical implications for long-term care. RECENT FINDINGS:Intensive lipid lowering remains key, with high-intensity statins, ezetimibe, and PCSK9 inhibitors used sequentially to achieve very low LDL-C targets, while triglyceride-lowering therapy may benefit selected high-risk patients. Aspirin remains the cornerstone of antithrombotic therapy, whereas dual antiplatelet therapy should be patient-specific. Routine long-term beta-blocker or renin-angiotensin system inhibitor therapy should be guided by established indications rather than CABG alone, while calcium channel blockers may have a role after radial artery grafting. SGLT2 inhibitors, GLP-1 receptor agonists, cardiac rehabilitation, smoking cessation, obesity management, vaccination, and mental health and cognitive screening have broadened secondary prevention beyond traditional risk-factor control. SUMMARY:Secondary prevention after CABG is a lifelong, multidisciplinary strategy aimed at preserving graft function, slowing disease progression, improving quality of life, and reducing recurrent cardiovascular events. Contemporary care should be individualized according to clinical phenotype, conduit strategy, comorbidity burden, thrombotic and bleeding risk, functional status, and treatment burden. Future studies should clarify persistent evidence gaps in antithrombotic therapy, cardiometabolic treatment, graft-specific outcomes, rehabilitation delivery, adherence, and patient-centered care.
PURPOSE OF REVIEW:Women undergoing coronary artery bypass grafting (CABG) continue to experience worse perioperative and long-term outcomes than men despite advances in surgical techniques and perioperative care. This review summarizes contemporary evidence on sex-related differences in coronary artery disease (CAD), surgical outcomes, and secondary prevention. Gaps in the current evidence are identified and priorities for optimizing outcomes and informing sex-specific clinical practice are highlighted. RECENT FINDINGS:Women present with distinct patterns of CAD, including higher prevalence of microvascular dysfunction and nonobstructive disease, contributing to delayed diagnosis and referral for surgical revascularization. Women are less likely to receive guideline-recommended revascularization strategies, including multiple arterial grafting. Women also experience higher rates of graft failure, mortality, and stroke after CABG. Emerging observational evidence suggests that off-pump and minimally invasive CABG approaches may reduce the disparities in female patients, although randomized sex-specific data remains limited. Secondary prevention remains suboptimal, with persistent gaps in implementation of guideline-directed therapies. SUMMARY:Significant disparities persist across the continuum of care for women undergoing CABG, from diagnosis through long-term secondary prevention. Improving equitable implementation of evidence-based surgical strategies, increasing representation of women in randomized clinical trials, and developing sex-specific evidence are essential to optimize outcomes and inform future clinical guidelines.
Purpose of review Constrictive pericarditis is a complex disease whose distinction from clinical mimickers remains challenging yet critically important. Diagnosis frequently requires integration of findings across multiple imaging modalities. Artificial intelligence (AI) applications in cardiac imaging are rapidly evolving and may play an increasingly important role in the diagnosis of constrictive pericarditis. Recent findings Most established evidence supporting AI in diagnosis of constrictive pericarditis involves machine learning and deep learning applied to echocardiography, particularly for differentiating constrictive pericarditis from restrictive cardiomyopathy. Newer approaches incorporate multiple echocardiographic views and emphasize model generalizability. Emerging applications span cardiac computed tomography (CT)-for automated pericardial thickening and calcification quantification-large language models (LLMs) in cardiac magnetic resonance interpretation, and deep learning electrocardiogram analysis. Summary Applications of AI for diagnosis of constrictive pericarditis are being studied across multiple imaging modalities, but remain in early stages of development. Emerging AI concepts, including multimodal LLMs and foundation models leveraging transfer learning, show promise for further advances and eventual meaningful implementation. Cardiac CT, though underrepresented in the current AI literature for constrictive pericarditis, represents an important target for future investigation given its established role in surgical planning.
PURPOSE OF REVIEW:Observational data suggests that multiarterial grafting (MAG) is associated with improved long-term outcomes for coronary artery bypass grafting (CABG), yet adoption remains low due to limited randomized evidence. This review synthesizes contemporary evidence comparing MAG with single arterial grafting (SAG), highlighting recent observational studies and ongoing randomized trials. RECENT FINDINGS:Large registry-based analyses consistently demonstrate a 15-25% relative reduction in long-term mortality and adverse cardiovascular events with MAG compared with SAG. However, randomized evidence is unclear; the Arterial Revascularization Trial (ART) showed no significant survival difference but possessed important methodological limitations. In contrast, randomized data support radial artery use over saphenous vein grafts as a second conduit. The ongoing randomized comparison of the clinical outcome of single vs. multiple arterial grafts (ROMA) trial is expected to provide definitive evidence. SUMMARY:MAG is supported by observational data, but uncertainty persists due to limited randomized evidence and variability in clinical adoption. The results of ROMA will clarify the role of MAG and help determine whether this should become the default strategy for CABG in select patients.
Purpose of review Assessment of left ventricular diastolic function remains one of the most challenging aspects of echocardiography. Artificial intelligence (AI) has emerged as a transformative tool capable of automating data acquisition, analysis, and interpretation. This review summarizes recent advances in the use of AI to facilitate diastolic function assessment. Recent findings An increasing number of studies have shown the potential for AI-based models to equal or exceed expert-guideline approaches for evaluating diastolic function while improving reproducibility and workflow. Recent trends include the use of more deep learning techniques, reliance on fewer input variables, validation with relevant clinical outcomes, and shift in diastolic function classification from a categorical grading system to a more continuous probabilistic score. Summary Current guideline-based approaches integrate multiple Doppler, structural, and hemodynamic variables to classify diastolic function. Although these algorithms have improved standardization, they remain limited by interobserver variability, discordant parameters, indeterminate classifications, incomplete datasets, and reduced applicability in complex clinical settings. Machine learning and deep learning approaches can integrate multidimensional echocardiographic features, electrocardiographic signals, and clinical variables to identify latent physiologic patterns beyond conventional rule-based algorithms. Future work will focus on addressing limitations of AI including explainability, generalizability, regulatory considerations, and integration into clinical workflows.
PURPOSE OF REVIEW:Secondary mitral regurgitation (SMR) remains a major contributor to symptoms and hospitalizations in heart failure, despite guideline-directed medical therapy (GDMT). This review synthesizes current evidence and proposes a structured framework for identifying patients most likely to benefit from mitral transcatheter edge-to-edge repair (M-TEER), integrating data from randomized clinical trials, proportionality concepts, and multimodality imaging. RECENT FINDINGS:Divergent results in MITRA-FR and COAPT mainly reflect differences in echocardiographic selection and left-ventricular remodeling, which means SMR severity should be judged relative to ventricular size and regurgitant burden. Contemporary trials such as RESHAPE-HF2 and MATTERHORN broaden the evidence and support M-TEER in selected patients and as a safer alternative to surgery in some operable cohorts. Beyond effective regurgitant orifice area, regurgitant volume and regurgitant fraction better capture MR load. Cardiac magnetic resonance refines quantification when echocardiography is discordant or limited. Right-ventricular dysfunction and pulmonary vascular involvement are key modifiers of prognosis and expected benefit. SUMMARY:Optimal candidate selection requires a structured, integrative evaluation: confirm clinically meaningful SMR despite GDMT, ensure anatomic suitability, quantify severity with a multiparametric echo approach supplemented by CMR when indicated, and incorporate ventricular-atrial-pulmonary coupling. This physiology-based strategy moves beyond single thresholds to identify patients most likely to achieve meaningful clinical benefit.
PURPOSE OF REVIEW:While pharmacologic and device therapies have improved heart failure care in recent decades, age-adjusted rehospitalization rates remain largely stable. While the adoption of many implanted devices shown to reduce heart failure hospitalizations has been slow due to their invasive nature and limited insurance coverage, wearable devices such as smartwatches are noninvasive and increasingly accessible for the general population. In this review, we discuss novel developments in clinical applications of wearable devices for heart failure. RECENT FINDINGS:While no wearable is currently recommended for heart failure monitoring or screening, recent studies have shown promising preliminary results that suggest wearables may be used to screen for prevalent heart failure, monitor congestion levels, predict acute exacerbation events, and evaluate response to interventions. We highlight research on smartwatch-based prediction of acute exacerbations and screening for heart failure, and patch-based pulmonary capillary wedge pressure estimation. SUMMARY:This review aims to serve as a primer for healthcare providers and researchers on advances for use of wearable devices in patients with heart failure. If properly validated and implemented, wearables offer potential to improve quality of life and self-efficacy of patients with heart failure while reducing their hospitalization risk.
PURPOSE OF REVIEW:Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce major adverse cardiovascular events (MACE), heart failure, and mortality through undetermined mechanisms independent of glycemic control. This review examines emerging evidence that GLP-1RAs overcome vascular regenerative cell exhaustion (VRCE), a pathological depletion of bone marrow-derived progenitor cells that mediate vessel repair. RECENT FINDINGS:VRCE, the progressive loss of circulating progenitor cells that mediate vessel regeneration, has recently emerged as an underappreciated driver of MACE risk in individuals living with type 2 diabetes (T2D), obesity or atherosclerotic cardiovascular disease. In a recent randomized translational trial of semaglutide vs. usual care, SEMA-VR CardioLink-15 provided the direct evidence that 6-month semaglutide administration could reverse VRCE profile associated with longstanding cardiometabolic disease (34.8% increase in VR myeloid progenitor cells, 66.2% expansion of endothelial precursor cells). Semaglutide additionally reduced circulating granulocyte content and suppressed pro-inflammatory TNF and interleukin family cytokines in sera. SUMMARY:GLP-1RAs can restore bone marrow progenitor cell output towards a more vessel regenerative profile. Reversal of VRCE may partially explain early event curve separation in cardiovascular outcome trials with multiple GLP-1RAs. Therefore, circulating VR cell content could serve as a measure of compromised vascular regenerative capacity and elevated cardiovascular disease risk.
Purpose of review The diagnostic evaluation of mitral regurgitation (MR) is complex, time-intensive, and prone to significant interobserver variability. This review examines the current evidence on artificial intelligence (AI) applications across the full MR diagnostic pathway, from pre-imaging screening to advanced multimodality imaging, and explores future directions for clinical integration. Recent findings AI-enabled digital stethoscopes and deep learning-based electrocardiographic models provide scalable upstream strategies for early detection and population-level risk stratification, although they currently function as enrichment tools rather than standalone diagnostics. In echocardiography, AI has demonstrated strong performance for automated valve segmentation, Doppler analysis, severity grading, and phenotypic classification. In cardiac magnetic resonance, AI enables automated valve tracking, ventricular segmentation, and tissue characterization, although dedicated algorithms for direct MR quantification remain under development. Beyond automation, AI-driven approaches have identified clinically meaningful phenotypes linking valvular dysfunction and cardiac remodeling with myocardial fibrosis and increased cardiovascular risk. Summary AI holds significant promise to improve reproducibility, consistency, and clinical integration of MR assessment. Widespread implementation, however, requires prospective validation, standardized acquisition protocols, improved model interpretability and, most importantly, proper regulations driven by a culture of safety.
Purpose of review Conventional coronary artery bypass grafting (CABG) is most commonly performed via median sternotomy, an approach that can be associated with postoperative pain, sternal wound complications, and prolonged recovery. Over the past two decades, multiple minimally invasive coronary surgery strategies have been developed, offering sternotomy-sparing alternatives that may reduce surgical trauma and accelerate recovery in appropriately selected patients. This review summarizes contemporary minimally invasive strategies, focusing on their procedural steps, patient selection, clinical outcomes, and evolving role in contemporary coronary revascularization. Recent findings Contemporary techniques include minimally invasive direct coronary artery bypass (MIDCAB), endoscopic/robotic-assisted coronary artery bypass, totally endoscopic coronary artery bypass (TECAB), and hybrid coronary revascularization (HCR), which combines CABG with percutaneous coronary intervention (PCI). Available evidence, largely from observational series and experienced centers, supports favorable graft patency and recovery profiles; however, comparative long-term data remain limited for multivessel and robotic approaches. Owing to their inherent technical complexity, steep learning curves, and high costs of robotic platforms, widespread adoption of MI-CABG has remained limited. Summary MI-CABG offers an important sternotomy-sparing option for selected patients with coronary artery disease. Wider adoption will depend on careful patient selection, structured training, multidisciplinary Heart Team decision-making, and stronger comparative evidence defining which patients benefit most.
Purpose of review Coronary angiography remains the principal imaging modality guiding coronary revascularization, but it provides only an anatomic representation of disease and does not reliably identify lesion-specific ischemia. This review summarizes contemporary evidence on coronary physiology and intravascular imaging in percutaneous and surgical revascularization. Recent findings Physiology-guided percutaneous coronary intervention (PCI) improves clinical outcomes by refining lesion selection and supporting safe deferral of nonflow-limiting stenoses. Fractional flow reserve and instantaneous wave-free ratio are supported by long-term randomized data, while angiography-derived quantitative flow ratio has shown favorable outcomes compared with angiography-guided PCI, although equivalence to pressure-wire-based strategies remains unsettled. In parallel, intravascular ultrasound and optical coherence tomography enhance procedural optimization by improving stent sizing, expansion, and detection of mechanical complications, with the strongest benefit observed in anatomically complex lesions. Postprocedural physiologic testing frequently reveals residual ischemia despite acceptable angiographic results. In coronary bypass surgery, physiologic assessment may refine target selection and clarify mechanisms of competitive flow, and postoperative quantitative flow ratio has been explored in assessing functional completeness; however, consistent improvement in clinical outcomes has not been demonstrated. Summary Current evidence strongly supports integration of coronary physiology and intravascular imaging in PCI, whereas their role in coronary artery bypass grafting remains investigational.
PURPOSE OF REVIEW:Cardiovascular disease (CVD) is the leading global cause of death and disability, with most disability-adjusted life-years linked to modifiable risk factors. Nutrition is a scalable intervention that influences multiple cardiometabolic pathways. This review is timely because recent scientific statements and global policy frameworks highlight the need to prioritize dietary strategies in community settings to reduce CVD burden and promote equity. RECENT FINDINGS:Community-based nutritional interventions in urban settings, neighborhoods and workplaces effectively reach underserved populations by leveraging trust and cultural relevance. Dietary patterns such as the Mediterranean and DASH diets have demonstrated improvements in blood pressure, lipid profiles, and inflammation. New approaches, including intermittent fasting and the EAT-Lancet reference diet, broaden prevention options. Policy actions such as taxes, nutrition labeling, and healthier procurement standards are recognized by the WHO as cost-effective measures. SUMMARY:Community-based nutritional interventions reduce cardiometabolic risk and promote equity. Strategies include fiscal policies, healthier food environments, education, digital tools, and "Food Is Medicine" programs. Their success relies on cultural adaptation and stakeholder engagement. Evidence supports their capacity to shift norms, improve diets, and sustain long-term reductions in CVD burden.
Purpose of review Right ventricular size and function are vital to risk stratification in pulmonary hypertension, valvular disease, and congenital heart disease, yet right ventricular assessment remains technically demanding and subject to interpreter variability. This review aims to synthesize the rapidly expanding evidence on the application of artificial intelligence to RV structural and functional assessment across echocardiography, cardiac magnetic resonance (CMR), and computed tomography. Recent findings Artificial intelligence has demonstrated accuracy approaching interobserver variability for automated right ventricular segmentation and chamber quantification across imaging modalities. Functional applications include artificial intelligence derived fractional area change, tricuspid annular plane systolic excursion, free-wall strain, and ejection fraction estimation compared against CMR. Emerging applications address right ventricular-pulmonary artery coupling and hemodynamic phenotyping through afterload-aware, physiology-centered models. Summary Current artificial intelligence tools can standardize and accelerate established right ventricular measurements, with the strongest performance in echocardiographic segmentation, annular tracking, and ejection fraction surrogates. Translation into clinical practice will require robust external validation across disease phenotypes, hybrid artificial intelligence workflows that loop in humans, and prospective studies that display measurable impact on clinical efficiency and patient outcomes.
PURPOSE OF REVIEW:Despite widespread use of renin-angiotensin-aldosterone system blockade, resistant and uncontrolled hypertension remain common, highlighting the need for novel therapeutic strategies. Growing recognition of aldosterone excess as a central driver of vascular, cardiac, and kidney injury has renewed interest in targeting this pathway. Recent advances in highly-selective aldosterone synthase inhibition (ASI) suggest this is a clinically viable approach. RECENT FINDINGS:ASIs, including baxdrostat and lorundrostat, demonstrate consistent blood pressure reductions of approximately 8-12 mmHg when administered in addition to standard antihypertensive therapy across phase 2 and phase 3 trials. These drugs may overcome limitations of mineralocorticoid receptor antagonists by suppressing aldosterone production upstream, mitigating aldosterone escape, and reducing adverse effects. There may also be benefits among patients with chronic kidney disease, primary aldosteronism, and heart failure with preserved ejection fraction, supporting a broader cardiorenal role. SUMMARY:Aldosterone synthase inhibition represents an advance in hypertension therapeutics. If ongoing and future outcome-driven trials confirm cardiovascular and renal benefit, ASIs may reshape treatment algorithms, complement existing renin-angiotensin-aldosterone-based strategies, and enable more precise targeting of aldosterone-mediated disease.
