The gut microbiome has a crucial role in host metabolism and immune regulation, and there is growing evidence that dysbiosis may be associated with the pathogenesis of cardiovascular disease (CVD). This narrative review provides an overview of the recent literature on mechanistic connections between the gut and heart, as well as on the therapeutic strategies and research gaps in the gut-heart axis. We conducted a systematic literature search on PubMed and Embase databases with MeSH and keyword terms: 'gut microbiome', 'cardiovascular disease', 'TMAO', 'short-chain fatty acids', 'probiotics' and 'faecal microbiota transplantation'. We considered human and relevant animal studies focusing on mechanistic pathways or microbiome treatments and excluded editorials, small (less than 10 subjects) case series and articles not published in the English language. Key microbiota-derived metabolites, trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), contribute to atherogenesis, blood pressure and myocardial inflammation. Dysbiosis-induced barrier dysfunction and disturbed bile acid signalling also serve as the mediators of cardiac remodelling. Dietary fibre, probiotics/prebiotics, postbiotics and faecal microbiota transplantation are emerging interventions for the modulation of CVD risk. Nevertheless, most result from observational studies, whilst such are heterogeneous in sequencing platforms and too small to draw any definitive conclusions. The modulation of gut microbiome might be a new target for CVD prevention and treatment. Large-scale, standardized randomized trials with hard cardiovascular endpoints, as well as integrated multi-omics profiling, will be required to validate microbial biomarkers and to optimize microbiome-based interventions.

Functional status is a predictor of rehospitalization and mortality in patients with heart failure (HF). The purpose of this study was to test the variables in the Multidimensional Model of Functional Status (MMFS) as determinants of functional status. Using structural equation modelling, we analysed data from 520 patients with HF to determine the best multivariate model of functional status. In the MMFS, the potential determinants of functional status include demographic, clinical, psychosocial, behavioural and symptom burden variables. We measured functional status using the Duke Activity Status Index. Other variables were collected by standardized questionnaires and patient interviews. Patients who were older, less educated, or had greater comorbidity burden or greater symptom burden had worse functional status. Sex, body mass index, depression, anxiety and social support were indirectly associated with functional status mediated by symptom burden. Being married was indirectly associated with better functional status via the pathways of more social support and fewer depressive symptoms through lower symptom burden. Multidimensional variables proposed in the MMFS were directly and indirectly associated with functional status. Among these variables, symptom burden is the most important mediator. Targeting these variables, especially symptom burden, may improve patients' functional status.

The use of an implantable closure device with medical therapy to prevent recurrent stroke in patent foramen ovale (PFO)-associated stroke has been shown to be superior to medical therapy alone. Recently, an alternative, suture-based method also has shown promise for effective PFO closure. There has been little published data comparing the outcomes of these two technologies. This retrospective study explores the safety and efficacy outcomes of device-based versus suture-based percutaneous PFO intervention. The occurrence of post-procedural atrial fibrillation was of primary interest. Data from 55 single-institution, single-operator PFO closure cases between 1 January 2021 and 8 April 2022 were analyzed. Closure occurred via one of two Food and Drug Administration (FDA)-approved occluders or the NobleStitch™ EL suture-based approach. Data were transcribed into a registered REDCap database for descriptive analysis. Demographics, medical history, imaging, procedural and post-procedural outcomes were the variables collected for each participant. All patients had successful PFO closure without major adverse outcomes. Overall efficacy was similar between the two groups. No patient had a residual shunt greater than grade 1. Several suture-group patients required multiple sutures for satisfactory closure. Those who had multiple sutures had no anomalous anatomic PFO features. Three patients (5%), all from the device group, developed atrial fibrillation after PFO closure. This study supports the safety and efficacy of device- and suture-based approaches in PFO closure. Suture-based closure would seem a reasonable option where device-based closure raises concerns. Future studies could further explore the observed disparity of atrial fibrillation occurrence between the two PFO closure strategies.

The development of eHealth has offered a solution to the challenge of effective self-management for patients with heart failure (HF) by facilitating health information exchange, enabling frequent home monitoring, enhancing self-management and promoting patient empowerment. This study aimed to evaluate the effectiveness of eHealth interventions in improving self-management for patients with HF. Systematic review and meta-analysis were performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, by first selecting the relevant publications from the Cochrane Library, EBSCOhost, Epistemonikos, ProQuest, PubMed and Scopus as of 25 February 2025. The quality of the included studies was appraised using Cochrane Risk of Bias 2.0 tool. A meta-analysis of randomized controlled trials was performed using Review Manager software to estimate odds ratios (ORs) and standardized mean differences (SMDs). We included 37 trials with 13,366 participants. eHealth reduced HF-related admissions (OR: 0.73 [95% confidence interval (CI): 0.62, 0.86; p=0.0002]). All-cause mortality did not differ (OR: 0.93 [95% CI: 0.85, 1.03; p=0.16]). Cardiovascular mortality was not reduced (OR: 0.85 [95% CI: 0.71, 1.01; p=0.07]). Quality of life showed borderline improvement on the Minnesota total score (mean difference: -7.25 [95% CI: -14.81, 0.31; p=0.06]; I²=91%). HF-related knowledge did not differ (SMD: 0.53 [95% CI: -0.12, 1.19; p=0.11]). This meta-analysis demonstrates that incorporating eHealth interventions, particularly telemedicine, into standard HF care substantially decreases hospital admissions. While broader impacts on mortality, quality of life and knowledge remain inconclusive, the findings underscore the value of standardized eHealth integration as a pragmatic strategy to strengthen HF management and optimize patient outcomes.

Hypertrophic cardiomyopathy (HCM) is characterised by unusual thickening of the interventricular septum leading to dynamic left ventricular outflow tract obstruction, mitral valve regurgitation, impaired diastolic function and arrhythmias. Mavacamten (MYK-461) is a first-in-class, selective allosteric modulator of cardiac myosin adenosine triphosphatase and received US Food and Drug Administration (FDA) approval on 28 April 2022 to treat symptomatic obstructive HCM (oHCM). A systematic search of Medline/PubMed and ClinicalTrials. gov was conducted using advanced search strategies with the terms 'mavacamten/MYK-461' and 'hypertrophic cardiomyopathy/HCM' to identify and include all clinical trials published to date. The clinical efficacy of mavacamten has been consistently demonstrated in the PIONEER-HCM, MAVERICK-HCM, EXPLORER-HCM, VALOR-HCM, EXPLORER-CN-HCM and HORIZON-HCM clinical trials - there was a notable decrease in the left ventricular outflow tract gradient. Apart from the MAVERICK experiment, which revealed no discernible change in functional class or peak volume of oxygen uptake (pVO2) in non-oHCM patients, improvements were reported in New York Heart Association functional class, pVO2 and quality-of-l ife metrics. Except for the PIONEER trial, which didn't report biomarker data such as N-terminal pro B-type natriuretic peptide (NT-proBNP) and troponins, mavacamten significantly reduced biomarkers in all investigations. Additionally, the VALOR trial showed that there was a reduced need for septal reduction therapy. Although systolic dysfunction is a major safety risk that requires careful monitoring, mavacamten was generally well tolerated. Mavacamten offered a promising, non-invasive pharmacological therapy for patients with symptomatic oHCM, particularly for those who are not candidates for or who have failed conventional treatments.

Despite strides in cardiovascular disease (CVD) management, dyslipidaemia remains a significant yet underdiagnosed and undertreated risk factor, particularly among women. Sex-based disparities persist in screening, diagnosis and treatment, leading to suboptimal management and increased CVD risk in female populations. This article explores the current literature on sex disparities in dyslipidaemia, analysing screening guidelines, diagnosis trends and treatment gaps. It examines factors influencing lipid metabolism across a woman's lifespan, including hormonal fluctuations, pregnancy, menopause and their impact on CVD risk. The article also highlights barriers to effective lipid management in women, including clinician biases, inadequate screening and lower prescription rates of statin and non-statin therapies. Women are less likely to undergo lipid screening despite having significant CVD risk factors. Even when diagnosed, they receive statin therapy at lower rates than men, and treatment intensification is less frequent. Additionally, clinical trials assessing lipid-lowering therapies often underrepresent women, limiting the applicability of evidence-based recommendations. The lack of sex-specific risk assessment tools further contributes to missed opportunities for prevention and treatment. Addressing disparities in dyslipidaemia management is crucial to reducing the burden of CVD in women. Enhancing awareness among clinicians, improving screening strategies, incorporating sex-specific risk factors into predictive models and increasing female representation in clinical trials are essential steps towards equitable cardiovascular care.

Epicardial adipose tissue (EAT), located between the myocardium and visceral pericardium, plays an active role in coronary artery disease (CAD) through local inflammatory and metabolic signalling. This review explores the prognostic significance of EAT volume and attenuation (density) as measured by cardiac computed tomography. While increased EAT volume has been linked to higher plaque burden, coronary artery calcium (CAC) and incident CAD - even in low-CAC populations - attenuation offers additional value by reflecting tissue inflammation and remodelling. Lower EAT density has been independently associated with major adverse cardiac events and vulnerable plaque features, outperforming both volume and CAC score in several cohorts. We also highlight the clinical relevance of these metrics in early disease detection and risk stratification, and their potential for therapeutic modulation. As evidence builds, EAT volume and density may soon serve as practical, imaging-based biomarkers to guide personalized prevention in CAD.

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality among women, particularly those of childbearing age and middle-aged women, who face heightened risks due to physiological changes, stress and systemic barriers. Women of colour and those from low socioeconomic backgrounds are disproportionately affected. This article evaluates the effectiveness of community-based participatory research (CBPR) in reducing CVD risk among midlife women, emphasizing the cultural relevance of interventions as a critical factor for success. Following the PRISMA guidelines, a systematic search of PubMed, Scopus and Web of Science identified 15 studies, including randomized controlled trials, practice-based participatory research (PBPRs) and mixed-methods research. These studies implemented CBPR interventions focusing on diet, physical activity, stress management and community participation for underserved populations. Outcomes measured included systolic and diastolic blood pressure, serum cholesterol, Body Mass Index (BMI) and fasting blood glucose, as well as participants' knowledge, behaviours and perceived community capacity. The analysis showed reductions in systolic and diastolic blood pressure (7 and 4 mmHg, respectively), low-density lipoprotein cholesterol (10-15 mg/dL) and BMI (0.5-1.2 kg/m²), along with increases in high-density lipoprotein cholesterol (5-8 mg/dL). Culturally tailored interventions, such as dietary adjustments, group exercise and peer support, demonstrated improved compliance and maintenance of behavioural changes. Patterns of cultural relevance, trust and community ownership emerged as key determinants of success. CBPR offers significant potential for addressing health disparities and reducing CVD risk. Expanding CBPR approaches and conducting long-term interventions can enhance health equity and achieve lasting benefits across diverse populations.

Left bundle branch area pacing has been a breakthrough in pacing therapy and is being increasingly adopted. It delivers a more physiological form of pacing compared with right ventricular and biventricular pacing and also avoids the risk of perforation of the ventricular free wall. However, the therapy comes at the price of new complications related to the transseptal route for placing the lead. This article provides an update on these complications and discusses how to avoid and manage these adverse events.

This meta-analysis article aimed to investigate the efficacy of magnesium in preventing new-onset postoperative atrial fibrillation (POAF). We searched Medline, Embase, Web of Science and Cochrane Library without any language or publication date restriction up to August 2023. We included randomized controlled trials (RCTs) that enrolled adults undergoing cardiac surgery without a history of atrial fibrillation, exploring the effect of magnesium supplementation in preventing new-onset POAF. We assessed the risk of bias using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. We conducted a random-effects meta-analysis using R and assessed the certainty of the evidence. A total of 24 RCTs with 3,373 participants were included. We found that magnesium may reduce the risk of POAF compared to the control group (relative risk [RR]: 0.55; 95% confidence interval [CI]: 0.41, 0.74; low certainty). The subgroup analysis for trials with low/some concerns risk of bias showed that magnesium reduces the risk of new-onset POAF compared to control (RR: 0.70 [95% CI: 0.58, 0.84]; high certainty). Magnesium consumption had no significant effect on all-cause mortality (RR: 1.00 [95% CI: 0.34, 2.90]) or days of hospitalization (mean difference: -0.34 [95% CI: -0.94, 0.26]). The evidence indicates that magnesium administration reduces the incidence of new-onset POAF.