German Anguiano Torres

In this new State-of-the-art paper, the authors review the evidence and guideline support for intracoronary imaging in contemporary clinical practice, and outline a modern, imaging-driven approach to PCI planning. eurointervention.pcronline.com/article/lesion…

Cardiogenic shock is associated with high early mortality. Prompt revascularization in infarct-related cardiogenic shock improves outcomes, and mechanical circulatory support may reduce mortality in specific groups. Read the Review Article “Cardiogenic Shock” by Holger Thiele, MD (@thiele_holger), and Christian Hassager, MD, from Heart Center Leipzig at Leipzig University, Leipzig Heart Science, Rigshospitalet, and the University of Copenhagen (@koebenhavns_uni): nej.md/49ohKyV

📚Ya está disponible la actualización 2025 de la Guía ESC 2019 sobre el manejo de las dislipemias. 🎯 Actualiza los objetivos terapéuticos 💊 Refuerza y optimiza las estrategias de tratamiento ➡️ Mejora el abordaje integral del riesgo cardiovascular 📄 Puedes descargarla aquí: secardiologia.es/publicaciones/… @VDelgadoGarcia

🔥🫀 Inflammation is no longer a hypothesis—it’s a therapeutic target The 2025 ACC Scientific Statement on Inflammation and Cardiovascular Disease marks a turning point: inflammation is now recognized as a causal, measurable, and actionable driver of cardiovascular risk, not just a bystander . 🧠 Key paradigm shift Even in statin-treated patients with optimal LDL-C, residual inflammatory risk—best captured by high-sensitivity C-reactive protein (hsCRP)—strongly predicts recurrent events and cardiovascular death. In fact, post-statin hsCRP is often more prognostic than LDL-C itself. 📏 Measure what you want to treat The statement makes a bold recommendation: 👉 Near-universal hsCRP screening in both primary and secondary prevention. hsCRP <1 mg/L → low risk 1–3 mg/L → intermediate risk 3 mg/L → high inflammatory risk Persistently elevated hsCRP (>2 mg/L) identifies patients who remain vulnerable despite guideline-directed therapy. 💊 Anti-inflammatory therapies: what works (and what doesn’t) ❌ Broad immunosuppression failed (e.g. methotrexate in CIRT). ✅ Targeted inflammation inhibition works: Canakinumab (CANTOS) proved the inflammation hypothesis—reducing events without lowering LDL-C. Low-dose colchicine (0.5 mg/day) reduced recurrent CV events by ~25% and is now FDA-approved for secondary prevention. 🚧 New frontiers: IL-6 inhibition (ziltivekimab, clazakizumab) in CKD, HFpEF, ACS—results expected soon. 🧘‍♂️ Lifestyle is anti-inflammatory medicine Mediterranean/DASH diets 🥗, omega-3 intake 🐟, exercise 🏃‍♀️, weight control, and smoking cessation are explicitly framed as anti-inflammatory interventions, not just “healthy habits.” 🖼️ Imaging: promising, not ready Advanced imaging of vascular inflammation (e.g. perivascular fat attenuation index) is exciting—but not yet for routine clinical use. 🔮 Bottom line Atherosclerosis is an inflammatory disease with lipid involvement. The time has come to treat cholesterol and inflammation—with biomarkers, lifestyle, and targeted therapies—moving cardiovascular prevention into a new era 🚀

🆕 Reparación mitral percutánea borde a borde en la insuficiencia mitral secundaria: a quién, cuándo y por qué. 📕 EuroIntervention 🔓 Resumen del artículo en cardioteca.com/hemodinamica-i…

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Management of bicuspid aortic valve disease in the transcatheter aortic valve implantation era. bit.ly/3YF2GYN

Non-ST-segment elevation acute coronary syndrome: understanding the full spectrum to guide management. Read this State-of-the-Art review in #EHJ 👉 ow.ly/NZVU50XK976 @RoccoMontone @ehj_ed #acutecoronarysyndrome

#EHJCVI 🫀 Curious about the differences in diastolic dysfunction guidelines across societies? 📖 This editorial by @jgrapsa, @argulian, @OttoSmiseth unpacks key differences and their clinical impact 👉 Read more: ow.ly/PhOx50XwIa9 #EchoFirst #CVImaging #Echocardiography @EHJCVIEiC @pabloplopez_ @EACVIpresident @MMukherjeeMD @JaeKOh2 @CASivaram1 @AllanLKleinMD1

In older patients with frailty who were receiving antihypertensive drugs and had a systolic blood pressure below 130 mm Hg, reducing antihypertensive drugs did not lead to lower all-cause mortality over 4 years than usual care. Full RETREAT-FRAIL trial results and Research Summary: nej.md/45NUK9v

Guía básica para leer una revisión sistemática + metaanálisis y aplicar los resultados a los pacientes. Una guía obligada para los profesionales de la salud. repositorio.uchile.cl/bitstream/hand…

Aplicaciones clínicas de la ecocardiografía de deformación miocárdica: Declaración de consenso clínico ASE/EACVI-ESC 👓 buff.ly/DfDoPeK ◀️ Primera publicación de la nueva sección "García Fernandez te pone al día"... ¡No te lo pierdas!

Beta-blocker use after myocardial infarction reduces the risk of death in patients with a reduced ejection fraction, but its benefit is less clear in patients without a reduced ejection fraction. Research findings from the REBOOT trial are summarized in a new Quick Take video. nej.md/47Az6rE

🚀 Calcium Score & CCTA: Key Highlights from the 2025 AHA Scientific Statement (DOI: 10.1161/CIR.0000000000001394) Non-obstructive CAD in Chest Pain Patients 🧊 1. CAC = Atherosclerotic Burden, Not Just a Number CAC is one of the strongest predictors of future ASCVD risk—better than biomarkers or stenosis alone. 📉 CAC = 0 → high NPV for obstructive CAD (but not zero risk: ~10% still have non-calcified plaque, especially if young or high-risk). 🔥 CAC ≥1000 = extreme risk → annual CV mortality similar to 2ndry prevention populations. 📊 CAC → intensity of preventive therapy: from lifestyle (CAC 0) → to statins (CAC ≥100) → to high-intensity LLT + aspirin (CAC ≥300). 🧮 2. CAC for Risk Upgrading & Therapy Decisions CAC ≥100 or ≥75th percentile supports starting statins even in borderline/intermediate-risk patients. - hidden high-risk phenotypes (eg, DM or preDM patients with CAC ≥100). 🌈 CAC from non-gated PET/SPECT CT is increasingly used and correlates well with dedicated CAC scans. 🫀 3. CCTA: The New Backbone of Chest Pain Evaluation The 2021 Chest Pain Guidelines expanded CCTA → leading to a surge in detecting nonobstructive CAD (NOCA). CCTA is essential because: - plaque beyond the lumen (including noncalcified plaque). - vessels down to ~2 mm (even smaller with photon-counting CT). - high-risk plaque features (LAP, positive remodeling, spotty calcification). 👁️ CCTA reveals that up to 50% of symptomatic patients have NOCA. 🧨 4. High-Risk Plaque on CCTA = High Future Event Risk High-risk markers include: 📦 High total plaque volume 🟣 Low-attenuation plaque (>4%) ➕ ≥2 high-risk features (per CAD-RADS 2.0) 🔥 Pericoronary adipose tissue (PCAT) inflammation These features predict MI better than stenosis, shifting the paradigm from stenosis-centric to plaque-centric care. 📈 5. CCTA-Based Risk Staging (CAD-RADS 2.0 + Plaque Volume) Stage 0 → no plaque Stage 1–2 → increasing plaque burden Stage 3 → high-risk NOCA 🎯 Treatment intensity escalates with plaque volume, not stenosis alone. 🔄 6. CAC + CCTA = The Most Powerful Combination CAC quantifies calcified burden → great for long-term risk and therapy escalation. CCTA quantifies total plaque (calcified + noncalcified) → great for short-term event risk. 💡 7. Why This Matters Most ACS events originate from nonobstructive lesions. 📢 The statement pushes clinicians to: Detect early plaque (especially noncalcified). Classify risk by plaque burden + inflammation. Intensify therapy before stenosis develops. #PCCT #Atherosclerosis #PhotonCountingCT #CCT #yesCCT

❤️‍🔥 AHA 2025 – Nonobstructive Coronary Artery Disease (NOCA): Time to Act! Slipczuk et al., Circulation 2025 🇺🇸 Non obstructive CAD is the modern frontier of atherosclerosis prevention, management, treatment. And Cardiac CT is the epicenter of this paradigm shift. 🎯 What’s new: Not all chest pain comes from blocked arteries! 🩻 👉 Up to 50% of symptomatic patients have nonobstructive CAD (NOCA) — plaques <50% stenosis but still dangerous 🚨 🧠 Key message: ➡️ NOCA ≠ benign. Patients with even mild plaque face up to 4× higher MI risk than those with no CAD ⚠️ ➡️ Microvascular dysfunction (CMD) affects 30–50% of these patients 💔 🩻 Modern imaging revolution: CCTA + CAC = new gold standard for detection & risk staging 🪩 AI & plaque quantification (total volume, % low-attenuation plaque, segment score) → better precision 🔬 Photon-Counting CT & AI-QCT identify high-risk noncalcified plaques unseen before 👁️ 🔥 High-risk red flags: 🚨 Plaque burden >15% 🚨 Low-attenuation plaque >4% 🚨 Segment involvement >7 🚨 Perivascular inflammation (FAI↑) 🚨 Left main NOCA involvement 💊 Medical management essentials: Aggressive lipid lowering: statin → ezetimibe → PCSK9i → <55 mg/dL Anti-inflammatory therapy: colchicine, statins, diet 🌶️ Icosapent ethyl & GLP1-RA = plaque stabilizers Lifestyle first: AHA Life’s Essential 8 🧘‍♀️ 💬 Why it matters: 👉 ACS often arises from nonobstructive lesions! 👉 Treating NOCA early = preventing tomorrow’s infarctions 💪 👉 Time to bridge the gap between “no stenosis” and “no risk.” 💡 Take-home: 🩻 CCTA & CAC must become routine for chest pain & screening. 🌈 NOCA is a continuum of risk — not a reassurance. 💪 Treat the plaque, not just the stenosis. 📣 #AHA2025 #NOCA #INOCA #ANOCA #CAD #CCTA #PhotonCountingCT #AIQCT #CardiacImaging #PrecisionCardiology #HeartHealth #YesCCT #Cardiology