Atherosclerosis, a term derived from the Greek “athero” (atheroma) and “sclerosis” (hardening), is a long-standing process that leads to the formation of atheromatous plaques in the arterial wall, contributing to the development of atherosclerotic cardiovascular disease. The proliferation and migration of vascular smooth muscle cells (VSMCs) and the switching of their phenotype play a crucial role in the whole process. Retinoic acid (RA), a natural derivative of vitamin A, has been used in the treatment of various inflammatory diseases and cell proliferation disorders. Numerous studies have demonstrated that RA has an important inhibitory effect on the proliferation, migration, and dedifferentiation of vascular smooth muscle cells, leading to a significant reduction in atherosclerotic lesions. In this review article, we explore the effects of RA on the pathogenesis of atherosclerosis, focusing on its regulatory action in VSMCs and its role in the phenotypic switching, proliferation, and migration of VSMCs. Despite the potential impact that RA may have on the process of atherosclerosis, further studies are required to examine its safety and efficacy in clinical practice.

Background: Drug-coated balloons have been used as a non-stenting treatment in coronary and peripheral artery disease. Until recently, only sirolimus- and paclitaxel-coated balloons have been investigated in clinical trials. We evaluated the safety and efficacy of an innovative everolimus-coated balloon (ECB) in a swine coronary artery model. Methods: thirty-two swine coronary arteries were prepared through dilatation with a non-coated angioplasty balloon in a closed-chest model. During a period of 90 days, the following four groups (four animals per group, two coronary arteries per animal) were compared for safety and efficacy: A, Rontis ECB with 2.5 μg/mm² of drug per balloon surface; B, Rontis ECB with 7.5 μg/mm²; C, Rontis Europa Ultra bare balloon; and D, Magic Touch, Concept Medical, sirolimus-coated balloon with a drug load of 1.3 μg/mm². Results: Differences in local biological effects (arterial reaction scores) and surface of intimal area (mm²) were not statistically significant between the treatment groups. Numerically, group A showed the lowest intimal area and intimal mean thickness, while group B showed the lowest stenosis among all groups. Conclusions: ECB was safe and effective in a porcine coronary artery model. The dose of everolimus may play a role in the biocompatibility of the balloon.

Background: Cardiogenic shock (CS) is a life threatening condition marked by inadequate tissue perfusion due to impaired cardiac output. Despite advances in diagnosis and management, mortality remains unacceptably high. Objective: This prospective, single-center observational study aimed to characterize the clinical profile, management strategies, and short- and long-term outcomes of patients with CS. Methods: Seventy patients (SCAI stages B–E) admitted to the Cardiac Intensive Care Unit (CICU) of a tertiary university hospital over a 24-month period were enrolled. Demographic, clinical, hemodynamic, echocardiographic, and biochemical data were collected. The primary outcomes were in-hospital, 1-month, and 1-year mortality. Secondary outcomes included the use of mechanical circulatory support (MCS), mechanical ventilation (MV), and continuous renal replacement therapy (CRRT). Results: Acute myocardial infarction-related CS (AMI-CS) and heart failure-related CS (HF-CS) accounted for 64% of cases. The overall in-hospital mortality was 49%. SCAI stage C was independently associated with higher mortality at all time points compared with stage B. Key predictors of mortality included higher SCAI stage, elevated lactate and creatinine levels, and reduced cardiac output. Intra-aortic balloon pump (IABP) use was more frequent in AMI-CS. Conclusions: CS continues to be associated with poor prognosis, particularly in patients with higher SCAI stages. Standardized clinical pathways and national registries are urgently needed to guide evidence-based and resource-appropriate care.

Although the incidence of restenosis and stent thrombosis has substantially declined during the last decades, they still constitute the two major causes of stent failure. These complications are partially attributed to the currently used cytostatic drugs, which can cause local in flammation, delay or prevent re-endothelialization and essentially cause arterial cell toxicity. Retinoic acid (RA), a vitamin A (retinol) derivative, is a naturally occurring substance used for the treatment of cell proliferation disorders. The agent has pleiotropic effects on vascular smooth muscle cells and macrophages: it in fluences the proliferation, migration, and transition of smooth muscle cells to other cell types and modulates macrophage activation. These observations are supported by accumulated evidence from in vitro and in vivo experiments. In addition, systemic and topical administration of RA can decrease the development of atherosclerotic plaques and reduce or inhibit restenosis after vascular injury (caused by embolectomy, balloon catheters, or ligation of arteries) in various experimental models. Recently, an RA -drug eluting stent (DES) has been tested in an animal model. In this review, we explore the effects of RA in atherosclerosis and the potential of the local delivery of RA through an RA -DES or RA -coated balloon for targeted therapeutic percutaneous vascular interventions. Despite promising published results, further experimental study is warranted to examine the safety and ef ficacy of RA -eluting devices in vascular artery disease. (Hellenic Journal of Cardiology 2024;76:75 -87) (c) 2023 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Cardiogenic shock (CS) is a heterogeneous pathophysiological state with high mortality, despite the development of cardiac intensive care units (CICUs) and the advanced treatments applied. The cornerstones of therapy that have been proposed in many algorithms are intravenous (i.v.) pressors and devices for mechanical circulatory support (MCS), depending on the CS profile (left, right, or biventricular involvement), etiology (acute myocardial infarction, heart failure, or other) and SCAI stage (A to E, with MCS generally recommended for Stages C–E). There are many gaps in the evidence regarding i.v. medications and devices, with the existing data being controversial. Moreover, there are differences in the devices’ availability and, as a result, a lack of experience in many centers. In this review article, an algorithm for the management of CS is proposed, and the gaps in every step are presented. Early clinical suspicion that leads to prompt diagnosis, health system organization, large-scale trials, and the configuration of national or regional shock centers could bridge the current therapeutic gaps and balance disparities in the management of CS in order to improve outcomes.

(1) Background: There are little data about the differences in clinical and echocardiographic characteristics between elderly (aged ≥ 65 years) and younger patients with acute pulmonary embolism (PE). (2) Methods: Consecutive patients diagnosed with PE in a tertiary hospital were identified. Clinical characteristics, biomarkers and transthoracic echocardiography indices including right ventricular free wall longitudinal strain (RV-FWLS) were recorded. (3) Results: Of 200 patients enrolled, 19 patients had high-risk PE and were excluded from the study. Compared to younger patients, elderly patients with PE had less frequently pain and typical symptoms and more often were hospitalized due to another reason before the PE diagnosis. The elderly had higher values of D-dimer, high-sensitivity troponin I and brain natriuretic peptide (BNP). Echocardiographic differences were noted and the elderly had lower values of pulmonary vascular acceleration time, RV E/A ratio and lower tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio. The RV-FWLS index did not show a statistically significant difference in distribution between age groups ≥ 65 and <65 years old. The RV diameter was similar across all age groups. (4) Conclusions: The elderly have differences compared with younger patients with PE regarding the mode of presentation, the values of biomarkers like D-dimer, BNP and troponins and some echocardiographic indices of RV affection.