Background: Cancer therapy–related cardiac dysfunction frequently occurs in patients receiving anthracycline. Ivabradine reduces heart rate without affecting contractility and showed anti‐inflammatory, antioxidant, and antiapoptotic effects in experimental cardiotoxicity models. This study aims to evaluate the effect of ivabradine on cancer therapy–related cardiac dysfunction in patients with lymphoma or sarcoma treated with anthracycline. Methods: In a randomized, triple‐blind trial, patients starting anthracycline therapy received either ivabradine 5 mg twice daily or placebo until 30 days after completing treatment. The primary outcome was the incidence of cardiotoxicity measured as a ≥10% relative reduction in global longitudinal strain at 12 months from baseline. Secondary outcomes included 12‐month clinical outcomes, a ≥10% decrease in the left ventricular ejection fraction to <55%, diastolic dysfunction, and troponin T and N‐terminal pro‐B‐type natriuretic peptide levels. Results: This study enrolled 107 patients (51 in the ivabradine group and 56 in the placebo group). The median dose of anthracycline was 300 mg/m ² (250–300 mg/m ² ) in both groups. Cardiotoxicity measured as a ≥10% relative reduction in global longitudinal strain at 12 months was reached in 57% versus 50% in the ivabradine and placebo groups (odds ratio, 1.32 [95% CI, 0.61–2.83]; P =0.477). Fewer patients in the ivabradine group than in the placebo group had troponin T levels ≥14 ng/L (16 [39.0%] versus 23 [62.2%]; P =0.041) at 6 months, with this difference not maintained at the 12‐month follow‐up. In addition, there were no differences in the other secondary outcomes. Conclusions: A fixed 10 mg/day dose of ivabradine does not protect patients with cancer against anthracycline cardiotoxicity. Registration: URL: https://clinicaltrials.gov/ ; Unique Identifier: NCT03650205.

As doenças cardiovasculares, especialmente a doença arterial coronariana crônica (DAC), são a principal causa de mortalidade tanto globalmente quanto no Brasil. Os avanços na imagem cardíaca, envolvendo a ecocardiografia, a tomografia computadorizada (TC) e a ressonância magnética (RM), têm desempenhado um papel significativo na melhoria do diagnóstico precoce, da estratificação de risco e da compreensão de biomarcadores em aterosclerose. O ecocardiograma, um exame não invasivo, acessível e de baixo custo, é tradicionalmente usado para avaliar a função cardíaca, mas também desempenha um papel crucial na detecção e acompanhamento das complicações da aterosclerose e da doença arterial coronariana. A TC se destaca pela resolução temporal e espacial, fornecendo uma avaliação precisa das artérias coronárias, enquanto a RM oferece excelente diferenciação tecidual, mas ainda é limitada para a avaliação coronariana. A tomografia do coração já é validada e incorporada em recomendações internacionais quanto à avaliação de aterosclerose calcificada pelo escore de cálcio coronariano e à avaliação do grau de estenose pela angiotomografia de coronárias (ATCC). No entanto, eventos de síndrome coronariana aguda frequentemente estão relacionados a placas não obstrutivas, e a ATCC também é capaz de analisar características de alto risco de placas ateroscleróticas, oferecendo uma alternativa não invasiva aos procedimentos de imagem intracoronária, como IVUS e FFR. As novas fronteiras de avaliação em aterosclerose são a estimativa de volume de ateroma (carga de placa) e a avaliação do tecido adiposo epicárdico (TAE), sendo o Índice de Atenuação da Gordura (FAI) um dos métodos propostos para sua quantificação. No entanto, a padronização e aplicabilidade desses métodos somente serão viáveis com a integração da inteligência artificial (IA) na análise e pós-processamento de imagens. Esta revisão destaca o cenário em evolução da imagem cardiovascular e seu potencial para guiar a prevenção e o tratamento da doença arterial coronariana e da aterosclerose

Heart transplantation remains the gold-standard therapy for selected patients with end-stage heart failure, yet acute rejection and cardiac allograft vasculopathy (CAV) continue to limit long-term survival. While endomyocardial biopsy and coronary angiography remain the reference standards for diagnosing rejection and CAV, respectively, echocardiography offers a non-invasive, repeatable tool for the longitudinal surveillance of heart transplant recipients. This review summarizes the expected echocardiographic findings following orthotopic heart transplantation according to surgical technique (biatrial versus bicaval) and describes the echocardiographic features of early graft dysfunction, acute allograft rejection, and late graft failure due to cardiac allograft vasculopathy. We also discuss the incremental value of newer echocardiographic techniques—including speckle-tracking-derived strain, myocardial work, and three-dimensional echocardiography—in detecting subclinical left ventricular and right ventricular dysfunction that may precede changes detectable by conventional parameters. No single echocardiographic parameter reliably diagnoses rejection or vasculopathy in isolation; an integrated, multiparametric approach combined with clinical data is required. Emerging techniques hold promise for reducing reliance on invasive surveillance, although further validation in larger, multicenter cohorts is needed. This review aims to provide echocardiographers and transplant cardiologists with a practical, imaging-based framework for the follow-up of heart transplant recipients across the early postoperative period and long-term surveillance.