Cardiovascular Medicine

11 pages, 453 KB

Open AccessArticle

Low Postoperative Cholesterol Level Is Associated with Adverse Outcomes After Coronary Artery Bypass Grafting

by Maarten de Haan, Etienne Bertjens, F. Joost ter Woorst, Mohamed A. Soliman-Hamad, Leon M. Montenij, Rick Bezemer, R. Arthur Bouwman and Herman G. Kreeftenberg

Cardiovasc. Med. 2026, 29(3), 35; https://doi.org/10.3390/cardiovascmed29030035 - 17 Sep 2026

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Abstract

Low cholesterol levels have been linked to severe illness, including sepsis. This study evaluated whether early postoperative cholesterol levels are associated with adverse outcomes in patients after elective Coronary Artery Bypass Grafting with extracorporeal circulation. This retrospective single-center study included 3280 adults who [...] Read more.

Low cholesterol levels have been linked to severe illness, including sepsis. This study evaluated whether early postoperative cholesterol levels are associated with adverse outcomes in patients after elective Coronary Artery Bypass Grafting with extracorporeal circulation. This retrospective single-center study included 3280 adults who had at least one cholesterol measurement within the first five postoperative days. The lowest cholesterol value was analyzed with demographic, comorbidity, intraoperative, and laboratory variables to assess associations with 30-day mortality, cerebrovascular accident, renal replacement therapy, and respiratory dysfunction. ROC analysis with Youden’s Index identified an optimal cut-off, and logistic regression determined independent associations. A cholesterol cut-off of 2.46 mmol/L best stratified 30-day mortality (AUC 0.716; 95% CI 0.657–0.775), with patients below this threshold showing higher mortality (3.9% vs. 1.2%; p < 0.001). Cholesterol < 2.46 mmol/L was independently associated with 30-day mortality (OR 2.759 (1.675–4.544); p < 0.001), cerebrovascular accident (OR 3.661 (1.271–10.540); p = 0.016), renal replacement therapy (OR 4.785 (1.809–12.658); p = 0.002), and respiratory dysfunction (OR 3.039 (1.648–5.602); p < 0.001). Early postoperative hypocholesterolemia shows concurrent associations with adverse outcomes after CABG. Cholesterol levels < 2.46 mmol/L are concurrently associated with higher 30-day mortality. Full article

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15 pages, 527 KB

Open AccessArticle

Impella 5.0/5.5-Assisted Off-Pump Coronary Artery Bypass Surgery in Patients with Severely Impaired Left Ventricular Function: A Single-Center Descriptive Feasibility and Safety Study

by Gohart Hoti, Laura Rings, Stak Dushaj, Nestoras Papadopoulos, Dragan Odavic, Igor Tudorache, Petar Risteski, Héctor Rodríguez Cetina Biefer and Omer Dzemali

Cardiovasc. Med. 2026, 29(3), 34; https://doi.org/10.3390/cardiovascmed29030034 - 15 Sep 2026

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Abstract

Patients with severely impaired left ventricular ejection fraction (LVEF) undergoing surgical coronary revascularization face elevated perioperative risk. We retrospectively analyzed all consecutive patients who underwent off-pump coronary artery bypass (OPCAB) surgery under prophylactic Impella 5.0/5.5 support at a single center between 2020 and [...] Read more.

Patients with severely impaired left ventricular ejection fraction (LVEF) undergoing surgical coronary revascularization face elevated perioperative risk. We retrospectively analyzed all consecutive patients who underwent off-pump coronary artery bypass (OPCAB) surgery under prophylactic Impella 5.0/5.5 support at a single center between 2020 and 2023. The primary endpoint was 30-day all-cause mortality; secondary endpoints were the change in LVEF to discharge, early graft patency on computed tomography angiography, duration of support, and device- and access-related complications. Twenty-one patients were included. Median age was 63 years (IQR 59–74), 19 (90.5%) were male, and median EuroSCORE II was 10.8% (IQR 7.8–17.8). Median preoperative LVEF was 20% (IQR 20–28). Complete revascularization was achieved in all patients, and none required intraoperative conversion to cardiopulmonary bypass. Median duration of Impella support was 4 days (IQR 2–7). Median LVEF at discharge was 38% (IQR 34–40), with a median within-patient change of +16 percentage points (IQR 10–20). Predischarge computed tomography angiography showed early graft failure in one patient (4.8%). Two patients (9.5%) required postoperative escalation to veno-arterial extracorporeal membrane oxygenation, and 30-day mortality was 4.8% (n = 1). Impella 5.0/5.5-assisted OPCAB appears feasible in selected patients, with a complication profile that warrants further evaluation given the low number of patients enrolled. This uncontrolled series cannot establish a benefit attributable to Impella; prospective controlled evaluation is required. Full article

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13 pages, 2016 KB

Open AccessReview

Beyond Coronary Stenosis: A Mechanism-Based Approach to Ischemic Heart Disease in Women

by Chiara Tognola, Rita Cristina Myriam Intravaia, Giulia Colombo, Alberto Preda, Marisa Varrenti, Alessandro Maloberti, Patrizio Mazzone, Cristina Giannattasio and Fabrizio Guarracini

Cardiovasc. Med. 2026, 29(3), 33; https://doi.org/10.3390/cardiovascmed29030033 - 15 Sep 2026

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Abstract

Despite major advances in cardiovascular medicine, ischemic heart disease (IHD) in women remains underrecognized and undertreated. A substantial proportion of symptomatic women have no flow-limiting epicardial stenosis, and ischemia may arise from coronary microvascular dysfunction, vasospasm, diffuse atherosclerosis, plaque-related mechanisms, spontaneous coronary artery [...] Read more.

Despite major advances in cardiovascular medicine, ischemic heart disease (IHD) in women remains underrecognized and undertreated. A substantial proportion of symptomatic women have no flow-limiting epicardial stenosis, and ischemia may arise from coronary microvascular dysfunction, vasospasm, diffuse atherosclerosis, plaque-related mechanisms, spontaneous coronary artery dissection (SCAD), or combinations of these processes. Female-specific biological factors—including hormonal transitions, vascular aging, inflammation, metabolic changes, and reproductive cardiovascular risk enhancers—modify the coronary substrate across the life course. This review integrates these determinants with contemporary coronary phenotyping and proposes a clinically oriented, mechanism-based framework for IHD in women. Multimodality imaging, invasive coronary functional testing, and intracoronary imaging are considered complementary tools for identifying predominant and coexisting mechanisms. Management should combine guideline-directed cardiovascular prevention with mechanism-targeted antianginal therapy and women-specific considerations, including reproductive planning, pregnancy counseling, medication safety, and psychosocial care. This framework is intended as a practical synthesis rather than a validated classification system and aims to support more precise diagnosis and individualized treatment of women with ischemic symptoms. Full article

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11 pages, 1925 KB

Open AccessCase Report

Rapidly Progressive Cardiac Sarcoidosis with Refractory Ventricular Arrhythmias Leading to Heart Transplantation: A Case Report and Literature Review

by Alexandra Rantas, Anna Giulia Pavon, Michele Martinelli and Giorgio Moschovitis

Cardiovasc. Med. 2026, 29(3), 32; https://doi.org/10.3390/cardiovascmed29030032 - 21 Aug 2026

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Abstract

Cardiac sarcoidosis (CS) is an inflammatory cardiomyopathy with heterogeneous presentation and potentially life-threatening complications, including ventricular arrhythmia, atrioventricular block, and heart failure. Early diagnosis is challenging and a multidisciplinary approach is pivotal for optimal treatment and better outcome. We report the case of [...] Read more.

Cardiac sarcoidosis (CS) is an inflammatory cardiomyopathy with heterogeneous presentation and potentially life-threatening complications, including ventricular arrhythmia, atrioventricular block, and heart failure. Early diagnosis is challenging and a multidisciplinary approach is pivotal for optimal treatment and better outcome. We report the case of a 47-year-old man with newly diagnosed systemic sarcoidosis who rapidly developed heart failure and therapy-refractory ventricular arrhythmias despite combined immunosuppressive and antiarrhythmic therapy. Within eight months from the first diagnosis of CS, the patient required four hospitalizations, ICD implantation, ventricular tachycardia ablation, and ultimately orthotopic heart transplantation. Histological examination of the explanted heart revealed extensive myocardial fibrosis without residual granulomas or inflammation, consistent with end-stage, burned-out CS—highlighting the irreversibility of myocardial damage once the fibrotic phase has developed. This case illustrates the potentially devastating course of CS despite aggressive immunosuppressive therapy, emphasizing that the overall prognosis of sarcoidosis disease is largely influenced by cardiac manifestation. Indeed, complete metabolic remission based on a serial FDG-PET/CT scan did not prevent progressive functional deterioration—underscoring that irreversible myocardial fibrosis may progress beyond maximal medical therapy, including anti-inflammatory, immunosuppressive and neuro-humoral treatment. Therefore, prompt screening for CS is essential, and once cardiac involvement is suspected and respectively confirmed, the therapy window may become particularly narrow in the case of rapidly progressive CS. Full article

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14 pages, 1600 KB

Open AccessArticle

Large Language Model Chatbots Cannot Reliably Calculate Clinical Risk Scores—A Comparative Accuracy Study

by Philippe Di Cicco, Wesley Bennar, Corentin Volet, Serban G. Puricel, Mario Togni, Stéphane Cook and Dorian Garin

Cardiovasc. Med. 2026, 29(3), 31; https://doi.org/10.3390/cardiovascmed29030031 - 18 Aug 2026

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Abstract

Background: Large language models (LLMs) are increasingly accessible to healthcare providers and patients for clinical decision support, yet their ability to perform precise mathematical calculations required for validated risk scores remains unexplored, and errors could compromise patient safety. The EuroSCORE II requires complex [...] Read more.

Background: Large language models (LLMs) are increasingly accessible to healthcare providers and patients for clinical decision support, yet their ability to perform precise mathematical calculations required for validated risk scores remains unexplored, and errors could compromise patient safety. The EuroSCORE II requires complex multivariable computation that could reveal fundamental limitations in LLM computational capabilities. Methods: We evaluated four publicly available chatbots (ChatGPT (GPT-4o, OpenAI), Claude (Sonnet 4.5, Anthropic), Gemini (2.5 Flash, Google) and Deepseek (V3)) in calculating EuroSCORE II for 105 patients from the CARDIO-FR registry with gold standard heart team calculations. Each model was tested using two approaches: direct calculation from clinical parameters alone and formula-based calculation with the explicit EuroSCORE II algorithm provided. Performance was assessed through mean absolute error (MAE), correlation coefficients, and clinical agreement within ±2% of gold standard values. Results: Direct LLM calculations demonstrated poor accuracy (MAE range: 3.3–6.4%) with the best performer (Gemini) achieving only 50.5% clinical agreement. Formula provision improved performance in three of four models, with ChatGPT formula achieving the lowest MAE (2.9%) and highest clinical agreement (51.4%), followed by Claude formula (MAE 3.2%, agreement 48.6%). Adding the formula to the prompt significantly improved performance and reduced bias. All methods exhibited significant systematic biases (p < 0.05 for 7/8 strategies). Conclusions: Publicly available LLM chatbots cannot reliably calculate EuroSCORE II for clinical use. Adding the formula to the prompt significantly improved performance, but was not sufficient to reach the clinically required threshold of 90% agreement. Clinicians should rely on validated risk calculation tools rather than LLM chatbots for quantitative clinical risk assessments. Full article

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24 pages, 1117 KB

Open AccessReview

Heart Rate Variability in Heart Failure: Mechanisms, Prognostic Value and Modulation Strategies

by Angelica Cersosimo, Lucio Teresi, Riccardo Rovelli, Elisa Brangi, Nicola Pierucci, Elena Cerani, Marco Metra and Enrico Vizzardi

Cardiovasc. Med. 2026, 29(3), 30; https://doi.org/10.3390/cardiovascmed29030030 - 5 Aug 2026

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Abstract

Heart rate variability (HRV) is a non-invasive marker of cardiac autonomic regulation that reflects the dynamic interaction between sympathetic and parasympathetic influences on the sinoatrial node. Reduced HRV is a hallmark of autonomic dysfunction and has been consistently associated with adverse outcomes across [...] Read more.

Heart rate variability (HRV) is a non-invasive marker of cardiac autonomic regulation that reflects the dynamic interaction between sympathetic and parasympathetic influences on the sinoatrial node. Reduced HRV is a hallmark of autonomic dysfunction and has been consistently associated with adverse outcomes across a wide range of cardiovascular conditions, particularly heart failure (HF). HRV is markedly reduced in HF, reflecting profound autonomic imbalance characterized by vagal withdrawal, impaired baroreflex sensitivity, and altered cardiorespiratory coupling. In heart failure with reduced ejection fraction (HFrEF), lower global HRV, particularly reduced SDNN, is consistently associated with mortality, sudden cardiac death, and disease progression. In heart failure with preserved ejection fraction (HFpEF), emerging observational evidence suggests that HRV alterations may accompany early autonomic dysregulation and may be associated with sex-specific patterns, although their mechanistic and prognostic significance remains incompletely defined. In acute HF, HRV assessed during hospitalization may provide additional prognostic information, although current evidence remains limited and heterogeneous. Pharmacological therapies, cardiac resynchronization therapy, exercise training, and lifestyle interventions have variably modulated HRV across studies, but the evidence is heterogeneous and changes in HRV should not be assumed to translate directly into improved clinical outcomes. Despite persistent challenges related to methodological standardization and clinical implementation, emerging technologies and multimodal approaches may refine the feasibility of integrating HRV into risk assessment frameworks. This narrative review aims to summarize the physiological basis of HRV, critically evaluate its alterations across different HF phenotypes, and discuss its prognostic associations, therapeutic modulation, and current practical limitations in clinical application. Full article

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16 pages, 1254 KB

Open AccessOpinion

Mechanism-Informed Drug Repurposing in MINOCA: Therapeutic Rationale and Trial Framework for Empagliflozin and Colchicine

by Zainab Atiyah Dakhil

Cardiovasc. Med. 2026, 29(3), 29; https://doi.org/10.3390/cardiovascmed29030029 - 3 Aug 2026

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Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinically important but heterogeneous syndrome associated with substantial long-term morbidity and adverse cardiovascular outcomes. Pharmacologic management remains largely extrapolated from obstructive coronary artery disease, creating a persistent mismatch between treatment strategies and the diversity [...] Read more.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinically important but heterogeneous syndrome associated with substantial long-term morbidity and adverse cardiovascular outcomes. Pharmacologic management remains largely extrapolated from obstructive coronary artery disease, creating a persistent mismatch between treatment strategies and the diversity of underlying mechanisms. Accurate diagnostic adjudication using cardiac magnetic resonance imaging, intracoronary imaging, coronary functional testing, and mechanistic biomarkers is therefore central to a phenotype-guided therapeutic approach. Inflammation, endothelial dysfunction, oxidative stress, autonomic dysregulation, coronary microvascular dysfunction, plaque-related injury, and adverse ventricular remodeling represent potentially targetable biological domains across selected MINOCA phenotypes. Empagliflozin and colchicine exert overlapping but distinct effects on several of these pathways and have demonstrated cardiovascular benefits in related clinical settings; however, direct evidence in MINOCA remains limited and predominantly observational. This article integrates the available mechanistic and clinical evidence into a comparative, phenotype-linked therapeutic framework and proposes a pragmatic trial strategy incorporating diagnostic adjudication, phenotype enrichment, biomarker-guided stratification, and adaptive or factorial designs. The proposed framework is hypothesis-generating and is intended to inform prospective investigation rather than support off-label prescribing or changes to current clinical practice. Full article

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10 pages, 472 KB

Open AccessArticle

Ticagrelor or Clopidogrel After PCI in Atrial Fibrillation? Insights from a Real-World Retrospective Analysis

by Ferhat Siyamend Yurdam and Ahmet Anıl Başkurt

Cardiovasc. Med. 2026, 29(3), 28; https://doi.org/10.3390/cardiovascmed29030028 - 3 Aug 2026

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Abstract

Background: Optimal antithrombotic therapy in patients with AF undergoing PCI while receiving OAC remains a clinical challenge. Although clopidogrel is generally recommended as the preferred P2Y12 inhibitor in this setting, evidence comparing clopidogrel with ticagrelor in real-world AF–PCI populations is limited. Objective: To [...] Read more.

Background: Optimal antithrombotic therapy in patients with AF undergoing PCI while receiving OAC remains a clinical challenge. Although clopidogrel is generally recommended as the preferred P2Y12 inhibitor in this setting, evidence comparing clopidogrel with ticagrelor in real-world AF–PCI populations is limited. Objective: To evaluate ischemic and bleeding outcomes in AF patients treated with DOAC combined with clopidogrel, ticagrelor, or TAT following PCI for ACS. Methods: This study involved 248 consecutive patients with non-valvular AF who underwent PCI for ACS and were discharged on DOAC plus clopidogrel (Group 1), DOAC plus ticagrelor (Group 2), or aspirin + clopidogrel + DOAC (Group 3). Cox regression analysis was used to determine the difference in survival rates among the three groups regarding the composite ischemic endpoint (stroke, MI, and stent restenosis) and bleeding. Results: In the Cox regression analysis performed, no statistically significant effect of the variables representing the antiplatelet treatment groups on ischemic outcomes was observed during the 1-year follow-up (Wald = 3.681; df = 2; p = 0.159). Conclusions: In this retrospective real-world cohort of AF patients undergoing PCI for ACS, clopidogrel-based dual therapy appeared to provide clinical outcomes comparable to ticagrelor with respect to thromboembolic and bleeding events. No clear ischemic advantage of ticagrelor was observed, although a numerical increase in minor bleeding was noted. Full article

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13 pages, 50949 KB

Open AccessArticle

The Biaxillary Access: A Cadaveric Proof-of-Concept Study of a Minimally Invasive Strategy for Combined Coronary Artery Bypass Grafting and Valve Surgery

by Sahra Tasdelen, Thomas Poschner, Gianluca Dimonte, Sami Mouritane, Andrei-Antonio Caracioni, Viktoriia Tymoshenko and Martin Andreas

Cardiovasc. Med. 2026, 29(3), 27; https://doi.org/10.3390/cardiovascmed29030027 - 28 Jul 2026

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Abstract

Coronary artery bypass grafting is frequently performed in combination with valve surgery; however, minimally invasive approaches for such combined procedures remain limited due to challenges in exposure and access. While bilateral minimally invasive strategies have been described in selected cases, standardized access concepts [...] Read more.

Coronary artery bypass grafting is frequently performed in combination with valve surgery; however, minimally invasive approaches for such combined procedures remain limited due to challenges in exposure and access. While bilateral minimally invasive strategies have been described in selected cases, standardized access concepts for concomitant procedures are not well defined. This study aimed to assess the anatomical accessibility and procedural workflow of a minimally invasive biaxillary access strategy for combined coronary and valve surgery in a human cadaver model. Combined coronary artery bypass grafting and valve procedures were performed in nine Thiel/ethanol-fixed human cadavers using a biaxillary access approach. Anatomical exposure, conduit length, graft harvesting and anastomosis times, and valve positioning were evaluated by macroscopic inspection and postprocedural three-dimensional computed tomography imaging. All planned procedural steps were completed in all nine cadavers. The mean left and right internal thoracic artery lengths were 18.1 ± 1.8 cm and 18.9 ± 1.9 cm, respectively. The average bilateral internal thoracic artery harvest and anastomosis times were 52.0 ± 17.6 min and 46.6 ± 12.6 min, respectively. Postprocedural three-dimensional computed tomography imaging and macroscopic inspection demonstrated consistent graft positioning and anatomical valve seating across all specimens. This cadaveric study demonstrates that a minimally invasive biaxillary access strategy allows anatomical exposure and supports a conceptual procedural workflow for combined coronary and valve interventions. These findings represent an early-stage technical proof-of-concept and require further validation before clinical application can be considered. Full article

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6 pages, 2229 KB

Open AccessCase Report

Hybrid Approach for Distal Stent Graft-Induced New Entry After Frozen Elephant Trunk: Case Report

by Boris N. Kozlov, Dmitri S. Panfilov, Evgeniya V. Lelik and Elizaveta A. Petrakova

Cardiovasc. Med. 2026, 29(3), 26; https://doi.org/10.3390/cardiovascmed29030026 - 15 Jul 2026

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Abstract

This case demonstrates the efficacy and feasibility of visceral–renal debranching with endovascular repair for the treatment of a distal stent graft-induced new entry (dSINE) that occurred 47 months after a frozen elephant trunk procedure in a patient with chronic aortic dissection type B. [...] Read more.

This case demonstrates the efficacy and feasibility of visceral–renal debranching with endovascular repair for the treatment of a distal stent graft-induced new entry (dSINE) that occurred 47 months after a frozen elephant trunk procedure in a patient with chronic aortic dissection type B. There were no perioperative complications. Postoperative computed tomography scans confirmed sealing dSINE and the patency of visceral and renal arteries. Full article

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20 pages, 726 KB

Open AccessArticle

Risk Stratification of Postoperative Vasoplegia After Cardiac Surgery

by Fabian Emrich, Lucia Lemaire, Afsaneh Karimian-Tabrizi, Marcus Hermann, Reza Fereidooni, Hanna Reichegger, Mustafa Al-Obaidi, Thomas Walther and Andreas Winter

Cardiovasc. Med. 2026, 29(3), 25; https://doi.org/10.3390/cardiovascmed29030025 - 15 Jul 2026

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Abstract

Vasoplegic syndrome is a common and potentially life-threatening complication following cardiac surgery with cardiopulmonary bypass. It is characterized by profound hypotension due to persistently reduced systemic vascular resistance despite preserved or increased cardiac output. The reported incidence ranges from 8% to 44%, and [...] Read more.

Vasoplegic syndrome is a common and potentially life-threatening complication following cardiac surgery with cardiopulmonary bypass. It is characterized by profound hypotension due to persistently reduced systemic vascular resistance despite preserved or increased cardiac output. The reported incidence ranges from 8% to 44%, and severe, catecholamine-resistant forms are associated with markedly increased mortality. In this retrospective study, 3937 cardiac surgical patients treated at the University Hospital Frankfurt between 2017 and 2021 were analyzed. Postoperative vasoplegic syndrome occurred in 17.5% of the cases and was classified as mild to moderate or severe according to vasopressor requirements. Preoperative, intraoperative, and postoperative variables were assessed using descriptive statistics as well as univariate and multivariable regression analyses to identify independent risk factors. Advanced age, elevated body mass index, EuroSCORE II > 10%, arterial degenerative diseases, preoperative dialysis dependence, atrioventricular valve surgery, emergency procedures, prolonged cardiopulmonary bypass and operative times, blood loss or transfusion and elevated preoperative hematocrit were identified as independent risk factors. Postoperatively, impaired renal function, increased inflammatory markers, and low hemoglobin levels were associated with vasoplegic syndrome. Severe vasoplegic syndrome was associated with increased mortality, prolonged intensive care unit stay, and extended hospitalization. Further research is required to establish standardized definitions and optimize prevention and treatment strategies. Full article

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28 pages, 6971 KB

Open AccessCase Report

A Clinical Experience with a Complex Case Treated with TriCValve^®: Narrative Review of the Medical Literature and Rehabilitative Implications

by Valerio Massimo Magro, Nicola Manocchio, Andrea Sorbino, Paola Russo, Anjeza Ago, Rita Mandarello, Gianluca Massaro, Concetta Ljoka, Gaetano Chiricolo and Calogero Foti

Cardiovasc. Med. 2026, 29(3), 24; https://doi.org/10.3390/cardiovascmed29030024 - 8 Jul 2026

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Abstract

Tricuspid regurgitation (TR) is being increasingly recognized in the patient population. It is a common cardiac cause of chronic disability. This pathology is characterized by a heterogeneous and broad spectrum of clinical manifestations with signs and symptoms. The results from various and different [...] Read more.

Tricuspid regurgitation (TR) is being increasingly recognized in the patient population. It is a common cardiac cause of chronic disability. This pathology is characterized by a heterogeneous and broad spectrum of clinical manifestations with signs and symptoms. The results from various and different analyses and studies suggest that TR-related deaths may have increased over the last 20 years. This trend may justify a greater focus on timely diagnosis and management of TR. For a long time, this problem has been underestimated or treated with only pharmacological therapy (diuretics). The use of the isolated surgical option remains infrequent, especially in patients at high surgical risk, for whom a significant number of patients with TR are still not treated, and a disability remains that is difficult to manage and rehabilitate. To date, there are emerging as an alternative to surgery in high-risk patients with severe TR multiple transcatheter devices that aim to reduce TR through different functional mechanisms. There are numerous minimally invasive treatments for TR, and many devices used for the treatment of this disabling pathology. In fact, there are various treatments with a transcatheter approach using ever-new devices. The use of heterotopic implantation of bioprosthetic valves in the superior and inferior vena cava represents an additional therapeutic armamentarium that, through caval reflux, can constitute an additional resource, too. Starting from a single clinical experience and describing a clinical case report, a narrative review has been undertaken by reviewing the various studies that have investigated this type of approach and their impact on the general, cardiac, and functional sides, to then discuss the cost–benefit ratio in light of knowledge on this specific topic. Full article

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5 pages, 536 KB

Open AccessTechnical Note

Four-Dimensional Cinematic Rendering of a Presumed Aortic Valve Papillary Fibroelastoma on Coronary CT Angiography

by Muhammad Umair and Amy Avakian

Cardiovasc. Med. 2026, 29(3), 23; https://doi.org/10.3390/cardiovascmed29030023 - 2 Jul 2026

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Abstract

Four-dimensional cinematic rendering represents a convergence of physically based volumetric visualization and time-resolved cardiac imaging, enabling simultaneous assessment of structure and motion within a continuous spatial context. Its application to valvular pathology remains limited. We present a technical implementation of four-dimensional cinematic rendering [...] Read more.

Four-dimensional cinematic rendering represents a convergence of physically based volumetric visualization and time-resolved cardiac imaging, enabling simultaneous assessment of structure and motion within a continuous spatial context. Its application to valvular pathology remains limited. We present a technical implementation of four-dimensional cinematic rendering applied to retrospectively electrocardiographically gated coronary computed tomography angiography for characterization of a presumed aortic valve papillary fibroelastoma. This approach enabled direct visualization of lesion morphology, stalk attachment, and dynamic mobility while preserving spatial relationships to valve cusps and the coronary ostium. In contrast to conventional two-dimensional and static three-dimensional techniques, four-dimensional cinematic rendering provided continuous spatial and temporal coherence, reducing interpretive fragmentation across imaging planes. Used as an adjunct to conventional cross-sectional interpretation, this method allows anatomical detail and functional behavior to be assessed concurrently, with potential implications for risk stratification and procedural planning in valvular disease. Full article

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