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J. Cardiovasc. Dev. Dis., Volume 10, Issue 2 (February 2023) – 58 articles

Cover Story (view full-size image): Cryoballoon ablation is the most widely used single-shot method to achieve pulmonary vein isolation, the cornerstone of ablative therapy for atrial fibrillation. The two main prerequisites are proper balloon apposition to each ostium, leading to complete occlusion following inflation, and adequate energy administration, both of which in turn ensure lesion durability. In the present article, based on the experience from over 1000 procedures, we provide guidance concerning both procedural tips and tricks regarding manipulation of the ablation system to ensure stable venous occlusion, and values of specific biophysical parameters to be monitored and evaluated to determine whether lesion durability is achieved. Finally, we present evidence-based methods to avoid complications, as well as regarding patient management post-procedurally. View this paper
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13 pages, 3038 KiB  
Systematic Review
Mechanical versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis
by Yefan Jiang, Song Wang, Jinhui Bian, Si Chen and Yongfeng Shao
J. Cardiovasc. Dev. Dis. 2023, 10(2), 90; https://doi.org/10.3390/jcdd10020090 - 20 Feb 2023
Cited by 3 | Viewed by 2573
Abstract
Background: Mechanical prostheses and bioprosthetic prostheses have their own advantages and disadvantages. Mechanical ones are recommended for younger patients (<50 years old), and bioprosthetic ones are recommended for older patients (>70 years old). There is still debate regarding which kind of prosthesis is [...] Read more.
Background: Mechanical prostheses and bioprosthetic prostheses have their own advantages and disadvantages. Mechanical ones are recommended for younger patients (<50 years old), and bioprosthetic ones are recommended for older patients (>70 years old). There is still debate regarding which kind of prosthesis is better for middle-aged patients (50 to 70 years old) receiving aortic valve replacement (AVR). To solve this problem, we conducted this meta-analysis. Given that only one randomized controlled trial (RCT) study was included, we conducted a subgroup analysis of RCT and propensity score matching (PSM) retrospective studies to reduce the bias. Methods: We systematically searched articles related to clinical outcomes of mechanical and bioprosthetic prostheses in middle-aged patients receiving AVR in the PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases. The published date was up to 1 October 2022. Studies were excluded if not only middle-aged patients were included, or if they lacked direct comparisons between mechanical and bioprosthetic prostheses. Results: In total, 22 studies with 32,298 patients were included in the final analysis. The results show that patients aged between 50 and 70 receiving AVR with mechanical prostheses achieved better long-term survival and fewer reoperations and valve-related events but suffered more with bleeding events. No significant difference could be found in terms of early mortality and long-term cardiac death. The same results could be observed in the subgroup analysis of RCT and PSM retrospective studies. Conclusion: Both mechanical and bioprosthetic prostheses are beneficial to middle-aged patients undertaking AVR procedures. However, mechanical prostheses show better clinical outcomes in long-term survival and comorbidities. Individual recommendation is still necessary. Full article
(This article belongs to the Section Cardiac Surgery)
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23 pages, 2062 KiB  
Article
Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence
by Resi M. Schoonderwoerd, Mariëlle Dik, Sumche Man, Arie C. Maan, J. Wouter Jukema and Cees A. Swenne
J. Cardiovasc. Dev. Dis. 2023, 10(2), 89; https://doi.org/10.3390/jcdd10020089 - 20 Feb 2023
Viewed by 1317
Abstract
Wilson assumed that the ventricular gradient (VG) is independent of the ventricular activation order. This paradigm has often been refuted and was never convincingly corroborated. We sought to validate Wilson’s concept by intra-individual comparison of the VG of sinus beats and ectopic beats, [...] Read more.
Wilson assumed that the ventricular gradient (VG) is independent of the ventricular activation order. This paradigm has often been refuted and was never convincingly corroborated. We sought to validate Wilson’s concept by intra-individual comparison of the VG of sinus beats and ectopic beats, thus assessing the effects of both altered ventricular conduction (caused by the ectopic focus) and restitution (caused by ectopic prematurity). We studied standard diagnostic ECGs of 118 patients with accidental extrasystoles: normally conducted supraventricular ectopic beats (SN, N = 6) and aberrantly conducted supraventricular ectopic beats (SA, N = 20) or ventricular ectopic beats (V, N = 92). In each patient, we computed the VG vectors of the predominant beat, VGp, of the ectopic beat, VGe, and of the VG difference vector, ΔVGep, and compared their sizes. VGe of the SA and V ectopic beats were significantly larger than VGp (53.7 ± 25.0 vs. 47.8 ± 24.6 mV∙ms, respectively; p < 0.001). ΔVGep were three times larger than the difference of VGe and VGp (19.94 ± 9.76 vs. 5.94 mV∙ms, respectively), demonstrating differences in the VGp and VGe spatial directions. The amount of ectopic prematurity was not correlated with ΔVGep, although the larger VG difference vectors were observed for the more premature (<80%) extrasystoles. Electrical restitution properties and electrotonic interactions likely explain our findings. We conclude that the concept of a conduction-independent VG should be tested at equal heart rates and without including premature extrasystoles. Full article
(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)
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11 pages, 3072 KiB  
Article
Modified Sequential Organ Failure Assessment Score vs. Early Warning Scores in Prehospital Care to Predict Major Adverse Cardiac Events in Acute Cardiovascular Disease
by Enrique Castro Portillo, Raúl López-Izquierdo, Miguel A. Castro Villamor, Ancor Sanz-García, José L. Martín-Conty, Begoña Polonio-López, Irene Sánchez-Soberón, Carlos del Pozo Vegas, Carlos Durantez-Fernández, Rosa Conty-Serrano and Francisco Martín-Rodríguez
J. Cardiovasc. Dev. Dis. 2023, 10(2), 88; https://doi.org/10.3390/jcdd10020088 - 17 Feb 2023
Cited by 1 | Viewed by 1507
Abstract
(1) Background: The Modified Sequential Organ Failure Assessment (mSOFA) is an Early Warning Score (EWS) that has proven to be useful in identifying patients at high risk of mortality in prehospital care. The main objective of this study was to evaluate the predictive [...] Read more.
(1) Background: The Modified Sequential Organ Failure Assessment (mSOFA) is an Early Warning Score (EWS) that has proven to be useful in identifying patients at high risk of mortality in prehospital care. The main objective of this study was to evaluate the predictive validity of prehospital mSOFA in estimating 2- and 90-day mortality (all-cause) in patients with acute cardiovascular diseases (ACVD), and to compare this validity to that of four other widely-used EWS. (2) Methods: We conducted a prospective, observational, multicentric, ambulance-based study in adults with suspected ACVD who were transferred by ambulance to Emergency Departments (ED). The primary outcome was 2- and 90-day mortality (all-cause in- and out-hospital). The discriminative power of the predictive variable was assessed and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC). (3) Results: A total of 1540 patients met the inclusion criteria. The 2- and 90-day mortality rates were 5.3% and 12.7%, respectively. The mSOFA showed the highest AUC of all the evaluated scores for both 2- and 90-day mortality, AUC = 0.943 (0.917–0.968) and AUC = 0.874 (0.847–0.902), respectively. (4) Conclusions: The mSOFA is a quick and easy-to-use EWS with an excellent ability to predict mortality at both 2 and 90 days in patients treated for ACVD, and has proved to be superior to the other EWS evaluated in this study. Full article
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20 pages, 3905 KiB  
Article
An In-Hospital Mortality Risk Model for Elderly Patients Undergoing Cardiac Valvular Surgery Based on LASSO-Logistic Regression and Machine Learning
by Kun Zhu, Hongyuan Lin, Xichun Yang, Jiamiao Gong, Kang An, Zhe Zheng and Jianfeng Hou
J. Cardiovasc. Dev. Dis. 2023, 10(2), 87; https://doi.org/10.3390/jcdd10020087 - 17 Feb 2023
Cited by 1 | Viewed by 1768
Abstract
Background: To preferably evaluate and predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery, we developed a new prediction model using least absolute shrinkage and selection operator (LASSO)-logistic regression and machine learning (ML) algorithms. Methods: Clinical data including baseline [...] Read more.
Background: To preferably evaluate and predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery, we developed a new prediction model using least absolute shrinkage and selection operator (LASSO)-logistic regression and machine learning (ML) algorithms. Methods: Clinical data including baseline characteristics and peri-operative data of 7163 elderly patients undergoing cardiac valvular surgery from January 2016 to December 2018 were collected at 87 hospitals in the Chinese Cardiac Surgery Registry (CCSR). Patients were divided into training (N = 5774 [80%]) and testing samples (N = 1389 [20%]) according to their date of operation. LASSO-logistic regression models and ML models were used to analyze risk factors and develop the prediction model. We compared the discrimination and calibration of each model and EuroSCORE II. Results: A total of 7163 patients were included in this study, with a mean age of 69.8 (SD 4.5) years, and 45.0% were women. Overall, in-hospital mortality was 4.05%. The final model included seven risk factors: age, prior cardiac surgery, cardiopulmonary bypass duration time (CPB time), left ventricular ejection fraction (LVEF), creatinine clearance rate (CCr), combined coronary artery bypass grafting (CABG) and New York Heart Association (NYHA) class. LASSO-logistic regression, linear discriminant analysis (LDA), support vector classification (SVC) and logistic regression (LR) models had the best discrimination and calibration in both training and testing cohorts, which were superior to the EuroSCORE II. Conclusions: The mortality rate for elderly patients undergoing cardiac valvular surgery was relatively high. LASSO-logistic regression, LDA, SVC and LR can predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery well. Full article
(This article belongs to the Special Issue Cardiac Surgery: Outcomes, Management and Critical Care)
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18 pages, 2891 KiB  
Article
Intracoronary Administration of Microencapsulated HGF in a Reperfused Myocardial Infarction Swine Model
by Virginia Blanco-Blázquez, Claudia Báez-Díaz, Francisco Miguel Sánchez-Margallo, Irene González-Bueno, Helena Martín, Rebeca Blázquez, Javier G. Casado, Alejandra Usón, Julia Solares, Itziar Palacios, Rob Steendam and Verónica Crisóstomo
J. Cardiovasc. Dev. Dis. 2023, 10(2), 86; https://doi.org/10.3390/jcdd10020086 - 17 Feb 2023
Cited by 1 | Viewed by 1873
Abstract
Therapy microencapsulation allows minimally invasive, safe, and effective administration. Hepatocyte growth factor (HGF) has angiogenic, anti-inflammatory, anti-apoptotic, and anti-fibrotic properties. Our objective was to evaluate the cardiac safety and effectiveness of intracoronary (IC) administration of HGF-loaded extended release microspheres in an acute myocardial [...] Read more.
Therapy microencapsulation allows minimally invasive, safe, and effective administration. Hepatocyte growth factor (HGF) has angiogenic, anti-inflammatory, anti-apoptotic, and anti-fibrotic properties. Our objective was to evaluate the cardiac safety and effectiveness of intracoronary (IC) administration of HGF-loaded extended release microspheres in an acute myocardial infarction (AMI) swine model. An IC infusion of 5 × 106 HGF-loaded microspheres (MS+HGF, n = 7), 5 × 106 placebo microspheres (MS, n = 7), or saline (SAL, n = 7) was performed two days after AMI. TIMI flow and Troponin I (TnI) values were assessed pre- and post-treatment. Cardiac function was evaluated with magnetic resonance imaging (cMR) before injection and at 10 weeks. Plasma cytokines were determined to evaluate the inflammatory profile and hearts were subjected to histopathological evaluation. Post-treatment coronary flow was impaired in five animals (MS+HGF and MS group) without significant increases in TnI. One animal (MS group) died during treatment. There were no significant differences between groups in cMR parameters at any time (p > 0.05). No statistically significant changes were found between groups neither in cytokines nor in histological analyses. The IC administration of 5 × 106 HGF-loaded-microspheres 48 h post-AMI did not improve cardiac function, nor did it decrease inflammation or cardiac fibrosis in this experimental setting. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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14 pages, 1708 KiB  
Article
Serum Catestatin Concentrations Are Increased in Patients with Atrial Fibrillation
by Josip Katic, Zrinka Jurisic, Marko Kumric, Josip A. Borovac, Ante Anic, Toni Breskovic, Daniela Supe-Domic and Josko Bozic
J. Cardiovasc. Dev. Dis. 2023, 10(2), 85; https://doi.org/10.3390/jcdd10020085 - 17 Feb 2023
Cited by 1 | Viewed by 1439
Abstract
The autonomic nervous system is crucial in initiating and maintaining atrial fibrillation (AF). Catestatin is a multipurpose peptide that regulates cardiovascular systems and reduces harmful, excessive activity of the sympathetic nervous system by blocking the release of catecholamines. We aimed to determine whether [...] Read more.
The autonomic nervous system is crucial in initiating and maintaining atrial fibrillation (AF). Catestatin is a multipurpose peptide that regulates cardiovascular systems and reduces harmful, excessive activity of the sympathetic nervous system by blocking the release of catecholamines. We aimed to determine whether serum catestatin concentrations are associated with AF severity, duration indices, and various clinical and laboratory indicators in these individuals to better define the clinical value of catestatin in patients with AF. The present single center study enrolled 73 participants with AF and 72 healthy age-matched controls. Serum catestatin concentrations were markedly higher in AF patients than controls (14.11 (10.21–26.02) ng/mL vs. 10.93 (5.70–20.01) ng/mL, p = 0.013). Furthermore, patients with a more severe form of AF had significantly higher serum catestatin (17.56 (12.80–40.35) vs. 10.98 (8.38–20.91) ng/mL, p = 0.001). Patients with higher CHA2DS2-VASc scores (17.58 (11.89–37.87) vs. 13.02 (8.47–22.75) ng/mL, p = 0.034) and higher NT-proBNP levels (17.58 (IQR 13.91–34.62) vs. 13.23 (IQR 9.04–22.61), p = 0.036) had significantly higher serum catestatin concentrations. Finally, AF duration correlated negatively with serum catestatin levels (r = −0.348, p = 0.003). The results of the present study implicate the promising role of catestatin in the intricate pathophysiology of AF, which should be explored in future research. Full article
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14 pages, 5136 KiB  
Article
Drug-Coated Balloon vs. Drug-Eluting Stents for De Novo Unprotected Left Main Stem Disease: The SPARTAN-LMS Study
by Tharusha D. Gunawardena, Natasha Corballis, Ioannis Merinopoulos, Upul Wickramarachchi, Johannes Reinhold, Clint Maart, Sulfi Sreekumar, Chris Sawh, Trevor Wistow, Toomas Sarev, Alisdair Ryding, Tim J. Gilbert, Allan Clark, Vassilios S. Vassiliou and Simon Eccleshall
J. Cardiovasc. Dev. Dis. 2023, 10(2), 84; https://doi.org/10.3390/jcdd10020084 - 16 Feb 2023
Cited by 5 | Viewed by 2459
Abstract
The objective of this study is to compare the outcomes of patients treated with drug-coated balloons (DCBs) or second-generation drug-eluting stents (DESs) for de novo unprotected left main stem (LMS) disease. Previous studies comparing the treatment of LMS disease suggest that the mortality [...] Read more.
The objective of this study is to compare the outcomes of patients treated with drug-coated balloons (DCBs) or second-generation drug-eluting stents (DESs) for de novo unprotected left main stem (LMS) disease. Previous studies comparing the treatment of LMS disease suggest that the mortality for DES PCI is not worse than CABG. There are limited data from studies investigating the treatment of de novo LMS disease with DCB angioplasty. We compared the all-cause and cardiac mortality of patients treated with paclitaxel DCB to those with second-generation DES for de novo LMS disease from July 2014 to November 2019. Data were analysed using Kaplan–Meier analyses and propensity-matched analyses. A total of 148 patients were treated with either a DCB or DES strategy. There was no significant difference in all-cause mortality in the DCB group (19.5%) compared to the DES group (15.9%) (HR 1.42 [0.61–3.32], p = 0.42). Regarding cardiac mortality, 2 (4.9%) were recorded for the DCB group and 7 (6.5%) for the DES group (HR 1.21 [0.31–4.67], p = 0.786); for target vessel myocardial infarction, there were 0 (0%) for the DCB group and 7 (6.5%) for the DES group; and for target lesion revascularisation, there were 3 (7.3%) in the DCB group and 9 (8.3%) in the DES group (HR: 0.89 [0.24–3.30]). p = 0.86. These remained not significant after propensity score matching. We found no difference in the mortality outcomes with DCB angioplasty compared to second-generation DES, with a median follow-up of 33 months. DCB can therefore be regarded as a safe option in the treatment of LMS disease in suitable patients. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
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8 pages, 530 KiB  
Brief Report
Stroke Recurrence among Stroke Patients Referred for Driving Assessment and Rehabilitation: A Cohort Study
by Narayanaswamy Venketasubramanian and Mei Leng Chan
J. Cardiovasc. Dev. Dis. 2023, 10(2), 83; https://doi.org/10.3390/jcdd10020083 - 16 Feb 2023
Cited by 2 | Viewed by 1952
Abstract
Returning to driving is one of the priorities for stroke survivors. However, the fear of the risk of recurrent stroke has led to concern about allowing driving post-stroke. This study was performed to study the impact of various vascular risk factors on stroke [...] Read more.
Returning to driving is one of the priorities for stroke survivors. However, the fear of the risk of recurrent stroke has led to concern about allowing driving post-stroke. This study was performed to study the impact of various vascular risk factors on stroke recurrence among drivers referred to our national referral center for Driving Assessment and Rehabilitation Program (DARP). Medical records of subjects who were diagnosed to have a stroke and were referred to DARP were retrospectively reviewed. Data on demographics (age and gender) and vascular risk factors (hypertension—HT, diabetes mellitus—DM, hyperlipidemia—HL, cigarette smoking—SM, previous stroke—PS, and heart disease—HD) were collected. Subjects were contacted and records scrutinized for a report of recurrent stroke. A total of 133 subjects were recruited, median 54 years (range 20–77 years), 95.5% male, 59.4% had HT, 32.3% DM, 65.4% HL, 43.6% SM, 3.8% PS, and 8.3% HD. Over a median follow-up of 30 months (range 1–78 months), the recurrence rate of stroke was 11.3%, 3.69/100 patient-years. On uni-variable analysis, the risk of stroke recurrence rose with age (HR 1.08, 95%CI 1.02–1.15, p = 0.01) and heart disease (HR 5.77, 95%CI 1.46–22.83, p = 0.01). On multivariable analysis, only age remained significant (HR 1.07, 95%CI 1.00–1.13, p = 0.045). Among those aged > 60 years, the HR was 3.88 (95%CI 1.35–11.20, p = 0.012). The risk of stroke recurrence is higher among older drivers and is not influenced by other vascular factors. Full article
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15 pages, 2114 KiB  
Article
Machine Learning to Identify Patients at Risk of Developing New-Onset Atrial Fibrillation after Coronary Artery Bypass
by Orlando Parise, Gianmarco Parise, Akshayaa Vaidyanathan, Mariaelena Occhipinti, Ali Gharaviri, Cecilia Tetta, Elham Bidar, Bart Maesen, Jos G. Maessen, Mark La Meir and Sandro Gelsomino
J. Cardiovasc. Dev. Dis. 2023, 10(2), 82; https://doi.org/10.3390/jcdd10020082 - 15 Feb 2023
Cited by 3 | Viewed by 2095
Abstract
Background: This study aims to get an effective machine learning (ML) prediction model of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) and to highlight the most relevant clinical factors. Methods: Four ML algorithms were employed to analyze 394 patients [...] Read more.
Background: This study aims to get an effective machine learning (ML) prediction model of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) and to highlight the most relevant clinical factors. Methods: Four ML algorithms were employed to analyze 394 patients undergoing CABG, and their performances were compared: Multivariate Adaptive Regression Spline, Neural Network, Random Forest, and Support Vector Machine. Each algorithm was applied to the training data set to choose the most important features and to build a predictive model. The better performance for each model was obtained by a hyperparameters search, and the Receiver Operating Characteristic Area Under the Curve metric was selected to choose the best model. The best instances of each model were fed with the test data set, and some metrics were generated to assess the performance of the models on the unseen data set. A traditional logistic regression was also performed to be compared with the machine learning models. Results: Random Forest model showed the best performance, and the top five predictive features included age, preoperative creatinine values, time of aortic cross-clamping, body surface area, and Logistic Euro-Score. Conclusions: The use of ML for clinical predictions requires an accurate evaluation of the models and their hyperparameters. Random Forest outperformed all other models in the clinical prediction of POAF following CABG. Full article
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13 pages, 891 KiB  
Article
Elevated Levels of Neutrophil-to Monocyte Ratio Are Associated with the Initiation of Paroxysmal Documented Atrial Fibrillation in the First Two Months after Heart Transplantation: A Uni-Institutional Retrospective Study
by Dragos-Florin Baba, Horatiu Suciu, Calin Avram, Manuela Gyorgy, Alina Danilesco, Laurentiu Huma and Ileana Anca Sin
J. Cardiovasc. Dev. Dis. 2023, 10(2), 81; https://doi.org/10.3390/jcdd10020081 - 15 Feb 2023
Cited by 1 | Viewed by 2304
Abstract
Background: Heart transplantation represents the treatment for patients with end-stage heart failure (HF) being symptomatic despite optimal medical therapy. We investigated the role of NMR (neutrophil-to-monocyte ratio), NLR (neutrophil-to-lymphocyte ratio), NPR (neutrophil-to-platelet ratio), NWR (neutrophil-to-white cells ratio), MLR (monocyte-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), [...] Read more.
Background: Heart transplantation represents the treatment for patients with end-stage heart failure (HF) being symptomatic despite optimal medical therapy. We investigated the role of NMR (neutrophil-to-monocyte ratio), NLR (neutrophil-to-lymphocyte ratio), NPR (neutrophil-to-platelet ratio), NWR (neutrophil-to-white cells ratio), MLR (monocyte-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), MWR (neutrophil-to-white cells ratio), and LWR (lymphocyte-to-white cells ratio) at the same cut-off values previously studied, to predict complications after heart transplant within 2 months after surgery. Methods: From May 2014 to January 2021, was included 38 patients in our study from the Cardiovascular and Transplant Emergency Institute of Târgu Mureș. Results: Preoperative NMR > 8.9 (OR: 70.71, 95% CI: 3.39–1473.64; p = 0.006) was a risk factor for the apparition of post-operative paroxysmal atrial fibrillation (Afib). In contrast, preoperative MWR > 0.09 (OR: 0.04, 95% CI: 0.003–0.58; p = 0.0182) represented a protective factor against AFib, but being the risk of complications of any cause (OR: 14.74, 95% CI: 1.05–206.59, p = 0.0458). Conclusion: Preoperative elevated levels of NMR were associated with the apparition of documented AFib, with high levels of MWR as a protective factor. High MWR was a risk factor in developing complications of any cause in the first 2 months after heart transplantation. Full article
(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)
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11 pages, 1345 KiB  
Article
Developing a Questionnaire on Knowledge, Perceptions and Application of Vascular-Aging Measurements
by Areti Triantafyllou, Stavria-Artemis Elia, Chloe Park, Rachel E Climie, Christopher C. Mayer, Ioana Mozos, Giacomo Pucci, Thomas Weber and Andrie G. Panayiotou
J. Cardiovasc. Dev. Dis. 2023, 10(2), 80; https://doi.org/10.3390/jcdd10020080 - 14 Feb 2023
Cited by 1 | Viewed by 2069
Abstract
Background: Vascular age (VA) is independent and chronological age for assessing cardiovascular disease (CVD) risk. However, tools for the implementation of VA are currently lacking. We aimed to develop a questionnaire to assess the current knowledge gaps related to VA and barriers to [...] Read more.
Background: Vascular age (VA) is independent and chronological age for assessing cardiovascular disease (CVD) risk. However, tools for the implementation of VA are currently lacking. We aimed to develop a questionnaire to assess the current knowledge gaps related to VA and barriers to its implementation in routine practice. Methods: Using a stepwise mixed-method approach, a quantitative questionnaire was constructed in four phases: (1) basic item generation and the development of a semi-qualitative questionnaire (SQQ); (2) dissemination to the VascAgeNet extended network and an analysis of the semi-qualitative questionnaire responses; (3) the development of a quantitative questionnaire (QQ); and (4) an assessment of the content and face validity and internal reliability in an additional sample. Results: Based on six main topics initially identified through an expert panel, a SQQ was developed and disseminated. Finally, a 22-item QQ was developed, with questions grouped around three main themes: knowledge of VA and its risk factors; perceptions and beliefs regarding the importance and contribution of VA to risk classification; and the application of VA measurements in clinical and research practice and its potential limitations (Cronbach’s alpha between 0.920 and 0.982 for all three categories). Conclusion: We report the development of a QQ on VA addressed to both clinicians and non-clinicians aiming to assess their knowledge, perceptions and application of VA measurements. Full article
(This article belongs to the Special Issue Epidemiological Research on Novel Cardiovascular Risk Factors)
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16 pages, 3746 KiB  
Article
Expression Pattern and Molecular Mechanism of Oxidative Stress-Related Genes in Myocardial Ischemia–Reperfusion Injury
by Jiahe Wu, Jingyi Luo, Huanhuan Cai, Chenze Li, Zhe Lei, Yi Lu, Lihua Ni, Jianlei Cao, Bo Cheng and Xiaorong Hu
J. Cardiovasc. Dev. Dis. 2023, 10(2), 79; https://doi.org/10.3390/jcdd10020079 - 13 Feb 2023
Cited by 4 | Viewed by 2082
Abstract
(1) Background: The molecular mechanism of oxidative stress-related genes (OSRGs) in myocardial ischemia–reperfusion injury (MIRI) has not been fully elucidated. (2) Methods: Differential expression analysis, enrichment analysis, and PPI analysis were performed on the MIRI-related datasets GSE160516 and GSE61592 to find key pathways [...] Read more.
(1) Background: The molecular mechanism of oxidative stress-related genes (OSRGs) in myocardial ischemia–reperfusion injury (MIRI) has not been fully elucidated. (2) Methods: Differential expression analysis, enrichment analysis, and PPI analysis were performed on the MIRI-related datasets GSE160516 and GSE61592 to find key pathways and hub genes. OSRGs were obtained from the Molecular Signatures Database (MSigDB). The expression pattern and time changes of them were studied on the basis of their raw expression data. Corresponding online databases were used to predict miRNAs, transcription factors (TFs), and therapeutic drugs targeting common differentially expressed OSRGs. These identified OSRGs were further verified in the external dataset GSE4105 and H9C2 cell hypoxia–reoxygenation (HR) model. (3) Results: A total of 134 DEGs of MIRI were identified which were enriched in the pathways of “immune response”, “inflammatory response”, “neutrophil chemotaxis”, “phagosome”, and “platelet activation”. Six hub genes and 12 common differentially expressed OSRGs were identified. A total of 168 miRNAs, 41 TFs, and 21 therapeutic drugs were predicted targeting these OSRGs. Lastly, the expression trends of Aif1, Apoe, Arg1, Col1a1, Gpx7, and Hmox1 were confirmed in the external dataset and HR model. (4) Conclusions: Aif1, Apoe, Arg1, Col1a1, Gpx7, and Hmox1 may be involved in the oxidative stress mechanism of MIRI, and the intervention of these genes may be a potential therapeutic strategy. Full article
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15 pages, 2368 KiB  
Article
Maternal Serum tRNA-Derived Fragments (tRFs) as Potential Candidates for Diagnosis of Fetal Congenital Heart Disease
by Enkang Lu, Lijun Wu, Bin Chen, Shipeng Xu, Ziyi Fu, Yun Wu, Yanhu Wu and Haitao Gu
J. Cardiovasc. Dev. Dis. 2023, 10(2), 78; https://doi.org/10.3390/jcdd10020078 - 13 Feb 2023
Cited by 4 | Viewed by 1773
Abstract
Background: Congenital heart disease (CHD) is one of the most predominant birth defects that causes infant death worldwide. The timely and successful surgical treatment of CHD on newborns after delivery requires accurate detection and reliable diagnosis during pregnancy. However, there are no biomarkers [...] Read more.
Background: Congenital heart disease (CHD) is one of the most predominant birth defects that causes infant death worldwide. The timely and successful surgical treatment of CHD on newborns after delivery requires accurate detection and reliable diagnosis during pregnancy. However, there are no biomarkers that can serve as an early diagnostic factor for CHD patients. tRNA-derived fragments (tRFs) have been reported to play an important role in the occurrence and progression of numerous diseases, but their roles in CHD remains unknown. Methods: High-throughput sequencing was performed on the peripheral blood of pregnant women with an abnormal fetal heart and a normal fetal heart, and 728 differentially expressed tRFs/tiRNAs were identified, among which the top 18 tRFs/tiRNAs were selected as predictive biomarkers of CHD. Then, a quantitative reverse transcriptase polymerase chain reaction verified the expression of tRFs/tiRNAs in more clinical samples, and the correlation between tRFs/tiRNAs abnormalities and CHD was analyzed. Results: tRF-58:74-Gly-GCC-1 and tiRNA-1:35-Leu-CAG-1-M2 may be promising biomarkers. Through further bioinformatics analysis, we predicted that TRF-58:744-GLy-GCC-1 could induce CHD by influencing biological metabolic processes. Conclusions: Our results provide a theoretical basis for the abnormally expressed tRF-58:74-Gly-GCC-1 in maternal peripheral blood as a new potential biomarker for the accurate diagnosis of CHD during pregnancy. Full article
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11 pages, 952 KiB  
Article
Does an eHealth Intervention Reduce Complications and Healthcare Resources? A mHeart Single-Center Randomized-Controlled Trial
by Mar Gomis-Pastor, Sonia Mirabet Perez, Anna De Dios Lopez, Vicenç Brossa Loidi, Laura Lopez Lopez, Rebeca Pelegrin Cruz and Mª Antonia Mangues Bafalluy
J. Cardiovasc. Dev. Dis. 2023, 10(2), 77; https://doi.org/10.3390/jcdd10020077 - 10 Feb 2023
Viewed by 1293
Abstract
(1) Background: In the mHeart trial, we showed that an eHealth intervention, mHeart, improved heart transplant (HTx) recipients’ adherence to immunosuppressive therapy compared with the standard of care. Herein, we present the analysis assessing whether mHeart reduces complication frequency and healthcare resource use, [...] Read more.
(1) Background: In the mHeart trial, we showed that an eHealth intervention, mHeart, improved heart transplant (HTx) recipients’ adherence to immunosuppressive therapy compared with the standard of care. Herein, we present the analysis assessing whether mHeart reduces complication frequency and healthcare resource use, and whether this reduction depends on patients’ adherence. (2) Methods: The mHeart was a single-center randomized-controlled trial (IIBSP-MHE-2014-55) in 134 adult HTx recipients (n = 71 intervention; n = 63 controls). The endpoints were mortality, complications, and resource use during follow-up (mean 1.6 ± 0.6 years). (3) Results: A significantly lower proportion of HTx recipients in mHeart had echocardiographic alteration (2.8% vs. 13.8%; p = 0.02), cardiovascular events (0.35% vs. 2.4%; p = 0.006), infections (17.2% vs. 56%; p = 0.03), and uncontrolled Hba1c (40.8% vs. 59.6%; p = 0.03) than controls. In addition, a significantly lower proportion of patients in the intervention needed hospital (32.4% vs. 56.9%; p = 0.004) or urgent admissions (16.9% vs. 41.4%; p = 0.002) and emergency room visits (50.7% vs. 69.0%; p = 0.03). Adherence status (measured by the self-reported SMAQ) influenced only controls regarding hospitalizations and emergency room visits. Differences were not significant on deaths (intervention 4.2% vs. control 9.5%; p = 0.4) (4) Conclusions: the mHeart strategy significantly reduced the occurrence of the studied post-transplant complications and the need for medical attention in HTx recipients. Adherence status influenced controls in their need for medical care. Full article
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13 pages, 2107 KiB  
Article
Genetic Predisposition to a Higher Whole Body Water Mass May Increase the Risk of Atrial Fibrillation: A Mendelian Randomization Study
by Qi Zhu, Qiyu Chen, Ying Tian, Jing Zhang, Rui Ran and Shiyu Shu
J. Cardiovasc. Dev. Dis. 2023, 10(2), 76; https://doi.org/10.3390/jcdd10020076 - 10 Feb 2023
Viewed by 1747
Abstract
Background: Observational studies have found an association between increased whole body water mass (BWM) and atrial fibrillation (AF). However, the causality has yet to be confirmed. To provide feasible protective measures on disease development, we performed Mendelian randomization (MR) design to estimate the [...] Read more.
Background: Observational studies have found an association between increased whole body water mass (BWM) and atrial fibrillation (AF). However, the causality has yet to be confirmed. To provide feasible protective measures on disease development, we performed Mendelian randomization (MR) design to estimate the potential causal relationship between increased BWM and AF. Methods: We implemented a two-sample MR study to assess whether increased BWM causally influences AF incidence. For exposure, 61 well-powered genetic instruments extracted from UK Biobank (N = 331,315) were used as the proxies of BWM. Summary genetic data of AF were obtained from FinnGen (Ncase = 22,068; Ncontrol = 116,926). Inverse-variance weighted (IVW), MR-Egger and weighted median methods were selected to infer causality, complemented with a series of sensitivity analyses. MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO) and Radial MR were employed to identify outliers. Furthermore, risk factor analyses were performed to investigate the potential mechanisms between increased BWM and AF. Results: Genetic predisposition to increased BWM was demonstrated to be significantly associated with AF in the IVW model (OR = 2.23; 95% CI = 1.47–3.09; p = 1.60 × 10−7), and the result was consistent in other MR approaches. There was no heterogeneity or pleiotropy detected in sensitivity analysis. MR-PRESSO identified no outliers with potential pleiotropy after excluding outliers by Radial MR. Furthermore, our risk factor analyses supported a positive causal effect of genetic predicted increased BWM on edematous diseases. Conclusions: MR estimates showed that a higher BWM could increase the risk of AF. Pathological edema is an important intermediate link mediating this causal relationship. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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13 pages, 1241 KiB  
Article
Effectiveness and Safety of Mitral Valve Plasty in Patients with an Anomalous Origin of the Coronary Artery from the Pulmonary Artery
by Lizhi Lv, Xinyue Lang, Simeng Zhang, Cheng Wang, Yuanhao Jin, Aihua Zhi and Qiang Wang
J. Cardiovasc. Dev. Dis. 2023, 10(2), 75; https://doi.org/10.3390/jcdd10020075 - 9 Feb 2023
Viewed by 1210
Abstract
The study aimed to determine the effectiveness and safety of anomalous coronary artery from pulmonary artery (ACAPA) patients with moderate or severe mitral valve regurgitation (MVR) receiving mitral valve plasty (MVP) concurrently. Consecutive ACAPA patients undergoing surgery between 2015 and 2021 were retrospectively [...] Read more.
The study aimed to determine the effectiveness and safety of anomalous coronary artery from pulmonary artery (ACAPA) patients with moderate or severe mitral valve regurgitation (MVR) receiving mitral valve plasty (MVP) concurrently. Consecutive ACAPA patients undergoing surgery between 2015 and 2021 were retrospectively included. Patients were divided into three groups: moderate MVR without MVP (non-MVP (moderate) N = 14), moderate MVR with MVP (MVP (moderate) N = 13), and severe MVR with MVP (MVP (severe) N = 13). The primary safety endpoint was in-hospital surgery-related complications. The primary effectiveness outcome was left ventricular ejection function (LVEF) and left ventricular end-diastolic diameter (LVEDD) z-score at 2- and 24-month follow-ups. Multivariable linear regression models were used to obtain the β coefficient. The median age of the included patients was 7.5 years (IQR 1.4–26.5). The in-hospital surgery-related complication rates were 7.1%, 15.4%, and 7.7% in non-MVP (moderate), MVP (moderate), and MVP (severe) groups, separately. At the 2-month follow-up, the non-MVP (moderate) group had a better LVEF and LVEDD z-score compared with the MVP (moderate) group (LVEF β = 9.22, 95%CI 1.09 to 17.35; LVEDD z-score β = −2.49, 95%CI −4.53 to −0.45). At the 24-month follow-up, the LVEF of all patients and the LVEDD z-score of 90% of patients in the three groups returned to normal. For ACAPA patients with moderate MVR, MVP was not necessary, especially for pediatric patients (age < 3 years) and patients with secondary MVR. Further studies for ACAPA patients with severe MVR are still needed. Full article
(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)
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15 pages, 913 KiB  
Review
Artificial Intelligence in Hypertension Management: An Ace up Your Sleeve
by Valeria Visco, Carmine Izzo, Costantino Mancusi, Antonella Rispoli, Michele Tedeschi, Nicola Virtuoso, Angelo Giano, Renato Gioia, Americo Melfi, Bianca Serio, Maria Rosaria Rusciano, Paola Di Pietro, Alessia Bramanti, Gennaro Galasso, Gianni D’Angelo, Albino Carrizzo, Carmine Vecchione and Michele Ciccarelli
J. Cardiovasc. Dev. Dis. 2023, 10(2), 74; https://doi.org/10.3390/jcdd10020074 - 9 Feb 2023
Cited by 12 | Viewed by 3914
Abstract
Arterial hypertension (AH) is a progressive issue that grows in importance with the increased average age of the world population. The potential role of artificial intelligence (AI) in its prevention and treatment is firmly recognized. Indeed, AI application allows personalized medicine and tailored [...] Read more.
Arterial hypertension (AH) is a progressive issue that grows in importance with the increased average age of the world population. The potential role of artificial intelligence (AI) in its prevention and treatment is firmly recognized. Indeed, AI application allows personalized medicine and tailored treatment for each patient. Specifically, this article reviews the benefits of AI in AH management, pointing out diagnostic and therapeutic improvements without ignoring the limitations of this innovative scientific approach. Consequently, we conducted a detailed search on AI applications in AH: the articles (quantitative and qualitative) reviewed in this paper were obtained by searching journal databases such as PubMed and subject-specific professional websites, including Google Scholar. The search terms included artificial intelligence, artificial neural network, deep learning, machine learning, big data, arterial hypertension, blood pressure, blood pressure measurement, cardiovascular disease, and personalized medicine. Specifically, AI-based systems could help continuously monitor BP using wearable technologies; in particular, BP can be estimated from a photoplethysmograph (PPG) signal obtained from a smartphone or a smartwatch using DL. Furthermore, thanks to ML algorithms, it is possible to identify new hypertension genes for the early diagnosis of AH and the prevention of complications. Moreover, integrating AI with omics-based technologies will lead to the definition of the trajectory of the hypertensive patient and the use of the most appropriate drug. However, AI is not free from technical issues and biases, such as over/underfitting, the “black-box” nature of many ML algorithms, and patient data privacy. In conclusion, AI-based systems will change clinical practice for AH by identifying patient trajectories for new, personalized care plans and predicting patients’ risks and necessary therapy adjustments due to changes in disease progression and/or therapy response. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
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13 pages, 1306 KiB  
Article
Nomogram and Risk Calculator for Postoperative Tracheostomy after Heart Valve Surgery
by Xiangchao Ding, Bing Sun, Liang Liu, Yuan Lei and Yunshu Su
J. Cardiovasc. Dev. Dis. 2023, 10(2), 73; https://doi.org/10.3390/jcdd10020073 - 8 Feb 2023
Viewed by 1823
Abstract
Postoperative tracheostomy (POT) is an important indicator of critical illness, associated with poorer prognoses and increased medical burdens. However, studies on POTs after heart valve surgery (HVS) have not been reported. The objectives of this study were first to identify the risk factors [...] Read more.
Postoperative tracheostomy (POT) is an important indicator of critical illness, associated with poorer prognoses and increased medical burdens. However, studies on POTs after heart valve surgery (HVS) have not been reported. The objectives of this study were first to identify the risk factors and develop a risk prediction model for POTs after HVS, and second to clarify the relationship between POTs and clinical outcomes. Consecutive adults undergoing HVS from January 2016 to December 2019 in a single cardiovascular center were enrolled, and a POT was performed in 1.8% of the included patients (68/3853). Compared to patients without POTs, the patients with POTs had higher rates of readmission to the ICU and in-hospital mortality, as well as longer ICU and hospital stays. Five factors were identified to be significantly associated with POTs after HVS by our multivariate analysis, including age, diabetes mellitus, pulmonary edema, intraoperative transfusion of red blood cells, and surgical types. A nomogram and a risk calculator were constructed based on the five factors, showing excellent discrimination, calibration, and clinical utility. Three risk intervals were defined as low-, medium-, and high-risk groups according to the nomogram and clinical practice. The findings of this study may be helpful for early risk assessment and perioperative management. Full article
(This article belongs to the Special Issue Cardiac Surgery: Outcomes, Management and Critical Care)
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10 pages, 1485 KiB  
Review
The Cardiac Effects of COVID-19 on Young Competitive Athletes: Results from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA)
by Nathaniel Moulson, Bradley J. Petek, Aaron L. Baggish, Kimberly G. Harmon, Stephanie A. Kliethermes, Manesh R. Patel, Timothy W. Churchill and Jonathan A. Drezner
J. Cardiovasc. Dev. Dis. 2023, 10(2), 72; https://doi.org/10.3390/jcdd10020072 - 6 Feb 2023
Cited by 6 | Viewed by 2944
Abstract
The Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study is a large-scale prospective investigation evaluating the cardiovascular effects and outcomes of SARS-CoV-2 infection on young competitive athletes. This review provides an overview of the key results from the ORCCA study. Results from [...] Read more.
The Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study is a large-scale prospective investigation evaluating the cardiovascular effects and outcomes of SARS-CoV-2 infection on young competitive athletes. This review provides an overview of the key results from the ORCCA study. Results from the ORCCA study have provided important insights into the clinical impact of SARS-CoV-2 infection on the cardiovascular health of young competitive athletes and informed contemporary screening and return to sport practices. Key results include defining a low prevalence of both cardiac involvement and adverse cardiovascular outcomes after SARS-CoV-2 infection and evaluating the utility of a return-to-play cardiac evaluation. Future aims of the ORCCA study include the longer-term evaluation of cardiovascular outcomes among athletes post-SARS-CoV-2 infection and the transition to investigating outcomes in young athletes with potentially high-risk genetic or structural cardiac diagnoses. Full article
(This article belongs to the Special Issue Cardiovascular Disease in Athletes)
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14 pages, 2884 KiB  
Article
Ticagrelor Can Regulate the Ion Channel Characteristics of Superior Cervical Ganglion Neurons after Myocardial Infarction
by Lijun Cheng, Lin Yu, Xiaoping Zhan, Gary Tse, Tong Liu, Huaying Fu and Guangping Li
J. Cardiovasc. Dev. Dis. 2023, 10(2), 71; https://doi.org/10.3390/jcdd10020071 - 6 Feb 2023
Cited by 1 | Viewed by 1632
Abstract
Background: The superior cervical ganglion (SCG) plays a key role in cardiovascular diseases. The aim of this study was to determine the changes in the ion channel characteristics of the SCG following myocardial infarction (MI) and the role of pretreatment with the P2Y12 [...] Read more.
Background: The superior cervical ganglion (SCG) plays a key role in cardiovascular diseases. The aim of this study was to determine the changes in the ion channel characteristics of the SCG following myocardial infarction (MI) and the role of pretreatment with the P2Y12 receptor antagonist ticagrelor (TIC). Methods: A total of 18 male rabbits were randomly divided into a control group, MI group, and P2Y12 receptor antagonist (TIC) group (abbreviated as the TIC group). Rabbit MI was performed via two abdominal subcutaneous injections of 150 mg·kg−1·d−1 of isoproterenol (ISO) with an interval of 24 h. TIC pretreatment at 20 mg·kg−1·d−1 was administered via gavage for two consecutive days. The cardiac function of each group was evaluated with echocardiography. ADP receptor P2Y12 expressions in SCGs were determined using RT-PCR and immunofluorescence staining. Ion channel characteristics of SCG neurons were measured using a whole-cell patch clamp. Intracellular calcium concentrations for SCG neurons were measured using confocal microscopy. Results: Cardiac function was reduced in the rabbits of the MI group, the sympathetic nerve activity of SCGs was increased, and the current amplitude of the neuron ion channel was increased. MI led to alterations in the activation and inactivation characteristics of INa channels accompanied by increased expression of P2Y12 in SCGs. Most of these abnormalities were prevented by TIC pretreatment in the TIC group. Conclusions: TIC pretreatment could attenuate the increase in P2Y12 expression in SCGs and the changes to the ion channel characteristics of SCG neurons after MI. This may be the mechanism underlying the cardiac protective effects of TIC. Full article
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11 pages, 1056 KiB  
Article
The Prolonged Effect of Shift Work and the Impact of Reducing the Number of Nightshifts on Arterial Stiffness—A 4-Year Follow-Up Study
by Marit Skogstad, Elisabeth Goffeng, Øivind Skare and Erika Zardin
J. Cardiovasc. Dev. Dis. 2023, 10(2), 70; https://doi.org/10.3390/jcdd10020070 - 6 Feb 2023
Cited by 1 | Viewed by 1633
Abstract
Aim: To assess changes in blood pressure (BP) and arterial stiffness among 84 rotating shift and 25 dayworkers (control subjects) at two industrial plants during a 4-year follow-up, and to assess changes in outcome variables among shift workers at the two plants after [...] Read more.
Aim: To assess changes in blood pressure (BP) and arterial stiffness among 84 rotating shift and 25 dayworkers (control subjects) at two industrial plants during a 4-year follow-up, and to assess changes in outcome variables among shift workers at the two plants after a reduction in the number of night shifts during the last year of follow-up in one of the plants. Methods: We collected demographic data using a questionnaire, examined systolic and diastolic blood pressure (sBP, dBP), central systolic and diastolic aorta pressure (cSP, cDP), augmentation pressure (AP), central pulse pressure (cPP), and pulse wave velocity (PWV). We registered sleep quality. The last 4–14 months of follow-up one plant implemented a 12-week shift plan reducing the total number of night shifts and consecutive night shifts from 16.8 to 14 and from 7.2 to 4. To assess differences in change of outcomes between study groups we applied linear mixed models. Results: The dayworkers were older, more hypertensive, reported less sleep disturbance, and smoked/snuffed less than the shift workers did. The adjusted annual increase in PWV was 0.34 m/s (95%CI, 0.22, 0.46) among shift workers and 0.09 m/s (95%CI, −0.05, 0.23) in dayworkers, yielding a significant difference of change of 0.25 m/s (95%CI, 0.06, 0.43). No significant differences were found between the two groups of shift workers in any cardiovascular disease (CVD) outcome during the last year of follow-up. Conclusions: Shift work in industry is associated with arterial stiffness, reflecting an increased risk of future CVD. No significant changes in arterial stiffness were identified as a consequence of a small reduction in the number of night shifts and consecutive night shifts. Full article
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9 pages, 1593 KiB  
Article
In Vitro Comparison of Several Thrombus Removal Tools
by Katarzyna Pigoń, Natalia Tomecka, Dominika Korner, Maciej Pękała, Sławomir Grzegorczyn, Adam Konka, Ewa Nowalany-Kozielska and Andrzej Tomasik
J. Cardiovasc. Dev. Dis. 2023, 10(2), 69; https://doi.org/10.3390/jcdd10020069 - 6 Feb 2023
Cited by 2 | Viewed by 1496
Abstract
Background: Although the routine use of thrombus aspiration is not recommended, the thrombectomy technique still might be considered for a selected population of patients. Therefore, the assessment of the effectiveness of commercially available thrombectomy devices is still clinically relevant. Aim: Here, we present [...] Read more.
Background: Although the routine use of thrombus aspiration is not recommended, the thrombectomy technique still might be considered for a selected population of patients. Therefore, the assessment of the effectiveness of commercially available thrombectomy devices is still clinically relevant. Aim: Here, we present an in vitro comparison of several different types of catheters that can be used for thrombus aspiration or removal. Methods: Through the removal of 6 h and 24 h human blood clots in an in vitro model, four catheters were compared: the Launcher, Pronto V4, Vasco+ and the stent-retriever Catchview. The aspiration efficacy was expressed as a percentage of the initial thrombus weight. The effectiveness of the patient’s aspiration was dependent on the time of thrombus formation and was significantly higher for a thrombus formed over 24 h (58.5 ± 26.5%) than for one formed over 6 h (48.0 ± 22.5%; p < 0.001). In the presented in vitro model, Pronto V4 and Launcher showed the highest efficiency. Conclusions: Large-bore aspiration catheters were found to be more effective than narrow-bore catheters or stent-retrievers in an in vitro model of thrombus removal. The thrombus aspiration efficacy increases with longer thrombus formation times. Full article
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16 pages, 4791 KiB  
Review
Sudden Cardiac Death in Athletes: Facts and Fallacies
by Jennie Han, Andrea Lalario, Enzo Merro, Gianfranco Sinagra, Sanjay Sharma, Michael Papadakis and Gherardo Finocchiaro
J. Cardiovasc. Dev. Dis. 2023, 10(2), 68; https://doi.org/10.3390/jcdd10020068 - 5 Feb 2023
Cited by 10 | Viewed by 10482
Abstract
The benefits of exercise for cardiovascular and general health are many. However, sudden cardiac death (SCD) may occur in apparently healthy athletes who perform at the highest levels. A diverse spectrum of diseases is implicated in SCD in athletes, and while atherosclerotic coronary [...] Read more.
The benefits of exercise for cardiovascular and general health are many. However, sudden cardiac death (SCD) may occur in apparently healthy athletes who perform at the highest levels. A diverse spectrum of diseases is implicated in SCD in athletes, and while atherosclerotic coronary artery disease predominates in individuals of >35 years of age, primary cardiomyopathies and ion channelopathies are prevalent in young individuals. Prevention of SCD in athletes relies on the implementation of health policies aimed at the early identification of arrhythmogenic diseases (such as cardiac screening) and successful resuscitation (such as widespread utilization of automatic external defibrillators and training members of the public on cardiopulmonary resuscitation). This review will focus on the epidemiology and aetiologies of SCD in athletes, and examine fallacies in the approach to this controversial field. Furthermore, potential strategies to prevent these tragic events will be discussed, analysing current practice, gaps in knowledge and future directions. Full article
(This article belongs to the Special Issue Cardiovascular Disease in Athletes)
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11 pages, 1709 KiB  
Article
Virtual Reality Simulator versus Conventional Advanced Life Support Training for Cardiopulmonary Resuscitation Post-Cardiac Surgery: A Randomized Controlled Trial
by Jette J. Peek, Samuel A. Max, Wouter Bakhuis, Isabelle C. Huig, Rodney A. Rosalia, Amir H. Sadeghi and Edris A. F. Mahtab
J. Cardiovasc. Dev. Dis. 2023, 10(2), 67; https://doi.org/10.3390/jcdd10020067 - 4 Feb 2023
Cited by 2 | Viewed by 2124
Abstract
External chest compressions are often ineffective for patients arresting after cardiac surgery, for whom emergency resternotomy may be required. A single-blinded randomized controlled trial (RCT) was performed, with participants being randomized to a virtual reality (VR) Cardiac Surgical Unit Advanced Life Support (CSU-ALS) [...] Read more.
External chest compressions are often ineffective for patients arresting after cardiac surgery, for whom emergency resternotomy may be required. A single-blinded randomized controlled trial (RCT) was performed, with participants being randomized to a virtual reality (VR) Cardiac Surgical Unit Advanced Life Support (CSU-ALS) simulator training arm or a conventional classroom CSU-ALS training arm. Twenty-eight cardiothoracic surgery (CTS) residents were included and subsequently assessed in a moulage scenario in groups of two, either participating as a leader or surgeon. The primary binary outcomes were two time targets: (1) delivering three stacked shocks within 1 min and (2) resternotomy within 5 min. Secondary outcomes were the number of protocol mistakes made and a questionnaire after the VR simulator. The conventional training group administered stacked shocks within 1 min in 43% (n = 6) of cases, and none in the VR group reached this target, missing it by an average of 25 s. The resternotomy time target was reached in 100% of the cases (n = 14) in the conventional training group and in 83% of the cases (n = 10) in the VR group. The VR group made 11 mistakes in total versus 15 for those who underwent conventional training. Participants reported that the VR simulator was useful and easy to use. The results show that the VR simulator can provide adequate CSU-ALS training. Moreover, VR training results in fewer mistakes suggesting that repetitive practice in an immersive environment improves skills. Full article
(This article belongs to the Section Cardiac Surgery)
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5 pages, 230 KiB  
Editorial
Advances in Neurological Diseases and Stroke
by Narayanaswamy Venketasubramanian
J. Cardiovasc. Dev. Dis. 2023, 10(2), 66; https://doi.org/10.3390/jcdd10020066 - 4 Feb 2023
Cited by 1 | Viewed by 1163
Abstract
Neurological diseases are a major cause of death and disability worldwide [...] Full article
16 pages, 2588 KiB  
Systematic Review
Direct Oral Anticoagulants as the First Choice of Anticoagulation for Patients with Peripheral Artery Disease to Prevent Adverse Vascular Events: A Systematic Review and Meta-Analysis
by Enikő Pomozi, Rita Nagy, Péter Fehérvári, Péter Hegyi, Boldizsár Kiss, Fanni Dembrovszky, Annamária Kosztin, Sándor Nardai, Endre Zima and Zoltán Szeberin
J. Cardiovasc. Dev. Dis. 2023, 10(2), 65; https://doi.org/10.3390/jcdd10020065 - 3 Feb 2023
Cited by 7 | Viewed by 3732
Abstract
The best method of anticoagulation for patients with peripheral artery disease (PAD) is still a topic of interest for physicians. We conducted a meta-analysis to compare the effects of direct oral anticoagulants (DOACs) with those of vitamin-K-antagonist (VKA) anticoagulants in patients with peripheral [...] Read more.
The best method of anticoagulation for patients with peripheral artery disease (PAD) is still a topic of interest for physicians. We conducted a meta-analysis to compare the effects of direct oral anticoagulants (DOACs) with those of vitamin-K-antagonist (VKA) anticoagulants in patients with peripheral artery disease. Five databases (Medline (via PubMed), EMBASE, Scopus, Web of Science, and CENTRAL) were searched systematically for studies comparing the effects of the two types of anticoagulants in patients with PAD, with an emphasis on lower-limb outcomes, cardiovascular events, and mortality. In PAD patients with concomitant non-valvular atrial fibrillation (NVAF), the use of DOACs significantly reduced the risk of major adverse limb events (HR = 0.58, 95% CI, 0.39–0.86, p < 0.01), stroke/systemic embolism (HR 0.76; 95% CI 0.61–0.95; p < 0.01), and all-cause mortality (HR 0.78; 95% CI 0.66–0.92; p < 0.01) compared with warfarin, but showed similar risks of MI (HR = 0.81, 95% CI, 0.59–1.11, p = 0.2) and cardiovascular mortality (HR = 0.77, 95% CI, 0.58–1.02, p = 0.07). Rivaroxaban at higher doses significantly increased the risk of major bleeding (HR = 1.16, 95% CI, 1.07–1.25, p < 0.01). We found no significant difference in terms of revascularization (OR = 1.49, 95% CI, 0.79–2.79, p = 0.14) in PAD patients in whom a poor distal runoff was the reason for the anticoagulation. DOACs have lower rates of major limb events, stroke, and mortality than VKAs in PAD patients with atrial fibrillation. Rivaroxaban at higher doses increased the risk of major bleeding compared with other DOAC drugs. More high-quality studies are needed to determine the most appropriate anticoagulation regimen for patients with lower-limb atherosclerosis. Full article
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14 pages, 1307 KiB  
Article
The Relationship between Postexercise Hypotension and Heart Rate Variability before and after Exercise Training
by Burak T. Cilhoroz, Amanda Zaleski, Beth Taylor, Antonio B. Fernandez, Lucas P. Santos, Thijs Vonk, Paul D. Thompson and Linda S. Pescatello
J. Cardiovasc. Dev. Dis. 2023, 10(2), 64; https://doi.org/10.3390/jcdd10020064 - 3 Feb 2023
Cited by 1 | Viewed by 2250
Abstract
Because data are scarce, we examined the relationship between postexercise hypotension (PEH) and heart rate variability (HRV) before and after aerobic exercise training among adults with hypertension. Participants completed a 12 w aerobic training program. Before and after training, they performed a peak [...] Read more.
Because data are scarce, we examined the relationship between postexercise hypotension (PEH) and heart rate variability (HRV) before and after aerobic exercise training among adults with hypertension. Participants completed a 12 w aerobic training program. Before and after training, they performed a peak graded exercise stress test (GEST) and nonexercise control (CONTROL) and were left attached to an ambulatory BP monitor. Prior to CONTROL, HRV was measured supine for 5 min using a 12-lead electrocardiogram (ECG). The participants (n = 18) were middle-aged (52.1 ± 11.7 y) and 50% men with hypertension (131.7 ± 9.8/85.9 ± 8.5 mmHg) and obesity (30.0 ± 3.7 kg·m−2). Before training, ambulatory systolic BP (ASBP) and diastolic ABP (ADBP) decreased by 3.2 ± 2.1 mmHg and 2.5 ± 1.5 mmHg, respectively, from baseline after the GEST versus CONTROL (p < 0.05). After training, ASBP tended to decrease by 3.5 ± 2.2 mmHg (p = 0.055) and ADBP decreased by 1.7 ± 2.5 mmHg (p = 0.001) from baseline after the GEST versus CONTROL. Before training, HRV high frequency (HFms2) (β = −0.441), age (β = 0.568), and resting SBP (β = 0.504) accounted for 66.8% of the ASBP response (p = 0.001), whereas the low frequency (LF)/HF ratio (β = 0.516) and resting DBP (β = 0.277) accounted for 35.7% of the ADBP response (p = 0.037). After training, the standard deviation of NN intervals (SDNN) (β = −0.556), age (β = 0.506), and resting SBP (β = 0.259) accounted for 60.7% of the ASBP response (p = 0.004), whereas SDNN (β = −0.236) and resting DBP (β = 0.785) accounted for 58.5% of the ADBP response (p = 0.001). Our preliminary findings show that adults with hypertension and parasympathetic suppression (i.e., lower SDNN and HFms2 and higher LF/HF) may elicit PEH to the greatest degree independent of training status versus adults with parasympathetic predominance, suggesting that resting HRV may be an important determinant of PEH. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
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8 pages, 437 KiB  
Brief Report
Association between Femoral Artery Flow-Mediated Dilation and Muscle Oxygen Saturation Parameters in Healthy, Young Individuals
by Vivian dos Santos Pinheiro, Anna Carolina Faria da Silva Tavares, Mônica Volino-Souza, Gustavo Vieira de Oliveira and Thiago Silveira Alvares
J. Cardiovasc. Dev. Dis. 2023, 10(2), 63; https://doi.org/10.3390/jcdd10020063 - 3 Feb 2023
Cited by 4 | Viewed by 1241
Abstract
Flow-mediated dilation (FMD) and muscle oxygen saturation (StO2) are measurements utilized to assess macro- and microvascular function, respectively. Macro- and microvascular dysfunction may occur differently depending on the clinical condition. Since microvascular responsiveness can influence upstream conduit artery hemodynamics, the present [...] Read more.
Flow-mediated dilation (FMD) and muscle oxygen saturation (StO2) are measurements utilized to assess macro- and microvascular function, respectively. Macro- and microvascular dysfunction may occur differently depending on the clinical condition. Since microvascular responsiveness can influence upstream conduit artery hemodynamics, the present study aimed to investigate whether a correlation between FMD and muscle StO2 parameters exists. Sixteen healthy, young individuals were enrolled in this study. Femoral artery FMD and tibial anterior muscle StO2 were evaluated by ultrasound and near-infrared spectroscopy, respectively. The FMD and muscle StO2 parameters were assessed by employing a vascular occlusion test (VOT). The oxygen resaturation rate was determined by calculating the upslope of StO2 immediately after occlusion and the magnitude of reperfusion as the difference between the highest and lowest StO2 value achieved during the reperfusion phase. The oxygen desaturation rate and the magnitude of desaturation during the VOT were also evaluated. A significant correlation between the FMD and oxygen resaturation rate (r = 0.628; p = 0.009), magnitude of reperfusion (r = 0.568; p = 0.022), oxygen desaturation rate (r = −0.509; p = 0.044), and magnitude of desaturation (r = 0.644; p = 0.007) was observed. This study demonstrated a moderate association between the femoral artery FMD and tibial anterior StO2 parameters in young individuals. Full article
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10 pages, 733 KiB  
Article
Impact of Systematic Use of Intracardiac Ultrasound during Transseptal Catheterization in the Electrophysiology Laboratory
by Nicola Bottoni, Paolo Donateo, Luca Rossi, Michele Malagù, Luca Tomasi, Fabio Quartieri, Andrea Biagi, Matteo Iori, Giacomo Mugnai, Antonella Battista, Stefano Cló, Michele Brignole and Matteo Bertini
J. Cardiovasc. Dev. Dis. 2023, 10(2), 62; https://doi.org/10.3390/jcdd10020062 - 2 Feb 2023
Cited by 3 | Viewed by 1453
Abstract
Aims: To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. Methods: A retrospective multicenter study collecting data from [...] Read more.
Aims: To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. Methods: A retrospective multicenter study collecting data from consecutive atrial fibrillation (AF) and supraventricular ablation procedures that required TSC was performed in five Italian centers. Based on physician discretion, TSC was performed with or without ICE. Periprocedural complications, separating all complications from complications directly related to TSC, were collected. Independent predictors of periprocedural complications and TSC-related complications were investigated. Results: A total of 2181 TSCs were performed on 1862 patients at five Italian centers from 2006 to 2021, in 76% of cases by AF ablation and in 24% by ablation of other arrhythmias with a circuit in the left atrium. Overall, 1134 (52%) procedures were performed with ICE support and 1047 (48%) without ICE. A total of 67 (3.1%) complications were detected, 19 (1.7%) in the ICE group and 48 (4.6%) in the no ICE group, p < 0.001. A total of 42 (1.5%) complications directly related to TSC: 0.9% in the ICE group and 3.1% in the no ICE group (p < 0.001). The independent predictors of all complications were age (OR 1,02 95% C.I 1.00–1.05; p = 0.036), TSC with the use of ICE (OR 0.27 95% C.I 0.15–0.46; p < 0.001) and AF ablation (OR 2,25 95%C.I 1.05–4.83; p = 0.037). The independent predictors for TSC complications were age (OR 1.03 95% C.I 1.01–1.06; p = 0.013) and TSC with the use of ICE (OR 0.24 95% C.I 0.11–0.49; p < 0.001). Conclusions: ICE reduced periprocedural and TSC-related complications during electrophysiological procedures for ablation of left atrial arrhythmias. Full article
(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)
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8 pages, 297 KiB  
Editorial
New Perspectives on Risk Stratification and Treatment in Patients with Atrial Fibrillation: An Analysis of Recent Contributions on the Journal of Cardiovascular Disease and Development
by Giuseppe Boriani, Niccolò Bonini, Jacopo Francesco Imberti and Marco Vitolo
J. Cardiovasc. Dev. Dis. 2023, 10(2), 61; https://doi.org/10.3390/jcdd10020061 - 2 Feb 2023
Viewed by 1502
Abstract
The medical approach to atrial fibrillation (AF) underwent a paradigm shift over time, evolving from considering AF as a simple arrhythmic phenomenon to a complex nosological entity [...] Full article
(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)
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