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J. Cardiovasc. Dev. Dis., Volume 11, Issue 6 (June 2024) – 26 articles

Cover Story (view full-size image): Fetal cardiac intervention (FCI) is an emerging and rapidly advancing group of interventions designed to improve outcomes for fetuses with cardiovascular disease. This review focuses on the rationale, criteria for inclusion, technical details, and current outcomes of the three most frequently performed catheter-based FCI procedures: 1) aortic valvuloplasty for critical aortic stenosis (AS) associated with evolving hypoplastic left heart syndrome (HLHS), 2) atrial septal intervention for HLHS with severely restrictive or intact atrial septum (R/IAS), and 3) pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum (PA/IVS). View this paper
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7 pages, 493 KiB  
Article
Empagliflozin and Dapagliflozin Improve Endothelial Function in Mexican Patients with Type 2 Diabetes Mellitus: A Double-Blind Clinical Trial
by Luis Ricardo Balleza Alejandri, Fernando Grover Páez, Erick González Campos, Carlos G. Ramos Becerra, Ernesto Germán Cardona Muñóz, Sara Pascoe González, María Guadalupe Ramos Zavala, Africa Samantha Reynoso Roa, Daniel Osmar Suárez Rico, Alberto Beltrán Ramírez, Jesús Jonathan García Galindo, David Cardona Müller and Claudia Yanette Galán Ruíz
J. Cardiovasc. Dev. Dis. 2024, 11(6), 182; https://doi.org/10.3390/jcdd11060182 - 15 Jun 2024
Viewed by 337
Abstract
Aim: To assess the acute effect of empagliflozin versus dapagliflozin administration on flow-mediated vasodilation in patients with type 2 diabetes mellitus. Design: A double-blind clinical trial, at the Experimental and Clinical Therapeutics Institute, University Health Sciences Center, at the Universidad de Guadalajara, in [...] Read more.
Aim: To assess the acute effect of empagliflozin versus dapagliflozin administration on flow-mediated vasodilation in patients with type 2 diabetes mellitus. Design: A double-blind clinical trial, at the Experimental and Clinical Therapeutics Institute, University Health Sciences Center, at the Universidad de Guadalajara, in inpatients with T2D according to the 2023 ADA criteria. Methods: Thirty patients (15 males and 15 females), aged between 35 and 65 years, were included in this study, according to the 2023 ADA criteria. The eligible patients were randomly assigned to three groups: empagliflozin 25 mg once daily, dapagliflozin 10 mg once daily, or placebo once daily. Anthropometric parameters were taken using validated techniques. FMD was measured using a high-resolution semiautomatic ultrasound UNEX-EF 38G (UNEX Co., Ltd., Nagoya, Japan). Arterial tension was determined with the OMRON electronic digital sphygmomanometer (HEM 907 XL, Kyoto, Japan). Results: The group of patients who received empagliflozin had a significantly lower baseline flow-mediated dilation (FMD) compared to the group receiving dapagliflozin (p = 0.017); at the end of this study, the empagliflozin group achieved a comparable FMD to the dapagliflozin group (p = 0.88). Conclusion: After the treatment period, the empagliflozin and dapagliflozin groups achieved similar FMD, suggesting a class effect. Full article
(This article belongs to the Special Issue Recent Progress in Cardiovascular Epidemiology)
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12 pages, 521 KiB  
Article
Contrast-Enhanced Magnetic Resonance Imaging Based T1 Mapping and Extracellular Volume Fractions Are Associated with Peripheral Artery Disease
by Asem I. Fitian, Michael C. Shieh, Olga A. Gimnich, Tatiana Belousova, Addison A. Taylor, Christie M. Ballantyne, Jean Bismuth, Dipan J. Shah and Gerd Brunner
J. Cardiovasc. Dev. Dis. 2024, 11(6), 181; https://doi.org/10.3390/jcdd11060181 - 14 Jun 2024
Viewed by 355
Abstract
Background: Extracellular volume fraction (ECV), measured with contrast-enhanced magnetic resonance imaging (CE-MRI), has been utilized to study myocardial fibrosis, but its role in peripheral artery disease (PAD) remains unknown. We hypothesized that T1 mapping and ECV differ between PAD patients and matched controls. [...] Read more.
Background: Extracellular volume fraction (ECV), measured with contrast-enhanced magnetic resonance imaging (CE-MRI), has been utilized to study myocardial fibrosis, but its role in peripheral artery disease (PAD) remains unknown. We hypothesized that T1 mapping and ECV differ between PAD patients and matched controls. Methods and Results: A total of 37 individuals (18 PAD patients and 19 matched controls) underwent 3.0T CE-MRI. Skeletal calf muscle T1 mapping was performed before and after gadolinium contrast with a motion-corrected modified look–locker inversion recovery (MOLLI) pulse sequence. T1 values were calculated with a three-parameter Levenberg–Marquardt curve fitting algorithm. ECV and T1 maps were quantified in five calf muscle compartments (anterior [AM], lateral [LM], and deep posterior [DM] muscle groups; soleus [SM] and gastrocnemius [GM] muscles). Averaged peak blood pool T1 values were obtained from the posterior and anterior tibialis and peroneal arteries. T1 values and ECV are heterogeneous across calf muscle compartments. Native peak T1 values of the AM, LM, and DM were significantly higher in PAD patients compared to controls (all p < 0.028). ECVs of the AM and SM were significantly higher in PAD patients compared to controls (AM: 26.4% (21.2, 31.6) vs. 17.3% (10.2, 25.1), p = 0.046; SM: 22.7% (19.5, 27.8) vs. 13.8% (10.2, 19.1), p = 0.020). Conclusions: Native peak T1 values across all five calf muscle compartments, and ECV fractions of the anterior muscle group and the soleus muscle were significantly elevated in PAD patients compared with matched controls. Non-invasive T1 mapping and ECV quantification may be of interest for the study of PAD. Full article
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15 pages, 477 KiB  
Article
Stroke Demographics, Risk Factors, Subtypes, Syndromes, Mechanisms and Inter-Ethnic Differences between Chinese, Malays and Indians in Singapore—A Hospital-Based Study
by Narayanaswamy Venketasubramanian
J. Cardiovasc. Dev. Dis. 2024, 11(6), 180; https://doi.org/10.3390/jcdd11060180 - 12 Jun 2024
Viewed by 347
Abstract
Disparities in stroke may be due to socioeconomics, demographics, risk factors (RF) and ethnicity. Asian data are scant. This retrospective hospital-based study aimed to explore demographics, RF, stroke subtypes and mechanisms among the Chinese, Malays and Indians in Singapore. Stroke was subtyped into [...] Read more.
Disparities in stroke may be due to socioeconomics, demographics, risk factors (RF) and ethnicity. Asian data are scant. This retrospective hospital-based study aimed to explore demographics, RF, stroke subtypes and mechanisms among the Chinese, Malays and Indians in Singapore. Stroke was subtyped into haemorrhagic stroke (HS) and ischaemic stroke (IS). For IS, the clinical syndrome was classified using the Oxfordshire Community Stroke Project (OCSP) classification while the stroke mechanism was categorised using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. During the study period 1 June 2015 to 31 December 2023, data were collected on 1165 patients, with a mean age of 65.6 ± 12.9 yr; 47.4% were female, 83% were Chinese and hypertension (63.5%) and hyperlipidaemia (60.3%) were the most common RF. HS comprised 23.5% (95%CI 21.1–26.1%) (intracerebral 21.7%, subarachnoid 1.3%) of the patients, while IS comprised 76.5% (95%CI 73.9–78.9%) (small artery occlusion 29.0%, cardioembolism 13.3%, large artery atherosclerosis 9.4%, stroke of other determined aetiology 6.2%, stroke of undetermined aetiology 18.6%); 55% of patients had lacunar syndrome. A multivariable analysis showed that HS was associated with ethnicity (p = 0.044), diabetes mellitus (OR 0.27, 95%CI 0.18–0.41, p < 0.001) and smoking (OR 0.47, 95%CI 0.34–0.64, p < 0.001). There were no significant inter-ethnic differences by the OCSP (p = 0.31) or TOAST (p = 0.103) classification. While differences in stroke subtype in Asia may be due to RF, ethnicity has a role. More studies are needed to further explore this. Full article
(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)
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14 pages, 1838 KiB  
Article
One-Year Outcome of an Ongoing Pre-Clinical Growing Animal Model for a Tissue-Engineered Valved Pulmonary Conduit
by Martin Schweiger, Bernard Krüger, Alexandra Malbon, Thea Fleischmann, Miriam Weisskopf, Thomas Frauenfelder, Frithjof Lemme, Nikola Cesarovic, Walter Knirsch and Michael Hübler
J. Cardiovasc. Dev. Dis. 2024, 11(6), 179; https://doi.org/10.3390/jcdd11060179 - 12 Jun 2024
Viewed by 283
Abstract
Objectives: A self-constructed valved pulmonary conduit made out of a de-cellularized porcine small intestinal submucosal extracellular matrix biological scaffold was tested in a chronic growing lamb model. Methods: The conduit was implanted in pulmonary valve position in 19 lambs. We monitored [...] Read more.
Objectives: A self-constructed valved pulmonary conduit made out of a de-cellularized porcine small intestinal submucosal extracellular matrix biological scaffold was tested in a chronic growing lamb model. Methods: The conduit was implanted in pulmonary valve position in 19 lambs. We monitored clinical, laboratory, and echocardiographic findings until 12 months after surgery. In two animals, euthanasia was planned at nine and twelve months. Pre-mortem chest computed tomography and post-mortem pathologic work up were performed. Data are presented as frequency and percentage, median and range, or mean and standard deviation. Results: Twelve (63.2%) animals survived the perioperative period. Three unexpected deaths occurred during the follow-up period: one due to aspiration pneumonia at 23 days after surgery, and two due to early and late infective endocarditis of the conduit at 18 and 256 days. In the two animals with planned scarification, the pre-mortem CT scan revealed mild or no calcification within the conduit or valve leaflets. In the echocardiographic examination at 12 months, peak and mean systolic pressure gradients across the conduit valve were 6.5 (3–21) mmHg and 3 (2–12) mmHg, while valve regurgitation was none (n = 2), trivial (n = 5), moderate (n = 1), or severe (n = 1). No clinical or laboratory signs of hemolysis were seen. After 12 months of follow-up, the animals’ body weights had increased from 33 (27–38) kg to 53 (38–66) kg (p = 0.010). Conclusions: Implantation of a valved pulmonary conduit in our growing lamb model was feasible. Infective endocarditis of the implanted valved conduit remained a significant complication. Full article
(This article belongs to the Section Basic and Translational Cardiovascular Research)
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14 pages, 1752 KiB  
Article
Improved Interpretation of Pulmonary Artery Wedge Pressures through Left Atrial Volumetry—A Cardiac Magnetic Resonance Imaging Study
by Gülmisal Güder, Theresa Reiter, Maria Drayss, Wolfgang Bauer, Björn Lengenfelder, Peter Nordbeck, Georg Fette, Stefan Frantz, Caroline Morbach and Stefan Störk
J. Cardiovasc. Dev. Dis. 2024, 11(6), 178; https://doi.org/10.3390/jcdd11060178 - 11 Jun 2024
Viewed by 504
Abstract
Background: The pulmonary artery wedge pressure (PAWP) is regarded as a reliable indicator of left ventricular end-diastolic pressure (LVEDP), but this association is weaker in patients with left-sided heart disease (LHD). We compared morphological differences in cardiac magnetic resonance imaging (CMR) in patients [...] Read more.
Background: The pulmonary artery wedge pressure (PAWP) is regarded as a reliable indicator of left ventricular end-diastolic pressure (LVEDP), but this association is weaker in patients with left-sided heart disease (LHD). We compared morphological differences in cardiac magnetic resonance imaging (CMR) in patients with heart failure (HF) and a reduced left ventricular ejection fraction (LVEF), with or without elevation of PAWP or LVEDP. Methods: We retrospectively identified 121 patients with LVEF < 50% who had undergone right heart catheterization (RHC) and CMR. LVEDP data were available for 75 patients. Results: The mean age of the study sample was 63 ± 14 years, the mean LVEF was 32 ± 10%, and 72% were men. About 53% of the patients had an elevated PAWP (>15 mmHg). In multivariable logistic regression analysis, NT-proBNP, left atrial ejection fraction (LAEF), and LV end-systolic volume index independently predicted an elevated PAWP. Of the 75 patients with available LVEDP data, 79% had an elevated LVEDP, and 70% had concomitant PAWP elevation. By contrast, all but one patient with elevated PAWP and half of the patients with normal PAWP had concomitant LVEDP elevation. The Bland–Altman plot revealed a systematic bias of +5.0 mmHg between LVEDP and PAWP. Notably, LAEF was the only CMR variable that differed significantly between patients with elevated LVEDP and a PAWP ≤ or >15 mmHg. Conclusions: In patients with LVEF < 50%, a normal PAWP did not reliably exclude LHD, and an elevated LVEDP was more frequent than an elevated PAWP. LAEF was the most relevant determinant of an increased PAWP, suggesting that a preserved LAEF in LHD may protect against backward failure into the lungs and the subsequent increase in pulmonary pressure. Full article
(This article belongs to the Special Issue Heart Failure: Clinical Diagnostics and Treatment)
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12 pages, 1296 KiB  
Article
The Usefulness of Intravascular Ultrasound and Optical Coherence Tomography in Patients Treated with Rotational Atherectomy: An Analysis Based on a Large National Registry
by Wojciech Siłka, Michał Kuzemczak, Krzysztof Piotr Malinowski, Łukasz Kołtowski, Kinga Glądys, Mariola Kłak, Ewa Kowacka, Damian Grzegorek, Piotr Waciński, Michał Chyrchel, Miłosz Dziarmaga, Sylwia Iwańczyk, Miłosz Jaguszewski, Wojciech Wańha, Wojciech Wojakowski, Fabrizio D’Ascenzo, Zbigniew Siudak and Rafał Januszek
J. Cardiovasc. Dev. Dis. 2024, 11(6), 177; https://doi.org/10.3390/jcdd11060177 - 10 Jun 2024
Viewed by 471
Abstract
Background: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve the clinical outcomes of percutaneous coronary interventions (PCIs) in selected subsets of patients. Aim: The aim was to investigate whether the use of OCT or IVUS during a PCI [...] Read more.
Background: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve the clinical outcomes of percutaneous coronary interventions (PCIs) in selected subsets of patients. Aim: The aim was to investigate whether the use of OCT or IVUS during a PCI with rotational atherectomy (RA-PCI) will increase the odds for successful revascularization, defined as thrombolysis in myocardial infarction (TIMI) 3 flow. Methods: Data were obtained from the national registry of PCIs (ORPKI) maintained by the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The dataset includes PCIs spanning from January 2014 to December 2021. Results: A total of 6522 RA-PCIs were analyzed, out of which 708 (10.9%) were guided by IVUS and 86 (1.3%) by OCT. The postprocedural TIMI 3 flow was achieved significantly more often in RA-PCIs guided by intravascular imaging (98.7% vs. 96.6%, p < 0.0001). Multivariable analysis revealed that using IVUS and OCT was independently associated with an increased chance of achieving postprocedural TIMI 3 flow by 67% (odds ratio (OR), 1.67; 95% confidence interval (CI): 1.40–1.99; p < 0.0001) and 66% (OR, 1.66; 95% CI: 1.09–2.54; p = 0.02), respectively. Other factors associated with successful revascularization were as follows: previous PCI (OR, 1.72; p < 0.0001) and coronary artery bypass grafting (OR, 1.09; p = 0.002), hypertension (OR, 1.14; p < 0.0001), fractional flow reserve assessment during angiogram (OR, 1.47; p < 0.0001), bifurcation PCI (OR, 3.06; p < 0.0001), and stent implantation (OR, 19.6, p < 0.0001). Conclusions: PCIs with rotational atherectomy guided by intravascular imaging modalities (IVUS or OCT) are associated with a higher procedural success rate compared to angio-guided procedures. Full article
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13 pages, 849 KiB  
Article
Linking Myocardial Infarction and Frailty Status at Old Age in Europe: Moderation Effects of Country and Gender
by Trinidad Sentandreu-Mañó, Zaira Torres, Cecilia Luján-Arribas, José M. Tomás, José Javier González-Cervantes and Elena Marques-Sule
J. Cardiovasc. Dev. Dis. 2024, 11(6), 176; https://doi.org/10.3390/jcdd11060176 - 8 Jun 2024
Viewed by 278
Abstract
Background: Myocardial infarction (MI) is a serious condition affecting a considerable number of individuals, with important clinical consequences. Understanding the associated factors is crucial for effective management and prevention. This study aimed to (1) examine the association between MI and frailty in a [...] Read more.
Background: Myocardial infarction (MI) is a serious condition affecting a considerable number of individuals, with important clinical consequences. Understanding the associated factors is crucial for effective management and prevention. This study aimed to (1) examine the association between MI and frailty in a sample of older European adults and (2) investigate the moderating effects of country and gender on this association. Methods: A cross-sectional survey of 22,356 Europeans aged 60 years and older was conducted. The data come from the sixth wave of the Survey of Health, Ageing and Retirement in Europe. Frailty, MI, gender, and country were studied. Results: Frailty is strongly associated with MI. Robust older adults are 13.31 times more likely not to have an MI. However, these odds drop to 5.09 if pre-frail and to 2.73 if frail. Gender, but not country, moderates this relationship. There is a strong association between MI and frailty in men, whereas for women, the association is not as strong. Conclusions: Frailty is highly associated with MI in European older adults. Country did not moderate the link between frailty and MI but gender does, with the relationship being notably stronger in men. The frailty–MI association remained significant even when controlling for a number of personal conditions and comorbidities. Full article
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19 pages, 1793 KiB  
Review
A New Hope for the Treatment of Atrial Fibrillation: Application of Pulsed-Field Ablation Technology
by Zhen Wang, Ming Liang, Jingyang Sun, Jie Zhang and Yaling Han
J. Cardiovasc. Dev. Dis. 2024, 11(6), 175; https://doi.org/10.3390/jcdd11060175 - 5 Jun 2024
Viewed by 425
Abstract
In recent years, the prevalence of and mortality associated with cardiovascular diseases have been rising in most countries and regions. AF is the most common arrhythmic condition, and there are several treatment options for AF. Pulmonary vein isolation is an effective treatment for [...] Read more.
In recent years, the prevalence of and mortality associated with cardiovascular diseases have been rising in most countries and regions. AF is the most common arrhythmic condition, and there are several treatment options for AF. Pulmonary vein isolation is an effective treatment for AF and is the cornerstone of current ablation techniques, which have one major limitation: even when diagnosed and treated at a facility that specializes in ablation, patients have a greater chance of recurrence. Therefore, there is a need to develop better ablation techniques for the treatment of AF. This article first compares the current cryoablation (CBA) and radiofrequency ablation (RFA) techniques for the treatment of AF and discusses the utility and advantages of the development of pulsed-field ablation (PFA) technology. The current research on PFA is summarized from three perspectives, namely, simulation experiments, animal experiments, and clinical studies. The results of different stages of experiments are summarized, especially during animal studies, where pulmonary vein isolation was carried out effectively without causing injury to the phrenic nerve, esophagus, and pulmonary veins, with higher safety and shorter incision times. This paper focuses on a review of various a priori and clinical studies of this new technique for the treatment of AF. Full article
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12 pages, 630 KiB  
Article
Benefits of Taurisolo in Diabetic Patients with Peripheral Artery Disease
by Bruno Amato, Ettore Novellino, Davide Morlando, Camilla Vanoli, Emilio Vanoli, Fulvio Ferrara, Rossana Difruscolo, Vito Maria Goffredo, Rita Compagna, Gian Carlo Tenore, Mariano Stornaiuolo, Mario Fordellone and Eugenio Caradonna
J. Cardiovasc. Dev. Dis. 2024, 11(6), 174; https://doi.org/10.3390/jcdd11060174 - 4 Jun 2024
Viewed by 432
Abstract
Trimethyl-N-oxide (TMAO) has been linked to peripheral artery disease (PAD). Taurisolo is a natural, balanced phytocomplex containing resveratrol, quercetin, catechins, procianidins, gallic acid, and caffeic acid. Numerous studies have shown that Taurisolo reduces the damage of TMAO and exerts [...] Read more.
Trimethyl-N-oxide (TMAO) has been linked to peripheral artery disease (PAD). Taurisolo is a natural, balanced phytocomplex containing resveratrol, quercetin, catechins, procianidins, gallic acid, and caffeic acid. Numerous studies have shown that Taurisolo reduces the damage of TMAO and exerts a protective effect on endothelial cells (ECs). The aim of this randomized, double-blind, single-center study was to evaluate the effects of Taurisolo on claudication in patients with PAD (Rutheford grade I, category II, Fontaine Classification: Stage IIA, American Medical Association Whole Person Impairment Classification: Class 0—WPI 0%) in two parallel groups of 31 patients. The primary outcomes were an increase in the pain-free walking distance and the ankle/brachial pressure index at the beginning and at the end of the treatment with Taurisolo. The secondary endpoint was the serum TMAO changes. The claudication distance improved by 14.1% in the Taurisolo group and by 2.0% in the placebo group, while the maximal distance increased by 15.8% and 0.6% only, respectively (both p < 0.05). The TMAO plasma levels decreased from 3.97 ± 2.13 micromole/L to 0.87 ± 0.48 (p < 0.0001) in the treated group. All these changes were highly significant both in univariate mixed models as well as in the adjusted model. Ultimately, Taurisolo might be an effective intervention to ameliorate intermittent claudication. Full article
(This article belongs to the Special Issue Management and Challenges in Peripheral Arterial Disease)
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12 pages, 1058 KiB  
Article
Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients
by Julia W. Erath, Nikolett Vigh, Balazs Muk, Carsten W. Israel, Sarah Keck, David Pilecky, Gabor Z. Duray and Mate Vamos
J. Cardiovasc. Dev. Dis. 2024, 11(6), 173; https://doi.org/10.3390/jcdd11060173 - 3 Jun 2024
Viewed by 286
Abstract
(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European [...] Read more.
(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months ± 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all p ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88–1.5; p = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75–1.45; p = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72–1.70; p = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA p < 0.01; LVEF p < 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock (p = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40–0.85; p = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up. Full article
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12 pages, 259 KiB  
Review
Ethical Considerations in Fetal Cardiology
by Stefani Samples, Rupali Gandhi, Joyce Woo and Angira Patel
J. Cardiovasc. Dev. Dis. 2024, 11(6), 172; https://doi.org/10.3390/jcdd11060172 - 1 Jun 2024
Viewed by 374
Abstract
Fetal cardiology has evolved over the last 40 years and changed the timing of diagnosis and counseling of congenital heart disease, decision-making, planning for treatment at birth, and predicting future surgery from the postnatal to the prenatal period. Ethical issues in fetal cardiology [...] Read more.
Fetal cardiology has evolved over the last 40 years and changed the timing of diagnosis and counseling of congenital heart disease, decision-making, planning for treatment at birth, and predicting future surgery from the postnatal to the prenatal period. Ethical issues in fetal cardiology transect multiple aspects of biomedical ethics including improvement in prenatal detection and diagnostic capabilities, access to equitable comprehensive care that preserves a pregnant person’s right to make decisions, access to all reproductive options, informed consent, complexity in shared decision-making, and appropriate use of fetal cardiac interventions. This paper first reviews the literature and then provides an ethical analysis of accurate and timely diagnosis, equitable delivery of care, prenatal counseling and shared decision-making, and innovation through in utero intervention. Full article
14 pages, 805 KiB  
Article
Heart Failure with Mid-Range or Mildly Reduced Ejection Fraction in the Era of Sodium–Glucose Co-Transporter 2 Inhibitors: Do We Now Provide Better Care for the “Middle Child of HF”? Real-World Experience from a Single Clinical Centre
by Marin Viđak, Jelena Kursar, Tomislava Bodrožić Džakić Poljak, Tomislav Letilović, Jasmina Ćatić, Vanja Ivanović Mihajlović, Petra Zebić Mihić, Šime Manola and Ivana Jurin
J. Cardiovasc. Dev. Dis. 2024, 11(6), 171; https://doi.org/10.3390/jcdd11060171 - 31 May 2024
Viewed by 365
Abstract
Heart failure (HF) with mid-range or mildly reduced ejection fraction (HFmrEF) is a separate clinical entity in the HF spectrum, with a left ventricular ejection fraction ranging from 40 to 49%. While sodium glucose co-transporter 2 inhibitors have become the cornerstone therapy for [...] Read more.
Heart failure (HF) with mid-range or mildly reduced ejection fraction (HFmrEF) is a separate clinical entity in the HF spectrum, with a left ventricular ejection fraction ranging from 40 to 49%. While sodium glucose co-transporter 2 inhibitors have become the cornerstone therapy for the entire HF spectrum, there are a few clinical trials of HFmrEF. This prospective observational study was conducted at Dubrava University Hospital, Zagreb, Croatia, from May 2021 to October 2023. We recruited 137 participants diagnosed with HFmrEF at admission. The majority were male, with a median age of 72 and overweight. A total of 110 participants were followed for 6 months and LVEF remained the same in the majority of patients (n = 62, 56.4%), improved in 32 patients (29.1%), and decreased in 3 patients (2.73%). A total of 64 participants were followed for 12 months: 39 remained the same (60.94%) and 25 improved. There were 13 deaths in (9.5%). While the empagliflozin group had a lower BMI at 6-month- and lower HbA1c at 12-month follow-up, there were no differences in death, HF hospitalizations, ER visits, or urinary tract infections in between groups. Despite recent and daily advances in the treatment of all HF phenotypes, HFmrEF still represents a challenge in everyday clinical practice. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
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9 pages, 332 KiB  
Review
The Evolving Role of Genetic Evaluation in the Prenatal Diagnosis and Management of Congenital Heart Disease
by Emily M. Bucholz, Sarah U. Morton, Erin Madriago, Amy E. Roberts and Christina Ronai
J. Cardiovasc. Dev. Dis. 2024, 11(6), 170; https://doi.org/10.3390/jcdd11060170 - 30 May 2024
Viewed by 190
Abstract
Congenital heart disease (CHD) is increasingly diagnosed prenatally and the ability to screen and diagnose the genetic factors involved in CHD have greatly improved. The presence of a genetic abnormality in the setting of prenatally diagnosed CHD impacts prenatal counseling and ensures that [...] Read more.
Congenital heart disease (CHD) is increasingly diagnosed prenatally and the ability to screen and diagnose the genetic factors involved in CHD have greatly improved. The presence of a genetic abnormality in the setting of prenatally diagnosed CHD impacts prenatal counseling and ensures that families and providers have as much information as possible surrounding perinatal management and what to expect in the future. This review will discuss the genetic evaluation that can occur prior to birth, what different genetic testing methods are available, and what to think about in the setting of various CHD diagnoses. Full article
22 pages, 401 KiB  
Review
Obesity and Transcatheter Aortic Valve Replacement
by Jiyoung Seo, Amrin Kharawala, Pawel Borkowski, Nikita Singh, Harriet Akunor, Sanjana Nagraj, Dimitrios V. Avgerinos and Damianos G. Kokkinidis
J. Cardiovasc. Dev. Dis. 2024, 11(6), 169; https://doi.org/10.3390/jcdd11060169 - 30 May 2024
Viewed by 204
Abstract
Amidst an aging population and escalating obesity prevalence, elucidating the impact of obesity on transcatheter aortic valve replacement (TAVR) outcomes becomes paramount. The so-called “obesity paradox”—a term denoting the counterintuitive association of obesity, typically a risk factor for cardiovascular diseases, with improved survival [...] Read more.
Amidst an aging population and escalating obesity prevalence, elucidating the impact of obesity on transcatheter aortic valve replacement (TAVR) outcomes becomes paramount. The so-called “obesity paradox”—a term denoting the counterintuitive association of obesity, typically a risk factor for cardiovascular diseases, with improved survival outcomes in TAVR patients relative to their leaner or normal-weight counterparts—merits rigorous examination. This review comprehensively investigates the complex relationship between obesity and the clinical outcomes associated with TAVR, with a specific focus on mortality and periprocedural complications. This study aims to deepen our understanding of obesity’s role in TAVR and the underlying mechanisms of the obesity paradox, thereby optimizing management strategies for this patient demographic, tailored to their unique physiological and metabolic profiles. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)
16 pages, 4869 KiB  
Article
Identification of Potential lncRNA-miRNA-mRNA Regulatory Network Contributing to Arrhythmogenic Right Ventricular Cardiomyopathy
by Haotong Li, Shen Song, Anteng Shi and Shengshou Hu
J. Cardiovasc. Dev. Dis. 2024, 11(6), 168; https://doi.org/10.3390/jcdd11060168 - 30 May 2024
Viewed by 337
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) can lead to sudden cardiac death and life-threatening heart failure. Due to its high fatality rate and limited therapies, the pathogenesis and diagnosis biomarker of ARVC needs to be explored urgently. This study aimed to explore the lncRNA-miRNA-mRNA [...] Read more.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) can lead to sudden cardiac death and life-threatening heart failure. Due to its high fatality rate and limited therapies, the pathogenesis and diagnosis biomarker of ARVC needs to be explored urgently. This study aimed to explore the lncRNA-miRNA-mRNA competitive endogenous RNA (ceRNA) network in ARVC. The mRNA and lncRNA expression datasets obtained from the Gene Expression Omnibus (GEO) database were used to analyze differentially expressed mRNA (DEM) and lncRNA (DElnc) between ARVC and non-failing controls. Differentially expressed miRNAs (DEmiRs) were obtained from the previous profiling work. Using starBase to predict targets of DEmiRs and intersecting with DEM and DElnc, a ceRNA network of lncRNA-miRNA-mRNA was constructed. The DEM and DElnc were validated by real-time quantitative PCR in human heart tissue. Protein–protein interaction network and weighted gene co-expression network analyses were used to identify hub genes. A logistic regression model for ARVC diagnostic prediction was established with the hub genes and their ceRNA pairs in the network. A total of 448 DEMs (282 upregulated and 166 downregulated) were identified, mainly enriched in extracellular matrix and fibrosis-related GO terms and KEGG pathways, such as extracellular matrix organization and collagen fibril organization. Four mRNAs and two lncRNAs, including COL1A1, COL5A1, FBN1, BGN, XIST, and LINC00173 identified through the ceRNA network, were validated by real-time quantitative PCR in human heart tissue and used to construct a logistic regression model. Good ARVC diagnostic prediction performance for the model was shown in both the training set and the validation set. The potential lncRNA-miRNA-mRNA regulatory network and logistic regression model established in our study may provide promising diagnostic methods for ARVC. Full article
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21 pages, 21208 KiB  
Review
Catheter-Based Fetal Cardiac Interventions
by Betul Yilmaz Furtun and Shaine Alaine Morris
J. Cardiovasc. Dev. Dis. 2024, 11(6), 167; https://doi.org/10.3390/jcdd11060167 - 29 May 2024
Viewed by 422
Abstract
Fetal cardiac intervention (FCI) is an emerging and rapidly advancing group of interventions designed to improve outcomes for fetuses with cardiovascular disease. Currently, FCI is comprised of pharmacologic therapies (e.g., trans-placental antiarrhythmics for fetal arrhythmia), open surgical procedures (e.g., surgical resection of pericardial [...] Read more.
Fetal cardiac intervention (FCI) is an emerging and rapidly advancing group of interventions designed to improve outcomes for fetuses with cardiovascular disease. Currently, FCI is comprised of pharmacologic therapies (e.g., trans-placental antiarrhythmics for fetal arrhythmia), open surgical procedures (e.g., surgical resection of pericardial teratoma), and catheter-based procedures (e.g., fetal aortic valvuloplasty for aortic stenosis). This review focuses on the rationale, criteria for inclusion, technical details, and current outcomes of the three most frequently performed catheter-based FCI procedures: (1) aortic valvuloplasty for critical aortic stenosis (AS) associated with evolving hypoplastic left heart syndrome (HLHS), (2) atrial septal intervention for HLHS with severely restrictive or intact atrial septum (R/IAS), and (3) pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum (PA/IVS). Full article
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22 pages, 1245 KiB  
Systematic Review
Congenital Gerbode Defect: A Left Ventricular to Right Atrial Shunt—State-of-the-Art Review of Its General Data, Diagnostic Modalities, and Treatment Strategies
by Lone Winter, Brigitte Strizek and Florian Recker
J. Cardiovasc. Dev. Dis. 2024, 11(6), 166; https://doi.org/10.3390/jcdd11060166 - 28 May 2024
Viewed by 368
Abstract
The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence, shed light on the clinical implications, and identify knowledge gaps. The systematic literature search was conducted in the [...] Read more.
The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence, shed light on the clinical implications, and identify knowledge gaps. The systematic literature search was conducted in the PubMed and Google Scholar medical databases using specifically selected keywords. The inclusion of each publication was assessed according to predefined eligibility criteria based on the PICOM (Population, Phenomenon of Interest, Context, Methodology) schema. Titles and abstracts were screened independently by two authors. Available full-text versions of included publications were reviewed and relevant information was extracted. A total of 78 reports were included. The compilation of all congenital Gerbode defect cases described in the literature revealed a variety of clinical presentations comprising dyspnea, palpitations, growth retardation, and asymptomatology. A suitable multimodal diagnostic approach for newborns consists of auscultation, TTE, and optionally TEE and MRI. Because of its rarity, diversity of findings, unknown pathophysiology, and similarity to more common cardiac diseases, the diagnostic challenge remains significant. To prevent untreated long-term sequelae, early individualized treatment is recommended. Surgical defect closure is preferred to device closure for evidence reasons, although major developments are currently taking place. In conclusion, the congenital Gerbode defect provides a diagnostic challenge for pediatricians to allow early diagnosis and intervention in order to improve patients’ quality of life. Full article
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11 pages, 835 KiB  
Article
Prognostic Significance of Serum Uric Acid and Exercise Capacity in Older Adults Hospitalized for Worsening Cardiovascular Disease
by Akihiro Hirashiki, Atsuya Shimizu, Takahiro Kamihara, Manabu Kokubo, Kakeru Hashimoto, Ikue Ueda and Toyoaki Murohara
J. Cardiovasc. Dev. Dis. 2024, 11(6), 165; https://doi.org/10.3390/jcdd11060165 - 26 May 2024
Viewed by 327
Abstract
Abstract: Elevated serum uric acid (sUA) is associated with the risk of developing cardiovascular disease (CVD). Here, we examined the prognostic significance of sUA and exercise capacity in 411 Japanese adults (age, ≥65; mean, 81 years) hospitalized for worsening CVD. When the [...] Read more.
Abstract: Elevated serum uric acid (sUA) is associated with the risk of developing cardiovascular disease (CVD). Here, we examined the prognostic significance of sUA and exercise capacity in 411 Japanese adults (age, ≥65; mean, 81 years) hospitalized for worsening CVD. When the patients were stratified by sUA into three groups (<5.3, 5.4–6.9, >7.0 mg/dL), the high-sUA group had a significantly worse peak VO2 and composite endpoint (rehospitalization due to worsening CVD and all-cause mortality) compared with low- and moderate-sUA groups (p < 0.001). When the patients were stratified by sUA into five groups (sUA < 3.9, 4.0–5.9, 6.0–7.9, 8.0–8.9, and >10.0 mg/dL), the incidence of the composite endpoint was significantly higher in the highest sUA group compared with that in the reference group, but only in women. Univariate Cox regression analysis, but not a multivariate analysis, indicated that sUA was significantly associated with the composite endpoint. Although sUA and exercise capacity may have some degree of prognostic significance in older patients with CVD, this significance may differ between men and women. Full article
10 pages, 315 KiB  
Article
Comparative Prevalence of Cerebrovascular Disease in Vietnamese Communities in South-Western Sydney
by Deena Alysha, Christopher Blair, Peter Thomas, Timmy Pham, Tram Nguyen, Theodore Ross Cordato, Helen Badge, Nicola Chappelow, Longting Lin, Leon Edwards, James Thomas, Suzanne Hodgkinson, Cecilia Cappelen-Smith, Alan McDougall, Dennis John Cordato and Mark Parsons
J. Cardiovasc. Dev. Dis. 2024, 11(6), 164; https://doi.org/10.3390/jcdd11060164 - 24 May 2024
Viewed by 394
Abstract
Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in these communities may improve health outcomes. We aimed to compare the rates of transient ischaemic attack (TIA), ischaemic stroke (IS), intracerebral haemorrhage (ICH), intracranial atherosclerosis (ICAD), and stroke [...] Read more.
Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in these communities may improve health outcomes. We aimed to compare the rates of transient ischaemic attack (TIA), ischaemic stroke (IS), intracerebral haemorrhage (ICH), intracranial atherosclerosis (ICAD), and stroke risk factors in Vietnamese-born residents of South-Western Sydney (SWS) with those of an Australian-born cohort. A 10-year retrospective analysis (2011–2020) was performed using data extracted from the Health Information Exchange database characterising stroke presentations and risk factor profiles. The rates of hypertension (83.7% vs. 70.3%, p <0.001) and dyslipidaemia (81.0% vs. 68.2%, p < 0.001) were significantly higher in Vietnamese patients, while the rates of ischaemic heart disease (10.4% vs. 20.3%, p < 0.001), smoking (24.4% vs. 40.8%, p < 0.001), and alcohol abuse (>1 drink/day) (9.6% vs. 15.9%, p < 0.001) were lower. The rates of ICAD and ICH were higher in Vietnamese patients (30.9% vs. 6.9%, p < 0.001 and 24.7% vs. 14.4%, p = 0.002). Regression analysis revealed that diabetes (OR: 1.86; 95% CI: 1.14–3.04, p = 0.014) and glycosylated haemoglobin (OR: 1.51; 95% CI: 1.15–1.98, p = 0.003) were predictors of ICAD in Vietnamese patients. Vietnamese patients had higher rates of symptomatic ICAD and ICH, with unique risk factor profiles. Culturally specific interventions arising from these findings may more effectively reduce the community burden of disease. Full article
(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)
27 pages, 9072 KiB  
Review
Diagnosis and Management of Fetal Arrhythmias in the Current Era
by Stacy A. S. Killen and Janette F. Strasburger
J. Cardiovasc. Dev. Dis. 2024, 11(6), 163; https://doi.org/10.3390/jcdd11060163 - 24 May 2024
Viewed by 596
Abstract
Diagnosis and management of fetal arrhythmias have changed over the past 40–50 years since propranolol was first used to treat fetal tachycardia in 1975 and when first attempts were made at in utero pacing for complete heart block in 1986. Ongoing clinical trials, [...] Read more.
Diagnosis and management of fetal arrhythmias have changed over the past 40–50 years since propranolol was first used to treat fetal tachycardia in 1975 and when first attempts were made at in utero pacing for complete heart block in 1986. Ongoing clinical trials, including the FAST therapy trial for fetal tachycardia and the STOP-BLOQ trial for anti-Ro-mediated fetal heart block, are working to improve diagnosis and management of fetal arrhythmias for both mother and fetus. We are also learning more about how “silent arrhythmias”, like long QT syndrome and other inherited channelopathies, may be identified by recognizing “subtle” abnormalities in fetal heart rate, and while echocardiography yet remains the primary tool for diagnosing fetal arrhythmias, research efforts continue to advance the clinical envelope for fetal electrocardiography and fetal magnetocardiography. Pharmacologic management of fetal arrhythmias remains one of the most successful achievements of fetal intervention. Patience, vigilance, and multidisciplinary collaboration are key to successful diagnosis and treatment. Full article
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20 pages, 4961 KiB  
Review
Diagnostic Challenges in Aortic Stenosis
by André González-García, Pablo Pazos-López, Francisco Eugenio Calvo-Iglesias, Tatiana Mallely Matajira-Chía, Raquel Bilbao-Quesada, Elisa Blanco-González, Carina González-Ríos, María Castiñeira-Busto, Manuel Barreiro-Pérez and Andrés Íñiguez-Romo
J. Cardiovasc. Dev. Dis. 2024, 11(6), 162; https://doi.org/10.3390/jcdd11060162 - 23 May 2024
Viewed by 475
Abstract
Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic [...] Read more.
Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic valve (AV) morphology and function. Despite the diagnosis of AS being considered straightforward for a very long time, based on high gradients and reduced aortic valve area (AVA), many patients with AS represent a real dilemma for cardiologist. On the one hand, the acoustic window may be inadequate and the TTE limited in some cases. On the other hand, a growing body of evidence shows that patients with low gradients (due to systolic dysfunction, concentric hypertrophy or coexistence of another valve disease such as mitral stenosis or regurgitation) may develop severe AS (low-flow low-gradient severe AS) with a similar or even worse prognosis. The use of complementary imaging techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDTC), or cardiac magnetic resonance (CMR) plays a key role in such scenarios. The aim of this review is to summarize the diagnostic challenges associated with patients with AS and the advantages of a comprehensive multimodality cardiac imaging (MCI) approach to reach a precise grading of the disease, a crucial factor to warrant an adequate management of patients. Full article
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17 pages, 523 KiB  
Systematic Review
The Effects of Exercise Training on Functional Capacity and Quality of Life in Patients with Rheumatoid Arthritis: A Systematic Review
by Amalia Athanasiou, Ourania Papazachou, Nikoletta Rovina, Serafim Nanas, Stavros Dimopoulos and Christos Kourek
J. Cardiovasc. Dev. Dis. 2024, 11(6), 161; https://doi.org/10.3390/jcdd11060161 - 22 May 2024
Viewed by 408
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation. The purpose of this systematic review is to evaluate the effectiveness of exercise training on functional capacity and quality of life (QoL) in patients with RA. We performed a search in four [...] Read more.
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation. The purpose of this systematic review is to evaluate the effectiveness of exercise training on functional capacity and quality of life (QoL) in patients with RA. We performed a search in four databases, selecting clinical trials that included community or outpatient exercise training programs in patients with RA. The primary outcome was functional capacity assessed by peak VO2 or the 6 min walking test, and the secondary outcome was QoL assessed by questionnaires. Seven studies were finally included, identifying a total number of 448 patients. The results of the present systematic review show a statistically significant increase in peak VO2 after exercise training in four out of seven studies. In fact, the improvement was significantly higher in two out of these four studies compared to the controls. Six out of seven studies provided data on the patients’ QoL, with five of them managing to show statistically significant improvement after exercise training, especially in pain, fatigue, vitality, and symptoms of anxiety and depression. This systematic review demonstrates the beneficial effects of exercise training on functional capacity and QoL in patients with RA. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
15 pages, 596 KiB  
Article
Percutaneous Coronary Interventions with Sirolimus-Eluting Alex Plus Stents in Patients with or without Diabetes: 4-Year Results
by Jacek Bil, Maciej Tyczynski, Adam Kern, Krystian Bojko and Robert J. Gil
J. Cardiovasc. Dev. Dis. 2024, 11(6), 160; https://doi.org/10.3390/jcdd11060160 - 22 May 2024
Viewed by 415
Abstract
We characterized the performance, as well as the safety, of a second-generation thin-strut sirolimus-eluting stent with a biodegradable polymer, Alex Plus (Balton, Poland), implanted in patients with type 2 diabetes (DM) with a 4-year follow-up. We defined the primary endpoint as the 48-month [...] Read more.
We characterized the performance, as well as the safety, of a second-generation thin-strut sirolimus-eluting stent with a biodegradable polymer, Alex Plus (Balton, Poland), implanted in patients with type 2 diabetes (DM) with a 4-year follow-up. We defined the primary endpoint as the 48-month rate of major cardiovascular adverse events (MACE), including cardiac death, myocardial infarction (MI), or target lesion revascularization (TLR). The secondary endpoints were all-cause death, cardiac death, MI, and TLR rates at 12, 24, 36, and 48 months. We enrolled 232 patients in whom 282 stents were implanted, including 97 DM and 135 non-DM patients. The mean age of the DM patients was 69.5 ± 10.1 years and females accounted for 30% of the patients. DM patients had higher rates of arterial hypertension (97% vs. 88%, p = 0.016), dyslipidemia (86% vs. 70%, p = 0.005), prior MI (61% vs. 40%, p = 0.002), prior PCI (65% vs. 50%, p = 0.020), and prior CABG (14% vs. 5.9%, p = 0.029). We recorded statistically significant differences for MACE (HR 1.85, 95% CI 1.01–3.41, p = 0.046), cardiac death (HR 4.46, 95% CI 1.44–13.8, p = 0.010), and MI (HR 3.17, 95% CI 1.10–9.12, p = 0.033), but not for TLR, between DM and non-DM patients in terms of the analyzed endpoints at 4 years. Our study showed that Alex Plus was efficient and safe in a contemporary cohort of real-world DM patients undergoing percutaneous revascularization. Full article
(This article belongs to the Special Issue Myocardial Infarction: Prevention, Treatment and Outcomes)
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12 pages, 2580 KiB  
Article
The Right Coronary Anatomy and Operative Topography of the Tricuspid Valve Annulus
by Michał Piotrowski, Marian Burysz, Jakub Batko, Radosław Litwinowicz, Mariusz Kowalewski, Krzysztof Bartuś, Krzysztof Wróbel, Łukasz Graczykowski and Artur Słomka
J. Cardiovasc. Dev. Dis. 2024, 11(6), 159; https://doi.org/10.3390/jcdd11060159 - 21 May 2024
Viewed by 528
Abstract
Background: The region of the tricuspid valve is an important area for various cardiac interventions. In particular, the spatial relationships between the right coronary artery and the annulus of the tricuspid valve should be considered during surgical interventions. The aim of this study [...] Read more.
Background: The region of the tricuspid valve is an important area for various cardiac interventions. In particular, the spatial relationships between the right coronary artery and the annulus of the tricuspid valve should be considered during surgical interventions. The aim of this study was to provide an accurate description of the clinical anatomy and topography of this region. Methods: We analyzed 107 computed tomography scans (44% female, age 62.1 ± 9.4 years) of the tricuspid valve region. The circumference of the free wall of the tricuspid valve annulus was divided into 13 annular points and measurements were taken at each point. The prevalence of danger zones (distance between artery and annulus less than 2 mm) was also investigated. Results: Danger zones were found in 20.56% of the cases studied. The highest prevalence of danger zones and the smallest distances were found at the annular points of the tricuspid valve located at the posterior insertion of the leaflets, without observed sex-specific differences. Conclusion: The highest risk of iatrogenic damage to the right coronary artery is in the posterior part of the tricuspid valve annulus. Full article
(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)
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13 pages, 873 KiB  
Article
Comparative Assessment of Percutaneous Left-Atrial Appendage Occlusion (LAAO) Devices—A Single Center Cohort Study
by Elham Kayvanpour, Max Kothe, Ziya Kaya, Sven Pleger, Norbert Frey, Benjamin Meder and Farbod Sedaghat-Hamedani
J. Cardiovasc. Dev. Dis. 2024, 11(6), 158; https://doi.org/10.3390/jcdd11060158 - 21 May 2024
Viewed by 517
Abstract
Background: Percutaneous left-atrial appendage closure (LAAC) is an established method for preventing strokes in patients with atrial fibrillation, offering an alternative to oral anticoagulation. Various occluder devices have been developed to cater to individual anatomical needs and ensure a safe and effective procedure. [...] Read more.
Background: Percutaneous left-atrial appendage closure (LAAC) is an established method for preventing strokes in patients with atrial fibrillation, offering an alternative to oral anticoagulation. Various occluder devices have been developed to cater to individual anatomical needs and ensure a safe and effective procedure. In this retrospective, monocentric cohort study, we compare different LAAO devices with respect to clinical outcomes, LAA sealing properties, and device-related complications. Methods: We conducted a retrospective analysis of 270 patients who underwent percutaneous LAA closure in our center between 2009 and 2023. Patient data were extracted from medical records, including gender, age at implantation, indication, device type and size, laboratory values, LAA anatomy, periprocedural complications, ECG parameters, transthoracic and transesophageal echocardiography parameters (TTE and TEE), as well as medication at discharge. Moreover, fluoroscopy time and implantation duration, as well as post-implantation clinical events up to 1 year, were collected. Endpoints were bleeding events, recurrent stroke, thrombi on devices, and death. Results: The implanted devices were the Watchman 2.5, Watchman FLX, Amplatzer Cardiac Plug (ACP), and Amulet. The procedural success rate was 95.7% (n = 265), with cactus anatomy posing the most challenges across all devices. The mean patient age was 75.5 ± 7.7 years, with 64.5% being male. The median CHA2DS2-VASc score was 4.8 ± 1.5 and the median HAS-BLED score was 3.8 ± 1.0. Indications for LAA closure included past bleeding events and elevated bleeding risk. Periprocedural complications were most commonly bleeding at the puncture site, particularly after ACP implantation (p = 0.014). Significant peridevice leaks (PDL) were observed in 21.4% of simple sealing mechanism devices versus 0% in double sealing mechanism devices (p = 0.004). Thrombi were detected on devices in six patients, with no subsequent ischemic stroke or thromboembolic event. Comparative analysis revealed no significant differences in the occurrence of stroke, transient ischemic attack (TIA), thromboembolic events, device-related thrombi, or mortality among different device types. A 62.3% relative risk reduction in thromboembolic events and 38.6% in major bleedings could be observed over 568.2 patient years. Conclusions: In summary, our study highlights the efficacy and safety of LAA closure using various occluder devices despite anatomical challenges. Our long-term follow-up findings support LAA closure as a promising option for stroke prevention in selected patient cohorts. Further research is needed to refine patient selection criteria and optimize outcomes in LAA closure procedures. Full article
(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)
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13 pages, 243 KiB  
Article
The Association between Major Adverse Cardiovascular Events and Peripheral Artery Disease Burden
by Oskari Niiranen, Juha Virtanen, Ville Rantasalo, Amer Ibrahim, Maarit Venermo and Harri Hakovirta
J. Cardiovasc. Dev. Dis. 2024, 11(6), 157; https://doi.org/10.3390/jcdd11060157 - 21 May 2024
Viewed by 425
Abstract
Objective: The aim of the present study was to investigate the possible relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs). Methods: All the consecutive symptomatic peripheral artery disease (PAD) patients admitted for digital subtraction angiography (DSA) [...] Read more.
Objective: The aim of the present study was to investigate the possible relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs). Methods: All the consecutive symptomatic peripheral artery disease (PAD) patients admitted for digital subtraction angiography (DSA) at Turku University Hospital department of Vascular Surgery between 1 January 2009 and 30 July 2011 were retrospectively analyzed. Angiography due to symptomatic PAD was used as the index date for the inclusion in the study. The segmental burden of atherosclerosis based on DSA was divided into three categories according to the highest disease burden of the defined artery segment: aorto-iliac, femoropopliteal, or tibial segments. The major association for the study was MACEs (defined as a cerebrovascular event, heart failure (HF) and myocardial infarction requiring hospital admission). Demographic data and MACEs were obtained from the hospital electronic medical records system. Results. The lower limb atherosclerosis burden of tibial vessels was related to an increased probability for HF (OR 3.9; 95%CI 2.4–6.5) and for MACEs overall (OR 2.3; 95%CI 1.4–3.6). The probability of both HF and MACEs overall rose with the increasing severity of the atherosclerosis burden. Moreover, the more severe the tibial vessel atherosclerosis, the higher the risk of HF and MACEs. The most extensive tibial atherosclerosis patients had an OR 4.5; 95%CI 2.6–8.0 for HF and an OR 3.1; and 95%CI 1.7–5.6 for MACEs overall. The femoropopliteal disease burden was also associated with an increased risk of HF (OR 2.3; 95%CI 1.6–3.2) and MACE (OR 1.9; 95%CI 1.3–2.7). However, the increasing extent of atherosclerosis of the femoropopliteal segment solely increased the risk of MACEs. Conclusions: PAD patients with severe tibial atherosclerosis are likely to present with MACEs. The risk is further enhanced as the extent of tibial vessel atherosclerosis is increased. An association between MACE and severe atherosclerosis on the aortoiliac segment was not detected. However, when the femoropopliteal segment was the most affected artery segment, the risk of MACEs was increased. Full article
(This article belongs to the Special Issue Clinical Burden of Comorbidities on Cardiovascular System and Beyond)
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