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J. Cardiovasc. Dev. Dis., Volume 12, Issue 2 (February 2025) – 29 articles

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11 pages, 560 KiB  
Article
PROthrombotic States in Transcatheter HEart Valve Leaflet thromboSIS (PROSTHESIS): Rationale and Early Results of the Observational Cohort Study
by Kajetan Grodecki, Katarzyna Pawlak, Matylda Grodecka, Bartosz Rymuza, Piotr Scislo, Olga Ciepiela, Janusz Kochman and Zenon Huczek
J. Cardiovasc. Dev. Dis. 2025, 12(2), 62; https://doi.org/10.3390/jcdd12020062 - 6 Feb 2025
Abstract
Subclinical leaflet thrombosis is an imaging phenomenon observed after transcatheter aortic valve implantation (TAVI) and characterized by hypoattenuating leaflet thickening (HALT) on computed tomography angiography. The clinical implications and underlying causes remain uncertain. Hypercoagulability, a component of Virchow’s triad, may contribute to thrombus [...] Read more.
Subclinical leaflet thrombosis is an imaging phenomenon observed after transcatheter aortic valve implantation (TAVI) and characterized by hypoattenuating leaflet thickening (HALT) on computed tomography angiography. The clinical implications and underlying causes remain uncertain. Hypercoagulability, a component of Virchow’s triad, may contribute to thrombus formation on bioprosthetic leaflets, but data on hypercoagulable disorders in TAVI patients and their impact on HALT are limited. The PROSTHESIS study (PROthrombotic States in Transcatheter HEart valve Subclinical leaflet thrombosIS) is a single-center observational cohort study aiming to include 130 TAVI patients. This pilot study aimed to (i) assess the effect of hypercoagulable disorders on HALT prevalence and (ii) evaluate their impact on the natural history of HALT. Patients were screened for common hypercoagulable disorders using genetic and functional assays and underwent multimodal imaging one year after TAVI to detect HALT. In patients with HALT, post-implant imaging was repeated after three months to assess its progression. Early results comparing 52 TAVI patients with 52 matched controls undergoing coronary angiography showed similar thrombophilia prevalence between the groups (16% vs. 12%, p = 0.565). HALT occurred in 15% of TAVI patients, more extensively in those with thrombophilia (712 mm3 vs. 135 mm3, p = 0.036). However, thrombophilia was not an independent predictor of HALT. One-year follow-up CTA revealed spontaneous HALT resolution in 63%, stability in 25%, and progression in 12%. This study aims to provide insights into HALT and its mechanisms, which may help prevent complications and improve bioprosthesis durability. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
13 pages, 2282 KiB  
Article
Clinical Decision Support for Patient Cases with Asymptomatic Carotid Artery Stenosis Using AI Models and Electronic Medical Records
by Mackenzie Madison, Xiao Luo, Jackson Silvey, Robert Brenner, Kartik Gannamaneni and Alan P. Sawchuk
J. Cardiovasc. Dev. Dis. 2025, 12(2), 61; https://doi.org/10.3390/jcdd12020061 - 6 Feb 2025
Abstract
An artificial intelligence (AI) analysis of electronic medical records (EMRs) was performed to analyze the differences between patients with carotid stenosis who developed symptomatic disease and those who remained asymptomatic. The EMRs of 872 patients who underwent a carotid endarterectomy between 2009 and [...] Read more.
An artificial intelligence (AI) analysis of electronic medical records (EMRs) was performed to analyze the differences between patients with carotid stenosis who developed symptomatic disease and those who remained asymptomatic. The EMRs of 872 patients who underwent a carotid endarterectomy between 2009 and 2022 were analyzed with AI. This included 408 patients who had carotid intervention for symptomatic carotid disease and 464 patients for asymptomatic, >70% stenosis. By analyzing the EMRs, the Support Vector Machine achieved the highest sensitivity at 0.626 for predicting which of these patients would go on to develop a stroke or TIA. Random Forest had the highest specificity at 0.906. The risk for stroke in patients with carotid stenosis was a balance between optimum medical treatment and the underlying disease processes. Risk factors for developing symptomatic carotid disease included elevated glucose, chronic kidney disease, hyperlipidemia, and current or recent smoking, while protective factors included cardiovascular agents, antihypertensives, and beta blockers. An AI review of EMRs can help determine which patients with carotid stenosis are more likely to develop a stroke to assist with decision making as to whether to proceed with intervention or to demonstrate and encourage reduced stroke risk with risk factor modification. Full article
(This article belongs to the Section Stroke and Cerebrovascular Disease)
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13 pages, 1425 KiB  
Article
Clinical Significance of Serum Omega-3 Fatty Acids on Endothelial Function in Patients with Coronary Artery Disease Under Statin Therapy
by Kei Yunoki, Hiroaki Matsumi, Toru Miyoshi, Motoki Kubo, Yoshiki Hata and Shinsuke Yuasa
J. Cardiovasc. Dev. Dis. 2025, 12(2), 60; https://doi.org/10.3390/jcdd12020060 (registering DOI) - 5 Feb 2025
Viewed by 257
Abstract
Vascular endothelial function plays an important role in the pathogenesis of atherosclerosis. The reduction in low-density lipoprotein cholesterol (LDL-C) is a key therapy for preventing coronary artery disease (CAD), but the role of omega-3 fatty acids as residual risk factors of CAD remains [...] Read more.
Vascular endothelial function plays an important role in the pathogenesis of atherosclerosis. The reduction in low-density lipoprotein cholesterol (LDL-C) is a key therapy for preventing coronary artery disease (CAD), but the role of omega-3 fatty acids as residual risk factors of CAD remains controversial. We studied the correlation between serum omega-3 fatty acid levels and endothelial function in patients with CAD receiving statin therapy and examined the effect of eicosapentaenoic acid (EPA) therapy on endothelial function. Methods: A total of 150 consecutive patients with CAD receiving statin therapy (LDL-C levels < 100 mg/dL) were enrolled. Serum omega-3 fatty acid levels were measured, and endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery. Subsequently, 65 patients with impaired FMD (<6%) and low EPA/arachidonic acid (AA) (<0.3) were administered EPA, and FMD was reassessed after 3 months. Results: A multivariate linear regression analysis demonstrated that serum docosahexaenoic acid (DHA) and EPA plus DHA levels were independent determinants of %FMD (β = 0.214 and 0.163, p < 0.05, respectively). The EPA therapy significantly improved %FMD (from 3.7 ± 1.0% to 4.1 ± 1.0%, p < 0.05) in patients with low EPA/AA, and especially in patients with low EPA/AA and high triglyceride levels (from 3.4 ± 1.0% to 4.0 ± 1.1%, p < 0.01). Conclusions: Serum omega-3 fatty acid levels were associated with endothelial dysfunction in patients with CAD receiving statin therapy. EPA therapy improves endothelial function in patients with low EPA/AA, especially those with low EPA/AA and high triglycerides. Full article
(This article belongs to the Special Issue Effects of Pharmaceutical Intervention on Cardiovascular Risk)
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12 pages, 890 KiB  
Article
Assessment of Paclitaxel Drug-Coated Balloon-Only Angioplasty for Stent Thrombosis: SPARTAN-ST Study
by Ioannis Merinopoulos, Bhalraam U, Tharusha Gunawardena, Natasha Corballis, Rajkumar Natarajan, Upul Wickramarachchi, Clint Maart, Sulfi Sreekumar, Chris Sawh, Johannes Reinhold, Trevor Wistow, Alisdair Ryding, Timothy Gilbert, Vassilios S. Vassiliou and Simon C. Eccleshall
J. Cardiovasc. Dev. Dis. 2025, 12(2), 59; https://doi.org/10.3390/jcdd12020059 - 5 Feb 2025
Viewed by 440
Abstract
Background: There are no data regarding the outcomes of patients with stent thrombosis (ST) being treated with drug-coated balloon (DCB) angioplasty. Our aim was to compare the outcomes of patients with ST treated with DCB vs. a drug eluting stent (DES). Methods: In [...] Read more.
Background: There are no data regarding the outcomes of patients with stent thrombosis (ST) being treated with drug-coated balloon (DCB) angioplasty. Our aim was to compare the outcomes of patients with ST treated with DCB vs. a drug eluting stent (DES). Methods: In this registry analysis, we identified all patients treated for ST in our institution from June 2011 until November 2019. We excluded patients who died in the cath lab, patients with uncrossable lesions, and patients treated with thrombectomy only. Patient outcomes were obtained from Hospital Episodes Statistics from NHS England. The primary endpoint of this study was the composite of cardiovascular mortality, acute coronary syndrome, or target lesion revascularisation. The data were analysed with Cox regression and Kaplan–Meier estimator plots. Results: A total of 173 patients were identified; 92 treated with DCB-only, 36 with balloon angioplasty (BA), 26 with DES, and 19 with a combination of DES and DCB. We compared the outcomes of 92 patients with DCB versus 20 patients with DES, all of which had presented with late or very late ST. There was no difference between DCB and DES in terms of the primary endpoint (p = 0.06). Multivariate analysis identified diabetes (adverse) and the use of GPIIbIIIa inhibitor (favourable) as the only independent predictors of the primary endpoint. Implantation of a DES was independently associated with worse cardiovascular mortality. Conclusions: This is the first study assessing the outcomes of patients with ST treated with DCB only. It has demonstrated that DCBs are an attractive therapeutic option with a tendency towards favourable outcomes when compared to DESs. Full article
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15 pages, 492 KiB  
Review
Stroke in Bangladesh: A Narrative Review of Epidemiology, Risk Factors and Acute Stroke Services
by Mudasar Aziz, Naznin Bipasha, Udit Gupta, Isabela V. P. Ramnarine, Jessica Redgrave, Ali N. Ali, Arshad Majid and Simon M. Bell
J. Cardiovasc. Dev. Dis. 2025, 12(2), 58; https://doi.org/10.3390/jcdd12020058 - 5 Feb 2025
Viewed by 271
Abstract
Introduction: Stroke is a major cause of mortality and disability worldwide. It is one of the foremost non-communicable diseases and the third leading cause of death in Bangladesh. Bangladesh is a developing country and as such, the prevalence, risk factors and management of [...] Read more.
Introduction: Stroke is a major cause of mortality and disability worldwide. It is one of the foremost non-communicable diseases and the third leading cause of death in Bangladesh. Bangladesh is a developing country and as such, the prevalence, risk factors and management of the condition has some differences with more Westernised populations. In this review, we look at the epidemiology of stroke in Bangladesh and what barriers exist to improving stroke care in this country. Methods: A systematic search of the PubMed database, Mymensingh Medical Journal, Bangladesh Journal of Neuroscience and Google Scholar was conducted for articles relating to stroke in Bangladesh. Results: The incidence of stroke in Bangladesh is 3 strokes per 1000 people. The prevalence of haemorrhagic stroke is higher than in Western populations, and novel risk factors such as sitting in a squatting position and betel nut chewing increase a Bangladeshi’s stroke risk. A lack of education on stroke symptoms and a poor internal infrastructure are the main barriers to improving stroke care in this country. Conclusions: Stroke in Bangladesh is associated with traditional risk factors and non-traditional risk factors that are behaviourally ingrained into the local culture. Improved outcomes for these patients will rely on education programmes for the population, a regard for these risk factors and improving the availability of evidence-based treatments. Innovative approaches from policy decision makers to enhance equitable access to stroke services may help in providing stroke care in Bangladesh. Full article
(This article belongs to the Special Issue Feature Review Papers in Stroke and Cerebrovascular Disease)
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15 pages, 5182 KiB  
Article
Predictors of Visceral Infectious Aneurysms in Patients with Infective Endocarditis and Systemic Embolization
by Monique Boukobza, Emila Ilic-Habensus, Xavier Duval and Jean-Pierre Laissy
J. Cardiovasc. Dev. Dis. 2025, 12(2), 57; https://doi.org/10.3390/jcdd12020057 - 4 Feb 2025
Viewed by 346
Abstract
Background: To study whether infective endocarditis patients (IE-patients) with visceral embolic events (VEEs) at admission are at greater risk of developing visceral infectious aneurysms (VIAs) in left-sided infective endocarditis (LSIE) patients. Methods: We compared the data of prospectively collected 474 consecutive LSIE-patients (2005–2020) [...] Read more.
Background: To study whether infective endocarditis patients (IE-patients) with visceral embolic events (VEEs) at admission are at greater risk of developing visceral infectious aneurysms (VIAs) in left-sided infective endocarditis (LSIE) patients. Methods: We compared the data of prospectively collected 474 consecutive LSIE-patients (2005–2020) with and without VIAs. A whole-body-CTA was part of the initial work-up for all patients. Results: A total of 24 patients (5.1%) with VIA were included, of whom 19 (79.2%) had at least one VEE, compared to a proportion of 34% (p < 0.001) in IE-patients without VIAs. Both groups also differed in terms of vegetation size (>15 mm: 48% vs. 18%, p < 0.001), microorganisms, Streptococcus spp. (68.5% vs. 42%, p= 0.003), rare microorganisms (36% vs. 8.3%, p < 0.001) and concomitant extra-visceral infectious aneurysms (42% vs. 12.8%, p < 0.001). Cardiac surgery was performed in 21 patients (87.5%) and in-hospital mortality occurred in 2 (8%). Conclusions: This study shows a different profile of VIA–LSIE patients compared to LSIE-patients without. Streptococcus species were the most frequent causal agents. Our study indicates that the presence of VEEs in LSIE-patients could suggest an increased risk of VIA. This study also shows the need for further abdominal-CTA in all cases of left sided IE to detect asymptomatic visceral aneurysms. Full article
(This article belongs to the Special Issue Current Practice in Cardiac Imaging)
17 pages, 4074 KiB  
Article
A Platform Integrating Biophysical and Biochemical Stimuli to Enhance Differentiation and Maturation of Cardiomyocyte Subtypes Derived from Human Induced Pluripotent Stem Cells
by Zhonggang Feng, Kota Sawada, Iori Ando, Riku Yoshinari, Daisuke Sato and Tadashi Kosawada
J. Cardiovasc. Dev. Dis. 2025, 12(2), 56; https://doi.org/10.3390/jcdd12020056 - 4 Feb 2025
Viewed by 319
Abstract
To enhance the differentiation and maturation of cardiomyocytes derived from human induced pluripotent stem cells, we developed a bioreactor system that simultaneously imposes biophysical and biochemical stimuli on these committed cardiomyocytes. The cells were cultured within biohydrogels composed of the extracellular matrix extracted [...] Read more.
To enhance the differentiation and maturation of cardiomyocytes derived from human induced pluripotent stem cells, we developed a bioreactor system that simultaneously imposes biophysical and biochemical stimuli on these committed cardiomyocytes. The cells were cultured within biohydrogels composed of the extracellular matrix extracted from goat ventricles and purchased rat-origin collagen, which were housed in the elastic PDMS culture chambers of the bioreactor. Elastic and flexible electrodes composed of PEDOT/PSS, latex, and graphene flakes were embedded in the hydrogels and chamber walls, allowing cyclic stretch and electrical pulses to be simultaneously and coordinately applied to the cultured cells. Furthermore, a dynamic analysis method employing the transverse forced oscillation theory of a cantilever was used to analyze and discriminate the subtype-specific beating behavior of the cardiomyocytes. It was found that myosin light chain 2v (MLC2v), a ventricular cell marker, was primarily upregulated in cells aggregated on the (+) electrode side, while cardiomyocytes with faint MLC2v but strong cardiac troponin T (cTNT) expression aggregated at the ground electrode (GND) side. mRNA analysis using rtPCR and the gel beating dynamics further suggested a subtype deviation on the different electrode sides. This study demonstrated the potential of our bioreactor system in enhancing cardiac differentiation and maturation, and it showed an intriguing phenomenon of cardiomyocyte subtype aggregation on different electrodes, which may be developed into a new method to enhance the maturation and separation of cardiomyocyte subtypes. Full article
(This article belongs to the Section Cardiac Development and Regeneration)
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11 pages, 1849 KiB  
Article
Outcomes of K-Clip Implantation for Functional Tricuspid Regurgitation Accompanied with Persistent Atrial Fibrillation
by Da-Wei Lin, Ling-Wei Zou, Jia-Xin Miao, Jia-Ning Fan, Min-Fang Meng, Yi-Ming Qi, Zhi Zhan, Wen-Zhi Pan, Da-Xin Zhou, Xiao-Chun Zhang and Jun-Bo Ge
J. Cardiovasc. Dev. Dis. 2025, 12(2), 55; https://doi.org/10.3390/jcdd12020055 - 3 Feb 2025
Viewed by 344
Abstract
Background: Atrial fibrillation (AF) has been identified as a risk factor for functional tricuspid regurgitation (FTR) in the absence of other known etiologies, although limited interventional options are available. K-Clip™, a novel transcatheter tricuspid annuloplasty device, is a clip-based annular plication approach for [...] Read more.
Background: Atrial fibrillation (AF) has been identified as a risk factor for functional tricuspid regurgitation (FTR) in the absence of other known etiologies, although limited interventional options are available. K-Clip™, a novel transcatheter tricuspid annuloplasty device, is a clip-based annular plication approach for FTR. To date, no studies have investigated the short-term outcomes of K-Clip™ for patients with severe FTR associated with AF. Therefore, the aim of this study was to explore the feasibility and effectiveness of transcatheter annular repair with K-Clip™ for FTR in patients with persistent AF. Methods: Patients with FTR and persistent AF who underwent transcatheter annular repair with K-Clip™ at nine centers in China during the inclusion period were included (This study derived from Confirmatory Clinical Study of Treating Tricuspid Regurgitation With K-Clip™ Transcatheter Annuloplasty System [TriStar study}). Baseline data, imaging results, and follow-up data were collected. Results: All 52 patients (23 men, 74.02 ± 7.03 years) received successful intervention, and the mean operation time and radian exposure were 2.64 ± 1.09 h and 133.33 ± 743.06 mGy, respectively. No death cases and a low major adverse event occurrence rate were reported in 30 days. A significant decrease in FTR was documented, and TR remained severe in only two patients (3.8%). The regurgitation volume decreased significantly, accompanied by a notable reduction in the effective regurgitation orifice area and tricuspid annulus diameter, which subsequently led to the reversal of right heart remodeling. Furthermore, a decrease in pulmonary artery systolic pressure and an increase in cardiac output were documented. Conclusions: Transcatheter annular repair with K-Clip™ showed favorable short-term prognosis and significant improvement in FTR in patients with severe FTR associated with persistent AF. K-Clip™ could be a novel option for that group of patients. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
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10 pages, 266 KiB  
Review
Coronary Endothelial Dysfunction and Vasomotor Dysregulation in Myocardial Bridging
by Takumi Toya
J. Cardiovasc. Dev. Dis. 2025, 12(2), 54; https://doi.org/10.3390/jcdd12020054 - 2 Feb 2025
Viewed by 299
Abstract
Myocardial bridging (MB), a congenital variant where a coronary artery segment is tunneled within the myocardium, is increasingly recognized as a contributor to coronary endothelial and vasomotor dysfunction. Beyond the hallmark systolic compression observed on angiography, MB disrupts endothelial integrity, impairs the release [...] Read more.
Myocardial bridging (MB), a congenital variant where a coronary artery segment is tunneled within the myocardium, is increasingly recognized as a contributor to coronary endothelial and vasomotor dysfunction. Beyond the hallmark systolic compression observed on angiography, MB disrupts endothelial integrity, impairs the release of vasoactive substances, and induces vasomotor abnormalities. These effects exacerbate ischemic symptoms and predispose to atherosclerosis in the proximal segment, particularly in conditions such as ischemia/myocardial infarction with nonobstructive coronary arteries. Recent studies underscore MB’s association with coronary vasospasm, microvascular endothelial dysfunction, and adverse cardiovascular outcomes, including sudden cardiac death. These findings highlight the interplay between MB’s structural anomalies and functional impairments, with factors such as the bridge’s length, depth, and orientation influencing its hemodynamic significance. Advances in imaging and coronary physiology assessment, including acetylcholine testing and stress diastolic fractional flow reserve/iFR/RFR, have enhanced diagnostic precision. This review explores the multifaceted impact of MB on coronary physiology, emphasizing its role in endothelial dysfunction and vasomotor regulation. Recognizing MB’s contribution to cardiovascular disease is essential for accurate diagnosis and tailored management strategies aimed at mitigating ischemic risk and improving patient outcomes. Full article
16 pages, 2620 KiB  
Article
Longitudinal Displacement for Left Ventricular Function Assessment
by Marina Leitman and Vladimir Tyomkin
J. Cardiovasc. Dev. Dis. 2025, 12(2), 53; https://doi.org/10.3390/jcdd12020053 - 31 Jan 2025
Viewed by 295
Abstract
: Background: Quantitative evaluation of myocardial function traditionally relies on parameters such as ejection fraction and strain. Strain, reflecting the relative change in the length of a myocardial segment over the cardiac cycle, has been extensively studied in various cardiac pathologies over the [...] Read more.
: Background: Quantitative evaluation of myocardial function traditionally relies on parameters such as ejection fraction and strain. Strain, reflecting the relative change in the length of a myocardial segment over the cardiac cycle, has been extensively studied in various cardiac pathologies over the past two decades. However, the absolute length change, or longitudinal displacement, of myocardial segments during the cardiac cycle has received limited attention. This study aims to evaluate longitudinal displacement in two separate groups: healthy athletes and patients with left ventricular dysfunction, providing new insights into myocardial function assessment. Methods: Echocardiographic examinations were performed on 30 healthy football players and 30 patients with left ventricular dysfunction using speckle-tracking imaging analysis. Global and regional peak longitudinal displacement values were calculated and compared with corresponding global and regional peak longitudinal strain measurements. A manual alternative for calculating global longitudinal strain was also proposed. Results: An inverse correlation was found between regional longitudinal displacement and regional longitudinal strain. Longitudinal displacement was maximal in the basal segments and lowest in the apex of the left ventricle, exhibiting a reversed basal-to-apical gradient (17.6 ± 3.5 mm vs. 11.5 ± 2.9 mm vs. 4.22 ± 1.7 mm in basal, mid, and apical segments, respectively; p < 0.000001). Maximal longitudinal displacement was observed in the inferior and posterior walls of the left ventricle. In the 30 patients with left ventricular dysfunction, global longitudinal displacement was significantly lower than in healthy individuals (4.4 ± 1.7 mm vs. 11.7 ± 1.5 mm, p < 0.000001). Global longitudinal displacement and global longitudinal strain showed a strong negative correlation (r = −0.72, p < 0.000001). Manually calculated global longitudinal strain demonstrated good agreement with speckle-tracking-based global longitudinal strain. Conclusions: Peak longitudinal displacement can be used to evaluate both regional and global myocardial function, similarly to peak longitudinal strain. Unlike strain, longitudinal displacement exhibits a reversed basal-to-apical gradient, with the highest values at the base of the left ventricle and the lowest at the apex. Global and regional longitudinal displacement is significantly reduced in patients with left ventricular dysfunction. Global longitudinal strain can be manually calculated using displacement measurements. Further studies are needed to evaluate peak longitudinal displacement in various cardiac pathologies. Full article
(This article belongs to the Special Issue The Role of Echocardiography in Cardiovascular Diseases)
12 pages, 731 KiB  
Article
Atrial Fibrillation Prediction Model Following Aortic Valve Replacement Surgery
by Nora Knez, Tomislav Kopjar, Tomislav Tokic and Hrvoje Gasparovic
J. Cardiovasc. Dev. Dis. 2025, 12(2), 52; https://doi.org/10.3390/jcdd12020052 - 31 Jan 2025
Viewed by 404
Abstract
(1) Background: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. It leads to increased perioperative morbidity and costs. Our study aimed to determine the incidence of new-onset POAF in patients undergoing isolated aortic valve replacement (AVR) and develop a [...] Read more.
(1) Background: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. It leads to increased perioperative morbidity and costs. Our study aimed to determine the incidence of new-onset POAF in patients undergoing isolated aortic valve replacement (AVR) and develop a multivariate model to identify its predictors. (2) Methods: We conducted a retrospective study including all consecutive patients who underwent isolated AVR at our institution between January 2010 and December 2022. Patients younger than 18, with a history of atrial fibrillation, previous cardiac surgery, or those who underwent concomitant procedures were excluded. Patients were dichotomized into POAF and No POAF groups. Multivariate logistic regression with backward elimination was utilized for predictive modeling. (3) Results: This study included 1108 patients, of which 297 (27%) developed POAF. The final multivariate model identified age, larger valve size, cardiopulmonary bypass time, delayed sternal closure, ventilation time, and intensive care unit stay as predictors of POAF. The model exhibited fair predictive ability (AUC = 0.678, p < 0.001), with the Hosmer–Lemeshow test confirming good model fit (p = 0.655). The overall correct classification percentage was 65.6%. (4) Conclusions: A POAF prediction model offers personalized risk estimates, allowing for tailored management strategies with the potential to enhance patient outcomes and optimize healthcare costs. Full article
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18 pages, 1448 KiB  
Review
Beyond the Lumen: Molecular Imaging to Unmask Vulnerable Coronary Plaques
by Geoffrey Currie and Hosen Kiat
J. Cardiovasc. Dev. Dis. 2025, 12(2), 51; https://doi.org/10.3390/jcdd12020051 - 30 Jan 2025
Viewed by 346
Abstract
Vulnerable coronary atherosclerotic plaque involves a dynamic pathophysiologic process within and surrounding an atheromatous plaque in coronary artery intima. The process drastically increases the risk of plaque rupture and is clinically responsible for most cases of acute coronary syndromes, myocardial infarctions, and sudden [...] Read more.
Vulnerable coronary atherosclerotic plaque involves a dynamic pathophysiologic process within and surrounding an atheromatous plaque in coronary artery intima. The process drastically increases the risk of plaque rupture and is clinically responsible for most cases of acute coronary syndromes, myocardial infarctions, and sudden cardiac deaths. Early detection of vulnerable plaque is crucial for clinicians to implement appropriate risk-mitigation treatment strategies, offer timely interventions, and prevent potentially life-threatening events. There is an imperative clinical need to develop practical diagnostic pathways that utilize non-invasive means to risk-stratify symptomatic patients. Since the early 1990s, the identification of vulnerable plaque in clinical practice has primarily relied on invasive imaging techniques. In the last two decades, CT coronary angiogram (CTCA) has rapidly evolved into the prevalent non-invasive diagnostic modality for assessing coronary anatomy. There are now validated plaque appearances on CTCA correlating with plaque vulnerability. It is worth noting that in clinical practice, most CTCA reports omit mention of vulnerable plaque details because spatial resolution (0.3–0.5 mm) is often insufficient to reliably detect some crucial features of vulnerable plaques, such as thin fibrous caps. Additionally, accurately identifying vulnerable plaque features requires substantial expertise and time, which many cardiologists or radiologists may lack in routine reporting. Cardiac magnetic resonance imaging (cMRI) is also non-invasive and allows simultaneous anatomic and functional assessment of coronary plaques. Despite several decades of research and development, routine clinical application of cMRI in coronary plaque imaging remains hampered by complex imaging protocols, inconsistent image quality, and cost. Molecular imaging with radiotracers, specifically positron emission tomography (PET) with sodium fluoride (Na18F PET), have demonstrated significant potential as a sensitive and specific imaging procedure for diagnosing vulnerable coronary artery plaque. The study protocol is robust and brief, requiring minimal patient preparation. Compared to CTCA and cMRI, the diagnostic accuracy of this test is less dependent on the experience and expertise of the readers. Furthermore, validated automated quantitative algorithms complement the visual interpretation of the study, enhancing confidence in the diagnosis. This combination of factors makes Na18F PET a promising tool in cardiology for identifying high-risk coronary plaques. Full article
(This article belongs to the Special Issue Current Practice in Cardiac Imaging)
10 pages, 254 KiB  
Article
Impact of Heart Failure Team on Inpatient Rapid Sequencing of Heart Failure Therapy
by Zhongrui Zhou, Khalid Kardas, Ying Xuan Gue, Ali Najm, Anas Tirawi, Rachel Goode, Robert Frodsham, Rory Kavanagh, Archana Rao, Rebecca Dobson, David Wright and Matthew Kahn
J. Cardiovasc. Dev. Dis. 2025, 12(2), 50; https://doi.org/10.3390/jcdd12020050 - 28 Jan 2025
Viewed by 643
Abstract
The management of heart failure (HF) has undergone a paradigm shift from conventional stepwise methods of initiation and the up-titration of HF therapy towards an early, more intensive initiation of pharmacotherapy to improve the prognosis. The aim of this study was to compare [...] Read more.
The management of heart failure (HF) has undergone a paradigm shift from conventional stepwise methods of initiation and the up-titration of HF therapy towards an early, more intensive initiation of pharmacotherapy to improve the prognosis. The aim of this study was to compare the outcomes of patients at the Liverpool Heart and Chest Hospital (LHCH), with new diagnosis of HF, who were reviewed by the inpatient heart failure team (HFT), compared to patients that were not reviewed. A retrospective review of the electronic records of patients admitted with a new diagnosis of HF to the LHCH from May to December 2023 was performed. Admission drugs were similar, apart from betablockers, which were more frequent in the non-HFT group (58% vs. 24.2%; p = 0.002). The length of inpatient stay was longer in the HFT group (median 5.5 days vs. 3 days; p = 0.001) and more likely to be on all four pillars of HF medical therapy (96.8% vs. 0; p < 0.001) within 30 days of discharge. The 30-day and 6-month mortality outcomes were not significantly different. Patients reviewed by the HFT were significantly more likely to receive the four pillars of HF therapy within 30 days of their diagnosis compared to their counterparts at the expense of a longer length of stay. Full article
9 pages, 5726 KiB  
Communication
Mixed Reality (Holography)-Guided Minimally Invasive Cardiac Surgery—A Novel Comparative Feasibility Study
by Winn Maung Maung Aye, Laszlo Kiraly, Senthil S. Kumar, Ayyadarshan Kasivishvanaath, Yujia Gao and Theodoros Kofidis
J. Cardiovasc. Dev. Dis. 2025, 12(2), 49; https://doi.org/10.3390/jcdd12020049 - 27 Jan 2025
Viewed by 363
Abstract
The operative field and exposure in minimally invasive cardiac surgery (MICS) are limited. Meticulous preoperative planning and intraoperative visualization are crucial. We present our initial experience with HoloLens® 2 as an intraoperative guide during MICS procedures: aortic valve replacement (AVR) via right [...] Read more.
The operative field and exposure in minimally invasive cardiac surgery (MICS) are limited. Meticulous preoperative planning and intraoperative visualization are crucial. We present our initial experience with HoloLens® 2 as an intraoperative guide during MICS procedures: aortic valve replacement (AVR) via right anterior small thoracotomy, coronary artery bypass graft surgery (CABG) via left anterior small thoracotomy (LAST), and pulmonary valve replacement (PVR) via LAST. Three-dimensional (3D) segmentations were performed using the patient’s computer tomography (CT) data subsequently rendered into a 3D hologram on the HoloLens® 2. The holographic image was then superimposed on the patient lying on the operating table, using the xiphoid and the clavicle as landmarks, and was used as a real-time anatomical image guide for the surgery. The incision site marking made using HoloLens® 2 differed by one intercostal space from the marking made using a conventional surgeon’s mental reconstructed image from the patient’s preoperative imaging and was found to be a more appropriate site of entry into the chest for the structure of interest. The transparent visor of the HoloLens® 2 provided unobstructed views of the operating field. A mixed reality (MR) device could contribute to preoperative surgical planning and intraoperative real-time image guidance, which facilitates the understanding of anatomical relationships. MR has the potential to improve surgical precision, decrease risk, and enhance patient safety. Full article
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14 pages, 603 KiB  
Review
Coronary CT Angiography in the Emergency Department: State of the Art and Future Perspectives
by Antonio De Vita, Marcello Covino, Sara Pontecorvo, Giacomo Buonamassa, Angelo Giuseppe Marino, Riccardo Marano, Luigi Natale, Giovanna Liuzzo, Francesco Burzotta and Francesco Franceschi
J. Cardiovasc. Dev. Dis. 2025, 12(2), 48; https://doi.org/10.3390/jcdd12020048 - 27 Jan 2025
Viewed by 436
Abstract
About 5% of annual access to emergency departments (EDs) and up to 25–30% of hospital admissions involve patients with symptoms suggestive of acute coronary syndrome (ACS). The process of evaluating and treating these patients is highly challenging for clinicians because failing to correctly [...] Read more.
About 5% of annual access to emergency departments (EDs) and up to 25–30% of hospital admissions involve patients with symptoms suggestive of acute coronary syndrome (ACS). The process of evaluating and treating these patients is highly challenging for clinicians because failing to correctly identify an ACS can result in fatal or life-threatening consequences. However, about 50–60% of these patients who are admitted to the hospital because of chest pain are found to have no ACS. Coronary computed tomographic angiography (CCTA) has emerged as a proposed new frontline test for managing acute chest pain in the ED, particularly for patients with low-to-intermediate risk. This narrative review explores the potential of adopting an early CCTA-based approach in the ED, its significance in the era of high-sensitivity troponins, its application to high-risk patients and its prognostic value concerning atherosclerotic burden and high-risk plaque features. Additionally, we address clinical and technical issues related to CCTA use for triaging acute chest pain in the ED, as well as the role of functional testing. Finally, we aim to provide insight into future perspectives for the clinical application of CCTA in the ED. Full article
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18 pages, 2514 KiB  
Article
Prevalence of Multimorbidity in Lithuania: Insights from National Health Insurance Fund Data
by Dovilė Ramanauskaitė, Roma Puronaitė, Audronė Jakaitienė and Sigita Glaveckaitė
J. Cardiovasc. Dev. Dis. 2025, 12(2), 47; https://doi.org/10.3390/jcdd12020047 - 26 Jan 2025
Viewed by 552
Abstract
(1) Background: As the burden of multimorbidity is increasing worldwide, little is known about its prevalence in Lithuania. We aimed to estimate the prevalence of chronic conditions and multimorbidity among Lithuanian adults and assess their impact on healthcare utilization. (2) Methods: [...] Read more.
(1) Background: As the burden of multimorbidity is increasing worldwide, little is known about its prevalence in Lithuania. We aimed to estimate the prevalence of chronic conditions and multimorbidity among Lithuanian adults and assess their impact on healthcare utilization. (2) Methods: A retrospective analysis of the Lithuanian National Health Insurance Fund database was performed in 2019. Multimorbidity was defined as having two or more chronic conditions. (3) Results: Of the Lithuanian population, 1,193,668 (51.5%) had at least one chronic condition, and 717,386 (31.0%) had multimorbidity. Complex multimorbidity (CM) was present in 670,312 (28.9%) patients, with 85.0% having complex cardiac multimorbidity (CCM) and 15.0% having complex non-cardiac multimorbidity (CNM). Multimorbidity increased with age, from 2% at age 18–24 to 77.5% at age 80 and above, and was more prevalent among women (63.3% vs. 36.7%, p < 0.001). One-third of multimorbid patients were hospitalized at least once per year, with half staying for a week or longer. CCM patients were more likely to be hospitalized, rehospitalized, and have more primary care visits (OR: 2.23, 1.60, 4.24, respectively, all p < 0.001). (4) Conclusions: Multimorbidity in Lithuania increases with age and affects women more. Chronic cardiovascular diseases contribute to a higher prevalence of multimorbidity and a more significant burden on the healthcare system. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
19 pages, 880 KiB  
Review
Diagnosis and Management of Hypertensive Heart Disease: Incorporating 2023 European Society of Hypertension and 2024 European Society of Cardiology Guideline Updates
by Brian Xiangzhi Wang
J. Cardiovasc. Dev. Dis. 2025, 12(2), 46; https://doi.org/10.3390/jcdd12020046 - 26 Jan 2025
Viewed by 693
Abstract
Hypertensive heart disease (HHD) continues to be a leading cause of cardiovascular morbidity and mortality worldwide, necessitating the evolution of evidence-based management strategies. This literature review examines the most recent updates from the 2023 and 2024 hypertension guidelines issued by the European Society [...] Read more.
Hypertensive heart disease (HHD) continues to be a leading cause of cardiovascular morbidity and mortality worldwide, necessitating the evolution of evidence-based management strategies. This literature review examines the most recent updates from the 2023 and 2024 hypertension guidelines issued by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). These guidelines are compared with previous key recommendations, such as the 2017 American College of Cardiology/American Heart Association guidelines and the 2018 ESC/ESH guidelines. The updated recommendations reflect a paradigm shift in the approach to hypertension diagnosis and management, including a stricter systolic blood pressure (BP) target of 120–129 mmHg, which underscores the importance of early and precise BP control. The difference between the classification of “elevated BP” and hypertension in the ESC versus ESH guidelines, particularly, regarding their implications for early detection and prevention of HHD, are critically examined, highlighting areas of clinical and academic debate. The introduction of a new “elevated BP” category (120–139/70–89 mmHg) highlights a proactive strategy aimed at identifying at-risk individuals earlier in the disease course to prevent progression to HHD. Additionally, the divergent roles of hypertension-mediated organ damage (HMOD), including HHD, in risk stratification as recommended by the ESC and ESH are discussed, emphasising their significance in tailoring management approaches. For patients with resistant hypertension, the 2023 and 2024 updates also endorse innovative therapies, such as renal denervation, an interventional procedure that has demonstrated significant promise in managing treatment-resistant cases. This review synthesises these updates, focusing on their implications for clinical practice in diagnosing and managing HHD. By emphasising aggressive intervention and the integration of novel treatment modalities, the review aims to bridge existing gaps in earlier approaches to hypertension management. The critical evaluation of guideline discrepancies and evolving evidence seeks to provide clinicians with a nuanced understanding to optimise outcomes for patients with HHD, particularly considering emerging therapeutic possibilities and more stringent BP control targets. Full article
(This article belongs to the Special Issue Contemporary Diagnosis and Management of Hypertensive Heart Disease)
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6 pages, 1751 KiB  
Case Report
A Rare Case of an Intracardial Ectopic Thyroid in the Right Ventricle
by Chuangwei Wei, Ying Zhao, Yanting Song, Dongting Liu, Nan Zhang, Jiayi Liu, Zhonghua Sun, Zhaoying Wen and Lei Xu
J. Cardiovasc. Dev. Dis. 2025, 12(2), 45; https://doi.org/10.3390/jcdd12020045 - 26 Jan 2025
Viewed by 302
Abstract
The ectopic thyroid gland is an abnormal development of the embryo. Most of the ectopic thyroid occurs in the path around the thyroglossal duct or on the lateral side of the neck. However, ectopic thyroid occurs in the heart, which is rare. We [...] Read more.
The ectopic thyroid gland is an abnormal development of the embryo. Most of the ectopic thyroid occurs in the path around the thyroglossal duct or on the lateral side of the neck. However, ectopic thyroid occurs in the heart, which is rare. We report a case of right ventricular ectopic thyroid. This case highlights the imaging characteristics of computed tomography (CT) and cardiac magnetic resonance (CMR) and discusses the underlying mechanisms for a timely diagnosis. Full article
(This article belongs to the Section Imaging)
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14 pages, 3282 KiB  
Article
Bioprostheses and Mechanical Prostheses for Aortic Valve Replacement in Patients Aged 50 to 65 Years Offer Similar Long-Term Survival Rates
by Tomáš Toporcer, Štefan Lukačín, Andrea Kraus, Marián Homola, Anton Bereš, Michal Trebišovský, Denis Radótzy, Vilém Rohn and Adrián Kolesár
J. Cardiovasc. Dev. Dis. 2025, 12(2), 44; https://doi.org/10.3390/jcdd12020044 - 26 Jan 2025
Viewed by 314
Abstract
Background: Aortic valve replacement (AVR) is the definitive therapy for patients with severe aortic valve stenosis (AoS). The aim of this work is to compare the effect of a mechanical prosthesis (MP) and a bioprosthesis (BP) on the survival of patients aged 50–65 [...] Read more.
Background: Aortic valve replacement (AVR) is the definitive therapy for patients with severe aortic valve stenosis (AoS). The aim of this work is to compare the effect of a mechanical prosthesis (MP) and a bioprosthesis (BP) on the survival of patients aged 50–65 years after AVR. Methods: The retrospective analysis included 276 patients aged 50 to 65 years who had undergone isolated AVR for AoS; 161 patients were implanted with an MP and 115 with a BP. Patient survival, adjusted for age, gender and risk parameters affecting survival, was assessed. A subgroup analysis was performed on the 208 patients with a modern valve (prosthesis models that are no longer used in clinical practice were removed from the sample). Results: After adjusting for risk factors for overall survival as well as for age and sex, the implantation of an MP did not have a significant effect on overall survival in comparison to a BP, at a median follow-up of 10.3 years (p = 0.477). The size of the MP had no significant effect on overall survival either (HR: 1.29; 95%CI: 0.16–10.21; p = 0.812). However, the indexed effective orifice area of the BP had a positive effect on overall survival (HR: 0.09; 95%CI: 0.01–0.78; p = 0.029). Conclusions: The estimated survival of patients aged between 50 and 65 years after implantation of a BP with a sufficiently large indexed effective orifice area may exceed that of patients with an MP. Full article
(This article belongs to the Section Cardiac Surgery)
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22 pages, 9934 KiB  
Review
Pregnancy-Related Cardiovascular Diseases: A Radiological Overview
by Francesco Lauriero, Giulia Mazza, Alessio Perazzolo, Giacomo Ottoni, Alessia Cipriani, José F. Castro Pereira, Riccardo Marano and Luigi Natale
J. Cardiovasc. Dev. Dis. 2025, 12(2), 43; https://doi.org/10.3390/jcdd12020043 - 25 Jan 2025
Viewed by 488
Abstract
Pregnancy induces significant hemodynamic changes, and cardiovascular diseases (CVDs) are one of the leading causes of non-obstetric maternal morbidity and mortality during pregnancy or the postpartum period in developed countries. The effective diagnosis and management of CVDs in pregnant women require a thorough [...] Read more.
Pregnancy induces significant hemodynamic changes, and cardiovascular diseases (CVDs) are one of the leading causes of non-obstetric maternal morbidity and mortality during pregnancy or the postpartum period in developed countries. The effective diagnosis and management of CVDs in pregnant women require a thorough evaluation that considers the health of both the mother and the fetus. Imaging plays a pivotal role in this evaluation, offering essential insights into the most significant pregnancy-related CVDs. However, due to concerns about fetal exposure, the use of contrast agents and radiation exposure must be carefully managed. Following to the principle of “As Low As Reasonably Achievable” (ALARA), strategies to minimize these risks are crucial for ensuring patient safety while maintaining diagnostic accuracy. This review highlights the contribution of cardiovascular imaging techniques, particularly computed tomography (CT) and magnetic resonance imaging (MRI), in the assessment of common pregnancy-related CVDs, and outlines strategies to reduce radiation exposure and limit contrast agent use when feasible, aiming to increase radiologists’ awareness of this crucial topic. Full article
(This article belongs to the Special Issue Women and Cardiovascular Disease: The Gender Gap)
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14 pages, 1506 KiB  
Review
Mitochondrial Dysfunction in Congenital Heart Disease
by Julie Pires Da Silva, Mariana Casa de Vito, Carissa Miyano and Carmen C. Sucharov
J. Cardiovasc. Dev. Dis. 2025, 12(2), 42; https://doi.org/10.3390/jcdd12020042 - 25 Jan 2025
Viewed by 448
Abstract
Mitochondria play a crucial role in multiple cellular processes such as energy metabolism, generation of reactive oxygen species, excitation–contraction coupling, cell survival and death. Dysfunction of mitochondria contributes to the development of cancer; neuromuscular, cardiovascular/congenital heart disease; and metabolic diseases, including diabetes. Mitochondrial [...] Read more.
Mitochondria play a crucial role in multiple cellular processes such as energy metabolism, generation of reactive oxygen species, excitation–contraction coupling, cell survival and death. Dysfunction of mitochondria contributes to the development of cancer; neuromuscular, cardiovascular/congenital heart disease; and metabolic diseases, including diabetes. Mitochondrial dysfunction can result in excessive reactive oxygen species, a decrease in energy production, mitophagy and apoptosis. All these processes are known to be dysregulated in cardiovascular diseases. The focus of this review is to summarize our current knowledge of mitochondrial dysfunction, including mitophagy and apoptosis, in pediatric congenital heart disease due to maternal diabetes or due to structural cardiac defects, with a focus on single-ventricle congenital heart disease. We also discuss recent mitochondria-targeted therapies for cardiovascular diseases. Full article
(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)
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16 pages, 417 KiB  
Article
Cardiovascular Outcomes in Hospitalized Patients with COVID-19: Does Age Really Matter?
by Alex Sotomayor-Julio, Manuela Escalante, Yorlany Rodas-Cortes, Andrea Alejandra Arteaga-Tobar, Andrea Valencia, Fernando Wyss, Roger Martín Correa, Paola Oliver, Wilbert Yabar Galindo, Jessica Mercedes, Alejandra Inés Christen, Iván Criollo, Juan Martin Brunialti, Carlos Eduardo Montenegro, Pedro Schwartzmann, Eglee Castillo, Freddy Pow Chong, Claudia Almonte, Cesar Herrera and Juan Esteban Gomez-Mesa
J. Cardiovasc. Dev. Dis. 2025, 12(2), 41; https://doi.org/10.3390/jcdd12020041 - 24 Jan 2025
Viewed by 498
Abstract
Background: An advanced age elevates risk for COVID-19-related cardiovascular complications and mortality. This study analyzes cardiovascular comorbidities and outcomes in hospitalized COVID-19 patients across age groups to assess its impact. Methods: The CARDIO COVID 19-20 registry is a prospective, multicenter cohort study of [...] Read more.
Background: An advanced age elevates risk for COVID-19-related cardiovascular complications and mortality. This study analyzes cardiovascular comorbidities and outcomes in hospitalized COVID-19 patients across age groups to assess its impact. Methods: The CARDIO COVID 19-20 registry is a prospective, multicenter cohort study of hospitalized SARS-CoV-2 patients across 44 institutions in 14 Latin American countries. Patients were categorized into four age groups, Group 1: under 40 years, Group 2: 40 to 64 years, Group 3: 65 to 79 years, and Group 4: 80 years or older. Results: A total of 3260 patients were included. A total of 36.8% were women, and key comorbidities included overweight/obesity (49.7% [G1: 48.9%, G2: 56.3%, G3: 45.6%, G4: 32.7%]), and hypertension (49% [G1: 11.3%, G2: 40.3%, G3: 67.9%, G4: 80.4%]). Primary cardiovascular complications during hospitalization were arrhythmias (9.1% [G1: 3.4%, G2: 6.1%, G3: 14.9%, G4: 12.9%]), and acute heart failure (8.5% [G1: 3.6%, G2: 6.1%, G3: 12.1%, and G4: 15.2%]). In our cohort, 53.5% of the patients were admitted to the intensive care unit (G1: 49.2%, G2: 57%, G3: 55.3%, G4: 38.3%). In-hospital mortality rose significantly in patients aged 65 and older; G3: 334 (34.7%) and G4: 156 (45.6%) (p value: <0.001). Conclusions: In Latin American COVID-19 patients, older age correlates with more comorbidities, cardiovascular complications, and higher in-hospital and 30-day mortality, indicating age as an independent mortality factor. Full article
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12 pages, 1800 KiB  
Article
Expiration-Triggered Sinus Arrhythmia Predicts Mortality Risk in the General Elderly Population
by Ralf Josef Dirschinger, Alexander Müller, Alexander Steger, Karl-Ludwig Laugwitz, Petra Barthel, Georg Schmidt and Daniel Sinnecker
J. Cardiovasc. Dev. Dis. 2025, 12(2), 40; https://doi.org/10.3390/jcdd12020040 - 24 Jan 2025
Viewed by 380
Abstract
Reduced respiratory sinus arrhythmia, quantified as expiration-triggered sinus arrhythmia (ETA) from simultaneous electrocardiogram and respiration recordings, is a strong long-term mortality predictor in myocardial infarction survivors. Here, we investigated whether ETA also predicts mortality risk in the general elderly population. ETA was quantified [...] Read more.
Reduced respiratory sinus arrhythmia, quantified as expiration-triggered sinus arrhythmia (ETA) from simultaneous electrocardiogram and respiration recordings, is a strong long-term mortality predictor in myocardial infarction survivors. Here, we investigated whether ETA also predicts mortality risk in the general elderly population. ETA was quantified from 30-min electrocardiogram and respiration recordings in 1788 general population subjects aged ≥60 years, who were then followed for a median of 4.0 years (median age 72 years, 58% female). Four-year all-cause mortality was 4.6%. Abnormal ETA using a predefined cutoff (≤0.19 ms) was associated with a 4-year mortality of 6.9%, compared to 3.7% in the remaining participants (p = 0.0022). ETA remained a significant mortality predictor in multivariable Cox analysis, also considering a modified Framingham score incorporating sex, age, smoking, cholesterol, blood pressure, antihypertensive medication, family history, diabetes and clinical atherosclerosis (multivariable hazard ratio 1.81; 95% confidence interval 1.17–2.81; p = 0.008). Combined risk prediction by ETA (using an optimized cutoff of ≤0.86 ms) and the Framingham score stratified patients into a low-risk (both parameters normal), an intermediate-risk (one parameter abnormal) and a high-risk group (both parameters abnormal), with 4-year mortality rates of 1.9%, 4.4% and 10.1%, respectively. We conclude that in elderly general population subjects, ETA is a mortality risk predictor that complements classical clinical risk stratification. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
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14 pages, 724 KiB  
Article
Key Factors of Adherence in Cardiological Follow-Up of Adults with Congenital Heart Disease
by Anna-Lena Ehmann, Emily Schütte, Janina Semmler, Felix Berger, Ulrike M. M. Bauer, Katharina Schmitt, Constanze Pfitzer and Paul C. Helm
J. Cardiovasc. Dev. Dis. 2025, 12(2), 39; https://doi.org/10.3390/jcdd12020039 - 24 Jan 2025
Viewed by 437
Abstract
Approximately 50% of adults with congenital heart defects (ACHD) lack specialised CHD care, increasing the risk of preventable complications and mortality. While there is evidence that psychological factors significantly influence adherence, predictors of attending cardiological routine examinations in ACHD remain understudied. This is [...] Read more.
Approximately 50% of adults with congenital heart defects (ACHD) lack specialised CHD care, increasing the risk of preventable complications and mortality. While there is evidence that psychological factors significantly influence adherence, predictors of attending cardiological routine examinations in ACHD remain understudied. This is the first German study to examine psychological and sociodemographic predictors of adherence in ACHD using the Common-Sense Model of Self-Regulation as a framework. A total of N = 1136 participants from the National Register for Congenital Heart Defects were analysed. Sociodemographic and psychological factors (illness perception, illness identity, emotion regulation and psychological distress) were recorded as predictors of the subjective importance of regular cardiological check-ups and the actual utilisation frequency. The results indicate that of the sociodemographic factors, only age is relevant for the subjective importance, while net income influences the actual utilisation of cardiological examinations. In contrast, several psychological aspects of illness perception, such as perceived treatment benefit, and illness identity play a role for both adherence measures, as do depressive symptoms for the frequency of examinations. Our results highlight the importance of addressing psychological factors and providing clear information about the benefits of cardiological care to improve adherence in ACHD and thereby reduce secondary diseases. Full article
(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)
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15 pages, 2781 KiB  
Review
Feeding Approach to Optimizing Nutrition in Infants with Congenital Heart Disease
by Belinda Chan, Anne Woodbury, Libbi Hazelwood and Yogen Singh
J. Cardiovasc. Dev. Dis. 2025, 12(2), 38; https://doi.org/10.3390/jcdd12020038 - 22 Jan 2025
Viewed by 659
Abstract
Congenital heart disease (CHD) affects 1% of live births globally. Infants with CHD often experience growth faltering and malnutrition due to increased metabolic demands, malabsorption, and feeding intolerance, further worsened by surgical interventions and frequent hospitalizations. Malnutrition in this population is linked to [...] Read more.
Congenital heart disease (CHD) affects 1% of live births globally. Infants with CHD often experience growth faltering and malnutrition due to increased metabolic demands, malabsorption, and feeding intolerance, further worsened by surgical interventions and frequent hospitalizations. Malnutrition in this population is linked to higher morbidity, extended hospital stays, and poor neurodevelopmental outcomes. The physiological diversity among CHD types presents significant challenges in developing a universal feeding strategy to optimize nutrition. This narrative review explores the interplay between CHD physiology and nutritional management. CHD types could be categorized into three hemodynamic groups—systemic hypoperfusion, global hypoxia, and pulmonary overcirculation—which help to consider a feeding approach based on such physiology. Nutritional management in these infants could be further tailored based on the disease severity, co-morbidities, and evolving hemodynamic changes. Based on clinical opinions, this review proposes a hemodynamic-focused risk-stratified feeding approach, considering ways that may enhance growth while possibly minimizing complications such as necrotizing enterocolitis (NEC), pulmonary overload, and worsening heart failure. This approach may help individualize nutritional management to address the complex needs of infants with CHD. Further quality improvement studies are needed to assess this approach. Beyond meeting macronutrient needs, micronutrients, including zinc, thiamine, magnesium, vitamin A, and calcium, potentially play a role in cardiovascular health. Given the complexity of nutritional management in these infants, a multidisciplinary team may be needed to optimize care, including cardiologists, neonatologists, pediatricians, dietitians, speech therapists, and pharmacists. With the current knowledge gap and lack of strong evidence, research should focus on nutritional interventions and study their potential impact on infant outcomes with CHDs. Full article
(This article belongs to the Special Issue Heart Diseases in Children)
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13 pages, 1177 KiB  
Article
High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study
by Thomas Rueskov Andersen, Katrine Schultz Overgaard, Laurits Juhl Heinsen, Roda Abdulkadir Mohamed, Freja Sønder Madsen, Helle Precht, Jess Lambrechtsen, Søren Auscher and Kenneth Egstrup
J. Cardiovasc. Dev. Dis. 2025, 12(2), 37; https://doi.org/10.3390/jcdd12020037 - 22 Jan 2025
Viewed by 451
Abstract
Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with [...] Read more.
Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with IGT and normal glucose tolerance (NGT) in patients suspected for stable CAD. Coronary computed tomography angiography (CCTA) identified LAP lesions and assessed plaque volumes, burdens, and high-risk plaque features. Glycemic tolerance was stratified using oral glucose tolerance tests. Among 148 patients, 202 LAP lesions were identified, with 93 patients classified as NGT and 55 as IGT. Patients with IGT had a significantly higher prevalence of LAP lesions compared with NGT (p = 0.007). LAP volume was higher in IGT (16.46 ± 12.52 mm3) compared with NGT (12.66 ± 9.72 mm3, p = 0.01), but this association did not persist in multivariate analysis. The LAP burden was greater in IGT (10.79 ± 6.84%) than NGT (8.62 ± 5.93%, p = 0.02), and the napkin-ring sign was more frequent in IGT (12%) versus NGT (5%, p = 0.02); these associations remained significant in multivariate analysis. Patients with IGT had a higher LAP burden and higher frequency of napkin-ring signs. These findings may help explain the common occurrence of prediabetes in patients with acute myocardial infarction. Full article
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21 pages, 4995 KiB  
Article
Ontogeny of Fetal Cardiometabolic Pathways: The Potential Role of Cortisol and Thyroid Hormones in Driving the Transition from Preterm to Near-Term Heart Development in Sheep
by Reza Amanollahi, Stacey L. Holman, Melanie R. Bertossa, Ashley S. Meakin, Kent L. Thornburg, I. Caroline McMillen, Michael D. Wiese, Mitchell C. Lock and Janna L. Morrison
J. Cardiovasc. Dev. Dis. 2025, 12(2), 36; https://doi.org/10.3390/jcdd12020036 - 21 Jan 2025
Viewed by 527
Abstract
Understanding hormonal and molecular changes during the transition from preterm to near-term gestation is essential for investigating how pregnancy complications impact fetal heart development and contribute to long-term cardiovascular risks for offspring. This study examines these cardiac changes in fetal sheep, focusing on [...] Read more.
Understanding hormonal and molecular changes during the transition from preterm to near-term gestation is essential for investigating how pregnancy complications impact fetal heart development and contribute to long-term cardiovascular risks for offspring. This study examines these cardiac changes in fetal sheep, focusing on the changes between 116 days (preterm) and 140 days (near term) of gestation (dG, term = 150) using Western blotting, LC-MS/MS, and histological techniques. We observed a strong correlation between cortisol and T3 (Triiodothyronine) in heart tissue in near-term fetuses, highlighting the role of glucocorticoid signalling in fetal heart maturation. Protein expression patterns in the heart revealed a decrease in multiple glucocorticoid receptor isoforms (GRα-A, GR-P, GR-A, GRα-D2, and GRα-D3), alongside a decrease in IGF-1R (a marker of cardiac proliferative capacity) and p-FOXO1(Thr24) but an increase in PCNA (a marker of DNA replication), indicating a shift towards cardiomyocyte maturation from preterm to near term. The increased expression of proteins regulating mitochondrial biogenesis and OXPHOS complex 4 reflects the known transition from glycolysis to oxidative phosphorylation, essential for meeting the energy demands of the postnatal heart. We also found altered glucose transporter expression, with increased pIRS-1(ser789) and GLUT-4 but decreased GLUT-1 expression, suggesting improved insulin responsiveness as the heart approaches term. Notably, the reduced protein abundance of SIRT-1 and SERCA2, along with increased phosphorylation of cardiac Troponin I(Ser23/24), indicates adaptations for more energy-efficient contraction in the near-term heart. In conclusion, these findings show the complex interplay of hormonal, metabolic, and growth changes that regulate fetal heart development, providing new insights into heart development that are crucial for understanding pathological conditions at birth and throughout life. Full article
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7 pages, 218 KiB  
Perspective
From a Few Cardiovascular Risk Factors to the Prediction of Age at Death: The Shifting Interests of Cardiovascular Epidemiologists
by Alessandro Menotti and Paolo Emilio Puddu
J. Cardiovasc. Dev. Dis. 2025, 12(2), 35; https://doi.org/10.3390/jcdd12020035 - 21 Jan 2025
Viewed by 483
Abstract
We describe the changing research interests and goals of the responsible investigators of the Italian Rural Areas (IRA) of the Seven Countries Study of cardiovascular diseases (CVD) during a period of 60 years, dealing with a cohort of middle-aged men. Our initial interest [...] Read more.
We describe the changing research interests and goals of the responsible investigators of the Italian Rural Areas (IRA) of the Seven Countries Study of cardiovascular diseases (CVD) during a period of 60 years, dealing with a cohort of middle-aged men. Our initial interest was to discover the basic risk factors of coronary heart disease (CHD). Subsequently, the same problem was tackled regarding stroke and heart diseases of uncertain etiology. Later on, cancer deaths also became an end-point for which risk factors were investigated. The long duration of the study and the fact that CVD and cancer fatalities already cover 70% of all-cause mortality prompted the idea to focus on all-cause mortality, and particularly on age-at-death when the follow-up period reached 61 years together with the extinction of the cohort. At that point, a larger number of risk factors measured at baseline, including those which were unable to predict CVD, became the determinants of all-cause mortality and age-at-death, a metric that summarizes the life-span of health and disease. This study is supported by the presentation of data derived from published papers. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
13 pages, 822 KiB  
Article
Coronary Artery Disease in Very Young Women: Risk Factors and Prognostic Insights from Extended Follow-Up
by Samuel Pintos-Rodríguez, Víctor Alfonso Jiménez Díaz, César Veiga, Carlos Martínez García, Francisco Caamaño Isorna, Andrés Íñiguez Romo and Pablo Juan-Salvadores
J. Cardiovasc. Dev. Dis. 2025, 12(2), 34; https://doi.org/10.3390/jcdd12020034 - 21 Jan 2025
Viewed by 524
Abstract
Coronary artery disease (CAD) is usually associated with the elderly, but an increase in its incidence has been recently reported among young people, including very young women. The aim of this study is to assess the associations between different clinical variables and the [...] Read more.
Coronary artery disease (CAD) is usually associated with the elderly, but an increase in its incidence has been recently reported among young people, including very young women. The aim of this study is to assess the associations between different clinical variables and the risk of early CAD and occurrence of major adverse cardiovascular events (MACEs) during follow-up. Our cohort consists of women ≤40 years referred for coronary angiography due to suspicion of CAD; a nested case–control study was conducted among these patients. In total, 19,321 coronary angiographies were performed between 2006 and 2015, of which 2.6% were in patients ≤40 years old; 52 women were finally included. Family history of CAD was strongly associated with the early onset of the disease [OR 5.94, 95%CI (1.13–31.15); p = 0.035] in young women. The incidence of MACE was also associated with depression [HR 8.20 95%CI (1.03–65.17); p = 0.047] and Castelli Index [HR 11.49, 95%CI (1.40–94.51); p = 0.023]. Primary prevention focused on genetic analysis for high-risk women with a family history of CAD and secondary prevention, targeting a better cholesterol management and mental health assistance must be considered. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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