Journal of Cardiovascular Development and Disease

9 pages, 800 KiB

Open AccessReview

Comprehensive Self-Management of Heart Failure

by Shunsuke Kiuchi, Shigeto Tsukamoto, Rie Sato, Keisuke Hosono, Jun Okuda, Makoto Natsumeda, Mitsuharu Kawamura, Hideaki Tachibana, Takashi Okada, Takuro Takagi, Yasushi Taniguchi, Jiro Ando, Yutaka Koyama, Toshiro Shinke and Takanori Ikeda

J. Cardiovasc. Dev. Dis. 2025, 12(3), 107; https://doi.org/10.3390/jcdd12030107 - 20 Mar 2025

Viewed by 316

Abstract

In response to the heart failure (HF) pandemic, it is important to introduce appropriate pharmacological and non-pharmacological treatments for HF patients. In addition, self-management of HF, including the continuation of appropriate pharmacological treatment, is also important. There have been many reports on self-management [...] Read more.

In response to the heart failure (HF) pandemic, it is important to introduce appropriate pharmacological and non-pharmacological treatments for HF patients. In addition, self-management of HF, including the continuation of appropriate pharmacological treatment, is also important. There have been many reports on self-management of HF. However, the effectiveness of patient education of HF is not consistent. One of the reasons may be whether the tools used are common or not. Moreover, unified systems of HF patient education and disease management in metropolitan areas are rare. We began joint HF patient education and disease management in the Tokyo southern medical district (JONAN Heart Failure Medical Collaboration: JHFeC). Patients undergo a multidisciplinary HF education program at JHFeC member hospitals to ensure that they are able to adequately record information on the self-management sheet. After discharge, the continuity of self-management will be evaluated, and further education will be provided if necessary. HF patient education is important even in severe HF requiring a left ventricular assist device, and such patient education needs to be provided appropriately in all manner of HF patients with stage A to D. Full article

(This article belongs to the Special Issue Feature Review Papers in Cardiovascular Clinical Research)

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11 pages, 1077 KiB

Open AccessReview

Myocardial Viability: Evolving Insights and Challenges in Revascularization and Functional Recovery

by Kristoffer Ken Ralota, Jamie Layland, Kyi Thar Han Win and Nay M. Htun

J. Cardiovasc. Dev. Dis. 2025, 12(3), 106; https://doi.org/10.3390/jcdd12030106 - 20 Mar 2025

Viewed by 462

Abstract

The prevalence of heart failure, driven significantly by ischemic heart disease, continues to rise globally. Myocardial viability—the potential ability of dysfunctional myocardium to recover contractile function after revascularization—remains an ongoing key area of research in managing ischemic cardiomyopathy. Advances in imaging modalities, including [...] Read more.

The prevalence of heart failure, driven significantly by ischemic heart disease, continues to rise globally. Myocardial viability—the potential ability of dysfunctional myocardium to recover contractile function after revascularization—remains an ongoing key area of research in managing ischemic cardiomyopathy. Advances in imaging modalities, including PET/SPECT, cardiac MRI, and dobutamine stress echocardiography, have enabled identification of viable myocardium that can potentially predict their functional recovery following revascularization. Despite these advances, recent evidence from major trials questions the routine reliance on viability testing for revascularization guidance. These studies found a limited correlation between myocardial viability and improved outcomes in key metrics including mortality. Furthermore, they highlighted the effectiveness of guideline-directed medical therapy in improving left ventricular function independent of revascularization. This narrative review explores the concept of myocardial viability, its assessment through contemporary imaging techniques, its clinical utility in decision making for revascularization, and future directions. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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12 pages, 853 KiB

Open AccessArticle

Gastrointestinal Bleeding During Long-Term Left Ventricular Assist Device Support: External Validation of UTAH Bleeding Risk Score

by Giuseppe Vadalà, Cristina Madaudo, Alessandra Fontana, Vincenzo Sucato, Gioele Bicelli, Laura Maniscalco, Antonio Luca Maria Parlati, Giovanna Panarello, Sergio Sciacca, Michele Pilato, Manlio Cipriani and Alfredo Ruggero Galassi

J. Cardiovasc. Dev. Dis. 2025, 12(3), 105; https://doi.org/10.3390/jcdd12030105 - 19 Mar 2025

Viewed by 258

Abstract

Background: Gastrointestinal bleeding (GIB) is a common complication of left ventricular assist device (LVAD) support. The UTAH bleeding risk score (UBRS) is the only dedicated GIB prediction model, but its efficacy has not been confirmed in an external validation cohort. Furthermore, the reliability [...] Read more.

Background: Gastrointestinal bleeding (GIB) is a common complication of left ventricular assist device (LVAD) support. The UTAH bleeding risk score (UBRS) is the only dedicated GIB prediction model, but its efficacy has not been confirmed in an external validation cohort. Furthermore, the reliability of other bleeding risk scores, such as ARC-HBR and HASBLED, has never been tested in this specific population. This study aims to validate the UBRS and compare its accuracy with the ARC-HBR and HASBLED scores. Methods: Major adverse events (MAEs) and bleeding events of 75 consecutive patients who had undergone LVAD implantation between 2010 and 2021 at a referral hospital for a heart transplant were retrospectively analyzed. The accuracy of the UBRS, ARC-HBR and HASBLED scores was evaluated using a ROC curve model. Results: At a mean follow-up of 905.9 ± 724 days, 58 (77.3%) patients had an MAE and 28 (37.3%) had a major bleeding event. Out of the 39 major bleeding events, the majority were GI (43%) and intracranial bleeding (33.3%). Compared with patients without major bleeding, those who experienced major bleeding showed a lower survival probability, regardless of the nature of the bleeding (GIB vs. other bleeding events). The UBRS effectively stratified the bleeding risk with an AUC of 0.86. In contrast, the ARC-HBR and HASBLED scores demonstrated lower discriminatory power, with AUCs of 0.61 and 0.52, respectively. Conclusions: UBRS accuracy was confirmed in our study population. Gastrointestinal bleeding is a common life-threatening complication and one of the main causes of re-hospitalization during VAD support, leading to a lower patient survival probability. Full article

(This article belongs to the Section Basic and Translational Cardiovascular Research)

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23 pages, 1518 KiB

Open AccessReview

Transition to Advanced Heart Failure: From Identification to Improving Prognosis

by Nikolaos-Iason Tepetes, Christos Kourek, Adamantia Papamichail, Andrew Xanthopoulos, Peggy Kostakou, Ioannis Paraskevaidis and Alexandros Briasoulis

J. Cardiovasc. Dev. Dis. 2025, 12(3), 104; https://doi.org/10.3390/jcdd12030104 - 17 Mar 2025

Viewed by 758

Abstract

Advanced heart failure (AHF) represents the terminal stage of heart failure (HF), characterized by persistent symptoms and functional limitations despite optimal guideline-directed medical therapy (GDMT). This review explores the clinical definition, pathophysiology, and therapeutic approaches for AHF. Characterized by severe symptoms, New York [...] Read more.

Advanced heart failure (AHF) represents the terminal stage of heart failure (HF), characterized by persistent symptoms and functional limitations despite optimal guideline-directed medical therapy (GDMT). This review explores the clinical definition, pathophysiology, and therapeutic approaches for AHF. Characterized by severe symptoms, New York Heart Association (NYHA) class III-IV, significant cardiac dysfunction, and frequent hospitalizations, AHF presents substantial challenges in prognosis and management. Pathophysiological mechanisms include neurohormonal activation, ventricular remodeling, and systemic inflammation, leading to reduced cardiac output and organ dysfunction. Therapeutic strategies for AHF involve a multidisciplinary approach, including pharmacological treatments, device-based interventions like ventricular assisted devices, and advanced options such as heart transplantation. Despite progress, AHF management faces limitations, including disparities in access to care and the need for personalized approaches. Novel therapies, artificial intelligence, and remote monitoring technologies offer future opportunities to improve outcomes. Palliative care, which focuses on symptom relief and quality of life, remains crucial for patients ineligible for invasive interventions. Early identification and timely intervention are pivotal for enhancing survival and functional outcomes in this vulnerable population. This review underscores the necessity of integrating innovative technologies, personalized medicine, and robust palliative strategies into AHF management to address its high morbidity and mortality. Full article

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17 pages, 1433 KiB

Open AccessArticle

Prevalence and Correlates of Dilated and Non-Dilated Left Ventricular Cardiomyopathy in Transfusion-Dependent Thalassemia: Data from a National, Multicenter, Observational Registry

by Antonella Meloni, Laura Pistoia, Anna Spasiano, Francesco Sorrentino, Giuseppe Messina, Michele Santodirocco, Zelia Borsellino, Valerio Cecinati, Vincenzo Positano, Gennaro Restaino, Nicolò Schicchi, Emanuele Grassedonio, Antonino Vallone, Michele Emdin, Alberto Clemente and Andrea Barison

J. Cardiovasc. Dev. Dis. 2025, 12(3), 103; https://doi.org/10.3390/jcdd12030103 - 16 Mar 2025

Viewed by 453

Abstract

We investigated the prevalence, clinical characteristics, and prognostic role of dilated cardiomyopathy (DCM) and non-dilated left ventricular cardiomyopathy (NDLVC) in patients with transfusion-dependent β-thalassemia (β-TDT). We retrospectively included 415 β-TDT patients who underwent cardiovascular magnetic resonance to quantify myocardial iron overload (MIO) and [...] Read more.

We investigated the prevalence, clinical characteristics, and prognostic role of dilated cardiomyopathy (DCM) and non-dilated left ventricular cardiomyopathy (NDLVC) in patients with transfusion-dependent β-thalassemia (β-TDT). We retrospectively included 415 β-TDT patients who underwent cardiovascular magnetic resonance to quantify myocardial iron overload (MIO) and biventricular function parameters and to detect replacement myocardial fibrosis. Demographic and laboratory parameters were comparable among patients with no overt cardiomyopathy (NOCM; n = 294), DCM (n = 12), and NDLVC (n = 109), while cardiac size and systolic function were significantly different. Compared to NOCM patients, DCM and NDLVC patients had a higher prevalence of MIO and replacement myocardial fibrosis. During a mean follow-up of 57.03 ± 18.01 months, cardiac complications occurred in 32 (7.7%) patients: 15 heart failures, 15 supraventricular arrhythmias, and 2 pulmonary hypertensions. Compared to the NOCM group, both the NDLVC and the DCM groups were associated with a significantly increased risk of cardiac complications (hazard ratio = 4.26 and 8.81, respectively). In the multivariate analysis, the independent predictive factors were age, MIO, and the presence of DCM and NDLVC versus the NOCM phenotype. In β-TDT, the detection of NDLVC and DCM phenotypes may hold value in predicting cardiac outcomes. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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9 pages, 1614 KiB

Open AccessArticle

Does Long-Term Sport Practice Facilitate the Development of Idiopathic Bradycardia Requiring Early Pacemaker Implantation During the Course of Life?

by Sergei Bondarev, Leonardo Brotto, Francesca Graziano, Alberto Cipriani, Domenico Corrado and Alessandro Zorzi

J. Cardiovasc. Dev. Dis. 2025, 12(3), 102; https://doi.org/10.3390/jcdd12030102 - 15 Mar 2025

Viewed by 404

Abstract

Background: Sinus bradycardia and first-/second-degree atrioventricular (AV) block in athletes are traditionally considered secondary to increased vagal tone and therefore reversible. However, recent studies have suggested that they may persist even after the cessation of physical activity, and combined with the effects [...] Read more.

Background: Sinus bradycardia and first-/second-degree atrioventricular (AV) block in athletes are traditionally considered secondary to increased vagal tone and therefore reversible. However, recent studies have suggested that they may persist even after the cessation of physical activity, and combined with the effects of aging, lead to the earlier onset of clinically significant bradyarrhythmias. Methods: We evaluated the correlation between lifetime sport practice and the age of the onset of premature (≤70 years old) idiopathic sinoatrial node or AV node dysfunction requiring pacemaker (PM) implantation. Results: Of the 1316 patients followed up with at our PM clinic in 2024, we included 79 (6%) who received a PM when they were ≤70 years old for bradyarrhythmias in the absence of secondary causes. Nineteen (24%) had engaged in at least 6 h of sports/week for ≥20 years and were classified as former athletes. For comparison, former athletes who received a PM for idiopathic bradycardia at >70 years old were 6% (p < 0.001). In the group ≤70 years old, the average age of PM implantation was 62.8 years in non-athletes versus 57.9 years in former athletes (p = 0.03). The main reason for PM implantation was AV block in both subgroups. Among former athletes, the correlation between the lifetime volume of sports activity and the age of PM implantation reached borderline statistical significance (p = 0.08). Echocardiography at the time of implant did not reveal significant differences between former athletes and non-athletes. Conclusions: In a cohort of patients who received a PM for bradyarrhythmia before the age of 70 years old in the absence of secondary causes, former athletes were implanted on average ≈5 years before non-athletes. This may suggest a contributing role of cumulative sports activity volume in the development of idiopathic sinus/AV node dysfunction. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management, 2nd Edition)

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16 pages, 1911 KiB

Open AccessArticle

Early vs. Late Endovascular Extension Following Frozen Elephant Trunk Procedure: Effects on Clinical Outcomes and Aortic Remodeling

by Martin Wenkel, Nancy Halloum, Achim Neufang, Marco Doemland, Philipp Pfeiffer, Ahmad Ghazy, Chris Probst, Daniel-Sebastian Dohle, Hendrik Treede and Hazem El Beyrouti

J. Cardiovasc. Dev. Dis. 2025, 12(3), 99; https://doi.org/10.3390/jcdd12030099 - 14 Mar 2025

Viewed by 399

Abstract

Background/Objectives: The frozen elephant trunk (FET) technique was introduced as a possible single-stage procedure for treating aortic arch pathologies. However, up to a third of patients are reported to need subsequent completion (extension). This retrospective analysis aimed to evaluate the impact of early [...] Read more.

Background/Objectives: The frozen elephant trunk (FET) technique was introduced as a possible single-stage procedure for treating aortic arch pathologies. However, up to a third of patients are reported to need subsequent completion (extension). This retrospective analysis aimed to evaluate the impact of early (within 30 days; EC group) versus late (>30 days; LC group) endovascular completion with thoracic endovascular aortic repair (TEVAR) in patients treated with FET. Methods: A single-center, retrospective analysis of all consecutive patients for the period between June 2017 and December 2023 who underwent FET and received endovascular extension was conducted. Indications for endovascular extension were aneurysms of the descending aorta, aneurysmal progress, endoleak, malperfusion, distal stent-induced new entry (dSINE), and aortic rupture. Results: A total of 37 of 232 FET patients received endovascular extension (15.9%). Average age at the time of TEVAR was 63.3 ± 10.3 years. There was an increase in the maximum total aortic diameter post-FET from 40.8 ± 9 mm to 45.1 ± 14 mm prior to TEVAR. Only 14 patients (37.8%) had the desired complete occlusion of the false lumen or aneurysm prior to extension; 23 (62.2%) still had relevant perfusion of the false lumen or aneurysm. The EC and LC groups were defined by time between FET and TEVAR: a mean of 4.8 ± 5.2 days in the EC group and 18.4 ± 18 months in the LC group. The EC group had markedly more complex procedures, reflected in intensive care (10.7 ± 6.9 vs. 0.1 ± 0.3 days, p < 0.001) and hospitalization (22.4 ± 14.0 vs. 8.1 ± 5.6 days, p = 0.003) durations. There was one early death due to multiorgan failure in the EC group and there were none in the LC group. There were no major cardiac events in either group. In the EC group, seven patients (50%) suffered from postoperative respiratory failure and four (28.6%) developed acute kidney failure requiring dialysis. Only one patient in the LC group (4.3%) experienced complications. During follow-up, another three patients (21.4%) of the EC group died, but none of the LC group did. Post-extension aortic remodeling was similar in both groups, with complete occlusion achieved in 27 cases (72%) during early follow-up and increased to 90.6% after a mean of 22.0 ± 23.4 months. Conclusions: Following aortic arch repair using FET, there is still a need for second-stage repair in 16% of patients. Endovascular completion post-FET is safe and feasible with a technical success rate of 100%, but early completion is associated with greater morbidity and mortality. TEVAR extension surgery may be better delayed, if possible, until after recovery from the hybrid arch repair. Full article

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24 pages, 1623 KiB

Open AccessReview

Exploring the Current Status of Risk Stratification in Hypertrophic Cardiomyopathy: From Risk Models to Promising Techniques

by Alexandros Kasiakogias, Christos Kaskoutis, Christos-Konstantinos Antoniou, Stavros Georgopoulos, Dimitrios Tsiachris, Petros Arsenos, Alexandrina Kouroutzoglou, Dimitrios Klettas, Charalambos Vlachopoulos, Konstantinos Tsioufis and Konstantinos Gatzoulis

J. Cardiovasc. Dev. Dis. 2025, 12(3), 101; https://doi.org/10.3390/jcdd12030101 - 14 Mar 2025

Viewed by 771

Abstract

Improving clinical prediction of sudden cardiac death is a crucial step in the management of patients with hypertrophic cardiomyopathy. However, finding the optimal method for risk evaluation has been challenging, given the complexity and the wide variation in clinical phenotypes. This is particularly [...] Read more.

Improving clinical prediction of sudden cardiac death is a crucial step in the management of patients with hypertrophic cardiomyopathy. However, finding the optimal method for risk evaluation has been challenging, given the complexity and the wide variation in clinical phenotypes. This is particularly important, as these patients are often of younger age and defibrillator implantation is associated with a low but tangible long-term risk of adverse events. A number of risk factors, including degree of hypertrophy, presence of syncope and family history of sudden cardiac death, have typically been considered to indicate a higher risk. The European risk score for prediction of sudden cardiac death is widely used; however, it may not apply well in patients with specific forms of the condition, such as those with extreme hypertrophy. Increasing evidence suggests that the presence and extent of myocardial fibrosis assessed with cardiac magnetic resonance imaging should be considered in clinical decision-making. Some research suggests that integrating electrophysiological studies into traditional risk assessment models may further optimize risk prediction and significantly improve accuracy in detecting high risk patients. Novel cardiac imaging techniques, better understanding of the genetic substrate and artificial intelligence-based algorithms may prove promising for risk refinement. The present review article provides an updated and in-depth viewpoint. Full article

(This article belongs to the Special Issue Advancements in the Epidemiology, Diagnosis and Treatment of Hypertrophic Cardiomyopathy)

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11 pages, 776 KiB

Open AccessArticle

The Prevalence and Impact of Atrial Fibrillation on Patients with Chronic Total Occlusions: Insights from the National Inpatient Sample

by Maximilian Will, Konstantin Schwarz, Eric Holroyd, Josip A. Borovac, Adnan I. Qureshi, Gregory Y. H. Lip, Julia Mascherbauer, Gregor Leibundgut, Thomas W. Weiss and Chun Shing Kwok

J. Cardiovasc. Dev. Dis. 2025, 12(3), 100; https://doi.org/10.3390/jcdd12030100 - 14 Mar 2025

Viewed by 470

Abstract

The impact of atrial fibrillation (AF) on patients with chronic total occlusions (CTOs) at the national level remains unclear. In this study, we conducted a retrospective analysis of data from the National Inpatient Sample to assess the characteristics and in-hospital outcomes of patients [...] Read more.

The impact of atrial fibrillation (AF) on patients with chronic total occlusions (CTOs) at the national level remains unclear. In this study, we conducted a retrospective analysis of data from the National Inpatient Sample to assess the characteristics and in-hospital outcomes of patients with CTO based on the presence or absence of AF. Multiple logistic and linear regressions examined factors associated with AF and evaluated its impact on length of stay (LoS), cost, and mortality. The analysis included 480,180 patients diagnosed with CTO, with AF present in 28.0% of cases. Patients with CTOs and AF were older (median age 73 vs. 66 years, p < 0.001) and exhibited lower female representation (25.0% vs. 27.9%, p < 0.001). Factors most strongly associated with AF included previous heart failure (OR 1.98, 95% CI 1.92–2.05, p < 0.001), liver disease (OR 1.37, 95% CI 1.27–1.48, p < 0.001), and obesity (OR 1.25, 95% CI 1.20–1.30, p < 0.001). AF correlated with increased in-hospital mortality (OR 1.29, 95% CI 1.18–1.40, p < 0.001), ischemic stroke (OR 1.27, 95% CI 1.13–1.42, p < 0.001), and major bleeding (OR 1.38, 95% CI 1.30–1.46). Moreover, AF was associated with a longer LoS (coef 1.58, 95% CI 1.50 to 1.67, p < 0.001) and higher in-hospital costs (coef 6.22, 95% CI 5.81 to 6.63, p < 0.001). Patients with CTOs and AF were older and had more underlying health problems compared to patients without AF. The patients with AF have worse outcomes in terms of mortality, ischemic stroke, major bleeding, length of stay, and costs. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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7 pages, 1063 KiB

Open AccessBrief Report

A Case Series of Completely Thrombosed Abdominal Aortic Aneurysms

by Raffaello Bellosta, Giulia Anna Sala, Marco Franchin, Luca Luzzani, Alessandro Pucci, Gabriele Piffaretti and Maria Cristina Cervarolo

J. Cardiovasc. Dev. Dis. 2025, 12(3), 98; https://doi.org/10.3390/jcdd12030098 - 11 Mar 2025

Viewed by 477

Abstract

Background: Completely thrombosed AAA (th-AAA) has been infrequently described in the literature. The present study evaluated the incidence and report the outcomes of open surgical repair (OSR) of a clinical series of th-AAAs. Methods: This is a single-center, observational cohort study of consecutive [...] Read more.

Background: Completely thrombosed AAA (th-AAA) has been infrequently described in the literature. The present study evaluated the incidence and report the outcomes of open surgical repair (OSR) of a clinical series of th-AAAs. Methods: This is a single-center, observational cohort study of consecutive th-AAAs identified between 10 October 1998, and 31 January 2024. Open repair was carried out through a transperitoneal route, and Dacron knitted graft replacement. Follow-up included the clinical visit and duplex ultrasound at 30 days, and annually thereafter. The primary outcome was overall survival. The secondary outcome was the freedom from aorta-related reintervention. Results: Out of 2237 AAA repairs, we identified 16 (0.7%) th-AAAs. They were all men with a mean age of 74 years ± 8 (range, 54–89). The median of aneurysm diameter was 49 mm (IQR, 46–52). Rupture was the presenting scenario in four (25%) patients. Early mortality and major amputation did not occur. At a mean follow-up of 70 months ± 48 (range, 11–192), the freedom from aorta-related mortality was 100%, and graft-related complications were not observed. Conclusions: The incidence of th-AAA was <1%. Although rupture was the presenting scenario in nearly 25% of the cases, OSR was safe and effective due to the absence of aorta-related mortality and the long-term durability of the repair. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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13 pages, 1638 KiB

Open AccessReview

Hemodynamic Effects of Positive Airway Pressure: A Cardiologist’s Overview

by Anna Di Cristo, Andrea Segreti, Nardi Tetaj, Simone Pasquale Crispino, Emiliano Guerra, Emanuele Stirpe, Gian Paolo Ussia and Francesco Grigioni

J. Cardiovasc. Dev. Dis. 2025, 12(3), 97; https://doi.org/10.3390/jcdd12030097 - 10 Mar 2025

Viewed by 1809

Abstract

Positive airway pressure (PAP) therapy is widely used to manage both acute and chronic respiratory failure and plays an increasingly important role in cardiology, particularly in treating patients with respiratory comorbidities. PAP, including continuous positive airway pressure and noninvasive ventilation, significantly impacts hemodynamics [...] Read more.

Positive airway pressure (PAP) therapy is widely used to manage both acute and chronic respiratory failure and plays an increasingly important role in cardiology, particularly in treating patients with respiratory comorbidities. PAP, including continuous positive airway pressure and noninvasive ventilation, significantly impacts hemodynamics by altering intrathoracic pressure, affecting preload, afterload, and stroke volume. These changes are crucial in conditions such as acute cardiogenic pulmonary edema, where PAP can enhance gas exchange, reduce the work of breathing, and improve cardiac output. PAP reduces the left ventricular afterload, which in turn increases stroke volume and myocardial contractility in patients with left-sided heart failure. However, the role of PAP in right ventricular function and its effects on venous return and cardiac output are critical in the cardiac intensive care setting. While PAP provides respiratory benefits, it must be used cautiously in patients with right heart failure or preload-dependent conditions to avoid adverse outcomes. Additionally, in recent years, the use of PAP has expanded in the treatment of severe obstructive sleep apnea and obesity hypoventilation syndrome, both of which significantly influence cardiovascular events and heart failure. This review provides an in-depth analysis of the hemodynamic effects of PAP in cardiovascular disease, focusing on its impact on ventricular function in both acute and chronic conditions. Evaluating clinical studies, guidelines, and recent advancements offers practical insights into the physiological mechanisms and key clinical considerations. Furthermore, this review aims to serve as a helpful guide for clinicians, assisting in decision-making processes where PAP therapy is applied. Full article

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14 pages, 787 KiB

Open AccessArticle

The Association of Socioeconomic Status (SES) with Procedural Management and Mortality After Percutaneous Coronary Intervention (PCI): An Observational Study from the Pan-London PCI (BCIS) Registry

by Krishnaraj S. Rathod, Pitt Lim, Sam Firoozi, Richard Bogle, Ajay K. Jain, Philip A. MacCarthy, Miles C. Dalby, Iqbal S. Malik, Anthony Mathur, James Spratt, Ranil De Silva, Roby Rakhit, Jonathan Hill, Sundeep Singh Kalra, Simon Redwood, Richard Andrew Archbold, Andrew Wragg and Daniel A. Jones

J. Cardiovasc. Dev. Dis. 2025, 12(3), 96; https://doi.org/10.3390/jcdd12030096 - 10 Mar 2025

Viewed by 532

Abstract

Background: Lower socioeconomic status (SES) has been associated with increased mortality from coronary heart disease. This excess risk, relative to affluent patients, may be due to a combination of more adverse cardiovascular-risk factors, inequalities in access to cardiac investigations, longer waiting times for [...] Read more.

Background: Lower socioeconomic status (SES) has been associated with increased mortality from coronary heart disease. This excess risk, relative to affluent patients, may be due to a combination of more adverse cardiovascular-risk factors, inequalities in access to cardiac investigations, longer waiting times for cardiac revascularisation and lower use of secondary prevention drugs. We sought to investigate whether socio-economic status influenced long-term all-cause mortality after PCI in a large metropolitan city (London), which serves a population of 11 million people with a mixed social background over a 10-year period. Methods: We conducted an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry. This data set is collected prospectively and includes all patients treated between January 2005 and December 2015. The database includes PCI performed for stable angina and ACS (ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina). Patient socio-economic status was defined by the English Index of Multiple Deprivation (IMD) score, according to residential postcode. Patients were analysed by quintile of IMD score (Q1, least deprived; Q5, most deprived). Median follow-up was 3.7 (IQR: 2.0–5.1) years and the primary outcome was all-cause mortality. Results: The mean age of the patients was 64.3 ± 12.1 years and 25.2% were female. A total of 22.4% of patients were diabetic and 27.3% had a history of previous myocardial infarction. The rates of long-term all-cause mortality increased progressively across quintiles of IMD score, with patients in Q5 showing significantly higher long-term mortality rates compared with patients in Q1 (p = 0.0044). This persisted following the inclusion of a propensity score in the proportional hazard model as a covariate (HR for Q5 compared to Q1: 1.15 [95% CI: 1.10–1.42]). Conclusions: This study has demonstrated that low SES is an independent predictor of adverse clinical outcomes following PCI in the large, diverse metropolitan city of London. There clearly are inequalities in cardio-vascular risk factors, time to access to medical treatment/PCI, access to complex imaging and devices during PCI, access to secondary prevention after PCI, and even race differences. Hence, attention to reducing the burden of cardiovascular risk factors and improving primary prevention, particularly in patients with lower SES, is required. Full article

(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)

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25 pages, 403 KiB

Open AccessReview

Findings and Methodological Shortcomings of Investigations Concerning the Relationship Between Sleep Duration and Blood Pressure: A Comprehensive Narrative Review

by Michael H. Smolensky, Ramón C. Hermida, Richard J. Castriotta and Yong-Jian Geng

J. Cardiovasc. Dev. Dis. 2025, 12(3), 95; https://doi.org/10.3390/jcdd12030095 - 8 Mar 2025

Viewed by 714

Abstract

Cardiology and sleep societies recommend 7–9 h sleep/night for adults (7–8 h for seniors) and more for youngsters; nonetheless, short sleep duration (SSD) of <7 h/night is epidemic. We searched PubMed for representative investigations, including those cited by meta-analyses, that reported association between [...] Read more.

Cardiology and sleep societies recommend 7–9 h sleep/night for adults (7–8 h for seniors) and more for youngsters; nonetheless, short sleep duration (SSD) of <7 h/night is epidemic. We searched PubMed for representative investigations, including those cited by meta-analyses, that reported association between SSD and long sleep duration (LSD) of >9 h/night and blood pressure (BP) levels to assess shortcomings of their methods. Studies indicate both SSD and LSD negatively impact BP despite major deficiencies, such as (i) reliance mainly on cross-sectional rather than longitudinal protocols, (ii) inclusion of participants diagnosed with hypertension (HTN) and/or taking antihypertension medications, (iii) assessment of BP and diagnosis of HTN performed by single wake-time office measurement rather than multiple measurements performed by 24 h ambulatory BP monitoring (ABPM), and (iv) determination of SD by subjective recall, single-night polysomnography, or diary recordings rather than objective wrist actigraphy of sufficient duration. The limited number of ABPM-based studies, despite evidencing major shortcomings, particularly (i) assessment for 24 h rather than preferred ≥48 h and (ii) inclusion of subjects diagnosed with HTN and/or taking antihypertension medications, also report association between abnormal SD and elevated 24 h ‘daytime’/wake-time diastolic and systolic (SBP) means plus ‘nighttime’/sleep-time SBP mean and dipping—the latter two indices, in combination, the strongest predictors of major adverse cardiovascular events. Full article

(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)

14 pages, 3489 KiB

Open AccessReview

Brugada Syndrome and Exercise: Is It Time for a Paradigm Change?

by Carolina Miguel Gonçalves, Adriana Vazão, Mariana Carvalho, Margarida Cabral, André Martins, Mónica Amado, Joana Pereira, Fátima Saraiva, Hélia Martins and Hélder Dores

J. Cardiovasc. Dev. Dis. 2025, 12(3), 94; https://doi.org/10.3390/jcdd12030094 - 6 Mar 2025

Viewed by 592

Abstract

Background: Despite the multiple benefits of exercise for health, exercise in the presence of arrhythmic disorders can trigger adverse clinical events, including sudden cardiac death (SCD). The aim of this narrative review is to summarize the most recent recommendations regarding physical activity and [...] Read more.

Background: Despite the multiple benefits of exercise for health, exercise in the presence of arrhythmic disorders can trigger adverse clinical events, including sudden cardiac death (SCD). The aim of this narrative review is to summarize the most recent recommendations regarding physical activity and exercise in individuals with Brugada Syndrome (BrS). Methods: An advanced literature search was performed on the Pubmed and clinicaltrials.gov databases and published articles/clinical trials registered until September 2024 were analyzed. The final analysis included 33 articles. Results: Despite initial reports suggesting a higher risk of SCD in BrS, the risk is not as high as expected, and there is no evidence that exercise is an independent predictor. Therefore, scientific recommendations have become less restrictive. However, consensus on risk scores is lacking, making the evaluation of BrS a real challenge. The most recent recommendations emphasize individual evaluation, risk stratification, shared decision-making, and general preventive measures, allowing asymptomatic BrS patients as well as genotype positive/phenotype negative patients to participate in competitive sports, excluding sports under extreme conditions. Regarding patients with an implantable cardioverter defibrillator, both leisure and competitive sports may be considered in asymptomatic patients, avoiding contact sports. Conclusions: Research on the relationship between exercise and cardiovascular disease is evolving, but evidence-based recommendations for sports in BrS patients are scarce and further studies are needed. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management, 2nd Edition)

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14 pages, 12690 KiB

Open AccessReview

Intraoperative Transesophageal Echocardiographic Guidance in Cardiac Surgery

by Yannis Dimitroglou, Antonios Karanasos, Andreas Katsaros, Argyro Kalompatsou, Grigorios Tsigkas, Konstantinos Toutouzas, Costantinos Tsioufis, Constantina Aggeli and Periklis Davlouros

J. Cardiovasc. Dev. Dis. 2025, 12(3), 93; https://doi.org/10.3390/jcdd12030093 - 4 Mar 2025

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Abstract

Transesophageal echocardiography (TEE) is a valuable tool for diagnosing structural heart diseases, offering superior resolution compared to transthoracic echocardiography. It allows for real-time evaluation of cardiac valves and both systolic and diastolic heart function. Additionally, TEE facilitates the prompt detection of potential complications [...] Read more.

Transesophageal echocardiography (TEE) is a valuable tool for diagnosing structural heart diseases, offering superior resolution compared to transthoracic echocardiography. It allows for real-time evaluation of cardiac valves and both systolic and diastolic heart function. Additionally, TEE facilitates the prompt detection of potential complications during cardiac surgeries, such as paravalvular leaks, iatrogenic aortic dissections, and pericardial effusions. Advances in imaging, including 3D echocardiography, have further enhanced the visualization of complex structures like cardiac valves, providing “surgical views” that improve preoperative planning. These features have also made TEE indispensable for postoperative evaluation of cardiac valve repairs and for intraoperative guidance during minimally invasive procedures. This review article aims to summarize the indications for using TEE as an intraoperative tool in cardiac surgery. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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15 pages, 1277 KiB

Open AccessArticle

Depression, Anxiety, and Quality of Life in a Cardiac Rehabilitation Program Without Dedicated Mental Health Resources Post-Myocardial Infarction

by Carlos Bertolín-Boronat, Víctor Marcos-Garcés, Héctor Merenciano-González, María Luz Martínez Mas, Josefa Inés Climent Alberola, Nerea Perez, Laura López-Bueno, María Concepción Esteban Argente, María Valls Reig, Ana Arizón Benito, Alfonso Payá Rubio, César Ríos-Navarro, Elena de Dios, Jose Gavara, Manuel F. Jiménez-Navarro, Francisco Javier Chorro, Juan Sanchis and Vicente Bodi

J. Cardiovasc. Dev. Dis. 2025, 12(3), 92; https://doi.org/10.3390/jcdd12030092 - 4 Mar 2025

Viewed by 674

Abstract

Anxiety and depression are common after a myocardial infarction (MI), so psychological and psychiatric mental health (MH) interventions are recommended during Cardiac Rehabilitation Programs (CRP). We aim to evaluate anxiety and depression symptoms and quality of life in MI sufferers followed in a [...] Read more.

Anxiety and depression are common after a myocardial infarction (MI), so psychological and psychiatric mental health (MH) interventions are recommended during Cardiac Rehabilitation Programs (CRP). We aim to evaluate anxiety and depression symptoms and quality of life in MI sufferers followed in a CRP without dedicated MH resources. We prospectively included 164 MI patients in our CRP without dedicated MH resources. Patient Health Questionnaire 2-item (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2) questionnaires for depression and anxiety screening (altered if ≥3 points) and the 36-Item Short Form Survey Instrument (SF-36) to analyze four MH components and Mental Component Summary (MCS) were assessed at the beginning and after CRP. The mean age was 61.35 ± 10.76 years, and most patients were male (86.6%). A significant improvement in SF-36 mental components (from +5.94 ± 27.98 to +8.31 ± 25 points, p < 0.001) and SF-36-MCS (+1.85 ± 10.23 points, p = 0.02) was noted, as well as a reduction in depression and anxiety symptoms in PHQ-2 and GAD-2 (p < 0.001). However, 33 (20.1%) patients showed a positive screening for depression and/or anxiety at the end of the program. These patients were younger (56.6 ± 8.05 vs. 62.55 ± 11.05 years, p = 0.004) and showed significantly worse initial scores of SF-36 mental components, PHQ-2, and GAD-2 (p < 0.001). We conclude that a Phase 2 CRP without dedicated MH resources can achieve significant improvements in MH well-being after MI. However, one-fifth of the population had substantial depression and/or anxiety symptoms at the end of the program. This subset, characterized by worse initial MH scores, may benefit from specific MH interventions during CRP. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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32 pages, 2106 KiB

Open AccessReview

Pathophysiology of Maternal Obesity and Hypertension in Pregnancy

by Joana Lourenço and Luís Guedes-Martins

J. Cardiovasc. Dev. Dis. 2025, 12(3), 91; https://doi.org/10.3390/jcdd12030091 - 3 Mar 2025

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Abstract

Obesity is one of the biggest health problems in the 21st century and the leading health disorder amongst women of fertile age. Maternal obesity is associated with several adverse maternal and fetal outcomes. In this group of women, the risk for the development [...] Read more.

Obesity is one of the biggest health problems in the 21st century and the leading health disorder amongst women of fertile age. Maternal obesity is associated with several adverse maternal and fetal outcomes. In this group of women, the risk for the development of hypertensive disorders of pregnancy (HDPs), such as gestational hypertension (GH) and pre-eclampsia (PE), is increased. In fact, there is a linear association between an increase in pre-pregnancy body mass index (BMI) and PE. Excessive weight gain during pregnancy is also related to the development of PE and GH. The role of obesity in the pathophysiology of HDP is complex and is most likely due to an interaction between several factors that cause a state of poor maternal cardiometabolic health. Adipokines seem to have a central role in HDP development, especially for PE. Hypoadiponectinemia, hyperleptinemia, insulin resistance (IR), and a proinflammatory state are metabolic disturbances related to PE pathogenesis, contributing to its development by inducing a state of maternal endothelial dysfunction. Hypertriglyceridemia is suggested to also be a part of the disease mechanisms of HDP. Therefore, this review seeks to explore the scientific literature to assess the complications of maternal obesity and its association with the development of HDP. Full article

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20 pages, 1895 KiB

Open AccessSystematic Review

Common Risk Factors for Atrial Fibrillation After Transcatheter Aortic Valve Implantation: A Systematic Review from 2009 to 2024

by John Fernando Montenegro-Palacios, Sinthia Vidal-Cañas, Nelson Eduardo Murillo-Benítez, Jhon Quintana-Ospina, Carlos Andrés Cardona-Murillo and Yamil Liscano

J. Cardiovasc. Dev. Dis. 2025, 12(3), 90; https://doi.org/10.3390/jcdd12030090 - 28 Feb 2025

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Abstract

Transcatheter Aortic Valve Implantation (TAVI) is an effective treatment for severe aortic stenosis in high-risk patients; however, atrial fibrillation (AF) is a common complication associated with the procedure. New-Onset Atrial Fibrillation (NOAF) after TAVI is linked to increased mortality and additional complications. This [...] Read more.

Transcatheter Aortic Valve Implantation (TAVI) is an effective treatment for severe aortic stenosis in high-risk patients; however, atrial fibrillation (AF) is a common complication associated with the procedure. New-Onset Atrial Fibrillation (NOAF) after TAVI is linked to increased mortality and additional complications. This study aimed to evaluate the incidence of NOAF following TAVI and identify risk factors associated with mortality and the development of thromboembolic events. A systematic review of 18 studies was conducted using databases such as MEDLINE/PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, Google Scholar, Wiley Online Library, SciELO, and Redalyc. No language restrictions were applied, and the search covered studies from 2009 to 2024. The follow-up period ranged from 48 h to 730 days, with a mean of 180 days. Early monitoring and management of AF are essential in patients undergoing TAVI. The incidence of NOAF ranged up to 29.04%, meaning about 29 out of every 100 patients were affected. AF rates varied between 7.2% and 37%, with an average of around 20. Standardizing anticoagulation strategies is important to reduce complications. Randomized studies are needed to evaluate the relationship between AF and post-TAVI mortality and to determine whether AF is a marker of higher risk or an independent factor in these patients. Full article

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Open AccessArticle

Incidence and Risk Factors for Developing Type 2 Diabetes Mellitus After Acute Myocardial Infarction—A Long-Term Follow-Up

by Tamara Yakubov, Muhammad Abu Tailakh, Arthur Shiyovich, Harel Gilutz and Ygal Plakht

J. Cardiovasc. Dev. Dis. 2025, 12(3), 89; https://doi.org/10.3390/jcdd12030089 - 28 Feb 2025

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Abstract

Acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM) share common risk factors. To evaluate the long-term incidence and predictors of new-onset T2DM (NODM) among post-AMI adults, we conducted a retrospective analysis of AMI survivors hospitalized between 2002 and 2017. Eligible patients [...] Read more.

Acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM) share common risk factors. To evaluate the long-term incidence and predictors of new-onset T2DM (NODM) among post-AMI adults, we conducted a retrospective analysis of AMI survivors hospitalized between 2002 and 2017. Eligible patients were followed for up to 16 years to identify NODM, stratified by demographic and clinical characteristics. Among 5147 individuals (74.2% males, mean age 64.6 ± 14.9 years) without pre-existing T2DM, 23.4% developed NODM (cumulative incidence: 0.541). Key risk factors included an age of 50–60 years, a minority ethnicity (Arabs), smoking, metabolic syndrome (MetS), hemoglobin A1C (HbA1C) ≥ 5.7%, and cardiovascular comorbidities. A total score (TS), integrating these factors, revealed a linear association with the NODM risk: each 1-point increase corresponded to a 1.2-fold rise (95% CI 1.191–1.276, p < 0.001). HbA1C ≥ 6% on the “Pre-DM sub-scale” conferred a 2.8-fold risk (p < 0.001), while other risk factors also independently predicted NODM. In conclusion, post-AMI patients with multiple cardiovascular risk factors, particularly middle-aged individuals, Arab individuals, and those with HbA1C ≥ 6% or MetS, are at a heightened risk of NODM. Early identification and targeted interventions may mitigate this risk. Full article

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9 pages, 838 KiB

Open AccessArticle

Gender Differences for His Bundle Pacing Long-Term Performance in the Elderly Population

by Catalin Pestrea, Ecaterina Cicala, Dragos Lovin, Adrian Gheorghe, Florin Ortan and Rosana Manea

J. Cardiovasc. Dev. Dis. 2025, 12(3), 88; https://doi.org/10.3390/jcdd12030088 - 26 Feb 2025

Viewed by 358

Abstract

Background and aims: His bundle pacing (HBP) is considered the most physiological form of cardiac pacing. Although feasibility studies have included older patients, specific data for HBP in this population are scarce. This study aimed to evaluate gender differences in HBP long-term performance [...] Read more.

Background and aims: His bundle pacing (HBP) is considered the most physiological form of cardiac pacing. Although feasibility studies have included older patients, specific data for HBP in this population are scarce. This study aimed to evaluate gender differences in HBP long-term performance in elderly patients with atrioventricular (AV) block. Methods: This retrospective study included 73 patients aged over 65 years with successful HBP and at least 2 years of follow-up. The patients’ baseline and follow-up clinical and procedural characteristics were recorded. Results: The mean age of the cohort was 72.8 ± 6.3 years, with 43 males and 30 females. The paced QRS complex was significantly narrower than the baseline value for both genders. Females had a narrower-paced QRS complex without differences in detection, type of His bundle capture, impedance, or fluoroscopy time. The pacing threshold increased progressively, reaching statistical significance compared to the baseline values at the two-year follow-up. The pacing threshold increased by more than 1 V over the follow-up period in twenty-four patients (32.9%) and by more than 2 V in six patients (8.2%), with no significant difference between genders. The pacing threshold increase occurred within the first year for most patients, without gender differences. Multivariate Cox regression analysis demonstrated that the paced QRS duration, left ventricular ejection fraction, and ischemic cardiomyopathy were significantly associated with the pacing threshold increase over time. Conclusion: In elderly patients with AV block, HBP remains a feasible pacing method, without significant gender differences, over a long-term follow-up period. Pacing threshold increases are expected in up to one-third of the patients, requiring regular follow-ups to adjust the programmed parameters and optimize battery longevity. Full article

(This article belongs to the Special Issue Cardiac Device Therapy: 2nd Edition)

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15 pages, 1479 KiB

Open AccessArticle

Obesity-Induced PVAT Dysfunction and Atherosclerosis Development: The Role of GHSR-1a in Increased Macrophage Infiltration and Adipocytokine Secretion

by Sorin Nicolae Peiu, Florin Zugun-Eloae, Bogdan Stoica, Ecaterina Anisie, Diana Gabriela Iosep, Mihai Danciu, Iustina Silivestru-Crețu, Fawzy Akad, Andrei Nicolae Avadanei, Laura Condur, Radu Florin Popa and Veronica Mocanu

J. Cardiovasc. Dev. Dis. 2025, 12(3), 87; https://doi.org/10.3390/jcdd12030087 - 26 Feb 2025

Viewed by 541

Abstract

In obesity, recent research revealed that increased expression of the growth hormone secretagogue receptor (GHSR) in macrophages plays a pivotal role in the development of meta-inflammation, promoting macrophage infiltration and pro-inflammatory polarization. This study aimed to examine the association between GHSR-1a expression in [...] Read more.

In obesity, recent research revealed that increased expression of the growth hormone secretagogue receptor (GHSR) in macrophages plays a pivotal role in the development of meta-inflammation, promoting macrophage infiltration and pro-inflammatory polarization. This study aimed to examine the association between GHSR-1a expression in atherosclerotic plaques and adjacent perivascular adipose tissue (PVAT) from 11 patients with obesity and peripheral artery disease (PAD) who underwent revascularization procedures. Immunohistochemistry was used to assess the expression of CD68, CD80, and CD14, while tissue homogenate levels of adiponectin, leptin, IL-6, and CRP were quantified via ELISA. Serum markers of inflammation were also measured. Among patients with GHSR-1a-positive (+) macrophages in atherosclerotic plaques, we observed significantly higher white blood cell counts and platelet-to-lymphocyte ratios in serum, a lower adiponectin-to-leptin ratio, and elevated IL-6 levels in both arterial and PVAT homogenates. Our findings suggest a link between GHSR-1a and macrophage/monocyte infiltration, macrophage polarization, and adipocytokine secretion in atherosclerotic plaques associated with obesity-induced PVAT dysfunction. Full article

(This article belongs to the Section Basic and Translational Cardiovascular Research)

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14 pages, 1382 KiB

Open AccessArticle

Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation

by Martha Zergioti, Melina Kyriakou, Andreas S. Papazoglou, Anastasios Kartas, Dimitrios V. Moysidis, Athanasios Samaras, Efstratios Karagiannidis, Vasileios Kamperidis, Antonios Ziakas and George Giannakoulas

J. Cardiovasc. Dev. Dis. 2025, 12(3), 86; https://doi.org/10.3390/jcdd12030086 - 26 Feb 2025

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Abstract

Background: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) [...] Read more.

Background: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in this demographic. Methods: This post hoc analysis of the MISOAC-AF trial focused on hospitalized AF patients aged ≥ 75 years prescribed OAC at discharge. Predictors of VKA and reduced DOAC dosing were identified using adjusted odds ratios (aORs). Cox regression models calculated adjusted hazard ratios (aHRs) for primary (all-cause mortality) and secondary outcomes (stroke, bleeding, AF or heart failure hospitalization, cardiovascular death). Results: Among 450 elderly patients, 63.6% received DOACs and 36.4% received VKAs. Higher CHA2DS2-VASc and HAS-BLED scores and antiplatelet use predicted VKA prescription. Hypertension, prior stroke, and bleeding history favored DOAC use. Advanced age and chronic kidney disease correlated with reduced DOAC dosing. Over a 3.7-year follow-up period, there was no significant difference in all-cause mortality between the DOAC and VKA groups (aHR 0.79, 95% CI 0.58–1.06) or between the full-dose and reduced-dose DOAC groups (aHR 0.96, 95% CI 0.60–1.53). Secondary analyses also did not yield statistically significant results in either comparison. Conclusions: Clinical profile parameters in elderly AF patients predict VKA or DOAC use. Clinical outcomes were similar between different OAC therapies. Full article

(This article belongs to the Special Issue Extensive Approach to Atrial Fibrillation: Background and Future Perspectives)

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11 pages, 685 KiB

Open AccessArticle

Predictive Threshold Value of the Breathing Reserve for the Decline in Cardiorespiratory Fitness Among the Healthy Middle-Aged Population

by Tao Shen, Yang Wang, Jinglin Li, Shunlin Xu, Peng Wang and Wei Zhao

J. Cardiovasc. Dev. Dis. 2025, 12(3), 85; https://doi.org/10.3390/jcdd12030085 - 24 Feb 2025

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Abstract

Objective: To investigate the cut-off value of the breathing reserve for predicting a decline in cardiorespiratory fitness (CRF) among healthy middle-aged Chinese individuals. Methods: Healthy middle-aged individuals who underwent cardiopulmonary exercise testing (CPET) at the Peking University Third Hospital from May to October [...] Read more.

Objective: To investigate the cut-off value of the breathing reserve for predicting a decline in cardiorespiratory fitness (CRF) among healthy middle-aged Chinese individuals. Methods: Healthy middle-aged individuals who underwent cardiopulmonary exercise testing (CPET) at the Peking University Third Hospital from May to October 2021 were selected. The study included 321 participants, with an average age of 48.8 ± 5.7 years. They were divided into two groups based on the peak oxygen uptake (VO₂peak): the adequate CRF group and the CRF decline group. Multivariate logistic regression analysis was used to explore the factors influencing CRF. Results: In the male CRF decline group, heart rate, alanine aminotransferase, end-tidal partial pressure of carbon dioxide (PETCO₂), and breathing reserve (BR%) were significantly higher, while the oxygen uptake at the anaerobic threshold (VO₂@AT) was lower. An elevated BR% was independently associated with CRF decline (OR = 1.111, 95% CI: 1.068–1.156). The female CRF decline group had significantly higher FEV1/FVC and BR% and significantly lower age, fasting glucose, hemoglobin, and VO₂@AT compared to the adequate CRF group. Elevated BR% was independently associated with CRF decline (OR = 1.086, 95% CI: 1.038–1.137). The receiver operating characteristic (ROC) curve for the males showed an area under the curve (AUC) of 0.769 (95% CI: 0.703–0.827) with an appropriate BR% cut-off value of 49.9%, sensitivity of 59.9%, and specificity of 77.8%. For the females, the ROC curve displayed an AUC of 0.694 (95% CI: 0.607–0.773) with an appropriate BR% cut-off value of 57.0%, sensitivity of 58.7%, and specificity of 86.0%. Conclusions: The breathing reserve was independently associated with CRF. The appropriate cut-off values for BR% to predict CRF decline were 49.9% for the males and 57.0% for the females. Full article

(This article belongs to the Special Issue Exercise Testing and Interventions in Cardiovascular Disease)

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13 pages, 6590 KiB

Open AccessReview

Not All SAVR Are Created Equal: All the Approaches Available for Surgical Aortic Valve Replacement

by Francesco Cabrucci, Serge Sicouri, Massimo Baudo, Dimitrios E. Magouliotis, Yoshiyuki Yamashita, Beatrice Bacchi, Dario Petrone, Beman Wasef, Aleksander Dokollari, Massimo Bonacchi and Basel Ramlawi

J. Cardiovasc. Dev. Dis. 2025, 12(3), 84; https://doi.org/10.3390/jcdd12030084 - 24 Feb 2025

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Abstract

Surgical Aortic Valve Replacement (SAVR) is still one of the pillars of cardiac surgery practice, and its role is evolving into a more complex operation. The competition with structural valve therapies and the urgent demand for less invasive solutions have unleashed surgeons’ creativity [...] Read more.

Surgical Aortic Valve Replacement (SAVR) is still one of the pillars of cardiac surgery practice, and its role is evolving into a more complex operation. The competition with structural valve therapies and the urgent demand for less invasive solutions have unleashed surgeons’ creativity in adapting to these new challenges. All the possible ways to surgically replace the aortic valve are analyzed in this review. Surgical techniques, advantages and disadvantages, and key differences are listed, helping surgeons navigate the available options. Sternotomy SAVR is the benchmark, but that is becoming obsolete and, in some cases, no longer performed for teaching purposes. Mini sternotomy is the easiest way to achieve minimal invasiveness in all anatomic situations, while right anterior thoracotomy is an elegant solution mastered by fewer surgeons. Endoscopic and robotic-assisted techniques are shaping the future of SAVR, yet they still lack wide adoption. The choice of approach is mainly dictated by the anatomic features of the patient and the surgeon’s skills. A flow diagram to overcome the learning curve and advance toward more complex surgery is provided here. Mastering as many techniques as possible is paramount when offering a patient-tailored approach and performing a safe and less invasive operation. Full article

(This article belongs to the Special Issue Feature Review Papers in Cardiovascular Clinical Research)

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28 pages, 3435 KiB

Open AccessReview

Developmental and Evolutionary Heart Adaptations Through Structure–Function Relationships

by Makena Phillips, Marina Nimmo and Sandra Rugonyi

J. Cardiovasc. Dev. Dis. 2025, 12(3), 83; https://doi.org/10.3390/jcdd12030083 - 22 Feb 2025

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Abstract

While the heart works as an efficient pump, it also has a high level of adaptivity by changing its structure to maintain function during healthy and diseased states. In this Review, we present examples of structure–function relationships across species and throughout embryonic development [...] Read more.

While the heart works as an efficient pump, it also has a high level of adaptivity by changing its structure to maintain function during healthy and diseased states. In this Review, we present examples of structure–function relationships across species and throughout embryonic development in mammals and birds. We also summarize current research on avian models aiming at understanding how biophysical and biological mechanisms closely interact during heart formation. We conclude by underscoring similarities between cardiac adaptations and structural changes over developmental and evolutionary time scales and how understanding the mechanisms behind these adaptations can help prevent or alleviate the effects of cardiac malformations and contribute to cardiac regeneration efforts. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Cardiac Development and Regeneration' Section — from Development to Regeneration)

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12 pages, 1447 KiB

Open AccessArticle

The Relationship Between Vitamin D Levels and Cardiac Remodelling in a Pediatric Dilated Cardiomyopathy Population: A Case-Control Study

by Asmaa Carla Hagau, Ioana-Octavia Matacuta-Bogdan, Lacramioara Eliza Chiperi, Beatrix-Jullia Hack and Iolanda Muntean

J. Cardiovasc. Dev. Dis. 2025, 12(3), 82; https://doi.org/10.3390/jcdd12030082 - 21 Feb 2025

Viewed by 362

Abstract

Dilated cardiomyopathy (DCM) is a significant contributor to heart failure (HF) in the pediatric population despite its lower incidence compared to adults. Method: We present a case-control study that investigates serum levels of Vitamin D, measured as 25-hydroxyvitamin D (25-OHD), in children diagnosed [...] Read more.

Dilated cardiomyopathy (DCM) is a significant contributor to heart failure (HF) in the pediatric population despite its lower incidence compared to adults. Method: We present a case-control study that investigates serum levels of Vitamin D, measured as 25-hydroxyvitamin D (25-OHD), in children diagnosed with DCM and explores the relationship between Vitamin D levels and left ventricular (LV) dimensions and systolic function. Results: Thirty patients (mean age: 10.61 ± 6.54 years) with DCM were included, with a control group of thirty-one matched healthy children. We found a high prevalence of 25-OHD deficiency (67%) in the DCM group, which was statistically significant compared to the control group (p < 0.05). Notably, a significant negative correlation was observed between 25-OHD levels and both LV end-diastolic diameter (LVEDD; r = −0.43, p < 0.01) and end-systolic diameter (LVESD; r = −0.46, p < 0.01). However, no significant correlation was found between Vitamin D levels and LV ejection fraction or shortening fraction. Conclusion: These findings emphasise the importance of assessing Vitamin D status in pediatric DCM patients and may suggest that Vitamin D supplementation can be beneficial in managing this condition through its potential effects on cardiac remodelling and function. Further research is warranted to clarify the underlying mechanisms and therapeutic implications. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, and Genetics of Cardiomyopathy)

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11 pages, 2301 KiB

Open AccessArticle

Evaluating Epicardial Fat Density Using ROI-Based Analysis: A Feasibility Study

by Giovanni Lorusso, Nicola Maggialetti, Luca De Marco, Sterpeta Guerra, Ilaria Villanova, Sara Greco, Chiara Morelli, Nicola Maria Lucarelli, Michele Mariano and Amato Antonio Stabile Ianora

J. Cardiovasc. Dev. Dis. 2025, 12(3), 81; https://doi.org/10.3390/jcdd12030081 - 20 Feb 2025

Viewed by 370

Abstract

Epicardial fat density (EFD) is implicated in cardiovascular diseases. This study aimed to assess the regional variability of epicardial fat density (EFD) using coronary computed tomography (CCT) and evaluate the feasibility of ROI-based measurements as an alternative to full segmentation. A retrospective analysis [...] Read more.

Epicardial fat density (EFD) is implicated in cardiovascular diseases. This study aimed to assess the regional variability of epicardial fat density (EFD) using coronary computed tomography (CCT) and evaluate the feasibility of ROI-based measurements as an alternative to full segmentation. A retrospective analysis was conducted on 171 patients undergoing coronary CCT. EFD was measured on non-contrast scans acquired globally and in three predefined regions of interest (ROIs) for coronary calcium scoring: the aortic bulb, right posterolateral wall, and cardiac apex. Global EFD was quantified using semi-automated segmentation software (3D Slicer 5.6.2), while regional EFD values were manually determined. Statistical analyses were performed to compare global and regional EFD measurements. Global EFD averaged −83.92 ± 5.19 HU, while regional EFD showed significant variability. The aortic bulb had lower EFD values (−97.54 ± 12.80 HU) compared to the apex (−93.42 ± 18.94 HU) and right posterolateral wall (−94.99 ± 12.16 HU). Paired t-tests confirmed statistically significant differences between global and regional EFD values (p < 0.000). This study highlights significant regional variability in EFD across specific cardiac regions, suggesting that ROI-based assessments may not reliably reflect global EFD characteristics. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))

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19 pages, 294 KiB

Open AccessArticle

Therapeutic Education and Pharmacotherapeutic Follow-Up Protocol, a Useful Tool for the Improvement of Patients at Cardiovascular Risk in Community Pharmacies

by Pilar Buenavida Jurado, Mª José De la Matta Martín, Mª José Martín Calero and Rocío De la Puerta

J. Cardiovasc. Dev. Dis. 2025, 12(3), 80; https://doi.org/10.3390/jcdd12030080 - 20 Feb 2025

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Abstract

The aim was to determine the influence of a complex intervention based on pharmacotherapeutic follow-up (PTF) and the application of therapeutic education (TE) protocols on the clinical and educational parameters of patients at cardiovascular risk (CVR) attending community pharmacies (CPs). A prospective, longitudinal, [...] Read more.

The aim was to determine the influence of a complex intervention based on pharmacotherapeutic follow-up (PTF) and the application of therapeutic education (TE) protocols on the clinical and educational parameters of patients at cardiovascular risk (CVR) attending community pharmacies (CPs). A prospective, longitudinal, randomized, controlled clinical trial was conducted over 6 months in patients from four Spanish CPs, divided into control (CG) and intervention (IG) groups. CG patients received usual pharmacy care and IG patients received a PTF- and TE-based intervention. The sample consisted of 85 elderly patients. After pharmaceutical follow-up of the IG patients, the following results were observed: significant reductions in cardiovascular risk (CVR) (p < 0.005), blood pressure (BP) (p < 0.05), and sedentary lifestyle (p < 0.001), as well as an improved knowledge of CVR and cardiovascular risk factors (CVRFs) (p < 0.001). Target values for BP were achieved in 27.2% of patients and for triglycerides in 12.4% of patients. The PTF of the patients showed that 29.2% did not have the expected response to some treatments, while 25% had untreated pathologies and 10% had adverse reactions. The TE protocols related to the patients’ educational needs, applied individually and in conjunction with the PTF, were able to improve their lifestyle habits, their knowledge of CVR, CVRFs, and pharmacotherapy, and their clinical parameters, and, thus, the level of development of their disease Full article

(This article belongs to the Special Issue Effects of Pharmaceutical Intervention on Cardiovascular Risk)

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J. Cardiovasc. Dev. Dis., Volume 12, Issue 3 (March 2025) – 28 articles

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