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Volume 12
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J. Cardiovasc. Dev. Dis., Volume 12, Issue 4 (April 2025) – 54 articles

Cover Story (view full-size image): Acute aortic valve infective endocarditis poses a major timing dilemma in the context of surgery. This study evaluates whether early surgery (within 7 days of starting antibiotics) impacts mortality and outcomes compared to delayed intervention. In a retrospective analysis of 204 non-emergency cases, early surgery was associated with similar in-hospital mortality and long-term outcomes. These findings suggest that early intervention may be safe and effective, challenging the conventional preference for delayed surgery. View this paper
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11 pages, 499 KiB  
Article
Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in Patients with Non-ST-Segment Elevation Myocardial Infarction in the United States: Results from Big Data Analysis
by Chayakrit Krittanawong, Song Peng Ang, Neil Sagar Maitra, Zhen Wang, Mahboob Alam, Hani Jneid and Samin Sharma
J. Cardiovasc. Dev. Dis. 2025, 12(4), 161; https://doi.org/10.3390/jcdd12040161 - 17 Apr 2025
Viewed by 167
Abstract
Non-ST-segment elevation myocardial infarction (NSTEMI) can be managed by ischemia guide strategies or early invasive strategies. Here, we present the findings of an updated contemporary analysis regarding the use of intracoronary imaging (ICI)-guided PCI versus angiography-guided PCI and in-hospital mortality in patients with [...] Read more.
Non-ST-segment elevation myocardial infarction (NSTEMI) can be managed by ischemia guide strategies or early invasive strategies. Here, we present the findings of an updated contemporary analysis regarding the use of intracoronary imaging (ICI)-guided PCI versus angiography-guided PCI and in-hospital mortality in patients with NSTEMI in the United States using the NIS database from 2016 to 2021. ICI use increased by nearly threefold between 2016 and 2021, without a significant difference in in-hospital mortality, though interestingly, mortality rates compared with angiography guidance were similar and relatively low. In this study, the use of ICI was associated with lower adjusted odds of in-hospital mortality, cardiogenic shock, and cardiac arrest, but with a longer length of stay and cost of hospitalization. Full article
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16 pages, 948 KiB  
Article
Echocardiographic Predictors of Postoperative Atrial Fibrillation After Cardiac Surgery: Assessing Atrial Mechanics for Risk Stratification
by Velimir Perić, Mlađan Golubović, Marija Stošić, Dragan Milić, Lela Lazović, Dalibor Stojanović, Milan Lazarević, Dejan Marković and Dragana Unić-Stojanović
J. Cardiovasc. Dev. Dis. 2025, 12(4), 160; https://doi.org/10.3390/jcdd12040160 - 17 Apr 2025
Viewed by 161
Abstract
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, increasing morbidity and healthcare costs. This study aimed to identify echocardiographic predictors of POAF to improve risk stratification. A total of 131 patients undergoing cardiac surgery were analyzed and divided into two [...] Read more.
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, increasing morbidity and healthcare costs. This study aimed to identify echocardiographic predictors of POAF to improve risk stratification. A total of 131 patients undergoing cardiac surgery were analyzed and divided into two groups based on POAF occurrence. Echocardiographic analysis showed that patients with POAF had larger left and right atrial dimensions and impaired atrial function. Prolonged total atrial conduction time (TACT), reduced atrial emptying volumes, and contractile function were more common in the POAF group. Univariable analysis identified LAEF (χ2 = 71.8, p < 0.001), LAKE (χ2 = 70.1, p < 0.001), RATEF (χ2 = 65.7, p < 0.001), and RAAEF (χ2 = 66.8, p < 0.001) as significant predictors of POAF, each with an area under the curve (AUC) greater than 0.89. In multivariable analysis, LAKE (OR = 0.27, p < 0.001), hypertension (OR = 11.87, p = 0.035), left ventricular ejection fraction (OR = 1.08, p = 0.020), and peripheral vascular disease (OR = 40.28, p = 0.002) were independent predictors. The final model showed a significant discriminatory ability (AUC = 0.94). LAKE and clinical factors remained independent predictors after adjustment. Full article
(This article belongs to the Special Issue Heart Rhythm Disorders: Diagnosis, Treatment, and Management)
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14 pages, 1817 KiB  
Review
Coronary Computed Angiography and Coronary Artery Calcium Score for Preoperative Cardiovascular Risk Stratification in Patients Undergoing Noncardiac Surgery
by Ioannis Kyriakoulis, Sriram S. Kumar, Georgios D. Lianos, Dimitrios Schizas and Damianos G. Kokkinidis
J. Cardiovasc. Dev. Dis. 2025, 12(4), 159; https://doi.org/10.3390/jcdd12040159 - 17 Apr 2025
Viewed by 182
Abstract
Perioperative and long-term postoperative major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients undergoing noncardiac surgery. In selected high-risk patients, when information about cardiovascular status may influence surgical decisions, preoperative risk stratification is reasonable, with stress imaging [...] Read more.
Perioperative and long-term postoperative major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients undergoing noncardiac surgery. In selected high-risk patients, when information about cardiovascular status may influence surgical decisions, preoperative risk stratification is reasonable, with stress imaging being the preferred method. Coronary computed angiography (CCTA) and coronary artery calcium score (CACS) offer direct anatomical assessment of atherosclerotic coronary arteries and help gauge the extent and severity of coronary artery disease. Strong evidence supports that CCTA and CACS, either alone or in combination, are reliable methods for assessing the risk of both perioperative and long-term postoperative MACE, often demonstrating equal or superior prognostic performance compared to traditional imaging tools. Moreover, integrating CCTA or CACS into standard preoperative imaging protocols further enhances perioperative risk prediction and improves the ability to accurately stratify patients. Future research is needed to better define the role of CCTA and CACS in preoperative cardiovascular risk evaluation of patients undergoing noncardiac surgery. Full article
(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))
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19 pages, 615 KiB  
Review
Narrative Review of High-Intensity Interval Training: Positive Impacts on Cardiovascular Health and Disease Prevention
by Jae-Myun Ko, Wi-Young So and Sung-Eun Park
J. Cardiovasc. Dev. Dis. 2025, 12(4), 158; https://doi.org/10.3390/jcdd12040158 - 17 Apr 2025
Viewed by 369
Abstract
Background: High-intensity interval training (HIIT) has gained recognition for its positive impacts on cardiovascular (CV) health, metabolic outcomes, mental health, and quality of life (QoL). This narrative review aims to comprehensively evaluate the efficacy of HIIT in enhancing CV health and preventing CV [...] Read more.
Background: High-intensity interval training (HIIT) has gained recognition for its positive impacts on cardiovascular (CV) health, metabolic outcomes, mental health, and quality of life (QoL). This narrative review aims to comprehensively evaluate the efficacy of HIIT in enhancing CV health and preventing CV disease (CVD). Methods: A comprehensive search of PubMed identified 257 articles, of which 39 studies met predefined inclusion and exclusion criteria for quality assessment. Key metrics evaluated included blood pressure, vascular function, lipid profiles, body composition, and CRF. Results: HIIT significantly improved vascular function, evidenced by reductions in systolic and diastolic blood pressure and enhanced flow-mediated dilation. Improvements in cardiac function were observed through increased cardiac output and heart rate variability. Additionally, HIIT positively influenced lipid profiles, decreasing low-density lipoprotein and triglycerides while increasing high-density lipoprotein. Significant reductions in body fat and improvements in VO2peak were noted, contributing to enhanced CRF. HIIT also positively impacted mental health and QoL, reducing anxiety and depressive symptoms. Importantly, HIIT was safely and effectively applied to high-risk populations—individuals with obesity, metabolic syndrome, CVD, and cancer survivors—with a low incidence of adverse effects. Conclusions: This review highlights HIIT as an effective and safe exercise modality for improving CV health, metabolic indicators, mental health, and QoL. Future research should focus on developing tailored HIIT protocols to optimize adherence and efficacy across diverse populations, considering variations in age, sex, health status, and underlying medical conditions. Full article
(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management, 2nd Edition)
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7 pages, 768 KiB  
Case Report
Non-ST-Elevation Myocardial Infarction as the Initial Manifestation of Calreticulin-Positive Essential Thrombocythemia: A Case Report
by Jared B. Hinton, Jalal S. Jwayyed, Sonum Jagetia, Hunter J. Landwehr and John D. Scrocco
J. Cardiovasc. Dev. Dis. 2025, 12(4), 157; https://doi.org/10.3390/jcdd12040157 - 16 Apr 2025
Viewed by 204
Abstract
Essential thrombocythemia (ET) is a rare myeloproliferative neoplasm characterized by excessive platelet production and a predisposition to thrombotic or hemorrhagic complications. We report a case of a 62-year-old male with no conventional cardiovascular risk factors who presented with a non-ST-segment elevation myocardial infarction [...] Read more.
Essential thrombocythemia (ET) is a rare myeloproliferative neoplasm characterized by excessive platelet production and a predisposition to thrombotic or hemorrhagic complications. We report a case of a 62-year-old male with no conventional cardiovascular risk factors who presented with a non-ST-segment elevation myocardial infarction (NSTEMI). Initial coronary angiography showed isolated proximal LAD stenosis. Laboratory tests revealed marked thrombocytosis (>1,000,000/μL) and a CALR mutation, confirming a diagnosis of ET. The patient was treated with percutaneous coronary intervention (PCI), dual antiplatelet therapy, and cytoreductive therapy with hydroxyurea, leading to a favorable outcome. This case illustrates how ET, particularly CALR-mutated subtypes, can manifest as acute coronary syndrome in the absence of atherosclerosis and underscores the need to consider hematologic malignancies in atypical presentations of myocardial infarction. Full article
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20 pages, 6059 KiB  
Review
The Prenatal Diagnosis and Perinatal Management of Congenital Long QT Syndrome: A Comprehensive Literature Review and Recent Updates
by Stefani Samples, Sara Cherny, Nitin Madan, Jeff Hong, Sheena A. Mansukhani, Janette F. Strasburger, Michael R. Carr and Sheetal R. Patel
J. Cardiovasc. Dev. Dis. 2025, 12(4), 156; https://doi.org/10.3390/jcdd12040156 - 14 Apr 2025
Viewed by 318
Abstract
Congenital long QT syndrome (LQTS) is a group of heritable conditions that are associated with cardiac repolarization abnormalities characterized by QT prolongation on electrocardiogram and the risk of life-threatening arrhythmias. The prenatal detection of LQTS presents significant challenges for clinicians, and a multidisciplinary [...] Read more.
Congenital long QT syndrome (LQTS) is a group of heritable conditions that are associated with cardiac repolarization abnormalities characterized by QT prolongation on electrocardiogram and the risk of life-threatening arrhythmias. The prenatal detection of LQTS presents significant challenges for clinicians, and a multidisciplinary approach is required for optimal prenatal and postnatal management. In this comprehensive literature review, we describe strategies for the fetal diagnosis of LQTS with variable initial presentation, genetic testing in suspected fetal LQTS, the utility of fetal magnetocardiography as an additional diagnostic tool, prenatal management, and postnatal treatment. We focus on a multidisciplinary team approach including fetal cardiology, adult and pediatric electrophysiology, neonatology, maternal–fetal medicine, and genetic counselors, all playing vital roles in the comprehensive prenatal management and orchestration of postnatal treatment to optimize neonatal outcomes. Full article
(This article belongs to the Special Issue Recent Advances in Fetal Cardiology)
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16 pages, 3536 KiB  
Review
Advances in Hypertension Management: Insights from the Latest European Guidelines
by Marco Zuin, Chiara Tognola, Alessandro Maloberti, Gianfranco Parati, Stefania Angela Di Fusco, Vered Gil Ad, Donatella Armata, Chiara Dalla Valle, Furio Colivicchi, Claudio Bilato, Massimo Grimaldi, Fabrizio Oliva and Pier Luigi Temporelli
J. Cardiovasc. Dev. Dis. 2025, 12(4), 155; https://doi.org/10.3390/jcdd12040155 - 14 Apr 2025
Viewed by 364
Abstract
Arterial hypertension is one of the most common and preventable risk factors for cardiovascular disease and its related mortality. Currently, the prevalence of hypertension in different European countries appears to be around 30–45% of the general population, with a steep increase with ageing. [...] Read more.
Arterial hypertension is one of the most common and preventable risk factors for cardiovascular disease and its related mortality. Currently, the prevalence of hypertension in different European countries appears to be around 30–45% of the general population, with a steep increase with ageing. Recent European guidelines have introduced novel recommendations for the management and treatment of hypertensive patients, with direct implications in daily clinical practice. Therefore, in this focused review, we will provide answers to the most common questions regarding the diagnosis, management and treatment of arterial hypertension according to the latest available European guidelines. Full article
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19 pages, 11089 KiB  
Review
Cardiac Magnetic Resonance Imaging in the Evaluation and Prognosis of Infiltrative Cardiomyopathies
by Merna Hussien, Francisca Bermudez, Patrick T. Bering, Gaby Weissman, Allison G. Hays and Farooq H. Sheikh
J. Cardiovasc. Dev. Dis. 2025, 12(4), 154; https://doi.org/10.3390/jcdd12040154 - 12 Apr 2025
Viewed by 386
Abstract
Advancements in cardiac magnetic resonance (CMR) imaging quality and availability have made it an essential tool in the care of individuals living with cardiomyopathies. CMR complements clinical suspicion, electrocardiogram patterns, and echocardiographic findings to help elucidate the etiology of cardiomyopathies and can also [...] Read more.
Advancements in cardiac magnetic resonance (CMR) imaging quality and availability have made it an essential tool in the care of individuals living with cardiomyopathies. CMR complements clinical suspicion, electrocardiogram patterns, and echocardiographic findings to help elucidate the etiology of cardiomyopathies and can also be used to prognosticate and follow treatment responses. In this review, we highlight the common CMR findings in cardiac amyloidosis, cardiac sarcoidosis, iron overload cardiomyopathy, and Fabry disease. We also summarize prognostic findings and additional potential roles for CMR in the management of infiltrative cardiomyopathies. Full article
(This article belongs to the Special Issue Cardiovascular Magnetic Resonance in Cardiology Practice: 2nd Edition)
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13 pages, 753 KiB  
Article
The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis?
by Michele D’Alonzo, Lorenzo Di Bacco, Antonio Fiore, Massimo Baudo, Francesca Zanin, Chiara Baldelli, Cyrus Moini, Thierry Folliguet and Claudio Muneretto
J. Cardiovasc. Dev. Dis. 2025, 12(4), 153; https://doi.org/10.3390/jcdd12040153 - 11 Apr 2025
Viewed by 177
Abstract
Background: Acute aortic valve infective endocarditis (IE) presents a critical surgical timing dilemma. This study investigates whether early surgical intervention (within seven days of targeted antibiotic therapy initiation) affects mortality and clinical outcomes compared to delayed/conventional surgery. Methods: A retrospective, multicenter analysis of [...] Read more.
Background: Acute aortic valve infective endocarditis (IE) presents a critical surgical timing dilemma. This study investigates whether early surgical intervention (within seven days of targeted antibiotic therapy initiation) affects mortality and clinical outcomes compared to delayed/conventional surgery. Methods: A retrospective, multicenter analysis of 204 patients with aortic IE was conducted, excluding emergency cases requiring immediate intervention. Patients were stratified into EARLY (≤7 days) and LATE (>7 days) surgical groups. Primary endpoints included in-hospital mortality and major adverse events, while secondary endpoints assessed long-term survival, recurrence, and reintervention rates. Results: No significant differences in in-hospital mortality were observed between groups (16% in both). The LATE group exhibited a trend toward increased permanent pacemaker implantation (16% vs. 8.2%; p = 0.100) and a higher incidence of postoperative atrial fibrillation (36% vs. 24%, p = 0.048). Infective endocarditis recurrence and long-term survival did not significantly differ between groups. Predictors of one-year mortality included chronic kidney disease, annular abscess, extracorporeal membrane oxygenation (ECMO) use, and prolonged mechanical ventilation. Conclusions: These findings suggest that early surgery, following a short course of antibiotics, does not compromise outcomes nor increase recurrence risk, challenging the conventional preference for delayed intervention in non-emergency IE cases. Full article
(This article belongs to the Section Cardiac Surgery)
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11 pages, 1507 KiB  
Article
Right Ventricular and Left Atrial Strain Predict Volumetric Response to Cardiac Resynchronization Therapy
by Shing Ching, Jeffrey Ji-Peng Li, Stefanie Maria Werhahn, Rebecca Elisabeth Beyer, Misael Estepa, Christian Stehning, Djawid Hashemi, Natalia Solowjowa, Christoph Klein, Henryk Dreger, Sebastian Kelle and Patrick Doeblin
J. Cardiovasc. Dev. Dis. 2025, 12(4), 152; https://doi.org/10.3390/jcdd12040152 - 11 Apr 2025
Viewed by 260
Abstract
Background: While left-bundle-branch-block-related contraction patterns as well as echocardiography-derived strain are variably associated with the volumetric response to cardiac resynchronization therapy (CRT), the role of CMR-derived strain parameters is unexplored. Methods: A total of 50 patients receiving CRT implantation were retrospectively analyzed, all [...] Read more.
Background: While left-bundle-branch-block-related contraction patterns as well as echocardiography-derived strain are variably associated with the volumetric response to cardiac resynchronization therapy (CRT), the role of CMR-derived strain parameters is unexplored. Methods: A total of 50 patients receiving CRT implantation were retrospectively analyzed, all of whom had undergone CMR imaging within one year before, and echocardiography within 6 months before and 6–12 months after CRT implantation. We assessed CMR-derived morphological and functional parameters with regard to the echocardiographic response, defined as a reduction in the left ventricular end-systolic volume of ≥15%. Results: Among the standard CMR parameters, the indexed right ventricular volumes in end-diastole (RVEDVi) (74.5 ± 19.5 vs. 94.8 ± 30.2 mL/m2, p = 0.006) and end-systole (RVESVi) (43.2 ± 13.3 vs. 61.6 ± 28.8 mL/m2, p = 0.003), as well as the left atrial (LA) area (24.8 ± 3.5 vs. 30.4 ± 9.5 cm2, p = 0.020), differed significantly between CRT responders and non-responders. In strain analysis, CRT responders showed a significantly better LA global longitudinal strain (GLS) (25.1 ± 10.4 vs. 15.3 ± 10.5, p = 0.002), LA global circumferential strain (GCS) (27.9 ± 14.7 vs. 17.1 ± 13.1%, p = 0.012), RV GLS (−25.0 ± 6.5 vs. −18.9 ± 7.6%, p = 0.004) and RV free wall strain (−31.1 ± 7.9 vs. −24.9 ± 9.5, p = 0.017). Conclusions: CMR-derived peak septal circumferential strain and RVEDVi correlated with the echocardiographic volumetric response to CRT at 6–12 months. Full article
(This article belongs to the Section Imaging)
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14 pages, 1433 KiB  
Review
Antiplatelet and Anticoagulation Therapy in Athletes: A Cautious Compromise… If Possible!
by Flavio D’Ascenzi, Guglielmo Leonardo Manfredi, Vincenzo Minasi, Gian Luca Ragazzoni, Luna Cavigli, Alessandro Zorzi, Giulia Elena Mandoli, Maria Concetta Pastore, Marta Focardi, Matteo Cameli, Massimo Fineschi and Serafina Valente
J. Cardiovasc. Dev. Dis. 2025, 12(4), 151; https://doi.org/10.3390/jcdd12040151 - 10 Apr 2025
Viewed by 370
Abstract
Antiplatelet and anticoagulation therapy are commonly used in the general population and sometimes in athletes experiencing cardiovascular disorders. In these cases, the treatment has to be tailored according to the individual bleeding and thrombotic risk profile, also considering the intrinsic risk of sports [...] Read more.
Antiplatelet and anticoagulation therapy are commonly used in the general population and sometimes in athletes experiencing cardiovascular disorders. In these cases, the treatment has to be tailored according to the individual bleeding and thrombotic risk profile, also considering the intrinsic risk of sports activities when advising athletes for eligibility for competitive sports. In athletes, it is necessary to pre-assess the individual bleeding risk, considering not only the personal bleeding risk (usually low in athletes) but also the type of sport the athlete would like to practice, with careful consideration in sports where traumatic collisions are highly likely. Additionally, non-steroidal anti-inflammatory drugs are commonly used among athletes, and antiplatelet therapy may further increase the bleeding risk. Therefore, in selected competitive athletes, the default approach for antithrombotic therapy could be personalized. This review discusses the clinical management challenges of competitive athletes under antithrombotic or antiplatelet therapy, focusing on the intrinsic risks of sports practice and the indications for sports eligibility and disqualification. Full article
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15 pages, 706 KiB  
Article
Autonomic Nervous System Control in Male and Female Elite Soccer Players: Importance of Different Training Routines and Perceived Stress
by Gianluigi Oggionni, Eleonora Pagani, Jacopo Rizzardini, Margherita Rigillo, Luca Giovanelli, Mara Malacarne, Nuno Loureiro, Júlia Machado Ribeiro, Piero Volpi, Massimo Pagani and Daniela Lucini
J. Cardiovasc. Dev. Dis. 2025, 12(4), 150; https://doi.org/10.3390/jcdd12040150 - 10 Apr 2025
Viewed by 281
Abstract
The assessment of cardiac autonomic regulation (CAR) with non-invasive techniques, such as heart rate variability (HRV), might be of practical interest in elite sports, considering its importance in determining training. We studied 117 soccer players (74 male and 43 female) from three First [...] Read more.
The assessment of cardiac autonomic regulation (CAR) with non-invasive techniques, such as heart rate variability (HRV), might be of practical interest in elite sports, considering its importance in determining training. We studied 117 soccer players (74 male and 43 female) from three First Division European soccer teams. We used a ranked Autonomic Nervous System Index (ANSI, resulting from the combination of multivariate statistical methodologies applied to HRV-derived indices) to assess CAR. We hypothesized that ANSI might differentiate playing positions, considering goalkeepers, defenders, midfielders, and forwards. We also assessed the perception of somatic symptoms and stress. We observed in male athletes that ANSI was significantly greater in males as compared to females (p < 0.001), being higher in midfielders and defenders (p = 0.035), who usually sustain the greatest external load. Interestingly, this result was not observed in female athletes, who, instead, reported a significantly higher perception of somatic symptoms (p = 0.018) and stress (p = 0.049), the latter being particularly high in midfielders and forwards (p = 0.045). This approach might represent a convenient model to study the effects of long-term physical exercise on CAR in soccer, even to unveil possible differences due to sex, different playing positions characterized by distinct exercise routines, or stress perception. Full article
(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management, 2nd Edition)
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12 pages, 1955 KiB  
Article
Echocardiographic Screening for Transcatheter Edge-to-Edge Mitral Valve Repair: Correlation Between Transthoracic and Transesophageal Assessment
by Michela Bonanni, Fausto Pizzino, Giovanni Benedetti, Rosangela Capasso, Rachele Manzo, Giuseppe Iuliano, Giancarlo Trimarchi, Andreina D’Agostino, Umberto Paradossi, Alessia Gimelli, Sergio Berti and Massimiliano Mariani
J. Cardiovasc. Dev. Dis. 2025, 12(4), 149; https://doi.org/10.3390/jcdd12040149 - 10 Apr 2025
Viewed by 187
Abstract
Background: In patients with significant mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (M-TEER), assessment of mitral valve (MV) anatomy is essential. While transthoracic echocardiography (TTE) is the initial diagnostic tool, transesophageal echocardiography (TOE) provides better anatomical details. The study aims to assess whether [...] Read more.
Background: In patients with significant mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (M-TEER), assessment of mitral valve (MV) anatomy is essential. While transthoracic echocardiography (TTE) is the initial diagnostic tool, transesophageal echocardiography (TOE) provides better anatomical details. The study aims to assess whether TTE is as effective as TOE in selecting patients with severe MR who are eligible for M-TEER. Methods: From January to December 2024, patients with severe MR eligible for TEER were enrolled at the Fondazione Monasterio Heart Hospital, Italy. They underwent a comprehensive TTE and TOE examination. Cardiologists assessed the severity of MR and valve anatomy using specific protocols. Measurements included MV area, MV gradient, posterior leaflet length, fossa ovalis high, presence of fails, clefts, and calcifications. Three levels of anatomic complexity were defined to determine eligibility for TEER. Results: The study includes 40 patients with severe MR. The correlation between TTE and TOE for key parameters was strong, with coefficients ranging from 0.734 to 0.901, indicating high agreement between the two methods. The comparison of categorical features showed high agreement between TTE and TOE in detecting critical MV conditions, with kappa values ranging from 0.717 to 0.930. The agreement for classifying patients as suitable for M-TEER was 87.5%, indicating moderate consistency between the two methods. Conclusions: TTE may be a viable alternative to TOE for assessing MV anatomy and function before M-TEER in MR patients, especially in high-volume centers. While TTE strongly correlated with TOE for most parameters, TOE was superior for some features. Further research is needed to refine the clinical application of TTE and to define patient selection criteria for its use as the primary imaging modality for pre-procedural M-TEER screening. Full article
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20 pages, 538 KiB  
Review
Myocardial Infarction in the Young: Aetiology, Emerging Risk Factors, and the Role of Novel Biomarkers
by Mithila Zaheen, Patrick Pender, Quan M. Dang, Eva Sinha, James J. H. Chong, Clara K. Chow and Sarah Zaman
J. Cardiovasc. Dev. Dis. 2025, 12(4), 148; https://doi.org/10.3390/jcdd12040148 - 10 Apr 2025
Viewed by 484
Abstract
Despite significant advancements in the primary and secondary prevention of cardiovascular disease, evidence shows a rising incidence of premature coronary artery disease (CAD) and myocardial infarction (MI) in patients aged < 50 years. This increase is linked to the growing prevalence of traditional [...] Read more.
Despite significant advancements in the primary and secondary prevention of cardiovascular disease, evidence shows a rising incidence of premature coronary artery disease (CAD) and myocardial infarction (MI) in patients aged < 50 years. This increase is linked to the growing prevalence of traditional cardiovascular risk factors among younger people, such as type 2 diabetes, hypertension, obesity, and hyperlipidaemia, which have led to a rise in atherosclerotic CAD. Additionally, emerging research points to the influence of less traditional risk factors, including chronic inflammation, autoimmune diseases, drug use, psychosocial factors, and novel biomarkers in the early onset of CAD. These factors collectively contribute to the rise in premature CAD, highlighting the need for improved prevention strategies and public health efforts focused on younger populations. In this review, we explore the aetiology, risk factor profile, role of novel biomarkers, and how each of these impact outcomes among younger patients with MI. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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14 pages, 557 KiB  
Article
Social Support and 10-Year Mortality Following Acute Myocardial Infarction
by Batya Betesh-Abay, Arthur Shiyovich and Ygal Plakht
J. Cardiovasc. Dev. Dis. 2025, 12(4), 147; https://doi.org/10.3390/jcdd12040147 - 10 Apr 2025
Viewed by 268
Abstract
This study investigates social support type and long-term mortality following AMI. Demographic and clinical data were collected retrospectively from a tertiary hospital for all patients with AMI (2011–2017). Study groups based on support type were defined: (1) employed partner (served as the reference [...] Read more.
This study investigates social support type and long-term mortality following AMI. Demographic and clinical data were collected retrospectively from a tertiary hospital for all patients with AMI (2011–2017). Study groups based on support type were defined: (1) employed partner (served as the reference group); (2) unemployed partner; (3) no partner, family support; (4) institutional or benefit-dependent; and (5) non-kin support (caregiver). Ten-year all-cause mortality risk was assessed and compared between the groups. We identified 2652 AMI patients with recorded support type: mean age 67.6 (SD = 14) years, 66% male; 40% had no partner, followed by those with an unemployed partner (31%). Over the follow-up of (median) 7.6 years, 1471 patients died; significantly higher mortality rates were observed in patients without family support (67.9%) or receiving non-kin support (94.9%). Those with non-kin support were at the highest mortality risk, AdjHR = 2.20, 95% CI: 1.67–2.91, p < 0.001, as compared with the reference group. Subgroup analyses found women below age 75 years, Arab women, and those with higher functional status to be most vulnerable to mortality in the absence of family support. Lack of family support was associated with increased long-term mortality among AMI patients. Assessment of support status among AMI patients is integral for secondary prevention. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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14 pages, 5777 KiB  
Review
Optimal Management of Spontaneous Aortic Thrombus Floating in the Ascending Aorta, from a Single Case Experience to a Literature Review
by Jacopo Gardellini, Daniele Linardi, Venanzio Di Nicola, Gino Puntel, Giovanni Puppini, Luca Barozzi and Giovanni Battista Luciani
J. Cardiovasc. Dev. Dis. 2025, 12(4), 146; https://doi.org/10.3390/jcdd12040146 - 9 Apr 2025
Viewed by 174
Abstract
As spontaneous ascending aortic thrombi (AATs) are uncommon in modern clinical practice, despite the application of new technology and the widespread use of contrast-enhanced computer tomography during primary assessments in patients without underlying predisposing conditions, a thrombus floating in the ascending aorta is [...] Read more.
As spontaneous ascending aortic thrombi (AATs) are uncommon in modern clinical practice, despite the application of new technology and the widespread use of contrast-enhanced computer tomography during primary assessments in patients without underlying predisposing conditions, a thrombus floating in the ascending aorta is rarely discovered in a timely manner; moreover, the ascending tract represents an unusual site for thrombus formation. The clinical presentation of AATs is also often in the form of peripheral arterial embolization, which can cause a wide variety of symptoms, from stroke to limb ischemia, and thus delay correct diagnosis. Medical management is a risky strategy, while surgical treatment is usually challenging due to the risk of thrombus dislodgement and difficulties related to prior embolization complication management. In this study, faced with a peculiar case of embolic stroke in an otherwise healthy 71-year-old woman, we analyzed the status of knowledge on spontaneous ascending aortic thrombus treatments and outcomes. A multidisciplinary approach represents the best choice for defining a patient’s timing of surgery and ensuring the management of complications. Sequential multistage treatment minimizes further complications and prevents worsening patient outcomes, leading to the best management for every possible clinical presentation. A less invasive surgical approach could lead to complete resolution of the pathology, avoiding further potentially lethal complications, facilitating postoperative management, avoiding delayed treatments, and resulting in better outcomes. Full article
(This article belongs to the Special Issue Aortic Pathology and Therapeutic Strategies)
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11 pages, 3100 KiB  
Article
A Hybrid Minimally Invasive Atrial Fibrillation Ablation Procedure Using Unilateral Thoracoscopy and Endocardial Pulsed Field Ablation: An Early Feasibility Study
by Ivan Eltsov, Luigi Pannone, Domenico Giovanni Della Rocca, Massimiliano Marini, Giacomo Talevi, Andrea Maria Paparella, Pasquale Vergara, Erwin Ströker, Juan Sieira, Gian-Battista Chierchia, Carlo de Asmundis and Mark La Meir
J. Cardiovasc. Dev. Dis. 2025, 12(4), 145; https://doi.org/10.3390/jcdd12040145 - 9 Apr 2025
Viewed by 289
Abstract
(1) Objective: To examine the efficiency and efficacy of using endovascular mapping and pulsed field ablation in the setting of a hybrid video-assisted thoracoscopic atrial fibrillation (AF) ablation procedure. (2) Methods: Eleven consecutive patients underwent hybrid video-assisted thoracoscopic epicardial ablation and left atrial [...] Read more.
(1) Objective: To examine the efficiency and efficacy of using endovascular mapping and pulsed field ablation in the setting of a hybrid video-assisted thoracoscopic atrial fibrillation (AF) ablation procedure. (2) Methods: Eleven consecutive patients underwent hybrid video-assisted thoracoscopic epicardial ablation and left atrial appendage exclusion followed by endocardial ablation using pulsed field ablation energy. The completeness of epicardial and endocardial lesion sets were assessed using 3D electro-anatomical mapping. (3) Results: Left atrial appendage (LAA) exclusion and durable pulmonary vein isolation (PVI) and posterior wall isolation (PWI) were achieved in all patients. The endovascular part of the necessary lesion set using PFA energy was successful in 100% of the patients. All patients remained in SR during the 12-month follow-up period. (4) Conclusions: Our study confirms the feasibility of using endovascular pulsed field ablation to complete previously performed epicardial lesion sets during the hybrid AF ablation procedures, without extending the procedure time or increasing the risk of complications. Full article
(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias, 2nd Edition)
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35 pages, 805 KiB  
Review
Copeptin in Acute Myocardial Infarction: Is There a Role in the Era of High-Sensitivity Troponins?
by Sofia Bezati, Ioannis Ventoulis, Vasiliki Bistola, Christos Verras, Dionysis Matsiras, Effie Polyzogopoulou and John Parissis
J. Cardiovasc. Dev. Dis. 2025, 12(4), 144; https://doi.org/10.3390/jcdd12040144 - 9 Apr 2025
Viewed by 315
Abstract
The quest for prompt and effective diagnosis of acute myocardial infarction (AMI) has been in the spotlight for decades. Ongoing research focuses on refined biomarker strategies for the early identification and disposition of patients with symptoms suggestive of AMI. Copeptin, a surrogate of [...] Read more.
The quest for prompt and effective diagnosis of acute myocardial infarction (AMI) has been in the spotlight for decades. Ongoing research focuses on refined biomarker strategies for the early identification and disposition of patients with symptoms suggestive of AMI. Copeptin, a surrogate of the hormone arginine vasopressin, has emerged as a novel biomarker that could potentially aid in the diagnostic approach of patients with chest pain presenting to the emergency department. Observational studies have demonstrated that copeptin is upregulated in patients with AMI, although the exact pathophysiological mechanisms implicated in its release during myocardial ischemia remain unclear. Following these observations, copeptin was proposed as an adjunct to troponin in an effort to augment the diagnostic accuracy of conventional troponin assays. However, after the introduction of high-sensitivity troponin assays, the diagnostic utility of copeptin has been debated. This narrative review aims to elucidate plausible pathophysiological mechanisms involved in copeptin release during myocardial ischemia and to summarize the most recent evidence regarding its diagnostic potential in combination with high-sensitivity troponin assays. Full article
(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)
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12 pages, 663 KiB  
Review
Neuroprotective Strategies in Coronary Artery Disease Interventions
by Maurish Fatima, Akbar Bazarbaev, Asama Rana, Ruman Khurshid, Victory Effiom, Nyle Khalid Bajwa, Afsheen Nasir, Katherine Candelario, Sair Ahmad Tabraiz, Samantha Colon, Chanseo Lee, Sedem Dankwa and Irbaz Hameed
J. Cardiovasc. Dev. Dis. 2025, 12(4), 143; https://doi.org/10.3390/jcdd12040143 - 8 Apr 2025
Viewed by 330
Abstract
Neuroprotective strategies in coronary artery interventions are essential due to the rising number of high-risk patients undergoing procedures like coronary artery bypass grafting (CABG), totally endoscopic coronary artery bypass (TECAB), and hybrid revascularization. In this review article, we summarize the neurological complications associated [...] Read more.
Neuroprotective strategies in coronary artery interventions are essential due to the rising number of high-risk patients undergoing procedures like coronary artery bypass grafting (CABG), totally endoscopic coronary artery bypass (TECAB), and hybrid revascularization. In this review article, we summarize the neurological complications associated with coronary artery disease intervention and the risk mitigation strategies. CABG carries significant risks, including ischemic stroke, encephalopathy, seizures, and peripheral nerve injuries. Risk factors include advanced age, hypertension, diabetes, and atherosclerosis. Off-pump CABG minimizes stroke risk by avoiding aortic manipulation and CPB. TECAB and hybrid revascularization have fewer reported neurological complications but still pose risks of stroke and cranial nerve injuries. Pharmacological neuroprotection includes agents such as barbiturates, volatile anesthetics, lidocaine, NMDA receptor antagonists, magnesium, nimodipine, corticosteroids, and aprotinin. Deep hypothermic circulatory arrest (DHCA) is reserved for complex aortic cases requiring a bloodless surgical field. Intraoperative strategies involve cerebral perfusion monitoring, embolic protection devices, and therapeutic hypothermia. Preoperative optimization targets risk factors, arrhythmia prevention, and antiplatelet therapy management. Postoperatively, timely antiplatelet administration, glucose control, hemodynamic stabilization, and cognitive monitoring are critical. Comprehensive neuroprotective approaches, spanning pre- to postoperative phases, aim to reduce neurological complications and enhance outcomes in coronary interventions. Full article
(This article belongs to the Special Issue 2nd Edition: Interventional Therapies and Management in Coronary Artery Disease)
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31 pages, 1257 KiB  
Review
Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review
by Domenico Simone Castiello, Federica Buongiorno, Lina Manzi, Viviana Narciso, Imma Forzano, Domenico Florimonte, Luca Sperandeo, Mario Enrico Canonico, Marisa Avvedimento, Roberta Paolillo, Alessandra Spinelli, Stefano Cristiano, Fiorenzo Simonetti, Federica Semplice, Dario D’Alconzo, Donato Maria Vallone, Giuseppe Giugliano, Alessandro Sciahbasi, Plinio Cirillo, Felice Gragnano, Paolo Calabrò, Giovanni Esposito and Giuseppe Gargiuloadd Show full author list remove Hide full author list
J. Cardiovasc. Dev. Dis. 2025, 12(4), 142; https://doi.org/10.3390/jcdd12040142 - 8 Apr 2025
Viewed by 421
Abstract
In the past decades, percutaneous coronary intervention (PCI) has become the most common modality for myocardial revascularization in patients with coronary artery disease (CAD). Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is essential in all patients undergoing PCI to prevent [...] Read more.
In the past decades, percutaneous coronary intervention (PCI) has become the most common modality for myocardial revascularization in patients with coronary artery disease (CAD). Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is essential in all patients undergoing PCI to prevent thrombotic complications. A large proportion of patients undergoing PCI also have concomitant atrial fibrillation (AF), thus requiring an oral anticoagulant (OAC) to prevent ischemic stroke or systemic embolism. However, the association between OAC and DAPT further increases the risk of bleeding. Compared with a triple antithrombotic therapy (TAT), dual antithrombotic therapy (DAT) has shown to reduce bleeding events, but at the cost of higher risk of stent thrombosis. In this field, patients with AF undergoing PCI represent a special population with significant challenges, and several strategies are needed to reduce the risk for bleeding complications. In this review, we will discuss both the procedural and antithrombotic strategies to optimize ischemic and bleeding outcomes in patients with AF undergoing PCI. Full article
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10 pages, 244 KiB  
Perspective
Ancel Keys, the Mediterranean Diet, and the Seven Countries Study: A Review
by Alessandro Menotti and Paolo Emilio Puddu
J. Cardiovasc. Dev. Dis. 2025, 12(4), 141; https://doi.org/10.3390/jcdd12040141 - 8 Apr 2025
Viewed by 412
Abstract
The identification of the “Mediterranean Diet” (MD) by Prof. Ancel Keys is described here, alongside its confirmation through the epidemiological study known as “The Seven Countries Study of Cardiovascular Diseases” (SCS). Prof. Keys’ intuition on the possible dietary determinants of coronary heart disease [...] Read more.
The identification of the “Mediterranean Diet” (MD) by Prof. Ancel Keys is described here, alongside its confirmation through the epidemiological study known as “The Seven Countries Study of Cardiovascular Diseases” (SCS). Prof. Keys’ intuition on the possible dietary determinants of coronary heart disease (CHD) was derived from several pilot studies conducted in various countries. His impression was that the healthy diet was eaten along the Mediterranean shores of Italy, former Yugoslavia, and Greece, characterized by a large intake of bread, cereals, vegetables, fruit, and olive oil, with a small intake of meat, milk, dairy, and sugar products. The SCS was conducted across 16 cohorts of middle-aged men in seven countries (USA, Finland, the Netherlands, Italy, former Yugoslavia, Greece, and Japan), with assessments of usual eating habits, repeated medical examinations, and long-term follow-up. Analyses by Keys on the data from the first 15 years of follow-up indicated that low intake of saturated fatty acids (SAFA), usually derived from animal foods, was associated with the lower occurrence of and mortality from CHD, confirming the idea that a diet such as the Mediterranean Diet could be healthy. Further analyses by collaborators of the SCS, over a longer follow-up period, included the use of food groups and dietary scores of different types, confirming that cohorts with a Mediterranean Diet had a lower risk and death rate from CHD, whereas the reverse occurred in populations consuming an unhealthy diet. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
11 pages, 421 KiB  
Review
Brief Review: Racial Disparities in the Presentation and Outcomes of Patients with Thoracic Aortic Aneurysms
by Nora Bacour, Rutger T. Theijsse, Simran Grewal, Robert J. M. Klautz and Nimrat Grewal
J. Cardiovasc. Dev. Dis. 2025, 12(4), 140; https://doi.org/10.3390/jcdd12040140 - 7 Apr 2025
Viewed by 178
Abstract
(1) Background: Thoracic aortic aneurysms (TAAs) pose critical health risks and are often asymptomatic until a rupture or dissection occurs. Guidelines recommend surgical repair based on specific aortic diameters and risk factors, emphasizing the importance of early detection and intervention. Despite established clinical [...] Read more.
(1) Background: Thoracic aortic aneurysms (TAAs) pose critical health risks and are often asymptomatic until a rupture or dissection occurs. Guidelines recommend surgical repair based on specific aortic diameters and risk factors, emphasizing the importance of early detection and intervention. Despite established clinical risk factors for the early detection of TAAs, the influence of racial disparities on TAAs remains underexplored. This study aims to provide a comprehensive summary of existing research on racial disparities in the presentation and outcomes of TAAs. (2) Methods: This literature review was conducted using a systematic search strategy to explore racial differences in the presentation and surgical outcomes of patients with TAAs. (3) Results: The findings demonstrated that black patients were younger at presentation and had a higher incidence of ruptured TAAs than non-black patients. Furthermore, compared to non-black patients, black patients had higher rates of cardiac arrhythmia and COPD, as well as comorbidities such as diabetes, hypertension, and renal insufficiency. For black patients undergoing open surgery, the surgical results showed improved 5-year survival rates after repair but higher perioperative mortality rates. All-cause or in-hospital mortality did not significantly differ between the racial groups, according to four studies. (4) Discussion: This review highlights significant racial disparities in TAA presentation and outcomes, underscoring the need for personalized risk stratification models. Standardized racial and ethnic definitions are essential for consistent and reliable research. Future studies should focus on identifying the underlying mechanisms driving racial disparities and on refining risk assessment models to enhance diagnostic and therapeutic strategies, ultimately improving patient outcomes across diverse populations. Full article
(This article belongs to the Special Issue Risk Factors and Prevention of Cardiovascular Diseases—Second Edition)
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12 pages, 935 KiB  
Article
Cardiopulmonary Bypass Time During Surgery for Acute Type A Aortic Dissection and Mid-Term Survival
by Mikko Uimonen, Christian Olsson, Anders Jeppsson, Arnar Geirsson, Vibeke Hjortdal, Emma C. Hansson, Igor Zindovic, Jacob Ede, Jarmo Gunn, Anders Wickbom, Tomas Gudbjartsson and Ari Mennander
J. Cardiovasc. Dev. Dis. 2025, 12(4), 139; https://doi.org/10.3390/jcdd12040139 - 7 Apr 2025
Viewed by 204
Abstract
We evaluated the association between cardiopulmonary bypass (CPB) time during surgery for acute type A aortic dissection (ATAAD) and mid-term survival. Data of 1122 patients who underwent surgery for ATAAD in eight Nordic centers from January 2005 to December 2014 were retrospectively analyzed. [...] Read more.
We evaluated the association between cardiopulmonary bypass (CPB) time during surgery for acute type A aortic dissection (ATAAD) and mid-term survival. Data of 1122 patients who underwent surgery for ATAAD in eight Nordic centers from January 2005 to December 2014 were retrospectively analyzed. An adjusted logistic regression analysis was performed to investigate the association of incremental 30 min CPB time on 30-day mortality. In addition, the patients were divided into those that underwent surgery with >210 min (n = 369) or <210 min CPB time (n = 605) based on spline analysis and a receiver operating characteristic curve. The restricted mean survival time ratios adjusted for patient characteristics and surgical details between the groups were calculated for survival and aortic reoperation-free survival. The median follow-up time was 2.6 (inter-quartile range 0.9–4.9) years. Incremental CPB time was associated with higher 30-day mortality (OR 1.25 per 30 min, 95% CI 1.15–1.35, p < 0.001). Mid-term survival for all patients was inferior in the >210 min group as compared with the <210 min group (adjusted restricted mean survival time ratio 0.88, 95% confidence interval [CI] 0.81–0.96, p = 0.003). Reoperation-free survival was similar in patients with CPB time > 210 min as compared with <210 min. Prolonged CPB time is associated with higher 30-day mortality and inferior mid-term survival but not with inferior reoperation-free survival after surgical repair of ATAAD. Full article
(This article belongs to the Section Acquired Cardiovascular Disease)
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8 pages, 621 KiB  
Article
Trends of Cardiac Complaints in Pediatric and Young Adult Populations During the COVID-19 Pandemic
by Emily M. Ferraro, Madeline I. Dorr, Cade M. Nylund, Apryl Susi, Elizabeth Hisle-Gorman, Michael Rajnik and Brian N. Hughes
J. Cardiovasc. Dev. Dis. 2025, 12(4), 138; https://doi.org/10.3390/jcdd12040138 - 7 Apr 2025
Viewed by 228
Abstract
The COVID-19 pandemic had a significant impact on the physical and mental health of all age groups. While many studies have evaluated the serious cardiac manifestation associated with multisystem inflammatory syndrome of children, there are less studies evaluating how the COVID-19 pandemic impacted [...] Read more.
The COVID-19 pandemic had a significant impact on the physical and mental health of all age groups. While many studies have evaluated the serious cardiac manifestation associated with multisystem inflammatory syndrome of children, there are less studies evaluating how the COVID-19 pandemic impacted the presentation of less severe symptomatic cardiac manifestations. This large retrospective cross-sectional study examined the impact of the COVID-19 pandemic on the cardiovascular health of patients 1 to 24 years of age by assessing care presentation trends for chest pain, palpitations, and syncope for patients in the military health system. Overall, chest pain had the highest rate of presentation when compared to syncope and palpitations. There was a significant decrease in the rate of incidence for all three cardiac symptoms during the first year of the COVID-19 pandemic compared to the pre-COVID-19 period. When comparing the second year of the COVID-19 pandemic to the pre-COVID-19 period, there was a significant decrease in chest pain and syncope but a slight increase in palpitations. Overall, our results showed that these common cardiac presentations did not greatly increase during the COVID-19 pandemic. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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16 pages, 258 KiB  
Article
Quality of Life in Heart Failure Patients: The Effect of Anxiety and Depression (Patient–Caregiver) and Caregivers’ Quality of Life
by Athanasia Tsami, Ioannis Koutelekos, Georgia Gerogianni, Georgios Vasilopoulos, Niki Pavlatou, Antonia Kalogianni, Theodore Kapadochos, Angleliki Stamou and Maria Polikandrioti
J. Cardiovasc. Dev. Dis. 2025, 12(4), 137; https://doi.org/10.3390/jcdd12040137 - 4 Apr 2025
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Abstract
Patients with heart failure (HF) and their caregivers are a dyad inextricably linked that exert influence on patients’ quality of life (QoL). Purpose: The aim of this study was to explore factors affecting HF patients’ QoL. Factors were: (a) HF patients’ characteristics, (b) [...] Read more.
Patients with heart failure (HF) and their caregivers are a dyad inextricably linked that exert influence on patients’ quality of life (QoL). Purpose: The aim of this study was to explore factors affecting HF patients’ QoL. Factors were: (a) HF patients’ characteristics, (b) anxiety/depression of the dyad (patient–caregiver) and (c) caregivers’ QoL. Material and Methods: In this cross-sectional study, we enrolled 340 patients and 340 caregivers. Data collection was performed by the method of an interview using “The Hospital Anxiety and Depression Scale”, HADS) to assess anxiety and depression (patient–caregiver) as well as the “Minnesota Living with Heart Failure” and the “SF-36 Health Survey (SF-36)” to assess QoL (patient–caregiver, respectively). Results: From the 340 dyads who comprised the sample, 81.3% and 77.5% of patients experienced anxiety and depression, respectively, while 79.3% and 62.2% of caregivers experienced anxiety and depression, respectively. A statistically significant difference between patients and caregivers was only detected for depression (p = 0.001) and not for anxiety (p = 0.567). Patients with scores in HADS that indicate anxiety and depression had a worse QoL (total, physical, and mental). All subscales of the caregiver’s QoL were significantly associated with the patient’s QoL (p < 0.001) apart from the physical functioning scale. The correlation coefficients were all negative, indicating that a better caregiver’s QoL (higher SF36 scores) is associated with a better patient’s QoL (lower Minnesota scores). After controlling for the patient’s characteristics, the anxiety and depression of caregivers did not affect the patient’s QoL (confounding effect) whereas the patient’s anxiety/depression remained significant factors. Patients with anxiety and depression had 5.58 and 6.49 points, respectively, higher QoL score, meaning a worse QoL, compared to those with no anxiety/depression. Conclusions: Evaluating the impact of HF on patients’ QoL and anxiety/depression along with their caregivers permits acknowledgment of this dyadic relationship. Full article
14 pages, 502 KiB  
Article
Gender Differences in Objective and Subjective Social Isolation and Self-Reported Hypertension in Older Adults
by Tyrone C. Hamler, Ann W. Nguyen, Harry Owen Taylor, Weidi Qin and Fei Wang
J. Cardiovasc. Dev. Dis. 2025, 12(4), 136; https://doi.org/10.3390/jcdd12040136 - 4 Apr 2025
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Abstract
Hypertension is a major public health concern, especially in older adults, and gender differences are a factor in terms of its prevalence. Social connections benefit health, while social isolation is linked to negative outcomes. Prior studies suggest social isolation and connectedness vary by [...] Read more.
Hypertension is a major public health concern, especially in older adults, and gender differences are a factor in terms of its prevalence. Social connections benefit health, while social isolation is linked to negative outcomes. Prior studies suggest social isolation and connectedness vary by gender, but few have explored this relationship with hypertension. This study examined gender differences in the association between social isolation and hypertension in older adults using data from the National Survey of American Life (1280 adults aged ≥55). Weighted logistic regressions tested gender differences in objective and subjective social isolation and hypertension. Both men and women who were objectively isolated from family and friends, or only friends, were less likely to have hypertension than those not isolated. However, when accounting for subjective isolation, only isolation from family predicted hypertension. Gender moderated this relationship—men isolated from family and friends had a higher likelihood of hypertension, while no such association was found for women. Findings suggest that preventing objective isolation, particularly from family, may help reduce hypertension risk in older adults. This study highlights the need to further investigate social isolation’s impact on health and its underlying mechanisms among older adults in the U.S. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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15 pages, 827 KiB  
Review
Telomere Length and Clonal Hematopoiesis of Indeterminate Potential: A Loop Between Two Key Players in Aortic Valve Disease?
by Ilenia Foffa, Augusto Esposito, Ludovica Simonini, Sergio Berti and Cecilia Vecoli
J. Cardiovasc. Dev. Dis. 2025, 12(4), 135; https://doi.org/10.3390/jcdd12040135 - 3 Apr 2025
Viewed by 303
Abstract
Aortic valve stenosis (AVS) is the most common valvular heart disease that was considered, for a long time, a passive degenerative disease due to physiological aging. More recently, it has been recognized as an active, modifiable disease in which many cellular processes are [...] Read more.
Aortic valve stenosis (AVS) is the most common valvular heart disease that was considered, for a long time, a passive degenerative disease due to physiological aging. More recently, it has been recognized as an active, modifiable disease in which many cellular processes are involved. Nevertheless, since aging remains the major risk factor for AVS, a field of research has focused on the role of early (biological) aging and its dependent pathways in the initiation and progression of AVS. Telomeres are regions at the ends of chromosomes that are critical for maintaining genome stability in eukaryotic cells. Telomeres are the hallmarks and molecular drivers of aging and age-related degenerative pathologies. Clonal hematopoiesis of indeterminate potential (CHIP), a condition caused by somatic mutations of leukemia-associated genes in individuals without hematologic abnormalities or clonal disorders, has been reported to be associated with aging. CHIP represents a new and independent risk factor in cardiovascular diseases, including AVS. Interestingly, evidence suggests a causal link between telomere biology and CHIP in several pathological disorders. In this review, we discussed the current knowledge of telomere biology and CHIP as possible mechanisms of aortic valve degeneration. We speculated on how a better understanding of the complex relationship between telomere and CHIP might provide great potential for an early diagnosis and for developing novel medical therapies to reduce the constant increasing health burden of AVS. Full article
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15 pages, 1737 KiB  
Review
Endurance Training Exercise Dose in Coronary Artery Disease Rehabilitation
by Daria Neyroud and Aaron L. Baggish
J. Cardiovasc. Dev. Dis. 2025, 12(4), 134; https://doi.org/10.3390/jcdd12040134 - 3 Apr 2025
Viewed by 264
Abstract
Clinical management of patients with atherosclerotic coronary artery disease (CAD) following acute coronary syndrome includes cardiac rehabilitation. The well-established hallmark of cardiac rehabilitation is structured aerobic exercise training. To date, however, a limited number of studies have directly compared the effects of different [...] Read more.
Clinical management of patients with atherosclerotic coronary artery disease (CAD) following acute coronary syndrome includes cardiac rehabilitation. The well-established hallmark of cardiac rehabilitation is structured aerobic exercise training. To date, however, a limited number of studies have directly compared the effects of different doses of exercise on cardiovascular health, leaving uncertainty about the possible differential benefits of different exercise doses for use during cardiac rehabilitation. To address this area of uncertainty, we conducted a literature review and comparative analyses of studies that both compared two or more exercise interventions and assessed pre- and post-intervention peak oxygen consumption (V˙O2PEAK). Results from these analyses suggest that high exercise intensity, even when performed over relatively short duration interventions, appears to yield the most substantial improvements in cardiorespiratory fitness. However, this conclusion is based on the limited number of available studies, underscoring the need for future work examining exercise dose and clinical outcomes in the cardiac rehabilitation setting. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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11 pages, 595 KiB  
Article
Age-Dependent Risk of Long-Term All-Cause Mortality in Patients Post-Myocardial Infarction and Acute Kidney Injury
by Keren Skalsky, Mashav Romi, Arthur Shiyovich, Alon Shechter, Tzlil Grinberg, Harel Gilutz and Ygal Plakht
J. Cardiovasc. Dev. Dis. 2025, 12(4), 133; https://doi.org/10.3390/jcdd12040133 - 3 Apr 2025
Viewed by 193
Abstract
Objectives: We aimed to investigate the association between acute kidney injury (AKI) and the risk for long-term (up to 10 years) all-cause mortality among elderly compared with younger patients following an acute myocardial infarction (AMI). Methods: This study was a retrospective analysis of [...] Read more.
Objectives: We aimed to investigate the association between acute kidney injury (AKI) and the risk for long-term (up to 10 years) all-cause mortality among elderly compared with younger patients following an acute myocardial infarction (AMI). Methods: This study was a retrospective analysis of the Soroka Acute Myocardial Infarction registry and covered the years 2002 to 2017. It included patients diagnosed with an AMI who had a baseline estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m2 and serum creatinine measurements available during hospitalization. The patients were stratified by age: elderly (aged 65 years or older at admission) and younger. In each stratum, two groups were defined based on the presence of an AKI. The survival approach (Kaplan–Meier survival curves, log-rank test and Cox regressions) was utilized to estimate and compare the probability of long-term (up to 10 years) all-cause mortality in each group. Results: Among the 10,511 eligible patients, which consisted of 6132 younger patients (58.3%) and 4379 elderly (41.7%), an AKI occurred in 15.2% of cases, where the elderly patients experienced a higher incidence than the younger patients (20.9% vs. 11.2%, p < 0.001). The presence of an AKI significantly increased the risk of death in both age groups, with the association being stronger among the younger patients (AdjHR = 1.634, 95% CI: 1.363–1.959, p < 0.001) than among the elderly (AdjHR = 1.278, 95% CI: 1.154–1.415, p < 0.001, p-for-interaction = 0.020). Conclusions: An AKI following an AMI was associated with a high risk for long-term all-cause mortality in both age groups, with a stronger association among younger patients. Full article
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9 pages, 1789 KiB  
Article
Decreased Endothelial Progenitor Cells Are Associated with Severe Coronary Artery Disease: Insights from a Clinical Study
by Ivan Tomić, Ivan Zeljko, Ivica Brizić, Violeta Šoljić, Ivona Ivančić, Monika Tomić, Marina Ćurlin and Domagoj Tomić
J. Cardiovasc. Dev. Dis. 2025, 12(4), 132; https://doi.org/10.3390/jcdd12040132 - 3 Apr 2025
Viewed by 227
Abstract
Endothelial progenitor cells (EPCs) play a crucial role in vascular repair, and their depletion has been involved in coronary artery disease (CAD) severity. This study examines the relationship between circulating EPC levels and CAD complexity, as quantified by the Syntax Score I. A [...] Read more.
Endothelial progenitor cells (EPCs) play a crucial role in vascular repair, and their depletion has been involved in coronary artery disease (CAD) severity. This study examines the relationship between circulating EPC levels and CAD complexity, as quantified by the Syntax Score I. A total of 85 patients undergoing coronary angiography were enrolled, with EPCs quantified using flow cytometry. EPC proportion showed a significant inverse relationship with CAD severity, measured by Syntax Score I. Additionally, we investigated EPC levels in patients presenting with acute coronary syndrome (ACS) and found that EPC depletion was more pronounced in this group compared to non-ACS patients (median EPC count: 0.35 vs. 0.61, p = 0.027). These findings suggest that lower EPC levels are indicative of more severe CAD and ACS, reinforcing their potential as biomarkers for cardiovascular risk stratification, monitoring disease advancement, and identifying patients at risk of adverse events. Full article
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