Journal of Cardiovascular Development and Disease

12 pages, 965 KiB

Open AccessArticle

Genetic Spectrum of Lithuanian Familial Hypercholesterolemia Patients

by Urte Aliosaitiene, Rimante Cerkauskiene, Aleksandras Laucevicius, Migle Vilniskyte, Viktoras Sutkus, Antanas Mainelis, Birute Burnyte, Jurate Barysiene and Zaneta Petrulioniene

J. Cardiovasc. Dev. Dis. 2025, 12(5), 197; https://doi.org/10.3390/jcdd12050197 - 21 May 2025

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Abstract

Background and aims: Although familial hypercholesterolemia (FH) is a common congenital cause of elevated low-density lipoprotein cholesterol (LDL-C), it remains underdiagnosed and undertreated worldwide due to its inherent genetic heterogeneity. This study aimed to determine the prevalence of genetic variants in a Lithuanian [...] Read more.

Background and aims: Although familial hypercholesterolemia (FH) is a common congenital cause of elevated low-density lipoprotein cholesterol (LDL-C), it remains underdiagnosed and undertreated worldwide due to its inherent genetic heterogeneity. This study aimed to determine the prevalence of genetic variants in a Lithuanian patient cohort with clinically diagnosed FH and evaluate their possible clinical implications. Methods: A total of 172 patients were included in the retrospective analysis. The study population comprised males and females ranging from 0 to 85 years of age, with LDL-C levels exceeding 4.9 mmol/L in adults and 3.9 mmol/L in children. The subjects were divided into four groups according to the Dutch Lipid Clinic Network (DLCN) criteria (definite, probable, possible, and unlikely). Children were analyzed separately. Next-generation sequencing (NGS) has been chosen as the most appropriate technique for genetic testing. All identified variants were categorized into three groups: (1) pathogenic, (2) likely pathogenic, and (3) variants of uncertain significance. Subjects without detected variants were classified into group (4) No mutation. Results: Women were diagnosed with FH significantly later than men (p = 0.033). Genetic testing identified FH-causing variants in 41.86% of subjects, with 20.93% carrying pathogenic variants, 9.88% likely pathogenic, and 11.05% variants of uncertain significance (VUS). Frequently identified pathogenic variants were c.654_656del p.(Gly219del) in LDLR and c.10580G>A p.(Arg3527Gln) in APOB, which are both linked to the founder effect. Genetic testing led to a reassessment of Dutch Lipid Clinic Network scores, increasing the number of individuals classified as “Definite FH” by 86.2%. Conclusions: The increasing use of NGS in FH has enhanced diagnostic capabilities and suggests population-specific genetic patterns. However, it also increases VUS detection, for which reclassification rates are still low and require strenuous efforts. Moreover, despite the benefits of genetic testing, significant gender disparities remain and require further attention. Full article

(This article belongs to the Section Genetics)

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21 pages, 518 KiB

Open AccessReview

Therapeutic Management of LDL-C: Efficacy and Economic Impact Assessment

by Abdallah Elshafeey

J. Cardiovasc. Dev. Dis. 2025, 12(5), 196; https://doi.org/10.3390/jcdd12050196 - 20 May 2025

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Abstract

Cardiovascular disease (CVD) is one of the largest global disease burdens. Despite guidelines and recommendations and the proven advantages of lipid-lowering therapies (LLTs) in preventing CVD, achieving treatment targets remains disappointing. A key barrier to optimal LLT is therapy discontinuation. To be widely [...] Read more.

Cardiovascular disease (CVD) is one of the largest global disease burdens. Despite guidelines and recommendations and the proven advantages of lipid-lowering therapies (LLTs) in preventing CVD, achieving treatment targets remains disappointing. A key barrier to optimal LLT is therapy discontinuation. To be widely adopted in clinical practice, new lipid-lowering therapies must both prevent major adverse cardiovascular events (MACEs) and exhibit cost effectiveness to ensure widespread utilization by patients, physicians, and insurers. While non-statin LLTs have shown cardiovascular value, their cost effectiveness is controversial. This review highlights the LLTs that are currently widely adopted and summarizes the available evidence on their cost effectiveness. Full article

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20 pages, 631 KiB

Open AccessReview

Trading off Iodine and Radiation Dose in Coronary Computed Tomography

by Guillaume Fahrni, Thomas Saliba, Damien Racine, Marianna Gulizia, Georgios Tzimas, Chiara Pozzessere and David C. Rotzinger

J. Cardiovasc. Dev. Dis. 2025, 12(5), 195; https://doi.org/10.3390/jcdd12050195 - 20 May 2025

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Abstract

Coronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction, wide-area detectors, and dual-source systems, have helped mitigate early limitations, [...] Read more.

Coronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction, wide-area detectors, and dual-source systems, have helped mitigate early limitations, such as high radiation doses, motion artifacts, high iodine load, and non-diagnostic image quality. However, the adjustments between ionizing radiation and iodinated contrast material (CM) volumes remain a critical concern, especially due to the increasing use of CCTA in various indications. This review explores the balance between radiation and CM volumes, emphasizing patient-specific protocol optimization to improve diagnostic accuracy while minimizing risks. Radiation dose reduction strategies, such as low tube voltage protocols, prospective ECG-gating, and modern reconstruction algorithms, have significantly decreased radiation exposure, with some studies achieving sub-millisievert doses. Similarly, CM volume optimization, including adjustments in strategies for calculating CM volume, iodine concentration, and flow protocols, plays a role in managing risks such as contrast-associated acute kidney injury, particularly in patients with renal impairment. Emerging technologies, such as photon-counting CT and deep-learning reconstruction, promise further improvements in dose efficiency and image quality. This review summarizes current evidence, highlights the benefits and limitations of dose control approaches, and provides practical recommendations for practitioners. By tailoring protocols to patient characteristics, such as age, renal function, and body habitus, clinicians can achieve an optimal trade-off between diagnostic accuracy and patient safety, ensuring optimal operation of CT systems in clinical practice. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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19 pages, 421 KiB

Open AccessReview

Drug-Coated Balloons: Recent Evidence and Upcoming Novelties

by Zaid Mohammad Fahmi Shahrori, Marco Frazzetto, Shamin Hayat Mahmud, Wasfi Alghwyeen and Bernardo Cortese

J. Cardiovasc. Dev. Dis. 2025, 12(5), 194; https://doi.org/10.3390/jcdd12050194 - 20 May 2025

Viewed by 303

Abstract

Drug-coated balloons (DCBs) have emerged as a compelling alternative to drug-eluting stents in the treatment of coronary artery disease (CAD), offering the advantage of local drug delivery without permanent vascular scaffold implantation. Initially developed for managing in-stent restenosis, DCBs seem appealing for broader [...] Read more.

Drug-coated balloons (DCBs) have emerged as a compelling alternative to drug-eluting stents in the treatment of coronary artery disease (CAD), offering the advantage of local drug delivery without permanent vascular scaffold implantation. Initially developed for managing in-stent restenosis, DCBs seem appealing for broader indications, particularly in small vessel disease and bifurcation lesions. While paclitaxel-based DCBs remain the most investigated, newer limus formulations are showing promise and appear to be a valid alternative in early trials. Evidence from recent randomized clinical trials (RCTs) and meta-analyses highlights DCBs as a safe and effective option in selected patients, with potential benefits including lower restenosis rates, reduced need for dual antiplatelet therapy, and avoidance of late stent-related complications. As new large-scale trials near completion, DCBs are poised to take on a broader role in the treatment of CAD, particularly in patients where “leaving nothing behind” offers a clinical advantage. This review offers an overview of the DCB platforms commercially available, showing pharmacological differences, providing current indications in practical guidelines, and analyzing the most recent and impactful RCTs and meta-analyses in the field. Full article

(This article belongs to the Special Issue Leaders in Cardiovascular Research: A Special Issue Dedicated to Professor Patrick Serruys)

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10 pages, 678 KiB

Open AccessReview

Venous Hemodynamic Dysfunction and Recurrent Miscarriage: Case Series and Literature Review

by Elisa Sabattini, Helena Van Kerrebroeck and Wilfried Gyselaers

J. Cardiovasc. Dev. Dis. 2025, 12(5), 193; https://doi.org/10.3390/jcdd12050193 - 18 May 2025

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Abstract

(1) Background: Maternal venous hemodynamic dysfunction is an intrinsic part of the pathophysiology of pre-eclampsia and fetal growth restriction. The aim of this study is to evaluate whether venous hemodynamic dysfunction is present in women with a history of (unexplained) recurrent miscarriage, and [...] Read more.

(1) Background: Maternal venous hemodynamic dysfunction is an intrinsic part of the pathophysiology of pre-eclampsia and fetal growth restriction. The aim of this study is to evaluate whether venous hemodynamic dysfunction is present in women with a history of (unexplained) recurrent miscarriage, and to link this pilot observation to reported data in the literature. (2) Methods: A retrospective search of hospital records was conducted to find data on recurrent miscarriage and hemodynamics assessment prior to conception. We also performed a scoping search of the literature regarding the association between recurrent miscarriage and maternal hemodynamics, reproductive outcomes, maternal complications, neonatal complications, and long-term cardiovascular function in women and their offspring. (3) Results: Six out of nine women with a history of recurrent miscarriage had preconception venous hemodynamic dysfunction. This observation is in line with the reported data on reduced venous reserves in association with low plasma volume in women with recurrent miscarriage, and adds to the reported link between recurrent miscarriage, poor reproductive outcomes, and chronic cardiovascular disease. (4) Discussion: This retrospective observational cohort supports an association between venous hemodynamic dysfunction and recurrent miscarriage that is corroborated by data reported in the literature. Abnormal venous hemodynamic function can be improved before conception, and this opens a new and currently unexplored pathway in the management of recurrent miscarriage. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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17 pages, 483 KiB

Open AccessReview

Myocardial Fibrosis: Assessment, Quantification, Prognostic Signification, and Anti-Fibrosis Targets: A State-of-the-Art Review

by Salvatore Poddi, Cynthia L. Lefter, Daniele Linardi, Andrea Ardigò, Giovanni B. Luciani and Alessio Rungatscher

J. Cardiovasc. Dev. Dis. 2025, 12(5), 192; https://doi.org/10.3390/jcdd12050192 - 18 May 2025

Viewed by 342

Abstract

Myocardial fibrosis (MF) is the excessive deposition of extracellular matrix (ECM) from myofibroblasts and is crucial in patients with heart failure (HF). Much work is still needed to fully understand its features and clinical role. This review aims to summarize the state-of-the-art of [...] Read more.

Myocardial fibrosis (MF) is the excessive deposition of extracellular matrix (ECM) from myofibroblasts and is crucial in patients with heart failure (HF). Much work is still needed to fully understand its features and clinical role. This review aims to summarize the state-of-the-art of MF knowledge, focusing on assessment, quantification, predictive value, and future therapies. We performed a literature search about MF studies published between 2014 and 2024, including clinical studies on MF assessment or quantification, the role of MF as a prognostic factor in patients with HF, basic science studies on fibrosis assessment, and the role of the main mechanisms involved in MF. We identified 5161 potentially relevant articles. After excluding non-appropriate ones, we had 186 potentially suitable studies. After full reading and a review of references, 40 articles were included in our review: 8 were about MF assessment, 5 about quantification, and 27 about fibrosis as a prognostic factor. MF is a crucial process in patients with cardiac diseases and leads to HF and arrhythmias. Assessment and quantification have taken great steps forward, but more research is needed to strengthen MF’s role as a prognostic factor in the future. Basic science will play a key role in anti-fibrosis treatment. Full article

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

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9 pages, 736 KiB

Open AccessArticle

Isolated Rapid Deployment Aortic Valve Replacement in Patients with Aortic Stenosis: Single-Center Retrospective Study

by Ricardo Ferreira, Tiago R. Velho, João Gonçalves, André Sena, Beatriz Draiblate, Ana G. Almeida, Ângelo Nobre and Fausto Pinto

J. Cardiovasc. Dev. Dis. 2025, 12(5), 191; https://doi.org/10.3390/jcdd12050191 - 17 May 2025

Viewed by 248

Abstract

Background: Aortic valve stenosis remains the most prevalent valvular pathology in Western countries. Rapid deployment bioprosthesis (RD) has emerged as a promising alternative to conventional valves for surgical aortic valve replacement (SAVR), particularly in elderly and high-risk patients. This study reports the short- [...] Read more.

Background: Aortic valve stenosis remains the most prevalent valvular pathology in Western countries. Rapid deployment bioprosthesis (RD) has emerged as a promising alternative to conventional valves for surgical aortic valve replacement (SAVR), particularly in elderly and high-risk patients. This study reports the short- and long-term outcomes of RD in patients with isolated aortic stenosis. Methods: A retrospective single-center analysis was conducted on 382 patients who underwent RD-AVR between 2014 and 2020. Data were collected from clinical files and national electronic databases. Primary outcomes included cardiopulmonary bypass (CPB) and cross-clamping (XC) times, postoperative complications, and long-term survival. Results: The mean age was 75.6 ± 5.9 years, with 29.8% of patients over 80 years old and a mean EuroSCORE II of 2.3 ± 1.5%. CPB and XC times were 36.7 ± 10.8 and 27.4 ± 8.1 min, respectively. Postoperative complications included acute kidney injury (AKI, 53.4%), de novo atrial fibrillation (31.9%), and high-grade/complete atrioventricular block with permanent pacemaker implantation (9.8%). In-hospital and 30-day mortality was 1.02% and 2.3%, respectively. The 5-year survival rate was 77%. At 6 months postoperatively, the mean transvalvular gradient was 11.1 ± 4.7 mmHg. At a median follow-up of 6.7 years, no cases of structural valve deterioration and only one case of endocarditis were reported. Conclusion: In this single-center study, RD in isolated AVR demonstrated favorable short- and long-term outcomes, including no structural valve deterioration at mid-term follow-up. These devices offer a safe and effective alternative to conventional SAVR, particularly in high-risk populations. Full article

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12 pages, 1293 KiB

Open AccessArticle

Comparative Insights on Inpatient Outcomes in Diastolic Heart Failure with and Without Amyloidosis: A Nationwide Propensity-Matched Analysis

by Aravind Dilli Babu, Mirza Faris Ali Baig, David A. Baran, Jerry Estep, David Wolinsky, Nina Thakkar Rivera, Ram Bhutani, Harshit Narula, Prashant Chaulagain and David Snipelisky

J. Cardiovasc. Dev. Dis. 2025, 12(5), 190; https://doi.org/10.3390/jcdd12050190 - 16 May 2025

Viewed by 278

Abstract

Cardiac amyloidosis (CA), an infiltrative restrictive cardiomyopathy, is a frequently underrecognized etiology of diastolic heart failure (HF). This study aimed to evaluate inpatient outcomes among patients hospitalized with decompensated diastolic HF with and without a secondary diagnosis of amyloidosis, utilizing data from the [...] Read more.

Cardiac amyloidosis (CA), an infiltrative restrictive cardiomyopathy, is a frequently underrecognized etiology of diastolic heart failure (HF). This study aimed to evaluate inpatient outcomes among patients hospitalized with decompensated diastolic HF with and without a secondary diagnosis of amyloidosis, utilizing data from the National Inpatient Sample (2018–2021). Among 2,444,699 patients hospitalized for decompensated diastolic HF, 9205 (0.3%) had a documented secondary diagnosis of amyloidosis. After 1:1 propensity-score matching, 1841 patients in each group were analyzed. Multivariate logistic regression revealed that the presence of amyloidosis was associated with significantly higher odds of in-hospital mortality (4.0% vs. 2.7%), cardiogenic shock (5.4% vs. 2.4%), acute kidney injury (28.3% vs. 22.0%), ventricular tachycardia (12.4% vs. 6.0%), and acute myocardial injury (9.5% vs. 6.0%) (all p < 0.05). Additionally, patients with amyloidosis had a longer mean length of stay (7.1 vs. 5.7 days) and higher mean hospitalization costs ($85,594 vs. $48,484, p < 0.05). Although the overall incidence of acute myocardial injury was elevated, subgroup analysis of ST-elevation and non–ST-elevation myocardial infarction revealed no significant differences. These findings underscore the considerable clinical and economic burden of amyloidosis in patients hospitalized with decompensated diastolic heart failure. Full article

(This article belongs to the Topic Cardiovascular Disease in Special Populations: From Basic Science to Clinical Practice)

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20 pages, 6091 KiB

Open AccessReview

The Role of Cardiac Magnetic Resonance Imaging in the Management of Hypertrophic Cardiomyopathy

by Luca Pugliese, Alessandra Luciano and Marcello Chiocchi

J. Cardiovasc. Dev. Dis. 2025, 12(5), 189; https://doi.org/10.3390/jcdd12050189 - 15 May 2025

Viewed by 382

Abstract

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, caused by either sarcomere protein or other gene mutations. It is a complex and highly heterogeneous disorder, with phenotypes ranging from asymptomatic to severe disease, characterized by asymmetric left ventricular (LV) hypertrophy unexplained by [...] Read more.

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, caused by either sarcomere protein or other gene mutations. It is a complex and highly heterogeneous disorder, with phenotypes ranging from asymptomatic to severe disease, characterized by asymmetric left ventricular (LV) hypertrophy unexplained by loading conditions, which is also associated with myocardial fiber disarray, and preserved or increased ejection fraction without LV dilation. Comprehensive personal and family history, physical examination, and ECG testing raise suspicion of HCM, and echocardiogram represents the first-line imaging modality for confirming a diagnosis. Moreover, contrast-enhanced cardiac magnetic resonance (CMR) imaging has increasingly emerged as a fundamental diagnostic and prognostic tool in HCM management. This article reviews the role of CMR in HCM identification and differentiation from phenotypic mimics, characterization of HCM phenotypes, monitoring of disease progression, evaluation of pre- and post-septal reduction treatments, and selection of candidates for implantable cardioverter-defibrillator. By providing information on cardiac morphology and function and tissue characterization, CMR is particularly helpful in the quantification of myocardial wall thickness, the detection of hypertrophy in areas blind to echocardiogram, subtle morphologic features in the absence of LV hypertrophy, myocardial fibrosis, and apical aneurysm, the evaluation of LV outflow tract obstruction, and the assessment of LV function in end-stage dilated HCM. Full article

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

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32 pages, 3481 KiB

Open AccessReview

Deciphering Acute Coronary Syndromes Pathobiology Through Proteomics

by Gabriele Nieddu, Marilena Formato and Antonio Junior Lepedda

J. Cardiovasc. Dev. Dis. 2025, 12(5), 188; https://doi.org/10.3390/jcdd12050188 - 15 May 2025

Viewed by 374

Abstract

Acute coronary syndrome (ACS) refers to a spectrum of conditions characterized by a sudden decrease in blood flow to the heart. This includes unstable angina, the mildest form, as well as non-ST- and ST-segment elevation myocardial infarction. The primary cause of ACS is [...] Read more.

Acute coronary syndrome (ACS) refers to a spectrum of conditions characterized by a sudden decrease in blood flow to the heart. This includes unstable angina, the mildest form, as well as non-ST- and ST-segment elevation myocardial infarction. The primary cause of ACS is typically the rupture or erosion of an atherosclerotic plaque in a coronary artery, resulting in the formation of a blood clot that can, partially or completely, block the blood flow to the heart muscle. The ongoing discovery and comprehension of emerging biomarkers for atherosclerosis could enhance our capacity to predict future events, particularly when integrated alongside traditional risk factors in assessing overall risk profiles. With advancements in proteomic technologies, large-scale approaches have been increasingly instrumental in unraveling pathways implicated in atherosclerotic degeneration and identifying novel circulating markers, which may serve as early diagnostic indicators or targets for innovative therapies. Over recent decades, numerous matrices including plasma, urine, microparticles, lipoproteins, atherosclerotic plaque extracts and secretomes, as well as thrombi, have been examined to address these questions. Furthermore, proteomics has been applied to various experimental models of atherosclerosis to deepen our understanding of the mechanisms underlying atherogenesis. This review offers a critical overview of the past two decades of untargeted omics research focused on identifying circulating and tissue biomarkers relevant to ACS. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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29 pages, 3375 KiB

Open AccessReview

Spontaneous Intracranial Vertebral Artery Dissection: A Rare Cause of Ischemic Stroke

by Marialuisa Zedde and Rosario Pascarella

J. Cardiovasc. Dev. Dis. 2025, 12(5), 187; https://doi.org/10.3390/jcdd12050187 - 15 May 2025

Viewed by 410

Abstract

The dissection of the V4 vertebral artery (VA) is the most prevalent form of intracranial dissection, which can manifest either as ischemia or as a subarachnoid hemorrhage (SAH). Patient outcomes are significantly affected by their initial presentation; ischemic symptoms often indicate that the [...] Read more.

The dissection of the V4 vertebral artery (VA) is the most prevalent form of intracranial dissection, which can manifest either as ischemia or as a subarachnoid hemorrhage (SAH). Patient outcomes are significantly affected by their initial presentation; ischemic symptoms often indicate that the dissection remains primarily subintimal or within the medial layer, though it can occasionally extend to the basilar artery. In contrast, patients with ruptured VA dissection (VAD) experience a considerably higher mortality rate, as the dissection can reach the adventitial layer, heightening the risk of recurrent hemorrhage. It can show fluctuating imaging findings, making an accurate diagnosis and timely treatment essential. Currently, there are no established diagnostic criteria for VAD, and its diagnosis largely depends on imaging. The presence of intramural hematoma, identified via three-dimensional, black-blood, T1-weighted imaging, has been recognized as the most reliable indicator for diagnosing VAD and is crucial for establishing a definitive diagnosis. DSA remains a fundamental diagnostic technique not only in hemorrhagic patients but also in ischemic patients. The medical treatment of ischemic patients has not yet been well defined, and evidence-based data are lacking. This review aims to summarize the main clinical, pathophysiological, and neuroradiological features of intracranial VAD presenting with ischemic stroke, providing to clinicians the available information in order to individualize the treatment. Full article

(This article belongs to the Special Issue Stroke in the Young)

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10 pages, 1458 KiB

Open AccessReview

The Ross Procedure in Children with Congenital Heart Disease

by Nabil Dib, Nancy Poirier, Ismail Bouhout and Paul Khairy

J. Cardiovasc. Dev. Dis. 2025, 12(5), 186; https://doi.org/10.3390/jcdd12050186 - 15 May 2025

Viewed by 277

Abstract

Aortic valve disease accounts for approximately 5% of all congenital heart defects in children. Choosing the optimal valve replacement in this population is challenging, as it must ensure durability, accommodate growth, and minimize the need for long-term anticoagulation. Biological valves do not require [...] Read more.

Aortic valve disease accounts for approximately 5% of all congenital heart defects in children. Choosing the optimal valve replacement in this population is challenging, as it must ensure durability, accommodate growth, and minimize the need for long-term anticoagulation. Biological valves do not require anticoagulation but lack durability and growth potential, leading to frequent reoperations. Mechanical valves offer longevity but necessitate lifelong anticoagulation and do not grow with the child. Among the available surgical options, the Ross procedure has emerged as a preferred approach due to its favorable hemodynamic performance, growth potential, and freedom from anticoagulation. First described in 1967, this technique involves replacing the diseased aortic valve with a pulmonary autograft and reconstructing the right ventricular outflow tract using a human or non-human valve substitute. Despite its advantages, the procedure is technically demanding, has a considerable learning curve, and transforms a single-valve pathology into a bivalvular condition. This narrative review provides an updated perspective on the Ross procedure in children, focusing on long-term survival, reoperation rates, and the role of percutaneous valve replacement in delaying surgical reintervention. By synthesizing the latest evidence, we aim to clarify the current standing of the Ross procedure as a durable and effective solution for pediatric aortic valve disease. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Pediatric Cardiology and Congenital Heart Disease' Section)

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13 pages, 239 KiB

Open AccessArticle

In-Hospital Mortality and Costs of Added Morbidity in Heart Failure Patients at a University Hospital: A Retrospective Cross-Sectional Study

by Lourdes Raya Ortega, Jesús Martínez Tapias, María José Ferreras Fernández, Manuel Jiménez-Navarro, Almudena Ortega-Gómez, Miguel Romero-Cuevas and Juan José Gómez-Doblas

J. Cardiovasc. Dev. Dis. 2025, 12(5), 185; https://doi.org/10.3390/jcdd12050185 - 15 May 2025

Viewed by 701

Abstract

Background: Heart failure (HF) is a leading cause of hospital admissions and in-hospital mortality among the elderly. This study aims to characterize HF patients admitted to Virgen de la Victoria University Hospital (HUVV), identify factors associated with in-hospital mortality and analyze the impact [...] Read more.

Background: Heart failure (HF) is a leading cause of hospital admissions and in-hospital mortality among the elderly. This study aims to characterize HF patients admitted to Virgen de la Victoria University Hospital (HUVV), identify factors associated with in-hospital mortality and analyze the impact of added morbidity on healthcare costs. Methods: A cross-sectional study was conducted using data from the Minimum Basic Data Set (MBDS) at HUVV. We included all discharges with a primary diagnosis of HF in 2021. Logistic regression analysis was employed to identify factors associated with mortality, and cost analysis was performed to assess the economic impact of added morbidity. Results: A total of 731 hospital discharges for HF were analyzed, with a mortality rate of 14.77%. Mortality was significantly associated with age ≥ 75 years (OR = 4.12; p < 0.001), high or extreme severity (OR = 2.26 and 8.10, respectively; p < 0.001), and more than 10 diagnoses at discharge (OR = 2.95; p < 0.01). Treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) was associated with a reduced risk of death (OR = 0.29; p < 0.001). Hospital-acquired morbidity occurred in 27.22% of patients, resulting in an additional cost of EUR 152,780.61, representing a 3.8% increase over the total hospitalization costs. Conclusions: In-hospital mortality in HF patients at HUVV is strongly associated with advanced age, disease severity, and multiple comorbidities. Treatment with ACEIs or ARBs was associated with a lower likelihood of in-hospital mortality. Preventable added morbidity was associated with increased healthcare costs, highlighting the importance of infection control measures and multidisciplinary management to potentially improve outcomes and reduce costs. Full article

(This article belongs to the Special Issue Clinical Burden of Comorbidities on Cardiovascular System and Beyond: 2nd Edition)

15 pages, 680 KiB

Open AccessArticle

One-Year Outcome of Patients Undergoing Transcatheter Aortic Valve Replacement with Concomitant SignificantTricuspid Regurgitation

by Enrico Ferrari, Alberto Pozzoli, Catherine Klersy, Elena Caporali, Stefanos Demertzis and Giovanni Pedrazzini

J. Cardiovasc. Dev. Dis. 2025, 12(5), 184; https://doi.org/10.3390/jcdd12050184 - 14 May 2025

Viewed by 282

Abstract

Background: The outcome of patients undergoing transcatheter aortic valve replacement (TAVR) can be affected by coexisting tricuspid regurgitation (TR). The aim of the study is to investigate the clinical results of patients undergoing TAVR with or without concomitant significant TR. Methods: [...] Read more.

Background: The outcome of patients undergoing transcatheter aortic valve replacement (TAVR) can be affected by coexisting tricuspid regurgitation (TR). The aim of the study is to investigate the clinical results of patients undergoing TAVR with or without concomitant significant TR. Methods: Patients undergoing TAVR were divided into two groups according to TR severity: none/mild TR (low-grade) and moderate/severe TR (significant). Data were analysed and compared. Primary endpoint was the mortality 1-year. Secondary endpoints were re-hospitalization and the degree of postoperative and 1-year TR. Results: TAVR procedures were performed in 345 patients between September 2011 and February 2020. Median STS score was 4.3% (IQR: 2.6–7.2), median LVEF was 59.0% (IQR: 45.0–62.0), median aortic area was 0.70cm² (IQR: 0.60–0.86), median mean gradient was 43.0mmHg (IQR: 36.0–53.0). Before TAVR, 297 patients (86.1%) had low-grade TR and 48 (13.9%) significant TR. Mean age was 82.4 ± 5.7 and 83.8 ± 6.2 years in low-grade and significant TR group, respectively (p = 0.109), with 47.5% (low-grade TR) and 56.3% (significant TR) of female patients (p = 0.279). Patients showed differences in EuroSCORE-II (3.2% (IQR: 1.9–5.7) in low-grade TR vs. 5.6% (IQR: 3.7–8.1) in significant TR; p < 0.001), impaired right ventricular function (3.0% vs. 20.8%; p < 0.001) and pulmonary hypertension (9.1% vs. 39.6%; p < 0.001). Mean valve size was 27.7 ± 2.9 mm. Hospital mortality was 2.0% in low-grade TR and 4.2% in significantTR patients (p = 0.308). Among discharged patients (n = 337), seven patients died within 30 days (2.0% low-grade TR; 2.1% significant TR; logrank test p = 0.154) and 40 were re-hospitalized for heart failure (11.1% low-grade TR; 14.6% significant TR; p = 0.470). After one year, 26 patients died, corresponding to a mortality of 7.9 deaths per 100-person year (95% CI 5.2–12.0) in low-grade TR group and 9.1 deaths per 100-person year (95% CI 3.4–24.3) in significant TR group (logrank test p = 0.815), with HR (low grade vs. significant TR) of 0.87, 95% CI 0.26–2.89. Re-hospitalization for heart failure was 16.5% and 19.6% for low-grade and significant TR, respectively (p = 0.713). Echocardiographic and functional changes over time showed no significant interaction between TR and time. Conclusions: In our experience, patients undergoing TAVR showed similar 30-day and 1-year outcome and re-hospitalization rate, regardless of the degree of concomitant tricuspid regurgitation. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)

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11 pages, 712 KiB

Open AccessArticle

Prevalence and Risk Factors of Acute Ischemic Stroke in Patients with Antiphospholipid Syndrome: A Retrospective Monocenter Analysis

by Paschalis Evangelidis, Nikolaos Kotsiou, Panagiotis Kalmoukos, Zacharo Ntova, Theodosia Papadopoulou, Sofia Chissan, Anastasia Sarvani, Styliani Kokoris, Elisavet Grouzi, Michael Doumas, Sofia Vakalopoulou and Eleni Gavriilaki

J. Cardiovasc. Dev. Dis. 2025, 12(5), 183; https://doi.org/10.3390/jcdd12050183 - 14 May 2025

Viewed by 268

Abstract

(1) Background: Antiphospholipid syndrome (APS) is associated with thrombotic events and the laboratory identification of antiphospholipid antibodies (aPL), in which lupus anticoagulant (LA), anticardiolipin (aCL), and anti-β2 glycoprotein I antibodies are included. The aim of the current retrospective study is to examine clinical [...] Read more.

(1) Background: Antiphospholipid syndrome (APS) is associated with thrombotic events and the laboratory identification of antiphospholipid antibodies (aPL), in which lupus anticoagulant (LA), anticardiolipin (aCL), and anti-β2 glycoprotein I antibodies are included. The aim of the current retrospective study is to examine clinical characteristics and risk factors of ischemic stroke as a clinical manifestation of APS. (2) Methods: Adult patients diagnosed with APS between 1 January 2009 and 1 June 2024 were retrospectively enrolled in this study. Sydney-revised Sapporo criteria were used for the diagnosis of APS, while ischemic stroke was diagnosed based on the acute onset of focal neurologic deficits and confirmed with radiological findings. (3) Results: We studied 115 patients with APS. Specifically, 28 (24.35%) patients, with a mean age (standard deviation) of 54 (±12.5), had ischemic stroke as a clinical manifestation of APS. In univariate analysis, stroke development was associated with the following factors: age (p < 0.001), livedo reticularis (p = 0.046), avascular necrosis (AVN) (p = 0.046), hypertension (p < 0.001), dyslipidemia (p = 0.013), aCL IgG (U/L) antibodies title (p = 0.035), and adjusted global APS score (aGAPSS) (p = 0.047), while in multivariate analysis, it was associated with age (p = 0.006), hypertension (p < 0.001), AVN (p = 0.006), livedo reticularis (p = 0.035), aCL IgG title (p = 0.004), and aGAPSS (p = 0.002). (4) Conclusions: Stroke is a common initial manifestation of APS, with cardiovascular risk factors, particularly hypertension, being highly prevalent. Full article

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12 pages, 3394 KiB

Open AccessArticle

Remote Heart Failure Patients Telemonitoring: Results of the TreC Heart Failure Study

by Massimiliano Maines, Annachiara Benini, Annalisa Vinci, Anna Manica, Elisa Erbogasto, Giancarlo Tomasi, Luisa Poian, Luigi Martinelli, Lorenzo Gios, Stefano Forti, Luigi Patil, William Mantovani and Maurizio Del Greco

J. Cardiovasc. Dev. Dis. 2025, 12(5), 182; https://doi.org/10.3390/jcdd12050182 - 13 May 2025

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Abstract

(1) Aims: In our study, we evaluated the effectiveness of a telemonitoring program based on a nursing clinic, supported by a physician who remotely monitors patients via a dedicated application (TreC Cardiology), in reducing visits and hospitalizations for HF in patients affected by [...] Read more.

(1) Aims: In our study, we evaluated the effectiveness of a telemonitoring program based on a nursing clinic, supported by a physician who remotely monitors patients via a dedicated application (TreC Cardiology), in reducing visits and hospitalizations for HF in patients affected by HF living in Trentino in Italy. (2) Methods and Results: The TreC Heart Failure (TreC HF) study prospectively enrolled consecutive patients diagnosed with HF who attended our outpatient clinic and who were provided with the TreC Cardiology application. We analyzed primarily the number of visits and hospitalizations, comparing the year before and after the enrollment. From March 2021 to June 2023, we enrolled 211 patients, predominantly male (70.1%) and with a mean age of 71.5 ± 12.6 years. At baseline, 43.6% of patients were diagnosed with HFrEF, 28% with HFmrEF, and 28.4% with HFpEF. The mean left-ventricular ejection fraction (LV-EF) was 43.2 ± 11.9%. Outpatient visits in the year before the enrollment were on average 2.0 ± 1.2 vs. 1.6 ± 1.3 (p = 0.002) in the same following period. The percentage of patients who were hospitalized for heart failure went from 25.6% to 4.7% (p < 0.001). Analyzing HF categories separately, we found that, in the HFrEF population, after the enrollment, hospitalization for HF significantly decreased (32.6% vs. 7.6%, p < 0.001), while the number of outpatient visits did not vary (2.1 ± 1.4 vs. 2.1 ± 1.3, p = 0.795). In HFmrEF patients, both hospitalization for HF and outpatient visits significantly decreased (respectively, 30.5% vs. 1.7%, p < 0.001 and 2.0 ± 1.0 vs. 1.5 ± 1.3, p = 0.025). Finally, in the HFpEF population, only the number of outpatient visits significantly decreased after the enrollment (2.0 ± 1.1 vs. 1.0 ± 0.8, p < 0.001). (3) Conclusions: Our results confirm the enormous potential of telemonitoring, since in a real-world population affected by heart failure, it resulted in a significant reduction in hospitalization for HF and the number of outpatient visits. Full article

(This article belongs to the Special Issue Heart Failure: Focus on Management and Prognosis)

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14 pages, 2495 KiB

Open AccessArticle

Specific Premature Ventricular Complex Characteristics in Women: Insights from a Patient Cohort

by Ștefan Ailoaei, Laurențiu Șorodoc, Carina Ureche, Nicolae Sîtari, Alexandr Ceasovschih, Mihaela Grecu, Radu Andy Sascău and Cristian Stătescu

J. Cardiovasc. Dev. Dis. 2025, 12(5), 181; https://doi.org/10.3390/jcdd12050181 - 13 May 2025

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Abstract

Background: Premature ventricular complexes (PVCs) are common arrhythmias that can range from benign to clinically significant. While PVCs have been extensively studied in the general population, gender-specific differences in their characteristics, prevalence, and clinical impact remain underexplored. This study aims to investigate the [...] Read more.

Background: Premature ventricular complexes (PVCs) are common arrhythmias that can range from benign to clinically significant. While PVCs have been extensively studied in the general population, gender-specific differences in their characteristics, prevalence, and clinical impact remain underexplored. This study aims to investigate the unique features of PVCs in women and their potential implications for diagnosis and management. Methods: We analyzed a cohort of female patients diagnosed with PVCs, assessing their electrocardiographic patterns, symptomatology, and clinical outcomes. Data were collected from medical records, including Holter monitoring, electrocardiograms (ECGs), and echocardiographic findings. The study also evaluated the association between PVC burden and underlying cardiac conditions. Results: This study analyzed 161 patients (59 females, 91 males) with PVCs, revealing significant sex-based differences. Males were older, had higher BMI, and smoked more, while females experienced more presyncope. ECGs showed greater QRS fragmentation in males. TTE and CMR found males had larger ventricles, lower EF, and more myocardial fibrosis (LGE: 59.34% vs. 37.93%). Patients with LGE were older and had worse clinical outcomes, including higher ICD implantation and hospitalization rates. Despite these structural differences, treatment efficacy was similar across groups. Conclusion: This study highlights key differences in PVC characteristics among women, underscoring the need for gender-specific approaches in clinical evaluation and management. Recognizing these distinctions may aid in early diagnosis, reduce unnecessary interventions, and improve patient outcomes. Further research is warranted to explore the long-term implications of PVCs in women and optimize therapeutic strategies. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias, 2nd Edition)

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14 pages, 683 KiB

Open AccessArticle

Left Ventricular Systolic Function in Asymptomatic Men Aged 65–75 Years, Relation to Insulin Resistance and Pre-Diabetes: A DANCAVAS Cross-Sectional Sub-Study

by Johanna Larsson, Søren Auscher, Freja Sønder Madsen, Katrine Schultz Overgaard, Gokulan Pararajasingam, Laurits Juhl Heinsen, Thomas Rueskov Andersen, Jes Sanddal Lindholt, Jess Lambrechtsen and Kenneth Egstrup

J. Cardiovasc. Dev. Dis. 2025, 12(5), 180; https://doi.org/10.3390/jcdd12050180 - 13 May 2025

Viewed by 245

Abstract

Aim: Insulin resistance (IR) and hyperglycemia have been associated with increased risk of heart failure (HF) in patients with and without diabetes. Global longitudinel strain (GLS) has been shown to be superior in the detection of left ventricular (LV) systolic dysfunction when compared [...] Read more.

Aim: Insulin resistance (IR) and hyperglycemia have been associated with increased risk of heart failure (HF) in patients with and without diabetes. Global longitudinel strain (GLS) has been shown to be superior in the detection of left ventricular (LV) systolic dysfunction when compared to ejection fraction (EF). In this study, we aimed to assess GLS in relation to IR and pre-diabetes. Method: All participants underwent an echocardiography to assess LV systolic function using GLS. IR was evaluated using homeostatic model assessment for IR (HOMA-IR), and the participants were divided into tertiles based on their HOMA-IR values. An oral glucose tolerance test (OGTT) was performed to divide participants into normal glucose tolerance (NGT) and pre-diabetes. A multivariable linear regression model was used to assess GLS in relation to IR and glycemic groups. Results: In total, 359 men without significant coronary artery disease (CAD) and without diabetes were enrolled. Participants in the higher HOMA-IR tertile had significantly reduced GLS when compared with participants in the lower HOMA-IR tertile (−17.9% vs. −18.7%, p < 0.01). A significant trend was observed towards reduced GLS with increasing HOMA-IR tertile (p-trend 0.005). However, in the multivariable regression model, only waist-to-height-ratio (WH) (β 7.1 [95% CI 3.1–11.1, p = 0.001) remained significantly associated with GLS, whereas HOMA-IR tertile and pre-diabetes were not. Conclusions: In asymptomatic elderly men with no diabetes or CAD, neither IR nor pre-diabetes was associated with GLS in the adjusted regression model. Increased WH seems to be associated with reduced systolic function by GLS measurement. Full article

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12 pages, 755 KiB

Open AccessArticle

Percutaneous Coronary Intervention for Left Main Disease in High Bleeding Risk: Outcomes from a Subanalysis of the Delta 2 Registry

by Giulia Botti, Francesco Federico, Emanuele Meliga, Joost Daemen, Fabrizio D’Ascenzo, Davide Capodanno, Nicolas Dumonteil, Didier Tchetche, Nicolas M. Van Mieghem, Sunao Nakamura, Philippe Garot, Andrejs Erglis, Ciro Vella, Corrado Tamburino, Marie Claude Morice, Roxana Mehran, Matteo Montorfano and Alaide Chieffo

J. Cardiovasc. Dev. Dis. 2025, 12(5), 179; https://doi.org/10.3390/jcdd12050179 - 11 May 2025

Viewed by 339

Abstract

High bleeding risk (HBR) is a challenge in patients with complex coronary lesions undergoing percutaneous coronary intervention (PCI). This study investigates HBR in a wide and comprehensive cohort of patients undergoing left main (LM) PCI and reports in-hospital and follow-up outcomes. The analysis [...] Read more.

High bleeding risk (HBR) is a challenge in patients with complex coronary lesions undergoing percutaneous coronary intervention (PCI). This study investigates HBR in a wide and comprehensive cohort of patients undergoing left main (LM) PCI and reports in-hospital and follow-up outcomes. The analysis was performed on data from the DELTA (Drug Eluting Stent for Left Main Coronary Artery) 2 Registry, which included patients who underwent LM PCI at 19 centres worldwide. The patients were defined to be at HBR if ≥1 major criterion or ≥2 minor criteria from the Academic Research Consortium (ARC) were met. The primary endpoint was a composite of all-cause death, myocardial infarction (MI) or cerebrovascular accident (CVA) at median follow-up. A total of 1531 patients were included, and the rate of HBR was 65.8%. Besides the different clinical characteristics embedded in the ARC definition, HBR patients had higher prevalence of acute coronary syndrome (ACS) at presentation (49.2% vs. 26.8%, p < 0.001) and experienced higher in-hospital mortality (1.8% vs. 0.2%; p = 0.029) and MI (5.0% vs. 2.1%, p = 0.009). The median follow-up was 473 days. The rate of the primary endpoint was more than three times higher in HBR patients (20.8% vs. 6.1%; HR 3.3; 95%CI: 2.2–4.8) and driven by all-cause death at multivariate regression analysis. Conversely, no significant difference in target lesion revascularization and probable or defined stent thrombosis was reported. HBR patients undergoing LM PCI experienced higher rates of all-cause death at follow-up; similar outcomes were also reported in-hospital. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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10 pages, 241 KiB

Open AccessArticle

Quality of Life in Adults with Tetralogy of Fallot: Physical Limitations and Psychological Well-Being

by Panagiotis Zachos, Evelina Pappa, Nikias Milaras, Vasileios Nevras, Paschalis Karakasis, Nikolaos Ktenopoulos, Maria Karakosta, Alkistis-Eleni Kalesi, Nearchos Kasinos, Anastasios Theodosis Georgilas, Stefanos Despotopoulos, Sotiria Apostolopoulou and Dimitrios Niakas

J. Cardiovasc. Dev. Dis. 2025, 12(5), 178; https://doi.org/10.3390/jcdd12050178 - 7 May 2025

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Abstract

Background: Advances in medical care of patients with tetralogy of Fallot (ToF) have significantly altered the natural course of the disease by prolonging life. Thus, our focus has now shifted to exploring the health-related quality of life (HRQoL) of those patients. This study [...] Read more.

Background: Advances in medical care of patients with tetralogy of Fallot (ToF) have significantly altered the natural course of the disease by prolonging life. Thus, our focus has now shifted to exploring the health-related quality of life (HRQoL) of those patients. This study sought to explore the HRQoL of adult patients operated on for ToF using two validated instruments—the SF-36 and EQ-5D—that highlight both physical and mental aspects of the disease. Methods: A total of 115 individuals (53 ToF patients and 60 healthy controls) were recruited for the purposes of this study. HRQoL was assessed through the SF-36 and EQ-5D instruments. Comparisons were made between ToF patients and controls with subgroup analyses based on sex and age. Results: ToF patients reported significantly poorer HRQoL in the physical domains, namely Physical Functioning, Role Physical, General Health, and Physical Component Summary of the SF-36 when compared to controls (p < 0.05). Interestingly, there was a trend towards lower Bodily Pain and better Vitality scores in ToF subjects. Age influenced HRQoL, with older respondents rating their physical health lower than younger patients and controls (p < 0.05). EQ-5D VAS scores indicated that ToF patients perceived their overall health worse than controls (80.02 vs. 86.92, p < 0.001), with Anxiety/Depression being the most frequently reported problem (45.3%). Controls reported better HRQoL than ToF patients across all SF-36 domains in both health states (EQ-5D = 1 and EQ-5D > 1), except for Bodily Pain and Vitality in EQ-5D = 1. Significant differences were observed in Physical Functioning, Role Physical, General Health, Vitality, and Physical Component Score. Notably, ToF patients with EQ-5D = 1 showed unexpectedly higher Vitality scores than controls; however, this advantage diminished significantly in the EQ-5D > 1 group. Conclusions: Adult ToF survivors experience significant physical limitations as expected, while mental health seems to remain relatively unaffected compared to healthy peers. These findings underscore the importance of HRQoL assessment in patients with congenital heart disease and the need for disease-specific HRQoL instruments. Full article

(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)

18 pages, 1544 KiB

Open AccessReview

Vectorcardiography in CRT: What We Know and What There Is to Learn

by Muhammet Dural, Frederieke Eerenberg, Karin C. Smits, Uyên Châu Nguyên, Kevin Vernooy and Antonius M. W. van Stipdonk

J. Cardiovasc. Dev. Dis. 2025, 12(5), 177; https://doi.org/10.3390/jcdd12050177 - 7 May 2025

Viewed by 348

Abstract

Vectorcardiography (VCG) is an electrophysiological investigation technique, giving supplementary information about the electrical activation of the heart, compared to traditional 12-lead electrocardiography (ECG). Whereas the 12-lead ECG has found its way into global clinical cardiology practice in numerous cardiac pathophysiological instances, VCG has [...] Read more.

Vectorcardiography (VCG) is an electrophysiological investigation technique, giving supplementary information about the electrical activation of the heart, compared to traditional 12-lead electrocardiography (ECG). Whereas the 12-lead ECG has found its way into global clinical cardiology practice in numerous cardiac pathophysiological instances, VCG has not. In an investigation of the electrical activation of the heart in cardiac resynchronization therapy (CRT), in order to understand the baseline pathology in potentially eligible patients, and to understand and optimize CRT-derived paced activation of the heart in the therapy’s recipients, all of these aspects are essential to the success of the therapy. Due to a consistently present group of non-responders in CRT, VCG has gained interest as a potential improvement in this field. This review comprehensively summarizes the contemporary evidence for the additional value of VCG in CRT, as well as current deficiencies in evidence, to support its implementation in global practice in addition to, or as a substitution for, traditional 12-lead ECG. Full article

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18 pages, 694 KiB

Open AccessReview

Leaving Nothing Behind: Expanding the Clinical Frontiers of Drug-Coated Balloon Angioplasty in Coronary Artery Disease

by Marcello Marchetta, Stefano Sasso, Vincenzo Paragliola, Valerio Maffi, Gaetano Chiricolo, Gianluca Massaro, Giulio Russo, Daniela Benedetto, Saverio Muscoli, Giuseppe Colonna, Alessandro Mandurino-Mirizzi, Bernardo Cortese, Giuseppe Massimo Sangiorgi and Giuseppe Andò

J. Cardiovasc. Dev. Dis. 2025, 12(5), 176; https://doi.org/10.3390/jcdd12050176 - 5 May 2025

Viewed by 561

Abstract

Drug-coated balloons (DCBs) have emerged as a promising alternative therapeutic strategy to traditional drug-eluting stent (DES) implantation in various coronary artery lesion scenarios, aiming to minimize complications associated with permanent metallic scaffolds, such as chronic inflammation, delayed vessel healing, and stent thrombosis. This [...] Read more.

Drug-coated balloons (DCBs) have emerged as a promising alternative therapeutic strategy to traditional drug-eluting stent (DES) implantation in various coronary artery lesion scenarios, aiming to minimize complications associated with permanent metallic scaffolds, such as chronic inflammation, delayed vessel healing, and stent thrombosis. This review systematically evaluates the current clinical evidence supporting the use of DCBs across diverse anatomical and clinical contexts, including small-vessel disease, in-stent restenosis, bifurcation lesions, diffuse coronary lesions, acute coronary syndromes, and chronic total occlusions, as well as in special patient populations such as individuals with diabetes mellitus or at high bleeding risk. The literature analysis incorporated recent randomized controlled trials, observational studies, and real-world registries, highlighting the clinical efficacy, safety profiles, and specific advantages of DCB angioplasty. The findings consistently demonstrated non-inferior clinical outcomes of DCBs compared to DESs across multiple lesion types, with particular benefits observed in special populations, including reduced restenosis rates and comparable major adverse cardiac events (MACEs). Nevertheless, clinical data gaps remain, emphasizing the need for larger, longer-term randomized trials to refine patient selection and procedural techniques. In conclusion, DCB angioplasty represents a viable and effective alternative to conventional stenting, particularly advantageous in complex lesions and specific patient subsets, pending further definitive evidence. Full article

(This article belongs to the Special Issue Emerging Trends and Advances in Interventional Cardiology)

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13 pages, 1621 KiB

Open AccessArticle

Sex-Specific Patterns in Blood Pressure and Vascular Parameters: The MUJER-EVA Project

by Alicia Saz-Lara, Arturo Martínez-Rodrigo, Eva María Galán-Moya, Irene Martínez-García, Iris Otero-Luis, Carla Geovanna Lever-Megina, Nerea Moreno-Herraiz and Iván Cavero-Redondo

J. Cardiovasc. Dev. Dis. 2025, 12(5), 175; https://doi.org/10.3390/jcdd12050175 - 5 May 2025

Viewed by 775

Abstract

Recent evidence suggests that sex-related differences in cardiovascular health extend beyond traditional risk factors, affecting vascular structure and function. This study aimed to examine sex differences in vascular parameters, including central and peripheral blood pressure, pulse wave velocity (PWv), augmentation index at 75 [...] Read more.

Recent evidence suggests that sex-related differences in cardiovascular health extend beyond traditional risk factors, affecting vascular structure and function. This study aimed to examine sex differences in vascular parameters, including central and peripheral blood pressure, pulse wave velocity (PWv), augmentation index at 75 bpm (AIx75), cardiac output, stroke volume, and peripheral vascular resistance, using harmonized data from three population-based cohorts (EVasCu, VascuNET, and ExIC-FEp) as part of the MUJER-EVA project. A total of 669 adult participants were included in this pooled cross-sectional analysis. Sex-stratified comparisons were conducted using multiple linear regression models adjusted for anthropometric, sociodemographic, and clinical covariates. The results showed that men had significantly higher values for central and peripheral blood pressure (p < 0.001), PWv (p = 0.003), cardiac output (p < 0.001), and stroke volume (p < 0.001), whereas women presented higher values of AIx75 (p < 0.001) and peripheral vascular resistance (p = 0.002). These differences remained statistically significant after full adjustment for potential confounders. These findings highlight the need to consider sex as a key biological variable in cardiovascular research and clinical decision-making. Incorporating sex-specific reference values and personalized treatment strategies could improve vascular health assessment and the effectiveness of cardiovascular disease prevention. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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12 pages, 991 KiB

Open AccessArticle

V_o2peak, Ve/V_CO2, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure Patients

by Antonio Pagliaro, Luna Cavigli, Roberta Molle, Elisabetta Iardino, Francesca Anselmi, Francesca Righini, Luca Martini, Valerio Zacà, Giulia Elena Mandoli, Maria Concetta Pastore, Marta Focardi, Matteo Cameli, Sonia Bernazzali, Massimo Maccherini, Marco Chiostri, Flavio D’Ascenzi and Serafina Valente

J. Cardiovasc. Dev. Dis. 2025, 12(5), 174; https://doi.org/10.3390/jcdd12050174 - 2 May 2025

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Abstract

Accurate prognostic stratification in patients with chronic heart failure and reduced ejection fraction (HFrEF) remains a significant clinical challenge. Many different parameters, including left ventricular (LV) and right ventricular (RV) function and cardiopulmonary exercise testing (CPET) parameters, are available in the literature. LV [...] Read more.

Accurate prognostic stratification in patients with chronic heart failure and reduced ejection fraction (HFrEF) remains a significant clinical challenge. Many different parameters, including left ventricular (LV) and right ventricular (RV) function and cardiopulmonary exercise testing (CPET) parameters, are available in the literature. LV ejection fraction (LVEF) is the most used parameter in clinical practice. This study aimed to analyze CPET and echocardiographic data in patients under evaluation for heart transplantation (HTx) to identify the parameter that best correlates with cardiac events. Methods and Results. Echocardiography and CPET were performed in patients with HFrEF under evaluation for HTx. The population comprised 170 patients (mean age: 55 ± 9 years; 88% male; non-ischemic etiology: 63%). LVEF was 30.4 ± 7.6%, peak oxygen uptake (Vo_2peak) was 17.08 ± 4.6 mL/Kg/min; minute ventilation (VE)/carbon dioxide production (Vco₂) slope was 34.8 ± 8.7. During a follow-up of 4 ± 1 years, 37 hospitalizations, 4 deaths, 14 HTx, and 5 LV assist device implantation occurred. Patients who experienced major events had a lower Vo_2peak (p < 0.005), higher VE/Vco₂ slope (p < 0.005), greater LV end-systolic diameter (p < 0.005), and RV end-diastolic diameter (p < 0.005) than patients without events. Conversely, LVEF did not differ between these two groups. VE/Vco₂ slope and RV dimensions significantly correlated with hard cardiac events (p = 0.019 and p = 0.008, respectively). Conclusions. In patients with HFrEF, parameters quantifying the system reserve (i.e., Vo_2peak and VE/Vco₂ slope) and those demonstrating advanced biventricular remodeling may help stratify the risk of cardiac events. Conversely, LVEF showed a limited prognostic value in this setting. Full article

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13 pages, 1708 KiB

Open AccessArticle

Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion

by Stefano Branzoli, Massimiliano Marini, Domenico Catanzariti, Cecilia Pravadelli, Luigi Pannone, Giovanni D’Onghia, Mauro Fantinel, Fabrizio Guarracini, Gaia Franceschini, Mirco Zadro, Giulia Baroni, Silvia Casagrande, Donatella Ottaviani, Renato Turco, Serena Nicolussi Paolaz, Luciano Annicchiarico, Francesco Corsini, Roberto Rordorf, Kausilia Krishnadath, Flavia Ravelli, Carlo de Asmundis and Mark La Meir Show full author list Hide full author list

J. Cardiovasc. Dev. Dis. 2025, 12(5), 173; https://doi.org/10.3390/jcdd12050173 - 1 May 2025

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Abstract

Background: Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by left appendage occlusion without [...] Read more.

Background: Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by left appendage occlusion without any antithrombotic therapy in this category of patients. Methods: A total of 129 patients (male 85, mean age 76.6 ± 7.1, CHA₂DS₂Vasc 3.8 ± 1.5, HASBLED 3.3 ± 1.0; upper GI bleeding 10%, lower GI bleeding 86%, obscure occult 4.6%, on NOACS full dose 77.5%, NOACs reduced dose 13.1%, on anti-vitamin K 9.3%) with atrial fibrillation and history of repetitive gastrointestinal bleeding from ten centers underwent standalone thoracoscopic epicardial appendage closure without antithrombotic therapy for the entire follow up. Results: The observed bleeding rate was 0.91 events per year, equivalent to a relative risk of RR = 0.17 (p = 0.02) and a relative risk reduction (RRR) of 83%. The observed relative risk of stroke was 0.91 events per year, with a relative risk of RR = 0.19 (p = 0.03) and a relative risk reduction (RRR) of 81%. Conclusion: Standalone epicardial appendage occlusion without antithrombotic therapy in patients with repetitive gastrointestinal bleeding is safe and promising when rebleeding and stroke risk reduction need to be optimized. Full article

(This article belongs to the Special Issue Hybrid Ablation of the Atrial Fibrillation)

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17 pages, 3527 KiB

Open AccessArticle

Subclinical Cardiac Involvement in Asymptomatic ATTR Mutation Carriers: Insights from Cardiac MRI, Myocardial Strain, and Mapping Techniques

by Luca Conia, Daria Filatova, Giacomo Pambianchi, Livia Marchitelli, Giulia Cundari, Giuseppe Stancanelli, Maria Alfarano, Giulia Marchionni, Cristina Chimenti, Carlo Catalano and Nicola Galea

J. Cardiovasc. Dev. Dis. 2025, 12(5), 172; https://doi.org/10.3390/jcdd12050172 - 1 May 2025

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Abstract

Transthyretin cardiac amyloidosis (ATTR-CA) leads to myocardial infiltration, affecting prognosis and survival. Diagnosing early-stage ATTR-CA remains challenging due to its subtle manifestations. This study investigates subclinical myocardial alterations in asymptomatic ATTR mutation carriers (ATTR-MC) using advanced cardiac magnetic resonance (CMR) techniques, including T1 [...] Read more.

Transthyretin cardiac amyloidosis (ATTR-CA) leads to myocardial infiltration, affecting prognosis and survival. Diagnosing early-stage ATTR-CA remains challenging due to its subtle manifestations. This study investigates subclinical myocardial alterations in asymptomatic ATTR mutation carriers (ATTR-MC) using advanced cardiac magnetic resonance (CMR) techniques, including T1 mapping and myocardial strain analysis. A retrospective cohort of 60 subjects was analyzed, comprising 20 ATTR-CA patients, 20 asymptomatic ATTR-MC, and 20 controls. Standard CMR parameters were compared alongside myocardial strain analysis. Results indicated that despite preserved ejection fraction and myocardial morphology, ATTR-MC exhibited significantly impaired left ventricular global longitudinal strain (LV GLS), left atrial reservoir, conduit, and booster pump strain (LA RS, CS, and BPS) compared to controls. However, native T1 and extracellular volume (ECV) values remained within normal ranges, distinguishing early dysfunction from overt amyloid deposition seen in ATTR-CA. These findings suggest that myocardial strain analysis could serve as an early biomarker for subclinical ATTR-CA, offering a potential target for selecting patients who may benefit from early intervention. Implementing CMR-derived strain parameters in clinical practice may improve risk stratification and timely therapeutic decisions in ATTR-MC. Full article

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20 pages, 1250 KiB

Open AccessReview

Non-Traditional Cardiovascular Risk Factors: Tailored Assessment and Clinical Implications

by Francesco Perone, Marco Bernardi, Luigi Spadafora, Matteo Betti, Stefano Cacciatore, Francesco Saia, Federica Fogacci, Vikash Jaiswal, Elad Asher, Francesco Paneni, Salvatore De Rosa, Maciej Banach, Giuseppe Biondi Zoccai and Pierre Sabouret

J. Cardiovasc. Dev. Dis. 2025, 12(5), 171; https://doi.org/10.3390/jcdd12050171 - 28 Apr 2025

Viewed by 1151

Abstract

Non-traditional cardiovascular risk factors (RFs) are increasingly emerging as important modifiers of cardiovascular risk (CVR), offering insights beyond traditional metrics like hypertension, diabetes, and dyslipidemia. These include novel biomarkers, chronic conditions (e.g., chronic kidney disease and chronic obstructive pulmonary disease), environmental exposures, chronic [...] Read more.

Non-traditional cardiovascular risk factors (RFs) are increasingly emerging as important modifiers of cardiovascular risk (CVR), offering insights beyond traditional metrics like hypertension, diabetes, and dyslipidemia. These include novel biomarkers, chronic conditions (e.g., chronic kidney disease and chronic obstructive pulmonary disease), environmental exposures, chronic inflammation, infections, psychosocial factors, and sex-specific conditions, all of which influence the prediction, management, and outcomes of cardiovascular disease (CVD). These additional RFs may impact on CVD prediction and add valid information during tailored patient assessment and management. Therefore, a careful assessment of both traditional and non-traditional cardiovascular RFs, with a personalized treatment, could dramatically reduce the total CVD burden. Nevertheless, further research is needed to precisely estimate the magnitude of their impact as risk and prognosis modifiers in order to be included in future risk charts. This review provides a critical analysis of non-traditional RFs, their pathophysiological mechanisms, and their implications for personalized care. Integrating these factors into CVR assessment can reclassify patient risk categories, optimize therapeutic strategies, and improve prognosis. However, further research is needed to refine their inclusion in risk charts and evaluate their impact on public health outcomes. A tailored, multidisciplinary approach is essential to reduce the burden of CVD and associated mortality. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors: Focus on Epidemiology and Clinical Consequences)

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16 pages, 1305 KiB

Open AccessReview

Treatment Options in Isolated Atherosclerotic Popliteal Artery Disease

by Stephanie Rassam and Raphaël Coscas

J. Cardiovasc. Dev. Dis. 2025, 12(5), 170; https://doi.org/10.3390/jcdd12050170 - 27 Apr 2025

Viewed by 287

Abstract

Isolated popliteal artery (PA) lesions account for around 1% of lower limb revascularisations. Whatever treatment modality is chosen, the effects on the artery during knee flexion must be considered. The decision between a less invasive endovascular treatment (EVT) and traditional open interventions remains [...] Read more.

Isolated popliteal artery (PA) lesions account for around 1% of lower limb revascularisations. Whatever treatment modality is chosen, the effects on the artery during knee flexion must be considered. The decision between a less invasive endovascular treatment (EVT) and traditional open interventions remains complex due to anatomical, biomechanical, and pathophysiological considerations and the varying aetiology of PA lesions. Available data remain limited, making it more challenging to decide on the most effective and durable treatment approach. Nowadays, when EVT is planned, several non-stenting techniques are available, making a “leave-nothing-behind strategy” possible after adequate vessel preparation. If stent implantation is required, self-expanding vasculomimetic stents are preferred due to their ability to provide flexibility and resist compression during motion. This narrative review discusses the available treatment options, challenges, and specific considerations for isolated PA disease, highlighting the need for large-scale, high-quality studies to provide more robust evidence on the optimal treatment approach. Full article

(This article belongs to the Special Issue Management and Challenges in Peripheral Arterial Disease)

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15 pages, 1654 KiB

Open AccessReview

Lipoprotein(a): Assessing the Current Knowledge and Gaps in Screening and Treatment—A Narrative Review

by Octavian Amaritei, Oana Laura Mierlan, Cristian Gutu and Gabriela Gurau

J. Cardiovasc. Dev. Dis. 2025, 12(5), 169; https://doi.org/10.3390/jcdd12050169 - 26 Apr 2025

Viewed by 716

Abstract

Atherosclerotic cardiovascular disease (ASCVD) has long been screened using the traditional lipid profile, mainly focusing on LDL cholesterol. However, despite growing evidence supporting lipoprotein(a) [Lp(a)] as an independent risk factor involved in atherosclerosis, its clinical use remains limited. This review examines the reasons [...] Read more.

Atherosclerotic cardiovascular disease (ASCVD) has long been screened using the traditional lipid profile, mainly focusing on LDL cholesterol. However, despite growing evidence supporting lipoprotein(a) [Lp(a)] as an independent risk factor involved in atherosclerosis, its clinical use remains limited. This review examines the reasons behind the limited use of Lp(a) screening in clinical practice, assessing its role in cardiovascular risk, comparing it to traditional lipid markers and evaluating current assessment methods. It also explores existing and emerging treatments, including gene-silencing therapies, for managing elevated Lp(a) levels. One in four clinicians does not routinely check Lp(a) levels, which proves a lack of awareness amongst them. The reasons for that are implied to be that the cost is too high and that available treatments are scarce. The traditional lipid profile, including LDL, high-density lipoprotein (HDL) and triglycerides, continues to be the gold standard for CV risk assessment. One limitation of using Lp(a) in clinical practice is the significant variability in apo(a) sizes, which results from the presence of multiple isoforms determined by the number of kringle domains. This structural diversity poses challenges in standardizing measurement methods, affecting the accuracy and comparability of results. While statins have a minimal impact on Lp(a), PCSK9-i lowers its levels by 20–25%, although this class is not prescribed primarily for this reason. Lastly, gene-silencing therapies, which achieve the greatest reduction in Lp(a) levels, are still in phase III trials, and there is still a need to examine whether this reduction translates into CV benefits. These limitations should not discourage further research, because ASCVD’s complexity requires a more tailored approach. Current lipid-lowering therapy still fails in a minority of cases, as evidenced by new-onset cardiovascular events in patients with well-controlled LDL levels. There is a need for future interventional studies to assess whether a reduction in Lp(a) by PCSK9-i really translates into CV benefits, independent of LDL. Full article

(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)

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14 pages, 1789 KiB

Open AccessReview

Predicting the Outcomes of External Direct Current Cardioversion for Atrial Fibrillation: A Narrative Review of Current Evidence

by Ibrahim Antoun, Georgia R. Layton, Ahmed Abdelrazik, Mahmoud Eldesouky, Sherif Altoukhy, Mustafa Zakkar, Riyaz Somani and G. André Ng

J. Cardiovasc. Dev. Dis. 2025, 12(5), 168; https://doi.org/10.3390/jcdd12050168 - 25 Apr 2025

Viewed by 380

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia associated with significant morbidity and mortality. External direct current cardioversion (DCCV) is a cornerstone intervention for rhythm control in AF; however, its success is influenced by various patient-specific and procedural factors. This review examines [...] Read more.

Atrial fibrillation (AF) is the most common sustained arrhythmia associated with significant morbidity and mortality. External direct current cardioversion (DCCV) is a cornerstone intervention for rhythm control in AF; however, its success is influenced by various patient-specific and procedural factors. This review examines the predictors of DCCV success and AF recurrence with specific focus upon demographics, biochemical, cardiovascular imaging, and P-wave parameters and their likely ability to predict procedural outcomes. Demographic factors such as age, sex, and comorbidities influence DCCV outcomes, with prolonged AF duration, obesity, and heart failure being associated with higher failure rates. Elevated biochemical markers of inflammation and fibrosis, including C-reactive protein, galectin-3, and Type III procollagen-N-peptide, were predictive of poor outcomes. Imaging parameters, particularly left atrial (LA) volume and strain, emerged as critical indicators of atrial remodelling and DCCV failure. Increased P-wave duration and dispersion on electrocardiography were associated with an increased risk of recurrence. Biphasic waveforms and antiarrhythmic drugs, such as amiodarone and flecainide, improved cardioversion success. The predictors of DCCV success and recurrence reflect the interplay of structural, biochemical, and electrical remodelling in AF. Integrating these parameters into clinical practice can guide individualised patient management and improve outcomes. Further research is needed to validate these predictors and enhance precision medicine approaches in DCCV. Full article

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

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J. Cardiovasc. Dev. Dis., Volume 12, Issue 5 (May 2025) – 36 articles

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