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J. Cardiovasc. Dev. Dis., Volume 12, Issue 5 (May 2025) – 10 articles

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20 pages, 1250 KiB  
Review
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 130
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
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16 pages, 1305 KiB  
Review
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 54
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  
Review
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 196
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
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14 pages, 1789 KiB  
Review
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 120
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
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9 pages, 516 KiB  
Article
Beyond the Echo: Is Comprehensive Vascular Exploration Valuable in Cases of Non-Syndromic Thoracic Aortic Aneurysms or Bicuspid Aortic Valve?
by Austin Saugstad, Srekar Ravi, George Bcharah, Christine E. Firth, Hend Bcharah, Hussein Abdul Nabi, Hoang Nhat Pham, Ramzi Ibrahim, Sant J. Kumar, Mahmoud Abdelnabi, Linnea M. Baudhuin, Yuxiang Wang, Mayowa A. Osundiji and Fadi Shamoun
J. Cardiovasc. Dev. Dis. 2025, 12(5), 167; https://doi.org/10.3390/jcdd12050167 - 24 Apr 2025
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Abstract
Bicuspid aortic valve (BAV) and thoracic aortic aneurysms and dissections (TAAD) are recognized in syndromic connective tissue diseases (CTD), but most cases occur sporadically. The extent to which non-syndromic BAV or TAAD predisposes to additional arteriopathies, particularly in younger individuals, remains unclear. We [...] Read more.
Bicuspid aortic valve (BAV) and thoracic aortic aneurysms and dissections (TAAD) are recognized in syndromic connective tissue diseases (CTD), but most cases occur sporadically. The extent to which non-syndromic BAV or TAAD predisposes to additional arteriopathies, particularly in younger individuals, remains unclear. We retrospectively analyzed 1438 patients (mean age = 48.0, 67.7% female), excluding those with CTDs. Participants were ≤60 years old and categorized by the presence of BAV and/or TAAD. We examined co-existing arterial pathologies, including fibromuscular dysplasia, spontaneous coronary artery dissection, abdominal aortic aneurysms (AAA), mesenteric, peripheral extremity, and carotid/cerebral arteriopathies. Overall, 44.6% had either BAV or TAAD, and 27.2% had multiple arteriopathies. While vascular diseases were frequently noted, odds ratios demonstrated no significantly increased risk of extra-aortic arteriopathies in the BAV or TAAD cohorts. AAA exhibited a non-significant trend toward higher prevalence in TAAD patients. These findings support current guidelines recommending targeted imaging (transthoracic echocardiography of the aortic root and ascending aorta) over comprehensive “head-to-pelvis” screening for non-syndromic BAV or TAAD patients without additional risk factors. Ongoing genetic analyses may elucidate whether particular variants predispose to multi-site aneurysms or dissections. Consequently, targeted surveillance remains appropriate, with broader imaging reserved for patients with genetic or clinical indicators of higher risk. Full article
(This article belongs to the Special Issue Models and Methods for Computational Cardiology: 2nd Edition)
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10 pages, 1578 KiB  
Article
Impact of the Pre-Operative Standardized Nutritional Protocol in Infants with Congenital Heart Disease (CHD)
by Patrick Zacharias, Jenna Blinci, Ruthie Shenoy, Jesse Lee and Yogen Singh
J. Cardiovasc. Dev. Dis. 2025, 12(5), 166; https://doi.org/10.3390/jcdd12050166 - 23 Apr 2025
Viewed by 88
Abstract
Neonates with congenital heart disease (CHD) are at increased risk of growth failure and necrotizing enterocolitis (NEC), making nutritional management crucial for their outcomes. This study aimed to evaluate the impact of a standardized feeding protocol on growth and NEC incidence in CHD [...] Read more.
Neonates with congenital heart disease (CHD) are at increased risk of growth failure and necrotizing enterocolitis (NEC), making nutritional management crucial for their outcomes. This study aimed to evaluate the impact of a standardized feeding protocol on growth and NEC incidence in CHD infants. A retrospective study was conducted at a tertiary care center, including neonates diagnosed with CHDs from January 2020 to March 2023. Patients were divided into two groups: those receiving the standardized feeding protocol (protocol group, n = 12) and those who did not (non-protocol group, n = 39). Key metrics such as growth velocity at discharge, anthropometric z score changes at discharge since birth, days to full enteral feeds, NEC incidence, and length of stay were analyzed. Statistical comparisons were made using two-tailed Mann-Whitney test and chi-squared tests. The NEC incidence was 10% in the non-protocol group and 0% in the protocol group (p = 0.25), with no significant difference. All anthropometric growth markers at the time of discharge differed between the groups, with the protocol group demonstrating favorable outcomes across all measured variables; however, these differences did not reach statistical significance. The time to reach full enteral feeds was shorter (8.5 days vs. 11 days; p = 0.22), and length of stay was shorter in the protocol group (17 days vs. 23 days; p = 0.14), although neither was statistically significant. Although the protocol group showed trends towards reduced NEC and improved growth, this was not statistically significant, which could have been because of the small sample size. Our findings suggest that a standardized feeding protocol may reduce the time to full enteral feeds and hospital stay, but further large-scale studies are needed to confirm these results. Full article
(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)
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20 pages, 12839 KiB  
Article
Early Experience with Acuson AcuNav 4D-ICE to Guide Transcatheter Tricuspid Edge-to-Edge Repair: 4D Intracardiac Echocardiography Compared to Transesophageal Echocardiography
by Matteo Biroli, Fabio Fazzari, Francesco Cannata, Vincenzo De Peppo, Cristina Ferrari, Carlo Maria Giacari, Marco Gennari, Paolo Olivares, Manuela Muratori, Mauro Pepi, Gianluca Pontone and Federico De Marco
J. Cardiovasc. Dev. Dis. 2025, 12(5), 165; https://doi.org/10.3390/jcdd12050165 - 23 Apr 2025
Viewed by 96
Abstract
Tricuspid regurgitation is a common valvular disease associated with high morbidity and mortality if left untreated. While surgery has been the standard intervention, transcatheter tricuspid edge-to-edge repair (T-TEER) has emerged as an alternative for high-risk surgical candidates. Transesophageal echocardiography (TEE) is the gold-standard [...] Read more.
Tricuspid regurgitation is a common valvular disease associated with high morbidity and mortality if left untreated. While surgery has been the standard intervention, transcatheter tricuspid edge-to-edge repair (T-TEER) has emerged as an alternative for high-risk surgical candidates. Transesophageal echocardiography (TEE) is the gold-standard imaging modality for guiding T-TEER due to its high spatial and temporal resolution. However, it requires general anesthesia and esophageal intubation, limiting its use in certain patients. Additionally, TEE image quality may be compromised by anterior structure shadowing, which is common in T-TEER. The development of 4D intracardiac echocardiography (ICE) offers real-time, three-dimensional imaging, potentially overcoming these limitations. This study compared TEE and Acuson AcuNav 4D-ICE in guiding T-TEER in ten high-risk patients across eight crucial procedural steps. ICE showed optimal feasibility in key procedural steps, including valve steering and leaflet grasping, due to its proximity to target structures, minimizing shadowing artifacts. Both modalities performed equally in lesion identification and residual regurgitation assessment and achieved non-statistically different results in most quantitative measurements. This study supports the integration of 4D-ICE into T-TEER procedures, particularly for patients unsuited for TEE or with complex TEE windows. Its real-time imaging, reduced invasiveness, and feasibility in critical steps highlight its potential as a viable alternative or complement to TEE. Further multicenter studies are needed to validate its role, optimize protocols, and evaluate long-term outcomes in 4D-ICE-guided T-TEER. Full article
(This article belongs to the Section Imaging)
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10 pages, 2154 KiB  
Article
Riding the Highs and Lows of the Conduction System Pacing Wave—Our Experience
by Hooi Khee Teo, Yi Yi Chua, Julian Cheong Kiat Tay, Xuanming Pung, Jonathan Wei Sheng Ong, Germaine Jie Min Loo, Eric Tien Siang Lim, Kah Leng Ho, Daniel Thuan Tee Chong and Chi Keong Ching
J. Cardiovasc. Dev. Dis. 2025, 12(5), 164; https://doi.org/10.3390/jcdd12050164 - 22 Apr 2025
Viewed by 121
Abstract
Conduction system pacing started with His bundle pacing (HBP) and then rapidly switched gears into left bundle branch pacing (LBBP). We describe our center’s experience with LBBP using either lumenless leads (LLLs) or stylet-driven leads (SDLs). Patients who were admitted to two tertiary [...] Read more.
Conduction system pacing started with His bundle pacing (HBP) and then rapidly switched gears into left bundle branch pacing (LBBP). We describe our center’s experience with LBBP using either lumenless leads (LLLs) or stylet-driven leads (SDLs). Patients who were admitted to two tertiary centers between 1 April 2021 and 30 June 2024 and met the guidelines for pacing were recruited and prospectively followed up. A total of 124 patients underwent permanent pacemaker (PPM) implantation using the LBBP technique with a mean follow-up of 19.7 ± 13.3 months. In total, 90 patients were implanted with LLLs and 34 with SDLs. There was no significant difference in the procedural time and final paced QRS duration, but fluoroscopy time was significantly longer in the SDLs (26.2 ± 17.7 min vs. 17.5 ± 13.0 min, respectively, p = 0.026). The on-table impedance values were also significantly higher in the LLLs, and this persisted throughout the follow-up. There were no differences in the rates of complications. The success of conduction system pacing implantation with SDLs and LLLs is comparable with reasonable safety and reliable outcomes. Good pre-implant patient selection will contribute to improved outcomes. Full article
(This article belongs to the Special Issue Advances in Cardiac Pacing and Cardiac Resynchronisation Therapy)
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14 pages, 1278 KiB  
Article
Impact of Simulated Vascular Aging and Heart Rate on Myocardial Efficiency: A Tale of Two Paradigms from In Silico Modelling
by Lawrence J. Mulligan, Julian Thrash, Ludmil Mitrev, Daniel Ewert and Jeffrey C. Hill
J. Cardiovasc. Dev. Dis. 2025, 12(5), 163; https://doi.org/10.3390/jcdd12050163 - 22 Apr 2025
Viewed by 144
Abstract
Introduction: Vascular aging is associated with a loss of aortic compliance (CA), which results in increased left ventricular pressure–volume area (PVA), stroke work (SW) and myocardial oxygen consumption (MVO2). Myocardial efficiency (MyoEff) is derived from the PVA and MVO [...] Read more.
Introduction: Vascular aging is associated with a loss of aortic compliance (CA), which results in increased left ventricular pressure–volume area (PVA), stroke work (SW) and myocardial oxygen consumption (MVO2). Myocardial efficiency (MyoEff) is derived from the PVA and MVO2 construct, which includes potential energy (PE). However, the SW/MVO2 ratio does not include PE and provides a more accurate physiologic measure. Methods: We used a modified computational model (CM) to assess PVA and SW and calculate MVO2 using a pressure-work index (e MVO2), to derive MyoEff–PVA and MyoEff–SW metrics. Phase I evaluated five levels of human CA from normal (N) to stiff (S) at 80 bpm, and Phase II evaluated two levels of CA (N and S) at three heart rates (60, 100, and 140 bpm). Results: During Phase I, MyoEff–PVA increased from 20.7 to 31.2%, and MyoEff–SW increased from 14.8 to 18.9%. In Phase II, during the N setting coupled with increases in the heart rate, the MyoEff–PVA decreased from 29.4 to 14.8 to 9.5%; the MyoEff–SW also decreased from 22.5 to 10.3 to 5.9%. As expected, during the S setting, MyoEff–PVA decreased from 45.5 to 22.9 to 14.8; a similar effect occurred with the MyoEff–SW, demonstrating a decrease from 29.9 to 13.9 to 7.9%, respectively. Conclusions: The CM provided insights into a simple and clinically relevant calculation for assessing MyoEff. The agreement on the CM metrics aligns with studies conducted previously in the clinical setting. Full article
(This article belongs to the Special Issue Models and Methods for Computational Cardiology: 2nd Edition)
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12 pages, 1507 KiB  
Article
Sarcopenia in Patients with Chronic Thromboembolic Pulmonary Hypertension
by Steven Hopkins, Jillian Hall, Hollie Saunders, Riyaz Bashir, Vladimir Lakhter, Anjali Vaidya, Ahmed Sadek, Paul Forfia and Estefania Oliveros
J. Cardiovasc. Dev. Dis. 2025, 12(5), 162; https://doi.org/10.3390/jcdd12050162 - 22 Apr 2025
Viewed by 147
Abstract
Background: Sarcopenia, or loss of skeletal muscle mass, has been associated with poor outcomes (e.g., functional decline, increased mortality, and low quality of life), but its role in CTEPH remains unclear. The psoas muscle index (PMI) is a validated measure of sarcopenia. We [...] Read more.
Background: Sarcopenia, or loss of skeletal muscle mass, has been associated with poor outcomes (e.g., functional decline, increased mortality, and low quality of life), but its role in CTEPH remains unclear. The psoas muscle index (PMI) is a validated measure of sarcopenia. We investigated the incidence of sarcopenia using PMI in CTEPH. Methods: Retrospective analysis of a single-center cohort of patients with CTEPH with an available computed tomography of the abdomen and pelvis (CTAP). PMI was measured at the L3 level of the CTAP and was then calculated using the formula (left psoas area + right psoas area/height2). Patients in the first quartile of PMI were classified as sarcopenic. Results: We reviewed 558 patients with CTEPH, and 97 patients had an available CTAP before intervention. Sarcopenia was identified in 26 (24.8%) of the patients and was associated with worse baseline functional status (p = 0.008), higher mean pulmonary artery pressure (48 vs. 39 mmHg; p = 0.002), and higher pulmonary vascular resistance (9.9 vs. 6.8 WU; p = 0.013). Post-PTE, patients with sarcopenia exhibited longer intensive care unit (ICU) (9 vs. 4 days, p < 0.001) and overall hospital stays (24 vs. 11 days, p < 0.001), despite similar post-operative hemodynamics achieved compared to non-sarcopenic patients. Conclusions: CTEPH patients with sarcopenia have worse baseline functional class and hemodynamics. For those with sarcopenia requiring surgery, there is longer ICU and total hospitalization stays, but they achieve significant functional improvements and hemodynamics comparable to that of non-sarcopenic patients. Hence, the risk of longer perioperative hospitalization days is justified by the longer-term benefit of hemodynamic improvement. The use of PMI as part of routine pre-operative assessments could improve clinical decision-making in CTEPH patients undergoing surgical or medical intervention. Full article
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