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Volume 12
Issue 6
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J. Cardiovasc. Dev. Dis., Volume 12, Issue 6 (June 2025) – 38 articles

Cover Story (view full-size image): Vascular calcification serves as the most significant predictor of a cardiovascular event with no current therapeutic options for prevention or reversal. Vascular calcification is a complex disease that includes many different cell types and progresses at varying rates in different layers of the artery. This review explores the mechanisms, pathways, risk factors, and research models of vascular calcification and identifies potential therapeutic targets and discusses key considerations required for future development. View this paper
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21 pages, 3097 KiB  
Review
Navigating the Complexities of Cancer Treatment-Induced Hypertension
by Jose Arriola-Montenegro, John Roth and Maria L. Gonzalez Suarez
J. Cardiovasc. Dev. Dis. 2025, 12(6), 235; https://doi.org/10.3390/jcdd12060235 - 19 Jun 2025
Viewed by 658
Abstract
Cancer therapy-induced hypertension (HTN) is an increasingly recognized complication associated with a wide range of anticancer agents, including vascular endothelial growth factor (VEGF) inhibitors, proteasome inhibitors, tyrosine kinase inhibitors, and alkylating agents. The pathogenesis of HTN in this setting is multifactorial, involving mechanisms [...] Read more.
Cancer therapy-induced hypertension (HTN) is an increasingly recognized complication associated with a wide range of anticancer agents, including vascular endothelial growth factor (VEGF) inhibitors, proteasome inhibitors, tyrosine kinase inhibitors, and alkylating agents. The pathogenesis of HTN in this setting is multifactorial, involving mechanisms such as endothelial dysfunction, nitric oxide (NO) suppression, sympathetic nervous system activation, and vascular remodeling. Additional factors, including paraneoplastic syndromes, poorly controlled pain, mood disturbances, and overlapping cardiovascular risk factors like obesity and diabetes, further contribute to the complexity of diagnosis and management. Despite its prevalence and clinical implications, cancer therapy-induced HTN is often addressed using general population guidelines, with limited oncology-specific protocols available. Accurate blood pressure measurement and individualized treatment plans are critical to optimize outcomes and avoid interruptions to cancer therapy. Antihypertensive agents such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), and calcium channel blockers have shown efficacy in both blood pressure control and, in some cases, oncologic outcomes. A multidisciplinary approach involving oncologists, cardiologists, and primary care providers is essential to navigate the interplay between cancer treatment and cardiovascular health. Ongoing research is needed to develop targeted guidelines and improve the long-term care of cancer patients affected by treatment-induced HTN. Full article
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16 pages, 2531 KiB  
Article
Predictors of Five-Year Outcomes in Patients with Acute Coronary Syndromes
by Luca Di Vito, Giancarla Scalone, Federico Di Giusto, Filippo Bruscoli, Simona Silenzi, Adelina Selimi, Arianna Massari, Domenico Delfino, Federico Guerra and Pierfrancesco Grossi
J. Cardiovasc. Dev. Dis. 2025, 12(6), 234; https://doi.org/10.3390/jcdd12060234 - 18 Jun 2025
Viewed by 243
Abstract
Background: Residual risk after acute coronary syndromes (ACSs) continues to affect prognosis. We investigated the impact of female sex, non-ST-segment–elevation myocardial infarction (NSTEMI), diabetes mellitus (DM), and chronic kidney disease (CKD) on coronary atherosclerosis extent, culprit stenosis location, and bio-humoral data. The rate [...] Read more.
Background: Residual risk after acute coronary syndromes (ACSs) continues to affect prognosis. We investigated the impact of female sex, non-ST-segment–elevation myocardial infarction (NSTEMI), diabetes mellitus (DM), and chronic kidney disease (CKD) on coronary atherosclerosis extent, culprit stenosis location, and bio-humoral data. The rate of both major adverse cardiovascular events (MACE) and non-fatal recurrent coronary events (RCE) was additionally evaluated. Methods: We enrolled 1404 ACS patients and followed them for up to 5 years. Coronary culprit and non-culprit stenoses were analyzed using angiography. Biohumoral data was assessed at admission and at 1 month and 12 months after discharge. Patients were compared based on sex, NSTEMI, DM, and CKD presence. Results: NSTEMI patients had a higher number of total coronary stenoses (3.5 vs. 3.3, p = 0.013) and non-culprit stenoses (2.3 vs. 1.6, p = 0.0001). Non-culprit percent stenosis was significantly greater in NSTEMI as compared to STEMI patients (57.9% vs. 47.1%, p = 0.0001). DM patients had a higher frequency of bifurcation lesions (41% vs. 25%, p = 0.0001). CKD patients showed a higher prevalence of left main disease (3.4% vs. 1.5%, p = 0.038). Female patients had higher LDL-cholesterol values at 1 month and 12 months. NSTEMI, DM, and creatinine level were independent predictors of MACE. NSTEMI patients had an increased risk of non-fatal RCE. Conclusions: NSTEMI, DM, and creatinine levels at admission were independent predictors of MACE in the first 5 years after an ACS. Full article
(This article belongs to the Special Issue Risk Factors and Prevention of Cardiovascular Diseases—Second Edition)
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14 pages, 2111 KiB  
Review
Mitral Annular Calcification, a Not So Marginal and Relatively Benign Finding as Many of Us Think: A Review
by András Vereckei, Zsigmond Jenei, Hajnalka Vágó, Dorottya Balla, Alexisz Panajotu, Andrea Nagy and Gábor Katona
J. Cardiovasc. Dev. Dis. 2025, 12(6), 233; https://doi.org/10.3390/jcdd12060233 - 18 Jun 2025
Viewed by 439
Abstract
Mitral annular calcification (MAC) is usually considered an incidental, benign, age-related finding without serious complications in patients evaluated for cardiovascular or pulmonary disease with imaging studies that may result in mitral regurgitation or stenosis when severe. Therefore, it is usually not considered a [...] Read more.
Mitral annular calcification (MAC) is usually considered an incidental, benign, age-related finding without serious complications in patients evaluated for cardiovascular or pulmonary disease with imaging studies that may result in mitral regurgitation or stenosis when severe. Therefore, it is usually not considered a significant alteration. However, there is accumulating evidence that it is associated with a higher risk of cardiovascular events, such as atherosclerotic coronary artery disease, aortic artery disease, carotid artery disease, peripheral artery disease, stroke, atrial fibrillation, atrioventricular and/or intraventricular conduction disturbance, systemic embolization, infective endocarditis, heart failure and mortality. The presence of MAC also significantly influences the outcome of mitral valve transcatheter and surgical interventions. Several conditions may predispose to MAC. MAC is strongly related to cardiovascular risk factors, such as hypertension, diabetes, smoking and cardiovascular atherosclerosis, and inflammation may also play a role in the pathogenesis of MAC. Also, conditions that increase mitral valve stress, such as hypertension, aortic stenosis and hypertrophic cardiomyopathy, predispose to accelerated degenerative calcification of the mitral annulus area. Congenital disorders, e.g., Marfan syndrome and Hurler syndrome, are also associated with MAC, due to an intrinsic abnormality of the connective tissue composing the annulus. Full article
(This article belongs to the Section Imaging)
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25 pages, 2534 KiB  
Review
Anesthesia for Minimally Invasive Coronary Artery Bypass Surgery
by Miranda Holmes, Alexander N. J. White, Luke J. Rogers and Piroze M. Davierwala
J. Cardiovasc. Dev. Dis. 2025, 12(6), 232; https://doi.org/10.3390/jcdd12060232 - 18 Jun 2025
Viewed by 412
Abstract
Minimally invasive coronary artery bypass grafting (MI-CABG) has emerged as a transformative approach to coronary revascularization, offering reduced morbidity, faster recovery and improved cosmesis compared to conventional coronary artery bypass grafting (CABG). Performed without full sternotomy and commonly without cardiopulmonary bypass (CPB), MI-CABG [...] Read more.
Minimally invasive coronary artery bypass grafting (MI-CABG) has emerged as a transformative approach to coronary revascularization, offering reduced morbidity, faster recovery and improved cosmesis compared to conventional coronary artery bypass grafting (CABG). Performed without full sternotomy and commonly without cardiopulmonary bypass (CPB), MI-CABG encompasses a variety of techniques. These procedures present unique challenges for the anesthesiologist, necessitating a tailored perioperative strategy. This review explores the anesthetic management of MI-CABG, focusing on preoperative assessment, intraoperative techniques, and postoperative care. Preoperative evaluation emphasizes cardiac, respiratory, and vascular considerations, including suitability for one-lung ventilation (OLV) and the impact of comorbidities. Intraoperatively, anesthesiologists must manage hemodynamic instability, ensure effective OLV, and maintain normothermia. Postoperative strategies prioritize multimodal analgesia, early extubation, and rapid mobilization to leverage the benefits of a minimally invasive approach. By integrating surgical and anesthetic perspectives, this review underscores the anesthesiologist’s pivotal role in navigating the physiological demands of MI-CABG. As techniques evolve and experience grows, a comprehensive understanding of these principles will enhance the safety and efficacy of MI-CABG, making it a viable option for an expanding patient population. Full article
(This article belongs to the Special Issue New Advances in Minimally Invasive Coronary Surgery)
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14 pages, 701 KiB  
Article
Mental Health Treatment in Adults with Congenital Heart Disease in Germany: An Online, Cross-Sectional Study of Status, Needs, and Treatment Reasons
by Anna-Lena Ehmann, Emily Schütte, Janina Semmler, Felix Berger, Ulrike M. M. Bauer, Katharina Schmitt, Constanze Pfitzer and Paul C. Helm
J. Cardiovasc. Dev. Dis. 2025, 12(6), 231; https://doi.org/10.3390/jcdd12060231 - 18 Jun 2025
Viewed by 344
Abstract
Improved medical treatments have extended survival and life expectancy in adults with congenital heart defects (ACHD), placing greater emphasis on psychosocial health. Up to one-third of ACHD experience anxiety or depression, and half develop a mental illness during their lifetime. While there is [...] Read more.
Improved medical treatments have extended survival and life expectancy in adults with congenital heart defects (ACHD), placing greater emphasis on psychosocial health. Up to one-third of ACHD experience anxiety or depression, and half develop a mental illness during their lifetime. While there is solid evidence on the prevalence of mental health, many do not receive psychological, psychotherapeutic, or psychiatric treatment (PST) and the psychological care situation remains understudied. In a nationwide, online cross-sectional survey conducted in Q1 2024, 1486 ACHD aged 18 to 85 (Mage = 36.84 years; 60.8% female) registered in the German National Register for Congenital Heart Defects (NRCHD) completed self-report questionnaires on sociodemographics, illness identity (Illness Identity Questionnaire), mental well-being, and utilisation of PST. CHD diagnoses were determined in conformity with the International Pediatric and Congenital Cardiac Code (IPCCC) and CHD was classified according to Warnes et al. (simple/moderate/complex). Analyses included chi-square tests, t-tests, and binary logistic regression. Overall, 32.8% of participants reported current and/or previous PST (women 37.5%, men 25.3%). PST utilisation was significantly higher in those with complex (40.2%) compared to moderate (29.6%) and simple CHD (25.3%) (ps < 0.01). Primary treatment reasons were mental illness (41.7%) and CHD-related concerns (37.2%). Nearly half of treatments were self-initiated (45.8%) and about one-third were physician-recommended (30.8%). Logistic regression revealed CHD severity as a significant predictor of PST use (ps < 0.05), with lower odds for simple (OR = 0.48) and moderate (OR = 0.66) compared to complex CHD when controlling for sex (p < 0.001, OR = 1.87), age (p = 0.022, OR = 1.011), education level (ps between 0.060 and 0.780), and net income (ps < 0.05). Those receiving PST showed significantly higher maladaptive illness-identity scores (engulfment, rejection) and lower acceptance. Approximately one in three ACHD requires mental health support, particularly those with complex CHD. The CHD itself acts as a key stressor and treatment motivator. Findings underscore the need for integrated care linking cardiological and psychosocial services. Routine screening for psychological distress and low-threshold access to PST—also for patients with simple and moderate CHD—are essential to identify and address mental health needs early. Full article
(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)
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37 pages, 3931 KiB  
Review
Retinal Imaging as a Window into Cardiovascular Health: Towards Harnessing Retinal Analytics for Precision Cardiovascular Medicine
by Jay Bharatsingh Bisen, Hayden Sikora, Anushree Aneja, Sanjiv J. Shah and Rukhsana G. Mirza
J. Cardiovasc. Dev. Dis. 2025, 12(6), 230; https://doi.org/10.3390/jcdd12060230 - 17 Jun 2025
Viewed by 871
Abstract
Rising morbidity and mortality from cardiovascular disease (CVD) have increased interest in precision and preventive management to reduce long-term sequelae. While retinal imaging has traditionally been recognized for identifying vascular changes in systemic conditions such as hypertension and type 2 diabetes mellitus, a [...] Read more.
Rising morbidity and mortality from cardiovascular disease (CVD) have increased interest in precision and preventive management to reduce long-term sequelae. While retinal imaging has traditionally been recognized for identifying vascular changes in systemic conditions such as hypertension and type 2 diabetes mellitus, a new ophthalmologic field, cardiac-oculomics, has associated retinal biomarker changes with other cardiovascular diseases with retinal manifestations. Several imaging modalities visualize the retina, including color fundus photography (CFP), optical coherence tomography (OCT), and OCT angiography (OCTA), which visualize the retinal surface, the individual retinal layers, and the microvasculature within those layers, respectively. In these modalities, imaging-derived biomarkers can present due to CVD and have been linked to the presence, progression, or risk of developing a range of CVD, including hypertension, carotid artery disease, valvular heart disease, cerebral infarction, atrial fibrillation, and heart failure. Promising artificial intelligence (AI) models have been developed to complement existing risk-prediction tools, but standardization and clinical trials are needed for clinical adoption. Beyond risk estimation, there is growing interest in assessing real-time cardiovascular status to track vascular changes following pharmacotherapy, surgery, or acute decompensation. This review offers an up-to-date assessment of the cardiac-oculomics literature and aims to raise awareness among cardiologists and encourage interdepartmental collaboration. Full article
(This article belongs to the Section Imaging)
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15 pages, 2242 KiB  
Review
Early Echocardiographic Markers in Heart Failure with Preserved Ejection Fraction
by Annamaria Tavernese, Vincenzo Rizza, Valeria Cammalleri, Rocco Mollace, Cristina Carresi, Giorgio Antonelli, Nino Cocco, Luca D’Antonio, Martina Gelfusa, Francesco Piccirillo, Annunziata Nusca and Gian Paolo Ussia
J. Cardiovasc. Dev. Dis. 2025, 12(6), 229; https://doi.org/10.3390/jcdd12060229 - 16 Jun 2025
Viewed by 546
Abstract
Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial [...] Read more.
Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial volume index (LAVI), frequently fail to detect early functional changes. Advanced echocardiographic techniques have emerged as valuable tools for early diagnosis and risk stratification. Global Longitudinal Strain (GLS) allows for the identification of subclinical systolic dysfunction, even with preserved LVEF. Left Atrial Strain (LAS), particularly reservoir and pump strain, provides sensitive markers of diastolic function and elevated filling pressures, offering additional diagnostic and prognostic insights. Myocardial Work (MW), through non-invasive pressure–strain loops, enables load-independent assessment of contractility, while Right Ventricular Free Wall Longitudinal Strain (RVFWLS) captures early right heart involvement, often present in advanced HFpEF. The integration of these advanced parameters can enhance diagnostic precision and guide personalized treatment strategies. This review highlights the current evidence and clinical applications of strain-based imaging in HFpEF, underscoring the importance of a multiparametric, pathophysiology-oriented approach in heart failure evaluation. Full article
(This article belongs to the Special Issue Role of Cardiovascular Imaging in Heart Failure)
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11 pages, 5318 KiB  
Case Report
Severe Myocardial Involvement and Persistent Supraventricular Arrhythmia in a Premature Infant Due to Enterovirus Infection: Case Report and Literature Review
by Carolina Montobbio, Alessio Conte, Andrea Calandrino, Alessia Pepe, Francesco Vinci, Alessandra Siboldi, Roberto Formigari and Luca Antonio Ramenghi
J. Cardiovasc. Dev. Dis. 2025, 12(6), 228; https://doi.org/10.3390/jcdd12060228 - 14 Jun 2025
Viewed by 666
Abstract
Enterovirus (EV) infections in neonates can be transmitted vertically or horizontally, with symptoms ranging from mild to severe, including myocarditis, meningoencephalitis, and hepatitis. Neonates with EV-induced myocarditis may present severe cardiovascular disease with sudden onset of arrhythmia. Neonatal arrhythmias, particularly in low birth [...] Read more.
Enterovirus (EV) infections in neonates can be transmitted vertically or horizontally, with symptoms ranging from mild to severe, including myocarditis, meningoencephalitis, and hepatitis. Neonates with EV-induced myocarditis may present severe cardiovascular disease with sudden onset of arrhythmia. Neonatal arrhythmias, particularly in low birth weight or critically ill infants, can impair cardiac function and worsen outcomes. EV targets cardiomyocyte receptors, inducing apoptosis pathways and triggering cardiac conduction disturbances. We present an extremely low-birth-weight preterm infant (GW 27 + 6) who developed EV-induced myocarditis, complicated with a sudden onset of supraventricular tachycardia (SVT), pericardial effusion and bi-atrial enlargement. Despite multi-agent regimen, including propranolol, flecainide, and amiodarone, the infant showed persistent junctional rhythm until seven months of age, later transitioning to atrial rhythm with stable cardiac function. A review of previously published rhythm disturbances due to EV-induced myocarditis is presented. Newborns with EV-induced arrhythmia may require a multi-modal treatment such as a multi-agent medical regimen or, in severe non-responsive cases, an electrophysiological approach. EV infections may cause long-term cardiovascular comorbidities (such as left ventricular dysfunction or mitral valve regurgitation), necessitating continuous monitoring through echocardiography and ECG. Collaboration between neonatologists and pediatric cardiologists is crucial for effective treatment and follow-up. Full article
(This article belongs to the Topic Cardiovascular Disease in Special Populations: From Basic Science to Clinical Practice)
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12 pages, 2400 KiB  
Article
Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction
by Tony Li, Vinay B. Panday, Jessele Lai, Nicholas Gao, Beth Lim, Aloysius Leow, Sarah Tan, Quek Swee Chye, Ching Hui Sia, William Kong, Tiong Cheng Yeo, Ru San Tan, Liang Zhong and Kian Keong Poh
J. Cardiovasc. Dev. Dis. 2025, 12(6), 227; https://doi.org/10.3390/jcdd12060227 - 13 Jun 2025
Viewed by 318
Abstract
Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, dσ*/dtmax, is load-independent and has been reported to be associated with clinical outcomes in heart failure and aortic stenosis. We aim to [...] Read more.
Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, dσ*/dtmax, is load-independent and has been reported to be associated with clinical outcomes in heart failure and aortic stenosis. We aim to assess if dσ*/dtmax could predict adverse outcomes in patients with severe mitral regurgitation (MR). Methodology: We studied dσ*/dtmax in a cohort of 127 patients with isolated severe primary MR and preserved LVEF ≥ 60%. Patients with prior valvular intervention or concurrent valvular disease were excluded. We tested dσ*/dtmax against a composite of adverse outcomes including all-cause mortality, heart failure hospitalization, and mitral valve intervention. Results: The cohort had a mean age of 58 years old and was predominantly male. Of the 127 patients, eight (6.3%) needed subsequent hospitalization for heart failure, while 30 (23.6%) and 11 (8.7%) patients underwent mitral valve repair and replacement, respectively, And 14 (11.0%) passed away. Of the patients (n = 54 (42.5%)) who had an adverse outcome during follow-up, dσ*/dtmax demonstrated an independent association with composite adverse outcome, including its individual components. On ROC analysis, a cut-off of 2.15 s−1 was identified. Based on this cut-off, dσ*/dtmax retained an independent association with composite adverse outcome after adjusting for covariates including age, sex, ischemic heart disease, pulmonary artery systolic pressure, and left ventricular end systolic diameter. Conclusions: In patients with severe primary MR and preserved LVEF, reduced dσ*/dtmax was an independent predictor of adverse outcomes. It can be a useful addition to the armamentarium for assessing patients with severe MR. Full article
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3 pages, 191 KiB  
Reply
Reply to Neunhaeuserer et al. Comment on “Bianco et al. Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population. J. Cardiovasc. Dev. Dis. 2025, 12, 22”
by Massimiliano Bianco, Fabrizio Sollazzo, Riccardo Pella, Saverio Vicentini, Samuele Ciaffoni, Gloria Modica, Riccardo Monti, Michela Cammarano, Paolo Zeppilli and Vincenzo Palmieri
J. Cardiovasc. Dev. Dis. 2025, 12(6), 226; https://doi.org/10.3390/jcdd12060226 - 13 Jun 2025
Viewed by 208
Abstract
We have read the commentary on our article entitled ‘Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population’ [...] Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
2 pages, 162 KiB  
Comment
Comment on Bianco et al. Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population. J. Cardiovasc. Dev. Dis. 2025, 12, 22
by Daniel Neunhaeuserer, Francesca Battista, Giulia Quinto, Gino Degano, Andrea Gasperetti and Andrea Ermolao
J. Cardiovasc. Dev. Dis. 2025, 12(6), 225; https://doi.org/10.3390/jcdd12060225 - 13 Jun 2025
Cited by 1 | Viewed by 190
Abstract
The article by Bianco M [...] Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
10 pages, 2639 KiB  
Brief Report
Patterning Defects in Mice with Defective Ventricular Wall Maturation and Cardiomyopathy
by Javier Santos-Cantador, Marcos Siguero-Álvarez and José Luis de la Pompa
J. Cardiovasc. Dev. Dis. 2025, 12(6), 224; https://doi.org/10.3390/jcdd12060224 - 12 Jun 2025
Viewed by 374
Abstract
Ventricular chamber development involves the coordinated maturation of diverse cardiomyocyte cell populations. In the human fetal heart, single-cell and single-nucleus RNA sequencing technologies and spatial transcriptomics reveal marked regional gene expression differences. In contrast, the mouse ventricular wall appears more homogeneous, except for [...] Read more.
Ventricular chamber development involves the coordinated maturation of diverse cardiomyocyte cell populations. In the human fetal heart, single-cell and single-nucleus RNA sequencing technologies and spatial transcriptomics reveal marked regional gene expression differences. In contrast, the mouse ventricular wall appears more homogeneous, except for a transient hybrid cardiomyocyte population co-expressing compact (Hey2) and trabecular (Irx3, Nppa, Bmp10) markers, indicating a transitional lineage state. To further investigate this, we used in situ hybridization (ISH) to examine the expression of a selected set of cardiomyocyte markers in normal and left ventricular non-compaction cardiomyopathy (LVNC) mouse models. In developing mouse ventricles, the expression of key marker genes was largely restricted to two wide myocardial domains, compact and trabecular myocardium, suggesting a less complex regional organization than the human fetal heart. Other markers labeled endocardial and coronary endothelial cells rather than cardiomyocytes, differing from patterns observed in the human heart. In the LVNC model, various markers exhibited altered spatial expression, indicating that the precise regional organization of gene expression is critical for normal ventricular wall maturation. These findings underscore the critical role of spatially regulated gene programs in ventricular chamber development and point to their potential involvement in cardiomyopathy pathogenesis. Full article
(This article belongs to the Section Cardiac Development and Regeneration)
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5 pages, 204 KiB  
Editorial
Contemporary Clinical Treatment Options and Outcomes of Aortic Valve Disease: Integrating Modern Insights into a Cohesive Therapeutic Paradigm
by Mladen J. Kočica
J. Cardiovasc. Dev. Dis. 2025, 12(6), 223; https://doi.org/10.3390/jcdd12060223 - 12 Jun 2025
Viewed by 355
Abstract
Historically, the aortic valve (AV) was seen as a passive mechanical structure facilitating unidirectional blood flow by opening and closing in response to pressure changes, with little or no biological activity [...] Full article
(This article belongs to the Special Issue Contemporary Clinical Treatment Options and Outcomes of Aortic Valve Disease)
15 pages, 1762 KiB  
Article
Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery
by Pasquale Totaro, Martina Musto, Eduardo Tulumello, Antonella Degani, Vincenzo Argano and Stefano Pelenghi
J. Cardiovasc. Dev. Dis. 2025, 12(6), 222; https://doi.org/10.3390/jcdd12060222 - 12 Jun 2025
Viewed by 282
Abstract
Background: Antegrade root cardioplegia remains the most popular strategy for myocardial protection during coronary artery bypass graft (CABG) performed with cardiopulmonary bypass (CPB) and aortic cross clamp. In patients with depressed left ventricular function, however, especially if associated with severe multiple coronary stenosis, [...] Read more.
Background: Antegrade root cardioplegia remains the most popular strategy for myocardial protection during coronary artery bypass graft (CABG) performed with cardiopulmonary bypass (CPB) and aortic cross clamp. In patients with depressed left ventricular function, however, especially if associated with severe multiple coronary stenosis, increased pharmacological and/or mechanical support in the early post-CPB period is often required to support left ventricular recovery. In this study, we analyzed the results of a myocardial protection strategy that includes selective infusion of cardioplegia through each venous graft followed by warm reperfusion distal to each coronary anastomosis until complete removal of the aortic clamp (total antegrade cardioplegia infusion and warm reperfusion = TAWR) to improve early postoperative recovery in patients with depressed left ventricular function undergoing multi-vessel CABG. Methods: Out of 97 patients undergoing CABG using the TAWR strategy for myocardial protection, 32 patients presented with depressed left ventricle function (EF < 40%) and multi-vessel coronary diseases requiring ≥2 vein grafts and were enrolled as Group A. Combined primary outcomes and postoperative early and late left ventricle recovery (including spontaneous rhythm recovery, inotropic support and postoperative troponin release) were analyzed and compared with those of 32 matched patients operated on using standard antegrade root cardioplegia and limited warm reperfusion through LIMA graft (SAWR) enrolled as Group B. Results: Two patient died in hospital (in-hospital mortality 3.1%) with no statistical differences between the two groups. In Group A 27 patients (90%) had spontaneous recovery of idiopathic rhythm compared to 17 (53%) in group B (p = 0.001). Early inotropic support was required in nine patients (28%) of group A and seventeen patients (53%) of group B (p = 0.041). Furthermore, in eight patients (25%) of group A and seventeen (53%) of group B (p = 0.039) inotropic support was continued for >48 h. Conclusions: The TAWR strategy seems to significantly improve early postoperative cardiac recovery in patients with left ventricle depression undergoing multi-vessel CABG, when compared with SAWR strategy and could therefore be considered the strategy of choice in this subset of patients. Full article
(This article belongs to the Special Issue 2nd Edition: Interventional Therapies and Management in Coronary Artery Disease)
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16 pages, 365 KiB  
Review
The Role of Artificial Intelligence in Cardiac Amyloidosis: A Focus on Diagnosis and Clinical Application
by Roshan Wardak and David Snipelisky
J. Cardiovasc. Dev. Dis. 2025, 12(6), 221; https://doi.org/10.3390/jcdd12060221 - 11 Jun 2025
Viewed by 645
Abstract
The aim of this review is to provide an update on contemporary and evolving artificial intelligence (AI) methods and their role in diagnosing and managing cardiac amyloidosis (CA). AI is the broadest term which describes a variety of different techniques that enable computers [...] Read more.
The aim of this review is to provide an update on contemporary and evolving artificial intelligence (AI) methods and their role in diagnosing and managing cardiac amyloidosis (CA). AI is the broadest term which describes a variety of different techniques that enable computers to mimic human intelligence. It is widely used across different diagnostic tests including electrocardiograms, echocardiography, scintigraphy and cardiac magnetic resonance (CMR). Through a comprehensive search among four databases, we identified several insights into clinical applications, diagnostic modalities and different utilization of AI in CA. The elusive nature of CA, which often makes early diagnosis challenging, can greatly benefit from the integration of AI into the diagnostic process. The variability in diagnostic strategies of CA underscores the need for more AI-focused prospective clinical trials to establish evidence-based guidelines for AI-driven diagnostic pathways. Our review highlights the capabilities of AI, particularly in the diagnosis of cardiac amyloidosis. Full article
(This article belongs to the Special Issue Feature Review Papers in Cardiovascular Clinical Research)
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13 pages, 580 KiB  
Study Protocol
Effect of DAPAgliflozin on Myocardial Fibrosis and Ventricular Function in Patients with ST-Segment Elevation Myocardial Infarction—DAPA-STEMI Trial
by Luis Ortega-Paz, Claudio Laudani, Alessandro Sionis, Pablo Vidal-Cales, Victor Arevalos, Rut Andrea, Carlos Igor Morr, Oriol De Diego, Emilio Ortega, Francisco-Rafael Jimenez-Trinidad, Ana Paula Dantas, Dominick J. Angiolillo, Manel Sabaté, Jose T. Ortiz-Pérez and Salvatore Brugaletta
J. Cardiovasc. Dev. Dis. 2025, 12(6), 220; https://doi.org/10.3390/jcdd12060220 - 11 Jun 2025
Viewed by 506
Abstract
Background: Myocardial fibrosis leads to ventricular dysfunction and worsened prognosis, especially after ST-segment elevation myocardial infarction (STEMI). Sodium–glucose cotransporter 2 inhibitors (SGLT2is) offer cardiovascular benefits by reducing markers of myocardial fibrosis and fibroblast activity. However, the effects of SGLT2i on myocardial fibrosis deposition [...] Read more.
Background: Myocardial fibrosis leads to ventricular dysfunction and worsened prognosis, especially after ST-segment elevation myocardial infarction (STEMI). Sodium–glucose cotransporter 2 inhibitors (SGLT2is) offer cardiovascular benefits by reducing markers of myocardial fibrosis and fibroblast activity. However, the effects of SGLT2i on myocardial fibrosis deposition among STEMI patients undergoing primary percutaneous coronary intervention (PCI) have not yet been evaluated. Study and Design: The effect of DAPAgliflozin on myocardial fibrosis and ventricular function in patients with STEMI (DAPA-STEMI) trial is a phase III, multicenter, randomized, double-blind, placebo-controlled trial. The study aims to assess the effects of dapagliflozin on myocardial fibrosis and ventricular function, evaluated using cardiac magnetic resonance (CMR), in STEMI patients undergoing primary PCI. Eligible patients were 30 to 85 years old and exhibited a left ventricular ejection fraction ≤ 50%. A total of 120 patients with STEMI were expected to be randomized 1:1 to receive dapagliflozin 10 mg or placebo daily for six months. The primary endpoint is the change in the extracellular volume fraction of the remote myocardium from baseline to six months, as measured by CMR. The secondary endpoints include changes in the circulating C-terminal propeptide of type I procollagen, N-terminal propeptide of type III procollagen, and Galectin-3 from baseline to six months. The study was stopped prematurely due to slow recruitment, with 54 enrolled patients, limiting the statistical power to detect changes in the primary endpoint between groups. Conclusions: The DAPA-STEMI trial will provide insights into the impact of dapagliflozin on myocardial fibrosis and ventricular remodeling in patients with STEMI undergoing primary PCI. Clinical Trial Registration Unique Identifier: NCT06619600 Full article
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18 pages, 775 KiB  
Review
Cardiovascular Nursing in Rehabilitative Cardiology: A Review
by Carmine Izzo, Valeria Visco, Francesco Loria, Antonio Squillante, Chiara Iannarella, Antonio Guerriero, Alessandra Cirillo, Maria Grazia Barbato, Ornella Ferrigno, Annamaria Augusto, Maria Rosaria Rusciano, Nicola Virtuoso, Eleonora Venturini, Paola Di Pietro, Albino Carrizzo, Carmine Vecchione and Michele Ciccarelli
J. Cardiovasc. Dev. Dis. 2025, 12(6), 219; https://doi.org/10.3390/jcdd12060219 - 11 Jun 2025
Viewed by 686
Abstract
Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, necessitating comprehensive management and prevention strategies. Rehabilitative cardiology, also known as cardiac rehabilitation (CR), is a multidisciplinary approach aimed at enhancing recovery, reducing the risk of recurrent cardiac events, and improving patients’ quality [...] Read more.
Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, necessitating comprehensive management and prevention strategies. Rehabilitative cardiology, also known as cardiac rehabilitation (CR), is a multidisciplinary approach aimed at enhancing recovery, reducing the risk of recurrent cardiac events, and improving patients’ quality of life. This review explores the critical role of cardiovascular nursing in CR, highlighting its contributions to patient education, psychosocial support, and care coordination. Through an analysis of current evidence, we outline the core components of CR, including exercise training, risk factor modification, and behavioral interventions. Cardiovascular nurses play a pivotal role in optimizing patient outcomes by conducting assessments, providing tailored education, and addressing psychological challenges such as depression and anxiety, which often accompany CVDs. Despite the well-documented benefits of CR, participation rates remain low due to barriers such as inadequate referral systems, accessibility challenges, and socioeconomic disparities. Emerging solutions, including telemedicine and home-based CR, offer promising alternatives to improve adherence and accessibility. The review underscores the need for expanded nursing roles, interdisciplinary collaboration, and policy advancements to bridge existing gaps in CR utilization. By integrating innovative care models, cardiovascular nursing can further enhance the effectiveness of rehabilitative cardiology and contribute to improved long-term patient outcomes. Full article
(This article belongs to the Special Issue Feature Review Papers in Cardiovascular Clinical Research)
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17 pages, 1314 KiB  
Review
Biophysics and Clinical Effectiveness of Irreversible Electroporation for Catheter Ablation of Atrial Fibrillation
by Anna-Sophie Eberl, Gernot Plank, Martin Manninger, Ursula Rohrer, Laura Stix, Stefan Kurath-Koller, Andreas Zirlik and Daniel Scherr
J. Cardiovasc. Dev. Dis. 2025, 12(6), 218; https://doi.org/10.3390/jcdd12060218 - 7 Jun 2025
Viewed by 678
Abstract
Understanding the biophysics of electroporation—the mechanism by which pulsed electric fields achieve tissue ablation—is essential for advancing this emerging technology. In this review, we summarize key publications from past years to provide an overview of current knowledge and future perspectives. We discuss the [...] Read more.
Understanding the biophysics of electroporation—the mechanism by which pulsed electric fields achieve tissue ablation—is essential for advancing this emerging technology. In this review, we summarize key publications from past years to provide an overview of current knowledge and future perspectives. We discuss the fundamental principles of PFA at the cellular, physical, and technical levels, along with its potential benefits and limitations. A deeper understanding of these biophysical mechanisms and the parameters required to create durable lesions may contribute to improved clinical outcomes and drive future innovation. Full article
(This article belongs to the Topic New Research on Atrial Fibrillation)
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13 pages, 1157 KiB  
Article
Outcomes and Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with and Without Coronary Artery Disease
by Horațiu Suciu, Ayman Elkahlout, Viorel Nicolae, Flavius Tomșa, Alexandru Stan, Hussam Al-Hussein, Paul-Adrian Călburean, Anda-Cristina Scurtu, David Emanuel Aniței, László Hadadi, Klara Brînzaniuc and Marius Mihai Harpa
J. Cardiovasc. Dev. Dis. 2025, 12(6), 217; https://doi.org/10.3390/jcdd12060217 - 7 Jun 2025
Viewed by 616
Abstract
Background: The aim of this study was to compare costs and clinical outcomes associated with transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). A secondary analysis was performed in patients with coronary artery disease, and patients with TAVI and percutaneous [...] Read more.
Background: The aim of this study was to compare costs and clinical outcomes associated with transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). A secondary analysis was performed in patients with coronary artery disease, and patients with TAVI and percutaneous coronary intervention (PCI) were compared with SAVR and coronary artery bypass grafting (CABG). Methods: All patients who underwent the TAVI or SAVR procedure for severe degenerative aortic stenosis between August 2013 and February 2025 at a tertiary cardiovascular center were selected for inclusion in the present study. Patients were excluded if there was no available follow-up or if there was a crossover between treatments (especially CABG undergoing TAVI or SAVR undergoing PCI within a 6-month timeframe). Results: A total of 2452 patients (1925 undergoing SAVR and 527 undergoing TAVI) were included. Of those, 400 underwent SAVR + CABG and 75 underwent TAVI + PCI. During a median follow-up of 2.88 (1.12–6.43) years, a total of 404 all-cause events occurred, corresponding to 4.18 deaths per 100 patient-years. TAVI was associated with higher hospitalization costs and fewer in-hospital deaths than SAVR. However, long-term survival was similar between TAVI and SAVR and between TAVI + PCI and SAVR + CABG. Interventional treatment was more cost-effective in patients with EuroSCORE > 10%, while surgical treatment was more cost-effective in patients with EuroSCORE < 10%. Conclusions: In patients who are at high surgical risk, TAVI is more cost-effective than SAVR, and TAVI + PCI is more cost-effective than SAVR + CABG. In patients who are not at high surgical risk, SAVR is more cost-effective than TAVI, and SAVR + CABG is more cost-effective than TAVI + PCI. Full article
(This article belongs to the Special Issue Heart Valve Surgery: Repair and Replacement)
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15 pages, 666 KiB  
Article
The Efficacy and Safety of Outpatient Exercise Training for Patients with Chronic Thromboembolic Pulmonary Hypertension After Balloon Pulmonary Angioplasty
by Takayuki Masuda, Keitaro Akita, Ryota Sato, Takenori Ikoma, Yusuke Mizuno, Terumori Satoh, Masashi Takao, Kenichiro Suwa, Mikihiro Shimizu, Keiichi Odagiri, Katsuya Yamauchi and Yuichiro Maekawa
J. Cardiovasc. Dev. Dis. 2025, 12(6), 216; https://doi.org/10.3390/jcdd12060216 - 7 Jun 2025
Viewed by 454
Abstract
Background: To evaluate the efficacy and safety of outpatient exercise training in clinically stabilized patients with chronic thromboembolic pulmonary hypertension (CTEPH) after balloon pulmonary angioplasty (BPA). Methods: Twenty-four patients with CTEPH after BPA were enrolled in this prospective single-center study. Patients were assigned [...] Read more.
Background: To evaluate the efficacy and safety of outpatient exercise training in clinically stabilized patients with chronic thromboembolic pulmonary hypertension (CTEPH) after balloon pulmonary angioplasty (BPA). Methods: Twenty-four patients with CTEPH after BPA were enrolled in this prospective single-center study. Patients were assigned to the exercise and control groups. The exercise group comprised 12 patients who received 15 weeks of exercise training, with usual care. The control group received only the usual care, without exercise training. The exercise program included aerobic exercise thrice weekly and resistance exercise once or twice weekly. The assessments employed included a 6-min walk test, cardiopulmonary exercise testing, and an emPHasis-10 questionnaire. Results: In the exercise group, the 6-min walk distance was significantly longer (510.0 [467.5, 595.0] m vs. 425.0 [395.0, 465.0] m, p = 0.020), the time taken to walk 10 m was shorter (6.4 [5.9, 7.5] s vs. 8.9 [8.1, 9.1] s, p = 0.020), and the walking speed was faster (1.6 [1.3, 1.7] m/s vs. 1.1 [1.1, 1.2] m/s, p = 0.020) at 15 weeks compared with the results for the control group. The quality of life tended to improve at 15 weeks compared with that before the exercise training. However, hemodynamics did not change significantly before and after the exercise training, and no fatal arrhythmias or syncope were observed. Conclusions: Exercise training improved gait performance, without any adverse events, in patients with CTEPH after BPA. Therefore, exercise training as an adjunct to medical therapy may be a safe potential therapy for patients with CTEPH after BPA. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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10 pages, 3407 KiB  
Review
Management of TAVI Underexpansion with Self-Expanding Valves: A Practical Approach
by Rene Hameau, Marco B. Ancona, Vittorio Romano, Luca Ferri, Barbara Bellini, Filippo Russo, Ciro Vella, Christos Papageorgiu, Francesca Napoli, Marco Licciardi, Gianluca Ricchetti, Andrea Tripoli, Rocco Sabarese, Lorenzo Zaccaria and Matteo Montorfano
J. Cardiovasc. Dev. Dis. 2025, 12(6), 215; https://doi.org/10.3390/jcdd12060215 - 7 Jun 2025
Viewed by 497
Abstract
Underexpansion of a self-expanding transcatheter aortic valve (TAVI) is a critical issue that can negatively impact long-term outcomes, including paravalvular leak, valve thrombosis, and increased mortality. This paper provides a comprehensive review of the pathophysiology and consequences of such complications, including three primary [...] Read more.
Underexpansion of a self-expanding transcatheter aortic valve (TAVI) is a critical issue that can negatively impact long-term outcomes, including paravalvular leak, valve thrombosis, and increased mortality. This paper provides a comprehensive review of the pathophysiology and consequences of such complications, including three primary mechanisms: (1) infolding, (2) incorrect site of crossing and (3) true underexpansion. It also discusses strategies to address these challenges, including pre-procedural planning and procedural techniques to ensure proper valve deployment and expansion. Mitigating these issues is essential to improving both immediate and long-term outcomes in TAVI patients. Full article
(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)
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12 pages, 341 KiB  
Systematic Review
Systematic Review on HRV Reference Values
by Maximillian Brozat, Irina Böckelmann and Stefan Sammito
J. Cardiovasc. Dev. Dis. 2025, 12(6), 214; https://doi.org/10.3390/jcdd12060214 - 6 Jun 2025
Viewed by 1107
Abstract
Heart rate variability (HRV) has been established as a measure for the variation in time intervals between successive cardiac actions as a marker of the autonomic nervous system. However, despite many efforts in this field, there are no reference values that are generally [...] Read more.
Heart rate variability (HRV) has been established as a measure for the variation in time intervals between successive cardiac actions as a marker of the autonomic nervous system. However, despite many efforts in this field, there are no reference values that are generally accepted. The objective of this systematic review is, therefore, to present an overview of the studies on HRV normal values published to date, with due consideration of any influencing factors. A systematic database query was carried out in PubMed, Scopus, Ovid Medline, and PsychInfo using the search string “((hrv) or (heart rate variability)) and ((reference values) or (reference range) or (normal values))”. Of the 6640 studies yielded by the query, 58 were used for this systematic review. The STARD-HRV procedure was used to assess the quality of the studies. The studies considered date from 1989 to 2022. The number of subjects examined was between 20 and 84,772. The age of the subjects was between 1 day and 99 years. A total of 51 of the studies examined both male and female subjects. In total, 19 studies used long-term measurements, 22 studies used short-term measurements, and 17 studies used intermediate measuring periods. Many different HRV parameters were analyzed, most often traditional time-domain and frequency-domain ones. Nine studies described the subjects as “healthy” without giving more detailed explanations. There are no generally accepted HRV normal values (yet). Some large studies provide values that may be used for orientation purposes. However, further studies are required to collect HRV normal values. It was not possible to merge the results of the studies in terms of a meta-analysis; this would also not be practical since, among other reasons, the consideration of confounders as well as recording and measuring modalities sometimes vary to a large extent and impede the comparability of the studies. Generally, HRV seems to be influenced by various mechanisms and external factors that are still not fully understood. An exploration of these factors will ultimately allow HRV normal values to be obtained in a manner that is generally accepted. Full article
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17 pages, 956 KiB  
Review
Gender-Specific Differences in Diastolic Dysfunction and HFpEF: Pathophysiology, Diagnosis, and Therapeutic Strategies
by Francesca Coppi, Gianluca Pagnoni, Francesca Grossule, Ashraf Nassar, Arianna Maini, Giuseppe Masaracchia, Francesco Sbarra, Elisa Battigaglia, Enrico Maggio, Daniela Aschieri, Federica Moscucci, Marcello Pinti, Anna Vittoria Mattioli, Francesco Fedele and Susanna Sciomer
J. Cardiovasc. Dev. Dis. 2025, 12(6), 213; https://doi.org/10.3390/jcdd12060213 - 5 Jun 2025
Viewed by 645
Abstract
: Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of heart failure cases and is primarily characterized by impaired diastolic function, leading to increased ventricular filling pressures and symptoms like dyspnea and reduced exercise tolerance. Significant gender-specific differences are observed, [...] Read more.
: Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of heart failure cases and is primarily characterized by impaired diastolic function, leading to increased ventricular filling pressures and symptoms like dyspnea and reduced exercise tolerance. Significant gender-specific differences are observed, with women, particularly post-menopausal, experiencing higher prevalence and distinct clinical profiles compared to men. Diastolic dysfunction in HFpEF involves altered cellular mechanisms such as reduced SERCA2a expression, impacting calcium handling and myocardial relaxation. Diagnostic strategies mainly employ echocardiography, including Doppler imaging, tissue Doppler imaging, and strain imaging, to assess ventricular relaxation and stiffness. However, early identification remains challenging, necessitating advanced tools like cardiac magnetic resonance and exercise stress testing for accurate diagnosis, especially in women who often present with subtle symptoms. Treatment options for HFpEF have traditionally been limited, but recent trials, notably EMPEROR-PRESERVED and DELIVER, demonstrated significant cardiovascular benefits using sodium–glucose cotransporter-2 (SGLT2) inhibitors. Additionally, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown promising results, particularly in obese patients. Despite these advances, gender differences in therapeutic response necessitate further research for personalized management strategies. Understanding sex-specific pathophysiological mechanisms and optimizing diagnostic criteria remain essential to improving prognosis and quality of life in HFpEF patients. Full article
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22 pages, 717 KiB  
Review
Lifestyle and Pharmacological Interventions to Prevent Anthracycline-Related Cardiotoxicity in Cancer Patients
by Luigi Spadafora, Francesca Maria Di Muro, Chiara Intonti, Ludovica Massa, Mauro Monelli, Roberto Franco Enrico Pedretti, Edvige Palazzo Adriano, Pasquale Guarini, Gaia Cantiello, Marco Bernardi, Federico Russo, Stefano Cacciatore, Pierre Sabouret, Michele Golino, Giuseppe Biondi Zoccai, Francesca Romana Zimatore and Laura Adelaide Dalla Vecchia
J. Cardiovasc. Dev. Dis. 2025, 12(6), 212; https://doi.org/10.3390/jcdd12060212 - 4 Jun 2025
Viewed by 1156
Abstract
Anthracyclines remain a cornerstone of cancer therapy but are associated with a significant risk of cardiotoxicity, which can lead to overt heart failure. The risk is modulated by cumulative dose, pre-existing cardiovascular disease, and patient-specific factors. As cancer survival improves, the long-term cardiovascular [...] Read more.
Anthracyclines remain a cornerstone of cancer therapy but are associated with a significant risk of cardiotoxicity, which can lead to overt heart failure. The risk is modulated by cumulative dose, pre-existing cardiovascular disease, and patient-specific factors. As cancer survival improves, the long-term cardiovascular consequences of anthracycline exposure have become a growing concern, underscoring the need for effective preventive strategies. This narrative review examines lifestyle and pharmacological interventions aimed at mitigating anthracycline-induced cardiotoxicity. Evidence suggests that structured exercise programs and antioxidant-rich diets may enhance cardiovascular resilience, while beta-blockers, renin-angiotensin system inhibitors, and dexrazoxane remain central pharmacological options. Emerging therapies, including sodium-glucose co-transporter 2 inhibitors and sacubitril/valsartan, show promise but require further investigation. A comprehensive approach that integrates lifestyle modifications with pharmacological strategies within a multidisciplinary cardio-oncology framework may provide optimal protection, improving long-term cardiovascular outcomes in cancer patients receiving anthracyclines. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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15 pages, 2121 KiB  
Article
Driveline Relocation and Vacuum-Assisted Closure for Ventricular Assist Device Driveline Infections
by Mehmet Cahit Saricaoglu, Melisa Kandemir, Elif M. Saricaoglu, Ali Fuat Karacuha, Ezel Kadiroglu, Mustafa Farah Abdullahi, Mustafa Bahadir Inan, Alpay Azap and Ahmet Ruchan Akar
J. Cardiovasc. Dev. Dis. 2025, 12(6), 211; https://doi.org/10.3390/jcdd12060211 - 3 Jun 2025
Viewed by 946
Abstract
Background: Durable mechanical circulatory support (DMCS) infections remain a serious challenge. Ventricular assist device (VAD)-specific driveline infections (DLIs) are the most common type; however, no consensus exists on their surgical management. We aimed to define the incidence, risk factors, and microbiology of DLIs [...] Read more.
Background: Durable mechanical circulatory support (DMCS) infections remain a serious challenge. Ventricular assist device (VAD)-specific driveline infections (DLIs) are the most common type; however, no consensus exists on their surgical management. We aimed to define the incidence, risk factors, and microbiology of DLIs and discuss the surgical treatment modalities. Methods: We retrospectively reviewed 90 patients who underwent a left or biventricular ventricular assist device (LVAD or BiVAD) implantation with either a HeartMate 2 (Abbott), HeartWare HVAD (Medtronic), or HeartMate 3 (Abbott) in a single center between 1 March 2011 and 30 May 2023. Results: DLIs were detected in 20 (21.5%) patients during the follow-up. The mean duration of VAD support was 561.1 ± 833.2 days (1–4124 days), while it was 1277.9 ± 621.6 days in the DLI group. An extended duration of VAD support was associated with higher incidence rates of late-onset DLIs (p < 0.05). A younger age and lower plasma albumin levels were independent predictive factors for the risk of a DLI, with a hazard ratio of 9.77 (95%CI: 1.3–74.5) and 10.55 (95%CI: 1.40–79.35), respectively. The removal of the biofilm with velour and DL relocation through the rectus muscle combined with vacuum-assisted strategies (VAC) were performed in nine patients. One patient developed a recurrent infection, and another patient with a deep DLI subsequently received a heart transplant. No patient underwent a device exchange for an intractable DLI. Conclusions: Our results suggest that DLIs are common infectious complications after VAD implantation, which endanger patient autonomy, and impair their quality of life and overall survival. A DL relocation through the rectus muscles and VAC strategies have a role in controlling DLIs. Full article
(This article belongs to the Collection Current Challenges in Heart Failure and Cardiac Transplantation)
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11 pages, 1139 KiB  
Article
Sudden Cardiac Death Due to Ventricular Arrhythmia in Acute Coronary Occlusion: Potential Roles of the Sinoatrial Nodal Artery and Conus Artery
by Justine Bhar-Amato, Aurojit Roy, Benjamin Lambert, Sofia Kassou, Stephen P. Hoole and Sharad Agarwal
J. Cardiovasc. Dev. Dis. 2025, 12(6), 210; https://doi.org/10.3390/jcdd12060210 - 31 May 2025
Viewed by 422
Abstract
Background: Despite advances in the management of coronary disease, the incidence of sudden cardiac death (SCD) in the context of coronary artery disease (CAD) remains significant and unpredictable. We investigated the patient and angiographic characteristics, and predictors of long-term outcomes, of patients presenting [...] Read more.
Background: Despite advances in the management of coronary disease, the incidence of sudden cardiac death (SCD) in the context of coronary artery disease (CAD) remains significant and unpredictable. We investigated the patient and angiographic characteristics, and predictors of long-term outcomes, of patients presenting with cardiac arrest in the context of acute coronary occlusion, to elucidate possible mechanisms of ventricular arrhythmia. Methods: A total of 127 consecutive patients presenting to a tertiary cardiac centre with pulseless ventricular tachycardia or ventricular fibrillation during acute myocardial infarction (AMI) were compared to 100 patients with uncomplicated AMI (Cohort A). We also compared a separate group comprising 20 patients with acute RCA occlusion complicated by cardiac arrest and 24 patients with uncomplicated inferior STEMI (Cohort B). Results: In Cohort A, there was a higher incidence of proximal lesions in the arrest group (55% vs. 41%, p < 0.05). There was an almost equivalent incidence of both LAD and non-LAD (RCA/Cx) infarcts presenting with cardiac arrest. In the non-LAD arrest patients, sinoatrial nodal artery (SANa) involvement was seen in 77%, compared with 33% in non-arrest patients (p < 0.005). In Cohort B, involvement of the SANa or conus artery (CA) was found in 74% of arrest versus 21% of non-arrest patients (p < 0.005). Cohort A patients were followed up for 3.8 to 8.7 years, and at the end of this period, 22% of arrest patients and 16% of non-arrest patients were deceased. Mortality <30 days was highest in the arrest group (43% vs. 7%, p < 0.05). Beyond 30 days, there were no differences in all-cause mortality between arrest and non-arrest patients. There were more cardiac causes of death in the arrest group (54% vs. 20%, p < 0.05). Conclusions: VT/VF arrest due to acute coronary occlusion was more common in those with proximal disease and there was an increased incidence of SANa and/or CA involvement in non-LAD infarcts. Short-term mortality was higher in patients with cardiac arrest post-AMI, but beyond 30 days there was no significant difference. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
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7 pages, 471 KiB  
Brief Report
Comparative Diagnostic Efficacy of HeartLogic and TriageHF Algorithms in Remote Monitoring of Heart Failure: A Cohort Study
by David Ledesma Oloriz, Daniel García Iglesias, Rodrigo Ariel di Massa Pezzutti, Fernando López Iglesias and José Manuel Rubín López
J. Cardiovasc. Dev. Dis. 2025, 12(6), 209; https://doi.org/10.3390/jcdd12060209 - 31 May 2025
Viewed by 691
Abstract
Introduction: Implantable defibrillator devices (ICDs) can be used for remote monitoring of different variables, including some related to Heart Failure (HF). Two different algorithms (TriageHF and HeartLogic) arise by combining some of these variables to generate an estimation of HF decompensation risk in [...] Read more.
Introduction: Implantable defibrillator devices (ICDs) can be used for remote monitoring of different variables, including some related to Heart Failure (HF). Two different algorithms (TriageHF and HeartLogic) arise by combining some of these variables to generate an estimation of HF decompensation risk in the following days. Until now, no other trial has evaluated both algorithms in a head-to-head comparison. The primary objective is to compare diagnostic accuracy of both algorithms in a similar cohort of patients. Material and Methods: Descriptive monocentric cohort study of a series of 64 patients who have been implanted with a Medtronic or Boston Scientific ICD with the TriageHF or Heart Logic algorithm available during the period between January 2020 and June 2022, with a total of 27 patients in the HeartLogic group and 37 patients in the TriageHF group. Results: During the period of the study there were a total of 1142 alarms analyzed. There were no differences in the basal characteristics of both groups. We reported a risk alarm–patient ratio of 1.31 ± 1.89 in the HeartLogic group and of 3.32 ± 3.08 in the TriageHF group (p < 0.01). In the TriageHF group, we reported a lower specificity with (0.76), with higher sensitivity (0.97) and PPV (0.18), and similar NPV (1). Survival analysis shows no statistical differences between both algorithms in the 30 days following the alert. Conclusions: TriageHF algorithm had higher sensibility and PPV, leading to a higher number of alerts/patients, while HeartLogic algorithm had a better specificity. These differences should be considered to optimize patient follow-ups in home monitoring. Full article
(This article belongs to the Special Issue Artificial Intelligence in Cardiac Electrophysiology)
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18 pages, 730 KiB  
Article
Higher Physical Activity Is Associated with Improved Ventricular–Arterial Coupling: Assessment Using the cfPWV/GLS Ratio in Primary Care—A Pilot Study
by Paula-Anca Sulea, Ioan Tilea, Florin Stoica, Liviu Cristescu, Diana-Andreea Moldovan, Radu Tatar, Raluca-Maria Tilinca, Razvan Gheorghita Mares and Andreea Varga
J. Cardiovasc. Dev. Dis. 2025, 12(6), 208; https://doi.org/10.3390/jcdd12060208 - 30 May 2025
Viewed by 451
Abstract
Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular–arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid–femoral pulse wave velocity to global longitudinal [...] Read more.
Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular–arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid–femoral pulse wave velocity to global longitudinal strain (cfPWV/GLS) ratio, in a Romanian primary care cohort. Methods: The prospective cohort analysis was performed on 81 adults (49 females, mean age 50.27 ± 12.93 years). Physical activity was quantified through anamnesis using metabolic equivalents (METs) according with Compendium of Physical Activities, and patients were stratified into four groups: G1 (METs < 1.5, n = 39), G2 (METs = 1.5–2.9, n = 2), G3 (METs = 3–5.9, n = 23), and G4 (METs ≥ 6, n = 17). Demographic and echocardiographic data were recorded to explore associations between physical activity and VAC. Results: The cfPWV/GLS ratio differed significantly across groups (p = 0.012), with the lowest values present in the moderate-intensity group (G3). VAC ≥ 0.391 can predict sedentary lifestyles (AUC = 0.730; CI: 0.617–0.833, p > 0.001). Multivariate analysis revealed that age, arterial age, and hypertension independently predict VAC. Conclusions: Higher physical activity is inversely associated with VAC (cfPWV/GLS ratio) and can predict sedentary lifestyles. Encouraging moderate-to-vigorous exercise in primary care may improve cardiovascular function and aid prevention. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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26 pages, 975 KiB  
Review
Doxorubicin-Induced Cardiotoxicity: A Comprehensive Update
by Vasvi Bhutani, Fahimeh Varzideh, Scott Wilson, Urna Kansakar, Stanislovas S. Jankauskas and Gaetano Santulli
J. Cardiovasc. Dev. Dis. 2025, 12(6), 207; https://doi.org/10.3390/jcdd12060207 - 30 May 2025
Cited by 1 | Viewed by 1560 | Correction
Abstract
Doxorubicin is an anthracycline chemotherapeutic that is widely used for treating various malignancies, including breast cancer, lymphomas, and sarcomas. Despite its efficacy, its clinical utility is limited by a well-documented risk of cardiotoxicity, which may manifest acutely or chronically. Doxorubicin works by intercalating [...] Read more.
Doxorubicin is an anthracycline chemotherapeutic that is widely used for treating various malignancies, including breast cancer, lymphomas, and sarcomas. Despite its efficacy, its clinical utility is limited by a well-documented risk of cardiotoxicity, which may manifest acutely or chronically. Doxorubicin works by intercalating DNA and inhibiting topoisomerase II, leading to DNA damage and cell death. However, this mechanism is not selective to cancer cells and can adversely affect cardiac myocytes. The introduction of doxorubicin into oncologic practice has revolutionized cancer treatment, but its cardiotoxic effects remain a significant concern. This systematic review aims to comprehensively examine the multifaceted impact of doxorubicin on cardiac structure and function through both preclinical and clinical lenses. Full article
(This article belongs to the Special Issue 10th Anniversary of JCDD—Basic and Translational Cardiovascular Research)
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25 pages, 843 KiB  
Review
Considerations on the Development of Therapeutics in Vascular Calcification
by Ana M. Valentin Cabrera, Sophie K. Ashbrook and Joshua D. Hutcheson
J. Cardiovasc. Dev. Dis. 2025, 12(6), 206; https://doi.org/10.3390/jcdd12060206 - 29 May 2025
Viewed by 888
Abstract
Cardiovascular disease is the leading cause of death worldwide. Vascular calcification, the deposition of calcium phosphate mineral in the arterial wall, is the most significant predictor of morbidity and mortality. Vascular calcification can present as either medial or intimal calcification. Medial calcification is [...] Read more.
Cardiovascular disease is the leading cause of death worldwide. Vascular calcification, the deposition of calcium phosphate mineral in the arterial wall, is the most significant predictor of morbidity and mortality. Vascular calcification can present as either medial or intimal calcification. Medial calcification is most prevalent among patients with chronic kidney disease. Intimal calcification is associated with atherosclerosis and chronic inflammation. In both cases, vascular smooth muscle cells undergo osteogenic differentiation, leading to mineral deposition and associated wall stiffening; however, the effects on cardiovascular function and morbidity vary depending on mineral morphology and location. This review investigates vascular calcification, the mechanisms leading to calcium deposition, and what to consider when developing therapeutics for vascular calcification. Full article
(This article belongs to the Section Basic and Translational Cardiovascular Research)
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