Journal of Cardiovascular Development and Disease

19 pages, 13754 KB

Open AccessReview

Surgical and Transcatheter Tricuspid Valve Interventions: An Electrophysiology-Focused Review

by Kevin S. Tang, Mark W. Abdelnour, Robert M. Tungate, Christina Mansour, Fabio Sagebin, Antonio H. Frangieh and David M. Donaldson

J. Cardiovasc. Dev. Dis. 2026, 13(4), 172; https://doi.org/10.3390/jcdd13040172 - 19 Apr 2026

Viewed by 389

Abstract

Increasing recognition of the clinical impact of isolated tricuspid regurgitation has led to rapid expansion of surgical and transcatheter tricuspid valve interventions. Given the close anatomic relationship between the tricuspid valve and the atrioventricular conduction system, both surgical and transcatheter approaches carry a [...] Read more.

Increasing recognition of the clinical impact of isolated tricuspid regurgitation has led to rapid expansion of surgical and transcatheter tricuspid valve interventions. Given the close anatomic relationship between the tricuspid valve and the atrioventricular conduction system, both surgical and transcatheter approaches carry a significant risk of new conduction disturbances and permanent pacemaker implantation. A three-dimensional understanding of the atrioventricular conduction axis is essential to anticipate and mitigate these complications. This review provides a comprehensive overview of conduction system anatomy and physiology in the context of tricuspid valve interventions, highlighting the mechanisms underlying procedure-related conduction abnormalities. We also discuss contemporary management strategies, including approaches to pre-existing transvalvular leads, valve-sparing pacing alternatives, and the evolving role of electrophysiologists within the multidisciplinary heart team. Full article

(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)

► Show Figures

Graphical abstract

17 pages, 2078 KB

Open AccessArticle

A Pathophysiology-Oriented Imaging Phenotype Framework for Nonobstructive Coronary Artery Disease

by Hongqun Du, Wenyue Chen, Hao Tian, Hong Huang, Yong Wu, Jun Liu and Hongyan Qiao

J. Cardiovasc. Dev. Dis. 2026, 13(4), 171; https://doi.org/10.3390/jcdd13040171 - 18 Apr 2026

Viewed by 216

Abstract

Nonobstructive coronary artery disease (NOCAD) is increasingly recognized as a heterogeneous condition characterized by diverse pathophysiological mechanisms despite the absence of flow-limiting stenosis. We sought to establish a rule-based dominant imaging phenotype framework integrating functional, structural, and inflammatory dimensions derived from multiparametric coronary [...] Read more.

Nonobstructive coronary artery disease (NOCAD) is increasingly recognized as a heterogeneous condition characterized by diverse pathophysiological mechanisms despite the absence of flow-limiting stenosis. We sought to establish a rule-based dominant imaging phenotype framework integrating functional, structural, and inflammatory dimensions derived from multiparametric coronary computed tomography angiography (CCTA). In this retrospective cohort of 485 patients with NOCAD, CT-derived fractional flow reserve (CT-FFR), quantitative plaque burden and high-risk plaque features, and perivascular fat attenuation index (FAI) were assessed. Using predefined percentile thresholds and hierarchical rules, patients were categorized into function-, structure-, inflammation-dominant, or low-risk phenotypes. During a median follow-up of 36 months, 56 patients (11.5%) experienced major adverse cardiovascular events (MACE). After multivariable adjustment, function dominance was associated with the highest risk (hazard ratio [HR] 4.054, 95% confidence interval [CI] 1.984–8.281; p < 0.001), followed by structure dominance (HR 3.129, 95% CI 1.410–6.944; p = 0.005), whereas isolated inflammation dominance did not show a statistically significant independent association with events, with wide confidence intervals indicating limited precision. These findings suggest a graded pattern of prognostic associations across functional and structural abnormalities in NOCAD and support a phenotype-oriented interpretation of CCTA metrics reflecting distinct biological axes of coronary pathology. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

► Show Figures

Figure 1

11 pages, 899 KB

Open AccessArticle

Pediatric Out-of-Hospital Cardiac Arrest in a Physician-Staffed EMS System: A 13-Year Retrospective Descriptive Study from Southern Italy

by Luca Gregorio Giaccari, Gaetano Tammaro, Nicola D’Angelo, Daniele Antonaci, Eva Epifani, Luciana Mascia, Maria Caterina Pace, Vincenzo Pota and Pasquale Sansone

J. Cardiovasc. Dev. Dis. 2026, 13(4), 170; https://doi.org/10.3390/jcdd13040170 - 16 Apr 2026

Viewed by 406

Abstract

Background: Pediatric out-of-hospital cardiac arrest (OHCA) is rare and associated with poor outcomes. Evidence from physician-staffed EMS systems remains limited. This study aimed to describe the incidence, presenting rhythms, EMS response intervals, and outcomes of pediatric OHCA, and to describe incidence, presenting rhythms, [...] Read more.

Background: Pediatric out-of-hospital cardiac arrest (OHCA) is rare and associated with poor outcomes. Evidence from physician-staffed EMS systems remains limited. This study aimed to describe the incidence, presenting rhythms, EMS response intervals, and outcomes of pediatric OHCA, and to describe incidence, presenting rhythms, EMS response intervals, and prehospital outcomes in a local physician-staffed EMS system. Methods: We conducted a retrospective study of all pediatric (0–17 years) OHCA cases managed by the ASL Lecce physician-staffed EMS (southern Italy) between 2013 and 2025. Data were abstracted from standardized records. Variables included demographics, initial rhythm, EMS response intervals, temporal patterns, and return of spontaneous circulation (ROSC). The primary outcome was ROSC during prehospital care. Results: Twenty-seven cases were identified, corresponding to a cumulative incidence of 22.9 per 100,000 children over the study period (annualized incidence 1.73 per 100,000 children-year). Mean age was 11.9 ± 5.5 years (median 15); 59% were male. Initial rhythms were asystole in 81% and ventricular fibrillation (VF) in 19%; no pulseless ventricular tachycardia (pVT) or pulseless electrical activity (PEA) were recorded. Five patients had shockable rhythms, with seven shocks delivered overall. Mean time intervals were: event-to-call 1.0 ± 0.6 min, call-to-arrival 10.3 ± 4.1 min, event-to-arrival 11.3 ± 4.4 min. Arrests clustered during daytime (63%) and summer (41%). ROSC occurred in three patients (11%), two with VF and one with asystole; all arrests with ROSC were daytime events. In descriptive comparisons, ROSC cases showed a shorter call-to-arrival interval (T1–T2), whereas no consistent pattern was observed across all prehospital time intervals. Conclusions: Pediatric OHCA in this Italian physician-staffed EMS was infrequent, usually presented with asystole, and rarely achieved ROSC. Shockable rhythms were associated with better outcomes. Given the small sample size, findings related to response times should be interpreted with caution. System preparedness should include pediatric-specific training, early defibrillation access, and multicenter registries to improve care and track outcomes. Full article

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

► Show Figures

Figure 1

17 pages, 1724 KB

Open AccessArticle

Prognostic Significance of New-Onset Atrial Fibrillation Burden in Acute Myocardial Infarction Patients: A Comparison Based on Left Ventricular Ejection Fraction

by Yuan Fang, Xingxu Zhang, Yiwei Zhang, Yiqian Yuan, Xiaoming Qin, Baoxin Liu, Jiachen Luo and Yidong Wei

J. Cardiovasc. Dev. Dis. 2026, 13(4), 169; https://doi.org/10.3390/jcdd13040169 - 15 Apr 2026

Viewed by 377

Abstract

Acute myocardial infarction (AMI) with reduced or preserved left ventricular ejection fraction (LVEF) is associated with distinct prognoses and differing risk factor profiles. However, the use of new-onset atrial fibrillation (NOAF) burden in risk stratification of AMI patients, particularly across LVEF subgroups, remains [...] Read more.

Acute myocardial infarction (AMI) with reduced or preserved left ventricular ejection fraction (LVEF) is associated with distinct prognoses and differing risk factor profiles. However, the use of new-onset atrial fibrillation (NOAF) burden in risk stratification of AMI patients, particularly across LVEF subgroups, remains unclear. We analyzed consecutive AMI patients without prior AF who developed their first in-hospital AF episode between 2014 and 2022. The patients were stratified by LVEF (AMIrEF: <40%; AMIpEF: ≥40%) and AF burden (>10.87% vs. ≤10.87%). The primary endpoint was a major adverse cardiovascular event (MACE), including cardiovascular death and heart failure hospitalization. Among 644 patients with LVEF data, 178 (27.6%) were AMIrEF and 466 (72.4%) were AMIpEF; 248 (38.5%) had a high AF burden. Over a median follow-up time of 4.2 years, the MACE incidence was 18.9 and 23.0 per 100 person-years in low- and high-burden AMIrEF patients, and 7.2 and 17.5 in AMIpEF patients, respectively. After multivariable adjustment, a high NOAF burden was significantly associated with increased MACE in AMIpEF patients [hazard ratio (HR): 2.63, 95% confidence interval (CI): 1.82–3.79], but not in AMIrEF patients [HR: 1.29, 95% CI: 0.79–2.10]. Propensity-matched analysis yielded concordant results [AMIrEF: 1.15 (0.69–1.90); AMIpEF: 2.45 (1.75–3.45)]. In conclusion, a high NOAF burden is strongly associated with adverse long-term cardiovascular outcomes in AMIpEF patients, highlighting its potential utility for risk stratification in this population. Full article

(This article belongs to the Special Issue Further Understanding of Myocardial Infarction: Risk Factors, Treatment, and Clinical Outcomes)

► Show Figures

Graphical abstract

13 pages, 3553 KB

Open AccessArticle

New Perspectives Provided by Merging Computed Tomographic Scanning and Electroanatomical Mapping of Koch’s Pyramid

by Claudio Pandozi, Andrea Matteucci, Robert H. Anderson, Marco Galeazzi, Maurizio Russo, Gianmaria De Filippis, Massimiliano Danti, Marco Valerio Mariani, Carlo Lavalle, Andrea Bassi, Maurizio Malacrida, Mauro Bura and Furio Colivicchi

J. Cardiovasc. Dev. Dis. 2026, 13(4), 168; https://doi.org/10.3390/jcdd13040168 - 14 Apr 2026

Viewed by 291

Abstract

Background: Atrioventricular (AV) nodal re-entrant tachycardia (AVNRT) is strongly related to the anatomy and physiology of the AV nodal and junctional area. Objectives: This study aims to precisely ascertain the localization of structures within Koch’s triangle by employing the recording of nodal potentials [...] Read more.

Background: Atrioventricular (AV) nodal re-entrant tachycardia (AVNRT) is strongly related to the anatomy and physiology of the AV nodal and junctional area. Objectives: This study aims to precisely ascertain the localization of structures within Koch’s triangle by employing the recording of nodal potentials in conjunction with the integration of three-dimensional electrical maps merged with computed tomographic images. Methods: Five consecutive patients with typical AVNRT and an available cardiac computed tomographic scan were enrolled. High-resolution mapping was performed prior to the initial ablation attempt. Results: The low-frequency, low-amplitude humped nodal potential was consistently detected within the presumed compact node location, found in the superior septal area in three patients and in the mid-paraseptal region in two cases. The length of the region was 4.5 ± 1.2 mm, with its width measured at 2.7 ± 0.6 mm (distance from the atrioventricular membranous septum = 3 ± 0.8 mm). The nodal potential was consistently recorded alongside the slow pathway potential in the infero-septal region, anterior to the orifice of the coronary sinus (distance from the slow pathway potential to the site of His potential = 15 ± 3.2 mm). This suggests that the slow pathway electrogram likely represented the medial or distal portion of the inferior nodal extension, rather than the node itself. In all patients, successful ablation was achieved, requiring a median of 5 [4–6] radiofrequency deliveries. No procedural complications were encountered. Conclusions: This study, which integrates three-dimensional electroanatomical maps with reconstructed computed tomographic datasets and utilizes specific anatomical landmarks, provides a reliable and accurate estimation of the atrioventricular conduction axis components in relation to the Koch’s pyramid boundaries. Full article

(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)

► Show Figures

Figure 1

12 pages, 3025 KB

Open AccessArticle

The Frontal QRS-T Angle Remains Unchanged in Patients Without Structural Heart Disease Receiving Flecainide Therapy

by Mehmet Kucukosmanoglu, Mustafa Lutfullah Ardıc, Fadime Koca, Hilmi Erdem Sumbul and Mevlut Koc

J. Cardiovasc. Dev. Dis. 2026, 13(4), 167; https://doi.org/10.3390/jcdd13040167 - 14 Apr 2026

Viewed by 351

Abstract

Introduction: Prolongation of the QT interval and QRS duration, which are markers of ventricular repolarization and depolarization, has been reported in patients receiving flecainide therapy. However, the effects of flecainide on the QRS–T angle—a recognized indicator of transmural dispersion of repolarization—remain unclear. The [...] Read more.

Introduction: Prolongation of the QT interval and QRS duration, which are markers of ventricular repolarization and depolarization, has been reported in patients receiving flecainide therapy. However, the effects of flecainide on the QRS–T angle—a recognized indicator of transmural dispersion of repolarization—remain unclear. The aim of our study was to investigate the impact of flecainide therapy on the QRS–T angle. Method: In this study, 200 patients who were prescribed flecainide therapy due to atrial or ventricular arrhythmias were included. Prior to the initiation of flecainide treatment, all patients underwent a 12-lead electrocardiogram (ECG) in which heart rate (HR), PR and QRS durations, QT, QTc, JT, Tp–Te intervals and the frontal plane QRS–T angle were measured. At the 1-month follow-up, patients underwent repeat ECG recording and were evaluated for both cardiac and non-cardiac side effects of flecainide. The same ECG parameters were measured again using the follow-up recordings. Changes in ECG parameters between the baseline and 1-month post-treatment were analyzed. Results: Following flecainide administration, the drug was discontinued in 18 patients (9%) due to adverse effects (11 cases of cardiac and seven cases of non-cardiac). HR significantly decreased (78 ± 22 bpm to 74 ± 15 bpm and p < 0.05). PR interval and QRS duration significantly increased (148 ± 23 ms to 156 ± 9 ms and 89 ± 17 ms to 99 ± 19 ms, respectively p < 0.05 for each). Additionally, JT interval (326 ± 27 ms vs. 334 ± 6 ms), QT interval (416 ± 24 ms vs. 434 ± 24 ms), QTc interval (431 ± 24 vs. 447 ± 25 ms) and Tp–Te interval (84 ± 17 vs. 87 ± 18 ms) all showed statistically significant increases after flecainide treatment (p < 0.05 for-each). However, no significant change was observed in the frontal QRS–T angle. Discussion: In patients receiving flecainide therapy for atrial and ventricular arrhythmias, prolongation was observed in atrioventricular conduction, ventricular depolarization and repolarization parameters as measured by ECG. However, no significant change was detected in the frontal QRS–T angle. Full article

(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)

► Show Figures

Figure 1

11 pages, 1537 KB

Open AccessArticle

A Novel Minimally Invasive Porcine Model of Functional Tricuspid Regurgitation

by Claudia González-Cucharero, Ignacio Hernández, Javier Díez-Mata, Rafael Ramírez-Carracedo, Marta Saura, Claudia Baéz-Díaz, Fátima Vázquez-López, Francisco M. Sánchez-Margallo, Jose L. Zamorano, Verónica Crisóstomo and Carlos Zaragoza

J. Cardiovasc. Dev. Dis. 2026, 13(4), 166; https://doi.org/10.3390/jcdd13040166 - 14 Apr 2026

Viewed by 419

Abstract

Tricuspid regurgitation (TR) is a prevalent cardiovascular disorder with significant clinical impact. TR is frequently silent and underdiagnosed and is estimated to impact over 70 million people globally. Characterized by retrograde blood flow from the right ventricle into the right atrium due to [...] Read more.

Tricuspid regurgitation (TR) is a prevalent cardiovascular disorder with significant clinical impact. TR is frequently silent and underdiagnosed and is estimated to impact over 70 million people globally. Characterized by retrograde blood flow from the right ventricle into the right atrium due to incomplete valve closure, TR leads to right heart dilation, systemic congestion, and eventually right-sided heart failure. Importantly, TR may contribute to the onset of atrial fibrillation (AF), the most common sustained arrhythmia, affecting approximately 59 million individuals worldwide. Despite its growing clinical importance, the pathophysiology of TR remains incompletely understood, and current animal models of TR, based on direct valve manipulation, limit translational applicability. We present a novel, minimally invasive porcine model of TR established via femoral/jugular vein catheterization with deployment of an inferior vena cava (IVC) filter. The filter partially impedes tricuspid valve closure, inducing TR without valvular injury. Validation was achieved through multimodal imaging, including fluoroscopy, echocardiography, and electrocardiography, confirming hallmark features of TR, including right atrial and ventricular enlargement and arrhythmic activity. This model provides a reproducible, minimally invasive platform for studying selected features of TR progression. Its minimally invasive nature and preservation of native valvular structure make it a useful preclinical platform for mechanistic and translational research. Full article

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

► Show Figures

Graphical abstract

16 pages, 1222 KB

Open AccessArticle

A Novel Integrated Perioperative Cardiovascular Risk Score (PERFORM-CV) in Non-Cardiac Surgical Patients

by Andreea Boghean, Cristian Gutu, Laura Florentina Rebegea and Dorel Firescu

J. Cardiovasc. Dev. Dis. 2026, 13(4), 165; https://doi.org/10.3390/jcdd13040165 - 10 Apr 2026

Viewed by 1746

Abstract

Background: Perioperative cardiovascular risk assessment remains challenging in non-cardiac surgery, particularly in older patients and those with multiple comorbidities. Traditional models rely largely on clinical history and may not fully reflect current cardiovascular functional status. This study aimed to derive and assess the [...] Read more.

Background: Perioperative cardiovascular risk assessment remains challenging in non-cardiac surgery, particularly in older patients and those with multiple comorbidities. Traditional models rely largely on clinical history and may not fully reflect current cardiovascular functional status. This study aimed to derive and assess the apparent performance of a new composite score, PERFORM-CV, integrating clinical, laboratory, and echocardiographic data. Methods: We conducted a prospective two-center cohort study including 503 non-cardiac surgical patients with cardiovascular comorbidity. The Revised Cardiac Risk Index (Lee/RCRI) and the AUB-HAS2 index were calculated according to their original published definitions as raw point totals ranging from 0 to 6; without additional normalization. The PERFORM-CV score was derived from univariable and multivariable analyses, with continuous predictors dichotomized using ROC-derived thresholds. Results: Emergency admission, chronic heart failure, and elevated serum creatinine remained independently associated with in-hospital mortality. Lower left ventricular ejection fraction, lower mitral annular plane systolic excursion (MAPSE), lower hemoglobin, and atrial fibrillation also contributed to the final composite score. ROC analysis showed good discrimination for PERFORM-CV (AUC 0.852; 95% CI 0.806–0.897; p < 0.001), comparable to Lee/RCRI (AUC 0.860; 95% CI 0.818–0.901; p < 0.001) and higher than AUB-HAS2 (AUC 0.779; 95% CI 0.731–0.826; p < 0.001). Conclusions: PERFORM-CV showed good apparent discrimination in the derivation cohort and may complement established bedside risk tools by incorporating echocardiographic and laboratory data. The ROC-derived thresholds should be interpreted as data-driven derivation cut-offs; resampling-based internal validation and external validation are required before broader clinical use. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

► Show Figures

Figure 1

13 pages, 265 KB

Open AccessArticle

Preoperative Systemic Immune–Inflammation Index as an Independent Predictor of Postoperative Wound Infection in Diabetic CABG Patients

by Hakan Öntaş and Asiye Aslı Gözüaçık Rüzgar

J. Cardiovasc. Dev. Dis. 2026, 13(4), 164; https://doi.org/10.3390/jcdd13040164 - 10 Apr 2026

Viewed by 402

Abstract

Background: This study evaluated the independent predictive value of preoperative Systemic Immune–Inflammation Index (SII) for postoperative wound infection (WI) in diabetic patients undergoing isolated Coronary Artery Bypass Grafting (CABG). Methods: A retrospective cohort of 300 diabetic patients (2024–2025) was analyzed. The primary outcome [...] Read more.

Background: This study evaluated the independent predictive value of preoperative Systemic Immune–Inflammation Index (SII) for postoperative wound infection (WI) in diabetic patients undergoing isolated Coronary Artery Bypass Grafting (CABG). Methods: A retrospective cohort of 300 diabetic patients (2024–2025) was analyzed. The primary outcome was 30-day postoperative WI. Preoperative SII was calculated from blood counts within 24 h before surgery. Multivariable logistic regression was performed using both a primary model (adjusting for age, BMI, and comorbidities) and an extended model including glycemic control (HbA1c), smoking status, operative duration, and transfusion requirements. Model discrimination was evaluated via Area Under the ROC Curve (AUC). Statistical power and sensitivity analyses were conducted to ensure the robustness of the findings. Results: WI occurred in 7% (n = 21). Preoperative SII was significantly lower in the WI group (958.48 ± 493.49 vs. 1293.56 ± 758.15, p = 0.047). SII remained an independent predictor in the adjusted model (Adjusted OR per 100-unit increase: 0.93; 95% CI: 0.86–1.00; p = 0.048). ROC analysis confirmed an inverse predictive pattern (AUC: 0.374, 95% CI: 0.312–0.436). Comparative analysis showed that SII provided superior additional insight compared to NLR and PLR in this population. Conclusions: Preoperative SII is an independent predictor for WI in diabetic CABG patients. However, given the modest discriminative performance (AUC: 0.374), it should be integrated into a broader clinical risk assessment. Contrary to conventional expectations, lower SII values indicated increased susceptibility, suggesting that immune exhaustion rather than hyperinflammation may drive infectious risk in diabetic patients. Full article

(This article belongs to the Section Cardiac Surgery)

11 pages, 908 KB

Open AccessArticle

Valvulo-Arterial Impedance in Patients with Severe Aortic Stenosis and Bicuspid Aortic Valve

by Chun Kit Ng, Pilar Lopez Santi, Marie-Ange Fleury, Jingjing He, Nadeem Elmasry, Steele C. Butcher, Marie-Annick Clavel, Philippe Pibarot, Jeroen J. Bax and Nina Ajmone Marsan

J. Cardiovasc. Dev. Dis. 2026, 13(4), 163; https://doi.org/10.3390/jcdd13040163 - 9 Apr 2026

Viewed by 385

Abstract

Background: Risk stratification in patients with bicuspid aortic valve (BAV) and severe aortic stenosis (AS) remains challenging. Valvulo-arterial impedance (Zva), an integrated marker of global left ventricular (LV) afterload, has shown prognostic value in tricuspid AS; however, data in BAV are limited. This [...] Read more.

Background: Risk stratification in patients with bicuspid aortic valve (BAV) and severe aortic stenosis (AS) remains challenging. Valvulo-arterial impedance (Zva), an integrated marker of global left ventricular (LV) afterload, has shown prognostic value in tricuspid AS; however, data in BAV are limited. This study aimed to evaluate the association of Zva with LV remodeling, symptoms, and all-cause death in patients with BAV and severe AS. Methods: In this retrospective, two-center cohort study, 147 patients with severe AS and BAV were included. Zva was calculated at the time of the first echocardiographic diagnosis of severe AS. The study endpoint was all-cause mortality. Results: Over a median follow-up of 9.8 years, 24 patients (16%) died. A Zva threshold of 5 mmHg/mL/m² was identified as optimal by ROC analysis. Patients with Zva ≥ 5 mmHg/mL/m² showed higher mortality rates (29% vs. 10%; p = 0.003), more advanced symptoms (NYHA III-IV: 41% vs. 9%; p < 0.001), adverse LV remodeling, lower LVEF (60% (IQR 36–66) vs. 66% (IQR 61–71); p = 0.001), and worse LV global longitudinal strain (14.8% ± 2.7 vs. 16.5% ± 3.0; p = 0.016). Zva ≥ 5 mmHg/mL/m² was independently associated with worse long-term survival after adjustment (HR 2.885; 95% CI 1.119–7.438; p = 0.028). Conclusions: Among patients with BAV and severe AS, an increased Zva was associated with more advanced symptoms, adverse LV remodeling, impaired LV systolic function, and worse long-term survival, and might therefore help in risk stratification of these patients. Full article

(This article belongs to the Special Issue The Role of Echocardiography in Cardiovascular Diseases)

► Show Figures

Graphical abstract

12 pages, 4770 KB

Open AccessCase Report

A Diagnostic Dilemma of Arrhythmogenic Cardiomyopathy Masquerading as Recurrent Myocarditis in a Pediatric Patient with a DES Gene Variant: A Case Report

by Qi Meng, Wei Li, Wenhong Ding, Hui Wang, Dong Chen, Ling Han, Yifei Li and Chencheng Dai

J. Cardiovasc. Dev. Dis. 2026, 13(4), 162; https://doi.org/10.3390/jcdd13040162 - 8 Apr 2026

Viewed by 372

Abstract

Background: Arrhythmogenic cardiomyopathy (ACM) is an inherited disorder characterized by fibrofatty replacement of cardiomyocytes. The inflammatory episodes of ACM, known as the “hot phase”, can mimic acute myocarditis. It was seldom observed in a DES-associated ACM as a “hot-phase” presentation. Case Presentation: [...] Read more.

Background: Arrhythmogenic cardiomyopathy (ACM) is an inherited disorder characterized by fibrofatty replacement of cardiomyocytes. The inflammatory episodes of ACM, known as the “hot phase”, can mimic acute myocarditis. It was seldom observed in a DES-associated ACM as a “hot-phase” presentation. Case Presentation: The proband, a 13-year-old female, initially presented with a series of clinical manifestations of fulminant myocarditis. Although recommendation-guided anti-immunotherapy had been provided, this patient still developed into an aggressive cardiomyopathy with biventricular dilation and severe systolic heart failure. Additionally, cardiac magnetic resonance demonstrated circumferential late gadolinium enhancement in left ventricular myocardium with diffuse fibrosis. Whole-exon sequencing identified a de novo missense variant, as c.335T>A (p.L112Q) of the DES gene, resulting in protein dysfunction. And a diagnosis of ACM due to a DES variant had been identified. Finally, this patient received heart transplantation, and biventricular fibrofatty infiltration was confirmed by pathological analysis. Conclusions: This case presented a de novo genetic variant that can induce severe and aggressive heart failure. This finding emphasizes the importance of comprehensive genetic analysis in patients suspected of having fulminant myocarditis, which would greatly benefit the precise clinical management and outcomes. Full article

(This article belongs to the Topic Molecular and Cellular Mechanisms of Heart Disease)

► Show Figures

Figure 1

10 pages, 229 KB

Open AccessArticle

Standardized Beating-Heart Aortic Arch Reconstruction with Simultaneous Cerebral and Coronary Perfusion in Neonates and Infants: A Single-Center Cardiovascular Cohort Study

by Shiraslan Bakhshaliyev and Ergin Arslanoglu

J. Cardiovasc. Dev. Dis. 2026, 13(4), 161; https://doi.org/10.3390/jcdd13040161 - 7 Apr 2026

Viewed by 314

Abstract

Background: Neonatal and infant aortic arch reconstruction remains a high-risk cardiovascular procedure requiring effective cerebral and myocardial protection. Variability in perfusion strategies may influence early hemodynamic stability and postoperative recovery. This study aimed to evaluate the early and short-term cardiovascular outcomes of a [...] Read more.

Background: Neonatal and infant aortic arch reconstruction remains a high-risk cardiovascular procedure requiring effective cerebral and myocardial protection. Variability in perfusion strategies may influence early hemodynamic stability and postoperative recovery. This study aimed to evaluate the early and short-term cardiovascular outcomes of a standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous antegrade selective cerebral and continuous coronary perfusion. Methods: In this retrospective single-center cohort study, 31 consecutive neonates and infants undergoing aortic arch reconstruction between November 2022 and December 2025 were analyzed. A standardized surgical protocol was applied, consisting of extensive ductal tissue resection, interdigitating posterior end-to-end anastomosis, anterior autologous pericardial patch augmentation, and moderate hypothermic antegrade selective cerebral perfusion combined with continuous coronary perfusion via innominate artery cannulation. Early postoperative outcomes and short-term echocardiographic follow-up results were assessed. Results: The cohort included 31 patients, 22.6% of whom had complex associated cardiac anomalies requiring concomitant procedures. Median cardiopulmonary bypass and aortic cross-clamp times were 119 and 64 min, respectively. There was no in-hospital mortality. Major complications were infrequent, and median intensive care unit stay was 5 days. During a median follow-up of 6.8 months, one patient (3.2%) developed recoarctation requiring reintervention. No late mortality was observed. Conclusions: A fully standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous cerebral and coronary perfusion demonstrated favorable early cardiovascular and short-term outcomes, even in anatomically complex cases. Preservation of continuous coronary perfusion may be associated with improved myocardial stability and early postoperative recovery; however, these findings should be interpreted as observational and hypothesis-generating given the absence of a control group. Larger multicenter studies with longer follow-up are warranted to confirm these findings. Full article

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

17 pages, 1694 KB

Open AccessArticle

Effect of SGLT2 Inhibitors on the Efficacy of First-Time Pulmonary Vein Isolation and Clinical Course of Patients with Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation

by Magdalena Balwierz-Podgórna, Bartosz Gruchlik, Katarzyna Mizia-Stec, Adriana Filak, Anna Hejmej, Piotr Paździora, Mikołaj Gołda, Aleksandra Spirkowicz, Karina Dzięcioł and Maciej Wybraniec

J. Cardiovasc. Dev. Dis. 2026, 13(4), 160; https://doi.org/10.3390/jcdd13040160 - 6 Apr 2026

Viewed by 429

Abstract

Background/Objectives: SGLT2 inhibitors (SGLT2i) became a cornerstone of heart failure with preserved ejection fraction (HFpEF) pharmacotherapy in the recent years However, their actual influence on pulmonary veins isolation (PVI) efficacy in this population remains unclear. The aim of the study was to [...] Read more.

Background/Objectives: SGLT2 inhibitors (SGLT2i) became a cornerstone of heart failure with preserved ejection fraction (HFpEF) pharmacotherapy in the recent years However, their actual influence on pulmonary veins isolation (PVI) efficacy in this population remains unclear. The aim of the study was to evaluate an impact of SGLT2i on one-year first-time PVI efficacy and clinical course of patients with HFpEF and atrial fibrillation (AF). Methods: This is a single-center retrospective study including 105 HFpEF and AF individuals, who underwent the first-time PVI (51 (48.6%) males; mean age at PVI: 65.2 ± 9.5 years). 53 patients treated with SGLT2i (hospitalized for PVI since 2023) and 52 patients without such a treatment (2020-mid-2023) were assessed according to the clinical presentation and hard endpoints. The primary endpoint was arrhythmia recurrence rate. The secondary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCE). Results: SGLT2i therapy was associated with greater symptom reduction after PVI (90.6% vs. 62.7%; p < 0.001). There was a statistical trend toward reduced all-cause mortality in SGLT2i (0% vs. 5.8%; p = 0.076). Although overall AF recurrence rates were similar between subgroups, Kaplan–Meier analysis showed a non-significant trend toward lower recurrence in the SGLT2i group (p = 0.096). The analysis did not reveal significant differences in terms of cardiovascular hospitalizations, stroke/transient ischemic attack (TIA) and MACCE incidence between the subgroups. Non-vitamin K antagonist oral anticoagulants (NOACs) administration was associated with a lower risk of AF recurrence (OR 0.27; 95% CI 0.096 to 0.77; p = 0.014). MACCE occurrence was predicted by higher CHA₂DS₂-VA (Congestive heart failure, Hypertension, Age ≥ 75, Diabetes, Stroke, Vascular disease, Age 65–74) (OR 5.63; 95% CI 1.57–20.12; p = 0.008), lower left ventricular ejection fraction (LVEF) (OR 0.74; 95% CI 0.57–0.99; p = 0.028) and (vitamin K antagonists) VKA use (OR 97.44; 95% CI 3.2–2962.57; p = 0.009). Conclusions: SGLT2i pharmacotherapy in the study population was linked to higher efficacy in symptom reduction, with a probability of AF recurrence and all-cause mortality reduction, which may suggest a potential beneficial role of SGLT2i in this cohort. Full article

(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)

► Show Figures

Figure 1

16 pages, 9888 KB

Open AccessArticle

Protective Role of Hesperidin Against Deltamethrin-Induced Cardiovascular Structural Damage: Involvement of Caspase-3-Driven Apoptosis and Fibrosis Suppression in Rats

by Burcu Gültekin, Halime Tuba Canbaz, Hasan Basri Savaş, Gökhan Cüce and Sabiha Serpil Kalkan

J. Cardiovasc. Dev. Dis. 2026, 13(4), 159; https://doi.org/10.3390/jcdd13040159 - 3 Apr 2026

Viewed by 331

Abstract

Background and Objectives: Deltamethrin (DLM), a widely used pyrethroid insecticide, has been linked to cardiotoxic effects in non-target organisms. Hesperidin (HSP), a dietary bioflavonoid with antioxidant and cardioprotective properties, may counteract these effects. This study investigated the protective role of HSP against DLM-induced [...] Read more.

Background and Objectives: Deltamethrin (DLM), a widely used pyrethroid insecticide, has been linked to cardiotoxic effects in non-target organisms. Hesperidin (HSP), a dietary bioflavonoid with antioxidant and cardioprotective properties, may counteract these effects. This study investigated the protective role of HSP against DLM-induced cardiotoxicity in male Wistar Albino rats. Materials and Methods: Thirty-two rats were divided into four groups: Control, DLM, DLM + HSP 100, and DLM + HSP 300. At the end of the experiment, serum ischemia-modified albumin (IMA), glucose, cholesterol, triglyceride, and HDL levels were analyzed. Cardiac and aortic tissues were assessed histopathologically. Masson’s trichrome staining evaluated cardiac fibrosis, Verhoeff–Van Gieson staining examined elastin and tunica media thickness, and caspase-3 expression in the aorta was determined immunohistochemically. Results: DLM administration caused cardiac and aortic damage by increasing IMA, glucose, caspase 3 activities, and tunica media thickness. HSP treatment, particularly at 300 mg/kg, reduced IMA (0.28 ± 0.02 vs. 0.60 ± 0.03 AU), glucose (141.12 ± 11.70 vs. 207.06 ± 9.85 mg/dL), cardiac histopathological damage score (2.17 ± 0.41 vs. 9.02 ± 1.35), tunica media thickness (95.29 ± 4.29 vs. 114.95 ± 17.20 µm), and caspase-3 expression score (0.62 ± 0.74 vs. 2.87 ± 0.35). All results showed significance at the p < 0.05 level. Conclusions: HSP exhibited dose-dependent protective effects against DLM-induced oxidative stress, apoptosis, and cardiovascular injury, suggesting its potential as a therapeutic candidate against pesticide-related cardiotoxicity. Full article

► Show Figures

Figure 1

22 pages, 696 KB

Open AccessReview

Acute Aortic Dissection in Women: A Comprehensive Review of Sex-Specific Differences, Clinical Management, and Outcomes

by Vasiliki Androutsopoulou, Dimitrios E. Magouliotis, Andrew Xanthopoulos, Kalliopi Keramida, Metaxia Bareka, Konstantinos Stamoulis, Kosmas Tsakiridis, Thanos Athanasiou and John Skoularigis

J. Cardiovasc. Dev. Dis. 2026, 13(4), 158; https://doi.org/10.3390/jcdd13040158 - 3 Apr 2026

Viewed by 1261

Abstract

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency characterized by important sex-related differences in presentation, management, and outcomes. Although women account for a smaller proportion of cases, they typically present at older ages and more frequently exhibit atypical symptoms, hemodynamic instability, and [...] Read more.

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency characterized by important sex-related differences in presentation, management, and outcomes. Although women account for a smaller proportion of cases, they typically present at older ages and more frequently exhibit atypical symptoms, hemodynamic instability, and complications such as pericardial effusion or tamponade, contributing to diagnostic delays and higher pre-hospital mortality. Beyond clinical factors, biological differences may influence disease expression in women. Menopause-associated vascular aging, hormonal modulation of extracellular matrix remodeling, and pregnancy-related hemodynamic and connective tissue changes may alter aortic wall integrity and susceptibility to dissection. Notably, women often experience dissection at smaller absolute aortic diameters, highlighting the potential importance of body-size indexing in risk stratification and surgical thresholds. In type A AAD, women are less likely to undergo extensive surgical repair in some cohorts, and although contemporary in-hospital mortality differences are narrowing, long-term survival disparities may persist. In type B AAD, women are more frequently managed conservatively, while outcomes following thoracic endovascular aortic repair appear broadly comparable between sexes. Pregnancy and the postpartum period represent particularly vulnerable windows, especially among patients with underlying heritable aortopathies. Greater awareness of sex-specific biological and clinical characteristics, incorporation of indexed aortic dimensions, and improved multidisciplinary management strategies are essential to optimize outcomes for women with acute aortic dissection. Full article

(This article belongs to the Special Issue Aortic Disease: Pathophysiology, Surgical Management, and Long-Term Outcomes)

► Show Figures

Figure 1

10 pages, 460 KB

Open AccessArticle

Nocturnal Cardiac Arrhythmias in Sleep Apnoea After Acute Myocardial Infarction and the Effect of Adaptive Servo-Ventilation: An Ancillary Study of the TEAM-ASV I Trial

by Jan Pec, Marek Nigl, Henrik Fox, Stefan Stadler, Michael Kohn, Sarah Driendl, Olaf Oldenburg, Florian Zeman, Stefan Buchner and Michael Arzt

J. Cardiovasc. Dev. Dis. 2026, 13(4), 157; https://doi.org/10.3390/jcdd13040157 - 2 Apr 2026

Viewed by 459

Abstract

(1) Background: Early treatment of sleep-disordered breathing (SDB) with adaptive servo-ventilation (ASV) after acute myocardial infarction (AMI) has been shown to improve myocardial salvage. This analysis evaluates nocturnal electrocardiogram (ECG) Holter data, derived from polygraphy in a randomised clinical trial (NCT02093377), to assess [...] Read more.

(1) Background: Early treatment of sleep-disordered breathing (SDB) with adaptive servo-ventilation (ASV) after acute myocardial infarction (AMI) has been shown to improve myocardial salvage. This analysis evaluates nocturnal electrocardiogram (ECG) Holter data, derived from polygraphy in a randomised clinical trial (NCT02093377), to assess the occurrence of nocturnal cardiac arrhythmias in patients with SDB and to explore the effect of ASV therapy. (2) Methods: In the TEAM-ASV I trial, patients were stratified by the presence/absence of SDB, defined by an apnoea–hypopnoea index (AHI) ≥15 events/h assessed with polygraphy. Those with SDB were subsequently randomised to receive ASV in addition to standard AMI care. Guideline-conforming semi-automated ECG analysis of nocturnal cardiac arrhythmias was conducted via Holter–ECG software (custo diagnostic, version 5.4). (3) Results: Patients with SDB had an increased incidence of non-sustained ventricular tachycardia (NSVT) (SDB: n = 8 (16%) vs. no SDB: n = 1 (2%); p = 0.024) and premature atrial contractions (PAC) (SDB: 1.2/h [0.3, 3.4] vs. no SDB: 0.3/h [0.1, 1.2]; p = 0.017). In patients with SDB who were randomised to ASV treatment early after AMI, we found no reduction in cardiac arrhythmias when ASV was added to standard care. (4) Conclusions: After AMI, SDB was linked to increased NSVT and PAC. ASV treatment demonstrated neither a harmful nor a beneficial effect on the occurrence of nocturnal cardiac arrhythmias. Further trials are warranted to confirm these findings. Full article

► Show Figures

Figure 1

33 pages, 1274 KB

Open AccessReview

Cardiogenic Shock: Clinical Management, Outcomes and Future Directions

by Aaqil Ahmad Aubdool, Andrew J. Sullivan, Daniel A. Jones, Anthony Mathur, Alastair Proudfoot and Krishnaraj S. Rathod

J. Cardiovasc. Dev. Dis. 2026, 13(4), 156; https://doi.org/10.3390/jcdd13040156 - 31 Mar 2026

Viewed by 2584

Abstract

Cardiogenic shock is a life-threatening condition caused by the heart’s sudden inability to pump sufficient blood to maintain adequate tissue perfusion, most commonly occurring following a myocardial infarction or acute decompensated heart failure. The resultant hypoperfusion can quickly progress to end-organ failure and [...] Read more.

Cardiogenic shock is a life-threatening condition caused by the heart’s sudden inability to pump sufficient blood to maintain adequate tissue perfusion, most commonly occurring following a myocardial infarction or acute decompensated heart failure. The resultant hypoperfusion can quickly progress to end-organ failure and ultimately death if not treated urgently. This review explores the management of cardiogenic shock, highlighting current treatments, their effectiveness, and the challenges faced by healthcare providers. It looks at both pharmacological therapies and devices used for cardiac support, including mechanical circulatory support and emergency revascularisation procedures to restore blood flow. We also examine how different stages of shock affect survival and how new technologies including artificial intelligence and wearable monitors could help detect and treat this condition earlier. In addition, this review discusses the significant pressure that cardiogenic shock places on healthcare provision, including the typical financial cost of treatment in the UK, resource utilisation and regional disparities. Finally, we outline future directions for trial design, better prevention, more rapid diagnosis and improved treatments that could improve morbidity and mortality. Full article

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

► Show Figures

Figure 1

34 pages, 2795 KB

Open AccessReview

Current Management of Infective Endocarditis: A Narrative Review Focused on Unmet Clinical Needs and the Multidisciplinary Approach

by Luca Di Vito, Giuseppina D’Amato, Riccardo Pascucci, Antonella D’Antonio, Giancarla Scalone, Mariavirginia Boni, Brunella Rossi, Ilaria Cimaroli, Claudia Acciarri, Marida Andreucci, Andrea Romandini, Simona Silenzi, Procolo Marchese and Pierfrancesco Grossi

J. Cardiovasc. Dev. Dis. 2026, 13(4), 155; https://doi.org/10.3390/jcdd13040155 - 30 Mar 2026

Viewed by 621

Abstract

Infective endocarditis (IE) is a severe infectious disease affecting cardiac valves (either native or prosthetic) or implantable cardiac devices, and it is associated with high rates of morbidity and mortality. Recent data from the Global Burden of Disease study have shown a significant [...] Read more.

Infective endocarditis (IE) is a severe infectious disease affecting cardiac valves (either native or prosthetic) or implantable cardiac devices, and it is associated with high rates of morbidity and mortality. Recent data from the Global Burden of Disease study have shown a significant increase in both the incidence and mortality of IE. One-year mortality following diagnosis can reach up to 30%. IE can present with a wide range of clinical manifestations, and its course may be complicated by systemic embolic events or intracardiac complications such as abscess formation or prosthetic valve dehiscence. Echocardiography remains the first-line imaging modality; however, an integrated multimodality imaging approach is increasingly adopted in contemporary practice, incorporating both cardiac computed tomography and positron emission tomography. A multidisciplinary approach involving cardiologists, cardiac surgeons, internists, infectious disease specialists, and nuclear medicine physicians is often required to ensure accurate diagnosis and effective treatment of IE. The prognosis of infective endocarditis depends on early diagnosis, appropriate antimicrobial therapy, and timely surgical intervention when indicated. This review aims to summarize the current knowledge on IE, from pathophysiological insights to surgical strategies. It also focuses on practical recommendations to address the most pressing unmet clinical needs through a multidisciplinary approach. Full article

► Show Figures

Figure 1

12 pages, 626 KB

Open AccessReview

Isometric Handgrip Training and Cardiovascular Risk Modulation: State of the Art

by Calogero Geraci, Francesca La Rocca, Salvatore Massimo Petrina, Agostino Buonauro, Giulio Geraci, Valentina Morello and Roberta Esposito

J. Cardiovasc. Dev. Dis. 2026, 13(4), 154; https://doi.org/10.3390/jcdd13040154 - 30 Mar 2026

Viewed by 689

Abstract

Cardiometabolic diseases remain the leading cause of morbidity and mortality worldwide, despite major advances in pharmacological and lifestyle interventions. Exercise training is a cornerstone of prevention and treatment; however, adherence to traditional aerobic programs remains suboptimal. Isometric handgrip (IHG) training has emerged as [...] Read more.

Cardiometabolic diseases remain the leading cause of morbidity and mortality worldwide, despite major advances in pharmacological and lifestyle interventions. Exercise training is a cornerstone of prevention and treatment; however, adherence to traditional aerobic programs remains suboptimal. Isometric handgrip (IHG) training has emerged as a simple, time-efficient, and potentially effective strategy for improving cardiovascular and metabolic outcomes. This state-of-the-art review synthesizes current evidence on the physiological mechanisms underlying IHG training, including autonomic modulation, vascular function improvement, endothelial adaptation, and metabolic regulation. We summarize clinical data regarding its effects on blood pressure, arterial stiffness, endothelial function, insulin sensitivity, and inflammatory markers. Special attention is given to its applicability in specific populations, including hypertensive patients, individuals with metabolic syndrome, heart failure patients, and cancer survivors. We also discuss methodological heterogeneity across studies, safety considerations, and knowledge gaps. Finally, we outline future research directions needed to define optimal protocols and clarify long-term cardiometabolic benefits. IHG training represents a promising adjunctive strategy within cardiometabolic prevention and rehabilitation programs. Full article

► Show Figures

Figure 1

26 pages, 795 KB

Open AccessReview

Obesity and Heart Failure: Introducing the Theme

by Francesco Monitillo, Paolo Basile and Giuseppe Lisco

J. Cardiovasc. Dev. Dis. 2026, 13(4), 153; https://doi.org/10.3390/jcdd13040153 - 30 Mar 2026

Viewed by 935

Abstract

Obesity is a chronic, highly prevalent disease affecting nearly one-third of the global population and represents a major independent risk factor for heart failure (HF), particularly heart failure with preserved ejection fraction (HFpEF). Excess adiposity—especially visceral and epicardial adipose tissue (EAT)—acts as an [...] Read more.

Obesity is a chronic, highly prevalent disease affecting nearly one-third of the global population and represents a major independent risk factor for heart failure (HF), particularly heart failure with preserved ejection fraction (HFpEF). Excess adiposity—especially visceral and epicardial adipose tissue (EAT)—acts as an active endocrine and immune organ, promoting chronic low-grade inflammation, oxidative stress, endothelial dysfunction, and adverse myocardial remodeling. Expanded EAT exerts both paracrine inflammatory effects and mechanical constraint on the myocardium, contributing to diastolic dysfunction, microvascular impairment, atrial arrhythmogenesis, and elevated filling pressures despite preserved systolic function. Evidence demonstrates a dose–response relationship between increasing body mass index and incident HF. Clinically, obesity-related HFpEF is characterized by concentric left ventricular hypertrophy, impaired relaxation, increased plasma volume, reduced exercise tolerance, and relatively low natriuretic peptide levels, complicating diagnosis. HF management includes traditional treatment with diuretics, renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and angiotensin receptor-neprilysin inhibitors. These agents widely remain foundational as they primarily target hemodynamic and neurohormonal pathways in HF. In contrast, sodium–glucose cotransporter 2 inhibitors consistently reduce HF hospitalizations across the ejection fraction spectrum, while glucagon-like peptide-1 receptor agonists and dual incretin therapies (e.g., tirzepatide) promote substantial weight loss, improve symptoms, and demonstrate promising anti-remodeling effects in obesity-related HFpEF. Recognizing obesity-driven HF as a distinct cardiometabolic entity supports an integrated therapeutic strategy combining structured weight reduction with guideline-directed HF polypharmacotherapy to address both hemodynamic burden and upstream adiposity-related mechanisms. Full article

(This article belongs to the Special Issue Obesity and Heart Failure)

► Show Figures

Graphical abstract

23 pages, 3765 KB

Open AccessReview

Multimodal Imaging for Monitoring of Disease Progression in Cardiac Amyloidosis: Advances and Gaps in Evidence

by Claudia Meier, Roja Soutodeh and Stephan Gielen

J. Cardiovasc. Dev. Dis. 2026, 13(4), 152; https://doi.org/10.3390/jcdd13040152 - 30 Mar 2026

Viewed by 580

Abstract

Among cardiac storage diseases, amyloidosis has emerged as a common cause of heart failure (HF), particularly in older people: it is diagnosed in up to 13–19% of patients with heart failure and preserved ejection fraction. Current treatments for transthyretin amyloidosis (ATTR) focus on [...] Read more.

Among cardiac storage diseases, amyloidosis has emerged as a common cause of heart failure (HF), particularly in older people: it is diagnosed in up to 13–19% of patients with heart failure and preserved ejection fraction. Current treatments for transthyretin amyloidosis (ATTR) focus on stopping the misfolding of the TTR protein or reducing TTR production and treating the symptoms with cardiac medication, while systemic chemotherapy is the focus for light-chain amyloidosis (AL). New fibril clearance agents and gene therapies are currently in development. In addition to clinical and laboratory observations, multimodal imaging is essential for the monitoring of the effects of treatment on the progression of heart disease, but it is not yet included in established staging systems. This narrative review collects current multimodal imaging parameters that have been evaluated in clinical trials to assess the progression of cardiac amyloidosis and used in phase III intervention studies. These evolving findings are compared with current consensus recommendations to identify gaps in knowledge for specific imaging modalities, particularly cardiac MRI. Ultimately, the goal should be to standardize imaging of disease progression in cardiac amyloidosis so that the therapeutic effects of new pharmacological treatment options can be compared with the current standard of care. Full article

► Show Figures

Figure 1

15 pages, 2073 KB

Open AccessArticle

Prognostic Value of the RVFWLS/PASP Ratio in Pulmonary Arterial Hypertension

by Hongjie Bian, Qinhua Zhao, Fengling Ju, Lan Wang, Yupei Han, Hongling Qiu, Cijun Luo, Pei Gang, Ke Li and Xumeng Ding

J. Cardiovasc. Dev. Dis. 2026, 13(4), 151; https://doi.org/10.3390/jcdd13040151 - 30 Mar 2026

Viewed by 442

Abstract

Background: The right ventricular free wall longitudinal strain to pulmonary arterial systolic pressure (RVFWLS/PASP) ratio is an emerging echocardiographic index for evaluating right ventricular–pulmonary artery (RV-PA) coupling. This study aimed to evaluate its prognostic significance and incremental value in risk stratification for patients [...] Read more.

Background: The right ventricular free wall longitudinal strain to pulmonary arterial systolic pressure (RVFWLS/PASP) ratio is an emerging echocardiographic index for evaluating right ventricular–pulmonary artery (RV-PA) coupling. This study aimed to evaluate its prognostic significance and incremental value in risk stratification for patients with pulmonary arterial hypertension (PAH). Methods: We conducted a retrospective–prospective cohort study of 149 adult PAH patients (87 idiopathic PAH and 62 connective tissue disease-associated PAH). RVFWLS was measured via speckle tracking echocardiography, and PASP was estimated using Doppler. The primary endpoint was event-free survival, defined as the first occurrence of all-cause mortality, lung transplantation, or rehospitalization for right heart failure. Kaplan–Meier and multivariate Cox regression analyses were performed to identify independent predictors. Results: During a median follow-up of 32 months, 78 primary events occurred. Patients in the lower RVFWLS/PASP group (<0.246%/mmHg) exhibited significantly worse exercise capacity, higher NT-proBNP levels, and poorer hemodynamics compared with the higher group (≥0.246%/mmHg) (all p < 0.001). The event-free survival rate for the composite endpoint was significantly lower in the group with reduced RVFWLS/PASP compared with that observed in the higher RVFWLS/PASP group (log-rank p < 0.05). Multivariate Cox regression analysis demonstrated RVFWLS/PASP ≥ 0.246%/mmHg was independently predictive of reduced risk for the primary endpoint (HR = 0.46, 95%CI 0.23–0.93, p < 0.05). Moreover, RVFWLS/PASP facilitated additional risk stratification among patients classified as low risk based on established models (FPHN, COMPERA 2.0, and REVEAL Lite 2). Conclusions: RVFWLS/PASP is a robust, independent determinant of long-term prognosis in patients with PAH. As a noninvasive measure of RV-PA coupling, it provides significant incremental value for clinical risk assessment and treatment monitoring. Full article

(This article belongs to the Special Issue Pulmonary Hypertension: Far from a Rare Disease—a Journey from Diagnosis to Treatment)

► Show Figures

Figure 1

11 pages, 988 KB

Open AccessReview

State-of-the-Art Definitive Femoropopliteal Lesion Treatment: A Case-Based Systematic Approach

by Grigorios Korosoglou, Nasser Malyar, Andrej Schmidt, Michael Lichtenberg, Gerd Grözinger, Dittmar Böckler, Christian A. Behrendt, Erwin Blessing, Ralf Langhoff, Thomas Zeller and Christos Rammos

J. Cardiovasc. Dev. Dis. 2026, 13(4), 150; https://doi.org/10.3390/jcdd13040150 - 28 Mar 2026

Viewed by 495

Abstract

After vessel preparation, using different strategies such as balloon angioplasty, specialty balloons, atherectomy or intravascular lithotripsy, definitive treatment has emerged as a key feature in endovascular treatment strategies. Based on current guidelines, endovascular treatment is the most common treatment option in patients with [...] Read more.

After vessel preparation, using different strategies such as balloon angioplasty, specialty balloons, atherectomy or intravascular lithotripsy, definitive treatment has emerged as a key feature in endovascular treatment strategies. Based on current guidelines, endovascular treatment is the most common treatment option in patients with claudication. In patients with chronic limb-threatening ischemia (CLTI), on the other hand, the best treatment modality, including bypass surgery and endovascular revascularization, needs to be selected by an interdisciplinary team, focusing on individual anatomic and patient-specific characteristics, on the availability of a vein graft and on cardiovascular and other comorbidities of the patients. With endovascular therapy, currently, a plethora of options are available for the treatment of femoropopliteal lesions, which are increasingly gaining in complexity. Therefore, a practical systematic case-based approach, entailing contemporary treatment options, like drug-coated balloon (DCB) angioplasty tools, self-expanding bare-metal stents (BMSs), drug-eluting stents (DESs), interwoven stents and covered stents, is crucial. Generally, most endovascular operators adhere to the ‘leave nothing behind’ concept, meaning that, after proper lesion preparation, lesions can be treated with DCBs, avoiding the implantation of permanent metallic implants. However, in the case of severe dissections or significant recoil, stent implantation becomes necessary to achieve adequate limb perfusion. The selection between long versus spot stenting and the different stent options depends on the current scientific evidence, guidelines and expert opinion statements. An interdisciplinary expert consensus was recently compiled on how these modalities should be used in specific lesions and patients in the femoropopliteal segment. Herein we present a practical case-based approach, which is based on this algorithm and aims at harmonization of endovascular treatment strategies in daily practice and ultimately at further improvements in limb and patient outcomes. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

► Show Figures

Figure 1

17 pages, 840 KB

Open AccessArticle

Estimated Pulse Wave Velocity as a Marker of Blood-Pressure-Dependent Arterial Load and Ventricular–Vascular Interaction in Severe Aortic Stenosis Before and After Transcatheter Aortic Valve Replacement

by Simina Mariana Moroz, Alina Gabriela Negru, Mirela Baba, Silvia Luca, Mihaela Valcovici, Alina Maria Lupu, Darius Buriman, Daniel-Dumitru Nișulescu, Ana Lascu, Daniel Florin Lighezan and Ioana Mozos

J. Cardiovasc. Dev. Dis. 2026, 13(4), 149; https://doi.org/10.3390/jcdd13040149 - 25 Mar 2026

Viewed by 487

Abstract

Background: Severe aortic stenosis (AS) increases left ventricular afterload and disrupts ventricular–vascular coupling. Transcatheter aortic valve replacement (TAVR) promptly relieves valvular obstruction, but its immediate effects on blood pressure-dependent arterial load and ventricular–vascular interactions are not fully clarified. Estimated pulse wave velocity (ePWV), [...] Read more.

Background: Severe aortic stenosis (AS) increases left ventricular afterload and disrupts ventricular–vascular coupling. Transcatheter aortic valve replacement (TAVR) promptly relieves valvular obstruction, but its immediate effects on blood pressure-dependent arterial load and ventricular–vascular interactions are not fully clarified. Estimated pulse wave velocity (ePWV), derived from age and mean arterial pressure, is a convenient surrogate of global arterial load. The study aimed to assess ePWV before and after TAVR and its relationship with ventricular function and inflammatory biomarkers. Methods: In this retrospective observational study, 100 elderly patients with severe AS undergoing TAVR underwent detailed clinical, laboratory, and echocardiographic assessments before and after the procedure. Arterial stiffness was quantified using ePWV, while left ventricular geometry and systolic function were evaluated by standard echocardiography. Post-procedural reassessment was performed at hospital discharge (median 8 days after TAVR). Results: TAVR led to a modest but significant reduction in ePWV (from 12.79 ± 1.54 to 12.39 ± 1.54 m/s, p < 0.01) and improvement in left ventricular ejection fraction (LVEF) (from 44.89 ± 9.2% to 46.7 ± 7.95%, p < 0.01). Higher baseline ePWV correlated with unfavorable left ventricular remodeling and systolic dysfunction, and post-procedural ePWV remained linked to right ventricular performance. Before TAVR, ePWV and LVEF were both associated with inflammatory biomarkers, relationships that disappeared after intervention. Conclusions: Overall, ePWV functioned as an integrated measure of ventricular–vascular interaction and global hemodynamic load, though its interpretation post-TAVR requires caution due to direct blood pressure dependence and confounding by acute procedural inflammation. Full article

(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges, 2nd Edition)

► Show Figures

Figure 1

Journal Menu

Journal Browser

J. Cardiovasc. Dev. Dis., Volume 13, Issue 4 (April 2026) – 24 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI