Journal Description
Hearts
Hearts
is an international, peer-reviewed, open access journal on cardiology and cardiac & vascular surgery, published quarterly online by MDPI.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within FSTA, and other databases.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 32.3 days after submission; acceptance to publication is undertaken in 3.7 days (median values for papers published in this journal in the second half of 2023).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
Latest Articles
The Impact of Sickle Cell Disease on Acute Coronary Syndrome and PCI Outcomes: A Retrospective Observational Study
Hearts 2024, 5(2), 236-245; https://doi.org/10.3390/hearts5020016 - 27 May 2024
Abstract
►
Show Figures
Introduction: Sickle cell disease (SCD) is a genetic disorder that is widely observed on a global scale and known for its substantial negative impact on health and mortality. The purpose of this research was to explore how SCD influences the outcomes of acute
[...] Read more.
Introduction: Sickle cell disease (SCD) is a genetic disorder that is widely observed on a global scale and known for its substantial negative impact on health and mortality. The purpose of this research was to explore how SCD influences the outcomes of acute coronary syndrome (ACS) and Percutaneous Coronary Intervention (PCI). Methods: A retrospective observational analysis was conducted using the National Inpatient Sample (NIS) data for the year 2020. Adult patients with concurrent ACS and SCD diagnoses were included in the study. Demographic information, clinical characteristics, in-hospital outcomes, and PCI complications were examined and compared between ACS patients with and without SCD. Results: Among a total of 779,895 ACS patients, 1495 had coexisting SCD. SCD patiets exhibited distinct demographic features, such as younger age (mean age: 59 vs. 66 years), predominantly female (53% vs. 35%), and primarily African American (91% vs. 11%). Comorbid conditions such as hypertension and chronic lung disease were more prevalent in SCD patients. While inpatient mortality odds did not significantly differ, SCD patients demonstrated slightly shorter lengths of stay in cases of STEMI and NSTEMI/UA. Notably, SCD patients faced a statistically significant increased risk of coronary dissection, highlighting a unique complication in this population. Although an increased incidence of atrial fibrillation and acute heart failure was observed in SCD patients, statistical significance was not achieved. Conclusions: This study provides valuable insight into the intricate interplay between SCD and ACS outcomes. SCD patients presented with distinctive demographic and clinical profiles that influenced their experience with ACS. The elevated risk of coronary dissection emphasizes the necessity for tailored interventions and careful management in SCD patients. These findings underscore the need for further research to elucidate underlying mechanisms and optimize treatment strategies for individuals with both SCD and ACS.
Full article
Open AccessArticle
Prognostic Value and Limits of Heart Rate and QT—Corrected in A Large Population
by
Paolo Giovanardi, Cecilia Vernia, Sara Roversi, Enrico Tincani, Giuseppe Spadafora, Federico Silipo and Claudio Giberti
Hearts 2024, 5(2), 225-235; https://doi.org/10.3390/hearts5020015 - 27 May 2024
Abstract
►▼
Show Figures
Background: The study aimed to compare the prognostic importance of the heart rate (HR) and QT—corrected (QTc) according to Fridericia, Framingham, and Bazett with respect to all-cause mortality in a large non-selected population. Methods: The analysis of digital electrocardiograms archived from 2008 to
[...] Read more.
Background: The study aimed to compare the prognostic importance of the heart rate (HR) and QT—corrected (QTc) according to Fridericia, Framingham, and Bazett with respect to all-cause mortality in a large non-selected population. Methods: The analysis of digital electrocardiograms archived from 2008 to 2022 in the metropolitan area of Modena, Italy, was carried out. The population under study was divided into three groups based on age, and survival analysis was performed. Results: 131,627 patients were enrolled and, during the follow-up (mean 1641.4 days), all-cause mortality was 8.9%. Both HR and QTc were associated with mortality. All-cause mortality significantly increased with HR values greater than 81 BPM and QTc values greater than 440 msec in young subjects and 455 msec in old subjects (values of the 75th percentiles/optimal operating point). A Cox analysis confirmed the better prognostic value of Bazett’s QTc and HR in the whole population and in the three age-groups. Conclusion: Bazett’s method performed better than the others, but, unexpectedly, the HR had the same or an even better correlation with all-cause mortality. Since the HR is simple and readily available, its evaluation should be improved. However, QTC and HR values are difficult to define, causing many confounding factors, and further population studies are required.
Full article
Graphical abstract
Open AccessArticle
Arterial Stiffness Is an Important Predictor of Heart Failure with Preserved Ejection Fraction (HFpEF)—The Effects of Phosphate Retention
by
Yuji Mizuno, Toshifumi Ishida, Kenichi Tsujita and Michihiro Yoshimura
Hearts 2024, 5(2), 211-224; https://doi.org/10.3390/hearts5020014 - 17 May 2024
Abstract
►▼
Show Figures
Heart failure with preserved ejection fraction (HFpEF) is a major health concern. There is a growing recognition of the causal interplay between arterial stiffness and HFpEF. We recently reported that phosphate retention is a trigger for arterial stiffness. This study focuses on whether
[...] Read more.
Heart failure with preserved ejection fraction (HFpEF) is a major health concern. There is a growing recognition of the causal interplay between arterial stiffness and HFpEF. We recently reported that phosphate retention is a trigger for arterial stiffness. This study focuses on whether arterial stiffness due to phosphate retention could be a predictor for HFpEF. Methods: The subjects of this study were 158 patients (68 males and 90 females, mean age 74.8 ± 11.2). HFpEF was defined according to the guidelines of the ESC 2019. Pulse wave velocity (PWV) and central systolic blood pressure (CSBP) were used as markers for arterial stiffness and afterload, respectively. We measured serum levels of fibroblast growth factor 23 (FGF23) as a marker of phosphate retention. Results: The serum levels of FGF23 had a significant relationship with PWV. PWV had significant relationships with LV mass index, plasma BNP levels, and relative wall thickness, e′, and E/e′ (p < 0.001, respectively). Multivariate logistic regression analysis revealed that higher PWV values and hypertension were significant predictors for the dependent factor (HFpEF). Arterial stiffness amplified afterload, leading to LV concentric hypertrophy and diastolic dysfunction. This study presents that arterial stiffness is a key predictor of HFpEF, and that phosphate retention is involved in the pathology of HFpEF.
Full article
Graphical abstract
Open AccessArticle
Dietary Fatty Acids Predicting Long Term Cardiovascular Mortality in a Cohort of Middle-Aged Men Followed-Up until Extinction
by
Alessandro Menotti and Paolo Emilio Puddu
Hearts 2024, 5(2), 196-210; https://doi.org/10.3390/hearts5020013 - 23 Mar 2024
Abstract
Objectives: To report the relationships of major dietary fatty acids with major cardiovascular disease mortality groups in a cohort of middle-aged men followed up with until extinction. Material and Methods: In the early 1960s, a cohort of men aged 40 to 59 years
[...] Read more.
Objectives: To report the relationships of major dietary fatty acids with major cardiovascular disease mortality groups in a cohort of middle-aged men followed up with until extinction. Material and Methods: In the early 1960s, a cohort of men aged 40 to 59 years was enrolled and examined within the Italian Rural Areas section of the Seven Countries Study including dietary history that allowed for the estimation of major fatty acid (FA) intake (saturated FAs: SAFAs; mono-unsaturated FAs: MUFAs; and poly-unsaturated FAs: PUFAs), their ratios, and the production of a dietary score derived from 18 food groups, the high levels of which corresponded to a Mediterranean diet profile. Results: During a follow-up of 61 years, the intake of SAFAs was directly while that of MUFAs was inversely and significantly associated with coronary heart disease (CHD) mortality (the hazard ratio for one standard deviation was 1.28 and 0.84, respectively) but not with other cases of Heart Disease of Uncertain Etiology (HDUE) and stroke mortality. The hazard ratio for SAFAs remained significant after factoring into the multivariate models the dietary score and other classical cardiovascular risk factors (age, smoking habits, cholesterol levels, and systolic blood pressure). The role of the dietary score was inverse and significant (hazard ratio of 0.73). Again, this was true for CHD but not for HDUE and stroke mortality. Conclusions: Both SAFAs and MUFAs predict long-term CHD mortality, together with a dietary score, but not HDUE and stroke, which represent different diseases also in relation to dietary habits.
Full article
Open AccessArticle
Significance of Smoking in Patients with Acute ST Elevation Myocardial Infarction (STEMI) Undergoing Primary Percutaneous Coronary Intervention: Evaluation of Coronary Flow, Microcirculation and Left Ventricular Systolic Function
by
Mariana Boulos, Yasmine Sharif, Nimer Assy and Dawod Sharif
Hearts 2024, 5(1), 182-195; https://doi.org/10.3390/hearts5010012 - 21 Mar 2024
Abstract
►▼
Show Figures
In the thrombolytic care era, myocardial infarction in cigarette smokers was associated with better six-month outcomes compared to non-smokers. Aims: We tested the hypothesis that in patients with anterior myocardial infarction with ST-segment elevation (STEMI) treated with primary percutaneous coronary intervention (PPCI), cigarette
[...] Read more.
In the thrombolytic care era, myocardial infarction in cigarette smokers was associated with better six-month outcomes compared to non-smokers. Aims: We tested the hypothesis that in patients with anterior myocardial infarction with ST-segment elevation (STEMI) treated with primary percutaneous coronary intervention (PPCI), cigarette smoking is associated with better coronary artery flow, myocardial perfusion, and left ventricular systolic function. Methods: Ninety-nine patients (sixty-six smokers) with anterior STEMI treated with PPCI were studied. Angiographic coronary artery flow TIMI grades, myocardial blush grades (MBGs) before and after PPCI, ST-segment elevation resolution, maximal troponin I and creatine phosphokinase blood levels, left ventricular echocardiographic systolic function as well as left anterior descending coronary artery (LAD) velocity parameters at admission and at discharge were evaluated. Results: Smokers and non-smokers were treated similarly. In smokers, the age was significantly younger, 54 ± 10, compared to non-smokers, 71.8 ± 10 years, p < 0.05, and had a lower prevalence of women, 13.6% compared to 36.6%. TIMI and MBG before and after PPCI were similar between smokers and non-smokers. Smokers had a lower prevalence of complete ST elevation resolution, 33% compared to 50% in non-smokers. Diastolic LAD velocity and integral were lower in smokers, p < 0.05. Maximal biomarker blood levels as well as LV systolic function at admission and on discharge were similar. Conclusions: Cigarette smokers with anterior STEMI treated with PPCI were younger with a lower prevalence of women and of complete ST elevation resolution and had lower LAD diastolic velocity and integral late after PPCI. However, angiographic parameters and LV systolic function parameters were similar.
Full article
Graphical abstract
Open AccessArticle
Temporal Responses of a Low-Energy Meal Replacement Plan or Exercise Training on Cardiovascular Function and Fibro-Inflammatory Markers in People with Type 2 Diabetes—A Secondary Analysis of the “Diabetes Interventional Assessment of Slimming or Training to Lessen Inconspicuous Cardiovascular Dysfunction” Study
by
Joanna M. Bilak, Gaurav S. Gulsin, Vasiliki Bountziouka, Kelly S. Parke, Emma Redman, Joseph Henson, Lei Zhao, Phillipe Costet, Mary Ellen Cvijic, Juan Maya, Ching-Pin Chang, Melanie J. Davies, Thomas Yates, Gerry P. McCann and Emer M. Brady
Hearts 2024, 5(1), 165-181; https://doi.org/10.3390/hearts5010011 - 16 Mar 2024
Abstract
►▼
Show Figures
Background: This study assesses the temporal responses of cardiovascular function, fibro-inflammation, and glucometabolic profiles in asymptomatic adults with type 2 diabetes, following a low-energy meal replacement plan (MRP) or exercise training. Methods: Secondary analysis of DIASTOLIC: a randomised, open-label, blinded-endpoint trial of 12
[...] Read more.
Background: This study assesses the temporal responses of cardiovascular function, fibro-inflammation, and glucometabolic profiles in asymptomatic adults with type 2 diabetes, following a low-energy meal replacement plan (MRP) or exercise training. Methods: Secondary analysis of DIASTOLIC: a randomised, open-label, blinded-endpoint trial of 12 weeks MRP (~810 kcal/day) or exercise training. Cardiac magnetic resonance, plasma fibroinflammatory, and metabolic markers were undertaken at baseline, 4, and 12 weeks. Results: Out of 24 participants in the MRP group and 22 in exercise training, 18 and 11 completed all three visits. MRP resulted in early (0–4 weeks) improvement in insulin resistance (HOMA-IR: 10.82 to 4.32), decrease in FABP-4 (4.87 ± 0.19 to 5.15 ± 0.32 mg/L), and improvement in left ventricular remodelling LV mass: volume (0.86 ± 0.14 to 0.78 ± 0.11), all with large effect sizes. MMP8 levels increased moderately at 4–12 weeks. Peak early diastolic strain rate (cPEDSR) initially decreased, then improved. Exercise training led to minor improvements in insulin resistance and MMP-8 levels, with no significant changes in cPEDSR or LV remodelling. Conclusions: MRP resulted in early improvements in insulin resistance, cardiac remodelling, and inflammation, but with an initial decrease in diastolic function, improving by 12 weeks. Exercise training showed minor early benefits in insulin resistance and inflammation, but no significant cardiac changes.
Full article
Figure 1
Open AccessEditorial
Second Edition of the German–Austrian S3 Guideline “Infarction-Related Cardiogenic Shock: Diagnosis, Monitoring and Treatment”
by
Kevin Pilarczyk, Udo Boeken, Martin Russ, Josef Briegel, Michael Buerke, Alexander Geppert, Uwe Janssens, Malte Kelm, Guido Michels, Axel Schlitt, Holger Thiele, Stephan Willems, Uwe Zeymer, Bernhard Zwissler, Georg Delle-Karth, Markus Wolfgang Ferrari, Hans Reiner Figulla, Axel Heller, Gerhard Hindricks, Emel Pichler-Cetin, Burkert Pieske, Roland Prondzinsky, Johann Bauersachs, Ina Kopp, Karl Werdan and Matthias Thielmannadd
Show full author list
remove
Hide full author list
Hearts 2024, 5(1), 142-164; https://doi.org/10.3390/hearts5010010 - 14 Mar 2024
Abstract
►▼
Show Figures
The mortality of patients with MI has significantly decreased in recent decades, mainly due to early reperfusion therapy with a probability of surviving of more than 90% if the patient reaches the hospital [...]
Full article
Figure 1
Open AccessReview
Complications in Acute Myocardial Infarction: Navigating Challenges in Diagnosis and Management
by
Errol Moras, Shreyas Yakkali, Kruti D. Gandhi, Hafeez Ul Hassan Virk, Mahboob Alam, Syed Zaid, Nitin Barman, Hani Jneid, Saraschandra Vallabhajosyula, Samin K. Sharma and Chayakrit Krittanawong
Hearts 2024, 5(1), 122-141; https://doi.org/10.3390/hearts5010009 - 13 Mar 2024
Abstract
►▼
Show Figures
In recent decades, significant advancements in pharmacological, catheter-based, and surgical reperfusion technologies have markedly improved outcomes for individuals undergoing acute myocardial infarction. Despite these remarkable progressions, a segment of patients, particularly those with extensive infarctions or delays in revascularization, remains vulnerable to the
[...] Read more.
In recent decades, significant advancements in pharmacological, catheter-based, and surgical reperfusion technologies have markedly improved outcomes for individuals undergoing acute myocardial infarction. Despite these remarkable progressions, a segment of patients, particularly those with extensive infarctions or delays in revascularization, remains vulnerable to the onset of mechanical complications associated with myocardial infarction. These complications, spanning mechanical, electrical, ischemic, inflammatory, and thromboembolic events, pose substantial risks of morbidity, mortality, and increased utilization of hospital resources. The management of patients experiencing these complications is intricate, necessitating collaborative efforts among various specialties. Timely identification, accurate diagnosis, hemodynamic stabilization, and decision-making support are crucial for guiding patients and their families in choosing between definitive treatments or palliative care. This review underscores the critical importance of promptly identifying and initiating therapy to reduce prolonged periods of cardiogenic shock and the potential for fatality. By presenting key clinical and diagnostic insights, this review aims to further improve early diagnosis and offer an updated perspective on current management strategies for the diverse range of complications associated with acute myocardial infarction.
Full article
Figure 1
Open AccessReview
The Evolution and Complications of Long-Term Mechanical Circulatory Support Devices
by
Christian R. Sargent, Sabrina Ali and Venkateswarlu Kanamarlapudi
Hearts 2024, 5(1), 105-121; https://doi.org/10.3390/hearts5010008 - 28 Feb 2024
Abstract
Heart failure, a common clinical syndrome caused by functional and structural abnormalities of the heart, affects 64 million people worldwide. Long-term mechanical circulatory support can offer lifesaving treatment for end-stage systolic heart failure patients. However, this treatment is not without complications. This review
[...] Read more.
Heart failure, a common clinical syndrome caused by functional and structural abnormalities of the heart, affects 64 million people worldwide. Long-term mechanical circulatory support can offer lifesaving treatment for end-stage systolic heart failure patients. However, this treatment is not without complications. This review covers the major complications associated with implantable mechanical circulatory support devices, including strokes, pump thrombosis and gastrointestinal bleeding. These complications were assessed in patients implanted with the following devices: Novacor, HeartMate XVE, CardioWest, Jarvik 2000, HeartMate II, EVAHEART, Incor, VentrAssist, HVAD and HeartMate 3. Complication rates vary among devices and remain despite the introduction of more advanced technology, highlighting the importance of device design and flow patterns. Beyond clinical implications, the cost of complications was explored, highlighting the difference in costs and the need for equitable healthcare, especially with the expected rise in the use of mechanical circulatory support. Future directions include continued improvement through advancements in design and technology to reduce blood stagnation and mitigate high levels of shear stress. Ultimately, these alterations can reduce complications and enhance cost-effectiveness, enhancing both the survival and quality of life for patients receiving mechanical circulatory support.
Full article
(This article belongs to the Topic Mechanical Circulatory Support in Heart Failure)
►▼
Show Figures
Figure 1
Open AccessReview
An Update on the Use of Artificial Intelligence in Cardiovascular Medicine
by
Shiavax J. Rao, Shaikh B. Iqbal, Ameesh Isath, Hafeez Ul Hassan Virk, Zhen Wang, Benjamin S. Glicksberg and Chayakrit Krittanawong
Hearts 2024, 5(1), 91-104; https://doi.org/10.3390/hearts5010007 - 9 Feb 2024
Abstract
►▼
Show Figures
Artificial intelligence, specifically advanced language models such as ChatGPT, have the potential to revolutionize various aspects of healthcare, medical education, and research. In this review, we evaluate the myriad applications of artificial intelligence in diverse healthcare domains. We discuss its potential role in
[...] Read more.
Artificial intelligence, specifically advanced language models such as ChatGPT, have the potential to revolutionize various aspects of healthcare, medical education, and research. In this review, we evaluate the myriad applications of artificial intelligence in diverse healthcare domains. We discuss its potential role in clinical decision-making, exploring how it can assist physicians by providing rapid, data-driven insights for diagnosis and treatment. We review the benefits of artificial intelligence such as ChatGPT in personalized patient care, particularly in geriatric care, medication management, weight loss and nutrition, and physical activity guidance. We further delve into its potential to enhance medical research, through the analysis of large datasets, and the development of novel methodologies. In the realm of medical education, we investigate the utility of artificial intelligence as an information retrieval tool and personalized learning resource for medical students and professionals.
Full article
Figure 1
Open AccessSystematic Review
Inspiratory Muscle Training Intensity in Patients Living with Cardiovascular Diseases: A Systematic Review
by
Anaïs Beaujolin, Jessica Mané, Céline Presse, Jordana Barbosa-Silva, Michela Bernini, Camilo Corbellini and Raphael Martins de Abreu
Hearts 2024, 5(1), 75-90; https://doi.org/10.3390/hearts5010006 - 7 Feb 2024
Abstract
►▼
Show Figures
The benefits of inspiratory muscle training (IMT) have been demonstrated in patients with cardiovascular diseases (CVD); however, the optimal training intensity is not yet fully clarified. The purpose of this study was to review the impact of IMT intensity on respiratory muscle strength,
[...] Read more.
The benefits of inspiratory muscle training (IMT) have been demonstrated in patients with cardiovascular diseases (CVD); however, the optimal training intensity is not yet fully clarified. The purpose of this study was to review the impact of IMT intensity on respiratory muscle strength, functional and exercise capacity, pulmonary function, and quality of life in patients with CVD. This systematic review was carried out according to PRISMA statement and registered in the PROSPERO database (review protocol: CRD42023442378). Randomized controlled trials were retrieved on 3 July 2023 in the following electronic databases: Web of Science, PubMed, EMBASE, and SCOPUS. Studies were included if they assessed the impact of isolated IMT on CVD patients in comparison with sham, different intensities and/or intervention groups. Eight studies were included for final analysis; IMT consistently led to significantly greater improvements in inspiratory muscle strength compared to control (CON) groups. The intensity of IMT varied in the studies based on different percentages of maximal inspiratory pressure (MIP), ranging from 25% to 60% of MIP. The time of intervention ranged from 4 to 12 weeks. Despite this variability, the studies collectively suggested that IMT is beneficial for enhancing CVD patients’ conditions. However, the optimal intensity range for benefits appeared to vary, and no single intensity emerged as universally superior across all studies.
Full article
Graphical abstract
Open AccessReview
Different Mechanisms in Doxorubicin-Induced Cardiomyopathy: Impact of BRCA1 and BRCA2 Mutations
by
Hien C. Nguyen, Jefferson C. Frisbee and Krishna K. Singh
Hearts 2024, 5(1), 54-74; https://doi.org/10.3390/hearts5010005 - 23 Jan 2024
Cited by 1
Abstract
Germline mutations in Breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2) cause breast, ovarian, and other cancers, and the chemotherapeutic drug doxorubicin (Dox) is widely used to treat these cancers. However, Dox use is limited by the latent induction of severe
[...] Read more.
Germline mutations in Breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2) cause breast, ovarian, and other cancers, and the chemotherapeutic drug doxorubicin (Dox) is widely used to treat these cancers. However, Dox use is limited by the latent induction of severe cardiotoxicity known as Dox-induced cardiomyopathy, for which there are no specific treatments currently available. Dox is administered into the systemic circulation, where it readily translocates into sub-cellular compartments and disrupts the integrity of DNA. Accumulating evidence indicates that oxidative stress, DNA damage, inflammation, and apoptosis all play a central role in Dox-induced cardiomyopathy. The BRCA1 and BRCA2 proteins are distinct as they perform crucial yet separate roles in the homologous recombination repair of DNA double-strand breaks, thereby maintaining genomic integrity. Additionally, both BRCA1 and BRCA2 mitigate oxidative stress and apoptosis in both cardiomyocytes and endothelial cells. Accordingly, BRCA1 and BRCA2 are essential regulators of pathways that are central to the development of cardiomyopathy induced by Doxorubicin. Despite extensive investigations, there exists a gap in knowledge about the role of BRCA1 and BRCA2 in Doxorubicin-induced cardiomyopathy. Here, we review the previous findings and associations about the expected role and associated mechanisms of BRCA1 and 2 in Dox-induced cardiomyopathy and future perspectives.
Full article
(This article belongs to the Collection Feature Papers from Hearts Editorial Board Members)
►▼
Show Figures
Figure 1
Open AccessArticle
Sex and Ethnic Disparities during COVID-19 Pandemic among Acute Coronary Syndrome Patients
by
Abdulmajeed Alharbi, Ahmed Elzanaty, Mohammad Safi, Momin Shah, Halah Alfatlawi, Zachary Holtzapple, Abed Jabr and Ehab Eltahawy
Hearts 2024, 5(1), 45-53; https://doi.org/10.3390/hearts5010004 - 12 Jan 2024
Abstract
Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a global pandemic that emerged in 2019. During this period, a significant disparity in hospitalization and mortality rates emerged, particularly in terms of Ethnicity and sex. Notably, this study aims to examine the
[...] Read more.
Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a global pandemic that emerged in 2019. During this period, a significant disparity in hospitalization and mortality rates emerged, particularly in terms of Ethnicity and sex. Notably, this study aims to examine the influence of sex and Ethnicity on acute coronary syndrome outcomes, specifically during the global SARS-CoV-2 pandemic. Methods: This retrospective observational study analyzed adult patients hospitalized with a primary diagnosis of acute coronary syndrome in the United States in 2020. Primary outcomes included inpatient mortality and the time from admission to percutaneous coronary intervention (PCI). Secondary outcomes encompassed the length of stay and hospital costs. The National Inpatient Sample (NIS) database was utilized to identify and study patients in our test group. Results: A total of 779,895 patients hospitalized with a primary diagnosis of acute coronary syndrome in the year 2020 and 935,975 patients in 2019 were included in this study. Baseline findings revealed that inpatient mortality was significantly higher in 2020 compared to 2019, regardless of sex and Ethnicity (adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI) 1.12–1.23, p-value < 0.001). Concerning primary outcomes, there was no difference in inpatient mortality for hospitalized patients of different sexes between 2019 and 2020 (STEMI: aOR 1.05, 95% CI 0.96–1.14, p-value 0.22; NSTEMI/UA aOR 1.08, 95% CI 0.98–1.19, p-value 0.13). Regarding time to admission for PCI, NSTEMI/UA cases were found to be statistically significant in female patients compared to males (mean difference 0.06 days, 95% CI 0.02–0.10, p-value < 0.01) and African Americans compared to Caucasians (mean difference 0.13 days, 95% CI 0.06–0.19, p < 0.001). In terms of the length of stay, female patients had a shorter length of stay compared to males (mean difference −0.22, 95% CI −0.27 to −0.16, p-value < 0.01). Conclusions: As acute coronary syndrome is an urgent diagnosis, a global pandemic has the potential to exacerbate existing healthcare disparities related to sex and Ethnicity. This study did not reveal any difference in inpatient mortality, aligning with studies conducted prior to the pandemic. However, it highlighted significantly longer treatment times (admission to PCI) for NSTEMI/UA management in female and African American populations. These findings suggest that some disparities may have diminished during the pandemic year, warranting further research to confirm these trends in the years to come.
Full article
(This article belongs to the Special Issue World Heart Day 2023)
Open AccessArticle
Canonical Correlation for the Analysis of Lifestyle Behaviors versus Cardiovascular Risk Factors and the Prediction of Cardiovascular Mortality: A Population Study
by
Alessandro Menotti and Paolo Emilio Puddu
Hearts 2024, 5(1), 29-44; https://doi.org/10.3390/hearts5010003 - 3 Jan 2024
Abstract
Objectives: To assess the overall association of lifestyle behaviors with multiple cardiovascular risk factors and mortality. Material and Methods: In the Italian Rural Areas of the Seven Countries Study, involving 1712 middle-aged men (40–59 years) enrolled in 1960, smoking habits, physical activity, dietary
[...] Read more.
Objectives: To assess the overall association of lifestyle behaviors with multiple cardiovascular risk factors and mortality. Material and Methods: In the Italian Rural Areas of the Seven Countries Study, involving 1712 middle-aged men (40–59 years) enrolled in 1960, smoking habits, physical activity, dietary habits, marital status, and socioeconomic status (SES) were studied as possible determinants of 15 measurable risk factors (body mass index, tricipital and subscapular skinfold, arm circumference, systolic and diastolic blood pressure, heart rate, double product (systolic blood pressure × heart rate), vital capacity, forced expiratory volume, serum cholesterol, urine protein, urine glucose, corneal arcus and xanthelasma) using canonical correlation (CC). Results: The first CC had a value of 0.54 (R2 0.29, p < 0.0001). The role of marital status was marginal; that of a high SES was contrary to expectations. The strongest behaviors based on standardized CC coefficients were dietary habits and physical activity. The risk factors mostly associated with overall lifestyle behaviors were some anthropometric and cardiovascular measurements. The mean levels of risk factors distributed in tertile classes of the CC variate score of lifestyle behaviors were largely associated in a coherent and graded way with the expected relationship of behaviors versus risk factors. In a large series of Cox models, the CC variate scores were significantly associated with 50-year coronary heart disease (CHD) mortality and much less with stroke and other heart diseases of uncertain etiology. Conclusions: Lifestyle behaviors correlate well with cardiovascular risk factors associated with CHD mortality, and CC is a useful method of analysis to detect long-term impacting characteristics.
Full article
Open AccessArticle
X-ray-Based 3D Histology of Murine Hearts Using Contrast-Enhanced Microfocus Computed Tomography (CECT) and Cryo-CECT
by
Camille Pestiaux, Alice Marino, Lauriane Simal, Sandrine Horman, Romain Capoulade and Greet Kerckhofs
Hearts 2024, 5(1), 14-28; https://doi.org/10.3390/hearts5010002 - 23 Dec 2023
Cited by 1
Abstract
►▼
Show Figures
Cardiovascular diseases are the most common cause of death worldwide, and they still have dramatic consequences on the patients’ lives. Murine models are often used to study the anatomical and microstructural changes caused by the diseases. Contrast-enhanced microfocus computed tomography (CECT) is a
[...] Read more.
Cardiovascular diseases are the most common cause of death worldwide, and they still have dramatic consequences on the patients’ lives. Murine models are often used to study the anatomical and microstructural changes caused by the diseases. Contrast-enhanced microfocus computed tomography (CECT) is a new imaging technique for 3D histology of biological tissues. In this study, we confirmed the nondestructiveness of Hf-WD 1:2 POM-based CECT and cryogenic CECT (cryo-CECT) to image the heart in 3D. The influence of the image quality (i.e., acquisition time and spatial resolution) was assessed for the characterization of the heart structural constituents: heart integrity, the coronary blood vessels and the heart valves. Coronary blood vessels were visualized and segmented in murine hearts, allowing us to distinguish veins from arteries and to visualize the 3D spatial distribution of the right coronary artery and the left main coronary artery. Finally, to demonstrate the added value of 3D imaging, the thickness distribution of the two leaflets in the mitral valve and three cusps in the aortic valve was computed in 3D. This study corroborates the added value of CECT and cryo-CECT compared to classical 2D histology to characterize ex vivo the structural properties of murine hearts and paves the way for the detailed 3D (micro)structural analyses of future cardiovascular disease models obtained in mice and rats.
Full article
Figure 1
Open AccessArticle
Excellence in Heart Failure: A Multidisciplinary Program on Heart Failure Management for Improved Patient Outcome
by
Olga Sousa, Marta Ponte, Daniel Caeiro, Eulália Pereira, Marisa Silva, Sandra Pestana, Pedro Braga and Ricardo Fontes-Carvalho
Hearts 2024, 5(1), 1-13; https://doi.org/10.3390/hearts5010001 - 21 Dec 2023
Abstract
►▼
Show Figures
Chronic heart failure (HF) is the 21st-century cardiovascular epidemic, marked by recurrent hospitalizations and high mortality rates, and represents a considerable burden on Western societies. The complex care demands of HF patients require multidisciplinary approaches, aligning with contemporary guidelines. Accordingly, the Excellence in
[...] Read more.
Chronic heart failure (HF) is the 21st-century cardiovascular epidemic, marked by recurrent hospitalizations and high mortality rates, and represents a considerable burden on Western societies. The complex care demands of HF patients require multidisciplinary approaches, aligning with contemporary guidelines. Accordingly, the Excellence in Heart Failure Program, implemented in Portuguese tertiary hospitals, aims to establish multidisciplinary HF outpatient clinics in Portugal, improving patients’ clinical outcomes. Herein, the results of its pilot project are presented, showing that the implementation of the multidisciplinary clinic resulted in a minimal number of hospitalizations and emergency visits, with only one rehospitalization reported. In addition, patients in the Program experienced significant improvements in ejection fraction (EF) and NT-proBNP levels. Despite the limited power of the sample, these findings underscore the effectiveness of the Program in the management of Portuguese HF patients, particularly in the early discharge period after heart failure, when patients are most vulnerable.
Full article
Figure 1
Open AccessArticle
Mitochondrial DNA Haplogroups and Variants Predispose to Chagas Disease Cardiomyopathy
by
Frédéric Gallardo, Pauline Brochet, David Goudenège, João Paulo Silva Nunes, Pauline Andrieux, Barbara Maria Ianni, Amanda Farage Frade, Charles Mady, Ronaldo Honorato Barros Santos, Andreia Kuramoto, Samuel Steffen, Antonio Noedir Stolf, Pablo Pomerantzeff, Alfredo Inacio Fiorelli, Edimar Alcides Bocchi, Cristina Wide Pissetti, Bruno Saba, Fabrício C. Dias, Marcelo Ferraz Sampaio, Fabio Antônio Gaiotto, José Antonio Marin-Neto, Abílio Fragata, Ricardo Costa Fernandes Zaniratto, Sergio Siqueira, Giselle De Lima Peixoto, Fernando Bacal, Paula Buck, Rafael Ribeiro Almeida, Hui Tzu Lin-Wang, André Schmidt, Mario Hiroyuki Hirata, Eduardo Antonio Donadi, Alexandre Costa Pereira, Virmondes Rodrigues Junior, Martino Martinelli, Michel Naslavsky, Jorge Kalil, Vincent Procaccio, Edecio Cunha-Neto and Christophe Chevillardadd
Show full author list
remove
Hide full author list
Hearts 2023, 4(4), 97-117; https://doi.org/10.3390/hearts4040013 - 5 Dec 2023
Abstract
►▼
Show Figures
Cardiomyopathies are major causes of heart failure. Chagas disease (CD) is caused by the parasite Trypanosoma cruzi, and it is endemic in Central and South America. Thirty percent of cases evolve into chronic chagas cardiomyopathy (CCC), which has worse prognosis as compared
[...] Read more.
Cardiomyopathies are major causes of heart failure. Chagas disease (CD) is caused by the parasite Trypanosoma cruzi, and it is endemic in Central and South America. Thirty percent of cases evolve into chronic chagas cardiomyopathy (CCC), which has worse prognosis as compared with other cardiomyopathies. In vivo bioenergetic analysis and ex vivo proteomic analysis of myocardial tissues highlighted worse mitochondrial dysfunction in CCC, and previous studies identified nuclear-encoded mitochondrial gene variants segregating with CCC. Here, we assessed the role of the mitochondrial genome through mtDNA copy number variations and mtDNA haplotyping and sequencing from heart or blood tissues of severe, moderate CCC and asymptomatic/indeterminate Chagas disease as well as healthy controls as an attempt to help decipher mitochondrial-intrinsic genetic involvement in Chagas disease development. We have found that the mtDNA copy number was significantly lower in CCC than in heart tissue from healthy individuals, while blood mtDNA content was similar among asymptomatic Chagas disease, moderate, and severe CCC patients. An MtDNA haplogrouping study has indicated that African haplogroups were over represented in the Chagas subject groups in comparison with healthy Brazilian individuals. The European lineage is associated with protection against cardiomyopathy and the macro haplogroup H is associated with increased risk towards CCC. Using mitochondria DNA sequencing, 84 mtDNA-encoded protein sequence pathogenic variants were associated with CCC. Among them, two variants were associated to left ventricular non-compaction and two to hypertrophic cardiomyopathy. The finding that mitochondrial protein-coding SNPs and mitochondrial haplogroups associate with risk of evolving to CCC is consistent with a key role of mitochondrial DNA in the development of chronic chagas disease cardiomyopathy.
Full article
Figure 1
Open AccessEditorial
The Challenges in Managing Peripheral Arterial Disease Complications
by
Federico Biscetti and Andrea Flex
Hearts 2023, 4(4), 94-96; https://doi.org/10.3390/hearts4040012 - 1 Dec 2023
Abstract
Peripheral arterial disease (PAD) afflicts millions of people across the globe, with the severe form often culminating in chronic limb-threatening ischemia (CLTI) [...]
Full article
Open AccessReview
Deciphering the Involvement of the Epicardium in Cardiac Diseases
by
Rita Carmona, Carmen López-Sánchez, Virginio García-Martinez, Virginio García-López, Ramón Muñoz-Chápuli, Estefanía Lozano-Velasco and Diego Franco
Hearts 2023, 4(4), 81-93; https://doi.org/10.3390/hearts4040011 - 10 Nov 2023
Abstract
The epicardium is a very dynamic cardiac layer with pivotal contributions during cardiogenesis, acting in the postnatal period as an apparently dormant single-cell layer. In mammalian embryos, the epicardium, which originates form the proepicardium, translocates into the pericardial cavity and subsequently rests on
[...] Read more.
The epicardium is a very dynamic cardiac layer with pivotal contributions during cardiogenesis, acting in the postnatal period as an apparently dormant single-cell layer. In mammalian embryos, the epicardium, which originates form the proepicardium, translocates into the pericardial cavity and subsequently rests on the surface of the myocardium. Later, it gives rise to the epicardium-derived cells, which migrate into subepicardial space, invade the developing myocardium, promoting its growth, and contribute to different cell types. Anomalies in the process of epicardial development, the generation of epicardium-derived cells and their signaling mechanisms in different experimental models lead to defective cardiac development, reminiscent of human congenital heart diseases. Furthermore, recent studies have reported that epicardial derivates in adults, i.e., epicardial adipose tissue, are associated with electrophysiological cardiovascular anomalies. Herein, we provide a state-of-the-art review focusing on both congenital and adult heart diseases associated with epicardial development.
Full article
(This article belongs to the Special Issue The Epicardium: Development, Pathology, and Regeneration)
►▼
Show Figures
Figure 1
Open AccessEditorial
Deciphering the Intricate Molecular Bases of Atrial Fibrillation
by
Diego Franco
Hearts 2023, 4(4), 78-80; https://doi.org/10.3390/hearts4040010 - 10 Nov 2023
Abstract
Atrial fibrillation (AF) is the most prevalent electrophysiological disorder in humans [...]
Full article
Highly Accessed Articles
Latest Books
E-Mail Alert
News
Topics
Conferences
Special Issues
Special Issue in
Hearts
The Epicardium: Development, Pathology, and Regeneration
Guest Editors: Diego Franco Jaime, Rita Carmona, Carmen Lopez-SanchezDeadline: 20 June 2024
Special Issue in
Hearts
Current Developments in Coronary Artery Bypass Grafting
Guest Editor: Matthias ThielmannDeadline: 15 September 2024
Special Issue in
Hearts
Selected Papers from 72nd International Congress European Society of Cardiovascular Surgery
Guest Editors: Matthias Thielmann, Ergun Demirsoy, Igor B. KončarDeadline: 30 November 2024
Topical Collections
Topical Collection in
Hearts
Feature Papers from Hearts Editorial Board Members
Collection Editor: Matthias Thielmann