Previous Issue
Volume 6, June
 
 

Hearts, Volume 6, Issue 3 (September 2025) – 8 articles

  • Issues are regarded as officially published after their release is announced to the table of contents alert mailing list.
  • You may sign up for e-mail alerts to receive table of contents of newly released issues.
  • PDF is the official format for papers published in both, html and pdf forms. To view the papers in pdf format, click on the "PDF Full-text" link, and use the free Adobe Reader to open them.
Order results
Result details
Select all
Export citation of selected articles as:
8 pages, 204 KB  
Article
Anxiety and Depression Symptoms in Children and Adolescents with Congenital Heart Disease
by Isabel Uphoff, Charlotte Schöneburg, Renate Oberhoffer-Fritz, Peter Ewert and Jan Müller
Hearts 2025, 6(3), 23; https://doi.org/10.3390/hearts6030023 - 15 Aug 2025
Viewed by 198
Abstract
Background: Congenital heart disease (CHD) is associated with an increased risk of anxiety and depression in adults. However, little is known about the mental health of children and adolescents with CHD. The aim of this study was to assess differences in anxiety and [...] Read more.
Background: Congenital heart disease (CHD) is associated with an increased risk of anxiety and depression in adults. However, little is known about the mental health of children and adolescents with CHD. The aim of this study was to assess differences in anxiety and depression symptoms between children and adolescents with CHD and healthy controls. Methods: A total of 232 children and adolescents (age 7–18 years; mean age 13.5 ± 2.7 years, 50.9% female) were enrolled, consisting of 116 patients with CHD and 116 age- and sex-matched healthy controls. Participants were recruited during routine medical examinations at the German Heart Center and Munich schools, respectively. The Beck Anxiety Inventory (BAI) and the Depression Inventory for Youth (BDI-Y) were used to assess anxiety and depression symptoms. Results: The CHD cohort included patients with right heart obstruction (11.2%), left heart obstruction (19.8%), isolated shunts (15.5%), transposition of the great arteries (14.7%), univentricular heart (14.7%), and other defects (24.1%). According to published cut-off values, at least a mild form of anxiety was present in 46.5% CHD patients. However, no significant differences were observed between the CHD group and healthy controls in either the BDI-Y score (CHD: 7.9 ± 7.7 vs. controls: 8.6 ± 8.5; p = 0.569) or the BAI score (CHD: 9.3 ± 8.6 vs. controls: 9.3 ± 10.3; p = 0.429). The complexity of the heart defect was not associated with BAI scores (simple: 5.9 ± 5.7; moderate: 11.1 ± 8.1; complex: 9.3 ± 9.0; p = 0.073) or BDI-Y scores (simple: 7.4 ± 7.5; moderate: 9.0 ± 7.1; complex: 7.0 ± 7.7; p = 0.453). No significant differences in BAI (p = 0.141) or BDI-Y (p = 0.326) scores were found by type of heart defect. Conclusions: Children and adolescents with CHD did not exhibit significantly higher levels of depression or anxiety symptoms compared to healthy controls. Nevertheless, given the increased psychological risk observed in adults with CHD, ongoing mental health monitoring remains important to enable early identification and timely intervention. Further research, particularly through longitudinal studies, is needed to monitor mental health trajectories over time and to identify early predictors of psychological vulnerability in this population. Full article
16 pages, 1255 KB  
Systematic Review
Systematic Review and Meta-Analysis of Cardiac MRI T1 and ECV Measurements in Pre-Heart Failure Populations
by Robert S. Doyle, Ross Walsh, Jamie Walsh, Hugo C. Temperley, John McCormick and Gerard Giblin
Hearts 2025, 6(3), 22; https://doi.org/10.3390/hearts6030022 - 13 Aug 2025
Viewed by 468
Abstract
Background/Objectives: Heart failure (HF) often develops from a prolonged asymptomatic phase where early detection could prevent progression. Pre-heart failure (pre-HF) populations—those with risk factors (Stage A) or subclinical myocardial changes (Stage B)—are critical for intervention. Cardiac magnetic resonance (CMR) with T1 and extracellular [...] Read more.
Background/Objectives: Heart failure (HF) often develops from a prolonged asymptomatic phase where early detection could prevent progression. Pre-heart failure (pre-HF) populations—those with risk factors (Stage A) or subclinical myocardial changes (Stage B)—are critical for intervention. Cardiac magnetic resonance (CMR) with T1 and extracellular volume (ECV) mapping offers a non-invasive approach to detect early myocardial changes in these groups. This systematic review evaluates the role of T1 and ECV mapping in pre-HF populations, focusing on their diagnostic and prognostic utility. Methods: A systematic search of PubMed, EMBASE, and Cochrane was conducted up to April 2025, identifying 17 studies that met inclusion criteria. Data was extracted directly into Excel, and methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) for cohort and cross-sectional studies and AMSTAR-2 for systematic reviews and meta-analyses. A meta-analysis was performed using Review Manager (RevMan) to compare T1 and ECV values between pre-HF and control groups. Results: Studies consistently reported elevated T1 (989.6–1415.41 milliseconds) and ECV (25.7–42.81%) in pre-HF groups compared to controls (T1: 967–1310.63 ms, ECV: 23.5–29.9%). Meta-analysis showed a significant increase in T1 (MD: 27.62 ms, 95% CI: 8.04–47.19, p < 0.006) and ECV (MD: 2.97%, 95% CI: 1.88–4.06, p < 0.00001) in pre-HF groups. RQS scores ranged from 17.2% to 77.8% (mean: 37.9%), and NOS scores ranged from 5 to 8 (mean: 6.2), reflecting variability in study quality. The AMSTAR-2 rating for the systematic review was moderate. Conclusions: T1 and ECV mapping enhance CMR-based detection of early myocardial changes in pre-HF, offering a promising non-invasive approach to predict HF risk. However, variability in study quality, small sample sizes, and methodological inconsistencies limit generalisability. Future research should focus on standardised protocols, prospective designs, and multi-center studies to integrate these techniques into clinical practice, potentially guiding preventive therapies such as SGLT2is and tafamidis. Full article
Show Figures

Figure 1

16 pages, 713 KB  
Systematic Review
Machine Learning Application in Different Imaging Modalities for Detection of Obstructive Coronary Artery Disease and Outcome Prediction: A Systematic Review and Meta-Analysis
by Peter McGranaghan, Doreen Schoeppenthau, Antonia Popp, Anshul Saxena, Sharat Kothakapu, Muni Rubens, Gabriel Jiménez, Pablo Gordillo, Emir Veledar, Alaa Abd El Al, Anja Hennemuth, Volkmar Falk and Alexander Meyer
Hearts 2025, 6(3), 21; https://doi.org/10.3390/hearts6030021 - 7 Aug 2025
Viewed by 1647
Abstract
Background/Objectives: Invasive coronary angiography (ICA) is the gold standard for the diagnosis of coronary artery disease (CAD), with various non-invasive imaging modalities also available. Machine learning (ML) methods are increasingly applied to overcome the limitations of diagnostic imaging by improving accuracy and observer [...] Read more.
Background/Objectives: Invasive coronary angiography (ICA) is the gold standard for the diagnosis of coronary artery disease (CAD), with various non-invasive imaging modalities also available. Machine learning (ML) methods are increasingly applied to overcome the limitations of diagnostic imaging by improving accuracy and observer independent performance. Methods: This meta-analysis (PRISMA method) summarizes the evidence for ML-based analyses of coronary imaging data from ICA, coronary computed tomography angiography (CT), and nuclear stress perfusion imaging (SPECT) to predict clinical outcomes and performance for precise diagnosis. We searched for studies from Jan 2012–March 2023. Study-reported c index values and 95% confidence intervals were used. Subgroup analyses separated models by outcome. Combined effect sizes using a random-effects model, test for heterogeneity, and Egger’s test to assess publication bias were considered. Results: In total, 46 studies were included (total subjects = 192,561; events = 31,353), of which 27 had sufficient data. Imaging modalities used were CT (n = 34), ICA (n = 7) and SPECT (n = 5). The most frequent study outcome was detection of stenosis (n = 11). Classic deep neural networks (n = 12) and convolutional neural networks (n = 7) were the most used ML models. Studies aiming to diagnose CAD performed best (0.85; 95% CI: 82, 89); models aiming to predict clinical outcomes performed slightly lower (0.81; 95% CI: 78, 84). The combined c-index was 0.84 (95% CI: 0.81–0.86). Test of heterogeneity showed a high variation among studies (I2 = 97.2%). Egger’s test did not indicate publication bias (p = 0.485). Conclusions: The application of ML methods to diagnose CAD and predict clinical outcomes appears promising, although there is lack of standardization across studies. Full article
Show Figures

Graphical abstract

10 pages, 223 KB  
Article
Lipoprotein(a) Levels in Heart Failure with Reduced and Preserved Ejection Fraction: A Retrospective Analysis
by Alaukika Agarwal, Rubab Sohail and Supreeti Behuria
Hearts 2025, 6(3), 20; https://doi.org/10.3390/hearts6030020 - 6 Aug 2025
Viewed by 298
Abstract
Background/Objectives: While elevated Lp(a) levels are associated with incident heart failure development, the role of Lp(a) in established heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF) remains unexplored. Methods: We conducted a retrospective analysis of 387 [...] Read more.
Background/Objectives: While elevated Lp(a) levels are associated with incident heart failure development, the role of Lp(a) in established heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF) remains unexplored. Methods: We conducted a retrospective analysis of 387 heart failure patients from our institutional database (January 2018–June 2024). Patients were categorized as HFrEF (n = 201) or HFpEF (n = 186) using ICD-10 codes. Categorical variables were compared between heart failure types using the Chi-square test or Fisher’s Exact test, and continuous variables were compared using the two-sample t-test or Wilcoxon rank-sum test, as appropriate. Logistic regression was utilized to assess heart failure type as a function of Lp(a) levels, adjusting for covariates. Spearman correlation assessed relationships between Lp(a) and pro-BNP levels. Results: Despite significant demographic and clinical differences between HFrEF and HFpEF patients, Lp(a) concentrations showed no significant variation between groups. Median Lp(a) levels were 60.9 nmol/dL (IQR: 21.9–136.7) in HFrEF versus 45.0 nmol/dL (IQR: 20.1–109.9) in HFpEF (p = 0.19). After adjusting for demographic and clinical covariates, Lp(a) showed no association with heart failure subtype (OR: 1.001, 95% CI: 0.99–1.004; p = 0.59). Conclusions: Lp(a) levels do not differ significantly between HFrEF and HFpEF phenotypes, suggesting possible shared pathophysiological mechanisms rather than phenotype-specific biomarker properties. These preliminary findings may support unified screening and treatment strategies for elevated Lp(a) across heart failure, pending confirmation in larger studies. Full article
14 pages, 320 KB  
Article
Evaluating Large Language Models in Cardiology: A Comparative Study of ChatGPT, Claude, and Gemini
by Michele Danilo Pierri, Michele Galeazzi, Simone D’Alessio, Melissa Dottori, Irene Capodaglio, Christian Corinaldesi, Marco Marini and Marco Di Eusanio
Hearts 2025, 6(3), 19; https://doi.org/10.3390/hearts6030019 - 19 Jul 2025
Viewed by 2435
Abstract
Background: Large Language Models (LLMs) such as ChatGPT, Claude, and Gemini are being increasingly adopted in medicine; however, their reliability in cardiology remains underexplored. Purpose of the study: To compare the performance of three general-purpose LLMs in response to cardiology-related clinical queries. Study [...] Read more.
Background: Large Language Models (LLMs) such as ChatGPT, Claude, and Gemini are being increasingly adopted in medicine; however, their reliability in cardiology remains underexplored. Purpose of the study: To compare the performance of three general-purpose LLMs in response to cardiology-related clinical queries. Study design: Seventy clinical prompts stratified by diagnostic phase (pre or post) and user profile (patient or physician) were submitted to ChatGPT, Claude, and Gemini. Three expert cardiologists, who were blinded to the model’s identity, rated each response on scientific accuracy, completeness, clarity, and coherence using a 5-point Likert scale. Statistical analysis included Kruskal–Wallis tests, Dunn’s post hoc comparisons, Kendall’s W, weighted kappa, and sensitivity analyses. Results: ChatGPT outperformed both Claude and Gemini across all criteria (mean scores: 3.7–4.2 vs. 3.4–4.0 and 2.9–3.7, respectively; p < 0.001). The inter-rater agreement was substantial (Kendall’s W: 0.61–0.71). Pre-diagnostic and patient-framed prompts received higher scores than post-diagnostic and physician-framed ones. Results remained robust across sensitivity analyses. Conclusions: Among the evaluated LLMs, ChatGPT demonstrated superior performance in generating clinically relevant cardiology responses. However, none of the models achieved maximal ratings, and the performance varied by context. These findings highlight the need for domain-specific fine-tuning and human oversight to ensure a safe clinical deployment. Full article
Show Figures

Graphical abstract

14 pages, 525 KB  
Review
Hypertensive Left Ventricular Hypertrophy: Pathogenesis, Treatment, and Health Disparities
by Sherldine Tomlinson
Hearts 2025, 6(3), 18; https://doi.org/10.3390/hearts6030018 - 17 Jul 2025
Viewed by 3083
Abstract
Hypertensive left ventricular hypertrophy (LVH) is an ominous cardiovascular sequel to chronic hypertension, marked by structural and functional alterations in the heart. Identified as a significant risk factor for adverse cardiovascular outcomes, LVH is typically detected through echocardiography and is characterized by pathological [...] Read more.
Hypertensive left ventricular hypertrophy (LVH) is an ominous cardiovascular sequel to chronic hypertension, marked by structural and functional alterations in the heart. Identified as a significant risk factor for adverse cardiovascular outcomes, LVH is typically detected through echocardiography and is characterized by pathological thickening of the left ventricular wall. This hypertrophy results from chronic pressure overload (increased afterload), leading to concentric remodelling, or from increased diastolic filling (preload), contributing to eccentric changes. Apoptosis, a regulated process of cell death, plays a critical role in the pathogenesis of LVH by contributing to cardiomyocyte loss and subsequent cardiac dysfunction. Given the substantial clinical implications of LVH for cardiovascular health, this review critically examines the role of cardiomyocyte apoptosis in its disease progression, evaluates the impact of pharmacological interventions, and highlights the necessity of a comprehensive, multifaceted treatment approach for the prevention and management of hypertensive LVH. Finally, we address the health disparities associated with LVH, with particular attention to the disproportionate burden faced by African Americans and other Black communities, as this remains a key priority in advancing equity in cardiovascular care. Full article
Show Figures

Graphical abstract

18 pages, 1726 KB  
Review
A Contemporary Review of Clinical Manifestations, Evaluation, and Management of Cardiac Complications of Iron Overload
by Ankit Agrawal, Joseph El Dahdah, Elio Haroun, Aro Daniela Arockiam, Ahmad Safdar, Sharmeen Sorathia, Tiffany Dong, Brian Griffin and Tom Kai Ming Wang
Hearts 2025, 6(3), 17; https://doi.org/10.3390/hearts6030017 - 3 Jul 2025
Viewed by 1965
Abstract
Cardiac iron overload is a rare but important adverse consequence of systemic iron overload, marked by the abnormal accumulation of iron in the myocardium. It is most typically caused by hereditary hemochromatosis (mutations in the HFE gene) or secondary iron overload conditions, such [...] Read more.
Cardiac iron overload is a rare but important adverse consequence of systemic iron overload, marked by the abnormal accumulation of iron in the myocardium. It is most typically caused by hereditary hemochromatosis (mutations in the HFE gene) or secondary iron overload conditions, such as transfusion-dependent anemias. Excess iron in the myocardium causes oxidative stress, cardiomyocyte damage, and progressive fibrosis, ultimately leading to cardiomyopathy. Clinical manifestations are diverse and may include heart failure, arrhythmias, and restrictive or dilated cardiomyopathy. Given the worsened prognosis with cardiac involvement, timely diagnosis and management are essential to improve clinical outcomes. This review provides a contemporary overview of the cardiovascular complications associated with iron overload, including clinical manifestations, diagnostic approaches, and treatment options. Full article
Show Figures

Figure 1

9 pages, 200 KB  
Article
Use of Cangrelor in Patients Undergoing Percutaneous Coronary Intervention: Insights and Outcomes from District General Hospital
by Ibrahim Antoun, Sotirios Dardas, Falik Sher, Mueed Akram, Navid Munir, Georgia R. Layton, Mustafa Zakkar, Kamal Chitkara, Riyaz Somani and Andre Ng
Hearts 2025, 6(3), 16; https://doi.org/10.3390/hearts6030016 - 22 Jun 2025
Viewed by 521
Abstract
Background/Objectives: Cangrelor, an intravenous P2Y12 inhibitor, is increasingly used during percutaneous coronary intervention (PCI) for rapid and reversible platelet inhibition in patients unable to take oral antiplatelet agents, particularly in emergencies such as ST-elevation myocardial infarction (STEMI), cardiac arrest, or cardiogenic shock. [...] Read more.
Background/Objectives: Cangrelor, an intravenous P2Y12 inhibitor, is increasingly used during percutaneous coronary intervention (PCI) for rapid and reversible platelet inhibition in patients unable to take oral antiplatelet agents, particularly in emergencies such as ST-elevation myocardial infarction (STEMI), cardiac arrest, or cardiogenic shock. This single-centre study evaluates cangrelor and outcomes in a non-surgical centre. Methods: Between June 2017 and December 2021, all the patients for whom cangrelor was used at a district general hospital (DGH) in the UK were included in this study. Data collection included baseline characteristics, admission, procedural details, and patient outcomes. The primary outcome was a composite of all-cause mortality, bleeding, and cardiovascular events, including myocardial infarction, stent thrombosis, and stroke, within 48 h. Secondary outcomes included predictors of the composite outcome at 48 h. Results: During the study period, cangrelor was administered peri-procedurally to 93 patients. Males comprised 85% of the patients; the mean age was 65.5 ± 10.6 years. A total of 1 patient (1.1%) had a cardiovascular event within 48 h of cangrelor administration, whereas all-cause mortality occurred in 17 patients (18%) within 48 h. No major bleeding events were noted at 48 h following cangrelor administration. Regression analysis did not find predictors of composite outcomes at 48 h. Conclusions: Cangrelor offers a potential alternative to oral P2Y12 inhibitors in specific high-risk scenarios. Further research is needed to validate its role in broader populations. Full article
Previous Issue
Back to TopTop