Journal of Cardiovascular Development and Disease

11 pages, 752 KiB

Open AccessArticle

Impact of the Presence of Chronic Total Occlusions on the Survival of Patients Treated with Coronary Artery Bypass Grafting

by Albi Fagu, Joseph Kletzer, Franziska Marie Ernst, Laurin Micek, Stoyan Kondov, Maximilian Kreibich, Clarence Pingpoh, Matthias Siepe, Martin Czerny and Tim Berger

J. Cardiovasc. Dev. Dis. 2025, 12(7), 243; https://doi.org/10.3390/jcdd12070243 - 25 Jun 2025

Abstract

Although chronic total occlusions (CTO) are a common finding in patients treated with coronary artery bypass grafting (CABG), it is still not clear how their presence impacts the long-term outcomes achieved with surgery. We aimed to investigate the impact of CTO on the [...] Read more.

Although chronic total occlusions (CTO) are a common finding in patients treated with coronary artery bypass grafting (CABG), it is still not clear how their presence impacts the long-term outcomes achieved with surgery. We aimed to investigate the impact of CTO on the long-term results of patients with coronary artery disease who underwent CABG. Patients from 2005 to 2023 operated on at the University Hospital Freiburg-Bad Krozingen were analyzed. The primary outcome was all-cause mortality after 3-, 5-, and 10 years. The secondary outcome was the need for coronary reintervention in the follow-up period. Propensity score matching and multivariable Cox regression were performed, and Kaplan–Meier curves were used to graphically display the outcomes for the two groups. Of the 3424 patients included in the analysis, 1784 (52%) were categorized as CTO and 1640 (48%) were categorized as no-CTO. After propensity scoring, 1232 pairs were successfully matched. The 3-, 5-, and 10-year all-cause mortality was significantly higher in patients with CTO (p = 0.028; p < 0.001; p < 0.001). The need for coronary reintervention after 3-, 5-, and 10 years was comparable in both groups. In addition, multivariable Cox Regression showed that CTO presence (HR 1.220, 95% CI 1.047–1.420, p = 0.010) was an independent predictor of 10-year mortality. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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1 pages, 155 KiB

Open AccessCorrection

Correction: Bhutani et al. Doxorubicin-Induced Cardiotoxicity: A Comprehensive Update. J. Cardiovasc. Dev. Dis. 2025, 12, 207

by Vasvi Bhutani, Fahimeh Varzideh, Scott Wilson, Urna Kansakar, Stanislovas S. Jankauskas and Gaetano Santulli

J. Cardiovasc. Dev. Dis. 2025, 12(7), 242; https://doi.org/10.3390/jcdd12070242 - 25 Jun 2025

Abstract

In the original publication [...] Full article

17 pages, 1976 KiB

Open AccessArticle

Feasibility, Added Value, and Radiation Dose of Combined Coronary CT Angiography and Stress Dynamic CT Myocardial Perfusion Imaging in Moderate Coronary Artery Disease: A Real-World Study

by Marco Fogante, Enrico Paolini, Fatjon Cela, Paolo Esposto Pirani, Liliana Balardi, Gian Piero Perna and Nicolò Schicchi

J. Cardiovasc. Dev. Dis. 2025, 12(7), 241; https://doi.org/10.3390/jcdd12070241 - 24 Jun 2025

Abstract

Objective: We aimed to evaluate the feasibility, added value, and radiation dose of coronary computed tomography angiography (CCTA) and stress dynamic CT myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD) in a real-world setting. Materials and Methods: This retrospective study [...] Read more.

Objective: We aimed to evaluate the feasibility, added value, and radiation dose of coronary computed tomography angiography (CCTA) and stress dynamic CT myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD) in a real-world setting. Materials and Methods: This retrospective study included 65 patients (mean age: 51.2 ± 11.5 years; 21 female) with moderate CAD, selected from the Radiological Database of our hospital between May 2022 and December 2024. All patients underwent CCTA and stress dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used for CT-MPI with 60 mL of contrast (iopamidol, 370 mg iodine/mL) administered at a flow rate of 6 mL/s. The mean myocardial blood flow (MBF) and other quantitative parameters were measured for both CAD and reference segments (RSs). A 17-segment-based analysis was employed (excluding the apex). The MBF ratio, defined as the mean MBF value of CAD segments divided by that of RS, was used with a cut-off value of 0.85 to distinguish hypoperfused from non-hypoperfused segments within CAD territories. Non-parametric statistical tests were applied. Results: A total of 1040 segments were evaluated. In 62 segments, the mean MBF of CAD territories was found to have decreased. The mean MBF and myocardial blood volume (MBV) in hypoperfused CAD segments were 65.1 ± 19.8 mL/100 mL/min and 14.5 ± 2.7 mL/100 mL, respectively, both significantly lower compared to non-hypoperfused CAD segments and RSs (p < 0.001). The mean effective dose of the protocol was 6.3 ± 1.4 mSv, corresponding to an estimated individual lifetime cancer risk of approximately 0.06% per test, based on BEIR VII Phase 2 modeling. This risk is cumulative, with repeat testing over a 10-year period potentially increasing lifetime cancer risk in proportion to total radiation exposure. The mean total examination time was 26 ± 4 min. Conclusion: The combined CCTA and dynamic CT-MPI protocol is feasible in real-world clinical practice and offers a comprehensive morphological and functional assessment of moderate CAD, with a manageable radiation dose and examination time. Full article

(This article belongs to the Section Imaging)

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21 pages, 316 KiB

Open AccessReview

Prediction of Right Heart Failure in LVAD Candidates: Current Approaches and Future Directions

by Frederick Vogel, Zachary W. Sollie, Arman Kilic and Ethan Kung

J. Cardiovasc. Dev. Dis. 2025, 12(7), 240; https://doi.org/10.3390/jcdd12070240 - 23 Jun 2025

Abstract

Right heart failure is a condition where the right ventricle fails to pump blood into the pulmonary artery, and, in turn, the lungs. This condition frequently presents after the implantation of a left ventricular assist device (LVAD). Ventricular assist candidates who have LVADs [...] Read more.

Right heart failure is a condition where the right ventricle fails to pump blood into the pulmonary artery, and, in turn, the lungs. This condition frequently presents after the implantation of a left ventricular assist device (LVAD). Ventricular assist candidates who have LVADs implanted possess various pathophysiological and cardiovascular features that contribute to the later development of RHF. With LVADs serving as bridge-to-transplantation, bridge-to-candidacy, and destination therapies, it is imperative that the pre-operative indicators of RHF are identified and assessed. Multiple predictive models and parameters have been developed to quantify the risk of post-LVAD right heart failure. Clinical, laboratory, hemodynamic, and echocardiographic parameters have all been used to develop these predictive approaches. RHF remains a major cause of morbidity and mortality after LVAD implantation. Predicting RHF helps clinicians assess treatment options, including biventricular support or avoiding high-risk surgery. In our review, we noted the varying definitions for RHF in recent models, which affected respective predictive accuracies. The pulmonary arterial pulsatile index (PAPi) and right ventricular longitudinal strain parameters were noted for their potential to enhance current models incrementally. Meanwhile, mechanistic and machine learning approaches present a more fundamental shift in the approach to making progress in this field. Full article

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15 pages, 558 KiB

Open AccessArticle

Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes

by Angelo M. Dell’Aquila, Konrad Wisniewski, Adrian-Iustin Georgevici, Gábor Szabó, Francesco Onorati, Till J. Demal, Andreas Rukosujew, Sven Peterss, Caroline Radner, Joscha Buech, Antonio Fiore, Andrea Perrotti, Angel G. Pinto, Javier Rodriguez Lega, Marek Pol, Petr Kacer, Enzo Mazzaro, Giuseppe Gatti, Igor Vendramin, Daniela Piani, Luisa Ferrante, Mauro Rinaldi, Eduard Quintana, Robert Pruna-Guillen, Dario Di Perna, Zein El-Dean, Hiwa Sherzad, Giovanni Mariscalco, Mark Field, Amer Harky, Manoj Kuduvalli, Matteo Pettinari, Stefano Rosato, Tatu Juvonen, Timo Mäkikallio, Lenard Conradi, Giorgio Mastroiacovo and Fausto Biancari Show full author list Hide full author list

J. Cardiovasc. Dev. Dis. 2025, 12(7), 239; https://doi.org/10.3390/jcdd12070239 - 23 Jun 2025

Abstract

Objectives: Several conditions associated with type A aortic dissection may require preoperative invasive mechanical ventilation (IMV). The current literature lacks data on this subset of patients’ prevalence and postoperative outcomes. This study aims to investigate this unexplored issue in a multicenter European registry. [...] Read more.

Objectives: Several conditions associated with type A aortic dissection may require preoperative invasive mechanical ventilation (IMV). The current literature lacks data on this subset of patients’ prevalence and postoperative outcomes. This study aims to investigate this unexplored issue in a multicenter European registry. Methods: Data from 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD) were the subject of this analysis. Bootstrapped Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was performed for variable selection to identify key predictors of hospital death. In the second step, a multilevel multivariable logistic regression (MMLR) was carried out, given the clustered structure of the data. Results: A total of 346 (9.3%) out of 3735 patients required preoperative IMV. Compared to the non-IMV patients, patients requiring IMV had a significantly higher rate of organ malperfusion (52% vs. 35%, p < 0.001) and a higher proportion of tears in the aortic root (p = 0.048). The in-hospital mortality rate among IMV patients was 38% vs. 15% in non-IMV patients (p < 0.001), without a difference in post-discharge survival (p = 0.84). At the MMLR, patients who required IMV had 135% higher odds of in-hospital death compared to the remaining patients. IMV yielded the second highest odds in the prediction model for in-hospital mortality (OR 2.13, CI 1.60 to 2.85, p < 0.001). Among IMV patients, the extension of surgery to the aortic arch was significantly associated with increased in-hospital mortality (p < 0.001, OR 2.98). In multivariable analysis, preoperative IMV was independently associated with increased odds of in-hospital mortality. Conclusions: The need for invasive mechanical ventilation before surgical repair for type A aortic dissection is not infrequent. In this subpopulation, the in-hospital mortality rate was twofold compared to patients who did not require IMV. The awareness of the preoperative risk profile and outcomes of this subset of patients should urge surgeons to tailor the surgical strategy more appropriately to improve the immediate postoperative results. Full article

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19 pages, 334 KiB

Open AccessReview

Hemodynamic Definitions, Phenotypes, Pathophysiology, and Evaluation of Pulmonary Hypertension Related to Left Heart Disease

by Elizabeth C. Ghandakly, Akshat Banga and Roop Kaw

J. Cardiovasc. Dev. Dis. 2025, 12(7), 238; https://doi.org/10.3390/jcdd12070238 - 22 Jun 2025

Abstract

Pulmonary hypertension (PH) can develop from multiple etiologic mechanisms and disease states. Of all such conditions, left-sided heart disease (LHD) is commonly understood to be the most common etiology or mechanism. Given the widespread prevalence of left heart disease and the prognostic implications [...] Read more.

Pulmonary hypertension (PH) can develop from multiple etiologic mechanisms and disease states. Of all such conditions, left-sided heart disease (LHD) is commonly understood to be the most common etiology or mechanism. Given the widespread prevalence of left heart disease and the prognostic implications of PH, early diagnosis is imperative. More recently, the diagnostic cut-offs for mean pulmonary arterial pressure as well as peripheral vascular resistance have been lowered to achieve this objective. Despite these revised standards, the current indications for right heart catheterization are mostly aimed at identifying advanced disease. Proven vasodilator therapies for pulmonary arterial hypertension have so far not shown a meaningful role in the management of PH in LHD. This is largely related to the fact that multiple mechanisms and co-morbidities can independently lead to the development of PH in an individual patient. Understanding and identifying those phenotypes remain important in devising future treatment strategies. Molecular pathways that eventually lead to irreversibility of PH can provide another frontier in the pharmacologic management of PH in LHD. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Pulmonary Hypertension)

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24 pages, 1766 KiB

Open AccessArticle

An Analysis of Arterial Pulse Wave Time Features and Pulse Wave Velocity Calculations Based on Radial Electrical Bioimpedance Waveforms in Patients Scheduled for Coronary Catheterization

by Kristina Lotamõis, Tiina Uuetoa, Andrei Krivošei, Paul Annus, Margus Metshein, Marek Rist, Sulev Margus, Mart Min and Gert Tamberg

J. Cardiovasc. Dev. Dis. 2025, 12(7), 237; https://doi.org/10.3390/jcdd12070237 - 20 Jun 2025

Abstract

The monitoring of peripheral electrical bioimpedance (EBI) variations is a promising method that has the potential to replace invasive or burdensome techniques for cardiovascular measurements. Segmental or continuous recording of peripheral pulse waves can serve as a basis for calculating prognostic markers like [...] Read more.

The monitoring of peripheral electrical bioimpedance (EBI) variations is a promising method that has the potential to replace invasive or burdensome techniques for cardiovascular measurements. Segmental or continuous recording of peripheral pulse waves can serve as a basis for calculating prognostic markers like pulse wave velocity (PWV) or include parameters such as pulse transit time (PTT) or pulse arrival time (PAT) for noninvasive blood pressure (BP) estimation, as well as potentially novel cardiovascular risk indicators. However, several technical, analytical, and interpretative aspects need to be resolved before the EBI method can be adopted in clinical practice. Our goal was to investigate and improve the application of EBI, executing its comparison with other cardiovascular assessment methods in patients hospitalized for coronary catheterization procedures. Methods: We analyzed data from 44 non-acute patients aged 45–74 years who were hospitalized for coronary catheterization at East Tallinn Central Hospital between 2020 and 2021. The radial EBI and electrocardiogram (ECG) were measured simultaneously with central and contralateral pressure curves. The Savitzky–Golay filter was used for signal smoothing. The Hankel matrix decomposer was applied for the extraction of cardiac waveforms from multi-component signals. After extracting the cardiac component, a period detection algorithm was applied to EBI and blood pressure curves. Results: Seven points of interest were detected on the pressure and EBI curves, and four with good representativeness were selected for further analysis. The Spearman correlation coefficient was low for all but the central and distal pressure curve systolic upstroke time points. A high positive correlation was found between PWV measured both invasively and with EBI. The median value of complimentary pulse wave velocity (CPWV), a parameter proposed in the paper, was significantly lower in patients with normal coronaries compared to patients with any stage of coronary disease. Conclusions: With regard to wearable devices, the EBI-derived PAT can serve as a substrate for PWV calculations and cardiovascular risk assessment, although these data require further confirmation. Full article

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19 pages, 1377 KiB

Open AccessArticle

The Early Prediction of Patient Outcomes in Acute Heart Failure: A Retrospective Study

by Maria Boesing, Justas Suchina, Giorgia Lüthi-Corridori, Fabienne Jaun, Michael Brändle and Jörg D. Leuppi

J. Cardiovasc. Dev. Dis. 2025, 12(7), 236; https://doi.org/10.3390/jcdd12070236 - 20 Jun 2025

Abstract

Background: Acute heart failure (AHF) is a major cause of hospitalizations, posing significant challenges to healthcare systems. Despite advancements in management, the rate of poor outcomes remains high globally, emphasizing the need for timely interventions. This study aimed to identify early admission-based factors [...] Read more.

Background: Acute heart failure (AHF) is a major cause of hospitalizations, posing significant challenges to healthcare systems. Despite advancements in management, the rate of poor outcomes remains high globally, emphasizing the need for timely interventions. This study aimed to identify early admission-based factors predictive of poor outcomes in hospitalized AHF patients, in order to contribute to early risk stratification and optimize patient care. Methods: This retrospective single-center study analyzed routine data of adult patients hospitalized for AHF at a public university teaching hospital in Switzerland. Outcomes included in-hospital death, intensive care (ICU) treatment, and length of hospital stay (LOHS). Potential predictors were limited to routine parameters, readily available at admission. Missing predictor data was imputed and predictors were identified by means of multivariable regression analysis. Results: Data of 638 patients (median age 84 years, range 45–101 years, 50% female) were included in the study. In-hospital mortality was 7.1%, ICU admission rate 3.8%, and median LOHS was 8 days (IQR 5–12). Systolic blood pressure ≤ 100 mmHg (Odds ratio (OR) 3.8, p = 0.009), peripheral oxygen saturation ≤ 90% or oxygen supplementation (OR 5.9, p < 0.001), and peripheral edema (OR 2.7, p = 0.044) at hospital admission were identified as predictors of in-hospital death. Furthermore, a stroke or transient ischemic attack in the patient’s history (OR 3.2, p = 0.023) was associated with in-hospital death. ICU admission was associated with oxygen saturation ≤ 90% or oxygen supplementation (OR 22.9, p < 0.001). Factors linked to longer LOHS included oxygen saturation ≤ 90% or oxygen supplementation (IRR 1.2, p < 0.001), recent weight gain (IRR 1.1, p = 0.028), and concomitant chronic kidney disease (IRR 1.2, p < 0.001). Conclusions: This study validated established predictors of AHF outcomes in a Swiss cohort, highlighting the predictive value of poor perfusion status, fluid overload, and comorbidities such as chronic kidney disease. The identified predictors imply potential for developing tools to improve rapid treatment decisions. Future research should focus on the prospective external validation of the identified predictors and the design and validation of risk scores, incorporating these parameters to optimize early interventions and reduce adverse outcomes in AHF. Full article

(This article belongs to the Special Issue Epidemiological, Basic Science and Clinical Research Studies in Heart Failure)

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21 pages, 3097 KiB

Open AccessReview

Navigating the Complexities of Cancer Treatment-Induced Hypertension

by Jose Arriola-Montenegro, John Roth and Maria L. Gonzalez Suarez

J. Cardiovasc. Dev. Dis. 2025, 12(6), 235; https://doi.org/10.3390/jcdd12060235 - 19 Jun 2025

Abstract

Cancer therapy-induced hypertension (HTN) is an increasingly recognized complication associated with a wide range of anticancer agents, including vascular endothelial growth factor (VEGF) inhibitors, proteasome inhibitors, tyrosine kinase inhibitors, and alkylating agents. The pathogenesis of HTN in this setting is multifactorial, involving mechanisms [...] Read more.

Cancer therapy-induced hypertension (HTN) is an increasingly recognized complication associated with a wide range of anticancer agents, including vascular endothelial growth factor (VEGF) inhibitors, proteasome inhibitors, tyrosine kinase inhibitors, and alkylating agents. The pathogenesis of HTN in this setting is multifactorial, involving mechanisms such as endothelial dysfunction, nitric oxide (NO) suppression, sympathetic nervous system activation, and vascular remodeling. Additional factors, including paraneoplastic syndromes, poorly controlled pain, mood disturbances, and overlapping cardiovascular risk factors like obesity and diabetes, further contribute to the complexity of diagnosis and management. Despite its prevalence and clinical implications, cancer therapy-induced HTN is often addressed using general population guidelines, with limited oncology-specific protocols available. Accurate blood pressure measurement and individualized treatment plans are critical to optimize outcomes and avoid interruptions to cancer therapy. Antihypertensive agents such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), and calcium channel blockers have shown efficacy in both blood pressure control and, in some cases, oncologic outcomes. A multidisciplinary approach involving oncologists, cardiologists, and primary care providers is essential to navigate the interplay between cancer treatment and cardiovascular health. Ongoing research is needed to develop targeted guidelines and improve the long-term care of cancer patients affected by treatment-induced HTN. Full article

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16 pages, 2531 KiB

Open AccessArticle

Predictors of Five-Year Outcomes in Patients with Acute Coronary Syndromes

by Luca Di Vito, Giancarla Scalone, Federico Di Giusto, Filippo Bruscoli, Simona Silenzi, Adelina Selimi, Arianna Massari, Domenico Delfino, Federico Guerra and Pierfrancesco Grossi

J. Cardiovasc. Dev. Dis. 2025, 12(6), 234; https://doi.org/10.3390/jcdd12060234 - 18 Jun 2025

Abstract

Background: Residual risk after acute coronary syndromes (ACSs) continues to affect prognosis. We investigated the impact of female sex, non-ST-segment–elevation myocardial infarction (NSTEMI), diabetes mellitus (DM), and chronic kidney disease (CKD) on coronary atherosclerosis extent, culprit stenosis location, and bio-humoral data. The rate [...] Read more.

Background: Residual risk after acute coronary syndromes (ACSs) continues to affect prognosis. We investigated the impact of female sex, non-ST-segment–elevation myocardial infarction (NSTEMI), diabetes mellitus (DM), and chronic kidney disease (CKD) on coronary atherosclerosis extent, culprit stenosis location, and bio-humoral data. The rate of both major adverse cardiovascular events (MACE) and non-fatal recurrent coronary events (RCE) was additionally evaluated. Methods: We enrolled 1404 ACS patients and followed them for up to 5 years. Coronary culprit and non-culprit stenoses were analyzed using angiography. Biohumoral data was assessed at admission and at 1 month and 12 months after discharge. Patients were compared based on sex, NSTEMI, DM, and CKD presence. Results: NSTEMI patients had a higher number of total coronary stenoses (3.5 vs. 3.3, p = 0.013) and non-culprit stenoses (2.3 vs. 1.6, p = 0.0001). Non-culprit percent stenosis was significantly greater in NSTEMI as compared to STEMI patients (57.9% vs. 47.1%, p = 0.0001). DM patients had a higher frequency of bifurcation lesions (41% vs. 25%, p = 0.0001). CKD patients showed a higher prevalence of left main disease (3.4% vs. 1.5%, p = 0.038). Female patients had higher LDL-cholesterol values at 1 month and 12 months. NSTEMI, DM, and creatinine level were independent predictors of MACE. NSTEMI patients had an increased risk of non-fatal RCE. Conclusions: NSTEMI, DM, and creatinine levels at admission were independent predictors of MACE in the first 5 years after an ACS. Full article

(This article belongs to the Special Issue Risk Factors and Prevention of Cardiovascular Diseases—Second Edition)

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14 pages, 2111 KiB

Open AccessReview

Mitral Annular Calcification, a Not So Marginal and Relatively Benign Finding as Many of Us Think: A Review

by András Vereckei, Zsigmond Jenei, Hajnalka Vágó, Dorottya Balla, Alexisz Panajotu, Andrea Nagy and Gábor Katona

J. Cardiovasc. Dev. Dis. 2025, 12(6), 233; https://doi.org/10.3390/jcdd12060233 - 18 Jun 2025

Abstract

Mitral annular calcification (MAC) is usually considered an incidental, benign, age-related finding without serious complications in patients evaluated for cardiovascular or pulmonary disease with imaging studies that may result in mitral regurgitation or stenosis when severe. Therefore, it is usually not considered a [...] Read more.

Mitral annular calcification (MAC) is usually considered an incidental, benign, age-related finding without serious complications in patients evaluated for cardiovascular or pulmonary disease with imaging studies that may result in mitral regurgitation or stenosis when severe. Therefore, it is usually not considered a significant alteration. However, there is accumulating evidence that it is associated with a higher risk of cardiovascular events, such as atherosclerotic coronary artery disease, aortic artery disease, carotid artery disease, peripheral artery disease, stroke, atrial fibrillation, atrioventricular and/or intraventricular conduction disturbance, systemic embolization, infective endocarditis, heart failure and mortality. The presence of MAC also significantly influences the outcome of mitral valve transcatheter and surgical interventions. Several conditions may predispose to MAC. MAC is strongly related to cardiovascular risk factors, such as hypertension, diabetes, smoking and cardiovascular atherosclerosis, and inflammation may also play a role in the pathogenesis of MAC. Also, conditions that increase mitral valve stress, such as hypertension, aortic stenosis and hypertrophic cardiomyopathy, predispose to accelerated degenerative calcification of the mitral annulus area. Congenital disorders, e.g., Marfan syndrome and Hurler syndrome, are also associated with MAC, due to an intrinsic abnormality of the connective tissue composing the annulus. Full article

(This article belongs to the Section Imaging)

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25 pages, 2534 KiB

Open AccessReview

Anesthesia for Minimally Invasive Coronary Artery Bypass Surgery

by Miranda Holmes, Alexander N. J. White, Luke J. Rogers and Piroze M. Davierwala

J. Cardiovasc. Dev. Dis. 2025, 12(6), 232; https://doi.org/10.3390/jcdd12060232 - 18 Jun 2025

Abstract

Minimally invasive coronary artery bypass grafting (MI-CABG) has emerged as a transformative approach to coronary revascularization, offering reduced morbidity, faster recovery and improved cosmesis compared to conventional coronary artery bypass grafting (CABG). Performed without full sternotomy and commonly without cardiopulmonary bypass (CPB), MI-CABG [...] Read more.

Minimally invasive coronary artery bypass grafting (MI-CABG) has emerged as a transformative approach to coronary revascularization, offering reduced morbidity, faster recovery and improved cosmesis compared to conventional coronary artery bypass grafting (CABG). Performed without full sternotomy and commonly without cardiopulmonary bypass (CPB), MI-CABG encompasses a variety of techniques. These procedures present unique challenges for the anesthesiologist, necessitating a tailored perioperative strategy. This review explores the anesthetic management of MI-CABG, focusing on preoperative assessment, intraoperative techniques, and postoperative care. Preoperative evaluation emphasizes cardiac, respiratory, and vascular considerations, including suitability for one-lung ventilation (OLV) and the impact of comorbidities. Intraoperatively, anesthesiologists must manage hemodynamic instability, ensure effective OLV, and maintain normothermia. Postoperative strategies prioritize multimodal analgesia, early extubation, and rapid mobilization to leverage the benefits of a minimally invasive approach. By integrating surgical and anesthetic perspectives, this review underscores the anesthesiologist’s pivotal role in navigating the physiological demands of MI-CABG. As techniques evolve and experience grows, a comprehensive understanding of these principles will enhance the safety and efficacy of MI-CABG, making it a viable option for an expanding patient population. Full article

(This article belongs to the Special Issue New Advances in Minimally Invasive Coronary Surgery)

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14 pages, 701 KiB

Open AccessArticle

Mental Health Treatment in Adults with Congenital Heart Disease in Germany: An Online, Cross-Sectional Study of Status, Needs, and Treatment Reasons

by Anna-Lena Ehmann, Emily Schütte, Janina Semmler, Felix Berger, Ulrike M. M. Bauer, Katharina Schmitt, Constanze Pfitzer and Paul C. Helm

J. Cardiovasc. Dev. Dis. 2025, 12(6), 231; https://doi.org/10.3390/jcdd12060231 - 18 Jun 2025

Abstract

Improved medical treatments have extended survival and life expectancy in adults with congenital heart defects (ACHD), placing greater emphasis on psychosocial health. Up to one-third of ACHD experience anxiety or depression, and half develop a mental illness during their lifetime. While there is [...] Read more.

Improved medical treatments have extended survival and life expectancy in adults with congenital heart defects (ACHD), placing greater emphasis on psychosocial health. Up to one-third of ACHD experience anxiety or depression, and half develop a mental illness during their lifetime. While there is solid evidence on the prevalence of mental health, many do not receive psychological, psychotherapeutic, or psychiatric treatment (PST) and the psychological care situation remains understudied. In a nationwide, online cross-sectional survey conducted in Q1 2024, 1486 ACHD aged 18 to 85 (M_age = 36.84 years; 60.8% female) registered in the German National Register for Congenital Heart Defects (NRCHD) completed self-report questionnaires on sociodemographics, illness identity (Illness Identity Questionnaire), mental well-being, and utilisation of PST. CHD diagnoses were determined in conformity with the International Pediatric and Congenital Cardiac Code (IPCCC) and CHD was classified according to Warnes et al. (simple/moderate/complex). Analyses included chi-square tests, t-tests, and binary logistic regression. Overall, 32.8% of participants reported current and/or previous PST (women 37.5%, men 25.3%). PST utilisation was significantly higher in those with complex (40.2%) compared to moderate (29.6%) and simple CHD (25.3%) (ps < 0.01). Primary treatment reasons were mental illness (41.7%) and CHD-related concerns (37.2%). Nearly half of treatments were self-initiated (45.8%) and about one-third were physician-recommended (30.8%). Logistic regression revealed CHD severity as a significant predictor of PST use (ps < 0.05), with lower odds for simple (OR = 0.48) and moderate (OR = 0.66) compared to complex CHD when controlling for sex (p < 0.001, OR = 1.87), age (p = 0.022, OR = 1.011), education level (ps between 0.060 and 0.780), and net income (ps < 0.05). Those receiving PST showed significantly higher maladaptive illness-identity scores (engulfment, rejection) and lower acceptance. Approximately one in three ACHD requires mental health support, particularly those with complex CHD. The CHD itself acts as a key stressor and treatment motivator. Findings underscore the need for integrated care linking cardiological and psychosocial services. Routine screening for psychological distress and low-threshold access to PST—also for patients with simple and moderate CHD—are essential to identify and address mental health needs early. Full article

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

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37 pages, 3931 KiB

Open AccessReview

Retinal Imaging as a Window into Cardiovascular Health: Towards Harnessing Retinal Analytics for Precision Cardiovascular Medicine

by Jay Bharatsingh Bisen, Hayden Sikora, Anushree Aneja, Sanjiv J. Shah and Rukhsana G. Mirza

J. Cardiovasc. Dev. Dis. 2025, 12(6), 230; https://doi.org/10.3390/jcdd12060230 - 17 Jun 2025

Abstract

Rising morbidity and mortality from cardiovascular disease (CVD) have increased interest in precision and preventive management to reduce long-term sequelae. While retinal imaging has traditionally been recognized for identifying vascular changes in systemic conditions such as hypertension and type 2 diabetes mellitus, a [...] Read more.

Rising morbidity and mortality from cardiovascular disease (CVD) have increased interest in precision and preventive management to reduce long-term sequelae. While retinal imaging has traditionally been recognized for identifying vascular changes in systemic conditions such as hypertension and type 2 diabetes mellitus, a new ophthalmologic field, cardiac-oculomics, has associated retinal biomarker changes with other cardiovascular diseases with retinal manifestations. Several imaging modalities visualize the retina, including color fundus photography (CFP), optical coherence tomography (OCT), and OCT angiography (OCTA), which visualize the retinal surface, the individual retinal layers, and the microvasculature within those layers, respectively. In these modalities, imaging-derived biomarkers can present due to CVD and have been linked to the presence, progression, or risk of developing a range of CVD, including hypertension, carotid artery disease, valvular heart disease, cerebral infarction, atrial fibrillation, and heart failure. Promising artificial intelligence (AI) models have been developed to complement existing risk-prediction tools, but standardization and clinical trials are needed for clinical adoption. Beyond risk estimation, there is growing interest in assessing real-time cardiovascular status to track vascular changes following pharmacotherapy, surgery, or acute decompensation. This review offers an up-to-date assessment of the cardiac-oculomics literature and aims to raise awareness among cardiologists and encourage interdepartmental collaboration. Full article

(This article belongs to the Section Imaging)

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15 pages, 2242 KiB

Open AccessReview

Early Echocardiographic Markers in Heart Failure with Preserved Ejection Fraction

by Annamaria Tavernese, Vincenzo Rizza, Valeria Cammalleri, Rocco Mollace, Cristina Carresi, Giorgio Antonelli, Nino Cocco, Luca D’Antonio, Martina Gelfusa, Francesco Piccirillo, Annunziata Nusca and Gian Paolo Ussia

J. Cardiovasc. Dev. Dis. 2025, 12(6), 229; https://doi.org/10.3390/jcdd12060229 - 16 Jun 2025

Abstract

Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial [...] Read more.

Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial volume index (LAVI), frequently fail to detect early functional changes. Advanced echocardiographic techniques have emerged as valuable tools for early diagnosis and risk stratification. Global Longitudinal Strain (GLS) allows for the identification of subclinical systolic dysfunction, even with preserved LVEF. Left Atrial Strain (LAS), particularly reservoir and pump strain, provides sensitive markers of diastolic function and elevated filling pressures, offering additional diagnostic and prognostic insights. Myocardial Work (MW), through non-invasive pressure–strain loops, enables load-independent assessment of contractility, while Right Ventricular Free Wall Longitudinal Strain (RVFWLS) captures early right heart involvement, often present in advanced HFpEF. The integration of these advanced parameters can enhance diagnostic precision and guide personalized treatment strategies. This review highlights the current evidence and clinical applications of strain-based imaging in HFpEF, underscoring the importance of a multiparametric, pathophysiology-oriented approach in heart failure evaluation. Full article

(This article belongs to the Special Issue Role of Cardiovascular Imaging in Heart Failure)

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11 pages, 5318 KiB

Open AccessCase Report

Severe Myocardial Involvement and Persistent Supraventricular Arrhythmia in a Premature Infant Due to Enterovirus Infection: Case Report and Literature Review

by Carolina Montobbio, Alessio Conte, Andrea Calandrino, Alessia Pepe, Francesco Vinci, Alessandra Siboldi, Roberto Formigari and Luca Antonio Ramenghi

J. Cardiovasc. Dev. Dis. 2025, 12(6), 228; https://doi.org/10.3390/jcdd12060228 - 14 Jun 2025

Abstract

Enterovirus (EV) infections in neonates can be transmitted vertically or horizontally, with symptoms ranging from mild to severe, including myocarditis, meningoencephalitis, and hepatitis. Neonates with EV-induced myocarditis may present severe cardiovascular disease with sudden onset of arrhythmia. Neonatal arrhythmias, particularly in low birth [...] Read more.

Enterovirus (EV) infections in neonates can be transmitted vertically or horizontally, with symptoms ranging from mild to severe, including myocarditis, meningoencephalitis, and hepatitis. Neonates with EV-induced myocarditis may present severe cardiovascular disease with sudden onset of arrhythmia. Neonatal arrhythmias, particularly in low birth weight or critically ill infants, can impair cardiac function and worsen outcomes. EV targets cardiomyocyte receptors, inducing apoptosis pathways and triggering cardiac conduction disturbances. We present an extremely low-birth-weight preterm infant (GW 27 + 6) who developed EV-induced myocarditis, complicated with a sudden onset of supraventricular tachycardia (SVT), pericardial effusion and bi-atrial enlargement. Despite multi-agent regimen, including propranolol, flecainide, and amiodarone, the infant showed persistent junctional rhythm until seven months of age, later transitioning to atrial rhythm with stable cardiac function. A review of previously published rhythm disturbances due to EV-induced myocarditis is presented. Newborns with EV-induced arrhythmia may require a multi-modal treatment such as a multi-agent medical regimen or, in severe non-responsive cases, an electrophysiological approach. EV infections may cause long-term cardiovascular comorbidities (such as left ventricular dysfunction or mitral valve regurgitation), necessitating continuous monitoring through echocardiography and ECG. Collaboration between neonatologists and pediatric cardiologists is crucial for effective treatment and follow-up. Full article

(This article belongs to the Topic Cardiovascular Disease in Special Populations: From Basic Science to Clinical Practice)

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12 pages, 2400 KiB

Open AccessArticle

Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction

by Tony Li, Vinay B. Panday, Jessele Lai, Nicholas Gao, Beth Lim, Aloysius Leow, Sarah Tan, Quek Swee Chye, Ching Hui Sia, William Kong, Tiong Cheng Yeo, Ru San Tan, Liang Zhong and Kian Keong Poh

J. Cardiovasc. Dev. Dis. 2025, 12(6), 227; https://doi.org/10.3390/jcdd12060227 - 13 Jun 2025

Abstract

Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, dσ*/dt_max, is load-independent and has been reported to be associated with clinical outcomes in heart failure and aortic stenosis. We aim to [...] Read more.

Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, dσ*/dt_max, is load-independent and has been reported to be associated with clinical outcomes in heart failure and aortic stenosis. We aim to assess if dσ*/dt_max could predict adverse outcomes in patients with severe mitral regurgitation (MR). Methodology: We studied dσ*/dt_max in a cohort of 127 patients with isolated severe primary MR and preserved LVEF ≥ 60%. Patients with prior valvular intervention or concurrent valvular disease were excluded. We tested dσ*/dt_max against a composite of adverse outcomes including all-cause mortality, heart failure hospitalization, and mitral valve intervention. Results: The cohort had a mean age of 58 years old and was predominantly male. Of the 127 patients, eight (6.3%) needed subsequent hospitalization for heart failure, while 30 (23.6%) and 11 (8.7%) patients underwent mitral valve repair and replacement, respectively, And 14 (11.0%) passed away. Of the patients (n = 54 (42.5%)) who had an adverse outcome during follow-up, dσ*/dt_max demonstrated an independent association with composite adverse outcome, including its individual components. On ROC analysis, a cut-off of 2.15 s⁻¹ was identified. Based on this cut-off, dσ*/dt_max retained an independent association with composite adverse outcome after adjusting for covariates including age, sex, ischemic heart disease, pulmonary artery systolic pressure, and left ventricular end systolic diameter. Conclusions: In patients with severe primary MR and preserved LVEF, reduced dσ*/dt_max was an independent predictor of adverse outcomes. It can be a useful addition to the armamentarium for assessing patients with severe MR. Full article

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3 pages, 191 KiB

Open AccessReply

Reply to Neunhaeuserer et al. Comment on “Bianco et al. Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population. J. Cardiovasc. Dev. Dis. 2025, 12, 22”

by Massimiliano Bianco, Fabrizio Sollazzo, Riccardo Pella, Saverio Vicentini, Samuele Ciaffoni, Gloria Modica, Riccardo Monti, Michela Cammarano, Paolo Zeppilli and Vincenzo Palmieri

J. Cardiovasc. Dev. Dis. 2025, 12(6), 226; https://doi.org/10.3390/jcdd12060226 - 13 Jun 2025

Abstract

We have read the commentary on our article entitled ‘Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population’ [...] Full article

(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)

2 pages, 162 KiB

Open AccessComment

Comment on Bianco et al. Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population. J. Cardiovasc. Dev. Dis. 2025, 12, 22

by Daniel Neunhaeuserer, Francesca Battista, Giulia Quinto, Gino Degano, Andrea Gasperetti and Andrea Ermolao

J. Cardiovasc. Dev. Dis. 2025, 12(6), 225; https://doi.org/10.3390/jcdd12060225 - 13 Jun 2025

Abstract

The article by Bianco M [...] Full article

(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)

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