Journal of Cardiovascular Development and Disease

7 pages, 471 KiB

Open AccessBrief Report

Comparative Diagnostic Efficacy of HeartLogic and TriageHF Algorithms in Remote Monitoring of Heart Failure: A Cohort Study

by David Ledesma Oloriz, Daniel García Iglesias, Rodrigo Ariel di Massa Pezzutti, Fernando López Iglesias and José Manuel Rubín López

J. Cardiovasc. Dev. Dis. 2025, 12(6), 209; https://doi.org/10.3390/jcdd12060209 (registering DOI) - 31 May 2025

Abstract

Introduction: Implantable defibrillator devices (ICDs) can be used for remote monitoring of different variables, including some related to Heart Failure (HF). Two different algorithms (TriageHF and HeartLogic) arise by combining some of these variables to generate an estimation of HF decompensation risk in [...] Read more.

Introduction: Implantable defibrillator devices (ICDs) can be used for remote monitoring of different variables, including some related to Heart Failure (HF). Two different algorithms (TriageHF and HeartLogic) arise by combining some of these variables to generate an estimation of HF decompensation risk in the following days. Until now, no other trial has evaluated both algorithms in a head-to-head comparison. The primary objective is to compare diagnostic accuracy of both algorithms in a similar cohort of patients. Material and Methods: Descriptive monocentric cohort study of a series of 64 patients who have been implanted with a Medtronic or Boston Scientific ICD with the TriageHF or Heart Logic algorithm available during the period between January 2020 and June 2022, with a total of 27 patients in the HeartLogic group and 37 patients in the TriageHF group. Results: During the period of the study there were a total of 1142 alarms analyzed. There were no differences in the basal characteristics of both groups. We reported a risk alarm–patient ratio of 1.31 ± 1.89 in the HeartLogic group and of 3.32 ± 3.08 in the TriageHF group (p < 0.01). In the TriageHF group, we reported a lower specificity with (0.76), with higher sensitivity (0.97) and PPV (0.18), and similar NPV (1). Survival analysis shows no statistical differences between both algorithms in the 30 days following the alert. Conclusions: TriageHF algorithm had higher sensibility and PPV, leading to a higher number of alerts/patients, while HeartLogic algorithm had a better specificity. These differences should be considered to optimize patient follow-ups in home monitoring. Full article

(This article belongs to the Special Issue Artificial Intelligence in Cardiac Electrophysiology)

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18 pages, 586 KiB

Open AccessArticle

Higher Physical Activity Is Associated with Improved Ventricular–Arterial Coupling: Assessment Using the cfPWV/GLS Ratio in Primary Care—A Pilot Study

by Paula-Anca Sulea, Ioan Tilea, Florin Stoica, Liviu Cristescu, Diana-Andreea Moldovan, Radu Tatar, Raluca-Maria Tilinca, Razvan Gheorghita Mares and Andreea Varga

J. Cardiovasc. Dev. Dis. 2025, 12(6), 208; https://doi.org/10.3390/jcdd12060208 (registering DOI) - 30 May 2025

Abstract

Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular–arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid–femoral pulse wave velocity to global longitudinal [...] Read more.

Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular–arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid–femoral pulse wave velocity to global longitudinal strain (cfPWV/GLS) ratio, in a Romanian primary care cohort. Methods: The prospective cohort analysis was performed on 81 adults (49 females, mean age 50.27 ± 12.93 years). Physical activity was quantified through anamnesis using metabolic equivalents (METs) according with Compendium of Physical Activities, and patients were stratified into four groups: G1 (METs < 1.5, n = 39), G2 (METs = 1.5–2.9, n = 2), G3 (METs = 3–5.9, n = 23), and G4 (METs ≥ 6, n = 17). Demographic and echocardiographic data were recorded to explore associations between physical activity and VAC. Results: The cfPWV/GLS ratio differed significantly across groups (p = 0.012), with the lowest values present in the moderate-intensity group (G3). VAC ≥ 0.391 can predict sedentary lifestyles (AUC = 0.730; CI: 0.617–0.833, p > 0.001). Multivariate analysis revealed that age, arterial age, and hypertension independently predict VAC. Conclusions: Higher physical activity is inversely associated with VAC (cfPWV/GLS ratio) and can predict sedentary lifestyles. Encouraging moderate-to-vigorous exercise in primary care may improve cardiovascular function and aid prevention. Full article

(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)

26 pages, 975 KiB

Open AccessReview

Doxorubicin-Induced Cardiotoxicity: A Comprehensive Update

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

J. Cardiovasc. Dev. Dis. 2025, 12(6), 207; https://doi.org/10.3390/jcdd12060207 - 30 May 2025

Abstract

Doxorubicin is an anthracycline chemotherapeutic that is widely used for treating various malignancies, including breast cancer, lymphomas, and sarcomas. Despite its efficacy, its clinical utility is limited by a well-documented risk of cardiotoxicity, which may manifest acutely or chronically. Doxorubicin works by intercalating [...] Read more.

Doxorubicin is an anthracycline chemotherapeutic that is widely used for treating various malignancies, including breast cancer, lymphomas, and sarcomas. Despite its efficacy, its clinical utility is limited by a well-documented risk of cardiotoxicity, which may manifest acutely or chronically. Doxorubicin works by intercalating DNA and inhibiting topoisomerase II, leading to DNA damage and cell death. However, this mechanism is not selective to cancer cells and can adversely affect cardiac myocytes. The introduction of doxorubicin into oncologic practice has revolutionized cancer treatment, but its cardiotoxic effects remain a significant concern. This systematic review aims to comprehensively examine the multifaceted impact of doxorubicin on cardiac structure and function through both preclinical and clinical lenses. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—Basic and Translational Cardiovascular Research)

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25 pages, 843 KiB

Open AccessReview

Considerations on the Development of Therapeutics in Vascular Calcification

by Ana M. Valentin Cabrera, Sophie K. Ashbrook and Joshua D. Hutcheson

J. Cardiovasc. Dev. Dis. 2025, 12(6), 206; https://doi.org/10.3390/jcdd12060206 - 29 May 2025

Abstract

Cardiovascular disease is the leading cause of death worldwide. Vascular calcification, the deposition of calcium phosphate mineral in the arterial wall, is the most significant predictor of morbidity and mortality. Vascular calcification can present as either medial or intimal calcification. Medial calcification is [...] Read more.

Cardiovascular disease is the leading cause of death worldwide. Vascular calcification, the deposition of calcium phosphate mineral in the arterial wall, is the most significant predictor of morbidity and mortality. Vascular calcification can present as either medial or intimal calcification. Medial calcification is most prevalent among patients with chronic kidney disease. Intimal calcification is associated with atherosclerosis and chronic inflammation. In both cases, vascular smooth muscle cells undergo osteogenic differentiation, leading to mineral deposition and associated wall stiffening; however, the effects on cardiovascular function and morbidity vary depending on mineral morphology and location. This review investigates vascular calcification, the mechanisms leading to calcium deposition, and what to consider when developing therapeutics for vascular calcification. Full article

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

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11 pages, 418 KiB

Open AccessArticle

Impact of Primary Diagnosis on the Outcome of Heart Transplantation in Children

by Csaba Vilmányi, Zsolt L. Nagy, György S. Reusz and László Ablonczy

J. Cardiovasc. Dev. Dis. 2025, 12(6), 205; https://doi.org/10.3390/jcdd12060205 - 29 May 2025

Abstract

Introduction: Pediatric heart transplantation (HTX) remains the only therapeutic option for end-stage heart failure not amenable to conventional surgical or catheter interventions. We reviewed our pediatric HTX outcomes according to primary diagnosis. Patients and Methods: Sixty-two patients underwent HTX between 01/2007 and 12/2022. [...] Read more.

Introduction: Pediatric heart transplantation (HTX) remains the only therapeutic option for end-stage heart failure not amenable to conventional surgical or catheter interventions. We reviewed our pediatric HTX outcomes according to primary diagnosis. Patients and Methods: Sixty-two patients underwent HTX between 01/2007 and 12/2022. Patients were divided into congenital heart disease (CHD, n = 20) and cardiomyopathy (CMP, n = 42) groups. All potential variables relevant to patient recovery and long-term survival with endpoints of retransplantation or death were analyzed. Results: CHD patients underwent HTX after significantly more multiple major cardiac surgeries per patient (2.5 [0–5]) than CMP patients (0.5 [0–2], p < 0.01), without notable allosensitization. Post-HTX recovery was longer in CHD (mean mechanical ventilation 7 vs. 3 days, p = 0.001), likely due to longer surgical time (468 vs. 375 min, p = 0.037). There were no significant differences in the frequency of rejections between the two groups (4/20 vs. 9/42). Midterm survival was slightly better (85/70% p = NS) in CMP (median follow-up 44.5 [0–177] months). Conclusion: Our study confirmed good short- and long-term outcomes of pediatric HTX in both CMP and CHD. The longer postoperative recovery in CHD did not lead to higher mortality. No higher pretransplant hypersensitization was observed, possibly explaining the lack of difference in the number and severity of rejections. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Pediatric Cardiology and Congenital Heart Disease' Section)

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9 pages, 208 KiB

Open AccessArticle

Assessment of Age and Sex Difference in Cardiopulmonary Function of Children and Adolescents with Ventricular Septal Defect

by Chao-Ruei Lin, Ya-Fen Liu, I-Ching Huang, Yi-Jen Chen, Chia-Hsin Chen and Ko-Long Lin

J. Cardiovasc. Dev. Dis. 2025, 12(6), 204; https://doi.org/10.3390/jcdd12060204 - 28 May 2025

Abstract

In the past, an isolated ventricular septal defect (VSD) was categorized as a simple lesion with assumed negligible long-term risks when treated correctly in childhood; however, evidence has suggested that patients with isolated congenital VSDs carry a substantial burden of cardiovascular morbidity throughout [...] Read more.

In the past, an isolated ventricular septal defect (VSD) was categorized as a simple lesion with assumed negligible long-term risks when treated correctly in childhood; however, evidence has suggested that patients with isolated congenital VSDs carry a substantial burden of cardiovascular morbidity throughout life. This study aimed to investigate the cardiopulmonary function (CPF) in isolated VSD patients of a young age and the relationship of CPF with age, sex and body mass index (BMI). This retrospective cohort study was conducted at a tertiary medical center in southern Taiwan. We recruited children and adolescents (aged 5 to 18 years) with isolated VSDs who underwent the symptom-limited treadmill exercise test. Data from 289 children and adolescents (157 males, 132 females) were included in the analysis. The participants were stratified into three groups according to age. The male patients had a significantly higher oxygen uptake at the anaerobic threshold (AT VO₂) and a higher peak oxygen uptake (peak VO₂) (all p < 0.05). Normalized AT VO₂ (mL/kg/min) and normalized peak VO₂ (mL/kg/min) were significantly negatively associated with BMI. In conclusion, male patients with isolated VSDs had similar or better CPF compared with female patients. BMI had a negative association with CPF in young VSD patients. Full article

8 pages, 1135 KiB

Open AccessArticle

A Sphincter-like Function of Pulmonary Vein Ostia in Normal and Atrial Fibrillation Subjects

by Stefano Bonapace, Matteo Falanga, Carmelo Cicciò, Cristiana Corsi and Giulio Molon

J. Cardiovasc. Dev. Dis. 2025, 12(6), 203; https://doi.org/10.3390/jcdd12060203 - 28 May 2025

Abstract

Background: Early anatomical study suggested that the pulmonary vein (PVs) junction may have putative sphincter-like activity. The aim of this study was to evaluate this activity in normal and paroxysmal/persistent atrial fibrillation subjects. Methods: The Cardiac Computed Tomography (CCT) scans of 45 subjects [...] Read more.

Background: Early anatomical study suggested that the pulmonary vein (PVs) junction may have putative sphincter-like activity. The aim of this study was to evaluate this activity in normal and paroxysmal/persistent atrial fibrillation subjects. Methods: The Cardiac Computed Tomography (CCT) scans of 45 subjects [15 normal controls, 15 patients with paroxysmal atrial fibrillation (PAR-AF), and 15 with persistent AF (PER-AF)] were retrospectively analyzed. All subjects were in sinus rhythm during the CCT scan. A 3D anatomical model was developed, enabling us to identify the PV ostia and to measure their area dynamic changes during the cardiac cycle. Results: The area changes in the superior PVs within the three groups were significantly higher compared to the inferior (control p = 0.007, PAR-AF p = 0.0003, PER-AF p = 0.04). Moreover, these variations were significantly reduced in PAR-AF and PER-AF compared to the control in all PVs (LSPV (p < 0.001), RSPV (p < 0.001), RIPV (p = 0.037), and LIPV (p < 0.001)). Conclusions: This sphincter-like activity, most prominent in superior PVs, is progressively impaired in patients with paroxysmal and persistent AF. Full article

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

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9 pages, 384 KiB

Open AccessArticle

The Role of Serum Uric Acid and Serum Creatinine Ratio as Possible Markers of Autonomic Dysfunction and Left Ventricular Mass Index in Atherosclerotic Renal Artery Stenosis

by Antonietta Gigante, Rosa Cascone, Chiara Pellicano, Francesco Iannazzo, Francesca Romana Gadaleta, Edoardo Rosato and Rosario Cianci

J. Cardiovasc. Dev. Dis. 2025, 12(6), 202; https://doi.org/10.3390/jcdd12060202 - 28 May 2025

Abstract

Background: Serum uric acid and serum creatinine ratio (SUA/sCr) is strongly linked to increased cardiovascular risk. Atherosclerotic renal artery stenosis (ARAS) is a secondary cause of hypertension and is associated with ischemic nephropathy, congestive heart failure, accelerated cardiovascular disease, and autonomic dysfunction. The [...] Read more.

Background: Serum uric acid and serum creatinine ratio (SUA/sCr) is strongly linked to increased cardiovascular risk. Atherosclerotic renal artery stenosis (ARAS) is a secondary cause of hypertension and is associated with ischemic nephropathy, congestive heart failure, accelerated cardiovascular disease, and autonomic dysfunction. The aim of this study was to investigate whether SUA levels and SUA/sCr could represent markers of autonomic dysfunction and increased left ventricular mass index (LVMI) in patients with ARAS. Methods: Patients diagnosed with ARAS were enrolled in the study. All patients underwent clinical evaluation, biochemical analysis, 24 h electrocardiogram (ECG), and Renal Doppler Ultrasound with renal resistive index parameters. Heart rate variability for global autonomic dysfunction was assessed through the analysis of a 24 h ECG to detect the standard deviation of normal-to-normal RR intervals (SDNN). Echocardiographic measurement of LVMI was performed. Results: A total of 27 patients (F = 16 (59%), median age 67 years (IQR 60–77)) diagnosed with ARAS were enrolled in the study. We found a statistically significant negative linear correlation between SUA/sCr and SDNN (r = −0.519, p < 0.01). We found a statistically significant positive linear correlation between SUA/sCr and LVMI (r = 0.413, p < 0.05). Median SDNN was significantly lower in patients with SUA ≥ 5.6 mg/dL than in patients with SUA < 5.6 mg/dL (94.2 (IQR 86.8–108.1) vs. 112.8 (IQR 108.9–114.7), p < 0.01). Median LVMI was significantly higher in patients with SUA ≥ 5.6 mg/dL compared to patients with SUA < 5.6 mg/dL (133 g/m² (IQR 120–149) vs. 111 g/m² (IQR 99–129), p < 0.05). Conclusion: In patients with ARAS, SUA/sCr is associated with autonomic dysfunction and LVMI in ARAS patients. The ratio and related cut-off value of SUA/sCr could represent a useful biomarker to evaluate cardiovascular risk in ARAS patients. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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6 pages, 885 KiB

Open AccessCase Report

A Rare Case of Hypercalcemia from Mediastinal Ectopic Hyperparathyroidism

by Nasrin Dhapa, Lamar Alocozy and Rumana Khan

J. Cardiovasc. Dev. Dis. 2025, 12(6), 201; https://doi.org/10.3390/jcdd12060201 - 28 May 2025

Abstract

Hypercalcemia is frequently attributed to primary hyperparathyroidism, commonly a result of parathyroid adenomas. Ectopic hyperparathyroidism is characterized by hyperfunctioning parathyroid tissue located outside of expected anatomical locations of endocrine tissue. In this report, we present a rare case of hypercalcemia secondary to a [...] Read more.

Hypercalcemia is frequently attributed to primary hyperparathyroidism, commonly a result of parathyroid adenomas. Ectopic hyperparathyroidism is characterized by hyperfunctioning parathyroid tissue located outside of expected anatomical locations of endocrine tissue. In this report, we present a rare case of hypercalcemia secondary to a mediastinal ectopic parathyroid adenoma, located between the left atrium and pulmonary artery. Given the unique location of the ectopic gland, diagnosis was delayed with additional complications that followed due to difficulty accessing the gland surgically. Despite this, urgent surgical removal of the ectopic gland allowed for remarkable improvement in presenting symptoms. This clinical case highlights diagnostic and therapeutic challenges that present a unique situation worthy of clinical discussion. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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22 pages, 1675 KiB

Open AccessReview

Cardiac Magnetic Resonance in Heart Failure: Diagnostic and Prognostic Assessments

by Sara Pezzini, Francesca Daus, Giorgia Galli, Andrea Farina, Gabriele Fragasso and Roberto Spoladore

J. Cardiovasc. Dev. Dis. 2025, 12(6), 200; https://doi.org/10.3390/jcdd12060200 - 23 May 2025

Abstract

With its high spatial resolution and tissue contrast, cardiac magnetic resonance (CMR) is an extremely flexible imaging technique that enables a thorough morphological and functional evaluation of the heart and vascular system. From diagnosis to treatment planning and risk assessment, CMR is being [...] Read more.

With its high spatial resolution and tissue contrast, cardiac magnetic resonance (CMR) is an extremely flexible imaging technique that enables a thorough morphological and functional evaluation of the heart and vascular system. From diagnosis to treatment planning and risk assessment, CMR is being utilized more and more in the evaluation of patients with heart failure (HF). CMR offers a variety of techniques for characterizing myocardial tissue, aiding in identifying the cause of HF, as well as whole-heart cine imaging for precise measurement of biventricular dimensions and function. The aim of this review is to the describe the role of CMR in chronic heart failure, in particular for diagnostic workups, differential diagnosis, and information on how CMR influences treatment planning choices. Full article

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

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4 pages, 186 KiB

Open AccessEditorial

Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity

by Narayanaswamy Venketasubramanian

J. Cardiovasc. Dev. Dis. 2025, 12(6), 199; https://doi.org/10.3390/jcdd12060199 - 23 May 2025

Abstract

Stroke remains a leading cause of death and disability globally [...] Full article

(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)

17 pages, 1107 KiB

Open AccessArticle

Psychosocial Risk and Recurrent Hospitalizations in Women and Men Following LVAD Implantation: A Multi-State Analysis of the INTERMACS Registry

by Lisa-Marie Maukel, Sandra Schmeller, Gerdi Weidner, Jan Beyersmann and Heike Spaderna

J. Cardiovasc. Dev. Dis. 2025, 12(6), 198; https://doi.org/10.3390/jcdd12060198 - 22 May 2025

Abstract

Background: Women experience higher rates of adverse events and first rehospitalization after left ventricular assist device (LVAD) implantation compared with men. This study investigated the role of sex and preimplant psychosocial risk in recurrent hospitalizations. Methods: Data from 20,123 INTERMACS patients (21.3% women) [...] Read more.

Background: Women experience higher rates of adverse events and first rehospitalization after left ventricular assist device (LVAD) implantation compared with men. This study investigated the role of sex and preimplant psychosocial risk in recurrent hospitalizations. Methods: Data from 20,123 INTERMACS patients (21.3% women) were analyzed. Cumulative transition rates (e.g., home to hospitalization) were estimated and Andersen–Gill models, adjusted for covariates, examined the association between sex, preimplant psychosocial risk, and cumulative transition hazards for rehospitalization. State occupation probabilities, the mean number of hospitalizations, and the cumulative average length of hospital stay were calculated and stratified by sex and psychosocial risk. Results: Psychosocial risk preimplant was more prevalent in men than in women (21.4% vs. 17.5%, p < 0.001). The interaction of female sex and psychosocial risk increased rehospitalization hazards, independently of covariates [HR_adj 1.11, 95% CI (1.01–1.22), p = 0.036]. One-year postimplant, women with vs. without psychosocial risk had 2.2 vs. 1.8 hospitalizations, while men experienced 1.8 vs. 1.7 hospitalizations, respectively. Women with vs. without psychosocial risk spent 20 vs.16 days hospitalized, and men 15 vs. 14 days (all p < 0.001). Conclusions: Preimplant psychosocial risk independently contributed to recurrent hospitalizations post-LVAD, particularly affecting women. The early identification and management of these factors may reduce rehospitalizations and improve clinical outcomes. Full article

(This article belongs to the Special Issue Women and Cardiovascular Disease: The Gender Gap)

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12 pages, 965 KiB

Open AccessArticle

Genetic Spectrum of Lithuanian Familial Hypercholesterolemia Patients

by Urte Aliosaitiene, Rimante Cerkauskiene, Aleksandras Laucevicius, Migle Vilniskyte, Viktoras Sutkus, Antanas Mainelis, Birute Burnyte, Jurate Barysiene and Zaneta Petrulioniene

J. Cardiovasc. Dev. Dis. 2025, 12(5), 197; https://doi.org/10.3390/jcdd12050197 - 21 May 2025

Abstract

Background and aims: Although familial hypercholesterolemia (FH) is a common congenital cause of elevated low-density lipoprotein cholesterol (LDL-C), it remains underdiagnosed and undertreated worldwide due to its inherent genetic heterogeneity. This study aimed to determine the prevalence of genetic variants in a Lithuanian [...] Read more.

Background and aims: Although familial hypercholesterolemia (FH) is a common congenital cause of elevated low-density lipoprotein cholesterol (LDL-C), it remains underdiagnosed and undertreated worldwide due to its inherent genetic heterogeneity. This study aimed to determine the prevalence of genetic variants in a Lithuanian patient cohort with clinically diagnosed FH and evaluate their possible clinical implications. Methods: A total of 172 patients were included in the retrospective analysis. The study population comprised males and females ranging from 0 to 85 years of age, with LDL-C levels exceeding 4.9 mmol/L in adults and 3.9 mmol/L in children. The subjects were divided into four groups according to the Dutch Lipid Clinic Network (DLCN) criteria (definite, probable, possible, and unlikely). Children were analyzed separately. Next-generation sequencing (NGS) has been chosen as the most appropriate technique for genetic testing. All identified variants were categorized into three groups: (1) pathogenic, (2) likely pathogenic, and (3) variants of uncertain significance. Subjects without detected variants were classified into group (4) No mutation. Results: Women were diagnosed with FH significantly later than men (p = 0.033). Genetic testing identified FH-causing variants in 41.86% of subjects, with 20.93% carrying pathogenic variants, 9.88% likely pathogenic, and 11.05% variants of uncertain significance (VUS). Frequently identified pathogenic variants were c.654_656del p.(Gly219del) in LDLR and c.10580G>A p.(Arg3527Gln) in APOB, which are both linked to the founder effect. Genetic testing led to a reassessment of Dutch Lipid Clinic Network scores, increasing the number of individuals classified as “Definite FH” by 86.2%. Conclusions: The increasing use of NGS in FH has enhanced diagnostic capabilities and suggests population-specific genetic patterns. However, it also increases VUS detection, for which reclassification rates are still low and require strenuous efforts. Moreover, despite the benefits of genetic testing, significant gender disparities remain and require further attention. Full article

(This article belongs to the Section Genetics)

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21 pages, 518 KiB

Open AccessReview

Therapeutic Management of LDL-C: Efficacy and Economic Impact Assessment

by Abdallah Elshafeey

J. Cardiovasc. Dev. Dis. 2025, 12(5), 196; https://doi.org/10.3390/jcdd12050196 - 20 May 2025

Abstract

Cardiovascular disease (CVD) is one of the largest global disease burdens. Despite guidelines and recommendations and the proven advantages of lipid-lowering therapies (LLTs) in preventing CVD, achieving treatment targets remains disappointing. A key barrier to optimal LLT is therapy discontinuation. To be widely [...] Read more.

Cardiovascular disease (CVD) is one of the largest global disease burdens. Despite guidelines and recommendations and the proven advantages of lipid-lowering therapies (LLTs) in preventing CVD, achieving treatment targets remains disappointing. A key barrier to optimal LLT is therapy discontinuation. To be widely adopted in clinical practice, new lipid-lowering therapies must both prevent major adverse cardiovascular events (MACEs) and exhibit cost effectiveness to ensure widespread utilization by patients, physicians, and insurers. While non-statin LLTs have shown cardiovascular value, their cost effectiveness is controversial. This review highlights the LLTs that are currently widely adopted and summarizes the available evidence on their cost effectiveness. Full article

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20 pages, 631 KiB

Open AccessReview

Trading off Iodine and Radiation Dose in Coronary Computed Tomography

by Guillaume Fahrni, Thomas Saliba, Damien Racine, Marianna Gulizia, Georgios Tzimas, Chiara Pozzessere and David C. Rotzinger

J. Cardiovasc. Dev. Dis. 2025, 12(5), 195; https://doi.org/10.3390/jcdd12050195 - 20 May 2025

Abstract

Coronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction, wide-area detectors, and dual-source systems, have helped mitigate early limitations, [...] Read more.

Coronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction, wide-area detectors, and dual-source systems, have helped mitigate early limitations, such as high radiation doses, motion artifacts, high iodine load, and non-diagnostic image quality. However, the adjustments between ionizing radiation and iodinated contrast material (CM) volumes remain a critical concern, especially due to the increasing use of CCTA in various indications. This review explores the balance between radiation and CM volumes, emphasizing patient-specific protocol optimization to improve diagnostic accuracy while minimizing risks. Radiation dose reduction strategies, such as low tube voltage protocols, prospective ECG-gating, and modern reconstruction algorithms, have significantly decreased radiation exposure, with some studies achieving sub-millisievert doses. Similarly, CM volume optimization, including adjustments in strategies for calculating CM volume, iodine concentration, and flow protocols, plays a role in managing risks such as contrast-associated acute kidney injury, particularly in patients with renal impairment. Emerging technologies, such as photon-counting CT and deep-learning reconstruction, promise further improvements in dose efficiency and image quality. This review summarizes current evidence, highlights the benefits and limitations of dose control approaches, and provides practical recommendations for practitioners. By tailoring protocols to patient characteristics, such as age, renal function, and body habitus, clinicians can achieve an optimal trade-off between diagnostic accuracy and patient safety, ensuring optimal operation of CT systems in clinical practice. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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19 pages, 421 KiB

Open AccessReview

Drug-Coated Balloons: Recent Evidence and Upcoming Novelties

by Zaid Mohammad Fahmi Shahrori, Marco Frazzetto, Shamin Hayat Mahmud, Wasfi Alghwyeen and Bernardo Cortese

J. Cardiovasc. Dev. Dis. 2025, 12(5), 194; https://doi.org/10.3390/jcdd12050194 - 20 May 2025

Abstract

Drug-coated balloons (DCBs) have emerged as a compelling alternative to drug-eluting stents in the treatment of coronary artery disease (CAD), offering the advantage of local drug delivery without permanent vascular scaffold implantation. Initially developed for managing in-stent restenosis, DCBs seem appealing for broader [...] Read more.

Drug-coated balloons (DCBs) have emerged as a compelling alternative to drug-eluting stents in the treatment of coronary artery disease (CAD), offering the advantage of local drug delivery without permanent vascular scaffold implantation. Initially developed for managing in-stent restenosis, DCBs seem appealing for broader indications, particularly in small vessel disease and bifurcation lesions. While paclitaxel-based DCBs remain the most investigated, newer limus formulations are showing promise and appear to be a valid alternative in early trials. Evidence from recent randomized clinical trials (RCTs) and meta-analyses highlights DCBs as a safe and effective option in selected patients, with potential benefits including lower restenosis rates, reduced need for dual antiplatelet therapy, and avoidance of late stent-related complications. As new large-scale trials near completion, DCBs are poised to take on a broader role in the treatment of CAD, particularly in patients where “leaving nothing behind” offers a clinical advantage. This review offers an overview of the DCB platforms commercially available, showing pharmacological differences, providing current indications in practical guidelines, and analyzing the most recent and impactful RCTs and meta-analyses in the field. Full article

(This article belongs to the Special Issue Leaders in Cardiovascular Research: A Special Issue Dedicated to Professor Patrick Serruys)

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10 pages, 678 KiB

Open AccessReview

Venous Hemodynamic Dysfunction and Recurrent Miscarriage: Case Series and Literature Review

by Elisa Sabattini, Helena Van Kerrebroeck and Wilfried Gyselaers

J. Cardiovasc. Dev. Dis. 2025, 12(5), 193; https://doi.org/10.3390/jcdd12050193 - 18 May 2025

Abstract

(1) Background: Maternal venous hemodynamic dysfunction is an intrinsic part of the pathophysiology of pre-eclampsia and fetal growth restriction. The aim of this study is to evaluate whether venous hemodynamic dysfunction is present in women with a history of (unexplained) recurrent miscarriage, and [...] Read more.

(1) Background: Maternal venous hemodynamic dysfunction is an intrinsic part of the pathophysiology of pre-eclampsia and fetal growth restriction. The aim of this study is to evaluate whether venous hemodynamic dysfunction is present in women with a history of (unexplained) recurrent miscarriage, and to link this pilot observation to reported data in the literature. (2) Methods: A retrospective search of hospital records was conducted to find data on recurrent miscarriage and hemodynamics assessment prior to conception. We also performed a scoping search of the literature regarding the association between recurrent miscarriage and maternal hemodynamics, reproductive outcomes, maternal complications, neonatal complications, and long-term cardiovascular function in women and their offspring. (3) Results: Six out of nine women with a history of recurrent miscarriage had preconception venous hemodynamic dysfunction. This observation is in line with the reported data on reduced venous reserves in association with low plasma volume in women with recurrent miscarriage, and adds to the reported link between recurrent miscarriage, poor reproductive outcomes, and chronic cardiovascular disease. (4) Discussion: This retrospective observational cohort supports an association between venous hemodynamic dysfunction and recurrent miscarriage that is corroborated by data reported in the literature. Abnormal venous hemodynamic function can be improved before conception, and this opens a new and currently unexplored pathway in the management of recurrent miscarriage. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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17 pages, 483 KiB

Open AccessReview

Myocardial Fibrosis: Assessment, Quantification, Prognostic Signification, and Anti-Fibrosis Targets: A State-of-the-Art Review

by Salvatore Poddi, Cynthia L. Lefter, Daniele Linardi, Andrea Ardigò, Giovanni B. Luciani and Alessio Rungatscher

J. Cardiovasc. Dev. Dis. 2025, 12(5), 192; https://doi.org/10.3390/jcdd12050192 - 18 May 2025

Abstract

Myocardial fibrosis (MF) is the excessive deposition of extracellular matrix (ECM) from myofibroblasts and is crucial in patients with heart failure (HF). Much work is still needed to fully understand its features and clinical role. This review aims to summarize the state-of-the-art of [...] Read more.

Myocardial fibrosis (MF) is the excessive deposition of extracellular matrix (ECM) from myofibroblasts and is crucial in patients with heart failure (HF). Much work is still needed to fully understand its features and clinical role. This review aims to summarize the state-of-the-art of MF knowledge, focusing on assessment, quantification, predictive value, and future therapies. We performed a literature search about MF studies published between 2014 and 2024, including clinical studies on MF assessment or quantification, the role of MF as a prognostic factor in patients with HF, basic science studies on fibrosis assessment, and the role of the main mechanisms involved in MF. We identified 5161 potentially relevant articles. After excluding non-appropriate ones, we had 186 potentially suitable studies. After full reading and a review of references, 40 articles were included in our review: 8 were about MF assessment, 5 about quantification, and 27 about fibrosis as a prognostic factor. MF is a crucial process in patients with cardiac diseases and leads to HF and arrhythmias. Assessment and quantification have taken great steps forward, but more research is needed to strengthen MF’s role as a prognostic factor in the future. Basic science will play a key role in anti-fibrosis treatment. Full article

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

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Open AccessArticle

Isolated Rapid Deployment Aortic Valve Replacement in Patients with Aortic Stenosis: Single-Center Retrospective Study

by Ricardo Ferreira, Tiago R. Velho, João Gonçalves, André Sena, Beatriz Draiblate, Ana G. Almeida, Ângelo Nobre and Fausto Pinto

J. Cardiovasc. Dev. Dis. 2025, 12(5), 191; https://doi.org/10.3390/jcdd12050191 - 17 May 2025

Abstract

Background: Aortic valve stenosis remains the most prevalent valvular pathology in Western countries. Rapid deployment bioprosthesis (RD) has emerged as a promising alternative to conventional valves for surgical aortic valve replacement (SAVR), particularly in elderly and high-risk patients. This study reports the short- [...] Read more.

Background: Aortic valve stenosis remains the most prevalent valvular pathology in Western countries. Rapid deployment bioprosthesis (RD) has emerged as a promising alternative to conventional valves for surgical aortic valve replacement (SAVR), particularly in elderly and high-risk patients. This study reports the short- and long-term outcomes of RD in patients with isolated aortic stenosis. Methods: A retrospective single-center analysis was conducted on 382 patients who underwent RD-AVR between 2014 and 2020. Data were collected from clinical files and national electronic databases. Primary outcomes included cardiopulmonary bypass (CPB) and cross-clamping (XC) times, postoperative complications, and long-term survival. Results: The mean age was 75.6 ± 5.9 years, with 29.8% of patients over 80 years old and a mean EuroSCORE II of 2.3 ± 1.5%. CPB and XC times were 36.7 ± 10.8 and 27.4 ± 8.1 min, respectively. Postoperative complications included acute kidney injury (AKI, 53.4%), de novo atrial fibrillation (31.9%), and high-grade/complete atrioventricular block with permanent pacemaker implantation (9.8%). In-hospital and 30-day mortality was 1.02% and 2.3%, respectively. The 5-year survival rate was 77%. At 6 months postoperatively, the mean transvalvular gradient was 11.1 ± 4.7 mmHg. At a median follow-up of 6.7 years, no cases of structural valve deterioration and only one case of endocarditis were reported. Conclusion: In this single-center study, RD in isolated AVR demonstrated favorable short- and long-term outcomes, including no structural valve deterioration at mid-term follow-up. These devices offer a safe and effective alternative to conventional SAVR, particularly in high-risk populations. Full article

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