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12 pages, 1052 KiB

Open AccessArticle

Predictive Value of the Naples Prognostic Score for One-Year Mortality in NSTEMI Patients Undergoing Selective PCI

by Mesut Gitmez, Evren Ekingen and Sueda Zaman

Diagnostics 2025, 15(5), 640; https://doi.org/10.3390/diagnostics15050640 - 6 Mar 2025

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Abstract

Objectives: Non-ST-elevation myocardial infarction (NSTEMI) is a common and severe condition that requires rapid and accurate risk assessment and treatment. The Naples prognostic score (NPS) is a novel risk score that integrates nutritional and inflammatory parameters. The aim of this study was to [...] Read more.

Objectives: Non-ST-elevation myocardial infarction (NSTEMI) is a common and severe condition that requires rapid and accurate risk assessment and treatment. The Naples prognostic score (NPS) is a novel risk score that integrates nutritional and inflammatory parameters. The aim of this study was to investigate the NPS as a predictor of one-year mortality in NSTEMI patients undergoing percutaneous coronary intervention (PCI). Methods: This retrospective study included 197 NSTEMI patients who underwent selective PCI from January 2020 to December 2020. The NPS was calculated based on the total cholesterol, serum albumin, neutrophil/lymphocyte ratio, and lymphocyte/monocyte ratio. Patients were categorized into two groups based on their NPS values: Group 1 (NPS 0–2) and Group 2 (NPS 3 or 4). The one-year mortality status of the patients was determined through phone calls or by querying the national death registry system. Results: During the follow-up period, the overall mortality rate was 19.3% (n = 38). The high NPS group exhibited a significantly higher mortality rate compared to the low NPS group, with rates of 33.7% and 8.1%, respectively (p < 0.001). A Cox regression analysis indicated that a high NPS score is an independent predictor of one-year mortality, with a hazard ratio of 4.52 (95% CI: 1.93–10.58; p < 0.001). Conclusions: The NPS is a simple, cheap, and easily accessible tool that can be used for risk stratification and treatment selection in NSTEMI patients. It also highlights the importance of inflammatory and nutritional status in influencing the prognosis of NSTEMI patients. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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15 pages, 2262 KiB

Open AccessArticle

Retrospective Cohort Study: Severe COVID-19 Leads to Permanent Blunted Heart Rate Turbulence

by Mücahid Yılmaz and Çetin Mirzaoğlu

Diagnostics 2025, 15(5), 621; https://doi.org/10.3390/diagnostics15050621 - 5 Mar 2025

Viewed by 478

Abstract

Background: Heart rate turbulence (HRT) is a non-invasive technique that can be used to evaluate autonomic nervous system (ANS) function and cardiac arrhythmia. The objective of this study is to investigate whether COVID-19 can lead to long-term blunted HRT following recovery. Methods: This [...] Read more.

Background: Heart rate turbulence (HRT) is a non-invasive technique that can be used to evaluate autonomic nervous system (ANS) function and cardiac arrhythmia. The objective of this study is to investigate whether COVID-19 can lead to long-term blunted HRT following recovery. Methods: This retrospective cohort study included 253 individuals with a confirmed history of COVID-19, referred to as the recovered COVID-19 group, along with 315 healthy participants who had no history of the virus. The recovered COVID-19 group was categorized into three subgroups based on their chest CT severity scores. The HRT analyses were obtained from a 24-h electrocardiography-Holter recording. Results: This study revealed that the HRT onset value was elevated in the recovered COVID-19 group, while the HRT slope value showed a significant decrease when compared to the control group. Correlation analyses indicated a positive relationship between the chest CT severity score and HRT onset, whereas a negative correlation was observed between the chest CT severity score and HRT slope. Regression analyses identified recovery from severe COVID-19, chest CT severity score, hypertension (HT), and smoking as independent predictors of both abnormal HRT onset and the existence of an abnormal HRT slope. Conclusions: Individuals who have recovered from severe COVID-19 are expected to encounter a permanent blunting of HRT, which is regarded as a significant indicator of an increased risk of ventricular arrhythmias and impaired autonomic nervous system (ANS) function. Recovered severe COVID-19 individuals should be carefully evaluated for HRT with 24-h ECG-Holter. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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13 pages, 860 KiB

Open AccessArticle

Aortic Root Replacement Procedures: A Validation Study of the Western Denmark Heart Registry from 1999 to 2022

by Emil Johannes Ravn, Viktor Poulsen, Poul Erik Mortensen, Jordi Sanchez Dahl, Kristian Øvrehus, Oke Gerke, Ivy Susanne Modrau, Katrine Müllertz, Lars Peter Schødt Riber and Lytfi Krasniqi

Diagnostics 2025, 15(5), 611; https://doi.org/10.3390/diagnostics15050611 - 4 Mar 2025

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Abstract

Background/Objectives: We reviewed data from the Western Danish Heart Registry (WDHR), which collects mandatory information on heart surgeries in Western Denmark, to validate cases with aortic root replacement (ARR) and assess the validity of registered data for all recorded cases. Methods: [...] Read more.

Background/Objectives: We reviewed data from the Western Danish Heart Registry (WDHR), which collects mandatory information on heart surgeries in Western Denmark, to validate cases with aortic root replacement (ARR) and assess the validity of registered data for all recorded cases. Methods: Patients registered in the WDHR with Danish Health Care Classification System (SKS) codes KFC and KFM from January 1999 to April 2022 were reviewed using electronic medical records. All patients who underwent ARR were included, and clinical data from the WDHR were adjudicated against electronic medical records. Results: A total of 847 cases with ARR were identified. Missing values averaged 12.0% in baseline variables (range: 3.2–22.1%), 7.3% in EuroSCORE II variables (range: 0.8–48.9%), and 5.5% in postoperative outcome variables (range: 4.1–8.1%). After adjudication, unrecovered data averaged 6.5% for baseline variables (range: 0.1–11.7%), 5.3% for EuroSCORE II variables (range: 0–32.5%), and 0.5% for postoperative outcomes (range: 0–0.8%). Missing data among EuroSCORE II were lower from 2012 and beyond (2.9% (range: 0.6–14.3%)). The median EuroSCORE II according to the WDHR was 6.2% (95% confidence interval 1.4–6.3) and after adjudication 10.7% (95% confidence interval 3.3–13.3). The positive predictive value for arrhythmia, central nervous damage, dialysis, reoperation for bleeding, and reoperation for ischemia exceeded 95%. Conclusions: The WDHR demonstrated overall value for clinical epidemiological research in ARR, but cases require validation to differentiate between procedures due to insufficient coding, while adjudication resulted in significantly higher data completeness for the majority of the variables. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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16 pages, 5391 KiB

Open AccessArticle

Tissue Doppler Imaging Provides Incremental Value in Predicting Six Months In-Stent Restenosis in Patients with Coronary Artery Disease

by Jih-Kai Yeh, Victor Chien-Chia Wu, Fen-Chiung Lin, I-Chang Hsieh, Po-Cheng Chang, Chun-Chi Chen, Chia-Hung Yang, Wen-Pin Chen and Kuo-Chun Hung

Diagnostics 2025, 15(5), 579; https://doi.org/10.3390/diagnostics15050579 - 27 Feb 2025

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Abstract

Background: Invasive coronary angiography is the gold standard for assessing in-stent restenosis (ISR) in patients with coronary artery disease. However, the predictive value of non-invasive Tissue Doppler Imaging (TDI) to evaluate patients with ISR has not been studied extensively. Methods: A total of [...] Read more.

Background: Invasive coronary angiography is the gold standard for assessing in-stent restenosis (ISR) in patients with coronary artery disease. However, the predictive value of non-invasive Tissue Doppler Imaging (TDI) to evaluate patients with ISR has not been studied extensively. Methods: A total of 41 patients (19 with acute myocardial infarction and 22 with stable angina pectoris) who received percutaneous coronary intervention (PCI) were enrolled in the study. Time-to-peak velocities (TpV) of 12 non-apical segments of the left ventricle, by pulse wave TDI echocardiography, were obtained within two days prior to the PCI and six months later. Results: A 12-segmental mean TpV ≥ 279.6 ms at six months after PCI was able to detect ISR (odds ratio: 2.09, 95% CI 1.004–4.352, p = 0.049). Moreover, a significant decrease in the standard deviation of TpV was demonstrated in patients without ISR (85.8 ± 44.8 vs. 60.3 ± 31.7 ms, p = 0.001), but not in patients with ISR (97.7 ± 53.3 vs. 91.2 ± 52.6 ms, p = 0.57). Conclusions: Pulse-wave TDI echocardiography is a promising tool in the detection of ISR six months after PCI in patients with coronary artery disease. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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9 pages, 538 KiB

Open AccessArticle

Adult Congenital Heart Disease in Serbia: Insights from a Single-Center Registry

by Aleksandra Nikolić, Stefan Veljković, Jovana Lakčević, Ana Peruničić, Armin Šljivo, Miloš Babić, Marko Nikolić, Slobodan Tomić, Dragana Radoičić, Mihajlo Farkić, Darko Boljević, Sanja Vučinić, Sanja Kablar and Milovan Bojić

Diagnostics 2025, 15(4), 498; https://doi.org/10.3390/diagnostics15040498 - 19 Feb 2025

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Abstract

Background/Objectives: Congenital heart disease (CHD), affecting approximately 1% of live births, has transitioned to a chronic condition due to advances in diagnostics and surgery, resulting in an increasing adult congenital heart disease (ACHD) population. This study characterizes the clinical and demographic profiles of [...] Read more.

Background/Objectives: Congenital heart disease (CHD), affecting approximately 1% of live births, has transitioned to a chronic condition due to advances in diagnostics and surgery, resulting in an increasing adult congenital heart disease (ACHD) population. This study characterizes the clinical and demographic profiles of ACHD patients in Serbia, focusing on congenital anomalies, mortality rates, and key clinical factors to identify opportunities for improving care and outcomes. Methods: This observational single-center study was conducted at the Cardiovascular Institute “Dedinje” in Belgrade, Serbia, involving patients diagnosed or treated for CHD between 2006 and 2022. Results: A total of 1532 patients were included in the study, with common diagnoses including atrial septal defects (ASD) (47.65%) and ventricular septal defects (VSD) (13.19%). The mean patient age was 48.31 years, with a slight predominance of females (57.21%). The complexity of CHD was categorized as mild (54.6%), moderate (36.5%), and severe (6.3%). The mortality rate was 4.2%, with higher rates observed in conditions like Ebstein anomaly (17.78%) and congenital aortic stenosis (11.76%). Conclusions: This study provides a comprehensive overview of the current state of ACHD management in Serbia, highlighting the high prevalence of ASD and VSD among patients, the challenges associated with moderate and severe CHD, and the notable mortality rates for certain conditions. The findings underscore the importance of improving early detection, individualized treatment plans, and multidisciplinary care to enhance patient outcomes in this growing population. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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11 pages, 1353 KiB

Open AccessArticle

A Pilot Study Investigating the Relationship Between Choroidal Thickness and Choroidal Vascular Index and Coronary Artery Ectasia

by Dogukan Comerter and Tufan Cinar

Diagnostics 2025, 15(3), 286; https://doi.org/10.3390/diagnostics15030286 - 26 Jan 2025

Viewed by 525

Abstract

Objective: The objective of this study was to compare changes in choroidal thickness (ChT) and choroidal vascular index (CVI) between patients with coronary artery ectasia (CAE) and healthy individuals. Methods: This study included 34 patients with CAE and 40 age-matched healthy [...] Read more.

Objective: The objective of this study was to compare changes in choroidal thickness (ChT) and choroidal vascular index (CVI) between patients with coronary artery ectasia (CAE) and healthy individuals. Methods: This study included 34 patients with CAE and 40 age-matched healthy subjects with normal coronary arteries. Measurements of ChT and CVI were taken using spectral-domain optical coherence tomography, employing the binarization method for CVI calculation. Additional parameters, including central macula thickness (CMT), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCC) thickness, were also documented. Results: The results indicated no significant differences in either subfoveal ChT or in ChT at 1500 µm both nasal and temporal to the fovea. However, significant differences were noted in ChT at the 500 µm nasal and temporal areas. The CVI was found to be significantly lower in the CAE group compared to the healthy controls. Furthermore, this study noted a significant difference in GCC thickness between the two groups, while no significant differences were observed in CMT and RNFL measurements. Conclusions: The findings suggest that patients with CAE exhibit decreased ChT and CVI in comparison to healthy controls. This highlights the potential role of ChT and CVI as important markers of disease in coronary artery ectasia, offering valuable insights into systemic cardiovascular health. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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12 pages, 1188 KiB

Open AccessArticle

Diagnostic Potential of CTRP5 and Chemerin for Coronary Artery Disease: A Study by Coronary Computed Tomography Angiography

by Taha Okan, Cihan Altın, Caner Topaloglu, Mehmet Doruk and Mehmet Birhan Yılmaz

Diagnostics 2025, 15(2), 206; https://doi.org/10.3390/diagnostics15020206 - 17 Jan 2025

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Abstract

Background/Objectives: As an endocrine organ, adipose tissue produces adipokines that influence coronary artery disease (CAD). The objective of this study was to assess the potential value of CTRP5 and chemerin in differentiating coronary computed tomography angiography (CCTA)-confirmed coronary artery disease (CAD) versus [...] Read more.

Background/Objectives: As an endocrine organ, adipose tissue produces adipokines that influence coronary artery disease (CAD). The objective of this study was to assess the potential value of CTRP5 and chemerin in differentiating coronary computed tomography angiography (CCTA)-confirmed coronary artery disease (CAD) versus non-CAD. Secondarily, within the CCTA-confirmed CAD group, the aim was to investigate the relationship between the severity and extent of CAD, as determined by coronary artery calcium score (CACS), and the levels of CTRP5 and chemerin. Methods: Consecutive individuals with chest pain underwent CCTA to evaluate coronary artery anatomy and were divided into two groups. The CCTA-confirmed CAD group included patients with any atherosclerotic plaque (soft, mixed, or calcified) regardless of calcification, while the non-CAD group consisted of individuals without plaques on CCTA, with zero CACS, and without ischemia on stress ECG. Secondarily, in the CCTA-confirmed CAD group, the severity and extent of CAD were evaluated using CACS. Blood samples were collected and stored at −80 °C for analysis of CTRP5 and chemerin levels via ELISA. Results: Serum CTRP5 and chemerin levels were significantly higher in the CAD group compared to the non-CAD group (221.83 ± 103.81 vs. 149.35 ± 50.99 ng/mL, p = 0.003 and 105.02 ± 35.62 vs. 86.07 ± 19.47 ng/mL, p = 0.005, respectively). Receiver operating characteristic (ROC) analysis showed that a CTRP5 cutoff of 172.30 ng/mL had 70% sensitivity and 73% specificity for identifying CAD, while a chemerin cutoff of 90.46 ng/mL had 61% sensitivity and 62% specificity. A strong positive correlation was observed between CTRP5 and chemerin, but neither adipokine showed a correlation with the Agatston score, a measure of CAD severity and extent, nor with coronary artery stenosis as determined by CCTA. Conclusions: CTRP5 and chemerin were significantly elevated in the CCTA-confirmed CAD group compared to the non-CAD group, with CTRP5 showing greater sensitivity and specificity. However, neither adipokine was linked to CAD severity and extent, differing from findings based on invasive coronary angiography (ICA). CTRP5 may serve as a promising “all-or-none biomarker” for CAD presence. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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14 pages, 2007 KiB

Open AccessArticle

The Possible Role of Rosuvastatin Therapy in HFpEF Patients—A Preliminary Report

by Tomasz Urbanowicz, Ievgen Spasenenko, Marta Banaszkiewicz, Anna Olasińska-Wiśniewska, Aleksandra Krasińska-Płachta, Andrzej Tykarski, Krzysztof J. Filipiak, Zbigniew Krasiński and Beata Krasińska

Diagnostics 2024, 14(22), 2579; https://doi.org/10.3390/diagnostics14222579 - 16 Nov 2024

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Abstract

Background: An increasing number of heart failure with preserved ejection fraction (HFpEF) syndromes has been reported in tandem with increasing age and burdens of obesity and cardiometabolic disorders. Identifying possible risk and modulatory HFpEF factors has significant epidemiological and clinical value. This study [...] Read more.

Background: An increasing number of heart failure with preserved ejection fraction (HFpEF) syndromes has been reported in tandem with increasing age and burdens of obesity and cardiometabolic disorders. Identifying possible risk and modulatory HFpEF factors has significant epidemiological and clinical value. This study aimed to assess the prevalence of echocardiographic diagnostic criteria of left ventricular dysfunction in patients with chronic coronary syndrome depending on rosuvastatin therapy. Method: There were 81 (33 (41%) male) consecutive patients with a median age of 70 (62–75) years, presenting with stable heart failure symptoms according to the New York Heart Association (NYHA) classification I to III. They presented with chronic coronary syndrome and were hospitalized between March and August 2024. Patients were divided according to the type of long-term lipid-lowering therapy into patients with rosuvastatin and with other statin therapy. The echocardiographic analysis based on diastolic dysfunction evaluation was performed on admission and compared with demographical, clinical, and laboratory results. Results: In the multivariable model for diastolic dysfunction prediction in the analyzed group based on three echocardiographic parameters, septal E’ below 7 cm/s, lateral E’ below 10 cm/s, and LAVI above 34 mL/m², the following factors were found to be significant: sex (male) (OR: 0.19, 95% CI: 0.04–0.83, p = 0.027), obesity (defined as BMI > 30) (OR: 12.78, 95% CI: 2.19–74.50, p = 0.005), and rosuvastatin therapy (OR: 0.09, 95% CI: 0.02–0.51, p = 0.007). Conclusions: Rosuvastatin therapy can be regarded as a possible protective therapy against left ventricular diastolic dysfunction in chronic coronary syndrome. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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Review

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28 pages, 2265 KiB

Open AccessReview

Contemporary Perspectives on Congestion in Heart Failure: Bridging Classic Signs with Evolving Diagnostic and Therapeutic Strategies

by Mihai Grigore, Camelia Nicolae, Andreea-Maria Grigore, Ana-Maria Balahura, Nicolae Păun, Gabriela Uscoiu, Ioana Verde and Adriana-Mihaela Ilieșiu

Diagnostics 2025, 15(9), 1083; https://doi.org/10.3390/diagnostics15091083 - 24 Apr 2025

Abstract

Congestion represents a defining hallmark of heart failure (HF) leading to increased morbidity and mortality in HF patients. While it was traditionally viewed as a simple and uniform state of volume overload, contemporary understanding has emphasized its complexity, distinguishing between intravascular, interstitial, and [...] Read more.

Congestion represents a defining hallmark of heart failure (HF) leading to increased morbidity and mortality in HF patients. While it was traditionally viewed as a simple and uniform state of volume overload, contemporary understanding has emphasized its complexity, distinguishing between intravascular, interstitial, and tissue congestion. Congestion contributes to overt clinical manifestation of HF. However, subclinical congestion often goes undetected, increasing the risk of adverse outcomes. Residual congestion, in particular, remains a frequent and challenging issue, with its persistence at discharge being strongly linked to rehospitalization and poor prognosis. Clinical evaluation often fails to reliably identify the resolution of congestion, highlighting the need for supplementary diagnostic methods. Improvement in imaging modalities, including lung ultrasound, venous Doppler, and echocardiography, have significantly enhanced the detection of congestion. Moreover, biomarkers such as natriuretic peptides, bioactive adrenomedullin, soluble CD146, and carbohydrate antigen 125 offer valuable, complementary insights into fluid distribution and the severity of HF congestion. Therefore, a comprehensive, multimodal strategy that integrates clinical evaluation with imaging and biomarker data is crucial for optimizing the management of congestion in HF. Future approaches should prioritize personalized decongestive therapy, addressing both intravascular and tissue congestion, while aiming to preserve renal function and limit neurohormonal activation. Refinement of these strategies holds promise for improving long-term outcomes, reducing rehospitalizations, and enhancing overall patient prognosis. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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16 pages, 1051 KiB

Open AccessReview

Cardiac Troponin as a Prognostic Indicator for Major Adverse Cardiac Events in Non-Cardiac Surgery: A Narrative Review

by Syarifah Noor Nazihah Sayed Masri, Fadzwani Basri, Siti Nadzrah Yunus and Saw Kian Cheah

Diagnostics 2025, 15(9), 1061; https://doi.org/10.3390/diagnostics15091061 - 22 Apr 2025

Abstract

A major adverse cardiac event (MACE) following non-cardiac surgery encompasses critical postoperative cardiovascular complications such as myocardial infarction or injury, cardiac arrest, or stroke that are associated with increased perioperative morbidity, mortality, and healthcare resource utilisation. Cardiac troponin (cTn), particularly high-sensitivity cardiac troponin [...] Read more.

A major adverse cardiac event (MACE) following non-cardiac surgery encompasses critical postoperative cardiovascular complications such as myocardial infarction or injury, cardiac arrest, or stroke that are associated with increased perioperative morbidity, mortality, and healthcare resource utilisation. Cardiac troponin (cTn), particularly high-sensitivity cardiac troponin (hs-cTn), has emerged as a key biomarker for prediction of MACE. Despite its recognised utility, there is no consensus on how cTn levels should be used for standardised postoperative surveillance. Interpretation of the cTn levels may vary depending on sex-specific reference values and baseline comorbidities such as chronic kidney disease, sepsis, critical illness, and non-ischaemic conditions. The balance between cost-effectiveness and clinical benefit in implementing universal versus targeted postoperative hs-cTn screening remains to be fully explored. This review examines the prognostic value of cardiac troponin (cTn) levels in predicting major adverse cardiovascular events (MACEs) in patients undergoing non-cardiac surgery, with a focus on perioperative cTn elevations—particularly those associated with myocardial injury after non-cardiac surgery (MINS)—as potential early indicators of increased cardiovascular risk. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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18 pages, 945 KiB

Open AccessReview

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and Management

by Chiara Tognola, Alessandro Maloberti, Marisa Varrenti, Patrizio Mazzone, Cristina Giannattasio and Fabrizio Guarracini

Diagnostics 2025, 15(7), 942; https://doi.org/10.3390/diagnostics15070942 - 7 Apr 2025

Viewed by 435

Abstract

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an increasingly recognized clinical entity characterized by myocardial injury in the absence of a significant coronary artery obstruction. MINOCA encompasses a diverse range of pathophysiological mechanisms, including coronary plaque disruption, coronary vasospasm, coronary microvascular dysfunction, [...] Read more.

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an increasingly recognized clinical entity characterized by myocardial injury in the absence of a significant coronary artery obstruction. MINOCA encompasses a diverse range of pathophysiological mechanisms, including coronary plaque disruption, coronary vasospasm, coronary microvascular dysfunction, thromboembolism, and spontaneous coronary artery dissection. A systematic diagnostic approach is essential to identify the underlying etiology and guide appropriate management strategies. Advanced imaging techniques, particularly cardiac magnetic resonance, play a pivotal role in distinguishing ischemic from non-ischemic myocardial injury and refining prognosis. Despite growing awareness, standardized treatment protocols remain limited, with current management largely extrapolated from strategies used in obstructive coronary artery disease. Notably, MINOCA is significantly more prevalent in women, emphasizing the need to understand sex-related differences in its pathophysiology, presentation, and clinical outcomes. This narrative review offers a comprehensive and up-to-date overview of MINOCA, including a dedicated chapter on sex-related considerations. It integrates recent advancements and highlights the importance of personalized management strategies. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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12 pages, 1355 KiB

Open AccessReview

Growth Hormone and Heart Failure: Implications for Patient Stratification, Prognosis, and Precision Medicine

by Nikolaos Theodorakis, Magdalini Kreouzi, Christos Hitas, Dimitrios Anagnostou and Maria Nikolaou

Diagnostics 2024, 14(24), 2831; https://doi.org/10.3390/diagnostics14242831 - 16 Dec 2024

Cited by 9 | Viewed by 1475

Abstract

Heart failure (HF) remains a major cause of morbidity and mortality worldwide. While standard treatments primarily target neurohormonal pathways, emerging evidence highlights the significant role of hormonal deficiencies, such as impaired growth hormone (GH) signaling, in HF progression and outcomes. GH is crucial [...] Read more.

Heart failure (HF) remains a major cause of morbidity and mortality worldwide. While standard treatments primarily target neurohormonal pathways, emerging evidence highlights the significant role of hormonal deficiencies, such as impaired growth hormone (GH) signaling, in HF progression and outcomes. GH is crucial for cardiovascular and skeletal muscle function, and its deficiency has been associated with worse prognosis. This review synthesizes recent findings from randomized controlled trials (RCTs) to explore how GH can contribute to personalized care and improve patient stratification in HF. A comprehensive literature review was conducted using PubMed up to 10 October 2024. Search terms included “growth hormone” combined with “heart failure”, “HFrEF”, “HFpEF”, and “HFmrEF.” Only placebo-controlled RCTs published in English and involving human subjects were considered. Data on study design, participant characteristics, GH dosing, and key clinical outcomes were systematically extracted and analyzed. Several trials demonstrated that GH therapy can transiently improve left ventricular ejection fraction (LVEF), exercise capacity, and reduce inflammatory markers. For example, one study has reported an increase in LVEF from 32 ± 3.8% to 43.8 ± 4.6% (p = 0.002), following three months of GH therapy in post-MI HF patients. However, benefits diminished after discontinuation. Additional studies have observed sustained improvements in peak oxygen consumption and LVEF over four years, with an additional trend towards hard endpoint improvement. Conversely, some studies showed no significant impact on cardiac function, highlighting heterogeneity in outcomes. As a result, GH therapy holds promise for improving cardiac and functional parameters in HF patients, but evidence remains mixed. Larger, long-term RCTs are needed to confirm its efficacy and safety. Precision medicine approaches and biomarker-driven strategies may optimize patient outcomes and guide clinical practice. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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Other

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22 pages, 1174 KiB

Open AccessSystematic Review

Central Venous Pressure as a Predictor of Acute Kidney Injury in Cardiac Surgery: A Systematic Review of Observational Studies

by Panagiota Griva, Vasiliki Griva, Dimitra Samara, Christina Talliou, Konstantina Panagouli and Loizos Roungeris

Diagnostics 2025, 15(5), 530; https://doi.org/10.3390/diagnostics15050530 - 21 Feb 2025

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Abstract

Background/Objectives: Acute kidney injury (AKI) is a syndrome characterized by impaired kidney function, which is associated with reduced survival and increased morbidity. Central venous pressure (CVP) is a widely used hemodynamic parameter for assessing the volume status of patients and evaluating their [...] Read more.

Background/Objectives: Acute kidney injury (AKI) is a syndrome characterized by impaired kidney function, which is associated with reduced survival and increased morbidity. Central venous pressure (CVP) is a widely used hemodynamic parameter for assessing the volume status of patients and evaluating their response to fluid resuscitation. This systematic review aims to analyze various prospective and retrospective observational and controlled trials to determine the association between CVP and the risk of developing AKI in patients undergoing cardiac surgery. Additionally, it examines whether elevated CVP serves as an accurate predictor of AKI in this patient population. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using PubMed as the primary database. The search focused on studies published after 2014 that included adult patients undergoing cardiac surgery with reported measurements of CVP and kidney function assessment. Studies conducted on animals, pediatric populations, those published before 2014, or in languages other than English were excluded from the review. Results: Through the analysis of 21 studies, a clear association between higher CVP and increased AKI risk emerged. The most critical CVP thresholds identified were 10 mmHg, 12 mmHg, 14 mmHg, and 20 mmHg, with risk increasing progressively beyond these values. CVP ≥ 10 mmHg was the most commonly reported cutoff for elevated AKI risk, showing 1.42 to 4.53 times increased odds. CVP ≥ 12 mmHg further amplified the risk, while CVP ≥ 14 mmHg was consistently associated with severe AKI and the need for RRT. The highest threshold (CVP ≥ 20 mmHg) showed the greatest risk escalation, linked to fluid overload, right heart failure, and mortality. Studies also suggest an optimal CVP range of 6–8 mmHg to minimize AKI incidence. Conclusions: Elevated CVP is an independent risk factor for the development of AKI in patients undergoing cardiac surgery. These findings suggest that CVP monitoring can play a significant role in predicting AKI and guiding perioperative management strategies. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)

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