Journal of Cardiovascular Development and Disease

12 pages, 1372 KB

Open AccessArticle

Endothelial Activation and Stress Index Predicts Poor Coronary Collateral Development in Chronic Total Occlusion

by Muhammed Ulvi Yalcin, Kadri Murat Gurses, Canan Aydoğan, Sevil Butun, Abdullah Tunçez, Hüseyin Tezcan, Yasin Ozen, Kenan Demir, Nazif Aygul, Mustafa Kirmizigul, Aslihan Merve Toprak Su, Burak Erdogan, Tolgahan Karaman and Bulent Behlul Altunkeser

J. Cardiovasc. Dev. Dis. 2026, 13(3), 124; https://doi.org/10.3390/jcdd13030124 - 9 Mar 2026

Abstract

Background/Objectives: Coronary collateral circulation (CCC) reduces ischemic damage in patients with chronic total occlusion (CTO), yet collateral development varies considerably among individuals. Endothelial stress and systemic inflammation are key biological processes involved in collateral vessel formation. The Endothelial Activation and Stress Index (EASIX), [...] Read more.

Background/Objectives: Coronary collateral circulation (CCC) reduces ischemic damage in patients with chronic total occlusion (CTO), yet collateral development varies considerably among individuals. Endothelial stress and systemic inflammation are key biological processes involved in collateral vessel formation. The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase, creatinine, and platelet count, is a simple marker reflecting endothelial dysfunction and inflammatory status. However, evidence regarding its relationship with angiographic coronary collateral development in CTO remains limited. Therefore, this study aimed to evaluate the association between EASIX and CCC grades in patients with CTO. Methods: This retrospective study included 186 patients with CTO who underwent coronary angiography. CCC was evaluated using the Rentrop–Cohen classification and categorized as poorly developed (grades 0–1) or well-developed (grades 2–3). Clinical and laboratory data, including EASIX, were collected. Univariate and multivariate binary logistic regression analyses were performed to identify factors associated with poorly developed CCC. EASIX was standardized (z-score), and odds ratios were reported per 1-standard deviation increase. The predictive performance of EASIX was assessed using receiver operating characteristic (ROC) curve analysis. Results: Poorly developed CCC was observed in 70 patients (37.6%). Patients with well-developed CCC had significantly lower EASIX values (median 0.44 vs. 0.67, p < 0.001) and higher HDL cholesterol levels (p = 0.043). Neutrophil-to-lymphocyte ratio was also higher in the poorly developed CCC group (median 2.59 [2.19–3.59] vs. 2.41 [1.59–3.49], p = 0.028). In multivariate analysis, standardized EASIX remained independently associated with poorly developed CCC (OR 2.536 per 1-SD increase, 95% CI 1.734–3.710, p < 0.001). ROC analysis showed that EASIX provided moderate discrimination for poorly developed CCC (AUC 0.718), with 72.9% sensitivity and 62.1% specificity at a cutoff of >0.51. Conclusions: Higher EASIX values were independently associated with poorly developed CCC in patients with CTO. These findings support a link between systemic endothelial stress and impaired collateral vessel formation. EASIX may serve as a simple, practical, and low-cost biomarker to support risk stratification in CTO patients; however, prospective studies are needed to confirm these results and clarify clinical implications. Full article

(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)

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11 pages, 513 KB

Open AccessArticle

Central Aortic Cannulation for Total Coronary Revascularization via Anterior Thoracotomy: A Single-Center Initial Experience

by Tuna Demirkıran, Işıl Taşöz Özdaş, Gizem Işık Ökten, Furkan Burak Akyol, Tayfun Özdem, Yiğit Tokgöz, Hüma Kekeçdil, Murat Kadan and Kubilay Karabacak

J. Cardiovasc. Dev. Dis. 2026, 13(3), 123; https://doi.org/10.3390/jcdd13030123 - 7 Mar 2026

Abstract

Objective: We aimed to evaluate the feasibility, safety, and technical challenges of central aortic cannulation for total coronary revascularization via left anterior thoracotomy (TCRAT). Methods: A retrospective, single-center observational study was conducted on the first 29 TCRAT cases performed with central aortic cannulation. [...] Read more.

Objective: We aimed to evaluate the feasibility, safety, and technical challenges of central aortic cannulation for total coronary revascularization via left anterior thoracotomy (TCRAT). Methods: A retrospective, single-center observational study was conducted on the first 29 TCRAT cases performed with central aortic cannulation. The primary outcomes included operative mortality, stroke, conversion to sternotomy, major aortic bleeding, and dissection; the secondary outcomes included delirium, reoperation, infection, ICU stay, and hospitalization. The descriptive statistics were reported as means ± SD or median (interquartile range [IQR]). Results: The mean age of the patients was 57.2 ± 9.8 years, with 72% of these being male. The most frequent comorbidities observed in the study population were hypertension (62%), diabetes (52%), and peripheral artery disease (28%). The mean cross-clamp time was found to be 63 ± 27 min, and the mean CPB time was 118.6 ± 41.6 min. The occurrence of stroke, aortic dissection, major bleeding, and sternotomy conversions was not observed. One patient died from severe pneumonia on the ninth post-operative day. The mean ICU stay was 1.2 ± 0.4 days, and the mean hospital stay was 5.3 ± 1.1 days. Conclusions: Central aortic cannulation appears to be a safe and feasible procedure for TCRAT, providing physiological antegrade flow and eliminating the complications associated with peripheral cannulation. The preliminary findings suggest that central arterial cannulation may be a safe and practical alternative for the TCRAT technique, but prospective comparative studies are required to confirm its benefits over the femoral and axillary approaches. Full article

(This article belongs to the Special Issue Minimally Invasive Coronary Revascularization: State of the Art)

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35 pages, 1225 KB

Open AccessReview

Twin Transformation in Cardiothoracic Surgery: The Convergence of Digital Innovation and Sustainability

by Vasileios Leivaditis, Roman Gottardi, Andreas Antonios Maniatopoulos, Francesk Mulita, Charalampia Pylarinou, Spyros Papadoulas, Konstantinos Nikolakopoulos, Ioannis Panagiotopoulos, Efstratios Koletsis, Manfred Dahm and Anastasios Sepetis

J. Cardiovasc. Dev. Dis. 2026, 13(3), 122; https://doi.org/10.3390/jcdd13030122 - 7 Mar 2026

Abstract

Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods: [...] Read more.

Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods: This narrative review synthesizes PubMed-indexed literature published over the past two decades, supplemented by relevant policy documents and guidelines. The review examines digital transformation and sustainability initiatives in cardiothoracic surgery through the lens of the twin transformation framework, which conceptualizes digitalization and sustainability as interdependent and mutually reinforcing processes. Results: Key domains of digital transformation include artificial intelligence and big data-driven decision-making, robotic and minimally invasive surgical techniques, digital twins and simulation-based training, telemedicine and remote monitoring, and interoperable electronic health records. Sustainability-related themes encompass the substantial environmental burden of operating rooms, green surgical practices, sustainable procurement, and hospital-level decarbonization strategies. Emerging evidence suggests that aligning digital technologies with sustainability objectives can improve clinical outcomes, enhance operational efficiency, and reduce environmental impact. However, current evidence is largely derived from pilot studies and single-center experiences. Conclusions: Twin transformation offers a coherent and forward-looking framework for the future evolution of cardiothoracic surgery, demonstrating that digital innovation and sustainability can be synergistic rather than competing goals. While significant challenges remain—including high implementation costs, limited long-term data, and fragmented regulatory frameworks—integrating digital health technologies with sustainable practices represents a promising pathway toward high-quality, efficient, and environmentally responsible cardiothoracic care. Full article

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13 pages, 1274 KB

Open AccessArticle

Early Prediction of Postoperative Peritoneal Dialysis Using Lung Ultrasound Scoring in Neonates After Cardiopulmonary Bypass

by Duygu Tunçel, Süleyman Geter, Leyla Şero, Yiğit Kılıç, Nilüfer Okur and Bedri Aldudak

J. Cardiovasc. Dev. Dis. 2026, 13(3), 121; https://doi.org/10.3390/jcdd13030121 - 6 Mar 2026

Abstract

Background: Neonates and young infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) are highly vulnerable to pulmonary dysfunction, systemic inflammation, capillary leak, and fluid overload, which may lead to acute kidney injury (AKI) and the need for peritoneal dialysis (PD). Lung ultrasound (LUS) [...] Read more.

Background: Neonates and young infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) are highly vulnerable to pulmonary dysfunction, systemic inflammation, capillary leak, and fluid overload, which may lead to acute kidney injury (AKI) and the need for peritoneal dialysis (PD). Lung ultrasound (LUS) is a bedside, radiation-free tool that allows real-time assessment of lung aeration and pulmonary congestion. However, its role in predicting postoperative renal support remains limited. This study aimed to evaluate whether early postoperative LUS scores could predict the need for PD in neonates after congenital heart surgery with CPB. Methods: In this prospective single-center study, 53 neonates undergoing cardiac surgery with CPB between June 2025 and January 2026 were included. LUS was performed preoperatively and at 0–2 h, 24–48 h, 72 h, 120 h, and 168 h postoperatively using a standardized six-zone scoring system (0–18). The primary outcome was postoperative PD requirement. ROC analysis assessed predictive performance, and multivariable logistic regression identified independent predictors. Results: Total LUS scores significantly increased in the early postoperative period, remained elevated for 24–72 h, and gradually declined by days 5–7. Infants requiring PD (n = 16) had significantly higher LUS scores at 0–2 h, 24–48 h, and 72 h (p < 0.05). The 24–48 h (AUC = 0.784; sensitivity 87%, specificity 62% at cut-off ≥ 11.5) LUS score showed the best predictive value for PD (AUC = 0.831; sensitivity 86%, specificity 74% at cut-off ≥ 13). In multivariable analysis, higher LUS scores at 0–2 h (OR 1.625, p = 0.048) and 24–48 h (OR 1.621, p = 0.048) independently predicted PD. Conclusion: Postoperative LUS is a reliable, noninvasive tool that can aid in predicting the need for PD in neonates undergoing cardiac surgery with CPB, supporting timely fluid and renal management. Full article

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10 pages, 1130 KB

Open AccessArticle

Exploratory Study of Selective Brain Hypothermia Using Transnasal Evaporative Cooling Under Controlled Normothermia with an Endovascular Device

by Mitsuaki Nishikimi, Kazuya Kikutani, Mayumi Higashi, Shinichiro Ohshimo, Tatsuhiko Anzai and Nobuaki Shime

J. Cardiovasc. Dev. Dis. 2026, 13(3), 120; https://doi.org/10.3390/jcdd13030120 - 6 Mar 2026

Abstract

Introduction: Selective brain hypothermia has been investigated to improve neurological outcomes in patients with cardiac arrest; however, an optimal clinical method has not yet been established. This study aimed to evaluate the feasibility of a technique combining transnasal evaporative cooling with simultaneous endovascular [...] Read more.

Introduction: Selective brain hypothermia has been investigated to improve neurological outcomes in patients with cardiac arrest; however, an optimal clinical method has not yet been established. This study aimed to evaluate the feasibility of a technique combining transnasal evaporative cooling with simultaneous endovascular temperature management to achieve selective brain hypothermia while preventing systemic hypothermia. Methods: Three adult male Göttingen swine were anesthetized and mechanically ventilated. Transnasal cooling was initiated at maximum output while endovascular warming preserved systemic temperature. Brain parenchymal and rectal temperatures, mean arterial pressure (MAP), heart rate (HR), and cardiac output (CO) were continuously monitored for 60 min. Temperature differences between brain and rectum at 60 min were analyzed. Results: A brain–rectal gradient ≥1.0 °C was achieved in all swine at 25, 40, and 30 min, respectively, and maintained at 1.0–1.5 °C thereafter. Brain temperature (34.5 ± 0.34 °C) was significantly lower than rectal temperature (35.8 ± 0.35 °C) at 60 min after initiation of the selective cooling procedure (p = 0.0048). MAP, HR, and CO showed no deviations from baseline. Conclusions: The combination of transnasal cooling and endovascular warming reliably induced selective brain hypothermia of 1–1.5 °C without adverse effects on hemodynamic parameters in swine. Full article

(This article belongs to the Special Issue Clinical Outcome and Treatment of Cardiac Arrest)

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15 pages, 2031 KB

Open AccessReview

Artificial Intelligence in Venous Thromboembolism Prevention: A Narrative Review of Machine Learning, Deep Learning, and Natural Language Processing

by Daniela Nicoleta Crisan, Talida Georgiana Cut, Lucian-Flavius Herlo, Nina Ivanovic, Alexandra Herlo, Luana Alexandrescu, Andreea Sălcudean and Raluca Dumache

J. Cardiovasc. Dev. Dis. 2026, 13(3), 119; https://doi.org/10.3390/jcdd13030119 - 6 Mar 2026

Abstract

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a significant and preventable cause of morbidity and mortality worldwide. Despite the existence of clinical prediction models, biomarker-based risk assessments, and imaging techniques, gaps remain in accurately identifying and managing high-risk [...] Read more.

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a significant and preventable cause of morbidity and mortality worldwide. Despite the existence of clinical prediction models, biomarker-based risk assessments, and imaging techniques, gaps remain in accurately identifying and managing high-risk patients. In recent years, artificial intelligence has emerged as a transformative tool in healthcare, offering promising applications for enhancing VTE prevention strategies. This narrative review synthesizes current evidence on the use of artificial intelligence (AI) technologies including machine learning (ML), deep learning (DL), and natural language processing (NLP). We explore how supervised ML algorithms, such as random forests, support vector machines, and gradient boosting, improve predictive performance compared to traditional models by capturing complex, nonlinear relationships within electronic health record data. We also examine the role of DL models, particularly convolutional neural networks, in interpreting imaging data, achieving diagnostic accuracies comparable to expert radiologists. Additionally, the review highlights NLP applications in extracting risk-relevant information from unstructured clinical notes and the emerging integration of wearable device data and time-series analysis for dynamic risk assessment. We argue that the successful integration of AI into routine VTE prevention workflows requires rigorous prospective validation, cross-institutional collaboration, and thoughtful implementation into clinical decision support systems. Full article

(This article belongs to the Special Issue Machine Learning and Artificial Intelligence in Cardiovascular Medicine, 2nd Edition)

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13 pages, 1654 KB

Open AccessArticle

Prognostic Value of Cadmium-Zinc-Telluride Dedicated Cardiac SPECT Dynamic Myocardial Perfusion Quantitative Imaging in Patients with Coronary Chronic Total Occlusion: A Pilot Study

by Linlin Li, Zekun Pang, Jianming Li and Wengui Xu

J. Cardiovasc. Dev. Dis. 2026, 13(3), 118; https://doi.org/10.3390/jcdd13030118 - 4 Mar 2026

Abstract

Background: The prevalence of chronic total occlusion (CTO) lesions is as high as 30% in patients undergoing coronary angiography (CAG). Some CTO patients do not undergo revascularization due to procedural complexity and high risks. This study aimed to investigate the value of cadmium-zinc-telluride [...] Read more.

Background: The prevalence of chronic total occlusion (CTO) lesions is as high as 30% in patients undergoing coronary angiography (CAG). Some CTO patients do not undergo revascularization due to procedural complexity and high risks. This study aimed to investigate the value of cadmium-zinc-telluride (CZT) SPECT dynamic myocardial perfusion imaging (MPI) for risk stratification and prognosis assessment in patients with coronary CTO. Methods: This study retrospectively included 62 patients who underwent CZT SPECT dynamic MPI examination and were diagnosed with CTO by angiography. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, late coronary revascularization, or hospitalization for unstable angina. Results: Over a median follow-up of 17 months (IQR 11–23), 15 MACEs occurred. The stress myocardial blood flow (sMBF) and coronary flow reserve (CFR) in the CTO territory were significantly lower in the MACEs group compared to the non-MACEs group (all p < 0.05). Receiver operating characteristic analysis determined the optimal cut-off values for predicting MACEs as sMBF < 0.75 (sensitivity 78.7%, specificity 73.3%, AUC = 0.74, p < 0.05) and CFR < 1.39 (sensitivity 70.2%, specificity 80.0%, AUC = 0.75, p < 0.01). Kaplan–Meier survival analysis showed that patients with impaired sMBF (p < 0.001) or impaired CFR (p < 0.01), defined by these cut-off values, had significantly worse clinical outcomes. Conclusions: The results of this study indicate that sMBF and CFR obtained from CZT SPECT dynamic MPI provide valuable prognostic prediction for patients with coronary CTO lesions, offering critical evidence for identifying high-risk patients requiring active intervention. Full article

(This article belongs to the Special Issue Noninvasive Imaging in Cardiology: From Diagnosis to Treatment)

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11 pages, 639 KB

Open AccessArticle

Is Resynchronization Pacing Proarrhythmic Among Congenital Heart Patients? An Evaluation and Review

by Peter P. Karpawich, Kathleen Zelin, Corinne Biggs, Swati Sehgal, Jennifer Blake, Chenni Sriram and Pooja Gupta

J. Cardiovasc. Dev. Dis. 2026, 13(3), 117; https://doi.org/10.3390/jcdd13030117 - 4 Mar 2026

Abstract

Background: Cardiac resynchronization therapy (CRT) can be an effective form of heart failure (HF) management among congenital heart disease (CHD) patients (pts) with and without surgically repaired defects. However, very long-term results are limited. Recently, CRT has been implicated to be proarrhythmic among [...] Read more.

Background: Cardiac resynchronization therapy (CRT) can be an effective form of heart failure (HF) management among congenital heart disease (CHD) patients (pts) with and without surgically repaired defects. However, very long-term results are limited. Recently, CRT has been implicated to be proarrhythmic among older CRT recipients. This issue is largely unknown among younger CHD-CRT pts. This study presents up to a 20-year (y) continuous review of any arrhythmia (Arr) burden associated with CRT among CHD-HF pts. Methods: From 1999 to 2024, outcomes of 45 CHD-HF pts (NYHA II-IV) (age 4–57 y [mean 26]; 31% female) were compared between those on established medical management (MM) (n = 18) and CRT recipients (n = 27) followed continuously for 1–20 years. Pre-existing and any de novo Arr that occurred following CRT were documented. Clinical assessments were continuous. Results: Follow-up was for 1 to 20 y (mean 7.5 y ± 0.7 sem). Patient demographics (CRT vs. MM groups) were comparable. Pre-existing Arr were found in 16 pts (38%) from both groups: accelerated junction (one CRT), atrial flutter (one CRT; two MM), and ventricular tachycardia (six CRT; six MM). During follow-up, outcomes included 14 pt deaths and 7 heart transplants (HTs). Of these, pre-existing Arr were causative among three CRT recipients: two ≤ 2 y and one > 5 y after CRT. There were no new-onset Arr in any pt groups. CRT significantly improved patient survival free from HT or death at 10 y (44 vs. 13% [p < 0001]). Conclusion: When applied effectively, CRT benefits CHD-HF pts without causing additional arrhythmias. However, pre-existing Arr remain a concern reflecting persistently adverse intrinsic myocellular issues among CHD-HF pts. Full article

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

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10 pages, 530 KB

Open AccessArticle

Valve-Sparing Versus Composite Graft Aortic Root Replacement in Acute Type A Aortic Dissection with Standardized Hemiarch Repair: A Propensity Score Matching Analysis

by Mohammed Morjan, Tong Li, Luis J. Vallejo Castano, Carlos A. Mestres, Amin Thwairan, Freya S. Jenkins, Hannan Dalyanoglu and Artur Lichtenberg

J. Cardiovasc. Dev. Dis. 2026, 13(3), 116; https://doi.org/10.3390/jcdd13030116 - 4 Mar 2026

Abstract

Objectives: The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic [...] Read more.

Objectives: The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic dissection (ATAAD) in a propensity score matching analysis. Methods: In this retrospective study we compared the outcomes before and after propensity score matching of patients who underwent emergency surgical repair for ATAAD requiring replacement of the aortic hemiarch with replacement of the aortic root between 2001 and 2023 at our institute. The 154 patients were divided into two groups: the first group consisted of patients undergoing David (n = 59), and the second group of patients undergoing Bentall (n = 95) procedures combined with an aortic hemiarch replacement. To reduce the confounding impact of pre-operative variables in this non-randomized study, 1:1 propensity score matching using the Nearest-Neighbour Matching algorithm was used. Results: Patients in the David plus Hemiarch group were significantly younger (62.16 ± 12.35 vs. 55.55 ± 10.80, p = 0.001). After the propensity score matching there were no significant differences between the two groups regarding intra-operative variables and hospital outcomes. In-hospital death was 15% (n = 6) in the David plus Hemiarch group compared to 24% (n = 10) in the Bentall plus Hemiarch group (15% vs. 24%, p = 0.40). Operation time was also similar between the two groups, being 402 and 384 min, respectively. Survival analyses also did not show any difference in long-term survival between both groups. Conclusions: When a standardized hemiarch replacement was used, no significant differences in short- and long-term outcomes were observed between a valve-sparing procedure and composite graft replacement in patients undergoing surgical repair for ATAAD. Surgeons should opt for the surgical strategy they are most comfortable with. This study represents one of the few analyses comparing the David and Bentall techniques in ATAAD patients undergoing standardized hemiarch replacement. Despite its retrospective nature, it provides clinically relevant insights for surgical decision-making in emergency settings. Full article

(This article belongs to the Special Issue Aortic Surgery—Back to the Roots and Looking to the Future)

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11 pages, 969 KB

Open AccessArticle

Prognostic Impact of Untreated Chronic Coronary Artery Obstruction After Surgery for Aortic Regurgitation

by Xin Li, Vito Domenico Bruno, Yi Jiang, Yunxing Xue and Dongjin Wang

J. Cardiovasc. Dev. Dis. 2026, 13(3), 115; https://doi.org/10.3390/jcdd13030115 - 3 Mar 2026

Abstract

Background: The optimal management strategy for 50–70% chronic coronary artery stenosis in patients undergoing aortic valve surgery for aortic regurgitation (AR) remains controversial. This study evaluates the prognostic impact of chronic coronary obstruction severity on surgical outcomes and mid-term survival. Methods: This retrospective [...] Read more.

Background: The optimal management strategy for 50–70% chronic coronary artery stenosis in patients undergoing aortic valve surgery for aortic regurgitation (AR) remains controversial. This study evaluates the prognostic impact of chronic coronary obstruction severity on surgical outcomes and mid-term survival. Methods: This retrospective cohort study included 717 patients undergoing aortic valve surgery for AR, grouped by coronary stenosis into <50% (n = 641) and 50–70% (n = 76). Following 1:1 propensity score matching (72 patients per group), the primary outcome of major adverse cardiovascular events (MACE) and the secondary outcome of all-cause death were compared. Results: No intergroup differences emerged in perioperative mortality (1.32% vs. 1.56%, p = 1.000) or complication rate. With a median follow-up of 2.53 years, 50–70% coronary obstruction does not increase MACE (HR = 2.050; 95% CI 0.375–11.197; log-rank p = 0.397) and all-cause mortality (HR = 0.710; 95% CI 0.200–2.522; log-rank p = 0.595). Similar results were obtained in the competing risk regression and multivariable analyses. Conclusions: In patients with AR, 50–70% chronic coronary obstruction does not increase perioperative complications, MACE, and all-cause mortality. Full article

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16 pages, 554 KB

Open AccessArticle

Utility of Field Tests for Predicting Cardiorespiratory Fitness and Prescribing Exercise Intensity in Cardiac Rehabilitation Programs: A Randomized Crossover Trial

by Blake E. G. Collins, Brett A. Gordon, Daniel W. T. Wundersitz, Jayden R. Hunter, Lisa C. Hanson and Michael I. C. Kingsley

J. Cardiovasc. Dev. Dis. 2026, 13(3), 114; https://doi.org/10.3390/jcdd13030114 - 3 Mar 2026

Abstract

The aims of this study are the following: To examine whether field tests predict cardiorespiratory fitness in people with coronary heart disease (CHD) and to determine if heart rate (HR) agreement between the first ventilatory threshold (VT₁) and field tests is [...] Read more.

The aims of this study are the following: To examine whether field tests predict cardiorespiratory fitness in people with coronary heart disease (CHD) and to determine if heart rate (HR) agreement between the first ventilatory threshold (VT₁) and field tests is sufficient for prescribing exercise intensity. Participants randomly completed field tests and a cardiopulmonary exercise test (CPET). Linear regression models were developed to predict VT₁. Agreement between predicted and measured peak oxygen consumption (V̇O_2peak) as well as field test terminal HR and HR at VT₁ (VT_1HR) was assessed using Pearson correlations, Bland–Altman analyses, mean absolute percentage error (MAPE), Lin’s concordance correlation coefficient (CCC), and standard error of estimate (SEE). Agreement between predicted and measured V̇O_2peak was modest (Pearson’s r = 0.27–0.77; Lin’s CCC = 0.132–0.735; MAPE = 16.1–30.1%; SEE = 4.7–6.8 mL·kg⁻¹·min⁻¹). Agreement between field test terminal HR and VT_1HR was moderate (Pearson’s r = 0.50–0.67; Lin’s CCC = 0.36–0.68; MAPE = 8.9–13.7%; SEE = 11.9–18.7 bpm; Bland–Altman 95%LOA = −3.5 to 13.7 bpm). Field tests demonstrated variable accuracy for predicting V̇O_2peak, with none meeting predefined agreement criteria. Regression models indicate field tests can estimate VT_1; however, levels of HR agreement indicate CPET is necessary for prescribing exercise intensity. Full article

(This article belongs to the Special Issue Advancing Cardiac Rehabilitation Delivery and Outcomes: Focusing on Exercise and Lifestyle)

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13 pages, 795 KB

Open AccessArticle

Radiomic Assessment of Epicardial Adipose Tissue for the Prediction of Non-Calcified Coronary Atherosclerotic Plaques

by Carlo Di Donna, Armando Ugo Cavallo, Eliseo Picchi, Mario Laudazi, Massimo Federici, Marcello Chiocchi and Francesco Garaci

J. Cardiovasc. Dev. Dis. 2026, 13(3), 113; https://doi.org/10.3390/jcdd13030113 - 2 Mar 2026

Abstract

Epicardial adipose tissue (EAT) has previously been associated with coronary artery calcium scores, an increased burden of coronary artery disease (CAD), and features of plaque instability. These associations are likely mediated by endocrine and paracrine signaling from bioactive molecules secreted by EAT, which [...] Read more.

Epicardial adipose tissue (EAT) has previously been associated with coronary artery calcium scores, an increased burden of coronary artery disease (CAD), and features of plaque instability. These associations are likely mediated by endocrine and paracrine signaling from bioactive molecules secreted by EAT, which may contribute to coronary atherosclerosis. EAT can be non-invasively quantified on images obtained during coronary computed tomography angiography (CCTA). This study aimed to evaluate the potential association between EAT and non-calcified coronary plaques with severe stenosis using radiomic methodology. Materials and Methods: A total of 128 consecutive patients undergoing CCTA—both with and without contrast—for known or suspected CAD were retrospectively analyzed. EAT features were extracted from contrast scans. Coronary artery plaque features were evaluated using Coronary Artery Disease-Reporting and Data System (CAD-RADS). Results: EAT features showed a statistically significant positive correlation with non-calcified coronary plaques with severe grades of stenosis (CAD-RADS > 4). The Ensemble Machine Learning (EML) model combined with coronary plaque data showed a sensitivity of 1.00 and a specificity of 0.93, with a negative predictive value of 1.00 and a positive predictive value of 0.85, and an accuracy of 0.95 (95% CI: 0.9221–1) in internal validation. Conclusions: EAT may represent a novel imaging biomarker associated with the presence of actionable coronary plaques. Radiomic texture analysis of EAT could enhance the non-invasive prediction of coronary stenoses. These preliminary findings support the clinical utility of EAT evaluation via CCTA in patients with low to intermediate cardiovascular risk. Full article

(This article belongs to the Special Issue Feature Papers in Imaging—Second Edition)

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15 pages, 871 KB

Open AccessReview

Periprocedural Myocardial Infarction: Do We Need an Updated Definition?

by Marcello Casuso Alvarez, Leonardo Luca Bavuso, Michele Di Leo, Marco Basile, Nicolò Vasumini, Tommaso Manaresi, Angelo Maida, Marco Moretti, Daniele Cavallo, Lisa Canton, Sara Amicone, Damiano Fedele, Elisa Conficoni, Alessandro Marinelli, Roberto Carletti, Francesco Angeli, Luca Bergamaschi, Matteo Armillotta and Carmine Pizzi

J. Cardiovasc. Dev. Dis. 2026, 13(3), 112; https://doi.org/10.3390/jcdd13030112 - 2 Mar 2026

Abstract

Periprocedural myocardial infarction after percutaneous coronary intervention (PCI) remains a debated entity, especially in the era of high-sensitivity cardiac troponin assays, which frequently detect biomarker rises even when clinically meaningful ischemia is absent. This review critically examines the main contemporary frameworks used to [...] Read more.

Periprocedural myocardial infarction after percutaneous coronary intervention (PCI) remains a debated entity, especially in the era of high-sensitivity cardiac troponin assays, which frequently detect biomarker rises even when clinically meaningful ischemia is absent. This review critically examines the main contemporary frameworks used to define these events, including the Fourth Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 consensus, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition, comparing biomarker thresholds, requirements for objective evidence of ischemia, and procedural criteria. We discuss how differences among definitions shape reported event rates and contribute to heterogeneity in event adjudication across studies. Key pathophysiologic mechanisms of myocardial injury during PCI are summarized, including side-branch compromise, distal embolization, microvascular dysfunction, and mechanical complications. Particular attention is given to the limitations of current criteria, such as incomplete assay standardization, variability in sampling timing, inconsistent reliability of ancillary criteria, including electrocardiography and imaging, and an uneven relationship between biomarker elevation and subsequent outcomes. Finally, we outline priorities for future updates, including harmonization of biomarker thresholds, greater emphasis on relative biomarker dynamics, and structured adjudication that integrates biomarkers with objective ischemic evidence. These steps may improve diagnostic specificity, reduce misclassification, and strengthen the clinical and trial relevance of periprocedural ischemic endpoints. Full article

(This article belongs to the Special Issue Role of Biochemical Markers of Cardiovascular Disease in Clinical Practice)

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15 pages, 2445 KB

Open AccessArticle

The Prognostic Value of Left Atrial Size and Strain Assessed by Cardiac Magnetic Resonance in the Coronary Chronic Total Occlusion

by Jinfan Tian, Wenxiao Xia, Xueyao Yang, Mingduo Zhang, Huijuan Zuo, Libo Liu, Min Zhang, Yuan Zhou, Ziyu An, Xin Zhao, Lijun Zhang, Yi He and Xiantao Song

J. Cardiovasc. Dev. Dis. 2026, 13(3), 111; https://doi.org/10.3390/jcdd13030111 - 27 Feb 2026

Abstract

Background: The relationship between left atrial (LA) size, LA strain, and long-term prognosis in patients with coronary chronic total occlusion (CTO) remains unclear. This study aimed to evaluate the association of LA size and LA strain with clinical outcomes in CTO patients using [...] Read more.

Background: The relationship between left atrial (LA) size, LA strain, and long-term prognosis in patients with coronary chronic total occlusion (CTO) remains unclear. This study aimed to evaluate the association of LA size and LA strain with clinical outcomes in CTO patients using cardiac magnetic resonance (CMR). Methods: This retrospective study included 168 patients with left ventricular ejection fraction (LVEF) ≥ 40%. The primary endpoint was the composite of major adverse cardiovascular and cerebrovascular events (MACCE). Model 1 was established by adjusting for clinically relevant parameters and standard CMR metrics. Models 2–4 were developed using Cox regression based on Model 1, with additional adjustment for each LA strain parameter separately. Results: A total of 168 patients with an LVEF ≥ 40% were analyzed, of whom 39 (23.2%) experienced MACCE during a mean follow-up of 45.9 months (median, 42 months). A preliminary model suggested that LA maximum volume index (LAVI_max) was independently associated with MACCE (HR 1.05, 95% CI 1.02–1.08, p = 0.004). Specifically, compared to the first quartile of LAVI_max, the second, third, and fourth quartiles were associated with an increased risk of MACCE (Q2: HR 4.50, 95% CI 1.42–14.27, p = 0.011; Q3: HR 4.40, 95% CI 1.29–14.96, p = 0.018; Q4: HR 5.55, 95% CI 1.71–18.06, p = 0.004). In Models 2–4, higher LAVI_max remained independently associated with MACCE (all p < 0.05), after adjusting for LA reservoir strain, conduit strain and booster strain, separately. In contrast, none of the LA strain parameters were associated with MACCE. Conclusions: Among CTO patients with LVEF ≥ 40%, LAVI_max was independently associated with MACCE. Full article

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17 pages, 3874 KB

Open AccessArticle

Study on the Role and Mechanism of TOPORS in Regulating Aortic Dissection by Mediating SUMOylation

by Yuan Hu, Luxi Yang, Wenjun Zhou, Hao Chen, Yuanmin Li, Bing Song and Cuntao Yu

J. Cardiovasc. Dev. Dis. 2026, 13(3), 110; https://doi.org/10.3390/jcdd13030110 - 27 Feb 2026

Abstract

Aortic dissection (AD) is a fatal acute cardiovascular emergency. SUMOylation participates in cell proliferation, apoptosis, and inflammation, but its role in AD, especially via TOPORS, remains unclear. This study investigates how TOPORS regulates AD pathogenesis through SUMOylation. AD and normal aortic samples [...] Read more.

Aortic dissection (AD) is a fatal acute cardiovascular emergency. SUMOylation participates in cell proliferation, apoptosis, and inflammation, but its role in AD, especially via TOPORS, remains unclear. This study investigates how TOPORS regulates AD pathogenesis through SUMOylation. AD and normal aortic samples were collected to detect TOPORS expression. AD mouse and VSMCs models were constructed to assess TOPORS depletion and overexpression effects on AD progression. In AD aortic tissues, TOPORS expression was upregulated, while tripartite motif containing 27 (TRIM27) and Sentrin-specific protease 6 (SENP6) expression showed no significant change. In vivo and in vitro experiments demonstrated that inhibition of TOPORS alleviated aortic dilation and elastic fiber degradation. TOPORS knockout suppressed the secretion of inflammatory cytokines (TNF-α, IL-1β, IL-6, and IFN-α), promoted PI3K/AKT phosphorylation, and downregulated p53 signaling. The p53 inhibitor PFTα reduced AD-induced cell apoptosis and upregulation of inflammatory cytokines. Co-immunoprecipitation further confirmed that inhibition of TOPORS decreases SUMOylation of p53. Conclusions: TOPORS activates p53, inhibits PI3K/AKT phosphorylation via SUMOylation, promotes vascular smooth muscle cell (VSMC) apoptosis and inflammation, and exacerbates AD pathogenesis. Full article

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15 pages, 1402 KB

Open AccessArticle

The Impact of Body Mass Index and Nutritional Status on Cardiac Electrophysiological Balance Using ICEB and ICEBc: A Cross-Sectional Approach

by Fethullah Kayan, Ömer Faruk Alakuş, Mihriban Elçiçek, Serdar Soner, Cansu Öztürk, Geylani Güleken and Ihsan Solmaz

J. Cardiovasc. Dev. Dis. 2026, 13(3), 109; https://doi.org/10.3390/jcdd13030109 - 26 Feb 2026

Abstract

Background: The Index of Cardiac Electrophysiological Balance (ICEB) has emerged as a electrocardiographic marker reflecting the equilibrium between ventricular depolarization and repolarization. Although obesity is known to alter cardiac electrophysiology, the combined influence of body mass index (BMI) and objective nutritional status on [...] Read more.

Background: The Index of Cardiac Electrophysiological Balance (ICEB) has emerged as a electrocardiographic marker reflecting the equilibrium between ventricular depolarization and repolarization. Although obesity is known to alter cardiac electrophysiology, the combined influence of body mass index (BMI) and objective nutritional status on ICEB and its heart rate-corrected form (ICEBc) remains insufficiently defined. This study aimed to investigate the associations between BMI categories, nutritional status, and cardiac electrophysiological balance. Methods: This cross-sectional study included 591 adult patients classified as normal-weight, overweight, or obese according to BMI. Electrophysiological assessment of ICEB (QT/QRS) and ICEBc (QTc/QRS) values was calculated from standard 12-lead electrocardiogram recordings. Participants’ nutritional status was analyzed using validated clinical indices such as the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), Geriatric Nutritional Risk Index (GNRI) and Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) score. Results: According to the results, both ICEB and ICEBc showed significant differences among BMI categories (p < 0.001). ICEB/ICEBc exhibited a non-linear distribution. The ICEB/ICEBc values were found to be minimum in the normal weight group at 4.22 ± 0.54/4.87 ± 0.66 and maximum in the obese group at 4.27 ± 0.51/4.99 ± 0.59. The ICEB/ICEBc value closest to the optimal physiological limits was found in the overweight group at 4.04 ± 0.53/4.59 ± 0.58. Higher ICEBc quartiles were accompanied by increased GNRI (120.9 ± 13.7, 129 ± 15.1, 130.5 ± 16.3, 131.8 ± 17.6, p < 0.001)and decreased HALP scores (59.7 ± 24.4, 56.1 ± 25.3, 55.2 ± 25.9, 51.1 ± 19.4, p: 0.025). Conclusion: The association between BMI and cardiac electrophysiological balance is non-linear and appears to be modulated by nutritional and inflammatory status. ICEBc may represent a more sensitive marker than ICEB for detecting subtle electrophysiological alterations related to obesity. Full article

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

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16 pages, 695 KB

Open AccessReview

Antithrombotic Therapy in Percutaneous Atrial Structural Interventions

by Konstantinos Pitsikakis, Ioannis Skalidis, Emmanuel Skalidis, Dimitrios Lempidakis, Antonios Papoutsakis, Emmanuel Sideras, Evangelos Zacharis, Stylianos Petousis and Michalis Hamilos

J. Cardiovasc. Dev. Dis. 2026, 13(3), 108; https://doi.org/10.3390/jcdd13030108 - 26 Feb 2026

Abstract

Percutaneous left atrial appendage occlusion (LAAO), patent foramen ovale (PFO) closure, and atrial septal defect (ASD) closure rely on temporary antithrombotic therapy to prevent device-related thrombus during endothelialization, yet optimal regimens remain uncertain and vary widely across clinical practice. This review synthesizes contemporary [...] Read more.

Percutaneous left atrial appendage occlusion (LAAO), patent foramen ovale (PFO) closure, and atrial septal defect (ASD) closure rely on temporary antithrombotic therapy to prevent device-related thrombus during endothelialization, yet optimal regimens remain uncertain and vary widely across clinical practice. This review synthesizes contemporary evidence on postprocedural antithrombotic strategies, comparing efficacy and safety data and identifying key gaps in knowledge. After LAAO, therapeutic approaches range from short-term anticoagulation with vitamin K antagonists or direct oral anticoagulants to dual or single antiplatelet therapy in patients with high bleeding risk; observational data increasingly support DOAC-based regimens, although device-related thrombus remains a significant concern, and follow-up imaging protocols are inconsistent. Following PFO and ASD closure, antiplatelet-only regimens—typically brief dual antiplatelet therapy followed by aspirin—are widely used, with evidence suggesting that simplified or abbreviated strategies may be sufficient in selected patients. Despite extensive clinical experience, high-quality comparative trials are limited, and optimal therapy, duration, and surveillance remain debated. Standardized imaging definitions, randomized studies, and individualized risk-based frameworks are needed to optimize antithrombotic care after atrial structural interventions. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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18 pages, 860 KB

Open AccessArticle

Identifying Inadequate Maternal Nutrition in Pregnancies Affected by Fetal Heart Defects: A Feasibility Pilot Study Using Photo-Based Diet Quality Assessment

by Carson Flamm, Michelle Udine, Sarah Clauss, Anita Krishnan, Mary T. Donofrio, Michele Mietus-Snyder, Gary M. Shaw and Jennifer Klein

J. Cardiovasc. Dev. Dis. 2026, 13(3), 107; https://doi.org/10.3390/jcdd13030107 - 25 Feb 2026

Abstract

Etiologies of congenital heart disease (CHD) are multifactorial. The role of maternal nutrition and environmental factors among these CHD etiologies remain insufficiently understood. This pilot study evaluated the potential association between maternal diet quality, nutrient intake, and food security to fetal CHD in [...] Read more.

Etiologies of congenital heart disease (CHD) are multifactorial. The role of maternal nutrition and environmental factors among these CHD etiologies remain insufficiently understood. This pilot study evaluated the potential association between maternal diet quality, nutrient intake, and food security to fetal CHD in a cohort of 100 pregnant individuals, including 20 with CHD-affected pregnancies identified in a fetal cardiology clinic at an urban tertiary care hospital. A Diet Quality Photo Navigation (DQPN) tool assessed dietary quality and nutrient intake, while a survey collected data on demographics, health history, and food security. Comparison tests assessed for differences between CHD- and non-CHD-affected pregnancies. CHD-affected pregnancies demonstrated descriptively lower Healthy Eating Index scores, reduced prenatal multivitamin use, and lower intake of iron, manganese, fiber, and vitamin C. The non-CHD group demonstrated a significantly higher consumption of healthier snacks (p = 0.03), plant-based meat alternatives (p = 0.05), and unsweetened beverages (p = 0.05), while descriptively showing greater fruit and vegetable intake as compared to the CHD-affected group. No statistically significant differences in food security or socioeconomic indicators were identified. These findings demonstrate the feasibility of applying a DQPN tool in fetal health research and describe maternal dietary patterns that may inform the design of future hypothesis-driven studies. Continued investigation into maternal diet quality is critical to understand its potential role in mitigating CHD risk through targeted nutritional interventions. Full article

(This article belongs to the Special Issue Cardiovascular Disease and Nutrition)

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17 pages, 1169 KB

Open AccessReview

ROS-Mediated Cardiomyocyte Proliferation and Myocardial Regeneration: Mechanisms and Targeted Strategies for Ischemic Heart Disease

by Mengqi Chen, Tingting Liu, Fangling Sun, Xin Tian, Wenrong Zheng, Zixin Zhu and Wen Wang

J. Cardiovasc. Dev. Dis. 2026, 13(3), 105; https://doi.org/10.3390/jcdd13030105 - 25 Feb 2026

Abstract

Cardiovascular disease (CVD) persists as the leading cause of global mortality, with adult mammalian hearts exhibiting limited regenerative capacity. Although cardiomyocytes (CMs) can re-enter the cell cycle and undergo DNA synthesis in response to injury, they fail to complete mitosis and cytokinesis, resulting [...] Read more.

Cardiovascular disease (CVD) persists as the leading cause of global mortality, with adult mammalian hearts exhibiting limited regenerative capacity. Although cardiomyocytes (CMs) can re-enter the cell cycle and undergo DNA synthesis in response to injury, they fail to complete mitosis and cytokinesis, resulting in a functional blockade of productive proliferation following ischemic or aging-related injury. Reactive oxygen species (ROS) exhibit a context-dependent duality in cardiac regeneration: while maintaining redox homeostasis and supporting developmental signaling at physiological concentrations, pathological ROS accumulation exacerbates myocardial decline by inducing DNA damage response (DDR)-mediated cell cycle arrest at G2/M phase, along with structural and functional impairments. This review examines the mechanisms of ROS generation—from its cellular origins to its molecular drivers—in ischemic heart disease, and explores the modulation of regenerative signaling by oxidative stress. We further critically assess emerging therapeutic interventions targeting ROS-mediated myocardial regeneration. By delineating the functional roles of ROS in cardiac injury and repair, this review provides a mechanistic and translational framework for developing redox-based therapies aimed at promoting cardiomyocyte proliferation and myocardial regeneration after ischemic injury. Full article

(This article belongs to the Special Issue Cutting-Edge Advances in Cardiac Development, Anatomy, and Regeneration)

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