Journal of Cardiovascular Development and Disease

12 pages, 983 KB

Open AccessArticle

Apelin Levels in HFrEF and Association with Sustained VT Detected by ICD Interrogation: A Retrospective Pilot Study

by Abdullah Eren Cetin, Mustafa Lutfullah Ardic, Fadime Koca, Hilmi Erdem Sumbul and Mevlut Koc

J. Cardiovasc. Dev. Dis. 2026, 13(2), 79; https://doi.org/10.3390/jcdd13020079 - 4 Feb 2026

Introduction: The serum apelin level in patients with heart failure with reduced ejection fraction (HFrEF) and its relationship with ventricular tachycardia (VT) are not clearly known. This study aimed to investigate changes in serum apelin levels in patients with HFrEF and their relationship [...] Read more.

Introduction: The serum apelin level in patients with heart failure with reduced ejection fraction (HFrEF) and its relationship with ventricular tachycardia (VT) are not clearly known. This study aimed to investigate changes in serum apelin levels in patients with HFrEF and their relationship with VT. Method: This retrospective pilot study included 90 patients with 30 patients in each group: Group I: HFrEF with documented VT; Group II: HFrEF without VT; Group III: control group without HFrEF. In addition to routine parameters, apelin levels were measured. All parameters were compared between Group I–II–III. Parameters associated with VT were identified. Result: Apelin levels were found to be significantly lower in Group I–II than in Group III. Serum glucose, creatinine, and left atrial diameter were shown to be significantly higher in Group I–II than in Group III. HDL cholesterol and left ventricular ejection fraction (LVEF) levels were significantly lower in Group I–II compared with Group III. A positive and negative correlation was found between plasma apelin levels and LVEF and age, respectively. In logistic regression analysis, apelin levels and LVEF were found to independently determine VT (OR = 0.313, 95%CI: 0.124–0.788, p = 0.014 and OR = 0.912, 95%CI: 0.877–0.968, p < 0.001). In the ROC analysis, the cut-off value for apelin was determined to be 0.80 ng/mL, and it distinguished VT status in this sample with acceptable sensitivity and specificity. Discussion: According to the results of our study, apelin levels are significantly reduced in patients with HFrEF, and reduced apelin levels are associated with the presence of VT in these patients. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias: Epidemiology, Diagnosis and Treatment)

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13 pages, 2074 KB

Open AccessArticle

Epicardial Adipose Tissue Volume and Left Atrial Remodeling: A J-Shaped Association in Older Adults

by Xinyue Zhao, Guangjian Wang, Xuefeng Ni and Hui Lian

J. Cardiovasc. Dev. Dis. 2026, 13(2), 78; https://doi.org/10.3390/jcdd13020078 - 4 Feb 2026

Abstract

Background: Previous studies identified epicardial adipose tissue (EAT) as a metabolic risk factor for atrial remodeling. However, given the distinct physiological changes associated with aging, findings from the general population may not translate directly to older adults. This study aims to clarify the [...] Read more.

Background: Previous studies identified epicardial adipose tissue (EAT) as a metabolic risk factor for atrial remodeling. However, given the distinct physiological changes associated with aging, findings from the general population may not translate directly to older adults. This study aims to clarify the relationship between EAT and left atrial (LA) diameter in older adults specifically. Methods: This retrospective cross-sectional study was conducted among in an older adult cohort (aged ≥ 65 years) at Peking Union Medical College Hospital. The association between EAT and LA diameter was evaluated using multivariable linear regression, a generalized additive model, and restricted cubic spline (RCS) modeling. Results: Among 353 participants (median age 75 years), EAT was independently associated with LA diameter (β = 0.286, p < 0.001) after adjusting for confounders including age, BMI, and LDL-C. Notably, RCS analysis revealed a J-shaped relationship between EAT volume and LA dimensions. Specifically, when EAT exceeded 110.7 cm³, the LA diameter increased significantly by 0.22 mm per 10 cm³ increase in EAT (p = 0.004). Conclusions: EAT accumulation shows a non-linear association with left atrial remodeling in older adults, with an identifiable threshold at 110.7 cm³. EAT may be a valuable biomarker for cardiovascular risk stratification, suggesting that EAT burden monitoring could be beneficial in older populations. Full article

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

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39 pages, 1362 KB

Open AccessReview

Engineering Mitochondrial Biogenesis in iPSC-CMs: CRISPR-Guided Approaches for Advanced Cardiomyocyte Development

by Dhienda C. Shahannaz, Tadahisa Sugiura, Brandon E. Ferrell and Taizo Yoshida

J. Cardiovasc. Dev. Dis. 2026, 13(2), 77; https://doi.org/10.3390/jcdd13020077 - 3 Feb 2026

Abstract

Human iPSC-derived cardiomyocytes (iPSC-CMs) exhibit fetal-like mitochondrial networks and limited oxidative metabolism, constraining their translational utility. The key bottleneck is mitochondrial immaturity, resulting from blunted PGC-1α–NRF1/2–TFAM axis activation and insufficient nuclear–mitochondrial coordination, rather than sarcomeric or electrophysiological immaturity alone. This review synthesizes [...] Read more.

Human iPSC-derived cardiomyocytes (iPSC-CMs) exhibit fetal-like mitochondrial networks and limited oxidative metabolism, constraining their translational utility. The key bottleneck is mitochondrial immaturity, resulting from blunted PGC-1α–NRF1/2–TFAM axis activation and insufficient nuclear–mitochondrial coordination, rather than sarcomeric or electrophysiological immaturity alone. This review synthesizes genome-guided interventions (CRISPRa and mtDNA editing) and complementary environmental strategies—including metabolic substrate switching, electromechanical stimulation, and extracellular vesicle (EV)-mediated mitochondrial transfer—to drive mitochondrial biogenesis and maturation in iPSC-CMs. We systematically reviewed studies (2005–2025) targeting (1) key regulators of mitochondrial biogenesis (PGC-1α, NRF1/2, TFAM), (2) CRISPR-based transcriptional activators/repressors and mtDNA editors (DdCBE, mitoTALENs), and (3) maturation approaches such as metabolic conditioning, electromechanical stimulation, 3D tissue culture, and EV-mediated mitochondrial transfer. CRISPRa-mediated activation of PGC-1α, NRF1, and GATA4, combined with mtDNA base editors, enhances mitochondrial mass and OXPHOS function, while integration with environmental maturation strategies further promotes adult-like phenotypes. Integrative approaches that combine genome-guided interventions (CRISPRa, mtDNA editing) with environmental maturation cues yield the most adult-like iPSC-CM phenotypes reported to date. CRISPR-guided mitochondrial biogenesis thus represents a frontier for producing metabolically competent, structurally mature iPSC-CMs for disease modeling and therapy. Remaining translational challenges include efficient mitochondrial delivery, metabolic homeostasis, and multi-omics validation. We propose standardized workflows to couple nuclear and mitochondrial editing with maturation strategies. Full article

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

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15 pages, 1918 KB

Open AccessSystematic Review

Cor Triatriatum Dexter: The Largest Comprehensive Review in the Field on 124 Worldwide Cases (1968–Now)

by Pier Paolo Bassareo, Erica Franco, Sophie Duignan, Massimo Chessa, Mariateresa Cascio, Colin Joseph McMahon, Kevin Patrick Walsh and Marco Alfonso Perrone

J. Cardiovasc. Dev. Dis. 2026, 13(2), 76; https://doi.org/10.3390/jcdd13020076 - 3 Feb 2026

Abstract

Background. Cor triatriatum dexter (CTD) is a rare congenital heart defect where a membrane divides the right atrium into two chambers, resulting from the incomplete regression of the right valve of the sinus venosus. Due to its rarity, only individual case reports and [...] Read more.

Background. Cor triatriatum dexter (CTD) is a rare congenital heart defect where a membrane divides the right atrium into two chambers, resulting from the incomplete regression of the right valve of the sinus venosus. Due to its rarity, only individual case reports and a limited number of case series have been published to date. This study constitutes the most extensive comprehensive review conducted in this area. Eight factors were evaluated: age at diagnosis, sex, clinical presentation, electrocardiographic findings, imaging (ultrasound, CT, or MRI), associated cardiac anomalies, and patient outcomes. Methods. The electronic databases PubMed and Scopus were searched from their inception until 30 October 2025. Only case reports and case series were considered for inclusion. Studies involving foetuses, autopsies, and animals were excluded. The collected data were primarily presented as percentages. Results. One hundred fourteen studies were found encompassing 124 patients. The mean age at diagnosis was 33.3 ± 9.4 years The most common clinical presentations were dyspnoea (44.3%) and cyanosis (29.5%). The most commonly encountered ECG changes were supraventricular tachycardia/atrial flutter/atrial fibrillation (33.3%) and right bundle branch block (22.6%). On chest X-ray, cardiomegaly was noted in 46.5%. CTD was suspected or diagnosed by echocardiography in 95.2% of cases. The diagnosis was confirmed by CT and/or MRI in 34.1% of cases. A concomitant congenital heart defect was found in 67.7%, especially in the form of all kinds of atrial septal defect (38.1%) and of right valvular and right ventricular involvement (20.1%). An outcome was reported in 97/124. Surgical correction was the treatment of choice in 51.6%. Since 1991, a percutaneous approach has been employed in selected cases (5.1%). Conservative management was the treatment of choice in 43.3%. The mortality rate was 8.2%. Discussion. The principal limitation of this systematic review lies in its reliance solely on case reports and small case series, reflecting the absence of large-scale studies on CTD. Nonetheless, it constitutes the most comprehensive analysis available to date. Full article

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

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14 pages, 1274 KB

Open AccessArticle

Cardiac CT Angiography in Diagnosing Patent Foramen Ovale: A Study on Patients with Suspected Patent Foramen Ovale-Associated Stroke

by Lijie Sun, Chong Zheng, Zhenxing Fan, Jing Gao, Zhi Liu, Jin Si, Keling Xiao, Ming Yi, Haoyu Zhang, Jinghao Sun, Yijin Liu, Yang Hua, Yingqi Xing, Jie Lu and Jing Li

J. Cardiovasc. Dev. Dis. 2026, 13(2), 75; https://doi.org/10.3390/jcdd13020075 - 2 Feb 2026

Abstract

Background: Cardiac computed tomographic angiography (CTA) detects patent foramen ovale (PFO) with variable accuracy. This study investigated factors affecting CTA detectability for PFO in patients with suspected PFO-associated stroke. Methods: Consecutive patients with cryptogenic stroke and positive findings on contrast transcranial Doppler (cTCD) [...] Read more.

Background: Cardiac computed tomographic angiography (CTA) detects patent foramen ovale (PFO) with variable accuracy. This study investigated factors affecting CTA detectability for PFO in patients with suspected PFO-associated stroke. Methods: Consecutive patients with cryptogenic stroke and positive findings on contrast transcranial Doppler (cTCD) examinations were enrolled between November 2020 and April 2023 in this retrospective study. Each participant underwent transesophageal echocardiography (TEE) and cardiac CTA. Patients with confirmed PFO on TEE were categorized into two groups based on CTA detectability: the CTA-positive group (PFO identified by CTA) and the CTA-negative group (PFO missed by CTA). Univariate and multivariate logistic regression analyses were performed to identify predictors of CTA false-negative results. Results: Among 108 patients (mean age 46.7 ± 14.9 years, 47.2% male), the prevalence of PFO by TEE was 94.4% (102/108). Compared to TEE, cardiac CTA had a sensitivity of 70% (95%CI 61–79%), a specificity of 100% (95%CI 54–100%), a positive predictive value of 100% (95%CI 95–100%), and a negative predictive value of 16% (95%CI 6–32%). Among patients with PFO confirmed by TEE (n = 102), the incidence of moderate to large right-to-left shunts (RLS) was significantly higher in the CTA-positive group than in the CTA-negative (77.5% vs. 22.5%, p < 0.001). After adjusting for confounders, patients with moderate to large shunts showed a significantly lower likelihood of a CTA false-negative result compared to those with small shunts (OR 0.113, 95%CI 0.035–0.365, p < 0.001). In patients with moderate to large RLS, the sensitivity of cardiac CTA for diagnosing PFO increased to 90.16% (95% CI 82.69–97.64%). Conclusion: Cardiac CTA could be an effective complementary modality for selected patients with suspected PFO-associated stroke. Its diagnostic performance appears more reliable for identifying PFO in patients with moderate-to-large RLS than in those with small RLS. Full article

(This article belongs to the Section Stroke and Cerebrovascular Disease)

24 pages, 1538 KB

Open AccessReview

Mechanisms and Therapeutic Potential of Human Cardiomyocyte Proliferation

by Richard D. McLane, Abhay Cheruku, Ashley B. Williams and Ravi Karra

J. Cardiovasc. Dev. Dis. 2026, 13(2), 74; https://doi.org/10.3390/jcdd13020074 - 2 Feb 2026

Abstract

The limited capacity for cardiomyocyte proliferation in the adult human heart restricts its ability to recover from injury. Building on discoveries in regenerative model systems, such as zebrafish and neonatal mice, reactivation of a latent potential for cardiomyocyte proliferation is a strategy to [...] Read more.

The limited capacity for cardiomyocyte proliferation in the adult human heart restricts its ability to recover from injury. Building on discoveries in regenerative model systems, such as zebrafish and neonatal mice, reactivation of a latent potential for cardiomyocyte proliferation is a strategy to promote therapeutic heart regeneration. Although cardiomyocyte proliferation remains modest even with the most effective mitogenic stimuli identified to date, evidence for a potential functional benefit in pre-clinical model systems has led to the initiation of several early-phase clinical programs. Here, we review insights from model organisms that inform the potential efficacy and limitations of therapeutic cardiomyocyte proliferation, systems to study human cardiomyocyte proliferation, and the natural history of cardiomyocyte proliferation in the human heart. We also examine the translational trajectory of selected discoveries, including therapeutic delivery modalities, and attendant safety concerns. Finally, we discuss critical challenges that will need to be addressed to enable successful clinical translation. Full article

(This article belongs to the Section Cardiac Development and Regeneration)

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11 pages, 2325 KB

Open AccessEditorial

Scientific Publication Trend: Using Advanced Technologies in Cardiovascular Disease Research in the Journal of Cardiovascular Development and Disease

by Florin Anghel, Raluca-Oana Raianu and Zhonghua Sun

J. Cardiovasc. Dev. Dis. 2026, 13(2), 73; https://doi.org/10.3390/jcdd13020073 - 2 Feb 2026

Abstract

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide [...] Full article

(This article belongs to the Section Imaging)

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5 pages, 1041 KB

Open AccessCase Report

Percutaneous Treatment of Type A Aortic Dissection Using Atrial Septal Defect Occlusion Device

by Georgiana Pintea Bentea, Marielle Morissens, Pierre-Emmanuel Massart and Jose Castro Rodriguez

J. Cardiovasc. Dev. Dis. 2026, 13(2), 72; https://doi.org/10.3390/jcdd13020072 - 2 Feb 2026

Abstract

Endovascular techniques are commonly employed for type B aortic dissections and are rarely reported for type A dissections. We present the case of a 78-year-old female diagnosed with a type A aortic dissection, with coronary arteries and supra-aortic vessels perfused from the true [...] Read more.

Endovascular techniques are commonly employed for type B aortic dissections and are rarely reported for type A dissections. We present the case of a 78-year-old female diagnosed with a type A aortic dissection, with coronary arteries and supra-aortic vessels perfused from the true lumen and no significant aortic valve dysfunction. Given her recent cardiovascular surgery, the anticipated prolonged recovery, and multiple comorbidities, a percutaneous approach was preferred, with classical surgery available as stand by. The patient underwent endovascular treatment using two self-expandable, double-disc atrial septal defect occlusion devices. Intracardiac echocardiography facilitated device deployment, offering superior visualization compared with transesophageal echocardiography, which can be partially obscured by the left pulmonary artery. To our knowledge, the false lumen-to-true lumen approach in percutaneous management of type A aortic dissection has not been previously described. Full article

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16 pages, 2659 KB

Open AccessArticle

by Ali Aljalloud, Yusuf Shieba, Rashad Zayat, Ajay Moza and Ahmed Farghal Ahmed Mohammed

J. Cardiovasc. Dev. Dis. 2026, 13(2), 71; https://doi.org/10.3390/jcdd13020071 - 31 Jan 2026

Abstract

(1) Background: Prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR) impairs left ventricular (LV) recovery and is more common in women due to smaller aortic dimensions. Although the Perceval sutureless valve provides larger effective orifice areas, sex-specific PPM outcomes remain unclear. This study [...] Read more.

(1) Background: Prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR) impairs left ventricular (LV) recovery and is more common in women due to smaller aortic dimensions. Although the Perceval sutureless valve provides larger effective orifice areas, sex-specific PPM outcomes remain unclear. This study evaluated sex-related differences in PPM incidence, severity, and early impact after Perceval AVR. (2) Methods: We retrospectively analyzed 139 patients (68 males, 71 females) who underwent Perceval AVR between 2016 and 2020. PPM was defined per Valve Academic Research Consortium-3 (VARC-3) criteria using indexed effective orifice area (EOAi) and stratified by body-mass-index (BMI) (<30 vs. ≥30 kg/m²). Echocardiography assessed hemodynamic performance. (3) Results: PPM was markedly more frequent in women than men (74.6% vs. 22.1%, p < 0.001). Among non-obese patients, 47.9% of females versus 16.2% of males developed PPM (p < 0.001). Women received smaller valves and consistently exhibited lower EOAi despite similar gradients. Postoperatively, females had reduced EOAi (0.8 vs. 0.9 cm²/m², p < 0.001) but higher LV ejection fraction (55.8% vs. 49.5%, p = 0.004). Early clinical outcomes were comparable between sexes. (4) Conclusions: Despite favorable hemodynamics of sutureless AVR, anatomical sex differences result in persistently higher PPM rates in women, predominantly of moderate severity. Tailored strategies—including aortic root enlargement and sex-specific EOAi thresholds—may improve prosthesis selection and outcomes in female patients. Full article

(This article belongs to the Section Cardiac Surgery)

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14 pages, 9609 KB

Open AccessReview

Routine Echocardiographic Assessment in LVAD Patients—A Structured Approach to Acquisition and Interpretation

by Nicolas Merke, Felix Schoenrath, Evgenij Potapov and Jan Knierim

J. Cardiovasc. Dev. Dis. 2026, 13(2), 70; https://doi.org/10.3390/jcdd13020070 - 30 Jan 2026

Abstract

Durable left ventricular assist devices (LVADs) are an established and highly effective therapy for patients with advanced heart failure. Ongoing technological improvements and structured follow-up programs have significantly enhanced device durability, reduced complications, and improved long-term survival. Consequently, a growing number of patients [...] Read more.

Durable left ventricular assist devices (LVADs) are an established and highly effective therapy for patients with advanced heart failure. Ongoing technological improvements and structured follow-up programs have significantly enhanced device durability, reduced complications, and improved long-term survival. Consequently, a growing number of patients with LVAD support require long-term outpatient care and increasingly present to both specialized and non-specialized hospitals, including for admissions unrelated to heart failure. In this context, echocardiography plays a central role. It is essential not only for routine follow-up at dedicated LVAD clinics but also for the assessment of cardiac status during inpatient admissions for extracardiac conditions. However, echocardiographic evaluation in LVAD patients is technically demanding and requires a solid understanding of LVAD physiology, device–heart interactions, and the specific hemodynamic conditions of continuous-flow support. Without this knowledge, standard echocardiographic parameters may be misleading. This review provides sonographers and cardiologists with a practical, clinically oriented framework for routine transthoracic echocardiography in patients with durable LVAD support. We summarize key principles of LVAD hemodynamics, discuss interpretation of LVAD console parameters, propose a standardized imaging protocol, and outline a structured approach to common echocardiographic findings in routine ambulatory and inpatient settings. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—Modern Diagnostic and Therapeutic Strategies in Advanced Heart Failure and Heart Transplantation)

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13 pages, 2480 KB

Open AccessArticle

Tnni3k Is Cardioprotective in Viral Myocarditis

by Kelsey Tjen, Ruolan Song, Baylee C. Westbury, Lunndon A. Lewis, Ge Tao, Kristine Y. DeLeon-Pennell, Katelyn A. Bruno and Henry M. Sucov

J. Cardiovasc. Dev. Dis. 2026, 13(2), 69; https://doi.org/10.3390/jcdd13020069 - 30 Jan 2026

Abstract

The severity of viral myocarditis in humans and mice is variable between individuals. Numerous observations demonstrate the influence of host genetics on disease course, but few genes have actually been identified to have such properties. In past work, mouse strains that are sensitive [...] Read more.

The severity of viral myocarditis in humans and mice is variable between individuals. Numerous observations demonstrate the influence of host genetics on disease course, but few genes have actually been identified to have such properties. In past work, mouse strains that are sensitive or resistant to severe disease were used to map the viral myocarditis susceptibility locus Vms1. Here, we demonstrate that Tnni3k, one of the genes within the Vms1 locus, influences the severity of disease following inoculation with coxsackievirus CVB3. Compared to disease-resistant C57BL/6J wild-type mice, strain-matched Tnni3k knockout mice showed higher cardiac inflammation and, in particular, a greater infiltration of macrophages into the heart. Long-term damage associated with viral infection was comparable in mice of both genotypes. Use of a second mouse line engineered with a point mutation to encode a kinase-dead version of Tnni3k showed the same elevated inflammation as the full null. These results identify Tnni3k and its kinase activity as being protective in modulating the acute phase of inflammatory response to CVB3 infection in the heart. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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4 pages, 194 KB

Open AccessReply

Reply to Pugnaloni et al. Comment on “Othman et al. Ventricular Topology in Congenital Heart Defects Associated with Heterotaxy: Can We Find Patterns Reflecting the Syndrome-Specific Tendency for Visceral Symmetry? J. Cardiovasc. Dev. Dis. 2025, 12, 430”

by Jörg Männer and Talat Mesud Yelbuz

J. Cardiovasc. Dev. Dis. 2026, 13(2), 68; https://doi.org/10.3390/jcdd13020068 - 27 Jan 2026

Abstract

We greatly appreciate the thoughtful and detailed comments provided by Bruno Marino and his colleagues [...] Full article

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

3 pages, 201 KB

Open AccessComment

Comment on Othman et al. Ventricular Topology in Congenital Heart Defects Associated with Heterotaxy: Can We Find Patterns Reflecting the Syndrome-Specific Tendency for Visceral Symmetry? J. Cardiovasc. Dev. Dis. 2025, 12, 430

by Flaminia Pugnaloni, Giulio Calcagni and Bruno Marino

J. Cardiovasc. Dev. Dis. 2026, 13(2), 67; https://doi.org/10.3390/jcdd13020067 - 27 Jan 2026

Abstract

We read with great interest the recent and important paper by Othman et al [...] Full article

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

11 pages, 841 KB

Open AccessArticle

Prognostic Role of the Endothelial Activation and Stress Index (EASIX) in Functional Outcomes and Mortality After Acute Ischemic Stroke: A Retrospective Pilot Cohort Study

by Michail Makris, Eleftheria Ztriva, Eleni Gavriilaki, Vasileios Patriarcheas, Vasiliki Gougoula, Michail Giannakakis, Alexandros Tselepis, Georgios Ntaios, Christos Savopoulos and Georgia Kaiafa

J. Cardiovasc. Dev. Dis. 2026, 13(2), 66; https://doi.org/10.3390/jcdd13020066 - 27 Jan 2026

Abstract

Background: Endothelial dysfunction is a key player in stroke pathophysiology. The Endothelial Activation and Stress Index (EASIX) is a biomarker of endothelial injury validated in hematology, sepsis, and cardiovascular cohorts; however, its prognostic role in stroke remains unclear. This retrospective cohort study aims [...] Read more.

Background: Endothelial dysfunction is a key player in stroke pathophysiology. The Endothelial Activation and Stress Index (EASIX) is a biomarker of endothelial injury validated in hematology, sepsis, and cardiovascular cohorts; however, its prognostic role in stroke remains unclear. This retrospective cohort study aims to provide preliminary evidence on the potential utility of EASIX levels as a biomarker for assessing stroke severity and predicting outcomes. Methods: We retrospectively studied 100 patients aged ≥ 18 years admitted with acute ischemic stroke (AIS) or transient ischemic attack (TIA) between January 2020 and July 2024. EASIX was calculated on admission as LDH × creatinine/platelets. Outcomes included in-hospital and 12-month mortality, stroke severity assessed by the NIHSS score, and disability assessed as a modified Rankin score (mRS). Results: Median age was 82 years; 56% were female. The in-hospital and 12-month mortality rates were 47.9% in patients with AIS and 17.2% in patients with TIA, respectively. Overall, EASIX was not associated with NIHSS, mRS, or mortality in the total cohort. Ιn the subgroup of patients with small vessel disease (n = 10), higher EASIX was associated with worse mRS at 12 months (β = 2.383, p = 0.02) and increased mortality (β = 0.653, p = 0.02). EASIX correlated positively with WBC (p < 0.001) and CRP (p = 0.01). Female sex was associated with lower EASIX values. Conclusions: EASIX was not associated with outcomes in the overall AIS/TIA cohort, but it demonstrated potential prognostic relevance in small vessel disease (SVD), which has not been reported previously in the literature. Further prospective research is warranted to validate the potential association between systemic endothelial stress and small vessel disease before the implementation of EASIX as a prognostic tool in patients with stroke due to SVD. Full article

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

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14 pages, 1186 KB

Open AccessArticle

Clinical Evaluation of Neonatal Arrhythmias: Experience from a Specialized Pediatric Cardiac Center

by Halise Zeynep Genc, Elnur Karimov, Seyma Yakut, Dilek Yavuzcan Ozturk, Demet Oguz, Merih Cetinkaya, Gulhan Tunca Sahin and Erkut Ozturk

J. Cardiovasc. Dev. Dis. 2026, 13(2), 65; https://doi.org/10.3390/jcdd13020065 - 27 Jan 2026

Abstract

Neonatal arrhythmias, though relatively uncommon, can range from benign self-limiting conditions to life-threatening disorders requiring intensive management. Data on their clinical spectrum, management, and outcomes remain limited. This study aimed to evaluate the types, frequency, clinical characteristics, treatment strategies, and prognosis of neonatal [...] Read more.

Neonatal arrhythmias, though relatively uncommon, can range from benign self-limiting conditions to life-threatening disorders requiring intensive management. Data on their clinical spectrum, management, and outcomes remain limited. This study aimed to evaluate the types, frequency, clinical characteristics, treatment strategies, and prognosis of neonatal arrhythmias in a tertiary pediatric cardiac center. We retrospectively reviewed neonates diagnosed with arrhythmia within the first 28 days of life at Basaksehir Cam and Sakura City Hospital between 1 January 2021 and 1 May 2025. Demographic data, electrocardiographic and echocardiographic findings, treatment modalities, recurrence, morbidity, and mortality were analyzed. Patients were categorized as having benign or non-benign arrhythmias. A total of 65 neonates (57% male, mean weight 3.2 kg) were included. Non-benign arrhythmias were more frequent (77%) compared to benign arrhythmias (23%). Supraventricular tachycardia (35%) was the most common non-benign arrhythmia, followed by long QT syndrome (10.7%) and complete atrioventricular block (9.2%). Antiarrhythmic therapy was required in 55% of patients. Pacemaker implantation was performed in seven infants with conduction disorders. Recurrence occurred in 3% of cases, exclusively among patients with supraventricular tachycardia. During a median follow-up of 12.8 months, no mortality was observed. Prenatal diagnosis and early management contribute to favorable outcomes, as reflected in the absence of mortality in this cohort. Larger, prospective studies are warranted to define optimal management strategies and treatment durations for neonatal arrhythmias. Full article

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

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12 pages, 1759 KB

Open AccessArticle

Elevated IL-1 Beta Plasma Levels, Altered Platelet Activation and Cardiac Remodeling Lead to Moderately Decreased LV Function in Alzheimer Transgenic Mice After Myocardial Ischemia and Reperfusion

by Lili Donner, Simone Gorressen, Jens W. Fischer and Margitta Elvers

J. Cardiovasc. Dev. Dis. 2026, 13(2), 64; https://doi.org/10.3390/jcdd13020064 - 26 Jan 2026

Abstract

Background: Neurodegeneration and dementia are key factors in Alzheimer’s disease (AD). The deposition of amyloid-ß into senile plaques in the brain parenchyma and in cerebral vessels known as cerebral amyloid angiopathy (CAA) are the main clinical parameters of AD. Acute myocardial infarction (AMI) [...] Read more.

Background: Neurodegeneration and dementia are key factors in Alzheimer’s disease (AD). The deposition of amyloid-ß into senile plaques in the brain parenchyma and in cerebral vessels known as cerebral amyloid angiopathy (CAA) are the main clinical parameters of AD. Acute myocardial infarction (AMI) and AD share a comparable pathophysiology. However, the underlying mechanisms and the consequences of AMI in AD patients are unclear to date. Methods: AD transgenic APP23 mice were analyzed in experimental AMI using the closed-chest model. Results: APP23 mice displayed significantly decreased left ventricular function as detected by FS/MPI (fractional shortening/myocardial performance index) after 24 h and 3 weeks after ligation of the LAD compared to WT controls. No differences have been observed in infarct and scar size. The analysis of cardiac remodeling after 3 weeks showed an altered composition of the collagen tissue of the scar with elevated tight but reduced fine collagen in APP23 mice. Altered scar formation was accompanied by elevated degranulation of platelets following activation of the collagen receptor GPVI. Conclusions: These results suggest that AD patients are at higher risk for cardiac damage after AMI. This implies the need for a personalized therapy of AMI in AD patients. Full article

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

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19 pages, 856 KB

Open AccessReview

Preventing Postpericardiotomy Syndrome: Current Evidence and Future Directions

by Christos E. Ballas, Thomas Theologou, Evangelia Samara, Fotios Barkas, Theodora Bampali, Kyriakos Kintzoglanakis, Christos Diamantis, Petros Tzimas, Christos S. Katsouras and Christos Alexiou

J. Cardiovasc. Dev. Dis. 2026, 13(2), 63; https://doi.org/10.3390/jcdd13020063 - 24 Jan 2026

Abstract

Postpericardiotomy syndrome (PPS) is the most frequent inflammatory after-effect of cardiac surgery and is characterized by high morbidity, delayed hospitalization, and increased long-term mortality rates. Although PPS is common, empirical anti-inflammatory therapy has historically been employed for its prevention, and mechanism-based approaches have [...] Read more.

Postpericardiotomy syndrome (PPS) is the most frequent inflammatory after-effect of cardiac surgery and is characterized by high morbidity, delayed hospitalization, and increased long-term mortality rates. Although PPS is common, empirical anti-inflammatory therapy has historically been employed for its prevention, and mechanism-based approaches have not yet been standardized. In this literature review, which was conducted on the basis of randomized controlled trials, meta-analyses, cohort studies, and mechanistic research regarding pharmacologic interventions, surgical modalities, and biomarker-based preventive strategies, the deficiencies of a critical synthesis of existing preventive strategies and emerging risk stratification instruments for PPS are addressed. The review affirms that the most evidence-based pharmacologic intervention is colchicine, which demonstrates a consistent reduction in PPS incidence across a range of randomized trials. Nonsteroidal anti-inflammatory drugs show variable responses, whereas corticosteroids are no longer recommended for routine prophylaxis due to relapse. Specific anti–interleukin-1 therapies represent a promising novel approach for high-risk patients. Surgical interventions, such as pericardial closure using biomaterials and posterior pericardiotomy, are important and do not lead to increased hemodynamic complications, while postoperative effusions, atrial fibrillation, and tamponade are reduced. Less invasive methods may also be employed to mitigate inflammatory causes, particularly in valve-sparing procedures and congenital operations. Emerging biomarker data, including postoperative neutrophil-to-lymphocyte ratios, C-reactive protein levels, and pericardial fluid cytokines, enable the identification of high-risk patients and form the basis for a personalized prevention approach. In summary, pharmacologic prophylaxis, innovative surgical techniques, and biomarker-based risk stratification represent a pathway toward reducing the incidence and burden of PPS in modern cardiac surgery. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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14 pages, 1437 KB

Open AccessArticle

Impact of Fitness on Cardiac Torsion and Wall Mechanics in Ischemic Heart Disease Study (FIT-TWIST)

by Priscilla Wessly, Maiteder Larrauri Reyes, Syed I. Zaidi, Selin Sendil, Tarec K. Elajami and Christos G. Mihos

J. Cardiovasc. Dev. Dis. 2026, 13(2), 62; https://doi.org/10.3390/jcdd13020062 - 24 Jan 2026

Abstract

Background: Cardiac rehabilitation (CR) and mechanics are individually associated with cardiovascular outcomes in ischemic heart disease (IHD); however, their interaction remains less defined. We hypothesized that a 36-session CR program improves cardiac strain and torsional mechanics in IHD patients. Methods: Ninety IHD patients [...] Read more.

Background: Cardiac rehabilitation (CR) and mechanics are individually associated with cardiovascular outcomes in ischemic heart disease (IHD); however, their interaction remains less defined. We hypothesized that a 36-session CR program improves cardiac strain and torsional mechanics in IHD patients. Methods: Ninety IHD patients on guideline-directed medical therapy with complete revascularization were prospectively enrolled, of which 27 electively completed a 36-session standardized exercise CR program. Speckle-tracking echocardiography was utilized to assess left ventricular (LV) global longitudinal strain (GLS) and peak twist, and right ventricular free wall strain (RVFWS) at baseline and after program completion. Participants were propensity-scoring matched 1:1 with 27 patients who declined participation (No-CR). Results: Clinical characteristics were similar between groups (mean age: 63 ± 10 years, 82% male, 31% three-vessel coronary artery disease). When compared with baseline, the CR group experienced a significant improvement in LV GLS (−14.9 ± 2.9 vs. −16.2 ± 3.1%, p = 0.003), with a numerical but non-significant increase in peak LV twist (14.4 ± 7.4 vs. 16.8 ± 5.3°, p = 0.162). The No-CR group showed significant deterioration in RVFWS (−22.9 ± 4.6% vs. −19.3 ± 5.4%, p = 0.009), with no other changes including in GLS (−14.8 ± 3.1 vs. −15 ± 3.3%, p = 0.831). Follow-up comparisons between CR versus No-CR revealed significantly greater peak LV twist (16.8 ± 5.3 vs. 12.1 ± 4.2°, p = 0.001) and a healthier RVFWS (−22.2 ± 4.5 vs. −19.3 ± 5.4, p = 0.044) in CR participants. Conclusions: CR in patients with IHD improved LV GLS and, compared with No-CR, conferred better LV twist and RVFWS. Full article

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11 pages, 253 KB

Open AccessReview

Real-World Cardiovascular Research Using the German IQVIA Disease Analyzer Database: Methods, Evidence, and Limitations (2000–2025)

by Karel Kostev, Marcel Konrad and Mark Luedde

J. Cardiovasc. Dev. Dis. 2026, 13(2), 61; https://doi.org/10.3390/jcdd13020061 - 24 Jan 2026

Abstract

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. This increases the demand for real-world evidence to complement findings from randomized controlled trials. The German IQVIA Disease Analyzer (DA) database, which is populated with anonymized electronic medical records from general [...] Read more.

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. This increases the demand for real-world evidence to complement findings from randomized controlled trials. The German IQVIA Disease Analyzer (DA) database, which is populated with anonymized electronic medical records from general practitioners and specialists, has become an increasingly valuable source for cardiovascular research. Over the past two decades, and especially between 2020 and 2025, numerous epidemiological studies have used this database to explore associations between cardiovascular risk factors, comorbidities, therapeutic patterns, and cardiovascular outcomes in large, broadly representative outpatient populations. This review synthesizes evidence from 13 selected DA-based studies examining atrial fibrillation, heart failure, cardiometabolic disease, lipid management, non-alcoholic fatty liver disease (NAFLD)–related cardiovascular risks, cerebrovascular complications, COVID-19-associated vascular events, and modifiable behavioral and anthropometric factors. These studies were selected based on predefined criteria including cardiovascular relevance, methodological rigor, large sample size, and representativeness of key disease domains across the 2000–2025 period. Eligible studies were identified through targeted searches of peer-reviewed literature using the German IQVIA Disease Analyzer database and were selected to reflect major cardiovascular disease domains, risk factors, and therapeutic areas. Across disease domains, the reviewed studies consistently demonstrate the DA database’s capacity to identify reproducible associations between cardiometabolic risk factors, comorbidities, and cardiovascular outcomes in routine outpatient care. While causal inference is not possible, the database enables the identification of clinically meaningful associations that inform hypothesis generation, help quantify disease burden, and highlight gaps in prevention or treatment. The database’s strengths include large sample sizes (often exceeding 100,000 patients), long follow-up periods, and high external validity, while limitations relate to coding accuracy, residual confounding, and the absence of detailed clinical measures. Collectively, the evidence underscores the importance of the DA database as a crucial platform for real-world cardiovascular research. Full article

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

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Journal of Cardiovascular Development and Disease

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