Journal of Cardiovascular Development and Disease

20 pages, 996 KB

Open AccessReview

SGLT2 Inhibitors Confer Cardiovascular Protection via the Gut-Kidney-Heart Axis: Mechanisms and Translational Perspectives

by Yimei Tao, Ning Zhang, Zhaoxiang Wang, Ying Pan, Shao Zhong and Hongying Liu

J. Cardiovasc. Dev. Dis. 2025, 12(12), 471; https://doi.org/10.3390/jcdd12120471 (registering DOI) - 30 Nov 2025

Abstract

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated significant cardiovascular and renal benefits beyond glycemic control, yet their integrated mechanisms remain incompletely understood. Emerging evidence highlights the gut-kidney-heart axis as a pivotal pathological network, wherein gut dysbiosis, toxic metabolite accumulation, intestinal barrier disruption, and [...] Read more.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated significant cardiovascular and renal benefits beyond glycemic control, yet their integrated mechanisms remain incompletely understood. Emerging evidence highlights the gut-kidney-heart axis as a pivotal pathological network, wherein gut dysbiosis, toxic metabolite accumulation, intestinal barrier disruption, and systemic inflammation synergistically drive cardiorenal injury. This review systematically elucidates how SGLT2i modulate this axis through multi-level interventions: reshaping gut microbiota composition, enriching short-chain fatty acid-producing bacteria, suppressing trimethylamine and other toxin-generating microbes, restoring tight junction integrity, and regulating bile acid metabolism. These upstream effects reduce systemic inflammatory and metabolic stress, interrupt kidney-derived toxin amplification, and mitigate myocardial remodeling. Unlike previous reviews focusing on single-organ pathways, this work integrates microecological regulation, metabolite reprogramming, and cross-organ protection into a unified “three-axis convergence to the heart” framework. We also highlight potential species-specific microbiota regulatory profiles among different SGLT2i and propose future directions, including fecal microbiota transplantation and microbiota-targeted co-therapies, to clarify causal relationships and optimize therapeutic strategies. By positioning the gut as a modifiable upstream driver, this framework provides novel mechanistic insight and translational potential for expanding SGLT2i applications in metabolic cardiovascular disease, including in non-diabetic populations. Full article

15 pages, 2769 KB

Open AccessArticle

Temporal Dynamics of the Association Between Acute Kidney Injury and Mortality After Transcatheter Aortic Valve Implantation: Insights from Time-Varying and Landmark Survival Analyses

by Seda Elcim Yildirim, Bahadır Akar, Berkay Palac, Hakan Bozkurt, Tarik Yildirim, Tuncay Kiris and Eyüp Avci

J. Cardiovasc. Dev. Dis. 2025, 12(12), 470; https://doi.org/10.3390/jcdd12120470 (registering DOI) - 30 Nov 2025

Abstract

Background: Acute kidney injury (AKI) is a frequent complication following transcatheter aortic valve implantation (TAVI) and has been linked to increased mortality. However, the temporal pattern of this association remains uncertain. This study aimed to evaluate the time-dependent impact of AKI on mortality [...] Read more.

Background: Acute kidney injury (AKI) is a frequent complication following transcatheter aortic valve implantation (TAVI) and has been linked to increased mortality. However, the temporal pattern of this association remains uncertain. This study aimed to evaluate the time-dependent impact of AKI on mortality after TAVI using advanced survival analyses. Methods: We retrospectively analyzed 381 consecutive patients who underwent transfemoral TAVI between December 2016 and October 2024 at two tertiary cardiovascular centers. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. The primary outcome was all-cause mortality. Patients were categorized into AKI and non-AKI groups. Clinical outcomes, including 30-day, 1-year, and overall mortality, were evaluated. Results: Among 381 patients who underwent TAVI, 59 (15.5%) developed AKI according to the AKIN criteria. During a 33.9 months (18.0–59.2) median follow-up of overall mortality was significantly higher in the AKI group compared with those without AKI. In the multivariate Cox regression analysis, AKI was significantly associated with long-term mortality (HR: 2.07, 95% CI 1.32–3.25; p = 0.002). The time-varying hazard ratio curve demonstrated that the excess mortality risk associated with AKI was most pronounced in the early period and gradually declined thereafter. In time-interval–specific analyses, AKI was strongly associated with mortality within the first month (HR 6.30, 95% CI 3.03–13.08, p < 0.001) and remained significant up to 12 months (HR 2.18, 95% CI 1.32–3.59, p = 0.002). Beyond the first year, this association attenuated and lost statistical significance at 12–36 months (HR 0.90, p = 0.79), 36–60 months (HR 0.57, p = 0.24), and >60 months (HR 0.43, p = 0.13). Conclusions: AKI is an important predictor of early and mid-term mortality following TAVI, but its long-term prognostic impact is less pronounced. Preventive strategies and early management of AKI may improve outcomes in this high-risk population. Full article

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10 pages, 1864 KB

Open AccessArticle

2020 ESC Guidelines on Sports Cardiology: Impact of CMR Criteria on Return-to-Play Clearance After Acute Myocarditis

by Carlo Maria Gallinoro, Alessandra Scatteia, Dario Catapano, Carmine Emanuele Pascale, Giuseppe Russo, Franca Di Meglio and Santo Dellegrottaglie

J. Cardiovasc. Dev. Dis. 2025, 12(12), 469; https://doi.org/10.3390/jcdd12120469 (registering DOI) - 29 Nov 2025

Abstract

Cardiovascular magnetic resonance (CMR) imaging is a key component of current diagnostic pathways in subjects with acute myocarditis. The 2020 ESC Guidelines on Sports Cardiology recommend athletes with acute myocarditis to abstain from sports during the recovery phase from inflammation and to undergo [...] Read more.

Cardiovascular magnetic resonance (CMR) imaging is a key component of current diagnostic pathways in subjects with acute myocarditis. The 2020 ESC Guidelines on Sports Cardiology recommend athletes with acute myocarditis to abstain from sports during the recovery phase from inflammation and to undergo comprehensive evaluation—including CMR—before safely returning to play. This retrospective study analyzed 95 non-competitive athletes presenting with acute myocarditis and evaluated by initial and repeated CMRs. CMR exams assessed myocardial inflammation, edema, and scarring as defined based on the updated Lake Louise criteria. As per 2020 ESC Guidelines, eligibility was granted by excluding extensive myocardial damage. Initial CMR showed 84% positive STIR (edema) and 79% with LGE ≥ 3 segments. After 3–6 months, STIR positivity dropped to 12%, LGE extent remained globally stable, but with some reduction in 42%. Few experienced recurrent myocarditis or LVEF decline; 24% met return-to-play criteria by repeated CMR. Our study shows that few non-competitive athletes recovering from acute myocarditis meet ESC CMR criteria to resume competitive sports at prescribed follow-up evaluation. The long-term prognostic value of CMR markers like LGE and edema remains unclear, highlighting the need for further research to refine return-to-play guidelines and ensure athlete safety. Full article

(This article belongs to the Special Issue Advanced Cardiovascular Imaging in Structural Heart Disease: Diagnostic, Prognostic, and Therapeutic Perspectives)

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18 pages, 344 KB

Open AccessArticle

Clinical Significance of TAPSE/PASP Ratio in Risk Stratification for Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Replacement

by Simina Mariana Moroz, Alina Gabriela Negru, Silvia Luca, Daniel Nișulescu, Mirela Baba, Darius Buriman, Ana Lascu, Daniel Florin Lighezan and Ioana Mozos

J. Cardiovasc. Dev. Dis. 2025, 12(12), 468; https://doi.org/10.3390/jcdd12120468 (registering DOI) - 29 Nov 2025

Abstract

Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially [...] Read more.

Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially in elderly or high-risk patients. Objectives: The present study aims to assess the influence of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary systolic arterial pressure (PASP) ratio on clinical outcomes in patients with aortic stenosis undergoing TAVR and offer valuable insights into patient selection and tailored management strategies for individuals undergoing TAVR. Methods: A retrospective analysis was conducted on 100 patients with AS who underwent TAVR, included in two distinct groups based on their median TAPSE/PASP ratio. Results: Patients were divided according to their median TAPSE/PASP ratio into two groups. Those with lower TAPSE/PASP ratios had a higher incidence of post-procedural atrial fibrillation (AF) (48% vs. 28%, p = 0.0404), lower left-ventricular ejection fraction (LVEF) (41.06% vs. 49.50%, p < 0.0001), a more pronounced inflammatory and hematologic response, and longer hospitalization. Receiver-operating characteristic (ROC) analysis demonstrated modest but significant discrimination rather than high sensitivity or specificity for postprocedural arrhythmias, particularly atrial fibrillation. Conclusions: TAPSE/PASP should be regarded as a clinically useful risk-stratification marker in patients with AS undergoing TAVR, enabling the identification of high-risk patients and optimizing peri-procedural management. Full article

(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)

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22 pages, 623 KB

Open AccessReview

The Dual Role of ADAMTS1 in Cardiovascular Remodeling: Balancing Extracellular Matrix Homeostasis and Pathological States

by Siqin Sheng and Shunrong Zhang

J. Cardiovasc. Dev. Dis. 2025, 12(12), 467; https://doi.org/10.3390/jcdd12120467 (registering DOI) - 29 Nov 2025

Abstract

Extracellular matrix metalloproteinase ADAMTS1 (adhesion metalloproteinase with thrombospondin-type domain 1) is a key regulator in cardiovascular remodeling with functional paradoxes. This review synthesizes existing evidence to clarify its context-dependent dual roles across various cardiovascular diseases: on the one hand, ADAMTS1 exerts protective functions [...] Read more.

Extracellular matrix metalloproteinase ADAMTS1 (adhesion metalloproteinase with thrombospondin-type domain 1) is a key regulator in cardiovascular remodeling with functional paradoxes. This review synthesizes existing evidence to clarify its context-dependent dual roles across various cardiovascular diseases: on the one hand, ADAMTS1 exerts protective functions by maintaining vascular integrity and mitigating inflammatory responses; on the other hand, in conditions such as myocardial infarction and aortic aneurysms, ADAMTS1 promotes pathological progression by excessively hydrolyzing the multifunctional proteoglycan versican and other substrates, leading to tissue disruption and adverse remodeling. This functional switch in ADAMTS1 is jointly regulated by its cellular origin, temporal expression dynamics, and local microenvironment. In summary, ADAMTS1 represents a critical homeostasis node in the cardiovascular system. Therapeutic interventions targeting it should avoid broad-spectrum inhibition strategies; instead, future efforts should focus on developing precise, context-specific regulatory approaches. Full article

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

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14 pages, 603 KB

Open AccessArticle

Genetic Profiling and Phenotype Spectrum in a Chinese Cohort of Pediatric Cardiomyopathy Patients

by Guofeng Xing, Li Chen, Lizhi Lv, Guanyi Xu, Yabing Duan, Jiachen Li, Xiaoyan Li and Qiang Wang

J. Cardiovasc. Dev. Dis. 2025, 12(12), 466; https://doi.org/10.3390/jcdd12120466 (registering DOI) - 29 Nov 2025

Abstract

This study examines pediatric cardiomyopathies by analyzing genetic and clinical data from 55 patients (2021–2024) at Beijing Anzhen Hospital. Four subtypes were studied: dilated (DCM, 24), hypertrophic (HCM, 22), arrhythmogenic right ventricular (ARVC, 7), and restrictive (RCM, 2). Clinical data, imaging, labs, and [...] Read more.

This study examines pediatric cardiomyopathies by analyzing genetic and clinical data from 55 patients (2021–2024) at Beijing Anzhen Hospital. Four subtypes were studied: dilated (DCM, 24), hypertrophic (HCM, 22), arrhythmogenic right ventricular (ARVC, 7), and restrictive (RCM, 2). Clinical data, imaging, labs, and family histories were collected, with whole-exome sequencing (WES) identifying disease-causing variants classified via ACMG guidelines. Statistical analysis revealed a median age of 11 years, a proportion of 58% male participants, and ethnic diversity (21 northern Han, 29 southern Han, 5 minorities). In the cohort, 13 cases had an LVEF below 35%. Pathogenic/likely pathogenic (P/LP) variants were found in 21.8% of the patients, and variants of uncertain significance (VUS) were present in 38.2%, with MYH7 (seven cases) and MYBPC3 (five) being the most common. The WES positivity rates varied, at 58.3% (DCM), 72.7% (HCM), and 33.3% (ARVC/RCM). DCM patients with P/LP/VUS variants showed better contractile function (Fractional Shortening: 29.0% vs. 16.5%, p = 0.008). Females in the DCM group had poorer cardiac function (lower LVEF, higher LVESd, lower cardiac output) compared to males, with more females (nine vs. three) exhibiting an LVEF < 35% (p = 0.041). No significant gender differences were observed in the HCM cases. These findings highlight genotype–phenotype correlations and underscore the need for early intervention in female DCM patients. Full article

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

10 pages, 256 KB

Open AccessArticle

Berlin Heart EXCOR as a Bridge to Transplantation in Pediatric End-Stage Heart Failure: A Retrospective Cohort Study

by Mohannad Dawary, Dimpna Brotons and Felix W. Tsai

J. Cardiovasc. Dev. Dis. 2025, 12(12), 465; https://doi.org/10.3390/jcdd12120465 (registering DOI) - 29 Nov 2025

Abstract

Background: Ventricular assist devices serve as a critical bridge to transplantation for pediatric patients with end-stage heart failure. This study evaluated the outcomes of pediatric patients who received Berlin Heart EXCOR support for end-stage heart failure. Methods: We retrospectively analyzed data [...] Read more.

Background: Ventricular assist devices serve as a critical bridge to transplantation for pediatric patients with end-stage heart failure. This study evaluated the outcomes of pediatric patients who received Berlin Heart EXCOR support for end-stage heart failure. Methods: We retrospectively analyzed data from 11 consecutive pediatric patients (63.64% male, median age 60 months) who underwent Berlin Heart implantation from November 2021 to April 2025. The majority (90.90%) had dilated cardiomyopathy, and 72.73% were INTERMACS class I. Results: Of the 11 patients, 54.54% received an LVAD only, 36.36% received a BiVAD, and 9.09% required an LVAD followed by an RVAD. The postoperative mean ICU stay was 140 ± 73 days, and total hospital stay was 192 ± 96 days. Significant post-implant complications included stroke (27.27%), bleeding requiring exploration (27.27%), and pneumonia (36.36%). Ten patients (90.91%) were successfully bridged to heart transplantation, with one pre-transplant mortality (9.09%) due to brain hemorrhage. The median time to transplantation was 88 days (interquartile range, IQR: 78–177). During a median follow-up of 17 months (IQR: 7–32), two patients died post-transplant, resulting in an overall survival rate of 67.50% at 3 years. Conclusion: Despite significant complications and prolonged hospitalization, the Berlin Heart demonstrated effectiveness as a mechanical circulatory support device for pediatric patients, with a high rate of successful bridging to transplantation and acceptable mid-term survival. These findings support its use as a viable bridge to transplantation in pediatric end-stage heart failure. Full article

15 pages, 1726 KB

Open AccessSystematic Review

Efficacy and Safety of Drug and Device Strategies for Stroke Prevention in Atrial Fibrillation After Intracranial Hemorrhage: A Bayesian Network Meta-Analysis

by Fenglin Qi, Yuhang Yang, Lili Wang, Sixian Weng, Qinchao Wu, Yijie Liu, Zhipeng Hu, Liying Chen and Yunlong Wang

J. Cardiovasc. Dev. Dis. 2025, 12(12), 464; https://doi.org/10.3390/jcdd12120464 (registering DOI) - 28 Nov 2025

Abstract

(1) Background: Whether anticoagulation can be resumed in atrial fibrillation (AF) combined with intracranial hemorrhage (ICH), and which anticoagulation modality is used with better efficacy and safety, is unknown. (2) Method: Randomized controlled trials (RCTs) and observational studies on relevant topics were included [...] Read more.

(1) Background: Whether anticoagulation can be resumed in atrial fibrillation (AF) combined with intracranial hemorrhage (ICH), and which anticoagulation modality is used with better efficacy and safety, is unknown. (2) Method: Randomized controlled trials (RCTs) and observational studies on relevant topics were included by searching five databases: PubMed, EMBASE, EBSCO, Cochrane Central Register of Controlled Trial and ClinicalTrials. Bayesian network meta-analysis was performed to analyze the effect of oral anticoagulant (OAC), new oral anticoagulant (NOAC), warfarin, antiplatelet, left atrial appendage occlusion (LAAO) and no therapy in patients with AF after intracranial hemorrhage. (3) Results: We included 16 studies involving 25,483 patients. Compared with no antithrombotic therapy, the risk of thromboembolism and all-cause mortality were both reduced with OAC (OR: 0.38, 95% CI: 0.21–0.67; OR: 0.45, 95% CI: 0.25–0.8) and LAAO (OR: 0.11, 95% CI: 0.01–0.76; OR: 0.11, 95% CI: 0.01–0.88), and there was no increased risk of recurrent intracranial hemorrhage. Regarding thromboembolism, OAC (OR: 0.28, 95% CI: 0.11–0.69) was superior to antiplatelet therapy, and antiplatelet therapy (OR: 12.59, 95% CI: 1.57–133.50) was associated with a higher risk of thromboembolism than LAAO. There were no significant differences in recurrent intracranial hemorrhage between the interventions. LAAO appeared to be the best option for reducing thromboembolism (SUCRA: 0.96), recurrent intracranial hemorrhage (SUCRA: 0.75) and all-cause mortality (SUCRA: 0.94). (4) Conclusions: Based on this network meta-analysis, we hypothesize that LAAO has the highest likelihood of reducing the risk of thromboembolism and recurrent intracranial hemorrhage, as well as all-cause mortality in patients with AF after intracranial hemorrhage, followed by OAC. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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24 pages, 1574 KB

Open AccessArticle

Predictive Value of MELD Score and Charlson Comorbidity Index in Thoracic Aortic Surgery Patients

by Ismail Dalyanoglu, Freya Sophie Jenkins, Luis Jaime Vallejo Castano, Esma Yilmaz, Mohammed Morjan, Amin Thwairan, Johanna Wedy, Georg Ulrich Holley, Artur Lichtenberg and Hannan Dalyanoglu

J. Cardiovasc. Dev. Dis. 2025, 12(12), 463; https://doi.org/10.3390/jcdd12120463 - 28 Nov 2025

Abstract

Thoracic aortic aneurysms (TAAs) carry a high risk of fatal rupture, necessitating improved preoperative risk stratification. This study evaluates the predictive value of systemic risk scores—specifically the Model for End-Stage Liver Disease (MELD) and the Charlson Comorbidity Index (CCI)—for in-hospital mortality, length of [...] Read more.

Thoracic aortic aneurysms (TAAs) carry a high risk of fatal rupture, necessitating improved preoperative risk stratification. This study evaluates the predictive value of systemic risk scores—specifically the Model for End-Stage Liver Disease (MELD) and the Charlson Comorbidity Index (CCI)—for in-hospital mortality, length of stay, and one-year mortality in patients undergoing elective ascending aortic surgery. The study further compares MELD variants (MELD-Na and MELD-XI) for their prognostic performance in this context. This retrospective single-center study analyzed digital medical records of 500 patients undergoing elective surgery for ascending thoracic aortic disease between 2003 and 2023. MELD, MELD-Na (incorporating sodium), and MELD-XI (excluding INR for anticoagulated patients) were calculated from preoperative laboratory data. The CCI was derived from documented comorbidities. Outcomes included in-hospital mortality, length of stay (from admission to discharge), and one-year mortality assessed via outpatient follow-up. The study excluded patients undergoing emergency surgery for Stanford type A aortic dissection. MELD-Na incorporates serum sodium, while MELD-XI is a variant that excludes INR for patients with anticoagulation. The Charlson Comorbidity Index (CCI) was derived from patients’ medical histories prior to surgery. Length of stay was defined as total inpatient days between admission and discharge. One-year mortality was assessed via outpatient follow-up data. Loss to follow-up did not exceed 30%. Of 500 patients (median age 64 years, 72.8% male), the MELD-Na score showed the strongest ability to predict in-hospital mortality (AUC = 0.698), outperforming both the standard MELD (AUC = 0.690) and the age-adjusted CCI (AUC = 0.631). For one-year mortality (N = 355), MELD-Na again performed best (AUC = 0.732), while the unadjusted CCI showed minimal predictive value (AUC = 0.509). Predictive power for hospital length of stay was limited across all scores; the age-adjusted CCI achieved the highest, though modest, discrimination (AUC = 0.627). 1-year mortality was assessed in 355 patients with available follow-up data (29.0% lost to follow-up). Among these, non-survivors had significantly higher MELD scores (p < 0.001). MELD-Na demonstrated the strongest predictive performance (AUC = 0.732). The MELD score, particularly MELD-Na, demonstrated strong predictive ability for in-hospital and 1-year mortality, but showed limited value in estimating hospital stay duration. MELD-Na and the age-adjusted CCI provide valuable preoperative prognostic information for patients undergoing elective ascending aortic surgery. While not intended to replace established risk models, their simplicity and reliance on routine clinical data make them attractive tools for early triage, especially in older or multimorbid patients. Their integration into preoperative planning may enhance individualized risk assessment and resource allocation. Full article

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21 pages, 514 KB

Open AccessSystematic Review

Therapeutic Strategies for Abdominal Aortic Aneurysm: A Comprehensive Systematic Review

by Egle Kavaliunaite, Joachim Sejr Skovbo Kristensen, Sissel Scheurer, Ida Berg, Jes Sanddal Lindholt and Jane Stubbe

J. Cardiovasc. Dev. Dis. 2025, 12(12), 462; https://doi.org/10.3390/jcdd12120462 - 27 Nov 2025

Abstract

Background: Abdominal aortic aneurysm (AAA) is a life-threatening condition with no proven pharmacological treatment to halt its progression. While animal models offer insights into pathophysiology and drug response, clinical translation remains limited. Methods: We conducted a systematic review of repurposed drugs, classified by [...] Read more.

Background: Abdominal aortic aneurysm (AAA) is a life-threatening condition with no proven pharmacological treatment to halt its progression. While animal models offer insights into pathophysiology and drug response, clinical translation remains limited. Methods: We conducted a systematic review of repurposed drugs, classified by Anatomical Therapeutic Chemical (ATC) codes, tested in animal models for their effects on AAA progression. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a PROSPERO-registered protocol (CRD42024323430), we screened 14,127 articles and included 144 studies across 13 of the 14 ATC categories. Results: Most drug classes, particularly cardiovascular, metabolic, and immunomodulatory agents—including statins, angiotensin II receptor blockers (ARBs), metformin, and rapamycin—showed a reduced aneurysm diameter. However, high heterogeneity in models, treatment timing, and methodological shortcomings, including a lack of blinding and power calculations, limit translational value. The predominance of positive findings suggests potential publication bias. Conclusions: Nevertheless, drugs effective post-aneurysm initiation may offer the greatest clinical promise. Our findings underscore the need for standardized, high-quality, preclinical research to support future human trials. Full article

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

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13 pages, 709 KB

Open AccessArticle

Evaluation of the Comprehensive Complication Index Versus the Clavien–Dindo Classification for Predicting Clinical Outcomes After Cardiac Surgery in Adult Patients

by Xinfang Zhang, Lu Zhang, Jimei Chen, Huigen Huang, Huan Ma, Jinlin Wu, Shuyuan Tan, Xiangyu Cai, Hongru Zhu and Ling Wang

J. Cardiovasc. Dev. Dis. 2025, 12(12), 461; https://doi.org/10.3390/jcdd12120461 - 27 Nov 2025

Abstract

Background: Adult patients undergoing cardiac surgery are at an elevated risk of experiencing postoperative complications. However, there is currently no consensus on the most accurate instrument for assessing clinical outcomes following the occurrence of such complications in cardiac surgery. Objective: The objective was [...] Read more.

Background: Adult patients undergoing cardiac surgery are at an elevated risk of experiencing postoperative complications. However, there is currently no consensus on the most accurate instrument for assessing clinical outcomes following the occurrence of such complications in cardiac surgery. Objective: The objective was to validate the comprehensive complication index (CCI^®) and Clavien–Dindo classification (CDC) regarding their ability to evaluate clinical outcomes in adult cardiac surgery. Methods: This retrospective study included 1896 adult patients who underwent cardiac surgery between September 2023 and October 2024. Among these patients, 849 developed postoperative complications. Complications were graded using the CDC, which were then converted to the CCI^®. The validation of the CCI and CDC was evaluated. The strength of the correlation between the CCI^®/CDC and clinical outcomes, including ICU stay duration, length of hospital stay, and hospitalization cost were compared using Spearman’s ρ and Fisher’s z-transformation. We also employed generalized linear models to analyze the variables that influenced clinical outcomes. Results: The median age of the patients was 58.0 years; the median CCI^® score was 0.0 (interquartile range [IQR]: 0.0, 20.9). Pneumonia (92.8%) was the most common complication. The correlation of the CCI^® with postoperative outcomes was stronger than the CDC: ICU stay (ρ = 0.786 vs. 0.401, p < 0.001), LOS (ρ = 0.465 vs. 0.342, p = 0.002), and hospitalization cost (ρ = 0.602 vs. 0.354, p < 0.001). Conclusions: Both the CCI^® and CDC are valid tools for evaluating postoperative outcomes, while the CCI^® has superior discriminative ability for evaluation ICU stay duration, LOS, and hospitalization cost in adult cardiac surgery patients. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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12 pages, 368 KB

Open AccessArticle

Sex-Based Comparative Analysis of Outcomes Following Minimally Invasive Direct Coronary Artery Bypass: A 20-Year Study

by Maria Comanici, Abu A. Farmidi, Fabio De Robertis, Nandor Marczin, Sunil K. Bhudia, Toufan Bahrami and Shahzad G. Raja

J. Cardiovasc. Dev. Dis. 2025, 12(12), 460; https://doi.org/10.3390/jcdd12120460 - 27 Nov 2025

Abstract

Background: Despite the increasing adoption of minimally invasive direct coronary artery bypass (MIDCAB), data on its long-term outcomes—particularly regarding sex-based differences—remain limited. This study presents a robust 20-year analysis comparing males and females, assessing perioperative outcomes, long-term survival, and independent predictors of mortality [...] Read more.

Background: Despite the increasing adoption of minimally invasive direct coronary artery bypass (MIDCAB), data on its long-term outcomes—particularly regarding sex-based differences—remain limited. This study presents a robust 20-year analysis comparing males and females, assessing perioperative outcomes, long-term survival, and independent predictors of mortality to inform sex-sensitive clinical decision-making. Methods: A retrospective cohort analysis of 676 patients (138 females, 538 males) undergoing MIDCAB was performed. Propensity score matching (PSM) generated balanced female and male cohorts (n = 129 each). Preoperative demographics, short-term outcomes, and long-term survival were assessed using Kaplan–Meier analysis and Cox regression modelling. Results: In unmatched cohorts, females exhibited significantly lower NYHA class distribution (p = 0.011) and higher atrial fibrillation prevalence (p = 0.038), with otherwise comparable comorbidities. Propensity score matching achieved cohort balance, and short-term outcomes—including 30-day mortality, stroke/TIA, and reoperation—were similar across sexes. Kaplan–Meier analysis of matched cohorts revealed no significant survival difference (log-rank p = 0.3370), though females demonstrated greater 20-year survival than males (77.6% versus 55.8%). In females, age 70–79 (HR 2.66; 95% CI: 1.02–6.95; p = 0.046) and cerebrovascular disease (HR 5.33; 95% CI: 1.49–19.03; p = 0.010) were independently associated with mortality. In males, significant predictors included diabetes (HR 1.86; 95% CI: 1.02–3.38; p = 0.042), chronic kidney disease (HR 4.92; 95% CI: 1.21–20.02; p = 0.026), pulmonary disease (HR 2.35; 95% CI: 1.20–4.60; p = 0.013), cerebrovascular disease (HR 4.77; 95% CI: 1.97–11.56; p < 0.001), and reduced left ventricular ejection fraction (HR 0.17; 95% CI: 0.06–0.43; p < 0.001). Conclusions: This 20-year study, the longest to date, demonstrates that MIDCAB achieves durable and equivalent long-term survival in males and females. It highlights sex-specific predictors of mortality, emphasizing the necessity for personalized preoperative risk assessment and postoperative management. Full article

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

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10 pages, 406 KB

Open AccessArticle

Clinical Outcomes and Treatment Strategies in Catastrophic High-Risk Pulmonary Embolism: A Retrospective Analysis

by María Caridad Mata, Ignacio Español, Arantxa Gelabert, Jesús Aibar, Núria Albacar, Elena Sandoval, Pedro Castro, Sònia Jiménez, Jeisson Osorio and Jorge Moisés

J. Cardiovasc. Dev. Dis. 2025, 12(12), 459; https://doi.org/10.3390/jcdd12120459 - 25 Nov 2025

Abstract

High-risk pulmonary embolism (PE) is a life-threatening condition characterized by hemodynamic instability, often leading to catastrophic outcomes such as cardiac arrest and cardiogenic shock. We conducted a retrospective analysis of patients diagnosed with high-risk PE at a single tertiary center between 2018 and [...] Read more.

High-risk pulmonary embolism (PE) is a life-threatening condition characterized by hemodynamic instability, often leading to catastrophic outcomes such as cardiac arrest and cardiogenic shock. We conducted a retrospective analysis of patients diagnosed with high-risk PE at a single tertiary center between 2018 and 2024. Catastrophic PE was defined as high-risk PE with hemodynamic collapse, including cardiac arrest and/or the requirement for high-dose vasopressors. Data on clinical characteristics, treatments, and outcomes were analyzed. Catastrophic PE accounted for 59% of cases. Systemic thrombolysis was the most frequent reperfusion strategy (67%), while catheter-directed therapies (35.4%) and VA-ECMO (11.4%) were used selectively. Despite aggressive management, catastrophic PE exhibited significantly higher mortality rates at 7 days (40%) and 30 days (49%) compared to non-catastrophic cases (9% and 12.5%, respectively). These patients also showed higher rates of multiorgan failure and required more invasive support. This study underscores the importance of early recognition and tailored treatment strategies for catastrophic PE, highlighting its distinct clinical presentation and worse outcomes compared to non-catastrophic high-risk PE. Further research is essential to refine treatment protocols and improve survival in this critically ill population, emphasizing the utility of a standardized classification to enhance clinical management and research consistency. Full article

(This article belongs to the Special Issue Venous Thromboembolism (VTE): Risk, Prevention and Management)

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16 pages, 3502 KB

Open AccessSystematic Review

Effects of Exercise on Flow-Mediated Dilation in Patients with Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Yongjie Chen, Bing Han, Yifan Zhang, Boya Gu, Yuanyuan Lv and Laikang Yu

J. Cardiovasc. Dev. Dis. 2025, 12(12), 458; https://doi.org/10.3390/jcdd12120458 - 25 Nov 2025

Abstract

This study aimed to evaluate the effects of exercise on vascular flow-mediated dilation (FMD) in patients with heart failure (HF) and to identify the optimal exercise model for this population. A comprehensive search was conducted in the Web of Science, Scopus, PubMed, Embase, [...] Read more.

This study aimed to evaluate the effects of exercise on vascular flow-mediated dilation (FMD) in patients with heart failure (HF) and to identify the optimal exercise model for this population. A comprehensive search was conducted in the Web of Science, Scopus, PubMed, Embase, and Cochrane databases, including data published up to 18 August 2025. A meta-analysis was conducted to calculate standardized mean difference (SMD) and 95% confidence interval. Eleven studies met the inclusion criteria, comprising 224 participants in the intervention groups and 185 participants in the control groups. The results demonstrated that exercise significantly improved FMD (SMD = 1.14, p < 0.0001). Subgroup analysis showed that aerobic exercise (SMD = 1.25, p < 0.0001), intervention period ≤ 8 weeks (SMD = 2.19, p < 0.00001) Intervention frequency > 3 times per week (SMD = 2.82, p < 0.00001) and each intervention duration < 60 min (SMD = 1.22, p = 0.01) were the most effective in improving FMD in patients with HF. This meta-analysis indicates that aerobic exercise performed more than three times per week, for sessions under 60 min and over an intervention period of up to 8 weeks, is associated with meaningful improvements in FMD in HF patients. These findings offer clear and actionable guidance for clinicians when prescribing exercise to support vascular health in this population. Full article

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

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8 pages, 2454 KB

Open AccessCase Report

Angioplasty in Patients with Central Venous Occlusion Prior to Device Lead Implantation

by Athanasios Frydas, Felix-Lucas Baehr, Henryk Dreger, Leif-Hendrik Boldt, Abdul Shokor Parwani, Gerhard Hindricks, Bernhard Gebauer, Ingo Hilgendorf and Florian Blaschke

J. Cardiovasc. Dev. Dis. 2025, 12(12), 457; https://doi.org/10.3390/jcdd12120457 - 25 Nov 2025

Abstract

Venous stenosis or occlusion often hinders transvenous cardiac device lead implantation, especially in patients with prior devices or long-term venous access. Surgical alternatives and femoral routes carry higher risk. We retrospectively evaluated percutaneous transluminal angioplasty (PTA) in 11 patients with significant venous obstruction. [...] Read more.

Venous stenosis or occlusion often hinders transvenous cardiac device lead implantation, especially in patients with prior devices or long-term venous access. Surgical alternatives and femoral routes carry higher risk. We retrospectively evaluated percutaneous transluminal angioplasty (PTA) in 11 patients with significant venous obstruction. Recanalization was successful in 10/11 cases (91%). Eight leads were implanted immediately, two delayed, with one re-occlusion linked to delay. No peri-procedural complications occurred. Technical success was defined as successful lead implantation through the recanalized vein; clinical success was defined as absence of subclavian venous syndrome (no arm pain or swelling) during follow-up. During follow-up, no symptomatic re-occlusion was observed. PTA appears safe and effective, with same-session lead implantation minimizing re-occlusion risk, offering a valuable alternative when conventional venous access is not feasible. Full article

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9 pages, 652 KB

Open AccessArticle

Initial Outcomes from a Minimally Invasive Cardiac Surgery—Off-Pump Coronary Artery Bypass Grafting (MICS-OPCAB) Programme: A Case Series of the First 50 Patients Single-Centre Experience

by Omar AlMawajdeh, Bilal H. Kirmani, Haytham Sabry and Andrew D. Muir

J. Cardiovasc. Dev. Dis. 2025, 12(12), 456; https://doi.org/10.3390/jcdd12120456 - 25 Nov 2025

Abstract

Background: Minimally invasive off-pump coronary artery bypass grafting (MICS-OPCAB) offers potential advantages over conventional sternotomy, including reduced trauma and faster recovery. This study evaluates the safety and feasibility of MICS-OPCAB at our centre. Methods: We retrospectively analysed 50 consecutive MICS-OPCAB procedures performed via [...] Read more.

Background: Minimally invasive off-pump coronary artery bypass grafting (MICS-OPCAB) offers potential advantages over conventional sternotomy, including reduced trauma and faster recovery. This study evaluates the safety and feasibility of MICS-OPCAB at our centre. Methods: We retrospectively analysed 50 consecutive MICS-OPCAB procedures performed via left anterior thoracotomy at our institution between January 2023 and June 2025. Data collected included patient demographics, operative details, and postoperative outcomes. Endpoints were 30-day mortality, conversion to sternotomy, and postoperative complications. Results: The cohort included 41 males (82%) with a mean age of 63.1 ± 8.7 years (range 40–80) and mean BMI 27.8 ± 4.3 kg/m². Comorbidities included diabetes mellitus in 26%, COPD in 12%, and chronic kidney disease in 8%. Canadian Cardiovascular Society angina classes III–IV were present in 46%. The majority of patients (64%) had single-vessel CAD while 34% had two-vessel and 2% had three-vessel involvement. The mean Logistic EuroSCORE I was 2.19 ± 1.53. Left internal mammary artery (LIMA) grafting was performed in 96% of cases. Additional conduits included left radial artery in 32% and saphenous vein in 8%, with T-grafts in 26% and sequential grafting in 4%. The average number of grafts per patient was 1.35 ± 0.53 (range 1–3). The procedure was performed off-pump in 96% of cases, with two patients (4%) requiring CPB support during conversion from mini-thoracotomy. The overall conversion rate to sternotomy was 16% (eight patients), predominantly due to difficult or injurious IMA harvest or anatomical limitations. The mean operative time was 197.8 ± 76.8 min and decreased significantly after the first 25 cases (220 min vs. 175 min). Atrial fibrillation occurred in 18%, pleural effusion in 28% (10% requiring drainage), and chest infection in 8%. Wound complications arose in 4%. There was no 30-day mortality. ICU stay averaged 2 ± 2.2 days (range 1–14), and total hospital stay was 5.7 ± 2.7 days where institutional coronary bypass stay is normally 7.9 +/− 7.0 days. Conclusion: These results demonstrate that MICS-OPCAB is a safe and feasible approach for selected patients requiring multivessel coronary artery bypass grafting. There are some technical challenges during the learning curve for which conversion to open surgery can confer good outcomes. Traversing the early learning curve can confer additional benefits to later patients. Full article

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

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12 pages, 3260 KB

Open AccessReview

Transcatheter Edge-to-Edge Mitral Valve Repair for Severe Regurgitation in Cardiogenic Shock: A Comprehensive Review

by Medha Biswas, William Edward Katz, Matthew Suffoletto, Zachary Rhinehart, Anson Conrad Smith, Jeffrey Fowler and Leyla Elif Sade

J. Cardiovasc. Dev. Dis. 2025, 12(12), 455; https://doi.org/10.3390/jcdd12120455 - 24 Nov 2025

Abstract

Cardiogenic shock is a critical pathological state marked by end-organ hypoperfusion due to severe cardiac dysfunction and is associated with high mortality. A substantial portion of patients with cardiogenic shock have concomitant severe mitral regurgitation (MR), which exacerbates hemodynamic instability by reducing forward [...] Read more.

Cardiogenic shock is a critical pathological state marked by end-organ hypoperfusion due to severe cardiac dysfunction and is associated with high mortality. A substantial portion of patients with cardiogenic shock have concomitant severe mitral regurgitation (MR), which exacerbates hemodynamic instability by reducing forward cardiac output and contributes to pulmonary edema and respiratory failure through regurgitant backflow. In this high-risk setting, mitral transcatheter edge-to-edge repair (M-TEER) offers a minimally invasive treatment that can lead to hemodynamic and symptomatic improvement and potential mortality benefit. Initially indicated for patients with severe MR at prohibitive surgical risk, M-TEER is now guideline-supported for both primary and secondary MR in select populations. Emerging data suggest that M-TEER can reduce heart failure hospitalizations and improve patient quality of life. As clinical indications for M-TEER continue to expand, there is growing interest in the role of M-TEER as a stabilizing intervention in patients with cardiogenic shock and severe MR. This review aims to synthesize the current evidence surrounding the use of M-TEER in cardiogenic shock with a focus on patient selection, procedural and clinical considerations, and short- and long-term outcomes. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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16 pages, 942 KB

Open AccessArticle

Enhanced Risk Prediction for Coronary Heart Disease by Leveraging Polygenic Risk Score and Clinical Risk Score in European Hypertensive Adults

by Siyuan Shen, Yuquan Wang and Yue-Qing Hu

J. Cardiovasc. Dev. Dis. 2025, 12(12), 454; https://doi.org/10.3390/jcdd12120454 - 24 Nov 2025

Abstract

Background: Coronary heart disease (CHD) is the leading cause of premature mortality. The incremental value of a polygenic risk score (PRS) to a clinical risk score towards improving CHD prediction is controversial. Meanwhile, the effect of PRSs on CHD prediction in the chronic [...] Read more.

Background: Coronary heart disease (CHD) is the leading cause of premature mortality. The incremental value of a polygenic risk score (PRS) to a clinical risk score towards improving CHD prediction is controversial. Meanwhile, the effect of PRSs on CHD prediction in the chronic disease population is unclear. Methods: Utilizing publicly available summary statistical data, we developed several PRSs using the genome data of European ancestry from the Atherosclerosis Risk in Communities Study. Furthermore, we investigated the association of CHD with the best-performing PRS in both the overall and chronic disease cohorts. Additionally, we evaluated whether adding the best-performing PRS to the clinical risk score improves risk prediction. Results: A total of 6152 subjects (767 CHD cases) were included in this study. The high values from the developed best-performing PRS were significantly associated with an increased risk of CHD, with a stronger association in the hypertensive population (interaction p = 0.0144). Compared with individuals in the bottom 20% of the PRS values, those in the top 20% were more than 3-fold more likely to develop CHD in the overall cohort, rising to 5-fold in the hypertensive cohort. Adding PRS to the clinical risk score significantly improved the C-index (0.72 to 0.74; p = 0.004), with a 10% net reclassification improvement overall. The hypertensive population showed the greatest improvements. Furthermore, we observed a significant gradient of 10-year and lifetime risk of CHD based on the PRS within each clinical risk category. Conclusions: Compared to the clinical risk score, integrating the PRS significantly improved CHD prediction and better identified CHD risk trajectories, especially in the European hypertensive adult population. Full article

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15 pages, 1403 KB

Open AccessArticle

Impact of Atrial Fibrillation Type on Quality of Life and Clinical Parameters in Patients with Diabetes Mellitus

by Paul Gabriel Ciubotaru, Nilima Rajpal Kundnani, Lucretia Marin-Bancila, Daniel-Dumitru Nisulescu, Nicolae Albulescu, Abhinav Sharma, Vlad-Sabin Ivan, Roxana Buzas, Veronica Ciocan and Daniel Florin Lighezan

J. Cardiovasc. Dev. Dis. 2025, 12(12), 453; https://doi.org/10.3390/jcdd12120453 - 21 Nov 2025

Abstract

Background: Atrial fibrillation (AF) is a prevalent condition with a major influence on patients’ quality of life, especially when blood glucose and heart rate are disrupted and systemic inflammation is present. Objective: This study aimed to compare Kansas City Cardiomyopathy Questionnaire (KCCQ) scores [...] Read more.

Background: Atrial fibrillation (AF) is a prevalent condition with a major influence on patients’ quality of life, especially when blood glucose and heart rate are disrupted and systemic inflammation is present. Objective: This study aimed to compare Kansas City Cardiomyopathy Questionnaire (KCCQ) scores of diabetic patients by AF type and their correlations with different clinical and biological parameters. Material and methods: The retrospective study included 220 patients, from which only 200 were selected because of missing data. Patients were divided into three groups: paroxysmal AF (n = 49), persistent AF (n = 54), and permanent AF (n = 97). Demographic, clinical, and analytical data, echocardiographic parameters, heart rate, blood glucose, renal function, and inflammatory markers were compared between the three groups and their relationship with KCCQ scores. Results: The KCCQ score was significantly higher in patients with paroxysmal AF (69.50 ± 5.93), compared to persistent AF (56.92 ± 3.04) and permanent AF (42.28 ± 5.89), p < 0.001. In subanalyses, based on left ventricular ejection fraction (LVEF), the same trend was maintained, with lower KCCQ scores associated with more severe forms of AF. Significant negative correlations of the KCCQ score with blood glucose level (r = −0.2535, p = 0.0003), heart rate (r = −0.3071, p < 0.0001), and neutrophil–lymphocyte ratio (NLR) (r = −0.2395, p = 0.0006), and a positive correlation with glomerular filtration rate (GFR) (r = 0.4349, p < 0.0001) were identified. Conclusions: The type of atrial fibrillation significantly influences the quality of life assessed by the KCCQ score. Clinical and analytical parameters such as blood glucose, heart rate, systemic inflammation, and renal function significantly correlate with patients’ perception of health, indicating the importance of integrated management of AF. Full article

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Journal of Cardiovascular Development and Disease

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