Journal of Cardiovascular Development and Disease

9 pages, 838 KiB

Open AccessEditor’s ChoiceArticle

Gender Differences for His Bundle Pacing Long-Term Performance in the Elderly Population

by Catalin Pestrea, Ecaterina Cicala, Dragos Lovin, Adrian Gheorghe, Florin Ortan and Rosana Manea

J. Cardiovasc. Dev. Dis. 2025, 12(3), 88; https://doi.org/10.3390/jcdd12030088 - 26 Feb 2025

Viewed by 438

Abstract

Background and aims: His bundle pacing (HBP) is considered the most physiological form of cardiac pacing. Although feasibility studies have included older patients, specific data for HBP in this population are scarce. This study aimed to evaluate gender differences in HBP long-term performance [...] Read more.

Background and aims: His bundle pacing (HBP) is considered the most physiological form of cardiac pacing. Although feasibility studies have included older patients, specific data for HBP in this population are scarce. This study aimed to evaluate gender differences in HBP long-term performance in elderly patients with atrioventricular (AV) block. Methods: This retrospective study included 73 patients aged over 65 years with successful HBP and at least 2 years of follow-up. The patients’ baseline and follow-up clinical and procedural characteristics were recorded. Results: The mean age of the cohort was 72.8 ± 6.3 years, with 43 males and 30 females. The paced QRS complex was significantly narrower than the baseline value for both genders. Females had a narrower-paced QRS complex without differences in detection, type of His bundle capture, impedance, or fluoroscopy time. The pacing threshold increased progressively, reaching statistical significance compared to the baseline values at the two-year follow-up. The pacing threshold increased by more than 1 V over the follow-up period in twenty-four patients (32.9%) and by more than 2 V in six patients (8.2%), with no significant difference between genders. The pacing threshold increase occurred within the first year for most patients, without gender differences. Multivariate Cox regression analysis demonstrated that the paced QRS duration, left ventricular ejection fraction, and ischemic cardiomyopathy were significantly associated with the pacing threshold increase over time. Conclusion: In elderly patients with AV block, HBP remains a feasible pacing method, without significant gender differences, over a long-term follow-up period. Pacing threshold increases are expected in up to one-third of the patients, requiring regular follow-ups to adjust the programmed parameters and optimize battery longevity. Full article

(This article belongs to the Special Issue Cardiac Device Therapy: 2nd Edition)

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13 pages, 6590 KiB

Open AccessEditor’s ChoiceReview

Not All SAVR Are Created Equal: All the Approaches Available for Surgical Aortic Valve Replacement

by Francesco Cabrucci, Serge Sicouri, Massimo Baudo, Dimitrios E. Magouliotis, Yoshiyuki Yamashita, Beatrice Bacchi, Dario Petrone, Beman Wasef, Aleksander Dokollari, Massimo Bonacchi and Basel Ramlawi

J. Cardiovasc. Dev. Dis. 2025, 12(3), 84; https://doi.org/10.3390/jcdd12030084 - 24 Feb 2025

Viewed by 1345

Abstract

Surgical Aortic Valve Replacement (SAVR) is still one of the pillars of cardiac surgery practice, and its role is evolving into a more complex operation. The competition with structural valve therapies and the urgent demand for less invasive solutions have unleashed surgeons’ creativity [...] Read more.

Surgical Aortic Valve Replacement (SAVR) is still one of the pillars of cardiac surgery practice, and its role is evolving into a more complex operation. The competition with structural valve therapies and the urgent demand for less invasive solutions have unleashed surgeons’ creativity in adapting to these new challenges. All the possible ways to surgically replace the aortic valve are analyzed in this review. Surgical techniques, advantages and disadvantages, and key differences are listed, helping surgeons navigate the available options. Sternotomy SAVR is the benchmark, but that is becoming obsolete and, in some cases, no longer performed for teaching purposes. Mini sternotomy is the easiest way to achieve minimal invasiveness in all anatomic situations, while right anterior thoracotomy is an elegant solution mastered by fewer surgeons. Endoscopic and robotic-assisted techniques are shaping the future of SAVR, yet they still lack wide adoption. The choice of approach is mainly dictated by the anatomic features of the patient and the surgeon’s skills. A flow diagram to overcome the learning curve and advance toward more complex surgery is provided here. Mastering as many techniques as possible is paramount when offering a patient-tailored approach and performing a safe and less invasive operation. Full article

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

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11 pages, 473 KiB

Open AccessEditor’s ChoiceArticle

Determinants of Longitudinal Changes in Exercise Blood Pressure in a Population of Young Athletes: The Role of BMI

by Francesca Battista, Marco Vecchiato, Kiril Chernis, Sara Faggian, Federica Duregon, Nicola Borasio, Sara Ortolan, Giacomo Pucci, Andrea Ermolao and Daniel Neunhaeuserer

J. Cardiovasc. Dev. Dis. 2025, 12(2), 74; https://doi.org/10.3390/jcdd12020074 - 15 Feb 2025

Viewed by 633

Abstract

AIM: Higher exercise blood pressure in adults correlates with many cardiometabolic markers. The aim of this study was to investigate the main determinants of longitudinal variations in exercise blood pressure in young athletes. METHODS: A longitudinal retrospective study was conducted on adolescent athletes [...] Read more.

AIM: Higher exercise blood pressure in adults correlates with many cardiometabolic markers. The aim of this study was to investigate the main determinants of longitudinal variations in exercise blood pressure in young athletes. METHODS: A longitudinal retrospective study was conducted on adolescent athletes who underwent at least two sport-related pre-participation screening visits, including exercise testing with a standardized incremental ramp protocol on treadmill. Blood pressure was assessed at rest (SBP_rest), at the 3rd minute of exercise (SBP_3min), and at peak exercise (SBP_peak). Predictors of blood pressure response (i.e., respective changes vs. baseline (Δ)) were determined by multivariate regression models after adjustment for age, sex, follow-up duration, related baseline SBP values, characteristics of sport, and ΔBMI. RESULTS: A total of 351 young athletes (mean age at baseline 13 ± 2 years, 54% boys, average follow-up duration 3.4 ± 2.2 years) were enrolled. BMI increased by 1.5 ± 1.8 kg/m² (p < 0.001) during follow-up. At baseline, mean SBP_rest was 103 ± 14 mmHg, mean SBP_3min 124 ± 18 mmHg, and mean SBPpeak 154 ± 23 mmHg. A significant between-visit increase in SBP_rest (ΔSBP_rest 7.0 ± 17.4 mmHg; p < 0.001), ΔSBP_3min (4.8 ± 11 mmHg, p < 0.001), and ΔSBP_peak (11.7 ± 24 mmHg, p < 0.001) was observed. ΔSBP_3min was significantly predicted by male sex (p < 0.01), baseline BMI (p < 0.01), ΔBMI (p < 0.01), and number of practiced sports (p < 0.05), whereas ΔSBP_peak was positively predicted by male gender (p < 0.01), baseline BMI (p < 0.05), and ΔBMI (p < 0.01) and negatively by baseline resting heart rate (p < 0.01). In a logistic regression model, ΔBMI was the only independent determinant of passing from a lower to an upper quartile of SBP_3min (p < 0.001), while ΔBMI and male sex were independent determinants of moving to a higher quartile of SBP_peak (p < 0.001). CONCLUSIONS: Increase in BMI during development and male sex are independent determinants of the increase in exercise blood pressure, both at light and maximal intensity, in a population of adolescent athletes. Full article

(This article belongs to the Special Issue Exercise Testing and Interventions in Cardiovascular Disease)

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11 pages, 1677 KiB

Open AccessEditor’s ChoiceArticle

Prothrombotic States in Transcatheter Heart Valve Leaflet Thrombosis (PROSTHESIS): Rationale and Early Results of the Observational Cohort Study

by Kajetan Grodecki, Katarzyna Pawlak, Matylda Grodecka, Bartosz Rymuza, Piotr Scislo, Olga Ciepiela, Janusz Kochman and Zenon Huczek

J. Cardiovasc. Dev. Dis. 2025, 12(2), 62; https://doi.org/10.3390/jcdd12020062 - 6 Feb 2025

Viewed by 736

Abstract

Subclinical leaflet thrombosis is an imaging phenomenon observed after transcatheter aortic valve implantation (TAVI) and characterized by hypoattenuating leaflet thickening (HALT) on computed tomography angiography. The clinical implications and underlying causes remain uncertain. Hypercoagulability, a component of Virchow’s triad, may contribute to thrombus [...] Read more.

Subclinical leaflet thrombosis is an imaging phenomenon observed after transcatheter aortic valve implantation (TAVI) and characterized by hypoattenuating leaflet thickening (HALT) on computed tomography angiography. The clinical implications and underlying causes remain uncertain. Hypercoagulability, a component of Virchow’s triad, may contribute to thrombus formation on bioprosthetic leaflets, but data on hypercoagulable disorders in TAVI patients and their impact on HALT are limited. The PROSTHESIS study (Prothrombotic States in Transcatheter Heart Valve Subclinical Leaflet Thrombosis) is a single-center observational cohort study aiming to include 130 TAVI patients. This pilot study aimed to (i) assess the effect of hypercoagulable disorders on HALT prevalence and (ii) evaluate their impact on the natural history of HALT. Patients were screened for common hypercoagulable disorders using genetic and functional assays and underwent multimodal imaging one year after TAVI to detect HALT. In patients with HALT, post-implant imaging was repeated after three months to assess its progression. Early results comparing 52 TAVI patients with 52 matched controls undergoing coronary angiography showed similar thrombophilia prevalence between the groups (16% vs. 12%, p = 0.565). HALT occurred in 15% of TAVI patients, more extensively in those with thrombophilia (712 mm³ vs. 135 mm³, p = 0.036). However, thrombophilia was not an independent predictor of HALT. One-year follow-up CTA revealed spontaneous HALT resolution in 63%, stability in 25%, and progression in 12%. This study aims to provide insights into HALT and its mechanisms, which may help prevent complications and improve bioprosthesis durability. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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13 pages, 2282 KiB

Open AccessEditor’s ChoiceArticle

Clinical Decision Support for Patient Cases with Asymptomatic Carotid Artery Stenosis Using AI Models and Electronic Medical Records

by Mackenzie Madison, Xiao Luo, Jackson Silvey, Robert Brenner, Kartik Gannamaneni and Alan P. Sawchuk

J. Cardiovasc. Dev. Dis. 2025, 12(2), 61; https://doi.org/10.3390/jcdd12020061 - 6 Feb 2025

Viewed by 1656

Abstract

An artificial intelligence (AI) analysis of electronic medical records (EMRs) was performed to analyze the differences between patients with carotid stenosis who developed symptomatic disease and those who remained asymptomatic. The EMRs of 872 patients who underwent a carotid endarterectomy between 2009 and [...] Read more.

An artificial intelligence (AI) analysis of electronic medical records (EMRs) was performed to analyze the differences between patients with carotid stenosis who developed symptomatic disease and those who remained asymptomatic. The EMRs of 872 patients who underwent a carotid endarterectomy between 2009 and 2022 were analyzed with AI. This included 408 patients who had carotid intervention for symptomatic carotid disease and 464 patients for asymptomatic, >70% stenosis. By analyzing the EMRs, the Support Vector Machine achieved the highest sensitivity at 0.626 for predicting which of these patients would go on to develop a stroke or TIA. Random Forest had the highest specificity at 0.906. The risk for stroke in patients with carotid stenosis was a balance between optimum medical treatment and the underlying disease processes. Risk factors for developing symptomatic carotid disease included elevated glucose, chronic kidney disease, hyperlipidemia, and current or recent smoking, while protective factors included cardiovascular agents, antihypertensives, and beta blockers. An AI review of EMRs can help determine which patients with carotid stenosis are more likely to develop a stroke to assist with decision making as to whether to proceed with intervention or to demonstrate and encourage reduced stroke risk with risk factor modification. Full article

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

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18 pages, 3350 KiB

Open AccessEditor’s ChoiceReview

Beyond the Lumen: Molecular Imaging to Unmask Vulnerable Coronary Plaques

by Geoffrey Currie and Hosen Kiat

J. Cardiovasc. Dev. Dis. 2025, 12(2), 51; https://doi.org/10.3390/jcdd12020051 - 30 Jan 2025

Viewed by 1379

Abstract

Vulnerable coronary atherosclerotic plaque involves a dynamic pathophysiologic process within and surrounding an atheromatous plaque in coronary artery intima. The process drastically increases the risk of plaque rupture and is clinically responsible for most cases of acute coronary syndromes, myocardial infarctions, and sudden [...] Read more.

Vulnerable coronary atherosclerotic plaque involves a dynamic pathophysiologic process within and surrounding an atheromatous plaque in coronary artery intima. The process drastically increases the risk of plaque rupture and is clinically responsible for most cases of acute coronary syndromes, myocardial infarctions, and sudden cardiac deaths. Early detection of vulnerable plaque is crucial for clinicians to implement appropriate risk-mitigation treatment strategies, offer timely interventions, and prevent potentially life-threatening events. There is an imperative clinical need to develop practical diagnostic pathways that utilize non-invasive means to risk-stratify symptomatic patients. Since the early 1990s, the identification of vulnerable plaque in clinical practice has primarily relied on invasive imaging techniques. In the last two decades, CT coronary angiogram (CTCA) has rapidly evolved into the prevalent non-invasive diagnostic modality for assessing coronary anatomy. There are now validated plaque appearances on CTCA correlating with plaque vulnerability. It is worth noting that in clinical practice, most CTCA reports omit mention of vulnerable plaque details because spatial resolution (0.3–0.5 mm) is often insufficient to reliably detect some crucial features of vulnerable plaques, such as thin fibrous caps. Additionally, accurately identifying vulnerable plaque features requires substantial expertise and time, which many cardiologists or radiologists may lack in routine reporting. Cardiac magnetic resonance imaging (cMRI) is also non-invasive and allows simultaneous anatomic and functional assessment of coronary plaques. Despite several decades of research and development, routine clinical application of cMRI in coronary plaque imaging remains hampered by complex imaging protocols, inconsistent image quality, and cost. Molecular imaging with radiotracers, specifically positron emission tomography (PET) with sodium fluoride (Na¹⁸F PET), have demonstrated significant potential as a sensitive and specific imaging procedure for diagnosing vulnerable coronary artery plaque. The study protocol is robust and brief, requiring minimal patient preparation. Compared to CTCA and cMRI, the diagnostic accuracy of this test is less dependent on the experience and expertise of the readers. Furthermore, validated automated quantitative algorithms complement the visual interpretation of the study, enhancing confidence in the diagnosis. This combination of factors makes Na¹⁸F PET a promising tool in cardiology for identifying high-risk coronary plaques. Full article

(This article belongs to the Special Issue Current Practice in Cardiac Imaging)

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14 pages, 1506 KiB

Open AccessEditor’s ChoiceReview

Mitochondrial Dysfunction in Congenital Heart Disease

by Julie Pires Da Silva, Mariana Casa de Vito, Carissa Miyano and Carmen C. Sucharov

J. Cardiovasc. Dev. Dis. 2025, 12(2), 42; https://doi.org/10.3390/jcdd12020042 - 25 Jan 2025

Cited by 1 | Viewed by 1211

Abstract

Mitochondria play a crucial role in multiple cellular processes such as energy metabolism, generation of reactive oxygen species, excitation–contraction coupling, cell survival and death. Dysfunction of mitochondria contributes to the development of cancer; neuromuscular, cardiovascular/congenital heart disease; and metabolic diseases, including diabetes. Mitochondrial [...] Read more.

Mitochondria play a crucial role in multiple cellular processes such as energy metabolism, generation of reactive oxygen species, excitation–contraction coupling, cell survival and death. Dysfunction of mitochondria contributes to the development of cancer; neuromuscular, cardiovascular/congenital heart disease; and metabolic diseases, including diabetes. Mitochondrial dysfunction can result in excessive reactive oxygen species, a decrease in energy production, mitophagy and apoptosis. All these processes are known to be dysregulated in cardiovascular diseases. The focus of this review is to summarize our current knowledge of mitochondrial dysfunction, including mitophagy and apoptosis, in pediatric congenital heart disease due to maternal diabetes or due to structural cardiac defects, with a focus on single-ventricle congenital heart disease. We also discuss recent mitochondria-targeted therapies for cardiovascular diseases. Full article

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

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13 pages, 1177 KiB

Open AccessEditor’s ChoiceArticle

High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study

by Thomas Rueskov Andersen, Katrine Schultz Overgaard, Laurits Juhl Heinsen, Roda Abdulkadir Mohamed, Freja Sønder Madsen, Helle Precht, Jess Lambrechtsen, Søren Auscher and Kenneth Egstrup

J. Cardiovasc. Dev. Dis. 2025, 12(2), 37; https://doi.org/10.3390/jcdd12020037 - 22 Jan 2025

Viewed by 829

Abstract

Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with [...] Read more.

Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with IGT and normal glucose tolerance (NGT) in patients suspected for stable CAD. Coronary computed tomography angiography (CCTA) identified LAP lesions and assessed plaque volumes, burdens, and high-risk plaque features. Glycemic tolerance was stratified using oral glucose tolerance tests. Among 148 patients, 202 LAP lesions were identified, with 93 patients classified as NGT and 55 as IGT. Patients with IGT had a significantly higher prevalence of LAP lesions compared with NGT (p = 0.007). LAP volume was higher in IGT (16.46 ± 12.52 mm³) compared with NGT (12.66 ± 9.72 mm³, p = 0.01), but this association did not persist in multivariate analysis. The LAP burden was greater in IGT (10.79 ± 6.84%) than NGT (8.62 ± 5.93%, p = 0.02), and the napkin-ring sign was more frequent in IGT (12%) versus NGT (5%, p = 0.02); these associations remained significant in multivariate analysis. Patients with IGT had a higher LAP burden and higher frequency of napkin-ring signs. These findings may help explain the common occurrence of prediabetes in patients with acute myocardial infarction. Full article

(This article belongs to the Special Issue Coronary Artery Disease: Risk Stratification and Optimization of Intervention Strategies)

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21 pages, 4995 KiB

Open AccessEditor’s ChoiceArticle

Ontogeny of Fetal Cardiometabolic Pathways: The Potential Role of Cortisol and Thyroid Hormones in Driving the Transition from Preterm to Near-Term Heart Development in Sheep

by Reza Amanollahi, Stacey L. Holman, Melanie R. Bertossa, Ashley S. Meakin, Kent L. Thornburg, I. Caroline McMillen, Michael D. Wiese, Mitchell C. Lock and Janna L. Morrison

J. Cardiovasc. Dev. Dis. 2025, 12(2), 36; https://doi.org/10.3390/jcdd12020036 - 21 Jan 2025

Cited by 1 | Viewed by 1351

Abstract

Understanding hormonal and molecular changes during the transition from preterm to near-term gestation is essential for investigating how pregnancy complications impact fetal heart development and contribute to long-term cardiovascular risks for offspring. This study examines these cardiac changes in fetal sheep, focusing on [...] Read more.

Understanding hormonal and molecular changes during the transition from preterm to near-term gestation is essential for investigating how pregnancy complications impact fetal heart development and contribute to long-term cardiovascular risks for offspring. This study examines these cardiac changes in fetal sheep, focusing on the changes between 116 days (preterm) and 140 days (near term) of gestation (dG, term = 150) using Western blotting, LC-MS/MS, and histological techniques. We observed a strong correlation between cortisol and T₃ (Triiodothyronine) in heart tissue in near-term fetuses, highlighting the role of glucocorticoid signalling in fetal heart maturation. Protein expression patterns in the heart revealed a decrease in multiple glucocorticoid receptor isoforms (GRα-A, GR-P, GR-A, GRα-D2, and GRα-D3), alongside a decrease in IGF-1R (a marker of cardiac proliferative capacity) and p-FOXO1(Thr24) but an increase in PCNA (a marker of DNA replication), indicating a shift towards cardiomyocyte maturation from preterm to near term. The increased expression of proteins regulating mitochondrial biogenesis and OXPHOS complex 4 reflects the known transition from glycolysis to oxidative phosphorylation, essential for meeting the energy demands of the postnatal heart. We also found altered glucose transporter expression, with increased pIRS-1(ser789) and GLUT-4 but decreased GLUT-1 expression, suggesting improved insulin responsiveness as the heart approaches term. Notably, the reduced protein abundance of SIRT-1 and SERCA2, along with increased phosphorylation of cardiac Troponin I(Ser23/24), indicates adaptations for more energy-efficient contraction in the near-term heart. In conclusion, these findings show the complex interplay of hormonal, metabolic, and growth changes that regulate fetal heart development, providing new insights into heart development that are crucial for understanding pathological conditions at birth and throughout life. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Cardiac Development and Regeneration' Section — from Development to Regeneration)

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13 pages, 822 KiB

Open AccessEditor’s ChoiceArticle

Coronary Artery Disease in Very Young Women: Risk Factors and Prognostic Insights from Extended Follow-Up

by Samuel Pintos-Rodríguez, Víctor Alfonso Jiménez Díaz, César Veiga, Carlos Martínez García, Francisco Caamaño Isorna, Andrés Íñiguez Romo and Pablo Juan-Salvadores

J. Cardiovasc. Dev. Dis. 2025, 12(2), 34; https://doi.org/10.3390/jcdd12020034 - 21 Jan 2025

Viewed by 1364

Abstract

Coronary artery disease (CAD) is usually associated with the elderly, but an increase in its incidence has been recently reported among young people, including very young women. The aim of this study is to assess the associations between different clinical variables and the [...] Read more.

Coronary artery disease (CAD) is usually associated with the elderly, but an increase in its incidence has been recently reported among young people, including very young women. The aim of this study is to assess the associations between different clinical variables and the risk of early CAD and occurrence of major adverse cardiovascular events (MACEs) during follow-up. Our cohort consists of women ≤40 years referred for coronary angiography due to suspicion of CAD; a nested case–control study was conducted among these patients. In total, 19,321 coronary angiographies were performed between 2006 and 2015, of which 2.6% were in patients ≤40 years old; 52 women were finally included. Family history of CAD was strongly associated with the early onset of the disease [OR 5.94, 95%CI (1.13–31.15); p = 0.035] in young women. The incidence of MACE was also associated with depression [HR 8.20 95%CI (1.03–65.17); p = 0.047] and Castelli Index [HR 11.49, 95%CI (1.40–94.51); p = 0.023]. Primary prevention focused on genetic analysis for high-risk women with a family history of CAD and secondary prevention, targeting a better cholesterol management and mental health assistance must be considered. Full article

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

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24 pages, 2004 KiB

Open AccessEditor’s ChoiceSystematic Review

The Effect of Xanthine Oxidase Inhibitors in the Prevention and Treatment of Stroke: A Systematic Review and Meta-Analysis

by Lin Bai, Gerhard Litscher and Xiaoning Li

J. Cardiovasc. Dev. Dis. 2024, 11(12), 409; https://doi.org/10.3390/jcdd11120409 - 21 Dec 2024

Cited by 1 | Viewed by 1220

Abstract

Background: Xanthine oxidase inhibitors (XOIs) may help prevent stroke. However, heterogeneity can be found in the conclusions of different studies. The relevant evidence was summarized in this systematic review and meta-analysis to further clarify the role of XOIs in the prevention and treatment [...] Read more.

Background: Xanthine oxidase inhibitors (XOIs) may help prevent stroke. However, heterogeneity can be found in the conclusions of different studies. The relevant evidence was summarized in this systematic review and meta-analysis to further clarify the role of XOIs in the prevention and treatment of stroke, with a focus on evaluating the effects of XOIs in primary and secondary prevention of stroke, acute stroke treatment, and reduction of post-stroke complications. Methods: Randomized controlled trials (RCTs) or cohort studies on the effect of XOIs in the prevention and treatment of stroke were searched in PubMed, EMBASE, and Cochrane Library from inception to 3 March 2024, along with hand searching. The analyses were carried out using Review Manager 5.4. Results: The analysis included 14 studies (115,579 patients). While XOIs did not significantly reduce the risk of stroke (RR: 0.89; 95% CI: 0.59–1.34), they improved post-stroke functional outcomes, with a reduction in the modified Rankin scale scores (mean difference: −0.6; 95% CI: −0.8 to −0.4), decreased intercellular adhesion molecule-1 levels (mean difference: −15.2 ng/mL; 95% CI: −22.3 to −8.1), improved augmentation index (AIx) by 4.2% (95% CI: 2.5–5.9%), reduced central blood pressure (mean reduction: 4.8 mmHg; 95% CI: 2.6–6.9), and delayed carotid intima-media thickness progression (mean difference: −0.05 mm/year; 95% CI: −0.08 to −0.02). Full article

(This article belongs to the Special Issue Feature Review Papers in Stroke and Cerebrovascular Disease)

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19 pages, 658 KiB

Open AccessEditor’s ChoiceReview

Drug-Induced Myocardial Infarction: A Review of Pharmacological Triggers and Pathophysiological Mechanisms

by Ioana Boarescu and Paul-Mihai Boarescu

J. Cardiovasc. Dev. Dis. 2024, 11(12), 406; https://doi.org/10.3390/jcdd11120406 - 18 Dec 2024

Cited by 2 | Viewed by 8157

Abstract

Myocardial infarction (MI) is a significant cardiovascular event caused by the decrease in or complete cessation of blood flow to a portion of the myocardium. It can arise from a variety of etiological factors, including pharmacological triggers. This review aims to explore the [...] Read more.

Myocardial infarction (MI) is a significant cardiovascular event caused by the decrease in or complete cessation of blood flow to a portion of the myocardium. It can arise from a variety of etiological factors, including pharmacological triggers. This review aims to explore the diverse drugs and substances that might lead to drug-induced myocardial infarction, focusing on their mechanisms of action and the pathophysiological processes involved. Various established and emerging pharmacological agents that could elevate the risk of myocardial infarction, such as nonsteroidal anti-inflammatory drugs, hormonal therapies, anticoagulants, and antipsychotic medications, are discussed. The role of drug-induced endothelial dysfunction, coronary artery spasm, and thrombosis are presented in order to highlight the underlying mechanisms. This review emphasizes the need for increased awareness among healthcare professionals to mitigate the risks associated with different pharmacological therapies to improve patient outcomes. Full article

(This article belongs to the Special Issue Food, Drugs and Environmental Exposures as Triggers of Myocardial Injury and Myocardial Infarction)

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9 pages, 280 KiB

Open AccessEditor’s ChoiceReview

Contemporary Review of Minimally Invasive Mitral Valve Surgery: Current Considerations and Innovations

by Sharifa Alsheebani, Daniel Goubran, Benoit de Varennes and Vincent Chan

J. Cardiovasc. Dev. Dis. 2024, 11(12), 404; https://doi.org/10.3390/jcdd11120404 - 14 Dec 2024

Cited by 1 | Viewed by 1047

Abstract

Minimally invasive mitral valve surgery (MIMVS) has become a well-established alternative to traditional median sternotomy at high-volume surgical centers. Advancements in surgical instruments have led to further refinement of MIMVS. However, MIMVS remains limited to select patients in select settings. In this review, [...] Read more.

Minimally invasive mitral valve surgery (MIMVS) has become a well-established alternative to traditional median sternotomy at high-volume surgical centers. Advancements in surgical instruments have led to further refinement of MIMVS. However, MIMVS remains limited to select patients in select settings. In this review, we provide a brief overview of the evolution of MIMVS, as well as a technical description of the most relevant aspects of minimally invasive mitral valve surgery. Full article

12 pages, 1522 KiB

Open AccessEditor’s ChoiceArticle

Unifocalization of Major Aortopulmonary Collateral Arteries (MAPCAs) and Native Pulmonary Arteries in Infancy—Application of 3D Printing and Virtual Reality

by Jacek Kolcz, Anna Rudek-Budzynska and Krzysztof Grandys

J. Cardiovasc. Dev. Dis. 2024, 11(12), 403; https://doi.org/10.3390/jcdd11120403 - 13 Dec 2024

Viewed by 1809

Abstract

Background. Major aortopulmonary collateral arteries (MAPCAs) are rare remnants of pulmonary circulation embryological development usually associated with complex congenital anomalies of the right ventricular outflow tract and pulmonary arteries. Effective management requires surgical unifocalization of MAPCAs and native pulmonary arteries (NPAs). Traditional imaging [...] Read more.

Background. Major aortopulmonary collateral arteries (MAPCAs) are rare remnants of pulmonary circulation embryological development usually associated with complex congenital anomalies of the right ventricular outflow tract and pulmonary arteries. Effective management requires surgical unifocalization of MAPCAs and native pulmonary arteries (NPAs). Traditional imaging may lack the spatial clarity needed for precise surgical planning. Aim. This study evaluated the feasibility of integrating three-dimensional (3D) printing and virtual reality (VR) into preoperative planning to improve surgical precision, team communication, and parental understanding. In a prospective cohort study, nine infants undergoing MAPCA unifocalization were included. Four patients underwent conventional imaging-based planning (control), while five were additionally assessed using VR and 3D-printed models (intervention). The outcomes measured included operative times, team confidence, collaboration, and parental satisfaction. Statistical analysis was performed using standard tests. Results. The intervention group had shorter operative and cardiopulmonary bypass times compared to the control group. Intraoperative complications were absent in the VR/3D group but occurred in the control group. Medical staff in the VR/3D group reported significantly improved understanding of anatomy, surgical preparedness, and team collaboration (p < 0.05). Parents also expressed higher satisfaction, with better comprehension of their child’s anatomy and surgical plan. Conclusions. VR and 3D printing enhanced preoperative planning, surgical precision, and communication, proving valuable for complex congenital heart surgery. These technologies offer promising potential to improve clinical outcomes and patient–family experiences, meriting further investigation in larger studies. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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12 pages, 3229 KiB

Open AccessEditor’s ChoiceArticle

Extracellular Volume by Computed Tomography Is Useful for Prediction of Prognosis in Dilated Cardiomyopathy Cases with Heart Failure with Reduced Ejection Fraction

by Satomi Yashima, Hiroyuki Takaoka, Joji Ota, Moe Matsumoto, Yusei Nishikawa, Yoshitada Noguchi, Shuhei Aoki, Kazuki Yoshida, Katsuya Suzuki, Makiko Kinoshita, Haruka Sasaki, Noriko Suzuki-Eguchi, Tomonori Kanaeda and Yoshio Kobayashi

J. Cardiovasc. Dev. Dis. 2024, 11(12), 399; https://doi.org/10.3390/jcdd11120399 - 11 Dec 2024

Viewed by 1192

Abstract

Objective: Cardiac computed tomography (CT) helps screen coronary artery stenosis in cases with dilated cardiomyopathy (DCM). Extracellular volume fraction (ECV) analysis has recently been eligible for CT. Method: We evaluated the impact of ECV on the CT to predict the prognosis in DCM [...] Read more.

Objective: Cardiac computed tomography (CT) helps screen coronary artery stenosis in cases with dilated cardiomyopathy (DCM). Extracellular volume fraction (ECV) analysis has recently been eligible for CT. Method: We evaluated the impact of ECV on the CT to predict the prognosis in DCM patients with heart failure with reduced ejection fraction (HFrEF). Patients or Materials: We analyzed 101 consecutive DCM cases with HFrEF who underwent cardiac CT. All the patients had a lower left ventricular (LV) ejection fraction (LVEF) of less than 40%. We evaluated the effect of ECV to predict the patients’ prognosis. Cardiovascular death, hospitalization due to heart failure, and fatal arrhythmic events were included in the major adverse cardiac events (MACE). Results: MACE occurred in 27 cases (27%). The patients with MACE (27 cases) had an increased ECV on the LVM on the CT (37.2 ± 6.7 vs. 32.2 ± 3.6%, p = 0.0008) compared to the others (74 cases). Based on the receiver operating characteristics curve analysis, the best cutoff value of the ECV on the LVM to predict the MACE was 32.3%. The patients with ECV ≥ 32.3% had significantly higher MACE based on the Kaplan–Meier analysis. The ECV on the LVM was a significant marker to predict MACE based on the univariate Cox proportional hazard model (hazard ratio of 8.00, 95% confidence interval 1.88–33.97, p = 0.0048). Conclusions: ECV by CT is helpful to predict MACE in cases with DCM and HFrEF. Full article

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

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24 pages, 1158 KiB

Open AccessEditor’s ChoiceReview

Tailored Therapies for Cardiogenic Shock in Hypertrophic Cardiomyopathy: Navigating Emerging Strategies

by George E. Zakynthinos, Ioannis Gialamas, Vasiliki Tsolaki, Panteleimon Pantelidis, Athina Goliopoulou, Maria Ioanna Gounaridi, Ioanna Tzima, Andrew Xanthopoulos, Konstantinos Kalogeras, Gerasimos Siasos and Evangelos Oikonomou

J. Cardiovasc. Dev. Dis. 2024, 11(12), 401; https://doi.org/10.3390/jcdd11120401 - 11 Dec 2024

Viewed by 2794

Abstract

Hypertrophic cardiomyopathy (HCM) is a complex and heterogeneous cardiac disorder, often complicated by cardiogenic shock, a life-threatening condition marked by severe cardiac output failure. Managing cardiogenic shock in HCM patients presents unique challenges due to the distinct pathophysiology of the disease, which includes [...] Read more.

Hypertrophic cardiomyopathy (HCM) is a complex and heterogeneous cardiac disorder, often complicated by cardiogenic shock, a life-threatening condition marked by severe cardiac output failure. Managing cardiogenic shock in HCM patients presents unique challenges due to the distinct pathophysiology of the disease, which includes dynamic left ventricular outflow tract obstruction, diastolic dysfunction, and myocardial ischemia. This review discusses current and emerging therapeutic strategies tailored to address the complexities of HCM-associated cardiogenic shock and other diseases with similar pathophysiology that provoke left ventricular outflow tract obstruction. We explore the role of pharmacological interventions, including the use of vasopressors and inotropes, which are crucial in stabilizing hemodynamics but require careful selection to avoid exacerbating the outflow obstruction. Additionally, the review highlights advancements in mechanical circulatory support devices such as extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs), which have become vital in the acute management of cardiogenic shock. These devices provide temporary support and bridge patients to recovery, definitive therapy, or heart transplantation, which remains a critical option for those with end-stage disease. Furthermore, the review delves into the latest research and clinical trials that are refining these therapeutic approaches, ensuring they are optimized for HCM patients. The impact of these treatments on patient outcomes, including survival rates and quality of life, is also critically assessed. In conclusion, this review underscores the importance of a tailored therapeutic approach in managing cardiogenic shock in HCM patients, integrating pharmacological and mechanical support strategies to improve outcomes in this high-risk population. Full article

(This article belongs to the Special Issue Advancements in the Epidemiology, Diagnosis and Treatment of Hypertrophic Cardiomyopathy)

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22 pages, 8866 KiB

Open AccessEditor’s ChoiceArticle

Evaluation of the Efficacy and Accuracy of Super-Flexible Three-Dimensional Heart Models of Congenital Heart Disease Made via Stereolithography Printing and Vacuum Casting: A Multicenter Clinical Trial

by Isao Shiraishi, Masaaki Yamagishi, Takaya Hoashi, Yoshiaki Kato, Shigemitsu Iwai, Hajime Ichikawa, Tatsuya Nishii, Hiroyuki Yamagishi, Satoshi Yasukochi, Masaaki Kawada, Takaaki Suzuki, Takeshi Shinkawa, Naoki Yoshimura, Ryo Inuzuka, Yasutaka Hirata, Keiichi Hirose, Akio Ikai, Kisaburo Sakamoto, Yasuhiro Kotani, Shingo Kasahara, Toshiaki Hisada and Kenichi Kurosaki Show full author list Hide full author list

J. Cardiovasc. Dev. Dis. 2024, 11(12), 387; https://doi.org/10.3390/jcdd11120387 - 3 Dec 2024

Viewed by 1510

Abstract

Three-dimensional (3D) printing is an advanced technology for accurately understanding anatomy and supporting the successful surgical management of complex congenital heart disease (CHD). We aimed to evaluate whether our super-flexible 3D heart models could facilitate preoperative decision-making and surgical simulation for complex CHD. [...] Read more.

Three-dimensional (3D) printing is an advanced technology for accurately understanding anatomy and supporting the successful surgical management of complex congenital heart disease (CHD). We aimed to evaluate whether our super-flexible 3D heart models could facilitate preoperative decision-making and surgical simulation for complex CHD. The super-flexible heart models were fabricated by stereolithography 3D printing of the internal and external contours of the heart from cardiac computed tomography (CT) data, followed by vacuum casting with a polyurethane material similar in elasticity to a child’s heart. Nineteen pediatric patients with complex CHD were enrolled (median age, 10 months). The primary endpoint was defined as the percentage of patients rated as “essential” on the surgeons’ postoperative 5-point Likert scale. The accuracy of the models was validated by a non-destructive method using industrial CT. The super-flexible heart models allowed detailed anatomical diagnosis and simulated surgery with incisions and sutures. Thirteen patients (68.4%) were classified as “essential” by the primary surgeons after surgery, with a 95% confidence interval of 43.4–87.4%, meeting the primary endpoint. The product error within 90% of the total external and internal surfaces was 0.54 ± 0.21 mm. The super-flexible 3D heart models are accurate, reliable, and useful tools to assist surgeons in decision-making and allow for preoperative simulation in CHD. Full article

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

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10 pages, 611 KiB

Open AccessEditor’s ChoiceReview

Bridging the Gender Gap in Cardiovascular Medicine: Addressing Drug Intolerances and Personalized Care for Women with Angina/Ischemia with Non-Obstructive Coronary Artery Disease

by Johanna McChord and Peter Ong

J. Cardiovasc. Dev. Dis. 2024, 11(12), 381; https://doi.org/10.3390/jcdd11120381 - 28 Nov 2024

Cited by 1 | Viewed by 1314

Abstract

Gender medicine has increasingly underscored the necessity of addressing sex-based differences in disease prevalence and management, particularly within cardiovascular conditions and drug intolerance. Women often present cardiovascular diseases distinctively from men, with a higher prevalence of non-obstructive coronary artery disease and varied ischemic [...] Read more.

Gender medicine has increasingly underscored the necessity of addressing sex-based differences in disease prevalence and management, particularly within cardiovascular conditions and drug intolerance. Women often present cardiovascular diseases distinctively from men, with a higher prevalence of non-obstructive coronary artery disease and varied ischemic manifestations, such as coronary microvascular dysfunction and epicardial or microvascular coronary spasm. This disparity is further exacerbated by elevated drug intolerance rates among women, influenced by hormonal, genetic, and psychosocial factors. The 2024 ESC guidelines for managing chronic coronary syndromes stress the need for personalized approaches to treat angina and ischemia with non-obstructive coronary artery disease (ANOCA/INOCA), recommending a combination of antianginal medications. Despite standard treatments, up to 40% of ANOCA/INOCA patients experience refractory angina, necessitating a multifaceted approach that often involves multiple antianginal drugs, which can increase the likelihood of drug intolerances. Future research should focus on including women in drug studies and addressing sex-specific differences, while healthcare providers must be equipped to manage gender-specific drug intolerances. Enhanced awareness, individualized treatment strategies, and gender-sensitive healthcare policies are crucial for improving outcomes and bridging the gender gap in cardiovascular medicine. Full article

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

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15 pages, 3197 KiB

Open AccessEditor’s ChoiceSystematic Review

Effect of Coenzyme Q10 Supplementation on Lipid and Glycaemic Profiles: An Umbrella Review

by Silvana Patiño-Cardona, Miriam Garrido-Miguel, Carlos Pascual-Morena, Carlos Berlanga-Macías, Maribel Lucerón-Lucas-Torres, Sofía Alfaro-González and Irene Martínez-García

J. Cardiovasc. Dev. Dis. 2024, 11(12), 377; https://doi.org/10.3390/jcdd11120377 - 25 Nov 2024

Cited by 1 | Viewed by 2995

Abstract

Coenzyme Q10 (CoQ10) has been suggested as an adjunct therapy for endocrine and metabolic disorders. The aim of this study was to synthesise the evidence for the effect of CoQ10 supplementation on lipid and/or glycaemic alterations, including total cholesterol (TC), LDL- and HDL-cholesterol [...] Read more.

Coenzyme Q10 (CoQ10) has been suggested as an adjunct therapy for endocrine and metabolic disorders. The aim of this study was to synthesise the evidence for the effect of CoQ10 supplementation on lipid and/or glycaemic alterations, including total cholesterol (TC), LDL- and HDL-cholesterol (LDL-C and HDL-C), lipoprotein a, fasting blood glucose (FBG), haemoglobin A1c (HbA1c), fasting insulin and Homeostatic Model Assessment of Insulin Resistance. A systematic search was conducted in Medline, Scopus, Web of Science and the Cochrane Library from their inception to July 2024. Meta-analyses that evaluated the effect of CoQ10 on the lipid or glycaemic profiles were included. Results were expressed as mean difference (MD) or standardised mean difference (SMD). CoQ10 showed an effect on the glycaemic profile, especially on FBG (MD from −11.21 to −5.2 mg/dL, SMD from −2.04 to −0.17) and on HbA1c (MD from −1.83 to −0.12%, SMD of −0.30). CoQ10 may also have an effect on the lipid profile, such as TC, triglycerides, HDL-C and even LDL-C, although the inconsistency of the results was somewhat higher. Supplementation with CoQ10 may be beneficial, especially in populations with diabetes mellitus or other endocrine and metabolic disorders. It could also have some effect on lipid parameters, which, together with the above, may reduce cardiovascular morbidity and mortality, although this is something that needs further research. Full article

(This article belongs to the Special Issue Food, Drugs and Environmental Exposures as Triggers of Myocardial Injury and Myocardial Infarction)

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16 pages, 563 KiB

Open AccessEditor’s ChoiceSystematic Review

Cardiac Rehabilitation After Open Heart Surgery: A Narrative Systematic Review

by Eleni Delimanoli, Olav Muurlink, Pavlos Myrianthefs and Anna Korompeli

J. Cardiovasc. Dev. Dis. 2024, 11(11), 376; https://doi.org/10.3390/jcdd11110376 - 20 Nov 2024

Cited by 3 | Viewed by 2395

Abstract

Background: Postoperative cardiac rehabilitation (CR) programs are increasingly recommended by clinicians, but only a minority of patients who have undergone open heart surgery participate in such programs. Participation rates in postoperative CR, if anything, appear to be declining. This systematic review examines the [...] Read more.

Background: Postoperative cardiac rehabilitation (CR) programs are increasingly recommended by clinicians, but only a minority of patients who have undergone open heart surgery participate in such programs. Participation rates in postoperative CR, if anything, appear to be declining. This systematic review examines the effectiveness of post-operative CR and reveals possible participation barriers. Methods: A search of two scholarly databases for primary research papers published in the last decade examining the impact of post-operative CR was conducted and the resultant papers reviewed. Results: The 21 resulting studies revealed physiological functioning improvement and a reduction in mortality and readmission rates, while highlighting an enhancement in mental status. Some of the studies recognized the need for nutritional support and suggested that age, gender, access to CR centers, and socioeconomic variables impact participation in CR. Conclusions: Post-operative CR participation rates continue to decline despite increasing evidence of the value of the approach. Full article

(This article belongs to the Section Cardiac Surgery)

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26 pages, 14150 KiB

Open AccessEditor’s ChoiceArticle

New Insights on the Formation of the Mitral Valve Chordae Tendineae in Fetal Life

by Meghan Martin, Kate Gillett, Parker Whittick and Sarah Melissa Wells

J. Cardiovasc. Dev. Dis. 2024, 11(11), 367; https://doi.org/10.3390/jcdd11110367 - 15 Nov 2024

Cited by 1 | Viewed by 1205

Abstract

There is an increasing understanding that some mitral valve pathologies have developmental origins. The time course of valvulogenesis varies by animal model; in cattle, the branched chordae tendineae architecture becomes fully developed at full term. The mechanism by which chordae tendineae bifurcate during [...] Read more.

There is an increasing understanding that some mitral valve pathologies have developmental origins. The time course of valvulogenesis varies by animal model; in cattle, the branched chordae tendineae architecture becomes fully developed at full term. The mechanism by which chordae tendineae bifurcate during fetal development remains unknown. The current study presents a detailed description of bovine chordae tendineae formation and bifurcation during fetal development. Analysis of Movat Pentachrome-stained histological sections of the developing mitral valve apparatus was accompanied by micro-CT imaging. TEM imaging of chordae branches and common trunks allowed the measurement of collagen fibril diameter distributions. We observed a proteoglycan-rich “transition zone” at the junction between the fetal mitral valve anterior leaflet and chordae tendineae with “perforations” lined by MMP1/2 and Ki-67 expressing endothelial cells. This region also contained clusters of proliferating endothelial cells within the bulk of the tissue. We hypothesize this zone marks a region where chordae tendineae bifurcate during fetal development. In particular, perforations created by localized MMP activity serve as a site for the initiation of a “split” of a single chordae attachment into two. This is supported by TEM results that suggest a similar population of collagen fibrils runs from the branches into a common trunk. A clear understanding of normal mitral valvulogenesis and its signaling mechanisms will be crucial in developing therapeutics and/or tissue-engineered valve replacements. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Cardiac Development and Regeneration' Section — from Development to Regeneration)

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21 pages, 2156 KiB

Open AccessEditor’s ChoiceReview

The Complementary Role of Cardiopulmonary Exercise Testing in Coronary Artery Disease: From Early Diagnosis to Tailored Management

by Simone Pasquale Crispino, Andrea Segreti, Martina Ciancio, Dajana Polito, Emiliano Guerra, Giuseppe Di Gioia, Gian Paolo Ussia and Francesco Grigioni

J. Cardiovasc. Dev. Dis. 2024, 11(11), 357; https://doi.org/10.3390/jcdd11110357 - 5 Nov 2024

Viewed by 2218

Abstract

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, accounting for over 9 million deaths annually. The prevalence of CAD continues to rise, driven by ageing and the increasing prevalence of risk factors such as hypertension, diabetes, and obesity. [...] Read more.

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, accounting for over 9 million deaths annually. The prevalence of CAD continues to rise, driven by ageing and the increasing prevalence of risk factors such as hypertension, diabetes, and obesity. Current clinical guidelines emphasize the importance of functional tests in the diagnostic pathway, particularly for assessing the presence and severity of ischemia. While recommended tests are valuable, they may not fully capture the complex physiological responses to exercise or provide the necessary detail to tailor personalized treatment plans. Cardiopulmonary exercise testing (CPET) offers a comprehensive assessment of the cardiovascular, pulmonary, and muscular systems under stress, potentially addressing these gaps and providing a more precise understanding of CAD, particularly in settings where traditional diagnostics may be insufficient. By enabling more personalized and precise treatment strategies, CPET could play a central role in the future of CAD management. This narrative review examines the current evidence supporting the use of CPET in CAD diagnosis and management and explores the potential for integrating CPET into existing clinical guidelines, considering its diagnostic and prognostic capabilities, cost-effectiveness, and the challenges associated with its adoption. Full article

(This article belongs to the Special Issue Exercise and Cardiovascular Disease in Older Adults)

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9 pages, 417 KiB

Open AccessEditor’s ChoiceArticle

Validity and Reliability of Self-Reported Prevalent and Incident Cardiovascular Disease Among Asian Adults

by Charumathi Sabanayagam, Feng He, Miao Li Chee and Ching-Yu Cheng

J. Cardiovasc. Dev. Dis. 2024, 11(11), 350; https://doi.org/10.3390/jcdd11110350 - 1 Nov 2024

Cited by 2 | Viewed by 1049

Abstract

Cardiovascular disease (CVD) is the leading cause of death in Asians. We aimed to examine the validity and reliability of self-reported (SR) CVD in 6762 Chinese, Malay, and Indian adults aged 40–80 years who attended the baseline (November 2004) and 6-year follow-up visit [...] Read more.

Cardiovascular disease (CVD) is the leading cause of death in Asians. We aimed to examine the validity and reliability of self-reported (SR) CVD in 6762 Chinese, Malay, and Indian adults aged 40–80 years who attended the baseline (November 2004) and 6-year follow-up visit (2011–2017) of a population-based cohort study in Singapore. CVD was defined based on the presence of existing (prevalent) or new onset (incident) cases of acute myocardial infarction (AMI) or stroke. The validity of SR-CVD was assessed by comparing it against diagnosed CVD using sensitivity and specificity. The reliability of SR-CVD was evaluated by calculating the percentage of positive agreement between baseline and follow-up visits. The sensitivity and specificity of SR-CVD were 62.7% and 93.8% for prevalent SR-CVD and 50.9% and 98.5% for incident SR-CVD. The negative predictive value (NPV) was 98.1% for both prevalent and incident SR-CVD. The reliability of positive self-reports between the baseline and follow-up was substantial, at 85%. The excellent specificity and NPV of SR-CVD suggest that it could serve as a valuable tool for excluding AMI and stroke. However, its moderate sensitivity suggests that positive SR-CVD reports should prompt further clinical evaluation to prevent potential false positives. Full article

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

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12 pages, 3104 KiB

Open AccessEditor’s ChoiceArticle

Distinct Patterns of Smooth Muscle Phenotypic Modulation in Thoracic and Abdominal Aortic Aneurysms

by Chien-Jung Lin, Campbell Keating, Robyn Roth, Yasar Caliskan, Mustafa Nazzal, Vernat Exil, Richard DiPaolo, Divya Ratan Verma, Kishore Harjai, Mohamed Zayed, Chieh-Yu Lin, Robert P. Mecham and Ajay K. Jain

J. Cardiovasc. Dev. Dis. 2024, 11(11), 349; https://doi.org/10.3390/jcdd11110349 - 1 Nov 2024

Cited by 1 | Viewed by 1426

Abstract

Thoracic and abdominal aortic aneurysms (TAAs and AAAs, respectively) share morphological features but have distinct clinical and hereditary characteristics. Studies using bulk RNA comparisons revealed distinct patterns of gene expression in human TAA and AAA tissues. However, given the summative nature of bulk [...] Read more.

Thoracic and abdominal aortic aneurysms (TAAs and AAAs, respectively) share morphological features but have distinct clinical and hereditary characteristics. Studies using bulk RNA comparisons revealed distinct patterns of gene expression in human TAA and AAA tissues. However, given the summative nature of bulk RNA studies, these findings represent the totality of gene expression without regards to the differences in cellular composition. Single-cell RNA sequencing provides an opportunity to interrogate cell-type-specific transcriptomes. Single cell RNA sequencing datasets from mouse TAA (GSE153534) and AAA (GSE164678 and GSE152583) with respective controls were obtained from the Gene Expression Omnibus. Bioinformatic analysis was performed with the Seurat 4, clusterProfiler, and Connectome software packages (V1.0.1). Immunostaining was performed with standard protocols. Within normal and aneurysmal aortae, three unique populations of cells that express smooth muscle cell (SMC) markers were identified (SMC1, SMC2, and SMCmod). A greater proportion of TAA SMCs clustered as a unique population, SMCmod, relative to the AAA SMCs (38% vs. 10–12%). These cells exhibited transcriptional features distinct from other SMCs, which were characterized by Igfbp2 and Tnfrsf11b expression. Genes upregulated in TAA SMCs were enriched for the Reactome terms “extracellular matrix organization” and “insulin-like growth factor (IGF) transport and uptake by IGF binding proteins (IGFBPs)”, indicating a role for Igfbp2 in TAA pathogenesis. Regulon analysis revealed transcription factors enriched in TAAs and AAAs. Validating these mouse bioinformatic findings, immunostaining demonstrated that both IGFBP2 and TNFRSF11B proteins increased in human TAAs compared to AAAs. These results highlight the unique cellular composition and transcriptional signature of SMCs in TAAs and AAAs. Future studies are needed to reveal the pathogenetic pathways of IGFBP2 and TNFRSF11B. Full article

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12 pages, 2125 KiB

Open AccessEditor’s ChoiceArticle

Clinical Relevance of Different Loads of Perivascular Spaces According to Their Localization in Patients with a Recent Small Subcortical Infarct

by Caterina Sozzi, Carla Brenlla, Inés Bartolomé, Andrés Girona, Emma Muñoz-Moreno, Carlos Laredo, Alejandro Rodríguez-Vázquez, Antonio Doncel-Moriano, Salvatore Rudilosso and Ángel Chamorro

J. Cardiovasc. Dev. Dis. 2024, 11(11), 345; https://doi.org/10.3390/jcdd11110345 - 1 Nov 2024

Cited by 1 | Viewed by 1345

Abstract

Background and Purpose: Perivascular spaces (PVS) are usually enlarged in small vessel disease (SVD). However, the significance of PVS patterns in different locations is uncertain. Hence, we analyzed the distribution of PVS in patients with a recent small subcortical infarct (RSSI) and [...] Read more.

Background and Purpose: Perivascular spaces (PVS) are usually enlarged in small vessel disease (SVD). However, the significance of PVS patterns in different locations is uncertain. Hence, we analyzed the distribution of PVS in patients with a recent small subcortical infarct (RSSI) and their correlation with clinical and imaging factors. Materials and Methods: In a cohort of 71 patients with an RSSI with complete clinical data, including the Pittsburgh Sleep Quality Index (PSQI), we segmented PVS in white matter (WM-PVS), basal ganglia (BG-PVS), and brainstems (BS-PVS) on 3T-MRI T2-weighted sequences, obtaining fractional volumes (%), and calculated the WM/BG-PVS ratio. We analyzed the Pearson’s correlation coefficients between PVS regional loads. We used normalized PVS measures to assess the associations with clinical and MRI-SVD features (white matter hyperintensities (WMHs), number of lacunes, and microbleeds) in univariable and multivariable linear regressions adjusted for age, sex, and hypertension. Results: In our cohort (mean age 70 years; 27% female), the Pearson’s correlation coefficients between WM-PVS/BG-PVS, WM-PVS/BS-PVS, and BG-PVS/BS-PVS were 0.67, 0.61, and 0.59 (all p < 0.001). In the adjusted models, BG-PVS were associated with lacunes (p = 0.034), WMHs (p = 0.006), and microbleeds (p = 0.017); WM-PVS with lacunes (p = 0.003); while BS-PVS showed no associations. The WM/BG-PVS ratio was associated with lacunes (p = 0.018) and the PSQI (p = 0.046). Conclusions: PVS burdens in different regions are highly correlated in patients with RSSI but with different SVD patterns. Sleep quality impairment might affect waste removal mechanisms differently in the WM and BG regions. Full article

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

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11 pages, 2360 KiB

Open AccessEditor’s ChoiceArticle

cpt1b Regulates Cardiomyocyte Proliferation Through Modulation of Glutamine Synthetase in Zebrafish

by Xiaohan Cheng, Jingyi Ju, Wenping Huang, Zongyi Duan and Yanchao Han

J. Cardiovasc. Dev. Dis. 2024, 11(11), 344; https://doi.org/10.3390/jcdd11110344 - 1 Nov 2024

Viewed by 1393

Abstract

Carnitine palmitoyltransferase 1b (Cpt1b) is a crucial rate-limiting enzyme in fatty acid metabolism, but its role and mechanism in early cardiac development remains unclear. Here, we show that cpt1b regulates cardiomyocyte proliferation during zebrafish development. Knocking out entire cpt1b coding sequences leads to [...] Read more.

Carnitine palmitoyltransferase 1b (Cpt1b) is a crucial rate-limiting enzyme in fatty acid metabolism, but its role and mechanism in early cardiac development remains unclear. Here, we show that cpt1b regulates cardiomyocyte proliferation during zebrafish development. Knocking out entire cpt1b coding sequences leads to impaired cardiomyocyte proliferation, while cardiomyocyte-specific overexpression of cpt1b promotes cardiomyocyte proliferation. RNA sequencing analysis and pharmacological studies identified glutamine synthetase as a key downstream effector of cpt1b in regulating cardiomyocyte proliferation. Our study elucidates a novel mechanism whereby cpt1b promotes zebrafish cardiomyocyte proliferation through glutamine synthetase, which provides new perspectives on the significance of fatty acid metabolism in heart development and the interplay between fatty acid and amino acid metabolic pathways. Full article

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

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20 pages, 38951 KiB

Open AccessEditor’s ChoiceReview

The Key Role of 3D TEE in Assessing the Morphology of Degenerative Mitral Valve Regurgitation

by Francesco Fulvio Faletra, Eluisa La Franca, Laura Anna Leo, Leyla Elif Sade, William Katz, Francesco Musumeci, Caterina Gandolfo, Michele Pilato and Manlio Cipriani

J. Cardiovasc. Dev. Dis. 2024, 11(11), 342; https://doi.org/10.3390/jcdd11110342 - 28 Oct 2024

Viewed by 2116

Abstract

Two-dimensional transthoracic echocardiography (2D TTE) and two-dimensional transesophageal echocardiography (2D TEE) are regarded as the main imaging techniques for the assessment of degenerative mitral valve regurgitation (DMVR). However, describing the complex morphology of DMVR with 2D TTE and 2D TEE remains at the [...] Read more.

Two-dimensional transthoracic echocardiography (2D TTE) and two-dimensional transesophageal echocardiography (2D TEE) are regarded as the main imaging techniques for the assessment of degenerative mitral valve regurgitation (DMVR). However, describing the complex morphology of DMVR with 2D TTE and 2D TEE remains at the very least challenging. Three-dimensional (3D) TEE is an ideal technique for illustrating the extremely variable morphology of DMVR, providing images of unparalleled quality in terms of anatomical detail. In this review, we describe the key role of 3D TEE in various morphological scenarios that reflect everyday experiences in an echocardiographic laboratory. We also discuss the growing role of 3D TEE in mitral valve (MV) transcatheter edge-to-edge repair (TEER) and new modalities such as photorealistic and transparent displays, surface rendering parametric color maps, new algorithms for MVR quantification, and the potential role of new mini-TEE probes in adult patients with DMVR. Full article

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

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15 pages, 3019 KiB

Open AccessEditor’s ChoiceSystematic Review

The Impact of Frailty and Surgical Risk on Health-Related Quality of Life After TAVI

by Kim E. H. M. van der Velden, Bart P. A. Spaetgens, Wolfgang F. F. A. Buhre, Bart Maesen, Dianne J. D. de Korte-de Boer, Sander M. J. van Kuijk, Arnoud W. J. van ‘t Hof and Jan U. Schreiber

J. Cardiovasc. Dev. Dis. 2024, 11(10), 333; https://doi.org/10.3390/jcdd11100333 - 18 Oct 2024

Cited by 1 | Viewed by 1531

Abstract

Symptomatic aortic stenosis and frailty reduce health-related quality of life (HrQoL). Transcatheter aortic valve implantation (TAVI) in patients at high to extreme risk has been proven to have a beneficial effect on HrQoL. Currently, TAVI is also considered in patients at intermediate risk. [...] Read more.

Symptomatic aortic stenosis and frailty reduce health-related quality of life (HrQoL). Transcatheter aortic valve implantation (TAVI) in patients at high to extreme risk has been proven to have a beneficial effect on HrQoL. Currently, TAVI is also considered in patients at intermediate risk. Our meta-analysis investigates whether benefits to HrQoL after TAVI is more pronounced in frail patients and patients at high to extreme vs. intermediate surgical risk. A systematic search of the literature was performed in November 2021 and updated in November 2023 in PUBMED, EMBASE, and the Cochrane Controlled Trials Register. Statistical analysis was performed according to the inverse variance method and the random effects model. A total of 951 studies were assessed, of which 19 studies were included. Meta-analysis showed a mean increase in the Kansas City Cardiomyopathy Questionnaire (KCCQ) score of 29.6 points (6.0, 33.1) in high to extreme risk patients versus 21.0 (20.9, 21.1) in intermediate risk patients (p < 0.00001) and 24.6 points (21.5, 27.8) in frail patients versus 26.8 (20.2, 33.4) in the general TAVI population (p = 0.55). However, qualitative analyses of non-randomized studies showed the opposite results. In conclusion, TAVI improves HrQoL more in high to extreme than intermediate risk patients. Frailty’s impact on HrQoL post-TAVI is inconclusive due to varying outcomes in RCTs vs. non-RCTs. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)

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12 pages, 953 KiB

Open AccessEditor’s ChoiceReview

Device-Assisted Left Atrial Appendage Exclusion: From Basic Sciences to Clinical Applications

by Julia Izabela Karpierz, Michał Piotrowski, Krzysztof Bartuś, Radosław Chmiel, Katarzyna Wijatkowska and Artur Słomka

J. Cardiovasc. Dev. Dis. 2024, 11(10), 332; https://doi.org/10.3390/jcdd11100332 - 18 Oct 2024

Viewed by 1538

Abstract

Device-assisted left atrial appendage exclusion plays a crucial role in the prevention of fatal ischemic complications in patients with atrial fibrillation and contraindications to anticoagulation treatment. Various devices with different safety profiles and device-related complications are available in daily practice to perform this [...] Read more.

Device-assisted left atrial appendage exclusion plays a crucial role in the prevention of fatal ischemic complications in patients with atrial fibrillation and contraindications to anticoagulation treatment. Various devices with different safety profiles and device-related complications are available in daily practice to perform this procedure. In this review, the anatomy, physiology, and functions of the left atrial appendage were detailed, and all available devices used for epicardial and endocardial exclusion of the left atrial appendage and their clinical outcomes were discussed. Future research should aim to further investigate the long-term effects of left atrial appendage exclusion on body homeostasis, blood coagulation, and cardiac function. Full article

(This article belongs to the Special Issue Feature Review Papers in Stroke and Cerebrovascular Disease)

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15 pages, 5473 KiB

Open AccessEditor’s ChoiceReview

Electrocardiographic Clues for Early Diagnosis of Ventricular Pre-Excitation and Non-Invasive Risk Stratification in Athletes: A Practical Guide for Sports Cardiologists

by Simone Ungaro, Francesca Graziano, Sergei Bondarev, Matteo Pizzolato, Domenico Corrado and Alessandro Zorzi

J. Cardiovasc. Dev. Dis. 2024, 11(10), 324; https://doi.org/10.3390/jcdd11100324 - 14 Oct 2024

Viewed by 2113

Abstract

Ventricular pre-excitation (VP) is a cardiac disorder characterized by the presence of an accessory pathway (AP) that bypasses the atrioventricular node (AVN), which, although often asymptomatic, exposes individuals to an increased risk of re-entrant supraventricular tachycardias and sudden cardiac death (SCD) due to [...] Read more.

Ventricular pre-excitation (VP) is a cardiac disorder characterized by the presence of an accessory pathway (AP) that bypasses the atrioventricular node (AVN), which, although often asymptomatic, exposes individuals to an increased risk of re-entrant supraventricular tachycardias and sudden cardiac death (SCD) due to rapid atrial fibrillation (AF) conduction. This condition is particularly significant in sports cardiology, where preparticipation ECG screening is routinely performed on athletes. Professional athletes, given their elevated risk of developing malignant arrhythmias, require careful assessment. Early identification of VP and proper risk stratification are crucial for determining the most appropriate management strategy and ensuring the safety of these individuals during competitive sports. Non-invasive tools, such as resting electrocardiograms (ECGs), ambulatory ECG monitoring, and exercise stress tests, are commonly employed, although their interpretation can sometimes be challenging. This review aims to provide practical tips and electrocardiographic clues for detecting VP beyond the classical triad (short PR interval, delta wave, and prolonged QRS interval) and offers guidance on non-invasive risk stratification. Although the diagnostic gold standard remains invasive electrophysiological study, appropriate interpretation of the ECG can help limit unnecessary referrals for young, often asymptomatic, athletes. Full article

(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)

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17 pages, 264 KiB

Open AccessEditor’s ChoiceArticle

Safety of Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices

by Hugo Lanz, Katharina Strauß, Julia Höpler, Marie Kraft, Sabine Hoffmann, Leonhard Binzenhöfer, Nils Gade, Daniel Roden, Inas Saleh, Stefan Kääb, Korbinian Lackermair, Sebastian Sadoni, Christian Hagl, Steffen Massberg, Heidi Estner, Stephanie Fichtner and Enzo Lüsebrink

J. Cardiovasc. Dev. Dis. 2024, 11(10), 313; https://doi.org/10.3390/jcdd11100313 - 8 Oct 2024

Cited by 3 | Viewed by 2322

Abstract

Background: MRI (magnetic resonance imaging) represents the diagnostic image modality of choice in several conditions. With an increasing number of patients requiring MRI for diagnostic purposes, the issue of safety in patients with cardiac implantable electronic devices (CIED) undergoing this imaging modality will [...] Read more.

Background: MRI (magnetic resonance imaging) represents the diagnostic image modality of choice in several conditions. With an increasing number of patients requiring MRI for diagnostic purposes, the issue of safety in patients with cardiac implantable electronic devices (CIED) undergoing this imaging modality will play an ever more important role. The purpose of this study was to assess the safety and device function following MRI in an unrestricted real-world cohort of patients with a wide array of cardiac devices. Methods: We conducted a retrospective single-center study including 1010 MRI studies conducted in adult patients (≥18 years) with an implanted CIED treated in the University Hospital of Munich (LMU) between July 2012 and March 2024. Patients with non-MR conditionally labeled leads, abandoned or epicardial leads, as well as lead fragments, were included for analysis. Results: Across a total of 1010 MRIs (920 total MR-conditional device generators) performed in patients with an implanted CIED, there were no deaths, reports of discomfort, palpitations, heating, or ventricular arrythmias in the 24 h following MRI. Only 2/1010 MRIs were followed by a reported atrial arrhythmia within 24 h, both in patients with an MR-conditional pacemaker (PM) device without an abandoned lead. No significant changes in device function following MRI from baseline were observed across all included CIEDs. Lastly, no instances of severe malfunction, such as generator failure, loss of capture, electrical reset, or inappropriate inhibition of pacing, were found in post-MRI interrogation reports across all MRI studies. Conclusions: Based on the analysis of 1010 MRIs undergone by patients with CIEDs, following standardized device interrogation, manufacturer-advised device programming, monitoring of vital function, and manufacturer-advised reprogramming, MRI can be performed safely and without adverse events or changes in device function. Full article

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

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10 pages, 563 KiB

Open AccessEditor’s ChoiceReview

Physical Activity and Executive Functioning in Children and Adolescents with Congenital Heart Defects: A Scoping Review

by Amanda Clifton, Neva Kirk-Sanchez, Gerson Cipriano, Jr., James G. Moore and Lawrence P. Cahalin

J. Cardiovasc. Dev. Dis. 2024, 11(10), 309; https://doi.org/10.3390/jcdd11100309 - 5 Oct 2024

Viewed by 1413

Abstract

Children and adolescents (C&As) with congenital heart defects (CHDs) have decreased functional capacity and executive functioning (EF) due to brain abnormalities and decreased cerebral perfusion. Exercise may improve EF via increased cognitive demands and cerebral blood supply. The purpose of this review was [...] Read more.

Children and adolescents (C&As) with congenital heart defects (CHDs) have decreased functional capacity and executive functioning (EF) due to brain abnormalities and decreased cerebral perfusion. Exercise may improve EF via increased cognitive demands and cerebral blood supply. The purpose of this review was to identify evidence describing the impact of physical activity (PA) interventions on EF in C&As with CHDs. The following databases were searched from 2000 to 2024: MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL, and PsycInfo. The inclusion criteria consisted of participants aged from birth to 18 years with CHD, interventions related to PA, and EF as an outcome measure. Articles were excluded if adults were included, translation to English was impossible, and full access was unavailable. Of 613 initial articles, 3 were analyzed, with only 1 meeting all inclusion criteria. The included study found significant improvements in self-reported cognitive functioning and parent-reported social functioning after 12 weeks of aerobic exercise in children aged 10–15 years with CHDs. Common themes among the reviewed articles indicated that EF remains impaired throughout the lifespan, children have unique interventional and developmental needs, and research remains limited despite theoretical benefits. Further investigation of the effect of PA on EF in C&As with CHDs is needed. Full article

(This article belongs to the Special Issue Heart Diseases in Children)

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22 pages, 936 KiB

Open AccessEditor’s ChoiceReview

Statins in the Cause and Prevention of Cancer: Confounding by Indication and Mediation by Rhabdomyolysis and Phosphate Toxicity

by Ronald B. Brown

J. Cardiovasc. Dev. Dis. 2024, 11(9), 296; https://doi.org/10.3390/jcdd11090296 - 23 Sep 2024

Cited by 1 | Viewed by 3236

Abstract

Statins are drugs used in cardiovascular pharmacotherapy to decrease hypercholesterolemia and lower the risk of atherosclerosis. Statins also increase the risk of rhabdomyolysis, which is often minimized in comparison with large relative risk reductions of cardiovascular disease reported in clinical trials. By contrast, [...] Read more.

Statins are drugs used in cardiovascular pharmacotherapy to decrease hypercholesterolemia and lower the risk of atherosclerosis. Statins also increase the risk of rhabdomyolysis, which is often minimized in comparison with large relative risk reductions of cardiovascular disease reported in clinical trials. By contrast, absolute risk reductions of cardiovascular disease are often clinically insignificant and unreported in statin clinical trials. Additionally, cytotoxic effects of statins inhibit cancer cell proliferation and reduce cancer risk, but other studies found that statins are carcinogenic. Due to an inverse association between incidence of cancer and atherosclerosis, the indication to prescribe statins likely biases the association of statins with cancer prevention. Dietary patterns associated with atherosclerosis and cancer contain inverse amounts of cholesterol and phosphate, an essential mineral that stimulates tumorigenesis. Accordingly, lower cancer risk is associated with high dietary cholesterol intake and increased risk of atherosclerosis. Furthermore, serum is exposed to excessive inorganic phosphate that could increase cancer risk as rhabdomyolysis induced by statins releases phosphate from skeletal muscle breakdown. Increased risk of comorbid conditions associated with statins may share the mediating factor of phosphate toxicity. More research is warranted on statins in the cause and prevention of cancer. Full article

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

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16 pages, 2737 KiB

Open AccessEditor’s ChoiceReview

Developmental Changes in the Excitation–Contraction Mechanisms of the Ventricular Myocardium and Their Sympathetic Regulation in Small Experimental Animals

by Shogo Hamaguchi, Naoki Agata, Maika Seki, Iyuki Namekata and Hikaru Tanaka

J. Cardiovasc. Dev. Dis. 2024, 11(9), 267; https://doi.org/10.3390/jcdd11090267 - 29 Aug 2024

Cited by 1 | Viewed by 1769

Abstract

The developmental changes in the excitation–contraction mechanisms of the ventricular myocardium of small animals (guinea pig, rat, mouse) and their sympathetic regulation will be summarized. The action potential duration monotonically decreases during pre- and postnatal development in the rat and mouse, while in [...] Read more.

The developmental changes in the excitation–contraction mechanisms of the ventricular myocardium of small animals (guinea pig, rat, mouse) and their sympathetic regulation will be summarized. The action potential duration monotonically decreases during pre- and postnatal development in the rat and mouse, while in the guinea pig it decreases during the fetal stage but turns into an increase just before birth. Such changes can be attributed to changes in the repolarizing potassium currents. The T-tubule and the sarcoplasmic reticulum are scarcely present in the fetal cardiomyocyte, but increase during postnatal development. This causes a developmental shift in the Ca²⁺ handling from a sarcolemma-dependent mechanism to a sarcoplasmic reticulum-dependent mechanism. The sensitivity for beta-adrenoceptor-mediated positive inotropy decreases during early postnatal development, which parallels the increase in sympathetic nerve innervation. The alpha-adrenoceptor-mediated inotropy in the mouse changes from positive in the neonate to negative in the adult. This can be explained by the change in the excitation–contraction mechanism mentioned above. The shortening of the action potential duration enhances trans-sarcolemmal Ca²⁺ extrusion by the Na⁺-Ca²⁺ exchanger. The sarcoplasmic reticulum-dependent mechanism of contraction in the adult allows Na⁺-Ca²⁺ exchanger activity to cause negative inotropy, a mechanism not observed in neonatal myocardium. Such developmental studies would provide clues towards a more comprehensive understanding of cardiac function. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Cardiac Development and Regeneration' Section — from Development to Regeneration)

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27 pages, 4960 KiB

Open AccessEditor’s ChoiceReview

The Functional Significance of Cardiac Looping: Comparative Embryology, Anatomy, and Physiology of the Looped Design of Vertebrate Hearts

by Jörg Männer

J. Cardiovasc. Dev. Dis. 2024, 11(8), 252; https://doi.org/10.3390/jcdd11080252 - 17 Aug 2024

Cited by 2 | Viewed by 3979

Abstract

The flow path of vertebrate hearts has a looped configuration characterized by curved (sigmoid) and twisted (chiral) components. The looped heart design is phylogenetically conserved among vertebrates and is thought to represent a significant determinant of cardiac pumping function. It evolves during the [...] Read more.

The flow path of vertebrate hearts has a looped configuration characterized by curved (sigmoid) and twisted (chiral) components. The looped heart design is phylogenetically conserved among vertebrates and is thought to represent a significant determinant of cardiac pumping function. It evolves during the embryonic period of development by a process called “cardiac looping”. During the past decades, remarkable progress has been made in the uncovering of genetic, molecular, and biophysical factors contributing to cardiac looping. Our present knowledge of the functional consequences of cardiac looping lags behind this impressive progress. This article provides an overview and discussion of the currently available information on looped heart design and its implications for the pumping function. It is emphasized that: (1) looping seems to improve the pumping efficiency of the valveless embryonic heart. (2) bilaterally asymmetric (chiral) looping plays a central role in determining the alignment and separation of the pulmonary and systemic flow paths in the multi-chambered heart of tetrapods. (3) chiral looping is not needed for efficient pumping of the two-chambered hearts of fish. (4) it is the sigmoid curving of the flow path that may improve the pumping efficiency of lower as well as higher vertebrate hearts. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Cardiac Development and Regeneration' Section — from Development to Regeneration)

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11 pages, 1736 KiB

Open AccessEditor’s ChoiceReview

Socioeconomic Status and Access to Care for Pediatric and Adult Congenital Heart Disease in Universal Health Coverage Models

by Amanda A. Greenwell, Mimi X. Deng, Shelagh Ross, Viktoria Weixler and Dominique Vervoort

J. Cardiovasc. Dev. Dis. 2024, 11(8), 250; https://doi.org/10.3390/jcdd11080250 - 16 Aug 2024

Cited by 1 | Viewed by 2381

Abstract

Congenital heart disease (CHD) is the most common major congenital anomaly, affecting one in every 100 live births. Whereas over 90% of children born with CHD in low- and middle-income countries cannot access the care they need, early detection, advances in management, and [...] Read more.

Congenital heart disease (CHD) is the most common major congenital anomaly, affecting one in every 100 live births. Whereas over 90% of children born with CHD in low- and middle-income countries cannot access the care they need, early detection, advances in management, and financial risk protection have resulted in over 90% of children with CHD in high-income countries surviving into adulthood. Despite the presence of universal health coverage, barriers to accessing high-quality cardiovascular and non-cardiovascular care for CHD remain common. Lower socioeconomic status has been associated with differential access to cardiac care and poorer outcomes across multiple cardiovascular conditions and subspecialties. In this review article, we describe the relationship between socioeconomic status and access to CHD care in countries with universal health coverage models. We further evaluate notable challenges and opportunities to improve equitable, high-quality CHD care in these countries. Full article

(This article belongs to the Special Issue Congenital Heart Disease: The Effects of Social Determinants of Health on Burdens and Outcomes)

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21 pages, 2177 KiB

Open AccessEditor’s ChoiceReview

Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function

by Mario Mangia, Emilio D’Andrea, Antonella Cecchetto, Riccardo Beccari, Donato Mele and Stefano Nistri

J. Cardiovasc. Dev. Dis. 2024, 11(8), 241; https://doi.org/10.3390/jcdd11080241 - 5 Aug 2024

Cited by 2 | Viewed by 2177

Abstract

The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular [...] Read more.

The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a’]), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function. Full article

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

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15 pages, 3779 KiB

Open AccessEditor’s ChoiceReview

A Review Paper on Optical Coherence Tomography Evaluation of Coronary Calcification Pattern: Is It Relevant Today?

by Horea-Laurentiu Onea, Maria Olinic, Florin-Leontin Lazar, Calin Homorodean, Mihai Claudiu Ober, Mihail Spinu, Alexandru Achim, Dan Alexandru Tataru and Dan Mircea Olinic

J. Cardiovasc. Dev. Dis. 2024, 11(8), 231; https://doi.org/10.3390/jcdd11080231 - 24 Jul 2024

Cited by 2 | Viewed by 1934

Abstract

The process of coronary calcification represents one of the numerous pathophysiological mechanisms involved in the atherosclerosis continuum. Optical coherence tomography (OCT) represents an ideal imaging modality to assess plaque components, especially calcium. Different calcification patterns have been contemporarily described in both early stages [...] Read more.

The process of coronary calcification represents one of the numerous pathophysiological mechanisms involved in the atherosclerosis continuum. Optical coherence tomography (OCT) represents an ideal imaging modality to assess plaque components, especially calcium. Different calcification patterns have been contemporarily described in both early stages and advanced atherosclerosis. Microcalcifications and spotty calcifications correlate positively with macrophage burden and inflammatory markers and are more frequently found in the superficial layers of ruptured plaques in acute coronary syndrome patients. More compact, extensive calcification may reflect a later stage of the disease and was traditionally associated with plaque stability. Nevertheless, a small number of culprit coronary lesions demonstrates the presence of dense calcified plaques. The purpose of the current paper is to review the most recent OCT data on coronary calcification and the interrelation between calcification pattern and plaque vulnerability. How different calcified plaques influence treatment strategies and associated prognostic implications is of great interest. Full article

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

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19 pages, 1990 KiB

Open AccessEditor’s ChoiceReview

Arrhythmic Risk Stratification in Cardiac Amyloidosis: A Review of the Current Literature

by Eleonora Bonvicini, Alberto Preda, Chiara Tognola, Raffaele Falco, Roberto Gidiucci, Giulio Leo, Sara Vargiu, Marisa Varrenti, Lorenzo Gigli, Matteo Baroni, Marco Carbonaro, Giulia Colombo, Alessandro Maloberti, Cristina Giannattasio, Patrizio Mazzone and Fabrizio Guarracini

J. Cardiovasc. Dev. Dis. 2024, 11(7), 222; https://doi.org/10.3390/jcdd11070222 - 14 Jul 2024

Viewed by 2529

Abstract

Cardiac amyloidosis is the most frequent infiltrative disease caused by the deposition of misfolded proteins in the cardiac tissue, leading to heart failure, brady- and tachyarrhythmia and death. Conduction disorders, atrial fibrillation (AF) and ventricular arrhythmia (VA) significantly impact patient outcomes and demand [...] Read more.

Cardiac amyloidosis is the most frequent infiltrative disease caused by the deposition of misfolded proteins in the cardiac tissue, leading to heart failure, brady- and tachyarrhythmia and death. Conduction disorders, atrial fibrillation (AF) and ventricular arrhythmia (VA) significantly impact patient outcomes and demand recognition. However, several issues remain unresolved regarding early diagnosis and optimal management. Extreme bradycardia is the most common cause of arrhythmic death, while fast and sustained VAs can be found even in the early phases of the disease. Risk stratification and the prevention of sudden cardiac death are therefore to be considered in these patients, although the time for defibrillator implantation is still a subject of debate. Moreover, atrial impairment due to amyloid fibrils is associated with an increased risk of AF resistant to antiarrhythmic therapy, as well as recurrent thromboembolic events despite adequate anticoagulation. In the last few years, the aging of the population and progressive improvements in imaging methods have led to increases in the diagnosis of cardiac amyloidosis. Novel therapies have been developed to improve patients’ functional status, quality of life and mortality, without data regarding their effect on arrhythmia prevention. In this review, we consider the latest evidence regarding the arrhythmic risk stratification of cardiac amyloidosis, as well as the available therapeutic strategies. Full article

(This article belongs to the Special Issue Arrhythmic Risk Stratification)

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15 pages, 273 KiB

Open AccessEditor’s ChoiceArticle

Time Changes of Survival and Cardiovascular Determinants in a Cohort of Middle-Aged Men Followed Up for 61 Years until Extinction

by Alessandro Menotti and Paolo Emilio Puddu

J. Cardiovasc. Dev. Dis. 2024, 11(7), 221; https://doi.org/10.3390/jcdd11070221 - 13 Jul 2024

Cited by 1 | Viewed by 1214

Abstract

Objective: To study possible determinants of longevity in a cohort of middle-aged men followed for 61 years until extinction using measurements taken at baseline and at years 31 or 61 of follow-up. Material and Methods: In 1960, two rural cohorts including a total [...] Read more.

Objective: To study possible determinants of longevity in a cohort of middle-aged men followed for 61 years until extinction using measurements taken at baseline and at years 31 or 61 of follow-up. Material and Methods: In 1960, two rural cohorts including a total of 1712 men aged 40–59 years were enrolled within the Italian section of the Seven Countries Study of Cardiovascular Diseases, and measurements related to mainly cardiovascular risk factors, lifestyle behaviors, and chronic diseases were taken at year 0 and year 31 of follow-up (when only 390 could be examined). Multiple linear regression models were computed to relate personal characteristics with the length of survival in both dead men and survivors. Results: Baseline cardiovascular risk factors, smoking and dietary habits, and chronic diseases (taken at year 0 with men aged 40–59 years) were significant predictors of the length of survival both from year 0 to year 31 and from year 0 to year 61, but only chronic diseases were independent predictors for the period of 31 to 61 years. Significant predictors of survival using measurements taken at year 31 (age range 71 to 90 years) were only smoking and dietary habits and chronic diseases. Conclusions: During a lifetime of follow-up, the personal characteristics with continuous predictive power of survival were only lifestyle behaviors and major chronic diseases. Full article

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

13 pages, 2415 KiB

Open AccessEditor’s ChoiceReview

Arrhythmic Mitral Valve Prolapse Syndrome and Ventricular Arrhythmias: A Comprehensive Review and the Role of Catheter Ablation

by Ehsan Mahmoodi and Haris M. Haqqani

J. Cardiovasc. Dev. Dis. 2024, 11(7), 218; https://doi.org/10.3390/jcdd11070218 - 10 Jul 2024

Cited by 1 | Viewed by 2065

Abstract

Mitral valve prolapse (MVP) affects 2–3% of the general population, and despite its benign prognosis overall, it is associated with sudden death in a small subset of patients. The term “arrhythmic MVP syndrome” (AMVPS) refers to the presence of frequent or complex ventricular [...] Read more.

Mitral valve prolapse (MVP) affects 2–3% of the general population, and despite its benign prognosis overall, it is associated with sudden death in a small subset of patients. The term “arrhythmic MVP syndrome” (AMVPS) refers to the presence of frequent or complex ventricular arrhythmias, commonly reported in female patients with a stereotypical phenotype including bileaflet myxomatous disease, ECG repolarisation abnormalities in inferior leads, mitral annular disjunction, and significant fibrosis in the inferolateral LV and papillary muscles. Modern imaging technologies have led to the identification of new risk factors that have been implemented in recent risk stratification guidelines; however, screening for patients with MVP who are at risk of sudden cardiac death (SCD) remains challenging. In addition, there is a limited amount of data on the outcomes of different treatment approaches in AMVP and no specific indication for targeted or disease-modifying therapies within current guidelines. Potential arrhythmic substrates in patients with AMVP syndrome have been the subject of interest in previous studies, with areas consisting of fibrosis at the papillary muscle level and the Purkinje system. Premature ventricular contractions (PVCs) originating from these areas have been shown to play an important role as triggers for ventricular fibrillation and SCD in patients with AMVP. Catheter ablation has emerged as a potential treatment modality in patients with MVP and ventricular arrhythmias (VAs), targeting arrhythmic substrates and triggering PVC foci. The aim of this review is to explore the role of catheter ablation in treating patients with AMVP. Full article

(This article belongs to the Special Issue Arrhythmic Mitral Valve Prolapse: Risk Factors, Pathophysiology and Risk Stratification for Cardiac Arrhythmias)

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13 pages, 889 KiB

Open AccessEditor’s ChoiceArticle

The Modified Risk of Paradoxical Embolism Score Is Associated with Patent Foramen Ovale in Patients with Ischemic Stroke: A Nationwide US Analysis

by Chun Shing Kwok, Zaheer Alisiddiq, Maximilian Will, Konstantin Schwarz, Chee Khoo, Adrian Large, Robert Butler, Gregory Y. H. Lip, Adnan I. Qureshi and Josip Andelo Borovac

J. Cardiovasc. Dev. Dis. 2024, 11(7), 213; https://doi.org/10.3390/jcdd11070213 - 5 Jul 2024

Cited by 1 | Viewed by 1903

Abstract

Background: The Risk of Paradoxical Embolism (RoPE) score was developed to identify stroke-related patent foramen ovale (PFO) in patients with cryptogenic stroke. Methods: We conducted a retrospective analysis of the 2016 to 2020 National Inpatient Sample to determine the performance of the modified [...] Read more.

Background: The Risk of Paradoxical Embolism (RoPE) score was developed to identify stroke-related patent foramen ovale (PFO) in patients with cryptogenic stroke. Methods: We conducted a retrospective analysis of the 2016 to 2020 National Inpatient Sample to determine the performance of the modified RoPE score in identifying the presence of a PFO in patients with acute ischemic stroke (AIS). Results: A total of 3,338,805 hospital admissions for AIS were analysed and 3.0% had PFO. Patients with PFO were younger compared to those without a PFO (median 63 years vs. 71 years, p < 0.001) and fewer were female (46.1% vs. 49.7%, p < 0.001). The patients with PFO had greater mean modified RoPE scores (4.0 vs. 3.3, p < 0.001). The area under the curve for the RoPE score in predicting PFOs was 0.625 (95%CI 0.620–0.629). The best diagnostic power of the RoPE score was achieved with a cut-off point of ≥4 where the sensitivity was 55% and the specificity was 64.2%. A cut-off point of ≥5 increased the specificity (83.1%) at the expense of sensitivity (35.8%). The strongest predictor of PFOs was deep vein thrombosis (OR 3.97, 95%CI 3.76–4.20). Conclusions: The modified RoPE score had modest predictive value in identifying patients with PFO among patients admitted with AIS. Full article

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

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15 pages, 2835 KiB

Open AccessEditor’s ChoiceReview

Potential Role of Left Atrial Strain to Predict Atrial Fibrillation Recurrence after Catheter Ablation Therapy: A Clinical and Systematic Review

by Maria Barilli, Giulia Elena Mandoli, Nicolò Sisti, Aleksander Dokollari, Nicolò Ghionzoli, Hatem Soliman-Aboumarie, Flavio D’Ascenzi, Marta Focardi, Luna Cavigli, Maria Concetta Pastore and Matteo Cameli

J. Cardiovasc. Dev. Dis. 2024, 11(7), 203; https://doi.org/10.3390/jcdd11070203 - 30 Jun 2024

Cited by 2 | Viewed by 2105

Abstract

Pulmonary vein isolation (PVI) with catheter ablation (CA) represents an effective therapy for atrial fibrillation (AF). Unfortunately, it is still not exempt from severe complications. The balance of risks and benefits should be assessed, and a patient-tailored approach is desirable. So far, several [...] Read more.

Pulmonary vein isolation (PVI) with catheter ablation (CA) represents an effective therapy for atrial fibrillation (AF). Unfortunately, it is still not exempt from severe complications. The balance of risks and benefits should be assessed, and a patient-tailored approach is desirable. So far, several clinical and cardiac imaging parameters have been evaluated to investigate pre- and post-procedural features that could help clinicians in the selection of patients at high risk of a poor outcome after CA. This clinical and systematic review analyses the potential role of new LA parameters, such as LA reservoir strain, to predict AF recurrence after CA therapy. Notably, LA reservoir strain gains substantial clinical importance in patients with paroxysmal AF and when a low CHADS2-VASc score is retrieved. LA reservoir strain provides data concerning the risk of AF recurrence after PVI and, thus, in the management of long-term medical therapy in this patient’s group. Full article

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

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19 pages, 4961 KiB

Open AccessEditor’s ChoiceReview

Diagnostic Challenges in Aortic Stenosis

by André González-García, Pablo Pazos-López, Francisco Eugenio Calvo-Iglesias, Tatiana Mallely Matajira-Chía, Raquel Bilbao-Quesada, Elisa Blanco-González, Carina González-Ríos, María Castiñeira-Busto, Manuel Barreiro-Pérez and Andrés Íñiguez-Romo

J. Cardiovasc. Dev. Dis. 2024, 11(6), 162; https://doi.org/10.3390/jcdd11060162 - 23 May 2024

Cited by 2 | Viewed by 4691

Abstract

Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic [...] Read more.

Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic valve (AV) morphology and function. Despite the diagnosis of AS being considered straightforward for a very long time, based on high gradients and reduced aortic valve area (AVA), many patients with AS represent a real dilemma for cardiologist. On the one hand, the acoustic window may be inadequate and the TTE limited in some cases. On the other hand, a growing body of evidence shows that patients with low gradients (due to systolic dysfunction, concentric hypertrophy or coexistence of another valve disease such as mitral stenosis or regurgitation) may develop severe AS (low-flow low-gradient severe AS) with a similar or even worse prognosis. The use of complementary imaging techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDTC), or cardiac magnetic resonance (CMR) plays a key role in such scenarios. The aim of this review is to summarize the diagnostic challenges associated with patients with AS and the advantages of a comprehensive multimodality cardiac imaging (MCI) approach to reach a precise grading of the disease, a crucial factor to warrant an adequate management of patients. Full article

(This article belongs to the Special Issue Diseases of the Aortic Valve and Ascending Aorta: An Overview of Current Knowledge on Pathogenesis, Diagnosis and Treatment)

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18 pages, 8152 KiB

Open AccessEditor’s ChoiceReview

Heart Failure with Mildly Reduced Ejection Fraction—A Phenotype Waiting to Be Explored

by Anugrah Nair, Lukah Q. Tuan, Natasha Jones-Lewis, Deep Chandh Raja, Jenish Shroff and Rajeev Kumar Pathak

J. Cardiovasc. Dev. Dis. 2024, 11(5), 148; https://doi.org/10.3390/jcdd11050148 - 9 May 2024

Cited by 1 | Viewed by 3381

Abstract

Heart failure (HF) presents a significant global health challenge recognised by frequent hospitalisation and high mortality rates. The assessment of left ventricular (LV) ejection fraction (EF) plays a crucial role in diagnosing and predicting outcomes in HF, leading to its classification into preserved [...] Read more.

Heart failure (HF) presents a significant global health challenge recognised by frequent hospitalisation and high mortality rates. The assessment of left ventricular (LV) ejection fraction (EF) plays a crucial role in diagnosing and predicting outcomes in HF, leading to its classification into preserved (HFpEF), reduced (HFrEF), and mildly reduced (HFmrEF) EF. HFmrEF shares features of both HFrEF and HFpEF but also exhibits distinct characteristics. Despite advancements, managing HFmrEF remains challenging due to its diverse presentation. Large-scale studies are needed to identify the predictors of clinical outcomes and treatment responses. Utilising biomarkers for phenotyping holds the potential for discovering new treatment targets. Given the uncertainty surrounding optimal management, individualised approaches are imperative for HFmrEF patients. This chapter examines HFmrEF, discusses the rationale for its re-classification, and elucidates HFmrEF’s key attributes. Furthermore, it provides a comprehensive review of current treatment strategies for HFmrEF patients. Full article

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

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20 pages, 674 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Semaglutide in Cardiometabolic Diseases: SELECTing the Target Population

by Francesco Natale, Ettore Luisi, Rosa Franzese, Noemi Mollo, Achille Solimene, Valentina Maria Caso, Andrea Corvino, Paolo Golino and Giovanni Cimmino

J. Cardiovasc. Dev. Dis. 2024, 11(5), 145; https://doi.org/10.3390/jcdd11050145 - 7 May 2024

Cited by 2 | Viewed by 3764

Abstract

Cardiovascular diseases remain the main cause of death and disability worldwide. Despite the tremendous improvement in pharmacological, minimally invasive and rehabilitative strategies, global deaths due to cardiovascular diseases are still increasing. Additional risk factors have been recently proposed, and thanks to scientific progress, [...] Read more.

Cardiovascular diseases remain the main cause of death and disability worldwide. Despite the tremendous improvement in pharmacological, minimally invasive and rehabilitative strategies, global deaths due to cardiovascular diseases are still increasing. Additional risk factors have been recently proposed, and thanks to scientific progress, novel drugs for the control of the main risk factors focusing on the cardiometabolic pathways have been identified. Glucagon-like peptide-1 (GLP-1) receptor agonists represent an innovative step in the management of patients affected by type 2 diabetes mellitus. In addition to their significant efficacy on glycemic homeostasis, some members of this class of drugs have indications in the treatment of obesity. Furthermore, accumulated evidence in the literature has finally suggested a protective role in cardiovascular health. The possible role of GLP-1R agonist drugs (GLP-1RAs) on the mechanisms underlying chronic inflammation and the almost ubiquitous distribution of GLP-1 receptors could explain the enormous versatility of these drugs. Semaglutide is a GLP-1RA recently proven to be effective in cardiovascular outcomes. In the present article, we will review the available data on semaglutide in light of the most recent publications to better characterize the target population achieving cardiovascular benefits. Full article

(This article belongs to the Special Issue Unraveling the Complexities of Cardiometabolic Diseases: Interdisciplinary Insights and Innovative Approaches)

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12 pages, 1093 KiB

Open AccessEditor’s ChoiceArticle

Clinical Features and Patient Outcomes in Infective Endocarditis with Surgical Indication: A Single-Centre Experience

by Fausto Pizzino, Umberto Paradossi, Giancarlo Trimarchi, Giovanni Benedetti, Federica Marchi, Sara Chiappino, Mattia Conti, Gianluca Di Bella, Michele Murzi, Silvia Di Sibio, Giovanni Concistrè, Giacomo Bianchi and Marco Solinas

J. Cardiovasc. Dev. Dis. 2024, 11(5), 138; https://doi.org/10.3390/jcdd11050138 - 29 Apr 2024

Cited by 11 | Viewed by 1795

Abstract

Background: Infective endocarditis (IE) is marked by a heightened risk of embolic events (EEs), uncontrolled infection, or heart failure (HF). Methods: Patients with IE and surgical indication were enrolled from October 2015 to December 2018. The primary endpoint consisted of a composite of [...] Read more.

Background: Infective endocarditis (IE) is marked by a heightened risk of embolic events (EEs), uncontrolled infection, or heart failure (HF). Methods: Patients with IE and surgical indication were enrolled from October 2015 to December 2018. The primary endpoint consisted of a composite of major adverse events (MAEs) including all-cause death, hospitalizations, and IE relapses. The secondary endpoint was all-cause death. Results: A total of 102 patients (66 ± 14 years) were enrolled: 50% with IE on prosthesis, 33% with IE-associated heart failure (IE-aHF), and 38.2% with EEs. IE-aHF and EEs were independently associated with MAEs (HR 1.9, 95% CI 1.1–3.4, p = 0.03 and HR 2.1, 95% CI 1.2–3.6, p = 0.01, respectively) and Kaplan–Meier survival curves confirmed a strong difference in MAE-free survival of patients with EEs and IE-aHF (p < 0.01 for both). IE-aHF (HR 4.3, 95% CI 1.4–13, p < 0.01), CRP at admission (HR 5.6, 95% CI 1.4–22.2, p = 0.01), LVEF (HR 0.9, 95% CI 0.9–1, p < 0.05), abscess (HR 3.5, 95% CI 1.2–10.6, p < 0.05), and prosthetic detachment (HR 4.6, 95% CI 1.5–14.1, p < 0.01) were independently associated with the all-cause death endpoint. Conclusions: IE-aHF and EEs were independently associated with MAEs. IE-aHF was also independently associated with the secondary endpoint. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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12 pages, 1313 KiB

Open AccessEditor’s ChoiceArticle

Epicardial Atrial Fat at Cardiac Magnetic Resonance Imaging and AF Recurrence after Transcatheter Ablation

by Andrea Ballatore, Marco Gatti, Serena Mella, Davide Tore, Henri Xhakupi, Fabio Giorgino, Andrea Saglietto, Ludovica Carmagnola, Edoardo Roagna, Gaetano Maria De Ferrari, Riccardo Faletti and Matteo Anselmino

J. Cardiovasc. Dev. Dis. 2024, 11(5), 137; https://doi.org/10.3390/jcdd11050137 - 28 Apr 2024

Cited by 3 | Viewed by 2069

Abstract

The relationship between epicardial adipose tissue (EAT) and atrial fibrillation (AF) has gained interest in recent years. The previous literature on the topic presents great heterogeneity, focusing especially on computed tomography imaging. The aim of the present study is to determine whether an [...] Read more.

The relationship between epicardial adipose tissue (EAT) and atrial fibrillation (AF) has gained interest in recent years. The previous literature on the topic presents great heterogeneity, focusing especially on computed tomography imaging. The aim of the present study is to determine whether an increased volume of left atrial (LA) EAT evaluated at routine pre-procedural cardiac magnetic resonance imaging (MRI) relates to AF recurrences after catheter ablation. A total of 50 patients undergoing AF cryoballoon ablation and pre-procedural cardiac MRI allowing quantification of LA EAT were enrolled. In one patient, the segmentation of LA EAT could not be achieved. After a median follow-up of 16.0 months, AF recurrences occurred in 17 patients (34%). The absolute volume of EAT was not different in patients with and without AF recurrences (10.35 mL vs. 10.29 mL; p-value = 0.963), whereas the volume of EAT indexed on the LA volume (EATi) was lower, albeit non-statistically significant, in patients free from arrhythmias (12.77% vs. 14.06%; p-value = 0.467). The receiver operating characteristic curve testing the ability of LA EATi to predict AF recurrence after catheter ablation showed sub-optimal performance (AUC: 0.588). The finest identified cut-off of LA EATi was 10.65%, achieving a sensitivity of 0.5, a specificity of 0.82, a positive predictive value of 0.59 and a negative predictive value of 0.76. Patients with values of LA EATi lower than 10.65% showed greater survival, free from arrhythmias, than patients with values above this cut-off (84% vs. 48%; p-value = 0.04). In conclusion, EAT volume indexed on the LA volume evaluated at cardiac MRI emerges as a possible independent predictor of arrhythmia recurrence after AF cryoballoon ablation. Nevertheless, prospective studies are needed to confirm this finding and eventually sustain routine EAT evaluation in the management of patients undergoing AF catheter ablation. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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15 pages, 4871 KiB

Open AccessEditor’s ChoiceReview

How Artificial Intelligence Can Enhance the Diagnosis of Cardiac Amyloidosis: A Review of Recent Advances and Challenges

by Moaz A. Kamel, Mohammed Tiseer Abbas, Christopher N. Kanaan, Kamal A. Awad, Nima Baba Ali, Isabel G. Scalia, Juan M. Farina, Milagros Pereyra, Ahmed K. Mahmoud, D. Eric Steidley, Julie L. Rosenthal, Chadi Ayoub and Reza Arsanjani

J. Cardiovasc. Dev. Dis. 2024, 11(4), 118; https://doi.org/10.3390/jcdd11040118 - 13 Apr 2024

Cited by 9 | Viewed by 3598

Abstract

Cardiac amyloidosis (CA) is an underdiagnosed form of infiltrative cardiomyopathy caused by abnormal amyloid fibrils deposited extracellularly in the myocardium and cardiac structures. There can be high variability in its clinical manifestations, and diagnosing CA requires expertise and often thorough evaluation; as such, [...] Read more.

Cardiac amyloidosis (CA) is an underdiagnosed form of infiltrative cardiomyopathy caused by abnormal amyloid fibrils deposited extracellularly in the myocardium and cardiac structures. There can be high variability in its clinical manifestations, and diagnosing CA requires expertise and often thorough evaluation; as such, the diagnosis of CA can be challenging and is often delayed. The application of artificial intelligence (AI) to different diagnostic modalities is rapidly expanding and transforming cardiovascular medicine. Advanced AI methods such as deep-learning convolutional neural networks (CNNs) may enhance the diagnostic process for CA by identifying patients at higher risk and potentially expediting the diagnosis of CA. In this review, we summarize the current state of AI applications to different diagnostic modalities used for the evaluation of CA, including their diagnostic and prognostic potential, and current challenges and limitations. Full article

(This article belongs to the Special Issue Feature Review Papers in Acquired Cardiovascular Disease)

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11 pages, 1111 KiB

Open AccessEditor’s ChoiceReview

Ductus Arteriosus in Fetal and Perinatal Life

by Flaminia Pugnaloni, Daniela Doni, Mariella Lucente, Stefano Fiocchi and Irma Capolupo

J. Cardiovasc. Dev. Dis. 2024, 11(4), 113; https://doi.org/10.3390/jcdd11040113 - 1 Apr 2024

Cited by 5 | Viewed by 5440

Abstract

The ductus arteriosus represents an essential vascular structure connecting the pulmonary artery and the aorta. Over the past decades, there has been substantial advancement in our understanding of both the fundamental and clinical aspects of the ductus arteriosus. In particular, the clarification of [...] Read more.

The ductus arteriosus represents an essential vascular structure connecting the pulmonary artery and the aorta. Over the past decades, there has been substantial advancement in our understanding of both the fundamental and clinical aspects of the ductus arteriosus. In particular, the clarification of the regulatory mechanisms governing ductal patency in critical stages such as the fetal and the perinatal period has enabled optimal management of both physiological and pathological conditions in which the ductus arteriosus plays a crucial role. Furthermore, a more in-depth understanding of the regulatory mechanisms controlling this fundamental structure has facilitated the development of advanced therapeutic strategies and personalized interventions. In the present review, we provide a comprehensive overview of the ductus arteriosus during fetal and perinatal life, encompassing its physiological functions, pathological conditions, and clinical implications. Through this examination, we aim to contribute to a broader understanding of the ductus arteriosus’ role in these critical developmental stages and its significance in clinical practice. Full article

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