Journal of Cardiovascular Development and Disease

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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

Cited by 1 | Viewed by 536

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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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

Cited by 1 | Viewed by 776

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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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

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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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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

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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, 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

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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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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

Cited by 1 | Viewed by 1573

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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21 pages, 4995 KiB

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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 2 | Viewed by 1551

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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12 pages, 1522 KiB

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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

Cited by 1 | Viewed by 2008

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

Cited by 2 | Viewed by 1301

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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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

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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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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 1321

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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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 1514

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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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 1102

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, 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 1468

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 1512

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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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 4 | Viewed by 2535

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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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 1266

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, 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 2 | Viewed by 2082

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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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 12 | Viewed by 1876

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 2144

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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9 pages, 1460 KiB

Open AccessEditor’s ChoiceArticle

Radiation Exposure and Contrast Agent Use during Endovascular Aortic Repair Using Mobile Versus Fixed Angiography Systems

by Amir Arnautovic, Waseem Garabet, Reinhold Thomas Ziegler, Joscha Mulorz, Sönke Maximilian Braß, Alexander Oberhuber, Hubert Schelzig, Markus Udo Wagenhäuser and Philip Dueppers

J. Cardiovasc. Dev. Dis. 2024, 11(3), 83; https://doi.org/10.3390/jcdd11030083 - 29 Feb 2024

Cited by 1 | Viewed by 2099

Abstract

Background: For (thoracic) endovascular aortic repair ((T)EVAR) procedures, both mobile (standard operating room (SOR)) and fixed C-arm (hybrid operating room (HOR)) systems are available. This study evaluated differences in key procedural parameters, and procedural success for (T)EVAR in the SOR versus the HOR. [...] Read more.

Background: For (thoracic) endovascular aortic repair ((T)EVAR) procedures, both mobile (standard operating room (SOR)) and fixed C-arm (hybrid operating room (HOR)) systems are available. This study evaluated differences in key procedural parameters, and procedural success for (T)EVAR in the SOR versus the HOR. Methods: All patients who underwent standard elective (T)EVAR at the Clinic for Vascular and Endovascular Surgery at the University Hospital Duesseldorf, Germany, between 1 January 2012 and 1 January 2019 were included. Data were retrieved from archived medical records. Endpoints were analyzed for SOR versus HOR during (T)EVAR. Results: A total of 93 patients, including 50 EVAR (SOR (n = 20); HOR (n = 30)) and 43 TEVAR (SOR (n = 22); HOR (n= 21)) were included. The dose area product (DAP) for EVAR and TEVAR was lower in the SOR than in the HOR (EVAR, SOR: 1635 ± 1088 cGy·cm²; EVAR, HOR: 7819 ± 8928 cGy·cm²; TEVAR, SOR: 8963 ± 34,458 cGy·cm²; TEVAR, HOR: 14,591 ± 11,584 cGy·cm² (p < 0.05)). Procedural fluoroscopy time was shorter in the SOR than in the HOR for EVAR and TEVAR (EVAR, SOR: 7 ± 4 min; EVAR, HOR: 18.8 ± 11.3 min; TEVAR, SOR: 6.6 ± 9.6 min; TEVAR, HOR: 13.9 ± 11.8 min (p < 0.05)). Higher volumes of contrast agent were applied during EVAR and TEVAR in the SOR than in the HOR (EVAR, SOR: 57.5 ± 20 mL; EVAR: HOR: 33.3 ± 5 mL (p < 0.05); TEVAR; SOR: 71.5 ± 53.4 mL, TEVAR, HOR: 48.2 ± 27.5 mL (p ≥ 0.05). Conclusion: The use of a fixed C-arm angiography system in the HOR results in higher radiation exposure and longer fluoroscopy times but lower contrast agent volumes when compared with mobile C-arm systems in the SOR. Because stochastic radiation sequelae are more likely to be tolerated in an older patient population and, in addition, there is a higher incidence of CKD in this patient population, allocation of patients to the HOR for standard (T)EVAR seems particularly advisable based on our results. Full article

(This article belongs to the Section Imaging)

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13 pages, 754 KiB

Open AccessEditor’s ChoiceArticle

Exploring the Correlation between Systemic Inflammatory Markers and Carotid Atherosclerosis Indices in Middle-Aged Adults: A Cross-Sectional Study

by Ji-Eun Song, Ji-In Hwang, Hae-Jin Ko, Ji-Yeon Park, Hee-Eun Hong and A-Sol Kim

J. Cardiovasc. Dev. Dis. 2024, 11(3), 73; https://doi.org/10.3390/jcdd11030073 - 21 Feb 2024

Cited by 7 | Viewed by 2569

Abstract

Background: This study investigated the association between atherosclerosis and systemic inflammation markers, specifically the C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in healthy middle-aged adults. Methods: A retrospective cross-sectional study was conducted on a total of [...] Read more.

Background: This study investigated the association between atherosclerosis and systemic inflammation markers, specifically the C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in healthy middle-aged adults. Methods: A retrospective cross-sectional study was conducted on a total of 1264 Korean adults aged 40–65. We assessed these inflammatory markers and carotid metrics, such as carotid intima–media thickness (cIMT), plaque number (PN), plaque stenosis score (PSS), and plaque score (PS), using linear regression, logistic regression, and receiver operating characteristic analysis. Results: In males, the ESR and CRP were significantly correlated with the PN (p < 0.001 and p = 0.048, respectively). The ESR was correlated with the PN in females (p = 0.004). The NLR and PLR both correlated with the PS in males (p < 0.001 and p = 0.015, respectively) and females (p = 0.015 and p = 0.023, respectively). The odds ratio for the NLR as a risk factor for increased cIMT was 1.15 (95% confidence interval [CI], 1.03–2.15) for males and 1.05 (95% CI, 1.01–1.29) for females. The AUC for the NLR and PLR as a predictor for the PS showed significance in both men and women. Conclusions: Inflammatory markers, particularly the NLR and PLR, demonstrate a correlation with carotid atherosclerosis. Both the NLR and PLR hold potential as valuable surrogate markers for carotid atherosclerosis. To further substantiate their predictive efficacy, further prospective studies are needed. Full article

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16 pages, 2014 KiB

Open AccessEditor’s ChoiceArticle

Adding Electroanatomical Mapping to Cryoballoon Pulmonary Vein Isolation Improves 1-Year Clinical Outcome and Durability of Pulmonary Vein Isolation: A Propensity Score-Matched Analysis

by Maxime Tijskens, Juan Pablo Abugattas, Hendrik Thoen, Antanas Strazdas, Bruno Schwagten, Michael Wolf and Yves De Greef

J. Cardiovasc. Dev. Dis. 2024, 11(2), 57; https://doi.org/10.3390/jcdd11020057 - 6 Feb 2024

Cited by 4 | Viewed by 2308

Abstract

Background: Adding electroanatomical left atrial (LA) voltage mapping to cryoballoon ablation (CBA) improves validation of acute pulmonary vein isolation (PVI). Aims: To determine whether the addition of mapping can improve outcome and PVI durability. Methods: One-year outcome and PV reconnection (PVR) rate at [...] Read more.

Background: Adding electroanatomical left atrial (LA) voltage mapping to cryoballoon ablation (CBA) improves validation of acute pulmonary vein isolation (PVI). Aims: To determine whether the addition of mapping can improve outcome and PVI durability. Methods: One-year outcome and PV reconnection (PVR) rate at first repeat ablation were studied in 400 AF patients in a propensity-matched analysis (age, AF type, CHA₂DS₂-VASc score) between Achieve catheter-guided CBA with additional EnSite LA voltage maps performed pre- and post-CBA (mapping group; N = 200) and CT- and Achieve catheter-guided CBA (control group; N = 200). Clinical success was defined as freedom of documented AF or atrial tachycardia (AT) > 30 s. PV reconnection patterns were characterized in repeat ablations. Results: At 1 year, 77 (19.25%) patients had recurrence of AF/AT, significantly lower than in the mapping group: 21 (10.5%) vs. 56 (28%), p < 0.001. Procedure time was shorter (72.2 ± 25.4 vs. 78.2 ± 29.3 min, p = 0.034) and radiation exposure lower (4465.0 ± 3454.6 Gy.cm² vs. 5940.5 ± 4290.5 Gy.cm², p = 0.037). Use of mapping was protective towards AF/AT recurrence (HR = 0.348; 95% CI 0.210–0.579; p < 0.001), independent of persistent AF type (HR = 1.723; 95% CI 1.034–2.872; p = 0.037), and LA diameter (HR = 1.055; 95% CI 1.015–1.096; p = 0.006). At repeat ablation (N = 90), persistent complete PVI was seen in 14/20 (70.0%) versus 23/70 (32.9%) in the mapping and conventional group, respectively (p = 0.03). Reconnection rate of the right inferior PV was lower with mapping (10.0% vs. 34,3%, p = 0.035). Conclusions: Adding electroanatomical LA voltage mapping to CBA improves 1-year clinical outcome and lowers both procedure time and radiation exposure. At repeat, use of mapping increases complete persistent PVI mainly by improving PVI durability of the RIPV. Full article

(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: New Emerging Technologies, Promising Ablation Strategies beyond the Pulmonary Veins and Potential Role of Ablation in Improving Patient Prognosis)

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11 pages, 672 KiB

Open AccessEditor’s ChoiceArticle

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

by Natsumi Kikuchi, Taichiro Goto, Nobuyuki Katsumata, Yasushi Murakami, Tamao Shinohara, Yuki Maebayashi, Aiko Sakakibara, Chisato Saito, Yohei Hasebe, Minako Hoshiai, Atsushi Nemoto and Atsushi Naito

J. Cardiovasc. Dev. Dis. 2024, 11(1), 26; https://doi.org/10.3390/jcdd11010026 - 16 Jan 2024

Cited by 7 | Viewed by 4727

Abstract

In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm [...] Read more.

In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm infants with a birth weight of less than 1500 g who were admitted to our NICU over a period of 9 years (2011–2019) and were diagnosed with PDA were included. A new version of the K-type developmental test for corrected ages of 1.5 and 3 years was used as an index of development. The relationship between the duration of PDA and the developmental index was evaluated using Pearson’s correlation coefficient, and multiple regression analysis was performed. Development quotient (DQ) at the ages of 1.5 and 3 years showed a correlation with the PDA closure date and the standard deviation (SD) value of the term birth weight. Multiple regression analysis showed a positive correlation of the DQ at 1.5 and 3 years with the SD value of the term birth weight and a negative correlation with the PDA closure date. In addition, a stronger correlation was found in the “posture/motor” sub-item at 3 years. On the other hand, the analysis including preterm infants without PDA showed that preterm infants with PDA closure on the 6th day or later after birth had a significantly lower 3-year-old DQ than preterm infants with a PDA exposure within 5 days. In conclusion, it is suggested that the decrease in cerebral blood flow due to PDA in preterm infants has an adverse effect on long-term neurodevelopment. Appropriate interventions, including surgical treatment for PDA in preterm infants without delay, ideally within 5 days of birth, may be effective in improving the developmental prognosis. Full article

(This article belongs to the Special Issue Patent Ductus Arteriosus in Premature Babies)

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12 pages, 808 KiB

Open AccessEditor’s ChoiceArticle

“I Just Want You to Hear That Term”: Characterizing Language Used in Fetal Cardiology Consultations

by Kelsey Schweiberger, Kelly W. Harris, Ann Kavanaugh-McHugh, Abdesalam Soudi, Robert M. Arnold, Jessica S. Merlin, Nadine A. Kasparian and Judy C. Chang

J. Cardiovasc. Dev. Dis. 2023, 10(9), 394; https://doi.org/10.3390/jcdd10090394 - 13 Sep 2023

Cited by 4 | Viewed by 2712

Abstract

The way clinicians communicate with parents during pregnancy about congenital heart disease (CHD) can significantly influence parental understanding of and psychological response to the diagnosis. A necessary first step to improving communication used in fetal cardiology consultations is to understand and describe the [...] Read more.

The way clinicians communicate with parents during pregnancy about congenital heart disease (CHD) can significantly influence parental understanding of and psychological response to the diagnosis. A necessary first step to improving communication used in fetal cardiology consultations is to understand and describe the language currently used, which this paper aims to do. Nineteen initial fetal cardiology consultations with parents were audio-recorded, transcribed verbatim, and coded by two independent coders. A codebook was inductively developed and applied to all transcripts. The finalized coding was used to characterize fetal cardiologists’ language. We identified four discourse styles employed in fetal cardiology consultations: small talk, medical, plain, and person-centered. Plain language was used to define and emphasize the meaning of medical language. Person-centered language was used to emphasize the baby as a whole person. Each consultation included all four discourse styles, with plain and medical used most frequently. Person-centered was used less frequently and mostly occurred near the end of the encounters; whether this is the ideal balance of discourse styles is unknown. Clinicians also used person-centered language (as opposed to disease-centered language), which is recommended by medical societies. Future studies should investigate the ideal balance of discourse styles and the effects of clinician discourse styles on family outcomes, including parents’ decision-making, psychological adjustment, and quality of life. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Risk Factors, Prenatal Diagnosis, and Outcomes)

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14 pages, 3146 KiB

Open AccessEditor’s ChoiceArticle

Cardiac Morphology, Function, and Left Ventricular Geometric Pattern in Patients with Hypertensive Crisis: A Cardiovascular Magnetic Resonance-Based Study

by Mohammed A. Talle, Anton F. Doubell, Pieter-Paul S. Robbertse, Sa’ad Lahri and Philip G. Herbst

J. Cardiovasc. Dev. Dis. 2023, 10(9), 367; https://doi.org/10.3390/jcdd10090367 - 27 Aug 2023

Cited by 1 | Viewed by 1925

Abstract

(1) Background: Altered cardiac morphology and function are associated with increased risks of adverse cardiac events in hypertension. Our study aimed to assess left ventricular (LV) morphology, geometry, and function using cardiovascular magnetic resonance (CMR) imaging in patients with hypertensive crisis. (2) Methods: [...] Read more.

(1) Background: Altered cardiac morphology and function are associated with increased risks of adverse cardiac events in hypertension. Our study aimed to assess left ventricular (LV) morphology, geometry, and function using cardiovascular magnetic resonance (CMR) imaging in patients with hypertensive crisis. (2) Methods: Patients with hypertensive crisis underwent CMR imaging at 1.5 Tesla to assess cardiac volume, mass, function, and contrasted study. Left ventricular (LV) function and geometry were defined according to the guideline recommendations. Late gadolinium enhancement (LGE) was qualitatively assessed and classified into ischemic and nonischemic patterns. Predictors of LGE was determined using regression analysis. (3) Results: Eighty-two patients with hypertensive crisis (aged 48.5 ± 13.4 years, and 57% males) underwent CMR imaging. Of these patients, seventy-eight percent were hypertensive emergency and twenty-two percent were urgency. Diastolic blood pressure was higher under hypertensive emergency (p = 0.032). Seventy-nine percent (92% of emergency vs. 59% of urgency, respectively; p = 0.003) had left ventricular hypertrophy (LVH). The most prevalent LV geometry was concentric hypertrophy (52%). Asymmetric LVH occurred in 13 (22%) of the participants after excluding ischemic LGE. Impaired systolic function occurred in 46% of patients, and predominantly involved hypertensive emergency. Nonischemic LGE occurred in 75% of contrasted studies (67.2% in emergency versus 44.4% in urgency, respectively; p < 0.001). Creatinine and LV mass were independently associated with nonischemic LGE. (5) Conclusion: LVH, altered geometry, asymmetric LVH, impaired LV systolic function, and LGE are common under hypertensive crisis. LVH and LGE more commonly occurred under hypertensive emergency. Longitudinal studies are required to determine the prognostic implications of asymmetric LVH and LGE in hypertensive crisis. Full article

(This article belongs to the Section Imaging)

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24 pages, 16692 KiB

Open AccessEditor’s ChoiceArticle

Recognition of Supraventricular Arrhythmias in Holter ECG Recordings by ECHOView Color Map: A Case Series Study

by Stefan Naydenov, Irena Jekova and Vessela Krasteva

J. Cardiovasc. Dev. Dis. 2023, 10(9), 360; https://doi.org/10.3390/jcdd10090360 - 24 Aug 2023

Cited by 2 | Viewed by 4416

Abstract

Ambulatory 24–72 h Holter ECG monitoring is recommended for patients with suspected arrhythmias, which are often transitory and might remain unseen in resting standard 12-lead ECG. Holter manufacturers provide software diagnostic tools to assist clinicians in evaluating these large amounts of data. Nevertheless, [...] Read more.

Ambulatory 24–72 h Holter ECG monitoring is recommended for patients with suspected arrhythmias, which are often transitory and might remain unseen in resting standard 12-lead ECG. Holter manufacturers provide software diagnostic tools to assist clinicians in evaluating these large amounts of data. Nevertheless, the identification of short arrhythmia events and differentiation of the arrhythmia type might be a problem in limited Holter ECG leads. This observational clinical study aims to explore a novel and weakly investigated ECG modality integrated into a commercial diagnostic tool ECHOView (medilog DARWIN 2, Schiller AG, Switzerland), while used for the interpretation of long-term Holter-ECG records by a cardiologist. The ECHOView transformation maps the beat waveform amplitude to a color-coded bar. One ECHOView page integrates stacked color bars of about 1740 sequential beats aligned by R-peak in a window (R ± 750 ms). The collected 3-lead Holter ECG recordings from 86 patients had a valid duration of 21 h 20 min (19 h 30 min–22 h 45 min), median (quartile range). The ECG rhythm was reviewed with 3491 (3192–3723) standard-grid ECG pages and a substantially few number of 51 (44–59) ECHOView pages that validated the ECHOView compression ratio of 67 (59–74) times. Comments on the ECG rhythm and ECHOView characteristic patterns are provided for 14 examples representative of the most common rhythm disorders seen in our population, including supraventricular arrhythmias (supraventricular extrasystoles, paroxysmal supraventricular arrhythmia, sinus tachycardia, supraventricular tachycardia, atrial fibrillation, and flutter) and ventricular arrhythmias (ventricular extrasystoles, non-sustained ventricular tachycardia). In summary, the ECHOView color map transforms the ECG modality into a novel diagnostic image of the patient’s rhythm that is comprehensively interpreted by a cardiologist. ECHOView has the potential to facilitate the manual overview of Holter ECG recordings, to visually identify short-term arrhythmia episodes, and to refine the diagnosis, especially in high-rate arrhythmias. Full article

(This article belongs to the Special Issue Advanced Diagnostic Imaging for Cardiovascular Disease)

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10 pages, 1063 KiB

Open AccessEditor’s ChoiceArticle

Changes in the Cath Lab in the Treatment of Adult Patients with Congenital Heart Disease: A 12-Year Experience in a Single Referral Center with the Establishment of a Dedicated Working Group

by Maria Giulia Gagliardi, Roberto Formigari, Marco Alfonso Perrone, Elettra Pomiato, Francesca Fanisio, Mario Panebianco, Rosaria Barracano, Paolo Guccione, Rosalinda Palmieri, Massimiliano Raponi and Lorenzo Galletti

J. Cardiovasc. Dev. Dis. 2023, 10(8), 314; https://doi.org/10.3390/jcdd10080314 - 25 Jul 2023

Cited by 2 | Viewed by 2017

Abstract

Background: Adults with congenital heart disease (ACHD) are a growing population needing ongoing care. The aim of this study was to investigate if a dedicated ACHD team impacted the timing and indication of invasive cardiology procedures in these patients at our hospital. Methods: [...] Read more.

Background: Adults with congenital heart disease (ACHD) are a growing population needing ongoing care. The aim of this study was to investigate if a dedicated ACHD team impacted the timing and indication of invasive cardiology procedures in these patients at our hospital. Methods: Our retrospective single-center study enrolled adult patients with moderate or complex congenital heart disease and with at least one cardiac catheterization between January 2010 and December 2021. According to the period, procedures were labeled as group A (2010 to 2015) or group B (2016 to 2021) and further divided into diagnostic (DCC) and interventional cardiac catheterizations (ICC). Results: 594 patients were eligible for the study. Both DCC (p < 0.05) and ICC increased between groups A and B (p < 0.05). In group B: Fontan patients accounted for the majority of DCC (p < 0.001), while DCC decreased in arterial switch repair (p < 0.001). In Fontan patients, conduit stenting was prevalent (p < 0.001), while fenestration closures dropped (p < 0.01). In patients with tetralogy of Fallot and native outflow tract, percutaneous pulmonary valve implantations (PPVI) increased, with a concurrent reduction in pulmonary valve replacements (p < 0.001 vs. surgical series). In right ventricular conduits, ICC increased (p < 0.01), mainly due to PPVI. Among Mustard/Senning patients, baffle stenting increased from Group A to Group B (p < 0.001). In patients with pulmonary atresia and biventricular repair, ICC often increased for pulmonary artery stenting. Conclusions: A dedicated working group could improve ACHD patients’ indications for interventional procedures, leading to tailored treatment, better risk stratification and optimizing time until heart transplantation. Full article

(This article belongs to the Special Issue Recent Advances in Adult Congenital Heart Disease Cardiovascular Medicine)

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19 pages, 10151 KiB

Open AccessEditor’s ChoiceArticle

H3K36 Di-Methylation Marks, Mediated by Ash1 in Complex with Caf1-55 and MRG15, Are Required during Drosophila Heart Development

by Jun-yi Zhu, Chen Liu, Xiaohu Huang, Joyce van de Leemput, Hangnoh Lee and Zhe Han

J. Cardiovasc. Dev. Dis. 2023, 10(7), 307; https://doi.org/10.3390/jcdd10070307 - 18 Jul 2023

Cited by 1 | Viewed by 2403

Abstract

Methyltransferases regulate transcriptome dynamics during development and aging, as well as in disease. Various methyltransferases have been linked to heart disease, through disrupted expression and activity, and genetic variants associated with congenital heart disease. However, in vivo functional data for many of the [...] Read more.

Methyltransferases regulate transcriptome dynamics during development and aging, as well as in disease. Various methyltransferases have been linked to heart disease, through disrupted expression and activity, and genetic variants associated with congenital heart disease. However, in vivo functional data for many of the methyltransferases in the context of the heart are limited. Here, we used the Drosophila model system to investigate different histone 3 lysine 36 (H3K36) methyltransferases for their role in heart development. The data show that Drosophila Ash1 is the functional homolog of human ASH1L in the heart. Both Ash1 and Set2 H3K36 methyltransferases are required for heart structure and function during development. Furthermore, Ash1-mediated H3K36 methylation (H3K36me2) is essential for healthy heart function, which depends on both Ash1-complex components, Caf1-55 and MRG15, together. These findings provide in vivo functional data for Ash1 and its complex, and Set2, in the context of H3K36 methylation in the heart, and support a role for their mammalian homologs, ASH1L with RBBP4 and MORF4L1, and SETD2, during heart development and disease. Full article

(This article belongs to the Special Issue Epigenetic Regulation of Cardiac Development, Regeneration and Disease)

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15 pages, 3007 KiB

Open AccessEditor’s ChoiceArticle

Imaging Predictors of Left Ventricular Functional Recovery after Reperfusion Therapy of ST-Elevation Myocardial Infarction Assessed by Cardiac Magnetic Resonance

by Agneta Virbickiene, Tomas Lapinskas, Christoph D. Garlichs, Stephan Mattecka, Radu Tanacli, Wolfgang Ries, Jan Torzewski, Franz Heigl, Christian Pfluecke, Harald Darius, Hueseyin Ince, Peter Nordbeck, Christian Butter, Andreas Schuster, Steffen Mitzner, Olivija Dobiliene, Ahmed Sheriff and Sebastian Kelle

J. Cardiovasc. Dev. Dis. 2023, 10(7), 294; https://doi.org/10.3390/jcdd10070294 - 11 Jul 2023

Cited by 2 | Viewed by 2161

Abstract

Background: Left ventricular global longitudinal strain (LV GLS) is a superior predictor of adverse cardiac events in patients with myocardial infarction and heart failure. We investigated the ability of morphological features of infarcted myocardium to detect acute left ventricular (LV) dysfunction and predict [...] Read more.

Background: Left ventricular global longitudinal strain (LV GLS) is a superior predictor of adverse cardiac events in patients with myocardial infarction and heart failure. We investigated the ability of morphological features of infarcted myocardium to detect acute left ventricular (LV) dysfunction and predict LV functional recovery after three months in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: Sixty-six STEMI patients were included in the C-reactive protein (CRP) apheresis in Acute Myocardial Infarction Study (CAMI-1). LV ejection fraction (LVEF), LV GLS, LV global circumferential strain (LV GCS), infarct size (IS), area-at-risk (AAR), and myocardial salvage index (MSI) were assessed by CMR 5 ± 3 days (baseline) and 12 ± 2 weeks after (follow-up) the diagnosis of first acute STEMI. Results: Significant changes in myocardial injury parameters were identified after 12 weeks of STEMI diagnosis. IS decreased from 23.59 ± 11.69% at baseline to 18.29 ± 8.32% at follow-up (p < 0.001). AAR and MVO also significantly reduced after 12 weeks. At baseline, there were reasonably moderate correlations between IS and LVEF (r = −0.479, p < 0.001), LV GLS (r = 0.441, p < 0.001) and LV GCS (r = 0.396, p = 0.001) as well as between AAR and LVEF (r = −0.430, p = 0.003), LV GLS (r = 0.501, p < 0.001) and weak with LV GCS (r = 0.342, p = 0.020). At follow-up, only MSI and change in LV GCS over time showed a weak but significant correlation (r = −0.347, p = 0.021). Patients with larger AAR at baseline improved more in LVEF (p = 0.019) and LV GLS (p = 0.020) but not in LV GCS. Conclusion: The CMR tissue characteristics of myocardial injury correlate with the magnitude of LV dysfunction during the acute stage of STEMI. AAR predicts improvement in LVEF and LV GLS, while MSI is a sensitive marker of LV GCS recovery at three months follow-up after STEMI. Full article

(This article belongs to the Special Issue Cardiovascular Magnetic Resonance in Cardiology Practice)

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13 pages, 433 KiB

Open AccessEditor’s ChoiceArticle

Cardiac Function and Serum Biomarkers throughout Staged Fontan Palliation: A Prospective Observational Study

by J. P. G. van der Ven, V P. Kamphuis, E van den Bosch, D Gnanam, C Terol, A J. J. C. Bogers, J. M. P. J. Breur, R. M. F. Berger, N. A. Blom, A. D. J. ten Harkel, L. Koopman and W. A. Helbing

J. Cardiovasc. Dev. Dis. 2023, 10(7), 289; https://doi.org/10.3390/jcdd10070289 - 7 Jul 2023

Cited by 3 | Viewed by 1995

Abstract

Fontan patients undergo multiple cardiothoracic surgeries in childhood. Following these procedures, ventricular function is temporarily decreased, and recovers over months. This is presumably related to cardiopulmonary bypass, but this is incompletely understood. Throughout the Fontan palliation, cardiac function is also affected by volume [...] Read more.

Fontan patients undergo multiple cardiothoracic surgeries in childhood. Following these procedures, ventricular function is temporarily decreased, and recovers over months. This is presumably related to cardiopulmonary bypass, but this is incompletely understood. Throughout the Fontan palliation, cardiac function is also affected by volume unloading. We aimed to gain insight into the biological processes related to impaired ventricular function and recovery following Fontan palliations using a panel of biomarkers. Furthermore, we described changes in ventricular function across the Fontan palliation due to volume unloading. We performed a prospective multicenter observational study in patients undergoing partial (PCPC) or total cavo-pulmonary connection (TCPC). Patients underwent assessment—including echocardiography and blood sampling—before surgery (T1), at first follow-up (T2), and 1 year after their procedures (T3). Blood samples were analyzed using a biomarker panel (OLINK CVD-III). Ninety-two biomarkers were expressed as principal components (PC) to limit multiple statistical testing. We included 32 PCPC patients aged 7.2 [5.3–10.3] months, and 28 TCPC patients aged 2.7 [2.2–3.8] years. The single ventricular longitudinal strain (SV GLS) temporarily decreased for PCPC patients at T2 (−15.1 ± 5.6 (T1) to −13.5 ± 5.2 (T2) to −17.3 ± 4.5 (T3), p < 0.047 for all differences), but not following TCPC. The serum biomarkers were expressed as 4 PCs. PC1, including biomarkers of cell–cell adhesion, was not related to any patient characteristic. PC2, including biomarkers of superoxide anion regulation, increased at T2. PC3, including biomarkers of cardiovascular development, related to the stage of Fontan palliation. PC4 was of uncertain biological or clinical significance. No PC was found that related to ventricular performance. The SV GLS was temporarily diminished following PCPC, but not following TCPC. Several biomarkers were related to post-operative stress and adaptation to the PCPC or TCPC circulation, but none were related to the outcome. Full article

(This article belongs to the Special Issue Echocardiography in Pediatric Heart Disease)

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15 pages, 1514 KiB

Open AccessEditor’s ChoiceArticle

Purkinje Cardiomyocytes of the Adult Ventricular Conduction System Are Highly Diploid but Not Uniquely Regenerative

by Hirofumi Watanabe, Ge Tao, Peiheng Gan, Baylee C. Westbury, Kristie D. Cox, Kelsey Tjen, Ruolan Song, Glenn I. Fishman, Takako Makita and Henry M. Sucov

J. Cardiovasc. Dev. Dis. 2023, 10(4), 161; https://doi.org/10.3390/jcdd10040161 - 7 Apr 2023

Cited by 3 | Viewed by 2812

Abstract

Adult hearts are characterized by inefficient regeneration after injury, thus, the features that support or prevent cardiomyocyte (CM) proliferation are important to clarify. Diploid CMs are a candidate cell type that may have unique proliferative and regenerative competence, but no molecular markers are [...] Read more.

Adult hearts are characterized by inefficient regeneration after injury, thus, the features that support or prevent cardiomyocyte (CM) proliferation are important to clarify. Diploid CMs are a candidate cell type that may have unique proliferative and regenerative competence, but no molecular markers are yet known that selectively identify all or subpopulations of diploid CMs. Here, using the conduction system expression marker Cntn2-GFP and the conduction system lineage marker Etv1Cre^ERT2, we demonstrate that Purkinje CMs that comprise the adult ventricular conduction system are disproportionately diploid (33%, vs. 4% of bulk ventricular CMs). These, however, represent only a small proportion (3%) of the total diploid CM population. Using EdU incorporation during the first postnatal week, we demonstrate that bulk diploid CMs found in the later heart enter and complete the cell cycle during the neonatal period. In contrast, a significant fraction of conduction CMs persist as diploid cells from fetal life and avoid neonatal cell cycle activity. Despite their high degree of diploidy, the Purkinje lineage had no enhanced competence to support regeneration after adult heart infarction. Full article

(This article belongs to the Special Issue Cardiac Development, Regeneration and Repair)

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13 pages, 2727 KiB

Open AccessEditor’s ChoiceArticle

Morphological and Functional Remodeling of the Ischemic Heart Correlates with Homocysteine Levels

by Attila Cziraki, Zoltan Nemeth, Sandor Szabados, Tamas Nagy, Márk Szántó, Csaba Nyakas and Akos Koller

J. Cardiovasc. Dev. Dis. 2023, 10(3), 122; https://doi.org/10.3390/jcdd10030122 - 14 Mar 2023

Cited by 3 | Viewed by 2787

Abstract

Background: Homocysteine (Hcy) is involved in various methylation processes, and its plasma level is increased in cardiac ischemia. Thus, we hypothesized that levels of homocysteine correlate with the morphological and functional remodeling of ischemic hearts. Thus, we aimed to measure the Hcy levels [...] Read more.

Background: Homocysteine (Hcy) is involved in various methylation processes, and its plasma level is increased in cardiac ischemia. Thus, we hypothesized that levels of homocysteine correlate with the morphological and functional remodeling of ischemic hearts. Thus, we aimed to measure the Hcy levels in the plasma and pericardial fluid (PF) and correlate them with morphological and functional changes in the ischemic hearts of humans. Methods: Concentration of total homocysteine (tHcy) and cardiac troponin-I (cTn-I) of plasma and PF were measured in patients undergoing coronary artery bypass graft (CABG) surgery (n = 14). Left-ventricular (LV) end-diastolic diameter (LVED), LV end-systolic diameter (LVES), right atrial, left atrial (LA) area, thickness of interventricular septum (IVS) and posterior wall, LV ejection fraction (LVEF), and right ventricular outflow tract end-diastolic area (RVOT EDA) of CABG and non-cardiac patients (NCP; n = 10) were determined by echocardiography, and LV mass was calculated (cLVM). Results: Positive correlations were found between Hcy levels of plasma and PF, tHcy levels and LVED, LVES and LA, and an inverse correlation was found between tHcy levels and LVEF. cLVM, IVS, and RVOT EDA were higher in CABG with elevated tHcy (>12 µM/L) compared to NCP. In addition, we found a higher cTn-I level in the PF compared to the plasma of CABG patients (0.08 ± 0.02 vs. 0.01 ± 0.003 ng/mL, p < 0.001), which was ~10 fold higher than the normal level. Conclusions: We propose that homocysteine is an important cardiac biomarker and may have an important role in the development of cardiac remodeling and dysfunction in chronic myocardial ischemia in humans. Full article

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11 pages, 1077 KiB

Open AccessEditor’s ChoiceArticle

Target Balloon-Assisted Antegrade and Retrograde Use of Re-Entry Catheters in Complex Chronic Total Occlusions

by Lorenzo Patrone, Nada Selva Theivacumar, Brahman Dharmarajah, Narayanan Thulasidasan, Athanasios Diamantopoulos, Luis Mariano Palena, Muliadi Antaredja, Lisa Tilemann and Erwin Blessing

J. Cardiovasc. Dev. Dis. 2023, 10(2), 53; https://doi.org/10.3390/jcdd10020053 - 29 Jan 2023

Cited by 2 | Viewed by 3408

Abstract

Purpose, Retrograde recanalizations have gained increasing recognition in complex arterial occlusive disease. Re-entry devices are a well described adjunct for antegrade recanalizations. We present our experience with target balloon-assisted antegrade and retrograde recanalizations using re-entry devices in challenging chronic total occlusions. Materials and [...] Read more.

Purpose, Retrograde recanalizations have gained increasing recognition in complex arterial occlusive disease. Re-entry devices are a well described adjunct for antegrade recanalizations. We present our experience with target balloon-assisted antegrade and retrograde recanalizations using re-entry devices in challenging chronic total occlusions. Materials and Methods: We report data from a retrospective multicenter registry. Eligibility criteria included either antegrade or retrograde use of the Outback^TM or GoBack^TM re-entry catheter in combination with a balloon as a target to accomplish wire passage, when conventional antegrade and retrograde recanalization attempts had been unsuccessful. Procedural outcomes included technical success (defined as wire passage though the occlusion and delivery of adjunctive therapy with <30% residual stenosis at final angiogram), safety (periprocedural complications, e.g., bleeding, vessel injury, or occlusion of the artery at the re-entry site, and distal embolizations), and clinical outcome (amputation-free survival and freedom from target lesion revascularization after 12-months follow-up). Results: Thirty-six consecutive patients underwent target balloon-assisted recanalization attempts. Fourteen (39 %) patients had a history of open vascular surgery in the index limb. Fifteen patients were claudications (Rutherford Class 2 or 3, 21 presented with chronic limb threatening limb ischemia (Rutherford Class 4 to 6). The locations of the occlusive lesions were as follows: iliac arteries in 3 cases, femoropopliteal artery in 39 cases, and in below-the-knee arteries in 12 cases. In 15 cases, recanalization was attempted in multilevel occlusions. Retrograde access was attempted in 1 case in the common femoral artery, in the femoropopliteal segment in 10 cases, in below-the-knee arteries in 23 cases, and finally in 2 patients via the brachial artery. In 10 cases, the re-entry devices were inserted via the retrograde access site. Technical success was achieved in 34 (94 %) patients. There were 3 periprocedural complications, none directly related to the target balloon-assisted re-entry maneuver. Amputation-free survival was 87.8 % and freedom from clinically driven target lesion revascularization was 86.6 % after 12-months follow-up. Conclusion: Target balloon-assisted use of re-entry devices in chronic total occlusions provides an effective and safe endovascular adjunct, when conventional antegrade and retrograde recanalization attempts have failed. Full article

(This article belongs to the Special Issue Management and Challenges in Peripheral Arterial Disease)

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13 pages, 1036 KiB

Open AccessEditor’s ChoiceArticle

An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery

by Ulvi Cenk Oezpeker, Fabian Barbieri, Daniel Höfer, Can Gollmann-Tepeköylü, Johannes Holfeld, Florian Sommerauer, Julian Wagner, Sasa Rajsic, Suat Ersahin, Nikolaos Bonaros, Michael Grimm and Müller Ludwig

J. Cardiovasc. Dev. Dis. 2023, 10(1), 28; https://doi.org/10.3390/jcdd10010028 - 11 Jan 2023

Cited by 1 | Viewed by 2256

Abstract

Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we [...] Read more.

Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we developed a personalized, minimized-invasiveness algorithm for MVS. Methods: In this retrospective analysis, 517 elderly patients (≥70 years) were identified who had undergone MVS ± TV repair. MVS was performed via MT (n = 274), FS (n = 128) and PS (n = 115). The appropriate access type was defined according to several clinical patient conditions. Using uni- and multivariate regression models, we analyzed combined operative success (residual MV regurgitation, conversion to MV replacement or larger thoracic incisions); perioperative success (30-days mortality, thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation); and reoperation-free long-term survival. An additional EuroSCORE2 adjustment was performed to reduce the bias of clinical conditions between all access types. Results: The EuroSCORE2-adjusted Cox regression analysis showed significantly increased reoperation-free survival in the MT cohort compared to FS (HR 0.640; 95% CI 0.442–0.926; p = 0.018). Mortality was additionally reduced after the implementation of PS (p = 0.023). Combined operative success was comparable between the three access types. The perioperative success was higher in the MT cohort compared to FS (OR 2.19, 95% CI 1.32–3.63; p = 0.002). Conclusion: Less-invasive approaches in elderly patients improve perioperative success and reoperation-free survival in those undergoing MVS procedures. Full article

(This article belongs to the Special Issue Minimal Access Cardiac Surgery: State of the Art and Future Perspectives)

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14 pages, 24390 KiB

Open AccessEditor’s ChoiceArticle

Elderly with Varying Extents of Cardiac Disease Show Interindividual Fluctuating Myocardial TRPC6-Immunoreactivity

by Jan Michael Federspiel, Jil Gartner, Peter Lipp, Peter Schmidt and Thomas Tschernig

J. Cardiovasc. Dev. Dis. 2023, 10(1), 26; https://doi.org/10.3390/jcdd10010026 - 9 Jan 2023

Cited by 3 | Viewed by 2349

Abstract

Both particular myocardial locations in the human heart and the canonical transient receptor potential 6 (TRPC6) cation channel have been linked with cardiac pathophysiologies. Thus, the present study mapped TRPC6-protein distribution in select anatomic locations associated with cardiac disease in the context of [...] Read more.

Both particular myocardial locations in the human heart and the canonical transient receptor potential 6 (TRPC6) cation channel have been linked with cardiac pathophysiologies. Thus, the present study mapped TRPC6-protein distribution in select anatomic locations associated with cardiac disease in the context of an orienting pathological assessment. Specimens were obtained from 5 body donors (4 formalin fixation, 1 nitrite pickling salt-ethanol-polyethylene glycol (NEP) fixation; median age 81 years; 2 females) and procured for basic histological stains and TRPC6-immunohistochemistry. The latter was analyzed descriptively regarding distribution and intensity of positive signals. The percentage of positively labelled myocardium was also determined (optical threshold method). Exclusively exploratory statistical analyses were performed. TRPC6-protein was distributed widespread and homogenously within each analyzed sample. TRPC6-immunoreactive myocardial area was comparable regarding the different anatomic regions and sex. A significantly larger area of TRPC6-immunoreactive myocardium was found in the NEP-fixed donor compared to the formalin fixed donors. Two donors with more severe heart disease showed smaller areas of myocardial TRPC6-immunoreactivity overall compared to the other 3 donors. In summary, in the elderly, TRPC6-protein is widely and homogenously distributed, and severe cardiac disease might be associated with less TRPC6-immunoreactive myocardial area. The tissue fixation method represents a potential confounder. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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11 pages, 808 KiB

Open AccessEditor’s ChoiceArticle

Higher Incidence of Cancer Therapy-Related Cardiac Dysfunction in the COVID-19 Era: A Single Cardio-Oncology Center Experience

by Daniela Di Lisi, Cristina Madaudo, Luca Di Fazio, Antonino Gulotta, Oreste Fabio Triolo, Alfredo Ruggero Galassi, Lorena Incorvaia, Antonio Russo and Giuseppina Novo

J. Cardiovasc. Dev. Dis. 2023, 10(1), 23; https://doi.org/10.3390/jcdd10010023 - 6 Jan 2023

Cited by 4 | Viewed by 2468

Abstract

Aim: COVID-19 pandemic had a big impact on our life, it has revolutionized the practice of cardiology and the organization of hospital and outpatient activities. Thus the aim of our study was to assess the impact of the COVID-19 pandemic on the development [...] Read more.

Aim: COVID-19 pandemic had a big impact on our life, it has revolutionized the practice of cardiology and the organization of hospital and outpatient activities. Thus the aim of our study was to assess the impact of the COVID-19 pandemic on the development of cancer therapy-related cardiac dysfunction (CTRCD). Methods and results: A single center retrospective study was carried out evaluating 96 cancer patients treated with anthracyclines and admitted to our Cardio-Oncology unit from June to August 2019 and 60 patients from June to August 2021. The incidence of CTRCD was assessed performing an echocardiogram at the time of the enrollment. We found a significantly higher incidence of CTRCD in the second period compared to first period (13% vs. 2%, p value 0.0058). In addition we found that fewer yearly visits were performed in our Cardio-oncology unit in 2021 compared to 2019 (300 patients/year in 2019 vs. 144 patients/year in the COVID era). Conclusion: COVID-19 pandemic seems to influence the onset of CTRCD in cancer patients by indirectly reducing hospital access of cancer patients and cardiological checks. In addition our data reflect the impact of the COVID-19 pandemic in the late diagnosis of cancer, in the reduction of hospital admissions and regular medical checks, in the increase of comorbidities and cardiovascular complications. Full article

(This article belongs to the Special Issue Cardiovascular Toxicity Related to Cancer Treatment)

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20 pages, 3376 KiB

Open AccessEditor’s ChoiceArticle

A Story of PA/BSA and Biomarkers to Diagnose Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—The Rise of IGF-BP2 and GDF-15

by Joseph Kletzer, Stefan Hecht, Susanne Ramsauer, Bernhard Scharinger, Reinhard Kaufmann, Jürgen Kammler, Jörg Kellermair, Kaveh Akbari, Hermann Blessberger, Clemens Steinwender, Klaus Hergan, Uta C. Hoppe, Michael Lichtenauer and Elke Boxhammer

J. Cardiovasc. Dev. Dis. 2023, 10(1), 22; https://doi.org/10.3390/jcdd10010022 - 5 Jan 2023

Cited by 3 | Viewed by 2958

Abstract

(1) Background: Currently, echocardiography is the primary non-invasive diagnostic method used to screen patients with severe aortic valve stenosis (AS) for pulmonary hypertension (PH) by estimating systolic pulmonary artery pressure (sPAP). Other radiological methods have been a focus of research in the past [...] Read more.

(1) Background: Currently, echocardiography is the primary non-invasive diagnostic method used to screen patients with severe aortic valve stenosis (AS) for pulmonary hypertension (PH) by estimating systolic pulmonary artery pressure (sPAP). Other radiological methods have been a focus of research in the past couple of years, as it was shown that by determining the pulmonary artery (PA) diameter, prognostic statements concerning overall mortality could be made in these patients. This study compared established and novel cardiovascular biomarkers with the PA/BSA value to detect PH in patients with severe AS. (2) Methods: The study cohort comprised 188 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR), who were then divided into two groups based on PA/BSA values obtained through CT-angiography. The presence of PH was defined as a PA/BSA ≥ 16.6 mm/m² (n = 81), and absence as a PA/BSA < 16.6 mm/m² (n = 107). Blood samples were taken before TAVR to assess cardiovascular biomarkers used in this study, namely brain natriuretic peptide (BNP), cardiac troponin I (cTnI), high-sensitive troponin (hsTN), soluble suppression of tumorigenesis-2 (sST2), growth/differentiation factor 15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), insulin-like growth factor binding protein 2 (IGF-BP2), and soluble urokinase-type plasminogen activator receptor (suPAR). (3) Results: Patients with a PA/BSA ≥ 16.6 mm/m² showed significantly higher levels of BNP (p = <0.001), GDF-15 (p = 0.040), and H-FABP (p = 0.007). The other investigated cardiovascular biomarkers did not significantly differ between the two groups. To predict a PA/BSA ≥ 16.6 mm/m², cut-off values for the biomarkers were calculated. Here, GDF-15 (p = 0.029; cut-off 1172.0 pg/mL) and BNP (p < 0.001; cut-off 2194.0 pg/mL) showed significant results. Consequently, analyses of combined biomarkers were performed, which yielded IGF-BP2 + BNP (AUC = 0.721; 95%CI = 0.585–0.857; p = 0.004) as the best result of the two-way analyses and GDF-15 + IGF-BP2 + BNP (AUC = 0.727; 95%CI = 0.590–0.864; p = 0.004) as the best result of the three-way analyses. No significant difference regarding the 1-year survival between patients with PA/BSA < 16.6 mm/m² and patients with PA/BSA ≥ 16.6 mm/m² was found (log-rank test: p = 0.452). (4) Conclusions: Although PA/BSA aims to reduce the bias of the PA value caused by different body compositions and sizes, it is still a controversial parameter for diagnosing PH. Combining the parameter with different cardiovascular biomarkers did not lead to a significant increase in the diagnostic precision for detecting PH in patients with severe AS. Full article

(This article belongs to the Special Issue New Perspectives on Pulmonary Hypertension (PH))

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8 pages, 655 KiB

Open AccessEditor’s ChoiceArticle

Right Ventricular Septal Versus Apical Pacing: Long-Term Incidence of Heart Failure and Survival

by André Dias-Frias, Ricardo Costa, Andreia Campinas, André Alexandre, David Sá-Couto, Maria João Sousa, Carla Roque, Pinheiro Vieira, Vitor Lagarto, Hipólito Reis and Severo Torres

J. Cardiovasc. Dev. Dis. 2022, 9(12), 444; https://doi.org/10.3390/jcdd9120444 - 9 Dec 2022

Cited by 5 | Viewed by 2860

Abstract

The clinical benefits of right ventricular septal (RVS) pacing compared to those of right ventricular apical (RVA) pacing are still in debate. We aimed to compare the incidence of heart failure (HF) and all-cause mortality in patients submitted to RVS and RVA pacing [...] Read more.

The clinical benefits of right ventricular septal (RVS) pacing compared to those of right ventricular apical (RVA) pacing are still in debate. We aimed to compare the incidence of heart failure (HF) and all-cause mortality in patients submitted to RVS and RVA pacing during a longer follow-up. This a single-center, retrospective study analysis of consecutive patients submitted to pacemaker implantation. The primary outcome was defined as the occurrence of HF during follow-up. The secondary outcome was all-cause death. A total of 251 patients were included, 47 (18.7%) with RVS pacing. RVS pacing was associated to younger age, male gender, lower body mass index, ischemic heart disease, and atrial fibrillation. During a follow-up period of 5.2 years, the primary outcome occurred in 89 (37.1%) patients. RVS pacing was independently associated with a 3-fold lower risk of HF, after adjustment. The secondary outcome occurred in 83 (34.2%) patients, and pacemaker lead position was not a predictor. Fluoroscopy time and rate of complications (rarely life-threatening) were similar in both groups. Our study points to a potential clinical benefit of RVS positioning, with a 3.3-fold lower risk of HF, without accompanying increase in procedure complexity nor complication rate. Full article

(This article belongs to the Special Issue Heart Failure: Clinical Diagnostics and Treatment)

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8 pages, 579 KiB

Open AccessEditor’s ChoiceArticle

Pre-Stroke Statin Use Is Associated with Mild Neurological Deficits at the Onset of Acute Ischemic Stroke

by Takahisa Mori, Kazuhiro Yoshioka and Yuichi Miyazaki

J. Cardiovasc. Dev. Dis. 2022, 9(11), 396; https://doi.org/10.3390/jcdd9110396 - 16 Nov 2022

Cited by 2 | Viewed by 2195

Abstract

Pre-stroke statin use reduces infarct size. Therefore, this retrospective study aimed to investigate whether pre-stroke statin use is associated with mild neurological deficits (mND) at the onset of acute ischemic stroke (AIS). We included patients with AIS admitted to our institution within 24 [...] Read more.

Pre-stroke statin use reduces infarct size. Therefore, this retrospective study aimed to investigate whether pre-stroke statin use is associated with mild neurological deficits (mND) at the onset of acute ischemic stroke (AIS). We included patients with AIS admitted to our institution within 24 h of stroke onset between 2011 and 2019. We collected data on age, sex, pre-stroke use of statins, the National Institutes of Health Stroke Scale (NIHSS) score, the serum biomarker levels, and stroke subtypes at admission. In addition, we defined mND as an NIHSS score ≤3 points. We conducted a logistic regression analysis using variables for pre-stroke statin initiation, calculated the propensity scores for pre-stroke statin use, and implemented propensity score matching (PSM). Finally, we used the McNemar test to evaluate whether pre-stroke statin administration significantly affected mND. Of 4370 patients, 2615 met our inclusion criteria. Among the 594 patients with pre-stroke statin use, 308 presented with mND. After PSM, 555 patients received pre-stroke statin treatment, while 286 patients with pre-stroke statin use presented with mND at admission (p = 0.0411). The binary matched pairs contingency table of mND was not symmetrical (p = 0.0385). Pre-stroke statin use is thus associated with mND at the onset of AIS. Full article

(This article belongs to the Special Issue Ischemic Stroke: New Insights from Risk Factors, Mechanisms and Outcomes)

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16 pages, 20381 KiB

Open AccessEditor’s ChoiceArticle

OCT Meets micro-CT: A Subject-Specific Correlative Multimodal Imaging Workflow for Early Chick Heart Development Modeling

by Nina Kraus, Fabian Placzek and Brian Metscher

J. Cardiovasc. Dev. Dis. 2022, 9(11), 379; https://doi.org/10.3390/jcdd9110379 - 3 Nov 2022

Cited by 4 | Viewed by 2823

Abstract

Structural and Doppler velocity data collected from optical coherence tomography have already provided crucial insights into cardiac morphogenesis. X-ray microtomography and other ex vivo methods have elucidated structural details of developing hearts. However, by itself, no single imaging modality can provide comprehensive information [...] Read more.

Structural and Doppler velocity data collected from optical coherence tomography have already provided crucial insights into cardiac morphogenesis. X-ray microtomography and other ex vivo methods have elucidated structural details of developing hearts. However, by itself, no single imaging modality can provide comprehensive information allowing to fully decipher the inner workings of an entire developing organ. Hence, we introduce a specimen-specific correlative multimodal imaging workflow combining OCT and micro-CT imaging which is applicable for modeling of early chick heart development—a valuable model organism in cardiovascular development research. The image acquisition and processing employ common reagents, lab-based micro-CT imaging, and software that is free for academic use. Our goal is to provide a step-by-step guide on how to implement this workflow and to demonstrate why those two modalities together have the potential to provide new insight into normal cardiac development and heart malformations leading to congenital heart disease. Full article

(This article belongs to the Special Issue Models and Methods for Computational Cardiology)

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10 pages, 522 KiB

Open AccessEditor’s ChoiceArticle

Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation

by Gaetano Pinnacchio, Eleonora Ruscio, Erica Rocco, Carlo Trani, Francesco Burzotta, Cristina Aurigemma, Enrico Romagnoli, Roberto Scacciavillani, Maria Lucia Narducci, Gianluigi Bencardino, Francesco Perna, Francesco Raffaele Spera, Gianluca Comerci, Antonio Bisignani and Gemma Pelargonio

J. Cardiovasc. Dev. Dis. 2022, 9(10), 324; https://doi.org/10.3390/jcdd9100324 - 24 Sep 2022

Cited by 1 | Viewed by 3666

Abstract

Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, [...] Read more.

Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4–6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 ± 50 to 230 ± 51, p = 0.02; QRS interval from 124 ± 23 to 147 ± 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible. Full article

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

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10 pages, 280 KiB

Open AccessEditor’s ChoiceArticle

Contractile Reserve in Heart Failure with Preserved Ejection Fraction

by Daniela Di Lisi, Quirino Ciampi, Cristina Madaudo, Girolamo Manno, Francesca Macaione, Salvatore Novo and Giuseppina Novo

J. Cardiovasc. Dev. Dis. 2022, 9(8), 248; https://doi.org/10.3390/jcdd9080248 - 4 Aug 2022

Cited by 1 | Viewed by 2461

Abstract

Background: Diastolic stress echocardiography (SE) is useful for confirming the diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) when it is uncertain. The aim of this study was to assess the value of new echocardiographic parameters during diastolic SE in [...] Read more.

Background: Diastolic stress echocardiography (SE) is useful for confirming the diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) when it is uncertain. The aim of this study was to assess the value of new echocardiographic parameters during diastolic SE in patients with dyspnea and suspected HFpEF. Methods: Sixty-two patients with exertional dyspnea and inconclusive rest echocardiography for a diagnosis of HFpEF were enrolled. Exercise SE was performed in all patients. Contractile reserve (LVCR) was assessed by measuring: 1. changes in the left ventricular ejection fraction (LVEF) between rest and peak stress; 2. stress-to-rest ratio of force (force was defined as the ratio between systolic arterial pressure and left ventricular end-systolic volume); and 3. mechanical reserve, defined as the change in systolic strain (GLS) between rest and peak stress. Results: Diagnosis of HFpEF was performed by SE in 26 patients. Comparing patients with a diagnosis of HFpEF (group A) to patients with other causes of dyspnea (group B), we found a significant increase in the E/e’ ratio in group A at peak stress. LV GLS was significantly reduced in group A compared to group B at rest and stress (p value 0.01 at rest; p value 0.04 at stress). At peak stress, GLS did not significantly increase in group A, while it increased in group B (p value 0.04). LVEF increased significantly in both groups. Conclusion: Patients with HFpEF have impaired LVCR when assessed using GLS. Thus, the assessment of mechanical reserve could give additional diagnostic information during stress tests in patients with HFpEF. Full article

(This article belongs to the Section Imaging)

13 pages, 3337 KiB

Open AccessEditor’s ChoiceArticle

Characteristics and Prognostic Relevance of Ventricular Arrhythmia in Patients with Myocarditis

by Ann-Kathrin Kahle, Rebekka Güde, Jana M. Schwarzl, Paula Münkler, Ruken Ö. Akbulak, Charlotte Jahnke, Sebastian Bohnen, Tilman Würger, Michael Schwarzl, Stephan Willems, Ulf K. Radunski and Christian Meyer

J. Cardiovasc. Dev. Dis. 2022, 9(8), 243; https://doi.org/10.3390/jcdd9080243 - 29 Jul 2022

Viewed by 3718

Abstract

Myocarditis is characterized by various clinical manifestations, with ventricular arrhythmia (VA) as a frequent symptom at initial presentation. Here, we investigated characteristics and prognostic relevance of VA in patients with myocarditis. The study population consisted of 76 patients with myocarditis, verified by biopsy [...] Read more.

Myocarditis is characterized by various clinical manifestations, with ventricular arrhythmia (VA) as a frequent symptom at initial presentation. Here, we investigated characteristics and prognostic relevance of VA in patients with myocarditis. The study population consisted of 76 patients with myocarditis, verified by biopsy and/or cardiac magnetic resonance (CMR) imaging, including 38 consecutive patients with VA (45 ± 3 years, 68% male) vs. 38 patients without VA (NVA) (38 ± 2 years, 84% male) serving as a control group. VA was monomorphic ventricular tachycardia in 55% of patients, premature ventricular complexes in 50% and ventricular fibrillation in 29%. The left ventricular ejection fraction at baseline was 47 ± 2% vs. 40 ± 3% in VA vs. NVA patients (p = 0.069). CMR showed late gadolinium enhancement more often in VA patients (94% vs. 69%; p = 0.016), incorporating 17.6 ± 1.8% vs. 8.2 ± 1.3% of myocardial mass (p < 0.001). Radiofrequency catheter ablation for VA was initially performed in nine (24%) patients, of whom five remained free from any recurrence over 24 ± 3 months. Taken together, in patients with myocarditis, reduced left ventricular ejection fraction does not predict VA occurrence but CMR shows late gadolinium enhancement more frequently and to a larger extent in VA than in NVA patients, potentially guiding catheter ablation as a reasonable treatment of VA in this population. Full article

(This article belongs to the Special Issue Catheter Ablation of Cardiac Arrhythmias: Practices and Outcomes)

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12 pages, 5052 KiB

Open AccessEditor’s ChoiceArticle

Electroporation Parameters for Human Cardiomyocyte Ablation In Vitro

by Jara M. Baena-Montes, Tony O’Halloran, Cormac Clarke, Kevin Donaghey, Eoghan Dunne, Martin O’Halloran and Leo R. Quinlan

J. Cardiovasc. Dev. Dis. 2022, 9(8), 240; https://doi.org/10.3390/jcdd9080240 - 28 Jul 2022

Cited by 22 | Viewed by 4196

Abstract

Cardiac ablation with irreversible electroporation (IRE) is quickly being established as a modality of choice for atrial fibrillation treatment. While it has not yet been optimised, IRE has the potential to significantly limit collateral damage and improve cell-specific targeting associated with other energy [...] Read more.

Cardiac ablation with irreversible electroporation (IRE) is quickly being established as a modality of choice for atrial fibrillation treatment. While it has not yet been optimised, IRE has the potential to significantly limit collateral damage and improve cell-specific targeting associated with other energy sources. However, more tissue and cell-specific evidence is required to demonstrate the selective threshold parameters for human cells. The aim here is to determine the optimal ablation threshold parameters related to lesion size for human cardiomyocytes in 2D culture. Conventional biphasic pulses of different field strengths and on-times were delivered in a monolayer culture system of human AC16 cardiomyocytes. The dynamics of cell death and lesion dimensions were examined at different time points. Human cardiomyocytes are susceptible to significant electroporation and cell death at a field strength of 750 V/cm or higher with 100 μs pulses. Increasing the IRE on-time from 3 ms to 60 ms reduces the effective field threshold to 250 V/cm. Using very short pulses of 2 μs and 5 μs also causes significant cell death, but only at fields higher than 1000 V/cm. A longer on-time results in more cell death and induced greater lesion area in 2D models. In addition, different forms of cell death are predicted based on the evolution of cell death over time. This study presents important findings on the ability of different IRE parameters to induce human cardiomyocyte cell death. Lesion size can be tuned by appropriate choice of IRE parameters and cardiomyocytes display an upregulation of delayed cell death 24 h after electroporation, which is an important consideration for clinical practice. Full article

(This article belongs to the Special Issue Catheter Ablation of Cardiac Arrhythmias: Practices and Outcomes)

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13 pages, 1548 KiB

Open AccessEditor’s ChoiceArticle

Left Atrial Remodeling after Mitral Valve Repair for Primary Mitral Regurgitation: Evolution over Time and Prognostic Significance

by Jan Stassen, Aniek L. van Wijngaarden, Hoi W. Wu, Meindert Palmen, Anton Tomsic, Victoria Delgado, Jeroen J. Bax and Nina Ajmone Marsan

J. Cardiovasc. Dev. Dis. 2022, 9(7), 230; https://doi.org/10.3390/jcdd9070230 - 18 Jul 2022

Cited by 6 | Viewed by 3574

Abstract

Left atrial (LA) dilatation is associated with worse outcomes in primary mitral regurgitation (MR). However, the effects of mitral valve repair on LA size and its prognostic implications are not well known. In the current study, LA volume index (LAVi) and LA reservoir [...] Read more.

Left atrial (LA) dilatation is associated with worse outcomes in primary mitral regurgitation (MR). However, the effects of mitral valve repair on LA size and its prognostic implications are not well known. In the current study, LA volume index (LAVi) and LA reservoir strain (LASr) were evaluated immediately before and after surgery, and during long-term follow-up in 226 patients undergoing mitral valve repair for primary MR (age 62 ± 13 years, 66% male). Mean LAVi was reduced significantly after surgery and at long-term follow-up (from 56 ± 28 to 38 ± 21 to 32 ± 17 mL/m²; p < 0.001). LASr reduced significantly after surgery but increased again during the long-term (from 23.6 ± 9.4 to 11.5 ± 5.0 to 17.3 ± 7.5%; p < 0.001). Age, pre-operative LAVi, MR severity, and postoperative transmitral pressure gradient were associated with LA reverse remodeling by the long-term check-up. During a median follow-up of 72 (40–114) months, 43 (19%) patients died. Patients with LAVi ≥ 42 mL/m² at long-term follow-up showed significant higher mortality rates compared to patients with LAVI < 42 mL/m² (p < 0.001), even after adjusting for clinical covariates. In conclusion, significant LA reverse remodeling was observed both immediately and at long-term follow-up after mitral valve repair. LA dilatation at long term follow-up after surgery was still associated with all-cause mortality. Full article

(This article belongs to the Special Issue Mitral Valve Prolapse and Mitral Regurgitation)

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11 pages, 899 KiB

Open AccessEditor’s ChoiceArticle

Low Prevalence of Cardiomyopathy in Patients with Mitochondrial Disease and Neurological Manifestations

by Anish Nikhanj, Jesi Bautista, Zaeem A. Siddiqi, Cecile L. Phan and Gavin Y. Oudit

J. Cardiovasc. Dev. Dis. 2022, 9(7), 221; https://doi.org/10.3390/jcdd9070221 - 9 Jul 2022

Cited by 2 | Viewed by 3107

Abstract

Patients with mitochondrial diseases can develop cardiomyopathy but with variable expressivity and penetrance. Our prospective study enrolled and evaluated a cohort of 53 patients diagnosed with chronic progressive ophthalmoplegia (CPEO, n = 34), Kearns–Sayre syndrome (KSS, n = 3), neuropathy ataxia and retinitis [...] Read more.

Patients with mitochondrial diseases can develop cardiomyopathy but with variable expressivity and penetrance. Our prospective study enrolled and evaluated a cohort of 53 patients diagnosed with chronic progressive ophthalmoplegia (CPEO, n = 34), Kearns–Sayre syndrome (KSS, n = 3), neuropathy ataxia and retinitis pigmentosa (NARP, n = 1), myoclonic epilepsy with ragged red fibers (MERRF, n = 1), Harel–Yoon Syndrome (HYS, n = 1) and 13 patients with undefined mitochondrial diseases, presenting primarily with neurological symptoms. Over a 4-year period, six patients in our study cohort were diagnosed with heart disease (11.3%), with only three patients having defined cardiomyopathy (5.7%). Cardiomyopathy was present in a 21-year-old patient with HYS and two CPEO patients having mild cardiomyopathy at an older age. Two CPEO patients had congenital heart disease, and a third CPEO had LV hypertrophy secondary to hypertension. In three patients, traditional risk factors for heart disease, including dyslipidemia, hypertension, and respiratory disease, were present. The majority of our adult cohort of patients have normal cardiac investigations with a median left ventricular (LV) ejection fraction of 59.0%, indexed LV mass of 67.0 g/m², and normal diastolic and valvular function at baseline. A 12-lead electrocardiogram showed normal cardiac conduction across the study cohort. Importantly, follow-up assessments showed consistent cardiac structure and function. Our study shows a low prevalence of cardiomyopathy and highlights the breadth of phenotypic variability in patients with mitochondrial disorders. The presence of cardiovascular risk factors and aging are important comorbidities in our cohort. Full article

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9 pages, 1780 KiB

Open AccessEditor’s ChoiceArticle

A Comparative Study on Surgical Treatment of Valvular Heart Disease between High-Volume Cardiac Centers in China and STS Data

by Hongyuan Lin, Jiamiao Gong, Yongjian Wu, Zhe Zheng and Jianfeng Hou

J. Cardiovasc. Dev. Dis. 2022, 9(7), 212; https://doi.org/10.3390/jcdd9070212 - 2 Jul 2022

Cited by 7 | Viewed by 2698

Abstract

The goal of this study is to summarize valvular surgery data from the Chinese Cardiac Surgery Registry (CCSR) and compare it to the most recent data from the Society of Thoracic Surgeons (STS). From 2016 to 2018, a total of 34,386 cases of [...] Read more.

The goal of this study is to summarize valvular surgery data from the Chinese Cardiac Surgery Registry (CCSR) and compare it to the most recent data from the Society of Thoracic Surgeons (STS). From 2016 to 2018, a total of 34,386 cases of the seven most common valvular surgical procedures was obtained from the CCSR. We calculated the proportions of different procedures in the CCSR cohort (n = 34,386) as well as the change in operation volume for each procedure. We also compiled rates of postoperative in-hospital mortality and five major complications across all procedures. All of the results were compared to the STS data. The CCSR and STS data showed divergent trends in valvular heart disease features and operation volume. Although the proportion of MV repair in the CCSR (13.7%) data was lower than in the STS data (23.2%), it demonstrated a substantial upward trend. In terms of operation volume, the CCSR data showed an upward trend, but the STS data showed a downward trend. CCSR procedures showed lower mortality (2% vs. 2.6%), reoperation (2.8% vs. 4.3%), and permanent stroke (0.5% vs. 1.6%) rates than STS procedures but higher rates of prolonged ventilation (22.4% vs. 10.4%) and renal failure (5.6% vs. 3.2%). Valvular surgery quality in China’s leading cardiac hospitals is roughly comparable to that in the United States. China, on the other hand, has some shortcomings that need improvement. Full article

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13 pages, 2385 KiB

Open AccessEditor’s ChoiceArticle

Biventricular versus Conduction System Pacing after Atrioventricular Node Ablation in Heart Failure Patients with Atrial Fibrillation

by Maja Ivanovski, Miha Mrak, Anja Zupan Mežnar and David Žižek

J. Cardiovasc. Dev. Dis. 2022, 9(7), 209; https://doi.org/10.3390/jcdd9070209 - 1 Jul 2022

Cited by 27 | Viewed by 4491

Abstract

Conduction system pacing (CSP) modalities, including His-bundle pacing (HBP) and left bundle branch pacing (LBBP), are increasingly used as alternatives to biventricular (BiV) pacing in heart failure (HF) patients scheduled for pace and ablate strategy. The aim of the study was to compare [...] Read more.

Conduction system pacing (CSP) modalities, including His-bundle pacing (HBP) and left bundle branch pacing (LBBP), are increasingly used as alternatives to biventricular (BiV) pacing in heart failure (HF) patients scheduled for pace and ablate strategy. The aim of the study was to compare clinical outcomes of HF patients with refractory AF who received either BiV pacing or CSP in conjunction with atrio-ventricular node ablation (AVNA). Fifty consecutive patients (male 48%, age 70 years (IQR 9), left ventricular ejection fraction (LVEF) 39% (IQR 12)) were retrospectively analysed. Thirteen patients (26%) received BiV pacing, 27 patients (54%) HBP and 10 patients (20%) LBBP. All groups had similar baseline characteristics and acute success rate. While New York Heart. Association (NYHA) class improved in both HBP (p < 0.001) and LBBP (p = 0.008), it did not improve in BiV group (p = 0.096). At follow-up, LVEF increased in HBP (form 39% (IQR 15) to 49% (IQR 16), p < 0.001) and LBBP (from 28% (IQR 13) to 40% (IQR 13), p = 0.041), but did not change in BiV group (p = 0.916). Conduction system pacing modalities showed superior symptomatic and echocardiographic improvement compared to BiV pacing after AVNA. With more stable pacing parameters, LBBP could present a more feasible pacing option compared to HBP. Full article

(This article belongs to the Special Issue Atherosclerotic Cardiovascular Disease: Risk Assessment, Prevention and Treatment Strategies)

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13 pages, 677 KiB

Open AccessEditor’s ChoiceArticle

Serum and Vascular Stiffness Biomarkers Associated with the Severity of Degenerative Aortic Valve Stenosis and Cardiovascular Outcomes

by Jakub Baran, Łukasz Niewiara, Jakub Podolec, Mateusz Siedliński, Ewelina Józefczuk, Anna Bernacik, Rafał Badacz, Tadeusz Przewłocki, Piotr Pieniążek, Krzysztof Żmudka, Jacek Legutko and Anna Kabłak-Ziembicka

J. Cardiovasc. Dev. Dis. 2022, 9(6), 193; https://doi.org/10.3390/jcdd9060193 - 17 Jun 2022

Cited by 9 | Viewed by 3075

Abstract

Background: Although degenerative aortic valve stenosis (DAS) is the most prevalent growth-up congestive heart valve disease, still little known about relationships between DAS severity, vascular stiffness (VS), echocardiographic parameters, and serum biomarkers in patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR). [...] Read more.

Background: Although degenerative aortic valve stenosis (DAS) is the most prevalent growth-up congestive heart valve disease, still little known about relationships between DAS severity, vascular stiffness (VS), echocardiographic parameters, and serum biomarkers in patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR). The objective of this study was to identify biomarkers associated with DAS severity, and those that are associated with cardiovascular death (CVD) and episodes of chronic heart failure (CHF) exacerbation. Methods: A total of 137 patients with initially moderate-to-severe DAS were prospectively evaluated for the relationship between DAS severity, baseline VS, and serum biomarkers (uPAR, GDF-15, Gal-3, IL-6Rα, ET-1, PCSK9, RANTES/CCL5, NT-proBNP, and hs-TnT), and were followed-up for 48 months. The prognostic significance of each variable for CVD and CHF risk was measured by hazard ratio of risk (HR), which was calculated by Cox’s proportional hazard model. Results: DAS severity showed correlations with IL-6Rα (r = 0.306, p < 0.001), uPAR (r = 0.184, p = 0.032), and NT-proBNP (r = −0.389, p < 0.001). Levels of ET-1 and Gal-3 were strongly correlated with VS parameters (r = 0.674, p < 0.001; r = 0.724, p < 0.001). Out of 137 patients, 20 were referred to TAVR, 88 to SAVR, and 29 to OMT. In TAVR patients, the highest levels of ET-1, Gal-3, and VS were found as compared to other patients. The highest incidence of CVD was observed in patients who underwent TAVR (35%), compared to SAVR (8%) and OMT (10.3%) (p = 0.004). In a multivariate analysis, ET-1 occurred predictive of CVD risk (HR 25.1, p = 0.047), while Gal-3 > 11.5 ng/mL increased the risk of CHF exacerbation episodes requiring hospital admission by 12%. Conclusions: Our study indicated that ET-1 and Gal-3 levels may be associated with the outcomes in patients with DAS. Full article

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

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