Journal of Cardiovascular Development and Disease

Review

19 pages, 658 KiB

Open AccessEditor’s ChoiceReview

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

by Ioana Boarescu and Paul-Mihai Boarescu

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

Cited by 2 | Viewed by 8466

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

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

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

► Show Figures

Figure 1

9 pages, 280 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 1 | Viewed by 1072

Abstract

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

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

24 pages, 1158 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Viewed by 2950

Abstract

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

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

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

► Show Figures

Figure 1

10 pages, 611 KiB

Open AccessEditor’s ChoiceReview

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

by Johanna McChord and Peter Ong

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

Cited by 1 | Viewed by 1348

Abstract

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

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

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

► Show Figures

Figure 1

21 pages, 2156 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Viewed by 2313

Abstract

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

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

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

► Show Figures

Figure 1

20 pages, 38951 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Viewed by 2185

Abstract

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

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

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

► Show Figures

Figure 1

12 pages, 953 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Viewed by 1580

Abstract

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

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

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

► Show Figures

Figure 1

15 pages, 5473 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Viewed by 2181

Abstract

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

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

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

► Show Figures

Figure 1

10 pages, 563 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Viewed by 1447

Abstract

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

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

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

► Show Figures

Figure 1

22 pages, 936 KiB

Open AccessEditor’s ChoiceReview

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

by Ronald B. Brown

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

Cited by 1 | Viewed by 3307

Abstract

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

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

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

► Show Figures

Figure 1

16 pages, 2737 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 1 | Viewed by 1786

Abstract

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

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

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

► Show Figures

Figure 1

27 pages, 4960 KiB

Open AccessEditor’s ChoiceReview

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

by Jörg Männer

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

Cited by 2 | Viewed by 4118

Abstract

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

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

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

► Show Figures

Figure 1

11 pages, 1736 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 1 | Viewed by 2416

Abstract

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

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

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

► Show Figures

Figure 1

21 pages, 2177 KiB

Open AccessEditor’s ChoiceReview

Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function

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

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

Cited by 2 | Viewed by 2214

Abstract

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

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

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

► Show Figures

Figure 1

15 pages, 3779 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 2 | Viewed by 1961

Abstract

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

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

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

► Show Figures

Figure 1

19 pages, 1990 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Viewed by 2568

Abstract

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

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

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

► Show Figures

Figure 1

13 pages, 2415 KiB

Open AccessEditor’s ChoiceReview

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

by Ehsan Mahmoodi and Haris M. Haqqani

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

Cited by 1 | Viewed by 2089

Abstract

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

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

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

► Show Figures

Figure 1

15 pages, 2835 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 2 | Viewed by 2161

Abstract

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

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

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

► Show Figures

Figure 1

19 pages, 4961 KiB

Open AccessEditor’s ChoiceReview

Diagnostic Challenges in Aortic Stenosis

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

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

Cited by 2 | Viewed by 4775

Abstract

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

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

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

► Show Figures

Figure 1

18 pages, 8152 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 1 | Viewed by 3456

Abstract

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

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

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

► Show Figures

Figure 1

20 pages, 674 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Semaglutide in Cardiometabolic Diseases: SELECTing the Target Population

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

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

Cited by 2 | Viewed by 3853

Abstract

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

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

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

► Show Figures

Figure 1

15 pages, 4871 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 9 | Viewed by 3649

Abstract

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

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

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

► Show Figures

Figure 1

11 pages, 1111 KiB

Open AccessEditor’s ChoiceReview

Ductus Arteriosus in Fetal and Perinatal Life

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

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

Cited by 6 | Viewed by 5630

Abstract

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

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

► Show Figures

Figure 1

12 pages, 618 KiB

Open AccessEditor’s ChoiceReview

Updated Clinical Classification and Hemodynamic Definitions of Pulmonary Hypertension and Its Clinical Implications

by Mithum Kularatne, Christian Gerges, Mitja Jevnikar, Marc Humbert and David Montani

J. Cardiovasc. Dev. Dis. 2024, 11(3), 78; https://doi.org/10.3390/jcdd11030078 - 27 Feb 2024

Cited by 6 | Viewed by 8198

Abstract

Pulmonary hypertension (PH) refers to a pathologic elevation of the mean pulmonary artery pressure (mPAP) and is associated with increased morbidity and mortality in a wide range of medical conditions. These conditions are classified according to similarities in pathophysiology and management in addition [...] Read more.

Pulmonary hypertension (PH) refers to a pathologic elevation of the mean pulmonary artery pressure (mPAP) and is associated with increased morbidity and mortality in a wide range of medical conditions. These conditions are classified according to similarities in pathophysiology and management in addition to their invasive hemodynamic profiles. The 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension present the newest clinical classification system and includes significant updates to the hemodynamic definitions. Pulmonary hypertension is now hemodynamically defined as an mPAP > 20 mmHg, reduced from the previous threshold of ≥25 mmHg, due to important insights from both normative and prognostic data. Pulmonary vascular resistance has been extended into the definition of pre-capillary pulmonary hypertension, with an updated threshold of >2 Wood Units (WU), to help differentiate pulmonary vascular disease from other causes of increased mPAP. Exercise pulmonary hypertension has been reintroduced into the hemodynamic definitions and is defined by an mPAP/cardiac output slope of >3 mmHg/L/min between rest and exercise. While these new hemodynamic thresholds will have a significant impact on the diagnosis of pulmonary hypertension, no evidence-based treatments are available for patients with mPAP between 21–24 mmHg and/or PVR between 2–3 WU or with exercise PH. This review highlights the evidence underlying these major changes and their implications on the diagnosis and management of patients with pulmonary hypertension. Full article

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

► Show Figures

Figure 1

16 pages, 1309 KiB

Open AccessEditor’s ChoiceReview

Cardiac and Renal Fibrosis, the Silent Killer in the Cardiovascular Continuum: An Up-to-Date

by Traian Chiuariu, Delia Șalaru, Carina Ureche, Laura Vasiliu, Ancuta Lupu, Vasile Valeriu Lupu, Adela Mihaela Șerban, Alexandra Zăvoi, Laura Catalina Benchea, Alexandra Clement, Bogdan-Sorin Tudurachi, Radu Andy Sascău and Cristian Stătescu

J. Cardiovasc. Dev. Dis. 2024, 11(2), 62; https://doi.org/10.3390/jcdd11020062 - 16 Feb 2024

Cited by 2 | Viewed by 3804

Abstract

Cardiovascular disease (CVD) and chronic kidney disease (CKD) often coexist and have a major impact on patient prognosis. Organ fibrosis plays a significant role in the pathogenesis of cardio-renal syndrome (CRS), explaining the high incidence of heart failure and sudden cardiac death in [...] Read more.

Cardiovascular disease (CVD) and chronic kidney disease (CKD) often coexist and have a major impact on patient prognosis. Organ fibrosis plays a significant role in the pathogenesis of cardio-renal syndrome (CRS), explaining the high incidence of heart failure and sudden cardiac death in these patients. Various mediators and mechanisms have been proposed as contributors to the alteration of fibroblasts and collagen turnover, varying from hemodynamic changes to the activation of the renin–angiotensin system, involvement of FGF 23, and Klotho protein or collagen deposition. A better understanding of all the mechanisms involved has prompted the search for alternative therapeutic targets, such as novel inhibitors of the renin–angiotensin–aldosterone system (RAAS), serelaxin, and neutralizing interleukin-11 (IL-11) antibodies. This review focuses on the molecular mechanisms of cardiac and renal fibrosis in the CKD and heart failure (HF) population and highlights the therapeutic alternatives designed to target the responsible pathways. Full article

► Show Figures

Figure 1

26 pages, 3499 KiB

Open AccessEditor’s ChoiceReview

Takotsubo Syndrome and Coronary Artery Disease: Which Came First—The Chicken or the Egg?

by Mihail Celeski, Annunziata Nusca, Valeria Maria De Luca, Giorgio Antonelli, Valeria Cammalleri, Rosetta Melfi, Fabio Mangiacapra, Elisabetta Ricottini, Paolo Gallo, Nino Cocco, Raffaele Rinaldi, Francesco Grigioni and Gian Paolo Ussia

J. Cardiovasc. Dev. Dis. 2024, 11(2), 39; https://doi.org/10.3390/jcdd11020039 - 26 Jan 2024

Cited by 6 | Viewed by 4013

Abstract

Takotsubo syndrome (TTS) is a clinical condition characterized by temporary regional wall motion anomalies and dysfunction that extend beyond a single epicardial vascular distribution. Various pathophysiological mechanisms, including inflammation, microvascular dysfunction, direct catecholamine toxicity, metabolic changes, sympathetic overdrive-mediated multi-vessel epicardial spasms, and transitory [...] Read more.

Takotsubo syndrome (TTS) is a clinical condition characterized by temporary regional wall motion anomalies and dysfunction that extend beyond a single epicardial vascular distribution. Various pathophysiological mechanisms, including inflammation, microvascular dysfunction, direct catecholamine toxicity, metabolic changes, sympathetic overdrive-mediated multi-vessel epicardial spasms, and transitory ischemia may cause the observed reversible myocardial stunning. Despite the fact that TTS usually has an acute coronary syndrome-like pattern of presentation, the absence of culprit atherosclerotic coronary artery disease is often reported at coronary angiography. However, the idea that coronary artery disease (CAD) and TTS conditions are mutually exclusive has been cast into doubt by numerous recent studies suggesting that CAD may coexist in many TTS patients, with significant clinical and prognostic repercussions. Whether the relationship between CAD and TTS is a mere coincidence or a bidirectional cause-and-effect is still up for debate, and misdiagnosis of the two disorders could lead to improper patient treatment with unfavourable outcomes. Therefore, this review seeks to provide a profound understanding of the relationship between CAD and TTS by analyzing potential common underlying pathways, addressing challenges in differential diagnosis, and discussing medical and procedural techniques to treat these conditions appropriately. Full article

► Show Figures

Figure 1

11 pages, 515 KiB

Open AccessEditor’s ChoiceReview

Psychological Impact of a Prenatal Diagnosis of Congenital Heart Disease on Parents: Is It Time for Tailored Psychological Support?

by Giulia Mutti, Lamia Ait Ali, Marco Marotta, Silvia Nunno, Veronica Consigli, Stefania Baratta, Maria Letizia Orsi, Francesca Mastorci, Cecilia Vecoli, Alessandro Pingitore, Pierluigi Festa, Sabrina Costa and Ilenia Foffa

J. Cardiovasc. Dev. Dis. 2024, 11(1), 31; https://doi.org/10.3390/jcdd11010031 - 20 Jan 2024

Cited by 3 | Viewed by 3354

Abstract

The prenatal diagnosis of congenital heart disease (CHD) represents, for both parents, a particularly stressful and traumatic life event from a psychological point of view. The present review sought to summarize the findings of the most relevant literature on the psychological impact of [...] Read more.

The prenatal diagnosis of congenital heart disease (CHD) represents, for both parents, a particularly stressful and traumatic life event from a psychological point of view. The present review sought to summarize the findings of the most relevant literature on the psychological impact of prenatal diagnosis of CHD on parents, describing the most common mechanisms employed in order to face this unexpected finding. We also highlight the importance of counseling and the current gaps in the effects of psychological support on this population. Full article

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

► Show Figures

Figure 1

49 pages, 32709 KiB

Open AccessEditor’s ChoiceReview

Cardiovascular Computed Tomography in the Diagnosis of Cardiovascular Disease: Beyond Lumen Assessment

by Zhonghua Sun, Jenna Silberstein and Mauro Vaccarezza

J. Cardiovasc. Dev. Dis. 2024, 11(1), 22; https://doi.org/10.3390/jcdd11010022 - 12 Jan 2024

Cited by 4 | Viewed by 3653

Abstract

Cardiovascular CT is being widely used in the diagnosis of cardiovascular disease due to the rapid technological advancements in CT scanning techniques. These advancements include the development of multi-slice CT, from early generation to the latest models, which has the capability of acquiring [...] Read more.

Cardiovascular CT is being widely used in the diagnosis of cardiovascular disease due to the rapid technological advancements in CT scanning techniques. These advancements include the development of multi-slice CT, from early generation to the latest models, which has the capability of acquiring images with high spatial and temporal resolution. The recent emergence of photon-counting CT has further enhanced CT performance in clinical applications, providing improved spatial and contrast resolution. CT-derived fractional flow reserve is superior to standard CT-based anatomical assessment for the detection of lesion-specific myocardial ischemia. CT-derived 3D-printed patient-specific models are also superior to standard CT, offering advantages in terms of educational value, surgical planning, and the simulation of cardiovascular disease treatment, as well as enhancing doctor–patient communication. Three-dimensional visualization tools including virtual reality, augmented reality, and mixed reality are further advancing the clinical value of cardiovascular CT in cardiovascular disease. With the widespread use of artificial intelligence, machine learning, and deep learning in cardiovascular disease, the diagnostic performance of cardiovascular CT has significantly improved, with promising results being presented in terms of both disease diagnosis and prediction. This review article provides an overview of the applications of cardiovascular CT, covering its performance from the perspective of its diagnostic value based on traditional lumen assessment to the identification of vulnerable lesions for the prediction of disease outcomes with the use of these advanced technologies. The limitations and future prospects of these technologies are also discussed. Full article

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

► Show Figures

Figure 1

33 pages, 904 KiB

Open AccessEditor’s ChoiceReview

Contaminant Metals and Cardiovascular Health

by Karl Kristian Lundin, Yusuf Kamran Qadeer, Zhen Wang, Salim Virani, Roman Leischik, Carl J. Lavie, Markus Strauss and Chayakrit Krittanawong

J. Cardiovasc. Dev. Dis. 2023, 10(11), 450; https://doi.org/10.3390/jcdd10110450 - 31 Oct 2023

Cited by 11 | Viewed by 4247

Abstract

A growing body of research has begun to link exposure to environmental contaminants, such as heavy metals, with a variety of negative health outcomes. In this paper, we sought to review the current research describing the impact of certain common contaminant metals on [...] Read more.

A growing body of research has begun to link exposure to environmental contaminants, such as heavy metals, with a variety of negative health outcomes. In this paper, we sought to review the current research describing the impact of certain common contaminant metals on cardiovascular (CV) health. We reviewed ten metals: lead, barium, nickel, chromium, cadmium, arsenic, mercury, selenium, zinc, and copper. After a literature review, we briefly summarized the routes of environmental exposure, pathophysiological mechanisms, CV health impacts, and exposure prevention and/or mitigation strategies for each metal. The resulting article discloses a broad spectrum of pathological significance, from relatively benign substances with little to no described effects on CV health, such as chromium and selenium, to substances with a wide-ranging and relatively severe spectrum of CV pathologies, such as arsenic, cadmium, and lead. It is our hope that this article will provide clinicians with a practical overview of the impact of these common environmental contaminants on CV health as well as highlight areas that require further investigation to better understand how these metals impact the incidence and progression of CV diseases. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Risk Factors and Prevention)

► Show Figures

Figure 1

16 pages, 3134 KiB

Open AccessEditor’s ChoiceReview

Transport and Anaesthesia Consideration for Transcatheter Patent Ductus Arteriosus Closure in Premature Infants

by Tuan Chen Aw, Belinda Chan and Yogen Singh

J. Cardiovasc. Dev. Dis. 2023, 10(9), 377; https://doi.org/10.3390/jcdd10090377 - 1 Sep 2023

Cited by 6 | Viewed by 2628

Abstract

Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and [...] Read more.

Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and limited reserves presents unique challenges. This review article focuses on the key considerations throughout the clinical pathway for the PDA device closure, including referral hospital consultation, patient selection, intra- and inter-hospital transport, and anaesthesia management. The key elements encompass comprehensive patient assessment, meticulous airway management, optimised ventilation strategies, precise thermoregulation, patient-tailored sedation protocols, vigilant haemodynamic monitoring, and safe transport measures throughout the pre-operative, intra-operative, and post-operative phases. A multidisciplinary approach enhances the chances of procedure success, improves patient outcomes, and minimises the risk of complications. Full article

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

► Show Figures

Figure 1

13 pages, 10975 KiB

Open AccessEditor’s ChoiceReview

Cardiac Magnetic Resonance—Detected Acute Myocardial Edema as Predictor of Favourable Prognosis: A Comprehensive Review

by Giulio Sinigiani, Laura De Michieli, Giorgio De Conti, Fabrizio Ricci, Manuel De Lazzari, Federico Migliore, Martina Perazzolo Marra, Alessandro Zorzi, Domenico Corrado and Alberto Cipriani

J. Cardiovasc. Dev. Dis. 2023, 10(8), 319; https://doi.org/10.3390/jcdd10080319 - 27 Jul 2023

Cited by 2 | Viewed by 2734

Abstract

Acute myocardial edema (AME) is increased water content in the myocardium and represents the first and transient pathophysiological response to an acute myocardial injury. In-vivo and non-invasive evaluation is feasible with cardiac magnetic resonance (CMR), which is a powerful imaging technique capable of [...] Read more.

Acute myocardial edema (AME) is increased water content in the myocardium and represents the first and transient pathophysiological response to an acute myocardial injury. In-vivo and non-invasive evaluation is feasible with cardiac magnetic resonance (CMR), which is a powerful imaging technique capable of tissue characterization. In the clinical setting, early demonstration of AME has a recognized diagnostic value for acute coronary syndromes and acute myocarditis, although its prognostic value is not well established. This article provides a comprehensive narrative review on the clinical meaning of AME in heart diseases. In particular, the available evidence of a possible favourable prognostic value in several clinical scenarios is addressed. Full article

(This article belongs to the Section Imaging)

► Show Figures

Figure 1

17 pages, 1475 KiB

Open AccessEditor’s ChoiceReview

The Roles of Histone Lysine Methyltransferases in Heart Development and Disease

by Jun-yi Zhu, Joyce van de Leemput and Zhe Han

J. Cardiovasc. Dev. Dis. 2023, 10(7), 305; https://doi.org/10.3390/jcdd10070305 - 18 Jul 2023

Cited by 7 | Viewed by 3256

Abstract

Epigenetic marks regulate the transcriptomic landscape by facilitating the structural packing and unwinding of the genome, which is tightly folded inside the nucleus. Lysine-specific histone methylation is one such mark. It plays crucial roles during development, including in cell fate decisions, in tissue [...] Read more.

Epigenetic marks regulate the transcriptomic landscape by facilitating the structural packing and unwinding of the genome, which is tightly folded inside the nucleus. Lysine-specific histone methylation is one such mark. It plays crucial roles during development, including in cell fate decisions, in tissue patterning, and in regulating cellular metabolic processes. It has also been associated with varying human developmental disorders. Heart disease has been linked to deregulated histone lysine methylation, and lysine-specific methyltransferases (KMTs) are overrepresented, i.e., more numerous than expected by chance, among the genes with variants associated with congenital heart disease. This review outlines the available evidence to support a role for individual KMTs in heart development and/or disease, including genetic associations in patients and supporting cell culture and animal model studies. It concludes with new advances in the field and new opportunities for treatment. Full article

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

► Show Figures

Figure 1

28 pages, 2937 KiB

Open AccessEditor’s ChoiceReview

The Impacts of Animal-Based Diets in Cardiovascular Disease Development: A Cellular and Physiological Overview

by Rami Salim Najjar

J. Cardiovasc. Dev. Dis. 2023, 10(7), 282; https://doi.org/10.3390/jcdd10070282 - 30 Jun 2023

Cited by 5 | Viewed by 29014

Abstract

Cardiovascular disease (CVD) is the leading cause of death in the United States, and diet plays an instrumental role in CVD development. Plant-based diets have been strongly tied to a reduction in CVD incidence. In contrast, animal food consumption may increase CVD risk. [...] Read more.

Cardiovascular disease (CVD) is the leading cause of death in the United States, and diet plays an instrumental role in CVD development. Plant-based diets have been strongly tied to a reduction in CVD incidence. In contrast, animal food consumption may increase CVD risk. While increased serum low-density lipoprotein (LDL) cholesterol concentrations are an established risk factor which may partially explain the positive association with animal foods and CVD, numerous other biochemical factors are also at play. Thus, the aim of this review is to summarize the major cellular and molecular effects of animal food consumption in relation to CVD development. Animal-food-centered diets may (1) increase cardiovascular toll-like receptor (TLR) signaling, due to increased serum endotoxins and oxidized LDL cholesterol, (2) increase cardiovascular lipotoxicity, (3) increase renin-angiotensin system components and subsequent angiotensin II type-1 receptor (AT1R) signaling and (4) increase serum trimethylamine-N-oxide concentrations. These nutritionally mediated factors independently increase cardiovascular oxidative stress and inflammation and are all independently tied to CVD development. Public policy efforts should continue to advocate for the consumption of a mostly plant-based diet, with the minimization of animal-based foods. Full article

(This article belongs to the Special Issue Diet and Cardiovascular Diseases—Current Views and Trends)

► Show Figures

Figure 1

13 pages, 364 KiB

Open AccessEditor’s ChoiceReview

Referral of Patients for Surgical Aortic Valve Replacement before and after Introduction of the Transcatheter Aortic Valve Implantation—Changing Patterns of Preoperative Characteristics and Volume and Postoperative Outcome

by Wilhelm Mistiaen

J. Cardiovasc. Dev. Dis. 2023, 10(5), 223; https://doi.org/10.3390/jcdd10050223 - 22 May 2023

Cited by 3 | Viewed by 1689

Abstract

Transcatheter aortic valve implantation (TAVI) was first presented in 2002 as a case report. Randomized controlled trials showed that TAVI could serve as an alternative for surgical aortic valve replacement (SAVR) in high-risk patients. While the indications for TAVI have expanded into low-risk [...] Read more.

Transcatheter aortic valve implantation (TAVI) was first presented in 2002 as a case report. Randomized controlled trials showed that TAVI could serve as an alternative for surgical aortic valve replacement (SAVR) in high-risk patients. While the indications for TAVI have expanded into low-risk groups, favorable results of SAVR in elderly showed an increase in application of surgical treatment in this age category. This review aims to explore the effect of the introduction of TAVI in the referral for SAVR with respect to volume, patient profile, early outcome, and use of mechanical heart valves. Results show that the volume of SAVR has increased in several cardiac centers. In a small minority of series, age and risk score of the referred patients also increased. In most of the series, early mortality rate reduced. These findings, however are not universal. Different management policies could be responsible for this observation. Moreover, some patients in whom aortic valve replacement in whatever form is indicated still do not receive adequate treatment. This can be due to several reasons. Heart teams consisting of interventional cardiologists and cardiac surgeons should become a universal approach in order to minimize the number of untreated patients. Full article

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

29 pages, 3379 KiB

Open AccessEditor’s ChoiceReview

Noncoding RNAs as Key Regulators for Cardiac Development and Cardiovascular Diseases

by Satoshi Kawaguchi, Bruno Moukette, Taiki Hayasaka, Angela K. Haskell, Jessica Mah, Marisa N. Sepúlveda, Yaoliang Tang and Il-man Kim

J. Cardiovasc. Dev. Dis. 2023, 10(4), 166; https://doi.org/10.3390/jcdd10040166 - 12 Apr 2023

Cited by 14 | Viewed by 4252

Abstract

Noncoding RNAs (ncRNAs) play fundamental roles in cardiac development and cardiovascular diseases (CVDs), which are a major cause of morbidity and mortality. With advances in RNA sequencing technology, the focus of recent research has transitioned from studies of specific candidates to whole transcriptome [...] Read more.

Noncoding RNAs (ncRNAs) play fundamental roles in cardiac development and cardiovascular diseases (CVDs), which are a major cause of morbidity and mortality. With advances in RNA sequencing technology, the focus of recent research has transitioned from studies of specific candidates to whole transcriptome analyses. Thanks to these types of studies, new ncRNAs have been identified for their implication in cardiac development and CVDs. In this review, we briefly describe the classification of ncRNAs into microRNAs, long ncRNAs, and circular RNAs. We then discuss their critical roles in cardiac development and CVDs by citing the most up-to-date research articles. More specifically, we summarize the roles of ncRNAs in the formation of the heart tube and cardiac morphogenesis, cardiac mesoderm specification, and embryonic cardiomyocytes and cardiac progenitor cells. We also highlight ncRNAs that have recently emerged as key regulators in CVDs by focusing on six of them. We believe that this review concisely addresses perhaps not all but certainly the major aspects of current progress in ncRNA research in cardiac development and CVDs. Thus, this review would be beneficial for readers to obtain a recent picture of key ncRNAs and their mechanisms of action in cardiac development and CVDs. Full article

► Show Figures

Figure 1

12 pages, 2546 KiB

Open AccessEditor’s ChoiceReview

Moderator Band and Ventricular Tachycardia: Structural or Functional Substrate?

by Federico Landra, Carmine Marallo, Amato Santoro, Simone Taddeucci, Maria Cristina Tavera, Claudia Baiocchi and Alberto Palazzuoli

J. Cardiovasc. Dev. Dis. 2023, 10(4), 159; https://doi.org/10.3390/jcdd10040159 - 6 Apr 2023

Viewed by 7809

Abstract

The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated [...] Read more.

The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated in the genesis of life-threatening arrhythmias. However, right Purkinje network arrhythmias have been much less reported in the literature compared to the left counterpart. The MB has unique anatomical and electrophysiological properties, which may account for its arrhythmogenicity and may be responsible for a significant portion of idiopathic ventricular fibrillation. MB embodies autonomic nervous system cells, with important implications in arrhythmogenesis. Some idiopathic ventricular arrhythmias, defined as the absence of any identifiable structural heart disorder, can begin from this site. Due to these complex structural and functional peculiarities strictly interplayed each other, it is arduous to determine the precise mechanism underlying MB arrhythmias. MB-related arrhythmias should be differentiated from other right Purkinje fibers arrhythmias because of the opportunity for intervention and the unusual site for the ablation poorly described in the literature. In the current paper, we report the characteristics and electrical properties of the MB, their involvement in arrhythmogenesis, clinical and electrophysiological peculiarities of MB-related arrhythmias, and current treatment options. Full article

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

► Show Figures

Figure 1

12 pages, 992 KiB

Open AccessEditor’s ChoiceReview

Growing Heart Valve Implants for Children

by Haley Konsek, Curry Sherard, Cora Bisbee, Lillian Kang, Joseph W. Turek and Taufiek K. Rajab

J. Cardiovasc. Dev. Dis. 2023, 10(4), 148; https://doi.org/10.3390/jcdd10040148 - 31 Mar 2023

Cited by 15 | Viewed by 4146

Abstract

The current standard of care for pediatric patients with unrepairable congenital valvular disease is a heart valve implant. However, current heart valve implants are unable to accommodate the somatic growth of the recipient, preventing long-term clinical success in these patients. Therefore, there is [...] Read more.

The current standard of care for pediatric patients with unrepairable congenital valvular disease is a heart valve implant. However, current heart valve implants are unable to accommodate the somatic growth of the recipient, preventing long-term clinical success in these patients. Therefore, there is an urgent need for a growing heart valve implant for children. This article reviews recent studies investigating tissue-engineered heart valves and partial heart transplantation as potential growing heart valve implants in large animal and clinical translational research. In vitro and in situ designs of tissue engineered heart valves are discussed, as well as the barriers to clinical translation. Full article

► Show Figures

Figure 1

12 pages, 2596 KiB

Open AccessEditor’s ChoiceReview

Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce?

by Francesca Baessato, Laura Fusini, Manuela Muratori, Gloria Tamborini, Sarah Ghulam Ali, Valentina Mantegazza, Andrea Baggiano, Saima Mushtaq, Mauro Pepi, Giuseppe Patti and Gianluca Pontone

J. Cardiovasc. Dev. Dis. 2023, 10(4), 150; https://doi.org/10.3390/jcdd10040150 - 31 Mar 2023

Cited by 6 | Viewed by 3737

Abstract

Quantification of chronic mitral regurgitation (MR) is essential to guide patients’ clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and [...] Read more.

Quantification of chronic mitral regurgitation (MR) is essential to guide patients’ clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and quantitative parameters. Of note, quantitative parameters, such as the echocardiographic effective regurgitant orifice area, regurgitant volume (RegV), and regurgitant fraction (RegF), are considered the most reliable indicators of MR severity. In contrast, cardiac magnetic resonance (CMR) has demonstrated high accuracy and good reproducibility in quantifying MR, especially in cases with secondary MR; nonholosystolic, eccentric, and multiple jets; or noncircular regurgitant orifices, where quantification with echocardiography is an issue. No gold standard for MR quantification by noninvasive cardiac imaging has been defined so far. Only a moderate agreement has been shown between echocardiography, either with transthoracic or transesophageal approaches, and CMR in MR quantification, as supported by numerous comparative studies. A higher agreement is evidenced when echocardiographic 3D techniques are used. CMR is superior to echocardiography in the calculation of the RegV, RegF, and ventricular volumes and can provide myocardial tissue characterization. However, echocardiography remains fundamental in the pre-operative anatomical evaluation of the mitral valve and of the subvalvular apparatus. The aim of this review is to explore the accuracy of MR quantification provided by echocardiography and CMR in a head-to-head comparison between the two techniques, with insight into the technical aspects of each imaging modality. Full article

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

► Show Figures

Figure 1

10 pages, 1369 KiB

Open AccessEditor’s ChoiceReview

Minimal Access Tricuspid Valve Surgery

by Jean-Alexandre Sauvé, Yung-Szu Wu, Ravi Ghatanatti and Joseph Zacharias

J. Cardiovasc. Dev. Dis. 2023, 10(3), 118; https://doi.org/10.3390/jcdd10030118 - 13 Mar 2023

Cited by 2 | Viewed by 2863

Abstract

Tricuspid valve diseases are a heterogeneous group of pathologies that typically have poor prognoses when treated medically and are associated with significant morbidity and mortality with traditional surgical techniques. Minimal access tricuspid valve surgery may mitigate some of the surgical risks associated with [...] Read more.

Tricuspid valve diseases are a heterogeneous group of pathologies that typically have poor prognoses when treated medically and are associated with significant morbidity and mortality with traditional surgical techniques. Minimal access tricuspid valve surgery may mitigate some of the surgical risks associated with the standard sternotomy approach by limiting pain, reducing blood loss, lowering the risk of wound infections, and shortening hospital stays. In certain patient populations, this may allow for a prompt intervention that could limit the pathologic effects of these diseases. Herein, we review the literature on minimal access tricuspid valve surgery focusing on perioperative planning, technique, and outcomes of minimal access endoscopic and robotic surgery for isolated tricuspid valve disease. Full article

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

► Show Figures

Graphical abstract

18 pages, 2280 KiB

Open AccessEditor’s ChoiceReview

Tricuspid Valve Regurgitation in Hypoplastic Left Heart Syndrome: Current Insights and Future Perspectives

by Colton J. Ross, Arshid Mir, Harold M. Burkhart, Gerhard A. Holzapfel and Chung-Hao Lee

J. Cardiovasc. Dev. Dis. 2023, 10(3), 111; https://doi.org/10.3390/jcdd10030111 - 7 Mar 2023

Cited by 3 | Viewed by 5437

Abstract

Hypoplastic Left Heart Syndrome (HLHS) is a congenital heart defect that requires a three-stage surgical palliation to create a single ventricle system in the right side of the heart. Of patients undergoing this cardiac palliation series,

25 %

will develop tricuspid regurgitation (TR), [...] Read more.

Hypoplastic Left Heart Syndrome (HLHS) is a congenital heart defect that requires a three-stage surgical palliation to create a single ventricle system in the right side of the heart. Of patients undergoing this cardiac palliation series,

25 %

will develop tricuspid regurgitation (TR), which is associated with an increased mortality risk. Valvular regurgitation in this population has been extensively studied to understand indicators and mechanisms of comorbidity. In this article, we review the current state of research on TR in HLHS, including identified valvular anomalies and geometric properties as the main reasons for the poor prognosis. After this review, we present some suggestions for future TR-related studies to answer the central question: What are the predictors of TR onset during the three palliation stages? These studies involve (i) the use of engineering-based metrics to evaluate valve leaflet strains and predict tissue material properties, (ii) perform multivariate analyses to identify TR predictors, and (iii) develop predictive models, particularly using longitudinally tracked patient cohorts to foretell patient-specific trajectories. Regarded together, these ongoing and future efforts will result in the development of innovative tools that can aid in surgical timing decisions, in prophylactic surgical valve repair, and in the refinement of current intervention techniques. Full article

(This article belongs to the Special Issue Congenital Heart Defects: Diagnosis, Management, and Treatment)

► Show Figures

Figure 1

10 pages, 830 KiB

Open AccessEditor’s ChoiceReview

Targeted Atrial Fibrillation Therapy and Risk Stratification Using Atrial Alternans

by Neha Muthavarapu, Anmol Mohan, Sharanya Manga, Palak Sharma, Aditi Kishor Bhanushali, Ashima Yadav, Devanshi Narendra Damani, Pierre Jais, Richard D. Walton, Shivaram P. Arunachalam and Kanchan Kulkarni

J. Cardiovasc. Dev. Dis. 2023, 10(2), 36; https://doi.org/10.3390/jcdd10020036 - 20 Jan 2023

Cited by 3 | Viewed by 3018

Abstract

Atrial fibrillation (AF) is the most persistent arrhythmia today, with its prevalence increasing exponentially with the rising age of the population. Particularly at elevated heart rates, a functional abnormality known as cardiac alternans can occur prior to the onset of lethal arrhythmias. Cardiac [...] Read more.

Atrial fibrillation (AF) is the most persistent arrhythmia today, with its prevalence increasing exponentially with the rising age of the population. Particularly at elevated heart rates, a functional abnormality known as cardiac alternans can occur prior to the onset of lethal arrhythmias. Cardiac alternans are a beat-to-beat oscillation of electrical activity and the force of cardiac muscle contraction. Extensive evidence has demonstrated that microvolt T-wave alternans can predict ventricular fibrillation vulnerability and the risk of sudden cardiac death. The majority of our knowledge of the mechanisms of alternans stems from studies of ventricular electrophysiology, although recent studies offer promising evidence of the potential of atrial alternans in predicting the risk of AF. Exciting preclinical and clinical studies have demonstrated a link between atrial alternans and the onset of atrial tachyarrhythmias. Here, we provide a comprehensive review of the clinical utility of atrial alternans in identifying the risk and guiding treatment of AF. Full article

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

► Show Figures

Figure 1

13 pages, 1066 KiB

Open AccessEditor’s ChoiceReview

Inflammation and Heart Failure: Searching for the Enemy—Reaching the Entelechy

by Ioannis Paraskevaidis, Dimitrios Farmakis, Georgios Papingiotis and Elias Tsougos

J. Cardiovasc. Dev. Dis. 2023, 10(1), 19; https://doi.org/10.3390/jcdd10010019 - 4 Jan 2023

Cited by 14 | Viewed by 3245

Abstract

The pivotal role of inflammation in the pathophysiology of heart-failure (HF) development and progression has long been recognized. High blood levels of pro-inflammatory and inflammatory markers are present and associated with adverse outcomes in patients with HF. In addition, there seems to be [...] Read more.

The pivotal role of inflammation in the pathophysiology of heart-failure (HF) development and progression has long been recognized. High blood levels of pro-inflammatory and inflammatory markers are present and associated with adverse outcomes in patients with HF. In addition, there seems to be an interrelation between inflammation and neurohormonal activation, the cornerstone of HF pathophysiology and management. However, clinical trials involving anti-inflammatory agents have shown inconclusive or even contradictory results in improving HF outcomes. In the present review, we try to shed some light on the reciprocal relationship between inflammation and HF in an attempt to identify the central regulating factors, such as inflammatory cells and soluble mediators and the related inflammatory pathways as potential therapeutic targets. Full article

► Show Figures

Figure 1

18 pages, 691 KiB

Open AccessEditor’s ChoiceReview

SCUBA Diving in Adult Congenital Heart Disease

by Robert M. Kauling, Rienk Rienks, Judith A. A. E. Cuypers, Harald T. Jorstad and Jolien W. Roos-Hesselink

J. Cardiovasc. Dev. Dis. 2023, 10(1), 20; https://doi.org/10.3390/jcdd10010020 - 4 Jan 2023

Cited by 7 | Viewed by 4296

Abstract

Conventionally, scuba diving has been discouraged for adult patients with congenital heart disease (ACHD). This restrictive sports advice is based on expert opinion in the absence of high-quality diving-specific studies. However, as survival and quality of life in congenital heart disease (CHD) patients [...] Read more.

Conventionally, scuba diving has been discouraged for adult patients with congenital heart disease (ACHD). This restrictive sports advice is based on expert opinion in the absence of high-quality diving-specific studies. However, as survival and quality of life in congenital heart disease (CHD) patients have dramatically improved in the last decades, a critical appraisal whether such restrictive sports advice is still applicable is warranted. In this review, the cardiovascular effects of diving are described and a framework for the work-up for ACHD patients wishing to engage in scuba diving is provided. In addition, diving recommendations for specific CHD diagnostic groups are proposed. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

► Show Figures

Figure 1

12 pages, 1196 KiB

Open AccessEditor’s ChoiceReview

Cardiovascular Magnetic Resonance Parametric Mapping Techniques for the Assessment of Chronic Coronary Syndromes

by Maria Anna Bazmpani, Chrysovalantou Nikolaidou, Christos A. Papanastasiou, Antonios Ziakas and Theodoros D. Karamitsos

J. Cardiovasc. Dev. Dis. 2022, 9(12), 443; https://doi.org/10.3390/jcdd9120443 - 9 Dec 2022

Cited by 3 | Viewed by 2429

Abstract

The term chronic coronary syndromes encompasses a variety of clinical presentations of coronary artery disease (CAD), ranging from stable angina due to epicardial coronary artery disease to microvascular coronary dysfunction. Cardiac magnetic resonance (CMR) imaging has an established role in the diagnosis, prognostication [...] Read more.

The term chronic coronary syndromes encompasses a variety of clinical presentations of coronary artery disease (CAD), ranging from stable angina due to epicardial coronary artery disease to microvascular coronary dysfunction. Cardiac magnetic resonance (CMR) imaging has an established role in the diagnosis, prognostication and treatment planning of patients with CAD. Recent advances in parametric mapping CMR techniques have added value in the assessment of patients with chronic coronary syndromes, even without the need for gadolinium contrast administration. Furthermore, quantitative perfusion CMR techniques have enabled the non-invasive assessment of myocardial blood flow and myocardial perfusion reserve and can reliably identify multivessel coronary artery disease and microvascular dysfunction. This review summarizes the clinical applications and the prognostic value of the novel CMR parametric mapping techniques in the setting of chronic coronary syndromes and discusses their strengths, pitfalls and future directions. Full article

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

► Show Figures

Figure 1

12 pages, 1428 KiB

Open AccessEditor’s ChoiceReview

The Role of Cardiovascular Magnetic Resonance in Patients with Mitral Regurgitation

by Anna Giulia Pavon, Marco Guglielmo, Pierpaolo Mattia Mennilli, Mariana B. L. Falcão, Luca Bergamaschi, David Filip Costantin, Michele Vivaldo, Laura Anna Leo, Susanne Schlossbauer, Christopher W. Roy, Matthias Stuber, Giovanni Pedrazzini and Francesco Faletra

J. Cardiovasc. Dev. Dis. 2022, 9(11), 399; https://doi.org/10.3390/jcdd9110399 - 18 Nov 2022

Cited by 5 | Viewed by 3490

Abstract

The 2019 Global Burden of Disease (GBD) study estimated that there were approximately 24.2 million people affected worldwide by degenerative mitral regurgitation (MR), resulting in 34,200 deaths. After aortic stenosis, MR is the most prevalent VHD in Europe and the second-most common VHD [...] Read more.

The 2019 Global Burden of Disease (GBD) study estimated that there were approximately 24.2 million people affected worldwide by degenerative mitral regurgitation (MR), resulting in 34,200 deaths. After aortic stenosis, MR is the most prevalent VHD in Europe and the second-most common VHD to pose indications for surgery in western countries. Current ESC and AHA/ACC guidelines for the management of VHD emphasize the importance of an integrative approach for the assessment of MR severity, which is of paramount importance in dictating the timing for surgery. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are the first-line imaging modalities; however, despite the technological advancement, sometimes, the final diagnosis on the degree of the disease may still be challenging. In the last 20 years, CMR has emerged as a robust technique in the assessment of patients with cardiac disease, and, recently, its role is gaining more and more importance in the field of VHD. In fact, CMR is the gold standard in the assessment of cardiac volumes, and it is possible to accurately evaluate the regurgitant volume. The purpose of this review is to outline the current state-of-the-art management of MR by using Cardiac Magnetic Resonance (CMR). Full article

(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)

► Show Figures

Figure 1

18 pages, 904 KiB

Open AccessEditor’s ChoiceReview

New Biomarkers and Their Potential Role in Heart Failure Treatment Optimisation—An African Perspective

by Marheb Badianyama, Dineo Mpanya, Umar Adamu, Farai Sigauke, Samantha Nel and Nqoba Tsabedze

J. Cardiovasc. Dev. Dis. 2022, 9(10), 335; https://doi.org/10.3390/jcdd9100335 - 2 Oct 2022

Cited by 7 | Viewed by 3298

Abstract

Heart failure is a clinical syndrome resulting from various cardiovascular diseases of different aetiologies and pathophysiology. These varying pathologies involve several complex mechanisms that lead to the activation of the neurohumoral system, inflammation, angiogenesis, apoptosis, fibrosis, and eventually adverse cardiac remodelling associated with [...] Read more.

Heart failure is a clinical syndrome resulting from various cardiovascular diseases of different aetiologies and pathophysiology. These varying pathologies involve several complex mechanisms that lead to the activation of the neurohumoral system, inflammation, angiogenesis, apoptosis, fibrosis, and eventually adverse cardiac remodelling associated with a progressive decline in cardiac function. Once a diagnosis is made, the cardiac function has a gradual decline characterised by multiple hospital admissions. It is therefore imperative to identify patients at different stages of the heart failure continuum to better risk stratify and initiate optimal management strategies. Biomarkers may play a role in the diagnosis, prognostication, and monitoring response to treatment. This review discusses the epidemiology of heart failure and biomarkers commonly used in clinical practice such as natriuretic peptides and cardiac troponins. In addition, we provide a brief overview of novel biomarkers and genetic coding and non-coding biomarkers used in the management of patients with heart failure. We also discuss barriers that hinder the clinical application of novel biomarkers. Finally, we appraise the value of polygenic risk scoring, focusing on sub-Saharan Africa. Full article

(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)

► Show Figures

Figure 1

11 pages, 693 KiB

Open AccessEditor’s ChoiceReview

The Management of Myocardial Injury Related to SARS-CoV-2 Pneumonia

by Mohammed Ahmed Akkaif, Ahmad Naoras Bitar, Laith A. I. K. Al-Kaif, Nur Aizati Athirah Daud, Abubakar Sha’aban, Dzul Azri Mohamed Noor, Fatimatuzzahra’ Abd Aziz, Arturo Cesaro, Muhamad Ali SK Abdul Kader, Mohamed Jahangir Abdul Wahab, Chee Sin Khaw and Baharudin Ibrahim

J. Cardiovasc. Dev. Dis. 2022, 9(9), 307; https://doi.org/10.3390/jcdd9090307 - 16 Sep 2022

Cited by 10 | Viewed by 3228

Abstract

The global evolution of the SARS-CoV-2 virus is known to all. The diagnosis of SARS-CoV-2 pneumonia is expected to worsen, and mortality will be higher when combined with myocardial injury (MI). The combination of novel coronavirus infections in patients with MI can cause [...] Read more.

The global evolution of the SARS-CoV-2 virus is known to all. The diagnosis of SARS-CoV-2 pneumonia is expected to worsen, and mortality will be higher when combined with myocardial injury (MI). The combination of novel coronavirus infections in patients with MI can cause confusion in diagnosis and assessment, with each condition exacerbating the other, and increasing the complexity and difficulty of treatment. It would be a formidable challenge for clinical practice to deal with this situation. Therefore, this review aims to gather literature on the progress in managing MI related to SARS-CoV-2 pneumonia. This article reviews the definition, pathogenesis, clinical evaluation, management, and treatment plan for MI related to SARS-CoV-2 pneumonia based on the most recent literature, diagnosis, and treatment trial reports. Many studies have shown that early diagnosis and implementation of targeted treatment measures according to the different stages of disease can reduce the mortality rate among patients with MI related to SARS-CoV-2 pneumonia. The reviewed studies show that multiple strategies have been adopted for the management of MI related to COVID-19. Clinicians should closely monitor SARS-CoV-2 pneumonia patients with MI, as their condition can rapidly deteriorate and progress to heart failure, acute myocardial infarction, and/or cardiogenic shock. In addition, appropriate measures need to be implemented in the diagnosis and treatment to provide reasonable care to the patient. Full article

► Show Figures

Figure 1

22 pages, 1115 KiB

Open AccessEditor’s ChoiceReview

Effects of COVID-19 on Arrhythmia

by Yujia Zhan, Honghua Yue, Weitao Liang and Zhong Wu

J. Cardiovasc. Dev. Dis. 2022, 9(9), 292; https://doi.org/10.3390/jcdd9090292 - 2 Sep 2022

Cited by 14 | Viewed by 6699

Abstract

The World Health Organization announced that COVID-19, with SARS-CoV-2 as its pathogen, had become a pandemic on 11 March 2020. Today, the global epidemic situation is still serious. With the development of research, cardiovascular injury in patients with COVID-19, such as arrhythmia, myocardial [...] Read more.

The World Health Organization announced that COVID-19, with SARS-CoV-2 as its pathogen, had become a pandemic on 11 March 2020. Today, the global epidemic situation is still serious. With the development of research, cardiovascular injury in patients with COVID-19, such as arrhythmia, myocardial injury, and heart failure, is the second major symptom in addition to respiratory symptoms, and cardiovascular injury is related to the prognosis and mortality of patients. The incidence of arrhythmia in COVID-19 patients ranges from 10% to 20%. The potential mechanisms include viral infection-induced angiotensin-converting enzyme 2 expression change, myocarditis, cytokine storm, cardiac injury, electrophysiological effects, hypoxemia, myocardial strain, electrolyte abnormalities, intravascular volume imbalance, drug toxicities and interactions, and stress response caused by virus infection. COVID-19 complicated with arrhythmia needs to be accounted for and integrated in management. This article reviews the incidence, potential mechanisms, and related management measures of arrhythmia in COVID-19 patients. Full article

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

► Show Figures

Figure 1

15 pages, 3062 KiB

Open AccessEditor’s ChoiceReview

Ventricular Tachycardia Ablation Guided by Functional Substrate Mapping: Practices and Outcomes

by Sara Vázquez-Calvo, Ivo Roca-Luque and Andreu Porta-Sánchez

J. Cardiovasc. Dev. Dis. 2022, 9(9), 288; https://doi.org/10.3390/jcdd9090288 - 30 Aug 2022

Cited by 6 | Viewed by 4293

Abstract

Catheter ablation of ventricular tachycardia has demonstrated its important role in the treatment of ventricular tachycardia in patients with structural cardiomyopathy. Conventional mapping techniques used to define the critical isthmus, such as activation mapping and entrainment, are limited by the non-inducibility of the [...] Read more.

Catheter ablation of ventricular tachycardia has demonstrated its important role in the treatment of ventricular tachycardia in patients with structural cardiomyopathy. Conventional mapping techniques used to define the critical isthmus, such as activation mapping and entrainment, are limited by the non-inducibility of the clinical tachycardia or its poor hemodynamic tolerance. To overcome these limitations, a voltage mapping strategy based on bipolar electrograms peak to peak analysis was developed, but a low specificity (30%) for VT isthmus has been described with this approach. Functional mapping strategy relies on the analysis of the characteristics of the electrograms but also their propagation patterns and their response to extra-stimulus or alternative pacing wavefronts to define the targets for ablation. With this review, we aim to summarize the different functional mapping strategies described to date to identify ventricular arrhythmic substrate in patients with structural heart disease. Full article

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

► Show Figures

Figure 1

12 pages, 304 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Technical Aspects and Development of Transcatheter Aortic Valve Implantation

by Klemen Steblovnik and Matjaz Bunc

J. Cardiovasc. Dev. Dis. 2022, 9(8), 282; https://doi.org/10.3390/jcdd9080282 - 22 Aug 2022

Cited by 5 | Viewed by 3605

Abstract

Aortic stenosis is the most common valve disease requiring surgery or percutaneous treatment. Since the first-in-man implantation in 2002 we have witnessed incredible progress in transcatheter aortic valve implantation (TAVI). In this article, we review the technical aspects of TAVI development with a [...] Read more.

Aortic stenosis is the most common valve disease requiring surgery or percutaneous treatment. Since the first-in-man implantation in 2002 we have witnessed incredible progress in transcatheter aortic valve implantation (TAVI). In this article, we review the technical aspects of TAVI development with a look at the future. Durability, low thrombogenicity, good hydrodynamics, biocompatibility, low catheter profile, and deployment stability are the attributes of an ideal TAVI device. Two main design types exist—balloon-expandable and self-expanding prostheses. Balloon-expandable prostheses use a cobalt-chromium alloy frame providing high radial strength and radiopacity, while the self-expanding prostheses use a nickel-titanium (Nitinol) alloy frame, which expands to its original shape once unsheathed and heated to the body temperature. The valve is sewn onto the frame and consists of the porcine or bovine pericardium, which is specially treated to prevent calcinations and prolong durability. The lower part of the frame can be covered by polyethylene terephthalate fabric or a pericardial skirt, providing better sealing between the frame and aortic annulus. The main future challenges lie in achieving lower rates of paravalvular leaks and new pacemaker implantations following the procedure, lower delivery system profiles, more precise positioning, longer durability, and a good hemodynamic profile. Patient-specific design and the use of autologous tissue might solve these issues. Full article

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

Journal Menu

Journal Browser

Editor’s Choice Articles

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI