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Effect of Antihypertensive Losartan on Ca2+ Mobilization in the Aorta of Middle-Aged Spontaneously Hypertensive Female Rats -
Atrioventricular Junction Ablation with High-Definition Recording of Atrioventricular Node Potential -
Bioresorbable Scaffolds for Coronary Revascularization: From Concept to Clinical Maturity -
Reliability of Immersive Virtual Reality for Pre-Procedural Planning for TAVI: A CT-Based Validation
Journal Description
Journal of Cardiovascular Development and Disease
Journal of Cardiovascular Development and Disease
(JCDD) is an international, peer-reviewed, open access journal on cardiovascular medicine, published monthly online by MDPI.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
- Journal Rank: JCR - Q2 (Cardiac and Cardiovascular Systems) / CiteScore - Q2 (General Pharmacology, Toxicology and Pharmaceutics )
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 24.7 days after submission; acceptance to publication is undertaken in 3.6 days (median values for papers published in this journal in the second half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Impact Factor:
2.3 (2024);
5-Year Impact Factor:
2.7 (2024)
Latest Articles
Left Atrial Volume and Phasic Function Assessed by 4D Auto LAQ Echocardiography in Treatment-Naive, Newly Diagnosed Type 2 Diabetes Mellitus Patients Without Hypertension or Obesity
J. Cardiovasc. Dev. Dis. 2026, 13(3), 131; https://doi.org/10.3390/jcdd13030131 - 10 Mar 2026
Abstract
(1) Background: Our aim was to evaluate left atrial (LA) volumes and function in patients with newly diagnosed, treatment-naive type 2 diabetes mellitus (T2DM) using Four-Dimensional Automated Left Atrial Quantificative (four-dimensional auto LAQ) analysis and to explore the independent factors influencing left atrial
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(1) Background: Our aim was to evaluate left atrial (LA) volumes and function in patients with newly diagnosed, treatment-naive type 2 diabetes mellitus (T2DM) using Four-Dimensional Automated Left Atrial Quantificative (four-dimensional auto LAQ) analysis and to explore the independent factors influencing left atrial function in diabetic patients. (2) Method: A total of 62 treatment-naive, newly diagnosed T2DM patients without hypertension or obesity and 50 healthy controls were prospectively enrolled in the study. All participants underwent laboratory analyses, routine echocardiography and 4D LAQ assessment. The parameters were compared between the two groups, and independent factors influencing left atrial function in diabetic patients were investigated through univariate and multivariate linear regression analyses. (3) Results: Despite no significant difference in LA end-systolic anteroposterior diameter between groups, LA volume parameters (LAVmax, LAVmin, LAVpreA, and LAVmaxI) were significantly increased in T2DM patients (all p < 0.05). Regarding LA strain, reservoir and conduit function were significantly impaired in T2DM patients, as reflected by lower LASr, LAScd, LASr-c, and LAScd-c (all p < 0.05). Conversely, circumferential contractile strain (LASct-c) was significantly higher in the T2DM group (p = 0.029), while longitudinal contractile strain (LASct) did not differ significantly between groups (p = 0.146). Multivariate analysis revealed that HbA1c and E/e’ ratio were independently associated with multiple LA strain parameters (all p < 0.05). (4) Conclusion: Newly diagnosed, treatment-naive patients with T2DM exhibited increased LA volumes, decreased left atrial ejection fraction (LAEF), and impaired reservoir and conduit functions, accompanied by a compensatory increase in contractile function. Furthermore, HbA1c and E/e’ demonstrated an independent correlation with 4D strain parameters. 4D Auto LAQ echocardiography may serve as a sensitive tool for early detection of diabetic atrial myopathy.
Full article
(This article belongs to the Topic Cardiac Imaging: State of the Art, 2nd Edition)
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Open AccessArticle
Time-Varying Prognostic Impact of the Age×BUN/LVEF Index on Long-Term MACCE After ST-Elevation Myocardial Infarction
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Seda Elcim Yildirim, Tarik Yildirim, Mehmet Tolga Hekim, Tuncay Kiris and Eyüp Avci
J. Cardiovasc. Dev. Dis. 2026, 13(3), 130; https://doi.org/10.3390/jcdd13030130 - 10 Mar 2026
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Background: Despite advances in reperfusion strategies, long-term major adverse cardiac and cerebrovascular events (MACCE) remain frequent after ST-elevation myocardial infarction (STEMI). Practical risk stratification tools applicable at presentation are therefore needed. We investigated the prognostic value of a simple composite index integrating age,
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Background: Despite advances in reperfusion strategies, long-term major adverse cardiac and cerebrovascular events (MACCE) remain frequent after ST-elevation myocardial infarction (STEMI). Practical risk stratification tools applicable at presentation are therefore needed. We investigated the prognostic value of a simple composite index integrating age, blood urea nitrogen, and left ventricular ejection fraction (Age×BUN/LVEF) for predicting long-term MACCE in STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods: This retrospective, single-center cohort study included 313 consecutive STEMI patients undergoing primary PCI between 2020 and 2024. The Age×BUN/LVEF (AGEBUNeFR) index was calculated using age and admission blood urea nitrogen values and left ventricular ejection fraction assessed during index hospitalization. The primary outcome was long-term MACCE, defined as a composite of all-cause mortality, recurrent myocardial infarction, repeat revascularization, stroke, and heart failure hospitalization. The median follow-up was 2.24 years (interquartile range 1.40–3.06). Results: During follow-up, 93 patients (29.7%) experienced MACCE. The AGEBUNeFR index was independently associated with MACCE after multivariable adjustment (adjusted HR 1.028 per unit increase, 95% CI 1.016–1.040; p < 0.001). Time-varying analyses demonstrated a dynamic prognostic effect, with significant associations in the early post-PCI period (p = 0.002) and a pronounced re-emergence of risk during late follow-up (>36 months; p < 0.001). Conclusions: The AGEBUNeFR index is a simple, readily available, and powerful predictor of long-term MACCE in STEMI patients undergoing primary PCI. By integrating age, renal/hemodynamic stress, and cardiac function, this composite index provides dynamic and incremental prognostic information beyond conventional clinical models, supporting its potential role as a practical tool for long-term risk stratification after STEMI.
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Open AccessArticle
Real-World Outcomes of Inhaled Treprostinil in Pulmonary Hypertension Related to Interstitial Lung Disease: A Multicenter, Retrospective Analysis
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Andrew R. Kyle, Arun Jose, Kristen Catherman, Jean Elwing, Roxana Sulica, Gerald S. Zavorsky and Namita Sood
J. Cardiovasc. Dev. Dis. 2026, 13(3), 129; https://doi.org/10.3390/jcdd13030129 - 10 Mar 2026
Abstract
Inhaled Treprostinil is the primary treatment of pulmonary hypertension related to interstitial lung disease (PH-ILD). Despite treatment effectiveness in clinical trials, the real-world safety and tolerability of this therapy remains unclear. We conducted a multicenter, retrospective review of adults with PH-ILD who were
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Inhaled Treprostinil is the primary treatment of pulmonary hypertension related to interstitial lung disease (PH-ILD). Despite treatment effectiveness in clinical trials, the real-world safety and tolerability of this therapy remains unclear. We conducted a multicenter, retrospective review of adults with PH-ILD who were prescribed inhaled treprostinil. We assessed clinical outcomes, 6 min walk distance (6MWD) and changes in natriuretic peptides (BNP, NT-proBNP), as well as medication tolerance. Eighty-three patients met the inclusion criteria. The 6MWD data was collected but a limited number of patients had results within close proximity to initiation of inhalational treprostinil with only seven patients having assessments within the 3 months prior to initiation as well as 3 months post therapy. Limited 6MWD data is likely due, in part, to coinciding with the COVID pandemic, limiting face-to-face interactions and exercise testing. The majority of our subjects, 63%, had an absolute improvement in their BNP level, over a mean duration of 170 days. However, no significant difference was detected between baseline and follow-up natriuretic peptide levels. Adherence was assessed and the majority (77%) of patients remained on therapy at the time of censoring, with three-quarters (75%) meeting the target dose. Of the 15 patients intolerant to nebulized treprostinil who were transitioned to a dry powder inhaler, the majority (87%) were able to tolerate the other formulation. The medication was well-tolerated with a large percentage of patients remaining on therapy indefinitely and reaching the targeted therapeutic dose.
Full article
(This article belongs to the Special Issue The Past, Present, and Future of Pulmonary Hypertension: Pathophysiology and Treatment Prospects)
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Open AccessArticle
Muscular VSD Device Complications: Literature Review and Possible Implications for Echocardiographic Follow-Up
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Micah Tatum, Thomas Casto, Amulya Buddhavarapu, Elizabeth Lyman, Alison Gehred, Benjamin Blais and Clifford L. Cua
J. Cardiovasc. Dev. Dis. 2026, 13(3), 128; https://doi.org/10.3390/jcdd13030128 - 10 Mar 2026
Abstract
Long-term transthoracic echocardiogram (TTE) follow-up guidelines after muscular ventricular septal defect (mVSD) device closure are vague. The primary goal of this study was to perform a literature search to characterize the type and timing of complications that occur after mVSD device placement. The
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Long-term transthoracic echocardiogram (TTE) follow-up guidelines after muscular ventricular septal defect (mVSD) device closure are vague. The primary goal of this study was to perform a literature search to characterize the type and timing of complications that occur after mVSD device placement. The search was performed in Medline (PubMed) with English language and publication date (1983 to 2024) filters applied. Studies were included if they reported on patients who underwent mVSD device closure. Studies were excluded if they reported on other types of ventricular septal defect (VSD) device closures, were review papers, or did not report outcomes after the device procedure. A total of 139 articles met the criteria (retrospective, n = 63; prospective, n = 10; case reports, n = 66), encompassing 1668 patient cases. Age at the time of mVSD closure was 10.6 + 2.7 years. Incidence of complications was 17.9% (299/1668). Maximum follow-up was 160 months. Most complications were residual shunts (40.8%, 122/299), followed by valve dysfunction (13.7%, 41/299) and arrhythmias (13.7% 41/299). The vast majority of complications occurred ≤12 months post-device placement 98.0% (293/299). Only 1.3% (4/299) of complications occurred at >12 months (mild tricuspid regurgitation, n = 2; left bundle branch block, n = 1; atrial fibrillation, n = 1). Time until complication was not reported in 0.7% (2/299) of patients (residual shunts, n = 2). All clinically significant complications diagnosed via TTE occurred <12 months post-mVSD device procedure. The utility of repeat TTE beyond one year after mVSD device closure should be reassessed if no clinical concerns are present.
Full article
(This article belongs to the Special Issue Recent Advances in Transcatheter Closure of Atrial Septal Defects (ASD) and Ventricular Septal Defects (VSD))
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Open AccessSystematic Review
Genome-Wide Association Studies of Myocardial Infarction: A Systematic Literature Review
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Isabelle P. Thierry, Reza Jabbari, Thomas Engstrøm, Jacob Tfelt-Hansen and Charlotte Glinge
J. Cardiovasc. Dev. Dis. 2026, 13(3), 127; https://doi.org/10.3390/jcdd13030127 - 10 Mar 2026
Abstract
Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide, which can result in severe complications such as cardiac arrhythmia, heart failure, and sudden cardiac death. Genetic factors contribute to MI etiology and have been studied through genome-wide association studies (GWAS).
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Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide, which can result in severe complications such as cardiac arrhythmia, heart failure, and sudden cardiac death. Genetic factors contribute to MI etiology and have been studied through genome-wide association studies (GWAS). This systematic review aims to summarize all GWAS of MI reporting single-nucleotide polymorphisms (SNPs) reaching genome-wide significance (p < 5 × 10−8) and elucidate on their biological relevance and potential clinical utility. A systematic review following PRISMA guidelines was conducted using PubMed and the GWAS Catalog to identify eligible studies. This review included nine GWAS published between 2007 and 2023, conducted in both European and non-European cohorts. GWAS have identified multiple loci associated with MI, pinpointing potential biological pathways underlying MI, and potential therapeutic targets and enhancing risk prediction. Nonetheless, significant challenges remain, particularly the underrepresentation of diverse ancestries and the need for functional follow-up studies to define causal variants and clarify the mechanisms linking genetic variation to MI pathogenesis.
Full article
(This article belongs to the Special Issue Feature Review Papers in the ‘Genetics’ Section)
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Clinical Characteristics and Outcomes of 1894 Women with Peripartum Cardiomyopathy Treated with and Without Levosimendan in Germany
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Jan A. Kloka, Alexandra Popescu, Benjamin Friedrichson, Thomas Jasny, Lea V. Blum, Stephanie Noone, Armin Flinspach, Peter Kranke, Kai Zacharowski and Vanessa Neef
J. Cardiovasc. Dev. Dis. 2026, 13(3), 126; https://doi.org/10.3390/jcdd13030126 - 9 Mar 2026
Abstract
Background: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during the last month of pregnancy or within five months postpartum. While levosimendan is considered beneficial in heart failure and cardiogenic shock, evidence supporting its use in PPCM is limited. This
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Background: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during the last month of pregnancy or within five months postpartum. While levosimendan is considered beneficial in heart failure and cardiogenic shock, evidence supporting its use in PPCM is limited. This study investigated the prevalence of PPCM in Germany and evaluated outcomes associated with levosimendan use. Methods: Using national data from the German Statistical Office, all pregnant women diagnosed with PPCM and hospitalized between 2009 and 2022 were included. Patients were categorized into groups based on levosimendan treatment. Demographics, treatment modalities, peripartum complications, and transfusion rates were analyzed. Results: The prevalence of PPCM in Germany is 0.01%; 3.60% of patients received levosimendan, mostly after childbirth (61.76%). Peripartum complications and the use of mechanical circulatory support devices were significantly higher in the levosimendan group (p < 0.0001). Women in the levosimendan group suffered significantly more often from intrapartum bleeding and increased rates of blood transfusion compared to women in the non-levosimendan group. Conclusions: PPCM is a rare disease in Germany with a prevalence of 0.01%. Despite higher complication rates in women with levosimendan treatment, further studies are necessary to help determine the role and timing of levosimendan in the treatment of women with PPCM.
Full article
(This article belongs to the Special Issue Women and Cardiovascular Disease: The Gender Gap)
Open AccessCorrection
Correction: Cicek et al. A New Risk Prediction Model for the Assessment of Myocardial Injury in Elderly Patients Undergoing Non-Elective Surgery. J. Cardiovasc. Dev. Dis. 2025, 12, 6
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Vedat Cicek, Mert Babaoglu, Faysal Saylik, Samet Yavuz, Ahmet Furkan Mazlum, Mahmut Salih Genc, Hatice Altinisik, Mustafa Oguz, Berke Cenktug Korucu, Mert Ilker Hayiroglu, Tufan Cinar and Ulas Bagci
J. Cardiovasc. Dev. Dis. 2026, 13(3), 125; https://doi.org/10.3390/jcdd13030125 - 9 Mar 2026
Abstract
In the original publication [...]
Full article
(This article belongs to the Special Issue Models and Methods for Computational Cardiology: 2nd Edition)
Open AccessArticle
Endothelial Activation and Stress Index Predicts Poor Coronary Collateral Development in Chronic Total Occlusion
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Muhammed Ulvi Yalcin, Kadri Murat Gurses, Canan Aydoğan, Sevil Butun, Abdullah Tunçez, Hüseyin Tezcan, Yasin Ozen, Kenan Demir, Nazif Aygul, Mustafa Kirmizigul, Aslihan Merve Toprak Su, Burak Erdogan, Tolgahan Karaman and Bulent Behlul Altunkeser
J. Cardiovasc. Dev. Dis. 2026, 13(3), 124; https://doi.org/10.3390/jcdd13030124 - 9 Mar 2026
Abstract
Background/Objectives: Coronary collateral circulation (CCC) reduces ischemic damage in patients with chronic total occlusion (CTO), yet collateral development varies considerably among individuals. Endothelial stress and systemic inflammation are key biological processes involved in collateral vessel formation. The Endothelial Activation and Stress Index (EASIX),
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Background/Objectives: Coronary collateral circulation (CCC) reduces ischemic damage in patients with chronic total occlusion (CTO), yet collateral development varies considerably among individuals. Endothelial stress and systemic inflammation are key biological processes involved in collateral vessel formation. The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase, creatinine, and platelet count, is a simple marker reflecting endothelial dysfunction and inflammatory status. However, evidence regarding its relationship with angiographic coronary collateral development in CTO remains limited. Therefore, this study aimed to evaluate the association between EASIX and CCC grades in patients with CTO. Methods: This retrospective study included 186 patients with CTO who underwent coronary angiography. CCC was evaluated using the Rentrop–Cohen classification and categorized as poorly developed (grades 0–1) or well-developed (grades 2–3). Clinical and laboratory data, including EASIX, were collected. Univariate and multivariate binary logistic regression analyses were performed to identify factors associated with poorly developed CCC. EASIX was standardized (z-score), and odds ratios were reported per 1-standard deviation increase. The predictive performance of EASIX was assessed using receiver operating characteristic (ROC) curve analysis. Results: Poorly developed CCC was observed in 70 patients (37.6%). Patients with well-developed CCC had significantly lower EASIX values (median 0.44 vs. 0.67, p < 0.001) and higher HDL cholesterol levels (p = 0.043). Neutrophil-to-lymphocyte ratio was also higher in the poorly developed CCC group (median 2.59 [2.19–3.59] vs. 2.41 [1.59–3.49], p = 0.028). In multivariate analysis, standardized EASIX remained independently associated with poorly developed CCC (OR 2.536 per 1-SD increase, 95% CI 1.734–3.710, p < 0.001). ROC analysis showed that EASIX provided moderate discrimination for poorly developed CCC (AUC 0.718), with 72.9% sensitivity and 62.1% specificity at a cutoff of >0.51. Conclusions: Higher EASIX values were independently associated with poorly developed CCC in patients with CTO. These findings support a link between systemic endothelial stress and impaired collateral vessel formation. EASIX may serve as a simple, practical, and low-cost biomarker to support risk stratification in CTO patients; however, prospective studies are needed to confirm these results and clarify clinical implications.
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(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)
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Open AccessArticle
Central Aortic Cannulation for Total Coronary Revascularization via Anterior Thoracotomy: A Single-Center Initial Experience
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Tuna Demirkıran, Işıl Taşöz Özdaş, Gizem Işık Ökten, Furkan Burak Akyol, Tayfun Özdem, Yiğit Tokgöz, Hüma Kekeçdil, Murat Kadan and Kubilay Karabacak
J. Cardiovasc. Dev. Dis. 2026, 13(3), 123; https://doi.org/10.3390/jcdd13030123 - 7 Mar 2026
Abstract
Objective: We aimed to evaluate the feasibility, safety, and technical challenges of central aortic cannulation for total coronary revascularization via left anterior thoracotomy (TCRAT). Methods: A retrospective, single-center observational study was conducted on the first 29 TCRAT cases performed with central aortic cannulation.
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Objective: We aimed to evaluate the feasibility, safety, and technical challenges of central aortic cannulation for total coronary revascularization via left anterior thoracotomy (TCRAT). Methods: A retrospective, single-center observational study was conducted on the first 29 TCRAT cases performed with central aortic cannulation. The primary outcomes included operative mortality, stroke, conversion to sternotomy, major aortic bleeding, and dissection; the secondary outcomes included delirium, reoperation, infection, ICU stay, and hospitalization. The descriptive statistics were reported as means ± SD or median (interquartile range [IQR]). Results: The mean age of the patients was 57.2 ± 9.8 years, with 72% of these being male. The most frequent comorbidities observed in the study population were hypertension (62%), diabetes (52%), and peripheral artery disease (28%). The mean cross-clamp time was found to be 63 ± 27 min, and the mean CPB time was 118.6 ± 41.6 min. The occurrence of stroke, aortic dissection, major bleeding, and sternotomy conversions was not observed. One patient died from severe pneumonia on the ninth post-operative day. The mean ICU stay was 1.2 ± 0.4 days, and the mean hospital stay was 5.3 ± 1.1 days. Conclusions: Central aortic cannulation appears to be a safe and feasible procedure for TCRAT, providing physiological antegrade flow and eliminating the complications associated with peripheral cannulation. The preliminary findings suggest that central arterial cannulation may be a safe and practical alternative for the TCRAT technique, but prospective comparative studies are required to confirm its benefits over the femoral and axillary approaches.
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(This article belongs to the Special Issue Minimally Invasive Coronary Revascularization: State of the Art)
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Open AccessReview
Twin Transformation in Cardiothoracic Surgery: The Convergence of Digital Innovation and Sustainability
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Vasileios Leivaditis, Roman Gottardi, Andreas Antonios Maniatopoulos, Francesk Mulita, Charalampia Pylarinou, Spyros Papadoulas, Konstantinos Nikolakopoulos, Ioannis Panagiotopoulos, Efstratios Koletsis, Manfred Dahm and Anastasios Sepetis
J. Cardiovasc. Dev. Dis. 2026, 13(3), 122; https://doi.org/10.3390/jcdd13030122 - 7 Mar 2026
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Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods:
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Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods: This narrative review synthesizes PubMed-indexed literature published over the past two decades, supplemented by relevant policy documents and guidelines. The review examines digital transformation and sustainability initiatives in cardiothoracic surgery through the lens of the twin transformation framework, which conceptualizes digitalization and sustainability as interdependent and mutually reinforcing processes. Results: Key domains of digital transformation include artificial intelligence and big data-driven decision-making, robotic and minimally invasive surgical techniques, digital twins and simulation-based training, telemedicine and remote monitoring, and interoperable electronic health records. Sustainability-related themes encompass the substantial environmental burden of operating rooms, green surgical practices, sustainable procurement, and hospital-level decarbonization strategies. Emerging evidence suggests that aligning digital technologies with sustainability objectives can improve clinical outcomes, enhance operational efficiency, and reduce environmental impact. However, current evidence is largely derived from pilot studies and single-center experiences. Conclusions: Twin transformation offers a coherent and forward-looking framework for the future evolution of cardiothoracic surgery, demonstrating that digital innovation and sustainability can be synergistic rather than competing goals. While significant challenges remain—including high implementation costs, limited long-term data, and fragmented regulatory frameworks—integrating digital health technologies with sustainable practices represents a promising pathway toward high-quality, efficient, and environmentally responsible cardiothoracic care.
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Open AccessArticle
Early Prediction of Postoperative Peritoneal Dialysis Using Lung Ultrasound Scoring in Neonates After Cardiopulmonary Bypass
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Duygu Tunçel, Süleyman Geter, Leyla Şero, Yiğit Kılıç, Nilüfer Okur and Bedri Aldudak
J. Cardiovasc. Dev. Dis. 2026, 13(3), 121; https://doi.org/10.3390/jcdd13030121 - 6 Mar 2026
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Background: Neonates and young infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) are highly vulnerable to pulmonary dysfunction, systemic inflammation, capillary leak, and fluid overload, which may lead to acute kidney injury (AKI) and the need for peritoneal dialysis (PD). Lung ultrasound (LUS)
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Background: Neonates and young infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) are highly vulnerable to pulmonary dysfunction, systemic inflammation, capillary leak, and fluid overload, which may lead to acute kidney injury (AKI) and the need for peritoneal dialysis (PD). Lung ultrasound (LUS) is a bedside, radiation-free tool that allows real-time assessment of lung aeration and pulmonary congestion. However, its role in predicting postoperative renal support remains limited. This study aimed to evaluate whether early postoperative LUS scores could predict the need for PD in neonates after congenital heart surgery with CPB. Methods: In this prospective single-center study, 53 neonates undergoing cardiac surgery with CPB between June 2025 and January 2026 were included. LUS was performed preoperatively and at 0–2 h, 24–48 h, 72 h, 120 h, and 168 h postoperatively using a standardized six-zone scoring system (0–18). The primary outcome was postoperative PD requirement. ROC analysis assessed predictive performance, and multivariable logistic regression identified independent predictors. Results: Total LUS scores significantly increased in the early postoperative period, remained elevated for 24–72 h, and gradually declined by days 5–7. Infants requiring PD (n = 16) had significantly higher LUS scores at 0–2 h, 24–48 h, and 72 h (p < 0.05). The 24–48 h (AUC = 0.784; sensitivity 87%, specificity 62% at cut-off ≥ 11.5) LUS score showed the best predictive value for PD (AUC = 0.831; sensitivity 86%, specificity 74% at cut-off ≥ 13). In multivariable analysis, higher LUS scores at 0–2 h (OR 1.625, p = 0.048) and 24–48 h (OR 1.621, p = 0.048) independently predicted PD. Conclusion: Postoperative LUS is a reliable, noninvasive tool that can aid in predicting the need for PD in neonates undergoing cardiac surgery with CPB, supporting timely fluid and renal management.
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Open AccessArticle
Exploratory Study of Selective Brain Hypothermia Using Transnasal Evaporative Cooling Under Controlled Normothermia with an Endovascular Device
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Mitsuaki Nishikimi, Kazuya Kikutani, Mayumi Higashi, Shinichiro Ohshimo, Tatsuhiko Anzai and Nobuaki Shime
J. Cardiovasc. Dev. Dis. 2026, 13(3), 120; https://doi.org/10.3390/jcdd13030120 - 6 Mar 2026
Abstract
Introduction: Selective brain hypothermia has been investigated to improve neurological outcomes in patients with cardiac arrest; however, an optimal clinical method has not yet been established. This study aimed to evaluate the feasibility of a technique combining transnasal evaporative cooling with simultaneous endovascular
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Introduction: Selective brain hypothermia has been investigated to improve neurological outcomes in patients with cardiac arrest; however, an optimal clinical method has not yet been established. This study aimed to evaluate the feasibility of a technique combining transnasal evaporative cooling with simultaneous endovascular temperature management to achieve selective brain hypothermia while preventing systemic hypothermia. Methods: Three adult male Göttingen swine were anesthetized and mechanically ventilated. Transnasal cooling was initiated at maximum output while endovascular warming preserved systemic temperature. Brain parenchymal and rectal temperatures, mean arterial pressure (MAP), heart rate (HR), and cardiac output (CO) were continuously monitored for 60 min. Temperature differences between brain and rectum at 60 min were analyzed. Results: A brain–rectal gradient ≥1.0 °C was achieved in all swine at 25, 40, and 30 min, respectively, and maintained at 1.0–1.5 °C thereafter. Brain temperature (34.5 ± 0.34 °C) was significantly lower than rectal temperature (35.8 ± 0.35 °C) at 60 min after initiation of the selective cooling procedure (p = 0.0048). MAP, HR, and CO showed no deviations from baseline. Conclusions: The combination of transnasal cooling and endovascular warming reliably induced selective brain hypothermia of 1–1.5 °C without adverse effects on hemodynamic parameters in swine.
Full article
(This article belongs to the Special Issue Clinical Outcome and Treatment of Cardiac Arrest)
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Open AccessReview
Artificial Intelligence in Venous Thromboembolism Prevention: A Narrative Review of Machine Learning, Deep Learning, and Natural Language Processing
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Daniela Nicoleta Crisan, Talida Georgiana Cut, Lucian-Flavius Herlo, Nina Ivanovic, Alexandra Herlo, Luana Alexandrescu, Andreea Sălcudean and Raluca Dumache
J. Cardiovasc. Dev. Dis. 2026, 13(3), 119; https://doi.org/10.3390/jcdd13030119 - 6 Mar 2026
Abstract
Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a significant and preventable cause of morbidity and mortality worldwide. Despite the existence of clinical prediction models, biomarker-based risk assessments, and imaging techniques, gaps remain in accurately identifying and managing high-risk
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Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a significant and preventable cause of morbidity and mortality worldwide. Despite the existence of clinical prediction models, biomarker-based risk assessments, and imaging techniques, gaps remain in accurately identifying and managing high-risk patients. In recent years, artificial intelligence has emerged as a transformative tool in healthcare, offering promising applications for enhancing VTE prevention strategies. This narrative review synthesizes current evidence on the use of artificial intelligence (AI) technologies including machine learning (ML), deep learning (DL), and natural language processing (NLP). We explore how supervised ML algorithms, such as random forests, support vector machines, and gradient boosting, improve predictive performance compared to traditional models by capturing complex, nonlinear relationships within electronic health record data. We also examine the role of DL models, particularly convolutional neural networks, in interpreting imaging data, achieving diagnostic accuracies comparable to expert radiologists. Additionally, the review highlights NLP applications in extracting risk-relevant information from unstructured clinical notes and the emerging integration of wearable device data and time-series analysis for dynamic risk assessment. We argue that the successful integration of AI into routine VTE prevention workflows requires rigorous prospective validation, cross-institutional collaboration, and thoughtful implementation into clinical decision support systems.
Full article
(This article belongs to the Special Issue Machine Learning and Artificial Intelligence in Cardiovascular Medicine, 2nd Edition)
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Open AccessArticle
Prognostic Value of Cadmium-Zinc-Telluride Dedicated Cardiac SPECT Dynamic Myocardial Perfusion Quantitative Imaging in Patients with Coronary Chronic Total Occlusion: A Pilot Study
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Linlin Li, Zekun Pang, Jianming Li and Wengui Xu
J. Cardiovasc. Dev. Dis. 2026, 13(3), 118; https://doi.org/10.3390/jcdd13030118 - 4 Mar 2026
Abstract
Background: The prevalence of chronic total occlusion (CTO) lesions is as high as 30% in patients undergoing coronary angiography (CAG). Some CTO patients do not undergo revascularization due to procedural complexity and high risks. This study aimed to investigate the value of cadmium-zinc-telluride
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Background: The prevalence of chronic total occlusion (CTO) lesions is as high as 30% in patients undergoing coronary angiography (CAG). Some CTO patients do not undergo revascularization due to procedural complexity and high risks. This study aimed to investigate the value of cadmium-zinc-telluride (CZT) SPECT dynamic myocardial perfusion imaging (MPI) for risk stratification and prognosis assessment in patients with coronary CTO. Methods: This study retrospectively included 62 patients who underwent CZT SPECT dynamic MPI examination and were diagnosed with CTO by angiography. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, late coronary revascularization, or hospitalization for unstable angina. Results: Over a median follow-up of 17 months (IQR 11–23), 15 MACEs occurred. The stress myocardial blood flow (sMBF) and coronary flow reserve (CFR) in the CTO territory were significantly lower in the MACEs group compared to the non-MACEs group (all p < 0.05). Receiver operating characteristic analysis determined the optimal cut-off values for predicting MACEs as sMBF < 0.75 (sensitivity 78.7%, specificity 73.3%, AUC = 0.74, p < 0.05) and CFR < 1.39 (sensitivity 70.2%, specificity 80.0%, AUC = 0.75, p < 0.01). Kaplan–Meier survival analysis showed that patients with impaired sMBF (p < 0.001) or impaired CFR (p < 0.01), defined by these cut-off values, had significantly worse clinical outcomes. Conclusions: The results of this study indicate that sMBF and CFR obtained from CZT SPECT dynamic MPI provide valuable prognostic prediction for patients with coronary CTO lesions, offering critical evidence for identifying high-risk patients requiring active intervention.
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(This article belongs to the Special Issue Noninvasive Imaging in Cardiology: From Diagnosis to Treatment)
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Open AccessArticle
Is Resynchronization Pacing Proarrhythmic Among Congenital Heart Patients? An Evaluation and Review
by
Peter P. Karpawich, Kathleen Zelin, Corinne Biggs, Swati Sehgal, Jennifer Blake, Chenni Sriram and Pooja Gupta
J. Cardiovasc. Dev. Dis. 2026, 13(3), 117; https://doi.org/10.3390/jcdd13030117 - 4 Mar 2026
Abstract
Background: Cardiac resynchronization therapy (CRT) can be an effective form of heart failure (HF) management among congenital heart disease (CHD) patients (pts) with and without surgically repaired defects. However, very long-term results are limited. Recently, CRT has been implicated to be proarrhythmic among
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Background: Cardiac resynchronization therapy (CRT) can be an effective form of heart failure (HF) management among congenital heart disease (CHD) patients (pts) with and without surgically repaired defects. However, very long-term results are limited. Recently, CRT has been implicated to be proarrhythmic among older CRT recipients. This issue is largely unknown among younger CHD-CRT pts. This study presents up to a 20-year (y) continuous review of any arrhythmia (Arr) burden associated with CRT among CHD-HF pts. Methods: From 1999 to 2024, outcomes of 45 CHD-HF pts (NYHA II-IV) (age 4–57 y [mean 26]; 31% female) were compared between those on established medical management (MM) (n = 18) and CRT recipients (n = 27) followed continuously for 1–20 years. Pre-existing and any de novo Arr that occurred following CRT were documented. Clinical assessments were continuous. Results: Follow-up was for 1 to 20 y (mean 7.5 y ± 0.7 sem). Patient demographics (CRT vs. MM groups) were comparable. Pre-existing Arr were found in 16 pts (38%) from both groups: accelerated junction (one CRT), atrial flutter (one CRT; two MM), and ventricular tachycardia (six CRT; six MM). During follow-up, outcomes included 14 pt deaths and 7 heart transplants (HTs). Of these, pre-existing Arr were causative among three CRT recipients: two ≤ 2 y and one > 5 y after CRT. There were no new-onset Arr in any pt groups. CRT significantly improved patient survival free from HT or death at 10 y (44 vs. 13% [p < 0001]). Conclusion: When applied effectively, CRT benefits CHD-HF pts without causing additional arrhythmias. However, pre-existing Arr remain a concern reflecting persistently adverse intrinsic myocellular issues among CHD-HF pts.
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(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)
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Open AccessArticle
Valve-Sparing Versus Composite Graft Aortic Root Replacement in Acute Type A Aortic Dissection with Standardized Hemiarch Repair: A Propensity Score Matching Analysis
by
Mohammed Morjan, Tong Li, Luis J. Vallejo Castano, Carlos A. Mestres, Amin Thwairan, Freya S. Jenkins, Hannan Dalyanoglu and Artur Lichtenberg
J. Cardiovasc. Dev. Dis. 2026, 13(3), 116; https://doi.org/10.3390/jcdd13030116 - 4 Mar 2026
Abstract
Objectives: The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic
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Objectives: The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic dissection (ATAAD) in a propensity score matching analysis. Methods: In this retrospective study we compared the outcomes before and after propensity score matching of patients who underwent emergency surgical repair for ATAAD requiring replacement of the aortic hemiarch with replacement of the aortic root between 2001 and 2023 at our institute. The 154 patients were divided into two groups: the first group consisted of patients undergoing David (n = 59), and the second group of patients undergoing Bentall (n = 95) procedures combined with an aortic hemiarch replacement. To reduce the confounding impact of pre-operative variables in this non-randomized study, 1:1 propensity score matching using the Nearest-Neighbour Matching algorithm was used. Results: Patients in the David plus Hemiarch group were significantly younger (62.16 ± 12.35 vs. 55.55 ± 10.80, p = 0.001). After the propensity score matching there were no significant differences between the two groups regarding intra-operative variables and hospital outcomes. In-hospital death was 15% (n = 6) in the David plus Hemiarch group compared to 24% (n = 10) in the Bentall plus Hemiarch group (15% vs. 24%, p = 0.40). Operation time was also similar between the two groups, being 402 and 384 min, respectively. Survival analyses also did not show any difference in long-term survival between both groups. Conclusions: When a standardized hemiarch replacement was used, no significant differences in short- and long-term outcomes were observed between a valve-sparing procedure and composite graft replacement in patients undergoing surgical repair for ATAAD. Surgeons should opt for the surgical strategy they are most comfortable with. This study represents one of the few analyses comparing the David and Bentall techniques in ATAAD patients undergoing standardized hemiarch replacement. Despite its retrospective nature, it provides clinically relevant insights for surgical decision-making in emergency settings.
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(This article belongs to the Special Issue Aortic Surgery—Back to the Roots and Looking to the Future)
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Open AccessArticle
Prognostic Impact of Untreated Chronic Coronary Artery Obstruction After Surgery for Aortic Regurgitation
by
Xin Li, Vito Domenico Bruno, Yi Jiang, Yunxing Xue and Dongjin Wang
J. Cardiovasc. Dev. Dis. 2026, 13(3), 115; https://doi.org/10.3390/jcdd13030115 - 3 Mar 2026
Abstract
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Background: The optimal management strategy for 50–70% chronic coronary artery stenosis in patients undergoing aortic valve surgery for aortic regurgitation (AR) remains controversial. This study evaluates the prognostic impact of chronic coronary obstruction severity on surgical outcomes and mid-term survival. Methods: This retrospective
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Background: The optimal management strategy for 50–70% chronic coronary artery stenosis in patients undergoing aortic valve surgery for aortic regurgitation (AR) remains controversial. This study evaluates the prognostic impact of chronic coronary obstruction severity on surgical outcomes and mid-term survival. Methods: This retrospective cohort study included 717 patients undergoing aortic valve surgery for AR, grouped by coronary stenosis into <50% (n = 641) and 50–70% (n = 76). Following 1:1 propensity score matching (72 patients per group), the primary outcome of major adverse cardiovascular events (MACE) and the secondary outcome of all-cause death were compared. Results: No intergroup differences emerged in perioperative mortality (1.32% vs. 1.56%, p = 1.000) or complication rate. With a median follow-up of 2.53 years, 50–70% coronary obstruction does not increase MACE (HR = 2.050; 95% CI 0.375–11.197; log-rank p = 0.397) and all-cause mortality (HR = 0.710; 95% CI 0.200–2.522; log-rank p = 0.595). Similar results were obtained in the competing risk regression and multivariable analyses. Conclusions: In patients with AR, 50–70% chronic coronary obstruction does not increase perioperative complications, MACE, and all-cause mortality.
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Open AccessArticle
Utility of Field Tests for Predicting Cardiorespiratory Fitness and Prescribing Exercise Intensity in Cardiac Rehabilitation Programs: A Randomized Crossover Trial
by
Blake E. G. Collins, Brett A. Gordon, Daniel W. T. Wundersitz, Jayden R. Hunter, Lisa C. Hanson and Michael I. C. Kingsley
J. Cardiovasc. Dev. Dis. 2026, 13(3), 114; https://doi.org/10.3390/jcdd13030114 - 3 Mar 2026
Abstract
The aims of this study are the following: To examine whether field tests predict cardiorespiratory fitness in people with coronary heart disease (CHD) and to determine if heart rate (HR) agreement between the first ventilatory threshold (VT1) and field tests is
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The aims of this study are the following: To examine whether field tests predict cardiorespiratory fitness in people with coronary heart disease (CHD) and to determine if heart rate (HR) agreement between the first ventilatory threshold (VT1) and field tests is sufficient for prescribing exercise intensity. Participants randomly completed field tests and a cardiopulmonary exercise test (CPET). Linear regression models were developed to predict VT1. Agreement between predicted and measured peak oxygen consumption (V̇O2peak) as well as field test terminal HR and HR at VT1 (VT1HR) was assessed using Pearson correlations, Bland–Altman analyses, mean absolute percentage error (MAPE), Lin’s concordance correlation coefficient (CCC), and standard error of estimate (SEE). Agreement between predicted and measured V̇O2peak was modest (Pearson’s r = 0.27–0.77; Lin’s CCC = 0.132–0.735; MAPE = 16.1–30.1%; SEE = 4.7–6.8 mL·kg−1·min−1). Agreement between field test terminal HR and VT1HR was moderate (Pearson’s r = 0.50–0.67; Lin’s CCC = 0.36–0.68; MAPE = 8.9–13.7%; SEE = 11.9–18.7 bpm; Bland–Altman 95%LOA = −3.5 to 13.7 bpm). Field tests demonstrated variable accuracy for predicting V̇O2peak, with none meeting predefined agreement criteria. Regression models indicate field tests can estimate VT1; however, levels of HR agreement indicate CPET is necessary for prescribing exercise intensity.
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(This article belongs to the Special Issue Advancing Cardiac Rehabilitation Delivery and Outcomes: Focusing on Exercise and Lifestyle)
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Radiomic Assessment of Epicardial Adipose Tissue for the Prediction of Non-Calcified Coronary Atherosclerotic Plaques
by
Carlo Di Donna, Armando Ugo Cavallo, Eliseo Picchi, Mario Laudazi, Massimo Federici, Marcello Chiocchi and Francesco Garaci
J. Cardiovasc. Dev. Dis. 2026, 13(3), 113; https://doi.org/10.3390/jcdd13030113 - 2 Mar 2026
Abstract
Epicardial adipose tissue (EAT) has previously been associated with coronary artery calcium scores, an increased burden of coronary artery disease (CAD), and features of plaque instability. These associations are likely mediated by endocrine and paracrine signaling from bioactive molecules secreted by EAT, which
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Epicardial adipose tissue (EAT) has previously been associated with coronary artery calcium scores, an increased burden of coronary artery disease (CAD), and features of plaque instability. These associations are likely mediated by endocrine and paracrine signaling from bioactive molecules secreted by EAT, which may contribute to coronary atherosclerosis. EAT can be non-invasively quantified on images obtained during coronary computed tomography angiography (CCTA). This study aimed to evaluate the potential association between EAT and non-calcified coronary plaques with severe stenosis using radiomic methodology. Materials and Methods: A total of 128 consecutive patients undergoing CCTA—both with and without contrast—for known or suspected CAD were retrospectively analyzed. EAT features were extracted from contrast scans. Coronary artery plaque features were evaluated using Coronary Artery Disease-Reporting and Data System (CAD-RADS). Results: EAT features showed a statistically significant positive correlation with non-calcified coronary plaques with severe grades of stenosis (CAD-RADS > 4). The Ensemble Machine Learning (EML) model combined with coronary plaque data showed a sensitivity of 1.00 and a specificity of 0.93, with a negative predictive value of 1.00 and a positive predictive value of 0.85, and an accuracy of 0.95 (95% CI: 0.9221–1) in internal validation. Conclusions: EAT may represent a novel imaging biomarker associated with the presence of actionable coronary plaques. Radiomic texture analysis of EAT could enhance the non-invasive prediction of coronary stenoses. These preliminary findings support the clinical utility of EAT evaluation via CCTA in patients with low to intermediate cardiovascular risk.
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(This article belongs to the Special Issue Feature Papers in Imaging—Second Edition)
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Periprocedural Myocardial Infarction: Do We Need an Updated Definition?
by
Marcello Casuso Alvarez, Leonardo Luca Bavuso, Michele Di Leo, Marco Basile, Nicolò Vasumini, Tommaso Manaresi, Angelo Maida, Marco Moretti, Daniele Cavallo, Lisa Canton, Sara Amicone, Damiano Fedele, Elisa Conficoni, Alessandro Marinelli, Roberto Carletti, Francesco Angeli, Luca Bergamaschi, Matteo Armillotta and Carmine Pizzi
J. Cardiovasc. Dev. Dis. 2026, 13(3), 112; https://doi.org/10.3390/jcdd13030112 - 2 Mar 2026
Abstract
Periprocedural myocardial infarction after percutaneous coronary intervention (PCI) remains a debated entity, especially in the era of high-sensitivity cardiac troponin assays, which frequently detect biomarker rises even when clinically meaningful ischemia is absent. This review critically examines the main contemporary frameworks used to
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Periprocedural myocardial infarction after percutaneous coronary intervention (PCI) remains a debated entity, especially in the era of high-sensitivity cardiac troponin assays, which frequently detect biomarker rises even when clinically meaningful ischemia is absent. This review critically examines the main contemporary frameworks used to define these events, including the Fourth Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 consensus, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition, comparing biomarker thresholds, requirements for objective evidence of ischemia, and procedural criteria. We discuss how differences among definitions shape reported event rates and contribute to heterogeneity in event adjudication across studies. Key pathophysiologic mechanisms of myocardial injury during PCI are summarized, including side-branch compromise, distal embolization, microvascular dysfunction, and mechanical complications. Particular attention is given to the limitations of current criteria, such as incomplete assay standardization, variability in sampling timing, inconsistent reliability of ancillary criteria, including electrocardiography and imaging, and an uneven relationship between biomarker elevation and subsequent outcomes. Finally, we outline priorities for future updates, including harmonization of biomarker thresholds, greater emphasis on relative biomarker dynamics, and structured adjudication that integrates biomarkers with objective ischemic evidence. These steps may improve diagnostic specificity, reduce misclassification, and strengthen the clinical and trial relevance of periprocedural ischemic endpoints.
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(This article belongs to the Special Issue Role of Biochemical Markers of Cardiovascular Disease in Clinical Practice)
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