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Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 20 November 2025 | Viewed by 7359

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Prof. Dr. Joseph B. Selvanayagam

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Guest Editor

Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA 5042, Australia
Interests: heart failure; cardiomyopathies; cardiac magnetic resonance imaging; coronary artery disease; arrhythmia disorders

Dr. Sivabaskari Pasupathy

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Guest Editor

School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
Interests: myocardial infarction with non obstructive coronary arteries (MINOCA); angina with non obstructive coronary arteries (ANOCA); cardiac magnetic resonance imaging; coronary artery disease; heart failure; cardiomyopathies
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Special Issue Information

Dear Colleagues,

This Special Issue aims to address the emerging challenges and innovations in the management of cardiovascular disease, with a focus on advancing clinical practice through personalized approaches. As cardiovascular disease remains a leading cause of mortality worldwide, there is an urgent need for tailored interventions that account for individual patient variability. Recent advances in imaging technologies and data-driven predictive models have opened new pathways for precision medicine. However, the translation of these innovations into clinical practice faces hurdles such as heterogeneous patient populations and the integration of multi-modal data.

This Special Issue invites original research and reviews that explore personalized diagnostics, therapeutic strategies, and preventive measures in cardiovascular care. The scope includes novel biomarkers, cutting-edge imaging techniques, patient stratification methods, and advancements in pharmacotherapy that enhance treatment plans. The goal is to bring together leading experts in the field to share knowledge and mobilize future efforts in bridging the gap between research and clinical application, ultimately improving patient outcomes.

Prof. Dr. Joseph B. Selvanayagam
Dr. Sivabaskari Pasupathy
Guest Editors

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Keywords

personalized medicine
cardiovascular innovations
cardiac imaging
risk assessment
multimodal imaging
therapeutic strategies
data-driven decision making
clinical outcomes
translational research

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Published Papers (9 papers)

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Research

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12 pages, 370 KiB

Open AccessFeature PaperArticle

Characterization of the Left Ventricular Myocardium in Systemic Sclerosis

by Briella K. Egberts, Rajiv Ananthakrishna, Ranjit Shah, Antony Chun Fai So, Jennifer Walker, Sivabaskari Pasupathy, Susanna Proudman and Joseph B. Selvanayagam

J. Clin. Med. 2025, 14(16), 5627; https://doi.org/10.3390/jcm14165627 - 8 Aug 2025

Abstract

Background/Objectives: Cardiac involvement in systemic sclerosis (SSc) ranges from subclinical to severe. While pulmonary artery hypertension (PAH) is well-documented, the mechanism of left ventricular (LV) ischemia remains unclear. Oxygen-sensitive cardiovascular magnetic resonance (OS-CMR) imaging offers a novel approach to assessing myocardial oxygenation and ischemia. This study evaluated the changes in myocardial deoxygenation in response to stress using LV OS-CMR in SSc patients without known cardiac disease. Methods: We prospectively recruited SSc patients without prior cardiac disease or risk factors, and age- and sex-matched healthy volunteers (HVs). All participants underwent transthoracic echocardiography (TTE) and 3T CMR, including native T1 mapping, rest/stress OS-CMR, stress perfusion, and late gadolinium enhancement (LGE). The primary outcome was a change in the LV OS-CMR signal intensity (SI) after adenosine stress. Results: Thirty-three participants (23 SSc, 10 HV) were enrolled. SSc patients had significantly lower global LV OS-CMR SI compared to HV (13.4 ± 6.5 vs. 19.5 ± 3.6, p = 0.011). OS-CMR SI change ≤ 10% was observed in at least one segment in 20 (87%) SSc patients and globally in 12 (52%). LGE was present in 5 (22%) patients, and 18 (78%) had ≥1 abnormal T1 mapping segment. LV global longitudinal strain (GLS) was reduced in SSc patients compared to the HVs (−19.04 ± 3.86 vs. −21.92 ± 3.72, p = 0.045). All HVs had normal CMR and TTE findings. Conclusions: SSc patients without known cardiovascular disease or PAH demonstrated subclinical LV ischemia with an impaired myocardial oxygenation response to stress. They further demonstrated LV myocardial deformation abnormalities and LV diffuse fibrosis when compared to an age-matched control group. Our findings support the presence of early coronary microvascular dysfunction and LV myocardial fibrosis in this population, which may explain the adverse cardiovascular risk seen in this population, independent of the presence of PAH. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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12 pages, 452 KiB

Open AccessArticle

Coping Strategies and Health-Related Quality of Life in Individuals with Heart Failure

by Mohammed Owayrif Alanazi, Pallav Deka, Charles W. Given, Rebecca Lehto and Gwen Wyatt

J. Clin. Med. 2025, 14(9), 3073; https://doi.org/10.3390/jcm14093073 - 29 Apr 2025

Viewed by 710

Abstract

Background: Heart failure (HF) contributes to a poor physical and emotional health-related Quality of Life (HRQoL) and poor health outcomes. Coping strategies have been identified as essential in enhancing HRQoL. The study’s purpose was to examine the relationships between the factors that influence coping (i.e., age, sex, education, income, HF duration), HF severity, coping strategies (i.e., problem-focused, active emotion-focused, avoidant emotion-focused), and physical and emotional HRQoL. Methods: A cross-sectional study was conducted using online surveys. Descriptives, Pearson’s correlation, and one-way ANOVA analyses were used to analyze the data. Results: A total of 108 participants completed the study, with the majority being Black men. The result showed significant negative relationships (p < 0.05) between problem-focused and active emotion-focused coping and HF severity. Lower age was significantly related to the use of problem-focused and active emotion-focused coping (p < 0.05); females showed higher use of all coping strategies as compared with males (p < 0.05). A better physical HRQoL was significantly associated with active emotion-focused coping (r = −0.283, p = 0.005), whereas a better emotional HRQoL was significantly associated with problem-focused coping (r = −0.265, p = 0.005) and active emotion-focused coping (r = −0.373, p < 0.001). Conclusions: Findings showed that individuals with a lower HF severity, a younger age, and a higher income and education tended to predominantly utilize adaptive coping strategies. Individuals with HF who use problem-focused and active emotion-focused coping may experience better physical and emotional HRQoL, whereas those using primarily avoidant emotional-focused coping may need guidance in their coping strategies. Healthcare professionals may take factors such as HF severity into account to tailor interventions that promote adaptive coping and enhance HRQoL outcomes. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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11 pages, 957 KiB

Open AccessArticle

Clinical Outcomes of Transradial Versus Transfemoral Approach in Rotational Atherectomy: Results from the Rotational Atherectomy in Calcified Lesions in Korea (ROCK) Registry

by Kyunyeon Kim, Jin Jung, Sung-Ho Her, Kyusup Lee, Ji-Hoon Jung, Ki-Dong Yoo, Keon-Woong Moon, Donggyu Moon, Su-Nam Lee, Won-Young Jang, Ik-Jun Choi, Jae-Hwan Lee, Jang-Hoon Lee, Sang-Rok Lee, Seung-Whan Lee, Kyeong-Ho Yun and Hyun-Jong Lee

J. Clin. Med. 2025, 14(9), 3066; https://doi.org/10.3390/jcm14093066 - 29 Apr 2025

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Abstract

Background and Objectives: Rotational atherectomy (RA) is a crucial method for percutaneous coronary intervention (PCI) of heavily calcified coronary lesions. The aim of this study was to compare the clinical outcomes in patients undergoing RA via the radial versus femoral approach. Methods: The Rotational Atherectomy in Calcified Lesions in Korea (ROCK) registry included consecutive patients with severely calcified coronary artery disease who received RA during PCI at nine tertiary centers in Korea. A total of 540 patients who underwent PCI with RA were enrolled between October 2019 and January 2010. We retrospectively investigated the clinical outcomes between the transradial and transfemoral approaches. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 36 months of follow-up. Results: Of the 540 patients, 248 patients (45.9%) were in the transradial group, and 292 patients (54.1%) were in the transfemoral group. There were no significant differences in MACCE (11.3% vs. 17.8%, adjusted hazard ratio [HR]: 1.520; 95% confidence interval: 0.889–2.600; p = 0.126) and procedural success (97.6% vs. 95.2%, p = 0.145). The occurrence of in-hospital bleeding was numerically higher in the transfemoral group, but the difference was not statistically significant (8 [3.2%] vs. 19 [6.5%], p = 0.081) Conclusions: In this study, the transradial approach did not show a significant difference in clinical outcomes but tended to have lower bleeding events compared to the transfemoral approach. RA via the transradial approach can be a useful vascular access option compared to the transfemoral approach. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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15 pages, 858 KiB

Open AccessArticle

Hemoglobin-to-Creatinine Ratio Predicts One-Year Adverse Clinical Outcomes in ST-Elevation Myocardial Infarction: Retrospective and Propensity Score Matched Analysis

by Luigi Spadafora, Stefano Cacciatore, Mattia Galli, Carlos Collet, Matteo Betti, Gianmarco Sarto, Beatrice Simeone, Erica Rocco, Fabrizio D’Ascenzo, Gaetano Maria De Ferrari, Ovidio De Filippo, Pierre Sabouret, Iginio Colaiori, Roberto Carnevale, Valentina Valenti, Carlo Gaudio, Francesca Romana Zimatore, Giacomo Frati, Francesco Versaci, Sebastiano Sciarretta, Giuseppe Biondi Zoccai and Marco Bernardi Show full author list Hide full author list

J. Clin. Med. 2025, 14(8), 2756; https://doi.org/10.3390/jcm14082756 - 17 Apr 2025

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Abstract

Background/Objectives: Anemia and renal impairment are key predictors of adverse outcomes in acute coronary syndromes (ACSs). The hemoglobin-to-creatinine (Hb/Cr) ratio combines these parameters into a simple index. This study aimed to evaluate its prognostic value at discharge in patients with ST-elevation myocardial infarction (STEMI). Methods: The primary endpoint was one-year all-cause mortality; secondary endpoints included major bleeding and the composite of all-cause mortality or reinfarction. Optimal Hb/Cr cut-off values were identified using Liu’s method. Multivariable logistic regression and propensity score matching were used to assess associations with outcomes. Results: We analyzed 11,236 STEMI patients from the PRAISE registry with available hemoglobin and creatinine values at discharge. The optimal cut-points were 13.68 for mortality and 14.42 for secondary endpoints. Patients were stratified into low (<13.68; 26.5%) and high (≥13.68; 73.5%) Hb/Cr groups. The low Hb/Cr group was older, had more comorbidities, and received less intensive therapy. At one year, low Hb/Cr patients had significantly higher rates of all-cause mortality (8.7% vs. 2.4%), major bleeding (5.0% vs. 2.4%), and the composite outcome (11.5% vs. 4.9%). In the multivariate logistic regression, the Hb/Cr ratio was inversely associated with all outcomes, namely all-cause mortality (odds ratio [OR] 0.94; 95% confidence interval [CI]: 0.92–0.96), major bleeding (OR 0.96; 95% CI: 0.94–0.97), and the composite endpoint (OR 0.93; 95% CI: 0.91–0.96). The Hb/Cr ratio outperformed hemoglobin and creatinine alone in predicting mortality (AUC 0.684 vs. 0.649 and 0.645; p < 0.001). Conclusions: The Hb/Cr ratio is independently associated with one-year adverse outcomes in STEMI and may serve as a simple marker of increased vulnerability. Prospective studies are needed to validate its clinical utility. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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11 pages, 896 KiB

Open AccessArticle

Should the Right Coronary Artery Be Routinely Assessed During Provocative Spasm Testing?

by Olivia Girolamo, Rosanna Tavella, David Di Fiore, Abdul Sheikh, Sivabaskari Pasupathy, Eng Lee Ooi, Jessica A. Marathe, Christopher Zeitz and John F. Beltrame

J. Clin. Med. 2025, 14(4), 1355; https://doi.org/10.3390/jcm14041355 - 18 Feb 2025

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Abstract

Background/Objectives: The diagnosis of coronary artery spasm (CAS) frequently requires invasive provocation testing, typically utilising acetylcholine (ACh). Although the left coronary artery (LCA) is routinely assessed as a part of the testing protocol, assessment of the right coronary artery (RCA) is often avoided since it requires the insertion of a temporary pacing wire. We sought to compare the prevalence of inducible CAS in the LCA and RCA, among patients with CAS undergoing multivessel spasm provocation testing with ACh. Methods: A local multi-institutional ANOCA (angina and non-obstructive coronary arteries) database was analysed, which included 316 patients with angina and suspected CAS who underwent provocation testing (single vessel n = 266, multivessel n = 50) with incremental bolus doses of intracoronary ACh (25, 50, 100 μg in the LCA; 25, 50 μg in the RCA). CAS was defined as >90% constriction of the epicardial coronary artery as assessed visually on coronary angiography. Results: In the 50 patients (55 ± 10 years, 77% female) who underwent multivessel spasm provocation testing, CAS was induced in 20 patients (40%), with ACh provoking CAS only in the LCA system in 45%, only in the RCA system in 35%, and both LCA/RCA in 20%. Conclusions: These findings demonstrate that assessing only the LCA may miss up to one-third of CAS cases. Therefore, it is essential to routinely evaluate the RCA, particularly when no inducible spasm is detected in the LCA. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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Review

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16 pages, 300 KiB

Open AccessFeature PaperReview

SGLT2 Inhibitors and GLP-1 Receptor Agonists in PAD: A State-of-the-Art Review

by Alfredo Caturano, Damiano D’Ardes, Paola Giustina Simeone, Gianfranco Lessiani, Nicoletta Di Gregorio, Lorenzo Andreetto, Davide Grassi, Carla Serra, Francesca Santilli, Maria Teresa Guagnano, Fabio Piscaglia, Claudio Ferri, Francesco Cipollone and Andrea Boccatonda

J. Clin. Med. 2025, 14(15), 5549; https://doi.org/10.3390/jcm14155549 - 6 Aug 2025

Viewed by 335

Abstract

Sodium–glucose co-transporter-2 inhibitors (SGLT2is) and GLP-1 receptor agonists (GLP-1 RAs) are now established as cornerstone therapies for patients with type 2 diabetes mellitus (T2DM), given their cardiovascular and renal protective properties. However, their use in patients with peripheral artery disease (PAD) remains controversial due to concerns raised in early trials about potential increases in lower limb complications, particularly amputations. This narrative review examines current evidence on the association between SGLT2is and GLP-1 RAs in PAD-related outcomes, including limb events, amputation risk, and cardiovascular and renal endpoints. Drawing from randomized controlled trials, real-world cohort studies, and systematic reviews, we provide an integrated perspective on the safety and utility of SGLT2is and GLP-1 RAs in individuals with PAD, highlight patient selection considerations, and identify areas for future investigation. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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27 pages, 2226 KiB

Open AccessReview

Uncovering Plaque Erosion: A Distinct Pathway in Acute Coronary Syndromes and a Gateway to Personalized Therapy

by Angela Buonpane, Alberto Ranieri De Caterina, Giancarlo Trimarchi, Fausto Pizzino, Marco Ciardetti, Michele Alessandro Coceani, Augusto Esposito, Luigi Emilio Pastormerlo, Angelo Monteleone, Alberto Clemente, Umberto Paradossi, Sergio Berti, Antonio Maria Leone, Carlo Trani, Giovanna Liuzzo, Francesco Burzotta and Filippo Crea

J. Clin. Med. 2025, 14(15), 5456; https://doi.org/10.3390/jcm14155456 - 3 Aug 2025

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Abstract

Plaque erosion (PE) is now recognized as a common and clinically significant cause of acute coronary syndromes (ACSs), accounting for up to 40% of cases. Unlike plaque rupture (PR), PE involves superficial endothelial loss over an intact fibrous cap and occurs in a low-inflammatory setting, typically affecting younger patients, women, and smokers with fewer traditional risk factors. The growing recognition of PE has been driven by high-resolution intracoronary imaging, particularly optical coherence tomography (OCT), which enables in vivo differentiation from PR. Identifying PE with OCT has opened the door to personalized treatment strategies, as explored in recent trials evaluating the safety of deferring stent implantation in selected cases in favor of intensive medical therapy. Given its unexpectedly high prevalence, PE is now recognized as a common pathophysiological mechanism in ACS, rather than a rare exception. This growing awareness underscores the importance of its accurate identification through OCT in clinical practice. Early recognition and a deeper understanding of PE are essential steps toward the implementation of precision medicine, allowing clinicians to move beyond “one-size-fits-all” models toward “mechanism-based” therapeutic strategies. This narrative review aims to offer an integrated overview of PE, tracing its epidemiology, elucidating the molecular and pathophysiological mechanisms involved, outlining its clinical presentations, and placing particular emphasis on diagnostic strategies with OCT, while also discussing emerging therapeutic approaches and future directions for personalized cardiovascular care. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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15 pages, 840 KiB

Open AccessReview

Rethinking Pulmonary Embolism Management with an Interventional Perspective

by Panayotis K. Vlachakis, Stergios Soulaidopoulos, Emmanouil Mantzouranis, Panagiotis Theofilis, Paschalis Karakasis, Anastasios Apostolos, Ioannis Kachrimanidis, Maria Drakopoulou, Costas Tsioufis and Konstantinos Toutouzas

J. Clin. Med. 2025, 14(9), 3085; https://doi.org/10.3390/jcm14093085 - 29 Apr 2025

Viewed by 1484

Abstract

Pulmonary embolism (PE) remains a major cardiovascular emergency associated with significant morbidity and mortality. Despite advances in risk stratification models, accurately predicting which intermediate-high-risk patients will deteriorate remains challenging. Systemic thrombolysis, while effective in high-risk PE, is not a viable option for a significant proportion of patients due to contraindications, and its efficacy in the intermediate-high-risk group remains inconclusive. Drawing parallels from acute myocardial infarction and stroke, where percutaneous interventions have revolutionized treatment, interventional therapies are emerging as a promising alternative for PE management. However, challenges persist regarding optimal patient selection, procedural timing, and balancing efficacy with safety. The establishment of pulmonary embolism response teams (PERTs) has played a crucial role in streamlining decision-making and facilitating access to advanced therapies. As novel catheter-based techniques continue to evolve, the field of PE management is undergoing a paradigm shift, mirroring the transformation seen in acute coronary and cerebrovascular care, positioning interventional approaches at the forefront of therapy. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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Other

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46 pages, 1735 KiB

Open AccessSystematic Review

Gender Differences in Clinical Practice Regarding Coronary Heart Disease: A Systematic Review

by Emily Caitlin Lily Knox, Inmaculada Mateo-Rodríguez, Antonio Daponte-Codina, Fernando Rosell-Ortiz, Silvia Solá-Muñoz, Antía Codina-Rodríguez, Héctor Bueno and José Ignacio Ruiz-Azpiazu

J. Clin. Med. 2025, 14(5), 1583; https://doi.org/10.3390/jcm14051583 - 26 Feb 2025

Viewed by 2168

Abstract

Background/Objectives: A systematic review was performed with the aim of analysing potential sex differences in the overall treatment of coronary heart disease (CHD). Methods: Studies published between January 2011 and November 2023 that conducted a sex-based analysis of the provision of any type of therapeutic measure to treat CHD were included. A search was performed of the Web of Science database in November 2023, resulting in 9070 articles. Study quality was examined using the Newcastle–Ottawa scale. A worksheet was produced to extract data pertaining to the title, year of publication, sample, context, study design, dependent variables, time-frame, treatment type, and outcomes reported by each article. This systematic review followed PRISMA guidelines, and the research protocol was submitted to PROSPERO (CRD42022330238). Results: A total of 80 articles presenting data representing 560.070,624 individual datapoints were selected to comprise the final sample. The main findings revealed that the majority of studies highlighted inequalities that disadvantaged females in all analysed treatment categories (pharmacological treatment, invasive interventions, rehabilitation programmes, and other treatment types). Conclusions: Despite the abundance of evidence on the need to improve healthcare provision to females with CHD, few studies examined the reasons or mechanisms underlying the inequalities identified. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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