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Best Practices for Cardiovascular Team-Based Care: Cardiac Heart Diseases (CHD) Clinical Conundrum

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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: closed (20 March 2024) | Viewed by 5488

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Special Issue Editors

Dr. Fabiana Lucà

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Guest Editor

Department of Cariology, Big Metropolitan Hospital of Reggio Calabria, 89129 Reggio Calabria, Italy
Interests: atrial fibrillation; supraventricular arrhythmias; ventricular arrhythmias; sudden cardiac death (SCD); acute and chronic heart failure; ischemic heart disease; pacemaker; cardiac resynchronization therapy (CRT); implantable cardioverter defibrillator (ICD)
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Dr. Maurizio G. Abrignani

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Department of Cardiology, P.O. Sant’Antonio Abate, ASP Trapani, 91016 Erice, Italy
Interests: cardiovascular epidemiology; cardiovascular prevention; risk factors; coronary heart disease

Special Issue Information

Dear Colleagues,

Cardiac heart diseases (CHD) represent a clinical conundrum.

Team-based care uses multidisciplinary teams, health professionals, community health workers, and others.

Practical insights for physicians who cope with patients with cardiopathies should be constantly updated, addressing state-of-the-art of the entire spectrum of cardiac heart failure(HF), including HF with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmEF), and HF with reduced ejection fraction (HFrEF), coronary heart diseases (CHD), complex revascularization of coronary arteries and peripheral arterial disease (PAD), and other cardiomyopathies.

This Special Issue aims to highlight best practices for managing CHD as well as the assessment of emerging new therapies, treatment options, more advanced team-based strategies, clinic workflows and protocols.

Dr. Fabiana Lucà
Dr. Maurizio G. Abrignani
Guest Editors

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Keywords

team-based care
multidisciplinary teams
health professionals
heart failure(HF)
HFpEF
HFmEF
and HFrEF
coronary heart diseases (CHD)
revascularization
peripheric artery diseases (PAD)
cardiomyopathies

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Published Papers (5 papers)

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Research

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17 pages, 3640 KiB

Open AccessArticle

Are Endomyocardial Ventricular Biopsies Useful for Assessing Myocardial Fibrosis?

by Igor Makarov, Daria Voronkina, Alexander Gurshchenkov, Anton Ryzhkov, Anna Starshinova, Dmitry Kudlay and Lubov Mitrofanova

J. Clin. Med. 2024, 13(11), 3275; https://doi.org/10.3390/jcm13113275 - 31 May 2024

Viewed by 926

Abstract

Myocardial fibrosis is an important factor in the progression of cardiovascular diseases. However, there is still no universal lifetime method of myocardial fibrosis assessment that has a high prognostic significance. The aim of the study was to determine the significance of ventricular endomyocardial biopsies for the assessment of myocardial fibrosis and to identify the severity of myocardial fibrosis in different cardiovascular diseases. Material and Methods: Endomyocardial biopsies (EMBs) of 20 patients with chronic lymphocytic myocarditis (CM), endomyocardial fragments obtained during septal reduction of 21 patients with hypertrophic cardiomyopathy (HCM), and 36 patients with a long history of hypertensive and ischemic heart disease (HHD + IHD) were included in the study. The control group was formed from EMBs taken on 12–14 days after heart transplantation (n = 28). Also, for one patient without clinical and morphological data for cardiovascular pathology, postmortem myocardial fragments were taken from typical EMB and septal reduction sites. The relative area of fibrosis was calculated as the ratio of the total area of collagen fibers to the area of the whole biopsy. Endocardium and subendocardial fibrosis were not included in the total biopsy area. Results: The relative fibrosis area in the EMBs in the CM patient group was 5.6 [3.3; 12.6]%, 11.1 [6.6; 15.9]% in the HHD + IHD patient group, 13.4 [8.8; 16.7]% in the HCM patient group, and 2.7 [1.5; 4.6]% in the control group. When comparing the fibrosis area of the CM patients in repeat EMBs, it was found that the fibrosis area in the first EMBs was 7.6 [4.8; 12.0]%, and in repeat EMBs, it was 5.3 [3.2; 7.6]%. No statistically significant differences were found between the primary and repeat EMBs (p = 0.15). In ROC analysis, the area of fibrosis in the myocardium of 1.1% (or lower than one) was found to be highly specific for the control group of patients compared to the study patients. Conclusions: EMB in the assessment of myocardial fibrosis has a questionable role because of the heterogeneity of fibrotic changes in the myocardium. Full article

(This article belongs to the Special Issue Best Practices for Cardiovascular Team-Based Care: Cardiac Heart Diseases (CHD) Clinical Conundrum)

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15 pages, 1667 KiB

Open AccessArticle

Outcome of Surgery for Ischemic Mitral Regurgitation Depends on the Type and Timing of the Coronary Revascularization

by Terézia B. Andrási, Alannah C. Glück, Olfa Ben Taieb, Ildar Talipov, Nunijiati Abudureheman, Lachezar Volevski and Ion Vasiloi

J. Clin. Med. 2023, 12(9), 3182; https://doi.org/10.3390/jcm12093182 - 28 Apr 2023

Cited by 1 | Viewed by 1263

Abstract

Objective: Long-term outcomes of mitral valve (MV) repair versus MV replacement for ischemic mitral regurgitation (IMR) in patients undergoing either prior (PCR) or concomitant coronary revascularization (CCR) by surgery (CABG) or intervention (PCI) are uncertain. Methods and Results: Of 446 patients receiving MV surgery for IMR between July 2006 and December 2010, 125 patients—87 CCR (69.1%) and 38 PCR (30.9%)—were eligible for inclusion in the study. Survival was higher in CCR versus PCR at long-term follow-up (78.83% vs. 57.9%, p = 0.016). The incidence of MACCE was lower in the CCR compared to PCR at both hospital discharge (34.11% vs. 63.57%, p = 0.003) and at follow-up (34.11% vs. 65.79%, p = 0.0008). Patients receiving CABG or CABG with PCI in PCR had higher mortality risks after MV surgery than CCR patients (X² = 6.029, p = 0.014 and X² = 6.466, p = 0.011, respectively). Whereas in the PCR group, MV repair and MV replacement achieved similar survival probability (X² = 1.551, p = 0.213), MV repair in the CCR group led to improved survival compared to MV replacement (X² = 3.921, p = 0.048). In MV replacement, LAD-CABG improved survival compared to LAD-PCI (U = 15,000.00, Z = −2.373 p = 0.018), and a substantial impact of arterial IMA-LAD grafting was revealed in the Cox-regression analysis (HR 0.334, CI: 0.113–0.989, p = 0.048) as opposed to venous-LAD grafting (HR 0.588, CI: 0.166–2.078, p = 0.410). Conclusion: Early treatment of IMR concomitant to coronary revascularization enhances long-term survival compared to delayed MV surgery after PCR. MV repair is not superior to MV replacement when performed late after coronary revascularization; however, MV repair leads to better survival than MV replacement when performed concomitantly with CABG with arterial LAD revascularization. Full article

(This article belongs to the Special Issue Best Practices for Cardiovascular Team-Based Care: Cardiac Heart Diseases (CHD) Clinical Conundrum)

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Review

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14 pages, 33670 KiB

Open AccessReview

From ECG to Imaging: Challenges in the Diagnosis of Adult Congenital Heart Diseases

by Simina Crișan, Ruxandra-Maria Băghină, Silvia Luca, Oana Pătru, Mihai-Andrei Lazăr, Cristina Văcărescu, Marius Rus, Dragoș Cozma, Dan Gaiță and Constantin-Tudor Luca

J. Clin. Med. 2024, 13(16), 4865; https://doi.org/10.3390/jcm13164865 - 18 Aug 2024

Viewed by 631

Abstract

Congenital heart diseases (CHD) are one of the most common birth defects and the main leading cause of death in children. Many patients with CHD are reaching adulthood due to the success of improved contemporary surgical procedures. Understanding the etiology of CHD remains important for patient clinical management. Both genetic and environmental factors are involved in the development and progression of CHD. Variations in many different genes and chromosomal anomalies can be associated with CHD, by expression of different mechanisms. Sporadic cases are the most frequently encountered in these patients. Atrial septal defect is a common congenital heart disease that refers to direct communication between atrial chambers, found isolated or associated with other syndromes. Imaging techniques, especially transthoracic and transesophageal echocardiography (TOE) represent the key for diagnosis and management of ASD. The disease has a major incidence in adulthood, due to late symptomatology, but assessment and treatment are important to avoid time-related complications. Ebstein’s anomaly is a rare congenital disease, with a dominant genetic participation, characterized by an abnormal displacement of the tricuspid valve and right ventricular myopathy, often requiring surgical intervention. Alongside echocardiography, cardiac magnetic resonance (CMR) imaging is the gold standard tool for the assessment of ventricular volumes. Early diagnosis and adequate treatment are mandatory to avoid possible complications of CHD, and thus, ECG, as well as imaging techniques, are important diagnostic tools. However, patients with CHD need a special healthcare team for the entire monitorization in various life stages. Full article

(This article belongs to the Special Issue Best Practices for Cardiovascular Team-Based Care: Cardiac Heart Diseases (CHD) Clinical Conundrum)

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21 pages, 1545 KiB

Open AccessReview

A Look at Primary and Secondary Prevention in the Elderly: The Two Sides of the Same Coin

by Maurizio Giuseppe Abrignani, Fabiana Lucà, Vincenzo Abrignani, Giuseppe Pelaggi, Alessandro Aiello, Furio Colivicchi, Francesco Fattirolli, Michele Massimo Gulizia, Federico Nardi, Paolo Giuseppe Pino, Iris Parrini and Carmelo Massimiliano Rao

J. Clin. Med. 2024, 13(15), 4350; https://doi.org/10.3390/jcm13154350 - 25 Jul 2024

Cited by 1 | Viewed by 700

Abstract

The global population is experiencing an aging trend; however, this increased longevity is not necessarily accompanied by improved health in older age. A significant consequence of this demographic shift is the rising prevalence of multiple chronic illnesses, posing challenges to healthcare systems worldwide. Aging is a major risk factor for multimorbidity, which marks a progressive decline in resilience and a dysregulation of multisystem homeostasis. Cardiovascular risk factors, along with aging and comorbidities, play a critical role in the development of heart disease. Among comorbidities, age itself stands out as one of the most significant risk factors for cardiovascular disease, with its prevalence and incidence notably increasing in the elderly population. However, elderly individuals, especially those who are frail and have multiple comorbidities, are under-represented in primary and secondary prevention trials aimed at addressing traditional cardiovascular risk factors, such as hypercholesterolemia, diabetes mellitus, and hypertension. There are concerns regarding the optimal intensity of treatment, taking into account tolerability and the risk of drug interactions. Additionally, uncertainty persists regarding therapeutic targets across different age groups. This article provides an overview of the relationship between aging and cardiovascular disease, highlighting various cardiovascular prevention issues in the elderly population. Full article

(This article belongs to the Special Issue Best Practices for Cardiovascular Team-Based Care: Cardiac Heart Diseases (CHD) Clinical Conundrum)

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10 pages, 735 KiB

Open AccessReview

Lights and Shadows of Clinical Applications of Cardiac Scintigraphy with Bone Tracers in Suspected Amyloidosis

by Riccardo Saro, Daniela Pavan, Aldostefano Porcari, Gianfranco Sinagra and Marco Mojoli

J. Clin. Med. 2023, 12(24), 7605; https://doi.org/10.3390/jcm12247605 - 10 Dec 2023

Cited by 1 | Viewed by 1326

Abstract

Radionuclide bone scintigraphy is the cornerstone of an imaging-based algorithm for accurate non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). In patients with heart failure and suggestive echocardiographic and/or cardiac magnetic resonance imaging findings, the positive predictive value of Perugini grade 2 or 3 myocardial uptake on a radionuclide bone scan approaches 100% for the diagnosis of ATTR-CA as long as there is no biochemical evidence of a clonal dyscrasia. The technetium-labelled tracers that are currently validated for non-invasive diagnosis of ATTR-CA include pyrophosphate (^99mTc-PYP); hydroxymethylene diphosphonate (^99mTc-HMDP); and 3,3-diphosphono-1,2-propanodicarboxylate (^99mTc-DPD). Although nuclear scintigraphy has transformed the contemporary diagnostic approach to ATTR-CA, a number of grey areas remains, including the mechanism for binding tracers to the infiltrated heart, differences in the kinetics and distribution of these radiotracers, differences in protocols of image acquisition worldwide, the clinical significance of extra-cardiac uptake, and the use of this technique for prognostic stratification, monitoring disease progression and assessing the response to disease-modifying treatments. This review will deal with the most relevant unmet needs and clinical questions concerning scintigraphy with bone tracers in ATTR-CA, providing expert opinions on possible future developments in the clinical application of these radiotracers in order to offer practical information for the interpretation of nuclear images by physicians involved in the care of patients with this ATTR-CA. Full article

(This article belongs to the Special Issue Best Practices for Cardiovascular Team-Based Care: Cardiac Heart Diseases (CHD) Clinical Conundrum)

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