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Cardiovascular Diseases: From Basic Research to Clinical Application

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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (26 January 2024) | Viewed by 15869

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Special Issue Editors

Dr. Cristiana Bustea

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Guest Editor

Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
Interests: cardiovascular disease; pathophysiology; oxidative stress; inflammation; hemostasis; diabetes mellitus
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Delia Mirela Tit

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Guest Editor

1. Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
2. Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
Interests: pharmacology; alternative therapies; biochemistry; public health; therapeutics; One Health; sustainability in health; ecology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Presently, cardiovascular disease (CVD) is the most prominent threat to human health. Because CVD is still the leading cause of death, research in this field is a critical task. Although recent decades have seen tremendous progress regarding the risk factors of CVD, the molecular basis of atherosclerosis, coronary revascularization, and the treatment of heart failure (among others), much remains to be done, and the prospects are promising. In order to improve the quality and length of life for those at risk of CVD, research for better predictors of this disease and better means for prevention and treatment must be the target.

The purpose of this Special Issue is to identify several important advances in clinical and basic research in CVD that will provide the tools for further progress in the prevention and treatment of this disease. As artificial intelligence plays an increasingly important role in the prevention of CVD, it may be worth having a look at this particular field.

Therefore, it is our pleasure to invite all researchers with interest in CVD research and who are willing to be part of this Special Issue project to publish papers that address novelties in both clinical and basic cardiovascular research. We encourage the submission of all types of manuscripts including original studies, reviews and short communications

Dr. Cristiana Bustea
Prof. Dr. Delia Mirela Tit
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

CVDs
risk factors
prevention
treatment
novelties in research
artificial intelligence

Published Papers (11 papers)

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Research

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24 pages, 5423 KiB

Open AccessArticle

Possible Correlations between Mean Platelet Volume and Biological, Electrocardiographic, and Echocardiographic Parameters in Patients with Heart Failure

by Andreea Catană, Cătălina Liliana Andrei, Suzana Guberna, Octavian Ceban and Crina Julieta Sinescu

Life 2024, 14(2), 260; https://doi.org/10.3390/life14020260 - 16 Feb 2024

Viewed by 652

Abstract

(1) Background: Despite advancements in medical research and discoveries, heart failure (HF) still represents a significant and prevalent public health challenge. It is characterized by persistently high mortality and morbidity rates, along with increased rates of readmissions, particularly among the elderly population. (2) Methods: This study was conducted retrospectively on 260 patients with stable or decompensated chronic HF. The parameter of interest in the study population was the mean platelet volume (MPV), and the main objective of the research was to identify a possible relationship between MPV and several variables—biological (NT-proBNP, presepsin, red cell distribution width (RDW)), electrocardiographic (atrial fibrillation (AFib) rhythm, sinus rhythm (SR)), and echocardiographic (left ventricle ejection fraction (LVEF), left atrial (LA) diameter, left ventricle (LV) diameter, pulmonary hypertension (PH)). (3) Results: By applying logistic and linear regression models, we assessed whether there is a correlation between MPV and biological, electrocardiographic, and echocardiographic variables in patients with HF. The results revealed linear relationships between MPV and NT pro-BNP values and between MPV and RDW values, and an increased probability for the patients to have an AFib rhythm, reduced LVEF, dilated LA, dilated LV, and PH as their MPV value increases. The results were deemed statistically relevant based on a p-value below 0.05. (4) Conclusions: Through regression model analyses, our research revealed that certain negative variables in HF patients such as increased levels of NT-proBNP, increased levels of RDW, AFib rhythm, reduced LVEF, dilated LA, dilated LV, and PH, could be predicted based on MPV values. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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12 pages, 1651 KiB

Open AccessArticle

In Situ Endothelial SARS-CoV-2 Presence and PROS1 Plasma Levels Alteration in SARS-CoV-2-Associated Coagulopathies

by Marcello Baroni, Silvia Beltrami, Giovanna Schiuma, Paolo Ferraresi, Sabrina Rizzo, Angelina Passaro, Juana Maria Sanz Molina, Roberta Rizzo, Dario Di Luca and Daria Bortolotti

Life 2024, 14(2), 237; https://doi.org/10.3390/life14020237 - 08 Feb 2024

Viewed by 2212

Abstract

Background: Coagulation decompensation is one of the complications most frequently encountered in COVID-19 patients with a poor prognosis or long-COVID syndrome, possibly due to the persistence of SARS-CoV-2 infection in the cardiovascular system. To date, the mechanism underlying the alteration of the coagulation cascade in COVID-19 patients remains misunderstood and the anticoagulant protein S (PROS1) has been described as a potential risk factor for complications related to COVID-19, due to PLpro SARS-CoV-2 enzyme proteolysis. Methods: Biopsies and blood samples were collected from SARS-CoV-2 positive and negative swab test subjects with coagulopathies (peripheral arterial thrombosis), and SARS-CoV-2 presence, ACE2 and CD147 expression, and plasmatic levels of PROS1 were evaluated. Results: We reported a significant decrease of plasmatic PROS1 in the coagulopathic SARS-CoV-2 swab positive cohort, in association with SARS-CoV-2 in situ infection and CD147 peculiar expression. These data suggested that SARS-CoV-2 associated thrombotic/ischemic events might involve PROS1 cleavage by viral PLpro directly in the site of infection, leading to the loss of its anticoagulant function. Conclusions: Based on this evidence, the identification of predisposing factors, such as CD147 increased expression, and the use of PLpro inhibitors to preserve PROS1 function, might be useful for COVID-19 coagulopathies management. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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12 pages, 663 KiB

Open AccessArticle

Long-Term Clinical Impact of Patients with Multi-Vessel Non-Obstructive Coronary Artery Disease

by Jin Jung, Su-Nam Lee, Sung-Ho Her, Ki-Dong Yoo, Keon-Woong Moon, Donggyu Moon and Won-Young Jang

Life 2023, 13(11), 2119; https://doi.org/10.3390/life13112119 - 26 Oct 2023

Viewed by 760

Abstract

Background: Non-obstructive coronary artery disease (CAD) is a disease commonly diagnosed in patients undergoing coronary angiography. However, little is known regarding the long-term clinical impact of multi-vessel non-obstructive CAD. Therefore, the object of this study was to investigate the long-term clinical impact of multi-vessel non-obstructive CAD. Method: A total of 2083 patients without revascularization history and obstructive CAD were enrolled between January 2010 and December 2015. They were classified into four groups according to number of vessels involved in non-obstructive CAD (25% ≤ luminal stenosis < 70%): zero, one, two, or three diseased vessels (DVs). We monitored the patients for 5 years. The primary outcome was major cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiac death, stroke, and myocardial infarction (MI). Result: The occurrence of MACCEs increased as the number of non-obstructive DVs increased, and was especially high in patients with three DVs. After adjustment, patients with three DVs still showed significantly poorer clinical outcomes of MACCEs, stroke, and MI compared those with zero DVs. Conclusion: Multi-vessel non-obstructive CAD, especially in patients with non-obstructive three DVs, is strongly associated with poor long-term clinical outcomes. This finding suggests that more intensive treatment may be required in this subset of patients. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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10 pages, 1459 KiB

Open AccessArticle

The Relationship between Tricuspid Annular Longitudinal and Sphincter-like Features of Its Function in Healthy Adults: Insights from the MAGYAR-Healthy Study

by Attila Nemes, Gergely Rácz, Árpád Kormányos, Zoltán Ruzsa, Alexandru Achim and Csaba Lengyel

Life 2023, 13(10), 2079; https://doi.org/10.3390/life13102079 - 18 Oct 2023

Viewed by 701

Abstract

Introduction. The tricuspid valve is an atrioventricular valve located on the right side of the heart, which consists of the fibrous tricuspid annulus (TA), three valvular leaflets and a supporting apparatus, the papillary muscles and the tendinous chords. The TA is an oval-shaped three-dimensional (3D) fibrous structure with a complex spatial movement during the cardiac cycle. Three-dimensional echocardiography (3DE) could help during “en-face” assessment of TA dimensions and related functional properties featuring its “sphincter-like” function. TA plane systolic excursion (TAPSE) is a displacement of the lateral edge of the TA toward the apex in systole measured in apical long-axis using M-mode echocardiography (MME). The aim of this study was to determine potential relationships between TA size and its “sphincter-like” and “longitudinal” functions in healthy adults with no functional tricuspid regurgitation. Methods. The present study consisted of 119 healthy patients (age: 34.6 ± 11.5 years, 70 men) who underwent routine echocardiography with M-mode-derived TAPSE measurement and 3DE. Two subgroups of healthy subjects were compared with each other. A total of 29 subjects with TAPSE between 17 and 21 mm were compared with 90 cases with TAPSE ≥ 22 mm. Results. Subjects with TAPSE of 17–21 mm had tendentiously dilated TA dimensions compared with subjects with TAPSE ≥ 22 mm. Significant differences could be detected in the end-systolic TA area (5.85 ± 1.90 cm² vs. 3.70 ± 1.22 cm², p < 0.05), leading to impaired TAFAC (24.8 ± 9.0% vs. 35.1 ± 9.1%, p < 0.05) in subjects with lower TAPSE (17–21 mm) compared with subjects with TAPSE ≥ 22 mm. TAPSE did not show correlations with any TA size or “sphincter-like” functional parameters as determined using 3DE. Conclusions. Three-dimensional echocardiography is capable of measuring TA dimensions and functional “sphincter-like” properties, which are associated with MME-derived TAPSE, suggesting a sensitive and harmonic TA function in healthy adults without functional tricuspid regurgitation. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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13 pages, 1771 KiB

Open AccessArticle

Safety and Efficacy of an Innovative Everolimus-Coated Balloon in a Swine Coronary Artery Model

by Christos S. Katsouras, Alexandros Tousis, Georgios Vasilagkos, Arsen Semertzioglou, Athanassios Vratimos, Ioanna Samara, Georgia Karanasiou, Vasileios S. Loukas, Grigorios Tsigkas, Dimitrios Fotiadis, Lampros K. Michalis, Periklis Davlouros and Anargyros N. Moulas

Life 2023, 13(10), 2053; https://doi.org/10.3390/life13102053 - 13 Oct 2023

Viewed by 866

Abstract

Background: Drug-coated balloons have been used as a non-stenting treatment in coronary and peripheral artery disease. Until recently, only sirolimus- and paclitaxel-coated balloons have been investigated in clinical trials. We evaluated the safety and efficacy of an innovative everolimus-coated balloon (ECB) in a swine coronary artery model. Methods: thirty-two swine coronary arteries were prepared through dilatation with a non-coated angioplasty balloon in a closed-chest model. During a period of 90 days, the following four groups (four animals per group, two coronary arteries per animal) were compared for safety and efficacy: A, Rontis ECB with 2.5 μg/mm² of drug per balloon surface; B, Rontis ECB with 7.5 μg/mm²; C, Rontis Europa Ultra bare balloon; and D, Magic Touch, Concept Medical, sirolimus-coated balloon with a drug load of 1.3 μg/mm². Results: Differences in local biological effects (arterial reaction scores) and surface of intimal area (mm²) were not statistically significant between the treatment groups. Numerically, group A showed the lowest intimal area and intimal mean thickness, while group B showed the lowest stenosis among all groups. Conclusions: ECB was safe and effective in a porcine coronary artery model. The dose of everolimus may play a role in the biocompatibility of the balloon. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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17 pages, 1829 KiB

Open AccessArticle

Predictors of Readmission after the First Acute Coronary Syndrome and the Risk of Recurrent Cardiovascular Events—Seven Years of Patient Follow-Up

by Cristiana Bustea, Delia Mirela Tit, Alexa Florina Bungau, Simona Gabriela Bungau, Vlad Alin Pantea, Elena Emilia Babes and Larisa Renata Pantea-Roșan

Life 2023, 13(4), 950; https://doi.org/10.3390/life13040950 - 04 Apr 2023

Cited by 1 | Viewed by 2419

Abstract

Recurrent hospitalization after acute coronary syndromes (ACS) is common. Identifying risk factors associated with subsequent cardiovascular events and hospitalization is essential for the management of these patients. Our research consisted in observing the outcomes of subjects after they suffered an acute coronary event and identifying the factors that can predict rehospitalization in the first 12 months and the recurrence of another acute coronary episode. Data from 362 patients admitted with ACS during 2013 were studied. Recurrent hospitalizations were retrospectively reviewed from medical charts and electronic hospital archives over a period of seven years. The mean age of the studied population was 64.57 ± 11.79 years, 64.36% of them being males. The diagnosis of ACS without ST elevation was registered in 53.87% of the patients at index hospitalization. More than half had recurrent hospitalization in the first year after the first ACS episode. Patients with lower ejection fraction (39.20 ± 6.85 vs. 42.24 ± 6.26, p < 0.001), acute pulmonary edema during the first hospitalization (6.47% vs. 1.24%, p = 0.022), coexistent valvular heart disease (69.15% vs. 55.90%, p = 0.017), and three-vessel disease (18.90% vs. 7.45%, p = 0.002) were more frequently readmitted in the following twelve months after their first acute coronary event, while those with complete revascularization were less frequently admitted (24.87% vs. 34.78%, p = 0.005). In multiple regression, complete revascularization during the index event (HR = 0.58, 95% CI 0.35–0.95, p = 0.03) and a higher LVEF (left ventricular ejection fraction) (HR = 0.95, 95% CI 0.92–0.988, p = 0.009) remained independent predictors of fewer early readmissions. Complete revascularization of the coronary lesions at the time of the first event and a preserved LVEF were found to be the predictors of reduced hospitalizations in the first year after an acute coronary event. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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Review

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27 pages, 3338 KiB

Open AccessReview

Fibrin and Fibrinolytic Enzyme Cascade in Thrombosis: Unravelling the Role

by Rajni Singh, Prerna Gautam, Chhavi Sharma and Alexander Osmolovskiy

Life 2023, 13(11), 2196; https://doi.org/10.3390/life13112196 - 11 Nov 2023

Viewed by 2007

Abstract

Blood clot formation in blood vessels (thrombosis) is a major cause of life-threatening cardiovascular diseases. These clots are formed by αA-, βB-, and ϒ-peptide chains of fibrinogen joined together by isopeptide bonds with the help of blood coagulation factor XIIIa. These clot structures are altered by various factors such as thrombin, platelets, transglutaminase, DNA, histones, and red blood cells. Various factors are used to dissolve the blood clot, such as anticoagulant agents, antiplatelets drugs, fibrinolytic enzymes, and surgical operations. Fibrinolytic enzymes are produced by microorganisms (bacteria, fungi, etc.): streptokinase of Streptococcus hemolyticus, nattokinase of Bacillus subtilis YF 38, bafibrinase of Bacillus sp. AS-S20-I, longolytin of Arthrobotrys longa, versiase of Aspergillus versicolor ZLH-1, etc. They act as a thrombolytic agent by either enhancing the production of plasminogen activators (tissue or urokinase types), which convert inactive plasminogen to active plasmin, or acting as plasmin-like proteins themselves, forming fibrin degradation products which cause normal blood flow again in blood vessels. Fibrinolytic enzymes may be classified in two groups, as serine proteases and metalloproteases, based on their catalytic properties, consisting of a catalytic triad responsible for their fibrinolytic activity having different physiochemical properties (such as molecular weight, pH, and temperature). The analysis of fibrinolysis helps to detect hyperfibrinolysis (menorrhagia, renal failure, etc.) and hypofibrinolysis (diabetes, obesity, etc.) with the help of various fibrinolytic assays such as a fibrin plate assay, fibrin microplate assay, the viscoelastic method, etc. These fibrinolytic activities serve as a key aspect in the recognition of numerous cardiovascular diseases and can be easily produced on a large scale with a short generation time by microbes and are less expensive. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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19 pages, 713 KiB

Open AccessReview

Fighting Cardiac Thromboembolism during Transcatheter Procedures: An Update on the Use of Cerebral Protection Devices in Cath Labs and EP Labs

by Alberto Preda, Claudio Montalto, Michele Galasso, Andrea Munafò, Ilaria Garofani, Matteo Baroni, Lorenzo Gigli, Sara Vargiu, Marisa Varrenti, Giulia Colombo, Marco Carbonaro, Domenico Giovanni Della Rocca, Jacopo Oreglia, Patrizio Mazzone and Fabrizio Guarracini

Life 2023, 13(9), 1819; https://doi.org/10.3390/life13091819 - 28 Aug 2023

Cited by 3 | Viewed by 1214

Abstract

Intraprocedural stroke is a well-documented and feared potential risk of cardiovascular transcatheter procedures (TPs). Moreover, subclinical neurological events or covert central nervous system infarctions are concerns related to the development of dementia, future stroke, cognitive decline, and increased risk of mortality. Cerebral protection devices (CPDs) were developed to mitigate the risk of cardioembolic embolism during TPs. They are mechanical barriers designed to cover the ostium of the supra-aortic branches in the aortic arch, but newer devices are able to protect the descending aorta. CPDs have been mainly designed and tested to provide cerebral protection during transcatheter aortic valve replacement (TAVR), but their use in both Catheterization and Electrophysiology laboratories is rapidly increasing. CPDs have allowed us to perform procedures that were previously contraindicated due to high thromboembolic risk, such as in cases of intracardiac thrombosis identified at preprocedural assessment. However, several concerns related to their employment have to be defined. The selection of patients at high risk of thromboembolism is still a subjective choice of each center. The aim of this review is to update the evidence on the use of CPDs in either Cath labs or EP labs, providing an overview of their structural characteristics. Future perspectives focusing on their possible future employment are also discussed. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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17 pages, 597 KiB

Open AccessReview

Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview

by Fabrizio Guarracini, Alberto Preda, Eleonora Bonvicini, Alessio Coser, Marta Martin, Silvia Quintarelli, Lorenzo Gigli, Matteo Baroni, Sara Vargiu, Marisa Varrenti, Giovanni Battista Forleo, Patrizio Mazzone, Roberto Bonmassari, Massimiliano Marini and Andrea Droghetti

Life 2023, 13(8), 1652; https://doi.org/10.3390/life13081652 - 28 Jul 2023

Cited by 1 | Viewed by 1102

Abstract

The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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13 pages, 884 KiB

Open AccessReview

TAVR Interventions and Coronary Access: How to Prevent Coronary Occlusion

by Flavius-Alexandru Gherasie and Alexandru Achim

Life 2023, 13(7), 1605; https://doi.org/10.3390/life13071605 - 21 Jul 2023

Cited by 1 | Viewed by 1162

Abstract

Due to technological advancements during the past 20 years, transcatheter aortic valve replacements (TAVRs) have significantly improved the treatment of symptomatic and severe aortic stenosis, significantly improving patient outcomes. The continuous evolution of transcatheter valve models, refined imaging planning for enhanced accuracy, and the growing expertise of technicians have collectively contributed to increased safety and procedural success over time. These notable advancements have expanded the scope of TAVR to include patients with lower risk profiles as it has consistently demonstrated more favorable outcomes than surgical aortic valve replacement (SAVR). As the field progresses, coronary angiography is anticipated to become increasingly prevalent among patients who have previously undergone TAVR, particularly in younger cohorts. It is worth noting that aortic stenosis is often associated with coronary artery disease. While the task of re-accessing coronary artery access following TAVR is challenging, it is generally feasible. In the context of valve-in-valve procedures, several crucial factors must be carefully considered to optimize coronary re-access. To obtain successful coronary re-access, it is essential to align the prosthesis with the native coronary ostia. As part of preventive measures, strategies have been developed to safeguard against coronary obstruction during TAVR. One such approach involves placing wires and non-deployed coronary balloons or scaffolds inside an at-risk coronary artery, a procedure known as chimney stenting. Additionally, the bioprosthetic or native aortic scallops intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure offers an effective and safer alternative to prevent coronary artery obstructions. The key objective of our study was to evaluate the techniques and procedures employed to achieve commissural alignment in TAVR, as well as to assess the efficacy and measure the impact on coronary re-access in valve-in-valve procedures. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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20 pages, 5669 KiB

Open AccessReview

The Rare Condition of Left Ventricular Non-Compaction and Reverse Remodeling

by Cristiana Bustea, Alexa Florina Bungau, Delia Mirela Tit, Diana Carina Iovanovici, Mirela Marioara Toma, Simona Gabriela Bungau, Andrei-Flavius Radu, Tapan Behl, Adrian Cote and Elena Emilia Babes

Life 2023, 13(6), 1318; https://doi.org/10.3390/life13061318 - 03 Jun 2023

Cited by 1 | Viewed by 1605

Abstract

Left ventricular non-compaction (LVNC) is a rare disease defined by morphological criteria, consisting of a two-layered ventricular wall, a thin compacted epicardial layer, and a thick hyper-trabeculated myocardium layer with deep recesses. Controversies still exist regarding whether it is a distinct cardiomyopathy (CM) or a morphological trait of different conditions. This review analyzes data from the literature regarding diagnosis, treatment, and prognosis in LVNC and the current knowledge regarding reverse remodeling in this form of CM. Furthermore, for clear exemplification, we report a case of a 41-year-old male who presented symptoms of heart failure (HF). LVNC CM was suspected at the time of transthoracic echocardiography and was subsequently confirmed upon cardiac magnetic resonance imaging. A favorable remodeling and clinical outcome were registered after including an angiotensin receptor neprilysin inhibitor in the HF treatment. LVNC remains a heterogenous CM, and although a favorable outcome is not commonly encountered, some patients respond well to therapy. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: From Basic Research to Clinical Application)

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