Clinical Diagnosis and Management of Cardiovascular Disease

Background and Objectives: Peripheral artery disease (PAD) is a common manifestation of systemic atherosclerosis associated with significant morbidity and mortality, yet it remains underdiagnosed due to limited routine screening and its often-asymptomatic presentation. Although the ankle–brachial index (ABI) is the gold standard diagnostic tool for PAD, its use may be limited in some settings because it requires specialized equipment and trained personnel. In contrast, the electrocardiogram (ECG) is widely available and routinely performed. Given that ECG abnormalities may reflect systemic cardiovascular disease, we investigated the association between ECG findings and ABI classification. Materials and Methods: This retrospective case–control study analyzed patients with and without PAD who received care from outpatient vascular clinics between March 2018 and February 2022. PAD was defined as ABI ≤ 0.9 or toe–brachial index ≤ 0.67 with abnormal pedal pulses. The most recent ECG performed within one year of ABI measurement was retrieved for each patient and classified as normal, borderline, or abnormal according to standardized guideline recommendations. The association between ECG category and ABI classification was assessed using chi-square testing and multivariable logistic regression adjusted for age and sex, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). Discriminatory performance of the ability of ECG findings to predict ABI classification was evaluated using the area under the receiver operating characteristic curve (AUROC) with 95% CI. Model calibration was assessed using the Hosmer–Lemeshow test. Results: Overall, 491 patients had paired ECG and ABI data. ECGs were categorized as abnormal (n = 345), borderline (n = 58), or normal (n = 88). The prevalence of abnormal ABI (≤0.9) was highest among patients with abnormal ECGs (45.8%), compared to borderline (34.5%) and normal ECGs (28.4%) (p = 0.0067). On multivariable logistic regression analysis adjusted for age and sex, abnormal ECG findings were associated with increased odds of abnormal ABI compared to normal ECGs (adjusted OR 2.07, 95% CI 1.24–3.46, p = 0.005), whereas borderline ECGs were not (OR 1.31, 95% CI 0.64–2.68, p = 0.455). ECG categorization demonstrated moderate discrimination (AUROC 0.73, 95% CI 0.68–0.78) and good calibration (Hosmer–Lemeshow χ² 5.0, p = 0.76) for predicting abnormal ABI. Conclusions: In this retrospective case–control study, we found an association between abnormal ECG findings and abnormal ABI. These results support the concept that clinically significant ECG abnormalities may reflect systemic atherosclerotic burden rather than isolated cardiac pathology. Given the widespread availability and low cost of ECG testing, ECG interpretation may help identify patients who warrant further investigations, including PAD screening, vascular assessment, and risk-stratification, particularly in lower-resource settings without routine access to ABI testing. Prospective, multicenter studies are needed to validate these findings. Full article

Background and Objectives: Pericoronary adipose tissue (PCAT) attenuation measured on coronary CT angiography is a promising imaging biomarker of coronary inflammation; however, absolute values may be influenced by technical and inter-individual variability, and a standardized methodology for measurement has not been established. Our study aimed to evaluate the association between PCAT attenuation and CAC burden while comparing absolute attenuation values with normalized values to minimize these sources of variability. Materials and Methods: Two hundred patients undergoing cardiac CT were included and stratified into four CAC categories (0, 1–99, 100–299, ≥300). PCAT attenuation was measured at multiple locations on two main levels: aortic root level and four-chamber view level. Relative PCAT attenuation was calculated by subtracting subcutaneous fat attenuation from raw PCAT values. Group comparisons were performed using ANOVA or Kruskal–Wallis tests, and multivariable linear regression models were adjusted for age, sex, and body mass index. Results: In univariate analysis, relative PCAT attenuation differed significantly across CAC categories at the aortic-level right coronary artery (RCA) site (p = 0.007). In multivariable analysis, higher CAC categories were associated with increased relative PCAT attenuation at the aortic RCA (β = 8.56, p = 0.015 for CAC 100–299; β = 10.68, p = 0.005 for CAC ≥300), while associations at the left main coronary artery (LMCA) showed significance in low and moderate CAC categories (β = 6.91, p = 0.047 for CAC 1–99 and β = 8.57, p = 0.016 for CAC 100–299). No significant associations were observed between CAC and raw PCAT attenuation at the aortic level, while isolated and inconsistent findings were observed in other territories. Conclusions: Relative PCAT attenuation is independently associated with CAC severity and normalized values may reduce technical and biological variability, potentially enhancing the sensitivity and robustness of this CT-based biomarker. Full article

Background and Objectives: Systemic inflammation is a key driver in the progression and complexity of coronary artery disease (CAD). Serum calprotectin and the C-reactive protein–triglyceride–glucose index (CTI) have emerged as potential inflammatory and metabolic biomarkers; however, their association with angiographic disease severity has not been clearly defined. This study aimed to evaluate the relationship between serum calprotectin, CTI, and the SYNTAX score (SS) in patients with stable CAD. Materials and Methods: A total of 134 patients undergoing coronary angiography were enrolled. The SS was calculated to quantify coronary lesion complexity. Patients were classified into two groups based on the results of the coronary angiogram: low SS (n = 73, SS < 23), and intermediate–high SS (n = 61, SS ≥ 23). Serum calprotectin, and CTI were obtained at baseline. Correlation analyses were performed to evaluate associations between biomarkers and SS. Receiver operating characteristic (ROC) curve analysis assessed the ability of these biomarkers to predict intermediate–high SS. Univariable and multivariable logistic regression analyses were performed to determine independent associations. Results: Patients with intermediate–high SS had significantly higher levels of serum calprotectin (1009.5 vs. 505.7 ng/mL), and CTI (9.9 vs. 9.5) compared with those with low SS (all p < 0.001). Spearman correlation analysis demonstrated significant positive correlations between SS and, serum calprotectin (ρ = 0.488), and CTI (ρ = 0.453) (all p < 0.001). ROC analysis showed moderate association in respect to intermediate–high SS (0.739 for serum calprotectin, and 0.722 for CTI). In multivariable models, CTI showed the strongest independent association with intermediate–high SS (OR: 4.66, 95% CI: 2.00–10.84, p < 0.001). Conclusions: Serum calprotectin and CTI were significantly associated with coronary lesion complexity, as measured by the SS. These biomarkers may serve as valuable tools for identifying patients with greater CAD severity and anatomical complexity. Full article

Background and Objectives: Cardiac implantable electronic devices (CIEDs), including permanent pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, are increasingly used in an aging population characterized by multimorbidity and a high prevalence of psychiatric and cognitive disorders. Depression, anxiety, post-traumatic stress disorder (PTSD), mild cognitive impairment, and dementia may affect informed consent, adherence to therapy, quality of life, and long-term cardiovascular outcomes in patients undergoing CIED implantation. The aim of this review was to summarize the prevalence and clinical significance of psychiatric and cognitive disorders in patients undergoing CIED implantation and to discuss practical strategies for their assessment in routine cardiology practice. Materials and Methods: This narrative review was based on a literature search of PubMed, Web of Science, and the National Health Library database covering the literature from 2010 to 2025, including a broad search strategy. Original studies and review articles were included, having confirmed their definite association with the subject. Results: Psychiatric disorders and cognitive impairment were highly prevalent among patients with CIEDs and were associated with impaired adherence, reduced participation in rehabilitation, lower quality of life, and worse cardiovascular outcomes. ICD therapies, particularly inappropriate therapies, were strongly associated with anxiety, depressive symptoms, and PTSD-related distress. Cognitive impairment may compromise informed consent, recognition of complications, and compliance with post-implantation recommendations. Several validated screening tools, including MMSE, MoCA, HADS, BDI-II, STAI, and FSAS, may facilitate early identification of high-risk patients, and their most appropriate use in various clinical scenarios, including pre- and post-CIED implantation was described. Conclusions: Psychiatric disorders and cognitive impairment are common and clinically relevant in patients undergoing CIED implantation. Routine psychological and cognitive assessment before and after implantation should be considered an important component of modern multidisciplinary cardiac care, potentially affecting the decision to implant the device, and likely influencing the type of the implanted device. Full article

Background/Objectives: Evidence linking omega-3 intake to reductions in arterial stiffness remains inconsistent. This systematic review aimed to evaluate and synthesize evidence on the effectiveness of omega-3 supplementation in reducing arterial stiffness as measured by pulse wave velocity (PWV). Methods: Two search iterations were conducted in Scopus, PubMed, and Web of Science. The search was conducted through 2025. The search terms were “omega-3” AND “pulse wave velocity”. No filters for language or study type were applied. Results: In this set of 20 randomized controlled clinical trials, omega-3 supplementation had heterogeneous effects on arterial stiffness measured by PWV. Slightly more than half of the studies reported significant reductions in PWV, while the remaining studies reported no statistically significant changes. This heterogeneity may be explained by differences in study population, dose, and treatment duration. Favorable effects were more commonly observed in studies using moderately high omega-3 doses (approximately 1.8–4 g/day), interventions lasting ≥12 weeks, and populations with metabolic disorders or higher vascular risk. In contrast, studies using low doses, acute interventions, or plant-based omega-3 more frequently reported null results. Conclusions: These findings indicate that population characteristics, dose, and intervention duration should be considered when designing future trials and clinical recommendations. Full article

Sexual dysfunction (SD), more specifically vasculogenic erectile dysfunction (ED) in men and female sexual arousal disorder (FSAD) in women, is increasingly recognized as a marker of cardiovascular disease (CVD). While extensive literature documents vasculogenic ED as an early warning sign of coronary artery disease (CAD) and other atherosclerotic manifestations, the evidence for analogous phenomena in women is emerging but less mature. This perspective explores epidemiologic associations, shared pathophysiologic mechanisms, clinical implications, and screening paradigms for ED and FSAD as cardiovascular (CV) risk-enhancing conditions. This perspective endorses that clinicians should incorporate genital vasculogenic SD into CV risk stratification and that multidisciplinary care (primary care, cardiology, urology/gynecology) is warranted. A summary table outlines key features and actionable steps. Full article