Search Results (41)

Background/Objectives: With a 17.9 million annual mortality rate, cardiovascular disease is the leading global cause of death. As such, early detection and disease diagnosis are critical for effective treatment and symptom management. Cardiac auscultation, the process of listening to the heartbeat, often provides the first indication of underlying cardiac conditions. This practice allows for the identification of heart murmurs caused by turbulent blood flow. In this exploratory research paper, we propose an AI model to streamline this process to improve diagnostic accuracy and efficiency. Methods: We utilized data from the 2022 George Moody PhysioNet Heart Sound Classification Challenge, comprising phonocardiogram recordings of individuals under 21 years of age in Northeast Brazil. Only patients who had recordings from all four heart valves were included in our dataset. Audio files were synchronized across all recordings and converted to Mel spectrograms before being passed into a pre-trained Vision Transformer, and finally a MiniROCKET model. Additionally, data augmentation was conducted on audio files and spectrograms to generate new data, extending our total sample size from 928 spectrograms to 14,848. Results: Compared to the existing methods in the literature, our model yielded significantly enhanced quality assessment metrics, including Weighted Accuracy, Sensitivity, and F-Score, and resulted in a fast evaluation speed of 0.02 s per patient. Conclusions: The implementation of our method for the detection of heart murmurs can supplement physician diagnosis and contribute to earlier detection of underlying cardiovascular conditions, fast diagnosis times, increased scalability, and enhanced adaptability. Full article

Cardiac computed tomography (CT) has become a cornerstone in the non-invasive evaluation and management of cardiovascular disease, offering clinicians detailed anatomical and functional information that directly influences patient care. This review focuses on three primary clinical applications: coronary artery calcium (CAC) scoring, coronary CT angiography (CCTA), and preprocedural planning for structural heart interventions. CAC quantification remains one of the most powerful prognostic tools for cardiovascular risk stratification, with robust evidence supporting its use in asymptomatic and selected symptomatic individuals. CCTA provides a high-resolution assessment of coronary anatomy and plaque characteristics, guiding both preventive and acute care strategies. In structural heart disease, CT is indispensable for accurate device sizing, procedural planning, and complication avoidance in interventions such as transcatheter valve replacement or repair. Beyond these core applications, cardiac CT supports the evaluation of pericardial, myocardial, aortic, and congenital heart disease, and plays a role in pulmonary embolism risk assessment. Technological innovations—including artificial intelligence, dual-energy imaging, and photon-counting CT—are enhancing image quality, reducing radiation exposure, and broadening the modality’s prognostic capabilities. Collectively, these advances are solidifying cardiac CT as an integrated diagnostic and planning tool with a significant impact on clinical decision-making and patient outcomes. Full article

Tricuspid regurgitation (TR) represents a significant, often silently progressing, valvular heart disease with historically suboptimal management due to perceived high surgical risks. Transcatheter tricuspid valve interventions (TTVI) offer a promising, less invasive therapeutic avenue. Central to the success of TTVI is Right Ventricular Reverse Remodelling (RVRR), defined as an improvement in RV structure and function, which strongly correlates with enhanced patient survival. The right ventricle (RV) undergoes complex multi-scale biomechanical maladaptations, progressing from adaptive concentric to maladaptive eccentric hypertrophy, coupled with increased stiffness and fibrosis. Molecular drivers of this pathology include early failure of antioxidant defenses, metabolic shifts towards glycolysis, and dysregulation of microRNAs. Accurate RV function assessment necessitates advanced imaging modalities like 3D echocardiography, Cardiac Magnetic Resonance Imaging (CMR), and Computed Tomography (CT), along with strain analysis. Following TTVI, RVRR typically manifests as a biphasic reduction in RV volume overload, improved myocardial strain, and enhanced RV-pulmonary arterial coupling. Emerging molecular biomarkers alongside advanced imaging-derived biomechanical markers like CT-based 3D-TAPSE and RV longitudinal strain, are proving valuable. Artificial intelligence (AI) and machine learning (ML) are transforming prognostication by integrating diverse clinical, laboratory, and multi-modal imaging data, enabling unprecedented precision in risk stratification and optimizing TTVI strategies. Full article

Aortic stenosis (AS) is a progressive form of valvular heart disease most commonly associated with aging, with an exponential increase in prevalence after age 50. While men have historically been considered at higher risk, recent studies highlight a similar prevalence between men and women, with a higher prevalence in elderly women driven by longer life expectancy. Sex-related differences in clinical presentation, anatomy, and pathophysiology influence disease progression, severity assessment, and management. Women are often diagnosed at more advanced stages, exhibiting more pronounced symptoms, typically dyspnea and functional impairment, whereas men more often report chest pain. Women have a smaller body surface area, leading to smaller aortic annuli, left ventricular outflow tracts, aortic roots impacting flow dynamic, and severity grading. Diagnostic challenge contributes to the undertreatment of women. Despite experiencing severe AS, women receive fewer interventions and face delays in treatment. The advent of transcatheter aortic valve implantation (TAVI) improved outcomes, with studies suggesting a potential advantage in women compared to men. However, the anatomical differences, such as smaller annuli and more tortuous vascular access, necessitate tailored procedural approaches. Recognizing these sex-specific differences is essential to optimizing AS management, ensuring timely interventions, and improving patient outcomes. Future strategies should incorporate sex-specific thresholds for diagnosis and treatment while leveraging technological advancements, such as artificial intelligence, for personalized therapeutic decisions. Full article

Objective: The aim was to assess the long-term outcomes, safety, and durability of total endoscopic mitral valve repair for Barlow mitral valve disease. Methods: A retrospective analysis of 98 patients undergoing minimal invasive total endoscopic mitral valve repair for Barlow mitral valve disease was conducted between May 2009 and December 2023. A non-resectional repair approach using artificial neochordae and/or ring annuloplasty was performed. Clinical and echocardiographic follow-ups were completed. Rates per patient-years with 95% confidence intervals (CI) for all time-to-event outcomes were calculated. Results: The mean age was 59 ± 12, and 43% were female. Minimally invasive mitral valve repair was successfully performed in all 98 patients with no conversions to sternotomy or mitral valve replacement. There was no mitral valve-related reoperation during the hospital stay. Procedural safety was as follows: no in-hospital mortality, no stroke, and no perioperative myocardial infarction. The mean follow-up was 4.1 ± 3.1 years. Survival at seven years was 87% (95% CI 63% to 96%). Freedom from myocardial infarction, stroke, and congestive heart failure was 89% (95% CI 60% to 97%), 93% (95% CI 82% to 97%), and 100%, respectively. Recurrent mitral valve insufficiency at Grade ≥ 2 was diagnosed in n = 4 (4.1%) of cases. Conclusions: Minimally invasive mitral valve repair using a non-resectional technique for Barlow disease can be performed with a low complication rate. The total endoscopic approach is safe in the long term, with minimal risk of reoperation and recurrent mitral valve insufficiency. Full article

The advancement of medical 3D printing technology includes several enhancements, such as decreasing the length of surgical procedures and minimizing anesthesia exposure, improving preoperative planning, creating personalized replicas of tissues and bones specific to individual patients, bioprinting, and providing alternatives to human organ transplants. The range of materials accessible for 3D printing within the healthcare industry is significantly narrower when compared with conventional manufacturing techniques. Liquid silicone rubber (LSR) is characterized by its remarkable stability, outstanding biocompatibility, and significant flexibility, thus presenting substantial opportunities for manufacturers of medical devices who are engaged in 3D printing. The main objective of this study is to develop, refine, and assess a 3D printer that can employ UV-cured silicone for the fabrication of aortic heart valves. Additionally, the research aims to produce a 3D-printed silicone aortic heart valve and evaluate the feasibility of the final product. A two-level ANOVA experimental design was utilized to investigate the impacts of print speed, nozzle temperature, and layer height on the print quality of the aortic heart valve. The findings demonstrated that the 3D-printed heart valve’s UV-cured silicone functioned efficiently, achieving the target flow rates of 5 L/min and 7 L/min. Two distinct leaflet thicknesses (LT) of the heart valve, namely 0.8 mm and 1.6 mm, were also analyzed to simulate calcium deposition on the leaflets. Full article

Background/Objectives: This study aimed to explore antibiotic prescribing practices for dental implant placement in Croatia. Methods: We conducted a cross-sectional questionnaire-based study including dentists in Croatia who perform dental implant therapy. The questionnaire assessed the dentists’ age, working experience, education level, and whether they use antibiotics for dental implant placement, as well as the choice of antibiotics, timing, and reasons for antibiotics use. We used snowball and convenient sampling methods for recruiting dentists. Categorical data were described as absolute numbers and percentages. Differences in the use of antibiotics for specific health conditions were analyzed using Chi-Square, with p < 0.05. Results: Overall, 74 dentists completed the survey. The dentists used antibiotics either before and after (N = 37, 48.7%), before (N = 21; 27.6%), or after dental implant placement (N = 17, 22.4%). Most used Amoxicillin (N = 47, 61.8%), or Amoxicillin–clavulanic acid (N = 22, 28.9%). Almost all dentists used antibiotics in patients with artificial heart valves (N = 73, 97.3%) and a history of infective endocarditis (N = 74, 98.7%). Also, the dentists reported using antibiotics in patients with artificial joints (N = 52, 69.3%), diabetes (N = 48, 64%), HIV (N = 51, 34.2%), or those on antiresorptive drugs (N = 46, 61.3%), with 17 dentists (22.7%) prescribing antibiotics to all (p < 0.001). The main reasons for antibiotic prophylaxis were preventing complications at the implant site (N = 56; 73.7%) and reducing the early implant failure rate (N = 32; 42.1%). Around one-third of the dentists (34.2%) used antibiotics for their own safety. Conclusions: Croatian dentists may be overprescribing antibiotics during dental implant placement. Clear recommendations concerning antibiotic prophylaxis for dental implant therapy are needed to make well-informed clinical decisions. Full article

Abnormal heart valve function is a major cause of heart disease and is often associated with high rates of morbidity and mortality from heart disease. Focusing on the field of valve replacement, tissue-engineered heart valves are becoming popular and attracting more attention. In this work, an artificial heart valve scaffold based on polycaprolactone/polyurethane (PCL/PU) three-layer composite fibers was prepared by 3D printing and electrospinning, including an inner PCL layer, a middle PCL/PU layer, and an outer PCL layer. The obtained valve scaffold had strong circumferential mechanical properties when PCL/PU = 1:2, and its elastic modulus was 14.7 MPa, similar to that of natural valve. The heart valve scaffold had good cytocompatibility, and the final cell survival rate was 99.8% after 14 days of cell culture. The layered structure makes the artificial heart valve more similar to the natural structure of the mammalian heart, which is conducive to cell proliferation and differentiation, and provides a reference solution for interventional treatment of heart valves. Full article

Cardiovascular diseases are some of the underlying reasons contributing to the relentless rise in mortality rates across the globe. In this regard, there is a genuine need to integrate advanced technologies into the medical realm to detect such diseases accurately. Moreover, numerous academic studies have been published using AI-based methodologies because of their enhanced accuracy in detecting heart conditions. This research extensively delineates the different heart conditions, e.g., coronary artery disease, arrhythmia, atherosclerosis, mitral valve prolapse/mitral regurgitation, and myocardial infarction, and their underlying reasons and symptoms and subsequently introduces AI-based detection methodologies for precisely classifying such diseases. The review shows that the incorporation of artificial intelligence in detecting heart diseases exhibits enhanced accuracies along with a plethora of other benefits, like improved diagnostic accuracy, early detection and prevention, reduction in diagnostic errors, faster diagnosis, personalized treatment schedules, optimized monitoring and predictive analysis, improved efficiency, and scalability. Furthermore, the review also indicates the conspicuous disparities between the results generated by previous algorithms and the latest ones, paving the way for medical researchers to ascertain the accuracy of these results through comparative analysis with the practical conditions of patients. In conclusion, AI in heart disease detection holds paramount significance and transformative potential to greatly enhance patient outcomes, mitigate healthcare expenditure, and amplify the speed of diagnosis. Full article

The increasing antibiotic resistance among bacteria challenges the biotech industry to search for new antibacterial molecules. Endolysin TP84_28 is a thermostable, lytic enzyme, encoded by the bacteriophage (phage) TP-84, and it effectively digests host bacteria cell wall. Biofilms, together with antibiotic resistance, are major problems in clinical medicine and industry. The challenge is to keep antibacterial molecules at the site of desired action, as their diffusion leads to a loss of efficacy. The TP84_28 endolysin gene was cloned into an expression-fusion vector, forming a fusion gene cbd_tp84_28_his with a cellulose-binding domain from the cellulase enzyme. The Cellulose-Binding Thermostable TP84_Endolysin (CBD_TP84_28_His) fusion protein was biosynthesized in Escherichia coli and purified. Thermostability and enzymatic activities against various bacterial species were measured by a turbidity reduction assay, a spot assay, and biofilm removal. Cellulose-binding properties were confirmed via interactions with microcellulose and cellulose paper-based immunoblotting. The high affinity of the CBD allows for a high concentration of the fusion enzyme at desired target sites such as cellulose-based wound dressings, artificial heart valves and food packaging. CBD_TP84_28_His exhibits a lytic effect against thermophilic bacteria Geobacillus stearothemophilus, Thermus aquaticus, Bacillus stearothermophilus, and Geobacillus ICI and minor effects against mesophilic Bacillus cereus and Bacillus subtilis. CBD_TP84_28_His retains full activity after preincubation in the temperatures of 30–65 °C and exhibits significant activity up to its melting point at 73 °C. CBD_TP84_28_His effectively reduces biofilms. These findings suggest that integrating CBDs into thermostable endolysins could enable the development of targeted antibacterial recombinant proteins with diverse clinical and industrial applications. Full article

Background/Objectives: We assessed the effectiveness and safety of vitamin K antagonists (VKAs) versus direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) using artificial intelligence techniques. Methods: This is a retrospective study in 15 Spanish hospitals (2014–2020), including adult AF patients with no history of anticoagulation, thrombosis events, rheumatic mitral valvular heart disease, mitral valve stenosis, or pregnancy. We employed EHRead^® technology based on natural language processing (NLP) and machine learning (ML), along with SNOMED-CT terminology, to extract clinical data from electronic health records (EHRs). Using propensity score matching (PSM), the effectiveness, safety, and hospital mortality of VKAs versus DOACs were analyzed through Kaplan–Meier curves and Cox regression. Results: Out of 138,773,332 EHRs from 4.6 million individuals evaluated, 44,292 patients were included, 79.6% on VKAs and 20.4% on DOACs. Most patients were elderly [VKA 78 (70, 84) and DOAC 75 (66, 83) years], with numerous comorbidities (75.5% and 70.2% hypertension, 47.2% and 39.9% diabetes, and 40.3% and 34.8% heart failure, respectively). Additionally, 60.4% of VKA and 48.7% of DOAC users had a CHA2DS2-VASc Score ≥4. After PSM, 8929 patients per subgroup were selected. DOAC users showed a lower risk of thrombotic events [HR 0.81 (95% CI 0.70–0.94)], minor bleeding [HR 0.89 (95% CI 0.83–0.96)], and mortality [HR 0.80 (95% CI 0.69–0.92)]. Conclusions: Applying NLP and ML, we generated valuable real-world evidence on anticoagulated AF patients in Spain. Even in complex populations, DOACs have demonstrated a better safety and effectiveness profile than VKAs. Full article

Cardiac amyloidosis (CA) is a cardiac storage disease caused by the progressive extracellular deposition of misfolded proteins in the myocardium. Despite the increasing interest in this pathology, it remains an underdiagnosed condition. Non-invasive diagnostic techniques play a central role in the suspicion and detection of CA, also thanks to the continuous scientific and technological advances in these tools. The 12-lead electrocardiography is an inexpensive and reproducible test with a diagnostic accuracy that, in some cases, exceeds that of imaging techniques, as recent studies have shown. Echocardiography is the first-line imaging modality, although none of its parameters are pathognomonic. According to the 2023 ESC Guidelines, a left ventricular wall thickness ≥ 12 mm is mandatory for the suspicion of CA, making this technique crucial. Cardiac magnetic resonance provides high-resolution images associated with tissue characterization. The use of contrast and non-contrast sequences enhances the diagnostic power of this imaging modality. Nuclear imaging techniques, including bone scintigraphy and positron emission tomography, allow the detection of amyloid deposition in the heart, and their role is also central in assessing the prognosis and response to therapy. The role of computed tomography was recently evaluated by several studies, above in population affected by aortic stenosis undergoing transcatheter aortic valve replacement, with promising results. Finally, machine learning and artificial intelligence-derived algorithms are gaining ground in this scenario and provide the basis for future research. Understanding the new insights into non-invasive diagnostic techniques is critical to better diagnose and manage patients with CA and improve their survival. Full article

Since the 1960s, efforts have been made to develop new technologies to eliminate the risk of thrombosis in medical devices that come into contact with blood. Preventing thrombosis resulting from the contact of a medical device, such as an implant, with blood is a challenge due to the high mortality rate of patients and the high cost of medical care. To this end, various types of biomaterials coated with polymer-drug layers are being designed to reduce their thrombogenicity and improve their hemocompatibility. This review presents the latest developments in the use of polymer-drug systems to produce anti-thrombogenic surfaces in medical devices in contact with blood, such as stents, catheters, blood pumps, heart valves, artificial lungs, blood vessels, blood oxygenators, and various types of tubing (such as for hemodialysis) as well as microfluidic devices. This paper presents research directions and potential clinical applications, emphasizing the importance of continued progress and innovation in the field. Full article

Heart failure is a cardiovascular condition, leading to fatigue, breathlessness, and fluid retention. It affects around 56 million people globally and is a leading cause of hospitalization and mortality. Its prevalence is rising due to aging populations and lifestyle factors. Managing heart failure demands a multidisciplinary approach, encompassing medications, lifestyle modifications, and often medical devices or surgeries. The treatment burden is substantial, impacting patients’ daily lives and straining healthcare systems. Improving early detection, novel therapies, and patient education are crucial for alleviating the burden and enhancing the quality of life. There are notable advancements in the field of heart failure treatment and prevention. We will discuss significant pharmacological and device advances related to heart failure, including angiotensin receptor–neprilysin inhibitor, sodium–glucose co-transporter inhibition, glucagon-like peptide-1 agonist, cardiac resynchronization therapy, cardiac contractility modulation, mechanical circulatory support devices, and transcatheter valve interventions. We will also review novel therapies on the horizon, emerging technologies like CRISPR-based treatments for genetic anomalies, and the involvement of artificial intelligence in heart failure detection and management. Full article

The inherent disadvantages of traditional non-flexible aerogels, such as high fragility and moisture sensitivity, severely restrict their applications. To address these issues and make the aerogels efficient, especially for advanced medical applications, different techniques have been used to incorporate flexibility in aerogel materials. In recent years, a great boom in flexible aerogels has been observed, which has enabled them to be used in high-tech biomedical applications. The current study comprises a comprehensive review of the preparation techniques of pure polymeric-based hybrid and single-component aerogels and their use in biomedical applications. The biomedical applications of these hybrid aerogels will also be reviewed and discussed, where the flexible polymeric components in the aerogels provide the main contribution. The combination of highly controlled porosity, large internal surfaces, flexibility, and the ability to conform into 3D interconnected structures support versatile properties, which are required for numerous potential medical applications such as tissue engineering; drug delivery reservoir systems; biomedical implants like heart stents, pacemakers, and artificial heart valves; disease diagnosis; and the development of antibacterial materials. The present review also explores the different mechanical, chemical, and physical properties in numerical values, which are most wanted for the fabrication of different materials used in the biomedical fields. Full article