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Keywords = cardiological adverse effects

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16 pages, 2015 KB  
Article
Intravenous Immunoglobulin Efficacy and Safety in Paediatric Patients Diagnosed with Acute Myocarditis
by Adelina-Mihaela Sorescu, Oana Andreia Coman, Lupușoru Raoul-Vasile, Gabriela Duica, Nicolescu Alin, Eliza Elena Cinteză, Fulga Ion and Cristina Isabel Viorica Ghiță
J. Clin. Med. 2025, 14(21), 7835; https://doi.org/10.3390/jcm14217835 - 4 Nov 2025
Viewed by 1203
Abstract
Background: Acute myocarditis is defined as an inflammatory process consisting of multiple complex physiopathological processes. Due to its variability, the management of this condition has been a topic of debate. Our study aimed to evaluate the efficacy and safety of intravenous immunoglobulin (IVIg). [...] Read more.
Background: Acute myocarditis is defined as an inflammatory process consisting of multiple complex physiopathological processes. Due to its variability, the management of this condition has been a topic of debate. Our study aimed to evaluate the efficacy and safety of intravenous immunoglobulin (IVIg). Methods: We retrospectively collected data from patients admitted to a paediatric cardiology department from 2015 to 2020. Following the inclusion and exclusion criteria, a total of 68 patients diagnosed with acute myocarditis were selected and divided into two groups: treated with IVIg and untreated. We determined clinical and paraclinical parameters, such as symptom remission, normalisation of the ejection fraction at discharge, and cardiac marker evolution. Mixed-design analysis of variance and McNemar tests were performed to determine the statistical differences between groups. Results: In the treated group, 88.2% of the patients developed symptom remission at discharge vs. 50% in the untreated group, and 61.8% of the treated patients presented normalisation of the ejection fraction (EF) vs. 8.8% in the untreated group (p < 0.05). The evolution of cardiac markers did not statistically differ between the treated and untreated groups. Regarding safety, three treated patients presented mild, temporary side effects. Conclusions: Having found a statistically significant improvement in symptomatology and left ventricular EF, our study suggests the efficacy of IVIg in the treatment of acute myocarditis. Treatment with immunoglobulins was relatively safe, with only mild adverse reactions (fever and mild chest pain). Full article
(This article belongs to the Section Cardiology)
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19 pages, 2158 KB  
Systematic Review
Mitral Valve Prolapse in Athletes: Prevalence, Arrhythmic Associations, and Clinical Implications—A Systematic Review
by Andrea Sonaglioni, Gian Luigi Nicolosi, Michele Lombardo and Massimo Baravelli
J. Clin. Med. 2025, 14(21), 7475; https://doi.org/10.3390/jcm14217475 - 22 Oct 2025
Viewed by 1337
Abstract
Background: Mitral valve prolapse (MVP) is the most common valvular abnormality in the general population and has been linked to mitral regurgitation, arrhythmias, and sudden cardiac death. Its prevalence and prognostic significance in athletes remain uncertain, raising important questions for pre-participation screening, [...] Read more.
Background: Mitral valve prolapse (MVP) is the most common valvular abnormality in the general population and has been linked to mitral regurgitation, arrhythmias, and sudden cardiac death. Its prevalence and prognostic significance in athletes remain uncertain, raising important questions for pre-participation screening, eligibility for competition, and long-term follow-up. Methods: We systematically searched PubMed, Scopus, and EMBASE databases from inception through August 2025 for original studies reporting MVP prevalence in athletes, diagnosed by echocardiography or pathological assessment. Data on study characteristics, diagnostic definitions, prevalence, arrhythmias, and outcomes were independently extracted by three reviewers. Methodological quality was appraised using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twelve studies published between 1987 and 2024 met inclusion criteria, enrolling 19,463 athletes from diverse sports and competitive levels. A total of 407 MVP cases were identified, corresponding to a crude pooled prevalence of 2.4%. Prevalence estimates varied substantially (0.2–20%), reflecting heterogeneity in study populations and diagnostic definitions. When all studies were pooled using a random-effects model, the overall prevalence was 2.0% (95% CI 1.2–2.8%). A sensitivity analysis restricted to contemporary, unselected athletic cohorts yielded a prevalence of 1.1% (95% CI 0.4–1.9%), closely aligning with population-based estimates. Ventricular arrhythmias were more frequent than supraventricular arrhythmias, particularly in association with bileaflet prolapse, leaflet thickening, or significant mitral regurgitation. Most athletes were asymptomatic, and only one prospective study provided long-term follow-up, confirming a generally benign prognosis, though rare adverse events (atrial fibrillation, valve surgery) were documented. Conclusions: MVP is relatively uncommon in athletes and occurs at rates similar to the general population. In most cases, prognosis is favorable and should not preclude sports participation. Nonetheless, recognition of high-risk phenotypes with arrhythmogenic potential highlights the need for individualized evaluation and tailored surveillance strategies in sports cardiology practice. Full article
(This article belongs to the Special Issue Advancements in Diagnostic Innovations in Sports Cardiology)
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18 pages, 813 KB  
Review
Sleep Apnea: The Slept-Upon Cardiovascular Risk Factor
by Adriana-Loredana Pintilie, Dragos Traian Marius Marcu, Andreea Zabara-Antal, Raluca-Ioana Arcana, Diana-Gabriela Iosep, Mihnea Miron, Carina-Adina Afloarei, Mihai-Lucian Zabara and Radu Crisan Dabija
Biomedicines 2025, 13(10), 2529; https://doi.org/10.3390/biomedicines13102529 - 16 Oct 2025
Viewed by 2997
Abstract
Background: Obstructive sleep apnea (OSA) is prevalent and often underdiagnosed in cardiology. Worldwide, approximately 936 million adults aged 30–69 are affected by OSA, with the highest numbers in the USA, China, Brazil, and India. In cardiovascular clinics, OSA is found in about 40–80% [...] Read more.
Background: Obstructive sleep apnea (OSA) is prevalent and often underdiagnosed in cardiology. Worldwide, approximately 936 million adults aged 30–69 are affected by OSA, with the highest numbers in the USA, China, Brazil, and India. In cardiovascular clinics, OSA is found in about 40–80% of patients with hypertension, heart failure, coronary artery disease, atrial fibrillation, or stroke. Meta-analyses link OSA to nearly twice the risk of cardiovascular disease, stroke, and all-cause mortality. Continuous positive airway pressure (CPAP) therapy addresses the underlying mechanisms of OSA and enhances intermediate cardiovascular indicators. Materials and Methods: We conducted a narrative review using major medical search engines (PubMed, Embase, Cochrane) to examine recent statements, meta-analyses, large cohorts, and key trials. The review focused on the cardiovascular burden of sleep apnea and its pathophysiology—including arrhythmic, hemodynamic, vascular, and coagulation aspects—as well as the effects of CPAP on intermediate cardiovascular outcomes. We aimed to provide a synthesised overview of current cardiovascular evidence related to the burden and mechanisms of OSA, and to summarise the effects of continuous positive airway pressure (CPAP) on intermediate and clinical cardiovascular outcomes. Results: Intermittent hypoxia, sleep fragmentation, and major negative fluctuations in intrathoracic pressure create a clear pathway leading to adverse cardiovascular outcomes. This occurs through mechanisms like sympathetic activation, RAAS activation, endothelial dysfunction, oxidative stress, and inflammation, linking OSA to these health issues. Studies show that greater severity of OSA correlates with higher cardiovascular risk, including increased incidence and recurrence of AF, resistant hypertension, and new cases of heart failure. CPAP effectively lowers AHI and enhances nocturnal oxygen levels, as well as intermediate cardiovascular indicators such as blood pressure, sympathetic activity, and certain aspects of ventricular function, with clinical benefits most evident in adherent patients. Conclusions: OSA is a significant, modifiable risk factor for cardiovascular disease. Routine cardiovascular care should include targeted screening for OSA, especially in cases of resistant hypertension, atrial fibrillation, and heart failure, along with timely sleep testing and adherence-focused CPAP therapy, in addition to traditional risk-reduction methods. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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30 pages, 7258 KB  
Review
Cancer-Induced Cardiac Dysfunction: Mechanisms, Diagnostics, and Emerging Therapeutics in the Era of Onco-Cardiology
by Sarama Saha, Praveen K. Singh, Partha Roy, Vasa Vemuri, Mariusz Z. Ratajczak, Mahavir Singh and Sham S. Kakar
Cancers 2025, 17(19), 3225; https://doi.org/10.3390/cancers17193225 - 3 Oct 2025
Cited by 1 | Viewed by 1786
Abstract
Cancer-induced cardiac dysfunction has become a major clinical challenge as advances in cancer therapies continue to extend patient survival. Once regarded as a secondary concern, cardiotoxicity is now recognized as a leading contributor to morbidity and mortality among cancer patients and survivors. Its [...] Read more.
Cancer-induced cardiac dysfunction has become a major clinical challenge as advances in cancer therapies continue to extend patient survival. Once regarded as a secondary concern, cardiotoxicity is now recognized as a leading contributor to morbidity and mortality among cancer patients and survivors. Its pathophysiology is multifactorial, involving systemic inflammation (e.g., TNF-α, IL-6), oxidative stress driven by reactive oxygen species (ROS), neurohormonal imbalances (e.g., angiotensin II, endothelin-1), and metabolic disturbances. These mechanisms collectively promote cardiomyocyte apoptosis, atrophy, mitochondrial dysfunction, and impaired cardiac output. Cardiac complications may arise directly from cancer itself or as adverse effects of oncologic therapies such as anthracyclines, trastuzumab, and immune checkpoint inhibitors. These agents have been linked to heart failure (HF), systolic dysfunction, and cardiac atrophy, often progressing insidiously and underscoring the importance of early detection and careful monitoring. Current preventive and therapeutic strategies include pharmacological interventions such as ACE inhibitors, beta-blockers, statins, dexrazoxane, and endothelin receptor antagonists like atrasentan. Emerging compounds, particularly Withaferin A (WFA), have shown potential through their anti-inflammatory and cardiac protective properties. In addition, antioxidants and lifestyle modifications may provide supplementary cardioprotective benefits, while interventional cardiology procedures are increasingly considered in selected patients. Despite encouraging progress, standardized treatment protocols and robust long-term outcome data remain limited. Given the heterogeneity of cancer types and cardiovascular responses, a personalized and multidisciplinary approach is essential. Continued research and close collaboration between oncologists, cardiologists, and basic scientists will be the key to advancing care, reducing treatment-related morbidity, and ensuring that improvements in cancer survival are matched by preservation of cardiovascular health. Full article
(This article belongs to the Special Issue Cancer Induced Organ Dysfunctions (Cachexia))
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25 pages, 3236 KB  
Article
A Wearable IoT-Based Measurement System for Real-Time Cardiovascular Risk Prediction Using Heart Rate Variability
by Nurdaulet Tasmurzayev, Bibars Amangeldy, Timur Imankulov, Baglan Imanbek, Octavian Adrian Postolache and Akzhan Konysbekova
Eng 2025, 6(10), 259; https://doi.org/10.3390/eng6100259 - 2 Oct 2025
Viewed by 3178
Abstract
Cardiovascular diseases (CVDs) remain the leading cause of global mortality, with ischemic heart disease (IHD) being the most prevalent and deadly subtype. The growing burden of IHD underscores the urgent need for effective early detection methods that are scalable and non-invasive. Heart Rate [...] Read more.
Cardiovascular diseases (CVDs) remain the leading cause of global mortality, with ischemic heart disease (IHD) being the most prevalent and deadly subtype. The growing burden of IHD underscores the urgent need for effective early detection methods that are scalable and non-invasive. Heart Rate Variability (HRV), a non-invasive physiological marker influenced by the autonomic nervous system (ANS), has shown clinical relevance in predicting adverse cardiac events. This study presents a photoplethysmography (PPG)-based Zhurek IoT device, a custom-developed Internet of Things (IoT) device for non-invasive HRV monitoring. The platform’s effectiveness was evaluated using HRV metrics from electrocardiography (ECG) and PPG signals, with machine learning (ML) models applied to the task of early IHD risk detection. ML classifiers were trained on HRV features, and the Random Forest (RF) model achieved the highest classification accuracy of 90.82%, precision of 92.11%, and recall of 91.00% when tested on real data. The model demonstrated excellent discriminative ability with an area under the ROC curve (AUC) of 0.98, reaching a sensitivity of 88% and specificity of 100% at its optimal threshold. The preliminary results suggest that data collected with the “Zhurek” IoT devices are promising for the further development of ML models for IHD risk detection. This study aimed to address the limitations of previous work, such as small datasets and a lack of validation, by utilizing real and synthetically augmented data (conditional tabular GAN (CTGAN)), as well as multi-sensor input (ECG and PPG). The findings of this pilot study can serve as a starting point for developing scalable, remote, and cost-effective screening systems. The further integration of wearable devices and intelligent algorithms is a promising direction for improving routine monitoring and advancing preventative cardiology. Full article
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14 pages, 1235 KB  
Article
Adherence to Guideline-Directed Medical Therapy in Hospitalized Older People with Heart Failure at Discharge and 3-Month Follow-Up
by Renee C. M. A. Raijmann, Melanie Haverkamp, Manon G. van der Meer, Wilma Knol, Cheyenne C. S. Tseng, Carolina J. P. W. Keijsers, Marielle H. Emmelot-Vonk and Huiberdina L. Koek
J. Clin. Med. 2025, 14(19), 6928; https://doi.org/10.3390/jcm14196928 - 30 Sep 2025
Viewed by 1158
Abstract
Objectives: Heart failure is one of the leading causes of hospitalization in older adults. Guideline-directed medical therapy (GDMT) reduces the risk of decompensation and hospitalization, though it is challenging to implement GDMT in this group. Therefore, this study evaluated adherence to the 2021 [...] Read more.
Objectives: Heart failure is one of the leading causes of hospitalization in older adults. Guideline-directed medical therapy (GDMT) reduces the risk of decompensation and hospitalization, though it is challenging to implement GDMT in this group. Therefore, this study evaluated adherence to the 2021 ESC heart failure guideline in older patients and explored reasons for guideline deviations. Methods: A retrospective cohort study was performed in older patients (70+ years) with decompensated heart failure (ejection fraction < 50%) admitted to the cardiology or geriatrics department at a tertiary hospital (May 2022–September 2023). Data on GDMT-drug use, dosage, and reasons for guideline deviations were collected at discharge and three months post-discharge. Additionally, associations between GDMT non-adherence and factors such as age, frailty, comorbidities, and admission specialty were analyzed. Results: A total of 60 patients were included (mean age 79 years, 40% women, median EF 34%). The four GDMT drugs were prescribed to 15% of patients at discharge and 26% at follow-up, and 3% of the patients received the target dose for all drugs. Older patients (>80 years) received GDMT less frequently at discharge compared to younger patients (4% vs. 26%, p = 0.03). Though this difference was resolved at follow-up. The other studied factors were not significantly associated with GDMT adherence. Common reasons for guideline deviations were adverse effects, contraindications, reduced life expectancy, and postponed treatment. Conclusions: Adherence to GDMT in older heart failure patients is low due to several reasons, such as relevant contraindications. Physicians should carefully balance the risks and benefits of the guideline versus individual benefit, considering life expectancy and individual care goals. Full article
(This article belongs to the Section Cardiology)
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19 pages, 1897 KB  
Systematic Review
Unveiling the Mechanisms for the Development of Cardiotoxicity Following Chemotherapy Regimens Administration for Primary Colorectal Cancer: A Systematic Review
by Sophia Tsokkou, Ioannis Konstantinidis, Paraskevi Chatzikomnitsa, Menelaos Papakonstantinou, Evdokia Toutziari, Dimitrios Giakoustidis, Theodora Papamitsou, Vasileios Papadopoulos and Alexandros Giakoustidis
Cancers 2025, 17(19), 3129; https://doi.org/10.3390/cancers17193129 - 26 Sep 2025
Viewed by 1469
Abstract
Background/Introduction: Colorectal carcinoma (CRC) belongs to the most commonly diagnosed malignancies to this date, ranking as third across the globe. In addition, CRC remains a leading cause of cancer-related deaths as it is ranked as the second most common cause of mortality. [...] Read more.
Background/Introduction: Colorectal carcinoma (CRC) belongs to the most commonly diagnosed malignancies to this date, ranking as third across the globe. In addition, CRC remains a leading cause of cancer-related deaths as it is ranked as the second most common cause of mortality. Therapeutic strategies for the management and treatment of CRC have made significant progress in the last two decades, with both adjuvant and neoadjuvant approaches playing critical roles in enhancing favorable outcomes with regimens like FOLFOX, CAPOX, and 5-FU-based therapies demonstrating effectiveness. Nevertheless, growing evidence indicates that these therapies may pose a risk of cardiotoxicity development. A systematic review will be conducted to map the mechanistic pathways of chemotherapy-induced in CRC in order to bridge oncology and cardiology perspectives, highlighting emerging diagnostic tools and long-term surveillance gaps. Purpose: The objective of this study is the investigation of the prevalence and characteristics of cardiovascular problems linked to frequently employed chemotherapy regimens, as well as to evaluate existing diagnostic and therapeutic approaches. Methodology: A thorough search across databases, including PubMed (MEDLINE), Embase, and Cochrane Library, was performed to locate articles published up to 2025. The final studies included in the review underwent quality assessment. Results: Fourteen qualifying studies, comprising both prospective trials and case reports from diverse geographies, were included. Cardiovascular outcomes including myocardial strain, arrhythmias, angina, heart failure, and Takotsubo cardiomyopathy were evaluated. The diagnostic methods assessed comprised echocardiography, cardiac biomarkers, and electrocardiograms. In the reviewed trials, chemotherapy-induced cardiotoxicity varied from asymptomatic ventricular strain to serious cardiac complications. The FOLFOX and 5-FU regimens were predominantly linked to adverse cardiac outcomes. Prompt identification by echocardiographic strain imaging and biomarker monitoring facilitated timely intervention. Case studies revealed that, given proper cardiological support, certain patients could safely recommence chemotherapy following recovery. No standardized cardiac screening protocol was identified among the trials. Conclusions: Chemotherapy for colorectal cancer may present considerable cardiovascular hazards, highlighting the necessity for routine cardiac monitoring prior to and throughout treatment. This systematic review promotes collaborative cardio-oncology strategies to reduce risk and enhance therapeutic safety. Full article
(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine: 2nd Edition)
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16 pages, 5420 KB  
Case Report
Severe Aortic Stenosis and Pre-Excitation Syndrome in Pregnancy—A Multidisciplinary Approach
by Miruna Florina Ştefan, Lucia Ştefania Magda, Catalin Gabriel Herghelegiu, Doru Herghelegiu, Oana Aurelia Zimnicaru, Catalin Constantin Badiu, Maria Claudia Berenice Suran, Andreea Elena Velcea, Calin Siliste and Dragoș Vinereanu
Diagnostics 2025, 15(16), 2099; https://doi.org/10.3390/diagnostics15162099 - 20 Aug 2025
Viewed by 1653
Abstract
Background/Objectives: Heart disease affects 0.1% to 4% of pregnant women, with congenital heart defects being the leading cause in developed countries. While maternal mortality is generally low, pre-existing cardiac conditions substantially increase adverse outcome risks. This report describes the multidisciplinary management of [...] Read more.
Background/Objectives: Heart disease affects 0.1% to 4% of pregnant women, with congenital heart defects being the leading cause in developed countries. While maternal mortality is generally low, pre-existing cardiac conditions substantially increase adverse outcome risks. This report describes the multidisciplinary management of a pregnant patient with a bicuspid aortic valve, severe aortic stenosis, and ascending aortic ectasia. Case Presentation: A 34-year-old pregnant woman, asymptomatic but at high risk (World Health Organization Class III) for hemodynamic decompensation, was closely monitored throughout gestation. At 36 weeks, intrauterine growth restriction was detected, prompting an elective cesarean delivery at 38 weeks. Postpartum, the patient developed pre-eclampsia, which was managed successfully. Imaging revealed progressive aortic dilation, leading to surgical aortic valve replacement and ascending aorta reduction plasty. Post-operatively, atrioventricular reentrant tachycardia from an unrecognized accessory pathway developed; medical therapy effectively controlled the arrhythmia after failed catheter ablation. One year later, both mother and child remained in good health. Discussion: This case illustrates the complexity of managing pregnancy in women with congenital heart disease and significant aortic pathology. The physiological changes of pregnancy can exacerbate underlying lesions, necessitating individualized risk assessment, vigilant monitoring, and timely intervention. Conclusions: A multidisciplinary approach involving cardiology, obstetrics, anesthesiology, and genetics is essential to optimize outcomes for pregnant women with significant heart disease. As advances in care allow more women with congenital heart defects to reach childbearing age, structured care pathways remain vital for ensuring safe pregnancies and long-term cardiovascular health. Full article
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15 pages, 606 KB  
Article
Assessment of the Physical and Emotional Health-Related Quality of Life Among Congestive Heart Failure Patients with Preserved and Reduced Ejection Fraction at a Quaternary Care Teaching Hospital in Coastal Karnataka in India
by Rajesh Kamath, Vineetha Poojary, Nishanth Shekar, Kanhai Lalani, Tarushree Bari, Prajwal Salins, Gwendolen Rodrigues, Devesh Teotia and Sanjay Kini
Healthcare 2025, 13(15), 1874; https://doi.org/10.3390/healthcare13151874 - 31 Jul 2025
Viewed by 1073
Abstract
Introduction: Congestive heart failure (CHF), a complex clinical syndrome characterized by the heart’s inability to pump blood effectively due to structural or functional impairments, is a growing public health concern, with profound implications for patients’ physical and emotional well-being. In India, the burden [...] Read more.
Introduction: Congestive heart failure (CHF), a complex clinical syndrome characterized by the heart’s inability to pump blood effectively due to structural or functional impairments, is a growing public health concern, with profound implications for patients’ physical and emotional well-being. In India, the burden of CHF is rising due to aging demographics and increasing prevalence of lifestyle-related risk factors. Among the subtypes of CHF, heart failure with preserved ejection fraction (HFpEF), i.e., heart failure with left ventricular ejection fraction of ≥50% with evidence of spontaneous or provokable increased left ventricular filling pressure, and heart failure with reduced ejection fraction (HFrEF), i.e., heart failure with left ventricular ejection fraction of 40% or less and is accompanied by progressive left ventricular dilatation and adverse cardiac remodeling, may present differing impacts on health-related quality of life (HRQoL), i.e., an individual’s or a group’s perceived physical and mental health over time, yet comparative data remains limited. This study assesses HRQoL among CHF patients using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), one of the most widely used health-related quality of life questionnaires for patients with heart failure based on physical and emotional dimensions and identifies sociodemographic and clinical variables influencing these outcomes. Methods: A cross-sectional analytical study was conducted among 233 CHF patients receiving inpatient and outpatient care at the Department of Cardiology at a quaternary care teaching hospital in coastal Karnataka in India. Participants were enrolled using convenience sampling. HRQoL was evaluated through the MLHFQ, while sociodemographic and clinical characteristics were recorded via a structured proforma. Statistical analyses included descriptive measures, independent t-test, Spearman’s correlation and stepwise multivariable linear regression to identify associations and predictors. Results: The mean HRQoL score was 56.5 ± 6.05, reflecting a moderate to high symptom burden. Patients with HFpEF reported significantly worse HRQoL (mean score: 61.4 ± 3.94) than those with HFrEF (52.9 ± 4.64; p < 0.001, Cohen’s d = 1.95). A significant positive correlation was observed between HRQoL scores and age (r = 0.428; p < 0.001), indicating that older individuals experienced a higher burden of symptoms. HRQoL also varied significantly across NYHA functional classes (χ2 = 69.9, p < 0.001, ε2 = 0.301) and employment groups (χ2 = 17.0, p < 0.001), with further differences noted by education level, gender and marital status (p < 0.05). Multivariable linear regression identified age (B = 0.311, p < 0.001) and gender (B = –4.591, p < 0.001) as significant predictors of poorer HRQoL. Discussion: The findings indicate that patients with HFpEF experience significantly poorer HRQoL than those with HFrEF. Older adults and female patients reported greater symptom burden, underscoring the importance of demographic-sensitive care approaches. These results highlight the need for routine integration of HRQoL assessment into clinical practice and the development of comprehensive, personalized interventions addressing both physical and emotional health dimensions, especially for vulnerable subgroups. Conclusions: CHF patients, especially those with HFpEF, face reduced HRQoL. Key factors include age, gender, education, employment, marital status, and NYHA class, underscoring the need for patient-centered care. Full article
(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)
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15 pages, 638 KB  
Article
Efficacy, Toxicity and Effect of Pretreatment Cardiologic Consultation on Outcomes of Ibrutinib Therapy for Chronic Lymphocytic Leukemia—A KroHem Study
by Inga Mandac Smoljanović, Igor Aurer, Nikola Bulj, Barbara Dreta, Antonija Miljak, Fran Petričević, Marija Ivić, Sandra Bašić-Kinda, Viktor Zatezalo, Sanja Madunić, Dubravka Čaržavec, Jasminka Sinčić-Petričević, Dragana Grohovac, Ozren Jakšić, Ivan Krečak, Martina Morić-Perić, Božena Coha, Petra Berneš, Neno Živković and Vlatko Pejša
Cancers 2025, 17(14), 2302; https://doi.org/10.3390/cancers17142302 - 10 Jul 2025
Cited by 1 | Viewed by 912
Abstract
Background/Objectives: Ibrutinib has revolutionized the treatment of chronic lymphocytic leukemia but has off-target side effects, most notably cardiac. In order to evaluate the efficacy and toxicity of ibrutinib treatment, risk factors for adverse outcomes and the influence of pretreatment cardiologic evaluation, KroHem collected [...] Read more.
Background/Objectives: Ibrutinib has revolutionized the treatment of chronic lymphocytic leukemia but has off-target side effects, most notably cardiac. In order to evaluate the efficacy and toxicity of ibrutinib treatment, risk factors for adverse outcomes and the influence of pretreatment cardiologic evaluation, KroHem collected data on Croatian patients with chronic lymphocytic leukemia treated with this drug. Methods: This is a retrospective survey performed in order to analyze the efficacy and toxicity of ibrutinib in a real-life setting. Patients starting therapy with ibrutinib for chronic lymphocytic leukemia between the time the drug became reimbursable in 2015 and 31 December 2021 were included, irrespective of treatment line. Results: We identified 436 patients fulfilling entry criteria; 404 (92.7%) responded to treatment. Cardiovascular side effects occurred in 25.0% of patients and hemorrhagic in 15.6%. The dose of ibrutinib was permanently reduced in 22.2% of patients. Median follow-up of the cohort was 29 months (IQR 18–41 months), estimated median overall survival 75 months (IQR 36 months–not reached), progression-free survival 54 months (IQR 24–81 months) and time on ibrutinib treatment 44 months (IQR 14–78 months). Factors significantly related to overall survival in multivariate analysis were stage, treatment line and age. Factors significantly related to progression-free survival in multivariate analysis were treatment line, age and pretreatment history or ECG finding of cardiac arrhythmia. Factors significantly related to time on ibrutinib treatment in multivariate analysis were age, pretreatment history or ECG finding of cardiac arrhythmia, and permanent dose reduction for toxicity. Sex, FISH and the presence of arterial hypertension were not independently significantly related to any of these outcomes. Pretreatment cardiologic consultation did not improve time on ibrutinib therapy, progression-free survival, overall survival, risk of stopping treatment due to cardiovascular side effects or risk of cardiovascular or sudden death, neither in the whole cohort nor in the subgroup of patients with and without pretreatment cardiac arrhythmia. Conclusions: Our analysis confirms the efficacy and tolerability of ibrutinib for the treatment of chronic lymphocytic leukemia. Patients older than 75 do significantly less well. Routine pretreatment cardiologic consultation does not improve outcomes and should not be considered part of standard pretreatment assessment without additional proof of its usefulness. Future investigations should aim at identifying predictive factors, mechanisms, and preventive strategies for reducing cardiotoxicity in chronic lymphocytic leukemia patients taking Bruton tyrosine kinase inhibitors. Full article
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12 pages, 6126 KB  
Case Report
Improved Myocardial Function in Autoimmune-Mediated Fetal Complete Atrioventricular Block Following Dexamethasone and Intravenous Immunoglobulin: A Case Report
by Maria Elisa Martini Albrecht, Milena Giuberti Bathomarco, Gustavo Yano Callado, Nathalie Jeanne Bravo-Valenzuela and Edward Araujo Júnior
Women 2025, 5(2), 20; https://doi.org/10.3390/women5020020 - 6 Jun 2025
Cited by 1 | Viewed by 1622
Abstract
This case report describes a fetus diagnosed with complete atrioventricular block (CAVB) associated with positive maternal anti-Ro and anti-La antibodies, referred to our fetal cardiology unit at 25 weeks of gestation. The diagnosis of systemic lupus erythematosus (SLE) was established during the investigation [...] Read more.
This case report describes a fetus diagnosed with complete atrioventricular block (CAVB) associated with positive maternal anti-Ro and anti-La antibodies, referred to our fetal cardiology unit at 25 weeks of gestation. The diagnosis of systemic lupus erythematosus (SLE) was established during the investigation of the fetal condition. Oral dexamethasone was initiated and well tolerated, with no adverse effects reported throughout the remainder of the pregnancy. The fetal heart rate (HR) remained above 50 bpm, and, therefore, no beta-sympathomimetic agents were administered. Due to progressive reduction in myocardial contractility and the appearance of early signs of endocardial fibroelastosis, intravenous immunoglobulin (IVIG) therapy was initiated. The patient was hospitalized for the infusion, which was well tolerated without complications, and a second IVIG cycle was administered four weeks later. Significant improvement in ventricular contractility and reduction in fibroelastosis were observed. As reported in the literature, no chronotropic effect was noted, and fetal HR remained stable after treatment. Weekly monitoring of cardiovascular profile score and fetal HR was maintained, with the score consistently remaining at 8 throughout gestation, supporting continued outpatient management. Delivery occurred at 36 weeks and 3 days due to spontaneous preterm labor. A male neonate weighing 3025 g was delivered with Apgar scores of 8 and 9, and an initial heart rate of 84 bpm. Neonatal electrocardiography confirmed persistent CAVB, and the newborn was monitored in the neonatal intensive care unit. At follow-up, the infant remains clinically stable and has not required permanent pacemaker implantation. Full article
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16 pages, 6739 KB  
Article
A Multitask Deep Learning Model for Predicting Myocardial Infarction Complications
by Fazliddin Makhmudov, Normakhmad Ravshanov, Dilshot Akhmedov, Oleg Pekos, Dilmurod Turimov and Young-Im Cho
Bioengineering 2025, 12(5), 520; https://doi.org/10.3390/bioengineering12050520 - 14 May 2025
Cited by 2 | Viewed by 2424
Abstract
Myocardial infarction is one of the most severe forms of ischemic heart disease, associated with high mortality and disability worldwide. The accurate and reliable prediction of adverse cardiovascular events is critical for developing effective treatment strategies and improving outcomes in cardiac rehabilitation. Traditional [...] Read more.
Myocardial infarction is one of the most severe forms of ischemic heart disease, associated with high mortality and disability worldwide. The accurate and reliable prediction of adverse cardiovascular events is critical for developing effective treatment strategies and improving outcomes in cardiac rehabilitation. Traditional prognostic models, such as the GRACE and TIMI scores, often lack the flexibility to incorporate a wide range of contemporary clinical predictors. Therefore, machine learning methods, particularly deep neural networks, have recently emerged as promising alternatives capable of enhancing predictive accuracy and enabling more personalized care. This study presents a multitask deep learning model designed to simultaneously address two related tasks: multidimensional binary classification of myocardial infarction complications and multiclass classification of mortality causes. The model was trained on a dataset of 1700 patients, encompassing 111 clinical and demographic features. Experimental results demonstrate high predictive accuracy and the model’s capacity to capture complex interactions among risk factors, suggesting its potential as a valuable tool for clinical decision support in cardiology. Comparative analysis confirms that the proposed multitask approach performs comparably to, or better than, conventional machine learning models. Future research will focus on refining the model and validating its generalizability in real-world clinical environments. Full article
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13 pages, 1638 KB  
Review
Hemodynamic Effects of Positive Airway Pressure: A Cardiologist’s Overview
by Anna Di Cristo, Andrea Segreti, Nardi Tetaj, Simone Pasquale Crispino, Emiliano Guerra, Emanuele Stirpe, Gian Paolo Ussia and Francesco Grigioni
J. Cardiovasc. Dev. Dis. 2025, 12(3), 97; https://doi.org/10.3390/jcdd12030097 - 10 Mar 2025
Cited by 2 | Viewed by 8255
Abstract
Positive airway pressure (PAP) therapy is widely used to manage both acute and chronic respiratory failure and plays an increasingly important role in cardiology, particularly in treating patients with respiratory comorbidities. PAP, including continuous positive airway pressure and noninvasive ventilation, significantly impacts hemodynamics [...] Read more.
Positive airway pressure (PAP) therapy is widely used to manage both acute and chronic respiratory failure and plays an increasingly important role in cardiology, particularly in treating patients with respiratory comorbidities. PAP, including continuous positive airway pressure and noninvasive ventilation, significantly impacts hemodynamics by altering intrathoracic pressure, affecting preload, afterload, and stroke volume. These changes are crucial in conditions such as acute cardiogenic pulmonary edema, where PAP can enhance gas exchange, reduce the work of breathing, and improve cardiac output. PAP reduces the left ventricular afterload, which in turn increases stroke volume and myocardial contractility in patients with left-sided heart failure. However, the role of PAP in right ventricular function and its effects on venous return and cardiac output are critical in the cardiac intensive care setting. While PAP provides respiratory benefits, it must be used cautiously in patients with right heart failure or preload-dependent conditions to avoid adverse outcomes. Additionally, in recent years, the use of PAP has expanded in the treatment of severe obstructive sleep apnea and obesity hypoventilation syndrome, both of which significantly influence cardiovascular events and heart failure. This review provides an in-depth analysis of the hemodynamic effects of PAP in cardiovascular disease, focusing on its impact on ventricular function in both acute and chronic conditions. Evaluating clinical studies, guidelines, and recent advancements offers practical insights into the physiological mechanisms and key clinical considerations. Furthermore, this review aims to serve as a helpful guide for clinicians, assisting in decision-making processes where PAP therapy is applied. Full article
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21 pages, 2034 KB  
Review
Bridging the Gaps in Atrial Fibrillation Management in the Emergency Department
by Brian Xiangzhi Wang
J. Cardiovasc. Dev. Dis. 2025, 12(1), 20; https://doi.org/10.3390/jcdd12010020 - 8 Jan 2025
Viewed by 4038
Abstract
Atrial fibrillation (AF) frequently presents in emergency departments (EDs), contributing significantly to adverse cardiovascular outcomes. Despite established guidelines, ED management of AF often varies, revealing important gaps in care. This review addresses specific challenges in AF management for patients in the ED, including [...] Read more.
Atrial fibrillation (AF) frequently presents in emergency departments (EDs), contributing significantly to adverse cardiovascular outcomes. Despite established guidelines, ED management of AF often varies, revealing important gaps in care. This review addresses specific challenges in AF management for patients in the ED, including the nuances of rate versus rhythm control, the timing of anticoagulation initiation, and patient disposition. The updated 2024 European Society of Cardiology (ESC) guidelines advocate early rhythm control for select patients while recommending rate control for others; however, uncertainties persist, particularly regarding these strategies’ long-term impact on outcomes. Stroke prevention through timely anticoagulation remains crucial, though the ideal timing, especially for new-onset AF, needs further research. Additionally, ED discharge protocols and follow-up care for AF patients are often inconsistent, leaving many without proper long-term management. Integration of emerging therapies, including direct oral anticoagulants and advanced antiarrhythmic drugs, shows potential but remains uneven across EDs. Innovative multidisciplinary models, such as “AF Heart Teams” and observation units, could enhance care but face practical challenges in implementation. This review underscores the need for targeted research to refine AF management, optimize discharge protocols, and incorporate novel therapies effectively. Standardizing ED care for AF could significantly reduce stroke risk, lower readmission rates, and improve overall patient outcomes. Full article
(This article belongs to the Special Issue Heart Rhythm Disorders: Diagnosis, Treatment, and Management)
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28 pages, 3913 KB  
Article
Abuse of Anabolic-Androgenic Steroids as a Social Phenomenon and Medical Problem—Its Potential Negative Impact on Reproductive Health Based on 50 Years of Case Report Analysis
by Monika Skrzypiec-Spring, Julia Rozmus, Gina Abu Faraj, Kinga Brawańska-Maśluch, Krzysztof Kujawa and Adam Szeląg
J. Clin. Med. 2024, 13(19), 5892; https://doi.org/10.3390/jcm13195892 - 2 Oct 2024
Cited by 4 | Viewed by 10831
Abstract
Background/Objectives: Illegal anabolic-androgenic steroids are a significant lifestyle factor in infertility. The aim of our study was to analyze clinical cases resulting from their use for their frequency, geographical location, dynamics, substances used, the age and gender of the users, and the types [...] Read more.
Background/Objectives: Illegal anabolic-androgenic steroids are a significant lifestyle factor in infertility. The aim of our study was to analyze clinical cases resulting from their use for their frequency, geographical location, dynamics, substances used, the age and gender of the users, and the types of clinical complications. Methods: Publications were obtained by searching PubMed for the following terms: ‘anabolic-androgenic steroids’ and ‘clinical case’. Publications from 1973 to 2022 were qualified for the analysis. Results: An increasing trend in the number of clinical cases resulting from the use of steroids, as well as the number of substances used simultaneously, was observed. The substances changed over the decades, but in the last 20 years, testosterone, nandrolone, stanozolol, methandienone, trenbolone, and methenolone have predominated. Cardiological side effects predominated in each period, with a continuous increase in their occurrence. The most common among these were myocardial infarctions and hypertrophic cardiomyopathy. The next most numerous adverse events involved psychiatric, endocrinological, hepatic, and oncological problems. We demonstrated a possible relationship between the use of individual steroids and medical issues; the strongest associations were between testosterone and endocrine complications, and methylstenbolone and hepatic complications. Conclusions: There has been an increasing trend in case reports describing serious health problems associated with the use of anabolic-androgenic steroids, a tendency to use several substances simultaneously, and a preferential use of substances with a high potential of causing serious side effects. These phenomena mainly concern men, with an average age of 30, and the health problems that dominate in clinical case reports—including serious cardiological, psychiatric, endocrinological, hepatic, and oncological diseases—may potentially affect reproductive health and pose a challenge for reproductive medicine. Full article
(This article belongs to the Special Issue Reproductive Endocrinology and Infertility)
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