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Volume 10
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J. Cardiovasc. Dev. Dis., Volume 10, Issue 8 (August 2023) – 43 articles

Cover Story (view full-size image): Acute myocardial edema (AME) is an increased water content in myocardium, and it is the first response to an injury. Its in vivo, non-invasive evaluation is feasible with cardiac magnetic resonance (CMR). AME has diagnostic value, but its prognostic value is not certain, even if recent evidence suggests a possible role as a predictor of favourable prognosis. This article provides a review of the clinical meaning of AME in heart diseases. The available evidence of a favourable prognostic value in many scenarios, including acute coronary syndromes, acute myocarditis, Takotsubo syndrome and resuscitated sudden cardiac death, are addressed, providing a novel view of this CMR finding. View this paper
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12 pages, 1340 KiB  
Article
Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke
by Jamila Kremer, Joshua Jahn, Sabrina Klein, Mina Farag, Tobias Borst and Matthias Karck
J. Cardiovasc. Dev. Dis. 2023, 10(8), 356; https://doi.org/10.3390/jcdd10080356 - 21 Aug 2023
Cited by 3 | Viewed by 6939
Abstract
Background: Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery becomes [...] Read more.
Background: Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery becomes imperative. Methods: Out of 688 patients who were surgically treated for left-sided infective endocarditis, 187 presented with preoperative neurological events. The date of cerebral stroke onset was documented in 147 patients. The patients were stratified according to timing of surgery: 61 in the early group (0–7 days) vs. 86 in the delayed group (>7 days). Postoperative neurological outcome was assessed by the modified Rankin Scale. Results: Preoperative sepsis was more prevalent in patients with preoperative neurological complications (46.0% vs. 29.5%, p < 0.001). Patients with haemorrhagic stroke were operated on later (19.8% vs. 3.3%, p = 0.003). Postoperative cerebrovascular accidents were comparable between both groups (p = 0.13). Overall, we observed good neurological outcomes (p = 0.80) and a high recovery rate, with only 5% of cases showing neurological deterioration after surgery (p = 0.29). In-hospital mortality and long-term survival were not significantly different in the early and delayed surgery groups (log-rank, p = 0.22). Conclusions: Early valve surgery in high-risk patients with infective endocarditis and stroke can be performed safely and is not associated with worse outcomes. Full article
(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)
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19 pages, 9163 KiB  
Article
Temporal Progression of Aortic Valve Pathogenesis in a Mouse Model of Osteogenesis Imperfecta
by Kaitlyn Thatcher, Carol R. Mattern, Daniel Chaparro, Veronica Goveas, Michael R. McDermott, Jessica Fulton, Joshua D. Hutcheson, Brian R. Hoffmann and Joy Lincoln
J. Cardiovasc. Dev. Dis. 2023, 10(8), 355; https://doi.org/10.3390/jcdd10080355 - 20 Aug 2023
Cited by 3 | Viewed by 2611
Abstract
Organization of extracellular matrix (ECM) components, including collagens, proteoglycans, and elastin, is essential for maintaining the structure and function of heart valves throughout life. Mutations in ECM genes cause connective tissue disorders, including Osteogenesis Imperfecta (OI), and progressive debilitating heart valve dysfunction is [...] Read more.
Organization of extracellular matrix (ECM) components, including collagens, proteoglycans, and elastin, is essential for maintaining the structure and function of heart valves throughout life. Mutations in ECM genes cause connective tissue disorders, including Osteogenesis Imperfecta (OI), and progressive debilitating heart valve dysfunction is common in these patients. Despite this, effective treatment options are limited to end-stage interventions. Mice with a homozygous frameshift mutation in col1a2 serve as a murine model of OI (oim/oim), and therefore, they were used in this study to examine the pathobiology of aortic valve (AoV) disease in this patient population at structural, functional, and molecular levels. Temporal echocardiography of oim/oim mice revealed AoV dysfunction by the late stages of disease in 12-month-old mice. However, structural and proteomic changes were apparent much earlier, at 3 months of age, and were associated with disturbances in ECM homeostasis primarily related to collagen and proteoglycan abnormalities and disorganization. Together, findings from this study provide insights into the underpinnings of late onset AoV dysfunction in connective tissue disease patients that can be used for the development of mechanistic-based therapies administered early to halt progression, thereby avoiding late-stage surgical intervention. Full article
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9 pages, 6960 KiB  
Brief Report
Maturation and Function of the Intercalated Disc: Report of Two Pediatric Cases Focusing on Cardiac Development and Myocardial Hyperplasia
by Willem B. van Ham, Esmeralda E. M. Meijboom, Merel L. Ligtermoet, Peter G. J. Nikkels and Toon A. B. van Veen
J. Cardiovasc. Dev. Dis. 2023, 10(8), 354; https://doi.org/10.3390/jcdd10080354 - 19 Aug 2023
Cited by 1 | Viewed by 1471
Abstract
The development of the normal human heart, ranging from gestational age to the mature adult heart, relies on a very delicate and timely orchestrated order of processes. One of the most striking alterations in time is the gradual extinction of the ability for [...] Read more.
The development of the normal human heart, ranging from gestational age to the mature adult heart, relies on a very delicate and timely orchestrated order of processes. One of the most striking alterations in time is the gradual extinction of the ability for cardiomyocytes to proliferate. Once passing this event, cardiomyocytes grow and increase in contractile strength by means of physiological hypertrophy. This process, importantly, seems to depend on an adequate development of electromechanical coupling that is achieved by the appropriate formation of the intercellular junction named the intercalated disc (ICD). In this report, we describe two sudden death cases of young and apparently healthy-born individuals without external abnormalities compared to an age-matched control. Histological examination, including the comparison with the age-matched and histology-matched controls, showed a disturbed formation of the protein machinery composing the electromechanical junctions at the ICD and an increased nuclei count for both patients. As a cause or consequence, cardiomyocytes in both sudden death cases showed signs of a delayed developmental stage, presumably resulting in an exaggerated degree of hyperplasia. Full article
(This article belongs to the Special Issue Advances in the Diagnosis of Cardiovascular Diseases)
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14 pages, 1358 KiB  
Article
Tricuspid Regurgitation (TR) after Implantation of a Cardiac Implantable Electronic Device (CIED)—One-Year Observation of Patients with or without Left Ventricular Dysfunction
by Karolina Chodór-Rozwadowska, Magdalena Sawicka, Stanisław Morawski, Zbigniew Kalarus and Tomasz Kukulski
J. Cardiovasc. Dev. Dis. 2023, 10(8), 353; https://doi.org/10.3390/jcdd10080353 - 19 Aug 2023
Cited by 3 | Viewed by 1400
Abstract
The frequency of tricuspid regurgitation (TR) progression after cardiac implantable electronic devices (CIEDs) implantation varies from 7.2% to 44.7%. TR is associated with increased mortality and hospitalizations due to heart failure (HF) decompensation. The aim of this study was to assess the rate [...] Read more.
The frequency of tricuspid regurgitation (TR) progression after cardiac implantable electronic devices (CIEDs) implantation varies from 7.2% to 44.7%. TR is associated with increased mortality and hospitalizations due to heart failure (HF) decompensation. The aim of this study was to assess the rate of early TR progression after CIED implantation and the frequency of HF decompensation and mortality. The 101 patients, who received a CIED between March 2020 and October 2021, before the procedure were divided into two groups–one with left ventricle ejection fraction (LVEF) ≥ 40% (n = 60) and one with LVEF < 40% (n = 41). Lead-related tricuspid regurgitation (LRTR) was defined as an increase of TR by at least one grade. The follow-up period was similar between both groups and was on average 13 (12–16) months. In the whole study group, TR progression by one grade was 34.6% and by two or more grades 15.8%. The significant changes in the dynamic of TR degree were as follows before and after implantation: none/trivial TR in group 1 (61.7% vs. 28.3%, p = 0.01) and severe/massive TR in group 2 (0.0% vs. 14.6%, p = 0.03). The groups did not differ from each other in terms of survival from decompensation of HF (18.3% vs. 36.6%, p = 0.70) and survival from death (1.7% vs. 4.9%, p = 0.16). At the one-year follow-up, the baseline LVEF did not affect the survival rate from death or HF decompensation among patients with a progression of TR after CIED implantation. In this study, a progression by one grade was more common in group 1, but the occurrence of severe/massive TR after implantation was more specific for group 2. Full article
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27 pages, 1192 KiB  
Review
Autophagy in Heart Failure: Insights into Mechanisms and Therapeutic Implications
by Magdalena Bielawska, Marta Warszyńska, Monika Stefańska and Przemysław Błyszczuk
J. Cardiovasc. Dev. Dis. 2023, 10(8), 352; https://doi.org/10.3390/jcdd10080352 - 18 Aug 2023
Cited by 4 | Viewed by 3098
Abstract
Autophagy, a dynamic and complex process responsible for the clearance of damaged cellular components, plays a crucial role in maintaining myocardial homeostasis. In the context of heart failure, autophagy has been recognized as a response mechanism aimed at counteracting pathogenic processes and promoting [...] Read more.
Autophagy, a dynamic and complex process responsible for the clearance of damaged cellular components, plays a crucial role in maintaining myocardial homeostasis. In the context of heart failure, autophagy has been recognized as a response mechanism aimed at counteracting pathogenic processes and promoting cellular health. Its relevance has been underscored not only in various animal models, but also in the human heart. Extensive research efforts have been dedicated to understanding the significance of autophagy and unravelling its complex molecular mechanisms. This review aims to consolidate the current knowledge of the involvement of autophagy during the progression of heart failure. Specifically, we provide a comprehensive overview of published data on the impact of autophagy deregulation achieved by genetic modifications or by pharmacological interventions in ischemic and non-ischemic models of heart failure. Furthermore, we delve into the intricate molecular mechanisms through which autophagy regulates crucial cellular processes within the three predominant cell populations of the heart: cardiomyocytes, cardiac fibroblasts, and endothelial cells. Finally, we emphasize the need for future research to unravel the therapeutic potential associated with targeting autophagy in the management of heart failure. Full article
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11 pages, 951 KiB  
Article
Use of Intracorporeal Durable LVAD Support in Children Using HVAD or HeartMate 3—A EUROMACS Analysis
by Martin Schweiger, Hina Hussein, Theo M. M. H. de By, Daniel Zimpfer, Joanna Sliwka, Ben Davies, Oliver Miera and Bart Meyns
J. Cardiovasc. Dev. Dis. 2023, 10(8), 351; https://doi.org/10.3390/jcdd10080351 - 17 Aug 2023
Cited by 4 | Viewed by 1557
Abstract
Purpose: The withdrawal of HVAD in 2021 created a concern for the pediatric population. The alternative implantable centrifugal blood pump HeartMate 3 has since been used more frequently in children. This paper analyses the outcome of children on LVAD support provided with an [...] Read more.
Purpose: The withdrawal of HVAD in 2021 created a concern for the pediatric population. The alternative implantable centrifugal blood pump HeartMate 3 has since been used more frequently in children. This paper analyses the outcome of children on LVAD support provided with an HVAD or HM3. Methods: A retrospective analysis of the EUROMACS database on children supported with VAD < 19 years of age from 1 January 2009 to 1 December 2021 was conducted. All patients with an LVAD and either an HVAD or HM3 were included. Patients with missing data on VAD status and/or missing baseline and/or follow up information were excluded. Kaplan–Meier survival analysis was performed to evaluate survival differences. Analyses were performed using Fisher’s exact test. Results: The study included 150 implantations in 142 patients with 128 implants using an HVAD compared to 28 implants using an HM3. Nine patients (6%) needed temporary right ventricular mechanical support, which was significantly higher in the HM3 group, with 25% (p: 0.01). Patients in the HVAD group were significantly younger (12.7 vs. 14.5 years, p: 0.01), weighed less (45.7 vs. 60 kg, p: <0.000) and had lower BSA values (1.3 vs. 1.6 m2, p: <0.000). Median support time was 204 days. Overall, 98 patients (69%) were discharged and sent home, while 87% were discharged in group HM3 (p: ns). A total of 123 children (86%) survived to transplantation, recovery or are ongoing, without differences between groups. In the HVAD group, 10 patients (8%) died while on support, whereas in 12% of HM3 patients died (p: 0.7). Conclusions: Survival in children implanted with an HM3 was excellent. Almost 90% were discharged and sent home on the device. Full article
(This article belongs to the Topic Mechanical Circulatory Support in Heart Failure)
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16 pages, 2285 KiB  
Review
Lung Transplantation for Pulmonary Arterial Hypertension: Optimized Referral and Listing Based on an Evolving Disease Concept
by Xiaokun Hu, Ningying Ding, Wanqiu Songchen, Ruifeng Wang, Jing Chen, Ailing Zhong, Jinzhu Nan, Yujie Zuo, Heng Huang and Dong Tian
J. Cardiovasc. Dev. Dis. 2023, 10(8), 350; https://doi.org/10.3390/jcdd10080350 - 15 Aug 2023
Cited by 1 | Viewed by 2270
Abstract
Pulmonary hypertension (PH) was once a devastating and fatal disease entity, the outlook of which has been significantly improved by the continued progress of medical treatment algorithms. However, some patients still ultimately fail to achieve an adequate clinical response despite receiving maximal medical [...] Read more.
Pulmonary hypertension (PH) was once a devastating and fatal disease entity, the outlook of which has been significantly improved by the continued progress of medical treatment algorithms. However, some patients still ultimately fail to achieve an adequate clinical response despite receiving maximal medical treatment. Historically, lung transplantation (LTx) has been the only effective therapeutic option that could lead to satisfactory outcomes and save these advanced patients’ lives. However, patients with PH tend to have the highest mortality rates on the transplant waiting list; especially after comprehensive medical treatment, they continue to deteriorate very rapidly, eventually missing optimal transplantation windows. Balancing optimized medical treatment with the appropriate timing of referral and listing has been highly controversial in LTx for patients with PH. The 2021 consensus document for the selection of lung transplant candidates from the International Society for Heart and Lung Transplantation (ISHLT) updated the specific recommendations for the LTx referral and listing time for patients with PH based on objective risk stratification. Herein, we review the evolving PH-related concepts and highlight the optimization of LTx referral and listing for patients with PH, as well as their management on the waiting list. Full article
(This article belongs to the Special Issue New Perspectives on Pulmonary Hypertension (PH))
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14 pages, 812 KiB  
Article
Echocardiographic Assessment in Patients Recovered from Acute COVID-19 Illness
by Luke Stefani, Paula Brown, Monica Gerges, Peter Emerson, Aaisha Ferkh, Kristina Kairaitis, Nicole Gilroy, Mikhail Altman and Liza Thomas
J. Cardiovasc. Dev. Dis. 2023, 10(8), 349; https://doi.org/10.3390/jcdd10080349 - 15 Aug 2023
Cited by 1 | Viewed by 2151
Abstract
Coronavirus (COVID-19) infections have spread rapidly worldwide and posed an immense public health problem. COVID-19 infection can affect the cardiovascular system both acutely and in patients followed up some period after COVID-19 infection. The aim of this study was to evaluate left ventricular [...] Read more.
Coronavirus (COVID-19) infections have spread rapidly worldwide and posed an immense public health problem. COVID-19 infection can affect the cardiovascular system both acutely and in patients followed up some period after COVID-19 infection. The aim of this study was to evaluate left ventricular (LV) and right ventricular (RV) function by echocardiography in COVID-19 recovered patients (hospitalized and non-hospitalized). Forty-two patients who recovered from COVID-19 but had ongoing symptoms were included in this retrospective observational cross-sectional study. Patients were followed-up at a median time of 112 days from confirmed COVID-19 diagnosis and a comprehensive echocardiogram was performed. COVID-19 patients were age- and sex-matched to healthy controls. Traditional TTE parameters and advanced echocardiographic parameters including two-dimensional LV global longitudinal strain (GLS) and RV free wall strain (FWS) were measured. LV volumes and LV ejection fraction were similar in COVID-19 patients and controls; however, LV GLS was significantly worse in the COVID-19 group (p = 0.002). Similarly, RV volumes and traditional RV function parameters were similar, but RV FWS (p = 0.009) and RV global strain (p = 0.015) were reduced. Alterations in LV and RV strain were observed in both hospitalized and non-hospitalized patients. In the subset of COVID-19 patients without any co-morbidities (n = 30), LV GLS remained reduced compared to controls. According to multivariate analysis, COVID-19 infection was the only independent determinant of reduced LV GLS (p = 0.012), while COVID-19 infection, diastolic blood pressure, and RV fractional area change were determinants of RV FWS. In this observational study, prior COVID-19 infection demonstrated LV dysfunction in patients with persistent symptoms. Abnormal LV strain was evident in both hospitalized and non-hospitalized patients, suggesting that these changes are independent of the severity of COVID-19 infection at presentation. The use of LV GLS in COVID-19 patients could have potential clinical utility to support the indication for cardiac magnetic resonance imaging in patients with possible COVID-19 related myocarditis. Future longitudinal studies are needed to evaluate its correlation with adverse cardiovascular events. Full article
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14 pages, 870 KiB  
Article
In-Hospital Mortality Outcomes of ST-Segment Elevation Myocardial Infarction: A Cross-Sectional Study from a Tertiary Academic Hospital in Johannesburg, South Africa
by Lindokuhle Ndaba, Arthur Mutyaba, Dineo Mpanya and Nqoba Tsabedze
J. Cardiovasc. Dev. Dis. 2023, 10(8), 348; https://doi.org/10.3390/jcdd10080348 - 15 Aug 2023
Cited by 2 | Viewed by 1992
Abstract
In sub-Saharan Africa, the burden of atherosclerotic cardiovascular disease (ASCVD) is increasing. This study aimed to describe the clinical characteristics of patients with ST-segment elevation myocardial infarction (STEMI) and estimate the in-hospital all-cause mortality rate. We conducted a cross-sectional retrospective single-centre study of [...] Read more.
In sub-Saharan Africa, the burden of atherosclerotic cardiovascular disease (ASCVD) is increasing. This study aimed to describe the clinical characteristics of patients with ST-segment elevation myocardial infarction (STEMI) and estimate the in-hospital all-cause mortality rate. We conducted a cross-sectional retrospective single-centre study of STEMI patients who underwent diagnostic coronary angiography with or without percutaneous coronary intervention (PCI) between January 2015 and December 2019. We compared demographic and clinical parameters between survivors and non-survivors with descriptive statistics. Univariable and multivariable logistic regression analyses were performed to determine the predictors of all-cause mortality. The study population consisted of 677 patients with a mean age of 55.5 ± 11.3 years. The in-hospital all-cause mortality rate was 6.2% [95% confidence interval (CI): 4.5–8.3%]. Risk factors for ASCVD included smoking (56.1%), hypertension (52.8%), dyslipidemia (40.0%), and a family history of coronary artery disease (32.7%). A pharmaco-invasive management strategy (treatment with thrombolytic therapy and PCI) was implemented in 36.5% of patients and reduced all-cause mortality risk (OR: 0.16; CI: 0.04–0.71, p = 0.015). The in-hospital all-cause mortality rate in STEMI patients was 6.2%, and a pharmaco-invasive management strategy proved to be an effective approach. Full article
(This article belongs to the Special Issue Epidemiology and Risk of Cardiovascular Disease)
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12 pages, 3010 KiB  
Article
Analysis of Superficial Subcutaneous Fat Camper’s and Scarpa’s Fascia in a United States Cohort
by David Z. Chen, Aravinda Ganapathy, Yash Nayak, Christopher Mejias, Grace L. Bishop, Vincent M. Mellnick and David H. Ballard
J. Cardiovasc. Dev. Dis. 2023, 10(8), 347; https://doi.org/10.3390/jcdd10080347 - 14 Aug 2023
Viewed by 3948
Abstract
Together, the Camper’s and Scarpa’s fasciae form the superficial fat layer of the abdominal wall. Though they have clinical and surgical relevance, little is known about their role in body composition across diverse patient populations. This study aimed to determine the relationship between [...] Read more.
Together, the Camper’s and Scarpa’s fasciae form the superficial fat layer of the abdominal wall. Though they have clinical and surgical relevance, little is known about their role in body composition across diverse patient populations. This study aimed to determine the relationship between patient characteristics, including sex and body mass index, and the distribution of Camper’s and Scarpa’s fascial layers in the abdominal wall. A total of 458 patients’ abdominal CT examinations were segmented via CoreSlicer 1.0 to determine the surface area of each patient’s Camper’s, Scarpa’s, and visceral fascia layers. The reproducibility of segmentation was corroborated by an inter-rater analysis of segmented data for 20 randomly chosen patients divided between three study investigators. Pearson correlation and Student’s t-test analyses were performed to characterize the relationship between fascia distribution and demographic factors. The ratios of Camper’s fascia, both as a proportion of superficial fat (r = −0.44 and p < 0.0001) and as a proportion of total body fat (r = −0.34 and p < 0.0001), showed statistically significant negative correlations with BMI. In contrast, the ratios of Scarpa’s fascia, both as a proportion of superficial fat (r = 0.44 and p < 0.0001) and as a proportion of total body fat (r = 0.41 and p < 0.0001), exhibited statistically significant positive correlations with BMI. Between sexes, the females had a higher ratio of Scarpa’s facia to total body fat compared to the males (36.9% vs. 31% and p < 0.0001). The ICC values for the visceral fat, Scarpa fascia, and Camper fascia were 0.995, 0.991, and 0.995, respectively, which were all within the ‘almost perfect’ range (ICC = 0.81–1.00). These findings contribute novel insights by revealing that as BMI increases the proportion of Camper’s fascia decreases, while the ratio of Scarpa’s fascia increases. Such insights expand the scope of body composition studies, which typically focus solely on superficial and visceral fat ratios. Full article
(This article belongs to the Special Issue Cardiovascular Risk Factors: Focus on Epidemiology and Clinical Consequences)
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3 pages, 198 KiB  
Editorial
New Perspectives and Strategies for the Management of Hypertension
by Fabio Angeli
J. Cardiovasc. Dev. Dis. 2023, 10(8), 346; https://doi.org/10.3390/jcdd10080346 - 14 Aug 2023
Viewed by 1997
Abstract
Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide [...] Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
14 pages, 2248 KiB  
Article
Assessment of Hypertensive Patients’ Complex Metabolic Status Using Data Mining Methods
by Beáta Kovács, Ákos Németh, Bálint Daróczy, Zsolt Karányi, László Maroda, Ágnes Diószegi, Mariann Harangi and Dénes Páll
J. Cardiovasc. Dev. Dis. 2023, 10(8), 345; https://doi.org/10.3390/jcdd10080345 - 13 Aug 2023
Viewed by 1511
Abstract
Cardiovascular diseases are among the leading causes of mortality worldwide. Hypertension is a preventable risk factor leading to major cardiovascular events. We have not found a comprehensive study investigating Central and Eastern European hypertensive patients’ complex metabolic status. Therefore, our goal was to [...] Read more.
Cardiovascular diseases are among the leading causes of mortality worldwide. Hypertension is a preventable risk factor leading to major cardiovascular events. We have not found a comprehensive study investigating Central and Eastern European hypertensive patients’ complex metabolic status. Therefore, our goal was to calculate the prevalence of hypertension and associated metabolic abnormalities using data-mining methods in our region. We assessed the data of adults who visited the University of Debrecen Clinical Center’s hospital (n = 937,249). The study encompassed data from a period of 20 years (2001–2021). We detected 292,561 hypertensive patients. The calculated prevalence of hypertension was altogether 32.2%. Markedly higher body mass index values were found in hypertensive patients as compared to non-hypertensives. Significantly higher triglyceride and lower HDL-C levels were found in adults from 18 to 80 years old. Furthermore, significantly higher serum glucose and uric acid levels were measured in hypertensive subjects. Our study confirms that the calculated prevalence of hypertension is akin to international findings and highlights the extensive association of metabolic alterations. These findings emphasize the role of early recognition and immediate treatment of cardiometabolic abnormalities to improve the quality of life and life expectancy of hypertensive patients. Full article
(This article belongs to the Special Issue Cardiovascular Disease: Risk Factors and Prevention)
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20 pages, 16968 KiB  
Article
Development and Validation of Robust Ferroptosis-Related Genes in Myocardial Ischemia-Reperfusion Injury
by Xiuxian Wei, Yi Li, Pengcheng Luo, Yue Dai, Tao Jiang, Mulin Xu, Yi Hao, Cuntai Zhang and Yu Liu
J. Cardiovasc. Dev. Dis. 2023, 10(8), 344; https://doi.org/10.3390/jcdd10080344 - 12 Aug 2023
Cited by 1 | Viewed by 2272
Abstract
(1) Background: Despite the evidence that ferroptosis is involved in myocardial ischemia-reperfusion (MIR), the critical regulator of ferroptosis in MIR remains unclear. (2) Methods: We included three GEO datasets and a set of ferroptosis-related genes with 259 genes. Following the identification of the [...] Read more.
(1) Background: Despite the evidence that ferroptosis is involved in myocardial ischemia-reperfusion (MIR), the critical regulator of ferroptosis in MIR remains unclear. (2) Methods: We included three GEO datasets and a set of ferroptosis-related genes with 259 genes. Following the identification of the differentially expressed ferroptosis-related genes (DEFRGs) and hub genes, we performed the functional annotation, protein–protein interaction network, and immune infiltration analysis. The GSE168610 dataset, a cell model, and an animal model were then used to verify key genes. (3) Results: We identified 17 DEFRGs and 9 hub genes in the MIR samples compared to the control. Heme oxygenase 1 (Hmox1), activating transcription factor 3 (Atf3), epidermal growth factor receptor (Egfr), and X-box binding protein 1 (Xbp1) were significantly upregulated in response to ischemic and hypoxic stimuli. In contrast, glutathione peroxidase 4 (Gpx4) and vascular endothelial growth factor A (Vegfa) were consistently decreased in either the oxygen and glucose deprivation/reoxygenation cell or the MIR mouse model. (4) Conclusions: This study emphasized the relevance of ferroptosis in MIR. It has been successfully demonstrated that nine ferroptosis-related genes (Hmox1, Atf3, Egfr, Gpx4, Cd44, Vegfa, asparagine synthetase (Asns), Xbp1, and bromodomain containing 4 (Brd4)) are involved in the process. Additional studies are needed to explore potential therapeutic targets for MIR. Full article
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12 pages, 839 KiB  
Article
The Effects of Exercise Training on Exercise Capacity and Vascular Function after Transcatheter Aortic Valve Implantation—A Pilot Study
by Luka Vitez, Matjaž Bunc and Borut Jug
J. Cardiovasc. Dev. Dis. 2023, 10(8), 343; https://doi.org/10.3390/jcdd10080343 - 12 Aug 2023
Cited by 3 | Viewed by 1688
Abstract
Transcatheter aortic valve implantation (TAVI) improves event-free survival in patients with severe aortic stenosis, but patients’ exercise capacity remains poor after the procedure. Therefore, we sought to compare the effects of a supervised center-based exercise training program and unsupervised exercise routine on exercise [...] Read more.
Transcatheter aortic valve implantation (TAVI) improves event-free survival in patients with severe aortic stenosis, but patients’ exercise capacity remains poor after the procedure. Therefore, we sought to compare the effects of a supervised center-based exercise training program and unsupervised exercise routine on exercise capacity and vascular function in patients after TAVI. Patients were randomized to either center-based exercise training (12–24 sessions of combined aerobic and low-weight resistance training twice weekly for 8–12 weeks) or an unsupervised home-based exercise routine (initial appraisal with detailed recommendations and monthly follow-up). Exercise capacity (cardiopulmonary testing) and vascular function (ultrasonographic measurement of flow-mediated vasodilation (FMD) and arterial stiffness) were assessed at the baseline and after the study period. We included 23 patients (mean age of 81 years, 61% women), with higher-than-expected drop-out rates (41%) because of the coronavirus-19 pandemic outbreak. Exercise capacity improved over time, irrespective of the intervention group: 0.09 mL/min/kg increase in peak oxygen uptake (95% CI [0.01–0.16]; p = 0.02), 8.2 Watts increase in workload (95% CI [0.6–15.8]; p = 0.034), and 47 s increase in cumulative exercise time (95% CI [5.0–89.6]; p = 0.029). A between-group difference in change over time (treatment effect) was detected only for FMD (4.49%; 95% CI [2.35; 6.63], p < 0.001), but not for other outcome variables. Both supervised and unsupervised exercise training improve exercise capacity and vascular function in patients after TAVI, with supervised exercise training possibly yielding larger improvements in vascular function, as determined by FMD. Full article
(This article belongs to the Special Issue Exercise and Cardiovascular Disease in Older Adults)
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16 pages, 770 KiB  
Systematic Review
Impact of Obesity on Atrial Electrophysiological Substrate
by Corina Schram Serban and Natasja M. S. de Groot
J. Cardiovasc. Dev. Dis. 2023, 10(8), 342; https://doi.org/10.3390/jcdd10080342 - 8 Aug 2023
Cited by 2 | Viewed by 1575
Abstract
(1) Background. Obesity is a well-established worldwide recognised risk factor for atrial fibrillation (AF). Prior review papers reported on the associations between obesity and AF development, but not on the relation between obesity and atrial electrophysiology. We therefore conducted a systematic review to [...] Read more.
(1) Background. Obesity is a well-established worldwide recognised risk factor for atrial fibrillation (AF). Prior review papers reported on the associations between obesity and AF development, but not on the relation between obesity and atrial electrophysiology. We therefore conducted a systematic review to describe the current knowledge of the characteristics of the atrial electrophysiological substrate in obese individuals and how they relate to the development of AF. (2) Methods. A search was conducted in Pubmed, Embase, and the Cochrane Library for publications evaluating the impact of obesity on atrial electrophysiology, electrical substrates, and their relation to the development of AF. (3) Results. A systematic literature search retrieved 477 potential publications based on the inclusion criteria; 76 full-text articles were selected for the present systematic review. The literature demonstrated that obesity predisposes to not only a higher AF incidence but also to more extensive atrial electrophysiological abnormalities increasing susceptibility to AF development. (4) Conclusion. Obesity may predispose to an overall increase in atrial electropathology, consisting of an increase in the slowing of the conduction, conduction block, low-voltage areas, and complex fractionated electrograms. To determine the impact of obesity-induced atrial electrical abnormalities on the long-term clinical outcome, further prospective studies are mandatory. Full article
(This article belongs to the Special Issue Electropathology as the Foundation of Innovation in Diagnosis and Therapy of Atrial Fibrillation)
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8 pages, 1961 KiB  
Case Report
Intracoronary Pacing during “Chimney Technique” in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation?
by Alessandro Cafaro, Francesco Rizzo, Dionigi Fischetti, Luca Quarta, Marco Mussardo, Alessandro Mandurino-Mirizzi, Antonio Tondo, Marco Matteo Ciccone, Fortunato Iacovelli and Giuseppe Colonna
J. Cardiovasc. Dev. Dis. 2023, 10(8), 341; https://doi.org/10.3390/jcdd10080341 - 8 Aug 2023
Viewed by 1565
Abstract
Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and [...] Read more.
Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the “chimney technique”, after unsuccessful RLE-TRVP. Full article
(This article belongs to the Special Issue Aortic Stenosis: Diagnosis, Treatment and Management)
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8 pages, 3846 KiB  
Article
First-Trimester Ultrasound Imaging for Prenatal Assessment of the Extended Cardiovascular System Using the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL)
by Zita M. Gambacorti-Passerini, Cristina Martínez Payo, Coral Bravo Arribas, Santiago García-Tizón Larroca, Natalio García-Honduvilla, Miguel A. Ortega, Ricardo Pérez Fernández-Pachecho and Juan De León Luis
J. Cardiovasc. Dev. Dis. 2023, 10(8), 340; https://doi.org/10.3390/jcdd10080340 - 7 Aug 2023
Viewed by 1932
Abstract
Introduction and objectives: To compare fetal images obtained at the first- and second-trimester ultrasound scan when applying the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). Methods: Using the CASSEAL protocol, nine sequential axial views were acquired in B-mode and color Doppler at the first- [...] Read more.
Introduction and objectives: To compare fetal images obtained at the first- and second-trimester ultrasound scan when applying the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). Methods: Using the CASSEAL protocol, nine sequential axial views were acquired in B-mode and color Doppler at the first- and second-trimester ultrasound scans, visualizing the main components of the extended fetal cardiovascular system. Images were compared qualitatively between both trimesters. Results: We obtained comparable images for all the nine axial views described in the CASSEAL protocol, with few differences and limitations. Conclusions: The CASSEAL protocol is reproducible in the first trimester, and could help in the early detection of fetal cardiovascular abnormalities. It represents a promising additional tool in order to increase the CHD detection rate. Full article
(This article belongs to the Special Issue Echocardiography in Pediatric Heart Disease)
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8 pages, 1618 KiB  
Case Report
Transapical Mitral Valve-in-Ring Replacement Using the Innovative System under 3-Dimensional Printing Guidance
by Yiwei Wang, Yu Mao, Mengen Zhai, Yanyan Ma, Lanlan Li, Yang Liu and Jian Yang
J. Cardiovasc. Dev. Dis. 2023, 10(8), 339; https://doi.org/10.3390/jcdd10080339 - 7 Aug 2023
Viewed by 1610
Abstract
Background: Transcatheter mitral valve-in-ring replacement (TMViR) is an emerging alternative for patients with recurrent mitral regurgitation (MR) after a prior failed annuloplasty ring. However, intraoperative common issues and complications remain to be addressed. Case summary: We describe the case of a 67-year-old male [...] Read more.
Background: Transcatheter mitral valve-in-ring replacement (TMViR) is an emerging alternative for patients with recurrent mitral regurgitation (MR) after a prior failed annuloplasty ring. However, intraoperative common issues and complications remain to be addressed. Case summary: We describe the case of a 67-year-old male patient who underwent surgical mitral concomitant tricuspid annuloplasty repair 7 years ago who developed recurrent severe MR (New York Heart Association functional class IV). To avoid a high-risk surgical reoperation, we chose to perform a TMViR using an innovative dedicated device—the Mi-thos system—via a transapical approach. A patient-specific, 3-dimensional printed model was used to guide the procedure to avoid potential challenges. The procedure was performed successfully, and the patient exhibited symptomatic improvement. Conclusions: This case report highlights the first use of the innovative Mi-thos system in a TMViR procedure. The findings demonstrate the feasibility and safety of utilizing the Mi-thos system, guided by 3-dimensional printing technology, for patients who have experienced recurrent mitral regurgitation MR following a failed annuloplasty ring. Full article
(This article belongs to the Topic Usefulness and Clinical Applications of 3D Printing in Cardiovascular Diseases 2.0)
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12 pages, 1393 KiB  
Article
Three Decades of Experience with Aortic Prosthetic Valve Endocarditis
by Antonella Galeone, Jacopo Gardellini, Diletta Trojan, Venanzio Di Nicola, Renato Di Gaetano, Giuseppe Faggian and Giovanni Battista Luciani
J. Cardiovasc. Dev. Dis. 2023, 10(8), 338; https://doi.org/10.3390/jcdd10080338 - 6 Aug 2023
Cited by 4 | Viewed by 1582
Abstract
The objective of this study was to evaluate early and long-term outcomes of patients with aortic prosthetic valve endocarditis (a-PVE) treated with a prosthetic aortic valve (PAV), prosthetic valved conduit (PVC), or cryopreserved aortic homograft (CAH). A total of 144 patients, 115 male [...] Read more.
The objective of this study was to evaluate early and long-term outcomes of patients with aortic prosthetic valve endocarditis (a-PVE) treated with a prosthetic aortic valve (PAV), prosthetic valved conduit (PVC), or cryopreserved aortic homograft (CAH). A total of 144 patients, 115 male and 29 female, aged 67 ± 12 years, underwent surgery for a-PVE at our institution between 1994 and 2021. Median time from the original cardiac surgery was 1.9 [0.6–5.6] years, and 47 (33%) patients developed an early a-PVE. Of these patients, 73 (51%) underwent aortic valve replacement (AVR) with a biological or mechanical PAV, 12 (8%) underwent aortic root replacement (ARR) with a biological or mechanical PVC, and 59 (42%) underwent AVR or ARR with a CAH. Patients treated with a CAH had significantly more circumferential annular abscess multiple valve involvement, longer CPB and aortic cross-clamping times, and needed more postoperative pacemaker implantation than patients treated with a PAV. No difference was observed in survival, reoperation rates, or recurrence of IE between patients treated with a PAV, a PVC, or a CAH. CAHs are technically more demanding and more often used in patients who have extensive annular abscess and multiple valve involvement. However, the use of CAH is safe in patients with complex a-PVE, and it shows excellent early and long-term outcomes. Full article
(This article belongs to the Special Issue Two of the Current Hot Challenges in Cardiac Surgery: Rising Endocarditis Cases and Extensive Use of Antithrombotics)
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14 pages, 1189 KiB  
Review
Arrhythmias in Patients with Cardiac Amyloidosis: A Comprehensive Review on Clinical Management and Devices
by Alexandros Briasoulis, Christos Kourek, Adamantia Papamichail, Konstantinos Loritis, Dimitrios Bampatsias, Evangelos Repasos, Andrew Xanthopoulos, Elias Tsougos and Ioannis Paraskevaidis
J. Cardiovasc. Dev. Dis. 2023, 10(8), 337; https://doi.org/10.3390/jcdd10080337 - 5 Aug 2023
Cited by 9 | Viewed by 3595
Abstract
Cardiac amyloidosis (CA) is a rare but potentially life-threatening disease in which misfolded proteins accumulate in the cardiac wall tissue. Heart rhythm disorders in CA, including supraventricular arrhythmias, conduction system disturbances, or ventricular arrhythmias, play a major role in CA morbidity and mortality, [...] Read more.
Cardiac amyloidosis (CA) is a rare but potentially life-threatening disease in which misfolded proteins accumulate in the cardiac wall tissue. Heart rhythm disorders in CA, including supraventricular arrhythmias, conduction system disturbances, or ventricular arrhythmias, play a major role in CA morbidity and mortality, and thus require supplementary management. Among them, AF is the most frequent arrhythmia during CA hospitalizations and is associated with significantly higher mortality, while ventricular arrhythmias are also common and are usually associated with poor prognosis. Early diagnosis of potential arrythmias could be performed through ECG, Holter monitoring, and/or electrophysiology study. Clinical management of these patients is quite significant, and it usually includes initiation of amiodarone and/or digoxin in patients with AF, potential electrical cardioversion, or ablation in specific patients with indication, as well as initiation of anticoagulants in all patients, independent of AF and CHADS-VASc score, for potential intracardiac thrombus. Moreover, identification of patients with conduction disorders that could benefit from prophylactic pacemaker implantation and/or CRT as well as identification of patients with life-threatening ventricular arrythmias that could benefit from ICD could both increase the survival rates of these patients and improve their quality of life. Full article
(This article belongs to the Special Issue Feature Review Papers in Acquired Cardiovascular Disease)
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11 pages, 5171 KiB  
Article
Subclinical Atrial Fibrillation on Prolonged ECG Holter Monitoring: Results from the Multicenter Real-World SAFARI (Silent Atrial Fibrillation ANCE-Sicily Research Initiative) Study
by Cesare de Gregorio, Antonino Di Franco, Antonio Vittorio Panno, Marco Di Franco, Giuseppe Scaccianoce, Francesca Campanella, Giuseppina Novo, Alfredo Ruggero Galassi, Salvatore Novo and the SAFARI Study Group
J. Cardiovasc. Dev. Dis. 2023, 10(8), 336; https://doi.org/10.3390/jcdd10080336 - 4 Aug 2023
Viewed by 2154
Abstract
Background: The detection of subclinical/silent atrial fibrillation (SAF) in the general population is of the utmost importance, given its potential adverse consequences. Incident AF has been observed in 30% to 70% of patients with implanted devices, but its prevalence may indeed be lower [...] Read more.
Background: The detection of subclinical/silent atrial fibrillation (SAF) in the general population is of the utmost importance, given its potential adverse consequences. Incident AF has been observed in 30% to 70% of patients with implanted devices, but its prevalence may indeed be lower in the general population. The prospective, multicentric, observational Silent Atrial Fibrillation ANCE Research Initiative (SAFARI) study aimed at assessing the SAF prevalence in a real-world outpatient setting by the means of a small, wearable, prolonged ECG Holter monitoring (>5 days) device (CGM HI 3-Lead ECG; CGM TELEMEDICINE, Piacenza, Italy). Methods: Patients ≥ 55 years of age at risk for AF were screened according to the inclusion criteria to undergo prolonged 3-lead ECG Holter monitoring. SAF episodes were classified as follows: Class A, <30 s; Class B, 30 to 299 s; and Class C, ≥300 s. Results: In total, 119 patients were enrolled (64 men; median age 71 (IQR 55–85) years). At a median of 13.5 (IQR 5–21) days of monitoring, SAF episodes were found in 19 patients (16%). A total of 10,552 arrhythmic episodes were registered, 6901 in Class A (n = 7 patients), 2927 in Class B (n = 3), and 724 in Class C (n = 9), (Class A vs. B and C, p < 0.001). This latter group had multiple (all-class) episodes, and two patients had >1000 episodes. There were no clinical, echocardiographic, or laboratory findings able to discriminate patients with SAF from those in sinus rhythm in univariate and multivariable analyses; of note is that the Class C patients showed a higher diastolic blood pressure, resting heart rate, and indexed LA volume. Conclusions. Over a median of 13 days of Holter monitoring, the SAFARI study confirmed the usefulness of small wearable devices in detecting SAF episodes in real-world outpatients at risk for, but with no prior history of, AF. Full article
(This article belongs to the Special Issue Arrhythmic Risk Stratification)
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9 pages, 637 KiB  
Brief Report
The Clinical Validation of a Common Analytical Change Criteria for Cardiac Troponin for Ruling in an Acute Cardiovascular Outcome in Patients Presenting with Ischemic Chest Pain Symptoms
by Peter A. Kavsak, Sameer Sharif, Isabella Globe, Craig Ainsworth, Jinhui Ma, Matthew McQueen, Shamir Mehta, Dennis T. Ko and Andrew Worster
J. Cardiovasc. Dev. Dis. 2023, 10(8), 335; https://doi.org/10.3390/jcdd10080335 - 4 Aug 2023
Cited by 2 | Viewed by 1477
Abstract
Serial cardiac troponin (cTn) testing on patients with symptoms suggestive of acute coronary syndrome (ACS) is primarily to identify those patients with evolving myocardial injury. With the improved analytical performance of the high-sensitivity cTn (hs-cTn) assays, different change criteria have been proposed that [...] Read more.
Serial cardiac troponin (cTn) testing on patients with symptoms suggestive of acute coronary syndrome (ACS) is primarily to identify those patients with evolving myocardial injury. With the improved analytical performance of the high-sensitivity cTn (hs-cTn) assays, different change criteria have been proposed that are mostly assay dependent. Here, we developed and compared a new Common Change Criteria (3C for the combined criteria of >3 ng/L, >30%, or >15% based on the initial cTn concentration of <10 ng/L, 10 to 100 ng/L, or >100 ng/L, respectively) method, versus the 2 h assay-dependent absolute change criteria endorsed by the European Society of Cardiology (ESC), versus the common relative >20% change criterion. These different analytical change criteria were evaluated in 855 emergency department (ED) patients with symptoms of ACS and who had two samples collected 3 h apart. The cTn concentrations were measured with four different assays (Abbott hs-cTnI, Roche hs-cTnT, Ortho cTnI-ES, and Ortho hs-cTnI). The outcomes evaluated were myocardial infarction (MI) and a composite outcome (MI, unstable angina, ventricular arrhythmia, heart failure, or cardiovascular death) within 7 days of ED presentation. The combined change criteria (3C) method yielded higher specificities (range: 93.9 to 97.2%) as compared to the >20% criterion (range: 42.3 to 88.1%) for all four assays for MI. The 3C method only yielded a higher specificity estimate for MI for the cTnI-ES assay (95.9%) versus the absolute change criteria (71.7%). Similar estimates were obtained for the composite outcome. There was also substantial agreement between hs-cTnT and the different cTnI assays for MI with the 3C method, with the percent agreement being ≥95%. The Common Change Criteria (3C) method combining both absolute and different percent changes may be used with cTnI, hs-cTnT, and different hs-cTnI assays to yield similar high-specificity (rule-in) estimates for adverse cardiovascular events for patients presenting to the ED with ACS symptoms. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
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15 pages, 3821 KiB  
Article
Electrocardiographic Characteristics of Ventricular Arrhythmias Originating from Different Areas Adjacent to the Mitral Annulus
by Yi-Fan Lin, Que Xu, Cheng Zheng, Jia-Meng Shao, Bing Shen, Rui-Lin He, Jia-Feng Lin and Yan-Ru Chen
J. Cardiovasc. Dev. Dis. 2023, 10(8), 334; https://doi.org/10.3390/jcdd10080334 - 3 Aug 2023
Viewed by 1391
Abstract
Background: This study aimed to explore the electrocardiographic (ECG) characteristics of ventricular arrhythmias (VAs) arising from epicardial and endocardial areas adjacent to the mitral annulus (MA). Methods: This study involved 283 patients with MA-VAs who received radiofrequency catheter ablation at the center. The [...] Read more.
Background: This study aimed to explore the electrocardiographic (ECG) characteristics of ventricular arrhythmias (VAs) arising from epicardial and endocardial areas adjacent to the mitral annulus (MA). Methods: This study involved 283 patients with MA-VAs who received radiofrequency catheter ablation at the center. The ECG characteristics of these patients were analyzed retrospectively. Results: The origin of MA-VAs was judged based on the ECG variables. Among all MA-VAs, intrinsicoid deflection time (IDT) > 77 ms or maximum deflection index (MDI) > 0.505 predicted the VAs arising from the epicardium (sensitivity of 70.20% and 73.51%, specificity of 94.70% and 82.58%, positive predictive value (PPV) of 93.81% and 82.84%, and negative predictive value (NPV) of 73.53% and 73.15%). Among all epicardial MA-VAs, the RV1/RV2 ratio > 0.87 predicted the VAs originating from the epicardial anteroseptal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 62.86%, 98.06%, 91.67%, and 88.60%, respectively. Among all endocardial MA-VAs, Q(q)R(r) morphology in lead V1 predicted the VAs arising from the endocardial septal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 92.98%, 100%, 100%, and 94.94%, respectively. Among all endocardial septal MA-VAs, a predominant positive wave in lead II and a predominant negative wave in lead III predicted the VAs arising from the endocardial midseptal portion adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 86.04%, 100%, 100%, and 70.00%, respectively. Conclusion: the ECG characteristics of VAs from the different sites adjacent to the MA can enable judging the arrhythmia’s origin and designing the ablation plan accordingly. Full article
(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)
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17 pages, 1836 KiB  
Review
Unique Pulmonary Hypertensive Vascular Diseases Associated with Heart and Lung Developmental Defects
by Hidekazu Ishida, Jun Maeda, Keiko Uchida and Hiroyuki Yamagishi
J. Cardiovasc. Dev. Dis. 2023, 10(8), 333; https://doi.org/10.3390/jcdd10080333 - 3 Aug 2023
Cited by 1 | Viewed by 1830
Abstract
Although pediatric pulmonary hypertension (PH) shares features and mechanisms with adult PH, there are also some significant differences between the two conditions. Segmental PH is a unique pediatric subtype of PH with unclear and/or multifactorial pathophysiological mechanisms, and is often associated with complex [...] Read more.
Although pediatric pulmonary hypertension (PH) shares features and mechanisms with adult PH, there are also some significant differences between the two conditions. Segmental PH is a unique pediatric subtype of PH with unclear and/or multifactorial pathophysiological mechanisms, and is often associated with complex congenital heart disease (CHD), pulmonary atresia with ventricular septal defect, and aortopulmonary collateral arteries. Some cases of complex CHD, associated with a single ventricle after Fontan operation, show pathological changes in the small peripheral pulmonary arteries and pulmonary vascular resistance similar to those observed in pulmonary arterial hypertension (PAH). This condition is termed as the pediatric pulmonary hypertensive vascular disease (PPHVD). Recent advances in genetics have identified the genes responsible for PAH associated with developmental defects of the heart and lungs, such as TBX4 and SOX17. Targeted therapies for PAH have been developed; however, their effects on PH associated with developmental heart and lung defects remain to be established. Real-world data analyses on the anatomy, pathophysiology, genetics, and molecular biology of unique PPHVD cases associated with developmental defects of the heart and lungs, using nationwide and/or international registries, should be conducted in order to improve the treatments and prognosis of patients with these types of pediatric PH. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Pulmonary Vascular Diseases)
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18 pages, 2823 KiB  
Article
The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery
by Vasileios Leivaditis, Konstantinos Grapatsas, Anastasia Papaporfyriou, Michail Galanis, Efstratios Koletsis, Nikolaos Charokopos, Erich Haussmann, Vladislav Kaplunov, Athanasios Papatriantafyllou and Manfred Dahm
J. Cardiovasc. Dev. Dis. 2023, 10(8), 332; https://doi.org/10.3390/jcdd10080332 - 3 Aug 2023
Cited by 1 | Viewed by 1988
Abstract
Background: Postoperative myocardial dysfunction following cardiac surgery is a relatively common occurrence. Levosimendan, a calcium sensitizer and inotropic drug, has shown potential in improving outcomes for patients with low preoperative ejection fraction (EF) and myocardial dysfunction after cardiac surgery. This study aims to [...] Read more.
Background: Postoperative myocardial dysfunction following cardiac surgery is a relatively common occurrence. Levosimendan, a calcium sensitizer and inotropic drug, has shown potential in improving outcomes for patients with low preoperative ejection fraction (EF) and myocardial dysfunction after cardiac surgery. This study aims to evaluate the efficacy of levosimendan in optimizing the surgical outcome for such patients. Methods: A retrospective analysis was conducted on 314 patients with preoperative severe heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while a comparable group of 130 patients received conventional treatment. Results: The use of levosimendan demonstrated several advantages in postoperative outcomes. It significantly improved short- and long-term survival rates after cardiac surgery, enhanced hemodynamic stability, reduced the requirement for inotropic support, and facilitated faster weaning from ventilator support. Patients who received levosimendan reported reduced angina and dyspnea symptoms, as well as fewer postoperative arrhythmias. Furthermore, levosimendan helped minimize myocardial injury inevitable after cardiac surgery. The levosimendan group also exhibited a notable reduction in hospital readmissions. Conclusions: This study provides evidence of several benefits associated with the perioperative use of levosimendan. However, further prospective randomized studies are warranted to standardize and comprehensively document the other perioperative therapies, in order to validate these findings and establish stronger conclusions. Full article
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10 pages, 1861 KiB  
Article
Three-Dimensional-Derived Echocardiographic Left Ventricular Structure and Function and Indices from the 12-Lead Electrocardiogram across the Menstrual Cycle in Healthy Physically Active Females: An Exploratory Study
by Barbara N. Morrison, Allison J. Campbell, Anita T. Coté, Aleah Mohammad, Laura Sambrook, Georgia Robinson, Keith George and David Oxborough
J. Cardiovasc. Dev. Dis. 2023, 10(8), 331; https://doi.org/10.3390/jcdd10080331 - 3 Aug 2023
Viewed by 1187
Abstract
Background: The impact of the menstrual phases on left ventricular (LV) structure and function using 3D echocardiography and resting electrocardiogram (ECG) in healthy, eumenorrheic, and physically active females has not been investigated. Methods: sixteen females (20 y ± 2) underwent 3D echocardiography [...] Read more.
Background: The impact of the menstrual phases on left ventricular (LV) structure and function using 3D echocardiography and resting electrocardiogram (ECG) in healthy, eumenorrheic, and physically active females has not been investigated. Methods: sixteen females (20 y ± 2) underwent 3D echocardiography and an ECG at three time points in the menstrual cycle phases (follicular, ovulation, luteal). LV end-diastolic volume (LVEDVi), LV ejection fraction (LVEF), LV mass allometrically indexed to height2.7 (LVMi), torsion, and global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS) were evaluated. ECG data of the P and QRS waves were presented as well as axis deviation, chamber enlargement, and any rhythm abnormalities. Results: LVMi was significantly higher in the luteal phase (36.4 g/m2.7 ± 3.3) compared to the follicular (35.0 g/m2.7 ± 3.7) and ovulation (34.7 g/m2.7 ± 4.3) phases (p = 0.026). There were no differences in other indices of LV structure and function or ECG variables across all phases of the menstrual cycle or evidence of arrhythmia. Conclusions: In physically active females, there is a small but significantly higher LVMi associated with the luteal phase of the menstrual cycle with no concomitant change in LV function or ECG parameters. These findings are important to consider when conducting clinical or research serial assessments. Full article
(This article belongs to the Special Issue Sports Cardiology in the Modern Era)
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10 pages, 266 KiB  
Article
Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy
by Stephen Gerfer, Walid Bennour, Alina Chigri, Ahmed Elderia, Ihor Krasivskyi, Clara Großmann, Christopher Gaisendrees, Borko Ivanov, Soi Avgeridou, Kaveh Eghbalzadeh, Parwis Rahmanian, Ferdinand Kuhn-Régnier, Navid Mader, Ilija Djordjevic, Anton Sabashnikov and Thorsten Wahlers
J. Cardiovasc. Dev. Dis. 2023, 10(8), 330; https://doi.org/10.3390/jcdd10080330 - 2 Aug 2023
Cited by 1 | Viewed by 1620
Abstract
Background. Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, [...] Read more.
Background. Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective. Methods. This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack. Results. Preoperative patient’s characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications. Conclusions. Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures. Full article
(This article belongs to the Section Cardiac Surgery)
9 pages, 921 KiB  
Article
Lipid-Lowering Treatment and the Lipid Goals Attainment in Patients with a Very High Cardiovascular Risk
by Anna Lis, Paulina Lis, Weronika Łowicka, Małgorzata Grabarczyk, Michał Wita, Piotr Żarczyński, Małgorzata Żarczyńska and Maciej Haberka
J. Cardiovasc. Dev. Dis. 2023, 10(8), 329; https://doi.org/10.3390/jcdd10080329 - 2 Aug 2023
Cited by 2 | Viewed by 2276
Abstract
Hypercholesterolemia is the main cardiovascular (CV) risk factor with a large body of evidence. Our aim was to assess the achievement of the main therapeutic goal of Low-Density Lipoprotein Cholesterol (LDL-C) in patients with a very high CV risk and a high-dose statin [...] Read more.
Hypercholesterolemia is the main cardiovascular (CV) risk factor with a large body of evidence. Our aim was to assess the achievement of the main therapeutic goal of Low-Density Lipoprotein Cholesterol (LDL-C) in patients with a very high CV risk and a high-dose statin therapy. The study group consisted of 1413 consecutive patients hospitalised at the Upper-Silesian Medical Centre in Katowice due to acute myocardial infarction (AMI) treated with atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg. The lipid profile was performed on admission and within 12 months after AMI. The main therapeutic goal was defined as LDL-C < 55 mg%. The study group (n = 1413) included 979 males (69.3%) with arterial hypertension (83.3%), diabetes (33.5%), peripheral artery disease (13.6%) and nicotinism (46.2%). In the study group, only 61 patients (4.3%) were additionally taking ezetimibe. During hospitalisation, the primary LDL-C goal was found in only 186 patients (13.2%). Subsequently, a follow-up lipidogram within 12 months was performed in 652 patients (46%), and the therapeutic goal was achieved in 255 patients (39%). There were 258 (18.26%) patients who died within 12 months after myocardial infarction. The lowest mortality rate was found in the subgroup of patients with LDL-C < 55 mg% during follow-up (11.02%). The primary lipid goal attainment among patients with a high-dose statin and a very high CV risk is low and far from the expected rate. Patients hospitalised for AMI should be given a combination of statin and ezetimibe more frequently. Low LDL-C levels measured at follow-up predict a lower risk of death at 12-month follow-up in a large group of patients. Full article
(This article belongs to the Special Issue Dyslipidemia and Cardiovascular Disease: The Dawn of an Era with New Targets and Novel Therapies)
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9 pages, 747 KiB  
Article
Longitudinal Trends in Severe Dyslipidemia in the Czech Population: The Czech MONICA and Czech Post-MONICA Study
by Renata Cífková, Jan Bruthans, Peter Wohlfahrt, Alena Hrubeš Krajčoviechová, Pavel Šulc, Marie Jozífová, Lenka Eremiášová, Jan Pudil, Aleš Linhart, Jiří Widimský, Jr., Jan Filipovský, Otto Mayer, Jr., Rudolf Poledne, Petr Stávek, Věra Lánská and Larysa Strilchuk
J. Cardiovasc. Dev. Dis. 2023, 10(8), 328; https://doi.org/10.3390/jcdd10080328 - 31 Jul 2023
Cited by 1 | Viewed by 1415
Abstract
Background: Severe hypercholesterolemia is associated with an increase in the risk of developing atherosclerotic cardiovascular disease. The aim of this analysis was to assess longitudinal trends in severe dyslipidemia (defined as total cholesterol > 8 mmol/L or LDL-cholesterol > 5 mmol/L) in a [...] Read more.
Background: Severe hypercholesterolemia is associated with an increase in the risk of developing atherosclerotic cardiovascular disease. The aim of this analysis was to assess longitudinal trends in severe dyslipidemia (defined as total cholesterol > 8 mmol/L or LDL-cholesterol > 5 mmol/L) in a representative population sample of the Czech Republic and to analyze the longitudinal trends in the basic characteristics of individuals with severe dyslipidemia. Methods: Seven independent cross-sectional surveys were organized in the Czech Republic to screen for major cardiovascular risk factors (from 1985 to 2015–2018). A total of 20,443 randomly selected individuals aged 25–64 years were examined. Results: The overall prevalence of severe dyslipidemia was 6.6%, with a significant downward trend from the fifth survey onwards (2000/2001). Over the study period of 30+ years, the individuals with severe dyslipidemia became older, increased in BMI, and did not change their smoking habits. Total cholesterol and non-HDL-cholesterol decreased significantly in both sexes throughout the duration of the study. Conclusions: Despite a significant improvement in lipids in the Czech Republic from 1985, substantially contributing to the decline in cardiovascular mortality, the number of individuals with severe dyslipidemia remained high, and in most cases, they were newly detected during our screening examinations and were thus untreated. Full article
(This article belongs to the Special Issue Dyslipidemia and Cardiovascular Disease: The Dawn of an Era with New Targets and Novel Therapies)
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29 pages, 1899 KiB  
Review
Interventions to Address Cardiovascular Risk in Obese Patients: Many Hands Make Light Work
by Valeria Visco, Carmine Izzo, Davide Bonadies, Federica Di Feo, Giuseppe Caliendo, Francesco Loria, Costantino Mancusi, Pierpaolo Chivasso, Paola Di Pietro, Nicola Virtuoso, Albino Carrizzo, Carmine Vecchione and Michele Ciccarelli
J. Cardiovasc. Dev. Dis. 2023, 10(8), 327; https://doi.org/10.3390/jcdd10080327 - 31 Jul 2023
Cited by 4 | Viewed by 2660
Abstract
Obesity is a growing public health epidemic worldwide and is implicated in slowing improved life expectancy and increasing cardiovascular (CV) risk; indeed, several obesity-related mechanisms drive structural, functional, humoral, and hemodynamic heart alterations. On the other hand, obesity may indirectly cause CV disease, [...] Read more.
Obesity is a growing public health epidemic worldwide and is implicated in slowing improved life expectancy and increasing cardiovascular (CV) risk; indeed, several obesity-related mechanisms drive structural, functional, humoral, and hemodynamic heart alterations. On the other hand, obesity may indirectly cause CV disease, mediated through different obesity-associated comorbidities. Diet and physical activity are key points in preventing CV disease and reducing CV risk; however, these strategies alone are not always sufficient, so other approaches, such as pharmacological treatments and bariatric surgery, must support them. Moreover, these strategies are associated with improved CV risk factors and effectively reduce the incidence of death and CV events such as myocardial infarction and stroke; consequently, an individualized care plan with a multidisciplinary approach is recommended. More precisely, this review explores several interventions (diet, physical activity, pharmacological and surgical treatments) to address CV risk in obese patients and emphasizes the importance of adherence to treatments. Full article
(This article belongs to the Special Issue Cardiovascular Disease: Risk Factors and Prevention)
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