Journal of Cardiovascular Development and Disease

11 pages, 437 KiB

Open AccessArticle

The Role of Advanced Glycation End-Product Levels Measured by Skin Autofluorescence in the Development of Mitral Annular Calcification

by Bedrettin Boyraz and Tezcan Peker

J. Cardiovasc. Dev. Dis. 2023, 10(9), 406; https://doi.org/10.3390/jcdd10090406 - 20 Sep 2023

Cited by 1 | Viewed by 1359

Abstract

As a person ages, mitral annular calcification develops in the mitral annulus with increasing frequency. Lipid deposition, inflammation, and aging-related degeneration have been cited as potential causes of this pathophysiology, though there is currently no conclusive evidence to support this. AGEs accumulate in [...] Read more.

As a person ages, mitral annular calcification develops in the mitral annulus with increasing frequency. Lipid deposition, inflammation, and aging-related degeneration have been cited as potential causes of this pathophysiology, though there is currently no conclusive evidence to support this. AGEs accumulate in tissues due to the glycation of proteins and lipids, increasing the release of proinflammatory cytokines secondary to oxidative stress through the AGE receptor. The AGE levels increase in diabetic microvascular complications and degenerative aortic valve disease. Our study was planned prospectively as a case–control study involving 94 MAC-positive patients and 94 MAC-negative patients. The demographics, echocardiographic data and AGE levels of the patients were measured and recorded using the skin autofluorescence method. AGE levels were significantly higher in the MAC-positive patient group (3.2 vs. 2.7; p < 0.001). The AGE levels were observed as an independent predictor of MAC development in a regression analysis (OR: 8.05, 95% CI: 3.74–17.33, p < 0.001). In a ROC-curve analysis, the AUC was 0.79 (95% CI: 0.72–0.85). At a cut-off value of 2.7, 79.7% sensitivity and 69.1% specificity were observed. AGE levels can be used to cheaply, easily and non-invasively identify patients at risk of developing MAC. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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10 pages, 257 KiB

Open AccessArticle

Pre-Stroke Loop Diuretics and Anemia in Elderly Patients Are Associated Factors of Severe Renal Dysfunction at the Time of Acute Stroke Onset

by Takahisa Mori, Tetsundo Yano, Kazuhiro Yoshioka and Yuichi Miyazaki

J. Cardiovasc. Dev. Dis. 2023, 10(9), 405; https://doi.org/10.3390/jcdd10090405 - 19 Sep 2023

Cited by 1 | Viewed by 1597

Abstract

Background: Severe renal dysfunction (SRD), an advanced stage of chronic kidney disease (CKD), can limit the treatment options for acute stroke (AS) patients. Therefore, it is important to investigate the associated factors of SRD in AS patients to inhibit CKD progression to SRD [...] Read more.

Background: Severe renal dysfunction (SRD), an advanced stage of chronic kidney disease (CKD), can limit the treatment options for acute stroke (AS) patients. Therefore, it is important to investigate the associated factors of SRD in AS patients to inhibit CKD progression to SRD before AS. Sex differences exist in the renal function. Therefore, we investigated the frequency of SRD and its associated factors among AS patients by sex. Methods: Our cross-sectional study included patients admitted within 24 h of AS onset between 2013 and 2019 with available pre-stroke medication information. We used the Cockcroft–Gault equation for calculating the creatinine clearance (Ccr) and defined SRD as a Ccr < 30 mL/min. We performed multivariable logistic regression analysis to identify the independent factors associated with SRD. Results: Out of 4294 patients, 3472 matched our criteria. Of these, 1905 (54.9%) were male, with median ages of 75 and 81 years for males and females, respectively. The frequency of SRD was 9.7% in males and 18.7% in females. Loop diuretics and anemia were associated factors of SRD. Conclusions: Pre-stroke loop diuretics and anemia in elderly patients were associated factors of SRD in both sexes. Individualized drug therapy and anemia management are essential to prevent SRD. Full article

(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)

9 pages, 866 KiB

Open AccessArticle

Evaluation of Image Quality for High Heart Rates for Coronary Computed Tomographic Angiography with Advancement in CT Technology: The CONVERGE Registry

by Ayman Abdelkarim, Sion K. Roy, April Kinninger, Azadeh Salek, Olivia Baranski, Daniele Andreini, Gianluca Pontone, Edoardo Conte, Rachael O’Rourke, Christian Hamilton-Craig and Matthew J. Budoff

J. Cardiovasc. Dev. Dis. 2023, 10(9), 404; https://doi.org/10.3390/jcdd10090404 - 19 Sep 2023

Cited by 2 | Viewed by 1567

Abstract

Objective: This study aims to evaluate image quality in patients with heart rates above or equal to 70 beats per minute (bpm), performed on a 16 cm scanner (256-slice General Electric Revolution) in comparison to a CT scanner with only 4 cm of [...] Read more.

Objective: This study aims to evaluate image quality in patients with heart rates above or equal to 70 beats per minute (bpm), performed on a 16 cm scanner (256-slice General Electric Revolution) in comparison to a CT scanner with only 4 cm of coverage (64 slice Volume CT). Background: Recent advancements in image acquisition, such as whole-heart coverage in a single rotation and post-processing methods in coronary computed tomographic angiography (CCTA), include motion-correction algorithms, such as SnapShot Freeze (SSF), which improve temporal resolution and allow for the assessment of coronary artery disease (CAD) with lower motion scores and better image qualities. Studies from the comprehensive evaluation of high temporal- and spatial-resolution cardiac CT using a wide coverage system (CONVERGE) registry (a multicenter registry at four centers) have shown the 16 cm CT scanner having a better image quality in comparison to the 4 cm scanner. However, these studies failed to include patients with undesirable or high heart rates due to well-documented poor image acquisition on prior generations of CCTA scanners. Methods: A prospective, observational, multicenter cohort study comparing image quality, quantitively and qualitatively, on scans performed on a 16 cm CCTA in comparison to a cohort of images captured on a 4 cm CCTA at four centers. Participants were recruited based on broad inclusion criteria, and each patient in the 16 cm CCTA arm of the study received a CCTA scan using a 256-slice, whole-heart, single-beat scanner. These patients were then matched by age, gender, and heart rate to patients who underwent CCTA scans on a 4 cm CT scanner. Image quality was graded based on the signal-to-noise ratio, contrast-to-noise ratio, and on a Likert scale of 0–4: 0, very poor—4, excellent. Results: 104 patients were evaluated for this study. The mean heart rate was 75 ± 7 in the 4 cm scanner and 75 ± 7 in the 16 cm one (p = 0.426). The signal-to-noise and contrast-to-noise ratios were higher in the 16 cm scanner (p = 0.0001). In addition, more scans were evaluated as having an excellent quality on the 16 cm scanner than on the 4 cm scanner (p < 0.0001) based on a 4-point Likert scale. Conclusions: The 16 cm scanner has a superior image quality for fast heart rates compared to the 4 cm scanner. This study shows that there is a significantly higher frequency of excellent and good studies showing better contrast-to-noise and signal-to-noise ratios with the 16 cm scanner compared to the 4 cm scanner. Full article

(This article belongs to the Section Imaging)

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11 pages, 758 KiB

Open AccessReview

Unrecognized Pulmonary Hypertension in Non-Cardiac Surgical Patients: At-Risk Populations, Preoperative Evaluation, Intraoperative Management and Postoperative Complications

by Roop K. Kaw

J. Cardiovasc. Dev. Dis. 2023, 10(9), 403; https://doi.org/10.3390/jcdd10090403 - 19 Sep 2023

Viewed by 1839

Abstract

Pulmonary hypertension is a well-established independent risk factor for perioperative complications after elective non-cardiac surgery. Patients undergoing cardiac surgery are routinely evaluated for the presence of pulmonary hypertension in the preoperative period. Better monitoring in the postoperative critical care setting leads to more [...] Read more.

Pulmonary hypertension is a well-established independent risk factor for perioperative complications after elective non-cardiac surgery. Patients undergoing cardiac surgery are routinely evaluated for the presence of pulmonary hypertension in the preoperative period. Better monitoring in the postoperative critical care setting leads to more efficient management of potential complications. Data among patients with pulmonary hypertension undergoing elective non-cardiac surgery are scant. Moreover, the condition may be unidentified at the time of surgery. Also, monitoring after non-cardiac surgery can be very limited in the PACU setting, as opposed to the critical care setting. All these factors can result in a higher postoperative complication rate and poor outcomes. Full article

(This article belongs to the Special Issue New Perspectives on Pulmonary Hypertension (PH))

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13 pages, 1226 KiB

Open AccessArticle

A Simple Strategy to Reduce Contrast Media Use and Risk of Contrast-Induced Renal Injury during PCI: Introduction of an “Optimal Contrast Volume Protocol” to Daily Clinical Practice

by Aiste Zebrauskaite, Greta Ziubryte, Lukas Mackus, Austeja Lieponyte, Evelina Kairyte, Ramunas Unikas and Gediminas Jarusevicius

J. Cardiovasc. Dev. Dis. 2023, 10(9), 402; https://doi.org/10.3390/jcdd10090402 - 19 Sep 2023

Viewed by 1663

Abstract

Contrast-induced acute kidney injury is the leading cause of iatrogenic acute nephropathy. Development of contrast-induced nephropathy (CIN) increases the risk of adverse long- and short-term patients outcomes, the hospital costs, and length of hospitalization. There are a couple of methods described for CIN [...] Read more.

Contrast-induced acute kidney injury is the leading cause of iatrogenic acute nephropathy. Development of contrast-induced nephropathy (CIN) increases the risk of adverse long- and short-term patients outcomes, the hospital costs, and length of hospitalization. There are a couple of methods described for CIN prevention (statin prescription, prehydration, contrast media (CM) clearance from the blood system, and decrease amounts of contrast volume). The CM volume to patient’s creatinine clearance ratio is the main factor to predict the risk of CIN development. The safe CM to creatinine clearance ratio limits have been established. The usage of CM amount depends on personal operators habits and inside center regulations. There is no standardized contrast usage protocol worldwide. The aim of this study was to establish an easy to use, cheap, and efficient protocol to estimate a personalized safe CM dose limit for every patient based on their kidney function. These limits are announced during the “Time Out” before the procedure. Our study included 519 patients undergoing interventional coronary procedures: 207 patients into the “Optimal Contrast Volume” arm and 312 into the control group. Applying the protocol into a daily clinical practice leads to a significant reduction in CM volume used for all type of procedures and the development of CIN in comparison with a control group. Full article

(This article belongs to the Special Issue Complex Percutaneous Coronary Intervention - Indication, Preprocedural Planning, Techniques and Influence on Myocardium)

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15 pages, 1023 KiB

Open AccessSystematic Review

Pulmonary Arterial Hypertension in the Elderly: Peculiar Features and Challenges for a Proper Phenotyping Approach

by Riccardo Scagliola, Claudio Brunelli and Manrico Balbi

J. Cardiovasc. Dev. Dis. 2023, 10(9), 401; https://doi.org/10.3390/jcdd10090401 - 18 Sep 2023

Cited by 2 | Viewed by 2053

Abstract

(1) Introduction. Although pulmonary arterial hypertension (PAH) usually affects young people with a low cardiovascular risk profile, progressive epidemiologic changes have been providing a codified phenotype of elderly subjects with PAH and increased risk predictors for left heart disease. We therefore conducted a [...] Read more.

(1) Introduction. Although pulmonary arterial hypertension (PAH) usually affects young people with a low cardiovascular risk profile, progressive epidemiologic changes have been providing a codified phenotype of elderly subjects with PAH and increased risk predictors for left heart disease. We therefore conducted a systematic review to describe the current knowledge and characteristics of elderly individuals with PAH and further insights concerning their prognostic outcomes and therapeutic response. (2) Methods. A search was conducted in PubMed, Embase, and Cochrane Library for publications evaluating the epidemiology, diagnostic work-up, and treatment of PAH in elderly subjects. (3) Among the 74 publications initially retrieved, 16 full-text articles were selected for the present systematic review. Compared to their younger counterparts, elderly individuals with PAH showed greater clinical deterioration, reduced exercise capacity, and worse prognostic outcomes, as well as less response to PAH-targeted therapy and higher rates of PAH drug discontinuation. (4) Conclusions. Demographic changes over time contributed to define a peculiar PAH phenotype in elderly patients, with an increased burden of cardiovascular comorbidities and distinctive features compared to young patients. Further investigations are needed in order to better clarify the nosologic criteria, and management in this subset population. Full article

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16 pages, 649 KiB

Open AccessReview

The Relationship between Changes in MYBPC3 Single-Nucleotide Polymorphism-Associated Metabolites and Elite Athletes’ Adaptive Cardiac Function

by Emna Riguene, Maria Theodoridou, Laila Barrak, Mohamed A. Elrayess and Michail Nomikos

J. Cardiovasc. Dev. Dis. 2023, 10(9), 400; https://doi.org/10.3390/jcdd10090400 - 18 Sep 2023

Cited by 4 | Viewed by 2213

Abstract

Athletic performance is a multifactorial trait influenced by a complex interaction of environmental and genetic factors. Over the last decades, understanding and improving elite athletes’ endurance and performance has become a real challenge for scientists. Significant tools include but are not limited to [...] Read more.

Athletic performance is a multifactorial trait influenced by a complex interaction of environmental and genetic factors. Over the last decades, understanding and improving elite athletes’ endurance and performance has become a real challenge for scientists. Significant tools include but are not limited to the development of molecular methods for talent identification, personalized exercise training, dietary requirements, prevention of exercise-related diseases, as well as the recognition of the structure and function of the genome in elite athletes. Investigating the genetic markers and phenotypes has become critical for elite endurance surveillance. The identification of genetic variants contributing to a predisposition for excellence in certain types of athletic activities has been difficult despite the relatively high genetic inheritance of athlete status. Metabolomics can potentially represent a useful approach for gaining a thorough understanding of various physiological states and for clarifying disorders caused by strength–endurance physical exercise. Based on a previous GWAS study, this manuscript aims to discuss the association of specific single-nucleotide polymorphisms (SNPs) located in the MYBPC3 gene encoding for cardiac MyBP-C protein with endurance athlete status. MYBPC3 is linked to elite athlete heart remodeling during or after exercise, but it could also be linked to the phenotype of cardiac hypertrophy (HCM). To make the distinction between both phenotypes, specific metabolites that are influenced by variants in the MYBPC3 gene are analyzed in relation to elite athletic performance and HCM. These include theophylline, ursodeoxycholate, quinate, and decanoyl-carnitine. According to the analysis of effect size, theophylline, quinate, and decanoyl carnitine increase with endurance while decreasing with cardiovascular disease, whereas ursodeoxycholate increases with cardiovascular disease. In conclusion, and based on our metabolomics data, the specific effects on athletic performance for each MYBPC3 SNP-associated metabolite are discussed. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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23 pages, 2477 KiB

Open AccessReview

Robotic-Assisted Solutions for Invasive Cardiology, Cardiac Surgery and Routine On-Ward Tasks: A Narrative Review

by George Koulaouzidis, Dafni Charisopoulou, Piotr Bomba, Jaroslaw Stachura, Pawel Gasior, Jan Harpula, John Zarifis, Wojciech Marlicz, Damian Hudziak and Tomasz Jadczyk

J. Cardiovasc. Dev. Dis. 2023, 10(9), 399; https://doi.org/10.3390/jcdd10090399 - 18 Sep 2023

Cited by 5 | Viewed by 3242

Abstract

Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive [...] Read more.

Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive cardiac electrophysiology procedures as well as surgical operations including minimally invasive aortic and mitral valve repair, coronary artery bypass procedures, and structural heart diseases. Furthermore, machines are used as staff-assisting tools to support nurses with repetitive clinical duties i.e., food delivery. High precision and resolution allow for excellent maneuverability, enabling the performance of medical procedures in challenging anatomies that are difficult or impossible using conventional approaches. Moreover, robot-assisted techniques protect operators from occupational hazards, reducing exposure to ionizing radiation, and limiting risk of orthopedic injuries. Novel automatic systems provide advantages for patients, ensuring device stability with optimized utilization of fluoroscopy. The acceptance of robotic technology among healthcare providers as well as patients paves the way for widespread clinical application in the field of cardiovascular medicine. However, incorporation of robotic systems is associated with some disadvantages including high costs of installation and expensive disposable instrumentations, the need for large operating room space, and the necessity of dedicated training for operators due to the challenging learning curve of robotic-assisted interventional systems. Full article

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15 pages, 944 KiB

Open AccessReview

A Comprehensive Review of Management Strategies for Bicuspid Aortic Valve (BAV): Exploring Epidemiology, Aetiology, Aortopathy, and Interventions in Light of Recent Guidelines

by Halil Ibrahim Bulut, Arian Arjomandi Rad, Angeliki-Aikaterini Syrengela, Iakovos Ttofi, Jasmina Djordjevic, Ramanjit Kaur, Amar Keiralla and George Krasopoulos

J. Cardiovasc. Dev. Dis. 2023, 10(9), 398; https://doi.org/10.3390/jcdd10090398 - 18 Sep 2023

Cited by 1 | Viewed by 4564

Abstract

Objective: bicuspid aortic valve (BAV) stands as the most prevalent congenital heart condition intricately linked to aortic pathologies encompassing aortic regurgitation (AR), aortic stenosis, aortic root dilation, and aortic dissection. The aetiology of BAV is notably intricate, involving a spectrum of genes and [...] Read more.

Objective: bicuspid aortic valve (BAV) stands as the most prevalent congenital heart condition intricately linked to aortic pathologies encompassing aortic regurgitation (AR), aortic stenosis, aortic root dilation, and aortic dissection. The aetiology of BAV is notably intricate, involving a spectrum of genes and polymorphisms. Moreover, BAV lays the groundwork for an array of structural heart and aortic disorders, presenting varying degrees of severity. Establishing a tailored clinical approach amid this diverse range of BAV-related conditions is of utmost significance. In this comprehensive review, we delve into the epidemiology, aetiology, associated ailments, and clinical management of BAV, encompassing imaging to aortic surgery. Our exploration is guided by the perspectives of the aortic team, spanning six distinct guidelines. Methods: We conducted an exhaustive search across databases like PubMed, Ovid, Scopus, and Embase to extract relevant studies. Our review incorporates 84 references and integrates insights from six different guidelines to create a comprehensive clinical management section. Results: BAV presents complexities in its aetiology, with specific polymorphisms and gene disorders observed in groups with elevated BAV prevalence, contributing to increased susceptibility to other cardiovascular conditions. The altered hemodynamics inherent to BAV instigate adverse remodelling of the aorta and heart, thus fostering the development of epigenetically linked aortic and heart diseases. Employing TTE screening for first-degree relatives of BAV patients might be beneficial for disease tracking and enhancing clinical outcomes. While SAVR is the primary recommendation for indicated AVR in BAV, TAVR might be an option for certain patients endorsed by adept aortic teams. In addition, proficient teams can perform aortic valve repair for AR cases. Aortic surgery necessitates personalized evaluation, accounting for genetic makeup and risk factors. While the standard aortic replacement threshold stands at 55 mm, it may be tailored to 50 mm or even 45 mm based on patient-specific considerations. Conclusion: This review reiterates the significance of considering the multifactorial nature of BAV as well as the need for further research to be carried out in the field. Full article

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9 pages, 916 KiB

Open AccessReview

Epidemiology and Long-Term Outcomes in Thoracic Transplantation

by Abey S. Abraham, Manila Singh, Matthew S. Abraham and Sanchit Ahuja

J. Cardiovasc. Dev. Dis. 2023, 10(9), 397; https://doi.org/10.3390/jcdd10090397 - 18 Sep 2023

Cited by 2 | Viewed by 1819 | Correction

Abstract

Over the past five decades, outcomes for lung transplantation have significantly improved in the early post-operative period, such that lung transplant is now the gold standard treatment for end-stage respiratory disease. The major limitation that impacts lung transplant survival rates is the development [...] Read more.

Over the past five decades, outcomes for lung transplantation have significantly improved in the early post-operative period, such that lung transplant is now the gold standard treatment for end-stage respiratory disease. The major limitation that impacts lung transplant survival rates is the development of chronic lung allograft dysfunction (CLAD). CLAD affects around 50% of lung transplant recipients within five years of transplantation. We must also consider other factors impacting the survival rate such as the surgical technique (single versus double lung transplant), along with donor and recipient characteristics. The future is promising, with more research looking into ex vivo lung perfusion (EVLP) and bioengineered lungs, with the hope of increasing the donor pool and decreasing the risk of graft rejection. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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12 pages, 1699 KiB

Open AccessArticle

Evaluation of Pulmonary Vein Fibrosis Following Cryoballoon Ablation of Atrial Fibrillation: A Semi-Automatic MRI Analysis

by Andrea Ballatore, Erika Negrello, Marco Gatti, Mario Matta, Paolo Desalvo, Lorenzo Marcialis, Stefania Marconi, Davide Tore, Massimo Magnano, Arianna Bissolino, Giulia De Lio, Gaetano Maria De Ferrari, Michele Conti, Riccardo Faletti and Matteo Anselmino

J. Cardiovasc. Dev. Dis. 2023, 10(9), 396; https://doi.org/10.3390/jcdd10090396 - 14 Sep 2023

Cited by 1 | Viewed by 1871

Abstract

Current guidelines recommend the use of cardiac magnetic resonance imaging (MRI) for the management of atrial fibrillation (AF). However, the widespread use of cardiac MRI in clinical practice is difficult to achieve. The aim of the present study is to assess whether cardiac [...] Read more.

Current guidelines recommend the use of cardiac magnetic resonance imaging (MRI) for the management of atrial fibrillation (AF). However, the widespread use of cardiac MRI in clinical practice is difficult to achieve. The aim of the present study is to assess whether cardiac MRI can be adopted to identify ablation-induced fibrosis, and its relationship with AF recurrences. Fifty patients undergoing AF cryoballoon ablation were prospectively enrolled. Cardiac MRI was performed before and 30 days after the index ablation. Commercially available software and a specifically designed image processing workflow were used to quantify left atrium (LA) fibroses. Thirty-six patients were finally included in the analysis; twenty-eight were analyzed with the dedicated workflow. Acute electrical isolation was achieved in 98% of the treated pulmonary veins (PVs). After a median follow-up of 16 months, AF recurrences occurred in 12 patients (33%). In both analyses, no differences were found between the subgroups of patients with and without recurrence in the variation of either LA fibrosis or fibrosis at the ostium of the PV, before and after ablation. The ability to predict arrhythmic recurrences evaluated via the ROC curve of the variations in both LA fibrosis (AUC 0.566) and PV fibrosis (AUC 0.600) was low. Cardiac MRI holds the potential to provide clinically significant information on LA disease and AF progression; however, LA fibrosis cannot be easily identified, either by currently available commercial programs or custom tools. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prevention of Atrial Fibrillation)

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14 pages, 1175 KiB

Open AccessArticle

Age-Specific Cardiovascular Risk Factors for Major Adverse Cardiac Events in Patients Undergoing Myocardial Perfusion Imaging

by Rosario Megna, Mario Petretta, Carmela Nappi, Roberta Assante, Emilia Zampella, Valeria Gaudieri, Teresa Mannarino, Adriana D’Antonio, Roberta Green, Valeria Cantoni, Mariarosaria Panico, Wanda Acampa and Alberto Cuocolo

J. Cardiovasc. Dev. Dis. 2023, 10(9), 395; https://doi.org/10.3390/jcdd10090395 - 13 Sep 2023

Cited by 1 | Viewed by 1534

Abstract

Background: The prevalence of traditional cardiovascular risk factors shows different age-specific patterns. It is not known whether the prognostic impact of risk factors is similarly age-specific. We evaluated the profiles of cardiovascular risk factors and their prognostic impact on coronary artery disease (CAD) [...] Read more.

Background: The prevalence of traditional cardiovascular risk factors shows different age-specific patterns. It is not known whether the prognostic impact of risk factors is similarly age-specific. We evaluated the profiles of cardiovascular risk factors and their prognostic impact on coronary artery disease (CAD) in relation to age. Methods: We included 3667 patients with suspected or known CAD undergoing stress myocardial perfusion imaging (MPI). We evaluated the risk for major adverse cardiac events (MACE) within three years from the index MPI in patients belonging to three groups according to age tertile distribution: <59, 59–68, and >68 years. Gender, body mass index, diabetes, hypertension, dyslipidemia, family history of CAD, smoking, angina, dyspnea, previous CAD, and MPI outcome were assessed as risk factors by a multivariable Cox’s regression. Results: The three-year risk of MACE increased progressively with age and was 9%, 13%, and 18% for each group, respectively (p < 0.0001). Dyspnea and abnormal MPI outcome were significant risk factors for all age groups. Diabetes and smoking were significant from the age of 59 onwards, while hypertension resulted significant for patients older than 68 years. Conclusions: The number of risk factors was significantly associated with the occurrence of MACE increase with age. It is noteworthy that a personal history of CAD was not useful for risk stratification, while MPI results were. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Risk Factors and Prevention)

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12 pages, 808 KiB

Open AccessEditor’s ChoiceArticle

“I Just Want You to Hear That Term”: Characterizing Language Used in Fetal Cardiology Consultations

by Kelsey Schweiberger, Kelly W. Harris, Ann Kavanaugh-McHugh, Abdesalam Soudi, Robert M. Arnold, Jessica S. Merlin, Nadine A. Kasparian and Judy C. Chang

J. Cardiovasc. Dev. Dis. 2023, 10(9), 394; https://doi.org/10.3390/jcdd10090394 - 13 Sep 2023

Cited by 3 | Viewed by 2309

Abstract

The way clinicians communicate with parents during pregnancy about congenital heart disease (CHD) can significantly influence parental understanding of and psychological response to the diagnosis. A necessary first step to improving communication used in fetal cardiology consultations is to understand and describe the [...] Read more.

The way clinicians communicate with parents during pregnancy about congenital heart disease (CHD) can significantly influence parental understanding of and psychological response to the diagnosis. A necessary first step to improving communication used in fetal cardiology consultations is to understand and describe the language currently used, which this paper aims to do. Nineteen initial fetal cardiology consultations with parents were audio-recorded, transcribed verbatim, and coded by two independent coders. A codebook was inductively developed and applied to all transcripts. The finalized coding was used to characterize fetal cardiologists’ language. We identified four discourse styles employed in fetal cardiology consultations: small talk, medical, plain, and person-centered. Plain language was used to define and emphasize the meaning of medical language. Person-centered language was used to emphasize the baby as a whole person. Each consultation included all four discourse styles, with plain and medical used most frequently. Person-centered was used less frequently and mostly occurred near the end of the encounters; whether this is the ideal balance of discourse styles is unknown. Clinicians also used person-centered language (as opposed to disease-centered language), which is recommended by medical societies. Future studies should investigate the ideal balance of discourse styles and the effects of clinician discourse styles on family outcomes, including parents’ decision-making, psychological adjustment, and quality of life. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Risk Factors, Prenatal Diagnosis, and Outcomes)

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22 pages, 4318 KiB

Open AccessArticle

Identification of Rare Genetic Variants in Familial Spontaneous Coronary Artery Dissection and Evidence for Shared Biological Pathways

by Tamiel N. Turley, Jeanne L. Theis, Jared M. Evans, Zachary C. Fogarty, Rajiv Gulati, Sharonne N. Hayes, Marysia S. Tweet and Timothy M. Olson

J. Cardiovasc. Dev. Dis. 2023, 10(9), 393; https://doi.org/10.3390/jcdd10090393 - 12 Sep 2023

Cited by 1 | Viewed by 1891

Abstract

Rare familial spontaneous coronary artery dissection (SCAD) kindreds implicate genetic disease predisposition and provide a unique opportunity for candidate gene discovery. Whole-genome sequencing was performed in fifteen probands with non-syndromic SCAD who had a relative with SCAD, eight of whom had a second [...] Read more.

Rare familial spontaneous coronary artery dissection (SCAD) kindreds implicate genetic disease predisposition and provide a unique opportunity for candidate gene discovery. Whole-genome sequencing was performed in fifteen probands with non-syndromic SCAD who had a relative with SCAD, eight of whom had a second relative with extra-coronary arteriopathy. Co-segregating variants and associated genes were prioritized by quantitative variant, gene, and disease-level metrics. Curated public databases were queried for functional relationships among encoded proteins. Fifty-four heterozygous coding variants in thirteen families co-segregated with disease and fulfilled primary filters of rarity, gene variation constraint, and predicted-deleterious protein effect. Secondary filters yielded 11 prioritized candidate genes in 12 families, with high arterial tissue expression (n = 7), high-confidence protein-level interactions with genes associated with SCAD previously (n = 10), and/or previous associations with connective tissue disorders and aortopathies (n = 3) or other vascular phenotypes in mice or humans (n = 11). High-confidence associations were identified among 10 familial SCAD candidate-gene-encoded proteins. A collagen-encoding gene was identified in five families, two with distinct variants in COL4A2. Familial SCAD is genetically heterogeneous, yet perturbations of extracellular matrix, cytoskeletal, and cell–cell adhesion proteins implicate common disease-susceptibility pathways. Incomplete penetrance and variable expression suggest genetic or environmental modifiers. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Genetics' Section)

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14 pages, 1527 KiB

Open AccessArticle

Shared Decision Making and Cardioneuroablation Allow Discontinuation of Permanent Pacing in Patients with Vagally Mediated Bradycardia

by Sebastian Stec, Antoni Wileczek, Agnieszka Reichert, Janusz Śledź, Jarosław Kosior, Dariusz Jagielski, Anna Polewczyk, Magdalena Zając, Andrzej Kutarski, Dariusz Karbarz, Dorota Zyśko, Łukasz Nowarski and Edyta Stodółkiewicz-Nowarska

J. Cardiovasc. Dev. Dis. 2023, 10(9), 392; https://doi.org/10.3390/jcdd10090392 - 11 Sep 2023

Cited by 6 | Viewed by 1595

Abstract

Background: Safe discontinuation of pacemaker therapy for vagally mediated bradycardia is a dilemma. The aim of the study was to present the outcomes of a proposed diagnostic and therapeutic process aimed at discontinuing or not restoring pacemaker therapy (PPM) in patients with vagally [...] Read more.

Background: Safe discontinuation of pacemaker therapy for vagally mediated bradycardia is a dilemma. The aim of the study was to present the outcomes of a proposed diagnostic and therapeutic process aimed at discontinuing or not restoring pacemaker therapy (PPM) in patients with vagally mediated bradycardia. Methods: The study group consisted of two subgroups of patients with suspected vagally mediated bradycardia who were considered to have PPM discontinued or not to restore their PPM if cardioneuroablation (CNA) would successfully treat their bradycardia. A group of 3 patients had just their pacemaker explanted but reimplantation was suggested, and 17 patients had preexisting pacemakers implanted. An invasive electrophysiology study was performed. If EPS was negative, extracardiac vagal nerve stimulation (ECVS) was performed. Then, patients with positive ECVS received CNA. Patients with an implanted pacemaker had it programmed to pace at the lowest possible rate. After the observational period and control EPS including ECVS, redo-CNA was performed if pauses were induced. The decision to explant the pacemaker was obtained based on shared decision making (SDM). RESULTS: After initial clinical and electrophysiological evaluation, 17 patients were deemed eligible for CNA (which was then performed). During the observational period after the initial CNA, all 17 patients were clinically asymptomatic. The subsequent invasive evaluation with ECVS resulted in pause induction in seven (41%) patients, and these patients underwent redo-CNA. Then, SDM resulted in the discontinuation of pacemaker therapy or a decision to not perform pacemaker reimplantation in all the patients after CAN. The pacemaker was explanted in 12 patients post-CNA, while in 2 patients explantation was postponed. During a median follow-up of 18 (IQR: 8–22) months, recurrent syncope did not occur in the CNA recipients. Conclusions: Pacemaker therapy in patients with vagally mediated bradycardia could be discontinued safely after CNA. Full article

(This article belongs to the Special Issue Cardiac Device Therapy)

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15 pages, 1490 KiB

Open AccessArticle

Circulating and Cardiac Tissue miRNAs in Children with Dilated Cardiomyopathy

by Frehiwet T. Hailu, Anis Karimpour-Fard, Bonnie Neltner, Brian L. Stauffer, Steven Lipshultz, Shelley D. Miyamoto and Carmen C. Sucharov

J. Cardiovasc. Dev. Dis. 2023, 10(9), 391; https://doi.org/10.3390/jcdd10090391 - 11 Sep 2023

Viewed by 1484

Abstract

microRNAs (miRs) are small non-coding single-stranded RNAs that regulate gene expression. We previously evaluated expression of miRs in the cardiac tissue of children with dilated cardiomyopathy (DCM) using miRNA-seq. However, a comparative analysis of serum and cardiac miRs has not been performed in [...] Read more.

microRNAs (miRs) are small non-coding single-stranded RNAs that regulate gene expression. We previously evaluated expression of miRs in the cardiac tissue of children with dilated cardiomyopathy (DCM) using miRNA-seq. However, a comparative analysis of serum and cardiac miRs has not been performed in this population. The current study aimed to evaluate miR levels in the serum of pediatric DCM patients compared to healthy non-failing (NF) donor controls and investigate the association between miR levels in tissue and sera from the same pediatric DCM patients. Defining the relationship between serum and tissue miRs may allow the use of circulating miRs as surrogate markers of cardiac miRs. miR levels were investigated through miR-array in sera [n = 10 NF, n = 12 DCM] and miR-seq in tissue (n = 10 NF, n = 12 DCM). Pathway analysis was investigated using the miR enrichment analysis and annotation tool (miEAA) for the five miRs commonly dysregulated in the sera and tissue of pediatric DCM patients. Functional analysis of miRs commonly dysregulated in the sera and tissue of pediatric DCM patients suggests altered pathways related to cell growth, differentiation and proliferation, inflammation, mitochondrial function, and metabolism. These findings suggest that circulating miRs could reflect altered levels of cardiac tissue miRs. Full article

(This article belongs to the Topic Molecular and Cellular Mechanisms of Diseases: Heart Disease)

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15 pages, 1863 KiB

Open AccessReview

β₁ Adrenergic Receptor Autoantibodies and IgG Subclasses: Current Status and Unsolved Issues

by Akane Kawai, Yuji Nagatomo, Midori Yukino-Iwashita, Ryota Nakazawa, Akira Taruoka, Yusuke Yumita, Asako Takefuji, Risako Yasuda, Takumi Toya, Yukinori Ikegami, Nobuyuki Masaki, Yasuo Ido and Takeshi Adachi

J. Cardiovasc. Dev. Dis. 2023, 10(9), 390; https://doi.org/10.3390/jcdd10090390 - 10 Sep 2023

Cited by 1 | Viewed by 2132

Abstract

A wide range of anti-myocardial autoantibodies have been reported since the 1970s. Among them, autoantibodies against the β₁-adrenergic receptor (β₁AR-AAb) have been the most thoroughly investigated, especially in dilated cardiomyopathy (DCM). Β₁AR-Aabs have agonist effects inducing desensitization [...] Read more.

A wide range of anti-myocardial autoantibodies have been reported since the 1970s. Among them, autoantibodies against the β₁-adrenergic receptor (β₁AR-AAb) have been the most thoroughly investigated, especially in dilated cardiomyopathy (DCM). Β₁AR-Aabs have agonist effects inducing desensitization of β₁AR, cardiomyocyte apoptosis, and sustained calcium influx which lead to cardiac dysfunction and arrhythmias. Β₁AR-Aab has been reported to be detected in approximately 40% of patients with DCM, and the presence of the antibody has been associated with worse clinical outcomes. The removal of anti-myocardial autoantibodies including β₁AR-AAb by immunoadsorption is beneficial for the improvement of cardiac function for DCM patients. However, several studies have suggested that its efficacy depended on the removal of AAbs belonging to the IgG3 subclass, not total IgG. IgG subclasses differ in the structure of the Fc region, suggesting that the mechanism of action of β₁AR-AAb differs depending on the IgG subclasses. Our previous clinical research demonstrated that the patients with β₁AR-AAb better responded to β-blocker therapy, but the following studies found that its response also differed among IgG subclasses. Further studies are needed to elucidate the possible pathogenic role of IgG subclasses of β1AR-AAbs in DCM, and the broad spectrum of cardiovascular diseases including HF with preserved ejection fraction. Full article

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7 pages, 1536 KiB

Open AccessCase Report

Unexplained Left Ventricular Hypertrophy Diagnosed as a Cardiac Variant of Late-Onset Fabry Disease: A Case Report

by Maomao Zhao, Xiaowei Niu, Lu Bai, Yinchang Zhang, Ting Wang, Yongling Wa, Junchu Wei, Kang Dong, Xin Zhang and Ming Bai

J. Cardiovasc. Dev. Dis. 2023, 10(9), 389; https://doi.org/10.3390/jcdd10090389 - 10 Sep 2023

Viewed by 1856

Abstract

The cardiac variant of Fabry disease (FD) has high rates of missed diagnosis and misdiagnosis due to the lack of systemic symptoms. Here, we report a case of a 68-year-old female with delayed-onset FD presenting as concentric left ventricular hypertrophy (LVH) with right [...] Read more.

The cardiac variant of Fabry disease (FD) has high rates of missed diagnosis and misdiagnosis due to the lack of systemic symptoms. Here, we report a case of a 68-year-old female with delayed-onset FD presenting as concentric left ventricular hypertrophy (LVH) with right bundle branch block, atrial fibrillation, and diastolic dysfunction, which was first presented with coronary artery spasm. Early cardiac-specific signs are crucial for diagnosing this disease due to the lack of extracardiac indications and the late onset of symptoms. This case raises a new red flag that patients with unexplained LVH and its atypical electrocardiographic (ECG) manifestations accompanied by diastolic dysfunction should be considered for FD. We also recommend further refinement of examinations associated with Fabry disease, which will contribute to the early diagnosis and treatment of the disease. Full article

(This article belongs to the Topic New Insights on Chronic Illness: Pathogenesis, Prevalence, Prevention, and Systemic Therapies)

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15 pages, 733 KiB

Open AccessReview

Vericiguat: The Fifth Harmony of Heart Failure with Reduced Ejection Fraction

by Luigi Falco, Benedetta Brescia, Dario Catapano, Maria Luigia Martucci, Fabio Valente, Rita Gravino, Carla Contaldi, Giuseppe Pacileo and Daniele Masarone

J. Cardiovasc. Dev. Dis. 2023, 10(9), 388; https://doi.org/10.3390/jcdd10090388 - 8 Sep 2023

Cited by 5 | Viewed by 2844

Abstract

Heart failure with reduced ejection fraction is a chronic and progressive syndrome that continues to be a substantial financial burden for health systems in Western countries. Despite remarkable advances in pharmacologic and device-based therapy over the last few years, patients with heart failure [...] Read more.

Heart failure with reduced ejection fraction is a chronic and progressive syndrome that continues to be a substantial financial burden for health systems in Western countries. Despite remarkable advances in pharmacologic and device-based therapy over the last few years, patients with heart failure with reduced ejection fraction have a high residual risk of adverse outcomes, even when treated with optimal guideline-directed medical therapy and in a clinically stable state. Worsening heart failure episodes represent a critical event in the heart failure trajectory, carrying high residual risk at discharge and dismal short- or long-term prognosis. Recently, vericiguat, a soluble guanylate cyclase stimulator, has been proposed as a novel drug whose use is already associated with a reduction in heart failure-related hospitalizations in patients in guideline-directed medical therapy. In this review, we summarized the pathophysiology of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate cascade in patients with heart failure with reduced ejection fraction, the pharmacology of vericiguat as well as the evidence regarding their use in patients with HFrEF. Finally, tips and tricks for its use in standard clinical practice are provided. Full article

(This article belongs to the Special Issue Feature Review Papers in Acquired Cardiovascular Disease)

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10 pages, 1592 KiB

Open AccessArticle

Influence of Chromosome 9p21.3 rs1333049 Variant on Telomere Length and Their Interactive Impact on the Prognosis of Coronary Artery Disease

by Andrea Borghini, Antonella Mercuri, Jonica Campolo, Marina Parolini, Rudina Ndreu, Stefano Turchi and Maria Grazia Andreassi

J. Cardiovasc. Dev. Dis. 2023, 10(9), 387; https://doi.org/10.3390/jcdd10090387 - 7 Sep 2023

Cited by 1 | Viewed by 1405

Abstract

Background: Both telomere shortening and the chromosome 9p21.3 (Chr9p21) rs1333049 (G/C) variant are involved in coronary artery disease (CAD) risk, likely affecting mechanisms related to cell cycle arrest and vascular senescence. The aim of the study was to examine the link between Chr9p21 [...] Read more.

Background: Both telomere shortening and the chromosome 9p21.3 (Chr9p21) rs1333049 (G/C) variant are involved in coronary artery disease (CAD) risk, likely affecting mechanisms related to cell cycle arrest and vascular senescence. The aim of the study was to examine the link between Chr9p21 rs1333049 variant and leucocyte telomere length (LTL), as well as their interactive effect on the risk of major adverse cardiovascular events (MACEs). Methods: A cohort of 472 patients with angiographically proven and clinically stable CAD were included in the study. At baseline, the LTL, biochemical parameters, and genotype analysis of Chr9p21 rs1333049 variant were measured in all patients. The primary endpoint of this study was the occurrence of MACE defined as a composite of coronary-related death, nonfatal MI, and coronary revascularization. Results: On multivariable linear regression analysis, age (p = 0.02) and Chr9p21 rs1333049 variant (p = 0.002) were the only independent predictors of LTL levels. Carriers of the CC genotype of this SNP had shorter telomeres than GC carriers (p = 0.02) and GG carriers (p = 0.0005). After a follow-up with a mean period of 62 ± 19 months, 90 patients (19.1%) had MACE. Short LTL was an independent prognostic factor of MACE incidence (HR:2.2; 95% CI: 1.3–3.7; p = 0.005) after adjustment for potential confounders. There was a significant interaction (p = 0.01) between the LTL and rs1333049 variant, with patients with risk-allele C and short LTL having a higher risk (HR:5.8; 95% CI: 1.8–19.2; p = 0.004). Conclusion: A strong relationship between LTL and Chr9p21 rs1333049 variant was identified, and they interactively affect the risk of poor prognosis in CAD patients. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Genetics' Section)

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14 pages, 12547 KiB

Open AccessArticle

Liraglutide Attenuates Aortic Valve Calcification in a High-Cholesterol-Diet-Induced Experimental Calcific Aortic Valve Disease Model in Apolipoprotein E-Deficient Mice

by Yangzhao Zhou, Zhaoshun Yuan, Min Wang, Zhiyuan Zhang, Changming Tan, Jiaolian Yu, Yanfeng Bi, Xiaobo Liao, Xinmin Zhou, Md Sayed Ali Sheikh and Dafeng Yang

J. Cardiovasc. Dev. Dis. 2023, 10(9), 386; https://doi.org/10.3390/jcdd10090386 - 6 Sep 2023

Cited by 2 | Viewed by 1890

Abstract

Background: Calcific aortic valve disease (CAVD) is a significant cause of morbidity and mortality among elderly people. However, no effective medications have been approved to slow or prevent the progression of CAVD. Here, we examined the effect of liraglutide on aortic valve stenosis. [...] Read more.

Background: Calcific aortic valve disease (CAVD) is a significant cause of morbidity and mortality among elderly people. However, no effective medications have been approved to slow or prevent the progression of CAVD. Here, we examined the effect of liraglutide on aortic valve stenosis. Methods: Male Apoe^−/− mice were fed with a high-cholesterol diet for 24 weeks to generate an experimental CAVD model and randomly assigned to a liraglutide treatment group or control group. Echocardiography and immunohistological analyses were performed to examine the aortic valve function and morphology, fibrosis, and calcium deposition. Plasma Glucagon-like peptide-1 (GLP-1) levels and inflammatory contents were measured via ELISA, FACS, and immunofluorescence. RNA sequencing (RNA-seq) was used to identify liraglutide-affected pathways and processes. Results: Plasma GLP-1 levels were reduced in the CAVD model, and liraglutide treatment significantly improved aortic valve calcification and functions and attenuated inflammation. RNA-seq showed that liraglutide affects multiple myofibroblastic and osteogenic differentiations or inflammation-associated biological states or processes in the aortic valve. Those liraglutide-mediated beneficial effects were associated with increased GLP-1 receptor (GLP-1R) expression. Conclusions: Liraglutide blocks aortic valve calcification and may serve as a potential therapeutic drug for CAVD treatment. Full article

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12 pages, 1022 KiB

Open AccessArticle

Construction and Validation of a Nomogram Predicting Depression Risk in Patients with Acute Coronary Syndrome Undergoing Coronary Stenting: A Prospective Cohort Study

by Xing Miao, Yongli Chen, Xiaoxia Qiu and Rehua Wang

J. Cardiovasc. Dev. Dis. 2023, 10(9), 385; https://doi.org/10.3390/jcdd10090385 - 6 Sep 2023

Cited by 1 | Viewed by 1310

Abstract

Purpose: To construct and validate a nomogram for predicting depression after acute coronary stent implantation for risk assessment. Methods: This study included 150 patients with acute coronary syndrome (ACS) who underwent stent implantation. Univariate analysis was performed to identify the predictors of postoperative [...] Read more.

Purpose: To construct and validate a nomogram for predicting depression after acute coronary stent implantation for risk assessment. Methods: This study included 150 patients with acute coronary syndrome (ACS) who underwent stent implantation. Univariate analysis was performed to identify the predictors of postoperative depression among the 24 factors. Subsequently, multivariate logistic regression was performed to incorporate the significant predictors into the prediction model. The model was developed using the “rms” software package in R software, and internal validation was performed using the bootstrap method. Results: Of the 150 patients, 82 developed depressive symptoms after coronary stent implantation, resulting in an incidence of depression of 54.7%. Univariate analysis showed that sleep duration ≥7 h, baseline GAD-7 score, baseline PHQ-9 score, and postoperative GAD-7 score were associated with the occurrence of depression after stenting in ACS patients (all p < 0.05). Multivariate logistic regression analysis revealed that major life events in the past year (OR = 2.783,95%CI: 1.121–6.907, p = 0.027), GAD-7 score after operation (OR = 1.165, 95% CI: 1.275–2.097, p = 0.000), and baseline PHQ-9 score (OR = 3.221, 95%CI: 2.065–5.023, p = 0.000) were significant independent risk factors for ACS patients after stent implantation. Based on these results, a predictive nomogram was constructed. The model demonstrated good prediction ability, with an AUC of 0.857 (95% CI = 0.799–0.916). The correction curve showed a good correlation between the predicted results and the actual results (Brier score = 0.15). The decision curve analysis and prediction model curve had clinical practical value in the threshold probability range of 7 to 94%. Conclusions: This nomogram can help to predict the incidence of depression and has good clinical application value. This trial is registered with ChiCTR2300071408. Full article

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24 pages, 2737 KiB

Open AccessSystematic Review

Application of Patient-Specific Computational Fluid Dynamics in Anomalous Aortic Origin of Coronary Artery: A Systematic Review

by Anselm W. Stark, Andreas A. Giannopoulos, Alexander Pugachev, Isaac Shiri, Andreas Haeberlin, Lorenz Räber, Dominik Obrist and Christoph Gräni

J. Cardiovasc. Dev. Dis. 2023, 10(9), 384; https://doi.org/10.3390/jcdd10090384 - 6 Sep 2023

Cited by 3 | Viewed by 1954

Abstract

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart condition with fixed and dynamic stenotic elements, potentially causing ischemia. Invasive coronary angiography under stress is the established method for assessing hemodynamics in AAOCA, yet it is costly, technically intricate, [...] Read more.

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart condition with fixed and dynamic stenotic elements, potentially causing ischemia. Invasive coronary angiography under stress is the established method for assessing hemodynamics in AAOCA, yet it is costly, technically intricate, and uncomfortable. Computational fluid dynamics (CFD) simulations offer a noninvasive alternative for patient-specific hemodynamic analysis in AAOCA. This systematic review examines the role of CFD simulations in AAOCA, encompassing patient-specific modeling, noninvasive imaging-based boundary conditions, and flow characteristics. Screening articles using AAOCA and CFD-related terms prior to February 2023 yielded 19 publications, covering 370 patients. Over the past four years, 12 (63%) publications (259 patients) employed dedicated CFD models, whereas 7 (37%) publications (111 patients) used general-purpose CFD models. Dedicated CFD models were validated for fixed stenosis but lacked dynamic component representation. General-purpose CFD models exhibited variability and limitations, with fluid–solid interaction models showing promise. Interest in CFD modeling of AAOCA has surged recently, mainly utilizing dedicated models. However, these models inadequately replicate hemodynamics, necessitating novel CFD approaches to accurately simulate pathophysiological changes in AAOCA under stress conditions. Full article

(This article belongs to the Section Basic and Translational Cardiovascular Research)

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24 pages, 5219 KiB

Open AccessReview

Clinical and Translational Imaging and Sensing of Diabetic Microangiopathy: A Narrative Review

by Nikolina-Alexia Fasoula, Yi Xie, Nikoletta Katsouli, Mario Reidl, Michael A. Kallmayer, Hans-Henning Eckstein, Vasilis Ntziachristos, Leontios Hadjileontiadis, Dimitrios V. Avgerinos, Alexandros Briasoulis, Gerasimos Siasos, Kaveh Hosseini, Ilias Doulamis, Polydoros N. Kampaktsis and Angelos Karlas

J. Cardiovasc. Dev. Dis. 2023, 10(9), 383; https://doi.org/10.3390/jcdd10090383 - 6 Sep 2023

Cited by 1 | Viewed by 2252

Abstract

Microvascular changes in diabetes affect the function of several critical organs, such as the kidneys, heart, brain, eye, and skin, among others. The possibility of detecting such changes early enough in order to take appropriate actions renders the development of appropriate tools and [...] Read more.

Microvascular changes in diabetes affect the function of several critical organs, such as the kidneys, heart, brain, eye, and skin, among others. The possibility of detecting such changes early enough in order to take appropriate actions renders the development of appropriate tools and techniques an imperative need. To this end, several sensing and imaging techniques have been developed or employed in the assessment of microangiopathy in patients with diabetes. Herein, we present such techniques; we provide insights into their principles of operation while discussing the characteristics that make them appropriate for such use. Finally, apart from already established techniques, we present novel ones with great translational potential, such as optoacoustic technologies, which are expected to enter clinical practice in the foreseeable future. Full article

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25 pages, 2310 KiB

Open AccessReview

The Current State of Research on Sirtuin-Mediated Autophagy in Cardiovascular Diseases

by Yuqin Wang, Yongnan Li, Hong Ding, Dan Li, Wanxi Shen and Xiaowei Zhang

J. Cardiovasc. Dev. Dis. 2023, 10(9), 382; https://doi.org/10.3390/jcdd10090382 - 6 Sep 2023

Cited by 3 | Viewed by 3210

Abstract

Sirtuins belong to the class III histone deacetylases and possess nicotinamide adenine dinucleotide-dependent deacetylase activity. They are involved in the regulation of multiple signaling pathways implicated in cardiovascular diseases. Autophagy is a crucial adaptive cellular response to stress stimuli. Mounting evidence suggests a [...] Read more.

Sirtuins belong to the class III histone deacetylases and possess nicotinamide adenine dinucleotide-dependent deacetylase activity. They are involved in the regulation of multiple signaling pathways implicated in cardiovascular diseases. Autophagy is a crucial adaptive cellular response to stress stimuli. Mounting evidence suggests a strong correlation between Sirtuins and autophagy, potentially involving cross-regulation and crosstalk. Sirtuin-mediated autophagy plays a crucial regulatory role in some cardiovascular diseases, including atherosclerosis, ischemia/reperfusion injury, hypertension, heart failure, diabetic cardiomyopathy, and drug-induced myocardial damage. In this context, we summarize the research advancements pertaining to various Sirtuins involved in autophagy and the molecular mechanisms regulating autophagy. We also elucidate the biological function of Sirtuins across diverse cardiovascular diseases and further discuss the development of novel drugs that regulate Sirtuin-mediated autophagy. Full article

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19 pages, 1066 KiB

Open AccessTechnical Note

Design and Harmonization Approach for the Multi-Institutional Neurocognitive Discovery Study (MINDS) of Adult Congenital Heart Disease (ACHD) Neuroimaging Ancillary Study: A Technical Note

by Ashok Panigrahy, Vanessa Schmithorst, Rafael Ceschin, Vince Lee, Nancy Beluk, Julia Wallace, Olivia Wheaton, Thomas Chenevert, Deqiang Qiu, James N Lee, Andrew Nencka, Borjan Gagoski, Jeffrey I. Berman, Weihong Yuan, Christopher Macgowan, James Coatsworth, Lazar Fleysher, Christopher Cannistraci, Lynn A. Sleeper, Arvind Hoskoppal, Candice Silversides, Rupa Radhakrishnan, Larry Markham, John F. Rhodes, Lauryn M. Dugan, Nicole Brown, Peter Ermis, Stephanie Fuller, Timothy Brett Cotts, Fred Henry Rodriguez, Ian Lindsay, Sue Beers, Howard Aizenstein, David C. Bellinger, Jane W. Newburger, Laura Glass Umfleet, Scott Cohen, Ali Zaidi and Michelle Gurvitz Show full author list Hide full author list

J. Cardiovasc. Dev. Dis. 2023, 10(9), 381; https://doi.org/10.3390/jcdd10090381 - 6 Sep 2023

Viewed by 2193

Abstract

Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate [...] Read more.

Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate domain-specific neurocognitive deficits associated with reduced quality of life that include deficits in educational attainment and social interaction. Our hypothesis is that ACHD patients exhibit vascular brain injury and structural/physiological brain alterations that are predictive of specific neurocognitive deficits modified by behavioral and environmental enrichment proxies of cognitive reserve (e.g., level of education and lifestyle/social habits). This technical note describes an ancillary study to the National Heart, Lung, and Blood Institute (NHLBI)-funded Pediatric Heart Network (PHN) “Multi-Institutional Neurocognitive Discovery Study (MINDS) in Adult Congenital Heart Disease (ACHD)”. Leveraging clinical, neuropsychological, and biospecimen data from the parent study, our study will provide structural–physiological correlates of neurocognitive outcomes, representing the first multi-center neuroimaging initiative to be performed in ACHD patients. Limitations of the study include recruitment challenges inherent to an ancillary study, implantable cardiac devices, and harmonization of neuroimaging biomarkers. Results from this research will help shape the care of ACHD patients and further our understanding of the interplay between brain injury and cognitive reserve. Full article

(This article belongs to the Special Issue Congenital Heart Defects: Diagnosis, Management, and Treatment)

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11 pages, 1739 KiB

Open AccessReview

Is There a Future for Minimal Access and Robots in Cardiac Surgery?

by Gloria Faerber, Murat Mukharyamov and Torsten Doenst

J. Cardiovasc. Dev. Dis. 2023, 10(9), 380; https://doi.org/10.3390/jcdd10090380 - 4 Sep 2023

Viewed by 2163

Abstract

Minimally invasive techniques in cardiac surgery have found increasing use in recent years. Both patients and physicians often associate smaller incisions with improved outcomes (i.e., less risk, shorter hospital stay, and a faster recovery). Videoscopic and robotic assistance has been introduced, but their [...] Read more.

Minimally invasive techniques in cardiac surgery have found increasing use in recent years. Both patients and physicians often associate smaller incisions with improved outcomes (i.e., less risk, shorter hospital stay, and a faster recovery). Videoscopic and robotic assistance has been introduced, but their routine use requires specialized training and is associated with potentially longer operating times and higher costs. Randomized evidence is scarce and transcatheter treatment alternatives are increasing rapidly. As a result, the concept of minimally invasive cardiac surgery may be viewed with skepticism. In this review, we examine the current status and potential future perspectives of minimally invasive and robotic cardiac surgery. Full article

(This article belongs to the Special Issue Minimal Access Cardiac Surgery: State of the Art and Future Perspectives)

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14 pages, 6691 KiB

Open AccessSystematic Review

Allopurinol for Secondary Prevention in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Yuyang Ye, Guangzhi Liao, Ting Liu, Xinru Hu, Xuefeng Chen, Lin Bai and Yong Peng

J. Cardiovasc. Dev. Dis. 2023, 10(9), 379; https://doi.org/10.3390/jcdd10090379 - 4 Sep 2023

Cited by 4 | Viewed by 2372

Abstract

Background: The effects of allopurinol in patients with cardiovascular disease are not well defined; therefore, the latest evidence is summarized in this study. Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) of allopurinol in patients with [...] Read more.

Background: The effects of allopurinol in patients with cardiovascular disease are not well defined; therefore, the latest evidence is summarized in this study. Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) of allopurinol in patients with cardiovascular disease published up to 11 February 2023. The primary outcome was cardiovascular death. Results: We combined the results of 21 RCTs that included 22,806 patients. Compared to placebo/usual care, allopurinol treatment was not associated with a significant reduction in cardiovascular death (RR 0.60; 95% CI 0.33–1.11) or all-cause death (RR 0.90; 95% CI 0.72–1.12). However, evidence from earlier trials and studies with small sample sizes indicated that allopurinol might confer a protective effect in decreasing cardiovascular death (RR 0.34; 95% CI 0.15–0.76) across patients undergoing coronary artery bypass grafting (CABG) or having acute coronary syndrome (ACS). In comparisons between allopurinol and febuxostat, we observed no difference in cardiovascular death (RR 0.92; 95% CI 0.69–1.24) or all-cause death (RR 1.02; 95% CI 0.75–1.38). Conclusion: Allopurinol could not reduce cardiovascular (CV) death or major adverse CV outcomes significantly in patients with existing cardiovascular diseases. Given the limitations of the original studies, the potential advantages of allopurinol observed in patients undergoing CABG or presenting with ACS necessitate further confirmation through subsequent RCTs. In the comparisons between allopurinol and febuxostat, our analysis failed to uncover any marked superiority of allopurinol in reducing the risk of adverse cardiovascular incidents. Full article

(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)

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7 pages, 1433 KiB

Open AccessCase Report

“Troponinosis”, the Cardiologist’s Curse—When Clinic–Laboratory Interaction Unveils the Mystery: A Case Report

by Davide Bosi, Simone Canovi, Andrea Pennacchioni, Pierluigi Demola, Mattia Corradini, Vincenzo Guiducci, Rossana Colla and Alessandro Navazio

J. Cardiovasc. Dev. Dis. 2023, 10(9), 378; https://doi.org/10.3390/jcdd10090378 - 3 Sep 2023

Viewed by 1414

Abstract

Cardiac troponins are key diagnostic and prognostic biomarkers in acute myocardial infarction and, more generally, for the detection of myocardial injury. Since the introduction of the first immunochemistry methods, there has been a remarkable evolution in analytical performance, especially concerning a progressive improvement [...] Read more.

Cardiac troponins are key diagnostic and prognostic biomarkers in acute myocardial infarction and, more generally, for the detection of myocardial injury. Since the introduction of the first immunochemistry methods, there has been a remarkable evolution in analytical performance, especially concerning a progressive improvement in sensitivity. However, the measurement of circulating troponins remains rarely susceptible to analytical interferences. We report a case of persistently elevated troponin I concentrations in a patient with known ischemic heart disease, which almost led to unnecessary diagnostic–therapeutic interventions. A prompt laboratory consultation by the cardiologist ultimately led to the identification of an analytical interference due to troponin macrocomplexes (macrotroponin) causing elevated troponin values in the absence of a clinical presentation compatible with myocardial damage. Full article

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16 pages, 3134 KiB

Open AccessEditor’s ChoiceReview

Transport and Anaesthesia Consideration for Transcatheter Patent Ductus Arteriosus Closure in Premature Infants

by Tuan Chen Aw, Belinda Chan and Yogen Singh

J. Cardiovasc. Dev. Dis. 2023, 10(9), 377; https://doi.org/10.3390/jcdd10090377 - 1 Sep 2023

Cited by 4 | Viewed by 2104

Abstract

Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and [...] Read more.

Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and limited reserves presents unique challenges. This review article focuses on the key considerations throughout the clinical pathway for the PDA device closure, including referral hospital consultation, patient selection, intra- and inter-hospital transport, and anaesthesia management. The key elements encompass comprehensive patient assessment, meticulous airway management, optimised ventilation strategies, precise thermoregulation, patient-tailored sedation protocols, vigilant haemodynamic monitoring, and safe transport measures throughout the pre-operative, intra-operative, and post-operative phases. A multidisciplinary approach enhances the chances of procedure success, improves patient outcomes, and minimises the risk of complications. Full article

(This article belongs to the Special Issue Patent Ductus Arteriosus in Premature Babies)

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