Journal of Cardiovascular Development and Disease

13 pages, 1220 KiB

Open AccessArticle

Heart Rate Variability in Acute Myocardial Infarction: Results of the HeaRt-V-AMI Single-Center Cohort Study

by Crischentian Brinza, Mariana Floria, Dragos-Viorel Scripcariu, Alexandra Maria Covic, Adrian Covic, Iolanda Valentina Popa, Cristian Statescu and Alexandru Burlacu

J. Cardiovasc. Dev. Dis. 2024, 11(8), 254; https://doi.org/10.3390/jcdd11080254 - 22 Aug 2024

Viewed by 1001

Abstract

(1) Background: Heart rate variability (HRV) has been investigated in the context of ST-segment elevation myocardial infarction (STEMI). This study contributes to the field by assessing short-term HRV during primary percutaneous coronary intervention (PCI) using wearable technology, providing real-time insights into autonomic function. [...] Read more.

(1) Background: Heart rate variability (HRV) has been investigated in the context of ST-segment elevation myocardial infarction (STEMI). This study contributes to the field by assessing short-term HRV during primary percutaneous coronary intervention (PCI) using wearable technology, providing real-time insights into autonomic function. (2) Methods: This single-center, observational cohort study included 104 STEMI patients undergoing primary percutaneous coronary intervention (PCI). HRV parameters (including SDNN, RMSSD, pNN50, HF, SD1, and SD2/SD1 ratio) were measured using a wearable device (Empatica E4 wristband, CE certified). Measurements were taken throughout the entire duration of the primary PCI, as well as specifically during the initial 5 min and the final 5 min of the procedure. The association between HRV parameters and adverse outcomes, including in-hospital mortality and in-hospital major adverse cardiovascular events (MACE), were assessed. (3) Results: HRV parameters significantly decreased after myocardial revascularization, particularly SDNN, RMSSD, pNN50, HF, SD1, and SD2/SD1 ratio. Significant associations were found between reduced SD2/SD1 ratio, approximate entropy, and adverse outcomes, including increased in-hospital mortality and in-hospital MACE (respectively, p = 0.007, p = 0.017 and p = 0.006 and p = 0.005). The SD2/SD1 ratio was significantly lower in patients who died during the hospital stay (p = 0.008) compared to survivors. Approximate entropy was also significantly lower in deceased patients (p = 0.019). (4) Conclusions: Real-time HRV monitoring using wearable technology offers valuable data regarding dynamic physiological changes during primary PCI. Further studies are required to validate these preliminary results and to explore their potential implications for clinical practice. Full article

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8 pages, 614 KiB

Open AccessArticle

Patterns and Complications of Congenital Heart Disease in Adolescents and Adults in Ethiopia

by Misikr Alemu Eshetu, Dejuma Yadeta Goshu, Molla Asnake Kebede, Hashim Meketa Negate, Abiel Berhe Habtezghi, Paula Marsh Gregory, Amenu Tolera Wirtu and Jickssa Mulissa Gemechu

J. Cardiovasc. Dev. Dis. 2024, 11(8), 253; https://doi.org/10.3390/jcdd11080253 - 19 Aug 2024

Viewed by 1175

Abstract

Background: Congenital heart disease (CHD) encompasses morphofunctional anomalies in the heart and circulatory system present at birth, which may not become apparent until later in life. In Ethiopia, there needs to be more understanding of the prevalence, patterns, and associated complications of CHD [...] Read more.

Background: Congenital heart disease (CHD) encompasses morphofunctional anomalies in the heart and circulatory system present at birth, which may not become apparent until later in life. In Ethiopia, there needs to be more understanding of the prevalence, patterns, and associated complications of CHD malformations. This study aimed to investigate the patterns and complications of CHDs among patients receiving follow-up care at a specialized university referral hospital in Ethiopia. Methods: A hospital-based cross-sectional study was conducted on 199 patients with CHDs to assess the patterns and complications of defects. Retrospective data were collected from 16,972 patients who had follow-ups at a cardiac clinic in 2021 using medical records, and a statistical analysis was performed with SPSS version 24. Results: The most prevalent types of CHDs in our study population were atrial septal defects (ASDs) at 41.2% (82 cases), ventricular septal defects (VSDs) at 26.6% (53 cases), and patent ductus arteriosus (PDAs) at 9.5% (19 cases). Complications related to CHDs were observed in 69.3% (138) of patients, with 30.7% (61) experiencing a single complication and 39.2% (87) experiencing multiple complications. Conclusion: This study found a higher prevalence of CHDs in females (77.8%) compared to males, a trend consistent across various atrial and ventricular defect types. Individuals aged 15 to 25 years exhibited the highest incidence of ASD and VSD. Moreover, CHD-related anomalies were present in 69.3% of the patients studied. Full article

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27 pages, 4960 KiB

Open AccessEditor’s ChoiceReview

The Functional Significance of Cardiac Looping: Comparative Embryology, Anatomy, and Physiology of the Looped Design of Vertebrate Hearts

by Jörg Männer

J. Cardiovasc. Dev. Dis. 2024, 11(8), 252; https://doi.org/10.3390/jcdd11080252 - 17 Aug 2024

Viewed by 1588

Abstract

The flow path of vertebrate hearts has a looped configuration characterized by curved (sigmoid) and twisted (chiral) components. The looped heart design is phylogenetically conserved among vertebrates and is thought to represent a significant determinant of cardiac pumping function. It evolves during the [...] Read more.

The flow path of vertebrate hearts has a looped configuration characterized by curved (sigmoid) and twisted (chiral) components. The looped heart design is phylogenetically conserved among vertebrates and is thought to represent a significant determinant of cardiac pumping function. It evolves during the embryonic period of development by a process called “cardiac looping”. During the past decades, remarkable progress has been made in the uncovering of genetic, molecular, and biophysical factors contributing to cardiac looping. Our present knowledge of the functional consequences of cardiac looping lags behind this impressive progress. This article provides an overview and discussion of the currently available information on looped heart design and its implications for the pumping function. It is emphasized that: (1) looping seems to improve the pumping efficiency of the valveless embryonic heart. (2) bilaterally asymmetric (chiral) looping plays a central role in determining the alignment and separation of the pulmonary and systemic flow paths in the multi-chambered heart of tetrapods. (3) chiral looping is not needed for efficient pumping of the two-chambered hearts of fish. (4) it is the sigmoid curving of the flow path that may improve the pumping efficiency of lower as well as higher vertebrate hearts. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Cardiac Development and Regeneration' Section — from Development to Regeneration)

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11 pages, 1314 KiB

Open AccessArticle

The Effects of Colchicum Dispert and Bone Marrow-Derived Mesenchymal Stem Cell Therapy on Skeletal Muscle Injury in a Rat Aortic Ischemia–Reperfusion Model

by Atilla Orhan, Ömer Faruk Çiçek, Bahadır Öztürk, Hakan Akbayrak, Nejat Ünlükal, Hakan Vatansev, Merve Solmaz, Mustafa Büyükateş, Seda Aniç, Fadime Ovalı, Eissa Almaghrebi, Fatma Akat and Hüsamettin Vatansev

J. Cardiovasc. Dev. Dis. 2024, 11(8), 251; https://doi.org/10.3390/jcdd11080251 - 16 Aug 2024

Viewed by 1160

Abstract

Background: Abdominal aortic aneurysms and peripheral artery disease pose significant health risks, ranking third after heart attacks and cerebral strokes. Surgical interventions often involve temporary aortic clamping, leading to ischemia–reperfusion injury and tissue damage. Colchicine and mesenchymal stem cells have shown promise, individually, [...] Read more.

Background: Abdominal aortic aneurysms and peripheral artery disease pose significant health risks, ranking third after heart attacks and cerebral strokes. Surgical interventions often involve temporary aortic clamping, leading to ischemia–reperfusion injury and tissue damage. Colchicine and mesenchymal stem cells have shown promise, individually, in mitigating ischemia–reperfusion injury, but their combined effects remain understudied. Methods: This study utilized 42 male Wistar rats, divided into six groups: Control, Sham, Ischemia–Reperfusion, Colchicine, Mesenchymal stem cell, and Mix (colchicine and mesenchymal stem cell). The ischemia–reperfusion model involved clamping the abdominal aorta for 60 min, followed by 120 min of reperfusion. Colchicine and mesenchymal stem cell treatments were administered as pre- and post-ischemia interventions, respectively. Mesenchymal stem cells were cultured, characterized by flow cytometry, and verified for specific surface antigens. Blood and tissue samples were analyzed for oxidative stress markers, nitric oxide metabolites, and apoptosis using TUNEL. Results: There were significant differences between the groups in terms of the serum total antioxidant capacity (p < 0.001) and inflammation markers (ischemia-modified albumin, p = 0.020). The combined therapy group (Mix) exhibited the lowest inflammation levels. Arginine levels also showed significant variation (p = 0.028), confirming the ischemia–reperfusion injury model. In muscle tissues, the total antioxidant capacity (p = 0.022), symmetric dimethylarginine, and citrulline levels (p < 0.05) indicated nitric oxide metabolism. Apoptosis was notably high in the ischemia–reperfusion injury group as anticipated. It appeared to be reduced by colchicine, mesenchymal stem cells, and their combination, with the most significant decrease observed in the Mix group (p < 0.001). Conclusions: This study highlights the potential of using combined colchicine and mesenchymal stem cell therapy to reduce muscle damage caused by ischemia–reperfusion injury. Further research is needed to understand the underlying mechanisms and confirm the clinical significance of this approach in treating extremity ischemia–reperfusion injuries. Full article

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

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11 pages, 1736 KiB

Open AccessEditor’s ChoiceReview

Socioeconomic Status and Access to Care for Pediatric and Adult Congenital Heart Disease in Universal Health Coverage Models

by Amanda A. Greenwell, Mimi X. Deng, Shelagh Ross, Viktoria Weixler and Dominique Vervoort

J. Cardiovasc. Dev. Dis. 2024, 11(8), 250; https://doi.org/10.3390/jcdd11080250 - 16 Aug 2024

Cited by 1 | Viewed by 1441

Abstract

Congenital heart disease (CHD) is the most common major congenital anomaly, affecting one in every 100 live births. Whereas over 90% of children born with CHD in low- and middle-income countries cannot access the care they need, early detection, advances in management, and [...] Read more.

Congenital heart disease (CHD) is the most common major congenital anomaly, affecting one in every 100 live births. Whereas over 90% of children born with CHD in low- and middle-income countries cannot access the care they need, early detection, advances in management, and financial risk protection have resulted in over 90% of children with CHD in high-income countries surviving into adulthood. Despite the presence of universal health coverage, barriers to accessing high-quality cardiovascular and non-cardiovascular care for CHD remain common. Lower socioeconomic status has been associated with differential access to cardiac care and poorer outcomes across multiple cardiovascular conditions and subspecialties. In this review article, we describe the relationship between socioeconomic status and access to CHD care in countries with universal health coverage models. We further evaluate notable challenges and opportunities to improve equitable, high-quality CHD care in these countries. Full article

(This article belongs to the Special Issue Congenital Heart Disease: The Effects of Social Determinants of Health on Burdens and Outcomes)

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18 pages, 9680 KiB

Open AccessArticle

Efficient and Accurate 3D Thickness Measurement in Vessel Wall Imaging: Overcoming Limitations of 2D Approaches Using the Laplacian Method

by SeyyedKazem HashemizadehKolowri, Ebru Yaman Akcicek, Halit Akcicek, Xiaodong Ma, Marina S. Ferguson, Niranjan Balu, Thomas S. Hatsukami and Chun Yuan

J. Cardiovasc. Dev. Dis. 2024, 11(8), 249; https://doi.org/10.3390/jcdd11080249 - 15 Aug 2024

Viewed by 843

Abstract

The clinical significance of measuring vessel wall thickness is widely acknowledged. Recent advancements have enabled high-resolution 3D scans of arteries and precise segmentation of their lumens and outer walls; however, most existing methods for assessing vessel wall thickness are 2D. Despite being valuable, [...] Read more.

The clinical significance of measuring vessel wall thickness is widely acknowledged. Recent advancements have enabled high-resolution 3D scans of arteries and precise segmentation of their lumens and outer walls; however, most existing methods for assessing vessel wall thickness are 2D. Despite being valuable, reproducibility and accuracy of 2D techniques depend on the extracted 2D slices. Additionally, these methods fail to fully account for variations in wall thickness in all dimensions. Furthermore, most existing approaches are difficult to be extended into 3D and their measurements lack spatial localization and are primarily confined to lumen boundaries. We advocate for a shift in perspective towards recognizing vessel wall thickness measurement as inherently a 3D challenge and propose adapting the Laplacian method as an outstanding alternative. The Laplacian method is implemented using convolutions, ensuring its efficient and rapid execution on deep learning platforms. Experiments using digital phantoms and vessel wall imaging data are conducted to showcase the accuracy, reproducibility, and localization capabilities of the proposed approach. The proposed method produce consistent outcomes that remain independent of centerlines and 2D slices. Notably, this approach is applicable in both 2D and 3D scenarios. It allows for voxel-wise quantification of wall thickness, enabling precise identification of wall volumes exhibiting abnormal wall thickness. Our research highlights the urgency of transitioning to 3D methodologies for vessel wall thickness measurement. Such a transition not only acknowledges the intricate spatial variations of vessel walls, but also opens doors to more accurate, localized, and insightful diagnostic insights. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Imaging: An Exciting Future to Revolutionize the Diagnosis and Management of Cardiovascular Disease)

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17 pages, 2884 KiB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis of Randomized Trials to Evaluate the Impact of Exercise on Heart Rate Variability Post-Bariatric Surgery

by Tulio H. B. Bitencourt, Camila Marcondes de Oliveira, Andrey A. Porto, Davi C. de Andrade, David M. Garner, Rodrigo D. Raimundo and Vitor E. Valenti

J. Cardiovasc. Dev. Dis. 2024, 11(8), 248; https://doi.org/10.3390/jcdd11080248 - 13 Aug 2024

Viewed by 1431

Abstract

Bariatric surgery is an approach used to treat patients with obesity in a small minority of eligible patients. Non-pharmacological therapies are important to maintain decent health status post-bariatric surgery. We performed a systematic review with meta-analysis to evaluate the effects of exercise on [...] Read more.

Bariatric surgery is an approach used to treat patients with obesity in a small minority of eligible patients. Non-pharmacological therapies are important to maintain decent health status post-bariatric surgery. We performed a systematic review with meta-analysis to evaluate the effects of exercise on heart rate variability (HRV) in patients submitted to bariatric surgery. The searches were made via MEDLINE/PubMed (via the National Library of Medicine), EMBASE, Web of Science, and Scopus databases. We included non-blind, single-, or double-blind randomized control trials in patients older than 18 years of age submitted to bariatric surgery. The intervention group should be submitted to an exercise training protocol, including aerobic, strength, and other exercise modality after bariatric surgery. We documented 245 studies, and after screening and eligibility phases, only 4 were included. We observed no significant change for the SDNN: subtotal = 19.74 (CI: −4.98, 44.45), p = 0.12, I² = 85% (very low quality of evidence); pNN50: subtotal = 13.09 (CI: −9.17, 35.35), p = 0.25, I² = 93% (very low quality of evidence); RMSSD: subtotal = 8.44 (CI: −3.61, 25.50), p = 0.17, I² = 95% (very low quality of evidence); SD1: subtotal = 9.36 (CI: −4.48, 23.21), p = 0.19, I² = 96% (very low quality of evidence). We could not detect significant effects of exercise on resting HRV after bariatric surgery. The low certainty of the results via the evidence level analysis suggest further studies might be beneficial. Full article

(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)

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8 pages, 627 KiB

Open AccessBrief Report

Causal Relationship between Chronic Hepatitis B and Stroke in East Asians: A Mendelian Randomization Study

by Qi Zhang, Cancong Shen, Lei Zhang and Maiqiu Wang

J. Cardiovasc. Dev. Dis. 2024, 11(8), 247; https://doi.org/10.3390/jcdd11080247 - 10 Aug 2024

Viewed by 990

Abstract

Both chronic hepatitis B (CHB) and stroke contribute to a high burden of disease in the majority of low- and middle-income countries. Epidemiological studies yield conflicting results on the association between CHB and stroke, and the causal relationship remains inconclusive. This study aimed [...] Read more.

Both chronic hepatitis B (CHB) and stroke contribute to a high burden of disease in the majority of low- and middle-income countries. Epidemiological studies yield conflicting results on the association between CHB and stroke, and the causal relationship remains inconclusive. This study aimed to assess the causal effects of CHB on stroke and its subtypes in East Asians by Mendelian randomization (MR) analysis. Variants associated with CHB were obtained from a genome-wide association study (GWAS) of Chinese samples as instrumental variables. The summary statistics for stroke in East Asians were derived from the largest published GWAS to date. Two-sample MR analyses were implemented to evaluate the causal effects of CHB on stroke and its subtypes by using the canonical inverse variance weighting method and other supplementary approaches. We observed an association between genetic predisposition to CHB and a decreased risk of large-artery atherosclerotic stroke (odds ratio = 0.872, 95% confidence interval = 0.786–0.967, p = 0.010). The causal effects of CHB on other stroke outcomes were not statistically significant. Evidence for heterogeneity and horizontal pleiotropy were not found in our analyses. This study provides genetic evidence for a negative association between CHB and stroke in East Asians, which helps improve our understanding of the etiology of stroke. Full article

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

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12 pages, 626 KiB

Open AccessArticle

Invasive Mechanical Ventilation Is Associated with Worse Right Ventricular Strain in Acute Respiratory Failure Patients

by Shuyuan Wang, Zubair Bashir, Edward W. Chen, Vishnu Kadiyala, Charles F. Sherrod, Phinnara Has, Christopher Song, Corey E. Ventetuolo, James Simmons and Philip Haines

J. Cardiovasc. Dev. Dis. 2024, 11(8), 246; https://doi.org/10.3390/jcdd11080246 - 9 Aug 2024

Cited by 1 | Viewed by 810

Abstract

Right ventricular (RV) dysfunction is associated with poor prognosis in acute respiratory failure (ARF). Our study evaluates the efficacy of RV strain in detecting RV dysfunction in ARF patients requiring invasive mechanical ventilation (IMV) compared to tricuspid annular plane systolic excursion (TAPSE). In [...] Read more.

Right ventricular (RV) dysfunction is associated with poor prognosis in acute respiratory failure (ARF). Our study evaluates the efficacy of RV strain in detecting RV dysfunction in ARF patients requiring invasive mechanical ventilation (IMV) compared to tricuspid annular plane systolic excursion (TAPSE). In this retrospective study involving 376 patients diagnosed with ARF and requiring IMV, we extracted clinical and outcome data from patient records. RV global longitudinal strain (RVGLS), free wall longitudinal strain (FWLS), and TAPSE were measured retrospectively using speckle tracking echocardiography (STE) and traditional echocardiography, respectively. We divided the cohort into three groups: TTE during IMV (TTE-IMV, 223 patients), before IMV (TTE-bIMV, 68 patients), and after IMV (TTE-aIMV, 85 patients). Multivariable regression analysis, adjusted for covariates, revealed significantly higher RVGLS and FWLS in the groups not on IMV at the time of TTE compared to the TTE-IMV group. Specifically, the TTE-bIMV group showed higher RVGLS (β = 7.28, 95% CI 5.07, 9.48) and FWLS (β = 5.83, 95% CI 3.36, 8.31), while the TTE-aIMV group exhibited higher RVGLS (β = 9.39, 95% CI 6.10, 12.69) and FWLS (β = 7.54, 95% CI 4.83, 10.24). TAPSE did not reveal any significant differences across the groups. Our study suggests an association between IMV and lower RVGLS and FWLS in ARF patients, indicating that IMV itself may contribute to RV dysfunction. RVGLS and FWLS appear to be more sensitive than TAPSE in detecting changes in RV function that were previously subclinical in patients on IMV. Prospective studies with TTE before, during, and after IMV are necessary to assess the primary driver of RV dysfunction and to prognosticate STE-detected RV dysfunction in this population. Full article

(This article belongs to the Special Issue Critical Care in Modern Cardiology)

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29 pages, 4826 KiB

Open AccessReview

Charting the Unseen: How Non-Invasive Imaging Could Redefine Cardiovascular Prevention

by Giancarlo Trimarchi, Fausto Pizzino, Umberto Paradossi, Ignazio Alessio Gueli, Matteo Palazzini, Piero Gentile, Francesco Di Spigno, Enrico Ammirati, Andrea Garascia, Andrea Tedeschi and Daniela Aschieri

J. Cardiovasc. Dev. Dis. 2024, 11(8), 245; https://doi.org/10.3390/jcdd11080245 - 9 Aug 2024

Cited by 15 | Viewed by 1903

Abstract

Cardiovascular diseases (CVDs) remain a major global health challenge, leading to significant morbidity and mortality while straining healthcare systems. Despite progress in medical treatments for CVDs, their increasing prevalence calls for a shift towards more effective prevention strategies. Traditional preventive approaches have centered [...] Read more.

Cardiovascular diseases (CVDs) remain a major global health challenge, leading to significant morbidity and mortality while straining healthcare systems. Despite progress in medical treatments for CVDs, their increasing prevalence calls for a shift towards more effective prevention strategies. Traditional preventive approaches have centered around lifestyle changes, risk factors management, and medication. However, the integration of imaging methods offers a novel dimension in early disease detection, risk assessment, and ongoing monitoring of at-risk individuals. Imaging techniques such as supra-aortic trunks ultrasound, echocardiography, cardiac magnetic resonance, and coronary computed tomography angiography have broadened our understanding of the anatomical and functional aspects of cardiovascular health. These techniques enable personalized prevention strategies by providing detailed insights into the cardiac and vascular states, significantly enhancing our ability to combat the progression of CVDs. This review focuses on amalgamating current findings, technological innovations, and the impact of integrating advanced imaging modalities into cardiovascular risk prevention, aiming to offer a comprehensive perspective on their potential to transform preventive cardiology. Full article

(This article belongs to the Special Issue Clinical Burden of Comorbidities on Cardiovascular System and Beyond)

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13 pages, 7060 KiB

Open AccessArticle

Comparison of Two Generations of Self-Expandable Transcatheter Heart Valves in Nine Surgical Valves: An In Vitro Study

by Najla Sadat, Michael Scharfschwerdt, Stephan Ensminger and Buntaro Fujita

J. Cardiovasc. Dev. Dis. 2024, 11(8), 244; https://doi.org/10.3390/jcdd11080244 - 8 Aug 2024

Viewed by 866

Abstract

(1) Background: This study aimed to analyse the hydrodynamic performance of two generations of self-expanding transcatheter heart valves (THV) as a valve-in-valve (ViV) in different surgical aortic valve (SAV) models under standardised conditions. The nitinol-based Evolut R valve is frequently used in ViV [...] Read more.

(1) Background: This study aimed to analyse the hydrodynamic performance of two generations of self-expanding transcatheter heart valves (THV) as a valve-in-valve (ViV) in different surgical aortic valve (SAV) models under standardised conditions. The nitinol-based Evolut R valve is frequently used in ViV procedures. It is unclear whether its successor, the Evolut PRO, is superior in ViV procedures, particularly considering the previously implanted SAV model. (2) Methods: Evolut^TM R 26 mm and Evolut^TM PRO 26 mm prostheses were implanted in nine 21 mm labelled size SAV models (Hancock^® II, Mosaic^® Ultra^TM, Epic^TM Supra, Trifecta^TM GT, Perimount^®, Perimount^® Magna Ease, Avalus^TM, Intuity^TM, Freestyle^®) to analyse their hydrodynamic performance under defined circulatory conditions in a pulse duplicator. (3) Results: Both THVs presented with the lowest effective orifice area (EOA) and highest mean pressure gradient (MPG) inside Hancock^® II, whereas THVs in Intuity showed the highest EOA and lowest MPG. Evolut R and Evolut PRO showed significant hydrodynamic differences depending on the SAV. Both THVs performed similarly in porcine valves. Although the Evolut R performed better than Evolut PRO in stented bovine SAVs, the Evolut PRO was superior inside the Intuity. Further, the SAV model design markedly influenced the TAV’s geometric orifice area and pin-wheeling index. (4) Conclusions: These findings show that the Evolut R and Evolut PRO perform differently depending on the previously implanted SAV model. THV selection for treatment of a specific SAV model should consider these results. Full article

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11 pages, 1124 KiB

Open AccessReview

Antiarrhythmic Drug Use in Pregnancy: Considerations and Safety Profiles

by Marco Valerio Mariani, Nicola Pierucci, Vincenzo Mirco La Fazia, Pietro Cipollone, Marco Micillo, Andrea D’Amato, Francesca Fanisio, Giuseppe Ammirati, Nethuja Salagundla, Carlo Lavalle and Marco Alfonso Perrone

J. Cardiovasc. Dev. Dis. 2024, 11(8), 243; https://doi.org/10.3390/jcdd11080243 - 7 Aug 2024

Viewed by 1128

Abstract

Pregnancy entails notable physiological alterations and hormonal fluctuations that affect the well-being of both the fetus and the mother. Cardiovascular events and arrhythmias are a major concern during pregnancy, especially in women with comorbidities or a history of arrhythmias. This paper provides an [...] Read more.

Pregnancy entails notable physiological alterations and hormonal fluctuations that affect the well-being of both the fetus and the mother. Cardiovascular events and arrhythmias are a major concern during pregnancy, especially in women with comorbidities or a history of arrhythmias. This paper provides an overview of the prevalence, therapies, and prognoses of different types of arrhythmias during pregnancy. The administration of antiarrhythmic drugs (AADs) during pregnancy demands careful consideration because of their possible effect on the mother and fetus. AADs can cross the placenta or be present in breast milk, potentially leading to adverse effects such as teratogenicity, growth restriction, or premature birth. The safety profiles of different classes of AADs are discussed. Individualized treatment approaches and close monitoring of pregnant women prescribed AADs are essential to ensure optimal maternal and fetal outcomes. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

10 pages, 268 KiB

Open AccessArticle

The Great Saphenous Vein Proximal Part: Branches, Anatomical Variations, and Their Implications for Clinical Practice and Venous Reflux Surgery

by Krisztina Munteanu, Ovidiu Ghirlea, Daniel Breban-Schwarzkopf, Alexandra-Ioana Dănilă, Roxana-Georgeta Iacob, Ioan Adrian Petrache, Gabriel Veniamin Cozma, Anca Bordianu and Sorin Lucian Bolintineanu

J. Cardiovasc. Dev. Dis. 2024, 11(8), 242; https://doi.org/10.3390/jcdd11080242 - 7 Aug 2024

Viewed by 814

Abstract

The anatomical variations in the lower limb veins play a critical role in venous reflux surgeries. This study presents an analysis of the great saphenous vein (GSV) proximal part’s anatomical peculiarities, with 257 patients included, who were operated for venous reflux. This study [...] Read more.

The anatomical variations in the lower limb veins play a critical role in venous reflux surgeries. This study presents an analysis of the great saphenous vein (GSV) proximal part’s anatomical peculiarities, with 257 patients included, who were operated for venous reflux. This study highlighted a progressive increase in the GSV diameter in conjunction with the complexity of the anatomical variations, ranging from no tributaries to more than five tributaries, an anterior accessory GSV, or venous aneurysms. Statistical analysis evidenced this expansion to be significantly correlated with the variations. Additionally, the progression of the chronic venous disease (CVD) stages was notably more prevalent in the complex anatomical variations, suggesting a nuanced interplay between the GSV anatomy and CVD severity. Conclusively, our research articulates the paramount importance of recognizing GSV anatomical variations in optimizing surgical outcomes for CVD patients. These insights not only pave the way for enhanced diagnostic accuracy but also support the strategic framework within which surgical and interventional treatments are devised, advocating for personalized approaches to venous reflux surgery. Full article

21 pages, 2177 KiB

Open AccessEditor’s ChoiceReview

Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function

by Mario Mangia, Emilio D’Andrea, Antonella Cecchetto, Riccardo Beccari, Donato Mele and Stefano Nistri

J. Cardiovasc. Dev. Dis. 2024, 11(8), 241; https://doi.org/10.3390/jcdd11080241 - 5 Aug 2024

Viewed by 1433

Abstract

The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular [...] Read more.

The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a’]), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function. Full article

(This article belongs to the Special Issue Advances in the Diagnosis of Cardiovascular Diseases)

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17 pages, 1212 KiB

Open AccessArticle

Cardiovascular Risk Factors Predicting Cardiovascular and Cancer Deaths in a Middle-Aged Population Followed-Up for 61 Years until Extinction

by Alessandro Menotti, Paolo Emilio Puddu and Paolo Piras

J. Cardiovasc. Dev. Dis. 2024, 11(8), 240; https://doi.org/10.3390/jcdd11080240 - 5 Aug 2024

Cited by 1 | Viewed by 967

Abstract

Background and Aim. To study the relationships of cardiovascular risk factors with cancer and cardiovascular mortality in a cohort of middle-aged men followed-up for 61 years. Materials and Methods. A rural cohort of 1611 cancer- and cardiovascular disease-free men aged 40–59 years was [...] Read more.

Background and Aim. To study the relationships of cardiovascular risk factors with cancer and cardiovascular mortality in a cohort of middle-aged men followed-up for 61 years. Materials and Methods. A rural cohort of 1611 cancer- and cardiovascular disease-free men aged 40–59 years was examined in 1960 within the Italian Section of the Seven Countries Study, and 28 risk factors measured at baseline were used to predict cancer (n = 459) and cardiovascular deaths (n = 678) that occurred during 61 years of follow-up until the extinction of the cohort with Cox proportional hazard models. Results. A model with 28 risk factors and cancer deaths as the end-point produced eight statistically significant coefficients for age, smoking habits, mother early death, corneal arcus, xanthelasma and diabetes directly related to events, and arm circumference and healthy diet inversely related. In the corresponding models for major cardiovascular diseases and their subgroups, only the coefficients of age and smoking habits were significant among those found for cancer deaths, to which healthy diet can be added if considering coronary heart disease alone. Following a competing risks analysis by the Fine–Gray method, risk factors significantly common to both conditions were only age, smoking, and xanthelasma. Conclusions. A sizeable number of traditional cardiovascular risk factors were not predictors of cancer death in a middle-aged male cohort followed-up until extinction. Full article

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

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8 pages, 2808 KiB

Open AccessCase Report

Noninvasive Mapping System for the Stereotactic Radioablation Treatment of Ventricular Tachycardia: A Case Description

by Imma Romanazzi, Antonio Di Monaco, Ilaria Bonaparte, Noemi Valenti, Alessia Surgo, Fiorella Di Guglielmo, Alba Fiorentino and Massimo Grimaldi

J. Cardiovasc. Dev. Dis. 2024, 11(8), 239; https://doi.org/10.3390/jcdd11080239 - 5 Aug 2024

Cited by 1 | Viewed by 901

Abstract

Objectives: Sustained monomorphic ventricular tachycardia (SMVT) is a life-threatening condition that is often observed in patients with structural heart disease. Catheter ablation (CA) ablation is an effective and well-established treatment for the scar-related ventricular tachycardias (VTs). Sometimes, due to patient fragility or contraindications [...] Read more.

Objectives: Sustained monomorphic ventricular tachycardia (SMVT) is a life-threatening condition that is often observed in patients with structural heart disease. Catheter ablation (CA) ablation is an effective and well-established treatment for the scar-related ventricular tachycardias (VTs). Sometimes, due to patient fragility or contraindications to CA, a noninvasive procedure is required. In these cases, VT ablation with stereotactic arrhythmia radioablation (STAR) for SMVTs supported by the CardioInsight mapping system seems to be a promising and effective noninvasive approach. Methods and results: We report a case of a 55-year-old male smoker and heavy alcohol consumer who developed ischemic heart disease and frequent refractory SMVT relative to antiarrhythmic drugs. Catheter ablation was not practicable due to the presence of an apical thrombosis in the left ventricle. The CardioInsight^TM system (Cardioinsight Technologies Inc., Cleveland, OH, USA) was useful for noninvasively mapping the VTs, identifying two target areas on the septum and anterior wall of the left ventricle. A personalized STAR treatment plan was carefully designed, and it was delivered in a few minutes. During follow-up, a significant reduction in the arrhythmia burden was documented. Conclusions: Stereotactic arrhythmia radioablation supported by the CardioInsight system could be an alternative treatment for VTs when catheter ablation is not possible. Larger studies are needed to investigate this technique. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias: Epidemiology, Diagnosis and Treatment)

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13 pages, 288 KiB

Open AccessReview

Optimization of Hypothermic Protocols for Neurocognitive Preservation in Aortic Arch Surgery: A Literature Review

by Jordan Llerena-Velastegui, Sebastian Velastegui-Zurita, Kristina Zumbana-Podaneva, Melany Mejia-Mora, Ana Clara Fonseca Souza de Jesus and Pedro Moraes Coelho

J. Cardiovasc. Dev. Dis. 2024, 11(8), 238; https://doi.org/10.3390/jcdd11080238 - 1 Aug 2024

Viewed by 1486

Abstract

Shifts from deep to moderate hypothermic circulatory arrest (HCA) in aortic arch surgery necessitate an examination of their differential impacts on neurocognitive functions, especially structured verbal memory, given its significance for patient recovery and quality of life. This study evaluates and synthesizes evidence [...] Read more.

Shifts from deep to moderate hypothermic circulatory arrest (HCA) in aortic arch surgery necessitate an examination of their differential impacts on neurocognitive functions, especially structured verbal memory, given its significance for patient recovery and quality of life. This study evaluates and synthesizes evidence on the effects of deep (≤20.0 °C), low-moderate (20.1–24.0 °C), and high-moderate (24.1–28.0 °C) hypothermic temperatures on structured verbal memory preservation and overall cognitive health in patients undergoing aortic arch surgery. We evaluated the latest literature from major medical databases such as PubMed and Scopus, focusing on research from 2020 to 2024, to gather comprehensive insights into the current landscape of temperature management during HCA. This comparative analysis highlights the viability of moderate hypothermia (20.1–28.0 °C), supported by recent trials and observational studies, as a method to achieve comparable neuroprotection with fewer complications than traditional deep hypothermia. Notably, low-moderate and high-moderate temperatures have been shown to support substantial survival rates, with impacts on structured verbal memory preservation that necessitate careful selection based on individual surgical risks and patient profiles. The findings advocate for a nuanced approach to selecting hypothermic protocols in aortic arch surgeries, emphasizing the importance of tailoring temperature management to optimize neurocognitive outcomes and patient recovery. This study fills a critical gap in the literature by providing evidence-based recommendations for temperature ranges during HCA, calling for ongoing updates to clinical guidelines and further research to refine these recommendations. The implications of temperature on survival rates, complications, and success rates underpin the necessity for evolving cardiopulmonary bypass techniques and cerebral perfusion strategies to enhance patient outcomes in complex cardiovascular procedures. Full article

8 pages, 2343 KiB

Open AccessArticle

Long-Term Prognostic Impact of Three-Dimensional Speckle-Tracking Echocardiography-Derived Left Ventricular Global Longitudinal Strain in Healthy Adults—Insights from the MAGYAR-Healthy Study

by Attila Nemes, Árpád Kormányos, Dorottya Lilla Olajos, Alexandru Achim, Zoltán Ruzsa, Nóra Ambrus and Csaba Lengyel

J. Cardiovasc. Dev. Dis. 2024, 11(8), 237; https://doi.org/10.3390/jcdd11080237 - 31 Jul 2024

Viewed by 908

Abstract

Introduction. Three-dimensional (3D) speckle-tracking echocardiography (STE) combines the advantages of STE and volumetric 3D echocardiography, which shows the left ventricle (LV) in 3D during the cardiac cycle and is also suitable for accurate strain measurements in addition to volumetric assessments using the same [...] Read more.

Introduction. Three-dimensional (3D) speckle-tracking echocardiography (STE) combines the advantages of STE and volumetric 3D echocardiography, which shows the left ventricle (LV) in 3D during the cardiac cycle and is also suitable for accurate strain measurements in addition to volumetric assessments using the same virtual 3D LV cast. The present study aimed to confirm the prognostic impact of 3DSTE-derived LV global longitudinal strain (GLS) in healthy adults during a 12-year follow-up period. Patients and methods. The current study comprised 124 healthy individuals with a mean age of 31.0 ± 11.7 years (64 males) at the time of complete two-dimensional Doppler echocardiography (2DE) and 3DSTE. Results. During a mean follow-up of 8.01 ± 4.12 years, 10 healthy individuals suffered cardiovascular events, including 2 cardiac deaths. Using ROC analysis, 3DSTE-derived LV-GLS ≥ 14.77% was found to be a significant predictor for cardiovascular event-free survival (sensitivity 70%, specificity 71%, area under the curve 76%, p = 0.007). Using 2DE, higher LV end-diastolic and end-systolic volumes, a larger LV end-systolic diameter and a lower LV ejection fraction could be detected in subjects with LV-GLS < 14.77% as compared to cases with LV-GLS ≥ 14.77%. Subjects with events had thicker interventricular septa, a larger LV mass and lower 3DSTE-derived LV-GLS and a higher ratio of cases had LV-GLS < 14.77%. From subjects with LV-GLS < 14.77%, seven individuals (18%) had events. Multivariate regression analysis identified age and LV-GLS as independent predictors of event-free survival. Conclusions. 3DSTE-derived LV-GLS is a strong independent predictor of cardiovascular survival in healthy adults. Full article

(This article belongs to the Section Imaging)

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14 pages, 2785 KiB

Open AccessArticle

Compromised Cerebral Arterial Perfusion, Altered Brain Tissue Integrity, and Cognitive Impairment in Adolescents with Complex Congenital Heart Disease

by Nancy A. Pike, Bhaswati Roy, Cristina Cabrera-Mino, Nancy J. Halnon, Alan B. Lewis, Xingfeng Shao, Danny J. J. Wang and Rajesh Kumar

J. Cardiovasc. Dev. Dis. 2024, 11(8), 236; https://doi.org/10.3390/jcdd11080236 - 29 Jul 2024

Cited by 1 | Viewed by 1160

Abstract

(1) Introduction: Adolescents with complex congenital heart disease (CCHD) show brain tissue injuries in regions associated with cognitive deficits. Alteration in cerebral arterial perfusion (CAP), as measured by arterial transit time (ATT), may lead to perfusion deficits and potential injury. Our study aims [...] Read more.

(1) Introduction: Adolescents with complex congenital heart disease (CCHD) show brain tissue injuries in regions associated with cognitive deficits. Alteration in cerebral arterial perfusion (CAP), as measured by arterial transit time (ATT), may lead to perfusion deficits and potential injury. Our study aims to compare ATT values between CCHD patients and controls and assess the associations between ATT values, MD values, and cognitive scores in adolescents with CCHD. (2) Methods: 37 CCHD subjects, 14–18 years of age, who had undergone surgical palliation and 30 healthy controls completed cognitive testing and brain MRI assessments using a 3.0-Tesla scanner. ATT values and regional brain mean diffusivity [MD] were assessed for the whole brain using diffusion tensor imaging. (3) Results: The mean MoCA values [23.1 ± 4.1 vs. 28.1 ± 2.3; p < 0.001] and General Memory Index, with a subscore of WRAML2 [86.8 ± 15.4 vs. 110.3 ± 14.5; p < 0.001], showed significant cognitive deficits in CCHD patients compared to controls. The mean global ATT was significantly higher in CCHD patients versus controls (mean ± SD, s, 1.26 ± 0.11 vs. 1.19 ± 0.11, p = 0.03), respectively. The partial correlations between ATT values, MD values, and cognitive scores (p < 0.005) showed significant associations in areas including the hippocampus, prefrontal cortices, cerebellum, caudate, anterior and mid cingulate, insula, thalamus, and lingual gyrus. (4) Conclusions: Adolescents with CCHD had prolonged ATTs and showed correlation with clinical measurements of cognitive impairment and MRI measurements of brain tissue integrity. This suggests that altered CAP may play a role in brain tissue injury and cognitive impairment after surgical palliation. Full article

(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)

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15 pages, 3356 KiB

Open AccessReview

Revolutionizing Donor Heart Procurement: Innovations and Future Directions for Enhanced Transplantation Outcomes

by Marc Leon

J. Cardiovasc. Dev. Dis. 2024, 11(8), 235; https://doi.org/10.3390/jcdd11080235 - 27 Jul 2024

Viewed by 1347

Abstract

Heart failure persists as a critical public health challenge, with heart transplantation esteemed as the optimal treatment for patients with end-stage heart failure. However, the limited availability of donor hearts presents a major obstacle to meeting patient needs. In recent years, the most [...] Read more.

Heart failure persists as a critical public health challenge, with heart transplantation esteemed as the optimal treatment for patients with end-stage heart failure. However, the limited availability of donor hearts presents a major obstacle to meeting patient needs. In recent years, the most groundbreaking progress in heart transplantation has been in donor heart procurement, significantly expanding the donor pool and enhancing clinical outcomes. This review comprehensively examines these advancements, including the resurgence of heart donation after circulatory death and innovative recovery and evaluation technologies such as normothermic machine perfusion and thoraco-abdominal normothermic regional perfusion. Additionally, novel preservation methods, including controlled hypothermic preservation and hypothermic oxygenated perfusion, are evaluated. The review also explores the use of extended-criteria donors, post-cardiopulmonary resuscitation donors, and high-risk donors, all contributing to increased donor availability without compromising outcomes. Future directions, such as xenotransplantation, biomarkers, and artificial intelligence in donor heart evaluation and procurement, are discussed. These innovations promise to address current limitations and optimize donor heart utilization, ultimately enhancing transplantation success. By identifying recent advancements and proposing future research directions, this review aims to provide insights into advancing heart transplantation and improving patient outcomes. Full article

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23 pages, 1318 KiB

Open AccessReview

A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion

by Michał Święczkowski, Emil Julian Dąbrowski, Paweł Muszyński, Piotr Pogorzelski, Piotr Jemielita, Joanna Maria Dudzik, Tomasz Januszko, Małgorzata Duzinkiewicz, Maciej Południewski, Łukasz Kuźma, Marcin Kożuch, Paweł Kralisz and Sławomir Dobrzycki

J. Cardiovasc. Dev. Dis. 2024, 11(8), 234; https://doi.org/10.3390/jcdd11080234 - 27 Jul 2024

Viewed by 1311

Abstract

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the [...] Read more.

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care. Full article

(This article belongs to the Special Issue Feature Review Papers in Stroke and Cerebrovascular Disease)

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22 pages, 2390 KiB

Open AccessReview

Cardiovascular Sequelae of Bronchopulmonary Dysplasia in Preterm Neonates Born before 32 Weeks of Gestational Age: Impact of Associated Pulmonary and Systemic Hypertension

by Pramod Pharande, Arvind Sehgal and Samuel Menahem

J. Cardiovasc. Dev. Dis. 2024, 11(8), 233; https://doi.org/10.3390/jcdd11080233 - 26 Jul 2024

Viewed by 1201

Abstract

Bronchopulmonary dysplasia (BPD) remains the most common respiratory disorder of prematurity for infants born before 32 weeks of gestational age (GA). Early and prolonged exposure to chronic hypoxia and inflammation induces pulmonary hypertension (PH) with the characteristic features of a reduced number and [...] Read more.

Bronchopulmonary dysplasia (BPD) remains the most common respiratory disorder of prematurity for infants born before 32 weeks of gestational age (GA). Early and prolonged exposure to chronic hypoxia and inflammation induces pulmonary hypertension (PH) with the characteristic features of a reduced number and increased muscularisation of the pulmonary arteries resulting in an increase in the pulmonary vascular resistance (PVR) and a fall in their compliance. BPD and BPD-associated pulmonary hypertension (BPD-PH) together with systemic hypertension (sHTN) are chronic cardiopulmonary disorders which result in an increased mortality and long-term problems for these infants. Previous studies have predominantly focused on the pulmonary circulation (right ventricle and its function) and developing management strategies accordingly for BPD-PH. However, recent work has drawn attention to the importance of the left-sided cardiac function and its impact on BPD in a subset of infants arising from a unique pathophysiology termed postcapillary PH. BPD infants may have a mechanistic link arising from chronic inflammation, cytokines, oxidative stress, catecholamines, and renin–angiotensin system activation along with systemic arterial stiffness, all of which contribute to the development of BPD-sHTN. The focus for the treatment of BPD-PH has been improvement of the right heart function through pulmonary vasodilators. BPD-sHTN and a subset of postcapillary PH may benefit from afterload reducing agents such as angiotensin converting enzyme inhibitors. Preterm infants with BPD-PH are at risk of later cardiac and respiratory morbidities as young adults. This paper reviews the current knowledge of the pathophysiology, diagnosis, and treatment of BPD-PH and BPD-sHTN. Current knowledge gaps and emerging new therapies will also be discussed. Full article

(This article belongs to the Special Issue Echocardiography in Pediatric Heart Disease)

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11 pages, 1566 KiB

Open AccessArticle

Complex Pulmonary Artery Rehabilitation in Children with Alagille Syndrome: An Early Single-Center Experience of a Successful Collaborative Work

by Farida Karim, Gurumurthy Hiremath, Juan Carlos Samayoa and Sameh M. Said

J. Cardiovasc. Dev. Dis. 2024, 11(8), 232; https://doi.org/10.3390/jcdd11080232 - 25 Jul 2024

Viewed by 1284

Abstract

Objective: In this paper, we share our single-center experience of successful multidisciplinary management of patients with Alagille syndrome. In addition, we aim to highlight the need for an Alagille program for effectively managing these patients, in general, and particularly peripheral pulmonary artery stenosis [...] Read more.

Objective: In this paper, we share our single-center experience of successful multidisciplinary management of patients with Alagille syndrome. In addition, we aim to highlight the need for an Alagille program for effectively managing these patients, in general, and particularly peripheral pulmonary artery stenosis associated with this syndrome. Study Design: This is a retrospective review of six children with Alagille syndrome and advanced liver involvement who underwent pulmonary artery reconstruction between 2021 and 2022. Cardiac diagnosis, co-existing liver disease burdens, management approach, and short-term outcomes were analyzed. Results: All the patients underwent one-stage extensive bilateral branch pulmonary rehabilitation. Concomitant procedures included repair of tetralogy of Fallot in one patient and repair of supravalvar pulmonary artery stenosis in two. One patient had balloon pulmonary branch angioplasty before surgery. In all patients, there was a decrease in right ventricular systolic pressure post-operatively. Three patients underwent liver transplantation for pre-existing liver dysfunction. At a median 3-year follow-up, all the patients were alive with their right ventricular systolic pressure less than half of their systemic systolic pressure. One patient underwent balloon angioplasty due to new and recurrent left pulmonary artery stenosis 13 months after surgery. Conclusion: Pulmonary arteries can be successfully rehabilitated surgically in the presence of complex branch disease. Patients with advanced liver disease can undergo successful complex pulmonary artery reconstruction, which can facilitate their future liver transplantation course. A multidisciplinary team approach is a key for successful management of Alagille patients. Full article

(This article belongs to the Section Cardiac Surgery)

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15 pages, 3779 KiB

Open AccessEditor’s ChoiceReview

A Review Paper on Optical Coherence Tomography Evaluation of Coronary Calcification Pattern: Is It Relevant Today?

by Horea-Laurentiu Onea, Maria Olinic, Florin-Leontin Lazar, Calin Homorodean, Mihai Claudiu Ober, Mihail Spinu, Alexandru Achim, Dan Alexandru Tataru and Dan Mircea Olinic

J. Cardiovasc. Dev. Dis. 2024, 11(8), 231; https://doi.org/10.3390/jcdd11080231 - 24 Jul 2024

Viewed by 1276

Abstract

The process of coronary calcification represents one of the numerous pathophysiological mechanisms involved in the atherosclerosis continuum. Optical coherence tomography (OCT) represents an ideal imaging modality to assess plaque components, especially calcium. Different calcification patterns have been contemporarily described in both early stages [...] Read more.

The process of coronary calcification represents one of the numerous pathophysiological mechanisms involved in the atherosclerosis continuum. Optical coherence tomography (OCT) represents an ideal imaging modality to assess plaque components, especially calcium. Different calcification patterns have been contemporarily described in both early stages and advanced atherosclerosis. Microcalcifications and spotty calcifications correlate positively with macrophage burden and inflammatory markers and are more frequently found in the superficial layers of ruptured plaques in acute coronary syndrome patients. More compact, extensive calcification may reflect a later stage of the disease and was traditionally associated with plaque stability. Nevertheless, a small number of culprit coronary lesions demonstrates the presence of dense calcified plaques. The purpose of the current paper is to review the most recent OCT data on coronary calcification and the interrelation between calcification pattern and plaque vulnerability. How different calcified plaques influence treatment strategies and associated prognostic implications is of great interest. Full article

(This article belongs to the Special Issue Feature Papers in Imaging)

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12 pages, 2181 KiB

Open AccessArticle

Ablation Parameters Predicting Pulmonary Vein Reconnection after Very High-Power Short-Duration Pulmonary Vein Isolation

by Márton Boga, Gábor Orbán, Zoltán Salló, Klaudia Vivien Nagy, István Osztheimer, Arnold Béla Ferencz, Ferenc Komlósi, Patrik Tóth, Edit Tanai, Péter Perge, Béla Merkely, László Gellér and Nándor Szegedi

J. Cardiovasc. Dev. Dis. 2024, 11(8), 230; https://doi.org/10.3390/jcdd11080230 - 24 Jul 2024

Viewed by 1031

Abstract

Background: Recurrences due to discontinuity in ablation lines are substantial after pulmonary vein isolation (PVI) with radiofrequency ablation for atrial fibrillation. Data are scarce regarding the durability predictors for very high-power short-duration (vHPSD, 90 W/4 s) ablation. Methods: A total of 20 patients [...] Read more.

Background: Recurrences due to discontinuity in ablation lines are substantial after pulmonary vein isolation (PVI) with radiofrequency ablation for atrial fibrillation. Data are scarce regarding the durability predictors for very high-power short-duration (vHPSD, 90 W/4 s) ablation. Methods: A total of 20 patients were enrolled, who underwent 90 W PVI and a mandatory remapping procedure at 3 months. First-pass isolation (FPI) gaps, and acute pulmonary vein reconnection (PVR) sites were identified at the index procedure; and chronic PVR sites were identified at the repeated procedure. We analyzed parameters of ablation points (n = 1357), and evaluated their roles in predicting a composite endpoint of FPI gaps, acute and chronic PVR. Results: In total, 45 initial ablation points corresponding to gaps in the ablation lines were analyzed. Parameters associated with gaps were interlesion distance (ILD), baseline generator impedance, mean current, total charge, and loss of catheter–tissue contact. The optimal ILD cut-off for predicting gaps was 3.5 mm anteriorly, and 4 mm posteriorly. Conclusions: Biophysical characteristics dependent on generator impedance could affect the efficacy of vHPSD PVI. The use of smaller ILDs is required for effective and durable PVI with vHPSD compared to the consensus targets with lower power ablation, and lower ILDs for anterior applications seem necessary compared to posterior points. Full article

(This article belongs to the Special Issue Biophysical- and Engineering-Oriented Approaches to Energy-Based Cardiac Ablation Techniques)

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10 pages, 3154 KiB

Open AccessArticle

Hemodynamic Evaluation of Coronary Artery Lesions after Kawasaki Disease: Comparison of Fractional Flow Reserve during Cardiac Catheterization with Myocardial Flow Reserve during ¹³N-Ammonia PET

by Makoto Watanabe, Ryuji Fukazawa, Tomonari Kiriyama, Shogo Imai, Ryosuke Matsui, Kanae Shimada, Yoshiaki Hashimoto, Koji Hashimoto, Masanori Abe, Mitsuhiro Kamisago and Yasuhiko Itoh

J. Cardiovasc. Dev. Dis. 2024, 11(8), 229; https://doi.org/10.3390/jcdd11080229 - 23 Jul 2024

Viewed by 823

Abstract

Coronary artery lesions (CALs) after Kawasaki disease present complex coronary hemodynamics. We investigated the relationship between coronary fractional flow reserve (FFR), myocardial flow reserve (MFR), and myocardial blood flow volume fraction (MBF) and their clinical usefulness in CALs after Kawasaki disease. Nineteen patients [...] Read more.

Coronary artery lesions (CALs) after Kawasaki disease present complex coronary hemodynamics. We investigated the relationship between coronary fractional flow reserve (FFR), myocardial flow reserve (MFR), and myocardial blood flow volume fraction (MBF) and their clinical usefulness in CALs after Kawasaki disease. Nineteen patients (18 men, 1 woman) who underwent cardiac catheterization and ¹³N-ammonia positron emission tomography, with 24 coronary artery branches, were included. Five branches had inconsistent FFR and MFR values, two had normal FFR but abnormal MFR, and three had abnormal FFR and normal MFR. The abnormal MFR group had significantly higher MBF at rest than the normal group (0.86 ± 0.13 vs. 1.08 ± 0.09, p = 0.001). The abnormal FFR group had significantly lower MBF at adenosine loading than the normal group (2.23 ± 0.23 vs. 1.88 ± 0.29, p = 0.021). The three branches with abnormal FFR only had stenotic lesions, but the MFR may have been normal because blood was supplied by collateral vessels. Combining FFR, MFR, and MBF will enable a more accurate assessment of peripheral coronary circulation and stenotic lesions in CALs and help determine treatment strategy and timing of intervention. Full article

(This article belongs to the Special Issue Clinical Burden of Comorbidities on Cardiovascular System and Beyond)

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J. Cardiovasc. Dev. Dis., Volume 11, Issue 8 (August 2024) – 26 articles

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