Journal of Cardiovascular Development and Disease

22 pages, 936 KiB

Open AccessReview

Statins in the Cause and Prevention of Cancer: Confounding by Indication and Mediation by Rhabdomyolysis and Phosphate Toxicity

by Ronald B. Brown

J. Cardiovasc. Dev. Dis. 2024, 11(9), 296; https://doi.org/10.3390/jcdd11090296 - 23 Sep 2024

Viewed by 1607

Abstract

Statins are drugs used in cardiovascular pharmacotherapy to decrease hypercholesterolemia and lower the risk of atherosclerosis. Statins also increase the risk of rhabdomyolysis, which is often minimized in comparison with large relative risk reductions of cardiovascular disease reported in clinical trials. By contrast, [...] Read more.

Statins are drugs used in cardiovascular pharmacotherapy to decrease hypercholesterolemia and lower the risk of atherosclerosis. Statins also increase the risk of rhabdomyolysis, which is often minimized in comparison with large relative risk reductions of cardiovascular disease reported in clinical trials. By contrast, absolute risk reductions of cardiovascular disease are often clinically insignificant and unreported in statin clinical trials. Additionally, cytotoxic effects of statins inhibit cancer cell proliferation and reduce cancer risk, but other studies found that statins are carcinogenic. Due to an inverse association between incidence of cancer and atherosclerosis, the indication to prescribe statins likely biases the association of statins with cancer prevention. Dietary patterns associated with atherosclerosis and cancer contain inverse amounts of cholesterol and phosphate, an essential mineral that stimulates tumorigenesis. Accordingly, lower cancer risk is associated with high dietary cholesterol intake and increased risk of atherosclerosis. Furthermore, serum is exposed to excessive inorganic phosphate that could increase cancer risk as rhabdomyolysis induced by statins releases phosphate from skeletal muscle breakdown. Increased risk of comorbid conditions associated with statins may share the mediating factor of phosphate toxicity. More research is warranted on statins in the cause and prevention of cancer. Full article

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

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13 pages, 3854 KiB

Open AccessReview

The Role of Coronary Imaging in Chronic Total Occlusions: Applications and Future Possibilities

by Giuseppe Panuccio, Youssef S. Abdelwahed, Nicole Carabetta, Ulf Landmesser, Salvatore De Rosa and Daniele Torella

J. Cardiovasc. Dev. Dis. 2024, 11(9), 295; https://doi.org/10.3390/jcdd11090295 - 21 Sep 2024

Cited by 1 | Viewed by 1156

Abstract

Chronic total occlusions (CTOs) represent a challenging scenario in coronary artery disease (CAD). The prevalence of CTOS in patients undergoing coronary angiography underscores the need for effective diagnostic and therapeutic strategies. Coronary angiography, while essential, offers limited insights into lesion morphology, vessel course, [...] Read more.

Chronic total occlusions (CTOs) represent a challenging scenario in coronary artery disease (CAD). The prevalence of CTOS in patients undergoing coronary angiography underscores the need for effective diagnostic and therapeutic strategies. Coronary angiography, while essential, offers limited insights into lesion morphology, vessel course, and myocardial viability. In contrast, coronary imaging techniques—including optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography (CCTA)—provide comprehensive insights for each stage of CTO percutaneous coronary intervention (PCI). OCT facilitates the assessment of plaque morphology and stent optimization, despite low evidence and several limitations in CTO-PCI. IVUS offers deeper penetration, allowing managing proximal cap scenarios and guiding subintimal navigation. CCTA provides a non-invasive, three-dimensional view of coronary anatomy, enabling the precise evaluation of myocardial mass at risk and detailed procedural planning. Despite their individual limitations, these imaging modalities have enhanced the success rates of CTO-PCI, thus reducing procedural and long-term complications and improving patient outcomes. The future of CTO management lies in further technological advancements, including hybrid imaging, artificial intelligence (AI) integration, and improved fusion imaging. These innovations promise to refine procedural precision and personalize interventions, ultimately improving the care of patients with complex coronary artery disease. 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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10 pages, 1511 KiB

Open AccessArticle

High-Power Short-Duration Posterior Wall Isolation in Addition to Pulmonary Vein Isolation in Persistent Atrial Fibrillation Ablation Using the New TactiFlex™ Ablation Catheter

by Sergio Conti, Francesco Sabatino, Giulia Randazzo, Giuliano Ferrara, Antonio Cascino and Giuseppe Sgarito

J. Cardiovasc. Dev. Dis. 2024, 11(9), 294; https://doi.org/10.3390/jcdd11090294 - 20 Sep 2024

Viewed by 763

Abstract

Background: The TactiFlex™ ablation catheter, Sensor Enabled™ (Abbott, Minneapolis, MN, USA), is an open-irrigation radiofrequency (RF) ablation catheter with flexible tip technology. This catheter delivers high-power short-duration (HPSD) RF ablations and has been adopted for atrial fibrillation (AF) ablation. HPSD is well-established not [...] Read more.

Background: The TactiFlex™ ablation catheter, Sensor Enabled™ (Abbott, Minneapolis, MN, USA), is an open-irrigation radiofrequency (RF) ablation catheter with flexible tip technology. This catheter delivers high-power short-duration (HPSD) RF ablations and has been adopted for atrial fibrillation (AF) ablation. HPSD is well-established not only in pulmonary vein isolation (PVI) but also when targeting extra-pulmonary vein (PV) targets. This study aims to determine the safety, effectiveness, and acute outcomes of PVI plus posterior wall isolation (PWI) in patients with persistent atrial fibrillation (Pe-AF) using HPSD and the TactiFlex™ ablation catheter. Methods: Consecutive patients who underwent the ablation of Pe-AF in our centre between February 2023 and February 2024 were prospectively enrolled in the study. All patients underwent PVI plus PWI using TactiFlex™ and the HPSD strategy. The RF parameters were 50 W on all the PV segments and the roof, and within the posterior wall (PW). Left atrial mapping was performed with the EnSite X mapping system and the high-density multipolar Advisor HD Grid, Sensor Enabled™ mapping catheter. We compared the procedural data using HPSD with TactiFlex™ (n = 52) vs. a historical cohort of patients who underwent PVI plus PWI using HPSD settings and the TactiCath ablation catheter (n = 84). Results: Fifty-two consecutive patients were included in the study. PVI and PWI were achieved in all patients in the TactiFlex™ group. First-pass PVI was achieved in 97.9% of PVs (n = 195/199). PWI was obtained in all cases by delivering extensive RF lesions within the PW. There were no significant differences compared to the TactiCath group: first-pass PVI was achieved in 96.3% of PVs (n = 319/331). Adenosine administration revealed PV reconnection in 5.7% of patients, and two reconnections of the PW were documented. Procedure and RF time were significantly shorter in the TactiFlex™ group compared to the TactiCath group, 73.1 ± 12.6 vs. 98.5 ± 16.3 min, and 11.3 ± 1.5 vs. 23.5 ± 3.6 min, respectively, p < 0.001. The fluoroscopy time was comparable between both groups. No intraprocedural and periprocedural complications related to the ablation catheter were observed. Patients had an implantable loop recorder before discharge. At the 6-month follow-up, 76.8% of patients remained free from atrial arrhythmia, with no significant differences between groups. Conclusions: HPSD PVI plus PWI using the TactiFlex™ ablation catheter is effective and safe. Compared to a control group, the use of TactiFlex™ to perform HPSD PVI plus PWI is associated with a similar effectiveness but with a significantly shorter procedural and RF time. Full article

(This article belongs to the Special Issue Catheter Ablation of Cardiac Arrhythmias: Past, Present and Future)

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8 pages, 725 KiB

Open AccessCase Report

Septal Myectomy in Patients with Hypertrophic Cardiomyopathy and Nonclassical Anderson–Fabry Disease

by Alexandr Gurschenkov, Sofiya Andreeva, Vadim Zaitsev, Pavel Khazov, Gleb Ischmukhametov, Alexandra Kozyreva, Polina Sokolnikova, Olga Moiseeva, Anna Kostareva and Mikhail Gordeev

J. Cardiovasc. Dev. Dis. 2024, 11(9), 293; https://doi.org/10.3390/jcdd11090293 - 20 Sep 2024

Viewed by 739

Abstract

Anderson–Fabry disease (AFD) results from decreased enzyme activity of lysosomal enzymes and intralysosomal storage of nonhydrolyzed forms. Cardiovascular complications, mainly in the form of HCM, contribute substantially to AFD patient mortality. Here, we report three new cases of obstructive HCM (HOCM) in nonclassical [...] Read more.

Anderson–Fabry disease (AFD) results from decreased enzyme activity of lysosomal enzymes and intralysosomal storage of nonhydrolyzed forms. Cardiovascular complications, mainly in the form of HCM, contribute substantially to AFD patient mortality. Here, we report three new cases of obstructive HCM (HOCM) in nonclassical presentations of AFD and isolated cardiac involvement. In all three cases, the diagnosis of AFD was made postoperatively by routine genetic and morphological testing. Together with previously published cases, this report illustrates the potential safety and beneficial effect of septal surgical myectomy in patients with AFD-HOCM, as well as underlines the need for more thorough screening for clinical signs of AFD-associated cardiomyopathy and GLA variants among patients with HOCM. Full article

(This article belongs to the Special Issue Hypertrophic Cardiomyopathy: Pathogenesis, Diagnosis and Management)

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9 pages, 553 KiB

Open AccessArticle

Serum Klotho Is Elevated in Patients with Acute Myocardial Infarction and Could Predict Poor In-Hospital Prognosis

by Yuanyuan Pei, Wenfeng Huang, Lingjie Cao, Fengtao Yang, Cheng Chi and Jihong Zhu

J. Cardiovasc. Dev. Dis. 2024, 11(9), 292; https://doi.org/10.3390/jcdd11090292 - 20 Sep 2024

Cited by 1 | Viewed by 669

Abstract

Introduction: Klotho has emerged as a potential protective factor for cardiovascular diseases recently. Nevertheless, the levels of serum Klotho in acute coronary syndrome (ACS) have not been reported. Hence, we undertook a study to investigate the potential correlation between serum Klotho and ACS [...] Read more.

Introduction: Klotho has emerged as a potential protective factor for cardiovascular diseases recently. Nevertheless, the levels of serum Klotho in acute coronary syndrome (ACS) have not been reported. Hence, we undertook a study to investigate the potential correlation between serum Klotho and ACS patients. Method: This observational cohort study was conducted at Peking University People’s Hospital between May 2016 and April 2020. Upon admission, we collected the patients’ clinical data and conducted ELISA tests to measure their serum Klotho levels. Result: A total of 349 patients were enrolled in this study, including 14 patients with UA and 335 patients with AMI. We observed that serum Klotho levels were obviously higher in the AMI group compared to the UA group (median 479.8 vs. 233.8 pg/mL, p = 0.035). In addition, serum Klotho levels were positively correlated with cardiac function and more pronounced in patients who died in the hospital (median 721.1 vs. 468.3 pg/mL, p < 0.001). A logistic regression analysis indicated that age ≥ 78 years old, HR ≥ 90 bpm, Killip classification ≥ 3 grade, and serum Klotho > 645.0 pg/mL were risk factors for poor prognosis. Conclusions: Serum Klotho is obviously increased in patients with AMI and with a positive correlation with cardiac function, and its elevation could serve as a predictor of poor prognosis in ACS patients. Full article

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19 pages, 1677 KiB

Open AccessFeature PaperReview

Beyond Clinical Factors: Harnessing Artificial Intelligence and Multimodal Cardiac Imaging to Predict Atrial Fibrillation Recurrence Post-Catheter Ablation

by Edward T. Truong, Yiheng Lyu, Abdul Rahman Ihdayhid, Nick S. R. Lan and Girish Dwivedi

J. Cardiovasc. Dev. Dis. 2024, 11(9), 291; https://doi.org/10.3390/jcdd11090291 - 19 Sep 2024

Viewed by 2617

Abstract

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, with catheter ablation being a key alternative to medical treatment for restoring normal sinus rhythm. Despite advances in understanding AF pathogenesis, approximately 35% of patients experience AF recurrence at 12 months after [...] Read more.

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, with catheter ablation being a key alternative to medical treatment for restoring normal sinus rhythm. Despite advances in understanding AF pathogenesis, approximately 35% of patients experience AF recurrence at 12 months after catheter ablation. Therefore, accurate prediction of AF recurrence occurring after catheter ablation is important for patient selection and management. Conventional methods for predicting post-catheter ablation AF recurrence, which involve the use of univariate predictors and scoring systems, have played a supportive role in clinical decision-making. In an ever-changing landscape where technology is becoming ubiquitous within medicine, cardiac imaging and artificial intelligence (AI) could prove pivotal in enhancing AF recurrence predictions by providing data with independent predictive power and identifying key relationships in the data. This review comprehensively explores the existing methods for predicting the recurrence of AF following catheter ablation from different perspectives, including conventional predictors and scoring systems, cardiac imaging-based methods, and AI-based methods developed using a combination of demographic and imaging variables. By summarising state-of-the-art technologies, this review serves as a roadmap for developing future prediction models with enhanced accuracy, generalisability, and explainability, potentially contributing to improved care for patients with AF. Full article

(This article belongs to the Special Issue Extensive Approach to Atrial Fibrillation: Background and Future Perspectives)

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18 pages, 1816 KiB

Open AccessReview

Advancements in the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: A Comprehensive Review

by Randeep Gill, Arsalan Siddiqui, Brianna Yee, Michael V. DiCaro, Nazanin Houshmand and Tahir Tak

J. Cardiovasc. Dev. Dis. 2024, 11(9), 290; https://doi.org/10.3390/jcdd11090290 - 18 Sep 2024

Viewed by 941

Abstract

Hypertrophic cardiomyopathy (HCM) is characterized by excessive growth of myocardial tissue, most commonly due to genetic mutations in sarcomere proteins. This can lead to complications such as heart failure, mitral regurgitation, syncope, arrhythmias, sudden cardiac death, and myocardial ischemia. While we have come [...] Read more.

Hypertrophic cardiomyopathy (HCM) is characterized by excessive growth of myocardial tissue, most commonly due to genetic mutations in sarcomere proteins. This can lead to complications such as heart failure, mitral regurgitation, syncope, arrhythmias, sudden cardiac death, and myocardial ischemia. While we have come a long way in our understanding of the pathophysiology, genetics, and epidemiology of HCM, the past 10 years have seen significant advancements in diagnosis and treatment. As the body of evidence on hypertrophic cardiomyopathy continues to grow, a comprehensive review of the current literature is an invaluable resource in organizing this knowledge. By doing so, the vast progress that has been made thus far will be widely available to all experts in the field. This review provides a comprehensive analysis of the scientific literature, exploring both well-established and cutting-edge diagnostic and therapeutic options. It also presents a unique perspective by incorporating topics such as exercise testing, genetic testing, radiofrequency ablation, risk stratification, and symptomatic management in non-obstructive HCM. Lastly, this review highlights areas where current and future research is at the forefront of innovation in hypertrophic cardiomyopathy. Full article

(This article belongs to the Special Issue Advancements in the Epidemiology, Diagnosis and Treatment of Hypertrophic Cardiomyopathy)

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14 pages, 551 KiB

Open AccessSystematic Review

Nutritional Interventions in Older Persons with Type 2 Diabetes and Frailty: A Scoping Systematic Review

by German C. Giraldo Gonzalez, Luz M. González Robledo, Isabel C. Jaimes Montaña, Angela M. Benjumea Salgado, Sayda M. Pico Fonseca, Martha J. Arismendi Solano and Claudia L. Valencia Rico

J. Cardiovasc. Dev. Dis. 2024, 11(9), 289; https://doi.org/10.3390/jcdd11090289 - 18 Sep 2024

Viewed by 1097

Abstract

In the elderly, the coexistence of type 2 diabetes mellitus (T2DM) and frailty is frequent. Much has been described about pharmacological management and glycemic control goals. However, there is a knowledge gap in terms of the objectives and characteristics of interventions, especially nutritional [...] Read more.

In the elderly, the coexistence of type 2 diabetes mellitus (T2DM) and frailty is frequent. Much has been described about pharmacological management and glycemic control goals. However, there is a knowledge gap in terms of the objectives and characteristics of interventions, especially nutritional ones, for this population. A scoping review was performed to document the objectives, characteristics, and results of nutritional interventions in older people with T2DM and frailty. The five-stage framework of Arksey and O’Malley was used, as was the PRISMA extension for scoping reviews. The results stand out for three trends, as follows: (1) experimental studies with multicomponent intervention physical exercise programs and nutritional programs based on educational processes or behavioral intervention; (2) observational studies with an association of the kind of diet assessed by scales and their relation to stages of frailty; (3) a review that updates recommendations on pharmacological and non-pharmacological, diet, exercise, management, as well as glucose control goals for diabetes in frail older persons. Finally, the evidence shows that management of T2DM in older adults with frailty requires goals and interventions tailored to their functional capacity and health condition. The exercise, diet, and education programs reviewed have demonstrated their effectiveness in improving physical performance, reducing the risk of frailty or progression to more advanced stages, and achieving better glycemic control. Full article

(This article belongs to the Special Issue New Insight into Cardiovascular Disease in Elderly People)

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6 pages, 755 KiB

Open AccessCase Report

Paediatric HeartMate 3™, the Uneventful 22-Month Journey to Transplantation of a 14-Year-Old-Patient—Time for Prolonged LVAD Support in Children?

by Clemens Haselmann, Sonja Budäus, Michael Zellner, Robert Cesnjevar and Martin Schweiger

J. Cardiovasc. Dev. Dis. 2024, 11(9), 288; https://doi.org/10.3390/jcdd11090288 - 18 Sep 2024

Viewed by 668

Abstract

We report on a 14-year-old patient who was supported for nearly two years with an ic-LVAD and managed to complete his journey to transplantation without a single complication. Although mechanical assist device support is available for children up to 20 kg in body [...] Read more.

We report on a 14-year-old patient who was supported for nearly two years with an ic-LVAD and managed to complete his journey to transplantation without a single complication. Although mechanical assist device support is available for children up to 20 kg in body weight, availability is limited to paracorporeal devices. Intracorporal (ic) left ventricular assist devices (LVADs) for infants in the suitable weight class are a viable option as a bridge-to-transplant, where they make up more than 50% of transplant candidates in their category. A teenager with 59 kg body weight was newly diagnosed with DCM and listed for heart transplantation. After initially being on VA-ECMO, an Abbott HeartMate 3 LVAD with postoperative temporary RVAD support was initialised. RV-support was maintained for 10 days. The further postoperative course was uneventful, and he was discharged on day 98. He was seen regularly in the outpatient department and integrated into school routine again, following the extensive training of his classmates and the responsible school staff. After a total of 672 days on support, he was successfully transplanted. There were no unplanned admissions, thrombotic nor bleeding events, as well as no driveline infection, even though the patient participated in sport classes at school. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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11 pages, 565 KiB

Open AccessArticle

Lifestyle Habits and Risk of Cardiovascular Mortality in Menopausal Women with Cardiovascular Risk Factors: A Retrospective Cohort Study

by Adriana Lopez-Pineda, Cristina Soriano-Maldonado, Vicente Arrarte, Francisco Sanchez-Ferrer, Vicente Bertomeu-Gonzalez, Juan Miguel Ruiz-Nodar, Jose A. Quesada and Alberto Cordero

J. Cardiovasc. Dev. Dis. 2024, 11(9), 287; https://doi.org/10.3390/jcdd11090287 - 16 Sep 2024

Viewed by 856

Abstract

Current cardiovascular prevention guidelines emphasise considering sex, gender, and gender identity in risk assessment. This study evaluated the impact of lifestyle habits and chronic diseases on cardiovascular mortality risk in women over 50 with high vascular risk and developed a predictive model for [...] Read more.

Current cardiovascular prevention guidelines emphasise considering sex, gender, and gender identity in risk assessment. This study evaluated the impact of lifestyle habits and chronic diseases on cardiovascular mortality risk in women over 50 with high vascular risk and developed a predictive model for menopausal women with cardiovascular risk factors. A retrospective cohort study used data from the 2011 Spanish National Health Survey and the national death register, focusing on menopausal and postmenopausal women without prior cardiovascular events but with at least one major risk factor. Participants were followed for up to 10 years, assessing mortality from circulatory system diseases and other causes. Exposure variables included socio-demographics, lifestyle habits, health status, self-perceived health, health service use, and pharmacological treatments. Of the 21,007 respondents, 3057 women met the inclusion criteria. The 10-year cumulative incidence of mortality from circulatory causes was 5.9%, and from other causes, 12.7%. Independent predictors of cardiovascular mortality were never consuming legumes, poor self-perceived health, diabetes treatment, lack of physical activity, and older age. Lipid-lowering treatment was protective. The model demonstrated good fit and predictive capacity (C-index = 0.773). This study highlights the significant influence of physical activity, legume consumption, self-perceived health, and specific treatments on cardiovascular mortality risk in menopausal women. Full article

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

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9 pages, 555 KiB

Open AccessArticle

Addition of Bempedoic Acid to Statin–Ezetimibe versus Statin Titration in Patients with High Cardiovascular Risk: A Single-Centre Prospective Study

by Giuseppe Marazzi, Giuseppe Caminiti, Marco Alfonso Perrone, Giuseppe Campolongo, Luca Cacciotti, Domenico Mario Giamundo, Ferdinando Iellamo, Paolo Severino, Maurizio Volterrani and Giuseppe Rosano

J. Cardiovasc. Dev. Dis. 2024, 11(9), 286; https://doi.org/10.3390/jcdd11090286 - 14 Sep 2024

Viewed by 1134

Abstract

Reducing levels of low-density lipoprotein cholesterol (LDL-C) below recommended thresholds is a core component of cardiovascular prevention strategies. We hypothesized that the addition of bempedoic acid to patients already on statin–ezetimibe therapy was more effective than titrating the statin dose in reducing LDL-C. [...] Read more.

Reducing levels of low-density lipoprotein cholesterol (LDL-C) below recommended thresholds is a core component of cardiovascular prevention strategies. We hypothesized that the addition of bempedoic acid to patients already on statin–ezetimibe therapy was more effective than titrating the statin dose in reducing LDL-C. The study enrolled 120 patients at high cardiovascular risk and with LDL-C above 70 mg/dL. They were randomly divided into two groups: the bempedoic acid (BA) group, taking bempedoic acid in addition to statin plus ezitimibe, and the statin titration (ST) group, including patients who doubled the dose of statin. At 12 weeks, the BA group presented a more significant decrease in LDL-C compared to the ST group (−22.9% vs. 7.5% p 0.002). The total cholesterol decreased significantly in the BA group compared to ST (−14.8% vs.−4.7%; p 0.013) No significant between-group changes in HDL and triglycerides occurred. At 12 weeks, the number of patients who reached LDL-C lower than 70 mg/dL was 38 (63%) in the BA group versus 22 (37%) in the ST group (between groups, p 0.034). In the BA group, the LDL-lowering effect of bempedoic acid was similar between patients taking atorvastatin and rosuvastatin. No side effects occurred during the follow up period. In conclusion, the addition of bempedoic acid to statin–ezetimibe combined treatment was more effective than doubling the dose of statin in reducing LDL-C levels and increased the number of patients reaching the LDL-C goal. Full article

(This article belongs to the Special Issue Effects of Pharmaceutical Intervention on Cardiovascular Risk)

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10 pages, 1252 KiB

Open AccessArticle

Effect of Sport Activity on Uncomplicated Bicuspid Aortic Valve: Long-Term Longitudinal Echocardiographic Study

by Massimiliano Bianco, Fabrizio Sollazzo, Gloria Modica, Isabella Carlotta Zovatto, Rachele Di Mario, Riccardo Monti, Michela Cammarano, Vincenzo Palmieri and Paolo Zeppilli

J. Cardiovasc. Dev. Dis. 2024, 11(9), 285; https://doi.org/10.3390/jcdd11090285 - 10 Sep 2024

Viewed by 875

Abstract

Background: The bicuspid aortic valve (BAV) is a congenital heart defect that can lead to certain complications (aortic stenosis, regurgitation, dilatation and endocarditis), the diagnosis and clinical monitoring of which are effectively entrusted to transthoracic echocardiography (TTE). The impact of training on the [...] Read more.

Background: The bicuspid aortic valve (BAV) is a congenital heart defect that can lead to certain complications (aortic stenosis, regurgitation, dilatation and endocarditis), the diagnosis and clinical monitoring of which are effectively entrusted to transthoracic echocardiography (TTE). The impact of training on the natural history of the disease remains unclear. Methods: A retrospective cohort of athletes with uncomplicated BAV aged 18–50 years, who underwent at least 2 TTEs with a minimum follow-up of 5 years, subdivided according to the level of physical activity during follow-up into ‘’untrained’’ and ‘’trained’’, was collected. RESULTS: 47 athletes (87.3% male, median 21.0, (18.0; 33.0) years) were included. Median follow-up was 11.6 (8.4; 16.3) years. No statistically significant difference in the growing rate of aorta, left ventricle, nor a significant worsening of aortic stenosis and regurgitation was found. Moreover, there was no significant correlation between weekly training minutes during follow-up and the echocardiographic parameters related to heart size and function. Conclusions: In BAV without major complications, high training volumes do not correspond to a more rapid and significant deterioration in valve function nor to a more rapid increase in aortic or cardiac chamber size. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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11 pages, 4338 KiB

Open AccessArticle

The Effect of Upright Posture on Left Atrial Strain in Competitive Athletes

by Joscha Kandels, Stephan Stöbe, Robert Percy Marshall, Andreas Hagendorff and Michael Metze

J. Cardiovasc. Dev. Dis. 2024, 11(9), 284; https://doi.org/10.3390/jcdd11090284 - 9 Sep 2024

Viewed by 696

Abstract

Background: Left atrial strain (LAS) assessment by speckle tracking echocardiography (STE) has been shown to be a remarkable means of quantifying LA function as an early marker of LV pathology. As exercise testing is also performed on a treadmill, the aim of this [...] Read more.

Background: Left atrial strain (LAS) assessment by speckle tracking echocardiography (STE) has been shown to be a remarkable means of quantifying LA function as an early marker of LV pathology. As exercise testing is also performed on a treadmill, the aim of this study was to investigate the effect of upright posture on LAS in healthy athletes. Methods: Fifty male athletes (mean age 25.7 ± 7.3 years) underwent transthoracic echocardiography (TTE) in the upright and left lateral positions. In addition to the conventional echocardiographic parameters, in all athletes, LA conduction strain (LAScd), contraction strain (LASct), reservoir strain (LASr), and maximum LA volume (LAV_max) were assessed by STE in both positions. Results: Comparing upright posture and the left lateral position, LAScd (−14.0 ± 5.9% vs. −27.4 ± 7.1%; p < 0.001), LASct (−4.6 ± 3.5% vs. −11.3 ± 4.1%; p < 0.001), LASr (18.7 ± 7.6% vs. 38.7 ± 8.0%; p < 0.001), and LAV_max (24.4 ± 8.8% vs. 50.0 ± 14.2%) differed significantly. Conclusions: Upright posture has a significant effect on LA deformation, with decreased LAScd, LASct, and LASr. The results of this study contribute to the understanding of athletes’ hearts and must be considered when performing echocardiography in healthy athletes on a treadmill. Full article

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

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11 pages, 233 KiB

Open AccessArticle

Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock

by Cagdas Baran, Evren Ozcinar, Ahmet Kayan, Nur Dikmen, Canan Soykan Baran and Mustafa Bahadir Inan

J. Cardiovasc. Dev. Dis. 2024, 11(9), 283; https://doi.org/10.3390/jcdd11090283 - 8 Sep 2024

Viewed by 882

Abstract

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried [...] Read more.

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery. Full article

(This article belongs to the Topic Extracorporeal Membrane Oxygenation (ECMO))

3 pages, 176 KiB

Open AccessEditorial

Arrhythmic Risk Stratification—General Considerations in Specific Scenarios

by Marisa Varrenti and Patrizio Mazzone

J. Cardiovasc. Dev. Dis. 2024, 11(9), 282; https://doi.org/10.3390/jcdd11090282 - 7 Sep 2024

Viewed by 519

Abstract

Arrhythmic risk stratification is challenging for cardiologists managing patients with different forms of cardiomyopathy, ranging from post-ischemic or non-ischemic cardiomyopathies to systemic diseases with cardiac involvement such as neuromuscular disorders and infiltrative diseases [...] Full article

(This article belongs to the Special Issue Arrhythmic Risk Stratification)

10 pages, 5143 KiB

Open AccessArticle

Novel Computed Tomography Angiography Parameter Is Associated with Low Cardiac Index in Patients with Chronic Thromboembolic Pulmonary Hypertension: A Retrospective Analysis

by Estefania Oliveros, Michel Ibrahim, Carlos Manuel Romero, Paul Navo, Patricia Otero Valdes, Yevgeniy Brailovsky, Amir Darki, Riyaz Bashir, Anjali Vaidya, Paul Forfia and Chandra Dass

J. Cardiovasc. Dev. Dis. 2024, 11(9), 281; https://doi.org/10.3390/jcdd11090281 - 7 Sep 2024

Viewed by 748

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of incomplete resolution of acute pulmonary embolism. We hypothesize changes in CT Hounsfield Unit gradient (HU-Δ) created by the dispersion of IV contrast through the downstream blood pool correlate with cardiac index (CI). We sought [...] Read more.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of incomplete resolution of acute pulmonary embolism. We hypothesize changes in CT Hounsfield Unit gradient (HU-Δ) created by the dispersion of IV contrast through the downstream blood pool correlate with cardiac index (CI). We sought to compare HU-Δ with invasively obtained CI. Methods: We completed a retrospective analysis of CTEPH patients in which individuals with low CI (<2.2-L/min/m²) were identified. Both absolute and fractional HU-Δ were derived from pulmonary CTA by subtracting the HU value of the left atrium (LA) and left ventricle (LV) from the main pulmonary artery (MPA) (absolute) and expressing them as a percentage of MPA-HU (fractional) on static axial images. These were compared between low and normal CI. Results: Of the 237 patients, 50.2% were female, 53.2% were White, 36.7% were Black. Hemodynamics were mean pulmonary artery (PA) pressure = 45.4 ± 11.2-mmHg, pulmonary vascular resistance = 9.2 ± 4.4-WU, CI = 2.05 ± 0.48-L/min/m². There was a higher mean MPA-HU = 391.1 ± 113.6 than LA-HU = 251.6 ± 81. In patients with low CI, the HU-Δ was higher, HU-ΔMPA-LA was 148.9 ± 78.4 vs. 124.5 ± 77.2 (p = 0.02), and HU-ΔMPA-LV was 170.7 ± 87 vs. 140 ± 82 (p = 0.009). A HU-ΔMPA-LA = 118 had a sensitivity of 75.6% and specificity of 77% to detect low CI, AUC 0.61, p = 0.003. A HU-ΔPA-LV = 156 had a sensitivity of 77% and specificity of 53% to detect low CI, AUC = 0.62, p = 0.001. A fractional reduction HU-ΔMPA-LA of 35% had a sensitivity and specificity of 79% and 53%, respectively, to detect low CI (AUC 0.65, p < 0.001). A fractional reduction of the HU-ΔMPA-LV of 40% had a sensitivity and specificity of 80% and 55%, respectively, to detect low CI (AUC 0.65, p < 0.001). HU Δ were highly reproducible (Kappa = 0.9, p < 0.001, 95% CI 0.86–0.95). Conclusions: High HU Δ between MPA-LA and MPA-LV were associated with low CI in patients with CTEPH. Full article

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

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12 pages, 573 KiB

Open AccessArticle

Influence of Night Shift Work on Heart Rate Variability in an Age- and Gender-Matched Study Group

by Kai H. Barckhan, Irina Böckelmann and Stefan Sammito

J. Cardiovasc. Dev. Dis. 2024, 11(9), 280; https://doi.org/10.3390/jcdd11090280 - 7 Sep 2024

Viewed by 774

Abstract

Regular and long-term shift work is associated with a number of chronic diseases. There is some evidence that shift work also has an influence on the autonomous nervous system. Studies that have examined the effect of shift work on heart rate variability (HRV) [...] Read more.

Regular and long-term shift work is associated with a number of chronic diseases. There is some evidence that shift work also has an influence on the autonomous nervous system. Studies that have examined the effect of shift work on heart rate variability (HRV) have not taken into account age and gender. Therefore, the aim of this study was to investigate the influence of night shift based on 24 h long-term analyses carried out on non-night shift days with a matched control group for age and gender. In total, 172 (128 male, 44 female) healthy shift night workers were compared with subjects from a non-night shift worker group at a ratio of 1:1, forming matched pairs based on the subjects’ sex and age. HRV parameters were analyzed based on 24 h ECG recording. An analysis of the HRV parameters showed only a small difference but without statistical significance between the two groups with regard to all of the HRV parameters examined (SDNN, RMSSD, NN50, pNN50, VLF, LF, HF, LF/HF, DFA1, and DFA2). An analysis of the subgroup of subjects who had only worked night shifts for a minimum of 10 or 20 years, with the respective pairs matched by age and gender, did not reveal any significant differences between the HRV parameters of employees working night shifts and those not working night shifts. Taking into account qualitative aspects of HRV analysis, this study was thus able to show that working night shifts for many years may not have as big an influence on HRV as had been assumed so far. Full article

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13 pages, 1382 KiB

Open AccessArticle

Prevalence, Clinical Characteristics, and Treatment of Patients with Resistant Hypertension: A Single-Center Study

by Stefan Naydenov, Emil Manov and Nikolay Runev

J. Cardiovasc. Dev. Dis. 2024, 11(9), 279; https://doi.org/10.3390/jcdd11090279 - 5 Sep 2024

Viewed by 692

Abstract

Background: Resistant hypertension (HTN) is associated with a high risk of cardiovascular complications. Our study aimed to assess the prevalence, characteristics, and treatment of patients with resistant HTN. Methods: We screened 4340 consecutive cardiovascular patients hospitalized in our clinic and identified 3762 with [...] Read more.

Background: Resistant hypertension (HTN) is associated with a high risk of cardiovascular complications. Our study aimed to assess the prevalence, characteristics, and treatment of patients with resistant HTN. Methods: We screened 4340 consecutive cardiovascular patients hospitalized in our clinic and identified 3762 with HTN. Of them, 128 fulfilled criteria for resistant HTN and were included in our study. We matched these patients to 128 hospitalized patients with controlled HTN. Results: Resistant HTN patients comprised 3.4% of all hypertensive individuals. Most of these patients (67.2%) were at high or very high cardiovascular risk compared to controlled HTN patients (40.6%); p < 0001. Resistant HTN patients more commonly had concomitant chronic kidney disease (CKD) (60.9%), overweight/obesity (52.3%), dyslipidemias (35.2%), smoking (27.3%), and diabetes (21.9%) compared to controlled HTN patients (37.5%, 29.7%, 28.1%, 14.1%, and 7.8%, respectively); p < 0.001. Regression analysis showed the strongest association of resistant HTN with CKD (OR 6.64), stage III HTN (OR 3.07), and obesity/overweight (OR 2.60). In contrast, single-pill combinations (SPCs) were associated with a lower likelihood of uncontrolled HTN (OR 0.58). Conclusions: Resistant HTN represented a small proportion of all hypertensives in our study, but it was characterized by high/very high cardiovascular risk. Optimized therapy including increased use of SPCs could improve blood pressure control and long-term prognosis for these patients. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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12 pages, 1879 KiB

Open AccessArticle

Investigation of the Clinical Value of Four Visualization Modalities for Congenital Heart Disease

by Shen-yuan Lee, Andrew Squelch and Zhonghua Sun

J. Cardiovasc. Dev. Dis. 2024, 11(9), 278; https://doi.org/10.3390/jcdd11090278 - 5 Sep 2024

Viewed by 647

Abstract

Diagnosing congenital heart disease (CHD) remains challenging because of its complex morphology. Representing the intricate structures of CHD on conventional two-dimensional flat screens is difficult owing to wide variations in the pathologies. Technological advancements, such as three-dimensional-printed heart models (3DPHMs) and virtual reality [...] Read more.

Diagnosing congenital heart disease (CHD) remains challenging because of its complex morphology. Representing the intricate structures of CHD on conventional two-dimensional flat screens is difficult owing to wide variations in the pathologies. Technological advancements, such as three-dimensional-printed heart models (3DPHMs) and virtual reality (VR), could potentially address the limitations of viewing complex structures using conventional methods. This study aimed to investigate the usefulness and clinical value of four visualization modalities across three different cases of CHD, including ventricular septal defect, double-outlet right ventricle, and tetralogy of Fallot. Seventeen cardiac specialists were invited to participate in this study, which was aimed at assessing the usefulness and clinical value of four visualization modalities, namely, digital imaging and communications in medicine (DICOM) images, 3DPHM, VR, and 3D portable document format (PDF). Out of these modalities, 76.4% of the specialists ranked VR as the best for understanding the spatial associations between cardiac structures and for presurgical planning. Meanwhile, 94.1% ranked 3DPHM as the best modality for communicating with patients and their families. Of the various visualization modalities, VR was the best tool for assessing anatomical locations and vessels, comprehending the spatial relationships between cardiac structures, and presurgical planning. The 3DPHM models were the best tool for medical education as well as communication. In summary, both 3DPHM and VR have their own advantages and outperform the other two modalities, i.e., DICOM images and 3D PDF, in terms of visualizing and managing CHD. 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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19 pages, 551 KiB

Open AccessArticle

The Role of P Wave Parameters in Predicting Pulmonary Vein Isolation Outcomes for Paroxysmal Atrial Fibrillation: An Observational Cohort Study

by Ibrahim Antoun, Xin Li, Ahmed I. Kotb, Zakkariya Vali, Ahmed Abdelrazik, Abdulmalik Koya, Akash Mavilakandy, Ivelin Koev, Ali Nizam, Hany Eldeeb, Riyaz Somani and André Ng

J. Cardiovasc. Dev. Dis. 2024, 11(9), 277; https://doi.org/10.3390/jcdd11090277 - 5 Sep 2024

Viewed by 856

Abstract

Background: Pulmonary vein isolation (PVI) is an effective management method for paroxysmal atrial fibrillation (PAF). The P wave in the 12-lead electrocardiogram (ECG) represents atrial depolarisation. This study aims to utilise the P wave to predict PVI outcomes for PAF. Methods: This single-centre [...] Read more.

Background: Pulmonary vein isolation (PVI) is an effective management method for paroxysmal atrial fibrillation (PAF). The P wave in the 12-lead electrocardiogram (ECG) represents atrial depolarisation. This study aims to utilise the P wave to predict PVI outcomes for PAF. Methods: This single-centre retrospective study aimed to predict PVI outcomes using P wave parameters. It included 211 consecutive patients with first PVI for PAF between 2018 and 2019 and targeted the pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12-lead ECGs with 1–50 hertz bandpass filters were monitored before the procedure. Corrected P wave duration (PWDc), P wave amplitude (PWV), P wave dispersion (PWDisp), intra-atrial block (IAB), P wave area (PWA), and P wave terminal force in V1 (PTFV1) were measured before ablation and correlated with the outcomes. Results: Successful PVI occurred in 154 patients (73%). Demographics were similar between both arms. P wave parameters correlated with PVI failure included increased PWDc in all leads except for lead III, aVR, and V3, decreased PWV in lead I (hazard ratio [HR]: 0.7, 95% confidence interval [CI]: 0.53–0.95), lead II (HR: 0.45, 95% CI: 0.22–0.65), aVL (HR: 0.58, 95% CI: 0.22–0.98), and aVF (HR: 0.67, 95% CI: 0.58–0.87), decreased PWA in lead I (HR: 0.55, 95% CI: 0.21–0.76), lead II (HR: 0.48, 95% CI: 0.34–0.87), aVL (HR: 0.65, 95% CI: 0.45–0.96), and aVF (HR: 0.61, 95% CI: 0.32–0.89), and the presence of IAB (HR: 2, 95% CI: 1.4–4.2, p = 0.02). PWDisp and PTFV1 were not correlated with PVI outcome. Conclusions: PWDc, PWA, PWV, and IAB are valuable predictors for PVI outcome for PAF at 12 months. Full article

(This article belongs to the Special Issue Extensive Approach to Atrial Fibrillation: Background and Future Perspectives)

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16 pages, 2015 KiB

Open AccessSystematic Review

The Effect of Statins on Carotid Intima–Media Thickness and C–Reactive Protein in Type 2 Diabetes Mellitus: A Meta–Analysis

by Given Reneilwe Mashaba, Wendy Nokhwezi Phoswa and Kabelo Mokgalaboni

J. Cardiovasc. Dev. Dis. 2024, 11(9), 276; https://doi.org/10.3390/jcdd11090276 - 4 Sep 2024

Viewed by 998

Abstract

Background. The effect of statins on CIMT progression and C-reactive protein (CRP) in T2DM patients is widely reported. However, some studies demonstrated no effect of statins on CIMT and CRP in T2DM patients, while others reported otherwise. Thus, the current study comprehensively and [...] Read more.

Background. The effect of statins on CIMT progression and C-reactive protein (CRP) in T2DM patients is widely reported. However, some studies demonstrated no effect of statins on CIMT and CRP in T2DM patients, while others reported otherwise. Thus, the current study comprehensively and quantitatively analyzes data from previous studies to evaluate the overall effect of statins on CIMT and CRP in T2DM to rule out any inconsistencies observed in previous clinical evidence. Therefore, the aim of this meta-oanalysis was to evaluate the effect of statins on CIMT progression and CRP in T2DM. Methods. A comprehensive search for studies was performed using PubMed, Scopus, Web of Sciences, and the Cochrane Library, for publications from their inception to 16 July 2024. The meta-analysis was conducted using Jamovi (version 4.2.8) and Review Manager (version 5.4), with the overall effect sizes reported as standardized mean differences (SMD) and 95% confidence intervals (CI). Results. Evidence from eleven studies (fifteen statin dosages) that met the inclusion criteria with a sample size of 983 T2DM patients on statin treatment was analyzed. The overall effect size from the random effect model meta-analysis showed a reduction in the CIMT status amongst T2DM patients post-statin treatment compared to at baseline [SMD = −0.47, 95%CI (−0.76, −0.18), p = 0.001]. Furthermore, there was a reduction in the level of CRP in T2DM patients post-treatment [SMD = −1.80, 95% CI (−2.76, −0.84), p < 0.001]. Conclusions. Evidence gathered in this study suggests that statin therapy effectively reduces CIMT and CRP levels among patients living with T2DM. Interestingly, this evidence suggests that 20 mg of atorvastatin is more effective in reducing CIMT and CRP. Therefore, we recommend conducting further trials with larger sample sizes and proper methodology for T2DM. Full article

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11 pages, 1955 KiB

Open AccessArticle

Assessment of the Aorto-Septal Angle Post-Thoracic Endovascular Aortic Repair through Segmentation and the Semi-Automatic Analysis of Cardiosynchronized Computed Tomography Angiography Images

by Marco Magliocco, Michele Conti, Bianca Pane, Marco Canepa, Sara Seitun, Simone Morganti, Giovanni Pratesi and Giovanni Spinella

J. Cardiovasc. Dev. Dis. 2024, 11(9), 275; https://doi.org/10.3390/jcdd11090275 - 4 Sep 2024

Viewed by 659

Abstract

The aim of this study was to inviestigate cardiac and arterial remodelling before and after thoracic endovascular aortic repair (TEVAR) by measuring the Aorto-Septal Angle (AoSA) and the geometric characteristics of the aorta. Five patients were prospectively included. Pre- and post-operative cardio-CTA scans [...] Read more.

The aim of this study was to inviestigate cardiac and arterial remodelling before and after thoracic endovascular aortic repair (TEVAR) by measuring the Aorto-Septal Angle (AoSA) and the geometric characteristics of the aorta. Five patients were prospectively included. Pre- and post-operative cardio-CTA scans were used to create patient-specific 3D models to calculate the AoSA, defined by the intersection of the aortic and left ventricular axes. Additionally, geometric parameters and the inclination of the ascending aorta (AA) were measured. The results demonstrated a variation between pre- and post-operative AoSA in all patients, with an increase in the case of an aneurysmal disease from 112.36° ± 8.21° to 117.16° ± 9.65° (+4.1%, p = 0.041) and a decrease in the case of aortic dissection from 113.62° ± 0.96° to 107.83° ± 1.45° (−5.1%). Additionally, an increase in the length of both the outer and inner curvatures of the AA was observed from 102.21 ± 10.17 mm to 105.73 ± 11.2 mm (+ 3.33% p = 0.016) and from 55.55 ± 9.53 mm to 58.35 ± 9.96 mm (+4.8%, p = 0.04), respectively. This study introduced a new repeatable and reproducible method for assessing the AoSA using cardiac-CTA images. Thoracic stent deployment changes the AoSA, potentially impacting long-term left ventricle hemodynamics. Full article

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9 pages, 461 KiB

Open AccessArticle

Progression, Management, and Outcome of Aortic Valve Stenosis in Systemic Sclerosis: A Case Series

by Andrea Vergara, Antonio Orlando, Eleonora Caiazza, Serena Vettori, Giovanna Cuomo, Paola Argiento, Emanuele Romeo, Rosa Franzese, Berardo Sarubbi and Michele D’Alto

J. Cardiovasc. Dev. Dis. 2024, 11(9), 274; https://doi.org/10.3390/jcdd11090274 - 4 Sep 2024

Viewed by 632

Abstract

Background: In systemic sclerosis (SSc), cardiac involvement is frequent, heterogeneous, and related to a poor prognosis. Due to a longer life expectancy, the development of degenerative aortic stenosis (AS) is not uncommon. The aim of this article is to report the characteristics of [...] Read more.

Background: In systemic sclerosis (SSc), cardiac involvement is frequent, heterogeneous, and related to a poor prognosis. Due to a longer life expectancy, the development of degenerative aortic stenosis (AS) is not uncommon. The aim of this article is to report the characteristics of AS in SSc, analyzing the rate of progression, the management, and the outcome. Methods: This is a case series conducted at the Department of Cardiology of Monaldi Hospital, Naples, Italy. Results: From January 2007 to December 2022, we analyzed 234 patients with SSc. Ten/234 patients (4.3%) showed severe AS and were included in the analysis (age 75.5 years [IQR 58–84], nine females). Nine had limited and one diffuse SSc. Two patients were in NHYA/WHO II and eight in NYHA/WHO III. All had degenerative three-leaflet AS. Two patients showed severe AS at the first evaluation, and eight developed severe AS during the follow-up, with a time progression from moderate to severe AS of 3.2 ± 1.1 years (progression rate −0.190 ± 0.012 cm²/year for aortic valve area, 8.6 ± 6.1 mmHg/year for mean aortic gradient, 16 ± 7 mmHg/year for peak aortic gradient, and 0.5 ± 0.3 m/s/year for aortic peak velocity). Seven out of 10 patients underwent transcatheter aortic valve implantation (TAVI), one underwent surgical aortic valve replacement (SAVR), one was left untreated, and one was on a waiting list for TAVI. No major complications after TAVI or SAVR occurred. At a mean follow-up of 5.9 ± 3.9 years, eight patients are alive and two died. Conclusion: Severe AS is a relevant cardiac complication of SSc and must be considered in the screening and during the follow-up. Its rapid progression rate may tentatively be due to autoimmunity, degenerative burden, and chronic inflammation. Full article

(This article belongs to the Special Issue Aortic Pathology and Therapeutic Strategies)

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21 pages, 808 KiB

Open AccessReview

Direct Cardiac Reprogramming in the Age of Computational Biology

by Rachelle Ambroise, Paige Takasugi, Jiandong Liu and Li Qian

J. Cardiovasc. Dev. Dis. 2024, 11(9), 273; https://doi.org/10.3390/jcdd11090273 - 4 Sep 2024

Viewed by 980

Abstract

Heart disease continues to be one of the most fatal conditions worldwide. This is in part due to the maladaptive remodeling process by which ischemic cardiac tissue is replaced with a fibrotic scar. Direct cardiac reprogramming presents a unique solution for restoring injured [...] Read more.

Heart disease continues to be one of the most fatal conditions worldwide. This is in part due to the maladaptive remodeling process by which ischemic cardiac tissue is replaced with a fibrotic scar. Direct cardiac reprogramming presents a unique solution for restoring injured cardiac tissue through the direct conversion of fibroblasts into induced cardiomyocytes, bypassing the transition through a pluripotent state. Since its inception in 2010, direct cardiac reprogramming using the transcription factors Gata4, Mef2c, and Tbx5 has revolutionized the field of cardiac regenerative medicine. Just over a decade later, the field has rapidly evolved through the expansion of identified molecular and genetic factors that can be used to optimize reprogramming efficiency. The integration of computational tools into the study of direct cardiac reprogramming has been critical to this progress. Advancements in transcriptomics, epigenetics, proteomics, genome editing, and machine learning have not only enhanced our understanding of the underlying mechanisms driving this cell fate transition, but have also driven innovations that push direct cardiac reprogramming closer to clinical application. This review article explores how these computational advancements have impacted and continue to shape the field of direct cardiac reprogramming. 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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13 pages, 789 KiB

Open AccessArticle

Mortality Predictors and Neurological Outcomes Following Extracorporeal Cardiopulmonary Resuscitation (eCPR): A Single-Center Retrospective Study

by Sasa Rajsic, Helmuth Tauber, Robert Breitkopf, Corinna Velik Salchner, Fabian Mayer, Ulvi Cenk Oezpeker and Benedikt Treml

J. Cardiovasc. Dev. Dis. 2024, 11(9), 272; https://doi.org/10.3390/jcdd11090272 - 2 Sep 2024

Viewed by 890

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) offers cardiorespiratory support to patients experiencing cardiac arrest. However, this technology is not yet considered a standard treatment, and the evidence on eCPR criteria and its association with survival and good neurological outcomes remains scarce. Therefore, we aimed [...] Read more.

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) offers cardiorespiratory support to patients experiencing cardiac arrest. However, this technology is not yet considered a standard treatment, and the evidence on eCPR criteria and its association with survival and good neurological outcomes remains scarce. Therefore, we aimed to investigate the overall mortality and risk factors for mortality. Moreover, we provide a comparison of demographic, clinical, and laboratory characteristics of patients, including neurological outcomes and adverse events during support. Methods: This retrospective analysis included in-hospital and out-of-hospital cardiac arrest patients who received eCPR and were admitted between January 2008 and June 2022 at a tertiary and trauma one-level university hospital in Austria. Results: In total, 90 patients fulfilled inclusion criteria, 41 (46%) patients survived until intensive care unit discharge, and 39 (43%) survived until hospital discharge. The most common cause of cardiac arrest was myocardial infarction (42, 47%), and non-shockable initial rhythm was reported in 50 patients (56%). Of 33 survivors with documented outcomes, 30 had a good recovery as measured with Cerebral Performance Category score, 2 suffered severe disability, and 1 remained in a persistent vegetative state. Finally, multivariate analysis identified asystole as initial rhythm (HR 2.88, p = 0.049), prolonged CPR (HR 1.02, p = 0.043), and CPR on the weekend (HR 2.57, p = 0.032) as factors with a higher risk of mortality. Conclusions: eCPR-related decision-making could be additionally supported by the comprehension of the reported risk factors for mortality and severe disability. Further studies are needed to elucidate the impact of peri-arrest variables on outcomes, aiming to improve patient selection. Full article

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

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13 pages, 291 KiB

Open AccessArticle

Subclinical Atherosclerosis Progression in Low-Risk, Middle-Aged Adults: Carotid Leads Femoral in IMT Increase but Not in Plaque Formation

by Eva Szabóová, Alexandra Lisovszki, Alojz Rajnič, Peter Kolarčik, Peter Szabó, Tomáš Molnár and Lucia Dekanová

J. Cardiovasc. Dev. Dis. 2024, 11(9), 271; https://doi.org/10.3390/jcdd11090271 - 2 Sep 2024

Viewed by 866

Abstract

This study investigated subclinical atherosclerosis progression in low-risk, middle-aged adults (N = 141; a mean age of 49.6 ± 4.7 years) using a 5-year ultrasound follow-up. We compared the involvement of the carotid and femoral arteries. Methods: Clinical data, risk factors, carotid/femoral intima-media [...] Read more.

This study investigated subclinical atherosclerosis progression in low-risk, middle-aged adults (N = 141; a mean age of 49.6 ± 4.7 years) using a 5-year ultrasound follow-up. We compared the involvement of the carotid and femoral arteries. Methods: Clinical data, risk factors, carotid/femoral intima-media thickness (IMT), and plaque presence were analyzed. Results: Cardiovascular risk factors and scores increased significantly at follow-up. Both carotid and femoral mean IMT increased (p < 0.001). While plaque prevalence rose and was similar in both arteries (carotid: 4.8% to 17.9%, femoral: 3.6% to 17.7%, p < 0.001 for both), the progression of plaque burden was greater in femorals. Notably, the carotid mean IMT demonstrated a faster yearly progression rate compared to the mean femoral IMT. The prevalence of pathological nomogram-based mean IMT right or left was higher in the carotids (52.9% to 78.8%, p < 0.001) compared to femorals (23.2% to 44.7%, p < 0.001), with a significant increase at the end of follow-up in both territories. Conclusions: This study demonstrates significant subclinical atherosclerosis progression in low-risk, middle-aged adults over 5 years. Carotid arteries showed a faster progression rate of mean IMT and a higher prevalence of pathological nomogram-based mean IMT compared to the femoral arteries. However, plaque burden was similar in both territories, with greater progression in femorals. Identifying carotid and femoral atherosclerosis burden may be a valuable tool for risk stratification in this population. Full article

(This article belongs to the Special Issue Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment)

6 pages, 192 KiB

Open AccessBrief Report

Remote Monitoring: How to Maximize Efficiency through Appropriate Organization in a Device Clinic

by Massimiliano Maines, Giancarlo Tomasi, Luisa Poian, Marzia Simoncelli, Debora Zeni, Monica Santini and Maurizio Del Greco

J. Cardiovasc. Dev. Dis. 2024, 11(9), 270; https://doi.org/10.3390/jcdd11090270 - 30 Aug 2024

Viewed by 680

Abstract

Introduction: Remote device monitoring is indicated under class I A standard of care according to the latest HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic. Despite this strong endorsement and the supporting data, the adoption of remote monitoring practices [...] Read more.

Introduction: Remote device monitoring is indicated under class I A standard of care according to the latest HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic. Despite this strong endorsement and the supporting data, the adoption of remote monitoring practices remains lower than expected. One cause of the underutilization of telemonitoring devices is work overload. Thus, a crucial point for improving the adoption of remote monitoring systems is ensuring their sustainability. Materials and Method: After analyzing the resources necessary to manage a device telemonitoring clinic, we initiated a process to reduce redundant transmissions: 1. eliminated scheduled loop recorder transmissions, retaining only alert transmissions; 2. reduced the frequency of the scheduled transmissions of pacemakers from four to one per year and the scheduled transmissions for defibrillators from four to two per year; and 3. optimized and customized the programming of device alerts with two primary interventions. Results: These strategies allowed us to significantly reduce the number of transmissions/patient/year from 7.3 to 4.7. The first change was made in January 2020, which eliminated scheduled transmissions for loop recorders, reduced transmissions per patient from 14 to 10.4 for loop recorders, and decreased global transmissions per patient from 7.6 to 6.5. The subsequent adjustment in January 2021, which reduced the scheduled transmissions of pacemakers and defibrillators, further lowered transmissions per patient from 6.5 to 5.2 for pacemakers and from 4.7 to 3.1 for defibrillators. Additionally, enhanced attention to device reprogramming starting in January 2022 resulted in a further reduction in transmissions per patient from 5 to 4.7. Conclusion: Carrying out some simple changes in the number of scheduled transmissions and optimizing the programming of the devices made it possible to reduce the number of transmissions and make the remote monitoring of the devices more sustainable Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—Remote Monitoring with Cardiac Implanted Electronic Devices in Electrophysiology and Cardiovascular Physiology)

9 pages, 1244 KiB

Open AccessArticle

Anticoagulation Patterns in Ischemic Stroke Patients with Atrial Fibrillation in Developing Country: Insights from the Stroke Registry in Vietnam

by Mai Duy Ton, Dao Viet Phuong, Nguyen Tien Dung, Nguyen Van Chi, Truong Thi Hoa, Tran Cong Minh, Jeyaraj Pandian and Nguyen Huy Thang

J. Cardiovasc. Dev. Dis. 2024, 11(9), 269; https://doi.org/10.3390/jcdd11090269 - 30 Aug 2024

Viewed by 1513

Abstract

(1) Background: Atrial fibrillation (AF) poses a growing cardiovascular challenge globally, with significant implications in Vietnam. This study aimed to investigate the impact of AF on ischemic stroke/transient ischemic attack (TIA) and clinical outcomes, as well as the utilization of oral anticoagulation (OAC) [...] Read more.

(1) Background: Atrial fibrillation (AF) poses a growing cardiovascular challenge globally, with significant implications in Vietnam. This study aimed to investigate the impact of AF on ischemic stroke/transient ischemic attack (TIA) and clinical outcomes, as well as the utilization of oral anticoagulation (OAC) therapy in Vietnam. (2) Methods: Data from the Registry of Stroke Care Quality (RES-Q) across 66 hospitals in Vietnam between 2017 and 2023 were utilized. Patients diagnosed with ischemic stroke or TIA were included, and clinical characteristics, pre- and post-hospitalization medication, and hospitalized outcomes were examined. (3) Results: Of 94,144 patients, 15.1% had AF. Patients with AF were older and had a higher prevalence of heart failure and more severe strokes. AF was associated with increased mortality during hospitalization and a poorer prognosis. In AF patients, anticoagulation therapy utilization increased from 15.8% pre-hospitalization to 82.4% at discharge, with a preference for direct oral anticoagulants. (4) Conclusions: AF significantly impacts ischemic stroke/TIA outcomes in Vietnam. Pre-hospitalization and anticoagulation therapy utilization were low but improved at discharge. These findings emphasize the need for improved AF management and stroke prevention strategies in developing countries. Full article

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

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12 pages, 1021 KiB

Open AccessArticle

Risk of Cardiovascular Events in Adults Aged 40 to 79 Years with Diagnosed Hypertension, High Cholesterol, and/or Diabetes but Not on Medications: Findings from Nationwide Cross-Sectional Studies

by Shuting Wang, Yanji Qu, Jiayue Zhang, Xue Xue and Zuyao Yang

J. Cardiovasc. Dev. Dis. 2024, 11(9), 268; https://doi.org/10.3390/jcdd11090268 - 29 Aug 2024

Viewed by 688

Abstract

Many people with diagnosed hypertension, high cholesterol, and/or diabetes are not receiving drug treatment, partly because they perceive their cardiovascular disease (CVD) risk as low. This study aimed to quantify the risk for future CVD events, either first or recurrent, in people with [...] Read more.

Many people with diagnosed hypertension, high cholesterol, and/or diabetes are not receiving drug treatment, partly because they perceive their cardiovascular disease (CVD) risk as low. This study aimed to quantify the risk for future CVD events, either first or recurrent, in people with diagnosed hypertension, high cholesterol, and/or diabetes but not on medications for any of these conditions. Participants aged 40–79 years who had been diagnosed with hypertension, high cholesterol, and/or diabetes but were not on medications were identified from National Health and Nutrition Examination Surveys cycles 1999 to 2018. Among them, those with known CVD and those without known CVD but with complete data for estimating their 10-year CVD risk were included in this study. The participants were classified as (1) “high-risk” if they had known CVD or a 10-year predicted CVD risk ≥ 7.5% or (2) “low-risk” if they had a 10-year predicted CVD risk < 7.5%. Of the 5187 participants included, 2201 had known major CVD (n = 490, 9.45%) or a 10-year predicted CVD risk ≥ 7.5% (n = 1711, 32.99%), corresponding to a weighted proportion of 34.83% (95% CI: 33.15 to 36.51%) in the US general population. The proportions of high-risk participants were much higher in the elderly (65.50% for 60–69 years and 97.86% for 70–79 years), males (45.13%), and non-Hispanic Blacks (42.15%) than in others (all p < 0.001). These patterns were consistent across survey cycles during 1999–2018. Additional analyses that classified the participants into groups above or below the treatment threshold (rather than high- or low-risk groups) according to current guidelines yielded similar results. A comparison of the 2201 untreated high-risk participants with other participants who had been diagnosed with hypertension, high cholesterol, and/or diabetes and were on medications for these conditions showed that “lower BMI”, “smaller waist circumference”, and a “non-diabetic” status, among others, were associated with a higher likelihood of “not taking medications”. In conclusion, approximately one-third of the US adults aged 40 to 79 years with diagnosed hypertension, high cholesterol, and/or diabetes but not on medications had known CVD or a 10-year predicted CVD risk ≥ 7.5%, and this proportion was little changed over the past two decades. Interventions targeted at the subgroups with particular characteristics identified in this study may help improve the management of CVD and its risk factors. Full article

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

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Developmental Changes in the Excitation–Contraction Mechanisms of the Ventricular Myocardium and Their Sympathetic Regulation in Small Experimental Animals

by Shogo Hamaguchi, Naoki Agata, Maika Seki, Iyuki Namekata and Hikaru Tanaka

J. Cardiovasc. Dev. Dis. 2024, 11(9), 267; https://doi.org/10.3390/jcdd11090267 - 29 Aug 2024

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Abstract

The developmental changes in the excitation–contraction mechanisms of the ventricular myocardium of small animals (guinea pig, rat, mouse) and their sympathetic regulation will be summarized. The action potential duration monotonically decreases during pre- and postnatal development in the rat and mouse, while in [...] Read more.

The developmental changes in the excitation–contraction mechanisms of the ventricular myocardium of small animals (guinea pig, rat, mouse) and their sympathetic regulation will be summarized. The action potential duration monotonically decreases during pre- and postnatal development in the rat and mouse, while in the guinea pig it decreases during the fetal stage but turns into an increase just before birth. Such changes can be attributed to changes in the repolarizing potassium currents. The T-tubule and the sarcoplasmic reticulum are scarcely present in the fetal cardiomyocyte, but increase during postnatal development. This causes a developmental shift in the Ca²⁺ handling from a sarcolemma-dependent mechanism to a sarcoplasmic reticulum-dependent mechanism. The sensitivity for beta-adrenoceptor-mediated positive inotropy decreases during early postnatal development, which parallels the increase in sympathetic nerve innervation. The alpha-adrenoceptor-mediated inotropy in the mouse changes from positive in the neonate to negative in the adult. This can be explained by the change in the excitation–contraction mechanism mentioned above. The shortening of the action potential duration enhances trans-sarcolemmal Ca²⁺ extrusion by the Na⁺-Ca²⁺ exchanger. The sarcoplasmic reticulum-dependent mechanism of contraction in the adult allows Na⁺-Ca²⁺ exchanger activity to cause negative inotropy, a mechanism not observed in neonatal myocardium. Such developmental studies would provide clues towards a more comprehensive understanding of cardiac function. 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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J. Cardiovasc. Dev. Dis., Volume 11, Issue 9 (September 2024) – 42 articles

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