Journal of Cardiovascular Development and Disease

15 pages, 943 KiB

Open AccessSystematic Review

Spinal Cord Stimulation for Refractory Angina Pectoris: Current Status and Future Perspectives, a Narrative Review

by Roberto Gazzeri, Jacopo Mosca, Felice Occhigrossi, Marco Mercieri, Marcelo Galarza and Matteo Luigi Giuseppe Leoni

J. Cardiovasc. Dev. Dis. 2025, 12(1), 33; https://doi.org/10.3390/jcdd12010033 - 20 Jan 2025

Viewed by 512

Abstract

Refractory angina pectoris (RAP) is a clinical syndrome characterized by persistent chest pain caused by myocardial ischemia that is unresponsive to optimal pharmacological therapy and revascularization procedures. Spinal cord stimulation (SCS) has emerged as a promising therapeutic option for managing RAP, offering significant [...] Read more.

Refractory angina pectoris (RAP) is a clinical syndrome characterized by persistent chest pain caused by myocardial ischemia that is unresponsive to optimal pharmacological therapy and revascularization procedures. Spinal cord stimulation (SCS) has emerged as a promising therapeutic option for managing RAP, offering significant symptom relief and improved quality of life. A systematic literature review was conducted to evaluate the clinical effectiveness, mechanisms of action, and safety profile of SCS in treating RAP. Comprehensive searches were performed in PubMed, Scopus, and Web of Science for studies published between 1990 and 2023. Of 328 articles identified, 6 met the inclusion and exclusion criteria for final analysis. The included studies consistently demonstrated that SCS significantly reduces the frequency of anginal episodes and nitroglycerin use while improving exercise capacity and quality of life. Proposed mechanisms include modulation of pain signals via the gate control theory, enhancement of autonomic balance, and redistribution of myocardial perfusion. Novel stimulation modalities, including high-frequency, Burst, and Differential Target Multiplexed (DTM), show potential advantages in enhancing patient comfort and clinical outcomes. Nevertheless, long-term studies are necessary to validate these findings and establish the comparative efficacy of these advanced technologies. SCS is a safe and effective therapy for patients with RAP who are unsuitable for surgical interventions. Innovations in neurostimulation, including closed-loop systems and personalized treatment strategies have the potential to further optimize outcomes. Rigorous clinical trials are needed to consolidate the role of SCS as a cornerstone therapy for the management of RAP. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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15 pages, 1038 KiB

Open AccessArticle

Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective

by Joy Y. S. Ong, Aloysius S. T. Leow, Chun Yi Ng, Poay Huan Loh, Swee Chye Quek, William K. F. Kong, Tiong Cheng Yeo, Ching Hui Sia and Kian Keong Poh

J. Cardiovasc. Dev. Dis. 2025, 12(1), 32; https://doi.org/10.3390/jcdd12010032 - 19 Jan 2025

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Abstract

Background: Severe aortic stenosis (AS) stratified by sex has been increasingly studied in the European population. Sex-specific outcomes in Asian patients with AS remain poorly defined. Hence, we aimed to study the clinical characteristics and impact of sex in moderate-to-severe AS, undergoing both [...] Read more.

Background: Severe aortic stenosis (AS) stratified by sex has been increasingly studied in the European population. Sex-specific outcomes in Asian patients with AS remain poorly defined. Hence, we aimed to study the clinical characteristics and impact of sex in moderate-to-severe AS, undergoing both invasive and conservative interventions in an Asian cohort over 10 years. Methods: Consecutive data with echocardiographic diagnoses of AS were stratified according to gender in a tertiary academic center between 2011 and 2021. Demographics, comorbidities, and clinical outcomes were compared. Results: Seven hundred and three (703) patients were included (56%, n = 397 were female). Calcific AS was the dominant etiology in both genders. Females had higher incidences of anemia (p < 0.001) and chronic kidney disease (p = 0.026); although, females had lower incidences of cardiovascular complications of coronary artery disease (CAD) (p = 0.002) and prior acute myocardial infarction (AMI) (p = 0.015). Echocardiographically, females had a smaller left ventricular outflow tract diameter (LVOTd) (p < 0.001), LV mass (p < 0.001), and left ventricle end diastolic volume (LVEDV) (p < 0.001). Conversely, the left atrial (LA) area (p < 0.001) and volume index (LAVI) (p < 0.001) were larger in females. Females had higher average E/e’ (p = 0.010) ratios compared to males. The mean follow-up duration between genders was 4.1 ± 3.3 years. Upon univariate analysis, a greater proportion of female AS patients encountered cardiovascular (CV) hospitalization during follow-up (female: 27.5%, n = 109 vs. male: 18.3%, n = 56; p = 0.005) compared to male patients, but there were no significant differences for the outcomes of heart failure (p = 0.612), stroke (p = 0.664), and all-cause mortality (p = 0.827). Fewer females underwent aortic valve (AV) intervention compared to males (21.2% vs. 27.8%, p = 0.042), albeit with a longer duration to AV intervention (3.6 years ± 2.4 vs. 2.6 years ± 2.3, p = 0.016). In the severe AS cohort, female sex remained an independent predictor for subsequent heart failure (aHR 2.89, 95% CI 1.01–8.29, p = 0.048) and CV hospitalization (aHR 20.0, 95% CI 1.19–335, p = 0.037) after adjustments for age, ethnicity, body mass index (BMI), comorbidities, left ventricular ejection fraction (LVEF), and AV intervention. Conclusions: There was no difference in heart failure, stroke, and all-cause mortality outcomes between male and female Asian patients with moderate-to-severe AS. However, there were more cardiovascular hospitalizations, with fewer and longer duration to AV intervention in females compared to males in our cohort. Full article

(This article belongs to the Topic Cardiovascular Disease in Special Populations: From Basic Science to Clinical Practice)

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11 pages, 1147 KiB

Open AccessArticle

Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting

by Christian Sellin, Ahmed Belmenai, Volodymyr Demianenko, Marius Grossmann and Hilmar Dörge

J. Cardiovasc. Dev. Dis. 2025, 12(1), 31; https://doi.org/10.3390/jcdd12010031 - 18 Jan 2025

Viewed by 722

Abstract

Objective: Cardiopulmonary bypass (CPB) via the right axillary artery (RAA) has become an alternative perfusion strategy, especially in complex aortic procedures. This study delineates our technique and outcome with direct axillary cannulation utilizing the Seldinger technique, which we adopted as the standard perfusion [...] Read more.

Objective: Cardiopulmonary bypass (CPB) via the right axillary artery (RAA) has become an alternative perfusion strategy, especially in complex aortic procedures. This study delineates our technique and outcome with direct axillary cannulation utilizing the Seldinger technique, which we adopted as the standard perfusion strategy in the sternum-sparing minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) using CPB. Methods: From November 2019 to December 2023, a total of 413 consecutive patients underwent nonemergent isolated coronary artery bypass grafting (CABG) via left anterior minithoracotomy on CPB with peripheral cannulation via the RAA and cardioplegic cardiac arrest, using this technique as a default strategy in the daily routine. All patients had multivessel coronary artery disease. The primary outcome was intraoperative cannulation-related complications (bleeding, revision, ischemia, wound healing complications). The secondary outcome was cannulation-related events during follow-up (blood pressure differences, incidence of brachial plexus injury, clinical signs of circulatory problems of arm and hand, re-interventions). Mean midterm follow-up was 18.7 ± 12.3 [1.1–51.2] months. During follow-up, 16 patients died. Overall, a total of 397 patients (344 male; 67.6 ± 9.7 [32–88]) were included for follow-up (100%). Results: The RAA was successfully cannulated in 100% of patients. A cannula size of 16 Fr was used in 34.6%, 18 Fr in 63.9% and 20 Fr in 1.5% of all patients. There was no intraoperative bleeding complication. In two patients, intraoperative revision of the RAA was required, necessitating a venous patch repair. At follow-up, there were no differences between the systolic and diastolic blood pressure or the pressure gradients between the right and left arm. Transient numbness of the right hand was observed in two patients. Permanent numbness was not observed. No patient needed further intervention or surgical revision of the RAA. Conclusions: The right axillary cannulation is feasible and safe in terms of vascular injury and brachial plexus injury with excellent in-hospital and follow-up outcome. Full article

(This article belongs to the Special Issue New Advances in Minimally Invasive Coronary Surgery)

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21 pages, 716 KiB

Open AccessArticle

Interindividual Variability Response to Resistance and High-Intensity Interval Training on Blood Pressure Reduction in Hypertensive Older Adults

by Johnattan Cano-Montoya, Nicolas Hurtado, Carolina Núñez Vergara, Sebastián Báez Vargas, Marcela Rojas-Vargas, Sergio Martínez-Huenchullán, Cristian Alvarez and Mikel Izquierdo

J. Cardiovasc. Dev. Dis. 2025, 12(1), 30; https://doi.org/10.3390/jcdd12010030 - 16 Jan 2025

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Abstract

Background: This study evaluated the effects of resistance training (RT) and high-intensity interval training (HIIT) on systolic (SBP) and diastolic blood pressure (DBP) in hypertensive older adults undergoing pharmacological therapy over four and eight weeks. We compared the efficacy of RT and HIIT [...] Read more.

Background: This study evaluated the effects of resistance training (RT) and high-intensity interval training (HIIT) on systolic (SBP) and diastolic blood pressure (DBP) in hypertensive older adults undergoing pharmacological therapy over four and eight weeks. We compared the efficacy of RT and HIIT in reducing non-responders (NRs) between weeks 4 and 8 and analyzed time-course adaptations in NRs and responders (Rs). Methods: Thirty-nine participants were randomized into RT-G (n = 13), HIIT-G (n = 13), or control (CG, n = 13) groups. RT utilized elastic bands, and HIIT involved cycle ergometers, with three weekly 30 min sessions for 8 weeks. SBP and DBP were measured before intervention and at weeks 4 and 8, respectively. Individual responses were classified as NRs or Rs using the Hopkins method (SDIR = √[SDExp2–SDCon2]). Time-course adaptations were evaluated. Results: Both the RT-G and HIIT-G reduced SBP at 8 weeks (RT-G: −13 mmHg; [ES: 1.12]; HIIT-G: −12 mmHg [ES: 0.8]; both p < 0.05). The proportion of NRs for SBP decreased from 46% to 38% in RT-G and 69% to 46% in HIIT-G. Rs showed a peak SBP reduction at 4 weeks (−14.7 and −25.5 mmHg), stabilizing by week 8 (−22.8 and −19.6 mmHg) in RT-G and HIIT-G, respectively. Conclusion: Eight weeks of RT and HIIT effectively reduced SBP and NR prevalence, with time-course adaptations favoring Rs. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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14 pages, 2218 KiB

Open AccessArticle

Rapid Improvement in Cardiac Damage Predicts Better Prognosis After Transcatheter Aortic Valve Replacement

by Hao-Wei Lee, Chih-Hui Chin, Po-chin Chou, Chia-Hsiu Chang, Chiu-Ling Tsai and Chi-Hung Huang

J. Cardiovasc. Dev. Dis. 2025, 12(1), 29; https://doi.org/10.3390/jcdd12010029 - 16 Jan 2025

Viewed by 469

Abstract

Background: A staging system based on cardiac damage for severe aortic stenosis (AS) has been validated for prognosis prediction following transcatheter aortic valve replacement (TAVR). Our study aims to investigate whether TAVR can lead to changes in cardiac damage shortly after the procedure [...] Read more.

Background: A staging system based on cardiac damage for severe aortic stenosis (AS) has been validated for prognosis prediction following transcatheter aortic valve replacement (TAVR). Our study aims to investigate whether TAVR can lead to changes in cardiac damage shortly after the procedure and how these changes impact prognosis. Method: Patients in this retrospective cohort study were classified into five stages (0–4) before TAVR based on the echocardiographic findings of cardiac damage. The closest echocardiogram after TAVR was used for restaging cardiac damage. The primary composite outcome was all-cause mortality or hospitalization due to heart failure (HF). Results: A total of 64 patients were enrolled (53.1% male, mean age 81.7 ± 7.7 years). Within a mean interval of 4 days (interquartile range = 3 to 7 days) after TAVR, cardiac damage improved in 25.0% of patients, while it worsened in 20.3%. During a median follow-up of 2.5 ± 1.9 years, 34.4% of patients met the primary endpoint, which included 16 deaths and 6 HF hospitalizations. Cox regression analysis revealed that improvement in cardiac damage correlated with a lower risk of composite death or HF hospitalization (HR: 0.095; 95% CI: 0.014–0.627; p = 0.015). Conclusions: TAVR can lead to changes in cardiac damage over a short period in patients with severe AS, and rapid improvement in cardiac damage after TAVR is associated with a better prognosis. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)

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18 pages, 3401 KiB

Open AccessReview

Computed Tomography Angiography in the Catheterization Laboratory: A Guide Towards Optimizing Coronary Interventions

by Eirini Beneki, Kyriakos Dimitriadis, Nikolaos Pyrpyris, Alexios Antonopoulos, Konstantinos Aznaouridis, Panagiotis Antiochos, Christos Fragoulis, Henri Lu, David Meier, Konstantinos Tsioufis, Stephane Fournier, Constantina Aggeli and Georgios Tzimas

J. Cardiovasc. Dev. Dis. 2025, 12(1), 28; https://doi.org/10.3390/jcdd12010028 - 16 Jan 2025

Viewed by 606

Abstract

Cardiac computed tomography (CT) has become an essential tool in the pre-procedural planning and optimization of coronary interventions. Its non-invasive nature allows for the detailed visualization of coronary anatomy, including plaque burden, vessel morphology, and the presence of stenosis, aiding in precise decision [...] Read more.

Cardiac computed tomography (CT) has become an essential tool in the pre-procedural planning and optimization of coronary interventions. Its non-invasive nature allows for the detailed visualization of coronary anatomy, including plaque burden, vessel morphology, and the presence of stenosis, aiding in precise decision making for revascularization strategies. Clinicians can assess not only the extent of coronary artery disease but also the functional significance of lesions using techniques like fractional flow reserve (FFR-CT). By providing comprehensive insights into coronary structure and hemodynamics, cardiac CT helps guide personalized treatment plans, ensuring the more accurate selection of patients for percutaneous coronary interventions or coronary artery bypass grafting and potentially improving patient outcomes. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Imaging—Computed Tomography (CT) Focus Issue)

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Graphical abstract

16 pages, 316 KiB

Open AccessReview

Cardiovascular Disease Risk Factors in the Native American Population

by Krista Goerger, Karla Abbott, Mark K. Larson and Michael Holinstat

J. Cardiovasc. Dev. Dis. 2025, 12(1), 27; https://doi.org/10.3390/jcdd12010027 - 16 Jan 2025

Viewed by 498

Abstract

Native Americans are disproportionately affected by cardiovascular disease in comparison with other racial and ethnic groups in the United States. Previous research has analyzed risk factors, quantified prevalence rates, and examined outcomes of cardiovascular disease in Native Americans, yet few studies have considered [...] Read more.

Native Americans are disproportionately affected by cardiovascular disease in comparison with other racial and ethnic groups in the United States. Previous research has analyzed risk factors, quantified prevalence rates, and examined outcomes of cardiovascular disease in Native Americans, yet few studies have considered the role of societal and psychological factors on the increased burden of cardiovascular disease in Native Americans. Modifiable risk factors for cardiovascular disease, including poor nutrition, reduced physical activity, obesity, and increased substance use, are exacerbated in Native American communities due to cultural and historical factors. Further, Native Americans have endured historical trauma and continue to experience additional financial and healthcare stressors, resulting in increased levels of chronic stress. Chronic activation of stress responses through the hypothalamic–pituitary–adrenal and autonomic nervous system increases inflammation and cardiovascular dysfunction resulting in an increased risk for cardiovascular disease. Therefore, it is critical to examine the connection between these stressors and the cardiovascular health disparities in Native American communities to create effective strategies to improve health outcomes. Full article

(This article belongs to the Special Issue Risk Factors and Prevention of Cardiovascular Diseases)

8 pages, 2284 KiB

Open AccessCase Report

Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case Report

by Anna Lis, Paweł Kowalski, Marcin Wita, Tomasz Zawadzki, Tomasz Ilczak, Wojciech Żurawiński and Mateusz Majewski

J. Cardiovasc. Dev. Dis. 2025, 12(1), 26; https://doi.org/10.3390/jcdd12010026 - 14 Jan 2025

Viewed by 620

Abstract

Paradoxical embolism occurs when a clot originates in the venous system and traverses through a pulmonary or intracardiac shunt into the systemic circulation, with a mortality rate of around 18%. The risk factors for arterial embolism and venous thrombosis are similar, but different [...] Read more.

Paradoxical embolism occurs when a clot originates in the venous system and traverses through a pulmonary or intracardiac shunt into the systemic circulation, with a mortality rate of around 18%. The risk factors for arterial embolism and venous thrombosis are similar, but different disease entities can lead to a hypercoagulable state of the blood, including antithrombin III (AT III) deficiency. We report the case of a 43-year-old man with a massive central pulmonary embolism with a rider embolus and concomitant aortic arch embolism with involvement of the brachiocephalic trunk, bilateral subclavian and axillary arteries, and the right vertebral artery, followed by a secondary ischaemic stroke. The Pulmonary Embolism Response Team (PERT) consulted the patient on several occasions; he was treated initially with an intravenous infusion of unfractionated heparin under activation partial thromboplastin time (APTT) and AT III substitution. After several days of hospitalisation and the conversion of pharmacotherapy to oral anticoagulants, the patient was discharged home in a stable condition with recommendations for further follow-up in appropriate clinics. This case highlights the role of in-depth diagnostics for coagulation disorders in patients after pulmonary embolism, especially without known risk factors. Full article

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13 pages, 982 KiB

Open AccessArticle

Clinical Characteristics and Outcomes in Heart Failure Patients with Implantable Pulmonary Artery Pressure Monitors: A Single Centre Irish Experience

by Niall Leahy, Cillian O’Brien, Sara Essa Alsubai, Eileen Coen, Darragh Murphy and Faisal Sharif

J. Cardiovasc. Dev. Dis. 2025, 12(1), 25; https://doi.org/10.3390/jcdd12010025 - 14 Jan 2025

Viewed by 434

Abstract

Background: Hospitalisation for acute decompensated heart failure (HF) portends a poor prognosis. Fluid retention manifesting in dyspnoea and oedema are important clinical features of decompensated heart failure and drive hospital admissions. Intracardiac and pulmonary artery pressure (PAP) monitoring can help predict heart failure [...] Read more.

Background: Hospitalisation for acute decompensated heart failure (HF) portends a poor prognosis. Fluid retention manifesting in dyspnoea and oedema are important clinical features of decompensated heart failure and drive hospital admissions. Intracardiac and pulmonary artery pressure (PAP) monitoring can help predict heart failure decompensation, as changes in these haemodynamics occur before clinical congestion manifests. Methods: A retrospective single centre analysis of patients who underwent insertion of the Cordella™ PA Sensor System (Endotronix, Inc., Chicago, IL, USA) in University Hospital Galway, Ireland, as part of three separate clinical trials—SIRONA 1, SIRONA 2, PROACTIVE HF, was performed. The primary clinical outcome assessed was the difference between HF hospitalisation pre- and post-sensor implantation. Results: In total, there were 33 patients with symptomatic HF who underwent device insertion between 2018 and 2023. All patients had NYHA class 3 heart failure, and 48.5% (n = 16) of patients had HF with reduced ejection fraction. Only one device-related complication was noted, and no pressure sensor failures occurred. In total, there were 26 admissions for HF decompensation 1-year pre-device insertion and only three admissions post-insertion. The difference in the mean number of HF hospitalisations per patient pre- and post-device insertion was 0.70 (p < 0.0001). The difference in mean NYHA class score pre- and post-insertion was 1.0 (p < 0.001). Conclusions: Data from this single-centre cohort study have shown that the insertion of the Cordella™ PA Sensor System in symptomatic HF patients was safe and resulted in statistically significant improvements in HF hospitalisations and NYHA class. Full article

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16 pages, 1769 KiB

Open AccessReview

Perioperative Risk: Short Review of Current Approach in Non Cardiac Surgery

by Andreea Boghean, Cristian Guțu and Dorel Firescu

J. Cardiovasc. Dev. Dis. 2025, 12(1), 24; https://doi.org/10.3390/jcdd12010024 - 13 Jan 2025

Viewed by 652

Abstract

The rate of major surgery is constantly increasing worldwide, and approximately 85% are non-cardiac surgery. More than half of patients over 45 years presenting for non-cardiac surgical interventions have cardiovascular risk factors, and the most common: chronic coronary syndrome and history of stroke. [...] Read more.

The rate of major surgery is constantly increasing worldwide, and approximately 85% are non-cardiac surgery. More than half of patients over 45 years presenting for non-cardiac surgical interventions have cardiovascular risk factors, and the most common: chronic coronary syndrome and history of stroke. The preoperative cardiovascular risk is determined by the comorbidities, the clinical condition before the intervention, the urgency, duration or type. Cardiovascular risk scores are necessary tools to prevent perioperative cardiovascular morbidity and mortality and the most frequently used are Lee/RCRI (Revised Cardiac Risk Index), APACHE II (Acute Physiology and Chronic Health Evaluation), POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity), The American University of Beirut (AUB)-HAS2. To reduce the perioperative risk, there is a need for an appropriate preoperative risk assessment, as well as the choice of the type and timing of surgical intervention. Quantification of surgical risk as low, intermediate, and high is useful in identifying the group of patients who are at risk of complications such as myocardial infarction, thrombosis, arrhythmias, heart failure, stroke or even death. Currently there are not enough studies that can differentiate the risk according to gender, race, elective versus emergency procedure, the value of cardiac biomarkers. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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12 pages, 1406 KiB

Open AccessReview

The Management of the Aortic Arch in Type A Aortic Dissection: Replace, Repair with the AMDS, or Leave for Another Day?

by Ryaan EL-Andari and Michael C. Moon

J. Cardiovasc. Dev. Dis. 2025, 12(1), 23; https://doi.org/10.3390/jcdd12010023 - 12 Jan 2025

Viewed by 486

Abstract

Objectives: Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergent surgical intervention. Numerous surgical approaches exist for ATAAD, and controversy remains regarding the optimal arch interventions for ATAAD patients. Aortic Arch Interventions: Approaches to ATAAD repair include hemiarch repair [...] Read more.

Objectives: Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergent surgical intervention. Numerous surgical approaches exist for ATAAD, and controversy remains regarding the optimal arch interventions for ATAAD patients. Aortic Arch Interventions: Approaches to ATAAD repair include hemiarch repair or extended arch repairs, including the hemiarch with a hybrid stent implantation, such as the AMDS hybrid Prosthesis, total arch replacement (TAR), and the use of an elephant trunk and frozen elephant trunk. While indications for each procedure exist, such as entry tears in the arch, arch aneurysms, and head vessel communications for TAR and malperfusion and a reduced risk of distal anastomotic new entry tears in Debakey I aortic dissection for the AMDS and frozen elephant trunks, the optimal intervention depends on numerous factors. Surgeon and center experience, resource availability, patient risk, and anatomy all contribute to the decision-making process. TAR has improved in safety over the years and has been demonstrated to be comparable to the hemiarch repair in terms of safety in many settings. TAR may also prevent adverse remodeling and can effectively treat more distal diseases, the presence of arch tears, arch aneurysms, and branch vessel involvement or malperfusion. Conclusions: Numerous surgical approaches exist to manage ATAAD, allowing for the surgeon to tailor the repair to the individual patient and pathology. TAR allows for single or staged repair of extensive pathologies and can address distal entry tears, the aneurysmal arch, and head vessel pathologies. In cases with malperfusion, an AMDS can be used in many cases. The management strategy for ATAAD should always involve performing the best surgery for the patient, although in cases where a total arch is indicated but cannot be performed safely by a non-aortic surgeon, the safest approach may be to perform a hemiarch initially and to plan for an elective arch reoperation in the case it is required following close surveillance. Full article

(This article belongs to the Special Issue Current Status and Future Challenges of Aortic Arch Surgery)

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12 pages, 401 KiB

Open AccessArticle

Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population

by Massimiliano Bianco, Fabrizio Sollazzo, Riccardo Pella, Saverio Vicentini, Samuele Ciaffoni, Gloria Modica, Riccardo Monti, Michela Cammarano, Paolo Zeppilli and Vincenzo Palmieri

J. Cardiovasc. Dev. Dis. 2025, 12(1), 22; https://doi.org/10.3390/jcdd12010022 - 11 Jan 2025

Viewed by 466

Abstract

BACKGROUND: Sport practice may elevate the risk of cardiovascular events, including sudden cardiac death, in athletes with undiagnosed heart conditions. In Italy, pre-participation screening includes a resting ECG and either the Harvard Step Test (HST) or maximal exercise testing (MET), but the relative [...] Read more.

BACKGROUND: Sport practice may elevate the risk of cardiovascular events, including sudden cardiac death, in athletes with undiagnosed heart conditions. In Italy, pre-participation screening includes a resting ECG and either the Harvard Step Test (HST) or maximal exercise testing (MET), but the relative efficacy of the latter two tests for detecting arrhythmias and heart conditions remains unclear. METHODS: This study examined 511 paediatric athletes (8–18 years, 76.3% male) without known cardiovascular, renal, or endocrine diseases. All athletes underwent both HST and MET within 30 days. Absolute data and data relative to theoretical peak heart rates, arrhythmias (supraventricular and ventricular) and cardiovascular diagnoses were collected. RESULTS: HST resulted in a lower peak heart rate than MET (181.1 ± 9.8 vs. 187.5 ± 8.1 bpm, p < 0.001), but led to the detection of more supraventricular (18.6% vs. 13.1%, p < 0.001) and ventricular (30.5% vs. 22.7%, p < 0.001) arrhythmias, clustering during recovery (p = 0.014). This pattern was significant in males but not females. Among athletes diagnosed with cardiovascular diseases (22.3%), HST identified more ventricular arrhythmias (26.3% vs. 18.4%, p = 0.05), recovery-phase arrhythmias (20.2% vs. 14.0%, p = 0.035), and polymorphic arrhythmias (6.1% vs. 1.8%, p = 0.025). CONCLUSIONS: HST detects arrhythmias more effectively than MET in young male athletes, especially during recovery. More ventricular arrhythmias were highlighted even in athletes with cardiovascular conditions. Full article

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

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13 pages, 1496 KiB

Open AccessArticle

Risk Factors for Coronary Events After Robotic Hybrid Off-Pump Coronary Revascularization

by Aleksander Dokollari, Beatrice Bacchi, Serge Sicouri, Francesco Cabrucci, Massimo Bonacchi, Danielle Spragan, Mary Ann C. Wertan, Nitin Ghorpade, Stephanie Kjelstrom, Georgia Montone, Yoshiyuki Yamashita, Basel Ramlawi and Francis Sutter

J. Cardiovasc. Dev. Dis. 2025, 12(1), 21; https://doi.org/10.3390/jcdd12010021 - 10 Jan 2025

Viewed by 518

Abstract

Objectives: The impact of long-term complications after robotic hybrid coronary revascularization (HCR), including persistent angina, repeat revascularization, and myocardial infarction (MI), remains limited. This study aims to determine the risk factors for coronary events after robotic HCR and their time-varying effects on outcomes. [...] Read more.

Objectives: The impact of long-term complications after robotic hybrid coronary revascularization (HCR), including persistent angina, repeat revascularization, and myocardial infarction (MI), remains limited. This study aims to determine the risk factors for coronary events after robotic HCR and their time-varying effects on outcomes. Methods: We identified all consecutive patients who underwent robotic HCR at our institution. Baseline characteristics were explored as possible risk factors for angina, MI, and repeat revascularization with stents at any time during the follow-up. Results: A total of 875 patients (mean age 71.1 ± 11.1 years) were included. After a median follow-up of 3.32 years (IQR 1.18–6.34 years), angina occurred in 134 patients (15.3%), repeat revascularization with stents in 139 patients (15.8%), and MI in 36 patients (4.1%). The hazard rates for all outcomes increased with follow-up time, with a notable early rise around two years of follow-up for angina and, to a lesser extent, repeat revascularization. The risk factors were the lack of radial artery graft use, black race, diabetes, obesity, chronic obstructive pulmonary disease, low ejection fraction <50%, severe left main coronary artery stenosis (>50%), and more than three-vessel disease. Conclusions: Optimization of modifiable periprocedural risk factors may positively impact long-term prognosis in patients undergoing robotic HCR. Full article

(This article belongs to the Section Cardiac Surgery)

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21 pages, 2034 KiB

Open AccessReview

Bridging the Gaps in Atrial Fibrillation Management in the Emergency Department

by Brian Xiangzhi Wang

J. Cardiovasc. Dev. Dis. 2025, 12(1), 20; https://doi.org/10.3390/jcdd12010020 - 8 Jan 2025

Viewed by 517

Abstract

Atrial fibrillation (AF) frequently presents in emergency departments (EDs), contributing significantly to adverse cardiovascular outcomes. Despite established guidelines, ED management of AF often varies, revealing important gaps in care. This review addresses specific challenges in AF management for patients in the ED, including [...] Read more.

Atrial fibrillation (AF) frequently presents in emergency departments (EDs), contributing significantly to adverse cardiovascular outcomes. Despite established guidelines, ED management of AF often varies, revealing important gaps in care. This review addresses specific challenges in AF management for patients in the ED, including the nuances of rate versus rhythm control, the timing of anticoagulation initiation, and patient disposition. The updated 2024 European Society of Cardiology (ESC) guidelines advocate early rhythm control for select patients while recommending rate control for others; however, uncertainties persist, particularly regarding these strategies’ long-term impact on outcomes. Stroke prevention through timely anticoagulation remains crucial, though the ideal timing, especially for new-onset AF, needs further research. Additionally, ED discharge protocols and follow-up care for AF patients are often inconsistent, leaving many without proper long-term management. Integration of emerging therapies, including direct oral anticoagulants and advanced antiarrhythmic drugs, shows potential but remains uneven across EDs. Innovative multidisciplinary models, such as “AF Heart Teams” and observation units, could enhance care but face practical challenges in implementation. This review underscores the need for targeted research to refine AF management, optimize discharge protocols, and incorporate novel therapies effectively. Standardizing ED care for AF could significantly reduce stroke risk, lower readmission rates, and improve overall patient outcomes. Full article

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

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10 pages, 572 KiB

Open AccessArticle

Physician Perceptions of the Safety and Efficacy of GLP-1 Receptor Agonists: Underestimation of Cardiovascular Risk Reduction and Discrepancies with Clinical Evidence

by Srikanth Krishnan, Pratyaksh K. Srivastava, Jayram Attaluri, Rebecca Nayeri, Dhananjay Chatterjee, Jay Patel, Ali Nsair, Matthew Budoff and Arash Nayeri

J. Cardiovasc. Dev. Dis. 2025, 12(1), 19; https://doi.org/10.3390/jcdd12010019 - 7 Jan 2025

Viewed by 820

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists (GIP/GLP-1 RAs) are emerging as effective treatments for obesity and cardiometabolic disease. This study evaluated physician perceptions of the safety and efficacy of semaglutide and tirzepatide through a questionnaire administered to [...] Read more.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists (GIP/GLP-1 RAs) are emerging as effective treatments for obesity and cardiometabolic disease. This study evaluated physician perceptions of the safety and efficacy of semaglutide and tirzepatide through a questionnaire administered to 165 attending physicians specializing in internal or family medicine, with 122 responses received. Physicians reported an average patient weight loss of 9.22%, significantly lower than the 14.9% and 18.5% reported in the STEP and SURMOUNT trials, respectively. Estimated side effect rates (32.62%) were markedly lower than trial-reported rates (89.7% and 80.5%), while estimated discontinuation rates (8.59%) exceeded trial data. Cardiovascular benefits were perceived by 48.4% of physicians in diabetic patients, consistent with random guessing, and by only 39.3% in nondiabetic patients, significantly below random guessing expectations. These results highlight discrepancies between physician perceptions and clinical evidence, suggesting gaps in understanding regarding these agents’ efficacy and safety profiles. Addressing these gaps could enhance physician knowledge, patient adherence, and clinical outcomes. Full article

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

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11 pages, 1518 KiB

Open AccessArticle

Accuracy and Reproducibility of a Modified Echocardiographic Method for Right Ventricular Output Calculation in Neonates

by Carlotta Milocchi, Silvia Nogara, Giorgia Mazzuca, Federica Runfola, Martina Ciarcià, Iuri Corsini and Benjamim Ficial

J. Cardiovasc. Dev. Dis. 2025, 12(1), 18; https://doi.org/10.3390/jcdd12010018 - 6 Jan 2025

Viewed by 839

Abstract

We aimed to evaluate the accuracy and reproducibility of right ventricular output (RVO) using different anatomical landmarks: the internal pulmonary valve diameter (PVD) between the valve hinge points (hinge-PVD) according to the traditional technique, and PVD between the valve leaflet tips (tip-PVD). This [...] Read more.

We aimed to evaluate the accuracy and reproducibility of right ventricular output (RVO) using different anatomical landmarks: the internal pulmonary valve diameter (PVD) between the valve hinge points (hinge-PVD) according to the traditional technique, and PVD between the valve leaflet tips (tip-PVD). This was a retrospective analysis of prospective collected data. All neonates with echocardiographic measurements of RVO and left ventricular output (LVO) without congenital heart disease, including patent ductus arteriosus and patent foramen ovale > 3 mm, were included. Accuracy was assessed by comparison with LVO. Intra- and inter-observer reproducibility of the off-line analysis were assessed. Forty-five neonates were included. RVO calculation with tip-PVD was more accurate than hinge-PVD in comparison with LVO, r² 0.712 versus 0.464, bias (95% limits of agreement) 1.4 mL/kg/min (−26–29 mL/kg/min) versus 61 mL/kg/min (−11–132 mL/kg/min), respectively. Both hinge-PVD and tip-PVD presented similar reproducibility, with an intra-observer bias (95% LOA) of 0.3 (−1.0–0.5) and –0.2 (−0.8–0.5) respectively, and an inter-observer bias of 0.1 (−1.3–1.6) and 0.1 (−1.4–1.6). RVO calculation using tip-PVD was more accurate than the conventional technique, with similar reproducibility. Full article

(This article belongs to the Section Imaging)

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9 pages, 603 KiB

Open AccessStudy Protocol

The e-STROKE Study: The Design of a Prospective Observational Multicentral Study

by Kateřina Dvorníková, Veronika Kunešová, Svatopluk Ostrý, Robert Mikulík and Michal Bar

J. Cardiovasc. Dev. Dis. 2025, 12(1), 17; https://doi.org/10.3390/jcdd12010017 - 3 Jan 2025

Viewed by 707

Abstract

Introduction: The e-STROKE study is a prospective, multicenter observational study designed to assess the impact of various CT parameters (including e-ASPECT, CT perfusion (CTP), collateral flow status, and the size and location of the ischemic lesion) on the clinical outcomes of patients with [...] Read more.

Introduction: The e-STROKE study is a prospective, multicenter observational study designed to assess the impact of various CT parameters (including e-ASPECT, CT perfusion (CTP), collateral flow status, and the size and location of the ischemic lesion) on the clinical outcomes of patients with ischemic stroke, as evaluated by the modified Rankins Scale (mRS) three months post-stroke. This study also aims to investigate whether the use of multimodal CT imaging increases the number of patients eligible for recanalization therapy. The analysis will integrate data from the RES-Q registry and radiological data from the e-STROKE system provided by Brainomix Ltd. Aims: The primary aim is to determine the predictive value of CT parameters (e-ASPECTS, CTP, collateral vessel status, and ischemic lesion volume and location) on three-month functional outcomes, as defined by the mRS, in patients with non-lacunar stroke following recanalization treatment (IVT and/or MT). The secondary aim is to evaluate whether multimodal CT examination leads to an increase in the number of patients eligible for recanalization therapy. Additionally, this study seeks to assess the specificity and sensitivity of multimodal CT in distinguishing stroke mimics from actual strokes. Methods: This multicenter observational study involves patients with suspected acute ischemic stroke and a premorbid mRS ≤ 4, who are treated with endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or managed conservatively in stroke centers within the Czech Stroke Research Network (STROCZECH), which is part of the Czech Clinical Research Infrastructure Network (CZECRIN). Data collection includes demographic, clinical, and imaging data variables such as age, sex, ethnicity, risk factors, treatment times (OTT, DNT, and OGT), TICI scores, post-treatment hemorrhage (ECAS II), mRS outcome, stroke etiology, e-ASPECTS, acute ischemic volume (AIV), thrombus length on NCCT, CTA collateral score and collateral vessel density, location of large vessel occlusion, ischemic core, hypoperfusion volume, mismatch ratio and volume, final infarct volume, hemorrhage volume, and MRI in case of negative follow-up NCCT. Conclusions: We anticipate collecting robust clinical and radiological data from approximately 2000 patients across 22 centers over a 12-month period. The results are expected to enhance the precision of diagnostic and prognostic radiological markers in managing acute stroke. Full article

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

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13 pages, 2248 KiB

Open AccessReview

Current Trends and Perspectives of Pressure Wire-Based Coronary Artery Bypass Grafting

by Yoshiyuki Takami, Atsuo Maekawa, Koji Yamana, Kiyotoshi Akita, Kentaro Amano, Wakana Niwa, Kazuki Matsuhashi and Yasushi Takagi

J. Cardiovasc. Dev. Dis. 2025, 12(1), 16; https://doi.org/10.3390/jcdd12010016 - 2 Jan 2025

Viewed by 487

Abstract

Fractional flow reserve (FFR) has been well validated as a modality for evaluating myocardial ischemia, demonstrating the superiority of FFR-guided percutaneous coronary intervention (PCI) over conventional angiography-guided PCI. As a result, the strategy for coronary artery bypass grafting (CABG) is shifting toward FFR [...] Read more.

Fractional flow reserve (FFR) has been well validated as a modality for evaluating myocardial ischemia, demonstrating the superiority of FFR-guided percutaneous coronary intervention (PCI) over conventional angiography-guided PCI. As a result, the strategy for coronary artery bypass grafting (CABG) is shifting toward FFR guidance. However, the advantage of FFR-guided CABG over angiography-guided CABG remains unclear. While FFR-guided CABG can help avoid unnecessary grafting in cases of moderate stenosis, it may also carry the risk of incomplete revascularization. The limited use of FFR due to the need for hyperemia has led to the development of non-hyperemic pressure ratios (NHPRs). NHPR pullback provides trans-stenotic pressure gradients, which may offer valuable insights for CABG strategies. Recently, computed tomographic coronary angiography (CTCA) has emerged as a non-invasive modality that provides accurate data on lesion length, diameter, minimum lumen area, percentage stenosis, and the volume and distribution of high-risk plaques. With the introduction of FFR-CT, CTCA is now highly anticipated to provide both functional evaluation (of myocardial ischemia) via FFR-CT and anatomical information through serial quantitative assessment. Beyond the diagnostic phase, CTCA, augmented by automatic artificial intelligence, holds great potential for guiding therapeutic interventions in the future. Full article

(This article belongs to the Section Cardiac Surgery)

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13 pages, 1193 KiB

Open AccessArticle

Pulmonary Embolism in the Elderly: From Symptoms to Speckle Tracking Echocardiography

by Christos Ballas, Dimitrios Sfairopoulos, Ioanna Samara, Lampros Lakkas, Olga Kardakari, Athanasios Konstantinidis, Katerina K. Naka, Lampros K. Michalis and Christos S. Katsouras

J. Cardiovasc. Dev. Dis. 2025, 12(1), 15; https://doi.org/10.3390/jcdd12010015 - 31 Dec 2024

Viewed by 505

Abstract

(1) Background: There are little data about the differences in clinical and echocardiographic characteristics between elderly (aged ≥ 65 years) and younger patients with acute pulmonary embolism (PE). (2) Methods: Consecutive patients diagnosed with PE in a tertiary hospital were identified. Clinical characteristics, [...] Read more.

(1) Background: There are little data about the differences in clinical and echocardiographic characteristics between elderly (aged ≥ 65 years) and younger patients with acute pulmonary embolism (PE). (2) Methods: Consecutive patients diagnosed with PE in a tertiary hospital were identified. Clinical characteristics, biomarkers and transthoracic echocardiography indices including right ventricular free wall longitudinal strain (RV-FWLS) were recorded. (3) Results: Of 200 patients enrolled, 19 patients had high-risk PE and were excluded from the study. Compared to younger patients, elderly patients with PE had less frequently pain and typical symptoms and more often were hospitalized due to another reason before the PE diagnosis. The elderly had higher values of D-dimer, high-sensitivity troponin I and brain natriuretic peptide (BNP). Echocardiographic differences were noted and the elderly had lower values of pulmonary vascular acceleration time, RV E/A ratio and lower tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio. The RV-FWLS index did not show a statistically significant difference in distribution between age groups ≥ 65 and <65 years old. The RV diameter was similar across all age groups. (4) Conclusions: The elderly have differences compared with younger patients with PE regarding the mode of presentation, the values of biomarkers like D-dimer, BNP and troponins and some echocardiographic indices of RV affection. Full article

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16 pages, 2072 KiB

Open AccessReview

Papillary Muscles of the Left Ventricle: Integrating Electrical and Mechanical Dynamics

by Csilla Andrea Eötvös, Teodora Avram, Roxana Daiana Lazar, Iulia Georgiana Zehan, Madalina Patricia Moldovan, Patricia Schiop-Tentea, Giorgia Coseriu, Adriana Sarb, Gabriel Gusetu, Elena Buzdugan, Roxana Chiorescu, Diana Mocan-Hognogi, Sorin Pop, E. Kevin Heist and Dan Blendea

J. Cardiovasc. Dev. Dis. 2025, 12(1), 14; https://doi.org/10.3390/jcdd12010014 - 31 Dec 2024

Viewed by 539

Abstract

Background: Papillary muscles are structures integrated into the mitral valve apparatus, having both electrical and mechanical roles. The importance of the papillary muscles (PM) is mainly related to cardiac arrhythmias and mitral regurgitation. The aim of this review is to offer an overview [...] Read more.

Background: Papillary muscles are structures integrated into the mitral valve apparatus, having both electrical and mechanical roles. The importance of the papillary muscles (PM) is mainly related to cardiac arrhythmias and mitral regurgitation. The aim of this review is to offer an overview of the anatomy and physiology of the papillary muscles, along with their involvement in cardiovascular pathologies, including arrhythmia development in various conditions and their contribution to secondary mitral regurgitation. Methods: A literature search was performed on PubMed using the following relevant keywords: papillary muscles, mitral valve, arrhythmia, anatomy, and physiology. Results: During the cardiac cycle, papillary muscles have continuous dimensional and pressure changes. On one hand, their synchrony or dyssynchrony impacts the process of mitral valve opening and closure, and on the other hand, the pressure changes can trigger electrical instability. There is increased awareness of papillary muscles as an arrhythmic source. Arrhythmias arising from PM were found in patients with or without structural heart disease, via Purkinje fibres, due to increased automaticity or triggered activity. Conclusions: Despite the interest in mitral valve physiology, there are still many unknowns in relation to the papillary muscles, especially with regard to their role in arrhythmogenesis and the pathogenesis of mitral regurgitation. Full article

(This article belongs to the Special Issue State of the Art in Mitral Valve Disease)

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14 pages, 2239 KiB

Open AccessCase Report

Clinical and CT Features, Clinical Management, and Decision on Sport Eligibility of Professional Athletes with Congenital Coronary Anomalies: A Case Series Study

by Gianluca Guarnieri, Edoardo Conte, Davide Marchetti, Matteo Schillaci, Eleonora Melotti, Andrea Provera, Marco Doldi, Maria Rosaria Squeo, Antonio Pelliccia, Viviana Maestrini and Daniele Andreini

J. Cardiovasc. Dev. Dis. 2025, 12(1), 13; https://doi.org/10.3390/jcdd12010013 - 31 Dec 2024

Viewed by 478

Abstract

Background: Congenital coronary artery anomalies (CAAs) are a significant cause of sudden cardiac death and a key factor in determining athletes’ eligibility for competitive sports. Their prevalence varies with diagnostic modalities and may present as asymptomatic or with life-threatening ischemic or arrhythmic events. [...] Read more.

Background: Congenital coronary artery anomalies (CAAs) are a significant cause of sudden cardiac death and a key factor in determining athletes’ eligibility for competitive sports. Their prevalence varies with diagnostic modalities and may present as asymptomatic or with life-threatening ischemic or arrhythmic events. This case series highlights the diverse manifestations of CAAs and the clinical approaches used to determine sports eligibility. Cases description: Five competitive athletes with different CAAs are presented. These cases include anomalous coronary origins, intramyocardial bridges, and coronary fistulas. Diagnostic tools, including coronary CT angiography (CCTA), cardiac magnetic resonance imaging (CMR), and stress tests, were essential in evaluating these anomalies and determining treatment strategies. In some cases, such as intramyocardial bridges, surgical intervention was necessary, while others required conservative management or exclusion from competitive sports. Conclusions: CAAs require individualized care based on risk stratification through advanced imaging techniques and functional assessment. Surgical interventions are reserved for high-risk anomalies, while others may be managed conservatively. Early detection and tailored management are crucial for ensuring athletes’ safety, and ongoing research is needed to optimize long-term outcomes. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Imaging—Computed Tomography (CT) Focus Issue)

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9 pages, 228 KiB

Open AccessReview

ECMO in the Cardiac Catheterization Lab—Patient Selection Is Key

by William Tracy, Brandon E. Ferrell, John P. Skendelas, Mayuko Uehara and Tadahisa Sugiura

J. Cardiovasc. Dev. Dis. 2025, 12(1), 12; https://doi.org/10.3390/jcdd12010012 - 31 Dec 2024

Viewed by 446

Abstract

The use of extracorporeal membrane oxygenation (ECMO) has emerged as a rescue intervention for hemodynamically unstable patients and prophylactic intraprocedural hemodynamic support in the cardiac catheterization laboratory. The prompt initiation of ECMO provides immediate hemodynamic support and allows for the completion of bridging [...] Read more.

The use of extracorporeal membrane oxygenation (ECMO) has emerged as a rescue intervention for hemodynamically unstable patients and prophylactic intraprocedural hemodynamic support in the cardiac catheterization laboratory. The prompt initiation of ECMO provides immediate hemodynamic support and allows for the completion of bridging and/or life-saving interventions. However, there are no clinical practice guidelines for the use of extracorporeal support in this area. This review examines the role of patient selection and therapeutic intervention for extracorporeal support in the cardiac catheterization laboratory. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

16 pages, 2402 KiB

Open AccessArticle

Raphe-Type Bicuspid Aortic Valve as a Risk Factor for Transcatheter Aortic Valve Replacement Failure: Improving Outcomes Using the LIRA Method and the Medtronic FX Prosthesis

by Francesca Napoli, Barbara Bellini, Vittorio Romano, Greca Zanda, Ciro Vella, Filippo Russo, Luca Angelo Ferri, Marco Bruno Ancona, Paolo Bonfanti, Eustachio Agricola, Antonio Esposito and Matteo Montorfano

J. Cardiovasc. Dev. Dis. 2025, 12(1), 11; https://doi.org/10.3390/jcdd12010011 - 30 Dec 2024

Viewed by 1090

Abstract

Transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis and raphe-type bicuspid aortic valve (BAV) is still associated with poor outcomes in terms of increased risk of paravalvular regurgitation, stroke, and permanent pacemaker implantation. There is no definitive consensus on the [...] Read more.

Transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis and raphe-type bicuspid aortic valve (BAV) is still associated with poor outcomes in terms of increased risk of paravalvular regurgitation, stroke, and permanent pacemaker implantation. There is no definitive consensus on the optimal sizing method for prosthesis selection in this setting. The LIRA method is a supra-annular tailored sizing method specifically designed for bicuspid anatomy that might increase accuracy of prosthesis choice in BAV patients and improve TAVR outcomes. This is the first report of the combination of the novel LIRA method for prosthesis sizing together with the adoption of the technological improvements introduced by the Evolut FX prosthesis as a useful tool for improving outcomes in this high risk subgroup of patients. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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25 pages, 3570 KiB

Open AccessReview

Contemporary Trends in Pulsed Field Ablation for Cardiac Arrhythmias

by Hagai Yavin, Mark Prasad, Jonathan Gordon, Tolga Aksu and Henry D. Huang

J. Cardiovasc. Dev. Dis. 2025, 12(1), 10; https://doi.org/10.3390/jcdd12010010 - 30 Dec 2024

Viewed by 860

Abstract

Pulsed field ablation (PFA) is a catheter-based procedure that utilizes short high voltage and short-duration electrical field pulses to induce tissue injury. The last decade has yielded significant scientific progress and quickened interest in PFA as an energy modality leading to the emergence [...] Read more.

Pulsed field ablation (PFA) is a catheter-based procedure that utilizes short high voltage and short-duration electrical field pulses to induce tissue injury. The last decade has yielded significant scientific progress and quickened interest in PFA as an energy modality leading to the emergence of the clinical use of PFA technologies for the treatment of atrial fibrillation. It is generally agreed that more research is needed to improve our biophysical understanding of PFA for clinical cardiac applications as well as its potential as a potential alternative energy source to thermal ablation modalities for the treatment of other arrhythmias. In this review, we discuss the available preclinical and clinical evidence for PFA for atrial fibrillation, developments for ventricular arrhythmia (VA) ablation, and future perspectives. Full article

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

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19 pages, 2762 KiB

Open AccessReview

The Role of Advanced Cardiac Imaging in Monitoring Cardiovascular Complications in Patients with Extracardiac Tumors: A Descriptive Review

by Annamaria Tavernese, Valeria Cammalleri, Rocco Mollace, Giorgio Antonelli, Mariagrazia Piscione, Nino Cocco, Myriam Carpenito, Carmelo Dominici, Massimo Federici and Gian Paolo Ussia

J. Cardiovasc. Dev. Dis. 2025, 12(1), 9; https://doi.org/10.3390/jcdd12010009 - 29 Dec 2024

Viewed by 712

Abstract

Cardiac involvement in cancer is increasingly important in the diagnosis and follow-up of patients. A thorough cardiovascular evaluation using multimodal imaging is crucial to assess any direct cardiac involvement from oncological disease progression and to determine the cardiovascular risk of patients undergoing oncological [...] Read more.

Cardiac involvement in cancer is increasingly important in the diagnosis and follow-up of patients. A thorough cardiovascular evaluation using multimodal imaging is crucial to assess any direct cardiac involvement from oncological disease progression and to determine the cardiovascular risk of patients undergoing oncological therapies. Early detection of cardiac dysfunction, particularly due to cardiotoxicity from chemotherapy or radiotherapy, is essential to establish the disease’s overall prognostic impact. Comprehensive cardiovascular imaging should be integral to the clinical management of cancer patients. Echocardiography remains highly effective for assessing cardiac function, including systolic performance and ventricular filling pressures, with speckle-tracking echocardiography offering early insights into chemotoxicity-related myocardial damage. Cardiac computed tomography (CT) provides precise anatomical detail, especially for cardiac involvement due to metastasis or adjacent mediastinal or lung tumors. Coronary assessment is also important for initial risk stratification and monitoring potential coronary artery disease progression after radiotherapy or chemotherapeutic treatment. Finally, cardiac magnetic resonance (CMR) is the gold standard for myocardial tissue characterization, aiding in the differential diagnosis of cardiac masses. CMR’s mapping techniques allow for early detection of myocardial inflammation caused by cardiotoxicity. This review explores the applicability of echocardiography, cardiac CT, and CMR in cancer patients with extracardiac tumors. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Imaging—Computed Tomography (CT) Focus Issue)

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13 pages, 1311 KiB

Open AccessArticle

Rate of Perceived Exertion Based on Repetitions in Reserve Versus Percentage of One-Repetition Maximum for Resistance Training Prescription in Cardiac Rehabilitation: A Pilot Study

by Alessandro Gismondi, Ferdinando Iellamo, Giuseppe Caminiti, Barbara Sposato, Emanuele Gregorace, Valentino D’Antoni, Deborah Di Biasio, Sara Vadalà, Alessio Franchini, Annalisa Mancuso, Valentina Morsella and Maurizio Volterrani

J. Cardiovasc. Dev. Dis. 2025, 12(1), 8; https://doi.org/10.3390/jcdd12010008 - 27 Dec 2024

Viewed by 718

Abstract

The aims of this study were to assess the efficacy of the rate of perceived exertion (RPE) scale based on the number of repetitions in reserve (RIR) before exhaustion for the prescription of resistance training in cardiac rehabilitation and to compare it to [...] Read more.

The aims of this study were to assess the efficacy of the rate of perceived exertion (RPE) scale based on the number of repetitions in reserve (RIR) before exhaustion for the prescription of resistance training in cardiac rehabilitation and to compare it to the percentage of estimated one-repetition maximum (1RM) prescription method. Sixteen male patients (age 60 ± 8) with history of coronary artery disease were randomly assigned to two resistance training rehabilitation protocols lasting nine weeks and consisting of three sessions per week, with the same exercise selection, number of sets and repetitions, and rest periods, but different load prescription method (RPE vs. %1RM). Patients’ strength was evaluated pre- and post-intervention. Patients in the RPE group showed significant increases in strength across all the exercises of the protocol (leg press 24.25 ± 17.07 kg; chest press 7.25 ± 3.41 kg; seated row 13.88 ± 7.57 kg; leg extension 14.24 ± 4.53 kg; shoulder press 5.75 ± 4.06 kg; lat pulldown 7.50 ± 4.66 kg). Post-intervention between-group analysis showed no differences in strength gains (leg press p = 0.955; chest press p = 0.965; seated row p = 0.763; leg extension p = 0.565; shoulder press p = 0.868; lat pulldown p = 0.780) and trivial effect sizes (ES) for one prescription method over the other (leg press ES = −0.03; chest press ES = 0.00; seated row ES = 0.10; leg extension ES = −0.29; shoulder press ES = 0.18; lat pulldown ES = 0.05). RPE based on RIR seems to be an effective prescription method for resistance training in cardiac rehabilitation, showing similar efficacy to the standardized practice of percentage of 1RM. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management, 2nd Edition)

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17 pages, 598 KiB

Open AccessArticle

Muscular Performance and Blood Pressure After Different Pre-Strength Training Strategies in Recreationally Strength-Trained Women: Cross-Over Trial

by Estêvão Rios Monteiro, Linda S. Pescatello, Luis Leitão, Marcelo José Colonna de Miranda, Paulo H. Marchetti, Michelle Ribeiro Novaes, Gleisson da Silva Araújo, Victor Gonçalves Corrêa Neto and Jefferson da Silva Novaes

J. Cardiovasc. Dev. Dis. 2025, 12(1), 7; https://doi.org/10.3390/jcdd12010007 - 26 Dec 2024

Viewed by 547

Abstract

Background: This study aimed to investigate the acute effects of different pre-ST strategies on muscular performance and blood pressure (BP) responses in recreationally strength-trained women. Methods: Twelve overweight women with normal BP were recruited and performed six experimental protocols in a randomized order: [...] Read more.

Background: This study aimed to investigate the acute effects of different pre-ST strategies on muscular performance and blood pressure (BP) responses in recreationally strength-trained women. Methods: Twelve overweight women with normal BP were recruited and performed six experimental protocols in a randomized order: (1) control protocol (CC), where BP was assessed without exercises performed; (2) ST; (3) foam rolling warm-up followed by ST (FR + ST); (4) specific warm-up followed by ST (SW + ST); (5) aerobic exercise followed by ST (AE + ST); and (6) stretching exercises followed by ST (SE + ST). ST consisted of three sets at 80% of 10 repetition maximum with a self-suggested rest interval between sets for bench press, back squat, bench press 45°, front squat, lat pull-down, leg press, shoulder press, and leg extension. Results: All experimental protocol had a lower total training volume, fatigue index, and repetitions performance in relation to ST (p < 0.05). No significant reduction was observed in systolic and diastolic BP for any protocol or exercise, although the effect size magnitudes ranged from trivial to large. Decreases in maximum repetitions, resistance to fatigue, and total training volume were performed before ST as warm-up strategies. However, these strategies indicated a clinical reduction in BP with a large and meaningful magnitude (effect size) in recreationally strength-trained women with normal to elevated BP. Conclusions: The results of this investigation may help to influence decision-making by practitioners who desire to elicit a post-exercise hypotension response in both subjects with normal BP and hypertension. Full article

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

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13 pages, 1533 KiB

Open AccessArticle

A New Risk Prediction Model for the Assessment of Myocardial Injury in Elderly Patients Undergoing Non-Elective Surgery

by Vedat Cicek, Mert Babaoglu, Faysal Saylik, Samet Yavuz, Ahmet Furkan Mazlum, Mahmut Salih Genc, Hatice Altinisik, Mustafa Oguz, Berke Cenktug Korucu, Mert Ilker Hayiroglu, Tufan Cinar and Ulas Bagci

J. Cardiovasc. Dev. Dis. 2025, 12(1), 6; https://doi.org/10.3390/jcdd12010006 - 26 Dec 2024

Viewed by 585

Abstract

Background: Currently, recommended pre-operative risk assessment models including the revised cardiac risk index (RCRI) are not very effective in predicting postoperative myocardial damage after non-elective surgery, especially for elderly patients. Aims: This study aimed to create a new risk prediction model to assess [...] Read more.

Background: Currently, recommended pre-operative risk assessment models including the revised cardiac risk index (RCRI) are not very effective in predicting postoperative myocardial damage after non-elective surgery, especially for elderly patients. Aims: This study aimed to create a new risk prediction model to assess myocardial injury after non-cardiac surgery (MINS) in elderly patients and compare it with the RCRI, a well-known pre-operative risk prediction model. Materials and Methods: This retrospective study included 370 elderly patients who were over 65 years of age and had non-elective surgery in a tertiary hospital. Each patient underwent detailed physical evaluations before the surgery. The study cohort was divided into two groups: patients who had MINS and those who did not. Results: In total, 13% (48 out of 370 patients) of the patients developed MINS. Multivariable analysis revealed that creatinine, lymphocyte, aortic regurgitation (moderate-severe), stroke, hemoglobin, ejection fraction, and D-dimer were independent determinants of MINS. By using these parameters, a model called “CLASHED” was developed to predict postoperative MINS. The ROC analysis comparison demonstrated that the new risk prediction model was significantly superior to the RCRI in predicting MINS in elderly patients undergoing non-elective surgery (AUC: 0.788 vs. AUC: 0.611, p < 0.05). Conclusions: Our study shows that the new risk preoperative model successfully predicts MINS in elderly patients undergoing non-elective surgery. In addition, this new model is found to be superior to the RCRI in predicting MINS. Full article

(This article belongs to the Special Issue Models and Methods for Computational Cardiology: 2nd Edition)

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13 pages, 9949 KiB

Open AccessArticle

Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage Closure

by Julia Seeger, Philipp Seppelt, Mario Iturbe-Orbe, David Leistner, Jochen Wöhrle and Michael Joner

J. Cardiovasc. Dev. Dis. 2025, 12(1), 5; https://doi.org/10.3390/jcdd12010005 - 26 Dec 2024

Viewed by 408

Abstract

(1) Background: Cerebral magnetic resonance imaging has reported new cerebral ischemic lesions after left atrial appendage (LAA) closure in about one- third of patients. Stroke occurs predominantly periprocedurally. This study evaluated the characteristics of embolized debris captured by the SENTINEL^TM cerebral embolic [...] Read more.

(1) Background: Cerebral magnetic resonance imaging has reported new cerebral ischemic lesions after left atrial appendage (LAA) closure in about one- third of patients. Stroke occurs predominantly periprocedurally. This study evaluated the characteristics of embolized debris captured by the SENTINEL^TM cerebral embolic protection system in patients undergoing LAA closure; (2) Methods: Sixty filters of 30 consecutive patients undergoing LAA closure with the WATCHMAN FLX^TM device were collected and captured debris was analyzed by histopathology and histomorphometry. Clinical outcome measures were disabling and non-disabling stroke within 72 h; (3) Results: In most filters, no material was captured. The predominant captured debris was acute or organized thrombi. The most common pattern was acute fibrin-rich thrombus, which was detected in 11/30 (33.3%) patients. Particles of heart tissue were seen in 6/30 (20%) patients, and foreign material was seen in one (3.3%) patient. The number of particles ranged from 0 to 52 per patient with a maximum of 31 in the distal and 21 in the proximal filter. Particle diameter ranged from 131 to 2614 µm. By logistic regression analysis, only protected time remained a multivariable predictor for larger particles (p = 0.039). There was no disabling or non-disabling stroke. Compared to transfemoral aortic valve replacement, the number of particles is only about 1.5%. (4) Conclusion: LAA occlusion with the WATCHMAN FLX^TM was associated with a very low number of embolized particles captured with the double-filter SENTINEL^TM embolic protection system and no periprocedural stroke. Full article

(This article belongs to the Special Issue Innovative Trends in Cardiovascular Medicine and Surgery)

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14 pages, 1694 KiB

Open AccessArticle

Safety and Efficacy in Mitral Regurgitation Management with the MitraClip^® G4 System: Insights from a Single-Center Study

by Georgios E. Papadopoulos, Ilias Ninios, Sotirios Evangelou, Andreas Ioannidis and Vlasis Ninios

J. Cardiovasc. Dev. Dis. 2025, 12(1), 4; https://doi.org/10.3390/jcdd12010004 - 25 Dec 2024

Viewed by 866

Abstract

Background: Mitral regurgitation (MR) is a common valvular disorder linked to high morbidity and mortality. For patients unsuitable for surgery, transcatheter mitral edge-to-edge repair (TEER) with the MitraClip^® G4 system offers an alternative. This study aims to evaluate procedural, echocardiographic, functional, and [...] Read more.

Background: Mitral regurgitation (MR) is a common valvular disorder linked to high morbidity and mortality. For patients unsuitable for surgery, transcatheter mitral edge-to-edge repair (TEER) with the MitraClip^® G4 system offers an alternative. This study aims to evaluate procedural, echocardiographic, functional, and quality of life (QoL) outcomes in patients who underwent TEER with the MitraClip^® G4 system, along with possible predictors of New York Heart Association (NYHA) class I at 30 days and at 1 year. Methods: Patients with moderate-to-severe (3+) or severe (4+) degenerative MR (DMR) or functional MR (FMR), classified as NYHA class III or IV, and who underwent TEER with the MitraClip^® G4 system at our center between January 2021 and December 2023 were included. Results: A total of 83 patients [71% FMR, 66% male, median (IQR) age 70 (11) years] underwent TEER, with 100% procedural success. MR ≤ 2+ was achieved in 100% and 98% of patients at 30 days and 1 year, respectively. NYHA class I or II was achieved in 100% and 96.8% of patients at 30 days and 1 year, respectively. The Kansas City Cardiomyopathy Questionnaire (KCCQ) score improved from 51 ± 20 at baseline to 69 ± 15 at 30 days (p < 0.001) and 70.5 ± 15 at 1 year (p < 0.001). Lower baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) predicted achieving NYHA class I at 30 days (HR: 0.63, 95% CI: 0.41–0.95, p = 0.030), while lower European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and NT-proBNP predicted it at 1 year [(HR: 0.50, 95% CI: 0.28–0.89, p = 0.019), (HR: 0.67, 95% CI: 0.44–0.99, p = 0.049), respectively]. Conclusions: The MitraClip^® G4 system provides significant improvements in MR severity, functional class, and QoL. Lower NT-proBNP and EuroSCORE II were strong predictors of achieving optimal functional status (NYHA class I). Full article

(This article belongs to the Special Issue Heart Valve Surgery: Repair and Replacement)

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J. Cardiovasc. Dev. Dis., Volume 12, Issue 1 (January 2025) – 33 articles

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