Journal of Cardiovascular Development and Disease

12 pages, 1708 KiB

Open AccessArticle

Beyond the Obesity Paradox: Analysis of New Prognostic Factors in Transcatheter Aortic Valve Implantation Procedure

by Francesca Ricci, Leonardo Benelli, Monia Pasqualetto, Mario Laudazi, Luca Pugliese, Maria Volpe, Cecilia Cerimele, Carlo Di Donna, Francesco Garaci and Marcello Chiocchi

J. Cardiovasc. Dev. Dis. 2024, 11(11), 368; https://doi.org/10.3390/jcdd11110368 (registering DOI) - 15 Nov 2024

Abstract

Scope: The main purpose of our study was to collect computed tomography (CT) measurements of fat parameters that are significantly related to body mass index (BMI) and evaluate the associations of these measurements and sarcopenia with early and long-term complications after transcatheter aortic [...] Read more.

Scope: The main purpose of our study was to collect computed tomography (CT) measurements of fat parameters that are significantly related to body mass index (BMI) and evaluate the associations of these measurements and sarcopenia with early and long-term complications after transcatheter aortic valve implantation (TAVI) in order to investigate the existence of the so-called ‘obesity paradox’ and the role of sarcopenia in this phenomenon. Materials and Methods: We analyzed the significance of fat CT measurements in 85 patients undergoing the TAVI procedure and compared these with each other, as well as with quantified CT BMI and fat density measurements. Secondly, we evaluated the associations of BMI, CT measurements of fat, and CT evaluations of skeletal muscle mass with early and long-term complications after 24 months of post-TAVI follow-up. Results: We found positive and significant relationships between fat CT measurements with each other and with BMI and a negative and significant relation between fat density and fat quantity. By comparing the CT measurements of fat and skeletal muscle mass with early and long-term complications after TAVI, we confirmed the existence of the ‘obesity paradox’ and the poor effect of sarcopenia after the TAVI procedure. Conclusions: We confirm that overweight and obesity are good prognostic factors, and sarcopenia is a poor prognostic factor for outcomes following the TAVI procedure. We focused on the scientific validation of an easy and fast way to measure fat and skeletal muscle mass using CT to better predict the outcomes of patients undergoing TAVI. Full article

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

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26 pages, 14150 KiB

Open AccessArticle

New Insights on the Formation of the Mitral Valve Chordae Tendineae in Fetal Life

by Meghan Martin, Kate Gillett, Parker Whittick and Sarah Melissa Wells

J. Cardiovasc. Dev. Dis. 2024, 11(11), 367; https://doi.org/10.3390/jcdd11110367 (registering DOI) - 15 Nov 2024

Abstract

There is an increasing understanding that some mitral valve pathologies have developmental origins. The time course of valvulogenesis varies by animal model; in cattle, the branched chordae tendineae architecture becomes fully developed at full term. The mechanism by which chordae tendineae bifurcate during [...] Read more.

There is an increasing understanding that some mitral valve pathologies have developmental origins. The time course of valvulogenesis varies by animal model; in cattle, the branched chordae tendineae architecture becomes fully developed at full term. The mechanism by which chordae tendineae bifurcate during fetal development remains unknown. The current study presents a detailed description of bovine chordae tendineae formation and bifurcation during fetal development. Analysis of Movat Pentachrome-stained histological sections of the developing mitral valve apparatus was accompanied by micro-CT imaging. TEM imaging of chordae branches and common trunks allowed the measurement of collagen fibril diameter distributions. We observed a proteoglycan-rich “transition zone” at the junction between the fetal mitral valve anterior leaflet and chordae tendineae with “perforations” lined by MMP1/2 and Ki-67 expressing endothelial cells. This region also contained clusters of proliferating endothelial cells within the bulk of the tissue. We hypothesize this zone marks a region where chordae tendineae bifurcate during fetal development. In particular, perforations created by localized MMP activity serve as a site for the initiation of a “split” of a single chordae attachment into two. This is supported by TEM results that suggest a similar population of collagen fibrils runs from the branches into a common trunk. A clear understanding of normal mitral valvulogenesis and its signaling mechanisms will be crucial in developing therapeutics and/or tissue-engineered valve replacements. Full article

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

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11 pages, 279 KiB

Open AccessArticle

Bleeding Risk of Anticoagulation Reversal Strategies Before Heart Transplantation: A Retrospective Comparative Cohort Study

by Antonio Prieto-Romero, Sara Ibañez-García, Xandra García-González, Javier Castrodeza, Beatriz Torroba-Sanz, Carlos Ortiz-Bautista, Cristina Pascual-Izquierdo, José María Barrio-Gutiérrez, Ángel González-Pinto, Ana Herranz-Alonso and María Sanjurjo-Sáez

J. Cardiovasc. Dev. Dis. 2024, 11(11), 366; https://doi.org/10.3390/jcdd11110366 - 13 Nov 2024

Abstract

Heart transplantation (HT) poses high bleeding risks, especially for patients on anticoagulation. This study evaluates the use of idarucizumab for dabigatran (DBG) reversal compared to vitamin K antagonist (VKA) strategies in HT. A retrospective analysis of HT patients from January 2018 to December [...] Read more.

Heart transplantation (HT) poses high bleeding risks, especially for patients on anticoagulation. This study evaluates the use of idarucizumab for dabigatran (DBG) reversal compared to vitamin K antagonist (VKA) strategies in HT. A retrospective analysis of HT patients from January 2018 to December 2022, excluding those requiring ECMO immediately before or after surgery, was conducted. Outcomes included transfusion needs, re-surgery due to bleeding, ICU stay lengths, and 30-day survival. A cost analysis compared the direct expenses of each strategy. Among 34 patients, 20 were on DBG and 14 on VKAs or not anticoagulated. Idarucizumab significantly reduced the number of patients requiring transfusion (p = 0.034) and ICU stay lengths (p = 0.014), with no significant impact on re-surgery rates (p = 0.259) or survival (p = 0.955). Despite higher initial costs, overall expenses for idarucizumab were comparable to VKA reversal due to reduced transfusion needs and shorter ICU stays. Idarucizumab offers a viable and potentially cost-neutral anticoagulation reversal option for HT patients on DBG, presenting an alternative to VKA strategies. However, due to the retrospective nature of the study and the small sample size, further prospective studies are needed to confirm these findings. Full article

10 pages, 869 KiB

Open AccessArticle

Empowering EVAR: Revolutionizing Patient Understanding and Qualification with 3D Printing

by Michał Kargul, Patryk Skórka, Piotr Gutowski, Arkadiusz Kazimierczak and Paweł Rynio

J. Cardiovasc. Dev. Dis. 2024, 11(11), 365; https://doi.org/10.3390/jcdd11110365 - 10 Nov 2024

Abstract

Background: This study addresses the need for enhanced patient education in the context of abdominal aortic aneurysm (AAA) and its treatment through endovascular aneurysm repair (EVAR). Effective patient education is essential for improving comprehension and engagement, particularly for those facing complex medical conditions. [...] Read more.

Background: This study addresses the need for enhanced patient education in the context of abdominal aortic aneurysm (AAA) and its treatment through endovascular aneurysm repair (EVAR). Effective patient education is essential for improving comprehension and engagement, particularly for those facing complex medical conditions. Methods: A total of 55 patients scheduled for EVAR participated in the study. Patient-specific three-dimensional (3D)-printed models of the participants’ aneurysms were created using computed tomography angiogram (CTA) scans. The educational intervention included a structured session utilizing these 3D models, with assessments conducted before and after the session, including the Mini-Mental State Examination (MMSE). Statistical analyses evaluated the knowledge gain and its correlation with cognitive function. Results: The results showed a significant increase in knowledge scores post-education (p < 0.001), with a mean knowledge gain of 2.36 points. Patients rated the effectiveness of the 3D models highly on a Likert scale, with a mean score of 4.64 for improving their understanding of the medical condition and procedural aspects. A weak correlation was observed between MMSE scores and knowledge test results. Conclusions: This study demonstrates the potential of patient-specific 3D models to enhance patient education in the context of EVAR, improving patients’ understanding of their medical condition and the procedure and thereby facilitating more informed decision-making. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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19 pages, 1641 KiB

Open AccessArticle

Effects of Sodium–Glucose Co-Transporter 2 Inhibitors on Serum Chloride Concentrations in Patients with Heart Failure

by Ivana Jurin, Vanja Ivanović Mihajlović, Zrinka Šakić, Marin Pavlov, Tomislav Šipić, Petra Vitlov, Hrvoje Falak, Danijela Grizelj, Šime Manola and Mario Udovičić

J. Cardiovasc. Dev. Dis. 2024, 11(11), 364; https://doi.org/10.3390/jcdd11110364 - 9 Nov 2024

Abstract

Background and aims: In the past few years, some reports have shown that serum chloride concentration is a more powerful prognostic predictor than serum sodium levels in heart failure (HF). Elevated Na/Cl ratio has shown to be independently associated with all-cause death in [...] Read more.

Background and aims: In the past few years, some reports have shown that serum chloride concentration is a more powerful prognostic predictor than serum sodium levels in heart failure (HF). Elevated Na/Cl ratio has shown to be independently associated with all-cause death in acute HF. We evaluated changes in serum chloride concentrations and Na/Cl ratio in correlation with various clinical factors during 12 months of follow-up in patients in whom SGLT2is were initiated as part of HF therapy. Patients and methods: This was a prospective observational study conducted at University Hospital Dubrava and involving patients with HF. We included 241 participants between May 2021 and April 2023. All data were obtained before the introduction of SGLT2is, and the same parameters were obtained at 6 and 12 months of follow-up as well. Results: The results show that higher chloride concentration at both 6 and 12 months is an independent predictor of lower NT-proBNP levels. The chloride concentrations did not differ significantly between these groups in the follow-up period. There were no statistically significant differences in the Na/Cl ratio at different timepoints. The presence of cardiovascular risk factors did not significantly affect the increase in chloride concentration. Conclusions: Our results suggest that hypochloremia could be a potentially modifiable risk factor, given the influence of SGLT2is on chloride concentration, but also an ominous sign of a poor outcome in patients with HF. We believe that the determination of chloride concentrations should become routine in the monitoring of patients with HF. Full article

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10 pages, 458 KiB

Open AccessArticle

Associations of Left Atrial Volume Index to Left Ventricular Ejection Fraction Ratio with Clinical Outcomes in Transthyretin Cardiac Amyloidosis

by Yeabsra K. Aleligne, Machelle D. Wilson, Martin Cadeiras, Michael Gibson, Shirin Jimenez, Stella Yala, Pablo E. Acevedo, David A. Liem, Julie T. Bidwell and Imo A. Ebong

J. Cardiovasc. Dev. Dis. 2024, 11(11), 363; https://doi.org/10.3390/jcdd11110363 - 8 Nov 2024

Abstract

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) affects all cardiac chambers to cause left ventricular (LV) deformation as well as left atrial (LA) remodeling and functional impairment. We investigated the associations of the LA volume index (LAVI):LV ejection fraction (LVEF) ratio with the increased risk [...] Read more.

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) affects all cardiac chambers to cause left ventricular (LV) deformation as well as left atrial (LA) remodeling and functional impairment. We investigated the associations of the LA volume index (LAVI):LV ejection fraction (LVEF) ratio with the increased risk of death, heart transplant, or LV assist device implantation (LVAD) in patients with ATTR-CM. Methods: This was a retrospective cohort study involving 69 heart failure (HF) patients with ATTR-CM at an academic medical center between 1 November 2008 and 31 March 2024. ATTR-CM was diagnosed using a technetium–diphosphonate/pyrophosphate scan or an endomyocardial biopsy. The LAVI and LVEF were measured by echocardiography. Cox proportional hazards models were used for the analysis. Results: The mean (SD) age of the participants was 77.5 (9.3) years. Over a median (IQR) follow-up period of 1.96 (0.67–2.82) years, we observed 24 composite events that included twenty-two deaths, two heart transplants, and two LVAD implantations (who subsequently died). In multivariable-adjusted analyses that accounted for age and the glomerular filtration rate, a one-unit increase in the LAVI:LVEF ratio was associated with a doubling of the risk (HR, 95% CI: 2.06, 1.11–3.82) of experiencing the composite outcome. Conclusions: A one-unit increase in the LAVI:LVEF ratio was associated with an increased risk of death, heart transplant, or LVAD implantation in patients with ATTR-CM. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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24 pages, 4268 KiB

Open AccessArticle

Sex-Specific Changes in Cardiac Function and Electrophysiology During Progression of Adenine-Induced Chronic Kidney Disease in Mice

by Valentina Dargam, Anet Sanchez, Aashiya Kolengaden, Yency Perez, Rebekah Arias, Ana M. Valentin Cabrera, Daniel Chaparro, Christopher Tarafa, Alexandra Coba, Nathan Yapaolo, Perony da Silva Nogueira, Emily A. Todd, Monique M. Williams, Lina A. Shehadeh and Joshua D. Hutcheson

J. Cardiovasc. Dev. Dis. 2024, 11(11), 362; https://doi.org/10.3390/jcdd11110362 - 7 Nov 2024

Abstract

Chronic kidney disease (CKD) and cardiovascular disease (CVD) often co-exist, with notable sex-dependent differences in manifestation and progression despite both sexes sharing similar risk factors. Identifying sex-specific diagnostic markers in CKD-induced CVD could elucidate why the development and progression of these diseases differ [...] Read more.

Chronic kidney disease (CKD) and cardiovascular disease (CVD) often co-exist, with notable sex-dependent differences in manifestation and progression despite both sexes sharing similar risk factors. Identifying sex-specific diagnostic markers in CKD-induced CVD could elucidate why the development and progression of these diseases differ by sex. Adult, C57BL/6J male and female mice were fed a high-adenine diet for 12 weeks to induce CKD, while control mice were given a normal diet. Adenine-treated males showed more severe CKD than females. Cardiac physiology was evaluated using electrocardiogram (ECG) and echocardiogram markers. Only adenine-treated male mice showed markers of left ventricular (LV) hypertrophy. Adenine males showed markers of LV systolic and diastolic dysfunction throughout regimen duration, worsening as the disease progressed. Adenine males had prolonged QTc interval compared to adenine females and control males. We identified a new ECG marker, S_peak-J duration, which increased with disease progression and appeared earlier in adenine-treated males than in females. We identified sex-dependent differences in cardiac structure, function, and electrophysiology in a CKD-induced CVD mouse model, with adenine-treated males displaying markers of LV hypertrophy, dysfunction, and electrophysiological changes. This study demonstrates the feasibility of using this model to investigate sex-dependent cardiac differences resulting from CKD. Full article

(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)

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17 pages, 1531 KiB

Open AccessReview

Sternal Wound Reconstruction Following Deep Sternal Wound Infection: Past, Present and Future: A Literature Review

by Arwa Khashkhusha, Sundas Butt, Mariam Abdelghaffar, William Wang, Asveny Rajananthanan, Sakshi Roy, Bakht Noor Khurshid, Mohamed Zeinah and Amer Harky

J. Cardiovasc. Dev. Dis. 2024, 11(11), 361; https://doi.org/10.3390/jcdd11110361 - 7 Nov 2024

Abstract

This literature review critically examines the historical, current, and prospective dimensions of sternal wound reconstruction in the specific context of deep sternal wound infection (DSWI), aiming to enhance patient outcomes and optimise surgical techniques. Preventive measures, including prophylactic antibiotic administration and surgical site [...] Read more.

This literature review critically examines the historical, current, and prospective dimensions of sternal wound reconstruction in the specific context of deep sternal wound infection (DSWI), aiming to enhance patient outcomes and optimise surgical techniques. Preventive measures, including prophylactic antibiotic administration and surgical site preparation, are crucial in reducing the incidence of DSWI. Effective management necessitates a multidisciplinary approach encompassing surgical debridement, drainage, and sternum repair utilising diverse procedures in conjunction with antibiotic therapy. Traditional approaches to managing DSWI involved closed irrigation and drainage techniques. While these methods exhibited certain advantages, they also exhibited limitations and varying degrees of success. The current care paradigms emphasise prophylactic antibiotic administration and surgical interventions like closed suction and irrigation, vacuum-assisted closure, and flap reconstruction. Future advancements in surgical techniques and technology hold promise for further enhancing sternal wound reconstruction. This review separates and emphasises the distinct roles of prophylaxis, antibiotic treatment, and reconstructive techniques, each relevant specifically to DSWI management. Collaborative efforts between cardiac and plastic surgeons, supported by ongoing research and innovation, are indispensable to advance sternal wound restoration and achieve superior outcomes in terms of patient welfare, morbidity and mortality reduction, and surgical efficacy. Full article

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

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12 pages, 1137 KiB

Open AccessArticle

Patient-Level Pericoronary Adipose Tissue Mean Attenuation: Associations with Plaque Characteristics

by Katrine Schultz Overgaard, Thomas Rueskov Andersen, Roda Abdulkadir Mohamed, Sebastian Villesen Kristensen, Helle Precht, Jess Lambrechtsen, Søren Auscher and Kenneth Egstrup

J. Cardiovasc. Dev. Dis. 2024, 11(11), 360; https://doi.org/10.3390/jcdd11110360 - 7 Nov 2024

Abstract

Pericoronary adipose tissue attenuation (PCAT_a), observed from coronary computed tomography angiography (CCTA), is emerging as an inflammation marker. This study evaluated the relationship between PCAT_a and plaque characteristics, including plaque type, burden, and coronary calcification. An observational study was conducted [...] Read more.

Pericoronary adipose tissue attenuation (PCAT_a), observed from coronary computed tomography angiography (CCTA), is emerging as an inflammation marker. This study evaluated the relationship between PCAT_a and plaque characteristics, including plaque type, burden, and coronary calcification. An observational study was conducted on 466 patients with suspected chronic coronary syndrome who underwent clinically indicated CCTA. PCAT_a was measured along the proximal 40 mm of the coronary arteries and averaged to represent the patient’s level. Plaque type was assessed, compositional plaque volumes were measured, and plaque burdens were quantified. The coronary calcification scores (CCSs) were categorized into groups. Statistical methods included t-tests, ANOVA, and multivariate regression analysis. PCAT_a differed significantly between calcified (−81.7 Hounsfield units (HU)) and soft (−77.5 HU) plaques. PCAT_a was positively associated with total plaque burden (β = 3.6) and non-calcified plaque burden (β = 7.0), but negatively correlated with calcified plaque burden (β = −3.5), independent of clinical factors and tube voltage (p < 0.05). The effect of PCAT_a was stronger when plaques of a different composition were absent. No significant differences in PCAT_a were found among different CCS groups. PCAT_a increased for calcified compared to soft plaques. The non-calcified plaque burden was associated with a higher PCAT_a, while the calcified plaque burden was associated with a lower PCAT_a. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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13 pages, 2308 KiB

Open AccessReview

Cardiac Surgery and Transcatheter Intervention for Valvular Heart Disease in Carcinoid Syndrome: Risk Factors, Outcomes, and Evolving Therapeutic Strategies

by Mariagrazia Piscione, Valeria Cammalleri, Giorgio Antonelli, Valeria Maria De Luca, Myriam Carpenito, Dario Gaudio, Nino Cocco, Antonio Nenna, Carmelo Dominici, Antonio Bianchi, Francesco Grigioni and Gian Paolo Ussia

J. Cardiovasc. Dev. Dis. 2024, 11(11), 359; https://doi.org/10.3390/jcdd11110359 - 7 Nov 2024

Abstract

Carcinoid heart disease (CHD) affects right-sided valves and causes significant mortality and morbidity. Even though the pathophysiology of the disease is not entirely understood, it is known that chronic exposure to high levels of circulating serotonin is the main factor responsible for developing [...] Read more.

Carcinoid heart disease (CHD) affects right-sided valves and causes significant mortality and morbidity. Even though the pathophysiology of the disease is not entirely understood, it is known that chronic exposure to high levels of circulating serotonin is the main factor responsible for developing valvular heart disease. Cardiac imaging plays a critical role in the management of CHD, so the final diagnosis can be performed through multimodal imaging techniques and the measurement of biomarkers. Moreover, in observational studies, surgical treatment of carcinoid-induced valve disease has been found to improve outcomes. Despite advancements in pre-operative preparation in recent years, mortality rates remain high in elderly patients and those with multiple comorbidities due to the risk of intra-operative carcinoid crisis and high post-operative bleeding. In this comprehensive review, we will analyze the causes of carcinoid syndrome and how it can result in severe right heart failure. The role of different imaging modalities in detecting heart valve disease will be discussed together with the therapeutic options at our disposal, such as medical treatment, surgery, and the novel role of transcatheter intervention. Full article

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

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8 pages, 1095 KiB

Open AccessArticle

Endo-Aortic Clamp for Minimally Invasive Redo Mitral Valve Surgery: Early Outcome

by Cristina Barbero, Marco Pocar, Andrea Costamagna, Cecilia Capozza, Valentina Aloi, Erik Cura Stura, Stefano Salizzoni and Mauro Rinaldi

J. Cardiovasc. Dev. Dis. 2024, 11(11), 358; https://doi.org/10.3390/jcdd11110358 - 6 Nov 2024

Abstract

Objective: Redo mitral valve surgery still represents a challenging and high-risk procedure in cardiac surgery. The incidence of cardiac structural injuries during re-sternotomy remains consistent and is reported to be an independent risk factor for hospital mortality. Minimally invasive cardiac surgery with retrograde [...] Read more.

Objective: Redo mitral valve surgery still represents a challenging and high-risk procedure in cardiac surgery. The incidence of cardiac structural injuries during re-sternotomy remains consistent and is reported to be an independent risk factor for hospital mortality. Minimally invasive cardiac surgery with retrograde femoral arterial perfusion and endo-aortic clamping avoids re-entry injuries and reduces the requirement for dissection of adhesions and the risk of damage to cardiac structures. The aim of this study is to analyze redo patients undergoing mitral valve surgery with retrograde arterial perfusion and endo-aortic clamping setting. Methods: A retrospective analysis was performed on patients undergoing surgery from 2006 to 2022. Exclusion criteria were more than mild aortic regurgitation, moderate-to-severe peripheral vascular disease, dilated ascending aorta, and a lack of preoperative vascular screening. The primary outcome was perioperative mortality. Results: Two hundred eighty-five patients were analyzed. Mean age was 63.8 ± 13.3 years, mean EuroSCORE was 16.5 ± 14.5%, and one quarter of the patients had undergone two or more previous procedures via sternotomy. Perioperative mortality was 3.9% (11/285). Stroke was reported in six (2.1%) patients. Median intensive care unit and hospital length of stay were 1 and 8 days, respectively. Conclusions: Endo-aortic clamping setting in redo MV surgery avoids re-entry injuries and allows the surgeon to clamp the aorta and deliver the cardioplegia with minimal dissection of adhesions. In high-volume and experienced centers, this approach can be applied safely and effectively and may in the near future become the standard of care for redo mitral valve surgery. Full article

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

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21 pages, 2156 KiB

Open AccessReview

The Complementary Role of Cardiopulmonary Exercise Testing in Coronary Artery Disease: From Early Diagnosis to Tailored Management

by Simone Pasquale Crispino, Andrea Segreti, Martina Ciancio, Dajana Polito, Emiliano Guerra, Giuseppe Di Gioia, Gian Paolo Ussia and Francesco Grigioni

J. Cardiovasc. Dev. Dis. 2024, 11(11), 357; https://doi.org/10.3390/jcdd11110357 - 5 Nov 2024

Abstract

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, accounting for over 9 million deaths annually. The prevalence of CAD continues to rise, driven by ageing and the increasing prevalence of risk factors such as hypertension, diabetes, and obesity. [...] Read more.

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, accounting for over 9 million deaths annually. The prevalence of CAD continues to rise, driven by ageing and the increasing prevalence of risk factors such as hypertension, diabetes, and obesity. Current clinical guidelines emphasize the importance of functional tests in the diagnostic pathway, particularly for assessing the presence and severity of ischemia. While recommended tests are valuable, they may not fully capture the complex physiological responses to exercise or provide the necessary detail to tailor personalized treatment plans. Cardiopulmonary exercise testing (CPET) offers a comprehensive assessment of the cardiovascular, pulmonary, and muscular systems under stress, potentially addressing these gaps and providing a more precise understanding of CAD, particularly in settings where traditional diagnostics may be insufficient. By enabling more personalized and precise treatment strategies, CPET could play a central role in the future of CAD management. This narrative review examines the current evidence supporting the use of CPET in CAD diagnosis and management and explores the potential for integrating CPET into existing clinical guidelines, considering its diagnostic and prognostic capabilities, cost-effectiveness, and the challenges associated with its adoption. Full article

(This article belongs to the Special Issue Exercise and Cardiovascular Disease in Older Adults)

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12 pages, 745 KiB

Open AccessArticle

Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond

by Julian Cheong Kiat Tay, Jannah Lee Tarranza, Shaw Yang Chia, Xuan Ming Pung, Germaine Jie Min Loo, Hooi Khee Teo, Colin Yeo, Vern Hsen Tan, Eric Tien Siang Lim, Daniel Thuan Tee Chong, Kah Leng Ho and Chi Keong Ching

J. Cardiovasc. Dev. Dis. 2024, 11(11), 356; https://doi.org/10.3390/jcdd11110356 - 5 Nov 2024

Abstract

Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent [...] Read more.

Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from September 2022 to January 2024 were included. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence after a 90-day blanking period at 12 months. Safety endpoints included 30 days of all-cause death, cardiac tamponade, stroke, myocardial infarction, and heart failure hospitalization. One hundred and one (72.3% males, 79.2% pAF) patients underwent PFA for AF. Thirty-one (30.7%) had structural heart disease with mean LVEF of 57.4 ± 8.1% and CHA2DS2-VASc score of 1.4 ± 1.3. Twenty-nine (28.7%) underwent additional PWA (PVI + PWA) using PFA. PWA was acutely successful in all patients. Patients who underwent PWA were more likely to have persistent AF and require general anesthesia and electroanatomic mapping (all p < 0.05). Total PFA applications for PVI, LA dwell time, procedural time, and fluoroscopy time were similar between the PVI-only and PVI + PWA groups (all p > 0.05). The 1-year atrial arrhythmia recurrence rates were 10% for pAF and 21% for the persistent AF group. The primary efficacy endpoint was not significantly different between the PVI-only and PVI+PWA groups (12-month KM estimates 90.3% [95% CI, 83.3–97.3] and 82.8% [95% CI, 68.1–97.4], respectively). There were no complications related to PFA use. PFA can be safely, effectively, and efficiently adopted for AF ablation. Additional PWA, if pursued, had similar procedural metrics to the PVI-only strategy without increased complications. Full article

(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: New Emerging Technologies, Promising Ablation Strategies beyond the Pulmonary Veins and Potential Role of Ablation in Improving Patient Prognosis)

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20 pages, 4204 KiB

Open AccessArticle

Activation of a GPCR, ORL1 Receptor: A Novel Therapy to Prevent Heart Failure Progression

by Saliha S. Pathan, Aarthi Pugazenthi, Beverly R. E. A. Dixon, Theodore G. Wensel, Todd K. Rosengart and Megumi Mathison

J. Cardiovasc. Dev. Dis. 2024, 11(11), 355; https://doi.org/10.3390/jcdd11110355 - 5 Nov 2024

Abstract

The number of ischemic heart failure (HF) patients is growing dramatically worldwide. However, there are at present no preventive treatments for HF. Our previous study showed that Gata4 overexpression improved cardiac function after myocardial infarction in rat hearts. We also found that Gata4 [...] Read more.

The number of ischemic heart failure (HF) patients is growing dramatically worldwide. However, there are at present no preventive treatments for HF. Our previous study showed that Gata4 overexpression improved cardiac function after myocardial infarction in rat hearts. We also found that Gata4 overexpression significantly increased the expression of a Pnoc gene, an endogenous ligand for the cell membrane receptor ORL1. We hypothesized that the activation of the ORL1 receptor would suppress HF in a rat ischemic heart model. Adult Sprague Dawley rats (8 weeks old, six males and six females) underwent left anterior descending coronary artery ligation. Three weeks later, normal saline or MCOPPB (ORL1 activator, 2.5 mg/kg/day) intraperitoneal injection was started, and continued 5 days a week for 3 months. Echocardiography was performed six times: pre-operative, 3 days after coronary artery ligation, pre-MCOPPB or saline injection, and 1, 2, and 3 months after saline or MCOPPB injection started. Animals were euthanized after 3 months’ follow-up and the hearts were harvested for histological analysis. The ORL1 activator, MCOPPB, significantly improved cardiac function after myocardial infarction in rats (ejection fraction, MCOPPB vs. saline at euthanasia, 67 ± 3% vs. 43 ± 2%, p < 0.001). MCOPPB also decreased fibrosis and induced angiogenesis. Thus, the ORL1 activator, MCOPPB, may be a novel treatment for preventing HF progression. Full article

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

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11 pages, 1672 KiB

Open AccessArticle

The Impact of Triglyceride-Glucose (TyG) Index on Future Cardio and Cerebrovascular Events in Patients with Acute Coronary Syndrome, During 3 Years of Follow-Up

by Francesca Macaione, Daniela Di Lisi, Cristina Madaudo, Alessandro D’agostino, Daniele Adorno, Vincenzo Sucato, Giuseppina Novo and Salvatore Evola

J. Cardiovasc. Dev. Dis. 2024, 11(11), 354; https://doi.org/10.3390/jcdd11110354 - 5 Nov 2024

Abstract

Background: The triglyceride-glucose (TyG) index is a new alternative insulin resistance (IR) biomarker. The purpose of this study was to assess whether the TyG index can have a prognostic value in patients with acute coronary syndrome (ACS). Moreover, we wanted to compare the [...] Read more.

Background: The triglyceride-glucose (TyG) index is a new alternative insulin resistance (IR) biomarker. The purpose of this study was to assess whether the TyG index can have a prognostic value in patients with acute coronary syndrome (ACS). Moreover, we wanted to compare the TyG index with HOMA index. Methods: We retrospectively enrolled 115 consecutive subjects, 81 males and 34 females, referred for ACS to our Unit of Cardiovascular Care of Policlinico Paolo Giaccone, Palermo. The subjects were divided into tertiles according to TyG index values and we performed a 3-year follow-up study. We considered as an end point new cardiovascular and cerebral events (MACCEs) during follow-up. Results: We found a significant statistical correlation between the HOMA index and the TyG index (p = 0.001). Patients with elevated TyG index have a higher incidence of MACCE at a 3-year follow-up. In our study the TyG index was an independent predictor of MACCEs (95% CI 1.8158 to 16.8068; P 0.0026) and the optimal TyG index cut-off for predicting MACCEs was 4.92 (sensitivity 76.56% and specificity 72.55%). Conclusions: The TyG index seems to significantly have an important prognostic role in patients with ACS and high values of TyG index are superior to HOMA-IR in predicting MACCEs. Full article

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11 pages, 990 KiB

Open AccessArticle

Pregnant Woman in Outcomes with Prosthetic Heart Valves

by Giunai Sefiyeva, Ulyana Shadrina, Tatiana Vavilova, Olga Sirotkina, Andrey Bautin, Aigul Chynybekova, Anna Pozhidaeva, Ekaterina Stepanovykh, Anna Starshinova, Dmitry Kudlay and Olga Irtyuga

J. Cardiovasc. Dev. Dis. 2024, 11(11), 353; https://doi.org/10.3390/jcdd11110353 - 4 Nov 2024

Abstract

We here sought to assess thrombotic and hemorrhagic complications and associated risk factors during pregnancy, delivery, and postpartum in women with prosthetic heart valves (PHV). Methods: The retrospective cohort study covered January 2011 to December 2022. The objective of the study was to [...] Read more.

We here sought to assess thrombotic and hemorrhagic complications and associated risk factors during pregnancy, delivery, and postpartum in women with prosthetic heart valves (PHV). Methods: The retrospective cohort study covered January 2011 to December 2022. The objective of the study was to assess the risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery, and the postpartum period in women with PHV based on the experience of one perinatal center. We included 88 pregnancies with 77 prosthetic heart valves (PHV), which were divided into two groups, mechanical valve prostheses (MVP) (n = 64) and biological valve prosthesis (BVP) (n = 24). In the study we analyzed pregnancy outcomes, as well as thrombotic and hemorrhagic complication frequencies. Results: Of 88 pregnancies, 79 resulted in live births. In the MVP group, there were six miscarriages (9.4%) and two medical abortions (3.1%), including one due to Warfarin’s teratogenic effects. No miscarriages were reported in the BVP group, but one fetal mortality case (4.2%) occurred. During pregnancy, 11 MVP cases (17.2%) experienced thrombotic complications. In the BVP group, one patient (4.2%) had transient ischemic attack (TIA). Two MVP cases required surgical valve repair during pregnancy, and one in the post-delivery stage was caused by thrombotic complications. Postpartum, two MVP cases had strokes, and in one MVP patient, pulmonary embolism was registered, while no thrombotic complications occurred in the BVP group. Hemorrhagic complications affected 15 MVP cases (17.9%) in the postpartum period. There were no registered cases of maternal mortality. Conclusions: The effective control of anti-factor Xa activity reduced thrombotic events. However, the persistently high incidence of postpartum hemorrhagic complications suggests a need to reassess anticoagulant therapy regimens, lower target levels of anti-Xa, and reduce INR levels for discontinuing heparin bridge therapy. Despite the heightened mortality risk in MVP patients, our study cohort did not have any mortality cases, which contrasts with findings from other registries. Full article

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

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15 pages, 5572 KiB

Open AccessArticle

An In Vivo Model of Estrogen Supplementation Concerning the Expression of Ca²⁺-Dependent Exchangers and Mortality, Vitality and Survival After Myocardial Infarction in Ovariectomized Rats

by Tomáš Toporcer, Tomáš Grendel, Ivana Špaková, Alžbeta Blichárová, Ľudmila Verbóová, Zuzana Benetinová, Beata Čižmárová, Miroslava Rabajdová and Silvia Toporcerová

J. Cardiovasc. Dev. Dis. 2024, 11(11), 352; https://doi.org/10.3390/jcdd11110352 - 2 Nov 2024

Abstract

Background: Ischemic-reperfusion damage of cardiomyocytes due to myocardial infarction (MI) often leads to the death of an individual. Premenopausal women have been observed to have a significantly lower risk of cardiovascular disease (CVD) than men of the same age. In menopausal women, this [...] Read more.

Background: Ischemic-reperfusion damage of cardiomyocytes due to myocardial infarction (MI) often leads to the death of an individual. Premenopausal women have been observed to have a significantly lower risk of cardiovascular disease (CVD) than men of the same age. In menopausal women, this trend is significantly reversed, and the risk of CVD increases up to 10-fold. Estrogens affect the development and function of the heart muscle, and as they decrease, the risk and poor prognosis of CVD increase. This study is focused on the effects of estrogen supplementation on morbidity, vitality, and NCX1 expression after MI on a model system. Methods: In this study, female Sprague Dawley rats (n = 58), which were divided into three experimental groups (NN—control group, non-supplemented; OVX-N—ovariectomized, non-supplemented; OVX-S—ovariectomized, supplemented), received left thoracotomy in the fourth intercostal space. The left anterior descendent coronary artery was ligated 2 mm from its origin with an 8.0 suture. An immunohistological analysis as well as an RT-PCR analysis of NCX1 expression were performed. Results: A higher survival rate was recorded in the OVX-N group (86%) in comparison with the OVX-S group (53%) (p < 0.05). In addition, higher NCX1 expression 7 days/14 days after MI in the OVX-S group in comparison with the NN and OVX-N (p < 0.001 and p < 0.05) groups was recorded. Seven days after MI, a significantly higher expression (p < 0.005) of mRNA NCX1 in the OVX-N group was also recorded in comparison with the NN group. Conclusions: This study provides a comprehensive description of the effect of estrogen supplementation on NCX1 expression and overall vitality in ovariectomized rats that survived MI. Full article

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

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9 pages, 642 KiB

Open AccessReview

Effects of Respiratory Muscle Training Pre- and Post-Cardiac Surgery in Adults: A Scoping Review

by Giulia Starko, Daniel Müller, Antoine Lipka, Patrick Feiereisen, Camilo Corbellini and Raphael Martins de Abreu

J. Cardiovasc. Dev. Dis. 2024, 11(11), 351; https://doi.org/10.3390/jcdd11110351 - 2 Nov 2024

Abstract

Background: Coronary artery bypass grafts (CABGs) and cardiac valve replacement surgeries (CVRSs) are common lifesaving cardiac surgeries. They are linked to an increased risk of postoperative pulmonary complications (PPCs). This review scopes the effects of inspiratory muscle training (IMT) on adult patients, considering [...] Read more.

Background: Coronary artery bypass grafts (CABGs) and cardiac valve replacement surgeries (CVRSs) are common lifesaving cardiac surgeries. They are linked to an increased risk of postoperative pulmonary complications (PPCs). This review scopes the effects of inspiratory muscle training (IMT) on adult patients, considering mainly exercise capacity, lung function, and the occurrence of PPCs. Methods: This scoping review was built using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Four databases were searched in May 2024. Three reviewers independently screened the articles. The data were extracted and summarised in text and tables. Results: Five studies were included in the final analysis, where IMT was compared to sham or placebo IMT, and some studies added an exercise program to both groups. PeakVO₂, the six-minute walking test (6MWT), maximal inspiratory pressure (MIP), quality of life (QoL), PPCs, and spirometry outcomes showed significant improvements between the intervention group (IG) and control group (CG) and intragroup over time. Conclusions: IMT can be a non-conventional training method to prevent respiratory muscle weakness. It can be applied in pre- or post-surgical contexts, potentially affecting exercise capacity and quality of life in adult patients undergoing cardiac surgery. Full article

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9 pages, 417 KiB

Open AccessArticle

Validity and Reliability of Self-Reported Prevalent and Incident Cardiovascular Disease Among Asian Adults

by Charumathi Sabanayagam, Feng He, Miao Li Chee and Ching-Yu Cheng

J. Cardiovasc. Dev. Dis. 2024, 11(11), 350; https://doi.org/10.3390/jcdd11110350 - 1 Nov 2024

Abstract

Cardiovascular disease (CVD) is the leading cause of death in Asians. We aimed to examine the validity and reliability of self-reported (SR) CVD in 6762 Chinese, Malay, and Indian adults aged 40–80 years who attended the baseline (November 2004) and 6-year follow-up visit [...] Read more.

Cardiovascular disease (CVD) is the leading cause of death in Asians. We aimed to examine the validity and reliability of self-reported (SR) CVD in 6762 Chinese, Malay, and Indian adults aged 40–80 years who attended the baseline (November 2004) and 6-year follow-up visit (2011–2017) of a population-based cohort study in Singapore. CVD was defined based on the presence of existing (prevalent) or new onset (incident) cases of acute myocardial infarction (AMI) or stroke. The validity of SR-CVD was assessed by comparing it against diagnosed CVD using sensitivity and specificity. The reliability of SR-CVD was evaluated by calculating the percentage of positive agreement between baseline and follow-up visits. The sensitivity and specificity of SR-CVD were 62.7% and 93.8% for prevalent SR-CVD and 50.9% and 98.5% for incident SR-CVD. The negative predictive value (NPV) was 98.1% for both prevalent and incident SR-CVD. The reliability of positive self-reports between the baseline and follow-up was substantial, at 85%. The excellent specificity and NPV of SR-CVD suggest that it could serve as a valuable tool for excluding AMI and stroke. However, its moderate sensitivity suggests that positive SR-CVD reports should prompt further clinical evaluation to prevent potential false positives. Full article

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

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