Journal of Cardiovascular Development and Disease

11 pages, 536 KiB

Open AccessArticle

Preparticipation Screening of Athletes: The Prevalence of Positive Family History

by Bogna Jiravska Godula, Otakar Jiravsky, Petra Pesova, Libor Jelinek, Marketa Sovova, Katarina Moravcova, Jaromir Ozana, Miroslav Hudec, Roman Miklik, Jan Hecko, Libor Sknouril and Eliska Sovova

J. Cardiovasc. Dev. Dis. 2023, 10(4), 183; https://doi.org/10.3390/jcdd10040183 - 21 Apr 2023

Cited by 2 | Viewed by 2109

Abstract

Sudden cardiac death (SCD) is a leading cause of death among athletes, and those with a positive family history (FH) of SCD and/or cardiovascular disease (CVD) may be at increased risk. The primary objective of this study was to assess the prevalence and [...] Read more.

Sudden cardiac death (SCD) is a leading cause of death among athletes, and those with a positive family history (FH) of SCD and/or cardiovascular disease (CVD) may be at increased risk. The primary objective of this study was to assess the prevalence and predictors of positive FH of SCD and CVD in athletes using four widely used preparticipation screening (PPS) systems. The secondary objective was to compare the functionality of the screening systems. In a cohort of 13,876 athletes, 1.28% had a positive FH in at least one PPS system. Multivariate logistic regression analysis identified the maximum heart rate as significantly associated with positive FH (OR = 1.042, 95% CI = 1.027–1.056, p < 0.001). The highest prevalence of positive FH was found using the PPE-4 system (1.20%), followed by FIFA, AHA, and IOC systems (1.11%, 0.89%, and 0.71%, respectively). In conclusion, the prevalence of positive FH for SCD and CVD in Czech athletes was found to be 1.28%. Furthermore, positive FH was associated with a higher maximum heart rate at the peak of the exercise test. The findings of this study revealed significant differences in detection rates between PPS protocols, so further research is needed to determine the optimal method of FH collection. Full article

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

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13 pages, 323 KiB

Open AccessReview

Recognition of Strokes in the ICU: A Narrative Review

by Kotaro Noda, Masatoshi Koga and Kazunori Toyoda

J. Cardiovasc. Dev. Dis. 2023, 10(4), 182; https://doi.org/10.3390/jcdd10040182 - 21 Apr 2023

Viewed by 1833

Abstract

Despite the remarkable progress in acute treatment for stroke, in-hospital stroke is still devastating. The mortality and neurological sequelae are worse in patients with in-hospital stroke than in those with community-onset stroke. The leading cause of this tragic situation is the delay in [...] Read more.

Despite the remarkable progress in acute treatment for stroke, in-hospital stroke is still devastating. The mortality and neurological sequelae are worse in patients with in-hospital stroke than in those with community-onset stroke. The leading cause of this tragic situation is the delay in emergent treatment. To achieve better outcomes, early stroke recognition and immediate treatment are crucial. In general, in-hospital stroke is initially witnessed by non-neurologists, but it is sometimes challenging for non-neurologists to diagnose a patient’s state as a stroke and respond quickly. Therefore, understanding the risk and characteristics of in-hospital stroke would be helpful for early recognition. First, we need to know “the epicenter of in-hospital stroke”. Critically ill patients and patients who undergo surgery or procedures are admitted to the intensive care unit, and they are potentially at high risk for stroke. Moreover, since they are often sedated and intubated, evaluating their neurological status concisely is difficult. The limited evidence demonstrated that the intensive care unit is the most common place for in-hospital strokes. This paper presents a review of the literature and clarifies the causes and risks of stroke in the intensive care unit. Full article

(This article belongs to the Special Issue Ischemic Stroke: New Insights from Risk Factors, Mechanisms and Outcomes)

18 pages, 39311 KiB

Open AccessArticle

Left Ventricle Segmental Longitudinal Strain and Regional Myocardial Work Index Could Help Determine Mitral Valve Prolapse Patients with Increased Risk of Ventricular Arrhythmias

by Ludmiła Daniłowicz-Szymanowicz, Agnieszka Zienciuk-Krajka, Elżbieta Wabich, Marcin Fijałkowski, Jadwiga Fijałkowska, Krzysztof Młodziński and Grzegorz Raczak

J. Cardiovasc. Dev. Dis. 2023, 10(4), 181; https://doi.org/10.3390/jcdd10040181 - 20 Apr 2023

Cited by 1 | Viewed by 1830

Abstract

Mitral valve prolapse (MVP) could associate with malignant ventricular arrhythmias (VAs). Mitral annular disjunction, a putative mechanism for an arrhythmic substrate, leads to excessive mobility, stretch, and damage of some segments. Speckle tracking echocardiography (STE), with particular attention to the segmental longitudinal strain [...] Read more.

Mitral valve prolapse (MVP) could associate with malignant ventricular arrhythmias (VAs). Mitral annular disjunction, a putative mechanism for an arrhythmic substrate, leads to excessive mobility, stretch, and damage of some segments. Speckle tracking echocardiography (STE), with particular attention to the segmental longitudinal strain and myocardial work index (MWI), could be an indicator of the segments we aimed to check. Seventy-two MVP patients and twenty controls underwent echocardiography. Complex VAs documented prospectively after the enrollment was qualified as the primary endpoint, which was noticed in 29 (40%) patients. Pre-specified cut-off values for peak segmental longitudinal strain (PSS) and segmental MWI for basal lateral (−25%, 2200 mmHg%), mid-lateral (−25%, 2500 mmHg%), mid-posterior (−25%, 2400 mmHg%), and mid-inferior (−23%, 2400 mmHg%) segments were accurate predictors of complex VAs. A combination of PSS and MWI increased the probability of the endpoint, reaching the highest predictive value for the basal lateral segment: odds ratio 32.15 (3.78–273.8), p < 0.001 for PSS ≥ −25% and MWI ≥ 2200 mmHg%. STE may be a valuable tool for assessing the arrhythmic risk in MVP patients. Excessively increased segmental longitudinal strain with an augmented regional myocardial work index identifies patients with the highest risk of complex VAs. Full article

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

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20 pages, 6362 KiB

Open AccessArticle

Cardiac Fibrosis and Innervation State in Uncorrected and Corrected Transposition of the Great Arteries: A Postmortem Histological Analysis and Systematic Review

by Leo J. Engele, Roel L. F. van der Palen, Anastasia D. Egorova, Margot M. Bartelings, Lambertus J. Wisse, Claire A. Glashan, Philippine Kiès, Hubert W. Vliegen, Mark G. Hazekamp, Barbara J. M. Mulder, Marco C. De Ruiter, Berto J. Bouma and Monique R. M. Jongbloed

J. Cardiovasc. Dev. Dis. 2023, 10(4), 180; https://doi.org/10.3390/jcdd10040180 - 20 Apr 2023

Cited by 2 | Viewed by 1343

Abstract

In the transposition of the great arteries (TGA), alterations in hemodynamics and oxygen saturation could result in fibrotic remodeling, but histological studies are scarce. We aimed to investigate fibrosis and innervation state in the full spectrum of TGA and correlate findings to clinical [...] Read more.

In the transposition of the great arteries (TGA), alterations in hemodynamics and oxygen saturation could result in fibrotic remodeling, but histological studies are scarce. We aimed to investigate fibrosis and innervation state in the full spectrum of TGA and correlate findings to clinical literature. Twenty-two human postmortem TGA hearts, including TGA without surgical correction (n = 8), after Mustard/Senning (n = 6), and arterial switch operation (ASO, n = 8), were studied. In newborn uncorrected TGA specimens (1 day–1.5 months), significantly more interstitial fibrosis (8.6% ± 3.0) was observed compared to control hearts (5.4% ± 0.8, p = 0.016). After the Mustard/Senning procedure, the amount of interstitial fibrosis was significantly higher (19.8% ± 5.1, p = 0.002), remarkably more in the subpulmonary left ventricle (LV) than in the systemic right ventricle (RV). In TGA-ASO, an increased amount of fibrosis was found in one adult specimen. The amount of innervation was diminished from 3 days after ASO (0.034% ± 0.017) compared to uncorrected TGA (0.082% ± 0.026, p = 0.036). In conclusion, in these selected postmortem TGA specimens, diffuse interstitial fibrosis was already present in newborn hearts, suggesting that altered oxygen saturations may already impact myocardial structure in the fetal phase. TGA-Mustard/Senning specimens showed diffuse myocardial fibrosis in the systemic RV and, remarkably, in the LV. Post-ASO, decreased uptake of nerve staining was observed, implicating (partial) myocardial denervation after ASO. Full article

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

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13 pages, 472 KiB

Open AccessArticle

Subclinical Myocardial Injury in Patients Recovered from COVID-19 Pneumonia: Predictors and Longitudinal Assessment

by Antonella Cecchetto, Gianpaolo Torreggiani, Gabriella Guarnieri, Andrea Vianello, Giulia Baroni, Chiara Palermo, Leonardo Bertagna De Marchi, Giulia Lorenzoni, Patrizia Bartolotta, Emanuele Bertaglia, Filippo Donato, Patrizia Aruta, Sabino Iliceto and Donato Mele

J. Cardiovasc. Dev. Dis. 2023, 10(4), 179; https://doi.org/10.3390/jcdd10040179 - 19 Apr 2023

Cited by 3 | Viewed by 1036

Abstract

(1) Background: Emerging data regarding patients recovered from COVID-19 are reported in the literature, but cardiac sequelae have not yet been clarified. To quickly detect any cardiac involvement at follow-up, the aims of the research were to identify: elements at admission predisposing subclinical [...] Read more.

(1) Background: Emerging data regarding patients recovered from COVID-19 are reported in the literature, but cardiac sequelae have not yet been clarified. To quickly detect any cardiac involvement at follow-up, the aims of the research were to identify: elements at admission predisposing subclinical myocardial injury at follow up; the relationship between subclinical myocardial injury and multiparametric evaluation at follow-up; and subclinical myocardial injury longitudinal evolution. (2) Methods and Results: A total of 229 consecutive patients hospitalised for moderate to severe COVID-19 pneumonia were initially enrolled, of which 225 were available for follow-up. All patients underwent a first follow-up visit, which included a clinical evaluation, a laboratory test, echocardiography, a six-minute walking test (6MWT), and a pulmonary functional test. Of the 225 patients, 43 (19%) underwent a second follow-up visit. The median time to the first follow-up after discharge was 5 months, and the median time to the second follow-up after discharge was 12 months. Left ventricular global longitudinal strain (LVGLS) and right ventricular free wall strain (RVFWS) were reduced in 36% (n = 81) and 7.2% (n = 16) of the patients, respectively, at first the follow-up visit. LVGLS impairment showed correlations with patients of male gender (p 0.008, OR 2.32 (95% CI 1.24–4.42)), the presence of at least one cardiovascular risk factor (p < 0.001, OR 6.44 (95% CI 3.07–14.9)), and final oxygen saturation (p 0.002, OR 0.99 (95% CI 0.98–1)) for the 6MWTs. Subclinical myocardial dysfunction had not significantly improved at the 12-month follow-ups. (3) Conclusions: in patients recovered from COVID-19 pneumonia, left ventricular subclinical myocardial injury was related to cardiovascular risk factors and appeared stable during follow-up. Full article

(This article belongs to the Special Issue Further Understanding of Myocardial Diseases: From Mechanisms to Treatment)

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14 pages, 669 KiB

Open AccessReview

A Systematic Approach for the Interpretation of Cardiopulmonary Exercise Testing in Children with Focus on Cardiovascular Diseases

by Bibhuti B. Das

J. Cardiovasc. Dev. Dis. 2023, 10(4), 178; https://doi.org/10.3390/jcdd10040178 - 19 Apr 2023

Cited by 2 | Viewed by 2222

Abstract

Cardiopulmonary exercise testing (CPET) is the clinical standard for children with congenital heart disease (CHD), heart failure (HF) being assessed for transplantation candidacy, and subjects with unexplained dyspnea on exertion. Heart, lung, skeletal muscle, peripheral vasculature, and cellular metabolism impairment frequently lead to [...] Read more.

Cardiopulmonary exercise testing (CPET) is the clinical standard for children with congenital heart disease (CHD), heart failure (HF) being assessed for transplantation candidacy, and subjects with unexplained dyspnea on exertion. Heart, lung, skeletal muscle, peripheral vasculature, and cellular metabolism impairment frequently lead to circulatory, ventilatory, and gas exchange abnormalities during exercise. An integrated analysis of the multi-system response to exercise can be beneficial for differential diagnosis of exercise intolerance. The CPET combines standard graded cardiovascular stress testing with simultaneous ventilatory respired gas analysis. This review addresses the interpretation and clinical significance of CPET results with specific reference to cardiovascular diseases. The diagnostic values of commonly obtained CPET variables are discussed using an easy-to-use algorithm for physicians and trained nonphysician personnel in clinical practice. Full article

(This article belongs to the Special Issue Feature Review Papers in Pediatric Cardiology and Congenital Heart Disease)

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9 pages, 653 KiB

Open AccessArticle

Clinical Impact of ACE-I/ARB for Conservatively Treated Patients with Moderate to Severe Mitral Regurgitation: A Single Center Observational Study

by Robert Uzel, Raphael R. Bruno, Christian Jung, Christian Lang, Hannes Hoi, Martin Grünbart, Christian Datz, Friedrich Hoppichler and Bernhard Wernly

J. Cardiovasc. Dev. Dis. 2023, 10(4), 177; https://doi.org/10.3390/jcdd10040177 - 18 Apr 2023

Cited by 1 | Viewed by 1464

Abstract

(1) Background: Mitral regurgitation (MR) is associated with increased mortality and frequent hospital admissions. Although mitral valve intervention offers improved clinical outcomes for MR, it is not feasible in many cases. Moreover, conservative therapeutic opportunities remain limited. The aim of this study was [...] Read more.

(1) Background: Mitral regurgitation (MR) is associated with increased mortality and frequent hospital admissions. Although mitral valve intervention offers improved clinical outcomes for MR, it is not feasible in many cases. Moreover, conservative therapeutic opportunities remain limited. The aim of this study was to evaluate the impact of ACE inhibitors and angiotensin receptor blockers (ACE-I/ARB) on elderly patients with moderate-to-severe MR and mildly reduced to preserved ejection fraction. (2) Methods: In total, 176 patients were included in our hypothesis-generating, single-center observational study. Hospitalization for heart failure and all-cause death have been defined as the combined 1-year primary endpoint. (3) Results: Patients treated with ACE-I/ARB showed a lower risk for the combined endpoint of death and heart failure-related readmission (HR 0.52 95%CI 0.27–0.99; p = 0.046), even after adjustment for EUROScoreII and frailty (HR 0.52 95%CI 0.27–0.99; p = 0.049) (4) Conclusions: The use of an ACE-I/ARB in patients with moderate-to-severe MR and preserved to mildly reduced left-ventricular ejection fraction (LVEF) significantly associates with improved clinical outcome and might be indicated as a valuable therapeutic option in conservatively treated patients. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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Graphical abstract

11 pages, 1067 KiB

Open AccessArticle

Retrospective Analysis of the Effectiveness of Oral Semaglutide in Type 2 Diabetes Mellitus and Its Effect on Cardiometabolic Parameters in Japanese Clinical Settings

by Hodaka Yamada, Masashi Yoshida, Shunsuke Funazaki, Jun Morimoto, Shiori Tonezawa, Asuka Takahashi, Shuichi Nagashima, Kimura Masahiko, Otsuka Kiyoshi and Kazuo Hara

J. Cardiovasc. Dev. Dis. 2023, 10(4), 176; https://doi.org/10.3390/jcdd10040176 - 18 Apr 2023

Cited by 3 | Viewed by 2830

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RA) have a more potent glycated hemoglobin (HbA1c)-lowering effect than existing therapies and are widely used for treating type 2 diabetes mellitus (T2DM). Once-daily oral semaglutide is the world’s first oral GLP-1RA. This study aimed to provide real-world data [...] Read more.

Glucagon-like peptide-1 receptor agonists (GLP-1RA) have a more potent glycated hemoglobin (HbA1c)-lowering effect than existing therapies and are widely used for treating type 2 diabetes mellitus (T2DM). Once-daily oral semaglutide is the world’s first oral GLP-1RA. This study aimed to provide real-world data on oral semaglutide in Japanese patients with T2DM and its effects on cardiometabolic parameters. This was a single-center retrospective observational study. We examined changes in HbA1c and body weight (BW) and the rate of achieving HbA1c < 7% after 6 months of oral semaglutide treatment in Japanese patients with T2DM. Furthermore, we examined differences in the efficacy of oral semaglutide with multiple patient backgrounds. A total of 88 patients were included in this study. Overall, the mean (standard error of the mean) HbA1c at 6 months decreased by −1.24% (0.20%) from baseline, and BW at 6 months (n = 85) also decreased by −1.44 kg (0.26 kg) from baseline. The percentage of patients who achieved HbA1c < 7% changed significantly from 14% at baseline to 48%. HbA1c decreased from baseline regardless of age, sex, body mass index, chronic kidney disease, or diabetes duration. Additionally, alanine aminotransferase, total cholesterol, triglyceride, and non-high-density lipoprotein cholesterol were significantly reduced from baseline. Oral semaglutide may be an effective option for the intensification of therapy in Japanese patients with T2DM who have inadequate glycemic control with existing therapy. It may also reduce BW and improve cardiometabolic parameters. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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16 pages, 1717 KiB

Open AccessReview

Current and Future Use of Artificial Intelligence in Electrocardiography

by Manuel Martínez-Sellés and Manuel Marina-Breysse

J. Cardiovasc. Dev. Dis. 2023, 10(4), 175; https://doi.org/10.3390/jcdd10040175 - 17 Apr 2023

Cited by 10 | Viewed by 7570

Abstract

Artificial intelligence (AI) is increasingly used in electrocardiography (ECG) to assist in diagnosis, stratification, and management. AI algorithms can help clinicians in the following areas: (1) interpretation and detection of arrhythmias, ST-segment changes, QT prolongation, and other ECG abnormalities; (2) risk prediction integrated [...] Read more.

Artificial intelligence (AI) is increasingly used in electrocardiography (ECG) to assist in diagnosis, stratification, and management. AI algorithms can help clinicians in the following areas: (1) interpretation and detection of arrhythmias, ST-segment changes, QT prolongation, and other ECG abnormalities; (2) risk prediction integrated with or without clinical variables (to predict arrhythmias, sudden cardiac death, stroke, and other cardiovascular events); (3) monitoring ECG signals from cardiac implantable electronic devices and wearable devices in real time and alerting clinicians or patients when significant changes occur according to timing, duration, and situation; (4) signal processing, improving ECG quality and accuracy by removing noise/artifacts/interference, and extracting features not visible to the human eye (heart rate variability, beat-to-beat intervals, wavelet transforms, sample-level resolution, etc.); (5) therapy guidance, assisting in patient selection, optimizing treatments, improving symptom-to-treatment times, and cost effectiveness (earlier activation of code infarction in patients with ST-segment elevation, predicting the response to antiarrhythmic drugs or cardiac implantable devices therapies, reducing the risk of cardiac toxicity, etc.); (6) facilitating the integration of ECG data with other modalities (imaging, genomics, proteomics, biomarkers, etc.). In the future, AI is expected to play an increasingly important role in ECG diagnosis and management, as more data become available and more sophisticated algorithms are developed. Full article

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

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11 pages, 295 KiB

Open AccessArticle

Determining the Acceptance of Digital Cardiac Rehabilitation and Its Influencing Factors among Patients Affected by Cardiac Diseases

by Alexander Bäuerle, Charlotta Mallien, Tienush Rassaf, Lisa Jahre, Christos Rammos, Eva-Maria Skoda, Martin Teufel and Julia Lortz

J. Cardiovasc. Dev. Dis. 2023, 10(4), 174; https://doi.org/10.3390/jcdd10040174 - 17 Apr 2023

Cited by 4 | Viewed by 1401

Abstract

Background: Cardiac diseases are a major global health issue with an increasing prevalence of affected people. Rehabilitation following cardiac events is underutilized, despite its proven effectiveness. Digital interventions might present a useful addition to traditional cardiac rehabilitation. Aims: This study aims to assess [...] Read more.

Background: Cardiac diseases are a major global health issue with an increasing prevalence of affected people. Rehabilitation following cardiac events is underutilized, despite its proven effectiveness. Digital interventions might present a useful addition to traditional cardiac rehabilitation. Aims: This study aims to assess the acceptance of mobile health (mHealth) cardiac rehabilitation and to investigate the underlying factors of acceptance in patients with ischemic heart disease and congestive heart failure. Methods: A cross-sectional study was conducted from November 2021 to September 2022 with N = 290 patients. Sociodemographic, medical, and eHealth-related data were assessed. The Unified Theory of Acceptance and Use of Technology (UTAUT) was applied. Group differences in acceptance were examined and a multiple hierarchical regression analysis was conducted. Results: The overall acceptance of mHealth cardiac rehabilitation was high (M = 4.05, SD = 0.93). Individuals with mental illness reported significantly higher acceptance (t(288) = 3.15, p_adj = 0.007, d = 0.43). Depressive symptoms (β = 0.34, p < 0.001); digital confidence (β = 0.19, p = 0.003); and the UTAUT predictors of performance expectancy (β = 0.34, p < 0.001), effort expectancy (β = 0.34, p < 0.001), and social influence (β = 0.26, p < 0.001) significantly predicted acceptance. The extended UTAUT model explained 69.5% of the variance in acceptance. Conclusions: As acceptance is associated with the actual use of mHealth, the high level of acceptance found in this study is a promising basis for the future implementation of innovative mHealth offers in cardiac rehabilitation. Full article

(This article belongs to the Special Issue Role of the Multidisciplinary Healthcare Management in Cardiovascular Diseases)

13 pages, 1098 KiB

Open AccessArticle

Association between Cardiovascular Response and Inflammatory Cytokines in Non-Small Cell Lung Cancer Patients

by Xiaolin Wang, Mengying Cao, Zilong Liu, Liming Chen, Yufei Zhou, Pan Gao and Yunzeng Zou

J. Cardiovasc. Dev. Dis. 2023, 10(4), 173; https://doi.org/10.3390/jcdd10040173 - 17 Apr 2023

Cited by 1 | Viewed by 1404

Abstract

Cardiovascular disease is an essential comorbidity in patients with non-small cell lung cancer (NSCLC) and represents an independent risk factor for increased mortality. Therefore, careful monitoring of cardiovascular disease is crucial in the healthcare of NSCLC patients. Inflammatory factors have previously been associated [...] Read more.

Cardiovascular disease is an essential comorbidity in patients with non-small cell lung cancer (NSCLC) and represents an independent risk factor for increased mortality. Therefore, careful monitoring of cardiovascular disease is crucial in the healthcare of NSCLC patients. Inflammatory factors have previously been associated with myocardial damage in NSCLC patients, but it remains unclear whether serum inflammatory factors can be utilized to assess the cardiovascular health status in NSCLC patients. A total of 118 NSCLC patients were enrolled in this cross-sectional study, and their baseline data were collected through a hospital electronic medical record system. Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of leukemia inhibitory factor (LIF), interleukin (IL)-18, IL-1β, transforming growth factor-β1 (TGF-β1), and connective tissue growth factor (CTGF). Statistical analysis was performed using the SPSS software. Multivariate and ordinal logistic regression models were constructed. The data revealed an increased serum level of LIF in the group using tyrosine kinase inhibitor (TKI)-targeted drugs compared to non-users (p < 0.001). Furthermore, serum TGF-β1 (area under the curve, AUC: 0.616) and cardiac troponin T (cTnT) (AUC: 0.720) levels were clinically evaluated and found to be correlated with pre-clinical cardiovascular injury in NSCLC patients. Notably, the serum levels of cTnT and TGF-β1 were found to indicate the extent of pre-clinical cardiovascular injury in NSCLC patients. In conclusion, the results suggest that serum LIF, as well as TGFβ1 together with cTnT, are potential serum biomarkers for the assessment of cardiovascular status in NSCLC patients. These findings offer novel insights into the assessment of cardiovascular health and underscore the importance of monitoring cardiovascular health in the management of NSCLC patients. Full article

(This article belongs to the Special Issue Cardiovascular Toxicity Related to Cancer Treatment)

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16 pages, 841 KiB

Open AccessReview

Stereotactic Arrhythmia Radioablation Treatment of Ventricular Tachycardia: Current Technology and Evolving Indications

by Fabrizio Guarracini, Massimo Tritto, Antonio Di Monaco, Marco Valerio Mariani, Alessio Gasperetti, Paolo Compagnucci, Daniele Muser, Alberto Preda, Patrizio Mazzone, Sakis Themistoclakis and Corrado Carbucicchio

J. Cardiovasc. Dev. Dis. 2023, 10(4), 172; https://doi.org/10.3390/jcdd10040172 - 17 Apr 2023

Cited by 1 | Viewed by 2111

Abstract

Ventricular tachycardia in patients with structural heart disease is a significant cause of morbidity and mortality. According to current guidelines, cardioverter defibrillator implantation, antiarrhythmic drugs, and catheter ablation are established therapies in the management of ventricular arrhythmias but their efficacy is limited in [...] Read more.

Ventricular tachycardia in patients with structural heart disease is a significant cause of morbidity and mortality. According to current guidelines, cardioverter defibrillator implantation, antiarrhythmic drugs, and catheter ablation are established therapies in the management of ventricular arrhythmias but their efficacy is limited in some cases. Sustained ventricular tachycardia can be terminated by cardioverter-defibrillator therapies although shocks in particular have been demonstrated to increase mortality and worsen patients’ quality of life. Antiarrhythmic drugs have important side effects and relatively low efficacy, while catheter ablation, even if it is actually an established treatment, is an invasive procedure with intrinsic procedural risks and is frequently affected by patients’ hemodynamic instability. Stereotactic arrhythmia radioablation for ventricular arrhythmias was developed as bail-out therapy in patients unresponsive to traditional treatments. Radiotherapy has been mainly applied in the oncological field, but new current perspectives have developed in the field of ventricular arrhythmias. Stereotactic arrhythmia radioablation provides an alternative non-invasive and painless therapeutic strategy for the treatment of previously detected cardiac arrhythmic substrate by three-dimensional intracardiac mapping or different tools. Since preliminary experiences have been reported, several retrospective studies, registries, and case reports have been published in the literature. Although, for now, stereotactic arrhythmia radioablation is considered an alternative palliative treatment for patients with refractory ventricular tachycardia and no other therapeutic options, this research field is currently extremely promising. Full article

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

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21 pages, 1547 KiB

Open AccessReview

Metal-Binding Proteins Cross-Linking with Endoplasmic Reticulum Stress in Cardiovascular Diseases

by Kejuan Li, Yongnan Li, Hong Ding, Jianshu Chen and Xiaowei Zhang

J. Cardiovasc. Dev. Dis. 2023, 10(4), 171; https://doi.org/10.3390/jcdd10040171 - 17 Apr 2023

Cited by 2 | Viewed by 1327

Abstract

The endoplasmic reticulum (ER), an essential organelle in eukaryotic cells, is widely distributed in myocardial cells. The ER is where secreted protein synthesis, folding, post-translational modification, and transport are all carried out. It is also where calcium homeostasis, lipid synthesis, and other processes [...] Read more.

The endoplasmic reticulum (ER), an essential organelle in eukaryotic cells, is widely distributed in myocardial cells. The ER is where secreted protein synthesis, folding, post-translational modification, and transport are all carried out. It is also where calcium homeostasis, lipid synthesis, and other processes that are crucial for normal biological cell functioning are regulated. We are concerned that ER stress (ERS) is widespread in various damaged cells. To protect cells’ function, ERS reduces the accumulation of misfolded proteins by activating the unfolded protein response (UPR) pathway in response to numerous stimulating factors, such as ischemia or hypoxia, metabolic disorders, and inflammation. If these stimulatory factors are not eliminated for a long time, resulting in the persistence of the UPR, it will aggravate cell damage through a series of mechanisms. In the cardiovascular system, it will cause related cardiovascular diseases and seriously endanger human health. Furthermore, there has been a growing number of studies on the antioxidative stress role of metal-binding proteins. We observed that a variety of metal-binding proteins can inhibit ERS and, hence, mitigate myocardial damage. Full article

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13 pages, 2204 KiB

Open AccessArticle

A Pilot Study on the Role of Computed Tomography in the Management of Patients with Coronary Artery Anomalies in Romania

by Adriana Sorina Capisizu, Dragos Cuzino and Silviu Marcel Stanciu

J. Cardiovasc. Dev. Dis. 2023, 10(4), 170; https://doi.org/10.3390/jcdd10040170 - 15 Apr 2023

Cited by 1 | Viewed by 1428

Abstract

Coronary artery anomalies may occur during embryogenesis and can lead to changes in the vascularization of the heart, possible ischemia, and an increased risk of sudden death. A retrospective study was conducted with the aim of assessing the prevalence of coronary anomalies in [...] Read more.

Coronary artery anomalies may occur during embryogenesis and can lead to changes in the vascularization of the heart, possible ischemia, and an increased risk of sudden death. A retrospective study was conducted with the aim of assessing the prevalence of coronary anomalies in a Romanian sample of patients, investigated with computed tomography angiography for coronary artery disease. The objectives of the study were to identify the anomalies of the coronary arteries and to conduct an anatomical classification according to Angelini. The study also consisted of evaluations regarding coronary artery calcification in the sample of patients by the Agatston calcium score and assessments regarding the presence of cardiac symptoms and their association with coronary abnormalities. The results showed a prevalence of coronary anomalies of 8.7%, of which 3.8% were origin and course anomalies and 4.9% were coronary anomalies with intramuscular bridging of the left anterior descending artery. Recommendations for practice include the widespread use of coronary computed tomography angiography for the diagnosis of coronary artery anomalies and coronary artery disease in larger patient groups and encouraging this investigation across the country. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))

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12 pages, 2040 KiB

Open AccessArticle

Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach

by Amato Santoro, Federico Landra, Carmine Marallo, Simone Taddeucci, Nicolò Sisti, Andrea Pica, Andrea Stefanini, Maria Cristina Tavera, Antonio Pagliaro, Claudia Baiocchi and Matteo Cameli

J. Cardiovasc. Dev. Dis. 2023, 10(4), 169; https://doi.org/10.3390/jcdd10040169 - 14 Apr 2023

Cited by 3 | Viewed by 1303

Abstract

Background: Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently, conduction system pacing (CSP) has been proposed as an alternative in case of BiVP failure. The aim of this study is to define an algorithm to choose between BiVP [...] Read more.

Background: Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently, conduction system pacing (CSP) has been proposed as an alternative in case of BiVP failure. The aim of this study is to define an algorithm to choose between BiVP and CSP resynchronization using the interventricular conduction delays (IVCD) as a guide. Methods: Consecutive patients from January 2018 to December 2020 with an indication for CRT were prospectively enrolled in the study group (delays-guided resynchronization group, DRG). A treatment algorithm based on IVCD was used to decide whether to leave the left ventricular (LV) lead to perform BiVP or pull it out and perform CSP. Outcomes from the DRG group were compared to a historical cohort of CRT patients who underwent CRT procedures between January 2016 and December 2017 (resynchronization standard guide group, SRG). The primary endpoint was a composite of cardiovascular mortality, heart failure (HF) hospitalization, or HF event at 1 year after the date of intervention. Results: The study population consisted of 292 patients, of which 160 (54.8%) were in the DRG and 132 (45.2%) in the SRG. In the DRG, 41 of 160 patients underwent CSP based on the treatment algorithm (25.6%). The primary endpoint was significantly higher in the SRG (48/132, 36.4%) compared to the DRG (35/160, 21.8%) (hazard ratio (HR): 1.72; 95% confidence interval (CI): 1.12–2.65; p = 0.013). Conclusions: A treatment algorithm based on IVCD shifted one patient out of every four from BiVP to CSP, with consequent reduction in the primary endpoint after implantation. Therefore, its application could be useful to determine whether to perform BiVP or CSP. Full article

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

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11 pages, 1360 KiB

Open AccessArticle

Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease

by Francesco Perna, Alessandro Telesca, Roberto Scacciavillani, Maria Lucia Narducci, Gianluigi Bencardino, Gaetano Pinnacchio, Francesco Raffaele Spera, Rocco Sabarese, Gianluca Comerci and Gemma Pelargonio

J. Cardiovasc. Dev. Dis. 2023, 10(4), 168; https://doi.org/10.3390/jcdd10040168 - 13 Apr 2023

Cited by 1 | Viewed by 1717

Abstract

Background. Adults with congenital heart disease (ACHD) are often affected by cardiac arrhythmias requiring catheter ablation. Catheter ablation in this setting represents the treatment of choice but is flawed by frequent recurrencies. Predictors of arrhythmia relapse have been identified, but the role of [...] Read more.

Background. Adults with congenital heart disease (ACHD) are often affected by cardiac arrhythmias requiring catheter ablation. Catheter ablation in this setting represents the treatment of choice but is flawed by frequent recurrencies. Predictors of arrhythmia relapse have been identified, but the role of cardiac fibrosis in this setting has not been investigated. The aim of this study was to determine the role of the extension of cardiac fibrosis, detected by electroanatomical mapping, in predicting arrhythmia recurrencies after ablation in ACHD. Materials and Methods. Consecutive patients with congenital heart disease and atrial or ventricular arrhythmias undergoing catheter ablation were enrolled. An electroanatomical bipolar voltage map was performed during sinus rhythm in each patient and bipolar scar was assessed according to the current literature data. During follow-up, arrhythmia recurrences were recorded. The relationship between the extent of myocardial fibrosis and arrhythmia recurrence was assessed. Results. Twenty patients underwent successful catheter ablation of atrial (14) or ventricular (6) arrhythmias, with no inducible arrhythmia at the end of the procedure. During a median follow-up period of 207 weeks (IQR 80 weeks), eight patients (40%; five atrial and three ventricular arrhythmias) had arrhythmia recurrence. Of the five patients undergoing a second ablation, four showed a new reentrant circuit, while one patient had a conduction gap across a previous ablation line. The extension of the bipolar scar area (HR 1.049, CI 1.011–1.089, p = 0.011) and the presence of a bipolar scar area >20 cm² (HR 6.101, CI 1.147–32.442, p = 0.034) were identified as predictors of arrhythmia relapse. Conclusion. The extension of the bipolar scar area and the presence of a bipolar scar area >20 cm² can predict arrhythmia relapse in ACHD undergoing catheter ablation of atrial and ventricular arrhythmias. Recurrent arrhythmias are often caused by circuits other than those previously ablated. Full article

(This article belongs to the Special Issue Catheter Ablation of Cardiac Arrhythmias: Practices and Outcomes)

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11 pages, 290 KiB

Open AccessArticle

Comparison of Cardiorespiratory Fitness between Patients with Mitral Valve Prolapse and Healthy Peers: Findings from Serial Cardiopulmonary Exercise Testing

by Jin-Hui Chung, Yi-Ju Tsai, Ko-Long Lin, Ken-Pen Weng, Ming-Hsuan Huang, Guan-Bo Chen and Sheng-Hui Tuan

J. Cardiovasc. Dev. Dis. 2023, 10(4), 167; https://doi.org/10.3390/jcdd10040167 - 13 Apr 2023

Cited by 1 | Viewed by 2014

Abstract

Individuals with mitral valve prolapse (MVP) have exercise intolerance even without mitral valve regurgitation. Mitral valve degeneration may progress with aging. We aimed to evaluate the influence of MVP on the cardiopulmonary function (CPF) of individuals with MVP through serial follow-ups from early [...] Read more.

Individuals with mitral valve prolapse (MVP) have exercise intolerance even without mitral valve regurgitation. Mitral valve degeneration may progress with aging. We aimed to evaluate the influence of MVP on the cardiopulmonary function (CPF) of individuals with MVP through serial follow-ups from early to late adolescence. Thirty patients with MVP receiving at least two cardiopulmonary exercise tests (CPETs) using a treadmill (MVP group) were retrospectively analyzed. Age-, sex-, and body mass index-matched healthy peers, who also had serial CPETs, were recruited as the control group. The average time from the first CPET to the last CPET was 4.28 and 4.06 years in the MVP and control groups, respectively. At the first CPET, the MVP group had a significantly lower peak rate pressure product (PRPP) than the control group (p = 0.022). At the final CEPT, the MVP group had lower peak metabolic equivalent (MET, p = 0.032) and PRPP (p = 0.031). Moreover, the MVP group had lower peak MET and PRPP as they aged, whereas healthy peers had higher peak MET (p = 0.034) and PRPP (p = 0.047) as they aged. Individuals with MVP had poorer CPF than healthy individuals as they develop from early to late adolescence. It is important for individuals with MVP to receive regular CPET follow-ups. Full article

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

29 pages, 3379 KiB

Open AccessEditor’s ChoiceReview

Noncoding RNAs as Key Regulators for Cardiac Development and Cardiovascular Diseases

by Satoshi Kawaguchi, Bruno Moukette, Taiki Hayasaka, Angela K. Haskell, Jessica Mah, Marisa N. Sepúlveda, Yaoliang Tang and Il-man Kim

J. Cardiovasc. Dev. Dis. 2023, 10(4), 166; https://doi.org/10.3390/jcdd10040166 - 12 Apr 2023

Cited by 4 | Viewed by 2896

Abstract

Noncoding RNAs (ncRNAs) play fundamental roles in cardiac development and cardiovascular diseases (CVDs), which are a major cause of morbidity and mortality. With advances in RNA sequencing technology, the focus of recent research has transitioned from studies of specific candidates to whole transcriptome [...] Read more.

Noncoding RNAs (ncRNAs) play fundamental roles in cardiac development and cardiovascular diseases (CVDs), which are a major cause of morbidity and mortality. With advances in RNA sequencing technology, the focus of recent research has transitioned from studies of specific candidates to whole transcriptome analyses. Thanks to these types of studies, new ncRNAs have been identified for their implication in cardiac development and CVDs. In this review, we briefly describe the classification of ncRNAs into microRNAs, long ncRNAs, and circular RNAs. We then discuss their critical roles in cardiac development and CVDs by citing the most up-to-date research articles. More specifically, we summarize the roles of ncRNAs in the formation of the heart tube and cardiac morphogenesis, cardiac mesoderm specification, and embryonic cardiomyocytes and cardiac progenitor cells. We also highlight ncRNAs that have recently emerged as key regulators in CVDs by focusing on six of them. We believe that this review concisely addresses perhaps not all but certainly the major aspects of current progress in ncRNA research in cardiac development and CVDs. Thus, this review would be beneficial for readers to obtain a recent picture of key ncRNAs and their mechanisms of action in cardiac development and CVDs. Full article

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4 pages, 208 KiB

Open AccessEditorial

Novel Device Therapies for Heart Failure

by Deya Alkhatib, Sakiru Isa, Issa Pour-Ghaz, Asra Butt, Omar Al-Taweel, Ifeoma Ugonabo, Neeraja Yedlapati and John Lynn Jefferies

J. Cardiovasc. Dev. Dis. 2023, 10(4), 165; https://doi.org/10.3390/jcdd10040165 - 11 Apr 2023

Cited by 1 | Viewed by 1217

Abstract

Heart failure (HF) therapeutics have advanced significantly over the past few years [...] Full article

23 pages, 1702 KiB

Open AccessReview

Antithrombotic Therapy in Peripheral Artery Disease: Current Evidence and Future Directions

by Mario Enrico Canonico, Raffaele Piccolo, Marisa Avvedimento, Attilio Leone, Salvatore Esposito, Anna Franzone, Giuseppe Giugliano, Giuseppe Gargiulo, Connie N. Hess, Scott D. Berkowitz, Judith Hsia, Plinio Cirillo, Giovanni Esposito and Marc P. Bonaca

J. Cardiovasc. Dev. Dis. 2023, 10(4), 164; https://doi.org/10.3390/jcdd10040164 - 10 Apr 2023

Cited by 7 | Viewed by 3417

Abstract

Patients with peripheral artery disease (PAD) are at an increased risk of major adverse cardiovascular events, and those with disease in the lower extremities are at risk of major adverse limb events primarily driven by atherothrombosis. Traditionally, PAD refers to diseases of the [...] Read more.

Patients with peripheral artery disease (PAD) are at an increased risk of major adverse cardiovascular events, and those with disease in the lower extremities are at risk of major adverse limb events primarily driven by atherothrombosis. Traditionally, PAD refers to diseases of the arteries outside of the coronary circulation, including carotid, visceral and lower extremity peripheral artery disease, and the heterogeneity of PAD patients is represented by different atherothrombotic pathophysiology, clinical features and related antithrombotic strategies. The risk in this diverse population includes systemic risk of cardiovascular events as well as risk related to the diseased territory (e.g., artery to artery embolic stroke for patients with carotid disease, lower extremity artery to artery embolism and atherothrombosis in patients with lower extremity disease). Moreover, until the last decade, clinical data on antithrombotic management of PAD patients have been drawn from subanalyses of randomized clinical trials addressing patients affected by coronary artery disease. The high prevalence and related poor prognosis in PAD patients highlight the pivotal role of tailored antithrombotic therapy in patients affected by cerebrovascular, aortic and lower extremity peripheral artery disease. Thus, the proper assessment of thrombotic and hemorrhagic risk in patients with PAD represents a key clinical challenge that must be met to permit the optimal antithrombotic prescription for the various clinical settings in daily practice. The aim of this updated review is to analyze different features of atherothrombotic disease as well as current evidence of antithrombotic management in asymptomatic and secondary prevention in PAD patients according to each arterial bed. Full article

(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)

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16 pages, 796 KiB

Open AccessReview

Dual Antiplatelet Therapy with Parenteral P2Y₁₂ Inhibitors: Rationale, Evidence, and Future Directions

by Giulia Alagna, Paolo Mazzone, Marco Contarini and Giuseppe Andò

J. Cardiovasc. Dev. Dis. 2023, 10(4), 163; https://doi.org/10.3390/jcdd10040163 - 09 Apr 2023

Cited by 3 | Viewed by 3650

Abstract

Dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and an inhibitor of the platelet P2Y₁₂ receptor for ADP, remains among the most investigated treatments in cardiovascular medicine. While a substantial amount of research initially stemmed from the observations of late [...] Read more.

Dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and an inhibitor of the platelet P2Y₁₂ receptor for ADP, remains among the most investigated treatments in cardiovascular medicine. While a substantial amount of research initially stemmed from the observations of late and very late stent thrombosis events in the first-generation drug-eluting stent (DES) era, DAPT has been recently transitioning from a purely stent-related to a more systemic secondary prevention strategy. Oral and parenteral platelet P2Y₁₂ inhibitors are currently available for clinical use. The latter have been shown to be extremely suitable in drug-naïve patients with acute coronary syndrome (ACS), mainly because oral P2Y₁₂ inhibitors are associated with delayed efficacy in patients with STEMI and because pre-treatment with P2Y₁₂ inhibitors is discouraged in NSTE-ACS, and in patients with recent DES implantation and in need of urgent cardiac and non-cardiac surgery. More definitive evidence is needed, however, about optimal switching strategies between parenteral and oral P2Y₁₂ inhibitors and about newer potent subcutaneous agents that are being developed for the pre-hospital setting. Full article

(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)

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8 pages, 284 KiB

Open AccessCommunication

Validation of the Portuguese Version of the Kansas City Cardiomyopathy Questionnaire-12

by Mariane Cecilia dos Reis, Juliana Araújo Nascimento, Geisa Nascimento de Andrade, Ana Cláudia de Souza Costa, Julio Yoshio Takada, Antonio de Padua Mansur, Edimar Alcides Bocchi, Gianni Mara Silva dos Santos, John A. Spertus and Naomi Kondo Nakagawa

J. Cardiovasc. Dev. Dis. 2023, 10(4), 162; https://doi.org/10.3390/jcdd10040162 - 07 Apr 2023

Cited by 1 | Viewed by 1182

Abstract

The Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) is a simple, feasible, and sensitive questionnaire developed in English for assessing the health status (symptoms, function, and quality of life) of patients with heart failure (HF). We aimed to assess the internal consistency and construct validity [...] Read more.

The Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) is a simple, feasible, and sensitive questionnaire developed in English for assessing the health status (symptoms, function, and quality of life) of patients with heart failure (HF). We aimed to assess the internal consistency and construct validity of the Portuguese version of KCCQ-12. We administered the KCCQ-12, the Minnesota Living Heart Failure (MLHFQ), and the New York Heart Association (NYHA) classification by telephone. Internal consistency was assessed with Cronbach’s Alpha (α-Cronbach) and construct validity with correlations to the MLHFQ and NYHA. Internal consistency was high (α-Cronbach = 0.92 for the Overall Summary score and 0.77–0.85 for the subdomains). Construct validity was supported by finding high correlations between the KCCQ-12 Physical Limitation and the Symptom Frequency domains with the physical domain of the MLHFQ (r = −0.70 and r = −0.76, p < 0.001 for both) and the Overall Summary scale with NYHA classifications (r = −0.72, p < 0.001). The Portuguese version of KCCQ-12 has high internal consistency and shows a convergent construct validity with other measures quantifying the health status of patients with chronic HF and can be used confidently in Brazil for research and clinical care. Full article

15 pages, 1514 KiB

Open AccessEditor’s ChoiceArticle

Purkinje Cardiomyocytes of the Adult Ventricular Conduction System Are Highly Diploid but Not Uniquely Regenerative

by Hirofumi Watanabe, Ge Tao, Peiheng Gan, Baylee C. Westbury, Kristie D. Cox, Kelsey Tjen, Ruolan Song, Glenn I. Fishman, Takako Makita and Henry M. Sucov

J. Cardiovasc. Dev. Dis. 2023, 10(4), 161; https://doi.org/10.3390/jcdd10040161 - 07 Apr 2023

Viewed by 1691

Abstract

Adult hearts are characterized by inefficient regeneration after injury, thus, the features that support or prevent cardiomyocyte (CM) proliferation are important to clarify. Diploid CMs are a candidate cell type that may have unique proliferative and regenerative competence, but no molecular markers are [...] Read more.

Adult hearts are characterized by inefficient regeneration after injury, thus, the features that support or prevent cardiomyocyte (CM) proliferation are important to clarify. Diploid CMs are a candidate cell type that may have unique proliferative and regenerative competence, but no molecular markers are yet known that selectively identify all or subpopulations of diploid CMs. Here, using the conduction system expression marker Cntn2-GFP and the conduction system lineage marker Etv1Cre^ERT2, we demonstrate that Purkinje CMs that comprise the adult ventricular conduction system are disproportionately diploid (33%, vs. 4% of bulk ventricular CMs). These, however, represent only a small proportion (3%) of the total diploid CM population. Using EdU incorporation during the first postnatal week, we demonstrate that bulk diploid CMs found in the later heart enter and complete the cell cycle during the neonatal period. In contrast, a significant fraction of conduction CMs persist as diploid cells from fetal life and avoid neonatal cell cycle activity. Despite their high degree of diploidy, the Purkinje lineage had no enhanced competence to support regeneration after adult heart infarction. Full article

(This article belongs to the Special Issue Cardiac Development, Regeneration and Repair)

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10 pages, 266 KiB

Open AccessArticle

Prognostic Implication of Preoperative Anemia in Redo Cardiac Surgery: A Single-Center Propensity-Matched Analysis

by Antonino Salvatore Rubino, Luca Salvatore De Santo, Antonio Pio Montella, Caterina Golini Petrarcone, Lucrezia Palmieri, Denise Galbiati, Nicola Galdieri and Marisa De Feo

J. Cardiovasc. Dev. Dis. 2023, 10(4), 160; https://doi.org/10.3390/jcdd10040160 - 06 Apr 2023

Cited by 1 | Viewed by 1158

Abstract

Preoperative anemia has been associated with increased morbidity and mortality after cardiac surgery, but little is known about its prognostic value in the setting of redo procedure. A retrospective, observational cohort study of prospectively collected data was undertaken on 409 consecutive patients referred [...] Read more.

Preoperative anemia has been associated with increased morbidity and mortality after cardiac surgery, but little is known about its prognostic value in the setting of redo procedure. A retrospective, observational cohort study of prospectively collected data was undertaken on 409 consecutive patients referred for redo cardiac procedures between January 2011 and December 2020. The EuroSCORE II calculated an average mortality risk of 25.7 ± 15.4%. Selection bias was assessed with the propensity-adjustment method. The prevalence of preoperative anemia was 41%. In unmatched analysis, significant differences between the anemic and nonanemic groups emerged in the risk for postoperative stroke (0.6% vs. 4.4%, p = 0.023), postoperative renal dysfunction (29.7% vs. 15.6%, p = 0.001), a need for prolonged ventilation (18.1% vs. 7.2%, p = 0.002), and high-dosage inotropes (53.1% vs. 32.9%, p < 0.001) along with both length of ICU and hospital stay (8.2 ± 15.9 vs. 4.3 ± 5.4 days, p = 0.003 and 18.8 ± 17.4 vs. 14.9 ± 11.1, p = 0.012). After propensity matching (145 pairs), preoperative anemia was still significantly associated with postoperative renal dysfunction, stroke, and the need for high-dosage inotrope cardiac morbidity. Preoperative anemia is significantly associated with acute kidney injury, stroke, and the need for high-dosage inotropes in patients referred for redo procedures. Full article

(This article belongs to the Section Cardiac Surgery)

12 pages, 2546 KiB

Open AccessEditor’s ChoiceReview

Moderator Band and Ventricular Tachycardia: Structural or Functional Substrate?

by Federico Landra, Carmine Marallo, Amato Santoro, Simone Taddeucci, Maria Cristina Tavera, Claudia Baiocchi and Alberto Palazzuoli

J. Cardiovasc. Dev. Dis. 2023, 10(4), 159; https://doi.org/10.3390/jcdd10040159 - 06 Apr 2023

Viewed by 4124

Abstract

The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated [...] Read more.

The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated in the genesis of life-threatening arrhythmias. However, right Purkinje network arrhythmias have been much less reported in the literature compared to the left counterpart. The MB has unique anatomical and electrophysiological properties, which may account for its arrhythmogenicity and may be responsible for a significant portion of idiopathic ventricular fibrillation. MB embodies autonomic nervous system cells, with important implications in arrhythmogenesis. Some idiopathic ventricular arrhythmias, defined as the absence of any identifiable structural heart disorder, can begin from this site. Due to these complex structural and functional peculiarities strictly interplayed each other, it is arduous to determine the precise mechanism underlying MB arrhythmias. MB-related arrhythmias should be differentiated from other right Purkinje fibers arrhythmias because of the opportunity for intervention and the unusual site for the ablation poorly described in the literature. In the current paper, we report the characteristics and electrical properties of the MB, their involvement in arrhythmogenesis, clinical and electrophysiological peculiarities of MB-related arrhythmias, and current treatment options. Full article

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)

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20 pages, 3840 KiB

Open AccessSystematic Review

Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Comprehensive Systematic Literature Review and Meta-Analyses

by Vittoria Ardito, Lilit Sarucanian, Carla Rognoni, Marina Pieri, Anna Mara Scandroglio and Rosanna Tarricone

J. Cardiovasc. Dev. Dis. 2023, 10(4), 158; https://doi.org/10.3390/jcdd10040158 - 05 Apr 2023

Cited by 1 | Viewed by 2738

Abstract

Impella and VA-ECMO are two possible therapeutic courses for the treatment of patients with cardiogenic shock (CS). The study aims to perform a systematic literature review and meta-analyses of a comprehensive set of clinical and socio-economic outcomes observed when using Impella or VA-ECMO [...] Read more.

Impella and VA-ECMO are two possible therapeutic courses for the treatment of patients with cardiogenic shock (CS). The study aims to perform a systematic literature review and meta-analyses of a comprehensive set of clinical and socio-economic outcomes observed when using Impella or VA-ECMO with patients under CS. A systematic literature review was performed in Medline, and Web of Science databases on 21 February 2022. Nonoverlapping studies with adult patients supported for CS with Impella or VA-ECMO were searched. Study designs including RCTs, observational studies, and economic evaluations were considered. Data on patient characteristics, type of support, and outcomes were extracted. Additionally, meta-analyses were performed on the most relevant and recurring outcomes, and results shown using forest plots. A total of 102 studies were included, 57% on Impella, 43% on VA-ECMO. The most common outcomes investigated were mortality/survival, duration of support, and bleeding. Ischemic stroke was lower in patients treated with Impella compared to the VA-ECMO population, with statistically significant difference. Socio-economic outcomes including quality of life or resource use were not reported in any study. The study highlighted areas where further data collection is needed to clarify the value of complex, new technologies in the treatment of CS that will enable comparative assessments focusing both on the health impact on patient outcomes and on the financial burden for government budgets. Future studies need to fill the gap to comply with recent regulatory updates at the European and national levels. Full article

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11 pages, 2289 KiB

Open AccessArticle

Early and Mid-Term Outcomes of Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement: Updated Systematic Review and Meta-Analysis

by Tsahi T. Lerman, Amos Levi, Yeela Talmor-Barkan and Ran Kornowski

J. Cardiovasc. Dev. Dis. 2023, 10(4), 157; https://doi.org/10.3390/jcdd10040157 - 05 Apr 2023

Cited by 1 | Viewed by 1597

Abstract

(1) Background: The use of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis is expanding significantly. We aimed to perform a meta-analysis comparing the safety and efficacy of TAVI versus surgical aortic valve replacement (SAVR) during the early [...] Read more.

(1) Background: The use of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis is expanding significantly. We aimed to perform a meta-analysis comparing the safety and efficacy of TAVI versus surgical aortic valve replacement (SAVR) during the early and mid-term follow-up period. (2) Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing 1- to 2-year outcomes between TAVI and SAVR. The study protocol was preregistered in PROSPERO and the results were reported according to PRISMA guidelines. (3) Results: The pooled analysis included data from eight RCTs totaling 8780 patients. TAVI was associated with a lower risk of all-cause mortality or disabling stroke (OR 0.87, 95%CI 0.77–0.99), significant bleeding (OR 0.38, 95%CI 0.25–0.59), acute kidney injury (AKI; OR 0.53, 95%CI 0.40–0.69) and atrial fibrillation (OR 0.28, 95%CI 0.19–0.43). SAVR was associated with a lower risk of major vascular complication (MVC; OR 1.99, 95%CI 1.29–3.07) as well as permanent pacemaker implantation (PPI; OR 2.28, 95%CI 1.45–3.57). (3) Conclusions: TAVI compared with SAVR during early and mid-term follow-up was associated with a lower risk of all-cause mortality or disabling stroke, significant bleeding, AKI and atrial fibrillation; however, it was associated with a higher risk of MVC and PPI. Full article

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10 pages, 479 KiB

Open AccessArticle

Fluid Overload in Pediatric Univentricular Patients Undergoing Fontan Completion

by Victorien A. C. Luppes, Ariane Willems, Mark G. Hazekamp, Nico A. Blom and Arend D. J. Ten Harkel

J. Cardiovasc. Dev. Dis. 2023, 10(4), 156; https://doi.org/10.3390/jcdd10040156 - 05 Apr 2023

Viewed by 1287

Abstract

Background: Fluid overload (FO) is known to occur frequently after pediatric cardiac surgery and is associated with morbidity and mortality. Fontan patients are at risk to develop FO due to their critical fluid balance. Furthermore, they need an adequate preload in order to [...] Read more.

Background: Fluid overload (FO) is known to occur frequently after pediatric cardiac surgery and is associated with morbidity and mortality. Fontan patients are at risk to develop FO due to their critical fluid balance. Furthermore, they need an adequate preload in order to maintain adequate cardiac output. This study aimed to identify FO in patients undergoing Fontan completion and the impact of FO on pediatric intensive care unit (PICU) length of stay (LOS) and cardiac events, defined as death, cardiac re-surgery or PICU re-hospitalization during follow-up. Methods: In this retrospective single center study, the presence of FO was assessed in 43 consecutive children undergoing Fontan completion. Results: Patients with more than 5% maximum FO had an extended PICU LOS (3.9 [2.9–6.9] vs. 1.9 [1.0–2.6] days; p < 0.001) and an increased length of mechanical ventilation (21 [9–121] vs. 6 [5–10] h; p = 0.001). Regression analysis demonstrated that an increase of 1% maximum FO was associated with a prolonged PICU LOS of 13% (95% CI 1.042–1.227; p = 0.004). Furthermore, patients with FO were at higher risk to develop cardiac events. Conclusions: FO is associated with short-term and long-term complications. Further studies are needed to determine the impact of FO on the outcome in this specific population. Full article

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

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8 pages, 1794 KiB

Open AccessArticle

Treatment of Anomalous Coronary Arteries—Surgical Revascularisation Using the Pure Internal Thoracic Artery Technique

by Ramon L. James, Sudeep Das De, Sanjeet Singh Avtaar Singh, John Dreisbach, Stuart Watkins and Nawwar Al-Attar

J. Cardiovasc. Dev. Dis. 2023, 10(4), 155; https://doi.org/10.3390/jcdd10040155 - 02 Apr 2023

Viewed by 1145

Abstract

OBJECTIVES: To evaluate the use of CABG utilising an isolated pedicled Right Internal Thoracic Artery (RITA) or Left Internal Thoracic Artery (LITA) or the Pure Internal Thoracic Artery (PITA) technique to treat anomalous aortic origin of coronary artery (AAOCA). METHODS: A retrospective review [...] Read more.

OBJECTIVES: To evaluate the use of CABG utilising an isolated pedicled Right Internal Thoracic Artery (RITA) or Left Internal Thoracic Artery (LITA) or the Pure Internal Thoracic Artery (PITA) technique to treat anomalous aortic origin of coronary artery (AAOCA). METHODS: A retrospective review of all patients at our institution over an 8-year period (2013–2021) who underwent surgery for AAOCA was performed. Data assessed included patient demographics, initial presentation, morphology of coronary anomaly, surgical procedure, cross-clamp time, cardiopulmonary bypass time, and long-term outcome. RESULTS: A total of 14 patients underwent surgery, including 11 males (78.5%) with a median logistic EuroSCORE of 1.605 (IQR 1.34). The median age was 62.5 years (IQR 48.75). Presentation was angina (7 patients), acute coronary syndrome (5 patients), incidental findings in aortic valve pathology (2 patients). AAOCA morphology varied: RCA from left coronary sinus (6), RCA from left main stem (3), left coronary artery from the right coronary sinus (1), left main stem arising from right coronary sinus (2) and circumflex artery arising from the right coronary sinus (2). Overall, 7 patients had co-existing flow-limiting coronary artery disease. CABG was performed using either a pedicled skeletonized RITA, LITA or PITA technique. There was no perioperative mortality. Overall median follow-up time was 43 months. One patient presented with recurrent angina secondary to graft failure at 2 years and there were two non-cardiac-related deaths at 4 and 35 months. CONCLUSION: The use of internal thoracic artery grafts can provide a durable treatment option in patients with anomalous coronary arteries. The potential risk of graft failure in patients with no flow-limiting disease should be very carefully considered. However, a proposed benefit of this technique is the use of a pedicle flow to increase the long-term patency. More consistent results are obtained when ischaemia can be demonstrated preoperatively. Full article

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11 pages, 628 KiB

Open AccessArticle

Why Don’t More Mitochondrial Diseases Exhibit Cardiomyopathy?

by Nina Singh, Mindong Ren and Colin K. L. Phoon

J. Cardiovasc. Dev. Dis. 2023, 10(4), 154; https://doi.org/10.3390/jcdd10040154 - 01 Apr 2023

Viewed by 1279

Abstract

Background: Although the heart requires abundant energy, only 20–40% of children with mitochondrial diseases have cardiomyopathies. Methods: We looked for differences in genes underlying mitochondrial diseases that do versus do not cause cardiomyopathy using the comprehensive Mitochondrial Disease Genes Compendium. Mining additional online [...] Read more.

Background: Although the heart requires abundant energy, only 20–40% of children with mitochondrial diseases have cardiomyopathies. Methods: We looked for differences in genes underlying mitochondrial diseases that do versus do not cause cardiomyopathy using the comprehensive Mitochondrial Disease Genes Compendium. Mining additional online resources, we further investigated possible energy deficits caused by non-oxidative phosphorylation (OXPHOS) genes associated with cardiomyopathy, probed the number of amino acids and protein interactors as surrogates for OXPHOS protein cardiac “importance”, and identified mouse models for mitochondrial genes. Results: A total of 107/241 (44%) mitochondrial genes was associated with cardiomyopathy; the highest proportion were OXPHOS genes (46%). OXPHOS (p = 0.001) and fatty acid oxidation (p = 0.009) defects were significantly associated with cardiomyopathy. Notably, 39/58 (67%) non-OXPHOS genes associated with cardiomyopathy were linked to defects in aerobic respiration. Larger OXPHOS proteins were associated with cardiomyopathy (p < 0.05). Mouse models exhibiting cardiomyopathy were found for 52/241 mitochondrial genes, shedding additional insights into biological mechanisms. Conclusions: While energy generation is strongly associated with cardiomyopathy in mitochondrial diseases, many energy generation defects are not linked to cardiomyopathy. The inconsistent link between mitochondrial disease and cardiomyopathy is likely to be multifactorial and includes tissue-specific expression, incomplete clinical data, and genetic background differences. Full article

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

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J. Cardiovasc. Dev. Dis., Volume 10, Issue 4 (April 2023) – 51 articles

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