Review

15 pages, 2600 KiB

Open AccessReview

Right Ventricular Function in Arrhythmogenic Right Ventricular Cardiomyopathy: Potential Value of Strain Echocardiography

by Caroline Løkke Bjerregaard, Tor Biering-Sørensen, Kristoffer Grundtvig Skaarup, Morten Sengeløv, Mats Christian Højbjerg Lassen, Niklas Dyrby Johansen and Flemming Javier Olsen

J. Clin. Med. 2024, 13(3), 717; https://doi.org/10.3390/jcm13030717 - 26 Jan 2024

Viewed by 1024

Abstract

Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy, characterized by abnormal cell adhesions, disrupted intercellular signaling, and fibrofatty replacement of the myocardium. These changes serve as a substrate for ventricular arrhythmias, placing patients at risk of sudden cardiac death, even in the early [...] Read more.

Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy, characterized by abnormal cell adhesions, disrupted intercellular signaling, and fibrofatty replacement of the myocardium. These changes serve as a substrate for ventricular arrhythmias, placing patients at risk of sudden cardiac death, even in the early stages of the disease. Current echocardiographic criteria for diagnosing arrhythmogenic right ventricular cardiomyopathy lack sensitivity, but novel markers of cardiac deformation are not subject to the same technical limitations as current guideline-recommended measures. Measuring cardiac deformation using speckle tracking allows for meticulous quantification of global systolic function, regional function, and dyssynchronous contraction. Consequently, speckle tracking to quantify myocardial strain could potentially be useful in the diagnostic process for the determination of disease progression and to assist risk stratification for ventricular arrhythmias and sudden cardiac death. This narrative review provides an overview of the potential use of different myocardial right ventricular strain measures for characterizing right ventricular dysfunction in arrhythmogenic right ventricular cardiomyopathy and its utility in assessing the risk of ventricular arrhythmias. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

► Show Figures

Figure 1

24 pages, 4700 KiB

Open AccessReview

Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis

by Giuseppe Uccello, Giacomo Bonacchi, Valentina Alice Rossi, Giulia Montrasio and Matteo Beltrami

J. Clin. Med. 2024, 13(1), 150; https://doi.org/10.3390/jcm13010150 - 27 Dec 2023

Viewed by 1663

Abstract

Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term “chronic inflammatory cardiomyopathy” describes a persistent/chronic inflammatory condition with [...] Read more.

Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term “chronic inflammatory cardiomyopathy” describes a persistent/chronic inflammatory condition with a clinical phenotype of dilated and/or hypokinetic cardiomyopathy associated with symptoms of heart failure and increased risk for arrhythmias. A continuum can be identified between these two conditions. The importance of early diagnosis has grown markedly in the contemporary era with various diagnostic tools available. While cardiac magnetic resonance (CMR) is valid for diagnosis and follow-up, endomyocardial biopsy (EMB) should be considered as a first-line diagnostic modality in all unexplained acute cardiomyopathies complicated by hemodynamic instability and ventricular arrhythmias, considering the local expertise. Genetic counseling should be recommended in those cases where a genotype–phenotype association is suspected, as this has significant implications for patients’ and their family members’ prognoses. Recognition of the pathophysiological pathway and clinical “red flags” and an early diagnosis may help us understand mechanisms of progression, tailor long-term preventive and therapeutic strategies for this complex disease, and ultimately improve clinical outcomes. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

► Show Figures

Figure 1

23 pages, 351 KiB

Open AccessReview

Congestion in Heart Failure: From the Secret of a Mummy to Today’s Novel Diagnostic and Therapeutic Approaches: A Comprehensive Review

by Ioannis Alevroudis, Serafeim-Chrysovalantis Kotoulas, Stergios Tzikas and Vassilios Vassilikos

J. Clin. Med. 2024, 13(1), 12; https://doi.org/10.3390/jcm13010012 - 19 Dec 2023

Cited by 5 | Viewed by 822

Abstract

This review paper presents a review of the evolution of this disease throughout the centuries, describes and summarizes the pathophysiologic mechanisms, briefly discusses the mechanism of action of diuretics, presents their role in decongesting heart failure in patients, and reveals the data behind [...] Read more.

This review paper presents a review of the evolution of this disease throughout the centuries, describes and summarizes the pathophysiologic mechanisms, briefly discusses the mechanism of action of diuretics, presents their role in decongesting heart failure in patients, and reveals the data behind ultrafiltration in the management of acutely or chronically decompensated heart failure (ADHF), focusing on all the available data and advancements in this field. Acutely decompensated heart failure (ADHF) presents a critical clinical condition characterized by worsening symptoms and signs of heart failure, necessitating prompt intervention to alleviate congestion and improve cardiac function. Diuretics have traditionally been the mainstay for managing fluid overload in ADHF. Mounting evidence suggests that due to numerous causes, such as coexisting renal failure or chronic use of loop diuretics, an increasing rate of diuretic resistance is noticed and needs to be addressed. There has been a series of trials that combined diuretics of different categories without the expected results. Emerging evidence suggests that ultrafiltration may offer an alternative or adjunctive approach. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

18 pages, 352 KiB

Open AccessReview

Obstructive Sleep Apnea and Smoking Increase the Risk of Cardiovascular Disease: Smoking Cessation Pharmacotherapy

by Athanasia Pataka, Serafeim-Chrysovalantis Kotoulas, Aliki Karkala, Asterios Tzinas, George Kalamaras, Nectaria Kasnaki, Evdokia Sourla and Emiliza Stefanidou

J. Clin. Med. 2023, 12(24), 7570; https://doi.org/10.3390/jcm12247570 - 08 Dec 2023

Viewed by 949

Abstract

Tobacco smoking has been a recognized risk factor for cardiovascular diseases (CVD). Smoking is a chronic relapsing disease and pharmacotherapy is a main component of smoking cessation. Obstructive sleep apnea (OSA) and smoking both increase the risk of CVD and are associated with [...] Read more.

Tobacco smoking has been a recognized risk factor for cardiovascular diseases (CVD). Smoking is a chronic relapsing disease and pharmacotherapy is a main component of smoking cessation. Obstructive sleep apnea (OSA) and smoking both increase the risk of CVD and are associated with significant morbidity and mortality. There are few existing data examining how pharmacological treatment, such as nicotine replacement therapy (NRT), bupropion, and varenicline, affect smokers suffering with OSA and especially their cardiovascular effects. The aim of this review was to evaluate the effects of smoking cessation pharmacotherapy on OSA with a special emphasis on the cardiovascular system. Results: Only small studies have assessed the effect of NRTs on OSA. Nicotine gum administration showed an improvement in respiratory events but with no permanent results. No specific studies were found on the effect of bupropion on OSA, and a limited number evaluated varenicline’s effects on sleep and specifically OSA. Varenicline administration in smokers suffering from OSA reduced the obstructive respiratory events, especially during REM. Studies on second-line medication (nortriptyline, clonidine, cytisine) are even more limited. There are still no studies evaluating the cardiovascular effects of smoking cessation medications on OSA patients. Conclusions: Sleep disturbances are common withdrawal effects during smoking cessation but could be also attributed to pharmacotherapy. Smokers should receive personalized treatment during their quitting attempts according to their individual needs and problems, including OSA. Future studies are needed in order to evaluate the efficacy and safety of smoking cessation medications in OSA patients. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

19 pages, 1977 KiB

Open AccessReview

How Imaging Techniques Improve Ventricular Arrhythmia Ablation: A Multimodality-Based Approach

by Antonio Gianluca Robles, Matevž Jan, Tine Prolič Kalinšek, Bor Antolič, Martin Rauber, Luka Klemen, Matjaž Šinkovec, Silvio Romano, Luigi Sciarra and Andrej Pernat

J. Clin. Med. 2023, 12(23), 7420; https://doi.org/10.3390/jcm12237420 - 30 Nov 2023

Viewed by 892

Abstract

Although implantable cardioverter defibrillators offer the best protection against sudden cardiac death, catheter ablation for ventricular arrhythmias (VAs) can modify or prevent this event from occurring. In order to achieve a successful ablation, the correct identification of the underlying arrhythmogenic substrate is mandatory [...] Read more.

Although implantable cardioverter defibrillators offer the best protection against sudden cardiac death, catheter ablation for ventricular arrhythmias (VAs) can modify or prevent this event from occurring. In order to achieve a successful ablation, the correct identification of the underlying arrhythmogenic substrate is mandatory to tailor the pre-procedural planning of an ablative procedure as appropriately as possible. We propose that several of the imaging modalities currently used could be merged, including echocardiography (also intracardiac), cardiac magnetic resonance, cardiac computed tomography, nuclear techniques, and electroanatomic mapping. The aim of this state-of-the-art review is to present the value of each modality, that is, its benefits and limitations, in the assessment of arrhythmogenic substrate. Moreover, VAs can be also idiopathic, and in this paper we will underline the role of these techniques in facilitating the ablative procedure. Finally, a hands-on workflow for approaching such a VA and future perspectives will be presented. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

► Show Figures

Figure 1

22 pages, 12034 KiB

Open AccessReview

From Crafoord’s End-to-End Anastomosis Approach to Percutaneous Interventions: Coarctation of the Aorta Management Strategies and Reinterventions

by Corina Maria Vasile, Gerald Laforest, Cristian Bulescu, Zakaria Jalal, Jean-Benoit Thambo and Xavier Iriart

J. Clin. Med. 2023, 12(23), 7350; https://doi.org/10.3390/jcm12237350 - 27 Nov 2023

Viewed by 849

Abstract

First described in 1760 by the anatomist Morgagni, coarctation of the aorta (CoA) is a congenital heart defect characterized by narrowing the aorta, typically distal to the left subclavian artery. It accounts for approximately 5–8% of all congenital heart diseases, with an incidence [...] Read more.

First described in 1760 by the anatomist Morgagni, coarctation of the aorta (CoA) is a congenital heart defect characterized by narrowing the aorta, typically distal to the left subclavian artery. It accounts for approximately 5–8% of all congenital heart diseases, with an incidence estimated at 4 per 10,000 live births. In 1944, the Swedish surgeon Clarence Crafoord achieved the first successful surgical CoA repair by performing an aortic end-to-end anastomosis on two patients aged 12 and 27 years old. Presently, the most prevalent techniques for surgical repair, particularly in infants and neonates with isolated coarctation, involve resection with end-to-end anastomosis (EEA) and the modified Crafoord technique (extended resection with end-to-end anastomosis (EEEA)). Subclavian flap aortoplasty (SCAP) is an alternative surgical option for CoA repair in patients under two years of age. In cases where the stenosis extends beyond resection and end-to-end anastomosis feasibility, patch aortoplasty (PP) employing a prosthetic patch can augment the stenotic region, especially for older patients. Despite advances in pediatric cardiology and cardiac surgery, recoarctation remains a significant concern after surgical or interventional repair. This comprehensive review aims to provide a thorough analysis of coarctation management, covering the pioneering techniques introduced by Crafoord using end-to-end anastomosis and now extending to the contemporary era marked by percutaneous interventions as well as the recoarctation rate associated with each type. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

► Show Figures

Graphical abstract

17 pages, 1724 KiB

Open AccessReview

The RAAS Goodfellas in Cardiovascular System

by Ilaria Caputo, Giovanni Bertoldi, Giulia Driussi, Martina Cacciapuoti and Lorenzo A. Calò

J. Clin. Med. 2023, 12(21), 6873; https://doi.org/10.3390/jcm12216873 - 31 Oct 2023

Cited by 3 | Viewed by 950

Abstract

In the last two decades, the study of the renin–angiotensin–aldosterone system (RAAS) has revealed a counterregulatory protective axis. This protective arm is characterized by ACE2/Ang 1-7/MasR and Ang 1-9 that largely counteracts the classic arm of the RAAS mediated by ACE/Ang II/AT1R/aldosterone and [...] Read more.

In the last two decades, the study of the renin–angiotensin–aldosterone system (RAAS) has revealed a counterregulatory protective axis. This protective arm is characterized by ACE2/Ang 1-7/MasR and Ang 1-9 that largely counteracts the classic arm of the RAAS mediated by ACE/Ang II/AT1R/aldosterone and plays an important role in the prevention of inflammation, oxidative stress, hypertension, and cardiovascular remodeling. A growing body of evidence suggests that enhancement of this counterregulatory arm of RAAS represents an important therapeutic approach to facing cardiovascular comorbidities. In this review, we provide an overview of the beneficial effects of ACE2, Ang 1-7/MasR, and Ang 1-9 in the context of oxidative stress, vascular dysfunction, and organ damage. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

► Show Figures

Figure 1

15 pages, 1841 KiB

Open AccessReview

The Sympathetic Nervous System in Hypertensive Heart Failure with Preserved LVEF

by Filippos Triposkiadis, Alexandros Briasoulis, Pantelis Sarafidis, Dimitrios Magouliotis, Thanos Athanasiou, Ioannis Paraskevaidis, John Skoularigis and Andrew Xanthopoulos

J. Clin. Med. 2023, 12(20), 6486; https://doi.org/10.3390/jcm12206486 - 12 Oct 2023

Cited by 2 | Viewed by 1528

Abstract

The neurohormonal model of heart failure (HF) pathogenesis states that a reduction in cardiac output caused by cardiac injury results in sympathetic nervous system (SNS) activation, that is adaptive in the short-term and maladaptive in the long-term. This model has proved extremely valid [...] Read more.

The neurohormonal model of heart failure (HF) pathogenesis states that a reduction in cardiac output caused by cardiac injury results in sympathetic nervous system (SNS) activation, that is adaptive in the short-term and maladaptive in the long-term. This model has proved extremely valid and has been applied in HF with a reduced left ventricular (LV) ejection fraction (LVEF). In contrast, it has been undermined in HF with preserved LVEF (HFpEF), which is due to hypertension (HTN) in the vast majority of the cases. Erroneously, HTN, which is the leading cause of cardiovascular disease and premature death worldwide and is present in more than 90% of HF patients, is tightly linked with SNS overactivity. In this paper we provide a contemporary overview of the contribution of SNS overactivity to the development and progression of hypertensive HF (HHF) as well as the clinical implications resulting from therapeutic interventions modifying SNS activity. Throughout the manuscript the terms HHF with preserved LVEF and HfpEF will be used interchangeably, considering that the findings in most HFpEF studies are driven by HTN. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

► Show Figures

Figure 1

18 pages, 2047 KiB

Open AccessFeature PaperReview

Heart Failure in Patients with Chronic Kidney Disease

by Andrew Xanthopoulos, Adamantia Papamichail, Alexandros Briasoulis, Konstantinos Loritis, Angeliki Bourazana, Dimitrios E. Magouliotis, Pantelis Sarafidis, Ioannis Stefanidis, John Skoularigis and Filippos Triposkiadis

J. Clin. Med. 2023, 12(18), 6105; https://doi.org/10.3390/jcm12186105 - 21 Sep 2023

Cited by 2 | Viewed by 1956

Abstract

The function of the kidney is tightly linked to the function of the heart. Dysfunction/disease of the kidney may initiate, accentuate, or precipitate of the cardiac dysfunction/disease and vice versa, contributing to a negative spiral. Further, the reciprocal association between the heart and [...] Read more.

The function of the kidney is tightly linked to the function of the heart. Dysfunction/disease of the kidney may initiate, accentuate, or precipitate of the cardiac dysfunction/disease and vice versa, contributing to a negative spiral. Further, the reciprocal association between the heart and the kidney may occur on top of other entities, usually diabetes, hypertension, and atherosclerosis, simultaneously affecting the two organs. Chronic kidney disease (CKD) can influence cardiac function through altered hemodynamics and salt and water retention, leading to venous congestion and therefore, not surprisingly, to heart failure (HF). Management of HF in CKD is challenging due to several factors, including complex interplays between these two conditions, the effect of kidney dysfunction on the metabolism of HF medications, the effect of HF medications on kidney function, and the high risk for anemia and hyperkalemia. As a result, in most HF trials, patients with severe renal impairment (i.e., eGFR 30 mL/min/1.73 m² or less) are excluded. The present review discusses the epidemiology, pathophysiology, and current medical management in patients with HF developing in the context of CKD. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Review Special Issue Series: Recent Advances in Cardiovascular Medicine

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (9 papers)

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI