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Current Challenges and Personalized Treatment in Cardiovascular Disease

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Therapy and Drug Delivery".

Deadline for manuscript submissions: closed (10 November 2023) | Viewed by 13832

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Dr. Georgios Samanidis

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Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 356 Leoforos Syggrou, 17674 Athens, Greece
Interests: evidence based medicine; cardiac surgery; thoracic aorta diseases; heart valve diseases; minimal invasive cardiac surgery; outcomes; cardiovascular disease pathologies; cardiovascular disease treatments; biomarkers in cardiovascular disease; critical care patients
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Special Issue Information

Dear Colleagues,

Cardiovascular disease is the most common cause of death in developing and developed countries. Advanced coronary artery disease, heart valve disease, thoracic aorta disease, congenital heart disease and progressive heart failure negatively affect quality of life and reduce the survival rate of patients.

Acute aortic syndrome, including acute type A dissection, remains a life-threatening disease, even if it is treated surgically. Increasing age and the severe comorbidities of patients who are referred to hospital for the management of cardiovascular disease add additional risk factors for morbidity and mortality. On the other hand, congenital heart diseases constitute the minority of overall heart diseases, but the management of these patients is a challenge for modern cardiology and cardiac surgery. New minimally invasive cardiac surgery techniques contribute to minimizing the surgical stress of patients who undergo cardiac surgery. Newest transcatheter heart valve intervention techniques in patients with high or prohibitive risk for surgery offer an alternative therapeutic choice for these patients. Mechanical circulatory support increases survival expectancy in patients with end-stage heart failure. In addition, novel cardiovascular biomarkers offer the opportunity to predict and monitor cardiovascular disease. The personalized and targeted management of patients based on the current guidelines, innovation techniques and decisions of the heart team could offer the best results for patients with advanced cardiovascular disease.

The purpose of this Special Issue is to present the outcomes of current management and intervention techniques for patients with advanced cardiovascular diseases.

The cutting-edge researches of cardiovascular disease are minimally invasive cardiac surgery; transcatheter heart valve interventions; mechanical circulatory support; ECMO; biomarkers.

We welcome you to submit your research articles, in the form of original research articles and reviews.

Dr. Georgios Samanidis
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

evidence-based medicine
thoracic aorta diseases
minimally invasive cardiac surgery
transcatheter heart valve interventions
heart failure
ECMO
cardiac tumors
critical cardiac surgery patients
congenital heart disease
biomarkers and cardiovascular disease

Published Papers (10 papers)

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Research

Jump to: Review, Other

12 pages, 1600 KiB

Open AccessFeature PaperArticle

A Descriptive Analysis of Hybrid Cannulated Extracorporeal Life Support

by Sebastian D. Sahli, Alexander Kaserer, Julia Braun, Raed Aser, Donat R. Spahn and Markus J. Wilhelm

J. Pers. Med. 2024, 14(2), 179; https://doi.org/10.3390/jpm14020179 - 05 Feb 2024

Viewed by 723

Abstract

Background: Extracorporeal life support (ECLS) is pivotal for sustaining the function of failing hearts and lungs, and its utilization has risen. In cases where conventional cannulation strategies prove ineffective for providing adequate ECLS support, the implementation of an enhanced system with a third cannula may become necessary. Hybrid ECLS may be warranted in situations characterized by severe hypoxemia of the upper extremity, left ventricular congestion, and dilatation. Additionally, it may also be considered for patients requiring respiratory support or experiencing hemodynamic instability. Method: All hybrid ECLS cases of adults at the University Hospital Zurich, Switzerland, between January 2007 and December 2019 with initial triple cannulation were included. Data were collected via a retrospective review of patient records and direct export of the clinical information system. Results: 28 out of 903 ECLS cases were initially hybrid cannulated (3.1%). The median age was 57 (48.2 to 60.8) years, and the sex was equally distributed. The in-hospital mortality of hybrid ECLS was high (67.9%). In-hospital mortality rates differ depending on the indication (ARDS: 36.4%, refractory cardiogenic shock: 88.9%, cardiopulmonary resuscitation: 100%, post-cardiotomy: 100%, others: 75%). Survivors exhibited a lower SAPS II level compared with non-survivors (20.0 (12.0 to 65.0) vs. 55.0 (45.0 to 73.0)), and the allogenic transfusion of platelet concentrate was observed to be less frequent for survivors (0.0 (0.0) vs. 1.8 (2.5) units). Conclusion: The in-hospital mortality rate for hybrid ECLS was high. Different indications showed varying mortality rates, with survivors having lower SAPS II scores and requiring fewer platelet concentrate transfusions. These findings highlight the complexities of hybrid ECLS outcomes in different clinical scenarios and underline the importance of rigorous patient selection. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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9 pages, 882 KiB

Open AccessArticle

Resolved Proteinuria May Attenuate the Risk of Heart Failure: A Nationwide Population-Based Cohort Study

by Yoonkyung Chang, Min Kyoung Kang, Moo-Seok Park, Gwang-Hyun Leem and Tae-Jin Song

J. Pers. Med. 2023, 13(12), 1662; https://doi.org/10.3390/jpm13121662 - 28 Nov 2023

Viewed by 584

Abstract

Although proteinuria is a risk factor for heart failure (HF), proteinuria can be reversible or persistent. Our objective was to explore the link between changes in the proteinuria status and the risk of HF. We included participants from a Korean national health screening cohort who underwent health examinations in 2003–2004 and 2005–2006 and had no history of HF. Participants were categorized into four groups: proteinuria-free, proteinuria-resolved, proteinuria-developed, and proteinuria-persistent. The outcome of interest was the occurrence of HF. The study included 1,703,651 participants, among whom 17,543 (1.03%) were in the proteinuria-resolved group and 4585 (0.27%) were in the proteinuria-persistent group. After a median follow-up period of 14.04 years (interquartile range 14.19–15.07), HF occurred in 75,064 (4.41%) participants. A multivariable Cox proportional hazards regression analysis indicated that the proteinuria-persistent group had a higher risk of HF compared with the proteinuria-free group (hazard ratio (HR): 2.19, 95% confidence interval (CI): 2.03–2.36, p < 0.001). In a further pairwise comparison analysis, participants in the proteinuria-resolved group had a relatively low risk of HF compared with those in the proteinuria-persistent group (HR: 0.64, 95% CI: 0.58–0.70, p < 0.001). In conclusion, the risk of HF can change with alterations in the proteinuria status. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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15 pages, 815 KiB

Open AccessArticle

Positivity and Health Locus of Control: Key Variables to Intervene on Well-Being of Cardiovascular Disease Patients

by Bárbara Luque, Naima Z. Farhane-Medina, Marta Villalba, Rosario Castillo-Mayén, Esther Cuadrado and Carmen Tabernero

J. Pers. Med. 2023, 13(5), 873; https://doi.org/10.3390/jpm13050873 - 22 May 2023

Cited by 1 | Viewed by 1153

Abstract

Psychological well-being is a good predictor of several health outcomes in cardiovascular disease patients (adherence, quality of life, and healthy behaviors). The perception of health control and a positive orientation seem to have a beneficial effect on health and well-being. Therefore, the aim of this study was to investigate the role of the health locus of control and positivity in the psychological well-being and quality of life of cardiovascular patients. A total of 593 cardiac outpatients completed the Multidimensional Health Locus of Control Scale, the Positivity Scale and the Hospital Anxiety and Depression Scale at baseline (January 2017) and 9 m later (follow-up; n = 323). A Spearman rank correlation coefficient and a structural equation modeling approach were determined to explore the relationships between those variables both cross-sectionally and longitudinally. A cross-sectional correlation analysis at baseline revealed that the internal health locus of control and positivity were negatively associated with anxiety (r_s = −0.15 and −0.44, ps < 0.01) and depression (r_s = −0.22 and −0.55, ps < 0.01) and positively associated with health-related quality of life (r_s = 0.16 and 0.46, ps < 0.01). Similar outcomes were found at follow-up and in longitudinal correlations. According to the path analysis, positivity was found to be negatively associated with anxiety and depression level at baseline (β = −0.42 and −0.45, ps < 0.001). Longitudinally, positivity was negatively associated with depression (β = 0.15, p < 0.01) and together with the internal health locus of control, was positively associated with health-related quality of life (β = 0.16 and 0.10, respectively, ps < 0.05). These findings suggest that focusing on the health locus of control and especially positivity may be crucial in enhancing the psychological well-being of patients in the context of cardiac care. The potential impact of these results on future interventions is discussed. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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11 pages, 1015 KiB

Open AccessFeature PaperArticle

Depression and Anxiety in Heart Transplant Recipients: Prevalence and Impact on Post-Transplant Outcomes

by Emyal Alyaydin, Juergen Reinhard Sindermann, Jeanette Köppe, Joachim Gerss, Patrik Dröge, Thomas Ruhnke, Christian Günster, Holger Reinecke and Jannik Feld

J. Pers. Med. 2023, 13(5), 844; https://doi.org/10.3390/jpm13050844 - 17 May 2023

Viewed by 1527

Abstract

Background: Depression and anxiety (DA) are common mental disorders in patients with chronic diseases, but the research regarding their prevalence in heart transplantation (HTx) is still limited. Methods: We performed an analysis of the prevalence and prognostic relevance of DA in patients who underwent HTx between 2010 and 2018 in Germany. Data were obtained from Allgemeine Ortskrankenkasse (AOK), which is the largest public health insurance provider. Results: Overall, 694 patients were identified. More than a third of them were diagnosed with DA before undergoing HTx (n = 260, 37.5%). Patients with DA more often had an ischaemic cardiomyopathy (p < 0.001) and a history of previous myocardial infarction (p = 0.001) or stroke (p = 0.002). The prevalence of hypertension (p < 0.001), diabetes (p = 0.004), dyslipidaemia (p < 0.001) and chronic kidney disease (p = 0.003) was higher amongst transplant recipients with DA. Patients with DA were more likely to suffer an ischaemic stroke (p < 0.001) or haemorrhagic stroke (p = 0.032), or develop septicaemia (p = 0.050) during hospitalisation for HTx. Our analysis found no significant differences between the groups with respect to in-hospital mortality. The female sex and mechanical circulatory support were associated with an inferior prognosis. Pretransplant non-ischaemic cardiomyopathy was related to a favourable outcome. Conclusions: DA affect up to a third of the population undergoing HTx, with a greater prevalence in patients with comorbidities. DA are associated with a higher incidence of stroke and septicaemia after HTx. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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15 pages, 889 KiB

Open AccessArticle

Stroke Risk in Young Women with Primary Dysmenorrhea: A Propensity-Score-Matched Retrospective Cohort Study

by Chung-Hsin Yeh, Fung-Chang Sung, Chih-Hsin Muo, Pao-Sheng Yen and Chung Y. Hsu

J. Pers. Med. 2023, 13(1), 114; https://doi.org/10.3390/jpm13010114 - 04 Jan 2023

Viewed by 1474

Abstract

Background: Studies on strokes associated with dysmenorrhea are limited. We conducted a propensity-score-matched retrospective cohort study to assess the risk of stroke in women with primary dysmenorrhea (PD). Methods: From the claims data of one million people in Taiwan’s insurance program, we identified 18,783 women aged 15–40 years, newly diagnosed with PD in 2000–2010, without a history of stroke. We randomly selected a comparison cohort without stroke history and dysmenorrhea, with the same sample size matched by age, index date, and propensity score. We began a follow-up with individuals one year after cohort entry to the end of 2013 to capture stroke events. Results: The two study cohorts were well-matched for age and comorbidities, with 54% of women aged 15–24. Stroke incidence was 1.5-fold higher in the PD cohort than in the comparison cohort (6.05 vs. 4.01 per 10,000 person-years, or 99 vs. 65 cases), with an adjusted hazard ratio (aHR) of 1.51 (95%CI 1.11–2.06) after adjustment for matched pairs. Nearly 70% of strokes were ischemic strokes, which occurred 1.6 times more frequently in the PD cohort than in the comparison cohort (4.40 vs. 2.71 per 10,000 person-years, or 72 vs. 44 cases), aHR = 1.61 (95% CI 1.11–2.33), after adjustment for matched pairs. The incidence of hemorrhagic stroke was also higher in the PD cohort than in the comparison cohort (1.65 vs. 1.29 per 10,000 person-years, or 27 versus 21 cases), but the difference was not significant. Conclusion: Women of reproductive age with PD are at increased risk for ischemic stroke. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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9 pages, 257 KiB

Open AccessArticle

Risk Factors for Acute Postoperative Delirium in Cardiac Surgery Patients >65 Years Old

by Eleni Spiropoulou, George Samanidis, Meletios Kanakis and Ioannis Nenekidis

J. Pers. Med. 2022, 12(9), 1529; https://doi.org/10.3390/jpm12091529 - 18 Sep 2022

Cited by 3 | Viewed by 1909

Abstract

Background: Acute postoperative delirium is the most common neuropsychiatric disorder in cardiac surgery patients in the intensive care unit (ICU). The purpose of this study was to evaluate the possible risk factors of postoperative delirium (POD) for cardiac surgery patients in the ICU. Materials and Methods: The study population was composed of 86 cardiac surgery patients managed postoperatively in the cardiac surgery ICU. Presence of POD in patients was evaluated by the CAM-ICU scale. Results: According to the CAM-ICU scale, 22 (25.6%) patients presented POD; history of smoking, alcohol use, COPD, and preoperative permanent atrial fibrillation were associated with POD (for all, p < 0.05). The type of cardiac surgery operations, type of analgesia, and red blood cell transfusion in the ICU were not associated with POD (p > 0.05), while cardiac arrhythmia in the ICU, hypoxemia in the ICU after extubation (pO₂ < 60 mmHg), and heart rate after extubation were predisposing factors for POD (for all, p < 0.05). Multivariable logistic regression analysis (adjusted to risk factors) showed that hypoxemia after extubation (OR = 20.6; 95%CI: 2.82–150), heart rate after extubation (OR = 0.95; 95% CI: 0.92–0.98), and alcohol use (OR = 74.3; 95%CI: 6.41–861) were predictive factors for acute postoperative delirium (for all, p < 0.05). Conclusion: Alcohol use and respiratory dysfunction before and after heart operation were associated with acute postoperative delirium in cardiac surgery ICU patients. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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10 pages, 256 KiB

Open AccessFeature PaperReview

Outcomes after Transcatheter Mitral Valve Implantation: A Literature Review

by George Samanidis, Meletios Kanakis and Konstantinos Perreas

J. Pers. Med. 2022, 12(12), 2074; https://doi.org/10.3390/jpm12122074 - 16 Dec 2022

Viewed by 1238

Abstract

Mitral valve disease is the most common heart valve disease worldwide. Surgical mitral valve replacement or repair has been an established therapy in patients with severe mitral valve disease for many years. On the other hand, many patients with advanced mitral valve disease and severe comorbidities are treated conservatively and are excluded from the surgical procedure. Furthermore, in patients with severe comorbidities, transcatheter mitral valve repair by edge-to-edge technique with MitraClip or transcatheter mitral valve repair with a non-absorbable ring have been added as therapeutic options over the last few years. Alternative procedures for the treatment of patients with advanced prosthetic or native mitral valve diseases include transcatheter access for replacement or implantation of a new prosthetic valve in the diseased mitral valve. Promising results were published about short-term outcomes of patients who underwent the transcatheter mitral valve replacement. The current view and results of the transcatheter mitral valve implantation in patients with advanced native or prosthetic mitral valve disease are briefly discussed. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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9 pages, 869 KiB

Open AccessBrief Report

The Role of Myocardial Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events at 1 Year Follow-Up: A Single Center’s Experience

by Paraskevi Zotou, Aris Bechlioulis, Spyridon Tsiouris, Katerina K. Naka, Xanthi Xourgia, Konstantinos Pappas, Lampros Lakkas, Aidonis Rammos, John Kalef-Ezra, Lampros K. Michalis and Andreas Fotopoulos

J. Pers. Med. 2023, 13(5), 871; https://doi.org/10.3390/jpm13050871 - 22 May 2023

Viewed by 916

Abstract

Background: Myocardial perfusion imaging via single-photon emission computed tomography (SPECT MPI) is a well-established method of diagnosing coronary artery disease (CAD). The purpose of this study was to assess the role of SPECT MPI in predicting major cardiovascular events. Methods: The study population was composed of 614 consecutive patients (mean age: 67 years, 55% male) referred for SPECT MPI due to symptoms of stable CAD. The SPECT MPI was performed using a single-day protocol. We conducted a follow-up on all patients at 12 months via a telephone interview. Results: The majority of our patients (78%) presented findings suggestive of reversible ischemia, fixed defects or both. Extensive perfusion defects were found in 18% of the population, while LV dilation was found in 7%. During the 12-month follow-up, 16 deaths, 8 non-fatal MIs and 20 non-fatal strokes were recorded. There was no significant association of SPECT findings with the combined endpoint of all-cause death, non-fatal MI and non-fatal stroke. The presence of extensive perfusion defects was an independent predictor of mortality at 12 months (HR: 2.90, 95% CI: 1.05, 8.06, p = 0.041). Conclusions: In a high-risk patient population with suspected stable CAD, only large reversible perfusion defects in SPECT MPI were independently associated with mortality at 1 year. Further trials are needed to validate our findings and refine the role of SPECT MPI findings in the diagnosis and prognosis of cardiovascular patients. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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9 pages, 778 KiB

Open AccessBrief Report

A Comparative Study to Investigate the Effects of Bisoprolol in Patients with Chronic Heart Failure and Hypertension When Switched from Tablets to Transdermal Patches

by Akira Sezai, Hisakuni Sekino, Makoto Taoka, Shunji Osaka and Masashi Tanaka

J. Pers. Med. 2023, 13(5), 785; https://doi.org/10.3390/jpm13050785 - 01 May 2023

Viewed by 1870

Abstract

Background: Oral beta-blockers are effective for heart failure and hypertension. Here, we conducted a prospective study to investigate the efficacy of the beta-blocker bisoprolol in patients switching from the oral tablet to the transdermal patch. Methods: We studied 50 outpatients receiving oral bisoprolol for chronic heart failure and hypertension. After patients switched treatments, we measured heart rate (HR) over 24 h by Holter echocardiography as the primary endpoint. Secondary endpoints were (1) HR at 00:00, 06:00, 12:00, and 18:00, (2) the total number of premature atrial contractions (PACs) over 24 h and the incidence rate per time segment, and the total number of premature ventricular contractions (PVCs) over 24 h and the incidence rate per time segment, (3) blood pressure, (4) atrial natriuretic peptide and B-type natriuretic peptide, and (5) echocardiography. Results: Minimum, maximum, mean, and total HR over 24 h was not significantly different between the two groups. Mean and maximum HR at 06:00, total PACs, total PVCs, and PVCs at 00:00 to 05:59 and 06:00 to 11:59 were significantly lower in the patch group. Conclusion: Compared with oral bisoprolol, the bisoprolol transdermal patch lowers HR at 06:00 and inhibits the onset of PVCs during sleep and in the morning. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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14 pages, 593 KiB

Open AccessSystematic Review

Cerebral Aneurysms Caused by Atrial Myxoma—A Systematic Review of the Literature

by Justyna Chojdak-Łukasiewicz, Sławomir Budrewicz and Marta Waliszewska-Prosół

J. Pers. Med. 2023, 13(1), 8; https://doi.org/10.3390/jpm13010008 - 21 Dec 2022

Cited by 4 | Viewed by 1489

Abstract

Background: The association between cerebral aneurysms and left atrial myxoma is known but rare. We described its pathogenesis, clinical presentation, diagnostic findings and treatment using a systemic review of the literature. Methods: MEDLINE via PubMed was searched for articles published until August 2022 using the keywords “atrial myxoma”, “cardiac myxoma” and “cerebral aneurysm”. Results: In this review, 55 patients with multiple myxomas aneurysms were analyzed, and 65% were women. The average age when aneurysms were diagnosed was 42.5 ± 15.81; most patients were less than 60 years old (86%). Aneurysms could be found before the diagnosis, at the same time as cardiac myxoma, or even 25 years after resection of the atrial mass. In our review, the mean time to diagnoses was 4.5 years. Our review estimates that the most common symptoms were vascular incidents (25%) and seizures (14.3%). In 15 cases, variable headaches were reported. Regarding management strategies, 57% cases were managed conservatively as the primary choice. Conclusions: Although cerebral aneurysms caused by atrial myxoma are rare, the long-term consequences can be serious and patients should be monitored. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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