Updates in Cardiovascular Medicine: Diagnosis, Treatment and Technical Aspects

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: closed (31 August 2023) | Viewed by 12035

Special Issue Editors


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Guest Editor
Department of Cardiology, University Hospital of Patras, 26504 Rion-Patras, Greece
Interests: coronary artery disease; platelets; anticoagulation therapy; acute coronary syndromes; radial access for coronary interventions-snuffbox access; primary prevention
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E-Mail Website
Guest Editor
1. Department of Cardiology, University Hospital of Patras, 26504 Rion-Patras, Greece
2. First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
Interests: coronary artery disease; percutaneous coronary interventions; intravascular imaging; acute coronary syndromes; antiplatelets; structural heart diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are pleased to announce our new Special Issue entitled “Updates in Cardiovascular Medicine; Diagnosis, treatment and technical aspects” for “Life”. Cardiovascular science is developing rapidly; new diagnostic approaches, novel pharmaceutical treatments and current interventional procedures have emerged in recent years. Our aim in this Special Issue is to cover all the recent advances in cardiovascular medicine, including diagnostic, interventional and technical aspects. We welcome all types of articles from all areas of Cardiovascular Medicine. Please feel free to contact with us for further information regarding submission.

Dr. Grigorios Tsigkas
Dr. Anastasios Apostolos
Guest Editors

Manuscript Submission Information

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Keywords

  • cardiology
  • cardiovascular medicine
  • interventional cardiology

Published Papers (7 papers)

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Research

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13 pages, 1625 KiB  
Article
The Potential Role of Salivary NT-proBNP in Heart Failure
by Aidonis Rammos, Aris Bechlioulis, Petros Kalogeras, Chris J. Watson, Pietro Salvo, Tommaso Lomonaco, Olga Kardakari, Evanthia E. Tripoliti, Yorgos Goletsis, Dimitris I. Fotiadis, Christos S. Katsouras, Lampros K. Michalis and Katerina K. Naka
Life 2023, 13(9), 1818; https://doi.org/10.3390/life13091818 - 28 Aug 2023
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Abstract
Background: Serum natriuretic peptides (NPs) have an established role in heart failure (HF) diagnosis. Saliva NT-proBNP that may be easily acquired has been studied little. Methods: Ninety-nine subjects were enrolled; thirty-six obese or hypertensive with dyspnoea but no echocardiographic HF findings or raised [...] Read more.
Background: Serum natriuretic peptides (NPs) have an established role in heart failure (HF) diagnosis. Saliva NT-proBNP that may be easily acquired has been studied little. Methods: Ninety-nine subjects were enrolled; thirty-six obese or hypertensive with dyspnoea but no echocardiographic HF findings or raised NPs served as controls, thirteen chronic HF (CHF) patients and fifty patients with acute decompensated HF (ADHF) requiring hospital admission. Electrocardiogram, echocardiogram, 6 min walking distance (6MWD), blood and saliva samples, were acquired in all participants. Results: Serum NT-proBNP ranged from 60–9000 pg/mL and saliva NT-proBNP from 0.64–93.32 pg/mL. Serum NT-proBNP was significantly higher in ADHF compared to CHF (p = 0.007) and in CHF compared to controls (p < 0.05). There was no significant difference in saliva values between ADHF and CHF, or between CHF and controls. Saliva and serum levels were positively associated only in ADHF patients (R = 0.352, p = 0.012). Serum NT-proBNP was positively associated with NYHA class (R = 0.506, p < 0.001) and inversely with 6MWD (R = −0.401, p = 0.004) in ADHF. Saliva NT-proBNP only correlated with age in ADHF patients. Conclusions: In the current study, saliva NT-proBNP correlated with serum values in ADHF patients, but could not discriminate between HF and other causes of dyspnoea. Further research is needed to explore the value of saliva NT-proBNP. Full article
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13 pages, 2001 KiB  
Article
Mitral Annular Calcification and Thromboembolic Risk
by Paula Cristina Morariu, Daniela Maria Tanase, Diana Elena Iov, Oana Sîrbu, Alexandru Florinel Oancea, Cornel Gabriel Mircea, Cristina Petronela Chiriac, Genoveva Livia Baroi, Ionela-Daniela Morariu, Cristina Gena Dascălu, Laurenţiu Şorodoc and Mariana Floria
Life 2023, 13(7), 1568; https://doi.org/10.3390/life13071568 - 15 Jul 2023
Cited by 1 | Viewed by 898
Abstract
Thromboembolic (TE) risk scores used for atrial fibrillation (AF) patients do not include mitral annular calcification (MAC) as a potential indicator of vascular disease. This research evaluated the correlation between MAC and TE risk scores (CHADS2 and CHA2DS2-VASc). [...] Read more.
Thromboembolic (TE) risk scores used for atrial fibrillation (AF) patients do not include mitral annular calcification (MAC) as a potential indicator of vascular disease. This research evaluated the correlation between MAC and TE risk scores (CHADS2 and CHA2DS2-VASc). We compared TE risk score values and clinical and echocardiographic data in patients with and without MAC. We included, prospectively, 103 patients: 40.8% with AF, 83.5% with hypertension, 30.1% with type II diabetes mellitus, 79.6% with chronic heart failure, and 7.8% with a history of stroke. We identified MAC in 50.5% of patients. The mean CHADS2 and CHA2DS2-VASc scores were 2.56 ± 1.135 and 4.57 ± 1.61, respectively. In MAC patients, both scores tended to increase significantly compared with the control (2.88 ± 1.114 versus 2.24 ± 1.06, p = 0.005, and 5.21 ± 1.51 versus 3.92 ± 1.46, p < 0.001, respectively). The left ventricular ejection fraction negatively correlated with the presence of MAC (r = −0.254, p = 0.01). The presence of MAC was a risk factor for vascular disease (OR = 2.47, χ2 = 34.32, p < 0001). Conclusions: The presence of MAC is associated with greater TE risk scores and a higher risk of vascular disease. It appears that adding MAC as a vascular disease parameter to TE risk scores may have benefits for patients by improving their predictive value. Full article
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11 pages, 4637 KiB  
Article
The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial
by Maria Drakopoulou, Georgios Oikonomou, Anastasios Apostolos, Maria Karmpalioti, Chryssa Simopoulou, Leonidas Koliastasis, George Latsios, Andreas Synetos, Georgios Benetos, George Trantalis, Skevos Sideris, Polychronis Dilaveris, Costas Tsioufis and Konstantinos Toutouzas
Life 2023, 13(6), 1234; https://doi.org/10.3390/life13061234 - 24 May 2023
Cited by 1 | Viewed by 1152
Abstract
Background: The presence of an electrocardiographic (ECG) strain pattern—among other ECG features—has been shown to be predictive of adverse cardiovascular outcomes in asymptomatic patients with aortic stenosis. However, data evaluating its impact on symptomatic patients undergoing TAVI are scarce. Therefore, we tried to [...] Read more.
Background: The presence of an electrocardiographic (ECG) strain pattern—among other ECG features—has been shown to be predictive of adverse cardiovascular outcomes in asymptomatic patients with aortic stenosis. However, data evaluating its impact on symptomatic patients undergoing TAVI are scarce. Therefore, we tried to investigate the prognostic impact of baseline ECG strain pattern on clinical outcomes after TAVI. Methods: A sub-group of patients of the randomized DIRECT (Pre-dilatation in Transcatheter Aortic Valve Implantation Trial) trial with severe aortic stenosis who underwent TAVI with a self-expanding valve in one single center were consecutively enrolled. Patients were categorized into two groups according to the presence of ECG strain. Left ventricular strain was defined as the presence of ≥1 mm convex ST-segment depression with asymmetrical T-wave inversion in leads V5 to V6 on the baseline 12-lead ECG. Patients were excluded if they had paced rhythm or left bundle branch block at baseline. Multivariate Cox proportional hazard regression models were generated to assess the impact on outcomes. The primary clinical endpoint was all-cause mortality at 1 year after TAVI. Results: Of the 119 patients screened, 5 patients were excluded due to left bundle branch block. Among the 114 included patients (mean age: 80.8 ± 7), 37 patients (32.5%) had strain pattern on pre-TAVI ECG, while 77 patients (67.5%) did not exhibit an ECG strain pattern. No differences in baseline characteristics were found between the two groups. At 1 year, seven patients reached the primary clinical endpoint, with patients in the strain group demonstrating significantly higher mortality in Kaplan–Meier plots compared to patients without left ventricular strain (five vs. two, log-rank p = 0.022). There was no difference between the strain and no strain group regarding the performance of pre-dilatation (21 vs. 33, chi-square p = 0.164). In the multivariate analysis, left ventricular strain was found to be an independent predictor of all-cause mortality after TAVI [Exp(B): 12.2, 95% Confidence Intervals (CI): 1.4–101.9]. Conclusion: Left ventricular ECG strain is an independent predictor of all-cause mortality after TAVI. Thus, baseline ECG characteristics may aid in risk-stratifying patients scheduled for TAVI. Full article
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Review

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14 pages, 699 KiB  
Review
Spontaneous Coronary Artery Dissection and COVID-19: A Review of the Literature
by Grigorios Tsigkas, Maria Bozika, Kassiani-Maria Nastouli, Anastasios Apostolos, Michaela Routoula, Athanasia-Maria Georga, Anastasia Latta, Angeliki Papageorgiou, Michail I. Papafaklis, Georgios Leventopoulos, Grigoris V. Karamasis and Periklis Davlouros
Life 2024, 14(3), 315; https://doi.org/10.3390/life14030315 - 28 Feb 2024
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Abstract
SARS-CoV-2 is responsible for the global coronavirus disease 2019 (COVID-19) pandemic. While the cardiovascular effects of COVID-19 have been thoroughly described, there are limited published studies in the literature establishing a connection between spontaneous coronary artery dissection (SCAD) and COVID-19. Cardiovascular manifestations include, [...] Read more.
SARS-CoV-2 is responsible for the global coronavirus disease 2019 (COVID-19) pandemic. While the cardiovascular effects of COVID-19 have been thoroughly described, there are limited published studies in the literature establishing a connection between spontaneous coronary artery dissection (SCAD) and COVID-19. Cardiovascular manifestations include, among others, myocarditis, acute myocardial infraction, and thrombosis. In general, SCAD is an uncommon and underdiagnosed cause of acute myocardial infarction (AMI), particularly in younger women and in patients with underlying fibromuscular dysplasia (FMD). Many patients with SCAD often report significant emotional stress, especially in relation with job loss, during the week preceding their cardiac event. Moreover, the COVID-19 pandemic has led to societal stress and increased unemployment, factors that have been associated with cardiovascular morbidity. SCAD emerges as a rare manifestation of coronary artery disease, which a few recent case reports link to COVID-19. The aim of this article is to summarize the relevant data on the pathophysiology of COVID-19 and SCAD along with a review of the reported cases on acute coronary syndrome (ACS) following SARS-CoV2 infection and, thus, to provide insights about the relationship between COVID-19 and SCAD. Full article
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25 pages, 1193 KiB  
Review
Transcatheter Tricuspid Valve Interventions: A Triumph for Transcatheter Procedures?
by Kyriakos Dimitriadis, Nikolaos Pyrpyris, Konstantinos Aznaouridis, Panagiotis Iliakis, Aggeliki Valatsou, Panagiotis Tsioufis, Eirini Beneki, Emmanouil Mantzouranis, Konstantina Aggeli, Eleftherios Tsiamis and Konstantinos Tsioufis
Life 2023, 13(6), 1417; https://doi.org/10.3390/life13061417 - 20 Jun 2023
Cited by 1 | Viewed by 2379
Abstract
Tricuspid regurgitation (TR) is a common valvular pathology, estimated to affect 1.6 million people in the United States alone. Even though guidelines recommend either medical therapy or surgical treatment for TR, the misconception of TR as a benign disease along with the high [...] Read more.
Tricuspid regurgitation (TR) is a common valvular pathology, estimated to affect 1.6 million people in the United States alone. Even though guidelines recommend either medical therapy or surgical treatment for TR, the misconception of TR as a benign disease along with the high mortality rates of surgical intervention led to undertreating this disease and commonly describing it as a “forgotten” valve. Recently, the development of transcatheter interventions for TR show promising potential for use in the clinical setting. There are currently few approved and numerous tested percutaneously delivered devices, which can be categorized, based on their mechanism of action, to either valve repair or valve replacement procedures. Both procedures were tested in clinical trials and show an echocardiographic reduction in TR sustained for at least 1 year after the procedure, as well as symptom relief and functional improvement of the patients. Device selection should be personalized, taking into consideration the anatomy of each valve and the available options at each heart center. Moreover, appropriate patient selection and timing of the procedure are also crucial for the success of the procedure. In this review, we analyze the clinical trials available for all devices currently approved or tested, aiming to provide a comprehensive summary of the most recent evidence in the field of transcatheter TR interventions. Full article
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15 pages, 1034 KiB  
Review
Managing Anemia: Point of Convergence for Heart Failure and Chronic Kidney Disease?
by Oana Nicoleta Buliga-Finis, Anca Ouatu, Daniela Maria Tanase, Evelina Maria Gosav, Petronela Nicoleta Seritean Isac, Patricia Richter and Ciprian Rezus
Life 2023, 13(6), 1311; https://doi.org/10.3390/life13061311 - 01 Jun 2023
Cited by 5 | Viewed by 3268
Abstract
The pathologic triangle formed by chronic heart failure (HF), chronic kidney disease (CKD), and anemia carries high morbidity and mortality rates and decreases quality of life. Anemia represents a common condition in patients with advanced HF and CKD, with a total prevalence in [...] Read more.
The pathologic triangle formed by chronic heart failure (HF), chronic kidney disease (CKD), and anemia carries high morbidity and mortality rates and decreases quality of life. Anemia represents a common condition in patients with advanced HF and CKD, with a total prevalence in cardiorenal syndrome (CRS) ranging from 5% to 55%. Searching for a pragmatic approach for these patients with guided and disease-specific recommendations beyond just targeted hemoglobin therapeutic behavior represents the core of research for ongoing clinical trials. It is well known that the prevalence of anemia increases with the advancement of CKD and HF. The physiopathological mechanisms of anemia, such as the reduction of endogenous erythropoietin and the decrease in oxygen transport, are leading to tissue hypoxia, peripheral vasodilation, stimulating neurohormonal activity, and maintenance of the progressive renal and cardiac dysfunction. Given the challenges with the treatment options for patients with cardiorenal anemia syndrome (CRSA), new therapeutic agents such as hypoxia-inducible factor–prolyl hydroxylase domain inhibitors (HIF-PH) or hepcidin antagonists are emerging in the light of recent research. This review summarizes the potential therapeutic tools for anemia therapy in the cardiorenal population. Full article
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Other

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9 pages, 430 KiB  
Brief Report
Transcatheter Aortic Valve Implantation with the Portico Valve: 2-Year Outcomes of a Multicenter, Real-World Registry
by Matthaios Didagelos, Vlasis Ninios, Charalampos Kakderis, Lampros Lakkas, Antonios Kouparanis, Dimitrios Nikas, Katerina K. Naka, Aidonis Rammos, Thomas Zegkos, Vasileios Kamperidis, Ilias Ninios, Sotirios Evangelou, Dimitrios G. Tsalikakis, Lampros Michalis and Antonios Ziakas
Life 2023, 13(8), 1785; https://doi.org/10.3390/life13081785 - 21 Aug 2023
Viewed by 1402
Abstract
Introduction: The self-expanding, resheathable, repositionable transcatheter aortic heart valve Portico is being used successfully for transcatheter aortic valve implantation procedures (TAVI) in patients with severe aortic stenosis. The aim of this study was to evaluate outcomes at 2 years after TAVI with the [...] Read more.
Introduction: The self-expanding, resheathable, repositionable transcatheter aortic heart valve Portico is being used successfully for transcatheter aortic valve implantation procedures (TAVI) in patients with severe aortic stenosis. The aim of this study was to evaluate outcomes at 2 years after TAVI with the Portico valve. Methods: Multicenter registry of clinical, echocardiographic and survival data from consecutive patients treated with the Portico TAVI system (Abbott, Chicago, IL, USA) in three cath labs in Northern Greece and Epirus during 2017–2020. The primary end point was all-cause mortality at 24 months. Secondary end points included procedural outcomes (efficacy and safety) and echocardiographic measurements. Results: A total of 90 patients (81 ± 6 years, 50% females, mean age 81 ± 6 years) were included in the registry. The indication for implantation was severe, symptomatic aortic stenosis (NYHA III, IV) in eighty-two (91.1%) and degeneration of a prosthetic aortic valve in eight (8.9%) patients. All patients were categorized as high surgical risk (mean Logistic Euroscore 25.9 ± 10, Euroscore II 7.7 ± 4.4 and STS score 10.8 ± 8.9). The procedure was performed transfemorally in all patients, under general anesthesia in 95.6%, under TOE guidance in 21.1%, with native valve predilatation in 46.7%, and the “resheath” option was used in 31.1% of the cases. The implantation was successful in 97.8% and there was a need for a second valve in 2.2% of the cases. Complications included permanent pacemaker implantation (16.7%), access cite complications (15.6%), arrythmias (23.3%), paravalvular leak (moderate 7.8%, severe 1.1%), acute kidney injury (7.8%), no strokes and one death during the procedure. Aortic valve peak velocity, peak and mean pressure gradients, were significantly reduced after the procedure. All-cause mortality at 1, 12 and 24 months was 4.4%, 6.7% and 7.8%, respectively. Conclusions: TAVI with the Portico system comprises an effective and safe solution for the management of severe, symptomatic aortic stenosis in high-risk surgical patients. Full article
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