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Volume 11
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J. Cardiovasc. Dev. Dis., Volume 11, Issue 7 (July 2024) – 20 articles

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10 pages, 638 KiB  
Article
Prognostic Value of Serum Galectin-3 for Survival in Patients with Cardiac Light-Chain Amyloidosis
by Xinglin Yang, Jin Huang, Jinghong Zhang, Jian Li and Zhuang Tian
J. Cardiovasc. Dev. Dis. 2024, 11(7), 202; https://doi.org/10.3390/jcdd11070202 (registering DOI) - 29 Jun 2024
Abstract
Background: Amyloid light-chain (AL) amyloidosis is a multisystem disorder, with cardiac amyloid infiltration being a prevalent manifestation. This study aimed to explore the prognostic value of galectin-3 (Gal-3), a soluble marker associated with fibrosis, inflammation, heart failure, and kidney injury, in patients with [...] Read more.
Background: Amyloid light-chain (AL) amyloidosis is a multisystem disorder, with cardiac amyloid infiltration being a prevalent manifestation. This study aimed to explore the prognostic value of galectin-3 (Gal-3), a soluble marker associated with fibrosis, inflammation, heart failure, and kidney injury, in patients with cardiac AL amyloidosis. Methods: A total of 60 patients who were diagnosed with cardiac AL amyloidosis from January 2015 to May 2018 were enrolled. The prognostic value of Gal-3 was assessed. Receiver operating characteristic (ROC) curves were used to evaluate the predictive accuracy of Gal-3. A Gal-3 cut-off value was identified to predict survival rates. Results: The ROC curves demonstrated a moderate predictive accuracy of Gal-3 for 0.5- and 5-year survival, with area under the curve (AUC) values of 0.722 and 0.788, respectively. A Gal-3 cut-off value of 15.154 ng/mL was found to predict survival. Kaplan–Meier survival analysis revealed a significant difference in mean overall survival between patients with Gal-3 levels below and above the established cut-off (69.2 months versus 42.1 months, respectively; p = 0.036). Multivariate analysis confirmed that Gal-3 > 15.154 ng/mL remained an independent predictor of survival (HR 2.451, 95% CI 1.017–5.910, p = 0.046). Conclusions: This study suggests that Gal-3 holds independent prognostic value for survival in patients with cardiac AL amyloidosis. Gal-3 could potentially enhance the prognostic capabilities of the current soluble markers, thereby improving the management of cardiac AL amyloidosis. However, further validation in larger prospective studies is warranted. Full article
13 pages, 1094 KiB  
Article
Ten-Year Experience with a Transapical Approach for Transcatheter Aortic and Mitral Valve Implantation
by Antonella Galeone, Fabiola Perrone, Gabriele Pesarini, Flavio Luciano Ribichini, Renato Di Gaetano, Giovanni Battista Luciani and Francesco Onorati
J. Cardiovasc. Dev. Dis. 2024, 11(7), 201; https://doi.org/10.3390/jcdd11070201 (registering DOI) - 29 Jun 2024
Viewed by 109
Abstract
Background: The transfemoral approach represents the optimal access for TAVI due to its low invasiveness; however, up to 10–15% of TAVI candidates are considered unsuitable for femoral access because of significant peripheral vascular disease and need alternative access. Methods: This is a single-center [...] Read more.
Background: The transfemoral approach represents the optimal access for TAVI due to its low invasiveness; however, up to 10–15% of TAVI candidates are considered unsuitable for femoral access because of significant peripheral vascular disease and need alternative access. Methods: This is a single-center retrospective observational study including all consecutive adult patients undergoing transcatheter procedures through a TA approach from March 2015 to April 2024. Results: 213 patients underwent transcatheter aortic or mitral valve implantation through a TA approach and were enrolled in this study. The mean age of the patients was 79.5 ± 5.7 years, and 54% of the patients were males. The mean Euroscore II was 7.9 ± 6.4%. One-third of the patients had previous cardiac surgery. The overall mean survival time was 5.3 ± 0.3 years. Nine (4%) patients developed infective endocarditis (IE) during the follow-up. Conclusions: The transapical approach for transcatheter procedures is a safe and effective procedure for patients unsuitable for TF access with low periprocedural mortality and a low rate of post-procedural complications when performed by experienced surgeons and cardiologists. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)
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7 pages, 6021 KiB  
Case Report
Ventricular Fibrillation during Optical Coherence Tomography
by Paula Vela Martín, Carlos Arellano Serrano, Álvaro Lorente Ros, Juan Francisco Oteo and Arturo Garcia-Touchard
J. Cardiovasc. Dev. Dis. 2024, 11(7), 200; https://doi.org/10.3390/jcdd11070200 (registering DOI) - 29 Jun 2024
Viewed by 106
Abstract
Optical Coherence Tomography (OCT) imaging is a valuable tool for complex coronary interventions. While complications are rare, the occurrence of ventricular arrhythmias during its use is one of the most feared. Unfortunately, the mechanism by which these arrhythmias arise remains unclear. We describe [...] Read more.
Optical Coherence Tomography (OCT) imaging is a valuable tool for complex coronary interventions. While complications are rare, the occurrence of ventricular arrhythmias during its use is one of the most feared. Unfortunately, the mechanism by which these arrhythmias arise remains unclear. We describe the case of a patient under continuous electrocardiographic (ECG) monitoring who experienced ventricular fibrillation during an OCT procedure. A detailed analysis of the ECG event sequence was performed, from the administration of the contrast medium to the onset of ventricular fibrillation. Utilizing the collected data, we examined potential precipitating factors based on the observed alterations in the electrocardiogram. A comprehensive understanding of the mechanisms underlying these arrhythmias is crucial for the development of preventive measures that avoid such incidents in the future. Full article
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11 pages, 757 KiB  
Review
Narrative Review on Echocardiographic Evaluation of Patent Ductus Arteriosus in Preterm Infants
by Yogen Singh, Belinda Chan, Shahab Noori and Rangasamy Ramanathan
J. Cardiovasc. Dev. Dis. 2024, 11(7), 199; https://doi.org/10.3390/jcdd11070199 (registering DOI) - 28 Jun 2024
Viewed by 114
Abstract
Persistent Patent Ductus Arteriosus (PDA) is prevalent among extremely preterm infants, with its occurrence inversely related to gestational age. A persistent PDA correlates with increased mortality and morbidities such as intraventricular hemorrhage, pulmonary hemorrhage, chronic lung disease, bronchopulmonary dysplasia, and necrotizing enterocolitis as [...] Read more.
Persistent Patent Ductus Arteriosus (PDA) is prevalent among extremely preterm infants, with its occurrence inversely related to gestational age. A persistent PDA correlates with increased mortality and morbidities such as intraventricular hemorrhage, pulmonary hemorrhage, chronic lung disease, bronchopulmonary dysplasia, and necrotizing enterocolitis as observed clinically. Conversely, numerous randomized controlled trials have failed to demonstrate significant benefits from PDA treatment. One contributing factor to these conflicting findings is that PDA affects each individual differently depending on the cardiovascular decompensation and its hemodynamic impact. PDA management should be based on the hemodynamic significance, rather than just the presence or size of PDA. This comprehensive narrative review paper describes echocardiographic parameters that allow a better understanding of the hemodynamic impact of PDA. A newer modality, like lung ultrasound, is also described here as an adjunct to assess the PDA impact on the lungs from pulmonary overcirculation. Full article
(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)
13 pages, 527 KiB  
Systematic Review
Sodium–Glucose Transporter 2 Inhibitors in Heart Failure: An Overview of Systematic Reviews
by Yixuan Fang, Lihong Chen, Shiyi Sun and Xingwu Ran
J. Cardiovasc. Dev. Dis. 2024, 11(7), 198; https://doi.org/10.3390/jcdd11070198 - 28 Jun 2024
Viewed by 188
Abstract
Background: Several studies have shown that sodium-dependent glucose transporter 2 inhibitors can be used in the treatment of heart failure. This article summarized systematic reviews of sodium-dependent glucose transporter 2 inhibitors in the treatment of heart failure in order to evaluate efficacy and [...] Read more.
Background: Several studies have shown that sodium-dependent glucose transporter 2 inhibitors can be used in the treatment of heart failure. This article summarized systematic reviews of sodium-dependent glucose transporter 2 inhibitors in the treatment of heart failure in order to evaluate efficacy and safety. Methods: We systematically searched eight electronic databases from inception to July 2023. We used Assessment of Multiple Systematic Reviews 2 to evaluate the methodological quality, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 to assess report quality, Risk of Bias in Systematic Review to assess the risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation to rate the quality of evidence. Outcome: A total of 36 systematic reviews were included. Our results were classified as clear evidence of benefit: hospitalization for heart failure; possible benefit: cardiovascular death (mortality) and renal outcome composite; clear evidence of no effect or equivalence: atrial arrhythmias, ventricular arrhythmia, atrial fibrillation, and hypotension; possible harm: genital infection; insufficient evidence to draw a conclusion: atrial flutter, major adverse cardiovascular events, urinary tract infection, acute kidney injury, hypoglycemia, and bone fracture. Conclusions: Sodium-dependent glucose transporter 2 inhibitors are beneficial for the treatment of heart failure, especially in terms of heart failure hospitalization. Full article
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1 pages, 158 KiB  
Correction
Correction: Raiola et al. Imaging Approaches and the Quantitative Analysis of Heart Development. J. Cardiovasc. Dev. Dis. 2023, 10, 145
by Morena Raiola, Miquel Sendra and Miguel Torres
J. Cardiovasc. Dev. Dis. 2024, 11(7), 197; https://doi.org/10.3390/jcdd11070197 - 28 Jun 2024
Viewed by 85
Abstract
In the published publication [...] Full article
1 pages, 143 KiB  
Correction
Correction: Liu et al. Weight Change and Risk of Atherosclerosis Measured by Carotid Intima–Media Thickness (cIMT) from a Prospective Cohort—Analysis of the First-Wave Follow-Up Data of the Canadian Longitudinal Study on Aging (CLSA). J. Cardiovasc. Dev. Dis. 2023, 10, 435
by Jian Liu, Newman Siu Kwan Sze, Miya Narushima and Deborah O’Leary
J. Cardiovasc. Dev. Dis. 2024, 11(7), 196; https://doi.org/10.3390/jcdd11070196 - 28 Jun 2024
Viewed by 79
Abstract
There was missing information in the back matter of the original publication [...] Full article
19 pages, 1440 KiB  
Article
Hypoxia-Induced Pulmonary Injury—Adrenergic Blockade Attenuates Nitrosative Stress, and Proinflammatory Cytokines but Not Pulmonary Edema
by Isabel Riha, Aida Salameh, Annekathrin Hoschke, Coralie Raffort, Julia Koedel and Beate Rassler
J. Cardiovasc. Dev. Dis. 2024, 11(7), 195; https://doi.org/10.3390/jcdd11070195 - 27 Jun 2024
Viewed by 190
Abstract
Hypoxia can induce pulmonary edema (PE) and inflammation. Furthermore, hypoxia depresses left ventricular (LV) inotropy despite sympathetic activation. To study the role of hypoxic sympathetic activation, we investigated the effects of hypoxia with and without adrenergic blockade (AB) on cardiovascular dysfunction and lung [...] Read more.
Hypoxia can induce pulmonary edema (PE) and inflammation. Furthermore, hypoxia depresses left ventricular (LV) inotropy despite sympathetic activation. To study the role of hypoxic sympathetic activation, we investigated the effects of hypoxia with and without adrenergic blockade (AB) on cardiovascular dysfunction and lung injury, i.e., pulmonary edema, congestion, inflammation, and nitrosative stress. Eighty-six female rats were exposed for 72 h to normoxia or normobaric hypoxia and received infusions with NaCl, prazosin, propranolol, or prazosin–propranolol combination. We evaluated hemodynamic function and performed histological and immunohistochemical analyses of the lung. Hypoxia significantly depressed LV but not right ventricular (RV) inotropic and lusitropic functions. AB significantly decreased LV function in both normoxia and hypoxia. AB effects on RV were weaker. Hypoxic rats showed signs of moderate PE and inflammation. This was accompanied by elevated levels of tumor necrosis factor α (TNFα) and nitrotyrosine, a marker of nitrosative stress in the lungs. In hypoxia, all types of AB markedly reduced both TNFα and nitrotyrosine. However, AB did not attenuate PE. The results suggest that hypoxia-induced sympathetic activation contributes to inflammation and nitrosative stress in the lungs but not to PE. We suggest that AB in hypoxia aggravates hypoxia-induced inotropic LV dysfunction and backlog into the pulmonary circulation, thus promoting PE. Full article
11 pages, 821 KiB  
Brief Report
Association of PHACTR1 with Coronary Artery Calcium Differs by Sex and Cigarette Smoking
by Kirsten Voorhies, Kendra Young, Fang-Chi Hsu, Nicholette D. Palmer, Merry-Lynn N. McDonald, Sanghun Lee, Georg Hahn, Julian Hecker, Dmitry Prokopenko, Ann Chen Wu, Elizabeth A. Regan, Dawn DeMeo, Greg L. Kinney, James D. Crapo, Michael H. Cho, Edwin K. Silverman, Christoph Lange, Matthew J. Budoff, John E. Hokanson and Sharon M. Lutz
J. Cardiovasc. Dev. Dis. 2024, 11(7), 194; https://doi.org/10.3390/jcdd11070194 - 27 Jun 2024
Viewed by 194
Abstract
Background: Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis and is a complex heritable trait with both genetic and environmental risk factors, including sex and smoking. Methods: We performed genome-wide association (GWA) analyses for CAC among all participants and stratified by [...] Read more.
Background: Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis and is a complex heritable trait with both genetic and environmental risk factors, including sex and smoking. Methods: We performed genome-wide association (GWA) analyses for CAC among all participants and stratified by sex in the COPDGene study (n = 6144 participants of European ancestry and n = 2589 participants of African ancestry) with replication in the Diabetes Heart Study (DHS). We adjusted for age, sex, current smoking status, BMI, diabetes, self-reported high blood pressure, self-reported high cholesterol, and genetic ancestry (as summarized by principal components computed within each racial group). For the significant signals from the GWA analyses, we examined the single nucleotide polymorphism (SNP) by sex interactions, stratified by smoking status (current vs. former), and tested for a SNP by smoking status interaction on CAC. Results: We identified genome-wide significant associations for CAC in the chromosome 9p21 region [CDKN2B-AS1] among all COPDGene participants (p = 7.1 × 10−14) and among males (p = 1.0 × 10−9), but the signal was not genome-wide significant among females (p = 6.4 × 10−6). For the sex stratified GWA analyses among females, the chromosome 6p24 region [PHACTR1] had a genome-wide significant association (p = 4.4 × 10−8) with CAC, but this signal was not genome-wide significant among all COPDGene participants (p = 1.7 × 10−7) or males (p = 0.03). There was a significant interaction for the SNP rs9349379 in PHACTR1 with sex (p = 0.02), but the interaction was not significant for the SNP rs10757272 in CDKN2B-AS1 with sex (p = 0.21). In addition, PHACTR1 had a stronger association with CAC among current smokers (p = 6.2 × 10−7) than former smokers (p = 7.5 × 10−3) and the SNP by smoking status interaction was marginally significant (p = 0.03). CDKN2B-AS1 had a strong association with CAC among both former (p = 7.7 × 10−8) and current smokers (p = 1.7 × 10−7) and the SNP by smoking status interaction was not significant (p = 0.40). Conclusions: Among current and former smokers of European ancestry in the COPDGene study, we identified a genome-wide significant association in the chromosome 6p24 region [PHACTR1] with CAC among females, but not among males. This region had a significant SNP by sex and SNP by smoking interaction on CAC. Full article
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9 pages, 892 KiB  
Article
Immediate Increase in the Root Mean Square of Successive Differences after Three Bouts of Remote Ischemic Preconditioning: A Randomized Controlled Trial
by Charlotte Schöneburg, Benedicta Seyram Amevor, Theresa Bauer, Ivy Boateng, Bright Nsia-Tawia, Nehir Öztürk, Maria-Alexandra Pop and Jan Müller
J. Cardiovasc. Dev. Dis. 2024, 11(7), 193; https://doi.org/10.3390/jcdd11070193 - 26 Jun 2024
Viewed by 209
Abstract
(1) Background: Remote ischemic preconditioning (RIPC) is an intervention involving the application of brief episodes of ischemia and reperfusion to distant tissues to activate protective pathways in the heart. There is evidence suggesting the involvement of the autonomic nervous system (ANS) in RIPC-induced [...] Read more.
(1) Background: Remote ischemic preconditioning (RIPC) is an intervention involving the application of brief episodes of ischemia and reperfusion to distant tissues to activate protective pathways in the heart. There is evidence suggesting the involvement of the autonomic nervous system (ANS) in RIPC-induced cardioprotection. This study aimed to investigate the immediate effects of RIPC on the ANS using a randomized controlled trial. (2) Methods: From March 2018 to November 2018, we conducted a single-blinded randomized controlled study involving 51 healthy volunteers (29 female, 24.9 [23.8, 26.4] years). Participants were placed in a supine position and heart rate variability was measured over 260 consecutive beats before they were randomized into either the intervention or the SHAM group. The intervention group underwent an RIPC protocol (3 cycles of 5 min of 200 mmHg ischemia followed by 5 min reperfusion) at the upper thigh. The SHAM group followed the same protocol but on the right upper arm, with just 40 mmHg of pressure inflation, resulting in no ischemic stimulus. Heart rate variability measures were reassessed afterward. (3) Results: The intervention group showed a significant increase in RMSSD, the possible marker of the parasympathetic nervous system (IG: 14.5 [5.4, 27.5] ms vs. CG: 7.0 [−4.3, 23.1 ms], p = 0.027), as well as a significant improvement in Alpha 1 levels compared to the control group (IG: −0.1 [−0.2, 0.1] vs. CG: 0.0 [−0.1, 0.2], p = 0.001). (4) Conclusions: Our results hint that RIPC increases the RMSSD and Alpha 1 parameters showing possible immediate parasympathetic modulations. RIPC could be favorable in promoting cardioprotective or/and cardiovascular effects by ameliorating ANS modulations. Full article
(This article belongs to the Special Issue Cardiovascular Disease: Risk Factors and Prevention)
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11 pages, 652 KiB  
Article
BeGraft Aortic Stents: A European Multi-Centre Experience Reporting Acute Safety and Efficacy Outcomes for the Treatment of Vessel Stenosis in Congenital Heart Diseases
by Micol Rebonato, Mara Pilati, Sophie Malekzadeh Milani, Damien Bonnet, Emma Pascall, Matthew Jones, Pedro Betrian, Lisa Bianco, Hugues Lucron, Sebastien Hascoet, Alban-Elouen Baruteau, Luca Giugno and Gianfranco Butera
J. Cardiovasc. Dev. Dis. 2024, 11(7), 192; https://doi.org/10.3390/jcdd11070192 - 25 Jun 2024
Viewed by 500
Abstract
Background: Stent implantation has become the preferred method of treatment for treating vessel stenosis in congenital heart diseases. The availability of covered stents may decrease complications and have an important role in the management of patients with complex anatomy. Aim: This study aims [...] Read more.
Background: Stent implantation has become the preferred method of treatment for treating vessel stenosis in congenital heart diseases. The availability of covered stents may decrease complications and have an important role in the management of patients with complex anatomy. Aim: This study aims to evaluate the feasibility and safety of the pre-mounted cobalt–chromium stent-graft-covered ePTFE Aortic BeGraft in a broad spectrum of vascular lesions. Methods: This is a multicenter retrospective results analysis of 107 implanted BeGraft stents between 2016 and 2022 in six different European centers. Results: One hundred and four patients with a mean age of thirteen years (range 1–70 years) and with the body weight of 56.5 kg (range 11–115 kg) underwent the BeGraft stent implantation. Stents were implanted in the following conditions: aortic coarctation (74 patients), RVOT dysfunction (12 patients), Fontan circulation (7 patients), and miscellaneous (11 subjects with complex CHD). All the stents were implanted successfully. The median stent diameter was 16 mm (range 7–24 mm), and the median length was 39 mm (range 19–49 mm). Major complications occurred in five subjects (4.7%). During a median follow-up of fourteen (1–70) months, stents’ re-dilatation was performed in five patients. Conclusions: The BeGraft stent can be used safely and effectively in a wide spectrum of congenital heart diseases. Whether these good results will be stable in the longer term still needs to be investigated in a follow-up given its recent introduction into clinical practice, in particular regarding stent fracture or neointimal proliferation. Full article
(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)
13 pages, 992 KiB  
Article
Atrial and Ventricular Involvement in Acute Myocarditis Patients with Preserved Ejection Fraction: A Single-Center Cardiovascular Magnetic Resonance Study
by Riccardo Cau, Francesco Pisu, Giuseppe Muscogiuri, Jasjit S. Suri, Roberta Montisci and Luca Saba
J. Cardiovasc. Dev. Dis. 2024, 11(7), 191; https://doi.org/10.3390/jcdd11070191 - 25 Jun 2024
Viewed by 454
Abstract
Cardiac magnetic resonance (CMR) is commonly employed to confirm the diagnosis of acute myocarditis (AM). However, the impact of atrial and ventricular function in AM patients with preserved ejection fraction (EF) deserves further investigation. Therefore, the aim of this study was to explore [...] Read more.
Cardiac magnetic resonance (CMR) is commonly employed to confirm the diagnosis of acute myocarditis (AM). However, the impact of atrial and ventricular function in AM patients with preserved ejection fraction (EF) deserves further investigation. Therefore, the aim of this study was to explore the incremental diagnostic value of combining atrial and strain functions using CMR in patients with AM and preserved EF. This retrospective study collected CMR scans of 126 consecutive patients with AM (meeting the Lake Louise criteria) and with preserved EF, as well as 52 age- and sex-matched control subjects. Left atrial (LA) and left ventricular (LV) strain functions were assessed using conventional cine-SSFP sequences. In patients with AM and preserved EF, impaired ventricular and atrial strain functions were observed compared to control subjects. These impairments remained significant even in multivariable analysis. The combined model of atrial and ventricular functions proved to be the most effective in distinguishing AM patients with preserved ejection fraction from control subjects, achieving an area under the curve of 0.77 and showing a significant improvement in the likelihood ratio. These findings suggest that a combined analysis of both atrial and ventricular functions may improve the diagnostic accuracy for patients with AM and preserved EF. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging: An Exciting Future to Revolutionize the Diagnosis and Management of Cardiovascular Disease)
1 pages, 180 KiB  
Correction
Correction: Díaz del Moral et al. Cardiomyocyte-Specific Wt1 Is Involved in Cardiac Metabolism and Response to Damage. J. Cardiovasc. Dev. Dis. 2023, 10, 211
by Sandra Díaz del Moral, Maha Benaouicha, Cristina Villa del Campo, Miguel Torres, Nicole Wagner, Kay-Dietrich Wagner, Ramón Muñoz-Chápuli and Rita Carmona
J. Cardiovasc. Dev. Dis. 2024, 11(7), 190; https://doi.org/10.3390/jcdd11070190 - 24 Jun 2024
Viewed by 109
Abstract
In the published publication [...] Full article
8 pages, 691 KiB  
Article
Aortic Valve Infective Endocarditis Complicated by Annular Abscess: Antibiotics in the Abscess Cavity
by Zaki Haidari, Shehla Ufaq Ahmad, Stephan Knipp, Iskandar Turaev and Mohamed El Gabry
J. Cardiovasc. Dev. Dis. 2024, 11(7), 189; https://doi.org/10.3390/jcdd11070189 - 24 Jun 2024
Viewed by 286
Abstract
Objectives: Infective endocarditis of the aortic valve complicated by annular abscess is a challenging problem and often requires patch reconstruction after surgical debridement of the abscess cavity. Filling the remaining cavity with antibiotics is advocated to prevent recurrent endocarditis. This study aimed at [...] Read more.
Objectives: Infective endocarditis of the aortic valve complicated by annular abscess is a challenging problem and often requires patch reconstruction after surgical debridement of the abscess cavity. Filling the remaining cavity with antibiotics is advocated to prevent recurrent endocarditis. This study aimed at evaluating the role of local antibiotics in patients with aortic valve infective endocarditis complicated by annular abscess. Methods: Between January 2012 and December 2021, all consecutive patients with aortic valve infective endocarditis complicated by annular abscess undergoing cardiac surgery and annular patch reconstruction were included. Patients receiving local antibiotics were compared with patients without local antibiotics. The primary endpoints were the incidence of recurrent endocarditis, re-operation, and mortality during two-year follow-up. Results: A total of 41 patients with aortic valve infective endocarditis complicated by annular abscess underwent surgical patch reconstruction after radical debridement. In total, 20 patients received local antibiotics in the abscess cavity and 21 patients were treated without local antibiotics. The most common causative microorganisms were the staphylococci species and the most common location of the abscess was the non-coronary annulus. During two-year follow-up, one patient in each group developed recurrent endocarditis (p > 0.99) and both patients were reoperated (p > 0.99). Two-year mortality was 30% in the local antibiotic group and 24% in the control group (p = 0.65). Conclusions: Radical debridement and patch reconstruction of the aortic annulus in patients with aortic valve infective endocarditis complicated by annular abscess is an effective surgical strategy. Filling of the remaining abscess cavity with antibiotic seems not to affect the rate of recurrent endocarditis, reoperation, and mortality during two-year follow-up. Full article
(This article belongs to the Special Issue Contemporary Clinical Treatment Options and Outcomes of Aortic Valve Disease)
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6 pages, 217 KiB  
Perspective
The Current Status of Minimally Invasive Conduit Harvesting for Coronary Artery Bypass Grafting
by Devon Anderson, Bob Kiaii and Jorge Catrip
J. Cardiovasc. Dev. Dis. 2024, 11(7), 188; https://doi.org/10.3390/jcdd11070188 - 23 Jun 2024
Viewed by 244
Abstract
The harvesting of conduits for coronary artery bypass surgery has evolved over the last decade to include endoscopic approaches to access the saphenous vein, radial artery, and internal mammary artery. These minimally invasive techniques reduce the morbidity associated with open procedures by decreasing [...] Read more.
The harvesting of conduits for coronary artery bypass surgery has evolved over the last decade to include endoscopic approaches to access the saphenous vein, radial artery, and internal mammary artery. These minimally invasive techniques reduce the morbidity associated with open procedures by decreasing pain and recovery time and increasing mobility post operatively. This review highlights the differences in morbidity, quality, and patency between the most common conduits that are harvested minimally invasively for coronary artery bypass grafting surgery. Full article
(This article belongs to the Special Issue Minimal Access Cardiac Surgery: State of the Art and Future Perspectives)
25 pages, 693 KiB  
Review
Beyond Medical Therapy—An Update on Heart Failure Devices
by Luigi Falco, Fabio Valente, Aldo De Falco, Raffaele Barbato, Luigi Marotta, Davide Soviero, Luigi Mauro Cantiello, Carla Contaldi, Benedetta Brescia, Enrico Coscioni, Giuseppe Pacileo and Daniele Masarone
J. Cardiovasc. Dev. Dis. 2024, 11(7), 187; https://doi.org/10.3390/jcdd11070187 - 23 Jun 2024
Viewed by 208
Abstract
Heart failure (HF) is a complex and progressive disease marked by substantial morbidity and mortality rates, frequent episodes of decompensation, and a reduced quality of life (QoL), with severe financial burden on healthcare systems. In recent years, several large-scale randomized clinical trials (RCTs) [...] Read more.
Heart failure (HF) is a complex and progressive disease marked by substantial morbidity and mortality rates, frequent episodes of decompensation, and a reduced quality of life (QoL), with severe financial burden on healthcare systems. In recent years, several large-scale randomized clinical trials (RCTs) have widely expanded the therapeutic armamentarium, underlining additional benefits and the feasibility of rapid titration regimens. This notwithstanding, mortality is not declining, and hospitalizations are constantly increasing. It is widely acknowledged that even with guideline-directed medical therapy (GDMT) on board, HF patients have a prohibitive residual risk, which highlights the need for innovative treatment options. In this scenario, groundbreaking devices targeting valvular, structural, and autonomic abnormalities have become crucial tools in HF management. This has led to a full-fledged translational boost with several novel devices in development. Thus, the aim of this review is to provide an update on both approved and investigated devices. Full article
(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)
10 pages, 342 KiB  
Perspective
Facilitators and Barriers of Incremental Innovation by Fixed Dose Combinations in Cardiovascular Diseases
by András Inotai, Zoltán Kaló, Zsuzsanna Petykó, Kristóf Gyöngyösi, Derek T. O’Keeffe, Marcin Czech and Tamás Ágh
J. Cardiovasc. Dev. Dis. 2024, 11(7), 186; https://doi.org/10.3390/jcdd11070186 - 21 Jun 2024
Viewed by 329
Abstract
Despite the availability of affordable pharmaceuticals treating cardiovascular diseases (CVDs), many of the risk factors remain poorly controlled. Fixed-dose combinations (FDCs), a form of incremental innovation, have already demonstrated improvements over combinations of single medicines in adherence and hard clinical endpoints. Nevertheless, there [...] Read more.
Despite the availability of affordable pharmaceuticals treating cardiovascular diseases (CVDs), many of the risk factors remain poorly controlled. Fixed-dose combinations (FDCs), a form of incremental innovation, have already demonstrated improvements over combinations of single medicines in adherence and hard clinical endpoints. Nevertheless, there are many barriers related to the wider use of FDCs in CVDs. Our aim was to identify these barriers and explore system-level facilitators from a multi-stakeholder perspective. Identified barriers include (i) hurdles in evidence generation for manufacturers, (ii) limited acceptance of adherence as an endpoint by clinical guideline developers and policymakers, (iii) limited options for a price premium for incremental innovation for healthcare payers, (iv) limited availability of real-world evidence, and (v) methodological issues to measure improved adherence. Initiatives to standardize and link healthcare databases in European countries, movements towards improved patient centricity in healthcare, and extended value assessment provide opportunities to capture the benefits of FDCs. Still, there is an emerging need to facilitate the generalizability of sporadic clinical evidence across different FDCs and to improve adherence measures. Finally, healthcare payers need to be convinced to pay a fair premium price for the added value of FDCs to incentivize incremental innovation in CVD treatment. Full article
(This article belongs to the Section Basic and Translational Cardiovascular Research)
25 pages, 3849 KiB  
Article
A Vector Theory of Assessing Clinical Trials: An Application to Bioequivalence
by Vangelis D. Karalis
J. Cardiovasc. Dev. Dis. 2024, 11(7), 185; https://doi.org/10.3390/jcdd11070185 - 21 Jun 2024
Viewed by 318
Abstract
A novel idea is introduced regarding the statistical comparisons of endpoints in clinical trials. Currently, the (dis)similarity of measured endpoints is not assessed. Instead, statistical analysis is directly applied, which can lead to multiplicity issues, reduced statistical power, and the recruitment of more [...] Read more.
A novel idea is introduced regarding the statistical comparisons of endpoints in clinical trials. Currently, the (dis)similarity of measured endpoints is not assessed. Instead, statistical analysis is directly applied, which can lead to multiplicity issues, reduced statistical power, and the recruitment of more subjects. The Vector-Based Comparison (VBC) approach originates from vector algebra and considers clinical endpoints as “vectors”. In the general case of N clinical endpoints, a Cartesian coordinate system is defined, and the most important primary endpoint (E1) is set. Following an explicitly defined procedure, the pairwise relationships of the remaining N-1 endpoints with E1 are estimated, and the N-1 endpoints are decomposed into axes perpendicular to E1. The angle between vectors provides insight into the level of dependency between variables. Vectors that are perpendicular to each other are considered independent, and only these are used in the statistical analysis. In this work, VBC is applied to bioequivalence studies of three anti-hypertensive drugs: amlodipine, irbesartan, and hydrochlorothiazide. The results suggest that VBC is a reproducible, easily applicable method allowing for the discrimination and utilization of the endpoint component expressing different attributes. All clinical characteristics are assessed with increased statistical power, without inflation of type I error. Full article
(This article belongs to the Special Issue Feature Review Papers in Imaging)
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13 pages, 306 KiB  
Review
Surgical Management of Ischemic Cardiomyopathy Patients with Severe Left Ventricular Dysfunction: Is It Time to Reconsider Revascularization Surgery?
by Matiullah Masroor, Yixuan Wang, Chao Zhang and Nianguo Dong
J. Cardiovasc. Dev. Dis. 2024, 11(7), 184; https://doi.org/10.3390/jcdd11070184 - 21 Jun 2024
Viewed by 353
Abstract
Ischemic cardiomyopathy patients with severe left ventricular dysfunction are a specific group of patients with poor surgical outcomes. There are few surgical treatment options in practice for the treatment of these patients such as heart transplantation, coronary artery bypass surgery, surgical ventricular restoration, [...] Read more.
Ischemic cardiomyopathy patients with severe left ventricular dysfunction are a specific group of patients with poor surgical outcomes. There are few surgical treatment options in practice for the treatment of these patients such as heart transplantation, coronary artery bypass surgery, surgical ventricular restoration, etc. Despite multiple treatment options, there are no explicit clinical guidelines available to guide surgeons in choosing the most appropriate option and ensuring that the specific patient can benefit from the selected surgical treatment. Heart transplantation is the gold standard treatment for ischemic cardiomyopathy patients with severe left ventricular dysfunction, but it is limited to very few highly equipped centers around the world due to donor shortages, complex perioperative and surgical management, and limited technological and human resources. It is evident from some studies that heart transplant-eligible candidates can benefit from alternative surgical options such as coronary artery bypass surgery alone or combined with surgical ventricular restoration. Therefore, alternative surgical options that are used for most of the population, especially in developing and underdeveloped countries, need to be discussed to improve their outcomes. A challenge in the recent era which has yet to find a solution is to determine which heart transplant candidate can benefit from simple revascularization compared to a complex heart transplantation procedure. Myocardial viability testing was one of the most important determinants in deciding whether a patient should undergo revascularization, but its role in guiding appropriate surgical options has been challenged. This review aims to discuss the available surgical management options and their long-term outcomes for patients with ischemic cardiomyopathy, which will eventually help surgeons when choosing a surgical procedure. Full article
(This article belongs to the Section Cardiac Surgery)
18 pages, 8321 KiB  
Review
Impact of Ethanol Infusion to the Vein of Marshall in Atrial Fibrillation and Atrial Tachycardia
by Masateru Takigawa, Shinsuke Miyazaki and Tetsuo Sasano
J. Cardiovasc. Dev. Dis. 2024, 11(7), 183; https://doi.org/10.3390/jcdd11070183 - 21 Jun 2024
Viewed by 324
Abstract
The ligament of Marshall is an epicardial structure characterized by its composition of fat, fibrous tissue, blood vessels, muscle bundles, nerve fibers, and ganglia. Its intricate network forms muscular connections with the coronary sinus and left atrium, alongside adjacent autonomic nerves and ganglion [...] Read more.
The ligament of Marshall is an epicardial structure characterized by its composition of fat, fibrous tissue, blood vessels, muscle bundles, nerve fibers, and ganglia. Its intricate network forms muscular connections with the coronary sinus and left atrium, alongside adjacent autonomic nerves and ganglion cells. This complexity plays a pivotal role in initiating focal electrical activities and sustaining micro- and macro-reentrant circuits, thereby contributing to the onset of atrial fibrillation and atrial tachycardia. However, endocardial ablation in this area may encounter challenges due to anatomical variations and insulation by fibrofatty tissue. Combining ethanol infusion into the vein of Marshall with radiofrequency ablation presents a promising strategy for effectively and safely eliminating this arrhythmogenic structure and terminating associated tachycardias. Full article
(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias)
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