J. Cardiovasc. Dev. Dis., Volume 12, Issue 8 (August 2025) – 41 articles

Percutaneous Coronary Intervention (PCI) has advanced significantly with the incorporation of imaging and physiology assessment techniques. Fractional Flow Reserve (FFR) and Non-Hyperemic Pressure indices (NHPIs) provide information regarding the functional significance of coronary lesions, while Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) enhance anatomical characterization and guide stent implantation. This review explores the implementation of physiology- and imaging-guided strategies in clinical practice, comparing their efficacy and limitations. Novel technologies now allow for physiology estimation without hyperemic agents, and hybrid techniques, such as OCT-derived FFR, are increasingly integrated into clinical practice. These approaches offer the combined advantages of functional assessment and detailed anatomical imaging. Full article

Combined oxidative phosphorylation deficiency type 8 (COXPD8) is an autosomal recessive mitochondrial disorder caused by a mutation of the nuclear encoded mitochondrial alanyl-tRNA synthetase gene (AARS2). Clinical manifestations of COXPD8 include lethal infantile hypertrophic cardiomyopathy, pulmonary hypoplasia, generalized muscle weakness, and neurological involvement. We report a patient with COXPD8 caused by two mutations in the AARS2 gene. The c.1738 C>G mutation has not been previously reported, while the c.2872 C>T mutation has been associated with pulmonary hypoplasia and hypertrophic cardiomyopathy. Cardiac tissue, obtained through the LungMAP program, showed that, compared to other patients of similar ages, these two mutations affect not only the assembly of functional monomeric complexes (Cx) I and IV of the electron transport chain (ETC) but also limit the formation of respiratory supercomplexes. This patient had altered expression of some ETC proteins but normal expression of several enzymes of the tricarboxylic acid cycle. We also show that one of the control/comparison patients had an undiagnosed ETC Cx IV deficiency. In conclusion, our data demonstrate that the two mutations of the AARS2 gene are associated with failed assembly of Cx I and Cx IV and reduced formation of respiratory supercomplexes of the ETC, likely leading to acute bioenergetic stress. Full article

The role of blood pressure variability (BPV) as an important marker of cardiovascular (CV) health, specifically its relationship with arterial stiffness and left ventricular remodeling in patients with hypertension, was investigated. This review aimed to elucidate the intricate relationship between BPV, arterial stiffness, and cardiac remodeling. BPV, as both a risk factor and a target of treatment, was also evaluated. The results point to the pivotal role of BPV in cardiovascular events, serving as an independent factor contributing to arterial stiffness and adverse left ventricular remodeling. The article concludes that BPV is a modifiable risk factor and that there is a need for an intervention in specific regions. BPV is a therapy target that is significant in the treatment of hypertension. The optimization of risk and prevention needs a multidisciplinary approach involving rehabilitation therapy, which will improve cardiovascular conditions and patient outcomes. Full article

Background: Right heart catheterization (RHC) is the gold-standard for diagnosis of pulmonary hypertension (PH) but is a terminal procedure in neonatal mice. The objective was to validate echocardiographic measures of PH to establish the diagnostic capability against pulmonary vascular histology in neonatal mice. Methods: Adult mice, exposed to hypoxia or normoxia, were assessed by echocardiography and RHC to evaluate right ventricle (RV) morphometry and function. Echocardiographic measures identified in adult mice were then used to evaluate PH characteristics in hypoxia-exposed neonatal mice. Physiological parameters were compared to histopathology in all mice. Results: Hypoxia-challenged adult mice developed PH with RHC, demonstrating confirmed elevated RV systolic pressure (RVSP), RV hypertrophy, and increased cross-sectional area and neomuscularization of pulmonary vessels. Echocardiography-derived RV free wall (RVFW) thickness correlated with RV mass. Tricuspid valve annulus tissue Doppler imaging (TV TDI), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery acceleration measures (PAAT), and TAPSE × PAAT (a measure of RV work) all correlated with RVSP determined by RHC. In neonatal mice exposed to hypoxia, PAAT, TV TDI, TAPSE, and TAPSE × PAAT were decreased and RVFW thickness was increased, correlating with the histologic phenotype of PH. Conclusions: Echocardiographic indices of RV morphology and function provide reliable estimates of invasive RV hemodynamics in hypoxia-induced PH. Full article

(1) Introduction: Distal coronary emboli occur in up to 15–30.5% of patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and are associated with poor myocardial reperfusion in the territory of the infarct-related artery. The objective of this study was to analyze the possible laboratory, clinical and imaging indicators of distal coronary embolism detected with an angiography at the time of PCI with stent implantation for acute coronary syndrome (ACS). (2) Methods: This analysis included 137 patients with ACS. The levels of cardiac enzymes (creatine kinase [CK], muscle–brain fraction of CK, high-sensitivity troponin T [hsTnT]), inflammatory markers (high-sensitivity C-reactive protein, white blood cell counts), sex steroids (total 17β-estradiol, total testosterone, dehydroepiandrosterone sulfate [DHEA-S]), serum lipids and oxidized low-density lipoproteins (oxLDL) were measured and analyzed for their relationship with the incidence of distal coronary embolism at PCI. (3) Results: Slow coronary blood flow was detected in the coronary artery subject to intervention in 9.4% (n = 13) of patients. Triglyceride (TG), high-density lipoprotein (HDL), glucose and serum DHEA-S levels were found to be associated with distal coronary embolization and slow coronary flow at PCI with stenting (DHEA-S: 1.316, OR 1.044–1.659, p = 0.020; TG: 1.130, OR 0.990–1.300, p = 0.072; HDL: 2.326, OR 0.918–5.8977, p = 0.075; glucose: 1.130, OR 0.990–1.300, p = 0.072). In the multivariable model, only DHEA-S after PCI tended to indicate a risk of distal coronary embolism (DHEA-S: p = 0.071; TG: p = 0.339; glucose: p = 0.582; HDL: p = 0.502). (4) Conclusions: Patients with ACS with higher triglyceride levels are at risk of developing slow blood flow after percutaneous intervention with stent implantation. Elevated DHEA-S possibly reflects sympathoadrenal and hypothalamus–pituitary–adrenal hyperactivity associated with ACS and coronary intervention. Full article

Heart failure, a significant global health burden, is divided into heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF), characterized by systolic dysfunction and diastolic stiffness, respectively. While HFrEF benefits from pharmacological and device-based therapies, HFpEF lacks effective treatments, with both conditions leading to high rehospitalization rates and reduced quality of life, especially in older adults with comorbidities. This review explores the role of artificial intelligence (AI) in advancing autonomic neuromodulation for heart failure management. AI enhances patient selection, optimizes stimulation strategies, and enables adaptive, closed-loop systems. In HFrEF, vagus nerve stimulation and baroreflex activation therapy improve functional status and biomarkers, while AI-driven models adjust stimulation dynamically based on physiological feedback. In HFpEF, AI aids in deep phenotyping to identify responsive subgroups for neuromodulatory interventions. Clinical tools support remote monitoring, risk assessment, and symptom detection. However, challenges like data integration, ethical oversight, and clinical adoption limit real-world application. Algorithm transparency, bias minimization, and equitable access are critical for success. Interdisciplinary collaboration and ethical innovation are essential to develop personalized, data-driven, patient-centered heart failure treatment strategies through AI-guided neuromodulation. Full article

Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, poses a significant burden on global morbidity and healthcare expenditure. Although endocardial catheter ablation and surgical ablation are established therapeutic strategies, each exhibits inherent limitations in achieving comprehensive substrate modification. Hybrid ablation therapy, integrating both endocardial and epicardial approaches, aims to overcome these limitations by enabling the more extensive and transmural targeting of arrhythmogenic foci and the complex atrial substrate. This review synthesizes the electrophysiological basis and mechanistic rationale underpinning hybrid AF ablation, highlighting its potential for an enhanced efficacy compared to isolated techniques. Furthermore, it introduces the emerging paradigm of three-dimensional ablation within this evolving field. Full article

Late gadolinium enhancements (LGEs) appear in asymptomatic individuals as septal stripes, which mimic abnormal LGEs in patients with dilated cardiomyopathy (DCM). We aimed to evaluate the frequency and extent of LGE variation in asymptomatic individuals and to compare it with those of DCM group. This retrospective study included asymptomatic and DCM groups who underwent CMR imaging. LGE was defined as a myocardial signal intensity higher than five standard-deviations of normal myocardium. LGE was evaluated in right ventricular insertion points (RVIPs) and mid-interventricular septum. A total of 273 asymptomatic individuals (age, 54.3 ± 5.8 years, 209 males) and 100 patients with DCM (age, 55.3 ± 4.9 years, 73 males) were included. LGE was observed in 99.3% of asymptomatic and 100% of DCM groups. The average number of myocardial segments with LGE was distinguishable between asymptomatic and DCM groups (5.5 ± 1.7 vs. 7.6 ± 2.2; p < 0.001). The thickness of LGE differed between two groups in mid-septum (4.5 ± 1.3 mm vs. 5.7 ± 1.8 mm; p < 0.001), upper RVIP (6.1 ± 1.9 mm vs. 8.7 ± 2.7 mm; p < 0.001), and lower RVIP (6.4 ± 2.3 mm vs. 8.6 ± 2.8 mm; p < 0.001). Considerable overlap was observed in LGE between asymptomatic and DCM groups despite different LGE characteristics between them. LGEs within normal range should not be interpreted as abnormal findings in the evaluation of myocardial diseases including DCM. Full article

Mitral annular disjunction (MAD) is an increasingly recognized structural abnormality of the mitral valve apparatus, often associated with mitral valve prolapse and a heightened risk of ventricular arrhythmias and sudden cardiac death. It is defined by a separation between the mitral annulus and the left ventricular myocardium, best visualized during systole. In this review, we present an updated and comprehensive overview of MAD, drawing from recent large-scale imaging studies, expert consensus documents, and newly proposed classifications such as true versus pseudo-MAD. We discuss its prevalence, anatomical features, and diagnostic challenges across multiple imaging modalities, including transthoracic and transesophageal echocardiography, cardiovascular magnetic resonance, and computed tomography. We also explore its pathophysiological role in arrhythmogenesis, its prognostic implications, and current management strategies. Special attention is given to risk stratification based on imaging and cardiac rhythm findings, and we propose a practical clinical framework to guide decision-making. This review aims to support clinicians in recognizing MAD as a potentially arrhythmogenic condition that requires systematic evaluation and follow-up. Full article

Heart failure (HF) is characterized by adverse myocardial remodeling involving both the contractile cardiomyocytes and the conduction tissue. HF is often associated with atrioventricular (AV) node dysfunction, which frequently leads to conduction delays and subsequent dyssynchrony ultimately related to adverse clinical outcomes. Despite its clinical relevance, AV node pathology in HF remains poorly explored. This review aims to investigate the pathophysiology underlying AV node dysfunction and the clinical implications for patients with HF, and to provide an overview of current therapeutic approaches, including an analysis of potential future treatments. Full article

Objectives: This single-center retrospective comparative cohort study aimed to compare the outcomes of aortic valve replacement using a Perceval sutureless bioprosthesis versus a conventional stented bioprosthesis in patients with symptomatic severe aortic valve stenosis. Methods: A total of 233 consecutive elective patients undergoing aortic valve replacement (AVR) at the University Clinical Center of Serbia (July 2017–March 2021) were analyzed: 74 received a Perceval sutureless valve, and 159 received a conventional stented valve. Results: The baseline characteristics were similar between the groups, with most patients being male (54.1% vs. 56.6%), with a mean age of 72.6 years. Combined aortic valve replacement and coronary artery bypass grafting were performed in 19.3% of the patients. Mean aortic cross-clamp (ACC) time was significantly shorter in the Perceval group for combined procedures (104.5 ± 29.6 min, p < 0.05) but similar in isolated AVR, likely reflecting the early institutional learning curve. Thirty-day mortality was comparable (5.9% vs. 6.3%). Importantly, at 36 months, survival was higher in the Perceval group (88.3% vs. 76.8%, p = 0.048). Longer echocardiographic follow-up (up to 58 months) was available for the Perceval group. Conclusions: Perceval sutureless bioprostheses are a safe and effective option for elderly high-risk patients. The extended echocardiographic follow-up represents a novel contribution to the literature, although further data on long-term durability are needed. Full article

Perinatal cardiovascular disease accounts for nearly one-third of pregnancy-related deaths, with nearly 70% of these deaths preventable with appropriate cardio-obstetric care. The objective is to assess whether socioeconomic disadvantage, utilizing area deprivation index national and state rankings as a proxy, contributes to a higher risk of CV disease during the perinatal period. A single-site retrospective cohort study of 388 electronic health records patients seen at a novel cardio-obstetrics program between June 2022 and May 2024 was conducted. The main exposure was ADI state rankings, and the primary outcome of interest was diagnosis of perinatal CV disease, with secondary measures including preeclampsia, hypertension, and peripartum cardiomyopathy. Multivariable logistic regression models were utilized to examine the association between ADI and perinatal CV disease. National ADI ranking was associated with an increased odds of developing preeclampsia (OR: 2.56, 95% CI: 1.12–5.89) and HTN (OR: 2.37, 95% CI: 1.19–4.72). Socioeconomic disadvantage during the perinatal period is associated with a statistically significant risk of CV disease, including preeclampsia, hypertension, and peripartum cardiomyopathy, as well as any CV diagnosis in general. Full article

Background: After recovery from acute sepsis, patients can exhibit left ventricular systolic dysfunction (LVSD) and non-ischaemic myocardial fibrosis. The relationship between myocardial fibrosis and LVSD remains poorly defined. This study sought to fill this knowledge gap using quantitative late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). Methods: Twenty-eight sepsis survivors underwent CMR at 1.5-Tesla for the assessment of cardiac volumes, systolic function and LGE. Myocardial fibrosis burden was derived quantitatively by LGE, expressed as a percentage of LV mass. Results: Study patients (age 51 ± 16 years; 57% males) had a median LVEF of 59% (IQR: 43–64) of whom 43% had LVSD (LV ejection fraction [LVEF] < 50%). LGE was found in 64% of the study patients by visual assessment, mostly in non-ischaemic patterns. The overall myocardial fibrosis burden was 3.3% (IQR: 0.9–7.1) of LV mass. Myocardial fibrosis burden was inversely correlated to LVEF in sepsis survivors (Rho = -0.385; p = 0.043). Patients with LVSD had greater myocardial fibrosis burden than patients without LVSD (7.3 ± 6.0% vs. 3.1 ± 2.5%; p = 0.041). Myocardial fibrosis burden was not significantly influenced by the presence of major co-morbidities. Conclusions: Myocardial fibrosis burden may play a role in LV dysfunction in sepsis survivors. Further work is needed to better understand its prognostic value. Full article

Radiographic axial spondyloarthritis (r-axSpA) is associated with increased cardiovascular disease (CVD) risk. The coronary artery calcification (CAC) score, an atherosclerosis burden indicator that predicts CVD risk, is not well studied in r-axSpA. This study investigates CAC scores in patients with r-axSpA compared to controls without rheumatic disease and factors associated with CAC scores in r-axSpA patients. Fifty-eight r-axSpA patients from southwestern Sweden were assessed cross-sectionally using clinical disease measures, physical function, spinal mobility, lipid profiles, inflammation markers, and long-term time-averaged C-reactive protein (CRP). Four controls per patient were selected from the Swedish CArdioPulmonary bioImage Study (SCAPIS). CAC was scored on cardiac computed tomography (CT) using the Agatston method. The presence of CAC in the right coronary artery (RCA) was higher in patients compared to controls. However, no significant difference in total CAC scores was observed between r-axSpA patients and controls, despite numerically higher total CAC scores in patients. In r-axSpA patients, CAC scores correlated positively with time-averaged CRP, reduced physical function, and impaired spinal mobility. These findings suggest that chronic inflammation may contribute to coronary calcification and CVD risk in r-axSpA, highlighting the need for effective anti-inflammatory treatments. Further research is warranted to explore the association between coronary calcification, spinal immobility, and limitations in physical function. Full article

Introduction: Previous studies have reported sex differences in stroke. There are few Asian studies. This study was performed to investigate sex differences in stroke risk factors and mechanisms in a multi-ethnic Asian population. Methods: Data on patients admitted to Raffles Hospital for stroke were analysed. Data were extracted on sex, age, hypertension, diabetes mellitus (DM), hyperlipidaemia, smoking, heart disease, and prior cerebrovascular events (pCeVD). Stroke was subtyped into haemorrhagic stroke (HS) or ischaemic stroke (IS) based on brain scan. IS mechanism was categorised using Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, while the clinical syndrome by Oxfordshire Community Stroke Project (OCSP) classification. Results: Data were collected on 1165 patients, mean age 65.6 ± 12.9 yr; 47.4% female, 83.0% Chinese, with hypertension (63.5%) and hyperlipidaemia (60.3%) being the most common risk factors. HS comprised 23.5%. On regression analysis, compared to males, females had older age (OR 1.03, 95%CI 1.02–10.4) and DM (OR 1.60, 95%CI 1.11–2.30), but less smoking (OR 0.09, 95%CI 0.07–0.13), pCeVD (OR 0.67, 95%CI 0.49–0.93), and HS (OR 0.71, 95%CI 0.51–0.98). There were no differences in HS mechanisms, or IS mechanisms or syndromes. Sex–ethnic differences were found (p < 0.001), with more Chinese and fewer Indians among females compared to males. Conclusions: This study corroborates previous studies of significantly older age and more diabetes mellitus, but less smoking and haemorrhagic stroke among female stroke patients compared to males; differences in HS and IS mechanisms were not found. Novel in this study is that sex–ethnicity differences were found. Future studies should prospectively validate these sex/ethnic differences. Full article

Abnormal aortic elasticity serves as a marker for cardiovascular mortality and has a negative impact on the left ventricular (LV) afterload. Noncompaction cardiomyopathy (NCCM) is characterized by hypertrabeculation of the LV endomyocardial wall, with an underdeveloped endocardial helix. This may result in absence of LV twist, disturbed aortic elasticity, LV dysfunction, and ultimately premature heart failure (HF). This study compared the aortic stiffness and clinical outcome in patients with NCCM to that of a control group with dilated cardiomyopathy (DCM). Sixty NCCM patients, matched by age and sex, were compared with 60 DCM controls. Transthoracic echocardiography was performed to measure the systolic (SD) and diastolic diameters (DD) of the ascending aorta. These measurements, along with systolic (SBP) and diastolic blood pressure (DBP), were utilized to calculate the aortic stiffness index defined as ln(SBP/DBP)/[(SD-DD)/DD]. This index was then compared to clinical features and outcome. The mean age was 49 ± 16 years (55% males) in the NCCM group and 49 ± 16 years (55% male) in the DCM group. Aortic stiffness index (ASI) was significantly higher in the NCCM group than in the DCM group (7.0 [5.8–10.2] vs. 6.2 [4.8–7.7], p = 0.011). This difference remained statistically significant after adjustment for established risk factors associated with aortic stiffness (β = 1.771; 95% CI [0.253–3.289], p = 0.023). Patients with NCCM demonstrated increased aortic stiffness when compared to those with DCM, which may reflect the underlying pathophysiological processes. Additional research is necessary to evaluate the impact of aortic stiffness on the advancement of LV dysfunction, the onset of heart failure, and long-term outcomes. Full article

Heart failure (HF) is a major global health challenge, characterized by high morbidity, mortality, and frequent hospital readmissions. Despite the advent of guideline-directed medical therapies (GDMTs), the burden of HF continues to grow, necessitating a shift toward comprehensive, multidisciplinary care models. Heart Failure Disease Management Programs (HF-DMPs) have emerged as structured frameworks that integrate evidence-based medical therapy, patient education, telemonitoring, and support for social determinants of health to optimize outcomes and reduce healthcare costs. This review outlines the key components of HF-DMPs, including patient identification and risk stratification, pharmacologic optimization, team-based care, transitional follow-up, remote monitoring, performance metrics, and social support systems. Incorporating tools such as artificial intelligence, pharmacist-led titration, and community health worker support, HF-DMPs represent a scalable approach to improving care delivery. The success of these programs depends on tailored interventions, interdisciplinary collaboration, and health equity-driven strategies. Full article

Background: While epicardial adipose tissue (EAT) is a known predictor of adverse cardiovascular outcomes, lipomatous hypertrophy of the interatrial septum (LHIS) is composed of metabolically active fat such as brown adipose tissue, which may exert a different effect. This study investigates the coronary atherosclerosis profile in patients with LHIS using CTA, compared with a propensity score-matched control group. Methods: A total of 142 patients were included (n = 71 with LHIS and n = 71 controls) and propensity score-matched for age, gender, BMI, and the major CV risk factors (matching level, <0.05). CTA imaging parameters included HRP, coronary stenosis severity (CADRADS), and CAC score. Results: The mean age was 60.9 years +/− 10.6, there were nine (6.3%) women, and the mean BMI is 28.04 kg/m² +/− 4.99. HRP prevalence was significantly lower in LHIS patients vs. controls (21.1% vs. 40.8%; p < 0.011), while CAC (p = 0.827) and CADRADS (p = 0.329) were not different, and there was no difference in the obstructive disease rate. There was no difference in lipid panels (cholesterol, LDL, HDL, TG) and statin intake rate. Conclusions: HRP prevalence is lower in patients with LHIS than controls, while coronary stenosis severity and CAC score are not different. Clinical relevance: LHIS may serve as imaging biomarker for reversed CV risk. Full article

Elevated levels of atherogenic lipoproteins are known to be associated with an increased risk of incident and recurrent cardiovascular events. Knowing that the immediate post-acute coronary syndrome (ACS) period is associated with the maximum risk of recurrent events, the gradual escalation of therapy allows the patient to remain above the targets during the most vulnerable period. In addition, the percentage of lipid-lowering levels for each class of drugs is predictable and has a ceiling. Hence, it is prudent to immediately start with a combination of lipid-lowering drugs following ACS according to the baseline lipid levels. Multiple studies with injectable lipid-lowering agents (PCSK9 inhibitors) such as EVOPACS, PACMAN MI, and HUYGENS MI have shown the feasibility of achieving LDL-C goals by day 28 and beneficial plaque modification in non-infarct-related coronary arteries. Recently, a study from India demonstrated that an upfront triple combination of oral lipid-lowering agents was able to achieve LDL-C goals in a majority of patients in the early post-ACS period. This notion is also supported by a few recent lipid-lowering guidelines advocating for an upfront dual combination of a high-intensity statin and ezetimibe following ACS. Henceforth, the goal should not only be the achievement of lipid targets but also their early achievement. However, the impact of this strategy on long-term cardiovascular outcomes is yet to be ascertained. Full article

Anodal capture, characterized by a different QRS morphology compared to cathodal capture, is a well-known issue in cardiac resynchronization therapy (CRT). Left bundle branch area pacing (LBBAP), a novel physiological pacing technique, is also used as a bailout strategy following failed conventional CRT implantation. In LBBAP, QRS transition, defined by a change in paced QRS morphology, serves as a key marker of successful lead placement. This case report is the first to document both high-output anodal capture and LBBAP-induced QRS transition in a single individual receiving LBBAP with an implantable cardioverter–defibrillator (ICD) as a bailout strategy for failed cardiac resynchronization therapy with defibrillator (CRT-D) implantation. Their coexistence underscores unique device optimization challenges in this emerging approach. Full article

Background: The influence of the initial ablation modality on pulmonary vein (PV) reconnection and substrate characteristics in redo procedures for recurrent atrial fibrillation (AF) remains unclear. We assessed how different thermal strategies—ablation index (AI)-guided radiofrequency (RF) versus cryoballoon (CB) ablation—affect remapping findings during redo pulmonary vein isolation (PVI). Methods: We included patients undergoing redo ablation between 2015 and 2024 with high-density electroanatomic mapping. Initial PVI modalities were retrospectively classified as low-power, long-duration (LPLD) RF; high-power, short-duration (HPSD) RF; or second-/third-generation CB. Reconnection sites were mapped using multielectrode catheters. Redo PVI was performed using AI-guided RF. Segments showing PV reconnection were reisolated; if all PVs remained isolated and AF persisted, posterior wall isolation was performed. Results: Among 195 patients (LPLD: 63; HPSD: 30; CB: 102), complete PVI at redo was observed in 0% (LPLD), 23.3% (HPSD), and 10.1% (CB) (p < 0.01 for LPLD vs. HPSD). Reconnection patterns varied by technique; LPLD primarily affected the right carina, while HPSD and CB showed reconnections at the LSPV ridge. Organized atrial tachycardia was least frequent after CB (12.7%, p < 0.002). Conclusion: Initial ablation strategy significantly influences PV reconnection and post-PVI arrhythmia patterns, with implications for redo procedure planning. Full article

Aims: Sinus tachycardia after heart transplantation (HTX) due to cardiac graft denervation is associated with reduced post-transplant survival and requires adequate treatment. We analyzed the long-term effects of heart rate control with ivabradine or metoprolol succinate in HTX recipients. Methods: This observational retrospective single-center study analyzed the ten-year results of 110 patients receiving ivabradine (n = 54) or metoprolol succinate (n = 56) after HTX. Analysis included comparison of demographics, medications, heart rates, blood pressure values, echocardiographic features, cardiac catheterization data, cardiac biomarkers, and post-transplant survival including causes of death. Results: Both groups showed no significant differences concerning demographics or medications (except for ivabradine and metoprolol succinate). At 10-year follow-up, HTX recipients with ivabradine showed a significantly lower heart rate (72.7 ± 8.5 bpm) compared to baseline (88.8 ± 7.6 bpm; p < 0.001) and to metoprolol succinate (80.1 ± 8.1 bpm; p < 0.001), a significantly lower NT-proBNP level (588.4 ± 461.4 pg/mL) compared to baseline (3849.7 ± 1960.0 pg/mL; p < 0.001) and to metoprolol succinate (1229.0 ± 1098.6 pg/mL; p = 0.005), a significantly lower overall mortality (20.4% versus 46.4%; p = 0.004), and mortality due to graft failure (1.9% versus 21.4%; p = 0.001). Multivariate analysis showed a significantly decreased risk of death within 10 years after HTX in patients with post-transplant use of ivabradine (HR 0.374, CI 0.182–0.770; p = 0.008). Conclusions: In this single-center trial, patients with ivabradine revealed a significantly more pronounced heart rate reduction, a lower NT-proBNP level, and a superior 10-year survival after HTX. Full article

Background: Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic valve stenosis (AS). Balloon post-dilatation (PD) remains an important procedural step to optimize valve function by resolving incomplete valve expansion, which may lead to paravalvular regurgitation and other potentially adverse effects. There are only limited data on the predictors, incidence, and clinical impact of PD during TAVI. Methods: This retrospective, single-center study analyzed 585 patients who underwent TAVI (2016–2022). Pre-procedural evaluations included transthoracic echocardiography and CT angiography to assess key parameters, including the aortic valve calcium score (AVCS); aortic valve calcium density (AVCd); aortic valve maximal systolic transvalvular flow velocity (AV Vmax); and aortic valve mean systolic pressure gradient (AV MPG). We identified imaging predictors of PD and evaluated associated clinical outcomes by analyzing procedural endpoints (according to VARC-3 criteria) and long-term survival. Results: PD was performed on 67 out of 585 patients, with elevated AV Vmax (OR: 1.424, 95% CI: 1.039–1.950; p = 0.028) and AVCd (OR: 1.618, 95% CI: 1.227–2.132; p = 0.001) emerging as a significant independent predictor for PD in TAVI. Kaplan–Meier survival analysis revealed no significant differences in short- and mid-term survival between patients who underwent PD and those who did not. Interestingly, patients requiring PD exhibited a lower incidence of adverse events regarding major vascular complications, permanent pacemaker implantations and stroke. Conclusions: The study highlights AV Vmax and AVCd as key predictors of PD. Importantly, PD was not associated with increased procedural adverse events and did not predict adverse events in this contemporary cohort. Full article

The objective of the present study was to evaluate the association between liver cirrhosis (LC) and subsequent Heart failure (HF). This retrospective cohort study utilized data from the Disease Analyzer database (IQVIA) and included adults with a first-time diagnosis of LC in 1293 general practices in Germany between January 2005 and December 2023. A comparison cohort without liver diseases was matched to the cirrhosis group using 5:1 propensity score matching. Univariable Cox proportional hazards models were used to assess the association between alcoholic vs. non-alcoholic LC and HF. The final study cohort included 5530 patients with alcoholic LC and 27,650 matched patients without liver disease, as well as 7063 patients with non-alcoholic LC and 35,315 matched patients without liver disease. After up to 10 years of follow-up, HF was diagnosed in 20.9% of patients with alcoholic LC compared to 10.3% of matched cohort, and in 23.0% of patients with non-alcoholic LC, compared to 14.2% in matched cohort. Alcoholic LC (Hazard Ratio (HR): 2.07 (95% CI: 1.85–2.31) and non-alcoholic LC (HR: 1.70; 95% CI: 1.56–1.82) were associated with an increased risk of HF. The association was also stronger in men than in women. LC, both alcoholic and non-alcoholic, is significantly associated with an increased long-term risk of HF. The association is particularly pronounced in patients with alcoholic cirrhosis and in men. To the best of the authors’ knowledge, this is the first real-world evidence for the positive association between LC and subsequent HF from Europe. Full article

This review explores the advantages of ivabradine in the management of cardiac surgery patients, particularly highlighting its heart rate (HR)-reducing properties, its role in minimizing the impact of atrial fibrillation, and its contributions to improving left ventricular diastolic function, as well as reducing pain, stress, and anxiety. In parallel, studies provide evidence that ivabradine influences endothelial inflammatory responses through mechanisms such as biomechanical modulation. Unlike traditional beta-blockers that may induce hypotension, ivabradine selectively inhibits hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, allowing for effective HR reduction without compromising blood pressure stability. This characteristic is particularly beneficial for patients at risk of atrial fibrillation post-surgery, where HR control is crucial for cardiovascular stability. This is an area in which ivabradine appears to play a role prophylactically, possibly in combination with beta-blockers. Furthermore, ivabradine has been associated with enhanced diastolic parameters in left ventricular function, reflecting its potential to improve surgical outcomes in patients with compromised heart function. In addition to its cardiovascular benefits, it appears to alleviate psychological stress and anxiety, common in postoperative settings, by moderating the neuroendocrine response to stress, thereby reducing stress-induced hormone levels. Furthermore, it has notable analgesic properties, contributing to pain management through its action on HCN channels in both the peripheral and central nervous systems. Collectively, these findings indicate that ivabradine may serve as a valuable therapeutic agent in the perioperative care of cardiac surgery patients, addressing both physiological and psychological challenges during recovery. Full article

Tricuspid regurgitation (TR) is a well-recognized factor contributing to adverse outcomes and mortality. Recent developments in transcatheter valve repair techniques, with the emergence of tricuspid transcatheter edge-to-edge repair (TEER) devices, have altered the treatment algorithm of TR and now offer a safe and feasible alternative for the effective management of the disease and an improvement in patient symptoms. Evidence from large studies and registries showcases the benefit of tricuspid interventions in terms of heart failure hospitalization and quality of life; however, most studies do not report a significant benefit in terms of hard outcomes. Even though longer-term follow-up may be needed to identify such differences, it is important to also identify distinct patient phenotypes that would benefit the most from such interventions, moving from pure anatomical criteria to an overall assessment of the patient’s clinical status. Therefore, the aim of this review is to provide updates on potential moderators of the effect of tricuspid TEER, focusing on novel anatomical criteria, right cardiac function, and renal physiology, in order to guide patient selection and provide an insightful discussion on the optimal patient phenotype for future trial design. Full article

(1) Background: Comparison of clinical outcomes between patients with moderate-severe aortic valve stenosis and those with mild or no aortic valve stenosis undergoing surgical revascularization for critical limb threating ischemia (CLTI). (2) Methods: Single center retrospective analysis of consecutive patients undergoing surgical lower limb revascularization with femoro-distal bypass for critical ischemia between 2016 and 2022. All patients were evaluated preoperatively by echocardiographic examination and divided into two cohorts: group A with moderate-severe aortic valve stenosis (AVA-cm² < or =1.5 cm²) and group B with mild or absent stenosis (AVA-cm² > 1.5 cm²). Primary outcomes were major limb amputation and mortality between the two groups. The rate of major cardiovascular events (stroke, myocardial infarction, sudden cardiac death) and change in “preoperative functional status” were the secondary outcomes. Descriptive statistics for continuous variables were performed by calculating means, standard deviation (SD) medians, and interquartile range (IQR) while, for categorical variables, frequencies and percentages were performed. Intergroup comparison tests, for continuous variables, were performed by t-test or corresponding nonparametric tests (Mann-Whitney test) while, for categorical variables, Chi-square test was used. Evaluation of cut-offs for the variable AVA-fx-cm², in terms of predictive of outcome outcomes, was calculated by ROC curves. Comparison between clinical and outcome variables was performed using logistic regression models. A total of 316 patients were analyzed and divided in two groups: 50 (16%) patients with moderate or severe aortic valve stenosis (group A) and 266 (84%) with no or mild aortic valve stenosis (AVA > 1.5 cm²). Patients in group A were significantly older than those in group B (78 years vs. 74 years, p value = 0.005); no other significant comorbidity differences were found between the two groups. The mean follow-up was 1178 days (SD 991 days; 2–3869 days). There were no statistically significant differences between group A and group B in terms of major amputation rate (20% vs. 16.5%; p = 0.895) and overall mortality (48.0% vs. 40.6%; p = 0.640). In the total cohort, the statistically significant variables associated with the major amputation were systemic perioperative complication (OR 5.83, 95% CI: 2.36, 14.57, p < 0.001), bypass-related complication within 30 days of surgery (OR 2.74, 95% CI: 1.17, 6.45, p = 0.020), surgical revascularization below the knee (OR 7.72, 95% CI: 1.53, 140.68, p = 0.049), and the presence of a previous cardiovascular event (OR 2.65, 95% CI: 1.14, 6.26, p = 0.024). In patients undergoing surgical revascularization for CLTI, no significant difference in major amputation rate and overall mortality was found between subjects with mild or no aortic valve stenosis and those with moderate/severe stenosis. As expected, overall mortality was higher in older patients with worse functional status. A significantly higher rate of limb amputation was found in those subjects undergoing subgenicular revascularization, early bypass failure, or previous cardiovascular event. Full article

Cardiac devices have transformed the management of heart failure, ventricular arrhythmias, ischemic cardiomyopathy, and valvular heart disease. Technologies such as cardiac resynchronization therapy (CRT), conduction system pacing, left ventricular assist devices (LVADs), and implantable cardioverter-defibrillators have contributed to abated global cardiovascular risk through action onto pathophysiological processes such as mechanical unloading, electrical resynchronization, or hemodynamic optimization, respectively. While their clinical benefits are well established, their long-term molecular and structural effects on the myocardium remain under investigation. Cardiac devices dynamically interact with myocardial and vascular biology, inducing molecular and extracellular matrix adaptations that vary by pathology. CRT enhances calcium cycling and reduces fibrosis, but chronic pacing may lead to pacing-induced cardiomyopathy. LVADs and Impella relieve ventricular workload yet alter sarcomeric integrity and mitochondrial function. Transcatheter valve therapies influence ventricular remodeling, conduction, and coronary flow. Understanding these remodeling processes is crucial for optimizing patient selection, device programming, and therapeutic strategies. This narrative review integrates the current knowledge on the molecular and structural effects of cardiac devices, highlighting their impact across different disease settings. Full article

Heart failure (HF) and left ventricular hypertrophy (LVH) are linked to fibroblast growth factor 23 (FGF23). This study aims to analyze whether FGF23 can predict postoperative outcomes in unselected left ventricular assist device (LVAD) candidates. Methods: We conducted a prospective observational study that included 27 patients (25 HeartMate3 and 2 HeartMateII) with a median follow-up of 30 months. We measured preoperative FGF23 plasma levels and computed the HeartMateII risk score (HMRS), the HeartMate3 risk score (HM3RS) and the EuroSCOREII with respect to postoperative mortality, as well as the Michigan right heart failure risk score (MRHFS), the Euromacs RHF risk score (EURORHFS), the CRITT score with respect to RHF prediction and the kidney failure risk equation (KFRE) with respect to kidney failure. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: In the multivariate logistic regression, preoperative FGF23 level was found to be a predictor of postoperative RHF (OR: 1.37, 95-CI: 0.78–2.38; p = 0.031), mortality (OR: 1.10, 95%-CI: 0.90–1.60; p = 0.025) and the need for postoperative dialysis (OR: 1.09, 95%-CI: 0.91–1.44; p = 0.032). In the ROC analysis, FGF23 as a predictor of post-LVAD RHF had an area under the curve (AUC) of 0.81. Conclusions: FGF23 improves the prediction of clinically significant patient outcomes—such as need for dialysis, RHF and mortality—after HM3 and HMII implantation, as adding FGF23 to established risk scores increased their predictive value. Full article