Journal of Cardiovascular Development and Disease

21 pages, 577 KB

Open AccessReview

Between a Rock and a Hard Place: Balancing Embolic Stroke and Intracerebral Hemorrhage Risk in Left Atrial Appendage Occlusion

by Juan Felipe Daza-Ovalle, Johanna Seiden, Daniel Labovitz, Erick Daniel Martinez, Deepti Athreya and Charles Esenwa

J. Cardiovasc. Dev. Dis. 2026, 13(3), 148; https://doi.org/10.3390/jcdd13030148 - 23 Mar 2026

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Abstract

Patients with atrial fibrillation (AF) who are not candidates for long-term anticoagulation present a complex therapeutic dilemma due to competing risks of cardioembolic stroke and intracerebral hemorrhage (ICH). This challenge is particularly pronounced in neurologically vulnerable individuals, including those with prior ICH, cerebral [...] Read more.

Patients with atrial fibrillation (AF) who are not candidates for long-term anticoagulation present a complex therapeutic dilemma due to competing risks of cardioembolic stroke and intracerebral hemorrhage (ICH). This challenge is particularly pronounced in neurologically vulnerable individuals, including those with prior ICH, cerebral amyloid angiopathy (CAA), or neuroimaging markers of cerebral small vessel disease (SVD). Left atrial appendage occlusion (LAAO) has emerged as an alternative stroke prevention strategy for patients with contraindications to anticoagulation; however, optimal patient selection and post-procedural antithrombotic management remain uncertain, largely because existing bleeding risk scores inadequately capture ICH risk. Most hemorrhagic risk scores were designed to estimate systemic bleeding and demonstrate limited ability to predict ICH, as they do not incorporate hemorrhage etiology or neuroimaging features. Importantly, ICH recurrence risk varies substantially by subtype, with the highest risk observed in CAA-related hemorrhage, the lowest in hypertensive SVD, and intermediate risk in mixed or secondary etiologies. These distinctions have direct implications for anticoagulation decisions and consideration of LAAO. Finally, we synthesize contemporary evidence on ICH risk stratification, neuroimaging biomarkers, and antithrombotic strategies following LAAO. We propose a multidisciplinary, evidence-based decision-making framework integrating clinical risk scores, neuroimaging findings, and hemorrhage phenotype to support individualized stroke prevention strategies in high-risk patients with AF. Full article

(This article belongs to the Special Issue Controversies in Stroke and Cerebrovascular Disease)

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9 pages, 835 KB

Open AccessArticle

Vertical Right Axillary Thoracotomy for Repair of Ventricular Septal Defects in Infants and Children: Experience with 50 Consecutive Cases

by Yasin Essa, Ali H. Mashadi, Joseph Giamelli, Alexander Mittnacht, Mahmoud I. Salem and Sameh M. Said

J. Cardiovasc. Dev. Dis. 2026, 13(3), 147; https://doi.org/10.3390/jcdd13030147 - 23 Mar 2026

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Abstract

Objectives: Recently, there has been a growing interest in repairing congenital heart defects in children via right axillary thoracotomy. We sought to review our experience with ventricular septal defect closure through this approach. Patients and Methods: This is a retrospective single-center analysis of [...] Read more.

Objectives: Recently, there has been a growing interest in repairing congenital heart defects in children via right axillary thoracotomy. We sought to review our experience with ventricular septal defect closure through this approach. Patients and Methods: This is a retrospective single-center analysis of 50 children who underwent closure of ventricular septal defects via vertical right axillary thoracotomy between March 2018 and February 2024. We reviewed the patients’ characteristics, perioperative and follow-up data. Results: The study included 26 (52%) girls with a median age of 7 (1–132) months. All patients underwent vertical right axillary thoracotomy with no conversion to sternotomy. Membranous ventricular septal defect was the most common diagnosis and was present in 43 (89%) patients. The median cardiopulmonary bypass and aortic cross clamp times were 96.5 (47–157) and 73 (30–114) min, respectively. In 45 (90%) of the patients, a patch was used. No early or late mortality. All patients were extubated in the operating room, and the median length of hospital stay was 2 (1–321) days. One early reoperation for bleeding, and one patient needed a permanent pacemaker. No late reoperations and all patients/parents were pleased with the incision. Conclusions: The outcomes of the right axillary thoracotomy for repairing ventricular septal defects in children are excellent. The approach is safe and is associated with superior cosmetic results and very short hospital stay. It should be strongly considered as an alternate to sternotomy for closure of ventricular septal defects. Full article

(This article belongs to the Section Cardiac Surgery)

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14 pages, 844 KB

Open AccessArticle

Out-of-Hospital Cardiac Arrest in Southern Italy: A Retrospective Analysis of 11,653 Cases

by Luca Gregorio Giaccari, Pasquale Sansone, Nicola D’Angelo, Daniele Antonaci, Eva Epifani, Luciana Mascia, Maria Caterina Pace, Vincenzo Pota and Gaetano Tammaro

J. Cardiovasc. Dev. Dis. 2026, 13(3), 146; https://doi.org/10.3390/jcdd13030146 - 23 Mar 2026

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Abstract

(1) Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue, with survival largely determined by the initial rhythm and timeliness of resuscitation. Comprehensive population-based data are essential for guiding prevention, emergency medical services (EMS) planning, and improving outcomes. (2) Methods: We [...] Read more.

(1) Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue, with survival largely determined by the initial rhythm and timeliness of resuscitation. Comprehensive population-based data are essential for guiding prevention, emergency medical services (EMS) planning, and improving outcomes. (2) Methods: We performed a retrospective observational study of all adult OHCA cases managed by EMS in Lecce (Italy) between January 2013 and March 2025. Demographics, arrest circumstances, initial rhythm, time intervals, and return of spontaneous circulation (ROSC) were analyzed across age, sex, temporal, and pandemic-related strata. Rhythm classification followed European Resuscitation Council guidelines. (3) Results: A total of 11,653 cases were analyzed (mean age 76.8 ± 15.5 years, 56.6% male). Asystole (AS) was the predominant rhythm (88.7%), followed by ventricular fibrillation (VF, 7.6%), pulseless electrical activity (PEA, 1.3%), and pulseless ventricular tachycardia (pVT, 0.08%). VF was more common in younger and male patients, while AS increased with age. Hour-level analysis revealed circadian peaks: VF in late afternoon and AS in early morning. Pandemic analysis showed reduced VF and increased AS during COVID-19, with partial recovery post-pandemic. ROSC occurred in 3.47% overall, strongly associated with shockable rhythms. EMS response times were stable across day–night and pandemic phases. (4) Conclusions: AS dominates OHCA presentations, especially among the elderly, whereas VF remains the strongest predictor of ROSC. Circadian variation at the hourly level suggests potential for EMS optimization. Pandemic-related shifts in rhythm highlight the vulnerability of the chain of survival to societal disruptions. Strengthening bystander CPR, expanding AED availability, and tailoring EMS strategies remain key priorities for improving OHCA outcomes. Full article

(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)

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10 pages, 831 KB

Open AccessReview

Mechanical Circulatory Support in the Very Elderly Undergoing Complex High-Risk Indicated Procedures: A Case Report and Literature Review

by Giuseppe Giacchi and Antonino Nicosia

J. Cardiovasc. Dev. Dis. 2026, 13(3), 145; https://doi.org/10.3390/jcdd13030145 - 20 Mar 2026

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Abstract

Interventional treatment of very elderly patients with severe coronary artery disease is currently one of the central topics in interventional cardiology. Technological progress and increased life expectancy have made these patients appropriate candidates for contemporary standards of care, especially those with an active [...] Read more.

Interventional treatment of very elderly patients with severe coronary artery disease is currently one of the central topics in interventional cardiology. Technological progress and increased life expectancy have made these patients appropriate candidates for contemporary standards of care, especially those with an active lifestyle. We hereby report the case of a 95-year-old patient hospitalized for acute myocardial infarction, who underwent a complex percutaneous coronary intervention with mechanical circulatory support. A literature review on mechanical circulatory support devices in older adults is also provided. Full article

(This article belongs to the Special Issue Coronary Artery Disease: Risk Stratification and Optimization of Intervention Strategies)

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13 pages, 1539 KB

Open AccessArticle

Single-Site Experience in the ONSET–OFFSET Study Demonstrates Pharmacodynamic and Pharmacokinetic Advantages of Ticagrelor over Clopidogrel in Patients with Chronic Coronary Syndromes

by Heather M. Judge, William A. E. Parker and Robert F. Storey

J. Cardiovasc. Dev. Dis. 2026, 13(3), 144; https://doi.org/10.3390/jcdd13030144 - 20 Mar 2026

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Abstract

The ONSET–OFFSET study was a multicentre study assessing the pharmacodynamic responses to ticagrelor and clopidogrel in aspirin-treated patients with chronic coronary syndromes. Recent concerns have been raised about the study methodology, including at the single United Kingdom (UK) site in Sheffield. Here, we [...] Read more.

The ONSET–OFFSET study was a multicentre study assessing the pharmacodynamic responses to ticagrelor and clopidogrel in aspirin-treated patients with chronic coronary syndromes. Recent concerns have been raised about the study methodology, including at the single United Kingdom (UK) site in Sheffield. Here, we report data generated at this site along with additional analyses. The UK site recruited 40 out of 123 of the study participants. Platelet P2Y₁₂ receptor inhibition was assessed using light transmission aggregometry and whole-blood methodologies. Samples were obtained during the onset and offset dosing periods. Percentage inhibition of platelet aggregation (%IPA) was calculated with (pre-specified) and without (post hoc) truncation of values [0, 100]. Study conduct was monitored by an external contract research organisation. The results from the UK site were concordant with the main study findings. %IPA at 2 h after ticagrelor loading: main study 88%, UK site 91% (truncated), UK site 91% (untruncated). %IPA correlated with other measures of P2Y₁₂ inhibition (VerifyNow: p < 0.0001; VASP phosphorylation assay: p < 0.0001). One patient treated with ticagrelor had >2 h delay in the onset of platelet inhibition associated with co-administration of metformin. The primary endpoint for the offset period was also similar to the main study findings. The UK site data confirm the more rapid onset and offset of inhibitory effects and greater mean levels of platelet inhibition with ticagrelor compared with clopidogrel, regardless of the mode of %IPA data analysis. Study conduct was rigorously monitored in order to demonstrate the integrity and validity of the results. Metformin may delay the onset of action of a ticagrelor loading dose. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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Graphical abstract

5 pages, 192 KB

Open AccessEditorial

Transcatheter and Surgical Approaches to Addressing the Complications of Transcatheter Procedures: Current Trends and Future Challenges

by Antonio Nenna, Giovanni Casali, Giuseppe Patti and Carmelo Dominici

J. Cardiovasc. Dev. Dis. 2026, 13(3), 143; https://doi.org/10.3390/jcdd13030143 - 19 Mar 2026

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Abstract

Transcatheter structural heart procedures, including transcatheter aortic valve replacement (TAVR) and transcatheter edge-to-edge repair (TEER), have revolutionized the management of valvular heart diseases in selected or high-risk patients [...] Full article

(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)

16 pages, 653 KB

Open AccessArticle

Association Between Diet Quality, Physical Activity, and the Risk of Aortic Dissection—A Prospective Cohort Study

by Zahra Parvan, Yasmin Soltanzadeh-Naderi and Stefan Acosta

J. Cardiovasc. Dev. Dis. 2026, 13(3), 142; https://doi.org/10.3390/jcdd13030142 - 18 Mar 2026

Viewed by 283

Abstract

Background: Hypertension and smoking are well-known risk factors for aortic dissection (AD), but it is unclear whether other lifestyle factors influence the risk. The aim of this study was to investigate the association between diet quality, physical activity, and risk of AD. Methods: [...] Read more.

Background: Hypertension and smoking are well-known risk factors for aortic dissection (AD), but it is unclear whether other lifestyle factors influence the risk. The aim of this study was to investigate the association between diet quality, physical activity, and risk of AD. Methods: The study included 28,094 participants from the Malmö Diet and Cancer Study, recruited between 1991 and 1996 and followed through national health registers until 31 December 2022. Diet quality was assessed using a six-component Diet Quality Index. Incident AD was identified through ICD-9/ICD-10 codes in the Swedish National Patient Register. Associations were analyzed using Cox proportional hazards models. Results: During a median follow-up of 26.6 years, 130 participants developed AD. Higher age (HR 1.76/one standard deviation increment, 95% CI 1.41–2.20), male sex (HR 1.58, 95% CI 1.06–2.34), hypertension (HR 1.57, 95% CI 1.01–2.44), and current smoking (HR 3.04, 95% CI 1.86–4.98) were each independently associated with increased AD risk. No significant associations were found for diet quality and physical activity with AD risk. Conclusions: No associations were found between diet quality and physical activity and AD risk. Blood pressure control and smoking cessation are key preventive measures to reduce incidence of AD. Full article

(This article belongs to the Special Issue Risk Factors and Prevention of Cardiovascular Diseases—Second Edition)

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8 pages, 825 KB

Open AccessCase Report

First Reported Use of the AMDS Hybrid Prosthesis for Secondary Type A Aortic Dissection After Prior TEVAR

by Gjoko Boshkoski, Dorgam Natour, Atanas Jankulovski, Thomas Felderhoff and Aron. F. Popov

J. Cardiovasc. Dev. Dis. 2026, 13(3), 141; https://doi.org/10.3390/jcdd13030141 - 18 Mar 2026

Viewed by 267

Abstract

Type A aortic dissection represents one of the most life-threatening cardiovascular emergencies, with management strategies evolving toward hybrid and endovascular approaches, particularly in high-risk patients. The Ascyrus Medical Dissection Stent (AMDS) is an emerging adjunctive technology designed to promote true lumen expansion and [...] Read more.

Type A aortic dissection represents one of the most life-threatening cardiovascular emergencies, with management strategies evolving toward hybrid and endovascular approaches, particularly in high-risk patients. The Ascyrus Medical Dissection Stent (AMDS) is an emerging adjunctive technology designed to promote true lumen expansion and facilitate favorable aortic remodeling during open repair of acute Type A dissection. We present the first reported case of AMDS deployment in secondary Type A dissection following prior thoracic endovascular aortic repair (TEVAR). An 83-year-old female with extensive aortic history—including TEVAR in 2012 for intramural hematoma with chimney stenting to the left subclavian artery and carotid–subclavian bypass in 2013—developed acute Type A dissection extending into the existing stent graft in 2024. Emergency surgical intervention included ascending aortic replacement, aortic arch repair with AMDS implantation, aortic valve resuspension, and left atrial appendage resection under cardiopulmonary bypass and hypothermic circulatory arrest. Postoperative imaging confirmed appropriate AMDS positioning, false lumen exclusion, and preservation of prior endograft integrity. The patient tolerated the procedure well and was discharged in stable condition with favorable early follow-up outcomes. This case demonstrates the potential role of hybrid surgical strategies and adjunctive endovascular devices in managing complex, multi-stage aortic disease. Full article

(This article belongs to the Section Cardiac Surgery)

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8 pages, 203 KB

Open AccessArticle

Electrocardiographic Characteristics of Healthy Newborns During the First Postnatal Hour

by Duygu Besnili Acar and Erkut Ozturk

J. Cardiovasc. Dev. Dis. 2026, 13(3), 140; https://doi.org/10.3390/jcdd13030140 - 17 Mar 2026

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Abstract

Background: Few studies have reported electrocardiogram data collected during the neonatal period. The aim of this study was to evaluate electrocardiographic parameters in healthy neonates during the first postnatal hour. Methods: Electrocardiogram samples taken during the first hour of life from newborns born [...] Read more.

Background: Few studies have reported electrocardiogram data collected during the neonatal period. The aim of this study was to evaluate electrocardiographic parameters in healthy neonates during the first postnatal hour. Methods: Electrocardiogram samples taken during the first hour of life from newborns born at our hospital were analyzed in this prospective observational study. Demographic data and possible electrocardiogram changes were studied. The results were statistically analyzed. Results: A total of 260 patients were included during the study period. Among these, 50% were male (n = 130), the mean gestational age was 38.1 ± 1.4 weeks, and the mean birth weight was 3.2 ± 1.4 kg. In the electrocardiograms obtained, low atrial rhythm was detected in 0.3% of the patients (n = 1). Right axis deviation was observed in 1.5% of the patients (n = 4), and left axis deviation was observed in 1.2% of the patients (n = 3). An abnormal P-axis was found in one patient (0.3%), and an abnormal QRS-T angle was found in one patient (0.3%). No statistically significant differences were observed in the other parameters. Conclusion: Physiologic electrocardiographic findings can be observed during the first postnatal hour. Further studies are needed to clarify the interpretation of the electrocardiogram findings. Full article

(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)

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6 pages, 2256 KB

Open AccessCase Report

Heart Failure and a Large Ventricular Thrombus Following COVID-19 Infection

by Jouni Taavitsainen, Ville Vepsäläinen, Juha Hartikainen and Jarkko Hytönen

J. Cardiovasc. Dev. Dis. 2026, 13(3), 139; https://doi.org/10.3390/jcdd13030139 - 13 Mar 2026

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Abstract

Severe cases of heart failure (HF), both new onsets of HF and acute exacerbations of chronic HF, are frequently observed during infections. A potentially lethal complication of HF with very low left ventricular ejection fraction is thrombus formation within the heart chambers. A [...] Read more.

Severe cases of heart failure (HF), both new onsets of HF and acute exacerbations of chronic HF, are frequently observed during infections. A potentially lethal complication of HF with very low left ventricular ejection fraction is thrombus formation within the heart chambers. A 67-year-old male was admitted to our hospital with shortness of breath after a COVID-19 infection. He was diagnosed with severe acute heart failure and a massive thrombus in the left ventricle. While the thrombus subsided quickly without any observable embolic events, the patient had a lengthy hospitalization stay complicated by tachyarrhythmias and secondary infections. Eventually, his heart failure improved, and he continued to recover post-hospital discharge. We present a case of severe heart failure and intraventricular thrombosis following COVID-19 infection. The patient required potent anti-inflammatory medication in addition to conventional heart failure medication to recover from his HF. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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11 pages, 680 KB

Open AccessArticle

Left Ventricular Mechanics Are Associated with Short-Term Sinus Rhythm Maintenance After Electrical Cardioversion in Atrial Fibrillation

by Beata Uziębło-Życzkowska, Paulina Skalska, Marek Kiliszek, Małgorzata Kurpaska and Paweł Krzesiński

J. Cardiovasc. Dev. Dis. 2026, 13(3), 138; https://doi.org/10.3390/jcdd13030138 - 13 Mar 2026

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Abstract

(1) Background: Electrical cardioversion (ECV) is effective in restoring sinus rhythm (SR) in atrial fibrillation (AF), but the extent of atrioventricular remodeling and determinants of short-term rhythm maintenance remain unclear. This study evaluated echocardiographic changes following ECV and explored parameters associated with SR [...] Read more.

(1) Background: Electrical cardioversion (ECV) is effective in restoring sinus rhythm (SR) in atrial fibrillation (AF), but the extent of atrioventricular remodeling and determinants of short-term rhythm maintenance remain unclear. This study evaluated echocardiographic changes following ECV and explored parameters associated with SR persistence. (2) Methods: We prospectively enrolled 94 patients undergoing elective ECV and performed comprehensive echocardiography before, 24 h after, and 30 days after the procedure. Rhythm status was assessed at scheduled follow-up visits. Due to the limited sample size, failure to meet the assumptions required for regression analyses, and non-normal data distributions, the analyses were primarily non-parametric and exploratory. (3) Results: Among 94 patients (mean age 65.9 +/− 9.3 years; 69% male), SR was maintained in 76 patients at 24 h and 49 patients at 30 days. Patients with sustained SR showed progressive improvement in LA reservoir strain, LA emptying fraction, and LA stiffness index, consistent with reverse atrial remodeling. Left ventricular (LV) function also improved, including LV ejection fraction, global longitudinal strain, and myocardial work indices. Between-group analyses identified several baseline LV parameters (including global wasted work, global work efficiency, LV end-systolic volume, LV end-systolic diameter, and global work index) with moderate effect sizes and possible association with short-term SR maintenance. (4) Conclusions: Successful ECV is associated with significant short-term atrioventricular functional improvement. In this exploratory single-center cohort, selected LV mechanical parameters were associated with short-term SR maintenance, while LA functional parameters mainly reflected reverse remodeling after rhythm restoration. Larger studies with longer follow-up and adjusted analyses are needed. Full article

(This article belongs to the Special Issue Atrial Fibrillation: Current Considerations for Diagnosis, Therapy, and Management)

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13 pages, 891 KB

Open AccessArticle

Prognostic Impact of Frailty in Transcatheter Aortic Valve Implantation

by Ivana Jurin, Daniel Unić, Nikola Pavlović, Marin Pavlov, Savica Gjorgjievska, Tomislav Šipić, Šime Manola, Igor Rudež, Ana Šerman, Antonio Bulum, Karlo Gjuras and Irzal Hadžibegović

J. Cardiovasc. Dev. Dis. 2026, 13(3), 137; https://doi.org/10.3390/jcdd13030137 - 13 Mar 2026

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Abstract

Background: Frailty strongly influences outcomes after transcatheter aortic valve implantation (TAVI), but conventional risk models insufficiently capture functional and cognitive vulnerability. We compared conventional surgical risk scores with multidimensional frailty assessment and a biological score. Methods: This observational registry included 528 consecutive patients [...] Read more.

Background: Frailty strongly influences outcomes after transcatheter aortic valve implantation (TAVI), but conventional risk models insufficiently capture functional and cognitive vulnerability. We compared conventional surgical risk scores with multidimensional frailty assessment and a biological score. Methods: This observational registry included 528 consecutive patients with severe symptomatic aortic stenosis undergoing TAVI between January 2019 and November 2024. Frailty was assessed using the Essential Frailty Toolset (EFT), Katz Index, and cognitive screening, alongside French Aortic National CoreValve and Edwards 2 (FRANCE-2) and Age, Creatinine, and Ejection Fraction (ACEF) scores. HALP was calculated as (haemoglobin × albumin × lymphocytes) ÷ platelets. Primary endpoints were 30-day, 6-month, and 1-year all-cause mortality. Secondary outcomes included non-fatal major adverse cardiovascular events (MACE), complications, and quality-of-life improvement. Results: One-year mortality was 12.7%. EFT and Katz Index showed the strongest discrimination for 1-year mortality (AUC 0.72 and 0.75), outperforming EuroSCORE II and STS-PROM (AUC 0.66 and 0.68). After adjustment, EFT (HR 1.91, 95% CI 1.47–2.48), Katz Index (HR 0.57, 95% CI 0.47–0.70, and cognitive impairment (HR 2.24, 95% CI 1.34–3.75) independently predicted 1-year mortality. HALP was not associated with outcomes. FRANCE-2 independently predicted 1-year MACE (HR 1.24, p = 0.019). Conclusions: Functional frailty and cognitive impairment add prognostic value beyond conventional comparator models, whereas HALP does not. Brief functional and cognitive screening may help Heart Teams identify patients who need closer peri-procedural optimisation, rehabilitation planning, and discharge support rather than relying on surgical risk scores alone. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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22 pages, 1770 KB

Open AccessArticle

Walking Improves Cardiac Function: A Trial on the Effects of Walking on Left Ventricular Function in Type 2 Diabetes Patients

by Roman Leischik, Patrick Bank, Christian Erik Gerlach and Fabian Sanchis-Gomar

J. Cardiovasc. Dev. Dis. 2026, 13(3), 136; https://doi.org/10.3390/jcdd13030136 - 12 Mar 2026

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Abstract

Cardiometabolic abnormalities, which are common in diabetes patients, can be alleviated through exercise. We examined the specific effects of walking (4–5 METS) on diabetic patients’ cardiac function in a randomized study. Patients with type 2 diabetes (metformin-, insulin-, and diet-controlled; n = 32) [...] Read more.

Cardiometabolic abnormalities, which are common in diabetes patients, can be alleviated through exercise. We examined the specific effects of walking (4–5 METS) on diabetic patients’ cardiac function in a randomized study. Patients with type 2 diabetes (metformin-, insulin-, and diet-controlled; n = 32) were randomized to a 12-week walking intervention (40 min, three times/week; n = 16) or standard care (control group, n = 16). We prospectively compared metabolic, anthropometric, cardiac function and cardiorespiratory fitness parameters between the two groups via linear regression. Compared with that of the control group, the postintervention global strain of the walking group improved significantly (−19.0 (±3.0) vs. −20.9 (±2.6), Diff = −1.92 (CI = −2.61–−1.24), p < 0.001; control: −18.7 (±3.2) vs. −18.9 (±3.6), Diff = −0.19 (CI = −1.00–0.63), p = 0.650), with a pre/post between-group estimated mean difference of ~−1.73 (CI = −2.78–−0.69; p < 0.001). Abdominal circumference (−3 cm (CI = −4.41–−1.59), p < 0.001)), resting heart rate/bpm (−6.50 (CI = −9.69–−3.31, p < 0.001)) and body fat percentage (−2.74 (CI = −4.71–−0.76, p < 0.007)) changed significantly only in the walking group. Spiroergometric data revealed improved oxygen uptake in the walking group vs. the control group: abs_VO2max/L·min⁻¹ (0.19 (0.05–0.33), p < 0.008); rel_VO2max/mL·kg⁻¹·min⁻¹ (2.43 (1.03–3.83), p < 0.001). This first randomized intervention study of supervised walking in patients with type 2 diabetes demonstrated that even moderate-intensity physical activity (such as walking) can improve cardiac function and body composition, reduced waist circumference, and increased oxygen uptake, making it a cost-effective treatment with significant preventive and restorative benefits for cardiac function and body composition in these patients. Full article

(This article belongs to the Section Imaging)

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26 pages, 1900 KB

Open AccessSystematic Review

Effect Modification by Acute Coronary Syndrome Prevalence on Non-Invasive Ventilation Efficacy in Acute Cardiogenic Pulmonary Edema: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Marek Tomala, Monika Durak, Magdalena Borówka, Paweł Szkarłat and Maciej Kłaczyński

J. Cardiovasc. Dev. Dis. 2026, 13(3), 135; https://doi.org/10.3390/jcdd13030135 - 12 Mar 2026

Viewed by 394

Abstract

Non-invasive ventilation (NIV) reduces mortality in patients with acute cardiogenic pulmonary edema (ACPE). However, the 3CPO trial reported null results. Therefore, we hypothesized that the prevalence of acute coronary syndrome (ACS) would influence the effectiveness of NIV. A systematic literature review was conducted [...] Read more.

Non-invasive ventilation (NIV) reduces mortality in patients with acute cardiogenic pulmonary edema (ACPE). However, the 3CPO trial reported null results. Therefore, we hypothesized that the prevalence of acute coronary syndrome (ACS) would influence the effectiveness of NIV. A systematic literature review was conducted to identify randomized controlled trials (RCTs) comparing NIV and standard oxygen therapy in patients with ACPE from PubMed, CENTRAL, and Embase databases through December 2025. Random-effects meta-analysis and REML meta-regression were utilized, and evidence quality was evaluated using GRADE. (PROSPERO: CRD420251142245). Fourteen RCTs (n = 1967) were included in the analysis. NIV significantly reduced hospital mortality (RR 0.75, 95% CI 0.58–0.96; I² = 0%) and endotracheal intubation (RR 0.49, 95% CI 0.35–0.68). Meta-regression revealed that study-level ACS prevalence was significantly associated with the magnitude of NIV’s mortality effect (β₁ = −0.023 per 1% increase in ACS, p = 0.008; R² = 46.2%). The equilibrium point occurred at an ACS prevalence of 14.1% (95% CI 5.2–23.0%). At 3CPO’s ACS prevalence of 27%, the model predicted an RR of 0.75 (95% CI 0.58–0.97). The observed 3CPO RR was 0.97 (95% CI 0.66–1.43); the confidence intervals overlap substantially, and 3CPO was underpowered for mortality as an isolated endpoint. The mortality benefit of NIV appears to be associated with the prevalence of ACS among treated patients, though this ecological finding requires confirmation at the individual-patient level. Full article

(This article belongs to the Special Issue Acute Cardiovascular Care in the Cardiological Intensive Care Unit: What Is New?)

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12 pages, 559 KB

Open AccessArticle

Nationwide Multicentric Analysis Regarding In-Hospital Complications After Catheter Ablation of Cardiac Arrhythmias

by Florian Doldi, Christian Meyer, Johannes Brachmann, Fabienne Kreimer, Thorsten Lewalter, Roland Tilz, Malte Kuniss, Ibrahim Akin, Philipp Sommer, Thomas Riemer, Jochen Senges and Lars Eckardt

J. Cardiovasc. Dev. Dis. 2026, 13(3), 134; https://doi.org/10.3390/jcdd13030134 - 11 Mar 2026

Viewed by 357

Abstract

Objective and Background: With the increasing use of catheter ablation for tachyarrhythmias, continuous evaluation of in-hospital complications is essential. This study aimed at analyzing complications associated with catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) using nationwide administrative [...] Read more.

Objective and Background: With the increasing use of catheter ablation for tachyarrhythmias, continuous evaluation of in-hospital complications is essential. This study aimed at analyzing complications associated with catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) using nationwide administrative data. Methods: We conducted a retrospective multicentric data analysis from large German ablation centers between 2018 and 2023. Patients were identified using ICD and OPS codes for AF, AFL, and VT regarding predefined in-hospital complications: mortality, stroke, pericardial tamponade, pulmonary embolism, and vascular complications requiring intervention. Results: Among 19,258 ablation procedures from 11 centers, AF was most common (n = 12,241), followed by AFL (n = 5582) and VT (n = 1435). Major complications occurred in 2.2% (n = 433) of cases. VT ablations had the highest complication rate (9.8%), followed by AF (1.6%) and AFL (1.7%). Pericardial tamponade occurred in 0.9% patients, most commonly in VT ablations (4.0%). Vascular complications requiring intervention were reported in 1.1%, while stroke (0.3%) and pulmonary embolism (0.05%) were rare. In-hospital mortality was highest in VT patients (2.4%), compared to AF (0.08%) and AFL (0.13%). Higher AFL mortality as compared to AF was associated with older age and more comorbidities. Upon exploratory analysis, no statistical association between hospital volume and complication rates could be seen. Conclusions: In this multicenter analysis, catheter ablation was associated with a low overall complication rate. VT ablations carried the highest risk, highlighting the impact of structural heart disease and comorbidities. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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16 pages, 1600 KB

Open AccessArticle

Prognostic Value of a Composite Inflammation–Renal Function Score in Type A Aortic Dissection

by Rui-Qin Zhou, Yin-Ding Peng, Hao Cai, Cheng Zhang and Qing-Chen Wu

J. Cardiovasc. Dev. Dis. 2026, 13(3), 133; https://doi.org/10.3390/jcdd13030133 - 11 Mar 2026

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Abstract

Background and Objectives: Systemic inflammation and renal dysfunction play a central role in the progression and prognosis of type A aortic dissection (TAAD). This study evaluated the SCr score, a composite index combining the systemic inflammation response index (SIRI) and serum creatinine, to [...] Read more.

Background and Objectives: Systemic inflammation and renal dysfunction play a central role in the progression and prognosis of type A aortic dissection (TAAD). This study evaluated the SCr score, a composite index combining the systemic inflammation response index (SIRI) and serum creatinine, to assess its prognostic value postoperatively. Materials and Methods: Clinical data from 299 surgically treated TAAD patients were retrospectively analyzed. SCr scores were stratified into three levels using optimal cutoffs. Survival differences were examined using Kaplan–Meier curves. Independent predictors of overall survival (OS) and in-hospital mortality (IHM) were identified through multivariable Cox and logistic regression, respectively. A prognostic nomogram integrating SCr and significant clinical variables was developed, and model performance was evaluated and compared with previously published models. Results: Higher SCr scores were associated with a progressively increased mortality risk. In multivariable Cox analysis, both SCr scores of 1 and 2 emerged as independent predictors of worse long-term survival, with SCr = 2 demonstrating a particularly strong association (hazard ratio (HR) = 4.408, 95% confidence interval (CI): 1.786–10.881; p = 0.001). In logistic regression analysis, SCr scores remained an independent predictor of IHM (SCr = 1: odds ratio (OR) = 3.066, 95% CI: 1.032–9.102; SCr = 2: OR = 4.811, 95% CI: 1.081–21.409; p < 0.05 for both). A prognostic nomogram based on the SCr score and other clinical variables achieved strong discrimination for OS (area under the curve [AUC]: 0.845) and IHM (AUC: 0.821). Conclusions: The SCr score was independently associated with preoperative risk in patients with TAAD. An SCr-incorporating nomogram demonstrated favorable discriminative performance for predicting overall survival and in-hospital mortality. These findings suggest that SCr-based assessment may provide complementary information and assist in the identification of high-risk patients within established clinical assessment frameworks. Full article

(This article belongs to the Special Issue Aortic Surgery—Back to the Roots and Looking to the Future)

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9 pages, 11089 KB

Open AccessCase Report

The Co-Occurrence of Pertrochanteric Fracture and Acute Coronary Syndrome in a Geriatric Patient: A Case Report and Review of the Literature

by Jozef Dodulík, Jiří Demel, Jan Mrózek, Jiří Vrtal, Jiří Plášek and Jan Václavík

J. Cardiovasc. Dev. Dis. 2026, 13(3), 132; https://doi.org/10.3390/jcdd13030132 - 11 Mar 2026

Viewed by 273

Abstract

Background: Managing elderly patients with simultaneous acute cardiovascular and orthopedic emergencies presents a unique challenge. While ST-elevation myocardial infarction (STEMI) requires prompt revascularization and dual antiplatelet therapy (DAPT), pertrochanteric femoral fractures usually necessitate early surgical fixation to reduce morbidity and mortality. However, the [...] Read more.

Background: Managing elderly patients with simultaneous acute cardiovascular and orthopedic emergencies presents a unique challenge. While ST-elevation myocardial infarction (STEMI) requires prompt revascularization and dual antiplatelet therapy (DAPT), pertrochanteric femoral fractures usually necessitate early surgical fixation to reduce morbidity and mortality. However, the combination of these conditions complicates both standard treatment pathways. Case presentation: We present the case of an 86-year-old woman admitted after a low-energy fall, with a radiologically confirmed unstable pertrochanteric fracture of the right femur (AO/OTA 31-A2). Upon routine electrocardiogram, anterior STEMI with new-onset atrial fibrillation was diagnosed. Although asymptomatic from a cardiac perspective, bedside echocardiography revealed a severely reduced left ventricular ejection fraction of 10%. Urgent coronary angiography demonstrated a critical mid-left anterior descending lesion, successfully treated with rotational atherectomy, intravascular lithotripsy, and stent implantation. She was initiated on DAPT (aspirin + clopidogrel) and anticoagulated with low-molecular-weight heparin. Given the extremely high bleeding risk, surgical intervention for the femoral fracture was deemed unsafe. Instead, conservative management with skeletal traction (6 kg) was employed. Despite optimal supportive care and early rehabilitation, the patient experienced a complicated hospital course, including delirium, hematuria, and lower respiratory tract infection. She passed away 52 days post-admission. Conclusions: This case illustrates the complexity of clinical decision-making in geriatric patients with competing acute conditions. Current evidence on how to proceed in patients requiring both antithrombotic therapy and urgent orthopedic surgery is limited. Multidisciplinary teams must carefully weigh the risks and benefits of both surgical and conservative strategies. Further guidelines addressing such scenarios in elderly patients are urgently needed. Full article

(This article belongs to the Special Issue Acute Cardiovascular Care in the Cardiological Intensive Care Unit: What Is New?)

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14 pages, 923 KB

Open AccessArticle

Left Atrial Volume and Phasic Function Assessed by 4D Auto LAQ Echocardiography in Treatment-Naive, Newly Diagnosed Type 2 Diabetes Mellitus Patients Without Hypertension or Obesity

by Lin Li, Miao Li, Hong Ran, Ling-Ling Fang, Qian-Shan Ding and Ping-Yang Zhang

J. Cardiovasc. Dev. Dis. 2026, 13(3), 131; https://doi.org/10.3390/jcdd13030131 - 10 Mar 2026

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Abstract

(1) Background: Our aim was to evaluate left atrial (LA) volumes and function in patients with newly diagnosed, treatment-naive type 2 diabetes mellitus (T2DM) using Four-Dimensional Automated Left Atrial Quantificative (four-dimensional auto LAQ) analysis and to explore the independent factors influencing left atrial [...] Read more.

(1) Background: Our aim was to evaluate left atrial (LA) volumes and function in patients with newly diagnosed, treatment-naive type 2 diabetes mellitus (T2DM) using Four-Dimensional Automated Left Atrial Quantificative (four-dimensional auto LAQ) analysis and to explore the independent factors influencing left atrial function in diabetic patients. (2) Method: A total of 62 treatment-naive, newly diagnosed T2DM patients without hypertension or obesity and 50 healthy controls were prospectively enrolled in the study. All participants underwent laboratory analyses, routine echocardiography and 4D LAQ assessment. The parameters were compared between the two groups, and independent factors influencing left atrial function in diabetic patients were investigated through univariate and multivariate linear regression analyses. (3) Results: Despite no significant difference in LA end-systolic anteroposterior diameter between groups, LA volume parameters (LAVmax, LAVmin, LAVpreA, and LAVmaxI) were significantly increased in T2DM patients (all p < 0.05). Regarding LA strain, reservoir and conduit function were significantly impaired in T2DM patients, as reflected by lower LASr, LAScd, LASr-c, and LAScd-c (all p < 0.05). Conversely, circumferential contractile strain (LASct-c) was significantly higher in the T2DM group (p = 0.029), while longitudinal contractile strain (LASct) did not differ significantly between groups (p = 0.146). Multivariate analysis revealed that HbA1c and E/e’ ratio were independently associated with multiple LA strain parameters (all p < 0.05). (4) Conclusion: Newly diagnosed, treatment-naive patients with T2DM exhibited increased LA volumes, decreased left atrial ejection fraction (LAEF), and impaired reservoir and conduit functions, accompanied by a compensatory increase in contractile function. Furthermore, HbA1c and E/e’ demonstrated an independent correlation with 4D strain parameters. 4D Auto LAQ echocardiography may serve as a sensitive tool for early detection of diabetic atrial myopathy. Full article

(This article belongs to the Topic Cardiac Imaging: State of the Art, 2nd Edition)

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17 pages, 3541 KB

Open AccessArticle

Time-Varying Prognostic Impact of the Age×BUN/LVEF Index on Long-Term MACCE After ST-Elevation Myocardial Infarction

by Seda Elcim Yildirim, Tarik Yildirim, Mehmet Tolga Hekim, Tuncay Kiris and Eyüp Avci

J. Cardiovasc. Dev. Dis. 2026, 13(3), 130; https://doi.org/10.3390/jcdd13030130 - 10 Mar 2026

Viewed by 270

Abstract

Background: Despite advances in reperfusion strategies, long-term major adverse cardiac and cerebrovascular events (MACCE) remain frequent after ST-elevation myocardial infarction (STEMI). Practical risk stratification tools applicable at presentation are therefore needed. We investigated the prognostic value of a simple composite index integrating age, [...] Read more.

Background: Despite advances in reperfusion strategies, long-term major adverse cardiac and cerebrovascular events (MACCE) remain frequent after ST-elevation myocardial infarction (STEMI). Practical risk stratification tools applicable at presentation are therefore needed. We investigated the prognostic value of a simple composite index integrating age, blood urea nitrogen, and left ventricular ejection fraction (Age×BUN/LVEF) for predicting long-term MACCE in STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods: This retrospective, single-center cohort study included 313 consecutive STEMI patients undergoing primary PCI between 2020 and 2024. The Age×BUN/LVEF (AGEBUNeFR) index was calculated using age and admission blood urea nitrogen values and left ventricular ejection fraction assessed during index hospitalization. The primary outcome was long-term MACCE, defined as a composite of all-cause mortality, recurrent myocardial infarction, repeat revascularization, stroke, and heart failure hospitalization. The median follow-up was 2.24 years (interquartile range 1.40–3.06). Results: During follow-up, 93 patients (29.7%) experienced MACCE. The AGEBUNeFR index was independently associated with MACCE after multivariable adjustment (adjusted HR 1.028 per unit increase, 95% CI 1.016–1.040; p < 0.001). Time-varying analyses demonstrated a dynamic prognostic effect, with significant associations in the early post-PCI period (p = 0.002) and a pronounced re-emergence of risk during late follow-up (>36 months; p < 0.001). Conclusions: The AGEBUNeFR index is a simple, readily available, and powerful predictor of long-term MACCE in STEMI patients undergoing primary PCI. By integrating age, renal/hemodynamic stress, and cardiac function, this composite index provides dynamic and incremental prognostic information beyond conventional clinical models, supporting its potential role as a practical tool for long-term risk stratification after STEMI. Full article

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14 pages, 548 KB

Open AccessArticle

Real-World Outcomes of Inhaled Treprostinil in Pulmonary Hypertension Related to Interstitial Lung Disease: A Multicenter, Retrospective Analysis

by Andrew R. Kyle, Arun Jose, Kristen Catherman, Jean Elwing, Roxana Sulica, Gerald S. Zavorsky and Namita Sood

J. Cardiovasc. Dev. Dis. 2026, 13(3), 129; https://doi.org/10.3390/jcdd13030129 - 10 Mar 2026

Viewed by 619

Abstract

Inhaled Treprostinil is the primary treatment of pulmonary hypertension related to interstitial lung disease (PH-ILD). Despite treatment effectiveness in clinical trials, the real-world safety and tolerability of this therapy remains unclear. We conducted a multicenter, retrospective review of adults with PH-ILD who were [...] Read more.

Inhaled Treprostinil is the primary treatment of pulmonary hypertension related to interstitial lung disease (PH-ILD). Despite treatment effectiveness in clinical trials, the real-world safety and tolerability of this therapy remains unclear. We conducted a multicenter, retrospective review of adults with PH-ILD who were prescribed inhaled treprostinil. We assessed clinical outcomes, 6 min walk distance (6MWD) and changes in natriuretic peptides (BNP, NT-proBNP), as well as medication tolerance. Eighty-three patients met the inclusion criteria. The 6MWD data was collected but a limited number of patients had results within close proximity to initiation of inhalational treprostinil with only seven patients having assessments within the 3 months prior to initiation as well as 3 months post therapy. Limited 6MWD data is likely due, in part, to coinciding with the COVID pandemic, limiting face-to-face interactions and exercise testing. The majority of our subjects, 63%, had an absolute improvement in their BNP level, over a mean duration of 170 days. However, no significant difference was detected between baseline and follow-up natriuretic peptide levels. Adherence was assessed and the majority (77%) of patients remained on therapy at the time of censoring, with three-quarters (75%) meeting the target dose. Of the 15 patients intolerant to nebulized treprostinil who were transitioned to a dry powder inhaler, the majority (87%) were able to tolerate the other formulation. The medication was well-tolerated with a large percentage of patients remaining on therapy indefinitely and reaching the targeted therapeutic dose. Full article

(This article belongs to the Special Issue The Past, Present, and Future of Pulmonary Hypertension: Pathophysiology and Treatment Prospects)

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15 pages, 1052 KB

Open AccessArticle

Muscular VSD Device Complications: Literature Review and Possible Implications for Echocardiographic Follow-Up

by Micah Tatum, Thomas Casto, Amulya Buddhavarapu, Elizabeth Lyman, Alison Gehred, Benjamin Blais and Clifford L. Cua

J. Cardiovasc. Dev. Dis. 2026, 13(3), 128; https://doi.org/10.3390/jcdd13030128 - 10 Mar 2026

Viewed by 400

Abstract

Long-term transthoracic echocardiogram (TTE) follow-up guidelines after muscular ventricular septal defect (mVSD) device closure are vague. The primary goal of this study was to perform a literature search to characterize the type and timing of complications that occur after mVSD device placement. The [...] Read more.

Long-term transthoracic echocardiogram (TTE) follow-up guidelines after muscular ventricular septal defect (mVSD) device closure are vague. The primary goal of this study was to perform a literature search to characterize the type and timing of complications that occur after mVSD device placement. The search was performed in Medline (PubMed) with English language and publication date (1983 to 2024) filters applied. Studies were included if they reported on patients who underwent mVSD device closure. Studies were excluded if they reported on other types of ventricular septal defect (VSD) device closures, were review papers, or did not report outcomes after the device procedure. A total of 139 articles met the criteria (retrospective, n = 63; prospective, n = 10; case reports, n = 66), encompassing 1668 patient cases. Age at the time of mVSD closure was 10.6 + 2.7 years. Incidence of complications was 17.9% (299/1668). Maximum follow-up was 160 months. Most complications were residual shunts (40.8%, 122/299), followed by valve dysfunction (13.7%, 41/299) and arrhythmias (13.7% 41/299). The vast majority of complications occurred ≤12 months post-device placement 98.0% (293/299). Only 1.3% (4/299) of complications occurred at >12 months (mild tricuspid regurgitation, n = 2; left bundle branch block, n = 1; atrial fibrillation, n = 1). Time until complication was not reported in 0.7% (2/299) of patients (residual shunts, n = 2). All clinically significant complications diagnosed via TTE occurred <12 months post-mVSD device procedure. The utility of repeat TTE beyond one year after mVSD device closure should be reassessed if no clinical concerns are present. Full article

(This article belongs to the Special Issue Recent Advances in Transcatheter Closure of Atrial Septal Defects (ASD) and Ventricular Septal Defects (VSD))

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14 pages, 1415 KB

Open AccessSystematic Review

Genome-Wide Association Studies of Myocardial Infarction: A Systematic Literature Review

by Isabelle P. Thierry, Reza Jabbari, Thomas Engstrøm, Jacob Tfelt-Hansen and Charlotte Glinge

J. Cardiovasc. Dev. Dis. 2026, 13(3), 127; https://doi.org/10.3390/jcdd13030127 - 10 Mar 2026

Viewed by 385

Abstract

Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide, which can result in severe complications such as cardiac arrhythmia, heart failure, and sudden cardiac death. Genetic factors contribute to MI etiology and have been studied through genome-wide association studies (GWAS). [...] Read more.

Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide, which can result in severe complications such as cardiac arrhythmia, heart failure, and sudden cardiac death. Genetic factors contribute to MI etiology and have been studied through genome-wide association studies (GWAS). This systematic review aims to summarize all GWAS of MI reporting single-nucleotide polymorphisms (SNPs) reaching genome-wide significance (p < 5 × 10⁻⁸) and elucidate on their biological relevance and potential clinical utility. A systematic review following PRISMA guidelines was conducted using PubMed and the GWAS Catalog to identify eligible studies. This review included nine GWAS published between 2007 and 2023, conducted in both European and non-European cohorts. GWAS have identified multiple loci associated with MI, pinpointing potential biological pathways underlying MI, and potential therapeutic targets and enhancing risk prediction. Nonetheless, significant challenges remain, particularly the underrepresentation of diverse ancestries and the need for functional follow-up studies to define causal variants and clarify the mechanisms linking genetic variation to MI pathogenesis. Full article

(This article belongs to the Special Issue Feature Review Papers in the ‘Genetics’ Section)

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13 pages, 377 KB

Open AccessArticle

Clinical Characteristics and Outcomes of 1894 Women with Peripartum Cardiomyopathy Treated with and Without Levosimendan in Germany

by Jan A. Kloka, Alexandra Popescu, Benjamin Friedrichson, Thomas Jasny, Lea V. Blum, Stephanie Noone, Armin Flinspach, Peter Kranke, Kai Zacharowski and Vanessa Neef

J. Cardiovasc. Dev. Dis. 2026, 13(3), 126; https://doi.org/10.3390/jcdd13030126 - 9 Mar 2026

Viewed by 307

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during the last month of pregnancy or within five months postpartum. While levosimendan is considered beneficial in heart failure and cardiogenic shock, evidence supporting its use in PPCM is limited. This [...] Read more.

Background: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during the last month of pregnancy or within five months postpartum. While levosimendan is considered beneficial in heart failure and cardiogenic shock, evidence supporting its use in PPCM is limited. This study investigated the prevalence of PPCM in Germany and evaluated outcomes associated with levosimendan use. Methods: Using national data from the German Statistical Office, all pregnant women diagnosed with PPCM and hospitalized between 2009 and 2022 were included. Patients were categorized into groups based on levosimendan treatment. Demographics, treatment modalities, peripartum complications, and transfusion rates were analyzed. Results: The prevalence of PPCM in Germany is 0.01%; 3.60% of patients received levosimendan, mostly after childbirth (61.76%). Peripartum complications and the use of mechanical circulatory support devices were significantly higher in the levosimendan group (p < 0.0001). Women in the levosimendan group suffered significantly more often from intrapartum bleeding and increased rates of blood transfusion compared to women in the non-levosimendan group. Conclusions: PPCM is a rare disease in Germany with a prevalence of 0.01%. Despite higher complication rates in women with levosimendan treatment, further studies are necessary to help determine the role and timing of levosimendan in the treatment of women with PPCM. Full article

(This article belongs to the Special Issue Women and Cardiovascular Disease: The Gender Gap)

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2 pages, 304 KB

Open AccessCorrection

Correction: Cicek et al. A New Risk Prediction Model for the Assessment of Myocardial Injury in Elderly Patients Undergoing Non-Elective Surgery. J. Cardiovasc. Dev. Dis. 2025, 12, 6

by Vedat Cicek, Mert Babaoglu, Faysal Saylik, Samet Yavuz, Ahmet Furkan Mazlum, Mahmut Salih Genc, Hatice Altinisik, Mustafa Oguz, Berke Cenktug Korucu, Mert Ilker Hayiroglu, Tufan Cinar and Ulas Bagci

J. Cardiovasc. Dev. Dis. 2026, 13(3), 125; https://doi.org/10.3390/jcdd13030125 - 9 Mar 2026

Viewed by 187

Abstract

In the original publication [...] Full article

(This article belongs to the Special Issue Models and Methods for Computational Cardiology: 2nd Edition)

12 pages, 1372 KB

Open AccessArticle

Endothelial Activation and Stress Index Predicts Poor Coronary Collateral Development in Chronic Total Occlusion

by Muhammed Ulvi Yalcin, Kadri Murat Gurses, Canan Aydoğan, Sevil Butun, Abdullah Tunçez, Hüseyin Tezcan, Yasin Ozen, Kenan Demir, Nazif Aygul, Mustafa Kirmizigul, Aslihan Merve Toprak Su, Burak Erdogan, Tolgahan Karaman and Bulent Behlul Altunkeser

J. Cardiovasc. Dev. Dis. 2026, 13(3), 124; https://doi.org/10.3390/jcdd13030124 - 9 Mar 2026

Viewed by 300

Abstract

Background/Objectives: Coronary collateral circulation (CCC) reduces ischemic damage in patients with chronic total occlusion (CTO), yet collateral development varies considerably among individuals. Endothelial stress and systemic inflammation are key biological processes involved in collateral vessel formation. The Endothelial Activation and Stress Index (EASIX), [...] Read more.

Background/Objectives: Coronary collateral circulation (CCC) reduces ischemic damage in patients with chronic total occlusion (CTO), yet collateral development varies considerably among individuals. Endothelial stress and systemic inflammation are key biological processes involved in collateral vessel formation. The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase, creatinine, and platelet count, is a simple marker reflecting endothelial dysfunction and inflammatory status. However, evidence regarding its relationship with angiographic coronary collateral development in CTO remains limited. Therefore, this study aimed to evaluate the association between EASIX and CCC grades in patients with CTO. Methods: This retrospective study included 186 patients with CTO who underwent coronary angiography. CCC was evaluated using the Rentrop–Cohen classification and categorized as poorly developed (grades 0–1) or well-developed (grades 2–3). Clinical and laboratory data, including EASIX, were collected. Univariate and multivariate binary logistic regression analyses were performed to identify factors associated with poorly developed CCC. EASIX was standardized (z-score), and odds ratios were reported per 1-standard deviation increase. The predictive performance of EASIX was assessed using receiver operating characteristic (ROC) curve analysis. Results: Poorly developed CCC was observed in 70 patients (37.6%). Patients with well-developed CCC had significantly lower EASIX values (median 0.44 vs. 0.67, p < 0.001) and higher HDL cholesterol levels (p = 0.043). Neutrophil-to-lymphocyte ratio was also higher in the poorly developed CCC group (median 2.59 [2.19–3.59] vs. 2.41 [1.59–3.49], p = 0.028). In multivariate analysis, standardized EASIX remained independently associated with poorly developed CCC (OR 2.536 per 1-SD increase, 95% CI 1.734–3.710, p < 0.001). ROC analysis showed that EASIX provided moderate discrimination for poorly developed CCC (AUC 0.718), with 72.9% sensitivity and 62.1% specificity at a cutoff of >0.51. Conclusions: Higher EASIX values were independently associated with poorly developed CCC in patients with CTO. These findings support a link between systemic endothelial stress and impaired collateral vessel formation. EASIX may serve as a simple, practical, and low-cost biomarker to support risk stratification in CTO patients; however, prospective studies are needed to confirm these results and clarify clinical implications. Full article

(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)

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11 pages, 513 KB

Open AccessArticle

Central Aortic Cannulation for Total Coronary Revascularization via Anterior Thoracotomy: A Single-Center Initial Experience

by Tuna Demirkıran, Işıl Taşöz Özdaş, Gizem Işık Ökten, Furkan Burak Akyol, Tayfun Özdem, Yiğit Tokgöz, Hüma Kekeçdil, Murat Kadan and Kubilay Karabacak

J. Cardiovasc. Dev. Dis. 2026, 13(3), 123; https://doi.org/10.3390/jcdd13030123 - 7 Mar 2026

Viewed by 371

Abstract

Objective: We aimed to evaluate the feasibility, safety, and technical challenges of central aortic cannulation for total coronary revascularization via left anterior thoracotomy (TCRAT). Methods: A retrospective, single-center observational study was conducted on the first 29 TCRAT cases performed with central aortic cannulation. [...] Read more.

Objective: We aimed to evaluate the feasibility, safety, and technical challenges of central aortic cannulation for total coronary revascularization via left anterior thoracotomy (TCRAT). Methods: A retrospective, single-center observational study was conducted on the first 29 TCRAT cases performed with central aortic cannulation. The primary outcomes included operative mortality, stroke, conversion to sternotomy, major aortic bleeding, and dissection; the secondary outcomes included delirium, reoperation, infection, ICU stay, and hospitalization. The descriptive statistics were reported as means ± SD or median (interquartile range [IQR]). Results: The mean age of the patients was 57.2 ± 9.8 years, with 72% of these being male. The most frequent comorbidities observed in the study population were hypertension (62%), diabetes (52%), and peripheral artery disease (28%). The mean cross-clamp time was found to be 63 ± 27 min, and the mean CPB time was 118.6 ± 41.6 min. The occurrence of stroke, aortic dissection, major bleeding, and sternotomy conversions was not observed. One patient died from severe pneumonia on the ninth post-operative day. The mean ICU stay was 1.2 ± 0.4 days, and the mean hospital stay was 5.3 ± 1.1 days. Conclusions: Central aortic cannulation appears to be a safe and feasible procedure for TCRAT, providing physiological antegrade flow and eliminating the complications associated with peripheral cannulation. The preliminary findings suggest that central arterial cannulation may be a safe and practical alternative for the TCRAT technique, but prospective comparative studies are required to confirm its benefits over the femoral and axillary approaches. Full article

(This article belongs to the Special Issue Minimally Invasive Coronary Revascularization: State of the Art)

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34 pages, 1225 KB

Open AccessReview

Twin Transformation in Cardiothoracic Surgery: The Convergence of Digital Innovation and Sustainability

by Vasileios Leivaditis, Roman Gottardi, Andreas Antonios Maniatopoulos, Francesk Mulita, Charalampia Pylarinou, Spyros Papadoulas, Konstantinos Nikolakopoulos, Ioannis Panagiotopoulos, Efstratios Koletsis, Manfred Dahm and Anastasios Sepetis

J. Cardiovasc. Dev. Dis. 2026, 13(3), 122; https://doi.org/10.3390/jcdd13030122 - 7 Mar 2026

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Abstract

Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods: [...] Read more.

Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods: This narrative review synthesizes PubMed-indexed literature published over the past two decades, supplemented by relevant policy documents and guidelines. The review examines digital transformation and sustainability initiatives in cardiothoracic surgery through the lens of the twin transformation framework, which conceptualizes digitalization and sustainability as interdependent and mutually reinforcing processes. Results: Key domains of digital transformation include artificial intelligence and big data-driven decision-making, robotic and minimally invasive surgical techniques, digital twins and simulation-based training, telemedicine and remote monitoring, and interoperable electronic health records. Sustainability-related themes encompass the substantial environmental burden of operating rooms, green surgical practices, sustainable procurement, and hospital-level decarbonization strategies. Emerging evidence suggests that aligning digital technologies with sustainability objectives can improve clinical outcomes, enhance operational efficiency, and reduce environmental impact. However, current evidence is largely derived from pilot studies and single-center experiences. Conclusions: Twin transformation offers a coherent and forward-looking framework for the future evolution of cardiothoracic surgery, demonstrating that digital innovation and sustainability can be synergistic rather than competing goals. While significant challenges remain—including high implementation costs, limited long-term data, and fragmented regulatory frameworks—integrating digital health technologies with sustainable practices represents a promising pathway toward high-quality, efficient, and environmentally responsible cardiothoracic care. Full article

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13 pages, 1274 KB

Open AccessArticle

Early Prediction of Postoperative Peritoneal Dialysis Using Lung Ultrasound Scoring in Neonates After Cardiopulmonary Bypass

by Duygu Tunçel, Süleyman Geter, Leyla Şero, Yiğit Kılıç, Nilüfer Okur and Bedri Aldudak

J. Cardiovasc. Dev. Dis. 2026, 13(3), 121; https://doi.org/10.3390/jcdd13030121 - 6 Mar 2026

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Abstract

Background: Neonates and young infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) are highly vulnerable to pulmonary dysfunction, systemic inflammation, capillary leak, and fluid overload, which may lead to acute kidney injury (AKI) and the need for peritoneal dialysis (PD). Lung ultrasound (LUS) [...] Read more.

Background: Neonates and young infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) are highly vulnerable to pulmonary dysfunction, systemic inflammation, capillary leak, and fluid overload, which may lead to acute kidney injury (AKI) and the need for peritoneal dialysis (PD). Lung ultrasound (LUS) is a bedside, radiation-free tool that allows real-time assessment of lung aeration and pulmonary congestion. However, its role in predicting postoperative renal support remains limited. This study aimed to evaluate whether early postoperative LUS scores could predict the need for PD in neonates after congenital heart surgery with CPB. Methods: In this prospective single-center study, 53 neonates undergoing cardiac surgery with CPB between June 2025 and January 2026 were included. LUS was performed preoperatively and at 0–2 h, 24–48 h, 72 h, 120 h, and 168 h postoperatively using a standardized six-zone scoring system (0–18). The primary outcome was postoperative PD requirement. ROC analysis assessed predictive performance, and multivariable logistic regression identified independent predictors. Results: Total LUS scores significantly increased in the early postoperative period, remained elevated for 24–72 h, and gradually declined by days 5–7. Infants requiring PD (n = 16) had significantly higher LUS scores at 0–2 h, 24–48 h, and 72 h (p < 0.05). The 24–48 h (AUC = 0.784; sensitivity 87%, specificity 62% at cut-off ≥ 11.5) LUS score showed the best predictive value for PD (AUC = 0.831; sensitivity 86%, specificity 74% at cut-off ≥ 13). In multivariable analysis, higher LUS scores at 0–2 h (OR 1.625, p = 0.048) and 24–48 h (OR 1.621, p = 0.048) independently predicted PD. Conclusion: Postoperative LUS is a reliable, noninvasive tool that can aid in predicting the need for PD in neonates undergoing cardiac surgery with CPB, supporting timely fluid and renal management. Full article

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10 pages, 1130 KB

Open AccessArticle

Exploratory Study of Selective Brain Hypothermia Using Transnasal Evaporative Cooling Under Controlled Normothermia with an Endovascular Device

by Mitsuaki Nishikimi, Kazuya Kikutani, Mayumi Higashi, Shinichiro Ohshimo, Tatsuhiko Anzai and Nobuaki Shime

J. Cardiovasc. Dev. Dis. 2026, 13(3), 120; https://doi.org/10.3390/jcdd13030120 - 6 Mar 2026

Viewed by 646

Abstract

Introduction: Selective brain hypothermia has been investigated to improve neurological outcomes in patients with cardiac arrest; however, an optimal clinical method has not yet been established. This study aimed to evaluate the feasibility of a technique combining transnasal evaporative cooling with simultaneous endovascular [...] Read more.

Introduction: Selective brain hypothermia has been investigated to improve neurological outcomes in patients with cardiac arrest; however, an optimal clinical method has not yet been established. This study aimed to evaluate the feasibility of a technique combining transnasal evaporative cooling with simultaneous endovascular temperature management to achieve selective brain hypothermia while preventing systemic hypothermia. Methods: Three adult male Göttingen swine were anesthetized and mechanically ventilated. Transnasal cooling was initiated at maximum output while endovascular warming preserved systemic temperature. Brain parenchymal and rectal temperatures, mean arterial pressure (MAP), heart rate (HR), and cardiac output (CO) were continuously monitored for 60 min. Temperature differences between brain and rectum at 60 min were analyzed. Results: A brain–rectal gradient ≥1.0 °C was achieved in all swine at 25, 40, and 30 min, respectively, and maintained at 1.0–1.5 °C thereafter. Brain temperature (34.5 ± 0.34 °C) was significantly lower than rectal temperature (35.8 ± 0.35 °C) at 60 min after initiation of the selective cooling procedure (p = 0.0048). MAP, HR, and CO showed no deviations from baseline. Conclusions: The combination of transnasal cooling and endovascular warming reliably induced selective brain hypothermia of 1–1.5 °C without adverse effects on hemodynamic parameters in swine. Full article

(This article belongs to the Special Issue Clinical Outcome and Treatment of Cardiac Arrest)

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15 pages, 2031 KB

Open AccessReview

Artificial Intelligence in Venous Thromboembolism Prevention: A Narrative Review of Machine Learning, Deep Learning, and Natural Language Processing

by Daniela Nicoleta Crisan, Talida Georgiana Cut, Lucian-Flavius Herlo, Nina Ivanovic, Alexandra Herlo, Luana Alexandrescu, Andreea Sălcudean and Raluca Dumache

J. Cardiovasc. Dev. Dis. 2026, 13(3), 119; https://doi.org/10.3390/jcdd13030119 - 6 Mar 2026

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Abstract

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a significant and preventable cause of morbidity and mortality worldwide. Despite the existence of clinical prediction models, biomarker-based risk assessments, and imaging techniques, gaps remain in accurately identifying and managing high-risk [...] Read more.

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a significant and preventable cause of morbidity and mortality worldwide. Despite the existence of clinical prediction models, biomarker-based risk assessments, and imaging techniques, gaps remain in accurately identifying and managing high-risk patients. In recent years, artificial intelligence has emerged as a transformative tool in healthcare, offering promising applications for enhancing VTE prevention strategies. This narrative review synthesizes current evidence on the use of artificial intelligence (AI) technologies including machine learning (ML), deep learning (DL), and natural language processing (NLP). We explore how supervised ML algorithms, such as random forests, support vector machines, and gradient boosting, improve predictive performance compared to traditional models by capturing complex, nonlinear relationships within electronic health record data. We also examine the role of DL models, particularly convolutional neural networks, in interpreting imaging data, achieving diagnostic accuracies comparable to expert radiologists. Additionally, the review highlights NLP applications in extracting risk-relevant information from unstructured clinical notes and the emerging integration of wearable device data and time-series analysis for dynamic risk assessment. We argue that the successful integration of AI into routine VTE prevention workflows requires rigorous prospective validation, cross-institutional collaboration, and thoughtful implementation into clinical decision support systems. Full article

(This article belongs to the Special Issue Machine Learning and Artificial Intelligence in Cardiovascular Medicine, 2nd Edition)

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J. Cardiovasc. Dev. Dis., Volume 13, Issue 3 (March 2026) – 45 articles

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