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Biophysics and Clinical Effectiveness of Irreversible Electroporation for Catheter Ablation of Atrial Fibrillation
Genetic Spectrum of Lithuanian Familial Hypercholesterolemia Patients
Leaving Nothing Behind: Expanding the Clinical Frontiers of Drug-Coated Balloon Angioplasty in Coronary Artery Disease
Percutaneous Coronary Intervention for Left Main Disease in High Bleeding Risk: Outcomes from a Subanalysis of the Delta 2 Registry
Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion

Journal Description

Journal of Cardiovascular Development and Disease

Journal of Cardiovascular Development and Disease is an international, scientific, peer-reviewed, open access journal on cardiovascular medicine published monthly online by MDPI.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
Journal Rank: JCR - Q2 (Cardiac and Cardiovascular Systems) / CiteScore - Q2 (General Pharmacology, Toxicology and Pharmaceutics )
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 28.8 days after submission; acceptance to publication is undertaken in 2.9 days (median values for papers published in this journal in the first half of 2025).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.

Impact Factor: 2.3 (2024); 5-Year Impact Factor: 2.7 (2024)

Imprint Information Journal Flyer Open Access ISSN: 2308-3425

Latest Articles

33 pages, 6066 KiB

Open AccessReview

When Functional Assessment Meets Intravascular Imaging in Patients with Coronary Artery Disease

by Grigorios Tsigkas, Kassiani-Maria Nastouli, Anastasios Apostolos, Panagiota Spyropoulou, Maria Bozika, Michail I. Papafaklis, Stella Rouzi, Effrosyni Tsimara, Antonios Karanasos, Virginia Mplani and Periklis Davlouros

J. Cardiovasc. Dev. Dis. 2025, 12(8), 319; https://doi.org/10.3390/jcdd12080319 - 20 Aug 2025

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) [...] Read more.

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

(This article belongs to the Special Issue Advanced Cardiovascular Imaging in Structural Heart Disease: Diagnostic, Prognostic, and Therapeutic Perspectives)

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15 pages, 1684 KiB

Open AccessArticle

Dysfunctional Electron Transport Chain Assembly in COXPD8

by Gisela Beutner, Heidie L. Huyck, Gail Deutsch, Gloria S. Pryhuber and George A. Porter, Jr.

J. Cardiovasc. Dev. Dis. 2025, 12(8), 318; https://doi.org/10.3390/jcdd12080318 - 20 Aug 2025

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. [...] Read more.

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

(This article belongs to the Section Cardiac Development and Regeneration)

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12 pages, 508 KiB

Open AccessReview

Blood Pressure Variability in Hypertension: A Rehabilitation Perspective

by Manikandan Raju, Marco Alfonso Perrone, Anas R. Alashram and Ferdinando Iellamo

J. Cardiovasc. Dev. Dis. 2025, 12(8), 317; https://doi.org/10.3390/jcdd12080317 - 19 Aug 2025

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, [...] Read more.

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

(This article belongs to the Section Cardiovascular Clinical Research)

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19 pages, 3343 KiB

Open AccessArticle

Echocardiographic Assessment of Pulmonary Hemodynamics and Right Ventricular Performance in Neonatal Murine Hypoxia

by Kel Vin Woo, Philip T. Levy, Carla J. Weinheimer, Amanda L. Hauck, Aaron Hamvas, David M. Ornitz, Attila Kovacs and Gautam K. Singh

J. Cardiovasc. Dev. Dis. 2025, 12(8), 316; https://doi.org/10.3390/jcdd12080316 - 19 Aug 2025

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. [...] Read more.

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

(This article belongs to the Section Basic and Translational Cardiovascular Research)

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14 pages, 474 KiB

Open AccessArticle

Markers in Acute Coronary Syndrome: Distal Coronary Embolism at Percutaneous Coronary Intervention

by Niya Emilova Semerdzhieva, Simeon Dimitrov, Adelina Tsakova, Mariana Gospodinova, Petar Atanasov and Vesela Lozanova

J. Cardiovasc. Dev. Dis. 2025, 12(8), 315; https://doi.org/10.3390/jcdd12080315 - 19 Aug 2025

(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 [...] Read more.

(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

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

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28 pages, 1440 KiB

Open AccessReview

Artificial Intelligence-Guided Neuromodulation in Heart Failure with Preserved and Reduced Ejection Fraction: Mechanisms, Evidence, and Future Directions

by Rabiah Aslam Ansari, Sidhartha Gautam Senapati, Vibhor Ahluwalia, Gianeshwaree Alias Rachna Panjwani, Anmolpreet Kaur, Gayathri Yerrapragada, Jayavinamika Jayapradhaban Kala, Poonguzhali Elangovan, Shiva Sankari Karuppiah, Naghmeh Asadimanesh, Anjani Muthyala and Shivaram P. Arunachalam

J. Cardiovasc. Dev. Dis. 2025, 12(8), 314; https://doi.org/10.3390/jcdd12080314 - 19 Aug 2025

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 [...] Read more.

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

(This article belongs to the Special Issue Epidemiological, Basic Science and Clinical Research Studies in Heart Failure)

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12 pages, 2146 KiB

Open AccessReview

Hybrid Ablation in Atrial Fibrillation: Bridging Mechanistic Understanding and Clinical Practice

by Flavia Ravelli, Stefano Branzoli, Alessandro Cristoforetti, Silvia Quintarelli, Alessio Coser, Paolo Moggio, Mark La Meir, Carlo de Asmundis, Luigi Pannone, Francesco Onorati, Roberto Bonmassari and Massimiliano Marini

J. Cardiovasc. Dev. Dis. 2025, 12(8), 313; https://doi.org/10.3390/jcdd12080313 - 19 Aug 2025

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 [...] Read more.

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

(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias, 2nd Edition)

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14 pages, 1390 KiB

Open AccessArticle

Late Gadolinium Enhancement Variation in Asymptomatic Individuals: Comparison with Dilated Cardiomyopathy

by Seoyeon Park, Soo Jin Cho, Sung Mok Kim, Moon Young Kim and Yeon Hyeon Choe

J. Cardiovasc. Dev. Dis. 2025, 12(8), 312; https://doi.org/10.3390/jcdd12080312 - 18 Aug 2025

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 [...] Read more.

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

(This article belongs to the Special Issue Cardiovascular Magnetic Resonance in Cardiology Practice: 2nd Edition)

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14 pages, 1157 KiB

Open AccessReview

Mitral Annular Disjunction: Epidemiology, Diagnostic Methods, Prognosis, and Novel Implications

by Vasileios Tsimpiris, Georgia Kousourna, Aristi Boulmpou, Magdalini Petridou, Chalil Tsavousoglou, Dimitrios Kotzadamis, Christodoulos Papadopoulos, Dimitrios Ntelios, Theodoros Moysiadis, Vassilios Vassilikos and Efstathios Pagourelias

J. Cardiovasc. Dev. Dis. 2025, 12(8), 311; https://doi.org/10.3390/jcdd12080311 - 18 Aug 2025

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 [...] Read more.

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

(This article belongs to the Special Issue State of the Art in Mitral Valve Disease)

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11 pages, 647 KiB

Open AccessReview

Atrioventricular Node Dysfunction in Heart Failure: New Horizons from Pathophysiology to Therapeutic Perspectives

by Isabella Fumarulo, Elia Nunzio Maria Salerno, Andrea De Prisco, Salvatore Emanuele Ravenna, Maria Chiara Grimaldi, Francesco Burzotta and Nadia Aspromonte

J. Cardiovasc. Dev. Dis. 2025, 12(8), 310; https://doi.org/10.3390/jcdd12080310 - 15 Aug 2025

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 [...] Read more.

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

(This article belongs to the Special Issue Updates on Atrio-Ventricular Node Anatomy and Physiology and on AVNRTs Circuit)

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4 pages, 179 KiB

Open AccessEditorial

Feature Review Papers in Stroke and Cerebrovascular Disease

by Narayanaswamy Venketasubramanian

J. Cardiovasc. Dev. Dis. 2025, 12(8), 309; https://doi.org/10.3390/jcdd12080309 - 15 Aug 2025

The field of stroke is quickly evolving, with nearly half a million publications in Pubmed alone [...] Full article

(This article belongs to the Special Issue Feature Review Papers in Stroke and Cerebrovascular Disease)

15 pages, 3072 KiB

Open AccessArticle

Comparison of Surgical Treatment Outcomes in Patients with Symptomatic Severe Aortic Valve Stenosis Using the Perceval Sutureless Bioprosthesis Versus a Conventional Biological Valve

by Dejan M. Lazović, Milica Karadžić, Filip Vučićević, Gorica Marić, Miloš Grujić, Ivana Đurošev, Mladen J. Kočica, Svetozar Putnik and Dragan Cvetković

J. Cardiovasc. Dev. Dis. 2025, 12(8), 308; https://doi.org/10.3390/jcdd12080308 - 13 Aug 2025

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 [...] Read more.

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

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10 pages, 217 KiB

Open AccessArticle

Perinatal Socioeconomic Disadvantage and Cardiovascular Comorbidities: National and State-Level Results of a Novel Cardio-Obstetrics Program

by Sakshi Sehgal, Elinita Pollard, Toscha Charles, Marquetta Thomas, Marlo Vernon, Gyanendra Sharma and Chadburn Ray

J. Cardiovasc. Dev. Dis. 2025, 12(8), 307; https://doi.org/10.3390/jcdd12080307 - 13 Aug 2025

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 [...] Read more.

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

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

13 pages, 1602 KiB

Open AccessArticle

Implications of Myocardial Fibrosis Burden on Left Ventricular Systolic Function in Sepsis Survivors: Insights from a Retrospective Cohort Study Using Quantitative Late Gadolinium Enhancement Cardiovascular Magnetic Resonance

by Shayan Datta, Samuel Malomo, Thomas Oswald, Claire Phillips, Barbara Philips, Joon Lee, David Hildick-Smith, Victoria Parish and Alexander Liu

J. Cardiovasc. Dev. Dis. 2025, 12(8), 306; https://doi.org/10.3390/jcdd12080306 - 13 Aug 2025

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 [...] Read more.

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

(This article belongs to the Special Issue Clinical Burden of Comorbidities on Cardiovascular System and Beyond: 2nd Edition)

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11 pages, 1683 KiB

Open AccessArticle

Coronary Artery Calcification in Patients with Radiographic Axial Spondyloarthritis: A Comparative Study with Matched Controls in Southwestern Sweden

by Erik Hulander, Anna Deminger, Sofia Enegren, Magnus Hallström, Caroline Feldthusen, Erika Fagman, Oskar Angerås, Tatiana Zverkova Sandström, Mats Geijer and Helena Forsblad-d’Elia

J. Cardiovasc. Dev. Dis. 2025, 12(8), 305; https://doi.org/10.3390/jcdd12080305 - 12 Aug 2025

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 [...] Read more.

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

(This article belongs to the Section Acquired Cardiovascular Disease)

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14 pages, 299 KiB

Open AccessArticle

Sex Differences in Stroke Risk Factors and Mechanisms in a Multi-Ethnic Asian Population

by Narayanaswamy Venketasubramanian

J. Cardiovasc. Dev. Dis. 2025, 12(8), 304; https://doi.org/10.3390/jcdd12080304 - 12 Aug 2025

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 [...] Read more.

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

(This article belongs to the Section Stroke and Cerebrovascular Disease)

10 pages, 1568 KiB

Open AccessArticle

Decreased Aortic Elasticity in Noncompaction Cardiomyopathy Compared to Dilated Cardiomyopathy

by Martijn Tukker, Sharida Mohamedhoesein, Emrah Kaya, Arend F.L. Schinkel and Kadir Caliskan

J. Cardiovasc. Dev. Dis. 2025, 12(8), 303; https://doi.org/10.3390/jcdd12080303 - 11 Aug 2025

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 [...] Read more.

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

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17 pages, 926 KiB

Open AccessReview

Advancing Heart Failure Care Through Disease Management Programs: A Comprehensive Framework to Improve Outcomes

by Maha Inam, Robert M. Sangrigoli, Linda Ruppert, Pooja Saiganesh and Eman A. Hamad

J. Cardiovasc. Dev. Dis. 2025, 12(8), 302; https://doi.org/10.3390/jcdd12080302 - 5 Aug 2025

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 [...] Read more.

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

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13 pages, 1708 KiB

Open AccessArticle

Lipomatous Hypertrophy of the Interatrial Septum (LHIS) a Biomarker for Cardiovascular Protection? A Hypothesis Generating Case–Control Study

by Pietro G. Lacaita, Valentin Bilgeri, Fabian Barbieri, Yannick Scharll, Wolfgang Dichtl, Gerlig Widmann and Gudrun M. Feuchtner

J. Cardiovasc. Dev. Dis. 2025, 12(8), 301; https://doi.org/10.3390/jcdd12080301 - 4 Aug 2025

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 [...] Read more.

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

(This article belongs to the Section Imaging)

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16 pages, 2377 KiB

Open AccessReview

Intensive Lipid-Lowering Therapy Following Acute Coronary Syndrome: The Earlier the Better

by Akshyaya Pradhan, Prachi Sharma, Sudesh Prajapathi, Maurizio Aracri, Ferdinando Iellamo and Marco Alfonso Perrone

J. Cardiovasc. Dev. Dis. 2025, 12(8), 300; https://doi.org/10.3390/jcdd12080300 - 4 Aug 2025

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 [...] Read more.

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

(This article belongs to the Special Issue Effect of Lipids and Lipoproteins on Atherosclerosis)

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