Journal of Cardiovascular Development and Disease

18 pages, 890 KB

Open AccessReview

Cardiac Computed Tomography for the Assessment of Myocardial Bridging: A Scoping Review of the Emerging Role of Artificial Intelligence and Machine Learning

by Amro Abu Suleiman, Federico Russo, Luigi Della Valle, Davide Ausiello, Ewelina Bukowska-Olech, Vincenzo Iannibelli, M. Omar Al Droubi, Gabriella Sannino, Marco Bernardi and Luigi Spadafora

J. Cardiovasc. Dev. Dis. 2025, 12(9), 350; https://doi.org/10.3390/jcdd12090350 (registering DOI) - 12 Sep 2025

Abstract

(1) Background: Myocardial bridging (MB) is a congenital coronary anomaly with potential clinical significance. Artificial intelligence (AI) applied to cardiac computed tomography angiography (CCTA), particularly through CT-derived fractional flow reserve (CT-FFR), offers a novel, non-invasive approach for assessing MB. (2) Methods: We conducted [...] Read more.

(1) Background: Myocardial bridging (MB) is a congenital coronary anomaly with potential clinical significance. Artificial intelligence (AI) applied to cardiac computed tomography angiography (CCTA), particularly through CT-derived fractional flow reserve (CT-FFR), offers a novel, non-invasive approach for assessing MB. (2) Methods: We conducted a systematic review of the literature focusing on studies investigating AI-enhanced CCTA in the evaluation of MB. (3) Results: Ten studies were included. AI-based models, including radiomics, demonstrated moderate to high accuracy in predicting proximal plaque formation, and motion correction algorithms improved image quality and diagnostic confidence. Other findings were limited by the types of studies included and conflicting findings across studies. (4) Conclusions: AI-enhanced CCTA shows promise for the non-invasive functional assessment of MB and its risk stratification. Further prospective studies and validation are required to establish standardized protocols and confirm clinical utility. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Imaging—Computed Tomography (CT) Focus Issue)

22 pages, 3367 KB

Open AccessReview

Multimodal Imaging from Fetal to Adult Life: A Comprehensive Approach to Hypoplastic Left Heart Syndrome (HLHS)

by Sara Moscatelli, Jolanda Sabatino, Isabella Leo, Nunzia Borrelli, Martina Avesani, Giovanni Di Salvo, Claudia Montanaro, Valeria Pergola, Raffaella Motta, Jessica Ielapi, Assunta Di Costanzo, Rosalba De Sarro, Giulia Guglielmi, Irene Cattapan, Gabriella Gaudieri, Leonie Luedke and Marco Alfonso Perrone

J. Cardiovasc. Dev. Dis. 2025, 12(9), 349; https://doi.org/10.3390/jcdd12090349 - 11 Sep 2025

Abstract

Hypoplastic Left Heart Syndrome (HLHS) accounts for 2–3% of congenital heart diseases (CHDs). HLHS is characterized by reduced systemic blood flow due to hypoplastic left ventricle (LV) and underdeveloped left-sided cardiac structures. Without a series of staged interventional treatments, HLHS is often fatal, [...] Read more.

Hypoplastic Left Heart Syndrome (HLHS) accounts for 2–3% of congenital heart diseases (CHDs). HLHS is characterized by reduced systemic blood flow due to hypoplastic left ventricle (LV) and underdeveloped left-sided cardiac structures. Without a series of staged interventional treatments, HLHS is often fatal, typically within the first hours or days of life. This manuscript aims to provide a comprehensive overview of the role of echocardiography, cardiovascular magnetic resonance (CMR), and cardiac computed tomography angiography (CCTA) in the optimal management of patients with HLHS. Specifically, it explores the contributions of various non-invasive imaging modalities to the diagnosis, planning of staged palliative interventions, interstage monitoring, and long-term follow-up of HLHS. Furthermore, the advantages and limitations of each imaging technique will be highlighted to aid in clinical decision-making; however, it is important to note that, at present, no universal guidelines exist, and imaging strategies remain largely dependent on individual centre expertise and protocols. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Imaging Diagnosis, Treatment, and Future Challenges)

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13 pages, 3619 KB

Open AccessArticle

Topography of the Papillary Muscles in the Mitral Valve Complex and Their Relevance for Mitral Valve Function

by Alina-Jutta Van Laethem, Jens Figiel, Andreas H. Mahnken, Rabia Ramzan, Marc Irqsusi, Sebastian Vogt and Ardawan J. Rastan

J. Cardiovasc. Dev. Dis. 2025, 12(9), 348; https://doi.org/10.3390/jcdd12090348 - 11 Sep 2025

Abstract

Background: The mitral valve apparatus is a complex system that requires sufficient function of all involved structures. Previous studies have demonstrated that ventricular remodeling can cause displacement of subannular structures, including the papillary muscles, which in turn promotes the development of mitral regurgitation. [...] Read more.

Background: The mitral valve apparatus is a complex system that requires sufficient function of all involved structures. Previous studies have demonstrated that ventricular remodeling can cause displacement of subannular structures, including the papillary muscles, which in turn promotes the development of mitral regurgitation. Furthermore, in such cases, annuloplasty alone is often insufficient to restore optimal valve function. Instead, additional reconstruction of the subannular apparatus is associated with improved clinical outcomes. Our study aimed to analyze the topography of the papillary muscles in the mitral valve complex and their relevance for mitral valve function. Methods: In 148 patients who underwent both cardiac computed tomography (CT) and echocardiography, the position of the papillary muscles within the left ventricle was assessed. CT scans were evaluated in end-diastolic four-chamber view, two-chamber view, and short-axis view. CT analysis involved determining the position of the papillary muscles based on a modified left ventricular segmentation scheme, which subdivided the original segments into “a” and “b” subsegments in a counterclockwise manner. Furthermore, the midventricular diameter, ventricular length, as well as the angle between the papillary muscle (PM) and the left ventricular wall, were measured. Comorbidities were assessed. The presence of mitral regurgitation (MR) and ejection fraction was determined based on echocardiographic data. Echocardiography was conducted either as part of initial cardiological assessments or during follow-up examinations. For detailed statistical analysis, the patients were divided into the following groups: control group, MR-only group, coronary heart disease (CHD)-only group, and combined CHD and MR subgroup. Results: Mitral regurgitation was significantly correlated with age (p < 0.001) and hypertension (r = 0.1900, p = 0.0208), and in the MR-only subgroup, additionally with atrial fibrillation (r = 0.2426, p = 0.0462). The length (p < 0.001) and internal diameter (p < 0.001) of the left ventricle were significantly larger in men than in women. Different positions of the papillary muscles were identified. Segment 7a was significantly correlated with MR in the combined CHD and MR subgroup. In normal-sized ventricles, patients with MR and papillary muscle in 12a (p = 0.0095) or 10a (p = 0.0460) showed a significantly larger angle than patients without MR (overall dataset). Conclusions: Assessment of papillary muscle position is essential in diagnosing mitral regurgitation and should guide the consideration of subannular repair during surgical treatment. Full article

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

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14 pages, 660 KB

Open AccessArticle

Prognostic Utility of HEFESTOS Score and Complementary Lung Ultrasound for Heart Failure Decompensation in Primary Care Outpatients: A Prospective Cohort Study

by Marcos Haro-Montoya, Rosa Caballol-Angelats, José Fernández-Sáez, Maylin Montelongo-Sol, Laura Conangla-Ferrin, Victoria Cendrós-Cámara, Jose María Verdú-Rotellar and Josep Lluís Clua-Espuny

J. Cardiovasc. Dev. Dis. 2025, 12(9), 347; https://doi.org/10.3390/jcdd12090347 - 11 Sep 2025

Abstract

Heart failure (HF) is a major contributor to morbidity, mortality, and healthcare costs, particularly among older adults. Effective outpatient risk stratification remains a clinical challenge, especially following hospital discharge or episodes of acute decompensation. Although both lung ultrasound (LUS) and the HEFESTOS score [...] Read more.

Heart failure (HF) is a major contributor to morbidity, mortality, and healthcare costs, particularly among older adults. Effective outpatient risk stratification remains a clinical challenge, especially following hospital discharge or episodes of acute decompensation. Although both lung ultrasound (LUS) and the HEFESTOS score have shown individual prognostic value, their combined use in primary care settings has not been extensively explored. This prospective cohort study included 107 patients with confirmed HF followed at a primary care center in southern Catalonia. At baseline, all patients underwent LUS and HEFESTOS assessment. The primary outcome was HF decompensation, defined as worsening symptoms requiring medical attention, emergency care, hospitalization, or death. Over a mean follow-up of 72 days, 25 patients (23.3%) experienced decompensation. In multivariate analysis, only the HEFESTOS score was independently associated with decompensation. LUS and HEFESTOS showed moderate agreement (Kappa = 0.456), and LUS demonstrated moderate discriminative capacity (AUC = 0.677) with high sensitivity (81.7%) and positive predictive value (81.7%). These findings support the routine use of the HEFESTOS score in primary care and suggest that LUS may serve as a complementary tool, particularly for identifying subclinical pulmonary congestion. Their combined use could enhance outpatient risk stratification and guide individualized follow-up strategies in HF management. Full article

(This article belongs to the Section Imaging)

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16 pages, 1867 KB

Open AccessSystematic Review

Flow Diverting Stents for the Treatment of Complex Visceral and Renal Aneurysms—A Systematic Review

by Marcello Andrea Tipaldi, Elisa Zaccaria, Nicolò Ubaldi, Edoardo Massaro, Gianluigi Orgera, Tommaso Rossi, Aleksejs Zolovkins, Miltiadis Krokidis, Pasqualino Sirignano and Michele Rossi

J. Cardiovasc. Dev. Dis. 2025, 12(9), 346; https://doi.org/10.3390/jcdd12090346 - 11 Sep 2025

Abstract

Flow-diverting stents (FDS) are sophisticated endovascular devices that aim to modulate blood flow and promote aneurysm thrombosis while maintaining branch vessel patency. Initially designed and developed for the treatment of intracranial aneurysms, these devices have since been applied to the peripheral circulation. However, [...] Read more.

Flow-diverting stents (FDS) are sophisticated endovascular devices that aim to modulate blood flow and promote aneurysm thrombosis while maintaining branch vessel patency. Initially designed and developed for the treatment of intracranial aneurysms, these devices have since been applied to the peripheral circulation. However, they are still used sporadically, largely due to a lack of the scientific evidence supporting its use in visceral aneurysms. This review article aims to provide an overview of the current data on the clinical outcomes from the use of FDS in the treatment of complex visceral and renal aneurysms or pseudoaneurysms and to assess the added value of these devices. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Splanchnic and Peripheral Atherosclerotic Disease)

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30 pages, 1759 KB

Open AccessSystematic Review

AI Applied to Cardiac Magnetic Resonance for Precision Medicine in Coronary Artery Disease: A Systematic Review

by Cristina Jiménez-Jara, Rodrigo Salas, Rienzi Díaz-Navarro, Steren Chabert, Marcelo E. Andia, Julián Vega, Jesús Urbina, Sergio Uribe, Tetsuro Sekine, Francesca Raimondi and Julio Sotelo

J. Cardiovasc. Dev. Dis. 2025, 12(9), 345; https://doi.org/10.3390/jcdd12090345 - 9 Sep 2025

Abstract

Cardiac magnetic resonance (CMR) imaging has become a key tool in evaluating myocardial injury secondary to coronary artery disease (CAD), providing detailed assessments of cardiac morphology, function, and tissue composition. The integration of artificial intelligence (AI), including machine learning and deep learning techniques, [...] Read more.

Cardiac magnetic resonance (CMR) imaging has become a key tool in evaluating myocardial injury secondary to coronary artery disease (CAD), providing detailed assessments of cardiac morphology, function, and tissue composition. The integration of artificial intelligence (AI), including machine learning and deep learning techniques, has enhanced the diagnostic capabilities of CMR by automating segmentation, improving image interpretation, and accelerating clinical workflows. Radiomics, through the extraction of quantitative imaging features, complements AI by revealing sub-visual patterns relevant to disease characterization. This systematic review analyzed AI applications in CMR for CAD. A structured search was conducted in MEDLINE, Web of Science, and Scopus up to 17 March 2025, following PRISMA guidelines and quality-assessed with the CLAIM checklist. A total of 106 studies were included: 46 on classification, 19 using radiomics, and 41 on segmentation. AI models were used to classify CAD vs. controls, predict major adverse cardiovascular events (MACE), arrhythmias, and post-infarction remodeling. Radiomics enabled differentiation of acute vs. chronic infarction and prediction of microvascular obstruction, sometimes from non-contrast CMR. Segmentation achieved high performance for myocardium (DSC up to 0.95), but scar and edema delineation were more challenging. Reported performance was moderate-to-high across tasks (classification AUC = 0.66–1.00; segmentation DSC = 0.43–0.97; radiomics AUC = 0.57–0.99). Despite promising results, limitations included small or overlapping datasets. In conclusion, AI and radiomics offer substantial potential to support diagnosis and prognosis of CAD through advanced CMR image analysis. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Imaging: An Exciting Future to Revolutionize the Diagnosis and Management of Cardiovascular Disease)

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26 pages, 1566 KB

Open AccessReview

Personalized Treatment of Patients with Coronary Artery Disease: The Value and Limitations of Predictive Models

by Antonio Greco and Davide Capodanno

J. Cardiovasc. Dev. Dis. 2025, 12(9), 344; https://doi.org/10.3390/jcdd12090344 - 8 Sep 2025

Abstract

Risk prediction models are increasingly used in the management of coronary artery disease (CAD), with applications ranging from diagnostic stratification to prognostic assessment and therapeutic guidance. In the context of CAD and percutaneous coronary intervention, clinical decision-making often relies on risk scores to [...] Read more.

Risk prediction models are increasingly used in the management of coronary artery disease (CAD), with applications ranging from diagnostic stratification to prognostic assessment and therapeutic guidance. In the context of CAD and percutaneous coronary intervention, clinical decision-making often relies on risk scores to estimate the likelihood of ischemic and bleeding events and to tailor antithrombotic strategies accordingly. Traditional scores are derived from clinical, anatomical, procedural, and laboratory variables, and their performance is evaluated based on discrimination and calibration metrics. While many established models are simple, interpretable, and externally validated, their predictive ability is often moderate and may be limited by outdated derivation cohorts, overfitting, or lack of generalizability. Recent advances have introduced artificial intelligence and machine learning models that can process large, high-dimensional datasets and identify patterns not apparent through conventional methods, with the aim to incorporate complex data; however, they are not exempt from limitations and struggle with integration into clinical practice. Notably, ethical issues, such as equity in model application, over-stratification, and real-world implementation, are of critical importance. The ideal predictive model should be accurate, generalizable, and clinically actionable. This review aims at providing an overview of the main predictive models used in the field of CAD and to discuss methodological challenges, with a focus on strengths, limitations and areas of applicability of predictive models. Full article

(This article belongs to the Special Issue Leaders in Cardiovascular Research: A Special Issue Dedicated to Professor Patrick Serruys)

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16 pages, 2395 KB

Open AccessArticle

Non-Invasive Mapping of Ventricular Action Potential Reconstructed from Contactless Magnetocardiographic Recordings in Intact and Conscious Guinea Pigs

by Riccardo Fenici, Marco Picerni, Peter Fenici and Donatella Brisinda

J. Cardiovasc. Dev. Dis. 2025, 12(9), 343; https://doi.org/10.3390/jcdd12090343 - 6 Sep 2025

Abstract

Optical mapping, nanotechnology-based multielectrode arrays and automated patch-clamp allow transmembrane voltage mapping with high spatial resolution, as well as L-type calcium and inward rectifier currents measurements using native mammalian cardiomyocytes. However, these methods are limited to in vitro and ex vivo experiments, while [...] Read more.

Optical mapping, nanotechnology-based multielectrode arrays and automated patch-clamp allow transmembrane voltage mapping with high spatial resolution, as well as L-type calcium and inward rectifier currents measurements using native mammalian cardiomyocytes. However, these methods are limited to in vitro and ex vivo experiments, while magnetocardiography (MCG) might offer a novel approach for non-invasive preclinical safety assessments of new drugs in intact and even conscious rodents by reconstructing the ventricular action potential waveform (rVAPw) from MCG signals. Objective: This study aims to assess the feasibility of rVAPw reconstruction from MCG signals in Guinea pigs (GPs) and validate the results by comparison with simultaneously recorded epicardial ventricular monophasic action potentials (eVMAP). Methods: Unshielded MCG (uMCG) data of 18 GPs, investigated anaesthetized and awake at ages of 5, 14, and 26 months using a 36-channel DC-SQUID system, were analyzed to calculate rVAPw from MCG’s current arrow map. Results: Successful rVAPw reconstruction from averaged MCG showed good alignment with eVMAP waveforms. However, some rVAPw displayed incomplete or distorted repolarization at sites with lower MCG amplitude. Conclusions: 300-s uMCG averaging allowed rVAPw reconstruction in intact GPs. Occasionally distorted rVAPw suggests the need for dedicated MCG devices development, with higher density of optimized vector sensors, and modelling tailored for small animal hearts. Full article

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9 pages, 243 KB

Open AccessArticle

Comparative Study on Cardiac Findings in Patients with Transthyretin Amyloidosis Before and After Treatment with a Transthyretin Silencer

by Priya Arivalagan and Diego Hernan Delgado

J. Cardiovasc. Dev. Dis. 2025, 12(9), 342; https://doi.org/10.3390/jcdd12090342 - 5 Sep 2025

Abstract

Transthyretin amyloidosis (ATTR) is a rare disease caused by misfolded proteins, amyloids, that are deposited in various organs and tissues, typically the heart and/or nerves, causing the development of cardiomyopathy (CM) and polyneuropathy (PN). Although this may be an incurable disease, there are [...] Read more.

Transthyretin amyloidosis (ATTR) is a rare disease caused by misfolded proteins, amyloids, that are deposited in various organs and tissues, typically the heart and/or nerves, causing the development of cardiomyopathy (CM) and polyneuropathy (PN). Although this may be an incurable disease, there are various treatments that are currently available for patients with ATTR, including transthyretin (TTR) silencers such as inotersen and patisiran. The silencers help slow down the progression of disease and improve the quality of life of patients with ATTR by alleviating the cardiac and neurological symptoms that patients present. The purpose of this study was to compare the cardiac findings observed in the ⁹⁹Tc-PYP scintigraphy (PYP scan) parameters of patients with a mixed phenotype before and after treatment with inotersen or patisiran. This study included ten patients from the amyloidosis clinic at the University Health Network. All of the patients (average age: 63.80 ± 11.70; 60.0% males, 40.0% females) received inotersen or patisiran as their treatment. These patients underwent a PYP scan before and after treatment to observe any improvements in terms of their CM post-treatment. Nine (90.0%) patients showed an improvement with their CM, as they showed a decrease in their heart-to-contralateral lung (H/CL) ratio and/or pyrophosphate (PYP) grade based on their results from the PYP scan post-treatment with a TTR silencer. Only one patient (10.0%) had worsening results, as their H/CL ratio and PYP grade increased post-treatment in comparison to the PYP scan results pre-treatment. Patients with ATTR who have a mixed phenotype should undergo a PYP scan before and after treatment with a TTR silencer. By undergoing these scans, the effectiveness of this treatment could be determined by observing any improvements in the signs of CM. A decrease in the H/CL ratio and/or the PYP grade would indicate that the TTR silencer has been effective in alleviating the signs and symptoms of CM, and that the patients should continue with their treatment plan. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—Modern Diagnostic and Therapeutic Strategies in Advanced Heart Failure and Heart Transplantation)

15 pages, 1482 KB

Open AccessReview

Targeting Telomere Shortening in Vascular Aging and Atherosclerosis: Therapeutic Promise of Astragalus membranaceus

by Paola Canale and Maria Grazia Andreassi

J. Cardiovasc. Dev. Dis. 2025, 12(9), 341; https://doi.org/10.3390/jcdd12090341 - 4 Sep 2025

Abstract

Telomere dysfunction has emerged as a pivotal contributor to vascular senescence, a fundamental process in the pathogenesis of age-related cardiovascular diseases such as atherosclerosis. This connection underscores the therapeutic potential of targeting telomere biology to prevent or mitigate the progression of vascular aging. [...] Read more.

Telomere dysfunction has emerged as a pivotal contributor to vascular senescence, a fundamental process in the pathogenesis of age-related cardiovascular diseases such as atherosclerosis. This connection underscores the therapeutic potential of targeting telomere biology to prevent or mitigate the progression of vascular aging. In this context, Astragalus membranaceus and its bioactive constituents, including astragaloside IV, cycloastragenol, and the commercial telomerase activator TA-65, demonstrate significant promise in attenuating vascular aging and atherosclerotic disease. These compounds exert a range of pleiotropic effects, including anti-inflammatory, antioxidant, endothelial-protective, and lipid-modulating actions, while also modulating telomerase activity and supporting telomere maintenance. This review provides an overview of the mechanistic basis underlying the anti-atherosclerotic effects of Astragalus-derived compounds and underscores critical key knowledge gaps. It also outlines future research directions necessary to validate their efficacy and therapeutic potential in the prevention and treatment of atherosclerosis and other age-related vascular disorders. Full article

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

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13 pages, 4433 KB

Open AccessArticle

CMR-Derived Global Longitudinal Strain and Left Ventricular Torsion as Prognostic Markers in Dilated Cardiomyopathy

by Alexandru Zlibut, Michael Bietenbeck and Lucia Agoston-Coldea

J. Cardiovasc. Dev. Dis. 2025, 12(9), 340; https://doi.org/10.3390/jcdd12090340 - 4 Sep 2025

Abstract

Background: Non-ischemic dilated cardiomyopathy (DCM) is a heterogeneous myocardial disease associated with variable progression and an increased risk of major adverse cardiovascular events (MACEs). Cardiovascular magnetic resonance (CMR) allows the comprehensive evaluation of myocardial structure, function, and fibrosis. This prospective study aimed to [...] Read more.

Background: Non-ischemic dilated cardiomyopathy (DCM) is a heterogeneous myocardial disease associated with variable progression and an increased risk of major adverse cardiovascular events (MACEs). Cardiovascular magnetic resonance (CMR) allows the comprehensive evaluation of myocardial structure, function, and fibrosis. This prospective study aimed to assess the prognostic value of CMR-derived global longitudinal strain (GLS) and left ventricular (LV) torsion in patients with DCM. Methods: We prospectively enrolled 150 patients with newly diagnosed non-ischemic DCM and 100 age- and sex-matched healthy controls. All participants underwent standardized CMR protocols including cine imaging, late gadolinium enhancement (LGE), and feature-tracking analysis for myocardial deformation. LV volumes, ejection fraction (LVEF), GLS, and LV torsion were quantified. The primary endpoint was the first occurrence of MACE, defined as cardiac death, sustained ventricular arrhythmia, or heart failure hospitalization. The median follow-up was 33 months. Results: Compared to controls, DCM patients had significantly impaired LV function and myocardial mechanics: lower LVEF (35.1% vs. 65.2%, p < 0.001), reduced GLS (−9.2% vs. −19.7%, p < 0.001), and diminished LV torsion (1.04 vs. 1.95 °/cm, p < 0.001). GLS ≤ −8.6% was independently associated with increased MACE risk (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 1.01–1.61; p < 0.01). Similarly, reduced LV torsion predicted adverse events (adjusted HR: 1.37; 95% CI: 1.03–1.81; p < 0.01). The presence of LGE (42% of patients) further stratified risk (HR: 2.86; 95% CI: 1.48–12.52; p < 0.001). Conclusions: CMR-derived GLS and LV torsion are strong, independent predictors of adverse outcomes in DCM. Their integration into routine imaging protocols enhances risk stratification beyond conventional metrics such as LVEF and LGE. These findings support the use of myocardial deformation analysis in the comprehensive evaluation of patients with DCM. Full article

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16 pages, 1088 KB

Open AccessReview

Radiation-Free Percutaneous Coronary Intervention: Myth or Reality?

by Sotirios C. Kotoulas, Andreas S. Triantafyllis, Nestoras Kontogiannis, Pavlos Tsinivizov, Konstantinos Antoniades, Ibraheem Aqeel, Eleni Karapedi, Angeliki Kolyda and Leonidas E. Poulimenos

J. Cardiovasc. Dev. Dis. 2025, 12(9), 339; https://doi.org/10.3390/jcdd12090339 - 3 Sep 2025

Abstract

Background: Radiation exposure in the cardiac catheterization laboratory remains a critical occupational hazard for interventional cardiologists and staff, contributing to orthopedic injuries, cataracts, and malignancy. In parallel, procedural complexity continues to increase, demanding both precision and safety. Robotic-assisted percutaneous coronary intervention (R-PCI), alongside [...] Read more.

Background: Radiation exposure in the cardiac catheterization laboratory remains a critical occupational hazard for interventional cardiologists and staff, contributing to orthopedic injuries, cataracts, and malignancy. In parallel, procedural complexity continues to increase, demanding both precision and safety. Robotic-assisted percutaneous coronary intervention (R-PCI), alongside advanced shielding systems and imaging integration, has emerged as a transformative strategy to minimize radiation and enhance operator ergonomics. Objective: This state-of-the-art review synthesizes the current clinical evidence and technological advances that support a radiation-reduction paradigm in percutaneous coronary intervention (PCI), with a particular focus on the role of R-PCI platforms, procedural modifications, and emerging shielding technologies. Methods: We reviewed published clinical trials, registries, and experimental studies evaluating robotic PCI platforms, contrast and radiation dose metrics, ergonomic implications, procedural efficiency, and radiation shielding systems. Emphasis was given to the integration of CT-based imaging (coronary computed tomography angiography—CCTA, fractional flow reserve computed tomography—FFR-CT) and low-dose acquisition protocols. Results: R-PCI demonstrated technical success rates of 81–100% and clinical success rates up to 100% in both standard and complex lesions, with significant reductions in operator radiation exposure (up to 95%) and procedural ergonomic burden. Advanced shielding technologies offer radiation dose reductions ranging from 86% to nearly 100%, while integration of (CCTA), (FFR-CT), and Artificial Intelligence (AI) -assisted procedural mapping facilitates further fluoroscopy minimization. Robotic workflows, however, remain limited by lack of device compatibility, absence of haptic feedback, and incomplete integration of physiology and imaging tools. Conclusions: R-PCI, in combination with shielding technologies and imaging integration, marks a shift towards safer, radiation-minimizing interventional strategies. This transition reflects not only a technical evolution but a philosophical redefinition of safety, precision, and sustainability in modern interventional cardiology. Full article

(This article belongs to the Special Issue Emerging Trends and Advances in Interventional Cardiology)

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15 pages, 4052 KB

Open AccessReview

Hybrid PET/CT and PET/MR in Coronary Artery Disease: An Update for Clinicians, with Insights into AI-Guided Integration

by Francesco Antonio Veneziano, Flavio Angelo Gioia and Francesco Gentile

J. Cardiovasc. Dev. Dis. 2025, 12(9), 338; https://doi.org/10.3390/jcdd12090338 - 3 Sep 2025

Abstract

Imaging techniques such as positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MR) have emerged as powerful and versatile tools for the comprehensive assessment of coronary artery disease (CAD). By combining anatomical and functional information in a single examination, these [...] Read more.

Imaging techniques such as positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MR) have emerged as powerful and versatile tools for the comprehensive assessment of coronary artery disease (CAD). By combining anatomical and functional information in a single examination, these modalities offer complementary insights that significantly enhance diagnostic accuracy and support clinical decision-making. This is particularly relevant in complex clinical scenarios, such as multivessel disease, balanced ischemia, or suspected microvascular dysfunction, where conventional imaging may be inconclusive. This review aims to provide clinicians with an up-to-date summary of the principles, technical considerations, and clinical applications of hybrid PET/CT and PET/MR in CAD. Here, we describe how these techniques can improve the evaluation of myocardial perfusion, coronary plaque characteristics, and ischemic burden. Advantages such as improved sensitivity, spatial resolution, and quantification capabilities are discussed alongside limitations including cost, radiation exposure, availability, and workflow challenges. A dedicated focus is given to the emerging role of artificial intelligence (AI), which is increasingly being integrated to optimize image acquisition, fusion processes, and interpretation. AI has the potential to streamline hybrid imaging and promote a more personalized and efficient management of CAD. Finally, we outline future directions in the field, including novel radiotracers, automated quantitative tools, and the expanding use of hybrid imaging to guide patient selection and therapeutic decisions, particularly in revascularization strategies. 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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20 pages, 2448 KB

Open AccessReview

Comprehensive Assessment of Left Atrial Function: The Emerging Role of Cardiac Magnetic Resonance Feature Tracking

by Javier Solsona-Caravaca, Alessandro Giustiniani, Eduard Ródenas-Alesina, Laura Galian-Gay, Ruperto Oliveró, Filipa Valente, Guillem Casas, Gisela Teixidó-Turà, Nuria Vallejo, Rubén Fernández-Galera, Víctor González-Fernández, Pablo Escribano-Escribano, Axel Hernández-Pineda, Ignacio Ferreira-González and José Fernando Rodríguez-Palomares

J. Cardiovasc. Dev. Dis. 2025, 12(9), 337; https://doi.org/10.3390/jcdd12090337 - 2 Sep 2025

Abstract

Traditional volumetric parameters fall short of capturing the complex, phasic nature of atrial function. In contrast, atrial strain has become recognized as a sensitive, non-invasive imaging marker that enables earlier detection of myocardial dysfunction, refined risk stratification, and individualized therapeutic decision-making across a [...] Read more.

Traditional volumetric parameters fall short of capturing the complex, phasic nature of atrial function. In contrast, atrial strain has become recognized as a sensitive, non-invasive imaging marker that enables earlier detection of myocardial dysfunction, refined risk stratification, and individualized therapeutic decision-making across a wide range of cardiovascular diseases. Cardiovascular magnetic resonance feature tracking (CMR-FT) has emerged as a robust imaging technique for evaluating atrial strain, offering high spatial resolution, high reproducibility, and independence from acoustic window limitations. Despite its promise, the routine clinical adoption of CMR-FT atrial strain remains limited. Key barriers include intervendor variability in strain values, the absence of standardized post-processing protocols, the lengthy acquisition times inherent to CMR studies, and the time required for post-processing atrial strain analysis. Overcoming these barriers is crucial to facilitate the integration of atrial strain assessment into routine clinical CMR protocols, particularly in patients with heart failure, valvular disease, or cardiomyopathy who undergo imaging for diagnostic or prognostic evaluation. Full article

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

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10 pages, 724 KB

Open AccessArticle

Need for Coronary Artery Bypass Grafting in Acute Type A Aortic Dissection: Clinical Insights, Diagnostic Gaps, and Surgical Outcomes

by Mohammed Morjan, Charlotte Philippa Jürgens, Tong Li, Luis Jaime Vallejo Castano, Freya Jenkins, Amin Thwairan, Vivien Weyers, Hannan Dalyanoglu, Sebastian Daniel Reinartz and Artur Lichtenberg

J. Cardiovasc. Dev. Dis. 2025, 12(9), 336; https://doi.org/10.3390/jcdd12090336 - 2 Sep 2025

Abstract

Objectives: The need for concomitant coronary artery bypass grafting during acute type A aortic dissection repair is common and associated with high mortality. This study aims to characterize the patient cohort, assess outcomes, and evaluate the role of preoperative diagnostics in these high-risk [...] Read more.

Objectives: The need for concomitant coronary artery bypass grafting during acute type A aortic dissection repair is common and associated with high mortality. This study aims to characterize the patient cohort, assess outcomes, and evaluate the role of preoperative diagnostics in these high-risk patients. Methods: Patients who underwent concomitant coronary artery bypass and acute type A aortic dissection repair between March 2007 and June 2023 were included. In-hospital survivors and non-survivors were compared. Logistic regression analyses were performed to identify predictors of in-hospital mortality. Preoperative computed tomography scans were independently reviewed by a cardiovascular radiologist to assess potential coronary involvement. The agreement between computed tomography and intraoperative reports of coronary dissection was evaluated using Cohen’s κappa test. Results: The cohort consisted of ninety-eight patients. In-hospital mortality was 26.5% (n = 26). The right coronary artery was the most frequently grafted (57%, n = 56). Elevated preoperative creatine kinase was the only predictor of in-hospital mortality (p = 0.044). Of the 72 available preoperative CT scans, 76% (n = 55) indicated coronary involvement, whereas intraoperative coronary dissection requiring bypass grafting was documented in only 42% (n = 30)). The agreement between computer tomography and intraoperative dissection reports was poor (κappa 0.043 (95% CI, −0.155 to 0.241), p = 0.66). Conclusion: Simultaneous coronary artery bypass during acute type A aortic dissection repair remains associated with high mortality and morbidity. The right coronary artery is most often affected. Coronary bypass is not always linked to coronary dissection, making intraoperative detection challenging. This underscores the importance of preoperative diagnostics, especially computer tomography. Full article

(This article belongs to the Section Cardiac Surgery)

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18 pages, 1378 KB

Open AccessArticle

Clinical Characteristics and Outcomes of Patients Presenting with Acute Coronary Syndromes and Suspected Plaque Erosion Based on Clinical and Laboratory Criteria

by Luca Di Vito, Giancarla Scalone, Federico Di Giusto, Filippo Bruscoli, Michele Alfieri, Domenico Delfino, Federico Panzella, Simona Silenzi, Ik-Kyung Jang and Pierfrancesco Grossi

J. Cardiovasc. Dev. Dis. 2025, 12(9), 335; https://doi.org/10.3390/jcdd12090335 - 30 Aug 2025

Abstract

Background: Plaque erosion (PE) ranks as the second most prevalent pathology associated with acute coronary events, following plaque rupture. PE is characterized by endothelial denudation and the development of neutrophil extracellular traps. Specific clinical and laboratory predictors were shown to be associated with [...] Read more.

Background: Plaque erosion (PE) ranks as the second most prevalent pathology associated with acute coronary events, following plaque rupture. PE is characterized by endothelial denudation and the development of neutrophil extracellular traps. Specific clinical and laboratory predictors were shown to be associated with PE in patients with acute coronary syndrome. The aim of this study was to evaluate the clinical and laboratory results, as well as the outcomes of ACS patients with a high likelihood of PE. Methods: A total of 696 ACS patients were categorized into the suspected PE group and the less likely PE group based on the five validated predictors of PE. Baseline clinical characteristics and laboratory evaluations were analyzed between the two groups. Major adverse cardiovascular events were compared between the two groups at 20 months. Results: The group suspected of PE comprised 41% of patients, whereas the group with a lower likelihood of PE constituted 59%. The suspected PE group exhibited a greater incidence of current smokers and a higher BMI. Both CRP and fibrinogen levels were decreased; the incidence of one coronary vessel disease was elevated. The suspected PE group exhibited a markedly reduced incidence of MACEs at 20 months (7.4% compared to 28.8%, p = 0.0001). The recurrence of non-fatal coronary events tended to occur later in the suspected PE group (15 months (6–20) compared to 9 months (6–13), p = 0.062). A reduced coronary plaque burden and a low level of systemic inflammation characterized the distinctive features of the suspected PE cohort. Conclusions: The suspected PE group exhibited a more favorable prognosis at the 20-month follow-up, characterized by a considerably reduced mortality rate from all causes, whereas non-fatal coronary events tended to manifest at a later time. Full article

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11 pages, 644 KB

Open AccessArticle

Platelet-to-Lymphocyte and Glucose-to-Lymphocyte Ratios as Prognostic Markers in Hospitalized Patients with Acute Coronary Syndrome

by Christos Kofos, Andreas S. Papazoglou, Barbara Fyntanidou, Athanasios Samaras, Panagiotis Stachteas, Athina Nasoufidou, Aikaterini Apostolopoulou, Paschalis Karakasis, Alexandra Arvanitaki, Marios G. Bantidos, Dimitrios V. Moysidis, Nikolaos Stalikas, Dimitrios Patoulias, Apostolos Tzikas, George Kassimis, Nikolaos Fragakis and Efstratios Karagiannidis

J. Cardiovasc. Dev. Dis. 2025, 12(9), 334; https://doi.org/10.3390/jcdd12090334 - 30 Aug 2025

Abstract

Background: Novel and accessible biomarkers may add to the existing risk stratification schemes in patients with acute coronary syndrome (ACS). The platelet-to-lymphocyte ratio (PLR) and glucose-to-lymphocyte ratio (GLR) have emerged as potential indicators of systemic inflammation and metabolic stress, both of which are [...] Read more.

Background: Novel and accessible biomarkers may add to the existing risk stratification schemes in patients with acute coronary syndrome (ACS). The platelet-to-lymphocyte ratio (PLR) and glucose-to-lymphocyte ratio (GLR) have emerged as potential indicators of systemic inflammation and metabolic stress, both of which are pivotal in ACS pathophysiology. The aim of this study was to investigate the prognostic significance of the PLR and GLR in patients with ACS. Methods: We performed a retrospective cohort study of patients hospitalized with ACS between 2017 and 2023 at Hippokration Hospital of Thessaloniki, Greece. PLR and GLR were calculated from admission blood samples. The primary endpoint was all-cause mortality. Logistic and Cox regression models were used to investigate the associations of PLR and GLR with all-cause mortality. Receiver operating characteristic (ROC) analysis, Kaplan–Meier survival curves, and restricted cubic spline (RCS) modeling were also applied. Results: In total, 853 patients (median age: 65 years, 72.3% males) were included. Higher PLR and GLR were independently associated with increased risk of long-term mortality [adjusted Odds Ratio (aOR) for PLR: 1.007, 95% CI: 1.005–1.008; and for GLR: aOR = 1.006, 95% CI: 1.003–1.008]. The optimal cut-off values were 191.92 for PLR and 66.80 for GLR. Kaplan–Meier and Cox regression analyses confirmed significantly reduced survival in patients with GLR and PLR values exceeding these thresholds. RCS analysis revealed non-linear relationships, with mortality risk rising sharply at higher levels of both markers. PLR showed superior prognostic performance (AUC: 0.673, 95% CI: 0.614–0.723) compared to GLR (AUC: 0.602, 95% CI: 0.551–0.653). Conclusions: While PLR demonstrated greater predictive accuracy, both PLR and GLR were consistently associated with mortality and may provide complementary prognostic information. Incorporating those ratios into routine clinical assessment may improve risk stratification, particularly in resource-limited settings or for patients without traditional risk factors. Full article

(This article belongs to the Special Issue Role of Biochemical Markers of Cardiovascular Disease in Clinical Practice)

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24 pages, 3795 KB

Open AccessReview

Advancements in Acute Pulmonary Embolism Diagnosis and Treatment: A Narrative Review of Emerging Imaging Techniques and Intravascular Interventions

by Michaela Cellina, Matilde Pavan, Niccolò Finardi, Francesco Cicchetti, Maurizio Cè, Pierpaolo Biondetti, Carolina Lanza, Serena Carriero and Gianpaolo Carrafiello

J. Cardiovasc. Dev. Dis. 2025, 12(9), 333; https://doi.org/10.3390/jcdd12090333 - 29 Aug 2025

Abstract

Acute pulmonary embolism (APE) represents a significant cause of morbidity and mortality worldwide, requiring rapid and precise diagnosis and effective therapy strategies. Computed Tomography Pulmonary Angiography (CTPA) is currently the gold standard technique for diagnosing PE; however, it presents some disadvantages, including limited [...] Read more.

Acute pulmonary embolism (APE) represents a significant cause of morbidity and mortality worldwide, requiring rapid and precise diagnosis and effective therapy strategies. Computed Tomography Pulmonary Angiography (CTPA) is currently the gold standard technique for diagnosing PE; however, it presents some disadvantages, including limited sensitivity in detecting sub-segmental emboli and contrast-related risks. Recent advancements in imaging technologies, including Dual-Energy Computed Tomography (DECT) and Photon Counting (PC), offer improved sensitivity and specificity for APE and perfusion abnormalities detection. Digital Dynamic Radiography (DDR) perfusion imaging represents a novel imaging that allows pulmonary perfusion assessment without contrast medium administration, able to detect anomalies at the patient’s bedside, representing a promising advancement, particularly for critically ill or contrast-allergic patients. In parallel, interventional radiology has become integral to APE management, particularly for high-risk and intermediate–high-risk patients, with evolving intravascular treatment techniques such as catheter-directed thrombolysis, mechanical thrombectomy, and thrombus aspiration. This narrative review provides an overview of the latest developments in APE diagnostic imaging and interventional radiology, contextualizing them within current guideline recommendations for endovascular treatment. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Imaging: An Exciting Future to Revolutionize the Diagnosis and Management of Cardiovascular Disease)

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16 pages, 683 KB

Open AccessArticle

Metabolic Syndrome Clusters and Arterial Stiffness: Unraveling Early Predictors of Cardiovascular Risk in a Follow-Up Study

by Agnė Jucevičienė, Ligita Ryliškytė, Jolita Badarienė and Aleksandras Laucevičius

J. Cardiovasc. Dev. Dis. 2025, 12(9), 332; https://doi.org/10.3390/jcdd12090332 - 29 Aug 2025

Abstract

Background: The aim of this study was to assess the association between different metabolic syndrome (MetS) component clusters, arterial stiffness as measured by aortic pulse wave velocity (aPWV) and cardio-ankle vascular index (CAVI), and the incidence of major cardiovascular events during long-term follow-up. [...] Read more.

Background: The aim of this study was to assess the association between different metabolic syndrome (MetS) component clusters, arterial stiffness as measured by aortic pulse wave velocity (aPWV) and cardio-ankle vascular index (CAVI), and the incidence of major cardiovascular events during long-term follow-up. Methods: The prospective cohort study included 5307 participants with MetS, aged 40 to 64 years, who had no evident cardiovascular disease and were enrolled in the Lithuanian High Cardiovascular Risk primary prevention program. All participants were followed up for an average of 4.57 ± 2.74 years to monitor the occurrence of major cardiovascular events. Arterial stiffness was assessed using aPWV and CAVI measurements. The associations between different MetS component clusters, arterial stiffness, and cardiovascular outcomes were analyzed. Results: During the follow-up period, 3.34% of the subjects experienced a major cardiovascular event. Individuals meeting four MetS criteria had a higher risk of events compared to those meeting three. Elevated triglycerides and elevated glucose were each significantly associated with increased risk. Specific MetS combinations, particularly clusters involving WTHB (increased waist circumference [W], elevated triglycerides [T], decreased HDL cholesterol [H], and elevated blood pressure [B]), as well as WBG (waist circumference, blood pressure, and glucose [G]), were significantly associated with cardiovascular events. The cross-sectional analysis also revealed that arterial stiffness, assessed as aPWV, was significantly higher in subjects with the WBG, WTBG, and WTHBG clusters. Meanwhile, higher CAVI was associated with the WTBG cluster. In the logistic regression analysis, the presence of the following clusters was linked to more than twice increased odds for having extremely stiff arteries: WTBG (OR = 2.351) and WTHBG (OR = 2.201) for aPWV values above the 95th percentile (>11.3 m/s) and WTB (OR = 2.096) for CAVI values above the 95th percentile (>10.2). Conclusions: Our findings demonstrate that higher risk of CV events is associated with increased arterial stiffness and higher number of MetS components present, as well as with the presence of specific MetS components; in particular, increased levels of triglycerides and glucose. Furthermore, the cross-sectional analysis demonstrated that subjects with the unfavorable combination of MetS components, such as WTBG, WTHBG, and WTB, are more than twice as likely to have extremely stiff arteries. Full article

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Journal of Cardiovascular Development and Disease

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