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Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition

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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 6812

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Prof. Dr. Mariana Floria

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Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 University Street, Iasi, Romania
Interests: arrhythmias; atrial fibrillation; left atrium; cardiovascular disease; cardiovascular risk factor; echocardiography; gastroesophageal reflux disease; metabolic associated steato-hepatitis; heart–liver axis
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Dr. Daniela Maria Tanase

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Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 University Street, Iasi, Romania
Interests: cardiovascular diseases; cardiovascular complications; atherosclerosis; oxidative stress; inflammatory bowel disease; nonalcoholic fatty liver disease; gut microbiota; dysbiosis; type 2 diabetes.
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Prof. Dr. Anca Trifan

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Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
Interests: hepatic fibrosis; steatohepatitis; inflammatory bowel disease; alcoholic liver disease; gastroenterology and hepatology; cardiovascular complications
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The first, second, and third editions of this Special Issue were completed successfully. We intend to publish a fourth edition, and so we invite you to submit your research for publication.

First edition: https://www.mdpi.com/journal/life/special_issues/56Z399BE63

Second edition: https://www.mdpi.com/journal/life/special_issues/3ZTJ8J37B6

Third edition: https://www.mdpi.com/journal/life/special_issues/6Y9E00J37O

Cardiovascular diseases are a significant cause of death worldwide. Interdisciplinarity has become mandatory in many cardiovascular diseases like hypertension, ischemic heart disease, arrhythmias, congenital heart disease, pericarditis, arrhythmias, or valvular heart disease. The decision to implement a heart team has become a common recommendation in cardiology guidelines. Diagnosis and treatment algorithms in cardiovascular disease, therefore, imply interdisciplinary collaboration with gastroenterologists, nephrologists, pulmonologists, neurologists, rheumatologists, hematologists, etc.

Gastroesophageal reflux disease, inflammatory bowel diseases, or metabolic-associated steatohepatitis are some digestive diseases that require a mixed team, namely a cardiologist–gastroenterologist team. These diseases share common physiopathological mechanisms or substrates, and there are, therefore, diagnostic and therapeutic interferences.

Despite the importance of cardiorenal syndrome and cardiac complications of chronic kidney disease or kidney transplantation, the interaction between nephrology and cardiovascular medicine is much broader. Nowadays, there are many advancements in nephrology and cardiovascular medicine, which merge new diagnostic, monitoring, and therapeutic modalities. Patients with acute or chronic kidney disease have pathologies like ischemia, dyslipidemia, or hypertension, which require interdisciplinary collaboration with the cardiologist. Nephrocardiology or cardionephrology, defined as the interaction between nephrology and cardiovascular medicine, is the multidirectional interplay of cardiovascular diseases and nephrology-related conditions.

Respiratory medicine and cardiac pathology share multiple comorbidities such as pulmonary hypertension, pulmonary embolism, and COPD. The cardiovascular and respiratory systems share common physiological and pathophysiological mechanisms and complications. The recent COVID-19 pandemic is the best example of the interdisciplinarity between cardiologist and pulmonologist.

Beyond frequent interferences between cardiology with gastroenterohepatology, nephrology, or respiratory medicine, there are many others, like metabolic, endocrinology, or hematology diseases, that share common risk factors, comorbidities, and complications.

To conclude, the heart team concept brings to the forefront the need for interdisciplinarity collaboration in cardiology. Liver–heart, bowel–heart, brain–heart, or kidney–heart axes might explain the pathophysiologic interferences and the multiple clinical consequences. Therefore, the prevention, diagnosis, and therapy of cardiovascular diseases increasingly involve collaboration with other specialties to make the best decisions for our patients. In addition, interdisciplinarity in cardiovascular disease might create new algorithms from diagnostic or therapeutic points of view in some cardiovascular diseases.

Prof. Dr. Mariana Floria
Dr. Daniela Maria Tanase
Prof. Dr. Anca Trifan
Guest Editors

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Keywords

interdisciplinarity team
cardiovascular diseases
cardiovascular complications
gastro-esophago-enterology and hepatology
metabolic-associated steatohepatitis
gut microbiota
nephrocardiology
pulmonary diseases
rheumatology diseases
endocrinology diseases

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Published Papers (8 papers)

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Research

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18 pages, 1243 KB

Open AccessArticle

Cardiorenal Interactions in Acute Decompensated Heart Failure: Associations Between Renal Dysfunction, Albuminuria, and Echocardiographic Markers of Myocardial Function

by Claudia Andreea Palcău, Livia Florentina Păduraru and Ana Maria Alexandra Stănescu

Life 2026, 16(4), 645; https://doi.org/10.3390/life16040645 - 11 Apr 2026

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Abstract

Background: Renal dysfunction is common in patients hospitalized with acute decompensated heart failure (ADHF) and represents a key component of cardiorenal syndrome. However, the relationships between renal impairment, cardiorenal biomarkers, and echocardiographic markers of myocardial function remain incompletely characterized in ADHF populations. Methods: We conducted a cross-sectional analysis of 144 consecutive patients hospitalized with ADHF. Renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Clinical, laboratory, and echocardiographic parameters were compared according to renal function. Correlation analyses, multivariable logistic regression, and receiver operating characteristic (ROC) curve analyses were performed to evaluate associations between renal dysfunction, cardiorenal biomarkers, and myocardial functional indices. Results: Patients with renal dysfunction were older (p = 0.002) and more frequently had diabetes mellitus (p = 0.006). Echocardiographic evaluation demonstrated significantly lower systolic mitral annular velocity (S′) (p < 0.001) and higher E/e′ ratios (p < 0.001) in patients with renal dysfunction, whereas left ventricular ejection fraction (p = 0.133) and global longitudinal strain (GLS) (p = 0.121) were similar between groups. Log-transformed NT-proBNP and albuminuria were significantly correlated with S′, GLS, and E/e′ (all p < 0.001). In multivariable analysis adjusted for clinically relevant confounders, chronic kidney disease (OR 8.16, 95% CI 2.13–31.34; p = 0.002) and the E/e′ ratio (OR 2.01, 95% CI 1.52–2.66; p < 0.001) remained independently associated with renal dysfunction. ROC analysis showed that E/e′ had the strongest ability to distinguish between patients with and without renal dysfunction (AUC 0.887, 95% CI 0.834–0.941; p < 0.001). Conclusions: Renal dysfunction in ADHF is associated with echocardiographic markers reflecting impaired longitudinal myocardial function and elevated filling pressure, with E/e′ emerging as the strongest echocardiographic correlate. The integration of echocardiographic parameters with cardiorenal biomarkers may improve the characterization of the cardiorenal profile in patients hospitalized with ADHF. Full article

(This article belongs to the Special Issue Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition)

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18 pages, 594 KB

Open AccessArticle

Structured Functional Assessment Pathway and Pharmacological Optimization During Cardiovascular Rehabilitation in Chronic Heart Failure: A Retrospective Tertiary Center Study

by Miruna Popovici, Abhinav Sharma, Gabriel Florin Razvan Mogos, Nilima Rajpal Kundnani, Daniel Duda Marius Seiman, Victor Buciu and Simona Ruxanda Dragan

Life 2026, 16(4), 603; https://doi.org/10.3390/life16040603 - 4 Apr 2026

Viewed by 455

Abstract

Introduction: Optimization of guideline-directed medical therapy in chronic heart failure remains challenging in real-world practice, particularly outside settings with routine cardiopulmonary exercise testing. In this context, cardiovascular rehabilitation can improve functional capacity, symptoms, and quality of life, while structured follow-up may also facilitate treatment adjustment. We therefore evaluated whether exposure to a structured multimodal functional assessment pathway, embedded within a more intensive follow-up model, was associated with pharmacological optimization and functional change in chronic heart failure. Methods: We conducted a retrospective, single-center cohort study including adults with chronic heart failure with reduced or mildly reduced ejection fraction managed in a tertiary university clinic. Patients were classified according to documented exposure to an integrated pathway that combined standardized 6 min walk testing, heart rate dynamics, oxygen saturation response, perceived exertion, validated quality-of-life assessment, and prespecified interim reassessment, versus usual care. The integrated pathway involved more frequent clinical contact than usual care. The primary outcome was change in 6 min walk distance over 6 months. Secondary outcomes included changes in heart rate recovery, oxygen saturation nadir, Borg perceived exertion score, quality-of-life score, intensity of guideline-directed medical therapy, treatment intensification rates, and heart failure hospitalization. Results: The study included 250 patients with comparable baseline demographic and clinical characteristics. Patients managed within the structured pathway showed greater improvement in 6 min walk distance at 6 months than those receiving usual care, together with more pronounced improvement in secondary functional parameters and quality-of-life scores. Pharmacological optimization, reflected by higher uptake and intensification of guideline-directed medical therapy, also occurred more frequently in the structured pathway group. The integrated group, however, also had higher follow-up intensity, which limits causal interpretation of the observed between-group differences. Conclusions: In this real-world heart failure cohort, exposure to a structured care pathway combining repeated multimodal functional profiling with closer follow-up was associated with greater functional improvement and more intensive pharmacological optimization. These findings should be interpreted as pathway-level associations rather than proof that functional assessment alone drove benefit, and they require prospective validation. Full article

(This article belongs to the Special Issue Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition)

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13 pages, 649 KB

Open AccessArticle

Cardiovascular Safety Signals of Oral Versus Topical Minoxidil in FAERS: A Disproportionality Analysis (Analytic Cohort 2012–2025)

by Hima Bindu Makkena and Vikas Kasu

Life 2026, 16(3), 522; https://doi.org/10.3390/life16030522 - 21 Mar 2026

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Oral minoxidil, including low-dose regimens, is increasingly used off-label for alopecia, but cardiovascular safety remains a clinical concern. We compared cardiovascular adverse event reporting patterns for oral versus topical minoxidil using a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS). FAERS data (2004Q1–2025Q3) were imported and deduplicated; minoxidil reports were restricted to primary/secondary suspect (PS/SS) drugs and eligible reports from 2012 to 2025. Exposure was classified as ORAL, TOPICAL, BOTH, or UNKNOWN using a standardized route/dose-form dictionary. Signals for Core and Expanded cardiovascular MedDRA Preferred Terms (PTs) were assessed using reporting odds ratios (RORs) with 95% confidence intervals; sensitivity analyses included alopecia-restricted cohorts excluding hypertension indications. In the primary ORAL-versus-TOPICAL cohort (559 oral; 56,947 topical), 23 Core-list PTs and 31 Expanded-list PTs met the signal definition. Strongest primary signals included pericardial effusion (ROR 307; 95% CI 158–597), hypertensive crisis (ROR 1037; 95% CI 133–8117), pulmonary hypertension (ROR 932; 95% CI 118–7368), and pulmonary edema (ROR 1965; 95% CI 114–33,813). In an alopecia-restricted sensitivity cohort excluding hypertension/blood-pressure indications (146 oral; 24,367 topical), hemodynamic and effusion-related PTs (e.g., tachycardia, palpitations, orthostatic hypotension, syncope, and pericardial effusion) remained disproportionately reported, although event counts were smaller and confidence intervals were wider. Oral minoxidil PS/SS reports in FAERS showed disproportionate reporting of several cardiovascular PTs relative to topical minoxidil reports. However, because FAERS is a spontaneous reporting system without exposed-patient denominators and with important limitations including under-reporting, stimulated reporting, incomplete clinical information, and residual confounding, these findings should be interpreted strictly as hypothesis-generating reporting signals rather than evidence of incidence, relative risk, or definitive comparative clinical safety. Full article

(This article belongs to the Special Issue Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition)

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19 pages, 2110 KB

Open AccessArticle

Evaluating the Whole Patient: Lessons from the Pre-CKM Era Toward Integrated Cardio–Kidney–Liver–Metabolic Care

by Felicia Chantal Derendinger, Annina Salome Vischer, Michael Mayr, Lilian Sewing, Isabelle Arnet and Thilo Burkard

Life 2026, 16(3), 492; https://doi.org/10.3390/life16030492 - 17 Mar 2026

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Before the American Heart Association introduced the cardiovascular–kidney–metabolic (CKM) syndrome concept in 2023, clinical care was largely organ-specific. This retrospective study analyzed diagnostic patterns and gaps in 406 patients with hypertension referred to and evaluated at the University Hospital Basel Hypertension Centre in 2017, 2019, or 2022 to identify blind spots in the assessment of cardio–kidney–liver–metabolic health. Electronic health records were used to assess CKM-relevant diagnostics, including lipid profiles, N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography, kidney function (estimated glomerular filtration rate: eGFR, urinary albumin-to-creatinine ratio: uACR), and hepatic assessment (Fib-4 score, abdominal ultrasound). Previously undetected conditions were identified according to contemporary criteria for dyslipidemia, chronic kidney disease (CKD), suspected heart failure (HF), diabetes, and suspected metabolic dysfunction-associated steatotic liver disease (MASLD). Although 94% of participants had laboratory data, key CKM parameters were inconsistently assessed. Of the participants, 39% had neither NT-proBNP measurement nor echocardiography, and 27% lacked hepatic ultrasound or sufficient data for Fib-4 calculation. Previously unrecognized comorbidities were common (suspected HF 21%, CKD 6%, suspected MASLD 3%). Lipoprotein(a) testing increased from 0% in 2017 to 23.7% in 2022, indicating growing awareness. Despite specialized care, diagnostic fragmentation persisted, underlining the need for systematic, interdisciplinary screening and informing the design of prospective registries such as the Swiss CKLM Registry to integrate patient-centered cardio–kidney–liver–metabolic care. Full article

(This article belongs to the Special Issue Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition)

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16 pages, 548 KB

Open AccessArticle

Optimising Return to Work for Cardiovascular Patients: An Interdisciplinary Approach in Occupational Medicine and Cardiology

by Donatella Sansone, Antonella Cherubini, Fabiano Barbiero, Marina Bollini, Marcella Mauro, Andrea Di Lenarda, Francesca Rui, Luca Cegolon and Francesca Larese Filon

Life 2026, 16(1), 19; https://doi.org/10.3390/life16010019 - 22 Dec 2025

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Abstract

Background: This study explored facilitators and barriers to return to work (RTW) after acute cardiovascular events or elective cardiac surgery, integrating clinical, functional, and occupational factors. Methods: A prospective cohort study was conducted at the Occupational Medicine and Cardiac Rehabilitation Units of the Maggiore Hospital in Trieste, Italy. Employed adults (18–67 years) admitted for acute coronary syndrome, valve replacement, or thoracic aortic surgery between January 2024 and July 2025 were enrolled. Sociodemographic, clinical, and occupational data were collected alongside functional and psychosocial assessments, including the Work Ability Index (WAI) and EQ-5D-5L. Predictors of RTW were analyzed with Cox regression models. Results: Among 103 patients (mean age 56.8 years; 92.2% male), 77.7% returned to work after a mean of 58.9 days. Independent predictors of earlier RTW were self-employment (HR 5.08, 95% CI 2.52–10.27), occupational responsibility (HR 2.12, 95% CI 1.01–4.45), and percutaneous coronary intervention (HR 2.72, 95% CI 1.47–5.06). Higher job-related physical demands, arrhythmias, and cardiac rehabilitation participation were associated with delayed RTW. Mean WAI (37.2 ± 5.1) and EQ-5D index (0.92 ± 0.09; EQ-VAS 77.4 ± 12.9) indicated preserved function and quality of life. Conclusions: RTW after cardiovascular events is multifactorial. Integrating occupational medicine into cardiac rehabilitation is key to ensuring safe, sustainable reintegration. Full article

(This article belongs to the Special Issue Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition)

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Review

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24 pages, 2760 KB

Open AccessReview

Impact of Early Diagnosis and Immunosuppressive Therapy on Giant Cell Myocarditis Outcomes: A Review

by Nilima Rajpal Kundnani, Abhijit Kumar, Abhinav Sharma, Berceanu Vaduva Marcel Mihai, Cristina Diana Ardelean, Lucretia Marin-Bancila, Mihaela Valcovici, Codrina Levai, Adela Iancu and Ciprian Ilie Rosca

Life 2026, 16(4), 575; https://doi.org/10.3390/life16040575 - 1 Apr 2026

Viewed by 513

Abstract

Background: Giant cell myocarditis (GCM) is a rare condition with an incompletely understood immune pathogenesis, characterized by inflammatory damage to the myocardium and the presence of multinucleated giant cells on histopathological examination. The frequently fulminant and severe course requires rapid intervention for a correct diagnosis and the initiation of immunosuppressive therapy, which is often life-saving. Materials and methods: This article contains information from observational studies and case reports, systematically collected from prestigious publications such as JACC, NEJN, ESC, JCC, Heliyon, and Cureus found in the PubMed and ClinicalTrials.gov databases. Thus, 25 patients diagnosed with giant cell myocarditis between March 2019 and May 2025 were analyzed, with a focus not only on the initial clinical evolution, mortality incidence, and the need for heart transplantation but also on the incidence of major complications such as cardiogenic shock and malignant rhythm and conduction disorders refractory to drug treatment. These parameters were studied according to certain intrinsic factors that cannot be influenced, such as age at onset, gender, and associated pathology of the patient, as well as extrinsic factors that can be influenced, such as the time of diagnosis and the start of immunosuppressive therapy. The results obtained were compared with those in the literature from previous years, considering the limitations of the current study. Results: The selected patients were 13 women (52%) and 12 men (48%), mostly from the US and Japan, aged between 22 and 76 years, with an average age of 44.92 years. An associated autoimmune pathology was found in 40% of patients in this group, and previous cardiovascular pathology in 28%. Only 8% had a history of GCM. The clinical onset of new-onset heart failure, refractory to usual therapy, with progressive dyspnea as the cardinal symptom was found in 12 patients, representing 48% of cases; palpitations as an expression of rhythm or conduction disorders were found in five patients, representing 20%; precordial discomfort to precordial pain accompanied or not by ST-T segment changes was present in four patients, representing 16%; and general signs and symptoms or those of other organs were present in three (12%) cases. The diagnosis was made by histological examination of the biopsy fragment obtained by endomyocardial biopsy or from the myocardial fragment obtained during the implantation of mechanical cardiovascular support devices and, less frequently, on the explanted heart and at autopsy. In terms of progression, of the 25 patients, four (16%) died, four (16%) required heart transplantation, and 16 (64%) had a severe progression with cardiogenic shock, which required mechanical circulatory support in 11 (44%) cases. The outcome was mainly influenced by the early diagnosis and administration of immunosuppressive medication, but also by the age of the patients and associated chronic diseases. Conclusions: Giant cell myocarditis is a serious condition that, in the absence of rapid diagnosis and appropriate immunosuppressive therapy, has a fulminant, often fatal course. Clinical suspicion of giant cell myocarditis remains important in the initial diagnosis. Raising this suspicion, together with modern and improved paraclinical investigations compared to previous years, has led to faster diagnosis and administration of immunosuppressive therapy in this pathology. Histological examination remains the gold standard for final diagnosis, but it should be noted that it may be non-diagnostic. In the face of a strong suspicion of giant cell myocarditis, the best approach is to start immunosuppressive therapy and monitor the patient’s progress. Immunosuppressive treatment remains decisive in influencing the evolution of this condition, both through prompt administration and through the adaptation of therapeutic regimens to the evolution of patients. A more detailed understanding of the immune-mediated pathogenesis of GCM and the identification of clinical risk factors for unfavorable short- and long-term outcomes may enable earlier risk stratification and the development of more targeted, individualized therapeutic strategies. Full article

(This article belongs to the Special Issue Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition)

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28 pages, 1161 KB

Open AccessReview

Arrhythmias in Rheumatoid Arthritis: A Call for a Multidisciplinary Team

by Veronica Ungurean, Diana Elena Costan, Monica Claudia Dobos, Anca Ouatu, Paula Cristina Morariu, Alexandru Florinel Oancea, Maria Mihaela Godun, Diana-Elena Floria, Dragos Traian Marcu, Genoveva Livia Baroi, Silviu Marcel Stanciu, Anton Knieling, Daniela Maria Tanase, Codrina Ancuta and Mariana Floria

Life 2025, 15(9), 1426; https://doi.org/10.3390/life15091426 - 11 Sep 2025

Cited by 1 | Viewed by 1786

Abstract

Background: Rheumatoid arthritis is the most prevalent systemic inflammatory disease, mainly affecting the synovial tissue of small and large joints, also associated with significant extra-articular manifestations. Throughout the progression of the disease, cardiac structures may be affected, including the conducting system, myocardium, endocardium, coronary arteries, and valves, potentially resulting in a higher incidence of cardiac arrhythmias. Methods: We performed a narrative review of the most recent studies that highlight the epidemiology, pathophysiology, diagnosis, and management of arrhythmias occurring in patients with rheumatoid arthritis. Furthermore, we examined the impact of disease-modifying antirheumatic drugs (DMARDs)—including conventional synthetic (csDMARDs), biologic (bDMARDs), and targeted synthetic agents (tsDMARDs)—on cardiac electrophysiology. Results: Cardiac immune cells may influence arrhythmogenesis through non-canonical and inflammatory mechanisms by modifying myocardial tissue architecture or by interacting with cardiomyocytes, potentially altering their electrical function. Conclusions: This review emphasizes the essential role of a multidisciplinary approach integrating rheumatology and cardiology expertise in the screening and management of arrhythmias in patients with rheumatoid arthritis. Full article

(This article belongs to the Special Issue Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition)

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Other

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8 pages, 947 KB

Open AccessCase Report

Beyond the Usual Suspects: IgG4-Related Disease as a Rare Culprit in Cardiac Valvular Disorders

by Piera Costanzo, Savino Sciascia, Giacomo Quattrocchio, Pierluigi Sbarra, Antonella Barreca, Roberta Bracci, Irene Cecchi, Massimo Radin, Elisa Menegatti and Simone Baldovino

Life 2026, 16(4), 537; https://doi.org/10.3390/life16040537 - 24 Mar 2026

Viewed by 423

Abstract

Cardiologists consider degenerative or infectious causes when evaluating valvular heart disease. However, the role of autoimmune disorders, though less frequent, remains clinically significant. This report describes a young male patient presenting with persistent coronary disease and a suspected valvular cusp perforation initially attributed to infective endocarditis, which ultimately proved to be a manifestation of IgG4-related disease. IgG4-related disease is a rare condition, more prevalent in Asian populations, that typically affects the pancreas, salivary glands, lacrimal glands, and the retroperitoneum. Cardiac involvement, although uncommon, can present in various ways, including pericarditis, pulmonary arterial hypertension, valve dysfunction, cardiac pseudotumor, and coronary disease. Diagnosing and managing IgG4-related cardiac involvement requires heightened clinical suspicion, serological and histopathological assessment, and prompt interdisciplinary collaboration. Notably, involving rheumatologists in the management of these rare yet impactful autoimmune cardiac diseases is essential. Full article

(This article belongs to the Special Issue Interdisciplinarity in Cardiovascular Diseases: From Pathophysiology to Diagnosis and Treatment—4th Edition)

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