Journal of Cardiovascular Development and Disease

14 pages, 502 KiB

Open AccessArticle

Gender Differences in Objective and Subjective Social Isolation and Self-Reported Hypertension in Older Adults

by Tyrone C. Hamler, Ann W. Nguyen, Harry Owen Taylor, Weidi Qin and Fei Wang

J. Cardiovasc. Dev. Dis. 2025, 12(4), 136; https://doi.org/10.3390/jcdd12040136 - 4 Apr 2025

Hypertension is a major public health concern, especially in older adults, and gender differences are a factor in terms of its prevalence. Social connections benefit health, while social isolation is linked to negative outcomes. Prior studies suggest social isolation and connectedness vary by [...] Read more.

Hypertension is a major public health concern, especially in older adults, and gender differences are a factor in terms of its prevalence. Social connections benefit health, while social isolation is linked to negative outcomes. Prior studies suggest social isolation and connectedness vary by gender, but few have explored this relationship with hypertension. This study examined gender differences in the association between social isolation and hypertension in older adults using data from the National Survey of American Life (1280 adults aged ≥55). Weighted logistic regressions tested gender differences in objective and subjective social isolation and hypertension. Both men and women who were objectively isolated from family and friends, or only friends, were less likely to have hypertension than those not isolated. However, when accounting for subjective isolation, only isolation from family predicted hypertension. Gender moderated this relationship—men isolated from family and friends had a higher likelihood of hypertension, while no such association was found for women. Findings suggest that preventing objective isolation, particularly from family, may help reduce hypertension risk in older adults. This study highlights the need to further investigate social isolation’s impact on health and its underlying mechanisms among older adults in the U.S. Full article

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

► Show Figures

Figure 1

15 pages, 827 KiB

Open AccessReview

Telomere Length and Clonal Hematopoiesis of Indeterminate Potential: A Loop Between Two Key Players in Aortic Valve Disease?

by Ilenia Foffa, Augusto Esposito, Ludovica Simonini, Sergio Berti and Cecilia Vecoli

J. Cardiovasc. Dev. Dis. 2025, 12(4), 135; https://doi.org/10.3390/jcdd12040135 - 3 Apr 2025

Abstract

Aortic valve stenosis (AVS) is the most common valvular heart disease that was considered, for a long time, a passive degenerative disease due to physiological aging. More recently, it has been recognized as an active, modifiable disease in which many cellular processes are [...] Read more.

Aortic valve stenosis (AVS) is the most common valvular heart disease that was considered, for a long time, a passive degenerative disease due to physiological aging. More recently, it has been recognized as an active, modifiable disease in which many cellular processes are involved. Nevertheless, since aging remains the major risk factor for AVS, a field of research has focused on the role of early (biological) aging and its dependent pathways in the initiation and progression of AVS. Telomeres are regions at the ends of chromosomes that are critical for maintaining genome stability in eukaryotic cells. Telomeres are the hallmarks and molecular drivers of aging and age-related degenerative pathologies. Clonal hematopoiesis of indeterminate potential (CHIP), a condition caused by somatic mutations of leukemia-associated genes in individuals without hematologic abnormalities or clonal disorders, has been reported to be associated with aging. CHIP represents a new and independent risk factor in cardiovascular diseases, including AVS. Interestingly, evidence suggests a causal link between telomere biology and CHIP in several pathological disorders. In this review, we discussed the current knowledge of telomere biology and CHIP as possible mechanisms of aortic valve degeneration. We speculated on how a better understanding of the complex relationship between telomere and CHIP might provide great potential for an early diagnosis and for developing novel medical therapies to reduce the constant increasing health burden of AVS. Full article

► Show Figures

Figure 1

15 pages, 1737 KiB

Open AccessReview

Endurance Training Exercise Dose in Coronary Artery Disease Rehabilitation

by Daria Neyroud and Aaron L. Baggish

J. Cardiovasc. Dev. Dis. 2025, 12(4), 134; https://doi.org/10.3390/jcdd12040134 - 3 Apr 2025

Abstract

Clinical management of patients with atherosclerotic coronary artery disease (CAD) following acute coronary syndrome includes cardiac rehabilitation. The well-established hallmark of cardiac rehabilitation is structured aerobic exercise training. To date, however, a limited number of studies have directly compared the effects of different [...] Read more.

Clinical management of patients with atherosclerotic coronary artery disease (CAD) following acute coronary syndrome includes cardiac rehabilitation. The well-established hallmark of cardiac rehabilitation is structured aerobic exercise training. To date, however, a limited number of studies have directly compared the effects of different doses of exercise on cardiovascular health, leaving uncertainty about the possible differential benefits of different exercise doses for use during cardiac rehabilitation. To address this area of uncertainty, we conducted a literature review and comparative analyses of studies that both compared two or more exercise interventions and assessed pre- and post-intervention peak oxygen consumption (

\dot{V} O_{2 P E A K}

). Results from these analyses suggest that high exercise intensity, even when performed over relatively short duration interventions, appears to yield the most substantial improvements in cardiorespiratory fitness. However, this conclusion is based on the limited number of available studies, underscoring the need for future work examining exercise dose and clinical outcomes in the cardiac rehabilitation setting. Full article

(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)

► Show Figures

Figure 1

11 pages, 595 KiB

Open AccessArticle

Age-Dependent Risk of Long-Term All-Cause Mortality in Patients Post-Myocardial Infarction and Acute Kidney Injury

by Keren Skalsky, Mashav Romi, Arthur Shiyovich, Alon Shechter, Tzlil Grinberg, Harel Gilutz and Ygal Plakht

J. Cardiovasc. Dev. Dis. 2025, 12(4), 133; https://doi.org/10.3390/jcdd12040133 - 3 Apr 2025

Abstract

Objectives: We aimed to investigate the association between acute kidney injury (AKI) and the risk for long-term (up to 10 years) all-cause mortality among elderly compared with younger patients following an acute myocardial infarction (AMI). Methods: This study was a retrospective analysis of [...] Read more.

Objectives: We aimed to investigate the association between acute kidney injury (AKI) and the risk for long-term (up to 10 years) all-cause mortality among elderly compared with younger patients following an acute myocardial infarction (AMI). Methods: This study was a retrospective analysis of the Soroka Acute Myocardial Infarction registry and covered the years 2002 to 2017. It included patients diagnosed with an AMI who had a baseline estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m² and serum creatinine measurements available during hospitalization. The patients were stratified by age: elderly (aged 65 years or older at admission) and younger. In each stratum, two groups were defined based on the presence of an AKI. The survival approach (Kaplan–Meier survival curves, log-rank test and Cox regressions) was utilized to estimate and compare the probability of long-term (up to 10 years) all-cause mortality in each group. Results: Among the 10,511 eligible patients, which consisted of 6132 younger patients (58.3%) and 4379 elderly (41.7%), an AKI occurred in 15.2% of cases, where the elderly patients experienced a higher incidence than the younger patients (20.9% vs. 11.2%, p < 0.001). The presence of an AKI significantly increased the risk of death in both age groups, with the association being stronger among the younger patients (AdjHR = 1.634, 95% CI: 1.363–1.959, p < 0.001) than among the elderly (AdjHR = 1.278, 95% CI: 1.154–1.415, p < 0.001, p-for-interaction = 0.020). Conclusions: An AKI following an AMI was associated with a high risk for long-term all-cause mortality in both age groups, with a stronger association among younger patients. Full article

► Show Figures

Figure 1

9 pages, 1789 KiB

Open AccessArticle

Decreased Endothelial Progenitor Cells Are Associated with Severe Coronary Artery Disease: Insights from a Clinical Study

by Ivan Tomić, Ivan Zeljko, Ivica Brizić, Violeta Šoljić, Ivona Ivančić, Monika Tomić, Marina Ćurlin and Domagoj Tomić

J. Cardiovasc. Dev. Dis. 2025, 12(4), 132; https://doi.org/10.3390/jcdd12040132 - 3 Apr 2025

Abstract

Endothelial progenitor cells (EPCs) play a crucial role in vascular repair, and their depletion has been involved in coronary artery disease (CAD) severity. This study examines the relationship between circulating EPC levels and CAD complexity, as quantified by the Syntax Score I. A [...] Read more.

Endothelial progenitor cells (EPCs) play a crucial role in vascular repair, and their depletion has been involved in coronary artery disease (CAD) severity. This study examines the relationship between circulating EPC levels and CAD complexity, as quantified by the Syntax Score I. A total of 85 patients undergoing coronary angiography were enrolled, with EPCs quantified using flow cytometry. EPC proportion showed a significant inverse relationship with CAD severity, measured by Syntax Score I. Additionally, we investigated EPC levels in patients presenting with acute coronary syndrome (ACS) and found that EPC depletion was more pronounced in this group compared to non-ACS patients (median EPC count: 0.35 vs. 0.61, p = 0.027). These findings suggest that lower EPC levels are indicative of more severe CAD and ACS, reinforcing their potential as biomarkers for cardiovascular risk stratification, monitoring disease advancement, and identifying patients at risk of adverse events. Full article

► Show Figures

Figure 1

12 pages, 3195 KiB

Open AccessArticle

Subtraction CT Angiography for the Evaluation of Lower Extremity Artery Disease with Severe Arterial Calcification

by Ryoichi Tanaka and Kunihiro Yoshioka

J. Cardiovasc. Dev. Dis. 2025, 12(4), 131; https://doi.org/10.3390/jcdd12040131 - 2 Apr 2025

Abstract

(1) Background: Peripheral arterial CT angiography (CTA) is an alternative to conventional angiography for diagnosing lower extremity artery disease (LEAD). However, severe arterial calcifications often hinder accurate assessment of arterial stenosis. This study evaluated the diagnostic performance of subtraction CTA with volume position [...] Read more.

(1) Background: Peripheral arterial CT angiography (CTA) is an alternative to conventional angiography for diagnosing lower extremity artery disease (LEAD). However, severe arterial calcifications often hinder accurate assessment of arterial stenosis. This study evaluated the diagnostic performance of subtraction CTA with volume position matching compared to conventional CTA, using invasive digital subtraction angiography (DSA) as the gold standard. (2) Methods: Thirty-two patients with LEAD (mean age: 69.6 ± 10.8 years; M/F = 28:4) underwent subtraction CTA and DSA. The arterial tree was divided into 20 segments per patient, excluding segments with a history of bypass surgery. Subtraction was performed separately for each limb using volume position matching. Maximum intensity projections were reconstructed from both conventional and subtraction CTA data. Percent stenosis per arterial segment was measured using calipers and compared with DSA. Segments were classified as stenotic (>50% luminal narrowing) or not, with heavily calcified or stented segments assigned as incorrect. (3) Results: Of 640 segments, 636 were analyzed. Subtraction CTA and conventional CTA left 13 (2.0%) and 160 (25.2%) segments uninterpretable, respectively. Diagnostic accuracies (accuracy, precision, recall, macro F1 score) for subtraction CTA were 0.885, 0.884, 0.936, and 0.909, compared to 0.657, 0.744, 0.675, and 0.708 for conventional CTA. (4) Conclusions: Subtraction CTA with volume position matching is feasible and achieves high diagnostic accuracy in patients with severe calcific sclerosis. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))

► Show Figures

Figure 1

11 pages, 569 KiB

Open AccessReview

Cerebral and Spinal Cord Protection Strategies in Aortic Arch Surgery

by Andrea Myers, Ciprian Nita and Guillermo Martinez

J. Cardiovasc. Dev. Dis. 2025, 12(4), 130; https://doi.org/10.3390/jcdd12040130 - 2 Apr 2025

Abstract

Perioperative management of patients undergoing surgeries of the aortic arch is challenging. This cohort of patients has a high risk of poor neurological outcomes both as a consequence of the disease process as well as the methods employed during surgical management. Many strategies [...] Read more.

Perioperative management of patients undergoing surgeries of the aortic arch is challenging. This cohort of patients has a high risk of poor neurological outcomes both as a consequence of the disease process as well as the methods employed during surgical management. Many strategies have been put forward to ameliorate these complications; however, maintaining cerebral and spinal cord perfusion and reducing metabolic oxygen demand is the core principle of these strategies. Moderate hypothermia and selective ante-grade perfusion are the most promising methods that provide the best conditions for the competing requirements of both the brain and spinal cord. Intraoperative and postoperative monitoring is essential for early detection and intervention in delayed spinal cord ischaemia and stroke. In this article we aim to discuss the current methods of neuroprotection and spinal cord protection in aortic arch surgery and stenting. Full article

(This article belongs to the Special Issue Current Status and Future Challenges of Aortic Arch Surgery)

► Show Figures

Figure 1

15 pages, 2927 KiB

Open AccessArticle

Changes in Abdominal Artery Diameter in Patients Treated for Acute Aortic Dissection

by Marian Burysz, Radosław Litwinowicz, Mariusz Kowalewski, Jerzy Walocha and Jakub Batko

J. Cardiovasc. Dev. Dis. 2025, 12(4), 129; https://doi.org/10.3390/jcdd12040129 - 2 Apr 2025

Abstract

Background: Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already [...] Read more.

Background: Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already been demonstrated that changes in arterial diameter can be observed in patients with non-occlusive intestinal ischemia. The aim of this study was to compare the arterial branches of the abdominal aorta in patients with AAD preoperatively and postoperatively. Methods: Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure for the treatment of AAD were reconstructed and retrospectively analyzed with detailed medical data of the patients. Results: In patients without AAD at the level of the abdominal aorta, statistically significant differences were observed when comparing the diameter of the superior mesenteric artery (p < 0.001) and the renal arteries (p < 0.001) between preoperative and postoperative scans. Occlusion of the inferior mesenteric artery was more common in patients with AAD involving the abdominal aorta. Statistically significant differences in true and false lumen were observed at each level of the abdominal aorta after a successful frozen elephant trunk procedure. Conclusion: Significant changes in visceral artery diameter were observed at the abdominal aortic level in patients both with and without aortic dissection. Chronic or non-occlusive mesenteric ischemia may be associated with a lack of adjustment in arterial diameter. Patients with AAD of the abdominal aorta are more susceptible to occlusion of the inferior mesenteric artery. Full article

(This article belongs to the Special Issue Current Status and Future Challenges of Aortic Arch Surgery)

► Show Figures

Figure 1

11 pages, 1576 KiB

Open AccessArticle

Non-Invasive Measurement of Hemodynamic Parameters via Whole-Body Impedance Cardiography Among Hospitalized Heart Failure Patients: An Effective Alternative to Invasive Right Heart Catheterization?

by Felix Ausbuettel, Sabah Khwamurad, Murad Haj Abdo, Sebastian Kerber, Karin Nentwich, Martina Hautmann and Sebastian Barth

J. Cardiovasc. Dev. Dis. 2025, 12(4), 128; https://doi.org/10.3390/jcdd12040128 - 2 Apr 2025

Abstract

(1) Background: The measurement of hemodynamic parameters has proven to be crucial in the treatment of hospitalized heart failure patients, necessitating invasive measurement by right heart catheterization (RHC). The reliability of whole-body impedance cardiography (ICG) among this cohort has not been investigated to [...] Read more.

(1) Background: The measurement of hemodynamic parameters has proven to be crucial in the treatment of hospitalized heart failure patients, necessitating invasive measurement by right heart catheterization (RHC). The reliability of whole-body impedance cardiography (ICG) among this cohort has not been investigated to date; (2) Methods: The RHC and whole-body ICG examinations measured cardiac output (CO), the cardiac index (CI), total peripheral resistance (TPR), and pulmonary vascular resistance (PVR). To assess the accuracy of the whole-body ICG measurement, bias and precision were calculated as the mean difference and the twofold standard deviation between the average values of measurements; (3) Results: A total of 203 patients were analyzed. No significant bias was observed between the non-invasive CO and CI measurements when compared with the RHC measurements (−0.14 ± 2.56 L/min, p = 0.1; −0.09 ± 1.3 L/min/m², p = 0.06), but a significant bias occurred in the measurement of non-invasive TPR and non-invasive PVR (−1243 ± 3510 dyn × s⁻¹ × cm⁻⁵, p = 0.001; −121 ± 504 dyn × s⁻¹ × cm⁻⁵, p < 0.001); (4) Conclusions: CO and CI can be measured with whole-body ICG among hospitalized CHF patients with acceptable accuracy. The reliability of measuring TPR and PVR should be further investigated. Full article

► Show Figures

Figure 1

14 pages, 297 KiB

Open AccessReview

Frailty in Cardiac Surgery—Assessment Tools, Impact on Outcomes, and Optimisation Strategies: A Narrative Review

by Ashwini Chandiramani and Jason M. Ali

J. Cardiovasc. Dev. Dis. 2025, 12(4), 127; https://doi.org/10.3390/jcdd12040127 - 31 Mar 2025

Abstract

Background: Advancements in surgical care have made it possible to offer cardiac surgery to an older and frailer patient cohort. Frailty has been recognised as a prognostic indicator that impacts post-operative recovery and patient outcomes. The aim of this study is to identify [...] Read more.

Background: Advancements in surgical care have made it possible to offer cardiac surgery to an older and frailer patient cohort. Frailty has been recognised as a prognostic indicator that impacts post-operative recovery and patient outcomes. The aim of this study is to identify frailty assessment tools, evaluate the impact of frailty on post-operative outcomes, and explore strategies to optimise care for frail patients undergoing cardiac surgery. Methods: A comprehensive literature search was performed across PubMed, MEDLINE, and SCOPUS to identify articles reporting post-operative outcomes related to frail patients undergoing cardiac surgery. Results: Measurement tools such as gait speed, the Clinical Frailty Scale, Fried frailty phenotype, deficit accumulation frailty index and the Short Physical Performance Battery can be used to assess frailty. Frailty has been reported to increase the risk of post-operative morbidity and mortality. Multiple studies have also reported the association between frailty and an increased length of intensive care unit and hospital stays, as well as an increased risk of post-operative delirium. It is important to perform a comprehensive frailty assessment and implement perioperative optimisation strategies to improve outcomes in this patient population. Pre-operative strategies that can be considered include adequate nutritional support, cardiac prehabilitation, and assessing patients using a multidisciplinary team approach with geriatric involvement. Post-operatively, interventions such as early recognition and treatment of post-operative delirium, nutrition optimisation, early planning for cardiac rehabilitation, and occupational therapy can support patients’ recovery and reintegration into daily activities. Conclusions: The early identification of frail patients during the perioperative period is essential for risk stratification and tailored management strategies to minimise the impact of frailty on outcomes following cardiac surgery. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

19 pages, 13429 KiB

Open AccessReview

Perioperative Considerations, Anesthetic Management and Transesophageal Echocardiographic Evaluation of Patients Undergoing the Ross Procedure

by Giacomo Scorsese, Brandon Yonel, Eric Schmalzried, Alexandra Solowinska, Zhaosheng Jin and Jeremy Poppers

J. Cardiovasc. Dev. Dis. 2025, 12(4), 126; https://doi.org/10.3390/jcdd12040126 - 31 Mar 2025

Abstract

The Ross procedure introduced a new technique for aortic valve replacement by utilizing a pulmonary autograft to replace the diseased aortic valve. This approach provides a living, dynamic valve substitute capable of growth and adaptation to systemic pressures while addressing the limitations of [...] Read more.

The Ross procedure introduced a new technique for aortic valve replacement by utilizing a pulmonary autograft to replace the diseased aortic valve. This approach provides a living, dynamic valve substitute capable of growth and adaptation to systemic pressures while addressing the limitations of mechanical valves, which require lifelong anticoagulation, and bioprosthetic valves, which lack durability and growth potential. The Ross procedure offers superior hemodynamic performance and freedom from anticoagulation. While initially popular, utilization declined due to its technical complexity and concerns regarding the potential for the failure of two valves, requiring additional operations. Advances in surgical techniques, such as reinforced autografts, improved myocardial protection, and better homograft preservation, coupled with evidence of favorable long-term outcomes, have renewed interest in the procedure. Preoperative imaging with echocardiography, cardiac magnetic resonance imaging, and computed tomography angiography ensures optimal patient selection and preparation. Intraoperatively, precise autograft harvesting, accurate implantation, and meticulous right ventricular outflow tract reconstruction are critical for success. Blood conservation techniques, such as acute normovolemic hemodilution and retrograde autologous priming, are employed to minimize transfusion-related complications. The anesthesiologist plays a critical role, including meticulous monitoring of myocardial function and hemodynamics, with intraoperative transesophageal echocardiography being essential for assessing valve integrity and ventricular function. Recent studies suggest that the Ross procedure can restore life expectancy in appropriately selected patients, reinforcing its value as a surgical option for managing aortic valve disease. Full article

► Show Figures

Graphical abstract

20 pages, 1092 KiB

Open AccessReview

Paravalvular Leak in Transcatheter Aortic Valve Implantation: A Review of Current Challenges and Future Directions

by Andreas Synetos, Nikolaos Ktenopoulos, Odysseas Katsaros, Konstantina Vlasopoulou, Maria Drakopoulou, Leonidas Koliastasis, Ioannis Kachrimanidis, Anastasios Apostolos, Sotirios Tsalamandris, George Latsios, Konstantinos Toutouzas, Ioannis Patrikios and Constantinos Tsioufis

J. Cardiovasc. Dev. Dis. 2025, 12(4), 125; https://doi.org/10.3390/jcdd12040125 - 31 Mar 2025

Abstract

Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary therapeutic modality for the management of severe aortic stenosis (AS), particularly in patients who are at high or prohibitive risk for surgical aortic valve replacement (SAVR). Over the past decade, extensive clinical evidence [...] Read more.

Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary therapeutic modality for the management of severe aortic stenosis (AS), particularly in patients who are at high or prohibitive risk for surgical aortic valve replacement (SAVR). Over the past decade, extensive clinical evidence has expanded the indications for TAVI to include intermediate- and low-risk populations, which usually represent a population of younger age, in which the most common complications of TAVI, including paravalvular leak (PVL) and pacemaker implantation, should be avoided. This review focuses on the incidence and predictors of PVL in various types of TAVI implantation, its clinical implication, and the prevention strategies to tackle this complication. Full article

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

► Show Figures

Figure 1

19 pages, 1156 KiB

Open AccessReview

Unveiling the Systemic Impact of Congestion in Heart Failure: A Narrative Review of Multisystem Pathophysiology and Clinical Implications

by Daniela Mocan, Radu Jipa, Daniel Alexandru Jipa, Radu Ioan Lala, Florin Claudiu Rasinar, Iulia Groza, Ronela Sabau, Damaris Sulea Bratu, Diana Federica Balta, Sergiu Teodor Cioban and Maria Puschita

J. Cardiovasc. Dev. Dis. 2025, 12(4), 124; https://doi.org/10.3390/jcdd12040124 - 31 Mar 2025

Abstract

Congestion is a key clinical feature of heart failure (HF), contributing to hospitalizations, disease progression, and poor outcomes. While traditionally considered a hemodynamic issue, congestion is now recognized as a systemic process affecting multiple organs. Renal dysfunction arises from impaired perfusion and sodium [...] Read more.

Congestion is a key clinical feature of heart failure (HF), contributing to hospitalizations, disease progression, and poor outcomes. While traditionally considered a hemodynamic issue, congestion is now recognized as a systemic process affecting multiple organs. Renal dysfunction arises from impaired perfusion and sodium retention, leading to maladaptive left ventricular remodeling. Hepatic congestion contributes to cholestatic liver injury, while metabolic disturbances drive anemia, muscle wasting, and systemic inflammation. Additionally, congestion disrupts the intestinal barrier and immune function, exacerbating HF progression. Given its widespread impact, effective congestion management requires a shift from a cardiovascular-centered approach to a comprehensive, multidisciplinary strategy. Targeted decongestive therapy, metabolic and nutritional optimization, and immune modulation are crucial in mitigating congestion-related organ dysfunction. Early recognition and intervention are essential to slow disease progression, preserve functional capacity, and improve survival. Addressing HF congestion through personalized, evidence-based strategies is vital for optimizing long-term care and advancing treatment paradigms. Full article

► Show Figures

Figure 1

16 pages, 3070 KiB

Open AccessArticle

Effects of Pulmonary Vein Isolation for Atrial Fibrillation on Skin Sympathetic Nerve Activity in Association with Left Atrial Remodeling

by Yoichiro Nakagawa, Takashi Kusayama, Mayumi Morita, Yuta Nagamori, Kazutaka Takeuchi, Shuhei Iwaisako, Toyonobu Tsuda, Takeshi Kato, Soichiro Usui, Kenji Sakata, Kenshi Hayashi and Masayuki Takamura

J. Cardiovasc. Dev. Dis. 2025, 12(4), 123; https://doi.org/10.3390/jcdd12040123 - 30 Mar 2025

Abstract

Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). While it is known to affect the autonomic nervous system, the relationship between left atrial (LA) remodeling and PVI-mediated neuromodulation remains unclear. We aimed to assess the neuromodulatory effects of PVI [...] Read more.

Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). While it is known to affect the autonomic nervous system, the relationship between left atrial (LA) remodeling and PVI-mediated neuromodulation remains unclear. We aimed to assess the neuromodulatory effects of PVI using skin sympathetic nerve activity (SKNA). SKNA was recorded one day before and 2–3 days after PVI in 28 paroxysmal AF (PAF) and 33 persistent AF (PerAF) groups. Baseline low frequency to high frequency (LF/HF) ratio was higher in the PAF group (1.23 [interquartile range {IQR}: 0.79–1.76] vs. 0.74 [IQR: 0.49–1.38], p = 0.017). After PVI, the PAF group demonstrated significant reductions in burst amplitude (1.46 [IQR: 1.04–2.84] vs. 1.09 [IQR: 0.78–2.17] μV, p = 0.015) and LF/HF ratio (0.91 [IQR: 0.73–1.52] vs. 0.71 [IQR: 0.48–1.21], p = 0.012), whereas the PerAF group exhibited no such changes. A weak positive correlation was observed between the percentage change in LF/HF ratio and LA volume index in the PAF group (r = 0.572, p = 0.002). PVI significantly decreased SKNA in PAF patients but not in PerAF. LA remodeling may hinder the effectiveness of PVI-mediated neuromodulation. Full article

(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)

► Show Figures

Figure 1

12 pages, 6939 KiB

Open AccessSystematic Review

Wearable Devices for Quantifying Atrial Fibrillation Burden: A Systematic Review and Bayesian Meta-Analysis

by Ioannis Anagnostopoulos, Dimitrios Vrachatis, Maria Kousta, Sotiria Giotaki, Dimitra Katsoulotou, Christos Karavasilis, Gerasimos Deftereos, Nikolaos Schizas, Dimitrios Avramides, Georgios Giannopoulos, Theodore G. Papaioannou and Spyridon Deftereos

J. Cardiovasc. Dev. Dis. 2025, 12(4), 122; https://doi.org/10.3390/jcdd12040122 - 30 Mar 2025

Abstract

Background: Atrial fibrillation (AF) is the most common supraventricular arrhythmia and is associated with an impaired prognosis. Studies using implantable cardiac monitors suggest that this association is closely linked to AF burden, defined as the percentage of time spent in AF. Consequently, there [...] Read more.

Background: Atrial fibrillation (AF) is the most common supraventricular arrhythmia and is associated with an impaired prognosis. Studies using implantable cardiac monitors suggest that this association is closely linked to AF burden, defined as the percentage of time spent in AF. Consequently, there is a growing need for affordable and comfortable alternative devices, such as wearables, capable of reliably monitoring AF burden in patients with AF. Methods: Major electronic databases were searched for studies comparing AF burden quantification using wearables and reference ECG monitoring methods. A Bayesian approach was adopted for the final analysis. Results: Six studies, including a total of 448 patients and 36,978 h of valid simultaneous recordings, were analyzed. Bayesian analysis revealed no statistically significant differences between wearables and reference methods in AF burden quantification. The mean error was 1% (95% CrIs: −4% to 7%). Similar findings were observed in the subgroup analysis of studies assessing only smartwatches. Between-study heterogeneity was low, and no evidence of publication bias was detected. Conclusion: Our analysis suggests that AF burden quantification using wearables is comparable to reference ECG monitoring methods. These findings support the potential role of wearables in clinical practice, particularly for research and prognostic purposes. However, more studies are needed to determine whether the observed statistical equivalence translates to clinical significance, thereby supporting the widespread use of wearables in the assessment of rhythm control therapeutic strategies. Full article

(This article belongs to the Special Issue Extensive Approach to Atrial Fibrillation: Background and Future Perspectives)

► Show Figures

Graphical abstract

11 pages, 5139 KiB

Open AccessCase Report

Dilated Cardiomyopathy: A Novel BAG3 Mutation Associated with Aggressive Disease Progression and Ventricular Arrhythmias

by Paolo Pastori, Cristina Balla, Marta Rasia, Emilia Lo Jacono, Clelia Guerra, Roberta Schininà, Francesca Gualandi, Matteo Bertini and Giovanni Tortorella

J. Cardiovasc. Dev. Dis. 2025, 12(4), 121; https://doi.org/10.3390/jcdd12040121 - 28 Mar 2025

Abstract

We present the case of a 46-year-old man with a history of complex ventricular arrhythmias preceding the development of asymptomatic mild left ventricular dysfunction, who presented with acute-onset heart failure and was ultimately diagnosed with dilated cardiomyopathy. Genetic testing identified a novel, likely [...] Read more.

We present the case of a 46-year-old man with a history of complex ventricular arrhythmias preceding the development of asymptomatic mild left ventricular dysfunction, who presented with acute-onset heart failure and was ultimately diagnosed with dilated cardiomyopathy. Genetic testing identified a novel, likely pathogenic mutation in exon 4 of the BAG3 gene (NM_004281, c.1128del, (p.(Ser377AlafsTer47)), not previously reported in the literature. Given the presence of multiple clinical features indicative of a poor prognosis, he underwent prophylactic placement of a subcutaneous implantable cardioverter-defibrillator. The clinical presentation of this novel BAG3 mutation suggests that it may be associated with a significant arrhythmic phenotype. This case underscores the importance of close follow-up and genetic testing in patients presenting with mild left ventricular dysfunction and ventricular arrhythmias. Full article

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

► Show Figures

Figure 1

12 pages, 256 KiB

Open AccessArticle

Bradycardias in Patients with Pulmonary Hypertension—Prevalence, Pathophysiology and Clinical Relevance

by Paul Ole Behrendt, Lukas Ley, Hossein Ardeschir Ghofrani and Dirk Bandorski

J. Cardiovasc. Dev. Dis. 2025, 12(4), 120; https://doi.org/10.3390/jcdd12040120 - 28 Mar 2025

Abstract

Introduction: Arrhythmias are a frequent complication of pulmonary hypertension (PH). Supraventricular tachycardias (SVT) are predominantly reported and are associated with clinical deterioration and an increased mortality. In contrast, the prevalence and clinical relevance of bradycardias is largely unclear. Therefore, the aim of the [...] Read more.

Introduction: Arrhythmias are a frequent complication of pulmonary hypertension (PH). Supraventricular tachycardias (SVT) are predominantly reported and are associated with clinical deterioration and an increased mortality. In contrast, the prevalence and clinical relevance of bradycardias is largely unclear. Therefore, the aim of the present study was to determine a prevalence of bradycardias in PH patients and to outline their clinical relevance. Material and methods: Between January 2000 and June 2013, consecutive PH patients were pro- and retrospectively enrolled in two cohorts. Patients received either a 24 h or 72 h Holter ECG. Results: A total of 314 patients (58% female, mean age: 63 years) from PH groups 1–5 (39%, 11%, 19%, 28%, 3%) were included. Basic heart rhythm was sinus rhythm in 87% of patients (9% atrial fibrillation, 2% atrial flutter and 2% paced rhythm). Further arrhythmias were detected in 34% of patients (SVT: 12%, non-sustained ventricular tachycardia: 16%) with a 6% prevalence of relevant bradycardias. Atrioventricular block was revealed in 5% of patients (seven first-degree, one and three second-degree Wenckebach and Mobitz type, respectively, four third-degree), and 1% revealed sinoatrial block (one second-degree, third-degree and unspecified each). Conclusions: The prevalence of bradycardias appears to be about 5–10% in PH patients. Most of them are short and self-limiting. However, some patients experience syncope or clinical deterioration and, therefore, need specific treatment. To find these patients, long-term ECG monitoring combined with ECG-symptom correlation may be useful. Bradycardic medication should be excluded as a cause. Full article

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

15 pages, 2582 KiB

Open AccessArticle

Intraoperative Hemoadsorption in Heart Transplant Surgery: A 5-Year Experience

by Nikola Sliskovic, Gloria Sestan, Savica Gjorgjievska, Davor Baric, Daniel Unic, Josip Varvodic, Marko Kusurin, Dubravka Susnjar, Sarah Singer and Igor Rudez

J. Cardiovasc. Dev. Dis. 2025, 12(4), 119; https://doi.org/10.3390/jcdd12040119 - 28 Mar 2025

Abstract

Background: Hyperimmune response and cytokine release post-reperfusion might occur after orthotopic heart transplantation (HTx). Intraoperative hemoadsorption (HA) has been introduced to remove such elevated cytokines. We aimed to analyze the effect of intraoperative HA in patients undergoing orthotopic HTx. Methods: Between 2018 and [...] Read more.

Background: Hyperimmune response and cytokine release post-reperfusion might occur after orthotopic heart transplantation (HTx). Intraoperative hemoadsorption (HA) has been introduced to remove such elevated cytokines. We aimed to analyze the effect of intraoperative HA in patients undergoing orthotopic HTx. Methods: Between 2018 and 2022, 40 consecutive orthotopic HTx patients who underwent intraoperative hemoadsorption HA integrated into the cardiopulmonary bypass were compared to 41 historical controls. Primary outcome measures included postoperative hemodynamic stability and blood product requirements, while secondary outcomes were the incidence of acute kidney injury requiring dialysis (AKI-d) and 30-day mortality. Results: Postoperatively, the vasoactive-inotropic score (VIS) did not significantly differ between the groups. However, the use duration for milrinone and dobutamine was shortened by one day compared to controls. The HA group had fewer red blood cell transfusions (765 vs. 1330 mL, p = 0.01) and lower fresh frozen plasma requirements (945 vs. 1200 mL, p = 0.04). Mechanical ventilation duration was reduced (22 vs. 28 h, p = 0.02). AKI-d rates were similar, and 30-day mortality favored non-significantly the HA group (5% vs. 14.6%, p = ns). No device-related adverse events were observed. Conclusion: These findings suggest that intraoperative HA might improve immediate postoperative outcomes; however, further validation in larger randomized controlled trials is warranted. Full article

(This article belongs to the Collection Current Challenges in Heart Failure and Cardiac Transplantation)

► Show Figures

Figure 1

10 pages, 1218 KiB

Open AccessArticle

Comparison of 30-Day Readmission Between Early and Late Catheter Directed Thrombolysis for Acute Pulmonary Embolism in the United States

by Kwabena Sefah Nketiah Sarpong, Sun-Joo Jang, Mary Quien, Karthik Muralidharan, Abhinav Aggarwal, Ilhwan Yeo and Kavitha Gopalratnam

J. Cardiovasc. Dev. Dis. 2025, 12(4), 118; https://doi.org/10.3390/jcdd12040118 - 27 Mar 2025

Abstract

Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5–10% of in-hospital deaths. There is sparse comparative data on readmission patterns in patients who undergo early versus late catheter [...] Read more.

Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5–10% of in-hospital deaths. There is sparse comparative data on readmission patterns in patients who undergo early versus late catheter directed thrombolysis (CDT) for acute PE. Research Question: Is the procedure day for acute PE associated with a difference in 30-day readmission rates? Study Design and Method: This study was performed by using the Nationwide Readmissions Database between 2016 and 2019. Patients with acute PE who underwent CDT were identified using codes from the International Classification of Diseases, 10th Edition (ICD 10). Results: The 30-day readmission rates were higher for patients who underwent CDT on Day 2 or afterwards compared to Day 1 and Day 0 (7.1% vs. 5.7% vs. 5.2%). Patients who had CDT on Day 2 or later had a higher rate of 30-day readmission mortality compared to those who had CDT on Day 1 or 0 (0.6% vs. 0.3% vs. 0.2%. The 30-day readmission rates for heart failure were higher among patients who had CDT on Day 2 compared to those who had CDT on Day 0 of admission (2% vs. 1.0% vs. 0.9%). Interpretation: Delayed CDT for acute PE was associated with increased rates of 30-day readmission, readmission mortality, and readmission for heart failure. These findings emphasize the need for earlier CDT for the treatment of acute PE. Full article

► Show Figures

Figure 1

Journal Description

Journal of Cardiovascular Development and Disease

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI