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J. Cardiovasc. Dev. Dis., Volume 9, Issue 6 (June 2022) – 32 articles

Cover Story (view full-size image): CHD is a frequent occurrence, with a prevalence of almost 1% in the general population. The pathophysiology of anomalous heart development is still unclear in most patients: a definitive genetic origin only explains 35% of identified cases. The precisely choreographed embryology of the heart relies on the timed activation of developmental molecular cascades, spatially and temporally regulated through epigenetic regulation. This network is eminently susceptible to disruption, resulting in faulty cardiac development. Similarly, the heart is unique in its dynamic development: growth is intrinsically related to mechanical stimulation, and disruption of the intrauterine environment will have a direct impact on fetal embryology. These two converging axes offer new areas of research to characterize cardiac epigenetic regulation and identify points of fragility with teratogenic potential. View this paper
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Article
Long-Term Outcomes after Aortic Valve and Root Replacement in a Very High-Risk Population
by Jan Hlavicka, Kiril Antonov, Razan Salem, Florian Hecker, Spiros Marinos, Medhat Radwan, Fabian Emrich, Arnaud Van Linden, Anton Moritz, Thomas Walther and Tomas Holubec
J. Cardiovasc. Dev. Dis. 2022, 9(6), 197; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060197 - 20 Jun 2022
Cited by 2 | Viewed by 1615 | Correction
Abstract
Background: Aortic valve and root replacement (AVRR) is a standardised procedure to treat patients with aortic valve and root disease. In centres with a well-established aortic valve and root repair program (valve repairs and Ross operations), only patients with very complex conditions [...] Read more.
Background: Aortic valve and root replacement (AVRR) is a standardised procedure to treat patients with aortic valve and root disease. In centres with a well-established aortic valve and root repair program (valve repairs and Ross operations), only patients with very complex conditions receive AVRR; this procedure uses a mechanical or biological composite valve graft (modified Bentall–de Bono procedure). The aim of the study was to evaluate the short- and long-term results after AVRR in a high-risk population with complex pathologies. Methods: Between 2005 and 2018, a total of 273 consecutive patients (mean age 64 ± 12.8 years; 23% female) received AVRR. The indication for surgery was an acute type A aortic dissection in 18%, infective endocarditis in 36% and other pathologies in 46% patients; 39% were redo procedures. The median EuroSCORE II was 11.65% (range 1.48–95.63%). Concomitant surgery was required in 157 patients (58%). Results: The follow-up extended to 5.2 years (range 0.1–15 years) and it was complete in 96% of the patients. The 30-day mortality was 17%. The overall estimated survival at 5 and 10 years was 65% ± 3% and 49% ± 4%, respectively. Univariate and multivariate logistic regression analyses revealed the following risk factors for survival: perioperative neurological dysfunction (OR 5.45), peripheral artery disease (OR 4.4) and re-exploration for bleeding (OR 3.37). Conclusions: AVRR can be performed with acceptable short- and long-term results in a sick patient population. The Bentall–De Bono procedure may be determined to be suitable for only elderly or high-risk patients. Any other patients should receive an AV repair or the Ross procedure in well-established centres. Full article
(This article belongs to the Special Issue New Insights into Aortic Valve Surgery)
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12 pages, 505 KiB  
Review
Pregnancy in Pulmonary Arterial Hypertension: A Multidisciplinary Approach
by Yasmeen Daraz, Sandhya Murthy and Diana Wolfe
J. Cardiovasc. Dev. Dis. 2022, 9(6), 196; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060196 - 18 Jun 2022
Cited by 5 | Viewed by 2006
Abstract
Pulmonary arterial hypertension (PAH), a female predominant disease, carries a high maternal and fetal mortality in pregnancy despite improved insight and the development of novel therapies. The high risk is attributed to the adaptive changes that take place to promote healthy fetal development [...] Read more.
Pulmonary arterial hypertension (PAH), a female predominant disease, carries a high maternal and fetal mortality in pregnancy despite improved insight and the development of novel therapies. The high risk is attributed to the adaptive changes that take place to promote healthy fetal development during pregnancy, which can adversely affect the already compromised right ventricle in patients with PAH. While in the prior era emphasis was placed on termination of pregnancy, here we will illustrate through a multidisciplinary approach and meticulous planning at an expert center, these high-risk women can undergo successful childbirth. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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16 pages, 885 KiB  
Article
Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center
by Anjali Vaidya, Estefania Oliveros, Wadia Mulla, Diana Feinstein, Laura Hart and Paul Forfia
J. Cardiovasc. Dev. Dis. 2022, 9(6), 195; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060195 - 18 Jun 2022
Cited by 5 | Viewed by 3612
Abstract
(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension [...] Read more.
(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension (PH) center from 2013 to 2021. (3) Results: seven pregnancies in six women with PAH, ranging from low to high risk and 21 to 37 years old. Half had known pre-existing PAH before pregnancy. One had a multifetal gestation, and one was pregnant twice under our care. PH medical therapy and serial clinical assessment throughout pregnancy were implemented with focused attention on optimizing right heart function. Delivery was planned by a multidisciplinary team involving PH cardiology, maternal fetal medicine, and obstetric anesthesiology. Patients delivered between 31 and 40 weeks of gestation; five of the seven were via cesarean section. All received regional anesthesia and were monitored in the PH intermediate step-down unit after delivery until discharge. In all cases, delivery was without complications with excellent outcomes for the mother and child. (4) Conclusions: Multidisciplinary and tailored management of PAH in pregnancy, emphasizing optimized right heart function prior to delivery, can result in excellent clinical outcomes in a referral PH center. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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10 pages, 598 KiB  
Article
Influence of Discontinuation of Cardiac Rehabilitation in Elderly Outpatients Due to the COVID-19 Pandemic
by Noriyuki Mouri, Yasunori Suematsu, Yuiko Yano, Kai Morita, Miki Shirosaki, Masaomi Fujita, Takuro Matsuda, Sakiko Matsuo, Rie Tazawa, Kanta Fujimi and Shin-ichiro Miura
J. Cardiovasc. Dev. Dis. 2022, 9(6), 194; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060194 - 18 Jun 2022
Viewed by 1807
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has restricted people’s activities and necessitated the discontinuation of cardiac rehabilitation (CR) programs for outpatients. In our hospital, CR for outpatients had to be discontinued for 3 months. We investigated the influence of this discontinuation of [...] Read more.
Background: The coronavirus disease 2019 (COVID-19) pandemic has restricted people’s activities and necessitated the discontinuation of cardiac rehabilitation (CR) programs for outpatients. In our hospital, CR for outpatients had to be discontinued for 3 months. We investigated the influence of this discontinuation of CR on physical activity, body composition, and dietary intake in cardiovascular outpatients. Method: Seventy-eight outpatients who restarted CR were investigated. We measured body composition, balance test, stage of locomotive syndrome, and food frequency questionnaire (FFQ) results at restart and 3 months later. We also investigated the results of examination that were obtained before discontinuation. Results: With regard to baseline characteristics, the percentage of male was 62.7% (n = 49), and average age and body mass index were 74.1 ± 8.5 years and 24.9 ± 7.0 kg/m2, respectively. Stage of locomotive syndrome and the results of FFQ did not change significantly. The one-leg standing time with eyes open test significantly worsened at restart (p < 0.001) and significantly improved 3 months later (p = 0.007). With regard to body composition, all limb muscle masses were decreased at restart and decreased even further 3 months later. Conclusions: Discontinuation of CR influenced standing balance and limb muscle mass. While the restart of CR may improve a patient’s balance, more time is required for additional daily physical activities. The recent pandemic-related interruption of CR should inspire the development of alternatives that could ensure the continuity of CR in a future crisis. Full article
(This article belongs to the Section Cardiac Development and Regeneration)
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13 pages, 677 KiB  
Article
Serum and Vascular Stiffness Biomarkers Associated with the Severity of Degenerative Aortic Valve Stenosis and Cardiovascular Outcomes
by Jakub Baran, Łukasz Niewiara, Jakub Podolec, Mateusz Siedliński, Ewelina Józefczuk, Anna Bernacik, Rafał Badacz, Tadeusz Przewłocki, Piotr Pieniążek, Krzysztof Żmudka, Jacek Legutko and Anna Kabłak-Ziembicka
J. Cardiovasc. Dev. Dis. 2022, 9(6), 193; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060193 - 17 Jun 2022
Cited by 5 | Viewed by 2003
Abstract
Background: Although degenerative aortic valve stenosis (DAS) is the most prevalent growth-up congestive heart valve disease, still little known about relationships between DAS severity, vascular stiffness (VS), echocardiographic parameters, and serum biomarkers in patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR). [...] Read more.
Background: Although degenerative aortic valve stenosis (DAS) is the most prevalent growth-up congestive heart valve disease, still little known about relationships between DAS severity, vascular stiffness (VS), echocardiographic parameters, and serum biomarkers in patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR). The objective of this study was to identify biomarkers associated with DAS severity, and those that are associated with cardiovascular death (CVD) and episodes of chronic heart failure (CHF) exacerbation. Methods: A total of 137 patients with initially moderate-to-severe DAS were prospectively evaluated for the relationship between DAS severity, baseline VS, and serum biomarkers (uPAR, GDF-15, Gal-3, IL-6Rα, ET-1, PCSK9, RANTES/CCL5, NT-proBNP, and hs-TnT), and were followed-up for 48 months. The prognostic significance of each variable for CVD and CHF risk was measured by hazard ratio of risk (HR), which was calculated by Cox’s proportional hazard model. Results: DAS severity showed correlations with IL-6Rα (r = 0.306, p < 0.001), uPAR (r = 0.184, p = 0.032), and NT-proBNP (r = −0.389, p < 0.001). Levels of ET-1 and Gal-3 were strongly correlated with VS parameters (r = 0.674, p < 0.001; r = 0.724, p < 0.001). Out of 137 patients, 20 were referred to TAVR, 88 to SAVR, and 29 to OMT. In TAVR patients, the highest levels of ET-1, Gal-3, and VS were found as compared to other patients. The highest incidence of CVD was observed in patients who underwent TAVR (35%), compared to SAVR (8%) and OMT (10.3%) (p = 0.004). In a multivariate analysis, ET-1 occurred predictive of CVD risk (HR 25.1, p = 0.047), while Gal-3 > 11.5 ng/mL increased the risk of CHF exacerbation episodes requiring hospital admission by 12%. Conclusions: Our study indicated that ET-1 and Gal-3 levels may be associated with the outcomes in patients with DAS. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))
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17 pages, 670 KiB  
Review
Infective Endocarditis in the Elderly: Challenges and Strategies
by Carlos Bea, Sara Vela, Sergio García-Blas, Jose-Angel Perez-Rivera, Pablo Díez-Villanueva, Ana Isabel de Gracia, Eladio Fuertes, Maria Rosa Oltra, Ana Ferrer, Andreu Belmonte, Enrique Santas, Mauricio Pellicer, Javier Colomina, Alberto Doménech, Vicente Bodi, Maria José Forner, Francisco Javier Chorro and Clara Bonanad
J. Cardiovasc. Dev. Dis. 2022, 9(6), 192; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060192 - 17 Jun 2022
Cited by 8 | Viewed by 3421
Abstract
The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term “elderly” corresponds to different ages in the literature, but it is defined by considerable [...] Read more.
The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term “elderly” corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population. Full article
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14 pages, 900 KiB  
Article
Benefits of a Balance Exercise Assist Robot in the Cardiac Rehabilitation of Older Adults with Cardiovascular Disease: A Preliminary Study
by Kakeru Hashimoto, Akihiro Hirashiki, Kenichi Ozaki, Koki Kawamura, Junpei Sugioka, Shunya Tanioku, Kenji Sato, Ikue Ueda, Naoki Itoh, Kenichiro Nomoto, Manabu Kokubo, Atsuya Shimizu and Izumi Kondo
J. Cardiovasc. Dev. Dis. 2022, 9(6), 191; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060191 - 12 Jun 2022
Cited by 1 | Viewed by 2246
Abstract
We examined whether adding robot-supported balance exercises to cardiac rehabilitation improves the ability to balance in older adults with cardiovascular disease (CVD). We conducted a prospective study in 52 older adults who had been hospitalized for worsening CVD. Once weekly for four months, [...] Read more.
We examined whether adding robot-supported balance exercises to cardiac rehabilitation improves the ability to balance in older adults with cardiovascular disease (CVD). We conducted a prospective study in 52 older adults who had been hospitalized for worsening CVD. Once weekly for four months, for a total of sixteen sessions as outpatients, the subjects used a Balance Exercise Assist Robot (BEAR) to perform balance exercises and an ergometer for aerobic exercises. Participants’ mean age was 76.9 ± 6.8 years (range, 65–95 years), and their mean brain natriuretic protein level was 164.0 ± 190.0 pg/mL. After the intervention, participants showed significant improvements in gait speed (before, 1.06 ± 0.33 m/s; after, 1.23 ± 0.30 m/s; p < 0.001), Short Physical Performance Battery score (before, 10.02 ± 2.25; after, 10.88 ± 1.79; p ˂ 0.001), timed up-and-go (before, 11.11 ± 5.07 s; after, 9.45 ± 3.45 s; p ˂ 0.001), and knee extension (before, 26.97 ± 11.78 kgf; after, 30.13 ± 13.04 kgf; p = 0.001). Cardiac rehabilitation including exercises using BEAR improved physical functioning and the ability to balance in older adults with CVD. Frail and prefrail patients improved, whereas robust ones did not change. Full article
(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)
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8 pages, 454 KiB  
Brief Report
A Cease in Shift Work Reverses Arterial Stiffness but Increases Weight and Glycosylated Hemoglobin A 5-Month Follow-Up in Industry
by Marit Skogstad, Hans Christian D. Aass, Lars-Kristian Lunde, Øivind Skare, Per Anton Sirnes and Dagfinn Matre
J. Cardiovasc. Dev. Dis. 2022, 9(6), 190; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060190 - 12 Jun 2022
Cited by 2 | Viewed by 1756
Abstract
Background: Literature suggests an association between shift work and cardiovascular disease (CVD). Limited evidence is available on how a cessation of shift work affects CVD risk factors. Aim: We investigated whether a five-month plant shutdown affected CVD risk factors in 30 industrial shift [...] Read more.
Background: Literature suggests an association between shift work and cardiovascular disease (CVD). Limited evidence is available on how a cessation of shift work affects CVD risk factors. Aim: We investigated whether a five-month plant shutdown affected CVD risk factors in 30 industrial shift workers. Methods: We collected demographic data, self-reported data on physical activity (PA) and medical history by questionnaire. Pre- and post-plant shutdown, we measured blood pressure (BP), heart rate, lipids, glycosylated hemoglobin (HbA1c) and C-reactive protein (CRP). Additionally, we collected markers of inflammation, Matrix metalloproteinase-9 (MMP-9), Interleukin-6 (IL-6), Monocyte chemoattractant protein-1 (MCP-1), Tumor necrosis factor-alpha (TNF-α), P-selectin, Interleukin-1 beta (IL-1β), and Interleukin-23 (IL-23). We also examined arterial stiffness (central blood pressure, augmentation pressure, and pulse wave velocity) by means of SphygmoCor® (AtCor Medical Pty Ltd., Sydney, Australia). We monitored sleep by actigraphy prior to and after plant shutdown, with additional registration of sleep quality and assessment of insomnia symptoms. Results: After five months of plant shutdown, we found that HbA1c increased by 1.9 mmol/mol, weight by 1 kg and MCP-1 by 27.3 pg/mL, all unexpectedly. The other markers of inflammation did not change during shutdown, but CRP decreased close to significant levels. There were no changes in lipids during follow-up. Pulse-wave velocity (PWV) was reduced from 8.1 m/s (SD = 1.5) to 7.6 m/s (SD = 1.5), p = 0.03. The workers reported fewer signs of insomnia after shutdown. Conclusions: Our findings suggest that a five-month cessation in shift work increases weight and HbA1c, but also improves insomnia symptoms and reverses arterial stiffening. Full article
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12 pages, 727 KiB  
Article
Structured Allocation of Transcatheter Aortic Valve Replacement Patients during Coronavirus Disease 2019 Pandemic: Impact on Patient Selection and Clinical Results
by Nora Berisha, Kathrin Klein, Verena Veulemans, Oliver Maier, Kerstin Piayda, Stephan Binnebößel, Shazia Afzal, Amin Polzin, Ralf Westenfeld, Patrick Horn, Christian Jung, Malte Kelm, Christine Quast and Tobias Zeus
J. Cardiovasc. Dev. Dis. 2022, 9(6), 189; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060189 - 10 Jun 2022
Viewed by 1515
Abstract
Due to shortages of medical resources during the Coronavirus Disease 2019 (COVID-19) pandemic, an allocation algorithm for Transcatheter Aortic Valve Replacement (TAVR) was established. We investigated the impact on patient selection and procedural results. In total, 456 TAVR patients before (pre-COVID-19 group) and [...] Read more.
Due to shortages of medical resources during the Coronavirus Disease 2019 (COVID-19) pandemic, an allocation algorithm for Transcatheter Aortic Valve Replacement (TAVR) was established. We investigated the impact on patient selection and procedural results. In total, 456 TAVR patients before (pre-COVID-19 group) and 456 TAVR patients after (COVID-19 group) the implementation of our allocation algorithm were compared. Concerning patient characteristics, the COVID-19 group revealed a higher rate of cardiac decompensations/cardiogenic shocks (10.5% vs. 1.3%; p < 0.001), severe angina pectoris (Canadian Cardiovascular Society (CCS) II, III and IV: 18.7% vs. 11.8%; p = 0.004), troponin elevation (>14 ng/L: 84.9% vs. 77%; p = 0.003) and reduced left ventricular ejection fraction (LVEF) (<45%: 18.9% vs. 12%; p = 0.006). Referring to procedural characteristics, more predilatations (46.3% vs. 35.1%; p = 0.001) and a longer procedural time (80.2 min (+/−29.4) vs. 66.9 min (+/−17.5); p < 0.001) were observed. The success rate was evenly high; no differences in safety parameters were reported. Examining the utilization of hospital resources, the COVID-19 group showed a shorter in-hospital stay (8.4 days (+/−5.9) vs. 9.5 days (+/−9.33); p = 0.041) and fewer TAVR patients were treated per month (39 (+/−4.55) vs. 46.11 (+/−7.57); p = 0.03). Our allocation algorithm supported prioritization of sicker patients with similar efficient and safe TAVR procedures. In-hospital stay could be shortened. Full article
(This article belongs to the Special Issue Aortic Stenosis: Diagnosis, Treatment and Management)
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17 pages, 1806 KiB  
Article
Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction
by Weijie Chen, Zengzhang Liu, Peilin Xiao, Yanping Xu, Dan Li, Qingsong Xiong, Lili Zou, Fang Qin, Xiexin Tao, Junan Chen, Xianbin Lan, Huaan Du, Yuehui Yin and Zhiyu Ling
J. Cardiovasc. Dev. Dis. 2022, 9(6), 188; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060188 - 10 Jun 2022
Cited by 5 | Viewed by 2395
Abstract
Cardioneuroablation (CNA) is proposed as a promising therapy for patients with sinoatrial node dysfunction (SND) that is mediated by excessive vagal tone. However, a series of urgent questions about CNA remain unanswered. From December 2020 to March 2022, six patients with symptomatic SND [...] Read more.
Cardioneuroablation (CNA) is proposed as a promising therapy for patients with sinoatrial node dysfunction (SND) that is mediated by excessive vagal tone. However, a series of urgent questions about CNA remain unanswered. From December 2020 to March 2022, six patients with symptomatic SND who underwent CNA were summarized in this report. Sequential CNA targeting Ao-SVC GP, PMLGP, RAGP, and LSGP was performed in patients, guided by fractionated intracardiac electrograms and dynamically evaluated by extracardiac vagal stimulation (ECVS). The results showed that Ao-SVC GP ablation led to a significant increase in heart rate (HR) and the elimination of sinus arrest evoked by ECVS, while the vagal responses of atrial ventricular block were eliminated by the ablation of PMLGP and LSGP. Post-procedure HR increased up to 64–86% of the maximum HR of an atropine test at baseline. The median HR from Holter monitoring increased from 52.8 ± 2.1 bpm at baseline to 73.0 ± 10.4 bpm after the procedure (p = 0.012) and to 71.3 ± 10.1 bpm at the six-month follow-up (p = 0.011). Bradycardia-related symptoms disappeared in all patients at the six-month follow-up. This case series reveals the feasibility of using the ECVS-assisted sequential CNA technique and indicates the critical role of ECVS in dynamically evaluating the impact of sequential CNA on the vagal control of SAN and AVN. Full article
(This article belongs to the Special Issue Catheter Ablation of Cardiac Arrhythmias: Practices and Outcomes)
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25 pages, 2530 KiB  
Review
When Does the Human Embryonic Heart Start Beating? A Review of Contemporary and Historical Sources of Knowledge about the Onset of Blood Circulation in Man
by Jörg Männer
J. Cardiovasc. Dev. Dis. 2022, 9(6), 187; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060187 - 09 Jun 2022
Cited by 5 | Viewed by 4960
Abstract
The onset of embryonic heart beating may be regarded as the defining feature for the beginning of personal human life. Clarifying the timing of the first human heartbeat, therefore, has religious, philosophical, ethical, and medicolegal implications. This article reviews the historical and contemporary [...] Read more.
The onset of embryonic heart beating may be regarded as the defining feature for the beginning of personal human life. Clarifying the timing of the first human heartbeat, therefore, has religious, philosophical, ethical, and medicolegal implications. This article reviews the historical and contemporary sources of knowledge on the beginning of human heart activity. Special attention is given to the problem of the determination of the true age of human embryos and to the problem of visualization of the human embryonic heart activity. It is shown that historical and current textbook statements about the onset of blood circulation in man do not derive from observations on living human embryos but derive from the extrapolation of observations on animal embryos to the human species. This fact does not preclude the existence of documented observations on human embryonic heart activity: Modern diagnostic (ultrasound) and therapeutic (IVF) procedures facilitate the visualization of early embryonic heart activity in precisely dated pregnancies. Such studies showed that the human heart started its pumping action during the fourth post-fertilization week. A small number of direct observations on the heart activity of aborted human embryos were reported since the 19th century, but did not receive much recognition by embryologists. Full article
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11 pages, 1359 KiB  
Article
Kidney Failure among Patients with Takotsubo Syndrome or Myocardial Infarction: A Retrospective Analysis
by Verena Bill, Ibrahim El-Battrawy, Marvin Kummer, Andreas Mügge, Assem Aweimer, Michael Behnes and Ibrahim Akin
J. Cardiovasc. Dev. Dis. 2022, 9(6), 186; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060186 - 09 Jun 2022
Viewed by 1563
Abstract
Background: Takotsubo syndrome (TTS) is a syndrome with ambiguous pathophysiology. Impaired kidney function (KF) seems to impact the outcome of patients with TTS. We hypothesized that KF worsens the outcome among TTS patients and furthermore, TTS patients with concomitant KF experience more adverse [...] Read more.
Background: Takotsubo syndrome (TTS) is a syndrome with ambiguous pathophysiology. Impaired kidney function (KF) seems to impact the outcome of patients with TTS. We hypothesized that KF worsens the outcome among TTS patients and furthermore, TTS patients with concomitant KF experience more adverse events compared to myocardial infarction (MI) patients with concomitant KF. Methods and Results: This retrospective single-center study comprised two groups (cohorts) of patients including patients with TTS and concomitant KF (n = 61, 27.1%) and patients with MI and concomitant KF (n = 164, 72.9%). The clinical outcomes were delineated as short-term outcomes defined as in-hospital adverse events during index hospitalization and long-term outcomes defined as adverse events over five-year clinical follow-ups. All-cause mortality, stroke, cardiopulmonary resuscitation (CPR), life-threatening arrhythmias, need for respiratory support, and cardiogenic shock with subsequent use of inotropic agents during index hospitalization were denoted as in-hospital adverse events. All-cause mortality, rehospitalization due to heart failure, stroke, thromboembolic events, and the recurrence of primary pathology (TTS and MI) were analyzed during five-year follow-ups after index hospitalization. A higher mortality rate was noted among TTS patients with KF compared to TTS without KF. In addition, in-hospital event rates in patients with TTS and concomitant KF compared to MI and concomitant KF were comparable with the exception of a higher rate of respiratory support in TTS patients. The mortality rate was significantly higher among patients with TTS and KF at 4 years (29.5% vs. 15.9%, p = 0.02) and 5 years (34.4% vs. 20.7%, p = 0.03) in comparison to patients with MI and concomitant KF. In contrast, the rate of re-hospitalization related to heart failure was higher at 30 days, and at one-, four-, and five-year follow-ups in patients suffering from MI and KF compared to TTS and concomitant KF. Additionally, the recurrence of MI after 4 and 5 years was higher than the recurrence of TTS (4.9% vs. 15.2%; 4.9% vs. 16.5%). There were no differences in life-threatening arrhythmias and stroke in both groups. Conclusions: Patients with TTS and concomitant KF have higher all-cause mortality when compared to MI and concomitant KF. The mechanisms responsible remain to be determined. Full article
(This article belongs to the Special Issue Takotsubo Syndrome, Short QT Syndrome and Brugada Syndrome)
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16 pages, 1239 KiB  
Review
Epigenetics and Congenital Heart Diseases
by Léa Linglart and Damien Bonnet
J. Cardiovasc. Dev. Dis. 2022, 9(6), 185; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060185 - 09 Jun 2022
Cited by 8 | Viewed by 2759
Abstract
Congenital heart disease (CHD) is a frequent occurrence, with a prevalence rate of almost 1% in the general population. However, the pathophysiology of the anomalous heart development is still unclear in most patients screened. A definitive genetic origin, be it single-point mutation or [...] Read more.
Congenital heart disease (CHD) is a frequent occurrence, with a prevalence rate of almost 1% in the general population. However, the pathophysiology of the anomalous heart development is still unclear in most patients screened. A definitive genetic origin, be it single-point mutation or larger chromosomal disruptions, only explains about 35% of identified cases. The precisely choreographed embryology of the heart relies on timed activation of developmental molecular cascades, spatially and temporally regulated through epigenetic regulation: chromatin conformation, DNA priming through methylation patterns, and spatial accessibility to transcription factors. This multi-level regulatory network is eminently susceptible to outside disruption, resulting in faulty cardiac development. Similarly, the heart is unique in its dynamic development: growth is intrinsically related to mechanical stimulation, and disruption of the intrauterine environment will have a direct impact on fetal embryology. These two converging axes offer new areas of research to characterize the cardiac epigenetic regulation and identify points of fragility in order to counteract its teratogenic consequences. Full article
(This article belongs to the Special Issue Congenital Heart Defects: Diagnosis, Management, and Treatment)
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7 pages, 9311 KiB  
Case Report
Resuscitated Sudden Cardiac Arrest of a Neonate with Congenital LQT Syndrome-Associated Torsades de Pointes: A Case Report and Literature Review
by Yen-Teng Hsu, Pi-Chang Lee, Yu-Hsuan Chen, Shu-Jen Yeh, Ming-Ren Chen, Kung-Hong Hsu, Chung-I Chang, Wei-Ting Lai and Wei-Li Hung
J. Cardiovasc. Dev. Dis. 2022, 9(6), 184; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060184 - 09 Jun 2022
Cited by 1 | Viewed by 2062
Abstract
Sudden infant death syndrome (SIDS), the most common cause of infant death in developed countries, is attributed to diverse trigger factors. Malignant cardiac dysrhythmias are potentially treatable etiologies, and congenital long QT syndrome (LQTS) is the most common cardiac ionic channelopathy confronted. β-Blockers [...] Read more.
Sudden infant death syndrome (SIDS), the most common cause of infant death in developed countries, is attributed to diverse trigger factors. Malignant cardiac dysrhythmias are potentially treatable etiologies, and congenital long QT syndrome (LQTS) is the most common cardiac ionic channelopathy confronted. β-Blockers or class Ib agents are the drugs of choice for the control of arrhythmias, and an implantable cardioverter defibrillator (ICD) should be considered for secondary prevention in survivors of lethal cardiac death. We report the case of a 4-day old neonate, later genetically confirmed as LQT type 3 (LQT3), who survived a pulseless torsades de pointes (TdP) attack and was successfully treated with propranolol, mexiletine, and ICD implantation. Full article
(This article belongs to the Section Pediatric Cardiology and Congenital Heart Disease)
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16 pages, 737 KiB  
Systematic Review
The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review
by Angus J. Davis, Christopher Semsarian, John W. Orchard, Andre La Gerche and Jessica J. Orchard
J. Cardiovasc. Dev. Dis. 2022, 9(6), 183; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060183 - 08 Jun 2022
Cited by 3 | Viewed by 3270
Abstract
Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A [...] Read more.
Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A systematic review was conducted of the MEDLINE, EMBASE, Scopus, SPORTDiscus, and Web of Science databases, for papers that assessed athlete screening ECGs and compared findings on the basis of ethnicity. Fifty-one papers which compared ECGs from various ethnicities were included. Most studies assessed Black athletes against Caucasian athletes and found a greater prevalence of T-wave inversion (TWI) (2.6–22.8% vs. 0–5.0%) and anterior TWI (3.7–14.3% vs. 0.6–2.0%). Black athlete subgroups in Africa had TWI (20–40%) and anterior TWI (4.3–18.7%) at a higher prevalence than other Black athletes. Athletes who were defined as mixed-race, Asian, and Pacific Islander are potentially more like Black athletes than Caucasian athletes. Black ethnicity is known to have an impact on the accurate interpretation of athlete ECGs; however, there is nuance related to origin of both parents. Asian and Pacific Islander origin also may impact athlete ECG interpretation. Further research is required to assist in distinguishing abnormal and normal athlete ECGs in different ethnic populations. Full article
(This article belongs to the Special Issue Cardiovascular Disease in Athletes)
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10 pages, 474 KiB  
Article
Efficacy and Safety of a Combined Aerobic, Strength and Flexibility Exercise Training Program in Patients with Implantable Cardiac Devices
by Maria Rosaria Squeo, Barbara Di Giacinto, Marco Alfonso Perrone, Massimo Santini, Maria Luisa Sette, Emanuele Fabrizi, Antonia Vaquer, Attilio Parisi, Antonio Spataro and Alessandro Biffi
J. Cardiovasc. Dev. Dis. 2022, 9(6), 182; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060182 - 06 Jun 2022
Cited by 1 | Viewed by 2252
Abstract
Purpose: The “FIDE Project” (Fitness Implantable DEvice) was organized by the Institute of Sports Medicine and Science and the World Society of Arrhythmias with the aim of demonstrating the usefulness of exercise training in improving functional capacity in patients with implantable cardiac [...] Read more.
Purpose: The “FIDE Project” (Fitness Implantable DEvice) was organized by the Institute of Sports Medicine and Science and the World Society of Arrhythmias with the aim of demonstrating the usefulness of exercise training in improving functional capacity in patients with implantable cardiac devices. Materials and Methods: Thirty sedentary patients were selected for the project (25 males and 5 females), with a mean age of 73 ± 5 years (range 44–94 years). Twenty-five were implanted with a Pacemaker (PM) and five with an Implantable Cardioverter Defibrillator (ICD). Atrial fibrillation/atrial flutter was present in ten (34%) patients, post-ischemic dilated cardiomyopathy in five (17.2%), sick sinus syndrome in six (20,7%), complete atrium-ventricular block in six (20.7%), hypertrophic cardiomyopathy in one (3.4%) and recurrent syncope in one (3.4%). The baseline assessment comprised cardiovascular examination, resting and stress ECG, cardiopulmonary exercise testing (V ̇O2peak), strength assessment of different muscle groups, and a flexibility test. The same measurements were repeated after 15–20 consecutive training sessions, over a 2-month period. The exercise prescription was set to 70–80% of HRR (Heart rate reserve) and to 50–70% of 1RM (1-repetition maximum, muscular force). The training protocol consisted of two training sessions per week performed in our institute, 90 min for each (warm-up, aerobic phase, strength phase and stretching) and one or more at home autonomously. Results: The cardiopulmonary testing after the training period documents a significant improvement in V ̇O2peak (15 ± 4 mL/kg/min vs. 17 ± 4; p = 0.001) and in work load (87 ± 30 watts vs. 108 ± 37; p = 0.001). Additionally, strength capacity significantly increased after the cardiac rehabilitation program, (quadriceps: 21 ± 18 kg vs. 29 ± 16 kg, p = 0.00003). Flexibility tests show a positive trend, but without statistical significance (sit-and-reach test: −19 ± 11 cm vs. −15 ± 11.7 cm; back-scratch test: −19 ± 11.6 cm vs. −15 ± 10 cm; lateral flexibility right −44 ± 1.4 cm vs. −43 ± 9.5 cm; left −43 ± 5 vs. −45 ± 8.7 cm). Conclusion: A brief period of combined aerobic, strength and flexibility exercise training (FIDE project) proved to be effective and safe in improving functional capacity in patients with cardiac implantable devices. Full article
(This article belongs to the Special Issue Cardiovascular Effects and Benefits of Exercise)
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11 pages, 1110 KiB  
Review
Complementary Role of Combined Indirect and Direct Cardiac Sympathetic (Hyper)Activity Assessment in Patients with Heart Failure by Spectral Analysis of Heart Rate Variability and Nuclear Imaging: Possible Application in the Evaluation of Exercise Training Effects
by Ferdinando Iellamo, Marco Alfonso Perrone, Andrea Cimini, Giuseppe Caminiti, Agostino Chiaravalloti, Attilio Parisi and Orazio Schillaci
J. Cardiovasc. Dev. Dis. 2022, 9(6), 181; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060181 - 05 Jun 2022
Cited by 7 | Viewed by 2041
Abstract
In chronic heart failure (CHF), abnormalities in cardiac autonomic control, characterized by sympathetic overactivity, contribute to the progression of the disease and are associated with an unfavorable prognosis. Assessing cardiac autonomic status is clinically important in the management of patients with CHF. To [...] Read more.
In chronic heart failure (CHF), abnormalities in cardiac autonomic control, characterized by sympathetic overactivity, contribute to the progression of the disease and are associated with an unfavorable prognosis. Assessing cardiac autonomic status is clinically important in the management of patients with CHF. To this aim, heart rate variability (HRV) analysis has been extensively used as a non-invasive tool for assessing cardiac autonomic regulation, and has been shown to predict the clinical outcome in patients with CHF. Adrenergic nerve activity has also been estimated using iodine-123 (I-123) metaiodobenzylguanidine (MIBG), a noradrenaline analogue. MIBG is an analogue of norepinephrine sharing the same cellular mechanism of uptake, storage, and release in presynaptic sympathetic neurons. As an innervation tracer, 123I-MIBG allows for the evaluation of cardiac sympathetic neuronal function. Cardiac MIBG imaging has also been reported to predict a poor clinical outcome in CHF. MIBG provides direct information on the function of the presynaptic sympathetic nerve endings, whereas HRV, which depends on postsynaptic signal transduction, reflects the end-organ response of the sinus node. The aim of this brief review is to provide the reader with some basic concepts regarding the spectral analysis of HRV and MIBG, highlighting what is known about their respective roles in detecting cardiac sympathetic hyperactivity in CHF and, in perspective, their possible combined use in assessing non-pharmacological treatments in patients with CHF and reduced ejection fraction, with a particular focus on the effects of exercise training. Full article
(This article belongs to the Special Issue Cardiovascular Effects and Benefits of Exercise)
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9 pages, 1111 KiB  
Article
Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis
by Katharina Birkl, Christoph Beyer, Fabian Plank, Gudrun Maria Feuchtner and Guy Friedrich
J. Cardiovasc. Dev. Dis. 2022, 9(6), 180; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060180 - 04 Jun 2022
Cited by 2 | Viewed by 1641
Abstract
Purpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary angiography (ICA) after CCTA [...] Read more.
Purpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary angiography (ICA) after CCTA were evaluated retrospectively. The primary indication for CCTA was assessed according to the consensus for intermediate-risk (15–85% pre-test probability) into appropriate (A), inappropriate (I), and uncertain while referring to published guidelines. Patients’ risk factors, angina, and heart failure symptoms (Canadian Cardiovascular Society classification (CCSC), New York Heart Association (NYHA); clinical data; and ICA results were gathered. Results: Of 1305 patients referred to CCTA prior to ICA, 496 (38.0%) were appropriate, 766 (56.9%) inappropriate, and 43 (3.3%) uncertain. Of 766 patients with inappropriate CCTA referrals, 370 (48.3%) were classified as “inappropriately low” (<15% pre-test probability) and 396 (51.7%) as “inappropriately high” (>85%) in regard to the recommended CCTA utilization. Sub-analysis of the adherence to the appropriate use criteria did not differ between the source of the referring physicians (intramural tertiary, private practice primary care, or external secondary care hospitals). Obstructive CAD with subsequent revascularization rates (total of 39.2%) did not differ significantly between the appropriate (38.3%), inappropriate (41.0%), or uncertain (23.3%) groups (p = 0.068). Conclusion: The total coronary revascularization rate after CCTA was 39.2% and not different among low, intermediate, and pre-test probability groups. These findings support the role of CCTA as an excellent gatekeeper in patients with suspected obstructive CAD even beyond pre-test probability calculation models. Full article
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12 pages, 795 KiB  
Article
Maternal Glycemic Spectrum and Adverse Pregnancy and Perinatal Outcomes in a Multiracial US Cohort
by Yaa Adoma Kwapong, Ellen Boakye, Guoying Wang, Xiumei Hong, Jennifer Lewey, Mamas Andreas Mamas, Pensee Wu, Michael Joseph Blaha, Khurram Nasir, Allison Gamboa Hays, Roger Scott Blumenthal, Xiaobin Wang and Garima Sharma
J. Cardiovasc. Dev. Dis. 2022, 9(6), 179; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060179 - 04 Jun 2022
Cited by 4 | Viewed by 2288
Abstract
Diabetes mellitus (pregestational (PDM) and gestational (GDM)) is associated with adverse pregnancy outcomes (APOs). However, studies exploring the association of APOs with maternal glycemia among women without PDM/GDM are limited. We utilized data from 4119 women (307—PDM; 582—GDM; 3230—non-PDM/GDM) in the Boston Birth [...] Read more.
Diabetes mellitus (pregestational (PDM) and gestational (GDM)) is associated with adverse pregnancy outcomes (APOs). However, studies exploring the association of APOs with maternal glycemia among women without PDM/GDM are limited. We utilized data from 4119 women (307—PDM; 582—GDM; 3230—non-PDM/GDM) in the Boston Birth Cohort (1998–2016). Women in the non-PDM/GDM group were subdivided by tertiles of 1 h, 50 g oral glucose load test at 24–32 weeks: T1: 50–95 mg/dL (n = 1166), T2: 96–116 mg/dL (n = 1151), T3: 117–201 mg/dL (n = 913). Using multivariable logistic regression, we examined the association of maternal glycemia with APOs—preterm birth (PTB) and hypertensive disorders of pregnancy (HDP)—and adverse perinatal outcomes—high birth weight (HBW), cesarean section (CS), and sub-analyses by race-ethnicity. Compared to women in T1, women in T2 and T3 had a higher prevalence of pre-existing hypertension (T1: 2.8% vs. T2: 5.2% vs. T3: 6.3%) and obesity (T1: 13.3% vs. T2: 18.1% vs. T3: 22.9%). Women in T2 and T3 had higher odds of HBW (adjusted odds ratio aOR T2: 1.47 [1.01–2.19] T3: 1.68 [1.13–2.50]) compared to women in T1. Additionally, women in T2, compared to T1, had higher odds of HDP (aOR 1.44 [1.10–1.88]). Among non-Hispanic Black (NHB) women, those in T2 and T3 had higher odds of HDP compared to T1 (aOR T2 1.67 [1.13–2.51]; T3: 1.68 [1.07–2.62]). GDM and PDM were associated with higher odds of HBW, CS, PTB, and HDP, compared to women in T1. In this predominantly NHB and Hispanic cohort, moderate maternal glycemia without PDM/GDM was associated with higher odds of HBW and HDP, even more strongly among NHB women. If confirmed, a review of current guidelines of glucose screening and risk stratification in pregnancy may be warranted. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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13 pages, 756 KiB  
Review
Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia
by Claudiu Ghiragosian, Marius Harpa, Alexandra Stoica, Flămînd Oltean Sânziana, Radu Bălău, Hussam Al Hussein, Ghiragosian-Rusu Simina Elena, Radu Mircea Neagoe and Horațiu Suciu
J. Cardiovasc. Dev. Dis. 2022, 9(6), 178; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060178 - 02 Jun 2022
Cited by 1 | Viewed by 2834
Abstract
The race for an ideal cardioplegic solution has remained enthusiastic since the beginning of the modern cardiac surgery era. The Bretschneider solution, belonging to the “intracellular cardioplegic” group, is safe and practical in myocardial protection during ischemic time. Over time, some particular concerns [...] Read more.
The race for an ideal cardioplegic solution has remained enthusiastic since the beginning of the modern cardiac surgery era. The Bretschneider solution, belonging to the “intracellular cardioplegic” group, is safe and practical in myocardial protection during ischemic time. Over time, some particular concerns have arisen regarding the effects on cardiac metabolism and postoperative myocardial functioning. This paper reviews the most important standpoints in terms of theoretical and practical analyses. Full article
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7 pages, 619 KiB  
Case Report
Supervised and Individualized Lifestyle Medicine Therapy of a Patient after Myocardial Infarction—Case Study
by Márton Dvorák, Ilona Sztancsik, László Babai, Miklós Tóth and Pongrác Ács
J. Cardiovasc. Dev. Dis. 2022, 9(6), 177; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060177 - 01 Jun 2022
Viewed by 1887
Abstract
Background: In the rehabilitation of patients with cardiovascular disease (CVD) and after myocardial infarction (MI), lifestyle modifications—exercise and nutritional therapy, smoking cessation, stress management—are essential and have a major, long-term impact on the overall health of patients. Methods: After MI and acute primary [...] Read more.
Background: In the rehabilitation of patients with cardiovascular disease (CVD) and after myocardial infarction (MI), lifestyle modifications—exercise and nutritional therapy, smoking cessation, stress management—are essential and have a major, long-term impact on the overall health of patients. Methods: After MI and acute primary care, a lifestyle medicine team (medical doctors, dietitian, exercise physiologist) supervised the therapy of a 40 year-old male patient for 12 months. The program included assessments, regular medical controls, personalized diet, and exercise therapy monitored by a heart rate watch. Results: Gradual and continuous weight loss, major reduction in medication and significant improvement in fitness level, blood glucose level, and cardiac function were measured after the program. Due to these positive changes, the patient’s overall health improved to an even better level than before his MI. Conclusion: The results of this program highlight the benefits and importance of the personalized therapy and the lifestyle medicine team approach in the rehabilitation of CVD patients. Individualized and supervised lifestyle therapy should be part of the primary hospital care of CVD patients lead by medical doctors and supported by other health care providers. Full article
(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)
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16 pages, 1229 KiB  
Article
The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation
by Aikaterini Vraka, José Moreno-Arribas, Juan M. Gracia-Baena, Fernando Hornero, Raúl Alcaraz and José J. Rieta
J. Cardiovasc. Dev. Dis. 2022, 9(6), 176; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060176 - 01 Jun 2022
Cited by 1 | Viewed by 1641
Abstract
Coronary sinus (CS) catheterization is critical during catheter ablation (CA) of atrial fibrillation (AF). However, the association of CS electrical activity with atrial substrate modification has been barely investigated and mostly limited to analyses during AF. In sinus rhythm (SR), atrial substrate modification [...] Read more.
Coronary sinus (CS) catheterization is critical during catheter ablation (CA) of atrial fibrillation (AF). However, the association of CS electrical activity with atrial substrate modification has been barely investigated and mostly limited to analyses during AF. In sinus rhythm (SR), atrial substrate modification is principally assessed at a global level through P-wave analysis. Cross-correlating CS electrograms (EGMs) and P-waves’ features could potentiate the understanding of AF mechanisms. Five-minute surface lead II and bipolar CS recordings before, during, and after CA were acquired from 40 paroxysmal AF patients. Features related to duration, amplitude, and heart-rate variability of atrial activations were evaluated. Heart-rate adjustment (HRA) was applied. Correlations between each P-wave and CS local activation wave (LAW) feature were computed with cross-quadratic sample entropy (CQSE), Pearson correlation (PC), and linear regression (LR) with 10-fold cross-validation. The effect of CA between different ablation steps was compared with PC. Linear correlations: poor to mediocre before HRA for analysis at each P-wave/LAW (PC: max. +18.36%, p = 0.0017, LR: max. +5.33%, p = 0.0002) and comparison between two ablation steps (max. +54.07%, p = 0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave/LAW: +43.82% to +69.91%, p < 0.0001 for PC and +18.97% to +47.25%, p < 0.0001 for LR, CA effect: +53.90% to +85.72%, p < 0.0210). CQSE reported negligent correlations (0.6–1.2). Direct analysis of CS features is unreliable to evaluate atrial substrate modification due to CA. HRA substantially solves this problem, potentiating correlation with P-wave features. Hence, its application is highly recommended. Full article
(This article belongs to the Special Issue Catheter Ablation of Cardiac Arrhythmias: Practices and Outcomes)
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10 pages, 1608 KiB  
Article
Telemonitoring Potential of Wearable Cardioverter-Defibrillators during the Follow-Up of Patients with Heart Failure
by Christian Blockhaus, Jan-Erik Guelker, Ludger Feyen, Alexander Bufe, Melchior Seyfarth and Dong-In Shin
J. Cardiovasc. Dev. Dis. 2022, 9(6), 175; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060175 - 01 Jun 2022
Cited by 1 | Viewed by 1355
Abstract
Background: Wearable cardioverter-defibrillators (WCDs) are a well-established tool to bridge the recovery time of left ventricular ejection fraction (LVEF) until the implantation of an implantable cardioverter defibrillator (ICD), as recommended by the current guidelines. Besides their function to detect and treat malignant arrhythmias, [...] Read more.
Background: Wearable cardioverter-defibrillators (WCDs) are a well-established tool to bridge the recovery time of left ventricular ejection fraction (LVEF) until the implantation of an implantable cardioverter defibrillator (ICD), as recommended by the current guidelines. Besides their function to detect and treat malignant arrhythmias, WCDs may be used as a telemonitoring system. In this study, we sought to illustrate and discuss the telemonitoring potential of WCDs and to analyze physical activity in specific patient cohorts. Methods and Results: We retrospectively included 140 patients with reduced LVEF who were prescribed WCDs in our clinic. We analyzed the patients’ physical activity (n = 105 with a WCD compliance above 21 h/day), body position and resting position. We found a reduced physical activity in women and in patients over the age of 65 compared to younger patients. Furthermore, the patients who were overweight or obese showed significantly reduced physical activity compared to the patients with a normal weight (6365 ± 3572 vs. 4972 ± 2476 vs. 7045 ± 3521, p = 0.02). Conclusion: WCDs may be used as a telemonitoring and intervention tool in patients with reduced LVEF. Specific patient groups may benefit from guidance from their treating physician regarding physical activity. Full article
(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)
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28 pages, 2622 KiB  
Review
A Comprehensive Outlook on Dilated Cardiomyopathy (DCM): State-Of-The-Art Developments with Special Emphasis on OMICS-Based Approaches
by Vivek Sarohi, Shriya Srivastava and Trayambak Basak
J. Cardiovasc. Dev. Dis. 2022, 9(6), 174; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060174 - 01 Jun 2022
Cited by 8 | Viewed by 3832
Abstract
Dilated cardiomyopathy (DCM) remains an enigmatic cardiovascular disease (CVD) condition characterized by contractile dysfunction of the myocardium due to dilation of the ventricles. DCM is one of the major forms of CVD contributing to heart failure. Dilation of the left or both ventricles [...] Read more.
Dilated cardiomyopathy (DCM) remains an enigmatic cardiovascular disease (CVD) condition characterized by contractile dysfunction of the myocardium due to dilation of the ventricles. DCM is one of the major forms of CVD contributing to heart failure. Dilation of the left or both ventricles with systolic dysfunction, not explained by known causes, is a hallmark of DCM. Progression of DCM leads to heart failure. Genetic and various other factors greatly contribute to the development of DCM, but the etiology has still remained elusive in a large number of cases. A significant number of studies have been carried out to identify the genetic causes of DCM. These candidate-gene studies revealed that mutations in the genes of the fibrous, cytoskeletal, and sarcomeric proteins of cardiomyocytes result in the development of DCM. However, a significant proportion of DCM patients are idiopathic in nature. In this review, we holistically described the symptoms, causes (in adults and newborns), genetic basis, and mechanistic progression of DCM. Further, we also summarized the state-of-the-art diagnosis, available biomarkers, treatments, and ongoing clinical trials of potential drug regimens. DCM-mediated heart failure is on the rise worldwide including in India. The discovery of biomarkers with a better prognostic value is the need of the hour for better management of DCM-mediated heart failure patients. With the advent of next-generation omics-based technologies, it is now possible to probe systems-level alterations in DCM patients pertaining to the identification of novel proteomic and lipidomic biomarkers. Here, we also highlight the onset of a systems-level study in Indian DCM patients by applying state-of-the-art mass-spectrometry-based “clinical proteomics” and “clinical lipidomics”. Full article
(This article belongs to the Special Issue Understanding Heart Failure Management and Treatment)
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12 pages, 1501 KiB  
Article
Perioperative Fluoroquinolone Treatment Deteriorates Prognosis Following Coronary Artery Bypass Grafting
by Min Zhang, Lijuan Jian, Xinping Min, Bowen Li, Xin Cai, Zhiwei Wang and Zhipeng Hu
J. Cardiovasc. Dev. Dis. 2022, 9(6), 173; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060173 - 28 May 2022
Viewed by 1441
Abstract
Background: Former studies have revealed that fluoroquinolone (FQ) can induce aortic expansion and rupture. While FQ is widely used in perioperative anti-infection therapy, its impact on graft patency and patient survival is unknown. Methods: Coronary artery bypass grafting (CABG) data were extracted from [...] Read more.
Background: Former studies have revealed that fluoroquinolone (FQ) can induce aortic expansion and rupture. While FQ is widely used in perioperative anti-infection therapy, its impact on graft patency and patient survival is unknown. Methods: Coronary artery bypass grafting (CABG) data were extracted from the MIMIC-III database. Chi-square tests, Fisher’s exact tests, t-tests, or ANOVAs were used to compare baseline data between groups determined by FQ therapy status, depending on the data type. Propensity score matching was used to establish a balanced cohort. Cox regression was used to investigate the impact of FQ on CABG patient survival, whereas paired t-tests were used to analyze secondary results. Results: Of the 5030 patients who underwent CABG, 937 (18.6%) received oral or intravenous FQ therapy. Using propensity score matching, these 819 patients were successfully matched with 819 controls in a 1:1 ratio. Cox regression showed that FQ significantly decreased survival among CABG patients (HR: 1.62, 95% CI: 1.21–2.15, p = 0.001). Furthermore, FQ usage was associated with longer hospitalization (<0.0001), ICU duration (<0.0001), ventilation period (<0.0001), and duration of vasopressor administration (<0.0001). Conclusions: Perioperative FQ therapy was associated with worse prognosis and a more difficult recovery among patients with CABG. Full article
(This article belongs to the Section Cardiac Surgery)
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9 pages, 267 KiB  
Article
Effects of Concurrent Aerobic Plus Resistance Training on Blood Pressure Variability and Blood Pressure Values in Patients with Hypertension and Coronary Artery Disease: Gender-Related Differences
by Giuseppe Caminiti, Marco Alfonso Perrone, Maurizio Volterrani, Ferdinando Iellamo, Giuseppe Marazzi, Serena Selli, Alessio Franchini and Elvira Padua
J. Cardiovasc. Dev. Dis. 2022, 9(6), 172; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060172 - 27 May 2022
Cited by 2 | Viewed by 1999
Abstract
The purpose of this study was to compare changes in blood pressure variability (BPV) and blood pressure (BP) values occurring in response to concurrent training (CT) between the two genders. A total of 35 males and 20 women aged 55–80 years, with hypertension and [...] Read more.
The purpose of this study was to compare changes in blood pressure variability (BPV) and blood pressure (BP) values occurring in response to concurrent training (CT) between the two genders. A total of 35 males and 20 women aged 55–80 years, with hypertension and coronary artery disease, were included. They underwent a 12-week CT program. The aerobic component of CT was performed according to the rate of perceived exertion while the intensity of the resistance component was set at 60% of 1 repetition maximum for the first 4 weeks and then increased to 80%. BP and BPV were evaluated at baseline and at the end of the CT program through 24 h ambulatory blood pressure monitoring. After 12-weeks, 24 h and daytime systolic BPV decreased in both men and women without significant between-groups differences. Twenty-four-hour daytime and nighttime diastolic BPV decreased in both genders with a significantly greater decrease in women compared to men. Twenty-four-hour daytime systolic and 24 h diastolic BP decreased in men while they were unchanged in women. In conclusion, CT induced similar reductions of systolic BPV in men and women and a greater decrease in diastolic BPV in women. Conversely, CT decreased BP values in males but not in females. CT appears to be an effective intervention for reducing BPV in both genders. Full article
(This article belongs to the Special Issue Cardiovascular Effects and Benefits of Exercise)
8 pages, 280 KiB  
Article
The Effects of Exercise Training on Cardiopulmonary Exercise Testing and Cardiac Biomarkers in Adult Patients with Hypoplastic Left Heart Syndrome and Fontan Circulation
by Marco Alfonso Perrone, Elettra Pomiato, Rosalinda Palmieri, Giulia Di Già, Fiorella Piemonte, Ottavia Porzio and Maria Giulia Gagliardi
J. Cardiovasc. Dev. Dis. 2022, 9(6), 171; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060171 - 27 May 2022
Cited by 10 | Viewed by 2010
Abstract
Background: Several studies have shown that adult patients with Hypoplastic Left Heart Syndrome (HLHS) and Fontan circulation have a reduced exercise tolerance that affects daily life. Recent studies have investigated the effects of aerobic exercise training in patients with univentricular heart; however, this [...] Read more.
Background: Several studies have shown that adult patients with Hypoplastic Left Heart Syndrome (HLHS) and Fontan circulation have a reduced exercise tolerance that affects daily life. Recent studies have investigated the effects of aerobic exercise training in patients with univentricular heart; however, this research topic is still poorly studied. The aim of this study was to evaluate the effects of an aerobic exercise training program on cardiopulmonary exercise testing parameters and cardiac biomarkers in patients with HLHS. Methods: We enrolled 12 patients with a mean age of 24 ± 2.5 years (range 22–27 years), 50% male, with HLHS at Bambino Gesù Children’s Hospital IRCCS. All patients underwent a cardiopulmonary test and blood sampling before (T0) and after (T1) a 4-week aerobic exercise program. Cardiac biomarkers hs-cTnT, NT-proBNP, ST2, GDF-15 were studied. Results: Data analysis demonstrated an increase in cardiorespiratory performance after 4 weeks of aerobic exercise training activity. In particular, the data showed a significant improvement in test duration (p < 0.05), heart rate at rest (p < 0.05), heart rate recovery 1 min (p < 0.05), VO2 max (p < 0.01) and oxygen uptake efficiency slope (p < 0.05). At the same time, the data showed a significant reduction in NT-proBNP and ST2 values (p < 0.01 and p < 0.05, respectively) and a significant increase in GDF-15 (p < 0.01). No significant changes were found between the hs-cTnT values. Conclusions: Our study demonstrated the 4-week efficacy of an aerobic training program in improving cardiorespiratory performance and cardiac biomarker values in adult patients with HLHS and Fontan circulation. More studies with larger numbers of patients will be needed to confirm these data. Full article
(This article belongs to the Special Issue Cardiovascular Effects and Benefits of Exercise)
11 pages, 1035 KiB  
Systematic Review
From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review
by Lukas Schmutzler, Moritz Mirna, Uta C. Hoppe and Michael Lichtenauer
J. Cardiovasc. Dev. Dis. 2022, 9(6), 170; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060170 - 25 May 2022
Cited by 1 | Viewed by 6375
Abstract
(1) Background: Myocarditis following group A streptococcal pharyngitis and tonsillitis is a relatively rare medical condition. The aim of this systematic review was to identify specific ECG changes, laboratory parameters and signs, and symptoms associated with this disease. (2) Methods: A systematic literature [...] Read more.
(1) Background: Myocarditis following group A streptococcal pharyngitis and tonsillitis is a relatively rare medical condition. The aim of this systematic review was to identify specific ECG changes, laboratory parameters and signs, and symptoms associated with this disease. (2) Methods: A systematic literature review was performed in concordance with the current PRISMA guidelines, including the databases PubMed/MEDLINE, Web of Science, CDSR, CENTRAL, CCAs, EBM Reviews, and LILACS. Articles were included if they covered myocarditis after streptococcal pharyngitis/tonsillitis in humans. Exclusion criteria were rheumatic, autoimmune, or toxic myocarditis. (3) Results: Patients that developed myocarditis after group A streptococcal throat infection frequently presented with chest pain, elevated cardiac markers, and ST-segment elevations, making it a condition that shows more similarities to acute coronary syndrome than viral myocarditis. (4) Conclusions: Myocarditis after streptococcal pharyngitis and/or tonsillitis is a rather infrequently described disease; however, it is necessary to consider this condition when investigating streptococcal sore throat because it can be associated with severe adverse events for the individual patient. Full article
(This article belongs to the Special Issue Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease)
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15 pages, 2310 KiB  
Review
Contemporary Diagnosis and Management of Hypertrophic Cardiomyopathy: The Role of Echocardiography and Multimodality Imaging
by Takeshi Kitai, Andrew Xanthopoulos, Shoko Nakagawa, Natsuko Ishii, Masashi Amano, Filippos Triposkiadis and Chisato Izumi
J. Cardiovasc. Dev. Dis. 2022, 9(6), 169; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060169 - 25 May 2022
Cited by 5 | Viewed by 5853
Abstract
Hypertrophic cardiomyopathy (HCM) is an underdiagnosed genetic heart disease with an estimated prevalence of 0.2–0.5%. Although the prognosis of HCM is relatively good, with an annual general mortality of ~0.7%, some patients have an increased risk of sudden death, or of developing severe [...] Read more.
Hypertrophic cardiomyopathy (HCM) is an underdiagnosed genetic heart disease with an estimated prevalence of 0.2–0.5%. Although the prognosis of HCM is relatively good, with an annual general mortality of ~0.7%, some patients have an increased risk of sudden death, or of developing severe heart failure requiring heart transplantation or left ventricular (LV) assist device therapy. Therefore, earlier diagnosis and proper identification of high-risk patients may reduce disease-related morbidity/mortality by promoting timely treatment. Echocardiography is the primary imaging modality for patients with suspected HCM; it plays central roles in differential diagnosis from other causes of LV hypertrophy and in evaluating morphology, hemodynamic disturbances, LV function, and associated valvular disease. Echocardiography is also an essential tool for the continuous clinical management of patients with confirmed HCM. Other imaging modalities, such as cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI), can supplement echocardiography in identifying high-risk as well as milder HCM phenotypes. The role of such multimodality imaging has been steadily expanding along with recent advancements in surgical techniques and minimally invasive procedures, and the emergence of novel pharmacotherapies directly targeting pathogenic molecules such as myosin inhibitors. Here we review essential knowledge surrounding HCM with a specific focus on structural and functional abnormalities assessed by imaging modalities, leading to treatment strategies. Full article
(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)
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16 pages, 6501 KiB  
Article
The Time-Dependent Role of Bisphosphonates on Atherosclerotic Plaque Calcification
by Amirala Bakhshian Nik, Hooi Hooi Ng, Manuel Garcia Russo, Francesco Iacoviello, Paul R. Shearing, Sergio Bertazzo and Joshua D. Hutcheson
J. Cardiovasc. Dev. Dis. 2022, 9(6), 168; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060168 - 25 May 2022
Cited by 4 | Viewed by 2219
Abstract
Atherosclerotic plaque calcification directly contributes to the leading cause of morbidity and mortality by affecting plaque vulnerability and rupture risk. Small microcalcifications can increase plaque stress and promote rupture, whereas large calcifications can stabilize plaques. Drugs that target bone mineralization may lead to [...] Read more.
Atherosclerotic plaque calcification directly contributes to the leading cause of morbidity and mortality by affecting plaque vulnerability and rupture risk. Small microcalcifications can increase plaque stress and promote rupture, whereas large calcifications can stabilize plaques. Drugs that target bone mineralization may lead to unintended consequences on ectopic plaque calcification and cardiovascular outcomes. Bisphosphonates, common anti-osteoporotic agents, have elicited unexpected cardiovascular events in clinical trials. Here, we investigated the role of bisphosphonate treatment and timing on the disruption or promotion of vascular calcification and bone minerals in a mouse model of atherosclerosis. We started the bisphosphonate treatment either before plaque formation, at early plaque formation times associated with the onset of calcification, or at late stages of plaque development. Our data indicated that long-term bisphosphonate treatment (beginning prior to plaque development) leads to higher levels of plaque calcification, with a narrower mineral size distribution. When given later in plaque development, we measured a wider distribution of mineral size. These morphological alterations might be associated with a higher risk of plaque rupture by creating stress foci. Yet, bone mineral density positively correlated with the duration of the bisphosphonate treatment. Full article
(This article belongs to the Section Basic and Translational Cardiovascular Research)
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