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Clinical Advances in Diagnostics & Management of Cardiovascular Diseases

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (22 May 2022) | Viewed by 22465

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Special Issue Editor

Dr. Jan Fedacko

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Guest Editor

Centre of Clinical and Preclinical Research MEDIPARK, Faculty of Medicine, Pavol Jozef Safarik University, 040-11 Kosice, Slovakia
Interests: preventive cardiology; echocardiography; lipidology; coronary artery disease; epidemiology of CVDs
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiovascular diseases (CVDs) are the number one cause of death globally, taking an estimated 17.9 million lives each year (WHO).

The main aim of this Special Issue of the Diagnostics Journal is to showcase new advances in the diagnosis and prevention of CVDs and new/innovative management strategies for CVD patients. This Special Issue is open to a new range of biomarkers (not only blood biomarkers), methodologies and strategies, diagnostics modalities and technologies, and advanced technologies such as artificial intelligence which could be used in the field of CVDs diagnostics or prevention.

The aim of this Special Issue will be to deliver new insight into the possibility of early detection of CVDs, which could lead to a decrease in the morbidity and mortality. Papers focused on the early identification of subclinical atherosclerosis or coronary artery disease are strongly encouraged.

Authors can submit short communications, reviews, case reports and original articles from the field of CVDs. We welcome submissions from clinical, translational, and basic research.

Dr. Jan Fedacko
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Cardiovascular Diseases
Biomarkers
Cardiac imaging
Echocardiography
Prevention of Cardiovascular Diseases
Advance Diagnostic of Cardiovascular Diseases
Coronary Artery Disease
Dyslipidemy
Heart Failure
Arrhythmia
Stroke
Nutritional Supplements
Epidemiology of CVDs

Published Papers (10 papers)

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Research

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19 pages, 1783 KiB

Open AccessArticle

Cardiovascular Factors Associated with COVID-19 from an International Registry of Primarily Japanese Patients

by Akira Matsumori, Matthew E. Auda, Katelyn A. Bruno, Katie A. Shapiro, Toru Kato, Toshihiro Nakamura, Koji Hasegawa, Ahmed Saleh, Sherif Abdelrazek, Hany Negm, Niyata Hananta Karunawan, Leslie T. Cooper, Jr. and DeLisa Fairweather

Diagnostics 2022, 12(10), 2350; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102350 - 28 Sep 2022

Cited by 3 | Viewed by 1844

Abstract

Aims: We developed an international registry to examine cardiovascular complications of COVID-19. Methods: A REDCap form was created in March 2020 at Mayo Clinic in collaboration with the International Society of Cardiomyopathy, Myocarditis and Heart Failure (ISCMF) and data were entered from April 2020 through April 2021. Results: Of the 696 patients in the COVID-19 Registry, 411 (59.2%) were male and 283 (40.8%) were female, with a sex ratio of 1.5:1 male to female. In total, 95.5% of the patients were from Japan. The average age was 52 years with 31.5% being >65 years of age. COVID-19 patients with a history of cardiovascular disease (CVD) had more pre-existing conditions including type II diabetes (p < 0.0001), cancer (p = 0.0003), obesity (p = 0.001), and kidney disease (p = 0.001). They also had a greater mortality of 10.1% compared to 1.7% in those without a history of CVD (p < 0.0001). The most common cardiovascular conditions in patients with a history of CVD were hypertension (33.7%), stroke (5.7%) and arrhythmias (5.1%). We found that troponin T, troponin I, brain natriuretic peptide (BNP), N-terminal pro-BNP (NT-proBNP), C-reactive protein (CRP), IL-6 and lambda immunoglobulin free light chains (Ig FLC) were elevated above reference levels in patients with COVID-19. Myocarditis is known to occur mainly in adults under the age of 50, and when we examined biomarkers in patients that were ≤50 years of age and had no history of CVD we found that a majority of patients had elevated levels of troponin T (71.4%), IL-6 (59.5%), creatine kinase/CK-MB (57.1%), D-dimer (57.8%), kappa Ig FLC (75.0%), and lambda Ig FLC (71.4%) suggesting myocardial injury and possible myocarditis. Conclusions: We report the first findings to our knowledge of cardiovascular complications from COVID-19 in the first year of the pandemic in a predominantly Japanese population. Mortality was increased by a history of CVD and pre-existing conditions including type II diabetes, cancer, obesity, and kidney disease. Our findings indicate that even in cases where no abnormalities are found in ECG or ultrasound cardiography that myocardial damage may occur, and cardiovascular and inflammatory biomarkers may be useful for the diagnosis. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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13 pages, 1219 KiB

Open AccessArticle

Cardiac Rehabilitation and Mortality Risk Reduction in Peripheral Artery Disease at 6-Month Outcome

by Razvan Anghel, Cristina Andreea Adam, Ovidiu Mitu, Dragos Traian Marius Marcu, Viviana Onofrei, Mihai Roca, Alexandru Dan Costache, Radu Stefan Miftode, Grigore Tinica and Florin Mitu

Diagnostics 2022, 12(6), 1500; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12061500 - 20 Jun 2022

Cited by 5 | Viewed by 2055

Abstract

The management of patients with peripheral artery disease (PAD) is integrative and multidisciplinary, in which cardiac rehabilitation (CR) plays a prognostic role in terms of functional status, quality of life, and long-term impact on morbidity and mortality. We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. Based on a prognostic index developed to stratify long-term mortality risk in PAD patients, we divided the cohort into two groups: low and low-intermediate risk group (45 cases) and high-intermediate and high risk group (52 cases). We analyzed demographics, clinical parameters, and paraclinical parameters in the two groups, as well as factors associated with cardiological reassessment prior to the established deadline of 6 months. Obesity (p = 0.048), renal dysfunction (p < 0.001), dyslipidemia (p < 0.001), tobacco use (p = 0.048), and diabetes mellitus (p < 0.001) are comorbidities with long-term prognostic value. Low-density lipoprotein cholesterol (p = 0.002), triglycerides (p = 0.032), fasting glucose (p = 0.011), peak oxygen uptake (p = 0.005), pain-free walking distance (p = 0.011), maximum walking time (p < 0.001), and maximum walking distance (p = 0.002) influence the outcome of PAD patients by being factors associated with clinical improvement at the 6-month follow-up. PAD patients benefit from enrollment in CR programs, improvement of clinical signs, lipid and carbohydrate profile, and weight loss and maintenance of blood pressure profile within normal limits, as well as increased exercise capacity being therapeutic targets. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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12 pages, 1697 KiB

Open AccessArticle

The Significance of Systemic Immune-Inflammatory Index for Mortality Prediction in Diabetic Patients Treated with Off-Pump Coronary Artery Bypass Surgery

by Tomasz Urbanowicz, Michał Michalak, Ahmed Al-Imam, Anna Olasińska-Wiśniewska, Michał Rodzki, Anna Witkowska, Assad Haneya, Piotr Buczkowski, Bartłomiej Perek and Marek Jemielity

Diagnostics 2022, 12(3), 634; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030634 - 04 Mar 2022

Cited by 15 | Viewed by 2278

Abstract

Diabetes mellitus (DM) represents a complex carbohydrate metabolism disorder characterized by inflammatory over-reactivity. The study aimed to investigate the potential influence of postoperative inflammatory activation on mortality risk after off-pump coronary artery bypass grafting in diabetic patients. There were 510 patients treated with off-pump coronary artery bypass grafting due to stable complex coronary artery disease, including 175 patients with type-2 DM (T2DM.) The mean follow-up time was 3.7 +/− 1.5 years with a 9% all-cause mortality rate in the diabetic group. In multivariable analysis, preoperative comorbidities (stroke, peripheral artery disease, postoperative systemic inflammatory index >952, and postoperative left ventricle ejection fraction (LVEF) < 45%) were revealed as prognostic factors. The receiver operator characteristics curve analysis for postoperative calculations of systemic immune-inflammatory index (SII) appeared significant (AUC = 0.698, p = 0.008), yielding sensitivity of 68.75% and specificity of 71.07%. Systemic immune-inflammatory index (SII) can be regarded as a predictive marker for long-term prognosis in diabetic patients after off-pump coronary artery bypass grafting. The role of perioperative inflammatory activation may play a crucial role in mortality prediction. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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13 pages, 11445 KiB

Open AccessArticle

Peripartum Cardiomyopathy: Diagnostic and Prognostic Value of Cardiac Magnetic Resonance in the Acute Stage

by Alexander Isaak, Tiyasha H. Ayub, Waltraut M. Merz, Anton Faron, Christoph Endler, Alois M. Sprinkart, Claus C. Pieper, Daniel Kuetting, Darius Dabir, Ulrike Attenberger, Sebastian Zimmer, Ulrich M. Becher and Julian A. Luetkens

Diagnostics 2022, 12(2), 378; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020378 - 01 Feb 2022

Cited by 4 | Viewed by 1814

Abstract

This study aimed to evaluate the diagnostic and prognostic value of cardiac magnetic resonance in acute peripartum cardiomyopathy (PPCM). A total of 17 patients with PPCM in the acute stage and 15 healthy controls were retrospectively analyzed regarding myocardial function, edema, late gadolinium enhancement (LGE), and T1 and T2 mappings (T1, T2). Echocardiographic follow-ups were performed. Functional recovery was defined as a left ventricular ejection fraction (LVEF) of ≥50%. Patients with PPCM displayed biventricular dysfunction with reduced myocardial strain parameters and left ventricular and atrial dilatation, as well as diffuse myocardial edema (T2 signal intensity ratio: 2.10 ± 0.34 vs. 1.58 ± 0.21, p < 0.001; T1: 1070 ± 51 ms vs. 980 ± 28 ms, p = 0.001; T2: 63 ± 5 ms vs. 53 ± 2 ms, p < 0.001). Visual myocardial edema was present in 10 patients (59%). LGE was positive in 2 patients (12%). A total of 13 patients (76%) showed full LVEF recovery. The absence of visual myocardial edema and impairment of strain parameters were associated with delayed LVEF recovery. Multivariable Cox regression analysis revealed global longitudinal strain as an independent prognostic factor for LVEF recovery. In conclusion, biventricular systolic dysfunction with diffuse myocardial edema seems to be present in acute PPCM. Myocardial edema and strain may have prognostic value for LVEF recovery. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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11 pages, 3412 KiB

Open AccessArticle

Effect of Body Mass Index in Coronary CT Angiography Performed on a 256-Slice Multi-Detector CT Scanner

by Wei-Yip Law, Guan-Lin Huang and Ching-Ching Yang

Diagnostics 2022, 12(2), 319; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020319 - 27 Jan 2022

Cited by 6 | Viewed by 1909

Abstract

We aimed to investigate the effect of a patient’s body mass index (BMI) on radiation dose and image quality in prospectively ECG-triggered coronary CT angiography (CCTA) performed on a 256-slice multi-detector CT scanner. In total, 87 consecutive patients receiving CCTA examinations acquired with tube current modulation (TCM) and iterative reconstruction (IR) were enrolled in this study. The dose report recorded from the CT scanner console was used to derive the effective dose for patients. Subjective image quality scoring and objective noise measurements were conducted to quantify the impact of BMI on the image quality of CCTA. Because of the TCM technique, we expected tube current and radiation dose to increase as BMI increased. However, using TCM did not always guarantee sufficient radiation exposure to achieve consistent image quality for overweight or obese patients since the maximum X-ray tube output in milliamperes and kilovoltage peak was reached. The impact of photon starvation noise on image quality was not significant until BMI ≥ 27 kg/m²; this result could be due to IR’s noise reduction capability. Our results also suggest that using TCM with a noise index of 25 HU can reduce radiation dose without compromising image quality compared to images obtained based on the manufacturer’s default settings. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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8 pages, 245 KiB

Open AccessArticle

Association of Trabecular Bone Score-Adjusted Fracture Risk Assessment Tool with Coronary Artery Calcification in Women

by Tzyy-Ling Chuang, Yuh-Feng Wang, Malcolm Koo and Mei-Hua Chuang

Diagnostics 2022, 12(1), 178; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12010178 - 12 Jan 2022

Cited by 1 | Viewed by 1363

Abstract

The trabecular bone score (TBS) was found to be significantly associated with moderate coronary artery calcification (CAC). The aim of this study was to further explore the association between TBS-adjusted Fracture Risk Assessment Tool (FRAX) and CAC score in women. The electronic medical record database of a regional teaching hospital in southern Taiwan yielded women who received both coronary computed tomography and bone mineral density (BMD) measurement during their general health examination. Health history, anthropomorphic measurements, laboratory results, BMD, and T-scores were obtained. TBS values were calculated from database spine dual-energy X-ray absorptiometry files. Linear regression analyses tested the association between CAC score and 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF) determined by TBS-adjusted FRAX. Of the 116 women (mean age 55.8 years) studied, 24.1% had osteoporosis. Simple linear regression showed a significant association of CAC score with an increase in MOF and HF risk as measured by TBS-adjusted FRAX. In multiple linear regression adjusted for potential confounders, CAC score remained significantly associated with TBS-adjusted FRAX for right MOF (p = 0.002), left MOF (p = 0 006), right HF (p = 0.005), and left HF (p = 0.015). In conclusion, clinicians should be vigilant to the potential increased risk of coronary events among women with increased TBS-adjusted FRAX for MOF and HF. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

8 pages, 943 KiB

Open AccessArticle

Neutrophil to Lymphocyte Ratio (NLR) as an Easily Accessible Parameter for Monitoring Tacrolimus Overdose after Heart Transplantation—Experimental Study

by Tomasz Urbanowicz, Anna Olasińska-Wiśniewska, Michał Michalak, Michał Rodzki, Anna Witkowska, Ewa Straburzyńska-Migaj, Bartłomiej Perek and Marek Jemielity

Diagnostics 2022, 12(1), 37; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12010037 - 24 Dec 2021

Cited by 3 | Viewed by 2247

Abstract

(1) Background: The combination of candidate selection, immunosuppressive therapy adjustment, and scrutinous monitoring is a cornerstone for optimizing long-term survival after a heart transplant. Neutrophil-to-lymphocyte ratio (NLR) is a simple marker of inflammatory reactions activation and may play a clinical role as a predictive marker in oncological and cardiovascular diseases. The aim of the study was to find simple hematologic indices available from whole blood count to help in immunosuppressive therapy monitoring. (2) Methods: Thirty patients (23 men and 7 women) with a mean age of 43 +/− 13 years who had undergone orthotopic heart transplantation were enrolled into the study. The blood samples for whole blood count and Tacrolimus level were collected during outpatient visits in heart transplant recipients every two months for 18 months after first year post transplantation. (3) Results: There was a significant correlation between Tacrolimus overdose (>15 ng/mL) and NLR (Spearman’s rho 0.99, p < 0.001) and mean platelet volume (Spearman’s rho 0.989, p < 0.001). The ROC analysis for NLR above 3.62 showed predictive properties for Tacrolimus overdose (over 15 ng/mL) (AUC =0.633, p = 0.008) with a sensitivity of 50% and specificity of 83.73%. (4) Conclusions: Our results suggest that NLR above 3.62 may be regarded as a simple indicator of tacrolimus overdose. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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18 pages, 2093 KiB

Open AccessArticle

Prevalence of Microalbuminuria and Its Association with Subclinical Carotid Atherosclerosis in Middle Aged, Nondiabetic, Low to Moderate Cardiovascular Risk Individuals with or without Hypertension

by Eva Szabóová, Alexandra Lisovszki, Eliška Fatľová, Peter Kolarčik, Peter Szabó and Tomáš Molnár

Diagnostics 2021, 11(9), 1716; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11091716 - 19 Sep 2021

Cited by 3 | Viewed by 2439

Abstract

Microalbuminuria is closely associated with the risk of cardiovascular disease and all-cause mortality in the general population. Less is known about its relationship with subclinical atherosclerosis. We aimed to assess the prevalence of microalbuminuria and its relationship with subclinical atherosclerosis in middle-aged, nondiabetic, apparently healthy individuals (N = 187; 40.1% men, 59.9% women; aged 35–55 years) as well as to evaluate its potential associations with established risk modifiers, especially with the presence of carotid plaque. Clinical and laboratory parameters, the estimated 10-year fatal cardiovascular risk (SCORE), as well as circulating, functional (flow mediated vasodilation, ankle-brachial index, augmentation index, and pulse wave velocity), and morphological markers (mean carotid intima–media thickness, and carotid plaque) of subclinical atherosclerosis were analysed in group with vs. without microalbuminuria. Microalbuminuria was present in 3.8% of individuals with SCORE risk 0.43 ± 0.79%. Functional markers predominated in both groups. Carotid intima–media thickness (mean ± SD) in both groups was in range: 0.5–0.55 ± 0.09–0.14 mm. Carotid plaque was more frequent in group with (14.3%) vs. without (4.4%) microalbuminuria. Microalbuminuria had no statistically significant effect on most markers of subclinical atherosclerosis, but the increasing value of microalbuminuria was significantly associated with the occurrence of carotid plaque (p = 0.035; OR = 1.035; 95% CI = 1.002–1.07). Additional multiple logistic regression analysis, where variables belonged to microalbuminuria, number of risk factors, and family history, finally showed only two variables: microalbuminuria (p = 0.034; OR = 1.04; 95%CI = 1.003–1.09) and the number of risk factors (p = 0.006; OR = 2.15; 95% CI = 1.24–3.73) with independent and significant impact on the occurrence of carotid plaque. Our results may indicate an association of microalbuminuria with the presence of carotid atherosclerotic plaque; in addition, microalbuminuria and the number of risk factors appear to be possible predictors of the carotid plaque occurrence. Monitoring microalbuminuria may improve the personalized cardiovascular risk assessment in nondiabetic, low-to-moderate cardiovascular risk individuals with or without hypertension. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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13 pages, 1111 KiB

Open AccessArticle

Potential Relation between Plasma BDNF Levels and Human Coronary Plaque Morphology

by Patrizia Amadio, Nicola Cosentino, Sonia Eligini, Simone Barbieri, Calogero Claudio Tedesco, Leonardo Sandrini, Marta Zarà, Franco Fabiocchi, Giampaolo Niccoli, Giulia Magnani, Francesco Fracassi, Filippo Crea, Fabrizio Veglia, Giancarlo Marenzi and Silvia Stella Barbieri

Diagnostics 2021, 11(6), 1010; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11061010 - 01 Jun 2021

Cited by 10 | Viewed by 2625

Abstract

Coronary artery disease (CAD) patients are at high ischemic risk, and new biomarkers reflecting atherosclerotic disease severity and coronary plaque vulnerability are required. The Brain-Derived Neurotrophic Factor (BDNF) affects endothelial and macrophage activation suggesting its involvement in atherosclerotic plaque behavior. To investigate whether plasma BDNF is associated with in vivo coronary plaque features, assessed by optical coherence tomography (OCT), in both acute myocardial infarction (AMI) and stable angina (SA) patients, we enrolled 55 CAD patients (31 SA and 24 AMI), and 21 healthy subjects (HS). BDNF was lower in CAD patients than in HS (p < 0.0001), and it decreased with the presence, clinical acuity and severity of CAD. The greater BDNF levels were associated with OCT features of plaque vulnerability in overall CAD as well as in SA and AMI patients (p < 0.03). Specifically, in SA patients, BDNF correlated positively with macrophages’ infiltration within atherosclerotic plaque (p = 0.01) and inversely with minimal lumen area (p = 0.02). In AMI patients a negative correlation between BDNF and cap thickness was found (p = 0.02). Despite a small study population, our data suggest a relationship between BDNF and coronary plaque vulnerability, showing that vulnerable plaque is positively associated with plasma BDNF levels, regardless of the clinical CAD manifestation. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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7 pages, 544 KiB

Open AccessCommentary

Alavi–Carlsen Calcification Score (ACCS): A Simple Measure of Global Cardiac Atherosclerosis Burden

by Babak Saboury, Lars Edenbrandt, Reza Piri, Oke Gerke, Tom Werner, Armin Arbab-Zadeh, Abass Alavi and Poul Flemming Høilund-Carlsen

Diagnostics 2021, 11(8), 1421; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11081421 - 05 Aug 2021

Cited by 13 | Viewed by 2291

Abstract

Multislice cardiac CT characterizes late stage macrocalcification in epicardial arteries as opposed to PET/CT, which mirrors early phase arterial wall changes in epicardial and transmural coronary arteries. With regard to tracer, there has been a shift from using mainly ¹⁸F-fluorodeoxyglucose (FDG), indicating inflammation, to applying predominantly ¹⁸F-sodium fluoride (NaF) due to its high affinity for arterial wall microcalcification and more consistent association with cardiovascular risk factors. To make NaF-PET/CT an indispensable adjunct to clinical assessment of cardiac atherosclerosis, the Alavi–Carlsen Calcification Score (ACCS) has been proposed. It constitutes a global assessment of cardiac atherosclerosis burden in the individual patient, supported by an artificial intelligence (AI)-based approach for fast observer-independent segmentation. Common measures for characterizing epicardial coronary atherosclerosis by NaF-PET/CT as the maximum standardized uptake value (SUV) or target-to-background ratio are more versatile, error prone, and less reproducible than the ACCS, which equals the average cardiac SUV. The AI-based approach ensures a quick and easy delineation of the entire heart in 3D to obtain the ACCS expressing ongoing global cardiac atherosclerosis, even before it gives rise to CT-detectable coronary calcification. The quantification of global cardiac atherosclerotic burden by the ACCS is suited for management triage and monitoring of disease progression with and without intervention. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnostics & Management of Cardiovascular Diseases)

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