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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 19064

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Special Issue Editor

Prof. Dr. Michael Henein

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Department of Public Health and Clinical Medical and Heart Center, Umea University, Umea, Sweden
Interests: non-invasive cardiology including valve disease; coronary artery disease; heart failure; cardiovascular imaging
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Special Issue Information

Dear Colleagues,

Cardiology and cardiovascular sciences are two rapidly growing areas in medicine, with heart diseases being the number one cause of death worldwide. The last four decades have witnessed many developments in various cardiological sciences, including coronary artery disease, valve disease, heart failure, congenital heart diseases, and cardiovascular imaging, with a number of newly developed concepts, such as cardio-oncology, cardio-renal diseases, and preventive cardiology.

This Special Issue (SI) of the Journal of Clinical Medicine, entitled “JCM-Advances in Cardiology”, focuses on recent advances in the cardiological sciences. It aims to publish ground-breaking research articles of significant clinical and scientific value, including observational studies, clinical trials, and review articles. Unique clinical cases, particularly supported by advanced imaging, will also be welcome. We anticipate that the success of the Advances in Cardiology SI will result in the publication of other SI in different cardiology subspecialties.

Dr. Michael Henein
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. Journal of Clinical Medicine 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

cardiology research
cardiovascular disease
heart valve disease
coroanry artery disease
myocardial disease
heart failure
preventive cardiology
cardio-oncology
cardio-renal diseases
atherosclerosis
arterial calcification

Published Papers (9 papers)

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Editorial

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5 pages, 187 KiB

Open AccessEditorial

COVID-19 Severity and Cardiovascular Disease: An Inseparable Link

by Michael Y. Henein, Matteo Cameli, Maria Concetta Pastore and Giulia Elena Mandoli

J. Clin. Med. 2022, 11(3), 479; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030479 - 18 Jan 2022

Cited by 1 | Viewed by 1494

Abstract

The COVID-19 pandemic is a global health issue that has so far affected over 250 million people worldwide [...] Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

Research

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15 pages, 535 KiB

Open AccessArticle

Relationship between Adipokines and Cardiovascular Ultrasound Parameters in Metabolic-Dysfunction-Associated Fatty Liver Disease

by Abdulrahman Ismaiel, Mihail Spinu, Livia Budisan, Daniel-Corneliu Leucuta, Stefan-Lucian Popa, Bogdan Augustin Chis, Ioana Berindan-Neagoe, Dan Mircea Olinic and Dan L. Dumitrascu

J. Clin. Med. 2021, 10(21), 5194; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10215194 - 07 Nov 2021

Cited by 8 | Viewed by 2252

Abstract

(1) Background: The role of adipokines such as adiponectin and visfatin in metabolic-dysfunction-associated fatty liver disease (MAFLD) and cardiovascular disease remains unclear. Therefore, we aim to assess serum adiponectin and visfatin levels in MAFLD patients and associated cardiovascular parameters. (2) Methods: A cross-sectional study involving 80 participants (40 MAFLD patients, 40 controls), recruited between January and September 2020, was conducted, using both hepatic ultrasonography and SteatoTestTM to evaluate hepatic steatosis. Echocardiographic and Doppler parameters were assessed. Serum adipokines were measured using ELISA kits. (3) Results: Adiponectin and visfatin levels were not significantly different in MAFLD vs. controls. Visfatin was associated with mean carotid intima-media thickness (p-value = 0.047), while adiponectin was associated with left ventricular ejection fraction (LVEF) (p-value = 0.039) and E/A ratio (p-value = 0.002) in controls. The association between adiponectin and E/A ratio was significant in the univariate analysis at 95% CI (0.0049–0.1331, p-value = 0.035), but lost significance after the multivariate analysis. Although LVEF was not associated with adiponectin in the univariate analysis, significant values were observed after the multivariate analysis (95% CI (−1.83–−0.22, p-value = 0.015)). (4) Conclusions: No significant difference in serum adiponectin and visfatin levels in MAFLD patients vs. controls was found. Interestingly, although adiponectin levels were not associated with LVEF in the univariate analysis, a significant inversely proportional association was observed after the multivariate analysis. Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

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13 pages, 1493 KiB

Open AccessArticle

Continuous Electrical Monitoring in Patients with Arrhythmic Myocarditis: Insights from a Referral Center

by Giovanni Peretto, Patrizio Mazzone, Gabriele Paglino, Alessandra Marzi, Georgios Tsitsinakis, Stefania Rizzo, Cristina Basso, Paolo Della Bella and Simone Sala

J. Clin. Med. 2021, 10(21), 5142; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10215142 - 01 Nov 2021

Cited by 7 | Viewed by 1608

Abstract

Background. The incidence and burden of arrhythmias in myocarditis are under-reported. Objective. We aimed to assess the diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis. Methods. We enrolled consecutive adult patients (n = 104; 71% males, age 47 ± 11 year, mean LVEF 50 ± 13%) with biopsy-proven active myocarditis and de novo ventricular arrhythmias (VAs). All patients underwent prospective monitoring by both sequential 24-h Holter ECGs and CAM, including either ICD (n = 62; 60%) or loop recorder (n = 42; 40%). Results. By 3.7 ± 1.6 year follow up, 45 patients (43%) had VT, 67 (64%) NSVT and 102 (98%) premature ventricular complexes (PVC). As compared to the Holter ECG (average 9.5 exams per patient), CAM identified more patients with VA (VT: 45 vs. 4; NSVT: 64 vs. 45; both p < 0.001), more VA episodes (VT: 100 vs. 4%; NSVT: 91 vs. 12%) and earlier NSVT timing (median 6 vs. 24 months, p < 0.001). The extensive ICD implantation strategy was proven beneficial in 80% of the population. Histological signs of chronically active myocarditis (n = 73, 70%) and anteroseptal late gadolinium enhancement (n = 26, 25%) were significantly associated with the occurrence of VTs during follow up, even in the primary prevention subgroup. Conclusion. In patients with arrhythmic myocarditis, CAM allowed accurate arrhythmia detection and showed a considerable clinical impact. Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

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14 pages, 1123 KiB

Open AccessArticle

Clinical Features of LMNA-Related Cardiomyopathy in 18 Patients and Characterization of Two Novel Variants

by Valentina Ferradini, Joseph Cosma, Fabiana Romeo, Claudia De Masi, Michela Murdocca, Paola Spitalieri, Sara Mannucci, Giovanni Parlapiano, Francesca Di Lorenzo, Annamaria Martino, Francesco Fedele, Leonardo Calò, Giuseppe Novelli, Federica Sangiuolo and Ruggiero Mango

J. Clin. Med. 2021, 10(21), 5075; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10215075 - 29 Oct 2021

Cited by 6 | Viewed by 2039

Abstract

Dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders characterized by ventricular dilation and depressed myocardial performance in the absence of hypertension, valvular, congenital, or ischemic heart disease. Mutations in LMNA gene, encoding for lamin A/C, account for 10% of familial DCM. LMNA-related cardiomyopathies are characterized by heterogeneous clinical manifestations that vary from a predominantly structural heart disease, mainly mild-to-moderate left ventricular (LV) dilatation associated or not with conduction system abnormalities, to highly pro-arrhythmic profiles where sudden cardiac death (SCD) occurs as the first manifestation of disease in an apparently normal heart. In the present study, we select, among 77 DCM families referred to our center for genetic counselling and molecular screening, 15 patient heterozygotes for LMNA variants. Segregation analysis in the relatives evidences other eight heterozygous patients. A genotype–phenotype correlation has been performed for symptomatic subjects. Lastly, we perform in vitro functional characterization of two novel LMNA variants using dermal fibroblasts obtained from three heterozygous patients, evidencing significant differences in terms of lamin expression and nuclear morphology. Due to the high risk of SCD that characterizes patients with lamin A/C cardiomyopathy, genetic testing for LMNA gene variants is highly recommended when there is suspicion of laminopathy. Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

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10 pages, 2298 KiB

Open AccessArticle

Check the Need–Prevalence and Outcome after Transvenous Cardiac Implantable Electric Device Extraction without Reimplantation

by Giuseppe D’Angelo, David Zweiker, Nicolai Fierro, Alessandra Marzi, Gabriele Paglino, Simone Gulletta, Mario Matta, Francesco Melillo, Caterina Bisceglia, Luca Rosario Limite, Manuela Cireddu, Pasquale Vergara, Francesco Bosica, Giulio Falasconi, Luigi Pannone, Luigia Brugliera, Teresa Oloriz, Simone Sala, Andrea Radinovic, Francesca Baratto, Lorenzo Malatino, Giovanni Peretto, Kenzaburo Nakajima, Michael D. Spartalis, Antonio Frontera, Paolo Della Bella and Patrizio Mazzone Show full author list Hide full author list

J. Clin. Med. 2021, 10(18), 4043; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10184043 - 07 Sep 2021

Cited by 5 | Viewed by 1777

Abstract

Background: after transvenous lead extraction (TLE) of cardiac implantable electric devices (CIEDs), some patients may not benefit from device reimplantation. This study sought to analyse predictors and long-term outcome of patients after TLE with vs. without reimplantation in a high-volume centre. Methods: all patients undergoing TLE at our centre between January 2010 and November 2015 were included into this analysis. Results: a total of 223 patients (median age 70 years, 22.0% female) were included into the study. Cardiac resynchronization therapy-defibrillator (CRT-D) was the most common device (40.4%) followed by pacemaker (PM) (31.4%), implantable cardioverter-defibrillator (ICD) (26.9%), and cardiac resynchronization therapy-PM (CRT-P) (1.4%). TLE was performed due to infection (55.6%), malfunction (35.9%), system upgrade (6.7%) or other causes (1.8%). In 14.8%, no reimplantation was performed after TLE. At a median follow-up of 41 months, no preventable arrhythmia-related events were documented in the no-reimplantation group, but 11.8% received a new CIED after 17–84 months. While there was no difference in short-term survival, five-year survival was significantly lower in the no-reimplantation group (78.3% vs. 94.7%, p = 0.014). Conclusions: in patients undergoing TLE, a re-evaluation of the indication for reimplantation is safe and effective. Reimplantation was not related to preventable arrhythmia events, but all-cause survival was lower. Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

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12 pages, 1231 KiB

Open AccessArticle

Obesity Strongly Predicts COVID-19-Related Major Clinical Adverse Events in Coptic Clergy

by Michael Y. Henein, Ibadete Bytyçi, Rachel Nicoll, Rafik Shenouda, Sherif Ayad, Federico Vancheri and Matteo Cameli

J. Clin. Med. 2021, 10(13), 2752; https://doi.org/10.3390/jcm10132752 - 22 Jun 2021

Cited by 3 | Viewed by 1483

Abstract

Background and Aims: The Coptic clergy, due to their specific work involving interaction with many people, could be subjected to increased risk of infection from COVID-19. The aim of this study, a sub-study of the COVID-19-CVD international study of the impact of the pandemic on the cardiovascular system, was to assess the prevalence of COVID-19 among Coptic priests and to identify predictors of clinical adverse events. Methods: Participants were geographically divided into three groups: Group-I: Europe and USA, Group II: Northern Egypt, and Group III: Southern Egypt. Participants’ demographic indices, cardiovascular risk factors, possible source of infection, number of liturgies, infection management, and major adverse events (MAEs), comprising death, or mechanical ventilation, were assessed. Results: Out of the 1570 clergy serving in 25 dioceses, 255 (16.2%) were infected. Their mean age was 49.5 ± 12 years and mean weekly number of liturgies was 3.44 ± 1.0. The overall prevalence rate was 16.2% and did not differ between Egypt as a whole and overseas (p = 0.23). Disease prevalence was higher in Northern Egypt clergy compared with Europe and USA combined (18.4% vs. 12.1%, p = 0.03) and tended to be higher than in Southern Egypt (18.4% vs. 13.6%, p = 0.09). Ten priests (3.92%) died of COVID-19-related complications, and 26 (10.2) suffered a MAE. The clergy from Southern Egypt were more obese, but the remaining risk factors were less prevalent compared with those in Europe and USA (p = 0.01). In multivariate analysis, obesity (OR = 4.180; 2.479 to 12.15; p = 0.01), age (OR = 1.055; 0.024 to 1.141; p = 0.02), and systemic hypertension (OR = 1.931; 1.169 to 2.004; p = 0.007) predicted MAEs. Obesity was the most powerful independent predictor of MAE in Southern Egypt and systemic hypertension in Northern Egypt (p < 0.05 for both). Conclusion: Obesity is very prevalent among Coptic clergy and seems to be the most powerful independent predictor of major COVID-19-related adverse events. Coptic clergy should be encouraged to follow the WHO recommendations for cardiovascular disease and COVID-19 prevention. Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

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9 pages, 1034 KiB

Open AccessArticle

Combined Cardiac Risk Factors Predict COVID-19 Related Mortality and the Need for Mechanical Ventilation in Coptic Clergy

by Michael Y. Henein, Ibadete Bytyçi, Rachel Nicoll, Rafik Shenouda, Sherif Ayad, Matteo Cameli and Federico Vancheri

J. Clin. Med. 2021, 10(10), 2066; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10102066 - 12 May 2021

Cited by 4 | Viewed by 1714

Abstract

Background and Aims: The clinical adverse events of COVID-19 among clergy worldwide have been found to be higher than among ordinary communities, probably because of the nature of their work. The aim of this study was to assess the impact of cardiac risk factors on COVID-19-related mortality and the need for mechanical ventilation in Coptic clergy. Methods: Of 1570 Coptic clergy participating in the COVID-19-Clergy study, serving in Egypt, USA and Europe, 213 had the infection and were included in this analysis. Based on the presence of systemic arterial hypertension (AH), participants were divided into two groups: Group-I, clergy with AH (n = 77) and Group-II, without AH (n = 136). Participants’ demographic indices, cardiovascular risk factors, COVID-19 management details and related mortality were assessed. Results: Clergy with AH were older (p < 0.001), more obese (p = 0.04), had frequent type 2 diabetes (DM) (p = 0.001), dyslipidemia (p = 0.001) and coronary heart disease (CHD) (p = 0.04) compared to those without AH. COVID-19 treatment at home, hospital or in intensive care did not differ between the patient groups (p > 0.05 for all). Clergy serving in Northern and Southern Egypt had a higher mortality rate compared to those from Europe and the USA combined (5.22%, 6.38%, 0%; p = 0.001). The impact of AH on mortality was significant only in Southern Egypt (10% vs. 3.7%; p = 0.01) but not in Northern Egypt (4.88% vs. 5.81%; p = 0.43). In multivariate analysis, CHD OR 1.607 ((0.982 to 3.051); p = 0.02) and obesity, OR 3.403 ((1.902 to 4.694); p = 0.04) predicted COVID-19 related mortality. A model combining cardiac risk factors (systolic blood pressure (SBP) ≥ 160 mmHg, DM, obesity and history of CHD) was the most powerful independent predictor of COVID-19-related mortality, OR 3.991 ((1.919 to 6.844); p = 0.002). Almost the same model also proved the best independent multivariate predictor of mechanical ventilation OR 1.501 ((0.809 to 6.108); p = 0.001). Conclusion: In Coptic clergy, the cumulative impact of risk factors was the most powerful predictor of mortality and the need for mechanical ventilation. Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

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7 pages, 229 KiB

Open AccessArticle

The Impact of COVID-19 on In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Patients

by Sherif Ayad, Rafik Shenouda and Michael Henein

J. Clin. Med. 2021, 10(2), 278; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10020278 - 14 Jan 2021

Cited by 14 | Viewed by 2253

Abstract

Primary percutaneous coronary intervention (PPCI) is one of the important clinical procedures that have been affected by the COVID-19 pandemic. In this study, we aimed to assess the incidence and impact of COVID-19 on in-hospital clinical outcome of ST elevation myocardial infarction (STEMI) patients managed with PPCI. This observational retrospective study was conducted on consecutive STEMI patients who presented to the International Cardiac Center (ICC) hospital, Alexandria, Egypt between 1 February and 31 October 2020. A group of STEMI patients presented during the same period in 2019 was also assessed (control group) and data was used for comparison. The inclusion criteria were established diagnosis of STEMI requiring PPCI.A total of 634 patients were included in the study. During the COVID-19 period, the number of PPCI procedures was reduced by 25.7% compared with previous year (mean 30.0 ± 4.01 vs. 40.4 ± 5.3 case/month) and the time from first medical contact to Needle (FMC-to-N) was longer (125.0 ± 53.6 vs. 52.6 ± 22.8 min, p = 0.001). Also, during COVID-19, the in-hospital mortality was higher (7.4 vs. 4.6%, p = 0.036) as was the incidence of re-infarction (12.2 vs. 7.7%, p = 0.041) and the need for revascularization (15.9 vs. 10.7%, p = 0.046). The incidence of heart failure, stroke, and bleeding was not different between groups, but hospital stay was longer during COVID-19 (6.85 ± 4.22 vs. 3.5 ± 2.3 day, p = 0.0025). Conclusion: At the ICC, COVID-19 pandemic contributed significantly to the PPCI management of STEMI patients with decreased number and delayed procedures. COVID-19 was also associated with higher in-hospital mortality, rate of re-infarction, need for revascularization, and longer hospital stay. Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

Review

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17 pages, 2672 KiB

Open AccessReview

ACE2, the Counter-Regulatory Renin–Angiotensin System Axis and COVID-19 Severity

by Filippos Triposkiadis, Andrew Xanthopoulos, Grigorios Giamouzis, Konstantinos Dean Boudoulas, Randall C. Starling, John Skoularigis, Harisios Boudoulas and Efstathios Iliodromitis

J. Clin. Med. 2021, 10(17), 3885; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10173885 - 29 Aug 2021

Cited by 14 | Viewed by 3003

Abstract

Angiotensin (ANG)-converting enzyme (ACE2) is an entry receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). ACE2 also contributes to a deviation of the lung renin–angiotensin system (RAS) towards its counter-regulatory axis, thus transforming harmful ANG II to protective ANG (1–7). Based on this purported ACE2 double function, it has been put forward that the benefit from ACE2 upregulation with renin–angiotensin–aldosterone system inhibitors (RAASi) counterbalances COVID-19 risks due to counter-regulatory RAS axis amplification. In this manuscript we discuss the relationship between ACE2 expression and function in the lungs and other organs and COVID-19 severity. Recent data suggested that the involvement of ACE2 in the lung counter-regulatory RAS axis is limited. In this setting, an augmentation of ACE2 expression and/or a dissociation of ACE2 from the ANG (1–7)/Mas pathways that leaves unopposed the ACE2 function, the SARS-CoV-2 entry receptor, predisposes to more severe disease and it appears to often occur in the relevant risk factors. Further, the effect of RAASi on ACE2 expression and on COVID-19 severity and the overall clinical implications are discussed. Full article

(This article belongs to the Special Issue JCM-Advances in Cardiology)

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