Journal of Cardiovascular Development and Disease (JCDD)

Background: Women experience higher rates of adverse events and first rehospitalization after left ventricular assist device (LVAD) implantation compared with men. This study investigated the role of sex and preimplant psychosocial risk in recurrent hospitalizations. Methods: Data from 20,123 INTERMACS patients (21.3% women) were analyzed. Cumulative transition rates (e.g., home to hospitalization) were estimated and Andersen–Gill models, adjusted for covariates, examined the association between sex, preimplant psychosocial risk, and cumulative transition hazards for rehospitalization. State occupation probabilities, the mean number of hospitalizations, and the cumulative average length of hospital stay were calculated and stratified by sex and psychosocial risk. Results: Psychosocial risk preimplant was more prevalent in men than in women (21.4% vs. 17.5%, p < 0.001). The interaction of female sex and psychosocial risk increased rehospitalization hazards, independently of covariates [HRadj 1.11, 95% CI (1.01–1.22), p = 0.036]. One-year postimplant, women with vs. without psychosocial risk had 2.2 vs. 1.8 hospitalizations, while men experienced 1.8 vs. 1.7 hospitalizations, respectively. Women with vs. without psychosocial risk spent 20 vs.16 days hospitalized, and men 15 vs. 14 days (all p < 0.001). Conclusions: Preimplant psychosocial risk independently contributed to recurrent hospitalizations post-LVAD, particularly affecting women. The early identification and management of these factors may reduce rehospitalizations and improve clinical outcomes.

Background and aims: Although familial hypercholesterolemia (FH) is a common congenital cause of elevated low-density lipoprotein cholesterol (LDL-C), it remains underdiagnosed and undertreated worldwide due to its inherent genetic heterogeneity. This study aimed to determine the prevalence of genetic variants in a Lithuanian patient cohort with clinically diagnosed FH and evaluate their possible clinical implications. Methods: A total of 172 patients were included in the retrospective analysis. The study population comprised males and females ranging from 0 to 85 years of age, with LDL-C levels exceeding 4.9 mmol/L in adults and 3.9 mmol/L in children. The subjects were divided into four groups according to the Dutch Lipid Clinic Network (DLCN) criteria (definite, probable, possible, and unlikely). Children were analyzed separately. Next-generation sequencing (NGS) has been chosen as the most appropriate technique for genetic testing. All identified variants were categorized into three groups: (1) pathogenic, (2) likely pathogenic, and (3) variants of uncertain significance. Subjects without detected variants were classified into group (4) No mutation. Results: Women were diagnosed with FH significantly later than men (p = 0.033). Genetic testing identified FH-causing variants in 41.86% of subjects, with 20.93% carrying pathogenic variants, 9.88% likely pathogenic, and 11.05% variants of uncertain significance (VUS). Frequently identified pathogenic variants were c.654_656del p.(Gly219del) in LDLR and c.10580G>A p.(Arg3527Gln) in APOB, which are both linked to the founder effect. Genetic testing led to a reassessment of Dutch Lipid Clinic Network scores, increasing the number of individuals classified as “Definite FH” by 86.2%. Conclusions: The increasing use of NGS in FH has enhanced diagnostic capabilities and suggests population-specific genetic patterns. However, it also increases VUS detection, for which reclassification rates are still low and require strenuous efforts. Moreover, despite the benefits of genetic testing, significant gender disparities remain and require further attention.

Coronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction , wide-area detectors, and dual-source systems, have helped mitigate early limitations , such as high radiation doses, motion artifacts, high iodine load, and non-diagnostic image quality. However, the adjustments between ionizing radiation and iodinated contrast material (CM) volumes remain a critical concern, especially due to the increasing use of CCTA in various indications. This review explores the balance between radiation and CM volumes, emphasizing patient-specific protocol optimization to improve diagnostic accuracy while minimizing risks. Radiation dose reduction strategies, such as low tube voltage protocols, prospective ECG-gating, and modern reconstruction algorithms, have significantly decreased radiation exposure, with some studies achieving sub-millisievert doses. Similarly, CM volume optimization, including adjustments in strategies for calculating CM volume, iodine concentration, and flow protocols, plays a role in managing risks such as contrast-associated acute kidney injury, particularly in patients with renal impairment. Emerging technologies, such as photon-counting CT and deep-learning reconstruction , promise further improvements in dose efficiency and image quality. This review summarizes current evidence, highlights the benefits and limitations of dose control approaches, and provides practical recommendations for practitioners. By tailoring protocols to patient characteristics, such as age, renal function, and body habitus, clini-cians can achieve an optimal trade-off between diagnostic accuracy and patient safety, ensuring optimal operation of CT systems in clinical practice.

Cardiovascular disease (CVD) is one of the largest global disease burdens. Despite guidelines and recommendations and the proven advantages of lipid-lowering therapies (LLTs) in preventing CVD, achieving treatment targets remains disappointing. A key barrier to optimal LLT is therapy discontinuation. To be widely adopted in clinical practice, new lipid-lowering therapies must both prevent major adverse cardiovascular events (MACEs) and exhibit cost effectiveness to ensure widespread utilization by patients, physicians, and insurers. While non-statin LLTs have shown cardiovascular value, their cost effectiveness is controversial. This review highlights the LLTs that are currently widely adopted and summarizes the available evidence on their cost effectiveness.

Drug-coated balloons (DCBs) have emerged as a compelling alternative to drug-eluting stents in the treatment of coronary artery disease (CAD), offering the advantage of local drug delivery without permanent vascular scaffold implantation. Initially developed for managing in-stent restenosis, DCBs seem appealing for broader indications, particularly in small vessel disease and bifurcation lesions. While paclitaxel-based DCBs remain the most investigated, newer limus formulations are showing promise and appear to be a valid alternative in early trials. Evidence from recent randomized clinical trials (RCTs) and meta-analyses highlights DCBs as a safe and effective option in selected patients, with potential benefits including lower restenosis rates, reduced need for dual antiplatelet therapy, and avoidance of late stent-related complications. As new large-scale trials near completion, DCBs are poised to take on a broader role in the treatment of CAD, particularly in patients where “leaving nothing behind” offers a clinical advantage. This review offers an overview of the DCB platforms commercially available, showing pharmacological differences, providing current indications in practical guidelines, and analyzing the most recent and impactful RCTs and meta-analyses in the field.

(1) Background: Maternal venous hemodynamic dysfunction is an intrinsic part of the pathophysiology of pre-eclampsia and fetal growth restriction. The aim of this study is to evaluate whether venous hemodynamic dysfunction is present in women with a history of (unexplained) recurrent miscarriage, and to link this pilot observation to reported data in the literature. (2) Methods: A retrospective search of hospital records was conducted to find data on recurrent miscarriage and hemodynamics assessment prior to conception. We also performed a scoping search of the literature regarding the association between recurrent miscarriage and maternal hemodynamics, reproductive outcomes, maternal complications, neonatal complications, and long-term cardiovascular function in women and their offspring. (3) Results: Six out of nine women with a history of recurrent miscarriage had preconception venous hemodynamic dysfunction. This observation is in line with the reported data on reduced venous reserves in association with low plasma volume in women with recurrent miscarriage, and adds to the reported link between recurrent miscarriage, poor reproductive outcomes, and chronic cardiovascular disease. (4) Discussion: This retrospective observational cohort supports an association between venous hemodynamic dysfunction and recurrent miscarriage that is corroborated by data reported in the literature. Abnormal venous hemodynamic function can be improved before conception, and this opens a new and currently unexplored pathway in the management of recurrent miscarriage.

Myocardial fibrosis (MF) is the excessive deposition of extracellular matrix (ECM) from myofibroblasts and is crucial in patients with heart failure (HF). Much work is still needed to fully understand its features and clinical role. This review aims to summarize the state-of-the-art of MF knowledge, focusing on assessment, quantification, predictive value, and future therapies. We performed a literature search about MF studies published between 2014 and 2024, including clinical studies on MF assessment or quantification, the role of MF as a prognostic factor in patients with HF, basic science studies on fibrosis assessment, and the role of the main mechanisms involved in MF. We identified 5161 potentially relevant articles. After excluding non-appropriate ones, we had 186 potentially suitable studies. After full reading and a review of references, 40 articles were included in our review: 8 were about MF assessment, 5 about quantification, and 27 about fibrosis as a prognostic factor. MF is a crucial process in patients with cardiac diseases and leads to HF and arrhythmias. Assessment and quantification have taken great steps forward, but more research is needed to strengthen MF’s role as a prognostic factor in the future. Basic science will play a key role in anti-fibrosis treatment.

Background: Aortic valve stenosis remains the most prevalent valvular pathology in Western countries. Rapid deployment bioprosthesis (RD) has emerged as a promising alternative to conventional valves for surgical aortic valve replacement (SAVR), particularly in elderly and high-risk patients. This study reports the short- and long-term outcomes of RD in patients with isolated aortic stenosis. Methods: A retrospective single-center analysis was conducted on 382 patients who underwent RD-AVR between 2014 and 2020. Data were collected from clinical files and national electronic databases. Primary outcomes included cardiopulmonary bypass (CPB) and cross-clamping (XC) times, postoperative complications, and long-term survival. Results: The mean age was 75.6 ± 5.9 years, with 29.8% of patients over 80 years old and a mean EuroSCORE II of 2.3 ± 1.5%. CPB and XC times were 36.7 ± 10.8 and 27.4 ± 8.1 min, respectively. Postoperative complications included acute kidney injury (AKI, 53.4%), de novo atrial fibrillation (31.9%), and high-grade/complete atrioventricular block with permanent pacemaker implantation (9.8%). In-hospital and 30-day mortality was 1.02% and 2.3%, respectively. The 5-year survival rate was 77%. At 6 months postoperatively, the mean transvalvular gradient was 11.1 ± 4.7 mmHg. At a median follow-up of 6.7 years, no cases of structural valve deterioration and only one case of endocarditis were reported. Conclusion: In this single-center study, RD in isolated AVR demonstrated favorable short- and long-term outcomes, including no structural valve deterioration at mid-term follow-up. These devices offer a safe and effective alternative to conventional SAVR, particularly in high-risk populations.

Cardiac amyloidosis (CA), an infiltrative restrictive cardiomyopathy, is a frequently underrecognized etiology of diastolic heart failure (HF). This study aimed to evaluate inpatient outcomes among patients hospitalized with decompensated diastolic HF with and without a secondary diagnosis of amyloidosis, utilizing data from the National Inpatient Sample (2018–2021). Among 2,444,699 patients hospitalized for decompensated diastolic HF, 9205 (0.3%) had a documented secondary diagnosis of amyloidosis. After 1:1 propensity-score matching, 1841 patients in each group were analyzed. Multivariate logistic regression revealed that the presence of amyloidosis was associated with significantly higher odds of in-hospital mortality (4.0% vs. 2.7%), cardiogenic shock (5.4% vs. 2.4%), acute kidney injury (28.3% vs. 22.0%), ventricular tachycardia (12.4% vs. 6.0%), and acute myocardial injury (9.5% vs. 6.0%) (all p < 0.05). Additionally, patients with amyloidosis had a longer mean length of stay (7.1 vs. 5.7 days) and higher mean hospitalization costs ($85,594 vs.$48,484, p < 0.05). Although the overall incidence of acute myocardial injury was elevated, subgroup analysis of ST-elevation and non–ST-elevation myocardial infarction revealed no significant differences. These findings underscore the considerable clinical and economic burden of amyloidosis in patients hospitalized with decompensated diastolic heart failure.

The dissection of the V4 vertebral artery (VA) is the most prevalent form of intracranial dissection, which can manifest either as ischemia or as a subarachnoid hemorrhage (SAH). Patient outcomes are significantly affected by their initial presentation; ischemic symptoms often indicate that the dissection remains primarily subintimal or within the medial layer, though it can occasionally extend to the basilar artery. In contrast, patients with ruptured VA dissection (VAD) experience a considerably higher mortality rate, as the dissection can reach the adventitial layer, heightening the risk of recurrent hemorrhage. It can show fluctuating imaging findings, making an accurate diagnosis and timely treatment essential. Currently, there are no established diagnostic criteria for VAD, and its diagnosis largely depends on imaging. The presence of intramural hematoma, identified via three-dimensional, black-blood, T1-weighted imaging, has been recognized as the most reliable indicator for diagnosing VAD and is crucial for establishing a definitive diagnosis. DSA remains a fundamental diagnostic technique not only in hemorrhagic patients but also in ischemic patients. The medical treatment of ischemic patients has not yet been well defined, and evidence-based data are lacking. This review aims to summarize the main clinical, pathophysiological, and neuroradiological features of intracranial VAD presenting with ischemic stroke, providing to clinicians the available information in order to individualize the treatment.

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, caused by either sarcomere protein or other gene mutations. It is a complex and highly heterogeneous disorder, with phenotypes ranging from asymptomatic to severe disease, characterized by asymmetric left ventricular (LV) hypertrophy unexplained by loading conditions, which is also associated with myocardial fiber disarray, and preserved or increased ejection fraction without LV dilation. Comprehensive personal and family history, physical examination, and ECG testing raise suspicion of HCM, and echocardiogram represents the first-line imaging modality for confirming a diagnosis. Moreover, contrast-enhanced cardiac magnetic resonance (CMR) imaging has increasingly emerged as a fundamental diagnostic and prognostic tool in HCM management. This article reviews the role of CMR in HCM identification and differentiation from phenotypic mimics, characterization of HCM phenotypes, monitoring of disease progression, evaluation of pre- and post-septal reduction treatments, and selection of candidates for implantable cardioverter-defibrillator. By providing information on cardiac morphology and function and tissue characterization, CMR is particularly helpful in the quantification of myocardial wall thickness, the detection of hypertrophy in areas blind to echocardiogram, subtle morphologic features in the absence of LV hypertrophy, myocardial fibrosis, and apical aneurysm, the evaluation of LV outflow tract obstruction, and the assessment of LV function in end-stage dilated HCM.

Acute coronary syndrome (ACS) refers to a spectrum of conditions characterized by a sudden decrease in blood flow to the heart. This includes unstable angina, the mildest form, as well as non-ST- and ST-segment elevation myocardial infarction. The primary cause of ACS is typically the rupture or erosion of an atherosclerotic plaque in a coronary artery, resulting in the formation of a blood clot that can, partially or completely, block the blood flow to the heart muscle. The ongoing discovery and comprehension of emerging biomarkers for atherosclerosis could enhance our capacity to predict future events, particularly when integrated alongside traditional risk factors in assessing overall risk profiles. With advancements in proteomic technologies, large-scale approaches have been increasingly instrumental in unraveling pathways implicated in atherosclerotic degeneration and identifying novel circulating markers, which may serve as early diagnostic indicators or targets for innovative therapies. Over recent decades, numerous matrices including plasma, urine, microparticles, lipoproteins, atherosclerotic plaque extracts and secretomes, as well as thrombi, have been examined to address these questions. Furthermore, proteomics has been applied to various experimental models of atherosclerosis to deepen our understanding of the mechanisms underlying atherogenesis. This review offers a critical overview of the past two decades of untargeted omics research focused on identifying circulating and tissue biomarkers relevant to ACS.

Aortic valve disease accounts for approximately 5% of all congenital heart defects in children. Choosing the optimal valve replacement in this population is challenging, as it must ensure durability, accommodate growth, and minimize the need for long-term anticoagulation. Biological valves do not require anticoagulation but lack durability and growth potential, leading to frequent reoperations. Mechanical valves offer longevity but necessitate lifelong anticoagulation and do not grow with the child. Among the available surgical options, the Ross procedure has emerged as a preferred approach due to its favorable hemodynamic performance, growth potential, and freedom from anticoagulation. First described in 1967, this technique involves replacing the diseased aortic valve with a pulmonary autograft and reconstructing the right ventricular outflow tract using a human or non-human valve substitute. Despite its advantages, the procedure is technically demanding, has a considerable learning curve, and transforms a single-valve pathology into a bivalvular condition. This narrative review provides an updated perspective on the Ross procedure in children, focusing on long-term survival, reoperation rates, and the role of percutaneous valve replacement in delaying surgical reintervention. By synthesizing the latest evidence, we aim to clarify the current standing of the Ross procedure as a durable and effective solution for pediatric aortic valve disease.

Background: Heart failure (HF) is a leading cause of hospital admissions and in-hospital mortality among the elderly. This study aims to characterize HF patients admitted to Virgen de la Victoria University Hospital (HUVV), identify factors associated with in-hospital mortality and analyze the impact of added morbidity on healthcare costs. Methods: A cross-sectional study was conducted using data from the Minimum Basic Data Set (MBDS) at HUVV. We included all discharges with a primary diagnosis of HF in 2021. Logistic regression analysis was employed to identify factors associated with mortality, and cost analysis was performed to assess the economic impact of added morbidity. Results: A total of 731 hospital discharges for HF were analyzed, with a mortality rate of 14.77%. Mortality was significantly associated with age ≥ 75 years (OR = 4.12; p < 0.001), high or extreme severity (OR = 2.26 and 8.10, respectively; p < 0.001), and more than 10 diagnoses at discharge (OR = 2.95; p < 0.01). Treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) was associated with a reduced risk of death (OR = 0.29; p < 0.001). Hospital-acquired morbidity occurred in 27.22% of patients, resulting in an additional cost of EUR 152,780.61, representing a 3.8% increase over the total hospitalization costs. Conclusions: In-hospital mortality in HF patients at HUVV is strongly associated with advanced age, disease severity, and multiple comorbidities. Treatment with ACEIs or ARBs was associated with a lower likelihood of in-hospital mortality. Preventable added morbidity was associated with increased healthcare costs, highlighting the importance of infection control measures and multidisciplinary management to potentially improve outcomes and reduce costs.

(1) Background: Antiphospholipid syndrome (APS) is associated with thrombotic events and the laboratory identification of antiphospholipid antibodies (aPL), in which lupus anticoagulant (LA), anticardiolipin (aCL), and anti-β2 glycoprotein I antibodies are included. The aim of the current retrospective study is to examine clinical characteristics and risk factors of ischemic stroke as a clinical manifestation of APS. (2) Methods: Adult patients diagnosed with APS between 1 January 2009 and 1 June 2024 were retrospectively enrolled in this study. Sydney-revised Sapporo criteria were used for the diagnosis of APS, while ischemic stroke was diagnosed based on the acute onset of focal neurologic deficits and confirmed with radiological findings. (3) Results: We studied 115 patients with APS. Specifically, 28 (24.35%) patients, with a mean age (standard deviation) of 54 (±12.5), had ischemic stroke as a clinical manifestation of APS. In univariate analysis, stroke development was associated with the following factors: age (p < 0.001), livedo reticularis (p = 0.046), avascular necrosis (AVN) (p = 0.046), hypertension (p < 0.001), dyslipidemia (p = 0.013), aCL IgG (U/L) antibodies title (p = 0.035), and adjusted global APS score (aGAPSS) (p = 0.047), while in multivariate analysis, it was associated with age (p = 0.006), hypertension (p < 0.001), AVN (p = 0.006), livedo reticularis (p = 0.035), aCL IgG title (p = 0.004), and aGAPSS (p = 0.002). (4) Conclusions: Stroke is a common initial manifestation of APS, with cardiovascular risk factors, particularly hypertension, being highly prevalent.

Background: The outcome of patients undergoing transcatheter aortic valve replacement (TAVR) can be affected by coexisting tricuspid regurgitation (TR). The aim of the study is to investigate the clinical results of patients undergoing TAVR with or without concomitant significant TR. Methods: Patients undergoing TAVR were divided into two groups according to TR severity: none/mild TR (low-grade) and moderate/severe TR (significant). Data were analysed and compared. Primary endpoint was the mortality 1-year. Secondary endpoints were re-hospitalization and the degree of postoperative and 1-year TR. Results: TAVR procedures were performed in 345 patients between September 2011 and February 2020. Median STS score was 4.3% (IQR: 2.6–7.2), median LVEF was 59.0% (IQR: 45.0–62.0), median aortic area was 0.70cm2 (IQR: 0.60–0.86), median mean gradient was 43.0mmHg (IQR: 36.0–53.0). Before TAVR, 297 patients (86.1%) had low-grade TR and 48 (13.9%) significant TR. Mean age was 82.4 ± 5.7 and 83.8 ± 6.2 years in low-grade and significant TR group, respectively (p = 0.109), with 47.5% (low-grade TR) and 56.3% (significant TR) of female patients (p = 0.279). Patients showed differences in EuroSCORE-II (3.2% (IQR: 1.9–5.7) in low-grade TR vs. 5.6% (IQR: 3.7–8.1) in significant TR; p < 0.001), impaired right ventricular function (3.0% vs. 20.8%; p < 0.001) and pulmonary hypertension (9.1% vs. 39.6%; p < 0.001). Mean valve size was 27.7 ± 2.9mm. Hospital mortality was 2.0% in low-grade TR and 4.2% in significantTR patients (p = 0.308). Among discharged patients (n = 337), seven patients died within 30 days (2.0% low-grade TR; 2.1% significant TR; logrank test p = 0.154) and 40 were re-hospitalized for heart failure (11.1% low-grade TR; 14.6% significant TR; p = 0.470). After one year, 26 patients died, corresponding to a mortality of 7.9 deaths per 100-person year (95% CI 5.2–12.0) in low-grade TR group and 9.1 deaths per 100-person year (95% CI 3.4–24.3) in significant TR group (logrank test p = 0.815), with HR (low grade vs. significant TR) of 0.87, 95% CI 0.26–2.89. Re-hospitalization for heart failure was 16.5% and 19.6% for low-grade and significant TR, respectively (p = 0.713). Echocardiographic and functional changes over time showed no significant interaction between TR and time. Conclusions: In our experience, patients undergoing TAVR showed similar 30-day and 1-year outcome and re-hospitalization rate, regardless of the degree of concomitant tricuspid regurgitation.

Background: Premature ventricular complexes (PVCs) are common arrhythmias that can range from benign to clinically significant. While PVCs have been extensively studied in the general population, gender-specific differences in their characteristics, prevalence, and clinical impact remain underexplored. This study aims to investigate the unique features of PVCs in women and their potential implications for diagnosis and management. Methods: We analyzed a cohort of female patients diagnosed with PVCs, assessing their electrocardiographic patterns, symptomatology, and clinical outcomes. Data were collected from medical records, including Holter monitoring, electrocardiograms (ECGs), and echocardiographic findings. The study also evaluated the association between PVC burden and underlying cardiac conditions. Results: This study analyzed 161 patients (59 females, 91 males) with PVCs, revealing significant sex-based differences. Males were older, had higher BMI, and smoked more, while females experienced more presyncope. ECGs showed greater QRS fragmentation in males. TTE and CMR found males had larger ventricles, lower EF, and more myocardial fibrosis (LGE: 59.34% vs. 37.93%). Patients with LGE were older and had worse clinical outcomes, including higher ICD implantation and hospitalization rates. Despite these structural differences, treatment efficacy was similar across groups. Conclusion: This study highlights key differences in PVC characteristics among women, underscoring the need for gender-specific approaches in clinical evaluation and management. Recognizing these distinctions may aid in early diagnosis, reduce unnecessary interventions, and improve patient outcomes. Further research is warranted to explore the long-term implications of PVCs in women and optimize therapeutic strategies.

(1) Aims: In our study, we evaluated the effectiveness of a telemonitoring program based on a nursing clinic, supported by a physician who remotely monitors patients via a dedicated application (TreC Cardiology), in reducing visits and hospitalizations for HF in patients affected by HF living in Trentino in Italy. (2) Methods and Results: The TreC Heart Failure (TreC HF) study prospectively enrolled consecutive patients diagnosed with HF who attended our outpatient clinic and who were provided with the TreC Cardiology application. We analyzed primarily the number of visits and hospitalizations, comparing the year before and after the enrollment. From March 2021 to June 2023, we enrolled 211 patients, predominantly male (70.1%) and with a mean age of 71.5 ± 12.6 years. At baseline, 43.6% of patients were diagnosed with HFrEF, 28% with HFmrEF, and 28.4% with HFpEF. The mean left-ventricular ejection fraction (LV-EF) was 43.2 ± 11.9%. Outpatient visits in the year before the enrollment were on average 2.0 ± 1.2 vs. 1.6 ± 1.3 (p = 0.002) in the same following period. The percentage of patients who were hospitalized for heart failure went from 25.6% to 4.7% (p < 0.001). Analyzing HF categories separately, we found that, in the HFrEF population, after the enrollment, hospitalization for HF significantly decreased (32.6% vs. 7.6%, p < 0.001), while the number of outpatient visits did not vary (2.1 ± 1.4 vs. 2.1 ± 1.3, p = 0.795). In HFmrEF patients, both hospitalization for HF and outpatient visits significantly decreased (respectively, 30.5% vs. 1.7%, p < 0.001 and 2.0 ± 1.0 vs. 1.5 ± 1.3, p = 0.025). Finally, in the HFpEF population, only the number of outpatient visits significantly decreased after the enrollment (2.0 ± 1.1 vs. 1.0 ± 0.8, p < 0.001). (3) Conclusions: Our results confirm the enormous potential of telemonitoring, since in a real-world population affected by heart failure, it resulted in a significant reduction in hospitalization for HF and the number of outpatient visits.

Aim: Insulin resistance (IR) and hyperglycemia have been associated with increased risk of heart failure (HF) in patients with and without diabetes. Global longitudinel strain (GLS) has been shown to be superior in the detection of left ventricular (LV) systolic dysfunction when compared to ejection fraction (EF). In this study, we aimed to assess GLS in relation to IR and pre-diabetes. Method: All participants underwent an echocardiography to assess LV systolic function using GLS. IR was evaluated using homeostatic model assessment for IR (HOMA-IR), and the participants were divided into tertiles based on their HOMA-IR values. An oral glucose tolerance test (OGTT) was performed to divide participants into normal glucose tolerance (NGT) and pre-diabetes. A multivariable linear regression model was used to assess GLS in relation to IR and glycemic groups. Results: In total, 359 men without significant coronary artery disease (CAD) and without diabetes were enrolled. Participants in the higher HOMA-IR tertile had significantly reduced GLS when compared with participants in the lower HOMA-IR tertile (−17.9% vs. −18.7%, p < 0.01). A significant trend was observed towards reduced GLS with increasing HOMA-IR tertile (p-trend 0.005). However, in the multivariable regression model, only waist-to-height-ratio (WH) (β 7.1 [95% CI 3.1–11.1, p = 0.001) remained significantly associated with GLS, whereas HOMA-IR tertile and pre-diabetes were not. Conclusions: In asymptomatic elderly men with no diabetes or CAD, neither IR nor pre-diabetes was associated with GLS in the adjusted regression model. Increased WH seems to be associated with reduced systolic function by GLS measurement.

High bleeding risk (HBR) is a challenge in patients with complex coronary lesions undergoing percutaneous coronary intervention (PCI). This study investigates HBR in a wide and comprehensive cohort of patients undergoing left main (LM) PCI and reports in-hospital and follow-up outcomes. The analysis was performed on data from the DELTA (Drug Eluting Stent for Left Main Coronary Artery) 2 Registry, which included patients who underwent LM PCI at 19 centres worldwide. The patients were defined to be at HBR if ≥1 major criterion or ≥2 minor criteria from the Academic Research Consortium (ARC) were met. The primary endpoint was a composite of all-cause death, myocardial infarction (MI) or cerebrovascular accident (CVA) at median follow-up. A total of 1531 patients were included, and the rate of HBR was 65.8%. Besides the different clinical characteristics embedded in the ARC definition, HBR patients had higher prevalence of acute coronary syndrome (ACS) at presentation (49.2% vs. 26.8%, p < 0.001) and experienced higher in-hospital mortality (1.8% vs. 0.2%; p = 0.029) and MI (5.0% vs. 2.1%, p = 0.009). The median follow-up was 473 days. The rate of the primary endpoint was more than three times higher in HBR patients (20.8% vs. 6.1%; HR 3.3; 95%CI: 2.2–4.8) and driven by all-cause death at multivariate regression analysis. Conversely, no significant difference in target lesion revascularization and probable or defined stent thrombosis was reported. HBR patients undergoing LM PCI experienced higher rates of all-cause death at follow-up; similar outcomes were also reported in-hospital.

Background: Advances in medical care of patients with tetralogy of Fallot (ToF) have significantly altered the natural course of the disease by prolonging life. Thus, our focus has now shifted to exploring the health-related quality of life (HRQoL) of those patients. This study sought to explore the HRQoL of adult patients operated on for ToF using two validated instruments—the SF-36 and EQ-5D—that highlight both physical and mental aspects of the disease. Methods: A total of 115 individuals (53 ToF patients and 60 healthy controls) were recruited for the purposes of this study. HRQoL was assessed through the SF-36 and EQ-5D instruments. Comparisons were made between ToF patients and controls with subgroup analyses based on sex and age. Results: ToF patients reported significantly poorer HRQoL in the physical domains, namely Physical Functioning, Role Physical, General Health, and Physical Component Summary of the SF-36 when compared to controls (p < 0.05). Interestingly, there was a trend towards lower Bodily Pain and better Vitality scores in ToF subjects. Age influenced HRQoL, with older respondents rating their physical health lower than younger patients and controls (p < 0.05). EQ-5D VAS scores indicated that ToF patients perceived their overall health worse than controls (80.02 vs. 86.92, p < 0.001), with Anxiety/Depression being the most frequently reported problem (45.3%). Controls reported better HRQoL than ToF patients across all SF-36 domains in both health states (EQ-5D = 1 and EQ-5D > 1), except for Bodily Pain and Vitality in EQ-5D = 1. Significant differences were observed in Physical Functioning, Role Physical, General Health, Vitality, and Physical Component Score. Notably, ToF patients with EQ-5D = 1 showed unexpectedly higher Vitality scores than controls; however, this advantage diminished significantly in the EQ-5D > 1 group. Conclusions: Adult ToF survivors experience significant physical limitations as expected, while mental health seems to remain relatively unaffected compared to healthy peers. These findings underscore the importance of HRQoL assessment in patients with congenital heart disease and the need for disease-specific HRQoL instruments.

Vectorcardiography (VCG) is an electrophysiological investigation technique, giving supplementary information about the electrical activation of the heart, compared to traditional 12-lead electrocardiography (ECG). Whereas the 12-lead ECG has found its way into global clinical cardiology practice in numerous cardiac pathophysiological instances, VCG has not. In an investigation of the electrical activation of the heart in cardiac resynchronization therapy (CRT), in order to understand the baseline pathology in potentially eligible patients, and to understand and optimize CRT-derived paced activation of the heart in the therapy’s recipients, all of these aspects are essential to the success of the therapy. Due to a consistently present group of non-responders in CRT, VCG has gained interest as a potential improvement in this field. This review comprehensively summarizes the contemporary evidence for the additional value of VCG in CRT, as well as current deficiencies in evidence, to support its implementation in global practice in addition to, or as a substitution for, traditional 12-lead ECG.

Drug-coated balloons (DCBs) have emerged as a promising alternative therapeutic strategy to traditional drug-eluting stent (DES) implantation in various coronary artery lesion scenarios, aiming to minimize complications associated with permanent metallic scaffolds, such as chronic inflammation, delayed vessel healing, and stent thrombosis. This review systematically evaluates the current clinical evidence supporting the use of DCBs across diverse anatomical and clinical contexts, including small-vessel disease, in-stent restenosis, bifurcation lesions, diffuse coronary lesions, acute coronary syndromes, and chronic total occlusions, as well as in special patient populations such as individuals with diabetes mellitus or at high bleeding risk. The literature analysis incorporated recent randomized controlled trials, observational studies, and real-world registries, highlighting the clinical efficacy, safety profiles, and specific advantages of DCB angioplasty. The findings consistently demonstrated non-inferior clinical outcomes of DCBs compared to DESs across multiple lesion types, with particular benefits observed in special populations, including reduced restenosis rates and comparable major adverse cardiac events (MACEs). Nevertheless, clinical data gaps remain, emphasizing the need for larger, longer-term randomized trials to refine patient selection and procedural techniques. In conclusion, DCB angioplasty represents a viable and effective alternative to conventional stenting, particularly advantageous in complex lesions and specific patient subsets, pending further definitive evidence.

Recent evidence suggests that sex-related differences in cardiovascular health extend beyond traditional risk factors, affecting vascular structure and function. This study aimed to examine sex differences in vascular parameters, including central and peripheral blood pressure, pulse wave velocity (PWv), augmentation index at 75 bpm (AIx75), cardiac output, stroke volume, and peripheral vascular resistance, using harmonized data from three population-based cohorts (EVasCu, VascuNET, and ExIC-FEp) as part of the MUJER-EVA project. A total of 669 adult participants were included in this pooled cross-sectional analysis. Sex-stratified comparisons were conducted using multiple linear regression models adjusted for anthropometric, sociodemographic, and clinical covariates. The results showed that men had significantly higher values for central and peripheral blood pressure (p < 0.001), PWv (p = 0.003), cardiac output (p < 0.001), and stroke volume (p < 0.001), whereas women presented higher values of AIx75 (p < 0.001) and peripheral vascular resistance (p = 0.002). These differences remained statistically significant after full adjustment for potential confounders. These findings highlight the need to consider sex as a key biological variable in cardiovascular research and clinical decision-making. Incorporating sex-specific reference values and personalized treatment strategies could improve vascular health assessment and the effectiveness of cardiovascular disease prevention.

Accurate prognostic stratification in patients with chronic heart failure and reduced ejection fraction (HFrEF) remains a significant clinical challenge. Many different parameters, including left ventricular (LV) and right ventricular (RV) function and cardiopulmonary exercise testing (CPET) parameters, are available in the literature. LV ejection fraction (LVEF) is the most used parameter in clinical practice. This study aimed to analyze CPET and echocardiographic data in patients under evaluation for heart transplantation (HTx) to identify the parameter that best correlates with cardiac events. Methods and Results. Echocardiography and CPET were performed in patients with HFrEF under evaluation for HTx. The population comprised 170 patients (mean age: 55 ± 9 years; 88% male; non-ischemic etiology: 63%). LVEF was 30.4 ± 7.6%, peak oxygen uptake (Vo2peak) was 17.08 ± 4.6 mL/Kg/min; minute ventilation (VE)/carbon dioxide production (Vco2) slope was 34.8 ± 8.7. During a follow-up of 4 ± 1 years, 37 hospitalizations, 4 deaths, 14 HTx, and 5 LV assist device implantation occurred. Patients who experienced major events had a lower Vo2peak (p < 0.005), higher VE/Vco2 slope (p < 0.005), greater LV end-systolic diameter (p < 0.005), and RV end-diastolic diameter (p < 0.005) than patients without events. Conversely, LVEF did not differ between these two groups. VE/Vco2 slope and RV dimensions significantly correlated with hard cardiac events (p = 0.019 and p = 0.008, respectively). Conclusions. In patients with HFrEF, parameters quantifying the system reserve (i.e., Vo2peak and VE/Vco2 slope) and those demonstrating advanced biventricular remodeling may help stratify the risk of cardiac events. Conversely, LVEF showed a limited prognostic value in this setting.