https://www.explorationpub.com/Journals/ec Most Recent Articles : Exploration of Cardiology. en-us Sun, 10 May 2026 16:05:01 GMT https://www.explorationpub.com/Journals/ec/Article/101274 Tricuspid valve disorders (TVDs) have historically been underrecognized by clinicians. However, recent years have seen increasing awareness of their clinical impact. This mini-review aims to briefly highlight some questions regarding TVDs, such as Review of tricuspid valve disorders, Decoding its trends, The gender and racial divide, Breaking barriers, Where you live matters, Surgery vs. minimally invasive options, Bridging the gap, and the underappreciated significance of TVDs and why they’re becoming a growing concern in the U.S. There is a significant change in perception of the tricuspid valve—from being the “forgotten valve” to being an important area of focus in cardiology as well as clinical medicine in general. With the aid of advanced imaging methods like echocardiography, CT, and MRI that show a clear and three-dimensional view of the tricuspid valve, there is a better understanding of both the prevalence and diagnostic precision of TVDs. Advancements involving more efficient and optimally timed treatment strategies are also occurring. Although medical and surgical approaches are still in use, developments such as transcatheter tricuspid valve interventions (TTVIs) are promising, particularly for high-risk patients with minimal improvement with surgical treatment. TVDs, especially tricuspid regurgitation, have gained widespread attention in the medical and research community, resulting in improved and evolving diagnostic and therapeutic progress to improve patient outcomes. Mini Review Mon, 29 Sep 2025 00:00:00 GMT Biruk DemisseAyalew, FareedaBrohi, Hailemariam ShimelisGebeyehu, Henok WoldeNida, Hanna TsehayAbebe, WaleedTariq, Yeamlak TarikuTewodros, AsadKhan, Muhammad UmarAhsan, Eden HaileHagos, IftikharKhan, MuhammadUmar, Mon, 29 Sep 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101274 https://www.explorationpub.com/Journals/ec/Article/10121 Not applicable. Editorial Thu, 30 Mar 2023 00:00:00 GMT EugenioPicano, Thu, 30 Mar 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10121 https://www.explorationpub.com/Journals/ec/Article/101218 Aim: Left atrial volume index (LAVI), left atrial reservoir function through left atrial reservoir strain (LASr), and B-lines in lung ultrasound serve as supplementary indicators of left ventricular filling pressures. This study analyzes the interrelation between LAVI, LASr, and B-lines in both resting and peak vasodilator stress. Methods: Dipyridamole stress echocardiography (SE) was conducted on 252 individuals (180 males, 71%, age 65 years ± 10 years) with chronic coronary syndromes. LAVI was quantified using the biplane disk summation method; LASr was obtained using 2-dimensional speckle tracking echocardiography; B-lines were evaluated through a simplified 4-site scan in the third intercostal space during lung ultrasound. Results: During SE, a reduction in LAVI (26 ml/m2 ± 14 ml/m2 vs. 24 ml/m2 ± 12 ml/m2, P < 0.001) and an increase in LASr from rest (33% ± 8% vs. 38% ± 10%, P < 0.001) were respectively observed from rest to stress. B-lines were increased significantly during SE, from 19 (7.5%) to 29 (11.5%), P < 0.001. A substantial, inverse linear correlation was identified between LAVI and LASr both at rest (r = –0.301, P < 0.001) and peak stress (r = –0.279, P < 0.001). At group analysis, peak B-lines showed a direct correlation with peak LAVI (r = 0.151, P = 0.017) and an inverse correlation with peak LASr (r = –0.234, P < 0.001). In individual assessments, 9.7% (20/207) of patients displayed stress B-lines with normal LAVI and preserved LASr, while 20% (9/45) exhibited stress B-lines with abnormalities in both LAVI and LASr. Conclusions: Vasodilator SE with combined left atrial and volume assessment, related to pulmonary congestion, is feasible with a high success rate. Pulmonary congestion is more frequent with dilated left atrium with reduced atrial contractile reserve (ClinicalTrials.gov identifier: NCT030.49995; NCT050.81115). Original Article Mon, 26 Feb 2024 00:00:00 GMT CostantinaProta, LauroCortigiani, EttoreCampagnano, KarinaWierzbowska-Drabik, JaroslawKasprzak, PaoloColonna, ElisaMerli, FioreManganelli, NicolaGaibazzi, AntonelloD’Andrea, EmmaCerracchio, LauraMeola, RodolfoCitro, BrunoVillari, QuirinoCiampi, Mon, 26 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101218 https://www.explorationpub.com/Journals/ec/Article/10122 Aim: Left ventricular (LV) hypertrophy (LVH) is a common and relevant complication of arterial hypertension (AH) and 12-lead electrocardiogram (ECG) is widely used for its preliminary assessment. The aim of the study was to compare the correlations of four ECG-derived criteria of LVH and left atrial (LA) anteroposterior diameter with LVH assessed by echocardiography and expressed as left ventricular mass (LVM) index (LVMI) in search of the most accurate preliminary indicator of LVH. Methods: The study included 61 subjects with AH [age (year) 69 ± 10, 17 females] and 27 without AH, (age 40 ± 9, 10 females) evaluated with 12-lead ECG and transthoracic echocardiography (TTE). As the ECG-based criteria of LVH Sokolow-Lyon index (SLI), Cornell voltage (CV), Cornell product (CP), and Romhilt-Estes point score (RES) system were evaluated. The ECG indices and LA diameter were correlated with LVMI and correlations coefficients were compared. Results: Among ECG-LVH indicators SLI showed the closest correlation with LVMI [rank correlation coefficients (rho) = 0.38, P < 0.0001], followed by CV and CP with rho = 0.33, P = 0.002 and rho = 0.32, P = 0.002, respectively, whereas RES did not correlate significantly with LVMI. The strongest correlation with LVMI was found for the LA diameter with rho = 0.73 and P < 0.0001, showing an even stronger correlation in women—rho = 0.8 (P < 0.0001) vs. rho = 0.65 (P < 0.0001) in men. In the multivariate analysis, the LA was the only independent predictor of the increased LVMI with R2 = 0.52, P < 0.0001. Conclusions: LA diameter outperformed significantly the ECG indices as far as the correlation with LVMI was concerned and emerged as the only independent predictor of mild and moderate LVH in hypertensive patients. Among the ECG criteria, the strongest correlation was shown for SLI, followed by CV and CP indices. Original Article Fri, 14 Jul 2023 00:00:00 GMT BogusławaNowak, RafałNowakowski, AleksandraGapys, TomaszRechciński, EwaTrzos, MałgorzataKurpesa, PiotrLipiec, Jarosław D.Kasprzak, KarinaWierzbowska-Drabik, Fri, 14 Jul 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10122 https://www.explorationpub.com/Journals/ec/Article/10123 The deleterious consequences of alcohol consumption are extensively documented across various dimensions of human health, encompassing somatic disorders such as nervous system impairments, digestive system abnormalities, and circulatory dysfunctions, in addition to socio-psychological aspects. Within the domain of cardiology, a substantial portion of the ongoing scientific discourse centers on elucidating the toxic dose of alcohol. Presented herewith are the findings from a comprehensive review of the latest publications pertinent to this crucial issue. Review Fri, 18 Aug 2023 00:00:00 GMT PiotrHamala, KarinaWierzbowska-Drabik, Fri, 18 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10123 https://www.explorationpub.com/Journals/ec/Article/10124 Aim: The aim of this study was to compare initial and final exercise tolerance and to evaluate the determinants of exercise capacity improvement—after three weeks of inpatient cardiac rehabilitation. Methods: A cohort of 494 patients after acute coronary syndrome (ACS), treated with primary coronary angioplasty (age 60 years ± 10 years, 27.5% women) was studied retrospectively. Possible correlations between improvement and age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF) and the initial exercise capacity (EXT1) were assessed. Results: The highest percentage of patients with improvement (43.6%) was in the medium tercile of LVEF (> 42% but ≤ 50%) and was more likely in the medium tercile of initial exercise tolerance [> 5.7 but ≤ 8.4 metabolic equivalent of tasks (METs)]. Receiver-operator characteristic (ROC) curves were developed and the following cut-off values were found: for LVEF > 43% (this value had 69.6% sensitivity in predicting improvement; the chance of improvement was 2.67 higher than in patients with LVEF ≤ 43%); for EXT1 ≤ 8.4 METs (this value had 70.8% sensitivity, the chance of improvement was 1.86 higher than in the other subgroup). No significant relationship between improvement and gender, age or BMI was found. Conclusions: The combination of LVEF > 43% and EXT1 ≤ 8.4 METs relates to the highest probability of exercise tolerance improvement after cardiac rehabilitation. Original Article Thu, 31 Aug 2023 00:00:00 GMT BarbaraUznańska-Loch, EwaWądołowska, KarinaWierzbowska-Drabik, UrszulaCieślik-Guerra, Jarosław D.Kasprzak, MałgorzataKurpesa, TomaszRechciński, Thu, 31 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10124 https://www.explorationpub.com/Journals/ec/Article/10125 Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommended by nutrition committees. Some regional guidelines still recommend one to two standard drinks per day. By the very recent (January 2023), World Health Organization and Canadian Guidance on alcohol emphasize that any alcoholic drink is hazardous to the health and the safe amount is zero. The risk starts with every single drop. It was also nicely summarized in the manuscript “Alcohol-dose question and the weakest link in a chemical interplay” (Explor Cardiol. 2023;1:15–25. doi: 10.37349/ec.2023.00003) especially from the standpoint of a researcher in the cardiovascular arena. The newest recommendations are based on observational studies and their meta-analysis, therefore establishing associations, pointing out that alcohol may somewhat prevent cardiovascular diseases and diabetes type 2, but with a significant increase in non-cardiovascular morbidity and mortality, especially cancers. Previous recommendations, therefore, may be obsolete as they were based on studies where abstainers from alcoholic beverages had inherent higher risks. The current controversy with conflicting guidelines for alcoholic beverage consumption in the era of precision medicine may stimulate more fundamental investigations up to genetic ones and find the cause-effect relations. In the era of precision medicine, it may come closer to discovering the causes of cancers and many other diseases, enabling predictions of reactions to alcoholic beverages by each person, not just in the population. Perspective Thu, 31 Aug 2023 00:00:00 GMT MiodragOstojic, VladoDjajic, TamaraKovacevic-Preradovic, DuskoVulic, Thu, 31 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10125 https://www.explorationpub.com/Journals/ec/Article/10126 Aim: Coronary flow velocity (CFV) can be obtained with transthoracic echocardiography (TTE) in the left anterior descending coronary artery (LAD). The physiologic flow velocity gradient across the different segments of LAD has not been established. This study aims to assess the normal values of resting CFV in proximal, mid, and distal LAD. Methods: In a single center, prospective, observational study design, TTE was attempted on 110 consecutive, asymptomatic middle-aged subjects (age = 55 years, 46% males) with a low likelihood of coronary artery disease (< 5%). Resting CFV in the LAD was assessed with high-end machines, dedicated coronary pre-set, and high-frequency transducers by pulsed-wave Doppler under color-Doppler guidance in the proximal, mid, and distal segments. Results: The technical success rate for CFV imaging was lowest for the proximal (101/110, 92%), intermediate for mid (106/110, 96%), and highest for the distal segment (108/110, 98%). All 3 segments were interpretable in 101 subjects. CFV was highest in proximal segments (38.6 cm/s ± 3.9 cm/s), intermediate in mid segments (34.3 cm/s ± 6.04 cm/s, P < 0.01 vs. proximal), and lowest in distal segments (28.1 cm/s ± 1.7 cm/s, P < 0.01 vs. proximal and vs. mid). Conclusions: A resting evaluation of CFV-LAD can be obtained by TTE in the large majority of consecutive subjects referred to the echocardiography laboratory. Feasibility is highest for distal and lowest for proximal-LAD segments. There is a clear physiologic gradient of CFV with decreasing values, of about 10% for each step, going from proximal to mid and distal segments of LAD. When resting CFV is considered, the site of the sampling is important to obtain comparable and physiologically meaningful data. Original Article Thu, 31 Aug 2023 00:00:00 GMT FaustoRigo, VeronicaSpadotto, Roberto SettimoFattore, PietroRenda, ChristianCugini, MaurizioAgnoletto, Thu, 31 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10126 https://www.explorationpub.com/Journals/ec/Article/10127 Aim: Transthoracic echocardiography (TTE) is the first-line imaging test for patients with chronic coronary syndrome (CCS) and the cornerstone of risk stratification is left ventricular (LV) ejection fraction (EF). Aim of the study was to investigate the value of TTE supplemented with strain echocardiography (STE) and lung ultrasound (LUS) to assess the risk of patients with CCS. Methods: In a prospective, single-center, observational study, from November 2020 to December 2022, 529 consecutive patients with CCS were recruited. All patients were evaluated at rest. A single vendor machine (GE Vivid E95) was used. EF with biplane Simpson’s method (abnormal cut-off < 50%), LV global longitudinal strain (GLS%, abnormal cut-off ≤ 16.2% by receiver-operating characteristics analysis) by STE, and B-line score (abnormal cut-off ≥ 2) by LUS (4-site simplified scan) were assessed. Integrated TTE score ranged from 0 (all 3 parameters normal) to 3 (all parameters abnormal). All patients were followed-up and a composite endpoint was considered, including all-cause death, acute coronary syndrome (ACS), and myocardial revascularization. Results: During a follow-up of 14.2 months ± 8.3 months, 72 events occurred: 10 deaths, 11 ACSs, and 51 myocardial revascularizations. In multivariable analysis, B lines [hazard ratio (HR) 1.76, 95% confidence Interval (CI) 1.05–2.97; P = 0.03], and GLS ≤ 16.2% (HR 2.0, 95% CI 1.17–3.45; P = 0.01) were independent predictors of events. EF < 50% was a significant predictor in univariate, but not in multivariable analysis. Event rate at 2 years increased from score 0 (8%), to score 1 (21%), 2 (23%), and 3 (40%), P < 0.0001. Conclusions: TTE with left ventricular ejection fraction (LVEF) can be usefully integrated with STE for GLS, and LUS for B-lines, for better prediction of outcome in CCS. The 3 parameters can be obtained in every echo lab with basic technology, no harm, no risk, and no stress. Original Article Mon, 18 Sep 2023 00:00:00 GMT LauroCortigiani, Maria FrancescaOrsino, MarcoFavilli, FrancescoBovenzi, Mon, 18 Sep 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10127 https://www.explorationpub.com/Journals/ec/Article/10128 The clinical manifestations of COVID-19 which mainly involve the respiratory system may however affect also cardiovascular system. There are a lot and still increasing numbers of reports revealing cardiovascular complications of COVID-19, which may occur in the acute phase as well as during longer follow-up period. The most clinically important diseases include: pulmonary embolism (PE), myocarditis, and acute coronary syndromes (ACS) as well as arrhythmias with the very common atrial fibrillation (AF) and pericarditis. In this review, cardiac imaging options in patients with and after coronavirus infection are presented, showing potential utility for expanding and improving the full and accurate diagnosis of potential complications. Echocardiography, magnetic resonance imaging, and computed tomography (CT) are considered in turn, highlighting their best advantages in patients affected by COVID. Review Mon, 30 Oct 2023 00:00:00 GMT IwonaDuraj, MałgorzataKilarska, AgnieszkaPawlos, KarinaWierzbowska-Drabik, Mon, 30 Oct 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10128 https://www.explorationpub.com/Journals/ec/Article/10129 Mitral valve prolapse (MVP) is a relatively common mitral valvulopathy and the most common cause of isolated primary mitral regurgitation (MR) requiring surgical repair. It affects about 1–3% of the general population. Although MVP is viewed as a benign condition, the association between MVP and sudden cardiac death (SCD) has been proven. Patients with MVP have a three times higher risk of SCD than the general population. The underlying mechanisms and predictors of arrhythmias, which occur in patients with MVP, are still poorly understood. However, some echocardiographic features such as mitral annulus disjunction (MAD), bileaflet MVP (biMVP), and papillary muscle (PM) fibrosis were frequently linked with increased number of arrhythmic events and are referred to as “arrhythmogenic” or “malignant”. Arrhythmogenic MVP (AMVP) has also been associated with other factors such as female sex, polymorphic premature ventricular contraction (PVC), abnormalities of T-waves, and Pickelhaube sign on tissue Doppler tracing of the lateral part of the mitral annulus. Cardiac magnetic resonance (CMR) imaging and speckle tracking echocardiography are new tools showing significant potential for detection of malignant features of AMVP. This paper presents various data coming from electrocardiography (ECG) analysis, echocardiography, and other imaging techniques as well as compilation of the recent studies on the subject of MVP. Review Wed, 01 Nov 2023 00:00:00 GMT MariaMożdżan, MonikaMożdżan, IwonaDuraj, ZofiaMożdżan, MateuszStaciwa, MarlenaBroncel, KarinaWierzbowska-Drabik, Wed, 01 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/10129 https://www.explorationpub.com/Journals/ec/Article/101210 The use of echocardiography, a straightforward and widely available technique, allows for a comprehensive assessment of the patient with hypertrophic cardiomyopathy (HCM) under both resting and stress conditions. The true prevalence of HCM has been redefined over time by this imaging approach, which has also made it feasible to pinpoint parameters that clinicians may use to stratify patients at risk for adverse cardiovascular events. The current and emerging prognostic predictors in HCM, assessed with transthoracic echocardiography at rest and during provocation, are discussed in this review. Review Wed, 01 Nov 2023 00:00:00 GMT AnnamariaDel Franco, Eszter DalmaPálinkás, GiorgiaPanichella, IacopoOlivotto, Wed, 01 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101210 https://www.explorationpub.com/Journals/ec/Article/101211 Aim: Transthoracic echocardiography is commonly used to assess coronary artery dilatation in Kawasaki disease (KD). However, existing criteria often miss early abnormalities. This study examines the utility of a new parameter, coronary external diameter index (CEDi), for early diagnosis and monitoring in KD. Methods: CEDi of left main (LM) and right coronary artery (RCA), calculated as the ratio of coronary artery external diameter (i.e., the distance between the outer coronary edges measured in the proximal segment of the artery) and the diameter of the aortic annulus, was evaluated in 34 patients (age 23 mouths ± 13 months) with KD at the hospital admission and after 2 weeks and 8 weeks of treatment. The control group consisted of 210 healthy children aged 20 months ± 13.4 months. Z-score charts for LM and RCA coronary external diameter (CED) were obtained. Results: Compared with controls, KD patients had a markedly higher mean value of LM CEDi (0.53 ± 0.06 vs. 0.33 ± 0.04; P < 0.0001) and RCA CEDi (0.48 ± 0.05 vs. 0.31 ± 0.04; P < 0.0001) at hospital admission. By ROC analysis, LM CEDi of 0.41, and RCA coronary artery thickness index (CATi) of 0.39 were the best cut-offs to confirm the clinical diagnosis of KD, both exhibiting 100% sensitivity and specificity. Mean LM CEDi and RCA CEDi values decreased significantly (P < 0.0001) after 2 weeks of follow-up and were similar to controls (P = 0.53 and P = 0.12, respectively) 8 weeks after admission. Conclusions: In patients with KD, CEDi of LM and RCA is an accurate parameter to evaluate coronary artery involvement in the early phase of the illness and during follow-up. Original Article Wed, 01 Nov 2023 00:00:00 GMT AndreaAzzarelli, CuonoCucco, LauroCortigiani, MarcoScalese, ValentinaAnnoni, FrancescoBovenzi, RaffaeleDomenici, AngelinaVaccaro, FrancescoVierucci, Wed, 01 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101211 https://www.explorationpub.com/Journals/ec/Article/101212 Congenital heart defects (CHD) represent the most frequent congenital anomalies among newborns, as well as the leading cause of spontaneous abortion, stillbirth, neonatal and infant death. CHD have been recognized as multifactorial diseases, with environmental contaminants as potential contributors to the etiopathogenesis of CHD. Toxic elements, such as arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) are known to be associated with adverse reproductive outcomes and certain congenital anomalies, however their association with the risk for CHD remains inconsistent. This review summarizes the updated evidence on the CHD-associated risk related to exposure to As, Cd, Hg, Pb during pregnancy, reporting the main findings from epidemiological and experimental studies and the underlying molecular mechanisms. Additionally, being diet the major source of these elements in the general population, after having identified the main vectors of toxic metals in food, possible remediation strategies to reduce diet-related risks are also described. Among these, a novel, consumer-centered approach in developing new foods is discussed, considering not only the nutritional characteristics of edible compounds foods are made up of, but also their organoleptic features, making the food even more appealing to the consumer. Overall, current data support the association of maternal exposure to As and Pb with increased risk for CHD, although significant associations have only been observed for total and/or specific subgroups. On the other hand, the evidence of association for Cd and Hg exposure in pregnancy with CHD in the offspring remains, yet, quite speculative. Further large prospective cohort studies and insights into the molecular and biomolecular processes of these relationships are warranted to further explore and/or verify these findings. Review Mon, 13 Nov 2023 00:00:00 GMT FrancescaGorini, AlessandroTonacci, Mon, 13 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101212 https://www.explorationpub.com/Journals/ec/Article/101213 Not applicable. Commentary Mon, 11 Dec 2023 00:00:00 GMT Maria GraziaAndreassi, Mon, 11 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101213 https://www.explorationpub.com/Journals/ec/Article/101214 Atherosclerosis is a chronic disease, characterized by chronic inflammation, endothelial dysfunction, and lipid deposition in the vessel. Although many major, well-identified risk factors for atherosclerosis [e.g., hyperlipidemia, hypertension, type 2 diabetes (T2D), smoking habit, and obesity] explain a lot about the risk, there is a considerable number of patients who develop atherosclerotic damage and undergo adverse events without presenting any of these established modifiable risk factors. This observation has stimulated an urgent need to expand knowledge towards the identification of additional, less established risk factors that may help in the assessment of risk and fill the gap of knowledge in the cardiovascular (CV) setting. Among them, the hypothesis of a possible relationship between viral infectious agents and atherosclerosis has risen since the early 1900s. However, there is still a great deal of debate regarding the onset and progression of CV disease in relation to the roles of the pathogens (as active inducers or bystanders), host genomic counterparts, and environmental triggers, affecting both virus abundance and the composition of viral communities. Accordingly, the aim of this review is to discuss the current state of knowledge on infectious agents in the atherosclerotic process, with particular focus on two environmental-related viruses, as examples of familiar (influenza) and unfamiliar [severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)] disease triggers. Review Wed, 27 Dec 2023 00:00:00 GMT CristinaVassalle, Wed, 27 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101214 https://www.explorationpub.com/Journals/ec/Article/101215 Lipoprotein(a) [Lp(a)] is composed of a low-density lipoprotein (LDL) and glycoprotein (a)—apolipoprotein(a) [apo(a)]. The size and concentration of Lp(a) in serum can vary among individuals and is determined by genetic factors. The environmental factors, diet, and physical activity have a negligible effect on Lp(a) level. Observational, epidemiological, and genetic studies improved that high levels of Lp(a) > 50 mg/dL (> 125 nmol/L) have been associated with an increased risk of myocardial infarction (MI), stroke, and calcific aortic valve stenosis (CAVS). It is recommended to measure Lp(a) at least once in adults to identify individuals with a high cardiovascular risk. This screening is particularly important in certain populations, including: youth with a history of ischemic stroke or a family history of premature atherosclerotic cardiovascular disease (CVD; ASCVD) or high Lp(a), individuals with recurrent cardiovascular events despite optimal hypolipemic treatment and no other identifiable risk factors or patients with familial hypercholesterolemia (FH). Considering Lp(a) levels in the evaluation of cardiovascular risk can provide valuable information for risk stratification and management decisions. However, it’s important to note that the treatments of elevated level of Lp(a) are limited. In recent years, there has been ongoing research and development of new drugs targeting Lp(a): pelacarsen—antisense oligonucleotide (ASO), and olpasiran—a small interfering RNA (siRNA). Review Fri, 29 Dec 2023 00:00:00 GMT MiłoszBroncel, MarlenaBroncel, Fri, 29 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101215 https://www.explorationpub.com/Journals/ec/Article/101216 Coronary vasospasm stands as a widely acknowledged and frequent culprit behind chest pain, acute coronary syndrome, and sudden cardiac death, yet it remains a challenging diagnosis. Current guidelines recommend invasive coronary function testing to assess pathophysiology and mechanisms and to define treatment. In reality, this protocol is rarely applied, because it necessitates extended occupation of the cath lab, repetitive administration of nephrotoxic iodine contrast agents, the need for repeated testing on both coronary arteries leading to considerable radiation exposure, and significant direct expenses. The promising perspective for vasospasm testing is a noninvasive approach with advanced echocardiographic techniques, such as transthoracic Doppler echocardiography, with more sensitive indicators of ischemia. Hyperventilation and exercise tests are used for vasospasm directed testing, with assessment of the new parameters: coronary flow velocities and reserve, allowing to see deeper into macro and microvascular pathophysiology. Association between coronary flow, global longitudinal strain and microvascular dysfunction (MVD) and impaired values at hyperemia was previously demonstrated. Reduction in coronary flow velocity (CFV) despite heightened myocardial oxygen consumption and double product during hyperventilation are indicative of coronary vasospasm. Normal coronary angiography finding in patients with documented evidence of ischemia should initiate additional diagnostic testing in order to increase the yield of specific diagnosis in patients with suspected vasospasm, which could help to personalize treatment and prognosis. In order to achieve this, non-invasive provocative stress echocardiography tests should be included in the diagnostic workup. This approach, characterized by its simplicity, feasibility, safety, and efficacy, is currently undergoing extensive testing on a large scale. Perspective Sun, 04 Feb 2024 00:00:00 GMT AnaDjordjevic Dikic, SrdjanDedic, NikolaBoskovic, VojislavGiga, Sun, 04 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101216 https://www.explorationpub.com/Journals/ec/Article/101217 Aim: There is a lack of studies that analyzed factors influencing on feasibility of coronary flow velocity reserve (CFVR) during exercise stress echocardiography (SE). The aim of the study was to define the feasibility of assessment of CFVR during exercise through SE depending on experience, techniques, and clinical factors. Methods: This is a single-center study. SE was performed using three generations of echo systems in five consecutive cohorts of patients by experienced and novice specialists. All patients performed a supine bicycle testing. CFVR was calculated in the middle/middle-distal parts of the left anterior descending artery (LAD). Three different adjustment settings were used for LAD visualization. Results: The study included 3,014 patients (59 years old ± 11 years old, 54% males). Age [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.96–0.99, P < 0.01], body mass index (BMI; OR 0.95, 95% CI 0.91–0.98, P < 0.003), rest heart rate (OR 0.98, 95% CI 0.97–0.99, P < 0.0005) and doctor’s experience (OR 2.7, 95% CI 1.57–4.53, P < 0.0003) were independent factors that influence on feasibility. The feasibility of CFVR assessment during exercise SE in the whole population by experienced doctors was 89.4%. The feasibility of CFVR assessment of LAD in obese patients performed by experienced doctors using modern echo machines and new techniques was high (86.0%). Conclusions: Coronary artery velocity reserve during supine exercise SE is a feasible, non-invasive available tool. The new generation echo machine and the new techniques provide a good feasibility of CFVR assessment, even in novice doctors. Despite a lower level of possibility to assess CFVR in obese patients or with a higher resting heart rate, this method is feasible in a great majority of such patients. Original Article Sun, 04 Feb 2024 00:00:00 GMT AngelaZagatina, OgulleylaHanjykova, EkaterinaPetrova, IrinaBegidova, ElenaKalinina, Sun, 04 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101217 https://www.explorationpub.com/Journals/ec/Article/101219 Myocardial bridging is a congenital defect characterized by the course of a segment of the coronary arteries within the heart muscle most frequently affecting the left anterior descending coronary artery (LAD). Patients with myocardial bridging may present with episodes of exertional anginal chest pain. The gold standard for non-invasive diagnosis of myocardial bridge is coronary computed tomography angiography (CCTA), which allows anatomical characterization. Coronary flow velocity reserve (CFVR) of the LAD on stress echocardiography (SE) can play an important role in the diagnosis of myocardial bridging of the LAD; a relationship between CVFR-LAD and coronary inflammation by estimating the attenuation of peri-coronary adipose tissue at CCTA has been demonstrated in patients without obstructive ischaemic heart disease. Therefore, coronary inflammation localized to the LAD has been assessed in patients diagnosed with myocardial bridging of the LAD and previous SE with CFVR-LAD in a case series. Perspective Fri, 01 Mar 2024 00:00:00 GMT DomenicoTuttolomondo, DaminiDey, Piotr JSlomka, CarminePizzi, LucaBergamaschi, NicolaGaibazzi, Fri, 01 Mar 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101219 https://www.explorationpub.com/Journals/ec/Article/101220 Aim: Cardio-ankle vascular index (CAVI) is a marker of arterial stiffness independent of blood pressure (BP) at the time of measurement. This work sought to evaluate the association of CAVI with left ventricular hypertrophy (LVH), a marker of long-standing hypertension (HTN) in the pediatric population. Methods: CAVI values from 236 children being evaluated for HTN were compared with their BP grade (normal, elevated, stage I HTN, and stage II HTN) in accordance with clinical guidelines. CAVI values were correlated to the presence of LVH and lipid profiles. One hundred seven of the studied patients had transthoracic echocardiograms available for comparison, and 126 had available lipid results. CAVI means between the groups were compared using analysis of variance. Results: There was no significant difference in CAVI values between the BP groups [median/interquartile range: normal BP (4.95/4.4–5.7), elevated BP (5.1/4.5–5.6), stage I/II HTN (5.0/4.3–5.5)]. Mean CAVI value was higher in the group that had LVH (5.53, standard deviation = 1.4 vs. 5.1, standard deviation = 1; P = 0.13) but was not statistically significant. However, higher mean CAVI value in children ≥ 15 years was significantly associated with the presence of LVH (5.9, standard deviation = 1.8 vs. 5.2 standard deviation = 0.8; P = 0.018). Conclusions: In post-pubertal children, CAVI may be a good predictor of LVH from long-standing HTN. This tool could prove useful in screening for the presence of atherosclerotic changes and provide opportunity for intervention/improved long-term outcomes. Original Article Sun, 07 Apr 2024 00:00:00 GMT EvanHarvey, Noel DelosSantos, BruceAlpert, NaemaZarish, BrittanyHedge, RonakNaik, RanjitPhilip, Sun, 07 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101220 https://www.explorationpub.com/Journals/ec/Article/101221 Aim: The DNA of the atheroma is hypermethylated relative to adjacent healthy vascular tissue. A significant portion of hypermethylated loci in the atheroma DNA map to genes related to macrophage function. Reversing macrophage DNA methylation to physiological levels by targeting DNA methyltransferase (DNMT) activity may therefore slow atherogenesis. Here, the anti-inflammatory and anti-atherogenic activity of macrophage-targeted DNMT inhibitor SGI-1027 were tested. Methods: SGI-1027 was encapsulated into human serum albumin (HSA) nanoparticle (HSANP) functionalized with the PP1 peptide, a macrophage scavenger receptor 1 ligand, fused to a FLAG epitope (S-HSANP-FLAGPP1). Results: Nanoparticle physico-chemical characteristics predicted good marginalization towards the vascular wall, although SGI-1027 encapsulation efficiency was relatively low (~23%). S-HSANP-FLAGPP1 were rapidly internalized compared to non-functionalized and, surprisingly, functionalized void controls, and induced a shift towards an anti-inflammatory profile of secreted cytokines in human THP-1 macrophages. S-HSANP-FLAGPP1 colonized the atheroma and induced a significant ~44% reduction of atherosclerosis burden in the aortic tree of apolipoprotein E (ApoE)-null mice compared to controls. A reduction in aortic root atherosclerosis was observed, although primarily induced by HSANP irrespective of loading or functionalization. No alteration of body weight, non-vascular tissue gross histology, plasma glucose, triglyceride or cholesterol were observed. HSA whether free or structured in nanoparticles, induced a 3–4-fold increase in high-density lipoprotein (HDL) compared to vehicle. Conclusions: Unexpectedly, effects that were likely non-epigenetic and induced by HSA per se were observed. HSANP loaded with SGI-1027 were anti-atherogenic but in an anatomical location-dependent fashion. SGI-1027 displayed a novel anti-inflammatory activity in non-proliferating THP-1 cells, implying that those effects are likely unrelated to DNMT inhibition. HSA elevated HDL per se, thus underlining a possible additional advantage of HSA-based nanocarriers. Original Article Wed, 10 Apr 2024 00:00:00 GMT Ana CristinaMárquez-Sánchez, AlejandroManzanares-Guzmán, RamónCarriles-Jaimes, LinoSánchez-Segura, DanniaColín-Castelán, DanKamen, Ekaterina K.Koltsova, AgustinoMartínez-Antonio, DaliaRodríguez-Ríos, Gloria del CarmenRomo-Morales, GertrudLund, SilvioZaina, Wed, 10 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101221 https://www.explorationpub.com/Journals/ec/Article/101222 Aim: The pattern and severity of coronary artery calcification (CAC) can influence prognosis and outcome in percutaneous coronary intervention. An objective assessment of CAC during invasive angiography may provide additional prognostic information. This study aimed to assess the correlation between the angiographic Birmingham calcium score (BCS) and the Agatston coronary calcium score (CCS) performed as part of single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Methods: In this retrospective observational study, patients undergoing SPECT-MPI and invasive coronary angiography as part of their routine management were included. BCS was calculated by reviewing angiography images in retrospect by an observer blinded to the SPECT-MPI calcium score. Spearman’s correlation was used to analyze the correlation between BCS and SPECT-MPI. Receiver operating characteristic curve was used to detect cut-off for BCS that would detect clinically significant CAC [> 400 Agatston units (AU)]. Kaplan-Meier was used to report on outcomes at 5 years follow-up. Results: In this cohort of 151 patients, there was a positive correlation between BCS and CCS [Spearman correlation coefficient (r) = 0.558, P < 0.001]. Cumulative BCS of 1 was able to identify clinically significant CAC [area under the curve 0.788, 95% confidence interval (CI) 0.714–0.863]. Cumulative BCS ≥ 3 was associated with major adverse outcomes at 5 years follow-up (log rank P = 0.013). Conclusion: BCS correlates well with established higher CCS. Application of BCS during invasive coronary angiography will aid risk stratification, management, and follow-up with no extra patient involvement, radiation, or costs. Original Article Mon, 15 Apr 2024 00:00:00 GMT ZafraanZathar, ManishPandit, AnneKarunatilleke, AlpNotghi, VinodaSharma, Mon, 15 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101222 https://www.explorationpub.com/Journals/ec/Article/101223 Drawing insights from a spectrum of in vitro, in vivo experimental, and clinical studies, this review illuminates the underlying mechanism by which iodinated contrast media (ICM) exerts an indirect genotoxic effect. The mechanism involves the photoelectric effect induced by iodine molecules, thereby augmenting radiation attenuation and subsequently elevating the locally absorbed radiation dose. The ensuing generation of secondary electrons from each photoelectric absorption interaction triggers molecular reactions, culminating in discernible DNA damage, notably in the form of DNA double-strand breaks. A convergence of evidence from in vitro, experimental, and clinical investigations underscores a consistent pattern: the addition of iodine contrast linearly heightens the absorbed radiation dose and associated DNA damage. This quantification was evident through alterations in attenuation and the manifestation of double-strand breaks in circulating lymphocytes, serving as an intermediate endpoint and a potential long-term indicator of cancer. The observed surplus of DNA damage in contrast-enhanced images compared to non-contrast images ranged notably from +30% to +200%. This broad range accentuates a substantial amplification effect on radiation-induced damage, particularly noteworthy at clinically relevant iodine doses. Crucially, this effect remains unaffected by brands or manufacturers and exhibits a robust, exclusive correlation with the concentration of iodine in the bloodstream. The significant augmentation of absorbed dose and genotoxic impact of X-rays due to the use of contrast agents warrants critical attention within the medical community. This often-unacknowledged genotoxic influence may play a pivotal role in elevating cancer risks among patients undergoing radiation-based procedures, necessitating a reconsideration of risk assessment protocols and clinical practices. Review Fri, 19 Apr 2024 00:00:00 GMT ChiaraIacconi, MariaXiarcou, ValeriaPiagneri, EnricaCiofini, Fri, 19 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101223 https://www.explorationpub.com/Journals/ec/Article/101224 While authorship practices can vary across different disciplines, authorship should reflect the individuals who have made a substantial contribution to the research project, take public responsibility for the paper’s content, and agree to its submission for publication. In real life, the article is usually authored by at least one truly genuine author and some parasitic authors. The first author and the last author are especially important. The middle authors are less important, and their participation is often wrongly seen as an inconsequential decorative favor. The honorary author, a gift or guest author, is added as a bonus to please someone higher in the hierarchy than the submitting author. This practice is believed to enhance the chances of publication, but usually, the excess of honorary authors will make reviewers more critical. A ghost author contributed substantially but it does not appear in the list of authors to avoid declaring an overt conflict of interest. The gold author is someone paid by a third party in direct or indirect forms, and capable of writing and signing everything asked by the payer, including overstating the merits of a new drug or ignoring its drawbacks. A fake author does not exist, and while it may seem humorous it is a breach of scientific integrity and can lead to serious consequences for the individuals involved. With Chat-generative pre-trained transformer (Chat-GPT), artificial intelligence may contribute decisively to the article content and presentation. Overall, it is important to maintain high standards of integrity and transparency in authorship practices to ensure that research findings are trustworthy and reliable. The reputation of your work is in the hands of your coauthors, so choose them carefully and make sure they share your commitment to scientific integrity. Editorial Mon, 13 May 2024 00:00:00 GMT EugenioPicano, Mon, 13 May 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101224 https://www.explorationpub.com/Journals/ec/Article/101225 Left ventricular (LV) function is typically evaluated through LV ejection fraction (EF), a robust indicator of risk, showing a nonlinear increase in mortality rates below 40%. Conversely, excessively high EF values (> 65%) also correlate with elevated mortality, following a U-shaped curve, with its nadir observed between 50% and 65%. This underscores the necessity for improved identification of the hypercontractile phenotype. However, EF is not synonymous with LV contraction function, as it can fluctuate independently of contractility due to variations in afterload, preload, heart rate, and ventricular-arterial coupling. Assessing the contractile status of the LV requires more specific metrics, such as LV elastance (or contractile force) and global longitudinal strain. Current guidelines outline various parameters for a more precise characterization of LV contractility, yet further research is warranted for validation. The true hypercontractile phenotype is evident in cardiac pathologies such as hypertrophic cardiomyopathy, ischemia with angiographically normal coronary arteries, Tako-tsubo syndrome, heart failure with preserved EF, and may also stem from systemic disorders including anemia, hyperthyroidism, liver, kidney, or pulmonary diseases. The hypercontractile phenotype constitutes a distinctive hemodynamic substrate underlying clinical manifestations such as angina, dyspnea, or arrhythmias, presenting a target for intervention through beta-blockers or specific cardiac myosin inhibitors. While EF remains pivotal for clinical classification, risk stratification, and therapeutic decision-making, integrating it with other indices of LV function can enhance the characterization of the hypercontractile phenotype. Review Mon, 17 Jun 2024 00:00:00 GMT YiWang, LixueYin, Mon, 17 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101225 https://www.explorationpub.com/Journals/ec/Article/101226 Metabolic syndrome (MetS) is known as a non-communicable disease (NCD) that affects more and more individuals. MetS is closely related to type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), obesity and inflammation. It is associated with T2DM due to the disturbance in insulin secretion/effect, eventually leading to insulin resistance (IR). The link between MetS and CVD is due to accelerated atherosclerosis in response to chronic inflammation. This literature review was based on a search in the PubMed database. All selected articles are written in English and cover a period of approximately 10 years (January 2014 to May 2023). The first selection used MeSH terms such as: “metabolic syndrome”, “type 2 diabetes mellitus”, “obesity”, “inflammation”, and “insulin resistance” and different associations between them. Titles and abstracts were analyzed. In the end, 44 articles were selected, 4 of which were meta-analysis studies. Currently, an individual is considered to have MetS if they present 3 of the following changes: increased waist circumference, increased triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), increased fasting blood glucose and hypertension. We believe this can often lead to a false diagnosis. The objective of this paper is to compile what we consider to be an appropriate panel of MetS indicators. The markers that stand out in this review are the lipid profile, anti- and pro-inflammatory function and oxidative stress. Considering the research, we believe that a complete panel, to correlate the most characteristic conditions of MetS, should include the following markers: TG/HDL-C ratio, small dense low-density lipoprotein cholesterol (SdLDL-C), lipid peroxidation markers, leptin/adiponectin ratio, plasminogen activator inhibitor-1 (PAI-1), activin-A and ferritin levels. Finally, it is important to expand research on the pathophysiology of MetS and confirm the most appropriate markers as well as discover new ones to correctly diagnose this condition. Review Mon, 24 Jun 2024 00:00:00 GMT FilipaMorgado, AnaValado, JoãoMetello, LeonelPereira, Mon, 24 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101226 https://www.explorationpub.com/Journals/ec/Article/101227 Adventitial crosslinking is a method in current investigational stage for preventing the rupture of aortic aneurysms. It is based on the photochemical crosslinking of adventitial collagen by exposure to ultraviolet A radiation. Essentially, an adventitial top layer is generated that displays enhanced mechanical properties and imparts additional strength and stiffness to the aneurysmal wall. Looking back upon the history of aortic surgery during 1940s, the aortic film wrapping, then dubbed “cellophane wrapping”, also was a procedure employed for delaying the aneurysmal rupture. In principle, the two procedures are similar in that both result in laminar composites, although the top layers differ fundamentally from each other. This review discussed in some detail the use and clinical outcomes of the aortic wrapping with artificial films, also mentioning the contemporary procedures still grouped under this umbrella term. The focus of the review was a comparative view on two procedures, the aortic film wrapping and adventitial crosslinking. It was concluded that the methods are different in many aspects, including the mechanisms of action. In fact, the promoters of adventitial crosslinking were not aware of the prior existence of aortic film wrapping. However, the achievements of the classical wrapping, by now regarded as merely historical episodes, did not discard prior knowledge, but repurposed it in a process that led to innovative strategies. Review Mon, 24 Jun 2024 00:00:00 GMT Traian V.Chirila, Mon, 24 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101227 https://www.explorationpub.com/Journals/ec/Article/101228 Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality worldwide. Percutaneous mechanical thrombectomy is indicated in patients with contraindications to thrombolysis. Complications include atrial or ventricular perforation causing tamponade. We describe one case of pericardial tamponade in an elderly woman who underwent thrombectomy for acute PE. An 88-year-old woman presented with acute shortness of breath. She was tachycardic, oxygen saturation of 80% and blood pressure of 95/57 mmHg. Bedside ultrasound showed a dilated right ventricle. Electrocardiogram showed large S wave in lead I, Q wave and inverted T wave in lead III. Computed tomography (CT) angiogram of the chest revealed an extensive saddle PE. Tissue plasminogen activator was deferred given patient’s age. Full dose anticoagulation was started and she underwent a successful percutaneous thrombectomy with FlowTriever device. Two hours later, she developed severe back pain and hypotension to 88/63 mmHg. Hemoglobin dropped from 13.7 g/dL to 8.8 g/dL. CT chest angiogram showed dense pericardial effusion, likely hemopericardium, with mass effect on the heart. Bedside pericardiocentesis was attempted and converted to pericardial window given sustained hypotension. She went into cardiac arrest. Emergent thoracotomy revealed significant hemothorax. The pericardium was opened yielding a blue, globally ischemic, and non-contracting heart. Cardiac massage and intra-cardiac epinephrine attempted unsuccessfully. Percutaneous thrombectomy using the large bore design FlowTriever system has shown promising results in reducing clot burden and improving hemodynamics. Attention must be paid to life threatening complications such as cardiac tamponade which can be precipitated by using these devices. Case Report Thu, 18 Jul 2024 00:00:00 GMT ShruthiSivakumar, AsherGorantla, Wayne-AndrewPalmer, AnanditaKishore, MichaelSchiable, EkenedilichukwuNnadi, AmmarAbdulfattah, SuzetteGraham-Hill, Thu, 18 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101228 https://www.explorationpub.com/Journals/ec/Article/101229 Aim: Temporary right ventricular assist device (t-RVAD) is an option for those patients in right ventricular failure (RVF) after left ventricular assist device (LVAD) resistant to ionotropic therapy. There are two options to placing a t-RVAD: an open, central technique or a percutaneous placement with Protek Duo® cannula. Methods: We compare these two t-RVAD devices that treat RVF after LVAD placement. Between 2013–2019, 22 patients were identified needing t-RVAD support after LVAD placement. Fourteen patients had open/central while 8 patients had percutaneous right ventricular assist device (RVAD) support. Results: There was no difference in length of ICU stay (49 ± 32 days Protek Duo® vs. 45 ± 22 days “open”; P = 0.73); hospital length of stay (57 ± 39 days vs. 55 ± 28 days; P = 0.088); discharge from ICU and hospital (62.1% Protek Duo® vs. 57% for “open”; P = 0.9 for both); or the one-year survival between the two groups (62% Protek Duo® vs. 50% “open”; P = 0.67). The Protek Duo® group had less total time on the ventilator (15 ± 9 days vs. 27 ± 17 days; P = 0.044) and required less amount of blood products (17 ± 8.9 units RBC and 2.0 ± 1.91 units FFP vs. 31 ± 20.5 units RBC and 11.5 ± 10 units FFP; P = 0.046 and P = 0.005). Conclusions: Percutaneous t-RVAD support is a viable option for patients whom undergo LVAD placement and require right ventricular mechanical support. Original Article Fri, 19 Jul 2024 00:00:00 GMT AmitPrasad, AnthonyKronfli, NadiaAssiaoui, ChristophBrehm, BehzadSoleimani, Fri, 19 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101229 https://www.explorationpub.com/Journals/ec/Article/101230 Vascular aging is recognized as one of the hallmarks of atherosclerosis. Currently, a growing body of evidence suggests that there exists a mutual crosstalk between telomere dysfunction and mitochondrial dysmetabolism during the process of vascular senescence. This underscores the importance of comprehensively studying the molecular mediators involved in this complex and intricate connection. In pursuit of this goal, the “VICTORIA” protocol entails a prospective single-center cohort study aimed at recruiting patients undergoing coronary angiography at Niguarda Hospital in Italy. The primary objective is to explore potential associations between peripheral markers of cell aging (telomere length and mtDNA content), dysregulation of non-coding RNA [specifically lncRNA TERRA and mitochondrial microRNA (MitomiR)], and the varied presentations of ischemic heart disease (stable angina, unstable angina, NSTEMI, and STEMI). Furthermore, we aim to investigate whether these markers correlate with vulnerable plaque characteristics, as assessed by optical coherence tomography findings. Additionally, systemic levels of pro-inflammatory biomarkers and novel indicators of senescence will be assessed. Patients will be followed up at 1 year to monitor primary outcomes including mortality, myocardial infarction, stroke, unplanned revascularization, and rehospitalization. The anticipated findings of this study hold promise for advancing our understanding of the telomere-mitochondria crosstalk, potentially paving the way for novel treatment modalities and refined risk stratification approaches for acute coronary syndrome. Protocol Thu, 25 Jul 2024 00:00:00 GMT JonicaCampolo, PaolaCanale, EmanuelaPiccaluga, IreneBossi, GianlucaGazzaniga, MarinaParolini, CinziaDellanoce, GiuseppeEsposito, JacopoOreglia, RudinaNdreu, AndreaBorghini, Maria GraziaAndreassi, Thu, 25 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101230 https://www.explorationpub.com/Journals/ec/Article/101231 Pneumopericardium, the presence of air within the pericardial sac, is a rare but critical condition that can lead to severe complications such as tension pneumopericardium and cardiac tamponade, causing hemodynamic instability and necessitating immediate intervention. Various etiologies include congenital defects, post-surgical complications, infections, and trauma. Malignancies, such as advanced esophageal cancer or lung carcinoma, can also cause pneumopericardium via fistula formation. Multimodal imaging, including chest X-ray, echocardiography, and computed tomography (CT), is essential for diagnosis. This case report discusses a 65-year-old male with advanced pancreatic adenocarcinoma who developed pneumopericardium following the removal of a left lobe liver drainage catheter. Initial CT imaging revealed liver lesions suspicious for metastatic disease or abscess, leading to drainage procedures. Following the removal of the drainage tube, the patient experienced respiratory distress and hypotension, and computed tomography pulmonary angiogram (CTPA) revealed pneumopericardium, likely due to a fistula formed between the abscess and pericardium. Despite no echocardiographic signs of tamponade, the patient’s persistent hypotension warranted CT-guided pericardiocentesis, resulting in gradual blood pressure improvement. This case highlights the intricate interplay between malignancy, infection, and procedural complications in developing pneumopericardium. It emphasizes the need for a multidisciplinary approach and the importance of considering both the quantity and rate of air accumulation when assessing the risk of hemodynamic compromise. The patient’s hemodynamic instability and subsequent improvement following pericardiocentesis underscore the critical role of timely intervention in managing this condition. Case Report Wed, 07 Aug 2024 00:00:00 GMT AhmedBasuoni, SameeraKhatri, YasirAl-Malki, MarwaMakhlouf, Wed, 07 Aug 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101231 https://www.explorationpub.com/Journals/ec/Article/101232 Redo surgical aortic valve replacement (SAVR) has long been the standard treatment for severe symptomatic aortic stenosis (AS) and insufficiency, but transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative, particularly for symptomatic AS. With calcification being a primary mechanism behind structural valve degeneration, factors such as patient characteristics and the type of bioprosthetic valve play crucial roles in determining risk. Valve-in-valve TAVR (ViV TAVR) has gained prominence as a viable alternative to redo SAVR in recent years. Echocardiography plays a pivotal role in patient selection, procedural guidance, and post-procedural evaluation in ViV TAVR. From pre-procedural assessment using transthoracic and transesophageal echocardiography to intra-procedural guidance and post-procedural follow-up, echocardiography aids in ensuring procedural success and monitoring valve function. Decision-making between redo SAVR and ViV TAVR involves multidisciplinary teams considering various factors like patient risk profile, anatomical considerations, and technical feasibility. While redo SAVR remains preferred for younger patients with lower risk, ViV TAVR is increasingly considered for older patients or those with higher reoperation risks. Factors such as coronary artery obstruction risk, patient-prosthesis mismatch, and paravalvular leak guide treatment decisions. Procedural techniques in ViV TAVR have evolved to minimize complications and optimize outcomes. Factors like access route selection, valve choice, and procedural guidance techniques significantly impact procedural success. Balloon valve fracture and preventive strategies against coronary obstruction are crucial considerations during the procedure. Post-procedural evaluation involves assessing clinical and hemodynamic outcomes, with long-term studies indicating favorable results but highlighting the importance of careful evaluation of transprosthetic gradients and valve function. ViV TAVR offers promising outcomes but requires meticulous patient selection, procedural planning, and post-procedural management to ensure optimal results. Review Fri, 16 Aug 2024 00:00:00 GMT Marco FabioCostantino, GianpaoloD’Addeo, FrancescaCortese, LuisianaStolfi, Fri, 16 Aug 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101232 https://www.explorationpub.com/Journals/ec/Article/101233 Chagas disease is a systemic illness characterized by acute and chronic phases. If untreated, it can lead to dysfunction of vital organs, notably the heart, ultimately resulting in heart failure. Transmission primarily occurs through the feces of triatomine insects carrying the protozoan parasite Trypanosoma cruzi, either via a bite wound or intact mucous membranes. Diagnosis of Chagas disease involves serological tests, electrocardiographic findings, and imaging studies. A 58-year-old male patient from Peru with chronic dilated cardiomyopathy underwent evaluation at a tertiary care hospital. Given the uncertain etiology, a comprehensive diagnostic approach was adopted, emphasizing the pivotal role of cardiovascular magnetic resonance imaging and computed tomography angiography in managing chronic cardiomyopathy of Chagas disease. Leveraging these imaging modalities together could augment our ability to evaluate myocardial inflammation and tailor therapeutic strategies accordingly. Case Report Mon, 23 Sep 2024 00:00:00 GMT LuigyVasquez-Yeng, Juan JoseHernandez-Ruiz, MauricioGarcia-Cardenas, RaulVelazquez-Castañeda, SantiagoLuna-Alcala, PavelMartinez-Dominguez, Enrique C.Guerra, JoséArmendariz-Ferrari, NildaEspinola-Zavaleta, Mon, 23 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101233 https://www.explorationpub.com/Journals/ec/Article/101234 Aim: The association of echocardiographic findings and subsequent risk of left-sided native valve endocarditis (LS-NVE) is undefined. The aim of this study was to determine if transthoracic echocardiography (TTE) measurements are associated with the subsequent development of LS-NVE in patients without cardiac predisposing conditions. Methods: Institutional databases were evaluated for adults diagnosed with LS-NVE from 2008 to 2020. Patients with prosthetic valves, cardiovascular implantable electronic devices, intracardiac devices, injection drug use, and predisposing cardiac conditions were excluded. Only patients who had a TTE performed 6 months to 3 years before the development of LS-NVE were included as cases. Controls were patients within the same Mayo location with a TTE report and were matched in a 1:3 ratio according to age, gender, Charlson comorbidity index, and echocardiography date. Results: There were 148 cases and 431 matched controls. As compared to controls, infective endocarditis (IE) cases had a higher prevalence of diabetes mellitus (46.6% vs. 30.4%) and chronic kidney disease (46.6% vs. 28.1%) (P < 0.001). Left ventricular outflow tract velocity (P = 0.017), left ventricular ejection fraction (P = 0.018), and E:e’ ratio (P = 0.050) were associated with LS-NVE. Conclusions: Echocardiographic measurements were associated with subsequent LS-NVE development in this pilot study. A larger cohort of LS-NVE patients, however, is needed to validate these findings. Original Article Wed, 25 Sep 2024 00:00:00 GMT Juan A.Quintero-Martinez, Joya-RitaHindy, Hector R.Villarraga, Brian D.Lahr, Mark J.Dayer, Martin H.Thornhill, John C.O’Horo, Hector I.Michelena, Nandan S.Anavekar, ParhamSendi, Daniel C.DeSimone, Larry M.Baddour, Wed, 25 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101234 https://www.explorationpub.com/Journals/ec/Article/101235 Carpal tunnel syndrome (CTS) is the most common type of entrapment neuropathy and affects approximately 1% to 5% of the general population, mostly patients older than 50 years. CTS is present in various conditions and diseases and could also be an early sign of systemic transthyretin amyloidosis (ATTR), associated with amyloid cardiomyopathy and subsequent heart failure. With advances in the treatment of cardiac amyloidosis, patient prognosis could be significantly improved with an early diagnosis. Amyloidosis represents a group of disorders characterized by the extracellular deposition of destabilized protein fragments, aggregating as amyloid fibrils, thereby leading to organ dysfunction. Among these, ATTR is a significant subgroup. This study protocol aims to explore the potential association between CTS and systemic and cardiac ATTR. The study design involves a case-control approach, with assessments including physical examination, laboratory tests, electromyography, electrocardiogram, wrist ultrasound, and scintigraphy with 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD). Histopathological analysis and genetic testing will be performed when appropriate. Statistical analysis will be conducted to evaluate the relationship between CTS and ATTR. The study seeks to contribute to a better understanding of the diagnostic and therapeutic implications of identifying ATTR in patients with idiopathic CTS (ClinicalTrials.gov identifier: NCT05409833). Protocol Fri, 25 Oct 2024 00:00:00 GMT SofiaPimenta, AnaMartins, MiguelCarvalho, Bernardo SousaPinto, Adriana SáPinto, JaneteSantos, InêsFortuna, PedroMadureira, PedroNegrão, JorgePereira, LúciaCosta, ElisabeteMartins, Fri, 25 Oct 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101235 https://www.explorationpub.com/Journals/ec/Article/101240 Aim: This study aimed to assess oral health’s influence on COVID-19 outcomes in recovered individuals with pre-existing cardiovascular conditions. Methods: In the main study employing a cross-sectional design based on a questionnaire survey, 464 Egyptian patients who had recovered from COVID-19 were enrolled, with 86 individuals who had pre-existing cardiovascular conditions included in a subgroup analysis. Oral health was classified as poor and good based on scores from an 18-question survey with higher scores indicating better health. Severe COVID-19 was defined by criteria that included elevated respiratory and heart rates, severe dyspnea low oxygen saturation, high fever, and need for hospitalization or ICU care. Participants’ recovery duration was classified into three groups: fast (≤ 2 weeks), intermediate (4 weeks), and delayed (6 weeks), characterized by symptom-free status. Moreover, C-reactive protein (CRP) levels (> 18 mg/L) were considered elevated. Results: Our results revealed that cardiac patients with poor oral health showed a significant association with severe COVID-19 cases, elevated CRP levels (> 18 mg/L), and a prolonged recovery period (6 weeks) (p < 0.001). In contrast, participants demonstrating good oral health were associated with milder COVID-19 cases, lower CRP levels, and faster recovery (p < 0.001). Conclusions: Our findings indicate a significant link between the condition of oral health and the experienced severity of COVID-19 in cardiac patients. Poor oral health was associated with elevated CRP levels, delayed recovery, and more severe symptoms. These results highlight the importance of good oral hygiene as a modifiable factor in reducing infection severity, especially in vulnerable cardiac populations. Original Article Mon, 25 Nov 2024 00:00:00 GMT AhmedBasuoni, Amany Hany MohamedKamel, Mon, 25 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101240 https://www.explorationpub.com/Journals/ec/Article/101241 Aim: This study aimed to investigate the relationship between heart rate variability (HRV) parameters and performance in soccer players. Methods: This study used a cross-sectional design to assess HRV parameters in a cohort of twenty-nine male athletes, aged 18 to 20 years, randomly selected from the Macapá Sports Club team in the Amazon region. Resting HRV data for ten minutes while maintaining normal breathing, acquired with a Polar V800 heart rate monitor recording at a sampling rate of 1,000 Hz, were analyzed using Kubios HRV software to extract time domain: mean of the normal sinus intervals (MRR), the standard deviation of normal sinus (NN) intervals (SDNN), root mean square of successive differences (RMSSD), the percentage of times that the change in consecutive normal sinus intervals exceeded 50 ms (pNN50), and frequency domain: low frequency (LF), high frequency (HF), and LF/HF ratio parameters. Factor analysis was then performed using principal component (PC) extraction and varimax rotation. The logarithmic transformation [normalized LF/HF by logarithmic transformation (LF/HFNormlog)] was applied to address this non-normality before factor analysis. Results: The first two PCs showed that 87.4% of the total variance was explained by the original variables. The LF (–0.93), HF (0.93), and LF/HFNormlog (–0.92) parameters contributed significantly to PC1, also known as the frequency domain component. In contrast, the MRR (0.60), SDNN (0.91), RMSSD (0.89), and pNN50 (0.79) parameters contributed to PC2, also known as the time domain component. Conclusions: This study provides valuable evidence of the complex relationship between autonomic factors affecting HRV parameters in soccer players. Identifying two distinct PCs related to sympathetic and parasympathetic activity highlights the importance of monitoring HRV to optimize performance and recovery. Machine learning is important to monitor these changes in the possible molecular mechanisms controlling HRV in soccer players. Original Article Fri, 10 Jan 2025 00:00:00 GMT WollnerMaterko, Sávio Andrei MedeirosMiranda, Thiago Henrique LobatoBezerra, Carlos Alberto Machadode Oliveira Figueira, Fri, 10 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101241 https://www.explorationpub.com/Journals/ec/Article/101242 Papillary muscle rupture is a rare but fatal complication of acute myocardial infarction. The incidence of this complication has been reduced to less than 0.1% of patients due to the advent of primary percutaneous coronary intervention. Cardiogenic shock and acute pulmonary edema are the most common clinical presentations. In this review, we describe the role of transthoracic and transesophageal echocardiography in identifying the type, location, and hemodynamic consequences of the three different echocardiographic patterns of papillary muscle rupture. This information is crucial for managing medical therapy and determining the appropriate surgical or percutaneous treatment. Review Fri, 10 Jan 2025 00:00:00 GMT Paolo G.Pino, IrisParrini, AntonellaMoreo, AntonioTerranova, FedericoNardi, Fri, 10 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101242 https://www.explorationpub.com/Journals/ec/Article/101243 Cardiovascular diseases, particularly ischemic heart disease (IHD), are the leading cause of mortality globally, accounting for 16% of deaths. Effective management of ischemic cardiomyopathy (ICM) is crucial, as outlined in the latest European Society of Cardiology (ESC) guidelines for chronic coronary syndrome (CCS). The guidelines emphasize a structured approach comprising four key steps: a general clinical evaluation to exclude non-cardiac causes, cardiac examination, and likelihood estimation using echocardiography, diagnostic testing such as stress echocardiography and coronary CT angiography, and treatment involving lifestyle changes and medication, alongside potential revascularization. The review underscores the importance of coronary angiography and functional assessments in diagnosing ischemic heart failure (IHF) and guiding treatment strategies. Non-invasive imaging techniques, including stress echocardiography and myocardial perfusion scintigraphy, are valuable for assessing ischemia and myocardial viability while reducing unnecessary invasive procedures. Coronary CT angiography is also examined for its procedural advantages and risks. A comparative analysis of diagnostic modalities highlights the strengths and limitations of each technique, emphasizing the need for individualized approaches based on patient characteristics. The ESC 2024 guidelines advocate for a patient-centered imaging strategy based on the likelihood of coronary artery disease (CAD) while addressing the economic and environmental impacts of imaging practices. Overall, implementing these guidelines and leveraging diverse imaging modalities can optimize management strategies for IHD, ultimately improving patient outcomes. Review Mon, 13 Jan 2025 00:00:00 GMT Marco FabioCostantino, FrancescaCortese, GianpaoloD’Addeo, AdrianoNicoletti, StefanoMancino, LuisianaStolfi, Mon, 13 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101243 https://www.explorationpub.com/Journals/ec/Article/101244 Data on the use of mechanical circulatory support devices in pregnant women are limited. A 27-year-old woman at 27 weeks and 6 days of gestation was supported by three different mechanical circulatory support devices due to cardiogenic shock. She came into spontaneous labor, which was complicated by major hemorrhage at the cannulation site, fetal distress, and transverse position, requiring emergency cesarean section. The postpartum period was complicated by intra-abdominal bleeding and arterial occlusion of lower extremity. When using mechanical circulatory support devices in pregnant women, a multidisciplinary approach is recommended. Case Report Tue, 14 Jan 2025 00:00:00 GMT Johanna A.van der Zande, DalilaBlel, Robert M.Kauling, H. RobTaal, Jeroen J. H.Bunge, AttieGo, HenrikEndeman, ArieFranx, Jerome M. J.Cornette, Tue, 14 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101244 https://www.explorationpub.com/Journals/ec/Article/101245 We present the case of a woman admitted for an acute ST-segment elevation myocardial infarction. Emergency catheterization was conducted, revealing diffuse lesions affecting 70% of the anterior descending artery from the mid to the distal third but with ventriculography compatible with Takotsubo syndrome. Two magnetic resonances were performed 90 days apart, confirming the unusual coexistence of Takotsubo syndrome and transmural infarction in the same event. Case Report Wed, 15 Jan 2025 00:00:00 GMT CristhianEspinoza Romero, Vinícius MachadoCorreia, WilliamsLata, KevinDe Paula Morales, Lenny BorjaValdivieso, Gabriela OttoniPin, Tatiana TorresLeal, Wed, 15 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101245 https://www.explorationpub.com/Journals/ec/Article/101246 The oxidation of lipoproteins has a key role in the development of atherosclerosis, a condition where plaque builds up in artery walls. Research shows that when low-density lipoprotein (LDL) oxidizes, it speeds up atherosclerosis. Oxidized LDL (Ox-LDL) causes many pathologic scenarios that lead to atherosclerosis. It was suggested as a fundamental player in endothelial dysfunction, creating foam cells, and triggering inflammation in artery walls. How Ox-LDL contributes and interacts with specific receptors on endothelial cells is crucial to these effects. This article aims to shed light on LDL oxidation, the stages of the process, and how Ox-LDL promotes atherosclerosis. A comprehensive search was conducted across various databases, including PubMed, Google Scholar, Scopus, and Ovid, to identify literature and studies that discuss Ox-LDL and their involvement in the pathogenesis of atherosclerosis and cardiovascular diseases, thereby establishing a well-defined perspective on the subject. This review will provide a closer look at the Ox-LDL particle, the different forms and stages of oxidation, and the role of various LDL receptors involved in LDL uptake and breakdown focusing on how they contribute to atherosclerosis. Then, it will discuss the role of scavenger receptors and their contribution to the uptake of Ox-LDL and how this contributes to the development of atherosclerosis. Review Fri, 17 Jan 2025 00:00:00 GMT Abdullatif TahaBabakr, Fri, 17 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101246 https://www.explorationpub.com/Journals/ec/Article/101247 Aim: This study aimed to establish a model based on gene expression in peripheral blood mononuclear cells (PBMCs) for predicting the incidence of heart failure with preserved ejection fraction (HFpEF) in patients with end-stage renal disease (ESRD). Methods: PBMCs were isolated from patients with stage 2–3 chronic kidney disease, ESRD, ESRD with HFpEF, and ESRD with heart failure with reduced ejection fraction (HFrEF). Differences in the expression of differentially expressed genes in PBMCs among different groups were compared using microarray. Results: In total, 43 differentially expressed genes were specifically identified in patients with ESRD with HFpEF. The expression of four genes encoding MMP7, S100A8, CXCR3, and CD163 was significantly upregulated. Hence, it played a role in the development of HFpEF. Based on these findings, a nomogram was established using data from the database including 343 patients with ESRD. The receiver operating characteristic curve, calibration curve, model consistency index, and decision curve analyses showed that the nomogram had a good predictive performance for predicting HFpEF. Conclusions: Specific gene detections can be an important early warning indicator and guide physicians in evaluating the risk of HFpEF in ESRD. Original Article Tue, 21 Jan 2025 00:00:00 GMT XinruiWang, MinghuiSong, LuMa, YangYang, Tue, 21 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101247 https://www.explorationpub.com/Journals/ec/Article/101248 By offering their expertise, reviewers help authors improve their work and also support editors in selecting high-quality studies, thereby reinforcing the integrity of scientific literature. Much like in a Sergio Leone film, your manuscript encounters three possible types of reviewers on its editorial journey: the Good, the Bad, and the Ugly. The Good Reviewer is, for reasons unknown, favorably disposed toward both you and your manuscript. They find it “well-written, with literary and enjoyable style”, “original and timely”, and addressing a topic that is “scientifically and socially relevant”. Their comments are respectful, constructive, and focused on minor but meaningful improvements. Unfortunately, the Good Reviewer is as rare as a white unicorn; some researchers reach the end of their careers without ever encountering one, leading them to question their very existence. The Bad Reviewer is both bad at reviewing and a bad influence on your work. They reject your manuscript, but their reasons are vague and unconvincing. Their objections are often asinine, and when you respond thoroughly and decisively, they counter with even more nonsensical arguments. They may pressure you to cite irrelevant literature—often their work or that of their colleagues. In the end, your once-solid and cohesive manuscript emerges in a far worse state than the original. None of this would have been possible without the Bad Reviewer, who, unleashed by a negligent editor, exerts their detrimental influence on your article. The Ugly Reviewer appears with unsettling regularity—at least once a month. They believe your article is truly terrible, and often, they are right. The Ugly Reviewer, though harsh, is no fool. Their critiques are brutal and unforgiving, yet accurate. Years later, you may find yourself grateful to them for preventing you from publishing work that, in hindsight, would have irreparably tarnished your already modest scientific reputation. Editorial Fri, 24 Jan 2025 00:00:00 GMT EugenioPicano, Fri, 24 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101248 https://www.explorationpub.com/Journals/ec/Article/101249 Aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, infection resulting in acute respiratory distress syndrome (ARDS) requiring veno-venous or veno-arterial extracorporeal membrane oxygenation (VV or VA-ECMO) support is a life-threatening disease process that requires prolonged intubation and has a high risk of mortality. Methods: In this retrospective, observational, single-center cohort study, we attempt to better understand the role of extubation in the course of treatment by dichotomizing groups into those extubated early while remaining on ECMO treatment (group A), compared to patients who remained intubated for the entirety of their ECMO treatment (group B). Results: The data indicate that early extubation of patients with COVID-19-associated ARDS requiring ECMO support leads to improved survival rates for group A (93%) compared to prolonged intubation (group B) throughout the course of ECMO therapy (64%) (p = 0.13). Additionally, patients extubated earlier (19 days vs. 59 days; p = 0.012) required significantly fewer vasoactive drugs (norepinephrine dosing: 0.03 mcg/kg/min vs. 0.093 mcg/kg/min; p = 0.04), and were less likely to require a tracheostomy (0 vs. 4, p = 0.026). Conclusions: Although the utility of ECMO in severe ARDS patients remains a contentious topic, early extubation seems to increase survival rates and overall patient outcomes in patients with COVID-19-associated ARDS requiring ECMO support. Original Article Wed, 05 Feb 2025 00:00:00 GMT SeanKelleher, ChristophBrehm, CarolDziedzina, ShouhaoZhou, CatherineNashed, RicardaWhite, MiriamFreundt, OctavioFalcucci, AmitPrasad, Wed, 05 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101249 https://www.explorationpub.com/Journals/ec/Article/101250 L-Carnitine (LC) is integral to energy production and fatty acid metabolism, facilitating the transport of long-chain fatty acids into mitochondria for β-oxidation. It modulates metabolic pathways, including pyruvate dehydrogenase activity, proteolysis, and protein synthesis, while also having anti-inflammatory and antioxidant characteristics. LC can be commonly applied to win the battle against HIV and cancer cachexia. Also, it can be recruited with the aim of improving physical and cognitive functions in athletes and the elderly. Despite these benefits, long-term LC administration has been associated to cardiovascular risks due its conversion to trimethylamine-N-oxide (TMAO) by the gut microbiota. Elevated TMAO levels are linked to atherosclerosis, oxidative stress, and an increased risk of cardiovascular disease, diabetes, and chronic kidney disease. Managing TMAO levels using dietary treatments and gut microbiota-targeting techniques, such as probiotics, may reduce these risks. This comprehensive review presents the state-of-the-art information on LC’s dual role, emphasizing the balance between its therapeutic potential and the risks of prolonged supplementation. It aims to guide clinicians and researchers in optimizing LC’s benefits while addressing its long term cardiovascular safety concerns. Review Tue, 11 Feb 2025 00:00:00 GMT Harsahaj SinghWilkhoo, FelciaReji, Afra WasamaIslam, Janadi AshinshaniKarawita, Adnan AkhtarShaikh, Tue, 11 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101250 https://www.explorationpub.com/Journals/ec/Article/101239 Pulmonary congestion is a key determinant of heart failure, but for a long time it has been an elusive target for the clinical cardiologist in the pre-B-line era, despite research efforts of Carlo Giuntini, a pneumologist who attempted the quantification of lung water in the seventies with too insensitive chest X-ray lung water score, too cumbersome nuclear medicine, and too complex invasive thermodilution techniques. Daniel Lichtenstein, is a French intensivist who first discovered lung ultrasound as a sign of extravascular lung water in 1997. B-lines (also known as ultrasound lung comets) detectable by lung ultrasound arise from the pleural line, extend towards the edge of the screen, and move synchronously with respiration. In cardiology, B-lines were introduced in 2004 and are now the dominant technique for research applications and clinical purposes. B-lines showed a prognostic value in several clinical scenarios, largely independent and additive over echocardiographic predictors such as ejection fraction. The methodology became user-friendly in the last years, with a reduction of the scanning sites from the original 28 to a simplified 4-site scan now extracting information on lung water in < 1 minute. More recently, B-lines were also studied during physical and pharmacological stress. Signs of pulmonary congestion are found during stress in 1 out of 3 all-comers with normal findings at rest. Artificial intelligence applied to ultrasound and clinical data allows for the detection of B lines, their quantification, and the assessment of their nature. The B-lines phenotype can cluster around different endotypes: dry (in systemic sclerosis and lung interstitial fibrosis); wet (water); sterile (as in cardiogenic edema); infective (as in COVID-19 and interstitial pneumonia); right heart-sided (as in pulmonary arterial hypertension); left-heart sided (as in heart failure or valvular heart disease). Artificial intelligence B-lines and pocket-size insonation of the B-lines-driven decongestion therapy are now on the horizon. Review Thu, 14 Nov 2024 00:00:00 GMT Marco Antonio RodriguesTorres, Natália Moraesde Quevedo, Thu, 14 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101239 https://www.explorationpub.com/Journals/ec/Article/101236 Exposure to ionizing radiation has recognized detrimental cancer and non-cancer health effects. These effects are now well-proven not only for high doses > 1,000 millisieverts (mSv) associated with head radiotherapy but also for moderate (100–1,000 mSv) and even low (< 100 mSv) doses, of interest for professionally exposed cardiologists. The head of interventional cardiologists is highly exposed to ionizing radiation, with possible damage to the eye and brain. Unprotected interventional cardiologists experience head radiation doses up to ten times greater than chest doses below lead aprons, with marked exposure to the left hemisphere of the brain reaching up to 2 Sv—equivalent to 10,000 chest X-rays over a professional lifetime. This narrative review aims to provide an overview of the background of radioprotection, the biological mechanisms involved, and the epidemiological evidence regarding the health effects of head exposure to ionizing radiation in invasive cardiologists. These health effects include cataracts, brain cancer, cerebrovascular diseases, neurodegeneration, and mood disorders. The evidence gathered from other exposed populations, which experienced similar eye and brain doses, has also been reviewed. This is important because the doses, risks, and effects are consistent in cases of repeated exposures, which occur more frequently for patients, and in situations involving chronic low doses, as seen with interventional cardiologists. Despite these risks, effective protective measures—such as suspended lead ceilings, curtains, and specialized eyewear—can reduce radiation exposure to near-zero levels. In some fields, like interventional cardiac electrophysiology, a groundbreaking near-zero radiation approach using non-fluoroscopic methods has been created, eliminating radiation exposure and alleviating orthopedic stress and operational discomfort. The race to zero radiation in interventional cardiology is ongoing. Review Tue, 05 Nov 2024 00:00:00 GMT AndreaBorghini, Tue, 05 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101236 https://www.explorationpub.com/Journals/ec/Article/101237 Pregnancy complications such as pre-eclampsia, gestational diabetes, and intrauterine growth restriction (IUGR) not only present immediate risks to maternal and fetal health but also have long-term implications for the cardiovascular health of offspring. Emerging evidence suggests that these complications may induce epigenetic changes, which in turn predispose offspring to cardiovascular diseases (CVDs) later in life. Epigenetic modifications, including DNA methylation, histone modifications, and non-coding RNA regulation, play crucial roles in fetal development by influencing gene expression without altering the DNA sequence. Aberrant DNA methylation patterns have been observed in offspring exposed to adverse intrauterine environments, affecting genes that regulate blood pressure, lipid metabolism, and inflammation, key factors in CVDs development. Similarly, histone modifications linked to pregnancy complications can disrupt the expression of genes involved in vascular function, contributing to increased cardiovascular risk. Additionally, dysregulation of microRNAs in response to complications like gestational diabetes may influence pathways related to insulin signaling and atherosclerosis. This review synthesizes current knowledge on the epigenetic mechanisms by which pregnancy complications increase CVDs risk in offspring, highlighting potential avenues for early intervention and therapeutic strategies. Understanding these mechanisms could lead to the development of targeted interventions during pregnancy, potentially reducing the intergenerational transmission of cardiovascular risk and improving long-term health outcomes for both mothers and their children. Review Fri, 08 Nov 2024 00:00:00 GMT Kazim RazaTalpur, IqraBano, Muhammad WaleedAbdullah, Fri, 08 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101237 https://www.explorationpub.com/Journals/ec/Article/101238 Ischemic heart disease (IHD) is a major global health issue, frequently resulting in myocardial infarction and ischemic cardiomyopathy. Prompt and precise diagnosis is essential to avert complications such as heart failure and sudden cardiac death. Although invasive coronary angiography remains the gold standard for high-risk patients, noninvasive multimodality imaging is becoming more prevalent for those at low-to-intermediate risk. This review evaluated the current state of multimodality imaging in IHD, including echocardiography, nuclear cardiology, cardiac magnetic resonance imaging (MRI), computed tomography (CT) angiography, and invasive coronary angiography. Each modality has distinct strengths and limitations, and their complementary use provides a comprehensive assessment of cardiac health. Integrating artificial intelligence (AI) into imaging workflows holds promise for enhancing diagnostic accuracy and efficiency. AI algorithms can optimize image acquisition, processing, and interpretation of complex imaging data. Emerging technologies like 4D flow MRI, molecular imaging, and hybrid systems [e.g., positron emission tomography (PET)/MRI, PET/CT] integrate anatomical, functional, and molecular data, providing comprehensive insights into cardiac pathology and potentially revolutionizing the management of IHD. This review also explored the clinical applications and impact of multimodality imaging on patient outcomes, emphasizing its role in improving diagnostic precision and guiding therapeutic decisions. Future directions include AI-driven decision support systems and personalized medicine approaches. Addressing regulatory and ethical challenges, such as data privacy and algorithm transparency, is crucial for the broader adoption of these advanced technologies. This review highlighted the transformative potential of AI-enhanced multimodality imaging in improving the diagnosis and management of IHD. Review Mon, 11 Nov 2024 00:00:00 GMT Praveen KumarChandra Sekar, RamakrishnanVeerabathiran, Mon, 11 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101238 https://www.explorationpub.com/Journals/ec/Article/101251 Age-related atrial fibrillation (AF) is a common condition that has yet to be fully understood, with mechanisms to explain its development under investigation. Notably, cellular senescence, cardiac fibrosis, coronary ischemia, cardiac valvular disease, autonomic dysfunction, channelopathies, and immune system remodeling are processes that have been seen to occur with aging and ample evidence has shown their association with the development of AF. Despite robust therapeutic approaches, the incidence of AF continues to rise, suggesting that the dynamic, multi-faceted interactions leading to AF are incompletely understood. One of the newer mechanisms currently being investigated is the gut microbiome. Although more research is needed to understand its impact on the development of age-related AF and targets for therapies, the gut microbiome is a promising new avenue of research that may provide future benefits in AF prophylaxis or enhanced management. As the field works towards developing this knowledge, there are important questions to answer as to the optimal role of potential gut microbiome targeting therapies and their potential risks versus the benefits they provide. This commentary first summarizes the currently understood mechanisms contributing to age-related AF, which is then followed by an analysis of the current work investigating the role of the gut microbiome in the development of age-related AF, and concludes by highlighting notable questions to consider in future work on the role of the gut microbiome and its relationship to age-related AF. Review Mon, 24 Mar 2025 00:00:00 GMT MichaelLi, EduardoCastañeda, Robert M.Lust, Mon, 24 Mar 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101251 https://www.explorationpub.com/Journals/ec/Article/101252 Aim: Significant tricuspid regurgitation (TR) may be a confounding factor when assessing right ventricular (RV) function with imaging techniques. Global myocardial work (GMW) has been proposed as a non-invasive surrogate of RV pressure–volume loops, and it might provide a more accurate evaluation of RV performance than standard echocardiographic parameters, accounting for both afterload and myocardial work efficiency. The aim of this study was to assess the relationship between RV GMW and hemodynamic indices of prognostic significance in pulmonary hypertension (PH) and to compare RV GMW in PH patients with or without TR. Methods: This was a proof-of-concept study. Thirty consecutive patients with PH undergoing diagnostic right heart catheterization (RHC) in sinus rhythm were enrolled. Echocardiography was performed in all patients within two hours of RHC. Results: Global work efficiency (GWE) was directly correlated (r = 0.562, p = 0.006), whereas global wasted work (GWW) was inversely correlated with stroke volume index (r = –0.447, p = 0.037). Poorer correlation was observed with tricuspid annular plane systolic excursion (TAPSE), and no correlation was observed with TAPSE/sPAP (ratio of TAPSE to systolic pulmonary artery pressure). Patients with moderate/severe TR had lower GWE [83% (77–89%) vs. 96% (94–96%), p < 0.001] and higher GWW [137% (90–179%) vs. 25% (18–89%), p = 0.002]. Similar results were obtained when the analysis was applied to subgroups of patients stratified according to either preserved or poor TAPSE/sPAP. Conclusions: RV myocardial work is more strongly associated with hemodynamic indicators of prognosis in PH than standard echocardiographic parameters. Patients with moderate/severe TR have significantly lower values of work efficiency and higher values of wasted work as compared to those without significant TR. Original Article Wed, 23 Apr 2025 00:00:00 GMT MauroAcquaro, ClaudioDi Lorenzo, LauraScelsi, AnnalisaTurco, AlessandraGreco, CarmineSpirito, BeatricePasotti, SandraSchirinzi, CatherineKlersy, GuidoTavazzi, StefanoGhio, Wed, 23 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101252 https://www.explorationpub.com/Journals/ec/Article/101253 Preterm birth, defined as delivery before 37 weeks of gestation, represents a global health concern linked to substantial cardiovascular risk later in life. Individuals born preterm, especially at earlier gestational ages, exhibit increased rates of hypertension, heart failure, and ischemic heart disease. The underlying mechanisms include disrupted fetal programming, impaired vascular remodeling, chronic neonatal inflammation, neuroendocrine immaturity, and epigenetic alterations. This review synthesizes current epidemiological evidence from large cohort studies and meta-analyses, integrating mechanistic insights from developmental biology. We discuss distinct prematurity categories—extremely preterm (< 28 weeks), very preterm (28–32 weeks), and moderate to late preterm (33–37 weeks)—highlighting their association with graded cardiovascular risk. Recent findings emphasize the role of non-transmitted parental genes and prenatal environmental toxic metal exposure as additional critical factors influencing fetal cardiovascular programming. A total of 57 articles, identified through a systematic search of PubMed, Embase, and Cochrane databases, were included to address these topics comprehensively. Early identification of preterm-born individuals as a high-risk cardiovascular group is essential for targeted screening, prevention, and interventions from childhood into adulthood. Future studies leveraging multi-omics and epigenetic approaches will further clarify these mechanisms, informing evidence-based guidelines to reduce cardiovascular morbidity associated with preterm birth. Review Wed, 23 Apr 2025 00:00:00 GMT LuisianaStolfi, Marco FabioCostantino, FrancescaCortese, GianpaoloD’Addeo, SimonaPesce, Wed, 23 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101253 https://www.explorationpub.com/Journals/ec/Article/101254 Aim: Evaluate the role of myocardial work by echocardiography and determine its utility as an early diagnosis of cardiotoxicity. Methods: Single-center included 180 patients over 18 years old undergoing chemotherapy, the definition of cardiotoxicity for this study was to observe a left ventricular ejection fraction (LVEF) less than 50% and, or a global longitudinal strain (GLS) less than 16%. With these parameters, we divided the population into two groups, with cardiotoxicity and without cardiotoxicity. ROC curves were performed to determine the best cut-off point for global myocardial work to define cardiotoxicity. 2 × 2 tables were made to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Results: Cardiotoxicity was established by obtaining cutoff points for global myocardial work index (GWI) with values lower than 1,381.5 mmHg%, Global Constructive Work (GCW) of 1,722 mmHg%, and myocardial efficiency [Global Work Efficiency (GWE)] of 88.5%, with a sensitivity (58.8%, 65.6%, and 52.9%) and specificity (91.8%, 82.1%, and 89.6%) respectively. Conclusions: We propose the measurement of myocardial work as a diagnostic tool for cardiotoxicity, as it has good specificity and negative predictive value, serving as an early diagnostic tool for cardiotoxicity without waiting for a decrease in LVEF and without being a marker influenced by loading conditions, in patients undergoing antineoplastic treatment. Original Article Sun, 27 Apr 2025 00:00:00 GMT DeniseCortes-Pérez, DianaRomero-Zertuche, GabrielaRodríguez-Guzmán, ItzelCalixto-Guízar, CarlosMartínez-Hernández, Sun, 27 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101254 https://www.explorationpub.com/Journals/ec/Article/101255 Tuberculosis (TB) continues to pose a significant public health burden in endemic regions, remaining a leading cause of morbidity and mortality. Although TB is associated with a range of complications, the occurrence of intracardiac thrombus is an exceptionally rare manifestation. We report the case of a 62-year-old male with active pulmonary TB, who had been on anti-tubercular therapy for one month and presented with recurrent syncope and exertional dyspnea. Transthoracic 2D echocardiography revealed a large, mobile thrombus in the left ventricular apex. Evaluation for underlying hypercoagulable states was unremarkable. The patient was managed with anticoagulation therapy in conjunction with ongoing anti-tubercular treatment. This case underscores the importance of clinical vigilance for rare thrombotic complications in TB to facilitate timely diagnosis and appropriate management. Case Report Wed, 30 Apr 2025 00:00:00 GMT AmitKumar, AmanDubey, YogeshSanwaria, ShwetaTanwar, Wed, 30 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101255 https://www.explorationpub.com/Journals/ec/Article/101256 An electrocardiogram (ECG) is a vital diagnostic tool used during cardiac imaging stress testing to evaluate the heart’s electrical activity under stress conditions. This combination of ECG and stress imaging testing provides comprehensive insights into cardiac function, particularly in detecting coronary artery disease (CAD) and assessing overall heart health. An ECG continuously monitors the heart’s electrical signals, capturing data on heart rate, rhythm, and electrical conduction patterns. The value of the ECG in this context lies in its ability to detect ischemic changes, which occur when there is insufficient blood flow to the heart muscle due to narrowed or blocked coronary arteries, but also for coronary vasospasm or coronary microvascular disease. Specific ECG changes, such as ST-segment depression or elevation, and the appearance of arrhythmias, can indicate myocardial ischemia. These findings, when correlated with symptoms like chest pain or shortness of breath during the test, may provide strong evidence for CAD even in the absence of diagnostic abnormality of cardiac imaging with regional wall motion or perfusion changes. Additionally, the ECG helps identify other conditions that may manifest under stress, such as arrhythmias or conduction abnormalities, which might not be apparent at rest. The ECG’s role extends beyond diagnosis. It helps stratify patients based on their risk of adverse cardiac events. For example, an abnormal ECG during a negative cardiac stress imaging test can suggest an increased likelihood of coronary calcification or abnormal coronary flow reserve and increased risk in the long term for cardiac events. In summary, the ECG is a valuable component of cardiac imaging stress testing. It provides real-time, non-invasive monitoring of the heart’s electrical activity under stress, aiding in the diagnosis and risk assessment of CAD and other cardiac conditions. This enhances patient management by guiding treatment decisions and preventive strategies. Mini Review Wed, 07 May 2025 00:00:00 GMT EmmaCerracchio, EttoreCampagnano, BrunoVillari, QuirinoCiampi, Wed, 07 May 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101256 https://www.explorationpub.com/Journals/ec/Article/101259 Aim: The efficacy of composite valve graft (CVG) versus stentless aortic root replacement (SARR) in patients with aortic valve and root pathologies remains a subject of debate. This study aims to analyze the in-hospital outcomes and long-term survival of these two surgical approaches. Methods: A retrospective analysis was conducted on 594 patients who underwent ARR between July 2003 and December 2023. Of these, 346 received a stentless aortic root and 248 CVG (100 biological and 148 mechanical). Propensity score matching (PSM) was utilized to create well-balanced cohorts based on preoperative demographics and intraoperative characteristics. Univariable and multivariable regression analyses were performed to evaluate in-hospital mortality and long-term survival rates. Kaplan-Meier curves were constructed to visualize survival outcomes. Results: After PSM, 212 patients in each group were well-balanced in terms of baseline characteristics. The analysis of in-hospital outcomes revealed no significant differences between the SARR and CVG groups for key outcomes except neurological complications that were consistently higher in the CVG group, with a significant difference observed in both unmatched (8.4% vs. 4.9%, P = 0.014) and matched cohorts (8.5% vs. 4.3%, P = 0.022). Long-term survival analysis in the matched cohorts demonstrated a statistically significant survival advantage for the SARR group, with a 20-year survival rate of 54% compared to 47% for the CVG group (log-rank P value of 0.047). Further analysis by specific graft type within the matched groups suggested that xenografts might offer a significant survival advantage (log-rank P value of 0.009). Conclusions: While SARR and CVG provided similar in-hospital outcomes, SARR, particularly xenografts, demonstrated a significant long-term survival advantage. Xenografts may be a preferable option for patients, especially those with longer life expectancies, due to their durability and reduced need for anticoagulation. Original Article Fri, 30 May 2025 00:00:00 GMT MariaComanici, Mohammad YousufSalmasi, FabioDe Robertis, ToufanBahrami, Sunil K.Bhudia, Jullien A.Gaer, Shahzad G.Raja, Fri, 30 May 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101259 https://www.explorationpub.com/Journals/ec/Article/101258 Aim: Atherosclerosis and diabetes mellitus (DM) often lead to severe conditions, such as acute ischemic stroke (AIS), cardiovascular disease (CVD), and chronic kidney disease (CKD). Some cancers are also associated with atherosclerosis. Therefore, identifying novel autoantibody biomarkers associated with atherosclerosis-related conditions is crucial for improving early diagnosis and risk assessment. Methods: We used an array of 9,480 proteins to detect IgG antibodies in the serum of patients with atherosclerosis. Following this screening, we quantified the antibody levels using an amplified luminescent proximity homogeneous assay-linked immunosorbent assay (AlphaLISA) with recombinant antigen proteins. Results: Ubiquitin conjugating enzyme E2 E3 (UBE2E3) was identified as a candidate antigen recognized by IgG antibodies in the sera of individuals diagnosed with atherosclerosis. Compared with healthy donors, significantly higher serum antibody levels against UBE2E3 were found in patients with AIS, DM, CVD, CKD, esophageal cancer (EC), and gastric cancer (GC), but not in those with colorectal cancer (CRC). Receiver operating characteristic (ROC) analysis revealed that the higher areas under the ROC curves for anti-UBE2E3 antibodies were observed in DM- or nephrosclerosis-associated CKD than in the others. Spearman’s correlation analysis revealed that serum anti-UBE2E3 antibody (s-UBE2E3-Ab) levels were associated with the plaque score, maximum intima-media thickness, and cardio-ankle vascular index, which are typical indices of atherosclerosis and stenosis. In the survival analysis of GC and CRC, patients who were s-UBE2E3-Ab-positive had significantly poorer prognoses than patients who were s-UBE2E3-Ab-negative. The difference became more prominent when s-UBE2E3-Abs were combined with anti-differential screening-selected gene aberrant in neuroblastoma antibody (DAN-Ab) or sclerostin domain-containing protein 1 (SOSTDC1), which are bone morphogenetic protein (BMP) antagonists. Conclusions: The s-UBE2E3-Ab marker is highly associated with atherosclerosis-related diseases, such as AIS, CVD, DM, CKD, and digestive tract cancers, suggesting the involvement of BMP signals. Original Article Fri, 30 May 2025 00:00:00 GMT TakakiHiwasa, YoichiYoshida, MasaakiKubota, Bo-ShiZhang, Shu-YangLi, TomooMatsutani, SeiichiroHirono, MinoruTakemoto, KatsuroIwase, SeiichiroMine, ToshioMachida, YoshioKobayashi, HirotakaTakizawa, MasaakiIto, SatoshiYajima, HideakiShimada, KoutaroYokote, YoshinoriHiguchi, Fri, 30 May 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101258 https://www.explorationpub.com/Journals/ec/Article/101257 Analysis of intraventricular pressure gradients has gained interest due to the recent development of a new method of image analysis based on cardiac magnetic resonance feature tracking or echocardiographic speckle tracking. Currently, images acquired from routinely performed cardiac magnetic resonance or echocardiography can be analyzed, and the left ventricular hemodynamic forces (HDF) curves generated and displayed for measurements. This modality has been applied in clinical scenarios and normal reference values are available. However, different parameters have been derived in the available studies on HDF, and there is no standardization on which parameters should be reported. In this short review, we describe how to assess HDF and discuss the different parameters that can be derived from the HDF curves. Perspective Wed, 28 May 2025 00:00:00 GMT AlessandroSalustri, GiovanniTonti, AizhanZhankorazova, NurmakhanZholshybek, BauyrzhanToktarbay, ZaukiyaKhamitova, DinaraJumadilova, Wed, 28 May 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101257 https://www.explorationpub.com/Journals/ec/Article/101260 Aim: Coronary heart disease (CHD) has been the leading cause of death worldwide for several decades. Non-alcoholic fatty liver disease (NAFLD), the most common liver pathology, is considered a risk factor (RF) for the development of CHD and a predictor of an unfavourable prognosis. Our study aimed to compare cardiometabolic parameters in patients with CHD with and without NAFLD. Methods: The study prospectively included 85 patients with CHD, 61 with NAFLD (group I) and 24 without NAFLD (group II). In both groups, a comparative analysis of RF, anthropometric parameters, lipidogram, glycemic profile, brachiocephalic arteries (BCA) ultrasound (USD), and heart structural and geometric parameters according to echocardiography (EchoCG) and coronary calcium (CC) parameters was performed. Results: Patients with CHD and NAFLD had statistically significantly higher levels of total cholesterol, very low-density lipoproteins, triglycerides, insulin, heart structural parameters, and CC. Conclusions: Thus, the relationship between NAFLD and CHD is two-way, and liver diseases can exacerbate the course of cardiovascular diseases (CVD). Original Article Thu, 12 Jun 2025 00:00:00 GMT Dilnora B.Yusupalieva, Rano B.Alieva, Ulugbek I.Nizamov, Aleksandr B.Shek, ShoxistaAxmedova, NargizaNurillaeva, Surayyo M.Shukurdjanova, Thu, 12 Jun 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101260 https://www.explorationpub.com/Journals/ec/Article/101261 Cardiac papillary fibroelastoma (CPF) is a rare, benign cardiac tumor with a significant risk for embolic complications, most notably ischemic stroke. This paper presents a case of a 54-year-old woman with cryptogenic stroke ultimately attributed to a CPF on the aortic valve, discovered via transesophageal echocardiography (TEE) after an initial unremarkable transthoracic study. Following diagnosis, the patient was treated with anticoagulation and scheduled for surgical excision. Although often asymptomatic, CPF can present with life-threatening embolic events, underscoring the importance of timely diagnosis through high-resolution imaging, particularly TEE. Surgical excision remains the definitive treatment in symptomatic or high-risk cases, but management of incidental, asymptomatic tumors remains controversial due to the absence of formal guidelines. This paper emphasizes the need for heightened clinical suspicion of CPF in cryptogenic stroke and advocates for individualized treatment approaches based on tumor characteristics and embolic risk. Case Report Thu, 12 Jun 2025 00:00:00 GMT SahilSabharwal, Eunhae HannahBae, Dahae HaileyBae, PradeepKumbham, TylerTroutman, SarahAssem, Thu, 12 Jun 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101261 https://www.explorationpub.com/Journals/ec/Article/101262 Peripartum cardiomyopathy (PPCM) is a rare condition characterized by heart failure secondary to left ventricular systolic dysfunction, occurring in women during the last trimester of pregnancy or within five months postpartum. Despite advancements in research, PPCM remains a life-threatening disorder associated with significant maternal morbidity and mortality. The primary clinical manifestations of PPCM result from heart failure due to impaired left ventricular systolic function. This article reviews the epidemiology, etiology, diagnostic criteria, management strategies, and outcomes of PPCM. Additionally, we present a case of a 34-year-old woman with PPCM who achieved full recovery within nine months, underscoring the importance of early recognition, prompt treatment, standardized medication, and regular follow-up. Case Report Mon, 07 Jul 2025 00:00:00 GMT JingwenGuo, XueyingWang, Mon, 07 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101262 https://www.explorationpub.com/Journals/ec/Article/101263 We report the case of a 58-year-old patient with chronic ischemic syndrome who underwent dipyridamole stress echocardiography for the evaluation of chest pain. The stress test was negative with normal coronary flow velocity reserve, preserved chronotropic competence, and no inducible wall motion abnormalities. However, upon administration of aminophylline at the end of the test, the patient developed acute chest pain, ST-segment elevation, and severe apical wall motion abnormalities. These findings resolved with intravenous nitrates. Subsequent coronary angiography revealed a significant vasospastic stenosis in the left anterior descending artery superimposed on a mild organic stenosis of around 50% after intracoronary nitrates. The coronary stenosis was successfully treated with a drug-eluting stent. This case highlights the potential for vasospastic angina to be unmasked following vasodilator reversal, even after a negative stress echocardiography. Case Report Mon, 14 Jul 2025 00:00:00 GMT LauroCortigiani, DavideDonelli, FrancescoBovenzi, Mon, 14 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101263 https://www.explorationpub.com/Journals/ec/Article/101266 We report a rare case of non-ischemic cardiomyopathy in a 62-year-old female with mucous membrane pemphigoid following rituximab therapy. The patient presented with dyspnea and chest pain, and cardiac evaluation-including transthoracic echocardiogram and nuclear medicine stress testing-revealed left ventricular dysfunction without evidence of ischemia. Given the temporal association and absence of other etiologies, rituximab was suspected as the causative agent. This case emphasizes the importance of recognizing the potential cardiotoxic effects of biological agents used in autoimmune disease management and supports the consideration of cardiac surveillance in at-risk patients receiving rituximab. Case Report Fri, 25 Jul 2025 00:00:00 GMT JasVirk, DavidNotman, VinayThohan, Fri, 25 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101266 https://www.explorationpub.com/Journals/ec/Article/101264 Fungal endocarditis (FE) is still an uncommon but devastating infection, especially when immunosuppression, prosthetic valve surgery, or prolonged health care is involved. Although being only responsible for 1–6% of infective endocarditis cases, the mortality rate is higher than 40–60% due to the time lag from diagnosis and therapeutic complexity. Etiology is led by Candida species, especially Candida albicans, followed by Aspergillus, and new pathogens like multidrug-resistant Candida auris are also seen. Non-C. albicans and the biofilm-forming species also add more complexity to the manageability. Diagnosis is challenging due to the high percentage of culture-negative cases, particularly for molds, requiring sophisticated investigations such as fungal biomarkers (β-D-glucan, galactomannan), molecular tests, and imaging studies such as 18F-FDG PET/CT (fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography). Early transesophageal echocardiography is crucial in the diagnosis of vegetations, whereas histopathology of resected non-cardiac tissue offers a definitive diagnosis. Treatment requires aggressive antifungal therapy, echinocandins, amphotericin B, or azoles, in conjunction with urgent valve surgery to reduce embolic risk and enhance survival. However, drug resistance, biofilm resistance, and patient comorbidities counteract the efficacy. Novel treatments such as rezafungin and ibrexafungerp are promising but have limited clinical hands-on evidence. Risk factors of immunosuppression, indwelling devices, and IV drug use imply a need for increased clinical suspicion in high-risk groups. Although there have been minor improvements in FE survival, the grim situation of FE persists, highlighting the importance of a multidisciplinary approach, early diagnosis, and tailored antifungal therapy to control this deadly infection. Review Wed, 23 Jul 2025 00:00:00 GMT SudeepEdpuganti, Wed, 23 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101264 https://www.explorationpub.com/Journals/ec/Article/101265 We aim to describe a unique case of a desmoplakin gene mutation with refractory ventricular arrhythmia and cardiomyopathy. We describe a 29-year-old man hospitalized for chest pain and cardiomyopathy, who subsequently developed ventricular arrhythmia that was refractory to multiple antiarrhythmic agents, ablation, immunotherapy, and sympathectomy. Diagnostic studies included coronary catheterization, cardiac MRI, and endomyocardial biopsy. He underwent placement of an Impella 5.5 temporary mechanical support device for multi-organ failure; eventually requiring a Heartmate 3 left ventricular assist device. This report details how cardiac MRI, endomyocardial biopsy, and genetic testing are crucial diagnostic modalities when assessing patients with refractory arrhythmias or myocarditis. Pathogenic variants in the desmoplakin gene can be associated with significant morbidity in patients and require multidisciplinary care from cardiology, electrophysiology, advanced heart failure, and cardiac surgery. Arrhythmogenic cardiomyopathies should be considered for patients suffering repeated episodes of myocarditis or refractory ventricular arrhythmias. We utilized various criteria of functional, electrocardiographic, arrhythmic, tissue characterization, and genetic findings to establish the diagnosis of arrhythmogenic cardiomyopathy, which will be discussed later in this paper. Case Report Wed, 23 Jul 2025 00:00:00 GMT JasVirk, DavidNotman, VinayThohan, Wed, 23 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101265 https://www.explorationpub.com/Journals/ec/Article/101267 Scientific evidence seems to indicate that, in males, intense and prolonged endurance sport can favor the onset of atrial fibrillation. A plausible explanation may be the impact that intense endurance sports produce on the three vertices of Coumel’s triangle. However, genetics is probably also involved in translating this impact into an arrhythmic phenotype. On a management level, the first task of the cardiologist is to exclude the presence of structural heart disease, channelopathy, endocrine and/or electrolyte disorders, and substance use. As for the treatment of arrhythmia, the “CARE” paradigm proposed by the latest ESC guidelines should probably be accompanied by detraining, although this suggestion is often rejected by the athlete. Anticoagulant therapy, where indicated, must take into account the risk of trauma that the sport entails, even if the particular pharmacodynamics/pharmacokinetics of DOACs should allow training/competition to take place when the anticoagulant effect of the previous administration has completely or almost completely worn off. Mini Review Wed, 30 Jul 2025 00:00:00 GMT MarcelloCostantini, Marcelo VictorElizari, MarioPrevitali, LuigiSciarra, FrancoLuzza, LorenzoCostantini, VincenzoCarbone, MicheleMaffia, Wed, 30 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101267 https://www.explorationpub.com/Journals/ec/Article/101268 Our cells and, therefore, our organism, need energy to function at their best, which is mainly produced by mitochondria. These intracellular organelles generate energy from food macromolecules across the Krebs cycle by oxidative phosphorylation. Energy is developed by converting adenosine triphosphate (ATP) to adenosine diphosphate (ADP). It is essential, for adequate mitochondrial energy production in the form of ATP, to have the right number of well-functioning mitochondria and the right amount of oxygen (O2) available. Unfortunately, the aging process and the chronic diseases that arise over the years are associated with a reduction in the number of mitochondria and their insufficient functioning. Among the chronic diseases related to significant damage of the arteries with a reduction in the supply of O2, there is atherosclerosis, where the process of atherothrombosis occurs. To keep our organs well-functioning despite aging, we must therefore protect our mitochondria and arteries. This can be achieved by intervening early in prevention with a lifestyle correction and diet integration with effective natural substances or, in some cases, with drugs. Among the many natural substances that have good scientific support, we have chosen four that have demonstrated benefits in the absence of side effects and that we know best: quercetin and pyrroloquinoline quinone to stimulate mitochondrial biogenesis and mitophagy, while L-arginine and nattokinase to protect the arteries from atherothrombosis. Review Fri, 08 Aug 2025 00:00:00 GMT SerafinoFazio, ValeriaFazio, FloraAffuso, Fri, 08 Aug 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101268 https://www.explorationpub.com/Journals/ec/Article/101269 We present the electrocardiogram (ECG) of an elderly woman with Mobitz II atrioventricular (AV) block, left bundle branch block (LBBB), and ventricular ectopic activity. At first glance, the ECG may give the misleading impression of Wenckebach periodicity and raise the suspicion of intermittent left anterior fascicular block (LAFB) and left posterior fascicular block (LPFB), suggesting an apparent alternating conduction block in the main divisions of the LBB. This intriguing appearance prompted us to present the case. Case Report Tue, 26 Aug 2025 00:00:00 GMT MarcelloCostantini, MarioPrevitali, LorenzoCostantini, PasqualeCaldarola, Marcelo VictorElizari, Tue, 26 Aug 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101269 https://www.explorationpub.com/Journals/ec/Article/101270 Aim: To assess the incidence and predictors of hypertensive response to exercise (HRE) of blood pressure during stress echocardiography (SE) with physical exercise in patients with known or probable coronary artery disease, and the effect of HRE on the results of the five-step SE. Methods: The single-center study included 193 patients who underwent ABCDE-SE. The incidence of HRE, predictors of its occurrence, and the relationship with positive results of the study protocol steps were investigated. Results: HRE was detected in 36.3% of patients (70 patients) and occurred more frequently during the bicycle ergometer test (p = 0.027). Patients with HRE had a significantly lower peak wall motion score index (p = 0.050) and achieved a preload ratio (p = 0.035), as well as higher left anterior descending coronary artery (LAD) blood flow velocity at rest and during exercise (p = 0.009 and p = 0.008, respectively). They also showed higher peak left ventricular (LV) contractile reserve and force (p = 0.002 and p = 0.006). Reduced contractile reserve was less common in patients with HRE (p = 0.013). Predictors related to HRE development were identified: history of LAD stenting, thickness of the LV posterior wall, LAD blood flow velocity, and normal LV force at rest (p = 0.006, p = 0.022, p = 0.004, and p = 0.003, respectively), as well as a positive step C (p = 0.005). Conclusions: The prevalence of HRE, its predictors, and the relationship with the ABCDE-SE results were revealed. The correlation between blood pressure response to exercise and SE steps, as well as its prognostic significance, needs further study. Original Article Thu, 28 Aug 2025 00:00:00 GMT Tatiana MichailovnaTimofeeva, Ayten FuadovnaSafarova, Zhanna DavidovnaKobalava, Thu, 28 Aug 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101270 https://www.explorationpub.com/Journals/ec/Article/101271 Resistant Kawasaki has been associated with the aggressive development of large coronary aneurysms, despite prompt treatment. In this paper, we present an infant who presented with resistant Kawasaki. Although initially he seemed to defervesce after the initial administration of intravenous immunoglobulin, he developed a new onset of fever, requiring a repeat dose of immunoglobulin. Coronary aneurysms developed rapidly, necessitating a second dose of immunoglobulins and second-line treatments such as anakinra and infliximab. High titers of COVID-19 antibodies have been a confounding factor in the management of that child, as the alternative diagnosis of multisystem inflammatory syndrome in children (MIS-C) was considered. Finally, the clinical and laboratory values were more in keeping with MIS-C. Case Report Mon, 22 Sep 2025 00:00:00 GMT AndrianaAnagnostopoulou, NikolaosAndreou, ElenaTsitsami, MariaTsinti, Nikolaos GEleftherakis, Mon, 22 Sep 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101271 https://www.explorationpub.com/Journals/ec/Article/101272 Phrenic nerve palsy (PNP) is a recognized complication of cryoballoon ablation (CBA) for atrial fibrillation (AF), particularly during the ablation of the right superior pulmonary vein (RSPV). We report the case of an 80-year-old female with a history of hypertension, who was admitted for CBA of paroxysmal AF. Despite optimal medical treatment with amiodarone, the patient experienced recurrent episodes of AF, prompting the decision to proceed with CBA. During the procedure, while isolating the RSPV, diaphragmatic movement was significantly weakened after 92 seconds of cryoablation at a temperature of –52°C. Immediate cessation of the procedure and intravenous methylprednisolone were administered, resulting in partial recovery of diaphragmatic movement. However, when the procedure resumed, diaphragmatic movement once again diminished, and despite further steroid treatment, the movement did not recover by discharge. The patient remained asymptomatic with stable oxygen saturation, and no respiratory distress was noted. At a six-month follow-up, the patient reported no symptoms of chest tightness or shortness of breath, and her general condition remained stable, although diaphragmatic movement had not fully recovered, indicating partial functional compensation. This case underscores the importance of continuous phrenic nerve monitoring during CBA, early detection of complications, and appropriate management to prevent irreversible injury, highlighting the need for careful procedural planning and postoperative follow-up in elderly patients with comorbidities. Case Report Mon, 22 Sep 2025 00:00:00 GMT WeiYu, WenPan, HaixiangXu, JianhuaFan, Mon, 22 Sep 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101272 https://www.explorationpub.com/Journals/ec/Article/101273 We report the case of a 58-year-old woman who developed typical chest pain following intravaginal administration of misoprostol, used routinely as a premedication before a hysteroscopy. Misoprostol is a synthetic prostaglandin E1 analogue widely employed for cervical softening and the medical management of an incomplete abortion, and is generally considered safe. The chest pain was accompanied by transient, severe ST-segment elevation (up to 6 mm) in the inferior and inferolateral electrocardiogram (ECG) leads, which resolved promptly after sublingual nitrate administration. A hyperventilation test (5 minutes at 30 breaths per minute) demonstrated a paradoxical reduction in peak diastolic flow velocity in the mid-to-distal left anterior descending coronary artery. Invasive coronary angiography showed smooth, angiographically normal coronary arteries, but provocation with intracoronary acetylcholine induced complete vasospasm of the left circumflex artery. This case underscores the importance of recognizing vasospastic angina even in non-cardiology settings. It highlights the value of targeted noninvasive and invasive diagnostic testing to confirm this often overlooked, underdiagnosed, and undertreated condition. Case Report Mon, 29 Sep 2025 00:00:00 GMT EttoreCampagnano, EmmaCerracchio, EugenioLaurenzano, NicoleCarabetta, BrunoVillari, QuirinoCiampi, Mon, 29 Sep 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101273 https://www.explorationpub.com/Journals/ec/Article/101276 A left ventricular pseudoaneurysm typically occurs as a result of myocardial infarction, blunt chest trauma, or cardiac surgery (typically coronary artery bypass grafting or mitral valve replacement). Pseudoaneurysms form due to left ventricular free wall rupture that is contained by the pericardium, not the myocardial wall, as is the case with a true aneurysm. Pseudoaneurysms have the tendency to expand rapidly as opposed to true aneurysms due to the weakness of the pericardium or fibrous tissue in comparison to myocardial tissue. This case presents a 63-year-old male found to have a very large left ventricular pseudoaneurysm measuring 8 × 7 × 5 cm. The vast majority of left ventricular pseudoaneurysms enlarge with worsening symptomatology and eventual rupture if not surgically repaired. Rarely, large pseudoaneurysms treated conservatively can lead to the gradual resolution of a patient’s symptoms and normalization of right ventricular function. The purpose of this case report is to describe the clinical course and outcomes of a patient with a large left ventricular pseudoaneurysm managed conservatively, thereby contributing to the limited medical data regarding the prognosis and long-term outcomes in this high-risk population. Case Report Thu, 16 Oct 2025 00:00:00 GMT DavidNotman, JasVirk, VinayThohan, Thu, 16 Oct 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101276 https://www.explorationpub.com/Journals/ec/Article/101275 Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, highlighting the necessity for better diagnostic modalities. Artificial intelligence (AI) and machine learning (ML) are increasingly being used with multimodal cardiovascular diagnostic testing to provide standardized and reproducible assessment methodologies that have been shown to detect subtle signals beyond human recognition. This state-of-the-art review will summarize the various applications of AI across key modalities: describing its use in electrocardiography to risk-stratify patients; in coronary computed tomography angiography (CCTA) for quantitative plaque and stenosis measurements as well as measuring fractional flow reserve (FFR) derived from imaging; in cardiac magnetic resonance imaging (MRI) to automatically segment cardiac chambers and characterize tissue; and in intracoronary imaging [specifically intravascular ultrasound (IVUS) and optical coherence tomography (OCT)], where automation is evolving. We will also discuss combining these sources of data through clinical decision support systems (CDSS) that can enhance the comprehensive evaluation of IHD. We anticipate several issues for implementation, including validation, regulation, transparency, and clinical integration. Overall, AI can help reduce the number of time-consuming manual measurements used to augment quantitative features of an assessment and improve physiology-based decision-making. However, there were marked differences in performance based on the task and dataset, and AI was not always better than the human experts. Ultimately, AI must be validated prospectively, must be generalizable, and reported transparently for safe adoption in IHD care globally. Review Thu, 16 Oct 2025 00:00:00 GMT MarekTomala, Thu, 16 Oct 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101275 https://www.explorationpub.com/Journals/ec/Article/101278 Background: Cardiac computed tomography (CT) has evolved from an anatomic test to a platform that quantifies functional, inflammatory, and tissue-characterization biomarkers. We synthesized evidence on the diagnostic and prognostic value of CT-based biomarkers. Methods: Systematic review of 29 human studies (2015–2025) appraising low-attenuation plaque (LAP), perivascular fat attenuation index (FAI/PCAT), total/non-calcified plaque burden, epicardial adipose tissue, CT-derived fractional flow reserve (FFR-CT), and CT myocardial perfusion. Study quality was assessed with risk of bias (RoB) 2.0, Newcastle-Ottawa Scale (NOS), and AMSTAR 2. Results: CT biomarkers extended risk assessment beyond stenosis severity. LAP burden > 4% predicted myocardial infarction (MI) [hazard ratio (HR) 4.65; 95% CI 2.06–10.5] and per-doubling LAP predicted MI (HR 1.60; 95% CI 1.10–2.34). Perivascular FAI/PCAT showed independent prognostic value: high FAI was associated with ~2-fold higher cardiac mortality (derivation HR 2.15, validation HR 2.06), and RCA PCAT ≥ −70.5 Hounsfield unit (HU) predicted MI (HR 2.45) with additive risk when combined with high-risk plaque (HRP) features (reported up to ~6-fold vs. reference). FFR-CT achieved up to 81% diagnostic accuracy (sensitivity ~86%, specificity ~79%) vs. invasive FFR, improving specificity over CTA alone. Emerging metrics (e.g., total plaque volume, CT perfusion) demonstrated incremental discrimination in selected cohorts, though standardization remains variable. Discussion: CT-based biomarkers provide measurable diagnostic and prognostic information on coronary anatomy, function, inflammation, and tissue health. Priorities include standardized acquisition/analysis, multicenter validation, and integration into decision pathways to optimize individualized risk stratification and therapy. Systematic Review Thu, 23 Oct 2025 00:00:00 GMT Mubariz AhmedHassan, MohammedMhanna, AshrafAlzahrani, Muhammad AdilAfzal, OlaAbdelkarim, RodrigoBello, PauloSavoia, PrompornSuksaranjit, Joao A. C.Lima, KimberlyDelcour, Thu, 23 Oct 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101278 https://www.explorationpub.com/Journals/ec/Article/101277 The diagnosis of acute myocarditis requires the exclusion of coronary artery disease (CAD). Coronary CTA (computed tomography angiography) is usually used to evaluate the coronary arteries in young patients. However, the use of coronary CTA for the diagnosis of myocarditis has been rarely reported. Here we present a Han male clinical myocarditis patient who was 18 years old, had a focus of enhancement in the subcardia, and predominantly involving the lateral wall of the left ventricle with iodinated contrast in coronary CTA. The patient was diagnosed with myocarditis. Immunoglobulin, vitamin C antioxidant, and myocardial nutrition were given to the patient for treatment. During follow-up, the patient’s myocardial enzymes gradually decreased to normal, and the original symptoms disappeared. As a non-invasive rapid examination method that can evaluate coronary artery and myocardial lesions at the same time, the utility of myocardial delayed enhancement on CTA may warrant further investigation. Case Report Thu, 23 Oct 2025 00:00:00 GMT ZhuyuanLiu, YanjuanWang, Thu, 23 Oct 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101277 https://www.explorationpub.com/Journals/ec/Article/101279 Cardiovascular aging is characterized by progressive endothelial dysfunction and arterial stiffening, two interrelated processes underlying the increased risk of hypertension, coronary artery disease, heart failure, and atrial fibrillation in older individuals. Endothelial dysfunction results from reduced nitric oxide bioavailability, increased oxidative stress, chronic low-grade inflammation, and accumulation of senescent endothelial cells that secrete pro-inflammatory mediators. In parallel, structural alterations of the vascular wall, including elastin fragmentation, collagen deposition, cross-linking by advanced glycation end products, vascular smooth muscle cell phenotypic switching, and calcification, lead to increased stiffness and impaired vascular compliance. These maladaptive changes reinforce one another, creating a vicious cycle in which dysfunctional endothelium accelerates stiffening, while mechanical alterations in turn amplify endothelial injury. Molecular pathways involving NADPH oxidases, mitochondrial dysfunction, NF-κB, JAK/STAT, AMPK, mTOR, sirtuins, and epigenetic regulators integrate oxidative, inflammatory, and metabolic signals that shape vascular aging. Clinically, endothelial dysfunction and vascular stiffness predict cardiovascular events independent of traditional risk factors and serve as emerging biomarkers of biological vascular age. Established therapies such as statins, renin-angiotensin system blockade, structured exercise, and dietary interventions improve vascular function, while novel approaches targeting senescence and redox imbalance are under investigation. Understanding these mechanisms provides opportunities to mitigate vascular aging and extend cardiovascular health span. Review Fri, 07 Nov 2025 00:00:00 GMT Muhammet CihatÇelik, MacitKalçık, AbdülmelikBirgün, MucahitYetim, LütfüBekar, YusufKaravelioğlu, Fri, 07 Nov 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101279 https://www.explorationpub.com/Journals/ec/Article/101282 Infective endocarditis (IE) remains a challenging diagnosis, particularly in patients with prosthetic valves, cardiac implantable electronic devices (CIEDs), or nonspecific presentations. With rising rates of healthcare-associated and device-related infections, the need for earlier and more reliable diagnosis has become increasingly important. Multimodality imaging now plays a central role in confirming IE, identifying complications, and guiding management. Echocardiography is the initial test of choice, with transesophageal echocardiography (TEE) offering better sensitivity for vegetations, leaflet perforation, and periannular extension, though its limitations in prosthetic valve endocarditis (PVE) have led to greater reliance on other modalities. Cardiac computed tomography (CT) provides detailed anatomical information that can reveal abscesses, pseudoaneurysms, and prosthetic dehiscence, and is frequently used for surgical planning. Functional imaging with 18F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) and white blood cell single-photon emission CT/CT (WBC-SPECT/CT) improves diagnostic accuracy in PVE and CIED infections while also detecting systemic embolic events. Brain magnetic resonance imaging (MRI) has become an important tool to uncover neurologic complications, including silent emboli and mycotic aneurysms. This review summarizes the strengths and limitations of each modality, outlines a stepwise approach to imaging decisions, and considers how findings should be incorporated into overall clinical care. This review also highlights surgical indications, evolving antimicrobial strategies, and the future role of standardized imaging protocols. Taken together, thoughtful use of multimodality imaging is critical to improving outcomes in patients with suspected or confirmed IE. Review Wed, 19 Nov 2025 00:00:00 GMT TessCalcagno, JosephEl Roumi, SaberioLo Presti Vega, Tom Kai MingWang, Wed, 19 Nov 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101282 https://www.explorationpub.com/Journals/ec/Article/101280 Pulmonary congestion and coronary microvascular dysfunction are central to hemodynamic adaptation before and after transcatheter aortic valve replacement (TAVR). This perspective proposes an exploratory, physiology-anchored framework that integrates lung ultrasound (LUS) and transthoracic Doppler of the left anterior descending artery (LAD) to track these domains on the same bedside platform. A concise anterior four-site LUS sampling captures early, posture- and stress-dependent interstitial congestion, while LAD Doppler provides a non-invasive window on resting diastolic coronary flow velocity (CFV) and CFV reserve (CFVR). In severe aortic stenosis, valve unloading with TAVR typically reduces filling pressures and restores diastolic coronary flow, though CFV and CFVR responses vary with the balance between myocardial oxygen demand and improved hyperemia. Interpreting these signals alongside standard echocardiographic indices (E/e’, LAVI, SPAP, and Doppler velocity index) ensures physiological coherence and avoids misattribution. Rather than focusing on numeric thresholds, this approach emphasizes trajectories—how B-lines, CFV, and CFVR evolve from baseline to post-TAVR follow-up. Concordant improvement supports decongestion and microvascular recovery, whereas discordance prompts investigation of right-sided or extra-cardiac mechanisms. Readily implemented with existing echocardiographic equipment, the combined LUS-LAD strategy offers a scalable, hypothesis-generating tool to explore pulmonary-coronary interactions, guide decongestive and anti-ischemic therapy, and inform future feasibility and reproducibility studies in the TAVR population. Perspective Tue, 11 Nov 2025 00:00:00 GMT Marco FabioCostantino, FrancescaCortese, Maria GiuseppinaVeglia, Maria MaddalenaDe Francesco, GianpaoloD’Addeo, Tue, 11 Nov 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101280 https://www.explorationpub.com/Journals/ec/Article/101281 Aim: Pulmonary vein isolation (PVI) is a widely accepted and effective treatment for atrial fibrillation (AF). Even though success rates have been climbing, some patients experience AF recurrence after ablation. This study aimed to identify predictors of AF recurrence, with a focus on the potential role of premature atrial contractions (PAC). Methods: A retrospective single-center analysis was conducted on 185 patients with AF who underwent primo PVI at a single center between 07/2014 and 01/2017. Patients underwent AF ablation using radiofrequency ablation (n = 61), by the CARTO (n = 50) and EnSite (n = 11) mapping systems, and the endoscopic laser balloon (n = 124). Exclusion criteria were combined procedures or the absence of a 24-hour Holter recording three months post-ablation. The primary endpoint was freedom from atrial arrhythmia 12 months after ablation with an application of a 90-day blanking period. Results: Survival analysis revealed a significant difference in AF recurrence rates between low and high PAC burden groups (log-rank test, p = 0.004). ROC-analysis identified an optimal PAC burden cut-off of 57 PAC’s over 24 hours (AUC 0.69). This association remained significant in multivariable Cox proportional hazards analysis, with a hazard ratio of 3.38 (p = 0.021). Conclusions: PAC burden measured on 24-hour Holter monitoring at three months proved to be an independent predictor of AF recurrence following PVI. Multivariable analysis confirmed a significant hazard ratio of 3.38 for AF recurrence within one year. An optimal predictive threshold of 57 PAC demonstrated high negative predictive value for AF recurrence. Original Article Fri, 14 Nov 2025 00:00:00 GMT RubenHoffmann, JohanVijgen, ZeshanAhmad, HendrikVan Engelshoven, PeterVan Der Loo, ThomasPhlips, PieterKoopman, Fri, 14 Nov 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101281 https://www.explorationpub.com/Journals/ec/Article/101283 Diabetes mellitus is one of the leading global health concerns, with an increasing burden of cardiovascular morbidity and mortality. Sexual dysfunction and peripheral artery disease are two frequent and interrelated complications in diabetic populations, both serving as potential indicators of systemic vascular and neural damage. The interplay of endothelial dysfunction, atherosclerosis, and diabetic neuropathy provides a mechanistic basis linking these complications with heightened cardiovascular risk. While sexual dysfunction is often underrecognized, it may represent an early marker of vascular impairment. Peripheral artery disease, on the other hand, is a well-established predictor of major cardiovascular events. Patient-centered education and comprehensive management approaches are essential to address these issues and improve outcomes. This narrative review synthesizes current evidence on vascular and neural mechanisms underlying sexual dysfunction and peripheral artery disease in diabetes, highlighting their clinical relevance and implications for cardiovascular risk stratification. Review Mon, 01 Dec 2025 00:00:00 GMT AbdülmelikBİRGÜN, Muhammet CihatÇELİK, MacitKALÇIK, MucahitYETİM, LütfüBEKAR, YusufKARAVELİOĞLU, Mon, 01 Dec 2025 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101283 https://www.explorationpub.com/Journals/ec/Article/101285 Pulmonary embolism (PE) is the third most common cause of cardiovascular mortality and presents a significant challenge in acute care settings. EkoSonic Endovascular System (EKOS) (ultrasound assisted catheter directed thrombolysis) and suction thrombectomy have emerged as key treatment options for high and intermediate risk PE. EKOS delivers localized fibrinolytic therapy, whereas thrombectomy provides definitive clot removal using devices such as the FlowTriever System (Inari Medical). However, the optimal treatment strategy, particularly in recurrent PE, remains uncertain. We report a case requiring escalation of therapy from EKOS to suction thrombectomy due to recurrent PE and worsening hemodynamic status despite initial thrombolysis. The patient was initially treated with EKOS for a saddle PE but was rehospitalized with syncope and persistent right ventricular (RV) strain. Given the inadequate response to thrombolysis, suction thrombectomy was performed, leading to marked improvement in RV function and overall clinical status. This case underscores the importance of individualized management and timely escalation when initial therapy is insufficient. Assessment of therapeutic success should include not only symptomatic relief but also resolution of clot burden and RV recovery. A focused literature review comparing EKOS and suction thrombectomy suggests that while both modalities are viable, suction thrombectomy may offer faster hemodynamic improvement in select patients. However, available data remains limited, highlighting the need for further comparative studies. Overall, this case and review support a tailored, multidisciplinary approach to PE management, emphasizing shared decision making and early escalation in patients with clinical deterioration despite initial intervention. Case Report Mon, 05 Jan 2026 00:00:00 GMT AhmadJalil, FatimaRajab, AtifIbrahim, ElshawwafMahmoud, AleenaMujahid, AimanRehman, Mon, 05 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101285 https://www.explorationpub.com/Journals/ec/Article/101284 Background: Patients with pre-existing heart failure (HF) are particularly vulnerable to adverse outcomes following coronavirus disease 2019 (COVID-19). Understanding of the long-term cardiovascular sequelae of COVID-19 in this high-risk group is essential to improve post-infection management and outcomes. Methods: A systematic review of PubMed, Scopus, Web of Science, and Embase was conducted to identify peer-reviewed studies published between 2020 and 2025. Eligible studies included adults with a confirmed diagnosis of HF prior to COVID-19 infection and reported cardiovascular outcomes assessed at least 12 weeks after the acute phase. Data were extracted on patient demographics, HF subtype, cardiovascular outcomes, quality of life (QoL), and management approaches. Results: Forty-five studies met the inclusion criteria, encompassing heterogeneous but predominantly high-income country populations across multiple regions and HF phenotypes. COVID-19 was associated with increased HF symptoms, hospital readmissions 28% [95% confidence interval (CI) 24–32%] at 12 months, and mortality 18% (95% CI 15–22%) at ≥ 12 months. Patients with HF with reduced ejection fraction (HFrEF) had a 1.4-fold greater readmission risk than HF with preserved ejection fraction (HFpEF). Mechanistic data implicated persistent myocardial inflammation, endothelial dysfunction, and autonomic dysregulation. Functional capacity declined, with a mean 68-meter reduction in six-minute walk distance (6MWD). Vaccination was associated with a ~40% reduction in mortality and major adverse cardiovascular events (MACE). Discussion: COVID-19 is associated with a sustained cardiovascular burden in individuals with HF, underscoring the importance of long-term surveillance, optimization of guideline-directed medical therapy, and structured rehabilitation. Standardized, prospective studies are needed to elucidate causal mechanisms and refine post-COVID management strategies. Systematic Review Sun, 04 Jan 2026 00:00:00 GMT RaziehParizad, JunialiHatwal, AjitBrar, AkashBatta, MohammadrezaTaban Sadeghi, BishavMohan, Sun, 04 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101284 https://www.explorationpub.com/Journals/ec/Article/101286 The editor-in-chief plays a vital role in ensuring a journal’s scientific integrity and quality. Their primary responsibilities include managing the peer-review process, selecting qualified reviewers, and making final decisions on manuscript acceptance, revision, or rejection. In cases of scientific misconduct, conflicts of interest, authorship disputes, or ethical concerns, the editor has the ultimate authority. An editor’s vision for the journal shapes which manuscripts are reviewed and accepted, influencing the journal’s academic direction. While the role offers benefits such as scientific prestige, greater research visibility, and financial compensation, it also entails significant ethical responsibilities. Academic editor malpractice refers to any actions that violate ethical standards or compromises the integrity of the peer-review process. Editors typically serve five-year terms, often with the possibility of renewal, and are frequently evaluated based on the journal’s impact factor trend. However, their role extends beyond editorial duties—they act as gatekeepers, literary agents, accountants, mediators, and judges, navigating the complex relationships among authors, reviewers, and publishers. Editors of major journals hold an extraordinary amount of power within the publication process. They act as an umpire to judge the scientific research that is being published. Like an umpire, they must know about the sport and rules of play, but they themselves should never be in the competition. The problem is that this ideal is not always met. Whether the subject is the efficacy of an antihypertensive drug, the value of a new costly biomarker, or the origin of a pandemic, editors often make decisions for multi-parametric—and also extra-scientific—reasons. On this basis, some papers are published while others are declined, and the stream of scientific evidence can be polluted. In summary, the editor-in-chief is a cornerstone of academic publishing, ensuring that scientific quality and integrity are upheld while balancing multiple responsibilities. Editorial Wed, 14 Jan 2026 00:00:00 GMT EugenioPicano, Wed, 14 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101286 https://www.explorationpub.com/Journals/ec/Article/101287 Exercise-related arrhythmia is attracting growing attention, according to the increased popularity of leisure-time sports, which have great benefits and acute risk, although the hemodynamics and therapeutics of exercise-related arrhythmia are poorly understood. We have experienced two cases of different types of exercise-related arrhythmias. In an 80-year-old woman, exercise-induced increase in supraventricular premature contractions (SVPCs) converted to atrial fibrillation (AF) during a control ergometric stress test (EST), but SVPCs were diminished, and AF was not observed in the secondary EST after starting bisoprolol. In a 39-year-old woman, idiopathic premature ventricular contractions (PVCs) appeared immediately after the termination of the control EST but were scarcely induced by the secondary EST under the treatment with bisoprolol. Post-exercise abnormal increase in the double product was suppressed, leading to the possibility of improved exercise tolerance in both cases. A couple of ESTs under the same protocol to compare the arrhythmic behaviors with and without treatment provides a therapeutic strategy in exercise-related arrhythmia, and short-term bisoprolol is concluded to be favorable to the specific types of exercise-related arrhythmia, at least in these two cases. Case Report Wed, 14 Jan 2026 00:00:00 GMT ToruMaruyama, YukoYamamoto, MichinariHieda, Wed, 14 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101287 https://www.explorationpub.com/Journals/ec/Article/101288 Rheumatoid arthritis (RA) confers an elevated cardiovascular disease (CVD) risk through systemic inflammation, arterial stiffness, and myocardial dysfunction. The ratio of carotid-femoral pulse wave velocity (PWV) to left ventricular global longitudinal strain (LV-GLS) has been proposed as a novel index of ventricular-arterial coupling. This study investigated whether a one-year physical activity intervention improves the PWV/LV-GLS ratio in RA patients without known CVD. Eighteen participants with RA from the prospective PARA 2010 study underwent baseline and one-year assessments. PWV was measured by oscillometry, and LV-GLS by speckle-tracking echocardiography. Physical activity was promoted through supervised circuit training and additional moderate-to-vigorous activity. At one year, very active participants [≥ 1,000 metabolic equivalent of task (MET)-minutes/week, n = 10] showed a relative reduction in PWV/LV-GLS ratio compared with baseline, while no change was observed in less active participants (< 1,000 MET-minutes/week, n = 8). Between-group comparison at follow-up demonstrated significantly lower PWV/LV-GLS ratio in very active versus less active patients (p < 0.05). No significant between-group differences were observed when PWV and LV-GLS were analyzed separately. In conclusion, a high level of physical activity was associated with improved ventricular-arterial coupling, reflected by a lower PWV/LV-GLS ratio, in RA patients. These findings support a potential dose-dependent effect of physical activity on subclinical cardiovascular function in RA. The clinical trial was registered at http://www.isrctn.com, unique identifier: ISRCTN88886304. Short Communication Mon, 19 Jan 2026 00:00:00 GMT SaraMeziani, KambizShahgaldi, DavidHupin, Jan G.Jakobsson, PhilipSarajlic, CeciliaFridén, BirgittaNordgren, AshwinVenkateshvaran, Christina H.Opava, Ingrid E.Lundberg, AristomenisManouras, MagnusBäck, Mon, 19 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101288 https://www.explorationpub.com/Journals/ec/Article/101289 Background: Myosin inhibitors have been shown to improve exercise capacity and symptoms, as well as reduce the left ventricular outflow tract (LVOT) gradient. This study explores the efficacy of mavacamten versus aficamten in hypertrophic cardiomyopathy (HCM) patients. Methods: From the inception to October 2024, the electronic databases [Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and ClinicalTrials.gov] were searched. Using a random-effects model and a frequentist framework, specific effect sizes [mean difference (MD) and risk ratio (RR)] were pooled. Results: This network meta-analysis included six randomized controlled trials (RCTs). A total of 826 individuals with HCM were included; 443 of them received a cardiac myosin inhibitor, while 383 received placebo. Comparison of aficamten versus mavacamten through a common comparator, placebo, showed that aficamten caused a lesser decrease in resting LVOT gradient than that of mavacamten [MD = 14.74, 95% CI (3.02; 26.47)]. Therefore, mavacamten ranked higher (P-score = 0.9966) than aficamten (P-score = 0.5034) in decreasing resting LVOT gradient. Aficamten significantly reduced left ventricular ejection fraction (LVEF) in contrast to mavacamten [MD = –5.59, 95% CI (–10.43; –0.75)]. According to P-score ranking, mavacamten (0.5053) ranked higher than aficamten (0.0059). For New York Heart Association (NYHA) class improvement, there was no statistically significant difference between the two groups [MD = –0.37, 95% CI (–1.79; 1.06)]. But P-score ranked mavacamten (0.8466) higher than aficamten (0.6533). Discussion: Mavacamten ranked superior to aficamten in HCM management. However, this ranking is based not on the absolute clinical benefit but on the network point estimates. Additionally, due to a larger body of clinical evidence supporting mavacamten, it has a clear advantage in terms of reliability. Therefore, more direct trials comparing the two drugs would be required to confirm which one is better and provide conclusive evidence. Meta-Analysis Fri, 23 Jan 2026 00:00:00 GMT AyeshaAman, BismaAkram, ArfaAkram, MominaMaham, EishaTariq, AimenHassan, Masooma ZainabBokhari, AleenaAkram, SaniaAkram, Malik Waleed ZebKhan, Fri, 23 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101289 https://www.explorationpub.com/Journals/ec/Article/101291 Left ventricular pseudoaneurysm is a rare acquired cardiac abnormality that frequently occurs after myocardial infarction or a previous cardiac procedure. Blunt chest trauma accounts for this uncommon entity in sporadic cases. However, this disease does not have any specific clinical findings, so it is necessary to monitor the suspected patient closely. The standard noninvasive techniques for diagnosing left ventricular pseudoaneurysms are transthoracic echocardiography and thoracic computed tomography. Untreated ventricular pseudoaneurysms carry a considerable risk of rupture, ranging from 30% to 45%. So, an urgent surgical treatment is often required. Herein, we aimed to present a 34-year-old male who underwent emergency surgery as a result of cardiac perforation three hours after a traffic accident and developed a giant left ventricular pseudoaneurysm 19 months after discharge. The giant pseudoaneurysm was successfully repaired. This case highlights the need for long‑term surveillance after blunt cardiac trauma to detect late pseudoaneurysm formation. Case Report Tue, 03 Feb 2026 00:00:00 GMT Emin CanAta, Tue, 03 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101291 https://www.explorationpub.com/Journals/ec/Article/101290 Redesigning cardiovascular services at the local level is a pressing task for decentralized health systems facing the rising burden of chronic cardiovascular disease. In northern Modena (Emilia-Romagna, Italy), a post-restructuring reorganization exposed the limits of hospital-centric models and the need for integrated, patient-centered care. In 2021, Santa Maria Bianca Hospital, Mirandola—a first-level, non-interventional facility serving a largely rural population—launched a program to build a digitally integrated, prevention-oriented cardiology network. This review distills that field experience into a scalable framework for organizing peripheral cardiovascular services. The Mirandola Cardiology Network evolved along six operational domains: (1) reactivation of the cardiology unit with community outreach; (2) expansion of outpatient services and telecardiology; (3) a day hospital platform for chronic heart failure management; (4) digital transformation of the echocardiography service; (5) development of an advanced imaging center integrating coronary computed tomography (CT) angiography and planned cardiac magnetic resonance imaging (MRI); and (6) consolidation of professional education, research, and network-wide governance. By combining digital tools, non-invasive imaging, and multidisciplinary collaboration, the model established continuity of care across inpatient, outpatient, and community settings while improving access to diagnostics and appropriateness of care. Although prospective or comparative outcomes are not presented, process indicators and implementation milestones suggest scalability and sustainability, with potential to reduce avoidable admissions and streamline clinical pathways. The Mirandola experience shows that innovation in cardiology is feasible in peripheral settings when investment in technology, governance, and training is aligned with a coherent, value-based vision. It offers actionable guidance for decentralized systems seeking to implement digitally enabled, community-focused cardiology consistent with contemporary recommendations on territorial care and chronic disease management. Review Tue, 03 Feb 2026 00:00:00 GMT CarloRatti, MattiaMalaguti, EmanueleMasia, BenedettaVeronesi, AnnaManduchi, GiuseppeLicitra, Tue, 03 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101290 https://www.explorationpub.com/Journals/ec/Article/101292 Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare but potentially life-threatening inherited arrhythmia disorder, often presenting in childhood or adolescence. Early and accurate diagnosis is critical, as untreated CPVT carries a high risk of sudden cardiac death, particularly in young individuals. This case underscores the importance of maintaining a high index of clinical suspicion and employing a systematic diagnostic approach. We highlight the value of integrating clinical history, family background, and targeted investigations in evaluating young adults presenting with sudden cardiac arrest. Prompt recognition and diagnosis of CPVT may be lifesaving and have significant implications for both patients and their families. Case Report Thu, 05 Feb 2026 00:00:00 GMT MónicaDias, SofiaFernandes, SérgiaRocha, CarinaArantes, Thu, 05 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101292 https://www.explorationpub.com/Journals/ec/Article/101293 Background: Heart failure (HF) remains a growing global health problem, with nearly half of all cases attributed to HF with preserved ejection fraction (HFpEF) and its precursor, left ventricular diastolic dysfunction (LVDD). Although echocardiography is the diagnostic gold standard, its high cost and limited availability restrict its use for large-scale screening. In contrast, the electrocardiogram (ECG) is inexpensive and widely accessible. Recent advances in artificial intelligence (AI) have created opportunities to leverage ECG data for the early detection of cardiac dysfunction. The objective of this study was to systematically review and meta-analyze the diagnostic performance of AI-based ECG models for detecting cardiac dysfunction. Methods: The QUADAS-2 tool was used to assess the risk of bias. Pooled sensitivity and specificity were estimated using a bivariate random-effects model, with heterogeneity quantified using the I2 statistic. Pre-specified subgroup analyses were conducted according to clinical endpoint and AI model type. Results: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, nine eligible studies evaluating AI algorithms applied to ECG data for the detection of HFpEF were identified. Considerable methodological and population heterogeneity was observed across studies. Risk of bias was generally low for reference standards, although concerns were noted in patient selection. The pooled specificity of AI-ECG models was high at 0.83 [95% confidence interval (CI): 0.74–0.89], while pooled sensitivity was 0.82 (95% CI: 0.70–0.90). Both estimates demonstrated extremely high heterogeneity (I2 > 96%). Subgroup analyses by endpoint and model type did not explain this variability. Discussion: AI-enhanced ECG models show good diagnostic accuracy, specifically in ruling out cardiac dysfunction due to their high specificity. However, the high and unexplained heterogeneity across these studies limits the immediate generalizability of the results. Large, prospective validation studies across diverse populations are essential before these models can be confidently adopted into routine clinical practice. Meta-Analysis Fri, 06 Feb 2026 00:00:00 GMT HabibShahzad, HumnaSulaiman, AmnaRoheel, Hasan N.Tahir, MursalaTahir, MahadTariq, HooriaSulaiman, Fri, 06 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101293 https://www.explorationpub.com/Journals/ec/Article/101295 Polycystic ovary syndrome (PCOS) is a common endocrine–metabolic condition that carries a higher cardiovascular risk than currently reflected by traditional screening tools. Emerging evidence suggests that resting tachycardia and autonomic dysfunction may serve as early, non-invasive indicators of cardiovascular dysregulation in this population. This review synthesizes current data on resting heart rate (RHR), heart rate variability (HRV), and direct autonomic markers in women with PCOS, drawing from human studies published between 2000 and 2025. Across 32 eligible studies, most reported increased sympathetic activity, reduced parasympathetic tone, elevated RHR, and impaired HRV patterns observed even in normal-weight or metabolically mild PCOS phenotypes. These alterations correlate with endothelial dysfunction, arterial stiffness, and subclinical atherosclerosis, underscoring their cardiovascular relevance. Mechanistic insights highlight the contributions of insulin resistance, hyperandrogenism, inflammation, adipokine imbalance, chemoreflex sensitization, and altered cortisol metabolism to autonomic disruption. Despite consistent findings, methodological variability in HRV protocols and inadequate adjustment for major confounders limit definitive interpretation. RHR, due to its simplicity and accessibility, including through wearable devices, holds promise as a supportive early risk signal; however, it should not be used in isolation. Future studies must adopt standardized autonomic measurements, including diverse cohorts, and evaluate whether modifying autonomic markers translates into improved cardiometabolic outcomes. Integrating RHR and HRV with metabolic and endocrine markers may enhance early cardiovascular risk stratification in women with PCOS. Review Thu, 12 Feb 2026 00:00:00 GMT Afra WasamaIslam, PrarthanaMotdhare, SwapnaBejoy, Harsahaj SinghWilkhoo, Thu, 12 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101295 https://www.explorationpub.com/Journals/ec/Article/101296 The Gerbode defect is characterized by a high ventricular septal defect associated with a defect in the septal leaflet of the tricuspid valve, allowing blood to enter the right atrium from the left ventricle. It accounts for approximately 0.08% of intracardiac shunts and may be congenital or acquired. We describe a rare case of Gerbode defect secondary to tricuspid valve endocarditis. A 58-year-old male patient presented with acute infective endocarditis due to Staphylococcus aureus, related to central venous access. Echocardiography showed a tricuspid valve with thickened leaflets and a small mobile image on the atrial side of the septal leaflet, as well as moderate to severe regurgitation. After completion of the antibiotic regimen with resolution of the infectious condition, the patient was discharged asymptomatic, and a new echocardiogram showed no vegetation on the tricuspid valve. During outpatient follow-up, he presented dyspnea on mild exertion, and consecutive echocardiograms showed moderate tricuspid insufficiency and significant pulmonary hypertension with a pulmonary artery systolic pressure of 83 mmHg (reference: 30 mmHg). He underwent right and left cardiac catheterization, which showed a Gerbode defect, and a transesophageal echocardiogram showed a shunt in the subaortic region measuring 6 to 8 mm, with a maximum gradient of 56 mmHg. He underwent elective surgery to correct the Gerbode defect and tricuspid valve repair, with a good clinical result. The Gerbode defect is rare, and the diagnosis can be challenging because it simulates other conditions. Treatment consists of closing the defect when it generates refractory symptoms or complications. The reported case was surgically corrected, with a good result and favorable evolution. Case Report Thu, 12 Feb 2026 00:00:00 GMT RobertoRamos Barbosa, Layla PasoliniLott, Layane BonfanteBatista, Anna JúliaCurcio de Paula Allemand, ViniciusEduardo Araújo Costa, Sergio LuísSantos Guedes, Bárbara KellerSchreiber, Lucas Crespo deBarros, Rodolfo CostaSylvestre, Luiz Fernando MachadoBarbosa, Thu, 12 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101296 https://www.explorationpub.com/Journals/ec/Article/101294 Heart failure (HF) is still one of the most common causes of death today. The vast majority of heart diseases end up leading to HF, which therefore has a high prevalence in the adult population (on average 1–2%), and which increases enormously (over 10%) after the age of 65, becoming the most frequent cause of hospitalization for these subjects. It is therefore necessary to increase efforts to deepen our understanding of the pathophysiological mechanisms that lead to HF and its worsening, particularly with regard to hormonal-metabolic derangements as contributors to HF development and progression. This, in the hope of being able, in the near future, to intervene on them, reducing the prevalence of this pathology and its economic impact on countries’ healthcare spending. To this aim, we performed a narrative review of the scientific literature on the interactions between both insulin and the growth hormone/insulin-like growth factor-1 axis and the cardiovascular system, and in particular, to verify the role that these hormones may play in the development and negative progression of HF. Review Thu, 12 Feb 2026 00:00:00 GMT ArturoCesaro, PaoloCalabrò, AntonioRuvolo, SerafinoFazio, Thu, 12 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101294 https://www.explorationpub.com/Journals/ec/Article/101297 Infective endocarditis (IE) is a rare but potentially life-threatening condition with a wide spectrum of clinical presentations, often leading to diagnostic delay. The COVID-19 pandemic has added further complexity by overlapping clinical features and imposing constraints on diagnostic pathways. We report the case of a 48-year-old male who presented with prolonged non-specific symptoms following a recent COVID-19 infection. Multiple emergency department visits resulted in an initial diagnosis of viral illness. Subsequent clinical deterioration prompted further evaluation, which revealed severe aortic regurgitation due to a large aortic valve vegetation on transthoracic echocardiography. Blood cultures grew α-haemolytic Streptococcus mitis fulfilling the modified Duke criteria for IE. The patient developed complications, including heart failure and peripheral arterial embolisation, necessitating urgent surgical aortic valve replacement. This case highlights the diagnostic challenges of IE in the context of recent COVID-19 infection, where overlapping symptoms and altered healthcare pathways may contribute to delayed recognition. Clinicians should maintain a high index of suspicion for IE in patients presenting with persistent or atypical symptoms following COVID-19 infection. Early recognition and prompt intervention are essential to prevent serious complications. Case Report Sat, 28 Feb 2026 00:00:00 GMT ErumAhmad, MubashiraFatima, Muhammad Abdul RehmanJauhar, Azeem S.Sheikh, Sat, 28 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101297 https://www.explorationpub.com/Journals/ec/Article/101298 Not applicable. Letter to the Editor Mon, 02 Mar 2026 00:00:00 GMT TimothyDaly, Jaime A.Teixeira da Silva, Mon, 02 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101298 https://www.explorationpub.com/Journals/ec/Article/101299 In the editorial game, authors are the players, reviewers are the linesmen on the sidelines, and the editor is the umpire. However, it is not uncommon for the umpire, to have a limited view of the pitch, only to be called back for revision through the video-assisted review. In the editorial context, the video-assisted review assistants are the readers, who critically evaluate the journal’s content and integrate, expand, and correct it when necessary. The journal remains open to this process, and we are well aware that only through dialectics—the comparison of differing views—can a sharper truth emerge. I described the role of the Editor-in-Chief as it is, based on my 40+ years of experience. Daly and Teixeira da Silva describe it as it should be, and this perspective is stimulating, refreshing, and timely. Commentary Sun, 08 Mar 2026 00:00:00 GMT EugenioPicano, Sun, 08 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/101299 https://www.explorationpub.com/Journals/ec/Article/1012100 The aim is to evaluate the transannular patch (TAP) repair and valve-sparing repair (VSR) techniques following tetralogy of Fallot (TOF) correction, focusing on post-operative complications and cardiac function. A comprehensive search was performed in PubMed, EMBASE, and Scopus using relevant terms like “Tetralogy of Fallot, right ventricular outflow tract (RVOT), VSR, pulmonary valve replacement, transannular-patch repair”. Results indicated that VSR is favored due to its shorter cardiopulmonary bypass duration, preservation of the pulmonary valve, less demanding surgical requirements, shorter post-operative hospital stays, lower mortality rates, survival of at least 30 years, reduced pulmonary regurgitation, decreased right ventricular dysfunction, and improved physical activity tolerance and neurodevelopment. While TAP alleviates RVOT obstruction (RVOTO), it is associated with long-term pulmonary regurgitation. Both TAP and VSR are effective in managing TOF, but VSR provides better valve function preservation and long-term outcomes. Review Mon, 09 Mar 2026 00:00:00 GMT Jui RajendraGaikwad, JessicaAnnamalai, KrishnaSarvaiya, Lester ThomasD Costa, Mon, 09 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012100 https://www.explorationpub.com/Journals/ec/Article/1012101 Aim: To evaluate the health literacy (HL) of patients with acute coronary syndrome (ACS) admitted to a public hospital of high complexity in the interior of Minas Gerais, Brazil, through the application of the instrument Short Assessment of Health Literacy for Portuguese Speaking Adults (SAHLPA)-18. Methods: Retrospective cross-sectional study, from the Good Clinical Practices (GCP) project developed in a tertiary hospital. The 175 patients with ACS were analyzed, in which the profile and the SAHLPA-18 were evaluated. Results: It was found that 55.43% (97 among 175; 95% CI: 48.07–62.79) were considered with inadequate HL, and 40.00% of patients who have completed elementary school or higher education had inadequate HL (36 among 90). Female sex and complete primary education or higher increased the HL, and diabetes decreased the HL. Conclusions: We observed low literacy even in the presence of formal education, which, combined with the presence of diabetes, may represent a risk to patients with ACS, highlighting the need for continuous health education in this group regardless of the profile. Original Article Fri, 13 Mar 2026 00:00:00 GMT Monielle Evelyn OliveiraFreitas, Suely Amorim deAraújo, Fabiola AlvesGomes, Rosangela de OliveiraFelice, Guilherme Silva deMendonça, Elmiro dos SantosResende, Fábio PapaTaniguchi, ClesnanMendes-Rodrigues, Fri, 13 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012101 https://www.explorationpub.com/Journals/ec/Article/1012102 Aim: Cardiac memory is classically expressed as persistent T wave changes following restoration of normal ventricular activation. Its manifestations in idiopathic intermittent left bundle branch block (ILBBB) remain incompletely characterized. The aim of this report is to describe a distinct electrocardiographic phenotype potentially related to cardiac memory. Methods: We retrospectively analyzed a homogeneous series of 14 patients with idiopathic, rate-dependent ILBBB, absence of demonstrable structural heart disease, homophasic T waves in leads V5–V6 during left bundle branch block (LBBB), and pseudo-ischemic T wave inversion in the right precordial leads during phases of normal conduction. Results: In all patients, memory-related negative T waves were observed during normal conduction, while concordant (homophasic) T waves were consistently present during LBBB. A close relationship emerged between the width of the intraventricular conduction zone and the severity of repolarization abnormalities: narrower conduction zones were associated with deeper T wave inversion during normal conduction. During follow-up, most patients progressed to permanent LBBB, without documented major arrhythmic events. Conclusions: These findings describe a distinctive and reproducible electrocardiographic phenotype within idiopathic ILBBB, likely related to cardiac memory. This pattern, provisionally designated homophasic idiopathic intermittent left bundle branch block and cardiac memory (OIL-CAME), warrants further confirmation in larger prospective studies. Original Article Tue, 24 Mar 2026 00:00:00 GMT MarcelloCostantini, Jorge AntonioSalerno Uriarte, LorenzoCostantini, LuigiSciarra, AntonioScarà, MarioPrevitali, Anna TeresaRanieri, Marcelo VictorElizari, Tue, 24 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012102 https://www.explorationpub.com/Journals/ec/Article/1012103 Coronary vasospasm, affecting both epicardial arteries and the coronary microcirculation, is a significant yet frequently underdiagnosed and undertreated cause of coronary syndromes. When promptly identified, it carries a relatively benign prognosis. Recognition can be straightforward in non-cardiology settings when triggered by known spasmogenic agents such as misoprostol (obstetrics) or 5-fluorouracil (oncology). Vasospasm may also be incidentally revealed during noninvasive functional testing, typically presenting as ST-segment elevation during early recovery phases, or after administration of agents like aminophylline following dipyridamole or β-blockers following dobutamine. In patients with high clinical suspicion but negative Holter or stress test findings, targeted provocation with ergonovine or hyperventilation protocols can safely induce vasospasm and unmask regional wall motion abnormalities, indicating epicardial involvement. Hyperventilation-Doppler echocardiography enables the detection of microvascular dysfunction through reductions in coronary flow velocity in the mid-distal left anterior descending coronary artery. A multi-stress, multi-marker functional testing approach offers a noninvasive, safe, and effective diagnostic strategy. Inducible wall motion abnormalities are specific for epicardial spasm, while Doppler-detected flow reduction is more sensitive for microvascular dysfunction. Early diagnosis is essential, as coronary vasospasm, though potentially life-threatening, is highly manageable with appropriate therapy. Management of patients with proven epicardial coronary artery or microvascular vasospasm involves starting therapy with calcium channel blockers and nitrates, and avoiding β-blockers, as they can worsen vasospasm by blocking β2-mediated vasodilation and leaving α1-mediated vasoconstriction unopposed. Perspective Mon, 20 Apr 2026 00:00:00 GMT AlbertVarga, GergelyÁgoston, Mon, 20 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012103 https://www.explorationpub.com/Journals/ec/Article/1012104 Implantable cardioverter defibrillators (ICDs) play a central role in the prevention of sudden cardiac death. Although implantation is generally safe, rare but clinically significant complications may occur. One such complication is inadvertent placement of a transvenous ICD lead into the left ventricle via a patent foramen ovale (PFO), which carries a risk of systemic thromboembolism and may remain clinically silent for prolonged periods. We report a case of an ICD lead malpositioned in the left ventricle through a PFO, detected 17 months after implantation during transthoracic echocardiography performed for worsening dyspnoea. Imaging demonstrated the lead traversing the interatrial septum and mitral valve into the left ventricle. The patient underwent successful transvenous extraction and reimplantation of a new right ventricular lead without complications. This case highlights the limitations of electrocardiographic clues alone and underscores the importance of multimodality imaging and meticulous implantation technique. A focused narrative review integrates current literature regarding mechanisms, diagnostic strategies, management options, and preventive considerations. Case Report Thu, 23 Apr 2026 00:00:00 GMT SamrinaJannat, AhmedUmer, Azeem SSheikh, Thu, 23 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012104 https://www.explorationpub.com/Journals/ec/Article/1012105 High-sensitivity cardiac biomarkers have transformed modern cardiology by enabling earlier diagnosis and refined risk stratification in acute coronary syndromes and heart failure. However, increasing analytical sensitivity has also amplified the clinical impact of immunoassay interferences, particularly those caused by heterophile antibodies. These endogenous antibodies can interact with assay antibodies and generate false-positive or false-negative results, most notably in sandwich immunoassays used for cardiac troponins and natriuretic peptides. Persistent, clinically implausible biomarker elevations related to heterophile antibody interference have led to unnecessary invasive procedures, inappropriate pharmacologic treatment, repeated hospital admissions, and prolonged diagnostic uncertainty. Conversely, false-negative results may delay diagnosis, result in inappropriate discharge, and contribute to adverse clinical outcomes in high-risk patients. This review summarizes the immunological basis and analytical mechanisms of heterophile antibody interference, highlights cardiac biomarkers most commonly affected, and outlines key clinical red flags that should prompt suspicion. Practical laboratory strategies include polyethylene glycol precipitation as an initial approach to detect antibody-mediated interference, followed by dilution studies, heterophile blocking reagents, and cautiously interpreted alternative platform testing within assay-specific reference frameworks, together with close clinician-laboratory collaboration. Greater awareness of analytical interference is critical as cardiology becomes increasingly biomarker-driven. Integrating clinical judgment with structured laboratory verification can substantially reduce diagnostic error, improve patient safety, and prevent avoidable healthcare utilization in contemporary cardiovascular practice. Review Fri, 24 Apr 2026 00:00:00 GMT Ömer BurakÇelik, MacitKalçık, AbdullahSarıhan, Mehmet MustafaYılmaz, OsmanKaraarslan, MucahitYetim, Muhammet CihatÇelik, LütfüBekar, MusaYılmaz, YusufKaravelioğlu, Fri, 24 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012105 https://www.explorationpub.com/Journals/ec/Article/1012106 Diabetes mellitus significantly increases the burden of coronary artery disease and peripheral arterial disease, frequently necessitating vascular bypass surgery. Imaging plays a central role across the perioperative continuum, from preoperative risk stratification and surgical planning to intraoperative guidance and postoperative surveillance. This narrative review synthesizes current evidence on the application of multimodality imaging in diabetic patients undergoing coronary artery bypass grafting and peripheral arterial bypass procedures. A structured literature search of major databases was undertaken to identify contemporary studies evaluating echocardiography, computed tomography angiography, duplex ultrasound, magnetic resonance angiography, digital subtraction angiography, and functional nuclear imaging. Diabetic-specific factors such as diffuse multivessel disease, medial arterial calcification, renal impairment, and microvascular dysfunction substantially influence imaging performance and modality selection. While noninvasive imaging increasingly guides surgical decision-making and follow-up, the available evidence remains heterogeneous and largely observational. Advanced and hybrid imaging techniques show promise for individualized care but are limited by cost, availability, and a lack of robust outcome-driven data. Standardized imaging pathways and higher-quality comparative studies are required to optimize perioperative imaging strategies in this high-risk population. Mini Review Thu, 30 Apr 2026 00:00:00 GMT NasirYaqoob, FaheelaTamseel, Amna BatoolAslam, Thu, 30 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012106 https://www.explorationpub.com/Journals/ec/Article/1012107 Aim: This study aims to evaluate how demographic and treatment variables, including age, tumor type, resectability, and metastasis, affect survival outcomes across prognostic subgroups of primary malignant cardiac tumors (PMCTs). Methods: PMCT cases diagnosed between 2000 and 2021 were identified from Surveillance, Epidemiology, and End Results (SEER) 18 registries. 730 patients were analyzed and categorized into prognosis groups based on 5-year survival (< 50%, 50–95%, > 95%). Demographic, histologic, and treatment varieties were examined using descriptive statistics, Kaplan-Meier estimates, and Cox proportional hazards models. Results: Among 730 patients, most were middle-aged (56.6%), male (52.5%), and White (60.1%). Soft tissue sarcomas predominated in the poorest-prognosis group (80.3%), while hematologic malignancies were most common in intermediate prognosis (52.0%). Younger age significantly reduced mortality risk [hazard ratio (HR) 0.49–0.52; p < 0.01]. Brain and lung metastases increased mortality (HR 2.04 and 1.89; p < 0.05). Surgical resection improved survival in sarcoma-dominant tumors, while systemic metastasis predicted poorer outcomes in hematologic malignancies. Chemotherapy improved survival in sarcomas (ρ = 0.457; p < 0.0001) but was associated with poorer outcomes in hematologic cancers (ρ = −0.337; p < 0.0001). Conclusions: PMCT prognosis is primarily influenced by histologic subtype and resectability. Sarcoma-dominant tumors benefit from aggressive surgical and chemotherapeutic management, conversely systemic control is key for hematologic malignancies. Younger age and absence of metastasis consistently predict better outcomes. Histology-specific and early intervention strategies are critical to improving survival in this rare malignancy. Original Article Wed, 06 May 2026 00:00:00 GMT RiyaMehta, ZubinMathew, SamuelKim, JohannaJeyaraj, TalalAsif, Wed, 06 May 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012107 https://www.explorationpub.com/Journals/ec/Article/1012109 Cardiopulmonary interaction is a fundamental physiological process during spontaneous breathing, but it is profoundly altered in critically ill patients receiving mechanical ventilation (MV). Positive-pressure ventilation modifies intrathoracic, pleural, and transpulmonary pressures, with major effects on pulmonary vascular hemodynamics and right ventricular performance. Among these consequences, acute pulmonary hypertension (aPH) has emerged as a clinically relevant yet frequently underrecognized complication. This review summarizes the current evidence on cardiopulmonary interaction during spontaneous breathing and MV, with particular emphasis on the mechanisms driving aPH and right ventricular dysfunction in critically ill patients. A narrative review was performed using PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. Free-text terms and controlled vocabulary related to positive-pressure ventilation, right ventricular dysfunction, pulmonary hypertension (PH), pulmonary vascular resistance (PVR), right heart catheterization, intensive care, and respiratory compliance were combined using Boolean operators. Priority was given to studies involving adult patients, including systematic reviews, observational studies, clinical trials, and relevant reference lists. During spontaneous breathing, cardiopulmonary interaction is governed by negative intrathoracic pressure, venous return (VR), transpulmonary pressure, and physiological ventilation-perfusion relationships. In contrast, MV reverses this physiological pressure profile and may reduce VR, increase right ventricular afterload, impair ventricular interdependence, and increase PVR. High tidal volumes, excessive positive end-expiratory pressure, increased plateau pressure, hypercapnia, hypoxemia, alveolar overdistension, and diffuse lung injury all contribute to aPH, potentially disrupting right ventricle-pulmonary artery coupling and promoting right ventricular dysfunction. MV profoundly reshapes cardiopulmonary physiology and may precipitate aPH and right ventricular dysfunction. Early recognition of these mechanisms and the application of protective ventilatory strategies are essential to reduce pulmonary and hemodynamic complications. Review Sat, 09 May 2026 00:00:00 GMT Angel BenjaminRojas, SusanaVanoni, CarlaGobbi, Juan CarlosVergottini, Sat, 09 May 2026 00:00:00 GMT https://www.explorationpub.com/Journals/ec/Article/1012109