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Topic Review
ECMO Management in Severely Hypothermic Cardiac Arrest Patients
Accidental hypothermia, defined as an unintentional drop of the body core temperature below 35 °C, is one of the causes of cardiocirculatory instability and reversible cardiac arrest. Currently, extracorporeal life support (ECLS) rewarming is recommended as a first-line treatment for hypothermic cardiac arrest patients. The aim of the ECLS rewarming is not only rapid normalization of core temperature but also maintenance of adequate organ perfusion. Veno-arterial extracorporeal membrane oxygenation (ECMO) is a preferred technique due to its lower anticoagulation requirements and potential to prolong circulatory support. Although highly efficient, ECMO is acknowledged as an invasive treatment option, requiring experienced medical personnel and is associated with the risk of serious complications. 
  • 419
  • 08 Nov 2023
Topic Review
Cardioplegic Solution with an Understanding of a Cardiochannelopathy
Cardiac surgeries have been improved by accompanying developing cardioplegia solutions. However, the cardioplegia application presents an ongoing challenge with a view of a sufficiently restored cardiac function.
  • 418
  • 15 Dec 2022
Topic Review
The Influence of Polyphenols on Atherosclerosis Development
Polyphenols have attracted tremendous attention due to their pro-health properties, including their antioxidant, anti-inflammatory, antibacterial and neuroprotective activities. Atherosclerosis is a vascular disorder underlying several cardiovascular diseases (CVDs). One of the main risk factors causing atherosclerosis is the type and quality of food consumed. Therefore, polyphenols represent promising agents in the prevention and treatment of atherosclerosis, as demonstrated by in vitro, animal, preclinical and clinical studies. However, most polyphenols cannot be absorbed directly by the small intestine. Gut microbiota play a crucial role in converting dietary polyphenols into absorbable bioactive substances. An increasing understanding of the field has confirmed that specific gut microbiota (GM) taxa strains mediate the gut microbiota–atherosclerosis axis.
  • 416
  • 28 Apr 2023
Topic Review
Valve-in-Valve Transcatheter Aortic Valve Replacement
Bioprosthetic heart valves (BHV) have been increasingly implanted instead of mechanical valves in patients undergoing surgical aortic valve replacement (SAVR). Structural valve deterioration (SVD) is a common issue at follow-up and can justify the need for a reintervention. In the evolving landscape of interventional cardiology, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has emerged as a remarkable innovation to address the complex challenges of patients previously treated with SAVR and has rapidly gained prominence as a feasible technique especially in patients at high surgical risk. On the other hand, the expanding indications for TAVR in progressively younger patients with severe aortic stenosis pose the crucial question on the long-term durability of transcatheter heart valves (THVs), as patients might outlive the bioprosthetic valve.
  • 415
  • 15 Mar 2024
Topic Review
Cardiac Morphofunctional Characteristics of Individuals with ERP
Based on electrocardiographic (ECG), electrophysiological, epicardial, and non-invasive electroanatomical mapping studies, the inferior and/or lateral part of the left ventricle (LV) is involved in individuals with early repolarization pattern (ERP) . In  Brugada syndrome (BrS), which is also a form of J-wave syndrome, structural changes were described in the outflow tract of the right ventricle (mild fibrosis, decreased connexin-43 expression, increased collagen content, or fibro-adipose infiltration), while wall motion abnormalities and mild dilatation have been noted in imaging studies. These structural changes are more frequently observed in patients who have died of sudden cardiac death (SCD). It is reasonable to assume that morphological changes, presumably similar to BrS, are also present in individuals with ERP, in myocardial regions involved in pathomechanism.
  • 414
  • 17 Apr 2023
Topic Review
Cardiac Magnetic Resonance in Hypertensive Heart Disease
Hypertension is one of the most important cardiovascular risk factors, associated with significant morbidity and mortality. Chronic high blood pressure leads to various structural and functional changes in the myocardium. Different sophisticated imaging methods are developed to properly estimate the severity of the disease and to prevent possible complications. Cardiac magnetic resonance can provide a comprehensive assessment of patients with hypertensive heart disease, including accurate and reproducible measurement of left and right ventricle volumes and function, tissue characterization, and scar quantification.
  • 413
  • 11 Jan 2023
Topic Review
The Mitochondrial Dysfunction in Atherosclerosis
Atherosclerosis is a multifactorial inflammatory pathology that involves metabolic processes. Improvements in therapy have drastically reduced the prognosis of cardiovascular disease. Nevertheless, a significant residual risk is still relevant, and is related to unmet therapeutic targets. Endothelial dysfunction and lipid infiltration are the primary causes of atherosclerotic plaque progression. In this contest, mitochondrial dysfunction can affect arterial wall cells, in particular macrophages, smooth muscle cells, lymphocytes, and endothelial cells, causing an increase in reactive oxygen species (ROS), leading to oxidative stress, chronic inflammation, and intracellular lipid deposition. 
  • 413
  • 31 Jan 2023
Topic Review
APJ in Myocardial Infarction- and Hypertension-Induced Heart Failure
The widely expressed G protein-coupled apelin receptor (APJ) is activated by two bioactive endogenous peptides, apelin and ELABELA (ELA). The apelin/ELA-APJ-related pathway has been found involved in the regulation of many physiological and pathological cardiovascular processes. Increasing studies are deepening the role of the APJ pathway in limiting hypertension and myocardial ischaemia, thus reducing cardiac fibrosis and adverse tissue remodelling, outlining APJ regulation as a potential therapeutic target for heart failure prevention.
  • 413
  • 10 May 2023
Topic Review
Perioperative Right Ventricular Dysfunction in Cardiac Surgery
Right ventricular (RV) dysfunction frequently occurs after cardiac surgery and is linked to adverse postoperative outcomes, including mortality, reintubation, stroke, and prolonged ICU stays. While various criteria using echocardiography and hemodynamic parameters have been proposed, a consensus remains elusive. Distinctive RV anatomical features include its thin wall, which presents a triangular shape in a lateral view and a crescent shape in a cross-sectional view. Principal causes of RV dysfunction after cardiac surgery encompass ischemic reperfusion injury, prolonged ischemic time, choice of cardioplegia and its administration, cardiopulmonary bypass weaning characteristics, and preoperative risk factors. Post-left ventricular assist device (LVAD) implantation RV dysfunction is common but often transient, with a favorable prognosis upon resolution. There is an ongoing debate regarding the benefits of concomitant surgical repair of the RV in the presence of regurgitation. According to the literature, the gold standard techniques for assessing RV function are cardiac magnetic resonance imaging and hemodynamic assessment using thermodilution. 
  • 413
  • 04 Dec 2023
Topic Review
Clotting Dysfunction in Sepsis
Sepsis is regarded as one of the main causes of death among the critically ill. Pathogen infection results in a host-mediated pro-inflammatory response to fight infection; as part of this response, significant endogenous reactive oxygen (ROS) and nitrogen species (RNS) production occurs, instigated by a variety of sources, including activated inflammatory cells, such as neutrophils, platelets, and cells from the vascular endothelium. Inflammation can become an inappropriate self-sustaining and expansive process, resulting in sepsis. Patients with sepsis often exhibit loss of aspects for normal vascular homeostatic control, resulting in abnormal coagulation events and development of disseminated intravascular coagulation. Diagnosis and treatment of sepsis remains a significant challenge for health care providers globally. Targeting the drivers of excessive oxidative/nitrosative stress using antioxidant treatments might be a therapeutic option.
  • 412
  • 14 Jan 2022
Topic Review
Impact of Iron Metabolism Disorders on Vascular Aging
Vascular aging is a physiological, multifactorial process that involves every type of vessel, from large arteries to microcirculation. This manifests itself as impaired vasomotor function, altered secretory phenotype, deteriorated intercellular transport function, structural remodeling, and aggravated barrier function between the blood and the vascular smooth muscle layer. Iron disorders, particularly iron overload, may lead to oxidative stress and, among other effects, vascular aging. The elevated transferrin saturation and serum iron levels observed in iron overload lead to the formation of a non-transferrin-bound iron (NTBI) fraction with high pro-oxidant activity. NTBI can induce the production of reactive oxygen species (ROS), which induce lipid peroxidation and mediate iron-related damage as the elements of oxidative stress in many tissues, including heart and vessels’ mitochondria. 
  • 411
  • 24 Nov 2022
Topic Review
Sarcomeric versus Non-Sarcomeric HCM
Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiovascular disorder and is characterized by left ventricular hypertrophy (LVH), which is unexplained by abnormal loading conditions. HCM is inherited as an autosomal dominant trait and, in about 40% of patients, the causal mutation is identified in genes encoding sarcomere proteins.
  • 411
  • 20 Jun 2023
Topic Review
Endomyocardial Biopsy in Pediatric Myocarditis and Cardiomyopathies
Endomyocardial biopsy is a well known diagnostic tool for the investigation and treatment of myocardial diseases and so far, remains the gold standard for the diagnosis of myocarditis. Due to its invasively with a complication rate ranging from 1% to 15%, its role in the diagnostic work-out of pediatric heart failure is not well established.
  • 409
  • 19 Apr 2022
Topic Review
Acute Rheumatic Fever and Rheumatic Heart Disease
Group A Streptococcus (GAS) causes superficial and invasive infections and immune mediated post-infectious sequalae (including acute rheumatic fever/rheumatic heart disease). Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are important determinants of global cardiovascular morbidity and mortality. ARF is a multiorgan inflammatory disease that is triggered by GAS infection that activates the innate immune system. In susceptible hosts the response against GAS elicits autoimmune reactions targeting the heart, joints, brain, skin, and subcutaneous tissue. Repeated episodes of ARF—undetected, subclinical, or diagnosed—may progressively lead to RHD, unless prevented by periodic administration of penicillin. The modified Duckett Jones criteria with stratification by population risk remains relevant for the diagnosis of ARF and includes subclinical carditis detected by echocardiography as a major criterion. Chronic RHD is defined by valve regurgitation and/or stenosis that presents with complications such as arrhythmias, systemic embolism, infective endocarditis, pulmonary hypertension, heart failure, and death.
  • 409
  • 07 Jul 2022
Topic Review
Atherothrombosis in Progression of Non-Coronary Artery Disease
Peripheral artery disease (PAD) encompasses a variety of non-coronary artery diseases, and its prevalence varies based on screening approaches and clinical features. Recent data reveal a global prevalence of 80 million strokes, the majority (87%) of which are ischemic.
  • 409
  • 25 Apr 2023
Topic Review
Most Frequent Cardiovascular Diseases
Cardiovascular diseases (CVDs) are a group of diseases with a very high rate of morbidity and mortality. The clinical presentation of CVDs can vary from asymptomatic to classic symptoms such as chest pain in patients with myocardial infarction. Current therapeutics for CVDs mainly target disease symptoms. The most common CVDs are coronary artery disease, acute myocardial infarction, atrial fibrillation, chronic heart failure, arterial hypertension, and valvular heart disease.
  • 409
  • 12 Dec 2023
Topic Review
Cardiac Remodeling and Repair
Repairing cardiac damage and restoring heart function includes cell-based, non-cellular, induced adult cardiomyocyte proliferation and manipulation of cardiac remodeling. Though there has been significant success in delineating the mechanism of cardiac injury and protection against acute ischemic injury, an efficient therapeutic intervention is still unavailable.
  • 408
  • 29 Mar 2022
Topic Review
Human Hematopoietic Stem/Progenitor Cells in T1DM Treatment
Type 1 diabetes mellitus (T1DM) is a highly prevalent autoimmune disease causing the destruction of pancreatic islet β-cells. The resulting insulin production deficiency leads to a lifelong need for insulin re-placement therapy, systemic complications, and reduced life quality and expectancy. Cell therapy has been extensively attempted to restore insulin independence (IID), and autologous nonmyeloablative hematopoietic stem cell transplantation (AHST) has appeared to give the most promising results.
  • 408
  • 19 Apr 2023
Topic Review
Ferroptosis in Cardiovascular Disease and Cardiomyopathies
In the realm of cardiovascular diseases, it significantly contributes to cardiomyopathies, including dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. Ferroptosis involves intricate interactions within cellular iron metabolism, lipid peroxidation, and the balance between polyunsaturated and monounsaturated fatty acids. Molecularly, factors like p53 and nuclear factor (erythroid-derived 2)-like 2 (Nrf2) impact cellular susceptibility to ferroptosis under oxidative stress. Understanding ferroptosis is vital in cardiomyopathies, where cardiac myocytes heavily depend on aerobic respiration, with iron playing a pivotal role. Dysregulation of the antioxidant enzyme glutathione peroxidase (GPX4) is linked to cardiomyopathies, emphasizing its significance. Ferroptosis’s role in myocardial ischemia-reperfusion injury, exacerbated in diabetes, underscores its relevance in cardiovascular conditions.
  • 408
  • 05 Mar 2024
Topic Review
Link of Endothelin System and Ischemia-Induced Ventricular Tachyarrhythmias
Sympathetic activation has long been known to play a key role in the pathophysiology of ischemia-induced arrhythmias, but the regulating factors remain under investigation. The endothelin system is implicated as an important modulator of sympathetic activation in the setting of acute coronary syndromes. This system consists of a family of three endothelin isopeptides (ET-1, ET-2, and ET-3), produced by numerous cell types, and two specific receptors (ETA and ETB) that are widely expressed throughout the body. Endothelin is synthesized and released continuously, but it is also stored in intracellular endothelial storage pools and secreted by exocytosis. The main source of circulating endothelin in the setting of acute coronary syndromes appears to be the ischemic myocardium, with plasma levels correlating with the incidence of VTs. In addition to its vasoconstrictive effects in the coronary circulation, endothelin is implicated in ischemia-induced arrhythmogenesis, both directly and indirectly, the latter mode exerted by modulating sympathetic responses.
  • 407
  • 20 Jan 2023
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