CVIA has just published a new issue, Volume 5 Issue 4.

This issue brings together important research papers from leading cardiologists in US and China in a combination of reviews, original research and case reports.

Three important papers in the issue are highlighted below.

Nikhil H. Shah, Steven J. Ross, Steve A. Noutong Njapo, Justin Merritt, Andrew Kolarich, Michael Kaufmann, William M. Miles, David E. Winchester, Thomas A. Burkart and Matthew McKillop

Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review (DOI: 10.15212/CVIA.2021.0005)

In this important review paper, the authors study the use of implantable cardioverter-defibrillators (ICDs) which can be life-saving devices, although they are expensive and may cause complications. In 2013, several professional societies published joint appropriate use criteria (AUC) assessing indications for ICD implantation. Data evaluating the clinical application of AUC are limited. Previous registry-based studies estimated that 22.5% of primary prevention ICD implantations were “non-evidence-based” implantations. On the basis of AUC, the authors aimed to determine the prevalence of “rarely appropriate” ICD implantation at their institution for comparison with previous estimates.

286 patients who underwent ICD implantation between 2013 and 2016 were reviewed. Appropriateness of each ICD implantation was assessed by independent review and rated on the basis of AUC.  Of 286 ICD implantations, two independent reviewers found that 89.5% and 89.2%, respectively, were appropriate, 5.6% and 7.3% may be appropriate, and 1.8% and 2.1% were rarely appropriate. No AUC indication was found for 3.5% and 3.4% of ICD implantations, respectively. Secondary prevention ICD implantations were more likely rarely appropriate or unrated. The reviewers found 3.5% and 3.4% of ICD implantations, respectively, were non-evidence-based implantations. The authors conclude that compared with prior reports, the prevalence of rarely appropriate ICD implantation was very low. The high appropriate use rate could be explained by the fact that AUC are based on current clinical practice. The AUC could benefit from additional secondary prevention indications. Most importantly, the authors insist that clinical judgement and individualized care should determine which patients receive ICDs irrespective of guidelines or criteria.

Zeyi Cheng, Miaomiao Qi, Chengyuan Zhang and Yanxia Mao

Myocardial Fibrosis in the Pathogenesis, Diagnosis, and Treatment of Hypertrophic Cardiomyopathy (DOI: 10.15212/CVIA.2021.0008)

In this important research paper, the authors consider hypertrophic cardiomyopathy (HCM). This is a type of hereditary cardiomyopathy caused by gene mutation. Its histological features include cardiomyocyte hypertrophy and disarray as well as myocardial fibrosis. Gene mutation, abnormal

signal transduction, and abnormal energy metabolism are considered the main mechanisms of myocardial fibrosis. There is a strong correlation between myocardial fibrosis and the occurrence, development, and prognosis of HCM. The authors review the application of myocardial fibrosis in the diagnosis and treatment of HCM, focusing on research progress and the application of magnetic resonance imaging on the basis of the characteristics of fibrosis in the diagnosis and prognosis of HCM.

Lei Zhang, Tiewei Lv, Xiaoyan Liu, Chuan Feng, Min Zheng, Jie Tian and Huichao Sun

A Case of Pediatric Heart Failure Caused by Anomalous Origin of the Left Coronary Artery from

the Pulmonary Artery: Case Report and Literature Review (DOI 10.15212/CVIA.2019.0585)

This case report studies a case where the patient received a diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), which is an extremely rare congenital heart defect that can cause severe heart failure during infancy, and is easily misdiagnosed

clinically. In this report, the authors show the process of misdiagnosis of the case and consult the relevant literature, hoping to improve the understanding and early diagnosis of ALCAPA.