From Editor-in-Chief: On current issue, journal`s performance in 2023, acknowledging best, authors` and reviewers` feedback on peer-review and content, insights on the latest trials and guidelines, and changes in COVID policies

Dear readers

We start this year introducing first in 2024 – March issue articles of interest for wide audience on topics including surgery, cardiac, thoracic, and vascular, pulmonary diseases, interventions, imaging, arrhythmias, cardio-oncology, rehabilitation  and anatomy of the heart; evaluating our performance in 2023, including citation analysis and feedback on peer-review and content, acknowledging best authors in 2023; providing insights on latest clinical trials and guidelines and change in public health policies.

Current issue

We prepared several Editorials to attract your attention to the latest important guidelines and expert documents on: revascularization in CCD –reappraisal of 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guidelines; 2023 update on Duke criteria for infectious diseases (ISCID), comment on new approach -conduction system pacing implantation - EHRA expert document. Also we published interesting editorial on healthy aging and cardiovascular disease in Kyrgyzstan, and comment on case report published in this issue on rehabilitation in pediatric re-transplantation.

Original research articles of interest for wide audience are: risk factors, clinical characteristics and short-mortality in on-pump and off-pump coronary bypass surgery (CABG) patients, two articles on COVID – population immunity to SARS-COV2 in Kyrgyz Republic and thromboembolic complications and deep venous thrombosis in COVID patients; procalcitonin as a marker of sepsis in intensive care unit; case series on rare Mondor’s disease; quality of life in patients during chemotherapy; treatment outcomes of  pulmonary aspergilloma; and hospital mortality in ischemic stroke. Innovative brief report on assessment of myocardial contraction fraction in transcatheter aortic valve replacement and systematic review on rehabilitation - inspiratory muscle training in patients with heart failure. We think these articles contribute to evidence pools and will be cited.

Challenging and rare case reports on: CABG and simultaneous removal of right heart myxoma;  cardiac rehabilitation in pediatric heart re-transplantation; CABG and repair of redo aorta coarctation; left ventricular (LV) perforation by a chest tube and neuromyelitis optica and NMDAR encephalitis in a child.

Letters to the editor- discussion of LV perforation by chest tube case – on use of 3 -dimensional computed tomography (CT) and magnetic resonance (MRI) imaging reconstruction to guide chest tube insertion and letter on medical policy sharing experience on humanitarian medical camp in Pakistan delivering expert care to rural population.

We have 2 quiz articles of interest to our readers on multimodality imaging of round mass in right atrium and refreshing knowledge on cardiac anatomy presented using modern techniques – topics we consider very important for cardiovascular diseases, interventions and surgery.

 Journal`s  performance

In 2023, we improved our performance in SCOPUS – our number of citations increased from 47 in 2022 to 67 in 2023 (1).

Our SCOPUS Hirsch index is 3 (Fig.1). As  I mentioned in previous issue our 2023 CiteScore is 0.2 and our ranking Q4, surgery – 456/495among surgery journals – 7th percentile, cardiovascular medicine -334/354 – 5th percentile and transplantation -50/51 2nd percentile.

We also increased number of citations to our articles in Crossref/Crosscite from 65 in 2022 to 100 in 2023.

Figure 1. SCOPUS Hirsch index of the journal for period of 2019-2023 –h-index -3

We received 228 citations in journals indexed in Google Scholar for the period 2017-2023. The 5 –year (2018 -2023) h5 index is 5 and h5-median index is 6 (Fig. 2). Thus, we made a good progress by 100% increase in citations - from 106 citations to 228 in 2023 and ranking - from h5 – 4 to h5 - 5 and h5 median – 5 to h5 median -6.

Thus we make a good progress in scientific performance by increasing citations number and ranking. We will apply in to PUBMED/PMC and further to Clarivate Emerging sources and  Web of Science databases.

The 2024 SCOPUS and Google Scholar metrics will be released in June 2024, I will update our readers.

We continue acknowledging authors with the most read articles. In this issue we congratulate authors of articles published in 2023, who gained highest number of impressions on Twitter and Facebook. Twitter (X) (Table 1)  - Carla Recupero and coauthors from Rome Italy – their Editorial on lesson from ACC Consensus document on management of amyloidosis received 2095 impressions; Cristina Aurigemma and coauthors from Rome,  Italy – their review article  valvular heart disease  management in women in transcatheter era – 1438 impressions; Dario Mafrica and coauthors  from Rome,  Chieti, Latina, Napoli, Italy  - Editorial on  Insights from EAPCI document on coronary physiology role in PCI   received 1283 impressions;  Theodora Metsovitis and coauthors Caserta, Rome, Italy  - Editorial timing of PBMV in rheumatic disease – 1212 impressions and Raul Cruz Palomera and coauthors from Puebla, Mexico whose case report on late presentation of ALCAPA syndrome  received 628 impressions. 

Figure 2.Google Scholar metrics for Heart, Vessels and Transplantation: h5 and h5-median indexes

On Facebook (Table 2): Raul Cruz Palomera and coauthors from Puebla, Mexico, for case report on late presentation of ALCAPA syndrome post that reached 12 908 people and received 14 351 impressions; Fabio Massimo Oddi and co-authors from Rome Italy on Editorial on lessons to be drawn  on ACC guideline on aortic disease –gained 13 251 impressions and reached 12 821 people and Rujuta Parikh and coauthors from Gujarat, India for case report on post-CABG subclavian coronary steal syndrome  - reached 20 039 people and gained 11 045 impressions.

I would like also to present results of survey on experience with peer-review and feedback on content from our authors, reviewers and editors participated in peer-review. Overall, we received response from authors, reviewers and editors from Australia, Brazil, France, Monaco, Kyrgyzstan, Kazakhstan, Italy, Mexico, Slovakia, Turkey and Ukraine.

Majority of our authors, reviewers and editors graded experience with peer-review as excellent (69%, 90%, and 75%, respectively) (Fig.3).

Figure 3. Overall satisfaction with peer-review process by participants of peer-review: authors, reviewers and editors

(5-excellent, 4-good, 3- satisfactory, 2 – unsatisfactory, 1- fail, 0 –not available)

Figure 4. Satisfaction with double-blind  (triple- blind) peer-review type (names of authors and reviewers, editors are concealed)  and whether it helped to provide unbiased evaluation of manuscript

(5-excellent, 4-good, 3- satisfactory, 2 – unsatisfactory, 1- fail, 0 –not available)

Feedback regarding  double-blind peer-review (Fig. 4): majority graded as excellent (69%, 70% and 75%), while 31% of authors, 20% of reviewers and 25% of editors graded as good; and 10% of reviewers found double- blinding satisfactory. 

Therefore, we continue double-blind peer-review process in current form and increased number of citations and H-indexes  also supports our peer-review policies.

Figure 5.  Feedback of authors regarding reviewers` and editors` reports

(5-excellent, 4-good, 3- satisfactory, 2 – unsatisfactory, 1- fail, 0 –not available)

Scientific value of reviewer`s report -  high  (4-5), moderate  (3) or low (2,1)

Level of objectivity of reviewer’s report:  biased (1, 2) with lack of objectivity or prejudiced (1, 2) or unbiased (3-5), objective (3-5) and fair (3-5)

When we look at authors` opinion on quality of reviewers and editors reports (Fig. 5): all authors were  satisfied with reviewers reports (77% -excellent and 23% good) and all agreed that  it helped to improve the content of  manuscript (77% -excellent and 23% good). Scientific value was graded as following:  76.9% of authors found reviewer report to be of high scientific value, 15.3% graded as good and 7.69% as satisfactory. Objectivity level was graded as fair, unbiased and objective (69.2- excellent, 23% good) and 7.69% biased and prejudiced.

Figure 6. Feedback of reviewers and editors  on peer-review: authors response and editor decision

(5-excellent, 4-good, 3- satisfactory, 2 – unsatisfactory, 1- fail, 0 –not available)

RF – reviewer form

We have to work on elimination of prejudice and bias, even in small percentage.  Our reviewers work hard to provide expert opinions and recommendations.

As to reviewers and editors opinions on satisfaction with tools provided for peer-review (Fig. 6), our data show that 50% of editors were fully satisfied with reviewer form and graded as excellent, while 12.5% graded as good, satisfactory and unsatisfactory; while reviewers have excellent (60%) and good (40%) grades for reviewer form.

Overall 60% of reviewers graded authors` response to comments and revision as excellent, 20% - as good and 20% as satisfactory. Editors appeared to be more appraising – only 37.5% found authors response as excellent, 25% as good, 25% as satisfactory and 12.5 as failed and absent.

Overall 60% of reviewers graded the editor`s decision and notification as excellent, 20% as good and 20% as satisfactory. Editors – 75% found it excellent, 12.5% as satisfactory and 12.5 as fail.

Thus, we have to work on improvement of tools in guiding reviewers and as well notification of final decisions – we already made improvements. Of course this a survey and we may have diverse opinions of reviewers on the same manuscript -  2 protagonist and 1 antagonist making revise or accept decision.   

As to authors responses, we have room for improvement and we work with authors. I always remind our authors do not  submit revision without answers, to respond to comments point-by- point, only then we accept revision and proceed with decision. It is a learning process, of academic discussion and precision – if you respond to every comment then you will make substantial improvement and benefit from expert opinions and your study will be well presented and recognized.

Majority of authors found journal content (Table 3) as excellent (61.53%), 30.76 as good and 7.69 as satisfactory. All types of articles received grade excellent from 61.53 authors, while lower percentage  (53.8%)  graded research articles as excellent and 46.1% as good, 30.7% of authors graded review articles as good, and 23.07% graded case reports, editorials, and letters as good and only 7.69% graded as satisfactory case reports and letters.

Reviewers and editors estimation of content was much lower and we are all work on improvement and see more space to advance. Only 44.4% of reviewers found content excellent, 33.3% as good and 22.2% as satisfactory. Research articles received excellent mark only from 22.2% of reviewers, while 66.6% - graded as good and 22.2 graded as satisfactory;

33.3% found review articles, case reports and brief reports excellent,   55.5%  graded as good  and 11.1% as satisfactory review articles; case reports, brief reports and letters were graded as good and satisfactory by 33.3% of reviewers. Editorials and CME articles received excellent mark from 55% of reviewers.

Fifty percent of Editors found research article as excellent, 37.5% as good and 12.5% as unsatisfactory; review articles – only 37.5% marked as excellent, 37.5  - as good, 12.5 as satisfactory and 12.5% - as fail. Half of editors participated in survey graded case reports, brief reports and letters as excellent, 50% graded cases and brief as good and letter were graded by 37.5% as good and by 12.5% – as satisfactory.

CME articles and editorials received excellent mark from majority of editors   (62.5%) and 37.5% graded these types of articles as good.

Therefore, we have to continue working on improvement of peer-review; reviewers` and editors` reports  quality and stimulating authors to work on revision, addressing comments and applying point-by-point revisions, if authors do not agree with comment or recommendation then explain  why and support by evidence if necessary. We also need to comply with presentation guidelines. This is the road to improving content. 

Updates on evidence –based knowledge

I would like to share latest updates on evidence-based knowledge and recommend several important guidelines and consensus statement documents that should help you improve patients` care. These includes guidelines from STS/SCVA/ASET  on management of acute kidney injury associated with adult cardiac surgery (2),   EACTS/STS guideline on management of acute and chronic syndromes of aorta organ (3), AHA/NCS consensus statement on critical care of cardiac arrest survivors (4),  AHA statement on treatment of cardiogenic shock in older adults (5),  AHA statement on management of cardiac implantable electronic devices (CIED) infections (6), AHA/PACES statement on management of fetal arrhythmias (7)  and EACVI document on use of stress echocardiography in evaluation of chronic coronary disease (8). Some of them will be introduced in Editorials in forthcoming issues.

Of particular interest is the AHA/NCS document on critical care of patients after cardiac arrest (4) is addressed to emergency, intensive and coronary care physicians. The document focuses on detailed neurological,  cardiac, pulmonary and other systems care in patients after cardiac arrest. Detailed description and concise  recommendations on methods of neurological (cerebral perfusion pressure, intracranial pressure monitoring, electroencephalography, oxygen saturation), cardiac (echocardiography, central venous pressure monitoring, catheterization, angiography, lactate level, oxygenation) pulmonary  diagnosis, monitoring, risk stratification  and treatment (neurological - brain oxygenation, reducing edema, seizures and sedation, cardiac-  inotropes,  intara-ortic balloon pump, LV assist devices and extracorporeal membranous oxygenation; pulmonary - ventilation, hematological and other) are delivered.  Recommendations are provided for scenarios based on  availability and non-availability of advanced methods and tools.

Advisory  document from AHA on prevention of infective endocarditis (IE) (9) in non-dental procedures demonstrated that patients at high risk of IE undergoing bronchoscopy, gastrointestinal procedures, bone marrow puncture, CIED implantation are at substantial increased risk of IE – cases per 100 000 vary from 14 to 49. Therefore the advisory suggests revision of guidelines. Until then thorough sterility  and infection prevention is  needed, in procedure where guideline recommends antibiotic treatment, following strict protocols is advised and use of local antibiotic impregnated material on surgical site is recommended.

Recent trial (10)  comparing  effect of single combined  pill of endothelin receptor antagonist macitentan and  phosphodiesterase 5 inhibitor -  tadalafil in patients with pulmonary hypertension (idiopathic, inherited, toxin induced and corrected congenital heart disease, HIV) reduced pulmonary vascular resistance - primary endpoint by  29%; (geometric mean ratio 0.71; 95% CL: 0.61-0.82; p<0.0001) as compared to single pill macitentan and by 28% ( geometric mean ratio 0.72; 95% CL: 0.64-0.80; p<0.0001) as compared to tadalafil.  This trail supports combined pill use, due to possible  higher patients` compliance and easy use. We will wait for more evidence and availability of such combined pill. 

Interesting study (11) on large sample (412 413 participants) compared women and men benefit in survival as a result of physical activity. The same level of physical activity compared to inactivity  in women and men was accompanied by greater  reduction of risk of all-cause mortality in women (24% reduction  (HR - 0.76; 95% CI: 0.73-0.80) and   15%  in men (HR - 0.85; 95% CI: 0.82-0.89). Cardiovascular risk was the same. Women should be encouraged to exercise as they derive higher benefit.

Another study deserving attention (12) was just released on effects of microplastics and nanoparticles in atheroma on cardiovascular events in patients undergoing carotid endarterectomy. In patients with asymptomatic carotid artery disease who underwent endarterectomy, presence of  microplastics and nanoparticles in excised atheroma was associated with 4.53 (2.0-10.27,  p<0.001) higher  risk of myocardial infarction, stroke and death as compared without patients without these particles. We need more studies on such association. 

There are 2 studies in the field of arrhythmia that deserve attention. Meta-analysis (13)  demonstrated that transesopahgeal echocardiography-detected peri- device leak in patients after left atrial appendage occlusion  is associated risk of thromboembolic events depending  on size of the leak:  any size - HR 1.82, 1.35-2.47 ( size >1 vs < 1 mm  – HR =2.13, >3 vs >3 mm – HR 4.14 and > 5vs < 5 mm – 4.44). Computed tomography detection rate was high but without  prognostic significance. The improvement of technique to reduce complications  is crucial.

RAFT trial (14) demonstrated that patients with heart failure with implanted cardiac resynchronization therapy-defibrillator have  good long-term (13 years) survival as compared to patients with only implantable cardiac defibrillator  (HR-0.80, 0.69-0.92, p=0.002).

Patients with severe tricuspid valve (TV) regurgitation at low and intermediate risk may benefit transcatheter valve implantation or surgical repair. TRI-SCORE study (15) demonstrated that patients with severe TV regurgitation  at low and intermediate risk  benefit in survival when treated with early transcatheter valve implantation or surgical TV repair as compared to conservations strategy (93%, 87% and 79%,  p<0.001). Patients with intermediate score with successful  transcatheter treatment had lower by 54%  risk of death (HR 0.46, 95% CI 0.25-0.85,  p=0.01) as compared to conservative strategy during 2 years follow-up.  Surgery in low risk patients was also associated by  65% reduction of adverse events (HR - 0.35 95% CI 0.18-0.69,  p=0.002) vs conservative strategy.

CDC changed isolation policies for COVID and though the new cases, hospitalizations rates and mortality significantly reduced, it is advised to continue protection by receiving updated vaccines that demonstrated good efficacy in preventing severe disease (15). 

Gulmira Kudaiberdieva

Editor-in-Chief

Heart, Vessels and Transplantation

Peer-review: Internal

Conflict of interest: None to declare

   Authorship: G.K.

            Acknowledgement and funding: None to declare