ISSN 2996-8215
International Journal of Cardiology | Vol. 12, No. 4, April 2021 | pp. 25–32
DOI: 10.46882/2021/IJC/000145
Original Research Article
Three-Year Survival Trends and Heart Failure Rehospitalizations Following Post-Procedural Moderate Paravalvular Leak
Jean-Pierre Dubois¹, Pierre Vigneron¹, Lucia Rossi²
¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
²Department of Cardiac Surgery, University of Milan, Milan, Italy
Abstract:
Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery for high-risk patients with severe aortic stenosis. However, paravalvular regurgitation (PVR) remains a common post-procedural finding due to calcific asymmetry. This study investigated the 3-year prognostic impact of post-procedural moderate PVR on mortality and heart failure hospitalization. We prospectively followed 240 consecutive high-risk patients who underwent successful TAVI with early-generation balloon-expandable or self-expanding valves. Post-procedural PVR severity was graded using multi-parametric transthoracic echocardiography at discharge. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization at 36 months. Moderate PVR was identified in 38 patients (15.8%), while 202 patients had none, trace, or mild PVR. At 3 years, the primary composite endpoint occurred significantly more frequently in the moderate PVR cohort than in the trace-to-mild group (47.4% vs. 21.8%, log-rank p < 0.001). This difference was driven by both higher all-cause mortality (28.9% vs. 12.4%, p = 0.01) and recurrent heart failure hospitalizations (36.8% vs. 14.9%, p < 0.01). Multivariable Cox proportional hazards analysis confirmed that post-procedural moderate PVR was an independent predictor of the 3-year composite endpoint (hazard ratio: 2.34, 95% CI: 1.41–3.88, p = 0.001). Post-procedural moderate paravalvular regurgitation significantly compromises 3-year survival and survival freedom from heart failure hospitalizations after TAVI, underscoring the importance of deploying next-generation anti-leak valve designs.
Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Paravalvular regurgitation, Echocardiography, Mortality, Long-term outcomes
Received: January 08, 2021; Revised: February 20, 2021; Accepted: March 12, 2021; Published: April 22, 2021
International Journal of Cardiology | Vol. 12, No. 10, October 2021 | pp. 73–80
DOI: 10.46882/2021/IJC/000151
Original Research Article
Prognostic Significance of Longitudinal Ventricular Strain in Patients with Severe Chronic Kidney Disease and Aortic Stenosis
Hans-Jürgen Schmidt¹, Werner Müller¹, Dieter Reinhardt²
¹Department of Cardiology and Pulmonology, Charité – Universitätsmedizin Berlin, Berlin, Germany
²Division of Vascular Medicine, University Hospital Leipzig, Leipzig, Germany
Abstract:
Valvular aortic stenosis (AS) in patients with advanced chronic kidney disease (CKD) accelerates myocardial remodeling, yielding an increased hazard profile. Standard metrics such as left ventricular ejection fraction (LVEF) often fail to capture subclinical contractile dysfunction caused by concurrent uremic cardiomyopathy. This prospective study evaluated the prognostic value of two-dimensional global longitudinal strain (GLS) in asymptomatic or minimally symptomatic patients with severe AS and stage 4 CKD. We enrolled 125 patients with an aortic valve area less than 1.0 cm², preserved LVEF (greater than or equal to 50%), and an estimated glomerular filtration rate (eGFR) between 15 and 29 mL/min/1.73m². All participants underwent speckle-tracking echocardiography at baseline. The primary endpoint was a composite of cardiac mortality or heart failure hospitalization over a 24-month follow-up period. Impeared baseline structural mechanics, defined as an absolute GLS less than 15.0%, was present in 44.0% of the cohort. At 24 months, the primary composite endpoint occurred in 42 patients (33.6%). Kaplan-Meier survival curves indicated a significantly lower event-free survival rate in the low absolute GLS group (51.2% vs. 81.3%, log-rank p < 0.001). After adjusting for age, eGFR, and plasma NT-proBNP levels, multivariable Cox proportional hazards analysis confirmed that an absolute GLS less than 15.0% was an independent predictor of the composite outcome (hazard ratio: 2.26, 95% CI: 1.38–3.68, p = 0.001). Quantitative baseline global longitudinal strain serves as an independent predictor of adverse outcomes in patients with severe aortic stenosis complicated by advanced renal dysfunction.
Keywords: Aortic stenosis, Chronic kidney disease, Global longitudinal strain, Echocardiography, Risk stratification, Cardiorenal syndrome
Received: July 02, 2021; Revised: August 14, 2021; Accepted: September 05, 2021; Published: October 18, 2021
International Journal of Cardiology | Vol. 12, No. 8, August 2021 | pp. 57–64
DOI: 10.46882/2021/IJC/000149
Original Research Article
High-Dose Atorvastatin Pre-Loading Safely Lowers Periprocedural Myonecrosis During Complex Multivessel Angioplasty
Yusuf Demir¹, Murat Kaya¹, Ahmet Yilmaz²
¹Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
²Division of Interventional Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
Abstract:
Periprocedural myocardial infarction (pMI) is a frequent complication during complex percutaneous coronary intervention (PCI). Statin reloading has shown efficacy in limiting pMI in general cohorts, but its impact during complex interventions in patients already established on maintenance statin treatment requires validation. This prospective, randomized, open-label trial evaluated whether high-dose atorvastatin reloading before complex PCI reduces pMI rates in patients on chronic statin therapy. We enrolled 240 chronic statin users undergoing complex PCI (defined as multi-vessel disease, bifurcation lesions, or total occlusions). Patients were randomized 1:1 to receive either an acute reload of atorvastatin (80 mg given 12 hours and 2 hours pre-PCI, n = 120) or to continue standard maintenance dosing (n = 120). The primary endpoint was the incidence of pMI, defined as an elevation of cardiac troponin I (cTnI) greater than 5 times the upper limit of normal within 24 hours post-procedure. The incidence of pMI was significantly lower in the atorvastatin reloading group than in the control arm (8.3% vs. 17.5%, p = 0.03). Post-procedural mean cTnI values were also significantly reduced with the reload (0.44 ± 0.12 ng/mL vs. 0.92 ± 0.22 ng/mL, p < 0.01). No cases of hepatic dysfunction or rhabdomyolysis occurred. High-dose atorvastatin reloading safely and significantly reduces periprocedural myocardial injury during complex percutaneous coronary intervention in patients on chronic maintenance statin therapy.
Keywords: Percutaneous coronary intervention, Atorvastatin, Statin reloading, Periprocedural myocardial infarction, Complex coronary lesions
Received: May 12, 2021; Revised: June 25, 2021; Accepted: July 11, 2021; Published: August 20, 2021
International Journal of Cardiology | Vol. 12, No. 12, December 2021 | pp. 89–96
DOI: 10.46882/2021/IJC/000153
Original Research Article
Association Between Coronary Artery Calcium Volume Scores and Quantitative Myocardial Perfusion Reserve via Rubidium-82 PET Imaging
Arjun Patel¹, Rohan Mehta¹, Vikram Singh²
¹Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
²Division of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi, India
Abstract:
The Agatston coronary artery calcium (CAC) score is a validated tool for predicting cardiovascular events, but its linear correlation with functional myocardial ischemia remains variable. This study investigated the quantitative relationship between CAC volume scores derived from computed tomography and stress myocardial blood flow (MBF) along with myocardial perfusion reserve (MPR) quantified non-invasively via Rubidium-82 (82Rb) positron emission tomography (PET). We prospectively evaluated 140 symptomatic patients with suspected coronary artery disease who underwent both non-contrast CT for calcium calculation and stress/rest 82Rb PET imaging within 14 days. Diffuse microvascular ischemia was defined as a global MPR less than 2.0 in the absence of regional focal defects. Severe macrovascular calcification (CAC volume score greater than 400) was present in 52 patients (37.1%). Global stress MBF was significantly lower in the high-CAC cohort compared to the low-CAC group (1.64 ± 0.32 mL/min/g vs. 2.24 ± 0.44 mL/min/g, p < 0.001). Consequently, baseline high CAC volume scores strongly correlated with impaired global MPR (r = -0.68, p < 0.001). Multivariable linear regression confirmed that log-transformed CAC volume scores were independently associated with reduced global MPR (beta-coefficient = -0.34, p = 0.002), after adjusting for traditional metabolic risk indices and stenotic severity. Extensive coronary artery calcification volumes demonstrate a strong independent association with impaired quantitative myocardial perfusion reserves, indicating a severe burden of concurrent coronary microvascular dysfunction.
Keywords: Coronary artery calcium, Positron emission tomography, Myocardial perfusion reserve, Computational imaging, Microvascular dysfunction, Ischemia
Received: September 05, 2021; Revised: October 20, 2021; Accepted: November 12, 2021; Published: December 18, 2021
International Journal of Cardiology | Vol. 12, No. 11, November 2021 | pp. 81–88
DOI: 10.46882/2021/IJC/000152
Original Research Article
Long-Term Impact of Subclinical Leaflet Thrombosis on Valve Hemodynamics After Transcatheter Aortic Valve Implantation
Jean-Pierre Dubois¹, Pierre Vigneron¹, Lucia Rossi²
¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
²Department of Cardiac Surgery, University of Milan, Milan, Italy
Abstract:
Subclinical leaflet thrombosis, characterized by hypo-attenuated leaflet thickening (HALT) on multi-detector computed tomography (MDCT), is frequently detected following transcatheter aortic valve implantation (TAVI). However, its long-term impact on transvalvular pressure gradients and clinical major adverse cardiac events (MACE) remains controversial. This prospective registry study evaluated the chronological progression of HALT and its association with late valve dysfunction. We evaluated 165 consecutive patients who underwent successful TAVI with newest-generation balloon-expandable or self-expanding bioprostheses. Four-dimensional MDCT scans were performed at 30 days post-procedure to identify HALT. Serial transthoracic echocardiography at discharge, 6 months, 12 months, and 36 months monitored mean transvalvular pressure gradients. HALT was identified in 24 patients (14.5%) at the 30-day screen. At 36 months, patients with early subclinical leaflet thrombosis demonstrated a significantly higher mean transvalvular gradient compared to those without HALT (16.4 ± 4.2 mmHg vs. 11.2 ± 3.1 mmHg, p < 0.01). Ischemia-driven target valve reintervention or stroke occurred in 16.7% of the HALT cohort versus 5.0% in the non-HALT group (p = 0.04). Multivariable logistic regression confirmed that early HALT was independently associated with a 3-year mean gradient rise greater than or equal to 5 mmHg (odds ratio: 3.42, 95% CI: 1.54–7.62, p = 0.003). Subclinical leaflet thrombosis identified early after TAVI is not benign, as it correlates with a significant rise in late transvalvular pressure gradients and an increased risk of mid-term thromboembolic events.
Keywords: Transcatheter aortic valve implantation, Hypo-attenuated leaflet thickening, Subclinical leaflet thrombosis, Computed tomography, Valve hemodynamics, Stroke
Received: August 01, 2021; Revised: September 15, 2021; Accepted: October 10, 2021; Published: November 20, 2021
International Journal of Cardiology | Vol. 12, No. 5, May 2021 | pp. 33–40
DOI: 10.46882/2021/IJC/000146
Original Research Article
Speckle-Tracking Echocardiography Derived Left Atrial Reservoir Strain for Predicting Arrhythmic Recurrence Post-PVI
Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²
¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark
Abstract:
Catheter ablation using pulmonary vein isolation is an effective rhythm control strategy for paroxysmal atrial fibrillation (AF), but anatomical left atrial (LA) diameter alone poorly predicts recurrence. Left atrial reservoir strain (LA-RS) evaluated by speckle-tracking echocardiography offers a direct indicator of structural remodeling and compliance. This study investigated the independent association between baseline LA-RS and long-term arrhythmia recurrence post-catheter ablation. We prospectively enrolled 150 patients with symptomatic paroxysmal AF scheduled for radiofrequency catheter ablation. LA-RS was analyzed off-line using apical four- and two-chamber views before the intervention. The primary endpoint was any documented recurrence of atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period over a 24-month follow-up. Arrhythmia recurrence occurred in 48 patients (32.0%). Baseline mean LA-RS was significantly lower in patients with recurrent events compared to those who maintained sinus rhythm (18.4% ± 3.2% vs. 28.5% ± 4.1%, p < 0.001). Multivariable Cox proportional hazards regression identified a depressed baseline LA-RS (absolute value less than 20%) as a powerful independent predictor of AF recurrence (hazard ratio: 2.45, 95% CI: 1.34–4.48, p = 0.003), whereas conventional LA volume indexing lost statistical significance. No major procedural access complications occurred. Left atrial reservoir strain is strongly and independently associated with atrial fibrillation recurrence following catheter ablation, outperforming traditional volumetric metrics for predicting long-term rhythm stability.
Keywords: Atrial fibrillation, Catheter ablation, Speckle-tracking echocardiography, Left atrial strain, Recurrence, Remodeling
Received: February 14, 2021; Revised: March 28, 2021; Accepted: April 15, 2021; Published: May 20, 2021