International Journal of Cardiology

International Journal of Cardiology | Vol. 9, No. 7, July 2018 | pp. 49–56

DOI: 10.46882/2018/IJC/000112

Original Research Article

Diagnostic Utility of High-Sensitivity Cardiac Troponin I vs T Rapid 1-Hour Rule-Out Strategies for Suspected ACS

Chloe Jenkins¹, Oliver Vance¹, Sarah E. Lawson²

¹Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

²School of Medicine, University of Queensland, Brisbane, Queensland, Australia

Abstract:
Accelerated diagnostic protocols using high-sensitivity cardiac troponin (hs-cTn) assays have dramatically reduced emergency department (ED) evaluation times for suspected acute myocardial infarction (AMI). However, a direct comparison between high-sensitivity troponin I (hs-cTnI) and high-sensitivity troponin T (hs-cTnT) rapid 1-hour rule-out strategies is limited. This prospective diagnostic study compared the safety and efficacy of 1-hour rule-out algorithms using hs-cTnI versus hs-cTnT in patients presenting with acute chest pain. We evaluated 450 consecutive patients presenting to the ED with chest pain suggestive of acute coronary syndrome. Serial blood samples were drawn at presentation (0h) and 1 hour later for both hs-cTnI and hs-cTnT quantification. The final diagnosis of AMI was adjudicated by an independent clinical panel. AMI was diagnosed in 62 patients (13.8%). The hs-cTnI 1h algorithm successfully ruled out AMI in 61.3% of patients, yielding a diagnostic sensitivity of 98.4% (95% CI: 91.3%–99.9%) and a negative predictive value (NPV) of 99.6% (95% CI: 98.0%–99.9%). The hs-cTnT 1h algorithm ruled out AMI in 58.4% of patients, providing a sensitivity of 96.8% (95% CI: 88.8%–99.6%) and an NPV of 99.2% (95% CI: 97.3%–99.9%). The area under the receiver operating characteristic curve was comparable between hs-cTnI and hs-cTnT (0.94 vs. 0.92, p = 0.35). No patient categorized as safe for rule-out by either assay experienced a major adverse cardiac event within 30 days. Both hs-cTnI and hs-cTnT 1-hour algorithms provide safe, highly efficient triage for ruling out acute myocardial infarction in the emergency department.

Keywords: High-sensitivity cardiac troponin, Acute myocardial infarction, Emergency department, Chest pain, Rapid rule-out, Diagnostic accuracy

Received: April 02, 2013; Revised: May 15, 2013; Accepted: June 08, 2013; Published: July 20, 2018

International Journal of Cardiology | Vol. 8, No. 1, January 2017 | pp. 1–8

DOI: 10.46882/2017/IJC/000094

Original Research Article

Incidence and Cardiac Magnetic Resonance Predictors of Left Ventricular Thrombus Formation After STEMI

Robert J. Davies¹, Edward M. Walsh¹, Simon T. Green²

¹Cardiovascular Research Center, Trinity College Dublin, Dublin, Ireland

²Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom

Abstract:
Left ventricular (LV) thrombus formation is a severe complication of ST-segment elevation myocardial infarction (STEMI) that poses a substantial systemic thromboembolic risk. While primary percutaneous coronary intervention (PPCI) limits overall infarct size, the modern incidence and specific predictors of LV thrombus remain poorly characterized in real-world clinical cohorts. This prospective observational study sought to determine the incidence and structural predictors of LV thrombus after STEMI in the current mechanical reperfusion era using delayed-enhancement cardiac magnetic resonance (CMR) imaging. We evaluated 210 consecutive patients successfully treated with timely PPCI for an acute first STEMI. All patients underwent comprehensive contrast-enhanced CMR imaging at a median of 5 days post-infarction. LV thrombus was identified in 16 patients (7.6%). On univariate analysis, thrombus formation was strongly associated with an anterior MI location, lower left ventricular ejection fraction (LVEF), and larger microvascular obstruction (MVO) zones. Multivariable logistic regression revealed that an anterior STEMI location (odds ratio: 4.12, 95% CI: 1.54–11.02, p = 0.005) and a baseline CMR-derived LVEF less than 40% (odds ratio: 3.24, 95% CI: 1.21–8.68, p = 0.02) were independent predictors of thrombus formation. Furthermore, total mass of late gadolinium enhancement significantly increased thrombus probability (odds ratio: 1.45 per 10g increase, p < 0.01). Despite prompt mechanical revascularization with PPCI, left ventricular thrombus forms in 7.6% of acute STEMI cases, concentrated primarily among patients presenting with anterior wall infarctions and severely depressed systolic function.

Keywords: ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Left ventricular thrombus, Cardiac magnetic resonance, Ejection fraction, Microvascular obstruction

Received: October 12, 2011; Revised: November 25, 2011; Accepted: December 15, 2011; Published: January 22, 2017

International Journal of Cardiology | Vol. 8, No. 3, March 2017 | pp. 17–24

DOI: 10.46882/2017/IJC/000096

Review Article

Molecular Mechanisms, Diagnostic Screening, and Cardioprotective Targets in Anthracycline-Induced Cardiotoxicity

Emily C. Thorne¹, William H. Edwards²

¹Department of Cardio-Oncology, Royal Marsden Hospital, London, United Kingdom

²Division of Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

Abstract:
Anthracyclines remain standard, highly effective therapeutic agents for numerous hematological malignancies and solid tumors, yet their long-term clinical utility is limited by dose-dependent cardiotoxicity, which can cause irreversible heart failure. This comprehensive review synthesizes the molecular mechanisms underlying anthracycline-induced cardiotoxicity and provides a structured overview of modern cardioprotective and monitoring strategies. The primary mechanism of anthracycline toxicity involves the generation of reactive oxygen species (ROS) via iron-dependent pathways, coupled with the direct inhibition of topoisomerase II-beta in mature cardiomyocytes, triggering severe mitochondrial damage and cell apoptosis. Clinical screening depends on tracking left ventricular ejection fraction (LVEF); however, modern speckle-tracking echocardiography can identify subclinical injury through variations in global longitudinal strain (GLS). A relative decrease in absolute GLS greater than 15% during active chemotherapy strongly predicts subsequent LVEF reduction, showing a pooled clinical sensitivity of 86.0% and a specificity of 82.0%. Neurohormonal antagonist therapies, particularly beta-blockers (such as carvedilol) and angiotensin-converting enzyme inhibitors (such as enalapril), show efficacy in blocking or attenuating anthracycline-mediated LVEF declines in high-risk patients. Dexrazoxane remains the only approved intracellular iron chelator that directly reduces ROS generation without altering oncological efficacy, providing a hazard ratio of 0.35 (95% CI: 0.22–0.54) for clinical heart failure prevention across historic cohorts. Effectively managing anthracycline cardiotoxicity requires a multidisciplinary cardio-oncology approach emphasizing early subclinical strain detection and prompt neurohormonal initiation.

Keywords: Anthracyclines, Cardiotoxicity, Cardio-oncology, Global longitudinal strain, Dexrazoxane, Heart failure prevention

Received: December 10, 2011; Revised: January 20, 2012; Accepted: February 08, 2012; Published: March 19, 2017

International Journal of Cardiology | Vol. 8, No. 10, October 2017 | pp. 73–80

DOI: 10.46882/2017/IJC/000103

Original Research Article

Cryoballoon Ablation versus Open-Irrigated Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: Procedural Efficiency and Outcomes

Guillaume Mercier¹, Pierre-Yves Roy¹, Jean-François Lebeau²

¹Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France

²Division of Cardiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

Abstract:
Pulmonary vein isolation (PVI) is the gold standard interventional therapy for symptomatic paroxysmal atrial fibrillation (AF). Point-by-point radiofrequency (RF) ablation is highly effective but technically demanding and time-consuming. Cryoballoon (CB) ablation has been introduced as a simplified single-shot alternative for achieving PVI. This randomized trial compared procedural characteristics, safety, and 12-month efficacy between second-generation cryoballoon and conventional RF ablation. We randomized 160 patients with symptomatic paroxysmal AF refractory to antiarrhythmic drugs to undergo either CB ablation (n = 80) or irrigated RF ablation (n = 80). The primary efficacy endpoint was freedom from any documented atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period without antiarrhythmic drugs. CB ablation demonstrated significantly shorter total procedure times (92 ± 18 minutes vs. 134 ± 24 minutes, p < 0.001) and shorter left atrial dwell times (54 ± 12 minutes vs. 88 ± 16 minutes, p < 0.001) compared with RF ablation. Total fluoroscopy time was slightly longer in the CB cohort (16.4 ± 4.2 minutes vs. 12.1 ± 3.5 minutes, p = 0.01). At 12 months, freedom from recurrent arrhythmia was achieved in 73.8% of the CB group and 71.3% of the RF group (p = 0.72), confirming non-inferiority. Transient phrenic nerve injury occurred in 3.8% of CB procedures, all resolving prior to hospital discharge. Major vascular complications did not differ between cohorts (2.5% vs. 1.3%, p = 0.56). Cryoballoon ablation achieves 12-month success rates equivalent to open-irrigated radiofrequency ablation for paroxysmal atrial fibrillation, while significantly reducing procedural duration.

Keywords: Atrial fibrillation, Pulmonary vein isolation, Cryoballoon ablation, Radiofrequency ablation, Procedural efficiency, Rhythm control

Received: July 05, 2012; Revised: August 19, 2012; Accepted: September 10, 2012; Published: October 22, 2017

International Journal of Cardiology | Vol. 8, No. 4, April 2017 | pp. 25–32

DOI: 10.46882/2017/IJC/000097

Original Research Article

Complete versus Culprit-Only Revascularization in Patients with Multivessel Disease Undergoing Primary PCI for STEMI

Jean-Claude Moreau¹, Philippe Laurent¹, Henri Dupont²

¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France

²Division of Cardiovascular Medicine, Centre Hospitalier Universitaire de Lyon, Lyon, France

Abstract:
Approximately 40% to 50% of patients presenting with acute ST-segment elevation myocardial infarction (STEMI) exhibit multivessel coronary artery disease (MVD). The optimal interventional management strategy for non-culprit obstructive lesions during the acute phase remains an area of clinical debate. This prospective randomized trial compared the 1-year clinical outcomes of complete revascularization versus culprit-only revascularization during primary percutaneous coronary intervention (PPCI) for STEMI. We randomized 240 patients presenting with STEMI and documented MVD into two distinct treatment arms: complete revascularization (PPCI of the culprit lesion followed by staged PCI of non-culprit stenoses within 7 days of index presentation, n = 120) or culprit-only revascularization (PPCI restricted strictly to the infarct-related artery, n = 120). The primary endpoint was the 1-year rate of major adverse cardiac events (MACE), defined as a composite of all-cause death, recurrent myocardial infarction, or ischemia-driven target vessel revascularization. At 1 year, MACE occurred in 8.3% of patients in the complete revascularization group compared to 16.7% in the culprit-only group (p = 0.04). This difference was driven by a significant reduction in the rate of subsequent ischemia-driven revascularization (3.3% vs. 10.8%, p = 0.02), whereas rates of all-cause mortality (3.3% vs. 4.2%, p = 0.73) and recurrent MI (1.7% vs. 1.7%, p = 1.00) were similar. In STEMI patients with multivessel disease, complete staged revascularization significantly reduces the 1-year risk of MACE compared to a culprit-only approach.

Keywords: ST-segment elevation myocardial infarction, Multivessel coronary artery disease, Percutaneous coronary intervention, Complete revascularization, Culprit lesion, Major adverse cardiac events

Received: January 08, 2012; Revised: February 22, 2012; Accepted: March 15, 2012; Published: April 24, 2017

International Journal of Cardiology | Vol. 8, No. 11, November 2017 | pp. 81–88

DOI: 10.46882/2017/IJC/000104

Review Article

Multimodality Imaging Strategies for the Evaluation and Management of Post-Procedural Transcatheter Aortic Valve Implantation Complications

Sophia L. Vance¹, Christopher J. Davies²

¹Department of Cardiovascular Imaging, St Bartholomew's Hospital, London, United Kingdom

²Division of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom

Abstract:
Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe symptomatic aortic stenosis in elderly and high-surgical-risk populations. Despite structural refinements and growing operator expertise, periprocedural and late complications continue to impact long-term survival. This comprehensive review synthesizes the pivotal role of multimodality imaging—specifically multi-detector computed tomography (MDCT), transthoracic/transesophageal echocardiography (TTE/TEE), and cardiac magnetic resonance (CMR)—in identifying, mitigating, and managing major TAVI complications. MDCT serves as the gold standard for pre-procedural planning, allowing precise annular sizing and identification of risk factors for coronary artery obstruction or aortic root rupture (prevalence approximately 0.5% to 1.0%). Intraprocedurally, 2D and 3D TEE are vital for diagnosing acute complications, such as valve malpositioning, infolding, or pericardial effusion. Post-procedurally, evaluating paravalvular regurgitation (PVR) is essential, as moderate-to-severe PVR increases long-term mortality (pooled hazard ratio: 2.18, 95% CI: 1.64–2.90). While Doppler echocardiography remains the primary tracking tool for PVR, CMR is increasingly integrated due to its superior inter-observer reproducibility and precise volumetric regurgitant fraction quantification. Furthermore, high-resolution MDCT is required to detect subclinical leaflet thrombosis, characterized by hypo-attenuated leaflet thickening (HALT). Effective management of modern TAVI complications demands an integrated multimodality imaging approach across pre-, intra-, and post-procedural phases to optimize device performance and improve patient durability.

Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Multimodality imaging, Transesophageal echocardiography, Paravalvular regurgitation, Leaflet thrombosis

Received: August 12, 2012; Revised: September 24, 2012; Accepted: October 14, 2012; Published: November 19, 2017