International Journal of Cardiology

International Journal of Cardiology | Vol. 5, No. 7, July 2014 | pp. 49–56

DOI: 10.46882/2014/IJC/000064

Original Research Article

Diagnostic Utility of High-Resolution Optical Coherence Tomography for Identifying Vulnerable Plaques in Acute Coronary Syndrome

Giovanni Rossi¹, Matteo Bianchi¹, Elena Rossi²

¹Department of Cardiovascular Sciences, University Hospital of Bologna, Bologna, Italy

²Division of Interventional Cardiology, San Raffaele Hospital, Milan, Italy

Abstract:
Identifying vulnerable coronary atherosclerotic plaques prone to rupture is essential for optimizing acute coronary syndrome (ACS) interventions. Optical coherence tomography (OCT) offers high-resolution intravascular visualization, but its systematic diagnostic accuracy for characterizing thin-cap fibroatheromas (TCFA) requires verification against intravascular ultrasound (IVUS). This prospective clinical study evaluated the diagnostic performance of high-resolution intravascular OCT for identifying vulnerable TCFA structures in patients presenting with non-ST-segment elevation ACS (NSTE-ACS). We evaluated 120 patients with NSTE-ACS who underwent ad hoc coronary angiography accompanied by both OCT and radiofrequency IVUS imaging of the culprit vessel. TCFA was defined by OCT as a lipid-rich plaque with a fibrous cap thickness less than 65 μm. Intravascular imaging safely evaluated a total of 142 distinct plaques. OCT successfully identified 42 TCFAs, demonstrating a diagnostic sensitivity of 91.3% (95% CI: 79.2%–97.6%) and a specificity of 89.6% (95% CI: 81.7%–94.9%) using IVUS as the comparative reference. The mean fibrous cap thickness quantified by OCT was 54.2 ± 11.4 μm in the ruptured plaque cohort. Multivariable logistic regression revealed that an OCT-derived fibrous cap thickness less than 65 μm was an independent predictor of microvascular obstruction post-stenting (odds ratio: 3.24, 95% CI: 1.45–7.24, p = 0.004). Intravascular optical coherence tomography achieves excellent diagnostic accuracy for characterizing thin-cap fibroatheromas, providing high-resolution morphological tracking to optimize risk stratification in acute coronary syndrome.

Keywords: Optical coherence tomography, Intravascular ultrasound, Thin-cap fibroatheroma, Acute coronary syndrome, Vulnerable plaque, Diagnostic accuracy

Received: April 05, 2014; Revised: May 19, 2014; Accepted: June 10, 2014; Published: July 22, 2014

Citation: International Journal of Cardiology, 2014, Vol. 5, No. 7, pp. 49–56, DOI: 10.46882/2014/IJC/000064

International Journal of Cardiology | Vol. 4, No. 8, August 2013 | pp. 57–64

DOI: 10.46882/2013/IJC/000053

Original Research Article

Cardioprotective Effects of Sacubitril/Valsartan versus Enalapril in a Chronic Ischemic Heart Failure Rat Model

Jean-Pierre Dubois¹, Pierre Vigneron¹, Henri Dupont²

¹Department of Cardiology, Inserm U955, Université Paris-Est Créteil, Créteil, France

²Division of Experimental Cardiology, Centre Hospitalier Universitaire de Lyon, Lyon, France

Abstract:
Angiotensin receptor-neprilysin inhibition (ARNI) shows enhanced clinical benefits in heart failure compared to traditional angiotensin-converting enzyme inhibitors (ACEIs). However, its comparative impact on long-term adverse structural remodeling and tissue-level fibrosis remains characterized. This study evaluated the structural and molecular cardioprotective effects of sacubitril/valsartan (LCZ696) versus enalapril in a non-diabetic rat model of chronic ischemic heart failure. Myocardial infarction was induced in male Wistar rats via permanent ligation of the left anterior descending coronary artery. Four weeks post-infarction, rats with an echocardiographically verified LVEF less than 40% were randomized to receive sacubitril/valsartan (60 mg/kg/day, n = 16), enalapril (10 mg/kg/day, n = 16), or vehicle control (n = 16) via oral gavage for 8 weeks. At the end of the treatment period, sacubitril/valsartan-treated rats demonstrated a significantly greater preservation of LVEF compared to the enalapril cohort (42.4% ± 3.5% vs. 36.8% ± 3.1%, p < 0.05). Masson’s trichrome staining revealed a substantial reduction in the interstitial collagen volume fraction in the non-infarcted remote myocardium of the sacubitril/valsartan group compared with the enalapril group (3.4% ± 0.6% vs. 5.2% ± 0.8%, p < 0.01). Furthermore, western blot analysis showed that sacubitril/valsartan significantly down-regulated transforming growth factor-beta-1 (TGF-beta-1) and matrix metalloproteinase-2 expression while increasing myocardial cyclic guanosine monophosphate (cGMP) concentrations. Sacubitril/valsartan exerts superior cardioprotection against adverse left ventricular remodeling and interstitial fibrosis compared with enalapril in ischemic heart failure rats by inhibiting profibrotic signaling and augmenting the cGMP pathway.

Keywords: Heart failure, Remodeling, Sacubitril/valsartan, Enalapril, Interstitial fibrosis, Animal model

Received: May 05, 2013; Revised: June 18, 2013; Accepted: July 10, 2013; Published: August 24, 2013

Citation: International Journal of Cardiology, 2013, Vol. 4, No. 8, pp. 57–64, DOI: 10.46882/2013/IJC/000053

International Journal of Cardiology | Vol. 4, No. 3, March 2013 | pp. 17–24

DOI: 10.46882/2013/IJC/000048

Original Research Article

Diagnostic Accuracy of High-Resolution 3D Late Gadolinium Enhancement CMR for Left Atrial Scar Quantification Post-Catheter Ablation

David M. Ross¹, Sarah L. Jenkins¹, Richard G. Carter²

¹Department of Cardiovascular Imaging, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia

²Division of Electrophysiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia

Abstract:
Catheter ablation using pulmonary vein isolation (PVI) is an effective strategy for managing atrial fibrillation, but recurrent arrhythmia occurs due to gaps in procedural scar lines. Visualizing and quantifying thin left atrial (LA) myocardial scar tissue requires optimized high-spatial-resolution imaging. This study evaluated the diagnostic accuracy of a novel high-resolution 3D late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) sequence for identifying and quantifying LA scars, using electroanatomical voltage mapping (EAM) as the reference standard. We prospectively evaluated 45 patients with recurrent atrial tachyarrhythmias scheduled for a repeat ablation procedure who underwent 3D LGE CMR (1.3 mm isotropic resolution) within 48 hours prior to the intervention. Scars were quantified off-line using a threshold of 3 standard deviations above normal atrial myocardium. Atrial structures were merged with intraprocedural 3D EAM. On a segment-based analysis (432 segments total), high-resolution 3D LGE CMR demonstrated a diagnostic sensitivity of 88.4% (95% CI: 82.5%–92.8%) and a specificity of 91.2% (95% CI: 86.4%–94.7%) for detecting low-voltage scar zones (bipolar voltage less than 0.5 mV). The total quantified LA scar surface area correlated strongly with EAM scar maps (r = 0.84, p < 0.001). No serious contrast-related adverse events occurred. High-spatial-resolution 3D late gadolinium enhancement CMR provides excellent diagnostic accuracy for detecting and quantifying left atrial scar tissue, facilitating non-invasive localization of conduction gaps before redo ablation procedures.

Keywords: Atrial fibrillation, Catheter ablation, Cardiac magnetic resonance, Late gadolinium enhancement, Left atrium, Electroanatomical mapping

Received: December 02, 2012; Revised: January 18, 2013; Accepted: February 08, 2013; Published: March 15, 2013

Citation: International Journal of Cardiology, 2013, Vol. 4, No. 3, pp. 17–24, DOI: 10.46882/2013/IJC/000048

International Journal of Cardiology | Vol. 4, No. 2, February 2013 | pp. 9–16

DOI: 10.46882/2013/IJC/000047

Original Research Article

Impact of Malnutrition on Clinical Outcomes in Elderly Patients Hospitalized for Acute Heart Failure

Maria G. Silva¹, Joao P. Santos¹, António F. Ribeiro²

¹Department of Internal Medicine and Cardiology, University Hospital of Coimbra, Coimbra, Portugal

²Division of Cardiovascular Medicine, Santa Maria Hospital, University of Lisbon, Lisbon, Portugal

Abstract:
Malnutrition is highly prevalent in elderly patients with chronic diseases and contributes to progressive cachexia. However, its baseline prevalence and direct impact on survival in acute heart failure (AHF) admissions are often underestimated. This prospective study evaluated the prevalence of malnutrition using the Controlling Nutritional Status (CONUT) score and determined its impact on long-term clinical outcomes in elderly AHF patients. We enrolled 195 patients aged 75 years or older admitted for AHF. The CONUT score, derived from serum albumin, total cholesterol, and total lymphocyte count, was calculated at admission to categorize nutritional status into normal, mild, moderate, or severe malnutrition. The primary endpoint was 2-year all-cause mortality. According to the CONUT score, only 22.1% of patients had normal nutritional status, while 44.6%, 26.7%, and 6.6% exhibited mild, moderate, and severe malnutrition, respectively. At 2 years, cumulative survival rates dropped progressively with increasing malnutrition severity (log-rank p < 0.001). Patients with moderate-to-severe malnutrition (CONUT score greater than or equal to 5) experienced a 48.2% mortality rate. Multivariable Cox proportional hazards analysis confirmed that moderate-to-severe baseline malnutrition was a powerful independent predictor of 2-year all-cause mortality (hazard ratio: 2.24, 95% CI: 1.45–3.48, p < 0.001), after controlling for age, LVEF, eGFR, and NT-proBNP levels. Malnutrition is highly prevalent in elderly patients hospitalized for acute heart failure and represents a critical, independent predictor of poor 2-year survival, suggesting that objective nutritional screening could enhance clinical risk stratification.

Keywords: Acute heart failure, Malnutrition, CONUT score, Elderly, Mortality, Prognosis

Received: November 14, 2012; Revised: December 28, 2012; Accepted: January 15, 2013; Published: February 20, 2013

Citation: International Journal of Cardiology, 2013, Vol. 4, No. 2, pp. 9–16, DOI: 10.46882/2013/IJC/000047

International Journal of Cardiology | Vol. 4, No. 4, April 2013 | pp. 25–32

DOI: 10.46882/2013/IJC/000049

Original Research Article

Prevalence and Prognostic Significance of Subclinical Left Ventricular Dysfunction in Severe Asymptomatic Primary Mitral Regurgitation

Elena R. Petrova¹, Dmitry V. Ivanov¹, Sergei N. Kozlov²

¹Department of Cardiology, Almazov National Medical Research Centre, St. Petersburg, Russia

²Division of Cardiovascular Surgery, Research Institute of Circulation Pathology, Novosibirsk, Russia

Abstract:
Timing surgical intervention in asymptomatic patients with severe primary mitral regurgitation (MR) and preserved left ventricular ejection fraction (LVEF greater than or equal to 60%) remains highly challenging. Subclinical myocardial dysfunction may develop before conventional threshold parameters are met. This study determined the prevalence of subclinical left ventricular dysfunction using global longitudinal strain (GLS) and evaluated its prognostic value for predicting post-operative heart failure development. We prospectively enrolled 115 asymptomatic patients with severe primary organic MR and an LVEF greater than or equal to 60%. Baseline standard and speckle-tracking echocardiography measured LVEF, left ventricular end-systolic diameter (LVESD), and GLS. Patients were tracked over a median of 38 months for the primary composite endpoint of heart failure symptom onset, new resting LVEF reduction less than 60%, or cardiac mortality. Subclinical LV dysfunction, defined as an absolute baseline GLS less than 18%, was identified in 38 patients (33.0%) despite a normal mean LVEF (64.2% ± 2.8%). The primary endpoint occurred in 28 patients (24.3%). Kaplan-Meier analysis revealed significantly lower event-free survival in patients with impaired GLS (log-rank p = 0.002). Multivariable Cox regression confirmed that an absolute GLS less than 18% was an independent predictor of long-term clinical worsening (hazard ratio: 2.12, 95% CI: 1.22–3.68, p = 0.005), outperforming conventional parameters like LVESD. Subclinical left ventricular dysfunction is prevalent in a third of asymptomatic patients with severe primary mitral regurgitation and independently predicts subsequent clinical decline.

Keywords: Primary mitral regurgitation, Echocardiography, Global longitudinal strain, Subclinical dysfunction, Prognosis, Mitral valve surgery

Received: January 08, 2013; Revised: February 20, 2013; Accepted: March 12, 2013; Published: April 18, 2013

Citation: International Journal of Cardiology, 2013, Vol. 4, No. 4, pp. 25–32, DOI: 10.46882/2013/IJC/000049

International Journal of Cardiology | Vol. 4, No. 10, October 2013 | pp. 73–80

DOI: 10.46882/2013/IJC/000055

Review Article

Pathophysiology, Diagnostic Criteria, and Therapeutic Targets in Heart Failure with Preserved Ejection Fraction: A Comprehensive Review

Sarah L. Jenkins¹, Nigel Kirkpatrick²

¹Department of Cardiovascular Sciences, British Heart Foundation Centre, King's College London, London, United Kingdom

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

Abstract:
Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure hospitalizations globally, yet its optimal management remains a clinical challenge. Unlike heart failure with reduced ejection fraction, which is driven by progressive cardiomyocyte loss and systolic failure, HFpEF stems from a complex interplay of systemic comorbidities that induce chronic microvascular inflammation and myocardial stiffness. This comprehensive review synthesizes the evolving pathophysiological paradigms of HFpEF, highlighting the roles of endothelial dysfunction, titin hypophosphorylation, and advanced glycation end-product accumulation in driving impaired diastolic relaxation. Diagnostic algorithms have progressed beyond simple resting echocardiography, requiring multi-parametric scores like the H2FPEF model, which incorporates body mass index, atrial fibrillation status, and invasive hemodynamic exercise testing. Right heart catheterization showing a pulmonary capillary wedge pressure greater than or equal to 15 mmHg at rest or greater than or equal to 25 mmHg during exercise remains the gold standard for definitive diagnosis. Therapeutic interventions targeting the renin-angiotensin-aldosterone system have historically failed to improve primary survival endpoints, but emerging data highlight the potential of sodium-glucose cotransporter 2 (SGLT2) inhibitors and targeted metabolic pathways to mitigate systemic inflammation and lower heart failure hospitalizations. Effective management of HFpEF requires early phenotyping and a multi-target strategy combining SGLT2 inhibition, rigorous blood pressure control, and aggressive treatment of underlying metabolic comorbidities.

Keywords: Heart failure with preserved ejection fraction, Diastolic dysfunction, Microvascular inflammation, Titin, Diuretics, SGLT2 inhibitors

Received: July 12, 2013; Revised: August 25, 2013; Accepted: September 15, 2013; Published: October 22, 2013

Citation: International Journal of Cardiology, 2013, Vol. 4, No. 10, pp. 73–80, DOI: 10.46882/2013/IJC/000055