International Journal of Cardiology

International Journal of Cardiology | Vol. 17, No. 2, February 2026 | pp. 9–16

DOI: 10.46882/2026/IJC/000202

Original Research Article

Controlled Nutro-Biometric Layering via Multi-Parametric Evaluation Panels for Risk Screening in Geriatric Congestion

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 frequently complicates heart failure progression in geriatric populations, precipitating severe cardiac cachexia. Despite its high prevalence, routine nutritional screening is rarely integrated into acute heart failure (AHF) admissions. This prospective study evaluated the clinical utility of the Controlling Nutritional Status (CONUT) score for predicting 3-year survival dynamics in elderly individuals hospitalized for AHF. We evaluated 210 patients aged 75 years or older admitted with primary AHF. The baseline CONUT score was calculated from automated serum albumin, total cholesterol, and absolute lymphocyte counts, stratifying patients into normal, mild, moderate, or severe nutritional risk categories. The primary clinical endpoint was 36-month all-cause mortality. Normal nutritional status was identified in only 21.4% of the cohort, while mild, moderate, and severe malnutrition risks were present in 43.8%, 28.1%, and 6.7% of patients, respectively. Over 3 years, all-cause mortality rose progressively with increasing malnutrition severity (log-rank p < 0.001). Patients with moderate-to-severe baseline malnutrition (CONUT score greater than or equal to 5) experienced an overall mortality rate of 51.4%. Multivariable Cox proportional hazards analysis confirmed that moderate-to-severe CONUT status was a powerful independent predictor of 3-year mortality (hazard ratio: 2.15, 95% CI: 1.32–3.52, p = 0.002), after adjusting for age, LVEF, eGFR, and admission NT-proBNP levels. Objective nutritional risk calculation using the CONUT score provides robust independent prognostic data in geriatric acute heart failure cohorts.

Keywords: Acute heart failure, Malnutrition, CONUT score, Geriatric cardiology, Mortality, Prognosis

Received: November 14, 2025; Revised: December 28, 2025; Accepted: January 15, 2026; Published: February 20, 2026

International Journal of Cardiology | Vol. 17, No. 3, March 2026 | pp. 17–24

DOI: 10.46882/2026/IJC/000203

Original Research Article

Three-Dimensional Threshold Quantification of Fibrotic Gaps via Isotropic Macro-Aqueous Structural Mapping

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). High-spatial-resolution 3D late gadolinium enhancement CMR provides excellent diagnostic accuracy for detecting 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, 2025; Revised: January 18, 2026; Accepted: February 08, 2026; Published: March 15, 2026

International Journal of Cardiology | Vol. 17, No. 1, January 2026 | pp. 1–8

DOI: 10.46882/2026/IJC/000201

Original Research Article

Mitochondrial Fuel Optimization via Selective SGLT2 Treatment in Experimental Non-Diabetic Ischemic Myopathy

Heinrich Scholz¹, Klaus Richter¹, Manfred Ziegler²

¹Department of Cardiovascular Pharmacology, University Heart Center Freiburg, Freiburg, Germany

²Division of Experimental Cardiology, Max Delbrück Center for Molecular Medicine, Berlin, Germany

Abstract:
Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce heart failure hospitalizations in clinical trials, but their exact cardiac mechanism of action remains poorly defined since SGLT2 is not directly expressed in the myocardium. This study investigated the direct cardioprotective effects of empagliflozin on myocardial function and tissue energetics in a non-diabetic rat model of chronic ischemic heart failure. Heart failure was induced in adult male Wistar rats via permanent ligation of the left anterior descending coronary artery. Two weeks post-ligation, surviving rats were randomized to receive either empagliflozin (20 mg/kg/day, n = 15) or vehicle control (n = 15) via oral gavage for 6 weeks. Cardiac function was tracked using high-resolution echocardiography, and myocardial high-energy phosphate metabolites were quantified post-sacrifice using nuclear magnetic resonance spectroscopy. Treatment with empagliflozin significantly attenuated left ventricular dilation and preserved LVEF compared with the vehicle control group (38.6% ± 3.4% vs. 31.2% ± 2.9%, p < 0.01). Mechanistically, empagliflozin-treated rats demonstrated a significant increase in the myocardial phosphocreatine-to-adenosine triphosphate (PCr/ATP) ratio (1.85 ± 0.14 vs. 1.42 ± 0.11, p < 0.01), indicating enhanced mitochondrial energetic efficiency. Myocardial glucose utilization was reduced, while beta-hydroxybutyrate oxidation was up-regulated, confirming a shift toward ketone body utilization. Empagliflozin significantly preserves left ventricular systolic function and attenuates adverse remodeling in non-diabetic ischemic heart failure rats by optimizing myocardial fuel selection and enhancing high-energy phosphate availability.

Keywords: Heart failure, SGLT2 inhibitors, Empagliflozin, Myocardial energetics, Remodeling, Animal model

Received: October 05, 2025; Revised: November 18, 2025; Accepted: December 08, 2025; Published: January 15, 2026

International Journal of Cardiology | Vol. 16, No. 3, March 2025 | pp. 17–24

DOI: 10.46882/2025/IJC/000191

Review Article

Cardioprotective Strategies and Monitoring Metrics via Strain Echocardiography 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, 2024; Revised: January 20, 2025; Accepted: February 08, 2025; Published: March 19, 2025

International Journal of Cardiology | Vol. 16, No. 4, April 2025 | pp. 25–32

DOI: 10.46882/2025/IJC/000192

Original Research Article

One-Year Rates of Major Adverse Cardiac Events Following Complete Staged versus Culprit-Only PPCI in STEMI Patients

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, 2025; Revised: February 22, 2025; Accepted: March 15, 2025; Published: April 24, 2025

International Journal of Cardiology | Vol. 16, No. 9, September 2025 | pp. 65–72

DOI: 10.46882/2025/IJC/000197

Original Research Article

Prospective Evaluation of 12-Month Cumulative Cardiovascular Death and Stroke Reductions with Ticagrelor in Post-PCI ACS Patients

Yukihiro Tanaka¹, Shinji Kato¹, Takuya Kobayashi²

¹Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

²Division of Interventional Cardiology, Tokyo Medical University Hospital, Tokyo, Japan

Abstract:
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the cornerstone of management for acute coronary syndrome (ACS). Ticagrelor provides faster, more consistent platelet inhibition than clopidogrel. This prospective observational study evaluated the real-world clinical efficacy and safety of ticagrelor versus clopidogrel in ACS patients undergoing percutaneous coronary intervention (PCI). We analyzed 380 consecutive ACS patients (ST-segment elevation myocardial infarction and non-ST-segment elevation ACS) who underwent successful PCI and received either ticagrelor (180 mg loading dose, 90 mg twice daily, n = 190) or clopidogrel (300 to 600 mg loading dose, 75 mg once daily, n = 190). The primary efficacy endpoint was a composite of cardiovascular death, myocardial infarction (MI), or stroke at 12 months. The safety endpoint was major bleeding according to PLATO criteria. At 12 months, the primary composite endpoint was significantly lower in the ticagrelor group than in the clopidogrel group (6.8% vs. 13.2%, hazard ratio: 0.50, 95% CI: 0.26–0.94, p = 0.03), driven primarily by lower rates of recurrent MI. The rate of definite stent thrombosis was also reduced with ticagrelor (0.5% vs. 2.1%, p < 0.05). The incidence of overall PLATO-defined major bleeding did not differ significantly between groups (8.4% vs. 7.9%, p = 0.85); however, non-CABG related bleeding and transient dyspnea were more frequent in the ticagrelor cohort (5.3% vs. 2.1%, p = 0.04). In real-world clinical practice, ticagrelor significantly reduces ischemic events and stent thrombosis in ACS patients undergoing PCI compared with clopidogrel, without significantly increasing overall major bleeding complications.

Keywords: Acute coronary syndrome, Percutaneous coronary intervention, Ticagrelor, Clopidogrel, Dual antiplatelet therapy, Stent thrombosis

Received: June 02, 2025; Revised: July 15, 2025; Accepted: August 04, 2025; Published: September 20, 2025