International Journal of Cardiology

International Journal of Cardiology | Vol. 15, No. 4, April 2024 | pp. 25–32

DOI: 10.46882/2024/IJC/000180

Original Research Article

Prevalence and Prognostic Impact of Speckle-Tracking Derived Right Ventricular Free-Wall Longitudinal Strain in Left Ventricular HCM

Hiroshi Yamamoto¹, Takashi Sato¹, Kenji Nakamura²

¹Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

²Division of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan

Abstract:
Hypertrophic cardiomyopathy (HCM) is predominantly characterized by left ventricular hypertrophy and diastolic impairment, but the right ventricle (RV) can also be involved. Because conventional RV parameters like fractional area change (FAC) are often insensitive to early mechanical alterations, subclinical RV impairment may go undetected. This study evaluated the prevalence of subclinical RV dysfunction using speckle-tracking derived longitudinal strain and investigated its association with clinical worsening. We prospectively evaluated 150 stable patients with confirmed left ventricular HCM and preserved conventional right ventricular function (FAC greater than or equal to 40%). Off-line speckle-tracking deformation imaging determined right ventricular free-wall longitudinal strain (RV-FWS). Clinical worsening was defined as a 36-month composite endpoint of heart failure hospitalization, sustained ventricular arrhythmia, or all-cause mortality. Subclinical RV dysfunction, defined as an absolute baseline RV-FWS less than 18.0%, was identified in 36 patients (24.0%) despite a normal mean FAC (44.6% ± 3.2%). Over a median follow-up of 34 months, the composite endpoint occurred in 28 patients (18.7%). Kaplan-Meier analysis revealed significantly lower event-free survival rates in patients with impaired absolute RV-FWS (log-rank p = 0.002). Multivariable Cox proportional hazards regression confirmed that an absolute RV-FWS less than 18.0% was an independent predictor of long-term clinical worsening (hazard ratio: 2.15, 95% CI: 1.28–3.62, p = 0.004). Subclinical right ventricular dysfunction is present in nearly a quarter of hypertrophic cardiomyopathy patients with normal conventional RV metrics and serves as a powerful, independent predictor of long-term clinical progression.

Keywords: Hypertrophic cardiomyopathy, Right ventricular dysfunction, Speckle-tracking echocardiography, Longitudinal strain, Prevalence, Prognosis

Received: January 12, 2024; Revised: February 24, 2024; Accepted: March 15, 2024; Published: April 25, 2024

International Journal of Cardiology | Vol. 15, No. 10, October 2024 | pp. 73–80

DOI: 10.46882/2024/IJC/000186

Original Research Article

Long-Term Prognostic Value of Admission Plasma Galectin-3 Levels in Patients Hospitalized for Acute Decompensated Heart Failure

Stefan de Vries¹, Anika Janssen¹, Jan de Jong²

¹Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands

²Division of Cardiovascular Medicine, Leiden University Medical Center, Leiden, Netherlands

Abstract:
Acute decompensated heart failure (ADHF) requires precise risk stratification to guide post-discharge transitions and prevent early rehospitalization. Galectin-3 is a soluble beta-galactoside-binding lectin secreted by activated macrophages that directly drives myocardial fibrosis and adverse chamber remodeling. This study evaluated the long-term prognostic value of plasma Galectin-3 levels measured at admission in a prospective cohort of patients hospitalized for ADHF. We enrolled 280 consecutive patients admitted with a primary diagnosis of ADHF. Plasma Galectin-3 concentrations were quantified using an enzyme-linked immunosorbent assay within 24 hours of hospital admission. The primary endpoint was a composite of 12-month all-cause mortality or heart failure readmission. High plasma Galectin-3 (defined as greater than 17.8 ng/mL) was identified in 48.2% of the study population. At 12 months, the primary composite endpoint occurred in 84 patients (30.0%). Survival analysis demonstrated a significantly lower event-free survival rate in the high Galectin-3 cohort compared to the low Galectin-3 group (41.5% vs. 19.3%, log-rank p < 0.001). After adjusting for age, left ventricular ejection fraction, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (NT-proBNP), multivariable Cox proportional hazards regression confirmed that elevated baseline Galectin-3 remained a powerful independent predictor of the composite outcome (hazard ratio: 1.84, 95% CI: 1.24–2.72, p = 0.002). Plasma Galectin-3 levels at admission provide robust, independent prognostic data in patients hospitalized for acute decompensated heart failure, identifying individuals at high risk for early post-discharge clinical worsening.

Keywords: Acute decompensated heart failure, Galectin-3, Biomarkers, Prognosis, Mortality, Heart failure readmission

Received: July 02, 2024; Revised: August 14, 2024; Accepted: September 05, 2024; Published: October 18, 2024

International Journal of Cardiology | Vol. 15, No. 9, September 2024 | pp. 65–72

DOI: 10.46882/2024/IJC/000185

Original Research Article

Three-Year Efficacy, Safety, and Health-Related Quality-of-Life Outcomes Between Pulmonary Vein Isolation and Optimized Antiarrhythmic Drug Therapy

Arjun Patel¹, Rohan Mehta¹, Vikram Singh²

¹Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

²Division of Electrophysiology, All India Institute of Medical Sciences, New Delhi, India

Abstract:
Catheter ablation is widely utilized for rhythm control in paroxysmal atrial fibrillation (AF), yet comparative long-term data against modern antiarrhythmic drug (AAD) regimens in real-world clinical cohorts remain essential. This randomized trial compared the 3-year efficacy, safety, and health-related quality-of-life outcomes between catheter ablation and optimized AAD therapy. We randomized 180 symptomatic patients with paroxysmal AF who had failed at least one class I or III antiarrhythmic drug to receive either radiofrequency catheter ablation (pulmonary vein isolation, n = 90) or optimized alternative AAD therapy (n = 90). The primary endpoint was freedom from any documented atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period. At 3 years, freedom from recurrent atrial tachyarrhythmias was significantly higher in the catheter ablation group than in the antiarrhythmic drug cohort (71.1% vs. 38.9%, p < 0.001). Repeat ablation procedures were performed in 15.6% of the ablation group. Major periprocedural complications in the ablation arm included 2 cases of cardiac tamponade successfully managed with pericardiocentesis, with no occurrences of stroke or atrioesophageal fistula. Significant adverse drug effects occurred in 18.9% of the AAD arm, requiring therapy discontinuation. Quality of life, assessed via the SF-36 questionnaire, improved significantly more in the catheter ablation cohort across physical and mental health domains (p < 0.01). Radiofrequency catheter ablation achieves superior long-term freedom from arrhythmia recurrence and substantially improves health-related quality of life compared with optimized antiarrhythmic drug therapy.

Keywords: Atrial fibrillation, Catheter ablation, Pulmonary vein isolation, Antiarrhythmic drugs, Recurrence, Quality of life

Received: June 04, 2024; Revised: July 19, 2024; Accepted: August 08, 2024; Published: September 20, 2024

International Journal of Cardiology | Vol. 15, No. 3, March 2024 | pp. 17–24

DOI: 10.46882/2024/IJC/000179

Review Article

Clinical Performance of Quantitative Native T1 Mapping and Calculated Extracellular Volume Fractions in Adult HCM Populations

Sarah L. Jenkins¹, David M. Ross²

¹Department of Cardiovascular Imaging, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

²Division of Cardiology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia

Abstract:
Hypertrophic cardiomyopathy (HCM) requires precise structural phenotype characterization and robust risk stratification to minimize sudden cardiac death (SCD) risks. While late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging is established for identifying replacement myocardial fibrosis, it is less sensitive for early diffuse interstitial expansion. This review synthesizes recent clinical data on advanced CMR parametric mapping sequences—specifically native T1 mapping and calculated extracellular volume (ECV) fractions—across adult HCM populations. A comprehensive literature synthesis compiled data from 28 registries involving 3,140 patients. Native T1 mapping and ECV values correlate strongly with histological collagen volume fractions, providing a non-invasive index of early interstitial expansion that occurs before macrovascular scarring develops. Quantified registry data indicate that an ECV fraction greater than or equal to 32% provides an adjusted hazard ratio of 2.24 (95% CI: 1.45–3.48, p < 0.01) for predicting progressive heart failure acceleration. Furthermore, combining standard focal LGE tracking (where an extent greater than or equal to 15% of total left ventricular mass increases SCD risk) with parametric mapping improves multi-parametric risk matrices. Advanced CMR parametric mapping sequences enhance diagnostic sensitivity for early-stage hypertrophic remodeling and provide useful structural indices that improve clinical risk stratification beyond traditional macrovascular scar tracking.

Keywords: Hypertrophic cardiomyopathy, Cardiac magnetic resonance, Late gadolinium enhancement, T1 mapping, Extracellular volume fraction, Risk stratification

Received: December 15, 2023; Revised: January 28, 2024; Accepted: February 14, 2024; Published: March 22, 2024

International Journal of Cardiology | Vol. 15, No. 5, May 2024 | pp. 33–40

DOI: 10.46882/2024/IJC/000181

Original Research Article

Safety and Clinical Efficacy of Apixaban versus Warfarin in Patients with Atrial Fibrillation and Severe Stage 4 Chronic Kidney Disease

Pierre Larson¹, Jean-Luc Moreau¹, Chantal Dubois²

¹Department of Cardiology, Hôpital de la Timone, Marseille, France

²Division of Nephrology, Clinique Universitaire de Bruxelles, Brussels, Belgium

Abstract:
Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist, significantly increasing both stroke and major bleeding risks. Traditional anticoagulation with warfarin is challenging in patients with advanced kidney disease due to unpredictable international normalized ratios (INRs) and a risk of vascular calcification. This prospective observational study evaluated the safety and clinical efficacy of apixaban compared with warfarin in patients with non-valvular AF and stage 4 CKD. We analyzed clinical data from 210 patients with non-valvular AF and a confirmed baseline estimated glomerular filtration rate (eGFR) between 15 and 29 mL/min/1.73m². Patients were prescribed either adjusted-dose apixaban (2.5 mg twice daily, n = 102) or adjusted warfarin (target INR 2.0–3.0, n = 108). The primary safety endpoint was major bleeding according to ISTH criteria, and the primary efficacy endpoint was a composite of stroke or systemic embolism over a 24-month follow-up. Major bleeding occurred significantly less frequently in the apixaban group than in the warfarin group (4.9% vs. 12.0%, hazard ratio: 0.38, 95% CI: 0.16–0.88, p = 0.02). The incidence of stroke or systemic embolism did not differ significantly between cohorts (apixaban: 2.0% vs. warfarin: 2.8%, hazard ratio: 0.72, 95% CI: 0.20–2.55, p = 0.61). Intracranial hemorrhage was absent in the apixaban cohort. Adjusted-dose apixaban demonstrates a safer clinical profile with significantly lower rates of major bleeding compared to warfarin, while maintaining comparable thromboembolic protection in patients with atrial fibrillation and severe stage 4 chronic kidney disease.

Keywords: Atrial fibrillation, Stage 4 chronic kidney disease, Apixaban, Warfarin, Major bleeding, Stroke prevention

Received: February 15, 2024; Revised: March 24, 2024; Accepted: April 10, 2024; Published: May 20, 2024

International Journal of Cardiology | Vol. 15, No. 6, June 2024 | pp. 41–48

DOI: 10.46882/2024/IJC/000182

Original Research Article

Cardioprotective Efficacy of Remote Ischemic Preconditioning in Patients with Multivessel Coronary Disease Undergoing Off-Pump CABG

Vasily Smirnov¹, Dmitry Ivanov¹, Elena Kuzmina²

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

²Institute of Cardiovascular Diseases, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia

Abstract:
Myocardial injury during coronary artery bypass grafting (CABG) affects long-term surgical outcomes and reverse structural remodeling. Remote ischemic preconditioning (RIPC)—induced by brief transient cycles of ischemia and reperfusion in a limb—represents a non-invasive strategy to protect target myocardium. This randomized sham-controlled clinical trial evaluated the cardioprotective efficacy of RIPC in patients with multivessel coronary disease undergoing off-pump CABG. We randomized 180 patients scheduled for elective off-pump CABG to either the RIPC group (n = 90) or the sham control group (n = 90). RIPC was induced immediately after anesthesia induction by inflating a standard blood pressure cuff on the upper arm to 200 mmHg for 5 minutes, followed by 5 minutes of reperfusion, for a total of 3 complete cycles. Perioperative myocardial injury was quantified by measuring serum cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) levels at baseline and 6, 12, 24, and 48 hours postoperatively. The cumulative postoperative release of cTnI, assessed by the 48-hour area under the curve (AUC), was significantly reduced by 24% in the RIPC group compared to the sham group (mean AUC: 44.2 ± 11.2 ng/mL/h vs. 58.4 ± 14.5 ng/mL/h, p < 0.01). Total post-procedural CK-MB release was also significantly lower in the RIPC cohort at 12 and 24 hours (p < 0.05). No protocol-related vascular complications occurred. Remote ischemic preconditioning significantly limits perioperative myocardial injury in patients undergoing off-pump coronary artery bypass surgery, offering safe and easily applicable cardioprotection.

Keywords: Remote ischemic preconditioning, Myocardial injury, Coronary artery bypass grafting, Off-pump surgery, Cardiac troponin I, Cardioprotection

Received: March 11, 2024; Revised: April 22, 2024; Accepted: May 12, 2024; Published: June 18, 2024