International Journal of Cardiology

International Journal of Cardiology | Vol. 13, No. 3, March 2022 | pp. 17–24

DOI: 10.46882/2022/IJC/000156

Original Research Article

Efficacy of Pulsed Field Ablation versus Cryoballoon Isolation for Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

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 cornerstone of interventional therapy for paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a novel non-thermal modality utilizing ultra-rapid electrical fields to selectively ablate myocardial tissue, minimizing collateral structural injury seen with thermal cryoballoon (CB) systems. This prospective randomized trial compared periprocedural parameters, safety profiles, and 12-month efficacy between PFA and CB isolation. We randomized 180 symptomatic patients with drug-refractory paroxysmal AF to undergo either multi-electrode PFA (n = 90) or standard CB ablation (n = 90). The primary efficacy endpoint was freedom from any documented atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period. Total procedure times were significantly shorter in the PFA cohort compared to the CB arm (64 ± 12 minutes vs. 88 ± 16 minutes, p < 0.001). Conversely, fluoroscopy times did not differ significantly (12.4 ± 3.1 minutes vs. 13.8 ± 3.5 minutes, p = 0.12). At 12 months, freedom from recurrent arrhythmia was achieved in 78.9% of the PFA group and 75.6% of the CB group (p = 0.58), confirming clinical non-inferiority. Phrenic nerve injury occurred in 4.4% of the CB group but was completely absent in the PFA arm (p = 0.04). Pulsed field ablation provides 12-month rhythm control efficacy equivalent to cryoballoon isolation while significantly enhancing procedural speed and eliminating collateral phrenic nerve complications.

Keywords: Atrial fibrillation, Pulmonary vein isolation, Pulsed field ablation, Cryoballoon ablation, Non-thermal ablation, Phrenic nerve safety

Received: December 10, 2021; Revised: January 20, 2022; Accepted: February 08, 2022; Published: March 19, 2022

Citation: International Journal of Cardiology, 2022, Vol. 13, No. 3, pp. 17–24, DOI: 10.46882/2022/IJC/000156

International Journal of Cardiology | Vol. 13, No. 6, June 2022 | pp. 41–48

DOI: 10.46882/2022/IJC/000159

Review Article

Diagnostic Advancements and Risk Stratification Matrices via Multi-Parametric CMR Mapping in Non-Ischemic Cardiomyopathies

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:
Non-ischemic cardiomyopathies (NICMs) exhibit diverse etiopathology, requiring advanced tissue tracking to optimize clinical management. Traditional late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging pathways reliably identify focal replacement scars but remain insensitive to early microscopic diffuse interstitial expandings. This comprehensive review synthesizes recent registry data evaluating quantitative multi-parametric CMR mapping sequences—specifically native T1 mapping, T2 mapping, and calculated extracellular volume (ECV) fractions—across major adult NICM phenotypes. A structured review compiled findings from 38 clinical databases representing 4,120 individuals. Parametric T2 mapping sequences demonstrate excellent specificity for identifying active localized inflammation in acute myocarditis, providing a pooled diagnostic accuracy of 89.5% against tissue biopsies. Concurrently, native T1 and ECV metrics quantify diffuse interstitial matrix expansion in dilated and hypertrophic configurations before macroscopic scars develop. Aggregated data indicate that an elevated baseline ECV fraction greater than or equal to 32% provides an adjusted hazard ratio of 2.12 (95% CI: 1.41–3.46, p < 0.01) for predicting progressive heart failure hospitalization. Multi-parametric quantitative CMR mapping provides non-invasive mechanical tracking that maps diffuse tissue variations, enhancing diagnostic specificity and risk stratification across non-ischemic cardiomyopathies.

Keywords: Cardiac magnetic resonance, Parametric mapping, Extracellular volume fraction, Non-ischemic cardiomyopathy, Myofibrosis, Prognosis

Received: March 11, 2022; Revised: April 25, 2022; Accepted: May 12, 2022; Published: June 19, 2022

International Journal of Cardiology | Vol. 13, No. 12, December 2022 | pp. 81–88

DOI: 10.46882/2022/IJC/000164

Original Research Article

High-Dose Atorvastatin Loading Safeguards Against Periprocedural Myocardial Infarction During Bifurcation Percutaneous Coronary Intervention

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: September 15, 2022; Revised: October 28, 2022; Accepted: November 12, 2022; Published: December 19, 2022

International Journal of Cardiology | Vol. 13, No. 8, August 2022 | pp. 57–64

DOI: 10.46882/2022/IJC/000161

Original Research Article

Diagnostic Utility of High-Sensitivity Cardiac Troponin I 0-Hour/1-Hour Rapid Triage Algorithm for Myocardial Infarction Rule-Out

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 utilizing high-sensitivity cardiac troponin I (hs-cTnI) assays have the potential to substantially shorten evaluation times for patients presenting to the emergency department (ED) with suspected acute coronary syndrome. This prospective diagnostic study evaluated the safety and clinical efficacy of an accelerated 0-hour/1-hour rule-out algorithm using hs-cTnI in patients presenting with acute chest pain. We evaluated 450 consecutive patients presenting to the ED with chest pain suggestive of myocardial ischemia. Serial blood samples were obtained at presentation (0h) and exactly 1 hour later. The final diagnosis of acute myocardial infarction (AMI) was adjudicated by an independent clinical panel using the universal definition. AMI was diagnosed in 62 patients (13.8%). A baseline hs-cTnI level below 5 ng/L or a 1-hour absolute change less than 3 ng/L successfully ruled out AMI in 61.3% of the cohort. This rapid protocol yielded an overall diagnostic sensitivity of 98.4% (95% CI: 91.3%–99.9%) and an exceptional negative predictive value (NPV) of 99.6% (95% CI: 98.0%–99.9%). The specificity and positive predictive value (PPV) were 68.4% and 33.2%, respectively. No patient classified as safe for early rule-out experienced an un-adjudicated myocardial infarction or major adverse cardiac event within a 30-day safety follow-up window. A rapid 0h/1h accelerated diagnostic protocol incorporating a high-sensitivity cardiac troponin I assay allows for safe, exceptionally fast exclusion of acute myocardial infarction in more than half of presenting ED chest pain patients.

Keywords: High-sensitivity cardiac troponin I, Acute myocardial infarction, Emergency department, Chest pain, Rapid rule-out, Negative predictive value

Received: May 12, 2022; Revised: June 25, 2022; Accepted: July 14, 2022; Published: August 20, 2022

International Journal of Cardiology | Vol. 13, No. 1, January 2022 | pp. 1–8

DOI: 10.46882/2022/IJC/000154

Original Research Article

Cardioprotective Action of Ipragliflozin against Myocardial Remodeling via Suppression of Left Ventricular Interstitial Fibrosis

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 improve functional clinical parameters in heart failure cohorts, but the structural tissue modifications driving these benefits require clarification in post-ischemic hearts. This study evaluated the structural and molecular cardioprotective actions of ipragliflozin on chronic ventricular dilation and left ventricular (LV) interstitial fibrosis in a non-diabetic rat model of ischemic heart failure. Myocardial infarction was induced in adult male Wistar rats via permanent ligation of the left anterior descending coronary artery. Four weeks post-ligation, rats showing an echocardiographically verified LVEF less than 40% were randomized 1:1 to receive ipragliflozin (3.0 mg/kg/day, n = 15) or vehicle control (n = 15) via oral gavage for 8 consecutive weeks. Ipragliflozin administration significantly preserved baseline LVEF compared to the vehicle arm (41.4% ± 3.2% vs. 34.6% ± 2.8%, p < 0.05) and limited progressive left ventricular diastolic expansion. Histological quantification via Masson's trichrome staining showed a distinct reduction in the collagen volume fraction within non-infarcted remote myocardial regions (3.6% ± 0.5% vs. 5.4% ± 0.8%, p < 0.01). Western blot assays confirmed that ipragliflozin significantly down-regulated transforming growth factor-beta-1 (TGF-beta-1) expression, suppressing the activation of pro-fibrotic Smad3 signaling pathways in isolated cells. Ipragliflozin exerts direct structural cardioprotective actions against adverse post-ischemic left ventricular remodeling in rats by actively attenuating interstitial collagen deposition through the inhibition of profibrotic TGF-beta-1 pathways.

Keywords: Ischemic heart failure, Ipragliflozin, SGLT2 inhibitors, Interstitial fibrosis, Left ventricular remodeling, Animal model

Received: October 12, 2021; Revised: November 25, 2021; Accepted: December 15, 2021; Published: January 22, 2022

International Journal of Cardiology | Vol. 13, No. 10, October 2022 | pp. 73–80

DOI: 10.46882/2022/IJC/000163

Original Research Article

Three-Year Prognostic Value of Pre-Procedural Right Ventricular Free-Wall Longitudinal Strain in Dilated Cardiomyopathy outpatients

Vasily Smirnov¹, Elena Kuzmina², Dmitry Ivanov¹

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

²Division of Cardiovascular Imaging, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia

Abstract:
While left ventricular parameters are traditionally prioritized in dilated cardiomyopathy (DCM), right ventricular (RV) function also independently impacts outcomes. This prospective study evaluated the long-term prognostic utility of right ventricular global longitudinal strain (RV-GLS) measured via speckle-tracking echocardiography in adult patients with DCM. We followed 185 stable DCM patients with a resting left ventricular ejection fraction (LVEF) less than 40%. Standard echocardiography quantified right ventricular fractional area change (FAC), and off-line deformation analysis measured absolute RV-GLS. The primary endpoint was a composite of cardiac mortality, urgent heart transplantation, or heart failure hospitalization over a 3-year follow-up period. Over a median follow-up of 34 months, 52 patients (28.1%) reached the primary endpoint. An impaired absolute baseline RV-GLS (defined as less than 15.5%) was strongly associated with a higher event rate. Kaplan-Meier analysis confirmed a significantly lower event-free survival rate in the low RV-GLS group (log-rank p < 0.001). After adjusting for age, NYHA class, LVEF, and NT-proBNP levels, multivariable Cox proportional hazards regression confirmed that an absolute RV-GLS less than 15.5% remained an independent predictor of the composite clinical endpoint (hazard ratio: 2.12, 95% CI: 1.28–3.52, p = 0.003). Conventional RV FAC did not retain independent predictive value in the fully adjusted model. Right ventricular global longitudinal strain is a powerful independent predictor of long-term clinical worsening in dilated cardiomyopathy, outperforming standard volumetric metrics.

Keywords: Dilated cardiomyopathy, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Heart failure

Received: July 12, 2022; Revised: August 25, 2022; Accepted: September 10, 2022; Published: October 22, 2022