International Journal of Cardiology

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. 4, April 2022 | pp. 25–32

DOI: 10.46882/2022/IJC/000157

Original Research Article

Prognostic Value of Right Ventricular Longitudinal Strain in Patients Undergoing Percutaneous Transcatheter Mitral Valve Edge-to-Edge Repair

Matteo Barbieri¹, Francesca Costa¹, Luigi Marini²

¹Department of Cardiology, San Raffaele Hospital, Milan, Italy

²Division of Cardiac Surgery, University Hospital of Bologna, Bologna, Italy

Abstract:
Transcatheter mitral valve edge-to-edge repair (TEER) using the MitraClip system is a validated intervention for high-surgical-risk patients presenting with severe mitral regurgitation (MR). While conventional selection parameters prioritize left ventricular dimensions, right ventricular (RV) baseline status may significantly influence clinical trajectory. This study evaluated the prognostic value of right ventricular free-wall longitudinal strain (RV-FWS) derived from speckle-tracking echocardiography for predicting 2-year survival post-TEER. We prospectively followed 150 consecutive high-risk patients with severe functional or organic MR who underwent successful TEER. Baseline absolute RV-FWS was quantified off-line from apical focus views. The primary endpoint was a composite of all-cause mortality or heart failure rehospitalization at 24 months. Impaired baseline RV mechanics, defined as an absolute RV-FWS less than 16.0%, was present in 36.0% of the cohort. At 2 years, the primary endpoint was significantly higher in patients with impaired baseline strain compared to those with preserved RV strain (46.3% vs. 20.8%, log-rank p = 0.002), driven primarily by recurrent heart failure rehospitalizations (37.0% vs. 13.5%, p < 0.01). Multivariable Cox proportional hazards analysis confirmed that an absolute baseline RV-FWS less than 16.0% was a powerful independent predictor of the 2-year composite endpoint (hazard ratio: 2.14, 95% CI: 1.25–3.62, p = 0.005), whereas traditional tricuspid annular plane systolic excursion (TAPSE) metrics lost significance. Baseline right ventricular free-wall longitudinal strain is an independent predictor of long-term failure transitions following transcatheter mitral valve repair.

Keywords: Mitral regurgitation, Transcatheter edge-to-edge repair, MitraClip, Right ventricular strain, Speckle-tracking echocardiography, Prognosis

Received: January 08, 2022; Revised: February 22, 2022; Accepted: March 15, 2022; Published: April 24, 2022

International Journal of Cardiology | Vol. 12, No. 10, October 2021 | pp. 73–80

DOI: 10.46882/2021/IJC/000151

Original Research Article

Prognostic Significance of Longitudinal Ventricular Strain in Patients with Severe Chronic Kidney Disease and Aortic Stenosis

Hans-Jürgen Schmidt¹, Werner Müller¹, Dieter Reinhardt²

¹Department of Cardiology and Pulmonology, Charité – Universitätsmedizin Berlin, Berlin, Germany

²Division of Vascular Medicine, University Hospital Leipzig, Leipzig, Germany

Abstract:
Valvular aortic stenosis (AS) in patients with advanced chronic kidney disease (CKD) accelerates myocardial remodeling, yielding an increased hazard profile. Standard metrics such as left ventricular ejection fraction (LVEF) often fail to capture subclinical contractile dysfunction caused by concurrent uremic cardiomyopathy. This prospective study evaluated the prognostic value of two-dimensional global longitudinal strain (GLS) in asymptomatic or minimally symptomatic patients with severe AS and stage 4 CKD. We enrolled 125 patients with an aortic valve area less than 1.0 cm², preserved LVEF (greater than or equal to 50%), and an estimated glomerular filtration rate (eGFR) between 15 and 29 mL/min/1.73m². All participants underwent speckle-tracking echocardiography at baseline. The primary endpoint was a composite of cardiac mortality or heart failure hospitalization over a 24-month follow-up period. Impeared baseline structural mechanics, defined as an absolute GLS less than 15.0%, was present in 44.0% of the cohort. At 24 months, the primary composite endpoint occurred in 42 patients (33.6%). Kaplan-Meier survival curves indicated a significantly lower event-free survival rate in the low absolute GLS group (51.2% vs. 81.3%, log-rank p < 0.001). After adjusting for age, eGFR, and plasma NT-proBNP levels, multivariable Cox proportional hazards analysis confirmed that an absolute GLS less than 15.0% was an independent predictor of the composite outcome (hazard ratio: 2.26, 95% CI: 1.38–3.68, p = 0.001). Quantitative baseline global longitudinal strain serves as an independent predictor of adverse outcomes in patients with severe aortic stenosis complicated by advanced renal dysfunction.

Keywords: Aortic stenosis, Chronic kidney disease, Global longitudinal strain, Echocardiography, Risk stratification, Cardiorenal syndrome

Received: July 02, 2021; Revised: August 14, 2021; Accepted: September 05, 2021; Published: October 18, 2021

International Journal of Cardiology | Vol. 12, No. 12, December 2021 | pp. 89–96

DOI: 10.46882/2021/IJC/000153

Original Research Article

Association Between Coronary Artery Calcium Volume Scores and Quantitative Myocardial Perfusion Reserve via Rubidium-82 PET Imaging

Arjun Patel¹, Rohan Mehta¹, Vikram Singh²

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

²Division of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi, India

Abstract:
The Agatston coronary artery calcium (CAC) score is a validated tool for predicting cardiovascular events, but its linear correlation with functional myocardial ischemia remains variable. This study investigated the quantitative relationship between CAC volume scores derived from computed tomography and stress myocardial blood flow (MBF) along with myocardial perfusion reserve (MPR) quantified non-invasively via Rubidium-82 (82Rb) positron emission tomography (PET). We prospectively evaluated 140 symptomatic patients with suspected coronary artery disease who underwent both non-contrast CT for calcium calculation and stress/rest 82Rb PET imaging within 14 days. Diffuse microvascular ischemia was defined as a global MPR less than 2.0 in the absence of regional focal defects. Severe macrovascular calcification (CAC volume score greater than 400) was present in 52 patients (37.1%). Global stress MBF was significantly lower in the high-CAC cohort compared to the low-CAC group (1.64 ± 0.32 mL/min/g vs. 2.24 ± 0.44 mL/min/g, p < 0.001). Consequently, baseline high CAC volume scores strongly correlated with impaired global MPR (r = -0.68, p < 0.001). Multivariable linear regression confirmed that log-transformed CAC volume scores were independently associated with reduced global MPR (beta-coefficient = -0.34, p = 0.002), after adjusting for traditional metabolic risk indices and stenotic severity. Extensive coronary artery calcification volumes demonstrate a strong independent association with impaired quantitative myocardial perfusion reserves, indicating a severe burden of concurrent coronary microvascular dysfunction.

Keywords: Coronary artery calcium, Positron emission tomography, Myocardial perfusion reserve, Computational imaging, Microvascular dysfunction, Ischemia

Received: September 05, 2021; Revised: October 20, 2021; Accepted: November 12, 2021; Published: December 18, 2021

International Journal of Cardiology | Vol. 12, No. 8, August 2021 | pp. 57–64

DOI: 10.46882/2021/IJC/000149

Original Research Article

High-Dose Atorvastatin Pre-Loading Safely Lowers Periprocedural Myonecrosis During Complex Multivessel Angioplasty

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: May 12, 2021; Revised: June 25, 2021; Accepted: July 11, 2021; Published: August 20, 2021

International Journal of Cardiology | Vol. 12, No. 3, March 2021 | pp. 17–24

DOI: 10.46882/2021/IJC/000144

Original Research Article

Intravascular Optical Coherence Tomography for Identifying Thin-Cap Fibroatheromas 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: December 10, 2020; Revised: January 22, 2021; Accepted: February 11, 2021; Published: March 18, 2021