ISSN 2996-8215
International Journal of Cardiology | Vol. 11, No. 7, July 2020 | pp. 49–56
DOI: 10.46882/2020/IJC/000136
Original Research Article
Baseline Left Atrial Reservoir Strain Predicts Arrhythmia Recurrence Following Radiofrequency Catheter Ablation
Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²
¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark
Abstract:
Catheter ablation using pulmonary vein isolation is an effective rhythm control strategy for paroxysmal atrial fibrillation (AF), but anatomical left atrial (LA) diameter alone poorly predicts recurrence. Left atrial reservoir strain (LA-RS) evaluated by speckle-tracking echocardiography offers a direct indicator of structural remodeling and compliance. This study investigated the independent association between baseline LA-RS and long-term arrhythmia recurrence post-catheter ablation. We prospectively enrolled 150 patients with symptomatic paroxysmal AF scheduled for radiofrequency catheter ablation. LA-RS was analyzed off-line using apical four- and two-chamber views before the intervention. The primary endpoint was any documented recurrence of atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period over a 24-month follow-up. Arrhythmia recurrence occurred in 48 patients (32.0%). Baseline mean LA-RS was significantly lower in patients with recurrent events compared to those who maintained sinus rhythm (18.4% ± 3.2% vs. 28.5% ± 4.1%, p < 0.001). Multivariable Cox proportional hazards regression identified a depressed baseline LA-RS (absolute value less than 20%) as a powerful independent predictor of AF recurrence (hazard ratio: 2.45, 95% CI: 1.34–4.48, p = 0.003), whereas conventional LA volume indexing lost statistical significance. No major procedural access complications occurred. Left atrial reservoir strain is strongly and independently associated with atrial fibrillation recurrence following catheter ablation, outperforming traditional volumetric metrics for predicting long-term rhythm stability.
Keywords: Atrial fibrillation, Catheter ablation, Speckle-tracking echocardiography, Left atrial strain, Recurrence, Remodeling
Received: April 10, 2020; Revised: May 20, 2020; Accepted: June 08, 2020; Published: July 25, 2020
International Journal of Cardiology | Vol. 10, No. 9, September 2019 | pp. 65–72
DOI: 10.46882/2019/IJC/000126
Original Research Article
Objective Nutritional Risk Assessment via the CONUT Score and Long-Term Survival Dynamics in Geriatric Patients with 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 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: June 05, 2019; Revised: July 18, 2019; Accepted: August 11, 2019; Published: September 15, 2019
International Journal of Cardiology | Vol. 10, No. 11, November 2019 | pp. 81–88
DOI: 10.46882/2019/IJC/000128
Original Research Article
Prognostic Value of Right Ventricular Longitudinal Strain in Patients Undergoing Transcatheter Aortic Valve Implantation
Jean-Pierre Dubois¹, Pierre Vigneron¹, Lucia Rossi²
¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
²Department of Cardiac Surgery, University of Milan, Milan, Italy
Abstract:
Right ventricular (RV) function is an essential modifier of outcomes in patients with severe aortic stenosis, but conventional indices like tricuspid annular plane systolic excursion (TAPSE) are limited by angle dependency. Right ventricular free-wall longitudinal strain (RV-FWS) provides a highly precise index of global RV myocardial performance. This prospective study evaluated the 2-year prognostic value of baseline RV-FWS in high-risk patients undergoing transcatheter aortic valve implantation (TAVI). We followed 180 consecutive high-risk patients who underwent successful TAVI. Transthoracic speckle-tracking echocardiography was performed within 48 hours before the procedure to quantify baseline absolute RV-FWS. The primary endpoint was a composite of all-cause mortality or heart failure rehospitalization at 24 months. Impaired baseline RV-FWS (defined as an absolute value less than 16.0%) was identified in 54 patients (30.0%). At 2 years, the primary composite endpoint occurred significantly more frequently in patients with impaired baseline RV-FWS than in those with preserved strain (44.4% vs. 21.4%, log-rank p = 0.004). This difference was driven by higher rates of heart failure rehospitalization (33.3% vs. 13.5%, p = 0.01). Multivariable Cox regression confirmed that an absolute baseline RV-FWS less than 16.0% was an independent predictor of the 2-year composite outcome (hazard ratio: 2.14, 95% CI: 1.28–3.58, p = 0.004), whereas TAPSE lost independent predictive value in the fully adjusted model. Right ventricular free-wall longitudinal strain is a powerful independent predictor of long-term mortality and heart failure rehospitalization following TAVI.
Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis
Received: August 04, 2019; Revised: September 15, 2019; Accepted: October 10, 2019; Published: November 18, 2019
International Journal of Cardiology | Vol. 10, No. 8, August 2019 | pp. 57–64
DOI: 10.46882/2019/IJC/000125
Original Research Article
Independent Prognostic Significance of Left Atrial Reservoir Strain for Predicting Late Atrial Fibrillation Recurrence Post-Cryoballoon Isolation
Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²
¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark
Abstract:
Cryoballoon catheter ablation achieves high rates of pulmonary vein isolation (PVI), but late arrhythmia recurrence remains a common limitation. Standard anatomical metrics like left atrial (LA) diameter fail to capture early compliance changes secondary to tissue remodeling. Left atrial reservoir strain (LA-RS), measured via speckle-tracking echocardiography, offers a non-invasive index of functional wall integrity. This study evaluated whether baseline LA-RS independently predicts late atrial fibrillation (AF) recurrence post-cryoballoon intervention. We prospectively enrolled 160 patients with symptomatic paroxysmal AF undergoing a first-time cryoballoon PVI. Transthoracic deformation imaging was performed before the procedure to quantify LA-RS across apical views. The primary endpoint was any documented recurrence of atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period, tracked over 36 months. Late arrhythmia recurrence occurred in 54 patients (33.8%) during the follow-up period. Baseline mean LA-RS was significantly lower in patients who experienced recurrence than in those who maintained sinus rhythm (18.2% ± 3.1% vs. 27.4% ± 4.2%, p < 0.001). Multivariable Cox proportional hazards analysis confirmed that an absolute baseline LA-RS less than 20% was a potent, independent predictor of late AF recurrence (hazard ratio: 2.34, 95% CI: 1.41–3.88, p = 0.001). Conversely, indexed left atrial volume metrics lost independent significance in the fully adjusted model. Left atrial reservoir strain is independently associated with late arrhythmia recurrence after cryoballoon ablation, providing superior prognostic data over standard volumetric criteria.
Keywords: Atrial fibrillation, Cryoballoon ablation, Speckle-tracking echocardiography, Left atrial strain, Recurrence, Structural remodeling
Received: May 12, 2019; Revised: June 25, 2019; Accepted: July 14, 2019; Published: August 20, 2019
International Journal of Cardiology | Vol. 10, No. 1, January 2019 | pp. 1–8
DOI: 10.46882/2019/IJC/000118
Original Research Article
Adjusted High-Dose Clopidogrel Maintenance Regimen in Patients with High Post-Treatment Platelet Reactivity Undergoing PCI
Ji-Hoon Kim¹, Min-Soo Park¹, Sung-Hoon Choi²
¹Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
²Division of Electrophysiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Abstract:
High post-treatment platelet reactivity (HPPR) following standard clopidogrel therapy is associated with an increased risk of ischemic events after percutaneous coronary intervention (PCI). Adjusting the antiplatelet regimen based on platelet function testing could mitigate this risk. This randomized open-label trial evaluated whether a high-dose clopidogrel regimen reduces major adverse cardiovascular events (MACE) in patients with documented HPPR undergoing PCI. We screened 650 patients scheduled for elective PCI using the VerifyNow P2Y12 assay. HPPR was defined as a P2Y12 reaction unit (PRU) value greater than 230. A total of 180 patients identified with HPPR were randomized 1:1 to either the high-dose group (clopidogrel 150 mg daily, n = 90) or the standard-dose group (clopidogrel 75 mg daily, n = 90) for 6 months. The primary endpoint was a composite of cardiac death, non-fatal myocardial infarction, or definite stent thrombosis at 6 months. At 6 months, high-dose clopidogrel significantly reduced the mean PRU value from 265 ± 24 to 192 ± 31 (p < 0.001), whereas platelet reactivity remained elevated in the standard-dose group (258 ± 22 PRU). The primary composite endpoint occurred in 4.4% of the high-dose cohort compared to 12.2% of the standard-dose cohort (p = 0.04). No significant difference was observed in the incidence of TIMI major bleeding complications (2.2% vs. 1.1%, p = 0.56). Adjusting to a high-dose clopidogrel maintenance regimen in patients with verified high post-treatment platelet reactivity significantly enhances platelet inhibition and safely reduces short-term ischemic events following PCI.
Keywords: Percutaneous coronary intervention, Clopidogrel, Platelet reactivity, VerifyNow, Stent thrombosis, Antiplatelet therapy
Received: October 10, 2013; Revised: November 24, 2013; Accepted: December 15, 2013; Published: January 18, 2019
International Journal of Cardiology | Vol. 10, No. 6, June 2019 | pp. 41–48
DOI: 10.46882/2019/IJC/000123
Original Research Article
Three-Year Clinical Outcomes of Complete Staged Revascularization versus Culprit-Only Revascularization in Older STEMI Patients with Multivessel Disease
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:
Multivessel coronary artery disease (MVD) significantly complicates management strategies during primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI). While early complete revascularization reduces short-term event rates, the long-term clinical durability of this approach remains poorly characterized in geriatric populations. This prospective randomized trial compared the 3-year outcomes of complete staged revascularization versus a culprit-only strategy in elderly individuals. We randomized 220 patients aged greater than or equal to 75 years with acute STEMI and angiographic MVD into two interventional groups: complete staged revascularization (PPCI of the culprit vessel followed by staged PCI of non-culprit stenoses within 10 days, n = 110) or culprit-only revascularization (PPCI restricted to the infarct-related artery, n = 110). The primary endpoint was the 36-month cumulative 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 3 years, the primary endpoint was significantly lower in the complete revascularization group than in the culprit-only group (14.5% vs. 26.4%, hazard ratio: 0.52, 95% CI: 0.28–0.96, p = 0.03). This benefit was sustained by a substantial reduction in subsequent target vessel revascularizations (4.5% vs. 15.5%, p < 0.01). Long-term all-cause mortality did not differ significantly between the arms (8.2% vs. 9.1%, p = 0.82). Staged complete revascularization provides superior long-term clinical outcomes in elderly STEMI patients with multivessel disease, effectively reducing 3-year MACE without increasing procedural hazard profiles.
Keywords: ST-segment elevation myocardial infarction, Multivessel disease, Percutaneous coronary intervention, Complete revascularization, Geriatric cardiology
Received: March 05, 2019; Revised: April 18, 2019; Accepted: May 11, 2019; Published: June 19, 2019