International Journal of Cardiology

International Journal of Cardiology | Vol. 10, No. 2, February 2019 | pp. 9–16

DOI: 10.46882/2019/IJC/000119

Original Research Article

Two-Dimensional Global Longitudinal Strain for Long-Term Risk Assessment in Light-Chain Cardiac Amyloidosis

Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²

¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden

²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark

Abstract:
Light-chain (AL) cardiac amyloidosis is characterized by progressive extracellular amyloid fibril deposition, leading to restrictive cardiomyopathy and severe heart failure. Early recognition of myocardial involvement is essential, as conventional metrics like LVEF often remain preserved until advanced stages. This study evaluated the long-term prognostic value of speckle-tracking derived global longitudinal strain (GLS) and the relative apical sparing pattern in patients with biopsy-proven AL amyloidosis. We prospectively followed 85 patients with systemic AL amyloidosis. All patients underwent comprehensive baseline echocardiography with off-line speckle-tracking deformation imaging. The primary endpoint was all-cause mortality over a 3-year follow-up period. Myocardial involvement was defined by standard extracellular volume metrics and wall thickness. An absolute baseline GLS less than 14.5% was identified in 64.7% of the cohort. Classic apical sparing, characterized by a preserved apical strain with severely reduced basal and mid-ventricular segment deformation, was present in 52.9% of patients. Over a median follow-up of 28 months, 32 patients (37.6%) died. Kaplan-Meier survival curves showed significantly worse survival in patients with a baseline absolute GLS less than 14.5% (log-rank p < 0.001). Multivariable Cox proportional hazards regression confirmed that baseline GLS was a potent, independent predictor of 3-year all-cause mortality (hazard ratio: 1.24 per 1% absolute reduction, 95% CI: 1.11–1.38, p < 0.001), outperforming traditional biomarkers like NT-proBNP and high-sensitivity troponin T. Two-dimensional global longitudinal strain is a powerful independent predictor of mortality in light-chain cardiac amyloidosis, serving as a critical tool for early risk stratification.

Keywords: Cardiac amyloidosis, Light-chain amyloidosis, Echocardiography, Global longitudinal strain, Apical sparing, Prognosis

Received: November 08, 2013; Revised: December 20, 2013; Accepted: January 12, 2014; Published: February 22, 2019

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. 3, March 2019 | pp. 17–24

DOI: 10.46882/2019/IJC/000120

Original Research Article

Diagnostic Utility of Non-Invasive FFR-CT for Ischemia Detection in Patients with High Coronary Calcium Scores

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:
Computed tomography coronary angiography (CTCA) exhibits limited diagnostic specificity in patients with heavy coronary calcification due to blooming artifacts that obscure luminal narrowings. Fractional flow reserve computed from CTCA datasets (FFR-CT) integrates computational fluid dynamics to evaluate lesion-specific ischemia non-invasively. This study evaluated the diagnostic accuracy of FFR-CT for identifying lesion-specific ischemia specifically in patients with high coronary artery calcium (CAC) scores. We prospectively enrolled 110 symptomatic patients with intermediate coronary stenoses and an Agatston CAC score greater than 400 who were scheduled for invasive coronary angiography and fractional flow reserve (FFR). FFR-CT was computed off-line using specialized processing software. Ischemia was defined as an invasive FFR less than or equal to 0.80. On a vessel-based analysis (134 vessels total), invasive FFR confirmed lesion-specific ischemia in 42 vessels (31.3%). FFR-CT demonstrated a diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of 85.7% (95% CI: 71.5%–94.6%), 81.5% (95% CI: 72.1%–88.9%), 67.9% (95% CI: 53.7%–80.1%), and 92.6% (95% CI: 84.6%–97.2%), respectively. The area under the receiver operating characteristic curve for FFR-CT was significantly superior to standard anatomical CTCA luminal assessment alone (0.87 vs. 0.64, p < 0.01). FFR-CT maintains high diagnostic accuracy and strong negative predictive value for identifying hemodynamically significant coronary stenoses even in the presence of severe calcification.

Keywords: Computed tomography coronary angiography, Fractional flow reserve, Coronary calcification, Computational fluid dynamics, Myocardial ischemia, Diagnostic accuracy

Received: December 05, 2013; Revised: January 18, 2014; Accepted: February 11, 2014; Published: March 20, 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

International Journal of Cardiology | Vol. 10, No. 7, July 2019 | pp. 49–56

DOI: 10.46882/2019/IJC/000124

Original Research Article

Diagnostic Precision of High-Resolution 3D Late Gadolinium Enhancement CMR for the Identification of Left Atrial Conduction Gaps Post-Cryoballoon Ablation

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:
Cryoballoon catheter ablation successfully isolates the pulmonary veins in paroxysmal atrial fibrillation (AF), but recurrent tachyarrhythmias arise if incomplete scar sets leave linear conduction gaps. Non-invasive mapping of thin left atrial (LA) scars requires optimized high-spatial-resolution sequencing to plan revision procedures. This study evaluated the diagnostic precision of high-resolution 3D late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for identifying pulmonary vein scar discontinuity, using electroanatomical voltage mapping (EAM) as the reference standard. We prospectively evaluated 52 patients with recurrent atrial tachyarrhythmias scheduled for a secondary ablation procedure who underwent pre-procedural 3D LGE CMR (1.3 mm isotropic voxel size). Left atrial walls were segmentally partitioned and thresholded to isolate scars at 3 standard deviations above healthy tissue. Segmental scar footprints were registered into intraprocedural 3D EAM matrices. On a segment-by-segment analysis (416 total sections), high-resolution 3D LGE CMR identified conduction gaps with a sensitivity of 86.4% (95% CI: 77.2%–92.8%), a specificity of 89.6% (95% CI: 82.3%–94.7%), and an overall diagnostic accuracy of 88.5%. The total computed circumference of circumscribed PVI scar patterns matched low-voltage areas on EAM maps (r = 0.82, p < 0.001). No severe contrast-related side effects were reported. High-resolution isotropic 3D late gadolinium enhancement CMR demonstrates excellent diagnostic precision for identifying left atrial scar gaps, offering a robust non-invasive method to localize conduction breaches prior to repeat ablation interventions.

Keywords: Atrial fibrillation, Cryoballoon ablation, Cardiac magnetic resonance, Late gadolinium enhancement, Left atrium, Electroanatomical mapping

Received: April 02, 2019; Revised: May 15, 2019; Accepted: June 08, 2019; Published: July 22, 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