International Journal of Cardiology

International Journal of Cardiology | Vol. 9, No. 2, February 2018 | pp. 9–16

DOI: 10.46882/2018/IJC/000107

Original Research Article

Objective Nutritional Screening Using the CONUT Score for Predicting Long-Term Survival in Elderly 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 is highly prevalent in elderly patients with chronic diseases and contributes to progressive cachexia. However, its baseline prevalence and direct impact on survival in acute heart failure (AHF) admissions are often underestimated. This prospective study evaluated the prevalence of malnutrition using the Controlling Nutritional Status (CONUT) score and determined its impact on long-term clinical outcomes in elderly AHF patients. We enrolled 195 patients aged 75 years or older admitted for AHF. The CONUT score, derived from serum albumin, total cholesterol, and total lymphocyte count, was calculated at admission to categorize nutritional status into normal, mild, moderate, or severe malnutrition. The primary endpoint was 2-year all-cause mortality. According to the CONUT score, only 22.1% of patients had normal nutritional status, while 44.6%, 26.7%, and 6.6% exhibited mild, moderate, and severe malnutrition, respectively. At 2 years, cumulative survival rates dropped progressively with increasing malnutrition severity (log-rank p < 0.001). Patients with moderate-to-severe malnutrition (CONUT score greater than or equal to 5) experienced a 48.2% mortality rate. Multivariable Cox proportional hazards analysis confirmed that moderate-to-severe baseline malnutrition was a powerful independent predictor of 2-year all-cause mortality (hazard ratio: 2.24, 95% CI: 1.45–3.48, p < 0.001), after controlling for age, LVEF, eGFR, and NT-proBNP levels. Malnutrition is highly prevalent in elderly patients hospitalized for AHF and represents a critical, independent predictor of poor 2-year survival.

Keywords: Acute heart failure, Malnutrition, CONUT score, Elderly, Mortality, Prognosis

Received: November 14, 2012; Revised: December 28, 2012; Accepted: January 15, 2013; Published: February 20, 2018

International Journal of Cardiology | Vol. 9, No. 8, August 2018 | pp. 57–64

DOI: 10.46882/2018/IJC/000113

Original Research Article

Cardioprotective Effects of Sacubitril/Valsartan versus Enalapril on Adverse Structural Remodeling and Tissue Fibrosis

Jean-Pierre Dubois¹, Pierre Vigneron¹, Henri Dupont²

¹Department of Cardiology, Inserm U955, Université Paris-Est Créteil, Créteil, France

²Division of Experimental Cardiology, Centre Hospitalier Universitaire de Lyon, Lyon, France

Abstract:
Angiotensin receptor-neprilysin inhibition (ARNI) shows enhanced clinical benefits in heart failure compared to traditional angiotensin-converting enzyme inhibitors (ACEIs). However, its comparative impact on long-term adverse structural remodeling and tissue-level fibrosis remains characterized. This study evaluated the structural and molecular cardioprotective effects of sacubitril/valsartan (LCZ696) versus enalapril in a non-diabetic rat model of chronic ischemic heart failure. Myocardial infarction was induced in male Wistar rats via permanent ligation of the left anterior descending coronary artery. Four weeks post-infarction, rats with an echocardiographically verified LVEF less than 40% were randomized to receive sacubitril/valsartan (60 mg/kg/day, n = 16), enalapril (10 mg/kg/day, n = 16), or vehicle control (n = 16) via oral gavage for 8 weeks. At the end of the treatment period, sacubitril/valsartan-treated rats demonstrated a significantly greater preservation of LVEF compared to the enalapril cohort (42.4% ± 3.5% vs. 36.8% ± 3.1%, p < 0.05). Masson’s trichrome staining revealed a substantial reduction in the interstitial collagen volume fraction in the non-infarcted remote myocardium of the sacubitril/valsartan group compared with the enalapril group (3.4% ± 0.6% vs. 5.2% ± 0.8%, p < 0.01). Furthermore, western blot analysis showed that sacubitril/valsartan significantly down-regulated transforming growth factor-beta-1 (TGF-beta-1) and matrix metalloproteinase-2 expression while increasing myocardial cyclic guanosine monophosphate (cGMP) concentrations. Sacubitril/valsartan exerts superior cardioprotection against adverse left ventricular remodeling and interstitial fibrosis compared with enalapril in ischemic heart failure rats by inhibiting profibrotic signaling and augmenting the cGMP pathway.

Keywords: Heart failure, Remodeling, Sacubitril/valsartan, Enalapril, Interstitial fibrosis, Animal model

Received: May 05, 2013; Revised: June 18, 2013; Accepted: July 10, 2013; Published: August 24, 2018

International Journal of Cardiology | Vol. 9, No. 6, June 2018 | pp. 41–48

DOI: 10.46882/2018/IJC/000111

Original Research Article

Prognostic Value of Right Ventricular Global Longitudinal Strain in Patients Presenting with Acute Pulmonary Embolism

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:
Acute pulmonary embolism (PE) frequently causes acute right ventricular (RV) overload and failure, which directly determines short-term mortality. Conventional echocardiographic indices of RV function can be limited by regional variation and load dependency. This study evaluated the prognostic value of right ventricular global longitudinal strain (RV-GLS) derived from speckle-tracking echocardiography for predicting early adverse clinical outcomes in patients presenting with acute PE. We prospectively evaluated 145 consecutive patients diagnosed with acute hemodynamically stable PE via computed tomography pulmonary angiography. Standard and speckle-tracking echocardiography were performed within 24 hours of admission to measure tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), and RV-GLS. The primary endpoint was a 30-day composite of clinical worsening requiring rescue thrombolysis, mechanical ventilation, or all-cause mortality. The primary endpoint occurred in 22 patients (15.2%). Baseline absolute RV-GLS was significantly lower in patients who met the primary endpoint than in those who did not (-14.2% ± 2.6% vs. -21.4% ± 3.1%, p < 0.001). Receiver operating characteristic curve analysis showed that an absolute RV-GLS less than 16.5% predicted 30-day adverse events with a sensitivity of 86.4% and a specificity of 81.3%. Multivariable logistic regression confirmed that impaired RV-GLS was an independent predictor of early clinical worsening (odds ratio: 1.34 per 1% absolute strain decrease, 95% CI: 1.14–1.58, p = 0.001), outperforming both TAPSE and FAC. Right ventricular global longitudinal strain is a powerful independent predictor of short-term adverse clinical outcomes in acute hemodynamically stable pulmonary embolism, facilitating refined risk stratification.

Keywords: Pulmonary embolism, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Risk stratification

Received: March 04, 2013; Revised: April 18, 2013; Accepted: May 10, 2013; Published: June 15, 2018

International Journal of Cardiology | Vol. 9, No. 10, October 2018 | pp. 73–80

DOI: 10.46882/2018/IJC/000115

Review Article

Evolving Pathophysiological Paradigms, Diagnostic Algorithms, and Therapeutic Targets in Heart Failure with Preserved Ejection Fraction

Sarah L. Jenkins¹, Nigel Kirkpatrick²

¹Department of Cardiovascular Sciences, British Heart Foundation Centre, King's College London, London, United Kingdom

²Division of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

Abstract:
Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure hospitalizations globally, yet its optimal management remains a clinical challenge. Unlike heart failure with reduced ejection fraction, which is driven by progressive cardiomyocyte loss and systolic failure, HFpEF stems from a complex interplay of systemic comorbidities that induce chronic microvascular inflammation and myocardial stiffness. This comprehensive review synthesizes the evolving pathophysiological paradigms of HFpEF, highlighting the roles of endothelial dysfunction, titin hypophosphorylation, and advanced glycation end-product accumulation in driving impaired diastolic relaxation. Diagnostic algorithms have progressed beyond simple resting echocardiography, requiring multi-parametric scores like the H2FPEF model, which incorporates body mass index, atrial fibrillation status, and invasive hemodynamic exercise testing. Right heart catheterization showing a pulmonary capillary wedge pressure greater than or equal to 15 mmHg at rest or greater than or equal to 25 mmHg during exercise remains the gold standard for definitive diagnosis. Therapeutic interventions targeting the renin-angiotensin-aldosterone system have historically failed to improve primary survival endpoints, but emerging data highlight the potential of sodium-glucose cotransporter 2 (SGLT2) inhibitors and targeted metabolic pathways to mitigate systemic inflammation and lower heart failure hospitalizations. Effective management of HFpEF requires early phenotyping and a multi-target strategy combining SGLT2 inhibition, rigorous blood pressure control, and aggressive treatment of underlying metabolic comorbidities.

Keywords: Heart failure with preserved ejection fraction, Diastolic dysfunction, Microvascular inflammation, Titin, Diuretics, SGLT2 inhibitors

Received: July 12, 2013; Revised: August 25, 2013; Accepted: September 15, 2013; Published: October 22, 2018

International Journal of Cardiology | Vol. 9, No. 1, January 2018 | pp. 1–8

DOI: 10.46882/2018/IJC/000106

Original Research Article

Empagliflozin Preserves Left Ventricular Function and Modulates Myocardial Tissue Energetics in Non-Diabetic Ischemic Heart Failure

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 reduce heart failure hospitalizations in clinical trials, but their exact cardiac mechanism of action remains poorly defined since SGLT2 is not directly expressed in the myocardium. This study investigated the direct cardioprotective effects of empagliflozin on myocardial function and tissue energetics in a non-diabetic rat model of chronic ischemic heart failure. Heart failure was induced in adult male Wistar rats via permanent ligation of the left anterior descending coronary artery. Two weeks post-ligation, surviving rats were randomized to receive either empagliflozin (20 mg/kg/day, n = 15) or vehicle control (n = 15) via oral gavage for 6 weeks. Cardiac function was tracked using high-resolution echocardiography, and myocardial high-energy phosphate metabolites were quantified post-sacrifice using nuclear magnetic resonance spectroscopy. Treatment with empagliflozin significantly attenuated left ventricular dilation and preserved LVEF compared with the vehicle control group (38.6% ± 3.4% vs. 31.2% ± 2.9%, p < 0.01). Mechanistically, empagliflozin-treated rats demonstrated a significant increase in the myocardial phosphocreatine-to-adenosine triphosphate (PCr/ATP) ratio (1.85 ± 0.14 vs. 1.42 ± 0.11, p < 0.01), indicating enhanced mitochondrial energetic efficiency. Myocardial glucose utilization was reduced, while beta-hydroxybutyrate oxidation was up-regulated, confirming a shift toward ketone body utilization. Empagliflozin significantly preserves left ventricular systolic function and attenuates adverse remodeling in non-diabetic ischemic heart failure rats by optimizing myocardial fuel selection and enhancing high-energy phosphate availability.

Keywords: Heart failure, SGLT2 inhibitors, Empagliflozin, Myocardial energetics, Remodeling, Animal model

Received: October 05, 2012; Revised: November 18, 2012; Accepted: December 08, 2012; Published: January 15, 2018

International Journal of Cardiology | Vol. 9, No. 3, March 2018 | pp. 17–24

DOI: 10.46882/2018/IJC/000108

Original Research Article

Diagnostic Accuracy of High-Spatial-Resolution isotropic 3D LGE CMR for Left Atrial Scar Characterization Pre-Redo 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:
Catheter ablation using pulmonary vein isolation (PVI) is an effective strategy for managing atrial fibrillation, but recurrent arrhythmia occurs due to gaps in procedural scar lines. Visualizing and quantifying thin left atrial (LA) myocardial scar tissue requires optimized high-spatial-resolution imaging. This study evaluated the diagnostic accuracy of a novel high-resolution 3D late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) sequence for identifying and quantifying LA scars, using electroanatomical voltage mapping (EAM) as the reference standard. We prospectively evaluated 45 patients with recurrent atrial tachyarrhythmias scheduled for a repeat ablation procedure who underwent 3D LGE CMR (1.3 mm isotropic resolution) within 48 hours prior to the intervention. Scars were quantified off-line using a threshold of 3 standard deviations above normal atrial myocardium. Atrial structures were merged with intraprocedural 3D EAM. On a segment-based analysis (432 segments total), high-resolution 3D LGE CMR demonstrated a diagnostic sensitivity of 88.4% (95% CI: 82.5%–92.8%) and a specificity of 91.2% (95% CI: 86.4%–94.7%) for detecting low-voltage scar zones (bipolar voltage less than 0.5 mV). The total quantified LA scar surface area correlated strongly with EAM scar maps (r = 0.84, p < 0.001). High-spatial-resolution 3D late gadolinium enhancement CMR provides excellent diagnostic accuracy for detecting left atrial scar tissue, facilitating non-invasive localization of conduction gaps before redo ablation procedures.

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

Received: December 02, 2012; Revised: January 18, 2013; Accepted: February 08, 2013; Published: March 15, 2013