International Journal of Cardiology

International Journal of Cardiology | Vol. 7, No. 8, August 2016 | pp. 57–64

DOI: 10.46882/2016/IJC/000089

Original Research Article

Prevalence and Prognostic Significance of Subclinical Left Ventricular Non-Compaction in an Unselected Adult Cardiomyopathy Cohort

Sophia Martinez¹, Carlos Gomez¹, Alejandro Rodriguez²

¹Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain

²Division of Cardiovascular Imaging, Hospital Clínic de Barcelona, Barcelona, Spain

Abstract:
Left ventricular non-compaction (LVNC) is a distinct phenotype characterized by prominent myocardial trabeculations and deep intertrabecular recesses. Its prevalence and independent prognostic impact within unselected adult cardiomyopathy cohorts remain controversial due to over-diagnostic tendencies when using standard echocardiography. This study investigated the prevalence and long-term prognosis of LVNC using cardiac magnetic resonance (CMR) criteria within a broad, real-world cardiomyopathy registry. We retrospectively analyzed 520 adult cardiomyopathy patients who underwent comprehensive diagnostic CMR imaging. LVNC was defined strictly according to the Petersen criterion (non-compacted to compacted myocardium ratio greater than 2.3 in end-diastole). Clinical outcomes were tracked over a median of 4.2 years for a composite endpoint of systemic thromboembolism, sustained ventricular arrhythmias, heart failure hospitalization, or cardiac death. Based on CMR criteria, an LVNC phenotype was identified in 34 patients (6.5%), with 18 showing isolated features and 16 displaying overlapping dilated cardiomyopathy characteristics. During follow-up, the composite endpoint occurred in 32.4% of LVNC patients versus 21.4% of non-LVNC cardiomyopathy patients (p = 0.14). Multivariable Cox proportional hazards analysis revealed that the structural presence of LVNC was not an independent predictor of adverse outcomes (hazard ratio: 1.12, 95% CI: 0.65–1.94, p = 0.68). Instead, a severely reduced left ventricular ejection fraction (LVEF less than 35%) and late gadolinium enhancement presence were the only independent prognostic factors. While an LVNC phenotype is present in 6.5% of broad cardiomyopathy cohorts under CMR assessment, its structural presence does not independently worsen long-term survival separate from underlying systolic dysfunction and myocardial scarring.

Keywords: Left ventricular non-compaction, Cardiac magnetic resonance, Cardiomyopathy, Prevalence, Prognosis, Ejection fraction

Received: May 12, 2016; Revised: June 20, 2016; Accepted: July 11, 2016; Published: August 26, 2016

International Journal of Cardiology | Vol. 7, No. 6, June 2016 | pp. 41–48

DOI: 10.46882/2016/IJC/000087

Original Research Article

Cardioprotective Effects of Remote Ischemic Preconditioning in Patients with Multivessel Disease Undergoing Off-Pump Coronary Artery Bypass Grafting

Vasily Smirnov¹, Dmitry Ivanov¹, Elena Kuzmina²

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

²Institute of Cardiovascular Diseases, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia

Abstract:
Myocardial injury during coronary artery bypass grafting (CABG) affects long-term surgical outcomes and reverse structural remodeling. Remote ischemic preconditioning (RIPC)—induced by brief transient cycles of ischemia and reperfusion in a limb—represents a non-invasive strategy to protect target myocardium. This randomized sham-controlled clinical trial evaluated the cardioprotective efficacy of RIPC in patients with multivessel coronary disease undergoing off-pump CABG. We randomized 180 patients scheduled for elective off-pump CABG to either the RIPC group (n = 90) or the sham control group (n = 90). RIPC was induced immediately after anesthesia induction by inflating a standard blood pressure cuff on the upper arm to 200 mmHg for 5 minutes, followed by 5 minutes of reperfusion, for a total of 3 complete cycles. Perioperative myocardial injury was quantified by measuring serum cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) levels at baseline and 6, 12, 24, and 48 hours postoperatively. The cumulative postoperative release of cTnI, assessed by the 48-hour area under the curve (AUC), was significantly reduced by 24% in the RIPC group compared to the sham group (mean AUC: 44.2 ± 11.2 ng/mL/h vs. 58.4 ± 14.5 ng/mL/h, p < 0.01). Total post-procedural CK-MB release was also significantly lower in the RIPC cohort at 12 and 24 hours (p < 0.05). No protocol-related vascular complications occurred. Remote ischemic preconditioning significantly limits perioperative myocardial injury in patients undergoing off-pump coronary artery bypass surgery, offering safe and easily applicable cardioprotection.

Keywords: Remote ischemic preconditioning, Myocardial injury, Coronary artery bypass grafting, Off-pump surgery, Cardiac troponin I, Cardioprotection

Received: March 11, 2016; Revised: April 22, 2016; Accepted: May 12, 2016; Published: June 18, 2016

International Journal of Cardiology | Vol. 7, No. 11, November 2016 | pp. 81–88

DOI: 10.46882/2016/IJC/000092

Original Research Article

Safety and Efficacy of Second-Generation Everolimus-Eluting Stents in Patients Undergoing Complex Percutaneous Coronary Intervention

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 Interventional Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Abstract:
First-generation drug-eluting stents (DES) significantly limited coronary restenosis but raised long-term concerns regarding late stent thrombosis in complex coronary anatomy due to delayed arterial healing. Second-generation DES incorporate thinner cobalt-chromium struts and highly biocompatible polymers to improve vascular compliance and endothelialization. This randomized, single-blind clinical trial evaluated the 2-year clinical safety and efficacy of second-generation everolimus-eluting stents (EES) compared with first-generation paclitaxel-eluting stents (PES) in patients with highly complex coronary artery lesions. We randomized 340 patients exhibiting complex lesions (classified as type B2 or C according to the ACC/AHA criteria) to undergo percutaneous coronary intervention (PCI) with either EES (n = 170) or PES (n = 170). The primary endpoint was target lesion failure (TLF) at 24 months, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization (TLR). At 2 years, the primary endpoint occurred significantly less frequently in the EES cohort than in the PES group (6.5% vs. 13.5%, p = 0.03), driven by a substantial reduction in TLR (2.9% vs. 8.2%, p < 0.05). Definite or probable stent thrombosis was also significantly lower with EES (0.6% vs. 2.4%, p = 0.04). Multivariable logistic regression identified first-generation PES deployment as an independent predictor of 2-year TLF (odds ratio: 2.24, 95% CI: 1.12–4.48, p = 0.02). Second-generation everolimus-eluting stents demonstrate superior safety and efficacy profiles over first-generation paclitaxel-eluting stents in complex coronary lesions, minimizing target lesion failure and stent thrombosis.

Keywords: Percutaneous coronary intervention, Drug-eluting stents, Everolimus, Paclitaxel, Complex coronary lesions, Stent thrombosis

Received: August 01, 2016; Revised: September 15, 2016; Accepted: October 10, 2016; Published: November 20, 2016

International Journal of Cardiology | Vol. 7, No. 5, May 2016 | pp. 33–40

DOI: 10.46882/2016/IJC/000086

Original Research Article

Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Warfarin in Patients with Atrial Fibrillation and Stage 4 Chronic Kidney Disease

Pierre Larson¹, Jean-Luc Moreau¹, Chantal Dubois²

¹Department of Cardiology, Hôpital de la Timone, Marseille, France

²Division of Nephrology, Clinique Universitaire de Bruxelles, Brussels, Belgium

Abstract:
Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist, significantly increasing both stroke and major bleeding risks. Traditional anticoagulation with warfarin is challenging in patients with advanced kidney disease due to unpredictable international normalized ratios (INRs) and a risk of vascular calcification. This prospective observational study evaluated the safety and clinical efficacy of apixaban compared with warfarin in patients with non-valvular AF and stage 4 CKD. We analyzed clinical data from 210 patients with non-valvular AF and a confirmed baseline estimated glomerular filtration rate (eGFR) between 15 and 29 mL/min/1.73m². Patients were prescribed either adjusted-dose apixaban (2.5 mg twice daily, n = 102) or adjusted warfarin (target INR 2.0–3.0, n = 108). The primary safety endpoint was major bleeding according to ISTH criteria, and the primary efficacy endpoint was a composite of stroke or systemic embolism over a 24-month follow-up. Major bleeding occurred significantly less frequently in the apixaban group than in the warfarin group (4.9% vs. 12.0%, hazard ratio: 0.38, 95% CI: 0.16–0.88, p = 0.02). The incidence of stroke or systemic embolism did not differ significantly between cohorts (apixaban: 2.0% vs. warfarin: 2.8%, hazard ratio: 0.72, 95% CI: 0.20–2.55, p = 0.61). Intracranial hemorrhage was absent in the apixaban cohort. Adjusted-dose apixaban demonstrates a safer clinical profile with significantly lower rates of major bleeding compared to warfarin, while maintaining comparable thromboembolic protection in patients with atrial fibrillation and severe stage 4 chronic kidney disease.

Keywords: Atrial fibrillation, Stage 4 chronic kidney disease, Apixaban, Warfarin, Major bleeding, Stroke prevention

Received: February 15, 2016; Revised: March 24, 2016; Accepted: April 10, 2016; Published: May 20, 2016

International Journal of Cardiology | Vol. 7, No. 9, September 2016 | pp. 65–72

DOI: 10.46882/2016/IJC/000090

Original Research Article

Long-Term Outcomes of Radiofrequency Catheter Ablation versus Optimized Antiarrhythmic Drug Therapy for Paroxysmal Atrial Fibrillation

Arjun Patel¹, Rohan Mehta¹, Vikram Singh²

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

²Division of Electrophysiology, All India Institute of Medical Sciences, New Delhi, India

Abstract:
Catheter ablation is widely utilized for rhythm control in paroxysmal atrial fibrillation (AF), yet comparative long-term data against modern antiarrhythmic drug (AAD) regimens in real-world clinical cohorts remain essential. This randomized trial compared the 3-year efficacy, safety, and health-related quality-of-life outcomes between catheter ablation and optimized AAD therapy. We randomized 180 symptomatic patients with paroxysmal AF who had failed at least one class I or III antiarrhythmic drug to receive either radiofrequency catheter ablation (pulmonary vein isolation, n = 90) or optimized alternative AAD therapy (n = 90). The primary endpoint was freedom from any documented atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period. At 3 years, freedom from recurrent atrial tachyarrhythmias was significantly higher in the catheter ablation group than in the antiarrhythmic drug cohort (71.1% vs. 38.9%, p < 0.001). Repeat ablation procedures were performed in 15.6% of the ablation group. Major periprocedural complications in the ablation arm included 2 cases of cardiac tamponade successfully managed with pericardiocentesis, with no occurrences of stroke or atrioesophageal fistula. Significant adverse drug effects occurred in 18.9% of the AAD arm, requiring therapy discontinuation. Quality of life, assessed via the SF-36 questionnaire, improved significantly more in the catheter ablation cohort across physical and mental health domains (p < 0.01). Radiofrequency catheter ablation achieves superior long-term freedom from arrhythmia recurrence and substantially improves health-related quality of life compared with optimized antiarrhythmic drug therapy.

Keywords: Atrial fibrillation, Catheter ablation, Pulmonary vein isolation, Antiarrhythmic drugs, Recurrence, Quality of life

Received: June 04, 2016; Revised: July 19, 2016; Accepted: August 08, 2016; Published: September 20, 2016

International Journal of Cardiology | Vol. 7, No. 1, January 2016 | pp. 1–8

DOI: 10.46882/2016/IJC/000082

Original Research Article

Efficacy of Sacubitril/Valsartan on Left Ventricular Remodeling in Stable Patients with Chronic Heart Failure and Reduced Ejection Fraction

Marcus Thorne¹, Elizabeth Vance¹, Nigel Kirkpatrick²

¹Cardiovascular Research Centre, University of Manchester, Manchester, United Kingdom

²Department of Hypertension, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

Abstract:
Angiotensin receptor-neprilysin inhibitors (ARNIs) reduce mortality and heart failure hospitalizations in patients with heart failure and reduced ejection fraction (HFrEF). However, prospective data detailing the precise time course of reverse structural remodeling in stable outpatients remain incomplete. This prospective observational study evaluated the 12-month impact of sacubitril/valsartan on left ventricular volumes, mass, and functional markers. We enrolled 140 stable outpatients with HFrEF (baseline LVEF less than or equal to 35%) who transitioned from standard ACE inhibitors or ARBs to sacubitril/valsartan. Echocardiography was performed at baseline, 6 months, and 12 months post-titration to monitor left ventricular end-systolic volume index (LVESVI), left ventricular end-diastolic volume index (LVEDVI), and left ventricular mass index (LVMI). At 12 months, sacubitril/valsartan therapy was associated with a significant reduction in mean LVESVI (from 74.2 ± 11.4 mL/m² to 58.6 ± 9.2 mL/m², p < 0.001) and LVEDVI (from 112.4 ± 14.8 mL/m² to 94.2 ± 12.1 mL/m², p < 0.001). Concurrently, mean LVEF improved significantly from 28.4% ± 3.4% to 36.5% ± 4.2% (p < 0.001), while LVMI dropped by an average of 18.4 g/m² (p < 0.01). Serum NT-proBNP levels demonstrated a rapid 42% reduction within the first 6 months (p < 0.05). No cases of life-threatening angioedema or severe hyperkalemia occurred. Transitioning to sacubitril/valsartan promotes significant, sustained reverse mechanical remodeling, characterized by marked reductions in left ventricular volumes and mass index alongside robust improvements in systolic performance in stable HFrEF outpatients.

Keywords: Heart failure with reduced ejection fraction, Sacubitril/valsartan, Left ventricular remodeling, Echocardiography, End-systolic volume, Biomarkers

Received: October 08, 2015; Revised: November 20, 2015; Accepted: December 12, 2015; Published: January 18, 2016