International Journal of Cardiology

International Journal of Cardiology | Vol. 6, No. 1, January 2015 | pp. 1–8

DOI: 10.46882/2015/IJC/000070

Original Research Article

Diagnostic Accuracy of CT-Derived Fractional Flow Reserve in Intermediate Coronary Stenosis

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) provides high structural accuracy for ruling out coronary artery disease (CAD) but lacks functional capacity to determine if intermediate anatomical stenoses induce myocardial ischemia. Fractional flow reserve computed non-invasively from CTCA datasets (FFR-CT) applies computational fluid dynamics to fill this gap. This prospective study evaluated the diagnostic accuracy of FFR-CT for identifying lesion-specific ischemia, using invasive FFR as the gold standard. We enrolled 110 symptomatic patients with a single intermediate coronary stenosis (30% to 70% lumen reduction on CTCA) who were scheduled for invasive coronary angiography and FFR testing. FFR-CT was processed off-line using specialized fluid software, with ischemia defined as an FFR-CT less than or equal to 0.80. On a vessel-based analysis (134 vessels total), invasive FFR confirmed ischemia in 42 vessels (31.3%). Non-invasive FFR-CT demonstrated a diagnostic sensitivity of 88.1% (95% CI: 74.4%–96.0%), a specificity of 85.9% (95% CI: 77.0%–92.3%), a positive predictive value of 74.0%, and an exceptional negative predictive value of 93.9% (95% CI: 86.3%–97.9%). The area under the receiver operating characteristic curve for FFR-CT was significantly superior to standard anatomical CTCA narrowing criteria alone (0.90 vs. 0.72, p < 0.001). Fractional flow reserve derived from computed tomography coronary angiography achieves excellent diagnostic accuracy and a high negative predictive value for identifying ischemia-producing intermediate lesions, presenting a reliable tool to minimize unnecessary diagnostic invasive examinations.

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

Received: October 10, 2014; Revised: November 24, 2014; Accepted: December 15, 2014; Published: January 18, 2015.

International Journal of Cardiology | Vol. 6, No. 10, October 2015 | pp. 73–80

DOI: 10.46882/2015/IJC/000079

Original Research Article

Predicting Prognosis in Dilated Cardiomyopathy Using Right Ventricular Strain

Vasily Smirnov¹, Elena Kuzmina², Dmitry Ivanov¹

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

²Division of Cardiovascular Imaging, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia

Abstract:
While left ventricular dimensions and ejection fractions are traditionally prioritized in dilated cardiomyopathy (DCM), right ventricular (RV) performance independently impacts mortality. This prospective study evaluated the long-term prognostic utility of right ventricular global longitudinal strain (RV-GLS) measured via two-dimensional speckle-tracking echocardiography in adult patients with DCM. We followed 185 stable DCM patients with a resting left ventricular ejection fraction (LVEF) less than 40%. Standard echocardiography quantified right ventricular fractional area change (FAC), and off-line deformation analysis measured baseline absolute RV-GLS. The primary endpoint was a composite of cardiac mortality, urgent heart transplantation, or heart failure hospitalization over a 3-year follow-up period. Over a median follow-up of 34 months, 54 patients (29.2%) reached the primary composite endpoint. An impaired absolute baseline RV-GLS (defined as less than 15.5%) was strongly associated with a higher rate of clinical events. Kaplan-Meier survival curves confirmed a significantly lower event-free survival rate in the low absolute RV-GLS cohort (log-rank p < 0.001). After adjusting for age, NYHA functional class, baseline LVEF, and serum NT-proBNP levels, multivariable Cox proportional hazards regression confirmed that an absolute RV-GLS less than 15.5% remained a potent independent predictor of long-term clinical worsening (hazard ratio: 2.14, 95% CI: 1.28–3.55, p = 0.003). Right ventricular global longitudinal strain serves as a powerful independent predictor of long-term clinical worsening in dilated cardiomyopathy, outperforming standard volumetric metrics.

Keywords: Dilated cardiomyopathy, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Heart failure worsening

Received: July 12, 2015; Revised: August 25, 2015; Accepted: September 10, 2015; Published: October 22, 2015

International Journal of Cardiology | Vol. 6, No. 8, August 2015 | pp. 57–64

DOI: 10.46882/2015/IJC/000077

Original Research Article

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

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:
Acute pulmonary embolism (PE) frequently causes acute right ventricular (RV) pressure overload, leading to acute failure and early mortality. Conventional echocardiographic parameters can be limited by angle dependency and regional loading. This study evaluated the short-term prognostic value of right ventricular free-wall longitudinal strain (RV-FWS) measured via speckle-tracking echocardiography in hemodynamically stable acute PE. We prospectively evaluated 140 consecutive patients diagnosed with acute hemodynamically stable PE confirmed by computed tomography angiography. Standard and speckle-tracking echocardiograms were performed within 24 hours of emergency admission to determine tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), and absolute RV-FWS. The primary endpoint was a 30-day composite of clinical worsening requiring emergency rescue thrombolysis, mechanical ventilation, or all-cause mortality. The primary endpoint occurred in 21 patients (15.0%). Baseline absolute RV-FWS was significantly reduced in patients who met the primary endpoint compared to those who did not (-13.8% ± 2.4% vs. -21.2% ± 3.2%, p < 0.001). Receiver operating characteristic curves showed that an absolute RV-FWS less than 16.0% predicted 30-day adverse clinical events with a sensitivity of 85.7% and a specificity of 82.4%. Multivariable logistic regression confirmed that impaired absolute RV-FWS was an independent predictor of short-term adverse clinical outcomes (odds ratio: 1.32 per 1% absolute strain reduction, 95% CI: 1.12–1.55, p = 0.001), outperforming both TAPSE and FAC. Right ventricular free-wall longitudinal strain serves as a powerful independent predictor of short-term adverse outcomes in hemodynamically stable acute pulmonary embolism, facilitating refined emergency risk stratification.

Keywords: Pulmonary embolism, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Short-term mortality

Received: May 12, 2015; Revised: June 25, 2015; Accepted: July 11, 2015; Published: August 20, 2015

International Journal of Cardiology | Vol. 6, No. 1, January 2015 | pp. 1–8

DOI: 10.46882/2015/IJC/000070

Original Research Article

Diagnostic Performance of Fractional Flow Reserve derived from Computed Tomography in Patients with Intermediate Coronary Stenosis

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) provides high structural accuracy for ruling out coronary artery disease (CAD) but lacks functional capacity to determine if intermediate anatomical stenoses induce myocardial ischemia. Fractional flow reserve computed non-invasively from CTCA datasets (FFR-CT) applies computational fluid dynamics to fill this gap. This prospective study evaluated the diagnostic accuracy of FFR-CT for identifying lesion-specific ischemia, using invasive FFR as the gold standard. We enrolled 110 symptomatic patients with a single intermediate coronary stenosis (30% to 70% lumen reduction on CTCA) who were scheduled for invasive coronary angiography and FFR testing. FFR-CT was processed off-line using specialized fluid software, with ischemia defined as an FFR-CT less than or equal to 0.80. On a vessel-based analysis (134 vessels total), invasive FFR confirmed ischemia in 42 vessels (31.3%). Non-invasive FFR-CT demonstrated a diagnostic sensitivity of 88.1% (95% CI: 74.4%–96.0%), a specificity of 85.9% (95% CI: 77.0%–92.3%), a positive predictive value of 74.0%, and an exceptional negative predictive value of 93.9% (95% CI: 86.3%–97.9%). The area under the receiver operating characteristic curve for FFR-CT was significantly superior to standard anatomical CTCA narrowing criteria alone (0.90 vs. 0.72, p < 0.001). Fractional flow reserve derived from computed tomography coronary angiography achieves excellent diagnostic accuracy and a high negative predictive value for identifying ischemia-producing intermediate lesions, presenting a reliable tool to minimize unnecessary diagnostic invasive examinations.

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

Received: October 10, 2014; Revised: November 24, 2014; Accepted: December 15, 2014; Published: January 18, 2015

International Journal of Cardiology | Vol. 6, No. 12, December 2015 | pp. 89–96

DOI: 10.46882/2015/IJC/000081

Original Research Article

Diagnostic Utility of High-Sensitivity Cardiac Troponin I Rapid 0-Hour/1-Hour Rule-Out Algorithm for Acute Myocardial Infarction

Chloe Jenkins¹, Oliver Vance¹, Sarah E. Lawson²

¹Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

²School of Medicine, University of Queensland, Brisbane, Queensland, Australia

Abstract:
Accelerated diagnostic protocols utilizing high-sensitivity cardiac troponin I (hs-cTnI) assays have the potential to substantially shorten evaluation times for patients presenting to the emergency department (ED) with suspected acute coronary syndrome. This prospective diagnostic study evaluated the safety and clinical efficacy of an accelerated 0-hour/1-hour rule-out algorithm using hs-cTnI in patients presenting with acute chest pain. We evaluated 450 consecutive patients presenting to the ED with chest pain suggestive of myocardial ischemia. Serial blood samples were obtained at presentation (0h) and exactly 1 hour later. The final diagnosis of acute myocardial infarction (AMI) was adjudicated by an independent clinical panel using the universal definition. AMI was diagnosed in 62 patients (13.8%). A baseline hs-cTnI level below 5 ng/L or a 1-hour absolute change less than 3 ng/L successfully ruled out AMI in 61.3% of the cohort. This rapid protocol yielded an overall diagnostic sensitivity of 98.4% (95% CI: 91.3%–99.9%) and an exceptional negative predictive value (NPV) of 99.6% (95% CI: 98.0%–99.9%). The specificity and positive predictive value (PPV) were 68.4% and 33.2%, respectively. No patient classified as safe for early rule-out experienced an un-adjudicated myocardial infarction or major adverse cardiac event within a 30-day safety follow-up window. A rapid 0h/1h accelerated diagnostic protocol incorporating a high-sensitivity cardiac troponin I assay allows for safe, exceptionally fast exclusion of acute myocardial infarction in more than half of presenting ED chest pain patients.

Keywords: High-sensitivity cardiac troponin I, Acute myocardial infarction, Emergency department, Chest pain, Rapid rule-out, Negative predictive value

Received: September 12, 2015; Revised: October 25, 2015; Accepted: November 10, 2015; Published: December 19, 2015

International Journal of Cardiology | Vol. 6, No. 3, March 2015 | pp. 17–24

DOI: 10.46882/2015/IJC/000072

Original Research Article

Comparison of Radial versus Femoral Access for Primary Percutaneous Coronary Intervention in Elderly Patients with STEMI

Giovanni Rossi¹, Matteo Bianchi¹, Antonio Ferrara²

¹Department of Cardiovascular Sciences, University Hospital of Bologna, Bologna, Italy

²Division of Interventional Cardiology, San Raffaele Hospital, Milan, Italy

Abstract:
Vascular access site complications significantly impact mortality after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI), particularly in elderly populations. This randomized clinical trial compared bleeding complications, procedural success, and net adverse clinical events between transradial access (TRA) and transfemoral access (TFA) in elderly STEMI patients. We randomized 260 consecutive patients aged greater than or equal to 75 years undergoing PPCI to either the TRA group (n = 130) or the TFA group (n = 130). The primary endpoint was a 30-day composite of major access-site bleeding or vascular complications according to BARC criteria. Procedural success rates did not differ significantly between cohorts (96.2% for TRA vs. 97.7% for TFA, p = 0.44). However, the primary safety endpoint was significantly lower in the transradial cohort than in the transfemoral cohort (1.5% vs. 6.9%, p = 0.03), driven by a distinct reduction in large access-site hematomas and vascular pseudoaneurysms. Total fluoroscopy time was slightly longer in the TRA arm (12.4 ± 3.4 minutes vs. 10.2 ± 2.8 minutes, p = 0.02). Post-procedural hospital stay was significantly shorter in the transradial group (3.2 ± 0.8 days vs. 4.8 ± 1.2 days, p < 0.01). Transradial access for primary percutaneous coronary intervention in elderly STEMI patients significantly minimizes entry-site vascular complications and shortens hospital stay without compromising mechanical revascularization success rates compared to transfemoral access.

Keywords: ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Transradial access, Transfemoral access, Vascular complications, Elderly

Received: December 10, 2014; Revised: January 22, 2015; Accepted: February 11, 2015; Published: March 18, 2015