International Journal of Cardiology

International Journal of Cardiology | Vol. 3, No. 11, November 2012 | pp. 81–88

DOI: 10.46882/2012/IJC/000044

Review Article

Role of Multimodality Imaging in the Diagnosis and Management of Transcatheter Aortic Valve Implantation Complications

Sophia L. Vance¹, Christopher J. Davies²

¹Department of Cardiovascular Imaging, St Bartholomew's Hospital, London, United Kingdom

²Division of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom

Abstract:
Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe symptomatic aortic stenosis in elderly and high-surgical-risk populations. Despite structural refinements and growing operator expertise, periprocedural and late complications continue to impact long-term survival. This comprehensive review synthesizes the pivotal role of multimodality imaging—specifically multi-detector computed tomography (MDCT), transthoracic/transesophageal echocardiography (TTE/TEE), and cardiac magnetic resonance (CMR)—in identifying, mitigating, and managing major TAVI complications. MDCT serves as the gold standard for pre-procedural planning, allowing precise annular sizing and identification of risk factors for coronary artery obstruction or aortic root rupture (prevalence approximately 0.5% to 1.0%). Intraprocedurally, 2D and 3D TEE are vital for diagnosing acute complications, such as valve malpositioning, infolding, or pericardial effusion. Post-procedurally, evaluating paravalvular regurgitation (PVR) is essential, as moderate-to-severe PVR increases long-term mortality (pooled hazard ratio: 2.18, 95% CI: 1.64–2.90). While Doppler echocardiography remains the primary tracking tool for PVR, CMR is increasingly integrated due to its superior inter-observer reproducibility and precise volumetric regurgitant fraction quantification. Furthermore, high-resolution MDCT is required to detect subclinical leaflet thrombosis, characterized by hypo-attenuated leaflet thickening (HALT). Effective management of modern TAVI complications demands an integrated multimodality imaging approach across pre-, intra-, and post-procedural phases to optimize device performance and improve patient durability.

Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Multimodality imaging, Transesophageal echocardiography, Paravalvular regurgitation, Leaflet thrombosis

Received: August 12, 2012; Revised: September 24, 2012; Accepted: October 14, 2012; Published: November 19, 2012

Citation: International Journal of Cardiology, 2012, Vol. 3, No. 11, pp. 81–88, DOI: 10.46882/2012/IJC/000044

International Journal of Cardiology | Vol. 3, No. 4, April 2012 | pp. 25–32

DOI: 10.46882/2012/IJC/000037

Original Research Article

Clinical Outcomes of Complete versus Culprit-Only Revascularization in Patients with Multivessel Disease Undergoing Primary PCI for STEMI

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:
Approximately 40% to 50% of patients presenting with ST-segment elevation myocardial infarction (STEMI) exhibit multivessel coronary artery disease (MVD). The optimal management strategy for non-culprit lesions during the acute phase remains controversial. This prospective randomized trial compared the 1-year clinical outcomes of complete revascularization versus culprit-only revascularization during primary percutaneous coronary intervention (PPCI) for STEMI. We randomized 240 patients with STEMI and documented MVD into two treatment groups: complete revascularization (PPCI of the culprit lesion followed by staged PCI of non-culprit stenoses within 7 days, n = 120) or culprit-only revascularization (PPCI restricted to the infarct-related artery, n = 120). The primary endpoint was the 1-year rate of major adverse cardiac events (MACE), defined as a composite of all-cause death, recurrent myocardial infarction, or ischemia-driven revascularization. At 1 year, MACE occurred in 8.3% of patients in the complete revascularization group compared to 16.7% in the culprit-only group (p = 0.04). This difference was driven by a significant reduction in the rate of ischemia-driven revascularization (3.3% vs. 10.8%, p = 0.02), whereas rates of all-cause mortality (3.3% vs. 4.2%, p = 0.73) and recurrent MI (1.7% vs. 1.7%, p = 1.00) were similar. Total contrast volume and radiation doses were higher in the complete revascularization arm, but post-procedural acute kidney injury rates did not differ significantly (2.5% vs. 1.7%, p = 0.68). In STEMI patients with multivessel disease, complete staged revascularization significantly reduces the 1-year risk of MACE compared to a culprit-only approach, primarily driven by a lower requirement for subsequent repeat revascularizations.

Keywords: ST-segment elevation myocardial infarction, Multivessel coronary artery disease, Percutaneous coronary intervention, Complete revascularization, Culprit lesion

Received: January 08, 2012; Revised: February 22, 2012; Accepted: March 15, 2012; Published: April 24, 2012

Citation: International Journal of Cardiology, 2012, Vol. 3, No. 4, pp. 25–32, DOI: 10.46882/2012/IJC/000037

International Journal of Cardiology | Vol. 3, No. 8, August 2012 | pp. 57–64

DOI: 10.46882/2012/IJC/000041

Original Research Article

Prognostic Value of Soluble ST2 in Patients with Acute Decompensated Heart Failure and Renal Dysfunction

Carlos Mendoza¹, Javier Delgado¹, Manuel Almería²

¹Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain

²Division of Cardiovascular Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain

Abstract:
Acute decompensated heart failure (ADHF) complicated by renal impairment, known as cardiorenal syndrome, carries an unfavorable prognosis. Soluble ST2 (sST2) is a biomarker of myocardial strain and fibrosis that is not significantly cleared by the kidneys, unlike natriuretic peptides. This study evaluated the prognostic value of sST2 in ADHF patients across varying levels of renal function. We prospectively enrolled 240 patients admitted for ADHF. Plasma sST2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured within 24 hours of admission. Renal function was assessed using the estimated glomerular filtration rate (eGFR). The primary endpoint was a composite of all-cause mortality or heart failure rehospitalization at 12 months. Patients were stratified into two groups: eGFR less than 60 mL/min/1.73m² (n = 112) and eGFR greater than or equal to 60 mL/min/1.73m² (n = 128). Elevated sST2 (greater than 35 ng/mL) was observed in 68% of the cohort. At 12 months, the primary endpoint occurred in 74 patients (30.8%). In patients with renal dysfunction (eGFR less than 60 mL/min/1.73m²), sST2 remained a powerful independent predictor of the primary composite endpoint (hazard ratio: 2.14, 95% CI: 1.34–3.42, p = 0.001) after adjusting for clinical covariates and NT-proBNP. Conversely, the predictive value of NT-proBNP was attenuated in this renal subgroup (hazard ratio: 1.28, p = 0.12). Soluble ST2 provides robust, independent prognostic utility in patients with acute decompensated heart failure and concurrent renal impairment, outperforming traditional natriuretic peptides in this high-risk cardiorenal cohort.

Keywords: Acute decompensated heart failure, Soluble ST2, Biomarkers, Cardiorenal syndrome, Renal impairment, Prognosis

Received: May 10, 2012; Revised: June 22, 2012; Accepted: July 12, 2012; Published: August 18, 2012

Citation: International Journal of Cardiology, 2012, Vol. 3, No. 8, pp. 57–64, DOI: 10.46882/2012/IJC/000041

International Journal of Cardiology | Vol. 3, No. 7, July 2012 | pp. 49–56

DOI: 10.46882/2012/IJC/000040

Original Research Article

Prognostic Value of Right Ventricular Longitudinal Strain in Patients with Chronic Heart Failure

Alexei Volkov¹, Elena Sokolova¹, Nikolai Petrov²

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

²Division of Cardiovascular Imaging, Research Institute of Cardiology, Tomsk, Russia

Abstract:
Right ventricular (RV) failure is a critical determinant of survival in patients with chronic heart failure (CHF). While conventional echocardiographic metrics like tricuspid annular plane systolic excursion (TAPSE) are widely used, they are limited by angle dependency and regional tracking. Two-dimensional speckle-tracking derived RV free-wall longitudinal strain (RV-FWS) offers a more sensitive method to quantify global RV myocardial function. This study evaluated the long-term prognostic value of baseline RV-FWS in patients with stable chronic heart failure. We prospectively followed 185 stable CHF patients with an LVEF less than 40%. Standard echocardiography and off-line speckle-tracking analyses were performed at enrollment to measure TAPSE, RV fractional area change (FAC), and RV-FWS. The primary endpoint was a composite of cardiovascular mortality or heart failure hospitalization over a 3-year follow-up period. During a median follow-up of 32 months, 54 patients (29.2%) reached the primary endpoint. Impaired RV-FWS (defined as an absolute value less than 16%) was strongly associated with a higher event rate. Kaplan-Meier analysis showed significantly reduced event-free survival in patients with impaired strain (log-rank p < 0.001). After adjusting for age, NYHA class, LVEF, and NT-proBNP levels, multivariable Cox regression confirmed that impaired RV-FWS remained an independent predictor of adverse outcomes (hazard ratio: 1.15 per 1% absolute reduction, 95% CI: 1.06–1.25, p = 0.001). Conversely, TAPSE and FAC did not retain independent significance in the fully adjusted multivariable model. Right ventricular free-wall longitudinal strain is a powerful independent predictor of long-term cardiovascular mortality and heart failure hospitalization in stable CHF patients, outperforming conventional RV metrics.

Keywords: Chronic heart failure, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Cardiovascular mortality

Received: April 05, 2012; Revised: May 18, 2012; Accepted: June 10, 2012; Published: July 24, 2012

Citation: International Journal of Cardiology, 2012, Vol. 3, No. 7, pp. 49–56, DOI: 10.46882/2012/IJC/000040

International Journal of Cardiology | Vol. 3, No. 2, February 2012 | pp. 9–16

DOI: 10.46882/2012/IJC/000035

Original Research Article

Cardiovascular Risk Factor Profiling and Prevalence of Subclinical Atherosclerosis in an Asymptomatic Urban West African Population

Chidi O. Okafor¹, Babajide A. Adebayo¹, Funmilayo K. Balogun²

¹Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria

²Division of Cardiology, University College Hospital, Ibadan, Nigeria

Abstract:
The burden of cardiovascular disease is rising rapidly in Sub-Saharan Africa due to urbanization and epidemiological shifts. However, data detailing the prevalence of subclinical macrovascular disease in native African populations remain sparse. This cross-sectional study evaluated cardiovascular risk profiles and estimated the prevalence of subclinical atherosclerosis using carotid intima-media thickness (CIMT) measurements in an asymptomatic adult urban population. We evaluated 350 asymptomatic civil servants aged 30 to 70 years residing in Lagos, Nigeria. Traditional risk factors were analyzed via laboratory and anthropometric profiling. High-resolution B-mode ultrasound quantified CIMT; subclinical atherosclerosis was defined as a CIMT greater than or equal to 0.9 mm or the presence of a distinct carotid plaque. The prevalence of hypertension, obesity, dyslipidemia, and impaired fasting glucose was 42.3%, 28.6%, 34.1%, and 11.4%, respectively. Subclinical carotid atherosclerosis was identified in 54 participants (15.4%), with discrete plaques found in 4.3% of the cohort. Multivariable logistic regression revealed that advanced age (odds ratio: 1.08 per year, p < 0.001), systolic blood pressure (odds ratio: 1.04 per mmHg, p = 0.01), and elevated low-density lipoprotein cholesterol (odds ratio: 1.32 per mmol/L, p = 0.03) were independently associated with subclinical atherosclerosis. Subclinical atherosclerosis is highly prevalent among asymptomatic urban West African adults, driven primarily by high rates of undetected or poorly controlled traditional risk factors like hypertension and dyslipidemia. This underscores the need for robust primary prevention initiatives.

Keywords: Cardiovascular risk factors, Subclinical atherosclerosis, Carotid intima-media thickness, Urban health, West Africa, Primary prevention

Received: November 04, 2011; Revised: December 19, 2011; Accepted: January 11, 2012; Published: February 15, 2012

Citation: International Journal of Cardiology, 2012, Vol. 3, No. 2, pp. 9–16, DOI: 10.46882/2012/IJC/000035

International Journal of Cardiology | Vol. 3, No. 5, May 2012 | pp. 33–40

DOI: 10.46882/2012/IJC/000038

Original Research Article

Diagnostic Performance of Fractional Flow Reserve derived from Computed Tomography Coronary Angiography

Kenji Takahashi¹, Satoshi Yamada¹, Kazuo Sato²

¹Department of Cardiovascular Imaging, Tokyo Heart Center, Tokyo, Japan

²Division of Cardiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

Abstract:
Computed tomography coronary angiography (CTCA) is established for ruling out coronary artery disease (CAD), but it lacks the capacity to assess the hemodynamic significance of anatomical stenoses. Fractional flow reserve derived from standard CTCA datasets (FFR-CT) utilizes computational fluid dynamics to non-invasively estimate blood flow. This prospective study evaluated the diagnostic performance of FFR-CT in identifying ischemia-producing lesions, using invasive FFR as the reference standard. We evaluated 115 symptomatic patients with intermediate coronary lesions (30% to 70% stenosis on CTCA) who were scheduled for invasive coronary angiography and FFR. FFR-CT was computed off-line using specialized fluid software. Ischemia was defined as an invasive FFR less than or equal to 0.80. On a vessel-based analysis (142 vessels total), invasive FFR confirmed ischemia in 45 vessels (31.7%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FFR-CT were 88.9% (95% CI: 75.9%–96.3%), 86.6% (95% CI: 78.2%–92.7%), 75.5% (95% CI: 61.7%–86.2%), and 94.4% (95% CI: 87.5%–98.2%), respectively. The area under the receiver operating characteristic curve (AUC) for FFR-CT was significantly higher than that of anatomical CTCA stenosis assessment alone (0.91 vs. 0.74, p < 0.001). No severe technical software artifacts prevented successful FFR-CT computation. FFR-CT provides excellent diagnostic accuracy and a high negative predictive value for identifying hemodynamically significant coronary stenoses, potentially reducing the rates of unnecessary diagnostic invasive coronary angiograms in patients with intermediate lesions.

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

Received: February 14, 2012; Revised: March 28, 2012; Accepted: April 14, 2012; Published: May 22, 2012

Citation: International Journal of Cardiology, 2012, Vol. 3, No. 5, pp. 33–40, DOI: 10.46882/2012/IJC/000038