International Journal of Cardiology

International Journal of Cardiology | Vol. 2, No. 1, January 2011 | pp. 1–8

DOI: 10.46882/2011/IJC/000022

Original Research Article

Efficacy of Renal Denervation in Patients with Treatment-Resistant Hypertension: A 12-Month Follow-Up Study

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:
Resistant hypertension poses a severe clinical challenge due to its strong correlation with stroke and myocardial infarction. Catheter-based renal denervation (RDN) has emerged as a novel option to disrupt sympathetic overactivity. This study assessed the 12-month efficacy and safety of bilateral RDN in patients with true treatment-resistant hypertension. We enrolled 85 patients taking an average of 4.2 ± 0.8 antihypertensive medications who exhibited a baseline automated office systolic blood pressure (BP) greater than or equal to 160 mmHg. True resistance was confirmed via 24-hour ambulatory blood pressure monitoring (ABPM). Catheter-based radiofrequency ablation of the renal arteries was performed successfully in all patients. The primary endpoint was the change in office and ambulatory systolic BP at 12 months. At 12 months post-procedure, office blood pressure dropped significantly by -28 ± 7 mmHg systolic and -11 ± 4 mmHg diastolic (p < 0.001). More importantly, 24-hour ambulatory systolic BP decreased by -16 ± 5 mmHg (p < 0.01). The treatment response was sustained throughout the study period, with 68.2% of patients classified as responders (systolic reduction greater than or equal to 10 mmHg). Renal artery duplex ultrasound at 12 months showed no evidence of renal artery stenosis or aneurysmal formation in any patient. Renal function, assessed by estimated glomerular filtration rate (eGFR), remained stable (from 78.4 ± 11.2 mL/min/1.73m² to 77.1 ± 10.8 mL/min/1.73m², p = 0.42). Catheter-based renal denervation provides a powerful, sustained reduction in both office and ambulatory blood pressure at 12 months without detrimental effects on renal function or vascular integrity.

Keywords: Resistant hypertension, Renal denervation, Sympathetic nervous system, Ambulatory blood pressure, Catheter ablation

Received: October 10, 2010; Revised: November 22, 2010; Accepted: December 12, 2010; Published: January 18, 2011

Citation: International Journal of Cardiology, 2011, Vol. 2, No. 1, pp. 1–8, DOI: 10.46882/2011/IJC/000022

International Journal of Cardiology | Vol. 2, No. 2, February 2011 | pp. 9–16

DOI: 10.46882/2011/IJC/000023

Original Research Article

Prognostic Impact of Right Ventricular Dysfunction in Patients Undergoing Transcatheter Mitral Valve Repair

Matteo Barbieri¹, Francesca Costa¹, Luigi Marini²

¹Department of Cardiology, San Raffaele Hospital, Milan, Italy

²Division of Cardiac Surgery, University Hospital of Bologna, Bologna, Italy

Abstract:
Transcatheter mitral valve repair using the MitraClip system is a validated therapy for high-risk surgical patients with severe mitral regurgitation (MR). While left ventricular parameters are traditionally prioritized, the impact of baseline right ventricular (RV) dysfunction on post-procedural outcomes is less defined. This study investigated whether pre-procedural RV dysfunction predicts long-term mortality and heart failure hospitalization after transcatheter repair. We prospectively evaluated 140 consecutive patients with severe functional or degenerative MR who underwent successful MitraClip implantation. Baseline RV function was categorized as normal or impaired based on tricuspid annular plane systolic excursion (TAPSE less than 16 mm) and RV fractional area change (FAC less than 35%). The primary endpoint was a composite of all-cause mortality and heart failure hospitalization at 2 years. Baseline RV dysfunction was present in 52 patients (37.1%). At 2 years, the primary endpoint was significantly higher in patients with baseline RV dysfunction compared to those with normal RV function (44.2% vs. 21.6%, log-rank p = 0.005). This difference was driven by both higher mortality (23.1% vs. 10.2%, p = 0.03) and recurrent heart failure hospitalizations (34.6% vs. 14.8%, p = 0.01). Multivariable Cox regression identified a baseline TAPSE less than 16 mm as an independent predictor of the composite outcome (hazard ratio: 2.15, 95% CI: 1.28–3.62, p = 0.004). Pre-procedural right ventricular dysfunction is a powerful, independent predictor of poor 2-year clinical outcomes in high-risk patients undergoing transcatheter mitral valve repair, highlighting the need for comprehensive biventricular assessment.

Keywords: Mitral regurgitation, MitraClip, Right ventricular dysfunction, TAPSE, Heart failure, Prognosis

Received: November 05, 2010; Revised: December 18, 2010; Accepted: January 10, 2011; Published: February 20, 2011

Citation: International Journal of Cardiology, 2011, Vol. 2, No. 2, pp. 9–16, DOI: 10.46882/2011/IJC/000023

International Journal of Cardiology | Vol. 2, No. 12, December 2011 | pp. 89–96

DOI: 10.46882/2011/IJC/000033

Original Research Article

Effect of High-Dose Atorvastatin Reloading Before Percutaneous Coronary Intervention in Patients on Chronic Statin Therapy

Yusuf Demir¹, Murat Kaya¹, Ahmet Yilmaz²

¹Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

²Division of Cardiovascular Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

Abstract:
Preprocedural statin loading reduces perioperative myocardial infarction (pMI) in statin-naive patients undergoing percutaneous coronary intervention (PCI). However, the clinical value of acute high-dose statin reloading in patients already on chronic, maintenance statin therapy remains unestablished. This prospective, randomized, open-label trial evaluated whether a high-dose atorvastatin reload prior to PCI reduces pMI in patients established on chronic statin therapy. We enrolled 260 patients with stable angina or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) on continuous statin therapy for greater than 30 days. Patients were randomized to receive either an acute reload of atorvastatin (80 mg administered 12 hours and 2 hours before PCI, n = 130) or to continue their standard maintenance dose (n = 130). The primary endpoint was the incidence of pMI, defined as an elevation of cardiac troponin I (cTnI) greater than 5 times the upper limit of normal within 24 hours post-PCI. The incidence of pMI was significantly lower in the atorvastatin reloading group than in the control group (7.7% vs. 16.2%, p = 0.03). Mean post-procedural cTnI levels were also significantly lower in reloaded patients (0.42 ± 0.15 ng/mL vs. 0.88 ± 0.24 ng/mL, p < 0.01). No cases of acute hepatic dysfunction or rhabdomyolysis were observed in either cohort. High-dose atorvastatin reloading safely reduces the incidence of periprocedural myocardial injury and infarction in patients undergoing PCI, even when they are already established on chronic maintenance statin therapy.

Keywords: Percutaneous coronary intervention, Atorvastatin, Statin loading, Periprocedural myocardial infarction, Stable angina, Acute coronary syndrome

Received: September 05, 2011; Revised: October 20, 2011; Accepted: November 12, 2011; Published: December 18, 2011

Citation: International Journal of Cardiology, 2011, Vol. 2, No. 12, pp. 89–96, DOI: 10.46882/2011/IJC/000033

International Journal of Cardiology | Vol. 2, No. 9, September 2011 | pp. 65–72

DOI: 10.46882/2011/IJC/000030

Original Research Article

Long-Term Outcomes of Catheter Ablation versus 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) therapy remain necessary. This randomized trial compared the 3-year efficacy, safety, and quality-of-life outcomes between catheter ablation and AAD therapy. We randomized 180 symptomatic patients with paroxysmal AF who failed at least one class I or III AAD to 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 tachyarrhythmia was significantly higher in the catheter ablation group than in the AAD group (71.1% vs. 38.9%, p < 0.001). Repeated procedures were performed in 15.6% of the ablation group. Major periprocedural complications in the ablation arm included 2 cases of cardiac tamponade successfully treated with pericardiocentesis, with no occurrences of stroke or atrioesophageal fistula. Significant adverse drug effects occurred in 18.9% of the AAD arm, necessitating discontinuation or therapy changes. Quality of life, measured via the SF-36 questionnaire, improved significantly more in the catheter ablation cohort across both physical and mental health domains (p < 0.01). Radiofrequency catheter ablation achieves superior long-term freedom from arrhythmia recurrence and substantially improves quality of life compared to continued antiarrhythmic drug therapy in patients with paroxysmal atrial fibrillation.

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

Received: June 04, 2011; Revised: July 19, 2011; Accepted: August 08, 2011; Published: September 20, 2011

Citation: International Journal of Cardiology, 2011, Vol. 2, No. 9, pp. 65–72, DOI: 10.46882/2011/IJC/000030

International Journal of Cardiology | Vol. 2, No. 10, October 2011 | pp. 73–80

DOI: 10.46882/2011/IJC/000031

Original Research Article

Prognostic Value of Galectin-3 in Acute Decompensated Heart Failure Patients with Preserved versus Reduced Ejection Fraction

Stefan de Vries¹, Anika Janssen¹, Maarten van der Meer²

¹Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands

²Division of Cardiovascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands

Abstract:
Galectin-3 is a soluble beta-galactoside-binding lectin implicated in myocardial fibrosis and remodeling. This study sought to evaluate the prognostic value of plasma Galectin-3 levels in patients admitted for acute decompensated heart failure (ADHF), comparing those with preserved ejection fraction (HFpEF) versus reduced ejection fraction (HFrEF). We prospectively enrolled 280 patients hospitalized with ADHF. Patients were classified into HFrEF (LVEF less than 40%, n = 155) or HFpEF (LVEF greater than or equal to 50%, n = 125). Plasma Galectin-3 was measured at admission. The primary endpoint was a composite of 12-month all-cause mortality or heart failure readmission. Baseline Galectin-3 concentrations were significantly higher in HFpEF patients than in HFrEF patients (21.4 ± 6.8 ng/mL vs. 17.6 ± 5.2 ng/mL, p < 0.01). At 12 months, the primary endpoint occurred in 84 patients (30.0%). High Galectin-3 (greater than 17.8 ng/mL) was associated with a significantly higher event rate in both cohorts. However, multivariable Cox proportional hazards analysis revealed that Galectin-3 was an independent predictor of the composite endpoint specifically in the HFpEF cohort (hazard ratio: 1.84, 95% CI: 1.24–2.72, p = 0.002), whereas its independent predictive value dropped after adjusting for eGFR and NT-proBNP in the HFrEF cohort (hazard ratio: 1.21, 95% CI: 0.91–1.62, p = 0.18). Elevated admission Galectin-3 levels are associated with poor 12-month outcomes in ADHF, demonstrating a stronger, independent prognostic utility in patients with preserved ejection fraction than in those with reduced ejection fraction.

Keywords: Acute decompensated heart failure, Galectin-3, Heart failure with preserved ejection fraction, Heart failure with reduced ejection fraction, Biomarkers, Prognosis

Received: July 02, 2011; Revised: August 14, 2011; Accepted: September 05, 2011; Published: October 18, 2011

Citation: International Journal of Cardiology, 2011, Vol. 2, No. 10, pp. 73–80, DOI: 10.46882/2011/IJC/000031

International Journal of Cardiology | Vol. 2, No. 3, March 2011 | pp. 17–24

DOI: 10.46882/2011/IJC/000024

Review Article

The Evolving Role of Cardiac Magnetic Resonance Imaging in the Assessment of Non-Ischemic Cardiomyopathies

Sarah L. Jenkins¹, David M. Ross²

¹Department of Cardiovascular Imaging, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

²Division of Cardiology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia

Abstract:
Non-ischemic cardiomyopathies (NICMs) encompass a heterogeneous group of myocardial diseases with diverse etiologies, pathophysiologies, and clinical trajectories. Traditional diagnostic modalities often fail to differentiate specific phenotypes or precisely risk-stratify patients. Over the past decade, cardiac magnetic resonance (CMR) imaging has emerged as an indispensable diagnostic and prognostic tool. This review synthesizes current clinical data on the utility of CMR tissue characterization techniques, focusing on late gadolinium enhancement (LGE) and parametric T1/T2 mapping, across major NICM phenotypes including hypertrophic (HCM), dilated (DCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC). LGE allows for the precise visualization of myocardial fibrosis, with replacement fibrosis in DCM showing a mid-wall pattern distinct from ischemic subendocardial scarring. In HCM, the extent of LGE (greater than or equal to 15% of total LV mass) is strongly linked to an increased risk of sudden cardiac death, providing a hazard ratio of 2.42 (95% CI: 1.50–3.92) across several pooled registries. Emerging T1 mapping methodologies provide non-invasive quantification of diffuse interstitial fibrosis, which precedes macrovascular scarring. Furthermore, T2-weighted imaging remains the gold standard for localized myocardial edema identification in suspected acute myocarditis. CMR provides unparalleled tissue characterization that significantly enhances diagnostic accuracy, guides therapeutic interventions, and improves risk stratification in non-ischemic cardiomyopathies, establishing it as a foundational pillar of modern personalized cardiovascular medicine.

Keywords: Cardiac magnetic resonance, Non-ischemic cardiomyopathy, Late gadolinium enhancement, Myocardial fibrosis, Hypertrophic cardiomyopathy, Risk stratification

Received: December 12, 2010; Revised: January 25, 2011; Accepted: February 14, 2011; Published: March 22, 2011

Citation: International Journal of Cardiology, 2011, Vol. 2, No. 3, pp. 17–24, DOI: 10.46882/2011/IJC/000024