International Journal of Cardiology

International Journal of Cardiology | Vol. 16, No. 11, November 2025 | pp. 81–88

DOI: 10.46882/2025/IJC/000199

Review Article

Clinical Application of Quantitative CMR Volumetric Interstitial Assessment for Mitigating Post-Procedural Structural Leakage

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, 2025; Revised: September 24, 2025; Accepted: October 14, 2025; Published: November 19, 2025

International Journal of Cardiology | Vol. 16, No. 1, January 2025 | pp. 1–8

DOI: 10.46882/2025/IJC/000189

Original Research Article

Incidence and Structural Predictors of Left Ventricular Thrombus after STEMI in the Primary Reperfusion Era Using Contrast CMR

Robert J. Davies¹, Edward M. Walsh¹, Simon T. Green²

¹Cardiovascular Research Center, Trinity College Dublin, Dublin, Ireland

²Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom

Abstract:
Left ventricular (LV) thrombus formation is a severe complication of ST-segment elevation myocardial infarction (STEMI) that poses a substantial systemic thromboembolic risk. While primary percutaneous coronary intervention (PPCI) limits overall infarct size, the modern incidence and specific predictors of LV thrombus remain poorly characterized in real-world clinical cohorts. This prospective observational study sought to determine the incidence and structural predictors of LV thrombus after STEMI in the current mechanical reperfusion era using delayed-enhancement cardiac magnetic resonance (CMR) imaging. We evaluated 210 consecutive patients successfully treated with timely PPCI for an acute first STEMI. All patients underwent comprehensive contrast-enhanced CMR imaging at a median of 5 days post-infarction. LV thrombus was identified in 16 patients (7.6%). On univariate analysis, thrombus formation was strongly associated with an anterior MI location, lower left ventricular ejection fraction (LVEF), and larger microvascular obstruction (MVO) zones. Multivariable logistic regression revealed that an anterior STEMI location (odds ratio: 4.12, 95% CI: 1.54–11.02, p = 0.005) and a baseline CMR-derived LVEF less than 40% (odds ratio: 3.24, 95% CI: 1.21–8.68, p = 0.02) were independent predictors of thrombus formation. Furthermore, total mass of late gadolinium enhancement significantly increased thrombus probability (odds ratio: 1.45 per 10g increase, p < 0.01). Despite prompt mechanical revascularization with PPCI, left ventricular thrombus forms in 7.6% of acute STEMI cases, concentrated primarily among patients presenting with anterior wall infarctions and severely depressed systolic function.

Keywords: ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Left ventricular thrombus, Cardiac magnetic resonance, Ejection fraction, Microvascular obstruction

Received: October 12, 2024; Revised: November 25, 2024; Accepted: December 15, 2024; Published: January 22, 2025

International Journal of Cardiology | Vol. 16, No. 5, May 2025 | pp. 33–40

DOI: 10.46882/2025/IJC/000193

Original Research Article

Diagnostic Performance of Fractional Flow Reserve derived from Computed Tomography in Symptomatic Intermediate Coronary Stenoses

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 well established for ruling out significant coronary artery disease (CAD), but it lacks the physiological 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 clinical study evaluated the diagnostic performance of FFR-CT in identifying ischemia-producing lesions, using invasive FFR as the gold standard reference. We evaluated 115 symptomatic patients with intermediate coronary lesions (defined as 30% to 70% lumen diameter reduction on CTCA) who were scheduled for diagnostic invasive coronary angiography and fractional flow reserve. FFR-CT was computed off-line using specialized fluid dynamics simulation software, with ischemia defined as an FFR-CT less than or equal to 0.80. On a vessel-based analysis (142 vessels total), invasive FFR confirmed lesion-specific ischemia in 45 vessels (31.7%). The non-invasive FFR-CT demonstrated a diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 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). FFR-CT provides excellent diagnostic accuracy and a high negative predictive value for identifying hemodynamically significant coronary stenoses.

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

Received: February 14, 2025; Revised: March 28, 2025; Accepted: April 14, 2025; Published: May 22, 2025

International Journal of Cardiology | Vol. 16, No. 12, December 2025 | pp. 89–96

DOI: 10.46882/2025/IJC/000200

Original Research Article

Clinical Value of Serial Holter Triage Frameworks for Ruling Out Oxidative Stress Induced Atrial Tachyarrhythmias

Dimitris Papadopoulos¹, Nikolaos Georgiadis¹, Andreas Angelopoulos²

¹Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece

²Division of Cardiovascular Diseases, AHEPA University Hospital, Thessaloniki, Greece

Abstract:
Hypertension is a major independent risk factor for atrial fibrillation (AF), which significantly drives cardioembolic stroke risk. Serum uric acid (SUA) is a marker of oxidative stress and tissue inflammation, but its independent link to new-onset AF in hypertensive patients remains controversial. This prospective cohort study investigated whether baseline SUA levels predict the long-term incidence of new-onset AF in an unselected hypertensive population. We followed 420 hypertensive individuals in sinus rhythm with no previous history of arrhythmia. Standard metabolic panels, including SUA, were measured at enrollment. New-onset AF was documented using serial electrocardiograms and 24-hour Holter monitoring performed during annual follow-up visits or symptomatic episodes. Hyperuricemia was defined as SUA greater than 7.0 mg/dL in men and greater than 6.0 mg/dL in women. Over a median follow-up of 4.8 years, new-onset AF developed in 46 patients (11.0%). The incidence of AF was significantly higher in patients with baseline hyperuricemia compared with those with normal SUA levels (18.4% vs. 7.1%, p < 0.001). After adjusting for age, body mass index, left atrial diameter, left ventricular mass index, eGFR, and antihypertensive medication use, multivariable Cox proportional hazards analysis confirmed that elevated SUA was an independent predictor of new-onset AF (hazard ratio per 1.0 mg/dL increase: 1.26, 95% CI: 1.10–1.44, p = 0.001). Serum uric acid is independently associated with an increased risk of new-onset atrial fibrillation in hypertensive patients, representing a simple, cost-effective biomarker for refined arrhythmic risk stratification.

Keywords: Hypertension, Atrial fibrillation, Uric acid, Hyperuricemia, Oxidative stress, Biomarkers

Received: September 10, 2024; Revised: October 20, 2024; Accepted: November 11, 2024; Published: December 22, 2025

International Journal of Cardiology | Vol. 16, No. 9, September 2025 | pp. 65–72

DOI: 10.46882/2025/IJC/000197

Original Research Article

Prospective Evaluation of 12-Month Cumulative Cardiovascular Death and Stroke Reductions with Ticagrelor in Post-PCI ACS Patients

Yukihiro Tanaka¹, Shinji Kato¹, Takuya Kobayashi²

¹Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

²Division of Interventional Cardiology, Tokyo Medical University Hospital, Tokyo, Japan

Abstract:
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the cornerstone of management for acute coronary syndrome (ACS). Ticagrelor provides faster, more consistent platelet inhibition than clopidogrel. This prospective observational study evaluated the real-world clinical efficacy and safety of ticagrelor versus clopidogrel in ACS patients undergoing percutaneous coronary intervention (PCI). We analyzed 380 consecutive ACS patients (ST-segment elevation myocardial infarction and non-ST-segment elevation ACS) who underwent successful PCI and received either ticagrelor (180 mg loading dose, 90 mg twice daily, n = 190) or clopidogrel (300 to 600 mg loading dose, 75 mg once daily, n = 190). The primary efficacy endpoint was a composite of cardiovascular death, myocardial infarction (MI), or stroke at 12 months. The safety endpoint was major bleeding according to PLATO criteria. At 12 months, the primary composite endpoint was significantly lower in the ticagrelor group than in the clopidogrel group (6.8% vs. 13.2%, hazard ratio: 0.50, 95% CI: 0.26–0.94, p = 0.03), driven primarily by lower rates of recurrent MI. The rate of definite stent thrombosis was also reduced with ticagrelor (0.5% vs. 2.1%, p < 0.05). The incidence of overall PLATO-defined major bleeding did not differ significantly between groups (8.4% vs. 7.9%, p = 0.85); however, non-CABG related bleeding and transient dyspnea were more frequent in the ticagrelor cohort (5.3% vs. 2.1%, p = 0.04). In real-world clinical practice, ticagrelor significantly reduces ischemic events and stent thrombosis in ACS patients undergoing PCI compared with clopidogrel, without significantly increasing overall major bleeding complications.

Keywords: Acute coronary syndrome, Percutaneous coronary intervention, Ticagrelor, Clopidogrel, Dual antiplatelet therapy, Stent thrombosis

Received: June 02, 2025; Revised: July 15, 2025; Accepted: August 04, 2025; Published: September 20, 2025

International Journal of Cardiology | Vol. 16, No. 7, July 2025 | pp. 49–56

DOI: 10.46882/2025/IJC/000195

Original Research Article

Long-Term Diagnostic Efficacy of Two-Dimensional Speckle-Tracking derived RV Free-Wall Longitudinal Strain in Stable CHF

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 localized 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). Right ventricular free-wall longitudinal strain is a powerful independent predictor of long-term cardiovascular mortality and heart failure hospitalization.

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

Received: April 05, 2025; Revised: May 18, 2025; Accepted: June 10, 2025; Published: July 24, 2025