International Journal of Cardiology

International Journal of Cardiology | Vol. 16, No. 8, August 2025 | pp. 57–64

DOI: 10.46882/2025/IJC/000196

Original Research Article

Independent Association of Baseline Myocardial Fibrosis Pathways with Soluble ST2 Levels in Cardiorenal Decompensation

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 clinical trajectory. Soluble ST2 (sST2) is an emerging biomarker of myocardial strain, stretch, and tissue fibrosis that is not significantly cleared by the kidneys, unlike conventional natriuretic peptides. This study evaluated the long-term prognostic value of sST2 in ADHF patients across varying levels of baseline renal function. We prospectively enrolled 240 patients admitted for ADHF. Plasma sST2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were quantified within 24 hours of hospital admission. Renal function was classified 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, 2025; Revised: June 22, 2025; Accepted: July 12, 2025; Published: August 18, 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. 2, February 2025 | pp. 9–16

DOI: 10.46882/2025/IJC/000190

Original Research Article

Cardiovascular Risk Profiles and Prevalence of Subclinical Atherosclerosis across Carotid Measurements in Asymptomatic Civil Servants

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 non-communicable cardiovascular disease is rising rapidly in Sub-Saharan Africa due to rapid urbanization, dietary modification, and epidemiological shifts. However, clinical data detailing the precise prevalence of subclinical macrovascular disease in native African cohorts remain sparse. This cross-sectional study evaluated traditional cardiovascular risk profiles and estimated the prevalence of subclinical atherosclerosis using high-resolution 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 metabolic and anthro-biometric risk factors were analyzed via structured laboratory profiling. B-mode ultrasound quantified CIMT; subclinical atherosclerosis was defined as a maximum 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 macrovascular plaques found in 4.3% of the overall 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 serum low-density lipoprotein cholesterol (odds ratio: 1.32 per mmol/L, p = 0.03) were independently associated with subclinical macrovascular disease. Subclinical carotid 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.

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

Received: November 04, 2024; Revised: December 19, 2024; Accepted: January 11, 2025; Published: February 15, 2025

International Journal of Cardiology | Vol. 15, No. 1, January 2024 | pp. 1–8

DOI: 10.46882/2024/IJC/000177

Original Research Article

Prospective Evaluation of Reverse Mechanical Remodeling Dynamics Following Sacubitril/Valsartan Outpatient Titration

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, 2023; Revised: November 20, 2023; Accepted: December 12, 2023; Published: January 18, 2024

International Journal of Cardiology | Vol. 15, No. 10, October 2024 | pp. 73–80

DOI: 10.46882/2024/IJC/000186

Original Research Article

Long-Term Prognostic Value of Admission Plasma Galectin-3 Levels in Patients Hospitalized for Acute Decompensated Heart Failure

Stefan de Vries¹, Anika Janssen¹, Jan de Jong²

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

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

Abstract:
Acute decompensated heart failure (ADHF) requires precise risk stratification to guide post-discharge transitions and prevent early rehospitalization. Galectin-3 is a soluble beta-galactoside-binding lectin secreted by activated macrophages that directly drives myocardial fibrosis and adverse chamber remodeling. This study evaluated the long-term prognostic value of plasma Galectin-3 levels measured at admission in a prospective cohort of patients hospitalized for ADHF. We enrolled 280 consecutive patients admitted with a primary diagnosis of ADHF. Plasma Galectin-3 concentrations were quantified using an enzyme-linked immunosorbent assay within 24 hours of hospital admission. The primary endpoint was a composite of 12-month all-cause mortality or heart failure readmission. High plasma Galectin-3 (defined as greater than 17.8 ng/mL) was identified in 48.2% of the study population. At 12 months, the primary composite endpoint occurred in 84 patients (30.0%). Survival analysis demonstrated a significantly lower event-free survival rate in the high Galectin-3 cohort compared to the low Galectin-3 group (41.5% vs. 19.3%, log-rank p < 0.001). After adjusting for age, left ventricular ejection fraction, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (NT-proBNP), multivariable Cox proportional hazards regression confirmed that elevated baseline Galectin-3 remained a powerful independent predictor of the composite outcome (hazard ratio: 1.84, 95% CI: 1.24–2.72, p = 0.002). Plasma Galectin-3 levels at admission provide robust, independent prognostic data in patients hospitalized for acute decompensated heart failure, identifying individuals at high risk for early post-discharge clinical worsening.

Keywords: Acute decompensated heart failure, Galectin-3, Biomarkers, Prognosis, Mortality, Heart failure readmission

Received: July 02, 2024; Revised: August 14, 2024; Accepted: September 05, 2024; Published: October 18, 2024

International Journal of Cardiology | Vol. 15, No. 5, May 2024 | pp. 33–40

DOI: 10.46882/2024/IJC/000181

Original Research Article

Safety and Clinical Efficacy of Apixaban versus Warfarin in Patients with Atrial Fibrillation and Severe 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, 2024; Revised: March 24, 2024; Accepted: April 10, 2024; Published: May 20, 2024