International Journal of Cardiology

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. 3, March 2024 | pp. 17–24

DOI: 10.46882/2024/IJC/000179

Review Article

Clinical Performance of Quantitative Native T1 Mapping and Calculated Extracellular Volume Fractions in Adult HCM Populations

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:
Hypertrophic cardiomyopathy (HCM) requires precise structural phenotype characterization and robust risk stratification to minimize sudden cardiac death (SCD) risks. While late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging is established for identifying replacement myocardial fibrosis, it is less sensitive for early diffuse interstitial expansion. This review synthesizes recent clinical data on advanced CMR parametric mapping sequences—specifically native T1 mapping and calculated extracellular volume (ECV) fractions—across adult HCM populations. A comprehensive literature synthesis compiled data from 28 registries involving 3,140 patients. Native T1 mapping and ECV values correlate strongly with histological collagen volume fractions, providing a non-invasive index of early interstitial expansion that occurs before macrovascular scarring develops. Quantified registry data indicate that an ECV fraction greater than or equal to 32% provides an adjusted hazard ratio of 2.24 (95% CI: 1.45–3.48, p < 0.01) for predicting progressive heart failure acceleration. Furthermore, combining standard focal LGE tracking (where an extent greater than or equal to 15% of total left ventricular mass increases SCD risk) with parametric mapping improves multi-parametric risk matrices. Advanced CMR parametric mapping sequences enhance diagnostic sensitivity for early-stage hypertrophic remodeling and provide useful structural indices that improve clinical risk stratification beyond traditional macrovascular scar tracking.

Keywords: Hypertrophic cardiomyopathy, Cardiac magnetic resonance, Late gadolinium enhancement, T1 mapping, Extracellular volume fraction, Risk stratification

Received: December 15, 2023; Revised: January 28, 2024; Accepted: February 14, 2024; Published: March 22, 2024

International Journal of Cardiology | Vol. 15, No. 2, February 2024 | pp. 9–16

DOI: 10.46882/2024/IJC/000178

Original Research Article

Concomitant Secondary Mitral Regurgitation Behavior and Predictors of Spontaneous Resolution Post-TAVI

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:
Concomitant secondary mitral regurgitation (SMR) is common in elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Whether baseline moderate-to-severe SMR independently impairs long-term survival or predictably resolves post-TAVI remains an area of active investigation. This study investigated the 2-year clinical outcomes and post-procedural course of SMR in high-risk patients. We prospectively followed 180 consecutive high-risk patients with severe aortic stenosis who underwent successful TAVI. Patients were divided into two baseline cohorts: non-significant SMR (none, trace, or mild, n = 124) and significant SMR (moderate-to-severe, n = 56). The primary endpoint was a composite of all-cause mortality or heart failure hospitalization at 24 months. Significant SMR was associated with a higher baseline logistic EuroSCORE (24.2% ± 5.1%). At 2 years, the primary composite endpoint occurred significantly more frequently in patients with baseline significant SMR than in those with non-significant SMR (42.9% vs. 21.8%, log-rank p = 0.004). This difference was driven by higher rates of heart failure rehospitalization (32.1% vs. 13.7%, p = 0.01). Echocardiographic follow-up at 6 months revealed that SMR improved by at least one grade in 53.6% of patients, primarily in those with preserved baseline left ventricular function. Multivariable Cox regression identified persistent baseline significant SMR as an independent predictor of 2-year clinical worsening (hazard ratio: 2.12, 95% CI: 1.25–3.58, p = 0.005). Significant baseline secondary mitral regurgitation increases the risk of long-term adverse events post-TAVI, although mechanical offloading induces spontaneous valvular improvement in over half of the surviving cohort.

Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Secondary mitral regurgitation, Heart failure, Mortality, Valvular remodeling

Received: November 10, 2023; Revised: December 19, 2023; Accepted: January 11, 2024; Published: February 20, 2024

International Journal of Cardiology | Vol. 14, No. 11, November 2023 | pp. 81–88

DOI: 10.46882/2023/IJC/000175

Original Research Article

Cardioprotective Benefit of High-Dose Atorvastatin Reloading Before Complex Percutaneous Coronary Intervention in Chronic Statin Users

Yusuf Demir¹, Murat Kaya¹, Ahmet Yilmaz²

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

²Division of Interventional Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Abstract:
Periprocedural myocardial infarction (pMI) is a common complication during complex percutaneous coronary intervention (PCI). Acute statin reloading limits pMI in statin-naive patients, but its effectiveness during complex interventional procedures in patients already established on chronic maintenance statin treatment requires verification. This prospective, randomized, open-label trial evaluated whether high-dose atorvastatin reloading before complex PCI reduces pMI rates in patients on chronic statin therapy. We enrolled 240 chronic statin users undergoing complex PCI (defined as multi-vessel disease, bifurcation lesions, or chronic total occlusions). Patients were randomized 1:1 to receive either an acute reload of atorvastatin (80 mg given 12 hours and 2 hours pre-PCI, n = 120) or to continue standard maintenance dosing (n = 120). 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-procedure. The incidence of pMI was significantly lower in the atorvastatin reloading group than in the control arm (8.3% vs. 16.7%, p = 0.04). Post-procedural mean cTnI values were also significantly reduced with the reload (0.42 ± 0.11 ng/mL vs. 0.88 ± 0.21 ng/mL, p < 0.01). No cases of hepatic dysfunction or rhabdomyolysis occurred. High-dose atorvastatin reloading safely and significantly reduces periprocedural myocardial injury during complex percutaneous coronary intervention in patients on chronic maintenance statin therapy.

Keywords: Percutaneous coronary intervention, Atorvastatin, Statin reloading, Periprocedural myocardial infarction, Complex coronary lesions

Received: August 04, 2023; Revised: September 15, 2023; Accepted: October 10, 2023; Published: November 18, 2023

International Journal of Cardiology | Vol. 14, No. 2, February 2023 | pp. 9–16

DOI: 10.46882/2023/IJC/000166

Original Research Article

Prognostic Value of Admission Soluble ST2 in Heart Failure with Preserved Ejection Fraction outpatients

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:
Heart failure with preserved ejection fraction (HFpEF) lacks well-validated biomarkers for long-term risk stratification compared to heart failure with reduced ejection fraction. Soluble ST2 (sST2) is an interleukin-1 receptor family member reflecting myocardial strain and fibrosis pathways. This study evaluated the long-term prognostic value of plasma sST2 levels in a prospective cohort of stable HFpEF patients. We enrolled 195 patients with documented HFpEF (LVEF greater than or equal to 50%). Plasma sST2 concentrations were measured at baseline during standard outpatient follow-up. The primary endpoint was a composite of cardiovascular mortality or heart failure hospitalization over a 24-month period. High baseline sST2 (defined as greater than 35 ng/mL) was identified in 38.5% of the study population. At 24 months, the primary composite endpoint occurred in 48 patients (24.6%). Survival analysis showed a significantly lower event-free survival rate in the high sST2 group compared to the low sST2 group (38.7% vs. 15.8%, log-rank p < 0.001). After adjusting for age, body mass index, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (NT-proBNP), multivariable Cox proportional hazards regression confirmed that elevated sST2 remained a powerful independent predictor of the composite outcome (hazard ratio: 2.12, 95% CI: 1.34–3.35, p = 0.001). Circulating soluble ST2 levels provide robust, independent prognostic data in patients with stable heart failure and preserved ejection fraction, outperforming traditional clinical metrics for predicting long-term decompensation.

Keywords: Heart failure with preserved ejection fraction, Soluble ST2, Biomarkers, Prognosis, Cardiovascular mortality, Heart failure hospitalization

Received: November 05, 2022; Revised: December 18, 2022; Accepted: January 10, 2023; Published: February 20, 2023

International Journal of Cardiology | Vol. 14, No. 6, June 2023 | pp. 41–48

DOI: 10.46882/2023/IJC/000170

Original Research Article

Early Postoperative High-Sensitivity Cardiac Troponin T Release as an Independent Predictor of New-Onset POAF

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:
Postoperative atrial fibrillation (POAF) complicates up to 30% of cardiac surgical interventions, increasing the risks of stroke and long-term healthcare expenditure. Subtle periprocedural myocardial injury may serve as an arrhythmogenic substrate, but its correlation with POAF development requires clarification. This prospective observational study evaluated the association between early postoperative high-sensitivity cardiac troponin T (hs-cTnT) elevations and the subsequent development of new-onset POAF. We enrolled 210 consecutive patients in baseline sinus rhythm who underwent elective coronary artery bypass grafting (CABG) or valvular replacement surgery. Serial plasma hs-cTnT levels were collected preoperatively and at 6, 12, and 24 hours postoperatively. Continuous cardiac telemetry monitored heart rhythms throughout the index hospitalization. POAF lasting longer than 30 seconds occurred in 64 patients (30.5%). Preoperative baseline hs-cTnT levels did not differ between cohorts. However, at 12 hours post-surgery, hs-cTnT levels peaked significantly higher in the POAF group than in the non-POAF group (425.4 ± 84.6 ng/L vs. 284.2 ± 62.1 ng/L, p < 0.001). Multivariable logistic regression revealed that a 12-hour postoperative hs-cTnT elevation above 350 ng/L was an independent predictor of POAF development (odds ratio: 2.34, 95% CI: 1.41–3.88, p = 0.002), alongside advanced age (odds ratio: 1.06 per year, p = 0.01). Elevated early postoperative hs-cTnT concentrations are strongly and independently linked to POAF development, indicating that subclinical periprocedural myocardial injury represents a primary contributor to postoperative atrial arrhythmogenesis.

Keywords: Atrial fibrillation, Cardiac surgery, High-sensitivity cardiac troponin T, Myocardial injury, Postoperative complications, Arrhythmogenesis

Received: March 12, 2023; Revised: April 25, 2023; Accepted: May 10, 2023; Published: June 19, 2023