International Journal of Cardiology

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

International Journal of Cardiology | Vol. 14, No. 3, March 2023 | pp. 17–24

DOI: 10.46882/2023/IJC/000167

Original Research Article

Transradial versus Transfemoral Entry-Site Complications in Geriatric STEMI Patients Undergoing Primary Mechanical Revascularization

Giovanni Rossi¹, Matteo Bianchi¹, Antonio Ferrara²

¹Department of Cardiovascular Sciences, University Hospital of Bologna, Bologna, Italy

²Division of Interventional Cardiology, San Raffaele Hospital, Milan, Italy

Abstract:
Vascular access site complications significantly impact mortality after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI), particularly in elderly populations. This randomized clinical trial compared bleeding complications, procedural success, and net adverse clinical events between transradial access (TRA) and transfemoral access (TFA) in elderly STEMI patients. We randomized 260 consecutive patients aged greater than or equal to 75 years undergoing PPCI to either the TRA group (n = 130) or the TFA group (n = 130). The primary endpoint was a 30-day composite of major access-site bleeding or vascular complications according to BARC criteria. Procedural success rates did not differ significantly between cohorts (96.2% for TRA vs. 97.7% for TFA, p = 0.44). However, the primary safety endpoint was significantly lower in the transradial cohort than in the transfemoral cohort (1.5% vs. 6.9%, p = 0.03), driven by a distinct reduction in large access-site hematomas and vascular pseudoaneurysms. Total fluoroscopy time was slightly longer in the TRA arm (12.4 ± 3.4 minutes vs. 10.2 ± 2.8 minutes, p = 0.02). Post-procedural hospital stay was significantly shorter in the transradial group (3.2 ± 0.8 days vs. 4.8 ± 1.2 days, p < 0.01). Transradial access for primary percutaneous coronary intervention in elderly STEMI patients significantly minimizes entry-site vascular complications and shortens hospital stay without compromising mechanical revascularization success rates compared to transfemoral access.

Keywords: ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Transradial access, Transfemoral access, Vascular complications, Elderly

Received: December 10, 2022; Revised: January 22, 2023; Accepted: February 11, 2023; Published: March 18, 2023

International Journal of Cardiology | Vol. 14, No. 7, July 2023 | pp. 49–56

DOI: 10.46882/2023/IJC/000171

Original Research Article

Diagnostic Performance of Non-Invasive FFR-CT for Identifying Ischemia-Producing Lesions in Severely Calcified Coronary Arteries

Arjun Patel¹, Rohan Mehta¹, Vikram Singh²

¹Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

²Division of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi, India

Abstract:
Severe coronary artery calcification introduces severe blooming artifacts during computed tomography coronary angiography (CTCA), which limits structural specificity and results in false-positive findings. Fractional flow reserve derived from standard CTCA datasets (FFR-CT) utilizes computational fluid dynamics to evaluate lesion-specific ischemia non-invasively. This multi-center prospective study evaluated the diagnostic performance of FFR-CT for identifying hemodynamically significant lesions in patients with heavy coronary calcification. We enrolled 115 symptomatic patients with an intermediate anatomical coronary stenosis (30% to 70%) and a baseline Agatston coronary artery calcium (CAC) score greater than 400 who were scheduled for invasive coronary angiography and fractional flow reserve (FFR). FFR-CT was processed off-line using specialized fluid dynamics 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%). Non-invasive FFR-CT demonstrated a diagnostic sensitivity of 86.7% (95% CI: 73.2%–94.9%), a specificity of 81.4% (95% CI: 72.3%–88.6%), and an overall negative predictive value (NPV) of 92.9% (95% CI: 85.3%–97.4%). The area under the receiver operating characteristic curve for FFR-CT was significantly superior to standard anatomical CTCA luminal assessment alone (0.88 vs. 0.65, p < 0.001). Fractional flow reserve computed non-invasively from CTCA datasets maintains high diagnostic precision and high negative predictive value even in severely calcified coronary arteries, reducing unnecessary diagnostic invasive procedures.

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

Received: April 02, 2023; Revised: May 15, 2023; Accepted: June 08, 2023; Published: July 24, 2023

International Journal of Cardiology | Vol. 14, No. 10, October 2023 | pp. 73–80

DOI: 10.46882/2023/IJC/000174

Original Research Article

Long-Term Clinical Value of Two-Dimensional Right Ventricular Global Longitudinal Strain in Dilated Cardiomyopathy Patients

Vasily Smirnov¹, Elena Kuzmina², Dmitry Ivanov¹

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

²Division of Cardiovascular Imaging, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia

Abstract:
While left ventricular dimensions and ejection fractions are traditionally prioritized in dilated cardiomyopathy (DCM), right ventricular (RV) performance independently impacts mortality. This prospective study evaluated the long-term prognostic utility of right ventricular global longitudinal strain (RV-GLS) measured via two-dimensional speckle-tracking echocardiography in adult patients with DCM. We followed 185 stable DCM patients with a resting left ventricular ejection fraction (LVEF) less than 40%. Standard echocardiography quantified right ventricular fractional area change (FAC), and off-line deformation analysis measured baseline absolute RV-GLS. The primary endpoint was a composite of cardiac mortality, urgent heart transplantation, or heart failure hospitalization over a 3-year follow-up period. Over a median follow-up of 34 months, 54 patients (29.2%) reached the primary composite endpoint. An impaired absolute baseline RV-GLS (defined as less than 15.5%) was strongly associated with a higher rate of clinical events. Kaplan-Meier survival curves confirmed a significantly lower event-free survival rate in the low absolute RV-GLS cohort (log-rank p < 0.001). After adjusting for age, NYHA functional class, baseline LVEF, and serum NT-proBNP levels, multivariable Cox proportional hazards regression confirmed that an absolute RV-GLS less than 15.5% remained a potent independent predictor of long-term clinical worsening (hazard ratio: 2.14, 95% CI: 1.28–3.55, p = 0.003). Right ventricular global longitudinal strain serves as a powerful independent predictor of long-term clinical worsening in dilated cardiomyopathy, outperforming standard volumetric metrics.

Keywords: Dilated cardiomyopathy, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Heart failure worsening

Received: July 12, 2023; Revised: August 25, 2023; Accepted: September 10, 2023; Published: October 22, 2023

International Journal of Cardiology | Vol. 14, No. 8, August 2023 | pp. 57–64

DOI: 10.46882/2023/IJC/000172

Original Research Article

Short-Term Prognostic Efficacy of Right Ventricular Free-Wall Longitudinal Strain in Hemodynamically Stable Acute Pulmonary Embolism

Jean-Pierre Dubois¹, Pierre Vigneron¹, Lucia Rossi²

¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France

²Department of Cardiac Surgery, University of Milan, Milan, Italy

Abstract:
Acute pulmonary embolism (PE) frequently causes acute right ventricular (RV) pressure overload, leading to acute failure and early mortality. Conventional echocardiographic parameters can be limited by angle dependency and regional loading. This study evaluated the short-term prognostic value of right ventricular free-wall longitudinal strain (RV-FWS) measured via speckle-tracking echocardiography in hemodynamically stable acute PE. We prospectively evaluated 140 consecutive patients diagnosed with acute hemodynamically stable PE confirmed by computed tomography angiography. Standard and speckle-tracking echocardiograms were performed within 24 hours of emergency admission to determine tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), and absolute RV-FWS. The primary endpoint was a 30-day composite of clinical worsening requiring emergency rescue thrombolysis, mechanical ventilation, or all-cause mortality. The primary endpoint occurred in 21 patients (15.0%). Baseline absolute RV-FWS was significantly reduced in patients who met the primary endpoint compared to those who did not (-13.8% ± 2.4% vs. -21.2% ± 3.2%, p < 0.001). Receiver operating characteristic curves showed that an absolute RV-FWS less than 16.0% predicted 30-day adverse clinical events with a sensitivity of 85.7% and a specificity of 82.4%. Multivariable logistic regression confirmed that impaired absolute RV-FWS was an independent predictor of short-term adverse clinical outcomes (odds ratio: 1.32 per 1% absolute strain reduction, 95% CI: 1.12–1.55, p = 0.001), outperforming both TAPSE and FAC. Right ventricular free-wall longitudinal strain serves as a powerful independent predictor of short-term adverse outcomes in hemodynamically stable acute pulmonary embolism, facilitating refined emergency risk stratification.

Keywords: Pulmonary embolism, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Short-term mortality

Received: May 12, 2023; Revised: June 25, 2023; Accepted: July 11, 2023; Published: August 20, 2023

International Journal of Cardiology | Vol. 14, No. 9, September 2023 | pp. 65–72

DOI: 10.46882/2023/IJC/000173

Original Research Article

Baseline Left Atrial Reservoir Strain for Predicting Late Arrhythmia Recurrence Following Cryoballoon Catheter Ablation

Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²

¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden

²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark

Abstract:
Cryoballoon catheter ablation is highly effective for achieving pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF), but anatomical left atrial (LA) diameter alone is a limited predictor of long-term rhythm stability. Left atrial reservoir strain (LA-RS) evaluated by speckle-tracking echocardiography provides a direct metric of structural tissue remodeling and wall compliance. This study investigated the independent association between baseline LA-RS and long-term arrhythmia recurrence following cryoballoon ablation. We prospectively followed 150 patients with symptomatic paroxysmal AF scheduled for cryoballoon catheter ablation. Transthoracic speckle-tracking deformation imaging quantified LA-RS prior to the intervention. The primary endpoint was any documented recurrence of atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day post-ablation blanking period over a 24-month follow-up. Recurrent tachyarrhythmias occurred in 46 patients (30.7%). Baseline mean LA-RS was significantly lower in patients with recurrent events compared to those who maintained stable sinus rhythm (17.8% ± 3.1% vs. 27.8% ± 4.2%, p < 0.001). Multivariable Cox proportional hazards regression identified a depressed baseline LA-RS (absolute value less than 20%) as a powerful independent predictor of post-ablation AF recurrence (hazard ratio: 2.38, 95% CI: 1.32–4.35, p = 0.003), whereas conventional indexed left atrial volumes did not retain independent predictive significance. Left atrial reservoir strain is strongly and independently associated with atrial fibrillation recurrence following cryoballoon ablation, providing superior risk assessment compared to conventional volumetric parameters.

Keywords: Atrial fibrillation, Cryoballoon ablation, Speckle-tracking echocardiography, Left atrial strain, Recurrence, Structural remodeling

Received: June 05, 2023; Revised: July 18, 2023; Accepted: August 11, 2023; Published: September 15, 2023