Circulation: Cardiovascular Imaging最新文献

Background: Multisystem Inflammatory Syndrome in Children is characterized by high rates of acute cardiovascular involvement with rapid recovery of organ dysfunction. However, information regarding long-term sequelae is lacking. We sought to characterize the systolic function and myocardial tissue properties using cardiac magnetic resonance (CMR) imaging in a multicenter observational cohort of Multisystem Inflammatory Syndrome in Children patients.

Methods: In this observational cohort study, comprising 32 centers in North America, CMR studies were analyzed by a core laboratory to assess ventricular volumetric data, tissue characterization, and coronary involvement.

Results: A total of 263 CMRs from 255 Multisystem Inflammatory Syndrome in Children patients were analyzed. The mean patient age was 11.4±4.4 years. Most studies were performed at 3 months (33%) or 6 months (45%) after hospitalization. Left ventricular dysfunction was present in 17 (6.7%) of the first CMRs and was never worse than mild. Dysfunction was observed in 4/7 (57%) patients at admission, 5/87 (6.9%) patients at 3 months, and 6/129 (4.6%) patients imaged either at 6 months or 1 year post-hospitalization. Late gadolinium enhancement was present in 2 (0.8%) patients, 1 at 3 months and another at 6 months following hospitalization. Coronary artery dilation was present in 13 of the 174 (7.5%) patients. Nine patients met the Lake Louise criteria for myocarditis (3.5%) at the time of CMR.

Conclusions: In this largest published multiinstitutional longitudinal CMR evaluation of confirmed Multisystem Inflammatory Syndrome in Children patients, the prevalence of ventricular dysfunction and myocardial tissue characterization abnormalities on medium-term follow-up was low. However, a small number of patients had mild residual abnormalities at 6 months and 1 year following hospitalization.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05287412.

Background: Microvascular obstruction (MVO) is associated with heart failure (HF) following ST-segment-elevation myocardial infarction. Angiography-derived microcirculatory resistance (AMR), a wire- and adenosine-free measure, may facilitate early assessment of microvascular function post-primary percutaneous coronary intervention. This study aimed to evaluate the ability of AMR to detect MVO and its prognostic value for predicting HF in patients with ST-segment-elevation myocardial infarction post-primary percutaneous coronary intervention.

Methods: Patients with consecutive ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention with a cardiac magnetic resonance examination 2 to 7 days post-procedure between April 2016 and February 2023 were retrospectively reviewed. AMR was computed from coronary angiography. MVO was identified and quantified via cardiac magnetic resonance. The end point was new-onset HF during follow-up.

Results: Overall, 475 patients (aged 56.8±11.7 years; 399 males) were included. The area under the curve for AMR to detect MVO was 0.821 (95% CI, 0.782-0.859), with an optimal cutoff value of 2.7 mm Hg*s/cm. During a median follow-up of 37.3 months, 121 (25.5%) patients developed HF. AMR, whether as a continuous (per 0.5-mm Hg*s/cm increase; hazard ratio, 1.29 [95% CI, 1.10-1.52]; P=0.002) or categorical (AMR >2.7 mm Hg*s/cm; hazard ratio, 2.15 [95% CI, 1.43-3.22]; P<0.001) variable, was independently associated with HF after adjusting for traditional risk factors (age, symptom-to-balloon time, left anterior descending coronary artery, and ejection fraction) and late gadolinium enhancement-cardiac magnetic resonance parameters. AMR improved prognostication over traditional risk factors and late gadolinium enhancement-cardiac magnetic resonance parameters (net reclassification improvement, 0.533; P<0.001; integrative discrimination index, 0.023; P=0.005).

Conclusions: AMR showed good diagnostic performance in detecting MVO and was an independent and incremental predictor of HF in patients with ST-segment-elevation myocardial infarction post-primary percutaneous coronary intervention.

Background: Bioprosthetic valve dysfunction and reoperations/reinterventions are common after aortic valve replacement (AVR) with bioprosthetic valves, leading to cycles of left ventricular (LV) pressure overload and unloading. The purpose of this study was to compare postoperative changes in LV structure and function and their relationship to clinical outcomes in young patients who underwent AVR with bioprosthetic valves (Bio_AVR group) versus mechanical prosthetic valves (Mech_AVR group).

Methods: Retrospective study of adults with congenital heart disease who underwent AVR at Mayo Clinic (2003-2023). The Bio_AVR group was matched 1:2 to the Mech_AVR group. LV indices (LV mass index, relative wall thickness, LV global longitudinal strain, averaged e', and averaged E/e') and clinical indices (NT-proBNP [N-terminal pro-B-type natriuretic peptide] and New York Heart Association class) were assessed preoperatively, and at 1, 5, and 10 years post-AVR.

Results: We studied 151 and 302 patients in the Bio_AVR and Mech_AVR groups, respectively (age 38±16 years, 58% males). Both groups had similar LV and clinical indices at baseline and 1 year post-AVR. However, the Bio_AVR group had higher LV mass index, relative wall thickness, and averaged E/e', and lower averaged e' and LV global longitudinal strain at 5 and 10 years post-AVR. Of 51 patients from the Bio_AVR group who underwent a second AVR, there was less robust improvement in LV indices and clinical indices after the second AVR compared with the first AVR.

Conclusions: AVR with a bioprosthetic valve was associated with progressive LV hypertrophy and dysfunction, and worsening clinical status compared with mechanical prosthetic valves. This provides further evidence against the use of bioprosthetic AVR in young patients.

Background: Myocardial perfusion imaging by positron emission tomography (PET) is recommended as a first-line test in stable patients with chest pain symptoms and as a selective second-line test after an abnormal coronary computed tomography angiography (CTA). It is, however, unknown whether the use of Rubidium-82 (⁸²Rb) versus [¹⁵O]H₂O (¹⁵O-water) affects the diagnostic performance in coronary artery disease (CAD). The aim of this study was to compare ⁸²Rb-PET versus ¹⁵O-water-PET head-to-head for diagnosing obstructive CAD.

Methods: The study included consecutive patients (n=1000) referred for CTA with symptoms suggestive of obstructive CAD. Patients with suspected stenosis based on CTA were referred for both ⁸²Rb-PET, ¹⁵O-water-PET, and subsequently invasive coronary angiography (ICA), including 3-vessel fractional flow reserve and coronary flow reserve measurements.

Results: In total, 196/270 (73%) patients with suspected stenosis on CTA completed ⁸²Rb-PET, ¹⁵O-water-PET, and ICA. Myocardial blood flow measurements from ⁸²Rb-PET and ¹⁵O-water-PET correlated strongly at rest (ρ, 0.62-0.69) but only moderately during hyperemia (ρ, 0.41-0.59). Only weak correlations were demonstrated between myocardial blood flow reserve by both PET tracers compared with ICA coronary flow reserve (ρ, 0.11-0.38). Hemodynamically obstructive CAD defined as ICA fractional flow reserve ≤0.80, was identified in 86/196 (44%) patients. Using predefined cutoffs, the diagnostic accuracies of ⁸²Rb-PET versus ¹⁵O-water-PET were similar (sensitivity 69% [58-78%] versus 71% [60-80%], P=0.59; specificity 85% [76-91%] versus 77% [68-85%], P=0.12). Using ICA diameter stenoses >70% as a reference, only 48/196 (24%) patients had anatomically severe CAD, and ⁸²Rb-PET and ¹⁵O-water-PET sensitivities increased to >85%.

Conclusions: For detection of obstructive CAD by PET myocardial perfusion imaging, ⁸²Rb versus ¹⁵O-water have similar diagnostic performance.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04707859.

Background: Coronary plaque features are imaging biomarkers of cardiovascular risk, but less is known about sex-specific patterns in their prognostic value. This study aimed to define sex differences in the coronary atherosclerotic phenotypes assessed by artificial intelligence-based quantitative coronary computed tomography (AI-QCT) and the associated risk of major adverse cardiovascular events (MACE). Methods: Global multicenter registry (CONFIRM2) including symptomatic patients with suspicion of CAD referred for coronary CTA. AI-QCT analyzed 16 CAD features. Primary endpoint was MACE defined as death, myocardial infarction, late revascularization, cerebrovascular events, unstable angina and congestive heart failure. Results: Among 3551 patients (mean age 59±12 years, 49.5% women), MACE occurred in 3.2% of women and 6.1% of men during an average follow-up of 4.8±2.2 years. The AI-QCT features total plaque volume (TPV), noncalcified plaque (NCP), calcified plaque (CP) and percentage atheroma volume (PAV) were significantly higher in men (p<0.001), and high-risk plaque (HRP) was more prevalent (9.2% vs 2.5%, p<0.0001). Independent of age and cardiovascular risk factors, the AI-QCT derived features of TPV, NCP, CP, and PAV conferred a higher relative risk of MACE in women than men. For every 50mm3 increase in TPV, relative risk increased by 17.7% (95% CI 1.12-1.24) in women vs 5.3% (95% CI 1.03-1.07) in men (p-interaction<0.001), for NCP relative risk increased by 27.1% (95% CI 1.17-1.38) vs 11.6% (95% CI 1.08-1.15) (p-interaction = 0.0015), and for CP, by 22.9% (95% CI 1.14-1.33) vs 5.4% (95% CI 1.01-1.10) (p-interaction = 0.0012), respectively. Similarly, for PAV the risk was higher in women. The findings remained unchanged when restricted to a secondary composite endpoint (death and myocardial infarction). Conclusions: The AI-QCT plaque features TPV, NCP, CP and PAV conferred a higher relative MACE risk in women and may prompt more aggressive anti-atherosclerotic therapy and reinforced preventive interventions.