Circulation: Cardiovascular Imaging最新文献

Background: In patients with obstructive coronary artery disease, early revascularization does not improve outcomes but may reduce angina symptoms. The objective of this study was to examine whether changes in health status outcomes following revascularization are explained by the extent of myocardial perfusion defects and improvement in myocardial perfusion.

Methods: Two trials enrolling stable patients with new-onset chest pain suggestive of obstructive coronary artery disease, the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) and the Dan-NICAD (Danish Study of Noninvasive Testing in Coronary Artery Disease) trials, were analyzed. Patients with single-vessel coronary artery disease who underwent nuclear myocardial perfusion imaging (nMPI) were included. In the ISCHEMIA trial, patients with moderate/severe ischemia were randomized to either optimal medical therapy alone or optimal medical therapy and invasive angiography. The Dan-NICAD trial enrolled patients with suspected stenosis on coronary computed tomographic angiography undergoing nMPI. Test-guided revascularization blinded to nMPI was performed, and patients with initially abnormal nMPI were reassessed after 12 months. The primary outcome was the change in the Seattle Angina Questionnaire angina frequency score.

Results: In total, 584 patients were eligible. In patients with a summed difference score of 5≤10 (n=149 [25%]) and ≥10 (n=152 [26%]), revascularization was associated with an improved angina frequency score (mean change ±SD: 16.4±20.9 and 19.0±24.1). No improvement was demonstrated in patients with a summed difference score <5. In multivariable logistic regression analysis (n=91), an increase in hyperemic myocardial blood flow at follow-up was associated with freedom from angina (odds ratio, 2.89 [95% CI, 1.04-8.70]).

Conclusions: In patients with single-vessel coronary artery disease, nMPI may identify patients more likely to experience improved symptoms from revascularization, potentially reflecting enhanced myocardial perfusion.

Pericarditis spans acute, recurrent/incessant, effusive, and constrictive phenotypes, and accurate assessment of inflammatory activity and chronicity is essential to guide therapy and anticipate outcomes. Although transthoracic echocardiography remains the first-line modality to evaluate pericardial effusion, tamponade physiology, and constrictive hemodynamics, it is limited for tissue characterization. Multimodality imaging integrates complementary strengths: cardiac magnetic resonance provides the most sensitive noninvasive assessment of pericardial edema and late gadolinium enhancement to phenotype active inflammation versus chronic fibrotic disease and to support prognostication (including identification of potentially reversible constriction); cardiac computed tomography offers superior anatomic detail for pericardial thickness, calcification, complex effusions, and preoperative planning for pericardiectomy, and can serve as an alternative when cardiac magnetic resonance is contraindicated; and ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography adds targeted value by detecting metabolically active pericardial inflammation in diagnostically ambiguous or refractory cases and may inform escalation to advanced therapies. We synthesize practical, guideline-aligned applications of these modalities, highlight common pitfalls and system-level constraints, and propose a simplified framework using key imaging biomarkers edema/inflammation, neovascularization (late gadolinium enhancement), thickening, effusion/tamponade, constriction, and fibrosis/calcification to enable imaging-guided therapy, including treatment escalation and tapering strategies in recurrent disease and selection of patients for pericardiectomy.

Background: Moderate and severe tricuspid regurgitation (TR) is associated with poor outcomes, yet current grading systems do not fully capture circulatory heterogeneity. We investigate the relationship of cardiac index (CI) with rest-exercise hemodynamics, metabolic and inflammatory profiles, and clinical outcomes in moderate and severe TRs.

Methods: We prospectively enrolled 300 outpatients with atrial secondary, nonatrial secondary, and lead-associated moderate and severe TRs without ≥moderate left-sided valve disease. All underwent comprehensive laboratory profiling and ultrasound evaluation at rest and during cardiopulmonary exercise. Patients were stratified by CI tertiles and followed clinically (primary end point: all-cause mortality or heart failure hospitalization).

Results: CI decreased with TR severity but showed wide interindividual variability. In patients with low CI, severe forward flow limitation was associated with more advanced right ventricle-pulmonary arterial uncoupling and biatrial dysfunction (P<0.05 versus the other tertiles), identifying a hypodynamic-uncoupled profile. Conversely, high CI identified a hyperdynamic-congestive phenotype characterized by advanced congestion, reduced systemic vascular resistance, and heightened systemic inflammation, metabolic-nutritional derangements, and mitochondrial dysfunction (P<0.05 versus the other tertiles). Intermediate CI showed the most favorable hemodynamic and laboratory profile. A U-shaped relationship between CI and adverse outcomes was observed, with the lowest risk at intermediate values. This pattern persisted across TR severity, cause, staging systems, and adiposity categories (P<0.05 for all).

Conclusions: In moderate and severe TRs, CI profiling captures cardiac and extracardiac determinants of flow and independently predicts outcomes beyond conventional TR grading and staging. Both low and high CIs identify high-risk patients, while an intermediate CI indicates a balanced, prognostically favorable state. CI profiling may refine risk stratification, guide individualized treatment strategies, and optimize patient selection and timing for tricuspid valve interventions.

Background: Quantitative coronary plaque measures differ in prognostic value between women and men. It remains unclear whether cardiovascular risk increases proportionally with plaque extent in both sexes. We aimed to compare cardiovascular risk trajectories across quantitative coronary plaque measures in women and men with stable chest pain.

Methods: We analyzed data from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) coronary computed tomography angiography arm, quantifying total coronary plaque volume and burden (plaque burden [PB]; % vessel volume), including calcified, noncalcified, and low-attenuation components. Associations with major adverse cardiovascular events (death, myocardial infarction, or unstable angina hospitalization) were assessed using sex-stratified spline Cox models over a median 26 months (interquartile range, 18-34).

Results: Among 4267 patients (mean age, 60.4±8.2; 2199 women), plaque was less frequent in women (55% versus 75%; P<0.001), with lower total plaque volume but similar total PB and incident major adverse cardiovascular events (2.3% versus 3.4%). Major adverse cardiovascular event risk became elevated at lower PB in women than in men: for total PB, hazard ratio crossed 1.0 at 20% in women versus 28% in men, reaching hazard ratio 1.5 at 32% in women versus 42% in men, respectively. Noncalcified PB showed a similar pattern, crossing hazard ratio 1.0 at 7% in women versus 9% in men; hazard ratio 1.5 at 13% in women versus 20% in men. Findings were similar after adjustment for atherosclerotic cardiovascular disease risk score.

Conclusions: In women, major adverse cardiovascular events appeared to emerge at a lower PB, and to rise more sharply. Findings support sex-specific interpretation of coronary computed tomography angiography-derived plaque metrics for timely intervention in women.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01174550.

Background: Moderate aortic stenosis (AS) poses a substantial risk for adverse outcomes, yet its prognostic determinants and cardiac remodeling markers remain underexplored. This study aimed to evaluate prognostic factors, including left atrial strain, and their predictive value for adverse cardiac events in patients with moderate AS.

Methods: A retrospective cohort study included 1125 patients diagnosed with moderate AS between 2008 and 2019. Cardiac remodeling indices, including left atrial reservoir strain (LARS) and left ventricular global longitudinal strain, were assessed using speckle-tracking echocardiography. The primary outcome was cardiac death, while the secondary outcome was a composite of cardiac death or heart failure hospitalization.

Results: Among the study population (median age, 74 years; 47.2% women), the Kaplan-Meier-estimated 5-year rates of cardiac mortality and the composite outcome were 16.7% and 33.9%, respectively, during a median follow-up of 42.8 months. Of the cardiac remodeling indices evaluated, LARS emerged as the most sensitive and independent predictor of cardiac death (adjusted hazard ratio, 0.948 per 1% increase; P=0.003) and the composite outcome (adjusted hazard ratio, 0.940 per 1% increase; P<0.001). Notably, the prognostic significance of reduced LARS persisted even after aortic valve replacement (hazard ratio, 2.177 for LARS <20.6% versus ≥20.6%; P=0.024). Furthermore, among all cardiac remodeling parameters analyzed, LARS showed the highest predictive performance for the composite outcome (C-index, 0.586 [95% CI, 0.541-0.632]) compared with other parameters.

Conclusions: LARS is a sensitive and independent prognostic marker in moderate AS, reflecting cardiac remodeling. Regular assessment of left atrial strain could enhance risk stratification and guide clinical management strategies in patients with moderate AS.