Circulation: Cardiovascular Imaging最新文献

Background: Physiologic interaction between the cardiovascular and renal systems is pivotal in the understanding of disease and as a target for therapeutic interventions, as highlighted in the cardiovascular-kidney-metabolic syndrome. This study explores the association of renal blood flow, derived noninvasively from cardiac positron emission tomography-computed tomography, with cardiovascular and renal outcomes.

Methods: We evaluated the association between renal blood flow and outcomes in a retrospective cohort of 295 consecutive patients who underwent ¹³N-ammonia positron emission tomography-computed tomography myocardial perfusion imaging between September 1, 2019, and March 1, 2020 (Brigham and Women's Hospital, Boston). Global myocardial blood flow, myocardial flow reserve, semiquantitative coronary artery calcium, and previously validated resting renal blood flow were obtained, along with clinical and laboratory data. Patients were followed for 4.0 (interquartile range, 1.7-4.1) years for a composite cardiovascular outcome of all-cause mortality, heart failure hospitalization, or acute coronary syndrome, and a composite renal outcome of 25% reduction in estimated glomerular filtration rate or end-stage renal disease. Survival analyses were adjusted for demographic and clinical characteristics and additionally for estimated glomerular filtration rate and myocardial flow reserve.

Results: The population had a mean age of 65.6 years, a body mass index of 29.2 kg/m², and was 49% female. Overall, 36% had chronic kidney disease stage ≥3. Patients were stratified into 3 renal blood flow groups: ≥75%, 25 to 75th, and ≤25% percentile. Lower renal blood flow was significantly associated with a higher risk of cardiovascular events (adjusted hazard ratio, 5.21 [95% CI 1.53-17.75]; P=0.008; lowest versus highest quartile), and with an elevated risk of adverse renal outcomes (P=0.026), independent of estimated glomerular filtration rate and myocardial flow reserve.

Conclusions: Impaired renal blood flow is associated with cardiac and kidney events, independent of the highly prognostic estimated glomerular filtration rate and myocardial flow reserve. Simultaneous quantification of cardiac and renal perfusion by noninvasive ¹³N-ammonia positron emission tomography-computed tomography may provide a valuable tool to interrogate pathophysiology and prognosis in the cardiovascular-kidney-metabolic syndrome.

Background: Computed tomography based planimetric assessment of the anatomic aortic valve area (aAVA^CTA) in aortic stenosis is routinely performed. Unlike transthoracic echocardiography-based effective AVA by transthoracic echocardiography, it lacks clearly defined severity cutoff values, limiting clinical utility.

Methods: In this retrospective single-center analysis with computed tomography angiography data from 2013 to 2025, cutoffs were determined from 1294 transthoracic echocardiography-based conclusive severe or nonsevere patients by congruence of maximum velocity, mean pressure gradient, and effective AVA by transthoracic echocardiography. In separate receiver operator curves analyses for tricuspid and bicuspid valves, the severe stenosis likely cutoff was defined by Youden index and the unlikely cutoff by a negative likelihood ratio <0.1. Cutoffs were internally validated in 480 patients, compared with the Agatston score by net reclassification index, and tested in 190 separate normal flow-low gradient-aortic stenosis cases.

Results: Correlation between aAVA^CTA and effective AVA by transthoracic echocardiography was moderate and strong in tricuspid and bicuspid valves, respectively (Pearson r 0.67 and 0.78; P<0.001). Severe stenosis was likely in tricuspid valves at aAVA^CTA ≤0.95 cm² (sensitivity 87%, specificity 78.9%) and unlikely at ≥1.10 cm² (negative likelihood ratio, 0.092). In bicuspid valves severe stenosis was likely at aAVA^CTA ≤1.08 cm² (sensitivity 88.3%, specificity 77.3%) and unlikely at ≥1.20cm² (negative likelihood ratio, 0.091). Validation showed comparable results. Net reclassification index compared with the Agatston score was 0.16 for likely and 0.17 for unlikely cutoffs (P<0.001). Cutoffs were applied to 190 suspected severe low-gradient cases. Adding aAVA^CTA as an additional severity marker led to reclassification to nonsevere in 5.8% of cases.

Conclusions: Direct planimetry of AVA is feasible and shows utility in low gradient-aortic stenosis. However, as the hemodynamic effect is impacted by valve shape, cutoff values should differentiate between tricuspid and bicuspid valves.

Background: Tricuspid regurgitation (TR) leads to systemic venous congestion and congestive hepatopathy, but conventional TR imaging parameters incompletely capture systemic consequences. Hepatic extracellular volume fraction (ECV) on cardiac magnetic resonance T1 mapping may reflect hepatic tissue remodeling and provide prognostic information beyond conventional risk markers.

Methods: Consecutive patients with moderate or greater TR who underwent cardiac magnetic resonance with hepatic T1 mapping were studied. Hepatic ECV was calculated using pre- and postcontrast T1 values and hematocrit. Patients were stratified by hepatic ECV tertiles. The primary end point was all-cause mortality.

Results: Among 234 patients (mean age, 65.6±15.8 years; 46.2% men), mean hepatic ECV was 37.7±9.0%, with tertile cutoffs at 32.5% and 41.3%. Higher hepatic ECV tertiles were associated with worse biventricular function and greater TR severity. Right ventricular ejection fraction decreased across tertiles (48.2% versus 48.5% versus 40.3%, P<0.001), while right ventricular end-diastolic volume index increased (107.4 versus 105.4 versus 127.4 mL/m², P<0.001). The prevalence of severe TR (regurgitant fraction ≥50%) increased from 10.9% (mean) across tertiles 1 and 2 to 29.5% in tertile 3 (P<0.001). During a mean follow-up of 2.2 years, 43 (18.4%) deaths occurred. Mortality increased across hepatic ECV tertiles: 12.8% versus 11.5% versus 30.8% (P=0.002 for trend). Kaplan-Meier analysis showed 3-year survival rates of 88%, 89%, and 57% across tertiles 1, 2, and 3, respectively. In multivariable Cox regression adjusting for age, right ventricular dysfunction, and severe TR, hepatic ECV tertiles remained independently predictive of mortality (HR, 1.62 [95% CI, 1.06-2.48]; P=0.027). Forward stepwise analysis yielded significant incremental prognostic value beyond traditional TR risk factors, improving model discrimination from χ²=24.4 to 30.1 (P=0.02).

Conclusions: Hepatic ECV is a novel prognostic marker that provides incremental risk stratification in TR and has potential to impact therapeutic decision-making in the era of expanded treatment options for TR.

Background: Depression is linked to major adverse cardiac events (MACE), yet the role of stress-related neural activity-previously implicated in stress and anxiety in mediating this association remains unclear. Because anxiety and depression frequently co-occur and share neurobiological pathways, we hypothesized that the relationship between depression, anxiety, and their co-occurrence with MACE is partially mediated by increased stress-related neural activity and related autonomic-immune mechanisms.

Methods: Data were obtained from participants enrolled in the Mass General Brigham Biobank (2010-2020). A subset underwent ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography imaging to assess stress-related neural activity, defined as the ratio of amygdala to background prefrontal cortical activity. Heart rate variability and CRP (C-reactive protein) served as indicators of autonomic activity and systemic inflammation. Depression and anxiety were determined at enrollment, and MACE was identified during follow-up using International Classification of Diseases codes. Each exposure (depression, anxiety, or concurrent anxiety plus depression) was modeled separately against study outcomes using linear and Cox regressions.

Results: Of 85 551 study subjects, 3078 (3.6%) participants developed MACE, over a median 3.4 years follow-up (interquartile range, 1.9-4.8). Depression was associated with higher MACE risk (hazard ratio, 1.24 [95% CI, 1.14-1.34]; P<0.001), with stronger associations for concurrent anxiety plus depression (hazard ratio, 1.35 [1.23-1.49]; P<0.001) and remained significant after adjustment for demographics, lifestyle, cardiovascular, and socioeconomic factors. In subsamples with available imaging (N=1123) or biomarkers (heart rate variability, N=7862; CRP, N=12 906), depression was linked to higher amygdala-to-cortex activity ratio (β=0.16; P=0.006), lower heart rate variability (β=-0.20; P<0.001), and higher CRP (β=0.14; P<0.001). Mediation analyses showed indirect effects of amygdala-to-cortex activity ratio, heart rate variability, and CRP on the depression-MACE relationship (log odds ratios, 0.04, 0.04, and 0.02, respectively; all P<0.05). Similar associations were observed for anxiety or concurrent anxiety plus depression.

Conclusions: Depression and anxiety independently associate with increased MACE risk, partly mediated by heightened stress-related neural activity and autonomic-immune dysregulation. The risk is greatest among those with both conditions, underscoring shared stress-related pathophysiology.

Percutaneous coronary intervention outcomes rely heavily on accurate lesion assessment and procedural planning. Invasive tools, such as fractional flow reserve, nonhyperemic pressure ratios, intravascular ultrasound, and optical coherence tomography, provide essential physiological and anatomic insights but are resource-intensive, prolong procedures, and increase contrast and radiation exposure. Coronary computed tomography (CT) angiography has emerged as a noninvasive modality with high diagnostic accuracy for coronary artery disease, capable of detailing plaque composition, lesion length, and vessel geometry. With the integration of CT-derived fractional flow reserve and CT myocardial perfusion imaging, coronary CT angiography now offers both anatomic and functional evaluation, bridging diagnostic and interventional decision-making. Despite guideline endorsement for coronary artery disease diagnosis, its role in guiding percutaneous coronary intervention strategies remains underutilized and absent from revascularization recommendations. This review outlines a practical, step-by-step framework for integrating coronary CT angiography into contemporary percutaneous coronary intervention planning, covering acquisition protocols, software platforms, lesion assessment, and stent strategy optimization. It also explores emerging intraprocedural applications, including fusion imaging, augmented and virtual reality, and holographic visualization. By synthesizing current evidence and identifying gaps, this review positions coronary CT angiography as a promising adjunct in precision-based percutaneous coronary intervention.

Background: Chronic aortic regurgitation (AR) is associated with significant cardiac remodeling, but the prevalence and prognostic impact of extravalvular cardiac damage remain unexplored.

Methods: Adults with moderate or greater chronic AR identified on echocardiogram between January 2008 and July 2024 were included. Exclusion criteria were acute AR, hypertrophic and infiltrative cardiomyopathies, prior cardiac surgery, and valve stenosis. Cardiac damage was classified into hierarchical stages: no cardiac damage (stage 0), left ventricular damage (stage 1), moderate or greater mitral regurgitation or left atrial enlargement or atrial fibrillation (stage 2), pulmonary hypertension or moderate or greater tricuspid regurgitation (stage 3), and significant right ventricular dysfunction (stage 4). The primary outcome was the association between cardiac damage stages and all-cause mortality under medical surveillance.

Results: Of 4026 patients (median age, 72 [61-80] years), 78% had moderate AR, 11% had moderate-severe, and 11% had severe AR. Cardiac damage was present in 87% of patients: 14% in stage 1, 53% in stage 2, 18% in stage 3, and 2% in stage 4. In a multivariable model, including age, sex, AR severity, and Charlson Comorbidity Index, cardiac damage stages were associated with mortality. Adjusted hazard ratios were 1.42 (95% CI, 1.04-1.96) for stage 1, 1.58 (95% CI, 1.21-2.06) for stage 2, 2.78 (95% CI, 2.10-3.67) for stage 3, and 5.34 (95% CI, 3.67-7.76) for stage 4. Adding cardiac damage staging to multivariable models improved predictive accuracy for mortality, increasing the concordance statistics from 0.73 (95% CI, 0.71-0.75) to 0.76 (95% CI, 0.74-0.77).

Conclusions: Cardiac damage is present in nearly 90% of patients with moderate or greater AR and is associated with increased mortality, highlighting the need for a more comprehensive evaluation of cardiac structure and function beyond the aortic valve and left ventricle.