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 patients with Multisystem Inflammatory Syndrome in Children.

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 patients with Multisystem Inflammatory Syndrome in Children 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 patients with Multisystem Inflammatory Syndrome in Children, 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.

Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by left ventricular diastolic dysfunction, elevated filling pressures, and normal ejection fraction (left ventricular ejection fraction ≥50%) in the absence of an underlying disease process. Its prevalence is increasing, driven by an aging population and rising comorbidities including obesity, diabetes, and hypertension. Given the benefit of emerging HFpEF therapies, such as glucagon-like peptide-1 inhibitors, early and accurate diagnosis is critical to improve outcomes. The diagnosis of HFpEF, however, can be challenging to make, and clinical practice relies heavily on echocardiographic evidence of diastolic dysfunction. There is a need for additional noninvasive diagnostic strategies to facilitate earlier HFpEF diagnosis to improve clinical outcomes. Emerging evidence suggests that cardiac magnetic resonance (CMR) imaging may have clinical value in enhancing HFpEF diagnosis and prognosis. Moreover, CMR tissue characterization by parametric mapping sequences (T1/T2 mapping and extracellular volume quantification) makes CMR a powerful tool for evaluating HFpEF mimickers, specific diseases that cause the clinical syndrome of heart failure in the setting of normal ejection fraction, which may confound HFpEF diagnosis. Finally, novel imaging sequences, such as magnetic resonance spectroscopy, diffusion tensor imaging, and elastography, are being developed to characterize metabolism and hemodynamics in vivo and may provide insight into HFpEF pathophysiology. The diagnostic and prognostic values of CMR-derived indices of diastolic dysfunction and the use of CMR to distinguish between HFpEF and its mimickers, as well as the use of novel CMR sequences in HFpEF, are reviewed herein.

Background: Left ventricular ejection fraction (LVEF) is an essential tool for heart failure (HF) assessment but is limited by load dependence. Additional tools are needed to risk-stratify normal LVEF populations. We aimed to assess the prognostic value of systolic blood pressure-indexed left ventricular end-systolic volume ratio, or cardiac contractility index (CCI).

Methods: In a prospective observational cohort study of people newly diagnosed with HF, we defined characteristics and outcomes associated with LVEF and CCI, including after stratification into HF with reduced ejection fraction or HF with preserved ejection fraction. We used UK Biobank to assess whether CCI is associated with subclinical myocardial dysfunction and incident HF.

Results: In people with HF, mortality increased over tertiles of declining CCI (P<0.001). Within the HF with preserved ejection fraction group, below-median CCI was associated with distinct clinical characteristics and an all-cause mortality risk approximately twice that of those with above median CCI (observed event rate 17.3/100 patient-years versus 8.8/100 patient-years; P<0.001), similar to those with HF with reduced ejection fraction. Modeled as continuous variables, there was a curvilinear relationship between mortality across the detected range of CCI, while there was no clear association with mortality risk across a wide range of LVEF (20%-55%). In UK Biobank for participants without HF and normal LVEF, below-median CCI was associated with ≈33% increased risk of incident HF (adjusted hazard ratio, 1.33 [1.01-1.75]; P=0.043). Decreasing CCI was also associated with lower myocardial contractility defined using global radial and circumferential strain.

Conclusions: CCI is a simple, noninvasive, relatively afterload-independent method to stratify HF risk in populations with normal LVEF. Its simplicity means CCI could be applied to existing clinical trial data sets or used be as an inclusion criterion in future randomized controlled trials.

Background: Clonal hematopoiesis of indeterminate potential is a novel, nontraditional risk factor linked to coronary heart disease. DNMT3A and TET2 are the 2 most prevalent clonal hematopoiesis of indeterminate potential-associated driver genes. This study aims to evaluate their effects on plaque characteristics and prognosis in patients with ST-segment-elevation myocardial infarction.

Methods: Consecutive patients with ST-segment-elevation myocardial infarction (May 2017-May 2019) undergoing routine optical coherence tomography were enrolled. Targeted deep exome sequencing of peripheral blood (custom panel targeting DNMT3A and TET2) identified mutations (with a threshold variant allele frequency ≥2%). The primary end point was major adverse cardiovascular events, defined as a composite end point that includes all-cause death, nonfatal myocardial infarction, nonfatal stroke, and revascularization due to clinical ischemic events.

Results: Among 628 patients, 12.3% were identified as carriers of DNMT3A or TET2 gene mutations. Patients with DNMT3A/TET2 mutations were older (62.5 versus 55.6 years; P<0.001), while the 2 groups showed comparable prevalence rates of hypertension (48.1% versus 43.2%), diabetes (22.1% versus 22.3%), and dyslipidemia (53.2% versus 61.7%). Carriers demonstrated greater plaque vulnerability characteristics on optical coherence tomography, including a higher macrophage proportion, smaller minimal lumen area, thinner fibrous cap, and higher lipid index. During a median follow-up of 2.4 years (interquartile range 2.0-3.0), major adverse cardiovascular events rates were significantly higher in the mutation group (39.5% versus 19.9%; P<0.001). Both DNMT3A/TET2 mutations (adjusted hazard ratio, 1.91 [95% CI, 1.19-3.07]; P=0.008) and TET2 mutations specifically (adjusted hazard ratio, 3.57 [95% CI, 1.78-7.17]; P<0.001) independently predicted major adverse cardiovascular events occurrence in patients with ST-segment-elevation myocardial infarction.

Conclusions: Patients with ST-segment-elevation myocardial infarction and DNMT3A/TET2 mutations exhibit vulnerable characteristics in their coronary plaques, along with an increased risk of experiencing major adverse cardiovascular events. Moreover, carrying TET2 mutations confers a worse prognosis compared with solely having DNMT3A mutations.

Background: 2D-speckle tracking echocardiography may help detect subclinical ventricular dysfunction, but data in multisystem inflammatory syndrome in children (MIS-C) are scarce. We investigated left ventricular (LV) strain parameters in MIS-C and their association with outcomes.

Methods: We performed an ambi-directional, 32-center cohort study on hospitalized patients with MIS-C (March 2020-November 2021) with at least 1 echocardiogram read by the Core Lab. Generalized estimating equation modeling was used to test associations between LV strain and a composite in-hospital adverse cardiovascular outcome (vasoactive support, arrhythmias, cardiac arrest, extracorporeal support, death, or heart transplant).

Results: Of 349 patients (median age, 8.7 years [interquartile range, 5.3-12.9]), 35% had decreased LV ejection fraction during hospitalization, and 45% had depressed LV strain (either 4-chamber LV longitudinal strain [4CH-LVLS] or mid-ventricular LV circumferential strain [mid-LVCS]). The worst 4CH-LVLS and mid-LVCS occurred at ≈5 days of illness; 50% of abnormal LV strain normalized within 1 week, and 95% within 50 days. In-hospital adverse outcomes occurred in 35% of patients; these patients were older (P=0.003) and, at admission, had more likely abnormal troponin (P<0.001) higher C-reactive protein (P<0.001), higher indexed LV end-diastolic volume (P<0.001) and mass (P=0.015), worse LV ejection fraction (P<0.001), and worse LV strain (4CH-LVLS, P=0.002; mid-LVCS, P=0.001). Covariate-adjusted individual models for each strain parameter showed that 4CH-LVLS (adjusted odds ratio, 1.09 [95% CI, 1.07-1.12]), mid-LVCS (adjusted odds ratio, 1.06 [95% CI, 1.04-1.09]), worst LV strain Z score between 4CH-LVLS and mid-LVCS (adjusted odds ratio, 1.30 [95% CI, 1.21-1.41]), and early diastolic longitudinal strain rate (adjusted odds ratio, 1.68 [95% CI, 1.26-2.23]) at admission were found to be associated with adverse outcomes.

Conclusions: About half of patients with MIS-C had abnormal LV strain during hospitalization. 4CH-LVLS, mid-LVCS, the most abnormal strain Z score, and early diastolic longitudinal strain rate at admission were independently associated with in-hospital adverse cardiovascular outcome. These data may help early characterization and prognostication in MIS-C.