European Heart Journal - Cardiovascular Imaging最新文献

Aims: Valve durability becomes a major issue as transcatheter aortic valve implantation (TAVI) is expanding to populations with longer life expectancy. We sought to i) determine the incidence of structural valve deterioration (SVD), ii) compare the incidence of SVD between balloon-expandable (BE) and self-expandable (SE) valves, and iii) analyze the impact of SVD.

Methods and results: 2040 patients who underwent TAVI (2007-2020) from 9 centers were included. After inverse probability treatment weighting (IPTW), 1848 patients were selected (973 BE and 875 SE). SVD was defined using recent echocardiographic definitions according to VARC-3 criteria: Median follow-up was 4.2 (IQR: 2.5-5.7) years. The estimated incidence of SVD and bioprosthetic valve failure (BVF) at 8-years follow-up for the overall cohort were 13.3% (95%CI 9.8-18%) and 11.5% (95%CI 8.9-14.8%), respectively. After IPTW and a median follow-up of 4 years, the risk of SVD (5.25 % vs. 1.19%; HR 10.25, 95%CI 3.79-27.71, p <0.001), and all-cause BVF (6.41% vs. 3.2%; HR 2.1, 95%CI 1.27-3.47 p=0.004), was significantly higher for BE compared to SE recipients. Patients developing SVD had a trend towards a higher incidence of cardiovascular death (p=0.06), as well as a significantly higher risk of heart failure rehospitalization (p=0.048). After IPTW, there were no differences between BE and SE recipients in the combined endpoint of cardiovascular death, heart failure rehospitalization and valve reintervention (p=0.46).

Conclusions: In this real-world registry, the incidence of SVD at 8-years after TAVI was relatively low. The risk of SVD was higher among BE compared to SE valve recipients. SVD was associated with increased risk of heart failure rehospitalization and a trend towards a higher risk of cardiovascular death.

Aims: Understanding determinants of thoracic aortic morphology is crucial for precise diagnostics and therapeutic approaches. This study aimed to automatically characterize ascending aortic morphology based on 3D non-contrast-enhanced magnetic resonance angiography (NC-MRA) data from the epidemiological cross-sectional German National Cohort (NAKO) and to investigate possible determinants of mid-ascending aortic diameter (mid-AAoD).

Methods and results: Deep learning (DL) automatically segmented the thoracic aorta and ascending aortic length, volume, and diameter was extracted from 25,073 NC-MRAs. Statistical analyses investigated relationships between mid-AAoD and demographic factors, hypertension, diabetes, alcohol, and tobacco consumption. Males exhibited significantly larger mid-AAoD than females (M:35.5±4.8mm, F:33.3±4.5mm). Age and body surface area (BSA) were positively correlated with mid-AAoD (age: male: r²=0.20, p<0.001, female: r²=0.16, p<0.001; BSA: male: r²=0.08, p<0.001, female: r²=0.05, p<0.001). Hypertensive and diabetic subjects showed higher mid-AAoD (ΔHypertension = 2.9 ± 0.5mm; ΔDiabetes = 1.5 ± 0.6mm). Hypertension was linked to higher mid-AAoD regardless of age and BSA, while diabetes and mid-AAoD were uncorrelated across age-stratified subgroups. Daily alcohol consumption (male: 37.4±5.1mm, female: 35.0±4.8mm) and smoking history exceeding 16.5 pack-years (male: 36.6±5.0mm, female: 33.9±4.3mm) exhibited highest mid-AAoD. Causal analysis (Peter-Clark algorithm) suggested that age, BSA, hypertension, and alcohol consumption are possibly causally related to mid-AAoD, while diabetes and smoking are likely spuriously correlated.

Conclusions: This study demonstrates the potential of DL and causal analysis for understanding ascending aortic morphology. By disentangling observed correlations using causal analysis, this approach identifies possible causal determinants, such as age, BSA, hypertension, and alcohol consumption. These findings can inform targeted diagnostics and preventive strategies, supporting clinical decision-making for cardiovascular health.

Growing evidence has demonstrated the clinical benefit of percutaneous left atrial appendage closure (LAAC) in patients with atrial fibrillation. Although procedural complication rates have declined with increasing experience, post-procedural device-related complications persist, impacting prognosis and reducing the long-term benefits of the procedure. Given the potential impact of these complications, surveillance imaging after LAAC is mandatory. Currently, different imaging modalities offer unique advantages to manage these complications which warrants a combined approach to optimize both short- and long-term follow-up. The aims of this review are to explore the distinct characteristics of each imaging modality, highlighting the primary findings to be assessed during each imaging follow-up. Additionally, we propose an optimized clinical imaging surveillance roadmap from discharge to long-term follow-up.