European Heart Journal - Cardiovascular Imaging最新文献

Aims: To identify differences in CT-derived perivascular (PVAT) and epicardial adipose tissue (EAT) characteristics that may indicate inflammatory status differences between post-treatment acute myocardial infarction (AMI) and stable coronary artery disease (CAD) patients.

Methods and results: A cohort of 205 post-AMI patients (age 59.8±9.2, 92.2% male) was propensity-matched with 205 stable CAD patients (age 60.5±10.0, 90.2% male). Coronary CT angiography and non-contrast CT scans were performed to assess PVAT mean attenuation across major coronary segments and EAT mean attenuation and volumes, respectively. For post-AMI patients, CT scans were conducted 28.6 ± 13.8 days after the AMI incidence. Post-AMI patients showed higher non-culprit PVAT and EAT mean attenuation than stable CAD patients (8.01HU, 95% CI 5.90 to 10.11 HU, p<0.001, 2.48 HU, 95% CI 0.83 to 4.13 HU, p=0.003, respectively). The EAT volume percentage at higher attenuation levels was higher in post-AMI patients compared to stable CAD (33.93cm3, 95% CI 16.86 to 51.00 cm3, p<0.001), with the difference maximized at the -70 HU threshold (4.75%, 95% CI 3.64% to 5.87%, p<0.001). PVAT mean attenuation positively correlated with EAT mean attenuations and the percentage of EAT volume >-70 HU (p<0.001 for both).

Conclusions: Post-AMI patients showed higher PVAT and EAT attenuation than stable CAD patients, potentially indicating AMI-associated inflammatory cardiac adipose tissue changes. -70 HU can act as a potential cut-off for inflamed EAT. These findings highlight the potential of using CT-derived adipose tissue characteristics to assess inflammation and guide post-AMI management strategies.

Aims: Proximal coronary artery calcium (CAC) may improve prediction of major adverse cardiac events (MACE) beyond the CAC score, particularly in patients with low CAC burden. We investigated whether the proximal CAC can be detected on gated cardiac computer tomography (CT) and whether it provides prognostic significance with artificial intelligence (AI).

Methods and results: A total of 2016 asymptomatic adults with baseline CAC CT scans from a single site were followed up for MACE for 14 years. An AI algorithm to classify CAC into proximal or not was created using expert annotations of total and proximal CAC and AI-derived cardiac structures. The algorithm was evaluated for prognostic significance on AI-derived CAC segmentation. In 303 subjects with expert annotations, the classification of proximal versus not proximal CAC reached an area under receiver operating curve of 0.93 (95% confidence interval [CI] 0.91-0.95). For prognostic evaluation, in an additional 588 subjects with mild AI-derived CAC scores, the AI proximal involvement was associated with worse MACE-free survival (P=0.008) and higher risk of MACE when adjusting for CAC score alone (hazard ratio [HR] 2.28, 95% CI 1.16-4.48, P=0.02) or CAC score and clinical risk factors (HR 2.12, 95% CI 1.03-4.36, P=0.04).

Conclusion: The AI algorithm could identify proximal CAC on CAC CT. The proximal location had modest prognostic significance in subjects with mild CAC scores. The AI identification of proximal CAC can be integrated into automatic CAC scoring and improves the risk prediction of CAC CT.

Aim: To establish an imaging-based method to quantify left ventricular (LV) diastolic pressures.

Methods/results: In 115 patients suspected of coronary artery disease, LV pressure was measured by micromanometers and images by echocardiography. LV filling pressure was measured as LV pre-atrial contraction pressure (pre-A PLV). Based on previous observations we hypothesized that pre-A PLV approximates the sum of minimum PLV and maximum transmitral pressure difference. Parameters used for pressure estimates included LV volumes and strain, left atrial strain, mitral flow velocities, systolic arterial cuff pressure and body mass index. Minimum PLV was estimated by predictors identified in a derivative cohort (n=81). Mitral pressure difference was calculated by a simplified Navier-Stokes equation. Accuracy of estimates of minimum PLV, pre-A PLV and end-diastolic PLV were investigated in a testing cohort (n=19). Patient-specific LV diastolic pressure curves were constructed by adjusting a reference curve according to pressure estimates at key diastolic events.There was good agreement between estimated and measured pre-A PLV: Bias 0.0, limits of agreement <3.1 mmHg (±1.96SD). Estimated minimum PLV and end-diastolic PLV also showed good agreement with measured pressures. Furthermore, there was good agreement between measured and estimated LV diastolic pressure curves, quantified as mean LV diastolic pressure: Bias 0.2, limits of agreement <3.2 mmHg.

Conclusion: The proposed non-invasive method provided estimates of minimum PLV, pre-A PLV and end-diastolic PLV, each reflecting different features of diastolic function. Additionally, it provided an estimate of the LV diastolic pressure curve. Validation in larger populations with different phenotypes is necessary to determine the validity of the method in clinical practice.

Aims: Less pronounced calcification of the aortic valve (AVC) was observed in women with aortic stenosis (AS) as compared to men. Since women have smaller aortic valves (AV), this could explain a lower calcium load. We aimed to analyze the association of AV size with AVC independent from sex.

Methods & results: Consecutive patients with high-gradient AS, who underwent cardiac computed tomography (CT), were assessed. AV annulus area and AVC with the Agatston score were measured on CT. In total, 601 patients (mean age 80±7 years, 45% female) were included. Women had smaller AV annulus areas (4.12±0.67cm2 vs 5.15 ±0.78cm2, p<0.001) and lower Agatston scores (2018 [1456-3017] vs. 3394 [2562-4530]; p<0.001) than men. We found a significant correlation (r=0.594, p<0.001) and independent association (β=926.20, p<0.001) of AV annulus area with AVC. On separate regression analyses for men and women, AVC was independently associated with AV annulus area in both sexes (βmen=887.77; βwomen=863.48, both p<0.001). When patients were stratified into AV size quartiles, patients in the lower quartiles were more likely to have AVC values below recommended sex-specific AVC thresholds. In the lowest quartile 28% of female and 27% of male patients had Agatston scores below 1200AU (women) and 2000AU (men) while this proportion decreased to 6% and 2%, respectively, in the quartiles with the largest annulus areas.

Conclusion: In high-gradient AS, AVC strongly depends on AV annulus area. This association is not dependent on sex. Thus, AVC should be indexed to AV size in addition to sex.

Structural, architectural, contractile or electrophysiological alterations may occur in the left atrium (LA). The concept of LA cardiopathy is supported by accumulating scientific evidence demonstrating that LA remodeling has become a cornerstone diagnostic and prognostic marker. The structure and the function of LA and left atrial appendage (LAA) which is an integral part of the LA, are key elements for a better understanding of multiple clinical conditions, most notably atrial fibrillation (AF), cardioembolism, heart failure and mitral valve diseases. Rational use of various imaging modalities is key to obtain the relevant clinical information. Accordingly, this clinical consensus document from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists and cardiac imagers for the best practice of imaging LA and LAA for the diagnosis, management and prognostication of the patients.

Aims: The REDUCE-AMI trial showed that beta-blockers in patients with preserved left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI) had no effect on mortality or cardiovascular outcomes. The aim of this substudy was to evaluate whether global longitudinal strain (GLS) is a better prognostic marker than LVEF, and if beta-blockers have a beneficial effect in patients with decreased GLS.

Methods and results: REDUCE-AMI was a registry-based randomized clinical trial. Conventional echocardiographic parameters and GLS were obtained and a likelihood ratio test between models adjusted for age, sex, hypertension, smoking, diabetes, previous AMI, and multi-vessel disease was used to compare LVEF and GLS as prognostic methods. A Cox regression model evaluated the impact of beta-blocker treatment on the composite endpoint of death from any cause or new AMI.

Results: 1436 patients (28.6% of total population) were included in this substudy. Due to poor image quality or incompatible equipment, 324 (22.6%) patients were excluded from analysis of GLS. Median GLS was 17.3%. The likelihood ratio test resulted in no difference (P = 0.56) when comparing the combination of GLS to LVEF. The results were robust when adding beta-blocker randomization status as an independent variable.

Conclusions: In patients after AMI with preserved LVEF, GLS did not add prognostic value regarding death from any cause or new AMI. In addition, beta-blocker treatment did not alter the prognostic information obtained from GLS. Consequently, this study does not support an additive value of GLS compared to standard echocardiographic measurement in this patient population.

Aim: Computed tomography (CT)-derived extracellular volume fraction (ECV) is a non-invasive method to quantify myocardial fibrosis. Evaluating CT-ECV during aortic valve replacement (AVR) planning CT in severe aortic stenosis (AS) may aid prognostic stratification. This meta-analysis evaluated the prognostic significance of CT-ECV in severe AS necessitating AVR.

Methods and results: Electronic database searches of PubMed, OVID-MEDLINE, and Cochrane Library were performed. The primary outcome was to compare the occurrence of a composite of cardiovascular outcomes in patients with severe AS undergoing AVR with elevated myocardial CT-ECV values versus patients with normal values. Secondary outcomes included all-cause mortality and heart failure (HF) related hospitalization. A total of 1223 patients undergoing AVR for severe AS were included in 10 studies: 524 patients with high values of CT-ECV and 699 with normal values of CT-ECV. The pooled CT-ECV cut-off to define elevated values and predict prognosis was 30.7% (95% CI: 28.5-33.7%). At a mean follow-up of 17.9±2.3 months after AVR, patients with elevated CT-ECV experienced a significantly higher number of cardiovascular events (43.4% vs 14.0%; OR:4.3, 95% CI:3.192/5.764, p <0.001). Regarding secondary outcomes, all-cause mortality occurred in 29.3% of patients with elevated CT-ECV vs 11.6% with CT-ECV below the cut-off (OR3.5, 95% CI:2.276/5.311, p<0.001), whereas HF hospitalization was observed in 25.5% vs 5.9% (OR 4.9, 95% CI: 2.283/10.376, p<0.001). Graphical Abstract.

Conclusion: Patients undergoing AVR for severe AS with elevated CT-ECV values experience a worse post-intervention prognosis. The implementation of CT-ECV evaluation in routine AVR planning protocols should be considered.

Aims: Pulmonary regurgitation (PR) after reparative intervention for congenital heart disease has been studied extensively. However, the burden, distribution of causes, and outcome of PR in adults is unknown. The study aimed to evaluate the prevalence, types, and outcomes of moderate/severe PR in adults in the community setting.

Methods and results: A total of 398 adult residents of Olmsted County who had clinically indicated echocardiography 2004-2023 at Mayo Clinic, Rochester and had moderate or severe PR were identified retrospectively. Median age was 77 years, 48% were females, and 61 (51%) had severe PR. The age and sex-adjusted U.S. prevalence was 0.11% (vs 0.67% for ≥moderate tricuspid regurgitation). Moderate/severe PR was due to pulmonary hypertension in 77%, congenital/iatrogenic in 11%, primary pulmonary valve disease in 2% (88% due to carcinoid), and idiopathic isolated in 10%. In contrast, severe PR was due to congenital/iatrogenic disease in 52%, pulmonary hypertension in 39%, primary PR in 5% and isolated idiopathic in 3%. All-cause mortality rate per 100-person-year was 73 in primary (mostly carcinoid) PR, 16 in pulmonary hypertension-related PR (not different vs propensity matched patients without PR), and 6 in isolated idiopathic PR (not different vs matched patients without PR).

Conclusions: Moderate or severe PR had a lower prevalence vs TR. The most frequent cause was pulmonary hypertension for ≥moderate PR and congenital/iatrogenic for severe PR. Mortality in patients with acquired ≥moderate PR appeared to be related to the underlying cause, with no excess mortality compared to matched patients without PR. Whether specifically severe PR confers excess mortality requires future investigation.