European Heart Journal - Cardiovascular Imaging最新文献

Aims: The study aimed to investigate the importance of infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) on the 10-year outcome in patients with ST-segment elevation myocardial infarction (STEMI).

Methods and results: Patients with STEMI had cardiac magnetic resonance (CMR) performed during admission and after three months to assess acute and three-month IS, MSI, left ventricular ejection fraction (LVEF), MVO and transmurality. Adjusted Cox regression models were used to investigate the association between CMR endpoints and all-cause mortality or hospitalization for heart failure 10 years after STEMI. A total of 811 patients had either acute or follow-up CMR performed. During median follow-up of 10.9 years, 173 (21%) patients died or were hospitalized for heart failure. Acute IS (adjusted hazard ratio (HR): 1.02; 95%-confidence interval (CI): 1.01-1.04; p=0.005), three-month IS (adjusted HR: 1.04; 95%-CI: 1.02-1.06; p<0.001), acute MSI (adjusted HR: 0.99; 95%-CI: 0.98-1.00; p=0.007), three-month MSI (adjusted HR: 0.99; 95%-CI: 0.98-1.00; p=0.004), acute LVEF (adjusted HR: 0.97; 95%-CI: 0.95-0.99; p=0.001), three-month LVEF (adjusted HR: 0.95; 95%-CI: 0.93-0.97; p<0.001), acute transmurality (adjusted HR: 1.01; 95%-CI: 1.00-1.02; p=0.024), and three-month transmurality (adjusted HR: 1.01; 95%-CI: 1.00-1.02; p=0.003) were all significant predictors of the composite outcome. MVO was not associated with the composite outcome (adjusted HR: 1.04; 95%-CI: 0.98-1.09; p=0.20).

Conclusion: Smaller IS, smaller transmurality, higher MSI, and higher LVEF measured acutely and three months after STEMI were independently associated with lower all-cause mortality and/or hospitalization for heart failure within 10 years after STEMI, whereas MVO was not.Clinical trial registration: Registered with ClinicalTrials.gov (identifiers: NCT01435408 and NCT01960933).

Aims: Myocardial fibrosis plays a crucial role in the pathophysiology of heart failure, increases myocardial stiffness, impairs diastolic function and is associated with adverse outcomes. Shear wave elastography (SWE) uses high frame rate echocardiography to assess shear waves in the myocardium. This technique may permit assessment of myocardial stiffness by measuring the propagation speed of myocardial shear waves. We aimed to validate the ability of SWE to assess the degree of myocardial fibrosis in patients with end-stage heart failure.

Methods and results: We performed high frame rate echocardiography in 16 heart failure patients who were listed for heart transplantation and 16 age- and sex-matched healthy control subjects. Naturally occurring shear waves triggered by mitral valve closure (MVC) and aortic valve closure (AVC) were analyzed by tissue Doppler imaging in the interventricular septum. Septal shear wave velocities were compared to septal collagen volume fraction (CVF) in explanted hearts.Mean septal CVF in cardiac explants was 17.1±7.6%. AVC and MVC wave velocities were associated with septal CVF (Spearman's correlation of mean septal values: ρ=0.75, p=0.02 and ρ=0.65, p=0.03, respectively). Similar results were observed in linear mixed-effects regression analysis by septal region (AVC wave: β=2.2, 95% CI [0.7, 3.8], p=0.004; MVC wave: β=1.5, 95% CI [0.4, 2.5], p=0.005). Shear waves could be measured in most patients but were limited by patient factors such as prosthetic valves and left ventricular assist devices.

Conclusion: Shear wave velocities from SWE correlate with CVF. SWE therefore hold promise as a novel non-invasive method for assessing myocardial fibrosis.

Aims: The prognostic value of late gadolinium enhancement (LGE) phenotypes-particularly subendocardial involvement-for sudden cardiac death (SCD) remains unclear in dilated cardiomyopathy (DCM). Whether LGE phenotype integrating pattern and location can improve SCD risk stratification is an unmet need.

Methods and results: DCM patients who underwent cardiac MRI were retrospectively enrolled. The endpoint was a composite of SCD and surrogate SCD events. Among 902 patients (mean age 46±14 years, 78.7% men), subendocardium-involved and mid-wall LGE were observed in 129 (14.3%) and 263 (29.1%) patients, predominantly involving the lateral (65.1%) and septal wall (97.7%), respectively. During a median follow-up of 77 months (IQR 40-92 months), 51 (5.7%) patients experienced SCD events. Multivariable analysis identified septal midwall LGE (HR 3.59; 95% CI 1.73-7.47; P = .001) and lateral subendocardium-involved LGE (HR 3.07; 95% CI 1.39-6.75; P = .005) as independent predictors. A three-tier risk stratification model was developed, classifying patients into: lowest risk (neither septal midwall nor lateral subendocardium-involved LGE; reference), intermediate risk (either phenotype alone; HR 4.8, 95% CI 2.2-10.46, P < .001), and highest risk (both phenotypes; HR 10.71, 95% CI 3.53-32.46, P < .001). The model showed the best improvement in model discrimination and reclassification over left ventricular ejection fraction (C-statistic improvement: 0.23; net reclassification improvement = 0.67; integrative discrimination index = 0.27; all P < .05).

Conclusions: SCD was predicted by both lateral subendocardium-involved LGE and septal midwall LGE in DCM. The novel SCD risk model integrating these phenotypes demonstrated superior prognostic performance compared to conventional prognosticators.

This document has been developed as a comprehensive roadmap to the organization of paediatric and congenital echocardiography laboratories, as well as the governance of echocardiography services and training across Europe. The following key topics will be reviewed and discussed: i) the setup and organization of paediatric and congenital echocardiography laboratories; ii) staffing requirements for these laboratories; iii) work time organization; and iv) quality improvement processes. This document aims to identify the minimum number of medical and allied health professional staff required for each laboratory based on specific workload demands, whilst also detailing the basic medical accreditation requirements needed. Principles of work time organisation will be addressed, including the time allocation needed for various types of echocardiographic examinations (e.g., first-time or complex examinations, follow-up, and quick assessments). The necessary time and space for reporting, communicating results (e.g., discussions with parents, liaising with other departments), and overall workflow will also be analysed. Additionally, quality improvement processes will be discussed, with a focus on strategies and minimum requirements for enhancing training and teaching. Approaches to encourage and support research initiatives within paediatric and congenital echocardiography laboratories will also be outlined.

Background: Cardiovascular magnetic resonance (CMR) offers comprehensive assessment of cardiomyopathy but lacks validated methods for estimating left ventricular filling pressure (LVFP), an important prognostic marker. Invasive pulmonary capillary wedge pressure (PCWP) measurements remain a gold standard but are impractical for routine use due to procedural risks. A CMR-modelled PCWP model offers a non-invasive alternative, but its ability to improve prognostic assessment beyond conventional markers has not been well established. We evaluated the prognostic utility of CMR PCWP in patients with non-ischemic cardiomyopathy (NICM).

Methods: NICM patients who underwent CMR between December 2008 and December 2017 were retrospectively included. CMR-modelled PCWP was calculated as: 6.1352 + (0.07204 × left atrial volume [LAV]) + (0.02256 × left ventricular mass [LVM]). The primary outcome was a composite of all-cause mortality, heart transplantation, or hospitalization for heart failure (HHF). Secondary outcomes included HHF and all-cause mortality separately. Multivariable Cox proportional hazards models assessed prognostic value.

Results: A total of 458 patients (mean age 53.2 years, BMI 29.3 kg/m², LVEF 32.8% ± 11.1%) were followed for a median of 3.6 years. The primary outcome occurred in 39% with PCWP ≥ 15 mmHg versus 21% with PCWP < 15 mmHg (HR 2.11, 95% CI 1.48-3.01; P-valute < 0.001).

Conclusion: CMR-modelled PCWP provides independent prognostic value providing further risk differentiation among patients traditionally classified as low-risk.

Aims: Echo-derived left atrial (LA) stiffness index improves prognostication in patients with heart failure preserved ejection fraction but has not been studied in adults with repaired coarctation of aorta (COA). We hypothesized that, among adults with COA, those with high LA stiffness index would have worse disease severity indices [peak VO2, NT-proBNP, and right ventricular to pulmonary artery (RV-PA) coupling], heart failure hospitalization, and all-cause mortality.

Methods and results: LA stiffness index was estimated using the baseline echocardiogram as the quotient of septal E/e' and LA reservoir strain (E/e'/LARS). Using the median septal LA stiffness index as the cut-off, patients were divided into high LA stiffness index (LA stiffness index >0.28) vs. low LA stiffness index groups (LA suggests index ≤0.28). The study comprised of 729 patients [age 36 ± 16 years; males 437 (60%)]. LA stiffness index correlated with RV-PA coupling (r = -0.56, P < 0.001), NT-proBNP (r = 0.62, P < 0.001), and predicted peak VO2 (r = -0.51, P < 0.001). High LA stiffness index was associated with heart failure hospitalization (adjusted HR 3.17, 95% confidence interval (CI) 1.84-7.36, P = 0.007) and all-cause mortality (adjusted HR 2.81, 95% CI 1.28-12.32, P = 0.005). LA stiffness index had superior prognostic performance for predicting 5-year risk of heart failure hospitalization (AUC 0.803, 95% CI 0.756-0.849, P < 0.001) and all-cause mortality (AUC 0.786, 95% CI 0.742-08.30, P < 0.001) compared with conventional echocardiographic indices of left heart diastolic function.

Conclusion: LA stiffness index improves prognostication in adults with COA and can potentially be used to guide timing of intervention or monitor response to therapy.