European Heart Journal - Cardiovascular Imaging最新文献

Background: The prevalence, characteristics, and prognosis of atrial functional mitral regurgitation (AFMR) based on severity remain unclear. No studies have systematically evaluated quantitative thresholds, such as effective regurgitant orifice area (EROA) or regurgitant volume, in relation to outcomes in AFMR. This multicenter study aimed to clarify the clinical implications of both qualitative and quantitative assessments of AFMR severity.

Methods: In this first multicenter study across 26 centers, patients with at least moderate AFMR-defined by preserved left ventricular (LV) function, enlarged left atrium (LA), and absence of primary mitral valve changes-were retrospectively analyzed. AFMR severity was evaluated using a comprehensive approach, including EROA, regurgitant volume, and regurgitant fraction.

Results: Among 1,007 patients, 728 (72.3%) had moderate, 146 (14.5%) moderate-to-severe, and 133 (13.2%) severe AFMR. Age, sex, natriuretic peptide levels, and LV ejection fraction were similar across all groups. Patients with severe AFMR had longer atrial fibrillation history, worse heart failure symptoms, larger LV and LA, and more severe tricuspid regurgitation. AFMR severity was independently associated with a higher risk of death, heart failure hospitalization, and mitral valve intervention (HR 1.51, p=0.001 for moderate-to-severe, 2.80, p<0.001 for severe). Quantitative thresholds showed a significantly higher event risk with EROA ≥0.30, regurgitant volume ≥60 mL, and regurgitant fraction ≥50%.

Conclusions: Severe AFMR was common and linked to greater atrial fibrillation burden, cardiac structural issues, and an increased risk of adverse clinical events. Quantitative thresholds offer valuable guidance for clinical decision-making and treatment planning.

Aims: Complete non-culprit (NC) revascularization may help reduce recurrent events after NSTEMI, especially if NC lesions would harbor high-risk plaque features similar to STEMI. The study aimed to assess differences in fractional flow reserve (FFR)-negative NC plaque morphology in patients presenting with NSTEMI versus STEMI and assess the association of high-risk plaque morphology and clinical outcome.

Methods and results: In the prospective PECTUS-obs study, 438 patients presenting with myocardial infarction (MI) underwent optical coherence tomography (OCT) of all FFR-negative intermediate NC lesions. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE, all-cause mortality, non-fatal MI or unplanned revascularization) at two-year follow-up. Four hundred and twenty patients had at least one analyzable OCT, including 203 (48.3%) with NSTEMI and 217 (51.7%) with STEMI. The prevalence of high-risk plaques (HRP), including thin-cap fibroatheromas (TCFA), plaque rupture and thrombus, was comparable between groups. MACE occurred in 29 (14.3%) NSTEMI patients and 16 (7.4%) STEMI patients (Punivariable=0.025 and Pmultivariable=0.270). Incidence of MACE was numerically higher among patients with HRP, irrespective of the clinical presentation at index (Pinteraction=0.684). Among high-risk plaque criteria, plaque rupture was associated with MACE in both NSTEMI (p<0.001) and STEMI (p=0.020).

Conclusion: Presence of NC HRP is comparable between NSTEMI and STEMI and leads to numerically higher event rates in both. These results call for additional research on complete revascularization in NSTEMI and treatment of HRP.

Background: Both left ventricular (LV) mechanical dyssynchrony and filling pressure have been shown to be associated with outcome in heart failure patient treated with cardiac resynchronization therapy (CRT).

Objectives: To investigate the mechanistic link between mechanical dyssynchrony and filling pressure and to assess their combined prognostic value in CRT candidates.

Methods: Left atrial pressure (LAP) estimation and quantification of mechanical dyssynchrony were retrospectively performed in 219 CRT patients using echocardiography. LAP was elevated (eLAP) in 49% of the population, normal (nLAP) in 40%, and indeterminate (iLAP) in 11%. CRT response was defined as %-decrease in LV end-systolic volume after 12±6 months CRT. Clinical endpoint was all-cause mortality during 4.8 years (interquartile range: 2.7-6.0 years). To investigate the mechanistic link between mechanical dyssynchrony and filling pressure, the CircAdapt computer model was used to simulate cardiac mechanics and hemodynamics in virtual hearts with LBBB and various causes of increased filling pressure.

Results: Patients with nLAP had more significant mechanical dyssynchrony than those with eLAP. The combined assessment of both parameters before CRT was significantly associated with reverse LV remodeling and post-CRT survival. Simulations revealed that mechanical dyssynchrony is attenuated by increased LV operational chamber stiffness, regardless of whether it is caused by passive or active factors, explaining the link between mechanical dyssynchrony and filling pressure.

Conclusion: Our combined clinical-computational data demonstrate that in patients with LBBB, the presence of mechanical dyssynchrony indicates relatively normal LV compliance and low filling pressure, which may explain their strong association with positive outcomes after CRT.

Background: Pulmonary vascular resistance (PVR) intimately correlates with right ventricular afterload and the development of secondary tricuspid regurgitation (sTR).

Objectives: We sought to investigate the prognostic roles of PVR derived by echocardiography in patients with sTR undergoing tricuspid annuloplasty (TA).

Methods: Data from 322 TA patients [median age (interquartile range): 65.0 (59.0-70.0) years; 35.7% males] were obtained from a prospective registry to determine the impact of PVR on the composite outcome (including all-cause mortality and heart failure hospitalization). PVR was calculated by dividing the peak TR velocity by time-velocity integral of the right ventricular outflow tract followed by adding 0.16.

Results: During a median follow-up of 5.2 years, 108 adverse events occurred including 48 deaths and 60 heart failure readmissions. Baseline PVR ≥2 WU was independently associated with a higher risk of composite outcome (HR:1.674, 95% CI: 1.028-2.726, P=0.038). Baseline PVR outperforms both pulmonary artery systolic pressure (PASP) and the ratio of tricuspid annulus plane systolic excursion to PASP in terms of outcome prediction, with pronounced improvement of global model fit, reclassification, and discrimination. In 150 patients who received short-term echocardiograms after surgery, the presence of postoperative PVR ≥2 WU (n=20, 13.3%) was independently associated with composite outcome (HR: 2.621, 95% CI: 1.292-5.319, P=0.008).

Conclusion: PVR derived by echocardiography is an independent determinant of outcomes in patients undergoing TA for sTR. The inclusion of noninvasive PVR may provide valuable information to improve patient selection and postoperative management in this population.

Aims: Patients with moderate aortic stenosis (AS) show a poor prognosis if they have high-risk features. We investigated the incremental prognostic value of left ventricular (LV) and left atrial (LA) strain in patients with moderate AS.

Methods and results: In a cohort of 923 patients with moderate AS (median age 74 years, men 55%, aortic valve area 1.18 [IQR 1.08-1.30] cm2, mean pressure gradient 25 [IQR 23-30] mmHg), LV global longitudinal strain (LV-GLS) and LA reservoir strain (LARS), were measured using speckle-tracking echocardiography. Absolute values of myocardial strain were used. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization.During a median of 5.9 years, the primary endpoint occurred in 186 patients (20.2%). The median LV-GLS and LARS were 17.7% (IQR 14.8-19.7) and 24.5% (IQR 18.7-29.3). LV-GLS (adjusted HR 0.92, 95% CI 0.87-0.97) and LARS (adjusted HR 0.97, 95% CI 0.95-0.99) were significant predictors of the primary outcome, independent of clinical and echocardiographic variables including LV ejection fraction. Notably, the prognostic value of LV-GLS was stronger than that of LARS, remaining significant after further adjustment for LARS. LV-GLS<17% and LARS<22% were identified as optimal cutoffs for the primary outcome. Patients with both reduced LV-GLS and LARS had the worst outcome (log-rank p<0.001). LV-GLS<17% and LARS<22% had incremental prognostic value on top of other clinical and echocardiographic variables.

Conclusion: In moderate AS, reduced LV-GLS and LARS have incremental prognostic value, and can refine risk stratification to identify high-risk patients.