European Heart Journal - Cardiovascular Imaging最新文献

Aims: This study aims to describe the prevalence of discordant mild/moderate aortic stenosis (AS) in a population-based study and to identify the mechanisms that lead to reduced stroke volume (SV) and discordant moderate AS.

Methods and results: Discordant high-gradient (HG)-mild AS, defined as AVA > 1.5 cm2 and mean pressure gradient (MG) of 20-40 mmHg, and discordant low-gradient (LG) moderate AS, defined as AVA 1.0-1.5 cm2 and MG < 20 mmHg, were assessed in 883 individuals from the DANCAVAS screening study with aortic valve calcification and 257 individuals form the PROGRESSA study excluding those with left ventricular (LV) ejection fraction < 50%. In the DANCAVAS cohort, 150 men had mild/moderate AS of which 34% had discordance between MG and AVA, representing 66% with moderate AS. Among 262 patients in the combined cohort, 39% had discordant LG-moderate AS and 6% discordant HG-mild AS. Compared with concordant mild and moderate AS, individuals with discordant LG-moderate AS were more likely to present with LV concentric remodelling geometry (26 vs. 33 vs. 45%, P < 0.001), increased valvulo-arterial impedance (3.3 ± 0.7 vs. 3.6 ± 0.5 vs. 4.1 ± 0.7 mmHg/mL/m2, P < 0.001), and reduced systemic arterial compliance (SAC) (0.74 ± 0.22 vs. 0.81 ± 0.22 vs. 0.64 ± 0.18 mL/m2/mmHg, P < 0.001). Factors associated with SV index were relative wall thickness, LV end-diastolic diameter index, SAC, and LV remodelling pattern.

Conclusion: Discordant moderate AS is common, accounting for two-thirds of patients with moderate AS in the general male population. Patients with discordant LG-moderate AS have predominantly a concentric remodelling pattern with reduced SV. Reduced SV index was associated with signs of reduced vascular compliance, suggesting that altered vascular properties drive differences in remodelling patterns and discordant moderate AS.

Aims: Non-ischemic ring-like late gadolinium enhancement (LGE) in the left ventricle (LV) detected by cardiac magnetic resonance (CMR) is an emerging biomarker associated with adverse outcomes. Data regarding ring-like LGE are limited to small patient cohorts. We aimed to assess the prevalence of ring-like LGE, its association with morpho-functional phenotypes, aetiologic background, and prognostic implications.

Methods and results: This single-center observational retrospective study included consecutive patients undergoing LGE-CMR between 2002 and 2024. Ring-like LGE was defined as continuous enhancement in ≥3 adjacent segments. Ischemic and amyloid cardiomyopathies were excluded. Clinical records were reviewed for etiologic diagnosis and clinical outcomes. The primary endpoint was a composite of all-cause mortality, heart transplantation, or LV assist device implantation. The secondary endpoint included sustained ventricular tachycardia, appropriate implantable cardioverter-defibrillator therapies, or sudden cardiac death.Among 14,091 unique patients who underwent LGE-CMR, ring-like LGE was identified in 152 patients (1.1%) with a median number of 10 segments, mostly involving the inferolateral segments. The most frequent morpho-functional phenotypes were dilated and non-dilated LV cardiomyopathy. Genetic testing identified likely pathogenic/pathogenic variants in 59 (58.4%) patients, affecting both desmosomal and non-desmosomal genes. Inflammatory cardiomyopathy was diagnosed in 15.8%. Other rare aetiologies included genetic neuromuscular diseases and inborn errors of metabolism. Primary and secondary endpoints occurred in 17.8% and 17.1%, respectively, over a median follow-up of 3 years.

Conclusion: Ring-like LGE is an uncommon, non-disease-specific feature found in various morpho-functional CMP phenotypes. It is associated with frequent genetically determined aetiologies and a high burden of adverse outcomes.

Aims: T1 mapping reactivity (ΔT1) has been proposed as a novel contrast-free technique to detect obstructive coronary artery disease (CAD). The aims of the study are: 1) to compare the cardiovascular magnetic resonance (CMR)-derived ΔT1 with quantitative perfusion (QP CMR) measures; 2) to assess the influence of sex and comorbidities on ΔT1; and 3) to assess the diagnostic accuracy of ΔT1 to detect obstructive CAD diagnosed with the invasive coronary angiography (ICA) and/or fractional flow reserve.

Methods and results: This study retrospectively analyzed 51 patients with suspected obstructive CAD who underwent CMR including rest and adenosine stress first-pass perfusion and native T1 mapping (MOLLI). A moderate correlation was found between pooled rest and stress native T1 mapping and MBF (Pearson's r=0.476; p<0.001). When stratified by MPR, ischemic myocardium had significantly lower stress T1 mapping values (p<0.001) and ΔT1 (p=0.005) vs. nonischemic myocardium. Male sex and history of diabetes were independently associated with lower ΔT1. The optimal cut-off value of Δ T1 to detect impaired MPR on a per-vessel basis was ≤5.4%, with an AUC of 0.662 (95% CI: 0.563-0.752, p=0.003), sensitivity of 84% (95% CI: 67-95) and specificity of 46% (95% CI: 34-58). When validated against ICA, stress T1 and Δ T1 did not reach statistical significance in detecting obstructive CAD.

Conclusion: ΔT1 is significantly influenced by sex and comorbidities and has poor diagnostic accuracy for detecting myocardial ischemia. Therefore, the clinical utility of ΔT1 in a real-world cohort of patients to detect obstructive CAD is limited.