European Heart Journal - Cardiovascular Imaging最新文献

Aims: Mean left atrial transit time (LATT) measures the mean blood transit time within the left atrium, which is closely correlated with left ventricular end diastolic pressure (LVEDP). In this prospective study, we sought to examine the relationships between prolonged LATT and biomarkers associated with elevated LVEDP and adverse outcome risk.

Methods and results: There were 563 subjects prospectively enrolled, including 15 normal controls. Mean LATT assessed by CMR using dynamic contrast profile within the LA and normalized by cardiac cycle length was used to predict LVEDP. Predicted LVEDP (pLVEDP) was highly correlated with invasive LVEDP (Pearson's correlation coefficient 0.83) in a subgroup of 46 patients. Patients (n = 548) were divided into three subgroups based on pLVEDP (≤12, 13-18, and >18 derived mmHg). Elevated pLVEDP was associated with significantly higher NT-proBNP (P < 0.001), lower LA reservoir strain (P = 0.001), and lower LV longitudinal strain (P < 0.001). After a mean follow-up of 8.1 ± 3.9 years, 99 (18%) subjects developed a composite outcome (hospitalized heart failure or all-cause death). Elevated pLVEDP was an independent risk factor for the composite outcome with an adjusted hazard ratio of 2.10 (95% confidence limits [CL] 1.30, 3.42) and 4.33 (95% CL 2.44, 7.68) for pLVEDP 13-18 and >18 derived mmHg, respectively. Patients with pLVEDP ≤12 derived mmHg had excellent event-free survival.

Conclusion: Predicted LVEDP by LATT corroborated well with invasive LVEDP and biomarkers that are linked to increased LVEDP and was associated with a significant long-term risk of adverse clinical outcomes.

Aims: The primary quantitative measure of tricuspid regurgitation (TR) severity uses the proximal isovelocity surface area (PISA) method to calculate effective regurgitant orifice area (EROA) and regurgitant volume (RegVol). However, EROAPISA has been demonstrated to underestimate TR severity due to reliance on several geometric assumptions. The aim of this study was to evaluate whether correcting for these parameters would improve this underestimation.

Methods and results: Patients with at least mild TR identified on transthoracic echocardiography were included in the study. EROAPISA and EROACORRECTED were compared with quantitative Doppler (EROADOPPLER) and 3-dimensional vena contracta area (3D-VCA). EROAPISA was corrected for flow, leaflet angle, and regurgitant orifice ellipticity (EROACORRECTED). Of 100 patients included in the study, EROAPISA (0.62 ± 0.47 cm2) was significantly lower than EROADOPPLER (1.40 ± 1.11 cm2) and 3D-VCA (1.66 ± 1.18 cm2). EROACORRECTED reduced the underestimation (1.31 ± 1.19 cm2, P = 0.73). Both EROAPISA and EROACORRECTED correlated well with EROADOPPLER (r = 0.81, r = 0.8, P < 0.001 for both) and 3D-VCA (r = 0.76, r = 0.70, P < 0.001 for both), although EROACORRECTED had higher agreement with both methods. EROACORRECTED ≥ 0.75 independently predicted morbidity and mortality on univariate (HR 1.84, CI 1.10-3.15, P = 0.02) and multivariate analysis (HR 2.00, CI 1.10-3.90, P = 0.04). EROADOPPLER and 3D-VCA ≥ 0.75 were also associated with worse outcomes on multivariate analysis.

Conclusion: Correcting PISA for flow, leaflet angle, and regurgitant orifice shape reduced its underestimation, and demonstrated high correlation and improved agreement with other quantitative methods.

Background and aims: The prognostic impact of vegetation size in infective endocarditis (IE) remains unclear. Our aim was to evaluate the relation between vegetation size and outcome.

Methods: Our data come from the Spanish IE registry between 2008 and 2024. From 6525 IE patients, 5,000 (76.6%) had vegetations, and 3,592 (55.1%) had documented vegetation size measurements. Patients were categorized into two groups based on maximum vegetation diameter: <10 mm (1,319 - 36.7%) and ≥10 mm (2,273 - 63.3%).

Results: Compared to patients with small vegetations, patients with vegetations ≥10 mm were younger (68 vs. 70 years, p<0.001), had more frequent right-sided IE (8.0% vs. 4.1%, p<0.001), less prosthetic valve IE (23.9% vs. 29.9%, p<0.001), higher surgical rates (55.9% vs. 40.1%, p<0.001), more embolic events (28.0% vs. 21.4%, p<0.001), higher in-hospital (28.3% vs. 19.6%, p<0.001) and one-year mortalities (35.6% vs. 27.5%, p<0.001). Large vegetation size was an independent predictor of in-hospital mortality (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-1.9, p<0.001), embolic events (OR 1.34, 95% CI 1.15-1.55, p<0.001), and one-year mortality (hazard ratio 1.32, 95% CI 1.17-1.50, p<0.001). Vegetation size was an independent predictor of inhospital mortality in left-sided IE (OR 1.7, 95% CI 1.4-2.1, p<0.001) but not in right-sided IE (OR 1.2, 95% CI 0.7-2.3, p = 0.50).

Conclusion: In patients with IE, large vegetation size is independently associated with embolic events and increased mortality particularly in those with left-sided IE, suggesting the need for more aggressive management in these patients.

Aims: While pre-defined reference shapes have been used to assess morphological changes in the left ventricle, standardized methods for evaluating right ventricular (RV) remodelling are lacking. This study aimed to develop and test a new 3D echocardiography (3DE)-based method for quantifying RV shape in a large cohort of healthy individuals and across various disease states.

Methods and results: 3DE-derived RV mesh models were reconstructed in 1043 healthy subjects from the World Alliance of Societies of Echocardiography (WASE) study and in 581 patients with severe aortic stenosis, heart failure with reduced ejection fraction (HFrEF), post-heart transplantation, severe primary mitral regurgitation (MR), atrial secondary tricuspid regurgitation (A-STR), tetralogy of Fallot (TOF), and pulmonary hypertension (PH). To assess global RV shape, hemi-sphericity volume ratio (HSVR) and hemi-conicity angle (HCA) were calculated, where a higher HSVR and a more acute HCA reflect more spherical and conical shapes, respectively. In the WASE population, females had more spherical RVs, whereas males had more conical RVs (P = 0.028). Considering age, younger females had more conical RVs, while older individuals in both sexes showed spherical remodelling (P < 0.05). Comparing disease groups with WASE controls, MR, HFrEF, and A-STR patients had more spherical RVs compared with controls (both P < 0.001), while PH and TOF patients showed conical remodelling (both P < 0.001). In A-STR, a more conical remodelling was associated with adverse clinical outcomes.

Conclusion: The proposed 3DE-based method comprehensively characterizes RV geometry, demonstrating demographic variation in healthy individuals and disease-specific alterations in patients, with important prognostic implications.

The co-ordinated interaction between atria and ventricles, termed atrioventricular (AV) coupling, is essential for maintaining efficient cardiac performance. The left/right atrium (LA/RA) modulates left/right ventricular (LV/RV) filling through its reservoir, conduit, and booster pump functions, while the LV/RV in turn determines atrial pressures and compliance. Disruption of this finely balanced interplay leads to impaired filling dynamics, abnormal pressure-volume relationships, and progressive remodelling. Mechanisms of uncoupling include mechanical dysfunction from atrial dilatation and fibrosis, ventricular diastolic stiffness, and loss of atrial contractile reserve, as well as electromechanical desynchrony due to conduction abnormalities such as AV block or prolonged PR interval. The concept of quantifying AV coupling has been formalized through the left/right AV coupling index (LACI/RACI), defined as the ratio of LA/RA end-diastolic volume to LV/RV end-diastolic volume. LACI/RACI can be non-invasively derived across imaging modalities-including echocardiography, computed tomography, and cardiovascular magnetic resonance-without requiring specific acquisition protocols. First described in large population cohorts, LACI has demonstrated independent and incremental prognostic value for heart failure, atrial fibrillation and mortality, outperforming isolated atrial or ventricular parameters. Moreover, its ability to capture dynamic remodelling makes it a promising biomarker for risk stratification across a broad spectrum of cardiovascular diseases. This review synthesizes current knowledge on left and right AV coupling, outlines the physiological and pathophysiological mechanisms of uncoupling, and highlights the role of LACI/RACI as both a diagnostic and prognostic tool. Standardization of assessment strategies and reference values will be essential to facilitate clinical translation and precision cardiology.

Introduction: Remodelling of the left atrium (LA) and left ventricle (LV) occurs in response to pathological and physiological stimuli, yet their inter-dependence is often overlooked in clinical practice. The left atrioventricular ratio (LA:LV)-the ratio of maximal LA end-systolic volume (LAESV) to LV end-diastolic volume (LVEDV)-may offer valuable context for distinguishing physiological from pathological cardiac remodelling.

Methods and results: This study evaluated LA:LV, assessed via echocardiography, and cardiorespiratory fitness assessed as peak oxygen uptake (VO2peak) in a multi-centre international cohort spanning the cardiorespiratory fitness spectrum. Exercise capacity in healthy participants was categorized by VO2 peak quartiles, and cardiac structural differences were analysed. Among 2943 adults (1600 healthy, 1343 pathology), healthy individuals had a median LA:LV of 0.49 [0.38, 0.61], consistent with LVEDV being roughly twice the LAESV. Pathology revealed higher LA:LV ratios [0.53 (0.38-0.75), P < 0.001], with marked elevations amongst AF [0.60 (0.45-0.78)] and HFpEF [0.70 (0.51-0.88)]-a 30% increase vs. healthy adults. The highest indexed LA volumes occurred in the highest VO₂ peak quartile [Q4: 36 (28-46) mL/m²], while the LA:LV ratio was highest in Q1 [0.53 (0.42-0.69)]. Among participants with elevated LAVi (≥34 mL/m²), concordance with elevated LA:LV ratio (≥0.75) varied markedly by fitness level: ∼60% in Q1-Q2 vs. only 7% in Q4, highlighting the importance of fitness context when interpreting LA enlargement.

Conclusion: The LA:LV ratio effectively discriminates between adaptive and maladaptive atrial remodelling. LA:LV is typically ∼0.5. Lower ratios correlate with higher functional capacity and physiological remodelling, whereas ratios ≥0.75 may indicate pathological remodelling and warrant consideration of atrial pathology.

Aims: Myocardial scarring assessed by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) predicts sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Post-processing enables characterization of scar components: borderzone (BZ), core, and BZ channels.

Methods and results: Evaluate scar composition as a predictor of VT/VF beyond traditional risk factors in HCM. We retrospectively analyzed HCM patients who underwent LGE-CMR. Scar components, alone or combined with ESC or ACC/AHA risk scores, were tested as predictors of a composite VT/VF endpoint (SCD, sustained VT, ICD therapy, or cardiac arrest). Four-hundred-ten patients (67% males, 55 years IQR: 41-65) were included, 298 of whom (72.6%) had LGE at CMR (LGE+). Total scar, BZ and core mass were 7.3% (IQR: 0.0-14.3), 6.4% (IQR: 0.0-12.2), and 0.9% (IQR: 0.0-2.1) of LV mass, respectively. BZ channels were found in 140 (34.1%) patients. At follow-up (65 months; IQR: 36-95), 26 (6.3%) patients met the endpoint. Total scar, BZ and core mass were higher in VT/VF patients (P < 0.001). BZ channels were observed in 88.5% of VT/VF patients vs. 30.5% of those without (P < 0.001). Patients with BZ channels had higher incidence of VT/VF. BZ channels mass was associated with an increased risk of VT/VF after adjustment for ESC (HR: 1.45; 95% CI: 1.26-1.67; P < 0.0001) and AHA/ACC (HR: 1.34; 95% CI: 1.16-1.54; P < 0.0001) risk estimate. The predictive performance of both ESC and AHA/ACC models was enhanced by integrating BZ channel mass (NRI: 0.19, P = 0.03 and 0.32, P < 0.001, respectively).

Conclusion: Scar composition and its organization in BZ channels provides strong, independent prognostic value for VT/VF in HCM, improving existing clinical risk stratification tools.

Aims: Quantitative stress perfusion (QP) cardiac magnetic resonance (CMR) can be performed using the dual sequence (DS) or dual bolus (DB) technique. DS does not require additional contrast and image acquisition but needs a research sequence. DB can be performed on all magnetic resonance imaging (MRI) scanners with standard perfusion sequences but requires additional contrast injection and image acquisition. Our aim was to compare the prognostic significance of DB and DS.

Methods and results: DB and DS were performed on the same patient and the same examination. Analysts were blinded to clinical outcomes. Stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) were quantified. The primary outcome was a composite of major adverse cardiovascular events (MACE) comprising acute coronary syndrome, stroke, heart failure (HF) hospitalization, late revascularization, and all-cause death. 570 patients (mean age: 63.2 ± 12.3 years; 61.2% male) were recruited. Median follow-up was 743 days; 54 events were documented. All QP CMR variables demonstrated significance in univariate Cox regression [DB stress MBF [HR = 0.53 (95%CI:0.35-0.78)], DB MPR [HR = 0.38 (95%CI:0.22-0.66)], DS stress MBF [HR = 0.27 (95%CI:0.18-0.40)] and DS MPR [HR = 0.19 (95%CI:0.13-0.29)]]. On multivariable Cox regression models, only DB MPR, DS MBF, and DS MPR remained significant for MACE (HR = 0.50 (95%CI:0.28-0.89), HR = 0.35 (95%CI:0.23-0.53); HR = 0.23 (95%CI 0.15-0.36), respectively). Harrell's C-index of DS MPR and DS stress MBF showed significantly better prognostication than their DB counterparts (P < 0.001 and P = 0.012, respectively).

Conclusion: In this blinded comparison, DS stress MBF and MPR demonstrated better prognostication than DB stress MBF and MPR. Our findings support DS as the preferred approach where available.