European Heart Journal - Cardiovascular Imaging最新文献

Cardiovascular Magnetic Resonance 2024 Conference (CMR2024) convened in London, UK, from 24 to 26 January 2024 and brought together 2705 learners and renowned cardiac imaging professionals to discuss and learn about the latest advancements. Organized by the Society for Cardiovascular Magnetic Resonance (SCMR) and the European Association of Cardiovascular Imaging (EACVI), in collaboration with the European Society of Cardiovascular Radiology (ESCR), CMR2024 was the largest international cardiac magnetic resonance conference to date. This conference underscored the collaboration between cardiologists, radiologists, scientists, and technologists by bringing together three major societies-SCMR, EACVI, and ESCR. Innovative session formats like 'Shark Tank' and 'Workflow, Innovations & Patients' facilitated expert opinion and practical experiences sharing in a 'TED-talk style'. With over 1168 abstract submissions and 75% acceptance rate, the programme featured multiple Early Career Award sessions, oral scientific sessions, oral case sessions, and rapid-fire sessions, all categorized by topic. Highlights included patient- and physician-centred imaging sessions, sharing referring physicians' and patients' insights of incremental value of cardiovascular magnetic resonance (CMR) in patient's management. The programme offered invited lectures in eight parallel tracks with three plenary and two keynote speakers. In addition, the interactive workshops and panel discussions provided a platform for knowledge exchange, support, and collaboration. A great emphasis was placed on collaboration between radiologists, cardiologists, scientists, and technologists, showcasing an ideal cardiac imaging marriage as a model for enhanced patient care around the globe. The event also featured exhibitions of the latest CMR technology and software, offering attendees a glimpse into the future cardiac imaging. CMR2024 emerged as a remarkable scientific, educational, and networking event, inspiring attendees to learn and collaborate within the global CMR community.

Aims: This study aimed to evaluate the association between cardiac MRI (CMR) multiparameters and significant acute cardiac allograft rejection (SR), and assess the incremental value of CMR multiparameters over conventional serum examinations for identifying SR.

Methods and results: Heart transplantation (HTx) recipients with endomyocardial biopsy and healthy controls were prospectively recruited for CMR assessment. CMR feature tracking (CMR-FT) was performed to evaluate the left ventricular (LV) global strain in all three directions. The last serum examinations including N-terminal pro brain natriuretic peptide (NT-proBNP) before anti-rejection therapy were recorded. Participants were divided into 3 groups: control, SR (acute cellular rejection grade≥2R and/or antibody-mediated rejection [AMR] grade≥pAMR1), and NSR (non-SR). Finally, thirty controls (43.3±13.6 years, 26 male) and 51 HTx recipients comprising 23 SRs (48.6±12.6 years, 24 male) and 28 NSRs (42.7±14.9 years, 16 male) were enrolled for analysis. Compared with NSRs, SRs showed elevated NT-proBNP (7797.0±7527.6pg/ml vs 3334.6±5935.3pg/ml, p<.001), worse LV global longitudinal strain (GLS) (-9.7±3.1% vs -13.1±2.9%, p<.001), and increased native T1 (1384±80.1ms vs 1321±69.9ms, p<.001) and T2 values (50.9±2.7ms vs 45.7±4.3ms, p<.001). In multivariable analysis, LVGLS (OR=0.76, 95%CI, 0.59 to 0.98, p=.03) and T2 value (OR=1.35, 95%CI, 1.10 to 1.65, p=.01) were independently associated with SR after NT-proBNP adjustment. Furthermore, the likelihood ratio test showed LVGLS (p=.002) and T2 value (p<.001) had incremental value over NT-proBNP for identifying SR.

Conclusion: LV GLS and T2 value were independently associated with SR, providing incremental value for non-invasive identification of significant rejection in HTx recipients.

Aims: The impact of sex on adverse left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) is unclear due to conflicting results. This study sought to establish sex-based differences in adverse LVR using Cardiovascular Magnetic Resonance (CMR) among STEMI patients and their impact on clinical outcomes.

Methods and results: The study included patients with a first STEMI who underwent primary percutaneous coronary intervention (PCI). CMR was performed at 6 days (Interquartile range [IQR]: 4-9 days) and after 6 months (6.42 months; IQR: 5.98-7.47 months). Follow-up was 6.94 years (IQR: 4.48-9.32 years).The primary endpoint was the presence of adverse LVR (>15% of LV end-diastolic volume and a decrease of >3% in LV ejection fraction) at 6 months. The secondary endpoint was major adverse cardiac events (MACE), defined as a combined variable: cardiovascular death, heart failure admission, or ventricular arrhythmias.One thousand sixty-seven patients were included (17.5% women; mean age: 58.71±11.85 years). Women were older and had more cardiovascular risk factors (CVRF). There was no association between sex and adverse LVR (OR 0.80; 95%CI 0.39-1.64, P=0.536). MACE occurred in 177 patients (16.7%) and was more frequent in women (22.6% vs. 15.4%, P=0.017). However, after adjusting for baseline differences and CVRF, the female sex was not associated with MACE (HR: 1.21 95% CI, 0.81-1.81, P=0.343).

Conclusions: The higher rate of MACE after STEMI in women compared to men appears to be associated with a higher prevalence of CVRF and comorbidities rather than a more significant occurrence of adverse LVR.

Background: Cardiac allograft vasculopathy (CAV) affects both epicardial and microvascular coronary arteries, however few studies have characterized microvascular dysfunction in this population. Several prior studies have shown positron emission tomography/computed tomography (PET/CT) can be used to screen for epicardial CAV, however the clinical implications of abnormal blood flow in the absence of epicardial CAV is unknown.

Objective: Our study sought to assess the prognostic implications of microvascular dysfunction and its sub-types, endogen/functional and classical/structural, using PET/CT in cardiac transplant patients without epicardial CAV.

Methods: Transplant patients with no prior history of CAV and normal myocardial perfusion imaging were included. Patients were then classified by the presence of microvascular dysfunction (CMD) (MFR <2.0); patients with CMD were further subcategorized into endogen/functional (stress myocardial blood flow ≥1.7 mL/min/g) and classical/structural (stress myocardial blood flow <1.7 mL/min/g). The primary outcomes were all-cause mortality and a composite of all-cause mortality, heart failure hospitalization, acute coronary syndrome, revascularization, and re-transplantation.

Results: 356 patients met the inclusion criteria. CMD was present in 141 (39.6%) patients, of which 112 (31.4%) had endogen/functional CMD and 29 (8.1%) had classical/structural CMD. After multivariable adjustment, endogen/functional CMD was associated with a higher rate of the composite outcome (HR 2.39, 95%CI 1.32-4.29, p = 0.004) and all-cause mortality (HR 2.98, 95%CI 1.34-6.64, p = 0.008). Classical/structural CMD was not associated with the primary composite outcome (HR 0.92, 95%CI 0.27-3.17, p = 0.893) or all-cause mortality (HR 1.22, 95%CI 0.263-5.69, p = 0.797).

Conclusions: In cardiac transplant patients with no history of CAV and normal myocardial perfusion, an endogen/functional pattern of CMD is associated with higher rate of adverse events and death. This association was not present in patients with a classical/structural CMD pattern. Incorporating endogen/microvascular dysfunction assessment in PET/CT reporting may identify a higher risk group hereto now considered low risk.

Aims: Models predicting the likelihood of obstructive coronary artery disease (CAD) on invasive coronary angiography (ICA) exist. However, as stable patients with new-onset chest pain frequently have lower clinical likelihood and preferably undergo index testing by noninvasive tests such as coronary computed tomography angiography (CCTA), clinical likelihood models calibrated against observed obstructive CAD at CCTA are warranted. The aim was to develop CCTA-calibrated risk-factor- and coronary artery calcium-score-weighted clinical likelihood models (i.e., RF-CLCCTA and CACS-CLCCTA models, respectively).

Methods and results: Based on age, sex, symptoms and cardiovascular risk factors, an advanced machine learning algorithm utilized a training cohort (n=38,269) of symptomatic outpatients with suspected obstructive CAD to develop both a RF-CLCCTA and a CACS-CLCCTA model to predict observed obstructive CAD on CCTA. The models were validated in several cohorts (n=28,340) and compared to a currently endorsed basic pre-test probability (Basic PTP) model. For both the training and pooled validation cohort, observed obstructive CAD at CCTA was defined as >50% diameter stenosis.Observed obstructive CAD at CCTA was present in 6,443 (22.7%) patients in the pooled validation cohort. While the Basic PTP underestimated the prevalence of observed obstructive CAD at CCTA, the RF-CLCCTA and CACS-CLCCTA models showed superior calibration. Compared to the Basic PTP model, the RF-CLCCTA and CACS-CLCCTA models showed superior discrimination (area under the receiver-operating curves 0.71 (95% confidence interval (CI) 0.70-0.72) vs. 0.74 (95%CI0.73-0.75) and 0.87 (95%CI 0.86-0.87), p<0.001 for both comparisons).

Conclusions: CCTA-calibrated clinical likelihood models improve calibration and discrimination of observed obstructive CAD at CCTA.

Clinicaltrials.gov identifier: N/A.