European Heart Journal - Cardiovascular Imaging最新文献

Doppler-echocardiography is the primary imaging modality for the evaluation and follow-up of valvular heart devices. This article highlights the unique pitfalls associated with these devices, including imaging challenges and flow dynamics, which often push echocardiography to its limits. The use of a multi-modality imaging approach including cardiac computed tomography (CT) and magnetic resonance, and positron emission tomography-CT is recommended to confirm the diagnosis of prosthetic valve dysfunction (PVD), quantify its severity and determine its mechanism and aetiology. Thus, the distinction between non-structural and structural PVD is important to make by assessing: (i) the morphology and mobility of the valve leaflets; (ii) the changes in valve haemodynamic parameters during echocardiographic follow-up. Algorithms are also proposed to assess the presence and severity of residual valve regurgitation and iatrogenic stenosis following mitral or tricuspid transcatheter edge-to-edge repair. This article aims to enhance the understanding of imaging challenges and to propose solutions for clinicians managing patients with valvular heart disease devices.

Aims: Mixed aortic valve disease poses unique haemodynamic challenges. This study compared the clinical outcomes of concomitant moderate aortic stenosis (AS) and moderate aortic regurgitation to isolated AS.

Methods and results: We analysed a multicentre cohort of valvular heart disease between 2008 and 2022 at three tertiary centres. The entire cohort was divided into three groups: moderate AS accompanied by moderate aortic regurgitation (moderate ASR), isolated severe AS, and isolated moderate AS. The primary outcome was a composite of cardiac death and hospitalization for heart failure. The final analysis included 4395 patients (median age: 76 years, 50.8% male), comprising 224 patients with moderate ASR, 1996 with severe AS, and 2175 with moderate AS. Over a median follow-up of 3.4 years, aortic valve replacement (AVR) rates were 11.1, 57.2, and 7.8 per 100 person-years in the moderate ASR, severe AS, and moderate AS groups, respectively (P < 0.001). Patients with moderate ASR had a significantly higher risk of the primary outcome compared with moderate AS [adjusted hazard ratio (aHR) 1.49; 95% confidence interval (CI) 1.15-1.92; P = 0.002] and a risk comparable to severe AS (aHR 1.28; 95% CI 1.00-1.64; P = 0.052). These results remained consistent even when AVR was included as a time-varying covariate. Older age, male sex, renal dysfunction, and lower left ventricular ejection fraction were independent predictors of the primary outcome in patients with moderate ASR.

Conclusion: Moderate ASR should not be considered a benign condition, as it is associated with poor clinical outcomes comparable to those of severe AS.

Aims: The GLIDE Score (septolateral gap, predominant jet location, image quality, chordal structure density, and en-face jet morphology) may predict successful tricuspid transcatheter edge-to-edge repair. This study aimed to evaluate its predictive value in transcatheter tricuspid valve annuloplasty (TTVA).

Methods and results: This study was performed on 204 consecutive patients who underwent TTVA between 2018 and 2023 at two tertiary German centres. The GLIDE Score was assessed using preprocedural transoesophageal echocardiograms.Residual tricuspid regurgitation (TR) grade ≤ I was achieved in 44.6% of cases; 83.7% had a TR reduction of ≥2 grades and 72.8% a residual TR grade ≤ II. Lower GLIDE Scores were significantly associated with higher rates of residual TR ≤ I, residual TR ≤ II (P < 0.001), and TR reduction of ≥2 grades (P = 0.001). Residual TR ≤ I was achieved in 79% of patients with a score of 0-1, compared to 19% with scores of ≥4. After adjustment for baseline TR grade, the GLIDE Score was still independently associated with procedural outcomes. In this TTVA cohort, a modified GLIDE Score, excluding chordal structure density and including anteroseptal and bicommissural annular diameters, demonstrated strong predictive performance, with an area under the curve of 0.84 [original GLIDE Score 0.79 (95% CI: 0.72-0.85)] in the main cohort and 0.76 in an external validation cohort (n = 86).

Conclusion: The GLIDE Score reliably identifies patients with a high likelihood of achieving procedural success after TTVA. Incorporating annular diameters may further improve predictive accuracy and guide treatment selection in patients undergoing transcatheter tricuspid valve repair.

Aims: Mitral annular calcification (MAC) is common in patients with severe aortic stenosis (AS); however, the impact of its severity and associated mitral valve dysfunction (MVD) on patient outcomes remains unclear. This study aims to assess the influence of MAC severity and MVD on outcomes in individuals with severe AS.

Methods and results: This retrospective study included 613 patients with severe AS. Patients were categorized by echocardiographic MAC severity and the presence of MVD, defined as a mean transmitral gradient (mTMG) ≥ 5 mmHg. In total, 309 (50.4%) of the 613 patients had MAC (44% mild, 40% moderate, and 16% severe), and 21% also displayed MVD. Patients with MAC had a lower 6-year survival (47 ± 3% vs. 64 ± 3%, log-rank P < 0.001) even after adjustment for covariates with prognostic impact {hazard ratio [HR] [95% confidence interval (CI)] = 1.24 [1.03-1.67]}. Severe MAC was associated with being older, being female, higher comorbidity scores, and high pulmonary pressures (all P < 0.05) and with a lower 6-year survival (23 ± 7%) than mild (55 ± 5%) or moderate MAC (50 ± 5%). Patients with both MAC and MVD had a 6-year survival of 28 ± 7%, markedly lower than the 53 ± 4% for those with MAC but not MVD. Multivariable analysis indicated that severe MAC [HR (95% CI) = 2.63 (.51-4.60)] and MVD [HR (95% CI) = 1.86 (1.24-2.77)] were independent predictors of death.

Conclusion: MAC is highly prevalent in patients with severe AS, affecting more than 50%. It is associated with shorter survival, particularly if MAC is severe or the patient also has MVD. These findings highlight the importance of evaluating MAC severity and mTMG in AS patients to guide clinical decisions.

Aims: In patients with ventricular functional mitral regurgitation (VFMR) undergoing transcatheter edge-to-edge repair (M-TEER), the prognostic significance of the ratio between mitral regurgitant volume and left atrial volume (LAV) remains unclear. This ratio may reflect the proportional or disproportionate burden of regurgitation on the left atrium. To address this gap, we aimed to investigate the association between the regurgitant volume (RVol)/LAV ratio and clinical outcomes in patients with VFMR, using data from a multicentre prospective registry.

Methods and results: We calculated the RVol/LAV ratio from baseline transthoracic echocardiograms. The median value of the RVol/LAV ratio was 0.40. A total of 1830 patients who underwent M-TEER were allocated into two groups: the low RVol/LAV (RVol/LAV ratio <0.40) and high RVol/LAV (RVol/LAV ratio ≥0.40) groups. The primary endpoint was heart failure hospitalization. Eight hundred eighty-eight and 942 patients were included into the low RVol/LAV ratio and high RVol/LAV ratio groups, respectively. The median follow-up period was 508 days. At 3 years after repair, 215 (37.6%) and 187 (32.1%) patients in the low RVol/LAV and high RVol/LAV groups, respectively, were hospitalized for heart failure. The patients in the low RVol/LAV group demonstrated a significantly higher risk of heart failure hospitalization than did those in the high RVol/LAV group (hazards ratio, 1.25; 95% confidence interval, 1.03-1.52; P = 0.022). Furthermore, using multivariable Cox regression analysis, the low RVol/LAV was an independent predictor of the primary endpoint.

Conclusion: The RVol/LAV ratio might serve as a valuable metric for improving risk stratification in patients with VFMR.

Clinical trials: OCEAN Mitral registry (UMIN ID: UMIN000023653).