European Heart Journal - Cardiovascular Imaging最新文献

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).

Aims: Accurate prediction of major adverse cardiovascular events (MACE) is crucial for risk stratification in patients with suspected coronary artery disease. CT myocardial perfusion imaging (CT-MPI) provides various parameters, which may help comprehensively characterize perfusion features. This study aimed to develop a combined model, including clinical risk factors, coronary atherosclerotic characteristics, and radiomic features derived from CT-MPI, to predict MACE.

Methods and results: 784 patients who underwent coronary CT angiography (CCTA) and CT-MPI from eight hospitals were retrospectively enrolled. Radiomic analysis was performed on eight perfusion parameter maps. Three prediction models were established accordingly: Model 1 (clinical risk factors and coronary atherosclerotic characteristics), Model 2 (incorporating myocardial blood flow values upon Model 1), and Model 3 (integrating radiomic scores upon Model 2). The C-indices for Model 3 in the training, internal validation, and external validation sets were 0.898 (95% confidence interval [CI]: 0.856-0.947), 0.844 (95% CI: 0.780-0.908), and 0.840 (95% CI: 0.791-0.889), respectively, demonstrating significant improvements over Model 1 and Model 2 (all p < 0.05). In the external validation set, Model 3 had the largest time-dependent areas under the curve (AUC) values for 1-, 3-, and 5-year MACE prediction (0.890 [95% CI: 0.831-0.948], 0.880 [95% CI: 0.823-0.938], and 0.837 [95% CI: 0.726-0.949]), compared to Model 1 and Model 2.

Conclusion: The radiomic features from multiparametric CT-MPI maps simultaneously captured perfusion features associated with MACE at both macrovascular and microvascular levels. The combined model exhibited improved MACE prognostic performance compared with conventional models while maintaining high interpretability.

Aims: Risk factor-weighted clinical likelihood (RF-CL) estimates the probability of obstructive coronary artery disease (CAD) in patients without known CAD. We examined whether adding lipoprotein(a) [Lp(a)] measurements to the RF-CL model improves predictions of obstructive CAD.

Methods and results: In a derivation cohort (N=4,262; 54% male; mean age 58 years), the prevalence of obstructive CAD at invasive angiography with fractional flow reserve was assessed by Lp(a)-strata. Based on initial results, an Lp(a)-adjusted model (RF-CLLp(a)) was developed: RF-CL was multiplied by 1.5 in patients with elevated Lp(a) (≥125 nmol/l) and otherwise unchanged. Discrimination, calibration, and reclassification were compared. Findings were validated in an external validation cohort (N=1,595; 49% male; mean age 60 years) using a comparative endpoint; significant stenosis at invasive angiography or coronary computed tomography.In the derivation cohort, 473 patients (11.1%) had obstructive CAD; in the validation cohort, 206 patients (12.9%) had significant stenosis. The relative risk in patients with elevated Lp(a) was 1.51 (95% confidence interval (CI) 1.23-1.86) and 1.19 (95% CI 0.88-1.60) in the derivation and validation cohort, respectively. In the derivation cohort, the RF-CLLp(a) model showed a higher area under the receiver operating curve than the RF-CL model (0.743 (standard error 0.011) vs 0.740 (0.013)) and better calibration in patients with elevated Lp(a). Reclassification from RF-CL to RF-CLLp(a) improved likelihood stratification in the derivation cohort but not in the validation cohort.

Conclusion: Adding elevated Lp(a) as a risk factor to the RF-CL model improves accuracy of obstructive CAD in patients with high Lp(a).

Background: Physical triggers (PT) are increasingly recognized as important determinants of outcomes in Takotsubo syndrome (TS). This multicenter study investigated the prevalence, clinical features, cardiovascular magnetic resonance (CMR) findings, and prognostic impact of PT in patients with TS.

Methods and results: In this retrospective registry, 399 TS patients (mean age 70.1 ± 11.8 years, 91% female) were included with a median follow-up of 26.7 months. A PT was identified in 30.5% of cases, an emotional trigger in 38.8%, and no trigger in 30.5%. Patients with PT showed higher C-reactive protein levels (p=0.008), lower troponin values (p=0.018), less frequent and less extensive T2-STIR abnormalities (p=0.007 and p=0.005, respectively) and LGE (p=0.002 and p=0.005, respectively), longer hospital stays (p=0.002), and more frequent in-hospital complications (p=0.001). Kaplan-Meier analysis demonstrated significantly lower event-free survival in the PT group compared with patients in the emotional or no-trigger groups (log-rank p=0.003). In multivariable Cox regression analysis, the presence of a physical trigger (p=0.037) and pre-existing neurological disease (p=0.027) were independently associated with a higher risk of all-cause mortality and post-discharge adverse events.

Conclusion: TS patients with PT represent a high-risk subgroup with worse in-hospital outcomes and increased post-discharge events. Careful identification of the trigger type may therefore help stratify risk, allowing for closer monitoring during hospitalization and more vigilant long-term management in the outpatient setting.

Aims: To assess whether baseline functional performance assessed by exercise treadmill stress testing (EST) has additive value to coronary computed tomography angiography (CCTA) for risk stratification among patients with chronic coronary disease (CCD) and moderate or severe ischemia.

Methods and results: We performed a subgroup analysis of the ISCHEMIA trial including participants who underwent EST and CCTA. EST data and severity of coronary artery disease (CAD) on CCTA were evaluated by core laboratories, blinded to clinical data and results of the other test. The primary outcome for this analysis was all-cause death. Secondary outcomes were cardiovascular death, cardiovascular death or myocardial infarction (MI), MI and a composite of cardiovascular death, MI, or hospitalization for heart failure, unstable angina, or resuscitated cardiac arrest. EST and number of vessels diseased on CCTA were both interpretable in 1864 patients (median age 62 years, IQR 55-68, 83% males). During a median follow-up of 3.1 years, 69 patients died. Higher peak metabolic equivalents (METs) achieved on the qualifying stress test was associated with lower all-cause death (HR 0.86, CI 0.76-0.98; p=0.025). The addition of peak METs to CAD severity improved the predictive ability of the all-cause death and CV death models by 10-20% and 8-13% respectively, depending on the metrics used for CCTA. Adding peak METs to CCTA anatomical models resulted in better prediction of MI by 11-17%, cardiovascular death or MI by 10-14%, and 5-component composite outcome by 12-16%.

Conclusion: Peak METs on EST, a marker of functional performance, added prognostic value to models including CCTA anatomical findings in patients with CCD and moderate or severe ischemia.