European Heart Journal - Cardiovascular Imaging最新文献

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.

Background and aims: Although the advantages of intra-coronary imaging guidance in percutaneous coronary intervention (PCI) have been reported, the advantage of optical coherence tomography (OCT) guided PCI has not been elucidated in patients with ST-elevation myocardial infarction (STEMI). This study assessed the association between OCT findings after stent implantation and 1-year outcomes in an all-comer STEMI population.

Methods: The ATLAS-OCT trial was a prospective, multicentre, single-arm study enrolling STEMI patients within 24 h of symptom onset. OCT-guided PCI was preferred when feasible. This analysis included patients with analysable post-PCI OCT images. The primary endpoint was target vessel failure (TVF; all-cause death, target vessel myocardial infarction [TVMI], or target vessel revascularisation [TVR]). OCT images were analysed independently, and outcomes assessed at 12 months.

Results: Of 632 patients, 439 (69.5%) underwent OCT-guided stenting with final analysable imaging. Mean minimal stent area (MSA) and stent expansion (SE) were 6.21 ± 2.27 mm² and 76.8 ± 15.6%, respectively. Optimisation criteria (MSA > 4.5 mm² and/or SE > 70%) were met in 87.7%. Suboptimal expansion was associated with higher TVF (20.4% vs. 8.1%; HR 2.57, 95% CI: 1.29-5.11), driven by TVMI and TVR. Each 1 mm² MSA decrease and 10% SE reduction increased TVF odds by 23% and 33%, respectively. Minor OCT findings were not significantly associated with outcomes.

Conclusion: In STEMI, suboptimal MSA and SE determined by OCT were associated with higher adverse event risk. These findings support OCT-guided PCI optimisation to improve outcomes and warrant further evaluation in randomised trials.

Study registration: University Hospital Medical Information Network Clinical Trials Registry of Japan (UMIN-CTR number: 000048590).

Aims: Transthoracic (TTE) and transoesophageal echocardiography (TEE) are fundamental tools in diagnosing infective endocarditis (IE). Although IE remains rare, ultrasound (US) requests are increasing. No long-term data exist regarding the appropriateness of US prescriptions for IE following the 2017 Appropriate Use Criteria (AUC) for Multimodality Imaging in Valvular Heart Disease.

Methods and results: US requests for suspected IE from September 2013 to June 2024 were reviewed. Patient records were retrieved electronically. Appropriateness was assessed using the 2017 AUC, the 2015 ESC Guidelines for IE management, and the 2013 Guidelines for TEE performance. Over 11 years, 2461 US requests, each referring to a unique hospitalized patient, were analysed. Most patients were males (60.5%), mean age 64 ± 17 years. Positive blood cultures were found in 41.8%, and IE was diagnosed in 10.6%, with a mortality rate of 7.6%. Overall, 1559 (63.4%) US requests were deemed inappropriate, with no significant change after guideline publication (P = 0.078). Specifically, 1402 (64.8%) TTE and 157 (52.7%) initial TEE requests were inappropriate. When TEE was used as a supplemental test, 138 (61.9%) were technically appropriate and 122 (54.7%) clinically appropriate. Cardiologists submitted more appropriate requests (65.8%) than non-cardiologists. Among appropriate requests, IE was confirmed in 15.3% of cases.

Conclusion: Most US requests for suspected IE were inappropriate, particularly those made by non-cardiologists, highlighting the need for improved adherence to imaging guidelines, with potential benefits for patient care and resource management.

Aims: Aortic valve calcium (AVC) is strongly associated with the risk for severe aortic stenosis (AS). The prevalence of AVC increases with age, but the impact of age on the progression of AVC and its association with moderate-severe AS is unknown.

Methods and results: Our study included 6810 participants (52.9% women) without overt cardiovascular disease between ages 45 and 84 from the Multi-Ethnic Study of Atherosclerosis. AVC was measured using non-contrast cardiac CT at Visit 1. Progression was calculated as the change in AVC divided by years between CT scans (2-10 years). Incident moderate-severe AS was adjudicated using medical chart review and echocardiogram data from Visit 6 (median follow-up of 16 years). The association between AVC and moderate-severe AS was assessed using multivariable adjusted Cox proportional hazards ratios. There were 5899 participants with AVC = 0 and 911 with AVC >0. There were 3834 participants age <65 years and 2979 age ≥65 years. The median AVC was 34.1 AU (IQR 13-1113) for participants <65 vs. 69.0 AU (IQR 23-2453) for participants ≥65. Participants <65 and ≥65 years had no significant difference in median annualized AVC progression within the baseline AVC categories of 1-99 (10 vs. 12 AU/year, P = 0.303) and AVC ≥100 (50 vs. 47 AU/year, P = 0.846). AVC >0 was associated with a similar significantly higher risk of incident moderate-severe AS for both younger (HR 13.37; 95% CI 5.67-31.52) and older participants (HR 10.59, 95% CI 6.77-16.56).

Conclusion: AVC progression was significantly associated with baseline AVC burden and was similar for younger vs. older persons after accounting for baseline AVC. The presence of AVC was significantly associated with a higher long-term risk for moderate-severe AS among both younger and older participants.