European Heart Journal - Cardiovascular Imaging最新文献

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.

Aims: Inorganic pyrophosphate (PPi) is an endogenous inhibitor of soft tissue calcification. A disturbed equilibrium between pro- and anti-mineralization agents, like extracellular phosphate (Pi) and PPi, has been implicated in the mechanism of aortic valve calcification (AVC). We aimed to investigate the association of the plasma PPi concentration and Pi/PPi ratio with the degree AVC in cardiovascular patients.

Methods and results: One hundred and fifty-four patients referred for cardiac computed tomography (CT), including 43 individuals with severe aortic stenosis, were prospectively enrolled. The aortic valve calcium score (AVCS) was measured on non-contrast CT images. Plasma PPi level was determined enzymatically. Of the entire population (age: 67 ± 12 years, 42.5% female), 42% had some degree of AVC (range 9-6641 AU). Plasma PPi showed a significant positive association with plasma Pi and LDL cholesterol (LDL-C) concentration and was inversely related to alkaline phosphatase activity. When controlled for age, female patients had higher PPi levels. In univariate analysis, plasma PPi level did not show an association with AVCS; however, the Pi/PPi ratio was significantly positively associated with the degree of AVC [estimate: 1508.1; standard error (SE) 616.0, P = 0.015], along with age, hypertension, plasma lipoprotein(a) concentration, and statin treatment, whereas estimated glomerular filtration rate and LDL-C level showed significant negative associations. In multivariate analysis, only age and Pi/PPi ratio remained significant determinant of the AVCS (estimate: 1128.6; SE 562.5, P = 0.047).

Conclusion: This is the first study to investigate the association between PPi homeostasis and AVC in humans. The plasma Pi/PPi ratio was significantly positively associated with the AVC load even after adjustment for traditional risk factors.

Aims: In advanced chronic aortic regurgitation (AR), left ventricular (LV) volume/pressure overload leads to LV hypertrophy and heart failure. Echocardiography often reveals gradual and continuous enlargement of the LV throughout diastole as AR adds to LV inflow. The severity, cardiac overload, and timing of therapeutic interventions in AR patients remain controversial. Here, we investigated mid-diastolic LV strain rate (SRmin) as a measure of LV load due to AR, its relationship to conventional AR measures, and its impact on surgical intervention.

Methods and results: This single-centre retrospective study included 248 patients (mean age, 73 years; 44% females) with chronic AR and LV ejection fraction (LVEF) > 50%, of whom 17% had moderate and 9% severe AR. SRmin values, obtained from a mean frame rate of 67 Hz (61-71), correlated with conventional indices such as vena contracta width (r = 0.40, P < 0.001) and regurgitant volume (r = 0.59, P < 0.001) and increased with AR severity. Using an SRmin cutoff of 0.085 (1/s) for severe AR, sensitivity and specificity were 87% (area under the curve, 0.943). The intraclass correlation coefficient for intra- and inter-observer reproducibility was both 0.97, and Bland-Altman analysis revealed a mean (standard deviation) bias of 0.004 (0.027) and 0.002 (0.026) (1/s), respectively. In 63 patients with moderate or severe AR, time to surgery was shorter in the SRmin ≥ 0.085 group [335.5 days (47.0-1234.0), P = 0.034] than that in the SRmin < 0.085 group (602.0 days [82.3-1038.5]).

Conclusion: SRmin, which reflects LV load by AR, can assess AR severity and indicate the timing of therapeutic intervention in patients with preserved LVEF.