European Heart Journal - Cardiovascular Imaging最新文献

Introduction: Myocardial perfusion imaging (MPI) is widely used to assess coronary artery disease (CAD). U.S. studies have reported increasing normal MPI findings over time. However, European data are limited. This study examined temporal trends in pre-test probability (PTP) and MPI findings at a large Swiss center.

Methods: In this retrospective study 45,686 MPI scans were analyzed. Clinical data included demographics, symptoms, risk factors, MPI results and, coronary artery calcium score (CACS). Endpoints were defined as abnormal MPI (Summed Stress Score ≥4), small ischemia (Summed Difference Score ≥2), and relevant ischemia (≥10% ischemia). PTP was calculated using the 2013/2019 ESC chronic coronary syndrome (CCS) guidelines, and risk factor-weighted clinical likelihood (RF-CL) from the 2024 guidelines.

Results: Normal MPI results increased significantly over time (53% (2000) → 66% (2024), p < 0.001), irrespective of unchanged PTP/RF-CL, modality, type of stress, symptoms and risk factors. Small ischemia decreased (37.6% → 34.2%), while relevant ischemia increased (11.0% → 13.2%, p < 0.001 each) slightly. SSS and SRS decreased significantly, whereas SDS remained unchanged. CACS and the prevalence of zero CACS remained unchanged over time. ESC PTP models overestimated the prevalence of abnormal MPI and small ischemia. Only RF-CL predicted relevant ischemia correctly in very low-risk patients.

Conclusion: The rate of normal MPI results increased over time, but the trend was less pronounced than previously published. Possible explanations include referral of healthier patients (unchanged CACS despite increasing age), less typical angina, a lower prevalence of established CAD, and more female patients.

Background: The impact of particulate matter (PM) exposure on early myocardial remodeling remains incompletely understood. Cardiac magnetic resonance (CMR) mapping provides sensitive markers of diffuse myocardial fibrosis and inflammation that may reveal subclinical injury.

Methods: Patients with structurally normal hearts and no late-gadolinium-enhancement on CMR from May 2020 to November 2024 were included. Long-term exposure to PM2.5 and PM10 was derived from the nearest European-Environment-Agency monitoring stations. Associations between PM and CMR parameters were tested with multivariable linear and logistic regression adjusted for demographic, clinical, socioeconomic factors, and inflammatory markers.

Results: Two-hundred-thirty-one patients (45±21 years; 53% males; mean annual PM2.5 and PM10 exposure of 28.6±14.8 µg/m3 and 56.0±35.3 µg/m3) were included. After adjustment, exposure to PM2.5 (β = 0.034%; 95% CI 0.005-0.063; p = 0.023) and PM10 (β = 0.021 per 1 µg/m3; 95% CI 0.009-0.032; p = 0.001) were associated with higher synthetic-extracellular volume (ECV), whereas only PM2.5 was associated with higher native T1 (β = 0.317 ms per 1 µg/m3; 95% CI 0.07-0.564; p = 0.012). No associations were observed with other CMR parameters, including T2 mapping. By multivariable logistic regression, PM2.5, but not PM10, was associated with increased native T1 and synthetic-ECV. The association between PM and mapping was most pronounced in males and patients ≥50 years, and no mediation effect of inflammatory markers was found.

Conclusions: In individuals with structurally normal hearts, chronic exposure to PM2.5 and PM10 was associated with higher synthetic-ECV values, suggesting early diffuse myocardial fibrosis related to air pollution.

Aims: Recurrent-stroke and new onset atrial fibrillation (AF) are prevalent following Embolic Stroke of Undetermined Source (ESUS). Various left atrial (LA) parameters are altered in ESUS patients versus those with non-cardioembolic stroke (non-CES); these parameters may help risk-stratify ESUS patients for recurrent-stroke and new-AF. We comprehensively evaluated LA parameters in ESUS patients compared to non-CES patients. We further determined LA parameters associated with recurrent-stroke and new-AF in ESUS patients.

Methods and results: We prospectively recruited ischaemic stroke patients (ESUS (n=203), non-CES (n=256)). Comprehensive echocardiographic evaluation included LA volume, function (strain) and sphericity (circularity). ESUS patients were followed for recurrent-stroke and new-AF. LA parameters were assessed for association with outcomes.ESUS patients had increased LA volume, reduced reservoir and contractile strain, and increased circularity compared to non-CES patients (p<0.0002 for all). 36(18%) of ESUS patients developed recurrent-stroke, and 54(27%) recurrent-stroke or new-AF. Larger LA volume, reduced phasic LA strain (reservoir, contractile and conduit), and increased circularity (p<0.05 for all) were associated with both outcomes in ESUS patients. Independent and incremental value was determined for reservoir and conduit strain, and circularity, in identifying patients at risk of recurrent-stroke and new-AF.

Conclusions: LA reservoir and conduit strain, and circularity have independent and incremental association with occurrence of recurrent-stroke and new-AF in ESUS patients. This may represent measurable non-invasive markers of atrial cardiomyopathy in a subset of ESUS patients, and enable risk-stratification, and targeted intervention. Future longitudinal studies are needed to confirm these findings.