European Heart Journal - Cardiovascular Imaging最新文献

Aims: Quantitative methods for tricuspid regurgitation (TR) severity assessment are insufficiently validated. This study aims to assess cardiac magnetic resonance (CMR) quantitation of TR severity and its association with clinical and physiological consequences.

Methods and results: Patients with prospective comprehensive CMR with TR assessment including regurgitant volume and fraction (TRF) were retrospectively identified. Comprehensive clinical, echocardiographic, and laboratory data were collected to assess other markers of TR severity and of TR-related heart-failure (HF), right-sided volumetric characteristics, and prognostic markers. A total of 335 patients were included presenting with a wide range of TR severity [median TRF 21% (13-33%)]. The number of guideline-based echocardiographic signs of severe TR was strongly associated with TRF (P < 0.001). TRF was significantly associated with subjective/objective signs of right-sided HF, including biomarkers of liver dysfunction and CMR-based liver extracellular volume [L-ECV, 36% (32-39%) for TRF > 40%, 31% (28-34%) for TRF 21-40% and 27% (26-30%) for TRF ≤ 20%, P < 0.001]. TRF was associated with maladaptive right-sided remodelling, including right ventricular end-diastolic volume-indexed [RV-EDVi, 117 mL/m2 (99-135 mL/m2) for T-RF > 40%, 98 mL/m2 (79-118 mL/m2)] for TRF 21-40% and 85 mL/m2 (73-103 mL/m2) for TRF ≤ 20%, P < 0.001]. TRF was also strongly associated with prognostic markers of outcomes in TR including TAPSE/PASP ratio [0.38 (0.32-0.46) for TRF > 40%, 0.53 (0.34-0.68) for TRF 21-40% and 0.69 (0.52-0.87) for TRF ≤ 20%, P < 0.001) and the TRISCORE [5 (3-7) for TRF > 40%, 2 (1-3) for TRF 21-40% and 1 (0-2) for TRF ≤ 20%, P < 0.001).

Conclusion: In this all-comers TR cohort, CMR quantification of TR using TRF associated with guideline-based criteria for echocardiographic diagnosis of severe TR. RV remodelling objective right-sided HF signs/symptoms already occurred at TRF thresholds ≥20%, supporting the physiological consequences.

Background: Post-capillary pulmonary hypertension (pcPH) is a frequent complication of heart failure (HF), associated with poor outcomes. While right heart catheterization (RHC) is the diagnostic gold standard, echocardiographic indices such as left atrial volume index (LAVI) and the TAPSE/PASP ratio may offer non-invasive prognostic value.

Objectives: To assess the prognostic utility of LAVI and TAPSE/PASP compared with invasive haemodynamic parameters in patients with HF and pcPH undergoing RHC.

Methods: The PH-HF study is a prospective multicentre cohort of adults with chronic HF and confirmed pcPH (mPAP > 20 mmHg and PAWP > 15 mmHg) enrolled across 13 French centres (2012-2018). Patients with precapillary PH or severe pulmonary/renal comorbidities were excluded. The primary outcome was a 3-year composite of all-cause mortality, urgent heart transplantation or LVAD, or unplanned HF hospitalization. Cox regression was used for survival analyses.

Results: Overall, 55% of patients met the composite echocardiographic risk criterion (LAVI > 35 mL/m2; or TAPSE/PASP < 0.40), which was associated with increased risk of adverse events (HR 1.97, 95% CI 1.41-2.75; p < 0.0001). Results were consistent across HFrEF and HFpEF phenotypes. In a multivariable model including the MAGGIC score, both the echocardiographic criterion and the clinical score remained independently associated with outcomes, supporting their complementary value in risk stratification.

Conclusion: LAVI and TAPSE/PASP are strong, non-invasive predictors of adverse outcomes in HF with pcPH and may enhance prognostic assessment beyond invasive haemodynamics and clinical scores.

Aims: Mitral valve edge-to-edge repair (M-TEER) is increasingly being used for the treatment of severe mitral regurgitation, however outcomes in inoperable patients with very complex or even unfavorable mitral valve (MV) disease as "ultima ratio"are unknown. The study aimed to evaluate patient outcomes according to mitral valve anatomical complexity, as recently suggested in a recent review article stratified by MR etiology.

Methods and results: In this single-center, retrospective analysis, consecutive patients who underwent M-TEER were categorized as "Non-Complex" (NC), "Complex" (C), "Very Complex" (VC) and "Ultimately Complex" (UC) M-TEER procedures. Study endpoints were MR reduction, symptomatic improvement as expressed by changes in New York Heart Association (NYHA) functional class and two-year survival. The study included 789 consecutive patients at a mean age of 74.9 ±11.1 years (42.7% female; 49% with secondary and 51% with primary or mixed MV disease). 203 patients (25.7%), 409 patients (51.8%), 138 patients (17.5%), and 39 patients (4.9%) were classified as NC, C, VC, UC, respectively. Improvement to NYHA functional class ≤II and two-year survival rates were comparable across anatomical complexity groups (NYHA≤II: 68.4%, 61.8%, 63.5%, 75.0%, p=0.454; survival: 64.6%, 71.2%, 68.0%, 71.0%; p=0.454; for NC, C, VC, UC, respectively). MR reduction was observed in all categories and it was comparable in secondary MV disease, while increasing MV complexity was associated with an increasing prevalence residual MR ≥3+ in primary MV disease (7.9%, 8.3%, 10.9%, 23.0% for NC, C, VC, UC, respectively; p=0.002).

Conclusions: This study provides the first large-scale validation of a recently proposed mitral valve complexity framework. Anatomical complexity showed an etiology-specific impact, with no relevant effect on MR reduction or clinical outcomes in SMR, but increasing residual MR in primary disease. Given an acceptable rate of MR reduction, M-TEER can even be considered in selected patients with unfavorable MV anatomy as "ultima ratio".

Aims: Conflicting results have been reported on the prognostic value of coronary stenosis grade and plaque burden. We aimed to investigate the time-varying risk for cardiovascular events associated with diameter stenosis (DS%) and plaque burden.

Methods and results: Patients without a documented cardiac history who underwent coronary computed tomography angiography for suspected coronary artery disease were included. The most severe DS% and plaque burden, defined as percentage atheroma volume (PAV), were used for analysis. The primary end point was a composite of all-cause mortality and non-fatal myocardial infarction. For analysis, the maximal follow-up time was 8 years. Among 2819 patients (mean age 62±10; 1245 (45%) male), 235 events occurred during a median follow-up of 6.9 years. Cox models including cardiovascular risk factors, DS% and PAV demonstrated that DS% but not PAV was predictive for short-term events at 1-year follow-up (adjusted hazard ratio [aHR] 1.028, 95% confidence interval [CI] 1.013-1.044 versus 1.015, 95% CI 0.978-1.053). In contrast, PAV but not DS% was predictive for long-term events at 8-year follow-up (aHR 1.035, 95% CI 1.021-1.050 versus 1.005, 95% CI 0.999-1.012). The predictive value of DS% was stronger before than after 1 year of follow-up (aHR <1 year 1.027, 95% CI 1.012-1.042 vs aHR 1-8 years 1.001, 95% CI 0.994-1.008; p<0.01 for difference), while the predictive value of PAV did not significantly change (p=0.12).

Conclusion: Coronary diameter stenosis holds the highest prognostic significance for short-term cardiovascular events, while plaque burden predicts events in the long term.

Aims: Lipoprotein(a) [Lp(a)] is an inherited cardiovascular risk factor. However, its association with coronary plaque characteristics beyond traditional risk enhancers remains unclear. We aimed to evaluate the association between Lp(a) levels and coronary plaque characteristics in asymptomatic primary prevention patients, and to compare its predictive value against other risk enhancers, including LDL particle concentration (LDL-P), high-sensitivity C-reactive protein (hsCRP), and coronary artery calcium (CAC) score.

Methods and results: We retrospectively analyzed 547 asymptomatic patients undergoing coronary computed tomography angiography (CCTA) between 2018-2024. Plaque characteristics were assessed using artificial intelligence-based quantitative CCTA. Associations between Lp(a), LDL-P, hsCRP, CAC score, and plaque features were evaluated using multivariable regression adjusted for age and sex. Median age was 56 years, 69.8% were male. Higher Lp(a) was associated with greater total plaque volume (β=23.1 mm³, p=0.006), calcified plaque (β=11.1 mm³, p=0.014), non-calcified plaque (β=12.0 mm³, p=0.027), and low-density non-calcified plaque (LDNCP; β=0.4 mm³, p<0.001) volumes, as well as increased area stenosis (β=1.9%, p=0.031) and remodeling index (β=0.02, p=0.017). In multivariable models, CAC score was the strongest predictor of overall plaque burden including calcified and non-calcified plaque (p<0.000) but was not associated with LDNCP. Lp(a) remained independently associated with LDNCP (β=0.45 mm³, p=0.013), while LDL-P and hsCRP showed no significant associations.

Conclusions: In asymptomatic primary prevention patients, Lp(a) was independently associated with high-risk coronary plaque features, specifically LDNCP, beyond traditional risk enhancers. These findings highlight the unique role of Lp(a) in identifying coronary plaque vulnerability and suggest complementary roles for Lp(a) and CAC in refining cardiovascular risk stratification.