European Heart Journal - Cardiovascular Imaging最新文献

Aims: Pulmonary vascular resistance (PVR) intimately correlates with right ventricular afterload and the development of secondary tricuspid regurgitation (sTR). We sought to investigate the prognostic roles of PVR derived by echocardiography in patients with sTR undergoing tricuspid annuloplasty (TA).

Methods and results: Data from 322 TA patients [median age (inter-quartile range): 65.0 (59.0-70.0) years; 35.7% males] were obtained from a prospective registry to determine the impact of PVR on the composite outcome [including all-cause mortality and heart failure (HF) hospitalization]. PVR was calculated by dividing the peak TR velocity by time-velocity integral of the right ventricular outflow tract followed by adding 0.16. During a median follow-up of 5.2 years, 108 adverse events occurred including 48 deaths and 60 HF readmissions. Baseline PVR ≥ 2 WU was independently associated with a higher risk of composite outcome (HR: 1.674, 95% CI: 1.028-2.726, P = 0.038). Baseline PVR outperforms both pulmonary artery systolic pressure (PASP) and the ratio of tricuspid annulus plane systolic excursion to PASP in terms of outcome prediction, with pronounced improvement of global model fit, reclassification, and discrimination. In 150 patients who received short-term echocardiograms after surgery, the presence of post-operative PVR ≥ 2 WU (n = 20, 13.3%) was independently associated with the composite outcome (HR: 2.621, 95% CI: 1.292-5.319, P = 0.008).

Conclusion: PVR derived by echocardiography is an independent determinant of outcomes in patients undergoing TA for sTR. The inclusion of non-invasive PVR may provide valuable information to improve patient selection and post-operative management in this population.

Aims: Image-based, patient-specific rupture risk analysis of AAAs is promising but it is limited by invasive and costly imaging modalities. Ultrasound (US) offers a safe, more affordable alternative, allowing multiple assessments during follow-up and enabling longitudinal studies on AAA rupture risk.

Methods and results: This study used time-resolved three-dimensional US to assess AAA rupture risk parameters over time, based on vessel and intraluminal thrombus (ILT) geometry. The locations and magnitude of peak wall rupture index (PWRI), peak wall stress (PWS), and maximum ILT thickness for varying AAA growth rates, and the correlation between PWRI, PWS, and geometric parameters were investigated.This study demonstrated that US-based biomechanical analysis is suitable for assessing rupture potential, providing insights into the evolution through various phases in AAA development. For the fast-growing AAAs, the location of PWRI moved closer to the locations of maximum ILT thickness, whereas the location of PWS moved further away. The newly introduced parameter, i.e., percentage of ILT expected for an aneurysm with a healthy lumen, showed a stronger correlation with PWS and PWRI and was less dependent on AAA size, indicating the potential for further research on ILT's impact on AAA rupture risk.

Conclusion: This study represents a step towards clinical introduction of US-based AAA rupture risk analysis. Further research and randomized trials are required to directly correlate PWRI with rupture risk. Further improvement of ILT visibility and personalization of the US-based models will be required to achieve clinical acceptance of model-based rupture risk predictions.

Aims: How the underlying etiology and pathophysiology of left ventricular (LV) hypertrophy affects LA remodeling and function remains unexplored. The present study aims to investigate the influence of various hypertrophic phenotypes on LA remodeling and function.

Methods and results: Patients with LV hypertrophy who underwent cardiac magnetic resonance (CMR) were compared to a control group. CMR data were analyzed retrospectively to assess LA strain, volume, sphericity and left atrioventricular coupling index (LACI). Independent clinical associates of LA strain were assessed using multivariable linear regression analysis.A total of 375 individuals were included: 148 hypertrophic cardiomyopathy (HCM), 35 cardiac amyloidosis (CA), 41 hypertensive heart disease (HTN), 97 severe asymptomatic aortic stenosis (AS) and 54 with normal CMR. Indexed LA end-systolic (iLVmax), diastolic volumes and LA sphericity were the largest in patients with CA (59.1±16.9ml/m2, 46.8±16.4ml/m2 and 83.2±2.1%, respectively). CA patients presented higher LACI when compared to other groups (58±2% vs 42±2% in HCM, 39±2% in HTN, 37±2% in AS and 22±1% in normal), while no differences were observed across others. CA patients showed the lowest LA reservoir (9.6%[0.6-18.6%]) and booster strain (9.1±5.4%), whereas no differences were observed across other groups. LACI and iLAVmax were independently correlated to LA reservoir (β=0.15 and β=-39.33, respectively), LA conduit (β=0.08 and β =-17.08, respectively) and LA booster strains (β=0.1 and β=-28.69, respectively). LA sphericity was independently correlated with LA reservoir strain (β=-0.51). Finally, LV global longitudinal strain was independently correlated with LA reservoir (β=-0.43), conduit (β=-0.20) and booster strain (β=-0.24).

Conclusions: LA characteristics differ among LV hypertrophic phenotypes. LACI and iLAVmax are independently correlated with LA function while LA sphericity correlates independently with LA reservoir strain.

With this document, the European Association of Cardiovascular Imaging (EACVI) provides an Expert Consensus on the role of multi-modality imaging (MMI) in the management of patients with multiple valvular heart disease (MVD). Emphasis is given to the use of MMI to unravel the diagnostic challenges that characterize these patients and to improve risk stratification. Complementing the last European Society of Cardiology and European Association of Cardio-Thoracic Surgery guidelines on valvular heart disease, this Expert Consensus document also outlines how MMI assessment should form an integral part of the multi-disciplinary heart team discussion for patients with MVD to help with complex decision-making regarding the choice and timing of treatment.

Aims: This study evaluates whether multi-chamber myocardial deformation analysis using speckle tracking echocardiography (STE) can enhance validated current staging systems and improve risk stratification for patients with moderate-to-severe aortic stenosis (AS).

Methods and results: We reanalyzed 2D, Doppler, and STE data obtained from two cohorts: derivation (654 patients, median age: 82 years; 51% men) and validation (237 patients, median age: 77 years; 55% men) with at least moderate AS (aortic valve area<1.5 cm2). The receiver operator characteristic curve analysis identified optimal cut-off values linked to outcomes: 15% for left ventricular global longitudinal strain (LVGLS), 13% for peak atrial longitudinal strain (PALS), and 19% for right ventricular free-wall strain (RVFWS). Patients have been divided into five stages: Stage 0 - no left-side damage (LVGLS≥15% and PALS≥13%); Stage 1 - partial left-side damage (LVGLS <15% or PALS <13%); Stage 2 - definite left-side damage, (LVGLS<15% and PALS<13%); Stage 3, no right-side damage (RVFWS≥19%); and Stage 4, right-side damage (RVFWS<19%). In a multivariable Cox regression analysis, the new staging scheme remained independently associated with an increased risk of all-cause death (adjusted-hazard ratio [aHR]: 1.28; 95%CI: 1.10-1.48; p=0.001). This new staging classification exhibited higher predictive power (AUC 0.67; 95% CI 0.62-0.73) than those proposed by Généreux (AUC 0.62; 95% CI 0.56-0.67; p=0.002) and Tastet (AUC 0.64; 95% CI 0.58-0.70; p=0.041) for 2-year all-cause death, with similar findings in the validation cohort.

Conclusions: Our staging system for detecting cardiac damage, incorporating multi-chamber myocardial deformation, exhibits a stronger association with outcomes than previously validated systems.