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Coronary inflammation: Identification, clinical impact and possible therapeutical solutions. 冠状动脉炎症:鉴定、临床影响和可能的治疗方案。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-07 DOI: 10.1016/j.ijcard.2026.134229
Francesco Prati, Flavio Giuseppe Biccirè, Maria Teresa Mallus, Flavio Mastroianni, Laura Gatto, Michela Ferrari, Eloisa Arbustini

Coronary inflammation is now widely recognized as a key driver of atherosclerotic plaque initiation, progression, and destabilization. Histopathological studies and advanced imaging have demonstrated the central role of local inflammation, including extensive macrophage infiltration, cytokine activation, and perivascular adipose tissue, in promoting plaque vulnerability and acute coronary syndromes. Among systemic biomarkers, high-sensitivity C-reactive protein remains the most widely used, although its limited specificity underscores the need for more targeted inflammatory markers such as interleukin-6. Invasive intracoronary imaging with optical coherence tomography can visualize macrophage accumulation and quantify local inflammatory burden. Hybrid molecular imaging with OCT-NIRF, novel PET tracers and peri-coronary adipose tissue attenuation can provide emerging opportunities to further characterize vascular inflammation and residual risk. Anti-inflammatory therapies represent a major opportunity to improve outcomes beyond lipid lowering. Among patients with coronary artery disease, the use of colchicine has demonstrated significant risk reduction in adverse events, though with mixed results. Important randomized trials are underway to investigate the efficacy of novel monoclonal antibodies targeting interleukin pathways. In addition, GLP-1 receptor agonists, SGLT2 inhibitors, and PCSK9 inhibitors have been described to exhibit favourable vascular anti-inflammatory effects in experimental and in-vivo studies. In this comprehensive review, we provide an updated reappraisal of the available evidence unravelling how accurate identification of high-risk patients through multimodal imaging and biomarker profiling, combined with selective anti-inflammatory therapy, can represent a promising strategy for further reducing residual cardiovascular risk.

冠状动脉炎症现在被广泛认为是动脉粥样硬化斑块起始、进展和不稳定的关键驱动因素。组织病理学研究和先进的影像学研究表明,局部炎症(包括广泛的巨噬细胞浸润、细胞因子激活和血管周围脂肪组织)在促进斑块易损和急性冠状动脉综合征中起着核心作用。在系统生物标志物中,高灵敏度c反应蛋白仍然是最广泛使用的,尽管其有限的特异性强调需要更多的靶向炎症标志物,如白细胞介素-6。有创冠状动脉内光学相干断层成像可以可视化巨噬细胞积聚并量化局部炎症负担。OCT-NIRF、新型PET示踪剂和冠状动脉周围脂肪组织衰减的混合分子成像可以为进一步表征血管炎症和残留风险提供新的机会。抗炎治疗是改善血脂降低之外的主要机会。在冠状动脉疾病患者中,使用秋水仙碱可显著降低不良事件的风险,尽管结果好坏参半。重要的随机试验正在进行中,以研究针对白细胞介素通路的新型单克隆抗体的疗效。此外,在实验和体内研究中,GLP-1受体激动剂、SGLT2抑制剂和PCSK9抑制剂已被描述为具有良好的血管抗炎作用。在这篇综合综述中,我们对现有证据进行了更新的重新评估,揭示了如何通过多模态成像和生物标志物分析来准确识别高危患者,并结合选择性抗炎治疗,可以代表进一步降低剩余心血管风险的有希望的策略。
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引用次数: 0
Phase III cardiac rehabilitation improves left ventricular ejection fraction in patients with coronary artery disease and mildly reduced ejection fraction after percutaneous coronary intervention. III期心脏康复改善冠心病患者左室射血分数,经皮冠状动脉介入治疗后射血分数轻度降低。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-07 DOI: 10.1016/j.ijcard.2026.134219
Mei-Lian Cai, Wu-Xiang Shi, Jing Li, Tao Li, Wei Zhang, Chuang-Biao Lin, Xin-Yun Wang, Yu-Ting Huang, Xin-Min Qing

Background: Exercise-based cardiac rehabilitation (ExCR) is standard for secondary prevention in coronary artery disease (CAD), yet its efficacy in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after percutaneous coronary intervention (PCI) remains unclear.

Methods: In this single-center RCT, 120 stable CAD patients with HFmrEF (LVEF 40-49%) post-PCI were randomized 1:1 to receive either guideline-directed medical therapy (GDMT) plus a 52-week structured ExCR program (intervention) or GDMT alone (control). Primary outcomes-LDL-C, TG, LVEF, and LVEDD-were assessed at 4, 12, 24, and 52 weeks. Linear Mixed Models analyzed longitudinal intervention effects.

Results: A significant Group × Time interaction was observed for LVEF (p = .032), indicating superior recovery in the ExCR group. At 52 weeks, the ExCR group showed greater improvement in LVEF (+5.0% vs. +4.0%, p = .023) and greater reduction in LDL-C (-1.43 mmol/L vs. -1.04 mmol/L, p = .030) versus control. No between-group differences were found in TG or LVEDD.

Conclusions: A 52-week structured ExCR program significantly enhances cardiac recovery and lipid control in HFmrEF patients post-PCI, providing incremental benefits beyond GDMT alone. Sustained ExCR should be considered essential in comprehensive management for this population.

背景:基于运动的心脏康复(ExCR)是冠状动脉疾病(CAD)二级预防的标准方法,但其对经皮冠状动脉介入治疗(PCI)后轻度射血分数降低(HFmrEF)心力衰竭患者的疗效尚不清楚。方法:在这个单中心随机对照试验中,120例稳定的CAD患者在pci后伴有HFmrEF (LVEF 40-49%),按1:1的比例随机分组,接受指导药物治疗(GDMT)加52周的结构化ExCR计划(干预)或单独GDMT(对照组)。主要结果- ldl - c、TG、LVEF和lvedd -在4、12、24和52 周进行评估。线性混合模型分析纵向干预效果。结果:LVEF组与组间存在显著的交互作用(p = )。032),表明ExCR组恢复较好。在52 周时,ExCR组的LVEF改善更大(+5.0% vs +4.0%, p = )。023)和更大程度的LDL-C降低(-1.43 mmol/L vs -1.04 mmol/L, p = )。030)对照。两组间TG和LVEDD均无差异。结论:52周的结构化ExCR计划可显著增强HFmrEF患者pci后的心脏恢复和脂质控制,提供比单独GDMT更多的益处。在对这一人群的综合管理中,应认为持续的ExCR是必不可少的。
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引用次数: 0
Central venous pressure, rather than cardiac output, is associated with peripheral chemoreceptor sensitivity in heart failure patients with left ventricular assist device. 在使用左心室辅助装置的心力衰竭患者中,中心静脉压而不是心输出量与外周化学受体敏感性相关。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1016/j.ijcard.2026.134228
Maksym Jura, Roman Przybylski, Piotr Niewiński, Mateusz Sokolski, Rafał Seredyński, Michał Zakliczyński, Piotr Ponikowski, Jan Biegus, Bartłomiej Paleczny

Background: Heart failure (HF) patients experience elevated sympathetic tone and abnormal peripheral chemoreceptor (PChR) function (elevated sensitivity [PChS] and tonicity [PChT]), which can be attributed to a reduction in cardiac output (CO) and resultant hypoperfusion of the carotid bodies. Left ventricular assist devices (LVADs) are known to increase CO, and can be used as a unique model to examine the impact of acute hemodynamic changes on PChR.

Methods and results: Fourteen HF patients with LVADs underwent assessment of PChS (using the transient hypoxia test) and PChT (using low-dose dopamine infusion) under different LVAD flow parameters, previously determined using right heart catheterization to achieve significantly distinct CO levels. PChS did not differ between the low- vs high-flow conditions (0.61 [0.49;0.74] vs. 0.67 [0.33;0.9] L/min/SpO2%, p = 0.36) as well as PChT (0.97 [-0.36;1.96] vs. 0.81 [-1.67;2.2] L/min-1, p = 0.81).). In 9 patients, central venous pressure (CVP) decreased in response to higher pump speeds. In this group, PChS more frequently increased and was significantly higher than in the remaining patients. ΔCVP was also inversely related to ΔHVR (R = 0.75, p = 0.002).

Conclusions: Acute changes in CO, as well as pulse pressure, did not affect PChS or PChT. Surprisingly, we observed a strong correlation between a decrease in CVP in response to higher LVAD speed and an increase in PChS, which can be explained by the function of low-pressure baroreceptors. These findings provide unique data on PChR function under different hemodynamic conditions in the LVAD population.

背景:心力衰竭(HF)患者交感神经张力升高,外周化学感受器(PChR)功能异常(敏感性[PChS]和紧张性[PChT]升高),这可归因于心输出量(CO)减少和颈动脉体灌注不足。已知左心室辅助装置(lvad)可以增加CO,并且可以作为一种独特的模型来检查急性血流动力学变化对PChR的影响。方法与结果:对14例合并LVAD的HF患者在不同LVAD血流参数下的PChS(使用短暂缺氧试验)和PChT(使用低剂量多巴胺输注)进行评估,这些参数之前是通过右心导管测定的,以达到明显不同的CO水平。PChS在低流量和高流量条件下没有差异(0.61[0.49;0.74]对0.67 [0.33;0.9]L/min/SpO2%, p = 0.36),以及PChT(0.97[-0.36;1.96]对0.81 [-1.67;2.2]L/min-1, p = 0.81)。9例患者中心静脉压(CVP)随泵速升高而降低。在这一组中,PChS更频繁地增加,并且显著高于其他患者。ΔCVP与ΔHVR呈负相关(R = 0.75,p = 0.002)。结论:急性CO和脉压变化不影响PChS和PChT。令人惊讶的是,我们观察到在LVAD速度升高时CVP的降低与PChS的增加之间存在很强的相关性,这可以通过低压压力感受器的功能来解释。这些发现提供了LVAD人群在不同血流动力学条件下PChR功能的独特数据。
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引用次数: 0
Association of common risk factors with major adverse cardiac events and mortality in patients with MINOCA: A systematic review and meta-analysis. 常见危险因素与MINOCA患者主要不良心脏事件和死亡率的关联:系统回顾和荟萃分析。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1016/j.ijcard.2026.134225
Sotirios Chiotis, Georgios Giannopoulos, Aristi Boulmpou, Aikaterini Zgouridou, Leonidas Koliastasis, Ioannis Efthymiou, Aikaterini Vassilikou, Prokopios Mamolis, Dimitrios Vrachatis, Efstathios Pagkourelias, Stergios Tzikas, Ioannis Doundoulakis, Christodoulos Papadopoulos, Vassileios P Vassilikos

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous condition with variable outcomes. The prognostic value of common clinical risk factors for major adverse cardiac events (MACEs) and all-cause mortality remains unclear. This study systematically evaluates associations between traditional risk factors and adverse outcomes in MINOCA.

Methods: A systematic review and meta-analysis was conducted to assess pooled hazard ratios (HRs) for clinical variables associated with MACEs and all-cause mortality. Eligible studies reporting HRs with at least 6 months of follow-up were included. Random-effects models were used to derive pooled estimates.

Results: Eleven studies including 12,081 patients were analyzed. Over a mean follow-up of 49.2 months, pooled MACEs incidence was 17% (95% CI: 11-26%) and all-cause mortality was 10% (95% CI: 8-14%). Older age increased the risk of MACEs (HR: 1.02; 95% CI: 1.01-1.04), while higher BMI was protective (HR: 0.92; 95% CI: 0.86-0.99). For all-cause mortality, significant predictors included age (HR: 1.04 per year), diabetes (HR: 1.33; 95% CI: 1.07-1.64), creatinine (HR: 1.01; 95% CI: 1.0009-1.02), and STEMI-pattern presentation (HR: 2.85; 95% CI: 1.09-7.44). Higher BMI (HR: 0.89; 95% CI: 0.82-0.98) and dyslipidemia (HR: 0.83; 95% CI: 0.76-0.90) were associated with lower mortality.

Conclusion: Only select clinical variables predict outcomes in MINOCA, while many traditional MI risk factors do not. These findings highlight the need for MINOCA-specific risk models and targeted management strategies.

背景:非阻塞性冠状动脉心肌梗死(MINOCA)是一种异质性疾病,具有不同的结局。主要心脏不良事件(mace)和全因死亡率的常见临床危险因素的预后价值尚不清楚。本研究系统地评估了MINOCA的传统危险因素与不良结局之间的关系。方法:进行系统回顾和荟萃分析,评估与mace和全因死亡率相关的临床变量的合并风险比(hr)。报告hr至少随访6 个月的符合条件的研究被纳入。随机效应模型用于得出汇总估计。结果:11项研究共纳入12081例患者。在平均49.2 个月的随访中,合并mace发生率为17% (95% CI: 11-26%),全因死亡率为10% (95% CI: 8-14%)。年龄越大会增加mace的风险(风险比:1.02;95% CI: 1.01-1.04),而较高的BMI具有保护作用(风险比:0.92;95% CI: 0.86-0.99)。对于全因死亡率,重要的预测因素包括年龄(HR: 1.04 /年)、糖尿病(HR: 1.33; 95% CI: 1.07-1.64)、肌酐(HR: 1.01; 95% CI: 1.0009-1.02)和stemi模式表现(HR: 2.85; 95% CI: 1.09-7.44)。较高的BMI(相对危险度:0.89;95% CI: 0.82-0.98)和血脂异常(相对危险度:0.83;95% CI: 0.76-0.90)与较低的死亡率相关。结论:只有特定的临床变量可以预测MINOCA的预后,而许多传统的心肌梗死危险因素不能预测预后。这些发现突出了minoca特有的风险模型和有针对性的管理策略的必要性。
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引用次数: 0
Microvascular vasomotor dysfunction is more prevalent in female versus epicardial vasomotor dysfunction in male ANOCA patients. 微血管舒缩功能障碍在女性患者中比男性ANOCA患者心外膜血管舒缩功能障碍更普遍。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1016/j.ijcard.2026.134226
J Woudstra, A C Dimitriu-Leen, C Crooijmans, B Yosofi, J G Meeder, M Meuwissen, A M J De Vos, V Paradies, E G M Olde Bijvank, P Winkler, N S Vos, K Arkenbout, P Woudstra, M G Stoel, T P Van de Hoef, S C H Van den Oord, J W M G Widdershoven, A Cetinyurek-Yavuz, A H E M Maas, C E M Vink, K M J Marques, S A J Chamuleau, H M den Ruijter, S E Elias-Smale, M A M Beijk, P Damman, Y Appelman

Background: Coronary vasomotor dysfunction, diagnosed by coronary function testing (CFT), has only recently been recognized as important contributor to chronic coronary syndromes, exposing knowledge gaps on sex and age differences. Therefore, these differences are evaluated in the Dutch national CFT registry (NL-CFT).

Methods: Included were 1008 patients (83% women, 60 ± 9.6 years old) with angina and non-obstructive coronary arteries (ANOCA) undergoing CFT between 2020 and 2024. CFT consisted of coronary vasospasm provocation testing and reduced microvascular vasodilatory capacity assessment, a decreased coronary flow reserve (CFR) and/or increased microvascular resistance (MR). Patients were allocated into three age groups based on quartiles: young (≤54 years, Q1), intermediate (>54 to <67 years, Q2-Q3), and elderly (≥67 years, Q4).

Results: The prevalence of coronary vasomotor dysfunction was high, and similar (76%) between sexes. However, endotype prevalences differed: epicardial spasm was more prevalent in men in young and intermediate age groups (37%vs61%, p = 0.007 and 36%vs54%, p = 0.002), but not in elderly (44%vs32%, p = 0.096). Microvascular spasm was more prevalent in women in younger and intermediate groups (31%vs6%, p = 0.002 and 28%vs10%, p < 0.001), but not in elderly (27%vs22%, p = 0.493). Functional reduced microvascular vasodilatory capacity (abnormal CFR) was more prevalent in women (15%vs9%, p = 0.044), while structural reduced microvascular vasodilatory capacity (abnormal CFR and MR) prevalences were similar between sexes, across age groups.

Conclusion: In ANOCA patients referred for CFT, epicardial spasm was more prevalent among men and microvascular spasm in women Functional reduced microvascular vasodilatory capacity was more common in women in all age groups while structural reduced microvascular vasodilatory capacity was similar between sexes.

背景:冠状动脉血管舒张功能障碍,通过冠状动脉功能测试(CFT)诊断,直到最近才被认为是慢性冠状动脉综合征的重要因素,暴露了性别和年龄差异方面的知识差距。因此,这些差异在荷兰国家CFT登记处(NL-CFT)中进行评估。方法:纳入2020 - 2024年间1008例心绞痛和非阻塞性冠状动脉(ANOCA)患者(83%为女性,60 ± 9.6 岁)。CFT包括冠状动脉痉挛激发试验和微血管舒张能力降低评估,冠状动脉血流储备(CFR)降低和/或微血管阻力(MR)增加。根据四分位数将患者分为三个年龄组:年轻(≤54 岁,Q1),中等(bbbb54)至结果:冠状动脉血管舒缩功能障碍的患病率很高,性别之间相似(76%)。然而,内型患病率不同:心外膜痉挛在年轻和中年年龄组男性中更为普遍(37%vs61%, p = 0.007和36% vss54%, p = 0.002),但在老年人中没有(44%vs32%, p = 0.096)。微血管痉挛在年轻组和中间组的女性中更为普遍(31%vs6%, p = 0.002,28%vs10%, p )结论:在转至CFT的ANOCA患者中,男性心外膜痉挛更为普遍,女性微血管痉挛在所有年龄组的女性中更为常见,而微血管舒张能力的结构性降低在两性之间相似。
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引用次数: 0
When opening the artery is not enough: Diastolic remodeling and CTO revascularization after STEMI. 当打开动脉不够时:STEMI后舒张重构和CTO血运重建术。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 10.1016/j.ijcard.2026.134220
Sant Kumar, Lorenzo Azzalini
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引用次数: 0
Redefining risk in diastolic function: mortality-based thresholds along a physiologic continuum. 重新定义舒张功能的风险:生理连续体中基于死亡率的阈值。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-04 DOI: 10.1016/j.ijcard.2026.134201
Mattia Alberti
{"title":"Redefining risk in diastolic function: mortality-based thresholds along a physiologic continuum.","authors":"Mattia Alberti","doi":"10.1016/j.ijcard.2026.134201","DOIUrl":"10.1016/j.ijcard.2026.134201","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":" ","pages":"134201"},"PeriodicalIF":3.2,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects beyond prognosis: Do SGLT2 inhibitors prevent electrical dyssynchrony in HFpEF? 预后以外的影响:SGLT2抑制剂能预防HFpEF的电非同步化吗?
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-04 DOI: 10.1016/j.ijcard.2026.134213
Omar Hajji, Mohammad Abumayyaleh, Ibrahim Akin, Tobias Schupp
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引用次数: 0
Blood speckle imaging for the assessment of aortic valve velocity in healthy children: Reproducibility and comparison with Doppler echocardiography. 血斑成像评估健康儿童主动脉瓣速度:可重复性及与多普勒超声心动图的比较。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-04 DOI: 10.1016/j.ijcard.2026.134223
Andrea Freixa-Benavente, Juan Garrido-Oliver, Ferran Roses-Noguer, Lydia Dux-Santoy, Andrea Guala, José Rodriguez-Palomares, Anna Sabaté-Rotés

Introduction: Blood speckle imaging (BSI) in paediatrics is a promising novel echocardiography technique that allows complex blood flow assessment via qualitative visualization and analysis of vorticity, energy gloss and kinetic energy. However, velocity quantification has scarcely been studied in vivo, albeit in children at the aortic valve level.

Methodology: Comparison of conventional Doppler and BSI velocities at the aortic valve level in healthy children by echocardiography. BSI maximal velocity was extracted via a custom code in Python. Analysis was performed using Pearson correlation and Bland Altman analysis. An inter-observer study variability for BSI analysis was also performed in a randomly selection of subjects.

Results: A total of 77 Doppler acquisitions in 33 patients were obtained. The median age was 84 months, and maximal velocity was 1.19 m/s. Modest correlation (R = 0.53, p-value<0.001) was found between maximal velocity by BSI and Doppler. When age-stratified, the younger subgroup (<6.5 years) showed good correlation (R = 0.59, p-value<0.001) whereas it was not significant in the older subjects. A non-significant trend towards BSI underestimating velocities was found, more marked in the older subgroup. Also, discrepancies between BSI and Doppler were higher in the older subjects. There was good inter-observer reproducibility of BSI analysis (R = 0.7, p-value = 0.006).

Discussion and conclusion: The BSI technique shows moderate correlation with Doppler in healthy children, with better performance at lower body size. A non-significant trend towards greater discrepancies at higher velocities was observed. Good BSI analysis inter-observer variability was found. The BSI echocardiography allows quantification of aortic valve maximum velocity in healthy children.

简介:血液斑点成像(BSI)在儿科是一种很有前途的新型超声心动图技术,可以通过定性可视化和分析涡度、能量光泽度和动能来评估复杂的血流。然而,尽管在儿童主动脉瓣水平上,速度量化几乎没有在体内进行过研究。方法:用超声心动图比较健康儿童主动脉瓣水平的常规多普勒和BSI速度。BSI最大速度是通过Python中的自定义代码提取的。采用Pearson相关和Bland Altman分析进行分析。在随机选择的受试者中,还进行了BSI分析的观察者间研究变异性。结果:33例患者共获得77张多普勒图像。中位年龄84 个月,最大速度1.19 m/s。适度相关(R = 0.53,p值)讨论与结论:健康儿童BSI技术与多普勒中度相关,小体表现更好。观察到速度越快,差异越大的非显著趋势。良好的BSI分析发现了观察者间的可变性。BSI超声心动图可以量化健康儿童主动脉瓣最大流速。
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引用次数: 0
Novel insights into myocardial synchrony: A CMR-based approach for improving the detection of coronary artery disease at rest. 心肌同步化的新见解:一种基于cmr的方法用于改善静止时冠状动脉疾病的检测。
IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-04 DOI: 10.1016/j.ijcard.2026.134221
Minghui Hua, Rong Liang, Weizhi Nie, Li Zhou, Yimeng Zhang, Ziyu Yan, Keyi Cui, Yufan Gao, Boxin Li, Jiwei Sun, Wenjiao Wang, Anhong Yu, Yafang Zheng, Xi Liu, Feng Wang, Zhen Xing, Shuo Liang, Jun Lv, Yanhe Ma, Ximing Li, Hong Zhang

Background: We aimed to develop a novel cardiac magnetic resonance (CMR)-based method for quantifying myocardial synchrony and evaluate its diagnostic value in detecting myocardial dysfunction of coronary artery disease (CAD).

Methods: Consecutive participants with anatomically/angiographically obstructive CAD (n = 112) and healthy participants (n = 87) undergoing CMR imaging were prospectively enrolled. Myocardial strain was analyzed using feature-tracking, and myocardial synchrony was quantified via Pearson correlation coefficients of segmental strain time series across the cardiac cycle. Machine learning models (strain-only, synchrony-only, combined) were developed and validated in an independent external cohort.

Results: Healthy participants exhibited high left ventricular myocardial synchrony (radial: 0.91 [IQR: 0.88, 0.93]; circumferential: 0.90 ± 0.04; longitudinal: 0.97 ± 0.02), significantly reduced in participants with CAD (radial: 0.84 [IQR: 0.75, 0.89]; circumferential: 0.81 ± 0.12; longitudinal: 0.90 ± 0.08), including those with preserved left ventricular ejection fraction (LVEF ≥50%) (radial: 0.86 [IQR: 0.82, 0.90]; circumferential: 0.86 ± 0.07; longitudinal: 0.91 ± 0.07), all p < 0.001. In model analysis, the combined model significantly outperformed individual models (AUC: 0.94 [95% CI: 0.89-1.00] vs. 0.84 [0.75-0.94] for strain model, p = 0.037; vs. 0.79 [0.68-0.90] for synchrony model, p = 0.001). Superiority persisted in CAD with preserved LVEF (AUC: 0.91 [95% CI: 0.83-1.00]) and external validation (AUC: 0.93 [95% CI: 0.84-1.00]).

Conclusions: This CMR-derived approach demonstrated the high degree of left ventricular synchrony in healthy populations and significant dyssynchrony in CAD, even in those with preserved LVEF. Integrating myocardial synchrony with strain significantly enhanced CAD myocardial dysfunction detection relative to strain alone, with robust diagnostic performance maintained in CAD with preserved LVEF.

背景:我们旨在建立一种新的基于心脏磁共振(CMR)的心肌同步化定量方法,并评估其在检测冠状动脉疾病(CAD)心肌功能障碍中的诊断价值。方法:前瞻性纳入连续的解剖/血管造影阻塞性CAD患者(n = 112)和健康患者(n = 87)进行CMR成像。采用特征跟踪方法分析心肌应变,并利用全心周期分段应变时间序列的Pearson相关系数量化心肌同步。在独立的外部队列中开发并验证了机器学习模型(仅限菌株,仅限同步,组合)。结果:健康的参与者表现出高左心室心肌同步(径向:0.91(差:0.88,0.93);圆周:0.90 ± 0.04;纵向: 0.97±0.02 ),显著降低参与者的CAD(径向:0.84(差:0.75,0.89);圆周:0.81 ± 0.12;纵向: 0.90±0.08 ),包括那些保护左心室射血分数(LVEF≥50%)(径向:0.86(差:0.82,0.90);圆周:0.86 ± 0.07;纵向:0.91 ± 0.07),所有p 结论:这种cmr衍生的方法表明,健康人群左室同步化程度高,CAD患者左室非同步化程度明显,即使在LVEF保存者中也是如此。与单独应变相比,将心肌同步与应变相结合可显著增强CAD心肌功能障碍的检测,并在保留LVEF的CAD中保持稳健的诊断性能。
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引用次数: 0
期刊
International journal of cardiology
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