Pub Date : 2025-12-01DOI: 10.1016/j.jcmg.2025.10.019
Thierry G Donati,Francesca Ortelli,Monika Hebeisen,Alexandros Protonotarios,Paul A S Olsen,Ardan M Saguner,Firat Duru,Konstantinos Savvatis,Perry M Elliott,Kristina H Haugaa,Felix C Tanner
BACKGROUNDRight ventricular outflow tract (RVOT) dilatation is a phenotypic feature of arrhythmogenic right ventricular cardiomyopathy (ARVC). The echocardiographic RVOT diameter is part of the 2010 Task Force Criteria and is widely measured in clinical practice. Nevertheless, few data exist on its prevalence, diagnostic value, and prognostic significance.OBJECTIVESThis study aimed to explore the association of RVOT diameter with adverse outcomes in ARVC patients without (primary prevention) or with (secondary prevention) previous ventricular arrhythmia (VA), identify the best RVOT diameter for diagnosing ARVC, and understand whether isolated RVOT dilatation occurs in ARVC.METHODSPatients with definite ARVC and genetic testing results were included in a cross-sectional outcome study. Isolated RVOT dilatation was defined as an enlarged RVOT diameter without concurrent right ventricular (RV) end-diastolic area dilatation. The diagnostic power of RVOT diameter was assessed compared with 100 healthy control subjects. The time to first event after baseline echocardiography was analyzed by Cox regression.RESULTSThe cohort consisted of 370 patients (mean age: 47 years; 56% male; 65% primary prevention; median follow-up: 6.8 years [Q1-Q3: 3.8-10.5 years]; 136 events [100 VA; 35 deaths]). RVOT dilatation occurred in 69% and isolated dilatation in 24% of patients. All RVOT diameters had similar diagnostic power (RVOT3/body surface area, AUC: 0.71 [95% CI: 0.66-0.76]) and a similar association with VA (RVOT3/body surface area, HR: 1.08 [95% CI: 1.04-1.13]; P < 0.001) or death (HR: 1.26 [95% CI: 1.18-1.35]; P < 0.001). Dilated RVOT was associated with a shorter time to VA or death in primary prevention and death in secondary prevention, and its feasibility was higher, its reproducibility was better, and its outcome association was stronger than those of RV free-wall strain.CONCLUSIONSIsolated RVOT dilatation occurred in more than 20% of ARVC patients. All RVOT diameters showed good diagnostic power, were strongly associated with time to adverse events, were associated with adverse events in primary and secondary prevention, and exhibited superior feasibility, reproducibility, and outcome association compared with RV free-wall strain.
{"title":"Right Ventricular Outflow Tract Diameter for Event Prediction in Arrhythmogenic Right Ventricular Cardiomyopathy: Incremental Value Over Echocardiographic Free-Wall Strain.","authors":"Thierry G Donati,Francesca Ortelli,Monika Hebeisen,Alexandros Protonotarios,Paul A S Olsen,Ardan M Saguner,Firat Duru,Konstantinos Savvatis,Perry M Elliott,Kristina H Haugaa,Felix C Tanner","doi":"10.1016/j.jcmg.2025.10.019","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.10.019","url":null,"abstract":"BACKGROUNDRight ventricular outflow tract (RVOT) dilatation is a phenotypic feature of arrhythmogenic right ventricular cardiomyopathy (ARVC). The echocardiographic RVOT diameter is part of the 2010 Task Force Criteria and is widely measured in clinical practice. Nevertheless, few data exist on its prevalence, diagnostic value, and prognostic significance.OBJECTIVESThis study aimed to explore the association of RVOT diameter with adverse outcomes in ARVC patients without (primary prevention) or with (secondary prevention) previous ventricular arrhythmia (VA), identify the best RVOT diameter for diagnosing ARVC, and understand whether isolated RVOT dilatation occurs in ARVC.METHODSPatients with definite ARVC and genetic testing results were included in a cross-sectional outcome study. Isolated RVOT dilatation was defined as an enlarged RVOT diameter without concurrent right ventricular (RV) end-diastolic area dilatation. The diagnostic power of RVOT diameter was assessed compared with 100 healthy control subjects. The time to first event after baseline echocardiography was analyzed by Cox regression.RESULTSThe cohort consisted of 370 patients (mean age: 47 years; 56% male; 65% primary prevention; median follow-up: 6.8 years [Q1-Q3: 3.8-10.5 years]; 136 events [100 VA; 35 deaths]). RVOT dilatation occurred in 69% and isolated dilatation in 24% of patients. All RVOT diameters had similar diagnostic power (RVOT3/body surface area, AUC: 0.71 [95% CI: 0.66-0.76]) and a similar association with VA (RVOT3/body surface area, HR: 1.08 [95% CI: 1.04-1.13]; P < 0.001) or death (HR: 1.26 [95% CI: 1.18-1.35]; P < 0.001). Dilated RVOT was associated with a shorter time to VA or death in primary prevention and death in secondary prevention, and its feasibility was higher, its reproducibility was better, and its outcome association was stronger than those of RV free-wall strain.CONCLUSIONSIsolated RVOT dilatation occurred in more than 20% of ARVC patients. All RVOT diameters showed good diagnostic power, were strongly associated with time to adverse events, were associated with adverse events in primary and secondary prevention, and exhibited superior feasibility, reproducibility, and outcome association compared with RV free-wall strain.","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jcmg.2025.10.023
Elliott S Moss,Edward G Jones,Shaine A Morris,Tam T Doan
{"title":"Mitral Annular Disjunction in Pediatric Loeys-Dietz Syndrome: A Step Toward Deep Phenotyping.","authors":"Elliott S Moss,Edward G Jones,Shaine A Morris,Tam T Doan","doi":"10.1016/j.jcmg.2025.10.023","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.10.023","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"140 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1016/j.jcmg.2025.10.024
Dermot M Phelan,Guido Claessen,Thijs M H Eijsvogels,Timothy W Churchill,Elizabeth H Dineen,Sabiha Gati,J Sawalla Guseh,Jeffrey J Hsu,Ankit B Shah,Brett W Sperry,Meagan M Wasfy,Andre La Gerche,Matthew W Martinez,Michael Papadakis,Aaron L Baggish,Jonathan H Kim,
Masters athletes (MAs), defined as individuals ≥35 years of age who are engaged in competitive or high-volume recreational sports or exercise training, comprise a growing group regularly cared for in sports cardiology. The cardiovascular care of MAs can be challenging because many of the classical tenets in sports cardiology and exercise physiology were derived from young, competitive athletes and therefore do not fully generalize to the care of MAs. Appropriate implementation of multimodality cardiovascular imaging is essential to guide the risk stratification and clinical management of MAs. In this state-of-the-art review, physiological and pathologic considerations unique to MAs are highlighted. The strengths and limitations of specific cardiovascular imaging modalities are reviewed along with guidance on their appropriate use in the care of MAs. The purpose of this document is to represent the first primary reference on best practice considerations for the use of multimodality cardiovascular imaging in the care of MAs.
{"title":"Cardiovascular Imaging Considerations for Masters-Aged Athletes.","authors":"Dermot M Phelan,Guido Claessen,Thijs M H Eijsvogels,Timothy W Churchill,Elizabeth H Dineen,Sabiha Gati,J Sawalla Guseh,Jeffrey J Hsu,Ankit B Shah,Brett W Sperry,Meagan M Wasfy,Andre La Gerche,Matthew W Martinez,Michael Papadakis,Aaron L Baggish,Jonathan H Kim, ","doi":"10.1016/j.jcmg.2025.10.024","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.10.024","url":null,"abstract":"Masters athletes (MAs), defined as individuals ≥35 years of age who are engaged in competitive or high-volume recreational sports or exercise training, comprise a growing group regularly cared for in sports cardiology. The cardiovascular care of MAs can be challenging because many of the classical tenets in sports cardiology and exercise physiology were derived from young, competitive athletes and therefore do not fully generalize to the care of MAs. Appropriate implementation of multimodality cardiovascular imaging is essential to guide the risk stratification and clinical management of MAs. In this state-of-the-art review, physiological and pathologic considerations unique to MAs are highlighted. The strengths and limitations of specific cardiovascular imaging modalities are reviewed along with guidance on their appropriate use in the care of MAs. The purpose of this document is to represent the first primary reference on best practice considerations for the use of multimodality cardiovascular imaging in the care of MAs.","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"72 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.jcmg.2025.10.012
Borek Foldyna,Ibrahim Hadzic,Thomas Mayrhofer,Júlia Karády,Jana Taron,Márton Kolossváry,Vineet K Raghu,Sara McCallum,Kayla Paradis,Marissa R Diggs,Sarah M Chu,Alex B Lu,Charurut Somboonwit,Jose I Bernardino,Michael P Dubé,Craig A Sponseller,Markella V Zanni,Gerald S Bloomfield,Carlos D Malvestutto,Carl J Fichtenbaum,Judith A Aberg,Judith S Currier,Heather J Ribaudo,Pamela S Douglas,Michael T Lu,Steven K Grinspoon
BACKGROUNDThe effects of statin therapy on pericoronary adipose tissue (PCAT) and its relationship with plaque progression and outcomes in people with HIV (PWH) remain poorly understood.OBJECTIVESThe aim of this study was to evaluate PCAT density changes over time; statin effects on PCAT; and associations among PCAT changes, coronary plaque, and clinical outcomes.METHODSIn the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) mechanistic computed tomographic (CT) substudy (n = 753, mean age 51 ± 6 years, 17% women), PCAT density was measured from noncontrast CT images at baseline and 2 years, while coronary plaque volumes (total, calcified, and noncalcified) were assessed from contrast-enhanced CT angiograms. Analyses were stratified by coronary artery disease burden (segment involvement score 0, 1-3, or ≥4) and adjusted for technical parameters, atherosclerotic cardiovascular disease risk, body mass index, inflammatory biomarkers, and statin allocation. Associations among PCAT, plaque changes, and events (all-cause mortality, major adverse cardiovascular events [MACE], and MACE or death) were evaluated.RESULTSBaseline PCAT density was -87.7 ± 10.5 HU, increasing by 4.5 HU (95% CI: 3.8-5.2; P < 0.001) over 2 years. Pitavastatin prevented this increase in participants with segment involvement scores ≥4 (-1.7 HU vs +3.8 HU; P = 0.016, pitavastatin vs placebo, respectively). Greater PCAT density was associated with higher noncalcified plaque volume (per +10 HU, +5.0 mm3; P = 0.075) and reduced calcified plaque progression (-3.2 mm3; P = 0.031). Over a median of 6.3 years, 4.2% of patients died. Baseline PCAT density was independently associated with all-cause mortality (HR per +10 HU: 1.95; 95% CI: 1.03-3.69; P = 0.040), but not MACE.CONCLUSIONSPCAT density increases over time in PWH, but pitavastatin mitigates this in those with high coronary artery disease burden. PCAT density is associated with vulnerable plaque morphology and all-cause mortality, supporting its potential as a prognostic imaging biomarker in PWH. (Randomized Trial to Prevent Vascular Events in HIV [REPRIEVE]; NCT02344290).
背景：他汀类药物治疗对HIV （PWH）患者冠状动脉周围脂肪组织（PCAT）的影响及其与斑块进展和结局的关系仍知之甚少。目的：本研究的目的是评估PCAT密度随时间的变化；他汀类药物对PCAT的影响；以及PCAT变化、冠状动脉斑块和临床结果之间的关系。方法在REPRIEVE（预防HIV血管事件的随机试验）机制计算机断层扫描（CT）亚研究（n = 753，平均年龄51±6岁，17%为女性）中，通过基线和2年的非对比CT图像测量PCAT密度，同时通过增强CT血管造影评估冠状动脉斑块体积（总、钙化和非钙化）。根据冠状动脉疾病负担（节段累及评分0、1-3或≥4）对分析进行分层，并根据技术参数、动脉粥样硬化性心血管疾病风险、体重指数、炎症生物标志物和他汀类药物分配进行调整。评估PCAT、斑块变化和事件（全因死亡率、主要不良心血管事件[MACE]以及MACE或死亡）之间的关系。结果基线PCAT密度为-87.7±10.5 HU， 2年内增加4.5 HU （95% CI: 3.8 ~ 5.2; P < 0.001）。匹伐他汀阻止了节段累及评分≥4的参与者的这种增加（-1.7 HU vs +3.8 HU; P = 0.016，匹伐他汀vs安慰剂）。更大的PCAT密度与更高的非钙化斑块体积（每+10 HU， +5.0 mm3, P = 0.075）和更少的钙化斑块进展（-3.2 mm3, P = 0.031）相关。在中位6.3年期间，4.2%的患者死亡。基线PCAT密度与全因死亡率独立相关（HR / +10 HU: 1.95; 95% CI: 1.03-3.69; P = 0.040），但与MACE无关。结论：PWH患者的spcat密度随时间增加，但匹伐他汀可减轻高冠状动脉疾病负担患者的spcat密度。PCAT密度与易损斑块形态和全因死亡率相关，支持其作为PWH预后成像生物标志物的潜力。预防HIV血管事件的随机试验[REPRIEVE]； NCT02344290)。
{"title":"Statin Effects on Pericoronary Adipose Tissue Density in People With HIV: Insights From the REPRIEVE Trial.","authors":"Borek Foldyna,Ibrahim Hadzic,Thomas Mayrhofer,Júlia Karády,Jana Taron,Márton Kolossváry,Vineet K Raghu,Sara McCallum,Kayla Paradis,Marissa R Diggs,Sarah M Chu,Alex B Lu,Charurut Somboonwit,Jose I Bernardino,Michael P Dubé,Craig A Sponseller,Markella V Zanni,Gerald S Bloomfield,Carlos D Malvestutto,Carl J Fichtenbaum,Judith A Aberg,Judith S Currier,Heather J Ribaudo,Pamela S Douglas,Michael T Lu,Steven K Grinspoon","doi":"10.1016/j.jcmg.2025.10.012","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.10.012","url":null,"abstract":"BACKGROUNDThe effects of statin therapy on pericoronary adipose tissue (PCAT) and its relationship with plaque progression and outcomes in people with HIV (PWH) remain poorly understood.OBJECTIVESThe aim of this study was to evaluate PCAT density changes over time; statin effects on PCAT; and associations among PCAT changes, coronary plaque, and clinical outcomes.METHODSIn the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) mechanistic computed tomographic (CT) substudy (n = 753, mean age 51 ± 6 years, 17% women), PCAT density was measured from noncontrast CT images at baseline and 2 years, while coronary plaque volumes (total, calcified, and noncalcified) were assessed from contrast-enhanced CT angiograms. Analyses were stratified by coronary artery disease burden (segment involvement score 0, 1-3, or ≥4) and adjusted for technical parameters, atherosclerotic cardiovascular disease risk, body mass index, inflammatory biomarkers, and statin allocation. Associations among PCAT, plaque changes, and events (all-cause mortality, major adverse cardiovascular events [MACE], and MACE or death) were evaluated.RESULTSBaseline PCAT density was -87.7 ± 10.5 HU, increasing by 4.5 HU (95% CI: 3.8-5.2; P < 0.001) over 2 years. Pitavastatin prevented this increase in participants with segment involvement scores ≥4 (-1.7 HU vs +3.8 HU; P = 0.016, pitavastatin vs placebo, respectively). Greater PCAT density was associated with higher noncalcified plaque volume (per +10 HU, +5.0 mm3; P = 0.075) and reduced calcified plaque progression (-3.2 mm3; P = 0.031). Over a median of 6.3 years, 4.2% of patients died. Baseline PCAT density was independently associated with all-cause mortality (HR per +10 HU: 1.95; 95% CI: 1.03-3.69; P = 0.040), but not MACE.CONCLUSIONSPCAT density increases over time in PWH, but pitavastatin mitigates this in those with high coronary artery disease burden. PCAT density is associated with vulnerable plaque morphology and all-cause mortality, supporting its potential as a prognostic imaging biomarker in PWH. (Randomized Trial to Prevent Vascular Events in HIV [REPRIEVE]; NCT02344290).","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"110 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-22DOI: 10.1016/j.jcmg.2025.09.021
Alexander van Rosendael,Rine Nakanishi,Jeroen J Bax,Gianluca Pontone,Saima Mushtaq,Ronny R Buechel,Christoph Gräni,Gudrun Feuchtner,Pietro G Lacaita,Amit R Patel,Cristiane C Singulane,Andrew D Choi,Mouaz Al-Mallah,Daniele Andreini,Ronald P Karlsberg,Geoffrey W Cho,Carlos E Rochitte,Mirvat Alasnag,Ashraf Hamdan,Filippo Cademartiri,Erica Maffei,Hugo Marques,Pedro de Araújo Gonçalves,Himanshu Gupta,Martin Hadamitzky,Omar Khalique,Dinesh Kalra,James D Mills,Nick S Nurmohamed,Paul Knaapen,Matthew Budoff,Kashif Shaikh,Enrico Martin,David M German,Maros Ferencik,Andrew C Oehler,Roderick Deaño,Prashant Nagpal,Marly van Assen,Carlo N De Cecco,Vasileios Kamperidis,Borek Foldyna,Jan M Brendel,Victor Y Cheng,Kelley R Branch,Marcio Bittencourt,Sabha Bhatti,Venkateshwar Polsani,George Wesbey,Rhanderson Cardoso,Ron Blankstein,Augustin Delago,Amit Pursnani,Amro Alsaid,Vasvi Singh,Melissa Aquino,Jisuk Park,Ibrahim Danad
BACKGROUNDThe severity and extent of whole heart coronary plaque volume and stenosis can be reliably measured by artificial intelligence-guided quantitative coronary computed tomography angiography (AI-QCT). Limited data are available on the potential incremental prognostic value compared with currently recommended qualitative coronary computed tomography angiography (CTA) reads and the coronary artery calcium score (CACS).OBJECTIVESThe aim of this study was to evaluate the prognostic value of AI-QCT compared with human coronary CTA reads, including the CAD-RADS (Coronary Artery Disease-Reporting and Data System), CACS, and the modified Duke Index.METHODSCONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is a multicenter, international, observational cohort study of patients undergoing clinically indicated coronary CTA with follow-up for major adverse cardiac events (MACE). Asymptomatic patients and those with cardiac history were excluded. Coronary artery disease presence, extent, and composition were quantified by AI-QCT across the coronary tree, yielding 24 patient-, vessel-, and plaque-level variables. On the basis of prior analyses, noncalcified plaque burden and diameter stenosis were identified as the strongest predictors and combined for statistical modeling as "AI-QCT." Comparator computed tomography scores included CAD-RADS, CACS, and the modified Duke Index, whereas clinical predictors were summarized in the risk factor-weighted clinical likelihood score. Area under the curve (AUC) and continuous net reclassification index (NRI) were calculated to assess the incremental value. The primary endpoint was MACE (death, myocardial infarction [MI], stroke, heart failure, late revascularization, or hospital stay for unstable angina), and the secondary endpoint was death or MI.RESULTSIn 1,916 patients with all risk scores available, 87 (4.5%) MACE and 27 (1.4%) death/MI events occurred during 3 years of follow-up. There was a stepwise risk increase with higher coronary artery disease classifications with CAD-RADS and CACS. The addition of AI-QCT significantly improved risk stratification for MACE compared with CAD-RADS (AUC: 0.81 vs 0.79; P < 0.001 and NRI: 0.47; P < 0.001), CACS (AUC: 0.79 vs 0.70; P < 0.001 and NRI 0.61; P < 0.001), the modified Duke Index (AUC: 0.81 vs 0.76; P < 0.001 and NRI: 0.52; P < 0.001), and CAD-RADS + CACS model (AUC: 0.81 vs 0.79; P = 0.004 and NRI: 0.54; P < 0.001). AI-QCT also improved discrimination when results were adjusted for the risk factor-weighted clinical likelihood and for the prediction of death/MI. Excluding 195 patients with severe stenosis (≥70%), in a multivariable model of CAD-RADS and AI-QCT, only AI-QCT was significantly associated with MACE and death/MI, and AI-QCT significantly improved risk stratification compared with CAD-RADS for MACE (AUC: 0.77 vs 0.72; P < 0.001 and NRI: 0.54; P < 0.001) and death/MI (AUC:
人工智能引导的定量冠状动脉计算机断层造影（AI-QCT）可以可靠地测量全心冠状动脉斑块体积和狭窄的严重程度和程度。与目前推荐的定性冠状动脉ct血管造影（CTA）读数和冠状动脉钙评分（CACS）相比，关于潜在的增量预后价值的数据有限。目的本研究的目的是评估AI-QCT与人类冠状动脉CTA读数的预后价值，包括CAD-RADS（冠状动脉疾病报告和数据系统）、CACS和改良的Duke指数。方法confirm2（定量冠状动脉CT血管造影评估用于评估临床结果：一项国际多中心注册研究）是一项多中心国际观察性队列研究，研究对象是接受临床指征冠状动脉CTA并随访主要心脏不良事件（MACE）的患者。排除无症状患者和有心脏病史的患者。通过AI-QCT对冠状动脉病变的存在、程度和组成进行量化，得出24个患者、血管和斑块水平变量。在先前分析的基础上，非钙化斑块负担和直径狭窄被确定为最强的预测因子，并将其合并为“AI-QCT”统计模型。比较计算机断层扫描评分包括CAD-RADS、CACS和改进的Duke指数，而临床预测指标则总结为危险因素加权临床似然评分。计算曲线下面积（Area under the curve， AUC）和连续净重分类指数（continuous net reclassification index， NRI）来评估增量值。主要终点为MACE（死亡、心肌梗死[MI]、卒中、心力衰竭、晚期血运重建术或因不稳定心绞痛住院），次要终点为死亡或心肌梗死。结果在获得所有风险评分的1916例患者中，3年随访期间发生了87例（4.5%）MACE和27例（1.4%）死亡/心肌梗死事件。CAD-RADS和CACS的冠状动脉疾病分类越高，风险越高。与CAD-RADS （AUC: 0.81 vs 0.79, P < 0.001, NRI: 0.47, P < 0.001）、CACS （AUC: 0.79 vs 0.70, P < 0.001, NRI 0.61, P < 0.001）、改良杜克指数（AUC: 0.81 vs 0.76, P < 0.001, NRI: 0.52, P < 0.001）和CAD-RADS + CACS模型（AUC: 0.81 vs 0.79, P = 0.004, NRI: 0.54, P < 0.001）相比，AI-QCT的加入显著改善了MACE的风险分层。当对危险因素加权的临床可能性和死亡/心肌梗死的预测结果进行调整时，AI-QCT也提高了识别能力。除195例严重狭窄患者（≥70%）外，在CAD-RADS和AI-QCT的多变量模型中，只有AI-QCT与MACE和死亡/MI显著相关，与CAD-RADS相比，AI-QCT显著改善了MACE （AUC: 0.77 vs 0.72; P < 0.001, NRI: 0.54; P < 0.001）和死亡/MI （AUC: 0.81 vs 0.73; P = 0.011, NRI: 0.69; P = 0.001）的风险分层。结论与CAD-RADS 2.0、CACS和改进的Duke指数相比，sai - qct在预测MACE以及死亡或非致死性心肌梗死的次要终点方面提供了更多的预后信息。
{"title":"Prognostic Value of AI-Based Quantitative Coronary CTA vs Human Reader-Based Visual Assessment: Results From the CONFIRM2 Registry.","authors":"Alexander van Rosendael,Rine Nakanishi,Jeroen J Bax,Gianluca Pontone,Saima Mushtaq,Ronny R Buechel,Christoph Gräni,Gudrun Feuchtner,Pietro G Lacaita,Amit R Patel,Cristiane C Singulane,Andrew D Choi,Mouaz Al-Mallah,Daniele Andreini,Ronald P Karlsberg,Geoffrey W Cho,Carlos E Rochitte,Mirvat Alasnag,Ashraf Hamdan,Filippo Cademartiri,Erica Maffei,Hugo Marques,Pedro de Araújo Gonçalves,Himanshu Gupta,Martin Hadamitzky,Omar Khalique,Dinesh Kalra,James D Mills,Nick S Nurmohamed,Paul Knaapen,Matthew Budoff,Kashif Shaikh,Enrico Martin,David M German,Maros Ferencik,Andrew C Oehler,Roderick Deaño,Prashant Nagpal,Marly van Assen,Carlo N De Cecco,Vasileios Kamperidis,Borek Foldyna,Jan M Brendel,Victor Y Cheng,Kelley R Branch,Marcio Bittencourt,Sabha Bhatti,Venkateshwar Polsani,George Wesbey,Rhanderson Cardoso,Ron Blankstein,Augustin Delago,Amit Pursnani,Amro Alsaid,Vasvi Singh,Melissa Aquino,Jisuk Park,Ibrahim Danad","doi":"10.1016/j.jcmg.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.09.021","url":null,"abstract":"BACKGROUNDThe severity and extent of whole heart coronary plaque volume and stenosis can be reliably measured by artificial intelligence-guided quantitative coronary computed tomography angiography (AI-QCT). Limited data are available on the potential incremental prognostic value compared with currently recommended qualitative coronary computed tomography angiography (CTA) reads and the coronary artery calcium score (CACS).OBJECTIVESThe aim of this study was to evaluate the prognostic value of AI-QCT compared with human coronary CTA reads, including the CAD-RADS (Coronary Artery Disease-Reporting and Data System), CACS, and the modified Duke Index.METHODSCONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is a multicenter, international, observational cohort study of patients undergoing clinically indicated coronary CTA with follow-up for major adverse cardiac events (MACE). Asymptomatic patients and those with cardiac history were excluded. Coronary artery disease presence, extent, and composition were quantified by AI-QCT across the coronary tree, yielding 24 patient-, vessel-, and plaque-level variables. On the basis of prior analyses, noncalcified plaque burden and diameter stenosis were identified as the strongest predictors and combined for statistical modeling as \"AI-QCT.\" Comparator computed tomography scores included CAD-RADS, CACS, and the modified Duke Index, whereas clinical predictors were summarized in the risk factor-weighted clinical likelihood score. Area under the curve (AUC) and continuous net reclassification index (NRI) were calculated to assess the incremental value. The primary endpoint was MACE (death, myocardial infarction [MI], stroke, heart failure, late revascularization, or hospital stay for unstable angina), and the secondary endpoint was death or MI.RESULTSIn 1,916 patients with all risk scores available, 87 (4.5%) MACE and 27 (1.4%) death/MI events occurred during 3 years of follow-up. There was a stepwise risk increase with higher coronary artery disease classifications with CAD-RADS and CACS. The addition of AI-QCT significantly improved risk stratification for MACE compared with CAD-RADS (AUC: 0.81 vs 0.79; P < 0.001 and NRI: 0.47; P < 0.001), CACS (AUC: 0.79 vs 0.70; P < 0.001 and NRI 0.61; P < 0.001), the modified Duke Index (AUC: 0.81 vs 0.76; P < 0.001 and NRI: 0.52; P < 0.001), and CAD-RADS + CACS model (AUC: 0.81 vs 0.79; P = 0.004 and NRI: 0.54; P < 0.001). AI-QCT also improved discrimination when results were adjusted for the risk factor-weighted clinical likelihood and for the prediction of death/MI. Excluding 195 patients with severe stenosis (≥70%), in a multivariable model of CAD-RADS and AI-QCT, only AI-QCT was significantly associated with MACE and death/MI, and AI-QCT significantly improved risk stratification compared with CAD-RADS for MACE (AUC: 0.77 vs 0.72; P < 0.001 and NRI: 0.54; P < 0.001) and death/MI (AUC: ","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"14 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/j.jcmg.2025.10.018
Nicholas Spetko, Yang Song, Hibiki Orui, Constance Angell-James, Madeline Cassidy, Kan Liu, Ron Blankstein, Sanjay Divakaran, Rishi K Wadhera, Jordan B Strom
Background: It is unclear whether geographic distance to a cardiovascular imaging center (CVIC) is associated with receipt of cardiovascular imaging (CVI).
Objectives: This study sought to assess temporal trends in distance to a CVIC and examine the relationship of distance to a CVIC and receipt of CVI overall and by modality.
Methods: Among 64,260,530 older U.S. Medicare fee-for-service and Medicare Advantage beneficiaries from 2018 to 2021, the study measured individual distances to the nearest CVIC. Poisson regression was used to evaluate the likelihood of receipt of CVI as a function of distance, overall and by modality.
Results: Of those beneficiaries included (age: 73.0 ± 8 years; 54.6% female; 80.1% White), 17.5% underwent CVI. The number of CVICs increased (0.02% per year), but median distances to CVICs remained stable (3.3-3.4 miles). Compared with beneficiaries living 10 to 16 miles from a CVIC, distance >16 miles from a CVIC was associated with lower likelihood of receipt (rate ratio: 0.957 [95% CI: 0.956-0.959]; P < 0.001). The lowest likelihood of receipt was within 10 miles of services (rate ratio: 0.923 [95% CI: 0.921-0.924]; P < 0.001). Distances to cardiac computed tomography (CCT), cardiac magnetic resonance (CMR), and positron emission tomography (PET) services were longer than distances to echocardiography and single-photon emission computed tomography (SPECT) services: (median distance: CCT: 8.1 miles [Q1-Q3: 3.7-21.3 miles]; CMR: 17.4 miles [Q1-Q3: 7.3-43.3 miles]; and PET: 88.9 miles [Q1-Q3: 26.2-194.6 miles] vs echocardiography: 3.4 miles [Q1-Q3: 0.4-7.0 miles]; and SPECT: 3.8 miles [Q1-Q3: 1.3-7.9 miles]).
Conclusions: From 2018 to 2021, the number of CVICs increased, although distances to CVICs remained stable. The lowest likelihood receipt of imaging overall was among those patients living within 10 miles of a CVIC, a finding suggesting that proximity is insufficient for access. CCT, CMR, and PET services were concentrated in large metropolitan academic centers.
{"title":"Distance and Likelihood of Cardiovascular Imaging Receipt Among Medicare Beneficiaries: Cardiovascular Imaging Deserts Among Medicare Beneficiaries.","authors":"Nicholas Spetko, Yang Song, Hibiki Orui, Constance Angell-James, Madeline Cassidy, Kan Liu, Ron Blankstein, Sanjay Divakaran, Rishi K Wadhera, Jordan B Strom","doi":"10.1016/j.jcmg.2025.10.018","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.10.018","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether geographic distance to a cardiovascular imaging center (CVIC) is associated with receipt of cardiovascular imaging (CVI).</p><p><strong>Objectives: </strong>This study sought to assess temporal trends in distance to a CVIC and examine the relationship of distance to a CVIC and receipt of CVI overall and by modality.</p><p><strong>Methods: </strong>Among 64,260,530 older U.S. Medicare fee-for-service and Medicare Advantage beneficiaries from 2018 to 2021, the study measured individual distances to the nearest CVIC. Poisson regression was used to evaluate the likelihood of receipt of CVI as a function of distance, overall and by modality.</p><p><strong>Results: </strong>Of those beneficiaries included (age: 73.0 ± 8 years; 54.6% female; 80.1% White), 17.5% underwent CVI. The number of CVICs increased (0.02% per year), but median distances to CVICs remained stable (3.3-3.4 miles). Compared with beneficiaries living 10 to 16 miles from a CVIC, distance >16 miles from a CVIC was associated with lower likelihood of receipt (rate ratio: 0.957 [95% CI: 0.956-0.959]; P < 0.001). The lowest likelihood of receipt was within 10 miles of services (rate ratio: 0.923 [95% CI: 0.921-0.924]; P < 0.001). Distances to cardiac computed tomography (CCT), cardiac magnetic resonance (CMR), and positron emission tomography (PET) services were longer than distances to echocardiography and single-photon emission computed tomography (SPECT) services: (median distance: CCT: 8.1 miles [Q1-Q3: 3.7-21.3 miles]; CMR: 17.4 miles [Q1-Q3: 7.3-43.3 miles]; and PET: 88.9 miles [Q1-Q3: 26.2-194.6 miles] vs echocardiography: 3.4 miles [Q1-Q3: 0.4-7.0 miles]; and SPECT: 3.8 miles [Q1-Q3: 1.3-7.9 miles]).</p><p><strong>Conclusions: </strong>From 2018 to 2021, the number of CVICs increased, although distances to CVICs remained stable. The lowest likelihood receipt of imaging overall was among those patients living within 10 miles of a CVIC, a finding suggesting that proximity is insufficient for access. CCT, CMR, and PET services were concentrated in large metropolitan academic centers.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":15.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.jcmg.2025.10.017
Nicola Ciocca, David Reineke, Lukas Hunziker, Beate Hugi-Mayr, Michele Martinelli, Lukas Capek, Moritz Hundertmark, Monika Fürholz, Bruno Schnegg, Christoph Gräni
{"title":"Multimodality Imaging Vignettes of Left Ventricular Assist Device Complications","authors":"Nicola Ciocca, David Reineke, Lukas Hunziker, Beate Hugi-Mayr, Michele Martinelli, Lukas Capek, Moritz Hundertmark, Monika Fürholz, Bruno Schnegg, Christoph Gräni","doi":"10.1016/j.jcmg.2025.10.017","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.10.017","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"37 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.jcmg.2025.10.009
Juul Bierens, Alida A. Postma, Kimberly Frehe, Bart A.J.M. Wagemans, Daniel Bos, Pim A. de Jong, Paul J. Nederkoorn, Werner H. Mess, Anna Kopczak, Andreas Schindler, Tobias Saam, Luca Saba, Luc J.M. Smits, Robert J. van Oostenbrugge, M. Eline Kooi
{"title":"Comparison of MRI- and CTA-Based Plaque-RADS to Predict Stroke and TIA in Symptomatic Carotid Disease","authors":"Juul Bierens, Alida A. Postma, Kimberly Frehe, Bart A.J.M. Wagemans, Daniel Bos, Pim A. de Jong, Paul J. Nederkoorn, Werner H. Mess, Anna Kopczak, Andreas Schindler, Tobias Saam, Luca Saba, Luc J.M. Smits, Robert J. van Oostenbrugge, M. Eline Kooi","doi":"10.1016/j.jcmg.2025.10.009","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.10.009","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"134 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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