JACC. Cardiovascular imaging最新文献

英文中文

Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical Low-Flow Low-Gradient Aortic Stenosis 利用加速度-射血时间比对未分化型低流量低梯度主动脉瓣狭窄进行诊断和介入指导

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.05.015

Adrian Chong MBBS, BPharm , Jonathan Sen MBBS, BHSc , Reza Reyaldeen MBBS, BSc , Sudhir Wahi MBBS, MD , Quan Huynh BMed, PhD , William Y.S. Wang MBBS, PhD , Thomas H. Marwick MBBS, PhD, MPH

Background

Studies in paradoxical low-flow low-gradient aortic stenosis (PLFAS) have demonstrated conflicting outcomes with variable survival advantage from aortic valve replacement (AVR). PLFAS is a heterogeneous composition of patients with uncertainty regarding true stenosis severity that continues to confound decision-making for AVR.

Objectives

The purpose of this study was to investigate the utility of the Doppler acceleration (AT) to ejection (ET) time ratio (AT:ET) for prediction of prognosis and benefit from AVR in undifferentiated PLFAS.

Methods

Patients with echocardiographic findings of PLFAS (aortic valve area <1.0 cm² or indexed aortic valve area <0.6 cm²/m², mean gradient <40 mm Hg, indexed stroke volume <35 mL/m², and left ventricular ejection fraction ≥50%) were identified and grouped according to an AT:ET cutoff of 0.35. The primary outcome was a 5-year composite of cardiac mortality or AVR. Secondary outcomes included the individual components of the primary endpoint and all-cause mortality at 5 years. Effect of AVR was analyzed in the AT:ET <0.35 and ≥0.35 groups.

Results

A total of 171 PLFAS patients (median age 77.0 years, 57% women) were followed for a median of 8.9 years. AT:ET ≥0.35 was an independent predictor of the primary outcome (HR: 4.77 [95% CI: 2.94-7.75]; P < 0.001) with incremental value over standard indices of stenosis severity (net reclassification improvement: 0.57 [95% CI: 0.14-0.84]). AT:ET ≥0.35 also remained predictive of increased cardiac death (HR: 2.91 [95% CI: 1.47-5.76]; P = 0.002) and AVR (HR: 8.45 [95% CI: 4.16-17.1]; P < 0.001), respectively, following competing risk analysis. No difference in all-cause mortality was observed. AVR in the AT:ET ≥0.35 group was associated with significant reductions in 5-year cardiac (HR: 0.09 [95% CI: 0.02-0.36]; P < 0.001) and all-cause mortality (HR: 0.16 [95% CI: 0.07-0.38]; P < 0.001). No improvement in survival from AVR was demonstrated in AT:ET <0.35 patients.

Conclusions

AT:ET ≥0.35 in PLFAS predicts poorer outcomes and/or need for AVR. In undifferentiated PLFAS patients, AT:ET may have a potential role in improving patient selection for prognostic AVR.

背景：对矛盾性低流量低梯度主动脉瓣狭窄（PLFAS）的研究表明，主动脉瓣置换术（AVR）的生存优势各不相同，结果也相互矛盾。PLFAS 患者的构成不尽相同，其真实狭窄严重程度不确定，这继续对 AVR 的决策造成困惑：本研究旨在探讨多普勒加速（AT）与射血（ET）时间比值（AT:ET）在预测未分化的 PLFAS 患者的预后和从 AVR 中获益方面的实用性：确定了超声心动图检查结果为 PLFAS 的患者（主动脉瓣面积 2 或指数化主动脉瓣面积 2/m2、平均梯度 2 和左室射血分数≥50%），并根据 AT:ET 临界值 0.35 进行分组。主要结果是心脏死亡率或 AVR 的 5 年综合结果。次要结果包括主要终点的各个组成部分和 5 年的全因死亡率。AVR的效果在AT:ET结果中进行分析：共有 171 名 PLFAS 患者（中位年龄 77.0 岁，57% 为女性）接受了中位 8.9 年的随访。AT:ET≥0.35 是主要结果的独立预测指标（HR：4.77 [95% CI：2.94-7.75]；P <0.001），与狭窄严重程度的标准指数相比具有增量价值（净再分类改进：0.57 [95% CI：0.14-0.84]）。在进行竞争风险分析后，AT:ET ≥0.35也仍可分别预测更高的心源性死亡（HR：2.91 [95% CI：1.47-5.76]；P = 0.002）和AVR（HR：8.45 [95% CI：4.16-17.1]；P < 0.001）。全因死亡率无差异。AT:ET≥0.35 组的 AVR 与 5 年心脏死亡率（HR：0.09 [95% CI：0.02-0.36]；P <0.001）和全因死亡率（HR：0.16 [95% CI：0.07-0.38]；P <0.001）的显著降低相关。结论：AT:ET 患者的 AVR 存活率没有改善：PLFAS 中 AT:ET≥0.35 的患者预示着较差的预后和/或需要进行 AVR。在未分化的 PLFAS 患者中，AT:ET 在改善预后性 AVR 患者选择方面具有潜在作用。

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引用次数: 0

Evaluating Patient-Oriented Echocardiogram Reports Augmented by Artificial Intelligence 评估人工智能增强的以患者为导向的超声心动图报告。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.05.021

Jacob A. Martin MD, MSCR, Theodore Hill BA, Muhamed Saric MD, PhD, Alan F. Vainrib MD, Daniel Bamira MD, Samuel Bernard MD, Richard Ro MD, Hao Zhang MS, Jonathan S. Austrian MD, Yindalon Aphinyanaphongs MD, PhD, Vidya Koesmahargyo MS, Mathew R. Williams MD, Larry A. Chinitz MD, Lior Jankelson MD, PhD

引用次数: 0

Imaging in Amyloidosis 淀粉样变性的成像：20 年的持续创新。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.06.005

Marianna Fontana MD, PhD , Aldostefano Porcari MD

引用次数: 0

Fibro-Calcific Imaging 纤维钙化成像：迈向主动脉瓣病理生理学更全面方法的一步？

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.07.020

Stephanie L. Sellers MSc, PhD , David Meier MD

引用次数: 0

Clinical Significance of Myocardial Injury in Patients Hospitalized for COVID-19 COVID-19 住院患者心肌损伤的临床意义：一项前瞻性、多中心、队列研究。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.06.008

Hunain Shiwani BMBS , Jessica Artico MD , James C. Moon MD , Miroslawa Gorecka MB , Gerry P. McCann MD , Giles Roditi MD , Andrew Morrow MBChB , Kenneth Mangion PhD , Elena Lukaschuk MSc , Mayooran Shanmuganathan MBBS , Christopher A. Miller PhD , Amedeo Chiribiri PhD , Mohammed Alzahir MBBS , Sara Ramirez MD , Andrew Lin MBBS , Peter P. Swoboda PhD , Adam K. McDiarmid PhD , Robert Sykes MBChB , Trisha Singh MBBS , Chiara Bucciarelli-Ducci PhD , Ifza Hussain

Background

Hospitalized COVID-19 patients with troponin elevation have a higher prevalence of cardiac abnormalities than control individuals. However, the progression and impact of myocardial injury on COVID-19 survivors remain unclear.

Objectives

This study sought to evaluate myocardial injury in COVID-19 survivors with troponin elevation with baseline and follow-up imaging and to assess medium-term outcomes.

Methods

This was a prospective, longitudinal cohort study in 25 United Kingdom centers (June 2020 to March 2021). Hospitalized COVID-19 patients with myocardial injury underwent cardiac magnetic resonance (CMR) scans within 28 days and 6 months postdischarge. Outcomes were tracked for 12 months, with quality of life surveys (EuroQol-5 Dimension and 36-Item Short Form surveys) taken at discharge and 6 months.

Results

Of 342 participants (median age: 61.3 years; 71.1% male) with baseline CMR, 338 had a 12-month follow-up, 235 had a 6-month CMR, and 215 has baseline and follow-up quality of life surveys. Of 338 participants, within 12 months, 1.2% died; 1.8% had new myocardial infarction, acute coronary syndrome, or coronary revascularization; 0.8% had new myopericarditis; and 3.3% had other cardiovascular events requiring hospitalization. At 6 months, there was a minor improvement in left ventricular ejection fraction (1.8% ± 1.0%; P < 0.001), stable right ventricular ejection fraction (0.4% ± 0.8%; P = 0.50), no change in myocardial scar pattern or volume (P = 0.26), and no imaging evidence of continued myocardial inflammation. All pericardial effusions (26 of 26) resolved, and most pneumonitis resolved (95 of 101). EuroQol-5 Dimension scores indicated an overall improvement in quality of life (P < 0.001).

Conclusions

Myocardial injury in severe hospitalized COVID-19 survivors is nonprogressive. Medium-term outcomes show a low incidence of major adverse cardiovascular events and improved quality of life. (COVID-19 Effects on the Heart; ISRCTN58667920)

背景：与对照组相比，肌钙蛋白升高的 COVID-19 住院患者的心脏异常发生率更高。然而，COVID-19 存活者心肌损伤的进展和影响仍不清楚：本研究旨在通过基线和随访成像评估肌钙蛋白升高的 COVID-19 幸存者的心肌损伤情况，并评估中期预后：这是一项前瞻性纵向队列研究，在英国的 25 个中心进行（2020 年 6 月至 2021 年 3 月）。住院的 COVID-19 心肌损伤患者在出院后 28 天和 6 个月内接受了心脏磁共振 (CMR) 扫描。在出院和 6 个月时进行生活质量调查（EuroQol-5 Dimension 和 36-Item Short Form 调查），对结果进行为期 12 个月的跟踪：在 342 名基线 CMR 患者（中位年龄：61.3 岁；71.1% 为男性）中，338 人接受了 12 个月的随访，235 人接受了 6 个月的 CMR 随访，215 人接受了基线和随访生活质量调查。在 338 名参与者中，1.2% 的人在 12 个月内死亡；1.8% 的人新发心肌梗死、急性冠状动脉综合征或冠状动脉血运重建；0.8% 的人新发心肌炎；3.3% 的人发生其他需要住院治疗的心血管事件。6 个月后，左心室射血分数略有改善（1.8% ± 1.0%；P < 0.001），右心室射血分数稳定（0.4% ± 0.8%；P = 0.50），心肌瘢痕形态或体积无变化（P = 0.26），也没有持续心肌炎症的影像学证据。所有心包积液（26 例中的 26 例）均已消退，大多数肺炎也已消退（101 例中的 95 例）。EuroQol-5维度评分显示生活质量总体有所改善（P < 0.001）：结论：COVID-19重症住院幸存者的心肌损伤是非进行性的。结论：COVID-19 严重住院病人的心肌损伤是非进行性的，中期结果显示重大不良心血管事件的发生率较低，生活质量有所改善。(COVID-19对心脏的影响；ISRCTN58667920）。

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引用次数: 0

Cancer and the Heart 癌症与心脏

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.09.003

Paaladinesh Thavendiranathan MD, SM (Associate Editor, JACC: Cardiovascular Imaging), Y. Chandrashekhar MD (Editor-in-Chief, JACC: Cardiovascular Imaging)

引用次数: 0

Unlocking Virtual Physiology Guided PCI 开启虚拟生理学引导的 PCI：护理点 CT-FFR 性能。

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JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.06.018

Mariusz Kruk MD, PhD, Marcin Demkow MD, PhD, Jan Henzel MD, PhD, Mariusz Dębski MD, PhD, Piotr Rudziński MD, PhD, Jakub Czarnecki, Marek Wiśniewski MD, Adam Witkowski MD, PhD, Cezary Kępka MD, PhD

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Medium-Term Outcomes of Hospitalized COVID-19 Patients With Myocardial Injury COVID-19心肌损伤住院患者的中期预后：谨慎乐观。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.07.012

Mahesh K. Vidula MD , Yuchi Han MD, MMSc

引用次数: 0

Optimal Identification of Severe Aortic Stenosis in Low-Flow, Low-Gradient State 低流量、低梯度状态下严重主动脉瓣狭窄的最佳识别：陪审团仍未做出结论。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.06.014

Roxy Senior MD, DM , Rajdeep S. Khattar DM

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Prognostic Impact of Culprit Lesion Calcified Nodule After Emergency Coronary Intervention 急诊冠状动脉介入治疗后病灶钙化结节的预后影响：TACTICS注册子分析。

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JACC. Cardiovascular imaging

Pub Date : 2024-11-01 DOI: 10.1016/j.jcmg.2024.06.010

Masahiro Hada MD, PhD, Tsunekazu Kakuta MD, PhD, Tomoyo Sugiyama MD, PhD, Masahiro Hoshino MD, PhD, Taishi Yonetsu MD, PhD, Eisuke Usui MD, PhD, Yoshihiro Hanyu MD, Tatsuhiro Nagamine MD, Kai Nogami MD, Hiroki Ueno MD, Kazuki Matsuda MD, Kodai Sayama MD, Mirei Setoguchi MD, Tomohiro Tahara MD, Tatsuya Sakamoto MD, Takashi Mineo MD, Nobuaki Kobayashi MD, PhD, Masamichi Takano MD, PhD, Seita Kondo MD, PhD, Kohei Wakabayashi MD, PhD, Toshiro Shinke MD, PhD

引用次数: 0

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