Pub Date : 2026-02-01DOI: 10.1016/j.jcmg.2025.09.022
Maan Malahfji MD , Mujtaba Saeed MD , Duc T. Nguyen MD, PhD , Yodying Kaolawanich MD , Hossam Lababidi MD , El-Moatasem Gabr MD , Alan Pan MS , Valentina Crudo MD , Michael J. Reardon MD , Michael Elliott MD , João L. Cavalcante MD , Venkateshwar Polsani MD , Sherif F. Nagueh MD , Robert O. Bonow MD , William A. Zoghbi MD , Raymond J. Kim MD , Dipan J. Shah MD
<div><h3>Background</h3><div>Management of patients with combined aortic and mitral regurgitation (AR and MR) is largely based on expert opinion. Specifically, the outcomes of patients with combined moderate AR and moderate MR under medical surveillance are uncertain.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate cardiac remodeling using cardiac magnetic resonance (CMR) in patients with combined AR/MR compared with isolated AR, to assess degree of MR associated with adverse outcomes, and evaluate the outcomes of asymptomatic patients with combined moderate AR and moderate MR under medical surveillance.</div></div><div><h3>Methods</h3><div>The authors conducted a multicenter observational outcome study of patients with moderate or severe AR on CMR, and evaluated the etiology and degree of concomitant MR in patients with combined AR and MR. They excluded patients if they had prior valvular surgery, > mild valve stenosis, hypertrophic or infiltrative cardiomyopathy, or congenital heart disease except bicuspid aortic valve. The authors evaluated ventricular volumes and function across the spectrum of regurgitation severity. Receiver-operating characteristic analyses for the association of concomitant MR severity with outcomes were performed. The primary outcome was all-cause death. Secondary outcome was all-cause death or heart failure (HF) hospitalization. Patients were censored at the time of valvular surgery or intervention. Propensity score matching was done between isolated AR and the combined AR/MR groups.</div></div><div><h3>Results</h3><div>The authors studied 915 patients with a median age of 61 years (Q1-Q3: 49-72 years), 79.5% male, 29% with bicuspid aortic valve, and a median AR fraction of 38% (Q1-Q3: 32%-45%). In 251 of 915 patients (27.4%) with concomitant MR, the median MR fraction was 24% (Q1-Q3: 17%-35%). The presence of concomitant ≥moderate MR (14.2% of the total population) was associated with a greater increase in ventricular volumes per unit increase in AR severity, and a decline in ventricular function (<em>P</em> for interaction ≤0.01). During a median follow-up of 3.0 years (Q1-Q3: 1.1-5.6 years), there were 152 deaths. Presence of concomitant ≥moderate MR was associated with an increased hazard for all-cause death (HR: 2.77; 95% CI: 1.91-4.01; <em>P <</em> 0.001), and the secondary outcome of death or HF (HR: 2.62; 95% CI: 1.87-3.67; <em>P <</em> 0.001). In asymptomatic or minimally symptomatic patients undergoing medical surveillance, the presence of combined moderate AR and moderate MR was independently associated with a higher hazard for the primary and secondary outcomes compared with isolated AR, independent of age, sex, comorbidities, ejection fraction, and end-systolic volume. Findings were consistent in the propensity matched cohort.</div></div><div><h3>Conclusions</h3><div>The presence of combined AR and MR on CMR is associated with a greater extent of ventricular remodeling and incr
{"title":"Cardiac Remodeling and Outcomes of Patients With Combined Aortic and Mitral Regurgitation","authors":"Maan Malahfji MD , Mujtaba Saeed MD , Duc T. Nguyen MD, PhD , Yodying Kaolawanich MD , Hossam Lababidi MD , El-Moatasem Gabr MD , Alan Pan MS , Valentina Crudo MD , Michael J. Reardon MD , Michael Elliott MD , João L. Cavalcante MD , Venkateshwar Polsani MD , Sherif F. Nagueh MD , Robert O. Bonow MD , William A. Zoghbi MD , Raymond J. Kim MD , Dipan J. Shah MD","doi":"10.1016/j.jcmg.2025.09.022","DOIUrl":"10.1016/j.jcmg.2025.09.022","url":null,"abstract":"<div><h3>Background</h3><div>Management of patients with combined aortic and mitral regurgitation (AR and MR) is largely based on expert opinion. Specifically, the outcomes of patients with combined moderate AR and moderate MR under medical surveillance are uncertain.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate cardiac remodeling using cardiac magnetic resonance (CMR) in patients with combined AR/MR compared with isolated AR, to assess degree of MR associated with adverse outcomes, and evaluate the outcomes of asymptomatic patients with combined moderate AR and moderate MR under medical surveillance.</div></div><div><h3>Methods</h3><div>The authors conducted a multicenter observational outcome study of patients with moderate or severe AR on CMR, and evaluated the etiology and degree of concomitant MR in patients with combined AR and MR. They excluded patients if they had prior valvular surgery, > mild valve stenosis, hypertrophic or infiltrative cardiomyopathy, or congenital heart disease except bicuspid aortic valve. The authors evaluated ventricular volumes and function across the spectrum of regurgitation severity. Receiver-operating characteristic analyses for the association of concomitant MR severity with outcomes were performed. The primary outcome was all-cause death. Secondary outcome was all-cause death or heart failure (HF) hospitalization. Patients were censored at the time of valvular surgery or intervention. Propensity score matching was done between isolated AR and the combined AR/MR groups.</div></div><div><h3>Results</h3><div>The authors studied 915 patients with a median age of 61 years (Q1-Q3: 49-72 years), 79.5% male, 29% with bicuspid aortic valve, and a median AR fraction of 38% (Q1-Q3: 32%-45%). In 251 of 915 patients (27.4%) with concomitant MR, the median MR fraction was 24% (Q1-Q3: 17%-35%). The presence of concomitant ≥moderate MR (14.2% of the total population) was associated with a greater increase in ventricular volumes per unit increase in AR severity, and a decline in ventricular function (<em>P</em> for interaction ≤0.01). During a median follow-up of 3.0 years (Q1-Q3: 1.1-5.6 years), there were 152 deaths. Presence of concomitant ≥moderate MR was associated with an increased hazard for all-cause death (HR: 2.77; 95% CI: 1.91-4.01; <em>P <</em> 0.001), and the secondary outcome of death or HF (HR: 2.62; 95% CI: 1.87-3.67; <em>P <</em> 0.001). In asymptomatic or minimally symptomatic patients undergoing medical surveillance, the presence of combined moderate AR and moderate MR was independently associated with a higher hazard for the primary and secondary outcomes compared with isolated AR, independent of age, sex, comorbidities, ejection fraction, and end-systolic volume. Findings were consistent in the propensity matched cohort.</div></div><div><h3>Conclusions</h3><div>The presence of combined AR and MR on CMR is associated with a greater extent of ventricular remodeling and incr","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 2","pages":"Pages 180-193"},"PeriodicalIF":15.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411491","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 : 2026-02-01DOI: 10.1016/j.jcmg.2025.09.013
Jolien Geers MD , Neil Craig MD , Kajetan Grodecki MD, PhD , Maria Lembo MD, PhD , Shruti S. Joshi MD, PhD , Trisha Singh MD, PhD , Rong Bing MD, PhD , Jacek Kwieciński MD, PhD , Lorenzo Carnevale PhD , Dorien Kimenai PhD , Soongu Kwak MD, PhD , Seung-Pyo Lee MD, PhD , Kush Patel MD , Thomas Treibel MD, PhD , Aroa Ruiz Muñoz MS , Jose F. Rodriguez Palomares MD, PhD , Jae-Kwan Song MD, PhD , Marie-Annick Clavel DVM, PhD , Pamela Piña MD , Daniel Lorenzatti MD , Marc R. Dweck MD, PhD
Background
Calcium scoring from noncontrast computed tomography (CT) is used clinically to adjudicate aortic stenosis severity in patients with discordant echocardiography.
Objectives
The aim of this study was to investigate whether quantification of aortic valve calcium volume from computed tomography angiography (CTA) can provide robust diagnostic discrimination of disease severity and inform risk stratification of patients with aortic stenosis.
Methods
Patients with mild to severe aortic stenosis who underwent concurrent CTA and echocardiography were included in a retrospective international multicenter observational cohort study. Accuracy of aortic valve calcium volume to diagnose severe aortic stenosis in patients with concordant disease on echocardiography was assessed. Association of aortic valve calcium volume with the incidence of aortic valve replacement or all-cause death was investigated.
Results
The study included 1,521 patients (mean age: 74 ± 10 years; 44% female; median peak aortic jet velocity: 3.8 m/s [Q1-Q3: 3.1-4.5 m/s]). Indexed aortic valve calcium volume correlated with peak aortic jet velocity (ρ = 0.723; P < 0.001) and noncontrast CT calcium score (ρ = 0.896; P < 0.001). In the derivation cohort (n = 689), sex-specific thresholds for indexed calcium volume (men: 122 mm3/cm2; women: 61 mm3/cm2) provided excellent diagnostic discrimination for severe aortic stenosis (C-statistic: 0.900 for men; 0.926 for women). Similar diagnostic discrimination was observed in the validation cohort (n = 459; C-statistic: 0.933 for men; 0.944 for women). Clinical outcomes were available in 711 patients (25% with discordant echocardiography), with 249 reaching the primary endpoint after 26 months (Q1-Q3: 12-53 months). Indexed calcium volume thresholds were independently associated with aortic valve replacement or all-cause mortality in both the cohort as a whole (HR: 2.01 [95% CI: 1.30-3.10]; P < 0.01) and those with discordant echocardiography (HR: 1.58 [95% CI: 1.01-2.44]).
Conclusions
In patients with aortic stenosis, indexed aortic valve calcium volume from CTA provides accurate discrimination of disease severity and additive prognostic information. This technique can be easily applied to patients undergoing CTA for transcatheter aortic valve replacement or coronary artery evaluation without the need for a separate noncontrast CT scan.
背景：非对比计算机断层扫描（CT）的钙评分在临床上用于判断超声心动图不一致患者主动脉狭窄的严重程度。目的：本研究的目的是探讨计算机断层血管造影（CTA）对主动脉瓣钙容量的量化是否能提供对疾病严重程度的有力诊断，并为主动脉瓣狭窄患者的风险分层提供信息。方法一项回顾性国际多中心观察队列研究纳入了同时进行CTA和超声心动图检查的轻度至重度主动脉瓣狭窄患者。评价超声心动图上主动脉瓣钙容量诊断重度主动脉狭窄的准确性。研究了主动脉瓣钙容量与主动脉瓣置换术或全因死亡发生率的关系。结果共纳入1521例患者，平均年龄74±10岁，女性44%，主动脉喷射速度中位数峰值为3.8 m/s [Q1-Q3: 3.1-4.5 m/s]。主动脉瓣指数化钙容量与峰值主动脉射流速度（ρ = 0.723, P < 0.001）和CT造影钙评分（ρ = 0.896, P < 0.001）相关。在衍生队列（n = 689）中，指数钙容量的性别特异性阈值（男性：122 mm3/cm2；女性：61 mm3/cm2）提供了对严重主动脉狭窄的良好诊断鉴别（c统计量：男性0.900；女性0.926）。在验证队列中观察到类似的诊断歧视（n = 459； c统计量：男性0.933；女性0.944）。711例患者的临床结果（25%超声心动图不一致），249例在26个月后达到主要终点（Q1-Q3: 12-53个月）。在整个队列中，指数钙容量阈值与主动脉瓣置换术或全因死亡率独立相关（HR: 2.01 [95% CI: 1.30-3.10]; P < 0.01），超声心动图不一致者（HR: 1.58 [95% CI: 1.01-2.44]）。结论在主动脉瓣狭窄患者中，CTA指数主动脉瓣钙容量可准确区分病情严重程度和附加预后信息。这项技术可以很容易地应用于接受CTA的经导管主动脉瓣置换术或冠状动脉评估的患者，而无需单独进行非对比CT扫描。
{"title":"Indexed Aortic Valve Calcium Volume by Computed Tomography Angiography in Patients With Aortic Stenosis","authors":"Jolien Geers MD , Neil Craig MD , Kajetan Grodecki MD, PhD , Maria Lembo MD, PhD , Shruti S. Joshi MD, PhD , Trisha Singh MD, PhD , Rong Bing MD, PhD , Jacek Kwieciński MD, PhD , Lorenzo Carnevale PhD , Dorien Kimenai PhD , Soongu Kwak MD, PhD , Seung-Pyo Lee MD, PhD , Kush Patel MD , Thomas Treibel MD, PhD , Aroa Ruiz Muñoz MS , Jose F. Rodriguez Palomares MD, PhD , Jae-Kwan Song MD, PhD , Marie-Annick Clavel DVM, PhD , Pamela Piña MD , Daniel Lorenzatti MD , Marc R. Dweck MD, PhD","doi":"10.1016/j.jcmg.2025.09.013","DOIUrl":"10.1016/j.jcmg.2025.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Calcium scoring from noncontrast computed tomography (CT) is used clinically to adjudicate aortic stenosis severity in patients with discordant echocardiography.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate whether quantification of aortic valve calcium volume from computed tomography angiography (CTA) can provide robust diagnostic discrimination of disease severity and inform risk stratification of patients with aortic stenosis.</div></div><div><h3>Methods</h3><div>Patients with mild to severe aortic stenosis who underwent concurrent CTA and echocardiography were included in a retrospective international multicenter observational cohort study. Accuracy of aortic valve calcium volume to diagnose severe aortic stenosis in patients with concordant disease on echocardiography was assessed. Association of aortic valve calcium volume with the incidence of aortic valve replacement or all-cause death was investigated.</div></div><div><h3>Results</h3><div>The study included 1,521 patients (mean age: 74 ± 10 years; 44% female; median peak aortic jet velocity: 3.8 m/s [Q1-Q3: 3.1-4.5 m/s]). Indexed aortic valve calcium volume correlated with peak aortic jet velocity (ρ = 0.723; <em>P <</em> 0.001) and noncontrast CT calcium score (ρ = 0.896; <em>P <</em> 0.001). In the derivation cohort (n = 689), sex-specific thresholds for indexed calcium volume (men: 122 mm<sup>3</sup>/cm<sup>2</sup>; women: 61 mm<sup>3</sup>/cm<sup>2</sup>) provided excellent diagnostic discrimination for severe aortic stenosis (C-statistic: 0.900 for men; 0.926 for women). Similar diagnostic discrimination was observed in the validation cohort (n = 459; C-statistic: 0.933 for men; 0.944 for women). Clinical outcomes were available in 711 patients (25% with discordant echocardiography), with 249 reaching the primary endpoint after 26 months (Q1-Q3: 12-53 months). Indexed calcium volume thresholds were independently associated with aortic valve replacement or all-cause mortality in both the cohort as a whole (HR: 2.01 [95% CI: 1.30-3.10]; <em>P <</em> 0.01) and those with discordant echocardiography (HR: 1.58 [95% CI: 1.01-2.44]).</div></div><div><h3>Conclusions</h3><div>In patients with aortic stenosis, indexed aortic valve calcium volume from CTA provides accurate discrimination of disease severity and additive prognostic information. This technique can be easily applied to patients undergoing CTA for transcatheter aortic valve replacement or coronary artery evaluation without the need for a separate noncontrast CT scan.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 2","pages":"Pages 210-221"},"PeriodicalIF":15.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357618","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 : 2026-02-01DOI: 10.1016/j.jcmg.2025.09.016
Frank A. Flachskampf MD, PhD , Thomas H. Marwick MD, PhD
{"title":"Is This the Last Word of the Diastology Epic?","authors":"Frank A. Flachskampf MD, PhD , Thomas H. Marwick MD, PhD","doi":"10.1016/j.jcmg.2025.09.016","DOIUrl":"10.1016/j.jcmg.2025.09.016","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 2","pages":"Pages 175-179"},"PeriodicalIF":15.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411647","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 : 2026-02-01DOI: 10.1016/j.jcmg.2025.10.006
Tom Kai Ming Wang MBCHB, MD, Simrat Kaur MD
{"title":"Expanding the Computed Tomography Angiography Toolkit","authors":"Tom Kai Ming Wang MBCHB, MD, Simrat Kaur MD","doi":"10.1016/j.jcmg.2025.10.006","DOIUrl":"10.1016/j.jcmg.2025.10.006","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 2","pages":"Pages 222-224"},"PeriodicalIF":15.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458751","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 : 2026-01-30DOI: 10.1016/j.jcmg.2025.12.011
Jin Kyung Oh,Soongu Kwak,Chan Soon Park,Byung Joo Sun,Sahmin Lee,Jun-Bean Park,Hyung-Kwan Kim,Yong-Jin Kim,Jong-Min Song,Duk-Hyun Kang,Jae-Kwan Song,Jae-Hyeong Park,Goo-Yeong Cho,Seung-Pyo Lee,Dae-Hee Kim
BACKGROUNDCurrent guidelines for degenerative mitral regurgitation (MR) emphasize left ventricular (LV) dysfunction. However, subclinical alterations in left atrial (LA) or LV strain may manifest earlier in severe MR.OBJECTIVESThis study sought to determine whether combined LA and LV strain measurements improve long-term mortality prediction in severe degenerative MR, especially in asymptomatic individuals.METHODSThis retrospective derivation cohort included 1,314 patients (mean age: 55 ± 13 years; 35% women) who underwent valve repair or replacement for severe MR. Preoperative peak atrial longitudinal strain (PALS) and LV-global longitudinal strain (GLS) were measured. Patients were categorized into 4 groups by using spline-derived thresholds (PALS: <21.4%; LV-GLS: >-20.5%). The primary outcome was all-cause mortality (median follow-up, 8.4 years). External validation included 605 independent patients.RESULTSImpaired PALS (adjusted HR [aHR]: 2.11; P < 0.001) and impaired LV-GLS (aHR: 1.66; P = 0.008) were independently associated with high mortality. The group with both impaired PALS and LV-GLS demonstrated the worst outcome (aHR: 2.50; P < 0.001). In asymptomatic patients (n = 900), the combined use of both strain parameters outperformed traditional LV dysfunction criteria (LV ejection fraction ≤60% or LV end-systolic dimension ≥40 mm), thereby significantly improving net reclassification (net reclassification index = 0.436; P < 0.001) and discrimination (integrated discrimination improvement = 0.024; P = 0.003). Subgroup analyses demonstrated that the prognostic contribution of each strain parameter varied by the functional status of the other chamber. External validation confirmed these associations.CONCLUSIONSConcomitant impairment of both PALS and LV-GLS identified patients at the highest mortality risk. These findings support an integrated atrial-ventricular strain assessment to improve prognostic stratification, particularly in asymptomatic patients with severe degenerative MR who are undergoing MV surgery.
背景：目前退行性二尖瓣反流（MR）的指南强调左心室（LV）功能障碍。然而，左房（LA）或左室应变的亚临床改变可能在严重MR中更早表现出来。目的：本研究旨在确定LA和左室应变联合测量是否能改善严重退行性MR的长期死亡率预测，特别是在无症状个体中。方法回顾性分析1314例严重mr患者（平均年龄55±13岁，女性占35%）行瓣膜修复或置换术，测量术前峰值心房纵向应变（PALS）和左心室整体纵向应变（GLS）。根据样条衍生阈值（PALS: -20.5%）将患者分为4组。主要结局为全因死亡率（中位随访8.4年）。外部验证包括605名独立患者。结果pal受损（校正HR [aHR]: 2.11, P < 0.001）和LV-GLS受损（aHR: 1.66, P = 0.008）与高死亡率独立相关。pal和LV-GLS均受损组预后最差（aHR: 2.50; P < 0.001）。在无症状患者（n = 900）中，两种应变参数联合使用优于传统的左室功能障碍标准（左室射血分数≤60%或左室收缩末期尺寸≥40 mm），从而显著改善净重分类（净重分类指数= 0.436,P < 0.001）和判别（综合判别改善= 0.024,P = 0.003）。亚组分析表明，每个应变参数的预后贡献因其他腔室的功能状态而异。外部验证证实了这些关联。结论pal和LV-GLS同时受损的患者死亡风险最高。这些发现支持综合的房室应变评估，以改善预后分层，特别是对无症状的严重退行性MR患者进行中压手术。
{"title":"Integrated Atrial and Ventricular Strain Assessment in Patients With Severe Degenerative Mitral Regurgitation Undergoing Surgery.","authors":"Jin Kyung Oh,Soongu Kwak,Chan Soon Park,Byung Joo Sun,Sahmin Lee,Jun-Bean Park,Hyung-Kwan Kim,Yong-Jin Kim,Jong-Min Song,Duk-Hyun Kang,Jae-Kwan Song,Jae-Hyeong Park,Goo-Yeong Cho,Seung-Pyo Lee,Dae-Hee Kim","doi":"10.1016/j.jcmg.2025.12.011","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.12.011","url":null,"abstract":"BACKGROUNDCurrent guidelines for degenerative mitral regurgitation (MR) emphasize left ventricular (LV) dysfunction. However, subclinical alterations in left atrial (LA) or LV strain may manifest earlier in severe MR.OBJECTIVESThis study sought to determine whether combined LA and LV strain measurements improve long-term mortality prediction in severe degenerative MR, especially in asymptomatic individuals.METHODSThis retrospective derivation cohort included 1,314 patients (mean age: 55 ± 13 years; 35% women) who underwent valve repair or replacement for severe MR. Preoperative peak atrial longitudinal strain (PALS) and LV-global longitudinal strain (GLS) were measured. Patients were categorized into 4 groups by using spline-derived thresholds (PALS: <21.4%; LV-GLS: >-20.5%). The primary outcome was all-cause mortality (median follow-up, 8.4 years). External validation included 605 independent patients.RESULTSImpaired PALS (adjusted HR [aHR]: 2.11; P < 0.001) and impaired LV-GLS (aHR: 1.66; P = 0.008) were independently associated with high mortality. The group with both impaired PALS and LV-GLS demonstrated the worst outcome (aHR: 2.50; P < 0.001). In asymptomatic patients (n = 900), the combined use of both strain parameters outperformed traditional LV dysfunction criteria (LV ejection fraction ≤60% or LV end-systolic dimension ≥40 mm), thereby significantly improving net reclassification (net reclassification index = 0.436; P < 0.001) and discrimination (integrated discrimination improvement = 0.024; P = 0.003). Subgroup analyses demonstrated that the prognostic contribution of each strain parameter varied by the functional status of the other chamber. External validation confirmed these associations.CONCLUSIONSConcomitant impairment of both PALS and LV-GLS identified patients at the highest mortality risk. These findings support an integrated atrial-ventricular strain assessment to improve prognostic stratification, particularly in asymptomatic patients with severe degenerative MR who are undergoing MV surgery.","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"73 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073078","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 : 2026-01-28DOI: 10.1016/j.jcmg.2025.12.009
Daniel A. Morris, Tor Biering‑Sørensen, Kristoffer Skaarup, Jo-Nan Liao, Philipp Stawowy, Tobias Trippel, Ingo Hilgendorf, Matthias Schneider-Reigbert, Chung-Lieh Hung, Athanasios Frydas
{"title":"Lower Limit of the Reference Normal Range for Left Atrial Strain","authors":"Daniel A. Morris, Tor Biering‑Sørensen, Kristoffer Skaarup, Jo-Nan Liao, Philipp Stawowy, Tobias Trippel, Ingo Hilgendorf, Matthias Schneider-Reigbert, Chung-Lieh Hung, Athanasios Frydas","doi":"10.1016/j.jcmg.2025.12.009","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.12.009","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"104 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146072219","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 : 2026-01-28DOI: 10.1016/j.jcmg.2025.12.008
Alexander C Razavi,Omar Dzaye,Harpreet S Bhatia,Viola Vaccarino,Anurag Mehta,Jerome I Rotter,Xiuqing Guo,Kent D Taylor,Jie Yao,Xiaohui Li,Stephen S Rich,Matthew J Budoff,Michael Y Tsai,Ron Blankstein,Michael D Shapiro,Khurram Nasir,Sotirios Tsimikas,Roger S Blumenthal,Seamus P Whelton,Michael J Blaha,Laurence S Sperling
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