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
{"title":"Modeling Benefit of Aspirin According to Lp(a) and Coronary Artery Calcium: MESA.","authors":"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","doi":"10.1016/j.jcmg.2025.12.008","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.12.008","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"82 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146072986","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 : 2026-01-12DOI: 10.1016/j.jcmg.2025.11.009
Jacob Abdaem,Dina Labib,Rhys Beaudry,Augustine Amakiri,Steven Dykstra,Yuanchao Feng,Melanie King,Jacqueline Flewitt,Danielle A Southern,Matthew T James,Stephen B Wilton,Carmen P Lydell,Andrew G Howarth,Bryan J Har,James A White,Robert J H Miller
BACKGROUNDViability testing is frequently used in patients with ischemic cardiomyopathy (ICM). However, its role in guiding revascularization decisions remains unclear.OBJECTIVESThis study aimed to evaluate the associations between a novel, segmentally registered viability and vascular jeopardy score and mortality following revascularization.METHODSThe study included patients with ICM, defined as obstructive coronary artery disease and LVEF <50%, undergoing cardiac magnetic resonance and invasive coronary angiography between 2015 and 2022. Segmental viability was defined as scar transmurality ≤50% detected by cardiac magnetic resonance. Spatially matched distributions of vascular perfusion jeopardy were established at the time of angiography by using a patient-specific coronary anatomy tree and lesion reporting algorithm. Interactions between viability extent, coronary artery disease severity, the novel marker of jeopardized but viable myocardium, and early revascularization were assessed using propensity score-adjusted time-to-event models for mortality.RESULTSOf 941 patients (mean age 65 years; 81% male), 193 underwent early revascularization. During a median follow-up of 4.8 years, 168 deaths occurred. There were no interactions between the number of viable segments and revascularization (interaction HR: 1.09; P = 0.211) or between the Duke jeopardy score and revascularization (interaction HR: 0.93; P = 0.245) with respect to future mortality. However, a significant interaction was identified for the number of jeopardized but viable segments (interaction HR: 0.91; P = 0.008). Patients with ≥3 jeopardized but viable segments experienced significantly lower mortality following early revascularization (propensity score-adjusted HR: 0.55; P = 0.015).CONCLUSIONSPatient-specific coronary tree-based reporting to define jeopardized but viable myocardium accurately is clinically feasible and identifies ICM patients who experience lower mortality from early revascularization.
{"title":"Patient-Specific Registration of Segmental Jeopardy and Viability: Novel Method to Guide Revascularization in Ischemic Cardiomyopathy.","authors":"Jacob Abdaem,Dina Labib,Rhys Beaudry,Augustine Amakiri,Steven Dykstra,Yuanchao Feng,Melanie King,Jacqueline Flewitt,Danielle A Southern,Matthew T James,Stephen B Wilton,Carmen P Lydell,Andrew G Howarth,Bryan J Har,James A White,Robert J H Miller","doi":"10.1016/j.jcmg.2025.11.009","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.11.009","url":null,"abstract":"BACKGROUNDViability testing is frequently used in patients with ischemic cardiomyopathy (ICM). However, its role in guiding revascularization decisions remains unclear.OBJECTIVESThis study aimed to evaluate the associations between a novel, segmentally registered viability and vascular jeopardy score and mortality following revascularization.METHODSThe study included patients with ICM, defined as obstructive coronary artery disease and LVEF <50%, undergoing cardiac magnetic resonance and invasive coronary angiography between 2015 and 2022. Segmental viability was defined as scar transmurality ≤50% detected by cardiac magnetic resonance. Spatially matched distributions of vascular perfusion jeopardy were established at the time of angiography by using a patient-specific coronary anatomy tree and lesion reporting algorithm. Interactions between viability extent, coronary artery disease severity, the novel marker of jeopardized but viable myocardium, and early revascularization were assessed using propensity score-adjusted time-to-event models for mortality.RESULTSOf 941 patients (mean age 65 years; 81% male), 193 underwent early revascularization. During a median follow-up of 4.8 years, 168 deaths occurred. There were no interactions between the number of viable segments and revascularization (interaction HR: 1.09; P = 0.211) or between the Duke jeopardy score and revascularization (interaction HR: 0.93; P = 0.245) with respect to future mortality. However, a significant interaction was identified for the number of jeopardized but viable segments (interaction HR: 0.91; P = 0.008). Patients with ≥3 jeopardized but viable segments experienced significantly lower mortality following early revascularization (propensity score-adjusted HR: 0.55; P = 0.015).CONCLUSIONSPatient-specific coronary tree-based reporting to define jeopardized but viable myocardium accurately is clinically feasible and identifies ICM patients who experience lower mortality from early revascularization.","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"29 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956052","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 : 2026-01-09DOI: 10.1016/j.jcmg.2025.12.003
Eike Nagel
{"title":"Stress CMR in ISCHEMIA: Function in Its Best Form.","authors":"Eike Nagel","doi":"10.1016/j.jcmg.2025.12.003","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.12.003","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"29 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947419","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 : 2026-01-09DOI: 10.1016/j.jcmg.2025.12.006
Robert S Zhang,Jonathan W Weinsaft
{"title":"Just When We Thought Viability Was in Jeopardy.","authors":"Robert S Zhang,Jonathan W Weinsaft","doi":"10.1016/j.jcmg.2025.12.006","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.12.006","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"56 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986396","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 : 2026-01-05DOI: 10.1016/j.jcmg.2025.12.005
Andre La Gerche, Stephanie J. Rowe
{"title":"Moving From Eyeball Assessment to Quantification of the Right Ventricular “Hot Spot” in Arrhythmogenic Cardiomyopathy","authors":"Andre La Gerche, Stephanie J. Rowe","doi":"10.1016/j.jcmg.2025.12.005","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.12.005","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902492","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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