JACC. Cardiovascular imaging最新文献

英文中文

High-Gradient “Moderate” Aortic Stenosis

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2024.10.013

William A. Zoghbi MD

引用次数: 0

Imaging Topic of the Year

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2025.01.001

Thomas H. Marwick MBBS, PhD, MPH (Executive Editor, JACC: Cardiovascular Imaging), Y. Chandrashekhar MD, DM (Editor-in-Chief, JACC: Cardiovascular Imaging)

引用次数: 0

Diffuse Interstitial Fibrosis of the Myocardium Predicts Outcome in Moderate and Asymptomatic Severe Aortic Stenosis 心肌弥漫性间质纤维化可预测中度和无症状重度主动脉瓣狭窄的预后

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2024.08.003

Hyun-Jung Lee MD, PhD , Anvesha Singh MBChB, PhD , Jaehyun Lim MD , Neil Craig MD , Rong Bing MD , Lionel Tastet PhD , Jun-Bean Park MD, PhD , Hyung-Kwan Kim MD, PhD , Yong-Jin Kim MD, PhD , Marie-Annick Clavel DVM, PhD , Bernhard L. Gerber MD, PhD , Gerry P. McCann MBChB, MD , Marc R. Dweck MD, PhD , Phillipe Pibarot DVM, PhD , Seung-Pyo Lee MD, PhD

Background

Patients with moderate or asymptomatic severe aortic stenosis (AS) are at risk of cardiovascular events.

Objectives

The authors investigated the utility of cardiac magnetic resonance (CMR) to identify drivers of outcome in patients with moderate or asymptomatic severe AS.

Methods

A prospective, international, multicenter cohort (n = 457) of patients with moderate (aortic valve area [AVA]: 1.0-1.5 cm²) or asymptomatic severe AS (AVA ≤1.0 cm² and NYHA functional class I-II) patients underwent CMR. Diffuse interstitial fibrosis and scar in the myocardium were analyzed with extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The outcome was a composite of mortality and heart failure admission.

Results

Median ECV% was 26.6% (IQR: 24.4%-29.9%), and LGE was present in 31.5% (median 0.8%; IQR: 0.1%-1.7%). Greater AS severity was associated with greater left ventricular mass and diastolic dysfunction, but not with ECV% or LGE. During a median 5.7 years of follow-up, 83 events occurred. Patients with events had higher ECV% (median ECV% 26.3% vs 28.2%; P = 0.003). Patients in the highest ECV% tertiles (ECV% >28.6%) had worse outcomes both in the entire cohort and in those with NYHA functional class I moderate or severe AS, and ECV% was independently associated with outcome (adjusted HR: 1.05; P = 0.039). The ECV% had significant incremental prognostic value when added to parameters of AS severity and cardiac function, comorbidities, aortic valve replacement, and LGE (P < 0.05).

Conclusions

Increased diffuse interstitial fibrosis of the myocardium is associated with poor outcomes in patients with moderate and asymptomatic severe AS and can help identify those who require closer surveillance for adverse outcomes.

背景：中度或无症状重度主动脉瓣狭窄（AS）患者有发生心血管事件的风险：作者研究了心脏磁共振（CMR）在确定中度或无症状重度主动脉瓣狭窄患者预后驱动因素方面的作用：对中度（主动脉瓣面积 [AVA]：1.0-1.5 cm2）或无症状重度 AS（AVA ≤1.0 cm2 且 NYHA 功能分级 I-II）患者进行了前瞻性、国际性、多中心队列（n = 457）CMR检查。通过细胞外体积分数（ECV%）和晚期钆增强（LGE）分析心肌弥漫性间质纤维化和瘢痕。结果是死亡率和心力衰竭入院率的综合：中位ECV%为26.6%（IQR：24.4%-29.9%），31.5%出现LGE（中位0.8%；IQR：0.1%-1.7%）。强直性脊柱炎的严重程度与左心室质量和舒张功能障碍的增加有关，但与ECV%或LGE无关。在中位 5.7 年的随访期间，共发生了 83 起事件。发生事件的患者ECV%较高（中位ECV% 26.3% vs 28.2%；P = 0.003）。无论是在整个队列中，还是在 NYHA 功能分级 I 中度或重度强直性脊柱炎患者中，ECV% 最高的三分位数（ECV% >28.6%）患者的预后都较差，ECV% 与预后有独立相关性（调整后 HR：1.05；P = 0.039）。如果将ECV%与AS严重程度和心功能参数、合并症、主动脉瓣置换术和LGE相加，则ECV%具有显著的增量预后价值（P < 0.05）：结论：心肌弥漫性间质纤维化的增加与中度和无症状重度强直性脊柱炎患者的不良预后有关，有助于识别需要更密切监测不良预后的患者。

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引用次数: 0

Definition and Validation of Prognostic Phenotypes in Moderate Aortic Stenosis 中度主动脉瓣狭窄预后表型的定义与验证

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2024.06.013

Jonathan Sen MBBS , Sudhir Wahi MD , William Vollbon BS, BAppS, GradDipCardiac (Ultrasound) , Marcus Prior HSC , Alex G.C. de Sá PhD , David B. Ascher PhD , Quan Huynh BMed, PhD , Thomas H. Marwick MBBS, PhD, MPH

Background

Adverse outcomes from moderate aortic stenosis (AS) may be caused by progression to severe AS or by the effects of comorbidities. In the absence of randomized trial evidence favoring aortic valve replacement (AVR) in patients with moderate AS, phenotyping patients according to risk may assist decision making.

Objectives

This study sought to identify and validate clusters of moderate AS that may be used to guide patient management.

Methods

Unsupervised clustering algorithms were applied to demographics, comorbidities, and echocardiographic parameters in a training data set in patients with moderate AS (n = 2,469). External validation was obtained by assigning the defined clusters to an independent group with moderate AS (n = 1,358). The primary outcome, a composite of cardiac death, heart failure hospitalization, or aortic valve (AV) intervention after 5 years, was assessed between clusters in both data sets.

Results

Four distinct clusters—cardiovascular (CV)-comorbid, low-flow, calcified AV, and low-risk—with significant outcomes (log-rank P < 0.0001 in both data sets) were identified and replicated. The highest risk was in the CV-comorbid cluster (validation HR: 2.00 [95% CI: 1.54-2.59]; P < 0.001). The effect of AVR on cardiac death differed among the clusters. There was a significantly lower rate of outcomes after AVR in the calcified AV cluster (validation HR: 0.21 [95% CI: 0.08-0.57]; P = 0.002), but no significant effect on outcomes in the other 3 clusters. These analyses were limited by the low rate of AVR.

Conclusions

Moderate AS has several phenotypes, and multiple comorbidities are the key drivers of adverse outcomes in patients with moderate AS. Outcomes of patients with noncalcified moderate AS were not altered by AVR in these groups. Careful attention to subgroups of moderate AS may be important to define treatable risk.

背景：中度主动脉瓣狭窄（AS）的不良后果可能是由于发展为重度AS或合并症的影响造成的。在缺乏随机试验证据支持对中度主动脉瓣狭窄患者进行主动脉瓣置换术（AVR）的情况下，根据风险对患者进行表型分析可能有助于决策：本研究旨在识别和验证可用于指导患者管理的中度 AS 聚类：方法：将无监督聚类算法应用于中度强直性脊柱炎患者（n = 2,469）训练数据集中的人口统计学、合并症和超声心动图参数。将定义好的聚类分配给独立的中度强直性脊柱炎患者组（n = 1,358），进行外部验证。主要结果是5年后心脏死亡、心衰住院或主动脉瓣（AV）介入治疗的综合结果，在两个数据集的群组间进行评估：结果：发现并复制了四个不同的群组--心血管（CV）并发症群组、低流量群组、主动脉瓣钙化群组和低风险群组--这些群组均有显著的结果（两个数据集的对数秩P均小于0.0001）。合并 CV 组的风险最高（验证 HR：2.00 [95% CI：1.54-2.59]；P <0.001）。AVR 对心脏性死亡的影响在各组间有所不同。在钙化房室群中，房室重建后的预后率明显较低（验证 HR：0.21 [95% CI：0.08-0.57]；P = 0.002），但对其他 3 个群中的预后没有明显影响。这些分析因房室重建率较低而受到限制：中度强直性脊柱炎有多种表型，多种并发症是导致中度强直性脊柱炎患者不良预后的主要因素。非钙化中度强直性脊柱炎患者的预后在这些组别中并未因房室重建而改变。仔细观察中度强直性脊柱炎的亚组对于确定可治疗的风险可能很重要。

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引用次数: 0

High-Risk Lesion-Level Physiology and Morphology 高风险病变水平的生理学和形态学：一个不幸福结局的婚姻....

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2024.09.013

Amir Ahmadi MD , Jagat Narula MD, PhD

引用次数: 0

Deep Learning Model of Diastolic Dysfunction Risk Stratifies the Progression of Early-Stage Aortic Stenosis 舒张功能障碍风险深度学习模型为早期主动脉瓣狭窄的进展分层

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2024.07.017

Márton Tokodi MD, PhD , Rohan Shah MD , Ankush Jamthikar MTech, PhD , Neil Craig MD , Yasmin Hamirani MD , Grace Casaclang-Verzosa MD, MBA , Rebecca T. Hahn MD , Marc R. Dweck MD, PhD , Philippe Pibarot DVM, PhD , Naveena Yanamala MSc, PhD , Partho P. Sengupta MD, DM

Background

The development and progression of aortic stenosis (AS) from aortic valve (AV) sclerosis is highly variable and difficult to predict.

Objectives

The authors investigated whether a previously validated echocardiography-based deep learning (DL) model assessing diastolic dysfunction (DD) could identify the latent risk associated with the development and progression of AS.

Methods

The authors evaluated 898 participants with AV sclerosis from the ARIC (Atherosclerosis Risk In Communities) cohort study and associated the DL-predicted probability of DD with 2 endpoints: 1) the new diagnosis of AS; and 2) the composite of subsequent mortality or AV interventions. Validation was performed in 2 additional cohorts: 1) in 50 patients with mild-to-moderate AS undergoing cardiac magnetic resonance (CMR) imaging and serial echocardiographic assessments; and 2) in 18 patients with AV sclerosis undergoing ¹⁸F-sodium fluoride (NaF) and ¹⁸F-fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) to assess valvular inflammation and calcification.

Results

In the ARIC cohort, a higher DL-predicted probability of DD was associated with the development of AS (adjusted HR: 3.482 [95% CI: 2.061-5.884]; P < 0.001) and subsequent mortality or AV interventions (adjusted HR: 7.033 [95% CI: 3.036-16.290]; P < 0.001). The multivariable Cox model (incorporating the DL-predicted probability of DD) derived from the ARIC cohort efficiently predicted the progression of AS (C-index: 0.798 [95% CI: 0.648-0.948]) in the CMR cohort. Moreover, the predictions of this multivariable Cox model correlated positively with valvular ¹⁸F-NaF mean standardized uptake values in the PET/CT cohort (r = 0.62; P = 0.008).

Conclusions

Assessment of DD using DL can stratify the latent risk associated with the progression of early-stage AS.

背景：主动脉瓣（AV）硬化引起的主动脉瓣狭窄（AS）的发展和进展变化很大且难以预测：作者研究了之前经过验证的基于超声心动图的舒张功能障碍（DD）评估深度学习（DL）模型能否识别与主动脉瓣狭窄的发展和进展相关的潜在风险：作者评估了来自 ARIC（社区动脉粥样硬化风险）队列研究的 898 名患有房室硬化症的参与者，并将 DL 预测的 DD 概率与 2 个终点相关联：1）强直性脊柱炎的新诊断；2）随后的死亡率或房室介入治疗的综合结果。在另外两个队列中进行了验证：1）50 名轻度至中度 AS 患者接受心脏磁共振（CMR）成像和连续超声心动图评估；2）18 名房室硬化患者接受 18F 氟化钠（NaF）和 18F 氟脱氧葡萄糖正电子发射断层扫描（PET）联合计算机断层扫描（CT）评估瓣膜炎症和钙化：在ARIC队列中，DD的DL预测概率越高，AS的发病率越高（调整后HR：3.482 [95% CI：2.061-5.884]；P < 0.001），随后的死亡率或AV干预率也越高（调整后HR：7.033 [95% CI：3.036-16.290]；P < 0.001）。来自 ARIC 队列的多变量 Cox 模型（包含 DL 预测的 DD 概率）可有效预测 CMR 队列中 AS 的进展（C 指数：0.798 [95% CI：0.648-0.948]）。此外，这一多变量 Cox 模型的预测值与 PET/CT 队列中的瓣膜 18F-NaF 平均标准化摄取值呈正相关（r = 0.62；P = 0.008）：结论：使用 DL 评估 DD 可以对与早期 AS 进展相关的潜在风险进行分层。

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引用次数: 0

High-Gradient Aortic Stenosis With Valve Area >1.0 cm2 瓣膜面积大于 1.0 平方厘米的高梯度主动脉瓣狭窄：被 "遗忘 "的不和谐血流动力学表型。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2024.07.025

Saki Ito MD, MSc , Jae K. Oh MD , Hector I. Michelena MD , Alexander C. Egbe MBBS, MPH , Heidi M. Connolly MD , Patricia A. Pellikka MD , Vuyisile T. Nkomo MD, MPH , Bradley R. Lewis MSc , William R. Miranda MD

Background

Clinical features and outcomes in severe aortic stenosis (AS) have been described according to the hemodynamic phenotypes.

Objectives

The aim of this study was to investigate the clinical features and prognosis of patients with high-gradient (HG) AS with aortic valve area (AVA) >1.0 cm².

Methods

A total of 3,209 patients were identified according to AVA (cm²), peak velocity (m/s), systolic mean pressure gradient (MG) (mm Hg): HG-AVA >1 = >1.0, ≥4, and ≥40, HG-AVA ≤1 = ≤1.0, ≥4, and ≥40; LG-AVA ≤1 (low-gradient) = ≤1.0, <4, and <40; moderate AS = 1.0 <AVA ≤1.5, 3 ≤ peak velocity <4, and 20 ≤ MG <40.

Results

HG-AVA >1 accounted for 230 individuals (7.2%). Compared with others, patients with HG-AVA >1 were younger (70.2 ± 12.0 years), more frequently male (85.7%), had fewer comorbidities, larger body surface area and stroke volume (115 ± 19.3 mL), and had higher prevalence of bicuspid valve (39.6%). After a follow-up of 944 days (Q1-Q3: 27-2,212 days), 1,523 deaths occurred. Compared with the HG-AVA >1 group, all-cause mortality was higher in HG-AVA ≤1 (HR: 1.4; 95% CI: 1.1-1.7), LG-AVA ≤1 (HR: 2.8; 95% CI: 2.2-3.6), and moderate AS (HR: 1.4; 95% CI: 1.1-1.7). These differences were no longer significant after adjustment for age, comorbidities, bicuspid valve, and cardiac function. In the HG-AVA >1 group, patients with aortic valve replacement had better survival outcomes than those without aortic valve replacement (P < 0.001) after balancing the 2 groups.

Conclusions

The underlying relative high-flow status is responsible for HG in patients with HG-AVA >1. This profile has better prognosis than others, being related to underlying younger age and better general and cardiac conditions, but aortic valve replacement may still benefit these patients.

背景：严重主动脉瓣狭窄（AS）的临床特征和预后是根据血液动力学表型描述的：本研究旨在调查主动脉瓣面积（AVA）大于1.0 cm2的高梯度（HG）主动脉瓣狭窄患者的临床特征和预后：方法：根据主动脉瓣面积（AVA）（cm2）、峰值速度（m/s）、收缩期平均压力阶差（MG）（mmHg）确定3209名患者：HG-AVA>1=>1.0、≥4和≥40，HG-AVA≤1=≤1.0、≥4和≥40；LG-AVA≤1（低阶差）=≤1.0，结果：HG-AVA>1的有230人（7.2%）。与其他患者相比，HG-AVA >1患者更年轻（70.2 ± 12.0岁），男性更多（85.7%），合并症更少，体表面积和卒中量更大（115 ± 19.3 mL），双尖瓣患病率更高（39.6%）。随访 944 天（Q1-Q3：27-2,212 天）后，1,523 人死亡。与 HG-AVA >1 组相比，HG-AVA ≤1（HR：1.4；95% CI：1.1-1.7）、LG-AVA ≤1（HR：2.8；95% CI：2.2-3.6）和中度 AS（HR：1.4；95% CI：1.1-1.7）组的全因死亡率较高。在对年龄、合并症、二尖瓣和心脏功能进行调整后，这些差异不再显著。在HG-AVA>1组中，对两组进行平衡后，主动脉瓣置换术患者的生存预后优于未行主动脉瓣置换术的患者（P<0.001）：HG-AVA>1患者的HG是由潜在的相对高流量状态引起的。这种情况的预后比其他情况好，这与潜在的年龄较小、全身和心脏状况较好有关，但主动脉瓣置换术仍可使这些患者受益。

{"title":"High-Gradient Aortic Stenosis With Valve Area >1.0 cm2","authors":"Saki Ito MD, MSc , Jae K. Oh MD , Hector I. Michelena MD , Alexander C. Egbe MBBS, MPH , Heidi M. Connolly MD , Patricia A. Pellikka MD , Vuyisile T. Nkomo MD, MPH , Bradley R. Lewis MSc , William R. Miranda MD","doi":"10.1016/j.jcmg.2024.07.025","DOIUrl":"10.1016/j.jcmg.2024.07.025","url":null,"abstract":"<div><h3>Background</h3><div>Clinical features and outcomes in severe aortic stenosis (AS) have been described according to the hemodynamic phenotypes.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate the clinical features and prognosis of patients with high-gradient (HG) AS with aortic valve area (AVA) >1.0 cm<sup>2</sup>.</div></div><div><h3>Methods</h3><div>A total of 3,209 patients were identified according to AVA (cm<sup>2</sup>), peak velocity (m/s), systolic mean pressure gradient (MG) (mm Hg): HG-AVA >1 = >1.0, ≥4, and ≥40, HG-AVA ≤1 = ≤1.0, ≥4, and ≥40; LG-AVA ≤1 (low-gradient) = ≤1.0, <4, and <40; moderate AS = 1.0 <AVA ≤1.5, 3 ≤ peak velocity <4, and 20 ≤ MG <40.</div></div><div><h3>Results</h3><div>HG-AVA >1 accounted for 230 individuals (7.2%). Compared with others, patients with HG-AVA >1 were younger (70.2 ± 12.0 years), more frequently male (85.7%), had fewer comorbidities, larger body surface area and stroke volume (115 ± 19.3 mL), and had higher prevalence of bicuspid valve (39.6%). After a follow-up of 944 days (Q1-Q3: 27-2,212 days), 1,523 deaths occurred. Compared with the HG-AVA >1 group, all-cause mortality was higher in HG-AVA ≤1 (HR: 1.4; 95% CI: 1.1-1.7), LG-AVA ≤1 (HR: 2.8; 95% CI: 2.2-3.6), and moderate AS (HR: 1.4; 95% CI: 1.1-1.7). These differences were no longer significant after adjustment for age, comorbidities, bicuspid valve, and cardiac function. In the HG-AVA >1 group, patients with aortic valve replacement had better survival outcomes than those without aortic valve replacement (<em>P <</em> 0.001) after balancing the 2 groups.</div></div><div><h3>Conclusions</h3><div>The underlying relative high-flow status is responsible for HG in patients with HG-AVA >1. This profile has better prognosis than others, being related to underlying younger age and better general and cardiac conditions, but aortic valve replacement may still benefit these patients.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 166-176"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287686","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}

引用次数: 0

Association Between Coronary Artery Spasm and Atherosclerotic Disease 冠状动脉痉挛与动脉粥样硬化疾病之间的关系

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2024.05.024

Denise Peeters MSc , Eva Woelders MD , Tijn Jansen MD , Regina Konst MD, PhD , Caïa Crooijmans MD , Tim van de Hoef MD, PhD , Frans Mensink MD , Jonathan Los MD , Dario Pellegrini MD, PhD , Jan Hein Cornel MD, PhD , Peter Ong MD, PhD , Niels van Royen MD, PhD , Aukelien Leen MD, PhD , Suzette Elias-Smale MD, PhD , Robert Jan van Geuns MD, PhD , Peter Damman MD, PhD

In at least one-half of the patients with angina or ischemia and nonobstructive coronary arteries undergoing coronary function testing, coronary artery spasm (CAS) is detected. CAS is associated with an adverse prognosis regarding recurrent complaints and ischemic events. Current treatment options are mainly focused on the complaints, not on the underlying pathophysiological process. In this review we discuss available evidence regarding the presence, amount, and morphology of atherosclerosis in CAS patients. The reviewed evidence confirmed that atherosclerosis and vulnerable plaque characteristics are often detected in patients with CAS. The amount of atherosclerosis is higher in patients with focal CAS compared with patients with diffuse CAS. Severity of atherosclerosis is associated with the presence of CAS and the prognosis in CAS patients with atherosclerotic stenosis is worse. Therefore, CAS patients with atherosclerosis might benefit from targeted atherosclerotic treatment. Longitudinal studies are needed to elucidate the exact relation between atherosclerosis and CAS.

在接受冠状动脉功能检测的心绞痛或心肌缺血且冠状动脉无阻塞的患者中，至少有二分之一的患者会被检测出冠状动脉痉挛（CAS）。CAS 与反复发作和缺血事件的不良预后有关。目前的治疗方案主要针对主诉，而非潜在的病理生理过程。在这篇综述中，我们讨论了有关 CAS 患者动脉粥样硬化的存在、数量和形态的现有证据。综述证据证实，在 CAS 患者中经常可以发现动脉粥样硬化和易损斑块特征。与弥漫性 CAS 患者相比，局灶性 CAS 患者的动脉粥样硬化程度更高。动脉粥样硬化的严重程度与 CAS 的存在有关，动脉粥样硬化性狭窄的 CAS 患者预后较差。因此，伴有动脉粥样硬化的 CAS 患者可能会从有针对性的动脉粥样硬化治疗中获益。要阐明动脉粥样硬化与 CAS 之间的确切关系，还需要进行纵向研究。

{"title":"Association Between Coronary Artery Spasm and Atherosclerotic Disease","authors":"Denise Peeters MSc , Eva Woelders MD , Tijn Jansen MD , Regina Konst MD, PhD , Caïa Crooijmans MD , Tim van de Hoef MD, PhD , Frans Mensink MD , Jonathan Los MD , Dario Pellegrini MD, PhD , Jan Hein Cornel MD, PhD , Peter Ong MD, PhD , Niels van Royen MD, PhD , Aukelien Leen MD, PhD , Suzette Elias-Smale MD, PhD , Robert Jan van Geuns MD, PhD , Peter Damman MD, PhD","doi":"10.1016/j.jcmg.2024.05.024","DOIUrl":"10.1016/j.jcmg.2024.05.024","url":null,"abstract":"<div><div>In at least one-half of the patients with angina or ischemia and nonobstructive coronary arteries undergoing coronary function testing, coronary artery spasm (CAS) is detected. CAS is associated with an adverse prognosis regarding recurrent complaints and ischemic events. Current treatment options are mainly focused on the complaints, not on the underlying pathophysiological process. In this review we discuss available evidence regarding the presence, amount, and morphology of atherosclerosis in CAS patients. The reviewed evidence confirmed that atherosclerosis and vulnerable plaque characteristics are often detected in patients with CAS. The amount of atherosclerosis is higher in patients with focal CAS compared with patients with diffuse CAS. Severity of atherosclerosis is associated with the presence of CAS and the prognosis in CAS patients with atherosclerotic stenosis is worse. Therefore, CAS patients with atherosclerosis might benefit from targeted atherosclerotic treatment. Longitudinal studies are needed to elucidate the exact relation between atherosclerosis and CAS.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 226-239"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Full Issue PDF

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/S1936-878X(25)00015-4

引用次数: 0

Cholesterol, Atherosclerotic, and Inflammatory Risks Among Patients With Statin Therapy 他汀类药物治疗患者的胆固醇、动脉粥样硬化和炎症风险。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-02-01 DOI: 10.1016/j.jcmg.2024.08.009

Neng Dai MD , Yiqing Hu MS , Xianglin Tang MD, WeiFeng Guo MD, Zhenyang Guo MS, Fan Zhou MS, Longjiang Zhang MD, Pranav Prakash Edavi MS, Hao Lu MD, Juying Qian MD, Junbo Ge MD

引用次数: 0

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