JACC. Cardiovascular imaging最新文献

英文中文

The Specificity of Left Ventricular Bite-Like Fibrofatty Replacement for Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy 诊断心律失常性右室心肌病的左心室咬合样纤维脂肪替代物的特异性

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.03.011

引用次数: 0

Left Atrial Improvement in Patients With Secondary Mitral Regurgitation and Heart Failure 继发性二尖瓣反流和心力衰竭患者的左心房改善：COAPT 试验

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.03.016

Background

Functional mitral regurgitation induces adverse effects on the left ventricle and the left atrium. Left atrial (LA) dilatation and reduced LA strain are associated with poor outcomes in heart failure (HF). Transcatheter edge-to-edge repair (TEER) of the mitral valve reduces heart failure hospitalization (HFH) and all-cause death in selected HF patients.

Objectives

The aim of this study was to evaluate the impact of LA strain improvement 6 months after TEER on the outcomes of patients enrolled in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial.

Methods

The difference in LA strain between baseline and the 6-month follow-up was calculated. Patients with at least a 15% improvement in LA strain were labeled as “LA strain improvers.” All-cause death and HFH were assessed between the 6- and 24-month follow-up.

Results

Among 347 patients (mean age 71 ± 12 years, 63% male), 106 (30.5%) showed improvement of LA strain at the 6-month follow-up (64 [60.4%] from the TEER + guideline-directed medical therapy [GDMT] group and 42 [39.6%] from the GDMT alone group). An improvement in LA strain was significantly associated with a reduction in the composite of death or HFH between the 6-month and 24-month follow-up, with a similar risk reduction in both treatment arms (P_interaction = 0.27). In multivariable analyses, LA strain improvement remained independently associated with a lower risk of the primary composite endpoint both as a continuous variable (adjusted HR: 0.94 [95% CI: 0.89-1.00]; P = 0.03) and as a dichotomous variable (adjusted HR: 0.49 [95% CI: 0.27-0.89]; P = 0.02). The best outcomes were observed in patients treated with TEER in whom LA strain improved.

Conclusions

In symptomatic HF patients with severe mitral regurgitation, improved LA strain at the 6-month follow-up is associated with subsequently lower rates of the composite endpoint of all-cause mortality or HFH, both after TEER and GDMT alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [COAPT]; NCT01626079)

背景：功能性二尖瓣反流会对左心室和左心房产生不利影响。左心房（LA）扩张和左心房应变降低与心力衰竭（HF）的不良预后有关。经导管二尖瓣边缘对边缘修补术（TEER）可减少部分心衰患者的心衰住院率（HFH）和全因死亡：本研究旨在评估经导管二尖瓣修复术（TEER）6个月后LA应变改善对COAPT（功能性二尖瓣反流心衰患者MitraClip经皮治疗的心血管预后评估）试验入组患者预后的影响：计算基线与 6 个月随访期间 LA 应变的差异。LA应变至少改善15%的患者被称为 "LA应变改善者"。在 6 个月和 24 个月的随访期间，对全因死亡和 HFH 进行了评估：在 347 名患者（平均年龄 71 ± 12 岁，63% 为男性）中，106 人（30.5%）在 6 个月的随访中显示 LA 应变有所改善（64 人 [60.4%] 来自 TEER + 指导性医疗疗法 [GDMT] 组，42 人 [39.6%] 来自单纯 GDMT 组）。在6个月和24个月的随访期间，LA应变的改善与死亡或HFH复合死亡率的降低有明显相关性，两种治疗方案的风险降低程度相似（Pinteraction = 0.27）。在多变量分析中，无论是作为连续变量（调整后 HR：0.94 [95% CI：0.89-1.00]；P = 0.03）还是作为二分变量（调整后 HR：0.49 [95% CI：0.27-0.89]；P = 0.02），LA 应变改善仍与主要复合终点风险降低独立相关。在接受 TEER 治疗的患者中，LA 应变得到改善的患者疗效最佳：结论：对于患有严重二尖瓣反流的无症状房颤患者，无论是接受 TEER 还是单独接受 GDMT 治疗，随访 6 个月时 LA 应变的改善都会降低全因死亡率或房颤的复合终点发生率。(功能性二尖瓣反流心衰患者 MitraClip 经皮疗法的心血管效果评估 [COAPT]；NCT01626079）。

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引用次数: 0

NSTEMI NSTEMI

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.06.021

Barbara Lawson MD, W. Gregory Hundley MD

引用次数: 0

What Is New With Understanding the Left Atrium and What It Can Tell Us 了解左心房的新进展及其启示

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.08.001

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

引用次数: 0

Characterization of Medical Professional Liability Claims Associated With Noninvasive Stress Testing 与无创压力测试相关的医疗职业责任索赔的特点。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.04.006

引用次数: 0

Uncovering Subclinical Atherosclerosis: Assessment of Low-Attenuation Plaques in Low Risk Group 发现亚临床动脉粥样硬化：评估低风险人群的低衰减斑块。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.04.004

引用次数: 0

Cardiovascular Magnetic Resonance Before Invasive Coronary Angiography in Suspected Non–ST-Segment Elevation Myocardial Infarction 在对疑似非 ST 段抬高型心肌梗死患者进行侵入性冠状动脉血管造影前进行心血管磁共振检查的临床实用性

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.05.007

Background

In suspected non–ST-segment elevation myocardial infarction (NSTEMI), this presumed diagnosis may not hold true in all cases, particularly in patients with nonobstructive coronary arteries (NOCA). Additionally, in multivessel coronary artery disease, the presumed infarct-related artery may be incorrect.

Objectives

This study sought to assess the diagnostic utility of cardiac magnetic resonance (CMR) before invasive coronary angiogram (ICA) in suspected NSTEMI.

Methods

A total of 100 consecutive stable patients with suspected acute NSTEMI (70% male, age 62 ± 11 years) prospectively underwent CMR pre-ICA to assess cardiac function (cine), edema (T₂-weighted imaging, T₁ mapping), and necrosis/scar (late gadolinium enhancement). CMR images were interpreted blinded to ICA findings. The clinical care and ICA teams were blinded to CMR findings until post-ICA.

Results

Early CMR (median 33 hours postadmission and 4 hours pre-ICA) confirmed only 52% (52 of 100) of patients had subendocardial infarction, 15% transmural infarction, 18% nonischemic pathologies (myocarditis, takotsubo, and other forms of cardiomyopathies), and 11% normal CMR; 4% were nondiagnostic. Subanalyses according to ICA findings showed that, in patients with obstructive coronary artery disease (73 of 100), CMR confirmed only 84% (61 of 73) had MI, 10% (7 of 73) nonischemic pathologies, and 5% (4 of 73) normal. In patients with NOCA (27 of 100), CMR found MI in only 22% (6 of 27 true MI with NOCA), and reclassified the presumed diagnosis of NSTEMI in 67% (18 of 27: 11 nonischemic pathologies, 7 normal). In patients with CMR-MI and obstructive coronary artery disease (61 of 100), CMR identified a different infarct-related artery in 11% (7 of 61).

Conclusions

In patients presenting with suspected NSTEMI, a CMR-first strategy identified MI in 67%, nonischemic pathologies in 18%, and normal findings in 11%. Accordingly, CMR has the potential to affect at least 50% of all patients by reclassifying their diagnosis or altering their potential management.

在疑似非 ST 段抬高型心肌梗死（NSTEMI）的病例中，这种假定诊断可能并非在所有病例中都成立，尤其是在冠状动脉无阻塞（NOCA）的患者中。此外，在多支冠状动脉疾病中，推测的梗死相关动脉可能并不正确。本研究旨在评估有创冠状动脉造影（ICA）前心脏磁共振（CMR）对疑似 NSTEMI 的诊断作用。共有 100 名连续稳定的疑似急性 NSTEMI 患者（70% 为男性，年龄为 62 ± 11 岁）前瞻性地接受了有创冠状动脉造影前的心脏磁共振检查，以评估心功能（cine）、水肿（T 加权成像，T 映射）和坏死/瘢痕（晚期钆增强）。CMR图像的解读与ICA结果无关。临床护理团队和 ICA 团队对 CMR 检查结果保持盲视，直至 ICA 术后。早期 CMR（入院后中位 33 小时，ICA 前 4 小时）证实只有 52% 的患者（100 例中有 52 例）患有心内膜下梗死，15% 患有透壁性梗死，18% 患有非缺血性病变（心肌炎、Takotsubo、心肌病），11% 患有正常 CMR；4% 无法确诊。根据 ICA 结果进行的子分析表明，在阻塞性冠状动脉疾病患者（100 例中有 73 例）中，CMR 证实只有 84% （73 例中有 61 例）患有心肌梗死，10% （73 例中有 7 例）患有非缺血性病变，5% （73 例中有 4 例）正常。在 NOCA 患者中（100 例中有 27 例），CMR 仅发现 22% 的患者有心肌梗死（27 例中有 6 例真正的心肌梗死伴 NOCA），67% 的患者（27 例中有 18 例：11 例非缺血性病变，7 例正常）的假定诊断为 NSTEMI。在患有 CMR-MI 和阻塞性冠状动脉疾病的患者中（100 例中有 61 例），CMR 发现了 11% 的患者（61 例中有 7 例）存在不同的梗死相关动脉。在疑似 NSTEMI 的患者中，CMR 第一策略发现了 67% 的 MI、18% 的非缺血性病变和 11% 的正常结果。因此，CMR 有可能对至少 50% 的患者产生影响，对其诊断进行重新分类或改变潜在的治疗方法。

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引用次数: 0

Cardiac Damage in Early Aortic Stenosis 早期主动脉瓣狭窄的心脏损伤：瓣膜是罪魁祸首吗？

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.05.003

Background

Despite the close association between aortic stenosis (AS) and cardiac damage (CD), it is unclear if CD is limited to patients with moderate and severe AS and which factors affect its progression. Although altered valvular hemodynamic status may drive the development of CD in AS, commonly occurring comorbidities may contribute.

Objectives

The aim of this study was to determine the prevalence of and factors associated with CD in mild AS.

Methods

This retrospective study included 9,611 patients with mild AS (peak aortic valve velocity [V_max] 2-3 m/s and description of abnormal aortic valve) from 2010 through 2021. CD was staged using the Genereux classification.

Results

All but 20% (n = 1,901; stage 0) of patients with mild AS demonstrated CD: 1,613 (17%) stage 1, 4,843 (50%) stage 2, 891 (9%) stage 3, and 363 (4%) stage 4. Patients with higher stages had more comorbidities (hypertension, heart failure, ischemic heart disease, stroke, peripheral arterial disease, chronic kidney disease, chronic pulmonary disease, and diabetes mellitus) but had valvular hemodynamic status similar to those without CD. CD stage did not worsen with higher V_max range (stage >1 in 64% with V_max <2.5 m/s vs 61% with V_max ≥2.5 m/s) but increased with the number of comorbidities, with stage >1 occurring in 50%, 53%, 60%, 66%, 72%, and 73% in the presence of 0, 1, 2, 3, 4, and 5 or more comorbidities, respectively.

Conclusions

CD was highly prevalent in patients with mild AS. Among patients with mild AS, there was no relationship between the degree of CD and AS severity; instead, CD was highly associated with comorbidities.

背景：尽管主动脉瓣狭窄（AS）与心脏损伤（CD）密切相关，但目前尚不清楚CD是否仅限于中度和重度AS患者，也不清楚哪些因素会影响CD的发展。虽然瓣膜血流动力学状态的改变可能是导致主动脉瓣狭窄患者发生心脏损害的原因，但常见的合并症也可能是导致心脏损害的原因之一：本研究旨在确定轻度强直性脊柱炎中 CD 的患病率及其相关因素：这项回顾性研究纳入了2010年至2021年的9611名轻度AS患者（主动脉瓣峰值速度[Vmax] 2-3 m/s，且描述主动脉瓣异常）。研究采用 Genereux 分类法对 CD 进行分期：除20%（1,901人；0期）的轻度AS患者外，其他患者均表现为CD：1,613人（17%）为1期，4,843人（50%）为2期，891人（9%）为3期，363人（4%）为4期。分期越高的患者合并症越多（高血压、心力衰竭、缺血性心脏病、中风、外周动脉疾病、慢性肾脏疾病、慢性肺部疾病和糖尿病），但其瓣膜血流动力学状态与无 CD 的患者相似。CD分期并不随着Vmax范围的增大而恶化（最大Vmax≥2.5 m/s的患者中64%分期>1），但随着合并症数量的增加而增加，在合并症为0、1、2、3、4和5个或更多的情况下，分别有50%、53%、60%、66%、72%和73%的患者分期>1：CD在轻度强直性脊柱炎患者中发病率很高。在轻度强直性脊柱炎患者中，CD的程度与强直性脊柱炎的严重程度没有关系；相反，CD与合并症高度相关。

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引用次数: 0

Risk Stratification in Cardiac Sarcoidosis With Cardiac Positron Emission Tomography 利用心脏正电子发射断层扫描对心脏肉样瘤病进行风险分层：系统回顾与元分析》。

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.05.013

Tahir S. Kafil MD , Omar M. Shaikh MD , Yehia Fanous MD , Joseph Benjamen MD , Muhammad M. Hashmi MD , Abdulazeez Jawad MD , Tahir Dahrouj MD , Rami M. Abazid MD , Mina Swiha MD , Jonathan Romsa MD , Rob S.B. Beanlands MD , Terrence D. Ruddy MD , Lisa Mielniczuk MD , David H. Birnie MD , Nikolaos Tzemos MD

Background

Although positron emission tomography (PET) imaging is well established for its diagnostic role in cardiac sarcoidosis, less is known about the prognostic value of PET and its use in risk stratification for major adverse cardiac events (MACE).

Objectives

The goal of this study was to perform a systematic review and meta-analysis looking at the prognostic value of PET imaging in patients with cardiac sarcoidosis.

Methods

Study investigators systematically searched EMBASE (Excerpta Medica dataBASE), MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ClinicalTrials.gov, and the European Union Clinical Trial Registry for cardiac sarcoidosis and PET imaging. The primary outcome of interest was MACE.

Results

The search revealed 3,010 records, of which 55 studies were included. This represented 5,250 patients. Factors associated with MACE included the following: the combination of abnormal fluorodeoxyglucose (FDG) uptake and perfusion defect, which had an OR of 2.86 (95% CI: 1.74-4.71; P < 0.0001); abnormal perfusion or FDG uptake, which had an OR of 2.69 (95% CI: 1.67-4.33); abnormal FDG uptake, which had an OR of 2.61 (95% CI: 1.51-4.50); focal abnormal right ventricular uptake, which had an OR of 6.27 (95% CI: 3.19-12.32; P < 0.00001); and a lack of response to immunosuppression on serial PET, which had an OR of 8.43 (95% CI: 3.25-21.85; P < 0.0001). A QUIPS (Quality in Prognostic Studies) tool analysis found a low to moderate risk of bias, particularly given the small sample sizes in the individual studies.

Conclusions

Multiple cardiac PET parameters provide risk stratification value in cardiac sarcoidosis. Focal right ventricular uptake and a lack of response to immunosuppressive therapy on serial PET imaging were particularly predictive of MACE.

背景：尽管正电子发射断层扫描（PET）成像在心脏肉样瘤病中的诊断作用已得到公认，但人们对 PET 的预后价值及其在重大心脏不良事件（MACE）风险分层中的应用却知之甚少：本研究旨在对心脏肉样瘤病患者 PET 成像的预后价值进行系统回顾和荟萃分析：研究人员系统检索了EMBASE (Excerpta Medica dataBASE)、MEDLINE、PubMed、Cochrane对照试验中央注册中心、Cochrane系统性综述数据库、CINAHL (Cumulative Index to Nursing and Allied Health Literature)、ClinicalTrials.gov和欧盟临床试验注册中心有关心脏肉样瘤病和PET成像的资料。主要研究结果为MACE：搜索结果显示有 3,010 条记录，其中包括 55 项研究。这代表了 5250 名患者。与MACE相关的因素包括：氟脱氧葡萄糖（FDG）摄取异常和灌注缺陷的组合，其OR值为2.86（95% CI：1.74-4.71；P<0.0001）；灌注或FDG摄取异常，其OR值为2.69（95% CI：1.67-4.33）；FDG摄取异常，其OR值为2.69（95% CI：1.67-4.33）；FDG摄取异常，其OR值为2.86（95% CI：1.74-4.71；P<0.0001）。33）；FDG 摄取异常，OR 为 2.61（95% CI：1.51-4.50）；局灶性右心室摄取异常，OR 为 6.27（95% CI：3.19-12.32；P <0.00001）；连续 PET 对免疫抑制缺乏反应，OR 为 8.43（95% CI：3.25-21.85；P <0.0001）。QUIPS（预后研究质量）工具分析发现存在低至中度偏倚风险，特别是考虑到个别研究的样本量较小：结论：多种心脏 PET 参数为心脏肉样瘤病的风险分层提供了价值。局部右心室摄取和连续 PET 成像对免疫抑制治疗缺乏反应尤其能预测 MACE。

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引用次数: 0

Harnessing PET Imaging for Prognostic Precision in Cardiac Sarcoidosis 利用正电子发射计算机断层成像对心脏肉样瘤病进行精确诊断

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2024-09-01 DOI: 10.1016/j.jcmg.2024.06.017

Panithaya Chareonthaitawee MD, John P. Bois MD

引用次数: 0

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