JACC. Cardiovascular imaging最新文献

英文中文

Variations of Severely Reduced Myocardial Flow Reserve in PET Myocardial Perfusion Imaging 心肌血流储备严重减少在PET心肌灌注成像中的变化。

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.08.013

Christoph Ryffel MD , Andreas A. Giannopoulos MD, PhD , Aju P. Pazhenkottil MD , Philipp A. Kaufmann MD , Ronny R. Buechel MD , Dominik C. Benz MD

引用次数: 0

Noninvasive Imaging for CAV CAV的无创成像

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.08.012

Fulei Gu MD, Sihong Lin MD, Zheng Fu MD

引用次数: 0

Changes in Myocardial Light Chain Amyloid Burden After Plasma Cell Therapy 浆细胞治疗后心肌轻链淀粉样蛋白负荷的变化。

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.07.017

Dominik C. Benz MD , Olivier F. Clerc MD, MPH , Sarah A.M. Cuddy MD, MPH , Vasvi Singh MD , Marie Foley Kijewski PhD , Giada Bianchi MD , Andrew J. Yee MD , Frederick L. Ruberg MD , Michael Jerosch-Herold PhD , Raymond Y. Kwong MD, MPH , Marcelo F. Di Carli MD , Ronglih Liao PhD , Rodney H. Falk MD , Sharmila Dorbala MD, MPH

Background

Current therapies for light chain (AL) amyloidosis target the plasma cell dyscrasia, but their effect on myocardial amyloid fibril burden remains poorly defined.

Objectives

The authors aimed to assess longitudinal changes in myocardial amyloid burden after plasma cell–directed chemotherapy.

Methods

This prospective study included 81 patients (58 with AL amyloid cardiomyopathy and 23 with AL amyloidosis without cardiomyopathy) with recently diagnosed, biopsy-proven AL amyloidosis, who underwent serial ¹⁸F-florbetapir positron emission tomography/computed tomography and cardiac magnetic resonance (including extracellular volume [ECV]) at baseline, 6 months (n = 52), and/or 12 months (n = 37). Molecular amyloid burden was estimated as ¹⁸F-florbetapir percentage injected dose (%ID), and changes are presented as absolute and relative %ID changes. Cardiac biomarker response was defined as a reduction in N-terminal pro–B-type natriuretic peptide (NT-proBNP) >30% and >300 ng/L when baseline NT-proBNP ≥650 ng/L. All change comparisons were paired within patients.

Results

In AL amyloid cardiomyopathy, amyloid burden decreased significantly at 6 and 12 months after therapy initiation (median absolute [relative] change %ID: −0.3% [−13%]; P = 0.002; and −0.3% [15%]; P = 0.003). Changes in %ID correlated moderately with changes in NT-proBNP at 12 months (ρ = 0.531). Of note, %ID decreased significantly among biomarker responders (P < 0.001), whereas there was no change in nonresponders (P = 0.542). In contrast, ECV did not change in biomarker responders (P = 0.193) or nonresponders (P = 0.695). In AL amyloidosis without cardiomyopathy, %ID did not change (P = 0.523), whereas ECV increased (P = 0.011).

Conclusions

Myocardial AL amyloid burden estimated by ¹⁸F-florbetapir %ID decreases in participants undergoing plasma cell therapy and is detectable at 6 months. Molecular amyloid and ECV changes probably reflect distinct aspects of myocardial remodeling in AL amyloidosis. (Molecular Imaging of Primary Amyloid Cardiomyopathy [MICA]: NCT02641145)

背景：目前轻链（AL）淀粉样变性的治疗目标是浆细胞病变，但它们对心肌淀粉样纤维负荷的影响仍不明确。目的评估血浆细胞定向化疗后心肌淀粉样蛋白负荷的纵向变化。方法：本前瞻性研究纳入了81例近期确诊、活检证实的AL淀粉样变性患者（58例AL淀粉样心肌病和23例AL淀粉样变性无心肌病），这些患者在基线、6个月（n = 52）和/或12个月（n = 37）时接受了一系列18F-florbetapir正电子发射断层扫描/计算机断层扫描和心脏磁共振（包括细胞外体积[ECV]）检查。分子淀粉样蛋白负荷估计为注射剂量的18F-florbetapir百分比（%ID），变化以绝对和相对%ID变化表示。心脏生物标志物反应被定义为当基线NT-proBNP≥650 ng/L时，n端前b型利钠肽(NT-proBNP) >降低30%，>降低300 ng/L。所有的变化比较在患者中进行配对。结果在AL淀粉样蛋白心肌病中，淀粉样蛋白负担在治疗开始后6个月和12个月显著下降（中位绝对[相对]变化%ID: -0.3% [-13%]; P = 0.002; -0.3% [15%]; P = 0.003）。%ID的变化与12个月NT-proBNP的变化适度相关（ρ = 0.531）。值得注意的是，在生物标志物应答者中，%ID显著降低（P < 0.001），而在无应答者中没有变化（P = 0.542）。相比之下，生物标志物应答者（P = 0.193）和无应答者（P = 0.695）的ECV没有变化。在无心肌病的AL淀粉样变性中，%ID没有变化（P = 0.523），而ECV增加（P = 0.011）。结论：通过18F-florbetapir %ID估算的心肌AL淀粉样蛋白负担在接受浆细胞治疗的患者中降低，并在6个月时可检测到。分子淀粉样蛋白和ECV的改变可能反映了AL淀粉样变性患者心肌重构的不同方面。（原发性淀粉样心肌病分子影像学[MICA]: NCT02641145）。

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引用次数: 0

Cardiac CT and PET for Surveillance of Heart Transplant Recipients 心脏CT和PET监测心脏移植受者：系统评价和贝叶斯荟萃分析。

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.05.019

Ahmed Sayed MBBS , Malek Nayfeh MD , Fares Alahdab MD, MSc , Mahmoud Al Rifai MD, MPH , Dmitry Abramov MD , Marat Fudim MD, MHS , Yasbanoo Moayedi MD, MHS , Rayan Yousefzai MD , Mouaz H. Al-Mallah MD, MSc

Background

For noninvasive surveillance of cardiac allograft vasculopathy (CAV), cardiac computed tomography (cardiac computed tomography [CT]) and positron emission tomography (PET) received a Class IIa recommendation by the 2023 ISHLT (International Society for Heart and Lung Transplantation) guidelines. However, implementation has lagged behind because of concerns about their ability to rule out disease and stratify risk.

Objectives

The purpose of this study was to define the diagnostic and prognostic ability of PET and cardiac CT in cardiac transplant recipients.

Methods

Electronic databases were searched for studies evaluating CT or PET for their diagnostic (for detecting angiographic CAV) and prognostic (for predicting major adverse cardiovascular outcomes) value. Sensitivity and specificity were pooled using Bayesian bivariate binormal-normal models with random-effects. HRs were pooled using Bayesian normal random-effects models.

Results

In total, 44 studies (32 CT and 12 PET) enrolling 3,049 patients were included. Coronary computed tomography angiography (CTA) showed high sensitivity (97.6%; 95% credible interval [CrI]: 93.7%-99.1%) and specificity (82.3%; 95% CrI: 75.3%-88.3%) for detecting any CAV. Coronary CTA also showed high sensitivity (92.6%; 95% CrI: 86.2%-96.2%) and specificity (92.6%; 95% CrI: 89.8%-94.9%) for significant CAV. The PET CAV algorithm for detecting significant CAV showed good sensitivity (83.9%; 95% CrI: 69.1%-92.4%) and specificity (89.6%; 95% CrI: 82.2%-94.2%). PET-derived parameters including myocardial flow reserve, stress myocardial blood flow, PET CAV score, and summed stress score, predicted future major adverse cardiovascular outcomes.

Conclusions

Both coronary CTA and PET can rule out significant CAV; however, at higher pretest probabilities, coronary CTA may be preferrable. Multiple PET-derived parameters may have prognostic value, whereas there is insufficient evidence for the long-term prognostic value of CT.

背景：对于同种异体心脏移植血管病变（CAV）的无创监测，心脏计算机断层扫描（心脏计算机断层扫描[CT]）和正电子发射断层扫描（PET）获得了2023年国际心肺移植学会指南的IIa级推荐。然而，由于担心它们排除疾病和分层风险的能力，实施工作滞后。目的探讨PET和心脏CT对心脏移植受者的诊断和预后能力。方法检索电子数据库，以评估CT或PET的诊断（用于检测血管造影CAV）和预后（用于预测主要不良心血管结局）价值。灵敏度和特异性采用随机效应的贝叶斯二元双正态-正态模型进行汇总。使用贝叶斯正态随机效应模型汇总hr。结果共纳入44项研究（32项CT和12项PET），共纳入3049例患者。冠状动脉ct血管造影（CTA）灵敏度高(97.6%；95%可信区间[CrI]: 93.7%-99.1%)和特异性(82.3%；95% CrI: 75.3% ~ 88.3%)。冠状动脉CTA也显示出较高的敏感性(92.6%；95% CrI: 86.2%-96.2%)和特异性(92.6%；95% CrI: 89.8% ~ 94.9%)。PET CAV算法检测显著CAV的灵敏度为83.9%；95% CrI: 69.1%-92.4%)和特异性(89.6%；95% CrI: 82.2% ~ 94.2%)。PET衍生参数包括心肌血流储备、应激心肌血流量、PET CAV评分和总应激评分，预测未来主要不良心血管结局。结论冠脉CTA和PET均可排除明显的CAV；然而，在较高的预测概率下，冠状动脉CTA可能是首选。多个pet衍生参数可能具有预后价值，而CT的长期预后价值证据不足。

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引用次数: 0

Aortic Size Matters 主动脉尺寸很重要，但它有帮助吗？

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.07.012

Nicholas S. Burris MD

引用次数: 0

Cardiac Allograft Vasculopathy 同种异体心脏移植血管病变：无创诊断的挑战和机遇。

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.07.004

Renée P. Bullock-Palmer MD

引用次数: 0

Current Status and Pending Developments of Robotic Tele-Echocardiography 机器人远程超声心动图的现状和未来发展。

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.07.002

Thomas H. Marwick MBBS, PhD, MPH , Edgar M. Hidalgo PhD , Leah Wright PhD , Mariadas Roshan PhD , Mats Isaksson PhD

Echocardiography is the gateway to appropriate therapy for many cardiovascular diseases, but access to this test is sometimes challenging. The consequence is that patients in rural and remote areas need to travel for testing, and the resulting time and monetary costs may prove a barrier, especially for hospital inpatients. Delays in obtaining echocardiograms lead to delayed diagnosis and treatment. Technological advances in miniaturization and processing power, and reductions in cost, have enabled diagnostic images to be obtained from inexpensive echocardiography machines. However, imaging by nonexperts is difficult, even with guidance by artificial intelligence. An alternative strategy is to use high-bandwidth, low-latency communication systems to bring the expertise of an expert sonographer to a remote patient by using a robot. Previous work has shown that remote robots are able to reproduce the hand movements performed by sonographers, and multiple types of robot-guided ultrasound examinations have been performed successfully in remote areas. However, despite clear clinical need and ongoing interest, the promise of robotic tele-echocardiography awaits clinical translation. Existing research points toward longer examination times and a need for additional personnel for local supervision of remotely acquired echocardiograms. The efficiencies of longer examinations and more personnel may be worthwhile to facilitate remote access, or within a hospital to avoid sonographer injury, or to improve safety from infection or radiation exposure during structural heart disease interventions. Potentially, autonomous robot-assisted ultrasound may replace the sonographer, by interfacing with artificial intelligence–guided acquisition, although this remains futuristic and uncertain. This paper reviews recent developments in controlling the speed and force of a recently developed robotic system, means of facilitating positioning of the probe, and haptic control. It emphasizes the primary concerns to be imaging time and safety.

超声心动图是许多心血管疾病的适当治疗的门户，但获得这种测试有时是具有挑战性的。其结果是，农村和偏远地区的患者需要长途跋涉进行检测，由此产生的时间和金钱成本可能成为一个障碍，特别是对住院患者而言。获得超声心动图的延迟导致诊断和治疗的延迟。小型化和处理能力方面的技术进步，以及成本的降低，使得从廉价的超声心动图机上获得诊断图像成为可能。然而，即使有人工智能的指导，非专业人士也很难进行成像。另一种策略是使用高带宽、低延迟的通信系统，通过机器人将专家超声医师的专业知识带给远程患者。先前的研究表明，远程机器人能够复制超声医师的手部动作，并且在偏远地区已经成功地进行了多种类型的机器人引导超声检查。然而，尽管有明确的临床需求和持续的兴趣，机器人远程超声心动图的前景仍有待临床转化。现有的研究指向更长的检查时间和需要额外的人员对远程获得的超声心动图进行本地监督。更长的检查时间和更多人员的效率对于促进远程访问，或在医院内避免超声检查人员伤害，或在结构性心脏病干预期间提高感染或辐射暴露的安全性可能是值得的。通过与人工智能引导的采集相结合，自主机器人辅助超声可能会取代超声仪，尽管这仍然是未来的和不确定的。本文回顾了最近在控制速度和力的最新发展，最近开发的机器人系统，手段方便定位的探针，和触觉控制。它强调的首要问题是成像时间和安全性。

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引用次数: 0

Outcomes of Left Atrial Appendage Patency After Device Closure Detected by Cardiac CT 心脏CT检测器械关闭后左心耳通畅的结果：荟萃分析。

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.07.018

Xander Jacquemyn MD , Michel Pompeu Sá MD, MSc, MHBA, PhD , Kasper Korsholm MD, PhD , Jens Erik Nielsen-Kudsk MD , Xavier Iriart MD , Jacqueline Saw MD , Mohamad Alkhouli MD , Sandeep Jain MD , Marcio Sommer Bittencourt MD, MPH, PhD , Ibrahim Sultan MD

Background

Residual leaks are common after left atrial appendage occlusion (LAAO).

Objectives

The authors aimed to systematically evaluate the prognostic implications of residual left atrial appendage (LAA) patency and peridevice leaks (PDLs) detected by cardiac computed tomography (CT) following LAAO.

Methods

The authors used traditional meta-analytical methods and a Bayesian framework to assess the probability of increased risks associated with these residual leaks.

Results

Seventeen studies encompassing 2,036 patients met the inclusion criteria. During follow-up, the presence of any LAA patency was significantly associated with an almost 2-fold increased OR of thromboembolism (pooled OR: 1.87, 95% CI: 1.08-3.24), corresponding to 28 (95% CI: 3-68) additional events per 1,000 patients. Although PDL showed a similar trend, it was not significantly associated with increased thromboembolism risk (pooled OR: 1.50, 95% CI: 0.85-2.65). For thromboembolism with LAA patency, under a noninformative prior, the mean logOR was 0.59 (95% credible interval [Crl]: 0.06-1.15), and translated median OR of 1.87 (95% CrI: 1.06-3.14) and a mean absolute risk difference (ARD) of 2.8% (95% CrI: 0.2%-6.8%). The posterior probability of ARD >0% was 98.5%. For any PDL, the mean logOR was 0.38 (95% CrI: −0.22 to 0.95), with a median OR of 1.53 (95% CrI: 0.80-2.59) and mean ARD of 1.9% (95% CrI: −0.7% to 5.4%). The posterior probability of ARD >0% was 89.8%.

Conclusions

LAA patency and PDL identified by CT may be associated with an increased risk of thromboembolism. These findings indicate that residual leaks detected by CT may be clinically significant and should not be regarded as benign.

背景：左心耳闭塞（LAAO）后残留漏是常见的。目的系统评价左心耳残留（LAA）通畅和心脏计算机断层扫描（CT）检测左心耳周围装置泄漏（PDLs）对预后的影响。方法：作者使用传统的元分析方法和贝叶斯框架来评估与这些残留泄漏相关的风险增加的概率。结果17项研究共2036例患者符合纳入标准。在随访期间，任何LAA通畅的存在与血栓栓塞的OR增加近2倍显着相关（合并OR: 1.87, 95% CI: 1.08-3.24），对应于每1000名患者有28例（95% CI: 3-68）额外事件。尽管PDL表现出类似的趋势，但与血栓栓塞风险增加没有显著相关（合并OR: 1.50, 95% CI: 0.85-2.65）。对于LAA通畅的血栓栓塞，在非信息先验条件下，平均logOR为0.59(95%可信区间[Crl]: 0.06-1.15)，翻译中位OR为1.87 (95% CrI: 1.06-3.14)，平均绝对风险差（ARD）为2.8% （95% CrI: 0.2 -6.8%）。后验概率为98.5%。对于任何PDL，平均logOR为0.38 (95% CrI: -0.22至0.95)，中位OR为1.53 (95% CrI: 0.80-2.59)，平均ARD为1.9% （95% CrI: -0.7%至5.4%）。后验概率为89.8%。结论CT显示的slaa通畅和PDL可能与血栓栓塞风险增加有关。这些结果表明，CT检测到的残余渗漏可能具有临床意义，不应视为良性。

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Quality, Novelty, and Impact at JACC: Cardiovascular Imaging 质量，新颖性和影响JACC：心血管成像

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.10.021

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

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IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging

Pub Date : 2025-12-01 DOI: 10.1016/j.jcmg.2025.06.013

Tristan T. Demmert MD, Konstantin Klambauer MD, Lukas J. Moser MD, Victor Schweiger MD, Victor Mergen MD, Michael Würdinger MD, Davide Di Vece MD, Andrea Biondo MD, Alexander Gotschy MD, Barbara Stähli MD, Julia Stehli MD, Martin F. Reiner MD, PhD, Jelena-R. Ghadri MD, Robert Manka MD, Matthias Eberhard MD, Christian Templin MD, PhD, Hatem Alkadhi MD, MPH

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