Progress in cardiovascular diseases最新文献

英文中文

Emerging tracers for cardiac imaging: Innovations and clinical implications 新兴的心脏成像示踪剂：创新和临床意义。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.08.011

Andrew C. Homb , Apollo W. Homb , Hayan Jouni

Imaging of cardiovascular disease is undergoing profound growth and transformation as conventional imaging modalities are increasingly being augmented with molecular functional imaging with the desire to accelerate more specific diagnosis, better quantify disease burden and prognosis, and ultimately provide more effective treatments and measures of success. Positron emission tomography (PET) with novel tracers can now target and image many molecular markers of various cardiovascular diseases, providing insight into changes in myocardial perfusion, fibrosis, metabolism, innervation, tissue repair, and inflammation that often proceeds irreversible structural changes and offers the opportunity for earlier and more targeted intervention via conventional therapy and theranostics concepts. Further, continued technologic advances in PET scanner technology and processing/quantification software (including artificial intelligence) further advances the utility of novel PET radiotracers by allowing for improved image quality and quantification, while reducing acquisition times and doses. While the future is exciting, much work needs to be done to identify and translate the most promising radiotracers to address the many unmet imaging needs of clinical cardiovascular practice.

随着分子功能成像日益增强传统成像方式，心血管疾病的成像正在经历深刻的发展和转变，人们希望加快更具体的诊断，更好地量化疾病负担和预后，并最终提供更有效的治疗和成功的衡量标准。带有新型示踪剂的正电子发射断层扫描（PET）现在可以靶向和成像各种心血管疾病的许多分子标记物，为心肌灌注、纤维化、代谢、神经分布、组织修复和炎症的变化提供深入了解，这些变化通常会导致不可逆的结构变化，并通过常规治疗和治疗概念提供更早、更有针对性的干预机会。此外，PET扫描仪技术和处理/量化软件（包括人工智能）的持续技术进步进一步推进了新型PET放射性示踪剂的实用性，提高了图像质量和量化，同时减少了采集时间和剂量。虽然未来是令人兴奋的，但需要做很多工作来确定和转化最有前途的放射性示踪剂，以解决临床心血管实践中许多未满足的成像需求。

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引用次数: 0

SPECT Myocardial Perfusion Imaging in the Era of PET and Multimodality Imaging: Challenges and Opportunities PET与多模态成像时代的SPECT心肌灌注成像：挑战与机遇。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.09.002

Maria Alwan, Alaaeddine El Ghazawi, Ahmad El Yaman, Mahmoud Al Rifai, Mouaz H. Al-Mallah

Single photon emission computed tomography (SPECT) remains the most widely used modality for the assessment of coronary artery disease (CAD) owing to its diagnostic and prognostic value, cost-effectiveness, broad availability, and ability to be performed with exercise testing. However, major cardiology guidelines recommend positron emission tomography (PET) over SPECT when available, largely due to its superior accuracy and ability to provide absolute myocardial blood flow quantification. A key limitation of SPECT is its reliance on relative perfusion imaging, which may overlook diffuse flow reductions, such as those seen in balanced ischemia, diffuse atherosclerosis, and microvascular dysfunction. With the shifting paradigm of CAD toward non-obstructive disease, the need for absolute quantification has become increasingly critical. This review highlights the strengths and limitations of SPECT and explores strategies to preserve its clinical relevance in the PET era. These include the adoption of CZT-SPECT technology for quantification, the use of hybrid systems for attenuation correction and calcium scoring, the adoption of stress-only protocols, the integration of quantitative data and calcium scoring into reporting, and the emerging applications of artificial intelligence (AI) among others.

单光子发射计算机断层扫描（SPECT）由于其诊断和预后价值、成本效益、广泛可用性以及与运动试验一起进行的能力，仍然是评估冠状动脉疾病（CAD）最广泛使用的方式。然而，主要的心脏病学指南推荐使用正电子发射断层扫描（PET），而不是SPECT，主要是因为它具有更高的准确性和提供绝对心肌血流定量的能力。SPECT的一个关键限制是它依赖于相对灌注成像，这可能会忽略弥漫性血流减少，例如在平衡缺血、弥漫性动脉粥样硬化和微血管功能障碍中所见的弥漫性血流减少。随着CAD模式向非阻塞性疾病的转变，对绝对量化的需求变得越来越重要。这篇综述强调了SPECT的优势和局限性，并探讨了在PET时代保持其临床相关性的策略。其中包括采用CZT-SPECT技术进行量化，使用混合系统进行衰减校正和钙评分，采用仅应力协议，将定量数据和钙评分整合到报告中，以及人工智能（AI）的新兴应用等。

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引用次数: 0

Radionuclide imaging in cardio-oncology: A clinical decision-making tool 放射性核素成像在心脏肿瘤学：临床决策工具。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.09.008

Teodora Donisan , Daniel Sykora , Dinu V. Balanescu , Ian C. Chang , Grace Lin , Joerg Herrmann , Martin Rodriguez-Porcel

Nuclear cardiology has become an integral component of cardiovascular care in oncology, providing robust tools for the detection, monitoring, and mechanistic assessment of cancer therapy-related cardiac dysfunction. This review outlines the evolving applications of nuclear imaging across the cardio-oncology continuum, from reproducible quantification of left ventricular ejection fraction with multigated acquisition to advanced molecular imaging with positron emission tomography for the identification of pathobiology. We discuss the utility of radionuclide techniques for early detection of subclinical cardiotoxicity, including phase analysis, metabolic imaging with ¹⁸F-fluorodeoxyglucose, and emerging tracers targeting inflammation, fibrosis, and immune cell activity. Special considerations are given to their role in differentiating ischemic from non-ischemic injury, evaluating cardiac tumors, and guiding therapeutic decisions. Comparative strengths and limitations relative to other imaging modalities are briefly addressed, along with practical considerations such as access, and modality selection. Looking forward, developments in hybrid imaging, artificial intelligence, and targeted radiotracers are poised to enhance risk stratification and enable personalized, mechanism-based cardioprotection. Nuclear cardiology, when integrated thoughtfully into multimodal strategies, will be essential to advancing precision care in cardio-oncology.

核心脏病学已经成为肿瘤学中心血管护理的一个组成部分，为癌症治疗相关心功能障碍的检测、监测和机制评估提供了强大的工具。这篇综述概述了核成像在心脏肿瘤学连续体中的不断发展的应用，从多重采集的左心室射血分数的可重复量化到用于病理生物学鉴定的正电子发射断层扫描的高级分子成像。我们讨论了放射性核素技术在亚临床心脏毒性早期检测中的应用，包括相分析、18f -氟脱氧葡萄糖代谢成像和针对炎症、纤维化和免疫细胞活性的新兴示踪剂。特别考虑到它们在区分缺血性和非缺血性损伤、评估心脏肿瘤和指导治疗决策方面的作用。相对于其他成像模式的比较优势和局限性简要地讨论，以及实际考虑，如访问和模式选择。展望未来，混合成像、人工智能和靶向放射性示踪剂的发展将增强风险分层，实现个性化、基于机制的心脏保护。核心脏病学，当周到地整合到多模式的策略，将是必不可少的，以推进心脏肿瘤学的精确护理。

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引用次数: 0

Clinical outcomes following TAVR for patients with low and very low gradient aortic stenosis 低梯度和极低梯度主动脉瓣狭窄患者行TAVR治疗的临床结果。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.09.005

Besir Besir, Tamari Lomaia, Shivabalan Kathavarayan Ramu, Judah Rajendran, Grant W. Reed, Rishi Puri, Serge C. Harb, Zoran Popovic, Amar Krishnaswamy, Samir R. Kapadia

Objectives

This study explores the impact of lower baseline aortic valve (AV) mean gradients on the clinical outcomes of patients with low-gradient aortic stenosis (LG AS) post-transcatheter aortic valve replacement (TAVR). Additionally, the study aims to understand the predictors of a lower baseline AV mean gradient (MG).

Background

Reduced left ventricular ejection fraction (LVEF) and low-flow states are known to correlate with worse clinical outcomes. Lower mean gradients are also known to correlate with poorer outcomes, but the outcomes of patients with very low-gradient AS compared to low-gradient AS are not well understood.

Methods

This is a retrospective cohort of patients >18 years who underwent TAVR at Cleveland Clinic between 2016 and 2020. Only patients with AV area < 1 cm², and AV MG <40 mmHg were included. Patients who underwent valve-in-valve TAVR were excluded. Patients were classified into 3 tertiles according to their baseline AV MG. Clinical outcomes included mortality and heart failure hospitalization. Survival analysis was used to assess the clinical outcomes between the tertiles.

Results

Around 60 % of the patients in this study were males, with a mean age of 80 years. The mean AV MG was 21.8 ± 4.0 mmHg for the first tertile, 30.9 ± 1.9 mmHg for the second tertile, and 37.1 ± 1.6 mmHg for the third tertile. The present study shows that patients with very low-gradient AS (first tertile) have higher mortality rates compared to those with low-gradient AS (third tertile) (hazard ratio: 2.07, 95 % confidence interval (1.2–3.6)), even after stratifying by flow and by LVEF. Lower stroke volume index (SVI), lower LVEF, atrial fibrillation, and moderate to severe TR were associated with lower mean gradients.

Conclusions

Patients with very low-gradient AS have worse outcomes than those with low-gradient AS. Multiple clinical characteristics, including a lower SVI, lower LVEF, and atrial fibrillation, correlate with having very low-gradient AS. Therefore patients with low-gradient AS should undergo earlier intervention to improve their clinical outcomes.

目的：本研究探讨低基线主动脉瓣（AV）平均梯度对经导管主动脉瓣置换术（TAVR）后低梯度主动脉瓣狭窄（LG AS）患者临床结局的影响。此外，该研究旨在了解较低基线AV平均梯度（MG）的预测因素。背景：已知左室射血分数（LVEF）降低和低血流状态与较差的临床结果相关。较低的平均梯度也与较差的预后相关，但与低梯度AS相比，非常低梯度AS患者的预后尚不清楚。方法：这是一项回顾性队列研究，纳入了2016年至2020年期间在克利夫兰诊所（Cleveland Clinic）接受TAVR治疗的18岁以上患者。结果：本研究中约60%的患者为男性，平均年龄为80岁。平均AV MG为21.8±4.0 mmHg，第一分位为21.8±4.0 mmHg，第二分位为30.9±1.9 mmHg，第三分位为37.1±1.6 mmHg。本研究表明，即使通过血流和LVEF分层，极低梯度AS（第一分位）患者的死亡率也高于低梯度AS（第三分位）患者（风险比：2.07,95%可信区间（1.2-3.6））。较低的脑卒中容积指数（SVI）、较低的LVEF、心房颤动和中度至重度TR与较低的平均梯度相关。结论：极低梯度AS患者的预后比低梯度AS患者差。多种临床特征，包括较低的SVI、较低的LVEF和心房颤动，与非常低梯度AS相关。因此，低梯度AS患者应尽早进行干预，以改善其临床预后。

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引用次数: 0

Artificial intelligence in nuclear cardiology: Enhancing diagnostic accuracy and efficiency 核心脏病学中的人工智能：提高诊断的准确性和效率。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.09.010

Robert J.H. Miller , Panithaya Chareonthaitawee , Piotr J. Slomka

Artificial intelligence (AI) is rapidly reshaping cardiovascular imaging, with nuclear cardiology uniquely positioned to benefit. By addressing the technical complexity of image acquisition, reconstruction, and interpretation, AI can enhance image quality, reduce radiation exposure, and improve efficiency. Beyond image optimization, AI enables virtual attenuation correction and automated quantification of novel risk markers that are otherwise impractical to assess manually. Machine learning models can also integrate multimodal data, including clinical, stress, and imaging features, to support more accurate diagnosis and to refine risk stratification. Deep learning can be used to provide direct diagnostic or risk stratification estimates from nuclear cardiology images. This review highlights recent advances in AI within nuclear cardiology, outlines their potential to transform clinical workflows, and discusses future directions for integrating these tools into routine practice.

人工智能（AI）正在迅速重塑心血管成像，核心脏病学将从中受益。通过解决图像采集、重建和解释的技术复杂性，人工智能可以提高图像质量，减少辐射暴露，提高效率。除了图像优化之外，人工智能还支持虚拟衰减校正和自动量化新的风险标记，否则人工评估是不切实际的。机器学习模型还可以整合多模态数据，包括临床、压力和成像特征，以支持更准确的诊断并优化风险分层。深度学习可用于从核心脏病学图像中提供直接诊断或风险分层估计。这篇综述强调了人工智能在核心脏病学中的最新进展，概述了它们改变临床工作流程的潜力，并讨论了将这些工具整合到常规实践中的未来方向。

引用次数: 0

Multimodality imaging approaches for diagnosis of cardiac amyloidosis 多模态成像方法诊断心脏淀粉样变性。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.11.001

Chaitanya Rojulpote , Sarah A.M. Cuddy , Marie Foley Kijewski , Sharmila Dorbala

Cardiac amyloidosis is increasingly recognized as an underdiagnosed cause of heart failure. This review article provides an overview of the role of multimodality cardiovascular imaging in raising the suspicion of cardiac amyloidosis, confirming the diagnosis, providing risk assessment and detection of myocardial changes in response to therapy. The clinical use of multimodality imaging in diagnosing cardiac amyloidosis is illustrated through a case-based approach. Finally, the emerging role of cardiac positron emission tomography as well as artificial intelligence in cardiac amyloidosis is discussed.

心脏淀粉样变越来越被认为是心衰的一种未被充分诊断的病因。本文综述了多模态心血管成像在提高对心脏淀粉样变的怀疑、确认诊断、提供风险评估和检测治疗后心肌改变方面的作用。临床使用的多模态成像诊断心脏淀粉样变性是通过一个案例为基础的方法说明。最后，讨论了心脏正电子发射断层扫描和人工智能在心脏淀粉样变性中的新作用。

引用次数: 0

Timing of transcatheter aortic valve replacement after balloon aortic valvuloplasty: Insights from a multicenter real-world cohort 球囊主动脉瓣成形术后经导管主动脉瓣置换术的时机：来自多中心真实世界队列的见解。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.10.005

Osamah Badwan, Akiva Rosenzveig, Fawzi Zghyer, Rishi Puri, Grant Reed, Venu Menon, Amar Krishnaswamy, Samir Kapadia

引用次数: 0

Advances in nuclear hybrid imaging: The role of SPECT/CT, PET/CT, and PET/MRI in cardiovascular diseases 核混合成像的进展：SPECT/CT、PET/CT和PET/MRI在心血管疾病中的作用。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.09.007

Ahmad El Yaman, Maria Alwan, Alaaeddine El Ghazawi, Mouaz H. Al-Mallah, Mahmoud Al Rifai

Hybrid imaging has transformed nuclear cardiology by integrating anatomical and molecular data. Positron emission tomography (PET) /CT and single-photon emission computed tomography (SPECT)/CT improve diagnostic accuracy through attenuation correction, coronary artery calcium (CAC) scoring, and precise localization of tracer uptake. These advances enhance risk stratification, differentiate obstructive from microvascular disease, and detect extracardiac pathology. Despite these strengths, adoption remains limited. Misregistration, motion artifacts, and suboptimal CT quality restrict image reliability, while reimbursement gaps, workforce shortages, and training standards may hinder broader adoption. The frequent detection of incidental findings further underscores the need for structured reporting protocols, yet reimbursement pathways remain unclear.

PET/magnetic resonance imaging (MRI) offers unique advantages by combining the molecular sensitivity of PET with the superior soft tissue characterization of MRI, without additional radiation. This modality is particularly valuable in myocarditis, sarcoidosis, viability assessment, and cardiac tumors, where multiparametric data refine diagnosis and guide management. Motion correction using real-time MRI tracking adds further potential. However, PET/MRI adoption is constrained by high costs, technical complexity, prolonged scan times, and limited validation outside tertiary centers. The lack of large multicenter outcome studies continues to restrict its role to research settings, where its strengths in tissue characterization and integrated functional assessment are most apparent.

混合成像通过整合解剖和分子数据改变了核心脏病学。正电子发射断层扫描(PET) /CT和单光子发射计算机断层扫描(SPECT)/CT通过衰减校正、冠状动脉钙（CAC）评分和精确定位示踪剂摄取来提高诊断准确性。这些进展加强了风险分层，区分阻塞性和微血管疾病，并检测心外病理。尽管有这些优势，采用仍然有限。配准错误、运动伪影和次优CT质量限制了图像的可靠性，而报销差距、劳动力短缺和培训标准可能会阻碍更广泛的采用。频繁发现的意外发现进一步强调了结构化报告协议的必要性，但报销途径仍不清楚。PET/磁共振成像（MRI）结合了PET的分子敏感性和MRI优越的软组织特征，提供了独特的优势，没有额外的辐射。这种模式在心肌炎、结节病、活力评估和心脏肿瘤中特别有价值，其中多参数数据可以改进诊断和指导管理。使用实时MRI跟踪的运动校正增加了进一步的潜力。然而，PET/MRI的采用受到高成本、技术复杂性、扫描时间延长和三级中心外验证有限的限制。缺乏大型多中心结果研究继续限制其在研究环境中的作用，其在组织表征和综合功能评估方面的优势最为明显。

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引用次数: 0

Quantification of myocardial blood flow using PET: Current status, clinical applications, and future directions PET定量心肌血流：现状、临床应用及未来发展方向。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.09.011

Shekhar Vohra , Sakul Sakul , Vikram Agarwal , Krishna K. Patel

This review highlights the evolving role of positron emission tomography (PET) in quantifying myocardial blood flow (MBF) and myocardial flow reserve (MFR) and its expanding clinical impact. The relative nature of perfusion assessment with single photon emission computed tomography often underestimates disease in patients with multivessel or microvascular involvement. Positron emission tomography (PET) enables absolute quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR), which provides deeper insights into coronary physiology. PET-derived MBF and MFR have shown clear diagnostic and prognostic value across a broad spectrum of conditions, including obstructive coronary artery disease, ischemia and angina without obstructive coronary artery disease, post-heart transplant cardiac allograft vasculopathy surveillance, diabetes, hypertension, and systemic inflammatory diseases. Impaired flow reserve consistently predicts adverse outcomes, even in the absence of visible perfusion defects. Newer tracers such as ¹⁸F-flurpiridaz, with their favorable kinetics and logistical advantages, are poised to expand clinical accessibility. At the same time, innovations such as artificial intelligence–driven analysis and total-body PET promise greater reproducibility and efficiency, further integrating flow assessment into everyday practice. Professional society guidelines now recommend routine incorporation of flow quantification into stress PET imaging, yet barriers remain, including limited access, heterogeneity in protocols, and a need for outcome-driven trials. As technology and evidence evolve, PET-based flow quantification is positioned to become an essential tool in precision cardiovascular care, bridging the gap between physiology and clinical decision-making.

本文综述了正电子发射断层扫描（PET）在量化心肌血流量（MBF）和心肌血流储备（MFR）方面不断发展的作用及其日益扩大的临床影响。单光子发射计算机断层扫描的灌注评估的相对性质往往低估了多血管或微血管受累患者的疾病。正电子发射断层扫描（PET）可以对心肌血流（MBF）和心肌血流储备（MFR）进行绝对定量，从而更深入地了解冠状动脉生理学。pet衍生的MBF和MFR在广泛的疾病中显示出明确的诊断和预后价值，包括阻塞性冠状动脉疾病、缺血和无阻塞性冠状动脉疾病的心绞痛、心脏移植后心脏移植血管病变监测、糖尿病、高血压和全身性炎症疾病。即使在没有明显灌注缺陷的情况下，血流储备受损始终预示着不良后果。较新的示踪剂，如18f -氟吡唑，具有良好的动力学和物流优势，准备扩大临床可及性。与此同时，人工智能驱动的分析和全身PET等创新技术有望提高重现性和效率，进一步将流量评估融入日常实践。目前，专业协会指南建议将血流量化纳入应激PET成像，但仍存在一些障碍，包括获取途径有限、方案的异质性以及需要结果驱动的试验。随着技术和证据的发展，基于pet的血流定量定位成为精准心血管护理的重要工具，弥合生理学和临床决策之间的差距。

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引用次数: 0

Redefining nuclear cardiology: Bridging innovation, evidence, and practice 重新定义核心脏病学：连接创新，证据和实践。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.11.004

Panithaya Chareonthaitawee , Mouaz H. Al-Mallah , Leandro Slipczuk

引用次数: 0

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