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Arrhythmic Mitral Valve Prolapse Phenotype: An Unsupervised Machine Learning Analysis Using a Multicenter Cardiac MRI Registry. 心律失常二尖瓣脱垂表型:使用多中心心脏磁共振成像注册表的无监督机器学习分析。
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.230247
Ralph Kwame Akyea, Stefano Figliozzi, Pedro M Lopes, Klemens B Bauer, Sara Moura-Ferreira, Lara Tondi, Saima Mushtaq, Stefano Censi, Anna Giulia Pavon, Ilaria Bassi, Laura Galian-Gay, Arco J Teske, Federico Biondi, Domenico Filomena, Vasileios Stylianidis, Camilla Torlasco, Denisa Muraru, Pierre Monney, Giuseppina Quattrocchi, Viviana Maestrini, Luciano Agati, Lorenzo Monti, Patrizia Pedrotti, Bert Vandenberk, Angelo Squeri, Massimo Lombardi, António M Ferreira, Juerg Schwitter, Giovanni Donato Aquaro, Gianluca Pontone, Amedeo Chiribiri, José F Rodríguez Palomares, Ali Yilmaz, Daniele Andreini, Anca-Rezeda Florian, Marco Francone, Tim Leiner, João Abecasis, Luigi Paolo Badano, Jan Bogaert, Georgios Georgiopoulos, Pier-Giorgio Masci

Purpose To use unsupervised machine learning to identify phenotypic clusters with increased risk of arrhythmic mitral valve prolapse (MVP). Materials and Methods This retrospective study included patients with MVP without hemodynamically significant mitral regurgitation or left ventricular (LV) dysfunction undergoing late gadolinium enhancement (LGE) cardiac MRI between October 2007 and June 2020 in 15 European tertiary centers. The study end point was a composite of sustained ventricular tachycardia, (aborted) sudden cardiac death, or unexplained syncope. Unsupervised data-driven hierarchical k-mean algorithm was utilized to identify phenotypic clusters. The association between clusters and the study end point was assessed by Cox proportional hazards model. Results A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 female, 230 male) with two phenotypic clusters were identified. Patients in cluster 2 (199 of 474, 42%) had more severe mitral valve degeneration (ie, bileaflet MVP and leaflet displacement), left and right heart chamber remodeling, and myocardial fibrosis as assessed with LGE cardiac MRI than those in cluster 1. Demographic and clinical features (ie, symptoms, arrhythmias at Holter monitoring) had negligible contribution in differentiating the two clusters. Compared with cluster 1, the risk of developing the study end point over a median follow-up of 39 months was significantly higher in cluster 2 patients (hazard ratio: 3.79 [95% CI: 1.19, 12.12], P = .02) after adjustment for LGE extent. Conclusion Among patients with MVP without significant mitral regurgitation or LV dysfunction, unsupervised machine learning enabled the identification of two phenotypic clusters with distinct arrhythmic outcomes based primarily on cardiac MRI features. These results encourage the use of in-depth imaging-based phenotyping for implementing arrhythmic risk prediction in MVP. Keywords: MR Imaging, Cardiac, Cardiac MRI, Mitral Valve Prolapse, Cluster Analysis, Ventricular Arrhythmia, Sudden Cardiac Death, Unsupervised Machine Learning Supplemental material is available for this article. © RSNA, 2024.

目的 使用无监督机器学习来识别心律失常性二尖瓣脱垂(MVP)风险增加的表型群。材料与方法 该回顾性研究纳入了 2007 年 10 月至 2020 年 6 月期间在 15 家欧洲三级中心接受晚期钆增强(LGE)心脏 MRI 检查的 MVP 患者,他们均无血流动力学意义上的二尖瓣反流或左心室(LV)功能障碍。研究终点是持续性室性心动过速、(中止的)心脏性猝死或不明原因晕厥的综合结果。采用无监督数据驱动的分层 K-均值算法来识别表型集群。通过 Cox 比例危险度模型评估集群与研究终点之间的关联。结果 共发现 474 名患者(平均年龄 47 岁 ± 16 [SD];女性 244 人,男性 230 人)有两个表型集群。与第1组患者相比,第2组患者(474人中有199人,占42%)的二尖瓣变性(即双叶MVP和瓣叶移位)、左右心腔重构和心肌纤维化(通过LGE心脏磁共振成像评估)更为严重。人口统计学和临床特征(即 Holter 监测中的症状和心律失常)对区分两个群组的作用微乎其微。与第 1 组相比,第 2 组患者在中位随访 39 个月后出现研究终点的风险明显更高(危险比:3.79 [95% CI:1.19, 12.12],P = .02)。结论 在没有明显二尖瓣反流或左心室功能障碍的 MVP 患者中,无监督机器学习主要根据心脏 MRI 特征识别出两个具有不同心律失常结局的表型群。这些结果鼓励使用基于影像学的深度表型对 MVP 进行心律失常风险预测。关键词磁共振成像,心脏,心脏磁共振成像,二尖瓣脱垂,聚类分析,室性心律失常,心脏性猝死,无监督机器学习 本文有补充材料。© RSNA, 2024.
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引用次数: 0
Prognostic Value of Stress Perfusion Cardiac MRI in Cardiovascular Disease: A Systematic Review and Meta-Analysis of the Effects of the Scanner, Stress Agent, and Analysis Technique. 应激灌注心脏磁共振成像在心血管疾病中的预后价值:扫描仪、应激剂和分析技术影响的系统回顾和元分析》。
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.230382
Qing Fu, Samer Alabed, Stephen P Hoole, George Abraham, Jonathan R Weir-McCall

Purpose To perform a systematic review and meta-analysis to assess the prognostic value of stress perfusion cardiac MRI in predicting cardiovascular outcomes. Materials and Methods A systematic literature search from the inception of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure until January 2023 was performed for articles that reported the prognosis of stress perfusion cardiac MRI in predicting cardiovascular outcomes. The quality of included studies was assessed using the Quality in Prognosis Studies tool. Reported hazard ratios (HRs) of univariable regression analyses with 95% CIs were pooled. Comparisons were performed across different analysis techniques (qualitative, semiquantitative, and fully quantitative), magnetic field strengths (1.5 T vs 3 T), and stress agents (dobutamine, adenosine, and dipyridamole). Results Thirty-eight studies with 58 774 patients with a mean follow-up time of 53 months were included. There were 1.9 all-cause deaths and 3.5 major adverse cardiovascular events (MACE) per 100 patient-years. Stress-inducible ischemia was associated with a higher risk of all-cause mortality (HR: 2.55 [95% CI: 1.89, 3.43]) and MACE (HR: 3.90 [95% CI: 2.69, 5.66]). For MACE, pooled HRs of qualitative, semiquantitative, and fully quantitative methods were 4.56 (95% CI: 2.88, 7.22), 3.22 (95% CI: 1.60, 6.48), and 1.78 (95% CI: 1.39, 2.28), respectively. For all-cause mortality, there was no evidence of a difference between qualitative and fully quantitative methods (P = .79). Abnormal stress perfusion cardiac MRI findings remained prognostic when subgrouped based on underlying disease, stress agent, and field strength, with HRs of 3.54, 2.20, and 3.38, respectively, for all-cause mortality and 3.98, 3.56, and 4.21, respectively, for MACE. There was no evidence of subgroup differences in prognosis between field strengths or stress agents. There was significant heterogeneity in effect size for MACE outcomes in the subgroups assessing qualitative versus quantitative stress perfusion analysis, underlying disease, and field strength. Conclusion Stress perfusion cardiac MRI is valuable for predicting cardiovascular outcomes, regardless of the analysis method, stress agent, or magnetic field strength used. Keywords: MR-Perfusion, MRI, Cardiac, Meta-Analysis, Stress Perfusion, Cardiac MR, Cardiovascular Disease, Prognosis, Quantitative © RSNA, 2024 Supplemental material is available for this article.

目的 对应激灌注心脏磁共振成像在预测心血管疾病预后方面的价值进行系统回顾和荟萃分析。材料和方法 系统性检索了从 PubMed、Embase、Web of Science 和中国国家知识基础设施开始到 2023 年 1 月的文献,以寻找报道应激灌注心脏磁共振成像在预测心血管预后方面的文章。纳入研究的质量采用预后研究质量工具进行评估。将单变量回归分析报告的危险比 (HR) 与 95% CIs 汇总。对不同的分析技术(定性、半定量和完全定量)、磁场强度(1.5 T 与 3 T)和应激药物(多巴酚丁胺、腺苷和双嘧达莫)进行比较。结果 共纳入 38 项研究,58 774 名患者,平均随访时间为 53 个月。每 100 名患者年中有 1.9 例全因死亡和 3.5 例主要不良心血管事件 (MACE)。应激诱导性心肌缺血与较高的全因死亡风险(HR:2.55 [95% CI:1.89, 3.43])和主要不良心血管事件风险(MACE:HR:3.90 [95% CI:2.69, 5.66])相关。对于 MACE,定性、半定量和完全定量方法的汇总 HR 分别为 4.56(95% CI:2.88,7.22)、3.22(95% CI:1.60,6.48)和 1.78(95% CI:1.39,2.28)。在全因死亡率方面,没有证据表明定性方法和完全定量方法之间存在差异(P = .79)。根据基础疾病、应激剂和磁场强度进行亚组时,异常应激灌注心脏 MRI 结果仍具有预后意义,全因死亡率的 HR 分别为 3.54、2.20 和 3.38,MACE 的 HR 分别为 3.98、3.56 和 4.21。没有证据表明不同场强或应激剂在预后方面存在亚组差异。在评估定性与定量应激灌注分析、潜在疾病和场强的亚组中,MACE结局的效应大小存在明显的异质性。结论 无论使用哪种分析方法、应激剂或磁场强度,应激灌注心脏 MRI 对预测心血管预后都有价值。关键词MR-灌注 MRI 心脏病 Meta 分析 压力灌注 心脏 MR 心血管疾病 预后 定量 © RSNA, 2024 这篇文章有补充材料。
{"title":"Prognostic Value of Stress Perfusion Cardiac MRI in Cardiovascular Disease: A Systematic Review and Meta-Analysis of the Effects of the Scanner, Stress Agent, and Analysis Technique.","authors":"Qing Fu, Samer Alabed, Stephen P Hoole, George Abraham, Jonathan R Weir-McCall","doi":"10.1148/ryct.230382","DOIUrl":"10.1148/ryct.230382","url":null,"abstract":"<p><p>Purpose To perform a systematic review and meta-analysis to assess the prognostic value of stress perfusion cardiac MRI in predicting cardiovascular outcomes. Materials and Methods A systematic literature search from the inception of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure until January 2023 was performed for articles that reported the prognosis of stress perfusion cardiac MRI in predicting cardiovascular outcomes. The quality of included studies was assessed using the Quality in Prognosis Studies tool. Reported hazard ratios (HRs) of univariable regression analyses with 95% CIs were pooled. Comparisons were performed across different analysis techniques (qualitative, semiquantitative, and fully quantitative), magnetic field strengths (1.5 T vs 3 T), and stress agents (dobutamine, adenosine, and dipyridamole). Results Thirty-eight studies with 58 774 patients with a mean follow-up time of 53 months were included. There were 1.9 all-cause deaths and 3.5 major adverse cardiovascular events (MACE) per 100 patient-years. Stress-inducible ischemia was associated with a higher risk of all-cause mortality (HR: 2.55 [95% CI: 1.89, 3.43]) and MACE (HR: 3.90 [95% CI: 2.69, 5.66]). For MACE, pooled HRs of qualitative, semiquantitative, and fully quantitative methods were 4.56 (95% CI: 2.88, 7.22), 3.22 (95% CI: 1.60, 6.48), and 1.78 (95% CI: 1.39, 2.28), respectively. For all-cause mortality, there was no evidence of a difference between qualitative and fully quantitative methods (<i>P</i> = .79). Abnormal stress perfusion cardiac MRI findings remained prognostic when subgrouped based on underlying disease, stress agent, and field strength, with HRs of 3.54, 2.20, and 3.38, respectively, for all-cause mortality and 3.98, 3.56, and 4.21, respectively, for MACE. There was no evidence of subgroup differences in prognosis between field strengths or stress agents. There was significant heterogeneity in effect size for MACE outcomes in the subgroups assessing qualitative versus quantitative stress perfusion analysis, underlying disease, and field strength. Conclusion Stress perfusion cardiac MRI is valuable for predicting cardiovascular outcomes, regardless of the analysis method, stress agent, or magnetic field strength used. <b>Keywords:</b> MR-Perfusion, MRI, Cardiac, Meta-Analysis, Stress Perfusion, Cardiac MR, Cardiovascular Disease, Prognosis, Quantitative © RSNA, 2024 <i>Supplemental material is available for this article.</i></p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"6 3","pages":"e230382"},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11211944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of Enzyme Replacement Therapy on Cardiac MRI Findings in Fabry Disease: A Systematic Review and Meta-Analysis. 酶替代疗法对法布里病心脏磁共振成像结果的影响:系统回顾与元分析》。
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.230154
Stefano Figliozzi, Eleni Kollia, Alexandros Simistiras, Antonia Camporeale, Kamil Stankowski, Pier Giorgio Masci, George Mavraganis, Massimo Lombardi, Gianluigi Condorelli, Marco Francone, Maurizio Pieroni, Georgios Georgiopoulos

Purpose To perform a systematic review and meta-analysis to assess the effect of enzyme replacement therapy on cardiac MRI parameters in patients with Fabry disease. Materials and Methods A systematic literature search was conducted from January 1, 2000, through January 1, 2024, in PubMed, ClinicalTrials.gov, Embase, and Cochrane Library databases. Study outcomes were changes in the following parameters: (a) left ventricular wall mass (LVM), measured in grams; (b) LVM indexed to body mass index, measured in grams per meters squared; (c) maximum left ventricular wall thickness (MLVWT), measured in millimeters; (d) late gadolinium enhancement (LGE) extent, measured in percentage of LVM; and (e) native T1 mapping, measured in milliseconds. A random-effects meta-analysis of the pooled mean differences between baseline and follow-up parameters was conducted. The study protocol was registered in PROSPERO (CRD42022336223). Results The final analysis included 11 studies of a total of 445 patients with Fabry disease (mean age ± SD, 41 years ± 11; 277 male, 168 female). Between baseline and follow-up cardiac MRI, the following did not change: T1 mapping (mean difference, 6 msec [95% CI: -2, 15]; two studies, 70 patients, I2 = 88%) and LVM indexed (mean difference, -1 g/m2 [95% CI: -6, 3]; four studies, 290 patients, I2 = 81%). The following measures minimally decreased: LVM (mean difference, -18 g [95% CI: -33, -3]; seven studies, 107 patients, I2 = 96%) and MLVWT (mean difference, -1 mm [95% CI: -2, -0.02]; six studies, 151 patients, I2 = 90%). LGE extent increased (mean difference, 1% [95% CI: 1, 1]; three studies, 114 patients, I2 = 85%). Conclusion In patients with Fabry disease, enzyme replacement therapy was associated with stabilization of LVM, MLVWT, and T1 mapping values, whereas LGE extent mildly increased. Keywords: Fabry Disease, Enzyme Replacement Therapy (ERT), Cardiac MRI, Late Gadolinium Enhancement (LGE) Supplemental material is available for this article. © RSNA, 2024.

目的 进行系统性回顾和荟萃分析,评估酶替代疗法对法布里病患者心脏磁共振成像参数的影响。材料和方法 在 PubMed、ClinicalTrials.gov、Embase 和 Cochrane Library 数据库中对 2000 年 1 月 1 日至 2024 年 1 月 1 日期间的文献进行了系统性检索。研究结果为以下参数的变化:(a) 左心室壁质量(LVM),以克为单位;(b) 与体重指数相关的左心室壁质量,以克/米平方为单位;(c) 最大左心室壁厚度(MLVWT),以毫米为单位;(d) 迟发性钆增强(LGE)程度,以左心室壁质量的百分比为单位;(e) 本地 T1 映射,以毫秒为单位。对基线和随访参数之间的汇总平均差异进行了随机效应荟萃分析。研究方案已在 PROSPERO 注册(CRD42022336223)。结果 最终分析包括 11 项研究,共涉及 445 名法布里病患者(平均年龄 ± SD,41 岁 ± 11;277 名男性,168 名女性)。在基线和随访心脏磁共振成像之间,以下指标没有发生变化:T1 映像(平均差异为 6 毫秒 [95% CI:-2,15];两项研究,70 名患者,I2 = 88%)和 LVM 指数(平均差异为-1 克/平方米 [95% CI:-6,3];四项研究,290 名患者,I2 = 81%)。以下指标的降幅最小:LVM(平均差异:-18 g [95% CI:-33,-3];7 项研究,107 名患者,I2 = 96%)和 MLVWT(平均差异:-1 mm [95% CI:-2,-0.02];6 项研究,151 名患者,I2 = 90%)。LGE 范围增加(平均差异为 1%[95% CI:1,1];3 项研究,114 名患者,I2 = 85%)。结论 在法布里病患者中,酶替代治疗与 LVM、MLVWT 和 T1 映射值的稳定有关,而 LGE 范围轻度增加。关键词法布里病、酶替代疗法(ERT)、心脏磁共振成像、晚期钆增强(LGE 本文有补充材料。© RSNA, 2024.
{"title":"Effects of Enzyme Replacement Therapy on Cardiac MRI Findings in Fabry Disease: A Systematic Review and Meta-Analysis.","authors":"Stefano Figliozzi, Eleni Kollia, Alexandros Simistiras, Antonia Camporeale, Kamil Stankowski, Pier Giorgio Masci, George Mavraganis, Massimo Lombardi, Gianluigi Condorelli, Marco Francone, Maurizio Pieroni, Georgios Georgiopoulos","doi":"10.1148/ryct.230154","DOIUrl":"10.1148/ryct.230154","url":null,"abstract":"<p><p>Purpose To perform a systematic review and meta-analysis to assess the effect of enzyme replacement therapy on cardiac MRI parameters in patients with Fabry disease. Materials and Methods A systematic literature search was conducted from January 1, 2000, through January 1, 2024, in PubMed, ClinicalTrials.gov, Embase, and Cochrane Library databases. Study outcomes were changes in the following parameters: <i>(a)</i> left ventricular wall mass (LVM), measured in grams; <i>(b)</i> LVM indexed to body mass index, measured in grams per meters squared; <i>(c)</i> maximum left ventricular wall thickness (MLVWT), measured in millimeters; <i>(d)</i> late gadolinium enhancement (LGE) extent, measured in percentage of LVM; and <i>(e)</i> native T1 mapping, measured in milliseconds. A random-effects meta-analysis of the pooled mean differences between baseline and follow-up parameters was conducted. The study protocol was registered in PROSPERO (CRD42022336223). Results The final analysis included 11 studies of a total of 445 patients with Fabry disease (mean age ± SD, 41 years ± 11; 277 male, 168 female). Between baseline and follow-up cardiac MRI, the following did not change: T1 mapping (mean difference, 6 msec [95% CI: -2, 15]; two studies, 70 patients, <i>I<sup>2</sup></i> = 88%) and LVM indexed (mean difference, -1 g/m<sup>2</sup> [95% CI: -6, 3]; four studies, 290 patients, <i>I<sup>2</sup></i> = 81%). The following measures minimally decreased: LVM (mean difference, -18 g [95% CI: -33, -3]; seven studies, 107 patients, <i>I<sup>2</sup></i> = 96%) and MLVWT (mean difference, -1 mm [95% CI: -2, -0.02]; six studies, 151 patients, <i>I<sup>2</sup></i> = 90%). LGE extent increased (mean difference, 1% [95% CI: 1, 1]; three studies, 114 patients, <i>I<sup>2</sup></i> = 85%). Conclusion In patients with Fabry disease, enzyme replacement therapy was associated with stabilization of LVM, MLVWT, and T1 mapping values, whereas LGE extent mildly increased. <b>Keywords:</b> Fabry Disease, Enzyme Replacement Therapy (ERT), Cardiac MRI, Late Gadolinium Enhancement (LGE) <i>Supplemental material is available for this article.</i> © RSNA, 2024.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"6 3","pages":"e230154"},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11211942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correlation of Noninvasive Cardiac MRI Measures of Left Ventricular Myocardial Function and Invasive Pressure-Volume Parameters in a Porcine Ischemia-Reperfusion Model. 猪缺血再灌注模型中左心室心肌功能的无创心脏磁共振成像测量与有创压力-容积参数的相关性
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.230252
Tejas Deshmukh, Dinesh Selvakumar, Sujitha Thavapalachandran, Oliver Archer, Gemma A Figtree, Michael Feneley, Stuart M Grieve, Liza Thomas, Faraz Pathan, James J H Chong

Purpose To assess the correlation between noninvasive cardiac MRI-derived parameters with pressure-volume (PV) loop data and evaluate changes in left ventricular function after myocardial infarction (MI). Materials and Methods Sixteen adult female swine were induced with MI, with six swine used as controls and 10 receiving platelet-derived growth factor-AB (PDGF-AB). Load-independent measures of cardiac function, including slopes of end-systolic pressure-volume relationship (ESPVR) and preload recruitable stroke work (PRSW), were obtained on day 28 after MI. Cardiac MRI was performed on day 2 and day 28 after infarct. Global longitudinal strain (GLS) and global circumferential strain (GCS) were measured. Ventriculo-arterial coupling (VAC) was derived from PV loop and cardiac MRI data. Pearson correlation analysis was performed. Results GCS (r = 0.60, P = .01), left ventricular ejection fraction (LVEF) (r = 0.60, P = .01), and cardiac MRI-derived VAC (r = 0.61, P = .01) had a significant linear relationship with ESPVR. GCS (r = 0.75, P < .001) had the strongest significant linear relationship with PRSW, followed by LVEF (r = 0.67, P = .005) and cardiac MRI-derived VAC (r = 0.60, P = .01). GLS was not significantly correlated with ESPVR or PRSW. There was a linear correlation (r = 0.82, P < .001) between VAC derived from cardiac MRI and from PV loop data. GCS (-3.5% ± 2.3 vs 0.5% ± 1.4, P = .007) and cardiac MRI-derived VAC (-0.6 ± 0.6 vs 0.3 ± 0.3, P = .001) significantly improved in the animals treated with PDGF-AB 28 days after MI compared with controls. Conclusion Cardiac MRI-derived parameters of MI correlated with invasive PV measures, with GCS showing the strongest correlation. Cardiac MRI-derived measures also demonstrated utility in assessing therapeutic benefit using PDGF-AB. Keywords: Cardiac MRI, Myocardial Infarction, Pressure Volume Loop, Strain Imaging, Ventriculo-arterial Coupling Supplemental material is available for this article. © RSNA, 2024.

目的 评估无创心脏磁共振成像衍生参数与压力-容积(PV)环路数据之间的相关性,并评估心肌梗塞(MI)后左室功能的变化。材料和方法 用心肌梗塞诱导 16 头成年雌性猪,其中 6 头作为对照组,10 头接受血小板衍生生长因子-AB (PDGF-AB)。在心肌梗死后第 28 天测量与负荷无关的心脏功能,包括收缩末压-容积关系斜率(ESPVR)和前负荷可招募搏动功(PRSW)。心肌梗塞后第 2 天和第 28 天进行了心脏核磁共振成像。测量了整体纵向应变(GLS)和整体周向应变(GCS)。根据 PV 环路和心脏磁共振成像数据得出心室-动脉耦合(VAC)。进行了皮尔逊相关分析。结果 GCS(r = 0.60,P = 0.01)、左室射血分数(LVEF)(r = 0.60,P = 0.01)和心脏磁共振成像得出的 VAC(r = 0.61,P = 0.01)与 ESPVR 呈显著线性关系。GCS(r = 0.75,P < .001)与 PRSW 的线性关系最为显著,其次是 LVEF(r = 0.67,P = .005)和心脏 MRI 导出 VAC(r = 0.60,P = .01)。GLS 与 ESPVR 或 PRSW 无明显相关性。心脏磁共振成像得出的 VAC 与 PV 回路数据之间存在线性相关(r = 0.82,P < .001)。与对照组相比,心肌梗死 28 天后接受 PDGF-AB 治疗的动物的 GCS(-3.5% ± 2.3 vs 0.5% ± 1.4,P = .007)和心脏 MRI 导出的 VAC(-0.6 ± 0.6 vs 0.3 ± 0.3,P = .001)显著改善。结论 MI 的心脏 MRI 派生参数与有创 PV 测量值相关,其中 GCS 的相关性最强。心脏磁共振成像衍生参数还证明了使用 PDGF-AB 评估治疗效果的实用性。关键词心脏磁共振成像、心肌梗死、压力容积环、应变成像、心室-动脉耦合 本文有补充材料。© RSNA, 2024.
{"title":"Correlation of Noninvasive Cardiac MRI Measures of Left Ventricular Myocardial Function and Invasive Pressure-Volume Parameters in a Porcine Ischemia-Reperfusion Model.","authors":"Tejas Deshmukh, Dinesh Selvakumar, Sujitha Thavapalachandran, Oliver Archer, Gemma A Figtree, Michael Feneley, Stuart M Grieve, Liza Thomas, Faraz Pathan, James J H Chong","doi":"10.1148/ryct.230252","DOIUrl":"10.1148/ryct.230252","url":null,"abstract":"<p><p>Purpose To assess the correlation between noninvasive cardiac MRI-derived parameters with pressure-volume (PV) loop data and evaluate changes in left ventricular function after myocardial infarction (MI). Materials and Methods Sixteen adult female swine were induced with MI, with six swine used as controls and 10 receiving platelet-derived growth factor-AB (PDGF-AB). Load-independent measures of cardiac function, including slopes of end-systolic pressure-volume relationship (ESPVR) and preload recruitable stroke work (PRSW), were obtained on day 28 after MI. Cardiac MRI was performed on day 2 and day 28 after infarct. Global longitudinal strain (GLS) and global circumferential strain (GCS) were measured. Ventriculo-arterial coupling (VAC) was derived from PV loop and cardiac MRI data. Pearson correlation analysis was performed. Results GCS (<i>r</i> = 0.60, <i>P</i> = .01), left ventricular ejection fraction (LVEF) (<i>r</i> = 0.60, <i>P</i> = .01), and cardiac MRI-derived VAC (<i>r</i> = 0.61, <i>P</i> = .01) had a significant linear relationship with ESPVR. GCS (<i>r</i> = 0.75, <i>P</i> < .001) had the strongest significant linear relationship with PRSW, followed by LVEF (<i>r</i> = 0.67, <i>P</i> = .005) and cardiac MRI-derived VAC (<i>r</i> = 0.60, <i>P</i> = .01). GLS was not significantly correlated with ESPVR or PRSW. There was a linear correlation (<i>r</i> = 0.82, <i>P</i> < .001) between VAC derived from cardiac MRI and from PV loop data. GCS (-3.5% ± 2.3 vs 0.5% ± 1.4, <i>P</i> = .007) and cardiac MRI-derived VAC (-0.6 ± 0.6 vs 0.3 ± 0.3, <i>P</i> = .001) significantly improved in the animals treated with PDGF-AB 28 days after MI compared with controls. Conclusion Cardiac MRI-derived parameters of MI correlated with invasive PV measures, with GCS showing the strongest correlation. Cardiac MRI-derived measures also demonstrated utility in assessing therapeutic benefit using PDGF-AB. <b>Keywords:</b> Cardiac MRI, Myocardial Infarction, Pressure Volume Loop, Strain Imaging, Ventriculo-arterial Coupling <i>Supplemental material is available for this article.</i> © RSNA, 2024.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"6 3","pages":"e230252"},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11211950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Left Atrial Function and Volume Associations with Hemodynamics in a Representative Aged Cohort: Unlocking New Insights. 具有代表性的老年队列中左心房功能和容积与血液动力学的关系:揭开新的视角。
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.240054
Jeremy D Collins
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引用次数: 0
Risk Stratification Using Right Ventricular Longitudinal Strain Ratio Derived from 13N-Ammonia PET in Patients with Ischemic Heart Disease. 利用 13N-Ammonia PET 得出的缺血性心脏病患者右心室纵向应变比进行风险分层
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.230298
Atsushi Yamamoto, Michinobu Nagao, Masateru Kawakubo, Risako Nakao, Yuka Matsuo, Akiko Sakai, Koichiro Kaneko, Kenji Fukushima, Mitsuru Momose, Shuji Sakai, Junichi Yamaguchi

Purpose To investigate whether right ventricular (RV) myocardial strain ratio (RVMSR) assessed using nitrogen 13 ammonia (13N-NH3) PET can predict cardiovascular events in patients with ischemic heart disease (IHD). Materials and Methods This retrospective study included 480 consecutive patients (mean age, 66 years ± 12 [SD]; 334 males and 146 females) with IHD who underwent 13N-NH3 PET. RVMSR was defined as the ratio of RV strain during stress to that at rest. The primary end point was major adverse cardiac events (MACEs), defined as cardiac death or heart failure hospitalization. The ability of RVMSR to predict MACE was assessed using receiver operating characteristic (ROC) curve and Kaplan-Meier analyses. Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) with 95% CIs. Results ROC curve analysis identified a sensitivity and specificity of 84% and 82%, respectively, for predicting MACE from RVMSR. Patients with reduced RVMSR (<110.2) displayed a significantly higher rate of MACE than those with a preserved RVMSR (34 of 240 vs four of 240; P < .001). Cox proportional hazards regression analysis of imaging parameters, including myocardial flow reserve, indicated that RVMSR was an independent predictor of MACE (HR, 0.94 [95% CI: 0.92, 0.97]; P < .001). Conclusion RVMSR was an independent predictor of MACE and has potential to aid in the risk stratification of patients with IHD. Keywords: Right Ventricular Myocardial Strain Ratio, Myocardial Flow Reserve, Ischemic Heart Disease, 13N-Ammonia Positron Emission Tomography Supplemental material is available for this article. © RSNA, 2024.

目的 探讨使用氮13氨(13N-NH3)PET评估的右心室(RV)心肌应变比(RVMSR)能否预测缺血性心脏病(IHD)患者的心血管事件。材料和方法 这项回顾性研究纳入了 480 名连续接受 13N-NH3 PET 检查的 IHD 患者(平均年龄为 66 岁 ± 12 [SD];男性 334 人,女性 146 人)。RVMSR 被定义为应激时 RV 应变与静息时 RV 应变的比值。主要终点是主要心脏不良事件(MACE),即心源性死亡或心衰住院。采用接收器操作特征曲线(ROC)和卡普兰-梅耶分析评估了 RVMSR 预测 MACE 的能力。Cox 比例危险回归分析用于计算危险比 (HR) 及 95% CI。结果 ROC 曲线分析表明,根据 RVMSR 预测 MACE 的灵敏度和特异度分别为 84% 和 82%。RVMSR降低的患者(P < .001)。对包括心肌血流储备在内的成像参数进行的 Cox 比例危险回归分析表明,RVMSR 是 MACE 的独立预测因子(HR,0.94 [95% CI:0.92, 0.97];P < .001)。结论 RVMSR是MACE的独立预测因子,具有帮助对IHD患者进行风险分层的潜力。关键词右心室心肌应变比 心肌血流储备 缺血性心脏病 13N-氨正电子发射断层扫描 本文有补充材料。© RSNA, 2024.
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引用次数: 0
Head-to-Head Comparison and Temporal Trends of Cardiac MRI Recommendations in ESC versus ACC/AHA Guidelines: A Systematic Review and Meta-Analysis. ESC与ACC/AHA指南中心脏磁共振成像建议的头对头比较和时间趋势:系统回顾和元分析。
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.230271
Nicola Ciocca, Henri Lu, Georgios Tzimas, Olivier Muller, Ambra Masi, Niccolò Maurizi, Ioannis Skalidis, Mark Colin Gissler, Pierre Monney, Juerg Schwitter, Yin Ge, Panagiotis Antiochos

Purpose To provide a comprehensive head-to-head comparison and temporal analysis of cardiac MRI indications between the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines to identify areas of consensus and divergence. Materials and Methods A systematic review and meta-analysis was conducted. ESC and ACC/AHA guidelines published until May 2023 were systematically screened for recommendations related to cardiac MRI. The class of recommendation (COR) and level of evidence (LOE) for cardiac MRI recommendations were compared between the two guidelines and between newer versus older versions of each guideline using χ2 or Fisher exact tests. Results ESC guidelines included 109 recommendations regarding cardiac MRI, and ACC/AHA guidelines included 90 recommendations. The proportion of COR I and LOE B was higher in ACC/AHA versus ESC guidelines (60% [54 of 90] vs 46.8% [51 of 109]; P = .06 and 53% [48 of 90] vs 35.8% [39 of 109], respectively; P = .01). The increase in the number of cardiac MRI recommendations over time was significantly higher in ESC guidelines (from 63 to 109 for ESC vs from 65 to 90 for ACC/AHA; P = .03). The main areas of consensus were found in heart failure and hypertrophic cardiomyopathy, while the main divergences were in valvular heart disease, arrhythmias, and aortic disease. Conclusion ESC guidelines included more recommendations related to cardiac MRI use, whereas the ACC/AHA recommendations had higher COR and LOE. The number of cardiac MRI recommendations increased significantly over time in both guidelines, indicating the increasing role of cardiac MRI evaluation and management of cardiovascular disease. Keywords: Cardiovascular Magnetic Resonance, Guideline, European Society of Cardiology, ESC, American College of Cardiology/American Heart Association, ACC/AHA Supplemental material is available for this article. © RSNA, 2024.

目的 对欧洲心脏病学会 (ESC) 和美国心脏病学会/美国心脏协会 (ACC/AHA) 指南的心脏 MRI 适应症进行全面的头对头比较和时间分析,以确定共识和分歧的领域。材料和方法 进行了系统回顾和荟萃分析。系统地筛选了 2023 年 5 月之前发布的 ESC 和 ACC/AHA 指南中与心脏 MRI 相关的建议。使用χ2或费舍尔精确检验比较了两份指南之间以及每份指南的新版与旧版之间有关心脏磁共振成像建议的推荐级别(COR)和证据级别(LOE)。结果 ESC指南包括109条有关心脏MRI的建议,ACC/AHA指南包括90条建议。与ESC指南相比,ACC/AHA指南中COR I和LOE B的比例更高(分别为60% [90条中的54条] vs 46.8% [109条中的51条];P = .06和53% [90条中的48条] vs 35.8% [109条中的39条];P = .01)。随着时间的推移,ESC指南中心脏MRI建议数量的增加幅度明显更高(ESC从63条增加到109条,ACC/AHA从65条增加到90条;P = .03)。达成共识的主要领域是心力衰竭和肥厚型心肌病,而存在分歧的主要领域是瓣膜性心脏病、心律失常和主动脉疾病。结论 ESC 指南包含更多与心脏磁共振成像使用相关的建议,而 ACC/AHA 建议的 COR 和 LOE 较高。随着时间的推移,两种指南中心脏核磁共振成像建议的数量都有显著增加,这表明心脏核磁共振成像在心血管疾病的评估和管理中发挥着越来越重要的作用。关键词:心血管磁共振心血管磁共振;指南;欧洲心脏病学会;ESC;美国心脏病学会/美国心脏协会;ACC/AHA 本文有补充材料。© RSNA, 2024.
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引用次数: 0
Cardiovascular Imaging, Climate Change, and Environmental Sustainability. 心血管成像、气候变化和环境可持续性。
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.240135
Suvai Gunasekaran, Andrew Szava-Kovats, Thomas Battey, Jonathan Gross, Eugenio Picano, Subha V Raman, Emil Lee, Malenka M Bissell, Mirvat Alasnag, Adrienne E Campbell-Washburn, Kate Hanneman

Environmental exposures including poor air quality and extreme temperatures are exacerbated by climate change and are associated with adverse cardiovascular outcomes. Concomitantly, the delivery of health care generates substantial atmospheric greenhouse gas (GHG) emissions contributing to the climate crisis. Therefore, cardiac imaging teams must be aware not only of the adverse cardiovascular health effects of climate change, but also the downstream environmental ramifications of cardiovascular imaging. The purpose of this review is to highlight the impact of climate change on cardiovascular health, discuss the environmental impact of cardiovascular imaging, and describe opportunities to improve environmental sustainability of cardiac MRI, cardiac CT, echocardiography, cardiac nuclear imaging, and invasive cardiovascular imaging. Overarching strategies to improve environmental sustainability in cardiovascular imaging include prioritizing imaging tests with lower GHG emissions when more than one test is appropriate, reducing low-value imaging, and turning equipment off when not in use. Modality-specific opportunities include focused MRI protocols and low-field-strength applications, iodine contrast media recycling programs in cardiac CT, judicious use of US-enhancing agents in echocardiography, improved radiopharmaceutical procurement and waste management in nuclear cardiology, and use of reusable supplies in interventional suites. Finally, future directions and research are highlighted, including life cycle assessments over the lifespan of cardiac imaging equipment and the impact of artificial intelligence tools. Keywords: Heart, Safety, Sustainability, Cardiovascular Imaging Supplemental material is available for this article. © RSNA, 2024.

包括空气质量差和极端温度在内的环境暴露因气候变化而加剧,并与心血管疾病的不良后果相关联。与此同时,医疗保健的提供也产生了大量的温室气体(GHG)排放,加剧了气候危机。因此,心脏成像团队不仅必须了解气候变化对心血管健康的不利影响,还必须了解心血管成像的下游环境影响。本综述旨在强调气候变化对心血管健康的影响,讨论心血管成像对环境的影响,并介绍改善心脏核磁共振成像、心脏 CT、超声心动图、心脏核成像和有创心血管成像的环境可持续性的机会。改善心血管成像环境可持续性的总体战略包括:在需要进行多项检查时,优先考虑温室气体排放量较低的成像检查;减少低价值成像;在不使用设备时将其关闭。针对具体模式的机会包括:有针对性的核磁共振成像方案和低强度应用、心脏 CT 中碘造影剂的回收计划、超声心动图中 US 增强剂的合理使用、核心脏病学中放射性药物采购和废物管理的改进,以及介入治疗室中可重复使用用品的使用。最后,重点介绍了未来的研究方向,包括心脏成像设备寿命周期评估和人工智能工具的影响。关键词心脏 安全性 可持续性 心血管成像 本文有补充材料。© RSNA, 2024.
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引用次数: 0
Right Ventricular Strain Derived from Cardiac MRI Feature Tracking for the Diagnosis and Prognosis of Arrhythmogenic Right Ventricular Cardiomyopathy. 从心脏磁共振成像特征追踪得出的右室应变用于诊断和预后致心律失常性右室心肌病
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.230292
Zhixiang Dong, Linlin Dai, Yanyan Song, Xuan Ma, Jiaxin Wang, Shiqin Yu, Shujuan Yang, Kai Yang, Kankan Zhao, Minjie Lu, Xiuyu Chen, Shihua Zhao

Purpose To demonstrate the myocardial strain characteristics of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), based on revised Task Force Criteria (rTFC), and to explore the prognostic value of strain analysis in ARVC. Materials and Methods This retrospective study included 247 patients (median age, 38 years [IQR, 28-48 years]; 167 male, 80 female) diagnosed with ARVC, based on rTFC, between 2014 and 2018. Patients were divided into "possible" (n =25), "borderline" (n = 40), and "definite" (n = 182) ARVC groups following rTFC. Biventricular global strain parameters were calculated using cardiac MRI feature tracking (FT). The primary outcome was defined as a composite of cardiovascular events, including cardiovascular death, heart transplantation, and appropriate implantable cardioverter defibrillator discharge. Univariable and multivariable cumulative logistic regression and Cox proportional hazards regression analysis were used to evaluate the diagnostic and prognostic value of right ventricle (RV) strain parameters. Results Patients with definite ARVC had significantly reduced RV global strain in all three directions compared with possible or borderline groups (all P < .001). RV global longitudinal strain (GLS) was an independent predictor for disease (odds ratio, 1.09 [95% CI: 1.02, 1.16]; P = .009). During a median follow-up of 3.4 years (IQR, 2.0-4.9 years), 55 patients developed primary end point events. Multivariable analysis showed that RV GLS was independently associated with the occurrence of cardiovascular events (hazard ratio, 1.15 [95% CI: 1.07, 1.24]; P < .001). Kaplan-Meier analysis showed that patients with RV GLS worse than median had a higher risk of combined cardiovascular events (log-rank P < .001). Conclusion RV GLS derived from cardiac MRI FT demonstrated good diagnostic and prognostic value in ARVC. Keywords: MR Imaging, Image Postprocessing, Cardiac, Right Ventricle, Cardiomyopathies, Arrhythmogenic Right Ventricular Cardiomyopathy, Revised Task Force Criteria, Cardiovascular MR, Feature Tracking, Cardiovascular Events Supplemental material is available for this article. © RSNA, 2024.

目的 根据修订的工作组标准(rTFC)展示心律失常性右室心肌病(ARVC)患者的心肌应变特征,并探讨应变分析在 ARVC 中的预后价值。材料与方法 这项回顾性研究纳入了 2014 年至 2018 年期间根据 rTFC 诊断为 ARVC 的 247 例患者(中位年龄 38 岁 [IQR,28-48 岁];男性 167 例,女性 80 例)。根据rTFC将患者分为 "可能"(25人)、"边缘"(40人)和 "明确"(182人)ARVC组。使用心脏磁共振成像特征跟踪(FT)计算双心室整体应变参数。主要结果定义为心血管事件的复合结果,包括心血管死亡、心脏移植和适当的植入式心脏除颤器放电。采用单变量和多变量累积逻辑回归及Cox比例危险回归分析来评估右心室(RV)应变参数的诊断和预后价值。结果 与可能组或边缘组相比,确诊为 ARVC 的患者在所有三个方向上的 RV 整体应变都明显降低(均 P < .001)。RV整体纵向应变(GLS)是疾病的独立预测因子(几率比:1.09 [95% CI:1.02, 1.16];P = .009)。在中位随访 3.4 年(IQR:2.0-4.9 年)期间,55 名患者出现了主要终点事件。多变量分析显示,RV GLS 与心血管事件的发生有独立关联(危险比为 1.15 [95% CI: 1.07, 1.24];P < .001)。Kaplan-Meier 分析显示,RV GLS 低于中位数的患者合并心血管事件的风险更高(对数秩 P < .001)。结论 由心脏磁共振成像 FT 得出的 RV GLS 对 ARVC 具有良好的诊断和预后价值。关键词磁共振成像,图像后处理,心脏,右心室,心肌病,致心律失常右室心肌病,修订工作组标准,心血管磁共振,特征追踪,心血管事件 本文有补充材料。© RSNA, 2024.
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引用次数: 0
Generalized Arterial Calcification of Infancy Mimicking Coarctation of Aorta in a Neonate. 模仿新生儿主动脉粥样硬化的婴儿期全身动脉钙化
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1148/ryct.230403
Neha A Varghese, Boobathi R Gopal, Anupama Maheswaran, Vijayakumar Raju, Aparna Vijayaraghavan

Generalized arterial calcification of infancy (GACI) is a rare genetic condition with varied clinical presentation. Consequently, diagnosis is frequently delayed or missed. GACI has a poor prognosis, with more than half of patients dying before the age of 6 months. Early diagnosis and treatment with bisphosphonates have been shown to improve survival in these patients. This is a case report of a newborn with respiratory distress who was initially diagnosed with coarctation of the aorta at echocardiography. Further imaging with CT revealed the aortic narrowing to be associated with GACI. Keywords: Genetic Defects, Congenital, Vascular, Calcification/Calculi, Aorta, Pulmonary Arteries, CT Angiography, Echocardiography, Pediatrics © RSNA, 2024.

婴儿期全身动脉钙化(GACI)是一种罕见的遗传病,临床表现多种多样。因此,诊断常常被延迟或漏诊。GACI 的预后很差,半数以上的患者在 6 个月前死亡。事实证明,早期诊断和使用双膦酸盐治疗可提高这些患者的存活率。这是一份新生儿呼吸窘迫的病例报告,超声心动图初步诊断为主动脉共动脉瘤。CT 的进一步成像显示主动脉狭窄与 GACI 有关。关键词遗传缺陷,先天性,血管,钙化/结石,主动脉,肺动脉,CT 血管造影,超声心动图,儿科 © RSNA, 2024.
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引用次数: 0
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Radiology. Cardiothoracic imaging
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