Archives of Cardiovascular Diseases Supplements最新文献_第8页

Characterization of impaired left ventricular mitral filling in HCM: A 4D-flow CMR study HCM左心室二尖瓣充盈受损的特征:4d血流CMR研究

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.017

H. Sakhi , G. Soulat , D. Craiem , U. Gencer , V. Stipechi , T. Puscas , A. Hagege , E. Mousseaux

Introduction

Diastolic dysfunction is common and contributes to many clinical manifestations in hypertrophic cardiomyopathy (HCM). 4-dimensionnal (4D) flow cardiac magnetic resonance (CMR) sequence can assess left ventricular mitral filling. The purpose of this study was to determine if the peak early filling rate normalized to the filling volume (PEFR/FV), estimated from 4D-flow sequence can accurately assess impaired left ventricular mitral filling and predict clinical outcomes.

Method

This monocentric study included 44 HCM patients from a prospective HCM register and 44 healthy volunteers, who all underwent CMR with 4D-Flow sequence. Median follow-up time of HCM cohort patients was 2.3 years (interquartile range: 1.7 to 3.3 years). The predefined primary endpoint was a composite criteria that included syncope, onset of atrial fibrillation, admission for congestive heart failure with administration of diuretics, decision to perform septal reduction therapy due to persistent symptomatic obstruction, stroke, ventricular tachycardia or fibrillation and cardiac death.

Results

PEFR/FV was significantly lower in HCM cohort compared to healthy volunteers (P < 0.001). PFR/FV significantly correlated with BNP (r = −0.31, P < 0.001) and with E/E’ ratio (r = −0.56, p < 0.001). PEFR/FV according to NYHA status in HCM cohort was statistically different (P = 0.001). Primary endpoint occurred in 14 patients (32%). In univariate and bivariate adjusted cox-model analysis PEFR/FV < 2.61 s -1 was significantly associated with primary endpoint with Hazard Ratio ranging from [HR = 9.46 (95% CI 2.61–45.17, P < 0.001) to 15.21 (95%CI 3.51–80.22, P < 0.001)] according to succesive bivariate models.

Conclusion

4D-Flow can accurately assess left ventricular mitral filling with a good predictive value of clinical outcomes in HCM patients. Relation of PEFR/FV calculated with 4D flow in HCM.

舒张功能障碍是肥厚性心肌病(HCM)常见的临床表现之一。四维血流心脏磁共振(CMR)序列可评估左心室二尖瓣充盈。本研究的目的是确定从4d血流序列估计的峰值早期充盈率与充盈体积(PEFR/FV)是否可以准确评估左心室二尖瓣充盈受损并预测临床结果。方法本单中心研究纳入了44例HCM患者和44名健康志愿者，均采用4D-Flow序列进行CMR。HCM队列患者的中位随访时间为2.3年(四分位数范围:1.7 ~ 3.3年)。预先确定的主要终点是一个复合标准，包括晕厥、房颤发作、充血性心力衰竭入院并给予利尿剂、由于持续症状性梗阻、中风、室性心动过速或房颤以及心源性死亡而决定进行间隔缩小治疗。结果HCM组spefr /FV显著低于健康组(P <0.001)。PFR/FV与BNP显著相关(r = - 0.31, P <0.001)， E/E比值(r = - 0.56, p <0.001)。HCM队列中NYHA状态的PEFR/FV差异有统计学意义(P = 0.001)。主要终点发生在14例患者(32%)。在单因素和双因素校正cox模型分析中，PEFR/FV <2.61 s -1与主要终点显著相关，风险比范围为[HR = 9.46] (95% CI 2.61 - 45.17, P <0.001)至15.21 (95%CI 3.51-80.22, P <0.001)]根据连续双变量模型。结论4d - flow能准确评估HCM患者左心室二尖瓣充盈情况，对HCM患者临床预后有较好的预测价值。HCM四维流动计算PEFR/FV的关系。

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引用次数: 0

A novel new 3D volume echo derived method for regurgitation fraction quantification in isolated aortic regurgitation 一种新的三维体积回波衍生方法用于孤立主动脉反流的定量分析

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.023

V. Baland, N. Pace, C. Selton Suty, A. Fraix, O. Huttin, D. Mandry, L. Filippetti

Introduction

Accurate quantification of chronic aortic regurgitation (AR) using 2D-TTE is sometimes challenging. Cardiac magnetic resonance imaging (CMR) is increasingly used to refine this assessment by estimating measurement of regurgitation fraction (RF), but remains not widely available. 3D echocardiography (3D-ETT) allows a non-invasive approach of right ventricular (RV) and left ventricular (LV) volumes with a good correlation with CMR measurements. The 3D-TTE volume method is based on the comparison of RV and LV stroke volumes, which is then used to calculate the RF of the aortic valve in isolated AR.The primary objective of this study was to investigate the ability of 3D-TTE to assess the severity of chronic AR based on the criterion of regurgitation fraction (RF) obtained by the volume method in comparison to PC-CMR.

Method

We enrolled 42 patients with isolated AR who underwent ASE algorithm-guided 2D echocardiography (2D-TTE), 3D echocardiography and CMR. Regurgitation fraction (RF) was calculated by 3D-TTE using the formula [(LV Stroke Volume–RV Stroke Volume)/LV Stroke Volume] × 100. Correlation and concordance between 3D-TTE-RF and PC-CMR-RF were analyzed. Reproducibility of 3D-TTE-RF measurement was evaluated.

Results

Seven (17%) had mild AR, 27 (64%) moderate AR, and 8 (19%) severe AR in PC-CMR. Mean RF was 32.7 ± 13.9% by 3D-TTE and 30,7 ± 14,9% by PC-CMR-RF (P < 0,05). 3D-TTE-RF and PC-CMR-RF had a good correlation (r = 0.90, P < 0,05). We found a good intra-operator (r:0.95, P < 0.05) and inter-operator (r:0.87, P < 0.05) reproductibility. The final gradation of AR was concordant between 3D TTE and PC-CMR in 88% of the cases.

Conclusion

The assessment of isolated aortic regurgitation fraction in 3D-TTE by the volumetric method is a feasible and reproducible method in daily clinical practice, with a good correlation to PC-CMR. Estimation of the aortic regurgitation fraction in (Fig. 1).

使用2D-TTE对慢性主动脉反流(AR)进行准确量化有时是具有挑战性的。心脏磁共振成像(CMR)越来越多地用于通过估计反流分数(RF)的测量来完善这一评估，但仍未广泛应用。3D超声心动图(3D- ett)允许无创入路右心室(RV)和左心室(LV)容量与CMR测量具有良好的相关性。3D-TTE容积法是基于左室和左室卒中容积的比较，然后用于计算孤立性AR的主动脉瓣RF。本研究的主要目的是研究3D-TTE基于容积法获得的反流分数(RF)标准来评估慢性AR严重程度的能力，并与PC-CMR进行比较。方法我们招募了42例孤立性AR患者，他们接受了ASE算法引导的2D超声心动图(2D- tte)、3D超声心动图和CMR。采用3D-TTE计算回流分数(RF)，计算公式为[(左室行程容积-右室行程容积)/左室行程容积]× 100。分析了3D-TTE-RF与PC-CMR-RF的相关性和一致性。对3D-TTE-RF测量的再现性进行了评价。结果PC-CMR轻度AR 7例(17%)，中度AR 27例(64%)，重度AR 8例(19%)。3D-TTE的平均RF为32.7±13.9%，PC-CMR-RF为30.7±14.9% (P <0 05)。3D-TTE-RF与PC-CMR-RF具有良好的相关性(r = 0.90, P <0 05)。我们发现了一个很好的内算子(r:0.95, P <0.05)和算子间(r:0.87, P <0.05)复现。在88%的病例中，3D TTE和PC-CMR的最终AR分级是一致的。结论体积法评估3D-TTE离体主动脉反流分数在日常临床实践中是一种可行且可重复的方法，与PC-CMR具有良好的相关性。估计主动脉反流分数(图1)。

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引用次数: 0

Exercise-induced pulmonary congestion assessed by lung ultra sound in patients with preserved left ventricular ejection fraction referred for exercise echocardiography to rule out myocardial ischemia 保留左心室射血分数患者的肺超声评估运动性肺充血，并参考运动超声心动图排除心肌缺血

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.013

C. Granger, L. Legrand, Y. Allali, P. Guedeney, R. Isnard, F. Pousset, J.P. Collet, G. Montalescot, N. Hammoudi

Introduction

Lung ultrasound (LUS) can detect pulmonary congestion assessed by B-lines in heart failure patients undergoing stress test. Exercise B-lines could help diagnose heart failure with preserved left ventricular ejection fraction (LVEF) at an early stage. This study aimed to assess exercise-induced pulmonary congestion in patients with preserved LVEF referred for exercise echocardiography to rule out myocardial ischemia.

Method

Data of stress echocardiography combined with LUS at rest and immediately after exercise in patients with LVEF ≥ 50% referred for investigation of inducible myocardial ischemia in a tertiary center of cardiology were retrospectively analyzed. B-lines were assessed by scanning 2 chest sites. Exercise-induced pulmonary congestion was defined as an increase of B-lines ≥ 2 between baseline and exercise.

Results

A total of 1114 patients were included. Mean age was 63 years, 54% of patients had hypertension and 27% had diabetes. Exercise-induced pulmonary congestion was identified in 131 (12%) patients. Age, left atrial volume index (LAVi), resting and 20 W septal E/e’ > 15 and peak tricuspid regurgitation velocity (TRV) were associated with increased exercise-induced B-lines. At multivariable analysis, LAVi (OR = 1.03; 95% confidence interval (CI): 1.01–1.06; P = 0.003) and peak TRV (OR = 3.8; 95%CI: 1.4–10.1; P = 0.009) were independent predictors of exercise-induced pulmonary congestion.

Conclusion

Exercise-induced pulmonary congestion could be diagnosed in patients with preserved LVEF referred to rule out inducible myocardial ischemia. Exercise B-lines are linked with left ventricular diastolic dysfunction indices.

肺超声(LUS)可在心力衰竭患者进行压力测试时检测出b线评估的肺充血。运动b线可以帮助早期诊断保留左心室射血分数(LVEF)的心力衰竭。本研究旨在评估运动超声心动图排除心肌缺血的运动性肺动脉充血患者。方法回顾性分析某三级心脏病中心引导性心肌缺血调查中LVEF≥50%患者静息及运动后应激超声合并LUS的资料。通过扫描2个胸部部位来评估b线。运动引起的肺充血定义为基线和运动之间b线增加≥2。结果共纳入1114例患者。平均年龄63岁，54%的患者有高血压，27%的患者有糖尿病。131例(12%)患者存在运动引起的肺充血。年龄、左房容积指数(LAVi)、静息及20 W间隔E/ E′>15和峰值三尖瓣反流速度(TRV)与运动诱导的b线增加有关。在多变量分析中，LAVi (OR = 1.03;95%置信区间(CI): 1.01-1.06;P = 0.003)和峰值TRV (OR = 3.8;95%置信区间:1.4—-10.1;P = 0.009)是运动性肺充血的独立预测因子。结论LVEF保留患者可诊断运动性肺充血，排除诱发性心肌缺血。运动b线与左室舒张功能障碍指数相关。

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引用次数: 0

Effectiveness of a radiation protective device of interventional echocardiographers during structural heart disease interventions 介入超声心动图医师在结构性心脏病干预中辐射防护装置的有效性

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.009

F. Magniez (Interne) , N. Piriou (Praticien Hospitalier) , P. Jaafar (Praticien Hospitalier) , P.Y. Tuergon , C. Cueff (Praticien Hospitalier) , M. Bertrand (Praticien Hospitalier) , J.M. Langlard (Praticien Hospitalier) , L. Legloan (Praticien Hospitalier) , L. Ammour (Radiophysicien) , P. Guerin

Introduction

Interventional echocardiographers (IE) have a crucial role in growing structural heart interventional procedures. Previous studies showed a 5 times higher exposure of IE than that of the invasive cardiologist. No dedicated and adapted radiation protection device currently exists for IE. It is from this observation that the interventional cardiology team of the Nantes University Hospital, together with the company “LemerPax”, have designed a radiation protection cabin (EchoSafe) dedicated to the protection of the IE in the operative room. The objective of this study is to evaluate the radioprotective performances of this cabin in real life.

Method

We included during 6 months all procedures that required transesophageal echocardiography. These procedures were divided into two groups (the first on which the usual protection device were used, i.e. a leaded glass door – the second on which the “Echosafe” device was used). We matched the procedures to obtain a total amount of irradiation estimated by the DAP (dose area product) close between the two groups. Irradiation measurements of the IE were performed with 10 TLD (thermoluminescent detectors) distributed over the whole body.

Results

We included a total of 64 procedures: 24 procedures in the control group, and 40 in the “echosafe” group. The cumulative DAP for each group was 75,206.9 Cgy/cm² in the control group, and 70,042 mGy.cm² in the echosafe group. Patient characteristics were identical between the two groups. The results show that in the “echosafe” group, irradiation was below the dose limit for the left lens, shoulders, thorax, and neck, a 49% reduction in irradiation of the right lens, 76% of the right wrist, 12% of the left wrist, 49% of the pubis, and 36% of the right ankle.

Conclusion

The “echosafe” device offers a clear reduction in the irradiation of the IE during structural heart intervention. Irradiation measurment of the sonographer (Fig. 1).

介入超声心动图(IE)在不断发展的结构性心脏介入手术中起着至关重要的作用。先前的研究表明，IE暴露比侵入性心脏病专家高5倍。目前没有针对IE的专用和适配的辐射防护装置。正是基于这一观察，南特大学医院介入心脏病学团队与“LemerPax”公司共同设计了一种专门用于保护手术室IE的辐射防护舱(EchoSafe)。本研究的目的是评估该舱在实际生活中的辐射防护性能。方法我们纳入6个月内所有需要经食管超声心动图的手术。这些程序被分为两组(第一组使用通常的保护装置，即含铅玻璃门-第二组使用“Echosafe”装置)。我们匹配程序，以获得由两组之间的DAP(剂量面积积)估计的总辐照量。用分布在全身的10个TLD(热释光探测器)对IE进行辐照测量。结果共纳入64例手术，对照组24例，echosafe组40例。各组累积DAP为75,206.9 Cgy/cm2，对照组为70,042 mGy。回声安全组Cm2。两组患者特征相同。结果显示，在“echosafe”组中，左晶状体、肩部、胸部和颈部的辐照量低于剂量限制，右侧晶状体、右手腕、左手腕、耻骨和右脚踝的辐照量分别减少了49%、76%、12%、49%和36%。结论“echosafe”装置可明显减少结构性心脏介入时IE的辐照。超声仪的辐照测量(图1)。

{"title":"Effectiveness of a radiation protective device of interventional echocardiographers during structural heart disease interventions","authors":"F. Magniez (Interne) , N. Piriou (Praticien Hospitalier) , P. Jaafar (Praticien Hospitalier) , P.Y. Tuergon , C. Cueff (Praticien Hospitalier) , M. Bertrand (Praticien Hospitalier) , J.M. Langlard (Praticien Hospitalier) , L. Legloan (Praticien Hospitalier) , L. Ammour (Radiophysicien) , P. Guerin","doi":"10.1016/j.acvdsp.2023.04.009","DOIUrl":"10.1016/j.acvdsp.2023.04.009","url":null,"abstract":"<div><h3>Introduction</h3><p>Interventional echocardiographers (IE) have a crucial role in growing structural heart interventional procedures. Previous studies showed a 5 times higher exposure of IE than that of the invasive cardiologist. No dedicated and adapted radiation protection device currently exists for IE. It is from this observation that the interventional cardiology team of the Nantes University Hospital, together with the company “LemerPax”, have designed a radiation protection cabin (EchoSafe) dedicated to the protection of the IE in the operative room. The objective of this study is to evaluate the radioprotective performances of this cabin in real life.</p></div><div><h3>Method</h3><p>We included during 6 months all procedures that required transesophageal echocardiography. These procedures were divided into two groups (the first on which the usual protection device were used, i.e. a leaded glass door – the second on which the “Echosafe” device was used). We matched the procedures to obtain a total amount of irradiation estimated by the DAP (dose area product) close between the two groups. Irradiation measurements of the IE were performed with 10 TLD (thermoluminescent detectors) distributed over the whole body.</p></div><div><h3>Results</h3><p>We included a total of 64 procedures: 24 procedures in the control group, and 40 in the “echosafe” group. The cumulative DAP for each group was 75,206.9 Cgy/cm<sup>2</sup> in the control group, and 70,042 mGy.cm<sup>2</sup><span> in the echosafe group. Patient characteristics<span> were identical between the two groups. The results show that in the “echosafe” group, irradiation was below the dose limit for the left lens, shoulders, thorax, and neck, a 49% reduction in irradiation of the right lens, 76% of the right wrist, 12% of the left wrist, 49% of the pubis, and 36% of the right ankle.</span></span></p></div><div><h3>Conclusion</h3><p><span>The “echosafe” device offers a clear reduction in the irradiation of the IE during structural heart intervention. Irradiation measurment of the sonographer (</span><span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48255772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

AI-based fully automated left atrioventricular coupling index as a prognostic marker in patients undergoing stress-CMR 基于人工智能的全自动左房室耦合指数作为压力- cmr患者的预后指标

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.025

T. Pezel , P. Garot , S. Toupin , F. Sanguineti , T. Hovasse , T. Unterseeh , S. Champagne , T. Chitiboi , B. Ambale Venkatesh , J.A.C. Lima , J. Garot

Introduction

The left atrioventricular coupling index (LACI) is a strong and independent predictor of heart failure (HF) in individuals without clinical cardiovascular disease. To determine in patients undergoing stress CMR whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF.

Method

Between 2016 and 2018, we conducted a study including all consecutive patients with abnormal vasodilator stress CMR [inducible ischemia or late gadolinium enhancement (LGE)]. Control subjects with normal CMR were selected using propensity score-matching. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome included hospitalization for acute HF or cardiovascular death using Cox regression.

Results

In 2662 patients [65 ± 12 years, 68% men, 1:1 matched patients (1331 with normal and 1331 with abnormal CMR)], LACI was positively associated with the primary outcome [median follow-up 5.2 (4.8–5.5) years] before and after adjustment for risk factors in the overall propensity-matched population [adjusted hazard ratio (HR), 5.94 (95%CI, 3.74–9.45) per 0.1% increment], patients with abnormal [adjusted HR, 6.38 (95%CI, 3.77–10.8) per 0.1% increment], and normal CMR [adjusted HR, 6.15 (95%CI, 2.97–12.7) per 0.1% increment; all P < 0.001]. After adjustment, a higher LACI of ≥ 25% showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-statistic improvement: 0.15; NRI = 0.705; IDI = 0.398, all P < 0.001; LR-test P < 0.001).

Conclusion

LACI is independently associated with hospitalization for HF and cardiovascular death in patients undergoing stress CMR, with an incremental prognostic value over traditional risk factors including inducible ischemia and LGE (Fig. 1).

引言在没有临床心血管疾病的个体中，左房室耦合指数（LACI）是心力衰竭（HF）的一个强大而独立的预测指标。为了确定在接受应激性CMR的患者中，基于全自动人工智能的LACI是否可以为预测HF提供增加的预后价值。方法在2016年至2018年间，我们进行了一项研究，包括所有连续出现异常血管舒张应激性CMR[诱导性缺血或晚期钆增强（LGE）]的患者。使用倾向评分匹配选择CMR正常的对照受试者。LACI定义为左心房与左心室舒张末期容积的比值。主要结果包括使用Cox回归法因急性心衰或心血管死亡住院治疗。结果在2662名患者[65±12岁，68%的男性，1:1匹配的患者（1331名CMR正常，1331名异常）]中，LACI与总体倾向匹配人群中风险因素调整前后的主要结果[中位随访5.2（4.8–5.5）年]呈正相关[调整后的危险比（HR），5.94（95%CI，3.74–9.45）/0.1%增量]，具有异常[调整后的HR，6.38（95%CI，3.77-10.8）/0.1%增量]和正常CMR[调整后HR，6.15（95%CI）/0.1%递增；所有P<；0.001]的患者。调整后，LACI≥25%表明，与传统的危险因素和压力CMR结果相比，模型识别和重新分类的改善最大（C统计学改善：0.15；NRI=0.705；IDI=0.398，所有P＜0.001；LR检验P＜0.001）CMR，与包括诱导性缺血和LGE在内的传统风险因素相比具有增加的预后价值（图1）。

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引用次数: 0

Post-processing methodology for the multimodal study of the left atrium during atrial fibrillation 心房颤动期间左心房多模式研究的后处理方法

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.043

T. Raoult

Introduction

In the context of a prospective study for the multimodal characterization of the left atrium in patients undergoing atrial fibrillation ablation, we developed a systematic pipeline to allow the co-registration and analysis of three different imaging modalities: LGE-CMR, 3D catheter-based invasive voltage maps and FDG uptake measured by PET.

Method

The software SLICER3D was choosed as the primary building block. As a free, open source software, it allows for the quick building and deployment of custom solutions thanks to its python wrapper. Several software solutions were developped in python using both the SLICER3D innate capabilities and the Vizualisation toolkit library (VTK) powerful post-processing power.

Results

Building on a previous work from Hohmann S. we developed a program allowing the importation in SLICER3D of CARTOv7 (biosense) voltage maps. Using built-in tools, 3D meshes were created from LGE-CMR and PET studies. Unto those 3D meshes, a custom program calculated a maximum intensity projection of the atrial wall along normal vectors, allowing for the creation of LGE and SUV 3D maps. Lastly, iterative point cloud registration permitted the fusion of all 3 mappings. Point-by-point test of association between low voltage, low FDG uptake and high-LGE was used.

Conclusion

We were able to fusion and do a point-by-point analysis of three different imaging studies of the left atrium in atria fibrillation: voltage maps, LGE-CMR, and PET. Software solutions developed for this post-processing pipeline are generic and could be adapted for other multimodalities studies. A prospective study using this methodology and involving patients in AF undergoing ablation is underway and will be presented at the ESC congress 2023 (Fig. 1).

在一项对房颤消融患者左心房多模态特征的前瞻性研究的背景下，我们开发了一个系统的管道，允许三种不同的成像模式的共同注册和分析:LGE-CMR，基于3D导管的侵入性电压图和PET测量的FDG摄取。方法选择SLICER3D软件作为主要构建模块。作为一个免费的开源软件，由于它的python包装器，它允许快速构建和部署自定义解决方案。使用SLICER3D固有功能和可视化工具包库(VTK)强大的后处理能力，在python中开发了几个软件解决方案。基于Hohmann S.先前的工作，我们开发了一个程序，允许在SLICER3D中输入CARTOv7(生物传感)电压图。使用内置工具，根据大磁共振成像和PET研究创建3D网格。对于这些3D网格，定制程序计算心房壁沿法向量的最大强度投影，允许创建LGE和SUV 3D地图。最后，迭代点云配准实现了3种映射的融合。采用逐点检验低电压、低FDG摄取与高lge之间的关系。结论:我们能够融合并逐点分析三种不同的左心房颤动成像研究:电压图、LGE-CMR和PET。为这种后处理管道开发的软件解决方案是通用的，可以适用于其他多模式研究。一项使用该方法并涉及房颤消融患者的前瞻性研究正在进行中，并将在2023年ESC大会上发表(图1)。

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引用次数: 0

Diagnostic value of the International Society of Cardio-Oncology (IC-OS) definition for suspected immune checkpoint inhibitor-associated myocarditis 国际心脏肿瘤学会（IC-OS）定义对疑似免疫检查点抑制剂相关性心肌炎的诊断价值

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.021

F. Deharo, J. Cautela, F. Thuny, M. Gaubert, F. Paganelli, N. Resseguier, F. Cadour, J. Alexandre, C. Dolladille

Introduction

The diagnosis of immune checkpoint inhibitor-associated myocarditis (ICI-M) is challenging. Recently, the International Society of Cardio-Oncology (IC-OS) proposed an empirical definition of ICI-M; however, this definition has never been validated. We aimed to assess the diagnostic value at admission of the IC-OS definition in a cohort of patients with suspected ICI-M and to determine whether the addition of other criteria to this definition would improve its performance.

Method

Between May 2017 and November 2021, all patients with suspected ICI-M were consecutively included in a multicenter cohort. The final diagnosis was the one recorded in the patient's electronic medical record, established within one month of hospital discharge by the expert cardio-oncology team that managed the patient.

Results

Of the 68 patients included, 45 patients presented with ICI-M. The sensitivity, specificity, and positive and negative likelihood ratios of the IC-OS definition were 93% (95% CI: 82%–99%), 70% (95% CI: 47%–87%), 3.1 (95% CI: 1.7–5.7), and 0.1 (95% CI: 0–0.3), respectively. A delay in the onset of the first events < 3 months after the introduction of ICIs was the only variable that was both significantly associated with the final diagnosis of ICI-M and did not already meet the criteria of the IC-OS definition (72% vs. 52%, P = 0.03). By including this variable as a new minor criterion and increasing the number of minor criteria for defining ICI-M to 3, the specificity increased from 70% to 83% (P = 0.08), and the sensitivity remained unchanged (93%).

Conclusion

The IC-OS definition for the diagnosis of ICI-M showed excellent sensitivity and moderate specificity. The latter could be increased by a modified definition including the time of the onset of the first events < 3 months after the introduction of ICIs (Fig. 1).

免疫检查点抑制剂相关性心肌炎(ICI-M)的诊断具有挑战性。最近，国际心脏肿瘤学会(IC-OS)提出了ICI-M的实证定义;然而，这一定义从未得到验证。我们的目的是评估一组疑似ci - m患者入院时采用IC-OS定义的诊断价值，并确定在此定义中加入其他标准是否会改善其表现。方法在2017年5月至2021年11月期间，将所有疑似ci - m患者连续纳入多中心队列。最终诊断记录在患者的电子病历中，由管理患者的心脏肿瘤学专家团队在出院后一个月内建立。结果纳入的68例患者中，45例出现ICI-M。IC-OS定义的敏感性、特异性和阳性和阴性似然比分别为93% (95% CI: 82%-99%)、70% (95% CI: 47%-87%)、3.1 (95% CI: 1.7-5.7)和0.1 (95% CI: 0-0.3)。最初事件发生的延迟<引入ici后3个月是唯一与ICI-M最终诊断显著相关且尚未达到IC-OS定义标准的变量(72%对52%，P = 0.03)。通过将该变量作为一个新的次要标准，并将定义ICI-M的次要标准增加到3个，特异性从70%提高到83% (P = 0.08)，敏感性保持不变(93%)。结论IC-OS定义诊断ICI-M具有良好的敏感性和中等的特异性。后者可以通过包括第一事件发生时间的修改定义来增加;ICIs引入后3个月(图1)。

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引用次数: 0

Prognostic value of right ventricular dysfunction in patients with acute pulmonary embolism and normal blood pressure 急性肺栓塞和血压正常患者右心室功能障碍的预后价值

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.053

M. Hassine, S. Lamine, M.Y. Kallala, S. Kraeim, N. Bouchehda, M.M. Boussaada, M. Ben Messoud, M. Mahjoub, H. Gamra

Introduction

The role of echocardiographic right ventricular (RV) dysfunction in predicting clinical outcome in clinically stable patients with pulmonary embolism (PE) is undefined. In this study, we assessed the prevalence and clinical outcome of normotensive patients with RV dysfunction among a broad spectrum of PE patients.

Method

This retrospective clinical outcome study included cohort of 186 consecutive patients (age: 62 ± 15 years) with documented PE. Acute RV dysfunction was diagnosed in the presence of one or more of the following criteria: a quotient of RV septal-lateral diameter/LV septal-lateral diameter > 0.9 in the 4 chamber view in TTE or CT, RV hypokinesis (TAPSE < 15 mm), Doppler evidence of pulmonary hypertension (PASP > 40 mmHg) and/or paradox septal systolic motion.

Results

Eighty-eight patients were judged to have RV dysfunction (47.3%). There was no difference in age, gender, prevalence of deep venous thrombosis (DVT), cancer or other risk factors in these two groups. In hospital mortality (21.6% vs. 5.4%; P = 0.001), cardiogenic shock (P = 0.001), and thrombolytic therapy use (P = 0.004) were significantly higher for RV dysfunction patients than for the other group. The multivariate logistic regression models revealed significant associations between RV dysfunction and in-hospital mortality (OR: 3.815, 95% CI: 1.012–10.47, P = 0.001)

Conclusion

A significant proportion (47%) of normotensive patients with acute PE presents with RV dysfunction; these patients with latent hemodynamic impairment have more PE-related shock and in-hospital mortality and may require aggressive therapeutic strategies.

超声心动图右室(RV)功能障碍在预测临床稳定的肺栓塞(PE)患者临床结局中的作用尚不明确。在这项研究中，我们在广泛的PE患者中评估了血压正常的右心室功能障碍患者的患病率和临床结果。方法回顾性临床结局研究纳入186例连续的PE患者(年龄:62±15岁)。急性左室功能障碍诊断有以下一项或多项标准:左室间隔外径/左室间隔外径>TTE或CT 4房位0.9，右心室收缩(TAPSE <肺动脉高压的多普勒证据(PASP >40 mmHg)和/或悖论性室间隔收缩运动。结果78例患者诊断为右心室功能障碍(47.3%)。两组患者在年龄、性别、深静脉血栓(DVT)患病率、癌症及其他危险因素方面均无差异。住院死亡率(21.6% vs. 5.4%;P = 0.001)、心源性休克(P = 0.001)和溶栓治疗(P = 0.004)在RV功能障碍患者中的发生率显著高于其他组。多因素logistic回归模型显示右心室功能障碍与住院死亡率之间存在显著相关性(OR: 3.815, 95% CI: 1.012-10.47, P = 0.001)。结论在正常血压的急性肺心病患者中，有显著比例(47%)存在右心室功能障碍;这些有潜在血流动力学障碍的患者有更多的pe相关休克和住院死亡率，可能需要积极的治疗策略。

{"title":"Prognostic value of right ventricular dysfunction in patients with acute pulmonary embolism and normal blood pressure","authors":"M. Hassine, S. Lamine, M.Y. Kallala, S. Kraeim, N. Bouchehda, M.M. Boussaada, M. Ben Messoud, M. Mahjoub, H. Gamra","doi":"10.1016/j.acvdsp.2023.04.053","DOIUrl":"10.1016/j.acvdsp.2023.04.053","url":null,"abstract":"<div><h3>Introduction</h3><p>The role of echocardiographic right ventricular (RV) dysfunction in predicting clinical outcome in clinically stable patients with pulmonary embolism (PE) is undefined. In this study, we assessed the prevalence and clinical outcome of normotensive patients with RV dysfunction among a broad spectrum of PE patients.</p></div><div><h3>Method</h3><p>This retrospective clinical outcome study included cohort of 186 consecutive patients (age: 62±15years) with documented PE. Acute RV dysfunction was diagnosed in the presence of one or more of the following criteria: a quotient of RV septal-lateral diameter/LV septal-lateral diameter><15mm), Doppler evidence of pulmonary hypertension (PASP>40mmHg) and/or paradox septal systolic motion.</p></div><div><h3>Results</h3><p><span>Eighty-eight patients were judged to have RV dysfunction (47.3%). There was no difference in age, gender, prevalence of deep venous thrombosis (DVT), cancer or other risk factors in these two groups. In hospital mortality (21.6% vs. 5.4%; </span><em>P</em>  <span>0.001), cardiogenic shock (</span><em>P</em>  <span>0.001), and thrombolytic therapy use (</span><em>P</em>  <span>0.004) were significantly higher for RV dysfunction patients than for the other group. The multivariate logistic regression models revealed significant associations between RV dysfunction and in-hospital mortality (OR: 3.815, 95% CI: 1.012–10.47, </span><em>P</em>  <!-->0.001)</p></div><div><h3>Conclusion</h3><p><span>A significant proportion (47%) of normotensive patients with acute PE presents with RV dysfunction; these patients with latent </span>hemodynamic impairment have more PE-related shock and in-hospital mortality and may require aggressive therapeutic strategies.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46761604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characterization of left atrial appendage geometry and function using three-dimensional transesophageal echocardiography in patients in atrial fibrillation 经食道三维超声心动图对房颤患者左心耳几何和功能的表征

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.046

L. Soulat-Dufour , T. Simon , S. Lang , S. Ederhy , S. Adavane-Scheuble , M. Chauvet-Droit , E. Capderou , C. Arnaud , P. Issaurat , F. Boccara , A. Cohen

Introduction

Few data are available on left atrial appendage (LAA) remodeling using three-dimensional (3D) transoesophageal echocardiography (TEE) in patients in atrial fibrillation (AF). The aim of this study was to evaluate LAA thrombogenic milieu, LAA velocities, spontaneous echocardiographic contrast/thrombus, 3D LAA geometry and volume in AF.

Method

We prospectively evaluated patients 206 hospitalized for AF with two-dimensional (2D) transthoracic and 3D TEE of the LAA within 24 hours of admission. 3D parameters were off-line analysed using Tomtec software (4D Cardio-View, Generic Volume, Philips) (Fig. 1). Patients were divided into two groups according to the type of AF at admission: paroxysmal AF (62 patients) or persistent AF (144 patients).

Results

Patients with persistent AF had higher BMI, more prevalent hypertension and diabetes, as well as history of AF, heart failure, renal failure. They had also higher CHA2DS2-VASc. Patients with persistent AF at admission had lower LVEF, higher left atrial volume, higher E and E/e′ and pulmonary arterial systolic pressure. Patients with persistent AF had more severe LAA spontaneous echo contrast/sludge, lower LAA emptying and filling flow velocity, and higher 3D LAA measurements (ostium area, length, volume) (Table 1).

Conclusion

3D evaluation of the LAA may reflect atrial remodeling in AF and seems to be associated with the burden of AF. Follow-up data are needed to determine the impact of such abnormalities in the risk stratification of such patients.

心房颤动(AF)患者经食管超声心动图(TEE)三维(3D)显示左心耳(LAA)重构的资料很少。本研究的目的是评估AF中LAA的血栓形成环境、LAA速度、自发超声心动图造影剂/血栓、3D LAA几何形状和体积。方法对206例AF住院患者在入院24小时内进行LAA二维(2D)经胸和3D TEE的前瞻性评估。使用Tomtec软件(4D Cardio-View, Generic Volume, Philips)离线分析3D参数(图1)。根据入院时房颤类型将患者分为两组:阵发性房颤(62例)或持续性房颤(144例)。结果持续性房颤患者BMI较高，高血压、糖尿病患病率较高，且有房颤、心衰、肾功能衰竭病史。他们也有较高的CHA2DS2-VASc。持续性房颤患者入院时LVEF较低，左房容积较高，E、E/ E′和肺动脉收缩压较高。持续性房颤患者LAA自发回声造影物/淤积更严重，LAA排空和充盈流速更低，3D LAA测量值(心房面积、长度、体积)更高(表1)。结论LAA的3D评估可能反映房颤的心房重构，似乎与房颤负担有关。需要随访数据来确定这些异常对此类患者风险分层的影响。

{"title":"Characterization of left atrial appendage geometry and function using three-dimensional transesophageal echocardiography in patients in atrial fibrillation","authors":"L. Soulat-Dufour , T. Simon , S. Lang , S. Ederhy , S. Adavane-Scheuble , M. Chauvet-Droit , E. Capderou , C. Arnaud , P. Issaurat , F. Boccara , A. Cohen","doi":"10.1016/j.acvdsp.2023.04.046","DOIUrl":"10.1016/j.acvdsp.2023.04.046","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Few data are available on left atrial appendage (LAA) remodeling using three-dimensional (3D) transoesophageal echocardiography (TEE) </span>in patients in atrial fibrillation (AF). The aim of this study was to evaluate LAA thrombogenic milieu, LAA velocities, spontaneous echocardiographic contrast/thrombus, 3D LAA geometry and volume in AF.</p></div><div><h3>Method</h3><p>We prospectively evaluated patients 206 hospitalized for AF with two-dimensional (2D) transthoracic and 3D TEE of the LAA within 24hours of admission. 3D parameters were off-line analysed using Tomtec software (4D Cardio-View, Generic Volume, Philips) (<span>Fig. 1</span><span>). Patients were divided into two groups according to the type of AF at admission: paroxysmal AF<span> (62 patients) or persistent AF (144 patients).</span></span></p></div><div><h3>Results</h3><p><span>Patients with persistent AF had higher BMI, more prevalent hypertension and diabetes, as well as history of AF, heart failure, renal failure. They had also higher CHA2DS2-VASc. Patients with persistent AF at admission had lower LVEF, higher left atrial volume, higher E and E/e′ and pulmonary arterial systolic pressure. Patients with persistent AF had more severe LAA spontaneous echo contrast/sludge, lower LAA emptying and filling flow velocity, and higher 3D LAA measurements (ostium area, length, volume) (</span><span>Table 1</span>).</p></div><div><h3>Conclusion</h3><p><span>3D evaluation of the LAA may reflect atrial remodeling in AF and seems to be associated with the burden of AF. Follow-up data are needed to determine the impact of such abnormalities in the </span>risk stratification of such patients.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43513572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death 心脏CT评估左房室耦合指数作为心血管死亡的预后标志

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.044

T. Pezel , J.G. Dillinger , S. Toupin , R. Mirailles , D. Logeart , A. Cohen-Solal , T. Gonçalves , J. Lima , V. Bousson , P. Henry

Introduction

Although the left atrioventricular coupling index (LACI) measured by Cardiac MRI is a strong predictor of CV events, the availability to CMR remains limited in clinical routine. Therefore, it would be useful to validate LACI assessment using other imaging methods such as computed tomography (CT). To investigate the prognostic value of the LACI assessed by cardiac CT, to predict the occurrence of CV death in consecutive patients without known CVD referred for CCTA.

Method

Between 2010 and 2020, we conducted a single-center study with all consecutive patients without known CVD referred for CCTA. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors and CCTA findings.

Results

In 1444 patients (70 ± 12 years, 43% men), 92 (6.4%) patients experienced all-cause death, including 67 (4.3%) patients with cardiovascular death after a median (IQR) follow-up of 6.8 (5.9–9.1) years. After adjustment for risk factors and CCTA findings, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR]: 1.07 [95% CI: 1.05–1.09] per 1% increment, P < 0.001), and all-cause death (adjusted HR, 1.05 [95% CI: 1.03–1.07] per 1% increment, P < 0.001). After adjustment, a LACI ≥ 25% showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA findings (C-statistic improvement: 0.27; NRI = 0.826; IDI = 0.209, all P < 0.001; LR-test P < 0.001).

Conclusion

LACI measured by CCTA is independently associated with cardiovascular death and all-cause death in patients without known CVD referred for CCTA, with an incremental prognostic value over traditional risk factors and CCTA findings. Incremental prognostic value of LACI using CT (Fig. 1).

虽然心脏MRI测量的左房室耦合指数(LACI)是心血管事件的一个强有力的预测指标，但CMR在临床常规中的可用性仍然有限。因此，使用计算机断层扫描(CT)等其他成像方法来验证LACI评估是有用的。目的:探讨心脏CT评估LACI的预后价值，预测无已知CVD的连续CCTA患者CV死亡的发生。方法在2010年至2020年期间，我们开展了一项单中心研究，纳入了所有无已知心血管疾病的连续患者进行CCTA。LACI定义为左室舒张末期容积与左室容积之比。主要终点为心血管死亡。在校正传统危险因素和CCTA结果后，采用Cox回归来评估LACI与主要结局的关系。结果1444例患者(70±12岁，男性43%)中，全因死亡92例(6.4%)，其中心血管死亡67例(4.3%)，中位(IQR)随访6.8(5.9 ~ 9.1)年。在对危险因素和CCTA结果进行校正后，LACI与心血管死亡的发生呈正相关(校正危险比[HR]: 1.07 [95% CI: 1.05-1.09]每增加1%，P <0.001)，全因死亡(调整后的危险比为1.05 [95% CI: 1.03-1.07]， P <0.001)。调整后，LACI≥25%对模型判别和再分类的改善效果优于传统危险因素和CCTA结果(C-statistic improvement: 0.27;nri = 0.826;IDI = 0.209，均P <0.001;lr检验P <0.001)。结论:CCTA测量的laci与接受CCTA治疗的无已知CVD患者的心血管死亡和全因死亡独立相关，其预后价值高于传统危险因素和CCTA结果。CT对LACI的增量预后价值(图1)。

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引用次数: 0