Archives of Cardiovascular Diseases Supplements最新文献

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Which factors are associated with low flow in rheumatic mitral stenosis patients? 哪些因素与风湿性二尖瓣狭窄患者的低血流相关?

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.055

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

Introduction

Stroke volume (SV) raised enthusiasm in the early investigations of rheumatic MS pathophysiology and was considered as a key component triggering dyspnea. Giving the discrepancies uncovered in later studies, its importance was later downgraded. The objective of this study was to assess correlations between LA reservoir function (LASr) and global left ventricular longitudinal strain (LVS) determined by 2D STE and stroke volume index (SVI).

Method

We performed TTE in a cohort of patients with rheumatic MS. Basic 2D and doppler parameters were recorded such as mean trans-mitral gradient (MTMG), mitral valve area (MVA) with 2D planimetry and PHT. Studied parameters represent mean of three consecutive cardiac cycles. LASr data was obtained on a dedicated 4C view with STE technique. LVS was generated based on the 3 basic apical views. Low-flow state was defined as a SVI ≤ 35 mL/m².

Results

One hundred and ninety-five patients were included between February 2018 and October 2021. We divided our cohort into two groups: group I with SVI ≤ 35 mL/m² and group II with SVI > 35 mL/m². There was not a significant difference in terms of age (49.8 ± 12 vs. 51.6 ± 10 yrs, P = 0.3), sex (70.7 vs. 72.2% were female, P = 0.8) and history of atrial fibrillation (67.4 vs. 55.7%, P = 0.09). 2D MVA was significantly lower in group I (1.22 ± 0.4 vs. 1.43 ± 0.5 cm², P = 0.003). Surprisingly, MVA determined with PHT did not significantly differ (1.43 ± 0.6 vs. 1.39 ± 0.4 cm², P = 0.5). The incidence of severe dyspnea was (44.3 vs. 44.4%, P = 0.9). TRVmax levels (3.23 ± 0.6 vs. 3.07 ± 0.6 m/s, P = 0.14) were comparable. Group I had significantly higher MTMG (12.1 ± 7 vs. 9.8 ± 4 mmHg, P = 0.01). LVS and LVEF were significantly lower in low-flow patients: (−15 ± 4 vs. −18 ± 2%, P < 0.001) and (61.1 ± 8% vs. 64.2 ± 5%, P = 0.04) respectively. LASr was higher in normal flow patients but did not reach the statistical significance. (9.5 ± 7 vs. 11.5 ± 6%, P = 0.062).

Conclusion

MVA, LVS and LVEF were significant associates of low-flow state in MS patients. LA reservoir function was not significantly

卒中量(SV)在风湿病MS病理生理学的早期研究中提高了人们的热情，被认为是引发呼吸困难的关键因素。考虑到后来的研究发现的差异，它的重要性后来被降低了。本研究的目的是评估左室储层功能(LASr)与2D STE和脑卒中容积指数(SVI)测定的左室纵向应变(LVS)之间的相关性。方法对一组风湿性ms患者行TTE手术，记录二维平面测量和PHT下的平均二尖瓣斜度(MTMG)、二尖瓣面积(MVA)等基本二维和多普勒参数。研究参数为三个连续心动周期的平均值。LASr数据是用STE技术在专用的4C视图上获得的。LVS是基于3个基本顶点视图生成的。低流量状态定义为SVI≤35 mL/m2。结果2018年2月至2021年10月共纳入195例患者。我们将研究对象分为两组:SVI≤35 mL/m2的I组和SVI >的II组;35毫升/ m2。年龄(49.8±12岁比51.6±10岁，P = 0.3)、性别(70.7比72.2%为女性，P = 0.8)、房颤史(67.4比55.7%，P = 0.09)差异无统计学意义。I组2D MVA明显降低(1.22±0.4 vs 1.43±0.5 cm2, P = 0.003)。令人惊讶的是，PHT测定的MVA没有显著差异(1.43±0.6 vs 1.39±0.4 cm2, P = 0.5)。严重呼吸困难的发生率为(44.3% vs. 44.4%， P = 0.9)。TRVmax水平(3.23±0.6 vs 3.07±0.6 m/s, P = 0.14)具有可比性。组MTMG明显增高(12.1±7∶9.8±4 mmHg, P = 0.01)。低流量患者LVS和LVEF显著降低:(- 15±4% vs - 18±2%，P <0.001)和(61.1±8%和64.2±5%,P = 0.04)。血流正常患者LASr较高，但未达到统计学意义。(9.5±7%比11.5±6%，P = 0.062)。结论mva、LVS和LVEF与MS患者低血流状态有显著相关性。LA水库功能与SVI无显著相关。

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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

LV and LA mechanics in pediatric HCM: A CMR study of phenotype-genotype correlation 儿童HCM的左心室和左心房力学：表型-基因型相关性的CMR研究

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.016

E. Panaioli , V. Dangouloff-Ros , N. Boddaert , D. Bonnet , D. Khraiche

Introduction

The relationship between the genotype variation and phenotype expression in paediatric hypertrophic cardiomyopathy (HCM) has not been fully elucidated. In HCM, fibrosis and hypertrophy contribute to left ventricular (LV) mechanics with a decreased global longitudinal and radial strains (GLS, GRS). The epicardial thickening leads to preserved global circumferential strain (GCS) and LV twist. Feature tracking – cardiac magnetic resonance (FT-CMR) has enhanced the non-invasive assessment of myocardial deformation in HCM. The aim of our study was to assess differences of LV and LA mechanics features on CMR between patients harbouring multiple pathogenic or likely pathogenic variants (MGv, n = 16) or single genetic variations (SGv, n = 35).

Method

Our retrospective CMR study included 51 patients (1.7–18.8 years ago). CMR data were: LV and LA's morphological values, late gadolinium enhancement (LGE) of LA and LV walls, LV feature tracking (FT) derived strain and LV twist (LVT). LV twist was calculated as the difference between basal and apical rotation. The LA feature FT derived strain and function's parameters were computed.

Results

In MGv group, the indexed LV mass 108.8–53.0 vs. 74.3 ± 22.2 in SGv (P = 0.03). LGE was present in 51% patients of the whole cohort, with LGE in 64% of MGv group. LV FT derived strain values were not statistically significant different between groups (MGv vs. SGv: GLS −15.8 ± 5.3 vs. −18.7 ± 4.8, GCS −27.8 ± 8 vs. −31.1 ± 8.6, GRS 44.7 ± 24.6 vs. 62.3 ± 32). LVT was reduced in MGv group (0.04 ± 7.6) vs. (7.4 ± 7.4) in SGv (P = 0.003). LA contractile function did not differ between the groups.

Conclusion

Patients with multiple genetic variants have a greater LV mass and altered LV mechanics with reduced LV twist. This study gives insights in phenotype-genotype correlation in paediatric HCM and warrants larger longitudinal studies to assess its clinical significance (Fig. 1).

儿童肥厚性心肌病(HCM)基因型变异与表型表达之间的关系尚未完全阐明。在HCM中，纤维化和肥厚导致左心室(LV)力学，整体纵向和径向应变降低(GLS, GRS)。心外膜增厚导致整体环向应变(GCS)和左室扭转保留。特征跟踪-心脏磁共振(FT-CMR)增强了HCM心肌变形的无创评估。本研究的目的是评估具有多种致病或可能致病变异(MGv, n = 16)或单一遗传变异(SGv, n = 35)的患者在CMR时左室和左室力学特征的差异。方法回顾性CMR研究纳入51例患者(1.7-18.8年)。CMR数据包括:左室和左室的形态学值、左室和左室壁的晚期钆增强(LGE)、左室特征跟踪(FT)衍生应变和左室扭转(LVT)。LV扭转被计算为基部和根尖旋转的差值。计算了LA特征FT导出的应变和函数参数。结果MGv组左室指数质量为108.8 ~ 53.0,SGv组为74.3±22.2 (P = 0.03)。整个队列中51%的患者存在LGE, MGv组中有64%的患者存在LGE。各组间LV FT衍生应变值差异无统计学意义(MGv vs. SGv: GLS - 15.8±5.3 vs. - 18.7±4.8,GCS - 27.8±8 vs. - 31.1±8.6,GRS - 44.7±24.6 vs. 62.3±32)。MGv组LVT降低(0.04±7.6)，SGv组LVT降低(7.4±7.4)(P = 0.003)。两组间LA收缩功能无差异。结论多基因变异患者左室质量增大，左室力学改变，左室扭转减小。该研究对儿童HCM的表型-基因型相关性提供了见解，并保证进行更大规模的纵向研究以评估其临床意义(图1)。

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引用次数: 0

Abnormal left atrial compliance is associated with history of life-threatening arrhythmia in corrected tetralogy of Fallot 法洛四联症患者左心房顺应性异常与危及生命的心律失常有关

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.049

M. Vautier

Introduction

This study examined the left atrial (LA) function and compliance using two-dimensional (2D) strain analysis in adult patients with corrected tetralogy of Fallot (c-ToF), as well as relationships between LA function and patient characteristics, especially history of life-threatening arrhythmia (h-LTA).

Method

Fifty-one patients (34 males, age: 39 ± 15 years; h-LTA: n = 13) with c-ToF were included in this retrospective monocenter study. Besides a 2D standard echocardiography examination, 2D strain imaging was performed to assess left ventricular (LV) and LA functions including peak-positive LA strain (LAS – reservoir function) and LA compliance [defined as the ratio LAS/(E/Ea)].

Results

Patients with h-LTA were older and exhibited a longer QRS duration. LV ejection fraction, LAS and LA compliance were significantly lower in the group of patients with h-LTA. Indexed LA and RA volumes, RV end-diastolic area and RV fractional area change were significantly higher in the h-LTA group. LA compliance was the best echocardiographic predictor for h-LTA (AUC: 0.839; P < 0.001). Moderate inverted correlations were found between LA compliance and age and either QRS duration. Among the echocardiographic parameters, LA compliance was moderately inversely correlated with RV end-diastolic area (r = −0.40, P = 0.01).

Conclusion

We documented abnormal LAS and LA compliance values in adults after c-ToF. Further study is needed to determine how best to incorporate LA strain, particularly LA compliance into multi-parametric predictive models for LTA in c-ToF.

引言本研究采用二维（2D）应变分析法检测了法洛四联症（c-ToF）成年患者的左心房（LA）功能和顺应性，以及左心房功能与患者特征之间的关系，特别是有危及生命的心律失常（h-LTA）病史。方法51例c-ToF患者（34名男性，年龄：39±15岁；h-LTA:n=13）纳入本回顾性单核研究。除了二维标准超声心动图检查外，还进行了二维应变成像以评估左心室（LV）和左心房功能，包括峰值阳性左心房应变（LAS-储层功能）和左心室顺应性[定义为LAS/（E/Ea）比值]。结果h-LTA患者年龄较大，QRS持续时间较长。h-LTA患者组的左心室射血分数、LAS和LA依从性显著降低。h-LTA组的指数左心房和右心房容积、右心室舒张末期面积和右心室部分面积变化显著较高。左心房顺应性是h-LTA的最佳超声心动图预测指标（AUC:0.839；P<；0.001）。左心房顺应率与年龄和QRS持续时间之间存在中度反向相关性。在超声心动图参数中，左心房顺应性与右心室舒张末期面积呈中度负相关（r=-0.40，P=0.01）。需要进一步的研究来确定如何最好地将LA应变，特别是LA顺应性纳入c-ToF中LTA的多参数预测模型中。

{"title":"Abnormal left atrial compliance is associated with history of life-threatening arrhythmia in corrected tetralogy of Fallot","authors":"M. Vautier","doi":"10.1016/j.acvdsp.2023.04.049","DOIUrl":"https://doi.org/10.1016/j.acvdsp.2023.04.049","url":null,"abstract":"<div><h3>Introduction</h3><p>This study examined the left atrial (LA) function and compliance using two-dimensional (2D) strain analysis in adult patients with corrected tetralogy of Fallot<span> (c-ToF), as well as relationships between LA function and patient characteristics, especially history of life-threatening arrhythmia (h-LTA).</span></p></div><div><h3>Method</h3><p>Fifty-one patients (34 males, age: 39±15years; h-LTA: <em>n</em>  <span>13) with c-ToF were included in this retrospective monocenter study. Besides a 2D standard echocardiography<span> examination, 2D strain imaging was performed to assess left ventricular (LV) and LA functions including peak-positive LA strain (LAS – reservoir function) and LA compliance [defined as the ratio LAS/(E/Ea)].</span></span></p></div><div><h3>Results</h3><p><span>Patients with h-LTA were older and exhibited a longer QRS duration. LV ejection fraction, LAS and LA compliance were significantly lower in the group of patients with h-LTA. Indexed LA and RA volumes, RV end-diastolic area and RV fractional area change were significantly higher in the h-LTA group. LA compliance was the best echocardiographic predictor for h-LTA (AUC: 0.839; </span><em>P</em>  =−0.40, <em>P</em>  <!-->0.01).</p></div><div><h3>Conclusion</h3><p>We documented abnormal LAS and LA compliance values in adults after c-ToF. Further study is needed to determine how best to incorporate LA strain, particularly LA compliance into multi-parametric predictive models for LTA in c-ToF.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 267"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49726298","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

Aortic valve replacement for aortic stenosis in patients under 65-years-old 65岁以下患者主动脉瓣狭窄的主动脉瓣置换术

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.006

R. Coelho, T. Bourguignon, A. Bernard

Introduction

Aortic valve stenosis is the most common valve disease in the world, with particularly poor prognosis if left untreated. Its management in young patients is based on surgical aortic valve replacement (bioprosthesis or mechanical prosthesis, and Ross or Ozaki technique), and rarely percutaneous (TAVR). In this population, the choice of the technique used is of primary importance in terms of hemodynamic performance and durability. The objective of this work is to compare 5 different techniques used in the management of aortic stenosis in patients under 65 years old at CHRU of Tours.

Method

We conducted a retrospective, single-center, observational study at the CHRU of Tours. Five cohorts (mechanical prosthesis, INSPIRIS bioprosthesis, Ross, Ozaki and TAVR) were compared in terms of pre-, per- and postoperative, clinical and hemodynamic parameters.

Results

We included 163 patients under 65-years-old with aortic stenosis operated at the CHRU of Tours between January 2015 and October 2021. Hemodynamically, after stratification on the prosthetic caliber, the best results were found with the Ozaki and Ross techniques, followed by TAVR, the INSPIRIS bioprosthesis and finally the mechanical prosthesis. A severe prosthesis-patient mismatch rate of 10% was found in all patients, with no significant difference between the different techniques (P = 0.1827). Clinically, there was no significant difference between the groups in terms of mortality or re-intervention related to the aortic valve after a mean follow-up of 19.2 months (P = 0.6545). However, pacemaker implantation was significantly higher in the TAVR group (P = 0.0178).

Conclusion

Each surgical and percutaneous technique has its specific advantages and complications. The excellent short-term hemodynamic parameters of the Ross and Ozaki techniques seem to encourage the use of these techniques in the management of aortic stenosis in young patients. More powerful studies with a longer follow-up time would allow to confirm these preliminary results.

主动脉瓣狭窄是世界上最常见的瓣膜疾病，如果不及时治疗，预后特别差。年轻患者的治疗基于外科主动脉瓣置换术(生物假体或机械假体，Ross或Ozaki技术)，很少经皮(TAVR)。在这一人群中，就血流动力学性能和耐久性而言，所使用的技术的选择是最重要的。本研究的目的是比较图尔CHRU治疗65岁以下患者主动脉瓣狭窄的5种不同技术。方法在图尔斯CHRU进行回顾性、单中心观察性研究。五个队列(机械假体、INSPIRIS生物假体、Ross、Ozaki和TAVR)在术前、术后、临床和血流动力学参数方面进行比较。我们纳入了163例2015年1月至2021年10月在图尔斯CHRU手术的65岁以下主动脉瓣狭窄患者。血液动力学方面，在假体口径分层后，Ozaki和Ross技术的效果最好，其次是TAVR、INSPIRIS生物假体，最后是机械假体。所有患者假体与患者的严重失配率均为10%，不同技术间无显著差异(P = 0.1827)。临床方面，平均随访19.2个月后，两组患者的死亡率和与主动脉瓣相关的再干预均无显著差异(P = 0.6545)。而TAVR组起搏器植入率明显高于TAVR组(P = 0.0178)。结论每一种手术和经皮穿刺技术都有其独特的优点和并发症。Ross和Ozaki技术出色的短期血流动力学参数似乎鼓励了这些技术在年轻患者主动脉狭窄治疗中的应用。更有力的研究和更长的随访时间将允许证实这些初步结果。

{"title":"Aortic valve replacement for aortic stenosis in patients under 65-years-old","authors":"R. Coelho, T. Bourguignon, A. Bernard","doi":"10.1016/j.acvdsp.2023.04.006","DOIUrl":"10.1016/j.acvdsp.2023.04.006","url":null,"abstract":"<div><h3>Introduction</h3><p><span><span>Aortic valve stenosis is the most common valve disease in the world, with particularly poor prognosis if left untreated. Its management in young patients is based on surgical </span>aortic valve<span> replacement (bioprosthesis or mechanical prosthesis, and Ross or Ozaki technique), and rarely percutaneous (TAVR). In this population, the choice of the technique used is of primary importance in terms of hemodynamic<span> performance and durability. The objective of this work is to compare 5 different techniques used in the management of aortic stenosis </span></span></span>in patients under 65 years old at CHRU of Tours.</p></div><div><h3>Method</h3><p>We conducted a retrospective, single-center, observational study at the CHRU of Tours. Five cohorts (mechanical prosthesis, INSPIRIS bioprosthesis, Ross, Ozaki and TAVR) were compared in terms of pre-, per- and postoperative, clinical and hemodynamic parameters.</p></div><div><h3>Results</h3><p><span>We included 163 patients under 65-years-old with aortic stenosis operated at the CHRU of Tours between January 2015 and October 2021. Hemodynamically, after stratification on the prosthetic caliber, the best results were found with the Ozaki and Ross techniques, followed by TAVR, the INSPIRIS bioprosthesis and finally the mechanical prosthesis. A severe prosthesis-patient mismatch rate of 10% was found in all patients, with no significant difference between the different techniques (</span><em>P</em>  ==0.0178).</p></div><div><h3>Conclusion</h3><p>Each surgical and percutaneous technique has its specific advantages and complications. The excellent short-term hemodynamic parameters of the Ross and Ozaki techniques seem to encourage the use of these techniques in the management of aortic stenosis in young patients. More powerful studies with a longer follow-up time would allow to confirm these preliminary results.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 245"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48199146","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

Machine-learning score using stress CMR and CCTA for prediction of cardiovascular events in patients with obstructive CAD 使用压力CMR和CCTA预测阻塞性CAD患者心血管事件的机器学习评分

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.027

T. Pezel , P. Garot , S. Toupin , K. Hamzi , T. Hovasse , T. Lefevre , T. Unterseeh , F. Sanguineti , T. Goncalves , J.G. Dillinger , V. Bousson , P. Henry , J. Garot

Introduction

In patients with suspected or known CAD, traditional prognostic risk assessment is based upon a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables. To investigate the accuracy of ML-score using simultaneously stress CMR, coronary CT angiography (CCTA), and clinical data to predict the occurrence of CV events in patients with suspected or known CAD.

Method

Between 2008 and 2020, consecutive symptomatic patients without known CAD referred for CCTA were screened in ICPS (Massy). Patients with obstructive CAD (at least one ≥ 50% stenosis on CCTA) were further referred for stress CMR and followed for the occurrence of major adverse cardiovascular events (MACE), defined as CV death or nonfatal myocardial infarction. Twenty-three clinical, 11 stress CMR and 11 CCTA parameters were evaluated. ML involved automated feature selection and model building by random survival forest. The external validation cohort was Lariboisiere Hospital (N = 274 patients).

Results

Of 2038 consecutive patients (47% men; mean age 69 ± 12 years), 281 (13.8%) patients experienced a MACE after a median follow-up of 6.7 years (interquartile range: 5.9–9.1). Our ML score exhibited a higher area-under-the-curve compared with stress CMR data alone, CCTA data alone, and traditional Cox model for prediction of 10-year MACE (ML: 0.88 vs. CMR data alone: 0.79, CCTA data alone: 0.72; traditional Cox model: 0.81, all P < 0.001). The ML score assessed in the derivation cohort (AUC: 0.88, F1-score 0.80) exhibited also a good area-under-the-curve in the external cohort for prediction of 10-year MACE (AUC: 0.86, F1-score 0.80).

Conclusion

The ML score including clinical, stress CMR and CCTA data exhibited a higher prognostic value to predict 10-year MACE compared with all traditional clinical data, CMR data or CCTA data alone (Fig. 1).

对于疑似或已知CAD的患者，传统的预后风险评估是基于有限的临床和影像学结果。机器学习(ML)方法可以考虑更多数量和更复杂的变量。探讨同时使用应激CMR、冠状动脉CT血管造影(CCTA)和临床数据预测疑似或已知CAD患者CV事件发生的ml评分的准确性。方法在2008年至2020年期间，在ICPS (Massy)中筛选连续无已知CAD症状的患者进行CCTA。梗阻性CAD患者(CCTA上至少有一个≥50%的狭窄)进一步进行应激性CMR，并随访主要不良心血管事件(MACE)的发生，MACE定义为CV死亡或非致死性心肌梗死。评估23个临床参数、11个应激CMR参数和11个CCTA参数。机器学习涉及随机生存森林的自动特征选择和模型构建。外部验证队列为Lariboisiere医院(N = 274例患者)。结果在2038例连续患者中(47%男性;平均年龄69±12岁)，281例(13.8%)患者在中位随访6.7年后出现MACE(四分位数间距:5.9-9.1)。与单独的应激CMR数据、单独的CCTA数据和传统的Cox模型预测10年MACE相比，我们的ML评分显示出更高的曲线下面积(ML: 0.88 vs单独的CMR数据:0.79，单独的CCTA数据:0.72;传统Cox模型:0.81，全部P <0.001)。衍生队列的ML评分(AUC: 0.88, F1-score 0.80)在预测10年MACE的外部队列中也表现出良好的曲线下面积(AUC: 0.86, F1-score 0.80)。与所有传统的临床数据、CMR数据或CCTA数据相比，包括临床、应激CMR和CCTA数据的ML评分在预测10年MACE方面具有更高的预后价值(图1)。

{"title":"Machine-learning score using stress CMR and CCTA for prediction of cardiovascular events in patients with obstructive CAD","authors":"T. Pezel , P. Garot , S. Toupin , K. Hamzi , T. Hovasse , T. Lefevre , T. Unterseeh , F. Sanguineti , T. Goncalves , J.G. Dillinger , V. Bousson , P. Henry , J. Garot","doi":"10.1016/j.acvdsp.2023.04.027","DOIUrl":"10.1016/j.acvdsp.2023.04.027","url":null,"abstract":"<div><h3>Introduction</h3><p><span>In patients<span> with suspected or known CAD, traditional prognostic risk assessment is based upon a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables. To investigate the accuracy of ML-score using simultaneously stress CMR, coronary </span></span>CT angiography (CCTA), and clinical data to predict the occurrence of CV events in patients with suspected or known CAD.</p></div><div><h3>Method</h3><p>Between 2008 and 2020, consecutive symptomatic patients without known CAD referred for CCTA were screened in ICPS (Massy). Patients with obstructive CAD (at least one ≥50% stenosis on CCTA) were further referred for stress CMR and followed for the occurrence of major adverse cardiovascular events (MACE), defined as CV death or nonfatal myocardial infarction. Twenty-three clinical, 11 stress CMR and 11 CCTA parameters were evaluated. ML involved automated feature selection and model building by random survival forest. The external validation cohort was Lariboisiere Hospital (<em>N</em>    <span>12 years), 281 (13.8%) patients experienced a MACE after a median follow-up of 6.7 years (interquartile range: 5.9–9.1). Our ML score exhibited a higher area-under-the-curve compared with stress CMR data alone, CCTA data alone, and traditional Cox model for prediction of 10-year MACE (ML: 0.88 vs. CMR data alone: 0.79, CCTA data alone: 0.72; traditional Cox model: 0.81, all </span><em>P</em>  <!-->0.001). The ML score assessed in the derivation cohort (AUC: 0.88, F1-score 0.80) exhibited also a good area-under-the-curve in the external cohort for prediction of 10-year MACE (AUC: 0.86, F1-score 0.80).</p></div><div><h3>Conclusion</h3><p>The ML score including clinical, stress CMR and CCTA data exhibited a higher prognostic value to predict 10-year MACE compared with all traditional clinical data, CMR data or CCTA data alone (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 257"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44429010","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

Machine learning model including left ventricular strain analysis for sudden cardiac death prediction in hypertrophic cardiomyopathy 包括左心室应变分析的机器学习模型用于预测肥厚型心肌病的心源性猝死

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.026

A. Al Wazzan , M. Taconne , V. Le Rolle , M. Inngjerdingen Forsaa , K. Hermann Haugaa , E. Galli , A. Hernandez , T. Edvarsen , E. Donal

Introduction

The excess mortality in HCM patients is mainly attributed to the occurrence of SCD. The prediction of ventricular arrhythmias remains challenging and could be improved. This study evaluated the added predictive value of a machine learning-based model combining clinical and conventional imaging parameters with information from left ventricular strain analysis to predict sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM).

Method

A total of 434 HCM patients (65% men, mean age 56 years) were retrospectively included from two referral centers (Oslo University Hospital, Rennes University Hospital) and followed longitudinally (mean duration 6 years). Mechanical and temporal parameters were automatically extracted from the left ventricle longitudinal strain (LV-LS) segmental curves of each patient and included in a Ridge Regression model alongside conventional clinical and imaging data. The composite endpoint included sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy, aborted cardiac arrest, or sudden cardiac death (Fig. 1).

Results

Thirty-four patients (7.8%) met the endpoint with an incidence of ventricular arrhythmias of 0.9%/years. From a subset of 18 most discriminating parameters, including 7 derived from LV-LS, and after n = 200 rounds of cross-validation, the final model showed superior predictive performance compared to conventional models with a mean area under the curve (AUC) of 0.83 ± 0.8.

Conclusion

A machine learning model including automatically extracted left ventricular strain-derived parameters was superior in the prediction of sustained ventricular arrhythmias and SCD in patients with HCM compared to existing models. Machine learning model including LV-LS analysis could improve SCD risk stratification in HCM patients (Fig. 1).

HCM患者的高死亡率主要归因于SCD的发生。室性心律失常的预测仍然具有挑战性，可以改进。本研究评估了一种基于机器学习的模型的附加预测价值，该模型将临床和常规成像参数与左心室应变分析信息相结合，用于预测肥厚性心肌病(HCM)患者的心源性猝死(SCD)。方法回顾性分析来自两个转诊中心(奥斯陆大学医院、雷恩大学医院)的434例HCM患者(65%为男性，平均年龄56岁)，并进行纵向随访(平均随访时间6年)。从每位患者的左心室纵向应变(LV-LS)分段曲线中自动提取力学和时间参数，并将其与常规临床和影像学数据一起纳入Ridge回归模型。复合终点包括持续性室性心动过速、适当的植入式心律转复除颤器治疗、心脏骤停流产或心源性猝死(图1)。结果34例(7.8%)患者达到终点，室性心律失常发生率为0.9%/年。从18个最具判别性的参数中，包括7个来自LV-LS的参数，经过n = 200轮交叉验证，最终模型的平均曲线下面积(AUC)为0.83±0.8，比传统模型具有更好的预测性能。结论自动提取左心室应变参数的机器学习模型在预测HCM患者持续性室性心律失常和SCD方面优于现有模型。包含LV-LS分析的机器学习模型可以改善HCM患者的SCD风险分层(图1)。

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引用次数: 0

Atrial strain in patients with pulmonary arterial hypertension associated with congenital heart disease 先天性心脏病合并肺动脉高压患者的心房应变

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.031

P. Moceri , J. Kraemer

Introduction

Pulmonary arterial hypertension (PAH) has a major impact on mortality and morbidity on congenital heart disease (CHD) patients. Atrial strain in PAH patients has been related to clinical severity and adverse outcomes. The aim of this study was therefore to assess the prognostic role and compare bi-atrial function in patients with CHD-PAH, PAH from other causes (nPAH) and healthy controls.

Method

We included in this prospective cohort study 65 patients with CHD-PAH, 67 patients with nPAH and 65 healthy volunteers. Transthoracic echocardiography, clinical assessment, BNP measurement and 6MWT were performed at baseline. Classic echocardiographic measurements and atrial function studying the 3 different phases strain were measured in both.

Results

Atrial strain parameters are decreased in patients with CHD-PAH as compared to healthy volunteers, especially the right atrial (RA) reservoir (RASR 29,67% vs. 44,15%, P < 0,0001) and conduit phase (RASCD −15,85 vs. −28,52, P < 0,0001), but also left atrial (LA) reservoir and conduit phases. Active contractile phase seems preserved in both PAH group. Atrial function was comparable between CHD-PAH and nPAH patients. On multivariate analysis, BNP, pericardial effusion, RA ejection fraction, RASR and RASCD were independently associated with death or transplantation. RASR ≤ 30% or RASCD > −8% strain identified patients with a more than 3-fold-increased risk of death or transplant.

Conclusion

Patients with CHD-PAH do not differ in atrial adaptation in comparison with npah. Impaired RASR and RASCD identify high risk PAH patients. RA conduit or reservoir function impairment represents a severity marker of PAH, including in patients with CHD-PAH suggesting the importance of RV diastolic dysfunction. This might be an early marker of poor prognosis (Fig. 1).

肺动脉高压（PAH）对先天性心脏病（CHD）患者的死亡率和发病率有重要影响。PAH患者的心房应变与临床严重程度和不良结果有关。因此，本研究的目的是评估CHD-PAH、其他原因PAH患者和健康对照组的预后作用，并比较其双心房功能。方法本前瞻性队列研究包括65例CHD-PAH患者、67例nPAH患者和65名健康志愿者。基线时进行经胸超声心动图、临床评估、BNP测量和6MWT。对三种不同阶段应变的经典超声心动图测量和心房功能进行了测量。结果与健康志愿者相比，CHD-PAH患者的心房应变参数降低，尤其是右心房（RA）储层（RASR 29,67%vs.44,15%，P<；00001）和导管期（RASRCD−15,85 vs.−28,52，P<！00001），以及左心房（LA）储层和导管期。PAH组和PAH组似乎都保留了活动收缩期。CHD-PAH和nPAH患者的心房功能相当。在多变量分析中，BNP、心包积液、RA射血分数、RASR和RASCD与死亡或移植独立相关。RASR≤30%或RASRC>；−8%的菌株确定患者的死亡或移植风险增加了3倍以上。结论CHD-PAH患者在心房适应方面与npah患者没有差异。RASR和RASCD受损可确定PAH的高危患者。RA导管或储液器功能损害是PAH的严重标志，包括CHD-PAH患者，表明RV舒张功能障碍的重要性。这可能是预后不良的早期标志（图1）。

{"title":"Atrial strain in patients with pulmonary arterial hypertension associated with congenital heart disease","authors":"P. Moceri , J. Kraemer","doi":"10.1016/j.acvdsp.2023.04.031","DOIUrl":"https://doi.org/10.1016/j.acvdsp.2023.04.031","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Pulmonary arterial hypertension (PAH) has a major impact on mortality and morbidity on congenital heart disease (CHD) patients. Atrial strain in PAH patients has been related to clinical severity and </span>adverse outcomes<span>. The aim of this study was therefore to assess the prognostic role and compare bi-atrial function in patients with CHD-PAH, PAH from other causes (nPAH) and healthy controls.</span></p></div><div><h3>Method</h3><p><span>We included in this prospective cohort study<span> 65 patients with CHD-PAH, 67 patients with nPAH and 65 healthy volunteers. Transthoracic echocardiography, clinical assessment, BNP measurement and 6MWT were performed at baseline. Classic echocardiographic measurements and </span></span>atrial function studying the 3 different phases strain were measured in both.</p></div><div><h3>Results</h3><p>Atrial strain parameters are decreased in patients with CHD-PAH as compared to healthy volunteers, especially the right atrial (RA) reservoir (RASR 29,67% vs. 44,15%, <em>P</em>  <≤30% or RASCD>−8% strain identified patients with a more than 3-fold-increased risk of death or transplant.</p></div><div><h3>Conclusion</h3><p><span>Patients with CHD-PAH do not differ in atrial adaptation in comparison with npah. Impaired RASR and RASCD identify high risk PAH patients. RA conduit or reservoir function impairment represents a severity marker of PAH, including in patients with CHD-PAH suggesting the importance of RV diastolic dysfunction. This might be an early marker of poor prognosis (</span><span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 259"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49762588","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

Index 指数

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/S1878-6480(23)00219-7

引用次数: 0

Heterogeneity of echocardiographic variables in systemic lupus erythematosus among clinical subgroups according to non-cardiac organ involvement 系统性红斑狼疮非心脏器官受累临床亚组超声心动图变量的异质性

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements

Pub Date : 2023-06-01 DOI: 10.1016/j.acvdsp.2023.04.050

C. Bourg , E. Le Tallec , L. Curtis , G. Bouzille , E. Oger , A. Lescoat , E. Donal

Introduction

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease. Cardiac involvement is rare but plays an important prognostic role. The degree of cardiac involvement according to SLE subsets defined by non-cardiac manifestations is unknown. The objective of this study was to identify differences in TTE parameters associated with different SLE subgroups.

Method

One hundred and eighty-one patients fulfilling the ACR/EULAR 2019 classification criteria for SLE and had a TTE were included in this cross-sectional study. We defined four subsets of SLE based on the predominant clinical manifestations. A multivariate multinomial regression analysis was performed to determine whether TTE parameters differ between the subsets.

Results

The first subset (n = 37) of patients showed features of mixed connective tissue disease (MCTD); the second subset (n = 76) had primarily cutaneous involvement; the third subset (n = 18) exhibited serositis and the last subset (n = 50) had severe disease with significant organ involvement, including renal involvement. Forty TTE parameters were assessed in each patient. Using a multivariate multinomial regression analysis, 3 parameters differed between groups: early diastolic tricuspid annular velocity (RV-E′, P < 0.0001), RV-S′ (RV-pulse DTI systolic peak wave, P = 0.0031), and RV end-diastole diameter (P = 0.0419). The degree of RV dysfunction was lowest in patients with primarily cutaneous involvement.

Conclusion

Four distinct clinical subsets based on clinical manifestations differed in terms of TTE parameters of right heart function and diastolic dysfunction. This could help to tailor the cardiac follow-up required by the different clinical subsets of SLE.

系统性红斑狼疮(SLE)是一种异质性自身免疫性疾病。心脏受累是罕见的，但起着重要的预后作用。根据非心脏表现定义的SLE亚群的心脏受累程度尚不清楚。本研究的目的是确定与不同SLE亚组相关的TTE参数的差异。方法:本横断面研究纳入181例符合ACR/EULAR 2019 SLE分类标准并有TTE的患者。我们根据主要的临床表现定义了SLE的四个亚群。进行多变量多项式回归分析以确定TTE参数在子集之间是否存在差异。结果第一亚群(n = 37)患者表现出混合性结缔组织病(MCTD)的特征;第二组(n = 76)主要为皮肤受累;第三个亚群(n = 18)表现为血清炎，最后一个亚群(n = 50)有严重的器官受累，包括肾脏受累。对每位患者的40个TTE参数进行评估。采用多元多项式回归分析，3个参数组间存在差异:舒张早期三尖瓣环速度(RV-E’，P <0.0001)、RV- s′(RV-pulse DTI收缩期峰值波，P = 0.0031)、RV舒张末期内径(P = 0.0419)。主要累及皮肤的右心室功能障碍程度最低。结论基于临床表现的四个不同的临床亚群在右心功能和舒张功能障碍的TTE参数上存在差异。这有助于定制不同临床亚型SLE所需的心脏随访。

{"title":"Heterogeneity of echocardiographic variables in systemic lupus erythematosus among clinical subgroups according to non-cardiac organ involvement","authors":"C. Bourg , E. Le Tallec , L. Curtis , G. Bouzille , E. Oger , A. Lescoat , E. Donal","doi":"10.1016/j.acvdsp.2023.04.050","DOIUrl":"10.1016/j.acvdsp.2023.04.050","url":null,"abstract":"<div><h3>Introduction</h3><p>Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease. Cardiac involvement is rare but plays an important prognostic role. The degree of cardiac involvement according to SLE subsets defined by non-cardiac manifestations is unknown. The objective of this study was to identify differences in TTE parameters associated with different SLE subgroups.</p></div><div><h3>Method</h3><p>One hundred and eighty-one patients fulfilling the ACR/EULAR 2019 classification criteria for SLE and had a TTE were included in this cross-sectional study. We defined four subsets of SLE based on the predominant clinical manifestations. A multivariate multinomial regression analysis was performed to determine whether TTE parameters differ between the subsets.</p></div><div><h3>Results</h3><p>The first subset (<em>n</em>  <span>37) of patients showed features of mixed connective tissue disease (MCTD); the second subset (</span><em>n</em>  =18) exhibited serositis and the last subset (<em>n</em>  <0.0001), RV-S′ (RV-pulse DTI systolic peak wave, <em>P</em>  =<!--> <span>0.0419). The degree of RV dysfunction was lowest in patients with primarily cutaneous involvement.</span></p></div><div><h3>Conclusion</h3><p>Four distinct clinical subsets based on clinical manifestations differed in terms of TTE parameters of right heart function and diastolic dysfunction. This could help to tailor the cardiac follow-up required by the different clinical subsets of SLE.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 267"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42584150","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}

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