The international journal of cardiovascular imaging最新文献

To assess differences in volumetry, image quality and acquisition time between balanced steady-state free precession cine sequences acquired using (a) a standardized sensitivity encoding (SENSE) approach and (b) deep learning-based super-resolution reconstruction based on high-resolution images acquired with compressed sensitivity encoding (C-SENSE). We retrospectively evaluated 31 consecutive patients (mean age 61.2 ± 13.1 years, 26% female (8/31) and 74% male (23/31)) undergoing cardiac magnetic resonance imaging (MRI) examinations to assess for the presence of ischemic and non-ischemic cardiomyopathies. Cine images were acquired using a 1.5T Philips Ingenia MRI scanner, with classic parallel imaging (SENSE) and compressed sensing (C-SENSE) accelerated acquisition techniques (R = 2 and R = 4, respectively). C-SENSE datasets were reconstructed using a deep learning-based denoising and super-resolution algorithm to enhance image resolution and quality (CS-SR). To evaluate cardiac function, manual left ventricular (LV) segmentation and volumetric analysis were performed on both datasets by two readers, who were blinded to the clinical data. Image quality was rated independently by three readers using Likert scales. Correlation between SENSE and CS-SR datasets with respect to LV volumetry was high (r = 0.98-1.00), with no significant differences found for end-diastolic volume (mean difference 0.04 ml, limits of agreement (LoA) -11.19 to 11.26 ml; p = 0.970) or end-systolic volume (mean difference 1.60 ml, LoA - 7.48 to 10.68 ml; p = 0.064). Overall subjective image quality was comparable (p = 0.061), with CS-SR offering better image sharpness at the cost of increased artifacts (p < 0.001 respectively). Image acquisition time was significantly accelerated with C-SENSE acquisition (SENSE: 411.1 ± 47.7 s, C-SENSE: 165.6 ± 21.5 s; p < 0.001). CS-SR shows promise in streamlining routine cardiac imaging by significantly shortening acquisition times, without impairing LV volumetric analysis, while preserving overall image quality and resolution.

Recent studies have suggested that focal and diffuse atherosclerotic coronary artery disease (CAD) have significantly different plaque composition, treatment efficacy and outcomes. In this study, we aimed to investigate the plaque characteristics of diffuse and focal lesions in patients who underwent coronary computed tomography angiography (CCTA) for the assessment of obstructive CAD. Patients with CAD-RADS score ≥ 2 were retrospectively reviewed. Plaque characteristics, composition and high-risk features were assessed. Plaques ≥ 20 mm or ≥ 25% of total vessel length were accepted as diffuse lesions and otherwise focal lesions. CCTA-derived plaque features and lesion-oriented cardiac outcomes were compared. After the exclusion of ineligible patients, 597 lesions of 441 patients were evaluated. The mean age of the study population was 55 ± 9,4 years. There were 463 focal lesions and 134 diffuse lesions. Diffuse lesions demonstrated higher calcification (p:0.001). CCTA-derived high-risk features, including spotty calcification (p:0.001), low-attenuation plaque (p: 0.041) and positive remodeling (p: 0.016), were more prevalent in focal disease. In addition, high-risk plaque was also higher in focal lesions(p: 0.022). Moreover, lesions with ≥ 70% plaque burden were significantly higher in focal lesions (p:0.044). Multivariate analysis demonstrated that plaque burden ≥ 70% and CCTA-derived high-risk plaque were independently associated with cardiac outcomes. During the follow-up, lesion-oriented myocardial infarction and revascularization were higher in diffuse disease (p < 0.001 and p:0.015, respectively). Diffuse and focal atherosclerotic lesions demonstrate significant differences regarding plaque vulnerability. Moreover, diffuse plaques have a worse prognosis compared to focal lesions.

Women with aortic stenosis (AS) are underdiagnosed and undertreated compared to men and face a higher mortality risk despite similar symptoms and fewer comorbidities. Sex-specific differences in left ventricular (LV) remodeling may contribute to this disparity. We investigated whether a fully automated, machine-learning-based three-dimensional echocardiography (3DE) approach, the Dynamic Heart Model (DHM), improves the detection of these differences compared to conventional two-dimensional echocardiography (2DE). This study investigates sex-related differences in cardiac remodeling and hemodynamics in AS patients with a preserved ejection fraction (EF ≥ 50%), comparing results from 2D echocardiography (2DE) and 3D echocardiography (3DE) via the DHM. The study included 101 consecutive patients with AS (42% women) who were assessed with 2DE and DHM. Parameters such as LV volumes, mass (LVM), stroke volume (SV), and aortic valve area (AVA) were measured and indexed to body surface area (BSA). Sex-specific differences were analyzed, with a focus on identifying significant remodeling patterns. Women exhibited smaller LV end-diastolic volume (EDV) and end-systolic volume (ESV) by DHM compared to men (115 mL vs. 155 mL, p < 0.001; 51 mL vs. 66 mL, p < 0.001). Indexed EDV (EDVi) and ESV (ESVi) were also significantly lower in women (69 mL/m² vs. 84 mL/m², p < 0.001; 30 mL/m² vs. 34 mL/m², p = 0.002). LVM and indexed LV mass (LVMi) were significantly lower in women when measured by DHM (131 g vs. 163 g, p < 0.001; 75 g/m² vs. 89 g/m², p = 0.005), whereas 2DE did not reveal statistically significant differences. Women exhibited a more concentric LV geometry, as reflected by higher relative wall thickness than men (0.42 vs. 0.36; p = 0.04). Despite similar hemodynamic parameters, women had significantly smaller DHM-derived AVA (0.90 cm² vs. 1.20 cm², p < 0.001), correlating with reduced SV (64 mL vs. 90 mL, p < 0.001). This study highlights that significant sex-related differences in LV remodeling and AS severity are better captured by DHM than 2DE, emphasizing the importance of sex-specific considerations and accurate measurements in evaluating and managing AS.

Left coronary artery fistula into the coronary sinus is a very rare anomaly. The 4D flow sequence is a useful tool that provides excellent anatomical delineation and enables shunt quantification.

Accurate assessment of coronary lesion complexity is essential for guiding revascularization strategies in patients with coronary artery disease. The SYNTAX score, originally derived from invasive coronary angiography (ICA), plays a key role in clinical decision-making. With advancements in cardiac computed tomography angiography (CCTA), its potential as a non-invasive tool for SYNTAX scoring has gained interest, but discrepancies between modalities remain uncertain. To systematically compare SYNTAX scores obtained by CCTA versus ICA and evaluate their concordance, with implications for clinical decision-making. We conducted a systematic review and meta-analysis of studies published between 2013 and 2024 comparing SYNTAX scores derived from CCTA and ICA in the same adult populations. Databases including PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched through January 2025. The primary outcome was the pooled standardized mean difference (Hedges' g) in SYNTAX scores between modalities. Risk of bias was assessed using QUADAS-2, and meta-regression explored potential sources of heterogeneity. Thirteen studies with a total of over 1,800 patients met inclusion criteria. The pooled analysis demonstrated a statistically significant underestimation of SYNTAX scores by CCTA compared to ICA (Hedges' g = - 0.121; 95% CI: -0.185 to - 0.056; p < 0.01). Heterogeneity was moderate (I² = 30.7%) after exclusion of one outlier. Meta-regression revealed no significant impact of publication year, scanner generation, or sample size on effect size. Several studies highlighted meaningful discrepancies in SYNTAX classification near critical decision thresholds (22 and 32). Funnel plot symmetry and Q-Q plot normality suggested minimal publication bias. CCTA systematically underestimates SYNTAX scores compared to ICA, which may impact treatment decisions in patients with complex coronary artery disease. While CCTA offers a promising non-invasive alternative, clinicians should interpret CCTA-derived SYNTAX scores with caution-particularly in borderline cases where therapeutic strategies may differ. Further standardization of scoring protocols and incorporation of functional imaging tools such as CT-FFR are warranted.

Fractional flow reserve (FFR) is an essential tool for evaluating coronary artery disease and directing percutaneous coronary intervention (PCI). The instantaneous wave-free ratio (iFR) has been validated as a non-hyperemic alternative with less procedural complexity and adverse effects, as no pharmacological induction of hyperemia is required. Nevertheless, iFR invasiveness limits the popularity of the technique in clinical practice. However, recent AI breakthroughs have led to improvements in the diagnostic accuracy of non-invasive iFR estimation via different imaging modalities such as X-ray coronary angiography (XCA) and coronary computed tomography angiography (CCTA). A systematic search was conducted in the Web of Science, PubMed, ScienceDirect, and Scopus databases without any date restriction. Only studies that resulted in the development of AI-based methods for the estimation of iFR were considered. Five studies met the inclusion criteria and used AI to estimate iFR from CCTA and XCA image data. The diagnostic accuracy reported varied from 58% to 90.2%, while sensitivity was between 37% and 87.2%, and specificity between 50% and 97.8%. Positive predictive value (PPV) and negative predictive value (NPV) ranged from 34% to 79% and 77% to 97.5%, respectively. The value of the receiver operating characteristic (ROC) curve ranged from 0.89 to 0.98. The QUADAS-2 tool was used to evaluate the quality of the study. AI models reported a promising improvement in the assessment of coronary artery disease based on accurate non-invasive methodologies. However, further research is needed to establish standardized practices and ensure the accessibility and applicability of these tools.

Multiparametric CMR can detect cardiac amyloidosis (CA) in patients with undifferentiated concentric left ventricular hypertrophy (LVH). A retrospective patient search was performed for patients ≥ 18 years of age who received 1.5T CMR from January 2018 to August 2022 to evaluate for myocardial infiltration in the setting of known concentric LVH at a tertiary medical center. Clinical records were reviewed for positive diagnosis or exclusion of CA. CMR were post-processed to evaluate ventricular volumes and function, native T1 mapping, and extracellular volume (ECV). Late gadolinium enhancement (LGE) was qualitatively evaluated and each segment categorized into vascular or non-vascular LGE using the American Heart Association 16 segment model. Feature tracking strain (FTS) was performed on a subset of CA positive and CA negative patients. Group comparisons were made using one-way ANOVA (parametric) or Kruskal-Wallis (non-parametric) tests. Receiver operator characteristic (ROC) analysis with area under curve (AUC) values were generated for both individual and combined parameters using binary logistic regression (IBM SPSS Statistics V26.0, and DATATab 2025) to determine optimal cut-off parameters for detection of CA. CMR were performed in 278 patients for myocardial infiltration evaluation in the setting of known concentric LVH (mean age 63.2 ± 14.9, 46% female). Diagnostic groups were determined as follows: CA positive (n = 60), CA negative (n = 100) and CA unknown (n = 118). CA positive patients, when compared to both CA negative and CA unknown groups, respectively, demonstrated significantly higher age (69.9 ± 10.3 vs. 59.7 ± 14.2 and 62.9 ± 16.4 years), native T1 (1122.4 ± 64.6 vs. 1056.8 ± 69.7 and 1051.4 ± 54.0 ms), ECV (46.4 ± 11.5 vs. 32.1 ± 7.2 and 32.1 ± 7.6%) and number of segments with infarct-atypical LGE (10.2 ± 7.3 vs. 2.7 ± 4.7 and 2.0 ± 4.3). ROC AUC values were calculated for native T1 (0.80), ECV (0.88), and number of infarct-atypical LGE segments (0.76). A 4 parameter model including age, native T1, ECV, number of segments with non-vascular LGE demonstrated an AUC of 0.91 for detection of CA, with a sensitivity of 92% and specificity of 81%, which when applied to the CA unknown group, indicated 13 patients (11%) in this group may have CA. CA positive patients demonstrated reduced basal peak systolic strain and diastolic strain rates when compared to CA negative patients; a model combining these parameters with patient age demonstrated an AUC of 0.79 for detection of CA. Multiparametric CMR can discriminate CA positive patients from CA negative and undifferentiated LVH patients in a real-world tertiary center population. These findings demonstrate that CMR has significant diagnostic potential for detection of CA in patients with undifferentiated LVH.

Aim: To investigate the association between functional and structural markers of left atrial (LA) dysfunction in patients with stroke of either (i) undetermined etiology or (ii) small or large-vessel stroke, and the recurrence of stroke or new-onset atrial fibrillation (AF).

Methods and results: Between 2019 and 2021 we consecutively included 91 patients with a recent stroke (< 30 days) without known or detected AF. All patients had cardiac magnetic resonance with late gadolinium enhancement to determine LA Emptying Fraction (LAEF), LA volumes, and LA fibrosis. Stroke adjudications were performed according to Trial of Org 10,172 in Acute Stroke Treatment classification as either undetermined etiology (n = 48) or stroke from large- or small-vessel disease (n = 43). The primary endpoint was a composite of stroke recurrence or new-onset AF. During follow-up, fourteen patients (15%) reached the combined primary endpoint of stroke or new-onset AF. Multivariable cause specific regression analysis demonstrated that a lower LAEF was associated with the primary endpoint (Hazard Ratio [HR], 1.41 per 5% decrease [95% CI, 1.09-1.82]) as well as LA enlargement (HR: 1.98 per 5 ml/m2 increase [95% CI 1.11-3.52]). LA fibrosis did not show any associations with the combined endpoint (HR 1.01 [95% CI 0.95-1.07]), or any of its components.

Conclusion: In patients with recent stroke, LAEF and LA enlargement, but not LA fibrosis, are associated with stroke recurrence or new-onset AF. Further studies are required to determine, whether LAEF as a component of ACM is a modifiable risk factor to reduce the risk of recurrent stroke and/or new-onset AF.