The international journal of cardiovascular imaging最新文献

To compare echocardiographic regional longitudinal strain with quantitative coronary angiography and assess temporal changes in regional strain in patients with STEMI and multivessel coronary artery disease. Thirty-two patients with STEMI and multivessel coronary artery disease underwent coronary angiography with 3D quantification and baseline echocardiography. Regional longitudinal strain was measured as the average strain of three adjacent myocardial segments (RLS-3S) with the most impaired strain values. Forty-one stenosed vessels were identified (9 LAD [19%], 21 LCx [50%] and 11 RCA [31%]). RLS-3S did not correlate with diameter stenosis, area stenosis or minimal luminal diameter. Receiver operating curve analysis of RLS-3S for hemodynamic significant lesions (defined as positive fractional flow reserve or composite of ≥ 70% diameter stenosis and minimal luminal diameter < 1.2 mm) demonstrated an area under the curve of 0.63 (95% CI 0.45-0.76) with an optimal cut-off value of < 9.8%. Sensitivity and specificity of RLS-3S was 86% (42-100) and 48% (31-66). RLS-3S < 9.8% at baseline in remote myocardium subtended by the stenosed coronary vessel predicted benefit from percutaneous coronary intervention in terms of regional functional recovery. RLS-3S does not correlate with individual coronary angiography measures and moderately predicts hemodynamically significant lesions. RLS-3S could be used to predict regional functional recovery after additional revascularization.

Left ventricular mechanical dyssynchrony (LVMD) is an important prognostic factor for heart failure (HF). Phase analysis of myocardial perfusion SPECT is actively being researched to evaluate LVMD. We performed a systematic review and meta-analysis on the prognostic significance of LVMD using gated SPECT in HF patient. PubMed, Embase, and the Cochrane library were searched until January 10, 2024, for studies reporting the prognostic value of LVMD in HF patients using gated SPECT for outcomes of all-cause death, cardiac death, or major adverse cardiovascular event (MACE). Hazard ratios (HRs) along with their corresponding 95% confidence intervals (CIs) were combined through meta-analysis employing a random-effects model. Funnel plots and Egger's tests were utilized to evaluate publication bias, and trim-and-fill method were applied where bias was identified. Ten studies (2585 patients) were included; six on MACE and five on all-cause or cardiac death. Prognoses were worse in patients with LVMD assessed by SPECT than in those without LVMD, with the overall pooled HR for MACE being 2.05 (95% CI, 1.65-2.54). The pooled HR for all-cause or cardiac death was 2.08 (95% CI, 1.10-3.94); however, publication bias was present (p = 0.0024), and after adjustment, the prognostic value of LVMD was not statistically significant (HR, 1.24; 95% CI, 0.68-2.23). Assessing LVMD through myocardial perfusion SPECT proves to be a significant indicator of subsequent adverse cardiac events in HF patients. Utilizing phase analysis of SPECT could offer valuable insights for risk assessment and decision-making regarding therapy in HF patients.

Purpose: To evaluate the reproducibility of important biomarkers like wall shear stress (WSS), pulse wave velocity (PWV), and net flow across two 4D flow MRI imaging protocols with different coverages: aorta-targeted 4D flow MRI (AT4D) and whole-heart 4D flow (WH4D) protocols.

Methods: Thirty-eight control subjects (43.2 ± 10.1 years old; 22 males) and ten patients (45.7 ± 8.9 years old; 7 males) with bicuspid aortic valve (BAV) were included. Each subject underwent AT4D and WH4D scans. Absolute WSS, PWV, and net flow were assessed for each patient across both protocols and compared using Bland-Altman analysis. Areas of elevated WSS were assessed for BAV patients across different WSS thresholds that define WSS to be elevated compared to a normal population average. A sensitivity analysis was conducted to determine the best WSS threshold at which WH4D-derived areas most closely resemble AT4D-derived areas. Inter-rater reproducibility was evaluated in twenty-four subjects.

Results: AT4D and WH4D PWV and WSS estimates demonstrated good agreement (PWV: -0.12 ± 1.84 m/s, p = 0.4; Median WSS: 0.06 ± 0.13 Pa, p < 0.01; Maximum WSS: 0.04 ± 0.27 Pa, p = 0.07). Good agreement was also found for AAo net flow (8.14 ± 24.86 mL/cycle, p < 0.01). PWV correlated with age across protocols (AT4D: r = 0.68, p < 0.01; WH4D: r = 0.72, p < 0.01). Sensitivity analysis identified a WSS threshold where WH4D-derived areas of elevated WSS most closely resembled AT4D-derived areas. Inter-rater assessment of the tested parameters resulted in a small mean difference percentage of < 3%.

Data conclusion: PWV, WSS, and net flow demonstrated good agreement across protocols. The WSS threshold should be adjusted for WH4D estimates to optimally match AT4D-derived output. Reproducibility analysis showed good test-retest agreement. This study demonstrates the reproducibility of certain hemodynamic parameters across two 4D flow MRI protocol.

Coronary obstruction remains a primary concern for redo transcatheter aortic valve implantation (TAVI) due to supra-annular leaflets. Hereby, we present two valve-in-valve-in-valve cases, initially incorporating a surgical valve implanted to clarify our concept that the surgical valve serves to safeguard against the coronary ostium obstruction.

Pulmonary hypertension (PH) is a progressive vascular disease characterized by elevated pulmonary arterial pressure and resistance in the pulmonary vascular bed. It is associated with high morbidity and mortality. Although right heart catheterization (RHC) is the gold standard for diagnosis, noninvasive methods, such as echocardiography, are essential for early detection and management. This study aimed to elucidate the potential of right ventricular outflow tract fractional shortening (RVOT-FS) as a noninvasive diagnostic tool for PH. This single-center observational cohort study was conducted between November 2023 and May 2024. The study included 141 patients referred to the PH clinic (75 with confirmed PH and 66 controls). Echocardiographic measurements were performed using standard protocols, and RVOT-FS was calculated. Hemodynamic parameters were obtained via RHC. RVOT-FS was significantly lower in the PH group (35.71%, IQR: 27.15-43.33) than in the control group (54.50%, IQR: 45.21-69.17) (p < 0.001). RVOT-FS showed negative correlations with mean pulmonary artery pressure (mPAP) (r = - 0.664, p < 0.001), pulmonary vascular resistance (PVR) (r = - 0.526, p < 0.001), and other RHC and RV echocardiographic parameters. ROC analysis demonstrated that RVOT-FS is a reliable parameter for predicting PH, with an area under the curve (AUC) of 0.866. An RVOT-FS value of 44.05% had a sensitivity of 82.7% and specificity of 83.3% for diagnosing PH. This study revealed that RVOT-FS was significantly lower in the PH group than in the control group. The correlations also observed between RVOT-FS and mPAP, PVR, and other RHC and echocardiographic parameters imply its potential clinical utility.

We demonstrate the case of a man presenting with chest pain in which an initial assessment with echocardiography and, subsequently, with cardiac computed tomography led to a final diagnosis of caseous mitral annular calcification complicated by multiple embolizations.

Purpose: This study aimed to evaluate the efficacy of the Chat Generative Pre-trained Transformer (ChatGPT) in guiding the need for invasive coronary angiography (ICA) in high-risk non-ST-elevation (NSTE) acute coronary syndrome (ACS) patients based on both standard clinical data and coronary computed tomography angiography (CCTA) findings.

Methods: This investigation is a sub-study of a larger prospective multicentric double blinded project where high-risk NSTE-ACS patients underwent CCTA prior to ICA to compare coronary lesion by both modalities. ChatGPT analyzed clinical vignettes containing patient data, electrocardiograms, troponin levels, and CCTA results to determine the necessity of ICA. The AI's recommendations were then compared to actual ICA findings to assess its decision-making accuracy.

Results: In total, 86 patients (age: 62 ± 13 years old, female 27%) were included. ChatGPT recommended against ICA for 19 patients, 16 of whom indeed had no significant findings. For 67 patients, ChatGPT advised proceeding with ICA, and a significant lesion was confirmed in 58 of them. Consequently, ChatGPT's overall accuracy stood at 86%, with a sensitivity of 95% (95% confidence interval (CI) 0.76-0.92) and a specificity of 64% (95% CI 0.62-0.94). The model's negative predictive value was 84% (95% CI 0.44-0.79), and its positive predictive value was 87% 95% CI 0.86-0.97).

Conclusion: Preliminary evidence suggests that ChatGPT can effectively assist in making ICA decisions for high-risk NSTE-ACS patients, potentially reducing unnecessary procedures. However, the study underscores the importance of data accuracy and calls for larger, more diverse investigations to refine artificial intelligence's role in clinical decision-making.

Hand-held ultrasound devices (HHUD) are increasingly used in routine clinical practice, though they lacked continuous (CW) Doppler capability until recent times. There is limited evidence on the utility of HHUD in assessing aortic stenosis (AS) in real-world settings. Our goal was to validate a new HHUD with CW Doppler assessing AS hemodynamic severity. An observational, single-center study at the Valdecilla University Hospital, Santander, Spain between October 2022 and August 2023 was conducted. Patients previously diagnosed with AS were consecutively recruited. Following a reference echocardiographic examination in the cardiac imaging laboratory by an experienced operator (American Society of Echocardiography, level III), a HHUD with CW Doppler (Kosmos, EchoNous™) was used by an operator with intermediate echocardiography experience (American Society of Echocardiography, level II). The focus was on measuring aortic transvalvular Doppler velocities. Agreement between the mean trans-aortic gradient (mAG) was assessed using the intraclass correlation coefficient (ICC) test. A total of 101 patients were included. The reference test obtained a mAG of 29 mmHg [19.8-42.2], while the HHUD test showed 27.2 mmHg [16.2-43.9]. A strong correlation was observed (r = 0.89), with an ICC value of 0.87 and no significant bias (1.61 ± 0.9). The HHUD demonstrated very good ability to identify severe AS (kappa = 0.81, 95% CI 0.68-0.94; global agreement 92.1%) and good agreement for moderate (kappa = 0.58; global agreement = 80.2%) and mild (kappa = 0.73; global agreement = 88.1%) AS. Agreement was lower in patients with obesity (ICC = 0.63), poor acoustic windows (ICC = 0.74), or atrial fibrillation (ICC = 0.74). The HHUD showed good agreement with standard echocardiography in assessing AS. While it slightly underestimated mAG, it was accurate enough to reliably quantify AS severity.