The international journal of cardiovascular imaging最新文献

The accurate evaluation of pulmonary vascular resistance (PVR) is critical for evaluating operability and guiding management in adults with unrepaired atrial septal defect (ASD). Non-invasive echocardiographic markers, such as the echocardiographic Pulmonary to Left Atrial Ratio (ePLAR), calculated by dividing the peak tricuspid regurgitation velocity (TR Vmax) by the ratio of the transmitral E-wave to mitral annular e' velocity, may facilitate early risk stratification and reduce reliance on invasive procedures. Eighty-nine adult patients with unrepaired ASD underwent comprehensive echocardiography and right heart catheterization. ePLAR and additional echocardiographic parameters were measured, and their ability to identify elevated PVR (≥5 Wood Units, WU) was assessed through correlation and receiver operating characteristic (ROC) analysis. PVR ≥ 5 group showed elevated ePLAR (0.41 vs. 0.29, p < 0.0001. ePLAR showed moderate ability to predict elevated PVR (AUC 0.754). The TR Vmax/ right ventricular outflow tract velocity-time integral (RVOT VTI) and TR Vmax²/RVOT VTI ratio demonstrated stronger discrimination (AUC 0.907 and 0.929). DeLong's test confirmed TR Vmax/RVOT VTI superiority (p = 0.0147). TRVmax/ right ventricular global longitudinal strain (RV GLS) shown to be an ineffective measure (AUC 0.265, p > 0.05). ePLAR is a practical, novel non-invasive echocardiographic parameter for identifying elevated pulmonary vascular resistance in adults with unrepaired ASD. With high sensitivity and independent predictive value, ePLAR is suitable for initial screening and risk stratification, potentially reducing unnecessary invasive testing and improving clinical decision-making.

To investigate whether non-calcified coronary plaque (NCP) volume differs between symptomatic versus asymptomatic individuals across strata of coronary artery calcium (CAC) score, and whether symptom status adds incremental value beyond CAC. In this retrospective single-center study, we analyzed 1,835 adults (14% symptomatic, 86% asymptomatic) who underwent coronary CT angiography (CCTA) with AI-based plaque quantification. Participants were stratified into five CAC categories: 0, 1-99, 100-299, 300-1000, and > 1000 Agatston units. Total NCP volume was compared between symptomatic and asymptomatic patients within each stratum using non-parametric tests. Median NCP volumes were similar in both groups for CAC 0 (17.7 vs. 18.6 mm³, p = 0.96) and CAC 1-99 (50.8 vs. 56.3 mm³, p = 0.37). A significant difference emerged in the CAC 100-299 category: symptomatic patients had higher NCP (152.3 vs. 112.3 mm³, p = 0.035). No significant differences were seen in CAC 300-1000 or > 1000 (p = 0.12 and p = 0.066, respectively). Symptom status may be associated with higher non-calcified plaque burden particularly in symptomatic patients with CAC 100-299. Prospective outcome studies are needed to determine whether AI-quantified NCP volume can guide preventive therapy independent of CAC.

Aortic diseases, particularly acute aortic syndromes (AAS) and aortic aneurysms (AA), represent critical cardiovascular conditions with high mortality rates requiring precise imaging for diagnosis and management. This review provides a comprehensive analysis of current imaging diagnostic techniques, focusing specifically on acquired thoracic and abdominal aortic pathologies. We first evaluate the comparative efficacy of Computed Tomography Angiography (CTA) and Magnetic Resonance Imaging (MRI) in the diagnosis of AAS (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer), highlighting the role of artificial intelligence in optimizing segmentation and detection. Subsequently, we discuss aortic aneurysms, emphasizing the shift from simple diameter-based assessment to functional risk stratification incorporating calcification scoring, inflammatory imaging, and hemodynamic parameters. Furthermore, the review addresses postoperative imaging surveillance, particularly for endoleak detection following endovascular aneurysm repair (EVAR). We conclude that while CTA remains the gold standard for emergency diagnosis due to its speed and spatial resolution, MRI offers superior value in functional assessment and radiation-free long-term follow-up. The integration of multimodal imaging and AI-driven analysis is essential for achieving precision medicine in the management of acquired aortic diseases.

Microvascular obstruction (MVO) is a phenomenon associated with worse outcome after acute myocardial infarction. While some studies suggested a benefit of an increased body mass index (BMI) in terms of MVO occurrence in ST-elevation myocardial infarction (STEMI), there are currently no data available on the influence of overweight on the development of MVO in Non-STEMI (NSTEMI). Thus, the aim of this study was to assess the association between MVO and BMI in NSTEMI patients. This study investigated a sub-cohort of the TATORT-NSTEMI trial. Overall, 354 patients were included with a median age of 68 years (25% women). Cardiac magnetic resonance imaging (CMR) was performed within four days after the index event. MVO was defined as hypointense core within the infarcted area in late-enhancement sequences. MVO occurred in 97 patients (27%) and patients with MVO had a significantly higher BMI (28.4 kg/m², interquartile range (IQR) 26.1-31.1 vs. 27.3 kg/m², IQR 24.8-30.3, p = 0.024). Dichotomized at 25.6 kg/m² (Youden-index), patients with a BMI above that threshold showed significantly more often MVO (33% vs. 15%, p < 0.001). In logistic regression analysis, BMI > 25.6 kg/m² was a significant predictor of MVO, independent of traditional cardiovascular risk factors. In the current study, an increased BMI has been associated with MVO after NSTEMI. Further, overweight and especially a BMI above 25.6 kg/m² were independent predictors of MVO in these patients, challenging the so-called "obesity paradox". Lastly, further research on the connection between body weight and microvascular damage in myocardial infarction is needed.