The international journal of cardiovascular imaging最新文献

In the ACC/AHA guidelines, the presence of symptoms plays a central role in determining timing surgery in primary mitral regurgitation (MR). Studies have shown a disconnect between the severity of MR and symptoms. The purpose of this study is to assess risk factors for symptoms in patients with chronic primary MR. There were 430 patients with degenerative MR and preserved left ventricular function who underwent cardiovascular magnetic resonance (CMR). MR volume (MRV) and MR fraction (MRF) were categorized as per the ACC/AHA guidelines. Patients were divided into three groups based on category of MRV and MRF: (1) MRV category > MRF category (V > F), (2) MRV = MRF category (V = F), and (3) MRV < MRF category (V < F). Symptoms were defined as shortness of breath, fatigue, and decreased exercise capacity and extracted from chart review. There were 134 (38%) patients who reported symptoms. Based on MRV, 236 (55%), 125 (29%), and 69 (16%) patients had mild moderate, and severe MR respectively. Based on MRF, 257 (60%), 130 (30%), and 43 (10%) patients had mild moderate, and severe MR respectively. There was no increase in the prevalence of symptoms with worsening MRV severity (39%, 40% and 30% for mild, moderate and severe MRV respectively, p = 0.4). There was a trend for increase in the prevalence of symptoms in patients with severe MRF (35%, 40% and 54% for mild, moderate and severe MRF respectively, p = 0.054). There was a significant increase in the prevalence of symptoms when comparing V > F, V = F, and V < F (20%, 40%, and 72% respectively, p < 0.0001). On multivariable analysis, risk factors for symptoms were age, female sex, MRF, and having a V < F. In patients undergoing CMR with degenerative MR the prevalence of symptoms do not increase with worsening MRV. MRV and MRF were not risk factors for symptoms but having V < F was a risk factors for the presence of symptoms. These findings suggest that symptomatic patients with MR may have other pathology which may be responsible for their symptoms. Further studies are needed to better characterize the relationship between MR severity and symptoms.

The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin + , age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID -/comorbidity + , 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.

For end-stage renal disease (ESRD) patients requiring hemodialysis, reliable vascular access is crucial, especially when conventional supradiaphragmatic options are exhausted. This study reviews the technical aspects, clinical outcomes, and complications of translumbar and transhepatic tunneled dialysis catheter (TDC) placements. These alternative infradiaphragmatic approaches provide essential hemodialysis access for patients with central venous occlusions. Translumbar catheter placement is associated with high technical success rates and prolonged patency, while the transhepatic approach serves as a last resort for patients with both superior and inferior vena cava occlusions. Careful patient selection and operator expertise are critical for placement of these advanced infradiaphragmatic dialysis catheter approaches.

Changes in hydration status may affect myocardial native T1 and T2 values and influence the clinical interpretation. We aimed to assess the impact of acute preload augmentation on native T1 and T2. Cardiovascular magnetic resonance (CMR) native T1 and T2 mapping were performed twice on the same day in 20 healthy participants before and after an acute preload augmentation by a 2-liter intravenous infusion of isotonic sodium chloride (0.9%). Test-retest reproducibility was evaluated in 30 healthy participants with two consecutive CMR examinations on the same day. Sixteen participants were included in both substudies. In the 20 healthy participants undergoing acute preload augmentation (55% males, mean age (interquartile range [IQR]) 43 [29-51] years), native T1 increased with 17 ms (95% confidence interval [CI] 7 to 26; p = 0.001), T2 with 1.7 ms (95% CI 0.8 to 2.4; p < 0.001), and blood T1 with 46 ms (95% CI 28 to 65; p < 0.001). Test-retest variability in 30 healthy participants (47% males, median age 43 [28-52] years) showed 95% limits of agreement (LOA) of ± 26 ms for native T1, ± 2.1 ms for T2, and ± 57 ms for blood T1. In the 16 participants included in both substudies, the mean differences in changes post-infusion versus test-retest were 22 ms (95% CI 8 to 36; p = 0.01) for native T1, 1.9 ms (95% CI 0.9 to 2.9; p = 0.001) for T2, and 62 ms (95% CI 32 to 91; p < 0.001) for blood T1. Native T1 and T2 values increased following acute preload augmentation. However, the changes were within the 95% LOA of the test-retest reproducibility.

Fontan-associated liver disease (FALD) may be caused by chronic liver congestion due to high central venous pressure (CVP). Recently, the usefulness of liver native T1 mapping in magnetic resonance imaging (MRI) in adulthood has been reported. To evaluate the usefulness of native liver T1 mapping in children with congenital heart disease (CHD), we investigated the utility of native liver T1 relaxation time (LT1) in pediatric Fontan patients in comparison to other CHDs. Correlations between LT1 and laboratory biomarkers or hemodynamic data were also assessed. A total of 155 patients with CHD (biventricular repair, n = 42; bidirectional Glenn circulation, n = 38; and Fontan circulation, n = 75) underwent blood tests, cardiac catheterization, and cardiac MRI within 48 h. Both CVP and LT1 levels were higher in Fontan patients than in bidirectional Glenn and biventricular patients. There were significant correlation in the overall population and weak correlation in Fontan patients between CVP and LT1(correlation coefficient 0.644 [0.541-0.728] and 0.244 [0.0179-0.446], P < 0.001 and 0.035, respectively). Among the laboratory data, the multiple linear regression analysis revealed that the fibrosis-4 index and alanine aminotransferase were significantly correlated with LT1 in the overall population (P = 0.008,0.012), and the fibrosis-4 index was correlated with LT1 in Fontan patients (P = 0.019). LT1 might have some role to predict elevated CVP and liver injury in children with CHD.

To evaluate dual-layer dual-energy computed tomography (dlDECT)-based characterization of thrombus composition for differentiation of acute pulmonary embolism (PE) and chronic thromboembolic pulmonary hypertension (CTEPH). This retrospective single center cohort study included 49 patients with acute PE and 33 patients with CTEPH who underwent CT pulmonary angiography on a dlDECT from 06/2016 to 06/2022. Conventional images), material specific images (virtual non-contrast [VNC], iodine density overlay [IDO], electron density [ED]), and virtual monoenergetic images (VMI_50KeV) were analyzed. Regions-of-interest (ROIs) were manually placed in pulmonary artery thrombi, and morphological imaging characteristics for acute and chronic PE were assessed. Area under the receiver operating characteristics curve (AUC) of ROI measurements, morphological imaging features, and their combination in distinguishing between acute PE and CTEPH were evaluated. Compared to PE, thrombi in patients with CTEPH had lower attenuation on conventional images (Median [inter-quartile range]: 40 [35-47] HU vs 64 [52-83] HU) and VMI_50keV reconstructions (59 [46-72] HU vs 101 [80-123] HU) as well as decreased iodine uptake (IDO: 0.5 [0.2-1.0] vs 1.2 [0.5-1.8]; p for all < 0.001). Conventional images and VMI_50keV reconstructions were the most accurate for differentiating between acute and chronic thrombi (conventional: AUC 0.92, 95% CI 0.86-0.98; VMI_50keV: AUC 0.91, 95% CI 0.85-0.97). Main pulmonary artery (MPA) diameter combined with thrombus attenuation significantly increased the AUC compared to MPA diameter alone (p = 0.002 respectively). Thrombi in patients with CTEPH exhibit lower attenuation and reduced contrast enhancement. Analyzing attenuation in pulmonary thrombi may add diagnostic information to established morphological parameters in differentiating acute PE from CTEPH.

Stress/Takotsubo cardiomyopathy (TCM) is a transient regional left ventricular (LV) systolic dysfunction, often mimicking acute myocardial infarction with normal coronary arteries. Rarely TCM can mimic hypertrophic cardiomyopathy (HCM). We describe a case where TCM presented with LV hypertrophy (LVH) and left ventricular outflow tract obstruction (LVOTO) which resolved on follow-up.

Patients with diabetes mellitus (DM) have an increased risk of in stent restenosis (ISR). Neovascularization (NV) is considered as a unique pathophysiology factor of ISR in diabetic patients. However, the restructuring patterns of in vivo human coronary NV and their relationship with ISR, especially in diabetic patients remain unclear. In this study, we aimed to investigate the NV structure differentiations between patients with and without DM after coronary stent implantation using optical coherence tomography (OCT). We included 136 patients with ISR (70 patients in DM group and 66 patients in non-DM group) who underwent OCT during coronary angiography follow-up. NVs were manually segmented, after which three-dimensional (3D) rendering of OCT images was conducted. NVs greater than 1 mm in length were classified as longitudinal running or coral tree types based on their 3D structures. NV structures were compared between DM and non-DM patients. The prevalence of the coral tree pattern NV in the DM group was 2.14-fold higher than in the non-DM group(p = 0.012). 47.14% of patients in the DM group and 51.51% of patients in the non-DM group presented longitudinal running NV (p = 0.610). The number of coral tree pattern NV was relatively higher in DM patients than in the non-DM patients (p = 0.019). However, the number of longitudinal running NV showed no difference between the two groups (p = 0.872). The normalized NV volume was significantly larger in the DM group (p = 0.008). Patients with coral tree pattern NV have thinner minimum fibrous cap thickness (p = 0.030). DM was the risk factor for coral tree pattern NV formation in ISR lesions after adjustment for other factors. NV with specific restructuring patterns, such as longitudinal running and coral tree patterns, can be identified in ISR lesions. NV with a coral tree pattern, characterized by higher leakiness and immaturity, is more commonly found in patients with DM and is associated with tissue instability in ISR. Accurate and feasible imaging modalities for NV might offer promising opportunities to evaluate NV and prevent progression of ISR in diabetic patients.

Coronary artery disease is the leading cause of death among non-communicable diseases. The management strategy prioritizes early detection and optimal treatment, with emerging roles for imaging approaches. Photon-counting computed tomography is a new non-invasive diagnostic imaging tool that can detect high-risk plaques in coronary artery disease patients. Using photon-counting computed tomography in screening and intravascular ultrasound later in verifying diagnosis and intervention guidance could be a new technique to swiftly discover unstable plaques, prepare lesions for surgery, and determine the optimal percutaneous intervention strategy. However, there is no documentation available for this new approach. We reported two acute coronary syndromes managed with a combination of two imaging methods. Despite receiving medical therapy, the first case continued to experience chest pain, leading to the detection of plaque ulceration in the left anterior descending artery. On the other hand, two PCCT screenings within 6 months revealed plaque progression in the second case. We then used IVUS to confirm the lesions and proceed to intervention. We successfully discharged both cases, and they showed no symptoms 6 months after discharge.

Artificial Intelligence (AI) has been proposed to improve workflow for coronary artery calcium scoring (CACS), but simultaneous demonstration of improved efficiency, accuracy, and clinical stability have not been demonstrated. 148 sequential patients who underwent routine calcium-scoring computed tomography were retrospectively evaluated using a previously validated AI model (syngo. CT CaScoring VB60, Siemens Healthineers, Forscheim, Germany). CACS was performed by manual (Expert alone), semi-automatic (AI + expert review), and automatic (AI alone) methods. Time to complete and intraclass correlation coefficients were the primary endpoints. Secondary endpoints included differences in multiethnic study of atherosclerosis (MESA) percentiles and stratification by calcium severity. AI and expert CACS agreement was excellent (ICC = 0.951; 95% CI 0.933-0.964). The global median time was 15 ± 2 s for AI ("Automatic"), 38 ± 13 s for the AI + manual review ("Semiautomatic") and 45 ± 24 s for the manual segmentation. Automatic segmentation was faster than manual segmentation for all CACS severities (P < 0.001). AI computational time was independent of calcium burden. Global mean bias in Agatston score across all patients was 7.4 ± 102.6. The mean bias for global MESA score percentile was 2.1% ± 12%. 95% of error corresponded to a ± 10% difference in MESA score. The use of AI for CACS performs excellent accuracy, saves approximately 60% of time in comparison to manual review, and demonstrates low bias for clinical risk profiles. Time benefits are magnified for patients with high CACS. However, a semi-automatic approach is still recommended to minimize potential errors while maintaining efficiency.