The international journal of cardiovascular imaging最新文献

This case report presents an extremely rare finding of congenital absence of the left atrial appendage in a newborn. Imaging modalities such as CT angiography play a crucial role in identifying such findings.

Transcatheter aortic valve implantation (TAVI) is the preferred treatment for elderly patients with symptomatic severe aortic stenosis (SAS). Left atrial (LA) dysfunction is an established prognostic marker in various clinical settings. This study aimed to evaluate the correlation between LA function, assessed by strain parameters, and the incidence of permanent pacemaker (PPM) implantation or major adverse cardiovascular events (MACE) in patients with SAS undergoing TAVI. A total of 157 patients with SAS treated with TAVI between January 2019 and April 2021 were screened. Patients with pre-existing cardiac implanted devices or permanent atrial fibrillation were excluded. The mean follow-up was 24 ± 13 months. LA function was assessed using transthoracic echocardiography (TTE) by measuring three strain parameters: LA reservoir strain (LASr), LA conduit strain (LASct), and LA contractile strain (LAScd). The study endpoints were the association between these strain parameters and the occurrence of PPM implantation or MACE during follow-up. Ninety-nine patients were included in the analysis. During follow-up, 43 patients experienced MACE. Mean values for LASr, LASct, and LAScd were 29.5 ± 12.7%, -18.7 ± 11.0%, and - 18.5 ± 7.3%, respectively. Patients requiring PPM implantation showed significantly reduced LA strain values compared to those who did not (LASr: 13.1% vs. 33.2%; LASct: -10.1% vs. -21.0%; LAScd: -6.7% vs. -21.6%, p < 0.001). Similarly, patients who developed MACE had reduced strain values compared to those without events (LASr: 21.9% vs. 35.4%; LASct: -14.3% vs. -21.8%; LAScd: -9.9% vs. -25.5%, p < 0.001). Pre-TAVI LA dysfunction, assessed through LA strain, is closely associated with increased risk of PPM implantation and MACE.

While sympathetic overactivity is a well-established driver of disease progression in heart failure with reduced ejection fraction, its role in early-stage heart failure with preserved ejection fraction (HFpEF) remains unclear. In particular, renal sympathetic activity-an important contributor to neurohormonal dysregulation-has not been systematically evaluated in HFpEF. Early-stage HFpEF refers to patients who present with mild symptoms, only modest elevations in B-type natriuretic peptide (BNP), and invasively confirmed elevated left ventricular end-diastolic pressure (LVEDP) but without overt structural remodeling or severe congestion. We conducted a single-center retrospective randomized controlled study including 121 patients with early-stage HFpEF and 44 matched controls. All participants underwent ¹³¹I-metaiodobenzylguanidine (¹³¹I-MIBG) scintigraphy to quantify sympathetic nerve activity in the heart and kidneys. Uptake ratios (15 min and 4 h heart-to-mediastinum [H/Ma] and kidney-to-posterior mediastinum [K/Mp]) and washout rates (Heart Washout Rate [HWR] and Kidney washout Rate [KWR]) were calculated. Correlations with these MIBG parameters and left ventricular end-diastolic pressure (LVEDP) were analyzed. HFpEF patients showed significantly higher cardiac H/Ma and renal K/Mp ratios, and lower HWR and KWR compared with controls (all P < 0.001). In the HFpEF group, both 4-h H/Ma and 4-h K/Mp ratios were positively correlated with LVEDP, while HWR and KWR were inversely correlated with these indices (all P < 0.01). Early-stage HFpEF patients show increased cardiac and renal sympathetic activity, highlighting the renal sympathetic nervous system as a potential therapeutic target and suggesting ¹³¹I-MIBG scintigraphy as a promising tool for risk stratification and early intervention.

We aimed to identify the most valuable variables in multi-modal ultrasound technologies and compare the performance of radiomics models in detecting symptomatic carotid plaques. From August 2013 to April 2021, we retrospectively enrolled 112 carotid plaque patients and randomly divided them into training and validation cohorts at a 3:1 ratio. Additionally, 42 patients from two other centers were enrolled as an independent test cohort. A traditional model (T model) was built using independently significant variables from multivariate analysis of clinical and multi-modal ultrasound characteristics. Radiomics models based on B-mode ultrasound, contrast-enhanced ultrasound (CEUS), and a combined approach (USR, CEUSR, and US-CEUSR models) were then developed. Model performance was assessed using area under the receiver operating characteristic curve (AUC) and decision curve analysis. Only intraplaque contrast enhancement from CEUS modality was independently associated with clinical symptoms [odds ratio = 3.328; 95% confidence interval (CI), 1.230-9.003; p = 0.018] and was used to construct the T model, which achieved an AUC of 0.658 (95% CI, 0.502-0.815) in the external test cohort. The radiomics model showed good and repeatable diagnostic performance for identifying symptomatic plaques, particularly the US-CEUSR model, which had an AUC of 0.775 (95% CI, 0.607-0.915) in external test cohort. This model also provided high clinical benefits in detecting symptomatic plaques. Intraplaque contrast enhancement, a qualitative variable by CEUS, is an independent risk factor for symptomatic carotid plaques, and radiomics features from B-mode ultrasound and CEUS can effectively identify symptomatic carotid plaques.

Catheter ablation of ventricular arrhythmias originating from papillary muscles (PMs) is challenging due to complex anatomical structures, dynamic motion, and potential deep intramural origin. Intracardiac echocardiography (ICE) has emerged as an essential tool for guiding catheter ablation. We report a case of premature ventricular complexes arising from the anterolateral PM of the left ventricle, successfully ablated under intraprocedural ICE guidance. This case underscores the key role of ICE in overcoming the anatomical challenges of PM ablation and ensuring procedural precision and safety.