The international journal of cardiovascular imaging最新文献

A four-dimensional phase-contrast magnetic resonance imaging sequence with respiratory-controlled adaptive k-space reordering (ReCAR-4DPC) offers potential benefits of improved scan efficiency and motion robustness. The purpose of this study was to evaluate the reproducibility of flow measurement using this technique and to compare hemodynamic metrics obtained to two-dimensional phase contrast MRI (2DPC)-derived metrics of the thoracic aorta. ReCAR-4DPC was performed with identical scan parameters in 15 healthy volunteers (6M,9F, mean [range] 37 [23-47] years) and 11 patients with thoracic aortic dissection (6M,5F, 56 [31-81] years) and acquisition time was recorded. Peak systolic velocity (PSV), average flow (AF) and net forward volume (NFV) were quantified by two readers for ReCAR-4DPC at ascending, descending and diaphragmatic aorta levels. Reference standard 2DPC measurements at the same levels were performed by a separate experienced cardiovascular radiologist. ReCAR-4DPC intra-reader agreement, inter-reader agreement, inter-scan repeatability and concordance with 2DPC-derived metrics (all segments combined) were evaluated with Lin's concordance correlation coefficient (LCCC) and reduced major axis regression. The overall average ± SD MRI acquisition time of all subjects was 11:59 ± 3:57 min, with shorter average times (9:37 ± 1:57 min) in healthy volunteers compared to patients (15:13 ± 3:44 min). There was near-perfect intra-reader, inter-reader and inter-scan concordance (LCCC for all metrics > 0.97, > 0.98 and > 0.92 respectively) for ReCAR-4DPC. Concordance with 2DPC was also high (LCCC all > 0.89), with overall minimally lower PSV, AF and NFV values derived from ReCAR-4DPC compared to reference 2DPC derived metrics. ReCAR-4DPC is a reproducible and relatively fast approach for comprehensive measurement of thoracic aortic flow metrics, with robust correlation to conventional 2DPC.

Post-operative transesophageal echocardiography (TEE) is standard of care to evaluate for residual disease and quality of surgical repair. The residual lesion score (RLS) as defined by the pediatric heart network explored the impact of residual lesions on outcomes using discharge transthoracic echocardiogram (TTE). In tetralogy of fallot with pulmonary stenosis (TOF/PS), the residual right ventricular outflow tract (RVOT) gradient is one marker of quality of repair. Given peri-operative differences in hemodynamics, this study aims to define the correlation between TEE and discharge TTE RVOT gradient. This single center retrospective study included patients with TOF/PS undergoing primary repair with accompanying perioperative TEE and discharge TTE. TEE and TTE measurements were compared. An RLS based on the type of repair was assigned to the post-operative TEE based on the RVOT doppler velocity. TEE RVOT peak velocity and VTI correlated with TTE RVOT peak velocity (Spearman rank correlation coefficient = 0.62 (p < 0.001)) and VTI (Spearman rank correlation coefficient = 0.66 (p < 0.001)) at time of discharge. Application of RLS at the time of the TEE does not accurately reflect RLS at the time of discharge based on current criteria (p-value based on McNemar's Chi-squared test = 0.24). The ability of post-op TEE measurement to predict need for re-intervention is just as effective as TTE. On ROC analysis, the TEE RVOT peak velocity had similar AUC (0.672) compared to discharge TTE RVOT peak velocity (0.721) on predicting need for re-intervention. After surgical repair of TOF/PS, there is a strong correlation between post-op TEE and discharge RVOT peak velocity. TEE offers a chance to guide immediate re-intervention if needed and may be applied to severe residual post-op RVOT peak velocity. Further studies are needed to identify RLS based on TEE and its relationship to outcomes and intraoperative management.

Bicuspid aortic valfves (BAV) are a relatively common cardiac abnormality, with an associated risk of aortic stenosis, aortic regurgitation and aortopathy. First-line diagnosis is via transthoracic echocardiography (TTE), which may be impacted by valve calcification and operator variability. Electrocardiogram-gated computed tomography (CT) offers an alternative form of assessment. The aim of this systematic review and meta-analysis is to evaluate the diagnostic performance of TTE versus CT for BAV. Eligible studies were retrieved from inception through to March 2024 on OVID Medline, Embase and Cochrane Library. All primary studies regarding the diagnostic performance of TTE and/or CT with regards to BAV were included. The QUADAS-2 tool was utilized for quality assessment. Sensitivity and specificity data were statistically analyzed. Of 4698 records, 19 were eligible for inclusion, and 16 had sufficient data for inclusion in the meta-analysis. There was only data regarding TTE vs. retrospectively ECG-gated CT. There was a significant difference between the sensitivity of retrospectively ECG-gated cardiac CT (95.5% (95% CI: [91.3-97.5%]) and TTE (79.7%, 95% CI: [71.6-86.0%]) for identifying BAV. The specificity was high and not significantly different for both CT and TTE (96%, 95% CI: [92.5-98.2%] and 91.3%, 95% CI: [87.3-93.8%], respectively). Retrospectively ECG-gated CT demonstrates greater sensitivity for diagnosis of BAV compared to TTE. Both modalities are non-invasive and demonstrate good specificity for excluding BAV. Given that CT scans are easily accessible, they offer a reasonable second-line investigation for diagnosis of BAV when an initial TTE is inconclusive.

After a cardiac transplantation, the steering of immunosuppression requires an active search for acute cellular rejection (ACR). Surveillance with endomyocardial biopsy (EMB) is the gold standard. Given the costs and potential complications, there is growing interest in the use of non-invasive screening methods. Thus, we have conducted a systematic review and meta-analysis to evaluate the role of speckle-tracking echocardiography as a screening method for ACR. We searched PubMed (CENTRAL) and gray literature for studies presenting data on speckle tracking echocardiography in heart-transplant patients experiencing acute cellular rejection. The primary outcomes of the meta-analysis were left and right ventricular global longitudinal strain. We used random effects models for all our calculations. We pre-registered our meta-analysis with PROSPERO (CRD42024508654). By incorporating data from over 2000 biopsies included in 18 studies, we found that both left (LVGLS, MD -1.96, 95% CI -2.85 to -1.07, p < 0.0001), and right (RVGLS, MD -2.90, 95% CI -4.03 to -1.76, p < 0.00001) ventricular longitudinal strain were lower among patients without ACR. The change of LVGLS from baseline over time was also greater among patients experiencing ACR (MD -2.43, 95% CI -4.82 to -0.05, p = 0.045). Current data suggest that myocardial strain measured by speckle tracking echocardiography is affected in ACR and could potentially be used for early rejection detection as a rule-out strategy, leading to reduction of routine EMB in heart transplant follow-up.

Aortic valve calcification (AVC) has been explored as a powerful predictor of procedural complications in patients undergoing transcatheter aortic valve implantation (TAVI). However, little evidence exists on its impact on intra-annular devices' performance. We aimed to investigate the impact of AVC burden and distribution pattern on the occurrence of paravalvular leak (PVL), conduction disturbances requiring permanent pacemaker implantation (PPI) and 30-day clinical outcomes in patients undergoing TAVI with a self-expanding, intra-annular device. According to AVC, 103 patients enrolled in a single medical centre from November 2019 to December 2022 were divided into tertiles. Valve Academic Research Consortium (VARC)-3 definitions were used to classify procedural complications and outcomes. Patients in the highest AVC tertile showed an increased occurrence of mild or more PVL and conduction disorders (p < 0.001 and p = 0.006). AVC tertiles (highest tertile) emerged as an independent predictor of PVL (OR 7.32, 95%CI 3.10-17.28, p < 0.001) and post-TAVI conduction disturbances (OR 3.73, 95%CI 1.31-10.60, p = 0.013) but not of PPI (OR 1.44, 95%CI 0.39-5.35, p = 0.579). Considering calcium distribution, ROC analyses revealed that annular AVC but not left ventricle outflow tract (LVOT) calcium burden significantly indicated the development of PVL (AUC 0.863, 0.77-0.93, p < 0.001) and conduction disorders/PPI (AUC 0.797, 0.70-0.89, p < 0.001 and 0.723, 0.58-0.86, p = 0.018, respectively). After adjustment for age and sex, the highest tertile remained an independent predictor of the 30-day composite outcome (death, myocardial infarction, stroke, major vascular complications, type 3/4 bleedings, acute kidney injury, PPI and ≥ moderate PVL) (OR 3.26; 95%CI 1.26-8.40, p = 0.014). A higher AVC is associated with an increased risk of PVL and conduction disturbances after TAVI with a self-expanding, intra-annular device. However, our findings suggest a minor role for LVOT calcification compared with annular AVC in the performance of this specific prosthesis.

We present the first robot-assisted transcatheter mitral edge-to-edge repair (M-TEER) for the treatment of severe mitral regurgitation. 68-year-old patient presented with worsening dyspnea on exertion and intermittent palpitations (NYHA class III). Transthoracic echocardiography revealed severe functional mitral regurgitation (MR) with moderate left ventricular and left atrial enlargement. Due to the patient's high surgical risk (STS score of 8.84%), a transcatheter mitral edge-to-edge repair was planned following heart team discussion. Results: The final transesophageal echocardiography confirmed that the MR had reduced from the original severe to mild. This case report demonstrates, the feasibility of a mitral TEER system with a robotic-assisted approach, potentially paving the way for future applications in structural heart and endovascular intervention.

Purpose: To compare the application of two contrast-enhanced time-resolved magnetic resonance angiography sequences on an aortic disease patient cohort: the conventional Cartesian-sampling-based, Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) sequence, and the radial-sampling-based Golden-angle RAdial Sparse Parallel (GRASP) sequence. TWIST is highly sensitive to patient movement, which can lead to blurring and reduced sharpness of vascular structures, particularly in dynamic regions like the aorta. Such motion artifacts can compromise diagnostic accuracy. Radial-sampling-based techniques are less sensitive to motion than cartesian sampling and are expected to improve the image quality in body parts subjected to motion.

Methods: 30 patients (60.9 ± 16.1y.o.) with various aortic diseases underwent a 1.5T magnetic resonance angiography examination. Assessment of image quality in the ascending aorta (AA), descending aorta (DA), and abdominal aorta (AbA) on a 4-point Likert scale (1 = excellent, 4 = non-diagnostic) as well as max. aortic diameters (Dmax) were performed. T-test and multilevel mixed-effect proportional-odds models were used for the image analysis.

Results: GRASP offered superior depiction of vascular structures in terms of vascular contrast for qualitative analysis (TWIST, reader 1: 1.6 ± 0.5; reader 2: 1.9 ± 0.4; reader 3: 1.1 ± 0.4; GRASP, reader 1: 1.5 ± 0.5; reader 2: 1.4 ± 0.5; reader 3: 1.0 ± 0.2) and vessel sharpness for qualitative (TWIST, reader 1: 1.9 ± 0.6; reader 2: 1.6 ± 0.6; reader 3: 2.0 ± 0.3; GRASP, reader 1: 1.4 ± 0.6; reader 2: 1.2 ± 0.4; reader 3: 1.3 ± 0.6) and quantitative analysis (TWIST, AA = 0.12 ± 0.04, DA = 0.12 ± 0.03, AbA = 0.11 ± 0.03; GRASP, AA = 0.20 ± 0.05, DA = 0.22 ± 0.06, AbA₌0.20 ± 0.05). Streaking artefacts of GRASP were more visible compared to TWIST (TWIST, reader 1: 2.2 ± 0.6; reader 2: 1.9 ± 0.3; reader 3: 2.0 ± 0.5; GRASP, reader 1: 2.6 ± 0.6; reader 2: 2.3 ± 0.5; reader 3: 2.8 ± 0.6). Aortic Dmax comparison among the sequence showed no clinical relevance.

Conclusion: GRASP outperformed TWIST in SNR, vessel sharpness, and reduction in image blurring; streaking artefacts were stronger with GRASP, but did not affect diagnostic image quality.

To investigate two different approaches to determine patient risk to develop cardiac events: the burden of coronary atherosclerosis, as assessed by the Gensini score, and plaque morphology, as assessed by intracoronary optical coherence tomography (OCT). We assessed the Gensini score and OCT features of plaque vulnerability in 847 patients from the CLIMA registry. Patients were divided into four Gensini quartiles. The main study endpoint was the 1-year composite of cardiac death, myocardial infarction (MI) and/or target vessel revascularization (TVR). A total of 56 patients (6.6%) experienced the one-year main composite endpoint. The composite endpoint was significantly affected by the Gensini score (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.11-1.81, p = 0.005), with a low incidence in the first Gensini quartile (Q1 1.3%) and a higher incidence in the remaining groups (Q2 8.3%, Q3 8.9% and Q4 8.3%). At the multivariable analysis, the combined four OCT criteria (HR 6.4, 95%CI 3.0-13.7, p < 0.001), thin fibrous cap (HR 2.9, 95%CI 1.7-5.0, p < 0.001), lipid arc > 180° (HR 2.1, 95%CI 1.2-3.6, p = 0.010), minimum lumen area < 3.5 mm² (HR 1.7, 95%CI 1.01-3.0, p = 0.047) and the Gensini score (HR 1.4, 95%CI 1.1-1.8, p = 0.017) were independent predictors of the main composite endpoint. In this post-hoc analysis of the CLIMA study, the burden of coronary atherosclerosis as assessed by the Gensini score and OCT plaque characteristics were independent predictors of cardiac events. Patients with the largest atherosclerosis burden and with plaque vulnerability by OCT were at the highest risk of poor outcome. Clinicaltrials.gov identifier: NCT02883088.

The purpose of this study was to investigate neo-aortic curvature and diameter variation using the principal component analysis in patients who underwent a Norwood procedure for hypoplastic left heart syndrome. We further assessed whether neo-aortic curvature and diameter features are associated with clinical outcomes, single right ventricle function and flow hemodynamic patterns derived by 4D-Flow MRI. 55 patients with Fontan circulation who underwent a Norwood procedure in infancy underwent cardiac MRI as part of surveillance of their Fontan circulation. Neo-aortic models segmented from the MRI angiography were subjected to principal component analysis. Principal component (PC) score values representing curvature and diameter variability were compared between patients with and without composite clinical event and correlated with standard cardiac hemodynamics. Fourteen patients experienced composite adverse clinical events. The PCs describing the variations in aortic curvature were not associated with cardiac MRI hemodynamics or clinical events. The diameter-based 2nd PC describing the degree of aortic tapering was significantly associated with the end-systolic volume index (R = 0.34, P = 0.011), ejection fraction (R = -0.44, P = 0.001), and viscous energy loss measured in the ascending aorta (R = 0.45, P = 0.009). High 2nd PC score values describing abrupt diameter changes were also associated with worse freedom from clinical events (P = 0.042). Neo-aortic shape variation described by gradual diameter tapering is strongly linked to better clinical and hemodynamic outcomes. Neo-aortic curvature and luminal trajectory seems to have less impact on the overall hemodynamics and long-term outcomes.