The international journal of cardiovascular imaging最新文献

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.

Background: Growing evidence shows an association between higher post-PCI quantitative flow ratios (QFR) and improved clinical prognosis, however, no models are available to predict suboptimal QFRs (< 0.91) after angiographically successful PCI. This study aims to establish a prediction nomogram for this domain.

Methods: This study included 450 vessels derived from 421 consecutive patients enrolled in the PIONEER IV trial, which were randomly assigned in a 1:1 ratio to a training (N = 225) and internal validation (N = 225) set, with external validation performed in 97 vessels from 95 consecutive patients enrolled in the ASET Japan trial. LASSO regression was used for optimal feature selection, and multivariate logistic regression was subsequently utilized to construct the nomogram. The performance of the nomograms was assessed and validated by area under the receiver operating characteristics curve (AUC), calibration curves, decision curve analysis, and clinical impact curves.

Results: The nomogram was constructed incorporating a novel metric, quantitative flow ratio derived pullback pressure gradient (QFR-PPG), alongside four conventional parameters: left anterior descending artery disease, pre-procedural QFR, reference vessel diameter, and percent diameter stenosis. AUCs of the nomogram were 0.866 (95%CI:0.818-0.914), 0.784 (95% CI:0.722-0.847), and 0.781 (95% CI:0.682-0.879) in the training, internal validation and external validation sets, respectively. Bias-corrected curves revealed a strong consistency between actual observations and prediction.

Conclusion: The risk of a suboptimal post-PCI QFR in patients after angiographically successful PCI can be effectively predicted using a nomogram incorporating five variables available pre-PCI, with its performance and clinical predictive value confirming its utility in helping clinicians with decision-making and planning revascularization.

Trial registration: Registered on clinicaltrial.gov (NCT04923191 and NCT05117866).

Myocarditis, characterized by inflammation of the myocardial tissue, presents substantial risks to cardiovascular functionality, potentially precipitating critical outcomes including heart failure and arrhythmias. This investigation primarily aims to identify the optimal cardiovascular magnetic resonance imaging (CMRI) views for distinguishing between normal and myocarditis cases, using deep learning (DL) methodologies. Analyzing CMRI data from a cohort of 269 individuals, with 231 confirmed myocarditis cases and 38 as control participants, we implemented an innovative DL framework to facilitate the automated detection of myocarditis. Our approach was divided into single-frame and multi-frame analyses to evaluate different views and types of acquisitions for optimal diagnostic accuracy. The results demonstrated a weighted accuracy of 96.9%, with the highest accuracy achieved using the late gadolinium enhancement (LGE) 2-chamber view, underscoring the potential of DL in distinguishing myocarditis from normal cases on CMRI data.

3DStent is a novel rotational angiography imaging capable of 3D reconstruction and measuring stent area and diameter, without need for intravascular imaging. To compare 3DStent and OCT-derived stent area and diameter after PCI. Patients with de novo coronary lesions who underwent treatment with a single DES and evaluated by OCT and 3DStent were included. Stent area and diameter were measured by 3DStent, at abluminal, mid and endoluminal side and by OCT. From September 2023 to February 2024 six coronary lesions were analyzed. Post-PCI stent area measured by OCT was (mean ± standard deviation) 7.03 ± 2.85 mm² and by 3DStent 9.41 ± 2.79 mm², 7.21 ± 2.23 mm² and 5.63 ± 1.83 mm² at abluminal, mid and endoluminal side, respectively. Stent diameter by OCT was 2.93 ± 0.58 mm, and by 3DStent 3.27 ± 0.50 mm, 2.86 ± 0.49 mm and 2.52 ± 0.45 mm at abluminal, mid and endoluminal side, respectively. Significant correlation was observed between OCT and 3DStent in relation to stent area (Exp(B) 3.35, mean of difference 0.19 ± 1.01 mm², 95%CI -1.80-2.17 mm², p < 0.001) and diameter (Exp(B) 3.18, mean difference - 0.07 ± 0.18 mm, 95%CI -0.43-0.30 mm, p < 0.001), particularly when 3DStent measurements performed at the mid side. Very high reproducibility was demonstrated by intra- and inter-observer analysis (r = 0.92 and r = 0.93 respectively). 3DStent appears to be an easy and reproducible tool to assess post-PCI stent area and diameter as compared to OCT.

Purpose: We aimed to evaluate an approach with resting echocardiography (TTE) and stress myocardial perfusion scintigraphy (MPS) compared to standard MPS in patients with stable angina and normal left ventricle (LV). We hypothesized that normal LV on TTE may allow for the elimination of rest MPS without compromising accuracy and offering an efficient diagnostic pathway with reduced radiation exposure.

Methods: In a prospective, non-randomized study TTE was performed prior to MPS in patients (pts) referred for assessment of coronary artery disease (CAD). In pts with normal LV assessment was performed using the hybrid and the standard approach. TTE and MPS were interpreted by two TTE readers (ER1-2) and two MPS readers (NR1-2). ECHO-MPS was compared with standard MPS for diagnostic accuracy.

Results: 103 patients, mean age 61 ± 12 year, (63 M, 40 W) were recruited. Standard MPS were normal in 75 patients and abnormal in 28 patients, with the hybrid approach 79 studies were reported as normal and 24 studies as abnormal. Kappa values were 0.580, (p < 0.001) for large, 0.394, (p < 0.001) for medium, and 0.298 (p = 0.002) for small defects. With standard MPS as a reference, sensitivity for detection of perfusion defects by ECHO-MPS was 75% (95% CI 0.67-0.83) [NR2] and 78% (95% CI 0.70-0.86)[NR1]. Specificity was 95% (95% CI 0.90-0.99) [NR2] and 95% (CI 95%CI 0.90-0.99) [NR1].

Conclusions: ECHO-MPS protocol provides similar diagnostic accuracy as standard stress-rest MPS. In patients with normal systolic LV function in TTE, performing only stress MPS provides similar information as standard rest and stress MPS.

Echocardiographic quantification of mitral regurgitation (MR) remains challenging, requiring dedicated image acquisition, and is limited by potential error from geometric assumptions of annular dimensions. Volume is a product of area and flow and assuming proportional mitral/aortic areas, an increased mitral-inflow volume compared to LV/RV-outflow semi-quantitatively represents greater MR regurgitant volume. Therefore, we investigated the feasibility and diagnostic performance of the mitral-aortic velocity-time integral(VTI) ratio in isolated MR. We also investigated the use of the mitral-pulmonary VTI ratio as an alternative in clinical situations where the LV outflow tract(LVOT) VTI could not be used. We reviewed 166 consecutive patients (33%, n = 54 severe MR by multi-parameter integrated expert opinion). Pulsed wave Doppler VTI at the mitral leaflet tips and the left ventricular outflow and continuous-wave Doppler of the RV outflow tract were measured individually and independently by blinded readers(expert and trainee status) to derive the ratio. Receiver operator characteristic area under the curve(AUC) comparison was calculated and compared with effective regurgitant orifice area(EROA > 40 mm), regurgitant volume(RVol > 60mL), vena contracta(VC > 0.7 cm), E-velocity > 1.2 cm, systolic flow reversal(SFR), left atrial and ventricular dilatation. Increasing ratio was associated with severe MR(AUC 0.94) with optimal threshold defined at 1.3. This provided significant discrimination for severe MR(AUC 0.81) compared to EROA(0.68), VC(0.52), LV dilatation(0.69), LA dilatation(0.70), SFR(0.73), E-velocity(0.68) all p < 0.05, with sensitivity 82% and specificity 94%. The mitral-pulmonary VTI ratio demonstrated similar discrimination(AUC 0.92) with optimal threshold defined at 1.14. Excellent inter-observer reproducibility(intra-class correlation 0.97) was seen between trainee and expert readers. There was no difference in AUC comparison by MR mechanism or patient rhythm. The mitral-aortic and mitral-pulmonary VTI ratios are simple, geometric-free parameters feasibly reproducible from routine echocardiographic datasets and are excellent discriminative tools for severe MR. Readers should consider integration of this parameter in routine reporting.

techniques of mitral valve repair has improved in the last decades. Percutaneous approach is now a reliable and safe therapy in those patients with high surgical risk. However, the presence of an implanted prothesis increases the risk of endocarditis. we describe a case of a 75-year-old man with medical history of recurrent cellulitis due to chronic lymphedema, who had percutaneous edge-to-edge mitral valve treatment. After three months he developed fever without any specific symptoms. Emocolture were positive for Staphilococcus lugdunensis. Transesophageal echocardiogram demonstrated a huge vegetation at the level of Edwards Pascal device. Patients was then referred to cardiac surgery for mitral valve replacement with bioprothesis. in patients needing a prothesis implantation the management and treatment of chronic infection is of paramount importance to reduce the risk of prothesis infection procedure. Endocarditis after percutaneous edge-to-edge mitral valve treatment represents a rare but a life-threatening condition.

Purpose: To compare the diagnostic efficacy of different relative myocardial blood flow (MBF) ratios in computed tomography perfusion (CTP) for myocardial ischemia in patients with obstructive coronary artery disease (CAD).

Methods: Between October 2020 and March 2024, patients with suspected or known obstructive CAD who underwent CTP + coronary computed tomography angiography and invasive coronary angiography/fractional flow reserve were retrospectively selected. Patients and vessels were categorized into ischemia and non-ischemia groups. The diagnostic efficacies of the three relative MBF ratios were compared in patients with obstructive CAD.

Results: This study included 48 patients (144 vessels). Notably, 34 of the 48 patients (70.83%) and 49 of the 144 vessels (34.03%) were considered to have myocardial ischemia. The area under the curve of Ratio-hi (0.944, 95% confidence interval: 0.893-0.976) was higher than those of Ratio-av, Ratio-Q3, and MBF-lowest; However, no statistical differences were found (P>0.005). The cutoff value for detecting Ratio-hi was 0.667, and the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 91.8%, 83.2%, 75%, 95.24%, and 86.81%, respectively.

Conclusion: Relative MBF ratios, especially Ratio-hi, demonstrated excellent performance and exhibited greater robustness in diagnosing myocardial ischemia in patients with obstructive CAD.