European heart journal. Imaging methods and practice最新文献

Aims: Cardiovascular magnetic resonance imaging has become pivotal in the non-invasive assessment of the heart. Bright-blood sequences are used to retrieve information about cardiac anatomy and function. Concurrently, novel black-blood late gadolinium enhancement sequences have showcased potential for scar detection by uncovering scar patterns that may be confounded with blood. In the acute setting, T2 mapping allows for quantitative characterization of oedematous tissue. Nowadays, these images are acquired sequentially through multiple breath-holds, adding to the workload of medical professionals, reducing patient comfort, and hampering image analysis.Here, we assess the clinical value of SPOT-MAPPING, a sequence combining co-registered T2 mapping and joint black- and bright-blood imaging.

Methods and results: Twenty-six patients (27% women, age 64 ± 12yo) with acute, chronic, ischaemic, non-ischaemic, and overlapping cardiomyopathies, prospectively underwent SPOT-MAPPING at 1.5T. Conventional PSIR images and T2 maps served as the reference standard. Left ventricular (LV) mass, scar mass, burden, and transmurality and T2 values were retrieved and compared between sequences. Acquisition times were recorded. Acquisition time for SPOT-MAPPING was in average twice shorter than combined reference sequences (5 min 55 s [5 min 14 s-6 min 30 s] vs. 11 min 56 s [10 min 39s-12 min 12 s]). High reproducibility was obtained with reference sequences for LV mass (ICC ≥ 0.93). Strong agreement was observed with PSIR in scar extraction (mean bias: mass +2.3 g, burden +1.1%LV mass, transmurality +1.4%). No significant difference with reference T2 mapping was observed in remote (P = 1.000) and oedematous myocardium (P = 0.883).

Conclusion: SPOT-MAPPING demonstrated its efficacy in a wide range of patients, proving itself as a time-efficient and reproducible CMR method for the assessment of various cardiac diseases.

Aims: Structural abnormalities of the outflow graft (OG), such as kinking or external obstruction, are recognized as serious complications in patients with left ventricular assist devices (LVADs). Generally, these abnormalities can be evaluated by contrast-enhanced computed tomography (CT) or angiography; however, the utility of transthoracic echocardiography (TTE) remains unclear.

Methods and results: This single-centre retrospective study included adult patients with LVADs who underwent both TTE and contrast-enhanced CT between January 2015 and December 2022. TTE evaluation employed a standardized protocol using subcostal and right parasternal approaches. OG structural abnormalities were defined as bending of ≥90°, or stenosis of ≥50%. The diagnostic accuracy of TTE was assessed using CT as the reference standard. Of 90 patients with LVADs, 54 patients (62 examinations of both TTE and CT) met inclusion criteria. Among 62 examinations, OG structural abnormalities were identified in 18 examinations by CT (12 proximal, 7 distal, 1 both). TTE demonstrated a sensitivity of 61% and specificity of 100% overall. Sensitivity was 33% for proximal and 71% for distal abnormalities.

Conclusion: TTE is an accurate and non-invasive modality for detecting OG structural abnormalities, particularly in distal segment. However, its diagnostic performance for proximal OG lesions is limited, likely due to acoustic interference and anatomical constraints. Further refinement of imaging techniques may enhance the utility of TTE in LVAD management.

Aims: Cardiovascular magnetic resonance (CMR) imaging is a key modality for characterizing heart diseases, but is limited in assessing diastolic dysfunction (DD). 4D flow CMR now enables transvalvular blood flow quantification, while biventricular tissue relaxation can be quantified through annular tissue velocity and strain on standard cine images. This study investigated the utility of 4D-CMR-derived E/e' in evaluating biventricular diastolic function. Secondary aims included comparison with echocardiography to establish 4D-E/e' cutoffs for detecting unknown DD.

Methods and results: Diastolic transvalvular flow (4D-E) was quantified from 4D flow in 75 controls and 57 patients with cardiovascular disease. Tissue velocity (e') was assessed using cine-derived mitral/tricuspid annular velocity, longitudinal strain rate (e'_FT-SR), and strain velocity (e'_FT-vel). Biventricular 4D-E/e' was feasible across all e' methods, and significantly higher in patients than controls (P < 0.05). The patients were split into two subgroups: one with echocardiographic graded DD to derive CMR cutoffs, and a second with unassessed diastolic function. 4D-E/e' using annular velocity best distinguished patients with echocardiography-confirmed DD in the left (AUC = 0.90 ± 0.05, P < 0.01) and right heart (AUC = 0.81 ± 0.07, P < 0.01). Among patients without a diastolic assessment, 71% were identified with abnormal left ventricular diastolic function and 61% with abnormal right ventricular diastolic function when stratified against the lower 4D-E/e' cutoffs.

Conclusion: 4D-E/e', integrating transvalvular flow and tissue velocity, is feasible for biventricular diastolic function assessment. CMR identified previously unrecognized biventricular diastolic abnormalities in patients with cardiovascular disease, suggesting 4D-E/e' may be a valuable tool for early detection and referral for further diastolic testing.

Aims: Myocardial response to exercise and its differences between heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) remain incompletely understood. Myocardial work (MyW) enables a non-invasive assessment of left ventricular performance under physiological stress. We investigated exercise-induced MyW responses in patients with chronic heart failure and healthy controls.

Methods and results: MyStress Pilot study enrolled 24 individuals (12 chronic heart failure patients (6 HFrEF, 6 HFpEF) and 12 healthy controls), aged 40-80 years, who underwent semi-supine exercise stress echocardiography (ESE) using a standardized protocol up to 75 Watt. MyW indices (global work index [GWI], global constructive work [GCW], global wasted work [GWW], global work efficiency [GWE]) were derived using pressure-strain analysis. Linear mixed-effects models assessed workload-dependent changes.Patients with HFrEF and HFpEF were older and achieved lower peak workloads than controls. At rest, GCW was reduced in HFrEF, while GWW was elevated in both heart failure groups. During exercise, controls demonstrated substantial increases in GCW and GWI. In contrast, HFrEF patients exhibited little or no augmentation of GCW and GWI, indicating absent contractile reserve, whereas HFpEF patients showed a blunted increase in GCW accompanied by an abnormal increase in GWW. These differences persisted despite similar systolic blood pressure trajectories across groups, indicating that altered MyW responses were not simply due to afterload. Diastolic parameters increased steeply in HFpEF, unmasking impaired diastolic reserve.

Conclusion: MyW analysis during ESE revealed distinct systolic and diastolic response patterns in heart failure phenotypes and controls. These findings illustrate how pressure-strain analysis can enrich ESE beyond conventional metrics.

Aims: People with HIV (PWH) and undetectable virus experience elevated cardiovascular risk independent of traditional risk factors. Vascular inflammation may contribute to this residual risk. The perivascular fat attenuation index (FAI), derived from coronary computed tomography angiography (CCTA), is a biomarker of coronary inflammation. Lipoprotein(a) [Lp(a)] carries oxidized phospholipids that may promote inflammation. Statins have demonstrated cardiovascular benefit in PWH, including pleiotropic anti-inflammatory effects. This study assessed the associations of Lp(a) and of statin use with coronary inflammation (FAI) in men with HIV (MWH).

Methods and results: We analysed FAI of the left anterior descending (LAD) and the right coronary arteries (RCA) in 583 men from the Multicenter AIDS Cohort Study, a prospective, multicentre cohort study, including 280 with undetectable HIV RNA, <50 copies/ml. Associations between log₁₀[Lp(a)] and LAD and RCA FAI were assessed using linear regression, adjusting for demographic and cardiovascular risk factors. Log₁₀[Lp(a)] was associated with LAD FAI in MWH with undetectable HIV in adjusted analysis [+1.99 HU (0.38, 3.59); P = 0.02] but not among men without HIV (MWoH) or MWH with detectable HIV. Associations with RCA FAI were only significant in the unadjusted analysis. Statin use was associated with lower FAI, less inflammation in the LAD in MWH with undetectable virus, but did not modify the association between Lp(a) and coronary inflammation.

Conclusion: Lp(a) was associated with increased coronary inflammation, independent of traditional cardiovascular risk factors, in MWH with undetectable virus. Statin therapy did not modify the relationship between coronary inflammation and Lp(a).

Aims: To investigate, using artificial intelligence (AI), the relationships between ultrasound (US)-defined systemic congestion and demographic, echocardiographic, and biohumoral parameters across the heart failure (HF) spectrum.

Methods and results: A total of 1588 subjects (651 Stage A-B, 376 HF with reduced left ventricular ejection fraction [HFrEF, <50%], and 561 HF with preserved ejection fraction [HFpEF, ≥50%]) underwent comprehensive clinical evaluation, laboratory testing, echocardiography, and US assessment of congestion, including inferior vena cava (IVC), lung ultrasound (LUS), renal venous flow (RVF), portal venous flow (PVF), and hepatic venous flow (HVF). Assessment of IVC, LUS, and RVF was available in the entire cohort, whereas HVF and PVF were performed in 359 and 289 patients, respectively. Overall, 856 patients had no US signs of congestion, 458 had one US sign, and 274 had ≥2 US signs (multi-organ congestion). AI-based predictive models were developed for each site of congestion and for multi-organ congestion using a 3-item model (IVC, LUS, RVF). Congestion-related features clustered into four domains: medical history, biohumoral variables, left heart morphology and function, and right heart and pulmonary circulation. The 3-item model identified mitral annular systolic velocity, systolic and diastolic pulmonary artery pressure, triglycerides, left atrial volume index, diabetes, and treatment with furosemide or angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers as key predictors of multi-organ congestion (area under the curve = 0.79).

Conclusion: AI-assisted integration of multi-organ US characterizes congestion as a multidimensional phenotype beyond conventional clinical assessment and biomarkers across the HF spectrum.

Aims: Transthyretin cardiac amyloidosis (ATTR CA) is a progressive disease arising from the deposition of amyloid fibrils in the myocardium. Cardiac magnetic resonance (CMR) tissue characterization imaging, including myocardial extracellular volume (ECV) fraction, is used to detect amyloid infiltration, but the identification of early-stage disease is challenging. We sought to describe the phenotype of low burden ATTR CA on CMR and identify imaging features that allow differentiation from potential disease mimickers.

Methods and results: Eighty-three patients with ATTR CA and prior contrast-enhanced CMR were stratified by quartiles of ECV into low (ECV ≤43%) or higher (ECV >43%) burden groups. Global and regional function and myocardial tissue characterization were used to phenotype disease. Receiver operating characteristic analysis was performed to assess the diagnostic performance of CMR for distinguishing low burden ATTR CA from hypertensive heart disease (HHD) and mild hypertrophic cardiomyopathy (HCM). Among 22 patients with low ECV burden, CMR measures of amyloid infiltration predominantly affected the basal left ventricular (LV) segments with progressive involvement of the mid and apical regions at higher ECV. Global myocardial late gadolinium enhancement (LGE) and ECV showed high accuracy for differentiating low burden ATTR CA from HHD and mild HCM, area under the curve (AUC) of 0.99 and 0.97, respectively, compared to strain-based measures, AUC 0.47-0.82.

Conclusion: Tissue characterization imaging (myocardial ECV and LV LGE) can be used to distinguish low burden ATTR from potential disease mimickers and appears to outperform traditional strain-based measures.

Aims: Cardiac computed tomography-derived extracellular volume (CCT-ECV) is a promising biomarker for non-invasive quantification of myocardial fibrosis. However, serum haematocrit (Hct) is required for accurate CCT-ECV calculation, posing a potential barrier to clinical implementation. This study aims to develop a method for predicting synthetic Hct to derive accurate ECV values without blood testing and investigate the impact of clinical factors on model performance.

Methods and results: A total of 108 patients [70% male, body mass index (BMI) 27.2 (7.4) kg/m², age 81.9 (8.6) years] undergoing CCT prior to clinically indicated transcatheter aortic valve implantation for severe aortic stenosis were recruited. A non-contrast baseline scan, electrocardiogram (ECG)-gated CT angiography, and a late iodine-enhanced scan were performed on the same day as blood tests for serum Hct and used to compute voxel-wise ECV in the left ventricle. A univariable linear regression model was developed to predict Hct from Hounsfield units at the centre of the blood pool, outperforming previous models in literature. Sex stratification improved accuracy, with a significant difference in models for men at a BMI threshold of 30.7 (P = 0.035). In females, restricting to BMI > 22.4 improved performance. Age, estimated glomerular filtration rate, and creatinine did not improve predictions. The final model with combined sex and BMI stratification demonstrated better performance (ECV Pearson R 0.89, P < 0.001) than univariable and literature models.

Conclusion: This study highlights the necessity for sex-specific models to estimate Hct and accurately estimate ECV from CCT. Sex-specific BMI stratification further improves predictions; however, more research is required for females with a low or very high BMI.