European heart journal. Imaging methods and practice最新文献

Aims: Multiple and mixed valvular heart disease (MMVD) are frequent situations in clinical practice. Despite a high prevalence, comprehensive insights into their clinical presentation, management strategies, impact of multimodality imaging, and outcomes are not well established, due to a lack of dedicated studies.

Methods and results: The 'EACVI-MMVD Study' will be a large prospective, multicentre, observational cohort study led by the Heart Imagers of Tomorrow of the European Association of Cardiovascular Imaging (EACVI). It will assess the proportion, management, and prognosis of MMVD over a 1-year period of follow-up. All consecutive patients diagnosed with MMVD using transthoracic echocardiography will be recruited over a 6-month recruitment period in 88 centres from 24 different countries. Baseline evaluation will be determined by physicians and encompass the whole spectrum of multimodality imaging including transthoracic and transoesophageal echocardiography, stress echocardiography, computed tomography, and cardiovascular magnetic resonance. Centres will have the opportunity to send cardiovascular imaging data for core laboratory analysis and to extend recruitment throughout a 5-year follow-up period.

Conclusion: The EACVI-MMVD study will be the largest international multicentre study evaluating the prevalence of MMVD in clinical routine and determining the impact of multimodality cardiovascular imaging in MMVD patients.Clinical Trial Registration: NCT06235385 URL: https://classic.clinicaltrials.gov/ct2/show/NCT06235385.

Aims: In the follow-up of patients with mitral regurgitation (MR), assessment of left ventricular (LV) dilatation using standard echocardiography often yields inconsistent results. We investigated whether measuring 3D LV end-systolic volume (3DLVESV) improves risk stratification in moderate or greater MR.

Methods and results: In the prospective 3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation (3D-PRIME) study, 227 patients -142 with primary (PMR) and 85 secondary MR (SMR)- underwent 2D/3D echocardiography. 3DLVESV was increased if ≥41.5/35 mL/m², and LV end-systolic diameter (LVESD) enlarged if ≥39.8/34.8 mm in men/women. The primary outcome was a composite of MR progression towards intervention, death, or heart failure hospitalization (HFH). Death or HFH was a secondary outcome.At baseline, 28% of PMR and 54% of SMR patients had increased 3DLVESV. After 21 (15-25) months, increased 3DLVESV was associated with 1.9-fold (1.2-3.2) higher adjusted risk of the primary outcome in PMR, and 4.1-fold (1.6-10.7) higher risk of death or HFH in SMR (P < 0.05). 3DLVESV and LVESD concordantly identified LV dilatation in 20% of PMR patients and were discordant in 27%. Both patients with increased 3DLVESV only, and those with increased both 3DLVESV and LVESD, had high risk of the primary outcome after adjusting for recommendations for intervention in PMR: HR 7.1 (2.9-16.9) and 4.9 (2.1-11.1), respectively (P < 0.001).

Conclusion: Increased 3DLVESV is associated with a higher risk of adverse events in patients with significant MR. In PMR, evaluating LV dilatation using both 3DLVESV and LVESD may enhance risk stratification and aid in patient selection for close follow-up.

Clinicaltrialsgov identifier: NCT04442828, 17 April 2020.

Aims: Cardiovascular magnetic resonance (CMR) strain imaging allows early detection of subclinical myocardial dysfunction and provides incremental diagnostic and prognostic information. Strain can be derived from dedicated sequences such as fast Strain-ENCoded imaging (fSENC) or from post-processing of cine images using feature tracking (FT) and tissue tracking (TT). However, it remains unclear whether strain values from different approaches are directly comparable, making the definition of universal reference values difficult. This study compared left ventricular (LV) strain assessed by FT, TT, and fSENC.

Methods and results: We studied 240 individuals (183 patients recovered from coronavirus disease 2019 [COVID-19] and 57 age- and sex-matched healthy controls), who underwent standardized CMR including cine imaging and fSENC. LV global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were analysed using FT and TT; fSENC provided GLS and GCS. Global strain values differed significantly between all methods (P < 0.001). Agreement between FT and TT was high for GLS (bias -0.8%, r = 0.77) and moderate for GCS (bias -1.2%, r = 0.63), but poor for GRS (bias -6.0%, r = 0.37). Compared with fSENC, GLS showed moderate agreement for FT (bias 2.3%, r = 0.57) and TT (bias 3.0%, r = 0.59), while agreement for GCS was weaker. All approaches demonstrated excellent reproducibility. Post-COVID-19 patients showed a consistent but mild reduction in GLS compared with controls across all techniques (all P < 0.05).

Conclusion: CMR strain imaging provides fast, reliable, and reproducible measurements. However, strain values are not directly interchangeable even between similar post-processing methods or when compared with dedicated sequences, highlighting the need for standardization and method-specific reference values.

Aims: Climate change poses a major threat to global health, with implications for cardiovascular disease. Cardiovascular imaging warrants attention due to its environmental footprint. Despite recognition of the need for climate-conscious healthcare, awareness and implementation of sustainable practices among cardiovascular imagers remain unclear. This study aims to assess current awareness, knowledge, and attitudes regarding climate change and sustainable cardiovascular imaging.

Methods and results: An anonymous 2-month online survey was disseminated via European Association of Cardiovascular Imaging newsletters, social media, and direct invitations. It explored: (i) general environmental consciousness, (ii) knowledge of climate-cardiovascular links, (iii) perceived barriers, strategies, incentives, and communication tools, and (iv) the survey's potential influence on practice. A total of 218 participants from 41 countries responded (51% female; 91% cardiologists; and 84% Europe). Only 11% had received formal education on climate or sustainable healthcare. Self -reported environmental consciousness was low in 12%, moderate in 65%, and high in 23%. While 90% acknowledged healthcare professionals' responsibility in addressing climate change, 60% rarely considered environmental impact when requesting imaging. Knowledge was limited: only 63% correctly answered ≥4 of 7 questions. Main barriers were the lack of awareness (47%) and institutional or medico-legal pressures encouraging frequent imaging (33%). Reducing unnecessary imaging and improving education were seen as the most effective strategies to address these barriers (50%). After completing the survey, 84% reported greater inclination to consider sustainable practice.

Conclusion: This international survey highlights a gap between environmental concern and its integration into cardiovascular imaging. Education, institutional support, and system-level strategies are needed to foster sustainable practice.

Aims: Clinical evaluation of congestion and perfusion in acute heart failure (AHF) has recognized limitations. Ultrasound tools such as the Venous Excess Ultrasound Score (VExUS) and the left ventricular outflow tract velocity-time integral (LVOT VTI) have gained increasing support for bedside haemodynamic profiling. We assessed the incremental prognostic value of a combined VTI-VExUS classification compared with standard clinical assessment.

Methods and results: We prospectively enrolled adults admitted with AHF. Within 24 h of presentation, VExUS (congestion) and LVOT VTI (perfusion) were assessed and integrated into four ultrasound-based profiles. The primary endpoint was a 30-day composite of all-cause mortality, cardiogenic shock, mechanical ventilation, short-term ventricular assist device use, and inotropic/vasopressor therapy. Among 167 patients (mean age 58.2 ± 13.4 years; 72% male), event rates increased across VTI-VExUS profiles (11.3%, 34.6%, 32.4%, and 69.2%, P < 0.001). Discrimination was superior for the VTI-VExUS model vs. clinical assessment alone (AUC 0.74 vs. 0.58, P = 0.0016). Integrated discrimination improvement confirmed the added prognostic contribution (IDI 0.157, P = 0.004). Ultrasound profiles were independently associated with outcomes.

Conclusion: VTI-VExUS ultrasound profiling provides significant incremental prognostic information beyond clinical assessment in AHF. These findings support its role as a complementary bedside tool for early risk stratification.

Aims: This European Association of Cardiovascular Imaging (EACVI) survey evaluated current practice patterns in the imaging assessment of tricuspid regurgitation (TR), focusing on conventional and advanced modalities, the adoption of recent classifications, and barriers to quantitative right heart assessment.

Methods and results: A 25-item online questionnaire was launched during EuroEcho Imaging 2024 and distributed via EACVI channels. From 10 December 2024 to 3 July 2025, 530 respondents from 69 countries participated. Most worked in tertiary/university hospitals (62%) and were imaging specialists (41%) or clinical cardiologists (40%). Transthoracic echocardiography (TTE) was almost universally applied (96%), while use of transoesophageal (TOE) and 3D echocardiography was variable. Tricuspid annular plane systolic excursion (TAPSE) and fractional area change (RVFAC) were frequently used, but RV strain and ejection fraction were underutilized due to time constraints and software unavailability. TR quantification relied mainly on colour Doppler-based parameters, with advanced approaches-3D colour Doppler, cardiac magnetic resonance (CMR)-reserved for selected patients. Half of the respondents routinely applied the 5-grade TR severity scheme, and leaflet-based anatomical classification was inconsistently adopted. Cardiac computed tomography, CMR, and invasive haemodynamics were more often used in patients referred for transcatheter interventions.

Conclusion: This EACVI survey highlights considerable heterogeneity in TR imaging practice, with increasing yet slow adoption of robust quantitative and advanced modalities for assessing TR severity and right heart morphology/function. These findings underscore the need for improved access to advanced imaging technologies and broader dissemination of contemporary standards to enhance the quality and consistency of TR imaging in clinical and research settings.

Aims: Quantifying mitral regurgitation (MR) in patients with mitral valve prolapse (MVP) is particularly challenging due to the complex mitral valve anatomy, presence of multiple eccentric jets, and non-holosystolic regurgitation. The continuity equation (CE) offers a potentially more accurate method for assessing MR regurgitant volume in this population.

Methods and results: We evaluated patients with MVP and at least moderate MR. Regurgitant volumes (RVol) were quantified using the three-dimensional continuity equation (3D-CE) with direct area measurements and compared with RVol derived from the conventional diameter-based continuity equation (D-CE) and cardiovascular magnetic resonance (CMR). Among 72 patients (mean age 59.7 years, 65% female), bileaflet MVP was present in 86% and MAD in 96%. Multiple MR jets (32%) limited PISA accuracy (r = 0.40 with CMR). Compared with 3D-CE, D-CE overestimated RVol by 19 mL, though correlation remained strong (r = 0.74). In 21 paired studies, 3D-CE and CMR showed excellent agreement (r = 0.94, bias +2.1 mL). Severity grading showed strong concordance, with most discrepancies within one category.

Conclusion: In patients with MVP, incorporating 3D annular measurements into 3D-CE improves agreement with CMR-based volumetric assessment and mitigates overestimation associated with D-CE and PISA-based methods. This approach may be particularly valuable in patients with moderate or moderate-severe MR, in whom conventional echocardiographic parameters are frequently discordant, and supports the role of integrative multimodality imaging in refining MR severity assessment and guiding clinical management. Larger prospective studies are warranted to confirm these findings.

Positron emission tomography (PET) is the most advanced myocardial perfusion (MPI) technique for the non-invasive assessment of coronary artery disease and its many manifestations, including ischaemia, hibernation, and scar. This comprehensive overview aims to empower clinicians, technicians, and patients with clear, structured knowledge on performing and interpreting PET MPI. This document will describe stress protocols, patient preparation, tracer pharmacodynamics and nuclear properties, camera capabilities, post-acquisition processing, and a comprehensive and clear reporting system for both perfusion and viability imaging.

Aims: Hypertension-mediated left ventricular hypertrophy (LVH) phenotypes: normal left ventricle (LV), LV remodelling, eccentric and concentric LVH have been reported using cardiac magnetic resonance (CMR). Although previous smaller studies have explored associations of these phenotypes with select CMR metrics, large population-based longitudinal data comparing their clinical trajectories are lacking. This study aimed to evaluate CMR characteristics across hypertension-mediated LVH phenotypes and their associations with incident cardiovascular outcomes.

Methods and results: In the UK Biobank imaging cohort, 24 463 hypertensives were categorized into LVH phenotypes using CMR. Logistic regression models explored the relationship between phenotypes, setting normal LV as the reference, and CMR parameters as exposures. Cox proportional hazard models evaluated associations with incident major adverse cardiovascular events (MACE) and separately heart failure over a median follow-up of 4.9 years. Among the participants, 23 206 had normal LV, 889 LV remodelling, 253 eccentric and 115 concentric LVH. Hypertensives with eccentric LVH had the most impaired LV function using ejection fraction and strain, and those with concentric LVH had the highest T1 values and maximal wall thickness. Hypertensives with eccentric LVH were associated with a 2.5 times higher rate of MACE (HR 2.5, CI: 1.7-3.8) and 9 times higher heart failure event rates (HR 9.0, CI: 5.7-14.2). Hypertensives with concentric LVH had 4.1 times higher heart failure events rates (HR 4.1, CI: 1.8-9.3), and no association with MACE.

Conclusion: In this large population study, we found distinct differences in CMR characteristics between hypertension-mediated LVH phenotypes with eccentric and concentric LVH exhibiting the worst prognosis.