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How to address the coronaries in TAVI candidates: can the need for revascularization be safely determined by CT angiography only? 如何处理 TAVI 候选者的冠状动脉:仅通过 CT 血管造影能否安全地确定是否需要进行血管再通术?
Pub Date : 2024-10-28 eCollection Date: 2024-04-01 DOI: 10.1093/ehjimp/qyae096
Katharina Theresa Julia Mascherbauer, Gudrun Lamm, Andreas Anselm Kammerlander, Maximilian Will, Christian Nitsche, Roya Anahita Mousavi, Caglayan Demirel, Philipp Emanuel Bartko, Konstantin Schwarz, Christian Hengstenberg, Julia Mascherbauer

Coronary artery disease (CAD) remains one of the most frequent comorbidities among transcatheter aortic valve implantation (TAVI) candidates. Whether routine assessment of CAD by invasive coronary angiography (CA) and eventual peri-procedural percutaneous coronary intervention (PCI) is generally beneficial in TAVI patients has recently been heavily questioned. CA carries significant risks, such as kidney injury, bleeding, and prolonged hospital stay, and may frequently be unnecessary if significant stenoses of the proximal coronary segments can be ruled out on computed tomography angiography. Moreover, the benefits of pre-emptive coronary revascularization at the time of TAVI are not well defined. Despite these facts and weak guideline recommendations, CA and eventual PCI of stable significant coronary lesions at the time of TAVI remain common practice. However, ongoing randomized trials currently challenge the efficacy of such strategies to enable a more streamlined, individualized, and resource-sparing treatment with TAVI.

冠状动脉疾病(CAD)仍然是经导管主动脉瓣植入术(TAVI)患者最常见的合并症之一。通过有创冠状动脉造影术(CA)对冠状动脉疾病进行常规评估并最终进行围手术期经皮冠状动脉介入治疗(PCI)是否对经导管主动脉瓣植入术(TAVI)患者有普遍益处,近来备受质疑。冠状动脉造影有很大的风险,如肾损伤、出血和住院时间延长,而且如果通过计算机断层扫描血管造影可以排除冠状动脉近端明显狭窄,那么冠状动脉造影往往是不必要的。此外,在进行 TAVI 时预先进行冠状动脉血运重建的益处尚未明确。尽管存在这些事实,且指南建议不充分,但在进行 TAVI 时对稳定的重要冠状动脉病变进行 CA 和最终 PCI 仍是常见的做法。然而,目前正在进行的随机试验对这些策略的疗效提出了质疑,这些策略可使 TAVI 治疗更加简化、个体化和节省资源。
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引用次数: 0
Feasibility validation of automatic diagnosis of mitral valve prolapse from multi-view echocardiographic sequences based on deep neural network. 基于深度神经网络从多视角超声心动图序列自动诊断二尖瓣脱垂的可行性验证。
Pub Date : 2024-10-28 eCollection Date: 2024-10-01 DOI: 10.1093/ehjimp/qyae086
Zijian Wu, Zhenyi Ge, Zhengdan Ge, Yumeng Xing, Weipeng Zhao, Lili Dong, Yongshi Wang, Dehong Kong, Chunqiang Hu, Yixiu Liang, Haiyan Chen, Wufeng Xue, Cuizhen Pan, Dong Ni, Xianhong Shu

Aims: To address the limitations of traditional diagnostic methods for mitral valve prolapse (MVP), specifically fibroelastic deficiency (FED) and Barlow's disease (BD), by introducing an automated diagnostic approach utilizing multi-view echocardiographic sequences and deep learning.

Methods and results: An echocardiographic data set, collected from Zhongshan Hospital, Fudan University, containing apical 2 chambers (A2C), apical 3 chambers (A3C), and apical 4 chambers (A4C) views, was employed to train the deep learning models. We separately trained view-specific and view-agnostic deep neural network models, which were denoted as MVP-VS and MVP view-agonistic (VA), for MVP diagnosis. Diagnostic accuracy, precision, sensitivity, F1-score, and specificity were evaluated for both BD and FED phenotypes. MVP-VS demonstrated an overall diagnostic accuracy of 0.94 for MVP. In the context of BD diagnosis, precision, sensitivity, F1-score, and specificity were 0.83, 1.00, 0.90, and 0.92, respectively. For FED diagnosis, the metrics were 1.00, 0.83, 0.91, and 1.00. MVP-VA exhibited an overall accuracy of 0.95, with BD-specific metrics of 0.85, 1.00, 0.92, and 0.94 and FED-specific metrics of 1.00, 0.83, 0.91, and 1.00. In particular, the MVP-VA model using mixed views for training demonstrated efficient diagnostic performance, eliminating the need for repeated development of MVP-VS models and improving the efficiency of the clinical pipeline by using arbitrary views in the deep learning model.

Conclusion: This study pioneers the integration of artificial intelligence into MVP diagnosis and demonstrates the effectiveness of deep neural networks in overcoming the challenges of traditional diagnostic methods. The efficiency and accuracy of the proposed automated approach suggest its potential for clinical applications in the diagnosis of valvular heart disease.

目的:通过引入一种利用多视角超声心动图序列和深度学习的自动诊断方法,解决二尖瓣脱垂(MVP)传统诊断方法的局限性,特别是纤维弹性不足(FED)和巴洛氏病(BD):我们利用从复旦大学附属中山医院收集的超声心动图数据集来训练深度学习模型,该数据集包含心尖2腔(A2C)、心尖3腔(A3C)和心尖4腔(A4C)视图。我们分别训练了特定视图和视图拮抗深度神经网络模型,并将其命名为 MVP-VS 和 MVP 视图拮抗(VA),用于 MVP 诊断。对 BD 和 FED 表型的诊断准确度、精确度、灵敏度、F1-分数和特异性进行了评估。MVP-VS 对 MVP 的总体诊断准确率为 0.94。在 BD 诊断方面,精确度、灵敏度、F1-分数和特异性分别为 0.83、1.00、0.90 和 0.92。对于 FED 诊断,这些指标分别为 1.00、0.83、0.91 和 1.00。MVP-VA 的总体准确率为 0.95,BD 特定指标分别为 0.85、1.00、0.92 和 0.94,FED 特定指标分别为 1.00、0.83、0.91 和 1.00。特别是,使用混合视图训练的 MVP-VA 模型表现出了高效的诊断性能,无需重复开发 MVP-VS 模型,并通过在深度学习模型中使用任意视图提高了临床流水线的效率:本研究开创性地将人工智能整合到 MVP 诊断中,并证明了深度神经网络在克服传统诊断方法挑战方面的有效性。所提出的自动化方法的效率和准确性表明其在瓣膜性心脏病诊断中的临床应用潜力。
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引用次数: 0
Deep learning improves test-retest reproducibility of regional strain in echocardiography. 深度学习提高了超声心动图区域应变的测试-复验再现性。
Pub Date : 2024-10-23 eCollection Date: 2024-10-01 DOI: 10.1093/ehjimp/qyae092
John Nyberg, Andreas Østvik, Ivar M Salte, Sindre Olaisen, Sigve Karlsen, Thomas Dahlslett, Erik Smistad, Torfinn Eriksen-Volnes, Harald Brunvand, Thor Edvardsen, Kristina H Haugaa, Lasse Lovstakken, Havard Dalen, Bjørnar Grenne

Aims: The clinical utility of regional strain measurements in echocardiography is challenged by suboptimal reproducibility. In this study, we aimed to evaluate the test-retest reproducibility of regional longitudinal strain (RLS) per coronary artery perfusion territory (RLSTerritory) and basal-to-apical level of the left ventricle (RLSLevel), measured by a novel fully automated deep learning (DL) method based on point tracking.

Methods and results: We measured strain in a dual-centre test-retest data set that included 40 controls and 40 patients with suspected non-ST elevation acute coronary syndrome. Two consecutive echocardiograms per subject were recorded by different operators. The reproducibility of RLSTerritory and RLSLevel measured by the DL method and by three experienced observers using semi-automatic software (2D Strain, EchoPAC, GE HealthCare) was evaluated as minimal detectable change (MDC). The DL method had MDC for RLSTerritory and RLSLevel ranging from 3.6 to 4.3%, corresponding to a 33-35% improved reproducibility compared with the inter- and intraobserver scenarios (MDC 5.5-6.4% and 4.9-5.4%). Furthermore, the DL method had a lower variance of test-retest differences for both RLSTerritory and RLSLevel compared with inter- and intraobserver scenarios (all P < 0.001). Bland-Altman analyses demonstrated superior reproducibility by the DL method for the whole range of strain values compared with the best observer scenarios. The feasibility of the DL method was 93% and measurement time was only 1 s per echocardiogram.

Conclusion: The novel DL method provided fully automated measurements of RLS, with improved test-retest reproducibility compared with semi-automatic measurements by experienced observers. RLS measured by the DL method has the potential to advance patient care through a more detailed, more efficient, and less user-dependent clinical assessment of myocardial function.

目的:超声心动图中区域应变测量的临床实用性受到重复性不佳的挑战。在这项研究中,我们旨在评估基于点跟踪的新型全自动深度学习(DL)方法测量的每个冠状动脉灌注区域(RLSTerritory)和左心室基底至心尖水平(RLSLevel)的区域纵向应变(RLS)的测试-重测可重复性:我们在双中心测试-重测数据集中测量了应变,其中包括 40 名对照组和 40 名疑似非 ST 段抬高急性冠状动脉综合征患者。每个受试者由不同的操作员记录两张连续的超声心动图。通过 DL 方法和三位经验丰富的观察者使用半自动软件(2D Strain,EchoPAC,GE HealthCare)测量的 RLSTerritory 和 RLSLevel 的重现性以最小可检测变化(MDC)进行评估。DL 方法的 RLSTerritory 和 RLSLevel 的 MDC 为 3.6% 至 4.3%,与观察者之间和观察者内部的情况(MDC 为 5.5-6.4% 和 4.9-5.4%)相比,可重复性提高了 33-35%。此外,与观察者间和观察者内方案相比,DL 方法在 RLSTerritory 和 RLSLevel 方面的测试-重测差异方差较小(所有 P < 0.001)。Bland-Altman分析表明,与最佳观察者方案相比,DL方法在整个应变值范围内的重现性更优。DL 方法的可行性为 93%,每张超声心动图的测量时间仅为 1 秒:结论:新颖的 DL 方法可对 RLS 进行全自动测量,与经验丰富的观察者进行的半自动测量相比,其测试重复性更高。通过 DL 方法测量的 RLS 可对心肌功能进行更详细、更高效、对用户依赖性更低的临床评估,从而提高对患者的护理水平。
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引用次数: 0
HoloPatch: improving intracardiac patch fit through holographically modelled templates. HoloPatch:通过全息建模模板改善心内补片贴合。
Pub Date : 2024-10-10 eCollection Date: 2024-07-01 DOI: 10.1093/ehjimp/qyae103
Matthias Lippert, Gabriella d' Albenzio, Kathrine Rydén Suther, Karl-Andreas Dumont, Rafael Palomar, Hans Henrik Odland, Ole Jakob Elle, Bjørn Bendz, Henrik Brun

Aims: Structural heart defects, including congenital ventricular septal defect closure or intracardiac rerouting, frequently require surgical reconstruction using hand-cut patch materials. Digitally modelled patch templates may improve patch fit and reduce outflow tract obstruction, residual defect risk, and conduction system damage. In this study, we benchmarked mixed-reality and a desktop application against a digitalized model of a real implanted patch.

Methods and results: Ten patients scheduled for the repair of various defects consented to prospective inclusion in the study. After surgery, a digital model of the implanted patch was created from the residual material. Five clinical experts created 10 digital patches, 1 per patient, both in mixed-reality and desktop application, for comparison with the reference measurements, including the digitalized model of the real patch used during the surgery. Subjective residual shunt risk prediction was performed using both modalities. Digital patches created in mixed-reality closely matched the surgical material, whereas those created using desktop applications were significantly smaller. Different evaluators showed varying preferences for the application of the residual shunt risk and area.

Conclusion: Digitally created patches can assist surgeons in preoperatively sizing of patch implants, potentially reducing post-operative complications.

目的:结构性心脏缺损,包括先天性室间隔缺损闭合或心脏内改道,经常需要使用手工切割的补片材料进行手术重建。数字模拟补片模板可改善补片贴合度,减少流出道阻塞、残余缺损风险和传导系统损伤。在这项研究中,我们以真实植入补片的数字化模型为基准,对混合现实和桌面应用程序进行了评估:十名计划修复各种缺损的患者同意加入本研究。手术后,根据残留材料创建了植入补片的数字化模型。五位临床专家在混合现实和桌面应用程序中创建了 10 个数字补片(每位患者 1 个),以便与参考测量值(包括手术中使用的真实补片的数字化模型)进行比较。主观残余分流风险预测使用两种模式进行。在混合现实中创建的数字补片与手术材料非常匹配,而使用桌面应用程序创建的补片则明显较小。不同的评估者对残余分流风险和面积的应用有不同的偏好:结论:数字创建的补片可以帮助外科医生在术前确定补片植入物的大小,从而减少术后并发症。
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引用次数: 0
Issue at a glance. 议题一览。
Pub Date : 2024-10-07 eCollection Date: 2024-04-01 DOI: 10.1093/ehjimp/qyae090
Oliver Gaemperli
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引用次数: 0
Automated computed tomography-derived fractional flow reserve model for diagnosing haemodynamically significant coronary artery disease: a prospective validation study. 用于诊断血流动力学显著性冠状动脉疾病的自动计算机断层扫描衍生分数血流储备模型:一项前瞻性验证研究。
Pub Date : 2024-09-30 eCollection Date: 2024-07-01 DOI: 10.1093/ehjimp/qyae102
Anders T Bråten, Fredrik E Fossan, Lucas O Muller, Arve Jørgensen, Knut H Stensæth, Leif R Hellevik, Rune Wiseth

Aims: This study aims to assess the diagnostic performance of a novel computed tomography-derived fractional flow reserve (CT-FFR) algorithm and to compare its accuracy at three predefined sites: (i) at the location of invasive FFR measurements (CT-FFRatloc), (ii) at selected sites determined by an automated module integrated within the algorithm (CT-FFRauto), and (iii) distally in the vessel (CT-FFRdistal).

Methods and results: We prospectively recruited 108 consecutive patients with stable symptoms of coronary artery disease and at least one suspected obstructive lesion on coronary computed tomography angiography (CCTA). CT-FFR was validated against invasive FFR as gold standard using FFR ≤ 0.80 to define myocardial ischaemia. CT-FFRatloc showed good correlation with invasive FFR (r = 0.67) and improved the ability to detect myocardial ischaemia compared with CCTA at both lesion [area under the curve (AUC) 0.83 vs. 0.65, P < 0.001] and patient level (AUC 0.87 vs. 0.74, P = 0.007). CT-FFRauto demonstrated similar diagnostic accuracy to CT-FFRatloc and significantly improved specificity compared with CT-FFRdistal (86% vs. 49%, P < 0.001). High end CT quality improved the diagnostic performance of CT-FFRauto, demonstrating an AUC of 0.92; similarly, the performance was improved in patients with low-to-intermediate coronary artery calcium score with an AUC of 0.88.

Conclusion: Implementing an automated module to determine the site of CT-FFR evaluations was feasible, and CT-FFRauto demonstrated comparable diagnostic accuracy to CT-FFRatloc when assessed against invasive FFR. Both CT-FFRatloc and CT-FFRauto improved the diagnostic performance compared with CCTA and improved specificity compared with CT-FFRdistal. High end CT quality and low-to-intermediate calcium burden improved the diagnostic performance of our algorithm.

Clinicaltrialsgov identifier: NCT03045601.

目的:本研究旨在评估一种新型计算机断层扫描衍生分数血流储备(CT-FFR)算法的诊断性能,并比较其在三个预定位点的准确性:(i) 有创 FFR 测量位置(CT-FFRatloc),(ii) 由集成在算法中的自动模块确定的选定位点(CT-FFRauto),(iii) 血管远端(CT-FFRdistal):我们前瞻性地招募了 108 名冠状动脉疾病症状稳定、冠状动脉计算机断层扫描血管造影术(CCTA)至少有一处疑似阻塞性病变的连续患者。CT-FFR 与作为金标准的有创 FFR 进行了验证,用 FFR ≤ 0.80 来定义心肌缺血。CT-FFRatloc 与有创 FFR 显示出良好的相关性(r = 0.67),与 CCTA 相比,在病变[曲线下面积 (AUC) 0.83 vs. 0.65,P < 0.001]和患者水平(AUC 0.87 vs. 0.74,P = 0.007)上都提高了检测心肌缺血的能力。CT-FFRauto 的诊断准确性与 CT-FFRatloc 相似,特异性则比 CT-FFRdistal 明显提高(86% 对 49%,P<0.001)。高端 CT 质量提高了 CT-FFRauto 的诊断性能,其 AUC 为 0.92;同样,中低端冠状动脉钙化评分患者的 CT-FFRauto 诊断性能也有所提高,其 AUC 为 0.88:采用自动模块确定 CT-FFR 评估部位是可行的,而且 CT-FFRauto 与 CT-FFRatloc 相比,诊断准确性相当。与CCTA相比,CT-FFRatloc和CT-FFRauto都提高了诊断性能,与CT-FFRdistal相比,特异性更高。高端 CT 质量和中低钙负荷提高了我们算法的诊断性能:NCT03045601。
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引用次数: 0
Concurrent coronary and extra-coronary spontaneous artery dissection in Ehlers-Danlos syndrome: multimodal imaging insights. 埃勒斯-丹洛斯综合征并发冠状动脉和冠状动脉外自发动脉夹层:多模态成像的启示。
Pub Date : 2024-09-28 eCollection Date: 2024-07-01 DOI: 10.1093/ehjimp/qyae101
Marta Zielonka, Tania Ramírez-Martínez, Ramon Bascompte Claret, Isabel Hernández-Martín, Kristian Rivera
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引用次数: 0
Correction to: Intravital imaging of cardiac tissue utilizing tissue-stabilized heart window chamber in live animal model. 更正:在活体动物模型中利用组织稳定的心脏窗腔对心脏组织进行轨道内成像。
Pub Date : 2024-09-24 eCollection Date: 2024-07-01 DOI: 10.1093/ehjimp/qyae095

[This corrects the article DOI: 10.1093/ehjimp/qyae062.].

[This corrects the article DOI: 10.1093/ehjimp/qyae062.].
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引用次数: 0
Less is more: X-ray-TEE fusion with a new mini probe. 少即是多:使用新型微型探头进行 X 射线-TEE 融合。
Pub Date : 2024-09-24 eCollection Date: 2024-07-01 DOI: 10.1093/ehjimp/qyae088
Covadonga Fernández-Golfín, Ana García-Martín, Irene Carrión, Luisa Salido Tahoces, Jose Luis Zamorano
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引用次数: 0
Can artificial intelligence-derived coronary atherosclerotic characteristics using CCTA/CACS predict the future onset of atrial fibrillation? 利用 CCTA/CACS 获得的人工智能冠状动脉粥样硬化特征能否预测心房颤动的未来发病?
Pub Date : 2024-09-23 eCollection Date: 2024-07-01 DOI: 10.1093/ehjimp/qyae098
Andrew Chiou, Melody Hermel, Christina Rodriguez Ruiz, Alexander van Rosendael, Tim Burton, Francesca Calicchio, Samantha Bagsic, Eric Hu, Elizabeth Epstein, Casey Joye, Shawn Newlander, Michael Salerno, Sanjeev P Bhavnani, Austin Robinson, Jorge Gonzalez, George E Wesbey
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引用次数: 0
期刊
European heart journal. Imaging methods and practice
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