European heart journal. Imaging methods and practice最新文献

Aims: Positron emission tomography (PET) perfusion with ¹⁵O-water is the reference standard for myocardial blood flow (MBF) quantification. Its strengths are low radiation dose, optimal tracer kinetics, and a short imaging protocol. However, the use of ¹⁵O-water or PET perfusion in patients with various complex congenital heart diseases has been rarely studied. We report the initial experiences of ¹⁵O-water PET perfusion in these patients.

Methods and results: All ¹⁵O-water scans from patients with complex congenital heart disease at Helsinki University Hospital were retrospectively assessed (11/2021-11/2025). Thirteen congenital heart disease patients who underwent adenosine-stress ¹⁵O-water PET were identified. Most common diagnoses were transposition of the great arteries (5/13, 38%), Tetralogy of Fallot (3/13, 23%), and univentricular heart (3/13, 23%). PET perfusion was diagnostic in all cases with no adverse effects reported. The radiation dose for stress protocol was 0.3 mSv for paediatric and 0.6 mSv for adult patients, and double when rest perfusion was also obtained to calculate myocardial flow reserve. The global stress MBF was normal (>2.3 mL/g/min) in 12/13 patients. Eleven patients (85%) had anatomical coronary imaging available, all without significant stenoses. One patient had an apical transmural scar on cardiac magnetic resonance imaging, and both stress and rest ¹⁵O-water PET perfusion was decreased.

Conclusion: ¹⁵O-water PET offers a feasible and safe ultra-low-dose approach to quantify myocardial perfusion in complex congenital heart disease and may help identify flow-limiting disease when CT anatomy alone is inconclusive.

Aims: Atrial myopathy encompasses structural, functional, electrical, and metabolic changes in the atrial myocardium. While remodelling such as left atrial (LA) dilation and reduced strain are well documented, metabolic alterations remain underexplored. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) provides a non-invasive tool to assess myocardial glucose metabolism. This study evaluates the relationship between atrial FDG avidity and LA remodelling in patients undergoing cardiac imaging for suspected cardiac sarcoidosis (CS).

Methods and results: We studied 120 patients who underwent both cardiac MRI and FDG-PET/CT at the University of Washington Medical Center. LA structural volume index (LAVi) and functional emptying fraction (LAEF), average long-axis strain, and phasic strain indices were derived from cine MRI using feature tracking. Atrial FDG avidity was quantified by SUVmax and atrial target-to-background ratio (aTBR) from PET/CT. LA average long axis strain was 37.1 ± 34.0%, LAEF 47.6 ± 16.1%, and LAVi 36.0 ± 23.0%. Atrial avidity was 2.4 ± 0.7 SUV. LA strain negatively and mildy correlated with both SUVmax (R = -0.44; P < 0.001) and moderately with aTBR (R = -0.53; P < 0.001), while LAVi positively and mildly correlated with both (R = 0.40 and R = 0.52, respectively; P < 0.001). These associations persisted after adjusting for age, gender, diabetes, CS, history of AF, HR, and pre-PET scan rhythm status. AF patients exhibited reduced LA strain and higher FDG avidity.

Conclusion: Increased atrial FDG avidity is independently associated with impaired strain and enlarged LA, highlighting a metabolic component of atrial myopathy that may precede clinical AF.

Aims: Myocardial vascular remodeling is a key feature in various diseases associated with right ventricular (RV) pressure overload but its non-invasive assessment remains challenging. The new technique attenuation-compensated fractional moving blood volume (acFMBV) based on ultrafast power Doppler (UPD) was developed for myocardial blood volume quantification, linked to RV remodeling and capillary density, but not validated in vivo.

Objectives: To quantify RV myocardial blood volume across the cardiac cycle using UPD in rodent models, with histopathological validation, and assess its feasibility in human patients.

Methods and results: Twelve rats (sex ratio 1/1) were randomized to pulmonary artery banding (PAB) (n = 6) or sham controls (n = 6). After 6 weeks, UPD-derived acFMBV was measured in the RV lateral wall, representing myocardial blood volume. Capillary density was quantified via CD31 immunostaining, and its correlation with mid-diastolic acFMBV was evaluated. UPD was also applied in seven healthy human volunteers and seven age-matched patients with RV pressure overload. Mid-diastolic acFMBV in PAB rats was significantly lower than in controls (5.3% ± 0.9% vs. 7.8% ± 1.2%, P < 0.05), correlating with reduced capillary density (r = 0.78, P < 0.01). In humans, mid-diastolic acFMBV was also lower in RV pressure overload patients compared with healthy volunteers (4.8% ± 0.7% vs. 3.1% ± 2.3%, respectively, P = 0.03).

Conclusion: In this pilot study, UPD-based acFMBV correlates with histological capillary density, supporting its potential as a reliable, non-invasive tool for quantifying RV myocardial blood volume in clinical settings. These observations will need to be confirmed in studies with larger sample sizes.

Condensed abstract: Myocardial vascular remodeling in right ventricle (RV) pressure overload is difficult to assess non-invasively. This study validated attenuation-compensated fractional moving blood volume (acFMBV) using ultrafast power Doppler (UPD) to quantify RV myocardial blood volume. Twelve rats underwent pulmonary artery banding (PAB) or sham surgery, with acFMBV measured and correlated with capillary density. PAB rats had lower mid-diastolic acFMBV and capillary density (r = 0.78, P < 0.01). In humans, RV pressure-overload patients showed reduced acFMBV compared with healthy volunteers (P = 0.03). UPD-based acFMBV correlates with histology, supporting its use as a non-invasive tool for assessing RV perfusion.

Aims: Multiple guidelines provide recommendations for assessing future risk of cardiovascular events in asymptomatic individuals without known coronary artery disease (CAD). We systematically reviewed current national and international guidelines that include imaging strategies for detecting subclinical CAD.

Methods and results: MEDLINE and EMBASE were searched for relevant guidelines published between January 2010 and December 2025. Major international guideline repositories and medical society websites were also screened. Two reviewers independently screened records assessed methodological rigour using the AGREE II instrument and extracted recommendations. Of four identified guidelines, three met predefined rigour thresholds and were included in the final analysis. Guidelines discouraged coronary artery calcium (CAC) use as a population-wide screening tool or in high-risk individuals. All three guidelines recommended limited use of scoring as a risk modifier in asymptomatic individuals when cardiovascular risk remains uncertain or near treatment thresholds and highlighted its role in shared decision-making. Differences were observed in the target populations for CAC assessment, recommendation strength, and re-screening intervals. Although CAC scoring was the principal imaging modality evaluated, CT coronary angiography was discussed in one guideline but not recommended due to insufficient evidence of clinical benefit.

Conclusion: Cardiovascular imaging for the detection of asymptomatic coronary artery disease is not recommended in the guidelines for population screening or in high-risk patients. CAC use is recommended in specific cases such as where patients are near treatment thresholds for primary prevention. Ongoing randomized studies may provide further outcomes and cost effectiveness driven insights.

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome defined by diastolic dysfunction and limited therapeutic options, with increasing recognition of right ventricular (RV) involvement. Using invasive pressure-volume loop analysis, we assessed biventricular hemodynamics in lean and obese ZSF1 rats, a well-established rodent model of HFpEF. Obese rats exhibited significantly increased RV and left ventricular (LV) chamber stiffness, with a positive correlation between RV and LV stiffness constants, indicating biventricular diastolic dysfunction. RV end-systolic elastance was preserved, whereas LV contractility was increased. Despite elevated RV stiffness, myocardial fibrosis was unchanged, while RV and septal cardiomyocyte hypertrophy was significantly increased. These findings demonstrate that RV diastolic dysfunction in this HFpEF model is driven primarily by myocytic stiffening rather than fibrotic remodeling. Our data provide invasive haemodynamic evidence of RV involvement in HFpEF and further support the translational relevance of the ZSF1 rat model for studying biventricular HFpEF pathophysiology.

Aims: Music can influence bodily rhythms, offering a powerful way of modulating autonomic physiology. Entrainment between music structure and physiologic responses provides a potential mechanism for this effect. This study examined (1) whether autonomic entrainment is driven primarily by objective music structure or by listeners' subjective perception of music boundaries and (2) how structural and dynamic features of opera shape entrainment.

Methods and results: Twenty-four participants (12 choristers, 12 non-choristers) listened to two Verdi excerpts while respiration, RR intervals, and continuous blood pressure were recorded. Entrainment between music features (loudness and tempo) and physiology was assessed using time-frequency coherence, revealing significant intra- and inter-individual coupling, strongest during Nabucco. Surrogate testing confirmed that these effects were linked to music structure rather than incidental physiologic fluctuations. Music boundaries were modelled as Gaussian envelopes derived from participant-defined (subjective) annotations and trained-annotator (objective) annotations. Objective boundary envelopes aligned more closely with physiologic envelopes than subjective annotations across signals. Subjective boundary performance improved when restricted to higher-strength annotations and when closely matching music structural changes. Choristers' boundary annotations were more consistent within the group, but overall physiology-music entrainment strength was similar between choristers and non-choristers.

Conclusion: Music structure plays a key role in shaping autonomic entrainment. Autonomic entrainment during music listening is most consistently explained by music structure changes, particularly well-defined and salient boundaries (objective annotations), rather than by an individual's perception of structure changes (subjective annotations). These findings support a scalable framework for music-based interventions grounded in extractable structural features rather than personalized perception.

Graphical AbstractFor image description, please refer to the figure legend and surrounding text.