European heart journal. Imaging methods and practice最新文献

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.

Aims: There is still a wide debate regarding the management of patients with chronic coronary syndrome, the choice of optimal non-invasive stress test, and the decision for coronary revascularization. Evidence has accumulated demonstrating the utility of global longitudinal strain (GLS) as a predictor of significant coronary disease. To evaluate the application of speckle tracking during resting echocardiography and after isometric loading with the hand-grip test, and to compare GLS parameters with fractional flow reserve (FFR).

Methods and results: Patients with known CCS who underwent angiography with evidence of coronary stenosis >40%<90% and were referred for functional assessment were enrolled in this study. Patients with previous MI, depressed LV systolic function, and poor acoustic window were excluded. Patients underwent a standard echocardiography with recordings suitable for LV speckle tracking. Subsequently, a dynamic hand-grip test was performed for 3 min, then the same images were captured. Global longitudinal strain was calculated at rest (rGLS), under stress conditions (sGLS), as well as the absolute difference between the two measurements - ΔGLS. Then, patients underwent invasive functional assessment with measurement of the FFR of the coronary lesion. Correlation analysis of myocardial strain parameters and FFR was performed. A total of 106 patients were included in the study. The mean rGLS was -18.5 ± 1.8, sGLS: -19.1 ± 2.0 and ΔGLS: 0.62 ± 1.4. In total, 44% of patients had a functionally significant coronary lesion when assessed with FFR. There was a statistically significant correlation between ΔGLS and FFR values, r = 0.660, P < 0.001. ΔGLS of 0.35 showed good diagnostic performance capacity (AUC 0.896, 95% CI: 0.83-0.96, specificity 85%, sensitivity 92%) for a functionally significant coronary lesion.

Conclusion: Dynamic GLS during isometric hand-grip exercise is a feasible method for functional assessment in patients with chronic coronary syndrome.

Aims: Acute myocardial infarction (MI) management has changed in the last decades with the introduction of routine early invasive revascularization and potent antiplatelet therapy followed by an improvement in patient prognosis. This study aimed to evaluate if it remains of long-term prognostic value to repeat the assessment of systolic function, determining change in ejection fraction (LVEF) and global longitudinal strain (GLS), within a year after an MI.

Methods and results: Patients hospitalized with acute MI (n = 256) were recruited in 2010 through 2012 at Uppsala University Hospital. All participants underwent an echocardiographic examination during the index hospital stay and at 1-year following discharge. Outcome data of time to first heart failure hospitalization or all-cause death was collected up until July 2022. Mean age was 66 years (80% men). Median follow-up was 11.7 (IQR 10.9-12.4) years with 63 observed events. A 1-year improvement in LVEF and GLS was not associated with the outcome [LVEF: adjusted HR 1.03 (CI 95% 0.51-2.05); GLS: adjusted HR 1.05 (CI 95% 0.55-2.04)], whereas a deterioration in GLS was associated with a higher event rate [adjusted HR 5.60 (CI 95% 2.04-15.39)]. Baseline GLS offered a higher C-index than LVEF [0.71 (0.65-0.78) vs. 0.68 (0.61-0.75)].

Conclusion: Improved systolic function after MI did not add incremental long-term prognostic information beyond the baseline systolic function, however, a deterioration in GLS may be associated with worse long-term prognosis. Our results favor a clinical strategy of risk stratification based on GLS rather than LVEF to enhance clinical risk prediction.

Non-coding RNA (ncRNA), including microRNA, long non-coding RNA, and circular RNA, are epigenetic signals acting as upstream regulators in several cardiovascular disease processes. This review explores how ncRNA profiling complements non-invasive cardiac imaging modalities by providing biological insights into structural and functional phenotypes. In conditions such as hypertensive heart disease and aortic stenosis, ncRNAs like microRNA (miR)-29 and miR-155 correlate with left ventricular hypertrophy and fibrosis. In dilated cardiomyopathy and heart failure, circulating miR-150-5p, miR-21, and LIPCAR associate with disease severity and prognosis beyond well-established echocardiographic prognosticators. Post-infarction remodelling has been linked to dynamic changes in miR-155, miR-143, and miR-150, while atrial disease and atrial fibrillation progression are reflected in distinct miRNA profiles. In valve disease, miR-206 levels mirror functional recovery after transcatheter aortic valve implantation, while they associate with right-ventricular dysfunction in the setting of pulmonary hypertension. Cardiac MRI studies have shown that ncRNA such as miR-29a and has-Chr8:96 may distinguish pathologies including hypertrophic cardiomyopathy and myocarditis. In nuclear imaging, circ-MBOAT2 and miR-495 correlate with myocardial perfusion in chronic total occlusion, and exosomal miRNA may support functional stratification. CT imaging may also benefit from ncRNA biomarkers such as miR-3154 in vascular disease. Despite promises, standardization and prospective validation remain crucial for clinical translation. Taken together, ncRNA enrich imaging phenotypes by illuminating molecular underpinnings, enhancing prognostication, and offering potential targets for personalized cardiovascular care.

Aims: Cardiac myosin inhibitors (CMIs) have revolutionized care for patients with obstructive hypertrophic cardiomyopathy (HCM), however they are associated with a risk of systolic dysfunction. Machine learning algorithms might expand access to frequent accurate assessment of left ventricular ejection fraction (LVEF). We assess the performance of a commercial ML-based LVEF model for patients with HCM.

Methods and results: Single centre prospective study of measurements of left ventricular function by Philips HeartModel® (automated) assessment, echocardiographer assessment (standard), and cardiac magnetic resonance imaging for patients with HCM. Assessments of LVEF, end diastolic volume and end systolic volume were studied across methods. 50 patients with HCM were included. Median age 64 years; 64% male; and 62% had cMRI data for analysis. Median automated LVEF was lower than standard [55.5% (IQR 9) vs. 62.5% (IQR 10), P 0.002, median difference-8% (IQR 14)] and cMRI assessment [55.5% (IQR 9) vs. 68% (IQR 9.5), P < 0.001, median difference-12% (IQR 16)]. Automated assessment traced larger EDVs and ESVs compared with standard 2D tracings [141 mL (IQR 66) vs. 114 mL (IQR 55), P 0.001, and 64 mL (IQR 35) vs. 41 mL (IQR 25), P < 0.001]. Automated assessment identified 11 (22%) patients as having LVEF < 50% vs. 6 (12%) patients identified by expert imaging assessment.

Conclusion: For patients with HCM, automated assessments of LV size and function differ significantly from standard assessments, raising concerns about the use of this ML-enabled LVEF software for this patient population and potential application to guiding CMI treatments.

Introduction: Myocardial perfusion imaging (MPI) is used to evaluate ischaemia in patients with chronic total occlusion (CTO), but its prognostic implications following percutaneous coronary intervention (PCI) of CTO remain uncertain.

Purpose: To evaluate outcomes in patients treated with CTO-PCI stratified by moderate-severe ischaemia on MPI prior to intervention.

Methods and results: Patients from the Western Danish Heart Registry assessed by nuclear MPI and subsequently treated with CTO-PCI ≤ 6 months were included. Moderate-severe ischaemia was defined as ≥10% left ventricle involvement. Primary endpoints were all-cause mortality and a composite of major adverse cardio- and cerebrovascular events [MACCE; cardiovascular death, myocardial infarction (MI), stroke, and hospitalization for heart failure (HF) or angina pectoris]. Secondary endpoints included the individual MACCE components. Outcomes were compared between patients with and without moderate-severe ischaemia using multivariable Cox regression and competing risk regression at 90-day and 5-year follow-ups. Among 319 patients, 208 (65.2%) had moderate-severe ischaemia. All-cause mortality was similar between patients with and without moderate-severe ischaemia [adjusted hazard ratio (aHR) 1.12, 95% confidence interval (CI): 0.52-2.43], P = 0.77). The estimated risk of MACCE was comparable between groups at 90 days [aHR 0.76 (0.38-1.55), P = 0.46] and 5 years [aHR 0.74 (0.45-1.20), P = 0.22]. No difference was found in MI [5 years: aHR 0.76 (0.26-2.22), P = 0.61] or hospitalization for HF [90 days: aHR 0.44 (0.16-1.21), P = 0.11]; 5 years: aHR 0.62 (0.30-1.30), P = 0.21]. Hospitalization for angina was similar at 90 days [aHR 0.75 (0.26-2.16), P = 0.60], but a decreased 5-year risk was observed in patients with moderate-severe ischaemia [aHR 0.46 (0.23-0.91), P = 0.026].

Conclusion: Moderate-severe ischaemia on nuclear MPI was not associated with differences in mortality or MACCE after CTO-PCI but was associated with a lower long-term risk of angina hospitalization.

Point-of-care ultrasound (POCUS) has rapidly evolved from a diagnostic adjunct into an essential extension of bedside clinical reasoning in acute cardiovascular care. By providing immediate, physiologically grounded, and non-invasive information, POCUS enhances diagnostic accuracy, risk stratification, and therapeutic guidance in real time. Among its core applications, lung ultrasound enables reliable detection and monitoring of pulmonary congestion, outperforming traditional methods such as chest X-ray and physical examination. The Venous Excess Ultrasound Score offers a structured assessment of systemic venous congestion through abdominal venous Doppler patterns. The left ventricular outflow tract velocity-time integral serves as a reproducible surrogate of forward flow and cardiac output, while focused cardiac ultrasound provides rapid structural and functional evaluation of the heart. The reliability and prognostic value of these modalities have been supported by growing evidence across diverse clinical contexts, though standardization of training and acquisition protocols remains crucial for widespread implementation. Integration of POCUS into daily workflows-through structured, serial assessments of pulmonary, venous, and haemodynamic status-holds promise to refine decision-making, individualize treatment strategies, and improve outcomes. This review summarizes current evidence, methodological considerations, and practical implications of POCUS in acute cardiovascular medicine, emphasizing its complementarity to, rather than replacement of, traditional diagnostic tools.

Background: Echocardiographic measurements of the left ventricle (LV) are fundamental in diagnosing and monitoring cardiac disease. Still, current understanding of how heart rate influences these measurements is incomplete. We aimed to explore the relationship between heart rate and LV global longitudinal strain (GLS), ejection fraction (LVEF), end-diastolic (LVEDV), and end-systolic volumes (LVESV), using atrial pacing and a transparent multi-step deep learning (DL)-based method for fully automated measurements.

Methods and results: Fifty participants with permanent pacemakers were enrolled. Heart rate was increased by atrial pacing in increments of 10 beats/min, from 50 to 140 beats/min, with echocardiographic 10-beat cine-loops recorded at each step. A DL-based method was utilized to measure GLS, LVEF, LVEDV, and LVESV at all levels.A total of 10 161 heart cycles were analysed, with 97% feasibility. As heart rate increased, all LV measures displayed significant and near-linear reductions. From 60 to 140 beats/min, GLS decreased by 32% (95% CI: 19-44%), LVEF by 33% (95% CI: 19-47%), LVEDV by 31% (95% CI: 19-43%), and LVESV by 10% (95% CI: -5% to 24%). Processing time per cardiac cycle was 1.3 (0.4) s, corresponding to 3.7 h for the entire dataset.

Conclusion: Heart rate significantly influences echocardiographic measures of LV function and volume, emphasizing the necessity of incorporating heart rate into clinical interpretation and reporting of echocardiographic measurements. This study further demonstrates the potential of DL to advance cardiovascular research by enabling rapid, accurate, and reproducible analyses, previously unachievable due to the inherent constraints of manual measurements.