European heart journal. Imaging methods and practice最新文献

Aims: To evaluate the accuracy and feasibility of artificial intelligence (AI) in left ventricular global longitudinal strain (GLS) analysis as compared to conventional (Manual) and semi-automated (SemiAuto) method in echocardiography (Echo).

Methods and results: GLS validation was performed on 550 standard Echo exams by expert cardiologists. The performance of a beginner cardiologist without experience of GLS analysis was assessed on a subset of 90 exams. The AI employs fully automated view selection, classification, endocardial border tracing, and calculation of GLS from an entire Echo exam, while SemiAuto requires manual chamber view selection, and Manual involves full user input. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC) for all three methods. Agreement of measures included Pearson's correlation (R) and Bland-Altman analysis [median bias; limits of agreement (LOA)]. With an 89% feasibility the AI showed good agreement with Manual (R = 0.92, bias = 0.7% and LOA: -3.5 to 4.8%) and with SemiAuto (r = 0.90, bias = 0.10% and LOA: -4.5 to 4%). ICCs for GLS were 1.0 for AI, 0.93 for SemiAuto, and 0.80 for Manual. After the 55th analysis, the beginner showed stable time performance with Manual (171 s), contrasting with the consistent performance of SemiAuto (85-69 s) from the beginning. The highest agreement between beginner and expert readers was achieved with AI (R = 1.00), followed by SemiAuto (R = 0.85) and Manual (R = 0.74).

Conclusion: Automated GLS analysis enhances efficiency and accuracy in cardiac diagnostics, particularly for novice users. Integration of automated solutions into routine clinical practice could yield more standardized results.

Aims: Right ventricular (RV) failure causes high mortality in patients with pulmonary arterial hypertension (PAH). RV stroke work index (RVSWi) poses as a potential predictor of outcome. We evaluated how RVSWi by echocardiography (ECHO) or right heart catheterization (RHC) is altered following PAH treatment and if RVSWi is an indicator of outcome in PAH.

Methods and results: Fifty-four patients with PAH performed ECHO and RHC (median, 0 days between examinations) at baseline and treatment follow-up. RVSWi_RHC was computed as (mPAP-mRAP)×SVi_RHC, (mPAP, mean pulmonary arterial pressure; mRAP, mean right atrial pressure; SVi, stroke volume indexed to body surface area). ECHO-derived RVSWi was calculated as RVSWi_ECHO-Mean = TR_meanPG × SVi_ECHO and RVSWi_ECHO-Max = TR_maxPG × SVi_ECHO (TR_meanPG and TR_maxPG: tricuspid regurgitant mean and maximum pressure gradient). Invasive sPAP, mPAP, and pulmonary vascular resistance decreased and SVi increased from baseline to follow-up (P < 0.01 for all). RVSWi_RHC and RVSWi_ECHO (Mean and Max) did not differ from baseline to follow-up (P > 0.05). Forty patients died during 109 ± 24 months. In univariate Cox proportional hazard analysis, age > 65 years, 6-minute-walk test < 160 m, WHO class III-IV and indexed right atrial volume were associated with long-term mortality, but none of the RVSWi methods. In multivariate analysis with clinical parameters, both RVSWi_ECHO methods were independently associated with mortality.

Conclusion: The RVSWi methods did not differ from baseline to short-term follow-up and were not associated with long-term outcomes in univariate analysis. However, baseline RVSWi_ECHO was associated with mortality when adjusting for clinical parameters.

Aims: Photon-counting detector computed tomography (PCD-CT), which allows the exclusion of electronic noise, shows promise for significant dose reduction in coronary CT angiography (CCTA). This study aimed to assess the radiation dose and image quality of CCTA using PCD-CT, combined with high-pitch helical scanning and an ultra-low tube potential of 70 kVp, and investigate the effect of a sharp kernel on image quality and stenosis assessment in such an ultra-low-dose CCTA setting.

Methods and results: Forty patients (65% male) with stable heart rates and no prior coronary interventions were included. Data on CT dose index volume (CTDIvol) and dose-length product (DLP) were collected, with effective radiation dose estimated using a conversion factor of 0.014. Images were reconstructed using kernels of Bv64 and Bv40 for image quality and stenosis assessment. The mean CTDIvol, DLP, and effective dose of CCTA were 1.72 ± 0.38 mGy, 29.1 ± 6.8 mGy·cm, and 0.41 ± 0.09 mSv, respectively. Image quality was similar (P = 0.75) between the two kernels, with over 95% of segments achieving a rating of good image quality for both kernels. The per-segment stenosis score distribution between Bv40 and Bv64 reconstruction images showed significant differences for both non-calcified and calcified plaques (P < 0.001 for both).

Conclusion: PCD-CT technology with high-pitch helical scanning and the tube potential of 70 kVp can provide CCTA with ultra-low radiation exposure (DLP, 29 mGy·cm). The noise reduction capability of PCD-CT allows the use of a sharp kernel even in this low-dose CCTA setting without compromising image quality, potentially improving the evaluation of coronary artery stenosis.

This review examines the differences and similarities between the European and American guidelines concerning the use of imaging in the diagnosis and management of peripheral arterial disease (PAD) and aortic disease. PAD and aortic conditions contribute significantly to global cardiovascular morbidity and mortality; yet, they are often underdiagnosed and undertreated. Imaging plays a critical role in addressing this gap, with the European Society of Cardiology and American Cardiac Society offering different approaches to diagnostic and interventional imaging modalities. The review highlights that while both guidelines endorse duplex ultrasound as the first-line imaging method for PAD, discrepancies arise in the use of advanced modalities such as computed tomography angiography and magnetic resonance angiography. The European guidelines adopts a more conservative approach, reserving these advanced techniques for specific clinical scenarios, whereas the American guidelines places a stronger emphasis on comprehensive imaging for all patients with suspected PAD. The review also compares the guidelines on aortic disease, noting consensus on the role of computed tomography angiography and magnetic resonance angiography for aortic aneurysm diagnosis, but with differences in the emphasis on transoesophageal echocardiography, which is more strongly recommended by the American guidelines for acute cases. The manuscript calls for harmonization of these guidelines to streamline clinical practice and improve patient outcomes.

The European Society of Cardiology recently updated guidelines on the management of chronic coronary syndromes upgrading the use of intracoronary imaging for complex percutaneous coronary interventions (PCI) to a class 1A recommendation. It is essential that the interventional community appreciate the additive value of intracoronary imaging over angiography alone-not only to obtain optimal acute PCI results but also to improve longer-term cardiovascular outcomes. The purpose of this manuscript is to review the latest evidence that informed the recent guideline recommendations and expand on the specific role of the different imaging modalities before, during, and after PCI.

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.