European heart journal. Imaging methods and practice最新文献

Aims: Left ventricular (LV) enlargement is a common training-induced adaptation in athletes, particularly in endurance sports. Previous research indicates that indexing LV volumes and mass to absolute peak oxygen uptake (VO₂_peak) better reflects physiological adaptation than traditional indexing to body surface area (BSA). Therefore, we investigated whether indexing LV end-diastolic volume (LVEDV) and mass to VO_2peak could eliminate differences in LV size among athletes from different sport categories (endurance, mixed, power, and technical).

Methods and results: This analysis included 70 athletes from the multicenter COSMO-S in Germany and 15 elite endurance athletes from Norway. All participants (29 ± 8 years, 52 male) underwent echocardiography and cardiopulmonary exercise testing. In regression analyses, VO_2peak (L/min) accounted for a significantly greater proportion of the variance in LVEDV than BSA (R² 0.64 vs. 0.19, P < 0.001), while this difference was not significant for LV mass (R² 0.54 vs. 0.36, P = 0.06). When indexed to BSA, both LVEDV and LV mass revealed significant differences across sports (both P ≤ 0.019), that disappeared when indexed to VO₂_peak (all P ≥ 0.40). In a cohort of 12 dilated cardiomyopathy (DCM) patients serving as a pathological reference group, indexing LVEDV and LV mass to VO_2peak better differentiated DCM patients from athletes than indexing to BSA.

Conclusion: Indexing LV size to VO₂_peak may provide a more physiological interpretation of cardiac adaptations in athletes and reduce sport-specific differences due to better consideration of training-induced adaptations. These findings should be replicated in larger cohorts and tested for the ability to detect subtle pathologies.

With the growing global adoption of transcatheter tricuspid valve intervention (TTVI) and the increasing number of available devices, a comprehensive understanding of right heart dysfunction has become essential. Right heart dysfunction is frequently observed both before and after TTVI and is associated with adverse clinical outcomes. Therefore, a thorough understanding of right heart anatomy and physiology is critical for accurately assessing its pathological states. This review synthesizes current knowledge by integrating findings from major landmark studies on TTVI, with a focus on the available assessment tools for predicting patient outcomes. The anatomy section systematically reviews each component of the right heart-the right atrium, right ventricle, tricuspid valve, and pulmonary valve -while the physiology section emphasizes microstructural characteristics and the pressure-volume relationships. In addition, recommendations from the Tricuspid Valve Academic Research Consortium and the imaging parameters used in recent studies are discussed. Finally, future directions for imaging-based assessment of right heart function in the context of TTVI are highlighted.

Aims: Ejection fraction (EF) and end-systolic volume (ESV) are prognostic markers in cardiovascular disease. While MRI provides accurate assessments, its cost limits widespread use. Non-contrast cardiac CT (NCCT), used for coronary artery disease screening, may offer additional functional information. To evaluate the accuracy of AI-derived ventricular volumes and EF from NCCT compared with contrast cardiac CT (CCT) and MRI.

Methods and results: This single center study included 205 patients who underwent cardiac CT for valve planning, divided into retrospective and prospective cohorts. A validated AI algorithm was applied to low-dose NCCT images at end-diastole and end-systole. Right (RV) and left ventricles (LV) volumes and their EFs were compared with CCT and MRI. In the prospective cohort (49 women, 53 men; mean age 73.9 ± 10.3 years), NCCT correlated strongly with CCT for LVEDV (152 mL; -14.2% relative difference; r = 0.91) and LVESV (96 mL; +32.6%; r = 0.84), with similar correlations for RVEDV (163 mL; -8.4%; r = 0.82) and RVESV (121.4 mL; +33.1%; r = 0.85). NCCT predicted LVEF <40% with 98% negative predictive value and 87% accuracy. LVEDV correlated strongly with MRI (n = 16) for CCT (240 mL; +4.2%; r = 0.99) and NCCT (197 mL; -14.3%; r = 0.97), as did LVESV for CCT (115 mL; -5%; r = 0.99) and NCCT (134 mL; +11%; r = 0.97).

Conclusion: AI-derived ventricular volumes from NCCT show moderate to strong correlations, but EF is underestimated. The derived EF can be a screening tool to rule out significant ventricular dysfunction.

Aims: Gould's simplified retention model (GSRM), as implemented in the HeartSee software, demonstrates 10% same-day test-retest precision for PET-CT myocardial perfusion using a 50 or 20 mL/min Rb-82 infusions. HeartSee-GSRM also accurately quantifies resting myocardial blood flow (rMBF) in transmural scar (0.26 mL/min/g), aligning with reference standards. However, the impact for varying infusion rates on precision and accuracy of a 1-tissue compartment model (1-TCM) as implemented within 4DM software remains unclear. We assessed whether varying infusion rates of Rb-82 impacts 1-TCM precision and accuracy.

Methods and results: Ninety-eight volunteers (Normals, Clinicals, and Infarcts), underwent 3D PET-CT stress testing. Three resting scans and two stress scans were performed with randomized fast (F) 50 mL/min or slow (S) 20 mL/min Rb-82 infusions. rMBF and stress MBF (sMBF) were calculated using 4DM software (1-TCM). Repeatability coefficients (RC) and coefficients of variance (COV) were calculated. Accuracy was assessed by comparing rMBF in infarcted myocardium (from 1-TCM and GSRM) against established reference standard for transmural myocardial scar (TMS). Fast infusion yielded better precision. RC was lower for F-F vs. S-S resting pairs (24.3% vs. 32.9%), and COV was lower (12.9% vs. 17.4%, P = 0.03). No difference in rMBF or sMBF was found between infusion rates (rMBF: 0.93 vs. 0.94 mL/min/g; sMBF: 2.23 vs. 2.30 mL/min/g). HeartSee GSRM produced rMBF values consistent with TMS (<0.30 mL/min/g), while 4DM 1-TCM overestimated rMBF (Fast: 0.79 ± 0.33; Slow: 0.82 ± 0.27 mL/min/g, P = 0.791), for both infusion profiles.

Conclusion: Fast infusion improves 4DM 1-TCM precision, but 4DM 1-TCM overestimates rMBF in TMS regardless of infusion rate. HeartSee GSRM remains accurate and precise across profiles.

Aims: Patients with type 2 diabetes mellitus (T2DM) and no significant carotid stenosis are often considered at moderate cardiovascular risk. However, some may harbour biologically active plaques. Intra-plaque vascularization (IPV), detectable in contrast-enhanced ultrasound (CEUS), reflects plaque vulnerability and may enhance risk stratification. We assessed the prognostic value of CEUS-derived IPV and the effects of SGLT2 inhibitors (SGLT2i) on cardiovascular outcomes and inflammatory markers.

Methods and results: In this 6-year prospective cohort study, 251 asymptomatic T2DM patients with carotid atherosclerosis <50% stenosis were enrolled. IPV was quantified by CEUS and stratified by tertiles. The primary endpoint was major adverse cardiovascular events (MACE: CV death, non-fatal MI, non-fatal stroke, or heart failure hospitalization). Secondary endpoints included changes in VEGF, IL-6, and TNF-α levels. Patients were also stratified by chronic SGLT2i use. High IPV was associated with greater MACE incidence (32.5%) compared with low IPV (7.4%; HR 3.84, 95% CI 1.89-7.78; P < 0.001). SGLT2i-treated patients showed reduced MACE incidence (12.1% vs. 26.3%, P = 0.004), particularly in the high-IPV subgroup (23.1% vs. 38.9%; HR 0.48, 95% CI 0.25-0.91; P = 0.026). Treatment was also linked to significant VEGF (-52.4 vs. -18.6 pg/mL) and IL-6 (-1.9 vs. -0.6 pg/mL) reductions (P < 0.001 for both).

Conclusion: CEUS-detected IPV predicts cardiovascular events in T2DM patients without significant stenosis. SGLT2i may reduce risk by modulating plaque inflammation and angiogenesis. CEUS combined with biomarker profiling may support personalized prevention strategies in diabetes.

Three-dimensional echocardiography (3DE), via both transthoracic and transoesophageal approaches, has become an essential tool in the assessment of mitral valve (MV) disease, providing detailed anatomical and functional insights fundamental to both diagnosis and therapeutic planning. By offering a unique volumetric perspective, 3DE allows a comprehensive visualization of the entire MV apparatus, enhancing the capacity to appreciate anatomical and functional details. In mitral regurgitation (MR), 3DE adds pivotal information about leaflet morphology, annular geometry, and sub-valvular structures across all Carpentier subtypes, playing a central role in surgical and percutaneous procedural planning. 3D colour-mode imaging improves spatial localization of regurgitant jets and enables advanced MR quantification techniques. Specifically, 3D proximal isovelocity surface area and 3D vena contracta area offer improved accuracy over 2D methods, particularly in functional MR, and in multiple or complex jets. Additionally, the 3D indirect volumetric method and emerging semi-automated software are further tools for MR quantification. In mitral stenosis, 3D planimetry via transthoracic and transoesophageal echocardiography provides more accurate and reproducible measurements of the MV area compared with 2D, especially in challenging anatomies or suboptimal imaging planes. 3DE, especially using the transoesophageal approach, also improves commissural evaluation, which is essential for patient selection for percutaneous valvuloplasty. Overall, 3DE has redefined MV imaging by offering unparalleled anatomical and quantitative assessment. Its integration into routine clinical practice is critical for modern echocardiography and should be considered a core competency for cardiovascular imaging specialists.

Aims: Deformation imaging has demonstrated incremental prognostic value compared to left ventricular ejection fraction (LVEF) in specific cardiovascular diseases; however, it remains widely underused. Consequently, we sought to investigate the significance of deformation imaging in an all-comers population to assess its value in a routine in- and outpatient setting.

Methods and results: Patients were prospectively recruited to the single-centre cardiac magnetic resonance registry. Volumetric right and left ventricular (RV/LV) analyses and global circumferential strain were assessed on short-axis stacks, RV and LV global longitudinal strain (GLS) on long-axis views respectively. Follow-up was conducted for primary (all-cause mortality and heart failure hospitalization) and secondary (all-cause mortality, hospitalized angina, infarction, and stroke) endpoints. In total, n = 1655 patients met n = 68 primary and n = 107 secondary endpoints during a median follow-up of 399 days. GLS (HR 1.12, 95%CI 1.04-1.21 P = 0.002; HR 1.10, 95%CI 1.03-1.16 P = 0.002) but not LVEF (P = 0.406; 0.209) was an independent predictor for the primary and secondary endpoint. GLS was an independent predictor for the primary endpoint after correction for commonly considered risk factors including, age, NYHA class, tissue characterization native T1, biomarker NT-proBNP, and glomerular filtration rate (HR 1.09, 95%CI 1.03-1.15, P = 0.003). After dichotomization at the median of -16.4%, GLS added incremental value to risk stratification for the primary endpoint on Kaplan-Meier plots in patients with LVEF above (P = 0.045) and below (P = 0.017) the median of 55%.

Conclusion: In an all-comers, low-risk patient population, GLS emerged as an independent risk predictor with incremental prognostic value relative to LVEF. This finding may support clinical routine implementation of GLS in cardiac in- and outpatient clinics.