European heart journal. Imaging methods and practice最新文献

Aims: Over the past decade, transcatheter valve replacement has emerged as a therapy for selected patients with valvular heart. Clinical experience with transcatheter mitral valve replacement (TMVR) has been limited to date and provides little insight into its potential as a viable therapy for MR. The present study aims to analyze the current longest follow-up real-life outcomes of TMVR procedures with a specific focus on the patient population left untreated due to the unfeasibility of the procedure.

Results: Out of 3400 patients referred for mitral pathology, 88 were screened for TMVR procedure, being unfeasible for surgical and TEER procedure (Transcatheter Edge-to-Edge Repair). 37 pts (45%) were screened positive and treated with TMVR; 30 (81%) with Tendyne system (Abbott) and 7 (19%) with Tiara. For cardiac death, in TMVR the survival was 97.2%, 90.7%, and 90.7% at 1, 2, and 4 years, respectively. Concerning MT, instead, it was 86.4%, 77%, and 42% at 1, 2, and 4 years, respectively. A difference is seen between the two groups, P-value 0.024.

Conclusion: TMVR is a valid option in selected patients and give valid longer follow-up results. The TMVR-ineligible patients showed a progressive detrimental worse survival across the follow-up.

Aims: Single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) has reduced accuracy in patients with small left ventricular (LV) size. Although transient ischaemic dilation (TID) is a sign of extensive coronary artery disease when accompanied by perfusion defects, its significance with normal perfusion remains unclear. We aim to study the relationship between the LV size and the TID ratio (TIDr) amongst females with normal SPECT MPI.

Methods and results: Retrospective single-centre study of female patients with normal dipyridamole stress MPI, defined as the summed stress score = 0 with both stress and rest LV ejection fraction ≥50% on gated images. Small LV was defined as a gated rest end diastolic volume (EDV) below the 20th percentile of the study cohort. TIDr was derived using the quantitative perfusion SPECT software. There were 107 female patients (mean age-70) included. The threshold for small LV size was determined to be an EDV of <36.6 mL. Patients with or without small LV were similar in age, ethnicity, body mass index, and comorbidities. TIDr was significantly greater for patients with small LV (1.33 vs. 1.28, P = 0.042). There was a significant negative correlation between the resting EDV and the TIDr (r = -0.34, P < 0.001), which remained significant after controlling for age, body mass index, resting left ventricular ejection fraction, diabetes mellitus, and hypertension (r = -0.35, P < 0.001).

Conclusion: In females with a normal dipyridamole stress SPECT MPI, TIDr is significantly higher in those with small LV. LV size should be considered when interpreting TID in females with otherwise normal MPI.

Aims: Cardiac miR-132 has been proposed as a target for heart failure (HF) therapy. CDR132L, a rationally designed synthetic oligonucleotide inhibitor of miR-132 has proved pre-clinical efficacy in non-ischaemic and ischaemic large animal HF models. The safety and tolerability of CDR132L were tested in chronic HF patients in a Phase 1b study (NCT04045405) and is currently being tested in a Phase 2 trial in post-MI HF patients (NCT05350969). The aim of the current study was to gain further data on myocardial function and efficacy of CDR132L by analysing left ventricular (LV) and atrial (LA) wall motion by serial cardiac magnetic resonance (cMRI) strain imaging in a clinically relevant large animal (pig) model of chronic HF.

Methods and results: Animals (15 per group) were randomized 1-month post-MI and received five intravenous (i.v.) monthly treatments with CDR132L (5 mg/kg) or placebo and were followed up for 6-month post-MI. LV and LA strain parameters were deteriorated after MI over time but significantly ameliorated by CDR132L treatment, compared with placebo. Strain parameters showed significant correlations with pharmacodynamic measures such as ejection fraction, NT-proBNP, and cardiac interstitial fibrosis in remodelling hearts 6 months post-MI.

Conclusion: LV and LA motion and contractility were improved by repeated monthly dosing of CDR132L in a large animal model of HF with reduced ejection fraction model with first dose given one month post-MI. The results highlight the translational value and usability of MRI-based cardiac strain imaging in HF drug development and support further clinical development of CDR132L.

Aims: Cardiovascular magnetic resonance (CMR)-derived pulmonary capillary wedge pressure (PCWP) has demonstrated diagnostic and prognostic utility in heart failure patients. However, its clinical value in acute myocardial infarction (AMI) remains undetermined. This study investigates the relationship between CMR-derived PCWP, myocardial injury, and left ventricular (LV) remodelling in re-perfused acute ST-elevation myocardial infarction (STEMI).

Methods and results: Sixty-nine patients with STEMI underwent CMR within 48 h and at 3 months. PCWP was estimated using the sex-specific equation: CMR PCWP: 5.7591 + (0.07505 × left atrial volume) [0.05289 × left ventricular mass (LVM)] - (1.9927 × sex) [female = 0; male = 1], where LAV is left atrial volume (mL) and LVM is left ventricular mass (g). LV remodelling was assessed via changes in LV end-diastolic volume (LVEDV) and ejection fraction (LVEF). Patients with high CMR PCWP (≥18 mmHg) exhibited greater myocardial scar burden (28.5% vs. 17.2%, P = 0.0008) and microvascular obstruction (7.6% vs. 2.5%, P < 0.0001). They also had higher acute LVEDV (193.7 ± 39.7 vs. 158.0 ± 29.5 mL, P < 0.0001) and lower LVEF (41.4 ± 10.4% vs. 48.5 ± 9.2%, P = 0.0066). At follow-up, higher baseline CMR PCWP was associated with greater LV remodelling (P < 0.0001) and persistently reduced LVEF (45.4 ± 10.2% vs. 55.0 ± 10.3%, P = 0.0005). Regression analysis confirmed baseline PCWP as an independent predictor of follow-up LVEF (P = 0.0036).

Conclusion: CMR-derived PCWP may be a valuable biomarker in STEMI, identifying patients at risk of adverse remodelling and LV dysfunction. Its integration into clinical practice may enhance risk stratification and guide targeted therapies.

Aims: In adult Fontan patients, a higher central venous pressure (CVP) is associated with worse clinical outcomes. Assessing CVP is helpful to guide therapeutic strategies; however, it remains unclear whether CVP can be accurately estimated from the inferior vena cava (IVC) diameter by echocardiography.

Methods and results: This single-centre, retrospective study enrolled 21 adult Fontan patients (median age: 21.5 years, 52% male) who had a transthoracic echocardiogram performed after admission for a scheduled cardiac catheterization. The relationship between CVP estimated by echocardiography and CVP measured by catheterization was investigated. According to echocardiographic guidelines, CVP was estimated to be 3, 8, or 15 mmHg on the basis of the IVC diameter and its respiratory collapse. To evaluate the agreement between estimated and measured CVP grades, measured CVP was also classified into three grades. The mean IVC diameter and measured CVP were 1.41 ± 0.27 cm and 11.9 ± 2.8 mmHg, respectively. Both the IVC diameter and the estimated CVP grade were correlated with measured CVP (r = 0.526, P = 0.014 and rho = 0.573, P = 0.007, respectively). However, the estimated CVP grade was concordant with the measured CVP grade in only two patients. In the remaining 19 patients (90%), the estimated CVP grade was lower than the measured CVP grade. Only slight agreement was observed between these two gradings of CVP [weighted kappa coefficient: 0.13, 95% confidence interval (CI): 0.00-0.25].

Conclusion: In adult Fontan patients, the echocardiographic classification of CVP grading using the IVC diameter may underestimate CVP, suggesting that this echocardiographic method cannot replace invasive methods in accurately assessing CVP.

Aims: The low reproducibility of echocardiographic measurements challenges the identification of subtle changes in left ventricular (LV) function. Deep learning (DL) methods enable real-time analysis of acquisitions and may improve echocardiography. The aim of this study was to evaluate the impact of DL-based guidance and automated measurements on the reproducibility of LV global longitudinal strain (GLS), end-diastolic (EDV) and end-systolic (ESV) volume, and ejection fraction (EF).

Methods and results: Forty-six patients (24 breast cancer and 22 general cardiology patients) were included and underwent four consecutive echocardiograms. Six were included twice, totalling 52 inclusions and 208 echocardiograms. One sonographer-cardiologist pair used DL guidance and measurements (DL group), while another did not use DL tools and performed manual measurements (manual group). DL group recordings were also measured using a commercially available DL-based EF tool. For GLS, the DL group had a 30% lower test-retest variability than the manual group (minimal detectable change 2.0 vs. 2.9, P = 0.036). LV volumes had ∼40% lower minimal detectable changes in the DL group vs. the manual group (32 mL vs. 52 mL for EDV and 18 mL vs. 32 mL for ESV, P ≤ 0.006). This did not translate to a significant improvement in EF reproducibility in the DL group. The benchmarking method showed similar results compared with the manual group.

Conclusion: Combining real-time DL guidance with automated measurements improved the reproducibility of LV size and function measurements compared with usual care, but future studies are needed to evaluate its clinical effect.

Trial registration number: NCT06310330.

Aims: To evaluate the current role and practice patterns in myocardial viability assessment through a European Association of Cardiovascular Imaging (EACVI) survey.

Methods and results: A total of 179 participants from 54 countries completed the survey. Most participants worked in tertiary centres (60.3%). Transthoracic echocardiography (TTE) was the most widely available modality (98.3%), followed by stress echocardiography (86.6%), cardiac computed tomography angiography (87.7%), and cardiovascular magnetic resonance (CMR, 84.9%). Single-photon emission computed tomography and positron emission tomography were less accessible (59.8 and 40.2%, respectively). CMR was the preferred imaging modality (76.0%), followed by TTE (41.9%), which were also the most frequently used techniques in clinical practice (42.7 and 38.7%, respectively). Viability imaging was regularly used by most respondents in patients with chronic ischaemic heart disease (57.0%) and prior to revascularization for chronic total occlusions (58.7%). Among late-presenting ST-elevation myocardial infarction patients, 60.7% of respondents assessed viability within index hospitalization or the first month, whereas 28.3% performed viability imaging after 1-3 months. However, considerable variation exists between respondents. Revascularization decisions were guided by viability findings with revascularization of only viable segments in 49.1% of cases, while 40.0% reported revascularizing all high-grade stenoses if any viable myocardium was present.

Conclusion: This study highlights the variability in myocardial viability imaging practices across Europe, with differences in availability, preferred modalities, and clinical application. While CMR and TTE remain the dominant modalities, standardization of imaging protocols and further research are needed to optimize viability assessment and its impact on revascularization decisions.

Aims: Left ventricular hypertrophy (LVH) regionality carries diagnostic and prognostic importance. Mean absolute deviation of maximum segmental wall thickness (MadWT) is a novel left ventricular wall thickness (LVWT) heterogeneity biomarker from cardiovascular magnetic resonance imaging (CMR).

Objectives: To compare MadWT to indexed LV mass (LVMi), maximum (MaxWT) and mean (MeanWT) wall thickness to predict incident cardiovascular disease (CVD) and differentiate physiological from pathological LVH in highly physically active individuals.

Methods and results: Deep learning-assisted analysis of 44 930 UK Biobank CMR scans produced WT indices. Cox regression modelled major adverse cardiovascular events (MACE), heart failure (HF), arrhythmia, and all-cause death against LVWT indices. In the top 1% most physically active biomarker differences between propensity score matched hypertensive and non-hypertensive groups were compared. Over median (Q1, Q3) follow-up of 5.7 (4.9, 7.1) years, MadWT, MaxWT, MeanWT, and LVMi were associated with greater risk of MACE, HF, arrhythmia (P < 0.05), but not all-cause death (P > 0.05). After adjusting for CMR biomarkers, including LVMi, MadWT remained independently prognostic of the greatest number of endpoints, including MACE, HF, and arrhythmia [HR 1.13 (1.04-1.23); HR 1.15 (1.01-1.32); and HR 1.26 (1.18-1.35) respectively]. In the top 1% most physically active by three metrics, MadWT was the only significantly different biomarker between hypertensive and non-hypertensive participants (P < 0.05).

Conclusion: MadWT is important prognostically beyond LV mass and may be useful when differentiating physiological from hypertensive LVH. Although findings require confirmation in athletic and diseased cohorts, MadWT is readily translatable to deep learning-assisted clinical CMR reporting, especially in early unexplained LVH.

Aims: Mitral annular calcification (MAC) increases the difficulty of mitral valve (MV) surgery and is associated with mortality. However, there is no standardized classification of MAC severity. A multi-parametric MAC score has been proposed using computed tomography. We evaluated the prognostic effect of MAC severity classification using the MAC score.

Methods and results: We included 331 patients with MAC who underwent MV surgery from 2011 through 2019. We calculated the MAC score based on five main components (range: 2-12): MAC Agatston calcium score, MAC angle, extension to left ventricular outflow tract, the involvement of trigones, and myocardial infiltration. According to the proposed MAC score, we classified the top tertile into the severe MAC group (scores: 9-12, n = 63) and the others into non-severe MAC group (scores: 2-8, n = 268). Propensity scores (PS) were estimated using seven clinical variables (age, sex, body mass index, hypertension, diabetes mellitus, heart failure, and chronic kidney disease), with severe MAC as the dependent variable. The median age was 74 years and 57.1% were female. During a median follow-up duration of 220 days, 47 patients (14.2%) died. After PS matching, there were 60 patients in each group. There were no significant differences in in-hospital mortality between the two groups, but patients with severe MAC had statistically significantly higher all-cause mortality compared to patients with non-severe MAC (25.0% vs. 8.3%, P = 0.026).

Conclusion: In patients undergoing MV surgery, systematic classification of MAC severity by MAC score helps predict prognosis.