Pub Date : 2023-09-19eCollection Date: 2023-09-01DOI: 10.1093/ehjimp/qyad010
Judit Simon, Kenneth Fung, Zahra Raisi-Estabragh, Nay Aung, Mohammed Y Khanji, Emese Zsarnóczay, Béla Merkely, Patricia B Munroe, Nicholas C Harvey, Stefan K Piechnik, Stefan Neubauer, Paul Leeson, Steffen E Petersen, Pál Maurovich-Horvat
Aims: Heart failure (HF) is a major health problem and early diagnosis is important. Atherosclerosis is the main cause of HF and carotid intima-media thickness (IMT) is a recognized early measure of atherosclerosis. This study aimed to investigate whether increased carotid IMT is associated with changes in cardiac structure and function in middle-aged participants of the UK Biobank Study without overt cardiovascular disease.
Methods and results: Participants of the UK Biobank who underwent CMR and carotid ultrasound examinations were included in this study. Patients with heart failure, angina, atrial fibrillation, and history of myocardial infarction or stroke were excluded. We used multivariable linear regression models adjusted for age, sex, physical activity, body mass index, body surface area, hypertension, diabetes, smoking, ethnicity, socioeconomic status, alcohol intake, and laboratory parameters. In total, 4301 individuals (61.6 ± 7.5 years, 45.9% male) were included. Multivariable linear regression analyses showed that increasing quartiles of IMT was associated with increased left and right ventricular (LV and RV) and left atrial volumes and greater LV mass. Moreover, increased IMT was related to lower LV end-systolic circumferential strain, torsion, and both left and right atrial ejection fractions (all P < 0.05).
Conclusion: Increased IMT showed an independent association over traditional risk factors with enlargement of all four cardiac chambers, decreased function in both atria, greater LV mass, and subclinical LV dysfunction. There may be additional risk stratification that can be derived from the IMT to identify those most likely to have early cardiac structural/functional changes.
{"title":"Association between subclinical atherosclerosis and cardiac structure and function-results from the UK Biobank Study.","authors":"Judit Simon, Kenneth Fung, Zahra Raisi-Estabragh, Nay Aung, Mohammed Y Khanji, Emese Zsarnóczay, Béla Merkely, Patricia B Munroe, Nicholas C Harvey, Stefan K Piechnik, Stefan Neubauer, Paul Leeson, Steffen E Petersen, Pál Maurovich-Horvat","doi":"10.1093/ehjimp/qyad010","DOIUrl":"10.1093/ehjimp/qyad010","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) is a major health problem and early diagnosis is important. Atherosclerosis is the main cause of HF and carotid intima-media thickness (IMT) is a recognized early measure of atherosclerosis. This study aimed to investigate whether increased carotid IMT is associated with changes in cardiac structure and function in middle-aged participants of the UK Biobank Study without overt cardiovascular disease.</p><p><strong>Methods and results: </strong>Participants of the UK Biobank who underwent CMR and carotid ultrasound examinations were included in this study. Patients with heart failure, angina, atrial fibrillation, and history of myocardial infarction or stroke were excluded. We used multivariable linear regression models adjusted for age, sex, physical activity, body mass index, body surface area, hypertension, diabetes, smoking, ethnicity, socioeconomic status, alcohol intake, and laboratory parameters. In total, 4301 individuals (61.6 ± 7.5 years, 45.9% male) were included. Multivariable linear regression analyses showed that increasing quartiles of IMT was associated with increased left and right ventricular (LV and RV) and left atrial volumes and greater LV mass. Moreover, increased IMT was related to lower LV end-systolic circumferential strain, torsion, and both left and right atrial ejection fractions (all <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Increased IMT showed an independent association over traditional risk factors with enlargement of all four cardiac chambers, decreased function in both atria, greater LV mass, and subclinical LV dysfunction. There may be additional risk stratification that can be derived from the IMT to identify those most likely to have early cardiac structural/functional changes.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"1 2","pages":"qyad010"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S A van Blydenstein, S Omar, B Jacobson, C N Menezes, R Meel
Abstract Aims The right ventricle is affected by Coronavirus disease 19 (COVID-19) via multiple mechanisms, which can result in right ventricular dysfunction (RVD). This study aimed to provide an assessment of right heart function using conventional echocardiography and advanced strain imaging, in patients with hypoxic pneumonia during the COVID-19 pandemic. Methods and results This study was an observational, prospective, single-centre study, including adults with hypoxic pneumonia, in two groups: COVID-19 pneumonia; and non-COVID-19 pneumonia. Bedside echocardiography was performed according to a pre-specified protocol and all right heart measurements were done as per standard guidelines. Right ventricular free wall strain (RVFWS) was measured using Philips® QLAB 11.0 speckle tracking software. Descriptive and comparative statistics were used to analyse data. Spearman Rank Order Correlations were used to determine the correlation between right ventricular (RV) parameters and clinical parameters. Univariate and multivariate logistic regression analyses were performed to characterize the predictors of in-hospital mortality. We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID-19 pneumonia. COVID-19 patients were significantly older with a higher frequency of hypertension and diabetes and a trend towards a lower severity of illness score. Mean RVFWS yielded the highest estimates for the prevalence of RVD (81%), with no difference between the two pneumonia groups. Median Tricuspid Annular Plane Systolic Excursion (TAPSE) and right ventricular systolic excursion velocity (RVS’) were not significantly different between COVID-19 (TAPSE 17.2 and RVS’ 12), and non-COVID-19 pneumonia (TAPSE 17.8 and RVS’ 12.1) with P values of 0.29 and 0.86, respectively. Non-COVID-19 pneumonia patients with moderate to severe hypoxaemia (PF < 150) were at greater risk of an elevated RV Systolic Pressure >30 mmHg respiratory rate = 3.25 (CI 1.35–7.82) on admission. Troponin levels discriminated between COVID-19 survivors (6 ng/L) and non-survivors (13 ng/L), P = 0.04. The mortality rate for COVID-19 was high (27%) compared to non-COVID-19 pneumonia (12%). Conclusion Patients with COVID-19 pneumonia had a similar admission prevalence of RVD when compared to patients with non-COVID-19 pneumonia. Despite preserved traditional parameters of RV systolic function, RVFWS was diminished in both groups, and we propose that RVFWS serves as an important marker of the subclinical disease of RV.
{"title":"Right heart echocardiography findings in hypoxic pneumonia patients during the COVID-19 pandemic in a South African population","authors":"S A van Blydenstein, S Omar, B Jacobson, C N Menezes, R Meel","doi":"10.1093/ehjimp/qyad030","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad030","url":null,"abstract":"Abstract Aims The right ventricle is affected by Coronavirus disease 19 (COVID-19) via multiple mechanisms, which can result in right ventricular dysfunction (RVD). This study aimed to provide an assessment of right heart function using conventional echocardiography and advanced strain imaging, in patients with hypoxic pneumonia during the COVID-19 pandemic. Methods and results This study was an observational, prospective, single-centre study, including adults with hypoxic pneumonia, in two groups: COVID-19 pneumonia; and non-COVID-19 pneumonia. Bedside echocardiography was performed according to a pre-specified protocol and all right heart measurements were done as per standard guidelines. Right ventricular free wall strain (RVFWS) was measured using Philips® QLAB 11.0 speckle tracking software. Descriptive and comparative statistics were used to analyse data. Spearman Rank Order Correlations were used to determine the correlation between right ventricular (RV) parameters and clinical parameters. Univariate and multivariate logistic regression analyses were performed to characterize the predictors of in-hospital mortality. We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID-19 pneumonia. COVID-19 patients were significantly older with a higher frequency of hypertension and diabetes and a trend towards a lower severity of illness score. Mean RVFWS yielded the highest estimates for the prevalence of RVD (81%), with no difference between the two pneumonia groups. Median Tricuspid Annular Plane Systolic Excursion (TAPSE) and right ventricular systolic excursion velocity (RVS’) were not significantly different between COVID-19 (TAPSE 17.2 and RVS’ 12), and non-COVID-19 pneumonia (TAPSE 17.8 and RVS’ 12.1) with P values of 0.29 and 0.86, respectively. Non-COVID-19 pneumonia patients with moderate to severe hypoxaemia (PF &lt; 150) were at greater risk of an elevated RV Systolic Pressure &gt;30 mmHg respiratory rate = 3.25 (CI 1.35–7.82) on admission. Troponin levels discriminated between COVID-19 survivors (6 ng/L) and non-survivors (13 ng/L), P = 0.04. The mortality rate for COVID-19 was high (27%) compared to non-COVID-19 pneumonia (12%). Conclusion Patients with COVID-19 pneumonia had a similar admission prevalence of RVD when compared to patients with non-COVID-19 pneumonia. Despite preserved traditional parameters of RV systolic function, RVFWS was diminished in both groups, and we propose that RVFWS serves as an important marker of the subclinical disease of RV.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"136 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135736374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wensu Chen, Alessandro Faragli, Collin Goetze, Victoria Zieschang, Karl Jakob Weiss, Djawid Hashemi, Rebecca Beyer, Lorena Hafermann, Philipp Stawowy, Sebastian Kelle, Patrick Doeblin
Aims Cardiac magnetic resonance (CMR) T1 relaxation time mapping is an established technique primarily used to identify diffuse interstitial fibrosis and oedema. The myocardial extracellular volume (ECV) can be calculated from pre- and post-contrast T1 relaxation times and is a reproducible parametric index of the proportion of volume occupied by non-cardiomyocyte components in myocardial tissue. The conventional calculation of the ECV requires blood sampling to measure the haematocrit (HCT). Given the high variability of the HCT, the blood collection is recommended within 24 h of the CMR scan, limiting its applicability and posing a barrier to the clinical routine use of ECV measurements. In recent years, several research groups have proposed a method to determine the ECV by CMR without blood sampling. This is based on the inverse relationship between the T1 relaxation rate (R1) of blood and the HCT. Consequently, a ‘synthetic’ HCT could be estimated from the native blood R1, avoiding blood sampling. Methods and results We performed a review and meta-analysis of published studies on synthetic ECV, as well as a secondary analysis of previously published data to examine the effect of the chosen regression modell on bias. While, overall, a good correlation and little bias between synthetic and conventional ECV were found in these studies, questions regarding its accuracy remain. Conclusion Synthetic HCT and ECV can provide a ‘non-invasive’ quantitative measurement of the myocardium’s extracellular space when timely HCT measurements are not available and large alterations in ECV are expected, such as in cardiac amyloidosis. Due to the dependency of T1 relaxation times on the local setup, calculation of local formulas using linear regression is recommended, which can be easily performed using available data.
{"title":"Quantification of myocardial extracellular volume without blood sampling","authors":"Wensu Chen, Alessandro Faragli, Collin Goetze, Victoria Zieschang, Karl Jakob Weiss, Djawid Hashemi, Rebecca Beyer, Lorena Hafermann, Philipp Stawowy, Sebastian Kelle, Patrick Doeblin","doi":"10.1093/ehjimp/qyad022","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad022","url":null,"abstract":"Aims Cardiac magnetic resonance (CMR) T1 relaxation time mapping is an established technique primarily used to identify diffuse interstitial fibrosis and oedema. The myocardial extracellular volume (ECV) can be calculated from pre- and post-contrast T1 relaxation times and is a reproducible parametric index of the proportion of volume occupied by non-cardiomyocyte components in myocardial tissue. The conventional calculation of the ECV requires blood sampling to measure the haematocrit (HCT). Given the high variability of the HCT, the blood collection is recommended within 24 h of the CMR scan, limiting its applicability and posing a barrier to the clinical routine use of ECV measurements. In recent years, several research groups have proposed a method to determine the ECV by CMR without blood sampling. This is based on the inverse relationship between the T1 relaxation rate (R1) of blood and the HCT. Consequently, a ‘synthetic’ HCT could be estimated from the native blood R1, avoiding blood sampling. Methods and results We performed a review and meta-analysis of published studies on synthetic ECV, as well as a secondary analysis of previously published data to examine the effect of the chosen regression modell on bias. While, overall, a good correlation and little bias between synthetic and conventional ECV were found in these studies, questions regarding its accuracy remain. Conclusion Synthetic HCT and ECV can provide a ‘non-invasive’ quantitative measurement of the myocardium’s extracellular space when timely HCT measurements are not available and large alterations in ECV are expected, such as in cardiac amyloidosis. Due to the dependency of T1 relaxation times on the local setup, calculation of local formulas using linear regression is recommended, which can be easily performed using available data.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135346620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamran Abbasi, Parveen Ali, Virginia Barbour, Kirsten Bibbins-Domingo, Marcel G M Olde Rikkert, Peng Gong, Andy Haines, Ira Helfand, Richard Horton, Bob Mash, Arun Mitra, Carlos Monteiro, Elena N Naumova, Eric J Rubin, Tilman Ruff, Peush Sahni, James Tumwine, Paul Yonga, Chris Zielinski
{"title":"Reducing the risks of nuclear war: the role of health professionals","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Kirsten Bibbins-Domingo, Marcel G M Olde Rikkert, Peng Gong, Andy Haines, Ira Helfand, Richard Horton, Bob Mash, Arun Mitra, Carlos Monteiro, Elena N Naumova, Eric J Rubin, Tilman Ruff, Peush Sahni, James Tumwine, Paul Yonga, Chris Zielinski","doi":"10.1093/ehjimp/qyad018","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad018","url":null,"abstract":"","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135200506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline Morbach, Isabelle Simon, Elisabeth Danner, Götz Gelbrich, Ulrich Stefenelli, Floran Sahiti, Nina Scholz, Vladimir Cejka, Judith Albert, Georg Ertl, Christiane E Angermann, Gülmisal Güder, Stefan Frantz, Peter U Heuschmann, Christoph Maack, Stefan Störk
Abstract Aims Systolic ejection time (SET) is discussed as a treatment target in patients with heart failure (HF) and a reduced left ventricular (LV) ejection fraction (EF). We derived reference values for SET correcting for its dependence on heart rate (SETc), and explored its prognostic utility in patients admitted with decompensated HF. Methods and results SETc was derived in 4836 participants of the population-based STAAB study (mean age 55 ± 12 years, 52% women). There, mean SETc was 328 ± 18 ms, increased with age (+4.7 ms per decade), was shorter in men than women (−14.9 ms), and correlated with arterial elastance (r = 0.30; all P < 0.001). In 134 patients hospitalized with acute HF, SETc at admission was shorter when compared with the general population and differed between patients with HF with reduced EF (HFrEF; LVEF ≤40%; 269 ± 35 ms), HF with mildly reduced EF (HFmrEF; LVEF 41–49%; 294 ± 27 ms), and HF with preserved EF (HFpEF; LVEF ≥50%; 317 ± 35 ms; P < 0.001). In proportional hazard regression, an in-hospital increase in SETc was associated with an age- and sex-adjusted hazard ratio of 0.38 (95% confidence interval 0.18–0.79) in patients with HFrEF, but a hazard ratio of 2.39 (95% confidence interval 1.24–4.64) in patients with HFpEF. Conclusion In the general population, SETc increased with age and an elevated afterload. SETc was mildly reduced in patients hospitalized with HFpEF, but markedly reduced in patients with HFrEF. In-hospital prolongation of SETc predicted a favourable outcome in HFrEF, but an adverse outcome in HFpEF. Our results support the concept of a U-shaped relationship between cardiac systolic function and risk, providing a rationale for a more individualized treatment approach in patients with HF.
{"title":"Heart rate–corrected systolic ejection time: population-based reference values and differential prognostic utility in acute heart failure","authors":"Caroline Morbach, Isabelle Simon, Elisabeth Danner, Götz Gelbrich, Ulrich Stefenelli, Floran Sahiti, Nina Scholz, Vladimir Cejka, Judith Albert, Georg Ertl, Christiane E Angermann, Gülmisal Güder, Stefan Frantz, Peter U Heuschmann, Christoph Maack, Stefan Störk","doi":"10.1093/ehjimp/qyad020","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad020","url":null,"abstract":"Abstract Aims Systolic ejection time (SET) is discussed as a treatment target in patients with heart failure (HF) and a reduced left ventricular (LV) ejection fraction (EF). We derived reference values for SET correcting for its dependence on heart rate (SETc), and explored its prognostic utility in patients admitted with decompensated HF. Methods and results SETc was derived in 4836 participants of the population-based STAAB study (mean age 55 ± 12 years, 52% women). There, mean SETc was 328 ± 18 ms, increased with age (+4.7 ms per decade), was shorter in men than women (−14.9 ms), and correlated with arterial elastance (r = 0.30; all P &lt; 0.001). In 134 patients hospitalized with acute HF, SETc at admission was shorter when compared with the general population and differed between patients with HF with reduced EF (HFrEF; LVEF ≤40%; 269 ± 35 ms), HF with mildly reduced EF (HFmrEF; LVEF 41–49%; 294 ± 27 ms), and HF with preserved EF (HFpEF; LVEF ≥50%; 317 ± 35 ms; P &lt; 0.001). In proportional hazard regression, an in-hospital increase in SETc was associated with an age- and sex-adjusted hazard ratio of 0.38 (95% confidence interval 0.18–0.79) in patients with HFrEF, but a hazard ratio of 2.39 (95% confidence interval 1.24–4.64) in patients with HFpEF. Conclusion In the general population, SETc increased with age and an elevated afterload. SETc was mildly reduced in patients hospitalized with HFpEF, but markedly reduced in patients with HFrEF. In-hospital prolongation of SETc predicted a favourable outcome in HFrEF, but an adverse outcome in HFpEF. Our results support the concept of a U-shaped relationship between cardiac systolic function and risk, providing a rationale for a more individualized treatment approach in patients with HF.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Infective endocarditis (IE) in the context of coronavirus disease (COVID-19) is an emerging clinical entity. If not identified timeously, it is associated with high morbidity and mortality. Herein, we provide an overview of the literature supported by a clinical vignette, and highlight the importance of early recognition and management of IE in the context of COVID-19 infection.
{"title":"An overview of infective endocarditis in the context of COVID-19 pneumonia","authors":"Ricardo Goncalves, Ruchika Meel","doi":"10.1093/ehjimp/qyad024","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad024","url":null,"abstract":"Abstract Infective endocarditis (IE) in the context of coronavirus disease (COVID-19) is an emerging clinical entity. If not identified timeously, it is associated with high morbidity and mortality. Herein, we provide an overview of the literature supported by a clinical vignette, and highlight the importance of early recognition and management of IE in the context of COVID-19 infection.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"221 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136354565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simon Thalén, Joao G Ramos, Henrik Engblom, Andreas Sigfridsson, Peder Sörensson, Martin Ugander
Abstract Aims T1 mapping cardiovascular magnetic resonance (CMR) imaging has been used to characterize pericardial effusions. The aim of this study was to measure pericardial fluid native T1 values in healthy volunteers to establish normal values. Methods and results Prospectively recruited volunteers (n = 30) underwent CMR at 1.5 T, and native T1 maps were acquired using a modified look-locker inversion recovery 5s(3s)3s acquisition scheme. A volume of pericardial fluid was imaged in a short-axis slice and in a slice perpendicular to the short-axis orientation. A reliable measurement had a region of interest (ROI) size > 10 mm2, coefficient of variation < 10%, and a relative difference < 5% between the two slice orientations. In 26/30 (87%) of volunteers, there was a sufficient amount of pericardial fluid to enable reliable measurement. Native T1 of pericardial fluid was 3262 ± 163 (95% normal limits 2943–3581 ms) and did not differ in the perpendicular slice orientation (3267 ± 173 ms, P = 0.75), due to sex (female 3311 ± 177 vs. male 3220 ± 142 ms, P = 0.17), age (R2 = 0.03, P = 0.44), heart rate (R2 = 0.005, P = 0.7), or size of the ROI (0.06, P = 0.23). Conclusion This study shows that T1 values can be reliably measured in the pericardial fluid of healthy volunteers. It is the first to report normal reference ranges for T1 values at 1.5 T in the pericardial fluid of healthy volunteers.
目的T1定位心血管磁共振(CMR)成像已被用于心包积液的表征。本研究的目的是测量健康志愿者心包液原生T1值，以建立正常值。方法和结果前瞻性招募的志愿者(n = 30)在1.5 T时进行CMR，并使用改进的look-locker反演恢复5s(3s)3s获取方案获得原生T1图谱。在短轴片和垂直于短轴方向的片上显示大量心包积液。一个可靠的测量有一个感兴趣的区域(ROI)大小>10 mm2，变异系数<10%的相对差异<两个切片方向之间的5%。在26/30(87%)的志愿者中，有足够的心包液来进行可靠的测量。心包积液原生T1为3262±163(95%正常范围2943 ~ 3581 ms)，在垂直层位(3267±173 ms, P = 0.75)、性别(女性3311±177 vs男性3220±142 ms, P = 0.17)、年龄(R2 = 0.03, P = 0.44)、心率(R2 = 0.005, P = 0.7)、ROI大小(0.06,P = 0.23)等因素上无差异。结论健康志愿者心包液中T1值的测定是可靠的。这是首次报道健康志愿者心包液T1值在1.5 T时的正常参考范围。
{"title":"Normal values for native T1 at 1.5 T in the pericardial fluid of healthy volunteers","authors":"Simon Thalén, Joao G Ramos, Henrik Engblom, Andreas Sigfridsson, Peder Sörensson, Martin Ugander","doi":"10.1093/ehjimp/qyad028","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad028","url":null,"abstract":"Abstract Aims T1 mapping cardiovascular magnetic resonance (CMR) imaging has been used to characterize pericardial effusions. The aim of this study was to measure pericardial fluid native T1 values in healthy volunteers to establish normal values. Methods and results Prospectively recruited volunteers (n = 30) underwent CMR at 1.5 T, and native T1 maps were acquired using a modified look-locker inversion recovery 5s(3s)3s acquisition scheme. A volume of pericardial fluid was imaged in a short-axis slice and in a slice perpendicular to the short-axis orientation. A reliable measurement had a region of interest (ROI) size &gt; 10 mm2, coefficient of variation &lt; 10%, and a relative difference &lt; 5% between the two slice orientations. In 26/30 (87%) of volunteers, there was a sufficient amount of pericardial fluid to enable reliable measurement. Native T1 of pericardial fluid was 3262 ± 163 (95% normal limits 2943–3581 ms) and did not differ in the perpendicular slice orientation (3267 ± 173 ms, P = 0.75), due to sex (female 3311 ± 177 vs. male 3220 ± 142 ms, P = 0.17), age (R2 = 0.03, P = 0.44), heart rate (R2 = 0.005, P = 0.7), or size of the ROI (0.06, P = 0.23). Conclusion This study shows that T1 values can be reliably measured in the pericardial fluid of healthy volunteers. It is the first to report normal reference ranges for T1 values at 1.5 T in the pericardial fluid of healthy volunteers.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135348862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aims To verify the level of appropriateness of referral to our nuclear cardiology laboratory for stress myocardial perfusion imaging (MPI) and explore the correlation between test appropriateness patterns and ischaemia. Methods and results In 1870 consecutive patients (mean age 73 ± 12 years; 33% female) undergoing MPI, the level of imaging test appropriateness was evaluated according to the 2023 Appropriate Use Criteria (AUC) and the current European Society of Cardiology (ESC) guidelines for the management of chronic coronary syndromes. The evidence of moderate-to-severe ischaemia (i.e. summed difference score >7) was recorded. According to the AUC criteria, the MPI of 1638 (88%), 130 (7%), and 102 (5%) patients could be classified as ‘appropriate’, ‘inappropriate’, and ‘uncertain’, respectively. Similarly, in 1685 (90%) patients, the referral to MPI was adherent to ESC guidelines, while in 185 (10%), it was not. The majority of appropriate MPI tests showed the presence of moderate-to-severe ischaemia (55%), while only a limited number (10%; P < 0.05) of MPI tests with uncertain clinical appropriateness or clearly inappropriate indications did not. In patients managed adherently to ESC guidelines, invasive coronary angiography more frequently showed obstructive coronary artery disease (CAD) (93 vs. 47%, P < 0.001) and led to coronary revascularization (65 vs. 23%, P < 0.001) compared with patients managed non-adherently. Conclusion In a single-centre, single-national, single-modality population, the current rate of appropriate MPI tests is high. Appropriate referrals are associated with a higher probability of moderate-to-severe ischaemia and better downstream resource utilization than inappropriate ones.
【摘要】目的探讨核心学实验室进行应激性心肌灌注显像(MPI)检查的适宜性，并探讨检查适宜性模式与心肌缺血的相关性。方法与结果1870例患者(平均年龄73±12岁;33%女性)接受MPI，根据2023年适当使用标准(AUC)和当前欧洲心脏病学会(ESC)慢性冠状动脉综合征管理指南评估影像学检查适当性水平。记录中度至重度缺血的证据(即总差异评分>7)。根据AUC标准，1638例(88%)、130例(7%)和102例(5%)患者的MPI可分别归类为“适当”、“不适当”和“不确定”。同样，在1685例(90%)患者中，转介到MPI的患者遵循了ESC指南，而在185例(10%)患者中，没有遵循ESC指南。大多数适当的MPI测试显示存在中度至重度缺血(55%)，而只有有限数量(10%;P, lt;不确定临床适宜性或明显不适宜适应症的MPI试验没有出现0.05)。在坚持ESC指南的患者中，有创冠状动脉造影更频繁地显示阻塞性冠状动脉疾病(CAD) (93% vs 47%， P <0.001)，并导致冠状动脉血运重建术(65% vs 23%， P <0.001)，与非依从治疗的患者相比。结论在单一中心、单一国家、单一模式的人群中，目前适当的MPI检测率很高。与不适当的转诊相比，适当的转诊与更高的中度至重度缺血的可能性和更好的下游资源利用有关。
{"title":"Impact of appropriateness in clinical practice: data from a single-centre nuclear cardiology laboratory","authors":"Riccardo Liga, Dario Grassini, Assuero Giorgetti, Enrico Grasso, Stefano Dalmiani, Alessia Gimelli","doi":"10.1093/ehjimp/qyad036","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad036","url":null,"abstract":"Abstract Aims To verify the level of appropriateness of referral to our nuclear cardiology laboratory for stress myocardial perfusion imaging (MPI) and explore the correlation between test appropriateness patterns and ischaemia. Methods and results In 1870 consecutive patients (mean age 73 ± 12 years; 33% female) undergoing MPI, the level of imaging test appropriateness was evaluated according to the 2023 Appropriate Use Criteria (AUC) and the current European Society of Cardiology (ESC) guidelines for the management of chronic coronary syndromes. The evidence of moderate-to-severe ischaemia (i.e. summed difference score &gt;7) was recorded. According to the AUC criteria, the MPI of 1638 (88%), 130 (7%), and 102 (5%) patients could be classified as ‘appropriate’, ‘inappropriate’, and ‘uncertain’, respectively. Similarly, in 1685 (90%) patients, the referral to MPI was adherent to ESC guidelines, while in 185 (10%), it was not. The majority of appropriate MPI tests showed the presence of moderate-to-severe ischaemia (55%), while only a limited number (10%; P &lt; 0.05) of MPI tests with uncertain clinical appropriateness or clearly inappropriate indications did not. In patients managed adherently to ESC guidelines, invasive coronary angiography more frequently showed obstructive coronary artery disease (CAD) (93 vs. 47%, P &lt; 0.001) and led to coronary revascularization (65 vs. 23%, P &lt; 0.001) compared with patients managed non-adherently. Conclusion In a single-centre, single-national, single-modality population, the current rate of appropriate MPI tests is high. Appropriate referrals are associated with a higher probability of moderate-to-severe ischaemia and better downstream resource utilization than inappropriate ones.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135782182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski
{"title":"Time to treat the climate and nature crisis as one indivisible global health emergency","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski","doi":"10.1093/ehjimp/qyad031","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad031","url":null,"abstract":"","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135738254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ramtin Hakimjavadi, Juan Lu, Yeung Yam, Girish Dwivedi, Gary R Small, Benjamin J W Chow
Abstract Aims Indiscriminate coronary computed tomography angiography (CCTA) referrals for suspected coronary artery disease could result in a higher rate of equivocal and non-diagnostic studies, leading to inappropriate downstream resource utilization or delayed time to diagnosis. We sought to develop a simple clinical tool for predicting the likelihood of a non-diagnostic CCTA to help identify patients who might be better served with a different test. Methods and results We developed a clinical scoring system from a cohort of 21 492 consecutive patients who underwent CCTA between February 2006 and May 2021. Coronary computed tomography angiography study results were categorized as normal, abnormal, or non-diagnostic. Multivariable logistic regression analysis was conducted to produce a model that predicted the likelihood of a non-diagnostic test. Machine learning (ML) models were utilized to validate the predictor selection and prediction performance. Both logistic regression and ML models achieved fair discriminate ability with an area under the curve of 0.630 [95% confidence interval (CI) 0.618–0.641] and 0.634 (95% CI 0.612–0.656), respectively. The presence of a cardiac implant and weight >100 kg were among the most influential predictors of a non-diagnostic study. Conclusion We developed a model that could be implemented at the ‘point-of-scheduling’ to identify patients who would be best served by another non-invasive diagnostic test.
【摘要】目的冠状动脉ct血管造影(CCTA)对疑似冠状动脉疾病的不加区分的转诊可能导致更高比例的模棱两可和非诊断性研究，导致下游资源利用不当或延误诊断时间。我们试图开发一种简单的临床工具来预测非诊断性CCTA的可能性，以帮助确定可能更适合使用其他测试的患者。方法和结果我们从2006年2月至2021年5月期间连续接受CCTA的21492名患者中开发了一个临床评分系统。冠状动脉ct血管造影研究结果分为正常、异常和非诊断性。进行多变量逻辑回归分析，以产生预测非诊断测试可能性的模型。使用机器学习(ML)模型来验证预测器的选择和预测性能。logistic回归和ML模型均获得了公平的区分能力，曲线下面积分别为0.630[95%置信区间(CI) 0.618-0.641]和0.634 (95% CI 0.612-0.656)。在非诊断性研究中，心脏植入物的存在和体重100公斤是最具影响力的预测因素。我们开发了一个可以在“调度点”实施的模型，以确定哪些患者最适合进行另一种非侵入性诊断测试。
{"title":"Pre-screening for Non-Diagnostic Coronary CT Angiography","authors":"Ramtin Hakimjavadi, Juan Lu, Yeung Yam, Girish Dwivedi, Gary R Small, Benjamin J W Chow","doi":"10.1093/ehjimp/qyad026","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad026","url":null,"abstract":"Abstract Aims Indiscriminate coronary computed tomography angiography (CCTA) referrals for suspected coronary artery disease could result in a higher rate of equivocal and non-diagnostic studies, leading to inappropriate downstream resource utilization or delayed time to diagnosis. We sought to develop a simple clinical tool for predicting the likelihood of a non-diagnostic CCTA to help identify patients who might be better served with a different test. Methods and results We developed a clinical scoring system from a cohort of 21 492 consecutive patients who underwent CCTA between February 2006 and May 2021. Coronary computed tomography angiography study results were categorized as normal, abnormal, or non-diagnostic. Multivariable logistic regression analysis was conducted to produce a model that predicted the likelihood of a non-diagnostic test. Machine learning (ML) models were utilized to validate the predictor selection and prediction performance. Both logistic regression and ML models achieved fair discriminate ability with an area under the curve of 0.630 [95% confidence interval (CI) 0.618–0.641] and 0.634 (95% CI 0.612–0.656), respectively. The presence of a cardiac implant and weight &gt;100 kg were among the most influential predictors of a non-diagnostic study. Conclusion We developed a model that could be implemented at the ‘point-of-scheduling’ to identify patients who would be best served by another non-invasive diagnostic test.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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