European heart journal. Imaging methods and practice最新文献

Although the use of bioprostheses for tricuspid valve replacement (bTVR) has always been controversial in terms of results, their long-term durability is not well described. This systematic review aimed to identify, assess the quality, and review the outcomes in studies reporting on long-term outcomes after bTVR published over the last 20 years. Medline, Embase, and Cochrane CENTRAL were searched for studies reporting on at least five years of follow-up after bTVR. Cohort characteristics, definitions of structural valve deterioration (SVD), whose definition followed the criteria, and outcomes were summarized. The risk of bias in included studies was assessed using the Cochrane QUIPS tool. Ninteen studies, including 2541 patients were identified. The commonest implanted bioprosthesis was porcine-type with 1950 patients receiving this valve, followed by bovine pericardial (BP) type with 591 cases. Freedom from SVD in studies reporting outcomes up to 5-10 years ranged from 80% to 100% and in studies reporting to 15-20 years from 47% to 90%. Freedom from re-operation in studies reporting up to 5-10 years ranged from 94.7% to 100% and in studies reporting up to 15-20 years ranged from 49% to 95%. Reports of post-operative echocardiography were lacking, despite the heavy reliance on echocardiography for SVD diagnosis. There is considerable variability in reporting bTVR-related long-term outcomes. As such, it is difficult to generate an unbiased, generalizable understanding of long-term outcomes after bTVR across the spectrum of tricuspid disease phenotypes. Future clinical research will require more attention and detailed data report to fil such a gap.

[This corrects the article DOI: 10.1093/ehjimp/qyaf049.].

Aims: Individuals experiencing a sudden cardiac arrest with ventricular fibrillation and no identifiable cause are diagnosed with idiopathic ventricular fibrillations (IVFs). 2D speckle tracking echocardiography (2DSTE) has been able to detect differences between IVF patients and controls. However, the association between these differences and the risk of ventricular arrhythmias (VAs) remains unknown.This study aimed to investigate whether parameters derived from myocardial deformation analysis using 2DSTE are associated with the recurrence of VA in IVF patients.

Methods and results: This single-centre, cross-sectional study enrolled IVF patients treated with an implantable cardioverter defibrillator. IVF patients were compared with healthy sex- and age-matched controls. Furthermore, IVF patients were categorized into two groups (IVF patients with or without recurrent VA) based on the recurrence of VA over a 5-year follow-up period. Left ventricular global longitudinal strain (LVGLS) and left ventricular mechanical dispersion (LVMD) were investigated using 2DSTE and compared across all groups. Fifty-six IVF patients, males 39 (69.9%), age 49 ± 15 years, and 55 controls were included. IVF patients showed significantly increased LVMD (35.78 ± 13.4 ms vs. 31.0 ± 9.8 ms; P = 0.03) and decreased LVGLS (-18.8% ± 3.0% vs. -20.5% ± 2.7%; P < 0.01) compared with controls. IVF patients with recurrent VA had significantly increased LVMD compared with IVF patients without recurrent VA (43.63 ± 13.63 vs. 33.16 ± 12.45; P = 0.02).

Conclusion: IVF patients had an increased LVMD and decreased LVGLS compared with healthy controls. Increased LVMD was significantly associated with recurrent VA in IVF patients suggesting a potential clinical value in risk stratification of VA recurrency in IVF patients.

Aortic diseases, including aneurysmal and occlusive pathologies of the thoracic and abdominal aorta, represent a significant source of cardiovascular morbidity and mortality. This narrative review explores the role of modern and emerging imaging modalities in the management of aortic disease and highlights the pivotal roles of computed tomography angiography (CTA), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS). CTA remains the cornerstone for evaluating aneurysms, dissections, and traumatic injuries, offering high spatial resolution, rapid acquisition, and detailed anatomical assessment. MRI, particularly with advanced sequences such as 4D flow, provides comprehensive multiparametric evaluation without radiation exposure, making it ideal for younger patients and those requiring repeat imaging. Positron emission tomography (PET), especially when integrated with CTA or MRI, enables metabolic characterization of inflammation and infection in aortic walls. Ultrasound, particularly CEUS, remains indispensable in abdominal aortic aneurysm (AAA) screening and post-endovascular aortic aneurysm repair (EVAR) surveillance, especially in patients with renal impairment. Emerging technologies, including hybrid imaging, radiomics, and artificial intelligence (AI) are reshaping the landscape of aortic diagnostics. These innovations enhance detection of subtle imaging features, automate measurements, and may enable prediction of disease progression or complications.

Aims: In acute ST-segment elevation myocardial infarction, ischaemia and reperfusion lead to a cascade of myocardial injury that can be characterized by cardiac magnetic resonance (CMR) imaging, including coagulation necrosis, oedema, papillary muscle damage, microvascular obstruction, and intramyocardial haemorrhage. Conventional CMR protocols require multiple sequences to be performed and complicated analysis. This study evaluates SPOT-MAPPING, a sequence that acquires co-registered T2 maps and dual bright- and black-blood late gadolinium enhancement (LGE) images in a single scan.

Methods and results: SPOT-MAPPING employs a single-shot, ECG-triggered 2D sequence alternating between bright- and black-blood LGE imaging with varying T2 weightings. We prospectively enrolled 20 STEMI patients undergoing CMR at 1.5 T within 4-7 days post-emergent coronary intervention. SPOT-MAPPING's segmentation times and reproducibility of myocardial injury markers (oedema, scar size, transmurality, papillary muscle damage) were assessed against conventional T2 mapping and phase-sensitive inversion recovery (PSIR). SPOT-MAPPING halved left ventricular wall segmentation time (∼3 min) while maintaining high reproducibility for oedema, scar size, and transmurality (ICC > 0.8). It improved papillary muscle damage detection over PSIR (8 vs. 3 patients) and showed comparable T2 values with conventional T2 mapping (remote: 45.0 ± 3.6 ms vs. 45.9 ± 3.7 ms, P = 0.746; oedema: 67.6 ± 10.3 ms vs. 71.8 ± 8.6 ms, P = 0.373). Agreement with PSIR for scar quantification was strong (mean bias: volume +1.5 mL, size +2.9%, transmurality +2.8%). SPOT-MAPPING demonstrated higher inter- and intraobserver reproducibility for scar size as a percentage of oedema volume compared with PSIR combined with conventional T2 mapping (ICC = 0.98 vs. 0.89 and 0.93 vs. 0.85).

Conclusion: SPOT-MAPPING offers a time-efficient and reproducible CMR method for myocardial injury assessment post-STEMI.

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.