Circulation: Cardiovascular Imaging最新文献

{"title":"Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction.","authors":"Doron Aronson, Hend Sliman, Sobhi Abadi, Ida Maiorov, Daniel Perlow, Diab Mutlak, Jonathan Lessick","doi":"10.1161/CIRCIMAGING.123.016276","DOIUrl":"10.1161/CIRCIMAGING.123.016276","url":null,"abstract":"<p><strong>Background: </strong>Quantification of left atrial (LA) conduit function and its contribution to left ventricular (LV) filling is challenging because it requires simultaneous measurements of both LA and LV volumes. The functional relationship between LA conduit function and the severity of diastolic dysfunction remains controversial. We studied the role of LA conduit function in maintaining LV filling in advanced diastolic dysfunction.</p><p><strong>Methods: </strong>We performed volumetric and flow analyses of LA function across the spectrum of LV diastolic dysfunction, derived from a set of consecutive patients undergoing multiphasic cardiac computed tomography scanning (n=489). From LA and LV time-volume curves, we calculated 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume. Results were prospectively validated on a group of patients with severe aortic stenosis (n=110).</p><p><strong>Results: </strong>The early passive filling progressively decreased with worsening diastolic function (<i>P</i><0.001). The atrial booster contribution to stroke volume modestly increases with impaired relaxation (<i>P</i>=0.021) and declines with more advanced diastolic function (<i>P</i><0.001), thus failing to compensate for the reduction in early filling. The conduit volume increased progressively (<i>P</i><0.001), accounting for 75% of stroke volume (interquartile range, 63-81%) with a restrictive filling pattern, compensating for the reduction in both early and booster functions. Similar results were obtained in patients with severe aortic stenosis. The pulmonary artery systolic pressure increased in a near-linear fashion when the conduit contribution to stroke volume increased above 60%. Maximal conduit flow rate strongly correlated with mitral E-wave velocity (r=0.71; <i>P</i><0.0001), indicating that the increase in mitral E wave in diastolic dysfunction represents the increased conduit flow.</p><p><strong>Conclusions: </strong>An increase in conduit volume contribution to stroke volume represents a compensatory mechanism to maintain LV filling in advanced diastolic dysfunction. The increase in conduit volume despite increasing LV diastolic pressures is accomplished by an increase in pulmonary venous pressure.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11111319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transthoracic Echocardiography-Guided Placement of a Pulmonary Artery Catheter in a Patient With a Known Persistent Left but Unknown Absent Right Superior Vena Cava.","authors":"Jenna L Leclerc, Raymond Clemes, Cristina Fuss, Conrad J Macon, Peter M Schulman","doi":"10.1161/CIRCIMAGING.123.016301","DOIUrl":"10.1161/CIRCIMAGING.123.016301","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normative Values of Echocardiographic Chamber Size and Function in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis.","authors":"Monica Mukherjee, Jordan B Strom, Jonathan Afilalo, Mo Hu, Lauren Beussink-Nelson, Jiwon Kim, Karima Addetia, Alain G Bertoni, John S Gottdiener, Erin D Michos, Julius M Gardin, Sanjiv J Shah, Benjamin H Freed","doi":"10.1161/CIRCIMAGING.123.016420","DOIUrl":"10.1161/CIRCIMAGING.123.016420","url":null,"abstract":"<p><strong>Background: </strong>Echocardiographic (2-dimensional echocardiography) thresholds indicating disease or impaired functional status compared with normal physiological aging in individuals aged ≥65 years are not clearly defined. In the present study, we sought to establish standard values for 2-dimensional echocardiography parameters related to chamber size and function in older adults without cardiopulmonary or cardiometabolic conditions.</p><p><strong>Methods: </strong>In this cross-sectional study of 3032 individuals who underwent 2-dimensional echocardiography at exam 6 in the MESA (Multi-Ethnic Study of Atherosclerosis), 608 participants fulfilled our inclusion criteria of healthy aging, with normative values defined as the mean ± 1.96 standard deviation and compared across sex and race and ethnicity. Functional status measures included NT-proBNP (N-terminal pro-B-type natriuretic peptide), 6-minute walk distance, and Kansas City Cardiomyopathy Questionnaire. Prognostic performance using MESA cutoffs was compared with established guideline cutoffs using time-to-event analysis.</p><p><strong>Results: </strong>The normative aging cohort (69.5±7.0 years, 46.2% male, 47.5% White) had lower NT-proBNP, higher 6-minute walk distance, and higher (better) Kansas City Cardiomyopathy Questionnaire summary values. Women had significantly smaller chamber sizes and better biventricular systolic function. White participants had the largest chamber dimensions, whereas Chinese participants had the smallest, even after adjustment for body size. Current guidelines identified 81.6% of healthy older adults in MESA as having cardiac abnormalities.</p><p><strong>Conclusions: </strong>Among a large, diverse group of healthy older adults, we found significant differences in cardiac structure and function by sex and race/ethnicity, which may signal sex-specific cardiac remodeling with advancing age. It is crucial for existing guidelines to consider the observed and clinically significant differences in cardiac structure and function associated with healthy aging. Our study highlights that existing guidelines, which grade abnormalities in echocardiographic cardiac chamber size and function based on younger individuals, may not adequately address the anticipated changes associated with normal aging.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11108741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Severity of Aortic Stenosis on CT-Have We Arrived?","authors":"Tiffany Dong, Tom Kai Ming Wang","doi":"10.1161/CIRCIMAGING.124.016920","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.016920","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Valve Calcification Density Measured by MDCT in the Assessment of Aortic Stenosis Severity.","authors":"Andréanne Powers, Mulham Ali, Nicolas Lavoie, Amal Haujir, Nils Sofus Borg Mogensen, Sebastian Ludwig, Kristian Altern Øvrehus, Lionel Tastet, Catherine Rhéaume, Niklas Schofer, Jordi Sanchez Dahl, Marie-Annick Clavel","doi":"10.1161/CIRCIMAGING.123.016267","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.123.016267","url":null,"abstract":"<p><strong>Background: </strong>Aortic valve calcification (AVC) indexation to the aortic annulus (AA) area measured by Doppler echocardiography (AVCd_Echo) provides powerful prognostic information in patients with aortic stenosis (AS). However, the indexation by AA measured by multidetector computed tomography (AVCd_CT) has never been evaluated. The aim of this study was to compare AVC, AVCd_CT, and AVCd_Echo with regard to hemodynamic correlations and clinical outcomes in patients with AS.</p><p><strong>Methods: </strong>Data from 889 patients, mainly White, with calcific AS who underwent Doppler echocardiography and multidetector computed tomography within the same episode of care were retrospectively analyzed. AA was measured both by Doppler echocardiography and multidetector computed tomography. AVCd_CT severity thresholds were established using receiver operating characteristic curve analyses in men and women separately. The primary end point was the occurrence of all-cause mortality.</p><p><strong>Results: </strong>Correlations between gradient/velocity and AVCd were stronger (both <i>P</i>≤0.005) using AVCd_CT (r=0.68, <i>P</i><0.001 and r=0.66, <i>P</i><0.001) than AVC (r=0.61, <i>P</i><0.001 and r=0.60, <i>P</i><0.001) or AVCd_Echo (r=0.61, <i>P</i><0.001 and r=0.59, <i>P</i><0.001). AVCd_CT thresholds for the identification of severe AS were 334 Agatston units (AU)/cm² for women and 467 AU/cm² for men. On a median follow-up of 6.62 (6.19-9.69) years, AVCd_CT ratio was superior to AVC ratio and AVCd_Echo ratio to predict all-cause mortality in multivariate analyses (hazard ratio [HR], 1.59 [95% CI, 1.26-2.00]; <i>P</i><0.001 versus HR, 1.53 [95% CI, 1.11-1.65]; <i>P</i>=0.003 versus HR, 1.27 [95% CI, 1.11-1.46]; <i>P</i><0.001; all likelihood test <i>P</i>≤0.004). AVCd_CT ratio was superior to AVC ratio and AVCd_Echo ratio to predict survival under medical treatment in multivariate analyses (HR, 1.80 [95% CI, 1.27-1.58]; <i>P</i><0.001 compared with HR, 1.55 [95% CI, 1.13-2.10]; <i>P</i>=0.007; HR, 1.28 [95% CI, 1.03-1.57]; <i>P</i>=0.01; all likelihood test <i>P</i><0.03). AVCd_CT ratio predicts mortality in all subgroups of patients with AS.</p><p><strong>Conclusions: </strong>AVCd_CT appears to be equivalent or superior to AVC and AVCd_Echo to assess AS severity and predict all-cause mortality. Thus, it should be used to evaluate AS severity in patients with nonconclusive echocardiographic evaluations with or without low-flow status. AVCd_CT thresholds of 300 AU/cm² for women and 500 AU/cm² for men seem to be appropriate to identify severe AS. Further studies are needed to validate these thresholds, especially in diverse populations.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microvascular Dysfunction in Hypertensive Disorders of Pregnancy: Implications for Evaluation, Treatment, and Further Research.","authors":"Kathryn J Lindley, Victor G Davila-Roman","doi":"10.1161/CIRCIMAGING.124.016816","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.016816","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Hypertensive Disorders of Pregnancy With Coronary Microvascular Dysfunction 8 to 10 Years After Delivery.","authors":"Malamo E Countouris, Janet M Catov, Jianhui Zhu, Nikki de Jong, Judith Brands, Xucai Chen, W Tony Parks, Kathryn L Berlacher, Robin E Gandley, Adam C Straub, Flordeliza S Villanueva","doi":"10.1161/CIRCIMAGING.124.016561","DOIUrl":"10.1161/CIRCIMAGING.124.016561","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy (HDP) are associated with subsequent adverse cardiac remodeling and cardiovascular disease. The role of myocardial microvascular disease among individuals with HDP and left ventricular (LV) remodeling as a potential link to cardiovascular disease is unknown. We aimed to determine whether individuals with HDP history have coronary microvascular dysfunction measured by coronary flow reserve 8 to 10 years after delivery and whether microvascular dysfunction correlates with LV remodeling.</p><p><strong>Methods: </strong>Individuals with pregnancies delivered from 2008 to 2010 underwent burst-replenishment myocardial contrast echocardiography (2017-2020) to quantify myocardial perfusion at rest and during dobutamine stress. Video intensity versus time data were used to derive β, the rate of rise of video intensity, a correlate for myocardial blood flow. Coronary flow reserve was calculated as the ratio of β at peak stress to β at rest, averaged across LV myocardial regions of interest.</p><p><strong>Results: </strong>We studied 91 individuals (aged 38±6 and 9.1±0.9 years postdelivery) and 19 with a history of HDP. Individuals with coronary microvascular dysfunction (coronary flow reserve <2.0; n=13) had a higher proportion of HDP (46.2% versus 16.7%; <i>P</i>=0.026) and higher prepregnancy body mass index, baseline heart rate, and hemoglobin A1c compared with those without microvascular dysfunction. The association of coronary flow reserve and HDP was attenuated after adjusting for cardiometabolic factors (<i>P</i>=0.133). In exploratory subgroup analyses, individuals with both LV remodeling (relative wall thickness >0.42) and HDP (n=12) had the highest proportion of microvascular dysfunction (41.7% versus +HDP-LV remodeling [n=7] 14.3%; -HDP+LV remodeling [n=26] 7.7%; <i>P</i>=0.0498).</p><p><strong>Conclusions: </strong>In this small study, HDP history is associated with coronary microvascular dysfunction 1 decade after delivery, findings that may, in part, be driven by metabolic factors including obesity and diabetes. Microvascular dysfunction may contribute to cardiovascular disease among individuals with a history of HDP.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11115371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nuclear Cardiology: The Past, Present, and Future.","authors":"Jamieson M Bourque, George A Beller","doi":"10.1161/CIRCIMAGING.124.016875","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.016875","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Conduit Volume Provides Insights Into Left Ventricular Diastolic Function.","authors":"Sherif F Nagueh","doi":"10.1161/CIRCIMAGING.124.016896","DOIUrl":"10.1161/CIRCIMAGING.124.016896","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In This Issue of the Journal.","authors":"Robert J Gropler","doi":"10.1161/CIRCIMAGING.124.017006","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.017006","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}