Circulation: Cardiovascular Imaging最新文献

{"title":"Impact of Virtual Reality on Transcatheter Aortic Valve Implantation: A Prospective Randomized Controlled Trial.","authors":"Dominika Kanschik, Dominik Steinhoff, Kathrin Klein, Artur Lichtenberg, Christina Ballázs, Dmytro Stadnik, Maximilian Scherner, Gerald Antoch, Malte Kelm, Tobias Zeus, Christian Jung","doi":"10.1161/CIRCIMAGING.125.018922","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.018922","url":null,"abstract":"<p><strong>Background: </strong>Accurate preprocedural planning is crucial for a successful transcatheter aortic valve implantation to ensure patient safety and valve longevity. Through 3-dimensional visualization, virtual reality (VR) offers the potential to enhance this process. The study investigated whether the inclusion of VR in preprocedural planning can improve the procedural preparation, impact intraprocedural parameters, and improve short-term patient outcomes.</p><p><strong>Methods: </strong>This randomized, prospective, controlled study included 140 patients who underwent transcatheter aortic valve implantation at the University Hospital Duesseldorf between April and August 2024. In the control group, preprocedural planning was based on multislice computed tomography data using 3mensio software, while in the intervention group, it was supplemented with VR software. In addition, interventionalists assessed both tools via a structured questionnaire.</p><p><strong>Results: </strong>The evaluation did not reveal any relevant differences in patient characteristics. VR was superior to 3mensio software with respect to the 3-dimensional understanding (<i>P</i><0.001). Similarly, depth perception, visualization of atherosclerotic plaques, and iliofemoral tortuosity were better in the VR group. Both methods were found to be useful and helpful in preparing for the procedure. There were no significant differences in procedural data between the 2 groups. However, the VR group had a lower rate of bleeding at the access site (<i>P</i><0.05). There was no significant difference in the length of hospital stay or postprocedural transthoracic echocardiography data evaluations.</p><p><strong>Conclusions: </strong>The data show that virtual reality visualization can optimize preparation for the procedure by improving the 3-dimensional understanding of the aortic valve and adjacent structures. The detailed visualization of the access routes can lead to a reduction in periprocedural complications.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018922"},"PeriodicalIF":7.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764122","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":"Kinetics of Technetium-Labeled Cardiac Amyloid Radionuclide Imaging.","authors":"Brett W Sperry, Evan O'Keefe, Eric V Burgett, Erika Hutt, Philip G Jones, James A Case, Timothy M Bateman","doi":"10.1161/CIRCIMAGING.125.019371","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.019371","url":null,"abstract":"<p><strong>Background: </strong>Technetium-labeled bone-avid tracers have been repurposed to diagnose transthyretin cardiac amyloidosis without rigorous kinetic studies. Supply shortages have necessitated the use of hydroxymethylene diphosphonate (HMDP) as an alternative to technetium-99m pyrophosphate, though comparative data remain limited. This study characterizes tracer kinetics using quantitative single-photon emission computed tomography with computed tomography.</p><p><strong>Methods: </strong>Twenty-four subjects undergoing evaluation for transthyretin cardiac amyloidosis underwent serial single-photon emission computed tomography with computed tomography imaging with pyrophosphate (n=11) or HMDP (n=13) on a cadmium zinc telluride system (SpectrumDynamics Veriton). Single-photon emission computed tomography acquisitions were obtained at intervals from 5 minutes to 3 hours post-injection. Quantitative parameters included standardized uptake values (SUVs), target-to-background ratios, and total cardiac activity derived from 3-dimensional volumes of interest for myocardium, blood pool, and bone. Mixed-effects models with splines compared time-activity trends between tracers.</p><p><strong>Results: </strong>All 16 subjects with positive imaging demonstrated visual myocardial uptake above the blood pool within 10 minutes post-injection. Myocardial SUVs were similar between tracers and decreased linearly over time, whereas blood pool SUVs declined biexponentially and bone SUVs increased exponentially. HMDP exhibited faster blood pool clearance and higher bone uptake than pyrophosphate, resulting in higher heart-to-blood pool target-to-background ratios across all time points. Bone activity exceeded myocardial activity earlier with HMDP (mean ≈90 versus 130 minutes; <i>P</i><0.001), resulting in a visual reduction of myocardial intensity with HMDP due to scaling. No association was observed between quantitative indices and clinical disease severity markers.</p><p><strong>Conclusions: </strong>Both pyrophosphate and HMDP provide diagnostic myocardial visualization within 10 minutes of injection, with similar myocardial SUVs that decline linearly over time. HMDP demonstrates more rapid blood pool clearance and greater bone uptake, resulting in earlier skeletal dominance and often requiring upward adjustment of image intensity to visualize myocardial uptake on delayed images. The results provide kinetic data that can inform future protocol optimization and quantitative standardization.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e019371"},"PeriodicalIF":7.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653898","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-Left Ventricular Tunnel Secondary to LVOT Diverticulum in an Adult.","authors":"Lan Lan, Zhiling Liu, Mei Zhu, Hao Liang, Qiao Li, Jie Zhang","doi":"10.1161/CIRCIMAGING.126.019659","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.126.019659","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e019659"},"PeriodicalIF":7.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638148","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":"Sex-Specific Prognostic Value of Aortic Valve Calcium and the Risk for Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis (MESA).","authors":"Natalie Marrero, Kunal Jha, Jelani K Grant, Alexander C Razavi, Matthew J Budoff, Sanjiv J Shah, Jerome I Rotter, Roger S Blumenthal, Wendy S Post, Martha Gulati, Leslee J Shaw, George Thanassoulis, Michael J Blaha, Seamus P Whelton","doi":"10.1161/CIRCIMAGING.125.018849","DOIUrl":"10.1161/CIRCIMAGING.125.018849","url":null,"abstract":"<p><strong>Background: </strong>In general, females have lower aortic valve calcium (AVC) scores compared with males of similar age, and the AVC score threshold for diagnosing severe aortic stenosis (AS) is lower for females. We examined whether the association of AVC with the long-term risk of clinically significant AS differed for females compared with males.</p><p><strong>Methods: </strong>AVC was measured using cardiac computed tomography among 6810 MESA (Multi-Ethnic Study of Atherosclerosis) participants. We examined AVC as a continuous (ln [AVC+1]) and categorical variable (0, 1-99, 100-299, ≥300 AU). Incident moderate or severe AS was adjudicated using standard clinical criteria with a median follow-up of 16 years. The association between AVC and AS was examined using multivariable-adjusted Cox proportional hazards regression.</p><p><strong>Results: </strong>Females comprised 52.9% of participants, with AVC >0 present among 10.1% of females and 17.0% of males. There were 65 cases of incident AS in females and 75 in males. AVC as a continuous variable was associated with a higher risk of incident AS for females (hazard ratio, 1.91 [95% CI, 1.68-2.16]) and males (hazard ratio, 2.13 [95% CI, 1.88-2.41]). There was no interaction between AVC and sex (<i>P</i>=0.31) for their association with AS. Females and males had similar adjusted hazards for incident AS across AVC categories, and for those with AVC ≥300, the hazard ratio was 134.9 (95% CI, 45.1-403.9) for females and 132.8 (95% CI, 6.2-274.9) for males.</p><p><strong>Conclusions: </strong>The association of AVC with the long-term risk of incident AS was similar for females and males, further supporting the utility of AVC as a prognostic marker for incident AS.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018849"},"PeriodicalIF":7.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638140","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":"Cardiac Imaging in Clinical Trials of Intervention in Aortic Valve Stenosis.","authors":"Bethlehem Mengesha, Carlos Giuliani, Georgios Tzimas, Antonela Zanuttini, Jonathon Leipsic, Philippe Pibarot","doi":"10.1161/CIRCIMAGING.125.018670","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.018670","url":null,"abstract":"<p><p>Cardiac imaging and in particular transthoracic echocardiography and computed tomography play a major role in the selection of the patients for surgical or transcatheter aortic valve replacement, for the assessment or procedural success and early prosthetic valve hemodynamics following aortic valve replacement, and for the evaluation and follow-up of the prosthetic valve structure and function in the longer-term, which is key to demonstrate the valve durability. The purpose of this review article is thus to present the role of cardiac imaging, and particularly transthoracic echocardiography and computed tomography, in: (1) patient selection for intervention; (2) assessment of procedural and device success, and of intended performance of the valve; and (3) assessment of the long-term success, valve durability, and prognosis, for clinical trials of intervention in patients with aortic stenosis. Transthoracic echocardiography is the primary imaging modality to detect and stage bioprosthetic valve dysfunction. However, multimodality imaging, including transesophageal echocardiography and computed tomography, is often necessary to determine the cause of bioprosthetic valve dysfunction and make the differential diagnosis between prosthesis-patient mismatch, structural valve deterioration, thrombosis, pannus, or endocarditis. The clinical trials in the field of structural heart disease, and particularly in the field of aortic valve intervention, include imaging end points as part of the primary or key secondary end points. Standardized methods and definitions should be applied to adjudicate these imaging end points, and ideally, these trial end points should be analyzed by independent imaging core labs.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018670"},"PeriodicalIF":7.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627308","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":"Ruptured Left Sinus of Valsalva Aneurysm With Concomitant Aortic Stenosis Treated by TAVR: CT and TEE Findings.","authors":"Yosuke Kirii, Masaki Ishiyama, Kosuke Kitada, Akihiro Takasaki, Taku Omori, Emiyo Sugiura, Tairo Kurita, Takeo Takahashi, Kaoru Dohi","doi":"10.1161/CIRCIMAGING.125.019498","DOIUrl":"10.1161/CIRCIMAGING.125.019498","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e019498"},"PeriodicalIF":7.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442823","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":"Multicenter Evaluation of Myocardial Flow Reserve as a Prognostic Marker for Mortality in ¹³N-Ammonia PET Myocardial Perfusion Imaging.","authors":"Giselle Ramirez, Valerie Builoff, Robert J H Miller, Mark Lemley, Isabel Carvajal-Juarez, Erick Alexanderson, Thomas L Rosamond, Na Song, Mark I Travin, Leandro Slipczuk, Andrew J Einstein, Samuel B Wopperer, Marcelo F Di Carli, Panithaya Chareonthaitawee, Piotr J Slomka","doi":"10.1161/CIRCIMAGING.125.018729","DOIUrl":"10.1161/CIRCIMAGING.125.018729","url":null,"abstract":"<p><strong>Background: </strong>Myocardial flow reserve (MFR), measured by positron emission tomography (PET) myocardial perfusion imaging, provides valuable information on epicardial coronary disease, diffuse atherosclerosis, and microvascular function. Despite its routine use, the prognostic efficacy of ¹³N-ammonia PET MFR remains unconfirmed in larger multicenter cohorts of patients with suspected or known coronary artery disease.</p><p><strong>Methods: </strong>We considered patients from 5 sites in the REFINE PET (Registry of Flow and Perfusion Imaging for Artificial Intelligence with PET) registry who underwent ¹³N-ammonia PET myocardial perfusion imaging for coronary artery disease. Clinical and imaging data were collected at the time of myocardial perfusion imaging. MFR was quantified as the ratio of stress to rest myocardial blood flow, using QPET software (Cedars-Sinai Medical Center, Los Angeles, CA). The primary outcome was all-cause mortality. Survival analyses were performed using Kaplan-Meier and Cox regression models adjusted for clinical and imaging covariates.</p><p><strong>Results: </strong>In total, 6277 patients were included (median age of 65 years, 56% male). Median follow-up time was 3.8 years. There were 1895 patients with MFR ≤2 and 4382 with MFR >2. Patients with MFR ≤2 had significantly higher mortality than those with MFR >2 (n=701 [37.0%] versus n=537 [12.3%], respectively; <i>P</i><0.001). Annualized all-cause mortality rates by MFR and summed stress score ranged from 1.7 to 15.8. In multivariable analysis, MFR ≤2 was independently associated with increased all-cause mortality in the overall population (hazard ratio, 2.70 [95% CI, 2.41-3.03]; <i>P</i><0.001), even among patients with no perfusion defects (hazard ratio, 2.36 [95% CI, 1.93-2.89]; <i>P</i><0.001). Mortality risk decreased across increasing MFR deciles, ranging from hazard ratio, 2.73 (95% CI, 2.39-3.11) to hazard ratio, 0.35 (95% CI, 0.25-0.49).</p><p><strong>Conclusions: </strong>In this large multicenter cohort, MFR derived from ¹³N-ammonia PET myocardial perfusion imaging is a strong, independent predictor of all-cause mortality, even in patients with normal perfusion. An MFR of ≤2 identifies elevated risk, while higher values are associated with improved survival. These findings support the routine integration of MFR to enhance risk stratification in patients with suspected or known coronary artery disease.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018729"},"PeriodicalIF":7.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084310","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":"Revascularization of Single-Vessel Coronary Artery Disease: Is it Still Worth Doing?","authors":"Riccardo Liga, Danilo Neglia","doi":"10.1161/CIRCIMAGING.126.019753","DOIUrl":"10.1161/CIRCIMAGING.126.019753","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e019753"},"PeriodicalIF":7.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627322","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":"Myocardial Flow Reserve With ¹³N-Ammonia PET: From Quantification to Clinical Consequence.","authors":"Kevin E Boczar, Robert deKemp, Rob S Beanlands","doi":"10.1161/CIRCIMAGING.126.019571","DOIUrl":"10.1161/CIRCIMAGING.126.019571","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e019571"},"PeriodicalIF":7.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622040","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":"How to Use Multimodality Imaging for Pericarditis.","authors":"Joseph El Roumi, Jibran Ikram, Tom Kai Ming Wang, Allan L Klein","doi":"10.1161/CIRCIMAGING.125.018544","DOIUrl":"10.1161/CIRCIMAGING.125.018544","url":null,"abstract":"<p><p>Pericarditis spans acute, recurrent/incessant, effusive, and constrictive phenotypes, and accurate assessment of inflammatory activity and chronicity is essential to guide therapy and anticipate outcomes. Although transthoracic echocardiography remains the first-line modality to evaluate pericardial effusion, tamponade physiology, and constrictive hemodynamics, it is limited for tissue characterization. Multimodality imaging integrates complementary strengths: cardiac magnetic resonance provides the most sensitive noninvasive assessment of pericardial edema and late gadolinium enhancement to phenotype active inflammation versus chronic fibrotic disease and to support prognostication (including identification of potentially reversible constriction); cardiac computed tomography offers superior anatomic detail for pericardial thickness, calcification, complex effusions, and preoperative planning for pericardiectomy, and can serve as an alternative when cardiac magnetic resonance is contraindicated; and ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography adds targeted value by detecting metabolically active pericardial inflammation in diagnostically ambiguous or refractory cases and may inform escalation to advanced therapies. We synthesize practical, guideline-aligned applications of these modalities, highlight common pitfalls and system-level constraints, and propose a simplified framework using key imaging biomarkers edema/inflammation, neovascularization (late gadolinium enhancement), thickening, effusion/tamponade, constriction, and fibrosis/calcification to enable imaging-guided therapy, including treatment escalation and tapering strategies in recurrent disease and selection of patients for pericardiectomy.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018544"},"PeriodicalIF":7.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472771","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}