Circulation: Cardiovascular Imaging最新文献

{"title":"Cardiac Imaging in Structural Valve Clinical Trials: Secondary Mitral Regurgitation.","authors":"Omar Chehab, Rosangela Capasso, Victoria Delgado, Rebecca T Hahn","doi":"10.1161/CIRCIMAGING.126.018671","DOIUrl":"10.1161/CIRCIMAGING.126.018671","url":null,"abstract":"<p><p>Transcatheter mitral valve interventions including transcatheter edge-to-edge repair and transcatheter mitral valve replacement have emerged as vital therapies for secondary mitral regurgitation (SMR) in patients at high or prohibitive surgical risk. Advanced multimodality imaging is central to patient selection, procedural guidance, and outcome assessment. This review delineates the roles of echocardiography (transthoracic and transesophageal), cardiac computed tomography, and cardiac magnetic resonance in structural valve clinical trials. We examine the imaging criteria used for patient selection in current transcatheter mitral valve intervention trials for SMR, as well as the key imaging findings following device implantation. Important lessons from advanced imaging in these trials include: (1) atrial and ventricular SMR (A-SMR and V-SMR) represent distinct disease morphologies that have led to divergent management recommendations; (2) the results of V-SMR trials can be explained by differences in regurgitant severity relative to left ventricular size; (3) numerous exclusionary anatomic considerations for transcatheter mitral valve replacement have limited trial enrollment and clinical applicability; (4) immediate postdevice imaging parameters predict outcomes; and (5) surrogate imaging end points at follow-up are associated with clinical outcomes.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018671"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073690","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":"Novel Transvalvular Flow Criteria Reduce Indeterminate Stress Echocardiography and Refine Risk Stratification in Low-Gradient Aortic Stenosis.","authors":"Anastasia Vamvakidou, Mohamed-Salah Annabi, Edyta Plonska-Gosciniak, Ana G Almeida, Tao Chen, Ezequiel Guzzetti, Abdellaziz Dahou, Ian G Burwash, Matthias Koschutnik, Philipp E Bartko, Jutta Bergler-Klein, Julia Mascherbauer, Stefan Orwat, Helmut Baumgartner, João L Cavalcante, Danuta Sorysz, Wojciech Kosmala, Zbigniew Gasior, Juan Felipe Ortega Restrepo, Oleksandr Danylenko, Rajdeep Khattar, Marie-Annick Clavel, Frank A Flachskampf, Philippe Pibarot, Roxy Senior","doi":"10.1161/CIRCIMAGING.125.018621","DOIUrl":"10.1161/CIRCIMAGING.125.018621","url":null,"abstract":"<p><strong>Background: </strong>Guidelines advocate the use of dobutamine stress echocardiography (DSE) in low-gradient aortic stenosis (aortic valve area [AVA] <1 cm² with aortic valve mean gradient <40 mm Hg) with reduced left ventricular ejection fraction (<50%) for subsequent patient management. A significant proportion of patients have nondiagnostic DSE (indeterminate aortic stenosis [AS]).</p><p><strong>Methods: </strong>We aimed to assess the impact of DSE on the management of patients with classical low-gradient AS and the use of the newly proposed transvalvular flow-based criteria for AS classification. Accordingly, we retrospectively analyzed 287 patients with classical low-gradient AS who underwent DSE. Both the conventional (severe AS when AVA <1 cm² and aortic valve mean gradient ≥40 mm Hg, moderate AS when AVA ≥1 cm², and indeterminate AS when AVA <1 cm² and aortic valve mean gradient <40 mm Hg during stress) and the proposed combined transvalvular flow criteria (severe AS when AVA <1 cm² at a flow rate ≥210 mL/s or projected AVA <1 cm²) were assessed.</p><p><strong>Results: </strong>After DSE, 84 (29%) patients had severe AS, 81 (28%) had moderate AS, and 122 (43%) had indeterminate AS. Over the median follow-up of 12.0 (interquartile range, 5-33) months, more patients with severe AS (73%) underwent aortic valve intervention compared with those with moderate (40%) and indeterminate AS (44%; <i>P</i><0.001). Use of the newly proposed criteria in the indeterminate AS group improved the proportion of diagnostic tests in the overall population from 57% to 91% and reduced the proportion of indeterminate AS to 9%. Aortic valve intervention was beneficial in patients with reclassified severe AS (HR, 0.50 [95% CI, 0.27-0.92]; <i>P</i>=0.03), whereas the benefit was uncertain in the remaining indeterminate AS group (HR, 0.77 [95% CI, 0.22-2.75]; <i>P</i>=0.69). After aortic valve intervention, patients with conventionally diagnosed severe AS had a better outcome compared with patients with reclassified severe AS (HR, 2.88 [95% CI, 1.34-6.21]; <i>P</i>=0.007).</p><p><strong>Conclusions: </strong>In this real-world study, the transvalvular flow-based criteria for severe AS markedly reduced the number of indeterminate DSE. Within the indeterminate AS group, patients with reclassified severe AS derived benefit from aortic valve intervention.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018621"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024020","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":"Virtual Reality to Supplement CT in Procedural Planning for Transcatheter Aortic Valve Implantation.","authors":"Krishnarpan Chatterjee, James Dundas","doi":"10.1161/CIRCIMAGING.126.020468","DOIUrl":"10.1161/CIRCIMAGING.126.020468","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e020468"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024053","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":"Optimal Patient Selection for Aortic Valve and Concomitant Ascending Aortic Procedures: Role of Multimodality Imaging.","authors":"Susan K Keen, Shinya Unai, Vidyasagar Kalahasti, Paul Schoenhagen, Lars G Svensson, Milind Y Desai","doi":"10.1161/CIRCIMAGING.126.019448","DOIUrl":"10.1161/CIRCIMAGING.126.019448","url":null,"abstract":"<p><p>Management of aortic valve and aortic root disease has evolved alongside an expanding therapeutic landscape that includes valve repair, valve-sparing root replacement, composite graft reconstruction, transcatheter therapies, and autograft-based approaches. Because these strategies differ in durability, hemodynamic performance, and implications for future reintervention, procedural selection must be individualized. Multimodality imaging is central to this process, integrating valve phenotype, annulus-root geometry, ventricular remodeling, and clinical context to refine procedural planning. As surgical and transcatheter options continue to expand, imaging remains fundamental to durable, patient-centered management of aortic valve and root disease.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e019448"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104814","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":"Impinged and Disrupted Left Bundle Branch by a Transcatheter Self-Expandable Aortic Valve.","authors":"Kyoko Miyazaki, Jo Anne Olivas, Yuichiro Miyazaki, Takanori Sato, Mark Rimmer, Issam D Moussa, Michael C Fishbein, Kalyanam Shivkumar, Shumpei Mori","doi":"10.1161/CIRCIMAGING.126.020146","DOIUrl":"10.1161/CIRCIMAGING.126.020146","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e020146"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548083","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":"Opportunistic CT-Based Quantification of Myosteatosis: A Potent Universal Imaging Biomarker for Frailty and Mortality.","authors":"Perry J Pickhardt","doi":"10.1161/CIRCIMAGING.126.020488","DOIUrl":"10.1161/CIRCIMAGING.126.020488","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e020488"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069304","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":"Navigating Indeterminate Stress Echocardiography in Low-Gradient Aortic Stenosis: Improved Phenotyping but With Unclear Clinical Implications.","authors":"Bassim El-Sabawi, Brian R Lindman","doi":"10.1161/CIRCIMAGING.126.020501","DOIUrl":"10.1161/CIRCIMAGING.126.020501","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e020501"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104837","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":"Response by Zhang et al to Letter Regarding Article, \"RACI: A Novel Prognostic Marker in Functional Tricuspid Regurgitation\".","authors":"Robert S Zhang, Elizabeth Manowitz, Jiwon Kim","doi":"10.1161/CIRCIMAGING.126.020492","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.126.020492","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e020492"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104865","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":"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":"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 VR 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":9.1,"publicationDate":"2026-10-01","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":"Granulomatous Mimic of Immune Checkpoint Inhibitor Myocarditis.","authors":"Maxime Robert-Halabi, Stephane Ederhy, Houssam Bendoudouch, Joe-Elie Salem","doi":"10.1161/CIRCIMAGING.126.020119","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.126.020119","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e020119"},"PeriodicalIF":9.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929123","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}