Circulation: Cardiovascular Imaging最新文献

{"title":"Angiography-Derived Microcirculatory Resistance in Detecting Microvascular Obstruction and Predicting Heart Failure After STEMI.","authors":"Guanyu Lu, Lei Zhao, Keyao Hui, Zhihui Lu, Xiaoli Zhang, Hai Gao, Xiaohai Ma","doi":"10.1161/CIRCIMAGING.124.017506","DOIUrl":"10.1161/CIRCIMAGING.124.017506","url":null,"abstract":"<p><strong>Background: </strong>Microvascular obstruction (MVO) is associated with heart failure (HF) following ST-segment-elevation myocardial infarction. Angiography-derived microcirculatory resistance (AMR), a wire- and adenosine-free measure, may facilitate early assessment of microvascular function post-primary percutaneous coronary intervention. This study aimed to evaluate the ability of AMR to detect MVO and its prognostic value for predicting HF in patients with ST-segment-elevation myocardial infarction post-primary percutaneous coronary intervention.</p><p><strong>Methods: </strong>Patients with consecutive ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention with a cardiac magnetic resonance examination 2 to 7 days post-procedure between April 2016 and February 2023 were retrospectively reviewed. AMR was computed from coronary angiography. MVO was identified and quantified via cardiac magnetic resonance. The end point was new-onset HF during follow-up.</p><p><strong>Results: </strong>Overall, 475 patients (aged 56.8±11.7 years; 399 men) were included. The area under the curve for AMR to detect MVO was 0.821 (95% CI, 0.782-0.859), with an optimal cutoff value of 2.7 mm Hg*s/cm. During a median follow-up of 37.3 months, 121 (25.5%) patients developed HF. AMR, whether as a continuous (per 0.5-mm Hg*s/cm increase; hazard ratio, 1.29 [95% CI, 1.10-1.52]; <i>P</i>=0.002) or categorical (AMR >2.7 mm Hg*s/cm; hazard ratio, 2.15 [95% CI, 1.43-3.22]; <i>P</i><0.001) variable, was independently associated with HF after adjusting for traditional risk factors (age, symptom-to-balloon time, left anterior descending coronary artery, and ejection fraction) and late gadolinium enhancement-cardiac magnetic resonance parameters. AMR improved prognostication over traditional risk factors and late gadolinium enhancement-cardiac magnetic resonance parameters (net reclassification improvement, 0.533; <i>P</i><0.001; integrative discrimination index, 0.023; <i>P</i>=0.005).</p><p><strong>Conclusions: </strong>AMR showed good diagnostic performance in detecting MVO and was an independent and incremental predictor of HF in patients with ST-segment-elevation myocardial infarction post-primary percutaneous coronary intervention.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017506"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771559","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":"Progressive LV Dysfunction and Adverse Outcomes After Aortic Valve Replacement With Bioprosthetic Valves in Young Patients.","authors":"Alexander C Egbe, Heidi M Connolly, Ahmed T Abdelhalim, Maan Jokhadar, Luke J Burchill, Joseph A Dearani, Hartzell V Schaff","doi":"10.1161/CIRCIMAGING.124.017905","DOIUrl":"10.1161/CIRCIMAGING.124.017905","url":null,"abstract":"<p><strong>Background: </strong>Bioprosthetic valve dysfunction and reoperations/reinterventions are common after aortic valve replacement (AVR) with bioprosthetic valves, leading to cycles of left ventricular (LV) pressure overload and unloading. The purpose of this study was to compare postoperative changes in LV structure and function and their relationship to clinical outcomes in young patients who underwent AVR with bioprosthetic valves (Bio_AVR group) versus mechanical prosthetic valves (Mech_AVR group).</p><p><strong>Methods: </strong>Retrospective study of adults with congenital heart disease who underwent AVR at Mayo Clinic (2003-2023). The Bio_AVR group was matched 1:2 to the Mech_AVR group. LV indices (LV mass index, relative wall thickness, LV global longitudinal strain, averaged e', and averaged E/e') and clinical indices (NT-proBNP [N-terminal pro-B-type natriuretic peptide] and New York Heart Association class) were assessed preoperatively, and at 1, 5, and 10 years post-AVR.</p><p><strong>Results: </strong>We studied 151 and 302 patients in the Bio_AVR and Mech_AVR groups, respectively (age 38±16 years, 58% males). Both groups had similar LV and clinical indices at baseline and 1 year post-AVR. However, the Bio_AVR group had higher LV mass index, relative wall thickness, and averaged E/e', and lower averaged e' and LV global longitudinal strain at 5 and 10 years post-AVR. Of 51 patients from the Bio_AVR group who underwent a second AVR, there was less robust improvement in LV indices and clinical indices after the second AVR compared with the first AVR.</p><p><strong>Conclusions: </strong>AVR with a bioprosthetic valve was associated with progressive LV hypertrophy and dysfunction, and worsening clinical status compared with mechanical prosthetic valves. This provides further evidence against the use of bioprosthetic AVR in young patients.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017905"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771675","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":"Impact of Aortic Valve Replacement Choices in Young Patients: Investing for a Lifetime of Success.","authors":"Simrat Kaur, Christine L Jellis","doi":"10.1161/CIRCIMAGING.125.018355","DOIUrl":"10.1161/CIRCIMAGING.125.018355","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018355"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966775","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":"From Pixels to Patterns: Radiomic Subphenotyping of Left Ventricular Hypertrophy on Echocardiography.","authors":"Evangelos K Oikonomou, Rohan Khera","doi":"10.1161/CIRCIMAGING.125.018291","DOIUrl":"10.1161/CIRCIMAGING.125.018291","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018291"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961339","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":"Multimodality Imaging of Arrhythmic Risk in Mitral Valve Prolapse.","authors":"Luca Cristin, Lionel Tastet, Dipan J Shah, Marc A Miller, Francesca N Delling","doi":"10.1161/CIRCIMAGING.124.017313","DOIUrl":"10.1161/CIRCIMAGING.124.017313","url":null,"abstract":"<p><p>Mitral valve prolapse (MVP) affects 2% to 3% of the general population and is typically benign. However, a subset of patients may develop arrhythmic complications, including sudden cardiac arrest and sudden cardiac death. This review explores the critical role of multimodality imaging in risk stratification for arrhythmic MVP, emphasizing high-risk features such as bileaflet involvement, mitral annular disjunction, the double-peak strain pattern, mechanical dispersion, and myocardial fibrosis. Echocardiography remains the first-line imaging tool for MVP diagnosis, enabling detailed assessment of leaflet morphology, mitral annular disjunction, and mitral regurgitation quantification. Speckle tracking provides insights into abnormal valvular-myocardial mechanics as a potential arrhythmogenic mechanism in MVP. Cardiac magnetic resonance (CMR) offers detailed myocardial tissue characterization through assessment of replacement and interstitial fibrosis using late gadolinium enhancement and T₁ mapping/extracellular volume fraction, respectively. Hybrid positron emission tomography/CMR highlights the role of inflammation, which may coexist with fibrosis, in explaining the presence of malignant arrhythmias even with relatively limited fibrosis. The assessment of diffuse fibrosis and inflammation by CMR and positron emission tomography/CMR is particularly valuable in patients without classic imaging risk factors such as mitral annular disjunction, severe mitral regurgitation, or replacement fibrosis. We propose an algorithm integrating clinical, rhythmic, echocardiographic, CMR, and positron emission tomography/CMR parameters for arrhythmic risk stratification and management. Although multimodality imaging is essential for comprehensive risk assessment, most available parameters have not yet been validated in prospective studies nor linked directly to mortality. Consequently, these imaging findings should be interpreted alongside the presence of complex ventricular ectopy, which remains the most robust predictor of mortality in arrhythmic MVP.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017313"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975358","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":"Rare Presentation and Treatment Strategy of Acute Myocardial Infarction in a Young Patient.","authors":"El-Moatasem Gabr, Amr Darwish, Mohammed A Chamsi-Pasha","doi":"10.1161/CIRCIMAGING.124.017546","DOIUrl":"10.1161/CIRCIMAGING.124.017546","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017546"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846011","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":"Two Hearts Beating in One Chest.","authors":"Isabella Leo, Giandomenico Bisaccia, Joyce Wong, Fernando Riesgo-Gil, Peter Kellman, Chiara Bucciarelli-Ducci","doi":"10.1161/CIRCIMAGING.124.017666","DOIUrl":"10.1161/CIRCIMAGING.124.017666","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017666"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846020","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":"Toward Multiparametric MRI to Unravel Myocardial Pathology in Cardiac Amyloidosis.","authors":"Olivier F Clerc, Michael Jerosch-Herold, Sharmila Dorbala","doi":"10.1161/CIRCIMAGING.125.018178","DOIUrl":"10.1161/CIRCIMAGING.125.018178","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018178"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961342","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":"Severe Mitral Regurgitation in Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis.","authors":"Shani Dahan, Jacob P Dal-Bianco, Ygal Plakht, Mayooran Namasivayam, Romain Capoulade, Xin Zeng, Jonathan Passeri, Evin Yucel, Michael H Picard, Robert A Levine, Judy Hung","doi":"10.1161/CIRCIMAGING.124.017598","DOIUrl":"10.1161/CIRCIMAGING.124.017598","url":null,"abstract":"<p><strong>Background: </strong>Patients with paradoxical low-flow, low-gradient severe aortic stenosis exhibit low transvalvular flow rate (Q), while maintaining preserved left ventricular ejection fraction. Severe mitral regurgitation (MR) also causes a low-flow state, adding complexity to diagnosis and management. This study aimed to examine the impact of severe MR on outcomes in paradoxical low-flow, low-gradient severe aortic stenosis.</p><p><strong>Methods: </strong>Data from an institutional echo database identified 1189 patients with adjudicated severe aortic stenosis (aortic valve area ≤1.0 cm²), low transaortic gradients (mean gradient <40 mm Hg), preserved left ventricular ejection fraction (≥50%), and low-flow rate (Q ≤210 mL/s) to confirm paradoxical low-flow, low-gradient severe aortic stenosis. Subgroups were based on MR severity (severe and non-severe). Clinical outcomes included all-cause mortality, aortic valve replacement, heart failure hospitalizations, and a composite outcome.</p><p><strong>Results: </strong>In the severe MR group (n=80), patients had lower flow rates, increased left ventricular dimensions, and a more eccentric hypertrophy pattern compared with non-severe MR (n=1109). Over a follow-up of up to 5 years, severe MR correlated with higher all-cause mortality (<i>P</i>=0.02) and aortic valve replacement rates (<i>P</i>=0.012). After multivariable adjustment, severe MR was independently associated with increased all-cause mortality risk (hazard ratio=1.43; <i>P</i>=0.011) and composite outcome (hazard ratio=1.64; <i>P</i><0.001). Aortic valve replacement significantly reduced mortality at every MR degree, with the most substantial impact in severe MR (hazard ratio=0.18; <i>P</i><0.001). Propensity-adjusted models demonstrated a stronger aortic valve replacement impact with increasing MR degree (<i>P</i>_interaction=0.044).</p><p><strong>Conclusions: </strong>Severe MR in paradoxical low-flow, low-gradient severe aortic stenosis is associated with adverse outcomes and distinctive left ventricular remodeling. Aortic valve replacement improves survival across all MR grades, with greater impact in severe MR.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017598"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669405","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":"Artificial Intelligence-Enhanced Analysis of Echocardiography-Based Radiomic Features for Myocardial Hypertrophy Detection and Etiology Differentiation.","authors":"Inki Moon, Jina Lee, Seung-Ah Lee, Dawun Jeong, Jaeik Jeon, Yeonggul Jang, Sihyeon Jeong, Jiyeon Kim, Hong-Mi Choi, In-Chang Hwang, Youngtaek Hong, Goo-Yeong Cho, Yeonyee E Yoon, Hyuk-Jae Chang","doi":"10.1161/CIRCIMAGING.124.017436","DOIUrl":"10.1161/CIRCIMAGING.124.017436","url":null,"abstract":"<p><strong>Background: </strong>While echocardiography is pivotal for detecting left ventricular hypertrophy (LVH), it struggles with etiology differentiation. To enhance LVH assessment, we aimed to develop an artificial intelligence algorithm using echocardiography-based radiomics. This algorithm is designed to detect LVH and differentiate its common etiologies, such as hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA), and hypertensive heart disease (HHD), based on echocardiographic images.</p><p><strong>Methods: </strong>The developmental data sets from multiple medical centers included 867 subjects, with an independent external test set from a single tertiary medical center containing 619 subjects. Radiomic feature analysis was conducted on 4 echocardiographic views, extracting both conventional and harmonization-driven myocardial textures along with myocardial geographic features. Then, we developed classification models for each condition. Variable contributions were evaluated using Shapley Additive Explanations analysis.</p><p><strong>Results: </strong>The radiomics-based LightGBM model, selected from internal validation, maintained strong performance in the external test set (area under the curve of 0.96 for HCM, 0.89 for CA, and 0.86 for HHD). Compared with the logistic regression model using conventional echocardiographic parameters (left ventricular ejection fraction, left ventricular mass index, left atrial volume index, and E/e'), the final model demonstrated superior sensitivity (0.89 versus 0.80 for HCM, 0.80 versus 0.80 for CA, and 0.75 versus 0.33 for HHD) and F1-score (0.87 versus 0.57 for HCM, 0.84 versus 0.72 for CA, and 0.82 versus 0.50 for HHD). Feature analysis highlighted that harmonization-driven textures played a key role in differentiating HCM, while conventional textures and myocardial thickness were influential in differentiating CA and HHD.</p><p><strong>Conclusions: </strong>This study confirms that artificial intelligence-enhanced echocardiography-based radiomics effectively differentiate the etiology of LVH, highlighting the potential of artificial intelligence-driven texture and geographic analysis in LVH evaluation.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017436"},"PeriodicalIF":6.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718012","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}