Circulation: Cardiovascular Imaging最新文献

{"title":"Serial Changes in Ventricular Strain in Symptomatic Obstructive Hypertrophic Cardiomyopathy Treated With Mavacamten: Insights From the VALOR-HCM Trial.","authors":"Milind Y Desai, Yuichiro Okushi, Andrew Gaballa, Qiuqing Wang, Jeffrey B Geske, Anjali T Owens, Sara Saberi, Andrew Wang, Paul C Cremer, Mark Sherrid, Neal K Lakdawala, Albree Tower-Rader, David Fermin, Srihari S Naidu, Kathy L Lampl, Amy J Sehnert, Steven E Nissen, Zoran B Popovic","doi":"10.1161/CIRCIMAGING.124.017185","DOIUrl":"10.1161/CIRCIMAGING.124.017185","url":null,"abstract":"<p><strong>Background: </strong>In severely symptomatic patients with obstructive hypertrophic cardiomyopathy, VALOR-HCM (A Study to Evaluate Mavacamten in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy Who Are Eligible for Septal Reduction Therapy) demonstrated that mavacamten reduces the need for septal reduction therapy with sustained improvement in left ventricular (LV) outflow tract gradients and symptoms. Global longitudinal strain (GLS), a measure of regional myocardial function, is a more sensitive marker of systolic function. In VALOR-HCM, we assessed serial changes in LV and right ventricular (RV) strain.</p><p><strong>Methods: </strong>VALOR-HCM included 112 patients with symptomatic obstructive hypertrophic cardiomyopathy (mean, 60 years; 51% male; LV ejection fraction, 68%). Patients assigned to mavacamten at baseline continued the drug for 56 weeks (n=56) and those assigned to placebo (n=52) transitioned to mavacamten from weeks 16 to 56 (40-week exposure). LV-GLS and RV-GLS assessment was performed using a vendor-neutral software. Non-foreshortened apical (4-, 3-, and 2-chamber) views were used to obtain peak LV-GLS. RV focused 4-chamber view was used to calculate RV 4-chamber and free wall strain. A more negative strain value is favorable.</p><p><strong>Results: </strong>At baseline, the mean LV-GLS, RV 4-chamber, and free wall strain values were -14.7%, -22.2%, and -16.8%, respectively (all worse than reported normal means). In the total study sample, LV-GLS significantly improved from baseline to week 56 (<i>P</i>=0.02). Twelve patients had transient reduction in LV ejection fraction (<50%) requiring temporary drug interruption (including 3 permanent discontinuations). The LV-GLS in this subgroup was worse at baseline versus total study population (-11.4%), with no significant worsening from baseline through week 56 (<i>P</i>=0.64). Both free wall and 4-chamber RV-GLS remained unchanged from baseline to week 56 (<i>P</i>=0.62 and <i>P</i>=0.56, respectively).</p><p><strong>Conclusions: </strong>In VALOR-HCM, treatment with mavacamten improved LV-GLS from baseline through week 56 (with no significant worsening of LV-GLS in patients with a reduction in LV ejection fraction ≤50%), suggesting a favorable long-term impact on regional LV systolic function. Additionally, there was no detrimental impact on RV systolic function.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04349072.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017185"},"PeriodicalIF":6.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104867","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":"Chronic Thromboembolic Pulmonary Hypertension: When Thrombus Mandates Definite Diagnosis to Occur in the Operating Room.","authors":"Irene Martín de Miguel, María Jesús López-Gude, Amaya Martínez Meñaca, Yolanda Revilla Ostolaza, Fernando Arribas Ynsaurriaga, Pilar Escribano Subías","doi":"10.1161/CIRCIMAGING.123.016543","DOIUrl":"10.1161/CIRCIMAGING.123.016543","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e016543"},"PeriodicalIF":6.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247618","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":"Giant Coronary Artery Aneurysm Causing Ventricular Tachycardia and Right Ventricular Outflow Tract Obstruction.","authors":"Usman Alam, Dan G Halpern, Robert M Donnino, Larry A Chinitz, Adam J Small","doi":"10.1161/CIRCIMAGING.124.016728","DOIUrl":"10.1161/CIRCIMAGING.124.016728","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e016728"},"PeriodicalIF":6.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260673","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":"Value of Ischemia and Coronary Anatomy in Prognosis and Guiding Revascularization Among Patients With Stable Ischemic Heart Disease.","authors":"Krishna K Patel, Poghni A Peri-Okonny, Assuero Giorgetti, Leslee J Shaw, Alessia Gimelli","doi":"10.1161/CIRCIMAGING.123.016587","DOIUrl":"10.1161/CIRCIMAGING.123.016587","url":null,"abstract":"<p><strong>Background: </strong>The value of physiological ischemia versus anatomic severity of disease for prognosis and management of patients with stable coronary artery disease (CAD) is widely debated.</p><p><strong>Methods: </strong>A total of 1764 patients who had rest-stress cadmium-zinc-telluride single-photon emission computed tomography myocardial perfusion imaging and angiography (invasive or computed tomography) were prospectively enrolled and followed for cardiac death/nonfatal myocardial infarction. The CAD prognostic index (CADPI) was used to quantify the extent and severity of angiographic disease. Prognostic value was assessed using Cox models, adjusted for pretest risk, known CAD, stressor, left ventricular ejection fraction, %ischemia and infarct, CADPI, and early (90-day) revascularization. Incremental prognostic value was evaluated using net reclassification index.</p><p><strong>Results: </strong>The mean age was 69.7±9.5 years, 24.4% were women, and 29.3% had known CAD. Significant ischemia (>10%) was present in 28.4%. Nonobstructive, single, and multivessel disease was present in 256 (14.5%), 772 (43.8%), and 736 (41.7%), respectively. Early revascularization occurred in 579 (32.8%). Cardiac death/myocardial infarction occurred in 148 (8.4%) over a 4.6-year median follow-up. Both %ischemia and CADPI provided independent and incremental prognostic value over pretest clinical risk (<i>P</i><0.001). In a model containing both ischemia and anatomy, ischemia was prognostic (hazard ratio per 5% ↑, 1.35 [95% CI, 1.11-1.63]; <i>P</i>=0.002) but CADPI was not (hazard ratio per 10-unit ↑, 1.09 [95% CI, 0.99-1.20]; <i>P</i>=0.07). Early revascularization modified the risk associated with %ischemia (interaction <i>P</i>=0.003) but not with CADPI (interaction <i>P</i>=0.6). %Ischemia and single-photon emission computed tomography variables added incremental prognostic value over clinical risk and CADPI (net reclassification index, 20.3% [95% CI, 9%-32%]; <i>P</i><0.05); however, CADPI was not incrementally prognostic beyond pretest risk, %ischemia, and single-photon emission computed tomography variables (net reclassification index, 3.1% [95% CI, -5% to 15%]; <i>P</i>=0.21).</p><p><strong>Conclusions: </strong>Ischemic burden provides independent and incremental prognostic value beyond CAD anatomy and identifies patients who benefit from early revascularization. The anatomic extent of disease has independent prognostic value over clinical risk factors but offers limited incremental benefit for prognosis and guiding revascularization beyond physiological severity (ischemia).</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e016587"},"PeriodicalIF":6.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11439561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153264","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":"Chronic Subepicardial Hematoma: A Multimodality Imaging Diagnostic Approach After Elective Percutaneous Transluminal Coronary Angioplasty.","authors":"Maria Riasat, Sakul Sakul, Vikram Agarwal","doi":"10.1161/CIRCIMAGING.124.016667","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.016667","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e016667"},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035428","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":"Carcinoid Pulmonary Valve Stenosis: Multimodality Imaging and Transcatheter Valve Implant With Prestenting Technique.","authors":"Valeria Cammalleri, Mariagrazia Piscione, Valeria Maria De Luca, Giorgio Antonelli, Nino Cocco, Annunziata Nusca, Dario Gaudio, Edoardo Nobile, Federica Coletti, Antonio Bianchi, Giovanni Schinzari, Francesco Grigioni, Gian Paolo Ussia","doi":"10.1161/CIRCIMAGING.124.016785","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.016785","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e016785"},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035427","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":"Impaired Left Atrial Reserve Function in Heart Failure With Preserved Ejection Fraction.","authors":"Kazuki Kagami, Tomonari Harada, Naoki Yuasa, Yuki Saito, Hidemi Sorimachi, Fumitaka Murakami, Ayami Naito, Yuta Tani, Toshimitsu Kato, Naoki Wada, Takeshi Adachi, Hideki Ishii, Masaru Obokata","doi":"10.1161/CIRCIMAGING.124.016549","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.016549","url":null,"abstract":"<p><strong>Background: </strong>Left atrial (LA) dysfunction is common in heart failure (HF) with preserved ejection fraction. However, data on the pathophysiologic impacts of impaired LA functional reserve remained limited. We sought to determine the association of abnormal LA dynamics during exercise with cardiovascular reserve, exercise capacity, and clinical outcomes.</p><p><strong>Methods: </strong>Patients with HF with preserved ejection fraction (n=231) and controls without HF (n=219) underwent exercise stress echocardiography with simultaneous expired gas analysis. LA function was assessed at rest and during exercise using speckle-tracking echocardiography.</p><p><strong>Results: </strong>Patients with HF with preserved ejection fraction demonstrated less increase in LA reservoir and booster pump strain during exercise than those in controls. The degree of LA dilation was more closely related to exercise LA reservoir strain than to resting LA strain (Meng test, <i>P</i>=0.002). The presence of impaired LA reservoir strain during exercise was associated with poorer biventricular systolic reserve and cardiac output augmentation, more severe right ventricular-pulmonary artery uncoupling, and lower peak oxygen consumption. Patients with a lower exercise LA reservoir strain had a 2.7-fold increased risk of HF events (hazard ratio, 2.66 [95% CI, 1.32-5.38]; <i>P</i>=0.006). Among patients with follow-up echocardiography, initiation of guideline-directed medical therapy or atrial fibrillation ablation showed significant improvements in LA reservoir (<i>P</i><0.001 and <i>P</i>=0.022) and booster pump strain (<i>P</i>=0.011 and 0.028) at rest and during exercise, respectively.</p><p><strong>Conclusions: </strong>Impaired LA reservoir function during exercise in HF with preserved ejection fraction is associated with biventricular reserve limitations, exercise intolerance, and increased risks of HF events.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":"17 8","pages":"e016549"},"PeriodicalIF":6.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008314","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":"Light Bulb in the Right Atrium.","authors":"Zhiyue Liu, Shichu Liang, He Huang","doi":"10.1161/CIRCIMAGING.123.016399","DOIUrl":"10.1161/CIRCIMAGING.123.016399","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e016399"},"PeriodicalIF":6.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874338","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 Ventricular Remodeling in Aortic Stenosis and Systemic Hypertension: Phenotypical Look-Alikes or Distinct Siblings?","authors":"Bobak Heydari, Michael Jerosch-Herold","doi":"10.1161/CIRCIMAGING.124.017266","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.017266","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":"17 8","pages":"e017266"},"PeriodicalIF":6.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008318","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":"Differentiating Left Ventricular Remodeling in Aortic Stenosis From Systemic Hypertension.","authors":"Masliza Mahmod, Kenneth Chan, Joao F Fernandes, Rina Ariga, Betty Raman, Ernesto Zacur, Ho-Fon Royce Law, Marzia Rigolli, Jane M Francis, Sairia Dass, Kevin O'Gallagher, Saul G Myerson, Theodoros D Karamitsos, Stefan Neubauer, Pablo Lamata","doi":"10.1161/CIRCIMAGING.123.016489","DOIUrl":"10.1161/CIRCIMAGING.123.016489","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular (LV) hypertrophy occurs in both aortic stenosis (AS) and systemic hypertension (HTN) in response to wall stress. However, differentiation of hypertrophy due to these 2 etiologies is lacking. The aim was to study the 3-dimensional geometric remodeling pattern in severe AS pre- and postsurgical aortic valve replacement and to compare with HTN and healthy controls.</p><p><strong>Methods: </strong>Ninety-one subjects (36 severe AS, 19 HTN, and 36 healthy controls) underwent cine cardiac magnetic resonance. Cardiac magnetic resonance was repeated 8 months post-aortic valve replacement (n=18). Principal component analysis was performed on the 3-dimensional meshes reconstructed from 109 cardiac magnetic resonance scans of 91 subjects at end-diastole. Principal component analysis modes were compared across experimental groups together with conventional metrics of shape, strain, and scar.</p><p><strong>Results: </strong>A unique AS signature was identified by wall thickness linked to a LV left-right axis shift and a decrease in short-axis eccentricity. HTN was uniquely linked to increased septal thickness. Combining these 3 features had good discriminative ability between AS and HTN (area under the curve, 0.792). The LV left-right axis shift was not reversible post-aortic valve replacement, did not associate with strain, age, or sex, and was predictive of postoperative LV mass regression (R²=0.339, <i>P</i>=0.014).</p><p><strong>Conclusions: </strong>Unique remodeling signatures might differentiate the etiology of LV hypertrophy. Preliminary findings suggest that LV axis shift is characteristic in AS, is not reversible post-aortic valve replacement, predicts mass regression, and may be interpreted to be an adaptive mechanism.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":"17 8","pages":"e016489"},"PeriodicalIF":6.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008313","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}