Malek Nayfeh, Mahmoud Al Rifai, Ahmed Ibrahim Ahmed, Faisal Nabi, Mouaz Al-Mallah
{"title":"The Prognostic Interplay of Coronary Artery Calcium Volume and Density with Myocardial Flow Reserve and Incident Cardiovascular Events.","authors":"Malek Nayfeh, Mahmoud Al Rifai, Ahmed Ibrahim Ahmed, Faisal Nabi, Mouaz Al-Mallah","doi":"10.1093/ehjci/jeaf143","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf143","url":null,"abstract":"<p><strong>Background: </strong>It is important to evaluate the relationship between coronary plaque characteristics and myocardial blood flow (MBF) to determine coronary phenotypes that may predispose to cardiovascular disease.</p><p><strong>Objectives: </strong>To study the association between coronary artery calcium (CAC) volume and density and positron emission tomography (PET)-derived myocardial flow reserve (MFR) and their relationship with incident cardiovascular disease.</p><p><strong>Methods: </strong>The study population consisted of consecutive patients who were referred for clinically indicated PET myocardial perfusion imaging between 2019 and 2024. CAC was assessed in a separate gated scan done just prior to PET and calculated using the Agatston score. Since the Agatston score includes calcified plaques (≥130 HU), soft and low-density plaques were not assessed. MFR was calculated as the ratio of stress to rest MBF. Patients with CAC=0 and those with known CAD were excluded.</p><p><strong>Results: </strong>The study population consisted of 3,884 individuals with mean (SD) age 69 (±10.5) years. When CAC volume and density were included in the same model, CAC density was positively associated with MFR (β coefficient= 0.10, 95% CI 0.06, 0.15) and CAC volume was inversely associated (β coefficient -0.08, 95% CI -0.10, -0.05). During a median follow-up of 13.7 months, the primary outcome (death/myocardial infarction) occurred in 218 individuals (5.6%). When CAC volume and density were included in the same model including demographics and cardiovascular risk factors, CAC density was inversely and significantly associated with the primary outcome (HR= 0.67, 95% CI 0.47, 0.96) while CAC volume was positively and significantly associated with it (HR= 1.57, 95% CI 1.34, 1.82). Results were no longer significant after further adjustment for CAC, stress test parameters and MFR.</p><p><strong>Conclusion: </strong>At any level of CAC volume, higher CAC density is significantly associated with higher MFR but not associated with risk of death/myocardial infarction.</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974480","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}
Jin-Yi Xiang, Yi-Si Dai, Jin-Yu Zheng, Ling-Yi Yu, Jiani Hu, Allen Song, Luke Wesemann, Jun Pu, E Mark Haacke, Lian-Ming Wu
{"title":"CMR-Derived Extracellular Volume Radiomics in Reperfused STEMI: Long-Term Prognostic Value and Risk Stratification.","authors":"Jin-Yi Xiang, Yi-Si Dai, Jin-Yu Zheng, Ling-Yi Yu, Jiani Hu, Allen Song, Luke Wesemann, Jun Pu, E Mark Haacke, Lian-Ming Wu","doi":"10.1093/ehjci/jeaf140","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf140","url":null,"abstract":"<p><strong>Aims: </strong>Global extracellular volume (ECV) fraction independently predicts outcomes after STEMI, but microvascular injuries complicate its interpretation. This study aims to assess the prognostic value of ECV-derived radiomics (RadScore) from cardiac magnetic resonance (CMR) for risk stratification in reperfused ST-elevation myocardial infarction (STEMI) patients.</p><p><strong>Methods and results: </strong>We retrospectively included 441 reperfused STEMI patients (mean age 60±11 years; 371 males) from two centers, divided into development (n=347) and validation cohort (n=94) by centers. CMR scan was performed one week within the index event. ECV mapping was obtained from pre- and post-contrast T1 mappings. A radiomics score (RadScore) was developed through radiomics analysis on ECV mapping, and its predictive performance for major adverse cardiovascular events (MACE) was evaluated via logistic and Cox regression analyses. Over a median 3.1-year follow-up, MACE occurred in 81 patients (18.4%). RadScore showed strong predictive capability with an area under the curve (AUC) of 0.865 (95% confidence inerval [CI]: 0.768-0.962) and 0.821 (95%CI: 0.701-0.940) on the internal and external test cohort respectively, reclassifying 44% and 32% of patients over clinical model respectively. Patients with RadScore above the optimal threshold (RS+) experienced a more than 12-fold increase in MACE risk (95%CI: 2.96-47.71, P<0.001) after adjusting for known risk factors. RS+ provide incremental prognostic value beyond LVEF.</p><p><strong>Conclusion: </strong>RadScore derived from ECV mapping was able to predict MACE and provided incremental prognostic value beyond established risk factors. Our findings underscore the potential long-term impact of acute changes in extracellular space patterns after myocardial infarction.</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989303","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}
Sebastian Ludwig, Augustin Coisne, Kenza Hamzi, Walid Ben Ali, Andrea Scotti, Benedikt Koell, Alison Duncan, Raj Makkar, Mariama Akodad, Sabine Bleiziffer, Georg Nickenig, Tsuyoshi Kaneko, Hendrik Ruge, Matti Adam, Lars Sondergaard, Gry Dahle, Maurizio Taramasso, Thomas Walther, Joerg Kempfert, Jean-François Obadia, Omar Chehab, Gilbert H L Tang, Sachin Goel, Neil Fam, Paolo Denti, Fabien Praz, Ralph Stephan von Bardeleben, Jörg Hausleiter, Azeem Latib, Lenard Conradi, Thomas Modine, Théo Pezel, Juan F Granada
{"title":"Phenotypic Clustering Analysis of Patients Rejected for Mitral Valve Interventions: Implications for Future Transcatheter Technologies.","authors":"Sebastian Ludwig, Augustin Coisne, Kenza Hamzi, Walid Ben Ali, Andrea Scotti, Benedikt Koell, Alison Duncan, Raj Makkar, Mariama Akodad, Sabine Bleiziffer, Georg Nickenig, Tsuyoshi Kaneko, Hendrik Ruge, Matti Adam, Lars Sondergaard, Gry Dahle, Maurizio Taramasso, Thomas Walther, Joerg Kempfert, Jean-François Obadia, Omar Chehab, Gilbert H L Tang, Sachin Goel, Neil Fam, Paolo Denti, Fabien Praz, Ralph Stephan von Bardeleben, Jörg Hausleiter, Azeem Latib, Lenard Conradi, Thomas Modine, Théo Pezel, Juan F Granada","doi":"10.1093/ehjci/jeaf141","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf141","url":null,"abstract":"<p><strong>Aims: </strong>Although several treatment options are available for patients with severe mitral regurgitation (MR), a significant proportion of patients remain ineligible for any mitral valve (MV) intervention. We aimed to analyze the phenotypic characteristics of surgical high-risk patients ineligible for MV interventions using an unsupervised phenotypic clustering approach.</p><p><strong>Methods and results: </strong>Between 2014 and 2022, the CHOICE-MI registry included 984 patients with MR undergoing screening for transcatheter mitral valve replacement at 33 international sites. For this study, only patients with screening failure receiving medical therapy alone were included. Patients receiving transcatheter or surgical treatment were excluded. A cluster analysis using K-means was performed on baseline clinical, demographic, and imaging variables to identify different patient phenotypes. Among 284 patients with MR (77.4±8.82 years, 56.0% female, EuroSCORE II: 6.6±5.8%) considered ineligible for any MV intervention, two clinically distinct phenogroups (PG) were identified using unsupervised hierarchical clustering of principal components. PG1: elderly women with primary MR, preserved left ventricular function, and annular calcification; and PG2: patients with secondary MR, advanced heart failure, and high prevalence of comorbidities. One-year all-cause mortality did not differ between the phenogroups (PG1: 21.4%, PG2: 23.4%, p=0.89). Predictors of mortality were albumin, renal function, extracardiac arteriopathy for PG1, and albumin, coronary artery disease, and prior myocardial infarction for PG2.</p><p><strong>Conclusions: </strong>This study identified two major subgroups among patients ineligible for mitral interventions showing profound differences in clinical and anatomical profiles. Identifying these factors may drive technological evolution to address the unmet clinical need for therapeutic options in MR patients.</p><p><strong>Clinicaltrials.gov identifier: </strong>NCT04688190 (CHOICE-MI Registry).</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963363","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":"NDLVC is just the entry door: advocating for an aetiology-oriented management.","authors":"Kristian Galanti, C Anwar C Chahal","doi":"10.1093/ehjci/jeaf135","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf135","url":null,"abstract":"","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990847","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}
Andrea Attanasio, Jessica Zannoni, Giandomenico Disabato, Gianluigi Guida, Lara Tondi, Antonia Camporeale, Antonio Rosato, Serena Anglese, Chiara Corrado, Mauro L Agnifili, Francesco Bedogni, Massimo Piepoli, Pietro Spagnolo, Alessandro Frigiola, Alessandro Giamberti, Mauro Lo Rito, Massimo Lombardi
{"title":"Dobutamine Stress Cardiac Magnetic Resonance role in patients with anomalous aortic origin of coronary arteries.","authors":"Andrea Attanasio, Jessica Zannoni, Giandomenico Disabato, Gianluigi Guida, Lara Tondi, Antonia Camporeale, Antonio Rosato, Serena Anglese, Chiara Corrado, Mauro L Agnifili, Francesco Bedogni, Massimo Piepoli, Pietro Spagnolo, Alessandro Frigiola, Alessandro Giamberti, Mauro Lo Rito, Massimo Lombardi","doi":"10.1093/ehjci/jeaf134","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf134","url":null,"abstract":"<p><strong>Background: </strong>Anomalous Aortic Origin of Coronary Arteries (AAOCA) is associated with myocardial ischemia and sudden cardiac death, particularly in young athletes. Although inducible myocardial ischemia investigation is generally recommended, there is no clear indication of the most appropriate stress test, as the ECG exercise stress test presents low diagnostic accuracy. Dobutamine-stress cardiac magnetic resonance (dsCMR) has been proposed as a promising diagnostic tool, but its application has been limited to pediatric populations.</p><p><strong>Objectives: </strong>This study aimed to evaluate the presence of inducible myocardial ischemia assessed by dsCMR in AAOCA patients, regardless of age, and to identify factors associated with inducible myocardial ischemia.</p><p><strong>Methods: </strong>In this single-center observational study, 100 AAOCA patients who underwent to dsCMR were enrolled from 2015 to 2024.</p><p><strong>Results: </strong>dsCMR resulted positive in 14 cases, all showing perfusion abnormalities, with only one presenting segmental wall motion abnormalities. dsCMR was found to be safe without major adverse events. Factors significantly associated with inducible ischemia included intramural course, the presence of ischemic late gadolinium enhancement (LGE), and a history of acute coronary syndrome (ACS). Nine patients (9%) showed small areas of ischemic LGE within the AAOCA territory, and they were older with a higher incidence of arterial hypertension, smoking habits and previous ACS episodes.</p><p><strong>Conclusions: </strong>dsCMR is a reliable test for the evaluation of myocardial ischemia in AAOCA, especially for those with intramural course, ischemic LGE, and previous ACS episodes. Although rare, older patients may have a myocardial ischemic scar without alteration of ventricular function.</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971094","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}