Yuanqi Yong MBBS , Julian Giovannucci MBBS , Sow Neng Pang MBChB , Wei Hong MBBS, BMedSc , Donghee Han MD , Daniel S. Berman MD , Damini Dey PhD , Stephen J. Nicholls MBBS, PhD , Nitesh Nerlekar MBBS, MPH, PhD , Andrew Lin MBBS, BMedSc, PhD
{"title":"Coronary Artery Calcium Density and Risk of Cardiovascular Events","authors":"Yuanqi Yong MBBS , Julian Giovannucci MBBS , Sow Neng Pang MBChB , Wei Hong MBBS, BMedSc , Donghee Han MD , Daniel S. Berman MD , Damini Dey PhD , Stephen J. Nicholls MBBS, PhD , Nitesh Nerlekar MBBS, MPH, PhD , Andrew Lin MBBS, BMedSc, PhD","doi":"10.1016/j.jcmg.2024.07.024","DOIUrl":"10.1016/j.jcmg.2024.07.024","url":null,"abstract":"<div><h3>Background</h3><div>There is increasing evidence that coronary artery calcium (CAC) density is inversely associated with plaque vulnerability and atherosclerotic cardiovascular disease risk.</div></div><div><h3>Objectives</h3><div>A systematic review and meta-analysis were performed to examine the predictive value of CAC density for future cardiovascular events in asymptomatic individuals undergoing noncontrast CAC scoring computed tomography.</div></div><div><h3>Methods</h3><div>Electronic databases were searched for studies reporting CAC density and subsequent cardiovascular disease (CVD) or coronary heart disease (CHD) events. Two independent reviewers performed data extraction. Random-effects models were used to estimate pooled HRs and 95% CIs. Subgroup analyses were performed with studies stratified by CVD vs CHD events and by statin use.</div></div><div><h3>Results</h3><div>Of 5,029 citations, 5 studies with 6 cohorts met inclusion criteria. In total, 1,309 (6.1%) cardiovascular events occurred in 21,346 participants with median follow-up ranging from 5.2 to 16.7 years. Higher CAC density was inversely associated with risk of cardiovascular events following adjustment for clinical risk factors and CAC volume (HR: 0.80 per SD of density [95% CI: 0.72-0.89]; <em>P <</em> 0.01; <em>I</em><sup>2</sup> = 0%). There was no significant difference in the pooled HRs for CVD vs CHD events (HR: 0.80 per SD [95% CI: 0.71-0.90] vs 0.74 per SD [95% CI: 0.59-0.94] respectively; <em>P =</em> 0.59). The protective association between CAC density and event risk persisted among statin-naive patients (HR: 0.79 per SD [95% CI: 0.70-0.89]; <em>P <</em> 0.01) but not statin-treated patients (HR: 0.97 per SD [95% CI: 0.77-1.22]; <em>P =</em> 0.78); the test for interaction indicated no significant between-group differences (<em>P =</em> 0.12).</div></div><div><h3>Conclusions</h3><div>Higher CAC density is associated with a lower risk of cardiovascular events when adjusted for risk factors and CAC volume. Future work may expand the contribution of CAC density in CAC scoring, and enhance its role in CVD risk assessment, treatment, and prevention.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 3","pages":"Pages 294-304"},"PeriodicalIF":12.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145679","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}
Joshua Cockrum MD , Makiya Nakashima MS , Carl Ammoury MD , Diane Rizkallah MD , Joseph Mauch MD , David Lopez MD , David Wolinksy MD , Tae Hyun Hwang PhD , Samir Kapadia MD , Lars G. Svensson MD, PhD , Richard Grimm DO , Mazen Hanna MD , W.H. Wilson Tang MD , Christopher Nguyen PhD , David Chen PhD , Deborah Kwon MD
{"title":"Leveraging a Vision Transformer Model to Improve Diagnostic Accuracy of Cardiac Amyloidosis With Cardiac Magnetic Resonance","authors":"Joshua Cockrum MD , Makiya Nakashima MS , Carl Ammoury MD , Diane Rizkallah MD , Joseph Mauch MD , David Lopez MD , David Wolinksy MD , Tae Hyun Hwang PhD , Samir Kapadia MD , Lars G. Svensson MD, PhD , Richard Grimm DO , Mazen Hanna MD , W.H. Wilson Tang MD , Christopher Nguyen PhD , David Chen PhD , Deborah Kwon MD","doi":"10.1016/j.jcmg.2024.09.010","DOIUrl":"10.1016/j.jcmg.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac magnetic resonance (CMR) imaging is an important diagnostic tool for diagnosis of cardiac amyloidosis (CA). However, discrimination of CA from other etiologies of myocardial disease can be challenging.</div></div><div><h3>Objectives</h3><div>The aim of this study was to develop and rigorously validate a deep learning (DL) algorithm to aid in the discrimination of CA using cine and late gadolinium enhancement CMR imaging.</div></div><div><h3>Methods</h3><div>A DL model using a retrospective cohort of 807 patients who were referred for CMR for suspicion of infiltrative disease or hypertrophic cardiomyopathy (HCM) was developed. Confirmed definitive diagnosis was as follows: 252 patients with CA, 290 patients with HCM, and 265 with neither CA or HCM (other). This cohort was split 70/30 into training and test sets. A vision transformer (ViT) model was trained primarily to identify CA. The model was validated in an external cohort of 157 patients also referred for CMR for suspicion of infiltrative disease or HCM (51 CA, 49 HCM, and 57 other).</div></div><div><h3>Results</h3><div>The ViT model achieved a diagnostic accuracy (84.1%) and an area under the curve of 0.954 in the internal testing data set. The ViT model further demonstrated an accuracy of 82.8% and an area under the curve of 0.957 in the external testing set. The ViT model achieved an accuracy of 90% (n = 55 of 61), among studies with clinical reports with moderate/high confidence diagnosis of CA, and 61.1% (n = 22 of 36) among studies with reported uncertain, missing, or incorrect diagnosis of CA in the internal cohort. DL accuracy of this cohort increased to 79.1% when studies with poor image quality, dual pathologies, or ambiguity of clinically significant CA diagnosis were removed.</div></div><div><h3>Conclusions</h3><div>A ViT model using only cine and late gadolinium enhancement CMR images can achieve high accuracy in differentiating CA from other underlying etiologies of suspected cardiomyopathy, especially in cases when reported human diagnostic confidence was uncertain in both a large single state health system and in an external CA cohort.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 3","pages":"Pages 278-290"},"PeriodicalIF":12.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785278","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":"Keeping Up With the Times","authors":"Alan C. Kwan MD , David Ouyang MD","doi":"10.1016/j.jcmg.2024.12.005","DOIUrl":"10.1016/j.jcmg.2024.12.005","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 3","pages":"Pages 291-293"},"PeriodicalIF":12.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535348","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}
Otto A. Smiseth MD, PhD , Oliver Rider BA, BMBCh, DPhil , Marta Cvijic MD, PhD , Ladislav Valkovič PhD , Espen W. Remme MSc, PhD , Jens-Uwe Voigt MD, PhD
{"title":"Myocardial Strain Imaging","authors":"Otto A. Smiseth MD, PhD , Oliver Rider BA, BMBCh, DPhil , Marta Cvijic MD, PhD , Ladislav Valkovič PhD , Espen W. Remme MSc, PhD , Jens-Uwe Voigt MD, PhD","doi":"10.1016/j.jcmg.2024.07.011","DOIUrl":"10.1016/j.jcmg.2024.07.011","url":null,"abstract":"<div><div>Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 3","pages":"Pages 340-381"},"PeriodicalIF":12.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251284","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}
Vidhu Anand MBBS , Hector I. Michelena MD , Christopher G. Scott MS , Alexander T. Lee BS , Vera H. Rigolin MD , Sorin V. Pislaru MD, PhD , Garvan C. Kane MD, PhD , Juan A. Crestanello MD , Patricia A. Pellikka MD
{"title":"Echocardiographic Markers of Early Left Ventricular Dysfunction in Asymptomatic Aortic Regurgitation","authors":"Vidhu Anand MBBS , Hector I. Michelena MD , Christopher G. Scott MS , Alexander T. Lee BS , Vera H. Rigolin MD , Sorin V. Pislaru MD, PhD , Garvan C. Kane MD, PhD , Juan A. Crestanello MD , Patricia A. Pellikka MD","doi":"10.1016/j.jcmg.2024.09.005","DOIUrl":"10.1016/j.jcmg.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>The ideal timing for surgery in asymptomatic chronic aortic regurgitation (AR) remains unclear. New thresholds for left ventricular ejection fraction (LVEF), left ventricular (LV) indexed end-systolic volume (iESV), and global longitudinal strain (GLS) have been associated with mortality in these patients. These represent markers of early LV dysfunction.</div></div><div><h3>Objectives</h3><div>The authors sought to assess the relationship between these markers (LVEF <60%, iESV ≥45 mL/m<sup>2</sup>, and GLS worse than −15%) and mortality, comparing them to Class I/IIa American College of Cardiology/American Heart Association guideline recommendations and absence of any of these.</div></div><div><h3>Methods</h3><div>A total of 673 asymptomatic patients with chronic clinically significant (≥ moderate-severe) AR between 2004 and 2019 at a single referral center were retrospectively analyzed. The primary study outcome was all-cause mortality.</div></div><div><h3>Results</h3><div>Mean age was 57 ± 17 years, 97 (14%) were female, 293 (45%) had hypertension, and 273 (41%) had an abnormal number of valve cusps. Aortic valve replacement was performed in 281 (48%) patients, and 69 (10%) died while under surveillance (without aortic valve replacement). LVEF <60% was present in 296 (44%) patients, 122 (25%) of 482 had GLS worse than −15%, and 261 (39%) had iESV ≥45 mL/m<sup>2</sup>. Mortality under surveillance was highest when Class I/IIa recommendations were present (HR: 4.22; 95% CI: 2.15-8.29), followed by the presence of 1 or more markers of early LV dysfunction (HR: 2.18; 95% CI: 1.21-3.92); no markers was used as the reference (all, <em>P</em> < 0.05). LVEF showed the strongest association with mortality, statistically slightly better than GLS and iESV. In the absence of Class I/IIa recommendations, 1 marker of early LV dysfunction was associated with higher, although not statistically significant, mortality compared with no markers (<em>P</em> = 0.063), followed by 2 markers; highest mortality was when all 3 markers were present (HR: 5.46 [95% CI: 2.51-11.90]; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Patients with asymptomatic clinically significant chronic AR incur a survival penalty when Class I/IIa guideline recommendations are attained. In patients without these recommendations, at least 2 markers of early LV dysfunction identify those with higher mortality risk who may benefit from early surgery.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 3","pages":"Pages 266-274"},"PeriodicalIF":12.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638826","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}
Xuezhu Wang MD , Kaini Shen MD , Yuke Zhang BS , Yajuan Gao MD , Bowei Liu BS , Yubo Guo BS , Chao Ren MM , Zhenghai Huang RA , Xiao Li MD , Long Chang MD , Haiyan Ding PhD , Hui Zhang PhD , Zhuang Tian MD , Marcus Hacker MD , Shuyang Zhang MD , Yining Wang MD , Jian Li MD , Xiang Li PhD , Li Huo MD
{"title":"Molecular Stratification of Light-Chain Cardiac Amyloidosis With 18F-Florbetapir and 68Ga-FAPI-04 for Enhanced Prognostic Precision","authors":"Xuezhu Wang MD , Kaini Shen MD , Yuke Zhang BS , Yajuan Gao MD , Bowei Liu BS , Yubo Guo BS , Chao Ren MM , Zhenghai Huang RA , Xiao Li MD , Long Chang MD , Haiyan Ding PhD , Hui Zhang PhD , Zhuang Tian MD , Marcus Hacker MD , Shuyang Zhang MD , Yining Wang MD , Jian Li MD , Xiang Li PhD , Li Huo MD","doi":"10.1016/j.jcmg.2024.10.001","DOIUrl":"10.1016/j.jcmg.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac involvement in amyloid light chain (AL) amyloidosis significantly influences prognosis, necessitating timely diagnosis and meticulous risk stratification.</div></div><div><h3>Objectives</h3><div>This prospective study aimed to delineate the molecular phenotypes of AL–cardiac amyloidosis (CA) by characterizing fibro-amyloid deposition using <sup>18</sup>F-florbetapir and gallium-68-labeled fibroblast activation protein inhibitor (<sup>68</sup>Ga-FAPI)-04 positron emission tomography (PET)/computed tomography (CT) imaging. The authors also proposed a novel molecular stratification methodology for prognosis.</div></div><div><h3>Methods</h3><div>Patients with confirmed AL-CA underwent echocardiography and <sup>18</sup>F-florbetapir and <sup>68</sup>Ga-FAPI-04 PET/CT imaging. Cardiac amyloid burden was quantified as <sup>18</sup>F-florbetapir cardiac amyloid volume and total cardiac amyloid. Meanwhile, cardiac fibroblast activation protein (FAP) was quantified as <sup>68</sup>Ga-FAPI-04 cardiac fibroblast activation protein volume (CFV) and total cardiac fibroblast activation protein (TCF). PET/CT metrics were calculated in correlation to clinical and echocardiographic markers and their association with overall survival (OS) evaluated.</div></div><div><h3>Results</h3><div>Among the 38 patients enrolled (median age: 58 years; 76.3% male), all patients exhibited amyloid deposition, and 86.8% (33 of 38) patients exhibited cardiac fibroblast activation. Cardiac amyloid burden was correlated with Mayo stage and several echocardiography metrics (<em>P <</em> 0.05). In addition, there was a correlation between CFV and N-terminal pro–B-type natriuretic peptide level (<em>P <</em> 0.05). Thirteen deaths occurred over a median follow-up of 24.8 months. Higher CFV and TCF were associated with shortened OS, particularly in Mayo stage III. In multivariable analysis, higher TCF was a primary determinant for shortened OS.</div></div><div><h3>Conclusions</h3><div>The study underscores that higher TCF on <sup>68</sup>Ga-FAPI-04 PET/CT imaging might be a correlated factor of worse clinical outcome in newly diagnosed AL-CA, and this metric seems to be a molecular imaging tool complementary to <sup>18</sup>F-florbetapir imaging. The combination might offer a holistic understanding of molecular attributes, assisting in clinical decision-making.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 3","pages":"Pages 323-336"},"PeriodicalIF":12.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965085","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}
Tara Shrout Allen MD, MSc, Mikaila Reyes MAS, Jonathan M. Kermanshahchi BA, Julie O. Denenberg MA, Joseph Yeboah MD, Matthew A. Allison MD, MPH, Michael H. Criqui MD, MPH, Harpreet S. Bhatia MD, MAS
{"title":"Coronary Artery Calcium Distribution and Cardiovascular Risk","authors":"Tara Shrout Allen MD, MSc, Mikaila Reyes MAS, Jonathan M. Kermanshahchi BA, Julie O. Denenberg MA, Joseph Yeboah MD, Matthew A. Allison MD, MPH, Michael H. Criqui MD, MPH, Harpreet S. Bhatia MD, MAS","doi":"10.1016/j.jcmg.2024.10.005","DOIUrl":"10.1016/j.jcmg.2024.10.005","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 3","pages":"Pages 392-394"},"PeriodicalIF":12.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784990","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}
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