Maria Lembo MD, PhD , Shruti S. Joshi MBBS , Jolien Geers MD , Rong Bing MD, PhD , Lorenzo Carnevale PhD , Tania A. Pawade MBChB, PhD , Mhairi K. Doris MBChB, PhD , Evangelos Tzolos MD, PhD , Kajetan Grodecki MD, PhD , Sebastien Cadet MSc , Neil Craig MBChB , Trisha Singh MBChB, PhD , Piotr J. Slomka PhD , Audrey White BSc , Andrea Guala MD, PhD , Jose F. Rodriguez-Palomares MD, PhD , Aroa Ruiz-Muñoz MS , Lydia Dux-Santoy PhD , Gisela Teixido-Tura MD, PhD , Laura Galian-Gay MD, PhD , Marc R. Dweck MD, PhD
{"title":"Quantitative Computed Tomography Angiography for the Evaluation of Valvular Fibrocalcific Volume in Aortic Stenosis","authors":"Maria Lembo MD, PhD , Shruti S. Joshi MBBS , Jolien Geers MD , Rong Bing MD, PhD , Lorenzo Carnevale PhD , Tania A. Pawade MBChB, PhD , Mhairi K. Doris MBChB, PhD , Evangelos Tzolos MD, PhD , Kajetan Grodecki MD, PhD , Sebastien Cadet MSc , Neil Craig MBChB , Trisha Singh MBChB, PhD , Piotr J. Slomka PhD , Audrey White BSc , Andrea Guala MD, PhD , Jose F. Rodriguez-Palomares MD, PhD , Aroa Ruiz-Muñoz MS , Lydia Dux-Santoy PhD , Gisela Teixido-Tura MD, PhD , Laura Galian-Gay MD, PhD , Marc R. Dweck MD, PhD","doi":"10.1016/j.jcmg.2024.06.007","DOIUrl":"10.1016/j.jcmg.2024.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Aortic stenosis (AS) is characterized by calcification and fibrosis. The ability to quantify these processes simultaneously has been limited with previous imaging methods.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to evaluate the aortic valve fibrocalcific volume by computed tomography (CT) angiography in patients with AS, in particular, to assess its reproducibility, association with histology and disease severity, and ability to predict/track progression.</div></div><div><h3>Methods</h3><div>In 136 patients with AS, fibrocalcific volume was calculated on CT angiograms at baseline and after 1 year. CT attenuation distributions were analyzed using Gaussian-mixture-modeling to derive thresholds for tissue types enabling the quantification of calcific, noncalcific, and fibrocalcific volumes. Scan-rescan reproducibility was assessed and validation provided against histology and in an external cohort.</div></div><div><h3>Results</h3><div>Fibrocalcific volume measurements took 5.8 ± 1.0 min/scan, demonstrating good correlation with ex vivo valve weight (r = 0.51; <em>P <</em> 0.001) and excellent scan-rescan reproducibility (mean difference −1%, limits of agreement −4.5% to 2.8%). Baseline fibrocalcific volumes correlated with mean gradient on echocardiography in both male and female participants (rho = 0.64 and 0.69, respectively; both <em>P <</em> 0.001) and in the external validation cohort (n = 66, rho = 0.58; <em>P <</em> 0.001). The relationship was driven principally by calcific volume in men and fibrotic volume in women. After 1 year, fibrocalcific volume increased by 17% and correlated with progression in mean gradient (rho = 0.32; <em>P =</em> 0.003). Baseline fibrocalcific volume was the strongest predictor of subsequent mean gradient progression, with a particularly strong association in female patients (rho = 0.75; <em>P <</em> 0.001).</div></div><div><h3>Conclusions</h3><div>The aortic valve fibrocalcific volume provides an anatomic assessment of AS severity that can track disease progression precisely. It correlates with disease severity and hemodynamic progression in both male and female patients.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 11","pages":"Pages 1351-1362"},"PeriodicalIF":12.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901833","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}
James D. Crane BMBS , George Joy PhD , Kristopher D. Knott MBBS , João B. Augusto MD , Clement Lau PhD , Anish N. Bhuva PhD , Andreas Seraphim PhD , Timothée Evain PhD , Louise A.E. Brown PhD , Amrit Chowdhary PhD , Tushar Kotecha PhD , Marianna Fontana PhD , Sven Plein PhD , Sasindran Ramar MS , Francesco Rubino MD , Peter Kellman PhD , Hui Xue PhD , Iain Pierce PhD , Rhodri H. Davies PhD , James C. Moon MD , Charlotte Manisty PhD
{"title":"The Impact of Bariatric Surgery on Coronary Microvascular Function Assessed Using Automated Quantitative Perfusion CMR","authors":"James D. Crane BMBS , George Joy PhD , Kristopher D. Knott MBBS , João B. Augusto MD , Clement Lau PhD , Anish N. Bhuva PhD , Andreas Seraphim PhD , Timothée Evain PhD , Louise A.E. Brown PhD , Amrit Chowdhary PhD , Tushar Kotecha PhD , Marianna Fontana PhD , Sven Plein PhD , Sasindran Ramar MS , Francesco Rubino MD , Peter Kellman PhD , Hui Xue PhD , Iain Pierce PhD , Rhodri H. Davies PhD , James C. Moon MD , Charlotte Manisty PhD","doi":"10.1016/j.jcmg.2024.05.022","DOIUrl":"10.1016/j.jcmg.2024.05.022","url":null,"abstract":"<div><h3>Background</h3><div>Coronary microvascular function is impaired in patients with obesity, contributing to myocardial dysfunction and heart failure. Bariatric surgery decreases cardiovascular mortality and heart failure, but the mechanisms are unclear.</div></div><div><h3>Objectives</h3><div>The authors studied the impact of bariatric surgery on coronary microvascular function in patients with obesity and its relationship with metabolic syndrome.</div></div><div><h3>Methods</h3><div>Fully automated quantitative perfusion cardiac magnetic resonance and metabolic markers were performed before and 6 months after bariatric surgery.</div></div><div><h3>Results</h3><div>Compared with age- and sex-matched healthy volunteers, 38 patients living with obesity had lower stress myocardial blood flow (MBF) (<em>P =</em> 0.001) and lower myocardial perfusion reserve (<em>P <</em> 0.001). A total of 27 participants underwent paired follow-up 6 months post-surgery. Metabolic abnormalities reduced significantly at follow-up including mean body mass index by 11 ± 3 kg/m<sup>2</sup> (<em>P <</em> 0.001), glycated hemoglobin by 9 mmol/mol (Q1-Q3: 4-19 mmol/mol; <em>P <</em> 0.001), fasting insulin by 142 ± 131 pmol/L (<em>P <</em> 0.001), and hepatic fat fraction by 5.6% (Q1-Q3: 2.6%-15.0%; <em>P <</em> 0.001). Stress MBF increased by 0.28 mL/g/min (Q1-Q3: −0.02 to 0.75 mL/g/min; <em>P =</em> 0.003) and myocardial perfusion reserve by 0.13 (Q1-Q3: −0.25 to 1.10; <em>P =</em> 0.036). The increase in stress MBF was lower in those with preoperative type 2 diabetes mellitus (0.1 mL/g/min [Q1-Q3: −0.09 to 0.46 mL/g/min] vs 0.75 mL/g/min [Q1-Q3: 0.31-1.25 mL/g/min]; <em>P =</em> 0.002). Improvement in stress MBF was associated with reduction in fasting insulin (beta = −0.45 [95% CI: −0.05 to 0.90]; <em>P =</em> 0.03).</div></div><div><h3>Conclusions</h3><div>Coronary microvascular function is impaired in patients with obesity, but can be improved significantly with bariatric surgery. Improvements in microvascular function are associated with improvements in insulin resistance but are attenuated in those with preoperative type 2 diabetes mellitus.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 11","pages":"Pages 1305-1316"},"PeriodicalIF":12.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901835","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}
Olivier F. Clerc MD, MPH , Sarah A.M. Cuddy MD , Michael Jerosch-Herold PhD , Dominik C. Benz MD , Ethan Katznelson MD , Jocelyn Canseco Neri MS , Alexandra Taylor BS , Marie Foley Kijewski PhD , Giada Bianchi MD , Frederick L. Ruberg MD , Marcelo F. Di Carli MD , Ronglih Liao PhD , Raymond Y. Kwong MD, MPH , Rodney H. Falk MD , Sharmila Dorbala MD, MPH
{"title":"Myocardial Characteristics, Cardiac Structure, and Cardiac Function in Systemic Light-Chain Amyloidosis","authors":"Olivier F. Clerc MD, MPH , Sarah A.M. Cuddy MD , Michael Jerosch-Herold PhD , Dominik C. Benz MD , Ethan Katznelson MD , Jocelyn Canseco Neri MS , Alexandra Taylor BS , Marie Foley Kijewski PhD , Giada Bianchi MD , Frederick L. Ruberg MD , Marcelo F. Di Carli MD , Ronglih Liao PhD , Raymond Y. Kwong MD, MPH , Rodney H. Falk MD , Sharmila Dorbala MD, MPH","doi":"10.1016/j.jcmg.2024.05.004","DOIUrl":"10.1016/j.jcmg.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><div>In systemic light-chain (AL) amyloidosis, cardiac involvement portends poor outcomes.</div></div><div><h3>Objectives</h3><div><span><span>The authors’ objectives were to detect early myocardial alterations, to analyze longitudinal changes with therapy, and to predict major adverse cardiac events (MACE) in participants with </span>AL amyloidosis using </span>cardiac magnetic resonance imaging (MRI).</div></div><div><h3>Methods</h3><div><span>Recently diagnosed participants were prospectively enrolled. AL amyloidosis<span><span> with and without cardiomyopathy (AL-CMP, AL-non-CMP) were defined based on abnormal cardiac biomarkers and wall thickness. MRI was performed at baseline, 6 months in all participants, and 12 months in participants with AL-CMP. MACE were defined as all-cause death, heart failure hospitalization, and </span>cardiac transplantation. Mayo stage was based on </span></span>troponin T, N-terminal pro–B-type natriuretic peptide, and difference in free light chains.</div></div><div><h3>Results</h3><div>This study included 80 participants (median age 62 years, 58% men). Extracellular volume (ECV) was abnormal (>32%) in all participants with AL-CMP and in 47% of those with AL-non-CMP. ECV tended to increase at 6 months (median +2%; AL-CMP <em>P</em> = 0.120; AL-non-CMP <em>P</em> = 0.018) and returned to baseline values at 12 months in participants with AL-CMP. Global longitudinal strain (GLS) improved at 6 months (median −0.6%; <em>P</em> = 0.048) and 12 months (median −1.2%; <em>P</em> < 0.001) in participants with AL-CMP. ECV and GLS were strongly associated with MACE (<em>P</em> < 0.001) and improved the prognostic value when added to Mayo stage (<em>P</em> ≤ 0.002). No participant with ECV ≤32% had MACE, while 74% of those with ECV >48% had MACE.</div></div><div><h3>Conclusions</h3><div><span>In patients with systemic AL amyloidosis, ECV detects subclinical myocardial alterations. With therapy, ECV tends to increase at 6 months and returns to values unchanged from baseline at 12 months, whereas GLS improves at 6 and 12 months in participants with AL-CMP. ECV and GLS offer additional prognostic performance over Mayo stage. (Molecular Imaging of Primary Amyloid Cardiomyopathy [MICA]; </span><span><span>NCT02641145</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 11","pages":"Pages 1271-1286"},"PeriodicalIF":12.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603659","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":"Cardiac Magnetic Resonance Evaluation of LV Remodeling Post-Myocardial Infarction","authors":"","doi":"10.1016/j.jcmg.2024.03.012","DOIUrl":"10.1016/j.jcmg.2024.03.012","url":null,"abstract":"<div><div><span><span>Adverse left ventricular remodeling (ALVR) and subsequent heart failure after myocardial infarction (MI) remain a major cause of patient morbidity and mortality worldwide. Overt inflammation has been identified as the common pathway underlying </span>myocardial fibrosis and development of ALVR post-MI. With its ability to simultaneously provide information about cardiac structure, function, perfusion, and tissue characteristics, </span>cardiac magnetic resonance<span> (CMR) is well poised to inform prognosis and guide early surveillance and therapeutics in high-risk cohorts. Further, established and evolving CMR-derived biomarkers may serve as clinical endpoints in prospective trials evaluating the efficacy of novel anti-inflammatory and antifibrotic therapies. This review provides an overview of post-MI ALVR and illustrates how CMR may help clinical adoption of novel therapies via mechanistic or prognostic imaging markers.</span></div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 11","pages":"Pages 1366-1380"},"PeriodicalIF":12.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179321","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}