JACC. Cardiovascular imaging最新文献

{"title":"Sex-Related Differences in Outcomes and Thresholds for Intervention in Primary Mitral Regurgitation","authors":"Edouard Long MSc,&nbsp;Rebecca T. Hahn MD,&nbsp;Martha Gulati MD, MS,&nbsp;Camelia Demetrescu MBBS,&nbsp;Benoy N. Shah MBBS, MD,&nbsp;Sanjeev Bhattacharya MBBS, MD,&nbsp;Narain Moorjani MBChB, MD,&nbsp;Gianluca Lucchese MD, PhD,&nbsp;Rajdeep Bilkhu MBChB, PhD,&nbsp;Paolo Bosco MD,&nbsp;Tiffany Patterson MBBS, PhD,&nbsp;Simon Redwood MBBS, MD,&nbsp;Philippe Pibarot DVM, PhD,&nbsp;Bernard Prendergast BM, BS, MD,&nbsp;Ronak Rajani BM, MD,&nbsp;Vitaliy Androshchuk MBBCh, PhD","doi":"10.1016/j.jcmg.2026.05.013","DOIUrl":"10.1016/j.jcmg.2026.05.013","url":null,"abstract":"<div><h3>Background</h3><div>Evidence on sex differences in outcomes after interventions for primary mitral regurgitation (PMR) remains conflicting. The authors performed a dedicated meta-analysis to examine whether guideline-recommended thresholds for intervention may contribute to these discrepancies.</div></div><div><h3>Methods</h3><div>Electronic databases were searched for studies reporting long-term outcomes of patients undergoing surgical or transcatheter interventions for PMR, stratified by sex. The primary endpoint was all-cause mortality, and the secondary endpoint was major adverse cardiovascular events. Reconstructed time-to-event individual patient data were used to derive frailty-adjusted Cox models and restricted mean survival time. To investigate whether sex-based differences in baseline characteristics had a modulating effect on differences in all-cause mortality, meta-regression was performed on individual patient data–derived HRs using a linear mixed-effects model.</div></div><div><h3>Results</h3><div>Across 17 studies (N = 25,690), women comprised the minority (n = 9,632, 37.5%) and were significantly older (mean difference: 3.2 years, 95% CI: 2.2-4.3) with a greater proportion of heart failure symptoms (OR: 1.8; 95% CI: 1.6-2.1). At 15.7 years of follow-up, women had significantly greater risk of all-cause mortality compared with men (HR: 1.15; 95% CI: 1.07-1.24), corresponding to a survival deficit of 5.8 months (95% CI: 3.7-7.7). Similar results were observed in sensitivity analyses restricted to surgical intervention studies (HR: 1.18; 95% CI: 1.10-1.27). Female sex was also associated with significantly increased major adverse cardiovascular events (n = 2,775) (HR: 1.37; 95% CI: 1.11-1.70; Δ restricted mean survival time: 8.5 months, 95% CI: 2.4-14.5). Age, ≥ moderate tricuspid regurgitation (TR), and concomitant tricuspid valve repair (TVr) emerged as significant moderators of sex differences in mortality after intervention for PMR (<em>P</em> &lt; 0.001, <em>P</em> = 0.03, and <em>P</em> &lt; 0.001, respectively). A greater proportion of ≥ moderate TR and TVr in women conferred increased mortality relative to men. Neither left ventricular nor left atrial parameters significantly moderated sex differences in all-cause mortality (all <em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>At the time of PMR intervention, women are older, have more symptoms, and worse long-term outcomes compared with men. Older female age alongside higher prevalence of ≥ moderate TR and TVr explained a significant proportion of this heterogeneity in sex-related all-cause mortality, whereas differences in left ventricular and left atrial parameters had no significant influence. A careful appraisal of current guidelines to ensure equality of health care outcomes between sexes is warranted.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Pages 1204-1218"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416611","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":"Ultrasound Cavitation of Microbubbles Augments Limb Perfusion and Promotes Ulcer Healing in Chronic Limb-Threatening Ischemia","authors":"Bethany A. Gholson RCS, ACS,&nbsp;Matteo Morello MD,&nbsp;Sofia Capdeville MD,&nbsp;J. Todd Belcik RDCS, ACS,&nbsp;James Hodovan RDCS, PhD,&nbsp;Yujin Choi BS,&nbsp;Ruei-Jen Abraham-Fan PhD,&nbsp;Khanh P. Nguyen MD,&nbsp;Brian P. Davidson MD,&nbsp;Jeffry Powers PhD,&nbsp;Jonathan R. Lindner MD","doi":"10.1016/j.jcmg.2026.06.009","DOIUrl":"10.1016/j.jcmg.2026.06.009","url":null,"abstract":"<div><h3>Background</h3><div>In patients with peripheral artery disease and chronic limb-threatening ischemia (CLTI), there is a lack of effective treatment options when arterial revascularization is not feasible. In preclinical models, ultrasound (US) cavitation of microbubble contrast agents can augment limb perfusion through multiple shear-mediated vasoactive pathways.</div></div><div><h3>Objectives</h3><div>This study aims to evaluate whether US cavitation increases limb tissue perfusion and accelerates healing of ischemic ulcers in patients with CLTI.</div></div><div><h3>Methods</h3><div>Patients (n = 24) with CLTI and chronic nonhealing ulcers were randomized to standard care or cavitation therapy, which was performed every 3 days × 6. Definity was infused, and US (1.3 MHz, mechanical index: 1.3) was performed for 15 minutes at the wound site and simultaneously over the ipsilateral femoral artery to leverage conducted vasodilation. The primary endpoints at day 18 were change in ulcer area and ulcer microvascular perfusion.</div></div><div><h3>Results</h3><div>Complete or partial ulcer healing occurred in almost all cavitation-treated patients, with a significant reduction in ulcer size only in the cavitation group and not the control group (median: −36.6% [Q1-Q3: −15.4% to −65.0%] vs +3.4% [Q1-Q3: −14.7% to +20.0%]; <em>P</em> = 0.039). In cavitation-treated patients, there was a 2.5-fold increase in ulcer margin perfusion, a 1.6-fold increase in functional microvascular density on super-resolution US microangiography, and a 1.8-fold increase in femoral artery flow (<em>P</em> &lt; 0.05 for all parameters). These flow parameters did not increase in control patients.</div></div><div><h3>Conclusions</h3><div>In patients with CLTI and nonhealing ulcers, periodic therapy with cavitation of microbubbles using US parameters approved for diagnostic imaging promotes healing of ischemic ulcers, likely through improvement in tissue perfusion and microvascular vascularity. (Ultrasound Cavitation Therapy for CLI; <span><span>NCT05749250</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Pages 1171-1182"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673734","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 Bubbles to Blood Flow","authors":"Howard Leong-Poi MD","doi":"10.1016/j.jcmg.2026.07.011","DOIUrl":"10.1016/j.jcmg.2026.07.011","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Pages 1183-1185"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818554","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":"Coronary Artery Calcium in ACC/AHA Prevention Guidelines","authors":"Kyvan Irannejad MD,&nbsp;Ruben Mora MD,&nbsp;Srikanth Krishnan MD,&nbsp;Suvasini Lakshmanan MD,&nbsp;Sion Roy MD,&nbsp;Matthew J. Budoff MD","doi":"10.1016/j.jcmg.2026.07.014","DOIUrl":"10.1016/j.jcmg.2026.07.014","url":null,"abstract":"<div><div>Coronary artery calcium (CAC) scoring is an established marker of subclinical atherosclerosis that improves cardiovascular risk stratification beyond traditional risk factors. Since the 2007 ACCF (American College of Cardiology Foundation)/AHA (American Heart Association) Clinical Expert Consensus Statement, the role of CAC in prevention guidelines has progressively evolved. The strength of CAC recommendations has increased from a Class IIb recommendation for selected intermediate-risk adults in 2007 to a Class IIa recommendation for risk refinement in the 2018 ACC/AHA cholesterol guideline and to Class I recommendations for selected CAC-defined populations in the 2026 ACC (American College of Cardiology)/AHA multisociety dyslipidemia guideline. The 2018 guideline incorporated CAC primarily to guide statin allocation when treatment decisions were uncertain. The 2026 guideline further expands CAC-based recommendations by incorporating age- and sex-adjusted percentiles, CAC-guided treatment intensity, and low-density lipoprotein–cholesterol goals, including management of very high CAC phenotypes. In this brief report, the authors review the evolution of CAC across the 2007, 2018, and 2026 ACC/AHA guideline documents and discuss the expanding role of CAC in personalized cardiovascular prevention.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Pages 1271-1275"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880295","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":"Beyond the Binary","authors":"Jonathan R. Weir-McCall PhD,&nbsp;Kavitha M. Chinnaiyan MD","doi":"10.1016/j.jcmg.2026.07.002","DOIUrl":"10.1016/j.jcmg.2026.07.002","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Pages 1253-1255"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673709","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 Cardiovascular Imaging in the Evaluation of Cardiac Sarcoidosis","authors":"Katharine E. Thomas,Eleanor C. Wicks,Sanjay Divakaran,Nikant Sabharwal,Charalambos Antoniades,Stefan K. Piechnik,Raymond Y. Kwong,Vanessa M. Ferreira","doi":"10.1016/j.jcmg.2026.07.024","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.07.024","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"1 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088759","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":"Indexed Stroke Volume Improvement in Low-Flow Aortic Stenosis After TAVI","authors":"Mathias Asyaei Dyreborg MD,&nbsp;Christian Juhl Terkelsen MD, DMSc, PhD,&nbsp;Henrik Nissen MD, PhD,&nbsp;Steen Hvitfeldt Poulsen MD, PhD,&nbsp;Kristian Hejlesen RN,&nbsp;Amal Haujir MD,&nbsp;Rasmus Carter-Storch MD, PhD,&nbsp;Anne Dybro MD, PhD,&nbsp;Philip Freeman BSc, MBBS, MRCP, PhD,&nbsp;Frederik Uttenthal MD,&nbsp;Ulrik Christiansen MD, PhD,&nbsp;Evald Høj Christiansen MD, PhD,&nbsp;Troels Thim MD, PhD,&nbsp;Jordi Sanchez Dahl MD, DMSc, PhD","doi":"10.1016/j.jcmg.2026.06.002","DOIUrl":"10.1016/j.jcmg.2026.06.002","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Pages 1286-1288"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148476284","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":"CT Perfusion vs FFR for Revascularization Guidance","authors":"Ioannis Skalidis MD, PhD,&nbsp;Giulia S. Beretta MD,&nbsp;Lisa Simioni MD,&nbsp;Stephane Cook MD,&nbsp;Mario Togni MD","doi":"10.1016/j.jcmg.2026.06.012","DOIUrl":"10.1016/j.jcmg.2026.06.012","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Page 1292"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088758","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":"Association of Hemodynamic Disease Severity and Distribution With Risk of Future Acute Coronary Syndrome","authors":"Seokhun Yang MD,&nbsp;Jae Wook Chung MD,&nbsp;Sang-Hyeon Park MD,&nbsp;Jinlong Zhang MD,&nbsp;Keehwan Lee MD,&nbsp;Doyeon Hwang MD,&nbsp;Kyu-Sun Lee MD,&nbsp;Sang-Hoon Na MD,&nbsp;Joon-Hyung Doh MD,&nbsp;Chang-Wook Nam MD,&nbsp;Tae Hyun Kim MD,&nbsp;Eun-Seok Shin MD,&nbsp;Eun Ju Chun MD,&nbsp;Su-Yeon Choi MD,&nbsp;Hyun Kuk Kim MD,&nbsp;Young Joon Hong MD,&nbsp;Hun-Jun Park MD,&nbsp;Song-Yi Kim MD,&nbsp;Mirza Husic MD,&nbsp;Jess Lambrechtsen MD,&nbsp;Bon-Kwon Koo MD","doi":"10.1016/j.jcmg.2026.05.012","DOIUrl":"10.1016/j.jcmg.2026.05.012","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Although physiological assessment has been used in decision-making for revascularization, its role in predicting the future risk of acute coronary syndrome (ACS) remains underexplored.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;This study aims to investigate the independent and combined prognostic significance of hemodynamic disease severity and distribution in identifying ACS culprit vessels, in conjunction with lumen and plaque characteristics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The EMERALD-II study is an international, multicenter, internal case-control study enrolling 351 patients with ACS who underwent coronary computed tomography angiography (CTA) 1 month to 3 years before the event. Culprit and nonculprit vessels were identified by matching invasive coronary angiography with coronary CTA findings. High-risk plaque (HRP) characteristics, including minimum lumen area &lt;4 mm&lt;sup&gt;2&lt;/sup&gt;, plaque burden ≥70%, low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign, were assessed by a core laboratory, with HRP defined as ≥3 HRP characteristics. From coronary CTA, the authors derived both the hemodynamic severity of the disease (fractional flow reserve derived from computed tomography [FFR&lt;sub&gt;CT&lt;/sub&gt;]) and its spatial distribution (diffuse vs focal), as assessed by the pullback pressure gradient derived from coronary CTA (PPG&lt;sub&gt;CT&lt;/sub&gt;). Vessels were categorized into 4 hemodynamic disease patterns: nonischemic (FFR&lt;sub&gt;CT&lt;/sub&gt; &gt;0.80), hemodynamic diffuse (FFR&lt;sub&gt;CT&lt;/sub&gt; ≤0.80 and PPG&lt;sub&gt;CT&lt;/sub&gt; ≤0.50), mixed (FFR&lt;sub&gt;CT&lt;/sub&gt; ≤0.80 and 0.50 &lt; PPG&lt;sub&gt;CT&lt;/sub&gt; ≤0.60), and focal disease (FFR&lt;sub&gt;CT&lt;/sub&gt; ≤0.80 and PPG&lt;sub&gt;CT&lt;/sub&gt; &gt;0.60).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 873 vessels, the mean FFR&lt;sub&gt;CT&lt;/sub&gt; was 0.74 ± 0.17 and the mean PPG&lt;sub&gt;CT&lt;/sub&gt; was 0.54 ± 0.14. Both lower FFR&lt;sub&gt;CT&lt;/sub&gt; and higher PPG&lt;sub&gt;CT&lt;/sub&gt; were independently associated with higher ACS risk (OR per 0.1 increase in FFR&lt;sub&gt;CT&lt;/sub&gt;: 0.71 [95% CI: 0.65-0.77]; &lt;em&gt;P&lt;/em&gt; &lt; 0.001; OR per 0.1 increase in PPG: 1.22 [95% CI: 1.09-1.37]; &lt;em&gt;P&lt;/em&gt; &lt; 0.001). Among the 4 subgroups of hemodynamic disease pattern, hemodynamic focal disease showed the highest risk of ACS (relative risk [RR]: 2.02 [95% CI: 1.74-2.36]; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), myocardial infarction (RR: 1.75 [95% CI: 1.43-2.14]; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), and unstable angina (RR: 2.54 [95% CI: 2.00-3.22]; &lt;em&gt;P&lt;/em&gt; &lt; 0.001). It remained a predictor for ACS in nonobstructive lesions (OR: 3.56 [95% CI: 1.43-8.84]), obstructive lesions (OR: 3.16 [95% CI: 1.96-5.07]), non-HRP (OR: 6.69 [95% CI: 3.59-12.5]), and HRP (OR: 2.98 [95% CI: 1.83-4.87]). Although the maximal lesion-level ΔFFR&lt;sub&gt;CT&lt;/sub&gt; (differences in FFR&lt;sub&gt;CT&lt;/sub&gt; across the lesion) demonstrated superior model performance compared with models incorporating FFR&lt;sub&gt;CT&lt;/sub&gt; and PPG&lt;sub&gt;CT&lt;/sub&gt;, higher PPG&lt;sub&gt;CT&lt;/sub&gt; was additionally associated with in","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Pages 1239-1252"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393521","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":"Paradoxical Apparent Native T1 Elevation in Triglyceride Deposit Cardiomyovasculopathy","authors":"Ayako Seno MD, PhD,&nbsp;Yoshitaka Iwanaga MD, PhD,&nbsp;Yuya Yamatani PhD,&nbsp;Nobuhiro Zaima PhD,&nbsp;Ryo Abe MD, PhD,&nbsp;Mitsunobu Kitamura MD, PhD,&nbsp;Kenji Onoue MD, PhD,&nbsp;Shungo Hikoso MD, PhD,&nbsp;Hajime Sakuma MD, PhD,&nbsp;Ken-ichi Hirano MD, PhD","doi":"10.1016/j.jcmg.2026.06.011","DOIUrl":"10.1016/j.jcmg.2026.06.011","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 10","pages":"Pages 1276-1282"},"PeriodicalIF":19.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673763","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}