JACC. Cardiovascular imaging最新文献

{"title":"Interaction Between Genotype, Phenotype, and Prognosis in Patients With Dilated Cardiomyopathy.","authors":"Yangjie Li, Yuanwei Xu, Yang Guo, Jiajun Guo, Weihao Li, Zhigang Zhang, Ke Wan, Ziqian Xu, Lutong Pu, Jie Wang, Jiayu Sun, Qing Zhang, Yuchi Han, Yang Shu, Heng Xu, Yucheng Chen","doi":"10.1016/j.jcmg.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.08.007","url":null,"abstract":"<p><strong>Background: </strong>Dilated cardiomyopathy (DCM) is a heterogeneous myocardial disease with variable clinical outcomes. Although both genetic variants and cardiac magnetic resonance (CMR)-derived fibrosis markers are associated with prognosis, their interactions and relative contributions to disease progression remain incompletely understood.</p><p><strong>Objectives: </strong>This study aims to explore the associations among genetic variants, CMR characteristics, and long-term prognosis in DCM.</p><p><strong>Methods: </strong>The authors prospectively enrolled patients diagnosed with DCM who underwent whole-genome sequencing and CMR examination. DCM-associated genetic status was classified as TTN variant, non-TTN variant, and genotype-negative. CMR evaluation included cardiac structure and function, late gadolinium enhancement (LGE), and T1 mapping. Clinical outcomes included cardiovascular death/heart transplantation, sudden cardiac death, and arrhythmic events.</p><p><strong>Results: </strong>Of the 837 enrolled patients, 163 (19.5%) carried pathogenic/likely pathogenic variants, including 78 (9.3%) non-TTN and 85 (10.2%) TTN variants. Patients with non-TTN variants demonstrated the greatest fibrosis burden, with higher LGE prevalence (69.2% vs 24.7% in patients with TTN variants and 46.6% in genotype-negative patients, P < 0.001), greater LGE extent, more frequent ring-like and subepicardial patterns, and higher native T1 and extracellular volume fraction (ECV) values. In multivariable Cox regression analysis, non-TTN variants independently predicted cardiovascular death/heart transplantation (adjusted HR: 2.39; 95% CI: 1.46-3.92; P < 0.001) and sudden cardiac death (adjusted HR: 3.26; 95% CI: 1.59-6.65; P = 0.001), together with left ventricular end-diastolic volume index, LGE, and ECV. Patients with non-TTN variants consistently had worse outcomes among patients with LGE presence, greater LGE extent, elevated ECV, and in both left ventricular ejection fraction strata (≤35% and >35%) (log-rank P < 0.05). Mediation analysis showed LGE (indirect HR: 1.26; 95% CI: 1.11-1.47; P = 0.008) and ECV (indirect HR: 1.29; 95% CI: 1.12-1.53; P = 0.006) partly mediated the association between non-TTN variants and adverse outcomes, whereas left ventricular end-diastolic volume index and left ventricular ejection fraction did not show significant mediating effects.</p><p><strong>Conclusions: </strong>Genetic background was associated with distinct myocardial fibrosis phenotypes and provided prognostic information beyond conventional CMR-derived fibrosis and functional phenotypes in DCM. Myocardial fibrosis partly mediates the association between non-TTN variants and adverse outcomes.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080588","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":"Toward Improved Risk Association: Arrhythmogenic Mitral Valve Prolapse and Electromechanical Window Negativity.","authors":"Lisa A Freed","doi":"10.1016/j.jcmg.2026.08.013","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.08.013","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227819","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":"Look Beyond the Trabeculae: CMR-Substrate Predicts Risk.","authors":"Christoph Gräni","doi":"10.1016/j.jcmg.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.08.012","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181857","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":"Quantitative Assessment of Myocardial Perfusion: A Review of PET/CT and CMR Methods.","authors":"Thomas Anderton, Christel H Kamani, Peter Kellman, John O Prior, Sven Plein","doi":"10.1016/j.jcmg.2026.06.013","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.06.013","url":null,"abstract":"<p><p>Noninvasive imaging is the cornerstone in the diagnosis and management of coronary artery disease, which continues to be a leading cause of morbidity and mortality worldwide. Of the modalities available, positron emission tomography/computed tomography and cardiac magnetic resonance have shown the highest accuracy for detecting flow-limiting coronary stenoses. Each modality additionally offers the ability to quantify the myocardial blood flow and myocardial perfusion reserve on a pixel-wise, segmental, and global level. Quantitative perfusion has shown additive diagnostic value over traditional perfusion imaging, particularly in difficult cases such as multivessel disease, and will likely be increasingly found in clinical workflows. This State-of-the-Art Review compares the principles, performance, limitations, and future directions of quantitative myocardial blood flow assessment using positron emission tomography/computed tomography and cardiac magnetic resonance and provides physicians with practical guidance on when to choose which test.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074747","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":"Native T1 for Diagnosis and Risk Prediction in Amyloid Transthyretin Cardiomyopathy: An Observational Study on 1,675 Subjects.","authors":"Alberto Aimo, Awais Sheikh, Sorayya Kakhi, Anouk Achten, Ana Martinez-Naharro, Lucia Venneri, Yousuf Razvi, Josephine Mansell, Brinda Thillainathan, Suzan Hatipoglu, Carol Whelan, Cristina Quarta, Ruta Virsinskaite, Daniel Feffer Barak, Ashutosh Wechalekar, Helen Lachmann, Daniel Knight, Tushar Kotecha, Peter Kellman, Charlotte Manisty, James Moon, Michele Emdin, Scott D Solomon, Philip N Hawkins, Julian Gillmore, Marianna Fontana","doi":"10.1016/j.jcmg.2026.07.026","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.07.026","url":null,"abstract":"<p><strong>Background: </strong>Native T1 mapping is a contrast-free cardiac magnetic resonance (CMR) marker of myocardial amyloid infiltration, but center-specific diagnostic cutoffs and prognostic strata remain incompletely defined across transthyretin amyloidosis (ATTR).</p><p><strong>Objectives: </strong>This study aims to define native T1 thresholds and risk strata across the ATTR spectrum and compare its diagnostic and prognostic performance with extracellular volume (ECV).</p><p><strong>Methods: </strong>In a cohort at a national referral amyloidosis center (2011-2025), 1,675 individuals undergoing CMR for suspected or confirmed ATTR were classified as asymptomatic TTR-variant carriers (n = 125), extracardiac ATTR (n = 44), early ATTR-CM (n = 73), or overt ATTR-CM (n = 1,433). Diagnostic targets were: 1) any cardiac involvement (early/overt ATTR-CM); and 2) overt vs early ATTR-CM. All-cause mortality from national records was analyzed with Cox models; native T1 strata were calibrated to predefined ECV strata using 3-year mortality.</p><p><strong>Results: </strong>Native T1 rose stepwise across disease categories and correlated with ECV (r = 0.62), with weaker coupling in advanced disease. Over a median 3.3 years, 822 of 1,675 (49%) participants died. Native T1 ≤1,050 ms (z-score +1.14) identified a low likelihood of cardiac involvement with 93% sensitivity and 84% specificity, whereas native T1 ≥1,100 ms (z-score +2.40) identified overt ATTR-CM with 75% sensitivity and 88% specificity. Calibration against ECV strata yielded native T1 risk categories that reproduced a stepwise 3-year mortality gradient, with a stronger gradient at low to intermediate T1 and relative plateauing at higher T1; adding native T1 strata improved prognostic information beyond clinical variables.</p><p><strong>Conclusions: </strong>Native T1 can provide pragmatic diagnostic supportive thresholds, whereas ECV-calibrated native T1 strata reproduced a graded 3-year mortality risk. Native T1 offers a practical contrast-free approach to support diagnosis and risk stratification, although ECV remains the preferred quantitative marker when contrast CMR is available. Thresholds and z-score based approaches still require local recalibration and external validation before adoption at other centers.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061442","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":"Grading Right Ventricular Dysfunction in Secondary Tricuspid Regurgitation: From Single Metrics to Integrated Assessment.","authors":"Denisa Muraru, Attila Kovács","doi":"10.1016/j.jcmg.2026.08.010","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.08.010","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038334","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":"New Eyes for an Old Problem.","authors":"Bálint Szilveszter","doi":"10.1016/j.jcmg.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.08.014","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038637","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":"Myocardial Tissue Characterization by CMR Captures Mechanistic Severity Beyond Filling Pressure in HFpEF: The Multicenter DECIPHER HFpEF Study.","authors":"Eike Nagel, Philip Wenzel, Tim Seidler, Karl-Philipp Rommel, Florian André, Sebastian Kelle, Andreas Rolf, Mariuca Vasa-Nicotera, Eva Herrmann, Felicitas Escher, Jedrzej Hoffmann, Frank Rademakers, Philipp Lurz, Valentina O Puntmann","doi":"10.1016/j.jcmg.2026.07.012","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.07.012","url":null,"abstract":"<p><strong>Background: </strong>Diastolic dysfunction (DD) in heart failure with preserved ejection fraction (HFpEF) reflects active relaxation (τ) and passive stiffness (β), conflated by end-diastolic pressure (EDP) and potentially requiring different therapies. Whether cardiac magnetic resonance (CMR) tissue mapping captures these beyond filling pressure is unknown.</p><p><strong>Objectives: </strong>This study aims to determine whether CMR tissue mapping (native T1 corrected for field strength and scanner [T1c], native T2 corrected for field strength and scanner [T2c]) captures τ and β as markers of mechanistic severity in HFpEF beyond EDP.</p><p><strong>Methods: </strong>In this prospective multicenter study, patients with suspected HFpEF underwent CMR with sequence-corrected tissue mapping and invasive pressure-volume loop analysis. HFpEF was defined as EDP ≥16 mm Hg (n = 52). Age- and sex-matched control patients (n = 32) and healthy volunteers (n = 18) provided cross-group context. Eighteen catheterized symptomatic patients with normal resting EDP underwent handgrip provocation for a continuum analysis. Partial correlations adjusted T1c-β and T2c-τ associations for EDP.</p><p><strong>Results: </strong>T1c and T2c differed between HFpEF and matched control patients (Cliff's δ 0.74 and 0.80; both P < 0.001). Within HFpEF, T1c correlated with β (partial ρ = 0.47; P = 0.003) and T2c with τ (ρ = 0.35; P = 0.018), both conditional on EDP. Exploratory partitioning around medoids clustering on τ and β identified 2 phenotypes (mild DD [n = 24], severe DD [n = 28]; adjusted Rand index: 0.78) that separated T1c and T2c (both P < 0.001), whereas an EDP median split did not, consistent with tissue mapping reflecting mechanistic severity beyond filling pressure.</p><p><strong>Conclusions: </strong>In invasively characterized HFpEF, CMR tissue mapping captures active relaxation impairment and passive stiffness conditional on filling pressure, robust to clinical covariate adjustment. The exploratory 2-phenotype partition is hypothesis-generating; prospective external validation, including treatment-response data, is required before clinical stratification. (Validation of CMR Against Invasive Heamodynamics in Patients With HFpEF [DECIPHER HFpEF]; NCT03251183).</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008622","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":"Long-Term Warranty Period of Stress CMR and SPECT in Stable Angina: Implications for Repeat Testing.","authors":"Giandomenico Bisaccia, Peter P Swoboda, John F Younger, Neil Maredia, Chiara Bucciarelli-Ducci, Sven Plein, John P Greenwood","doi":"10.1016/j.jcmg.2026.07.016","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.07.016","url":null,"abstract":"<p><strong>Background: </strong>Few prospective studies have explored the long-term prognostic value and warranty period of functional imaging in patients with stable chest pain. The CE-MARC (Clinical Evaluation of Magnetic Resonance in Coronary Heart Disease) trial recruited 752 patients with suspected angina and demonstrated the high diagnostic accuracy of stress cardiac magnetic resonance (CMR) compared with single-photon emission computed tomography (SPECT), using invasive coronary angiography as the reference standard.</p><p><strong>Objectives: </strong>This study aims to assess the comparative long-term prognostic value of stress CMR and SPECT and to establish operational warranty periods for normal test results.</p><p><strong>Methods: </strong>Participants in the CE-MARC trial were followed up for major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, and unplanned coronary revascularization. The warranty period identified the time interval during which patients with a normal test result remained 97.5% free of MACE. Multivariable regression analysis identified key warranty period modifiers.</p><p><strong>Results: </strong>Of 752 recruited patients, 652 (86.9%) with CMR and SPECT with follow-up available formed the study cohort. At a median of 15.5 years (Q1-Q3: 12.4-16.6 years), 40 (6.1%) cardiovascular deaths occurred, 29 (4.4%) patients experienced a myocardial infarction, and 47 (7.2%) unplanned revascularization. After adjustment for cardiovascular risk factors, an abnormal CMR remained a strong independent MACE predictor (HR: 2.74; 95% CI: 1.70-4.42; P < 0.001). Patients with a normal test result had a warranty period of 6.8 years for stress CMR and 5.1 years for SPECT. Age, smoking, and diabetes identified higher-risk patients who had a reduced warranty period for a normal result.</p><p><strong>Conclusions: </strong>In a long-term prospective study of patients with stable chest pain, stress CMR remained a strong, independent predictor of hard cardiovascular events, with a warranty period of almost 7 years for a normal scan. (Clinical Evaluation of Magnetic Resonance in Coronary Heart Disease; [CE-MARC]; ISRCTN77246133).</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976917","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":"How Big a Role for Invasive Hemodynamics in the Diagnosis of Heart Failure With Preserved Ejection Fraction?","authors":"Otto A Smiseth, James D Thomas, Thomas H Marwick, Frank A Flachskampf","doi":"10.1016/j.jcmg.2026.07.022","DOIUrl":"https://doi.org/10.1016/j.jcmg.2026.07.022","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":19.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038621","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}