JACC. Cardiovascular imaging最新文献

{"title":"3-Dimensional Echocardiographic Prediction of Left Ventricular Outflow Tract Area Prior to Transcatheter Mitral Valve Replacement","authors":"Joanna Bartkowiak MD ,&nbsp;Chrisoula Dernektsi MD ,&nbsp;Vratika Agarwal MD ,&nbsp;Mark A. Lebehn MD ,&nbsp;Treena A. Williams MS ,&nbsp;Russel A. Brandwein MS ,&nbsp;Nicolas Brugger MD ,&nbsp;Christoph Gräni MD ,&nbsp;Stephan Windecker MD ,&nbsp;Torsten P. Vahl MD ,&nbsp;Tamim M. Nazif MD ,&nbsp;Isaac George MD ,&nbsp;Susheel K. Kodali MD ,&nbsp;Fabien Praz MD ,&nbsp;Rebecca T. Hahn MD","doi":"10.1016/j.jcmg.2024.05.011","DOIUrl":"10.1016/j.jcmg.2024.05.011","url":null,"abstract":"<div><h3>Background</h3><div>New postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo–left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR).</div></div><div><h3>Objectives</h3><div>This study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT).</div></div><div><h3>Methods</h3><div>A total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients.</div></div><div><h3>Results</h3><div>There was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm², limit of agreement: −92.2 mm² to 143.3 mm²; <em>P</em> &lt; 0.001; mean bias pre/post CT: 28.3 mm², limit of agreement: −65.8 mm² to 122.4 mm²; <em>P =</em> 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r² = 0.481; <em>P</em> &lt; 0.001 for TEE and r² = 0.401; <em>P</em> &lt; 0.001 for CT).</div></div><div><h3>Conclusions</h3><div>TEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1168-1178"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788113","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":"Stress CMR Perfusion Imaging in the Medicare-Eligible Population: Insights From the SPINS Study.","authors":"Yin Ge, Panagiotis Antiochos, Benedikt Bernhard, Bobak Heydari, Kevin Steel, Scott Bingham, J Ronald Mikolich, Andrew E Arai, W Patricia Bandettini, Amit R Patel, Sujata M Shanbhag, Afshin Farzaneh-Far, John F Heitner, Chetan Shenoy, Steve W Leung, Jorge A Gonzalez, Dipan J Shah, Subha V Raman, Victor A Ferrari, Jeanette Schulz-Menger, Matthias Stuber, Orlando P Simonetti, Raymond Y Kwong","doi":"10.1016/j.jcmg.2024.07.029","DOIUrl":"https://doi.org/10.1016/j.jcmg.2024.07.029","url":null,"abstract":"<p><strong>Background: </strong>Patients aged ≥65 years account for a disproportionately large portion of cardiovascular (CV) events and pose a challenge for noninvasive detection of coronary artery disease.</p><p><strong>Objectives: </strong>This study sought to determine the prognostic value of stress cardiac magnetic resonance (CMR) in a Medicare-eligible group of patients in a multicenter setting in the United States.</p><p><strong>Methods: </strong>From a multicenter U.S. registry, the study identified patients aged ≥65 years who were referred for stress CMR for evaluation of myocardial inducible ischemia. The primary outcome was defined as CV death or nonfatal myocardial infarction, whereas the secondary outcome was defined as any primary outcome, hospitalization for unstable angina, hospitalization for congestive heart failure, and unplanned late coronary artery bypass grafting. The associations of CMR findings with CV outcomes adjusted to clinical risk markers and health care cost spending were determined.</p><p><strong>Results: </strong>Among 1,780 patients (aged 73 ± 5.7 years; 46% female), study investigators observed 144 primary events and 323 secondary events, over a median follow-up of 4.8 years. The presence of inducible ischemia and late gadolinium enhancement (LGE) was associated with incrementally higher event rates. Patients with neither inducible ischemia nor LGE experienced a <1% annualized rate of primary outcome. In a multivariable model adjusted for CV risk factors, inducible ischemia and LGE maintained an independent association with primary (HR: 2.80 [95% CI: 1.93-4.05]; P < 0.001; and HR: 1.85 [95% CI: 1.21-2.82]; P = 0.004, respectively) and secondary (HR: 2.46 [95% CI: 1.90-3.19]; P < 0.001; and HR: 1.72 [95% CI: 1.30-2.27]; P < 0.001, respectively) outcomes. Rates of revascularization, as well as downstream costs for patients without CMR-detected inducible ischemia, remained low throughout the follow-up period.</p><p><strong>Conclusions: </strong>In a multicenter cohort of Medicare-eligible older patients, stress CMR was effective in providing risk stratification. (Stress CMR Perfusion Imaging in the United States [SPINS] study; NCT03192891).</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465944","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":"Multiparametric Cardiac Magnetic Resonance Imaging to Discriminate Endomyocardial Biopsy-Proven Chronic Myocarditis From Healed Myocarditis","authors":"Jan M. Brendel MD ,&nbsp;Karin Klingel MD ,&nbsp;Christoph Gräni MD, PhD ,&nbsp;Ron Blankstein MD ,&nbsp;Jens Kübler MD ,&nbsp;Florian Hagen MD ,&nbsp;Meinrad Gawaz MD ,&nbsp;Konstantin Nikolaou MD ,&nbsp;Patrick Krumm MD ,&nbsp;Simon Greulich MD","doi":"10.1016/j.jcmg.2024.06.009","DOIUrl":"10.1016/j.jcmg.2024.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Detecting ongoing inflammation in myocarditis patients has prognostic relevance, but there are limited data on the detection of chronic myocarditis and its differentiation from healed myocarditis.</div></div><div><h3>Objectives</h3><div>This study sought to assess the performance of cardiac magnetic resonance (CMR) for the detection of ongoing inflammation and the discrimination of chronic myocarditis from healed myocarditis.</div></div><div><h3>Methods</h3><div>Consecutive patients with persistent symptoms (&gt;30 days) suggestive of myocarditis were prospectively enrolled from a single tertiary center. All patients underwent a multiparametric 1.5-T CMR protocol including biventricular strain, T₁/T₂ mapping, and late gadolinium enhancement (LGE). Endomyocardial biopsy was chosen for the reference standard diagnosis.</div></div><div><h3>Results</h3><div>Among 452 consecutive patients, 103 (median age: 50 years; 66 men) had evaluable CMR and cardiopathologic reference diagnosis: 53 (51%) with chronic lymphocytic myocarditis and 50 (49%) with healed myocarditis. T₂ mapping as a single parameter showed the best accuracy in detecting chronic myocarditis, if abnormal in ≥3 segments (92%; 95% CI: 85-97), and provided the best discrimination from healed myocarditis, as defined by the area under the receiver-operating characteristic curve (0.87 [95% CI: 0.79-0.93]; <em>P &lt;</em> 0.001), followed by radial peak systolic strain rate of the left ventricle (0.86) and the right ventricle (0.84); T₁ mapping (0.64), extracellular volume fraction (0.62), and LGE (0.57). Specificity increased when T₂ mapping was combined with elevation of either troponin or C-reactive protein.</div></div><div><h3>Conclusions</h3><div>A multiparametric CMR protocol allows detection of ongoing myocardial inflammation and discrimination of chronic myocarditis from healed myocarditis, with segmental T₂ mapping and biventricular strain analysis showing higher diagnostic accuracy compared with T₁ mapping, extracellular volume fraction, and LGE. The use of biomarkers (troponin or C-reactive protein) may improve specificity.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1182-1195"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901831","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":"Clinical Utility of LA Indices in Chronic Severe Aortic Regurgitation","authors":"Kazuaki Negishi MD, PhD, MSc ,&nbsp;Koya Ozawa MD, PhD","doi":"10.1016/j.jcmg.2024.07.028","DOIUrl":"10.1016/j.jcmg.2024.07.028","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1146-1148"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145678","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":"Reappraisal of the Concept and Implications of Pulmonary Hypertension in Degenerative Mitral Regurgitation","authors":"","doi":"10.1016/j.jcmg.2024.05.006","DOIUrl":"10.1016/j.jcmg.2024.05.006","url":null,"abstract":"<div><h3>Background</h3><div>European and U.S. clinical guidelines diverge regarding pulmonary hypertension (PHTN) in degenerative mitral regurgitation (DMR). Gaps in knowledge underpinning these divergences affect risk assessment and management recommendations attached to systolic pulmonary pressure (SPAP) in DMR.</div></div><div><h3>Objectives</h3><div>This study sought to define PHTN links to DMR severity, prognostic thresholds, and independent outcome impact in a large quantitative DMR registry.</div></div><div><h3>Methods</h3><div>This study gathered a large multicentric registry of consecutive patients with isolated moderate-to-severe DMR, with DMR and SPAP quantified prospectively at diagnosis.</div></div><div><h3>Results</h3><div>In 3,712 patients (age 67 ± 15 years, 36% women) with ≥ moderate-to-severe DMR, effective regurgitant orifice (ERO) was 0.42 ± 0.19 cm², regurgitant volume 66 ± 327 mL/beat and SPAP 41 ± 16 mm Hg. Spline-curve analysis showed excess mortality under medical management emerging around SPAP 35 mm Hg and doubling around SPAP 50 mm Hg. Accordingly, severe pulmonary hypertension (sPHTN) (SPAP ≥50 mm Hg) was detected in 916 patients, moderate pulmonary hypertension (mPHTN) (SPAP 35-49 mm Hg) in 1,128, and no-PHTN (SPAP &lt;35 mm Hg) in 1,668. Whereas SPAP was strongly associated with DMR-ERO, nevertheless excess mortality with sPHTN (adjusted HR: 1.65; 95% CI: 1.24-2.20) and mPHTN (adjusted HR: 1.44; 95% CI: 1.11-1.85; both <em>P</em> ≤ 0.005) was observed independently of ERO and all baseline characteristics and in all patient subsets. Nested models demonstrated incremental prognostic value of mPHTN and sPHTN (all <em>P</em> &lt; 0.0001). Despite higher operative risk with mPHTN and sPHTN, DMR surgical correction was followed by higher survival in all PHTN ranges with strong survival benefit of early surgery (&lt;3 months). Postoperatively, excess mortality was abolished (<em>P</em> ≥ 0.30) in mPHTN, but only abated in sPHTN.</div></div><div><h3>Conclusions</h3><div>This large international registry, with prospectively quantified DMR and SPAP, demonstrates a Doppler-defined PHTN impact on mortality, independent of DMR severity. Crucially, it defines objectively the new and frequent mPHTN range, independently linked to excess mortality under medical management, which is abolished by DMR correction. Thus, at DMR diagnosis, Doppler-SPAP measurement defining these new PHTN ranges, is crucial to guiding DMR management.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1149-1163"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456937","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 Computed Tomography Angiography for the Diagnosis of Spontaneous Coronary Artery Dissection","authors":"","doi":"10.1016/j.jcmg.2024.05.009","DOIUrl":"10.1016/j.jcmg.2024.05.009","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1252-1254"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544847","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":"Longitudinal Assessment of Left Atrial Remodeling in Patients With Chronic Severe Aortic Regurgitation","authors":"","doi":"10.1016/j.jcmg.2024.04.007","DOIUrl":"10.1016/j.jcmg.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><div>There are significant sex and age differences in left ventricular (LV) remodeling that may lead to disparity in outcomes when used to inform the timing of aortic regurgitation (AR) intervention.</div></div><div><h3>Objectives</h3><div>The aim of this study was to examine whether left atrial (LA) parameters might represent better criteria than LV parameters to inform the timing of AR intervention.</div></div><div><h3>Methods</h3><div><span>Using data on patients with moderate to severe or severe AR with serial echocardiography (2010-2016), the longitudinal trends in left atrial volume index (LAVI) and left atrial reservoir strain (LAr) were evaluated by sex and age. The incremental utility of these parameters in predicting </span>adverse events over LV parameters was also determined.</div></div><div><h3>Results</h3><div>In 525 patients (25.7% women) with 1,687 echocardiograms over a median follow-up period of 2.0 years (Q1-Q3: 1.0-3.6 years), there was significant increase in LAVI (1.0 mL/m² per year [95% CI: 0.76-1.2 mL/m² per year]) and decrease in LAr (−1.3% per year [95% CI: −1.6% to −0.92%]), without a significant interaction by sex or age category (<em>P</em> for interaction ≥ 0.17). In addition, both LAVI and LAr were significant predictors of adverse events independent of LV parameters. The optimal discriminatory thresholds were 37 mL/m² for LAVI and 35% for LAr. These thresholds were similar across categories of sex and age. Within the relatively short-term follow-up, surgery was associated with survival benefit among patients with LAVI ≥37 mL/m² (HR: 0.33 [95% CI: 0.15-0.72]; <em>P =</em> 0.006) but was not statistically significant among patients with LAVI &lt;37 mL/m² (HR: 0.46 [95% CI: 0.18-1.17]; <em>P =</em> 0.09). Similarly, surgery was associated with survival for the subgroup with LAr ≤35% but not among those with LAr &gt;35%.</div></div><div><h3>Conclusions</h3><div>Unlike LV remodeling, LA remodeling demonstrates a similar rate of progression between categories of sex and age among patients with AR. In addition, LA parameters provide incremental prognostic value over LV parameters.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1133-1145"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327454","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":"Calcification vs Inflammation","authors":"Charalambos Antoniades MD, PhD,&nbsp;Kenneth Chan MBBS","doi":"10.1016/j.jcmg.2024.08.006","DOIUrl":"10.1016/j.jcmg.2024.08.006","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1225-1228"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390653","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":"Diagnosing Myocarditis Using Cardiac Magnetic Resonance Imaging","authors":"Chetan Shenoy MBBS, MS,&nbsp;Parag H. Bawaskar MD, DM","doi":"10.1016/j.jcmg.2024.07.008","DOIUrl":"10.1016/j.jcmg.2024.07.008","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1196-1198"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107565","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":"Detection of Cardiac Involvement in Eosinophilic Granulomatosis With Polyangiitis (EGPA) With Multiparametric Cardiovascular Magnetic Resonance (CMR)","authors":"Alina Hua MBBS,&nbsp;Agata Sularz MBBS,&nbsp;Peter Wheen MBBS,&nbsp;Vardah Alam MBBS,&nbsp;Ronak Rajani BM, MD,&nbsp;Amedeo Chiribiri MD, PhD,&nbsp;David D'Cruz MBBS, PhD,&nbsp;Michelle Fernando MBBS, PhD,&nbsp;Jaideep Dhariwal MBBS, PhD,&nbsp;Alexandra M. Nanzer MBBS, PhD,&nbsp;David J. Jackson MBBS, PhD,&nbsp;Tevfik F. Ismail MBBS, PhD","doi":"10.1016/j.jcmg.2024.05.008","DOIUrl":"10.1016/j.jcmg.2024.05.008","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1261-1264"},"PeriodicalIF":12.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603657","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}