JACC. Cardiovascular imaging最新文献

{"title":"Prognostic Impact of Culprit Lesion Calcified Nodule After Emergency Coronary Intervention","authors":"Masahiro Hada MD, PhD, Tsunekazu Kakuta MD, PhD, Tomoyo Sugiyama MD, PhD, Masahiro Hoshino MD, PhD, Taishi Yonetsu MD, PhD, Eisuke Usui MD, PhD, Yoshihiro Hanyu MD, Tatsuhiro Nagamine MD, Kai Nogami MD, Hiroki Ueno MD, Kazuki Matsuda MD, Kodai Sayama MD, Mirei Setoguchi MD, Tomohiro Tahara MD, Tatsuya Sakamoto MD, Takashi Mineo MD, Nobuaki Kobayashi MD, PhD, Masamichi Takano MD, PhD, Seita Kondo MD, PhD, Kohei Wakabayashi MD, PhD, Toshiro Shinke MD, PhD","doi":"10.1016/j.jcmg.2024.06.010","DOIUrl":"10.1016/j.jcmg.2024.06.010","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 11","pages":"Pages 1384-1386"},"PeriodicalIF":12.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901832","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 Computed Tomography Angiography for the Evaluation of Valvular Fibrocalcific Volume in Aortic Stenosis","authors":"Maria Lembo MD, PhD ,&nbsp;Shruti S. Joshi MBBS ,&nbsp;Jolien Geers MD ,&nbsp;Rong Bing MD, PhD ,&nbsp;Lorenzo Carnevale PhD ,&nbsp;Tania A. Pawade MBChB, PhD ,&nbsp;Mhairi K. Doris MBChB, PhD ,&nbsp;Evangelos Tzolos MD, PhD ,&nbsp;Kajetan Grodecki MD, PhD ,&nbsp;Sebastien Cadet MSc ,&nbsp;Neil Craig MBChB ,&nbsp;Trisha Singh MBChB, PhD ,&nbsp;Piotr J. Slomka PhD ,&nbsp;Audrey White BSc ,&nbsp;Andrea Guala MD, PhD ,&nbsp;Jose F. Rodriguez-Palomares MD, PhD ,&nbsp;Aroa Ruiz-Muñoz MS ,&nbsp;Lydia Dux-Santoy PhD ,&nbsp;Gisela Teixido-Tura MD, PhD ,&nbsp;Laura Galian-Gay MD, PhD ,&nbsp;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 &lt;</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 &lt;</em> 0.001) and in the external validation cohort (n = 66, rho = 0.58; <em>P &lt;</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 &lt;</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}

{"title":"The Impact of Bariatric Surgery on Coronary Microvascular Function Assessed Using Automated Quantitative Perfusion CMR","authors":"James D. Crane BMBS ,&nbsp;George Joy PhD ,&nbsp;Kristopher D. Knott MBBS ,&nbsp;João B. Augusto MD ,&nbsp;Clement Lau PhD ,&nbsp;Anish N. Bhuva PhD ,&nbsp;Andreas Seraphim PhD ,&nbsp;Timothée Evain PhD ,&nbsp;Louise A.E. Brown PhD ,&nbsp;Amrit Chowdhary PhD ,&nbsp;Tushar Kotecha PhD ,&nbsp;Marianna Fontana PhD ,&nbsp;Sven Plein PhD ,&nbsp;Sasindran Ramar MS ,&nbsp;Francesco Rubino MD ,&nbsp;Peter Kellman PhD ,&nbsp;Hui Xue PhD ,&nbsp;Iain Pierce PhD ,&nbsp;Rhodri H. Davies PhD ,&nbsp;James C. Moon MD ,&nbsp;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 &lt;</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/m² (<em>P &lt;</em> 0.001), glycated hemoglobin by 9 mmol/mol (Q1-Q3: 4-19 mmol/mol; <em>P &lt;</em> 0.001), fasting insulin by 142 ± 131 pmol/L (<em>P &lt;</em> 0.001), and hepatic fat fraction by 5.6% (Q1-Q3: 2.6%-15.0%; <em>P &lt;</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}

{"title":"Myocardial Characteristics, Cardiac Structure, and Cardiac Function in Systemic Light-Chain Amyloidosis","authors":"Olivier F. Clerc MD, MPH ,&nbsp;Sarah A.M. Cuddy MD ,&nbsp;Michael Jerosch-Herold PhD ,&nbsp;Dominik C. Benz MD ,&nbsp;Ethan Katznelson MD ,&nbsp;Jocelyn Canseco Neri MS ,&nbsp;Alexandra Taylor BS ,&nbsp;Marie Foley Kijewski PhD ,&nbsp;Giada Bianchi MD ,&nbsp;Frederick L. Ruberg MD ,&nbsp;Marcelo F. Di Carli MD ,&nbsp;Ronglih Liao PhD ,&nbsp;Raymond Y. Kwong MD, MPH ,&nbsp;Rodney H. Falk MD ,&nbsp;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 (&gt;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> &lt; 0.001) in participants with AL-CMP. ECV and GLS were strongly associated with MACE (<em>P</em> &lt; 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 &gt;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}

{"title":"Full Issue PDF","authors":"","doi":"10.1016/S1936-878X(24)00411-X","DOIUrl":"10.1016/S1936-878X(24)00411-X","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 11","pages":"Pages I-CXXXI"},"PeriodicalIF":12.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578845","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":"Hepatic Steatosis and High-Risk Coronary Plaque","authors":"Sara Sukudom MD, MPH,&nbsp;Jason Wee MD,&nbsp;Gavin Huangfu MD,&nbsp;Oyekoya Ayonrinde MD, PhD,&nbsp;P. Gerry Fegan MBBS, PhD,&nbsp;Abdul Ihdayhid MD, PhD,&nbsp;Gerald F. Watts MBBS, PhD,&nbsp;Girish Dwivedi MD, PhD","doi":"10.1016/j.jcmg.2024.06.012","DOIUrl":"10.1016/j.jcmg.2024.06.012","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 11","pages":"Pages 1392-1394"},"PeriodicalIF":12.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874847","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 Plaque Radiomic Phenotypes Predict Fatal or Nonfatal Myocardial Infarction: Analysis of the SCOT-HEART Trial.","authors":"Márton Kolossváry, Andrew Lin, Jacek Kwiecinski, Sebastien Cadet, Piotr J Slomka, David E Newby, Marc R Dweck, Michelle C Williams, Damini Dey","doi":"10.1016/j.jcmg.2024.08.012","DOIUrl":"10.1016/j.jcmg.2024.08.012","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography (CT) angiography-derived attenuation-based plaque burden assessments can identify patients at risk of myocardial infarction.</p><p><strong>Objectives: </strong>This study sought to assess whether more detailed plaque morphology assessment using patient-based radiomic characterization could further enhance the identification of patients at risk of myocardial infarction during long-term follow-up.</p><p><strong>Methods: </strong>Post hoc analysis of coronary CT angiography was performed within the SCOT-HEART (Scottish Computed Tomography of the HEART) clinical trial. Coronary plaque segmentations were used to calculate plaque burdens and eigen radiomic features that described plaque morphology. Univariable and multivariable Cox proportional hazard models were used to evaluate the association between clinical and image-based features and fatal or nonfatal myocardial infarction, whereas Harrell's C-statistic and cumulative/dynamic area under the curve (AUC) values with cross-validation were used to evaluate prognostic performance.</p><p><strong>Results: </strong>Scans from 1,750 patients (aged 58 ± 9 years; 56% male) were analyzed. Over a median of 8.6 years of follow-up, 82 patients had a fatal or nonfatal myocardial infarction. Among the eigen radiomic features, 15 were associated with myocardial infarction in univariable analysis, and 8 features retained their association following adjustment for cardiovascular risk score and plaque burden metrics. Adding plaque burden metrics to a clinical model incorporating cardiovascular risk score, Agatston score and presence of obstructive coronary artery disease had similar prediction performance (C-statistic 0.70 vs 0.70), whereas further addition of eigen radiomic features improved model performance (C-statistic 0.74). In temporal analysis, the model including eigen radiomic features had higher cumulative/dynamic AUC values following the fifth year of follow-up.</p><p><strong>Conclusions: </strong>Radiomics-based precision phenotyping of coronary plaque morphology provided improvements to long-term prediction of myocardial infarction by CT angiography over and above clinical factors and plaque burden. (Scottish Computed Tomography of the HEART [SCOT-HEART]; NCT01149590).</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545611","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":"Echocardiographic Evaluation of Chronic Aortic Regurgitation: Comparison With Cardiac Magnetic Resonance and Implications for Guideline Recommendations.","authors":"Rowa Attar, Maan Malahfji, Clara Angulo, Duc T Nguyen, Edward A Graviss, Dipan J Shah, William A Zoghbi","doi":"10.1016/j.jcmg.2024.08.013","DOIUrl":"https://doi.org/10.1016/j.jcmg.2024.08.013","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for echocardiographic evaluation of aortic regurgitation (AR) have not been validated against an independent quantitative standard.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate the accuracy of the ASE (American Society of Echocardiography) AR guidelines against cardiac magnetic resonance (CMR) and to develop simplified approaches for detection of significant AR.</p><p><strong>Methods: </strong>Patients with AR underwent echocardiography and CMR <4 hours apart. AR severity was graded according to ASE guidelines. Quantitation of regurgitant volume (RegV) was performed with pulsed Doppler at the mitral annulus and right ventricular outflow compared with left ventricular (LV) outflow, and with proximal isovelocity surface area.</p><p><strong>Results: </strong>The authors studied 81 patients; median age was 52 years, and 58% had a bicuspid aortic valve. According to echo, 35 (43%) patients had mild AR, 18 (22%) moderate, 12 (15%) moderate to severe, and 16 (20%) had severe AR. The area under the curve (AUC) for detection of severe AR by CMR using ASE grading was 0.9 (82.4% sensitivity and 96.9% specificity). Feasibility of RegV quantitation was >88% using either echo volumetric method, and it was low for proximal isovelocity surface area (37%). The highest accuracy for echo parameters against CMR was seen with vena contracta width, jet width, and LV end-diastolic volume index (AUC: 0.86-0.89); pressure half-time had the lowest accuracy. Without RegV quantitation, a vena contracta width ≥0.5 cm and indexed LV end-diastolic volume ≥82 mL/m² had 95.5% positive predictive value and 87.5% negative predictive value for identifying ≥moderate to severe AR by CMR (AUC: 0.89).</p><p><strong>Conclusions: </strong>The ASE guidelines display very good performance in identifying significant AR. A simplified approach using vena contracta width and LV volumes can be used to reliably identify significant AR. Further validation of the findings in larger cohorts and against clinical outcomes is needed.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638804","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":"Echocardiographic Markers of Early Left Ventricular Dysfunction in Asymptomatic Aortic Regurgitation: Is It Time to Change the Guidelines?","authors":"Vidhu Anand, Hector I Michelena, Christopher G Scott, Alexander T Lee, Vera H Rigolin, Sorin V Pislaru, Garvan C Kane, Juan A Crestanello, Patricia A Pellikka","doi":"10.1016/j.jcmg.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.jcmg.2024.09.005","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>The authors sought to assess the relationship between these markers (LVEF <60%, iESV ≥45 mL/m², 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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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/m². 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, P < 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 (P = 0.063), followed by 2 markers; highest mortality was when all 3 markers were present (HR: 5.46; 95% CI: 2.51-11.90; P < 0.001).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2024-10-29","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}