European heart journal. Imaging methods and practice最新文献

{"title":"Right ventricular strain analysis in acute pulmonary embolism and its role for late complications.","authors":"Ioannis T Farmakis, Lina-Marie Brandes, Karsten Keller, Gerald S Laux-Winter, Sara Bombace, Philipp Lurz, Stavros V Konstantinides, Lukas Hobohm","doi":"10.1093/ehjimp/qyag166","DOIUrl":"10.1093/ehjimp/qyag166","url":null,"abstract":"<p><strong>Aims: </strong>Acute pulmonary embolism (PE) can result in long-term complications, including post-PE impairment (PPEI) and chronic thromboembolic pulmonary hypertension (CTEPH). Right ventricular global longitudinal strain (RVGLS) is a sensitive measure of RV myocardial deformation that may detect subclinical dysfunction and predict adverse outcomes; however, its value in the follow-up of post-PE assessment has not been yet elucidated.</p><p><strong>Methods and results: </strong>In this prospective sub-study of the FOCUS cohort, 175 consecutive PE survivors from the Mainz centre underwent echocardiographic follow-up at 3 and 12 months, including speckle-tracking assessment of RVGLS, RV free wall strain (RVFWLS), and strain-derived ventriculoarterial coupling indices. Conventional RV parameters, volumetric measures, and clinical outcomes were recorded. Overall, 175 patients were included, of whom 16 developed PPEI or CTEPH during follow-up. RV function improved over time in patients without PPEI/CTEPH, including increases in RVGLS (from -16 to -18%), RVFWLS, ejection fraction, and strain-based ventriculoarterial coupling, accompanied by reductions in RV volumes. In contrast, patients who developed PPEI/CTEPH (<i>n</i> = 16) displayed progressive deterioration of RV strain and strain-derived coupling despite relatively preserved TAPSE-based indices. At 3 months, RVGLS was significantly associated with the combined PPEI/CTEPH endpoint over 2 years (OR 1.10, 95% CI 1.01-1.21), whereas strain-derived ventriculoarterial coupling parameters demonstrated borderline associations [RVGLS/systolic pulmonary artery pressure (sPAP): OR 0.11, 95% CI 0.01-0.91; RVFWLS/sPAP: OR 0.16, 95% CI 0.02-1.17]. TAPSE/sPAP was not associated with the outcome.</p><p><strong>Conclusion: </strong>RV strain and strain-derived ventriculoarterial coupling may provide sensitive early markers of maladaptive RV remodelling after acute PE and were associated with the development of PPEI/CTEPH, highlighting their potential value in post-PE follow-up strategies.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 4","pages":"qyag166"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transthoracic echocardiography vs. cardiac magnetic resonance imaging for the diagnosis of left ventricular thrombus: an updated systematic review and diagnostic accuracy meta-analysis.","authors":"Ernesto Calderón Martinez, Carla Isabella Miret Durazo, Ajay Kumar, Rafael Pinto-Colmenarez, Palvi Mroke, Zishan Rahman, Ahmad Hammoud, Imran Baig, Lakshmi Sree Pugalenthi, Gabriela Flores Monar, Sachin Sapkota, Diego Ramonfaur","doi":"10.1093/ehjimp/qyag150","DOIUrl":"10.1093/ehjimp/qyag150","url":null,"abstract":"<p><p>Left ventricular thrombus (LVT) is a significant complication of myocardial infarction, associated with increased morbidity and mortality because of the risk of systemic embolization and stroke. Early detection of LVT is therefore important for the timely initiation of anticoagulation therapy. This systematic review and meta-analysis compared the diagnostic accuracy of cardiac magnetic resonance (CMR) with transthoracic echocardiography (TTE) for the detection of LVT. Following PRISMA guidelines, PubMed, Cochrane, CNKI, Scopus, LILACS, Web of Science, Google Scholar, EMBASE, and CINAHL were searched. Random-effects meta-analyses were performed in R (v3.4.3), with pooled proportions or area under the curve (AUC) values reported alongside 95% confidence intervals, and heterogeneity assessed using the <i>I</i>² statistic. Eighteen studies involving 3478 participants met the inclusion criteria. Most studies contributed to the primary analysis of TTE performance using CMR as the reference standard, while only five studies allowed direct head-to-head comparison using an independent reference standard. In the head-to-head analysis, CMR demonstrated higher sensitivity (70.5%, 95% CI: 0.554-0.822) and specificity (99.2%, 95% CI: 0.983-0.997) for detecting LVT compared with TTE, which showed a sensitivity of 31.8% (95% CI: 0.252-0.391) and specificity of 96.3% (95% CI: 0.929-0.981). The AUC for CMR was 0.985 compared with 0.59 for TTE. Heterogeneity was significant for TTE (<i>I</i>² = 75.8%) but low for CMR (<i>I</i>² = 0.0%). Funnel-plot assessment suggested a low likelihood of publication bias. These findings suggest that CMR may provide a diagnostic advantage over TTE for LVT detection, particularly in high-risk patients or when TTE findings are negative or inconclusive. However, this apparent advantage should be interpreted cautiously because most included studies used CMR, particularly late gadolinium enhancement CMR, as the reference standard rather than an independent imaging modality or pathological confirmation, and many studies were historical and used heterogeneous or non-optimized echocardiographic protocols. Further contemporary studies using independent validation standards are needed. <b>Systematic Review Registration</b>: PROSPERO CRD 42024558739.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 4","pages":"qyag150"},"PeriodicalIF":0.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered caval flow and wall shear stress in single ventricle circulation: insights from ferumoxytol-enhanced 4D flow MRI.","authors":"Vasupradha Suresh Kumar, Sarah Kollar, Ravi V Vegulla, Areen Almarkhan, Andrew Waberski, Yue-Hin Loke","doi":"10.1093/ehjimp/qyag158","DOIUrl":"https://doi.org/10.1093/ehjimp/qyag158","url":null,"abstract":"<p><strong>Aims: </strong>Patients with single ventricle (SV) congenital heart disease typically undergo surgical palliation that reroutes the superior/inferior vena cava (SVC/IVC) directly to the pulmonary arteries, which alters vascular flow dynamics. Four-dimensional flow (4DF) cardiovascular magnetic resonance (CMR), particularly with ferumoxytol contrast, enables comprehensive assessment of flow distribution and wall shear stress (WSS) in small paediatric vessels. This study aimed to evaluate the differences in caval flow and WSS between SV and BiV patients.</p><p><strong>Methods and results: </strong>We retrospectively analysed patients who underwent clinically indicated ferumoxytol-enhanced (FE) 4DF CMR between 2019 and 2024. Patients with anomalous systemic or pulmonary venous return were excluded. 4DF data were evaluated on the cloud-based Tempus platform. Flow in the SVC, IVC, aorta, and descending aorta was quantified and indexed to the body surface area. The average WSS over time was measured. Among 387 patients (<i>n</i> = 126 for SV; <i>n</i> = 261 for BiV), SV patients had lower indexed SVC flow (1.11 ± 0.51 vs. 1.50 ± 0.69 L/min/m², <i>P</i> < 0.0001) and lower WSS (16.0 ± 6.4 vs. 22.7 ± 9.1 cPa, <i>P</i> < 0.0001) compared with BiV patients. The SVC/caval flow ratio declined with age and body surface area, remaining independently lower in the SV group after multivariable adjustment (<i>P</i> = 0.0005).</p><p><strong>Conclusion: </strong>SV physiology is associated with lower SVC flow and WSS independent of age or body size, suggesting altered systemic venous return intrinsic to cavopulmonary circulation. 4DF CMR is a valuable tool for assessing and monitoring systemic venous physiology in congenital heart disease.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 3","pages":"qyag158"},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnitude of serum β-hydroxybutyrate elevations and myocardial glucose suppression in fluorine-18 fluorodeoxyglucose positron emission tomography for cardiac sarcoidosis.","authors":"Lamis El Harake, Richard Weinberg, Ike Okwuosa, Ryan Avery, Susan Lehrer, Paul C Cremer","doi":"10.1093/ehjimp/qyag161","DOIUrl":"10.1093/ehjimp/qyag161","url":null,"abstract":"<p><p>This retrospective cohort study evaluated the relationship between serum β-hydroxybutyrate (BHB) levels and myocardial glucose suppression in 74 patients undergoing fluorine-18 fluorodeoxyglucose positron emission tomography for suspected cardiac sarcoidosis. The average BHB concentration prior to FDG administration was 0.94 ± 0.78 mmol/L. The septal-to-blood pool uptake ratio (SUVmax_septal/SUVmean_blood pool) ranged from 0.50 to 0.88, with a median of 0.66 (Quartile 1 = 0.58; Quartile 3 = 0.73). No significant association was found between BHB levels and the septal-to-blood pool uptake ratio (<i>r</i> = 0.09; <i>P</i> = 0.48), suggesting a metabolic plateau regarding myocardial glucose utilization once adequate ketosis is achieved. These preliminary findings support a threshold effect rather than a dose-dependent relationship between serum BHB levels and myocardial glucose suppression following appropriate dietary preparation.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 3","pages":"qyag161"},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative imaging analysis in hypertrophic cardiomyopathy: phenotypic differentiation to prognostic stratification.","authors":"S Pradeep Kundur, A Rai, A Kandala, A Malik, S Sivalokanathan, F Jamal, S Jha, A Owens","doi":"10.1093/ehjimp/qyag162","DOIUrl":"10.1093/ehjimp/qyag162","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder and remains associated with sudden cardiac death (SCD), heart failure, and diagnostic uncertainty due to overlap with other causes of left ventricular hypertrophy, including hypertensive heart disease and cardiac amyloidosis. This review aimed to evaluate the evolving applications of radiomics in the context of related quantitative imaging techniques. A review was conducted of studies applying radiomics, texture analysis, machine learning, and deep learning to cardiac imaging in HCM. The evidence base derives predominantly from CMR, with a smaller and more recent body of work in echocardiography and CT. Current evidence suggests that radiomics can extract quantitative features of myocardial texture, shape, and signal heterogeneity beyond visual assessment. These approaches have shown promise in differentiating HCM from phenocopies, identifying myocardial fibrosis without contrast administration, and improving the prediction of adverse outcomes, including SCD and heart failure. Several studies reported incremental value over conventional imaging markers such as wall thickness, global T1 values, and binary late gadolinium enhancement. However, the literature remains limited by retrospective study design, small cohorts, heterogeneity in imaging acquisition and segmentation, and insufficient external validation. Radiomics has emerged as a promising adjunct to conventional cardiac imaging in HCM, with the potential to be adapted into a clinical decision support tool. Its future clinical role will depend on methodological standardization and robust external validation.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 3","pages":"qyag162"},"PeriodicalIF":0.0,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of cardiac magnetic resonance imaging after hospitalization for acute heart failure: insights from the French nationwide OFICA-2 cohort.","authors":"Alexandre Altes, Benjamin Alos, Damien Legallois, Maxime Doublet, Jerôme Costa, Aymeric Menet, Etienne Puymirat, Alexis Jacquier, Christophe Thuaire, François Picard, Jean-Noel Trochu, Nicolas Lamblin, Clément Delmas, Ariel Cohen, Charlotte Dagrenat, Lise Legrand, Marjorie Canu, Jerôme Corre, Laurent Desprets, Jeremy Laik, Thibaud Genet, Hubert Cochet, Nathan Mewton, Damien Logeart, Claire Bouleti","doi":"10.1093/ehjimp/qyag159","DOIUrl":"10.1093/ehjimp/qyag159","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac magnetic resonance (CMR) has a central role in the management of patients with acute heart failure (AHF), but timely access remains heterogeneous. We investigated real-world CMR use in patients hospitalized for AHF and its associations with demographic, clinical, and institutional characteristics.</p><p><strong>Methods and results: </strong>In the nationwide prospective OFICA2 cohort, conducted from March to April 2021 across 80 centres, we included 906 patients hospitalized for AHF, discharged alive, and without contraindications to CMR (mean age 74.7 years, 42.1% women). CMR use was identified through national billing codes during hospitalization and within 1 year using linked national administrative data. Analyses assessed CMR use across patient subgroups, hospital types, and care settings. Overall, 116 patients (12.8%) underwent CMR during hospitalization or within 1 year. CMR use was more frequent in younger patients, those without myocardial infarction, those with reduced LVEF, and patients with dilated rather than hypertensive or valvular cardiomyopathy. Among patients hospitalized for a first AHF episode, male sex was also associated with higher referral rates. CMR use varied across hospital types and care settings, with higher rates in university hospitals and intensive care units. Among patients with potential CMR indications according to the 2016 ESC Heart Failure guidelines, only 10.9% (class I) and 15.0% (class II) underwent the examination.</p><p><strong>Conclusion: </strong>In this nationwide AHF cohort, real-world use of CMR remained limited, even among patients with potential guideline-based indications, with marked patient- and institution-level disparities. These findings support coordinated efforts to improve timely access to CMR in heart failure care.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 3","pages":"qyag159"},"PeriodicalIF":0.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on 'Cardiac remodelling and clinical outcomes after mitral edge-to-edge repair with the PASCAL® system'.","authors":"Safa Özçelik","doi":"10.1093/ehjimp/qyag160","DOIUrl":"10.1093/ehjimp/qyag160","url":null,"abstract":"","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 3","pages":"qyag160"},"PeriodicalIF":0.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific shape models to disentangle sex effects and age-associated anatomical variation in biventricular cardiac anatomy.","authors":"Stefano Buoso, Valery L Visser, Pia Leuders, Tobias Kudelka, Maximilian Fuetterer, Christina Spengler, Robert Manka, Sebastian Kozerke","doi":"10.1093/ehjimp/qyag156","DOIUrl":"10.1093/ehjimp/qyag156","url":null,"abstract":"<p><strong>Aims: </strong>Age- and sex-related differences in cardiac anatomy are well established using conventional cardiovascular magnetic resonance biomarkers, but their representation in 3D ventricular shape remains unclear. In pooled statistical shape models, leading modes may be dominated by between-sex anatomical variation, potentially obscuring within-sex age-associated variation. This study evaluated whether sex-specific statistical shape models provide a more interpretable representation of age-associated ventricular variation than a sex-agnostic model.</p><p><strong>Methods: </strong>Biventricular meshes were reconstructed from cine cardiovascular magnetic resonance (CMR) images in a cross-sectional screened asymptomatic Swiss adult cohort aged 18-85 years. End-diastolic anatomies from 185 male and 187 female participants were used to construct statistical shape models for the pooled cohort and separately by sex. Shape modes were interpreted using anatomical visualization, variance decomposition, associations with conventional demographic, anthropometric, and CMR biomarkers.</p><p><strong>Results: </strong>The first pooled model mode explained 31% of total shape variance, compared with 22% and 19% for the first male- and female-specific modes. In the pooled model, 57% of first-mode variance was attributable to between-sex differences. Age-associated variation in the pooled model was distributed across the first two modes, whereas sex-specific models organized age-associated variation within each sex. In males, the strongest adjusted age association occurred in the second sex-specific mode, which correlated with ventricular volume and mass. In females, age-associated variation was concentrated in the first mode and was inversely associated with ventricular volumes and myocardial mass.</p><p><strong>Conclusion: </strong>These findings support sex-specific anatomical reference models for capturing within-sex cardiac ageing structure.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 2","pages":"qyag156"},"PeriodicalIF":0.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular magnetic resonance for therapy monitoring in cardiomyopathies.","authors":"Manuel Garofalo, Giorgia Panichella, Alberto Clemente, Carmelo De Gori, Andrea Barison, Michela Chianca, Alberto Aimo, Giancarlo Todiere","doi":"10.1093/ehjimp/qyag153","DOIUrl":"10.1093/ehjimp/qyag153","url":null,"abstract":"<p><p>Cardiomyopathies are increasingly managed with disease-modifying and phenotype-specific therapies, creating a need for imaging biomarkers that can reliably capture treatment response over time. Cardiovascular magnetic resonance (CMR) is uniquely suited to this role because it combines highly reproducible assessment of cardiac structure and function with detailed tissue characterization. Cine imaging enables serial evaluation of ventricular volumes, mass, and ejection fraction; late gadolinium enhancement identifies focal replacement fibrosis and arrhythmogenic substrate; and native T1/T2 mapping with extracellular volume quantification provides quantitative markers of diffuse fibrosis, oedema, inflammation, and infiltrative burden. In this review, we discuss the role of CMR in therapy monitoring across the spectrum of cardiomyopathies. In dilated cardiomyopathy, CMR tracks reverse remodelling and helps identify persistent scar and non-response despite guideline-directed therapy or cardiac resynchronization. In non-dilated and arrhythmogenic cardiomyopathies, serial tissue characterization helps refine dynamic arrhythmic risk. In hypertrophic cardiomyopathy, CMR documents structural and interstitial changes during treatment with myosin inhibitors and after septal reduction. In amyloid and metabolic/storage cardiomyopathies, mapping techniques are particularly useful for demonstrating stabilization or regression of myocardial disease under targeted treatments. Overall, CMR offers a framework for standardized longitudinal follow-up and for the development of biologically meaningful surrogate endpoints in clinical trials. Wider harmonization of acquisition, analysis, and reporting will be essential to fully integrate CMR into individualized therapeutic decision-making.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 3","pages":"qyag153"},"PeriodicalIF":0.0,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of left mainstem quadfurcation anatomy 'The Starfish Sign': an incidental finding or a variant of concern?","authors":"Anas Musa, Zoubia Fathima, Azza Mohamedelamin, Usama Al Bastaki, Edouard Long, Ronak Rajani","doi":"10.1093/ehjimp/qyag157","DOIUrl":"https://doi.org/10.1093/ehjimp/qyag157","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Left mainstem coronary artery quadrifurcation (LMQ) is a coronary variant with a wide-ranging estimated prevalence of 1.8-9.6%. Although often considered an incidental and benign finding, there is a dearth of literature to support this notion owing to suboptimal clinical characterization of this phenomenon. The aim of the current manuscript was to perform a systematic review of LMQ and to describe its prevalence, associated demographics and reported clinical outcomes. We furthermore propose new nomenclature for this finding. A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Eligible studies were detected for inclusion into the review using web-based sources (i.e. PubMed, Google Scholar) over a 20-year period from January 2005 to September 2025. Search terms included 'left mainstem quadrification/quadrifurcation/quadfurcation/tertrafurcation, coronary artery branches, coronary artery anomalies, and coronary intervention' using left main quadrifurcation and its wording variants. Where available, cardiovascular risk factors and clinical outcomes were recorded. Statistics were performed using SPSS V24 and R V3.4. LMQ prevalence was estimated by pooled analysis of cadaveric series using a DerSimonian-Laird random-effects model. &lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt;, Tau, and &lt;i&gt;Q&lt;/i&gt; statistics were also calculated to assess heterogeneity. Publication bias was assessed by Funnel plot and Egger's regression. In an exploratory analysis, comparative statistics were performed to assess differences between coronary angiography (CAG) and coronary computed tomographic angiography (CCTA) detection using the χ&lt;sup&gt;2&lt;/sup&gt; test, Student's &lt;i&gt;t-&lt;/i&gt;test, and Fisher's exact test, as appropriate. A &lt;i&gt;P-&lt;/i&gt;value &lt; 0.05 was taken to be significant by convention. Nineteen studies were identified, from which two were excluded. The total number of patients evaluated was 757. There were eight cadaveric series (total of 747 cases of which 44 had LMQ quadrification) and the pooled prevalence was 4.5% (95% CI: 2.53-6.47%). There was moderate heterogeneity (&lt;i&gt;I&lt;/i&gt; = 43.2%, &lt;i&gt;Q&lt;/i&gt; = 12.33, &lt;i&gt;P&lt;/i&gt; = 0.090, &lt;i&gt;T&lt;/i&gt; = 0.00034) with Egger's regression indicating asymmetry (intercept = -2.12, &lt;i&gt;P&lt;/i&gt; = 0.001), suggesting small-study effects. Although limited by study numbers (&lt;i&gt;k&lt;/i&gt; = 8), the overall risk of bias was low to moderate with consistently low bias in sample selection and measurement reliability and moderate risk in reporting completeness. There was a trend to earlier detection by CCTA compared with CAG (55.3 ± 10.8 years vs. 70 ± 8.5 years, &lt;i&gt;P&lt;/i&gt; = 0.056; 95% CI: 0.5-31.5). Clinical characterization of LMQ anatomy was inconsistent as was the documentation of clinical outcomes. In conclusion, Pooled analysis of post-mortem studies indicates the prevalence of LMQ anatomy to be 4.5%. Despite several prior reports, clinical characterization of this phenomenon remains poor. We propose a novel name for this phenomenon 'LMCA Starfish varia","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":"4 3","pages":"qyag157"},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}