Journal: Circ Cardiovasc Imaging

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<div><h4>Myocardial Work in Echocardiography.</h4><i>Marzlin N, Hays AG, Peters M, Kaminski A, ... Tajik AJ, Jain R</i><br /><AbstractText>Myocardial work is an emerging tool in echocardiography that incorporates left ventricular afterload into global longitudinal strain analysis. Myocardial work correlates with myocardial oxygen consumption, and work efficiency can also be assessed. Myocardial work has been evaluated in a variety of clinical conditions to assess the added value of myocardial work compared to left ventricular ejection fraction and global longitudinal strain. This review showcases the current use of myocardial work in adult echocardiography and its possible role in cardiac pathologies.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 03 Feb 2023:e014419; epub ahead of print</small></div>
Marzlin N, Hays AG, Peters M, Kaminski A, ... Tajik AJ, Jain R
Circ Cardiovasc Imaging: 03 Feb 2023:e014419; epub ahead of print | PMID: 36734221
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<div><h4>Nuclear Methods for Immune Cell Imaging: Bridging Molecular Imaging and Individualized Medicine.</h4><i>Heo GS, Diekmann J, Thackeray JT, Liu Y</i><br /><AbstractText>Inflammation is a key mechanistic contributor to the progression of cardiovascular disease, from atherosclerosis through ischemic injury and overt heart failure. Recent evidence has identified specific roles of immune cell subpopulations in cardiac pathogenesis that diverges between individual patients. Nuclear imaging approaches facilitate noninvasive and serial quantification of inflammation severity, offering the opportunity to predict eventual outcome, stratify patient risk, and guide novel targeted molecular therapies against specific leukocyte subpopulations. Here, we will discuss the established and emerging nuclear imaging methods to label and track exogenous and endogenous immune cells, with a particular focus on clinical situations in which targeted molecular inflammation imaging would be advantageous. The expanding options for imaging inflammation provide the foundation to bridge between molecular imaging and individual therapy.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014067</small></div>
Heo GS, Diekmann J, Thackeray JT, Liu Y
Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014067 | PMID: 36649445
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<div><h4>Molecular Imaging of Valvular Diseases and Cardiac Device Infection.</h4><i>Tarkin JM, Chen W, Dweck MR, Dilsizian V</i><br /><AbstractText>The use of positron emission tomography imaging with <sup>18</sup>F-fluorodeoxyglucose in the diagnostic workup of patients with suspected prosthetic valve endocarditis and cardiac device infection (implantable electronic device and left ventricular assist device) is gaining momentum in clinical practice. However, in the absence of prospective randomized trials, guideline recommendations about <sup>18</sup>F-fluorodeoxyglucose positron emission tomography in this setting are currently largely based on expert opinion. Measurement of aortic valve microcalcification occurring as a healing response to valvular inflammation using <sup>18</sup>F-sodium fluoride positron emission tomography represents another promising clinical approach, which is associated with both the risk of native valve stenosis progression and bioprosthetic valve degeneration in research trials. In this review, we consider the role of molecular imaging in cardiac valvular diseases, including aortic stenosis and valvular endocarditis, as well as cardiac device infections.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014652</small></div>
Tarkin JM, Chen W, Dweck MR, Dilsizian V
Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014652 | PMID: 36649447
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<div><h4>Imaging Methods: Magnetic Resonance Imaging.</h4><i>Thomas KE, Fotaki A, Botnar RM, Ferreira VM</i><br /><AbstractText>Myocardial inflammation occurs following activation of the cardiac immune system, producing characteristic changes in the myocardial tissue. Cardiovascular magnetic resonance is the non-invasive imaging gold standard for myocardial tissue characterization, and is able to detect image signal changes that may occur resulting from inflammation, including edema, hyperemia, capillary leak, necrosis, and fibrosis. Conventional cardiovascular magnetic resonance for the detection of myocardial inflammation and its sequela include T2-weighted imaging, parametric T1- and T2-mapping, and gadolinium-based contrast-enhanced imaging. Emerging techniques seek to image several parameters simultaneously for myocardial tissue characterization, and to depict subtle immune-mediated changes, such as immune cell activity in the myocardium and cardiac cell metabolism. This review article outlines the underlying principles of current and emerging cardiovascular magnetic resonance methods for imaging myocardial inflammation.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014068</small></div>
Thomas KE, Fotaki A, Botnar RM, Ferreira VM
Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014068 | PMID: 36649450
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<div><h4>Clinical Utilization of Multimodality Imaging for Myocarditis and Cardiac Sarcoidosis.</h4><i>Chareonthaitawee P, Gutberlet M</i><br /><AbstractText>Myocarditis is defined as inflammation of the myocardium according to clinical, histological, biochemical, immunohistochemical, or imaging findings. Inflammation can be categorized histologically by cell type or pattern, and many causes have been implicated, including infectious, most commonly viral, systemic autoimmune diseases, vaccine-associated processes, environmental factors, toxins, and hypersensitivity to drugs. Sarcoid myocarditis is increasingly recognized as an important cause of cardiomyopathy and has important diagnostic, prognostic, and therapeutic implications in patients with systemic sarcoidosis. The clinical presentation of myocarditis may include an asymptomatic, subacute, acute, fulminant, or chronic course and may have focal or diffuse involvement of the myocardium depending on the cause and time point of the disease. For most causes of myocarditis except sarcoidosis, myocardial biopsy is the gold standard but is limited due to risk, cost, availability, and variable sensitivity. Diagnostic criteria have been established for both myocarditis and cardiac sarcoidosis and include clinical and imaging findings particularly the use of cardiac magnetic resonance and positron emission tomography. Beyond diagnosis, imaging findings may also provide prognostic value. This case-based review focuses on the current state of multimodality imaging for the diagnosis and management of myocarditis and cardiac sarcoidosis, highlighting multimodality imaging approaches with practical clinical vignettes, with a discussion of knowledge gaps and future directions.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014091</small></div>
Chareonthaitawee P, Gutberlet M
Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014091 | PMID: 36649452
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<div><h4>Imaging Targets to Visualize the Cardiac Immune Landscape in Heart Failure.</h4><i>Wienecke LM, Leid JM, Leuschner F, Lavine KJ</i><br /><AbstractText>Heart failure involves a complex interplay between diverse populations of immune cells that dynamically shift across the natural history of disease. Within this context, the character of the immune response is a key determinant of clinical outcomes. Recent technological advances in single-cell transcriptomic, spatial, and proteomic technologies have fueled an explosion of new and clinically relevant insights into distinct immune cell populations that reside within the diseased heart including potential targets for molecular imaging and therapy. In this review, we will discuss the immune cell types and their respective functions with respect to myocardial infarction remodeling, dilated cardiomyopathy, and heart failure with preserved ejection fraction. In addition, we give a brief overview regarding myocarditis and cardiac sarcoidosis as inflammatory heart failure etiologies. We will highlight markers and cell populations as targets for molecular imaging to visualize inflammation and tissue healing and discuss clinical implications including the development and implementation of precision medicine approaches.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014071</small></div>
Wienecke LM, Leid JM, Leuschner F, Lavine KJ
Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014071 | PMID: 36649453
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<div><h4>Positron Emission Tomography Imaging of Vessel Wall Matrix Metalloproteinase Activity in Abdominal Aortic Aneurysm.</h4><i>Toczek J, Gona K, Liu Y, Ahmad A, ... Gropler RJ, Sadeghi MM</i><br /><b>Background</b><br />Matrix metalloproteinases (MMPs) play a key role in the pathogenesis of abdominal aortic aneurysm (AAA). Imaging aortic MMP activity, especially using positron emission tomography to access high sensitivity, quantitative data, could potentially improve AAA risk stratification. Here, we describe the design, synthesis, characterization, and evaluation in murine AAA and human aortic tissue of a first-in-class MMP-targeted positron emission tomography radioligand, <sup>64</sup>Cu-RYM2.<br /><b>Methods</b><br />The broad spectrum MMP inhibitor, RYM2 was synthetized, and its potency as an MMP inhibitor was evaluated by a competitive inhibition assay. Toxicology studies were performed. Tracer biodistribution was evaluated in a murine model of AAA induced by angiotensin II infusion in Apolipoprotein E-deficient mice. <sup>64</sup>Cu-RYM2 binding to normal and aneurysmal human aortic tissues was assessed by autoradiography.<br /><b>Results</b><br />RYM2 functioned as an MMP inhibitor with nanomolar affinities. Toxicology studies showed no adverse reaction in mice. Upon radiolabeling with Cu-64, the resulting tracer was stable in murine and human blood in vitro. Biodistribution and metabolite analysis in mice showed rapid renal clearance and acceptable in vivo stability. In vivo positron emission tomography/computed tomography in a murine model of AAA showed a specific aortic signal, which correlated with ex vivo measured MMP activity and <i>Cd68</i> gene expression. <sup>64</sup>Cu-RYM2 specifically bound to normal and aneurysmal human aortic tissues in correlation with MMP activity.<br /><b>Conclusions</b><br /><sup>64</sup>Cu-RYM2 is a first-in-class MMP-targeted positron emission tomography tracer with favorable stability, biodistribution, performance in preclinical AAA, and importantly, specific binding to human tissues. These data set the stage for <sup>64</sup>Cu-RYM2-based translational imaging studies of vessel wall MMP activity, and indirectly, inflammation, in AAA.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014615</small></div>
Toczek J, Gona K, Liu Y, Ahmad A, ... Gropler RJ, Sadeghi MM
Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014615 | PMID: 36649454
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<div><h4>Impact of Metabolic Activity of Vertebra and Amygdala on Stroke Recurrence: A Prospective Cohort Study.</h4><i>Kim JM, Lee R, Kim Y, Jeong HB, ... Park KY, Won Seok J</i><br /><b>Background</b><br />Elevated metabolic activity of amygdala is known to be related to atherosclerotic cardiovascular event by increasing inflammatory cell production from bone marrow. We tried to identify the factors of metabolic activity in the amygdala, vertebrae, liver, spleen, and internal carotid artery related to the future vascular events after stroke.<br /><b>Methods</b><br />A total of 110 patients with acute stroke were included (72±10 years of age, 39% women) and underwent whole-body <sup>18</sup>F-fluorodeoxyglucose (FDG) positron emission tomography between August 1, 2015 and February 28, 2020. We compared the FDG uptake in the amygdala, vertebrae, liver, spleen, and internal carotid artery between patients with and without recurrent vascular event. Cox proportional hazards model was used to identify factors related to recurrent stroke and vascular event.<br /><b>Results</b><br />During the median follow-up period of 18 months, 22 patients experienced vascular events, including 15 stroke recurrence. Patients with recurred vascular event had a significantly higher FDG uptake in the amygdala and vertebrae than those without. The Cox proportional hazard model including diabetes, renal function, and carotid stenosis showed that a higher FDG uptake in the amygdala was independently associated with total vascular events (hazard ratio, 3.11 [95% CI, 1.11-8.70]) and higher FDG uptake in the vertebrae with stroke recurrence (hazard ratio, 4.94 [95% CI, 1.29-18.9]).<br /><b>Conclusions</b><br />The increased metabolic activities of the vertebrae and amygdala are related to future vascular event among stroke survivors.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014544</small></div>
Kim JM, Lee R, Kim Y, Jeong HB, ... Park KY, Won Seok J
Circ Cardiovasc Imaging: 01 Jan 2023; 16:e014544 | PMID: 36649457
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<div><h4>Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention Leadership and Endorsed by the Society for Cardiovascular Magnetic Resonance.</h4><i>Ruberg FL, Baggish AL, Hays AG, Jerosch-Herold M, ... Weinsaft JW, Woodard PK</i><br /><AbstractText>The global pandemic of COVID-19 caused by infection with SARS-CoV-2 is now entering its fourth year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. Although pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play) following resolution of infection. A variety of different testing combinations that leverage ECG, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance imaging have been proposed and implemented to mitigate risk. Cardiovascular magnetic resonance in particular affords high sensitivity for myocarditis but has been employed and interpreted nonuniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to return to play. This consensus document synthesizes available evidence to contextualize the appropriate utilization of cardiovascular magnetic resonance in the return to play assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 21 Dec 2022:e014106; epub ahead of print</small></div>
Abstract
<div><h4>Association of Lipoprotein (a) With Coronary-Computed Tomography Angiography-Assessed High-Risk Coronary Disease Attributes and Cardiovascular Outcomes.</h4><i>Dai N, Chen Z, Zhou F, Zhou Y, ... Qian J, Ge J</i><br /><b>Background</b><br />Lipoprotein(a) [Lp(a)] is a risk factor for cardiovascular events. This study evaluated the relationship between Lp(a) and high-risk attributes by coronary computed tomography angiography as well as their prognostic value.<br /><b>Methods</b><br />Lp(a) and coronary computed tomography angiography from 377 consecutive patients at Zhongshan Hospital (Shanghai, China) were evaluated. High-risk attributes were defined as high-risk morphological attributes (low attenuation plaque, positive remodeling, napkin-ring sign, spotty calcification, minimum lumen area <4 mm<sup>2</sup>, or plaque burden [ratio between cross-sectional plaque area at the site of maximum stenosis and cross-sectional vessel area] ≥70%); inflammatory attribute represented by fat attenuation index; high-risk physiological attributes [lesion-specific ischemia defined by fractional flow reserve by coronary computed tomography angiography ≤0.8, physiologic diffuseness defined by fractional flow reserve by coronary computed tomography angiography pullback pressure gradient]. Total plaque volume in mm<sup>3</sup> was also quantified. Quintiles or binary classification of Lp(a) levels were used to evaluate its relationships with plaque features and clinical outcomes with ANOVA, Cox models, and log-rank tests, as appropriate. The major adverse cardiovascular event included cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization.<br /><b>Results</b><br />Lp(a) was significantly associated with total plaque volume (<i>P</i>=0.004), fat attenuation index (<i>P</i>=0.031), and fractional flow reserve by coronary computed tomography angiography pullback pressure gradient (<i>P</i>=0.038). Patients with a high Lp(a) level had a higher total plaque volume (393.3 mm<sup>3</sup> versus 293.9 mm<sup>3</sup>, <i>P</i><0.001), lower pullback pressure gradient (0.62 versus 0.69, <i>P</i>=0.023), higher fat attenuation index (-70.5HU versus -73.9HU, <i>P</i>=0.004), and higher incidence of major adverse cardiovascular event (14.5% versus 6.3%, adjusted hazard ratio: 2.52, 95% CI: 1.12-5.63, <i>P</i>=0.025). In a 4-group classification according to Lp(a) and high-risk attributes, patients with high Lp(a) and ≥3 high-risk attributes had the highest risk of major adverse cardiovascular event (25.9%; overall <i>P</i><0.001). Causal mediation analysis revealed that around 40% of the prognostic effect of Lp(a) was mediated by high-risk attributes.<br /><b>Conclusions</b><br />Lp(a) level is associated with coronary computed tomography angiography high-risk characteristics, including morphologic, physiologic, and inflammatory attributes as well as major adverse cardiovascular event. This effect is partly mediated by inflammation and vulnerable plaque.<br /><b>Registration</b><br />URL: https://www.<br /><b>Clinicaltrials</b><br />gov; Unique identifier: NCT05323227.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 12 Dec 2022:e014611; epub ahead of print</small></div>
Dai N, Chen Z, Zhou F, Zhou Y, ... Qian J, Ge J
Circ Cardiovasc Imaging: 12 Dec 2022:e014611; epub ahead of print | PMID: 36503252
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<div><h4>Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Congenital Heart Disease.</h4><i>Egbe AC, Miranda WR, Anderson JH, Pellikka PA, Connolly HM</i><br /><b>Background</b><br />Left ventricular global longitudinal strain (LVGLS) has been shown to improve risk stratification in patients with LV systolic dysfunction and subsequent recovery of LV ejection fraction (LVEF) in the acquired heart disease population. The purpose of this study was to assess the relationship between LVGLS and cardiovascular events (heart failure hospitalization, sustained ventricular tachycardia/appropriate shock, heart transplant, or cardiovascular death) and deterioration in LVEF (absolute decrease in LVEF ≥10% to LVEF <50%) in adults with congenital heart disease.<br /><b>Methods</b><br />Retrospective cohort study of congenital heart disease patients with previous diagnosis of LV systolic dysfunction (LVEF <50%) and subsequent recovery of LVEF (absolute increase in LVEF of ≥10% to LVEF ≥50%) on subsequent echocardiogram (index echocardiogram). Based on the index echocardiogram, patients were divided into normal LVGLS (absolute LVGLS >18%) versus abnormal LVGLS (absolute LVGLS ≤18%) groups.<br /><b>Results</b><br />Of 193 patients with recovered LVEF, 86 (45%) had normalization of LVGLS at index echocardiogram. A higher absolute LVGLS and use of renin angiotensin aldosterone system antagonist was associated with a lower risk of cardiovascular events and subsequent deterioration in LVEF, while hypertension was associated with higher risk of cardiovascular events and deterioration in LVEF.<br /><b>Conclusions</b><br />These results suggest that patients with congenital heart disease with recovered LVEF remained at risk for adverse outcomes, and LVGLS can be used to identify patients at risk for adverse outcomes. Medical therapy for heart failure and treatment of hypertension may reduce the risk of adverse outcome, but these findings require empirical validation, hence the need for a clinical trial.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 07 Dec 2022:e014865; epub ahead of print</small></div>
Egbe AC, Miranda WR, Anderson JH, Pellikka PA, Connolly HM
Circ Cardiovasc Imaging: 07 Dec 2022:e014865; epub ahead of print | PMID: 36475454
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<div><h4>Multiparametric Strategy to Predict Early Disease Decompensation in Asymptomatic Severe Aortic Regurgitation.</h4><i>Kočková R, Línková H, Hlubocká Z, Mědílek K, ... De Colle C, Pěnička M</i><br /><b>Background</b><br />Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)-derived indices and natriuretic peptides (BNP [brain natriuretic peptide] or NT-proBNP [N-terminnal pro-B type natriuretic peptide]) to predict early disease decompensation in asymptomatic severe AR.<br /><b>Methods</b><br />This prospective and multicenter study included asymptomatic patients with severe AR, preserved left ventricular ejection fraction (>50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines.<br /><b>Results</b><br />The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041-1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all <i>P</i><0.05). However, a combined model including one parameter of AR assessment (MRI regurgitant volume or regurgitant fraction or 3-dimensional vena contracta area), 1 parameter of left ventricular remodeling (MRI left ventricular end-diastolic volume index or echocardiography 2-dimensional global longitudinal strain or E wave), and BNP showed significantly higher predictive accuracy (area under the curve, 0.74-0.81) than any parameter alone (area under the curve, 0.61-0.72). These findings were confirmed in the validation cohort (n=100 patients, 38 end points).<br /><b>Conclusions</b><br />In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management.<br /><b>Registration</b><br />URL: https://www.<br /><b>Clinicaltrials</b><br />gov; Unique identifier: NCT02910349.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Dec 2022; 15:e014901</small></div>
Kočková R, Línková H, Hlubocká Z, Mědílek K, ... De Colle C, Pěnička M
Circ Cardiovasc Imaging: 01 Dec 2022; 15:e014901 | PMID: 36538596
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<div><h4>Myosin Inhibition and Left Ventricular Diastolic Function in Patients with Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Insights from the VALOR-HCM Study.</h4><i>Cremer PC, Geske JB, Owens A, Jaber WA, ... Nissen SE, Desai MY</i><br /><AbstractText><b>Background:</b> In the randomized phase 3 VALOR-HCM study of patients with obstructive hypertrophic cardiomyopathy (oHCM), mavacamten reduced the need for septal reduction therapy. Because mavacamten improves ventricular compliance, this sub-study examined the effects of treatment with this cardiac myosin inhibitor on diastolic function. <br /><b>Methods:</b><br/>Symptomatic oHCM patients on maximally-tolerated medical therapy referred for septal reduction therapy were randomized 1:1 to mavacamten or placebo. At baseline and week 16, a resting and stress echocardiogram was performed with interpretation by a core laboratory. In this exploratory sub-study, the principal endpoint was the change in parameters used to define the grade of diastolic function in patients treated with mavacamten and placebo. A related objective was to assess the proportion of patients with an improvement in diastolic function grade. A secondary aim was to assess for correlation between diastolic function parameters and the secondary endpoints from VALOR-HCM: NYHA class, quality of life, and cardiac biomarkers. <br /><b>Results:</b><br/>Diastolic dysfunction grade was evaluable in 98 patients at baseline and week 16. Among patients treated with mavacamten, 29.4% (15 of 51) demonstrated improvement in diastolic function grade compared to 12.8% (6 of 47) patients with placebo (p = 0.05). Average E/e\' ratio decreased significantly in patients treated with mavacamten (-3.4 ± 5.3) compared to placebo (0.57 ± 3.5) (p <0.001). Indexed left atrial volumes (mL/m2) (LAVi) also decreased significantly in patients who received mavacamten (-5.2 ± 7.8) compared to placebo (-0.51 ± 8.1) (p = 0.005). After adjustment for change in left ventricular outflow tract gradient and mitral regurgitation, mavacamten was significantly associated with a decrease in average E/e\' ratio and LAVi. Change in average E/e\' ratio was significantly correlated with the secondary endpoints from VALOR-HCM. <b>Conclusions:</b> In this exploratory substudy, after 16 weeks of therapy, mavacamten improved diastolic function, and this change correlated with improvement in clinical and biomarker endpoints.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 06 Nov 2022; epub ahead of print</small></div>
Cremer PC, Geske JB, Owens A, Jaber WA, ... Nissen SE, Desai MY
Circ Cardiovasc Imaging: 06 Nov 2022; epub ahead of print | PMID: 36335645
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