<div><h4>Normative Echocardiographic Left Ventricular Parameters and Reference Intervals in Infants.</h4><i>Vøgg ROB, Sillesen AS, Wohlfahrt J, Pihl C, ... Boyd HA, Bundgaard H</i><br /><b>Background</b><br />In pediatric echocardiography, reference intervals are required to distinguish normal variation from pathology. Left ventricular (LV) parameters are particularly important predictors of clinical outcome. However, data from healthy newborns are limited, and current reference intervals provide an inadequate approximation of normal reference ranges.<br /><b>Objectives</b><br />Normative reference intervals and z-scores for 2-dimensional echocardiographic measurements of LV structure and function based on a large group of healthy newborns were developed.<br /><b>Methods</b><br />The study population included 13,454 healthy newborns from the Copenhagen Baby Heart Study who were born at term to healthy mothers, had an echocardiogram performed within 30 days of birth, and did not have congenital heart disease. To develop normative reference intervals, this study modeled 10 LV parameters as a function of body surface area through joint modeling of 4 statistical components.<br /><b>Results</b><br />Infants in the study population (48.5% were female) had a median body surface area of 0.23 m<sup>2</sup> (IQR: 0.22-0.25 m<sup>2</sup>) and median age of 12.0 days (IQR: 8.0-15.0 days) at examination. All normative reference intervals performed well in both sexes without stratification on infant sex. In contrast, creation of separate reference models for infants examined at <7 days of age and those examined at 7-30 days of age was necessary to optimize the performance of the reference intervals.<br /><b>Conclusions</b><br />This study provides normative reference intervals and z-scores for 10 clinical, widely used echocardiographic measures of LV structure and function based on a large cohort of newborns. These results provide highly needed reference material for clinical application by pediatric cardiologists.<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 06 Jun 2023; 81:2175-2185</small></div>

<div><h4>Three-dimensional transoesophageal echocardiography: how to use and when to use-a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology.</h4><i>Faletra FF, Agricola E, Flachskampf FA, Hahn R, ... Keenan N, Stankovic I</i><br /><AbstractText>Three-dimensional transoesophageal echocardiography (3D TOE) has been rapidly developed in the last 15 years. Currently, 3D TOE is particularly useful as an additional imaging modality for the cardiac echocardiographers in the echo-lab, for cardiac interventionalists as a tool to guide complex catheter-based procedures cardiac, for surgeons to plan surgical strategies, and for cardiac anaesthesiologists and/or cardiologists, to assess intra-operative results. The authors of this document believe that acquiring 3D data set should become a \'standard part\' of the TOE examination. This document provides (i) a basic understanding of the physic of 3D TOE technology which enables the echocardiographer to obtain new skills necessary to acquire, manipulate, and interpret 3D data sets, (ii) a description of valvular pathologies, and (iii) a description of non-valvular pathologies in which 3D TOE has shown to be a diagnostic tool particularly valuable. This document has a new format: instead of figures randomly positioned through the text, it has been organized in tables which include figures. We believe that this arrangement makes easier the lecture by clinical cardiologists and practising echocardiographers.</AbstractText><br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 01 Jun 2023; epub ahead of print</small></div>

<div><h4>Association of left ventricular strain-volume loop characteristics with adverse events in patients with heart failure with preserved ejection fraction.</h4><i>Kerstens TP, Weerts J, van Dijk APJ, Weijers G, ... van Empel VPM, Thijssen DHJ</i><br /><b>Aims</b><br />Patients with heart failure with preserved ejection fraction (HFpEF) are characterized by impaired diastolic function. Left ventricular (LV) strain-volume loops (SVL) represent the relation between strain and volume during the cardiac cycle and provide insight into systolic and diastolic function characteristics. In this study, we examined the association of SVL parameters and adverse events in HFpEF.<br /><b>Methods and results</b><br />In 235 patients diagnosed with HFpEF, LV-SVL were constructed based on echocardiography images. The endpoint was a composite of all-cause mortality and Heart Failure (HF)-related hospitalization, which was extracted from electronic medical records. Cox-regression analysis was used to assess the association of SVL parameters and the composite endpoint, while adjusting for age, sex, and NYHA class. HFpEF patients (72.3% female) were 75.8 ± 6.9 years old, had a BMI of 29.9 ± 5.4 kg/m2, and a left ventricular ejection fraction of 60.3 ± 7.0%. Across 2.9 years (1.8-4.1) of follow-up, 73 Patients (31%) experienced an event. Early diastolic slope was significantly associated with adverse events [second quartile vs. first quartile: adjusted hazards ratio (HR) 0.42 (95%CI 0.20-0.88)] after adjusting for age, sex, and NYHA class. The association between LV peak strain and adverse events disappeared upon correction for potential confounders [adjusted HR 1.02 (95% CI 0.96-1.08)].<br /><b>Conclusion</b><br />Early diastolic slope, representing the relationship between changes in LV volume and strain during early diastole, but not other SVL-parameters, was associated with adverse events in patients with HFpEF during 2.9 years of follow-up.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 01 Jun 2023; epub ahead of print</small></div>

<div><h4>F-FDG PET/CT-derived total lesion glycolysis predicts abscess formation in patients with surgically confirmed infective endocarditis: Results of a retrospective study at a tertiary center.</h4><i>Sag SJM, Menhart K, Hitzenbichler F, Schmid C, ... Grosse J, Sag CM</i><br /><b>Background</b><br />Abnormal activity of <sup>18</sup>F-FDG PET/CT is a major Duke criterion in the diagnostic work-up of infective prosthetic valve endocarditis (IE). We hypothesized that quantitative lesion assessment by <sup>18</sup>F-FDG PET/CT-derived standard maximum uptake ratio (SURmax), metabolic volume (MV), and total lesion glycolysis (TLG) might be useful in distinct subgroups of IE patients (e.g. IE-related abscess formation).<br /><b>Methods</b><br />All patients (n = 27) hospitalized in our tertiary IE referral medical center from January 2014 to October 2018 with preoperatively performed <sup>18</sup>F-FDG PET/CT and surgically confirmed IE were included into this retrospective analysis.<br /><b>Results</b><br />Patients with surgically confirmed abscess formation (n = 10) had significantly increased MV (by ~ fivefold) and TLG (by ~ sevenfold) as compared to patients without abscess (n = 17). Receiver operation characteristics (ROC) analyses demonstrated that TLG (calculated as MV × SURmean, i.e. TLG (SUR)) had the most favorable area under the ROC curve (0.841 [CI 0.659 to 1.000]) in predicting IE-related abscess formation. This resulted in a sensitivity of 80% and a specificity of 88% at a cut-off value of 14.14 mL for TLG (SUR).<br /><b>Conclusion</b><br />We suggest that <sup>18</sup>F-FDG PET/CT-derived quantitative assessment of TLG (SUR) may provide a novel diagnostic tool in predicting endocarditis-associated abscess formation.<br /><br />© 2023. The Author(s).<br /><br /><small>J Nucl Cardiol: 01 Jun 2023; epub ahead of print</small></div>

<div><h4>FDG-PET/CT and rest myocardial perfusion imaging to predict high-degree atrioventricular block recovery in cardiac sarcoidosis.</h4><i>Lucinian YA, Martineau P, Poenaru R, Tremblay-Gravel M, ... Harel F, Pelletier-Galarneau M</i><br /><b>Backgrounds</b><br />High-degree atrioventricular block (AVB) recovery in CS has been shown to be highly variable despite immunosuppressive treatment, with no reliable tool available to predict odds of reversibility. This study sought to evaluate the potential of combined fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and resting myocardial perfusion imaging (rMPI) to predict reversibility of newly diagnosed high-grade AVB in cardiac sarcoidosis (CS).<br /><b>Methods</b><br />We performed a single-center, retrospective analysis of patients with CS presenting with high-grade AVB who underwent combined FDG-PET/CT and rMPI. The 2016 JCS and the 2014 HRS diagnostic criteria were used for the diagnosis of CS. Patients with a history of coronary artery disease or prior immunosuppressive treatment were excluded. Patients were divided into AVB recovery and non-recovery subgroups. CS disease staging was based on FDG-PET and rMPI findings: (Stage 0) normal FDG-PET and rMPI (Stage 1) positive FDG-PET and normal rMPI (Stage 2) positive FDG-PET with perfusion deficits on rMPI (Stage 3) normal FDG-PET with perfusion deficits on rMPI.<br /><b>Results</b><br />Twenty-seven patients, including 13 demonstrating AVB recovery, were identified. Eleven out of fourteen (78.6%) patients presenting with stage 1 CS demonstrated AVB recovery. Stage 1 CS was significantly more present in the recovery group compared to the non-recovery group (84.6% vs 21.4%, P = .002). Eleven presented with stage 2 CS, with only 2 (18.2%) recovering AV nodal conduction. Stage 2 CS presented more frequently in the non-recovery group (64.3% vs 15.4%, P = .020).<br /><b>Conclusions</b><br />Combined FDG-PET and rMPI employed to stage CS disease presenting with high-degree AVB appears to have good performance for predicting likelihood of recovery.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 31 May 2023; epub ahead of print</small></div>

<div><h4>A rare case of extensive biventricular cardiac sarcoidosis with reversible torrential tricuspid regurgitation.</h4><i>Okafor J, Azzu A, Ahmed R, Cassimon B, ... Guha K, Khattar R</i><br /><AbstractText>Reversal of torrential tricuspid regurgitation is rarely seen. We describe a case in which effective immunosuppression alongside conventional heart failure therapies lead to reversibility of torrential tricuspid regurgitation in a patient with cardiac sarcoidosis. We also discuss the diagnostic challenge in distinguishing cardiac sarcoidosis from other myocardial diseases in a patient presenting with biventricular failure.</AbstractText><br /><br />© 2023. The Author(s).<br /><br /><small>J Nucl Cardiol: 31 May 2023; epub ahead of print</small></div>

<div><h4>Meta-analysis of the effectiveness of heparin in suppressing physiological myocardial FDG uptake in PET/CT.</h4><i>Chan SH, Huang CK, Luzhbin D, Hou PN, Chang YT, Wu J</i><br /><b>Background</b><br />The present meta-analysis aims to investigate the effectiveness of heparin administration in suppressing physiological myocardial <sup>18</sup>F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/computed tomography (CT), as its role in this regard has not been well investigated.<br /><b>Methods</b><br />PRISMA guidelines were used to interrogate the PubMed, Embase, Cochrane library, Web of Knowledge, and www.clinicaltrail.gov databases from the earliest records to March 2023. The final analysis included five randomized controlled trials (RCTs). Meta-analysis was conducted to compare the effectiveness of unfractionated heparin (UFH) administration versus non-UFH administration, and subgroup analysis based on fixed and variable fasting durations was conducted. Effect sizes were pooled using a random-effects model, and the pooled odds ratios (ORs) were calculated.<br /><b>Results</b><br />Five eligible RCTs with a total of 910 patients (550 with heparin, 360 without heparin) were included. The forest plot analysis initially indicated no significant difference in the suppression of myocardial FDG uptake between the UFH and non-UFH groups (OR 2.279, 95% CI 0.593 to  8.755, p = 0.23), with a high degree of statistical heterogeneity (I<sup>2</sup> = 91.16%). Further subgroup analysis showed that the fixed fasting duration group with UFH administration had statistically significant suppression of myocardial FDG uptake (OR 4.452, 95% CI 1.221 to 16.233, p = 0.024), while the varying fasting duration group did not show a significant effect.<br /><b>Conclusions</b><br />According to the findings of our meta-analysis, we suggest that intravenous administration of UFH can be considered as a supplementary approach to suppress myocardial FDG uptake.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 31 May 2023; epub ahead of print</small></div>

<div><h4>Exponential dosing to standardize myocardial perfusion image quality with rubidium-82 PET.</h4><i>Tavoosi A, Khetarpal R, Wells RG, Beanlands RSB, deKemp RA</i><br /><b>Background</b><br /><sup>82</sup>Rb PET is commonly performed using the same injected activity in all patients, resulting in lower image quality in larger patients. This study compared <sup>82</sup>Rb dosing with exponential vs proportional functions of body weight on the standardization of myocardial perfusion image (MPI) quality.<br /><b>Methods</b><br />Two sequential cohorts of N = 60 patients were matched by patient weight. Rest and dipyridamole stress <sup>82</sup>Rb PET was performed using 0.1 MBq·kg<sup>-2</sup> exponential and 9 MBq·kg<sup>-1</sup> proportional dosing. MPI scans were compared qualitatively with visual image quality scoring (IQS) and quantitatively using the myocardium-to-blood contrast-to-noise ratio (CNR) and blood background signal-to-noise ratio (SNR) as a function of body weight.<br /><b>Results</b><br />Average (min-max) patient body weight was 81 ± 18 kg (46-137 kg). Proportional dosing resulted in decreasing CNR, SNR, and visual IQS with increasing body weight (P < 0.05). Exponential dosing eliminated the weight-dependent decreases in these image quality metrics that were observed in the proportional dosing group.<br /><b>Conclusion</b><br /><sup>82</sup>Rb PET dosing as an exponential (squared) function of body weight produced consistent stress perfusion image quality over a wide range of patient weights. Dramatically lower doses can be used in lighter patients, with the equivalent population dose shifted toward the heavier patients to standardize diagnostic image quality.<br /><br />© 2023. The Author(s).<br /><br /><small>J Nucl Cardiol: 31 May 2023; epub ahead of print</small></div>

<div><h4>Coronary artery disease is associated with impaired atrial function regardless of left ventricular filling pressure.</h4><i>Sharifov O, Denney TS, Girard AA, Gupta H, Lloyd SG</i><br /><b>Background</b><br />Left atrial (LA) strain is impaired in left ventricular (LV) diastolic dysfunction, associated with increased LV end diastolic pressure (LVEDP). In patients with preserved LV ejection fraction (LVEF), coronary artery disease (CAD) is known to impair LV diastolic function. The relationship of LVEDP with CAD and impact on LA strain is not well studied.<br /><b>Methods and results</b><br />Patients with LVEF >50% (n = 37, age 61 ± 7 years) underwent coronary angiography, high-fidelity LV pressure measurements and cardiac magnetic resonance imaging. LA volumes, LA emptying fraction (LAEF), LA reservoir strain (LARS) and LA long-axis shortening (LALAS) were measured. By coronary angiography, patients were assigned into 3 groups: severe-CAD (n = 19, with obstruction of major coronary arteries >70% and/or history of coronary revascularization), mild-to-moderate-CAD (n = 10, obstruction of major coronary arteries 30-60%), and no-CAD (n = 8, obstruction of major coronary arteries and branches <30%). Overall, LVEF was 65 ± 8% and LVEDP was 14.4 ± 5.6 mmHg. Clinical characteristics, LVEDP and LV function measurements were similar in 3 groups. Severe-CAD group had lower LAEF, LALAS and LARS than those in no-CAD group (P < 0.05 all). In regression analysis, LARS and LALAS were associated with CAD severity and treatment with Nitrates, whereas LAEF and LAEF<sub>active</sub> were associated with CAD severity, treatment with Nitrates and LA minimum volume (P < 0.05 all). LAEF<sub>passive</sub> was associated with LVED volume (P < 0.05).<br /><b>Conclusions</b><br />LA functional impairment may be affected by coexistent CAD severity, medications, in particular, Nitrates, and loading conditions, which should be considered when assessing LA function and LA-LV interaction. Our findings inspire exploration in a larger cohort.<br /><br />Copyright © 2023. Published by Elsevier B.V.<br /><br /><small>Int J Cardiol: 29 May 2023; epub ahead of print</small></div>

<div><h4>Right ventricular ejection fraction assessed by computed tomography in patients undergoing transcatheter tricuspid valve repair.</h4><i>Tanaka T, Sugiura A, Kavsur R, Öztürk C, ... Nickenig G, Weber M</i><br /><b>Aims</b><br />The role of right ventricular function in patients undergoing transcatheter tricuspid valve repair (TTVR) is poorly understood. This study investigated the association of right ventricular ejection fraction (RVEF) assessed by cardiac computed tomography (CCT) with clinical outcomes in patients undergoing TTVR.<br /><b>Methods and results</b><br />We retrospectively assessed three-dimensional (3D) RVEF by using pre-procedural CCT images in patients undergoing TTVR. RV dysfunction was defined as a CT-RVEF of <45%. The primary outcome was a composite outcome, consisting of all-cause mortality and hospitalization due to heart failure, within 1 year after TTVR. Of 157 patients, 58 (36.9%) presented with CT-RVEF <45%. Procedural success and in-hospital mortality were comparable between patients with CT-RVEF <45% and ≥45%. However, CT-RVEF of <45% was associated with a higher risk of the composite outcome (hazard ratio: 2.99; 95% confidence interval: 1.65-5.41; P = 0.001), which had an additional value beyond two-dimensional echocardiographic assessments of RV function to stratify the risk of the composite outcome. In addition, patients with CT-RVEF ≥45% exhibited the association of procedural success (i.e. residual tricuspid regurgitation of ≤2+ at discharge) with a decreased risk of the composite outcome, while this association was attenuated in those with CT-RVEF <45% (P for interaction = 0.035).<br /><b>Conclusion</b><br />CT-RVEF is associated with the risk of the composite outcome after TTVR, and a reduced CT-RVEF might attenuate the prognostic benefit of TR reduction. The assessment of 3D-RVEF by using CCT may refine the patient selection for TTVR.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 26 May 2023; epub ahead of print</small></div>

<div><h4>Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: results from the PARADIGM study.</h4><i>Park HB, Arsanjani R, Sung JM, Heo R, ... Min JK, Chang HJ</i><br /><b>Aims</b><br />To investigate the impact of statins on plaque progression according to high-risk coronary atherosclerotic plaque (HRP) features and to identify predictive factors for rapid plaque progression in mild coronary artery disease (CAD) using serial coronary computed tomography angiography (CCTA).<br /><b>Methods and results</b><br />We analyzed mild stenosis (25-49%) CAD, totaling 1432 lesions from 613 patients (mean age, 62.2 years, 63.9% male) and who underwent serial CCTA at a ≥2 year inter-scan interval using the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (NCT02803411) registry. The median inter-scan period was 3.5 ± 1.4 years; plaques were quantitatively assessed for annualized percent atheroma volume (PAV) and compositional plaque volume changes according to HRP features, and the rapid plaque progression was defined by the ≥90th percentile annual PAV. In mild stenotic lesions with ≥2 HRPs, statin therapy showed a 37% reduction in annual PAV (0.97 ± 2.02 vs. 1.55 ± 2.22, P = 0.038) with decreased necrotic core volume and increased dense calcium volume compared to non-statin recipient mild lesions. The key factors for rapid plaque progression were ≥2 HRPs [hazard ratio (HR), 1.89; 95% confidence interval (CI), 1.02-3.49; P = 0.042], current smoking (HR, 1.69; 95% CI 1.09-2.57; P = 0.017), and diabetes (HR, 1.55; 95% CI, 1.07-2.22; P = 0.020).<br /><b>Conclusion</b><br />In mild CAD, statin treatment reduced plaque progression, particularly in lesions with a higher number of HRP features, which was also a strong predictor of rapid plaque progression. Therefore, aggressive statin therapy might be needed even in mild CAD with higher HRPs.<br /><b>Clinical trial registration</b><br />ClinicalTrials.gov NCT02803411.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 26 May 2023; epub ahead of print</small></div>

<div><h4>Pulmonary Capillary Recruitment Is Attenuated Post Left Ventricular Assist Device Implantation.</h4><i>Kim CH, Sajgalik P, Schettle SD, Clavell AL, ... Taylor BJ, Johnson BD</i><br /><AbstractText>There is limited knowledge of pulmonary physiology and pulmonary function after continuous flow-left ventricular assist device (CF-LVAD) implantation. Therefore, this study investigated whether CF-LVAD influenced pulmonary circulation by assessing pulmonary capillary blood volume and alveolar-capillary conductance in addition to pulmonary function in patients with heart failure. Seventeen patients with severe heart failure who were scheduled for CF-LVAD implantation (HeartMate II, III, Abbott, Abbott Park, IL or Heart Ware, Medtronic, Minneapolis, MN) participated in the study. They underwent pulmonary function testing (measures of lung volumes and flow rates) and unique measures of pulmonary physiology using a rebreathe technique that quantified the diffusing capacity of the lungs for carbon monoxide (DLCO) and diffusing capacity of the lungs for nitric oxide before and 3 months after CF-LVAD implantation. After CF-LVAD, pulmonary function was not significantly changed (p >0.05). For lung diffusing capacity, alveolar volume (VA) was not changed (p = 0.47), but DLCO was significantly reduced (p = 0.04). After correcting for VA, DLCO/VA showed a trend toward reduction (p = 0.08). For the alveolar-capillary component, capillary blood volume (Vc) was significantly reduced (p = 0.04), and alveolar-capillary membrane conductance trended toward a reduction (p = 0.06). However, alveolar-capillary membrane conductance/Vc was not altered (p = 0.92). In conclusion, soon after CF-LVAD implantation, Vc is reduced likely because of pulmonary capillary derecruitment, which contributes to the decrease in lung diffusing capacity.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 26 May 2023; 199:44-49</small></div>

<div><h4>Effects of Long-Term Carvedilol Therapy in Patients With ST-Segment Elevation Myocardial Infarction and Mildly Reduced Left Ventricular Ejection Fraction.</h4><i>Amano M, Izumi C, Watanabe H, Ozasa N, ... Kimura T, CAPITAL-RCT Investigators</i><br /><AbstractText>The benefits of long-term oral β-blocker therapy in patients with ST-segment elevation myocardial infarction (STEMI) with mildly reduced left ventricular ejection fraction (LVEF; ≥40%) are still unknown. We sought to evaluate the efficacy of β-blocker therapy in patients with STEMI with mildly reduced LVEF. In the CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in Large-Scale Randomized Controlled Trial), patients with STEMI with successful percutaneous coronary intervention with an LVEF of ≥40% were randomly assigned to carvedilol or no β-blocker therapy. Among 794 patients, 280 patients had an LVEF of <55% at baseline (mildly reduced LVEF stratum), whereas 514 patients had an LVEF of ≥55% at baseline (normal LVEF stratum). The primary end point was a composite of all-cause death, myocardial infarction, hospitalization for acute coronary syndrome, and hospitalization for heart failure, and the secondary end point was a cardiac composite outcome: a composite of cardiac death, myocardial infarction, and hospitalization for heart failure. The median follow-up period was 3.7 years. The lower risk of carvedilol therapy relative to no β-blocker therapy was not significant for the primary end point in either the mildly reduced or normal LVEF strata. However, it was significant for the cardiac composite end point in the mildly reduced LVEF stratum (0.82/100 person-years vs 2.59/100 person-years, hazard ratio 0.32 [0.10 to 0.99], p = 0.047) but not in the normal LVEF stratum (1.48/100 person-years vs 1.06/100 person-years, hazard ratio 1.39 [0.62 to 3.13], p = 0.43, p for interaction = 0.04). In conclusion, long-term carvedilol therapy in patients with STEMI with primary percutaneous coronary intervention might be beneficial for preventing cardiac-related events in those with a mildly reduced LVEF.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 26 May 2023; 199:50-58</small></div>

<div><h4>Autonomic denervation, myocardial hypoperfusion and fibrosis may predict ventricular arrhythmia in the early stages of Chagas cardiomyopathy.</h4><i>de Brito ASX, Moll-Bernardes RJ, Pinheiro MVT, Camargo GC, ... Rosado-de-Castro PH, de Sousa AS</i><br /><b>Background</b><br />Sudden cardiac death (SCD) can be the first clinical event of Chagas heart disease (CHD). However, current guidelines contain no clear recommendation for early cardioverter-defibrillator implantation. Using imaging modalities, we evaluated associations among autonomic denervation, myocardial hypoperfusion, fibrosis and ventricular arrhythmia in CHD.<br /><b>Methods and results</b><br />Twenty-nine patients with CHD and preserved left ventricular function underwent 123I-metaiodobenzylguanidine (MIBG) scintigraphy, 99mTc-methoxyisobutylisonitrile (MIBI) myocardial perfusion and cardiac magnetic resonance imaging (MRI). They were divided into arrhythmic (≥ 6 ventricular premature complexes/h and/or non-sustained ventricular tachycardia on 24-hour Holter, n = 15) and non-arrhythmic (< 6 ventricular premature complexes/h and no ventricular tachycardia; n = 14) groups. The arrhythmic group had higher denervation scores from MIBG imaging (23.2 ± 18.7 vs 5.6 ± 4.9; P < .01), hypoperfusion scores from MIBI SPECT (4.7 ± 6.8 vs 0.29 ± 0.6: P = .02), innervation/perfusion mismatch scores (18.5 ± 17.5 vs 5.4 ± 4.8; P = .01) and fibrosis by late gadolinium enhancement on MRI (14.3% ± 13.5% vs 4.0% ± 2.9%; P = .04) than the non-arrhythmic group.<br /><b>Conclusion</b><br />These imaging parameters were associated with ventricular arrhythmia in early CHD and may enable risk stratification and the implementation of primary preventive strategies for SCD.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 24 May 2023; epub ahead of print</small></div>

<div><h4>Diagnostic accuracy of bone scintigraphy imaging for transthyretin cardiac amyloidosis: systematic review and meta-analysis.</h4><i>Ahluwalia N, Roshankar G, Draycott L, Jimenez-Zepeda V, ... Han D, Miller RJH</i><br /><b>Background</b><br />Bone scintigraphy imaging is frequently used to investigate patients with suspected transthyretin cardiac amyloidosis (ATTR-CM). However, the reported accuracy for interpretation approaches has changed over time. We performed a systematic review and meta-analysis to determine the diagnostic accuracy of visual planar grading, heart-to-contralateral (HCL) ratio, and quantitative analysis of SPECT imaging and evaluate reasons for shifts in reported accuracy.<br /><b>Methods</b><br />We performed a systematic review to identify studies of the diagnostic accuracy of bone scintigraphy for ATTR-CM from 1990 until February 2023 using PUBMED and EMBASE. Studies were reviewed separately by two authors for inclusion and for risk of bias assessment. Summary receiver operating characteristic curves and operating points were determined with hierarchical modeling.<br /><b>Results</b><br />Out of a total of 428 identified studies, 119 were reviewed in detail and 23 were included in the final analysis. The studies included a total of 3954 patients, with ATTR-CM diagnosed in 1337 (39.6%) patients and prevalence ranging from 21 to 73%. Visual planar grading and quantitative analysis had higher diagnostic accuracy (.99) than HCL ratio (.96). Quantitative analysis of SPECT imaging had the highest specificity (97%) followed by planar visual grade (96%) and HCL ratio (93%). ATTR-CM prevalence accounted for some of the observed between study heterogeneity.<br /><b>Conclusions</b><br />Bone scintigraphy imaging is highly accurate for identifying patients with ATTR-CM, with between study heterogeneity in part explained by differences in disease prevalence. We identified small differences in specificity, which may have important clinical implications when applied to low-risk screening populations.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 24 May 2023; epub ahead of print</small></div>

<div><h4>Longitudinal Changes in Ventricular Mechanics in Adolescents after the Fontan Operation.</h4><i>Aly S, Mertens L, Friedberg MK, Dragulescu A</i><br /><b>Background</b><br />Ventricular dysfunction is a significant clinical challenge in the long-term follow-up of patients with single ventricle (SV) physiology. Ventricular function and myocardial mechanics can be studied using speckle-tracking echocardiography (STE) which provides information on myocardial deformation. Limited information is available on serial changes in SV myocardial mechanics after the Fontan operation.<br /><b>Aims</b><br />In this study, we wanted to describe serial changes in myocardial mechanics in children after the Fontan operation and the relationship of these changes with myocardial fibrosis markers as obtained by cardiac magnetic resonance (CMR) and exercise performance parameters.<br /><b>Hypothesis</b><br />We hypothesized that ventricular mechanics declines in SV patients over time and is associated with increased myocardial fibrosis and reduced exercise performance.<br /><b>Methods</b><br />Single-center retrospective cohort study including adolescents after the Fontan operation. Ventricular strain and torsion were assessed using STE. CMR and cardiopulmonary exercise testing data closest to the latest echocardiograms were obtained. The most recent follow-up echocardiographic and CMR data were compared to sex and age-matched controls as well as to individual patients\' early post-Fontan data.<br /><b>Results</b><br />50 SV patients (31 LV, 13 RV, and 6 co-dominant) were included. Median time at follow-up echocardiogram from the time of Fontan was 12.8 (10.6-16.6) years. Compared to early post-Fontan echocardiograms, follow-up assessment showed reduced global longitudinal strain [-17.5% (-14.5 to -19.5) vs -19.8% (-16.0 to -21.7), p=0.01], circumferential strain [-15.7% (-11.4 to -18.7) vs -18.9% (-15.2 to -25.0), p=0.009], reduced torsion [1.28˚/cm (0.51 to 1.74) vs 1.72˚/cm (0.92 to 2.34), p= 0.02] with decreased apical rotation but no significant change in basal rotation. Single RVs had lower torsion compared to single LVs [1.04 ˚/cm (0.12 to 2.20) vs 1.25 ˚/cm (0.25 to 2.51), p=0.01]. T1 values were higher in SV compared to controls [1009±36ms vs 958±40ms, p=0.004], and in single RV compared to LV (1023±19ms vs 1006±17ms, p=0.02). T1 correlated circumferential strain (r=0.59, p=0.04) and inversely correlated with O<sub>2</sub> saturation (r=-0.67, p<0.001), and torsion (r=-0.71, p=0.02). Peak oxygen consumption correlated with torsion (r=0.52, p=0.001) and untwist rates (r=0.23, p=0.03) <br /><b>Conclusion:</b><br/>Post Fontan, there is a progressive decrease in myocardial deformation parameters. The progressive decrease in SV torsion is related to a decrease in apical rotation, which is more pronounced in single RVs. Decreased torsion is associated with increased markers of myocardial fibrosis and lower maximal exercise capacity. Torsional mechanics may be an important parameter to monitor after Fontan palliation but further prognostic information is required.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 24 May 2023; epub ahead of print</small></div>

<div><h4>Observer studies of image quality of denoising reduced-count cardiac single photon emission computed tomography myocardial perfusion imaging by three-dimensional Gaussian post-reconstruction filtering and deep learning.</h4><i>Pretorius PH, Liu J, Kalluri KS, Jiang Y, ... Wernick MN, King MA</i><br /><b>Background</b><br />The aim of this research was to asses perfusion-defect detection-accuracy by human observers as a function of reduced-counts for 3D Gaussian post-reconstruction filtering vs deep learning (DL) denoising to determine if there was improved performance with DL.<br /><b>Methods</b><br />SPECT projection data of 156 normally interpreted patients were used for these studies. Half were altered to include hybrid perfusion defects with defect presence and location known. Ordered-subset expectation-maximization (OSEM) reconstruction was employed with the optional correction of attenuation (AC) and scatter (SC) in addition to distance-dependent resolution (RC). Count levels varied from full-counts (100%) to 6.25% of full-counts. The denoising strategies were previously optimized for defect detection using total perfusion deficit (TPD). Four medical physicist (PhD) and six physician (MD) observers rated the slices using a graphical user interface. Observer ratings were analyzed using the LABMRMC multi-reader, multi-case receiver-operating-characteristic (ROC) software to calculate and compare statistically the area-under-the-ROC-curves (AUCs).<br /><b>Results</b><br />For the same count-level no statistically significant increase in AUCs for DL over Gaussian denoising was determined when counts were reduced to either the 25% or 12.5% of full-counts. The average AUC for full-count OSEM with solely RC and Gaussian filtering was lower than for the strategies with AC and SC, except for a reduction to 6.25% of full-counts, thus verifying the utility of employing AC and SC with RC.<br /><b>Conclusion</b><br />We did not find any indication that at the dose levels investigated and with the DL network employed, that DL denoising was superior in AUC to optimized 3D post-reconstruction Gaussian filtering.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 23 May 2023; epub ahead of print</small></div>

<div><h4>Left Atrial Function in Patients with Titin Cardiomyopathy.</h4><i>Henkens MTHM, Raafs AG, van Loon T, Vos JL, ... Lumens J, Verdonschot JAJ</i><br /><b>Background</b><br />Truncating titin variants (TTNtv) are the most prevalent genetic etiology of dilated cardiomyopathy (DCM). While TTNtv has been associated with atrial fibrillation, it remains unknown whether and how left atrial (LA) function differs between DCM patients with and without TTNtv. We aimed to determine and compare LA function in DCM patients with and without TTNtv and to evaluate whether and how left ventricular (LV) function affects the LA using computational modeling.<br /><b>Methods & results</b><br />DCM patients from the Maastricht DCM registry that underwent genetic testing and cardiovascular magnetic resonance (CMR) imaging were included in the current study. Subsequent computational modeling (CircAdapt model) was performed to identify potential LV and LA myocardial hemodynamic substrates.<br /><b>Results</b><br />In total, 377 DCM patients (N=42 with TTNtv; N=335 without a genetic variant) were included (median age 55 years, IQR [46-62], 62% men). TTNtv patients had a larger LA-volume, and reduced LA-strain compared to patients without a genetic variant (LA-volume index 60mLm<sup>-2</sup>[49;83] vs 51mLm<sup>-2</sup>[42;64];LA reservoir strain 24%[10;29] vs 28%[20;34];LA-booster strain 9%[4;14] vs 14%[10;17], respectively; all P<0.01). Computational modeling suggests that while the observed LV-dysfunction partially explains the observed LA-dysfunction in the TTNtv patients, both intrinsic LV- and LA-dysfunction are present in patients with and without a TTNtv.<br /><b>Conclusion</b><br />DCM patients with TTNtv have more severe LA dysfunction compared to patients without a genetic variant. Insights from computational modeling suggest that both intrinsic LV and LA dysfunction are present in DCM patients with and without TTNtv.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 23 May 2023; epub ahead of print</small></div>

<div><h4>The prognostic value of cardiopulmonary exercise testing and HFA-PEFF in patients with unexplained dyspnea and preserved left ventricular ejection fraction.</h4><i>Lee K, Jung JH, Kwon W, Ohn C, ... Park MW, Cho JS</i><br /><b>Background</b><br />HFA-PEFF and cardiopulmonary exercise testing (CPET) are comprehensive diagnostic tools for heart failure with preserved ejection fraction (HFpEF). We aimed to investigate the incremental prognostic value of CPET for the HFA-PEFF score among patients with unexplained dyspnea with preserved ejection fraction (EF).<br /><b>Methods</b><br />Consecutive patients with dyspnea and preserved EF (n = 292) were enrolled between August 2019 and July 2021. All patients underwent CPET and comprehensive echocardiography, including two-dimensional speckle tracking echocardiography in the left ventricle, left atrium and right ventricle. The primary outcome was defined as a composite cardiovascular event including cardiovascular-related mortality, acute recurrent heart failure hospitalization, urgent repeat revascularization/myocardial infarction or any hospitalization due to cardiovascular events.<br /><b>Results</b><br />The mean age was 58 ± 14.5 years, and 166 (56.8%) participants were male. The study population was divided into three groups based on the HFA-PEFF score: < 2 (n = 81), 2-4 (n = 159), and ≥ 5 (n = 52). HFA-PEFF score ≥ 5, VE/VCO<sub>2</sub> slope, peak systolic strain rate of the left atrium and resting diastolic blood pressure were independently associated with composite cardiovascular events. Furthermore, the addition of VE/VCO<sub>2</sub> and HFA-PEFF to the base model showed incremental prognostic value for predicting composite cardiovascular events (C-statistic 0.898; integrated discrimination improvement 0.129, p = 0.032; net reclassification improvement 1.043, p ≤0.001).<br /><b>Conclusions</b><br />CPET could be exploited for the HFA-PEFF approach in terms of incremental prognostic value and diagnosis among patients with unexplained dyspnea with preserved EF.<br /><br />Copyright © 2023. Published by Elsevier B.V.<br /><br /><small>Int J Cardiol: 23 May 2023; epub ahead of print</small></div>

<div><h4>FETAL CARDIAC FUNCTION AT MID-GESTATION AND SUBSEQUENT DEVELOPMENT OF PRE-ECLAMPSIA.</h4><i>Huluta I, Wright A, Mihaela Cosma L, Hamed K, Nicolaides KH, Charakida M</i><br /><b>Objective</b><br />To assess differences in cardiac morphology and function at mid-gestation in fetuses from pregnancies that subsequently developed pre-eclampsia (PE) or gestational hypertension (GH).<br /><b>Methods</b><br />This was a prospective study in 5801 women with singleton pregnancies attending for a routine ultrasound examination at mid-gestation, including 179 (3.1%) who subsequently developed PE and 149 (2.6%) who developed GH. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricle. The morphology of the fetal heart was assessed by calculating the right and left sphericity index.<br /><b>Results</b><br />In fetuses from the PE group (vs. the no PE or GH group) there was a significantly higher left ventricular global longitudinal strain and lower left ventricular ejection fraction which could not be accounted for by fetal size. All other indices of fetal cardiac morphology and function were comparable between groups. There was no significant correlation between fetal cardiac indices and uterine artery pulsatility index (UtA-PI) multiple of the median (MoM) or placental growth factor (PlGF) MoM.<br /><b>Conclusion</b><br />At mid-gestation, fetuses of mothers at risk of developing PE, but not those at risk of GH, have mild reduction in left ventricular myocardial function. Although absolute differences were minimal and most likely not clinically relevant, these may suggest an early programming effect on left ventricular contractility in fetuses of mothers who develop PE.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 23 May 2023; epub ahead of print</small></div>

<div><h4>Expert proposal to analyze the combination of aortic and mitral regurgitation in multiple valvular heart disease by comprehensive echocardiography.</h4><i>Hagendorff A, Helfen A, Brandt R, Knebel F, ... Stöbe S, Ewen S</i><br /><AbstractText>The assessment of valvular pathologies in multiple valvular heart disease by echocardiography remains challenging. Data on echocardiographic assessment-especially in patients with combined aortic and mitral regurgitation-are rare in the literature. The proposed integrative approach using semi-quantitative parameters to grade the severity of regurgitation often yields inconsistent findings and results in misinterpretation. Therefore, this proposal aims to focus on a practical systematic echocardiographic analysis to understand the pathophysiology and hemodynamics in patients with combined aortic and mitral regurgitation. The quantitative approach of grading the regurgitant severity of each compound might be helpful in elucidating the scenario in combined aortic and mitral regurgitation. To this end, both the individual regurgitant fraction of each valve and the total regurgitant fraction of both valves must be determined. This work also outlines the methodological issues and limitations of the quantitative approach by echocardiography. Finally, we present a proposal that enables verifiable assessment of regurgitant fractions. The overall interpretation of echocardiographic results includes the symptomatology of patients with combined aortic and mitral regurgitation and the individual treatment options with respect to their individual risk. In summary, a reproducible, verifiable, and transparent in-depth echocardiographic investigation might ensure consistent hemodynamic plausibility of the quantitative results in patients with combined aortic and mitral regurgitation. The quantitative approach to assess LV volumes in combined AR and MR patients: explanation and algorithm of how to determine the relevant target parameters. LVSV<sub>eff</sub>-effective left ventricular (LV) stroke volume, LVSV<sub>forward</sub>-forward LV stroke volume through the aortic valve (AV), LVSV<sub>tot</sub>-total LV stroke volume, RegVol<sub>AR</sub>-regurgitant volume through the AV, RegVol<sub>MR</sub>-regurgitant volume through the mitral valve (MV), LV<sub>filling volume</sub> = LV<sub>MV</sub>-Inflow - transmitral LV inflow, LVOT-left ventricular outflow tract, RF<sub>AR</sub>-regurgitant fraction of aortic regurgitation (AR), RF<sub>MR</sub>-regurgitant fraction of mitral regurgitation (MR), RVSV<sub>eff</sub> -effective right ventricular (RV) stroke volume, RVSV<sub>forward</sub>-forward RV stroke volume through the pulmonary valve, RVSV<sub>tot</sub>-total RV stroke volume.</AbstractText><br /><br />© 2023. The Author(s).<br /><br /><small>Clin Res Cardiol: 22 May 2023; epub ahead of print</small></div>

<div><h4>Association between segmental non-invasive myocardial work and microvascular perfusion in ST-segment elevation myocardial infarction: implications for left ventricular functional recovery and clinical outcomes.</h4><i>Sun S, Chen N, Sun Q, Wei H, ... Xie F, R PT</i><br /><b>Background</b><br />Predicting left ventricular recovery (LVR) after acute ST-segment elevation myocardial infarction (STEMI) is of prognostic importance. This study aims to explore the prognostic implications of segmental noninvasive myocardial work (MW) and microvascular perfusion (MVP) after STEMI.<br /><b>Methods</b><br />In this retrospective study, 112 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) and transthoracic echocardiography after PCI were enrolled. MVP was analyzed by myocardial contrast echocardiography (MCE), and segmental MW was analyzed by noninvasive pressure-strain loops. 671 segments with abnormal function at baseline were analyzed. The degrees of MVP were observed following intermittent high-mechanical index impluses: replenishment within 4 sec (normal MVP, nMVP), replenishment >4 sec and within 10 sec (delayed MVP, dMVP), persistent defect (microvascular obstruction, MVO). The correlation between MW and MVP was analyzed. The correlation of the MW and MVP with LVR (normalization of wall thickening, >25%) was assessed. The prognostic value of segmental MW and MVP for cardiac events (cardiac death, admission for congestive heart failure or recurrent myocardial infarction) were evaluated.<br /><b>Results</b><br />NMVP was seen in 70 segments, dMVP in 236, and MVO in 365. The sMW indices were independently correlated with MVP. 244 (36.4%) segments had segmental LVR at 3 month follow-up. Segmental myocardial work efficiency (sMWE) and MVP were independently associated with segmental LVR (P<0.05). The χ<sup>2</sup> of combination of sMWE and MVP was higher than either index alone for identifying segmental LVR (P<0.001). At a median follow-up of 42.0 months, cardiac events occurred in 13 patients; all regional MW parameters, high sensitivity troponin I (hs-TNI), regional longitudinal strain (rLS), et al were associated with cardiac events.<br /><b>Conclusion</b><br />SMW indices are associated with MVP within the infarct zone following reperfused STEMI. Both were independently associated with segmental LVR , and regional MW was associated with cardiac events , providing prognostic value in STEMI patients.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 22 May 2023; epub ahead of print</small></div>

<div><h4>Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE-ICM International Registry.</h4><i>Pontone G, Guaricci AI, Fusini L, Baggiano A, ... Masci PG, Schwitter J</i><br /><b>Background</b><br />Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF) ≤35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation.<br /><b>Objectives</b><br />The DERIVATE (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy)-ICM registry (NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM.<br /><b>Methods</b><br />A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF <50% participated. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints.<br /><b>Results</b><br />During a median follow-up of 1,054 days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95% CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95% CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95% CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007).<br /><b>Conclusions</b><br />The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care.<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>JACC Cardiovasc Imaging: 22 May 2023; epub ahead of print</small></div>

<div><h4>Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: positron emission tomography, computed tomography, and magnetic resonance.</h4><i>Murphy J, AlJaroudi WA, Hage FG</i><br /><AbstractText>In 2022, the Journal of Nuclear Cardiology® published many excellent original research articles and editorials focusing on imaging in patients with cardiovascular disease. In this review of 2022, we summarize a selection of articles to provide a concise recap of major advancements in the field. In the first part of this 2-part series, we addressed publications pertaining to single-photon emission computed tomography. In this second part, we focus on positron emission tomography, cardiac computed tomography, and cardiac magnetic resonance. We specifically review advances in imaging of non-ischemic cardiomyopathy, cardio-oncology, infectious disease cardiac manifestations, atrial fibrillation, detection and prognostication of atherosclerosis, and technical improvements in the field. We hope that this review will be useful to readers as a reminder to articles they have seen during the year as well as ones they have missed.</AbstractText><br /><br />© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.<br /><br /><small>J Nucl Cardiol: 19 May 2023; epub ahead of print</small></div>

<div><h4>Cardiac magnetic resonance imaging of pericardial diseases: a comprehensive guide.</h4><i>Antonopoulos AS, Vrettos A, Androulakis E, Kamperou C, ... Mohiaddin R, Lazaros G</i><br /><AbstractText>Cardiac magnetic resonance (CMR) imaging has been established as a valuable diagnostic tool in the assessment of pericardial diseases by providing information on cardiac anatomy and function, surrounding extra-cardiac structures, pericardial thickening and effusion, characterization of pericardial effusion, and the presence of active pericardial inflammation from the same scan. In addition, CMR imaging has excellent diagnostic accuracy for the non-invasive detection of constrictive physiology evading the need for invasive catheterization in most instances. Growing evidence in the field suggests that pericardial enhancement on CMR is not only diagnostic of pericarditis but also has prognostic value for pericarditis recurrence, although such evidence is derived from small patient cohorts. CMR findings could also be used to guide treatment de-escalation or up-titration in recurrent pericarditis and selecting patients most likely to benefit from novel treatments such as anakinra and rilonacept. This article is an overview of the CMR applications in pericardial syndromes as a primer for reporting physicians. We sought to provide a summary of the clinical protocols used and an interpretation of the major CMR findings in the setting of pericardial diseases. We also discuss points that are less well clear and delineate the strengths and weak points of CMR in pericardial diseases.</AbstractText><br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 19 May 2023; epub ahead of print</small></div>

<div><h4>Cardiac rupture in acute myocardial infarction: a cardiac magnetic resonance study.</h4><i>De Lazzari M, Cipriani A, Cecere A, Niero A, ... Iliceto S, Perazzolo Marra M</i><br /><b>Aims</b><br />We assessed the feasibility of cardiac magnetic resonance (CMR) and the role of myocardial strain in the diagnostic work-up of patients with acute myocardial infarction (AMI) and a clinical suspicion of cardiac rupture (CR).<br /><b>Methods and results</b><br />Consecutive patients with AMI complicated by CR who underwent CMR were enrolled. Traditional and strain CMR findings were evaluated; new parameters indicating the relative wall stress between AMI and adjacent segments, named wall stress index (WSI) and WSI ratio, were analysed. A group of patients admitted for AMI without CR served as control. 19 patients (63% male, median age 73 years) met the inclusion criteria. Microvascular obstruction (MVO, P = 0.001) and pericardial enhancement (P < 0.001) were strongly associated with CR. Patients with clinical CR confirmed by CMR exhibited more frequently an intramyocardial haemorrhage than controls (P = 0.003). Patients with CR had lower 2D and 3D global radial strain (GRS) and global circumferential strain (in 2D mode P < 0.001; in 3D mode P = 0.001), as well as 3D global longitudinal strain (P < 0.001), than controls. The 2D circumferential WSI (P = 0.010), as well as the 2D and 3D circumferential (respectively, P < 0.001 and P = 0.042) and radial WSI ratio (respectively, P < 0.001 and P: 0.007), were higher in CR patients than controls.<br /><b>Conclusion</b><br />CMR is a safe and useful imaging tool to achieve the definite diagnosis of CR and an accurate visualization of tissue abnormalities associated with CR. Strain analysis parameters can give insights into the pathophysiology of CR and may help to identify those patients with sub-acute CR.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 18 May 2023; epub ahead of print</small></div>

<div><h4>Differential biventricular adaption to pulmonary vascular disease in patients with idiopathic/heritable and congenital heart disease: a prospective cardiac magnetic resonance and invasive study.</h4><i>Xu Z, Dou R, Zhou Z, Zhang H, ... Xu L, Gu H</i><br /><b>Aims</b><br />Despite shared pathophysiological mechanisms, patients with idiopathic/heritable pulmonary arterial hypertension (IPAH/HPAH) have a poorer prognosis than those with PAH after congenital heart defect repair. Ventricular adaption remains unclear and could provide a basis for explaining differences in clinical outcomes. The aim of this prospective study was to assess clinical status, haemodynamic profile, and biventricular adaptation to PAH in children with various forms of PAH.<br /><b>Methods and results</b><br />Consecutive patients with IPAH/HPAH or post-operative PAH were prospectively recruited (n = 64). All patients underwent a comprehensive, protocolized assessment including functional assessment, measurement of brain natriuretic peptide (BNP) levels, invasive measurements, and a cardiac magnetic resonance (CMR) assessment. A cohort of age- and sex-matched healthy subjects served as controls. Patients with post-operative PAH had a better functional class (61.5 vs. 26.3% in Class I/II, P = 0.02) and a longer 6-min walk distance (320 ± 193 vs. 239 ± 156 m, P = 0.008) than IPAH/HPAH. While haemodynamic parameters were not significantly different between IPAH/HPAH and post-operative patients, post-operative patients with PAH presented with higher left ventricular volumes and better right ventricular function compared with patients with IPAH/HPAH (P < 0.05). On correlation analyses, left ventricular volumetric parameters were highly correlated with BNP and 6-min walk test distance in this population.<br /><b>Conclusion</b><br />Despite comparable haemodynamic profiles, patients with post-operative PAH had less functional limitation than their IPAH/HPAH counterparts. This is potentially related to the differential biventricular adaptation pattern evident on CMR with better myocardial contractility and higher left ventricular volumes in post-operative patients with PAH, highlighting the importance of ventriculo-ventricular interaction in the setting of PAH.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 18 May 2023; epub ahead of print</small></div>

<div><h4>Prognostic value of right ventricular longitudinal strain in patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair.</h4><i>Lupi L, Italia L, Pagnesi M, Pancaldi E, ... Metra M, Adamo M</i><br /><b>Aims</b><br />To evaluate the prognostic impact of pre-procedural right ventricular longitudinal strain (RVLS) in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge repair (TEER) in comparison with conventional echocardiographic parameters of RV function.<br /><b>Methods and results</b><br />This is a retrospective study including 142 patients with SMR undergoing TEER at two Italian centres. At 1-year follow-up 45 patients reached the composite endpoint of all-cause death or heart failure hospitalization. The best cut-off value of RV free-wall longitudinal strain (RVFWLS) to predict outcome was -18% [sensitivity 72%, specificity of 71%, area under curve (AUC) 0.78, P < 0.001], whereas the best cut-off value of RV global longitudinal strain (RVGLS) was -15% (sensitivity 56%, specificity 76%, AUC 0.69, P < 0.001). Prognostic performance was suboptimal for tricuspid annular plane systolic excursion, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity and fractional area change (FAC). Cumulative survival free from events was lower in patients with RVFWLS ≥ -18% vs. RVFWLS < -18% (44.0% vs. 85.4%; < 0.001) as well as in patients with RVGLS ≥ -15% vs. RVGLS < -15% (54.9% vs. 81.7%; P < 0.001). At multivariable analysis FAC, RVGLS and RVFWLS were independent predictors of events. The identified cut-off of RVFWLS and RVGLS both resulted independently associated with outcomes.<br /><b>Conclusion</b><br />RVLS is a useful and reliable tool to identify patients with SMR undergoing TEER at high risk of mortality and HF hospitalization, on top of other clinical and echocardiographic parameters, with RVFWLS offering the best prognostic performance.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 17 May 2023; epub ahead of print</small></div>

<div><h4>Clinical relevance and prognostic value of renal Doppler in acute decompensated precapillary pulmonary hypertension.</h4><i>Pichon J, Roche A, Fauvel C, Boucly A, ... Humbert M, Savale L</i><br /><b>Aims</b><br />We aim to evaluate the clinical relevance and the prognostic value of arterial and venous renal Doppler in acute decompensated precapillary pulmonary hypertension (PH).<br /><b>Methods and results</b><br />The renal resistance index (RRI) and the Doppler-derived renal venous stasis index (RVSI) were monitored at admission and on Day 3 in a prospective cohort of precapillary PH patients managed in intensive care unit for acute right heart failure (RHF). The primary composite endpoint included death, circulatory assistance, urgent transplantation, or rehospitalization for acute RHF within 90 days following inclusion. Ninety-one patients were enrolled (58% female, age 58 ± 16 years). The primary endpoint event occurred in 32 patients (33%). In univariate logistic regression analysis, variables associated with RRI higher than the median value were non-variable parameters (age and history of hypertension), congestion (right atrial pressure and renal pulse pressure), cardiac function [tricuspid annular plane systolic excursion (TAPSE) and left ventricular outflow tract- velocity time integral], systemic pressures and NT-proBNP. Variables associated with RVSI higher than the median value were congestion (high central venous pressure, right atrial pressure, and renal pulse pressure), right cardiac function (TAPSE), severe tricuspid regurgitation, and systemic pressures. Inotropic support was more frequently required in patients with high RRI (P = 0.01) or high RVSI (P = 0.003) at the time of admission. At Day 3, a RRI value <0.9 was associated with a better prognosis after adjusting to the estimated glomerular filtration rate.<br /><b>Conclusion</b><br />Renal Doppler provides additional information to assess the severity of patients admitted to the intensive care unit for acute decompensated precapillary PH.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 17 May 2023; epub ahead of print</small></div>

<div><h4>Relative apical sparing in cardiac amyloidosis is not always explained by an amyloid gradient.</h4><i>De Gaspari M, Sinigiani G, De Michieli L, Della Barbera M, ... Basso C, Cipriani A</i><br /><b>Aims</b><br />Myocardial longitudinal strain (LS) by two-dimensional (2D) speckle-tracking echocardiography has a diagnostic and prognostic role in cardiac amyloidosis (CA). Typically, the apical segments of the left ventricle (LV) are less affected by LS abnormalities, a finding called relative apical sparing (RELAPS). Whether a variable burden of CA might explain the RELAPS remains unknown.We aimed to evaluate the extent, distribution, and deposition pattern of amyloid in autopsy hearts of CA patients and to correlate the histopathology findings with 2D echocardiography.<br /><b>Methods and results</b><br />This is a retrospective study of whole heart specimens of CA patients who died and underwent autopsy and 2D echocardiography. Amyloid burden quantification was assessed by histomorphometry in each segment at different LV levels. The LS analysis results were compared with the amyloid burden and the base-to-apex distribution.Histopathology investigation of 27 hearts with CA [immunoglobulin light chains (AL) 17 cases and transthyretin (ATTR) 10 cases] demonstrated an amyloid base-to-apex gradient. In 11 CA patients with 2D echocardiography, analysis of LS and histological amyloid burden allowed to identify different patterns: RELAPS (8 cases, 73%), with (2) or without (6) amyloid gradient, normal or mildly reduced LS with diffuse low amyloid (2, 18%), and severely reduced LS with diffuse high amyloid (1, 9%).<br /><b>Conclusion</b><br />The typical RELAPS pattern at echocardiography is not always explained by a base-to-apex gradient of amyloid burden at histopathology, suggesting that RELAPS might be an epiphenomenon of complex interactions among amyloid infiltration, myocardial structure, and adaptation.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 16 May 2023; epub ahead of print</small></div>

<div><h4>Zero-Contrast Left Atrial Appendage Occlusion Using a Hybrid Echocardiography-Fluoroscopy Technique Without Iodinated Contrast.</h4><i>Blusztein DI, Gogia S, Hahn RT, Sommer RJ, ... Ranard L, Vahl TP</i><br /><AbstractText>Contrast exposure during left atrial appendage occlusion may be harmful in those with chronic kidney disease or allergy. This single-center registry (n = 31) demonstrates the feasibility and safety of zero-contrast percutaneous left atrial appendage occlusion using echocardiography, fluoroscopy, and fusion imaging, with 100% procedural success and no device complications at 45 days.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 May 2023; 198:53-55</small></div>

<div><h4>Reduced Left Atrial Appendage Flow Is Associated With Future Atrial Fibrillation After Cryptogenic Stroke.</h4><i>Dhont S, Wouters F, Deferm S, Bekelaar K, ... Vandervoort P, Bertrand PB</i><br /><b>Background</b><br />Hemostasis within the left atrial appendage (LAA) is a common cause of stroke, especially in patients with atrial fibrillation (AF). Although LAA flow provides insights into LAA function, its potential for predicting AF has yet to be established. The aim of this study was to explore whether LAA peak flow velocities early after cryptogenic stroke are associated with future AF on prolonged rhythm monitoring.<br /><b>Methods</b><br />A total of 110 patients with cryptogenic stroke were consecutively enrolled and underwent LAA pulsed-wave Doppler flow assessment using transesophageal echocardiography within the early poststroke period. Velocity measurements were analyzed offline by an investigator blinded to the results. Prolonged rhythm monitoring was conducted on all participants via 7-day Holter and implantable cardiac monitoring devices, with follow-up conducted over a period of 1.5 years to determine the incidence of AF. The end point of AF was defined as irregular supraventricular rhythm with variable RR interval and no detectable P waves lasting ≥30 sec during rhythm monitoring.<br /><b>Results</b><br />During a median follow-up period of 539 days (interquartile range, 169-857 days), 42 patients (38%) developed AF, with a median time to AF diagnosis of 94 days (interquartile range, 51-487 days). Both LAA filling velocity and LAA emptying velocity (LAAev) were lower in patients with AF (44.3 ± 14.2 and 50.7 ± 13.3 cm/s, respectively) compared with patients without AF (59.8 ± 14.0 and 76.8 ± 17.3 cm/sec, respectively; P < .001 for both). LAAev was most strongly associated with future AF, with an area under the receiver operating characteristic curve of 0.88 and an optimal cutoff value of 55 cm/sec. Age and mitral regurgitation were independent determinants of reduced LAAev.<br /><b>Conclusions</b><br />Impaired LAA peak flow velocities (LAAev < 55 cm/sec) in patients with cryptogenic stroke are associated with future AF. This may facilitate the selection of appropriate candidates for prolonged rhythm monitoring to improve its diagnostic accuracy and implementation.<br /><br />Copyright © 2023 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Soc Echocardiogr: 15 May 2023; epub ahead of print</small></div>

<div><h4>Changes in Computed-Tomography-Derived Segmental Left Ventricular Longitudinal Strain After Transcatheter Aortic Valve Implantation.</h4><i>Singh GK, Fortuni F, Kuneman JH, Vollema EM, ... Delgado V, Bax JJ</i><br /><AbstractText>Patients with severe aortic stenosis (AS) may show left ventricular (LV) apical longitudinal strain sparing. Transcatheter aortic valve implantation (TAVI) improves LV systolic function in patients with severe AS. However, the changes in regional longitudinal strain after TAVI have not been extensively evaluated. This study aimed to characterize the effect of the pressure overload relief after TAVI on LV apical longitudinal strain sparing. A total of 156 patients (mean age 80 ± 7 years, 53% men) with severe AS who underwent computed tomography before and within 1 year after TAVI (mean time to follow-up 50 ± 30 days) were included. LV global and segmental longitudinal strain were assessed using feature tracking computed tomography. LV apical longitudinal strain sparing was evaluated as the ratio between the apical and midbasal longitudinal strain and was defined as an LV apical to midbasal longitudinal strain ratio >1. LV apical longitudinal strain remained stable after TAVI (from 19.5 ± 7.2% to 18.7 ± 7.7%, p = 0.20), whereas LV midbasal longitudinal strain showed a significant increase (from 12.9 ± 4.2% to 14.2 ± 4.0%, p ≤0.001). Before TAVI, 88% of the patients presented with LV apical strain ratio >1% and 19% presented with an LV apical strain ratio >2. After TAVI, these percentages significantly decreased to 77% and 5% (p = 0.009, p ≤0.001), respectively. In conclusion, LV apical sparing of strain is a relatively common finding in patients with severe AS who underwent TAVI and its prevalence decreases after the afterload relief after TAVI.</AbstractText><br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 15 May 2023; epub ahead of print</small></div>

<div><h4>Coronary Volume to Left Ventricular Mass Ratio in Patients With Hypertension.</h4><i>van Rosendael SE, van Rosendael AR, Kuneman JH, Patel MR, ... Saraste A, Knuuti J</i><br /><AbstractText>The coronary vascular volume to left ventricular mass (V/M) ratio assessed by coronary computed tomography angiography (CCTA) is a promising new parameter to investigate the relation of coronary vasculature to the myocardium supplied. It is hypothesized that hypertension decreases the ratio between coronary volume and myocardial mass by way of myocardial hypertrophy, which could explain the detected abnormal myocardial perfusion reserve reported in patients with hypertension. Individuals enrolled in the multicenter ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry who underwent clinically indicated CCTA for analysis of suspected coronary artery disease with known hypertension status were included in current analysis. The V/M ratio was calculated from CCTA by segmenting the coronary artery luminal volume and left ventricular myocardial mass. In total, 2,378 subjects were included in this study, of whom 1,346 (56%) had hypertension. Left ventricular myocardial mass and coronary volume were higher in subjects with hypertension than normotensive patients (122.7 ± 32.8 g vs 120.0 ± 30.5 g, p = 0.039, and 3,105.0 ± 992.0 mm<sup>3</sup> vs 2,965.6 ± 943.7 mm<sup>3</sup>, p <0.001, respectively). Subsequently, the V/M ratio was higher in patients with hypertension than those without (26.0 ± 7.6 mm<sup>3</sup>/g vs 25.3 ± 7.3 mm<sup>3</sup>/g, p = 0.024). After correcting for potential confounding factors, the coronary volume and ventricular mass remained higher in patients with hypertension (least square) mean difference estimate: 196.3 (95% confidence intervals [CI] 119.9 to 272.7) mm<sup>3</sup>, p <0.001, and 5.60 (95% CI 3.42 to 7.78) g, p <0.001, respectively), but the V/M ratio was not significantly different (least square mean difference estimate: 0.48 (95% CI -0.12 to 1.08) mm<sup>3</sup>/g, p = 0.116). In conclusion, our findings do not support the hypothesis that the abnormal perfusion reserve would be caused by reduced V/M ratio in patients with hypertension.</AbstractText><br /><br />Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 15 May 2023; epub ahead of print</small></div>

<div><h4>Nomograms referenced by cardiac magnetic resonance in the prediction of cardiac injuries in patients with ST-elevation myocardial infarction.</h4><i>Zhao CX, Wei L, Dong JX, He J, ... Ge H, Pu J</i><br /><b>Background</b><br />Evaluation of cardiac injuries is essential in patients with ST-elevation myocardial infarction (STEMI). Cardiac magnetic resonance (CMR) has become the gold standard for quantifying cardiac injuries; however, its routine application is limited. A nomogram is a useful tool for prognostic prediction based on the comprehensive utilization of clinical data. We presumed that the nomogram models established using CMR as a reference could precisely predict cardiac injuries.<br /><b>Methods</b><br />This analysis included 584 patients with acute STEMI from a CMR registry study for STEMI (NCT03768453). The patients were divided into training (n = 408) and testing (n = 176) datasets. The least absolute shrinkage method, selection operator method, and multivariable logistic regression were used to construct nomograms for predicting left ventricular ejection fraction (LVEF) ≤40%, infarction size (IS) ≥ 20% on the LV mass, and microvascular dysfunction.<br /><b>Results</b><br />The nomogram for predicting LVEF≤40%, IS≥20%, and microvascular dysfunction comprised 14, 10, and 15 predictors, respectively. With the nomograms, the individual risk probability of developing specific outcomes could be calculated, and the weight of each risk factor was demonstrated. The C-index of the nomograms in the training dataset were 0.901, 0.831, and 0.814, respectively, and were comparable in the testing set, showing good nomogram discrimination and calibration. The decision curve analysis demonstrated good clinical effectiveness. Online calculators were also constructed.<br /><b>Conclusions</b><br />With the CMR results as the reference standard, the established nomograms demonstrated good effectiveness in predicting cardiac injuries after STEMI and could provide physicians with a new option for individual risk stratification.<br /><br />Copyright © 2023. Published by Elsevier B.V.<br /><br /><small>Int J Cardiol: 13 May 2023; epub ahead of print</small></div>

<div><h4>Machine Learning-Based Phenogrouping in Mitral Valve Prolapse Identifies Profiles Associated With Myocardial Fibrosis and Cardiovascular Events.</h4><i>Huttin O, Girerd N, Jobbe-Duval A, Constant Dit Beaufils AL, ... Selton-Suty C, Le Tourneau T</i><br /><b>Background</b><br />Structural changes and myocardial fibrosis quantification by cardiac imaging have become increasingly important to predict cardiovascular events in patients with mitral valve prolapse (MVP). In this setting, it is likely that an unsupervised approach using machine learning may improve their risk assessment.<br /><b>Objectives</b><br />This study used machine learning to improve the risk assessment of patients with MVP by identifying echocardiographic phenotypes and their respective association with myocardial fibrosis and prognosis.<br /><b>Methods</b><br />Clusters were constructed using echocardiographic variables in a bicentric cohort of patients with MVP (n = 429 patients, 54 ± 15 years) and subsequently investigated for their association with myocardial fibrosis (assessed by cardiac magnetic resonance) and cardiovascular outcomes.<br /><b>Results</b><br />Mitral regurgitation (MR) was severe in 195 (45%) patients. Four clusters were identified: cluster 1 comprised no remodeling with mainly mild MR, cluster 2 was a transitional cluster, cluster 3 included significant left ventricular (LV) and left atrial (LA) remodeling with severe MR, and cluster 4 included remodeling with a drop in LV systolic strain. Clusters 3 and 4 featured more myocardial fibrosis than clusters 1 and 2 (P < 0.0001) and were associated with higher rates of cardiovascular events. Cluster analysis significantly improved diagnostic accuracy over conventional analysis. The decision tree identified the severity of MR along with LV systolic strain <21% and indexed LA volume >42 mL/m<sup>2</sup> as the 3 most relevant variables to correctly classify participants into 1 of the echocardiographic profiles.<br /><b>Conclusions</b><br />Clustering enabled the identification of 4 clusters with distinct echocardiographic LV and LA remodeling profiles associated with myocardial fibrosis and clinical outcomes. Our findings suggest that a simple algorithm based on only 3 key variables (severity of MR, LV systolic strain, and indexed LA volume) may help risk stratification and decision making in patients with MVP. (Genetic and Phenotypic Characteristics of Mitral Valve Prolapse; NCT03884426 and Myocardial Characterization of Arrhythmogenic Mitral Valve Prolapse [MVP STAMP]; NCT02879825).<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>JACC Cardiovasc Imaging: 13 May 2023; epub ahead of print</small></div>

<div><h4>Improving evaluation for TTR amyloidosis by interactive filtering of Tc-99 m PYP SPECT images. The role for \"clean blood pool\" imaging.</h4><i>Hansen CL</i><br /><b>Background</b><br />Myocardial imaging with bone agents such as Tc-99 m PYP and HMDP has assumed a central role in the evaluation of patients with suspected transthyretin (TTR) amyloidosis. Visual scoring (VS) (0-3 +) and the heart to contralateral lung ratio (HCL) classify many patients as equivocal when mediastinal uptake is apparent but cannot be further differentiated into myocardial uptake versus blood pool. SPECT imaging has been recommended but current reconstruction protocols frequently produce amorphous mediastinal activity that also fails to discriminate between myocardial activity and blood pool. We hypothesized that interactive filtering interactively using a deconvolving filter would improve this.<br /><b>Methods</b><br />We identified 176 sequential patients referred for TTR amyloid imaging. All patients had planar imaging, 101 had planar imaging with a large field of view camera that allowed HCL measurements. SPECT imaging was performed on a 3-headed digital camera with lead fluorescence attenuation correction. One study was excluded for technical reasons. We created software to allow interactive filtering while reconstructing the images then overlay them on attenuation mu maps to assist localization of myocardial/mediastinal uptake. Conventional Butterworth and an interactive inverse Gaussian filters were employed to differentiate myocardial uptake from residual blood pool. We defined \"clean blood pool\" (CBP) as recognizable blood pool with no activity in the surrounding myocardium. A scan was determined diagnostic if it showed CBP, positive uptake or no identifiable mediastinal uptake.<br /><b>Results</b><br />76/175 (43%) were equivocal (1 +) by visual uptake. Of these 22 (29%) were diagnostic by Butterworth but 71 (93%) were by inverse gaussian (p < .0001). 71/101 (70%) were equivocal by HCL (1-1.5). Of these, 25 (35%) were diagnostic by Butterworth but 68 (96%) were diagnostic by inverse gaussian (p < .0001). This was driven by a greater than threefold increase in the identification of CBP by inverse gaussian filtering.<br /><b>Conclusion</b><br />CBP can be identified in the vast majority of patients with equivocal PYP scans using optimized reconstruction and can greatly reduce the number of equivocal scans.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 12 May 2023; epub ahead of print</small></div>

<div><h4>Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography.</h4><i>van Rosendael SE, Bax AM, Lin FY, Achenbach S, ... Shaw LJ, van Rosendael AR</i><br /><b>Aims</b><br />The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes.<br /><b>Methods and results</b><br />From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24 950 individuals. A total of 11 678 women (58.5 ± 12.4 years) and 13 272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or myocardial infarction). The age where the median risk score was above zero was 12 years higher in women vs. men (64-68 years vs. 52-56 years, respectively, P < 0.001). The Leiden CCTA risk score was independently associated with MACE: score 6-20: HR 2.29 (1.69-3.10); score > 20: HR 6.71 (4.36-10.32) in women, and score 6-20: HR 1.64 (1.29-2.08); score > 20: HR 2.38 (1.73-3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P-interaction = 0.003). In pre-menopausal women, the risk score was equally predictive and comparable with men. In post-menopausal women, the prognostic value was higher for women [score 6-20: HR 2.21 (1.57-3.11); score > 20: HR 6.11 (3.84-9.70) in women; score 6-20: HR 1.57 (1.19-2.09); score > 20: HR 2.25 (1.58-3.22) in men], with a significant interaction for the highest risk group (adjusted P-interaction = 0.004).<br /><b>Conclusion</b><br />Women developed coronary atherosclerosis approximately 12 years later than men. Post-menopausal women within the highest atherosclerotic burden group were at significantly higher risk for MACE than their male counterparts, which may have implications for the medical treatment intensity.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 11 May 2023; epub ahead of print</small></div>

<div><h4>Impact of change of ischemic burden on the outcomes of ESRD patients awaiting kidney transplantation.</h4><i>Tottleben J, Torres A, Doukky R</i><br /><b>Background</b><br />In asymptomatic patients with end-stage renal disease (ESRD) wait-listed for kidney transplantation (KT), it is unclear whether a change in ischemic burden on serial surveillance SPECT myocardial perfusion imaging (MPI) impacts outcome.<br /><b>Methods and results</b><br />In a retrospective cohort of 700 asymptomatic KT candidates with ≥ 2 sequential SPECT-MPI studies, we defined a significant change in ischemic burden between MPIs as ΔSDS of ≥ 2 points. Patients were followed for mean 19 ± 12 months after MPI<sub>2</sub> for cardiac death or myocardial infarction. Between MPIs, 29 (4%) subjects received coronary revascularization which was associated with a greater incidence of reduction in ischemic burden on MPI<sub>2</sub> (31% vs. 17%, P = 0.049). Among 514 patients with no ischemia on MPI<sub>1</sub> (SDS ≤ 1), 15% had new ischemia on MPI<sub>2</sub> which was associated with increased MACE (adjusted HR 1.75; CI 1.02-3.01; P = 0.041). Among 186 patients with ischemia on MPI<sub>1</sub> (SDS ≥ 2), 66% had improvement of ischemic burden on MPI<sub>2</sub> which was associated with significantly lower MACE (adjusted HR 0.46; CI 0.25-0.82; P = 0.009). There was no significant interaction between coronary revascularization and improvement in ischemic burden impacting outcome (interaction P = 0.845).<br /><b>Conclusion</b><br />Among KT candidates who underwent serial MPI for CAD surveillance, new ischemia was associated with increased MACE risk. Improvement in ischemic burden was associated with lower MACE risk irrespective of coronary revascularization status.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 11 May 2023; epub ahead of print</small></div>

<div><h4>Sex Differences in the Density of Lipidic Plaque Materials: Insights From the REASSURE-NIRS MultiCenter Registry.</h4><i>Kataoka Y, Nicholls SJ, Puri R, Kitahara S, ... Asaumi Y, Noguchi T</i><br /><b>Background</b><br />Intravascular imaging has shown better response of coronary atheroma to statin-mediated lowering of low-density lipoprotein cholesterol in women. However, its detailed mechanism remains to be determined yet. Modifiability of coronary atheroma under lipid-lowering therapies is partly driven by lipidic plaque component. Given a smaller plaque volume in women, lipidic plaque features including their density may differ between sex. Therefore, the current study sought to characterize sex-related differences in the density of lipidic plaque.<br /><b>Methods</b><br />We analyzed 1429 coronary lesions (culprit/nonculprit lesions=825/604) in 758 coronary artery disease patients (men/women=608/150) from the REASSURE-NIRS multicenter registry (Revelation of Pathophysiological Phenotypes of Vulnerable Lipid-Rich Plaque on Near-Infrared Spectroscopy). Total atheroma volume at 4-mm segment, maximum 4-mm-lipid-core burden index, and lipid plaque density index (=maximum 4-mm-lipid-core burden index/total atheroma volume at 4-mm segment) on near-infrared spectroscopy/intravascular ultrasound imaging at culprit and nonculprit lesions were compared in men and women.<br /><b>Results</b><br />Statin and high-intensity statin were used in 72.4 (<i>P</i>=0.81) and 22.9% (<i>P</i>=0.32) of study subjects, respectively. Women exhibited a smaller adjusted total atheroma volume at 4-mm segment (culprit lesions: 50.3±0.4 versus 54.2±0.3mm<sup>3</sup>, <i>P</i><0.001, nonculprit lesions: 31.5±3.0 versus 44.4±2.1mm<sup>3</sup>, <i>P</i><0.001), whereas their adjusted maximum 4-mm-lipid-core burden index did not differ between sex (culprit lesions: 544.7±29.9 versus 501.7±19.1, <i>P</i>=0.11, nonculprit lesions: 288.8±26.7 versus 272.7±18.9, <i>P</i>=0.51). Furthermore, a greater adjusted lipid plaque density index was observed in women (culprit lesions: 18.2±0.9 versus 9.8±0.6, <i>P</i><0.001, nonculprit lesions: 23.0±2.0 versus 7.8±1.4, <i>P</i><0.001). These adjustments of total atheroma volume at 4-mm segment, maximum 4-mm-lipid-core burden index, and lipid plaque density index included age, body mass index, hypertension, dyslipidemia, diabetes, smoking, a history of myocardial infarction and chronic kidney disease, low-density lipoprotein cholesterol level, statin and ezetimibe use, vessel volume, and hospital unit. The aforementioned plaque features consistently existed in both acute coronary syndrome and stable coronary artery disease subjects.<br /><b>Conclusions</b><br />Women harbored greater condensed lipidic plaque features, accompanied by smaller atheroma volume. These observations indicate potentially better modifiable disease in women, which underscores the need to intensify their lipid-lowering therapies for further improving their outcomes.<br /><b>Registration</b><br />URL: https://www.<br /><b>Clinicaltrials</b><br />gov/; Unique identifier: NCT04864171.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 10 May 2023:e015107; epub ahead of print</small></div>

<div><h4>Combined evaluation of CAC score and myocardial perfusion imaging in patients at risk of cardiovascular disease: where are we and what do the data say.</h4><i>Mannarino T, D\'Antonio A, Assante R, Zampella E, ... Cuocolo A, Acampa W</i><br /><AbstractText>Advances in the prevention and treatment of cardiovascular disease (CVD) over the last decades have led to a marked reduction in mortality for CVD. Nevertheless, atherosclerosis leading to coronary artery disease and stroke remains one of the most common causes of death in the world. The usefulness of imaging tests in the early identification of disease led to identify subjects at major risk of poor outcomes, suggesting risk factor modification. The aim of this article is to analyze the state of art of combined imaging in patients at risk of CVD referred to MPI evaluation, to highlight the present and potential features able to provide incremental prognostic information to help clinicians in patient management and to reduce adverse events.</AbstractText><br /><br />© 2023. The Author(s).<br /><br /><small>J Nucl Cardiol: 10 May 2023; epub ahead of print</small></div>

<div><h4>Pentoxifylline reduces inflammation and prevents myocardial perfusion derangements in experimental chronic Chagas\' cardiomyopathy.</h4><i>Tanaka DM, Fabricio CG, Marin-Neto JA, de Barros Filho ACL, ... Romano MMD, Simões MV</i><br /><b>Background</b><br />Myocardial perfusion defect (MPD) is common in chronic Chagas cardiomyopathy (CCC) and is associated with inflammation and development of left ventricular systolic dysfunction. We tested the hypothesis that pentoxifylline (PTX) could reduce inflammation and prevent the development of MPD in a model of CCC in hamsters.<br /><b>Methods and results</b><br />We investigated with echocardiogram and rest myocardial perfusion scintigraphy at baseline (6-months after T. cruzi infection/saline) and post-treatment (after additional 2-months of PTX/saline administration), female Syrian hamsters assigned to 3 groups: T. cruzi-infected animals treated with PTX (CH + PTX) or saline (CH + SLN); and uninfected control animals (CO). At the baseline, all groups showed similar left ventricular ejection fraction (LVEF) and MPD areas. At post-treatment evaluation, there was a significant increase of MPD in CH + SLN group (0.8 ± 1.6 to 9.4 ± 9.7%), but not in CH + PTX (1.9 ± 3.0% to 2.7 ± 2.7%) that exhibited MPD area similar to CO (0.0 ± 0.0% to 0.0 ± 0.0%). The LVEF decreased in both infected groups. Histological analysis showed a reduced inflammatory infiltrate in CH + PTX group (395.7 ± 88.3 cell/mm<sup>2</sup>), as compared to CH + SLN (515.1 ± 133.0 cell/mm<sup>2</sup>), but larger than CO (193.0 ± 25.7 cell/mm<sup>2</sup>). The fibrosis and TNF-α expression was higher in both infected groups.<br /><b>Conclusions</b><br />The prolonged use of PTX is associated with positive effects, including prevention of MPD development and reduction of inflammation in the chronic hamster model of CCC.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 10 May 2023; epub ahead of print</small></div>

<div><h4>Atrial Dysfunction in Significant Atrial Functional Mitral Regurgitation: Phenotypes and Prognostic Implications.</h4><i>Cramariuc D, Alfraidi H, Nagata Y, Levine RA, ... Andrews C, Hung J</i><br /><b>Background</b><br />Atrial functional mitral regurgitation (AFMR) is associated with increased morbidity and mortality. Left atrial (LA) size and function in AFMR are poorly characterized. We aimed to assess LA function by reservoir strain (LASr) and estimated reservoir work (LAWr) and their impact on outcome in AFMR.<br /><b>Methods</b><br />Consecutive patients at our institution between 2001 and 2019 and with significant (moderate or greater) AFMR were examined. LAWr was estimated as LASr×LA reservoir volume, and patients were grouped by median LASr and LAWr. Outcomes were all-cause death or heart failure hospitalizations.<br /><b>Results</b><br />Five hundred fifteen AFMR patients were followed up for 5 (1-17) years. Patients had previously documented atrial fibrillation (AF; 37%), heart failure with preserved ejection fraction (HFpEF) without AF (24%), or both (HFpEF+AF, 39%). LA volume was largest in AF, while LA function parameters were most impaired in the combined HFpEF+AF group. During follow-up, patients with low LASr or LAWr had higher risk of death (<i>P</i><0.001) and heart failure hospitalization (<i>P</i><0.05). In Cox regression analyses, low LASr and LAWr, but not LA volume or left ventricular function, were associated with a higher risk of death (LASr: hazard ratio, 2.3 [95% CI, 1.6-3.5]; LAWr: hazard ratio, 3.4 [95% CI, 2.4-4.9]; both <i>P</i><0.001) after adjustment for clinical and echocardiographic confounders. Low LASr and LAWr were strongest associated with death in HFpEF and HFpEF+AF.<br /><b>Conclusions</b><br />LA reservoir function but not LA size is a robust predictor of outcome in significant AFMR. This provides mechanistic insights into the interplay of functional versus geometric LA changes in AFMR.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 09 May 2023:e015089; epub ahead of print</small></div>

<div><h4>How can progression be predicted in patients with mild to moderate aortic valve stenosis?</h4><i>Seo JH, Kim KH, Chun KJ, Lee BK, Cho BR, Ryu DR</i><br /><b>Aims</b><br />The pressure increase per time unit (dP/dt) in aortic stenosis (AS) jet velocity is assumed to have inter-individual variability in the progressive AS stage. We sought to examine the association of aortic valve (AoV) Doppler-derived dP/dt in patients with mild to moderate AS with risk of progression to severe disease.<br /><b>Methods and results</b><br />A total of 481 patients diagnosed with mild or moderate AS [peak aortic jet velocity (Vmax) between 2 and 4 m/s] according to echocardiographic criteria were included. AoV Doppler-derived dP/dt was determined by measuring the time needed for the pressure to increase at a velocity of the AoV jet from 1 m/s to 2 m/s. During a median follow-up period of 2.7 years, 12 of 404 (3%) patients progressed from mild to severe AS and 31 of 77 (40%) patients progressed from moderate to severe AS. AoV Doppler-derived dP/dt had a good ability to predict risk of progression to severe AS (area under the curve = 0.868) and the cut-off value was 600 mmHg/s. In multivariable logistic regression, initial AoV calcium score (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.18-2.73; P = 0.006) and AoV Doppler-derived dP/dt (aOR, 1.52/100 mmHg/s higher dP/dt; 95% CI, 1.10-2.05; P = 0.012) were associated with progression to severe AS.<br /><b>Conclusion</b><br />AoV Doppler-derived dP/dt above 600 mmHg/s was associated with risk of AS progression to the severe stage in patients with mild to moderate AS. This may be useful in individualized surveillance strategies for AS progression.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 09 May 2023; epub ahead of print</small></div>

<div><h4>Prognostic impact of artificial intelligence-based fully automated global circumferential strain in patients undergoing stress CMR.</h4><i>Pezel T, Garot P, Toupin S, Hovasse T, ... Unterseeh T, Garot J</i><br /><b>Aims</b><br />To determine whether fully automated artificial intelligence-based global circumferential strain (GCS) assessed during vasodilator stress cardiovascular (CV) magnetic resonance (CMR) can provide incremental prognostic value.<br /><b>Methods and results</b><br />Between 2016 and 2018, a longitudinal study included all consecutive patients with abnormal stress CMR defined by the presence of inducible ischaemia and/or late gadolinium enhancement. Control subjects with normal stress CMR were selected using a propensity score-matching. Stress-GCS was assessed using a fully automatic machine-learning algorithm based on featured-tracking imaging from short-axis cine images. The primary outcome was the occurrence of major adverse clinical events (MACE) defined as CV mortality or nonfatal myocardial infarction. Cox regressions evaluated the association between stress-GCS and the primary outcome after adjustment for traditional prognosticators. In 2152 patients [66 ± 12 years, 77% men, 1:1 matched patients (1076 with normal and 1076 with abnormal CMR)], stress-GCS was associated with MACE [median follow-up 5.2 (4.8-5.5) years] after adjustment for risk factors in the propensity-matched population [adjusted hazard ratio (HR), 1.12 (95% CI, 1.06-1.18)], and patients with normal CMR [adjusted HR, 1.35 (95% CI, 1.19-1.53), both P < 0.001], but not in patients with abnormal CMR (P = 0.058). In patients with normal CMR, an increased stress-GCS showed the best improvement in model discrimination and reclassification above traditional and stress CMR findings (C-statistic improvement: 0.14; NRI = 0.430; IDI = 0.089, all P < 0.001; LR-test P < 0.001).<br /><b>Conclusion</b><br />Stress-GCS is not a predictor of MACE in patients with ischaemia, but has an incremental prognostic value in those with a normal CMR although the absolute event rate remains low.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 09 May 2023; epub ahead of print</small></div>

<div><h4>Left atrial stiffness and strain are novel indices of left ventricular diastolic function in children: validation followed by application in multisystem inflammatory syndrome in children due to COVID-19.</h4><i>Zuckerberg JC, Matsubara D, Kauffman HL, Chang JC, ... Wang Y, Banerjee A</i><br /><b>Aims</b><br />We hypothesized left atrial (LA) stiffness may serve as a surrogate marker in children to differentiate elevated pulmonary capillary wedge pressure (PCWP) from normal and help detect diastolic dysfunction in myocardial injury due to multisystem inflammatory syndrome in children (MIS-C).<br /><b>Methods and results</b><br />We validated LA stiffness in 76 patients (median age 10.5 years), 33 had normal PCWP (<12 mmHg) and 43 had elevated PCWP (≥12 mmHg). LA stiffness was applied to 42 MIS-C patients [28 with myocardial injury (+) and 14 without myocardial injury (-)], defined by serum biomarkers. The validation group consisted of a group with and without cardiomyopathies, whose PCWP values ranged from normal to severely elevated. Peak LA strain was measured by speckle-tracking and E/e\' from apical four chamber views. Noninvasive LA stiffness was calculated as: LAStiffness=E/e\'LAPeakStrain (%-1). Patients with elevated PCWP showed significantly elevated LA stiffness [median 0.71%-1 vs. 0.17%-1, P < 0.001]. Elevated PCWP group showed significantly decreased LA strain (median: 15.0% vs. 38.2%, P < 0.001). Receiver operator characteristic (ROC) curve for LA stiffness yielded an area under the curve (AUC) of 0.88 and cutoff value of 0.27%-1. In MIS-C group, ROC curve yielded an AUC of 0.79 and cutoff value of 0.29%-1 for identifying myocardial injury.<br /><b>Conclusion</b><br />In children with elevated PCWP, LA stiffness was significantly increased. When applied to children with MIS-C, LA stiffness classified myocardial injury accurately. LA stiffness and strain may serve as noninvasive markers of diastolic function in the pediatric population.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 09 May 2023; epub ahead of print</small></div>

<div><h4>Assessment of Left Ventricular Myocardial Fibrosis in Adult Patients With Ebstein Anomaly: A Retrospective Cohort Study Based on Cardiac Magnetic Resonance and Histopathological Samples.</h4><i>Fernandez-Badillo V, Serrano-Roman J, Antonio-Villa NE, Cabello-Ganem A, ... Alexanderson-Rosas E, Espinola-Zavaleta N</i><br /><b>Background</b><br />The association between Ebstein anomaly and myocardial fibrosis, particularly in the left ventricle, has been controversial. We aimed to assess the prevalence of replacement fibrosis with a focus on the left ventricle (LV) using cardiac magnetic resonance (CMR), make a histopathological association between LV fibrosis and CMR findings, and explore whether LV fibrosis is an independent risk factor for cardiovascular disease mortality using a derived risk score.<br /><b>Methods</b><br />We performed a 12-year (2009-2021) retrospective cohort of adult patients with Ebstein anomaly who underwent CMR. The CMR evaluation included a comprehensive assessment of myocardial fibrosis by late gadolinium enhancement (LGE). Four postmortem samples were obtained from our cohort and stained using Masson trichrome to characterize LV fibrosis. We used Cox-regression analysis to identify and derive a prediction score that associated LV fibrosis with cardiovascular disease mortality.<br /><b>Results</b><br />We included 57 adults with Ebstein anomaly (52% men; median age, 29.52 [interquartile range, 21.24-39.17] years), of whom 12 died during follow-up. LGE prevalence by CMR was observed in 52.6% in any chamber; LV-LGE in 29.8%. Histopathological findings revealed a mid-wall pattern with predominantly interstitial fibrosis and minimal replacement fibrosis. LV-LGE was associated with increased risk of cardiovascular disease mortality (hazard ratio, 6.02 [95% CI, 1.22-19.91]) attributable to lateral and mid-wall LV segment involvement. Our mortality score achieved an overall good prediction capacity (R<sup>2</sup>, 0.435; C statistic, 0.93; D<sub>xy</sub>, 0.86).<br /><b>Conclusions</b><br />There is a high prevalence of LV fibrosis replacement in adults with Ebstein anomaly, characterized by specific CMR and histological patterns. Furthermore, LV-LGE fibrosis is an independent predictor of cardiovascular disease mortality, which could be integrated into risk assessment in clinical management.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 08 May 2023:e015011; epub ahead of print</small></div>

<div><h4>Impact of cardiac surgery on left-sided infective endocarditis with intermediate-length vegetations.</h4><i>Scheggi V, Bohbot Y, Tribouilloy C, Trojette F, ... Habib G, Marchionni N</i><br /><b>Objective</b><br />The best strategy to manage patients with left-sided infective endocarditis (IE) and intermediate-length vegetations (10-15 mm) remains uncertain. We aimed to evaluate the role of surgery in patients with intermediate-length vegetations and no other European Society of Cardiology guidelines-approved surgical indication.<br /><b>Methods</b><br />We retrospectively enrolled 638 consecutive patients admitted to three academic centres (Amiens, Marseille and Florence University Hospitals) between 2012 and 2022 for left-sided definite IE (native or prosthetic) with intermediate-length vegetations (10-15 mm). We compared four clinical groups: medically (n=50) or surgically (n=345) treated complicated IE, medically (n=194) or surgically (n=49) treated uncomplicated IE.<br /><b>Results</b><br />Mean age was 67±14 years. Women were 182 (28.6%). The rate of embolic events on admission was 40% in medically treated and 61% in surgically treated complicated IE, 31% in medically treated and 26% in surgically treated uncomplicated IE. The analysis of all-cause mortality showed the lowest 5-year survival rate for medically treated complicated IE (53.7%). We found a similar 5-year survival rate for surgically treated complicated IE (71.4%) and medically treated uncomplicated IE (68.4%). The highest 5-year survival rate was observed in surgically treated uncomplicated IE group (82.4%, log-rank p<0.001). The analysis of the propensity score-matched cohort estimated an HR of 0.23 for uncomplicated IE treated surgically compared with medical therapy (p=0.005, 95% CI: 0.079 to 0.656).<br /><b>Conclusions</b><br />Our results suggest that surgery is associated with lower all-cause mortality than medical therapy in patients with uncomplicated left-sided IE with intermediate-length vegetations even in the absence of other guideline-based indications.<br /><br />© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.<br /><br /><small>Heart: 05 May 2023; epub ahead of print</small></div>

<div><h4>Determinants of post-operative left ventricular dysfunction in degenerative mitral regurgitation.</h4><i>Althunayyan AM, Alborikan S, Badiani S, Wong K, ... Lloyd G, Bhattacharyya S</i><br /><b>Aims</b><br />Chronic degenerative mitral regurgitation leads to volume overload causing left ventricular (LV) enlargement and eventually LV impairment. Current guidelines determining thresholds for intervention are based on LV diameters and ejection fraction (LVEF). There are sparse data examining the value of LV volumes and newer markers of LV performance on outcomes of surgery in mitral valve prolapse. The aim of this study is to identify the best marker of LV impairment after mitral valve surgery.<br /><b>Methods and results</b><br />Prospective, observational study of patients with mitral valve prolapse undergoing mitral valve surgery. Pre-operative LV diameters, volumes, LVEF, global longitudinal strain (GLS), and myocardial work measured. Post-operative LV impairment defined as LVEF < 50% at 1 year post-surgery. Eighty-seven patients included. Thirteen percent developed post-operative LV impairment. Patients with post-operative LV dysfunction showed significantly larger indexed LV end-systolic diameters, indexed LV end-systolic volumes (LVESVi), lower LVEF, and more abnormal GLS than patients without post-operative LV dysfunction. In multivariate analysis, LVESVi [odds ratio 1.11 (95% CI 1.01-1.23), P = 0.039] and GLS [odds ratio 1.46 (95% CI 1.00-2.14), P = 0.054] were the only independent predictors of post-operative LV dysfunction. The optimal cut-off of 36.3 mL/m2 for LVESVi had a sensitivity of 82% and specificity of 78% for detection of post-operative LV impairment.<br /><b>Conclusion</b><br />Post-operative LV impairment is common. Indexed LV volumes (36.3 mL/m2) provided the best marker of post-operative LV impairment.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 04 May 2023; epub ahead of print</small></div>

<div><h4>Adjustment of acquisition arc in cardiac malposition during myocardial perfusion SPECT imaging: computer simulation based on deterministic modeling.</h4><i>Qutbi M</i><br /><b>Objectives</b><br />To simulate cardiac malpositions, leftward and rightward shift and dextrocardia, and also to compare distribution of activity of septal and lateral walls of left ventricle acquired in standard acquisition arc and after relevant adjustment.<br /><b>Methods</b><br />In this study, digital phantoms with cardiac malpositions are designed and procedure of acquisition of scan in standard arc (from right anterior oblique to left posterior oblique) and adjusted acquisition arc is simulated. The three situations of malposition including leftward and rightward shift and dextrocardia are considered. For all types, acquisition is conducted in standard and then adjusted arcs (from anterior to posterior and also from right to left for leftward and rightward shifts, respectively, and for dextrocardia, from left anterior oblique to right posterior oblique). All obtained projections are reconstructed using the algorithm of filtered back projection. During forward projection to obtain sinograms, radiation attenuation is also modeled by incorporation of a simplified transmission map to emission map. The resulting tomographic slices of the LV (septum, apex, and lateral wall) are presented visually and are compared by plotting intensity profiles of the walls. Finally, normalized error images are also computed. All the computations are performed in MATLAB software package.<br /><b>Results</b><br />In transverse slice, septum and lateral wall are attenuated progressively from apex, which is closer to the camera, to the base in similar fashion. In tomographic slices of standard acquisition arc, the septum shows remarkably higher activity compared to lateral wall. However, after adjustment, both seems equally intense and progressively being attenuated from apex to base, similar to that found in phantom with normally positioned heart. Likewise, for the phantom with rightward shift, when the scanning was done in standard arc, the septum is more intense than the lateral wall. And similarly, adjustment of the arc renders both walls equally intense. In dextrocardia, level of attenuation of basal parts of septum and lateral wall is higher in 360° arc compared to adjusted 180° arc.<br /><b>Conclusion</b><br />Adjustment of acquisition arc exerts perceptible changes in distribution of activity over LV walls which are more compatible with normally positioned heart.<br /><br />© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.<br /><br /><small>J Nucl Cardiol: 04 May 2023; epub ahead of print</small></div>

<div><h4>Left ventricular adaptation to aortic regurgitation in adults with repaired coarctation of aorta.</h4><i>Egbe AC, Miranda WR, Anderson JH, Pellikka PA, ... Abozied O, Connolly HM</i><br /><b>Background</b><br />Aortic regurgitation (AR) can develop in adults with repaired coarctation of aorta (COA), but there are limited data about left ventricular (LV) remodeling and clinical outcomes in this population. The purpose of the study was to compare LV remodeling (LV mass index [LVMI], LV ejection fraction [LVEF], and septal E/e\') and onset of symptoms before aortic valve replacement, and LV reverse remodeling (%-change in LVMI, LVEF and E/e\') after aortic valve replacement in patients with versus without repaired COA presenting with AR.<br /><b>Methods</b><br />Asymptomatic adults with repaired COA presenting with moderate/severe AR (AR-COA group) were matched 1:2 to asymptomatic adults without COA and similar severity of AR (control group).<br /><b>Results</b><br />Although both groups (AR-COA n = 52, and control n = 104) had similar age, sex, body mass index, aortic valve gradient, and AR severity, the AR-COA group had higher LVMI (124 ± 28 versus 102 ± 25 g/m<sup>2</sup>, p < 0.001) and E/e\' (12.3 ± 2.3 versus 9.5 ± 2.1, p = 0.02) but similar LVEF (63 ± 9% versus 67 ± 10%, p = 0.4). COA diagnosis (adjusted HR 1.95, 95%CI 1.49-2.37, p < 0.001), older age, E/e\', and LV hypertrophy were associated with onset of symptoms. Of 89 patients (AR-COA n = 41, and control n = 48) with echocardiographic data at 1-year post- aortic valve replacement, the AR-COA group had less regression of LVMI (-8% [95%CI -5 to -11] versus -17% [95%CI -15 to -21], p < 0.001) and E/e\' (-5% [95% CI -3 to -7] versus -16% [95% CI -13 to -19], p < 0.001).<br /><b>Conclusions</b><br />Patients with COA and AR had a more aggressive clinical course, and perhaps may require a different threshold for surgical intervention.<br /><br />Copyright © 2023. Published by Elsevier B.V.<br /><br /><small>Int J Cardiol: 04 May 2023; epub ahead of print</small></div>