Topic: Imaging

Abstract

Stabilizing Ryanodine Receptors Improves Left Ventricular Function in Juvenile Dogs With Duchenne Muscular Dystrophy.

Cazorla O, Barthélémy I, Su JB, Meli AC, ... Ghaleh B, Lacampagne A
Background
Duchenne muscular dystrophy is associated with progressive deterioration in left ventricular (LV) function. The golden retriever muscular dystrophy (GRMD) dog model recapitulates the pathology and clinical manifestations of Duchenne muscular dystrophy. Importantly, they develop progressive LV dysfunction starting at early age.
Objectives
The authors tested the cardioprotective effect of chronic administration of the ARM036, a small molecule that stabilizes the closed conformation of the cardiac sarcoplasmic reticulum ryanodine receptor/calcium release channel (RyR2) in young GRMD-dogs.
Methods
Two-month-old GRMD-dogs were treated with ARM036 or placebo for 4 months. Healthy-dogs of the same genetic background served as controls. Cardiac function was evaluated by conventional and 2-dimensional speckle-tracking echocardiography. Cardiac cellular and molecular analyses were performed at 6 months old.
Results
Conventional echocardiography showed normal LV dimensions and ejection fraction in 6-month-old GRMD dogs. Interestingly, 2-dimensional speckle-tracking echocardiography revealed decreased global longitudinal strain and the presence of hypokinetic segments in placebo-treated GRMD dogs. Single-channel measurements revealed higher RyR2 open probability at low resting Ca2+ in GRMD cardiomyocytes than in controls. ARM036 prevented those in vivo and in vitro dysfunctions in GRMD dogs. Myofilament Ca2+-sensitivity was increased in permeabilized GRMD cardiomyocytes at short sarcomere length. ARM036 had no effect on this parameter. Cross-bridge cycling kinetics were altered in GRMD myocytes and recovered with ARM036 treatment, which coincided with the level of myosin binding protein-C-S glutathionylation.
Conclusions
GRMD-dogs exhibit early LV dysfunction associated with altered myofilament contractile properties. These abnormalities were prevented pharmacologically by stabilizing RyR2 with ARM036.

Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

J Am Coll Cardiol: 13 Dec 2021; 78:2439-2453
Cazorla O, Barthélémy I, Su JB, Meli AC, ... Ghaleh B, Lacampagne A
J Am Coll Cardiol: 13 Dec 2021; 78:2439-2453 | PMID: 34886965
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Implantable cardiac defibrillator events in patients with arrhythmogenic right ventricular cardiomyopathy.

Woźniak O, Borowiec K, Konka M, Cicha-Mikołajczyk A, ... Poślednik K, Biernacka EK
Objective
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a risk of sudden cardiac death. Optimal risk stratification is still under debate. The main purpose of this long-term, single-centre observation was to analyse predictors of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) interventions in the population of patients with ARVC with a high risk of life-threatening arrhythmias.
Methods
The study comprised 65 adult patients (median age 40 years, 48 men) with a definite diagnosis of ARVC who received ICD over a time span of 20 years in primary (40%) or secondary (60%) prevention of sudden cardiac death. The study endpoints were first appropriate and inappropriate ICD interventions (shock or antitachycardia pacing) after device implantation.
Results
During a median follow-up of 7.75 years after ICD implantation, nine patients died and six individuals underwent heart transplantation. Appropriate ICD interventions occurred in 43 patients (66.2%) and inappropriate ICD interventions in 18 patients (27.7%). Multivariable analysis using cause-specific hazard model identified three predictors of appropriate ICD interventions: right ventricle dysfunction (cause-specific HR 2.85, 95% CI 1.56 to 5.21, p<0.001), age <40 years at ICD implantation (cause-specific HR 2.37, 95% CI 1.13 to 4.94, p=0.022) and a history of sustained ventricular tachycardia (cause-specific HR 2.55, 95% CI 1.16 to 5.63, p=0.020). Predictors of inappropriate ICD therapy were not found. Complications related to ICD implantation occurred in 12 patients.
Conclusions
Right ventricle dysfunction, age <40 years and a history of sustained ventricular tachycardia were predictors of appropriate ICD interventions in patients with ARVC. The results may be used to improve risk stratification before ICD implantation.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Heart: 30 Dec 2021; 108:22-28
Woźniak O, Borowiec K, Konka M, Cicha-Mikołajczyk A, ... Poślednik K, Biernacka EK
Heart: 30 Dec 2021; 108:22-28 | PMID: 33674353
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Risk of left atrial appendage thrombus and stroke in patients with atrial fibrillation and mitral regurgitation.

Melduni R, Nkomo VT, Wysokinski W, Gersh BJ, ... Oh JK, Lee HC
Objective
To investigate the association of mitral regurgitation (MR) on thromboembolic risk of patients with non-valvular atrial fibrillation (NVAF) undergoing transoesophageal echocardiography (TEE)-guided cardioversion.
Methods
Data for consecutive patients who underwent TEE-guided cardioversion for NVAF between 2000 and 2012 were analysed. MR severity was assessed by Doppler echocardiography and classified as ≤mild, moderate or severe. Left atrial appendage emptying velocities were averaged for five consecutive cycles. Multivariable regression models were used to identify independent predictors of left atrial appendage thrombus (LAAT) and stroke.
Results
2950 patients (age, 69.3±12.2 years, 67% men) were analysed. 2173 (73.7%) had ≤mild MR; 631 (21.4%), moderate MR; and 146 (4.9%), severe MR. Patients with moderate (age, 72.4±10.7 years) and severe (age, 72.8±12.1 years) MR were older than those with ≤mild MR (age, 68.2±12.5 years). The prevalence of LAAT was 1.5% (n=43). CHA2DS2-VASc scores (≤mild MR, 3.0±1.6; moderate MR, 3.5±1.5; severe MR, 3.9±1.5; p<0.001) and heart failure frequency (≤mild MR, 38.4%; moderate MR, 48.0%; severe MR, 69.2%; p<0.001) were increasingly higher with greater MR severity. Multivariable logistic regression analysis showed no association of moderate MR (OR 0.77, 95% CI 0.38 to 1.56) or severe MR (OR 0.55, 95% CI 0.21 to 1.49) with LAAT. During a mean follow-up of 7.3±5.1 years (median 7.5, IQR, 2.7-10.9), 216 patients had an ischaemic stroke. Adjusted Cox regression analysis showed no significant association of moderate MR (HR 1.22, 95% CI 0.88 to 1.68) or severe MR (HR 0.73, 95% CI 0.31 to 1.46) with stroke.
Conclusions
Among patients with NVAF, the presence or severity of MR was not associated with a decreased risk of LAAT or stroke.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Heart: 30 Dec 2021; 108:29-36
Melduni R, Nkomo VT, Wysokinski W, Gersh BJ, ... Oh JK, Lee HC
Heart: 30 Dec 2021; 108:29-36 | PMID: 33766985
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic implications of left atrial dilation in aortic regurgitation due to bicuspid aortic valve.

Butcher SC, Fortuni F, Kong W, Vollema EM, ... Bax JJ, Delgado V
Objective
To investigate the prognostic value of left atrial volume index (LAVI) in patients with moderate to severe aortic regurgitation (AR) and bicuspid aortic valve (BAV).
Methods
554 individuals (45 (IQR 33-57) years, 80% male) with BAV and moderate or severe AR were selected from an international, multicentre registry. The association between LAVI and the combined endpoint of all-cause mortality or aortic valve surgery was investigated with Cox proportional hazard regression analyses.
Results
Dilated LAVI was observed in 181 (32.7%) patients. The mean indexed aortic annulus, sinus of Valsalva, sinotubular junction and ascending aorta diameters were 13.0±2.0 mm/m2, 19.4±3.7 mm/m2, 16.5±3.8 mm/m2 and 20.4±4.5 mm/m2, respectively. After a median follow-up of 23 (4-82) months, 272 patients underwent aortic valve surgery (89%) or died (11%). When compared with patients with normal LAVI (<35 mL/m2), those with a dilated LAVI (≥35 mL/m2) had significantly higher rates of aortic valve surgery or mortality (43% and 60% vs 23% and 36%, at 1 and 5 years of follow-up, respectively, p<0.001). Dilated LAVI was independently associated with reduced event-free survival (HR=1.450, 95% CI 1.085 to 1.938, p=0.012) after adjustment for LV ejection fraction, aortic root diameter, LV end-diastolic diameter and LV end-systolic diameter.
Conclusions
In this large, multicentre registry of patients with BAV and moderate to severe AR, left atrial dilation was independently associated with reduced event-free survival. The role of this parameter for the risk stratification of individuals with significant AR merits further investigation.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Heart: 30 Dec 2021; 108:137-144
Butcher SC, Fortuni F, Kong W, Vollema EM, ... Bax JJ, Delgado V
Heart: 30 Dec 2021; 108:137-144 | PMID: 33833069
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Left ventricular twist predicts mortality in severe aortic stenosis.

Erhart L, Donati T, Anwer S, Schindler M, ... Stähli BE, Tanner FC
Objective
Left ventricular (LV) twist is a major component of ventricular mechanics reflecting the helical orientation of cardiac fibres and compensating for afterload mismatch. However, it is not known whether it determines outcome after transcatheter aortic valve implantation (TAVI). This study sought to investigate TAVI-induced short-term changes of LV twist and to define its role in outcome prediction.
Methods
A total of 146 patients (median age 81.78 years, 50.7% male) undergoing TAVI for severe aortic stenosis were included. LV rotation and twist were determined by speckle tracking echocardiography within 3 months before and 2 weeks after TAVI. All-cause mortality at 2 years was defined as primary end point.
Results
Patients who survived exhibited a higher apical peak systolic rotation (APSR) (p<0.001), twist (p=0.003) and torsion (p=0.019) pre-TAVI compared with those who died (n=22). Within 2 weeks after TAVI, APSR, twist and torsion decreased in patients who survived (all p<0.001), while no change occurred in those who died. Cox regression analysis showed an association of pre-TAVI APSR (HR 0.92, p=0.010), twist (HR 0.93, p=0.018) and torsion (HR 0.68, p=0.040) with all-cause mortality and an even stronger association of the respective changes after TAVI (∆APSR: HR 1.15, p<0.001; ∆twist: HR 1.14, p<0.001; ∆torsion: HR 2.53, p<0.001). All the parameters determined outcome independently of global longitudinal strain (GLS) and LV ejection fraction (LVEF).
Conclusion
APSR, twist and torsion pre-TAVI as well as their change within 2 weeks after TAVI predict 2-year all-cause mortality after TAVI, adding incremental prognostic value to LVEF and GLS.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Heart: 30 Jan 2022; 108:225-232
Erhart L, Donati T, Anwer S, Schindler M, ... Stähli BE, Tanner FC
Heart: 30 Jan 2022; 108:225-232 | PMID: 33972358
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

High Variability of Right Ventricular Volumes and Function in Adults with Severe Pulmonary Regurgitation Late After Tetralogy of Fallot Repair.

Greutmann M, Ruperti J, Schwitz F, Haag N, ... Wustmann K, Tobler D
Our aim was to assess changes of right ventricular end-diastolic volumes (RVEDVi) and right ventricular ejection fraction (RVEF) in asymptomatic adults with repaired tetralogy of Fallot, with native right ventricular outflow tract and severe pulmonary regurgitation by serial cardiac magnetic resonance imaging (CMR). The study included 23 asymptomatic adults who underwent ≥3 CMR studies (total of 88 CMR studies). We compared changes in RVEDVi and RVEF between first and last study (median follow-up: 8.8 years, interquartile range: 6.3 to 13.1 years) and between all study pairs. Variability of measurements between study pairs (65 consecutive and 139 nonconsecutive CMR study pairs) were assessed using Bland-Altman analysis and intraclass correlation coefficients. On average, there were no significant changes of RVEDVi or RVEF over the study period (change in RVEDVi: +0.4 ± 17.8 ml/m2, change in RVEF: -1.0 ± 5.5%). Assessment of variability of measurements between study pairs demonstrated no systematic change in RVEDVi and RVEF between study pairs with limits of agreement within the range of previously published studies (RVEDVi -29.1 to +27.2 ml/m2; RVEF -11.5% to 10.2%). High intraclass correlation coefficients for RVEDVi (0.943, 95% CI 0.906 to 0.965, p <0.001) and RVEF (0.815, 95% CI 0.697 to 0.887, p <0.0001) indicate high reliability of reported measurements. In conclusion, in asymptomatic adults with repaired tetralogy of Fallot with native right ventricular outflow tracts and severe pulmonary regurgitation, CMR measurements of RV volumes and RVEF remain stable during follow-up with variability between CMR studies in individual patients, as expected for interobserver and interstudy variability. Measurements derived from a single CMR study or changes occurring between 2 CMR studies should be used with caution for clinical decision-making.

Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 19 Dec 2021; epub ahead of print
Greutmann M, Ruperti J, Schwitz F, Haag N, ... Wustmann K, Tobler D
Am J Cardiol: 19 Dec 2021; epub ahead of print | PMID: 34949470
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Value of Global Longitudinal Strain for Identification and Monitoring of Left Ventricular Dysfunction in Becker Muscular Dystrophy.

van de Velde NM, Gegenava T, Koeks Z, Butcher SC, ... Ajmone Marsan N, Niks EH
Cardiac involvement is the main cause of death in Becker muscular dystrophy (BMD). Identification of left ventricular (LV) function is crucial, but standard echocardiographic measurements such as LV ejection fraction (LVEF) might not be sensitive enough to detect early myocardial dysfunction. We explored the value of LV global longitudinal strain (GLS) as a more accurate echocardiographic parameter to detect and monitor LV dysfunction in BMD. Furthermore, we studied possible factors associated with LV dysfunction and progression. A total of 40 patients with BMD (age 39.0 ± 13.2 years) and 21 matched controls were included. Clinical variables, pulmonary tests, serum biomarkers, and echocardiograms were collected at baseline and after 2 years. LV systolic function was assessed by LVEF and LV GLS; a significant progression in LV dysfunction was defined as an absolute LV GLS deterioration ≥15%. Responsiveness to cardiac disease progression was determined using standardized response means. Patients showed impaired LVEF and LV GLS compared with controls (p <0.001). Of interest, 31 patients (77.5%) showed impaired LV GLS (defined as greater than -18%), whereas only 24 patients (60%) had reduced LVEF. LV GLS and LVEF correlated with troponin I (ρ = 0.553 and -0.523) and N-terminal pro-b-type natriuretic peptide (ρ = 0.506 and -0.585), but not with skeletal muscle or pulmonary function. At follow-up (2.0 ± 0.5 years, n = 29), LV GLS worsened significantly (-1.3 ± 0.8%, p = 0.002, standardized response mean = 0.70, annually = 0.60%), whereas LVEF remained stable. No risk factors for LV dysfunction progression were identified. In BMD, LV GLS is frequently impaired and shows deterioration over time compared with LVEF. LV GLS could be used as a more sensitive parameter to identify and monitor LV dysfunction.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Am J Cardiol: 31 Dec 2021; 162:170-176
van de Velde NM, Gegenava T, Koeks Z, Butcher SC, ... Ajmone Marsan N, Niks EH
Am J Cardiol: 31 Dec 2021; 162:170-176 | PMID: 34756724
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Relation of Left Atrial Flow, Volume, and Strain to Paroxysmal Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.

Nakao R, Nagao M, Higuchi S, Minami Y, ... Sakai S, Hagiwara N
This study aims to characterize flow, volume, and strain of the left atrium in hypertrophic cardiomyopathy (HC) with atrial fibrillation (AF) using cine cardiovascular magnetic resonance (CMR) imaging. Cine CMR data for 144 patients with HC, including 29 patients with episodes of paroxysmal AF and 13 patients with persistent AF, were retrospectively analyzed. The vortex flow of the left atrial (LA, %) was measured using a vortex flow map and was used as an estimate of flow. The LA end-systolic volume index (ml/m2), LA ejection fraction (%) and global peak longitudinal LA strain (%) derived from a feature-tracking method were used as estimates of volume and strain. Vortex flow of the LA in patients with paroxysmal AF was significantly smaller than in patients without AF (vertical long-axis view; 26.7 ± 10.8% vs 33.2 ± 12.2%, p <0.005). The patients with paroxysmal AF had greater LA end-systolic volume index and global peak longitudinal LA strain and lower LA ejection fraction compared with those without AF. In conclusion, patients with HC with paroxysmal AF are characterized by small vortex flow, large volume, and decreased strain of LA on cine CMR.

Copyright © 2021 Elsevier Inc. All rights reserved.

Am J Cardiol: 16 Dec 2021; epub ahead of print
Nakao R, Nagao M, Higuchi S, Minami Y, ... Sakai S, Hagiwara N
Am J Cardiol: 16 Dec 2021; epub ahead of print | PMID: 34930615
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Myocardial deformation assessed by CMR in children after multisystem inflammatory syndrome (MIS-C).

Krupickova S, Bautista-Rodriguez C, Hatipoglu S, Kang H, ... Pennell DJ, Voges I
Background
Short-term sequelae of Multisystem Inflammatory Syndrome in Children (MIS-C), recently published by our institution, showed rapid improvement of the cardiac abnormalities within a few weeks after the onset of the disease. However, subtle residual abnormalities, affecting mainly the myocardial interstitium, were shown in some of the patients. The current study aimed to assess myocardial deformation with CMR shortly after MIS-C.
Methods
Sixty children were included into the study; 30 following MIS-C (onset-to-scan mean 27 days, SD 11) and 30 controls. Strain values were compared between patients and controls and additionally to published paediatric normal CMR values. U-Mann Whitney test was used for comparison of the myocardial deformation between patients and controls.
Results
Median age of the patients was 9.0 years (range 0.99-14.4) and controls 9.8 years (range 4.7-14.9). All conventional CMR parameters in patients were in normal range. Strain values were significantly lower in patients than in controls. When compared to published centile graphs, radial and circumferential global strain was within 2.5th and 97.5th centile in all patients. Eleven patients had global longitudinal strain between 2.5th centile and 50th centile, 1 patient was below 2.5th centile and all the others above 50th centile. Only 3 controls had global longitudinal strain between 2.5th centile and 50th centile, all other had higher strain.
Conclusions
This study demonstrates that myocardial deformation indices measured by CMR are within normal range in the vast majority of the patients within a few weeks after the onset of MIS-C. However, when compared to healthy controls, all strain parameters were lower in patients.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 31 Dec 2021; 346:105-106
Krupickova S, Bautista-Rodriguez C, Hatipoglu S, Kang H, ... Pennell DJ, Voges I
Int J Cardiol: 31 Dec 2021; 346:105-106 | PMID: 34798209
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic relevance of peri-infarct zone measured by cardiovascular magnetic resonance in patients with ST-segment elevation myocardial infarction.

Jensch PJ, Stiermaier T, Reinstadler SJ, Feistritzer HJ, ... Thiele H, Eitel I
Background
Cardiac magnetic resonance (CMR) imaging provides valuable prognostic information in patients with ST-elevation myocardial infarction (STEMI). The peri-infarct zone (PIZ) is a potential marker for post-infarction risk stratification. The aim of this study was to assess the prognostic impact of PIZ in a large multicenter STEMI-trial.
Methods
The study population consisted of 704 consecutive patients undergoing CMR within 10 days after STEMI to assess established parameters of myocardial injury and additionally the extent of PIZ. The primary clinical endpoint was major adverse cardiac events (MACE) consisting of death, re-infarction and new congestive heart failure within 1 year after infarction.
Results
The median heterogeneous PIZ-volume in the overall population was 14 ml (interquartile range [IQR] 7 to 24 ml). Male sex, infarct size, and left ventricular ejection fraction were identified as independent predictors of larger PIZ alterations. Patients with MACE had a significantly larger PIZ volume compared to patients without adverse events (21 ml [IQR 12 to 35 ml] versus 14 ml [IQR 7 to 23 ml]; p = 0.001). In stepwise multivariable Cox regression analysis, PIZ > median (>14 ml) emerged as an independent predictor of MACE (hazard ratio [HR] 2.84; 95% confidence interval [CI] 1.34 to 6.00; p = 0.006) in addition to the Thrombolysis In Myocardial Infarction (TIMI) risk score (HR 1.53; 95% CI 1.19 to 1.53; p < 0.001). Addition of PIZ to a CMR risk model comprising LVEF, infarct size and microvascular obstruction resulted in net reclassification improvement of 0.46 (0.19-0.73, p < 0.001).
Conclusion
In this currently largest prospective, multicenter CMR study assessing PIZ, the extent of PIZ emerged as an independent predictor of MACE and a potential novel marker for optimized risk stratification in STEMI patients. ClinicalTrials.gov: NCT00712101.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 14 Jan 2022; 347:83-88
Jensch PJ, Stiermaier T, Reinstadler SJ, Feistritzer HJ, ... Thiele H, Eitel I
Int J Cardiol: 14 Jan 2022; 347:83-88 | PMID: 34767896
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Left atrial deformation imaging and atrial fibrillation in patients with rheumatic mitral stenosis.

Stassen J, Butcher SC, Namazi F, Marsan NA, Bax JJ, Delgado V
Background
Atrial fibrillation (AF) is a frequent complication of rheumatic mitral stenosis (MS) and is associated with worse outcomes. Prediction of new-onset AF by assessing left atrial (LA) mechanics with speckle tracking echocardiography might be useful for risk stratification and guiding therapeutic strategies. Therefore, the aim of this study was to assess the association of left atrial reservoir strain (LASr) and strain rate (LASRr) with AF at follow-up in patients with rheumatic MS.
Methods
LASr and LASRr, measured by speckle-tracking echocardiography, were assessed in 125 patients (mean age 50 ±15 years, 80.8% female) with rheumatic MS and without a history of prior AF. Patients were followed-up for the occurrence of a first episode of AF after the index echocardiogram.
Results
During a median follow-up of 32 (9.5 - 70) months, 41 patients (32.8%) developed new-onset AF. Patients who developed AF had significantly more impaired LASr (13.4±5.2% vs 18.9±8.2%, p<0.001) and LASRr (0.72±0.26 s-1 vs 0.98±0.36 s-1, p<0.001) compared to patients who remained in sinus rhythm. On multivariable Cox regression analysis, LASr <21% and LASRr <0.8 s-1 were independently associated with the development of AF at follow-up (hazard ratio [HR] 7.03, 95% confidence interval [CI] 2.08-23.77, p=0.002 and HR 3.42, 95% CI 1.59-7.34, p=0.002, respectively).
Conclusions
LASr and LASRr are impaired in patients with rheumatic MS and the degree of impairment is associated with new-onset AF at follow-up.

Copyright © 2021. Published by Elsevier Inc.

J Am Soc Echocardiogr: 21 Dec 2021; epub ahead of print
Stassen J, Butcher SC, Namazi F, Marsan NA, Bax JJ, Delgado V
J Am Soc Echocardiogr: 21 Dec 2021; epub ahead of print | PMID: 34954048
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Left Ventricular Unloading during Extracorporeal Life Support: Current Practice.

Rali AS, Hall EJ, Dieter R, Ranka S, ... Lindenfeld J, Chatterjee S
Veno-arterial extracorporeal life support (VA-ECLS) is a powerful tool that can provide complete cardiopulmonary support for patients with refractory cardiogenic shock. However, VA-ECLS increases left ventricular afterload resulting in greater myocardial oxygen demand, which can impair myocardial recovery and worsen pulmonary edema. These complications can be ameliorated by various LV venting strategies to unload the LV. Evidence suggests that LV venting improves outcomes in VA-ECLS, but there is a paucity of randomized trials to help guide optimal strategy and the timing of venting. In this review, we discuss the available evidence regarding LV venting in VA-ECLS, explain important hemodynamic principles involved, and propose a practical approach to LV venting in VA-ECLS.

Copyright © 2021. Published by Elsevier Inc.

J Card Fail: 18 Dec 2021; epub ahead of print
Rali AS, Hall EJ, Dieter R, Ranka S, ... Lindenfeld J, Chatterjee S
J Card Fail: 18 Dec 2021; epub ahead of print | PMID: 34936896
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Natural history of left ventricular hypertrophy in infants of diabetic mothers.

Monda E, Verrillo F, Altobelli I, Lioncino M, ... Russo MG, Limongelli G
Background
This study sought to describe the characteristics and the natural course of left ventricular hypertrophy (LVH) in a well-characterized consecutive cohort of infants of diabetic mothers (IDMs).
Methods
Sixty consecutive IDMs with LVH have been retrospectively identified and enrolled in the study. All IDMs were evaluated at baseline and every 6 months until LV wall thickness regression, defined as the decrease of wall thickness measurement into the normal reference range for cardiac parameters (z-score > -2 and < 2). A comprehensive assessment was performed in those patients with diagnostic markers suggestive of a different cause and/or without significant reduction of the LVH during follow-up.
Results
At 1-year follow-up, all IDMs showed a significant reduction of maximal wall thickness MWT (6.00 mm [IQR 5.00-712] vs. 5.50 mm [IQR 5.00-6.00], p-value <0.001; MWT-z-score: 4.86 [IQR 3.93-7.61] vs. 1.72 [IQR 1.08-2.85], p-value <0.001) compared to baseline, and all patients showed LV wall thickness regression or residual mild or moderate LVH (57%, 28%, and 12%, respectively), except 2 patients with persistent severe LVH, that after a comprehensive clinical-genetic assessment were diagnosed as Noonan syndrome with multiple lentigines. At multivariate analysis, MWT was negatively associated with LV wall thickness regression at 1-year follow-up (MWT-mm: OR 0.48[0.29-0.79], p-value = 0.004; MWT-z-score: OR 0.71[0.56-0.90], p-value = 0.004).
Conclusions
LVH in IDMs represents a benign condition with complete regression during the first years of life. In those patients without LV wall thickness regression, combined with clinical markers suggesting a specific disease, a complete work-up is required for a definite diagnosis.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 26 Dec 2021; epub ahead of print
Monda E, Verrillo F, Altobelli I, Lioncino M, ... Russo MG, Limongelli G
Int J Cardiol: 26 Dec 2021; epub ahead of print | PMID: 34968628
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Low voltage zones detected by omnipolar Vmax map accurately identifies the potential atrial substrate and predicts the AF ablation outcome after PV isolation.

Kuo MJ, Lo LW, Lin YJ, Chang SL, ... Kim S, Chen SA
Introduction
The presence of bipolar low-voltage zone (LVZ) is a predictor of AF recurrence after PV isolation (PVI). However, changes of wavefront and bipole directions may cause different electrogram characteristics. We aimed to investigate whether using omnipolar maximum voltage (Vmax) map derived from high density (HD) Grid mapping catheter could assess LVZ and AF ablation outcome accurately.
Methods
Fifty paroxysmal AF patients (27 males, 57.8 ± 9.5 years old) who underwent 3D mapping guided PVI were enrolled. Left atrial voltage mapping during sinus rhythm before ablation was performed. The significant LVZ (<0.5 mV with area > 5 cm2) were defined as sites by omnipolar Vmax, bipolar HD wave map, conventional bipolar electrograms acquired from electrode pairs along to and across to the catheter shaft. The primary end point was the first documented recurrence of any AF during follow-ups.
Results
PVI was performed in all patients, and there were 2 patients (4%) who also received additional non-PV triggers ablation. After a follow-up of 11.4 ± 5.4 months, recurrence of AF occurred in 12 patients (24%). The presence of a significant LVZ was less detected by omnipolar Vmax map, compared to HD wave map (24.0% vs. 58.0%, p = 0.001). LVZ detected by omnipolar Vmax map independently predicted the AF recurrence (odds ratio 16.91; 95% CI, 3.17-90.10; p = 0.001).
Conclusion
LVZ detected by omnipolar Vmax map accurately predicts the AF recurrence following ablation in paroxysmal AF, compared to conventional bipolar and HD wave maps, suggesting the omnipolar Vmax map can precisely define the atrial substrate property.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 22 Dec 2021; epub ahead of print
Kuo MJ, Lo LW, Lin YJ, Chang SL, ... Kim S, Chen SA
Int J Cardiol: 22 Dec 2021; epub ahead of print | PMID: 34954276
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reassessment of vegetation size as a sole indication for surgery in left-sided infective endocarditis.

Cabezón G, López J, Vilacosta I, Sáez C, ... Gómez I, San Román JA
Background
Guidelines recommend surgery in left-sided infective endocarditis (LSIE) associated with large vegetations. Given that most patients who undergo surgery also have other indications (heart failure and/or uncontrolled infection), it is not settled whether surgery should be routinely recommended in patients with large vegetations but no other predictors of poor outcome.
Methods
A total of 726 patients with definitive LSIE were included in our analysis. Mean age was 64.9 years, 61% were male. Multivariate analysis of all patients was performed to determine if vegetation size is related to death in LSIE. Then, patients were divided in two groups according to vegetation size: Group A (>10 mm, n=420) and group B (≤10 mm, n=306). Univariate and multivariate analyses of group A patients were carried out to identify the variables related to death in this group. Impact of surgery on mortality of group A patients without heart failure or uncontrolled local infection (n=139) was assessed.
Results
Age, Staphylococcus aureus, perivalvular complications, heart failure, kidney failure and septic shock, but not vegetation size, were associated with death. Patients with large vegetations showed increased mortality (31.7% in group A vs 24.8% in group B, p=0.045). Group A had more valve rupture and valve regurgitation than group B, but heart failure (55% vs 53%, p=0.678), stroke (22% vs 17.0%, p=0.091), systemic embolism (39% vs 32%, p=0.074), perivalvular complication (28% vs 28%, p=0.865) or septic shock (15% vs 13%, p=0.288) were similar in both groups. In patients from group A without heart failure or uncontrolled infection mortality was similar with and without surgery (n=139; n=70 with surgery, n=69 without surgery; mortality 18.6% vs 11.6% respectively, p=0.251).
Conclusions
large vegetations identify patients with poor outcome in LSIE. However, surgery is not associated with a better prognosis in patients with large vegetations if they do not present with another predictor of poor outcome such as heart failure or uncontrolled infection. These findings challenge whether vegetation size alone should be an indication for surgery in LSIE.

Copyright © 2021. Published by Elsevier Inc.

J Am Soc Echocardiogr: 27 Dec 2021; epub ahead of print
Cabezón G, López J, Vilacosta I, Sáez C, ... Gómez I, San Román JA
J Am Soc Echocardiogr: 27 Dec 2021; epub ahead of print | PMID: 34971762
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

CONTRAST ULTRASOUND ASSESSMENT OF SKELETAL MUSCLE RECRUITABLE PERFUSION AFTER PERMANENT LEFT VENTRICULAR ASSIST DEVICE: IMPLICATIONS FOR FUNCTIONAL RECOVERY.

Soman D, Hodovan J, Macon CJ, Davidson BP, ... Park BS, Lindner JR
Background
In heart failure with reduced ejection fraction (HFrEF), abnormal regulation of skeletal muscle perfusion contributes to reduced exercise tolerance. We hypothesized that improvement in functional status after permanent LVAD in HFrEF patients is related to improvement in muscle perfusion during work, which was measured by contrast-enhanced ultrasound (CEUS).
Methods
CEUS perfusion imaging of calf muscle at rest and during low-intensity plantar flexion exercise (20 watts, 0.2 Hz) was performed in HFrEF patients (n=22) at baseline and 3 months after placement of permanent LVAD. Parametric analysis of CEUS data was used to quantify muscle microvascular blood flow (MBF), blood volume index (MBVi), and flux rate. For subjects alive at 3 months, comparisons were made between those with NYHA class I-II (n=13) versus III-IV (n=7) status after LVAD. Subjects were followed for a median of 5.7 years for mortality.
Results
Echocardiographic data pre-LVAD and post-LVAD, and LVAD parameters were similar in subjects classified as either NYHA class I-II or class III-IV post-LVAD. Skeletal muscle MBF at rest and during exercise before LVAD was also similar between groups. Post-LVAD, resting MBF remained was similar between groups, but during exercise those with NYHA class I-II had greater exercise MBF (111±60 vs 52±38 IU/s, p=0.03), MBF reserve (median [IQR]: 4.45 [3.95-6.80] vs 2.22 [0.98-3.80], p=0.02), and percent change in exercise MBF from pre-LVAD (median [IQR]: 73% [-28-83] vs -45% [-80-26], p=0.03). During exercise, increases in MBF were attributable to faster microvascular flux rate, with little change in MBVi , indicating impaired exercise-mediated microvascular recruitment. The only clinical or echocardiographic feature that correlated with post-LVAD exercise MBF was a history of diabetes mellitus. There was a trend for better survival in those who demonstrated improvement in muscle exercise MBF post-LVAD placement (p=0.05).
Conclusions
CEUS perfusion imaging can quantify peripheral vascular responses to advanced therapies for HFrEF. After LVAD, improvement in functional class is seen in those with improvements in skeletal muscle exercise perfusion and flux rate, implicating a change in vasoactive substances that control resistance arteriolar tone.

Copyright © 2021. Published by Elsevier Inc.

J Am Soc Echocardiogr: 28 Dec 2021; epub ahead of print
Soman D, Hodovan J, Macon CJ, Davidson BP, ... Park BS, Lindner JR
J Am Soc Echocardiogr: 28 Dec 2021; epub ahead of print | PMID: 34973393
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Variations in Mitral Valve Leaflet and Scallop Anatomy on Three-Dimensional Transesophageal Echocardiography.

Sweeney J, Dutta T, Sharma M, Kabra N, ... Lansman SL, Spevack DM
Background
Textbook depictions of the mitral valve (MV) often illustrate it as composed of a single nonscalloped anterior leaflet, with the posterior leaflet having three symmetric and evenly spaced scallops. However, common variations in this anatomy have been noted in autopsy series for decades. Improved cardiac imaging with three-dimensional transesophageal echocardiography (TEE) now affords the ability to detect variations in scallop anatomy in vivo. The aims of this study were to catalog variations in mitral anatomy and to examine for association with mitral regurgitation in patients referred for clinical three-dimensional TEE.
Methods
Three-dimensional transesophageal echocardiographic images of the MV from 107 subjects were reviewed for MV variations. Three-dimensional analysis software was used to characterize mitral leaflet anatomy and assess the relative sizes of posterior leaflet scallops.
Results
Variations from the classic MV configuration were seen in 58.9%. Symmetric variations in the posterior leaflet (dominant P2 scallop, accessory P2 scallop, absent P2 scallop, and dichotomous P2 scallop) were seen in 33.6% of the study group. Asymmetric variants in the posterior leaflet (fused P1 and P2, fused P2 and P3, commissural scallop, accessory scallops, dichotomous P1 or P3, and dominant P2 or P3) were seen in 24.3%. Indentations or folds in the anterior leaflet were noted in 5.6%. Leaflet variations were not associated with patient demographics, indication for TEE, mitral regurgitation, mitral annular dimensions, or Carpentier class.
Conclusions
Mitral leaflet morphologic variants were well characterized using three-dimensional TEE. Variants are common and were present with a frequency consistent with autopsy series. Mitral scallop variations were not associated with mitral regurgitation.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 30 Dec 2021; 35:77-85
Sweeney J, Dutta T, Sharma M, Kabra N, ... Lansman SL, Spevack DM
J Am Soc Echocardiogr: 30 Dec 2021; 35:77-85 | PMID: 34311062
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular magnetic resonance-based predictors of complete left ventricular systolic functional recovery after rhythm restoration in patients with atrial tachyarrhythmia.

Stegmann C, Jahnke C, Lindemann F, Oebel S, ... Hindricks G, Paetsch I
Aims
To establish a cardiovascular magnetic resonance (CMR)-based prediction model for complete systolic left ventricular ejection fraction (LVEF) recovery for the distinction of \'arrhythmia-induced\' from \'arrhythmia-mediated\' cardiomyopathy in patients with atrial tachyarrhythmias.
Methods and results
Two hundred and fifty-three tachyarrhythmia patients referred for catheter ablation were enrolled and underwent CMR baseline imaging; patients with a reduced LVEF <50% at baseline and CMR imaging at 3-month follow-up after successful rhythm restoration constituted the final study population (n = 134). CMR at baseline consisted of standard functional cine imaging, determination of extracellular volume, and late gadolinium enhancement (LGE) imaging; follow-up CMR comprised standard functional cine imaging. Left ventricular end-diastolic volume index (LVEDVI) measurements were categorized in \'opposite\', \'normal\', and \'enlarged\'. At follow-up, 80% (107/134) presented with complete LVEF recovery, while in 20% (27/134) persistent LVEF impairment was observed. LVEDVI and LGE were independent predictors of complete LVEF recovery with LGE adding significant incremental value on logistic regression modelling. Model-derived probabilities for complete LVEF recovery in LVEDVI categories of opposite, normal, and enlarged for LGE negativity and positivity were 94%, 85%, and 29% and 77%, 55%, and 8%, respectively.
Conclusion
CMR-derived assessment of LVEDVI category and LGE allowed for identification of arrhythmia-induced cardiomyopathy with acceptable discriminative performance. Probabilities for complete LVEF recovery for the combination of opposite LVEDVI/LGE negativity and enlarged LVEDVI/LGE positivity were 94% and 8%, respectively. The CMR-based prediction model of complete LVEF recovery can be used to perform upfront stratification in atrial tachyarrhythmia-related LVEF impairment.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]

Europace: 03 Jan 2022; 24:12-19
Stegmann C, Jahnke C, Lindemann F, Oebel S, ... Hindricks G, Paetsch I
Europace: 03 Jan 2022; 24:12-19 | PMID: 34279613
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Feasibility and Accuracy of Automated Three-Dimensional Echocardiographic Analysis of Left Atrial Appendage for Transcatheter Closure.

Morais P, Fan Y, Queirós S, D\'hooge J, Lee AP, Vilaça JL
Background
Procedural success of transcatheter left atrial appendage closure (LAAC) is dependent on correct device selection. Three-dimensional (3D) transesophageal echocardiography (TEE) is more accurate than the two-dimensional modality for evaluation of the complex anatomy of the left atrial appendage (LAA). However, 3D transesophageal echocardiographic analysis of the LAA is challenging and highly expertise dependent. The aim of this study was to evaluate the feasibility and accuracy of a novel software tool for automated 3D analysis of the LAA using 3D transesophageal echocardiographic data.
Methods
Intraprocedural 3D transesophageal echocardiographic data from 158 patients who underwent LAAC were retrospectively analyzed using a novel automated LAA analysis software tool. On the basis of the 3D transesophageal echocardiographic data, the software semiautomatically segmented the 3D LAA structure, determined the device landing zone, and generated measurements of the landing zone dimensions and LAA length, allowing manual editing if necessary. The accuracy of LAA preimplantation anatomic measurement reproducibility and time for analysis of the automated software were compared against expert manual 3D analysis. The software feasibility to predict the optimal device size was directly compared with implanted models.
Results
Automated 3D analysis of the LAA on 3D TEE was feasible in all patients. There was excellent agreement between automated and manual measurements of landing zone maximal diameter (bias, -0.32; limits of agreement, -3.56 to 2.92), area-derived mean diameter (bias, -0.24; limits of agreement, -3.12 to 2.64), and LAA depth (bias, 0.02; limits of agreement, -3.14 to 3.18). Automated 3D analysis, with manual editing if necessary, accurately identified the implanted device size in 90.5% of patients, outperforming two-dimensional TEE (68.9%; P < .01). The automated software showed results competitive against the manual analysis of 3D TEE, with higher intra- and interobserver reproducibility, and allowed quicker analysis (101.9 ± 9.3 vs 183.5 ± 42.7 sec, P < .001) compared with manual analysis.
Conclusions
Automated LAA analysis on the basis of 3D TEE is feasible and allows accurate, reproducible, and rapid device sizing decision for LAAC.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 30 Dec 2021; 35:124-133
Morais P, Fan Y, Queirós S, D'hooge J, Lee AP, Vilaça JL
J Am Soc Echocardiogr: 30 Dec 2021; 35:124-133 | PMID: 34508840
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Doppler Mean Gradient Is Discordant to Aortic Valve Calcium Scores in Patients with Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement.

Alkurashi AK, Pislaru SV, Thaden JJ, Collins JD, ... Oh JK, Nkomo VT
Background
Doppler mean gradient (MG) may underestimate aortic stenosis (AS) severity when obtained during atrial fibrillation (AF) because of lower forward flow compared with sinus rhythm (SR). Whether AS is more advanced at the time of referral for aortic valve intervention in AF compared with SR is unknown. The aim of this study was to examine flow-independent computed tomographic aortic valve calcium scores (AVCS) and their concordance to MG in AF versus SR in patients undergoing transcatheter aortic valve replacement (TAVR).
Methods
Patients who underwent TAVR from 2016 to 2020 for native valve severe AS with left ventricular ejection fraction ≥ 50% were identified from an institutional TAVR database. MGs during AF and SR in high-gradient AS (HGAS) and low-gradient AS (LGAS) were compared with AVCS (AVCS/MG ratio). AVCS were obtained within 90 days of pre-TAVR echocardiography.
Results
Six hundred thirty-three patients were included; median age was 82 years (interquartile range [IQR], 76-86 years), and 46% were women. AF was present in 109 (17%) and SR in 524 (83%) patients during echocardiography. Aortic valve area index was slightly smaller in AF versus SR (0.43 cm2/m2 [IQR, 0.39-0.47 cm2/m2] vs 0.46 cm2/m2 [IQR, 0.41-0.51 cm2/m2], P = .0003). Stroke volume index, transaortic flow rate, and MG were lower in AF (P < .0001 for all). AVCS were higher in men with AF compared with SR (3,510 Agatston units [AU] [IQR, 2,803-4,030 AU] vs 2,722 AU [IQR, 2,180-3,467 AU], P < .0001) in HGAS but not in LGAS. AVCS were not different in women with AF versus SR. Overall AVCS/MG ratios were higher in AF versus SR in HGAS and LGAS (P < .03 for all), except in women with LGAS.
Conclusions
AVCS were higher than expected by MG in AF compared with SR. The very high AVCS in men with AF and HGAS at the time of TAVR suggests late diagnosis of severe AS because of underestimated AS severity during progressive AS and/or late referral to TAVR. Additional studies are needed to examine the extent to which echocardiography may be underestimating AS severity in AF.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 30 Dec 2021; 35:116-123
Alkurashi AK, Pislaru SV, Thaden JJ, Collins JD, ... Oh JK, Nkomo VT
J Am Soc Echocardiogr: 30 Dec 2021; 35:116-123 | PMID: 34506919
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Left atrial strain improves echocardiographic classification of diastolic function in patients with metabolic syndrome and overweight-obesity.

Alonso Gómez AM, Sierra LT, Mora NM, Toledo E, ... Schröder H, Salas-Salvadó J
Background
Current recommendations for echocardiographic assessment of diastolic function (2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) in patients with metabolic syndrome and overweight/obesity result in a significant number of patients with indeterminate diastolic dysfunction (LVDD). The aim of this article is to study whether the use of the left atrial strain criterion (LALS) reduces the number of indeterminate patients.
Methods
229 patients were studied with a complete echocardiographic study that included left ventricular longitudinal strain (LVLS) analysis, LALS and a maximal ergospirometry test with assessment of oxygen uptake (VO2max).
Results
The mean age was 65 ± 5 years, 153 (67%) males, with a mean EF of 60 ± 5%. The mean LVLS was -19.4 ± 2% and the LALS Reservoir was 23.8 ± 7%. There were 140 patients who did not meet LVDD criteria and 82 who did meet the indeterminate LVDD criterion. When the left atrial volume index (LAVI) >34 ml/m2 criterion was replaced in the 2016 ASE/EACVI algorithm by LALS Reservoir ≤20%, the number of indeterminate patients was reduced from 36% to 23% (p < 0.001) at the expense of increasing normal studies (61% and 74%). Adding the LALS Reservoir criterion ≤23% in the 82 patients of the indeterminate group resulted in two groups with a different VO2max (11.6 ± 3 and 18 ± 5 ml/kg/min, p:0.081).
Conclusions
This study confirms the low prevalence of diastolic dysfunction in overweight/obese patients with metabolic syndrome. Adding left atrial strain criterion to the current recommendations significantly reduces the number of indeterminate patients by reclassifying them as normal.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 31 Jan 2022; 348:169-174
Alonso Gómez AM, Sierra LT, Mora NM, Toledo E, ... Schröder H, Salas-Salvadó J
Int J Cardiol: 31 Jan 2022; 348:169-174 | PMID: 34890763
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Echocardiographic Variables Associated with Transvalvular Gradient After a Transcatheter Edge-To-Edge Mitral Valve Repair.

Hadjadj S, Freitas-Ferraz AB, Paquin A, Rouleau Z, ... Paradis JM, Beaudoin J
Background
Transcatheter edge-to-edge mitral valve repair may lead to a reduction in mitral valve area (MVA) and elevated mean transmitral gradient (TMG). The objectives of this study were to assess the value of baseline MVA by different imaging methods and to explore the associations between MVA indexed to body surface area or left ventricular forward stroke volume and postprocedural TMG.
Methods
Preprocedural echocardiographic images from 76 consecutive patients were retrospectively reviewed. MVA planimetry from two-dimensional (2D) transthoracic echocardiography (MVATTE), 2D transesophageal echocardiography in the transgastric view (MVA2D TEE), and three-dimensional (3D) transesophageal echocardiography (MVA3D) were measured. Postprocedural TMGs were assessed at 1 to 3 months and all-cause mortality at 1 year.
Results
Postprocedural mean TMG > 5 mm Hg was associated with a 3.42-fold (95% confidence interval [CI], 1.08-10.87; P = .04) increased risk for 1-year all-cause mortality. Patients with postprocedural TMG > 5 mm Hg (25% [19 of 76]) had significantly smaller preprocedural MVA3D (3.9 ± 0.8 vs 5.2 ± 1.3 cm2, P < .01) and MVATTE (4.9 ± 1.1 vs 5.8 ± 1.5 cm2, P = .01) compared with patients without elevated TMG. No significant difference was found for MVA2D TEE (P = .20). The best threshold values for MVA3D and MVATTE to be associated with postprocedural TMG > 5 mm Hg were, respectively, 3.9 cm2 (area under the curve [AUC] = 0.80; 95% CI, 0.66-0.94; sensitivity 62%, specificity 87%) and 4.6 cm2 (AUC = 0.68; 95% CI, 0.54-0.82; sensitivity 53%, specificity 80%). MVA3D indexed to body surface area and to stroke volume showed overall the best associations with postprocedural mean TMG > 5 mm Hg, with optimal thresholds, respectively, of 2.5 cm2/m2 (AUC = 0.88; 95% CI, 0.77-0.98; sensitivity 92%, specificity 74%) and 95 cm2/L (AUC = 0.87; 95% CI, 0.77-0.97; sensitivity 85%, specificity 82%).
Conclusions
Elevated TMG following transcatheter edge-to-edge mitral valve repair was associated with increased mortality. The present results indicate that MVA3D, MVA3D indexed to body surface area, and MVA3D indexed to stroke volume may be considered potential predictors of postprocedural TMG > 5 mm Hg and could help optimize patient selection, while the use of 2D methods for valve area were poorly associated with TMG.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 30 Dec 2021; 35:86-95
Hadjadj S, Freitas-Ferraz AB, Paquin A, Rouleau Z, ... Paradis JM, Beaudoin J
J Am Soc Echocardiogr: 30 Dec 2021; 35:86-95 | PMID: 34653599
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The V-LAP System for Remote Left Atrial Pressure Monitoring of Patients with Heart Failure: Remote Left Atrial Pressure Monitoring.

Perl L, Meerkin D, D\'Amario D, Avraham BB, ... Crea F, VECTOR-HF Trial Investigators
Objective
Patients with heart failure (HF) are at an increased risk of hospital admissions. The aim of this report is to describe the feasibility, safety and accuracy of a novel wireless left atrial pressure (LAP) monitoring system in HF patients.
Methods
The V-LAP Left Atrium Monitoring systEm for Patients With Chronic sysTOlic & Diastolic Congestive heart Failure (VECTOR-HF) study is a prospective, multicenter, single-arm, open-label, first-in human clinical trial to assess the safety, performance and usability of the V-LAP system (Vectorious Medical Technologies, Ltd) in NYHA Class III HF patients. The device was implanted in the inter-atrial septum via a percutaneous, trans-septal approach, guided by fluoroscopy and echocardiography. Primary endpoints included the successful deployment of the implant, ability to perform initial pressure measurements and safety outcomes.
Results
To date, 24 patients were implanted with the LAP monitoring device. No device-related complications have occurred. LAP was reported accurately, agreeing well with wedge pressure at 3 months (Lin\'s CCC=0.850). After 6 months, NYHA class improved in 40% of the patients (95% CI =16.4%-63.5%), while 6-minute walk test distance had not changed significantly (313.9 ± 144.9 vs. 232.5 ± 129.9 meters, p=0.076).
Conclusion
The V-LAP left atrium monitoring system appears to be safe and accurate.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 14 Jan 2022; epub ahead of print
Perl L, Meerkin D, D'Amario D, Avraham BB, ... Crea F, VECTOR-HF Trial Investigators
J Card Fail: 14 Jan 2022; epub ahead of print | PMID: 35041933
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Normal Values of Left Ventricular Size and Function on Three-Dimensional Echocardiography: Results of the World Alliance Societies of Echocardiography Study.

Addetia K, Miyoshi T, Amuthan V, Citro R, ... Lang RM, WASE Investigators
Background
Echocardiography remains the most widely used modality to assess left ventricular (LV) chamber size and function. Currently this assessment is most frequently performed using two-dimensional (2D) echocardiography. However, three-dimensional (3D) echocardiography has been shown to be more accurate and reproducible than 2D echocardiography. Current normative reference values for 3D LV analysis are based predominantly on data from North America and Europe. The World Alliance Societies of Echocardiography study was designed to sample normal subjects from around the world to provide more universal global reference ranges. The aim of this study was to assess the worldwide feasibility of LV 3D echocardiography and report on size and functional measurements.
Methods
A total of 2,262 healthy subjects were prospectively enrolled from 19 centers in 15 countries. Three-dimensional LV full-volume data sets were obtained and analyzed offline using vendor-neutral software. Measurements included LV end-diastolic and end-systolic volumes, LV ejection fraction (LVEF), global longitudinal strain (GLS), and global circumferential strain. Results were categorized by age (18-40, 41-65, and >65 years), sex, and race.
Results
A total of 1,589 subjects (feasibility 70%) had adequate LV data sets for analysis. Mean normal values for indexed end-diastolic volume, end-systolic volume, and LVEF in men and women were 70 ± 15 and 65 ± 12 mL/m2, 28 ± 7 and 25 ± 6 mL/m2, and 60 ± 5% and 62 ± 5%, respectively. Men had larger LV volumes and lower LVEFs than women. GLS and global circumferential strain were higher in magnitude in women. In both sexes, LV volumes were lower and LVEF tended to be higher with increasing age, especially considering the differences between the youngest and oldest age groups. Although GLS was similar across age groups in men, in women, the youngest and middle-age cohorts revealed higher magnitudes of GLS compared with the oldest age group. Global circumferential strain was higher in magnitude at older age in both men and women. Finally, Asians had smaller chamber sizes and higher LVEFs and absolute strain values than both blacks and whites.
Conclusions
Age, sex, and race should be considered when defining normal reference values for LV dimension and functional parameters obtained by 3D echocardiography.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 13 Dec 2021; epub ahead of print
Addetia K, Miyoshi T, Amuthan V, Citro R, ... Lang RM, WASE Investigators
J Am Soc Echocardiogr: 13 Dec 2021; epub ahead of print | PMID: 34920112
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Left Ventricular Hemodynamics and Relationship With Myocardial Recovery and Optimization in Patients Supported on CF-LVAD Therapy.

Rosenbaum AN, Geske JB, Stulak JM, Kushwaha SS, Clavell AL, Behfar A
Background
Despite interest in left ventricular (LV) recovery, there is an absence of data on the relationship between intrinsic LV hemodynamics and both reverse remodeling on a continuous flow LV assist device (CF-LVAD) therapy. We hypothesized that the markers of intrinsic LV function would be associated with remodeling, optimization, and outcomes.
Methods and results
Patients with continuous flow LVADs between 2015 and 2019 who underwent combined left and right heart catheterization ramp protocol at a single institution were enrolled. Patients were stratified by response to continuous flow LV assist device therapy: full responders, partial responders, or nonresponders per the Utah-Inova criteria. Hemodynamic data, including LV hemodynamics of peak LV dP/dt and tau (τ) were obtained at each phase. The 1-year heart failure hospitalization-free survival was the primary end point. Among 61 patients included in the current study 38 (62%) were classified as nonresponders, 14 as partial responders (23%), and 9 as full responders (15%). The baseline LV dP/dt and τ varied by response status (P ≤ .02) and generally correlated with reverse remodeling on linear regression. Biventricular filling pressures varied with τ and there was an interaction effect of speed on the relationship between τ and pulmonary capillary wedge pressure (P = .04). Last, τ was a prognostic marker and associated with 1-year HF hospital-free survival (odds ratio 1.04, 95% confidence interval 1.00-1.07, P = .02 per millisecond increase).
Conclusions
Significant correlations between τ and LV dP/dt and reverse remodeling were noted, with τ serving as a prognostic marker. A higher LVAD speed was associated with a greater reliance on LVAD for unloading. Future work should focus on defining the optimal level of LVAD support in relation to LV recovery.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 16 Dec 2021; epub ahead of print
Rosenbaum AN, Geske JB, Stulak JM, Kushwaha SS, Clavell AL, Behfar A
J Card Fail: 16 Dec 2021; epub ahead of print | PMID: 34929296
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The Association of Moderate Aortic Stenosis with Poor Survival Is Modified by Age and Left Ventricular Function: Insights from SHEBAHEART Big Data.

Itelman E, Vatury O, Kuperstein R, Ben-Zekry S, ... Guetta V, Maor E
Background
Data on the independent association of moderate aortic stenosis (AS) with excess mortality, even when it does not progress to severe AS, are limited. The aims of this study were to evaluate the association of moderate AS with poor survival and to identify clinically important modifiers of that association.
Methods
Consecutive patients who underwent echocardiographic evaluation between 2007 and 2019 were included. All-cause mortality and cancer data were available for all patients from national registries. Cox regression survival models were applied, with censoring of patients who developed metastatic cancer, developed more than moderate AS, or underwent aortic valve intervention during follow-up.
Results
The study population included 92,622 patients. There were 2,202 patients (2%) with moderate AS, with a median age of 79 years (interquartile range, 70-85 years), of whom 1,254 (57%) were men. During median follow-up of 5 years (interquartile range, 3-8 years), 19,712 patients (21%) died. The cumulative probability of death at 5 years was higher for patients with moderate AS (46% vs 18%, respectively, log-rank P < .001). Propensity score matching analysis (n = 2,896) that included clinical, laboratory, and echocardiographic predictors of poor survival demonstrated that compared with patients with mild or less AS, those with moderate AS were 17% more likely to die (95% CI, 1.04-1.30; P = .007). Moreover, the model showed that the moderate AS-associated risk was ejection fraction and age dependent, with a more pronounced association among nonoctogenarian patients (P for interaction = .001) and those with reduced ejection fractions (P for interaction = .016).
Conclusions
Moderate AS is independently associated with excess mortality, even when it does not progress to severe AS. The associated risk is more pronounced among patients with reduced ejection fractions and those <80 years of age.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 13 Dec 2021; epub ahead of print
Itelman E, Vatury O, Kuperstein R, Ben-Zekry S, ... Guetta V, Maor E
J Am Soc Echocardiogr: 13 Dec 2021; epub ahead of print | PMID: 34915134
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Aortic Root Anatomy Is Related to the Bicuspid Aortic Valve Phenotype.

Milleron O, Masi P, Eliahou L, Paul JF, ... Ou P, Jondeau G
Background
Bicuspid aortic valve (BAV) is associated with an asymmetric (not circular) aortic root, resulting in variability in the aortic root diameter measurements obtained using different techniques. The objective of this study was to describe aortic root asymmetry, including its orientation in the thorax, in relation to the various phenotypes of BAV and its impact on aortic root diameter measurements obtained using transthoracic echocardiography.
Methods
Aortic root asymmetry, orientation of the largest root diameter, and orientation of the valve opening were studied using computed tomographic scans of patients with BAV without significant aortic valve dysfunction referred for evaluation of a thoracic aortic aneurysm. Eighty-five patients with BAV were evaluated; BAV with fusion of the left and the right coronary cusps (L-R BAV), with or without raphe (n = 63), was compared with BAV with fusion of the right coronary and noncoronary cusps (N-R BAV), with or without raphe (n = 22).
Results
Asymmetry of the aortic root and its orientation in the thorax can be predicted from BAV phenotype: orientation of the valve opening differed from orientation of the largest root diameter by nearly 75° in both groups. The angle of the largest root diameter with the reference sagittal plane was 64.3° in the L-R BAV group versus 143.1° in the N-R BAV group (P < .0001). Therefore, using the parasternal long-axis view on transthoracic echocardiography, in N-R BAV, the ultrasound beam is roughly parallel to the valve opening orientation and almost orthogonal to the maximum diameter of the root. On the contrary, in L-R BAV, the ultrasound beam is roughly perpendicular to the valve opening orientation and almost parallel to the maximum diameter of the root. Consequently, the parasternal long-axis view on transthoracic echocardiography significantly underestimates maximal aortic root diameter in N-R BAV and modestly underestimates root diameter in L-R BAV (-6.1 ± 0.96 vs -2.3 ± 0.47 mm, P = .0008).
Conclusions
Aortic root morphology in patients with BAV can be predicted by BAV phenotype: the largest root diameter is roughly perpendicular to the orientation of the valve opening. Therefore, echocardiographic measurements according to present recommendations (parasternal long-axis view) underestimate maximal diameter in patients with N-R BAV.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 30 Nov 2021; epub ahead of print
Milleron O, Masi P, Eliahou L, Paul JF, ... Ou P, Jondeau G
J Am Soc Echocardiogr: 30 Nov 2021; epub ahead of print | PMID: 34861352
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Transcatheter edge-to-edge mitral valve repair in atrial functional mitral regurgitation: insights from the multi-center MITRA-TUNE registry.

Popolo Rubbio A, Testa L, Grasso C, Sisinni A, ... Tamburino C, Bedogni F
Background
A-FMR is considered a specific sub-type of secondary MR in patients with atrial fibrillation (AF) and preserved left ventricle ejection fraction (LVEF). Aim of the study was to investigate the acute and mid-term outcomes of transcatheter edge-to-edge mitral valve repair (TMVr) with the MitraClip in atrial functional mitral regurgitation (A-FMR).
Methods
The study included patients with A-FMR and concomitant AF who underwent to the MitraClip at 7 Italian Centers. Aim of the study was to assess the safety, efficacy and mid-term cardiovascular outcomes.
Results
After reviewing 1153 patients with FMR treated with TMVr from 2009 to 2021, 87 patients (median age 81 years, 61% female) with A-FMR were identified. Technical success was achieved in 97%, 30-day device success in 83% and 30-day procedural success in 80%. All-cause death at 30-day was 5%. Estimated two-year freedom from all-cause death and cardiac death was 60% and 77%, respectively, whereas freedom from all-cause death/heart failure hospitalization was 55%. Residual MR ≤ 2+ was encountered in 89% (n = 47/53) and improvement in NYHA class I/II in 79% (n = 48/61). Post-procedural MR ≥ 2+ (HR 5.400, CI 1.371-21.268) and inter-commissural annular diameter ≥ 35 mm (HR 4.159, CI 1.057-16.363) were independent predictors of all-cause death/heart failure hospitalization during the follow-up. Positive reverse remodeling of left atrium and mitral annular dimensions occurred after TMVr during the follow-up.
Conclusions
MitraClip resulted to be a safe and effective option to treat A-FMR in elderly patients.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 14 Feb 2022; 349:39-45
Popolo Rubbio A, Testa L, Grasso C, Sisinni A, ... Tamburino C, Bedogni F
Int J Cardiol: 14 Feb 2022; 349:39-45 | PMID: 34826500
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Normal Ranges of Global Left Ventricular Myocardial Work Indices in Adults: A Meta-Analysis.

Truong VT, Vo HQ, Ngo TNM, Mazur J, ... Nagueh SF, Chung ES
Background
Recent studies have demonstrated left ventricular myocardial work (MW) is incremental in diagnosis and prognostication when compared to left ventricular ejection fraction and myocardial strain. We performed a meta-analysis of normal ranges of non-invasive MW indices including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) and to determine confounder that may contribute to variance in reported values.
Methods
Four databases including Pubmed, Scopus, Embase, and Cochrane Library were searched through January 2021 using the key terms \"myocardial work\", \"global constructive work\", \"global wasted work\", \"global work index\", \"global work efficiency\". Studies were included if the articles reported LV myocardial work using 2D transthoracic echocardiography in healthy normal subjects, either in control group or comprising of the entire study cohort. The weighted mean was estimated by using the random effect model with a 95% confidence interval. Heterogeneity across included studies was assessed using the I2 test. Funnel plot and Egger\'s regression test were used to assess potential publication bias
Results:
The search yielded 476 articles. After abstract and full-text screening, we included 13 datasets with 1665 patients for the meta-analysis. The reported normal mean values of GWI and GCW among the studies were 2010 mmHg% (95% CI, 1907 to 2113), and 2278 mmHg% (95% CI, 2186 to 2369) respectively. The mean GWW was 80 mmHg% (95% CI, 73 to 87), and the mean GWE was 96.0% (95% CI, 96% to 96%). Furthermore, gender significantly contributed to variations in normal values of GWI, GWW, and GWE. No evidence of significant publication bias was observed.
Conclusion
In this meta-analysis, we provide echocardiographic reference ranges for non-invasive indices of MW. These normal values could be served as a reference for clinical and research use.

Copyright © 2021. Published by Elsevier Inc.

J Am Soc Echocardiogr: 16 Nov 2021; epub ahead of print
Truong VT, Vo HQ, Ngo TNM, Mazur J, ... Nagueh SF, Chung ES
J Am Soc Echocardiogr: 16 Nov 2021; epub ahead of print | PMID: 34800670
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Comparison between Nondedicated and Novel Dedicated Tracking Tool for Right Ventricular and Left Atrial Strain.

Mirea O, Duchenne J, Voigt JU
Background
Recently, dedicated speckle-tracking solutions for right ventricular (RV) and left atrial (LA) strain assessment have become commercially available. The purpose of this study was to assess the level of agreement between nondedicated (left ventricular [LV] tracking software) and novel dedicated tracking software for RV and LA strain.
Methods
In 200 patients with various cardiovascular pathologies, we measured global longitudinal strain (GLS), free wall strain (FWS), and segmental values, as well as LA strain during reservoir, conduit, and contraction phases, by using the (1) LV-tracking software and (2) the novel dedicated tracking software for RV or LA strain analysis. Agreement between corresponding measurements obtained with the LV and dedicated RV or LA software was determined by using mean absolute difference (MAD) and Bland-Altman test. The intra- and interobserver reproducibility related to the nondedicated and novel dedicated tracking software was tested in 30 randomly selected subjects.
Results
The dedicated RV-tracking software provided slightly lower strain values without reaching statistical significance. The agreement between software was best for RV GLS (MAD, 2.4 ± 1.8) and significantly poorer for segmental values (MAD ranging from 4.5 ± 3.8 to 5.1 ± 4.0; analysis of variance, P < .05). The intra- and interobserver reproducibility for RV measurements was similar with both software (P > .05 for all parameters). Left atrial mean values showed no statistical difference when obtained with the two tracking tools. The use of LA dedicated tracking software increased significantly the intra- and interobserver reproducibility for LA strain during reservoir and atrial contraction (P < .01 for both).
Conclusions
Our results suggest that the choice of tracking software does not significantly impact RV strain measurements. Nonetheless, the use of the same tracking software is recommended when performing serial measurements. The use of the dedicated software for LA strain analysis significantly improved the intra- and interobserver reproducibility.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 16 Nov 2021; epub ahead of print
Mirea O, Duchenne J, Voigt JU
J Am Soc Echocardiogr: 16 Nov 2021; epub ahead of print | PMID: 34800672
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association of Three-Dimensional Mesh-Derived Right Ventricular Strain with Short-Term Outcomes in Patients Undergoing Cardiac Surgery.

Keller M, Heller T, Duerr MM, Schlensak C, ... Rosenberger P, Magunia H
Background
Three-dimensional (3D) right ventricular (RV) strain analysis is not routinely performed perioperatively. Although 3D RV strain adds incrementally to outcome prediction in various cardiac diseases, its role in the perioperative setting is not sufficiently understood. The aim of this study was to investigate the association between 3D RV strain measured on RV meshes created from 3D transesophageal echocardiographic data and short-term outcomes among patients undergoing cardiac surgery.
Methods
A total of 496 patients undergoing cardiac surgery who underwent intraoperative 3D transesophageal echocardiography (under general anesthesia, before sternotomy) were retrospectively selected, and RV meshes were generated using commercially available speckle-tracking software. Custom-made software automatically quantified longitudinal and circumferential RV strains on the mesh surfaces. Echocardiographic and clinical parameters were entered into logistic regression models to determine their associations with the primary (in-hospital death or need for extracorporeal life support) and secondary (postoperative ventilation > 48 hours) end points.
Results
Mesh-derived RV strain analysis was feasible in 94% of patients and revealed distinct regional patterns with basal-apical gradients for both longitudinal and circumferential strain. Thirty-seven patients (7.6%) reached the primary end point, and 118 patients (23.8%) reached the secondary end point. In a multivariable logistic regression model, serum lactate (P < .01), an emergency indication for surgery (P < .01), tricuspid regurgitation (P < .001), and mesh-derived RV global longitudinal strain (RV-GLS; P < .01) were independently associated with the primary end point, while established measures of RV function (3D RV ejection fraction, fractional area change, tricuspid annular plane systolic excursion) and left ventricular (LV) function (3D-derived LV ejection fraction and LV-GLS) were not independently associated. Hematocrit (P < .01), serum lactate (P < .001), pulmonary hypertension (P = .04), tricuspid regurgitation (P < .01), emergency procedures (P = .02), LV-GLS (P = .02), and RV-GLS (P < .001) were associated with the secondary end point.
Conclusions
RV-GLS measured on RV meshes derived from 3D transesophageal echocardiography was independently associated with short-term outcomes in patients undergoing cardiac surgery and might be helpful for identifying patients at risk for adverse postoperative events.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 15 Nov 2021; epub ahead of print
Keller M, Heller T, Duerr MM, Schlensak C, ... Rosenberger P, Magunia H
J Am Soc Echocardiogr: 15 Nov 2021; epub ahead of print | PMID: 34793944
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Left Atrial Stiffness Index Independently Predicts Exercise Intolerance and Quality of Life in Older, Obese Patients With Heart Failure With Preserved Ejection Fraction.

Singleton MJ, Nelson MB, Samuel TJ, Kitzman DW, ... Chen H, Nelson MD
Background
Heart failure with preserved ejection fraction (HFpEF) is the fastest growing form of HF and is associated with high morbidity and mortality. The primary chronic symptom in HFpEF is exercise intolerance, associated with reduced quality of life. Emerging evidence implicates left atrial (LA) dysfunction as an important pathophysiologic mechanism. Here we extend prior observations by relating LA dysfunction to peak oxygen uptake (peak VO2), physical function (distance walked in 6 minutes [6MWD]) and quality of life (Kansas City Cardiomyopathy Questionnaire).
Methods and results
We compared 75 older, obese, patients with HFpEF with 53 healthy age-matched controls. LA strain was assessed by magnetic resonance cine imaging using feature tracking. LA function was defined according to its 3 distinct phases, with the LA serving as a reservoir during systole, as a conduit during early diastole, and as a booster pump at the end of diastole. The LA stiffness index was calculated as the ratio of early mitral inflow velocity-to-early annular tissue velocity (E/e\', by Doppler ultrasound examination) and LA reservoir strain. HFpEF had a decreased reservoir strain (16.4 ± 4.4% vs 18.2 ± 3.5%, P = .018), lower conduit strain (7.7 ± 3.3% vs 9.1 ± 3.4%, P = .028), and increased stiffness index (0.86 ± 0.39 vs 0.53 ± 0.18, P < .001), as well as decreased peak VO2, 6MWD, and lower quality of life. Increased LA stiffness was independently associated with impaired peak VO2 (β = 9.0 ± 1.6, P < .001), 6MWD (β = 117 ± 22, P = .003), and Kansas City Cardiomyopathy Questionnaire score (β = -23 ± 5, P = .001), even after adjusting for clinical covariates.
Conclusions
LA stiffness is independently associated with impaired exercise tolerance and quality of life and may be an important therapeutic target in obese HFpEF.
Registration
NCT00959660.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 09 Nov 2021; epub ahead of print
Singleton MJ, Nelson MB, Samuel TJ, Kitzman DW, ... Chen H, Nelson MD
J Card Fail: 09 Nov 2021; epub ahead of print | PMID: 34774747
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association between Isometric and Allometric Height-Indexed Left Atrial Size and Atrial Fibrillation.

Olsen FJ, Møgelvang R, Modin D, Schnohr P, Jensen GB, Biering-Sørensen T
Background
Height-based indexations for the evaluation of left atrial (LA) volumes have been proposed as an alternative method to account for body stature when body composition is abnormal. The aim of this study was to derive reference values for these indexation methods and to examine their association with atrial fibrillation (AF).
Methods
A healthy population was randomly split into derivation and validation cohorts (n = 493 each). The derivation cohort was used to derive reference values for iso- and allometric height-indexed LA volumes. Echocardiography included measurement of maximal LA volume (LAVmax) and minimal LA volume (LAVmin). Associations between these measures and AF were investigated in the validation cohort. Cox proportional-hazards regression was performed, adjusting for CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation) risk score.
Results
From 986 healthy subjects, allometric height-indexed exponents were determined to 1.72 and 1.56 for LAVmax and LAVmin, respectively. Upper reference values were determined to be LAVmax > 22.1 mL/m1.72 and LAVmin > 12.7 mL/m1.56. In the validation cohort, 41 patients (8%) developed AF during follow-up (median, 14.7 years). In unadjusted analyses, both isometric and allometric indexed LAVmax were associated with AF (hazard ratio, 1.07 [95% CI, 1.03-1.11; P < .001] and 1.11 [95% CI, 1.05-1.18; P < .001] per 1 mL/m and 1 mL/m1.72 increase, respectively) with equal C statistics of 0.63. Height-indexed LAVmin was also associated with AF, with higher C statistics than for LAVmax. All findings were consistent after multivariable adjustment. LAVmax > 22.1 mL/m1.72 posed an increased risk for AF (hazard ratio, 4.65; 95% CI, 1.83-11.86), but LAVmin > 12.7 mL/m1.56 carried a higher risk (hazard ratio, 6.33; 95% CI, 2.66-15.07).
Conclusions
Both isometric and allometric height-indexed LA volumes are associated with AF in the general population. LAVmin is more strongly associated with AF than LAVmax regardless of indexation.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 28 Oct 2021; epub ahead of print
Olsen FJ, Møgelvang R, Modin D, Schnohr P, Jensen GB, Biering-Sørensen T
J Am Soc Echocardiogr: 28 Oct 2021; epub ahead of print | PMID: 34757164
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-up of the World Alliance Societies of Echocardiography (WASE-COVID) Study.

Karagodin I, Singulane CC, Descamps T, Woodward GM, ... Asch FM, WASE-COVID Investigators
Background
COVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection.
Methods
Patients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyzable, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardiographic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function.
Results
For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not significantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a significant reduction of LVEF at follow-up (74.3% ± 3.1% vs 64.4% ± 8.1%, P < .001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5% ± 5.9% vs 49.3% ± 13.4%, P = .02), and those with normal LVEF had no change. Patients with normal LVLS (<-18%) at baseline had a significant reduction of LVLS at follow-up (-21.6% ± 2.6% vs -20.3% ± 4.0%, P = .006), while patients with impaired LVLS at baseline had a significant improvement at follow-up (-14.5% ± 2.9% vs -16.7% ± 5.2%, P < .001). Patients with abnormal RV global longitudinal strain (>-20%) at baseline had significant improvement at follow-up (-15.2% ± 3.4% vs -17.4% ± 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 ± 0.7 cm vs 4.6 ± 0.6 cm, P = .019).
Conclusions
Overall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 05 Nov 2021; epub ahead of print
Karagodin I, Singulane CC, Descamps T, Woodward GM, ... Asch FM, WASE-COVID Investigators
J Am Soc Echocardiogr: 05 Nov 2021; epub ahead of print | PMID: 34752928
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Resting Left Ventricular Global Longitudinal Strain to Identify Silent Myocardial Ischemia in Asymptomatic Patients with Diabetes Mellitus.

Albenque G, Rusinaru D, Bellaiche M, Di Lena C, ... Tribouilloy C, Bohbot Y
Background
Screening for silent coronary artery disease in asymptomatic patients with diabetes mellitus (DM) is challenging and controversial. In this context, it seems crucial to identify early markers of coronary artery disease.
Methods
The aim of this study was to investigate the incremental value of resting left ventricular (LV) global longitudinal strain (GLS) for the prediction of positive results on stress (exercise or dobutamine) transthoracic echocardiography in 273 consecutive asymptomatic high-risk patients with DM. Positive results on stress transthoracic echocardiography were defined as stress-induced LV wall motion abnormalities (new or worsening preexisting abnormalities).
Results
Compared with patients with negative stress results, those with positive stress results (n = 28 [10%]) more frequently had cardiovascular risk factors, complications of DM, vascular disease, moderate and severe calcification of the aortic valve and mitral annulus, and worse resting LV GLS (-16.7 ± 2.9% vs -19.0 ± 1.9%, P < .001). On multivariable logistic regression analysis, DM duration > 10 years, diabetic retinopathy, LV hypertrophy, and impaired LV GLS (odds ratio, 1.39 [95% CI, 1.14-1.70] per percentage increase; odds ratio, 5.16 [95% CI, 1.96-13.59] for LV GLS worse than -18%) were independently associated with positive results on stress transthoracic echocardiography. The area under the curve to predict positive results was 0.74 for LV GLS with a cutoff of -18.0% (sensitivity 68%, specificity 78%). The area under the curve of the multivariable model to predict test results was improved by the addition of LV GLS (P < .001), with a bias-corrected area under the curve after bootstrapping of 0.842 [95% CI, 0.753-0.893].
Conclusions
The present findings show that resting LV GLS is associated with the presence of silent ischemia and could be useful to better identify asymptomatic patients with DM who might benefit from coronary artery disease screening.

Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

J Am Soc Echocardiogr: 05 Nov 2021; epub ahead of print
Albenque G, Rusinaru D, Bellaiche M, Di Lena C, ... Tribouilloy C, Bohbot Y
J Am Soc Echocardiogr: 05 Nov 2021; epub ahead of print | PMID: 34752929
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

GORE® Cardioform ASD Occluder experience in transcatheter closure of \"complex\" atrial septal defects.

Santoro G, Cuman M, Pizzuto A, Haxhiademi D, ... Assanta N, Cantinotti M
Objective
To evaluate the GORE® Cardioform ASD Occluder (GCO) (WL Gore & Associates, Flagstaff, AZ) device for \"complex\" atrial septal defects (ASD) closure.
Background
Transcatheter ASD closure is still challenging in \"complex\" clinical/anatomic settings. This study evaluated the results of GCO in closure of \"complex\" ASD in a tertiary referral center.
Methods
Between January 2020 and March 2021, 72 patients with significant ASD were submitted to transcatheter closure with GCO at our Institution. Based on clinical/anatomic characteristics, they were classified as \"complex\" (n = 36, Group I) or \"simple\" (n = 36, Group II). We considered as \"complex\", defects with rim deficiency (< 5 mm) other than antero-superior, relatively large (diameter/patient weight > 1.2 or diameter/patient BSA > 20 mm/m2 ) or within a multifenestrated septum. Procedure results and early outcome were compared between the groups.
Results
Absolute and relative ASD size (20 ± 4 vs. 15 ± 3 mm, p < 0.0001; 0.9 ± 0.3 vs. 0.4 ± 0.2 mm/kg, p < 0.0001; 23 ± 7 vs. 12 ± 5 mm/m2 , p < 0.0001), QP/QS (2.0 ± 0.8 vs. 1.4 ± 0.3, p < 0.001), procedure and fluoroscopy times (73 ± 36 vs. 43 ± 21 min, p < 0.0001; 16 ± 9 vs. 9 ± 4 min, p < 0.0001, procedure feasibility (94.4 vs. 100%, p < 0.0001) and overall complication rate (13.9 vs. 0%, p < 0.0001) were significantly different between the groups. Successful closure of \"surgical\" ASDs was achieved in 92% of cases. Complete closure at last follow-up evaluation did not significantly differ between the groups (97.1 vs. 100%, p = NS), as was wireframe fractures rate (49.1% in the overall population), without clinical, EKG and echocardiographic consequences.
Conclusions
Percutaneous treatment with GCO device is effective and safe in high percentage of \"complex\" ASDs.

© 2021 Wiley Periodicals LLC.

Catheter Cardiovasc Interv: 31 Dec 2021; 99:E22-E30
Santoro G, Cuman M, Pizzuto A, Haxhiademi D, ... Assanta N, Cantinotti M
Catheter Cardiovasc Interv: 31 Dec 2021; 99:E22-E30 | PMID: 34652048
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Loss of left ventricular rotation is a significant determinant of functional mitral regurgitation.

Hasin T, Mann D, Welt M, Barrett O, ... Glikson M, Wolak A
Aim
To evaluate insufficient rotational movement of the left ventricle (LV) as a potential novel mechanism for functional regurgitation of the mitral valve (FMR).
Methods and results
We compared reference subjects and patients with LV dysfunction (LVD, ejection fraction EF < 50%) with and without FMR (regurgitant volume RVol>10 ml). Subjects without structural mitral valve pathology undergoing cardiac MRI were evaluated. Delayed enhancement, global LV remodeling parameters, systolic twist and torsion were measured (using manual and novel automated cardiac MRI tissue-tracking). The study included 117 subjects with mean ± SD age 50.4 ± 17.8 years, of which 30.8% were female. Compared to subjects with LVD without FMR (n = 31), those with FMR (n = 37) had similar clinical characteristics, diagnoses, delayed enhancement, EF, and longitudinal strain. Subjects with FMR had significantly larger left ventricles (EDVi:136.6 ± 41.8 vs 97.5 ± 26.2 ml/m, p < 0.0001) with wider separation between papillary muscles (21.1 ± 7.6 vs 17.2 ± 5.7 mm, p = 0.023). Notably, they had lower apical (p < 0.0001) but not basal rotation and lower peak systolic twist (3.1 ± 2.4° vs 5.5 ± 2.5°, p < 0.0001) and torsion (0.56 ± 0.38°/cm vs 0.88 ± 0.52°/cm, p = 0.004). In a multivariate model for RVol including age, gender, twist, LV end-diastolic volume, sphericity index and separation between papillary muscles, only gender, volume and twist were significant. Twist was the most powerful correlate (beta -2.23, CI -3.26 to -1.23 p < 0.001). In patients with FMR, peak systolic twist negatively correlates with RVol (r = -0.73, p < 0.0001).
Conclusion
Reduced rotational systolic LV motion is significantly and independently associated with RVol among patients with FMR, suggesting a novel pathophysiological mechanism and a potential therapeutic target.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 14 Dec 2021; 345:143-149
Hasin T, Mann D, Welt M, Barrett O, ... Glikson M, Wolak A
Int J Cardiol: 14 Dec 2021; 345:143-149 | PMID: 34626742
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinical and echocardiographic outcomes of transcatheter mitral valve repair in atrial functional mitral regurgitation.

Benito-González T, Carrasco-Chinchilla F, Estévez-Loureiro R, Pascual I, ... Alonso-Briales JH, Fernández-Vázquez F
Background
Isolated atrial fibrillation can cause mitral regurgitation (MR) in patients with normal left ventricular systolic function and no organic disease of the mitral valve. Little information is available regarding outcomes of Mitraclip in patients with atrial functional mitral regurgitation (AFMR). We aimed to evaluate 12-month clinical and echocardiographic outcomes of transcatheter mitral valve repair (TMVR) with MitraClip in patients with AFMR compared to those with ventricular functional or degenerative/mixed MR.
Methods
Registry-based analysis of all consecutive patients who underwent TMVR and were included in the Spanish Registry of Mitraclip. Changes in MR and NYHA functional class, and a combined endpoint including all-cause mortality and hospitalizations due to heart failure were the main outcomes.
Results
Overall, 1074 (69.1% male, 73.3 ± 10.2 years-old) patients were analyzed in this report. 48 patients (4.5%) presented AFMR. AFMR was significantly reduced after TMVR, with a procedural success rate of 91.7%, and this reduction persisted at 12-month (p < 0.001). Patients with AFMR showed a significant functional improvement at 6- and 12-month follow-up in our series (baseline: NYHA III 70.8% IV 18.8% vs. 1-year: NYHA III 21.7% IV 0%; p < 0.001). The probability of survival free of readmission for heart failure and all-cause mortality within the first year after TMVR was 74.9%. Procedural and clinical outcomes, as well as recurrent rates of MR were similar acutely and at 1-year compared to other etiologies.
Conclusion
TMVR in patients with AFMR showed no significant differences compared to ventricular functional or degenerative/mixed MR regarding MR reduction or clinical outcomes.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 14 Dec 2021; 345:29-35
Benito-González T, Carrasco-Chinchilla F, Estévez-Loureiro R, Pascual I, ... Alonso-Briales JH, Fernández-Vázquez F
Int J Cardiol: 14 Dec 2021; 345:29-35 | PMID: 34610357
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Myocardial contraction fraction by echocardiography and mortality in cardiac intensive care unit patients.

Jentzer JC, Wiley BM, Gersh BJ, Borlaug BA, Oh JK, Anavekar NS
Background
The myocardial contraction fraction (MCF) is proposed as an improved measure of left ventricular (LV) systolic function that overcomes important limitations of the left ventricular ejection fraction (LVEF). We sought to determine whether a low MCF was associated with higher mortality in cardiac intensive care unit (CICU) patients.
Methods
We retrospectively analyzed unique Mayo Clinic CICU patients from 2007 to 2018 with MCF calculated as the ratio of the stroke volume to the left ventricular myocardial volume from a transthoracic echocardiogram within 1 day of CICU admission. Multivariable logistic regression analyzed the association between MCF and hospital mortality, after adjustment for LVEF and clinical variables.
Results
We included 4794 patients with a mean age of 68.0 ± 14.8 years (37.1% females). The mean MCF was 0.41 ± 0.16, and was lower in the 6.6% of patients who died in the hospital (0.32 ± 0.14 versus 0.42 ± 0.16, p < 0.001). On multivariable analysis, higher MCF remained associated with lower hospital mortality (adjusted OR 0.78 per 0.1 higher, 95% CI 0.69-0.89, p < 0.001), whereas LVEF was not significantly associated with hospital mortality (unadjusted OR 0.91 per 10% higher, OR 95% CI 0.82-1.02, p = 0.09). Patients with MCF <0.2 had the highest in-hospital mortality, and those with MCF ≥0.5 had the lowest in-hospital mortality, irrespective of admission diagnosis or LVEF.
Conclusions
MCF demonstrated a strong, inverse relationship with hospital mortality in CICU patients, even after adjusting for LVEF and clinical variables. MCF can be used to identify prognostically-relevant myocardial dysfunction at the bedside, even among patients with preserved LVEF.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 30 Nov 2021; 344:230-239
Jentzer JC, Wiley BM, Gersh BJ, Borlaug BA, Oh JK, Anavekar NS
Int J Cardiol: 30 Nov 2021; 344:230-239 | PMID: 34563594
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Long-term outcome of left atrial appendage occlusion with multiple devices.

Radinovic A, Falasconi G, Marzi A, D\'Angelo G, ... Della Bella P, Mazzone P
Background
To evaluate long-term efficacy of left atrial appendage occlusion with multiple devices.
Methods
All consecutive patients who underwent left atrial appendage occlusion (LAAO) with a follow-up of at least 4 years, were included in this single center, retrospective registry. No specific exclusion criteria were applied. LAA occlusion was performed with the Watchman, Watchman FLX, Amplatzer Cardiac plug or Amplatzer Amulet occluder devices.
Results
A total of 224 consecutive patients underwent LAAO occlusion. Mean age was 72.5 ± 9.0 years. A history of stroke was present in 29%, TIA in 8.5% and a previous episode of bleeding in 64.7% of patients. In 63% there was a contraindication to oral anticoagulants. The average CHADS-VASc was 4.0 ± 1.6 and the average HAS-BLED was 3.4 ± 1.3. There was a reduction of strokes of 72.9%, thromboembolic events of 59.7% and major bleeding events of 70.9% compared to historic data. During follow-up, 48.3% of the ischemic and major bleeding events occurred within the first year. The annual mortality rate of 7.5 deaths/ 100 patients years. There were no significant differences in terms of outcome between the devices used and there were no late events associated with any device. The main antithrombotic regimen in the long term was with single antiplatelet therapy and the second one was no therapy.
Conclusion
LAAO is a safe and effective procedure, that reduces ischemic and bleeding events in the long-term, regardless of the type of device used, in AF patients at high risk of ischemic stroke and major bleeding, without the need of anticoagulation.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 30 Nov 2021; 344:66-72
Radinovic A, Falasconi G, Marzi A, D'Angelo G, ... Della Bella P, Mazzone P
Int J Cardiol: 30 Nov 2021; 344:66-72 | PMID: 34599944
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiac microvascular functions improved by MSC-derived exosomes attenuate cardiac fibrosis after ischemia-reperfusion via PDGFR-β modulation.

Wang X, Bai L, Liu X, Shen W, ... Liu W, Yu B
Microvascular dysfunction caused by cardiac ischemia-reperfusion (I/R) leads to multiple severe cardiac adverse events, such as heart failure and ventricular modeling, which plays a critical role in outcomes. Though marrow mesenchymal stem cell (MSC) therapy has been proven effective for attenuating I/R injury, the limitations of clinical feasibility cannot be ignored. Since exosomes are recognized as the main vehicles for MSCs paracrine effects, we assumed that MSC-derived exosomes could prevent microvascular dysfunction and further protect cardiac function. By establishing a rat cardiac I/R model in vivo and a cardiac microvascular endothelial cells (CMECs) hypoxia-reperfusion (H/R) model in vitro, we demonstrated that MSC-derived exosomes enhanced microvascular regeneration under stress, inhibited fibrosis development, and eventually improved cardiac function through platelet-derived growth factor receptor-β (PDGFR-β) modulation. Furthermore, we found that MSC-derived exosomes possessed better therapeutic effects than MSCs themselves.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 30 Nov 2021; 344:13-24
Wang X, Bai L, Liu X, Shen W, ... Liu W, Yu B
Int J Cardiol: 30 Nov 2021; 344:13-24 | PMID: 34534604
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Assessment of independent clinical predictors of early readmission after percutaneous endoluminal left atrial appendage closure with the Watchman device using National Readmission Database.

Rahman MU, Amritphale A, Kumar S, Trice C, Awan GM, Omar BA
Background
Percutaneous endoluminal left atrial appendage closure (pLAAC) procedure has been used to prevent strokes in patients who are not eligible for long-term prophylactic anticoagulation. Since its approval, multiple studies have looked at its efficacy with comparable outcomes to anticoagulation, the current standard of care.
Objectives
To assess the readmission rate and determine the factors associated with readmission after the endocardial pLAAC procedure using the Watchman device.
Methods
Data was obtained from the National Readmission Database (NRD), and we used SPSS software to determine statistically significant clinical predictors affecting readmission after implantation of the Watchman device at 30 days.
Results
The rate of readmission was found to be 9.2%. The true median cost of index hospitalization for the total population in the study was found to be [median (interquartile range = IQR), p] USD 24594 (USD 18883-31,041), whereas the true median cost of admission for those who were getting readmitted after 30 days was [median (IQR)] USD 7699 (USD 4955-14,243). Multivariate analysis of all clinically relevant predictors showed adjusted ratio for [adjusted odds ratio (OR), 95% confidence interval (95% CI), p-value] female genders (1.288, 1.104-1.503, p = 0.001), discharge to home health care (6.155, 1.509-25.096, p = 0.01), chronic kidney disease (CKD) (1.847,1.511-2.258, p < 0.001), chronic lung disease (1.419, 1.194-1.686, p < 0.001), heart failure (1.280, 1.040-1.574, p = 0.02), pericardial disorders (1.485, 1.011-2.179, p = 0.04), fluid and electrolyte disorders (1.456,1.050-2.018, p = 0.02) in those who were getting readmitted at 30-days compared to those who were not readmitted. The median length of stay for the index hospitalization was found to be one day, whereas the median length of stay at the 30-day readmission was reported to be [Median (IQR)] 4 days (2-6 days). Major cardiac reasons for readmission were heart failure, arrhythmias, and pericardial disorders.
Conclusion
Our study aims to assess 30-day outcomes in the US population after pLAAC using a Watchman device. Our analysis showed that one in ten patients were getting readmitted. In addition, chronic kidney disease, chronic obstructive pulmonary disease, heart failure, and pericardial disorders were associated with higher readmission rates. These findings will help us assess clinical correlations and predict which patients are more at risk of readmission after a Watchman procedure.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 14 Nov 2021; 343:21-26
Rahman MU, Amritphale A, Kumar S, Trice C, Awan GM, Omar BA
Int J Cardiol: 14 Nov 2021; 343:21-26 | PMID: 34481838
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular magnetic resonance characterisation of anthracycline cardiotoxicity in adults with normal left ventricular ejection fraction.

Harries I, Berlot B, Ffrench-Constant N, Williams M, ... Plana JC, Bucciarelli-Ducci C
Background
Anthracycline therapy may lead to changes in cardiac structure and function not detectable by solely evaluating left ventricular ejection fraction (LVEF).
Objectives
We hypothesized that cardiovascular magnetic resonance (CMR) would identify structural and functional myocardial abnormalities in anthracycline-treated cancer survivors with normal LVEF, compared to a matched control population.
Methods
Forty-five cancer survivors (56 ± 16 yrs., 60% female) with normal LVEF (59.5 ± 4.1%) were studied a median of 11 months (range 3-36) following administration of 237 ± 83 mg/m2 anthracycline, and compared with forty-five healthy control subjects of similar age and sex (53 ± 16 yrs., 60% female) with normal LVEF (60.8 ± 2.4%) using 1.5 T CMR.
Results
Significantly smaller indexed left ventricular mass (45.6 ± 8.7 vs 50.3 ± 10.1 g/m2, p = 0.02) and indexed myocardial cell volume (30.5 ± 5.7 vs 34.8 ± 7.2 ml/m2, p = 0.002) were evident in cancer survivors and the latter was inversely associated with cumulative anthracycline dose (r = -0.31, p = 0.02). Surrogate CMR markers of myocardial fibrosis were significantly increased in cancer survivors (native myocardial T1: 1021 ± 40 vs 996 ± 35 ms, p = 0.002; extracellular volume: 29.5 ± 4.5 vs 27.4 ± 2.3%, p = 0.006). CMR-derived feature-tracking global longitudinal strain (GLS) was significantly impaired in cancer survivors (2D GLS -18.3 ± 2.6 vs -20.0 ± 2.0%, p < 0.001; 3D GLS -14.5 ± 2.3 vs -16.4 ± 2.6%, p < 0.001). Parameters exhibited good to excellent (ICC = 0.86-0.98) inter- and intra-observer reproducibility.
Conclusions
Anthracycline-treated cancer survivors with normal LVEF have significant perturbations of LV mass, myocardial cell volume, native myocardial T1, ECV, CMR-derived 2D and 3D GLS, compared to controls, with good to excellent levels of inter- and intra-observer reproducibility.

Copyright © 2021 Elsevier B.V. All rights reserved.

Int J Cardiol: 14 Nov 2021; 343:180-186
Harries I, Berlot B, Ffrench-Constant N, Williams M, ... Plana JC, Bucciarelli-Ducci C
Int J Cardiol: 14 Nov 2021; 343:180-186 | PMID: 34454967
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Semi-quantitative assessment of ischemia with rubidium-82 PET myocardial perfusion imaging.

Borren NM, Gerritse TJ, Ottervanger JP, Mouden M, ... Jager PL, van Dijk JD
Purpose
Semi-quantitative scores can be used as an adjunct to visual assessment in rubidium-82 positron emission tomography (82Rb PET). The semi-quantitative cut-off values used in 82Rb PET are derived from single-photon emission computed tomography (SPECT). It is unknown whether these cut-off values can be extrapolated to 82Rb PET. We compared the semi-quantitative with the visual assessment of ischemia and determined which summed difference score (SDS) score predicts ischemia best.
Methods
We included 108 patients who underwent 82Rb PET imaging and performed visual and semi-quantitative assessment. A scan with a SDS ≥ 2 and a summed stress score (SSS) ≥ 4 was considered to demonstrate ischemia. We compared the semi-quantitative with the visual assessment.
Results
41 (38%) Normal scans, and 67 (62%) scans with ischemia and/or an irreversible defect were included. The semi-quantitative assessment showed ischemia more often than the visual assessment (51% vs 29%, P < .001). Patients with a low or intermediate pre-test probability of coronary artery disease (CAD) and a SDS < 4 did not demonstrate ischemia by visual assessment.
Conclusion
Semi-quantitative assessment in 82Rb PET imaging clearly demonstrates the presence of ischemia. Ischemia is unlikely in patients with low and intermediate pre-test probability of CAD and a SDS < 4.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 29 Dec 2021; epub ahead of print
Borren NM, Gerritse TJ, Ottervanger JP, Mouden M, ... Jager PL, van Dijk JD
J Nucl Cardiol: 29 Dec 2021; epub ahead of print | PMID: 34970710
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Role of Echocardiography for Assessment of Cardiac Remodeling in Congenitally Corrected Transposition of Great Arteries.

Egbe AC, Miranda WR, Connolly HM
Background
The purpose of this study was to assess the role of echocardiography for a comprehensive assessment of cardiac remodeling, and the relationship between indices of cardiac remodeling and cardiovascular events (defined as the composite end point of heart failure hospitalization, heart transplant, or cardiovascular death) in adults with congenitally corrected transposition of great arteries (cc-TGA).
Methods
This is a retrospective study of adults with cc-TGA who underwent echocardiogram (2003-2020). Offline image analysis was performed in all patients. Chamber (atrial and ventricular) function and size were assessed by strain imaging and 2-dimensional echocardiography.
Results
Of 233 patients with cc-TGA (40±15 years), 123 (55%) had at least one cardiac procedure before baseline echocardiogram. Of 233 patients, 76% and 61% had left atrial dysfunction and systemic right ventricular dysfunction, respectively; while 43% and 11% had right atrial dysfunction and left ventricular dysfunction, respectively. During a median follow-up of 8.9 years, 114 (49%) underwent additional cardiac procedures, and 66 (28%) had cardiovascular events. Left atrial reservoir strain, right ventricular global longitudinal strain, right atrial reservoir strain, left ventricular systolic pressure, and left ventricular global longitudinal strain were independently associated with cardiovascular events.
Conclusions
In addition to the clinical importance of right ventricular systolic dysfunction in cc-TGA that is already well described, the current study demonstrated, for the first time, that biatrial dysfunction was common and was associated with clinical outcomes. Since there are currently no effective therapies for atrial and ventricular dysfunction in patients with cc-TGA, there is a need for research to identify novel strategies to prevent atrial and ventricular dysfunction in this population.



Circ Cardiovasc Imaging: 27 Dec 2021:CIRCIMAGING121013477; epub ahead of print
Egbe AC, Miranda WR, Connolly HM
Circ Cardiovasc Imaging: 27 Dec 2021:CIRCIMAGING121013477; epub ahead of print | PMID: 34961324
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

F-18 meta-fluorobenzylguanidine PET imaging of myocardial sympathetic innervation.

Grkovski M, Zanzonico PB, Modak S, Humm JL, Narula J, Pandit-Taskar N
Background
I-123 meta-iodobenzylguanidine (MIBG) imaging has long been employed to noninvasively assess the integrity of human norepinephrine transporter-1 and, hence, myocardial sympathetic innervation. Positron-emitting F-18 meta-fluorobenzylguanidine (MFBG) has recently been developed for potentially superior quantitative characterization. We assessed the feasibility of MFBG imaging of myocardial sympathetic innervation.
Methods
16 patients were imaged with MFBG PET (30-minute dynamic imaging of chest, followed by 3 whole-body acquisitions between 30 minutes and 4-hour post-injection). Blood kinetics were assessed from multiple samples. Pharmacokinetic modeling with reversible 1- and 2-compartment models was performed. Kinetic rate constants were re-calculated from truncated datasets. All patients underwent concurrent MIBG SPECT.
Results
MFBG myocardial uptake was rapid and sustained; the mean standardized uptake value (SUV (mean ± standard deviation)) was 5.1 ± 2.2 and 3.4 ± 1.9 at 1 hour and 3-4-hour post-injection, respectively. The mean K1 and distribution volume (VT) were 1.1 ± 0.6 mL/min/g and 34 ± 22 mL/cm3, respectively. Both were reproducible when re-calculated from truncated 1-hour datasets (Intraclass Correlation Coefficient of 0.99 and 0.91, respectively). Spearman\'s ϱ = 0.86 between MFBG SUV and VT and 0.80 between MFBG PET-derived VT and MIBG SPECT-derived heart-to-mediastinum activity concentration ratio.
Conclusion
MFBG is a promising PET radiotracer for the assessment of myocardial sympathetic innervation.

© 2022. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 05 Jan 2022; epub ahead of print
Grkovski M, Zanzonico PB, Modak S, Humm JL, Narula J, Pandit-Taskar N
J Nucl Cardiol: 05 Jan 2022; epub ahead of print | PMID: 34993893
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Amyloid deposit corresponds to technetium-99m-pyrophosphate accumulation in abdominal fat of patients with transthyretin cardiac amyloidosis.

Takahashi K, Sasaki D, Yamashita M, Sakaue T, ... Yamashita T, Ueda M
Background
Radionuclide imaging using bone-avid tracers plays a critical role in diagnosing transthyretin cardiac amyloidosis (ATTR-CA), but technetium-99m-pyrophosphate (PYP) rarely allows the detection of extracardiac amyloid infiltration. We retrospectively investigated the frequency of PYP uptake in the subcutaneous abdominal fat of patients with ATTR-CA and its relevance to the results of fine-needle aspiration biopsy (FNAB) of this tissue.
Methods
Chest-centered images of PYP scintigraphy were obtained 2 h after the intravenous injection of the tracer (20 mCi), and the frequency of PYP uptake in the subcutaneous abdominal fat was evaluated. Amyloid deposits of fat smears taken by subcutaneous abdominal fat FNAB were assessed by Congo red staining.
Results
Twenty-four patients with ATTR-CA were included. Ten (41.7%) patients showed some PYP uptake in the subcutaneous abdominal fat (positive PYP group), and 14 patients did not (negative PYP group). Amyloid deposits were detected by subcutaneous abdominal fat FNAB in 7/10 patients (70.0%) of the positive PYP group versus 0/14 patients (0%) of the negative PYP group, and the difference was significant.
Conclusions
In patients with ATTR-CA, abnormal PYP uptake in the subcutaneous abdominal fat could reflect the regional amyloid deposition confirmed by FNAB of this tissue.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 27 Dec 2021; epub ahead of print
Takahashi K, Sasaki D, Yamashita M, Sakaue T, ... Yamashita T, Ueda M
J Nucl Cardiol: 27 Dec 2021; epub ahead of print | PMID: 34964085
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Regional myocardial sympathetic denervation precedes the development of left ventricular systolic dysfunction in chronic Chagas\' cardiomyopathy.

Gadioli LP, Miranda CH, Marin-Neto JA, Volpe GJ, ... de Figueiredo AB, Simões MV
Background
Regional myocardial sympathetic denervation is a conspicuous and early disorder in patients with chronic Chagas\' cardiomyopathy (CCC), potentially associated to the progression of myocardial dysfunction OBJECTIVE: To evaluate in a longitudinal study the association between the presence and the progression of regional myocardial sympathetic denervation with the deterioration of global and segmental left ventricular dysfunction in CCC.
Methods
18 patients with CCC were submitted at initial evaluation and after 5.5 years to rest myocardial scintigraphy with 123Iodo-metaiodobenzylguanidine and 99mTc-sestamibi and to two-dimensional echocardiography to assess myocardial sympathetic denervation, extent of fibrosis, and the left ventricular ejection fraction (LVEF) and wall motion abnormalities.
Results
In the follow-up evaluation, compared to the initial one, we observed a significant decrease in LVEF (56 ± 11 to 49% ± 12; P = .01) and increased summed defects scores in the myocardial innervation scintigraphy (15 ± 10 to 20 ± 9; P < .01). The presence of regional myocardial sympathetic denervation in ventricular regions of viable non-fibrotic myocardium presented an odds ratio of 4.25 for the development of new wall motion abnormalities (P = .001).
Conclusion
Regional and global myocardial sympathetic denervation is a progressive derangement in CCC. In addition, the regional denervation is topographically associated with areas of future development of regional systolic dysfunction in patients with CCC.

© 2022. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 03 Jan 2022; epub ahead of print
Gadioli LP, Miranda CH, Marin-Neto JA, Volpe GJ, ... de Figueiredo AB, Simões MV
J Nucl Cardiol: 03 Jan 2022; epub ahead of print | PMID: 34981413
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Metabolic activity of the left and right atria are differentially altered in patients with atrial fibrillation and LV dysfunction.

Santi ND, Wu KY, Redpath CJ, Nery PB, ... deKemp RA, Beanlands RSB
Background
Alterations in atrial metabolism may play a role in the perpetuation of atrial fibrillation (AF). This study sought to compare 18F-fluorodeoxyglucose (FDG) uptake on PET, in patients with LV dysfunction versus those without AF.
Methods
Seventy-two patients who underwent myocardial viability assessment were evaluated. AF patients (36) had persistent or permanent AF based on history and ECG. Patients without AF (36) were matched to AF patients based on sex, diabetes, age, and LVEF. Maximum and mean FDG Standard Uptake Values (SUV) in the left atrial (LA) wall and right atrial (RA) wall were measured. Tissue-to-blood ratios (TBR) were calculated as atrial wall to blood-pool activity. Atrial volumes were measured by echocardiography.
Results
Maximum and mean FDG SUV and TBRs were significantly increased in the RA (but not the LA) of patients with AF compared to those without (P < 0.01). When accounting for changes in atrial volume, the presence of AF remained a significant predictor of higher RAMAX, but not RAMEAN FDG uptake.
Conclusion
In patients with LV dysfunction from ischemic cardiomyopathy, LA and RA glucose metabolism are differentially altered in those with persistent atrial fibrillation. Further investigations should elucidate the temporal relationship between AF and glucose metabolic changes, as a potential target for therapy.

© 2022. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 05 Jan 2022; epub ahead of print
Santi ND, Wu KY, Redpath CJ, Nery PB, ... deKemp RA, Beanlands RSB
J Nucl Cardiol: 05 Jan 2022; epub ahead of print | PMID: 34993894
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Myocardial Parametric Mapping by Cardiac Magnetic Resonance Imaging in Pediatric Cardiology and Congenital Heart Disease.

Rao S, Tseng SY, Pednekar A, Siddiqui S, ... Taylor MD, Alsaied T
Parametric mapping, that is, a pixel-wise map of magnetic relaxation parameters, expands the diagnostic potential of cardiac magnetic resonance by enabling quantification of myocardial tissue-specific magnetic relaxation on an absolute scale. Parametric mapping includes T1 mapping (native and postcontrast), T2 and T2* mapping, and extracellular volume measurements. The myocardial composition is altered in various disease states affecting its inherent magnetic properties and thus the myocardial relaxation times that can be directly quantified using parametric mapping. Parametric mapping helps in the diagnosis of nonfocal disease states and allows for longitudinal disease monitoring, evaluating therapeutic response (as in Thalassemia patients with iron overload undergoing chelation), and risk-stratification of certain diseases. In this review article, we describe various mapping techniques and their clinical utility in congenital heart disease. We will also review the available literature on normative values in children, the strengths, and weaknesses of these techniques. This review provides a starting point for pediatric cardiologists to understand and implement parametric mapping in their practice.



Circ Cardiovasc Imaging: 04 Jan 2022:CIRCIMAGING120012242; epub ahead of print
Rao S, Tseng SY, Pednekar A, Siddiqui S, ... Taylor MD, Alsaied T
Circ Cardiovasc Imaging: 04 Jan 2022:CIRCIMAGING120012242; epub ahead of print | PMID: 34983186
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Sex Differences in Factors Associated With Progression of Aortic Valve Calcification in the General Population.

Diederichsen A, Lindholt JS, Møller JE, Gerke O, Rasmussen LM, Dahl JS
Background
Guidelines recommend measurement of the aortic valve calcification (AVC) score to help differentiate between severe and nonsevere aortic stenosis, but a paucity exists in data about AVC in the general population. The aim of this study was to describe the natural history of AVC progression in the general population and to identify potential sex differences in factors associated with this progression rate.
Methods
Noncontrast cardiac computed tomography was performed in 1298 randomly selected women and men aged 65 to 74 years who participated in the DANCAVAS trial (Danish Cardiovascular Screening). Participants were invited to attend a reexamination after 4 years. The AVC score was measured at the computed tomography, and AVC progression (ΔAVC) was defined as the difference between AVC scores at baseline and follow-up. Multivariable regression analyses were performed to identify factors associated with ΔAVC.
Results
Among the 1298 invited citizens, 823 accepted to participate in the follow-up examination. The mean age at follow-up was 73 years. Men had significantly higher AVC scores at baseline (median AVC score 13 Agatston Units [AU; interquartile range, 0-94 AU] versus 1 AU [interquartile range, 0-22 AU], P<0.001) and a higher ΔAVC (median 26 AU [interquartile range, 0-101 AU] versus 4 AU [interquartile range, 0-37 AU], P<0.001) than women. In the fully adjusted model, the most important factor associated with ΔAVC was the baseline AVC score. However, hypertension was associated with ΔAVC in women (incidence rate ratios, 1.58 [95% CI, 1.06-2.34], P=0.024) but not in men, whereas dyslipidemia was associated with ΔAVC in men (incidence rate ratio: 1.66 [95% CI, 1.18-2.34], P=0.004) but not in women.
Conclusions
The magnitude of the AVC score was the most important marker of AVC progression. However, sex differences were significant; hence, dyslipidemia was associated with AVC progression only among men; hypertension with AVC progression only among women.
Registration
URL: https://www.isrctn.com; Unique identifier: ISRCTN12157806.



Circ Cardiovasc Imaging: 04 Jan 2022:CIRCIMAGING121013165; epub ahead of print
Diederichsen A, Lindholt JS, Møller JE, Gerke O, Rasmussen LM, Dahl JS
Circ Cardiovasc Imaging: 04 Jan 2022:CIRCIMAGING121013165; epub ahead of print | PMID: 34983195
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Trajectory of Left Ventricular Remodeling in Children With Valvar Aortic Stenosis Following Balloon Aortic Valvuloplasty.

Papneja K, Blatman ZM, Kawpeng ID, Wheatley J, ... Benson LN, Mertens L
Background
Aortic valve stenosis is the most common type of congenital left ventricular (LV) outflow tract obstruction. Balloon aortic valvuloplasty (BAV) has become the first-line treatment pathway in many centers. Our aim was to assess the trajectory of LV remodeling following BAV in children and its relationship to residual aortic stenosis (AS) and insufficiency (AI).
Methods
Children <18 years of age who underwent BAV for isolated aortic stenosis from 2004 to 2012 were eligible for inclusion. Those with AI before BAV, other complex congenital heart lesions, or <2 accessible follow-up echocardiograms were excluded. Baseline and serial echocardiographic data pertaining to aortic valve and LV size and function were retrospectively collected through December 2017 or the first reintervention. Longitudinal data was assessed using per-patient time profiles with superimposed trend lines using locally estimated scatterplot smoothing. Associations with reintervention or death were also evaluated.
Results
Among the 98 enrolled children, the median (interquartile range) age at BAV was 2.8 months (0.2-75). The median (interquartile range) follow-up was 6.8 years (1.9-9.0). Children with predominantly residual AI (n=11) demonstrated progressive increases in their LV end-diastolic dimension Z score within the first 3 years after the BAV, followed by a plateau (P<0.001). Their mean LV circumferential and longitudinal strain values remained within the normal range but lower than in the non-AI group (P<0.001 and P=0.001, respectively). Children with predominantly residual aortic stenosis (n=44) had no changes in LV dimensions but had a rapid early increase in mean LV circumferential and longitudinal strain. The cumulative proportion (95% CI) of reintervention at 5 years following BAV was 33.7% (23.6%-42.4%).
Conclusions
Our study demonstrates that LV remodeling occurs mainly during the first 3 years in children with predominantly residual AI after BAV, with no subsequent significant functional changes over the medium term. These data improve our understanding of expected patient trajectories and thus may inform decisions on the timing of reintervention.



Circ Cardiovasc Imaging: 30 Dec 2021; 15:e013200
Papneja K, Blatman ZM, Kawpeng ID, Wheatley J, ... Benson LN, Mertens L
Circ Cardiovasc Imaging: 30 Dec 2021; 15:e013200 | PMID: 35041447
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Normalized Subendocardial Myocardial Attenuation on Coronary Computed Tomography Angiography Predicts Postoperative Adverse Cardiovascular Events: Coronary CTA VISION Substudy.

Walpot J, Massalha S, Jayasinghe P, Sadaf M, ... Sheth T, Chow BJW
Background
Abnormalities in computed tomography myocardial perfusion has been associated with coronary artery disease and major adverse cardiovascular events (MACE). We sought to investigate if subendocardial attenuation using coronary computed tomography angiography predicts MACE 30 days postelective noncardiac surgery.
Methods
Using a 17-segment model, coronary computed tomography angiography images were analyzed for subendocardial and transmural attenuation and the corresponding blood pool. The segment with the lowest subendocardial attenuation and transmural attenuation were normalized to the segment with the highest subendocardial and transmural attenuation, respectively (SUBnormalized, and TRANSnormalized, respectively). We evaluated the independent and incremental value of myocardial attenuation to predict the composite of cardiovascular death or nonfatal myocardial infarction.
Results
Of a total of 995 coronary CTA VISION (Coronary Computed Tomographic Angiography and Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study) patients, 735 had available images and complete data for these analyses. Among these patients, 60 had MACE. Based on Revised Cardiovascular Risk Index, 257, 302, 138, and 38 patients had scores of 0, 1, 2, and ≥3, respectively. On coronary computed tomography angiography, 75 patients had normal coronary arteries, 297 patients had nonobstructive coronary artery disease, 264 patients had obstructive disease, and 99 patients had extensive obstructive coronary artery disease. SUBnormalized was an independent and incremental predictor of events in the model that included Revised Cardiovascular Risk Index and coronary artery disease severity. Compared with patients in the highest tertile of SUBnormalized, patients in the second and first tertiles had an increased hazards ratio for events (2.23 [95% CI, 1.091-4.551] and 2.36 [95% CI, 1.16-4.81], respectively). TRANSnormalized, as a continuous variable, was also found to be a predictor of MACE (P=0.027).
Conclusions
Our study demonstrates that SUBnormalized and TRANSnormalized are independent and incremental predictors of MACE 30 days after elective noncardiac surgery. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01635309.



Circ Cardiovasc Imaging: 30 Dec 2021; 15:e012654
Walpot J, Massalha S, Jayasinghe P, Sadaf M, ... Sheth T, Chow BJW
Circ Cardiovasc Imaging: 30 Dec 2021; 15:e012654 | PMID: 35041449
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic value of divergent pattern detection by 99mTc-sestamibi gated SPECT in patients with anterior acute myocardial infarction.

Calabretta R, Castello A, Giglioli C, Cecchi E, ... Hacker M, Sciagrà R
Purpose
In gated myocardial perfusion SPECT, apical remodeling may be identified by the presence of a divergent pattern (DP) of the left ventricle (LV).
Methods and results
We examined 150 anterior ST-elevation myocardial infarction (STEMI) patients, all successfully treated with primary percutaneous coronary interventions (PCI). Perfusion gated-SPECT to measure infarct size, LV end-diastolic (ED) and end-systolic (ES) volumes and ejection fraction (EF) was acquired before hospital discharge and repeated at 6-month follow-up. DP was observed in 26 patients, who had larger infarct size (28 ± 19% vs. 15.7 ± 17%, P < 0.02), and lower EF (33 ± 7% vs. 41 ± 10%, P < 0.001) than patients without DP. At follow-up, DP patients had significantly larger EDV (156 ± 54 vs. 107 ± 44 mL, P < 0.0001), ESV (104 ± 47 vs. 59 ± 36 mL, P < 0.0001) and lower EF (35 ± 12% vs. 48 ± 13%, P < 0.0001). 54% of DP patients developed remodeling at follow-up vs. 12% of those without DP (P < 0.001). During follow up, 7 events in the DP group (27%) and 11 events in patients without DP (9%; P < 0.02) occurred. Kaplan-Meier survival curves showed a worse prognosis for DP patients.
Conclusion
In patients with anterior AMI, early DP detection is related to subsequent LV dysfunction, larger infarct size, and worse severity. It is helpful for predicting LV remodeling at short-term follow-up and has prognostic implications.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 15 Dec 2021; epub ahead of print
Calabretta R, Castello A, Giglioli C, Cecchi E, ... Hacker M, Sciagrà R
J Nucl Cardiol: 15 Dec 2021; epub ahead of print | PMID: 34914082
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Volumetric evaluation of Tc-pyrophosphate SPECT/CT for transthyretin cardiac amyloidosis: Methodology and correlation with cardiac functional parameters.

Watanabe S, Nakajima K, Wakabayashi H, Yoneyama H, ... Inaki A, Kinuya S
Background
Volumetric evaluation of 99mTechnetium-pyrophosphate (99mTc-PYP) SPECT/CT is a useful method for assessing transthyretin cardiac amyloidosis (ATTR-CA). We investigated the methodology and assessed its relationship with conventional parameters.
Methods and results
We retrospectively evaluated 99mTc-PYP SPECT/CT scans of 25 patients who underwent endomyocardial biopsy and/or gene testing. Fourteen (56%) patients were diagnosed with ATTR-CA. SPECT/CT images were acquired at 3 hours after injection. Total volumes of the myocardial regions where uptakes were > 1.2 and 1.4 × aortic blood pool SUVmax were evaluated and defined as cardiac pyrophosphate volume (CPV1.2 and CPV1.4). The heart-to-contralateral lung (H/CL) ratio and myocardial SUVmax were also calculated. CPV1.2 achieved the highest sensitivity and specificity in diagnosing ATTR-CA. In patients diagnosed with ATTR-CA (n = 14), CPV1.2 negatively correlated with left ventricular ejection fraction and positively correlated with left ventricular posterior wall thickness and QRS duration. The correlation was stronger in CPV1.2 than in the H/CL ratio and SUVmax.
Conclusion
Volumetric evaluation of 99mTc-PYP SPECT/CT may be superior to the H/CL ratio and SUVmax in assessing the disease burden of ATTR-CA. Larger studies are warranted to clarify whether volumetric measurement can assess prognosis and disease progression.

© 2021. The Author(s).

J Nucl Cardiol: 13 Dec 2021; epub ahead of print
Watanabe S, Nakajima K, Wakabayashi H, Yoneyama H, ... Inaki A, Kinuya S
J Nucl Cardiol: 13 Dec 2021; epub ahead of print | PMID: 34907500
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Multimodality imaging for diagnosis of subclinical hereditary transthyretin cardiac amyloidosis.

Asif T, Vij A, Radzik B, Stern H, ... Ghadiali Q, Malhotra S
We present a case of a patient with worsening visual acuity and dense vitreal debris who was found to have vitreal transthyretin amyloid (ATTR) infiltration. Cardiac workup, performed to identify systemic amyloidosis, demonstrated focal myocardial amyloid infiltration on pyrophosphate (PYP) scintigraphy and cardiac magnetic resonance (CMR), resulting in a diagnosis of subclinical ATTR cardiac amyloidosis (ATTR-CA). Patient was identified as a carrier of p.S70R mutation which results in an aggressive ATTR phenotype. Patient is tolerating transthyretin silencer therapy well. Through this case, we discuss the role of a multimodality imaging approach for the diagnosis of subclinical ATTR-CA.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 05 Dec 2021; epub ahead of print
Asif T, Vij A, Radzik B, Stern H, ... Ghadiali Q, Malhotra S
J Nucl Cardiol: 05 Dec 2021; epub ahead of print | PMID: 34873643
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Phase analysis for ventricular arrhythmia prediction: A retrospective monocentric cohort study.

Beneyto M, Maury P, Rollin A, Mondoly P, ... Galinier M, Lairez O
Background
Prediction of ventricular arrhythmias (VA) mostly relies on left ventricular ejection fraction (LVEF), but with limited performance. New echocardiographic parameters such as mechanical dispersion have emerged, but acoustic window sometimes precludes this measurement. Nuclear imaging may be an alternative. We aimed to assess the ability of mechanical dispersion, measured with phase standard deviation (PSD) on radionuclide angiocardiography (RNA), to predict VAs.
Methods
This retrospective monocentric observational study included all patients who underwent a tomographic RNA from 2015 to 2019. Phase analysis yielded PSD and follow-up was examined to identify VAs, heart transplantation, and death.
Results
The study population consisted of 937 patients, mainly with LVEF ≤ 35% (425, 45%). Most had ischemic (334, 36%) or dilated cardiomyopathies (245, 26%). We identified 86 (9%) VAs. PSD was strongly associated with the occurrence of VA [hazard ratio per 10 ms increase (HR10) 1.12 (1.09-1.16)], heart transplantation [HR10 1.09 (1.06-1.12)], and death [HR10 1.03 (1.00-1.05)]. The association between PSD and VA persisted after adjustment for age, sex, QRS duration, LVEF, global longitudinal strain (GLS), and echocardiography-assessed mechanical dispersion.
Conclusion
The occurrence of ventricular arrhythmias was predicted by mechanical dispersion assessed by RNA, even after adjustment for LVEF and GLS.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 06 Dec 2021; epub ahead of print
Beneyto M, Maury P, Rollin A, Mondoly P, ... Galinier M, Lairez O
J Nucl Cardiol: 06 Dec 2021; epub ahead of print | PMID: 34877639
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Coronary vasomotor dysfunction portends worse outcomes in patients with breast cancer.

Divakaran S, Caron JP, Zhou W, Hainer J, ... Nohria A, Di Carli MF
Background
Impaired MFR in the absence of flow-limiting CAD is associated with adverse events. Cardiovascular disease is an important cause of morbidity and mortality in patients with breast cancer. We sought to test the utility of MFR to predict outcomes in a cohort of patients with breast cancer.
Methods
We retrospectively studied consecutive patients with breast cancer or breast cancer survivors who underwent cardiac stress PET imaging from 2006 to 2017 at Brigham and Women\'s Hospital. Patients with a history of clinically overt CAD, LVEF < 45%, or abnormal myocardial perfusion were excluded. Subjects were followed from time of PET to the occurrence of a first major adverse cardiovascular event (MACE) and all-cause death.
Results
The final cohort included 87 patients (median age 69.0 years, 98.9% female, mean MFR 2.05). Over a median follow-up of 7.6 years after PET, the lowest MFR tertile was associated with higher cumulative incidence of MACE (adjusted subdistribution hazard ratio 4.91; 95% CI 1.68-14.38; p = 0.004) when compared with the highest MFR tertile.
Conclusions
In patients with breast cancer, coronary vasomotor dysfunction was associated with incident cardiovascular events. MFR may have potential as a risk stratification biomarker among patients with/survivors of breast cancer.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 23 Nov 2021; epub ahead of print
Divakaran S, Caron JP, Zhou W, Hainer J, ... Nohria A, Di Carli MF
J Nucl Cardiol: 23 Nov 2021; epub ahead of print | PMID: 34820770
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Anti-inflammatory effect of rosuvastatin in patients with HIV infection: An FDG-PET pilot study.

Boczar KE, Faller E, Zeng W, Wang J, ... MacPherson P, Dwivedi G
Aims
This study aimed to evaluate markers of systemic as well as imaging markers of inflammation in the ascending aorta, bone marrow, and spleen measured by 18F-FDG PET/CT, in HIV+ patients at baseline and following therapy with rosuvastatin.
Methods and results
Of the 35 HIV+ patients enrolled, 17 were randomized to treatment with 10 mg/day rosuvastatin and 18 to usual care for 6 months. An HIV- control cohort was selected for baseline comparison of serum inflammatory markers and monocyte markers of inflammation. 18F-FDG-PET/CT imaging of bone marrow, spleen, and thoracic aorta was performed in the HIV+ cohort at baseline and 6 months. While CD14++CD16- and CCR2 expressions were reduced, serum levels of IL-7, IL-8, and MCP-1 were elevated in the HIV+ population compared to the controls. There was a significant drop in FDG uptake in the bone marrow (TBRmax), spleen (SUVmax) and thoracic aortic (TBRmax) in the statin-treated group compared to the control group (bone marrow: - 10.3 ± 16.9% versus 5.0 ± 18.9%, p = .0262; spleen: - 9.8 ± 20.3% versus 11.3 ± 28.8%, p = .0497; thoracic aorta: - 19.1 ± 24.2% versus 4.3 ± 15.4%, p = .003).
Conclusions
HIV+ patients had significantly markers of systemic inflammation including monocyte activation. Treatment with low-dose rosuvastatin in the HIV+ cohort significantly reduced bone marrow, spleen and thoracic aortic FDG uptake.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 23 Nov 2021; epub ahead of print
Boczar KE, Faller E, Zeng W, Wang J, ... MacPherson P, Dwivedi G
J Nucl Cardiol: 23 Nov 2021; epub ahead of print | PMID: 34820771
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Incremental value of F-FDG cardiac PET imaging over dobutamine stress echocardiography in predicting myocardial ischemia in patients with suspected coronary artery disease.

Zampella E, Assante R, Acampa W, Gaudieri V, ... Petretta M, Cuocolo A
Background
To assess the incremental value of 18F-fluorodeoxyglucose (FDG) cardiac positron emission tomography (PET) over dobutamine stress echocardiography (DSE) in predicting myocardial ischemia in patients with suspected coronary artery disease (CAD).
Methods
Forty-one patients with suspected CAD underwent within 7 days apart rest-stress cardiac PET with 82Rb and DSE followed by cardiac 18F-FDG PET imaging. 18F-FDG images were scored on a 0 (no discernible uptake) to 2 (intense uptake) scale. Logistic regression analysis was performed to identify predictors of stress-induced ischemia. The incremental value of 18F-FDG PET over DSE in detecting ischemia at 82Rb PET cardiac imaging was assessed by the likelihood ratio chi-square and net reclassification index.
Results
On 82Rb-PET imaging, myocardial ischemia (ischemic total perfusion defect ≥ 5%) was detected in 20 (49%) patients. Inducible ischemia was found in 22 (54%) patients on DSE (biphasic or worsening response pattern in ≥ 1 segment) and in 21 (51%) patients on 18F-FDG PET (uptake score of 2 in ≥ 1 segment). 18F-FDG PET resulted as statistically significant predictor of ischemia on 82Rb-PET. The addition of 18F-FDG PET to DSE increased the likelihood of ischemia on 82Rb-PET (P < .05). 18F-FDG PET was able to reclassify the probability of stress-induced myocardial ischemia on both patient and vessel analyses.
Conclusion
18F-FDG PET performed after dobutamine stress test may provide incremental value to DSE in the evaluation of myocardial ischemia. These results suggest that stress-induced myocardial ischemia can be imaged directly using 18F-FDG PET after dobutamine stress test.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 16 Nov 2021; epub ahead of print
Zampella E, Assante R, Acampa W, Gaudieri V, ... Petretta M, Cuocolo A
J Nucl Cardiol: 16 Nov 2021; epub ahead of print | PMID: 34791621
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic value of cardiac inflammation in ST-segment elevation myocardial infarction: A F-fluorodeoxyglucose PET/CT study.

Xi XY, Liu Z, Wang LF, Yang MF
Background
18F-fluorodeoxyglucose (FDG) imaging is used to detect cardiac inflammation and predict functional outcome in acute myocardial infarction (MI). However, data on the correlation of post-MI acute cardiac inflammation evaluated by 18F-FDG imaging and major adverse cardiac events (MACE) are limited. Therefore, we sought to explore the prognostic value of cardiac 18F-FDG imaging in patients with acute ST-segment elevation MI (STEMI).
Methods
Thirty-six patients with STEMI underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) 5 days after primary percutaneous coronary intervention. 18F-FDG activity in infarcted and remote regions, as well as peri-coronary adipose tissue (PCAT), were measured and expressed as the maximum standardized uptake value (SUVmax). Patients were followed to determine the occurrence of MACE.
Results
The infarcted myocardium had a higher 18F-FDG intensity than the remote area. Moreover, the PCAT of culprit coronary arteries showed a higher 18F-FDG uptake than that of non-culprit arteries. Multivariate Cox regression analysis showed that increased SUVmax of PCAT [HR 5.198; 95% CI (1.058, 25.537), P = .042] was independently associated with a higher risk of MACE.
Conclusions
Enhanced PCAT activity after acute MI is related to the occurrence of MACE, and 18F-FDG PET/CT plays a promising role in providing prognostic information in patients with STEMI.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 11 Nov 2021; epub ahead of print
Xi XY, Liu Z, Wang LF, Yang MF
J Nucl Cardiol: 11 Nov 2021; epub ahead of print | PMID: 34773185
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Impact of residual subtraction on myocardial blood flow and reserve estimates from rapid dynamic PET protocols.

Poitrasson-Rivière A, Moody JB, Renaud JM, Hagio T, ... Ficaro EP, Murthy VL
Background
13N-ammonia and 18F-flurpiridaz require longer delays between rest and stress studies to allow for decay, lowering clinical throughput. In this study, we investigated the impact of residual subtraction on MBF and MFR estimates, as well as its effects on diagnostic accuracy.
Methods
We retrospectively analyzed 63 patients who underwent a dynamic ammonia rest/stress study and 231 patients from the flurpiridaz 301 trial. Residual subtraction was performed by subtracting the mean pre-injection activity in each sampled region from that region\'s time activity curve. Corrected and uncorrected MBF and MFR were analyzed. Diagnostic accuracy was compared to quantitative coronary angiograms (QCA) for the flurpiridaz population.
Results
With delays between injections above 3 half-lives, and a doubled stress dose, residual activity did not meaningfully increase ammonia MBF (< 5%). For shorter injection delays, stress MBF was overestimated by 13.6% ± 5.0% (P < .001). Residual activity had a large effect on flurpiridaz stress MBF, overestimating it by 37.9% ± 23.2% (P < .001). Comparison to QCA showed a significant improvement in AUC with residual subtraction (from 0.748 to 0.831, P = .001). MFR yielded similar results.
Conclusions
Accounting for residual activity has a marked impact on stress MBF and MFR and improves diagnostic accuracy relative to QCA.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 14 Nov 2021; epub ahead of print
Poitrasson-Rivière A, Moody JB, Renaud JM, Hagio T, ... Ficaro EP, Murthy VL
J Nucl Cardiol: 14 Nov 2021; epub ahead of print | PMID: 34780036
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Comparison of diabetes to other prognostic predictors among patients referred for cardiac stress testing: A contemporary analysis from the REFINE SPECT Registry.

Han D, Rozanski A, Gransar H, Tzolos E, ... Berman DS, Slomka PJ
Background
Diabetes mellitus (DM) is increasingly prevalent among contemporary populations referred for cardiac stress testing, but its potency as a predictor for major adverse cardiovascular events (MACE) vs other clinical variables is not well delineated.
Methods and results
From 19,658 patients who underwent SPECT-MPI, we identified 3122 patients with DM without known coronary artery disease (CAD) (DM+/CAD-) and 3564 without DM with known CAD (DM-/CAD+). Propensity score matching was used to control for the differences in characteristics between DM+/CAD- and DM-/CAD+ groups. There was comparable MACE in the matched DM+/CAD- and DM-/CAD+ groups (HR 1.15, 95% CI 0.97-1.37). By Chi-square analysis, type of stress (exercise or pharmacologic), total perfusion deficit (TPD), and left ventricular function were the most potent predictors of MACE, followed by CAD and DM status. The combined consideration of mode of stress, TPD, and DM provided synergistic stratification, an 8.87-fold (HR 8.87, 95% CI 7.27-10.82) increase in MACE among pharmacologically stressed patients with DM and TPD > 10% (vs non-ischemic, exercised stressed patients without DM).
Conclusions
Propensity-matched patients with DM and no known CAD have similar MACE risk compared to patients with known CAD and no DM. DM is synergistic with mode of stress testing and TPD in predicting the risk of cardiac stress test patients.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 09 Nov 2021; epub ahead of print
Han D, Rozanski A, Gransar H, Tzolos E, ... Berman DS, Slomka PJ
J Nucl Cardiol: 09 Nov 2021; epub ahead of print | PMID: 34757571
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Pulmonary perfusion and NYHA classification improve after cardiac resynchronization therapy.

Al-Mashat M, Borgquist R, Carlsson M, Arheden H, Jögi J
Background
Evaluation of cardiac resynchronization therapy (CRT) often includes New York Heart Association (NYHA) classification, and echocardiography. However, these measures have limitations. Perfusion gradients from ventilation/perfusion single-photon emission computed tomography (V/P SPECT) are related to left-heart filling pressures and have been validated against invasive right-heart catheterization. The aim was to assess if changes in perfusion gradients are associated with improvements in heart failure (HF) symptoms after CRT, and if they correlate with currently used diagnostic methods in the follow-up of patients with HF after receiving CRT.
Methods and results
Nineteen patients underwent V/P SPECT, echocardiography, NYHA classification, and the quality-of-life scoring system \"Minnesota living with HF\" (MLWHF), before and after CRT. CRT caused improvement in perfusion gradients from V/P SPECT which were associated with improvements in NYHA classification (P = .0456), whereas improvements in end-systolic volume (LVESV) from echocardiography were not. After receiving CRT, the proportion of patients who improved was lower using LVESV (n = 7/19, 37%) than perfusion gradients (n = 13/19, 68%). Neither change in perfusion gradients nor LVESV was associated with changes in MLWHF (P = 1.0, respectively).
Conclusions
Measurement of perfusion gradients from V/P SPECT is a promising quantitative user-independent surrogate measure of left-sided filling pressure in the assessment of CRT response in patients with HF.

© 2021. The Author(s).

J Nucl Cardiol: 07 Nov 2021; epub ahead of print
Al-Mashat M, Borgquist R, Carlsson M, Arheden H, Jögi J
J Nucl Cardiol: 07 Nov 2021; epub ahead of print | PMID: 34750725
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic implication of myocardial perfusion and contractile reserve in end-stage renal disease: A direct comparison of myocardial perfusion scintigraphy and dobutamine stress echocardiography.

Bautz J, Stypmann J, Reiermann S, Pavenstädt HJ, ... Reuter S, Schäfers M
Background
We aimed to compare the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) without known coronary artery disease.
Methods
Two-hundred twenty-nine ESRD patients who applied for kidney transplantation at our centre were prospectively evaluated by MPS and DSE. The primary endpoint was a composite of myocardial infarction (MI) or all-cause mortality. The secondary endpoint included MI or coronary revascularization (CR) not triggered by MPS or DSE at baseline.
Results
MPS detected reversible ischemia in 31 patients (13.5%) and fixed perfusion defects in 13 (5.7%) patients. DSE discovered stress-induced wall motion abnormalities (WMAs) in 28 (12.2%) and at rest in 18 (7.9%) patients. MPS and DSE results agreed in 85.6% regarding reversible defects (κ = 0.358; P < .001) and in 90.8% regarding fixed defects (κ = 0.275; P < .001). Coronary angiography detected relevant stenosis > 50% in only 15 of 38 patients (39.5%) with pathological findings in MPS and/or DSE. At a median follow-up of 8 years and 10 months, the primary endpoint occurred in 70 patients (30.6%) and the secondary endpoint in 24 patients (10.5%). The adjusted Cox hazard ratios (HRs) for the primary endpoint were 1.77 (95% CI 1.02-3.08; P = .043) for perfusion defects in MPS and 1.36 (95% CI 0.78-2.37; P = ns) for WMA in DSE. The secondary endpoint was significantly correlated with the findings of both modalities, MPS (HR 3.21; 95% CI 1.35-7.61; P = .008) and DSE (HR 2.67; 95% CI 1.15-6.20; P = .022).
Conclusion
Perfusion defects in MPS are a stronger determinant of all-cause mortality, MI and the need for future CR compared with WMAs in DSE. Given the complementary functional information provided by MPS vs DSE, results are sometimes contradictory, which may indicate differences in the underlying pathophysiology.

© 2021. The Author(s).

J Nucl Cardiol: 07 Nov 2021; epub ahead of print
Bautz J, Stypmann J, Reiermann S, Pavenstädt HJ, ... Reuter S, Schäfers M
J Nucl Cardiol: 07 Nov 2021; epub ahead of print | PMID: 34750727
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Potential novel imaging targets of inflammation in cardiac sarcoidosis.

Park J, Young BD, Miller EJ
Cardiac sarcoidosis (CS) is an inflammatory disease with high morbidity and mortality, with a pathognomonic feature of non-caseating granulomatous inflammation. While 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality to image inflammation and diagnose CS, there are limitations to its specificity and reproducibility. Imaging focused on the molecular processes of inflammation including the receptors and cellular microenvironments present in sarcoid granulomas provides opportunities to improve upon FDG-PET imaging for CS. This review will highlight the current limitations of FDG-PET imaging for CS while discussing emerging new nuclear imaging molecular targets for the imaging of cardiac sarcoidosis.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 02 Nov 2021; epub ahead of print
Park J, Young BD, Miller EJ
J Nucl Cardiol: 02 Nov 2021; epub ahead of print | PMID: 34734365
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

External validation of the CRAX2MACE model in an Italian cohort of patients with suspected coronary artery disease undergoing stress myocardial perfusion imaging.

Megna R, Petretta M, Assante R, Zampella E, ... Acampa W, Cuocolo A
Background
Prevention and development of diagnostic and therapeutic techniques reduced morbidity and mortality for coronary artery disease (CAD). In this context, the cardiovascular risk assessment for major adverse cardiac events (MACE) at 2-year (CRAX2MACE) model for prediction of 2-year major adverse cardiac events was developed. We performed an external validation of this model.
Methods
We included 1003 patients with suspected CAD undergoing stress-rest single-photon emission computed tomography myocardial perfusion imaging at our academic center between March 2015 and April 2019.
Results
Considering the occurrence of MACE (death from any cause, acute myocardial infarction, or late coronary revascularization), for the CRAX2MACE model the area under the receiver operating characteristic curve was 0.612 and the Brier score was 0.061. The Hosmer-Lemeshow test estimated a non-optimal fit (χ2 28, P < .001). Considering only hard events (cardiac death, acute myocardial infarction), the external validation of the CRAX2MACE model revealed a Brier score of 0.053 and an area under the receiver operating characteristic curve of 0.621. Hosmer-Lemeshow test was calculated by deciles and showed a poor fit (χ2 31, P < .001).
Conclusion
CRAX2MACE model had a limited value for predicting 2-year major adverse cardiovascular events in an external validation cohort of patients with suspected CAD.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 02 Nov 2021; epub ahead of print
Megna R, Petretta M, Assante R, Zampella E, ... Acampa W, Cuocolo A
J Nucl Cardiol: 02 Nov 2021; epub ahead of print | PMID: 34734366
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Effect of nitroglycerin on splanchnic and pulmonary blood volume.

Okamoto LE, Dupont WD, Biaggioni I, Kronenberg MW
Background
Sublingual nitroglycerin (SL NTG) is useful for treating acute decompensated heart failure, possibly by increasing splanchnic capacitance and reducing left ventricular (LV) preload. We evaluated a radionuclide method to study these effects, initially in subjects without heart failure.
Methods and results
Red blood cells were labelled by an in vitro method. Abdominal and chest images were obtained at rest, showing relative regional blood volumes. The abdomen was then re-imaged during progressive escalation of intrathoracic pressure using continuous positive airway pressure to assess baseline splanchnic capacitance (pressure-volume relationship, PVR) and compliance (slope of PVR). The procedure was repeated after 0.6 mg SL NTG, followed by chest images. Relative splanchnic blood volume increased at rest after SL NTG (P < .002), signifying an increase in splanchnic capacitance. The slope of the splanchnic PVR decreased in proportion to the baseline PVR (P = .0014), signifying increased compliance. The relative pulmonary blood volume decreased in proportion to the increase in splanchnic blood volume (P = .01).
Conclusions
A semi-quantitative radionuclide method demonstrated the effect of SL NTG for increasing splanchnic capacitance and compliance, with a proportional decrease in pulmonary blood volume. These data may be applied to quantitatively evaluate the importance of splanchnic vasodilation as a mechanism of LV preload reduction in the treatment of heart failure.
Clinical trials registration
NCT02425566.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 01 Nov 2021; epub ahead of print
Okamoto LE, Dupont WD, Biaggioni I, Kronenberg MW
J Nucl Cardiol: 01 Nov 2021; epub ahead of print | PMID: 34729682
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Normal imaging findings after ascending aorta prosthesis implantation on F-Fluorodeoxyglucose Positron Emission Tomography with computed tomography.

Wahadat AR, Tanis W, Mulders TA, Graven LH, ... Roos-Hesselink JW, Budde RPJ
Background
To diagnose abnormal 18F-Fluorodeoxyglucose (18F-FDG) uptake in suspected endocarditis after aortic root and/or ascending aorta prosthesis (ARAP) implantation, it is important to first establish the normal periprosthetic uptake on positron emission tomography with computed tomography (PET/CT).
Methods
Patients with uncomplicated ARAP implantation were prospectively included and underwent 18F-FDG-PET/CT at either 12 (± 2) weeks (group 1) or 52 (± 8) weeks (group 2) after procedure. Uptake on three different locations of the prosthesis (\"cranial anastomosis (CA),\" \"prosthetic heart valve (PHV),\" \"ascending aorta prosthesis (AAP)\") was scored visually (none/low/intermediate/high) and quantitatively (maximum standardized uptake value (SUVmax) and target-to-background ratio (SUVratio).
Results
In total, 20 patients (group 1: n = 10, group 2: n = 10) (mean age 64±7 years, 70% male) were included. Both groups had similar visual uptake intensity for all measured areas (CA: mostly low-intermediate (16/20 (80%)), p = .17; PHV: low-intermediate (16/20 (80%)), p = .88; AAP: low-intermediate (19/20 (95%)), p = .48). SUVmax for CA was 5.6 [4.1-6.1] and 3.8 [3.1-5.9] (median [IQR], p = .19), and around PHV 5.0 [4.1-5.7] and 6.3 [4.6-7.1] (p = .11) for groups 1 and 2, respectively. SUVratio for CA was 2.8 [2.3-3.2] and 2.0 [1.7-2.6] (median [IQR], p = .07) and around PHV 2.5 [2.4-2.8] and 2.9 [2.3-3.5] (median [IQR], p = .26) for groups 1 and 2, respectively.
Conclusion
No significant differences were observed between PET/CT findings at 3 months and 1 year after ARAP implantation, warranting caution in interpretation of PET/CT in the first year after implantation.

© 2021. The Author(s).

J Nucl Cardiol: 26 Oct 2021; epub ahead of print
Wahadat AR, Tanis W, Mulders TA, Graven LH, ... Roos-Hesselink JW, Budde RPJ
J Nucl Cardiol: 26 Oct 2021; epub ahead of print | PMID: 34708302
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Vascular/perivascular inflammation in IgG4-related disease.

Imai S, Tahara N, Igata S, Tahara A, ... Fukumoto Y, Tayama E
Background
Immunoglobulin G4-related disease (IgG4-RD) is characterized by the infiltration of IgG4-positive plasma cells and fibrosclerotic inflammation in multiple organs. Although vascular complications are present in some patients with IgG4-RD, vascular and/or perivascular inflammatory activity compared to control subjects remains unknown. This study sought to investigate vascular/perivascular inflammation in IgG4-RD patients compared to control subjects using 18F-fluorodeoxyglucose-positron emission tomography combined with computed tomography (FDG-PET/CT).
Methods
We examined 37 consecutive patients diagnosed as IgG4-RD (29 males, mean age of 64.3 ± 8.3 years old), who underwent FDG-PET/CT. Thirty-seven age- and gender-matched subjects without IgG4-RD were employed as controls. Vascular/perivascular inflammation was quantified by blood-normalized standardized uptake value, known as a target-to-background ratio (TBR).
Results
All IgG4-RD patients presented with multiple region involvements. Twelve (32.4%) of the IgG4-RD patients had vascular complications, all of which appeared in the abdominal aorta. IgG4-RD patients had significantly higher TBR values in the descending aorta, abdominal aorta, and common iliac artery than control subjects. Also, IgG4-RD patients with vascular complication exhibited higher TBR values in the infra-renal aorta and common iliac artery than those without vascular complication.
Conclusions
We found that vascular FDG activity is significantly elevated in IgG4-RD patients regardless of vascular complication than control subjects. FDG-PET/CT is a useful modality for assessing vascular/perivascular inflammation, which may contribute vascular complication in IgG4-RD patients.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 25 Oct 2021; epub ahead of print
Imai S, Tahara N, Igata S, Tahara A, ... Fukumoto Y, Tayama E
J Nucl Cardiol: 25 Oct 2021; epub ahead of print | PMID: 34704218
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

An optimized imaging protocol for [Tc]Tc-DPD scintigraphy and SPECT/CT quantification in cardiac transthyretin (ATTR) amyloidosis.

Schatka I, Bingel A, Schau F, Bluemel S, ... Rogasch JMM, Wetz C
Background
In [99mTc]Tc-DPD scintigraphy for myocardial ATTR amyloidosis, planar images 3 hour p.i. and SPECT/CT acquisition in L-mode are recommended. This study investigated if earlier planar images (1 hour p.i.) are beneficial and if SPECT/CT acquisition should be preferred in H-mode (180° detector angle) or L-mode (90°).
Methods
In SPECT/CT phantom measurements (NaI cameras, N = 2; CZT, N = 1), peak contrast recovery (CRpeak) was derived from sphere inserts or myocardial insert (cardiac phantom; signal-to-background ratio [SBR], 10:1 or 5:1). In 25 positive and 38 negative patients (reference: endomyocardial biopsy or clinical diagnosis), Perugini scores and heart-to-contralateral (H/CL) count ratios were derived from planar images 1 hour and 3 hour p.i.
Results
In phantom measurements, accuracy of myocardial CRpeak at SBR 10:1 (H-mode, 0.95-0.99) and reproducibility at 5:1 (H-mode, 1.02-1.14) was comparable for H-mode and L-mode. However, L-mode showed higher variability of background counts and sphere CRpeak throughout the field of view than H-mode. In patients, sensitivity/specificity were ≥ 95% for H/CL ratios at both time points and visual scoring 3 hour. At 1 hour, visual scores showed specificity of 89% and reduced reader\'s confidence.
Conclusions
Early DPD images provided no additional value for visual scoring or H/CL ratios. In SPECT/CT, H-mode is preferred over L-mode, especially if quantification is applied apart from the myocardium.

© 2021. The Author(s).

J Nucl Cardiol: 29 Nov 2021; 28:2483-2496
Schatka I, Bingel A, Schau F, Bluemel S, ... Rogasch JMM, Wetz C
J Nucl Cardiol: 29 Nov 2021; 28:2483-2496 | PMID: 34331215
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Changes in left atrial function in patients undergoing cardioversion for atrial fibrillation: relevance of left atrial strain in heart failure.

von Roeder M, Blazek S, Rommel KP, Kresoja KP, ... Thiele H, Lurz P
Background
Left atrial (LA) reservoir strain provides prognostic information in patients with and without heart failure (HF), but might be altered by atrial fibrillation (AF). The aim of the current study was to investigate changes of LA deformation in patients undergoing cardioversion (CV) for first-time diagnosis of AF.
Methods and results
We performed 3D-echocardiography and strain analysis before CV (Baseline), after 25 ± 10 days (FU-1) and after 190 ± 20 days (FU-2). LA volumes, reservoir, conduit and active function were measured. In total, 51 patients were included of whom 35 were in SR at FU-1 (12 HF and preserved ejection fraction (HFpEF)), while 16 had ongoing recurrence of AF (9 HFpEF). LA maximum volume was unaffected by cardioversion (Baseline vs. FU-2: 41 ± 11 vs 40 ± 10 ml/m2; p = 0.85). Restored SR led to a significant increase in LA reservoir strain (Baseline vs FU-1: 12.9 ± 6.8 vs 24.6 ± 9.4, p < 0.0001), mediated by restored LA active strain (SR group Baseline vs. FU-1: 0 ± 0 vs. 12.3 ± 5.3%, p < 0.0001), while LA conduit strain remained unchanged (Baseline vs. FU-1: 12.9 ± 6.8 vs 13.1 ± 6.2, p = 0.78). Age-controlled LA active strain remained the only significant predictor of LA reservoir strain on multivariable analysis (β 1.2, CI 1.04-1.4, p < 0.0001). HFpEF patients exhibited a significant increase in LA active (8.2 ± 4.3 vs 12.2 ± 6.6%, p = 0.004) and reservoir strain (18.3 ± 5.7 vs. 22.8 ± 8.8, p = 0.04) between FU-1 and FU-2, associated with improved LV filling (r = 0.77, p = 0.005).
Conclusion
Reestablished SR improves LA reservoir strain by restoring LA active strain. Despite prolonged atrial stunning following CV, preserved SR might be of hemodynamic and prognostic benefit in HFpEF.

© 2021. The Author(s).

Clin Res Cardiol: 20 Dec 2021; epub ahead of print
von Roeder M, Blazek S, Rommel KP, Kresoja KP, ... Thiele H, Lurz P
Clin Res Cardiol: 20 Dec 2021; epub ahead of print | PMID: 34932171
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prevalence and risk of progressive aortic aneurysm and dissection in adults with conotruncal anomalies.

Egbe AC, Miranda WR, Bonnichsen CR, Jain CC, ... Gandhi S, Connolly HM
Aims
Conotruncal anomalies share common embryogenic defects of the outflow tracts and great arteries, which result in a predisposition to aortic aneurysms. The purpose of this study was to describe the prevalence and risk of progressive aortic aneurysms in adults with conotruncal anomalies.
Methods and results
Retrospective study of adults with conotruncal anomalies that underwent cross-sectional imaging 2003-20. Aneurysm was defined as aortic root/mid-ascending aorta >2.1 mm/m2/>1.9 mm/m2, progressive aneurysm as increase by >2 mm, and severe aneurysm as dimension >50 mm. Of 2261 patients (38 ± 12 years; male 58%), 1167 (52%) had an aortic aneurysm, and 205 (14%) had a severe aortic aneurysm. Mean annual increase in aortic root/mid-ascending aorta was 0.3 ± 0.1 mm/0.2 ± 0.1 mm. The 3-, 5-, and 7-year cumulative incidence of the progressive aortic aneurysm was 4%, 7%, and 9%, respectively. The rate of aneurysm growth decreased with age, with no significant growth after age 40 years. There was an excellent correlation between aortic indices from cross-sectional imaging and echocardiography. Of 950 females, 184 had ≥1 pregnancy, and 81 (44%) of the 184 patients had aortic aneurysm prior to pregnancy. There was no aortic dissection or progression of the aortic aneurysm during pregnancy. Overall, there was no aortic dissection during 7984 patient-years of follow-up.
Conclusions
Aortic aneurysm was common in patients with conotruncal anomalies. However, the risk of progressive aneurysm or dissection was low. Collectively, these data suggest a benign natural history and perhaps a less frequent need for cross-sectional imaging. Further studies are required to determine the optimal timing for surgical intervention in this population.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]

Eur Heart J Cardiovasc Imaging: 21 Dec 2021; epub ahead of print
Egbe AC, Miranda WR, Bonnichsen CR, Jain CC, ... Gandhi S, Connolly HM
Eur Heart J Cardiovasc Imaging: 21 Dec 2021; epub ahead of print | PMID: 34939103
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

A three-dimensional atlas of child\'s cardiac anatomy and the unique morphological alterations associated with obesity.

Marciniak M, van Deutekom AW, Toemen L, Lewandowski AJ, ... Jaddoe VWV, Lamata P
Aims
Statistical shape models (SSMs) of cardiac anatomy provide a new approach for analysis of cardiac anatomy. In adults, specific cardiac morphologies associate with cardiovascular risk factors and early disease stages. However, the relationships between morphology and risk factors in children remain unknown. We propose an SSM of the paediatric left ventricle to describe its morphological variability, examine its relationship with biometric parameters and identify adverse anatomical remodelling associated with obesity.
Methods and results
This cohort includes 2631 children (age 10.2 ± 0.6 years), mostly Western European (68.3%) with a balanced sex distribution (51.3% girls) from Generation R study. Cardiac magnetic resonance short-axis cine scans were segmented. Three-dimensional left ventricular (LV) meshes are automatically fitted to the segmentations to reconstruct the anatomies. We analyse the relationships between the LV anatomical features and participants\' body surface area (BSA), age, and sex, and search for features uniquely related to obesity based on body mass index (BMI). In the SSM, 19 modes described over 90% of the population\'s LV shape variability. Main modes of variation were related to cardiac size, sphericity, and apical tilting. BSA, age, and sex were mostly correlated with modes describing LV size and sphericity. The modes correlated uniquely with BMI suggested that obese children present with septo-lateral tilting (R2 = 4.0%), compression in the antero-posterior direction (R2 = 3.3%), and decreased eccentricity (R2 = 2.0%).
Conclusions
We describe the variability of the paediatric heart morphology and identify anatomical features related to childhood obesity that could aid in risk stratification. Web service is released to provide access to the new shape parameters.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Eur Heart J Cardiovasc Imaging: 20 Dec 2021; epub ahead of print
Marciniak M, van Deutekom AW, Toemen L, Lewandowski AJ, ... Jaddoe VWV, Lamata P
Eur Heart J Cardiovasc Imaging: 20 Dec 2021; epub ahead of print | PMID: 34931224
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Contraction patterns of the systemic right ventricle: a three-dimensional echocardiography study.

Surkova E, Kovács A, Lakatos BK, Tokodi M, ... Senior R, Li W
Aims
To investigate contraction patterns of the systemic right ventricle (SRV) in patients with transposition of great arteries (TGA) post-atrial switch operation and with congenitally corrected transposition of great arteries (ccTGA).
Methods and results
Right ventricular (RV) volumes and ejection fraction (EF) were measured by three-dimensional echocardiography in 38 patients with the SRV (24 TGA and 14 ccTGA; mean age 45 ± 12 years, 63% male), and in 38 healthy volunteers. The RV contraction was decomposed along the longitudinal, radial, and anteroposterior directions providing longitudinal, radial, and anteroposterior EF (LEF, REF, and AEF, respectively) and their contributions to total right ventricular ejection fraction (LEFi, REFi, and AEFi, respectvely). SRV was significantly larger with lower systolic function compared with healthy controls. SRV EF and four-chamber longitudinal strain strongly correlated with B-type natriuretic peptide (BNP) level (Rho -0.73, P < 0.0001 and 0.70, P < 0.0001, respectively). In patients with TGA, anteroposterior component was significantly higher than longitudinal and radial components (AEF 17 ± 4.5% vs. REF 13 ± 4.9% vs. LEF 10 ± 3.3%, P < 0.0001; AEFi 0.48 ± 0.09 vs. REFi 0.38 ± 0.1 vs. LEFi 0.29 ± 0.08, P < 0.0001). In patients with ccTGA, there was no significant difference between three SRV components. AEFi was significantly higher in TGA subgroup compared with ccTGA (0.48 ± 0.09 vs. 0.36 ± 0.08, P = 0.0002).
Conclusion
Contraction patterns of the SRV are different in TGA and ccTGA. Anteroposterior component is dominant in TGA providing compensation for impaired longitudinal and radial components, while in ccTGA all components contribute equally to the total EF. SRV EF and longitudinal strain demonstrate strong correlation with BNP level and should be a part of routine echocardiographic assessment of the SRV.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]

Eur Heart J Cardiovasc Imaging: 19 Dec 2021; epub ahead of print
Surkova E, Kovács A, Lakatos BK, Tokodi M, ... Senior R, Li W
Eur Heart J Cardiovasc Imaging: 19 Dec 2021; epub ahead of print | PMID: 34928339
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Iatrogenic Atrial Septal Defects Following Transcatheter Mitral Valve Repair and Implications of Interventional Closure.

Lurz P, Unterhuber M, Rommel KP, Kresoja KP, ... Blazek S, von Roeder M
Objectives
The authors investigated whether iatrogenic atrial septal defect (iASD) closure post-transcatheter mitral valve edge-to-edge repair (TMVR) is superior to conservative therapy (CT) and whether outcomes (death/heart failure [HF] hospitalization) differ between patients with and without an iASD post-TMVR.
Background
Transseptal access for TMVR can create an iASD, which is associated with impaired outcomes. Controversially, the creation of an iASD in HF has been linked to improved hemodynamics.
Methods
80 patients with an iASD and relevant left-to-right shunting (Qp:Qs ≥1.3) 30 days following TMVR were randomized to CT or interventional closure of the iASD (MITHRAS [Closure of Iatrogenic Atrial Septal Defect Following Transcatheter Mitral Valve Repair] cohort), and 235 patients without an iASD served as a comparative cohort.
Results
All patients of the MITHRAS cohort (mean age 77 ± 9 years, 39% women) received their allocated treatment, and follow-up was completed for all MITHRAS and comparative cohort (mean age 77 ± 8 years, 47% women) patients. Twelve months post-TMVR, there was no significant difference in the combined endpoint of death or HF hospitalization within the MITHRAS cohort (iASD closure: 35% vs CT 50%; P = 0.26). The combined endpoint was more frequent among patients within the MITHRAS cohort as opposed to the comparative cohort (43% vs 17%; P < 0.0001), primarily driven by a higher rate of HF hospitalization (34% vs 8%; P = 0.004).
Conclusions
In this randomized controlled trial, interventional closure of a relevant iASD 1 month after TMVR did not result in improved clinical outcomes at 12 months post-TMVR. Patients with an iASD are at higher risk for HF hospitalization independent of iASD management and warrant close follow-up. (Closure of Iatrogenic Atrial Septal Defect Following Transcatheter Mitral Valve Repair [MITHRAS]; NCT03024268).

Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

JACC Cardiovasc Interv: 26 Dec 2021; 14:2685-2694
Lurz P, Unterhuber M, Rommel KP, Kresoja KP, ... Blazek S, von Roeder M
JACC Cardiovasc Interv: 26 Dec 2021; 14:2685-2694 | PMID: 34949392
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Atrial Septostomy for Left Ventricular Unloading During Extracorporeal Membrane Oxygenation for Cardiogenic Shock: Animal Model.

Mlcek M, Meani P, Cotza M, Kowalewski M, ... Lorusso R, Belohlavek J
Objectives
The aim of this study was to quantify and understand the unloading effect of percutaneous balloon atrial septostomy (BAS) in acute cardiogenic shock (CS) treated with venoarterial (VA) extracorporeal membranous oxygenation (ECMO).
Background
In CS treated with VA ECMO, increased left ventricular (LV) afterload is observed that commonly interferes with myocardial recovery or even promotes further LV deterioration. Several techniques for LV unloading exist, but the optimal strategy and the actual extent of such procedures have not been fully disclosed.
Methods
In a porcine model (n = 11; weight 56 kg [53-58 kg]), CS was induced by coronary artery balloon occlusion (57 minutes [53-64 minutes]). Then, a step-up VA ECMO protocol (40-80 mL/kg/min) was run before and after percutaneous BAS was performed. LV pressure-volume loops and multiple hemoglobin saturation data were evaluated. The Wilcoxon rank sum test was used to assess individual variable differences.
Results
Immediately after BAS while on VA ECMO support, LV work decreased significantly: pressure-volume area, end-diastolic pressure, and stroke volume to ∼78% and end-systolic pressure to ∼86%, while superior vena cava and tissue oximetry did not change. During elevating VA ECMO support (40-80 mL/kg/min) with BAS vs without BAS, we observed 1) significantly less mechanical work increase (122% vs 172%); 2) no end-diastolic volume increase (100% vs 111%); and 3) a considerable increase in end-systolic pressure (134% vs 144%).
Conclusions
In acute CS supported by VA ECMO, atrial septostomy is an effective LV unloading tool. LV pressure is a key component of LV work load, so whenever LV work reduction is a priority, arterial pressure should carefully be titrated low while maintaining organ perfusion.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

JACC Cardiovasc Interv: 26 Dec 2021; 14:2698-2707
Mlcek M, Meani P, Cotza M, Kowalewski M, ... Lorusso R, Belohlavek J
JACC Cardiovasc Interv: 26 Dec 2021; 14:2698-2707 | PMID: 34949394
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Left ventricular remodelling in bicuspid aortic valve disease.

Butcher SC, Pio SM, Kong WKF, Singh GK, ... Bax JJ, Delgado V
Aims
Characterization of left ventricular (LV) geometric pattern and LV mass could provide an important insight into the pathophysiological adaptations of the LV to pressure and/or volume overload in patients with bicuspid aortic valve (BAV) and significant (≥moderate) aortic valve (AV) disease. This study aimed to characterize LV remodelling and its prognostic impact in patients with BAV according to the predominant type of valvular dysfunction.
Methods and results
In this international, multicentre BAV registry, 1345 patients [51.0 (37.0-63.0) years, 71% male] with significant AV disease were identified. Patients were classified as having isolated aortic stenosis (AS) (n = 669), isolated aortic regurgitation (AR) (n = 499) or mixed aortic valve disease (MAVD) (n = 177). LV hypertrophy was defined as a LV mass index >115 g/m2 in males and >95 g/m2 in females. LV geometric pattern was classified as (i) normal geometry: no LV hypertrophy, relative wall thickness (RWT) ≤0.42, (ii) concentric remodelling: no LV hypertrophy, RWT >0.42, (iii) concentric hypertrophy: LV hypertrophy, RWT >0.42, and (iv) eccentric hypertrophy: LV hypertrophy, RWT ≤0.42. Patients were followed-up for the endpoints of event-free survival (defined as a composite of AV repair/replacement and all-cause mortality) and all-cause mortality. Type of AV dysfunction was related to significant variations in LV remodelling. Higher LV mass index, i.e. LV hypertrophy, was independently associated with the composite endpoint for patients with isolated AS [hazard ratio (HR) 1.08 per 25 g/m2, 95% confidence interval (CI) 1.00-1.17, P = 0.046] and AR (HR 1.19 per 25 g/m2, 95% CI 1.11-1.29, P < 0.001), but not for those with MAVD. The presence of concentric remodelling, concentric hypertrophy and eccentric hypertrophy were independently related to the composite endpoint in patients with isolated AS (HR 1.54, 95% CI 1.06-2.23, P = 0.024; HR 1.68, 95% CI 1.17-2.42, P = 0.005; HR 1.59, 95% CI 1.03-2.45, P = 0.038, respectively), while concentric hypertrophy and eccentric hypertrophy were independently associated with the combined endpoint for those with isolated AR (HR 2.49, 95% CI 1.35-4.60, P = 0.004 and HR 3.05, 95% CI 1.71-5.45, P < 0.001, respectively). There was no independent association observed between LV remodelling and the combined endpoint for patients with MAVD.
Conclusions
LV hypertrophy or remodelling were independently associated with the composite endpoint of AV repair/replacement and all-cause mortality for patients with isolated AS and isolated AR, although not for patients with MAVD.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]

Eur Heart J Cardiovasc Imaging: 29 Dec 2021; epub ahead of print
Butcher SC, Pio SM, Kong WKF, Singh GK, ... Bax JJ, Delgado V
Eur Heart J Cardiovasc Imaging: 29 Dec 2021; epub ahead of print | PMID: 34966913
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association between four-dimensional echocardiographic left atrial measures and left atrial fibrosis assessed by left atrial late gadolinium enhancement.

Olsen FJ, Bertelsen L, Vejlstrup N, Diederichsen SZ, ... Svendsen JH, Biering-Sørensen T
Aims
Left atrial (LA) fibrosis is a hallmark of atrial cardiomyopathy, and non-invasive surrogate measures of LA fibrosis are therefore needed. We investigated the association between four-dimensional (4D) echocardiographic LA measures and LA fibrosis.
Methods and results
A multimodality imaging substudy was performed in a randomized clinical trial (LOOP study), recruiting elderly participants with cardiovascular risk factors. LA late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging was used as a surrogate for LA fibrosis. 4D echocardiographic LA quantification was used to measure maximal and minimal LA volume (LAVmax and LAVmin, respectively), LA emptying fractions (LAEFtotal), and strain. Logistic regression was used to relate LA measures to high LA LGE (≥17 cm2). Of the 44 participants (mean age 76 years, 64% men, median LA LGE 13.1 cm2), 14 exhibited high LA LGE. These participants exhibited abnormalities in several LA functional measures but not LAVmax. In linear regressions, only increasing LAVmin, and decreasing LAEFtotal, and reservoir strain were associated with increasing LA LGE. Furthermore, increasing LAVmin was associated with a higher likelihood of high LA LGE [odds ratio (OR) = 1.19 (1.04-1.37)]. Decreasing LAEFtotal and reservoir strain were also associated with higher likelihood of LA LGE [OR = 1.18 (1.05-1.33)] and OR = 1.15 (1.02-1.30), per 1% decrease in LAEFtotal and reservoir strain, respectively]. These findings were consistent after multivariable adjustments. LAEFtotal provided the highest performance for detecting high LA LGE (area under the curve of 0.78).
Conclusion
LAVmin, LAEFtotal, and reservoir strain measured by 4D echocardiography are significantly associated with LA LGE. LAEFtotal provides the best performance for detecting high LA LGE.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]

Eur Heart J Cardiovasc Imaging: 28 Dec 2021; epub ahead of print
Olsen FJ, Bertelsen L, Vejlstrup N, Diederichsen SZ, ... Svendsen JH, Biering-Sørensen T
Eur Heart J Cardiovasc Imaging: 28 Dec 2021; epub ahead of print | PMID: 34964463
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

EACVI survey on hypertrophic cardiomyopathy.

Podlesnikar T, Cardim N, Ajmone Marsan N, D\'Andrea A, ... Haugaa KH, Dweck MR
Aims
The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate current practice for the assessment and management of patients with hypertrophic cardiomyopathy (HCM).
Methods and results
A total of 213 centres from 38 different countries (87% European) responded to the survey. One hundred twenty-one (57%) centres followed HCM patients in a general cardiology outpatient clinic and 85 (40%) centres in a specialized HCM/cardiomyopathy clinic. While echocardiography was the primary imaging modality, cardiovascular magnetic resonance (CMR) has become an important complementary tool. Cardiac anatomy, left ventricular (LV) systolic, and diastolic function were assessed according to current European guidelines and recommendations. To evaluate LV obstruction, 49% of the centres performed bedside provocation manoeuvres in every patient and 55% of the centres used exercise stress echocardiography. The majority of centres used the 5-year risk assessment of sudden cardiac death (SCD) calculated with the HCM Risk-SCD score. However, 34% of the centres also used extensive non-infarct late gadolinium enhancement on CMR and 27% the presence of LV apical aneurysm to help select patients for primary prevention implantable cardioverter-defibrillator therapy. Ninety-nine percent of the responding centres performed regular imaging follow-up of HCM patients.
Conclusion
Most centres followed European guidelines and recommendations for the diagnosis and management of patients with HCM. The importance of bedside provocation manoeuvres and exercise stress echocardiography to diagnose LV outflow obstruction requires emphasis. Additional risk markers for SCD are used in many centres and might indicate the need for an update of current European recommendations.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]

Eur Heart J Cardiovasc Imaging: 26 Dec 2021; epub ahead of print
Podlesnikar T, Cardim N, Ajmone Marsan N, D'Andrea A, ... Haugaa KH, Dweck MR
Eur Heart J Cardiovasc Imaging: 26 Dec 2021; epub ahead of print | PMID: 34957501
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association of left atrial strain by cardiovascular magnetic resonance with recurrence of atrial fibrillation following catheter ablation.

Benjamin MM, Moulki N, Waqar A, Ravipati H, ... Sanagala T, Syed MA
Background
Atrial fibrillation (AF) is a progressive condition, which is characterized by inflammation/fibrosis of left atrial (LA) wall, an increase in the LA size/volumes, and decrease in LA function. We sought to investigate the relationship of anatomical and functional parameters obtained by cardiovascular magnetic resonance (CMR), with AF recurrence in paroxysmal AF (pAF) patients after catheter ablation.
Methods
We studied 80 consecutive pAF patients referred for ablation, between January 2014 and December 2019, who underwent pre- and post-ablation CMR while in sinus rhythm. LA volumes were measured using the area-length method and included maximum, minimum, and pre-atrial-contraction volumes. CMR-derived LA reservoir strain (ℇR), conduit strain (ℇCD), and contractile strain (ℇCT) were measured by computer assisted manual planimetry. We used a multivariate logistical regression to estimate the independent predictors of AF recurrence after ablation.
Results
Mean age was 58.6 ± 9.4 years, 75% men, mean CHA2DS2-VASc score was 1.7, 36% had prior cardioversion and 51% were taking antiarrhythmic drugs. Patients were followed for a median of 4 years (Q1-Q3 = 2.5-6.2 years). Of the 80 patients, 21 (26.3%) patients had AF recurrence after ablation. There were no significant differences between AF recurrence vs. no recurrence groups in age, gender, CHA2DS2-VASc score, or baseline comorbidities. At baseline, patients with AF recurrence compared to without recurrence had lower LV end systolic volume index (32 ± 7 vs 37 ± 11 mL/m2; p = 0.045) and lower ℇCT (7.1 ± 4.6 vs 9.1 ± 3.7; p = 0.05). Post-ablation, patients with AF recurrence had higher LA minimum volume (68 ± 32 vs 55 ± 23; p = 0.05), right atrial volume index (62 ± 20 vs 52 ± 19 mL/m2; p = 0.04) and lower LA active ejection fraction (24 ± 8 vs 29 ± 11; p = 0.05), LA total ejection fraction (39 ± 14 vs 46 ± 12; p = 0.02), LA expansion index (73.6 ± 37.5 vs 94.7 ± 37.1; p = 0.03) and ℇCT (6.2 ± 2.9 vs 7.3 ± 1.7; p = 0.04). Adjusting for clinical variables in the multivariate logistic regression model, post-ablation minimum LA volume (OR 1.09; CI 1.02-1.16), LA expansion index (OR 0.98; CI 0.96-0.99), and baseline ℇR (OR 0.92; CI 0.85-0.99) were independently associated with AF recurrence.
Conclusion
Significant changes in LA volumes and strain parameters occur after AF ablation. CMR derived baseline ℇR, post-ablation minimum LAV, and expansion index are independently associated with AF recurrence.

© 2021. The Author(s).

J Cardiovasc Magn Reson: 02 Jan 2022; 24:3
Benjamin MM, Moulki N, Waqar A, Ravipati H, ... Sanagala T, Syed MA
J Cardiovasc Magn Reson: 02 Jan 2022; 24:3 | PMID: 34980165
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Normal sex and age-specific parameters in a multi-ethnic population: a cardiovascular magnetic resonance study of the Canadian Alliance for Healthy Hearts and Minds cohort.

Luu JM, Gebhard C, Ramasundarahettige C, Desai D, ... Friedrich MG, CAHHM Study Investigators
Background
Despite the growing utility of cardiovascular magnetic resonance (CMR) for cardiac morphology and function, sex and age-specific normal reference values derived from large, multi-ethnic data sets are lacking. Furthermore, most available studies use a simplified tracing methodology. Using a large cohort of participants without history of cardiovascular disease (CVD) or risk factors from the Canadian Alliance for Healthy Heart and Minds, we sought to establish a robust set of reference values for ventricular and atrial parameters using an anatomically correct contouring method, and to determine the influence of age and sex on ventricular parameters.
Methods and results
Participants (n = 3206, 65% females; age 55.2 ± 8.4 years for females and 55.1 ± 8.8 years for men) underwent CMR using standard methods for quantitative measurements of cardiac parameters. Normal ventricular and atrial reference values are provided: (1) for males and females, (2) stratified by four age categories, and (3) for different races/ethnicities. Values are reported as absolute, indexed to body surface area, or height. Ventricular volumes and mass were significantly larger for males than females (p < 0.001). Ventricular ejection fraction was significantly diminished in males as compared to females (p < 0.001). Indexed left ventricular (LV) end-systolic, end-diastolic volumes, mass and right ventricular (RV) parameters significantly decreased as age increased for both sexes (p < 0.001). For females, but not men, mean LV and RVEF significantly increased with age (p < 0.001).
Conclusion
Using anatomically correct contouring methodology, we provide accurate sex and age-specific normal reference values for CMR parameters derived from the largest, multi-ethnic population free of CVD to date.
Clinical trial registration
ClinicalTrials.gov, NCT02220582. Registered 20 August 2014-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02220582 .

© 2021. The Author(s).

J Cardiovasc Magn Reson: 02 Jan 2022; 24:2
Luu JM, Gebhard C, Ramasundarahettige C, Desai D, ... Friedrich MG, CAHHM Study Investigators
J Cardiovasc Magn Reson: 02 Jan 2022; 24:2 | PMID: 34980185
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study.

Zhao X, Hu L, Leng S, Tan RS, ... Zhong Y, Zhong L
Background
Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows quantification of biventricular blood flow by flow components and kinetic energy (KE) analyses. However, it remains unclear whether 4D flow parameters can predict cardiopulmonary exercise testing (CPET) as a clinical outcome in repaired tetralogy of Fallot (rTOF). Current study aimed to (1) compare 4D flow CMR parameters in rTOF with age- and gender-matched healthy controls, (2) investigate associations of 4D flow parameters with functional and volumetric right ventricular (RV) remodelling markers, and CPET outcome.
Methods
Sixty-three rTOF patients (14 paediatric, 49 adult; 30 ± 15 years; 29 M) and 63 age- and gender-matched healthy controls (14 paediatric, 49 adult; 31 ± 15 years) were prospectively recruited at four centers. All underwent cine and 4D flow CMR, and all adults performed standardized CPET same day or within one week of CMR. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes. Four flow components were analyzed: direct flow, retained inflow, delayed ejection flow and residual volume. Additionally, three phasic KE parameters normalized to end-diastolic volume (KEiEDV), were analyzed for both LV and RV: peak systolic, average systolic and peak E-wave.
Results
In comparisons of rTOF vs. healthy controls, median LV retained inflow (18% vs. 16%, P = 0.005) and median peak E-wave KEiEDV (34.9 µJ/ml vs. 29.2 µJ/ml, P = 0.006) were higher in rTOF; median RV direct flow was lower in rTOF (25% vs. 35%, P < 0.001); median RV delayed ejection flow (21% vs. 17%, P < 0.001) and residual volume (39% vs. 31%, P < 0.001) were both greater in rTOF. RV KEiEDV parameters were all higher in rTOF than healthy controls (all P < 0.001). On multivariate analysis, RV direct flow was an independent predictor of RV function and CPET outcome. RV direct flow and RV peak E-wave KEiEDV were independent predictors of RV remodelling index.
Conclusions
In this multi-scanner multicenter 4D flow CMR study, reduced RV direct flow was independently associated with RV dysfunction, remodelling and, to a lesser extent, exercise intolerance in rTOF patients. This supports its utility as an imaging parameter for monitoring disease progression and therapeutic response in rTOF. Clinical
Trial registration:
https://www.clinicaltrials.gov . Unique identifier: NCT03217240.

© 2021. The Author(s).

J Cardiovasc Magn Reson: 02 Jan 2022; 24:4
Zhao X, Hu L, Leng S, Tan RS, ... Zhong Y, Zhong L
J Cardiovasc Magn Reson: 02 Jan 2022; 24:4 | PMID: 34980199
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Wall shear stress angle is associated with aortic growth in bicuspid aortic valve patients.

Minderhoud SCS, Roos-Hesselink JW, Chelu RG, Bons LR, ... Wentzel JJ, Hirsch A
Aims
Aortic wall shear stress (WSS) distributions in bicuspid aortic valve (BAV) patients have been associated with aortic dilatation, but prospective, longitudinal data are missing. This study assessed differences in aortic WSS distributions between BAV patients and healthy controls and determined the association of WSS with aortic growth in patients.
Methods and results
Sixty subjects underwent four-dimensional (4D) flow cardiovascular magnetic resonance of the thoracic aorta (32 BAV patients and 28 healthy controls). Peak velocity, pulse wave velocity, aortic distensibility, peak systolic WSS (magnitude, axial, and circumferential), and WSS angle were assessed. WSS angle is defined as the angle between the WSSmagnitude and WSSaxial component. In BAV patients, three-year computed tomography angiography-based aortic volumetric growth was determined in the proximal and entire ascending aorta. WSSaxial was significantly lower in BAV patients compared with controls (0.93 vs. 0.72 Pa, P = 0.047) and WSScircumferential and WSS angle were significantly higher (0.29 vs. 0.64 Pa and 18° vs. 40°, both P < 0.001). Significant volumetric growth of the proximal ascending aorta occurred in BAV patients (from 49.1 to 52.5 cm3, P = 0.003). In multivariable analysis corrected for baseline aortic volume and diastolic blood pressure, WSS angle was the only parameter independently associated with proximal aortic growth (P = 0.031). In the entire ascending aorta, besides the WSS angle, the WSSmagnitude was also independently associated with growth.
Conclusion
Increased WSScircumferential and especially WSS angle are typical in BAV patients. WSS angle was found to predict aortic growth. These findings highlight the potential role of WSS measurements in BAV patients to stratify patients at risk for aortic dilation.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

Eur Heart J Cardiovasc Imaging: 02 Jan 2022; epub ahead of print
Minderhoud SCS, Roos-Hesselink JW, Chelu RG, Bons LR, ... Wentzel JJ, Hirsch A
Eur Heart J Cardiovasc Imaging: 02 Jan 2022; epub ahead of print | PMID: 34977931
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Myocardial involvement in children with post-COVID multisystem inflammatory syndrome: a cardiovascular magnetic resonance based multicenter international study-the CARDOVID registry.

Aeschlimann FA, Misra N, Hussein T, Panaioli E, ... Pushparajah K, Raimondi F
Background
Recent evidence shows an association between coronavirus disease 2019 (COVID-19) infection and a severe inflammatory syndrome in children. Cardiovascular magnetic resonance (CMR) data about myocardial injury in children are limited to small cohorts. The aim of this multicenter, international registry is to describe clinical and cardiac characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 using CMR so as to better understand the real extent of myocardial damage in this vulnerable cohort.
Methods and results
Hundred-eleven patients meeting the World Health Organization criteria for MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having clinical cardiac involvement and having received CMR imaging scan were included from 17 centers. Median age at disease onset was 10.0 years (IQR 7.0-13.8). The majority of children had COVID-19 serology positive (98%) with 27% of children still having both, positive serology and polymerase chain reaction (PCR). CMR was performed at a median of 28 days (19-47) after onset of symptoms. Twenty out of 111 (18%) patients had CMR criteria for acute myocarditis (as defined by the Lake Louise Criteria) with 18/20 showing subepicardial late gadolinium enhancement (LGE). CMR myocarditis was significantly associated with New York Heart Association class IV (p = 0.005, OR 6.56 (95%-CI 1.87-23.00)) and the need for mechanical support (p = 0.039, OR 4.98 (95%-CI 1.18-21.02)). At discharge, 11/111 (10%) patients still had left ventricular systolic dysfunction.
Conclusion
No CMR evidence of myocardial damage was found in most of our MIS-C cohort. Nevertheless, acute myocarditis is a possible manifestation of MIS-C associated with SARS-CoV-2 with CMR evidence of myocardial necrosis in 18% of our cohort. CMR may be an important diagnostic tool to identify a subset of patients at risk for cardiac sequelae and more prone to myocardial damage.
Clinical trial registration
The study has been registered on ClinicalTrials.gov, Identifier NCT04455347, registered on 01/07/2020, retrospectively registered.

© 2021. The Author(s).

J Cardiovasc Magn Reson: 29 Dec 2021; 23:140
Aeschlimann FA, Misra N, Hussein T, Panaioli E, ... Pushparajah K, Raimondi F
J Cardiovasc Magn Reson: 29 Dec 2021; 23:140 | PMID: 34969397
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Simultaneous [18F]fluoride and gadobutrol enhanced coronary positron emission tomography/magnetic resonance imaging for in vivo plaque characterization.

Wurster TH, Landmesser U, Abdelwahed YS, Skurk C, ... Bigalke B, Makowski MR
Aims
18F-sodium fluoride ([18F]fluoride) and gadobutrol are promising probes for positron emission tomography (PET) and magnetic resonance imaging (MRI) characterizing coronary artery disease (CAD) activity. Unlike [18F]fluoride-PET/computed tomography (CT), the potential of PET/MR using [18F]fluoride and gadobutrol simultaneously, has so far not been evaluated. This study assessed feasibility and diagnostic potential of [18F]fluoride and gadobutrol enhanced dual-probe PET/MR in patients with CAD.
Methods and results
Twenty-one patients (age, 66.7 ± 6.7 years) with CAD scheduled for invasive coronary angiography (XCA) underwent simultaneous [18F]fluoride (mean activity/effective dose: 157.2 ± 29.7 MBq/3.77 ± 0.72 mSv) and gadobutrol enhanced PET/MR on an integrated PET/MRI (3 T) scanner. Optical coherence tomography (OCT) was used as reference. Target-to-background ratio (TBR, [18F]fluoride-PET) and contrast-to-noise ratio (CNR) values (MRI, gadobutrol) were calculated for each coronary segment. Previously suggested PET/CT-TBR thresholds for adverse coronary events were evaluated. High-risk plaques, i.e. calcified and non-calcified thin-cap fibroatheromas (TCFAs) were predominantly located in segments with a TBR >1.28 (P = 0.012). Plaques containing a lipid core on OCT, were more frequently detected in segments with a TBR >1.25 (P < 0.001). TBR values significantly correlated with maximum calcification thickness (P = 0.009), while fibrous cap thickness was significantly less in segments with a TBR >1.28 (P = 0.044). Above a TBR threshold of >1.28, CNR values significantly correlated with the presence of calcified TCFAs (P = 0.032).
Conclusion
Simultaneous [18F]fluoride and gadobutrol dual-probe PET/MRI is feasible in clinical practice and may facilitate the identification of high-risk patients. The combination of coronary MR-derived CNR values post gadobutrol and [18F]fluoride based TBR values may improve identification of high-risk plaque features.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: [email protected]

Eur Heart J Cardiovasc Imaging: 06 Jan 2022; epub ahead of print
Wurster TH, Landmesser U, Abdelwahed YS, Skurk C, ... Bigalke B, Makowski MR
Eur Heart J Cardiovasc Imaging: 06 Jan 2022; epub ahead of print | PMID: 35015852
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Efficient non-contrast enhanced 3D Cartesian cardiovascular magnetic resonance angiography of the thoracic aorta in 3 min.

Fotaki A, Munoz C, Emanuel Y, Hua A, ... Botnar RM, Prieto C
Background
The application of cardiovascular magnetic resonance angiography (CMRA) for the assessment of thoracic aortic disease is often associated with prolonged and unpredictable acquisition times and residual motion artefacts. To overcome these limitations, we have integrated undersampled acquisition with image-based navigators and inline non-rigid motion correction to enable a free-breathing, contrast-free Cartesian CMRA framework for the visualization of the thoracic aorta in a short and predictable scan of 3 min.
Methods
35 patients with thoracic aortic disease (36 ± 13y, 14 female) were prospectively enrolled in this single-center study. The proposed 3D T2-prepared balanced steady state free precession (bSSFP) sequence with image-based navigator (iNAV) was compared to the clinical 3D T2-prepared bSSFP with diaphragmatic-navigator gating (dNAV), in terms of image acquisition time. Three cardiologists blinded to iNAV vs. dNAV acquisition, recorded image quality scores across four aortic segments and their overall diagnostic confidence. Contrast ratio (CR) and relative standard deviation (RSD) of signal intensity (SI) in the corresponding segments were estimated. Co-axial aortic dimensions in six landmarks were measured by two readers to evaluate the agreement between the two methods, along with inter-observer and intra-observer agreement. Kolmogorov-Smirnov test, Mann-Whitney U (MWU), Bland-Altman analysis (BAA), intraclass correlation coefficient (ICC) were used for statistical analysis.
Results
The scan time for the iNAV-based approach was significantly shorter (3.1 ± 0.5 min vs. 12.0 ± 3.0 min for dNAV, P = 0.005). Reconstruction was performed inline in 3.0 ± 0.3 min. Diagnostic confidence was similar for the proposed iNAV versus dNAV for all three reviewers (Reviewer 1: 3.9 ± 0.3 vs. 3.8 ± 0.4, P = 0.7; Reviewer 2: 4.0 ± 0.2 vs. 3.9 ± 0.3, P = 0.4; Reviewer 3: 3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.3). The proposed method yielded higher image quality scores in terms of artefacts from respiratory motion, and non-diagnostic images due to signal inhomogeneity were observed less frequently. While the dNAV approach outperformed the iNAV method in the CR assessment, the iNAV sequence showed improved signal homogeneity along the entire thoracic aorta [RSD SI 5.1 (4.4, 6.5) vs. 6.5 (4.6, 8.6), P = 0.002]. BAA showed a mean difference of < 0.05 cm across the 6 landmarks between the two datasets. ICC showed excellent inter- and intra-observer reproducibility.
Conclusions
Thoracic aortic iNAV-based CMRA with fast acquisition (~ 3 min) and inline reconstruction (3 min) is proposed, resulting in high diagnostic confidence and reproducible aortic measurements.

© 2021. The Author(s).

J Cardiovasc Magn Reson: 09 Jan 2022; 24:5
Fotaki A, Munoz C, Emanuel Y, Hua A, ... Botnar RM, Prieto C
J Cardiovasc Magn Reson: 09 Jan 2022; 24:5 | PMID: 35000609
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The valve uptake index: improving assessment of prosthetic valve endocarditis and updating [18F]FDG PET/CT(A) imaging criteria.

Roque A, Pizzi MN, Fernández-Hidalgo N, Romero-Farina G, ... Aguadé-Bruix S, Cuellar-Calabria H
Aims
Diagnosis of prosthetic valve endocarditis (PVE) by positron emission computed tomography angiography (PET/CTA) is based on visual and quantitative morpho-metabolic features. However, the fluorodeoxyglucose (FDG) uptake pattern can be sometimes visually unclear and susceptible to subjectivity. This study aimed to validate a new parameter, the valve uptake index [VUI, maximum standardized uptake value (SUVmax)-mean standardized uptake value (SUVmean)/SUVmax], designed to provide a more objective indication of the distribution of metabolic activity. Secondly, to re-evaluate the utility of traditionally used PVE imaging criteria and determine the potential value of adding the VUI in the diagnostic algorithm of PVE.
Methods and results
Retrospective analysis of 122 patients (135 prosthetic valves) admitted for suspicion of endocarditis, with a conclusive diagnosis of definite (N = 57) or rejected (N = 65) PVE, and who had undergone a cardiac PET/CTA scan as part of the diagnostic evaluation. We measured the VUI and recorded the SUVmax, SUVratio, uptake pattern, and the presence of endocarditis-related anatomic lesions. The VUI, SUVmax, and SUVratio values were 0.54 ± 0.1 vs. 0.36 ± 0.08, 7.68 ± 3.07 vs. 3.72 ± 1.11, and 4.28 ± 1.93 vs. 2.16 ± 0.95 in the \'definite\' PVE group vs. the \'rejected\' group, respectively (mean ± SD; P < 0.001). A cut-off value of VUI > 0.45 showed a sensitivity, specificity, and diagnostic accuracy for PVE of 85%, 88%, and 86.7% and increased diagnostic ability for confirming endocarditis when combined with the standard diagnostic criteria.
Conclusions
The VUI demonstrated good diagnostic accuracy for PVE, even increasing the diagnostic power of the traditionally used morphometabolic parameters, which also confirmed their own diagnostic performance. More research is needed to assess whether the integration of the VUI into the PVE diagnostic algorithm may clarify doubtful cases and thus improve the diagnostic yield of PET/CTA.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

Eur Heart J Cardiovasc Imaging: 05 Jan 2022; epub ahead of print
Roque A, Pizzi MN, Fernández-Hidalgo N, Romero-Farina G, ... Aguadé-Bruix S, Cuellar-Calabria H
Eur Heart J Cardiovasc Imaging: 05 Jan 2022; epub ahead of print | PMID: 34999818
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular magnetic resonance-derived left ventricular intraventricular pressure gradients among patients with precapillary pulmonary hypertension.

Vos JL, Leiner T, van Dijk APJ, Pedrizzetti G, ... Driessen MMP, Nijveldt R
Aims
Precapillary pulmonary hypertension (pPH) affects left ventricular (LV) function by ventricular interdependence. Since LV ejection fraction (EF) is commonly preserved, LV dysfunction should be assessed with more sensitive techniques. Left atrial (LA) strain and estimation of LV intraventricular pressure gradients (IVPG) may be valuable in detecting subtle changes in LV mechanics; however, the value of these techniques in pPH is unknown. Therefore, the aim of our study is to evaluate LA strain and LV-IVPGs from cardiovascular magnetic resonance (CMR) cines in pPH patients.
Methods and results
In this cross-sectional study, 31 pPH patients and 22 healthy volunteers underwent CMR imaging. Feature-tracking LA strain was measured on four- and two-chamber cines. LV-IVPGs (from apex-base) are computed from a formulation using the myocardial movement and velocity of the reconstructed 3D-LV (derived from long-axis cines using feature-tracking). Systolic function, both LV EF and systolic ejection IVPG, was preserved in pPH patients. Compared to healthy volunteers, diastolic function was impaired in pPH patients, depicted by (i) lower LA reservoir (36 ± 7% vs. 26 ± 9%, P < 0.001) and conduit strain (26 ± 6% vs. 15 ± 8%, P < 0.001) and (ii) impaired diastolic suction (-9.1 ± 3.0 vs. ‒6.4 ± 4.4, P = 0.02) and E-wave decelerative IVPG (8.9 ± 2.6 vs. 5.7 ± 3.1, P < 0.001). Additionally, 11 pPH patients (35%) showed reversal of IVPG at systolic-diastolic transition compared to none of the healthy volunteers (P = 0.002).
Conclusions
pPH impacts LV function by altering diastolic function, demonstrated by an impairment of LA phasic function and LV-IVPG analysis. These parameters could therefore potentially be used as early markers for LV functional decline in pPH patients.

© Crown copyright 2022.

Eur Heart J Cardiovasc Imaging: 04 Jan 2022; epub ahead of print
Vos JL, Leiner T, van Dijk APJ, Pedrizzetti G, ... Driessen MMP, Nijveldt R
Eur Heart J Cardiovasc Imaging: 04 Jan 2022; epub ahead of print | PMID: 34993533
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

A novel approach to determine aortic valve area with phase-contrast cardiovascular magnetic resonance.

Troger F, Lechner I, Reindl M, Tiller C, ... Mayr A, Klug G
Background
Transthoracic echocardiography (TTE) is the diagnostic routine standard for assessing aortic stenosis (AS). However, its inaccuracies in determining stroke volume (SV) and aortic valve area (AVA) call for a more precise and dependable method. Phase-contrast cardiovascular magnetic resonance imaging (PC-CMR) is a promising tool to push these boundaries. Thus, the aim of this study was to validate a novel approach based on PC-CMR against the gold-standard of invasive determination of AVA in AS compared to TTE.
Methods
A total of 50 patients with moderate or severe AS underwent TTE, cardiac catheterization and CMR. AVA via PC-CMR was determined by plotting momentary flow across the valve against flow-velocity. SV by CMR was measured directly via PC-CMR and volumetrically using cine-images. Invasive SV and AVA were determined via Fick-principle and Gorlin-formula, respectively. TTE yielded SV and AVA using continuity equation. Gradients were calculated via the modified Bernoulli-equation.
Results
SV by PC-CMR (85 ± 31 ml) correlated strongly (r: 0.73, p < 0.001) with cine-CMR (85 ± 19 ml) without significant bias (lower and upper limits of agreement (LLoA and ULoA): - 41 ml and 44 ml, p = 0.83). In PC-CMR, mean pressure gradient correlated significantly with invasive determination (r: 0.36, p = 0.011). Mean AVA, as determined by PC-CMR during systole (0.78 ± 0.25 cm2), correlated moderately (r: 0.54, p < 0.001) with invasive AVA (0.70 ± 0.23 cm2), resulting in a small bias of 0.08 cm2 (LLoA and ULoA: - 0.36 cm2 and 0.55 cm2, p = 0.017). Inter-methodically, AVA by TTE (0.81 ± 0.23 cm2) compared to invasive determination showed similar correlations (r: 0.58, p < 0.001 with a bias of 0.11 cm2, LLoA and ULoA: - 0.30 and 0.52, p < 0.001) to PC-CMR. Intra- and interobserver reproducibility were excellent for AVA (intraclass-correlation-coefficients of 0.939 and 0.827, respectively).
Conclusions
Our novel approach using continuous determination of flow-volumes and velocities with PC-CMR enables simple AVA measurement with no bias to invasive assessment. This approach highlights non-invasive AS grading through CMR, especially when TTE findings are inconclusive.

© 2021. The Author(s).

J Cardiovasc Magn Reson: 05 Jan 2022; 24:7
Troger F, Lechner I, Reindl M, Tiller C, ... Mayr A, Klug G
J Cardiovasc Magn Reson: 05 Jan 2022; 24:7 | PMID: 34986847
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Older ...

This program is still in alpha version.