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EACVI Research News – April 2024

European Association of Cardiovascular Imaging

The articles have been selected and commented on by members of the EACVI Research and Innovation Committee (Andrea Barison, Gianluca Pontone, Ana Teresa Timoteo, Danilo Neglia, Riccardo Liga, Saloua El Messaoudi, Arti Ramkisoensing, Sonia Borodzicz-Jazdzyk, Eylem Levelt) in collaboration with the EACVI HIT Committee (Giulia Elena Mandoli, Sara Moscatelli, Alexios Antonopoulos and Christina Luong).



Left ventricular end-diastolic pressure can be noninvasively estimated by a machine-learning derived left atrial strain index

Gruca MM, Slivnick JA, Singh A, et al.
Noninvasive assessment of left ventricular end-diastolic pressure using machine learning-derived phasic left atrial strain
Eur Heart J Cardiovasc Imaging 2023, 25:18-26; https://doi.org/10.1093/ehjci/jead231

 

In this study on 294 patients who underwent left heart catheterisation and echocardiography within 24 h, the Authors used machine learning to developed a novel echocardiographic marker of diastolic function, namely left atrial strain index (LASi) from the entirety of the left atrial strain (LAS) time curve, and validated it against invasive haemodynamic measurements. LASi performed similarly to peak LAS and the ASE/EACVI algorithm, without the use of ‘indeterminate’ strain classification and irrespective of LVEF. Additionally, LASi was accurate even in those with ‘indeterminate’ diastolic function by the ASE/EACVI guidelines and, importantly, more accurate than peak LAS. The utilisation of LASi has the potential to facilitate the noninvasive assessment of intracardiac volume status, resulting in improved haemodynamic management of patients with known and suspected heart failure.

Echo

Diastolic function

Heart failure

Artificial intelligence; left atrial function; filling pressures

Clinical feasibility and usefulness of in situ transoesophageal echocardiography before, during, and after electrical cardioversion

Tabrizi MT, Girardo M, Naqvi TZ.
In Situ Transesophageal Echocardiography During Electrical Cardioversion in Patients With Atrial Fibrillation-Safety and Echocardiographic Findings.
J Am Soc Echocardiogr 2024, 37:420-427; https://doi.org/10.1016/j.echo.2023.11.022

 

In 37 patients who underwent transoesophageal echocardiography (TEE) immediately before and after electrical cardioversion of atrial fibrillation (with the probe left in situ, for clinical reasons, during the procedure), the Authors analysed changes in left ventricular (LV) function, dynamic changes in valvular regurgitation, electromechanical coupling of the left atrium (LA), and qualitative spontaneous echo contrast. Immediately after cardioversion and restoration of normal sinus rhythm, there was an improvement in LV ejection fraction (47% ± 11.9% vs 40% ± 15.8%; P = 0.035) and a reduction in baseline mitral regurgitation. On the other hand, spontaneous echo contrast worsened in the LA appendage in 11 (31.4%) patients, 1 patient developed a new LA appendage thrombus, and 24 patients (72%) had evidence of electromechanical coupling with Doppler evidence of LA contraction. No procedural complications were observed. In situ TEE before, during, and after ECV is a safe procedure and provides useful clinical information regarding immediate cardiac changes after cardioversion.

ECHO   

Transesophageal echocardiography        

Other   

TEE; atrial fibrillation; electrical cardioversion

In patients with severe aortic stenosis, the presence of diabetes is associated with impaired myocardial energetics and myocardial blood flow both before and after aortic valve replacement

Jex N, Greenwood JP, Cubbon RM, et al.
Association Between Type 2 Diabetes and Changes in Myocardial Structure, Contractile Function, Energetics, and Blood Flow Before and After Aortic Valve Replacement in Patients With Severe Aortic Stenosis.
Circulation 2023, 148:1138-1153; https://doi.org/10.1161/CIRCULATIONAHA.122.063444

 

In 95 patients with severe aortic stenosis (AS), phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance were performed one month before and 6 months after aortic valve replacement (AVR). Before AVR, the phosphocreatine to ATP ratio (PCr/ATP) and adenosine stress myocardial blood flow (MBF) were impaired compared to 30 healthy volunteers; within the AS group, patients with type-2 diabetes mellitus had even worse PCr/ATP and vasodilator stress MBF. After AVR, PCr/ATP and vasodilator stress MBF normalized in non-diabetic AS patients, whereas diabetic AS patients showed no improvements in PCr/ATP and little improvement in vasodilator stress MBF. Moreover, global longitudinal strain, 6-minute walk distance, and NT-proBNP all improved after AVR in non-diabetic patients, while no improvement was observed in diabetic AS patients. In conclusion, among patients with severe AS, those with type-2 diabetes mellitus demonstrate persistent abnormalities in myocardial PCr/ATP, vasodilator stress MBF, and cardiac contractile function after AVR. On the other hand, AVR effectively normalizes myocardial PCr/ATP, vasodilator stress MBF, and cardiac contractile function in non-diabetic AS patients.

CMR     

Myocardial energetics; myocardial blood flow; stress CMR; MR spectroscopy             

Valvular heart disease

Aortic stenosis; diabetes mellitus

Routine stress testing one year after percutaneous coronary intervention increases the incidence of invasive coronary angiography and repeat revascularisation, but does not improve prognosis, even in diabetic patients

Kim H, Kang DY, Lee J, et al. 
Routine stress testing in diabetic patients after percutaneous coronary intervention: the POST-PCI trial
Eur Heart J 2024, 45:653-665; https://doi.org/10.1093/eurheartj/ehad722

 

The study randomised 1706 patients who had undergone percutaneous coronary intervention (PCI) to either a follow-up functional testing at 1 year or to standard care alone. Diabetic patients had more frequent comorbidities and a higher prevalence of complex anatomical or procedural characteristics than those without diabetes (n = 1046, 61.3%). Patients with diabetes (n = 660, 38.7%) had a 52% greater risk of primary composite events [hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.02–2.27; P = 0.039]. In both diabetic and non-diabetic groups, undergoing routine surveillance functional testing one year after PCI did not result in a reduction of major ischemic cardiovascular events or mortality within two years compared to receiving standard care alone. On the other hand, the incidences of invasive coronary angiography and repeat revascularization after 1 year was higher in the routine functional-testing group than the standard-care group, irrespective of diabetes status. Therefore, in the absence of clinical signs and symptoms of stent failure or disease progression, routine surveillance stress testing after PCI should not be recommended among both diabetic and non-diabetic patients.

 

Multimodal       

exercise ECG; stress echo; nuclear stress testing 

chronic ischaemic heart disease

CCS, diabetes, percutaneous coronary intervention

In patients with stable chest pain, coronary calcium score predicts the risk of cardiovascular events            

Biavati F, Saba L, Boussoussou M, et al.
Coronary Artery Calcium Score Predicts Major Adverse Cardiovascular Events in Stable Chest Pain.
Radiology 2024, 310:e231557; https://doi.org/10.1148/radiol.231557

 

In a subgroup analysis from the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial, 1749 patients with stable chest pain referred for ICA were randomly assigned to undergo either invasive coronary angiography (ICA) or coronary computed tomography (CCT). Calcium scores from noncontrast CT scans were categorized into low, intermediate, and high groups based on scores of 0, 1–399, and 400 or higher, respectively. During a median 3.5-year follow-up, the incidence of MACE (myocardial infarction, stroke, and cardiovascular death) was very low in the Ca-score 0 group (0.5%; HR, 0.08 [95% CI: 0.02, 0.30]; P <0.001) and intermediate-low in the Ca-score 1–399 group (1.9%; HR, 0.27 [95% CI: 0.13, 0.59]; P =0.001), compared with the Ca-score >400 group (6.8%). No significant difference in MACE between sexes was observed (P = 0.68).

CT         

Calcium Score   

Chronic ischaemic heart disease

Stable angina

Gender-related differences in myocardial T1 and T2 values

Thomas KE, Lukaschuk E, Shanmuganathan M, et al.
Misclassification of females and males in cardiovascular magnetic resonance parametric mapping: the importance of sex-specific normal ranges for diagnosis of health vs. disease.
Eur Heart J Cardiovasc Imaging 2024, 25:339-346; https://doi.org/10.1093/ehjci/jead247

 

This study evaluates the effect of using gender-neutral normal ranges on the misclassification of cardiovascular magnetic resonance parametric mapping values in healthy individuals. By analyzing T1 and T2 myocardial values from 142 volunteers using two 3T MR systems, it was found that normal values differ significantly between sexes. The research utilized the Monte Carlo method to simulate normal ranges, revealing that applying a mixed-sex approach leads to a substantial misclassification risk—up to 36% for females and 37% for males in T1 values, and up to 16% for females and 12% for males in T2 values. The findings suggest that sex-specific reference ranges are crucial for accurate diagnosis, underscoring the potential diagnostic inaccuracies and the risk of misdiagnosis when using a non-sex-specific baseline. This emphasises the importance of incorporating sex-specific reference ranges in clinical settings to improve diagnostic precision and patient care.

 

CMR     

Mapping            

Normal/healthy people

Reference values

Automatic measurements of left ventricular volumes and ejection fraction by artificial intelligence in transthoracic echocardiography

Olaisen S, Smistad E, Espeland T, et al.
Automatic measurements of left ventricular volumes and ejection fraction by artificial intelligence: clinical validation in real time and large databases.
Eur Heart J Cardiovasc Imaging 2024, 25:383-395; https://doi.org/10.1093/ehjci/jead280

 

This study explores the efficiency and accuracy of an artificial intelligence (AI)-based method for automatic measurements of left ventricular (LV) volumes and ejection fraction (EF) in echocardiography. The aim was to compare AI measurements' impact on acquisition and processing times and test–retest reproducibility against standard clinical workflows. This AI method was tested (i) in real-time scanning of 50 patients, (ii) in 40 subjects with repeated echocardiographic examinations, and (iii) in large internal and external databases totaling 2730 subjects. The analysis revealed a significant reduction in acquisition and processing time by 77% (to a median of 5.3 minutes) when using AI, alongside superior test–retest reproducibility and good agreement with reference measurements. The study concludes that AI software can significantly streamline the process of performing and analyzing routine echocardiograms, maintaining accuracy comparable to expert manual measurements, thereby enhancing patient management efficiency without compromising diagnostic quality.

 

Echo     

Artificial intelligence      

Normal/healthy people 

Left ventricular function; left ventricular volume

Abnormal myocardial perfusion testing is followed by an increased acetylsalicylic acid and statin prescription

Hijazi W, Feng Y, Southern DA, et al.
Impact of myocardial perfusion and coronary calcium on medical management for coronary artery disease.
Eur Heart J Cardiovasc Imaging 2024, 25:482-490; https://doi.org/10.1093/ehjci/jead288

 

The authors performed a retrospective analysis of 9908 consecutive patients who underwent single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) at a single centre between 2015 and 2021. After the test, statin prescription increased more in patients with abnormal perfusion (increase of 19.2 vs. 12.0%, P < 0.001) and in patients with extensive coronary artery calcium compared with no calcium (increase 12.1 vs. 7.8%, P < 0.001). In multivariable analyses, ischaemia and coronary artery calcium were independently associated with acetylsalicylic acid and statin prescription. In conclusion, abnormal MPI testing was associated with significant changes in medical therapy.

 

Nuclear

SPECT / CT, calcium        

Chronic ischaemic heart disease

CAD

Hypertension modifies the association between myocardial work indices and cardiovascular events in the general population.

Olsen FJ, Skaarup KG, Lassen MCH, et al.
Association between myocardial work indices and cardiovascular events according to hypertension in the general population
Eur Heart J Cardiovasc Imaging 2024, 25:413-424; https://doi.org/10.1093/ehjci/jead292

 

In this prospective community-based cohort study of 3932 individuals, myocardial work was assessed non-invasively with echocardiography by pressure-strain analysis. During a median follow-up of 3.5 years, 124 patients (3%) experienced an endpoint (composite of heart failure or cardiovascular death). Hypertension significantly modified the association between all work indices and outcome, such that work indices posed a higher risk of outcome in non-hypertensive than in hypertensive participants. After adjusting for Atherosclerosis Risk in Communities (ARIC)-HF risk variables, all work indices predicted outcome in non-hypertensive participants, but only Global Work Index (GWI), Global Constructive Work (GCW) and Global Work Efficiency (GWE) predicted outcome in hypertensive participants. Moreover, only GWE significantly increased C-statistics when added to ARIC-HF risk variables in hypertensive participants. Therefore, hypertension modifies the association between myocardial work indices and cardiovascular outcomes in the general population. All work indices are associated with outcome in normotensive participants. In hypertensive patients, only GWI, GCW, and GWE are independently associated with, but only GWE improves risk prediction.

ECHO   

Echo, myocardial work 

Hypertensive heart disease        

Hypertension   

In acute heart failure, left atrial dynamics predicts re-hospitalisation and cardiovascular outcome

Barki M, Losito M, Caracciolo MM, et al.
Left atrial strain in acute heart failure: clinical and prognostic insights.
Eur Heart J Cardiovasc Imaging 2024, 25:315-324; https://doi.org/10.1093/ehjci/jead287

 

The LAS-AHF trial assessed left atrial (LA) mechanics by speckle tracking echocardiography in 85 patients with acute heart failure (AHF), irrespective of left ventricular (LV) function. The primary outcome was time to first event of re-hospitalization, worsening HF, or cardiovascular death during a 12-month follow-up. From admission to discharge, right ventricular function significantly improved after decongestion, whereas no significant differences were observed in LA dynamics and LV function. In sinus rhythm patients with mild or no mitral regurgitation, decongestion was associated with a significant improvement of LA reservoir function (LAS) and LA pump strain rate during hospitalization. At 12 months, 24 cardiovascular events occurred and lack of LAS improvement at 12 months follow-up emerged as the most powerful predictor followed by NT-pro-BNP. A better survival was observed for LAS >16%, improvement of LAS > 5%, and an LAS/LA volume index ratio >0.25%/mL/m2 compared with lower cut-off values.

ECHO   

Echo, left atrial strain   

Heart failure      

Acute heart failure        

Three-dimensional echocardiographic assessment of right ventricular ejection fraction along the three main anatomical planes

Cotella JI, Kovacs A, Addetia K, et al.
Three-dimensional echocardiographic evaluation of longitudinal and non-longitudinal components of right ventricular contraction: results from the World Alliance of Societies of Echocardiography study.
Eur Heart J Cardiovasc Imaging 2024, 25:152-160; https://doi.org/10.1093/ehjci/jead213

 

In the World Alliance of Societies of Echocardiography (WASE) Study, right ventricular (RV) assessment was performed with a dedicated three-dimensional echocardiography (3DE) software (ReVISION) in 1043 prospectively enrolled healthy adult subjects. The aims of this study were (i) to establish normal values for RV 3D-derived longitudinal, radial, and anteroposterior ejection fraction (LEF, REF, and AEF, respectively) and their relative contributions to global RVEF, (ii) to calculate 3D RV strain normal values, and (iii) to determine sex-, age-, and race-related differences in these parameters. RV strain analysis included longitudinal, circumferential, and global area strains (GLS, GCS, and GAS, respectively). Absolute REF, AEF, LEF, and global RVEF were higher in women than in men (P < 0.001). With aging, both sexes exhibited a decline in all components of longitudinal shortening (P < 0.001), which was partially compensated in elderly women by an increase in radial contraction. Black subjects showed lower RVEF and GAS values compared with white and Asian subjects of the same sex (P < 0.001), and black men showed significantly higher RV radial but lower longitudinal contributions to global RVEF compared with Asian and white men. Therefore, 3DE evaluation of the non-longitudinal components of RV contraction provides additional information regarding RV physiology, including sex-, age-, and race-related differences in RV contraction patterns that may prove useful in disease states involving the right ventricle.

ECHO   

Echo, 3D echo   

Normal/healthy people

Right ventricular function

A reduced global constructive work at 2D speckle-tracking echocardiography is associated with ventricular arrhythmias after cardiac resynchronisation therapy

Saffi H, Winsløw U, Sakthivel T, et al.
Global constructive work is associated with ventricular arrhythmias after cardiac resynchronization therapy.
Eur Heart J Cardiovasc Imaging 2023, 25:29-36; https://doi.org/10.1093/ehjci/jead180

 

Patients on guideline-recommended treatment with a cardiac resynchronization defibrillator (CRT-D) device were evaluated by 2D speckle-tracking echocardiography including measurements of myocardial work by non-invasive left ventricular pressure-strain loops, at least 6 months after implantation. The primary outcome was a composite of appropriate defibrillator therapy and sustained ventricular arrhythmia under the monitor zone. A total of 162 patients, with a mean age of 66 years were included. During a median follow-up of 18 months, 16 (10%) patients experienced the primary outcome. Patients with a below-median global constructive work (GCW, <1473 mmHg%) had a hazard ratio (HR) for the outcome of 8.14 compared with patients above the median in a univariate model and remained an independent predictor after multivariate adjustment for the estimated glomerular filtration rate and QRS duration (HR 4.75). Therefore, GCW can predict an increased risk of ventricular arrhythmias.

ECHO   

Echo, myocardial work 

Heart failure      

Heart failure, cardiac resynchronisation therapy

Left ventricular mechanical dispersion is associated with increased mortality in patients with severe aortic stenosis

Thellier N, Altes A, Rietz M, et al.
Additive Prognostic Value of Left Ventricular Dispersion and Deformation in Patients With Severe Aortic Stenosis.
JACC Cardiovasc Imaging 2024, 17:235-245; https://doi.org/10.1016/j.jcmg.2023.09.010

 

A total of 364 patients with severe aortic stenosis (aortic valve area indexed ≤0.6 cm2/m2 and/or aortic valve area ≤1 cm2), left ventricular (LV) ejection fraction ≥50% and no or mild symptoms were enrolled. LV-mechanical dispersion (MD, defined by the standard deviation of the times to the peak of LV myocardial segments) and global longitudinal strain (GLS) were assessed by speckle tracking strain echocardiography. The endpoint was overall mortality. During a median follow-up of 41 months, 149 patients died. After adjustment, MD ≥68 ms was significantly associated with an increased risk of mortality (adjusted HR: 1.41). Adding MD ≥68 ms to a multivariable Cox regression model including GLS ≥−15% improved predictive performance in terms of overall mortality, with improved global model fit, reclassification, and better discrimination. Patients with both criteria had an important increase in mortality compared to patients with none or one criterion (adjusted HR: 2.02). Interobserver reproducibility of MD was good with an intraclass correlation coefficient of 0.90. Therefore, increased MD associated with depressed GLS identifies a subgroup of patients with an increased mortality risk.

ECHO   

Echo, left ventricular strain, mechanical dispersion, global longitudinal strain   

Valvular heart disease

Aortic stenosis 

Global longitudinal strain of the left atrium correlated with LV filling pressure and degree of LV fibrosis in advanced heart failure

Mandoli GE, Cameli M, Pastore MC, et al
Left ventricular fibrosis as a main determinant of filling pressures and left atrial function in advanced heart failure
Eur Heart J Cardiovasc Imaging 2024, 25:446-453; https://doi.org/10.1093/ehjci/jead340

 

In 64 patients with advanced heart failure undergoing heart transplantation, peak atrial longitudinal strain (PALS) at speckle-tracking echocardiography was correlated with invasive intracardiac pressures and with LV myocardial fibrosis at histological analysis of the explanted hearts. Global PALS was inversely correlated with pulmonary capillary wedge pressure (R = -0.83; P < 0.0001) and with LV fibrosis severity (R = -0.78; P < 0.0001) but did not correlate with LVEF (R = 0.15; P = 0.2). Among echocardiographic indices of LV filling pressures, global PALS proved the strongest [area under the curve 0.955 (95% confidence interval 0.87-0.99)] predictor of raised (>18 mmHg) pulmonary capillary wedge pressure.

 

ECHO   

Echo, left atrial strain   

heart failure      

Advanced heart failure

A worse left ventricular global longitudinal strain predicts an increased risk of mortality and heart failure hospitalisations in patients with primary mitral regurgitation undergoing transcatheter edge-to-edge repair

Shechter A, Hong GJ, Kaewkes D, et al.
Prognostic Value of Left Ventricular Global Longitudinal Strain in Transcatheter Edge-to-Edge Repair for Chronic Primary Mitral Regurgitation.
Eur Heart J Cardiovasc Imaging 2024, jeae083; https://doi.org/10.1093/ehjci/jeae083

 

The authors investigated whether left ventricular global longitudinal strain (LVGLS) predicted prognosis in 323 patients undergoing isolated transcatheter edge-to-edge repair (TEER) for chronic primary mitral regurgitation (MR). We aimed to assess its prognostic yield in the setting of TEER for chronic primary MR. Subjects with worse (i.e. less negative) LVGLS exhibited higher comorbidity, more advanced heart failure, and elevated procedural risk. Post-TEER, patients in the LVGLS quartile group sustained increased mortality and heart failure hospitalizations. Upon exploratory analysis, 1-month post-procedural LVGLS was worse than baseline values by 1.6%, and a more impaired 1-month value—but not the presence/extent of deterioration—conferred increased risk for all-cause mortality or heart failure hospitalisations.

ECHO   

Echo, left ventricular strain       

Valvular heart disease

Mitral regurgitation, TEER

Left atrial reservoir strain discriminates cardioembolic from non-cardioembolic stroke mechanisms

Bhat A, Gan GCH, Chen HHL, et al.
Left Atrial Reservoir Strain is a Superior Discriminator of Cardioembolism in Ischemic Stroke
European Heart Journal - Imaging Methods and Practice, 2024; qyae022; https://doi.org/10.1093/ehjimp/qyae022

 

The authors investigated the diagnostic performance of LA reservoir strain (LASr) in the identification of cardioembolism in the ischaemic stroke population compared to conventional echocardiographic parameters of left heart size and function. The study included 418 consecutive patients admitted with ischaemic stroke or transient ischaemic attack (cardioembolic in 229, non-cardioembolic in 189). LASr was impaired in cardioembolic compared to non-cardioembolic strokes (16.7 ± 8.2% vs 26.0 ± 5.5%, p < 0.01) and provided greatest discrimination [area under the curve (AUC) 0.813, 95%CI 0.773 to 0.858] in differentiating stroke subtypes when compared to LVEF (AUC difference 0.150, p < 0.01), LAVI (AUC difference 0.083, p < 0.01) and E/e’ (AUC difference 0.163, p < 0.01). LASr demonstrated improved diagnostic accuracy of identification of cardioembolic stroke subtypes which was best appreciated in patients without atrial fibrillation.

ECHO   

Echo, left atrial strain    

Other   

Atrial fibrillation, ischaemic stroke, left atrial function

Peripheral microvascular function is linked to cardiac involvement on CMR in systemic sclerosis-related pulmonary arterial hypertension

Vos JL, Lemmers JMJ, El Messaoudi S, et al.
Peripheral microvascular function is linked to cardiac involvement on CMR in systemic sclerosis-related pulmonary arterial hypertension.
Eur Heart J Cardiovasc Imaging 2024, jeae001; https://doi.org/10.1093/ehjci/jeae001

 

Twenty patients with systemic sclerosis-related pulmonary artery hypertension (SSc–PAH) and 5 patients with idiopathic pulmonary arterial hypertension (IPAH) were investigated with CMR, echocardiography, and nailfold capillaromicroscopy (NCM) with post-occlusive reactivity hyperaemia (PORH) testing on the same day. CMR imaging included T2 (oedema), native, and post-contrast T1 mapping to measure the extracellular volume fraction (ECV, fibrosis) and adenosine-stress-perfusion imaging measuring the relative myocardial upslope (microvascular coronary perfusion). SSc-PAH patients had higher T2 values and a trend towards a higher ECV than IPAH patients, as well as a lower nailfold capillary density and reduced capillary recruitment after PORH. Nailfold capillary density correlated with ECV and T2 and with markers of diastolic dysfunction on echocardiography. PORH testing, but not NCD, correlated with the adenosine-induced myocardial perfusion.

CMR     

pulmonary hypertension            

Systemic sclerosis, pulmonary arterial hypertension

Increased myeloperoxidase activity can be detected by molecular magnetic resonance imaging and correlates with histology and atherothrombotic events

Nadel J, Wang X, Saha P, et al.
Molecular magnetic resonance imaging of myeloperoxidase activity identifies culprit lesions and predicts future atherothrombosis
Eur Heart J - Imaging Methods and Practice, 2024; qyae004; https://doi.org/10.1093/ehjimp/qyae004

 

Unstable atherosclerotic plaques have increased activity of myeloperoxidase (MPO). In this study, 12 rabbits underwent molecular magnetic resonance imaging (MRI) of intraplaque MPO activity using the MPO-gadolinium (Gd) probe at 8 and 12 weeks after induction of atherosclerosis and before pharmacological triggering of atherothrombosis. MPO activity was higher in plaques that caused post-trigger atherothrombosis than plaques that did not; MPO-Gd was the best predictor of atherothrombosis. Moreover, MPO activity was measured in 30 human carotid endarterectomy specimens by MPO-Gd–enhanced MRI; MPO-Gd retention was significantly greater in histologic and MRI-graded American Heart Association (AHA) type VI than type III–V plaques. Excised plaques were used to confirm MPO activity by liquid chromatography–tandem mass spectrometry (LC–MSMS) and to determine MPO distribution by histology. Overall, this study shows that elevated intraplaque MPO activity detected by molecular MRI employing MPO-Gd predicts future atherothrombosis in a rabbit model and detects ruptured human atheroma, strengthening the translational potential of this approach to prospectively detect high-risk atherosclerosis.

CMR     

Molecular imaging, plaque imaging        

Vascular disease

Atherosclerosis, carotid plaque

In patients with a recent myocardial infarction, CMR-derived intraventricular pressure gradients are associated with adverse cardiovascular events

Konijnenberg NSF, Beijnink CWH, van Lieshout M, et al.
Cardiovascular magnetic resonance imaging-derived intraventricular pressure gradients in ST-segment elevation myocardial infarction: a long-term follow-up study
Eur Heart J - Imaging Methods and Practice, 2024, qyae009; https://doi.org/10.1093/ehjimp/qyae009

 

 In this multi-centre cohort study on 307 patients undergoing CMR within 14 days after the first STEMI, left ventricular intraventricular pressure gradients (LV-IVPGs) were estimated from routinely obtained long-axis cine cardiac magnetic resonance (CMR) images. During a median follow-up of 9.7 (5.9–12.5) years, 49 patients (16.0%) experienced a major composite event of cardiovascular death or heart failure hospitalisation. In univariable Cox regression, overall LV-IVPG was significantly associated with prognosis and remained significantly associated after adjustment for common clinical risk factors and myocardial injury parameters. However, adjusted for LV ejection fraction and LV global longitudinal strain (GLS), overall LV-IVPG did not provide additional prognostic value.

CMR     

Intraventricular pressure gradient; strain

Acute ischaemic heart disease

Myocardial infarction

Analysis of coronary computed tomography angiography with artificial intelligence improves the prediction of long-term cardiovascular events

Nurmohamed NS, Bom MJ, Jukema RA, et al.
AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD.
JACC Cardiovasc Imaging 2024, 17:269-280; https://doi.org/10.1016/j.jcmg.2023.05.020

 

In 536 patients referred for suspected coronary artery disease, coronary computed tomography angiography (CCTA) was analysed using an artificial intelligence-guided quantitative CCTA analysis (AI-QCT), which enables rapid analysis of atherosclerotic plaque burden and characteristics. During a median follow-up of 10.3 years, 114 patients (21%) experienced major adverse cardiovascular events (MACEs, composite of nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, and all-cause mortality). Patients with a higher percentage atheroma volume and percentage of noncalcified plaque volume has an increased risk of MACEs. Addition of AI-QCT improved a model with clinical risk factors and calcium score; moreover, AI-QCT achieved an improved area under the curve compared to Coronary Artery Disease Reporting and Data System 2.0 (CADRADs) and manual QCT, although net reclassification improvement was modest.

CT         

CCTA/ calcium score/ percentage atheroma volume        

Vascular diseases           

Major acute cardiovascular events

Myocardial radiomic features extracted from late enhancement images are strongly associated with arrhythmic risk of in hypertrophic cardiomyopathy and provide incremental risk stratification beyond current ESC or AHA/ACC risk models

Fahmy A, Rowin E, Jaafar N, et al.
Radiomics of Late Gadolinium Enhancement Reveals Prognostic Value of Myocardial Scar Heterogeneity in Hypertrophic Cardiomyopathy.
J Am Coll Cardiol Img 2024, 17: 16–27; https://doi.org/10.1016/j.jcmg.2023.05.003

 

In 1,229 patients with hypertrophic cardiomyopathy from 3 centers, left ventricular myocardial radiomic features were calculated from late enhancement images. Principal component analysis was used to reduce the radiomic features and calculate 3 principal radiomics (PrinRads). During a 4-year follow-up, sudden death events occurred in 30 (2.4%) patients. Risk prediction using PrinRads resulted in higher c-statistics than the ESC (0.69 vs 0.57; P = 0.02) and the ACC/AHA (0.69 vs 0.67; P = 0.75) models. One PrinRad was a significant predictor of SCD risk, while LGE heterogeneity was a major component of PrinRads and a significant predictor of SCD risk.

CMR

CMR/ radiomics

Cardiomyopathies          

HCM, prognosis

 

Notes to editor

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.