JournalTOCs

European Heart Journal - Cardiovascular Imaging
Journal Prestige (SJR): 3.625

Citation Impact (citeScore): 3
Number of Followers: 11

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2047-2404 - ISSN (Online) 2047-2412
Published by Oxford University Press

[413 journals]

EACVI survey on the management of patients with patent foramen ovale and
cryptogenic stroke
- Authors: D'Andrea A; , Dweck M, et al.
  Pages: 135 - 141
  Abstract: AbstractAims The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate the current practice for the assessment and management of patients with suspected patent foramen ovale (PFO) and cryptogenic stroke.Methods and results In total, 79 imaging centres from 34 countries across the world responded to the survey, which comprised 17 questions. Most non-invasive investigations for PFO were widely available in the responding centres, with the exception of transcranial colour Doppler which was only available in 70% of sites, and most commonly performed by neurologists. Standard transthoracic echocardiography, with or without bubbles, was considered the first-level test for suspected PFO in the majority of the centres, whereas transoesophageal echocardiography was an excellent second-level modality. Most centres would rule out atrial fibrillation (AF) as a source of embolism in all patients with cryptogenic stroke (63%), with the remainder reserving investigation for patients with multiple AF risk factors (33%). Cardiac magnetic resonance was the preferred tool for identifying other unusual aetiologies, like cardiac masses or thrombi. After PFO closure, there was variation in the use of antiplatelet therapy: a quarter recommended treatment for life, while only 12% recommended 5 years as stipulated in the guidelines (12%). Antibiotic prophylaxis prior to dental or endoscopic procedures was not recommended in 41% of centres, contrary to what the guidelines recommended.Conclusion Our survey revealed a variable adherence to the current recommendations for the diagnosis and management of patients with cryptogenic stroke and PFO. Efforts should focus on optimizing and standardizing diagnostic tests and treatment of this condition.
  PubDate: Mon, 21 Dec 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa318
  Issue No: Vol. 22, No. 2 (2020)
Right ventricular myocardial work: proof-of-concept for non-invasive
assessment of right ventricular function
- Authors: Butcher S; Fortuni F, Montero-Cabezas J, et al.
  Pages: 142 - 152
  Abstract: AbstractAimsRight ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure–strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease.Methods and resultsNon-invasive analysis of RVMW was performed in 22 HFrEF patients [median age 63 (59–67) years] who underwent echocardiography and invasive RHC within 48 h. Conventional RV functional measurements, RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analysed and compared with invasively measured stroke volume and stroke volume index. Non-invasive analysis of RVMW was also performed in 22 patients without cardiovascular disease to allow for comparison between groups. None of the conventional echocardiographic parameters of RV systolic function were significantly correlated with stroke volume or stroke volume index. In contrast, one of the novel indices derived non-invasively by pressure–strain loops, RVGCW, demonstrated a moderate correlation with invasively measured stroke volume and stroke volume index (r = 0.63, P = 0.002 and r = 0.59, P = 0.004, respectively). RVGWI, RVGCW, and RVGWE were significantly lower in patients with HFrEF compared to a healthy cohort, while values of RVGWW were significantly higher.ConclusionRVGCW is a novel parameter that provides an integrative analysis of RV systolic function and correlates more closely with invasively measured stroke volume and stroke volume index than other standard echocardiographic parameters.
  PubDate: Fri, 13 Nov 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa261
  Issue No: Vol. 22, No. 2 (2020)
Right ventricular work: a step forward for non-invasive assessment of
right ventricular function
- Authors: Smiseth O; Aalen J.
  Pages: 153 - 154
  Abstract: This editorial refers to ‘Right ventricular myocardial work: proof-of-concept for non-invasive assessment of right ventricular function’ S. C. Butcher, et al., pp. 142–152.
  PubDate: Sun, 06 Dec 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa296
  Issue No: Vol. 22, No. 2 (2020)
Prognostic validation of partition values for quantitative parameters to
grade functional tricuspid regurgitation severity by conventional
echocardiography
- Authors: Muraru D; Previtero M, Ochoa-Jimenez R, et al.
  Pages: 155 - 165
  Abstract: AbstractAimsQuantitative echocardiography parameters are seldom used to grade tricuspid regurgitation (TR) severity due to relative paucity of validation studies and lack of prognostic data. To assess the relationship between TR severity and the composite endpoint of death and hospitalization for congestive heart failure (CHF); and to identify the threshold values of vena contracta width (VCavg), effective regurgitant orifice area (EROA), regurgitant volume (RegVol), and regurgitant fraction (RegFr) to define low, intermediate, and high-risk TR based on patients’ outcome data. Methods and resultsA cohort of 296 patients with at least mild TR underwent 2D, 3D, and Doppler echocardiography. We built statistical models (adjusted for age, NYHA class, left ventricular ejection fraction, and pulmonary artery systolic pressure) for VCavg, EROA, RegVol, and RegFr to study their relationships with the hazard of outcome. The tertiles of the derived hazard values defined the threshold values of the quantitative parameters for TR severity grading. During 47-month follow-up, 32 deaths and 72 CHF occurred. Event-free rate was 14%, 48%, and 93% in patients with severe, moderate, and mild TR, respectively. Severe TR was graded as VCavg > 6 mm, EROA > 0.30 cm2, RegVol > 30 mL, and RegF > 45%.ConclusionThis outcome study demonstrates the prognostic value of quantitative parameters of TR severity and provides prognostically meaningful threshold values to grade TR severity in low, intermediate, and high risk.
  PubDate: Sat, 28 Nov 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa282
  Issue No: Vol. 22, No. 2 (2020)
Corrigendum to: Pivotal role of Cardiac CT in Chronic Coronary Syndrome
- Pages: 165 - 165
  Abstract: European Heart Journal - Cardiovascular Imaging 2020;doi:10.1093/ehjci/jeaa231
  PubDate: Thu, 19 Nov 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa309
  Issue No: Vol. 22, No. 2 (2020)
Secondary tricuspid regurgitation: neglected no more!
- Authors: Heitzinger G; Bartko P, Goliasch G.
  Pages: 166 - 167
  Abstract: This editorial refers to ‘Prognostic validation of partition values for quantitative parameters to grade functional tricuspid regurgitation severity by conventional echocardiography’, by D. Muraru et al., pp. 155–165.
  PubDate: Sun, 06 Dec 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa312
  Issue No: Vol. 22, No. 2 (2020)
Pressure–volume loop validation of TAPSE/PASP for right ventricular
arterial coupling in heart failure with pulmonary hypertension
- Authors: Schmeisser A; Rauwolf T, Groscheck T, et al.
  Pages: 168 - 176
  Abstract: AbstractAimsThe aim of this study was to validate the tricuspid annular plane systolic excursion/systolic pulmonary artery (PA) pressure (TAPSE/PASP) ratio with the invasive pressure–volume (PV) loop-derived end-systolic right ventricular (RV) elastance/PA elastance (Ees/Ea) ratio in patients with heart failure with reduced ejection fraction (HFREF) and secondary pulmonary hypertension (PH).Methods and resultsThe relationship of TAPSE and TAPSE/PASP with RV-PV loop (single-beat)-derived contractility Ees, afterload Ea, and Ees/Ea was assessed in 110 patients with HFREF with and without secondary PH. The results were compared with other surrogate parameters such as the fractional area change/PASP ratio. The association of the surrogates with all-cause mortality was evaluated. In patients with PH (n = 74, 67%), TAPSE significantly correlated with Ees (r = 0.356), inverse with Ea (r = −0.514) but was most closely associated with Ees/Ea (r = 0.77). Placing TAPSE in a ratio with PASP slightly reduced the relationship to Ees/Ea (r = 0.71) but was more closely related to the parameters of PA vascular load, diastolic RV function, and RV energetics. The area under the curve of TAPSE/PASP and TAPSE for discriminating overall survival in receiver operating characteristic analysis was not different (P = 0.78. Prognostic relevant cut-offs were 17 mm for TAPSE and 0.38 mm/mmHg for TAPSE/PASP. Both parameters in multivariate cox regression remained independently prognostically relevant.ConclusionTAPSE is an easily and reliably obtainable and valid surrogate parameter for RV–PA coupling in PH due to HFREF. Putting TAPSE into a ratio with PASP did not further improve the coupling information or prognostic assessment.Trial IdentifierDRKS—German Clinical Trials Register (DRKS00011133; https://www.drks.de/drks_web/navigate.do'navigationId=trial.HTML&TRIAL_ID=DRKS00011133).
  PubDate: Mon, 09 Nov 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa285
  Issue No: Vol. 22, No. 2 (2020)
Angiographic and intravascular ultrasound images of pulmonary artery
rupture during balloon pulmonary angioplasty
- Authors: Nakazato K; Sugimoto K, Kiko T, et al.
  Pages: 176 - 176
  PubDate: Fri, 12 Jun 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa161
  Issue No: Vol. 22, No. 2 (2020)
Simple imaging of the right heart phenotype in heart failure
- Authors: Naeije R.
  Pages: 177 - 178
  Abstract: This editorial refers to ‘Pressure-volume loop validation of TAPSE/PASP for right ventricular arterial coupling in heart failure with pulmonary hypertension’ by A. Schmeisser et al., pp. 168–176.
  PubDate: Sat, 14 Nov 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa302
  Issue No: Vol. 22, No. 2 (2020)
Corrigendum to: Multicenter reference values for cardiac MR imaging
derived ventricular size and function for children aged 0-18 years
- Pages: 178 - 178
  Abstract: Eur Heart J - Cardiovasc Imaging 2020;21:102–113 https://doi.org/10.1093/ehjci/jez164
  PubDate: Mon, 30 Nov 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa320
  Issue No: Vol. 22, No. 2 (2020)
Computed tomography angiography-derived extracellular volume fraction
predicts early recovery of left ventricular systolic function after
transcatheter aortic valve replacement
- Authors: Han D; Tamarappoo B, Klein E, et al.
  Pages: 179 - 185
  Abstract: AbstractAims Recovery of left ventricular ejection fraction (LVEF) after aortic valve replacement has prognostic importance in patients with aortic stenosis (AS). The mechanism by which myocardial fibrosis impacts LVEF recovery in AS is not well characterized. We sought to evaluate the predictive value of extracellular volume fraction (ECV) quantified by cardiac CT angiography (CTA) for LVEF recovery in patients with AS after transcatheter aortic valve replacement (TAVR).Methods and results In 109 pre-TAVR patients with LVEF <50% at baseline echocardiography, CTA-derived ECV was calculated as the ratio of change in CT attenuation of the myocardium and the left ventricular (LV) blood pool before and after contrast administration. Early LVEF recovery was defined as an absolute increase of ≥10% in LVEF measured by post-TAVR follow-up echocardiography within 6 months of the procedure. Early LVEF recovery was observed in 39 (36%) patients. The absolute increase in LVEF was 17.6 ± 8.8% in the LVEF recovery group and 0.9 ± 5.9% in the no LVEF recovery group (P < 0.001). ECV was significantly lower in patients with LVEF recovery compared with those without LVEF recovery (29.4 ± 6.1% vs. 33.2 ± 7.7%, respectively, P = 0.009). In multivariable analysis, mean pressure gradient across the aortic valve [odds ratio (OR): 1.07, 95% confidence interval (CI): 1.03–1.11, P: 0.001], LV end-diastolic volume (OR: 0.99, 95% CI: 0.98–0.99, P: 0.035), and ECV (OR: 0.92, 95% CI: 0.86–0.99, P: 0.018) were independent predictors of early LVEF recovery.Conclusion Increased myocardial ECV on CTA is associated with impaired LVEF recovery post-TAVR in severe AS patients with impaired LV systolic function.
  PubDate: Wed, 16 Dec 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa310
  Issue No: Vol. 22, No. 2 (2020)
Predicting left ventricular functional recovery after transcatheter aortic
valve implantation with computed tomography-derived extracellular volume
- Authors: van der Bijl P; Delgado V, Bax J.
  Pages: 186 - 187
  Abstract: This editorial refers to ‘CTA-derived extracellular volume fraction predicts early recovery of left ventricular systolic function after transcatheter aortic valve replacement’, by D. Han et al., pp. 179–185.
  PubDate: Wed, 30 Dec 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa313
  Issue No: Vol. 22, No. 2 (2020)
Corrigendum to: Training, competence, and quality improvement in
echocardiography: the European Association of Cardiovascular Imaging
recommendations: update 2020
- Pages: 187 - 187
  Abstract: [Eur Heart J Cardiovasc Imaging 2020;21:1305–1319]
  PubDate: Tue, 22 Dec 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa347
  Issue No: Vol. 22, No. 2 (2020)
5-Year prognostic value of the right ventricular strain-area loop in
patients with pulmonary hypertension
- Authors: Hulshof H; van Dijk A, Hopman M, et al.
  Pages: 188 - 195
  Abstract: AbstractAimsPatients with pre-capillary pulmonary hypertension (PH) show poor survival, often related to right ventricular (RV) dysfunction. In this study, we assessed the 5-year prognostic value of a novel echocardiographic measure that examines RV function through the temporal relation between RV strain (ϵ) and area (i.e. RV ϵ-area loop) for all-cause mortality in PH patients.Methods and resultsEchocardiographic assessments were performed in 143 PH patients (confirmed by right heart catheterization). Transthoracic echocardiography was utilized to assess RV ϵ-area loop. Using receiver operating characteristic curve-derived cut-off values, we stratified patients in low- vs. high-risk groups for all-cause mortality. Kaplan–Meier survival curves and uni-/multivariable cox-regression models were used to assess RV ϵ-area loop’s prognostic value (independent of established predictors: age, sex, N-terminal pro B-type natriuretic peptide, 6-min walking distance). During follow-up 45 (31%) patients died, who demonstrated lower systolic slope, peak ϵ, and late diastolic slope (all P < 0.05) at baseline. Univariate cox-regression analyses identified early systolic slope, systolic slope, peak ϵ, early diastolic uncoupling, and early/late diastolic slope to predict all-cause mortality (all P < 0.05), whilst peak ϵ possessed independent prognostic value (P < 0.05). High RV loop-score (i.e. based on number of abnormal characteristics) showed poorer survival compared to low RV loop-score (Kaplan–Meier: P < 0.01). RV loop-score improved risk stratification in high-risk patients when added to established predictors.ConclusionOur data demonstrate the potential for RV ϵ-area loops to independently predict all-cause mortality in patients with pre-capillary PH. The non-invasive nature and simplicity of measuring the RV ϵ-area loop, support the potential clinical relevance of (repeated) echocardiography assessment of PH patients.
  PubDate: Mon, 06 Jul 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa143
  Issue No: Vol. 22, No. 2 (2020)
New insights of tricuspid regurgitation: a large-scale prospective cohort
study
- Authors: Vieitez J; Monteagudo J, Mahia P, et al.
  Pages: 196 - 202
  Abstract: AbstractAimsTo evaluate the burden of tricuspid regurgitation (TR) in a large cohort, determine the right ventricle involvement of patients with TR and determine the characteristics of isolated TR.Methods and resultsProspective study where consecutive patients undergoing an echocardiographic study in 10 centres were included. All studies with significant TR (at least moderate) were selected. We considered that patients with one of pulmonary systolic hypertension >50 mmHg, left ventricular ejection fraction <35%, New York Heart Association III–IV, or older than 85 years, had a high surgical risk. A total of 35 088 echocardiograms were performed. Significant TR was detected in 6% of studies. Moderate TR was found in 69.6%, severe in 25.5%, massive in 3.9%, and torrential in 1.0% of patients. Right ventricle was dilated in 81.7% of patients with massive/torrential TR, in 55.9% with severe TR, and in 29.3% with moderate TR (P < 0.001). Primary TR was present in 7.4% of patients whereas secondary TR was present in 92.6%. Mitral or aortic valve disease was the most common aetiology (54.6%), following by isolated TR (16%). Up to 51.9% of patients with severe, massive, or torrential primary TR and 57% of patients with severe, massive, or torrential secondary TR had a high surgical risk.ConclusionSignificant TR is a prevalent condition and a high proportion of these patients have an indication for valve intervention. More than a half of patients with severe, massive, or torrential TR had a high surgical risk. Massive/torrential TR may have implications regarding selection and monitoring patients for percutaneous treatment.
  PubDate: Wed, 12 Aug 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa205
  Issue No: Vol. 22, No. 2 (2020)
Tricuspid regurgitation pressure gradient identifies prognostically
relevant worsening renal function in acute heart failure
- Authors: Hayasaka K; Matsue Y, Kitai T, et al.
  Pages: 203 - 209
  Abstract: AbstractAimsNot all worsening renal function (WRF) during heart failure treatment is associated with a poor prognosis. However, a metric capable providing a prognosis of relevant WRF has not been developed. Our aim was to evaluate if a change in tricuspid regurgitation pressure gradient (TRPG) could discriminate prognostically relevant and not relevant WRF in patients with acute heart failure (AHF).Methods and resultsWe examined 809 consecutive hospitalized patients with heart failure (78 ± 12 years, 54% male). WRF was defined as an increase in creatinine >0.3 mg and ≥25% from admission to discharge. TRPG was measured at admission and before discharge using echocardiography. The primary outcome was all-cause death within 1-year after discharge. Patients were classified as follows for analysis: no WRF and no TRPG increase (n = 523); no WRF and TRPG increase (no WRF with iTRPG, n = 170); WRF and no TRPG increase (WRF without iTRPG, n = 90); and WRF and TRPG increase (WRF with iTRPG, n = 26). A change in TRPG weakly but significantly correlated to a change in haemoglobin and haematocrit, a percent decrease in brain natriuretic peptide, and body weight reduction during the index period of hospitalization. All-cause mortality within 1 year was higher in patients with WRF and iTRPG, compared to the other three groups (P = 0.026). On Cox regression analysis, only WRF with iTRPG was associated with higher mortality (hazard ratio 4.24, P = 0.001), even after adjustment for other confounders.ConclusionAn increase in TRPG may provide a marker to identify prognostically relevant WRF in patients with AHF.
  PubDate: Wed, 11 Mar 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa035
  Issue No: Vol. 22, No. 2 (2020)
Prognostic power of left atrial strain in patients with acute heart
failure
- Authors: Park J; Hwang I, Park J, et al.
  Pages: 210 - 219
  Abstract: AbstractAimsLeft atrial (LA) dysfunction can be associated with left ventricular (LV) disorders; however, its clinical significance has not been well-studied in patients with acute heart failure (AHF). We evaluated prognostic power of peak atrial longitudinal strain (PALS) of the left atrium according to heart failure (HF) phenotypes and atrial fibrillation (AF).Methods and resultsFrom an AHF registry with 4312 patients, we analysed PALS in 3818 patients. Patients were categorized into PALS tertiles. We also divided the patients according to HF phenotypes [HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), or HF with preserved ejection fraction (HFpEF)] and presence of AF. The primary outcomes were all-cause mortality and HF hospitalization. PALS was weakly but significantly correlated with LA volume index (r = −0.310, P < 0.001), E/e′ (r = −0.245, P < 0.001), and LV ejection fraction (r = 0.371, P < 0.001). A total of 2016 patients (52.8%) experienced adverse clinical events during median follow-up duration of 30.6 months (interquartile ranges 11.6–54.4 months). In the multivariate analysis, PALS was a significant predictor of events [hazard ratio (HR) 0.984, 95% confidence interval (CI) 0.971–0.996; P = 0.012]. Patients with the lowest tertile (HR 1.576, 95% CI 1.219–2.038; P < 0.001) had a higher number of events than those with the highest tertile in the multivariate analysis. In the subgroup analysis, however, PALS was not a prognosticator (HR 0.987, 95% CI 0.974–1.000; P = 0.056) in AF patients. The prognostic power of PALS was not different between HFrEF (HR 0.977, 95% CI 0.969–0.974; P < 0.001), HFmrEF (HR 0.984, 95% CI 0.972–0.996; P = 0.008), and HFpEF (HR 0.980, 95% CI 0.973–0.987; P < 0.001, P for interaction = 0.433).ConclusionPALS was a significant prognostic marker in AHF patients. The prognostic power was similar regardless of HF phenotypes, but PALS was not associated with clinical events in AF patients.
  PubDate: Fri, 07 Feb 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa013
  Issue No: Vol. 22, No. 2 (2020)
Left atrial remodelling, mid-regional pro-atrial natriuretic peptide, and
prognosis across a range of ejection fractions in heart failure
- Authors: Putko B; , Savu A, et al.
  Pages: 220 - 228
  Abstract: AbstractAims Measures of structural and functional remodelling of the left atrium (LA) are emerging as useful biomarkers in heart failure (HF). We hypothesized that LA volume and its contribution to stroke volume (SV) would predict a composite endpoint of HF hospitalization or death in patients with HF.Methods and results We recruited 57 controls and 86 patients with HF, including preserved and reduced left ventricular ejection fraction (LVEF). Cardiac magnetic resonance imaging was used to evaluate LA volumes and contribution to LV SV. Plasma mid-region pro-atrial natriuretic peptide (MR-proANP) was evaluated. LA volume was negatively correlated with LVEF (P = 0.001) and positively correlated with LV mass in HFrEF (P < 0.001) but not in HFpEF. LA volume at end-diastole was associated with the composite endpoint in HFrEF (hazard ratio 1.26, 95% confidence interval 1.01–1.54; P = 0.044), but not HFpEF (1.06, 0.85–1.30; P = 0.612), per 10 mL/m increase. Active contribution to SV was negatively associated with the composite endpoint in HFpEF (0.32, 0.14–0.66; P = 0.001), but not HFrEF (0.91, 0.38–2.1; P = 0.828) per 10% increase. MR-proANP was associated with the composite endpoint in HFpEF (1.46, 1.03–1.94; P = 0.034), but not in HFrEF (1.14, 0.88–1.37; P = 0.278), per 100 pM increase.Conclusion We found different relationships between LA remodelling and biomarkers in HFrEF and HFpEF. Our results support the hypothesis that the pathophysiologic underpinnings of HFpEF and HFrEF are different, and atrial remodelling encompasses distinct components for each HF subtype.
  PubDate: Fri, 01 May 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa041
  Issue No: Vol. 22, No. 2 (2020)
Myocardial work index: a glimmer of hope in COVID-19
- Authors: Jaglan A; Roemer S, Jan M, et al.
  Pages: 228 - 228
  PubDate: Mon, 15 Jun 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa181
  Issue No: Vol. 22, No. 2 (2020)
Rational and design of the ROTAS study: a randomized study for the optimal
treatment of symptomatic patients with low-gradient severe aortic valve
stenosis and preserved left ventricular ejection fraction
- Authors: Galli E; Le Ven F, Coisne A, et al.
  Pages: 229 - 235
  Abstract: AbstractAimsFifteen to thirty percentage of patients with severe aortic stenosis (AS) have preserved left ventricular ejection fraction (LVEF) and a discordant AS pattern at Doppler echocardiography, which is characterized by a small (<1 cm2) aortic area and low mean aortic gradient (<40 mmHg). The ‘Randomized study for the Optimal Treatment of symptomatic patients with low-gradient severe Aortic Stenosis and preserved left ventricular ejection fraction’ (ROTAS trial) aims at demonstrating the superiority of aortic valve replacement vs. a ‘watchful waiting strategy’ in symptomatic patients with low-gradient (LS), severe AS, and preserved LVEF, stratified according to indexed stroke volume, in terms of all-cause mortality or cardiovascular-related hospitalization during follow-up (FU).Methods and resultsThe ROTAS trial will be a multicentre randomized non-blinded study involving 16 reference centres. AS severity will be confirmed by a multimodality approach (rest and stress echocardiography, calcium scoring, and cardiac magnetic resonance imaging for optimally characterize the population), which could provide important inputs to improve the pathophysiological understanding of this complex disease. Well-characterized patients will be randomized according to the management strategy. The primary endpoint will be the occurrence of all-cause mortality or cardiac related-hospitalizations during 2-year FU. One hundred and eighty subjects per group will be included.ConclusionThe management of patients with LS severe AS and preserved LVEF is largely debated. ROTAS trial will allow a comprehensive evaluation of this particular pattern of AS and will establish which is the most appropriate management of these patients.
  PubDate: Wed, 18 Mar 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa036
  Issue No: Vol. 22, No. 2 (2020)
A machine learning cardiac magnetic resonance approach to extract disease
features and automate pulmonary arterial hypertension diagnosis
- Authors: Swift A; Lu H, Uthoff J, et al.
  Pages: 236 - 245
  Abstract: AbstractAimsPulmonary arterial hypertension (PAH) is a progressive condition with high mortality. Quantitative cardiovascular magnetic resonance (CMR) imaging metrics in PAH target individual cardiac structures and have diagnostic and prognostic utility but are challenging to acquire. The primary aim of this study was to develop and test a tensor-based machine learning approach to holistically identify diagnostic features in PAH using CMR, and secondarily, visualize and interpret key discriminative features associated with PAH.Methods and resultsConsecutive treatment naive patients with PAH or no evidence of pulmonary hypertension (PH), undergoing CMR and right heart catheterization within 48 h, were identified from the ASPIRE registry. A tensor-based machine learning approach, multilinear subspace learning, was developed and the diagnostic accuracy of this approach was compared with standard CMR measurements. Two hundred and twenty patients were identified: 150 with PAH and 70 with no PH. The diagnostic accuracy of the approach was high as assessed by area under the curve at receiver operating characteristic analysis (P < 0.001): 0.92 for PAH, slightly higher than standard CMR metrics. Moreover, establishing the diagnosis using the approach was less time-consuming, being achieved within 10 s. Learnt features were visualized in feature maps with correspondence to cardiac phases, confirming known and also identifying potentially new diagnostic features in PAH.ConclusionA tensor-based machine learning approach has been developed and applied to CMR. High diagnostic accuracy has been shown for PAH diagnosis and new learnt features were visualized with diagnostic potential.
  PubDate: Thu, 30 Jan 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa001
  Issue No: Vol. 22, No. 2 (2020)
Does position matter'
- Authors: Tanel E; Roemer S, Salinas P, et al.
  Pages: 246 - 246
  PubDate: Thu, 21 May 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa159
  Issue No: Vol. 22, No. 2 (2020)
Late diagnosis of a sinus venosus defect allowed by atrial fibrillation
ablation
- Authors: Robaye B; Guedes A, Seldrum S, et al.
  Pages: 247 - 247
  PubDate: Fri, 12 Jun 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa160
  Issue No: Vol. 22, No. 2 (2020)
Left atrial wall pseudoaneurysm complicating mitral valve endocarditis:
additive value of a multimodality imaging diagnostic approach
- Authors: Melillo E; Ascione L, Carozza A, et al.
  Pages: 248 - 249
  PubDate: Mon, 06 Jul 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa171
  Issue No: Vol. 22, No. 2 (2020)
Pannus: a multi-modality imaging affair
- Authors: Vallabhajosyula S; Yang L, Glockner J, et al.
  Pages: 250 - 250
  PubDate: Sat, 05 Sep 2020 00:00:00 GMT
  DOI: 10.1093/ehjci/jeaa247
  Issue No: Vol. 22, No. 2 (2020)