Hug Cuellar-Calabria

Background: Cardiac magnetic resonance (CMR) enables the quantitative characterization of myocardial tissue through parametric myocardial tissue mapping. It shows a strong correlation with invasive histologic techniques in assessing diffuse myocardial fibrosis using native T1 mapping and extracellular volume (ECV), as well as in assessing myocardial edema with T2 mapping. Pediatric applicability is currently limited by a lack of specific reference values for this population, with no recommendations available from the Society of Cardiac Magnetic Resonance. Objective: To determine reference values for global left ventricular native T1, T2 mapping, and extracellular volume fraction and to assess the influence of age, heart rate, body surface area, and sex on these parameters in children and adolescents. Materials and methods: Data were retrospectively collected between 2018 and 2024. A total of 194 healthy children aged up to 17 years underwent CMR. The participants had a mean age of 12.6 (3.4) CI [12.1; 13.1] years (range 0.3–17), and 41% were female. A 1.5-T Siemens MAGNETOM Avanto Fit scanner was used. Native T1 mapping was performed at the base, mid-chamber, and apex of the left ventricle in the short-axis view at end-diastole using a MOLLI sequence, before and 15 min after the administration of a gadobutrol-based contrast agent. T2 mapping was performed before contrast administration at the base, mid-chamber, and apex of the left ventricle at end-diastole using a dark blood turbo spin echo sequence featuring a T2 preparation pulse and a balanced steady-state free precession (bSSFP). Linear regression models were employed to explore the relationships between native T1, ECV, and T2 mapping values and heart rate, age, and body surface area (BSA). Results: The results showed a mean global native T1 of 1004±37 ms, ECV of 25.9±3.6%, and T2 of 48.8±4 ms. T1 and ECV values were negatively correlated with age and BSA ( P P P P =0.953 in the septum and P =0.445 in the free wall). Native T1 values were significantly higher in female patients than in males when analyzed separately for the interventricular septum and the left ventricular free wall ( P =0.014 and P =0.001). Conclusion: This study provides a median range of values in native T1, T2 mapping, and ECV in a pediatric population. The low number of participants under the age of 6 should be taken into account in the results of our study. Our findings corroborate that native T1 is influenced by both age and heart rate, while T2 is primarily affected by age alone. We observed higher native T1 values in females, highlighting the need for separate, sex-specific reference ranges. Therefore, age, heart rate, and sex should be considered in pediatric myocardial mapping.

Background: Aortic valve calcification (AVC), as measured by gold-standard computed tomography (CT) Agatston score, provides an anatomic assessment of aortic stenosis (AS) severity and is a key predictor of AS progression and need for valve replacement. AVC detection and quantification from transthoracic echocardiography (TTE) could expand AS early diagnosis and risk stratification, currently limited by CT availability and radiation exposure. Methods: A multi-view video-based deep learning framework was developed using 1166 TTE aortic valve videos from 187 TTE studies acquired in 110 patients with available AVC score by CT. EchoAVC architecture includes a feature extraction model followed by a quality-aware model that aggregates video-level information to obtain patient-level predictions for AVC detection and quantification (score). The framework was validated internally with 173 TTE studies from 86 patients across seven centres, and externally using 430 TTE studies from 280 patients across four different centres. The associations between EchoAVC estimations and AS severity, progression, and need for aortic valve replacement were examined. Results: EchoAVC demonstrated excellent performance in AVC detection (AUROC 0.98, accuracy 94.4%), and quantification (R = 0.64) in the external multi-centre testing set. EchoAVC score was correlated with echocardiographic AS severity descriptors, including aortic valve mean pressure gradient (ρ = 0.749) and peak velocity (ρ = 0.757), and predicted future increase in mean pressure gradient (ρ = 0.382), peak velocity (ρ = 0.433) and calcium score by CT (ρ = 0.650). In 361 patients followed for a median of 3.8 years, 139 underwent aortic valve replacement. Baseline presence and extent of AVC as predicted by EchoAVC showed strong risk-stratification power for aortic valve replacement, remarkably in line with those obtained by CT, and incremental over TTE AS descriptors. EchoAVC was further tested in routine clinical practice images, confirming strong associations with AS severity and progression, including stratification for incident AS in previously unaffected individuals (p<0.001). Conclusions: EchoAVC enables accurate and non-invasive detection and quantification of AVC, offering substantial diagnostic and prognostic value for aortic stenosis progression and need for valve replacement. This technique holds promise as a scalable tool for early detection and clinical management of aortic valve stenosis. Clinical Perspective: What Is New?: * Aortic valve calcification can be detected and quantified on standard, two-dimensional transthoracic echocardiography * EchoAVC score is associated with echocardiographic metrics of aortic stenosis severity * EchoAVC predicts progressive increase in aortic stenosis severity and need for aortic valve replacement What Are the Clinical Implications?: * This openly available deep learning framework can be used to estimate aortic valve calcium in patients at risk of or presenting aortic stenosis to predict aortic stenosis progression * EchoAVC may help identify patients likely to have high aortic valve calcium and prioritize them for confirmatory CT assessment, thereby supporting earlier identification of calcific aortic valve disease in clinical pathways.

BACKGROUND: Ascending aorta dilation and aortic valve degeneration are common complications in patients with bicuspid aortic valve. Several retrospective studies have suggested the benefit of statins in reducing these complications. This study aimed to determine whether atorvastatin treatment is effective in reducing the growth of aortic diameters in bicuspid aortic valve and if it slows the progression of valve calcification. METHODS: In a randomized clinical trial, 220 patients with bicuspid aortic valve (43 women; 46±13 years of age) were included and treated with either 20 mg of atorvastatin per day or placebo for 3 years. Inclusion criteria were ≥18 years of age, nonsevere valvular dysfunction, nonsevere valve calcification, and ascending aorta diameter ≤50 mm. Computed tomography and echocardiography studies were performed at baseline and after 3 years of treatment. RESULTS: During follow-up, 28 patients (12.7%) discontinued medical treatment (15 on atorvastatin and 13 taking placebo). Thus, 192 patients completed the 36 months of treatment. Low-density lipoprotein cholesterol levels decreased significantly in the atorvastatin group (median [interquartile range], −30 mg/dL [−51.65 to −1.75 mg/dL] versus 6 mg/dL [−4, 22.5 mg/dL]; P P =0.613). Similarly, no significant differences were found for the progression of the aortic valve calcium score ( P =0.167) or valvular dysfunction. CONCLUSIONS: Among patients with bicuspid aortic valve without severe valvular dysfunction, atorvastatin treatment was not effective in reducing the progression of ascending aorta dilation and aortic valve calcification during 3 years of treatment despite a significant reduction in low-density lipoprotein cholesterol levels. REGISTRATION: URL: https://www.clinicaltrialsregister.eu ; Unique identifier: 2015-001808-57. URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02679261.

In participants with stable chest pain referred for invasive coronary angiography, those with a coronary artery calcium score of 0 at CT had very low, while higher scores had increasing occurrence ... Background Coronary artery calcium (CAC) has prognostic value for major adverse cardiovascular events (MACE) in asymptomatic individuals, whereas its role in symptomatic patients is less clear. Pur...

Background Recent trials support the role of cardiac CT in the evaluation of symptomatic patients suspected of having coronary artery disease (CAD); however, body mass index (BMI) has been reported to negatively impact CT image quality. Purpose To compare initial use of CT versus invasive coronary angiography (ICA) on clinical outcomes in patients with stable chest pain stratified by BMI category. Materials and Methods This prospective study represents a prespecified BMI subgroup analysis of the multicenter Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial conducted between October 2015 and April 2019. Adult patients with stable chest pain and a CAD pretest probability of 10%-60% were randomly assigned to undergo initial CT or ICA. The primary end point was major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction, or stroke. The secondary end point was an expanded MACE composite, including transient ischemic attack, and major procedure-related complications. Competing risk analyses were performed using the Fine and Gray subdistribution Cox proportional hazard model to assess the impact of the relationship between BMI and initial management with CT or ICA on the study outcomes, whereas noncardiovascular death and unknown causes of death were considered competing risk events. Results Among the 3457 participants included, 831 (24.0%), 1358 (39.3%), and 1268 (36.7%) had a BMI of less than 25, between 25 and 30, and greater than 30 kg/m², respectively. No interaction was found between CT or ICA and BMI for MACE (P = .29), the expanded MACE composite (P = .38), or major procedure-related complications (P = .49). Across all BMI subgroups, expanded MACE composite events (CT, 10 of 409 [2.4%] to 23 of 697 [3.3%]; ICA, 26 of 661 [3.9%] to 21 of 422 [5.1%]) and major procedure-related complications during initial management (CT, one of 638 [0.2%] to five of 697 [0.7%]; ICA, nine of 630 [1.4%] to 12 of 422 [2.9%]) were less frequent in the CT versus ICA group. Participants with a BMI exceeding 30 kg/m² exhibited a higher nondiagnostic CT rate (7.1%, P = .044) compared to participants with lower BMI. Conclusion There was no evidence of a difference in outcomes between CT and ICA across the three BMI subgroups. Clinical trial registration no. NCT02400229 © RSNA, 2024 Supplemental material is available for this article.

A difference of greater than 1.2 cm2 between areas of the proximal and distal entry tears at CT angiography in the subacute phase of aortic dissection was related to adverse events. Purpose To identify entry tear variables that are related to adverse clinical events by using CT angiography (CTA) performed during the subacute phase of aortic dissection. Materials and Methods In...