Cardiac sarcoidosis and myocarditis both can share histopathological and clinical features, making a distinct diagnosis challenging. Myocarditis is presently regarded as a distinct entity with solely cardiac manifestation, a rapidly progressive clinical course, and a poorer prognosis, whereas cardiac sarcoidosis is a systemic disorder with slower disease progression. However, both conditions can present similarly, often manifesting with high-degree atrioventricular block, ventricular tachyarrhythmias, and heart failure. Despite the use of multimodality imaging, endomyocardial biopsy, and a multidisciplinary team approach, which is considered the current gold standard, making a definitive diagnosis remains challenging. This case report underscores that a non-diagnostic biopsy does not exclude cardiac sarcoidosis in a middle-aged female presenting with unexplained syncope, ventricular ectopy, regional wall motion abnormalities, and non-ischaemic late gadolinium enhancement, highlighting the critical role of a multimodality, multidisciplinary approach to guide early, tailored management.
Cardiovascular disease remains a leading cause of death and disability worldwide. Adipose tissue dysfunction is a key driver, and perivascular adipose tissue (PVAT) exerts location‑specific effects on the cardiovascular system. This review focuses on PVAT in atherosclerosis, with particular attention to pericoronary PVAT, epicardial adipose tissue (EAT), carotid PVAT, and peri-aortic adipose tissue (PAAT). PVAT homeostasis relies on UCP1‑mediated thermogenesis for metabolic modulation and on paracrine signaling via adiponectin and apelin. Under aging, obesity, or diabetes, PVAT switches from an anti‑inflammatory to a pro‑inflammatory phenotype, accelerating plaque formation through bidirectional inflammatory crosstalk. For clinical assessment, this review highlights progress in multimodal imaging technologies, including CT fat attenuation index, MRI water‑lipid separation, PET/CT, and echocardiography, for noninvasive quantification of PVAT density, composition, and metabolic activity, and compares their advantages and limitations. This review further discusses artificial intelligence (AI)-driven radiomic and radiotranscriptomic approaches that extend PVAT assessment beyond conventional single-parameter metrics. We systematically review the research progress of these techniques in evaluating dynamic PVAT changes and their correlation with atherosclerosis, aiming to clarify the intrinsic correlation between imaging‑derived PVAT functional status and AS development. PVAT shifts from a protective, thermogenic depot to a pro-inflammatory driver of atherosclerosis with aging and metabolic disease, increasingly characterized by multimodal imaging and AI-driven radiomics.
The purpose of this study was to determine whether visual or quantitative mitral annular calcification (MAC) burden on routine non-contrast, non-ECG-gated chest computed tomography (CT) is associated with permanent pacemaker (PPM) implantation for advanced atrioventricular (AV) block. MAC has been linked to conduction disturbances after transcatheter aortic valve implantation (TAVI). Whether MAC visible on routine chest CT is associated with significant AV conduction disease in non-TAVI patients remains uncertain. In this retrospective single-center case-control study, 39 consecutive patients who underwent PPM implantation for symptomatic advanced AV block and had non-contrast chest CT were compared with 39 age- and sex-matched controls without AV block or prior PPM. MAC was graded visually by annular circumference involvement and quantified using an Agatston-based score. Visual MAC was more prevalent in the PPM (+) group than in the PPM (-) group (22 of 39 [56
To evaluate whether valve tracking 4D flow MRI can detect subtle age- and sex-related changes in left ventricular (LV) diastolic function in healthy adults. We retrospectively recruited healthy adults who had undergone cardiac MRI between October 2020 and March 2022, selecting those with whole-heart 4D flow MRI, 2D long-axis cine, and short-axis cine acquisitions. A dynamic plane at the mitral valve (MV) level was generated in 4D flow MRI using leaflet insertion points tracked on 2- and 4-chamber cine images. Through-plane velocities were computed from 4D flow data and corrected for MV motion. After contouring the transmitral region, early and late diastolic peak flow rates (Eflow, Aflow), peak velocities (Evel, Avel), and mitral forward flow volume (MFVol) were measured. Peak early LV relaxation velocity (EMV) was defined as the peak through-plane velocity of MV plane motion. A total of 39 adults (age range: 46 ± 13; 20 women) were included. With age, both Eflow/Aflow (r = − 0.79, p < 0.0001, adjusted for HR) and Evel/Avel (r = − 0.70, p < 0.0001, adjusted for HR) were significantly decreased, while Evel/EMV increased (r = 0.53, p < 0.001, adjusted for EDV). Early diastolic changes were sex-specific; women showed decreased Eflow and increased Evel/EMV with aging, whereas men showed no significant associations. Additionally, the normalized Eflow/MFVol decreased with aging, significantly in the sex-combined cohort (r = − 0.42, p = 0.008) and in women (r = − 0.68, p = 0.004), but not in men. Transmitral flow rates and peak velocities assessed by 4D flow MRI with cine-based valve tracking effectively detected physiologic age-related declines in diastolic function, exhibiting sex-specific differences.
The hemodynamic effects of end-stage kidney disease and associated pulmonary hypertension may impair right ventricular (RV) function and influence cardiovascular (CV) outcomes after kidney transplantation (KT). We aimed to evaluate the association between pre-transplant echocardiographic RV function parameters, including RV strain, and long-term CV outcomes following KT. In this retrospective cohort study, we included adult KT recipients at a single Midwest academic center from 2015 to 2024 who had adequate-quality pre-transplant echocardiograms and follow-up at our institution. RV function parameters included tricuspid annular systolic velocity (S′), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV index of myocardial performance (RIMP), and RV free wall strain measured by two-dimensional speckle-tracking echocardiography. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of CV death, non-fatal myocardial infarction, cerebrovascular accident, heart failure hospitalization, coronary revascularization, or sustained ventricular arrhythmias. Among 371 patients (mean age 53.5 ± 13.1 years; 56
