Background Although heart strain analysis is useful for diagnosing cardiac amyloidosis (CA), it remains unclear which chamber best distinguishes CA from hypertrophic cardiomyopathy (HCM). This study analyzed strain in all four cardiac chambers in patients with CA and HCM using cardiac magnetic resonance (CMR) feature-tracking. Methods We enrolled 30 patients with left ventricular hypertrophy (15 with CA and 15 with HCM) and 17 healthy volunteers as a reference. Participants underwent 1.5-Tesla CMR to assess volume, function, and strain parameters in both ventricles and atria. The primary analysis comprised four comparisons between CA and HCM, one representative parameter per chamber (bi-ventricular longitudinal strain and bi-atrial reservoir strain), with Bonferroni correction (P < 0.0125). Additionally, exploratory analyses of the other parameters were conducted comparing patients with CA to HCM. Results Left atrial (LA) and right atrial (RA) reservoir strain were lower in CA than in HCM (LA: 7.1 ± 4.1% vs. 10.3 ± 3.9%, P = 0.035; RA: 10.8 ± 6.9% vs. 22.1 ± 12.9%, P = 0.005), whereas ventricular longitudinal strain did not differ. After Bonferroni correction, only RA reservoir strain remained significant. In an exploratory receiver operating characteristic analysis, the areas under the curve for LA and RA reservoir strain were 0.73 and 0.78, respectively, and did not differ significantly. Conclusion Bi-atrial reservoir strain was lower in CA than in HCM, and the difference in RA reservoir strain remained significant after accounting for multiplicity. Atrial reservoir strain may provide adjunctive, contrast-free functional information to help differentiate CA from HCM.
Background In-stent restenosis (ISR) remains a major limitation after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). However, long-term patency data after chronic total occlusion (CTO) PCI are limited despite high ISR risk. We evaluated long-term ISR incidence and predictors after CTO PCI. Methods This prospective single-centre study (NCT07473596) included patients with successful CTO PCI and DES implantation in 2014–2021. Selected survivors underwent protocol-driven surveillance with coronary computed tomography angiography ≥3 years after the index procedure, with suspected ISR confirmed by invasive coronary angiography (ICA). ISR was also identified through clinically indicated ICA during follow-up in all patients. Patient-, lesion-, and procedure-related ISR predictors were analysed. Results The study included 294 patients (median age 66 years (IQR 57–74), 79.9% male) and 294 analysed CTO stents. Median clinical and imaging follow-up were 7.1 (IQR 5.1–8.9) and 4.4 (IQR 3.2–6.2) years, respectively. Follow-up imaging covered 186 patients and 186 analysed CTO stents (63.3%). ISR was diagnosed in 40 stents (13.6%). Aalen–Johansen cumulative ISR incidence was 4.8% (95% CI 2.9–7.9), 10.2% (95% CI 7.1–14.5), and 12.9% (95% CI 9.3–18.0) at 3, 5, and 8 years, respectively. Atrial fibrillation (HR 3.71, 95% CI 1.74–7.91, p < 0.001) and in-stent CTO (HR 3.51, 95% CI 1.53–8.04, p = 0.003) were independently associated with ISR. Conclusions Long-term ISR after CTO PCI was infrequent in this high-risk cohort, although estimates should be interpreted in the context of selected imaging follow-up among survivors. ISR was independently associated with atrial fibrillation and in-stent CTO at the index procedure.
Background Mortality risk stratification in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains challenging with heterogeneous temporary mechanical circulatory support (tMCS) use. We developed and temporally validated the admission-based AMICS-ADMIT model and bedside score and benchmarked them against established scores. Methods This retrospective single-centre study, reported according to TRIPOD+AI, included 479 consecutive patients with AMI-CS undergoing percutaneous coronary intervention (PCI) between January 2017 and July 2025. The primary endpoint was in-hospital mortality. AMICS-ADMIT was developed using multivariable logistic regression in the 2017–2022 cohort, internally evaluated by bootstrap resampling, and temporally validated in the 2023–2025 cohort. Missing data were multiply imputed. Performance was assessed using discrimination, calibration, and Brier scores. Benchmarking against CardShock, IABP-SHOCK II, and GRACE was restricted to temporal validation; tMCS-stratified performance was exploratory. Results In-hospital mortality was 42.6% (204/479). The final model included age, left ventricular ejection fraction, prior cardiopulmonary resuscitation, estimated glomerular filtration rate, vasoactive–inotropic score, and ST-segment elevation status. The continuous model achieved AUCs of 0.809 (95% CI 0.764–0.855) in development and 0.834 (95% CI 0.769–0.899) in temporal validation, with Brier scores of 0.176 and 0.167 and favourable calibration. The bedside score achieved AUCs of 0.777 (95% CI 0.728–0.826) and 0.775 (95% CI 0.699–0.851), respectively, with stepwise mortality separation across predefined risk categories. Discrimination did not differ significantly from CardShock, IABP-SHOCK II, or GRACE. Conclusions AMICS-ADMIT showed stable temporal performance and clinically interpretable early risk stratification in contemporary PCI-treated AMI-CS. External multicentre validation is required before clinical implementation.
