This study aims to identify the risk factors of re-intervention on targeted vessels after balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). We retrospectively analyzed consecutive patients with inoperable CTEPH undergoing BPA at a single center. Targeted vessels and patients were classified according to whether re-intervention occurred. Mixed-effects logistic regression with a patient-level random intercept was used to identify predictors of re-intervention. The optimal threshold was determined by ROC analysis. Time to re-intervention was described by vessel-level Kaplan–Meier curves, and model performance was evaluated using the C-statistic, bootstrap internal validation, calibration plots, and decision-curve analysis. We enrolled 62 patients with inoperable CTEPH who underwent 168 BPA sessions and 412 targeted vessels. Re-intervention occurred in 98/412 vessels (23.8

To assess the prognostic value of multiple late gadolinium enhancement (LGE) quantification methods for sudden cardiac death (SCD) prediction in hypertrophic cardiomyopathy (HCM). In this single-center retrospective study, 617 HCM patients who underwent cardiac magnetic resonance (CMR) examinations were consecutively enrolled. LGE was quantified using the n-standard deviation (SD) technique (with multiple thresholds) and the full width at half maximum method. “Gray zone” was defined as the myocardium with signal intensity between two predefined thresholds on LGE images. The primary outcome was SCD or aborted SCD. Among 617 HCM patients, 424 (68.7

BACKGROUND:Balloon pulmonary angioplasty (BPA) is an effective therapeutic alternative for patients with chronic thromboembolic pulmonary hypertension (CTEPH), which improved pulmonary arterial compliance (CPA) and pulmonary vascular resistance (PVR). OBJECTIVE:To investigate whether the CPA is a predictor of exercise tolerance after BPA. METHODS:The correlations between changes in each parameter and changes in six-minute walking distance (6MWD) were evaluated by Pearson's test. The determinants of functional capacity that was defined as 6MWD ≥440 m were assessed with a logistic regression model. Multiple linear regression analysis was used to identify the independent variables related to △6MWD. RESULTS:We enrolled 70 patients (female/male: 40/30, mean age: 64 years) who underwent a total of 271 BPA sessions which significantly increased CPA [1.0 (0.7, 1.3) vs. 2.1 (1.7, 2.5) mL/mmHg], and decreased PVR [6.7 (3.6, 9.7) vs. 3.0 (2.1, 4.3) wood units]. The correlation coefficient between improvement in 6MWD and changes in CPA was r = 0.328 (P = 0.006). At univariate analysis, duration of pulmonary hypertension symptoms and pulmonary arterial compliance were found to be associated with good exercise tolerance. Multivariate analysis demonstrated that CPA (95 %CI: 1.23 to 3.75, P = 0.026) was an independent predictor of exercise tolerance after BPA. The multiple linear regression analysis demonstrated that △CPA (β= 0.292, P = 0.019) was an independent predictor of △6MWD. CONCLUSION:BPA significantly improved CPA in inoperable patients with CTEPH and the resistance-compliance relationship maintained inversely associated. After successful BPA, baseline CPA is an important determinant of exercise tolerance.

BACKGROUND:MRI is important for cardiac disease evaluation, but accurate diagnosis remains challenging in less experienced centers. Although large language models (LLMs) have shown promise in medical imaging diagnosis, their application in cardiac MRI is limited. HYPOTHESIS:LLMs may be effective in achieving cardiac MRI diagnosis based on standardized descriptions. STUDY TYPE:Retrospective. POPULATION:A total of 203 hypertrophic cardiomyopathy, 186 dilated cardiomyopathy, 46 hypertensive heart disease, 198 ischemic cardiomyopathy, 38 constrictive pericarditis, 45 cardiac amyloidosis, 91 myocarditis, and 144 normal controls. FIELD STRENGTH/SEQUENCES:Balanced steady-state free-precession, short tau inversion recovery, and breath-hold inversion-recovery segmented gradient-echo sequences at 3.0 T. ASSESSMENT:Clinical and cardiac MRI information from each subject was converted into standardized descriptions and input into Generative Pre-trained Transformer-4.5 (GPT-4.5), GPT-4 Omni (GPT-4o), Deepseek-V3, and Deepseek-R1 LLMs. Cardiac MRI information included LV function, wall thickness and motion, and abnormalities on T2WI, perfusion and late gadolinium enhancement sequences. Each model was asked to generate an imaging diagnosis. In addition, a medical student (8 months experience) and three radiologists (junior, mid-level and senior: with 3, 6, and 10 years' experience, respectively) provided diagnoses based on cardiac MRI images and clinical information. STATISTIC TESTS:Frequency-weighted sensitivity and specificity were calculated. The diagnostic performances of the LLMs and human readers were compared using the McNemar test with Bonferroni correction. A p value < 0.05 was considered significant. RESULTS:All LLMs showed excellent frequency-weighted specificity (0.973-0.983). The frequency-weighted sensitivities of all LLMs were not significantly different from that of the junior radiologist, were significantly higher than that of the medical student, and significantly inferior to those of the senior radiologist (GPT-4.5: 0.863, GPT-4o: 0.821, Deepseek-V3: 0.843, and Deepseek-R1: 0.851 vs. junior radiologist: 0.850, all adjusted p = 1.000; vs. medical student: 0.731, all adjusted p < 0.001; vs. senior radiologist: 0.942, all adjusted p < 0.001). Additionally, the mid-level radiologist achieved a frequency-weighted sensitivity of 0.895, outperforming all LLMs except GPT-4.5. DATA CONCLUSION:LLMs may generate accurate diagnoses from standardized cardiac MRI descriptions, potentially benefiting less experienced physicians. LEVEL OF EVIDENCE: 4: TECHNICAL EFFICACY:Stage 5.

BACKGROUND:Microvascular obstruction (MVO) is associated with heart failure (HF) following ST-segment-elevation myocardial infarction. Angiography-derived microcirculatory resistance (AMR), a wire- and adenosine-free measure, may facilitate early assessment of microvascular function post-primary percutaneous coronary intervention. This study aimed to evaluate the ability of AMR to detect MVO and its prognostic value for predicting HF in patients with ST-segment-elevation myocardial infarction post-primary percutaneous coronary intervention. METHODS:Patients with consecutive ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention with a cardiac magnetic resonance examination 2 to 7 days post-procedure between April 2016 and February 2023 were retrospectively reviewed. AMR was computed from coronary angiography. MVO was identified and quantified via cardiac magnetic resonance. The end point was new-onset HF during follow-up. RESULTS:Overall, 475 patients (aged 56.8±11.7 years; 399 men) were included. The area under the curve for AMR to detect MVO was 0.821 (95% CI, 0.782-0.859), with an optimal cutoff value of 2.7 mm Hg*s/cm. During a median follow-up of 37.3 months, 121 (25.5%) patients developed HF. AMR, whether as a continuous (per 0.5-mm Hg*s/cm increase; hazard ratio, 1.29 [95% CI, 1.10-1.52]; P=0.002) or categorical (AMR >2.7 mm Hg*s/cm; hazard ratio, 2.15 [95% CI, 1.43-3.22]; P<0.001) variable, was independently associated with HF after adjusting for traditional risk factors (age, symptom-to-balloon time, left anterior descending coronary artery, and ejection fraction) and late gadolinium enhancement-cardiac magnetic resonance parameters. AMR improved prognostication over traditional risk factors and late gadolinium enhancement-cardiac magnetic resonance parameters (net reclassification improvement, 0.533; P<0.001; integrative discrimination index, 0.023; P=0.005). CONCLUSIONS:AMR showed good diagnostic performance in detecting MVO and was an independent and incremental predictor of HF in patients with ST-segment-elevation myocardial infarction post-primary percutaneous coronary intervention.

Background:While mitral annular disjunction (MAD) is associated with mitral valve prolapse (MVP) and ventricular arrhythmia (VA), its prevalence and clinical implication in subjects with normal heart remain unclear. Therefore, this study aimed to assess the incidence and characteristics of MAD in apparently normal hearts (ANH) confirmed by comprehensive cardiac magnetic resonance (CMR), and to explore its impact on myocardial contraction and potential association with VA. Methods:This retrospective cohort study was conducted on 444 patients who underwent CMR at a tertiary care center between January 2017 and March 2023. The study included both outpatient and inpatient individuals, who were consecutively enrolled. These patients were divided into two cohorts: a primary cohort consisting of 374 ANH individuals, and a control cohort of 70 isolated MVP patients. MAD was assessed by two radiologists on CMR. Demographic characteristics and medical history were collected from an electronic medical record database. The endpoints were composite events, defined as sudden cardiac deaths (SCD), aborted SCD, ablation therapy for VA, and implantation of an implantable cardioverter-defibrillator (ICD). Cardiac function parameters were analyzed using cvi42 software. The key statistical analysis was performed using the univariate and multivariate logistic regression. A P value <0.05 was considered statistically significant. Results:The final analysis included 374 ANH individuals [185 female (49.5%)] with an average age of 35.5±16.1 years (range, 9-76 years). The prevalence of MAD in the ANH group was 43.9%, commonly located at the anterior (7.4%), antero-lateral (6.5%) and inferior wall (41.7%), and was infrequent at the inferolateral wall (2.7%). There were no statistically significant differences in the history of syncope and hypertension between ANH individuals with and without MAD (P=0.83 and P=0.45, respectively). There were 131 patients (35.0%) experienced VA in the 374 ANH individuals. Multivariable logistic regression analysis showed that VA and female sex were independently associated with MAD (P=0.001 and P=0.03, respectively), while cardiac strain parameters were not (all P>0.05). The ANH patients with VA, when compared to those without VA, showed a higher frequency of inferolateral MAD (5.2% vs. 1.3%, P=0.04) and a longer MAD (3.1±1.1 vs. 2.2±1.5 mm, P=0.006), respectively, and these two factors were independently associated with the higher risk for VA. Conclusions:MAD is a common finding in normal adult hearts when assessed by CMR. Although MAD at the inferolateral wall is rare, it is found to be associated with VA. Based on our findings, further investigation may be warranted for patients with MAD at the inferolateral wall, particularly when arrhythmic symptoms are present.

ObjectiveThis study aims to preliminarily evaluate the early safety and efficacy of one-stage repair of residual aortic dissection using dense metal mesh stents combined with improved release and post-processing techniques.MethodsA prospective, single-center, single-arm clinical trial was designed and implemented, enrolling patients with residual aortic dissection to undergo metal mesh stent implantation under guidance of stent release and post-processing techniques. Patients received aortic CTA follow-up at 30 days post-surgery to assess early safety and efficacy.ResultsA total of 25 patients were enrolled, 14 in the (sub)acute phase and 11 in the chronic phase. No postoperative deaths, reinterventions, or aortic-related adverse events like malperfusion or ischemia were reported. The immediate technical success rate was 100%. For (sub)acute cases, the true lumen volume increased by 176.10%, while the false lumen decreased by 83.95%. False lumen thrombosis was grade II in two patients (14.29%), grade III in seven (50.00%), and grade IV in five (35.71%). For chronic cases, the true lumen volume increased by 96.92%, while the false lumen decreased by 73.43%. Thrombosis was grade II in three patients (27.27%), grade III in five (45.45%), and grade IV in three (27.27%). Postoperative aortic CTA showed that all visceral artery branches remained patent, and high-risk ischemic branches were converted to non-high-risk.ConclusionsPreliminary results suggest that dense mesh stents combined with release and post-processing techniques have acceptable early safety and efficacy. For acute and chronic residual aortic dissection patients with visceral artery branch involvement, this method may offer an alternative treatment option. Registration no. ChiCTR2200055277.

Purpose To develop a model integrating radiomics features from cardiac MR cine images with clinical and standard cardiac MRI predictors to identify patients with hypertrophic cardiomyopathy (HCM) at high risk for heart failure (HF). Materials and Methods In this retrospective study, 516 patients with HCM (median age, 51 years [IQR: 40-62]; 367 [71.1%] men) who underwent cardiac MRI from January 2015 to June 2021 were divided into training and validation sets (7:3 ratio). Radiomics features were extracted from cardiac cine images, and radiomics scores were calculated based on reproducible features using the least absolute shrinkage and selection operator Cox regression. Radiomics scores and clinical and standard cardiac MRI predictors that were significantly associated with HF events in univariable Cox regression analysis were incorporated into a multivariable analysis to construct a combined prediction model. Model performance was validated using time-dependent area under the receiver operating characteristic curve (AUC), and the optimal cutoff value of the combined model was determined for patient risk stratification. Results The radiomics score was the strongest predictor for HF events in both univariable (hazard ratio, 10.37; P < .001) and multivariable (hazard ratio, 10.25; P < .001) analyses. The combined model yielded the highest 1- and 3-year AUCs of 0.81 and 0.80, respectively, in the training set and 0.82 and 0.77 in the validation set. Patients stratified as high risk had more than sixfold increased risk of HF events compared with patients at low risk. Conclusion The combined model with radiomics features and clinical and standard cardiac MRI parameters accurately identified patients with HCM at high risk for HF. Keywords: Cardiomyopathies, Outcomes Analysis, Cardiovascular MRI, Hypertrophic Cardiomyopathy, Radiomics, Heart Failure Supplemental material is available for this article. © RSNA, 2024.

Journal of Magnetic Resonance ImagingEarly View Editorial Editorial for "Second-Order Motion-Compensated Echo-Planar Cardiac Diffusion-Weighted MRI: Usefulness of Compressed Sensitivity Encoding" Hongbo Zhang MD, Hongbo Zhang MD orcid.org/0000-0001-9745-2625 Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorXiaohai Ma MD, Xiaohai Ma MD orcid.org/0000-0003-1259-0119 Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorLei Zhao MD, Corresponding Author Lei Zhao MD [email protected] orcid.org/0000-0002-0619-6038 Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China Address reprint requests to: L.Z., Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing 100029, China. E-mail: [email protected].Search for more papers by this author Hongbo Zhang MD, Hongbo Zhang MD orcid.org/0000-0001-9745-2625 Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorXiaohai Ma MD, Xiaohai Ma MD orcid.org/0000-0003-1259-0119 Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorLei Zhao MD, Corresponding Author Lei Zhao MD [email protected] orcid.org/0000-0002-0619-6038 Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China Address reprint requests to: L.Z., Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing 100029, China. E-mail: [email protected].Search for more papers by this author First published: 25 April 2024 https://doi.org/10.1002/jmri.29410 Level of Evidence: 5 Technical Efficacy: Stage 1 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Nielles-Vallespin S, Scott A, Ferreira P, Khalique Z, Pennell D, Firmin D. Cardiac diffusion: Technique and practical applications. 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False lumen stent graft implantation is an infrequent but intractable complication of surgery for dissection. Surgery has a high rate of morbidity and mortality. We report the case of a 28-year-old patient with complicated type A aortic dissection (TAAD) who developed acute visceral malperfusion after implantation of a stent graft into the false lumen. The patient underwent urgent endovascular revision involving septal fenestration and distal extension of the stent graft into the true lumen. Clinical Impact This technology is a good supplement to the clinical practice, providing a new solution to the problem of stent placement in the prosthetic cavity, avoiding the patient to have another surgical operation, which is good for both medicine and patients.

Background Multiple balloon pulmonary angioplasty (BPA) sessions are required to manage hemodynamics effectively in chronic thromboembolic pulmonary hypertension (CTEPH) patients. But except for totally occlusive lesions and tortuous lesions that evidently require serial BPA sessions, factors correlated with re-intervention on the target vessels remain unclear. This study aims to identify risk factors of re-intervention on target vessels. Method s A retrospective analysis was conducted on inoperable CTEPH patients who underwent BPA from November 2021 to January 2024 at Beijing Anzhen Hospital. The primary endpoint was re-intervention on target vessels. Secondary endpoint was the result of pulmonary angiography at 6 months after final BPA session. Clinical data, hemodynamic parameters and pulmonary angiography images were collected. Logistic regression was employed to identify predictive factors for re-intervention on target vessels. The best predictive threshold for re-intervention was sought by means of receiver-operating characteristic (ROC) curves. Results Re-intervention was documented in 21 (51.2%) patients with 72 (23.1%) target vessels. The multivariate analysis identified the percent diameter stenosis (CI: 1.000-1.024, p = 0.049) and the baseline pulmonary flow grade (CI: 0.199-0.452, p <0.001) as the primary predictors. The ROC curve analysis demonstrated the combination of these two parameters to be a useful marker of the risk of re-intervention (AUC: 0.837, 95% CI: 0.790-0.885, p <0.001). Conclusions Baseline pulmonary flow grade and percent diameter stenosis are highly supportive to predict re-intervention on target vessels after BPA. Target vessels exhibiting significant stenosis and a poor initial pulmonary flow grade are more likely to be performed with re-intervention.

Background:Discriminating hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) is challenging, because both are characterized by left ventricular hypertrophy (LVH). Radiomics might be effective to differentiate HHD from HCM. Therefore, this study aimed to investigate discriminators and build discrimination models between HHD and HCM using multiparametric cardiac magnetic resonance (CMR) findings and radiomics score (radscore) derived from late gadolinium enhancement (LGE) and cine images.Methods:In this single center, retrospective study, 421 HCM patients [median and interquartile range (IQR), 50.0 (38.0-59.0) years; male, 70.5%] from January 2017 to September 2021 and 200 HHD patients [median and IQR, 44.5 (35.0-57.0) years; male, 88.5%] from September 2015 to July 2022 were consecutively included and randomly stratified into a training group and a validation group at a ratio of 6:4. Multiparametric CMR findings were obtained using cvi42 software and radiomics features using Python software. After dimensional reduction, the radscore was calculated by summing the remaining radiomics features weighted by their coefficients. Multiparametric CMR findings and radscore that were statistically significant in univariate logistic regression were used to build combined discrimination models via multivariate logistic regression.Results:After multivariate logistic regression, the maximal left ventricular end diastolic wall thickness (LVEDWT), left ventricular ejection fraction (LVEF), presence of LGE, cine radscore and LGE radscore were identified as significant characteristics and used to build a combined discrimination model. This model achieved an area under the receiver operator characteristic curve (AUC) of 0.979 (0.968-0.990) in the training group and 0.981 (0.967-0.995) in the validation group, significantly better than the model using multiparametric CMR findings alone (P<0.001).Conclusions:Radiomics features derived from cardiac cine and LGE images can effectively discriminate HHD from HCM.

Background:The early safety and efficacy of Castor branch stents have been demonstrated. However, the effect of aortic arch morphology on endovascular therapy remains an unresolved issue. This study aims to assess the impact of aortic arch morphology on the early outcomes of endovascular repair using Castor stent graft in patients who have acute type B aortic dissection involving the left subclavian artery (LSA). Methods:This is a retrospective cohort study. From January 2019 to December 2021, forty-one patients scheduled for thoracic endovascular aortic repair (TEVAR) of TBADs from Beijing Anzhen Hospital were enrolled in this retrospective cohort study and divided into two groups based on the length of the proximal landing zone left common carotid artery-LSA (PLZ LCCA-LSA), specifically the distance between the LCCA and the LSA (group A ≤10 mm and group B >10 mm). The study recorded technical success, mortality and aortic-related post-operative adverse events. Morphological indices were analyzed including the bird-beak configuration. The bird-beak configuration refers to the wedge-shaped gap between the undersurface of the endograft and the lesser curvature of the arch. The relationship between the risk of bird-beak configuration and PLZ was assessed with logistic regression analysis. Meanwhile, the relationship between the risk of aortic-related adverse events and bird-beak configuration was assessed with logistic regression analysis. Follow-up data were analyzed by Kaplan-Meier life table analysis. Results:The study included 41 patients with a mean age of 63.1±9.2 years, of which 80.5% were male. 18 patients from group A and 23 patients from group B were included in the comparative analysis. There were no significant differences in aortic-related adverse events, bird-beak phenomenon and re-intervention between groups A and B in 30-day outcomes. Six-month outcomes: aortic-related adverse events and the bird-beak phenomenon were observed in 11 (26.8%) and 12 (29.3%) patients, respectively. There was a significant difference in the occurrence of aortic-related adverse events (P=0.036) and bird-beak phenomenon (P=0.002) between groups A and B. In comparison to group B, the aortic-related adverse event rate was significantly higher in group A, with event-free rates of 83.3%, 83.3%, and 72.2% at 1, 3, and 6 months, respectively (P=0.020). Multivariable logistic regression analyses revealed that PLZ LCCA-LSA length [odds ratio (OR) 0.79; 95% CI: 0.64 to 0.97; P=0.026] was significantly associated with the occurrence of the bird-beak configuration, and bird-beak (OR 17.19; 95% CI: 2.24 to 131.81; P=0.006) was a significant risk factor for aortic-related adverse events. Conclusions:TEVAR with LSA revascularization has good early outcomes. However, it is more susceptible to aortic adverse events when the PLZ LCCA-LSA is less than 10 mm in length. This should be carefully considered, taking into account the risks and benefits.

Background: Aortic dissection is a life-threatening clinical emergency, but it is often missed and misdiagnosed due to the limitations of diagnostic technology. In this study, we developed a deep learningbased algorithm for identifying the true and false lumens in the aorta on non-contrast-enhanced computed tomography (NCE-CT) scans and to ascertain the presence of aortic dissection. Additionally, we compared the diagnostic performance of this algorithm with that of radiologists in detecting aortic dissection. Methods: We included 320 patients with suspected acute aortic syndrome from three centers (Beijing Anzhen Hospital Affiliated to Capital Medical University, Fujian Provincial Hospital, and Xiangya Hospital of Central South University) between May 2020 and May 2022 in this retrospective study. All patients underwent simultaneous NCE-CT and contrast-enhanced CT (CE-CT). The cohort comprised 160 patients with aortic dissection and 160 without aortic dissection. A deep learning algorithm, three-dimensional (3D) full-resolution U-Net, was continuously trained and refined to segment the true and false lumens of the aorta to determine the presence of aortic dissection. The algorithm's efficacy in detecting dissections was evaluated using the receiver operating characteristic (ROC) curve, including the area under the curve (AUC),sensitivity, and specificity. Furthermore, a comparative analysis of the diagnostic capabilities between our Results: In diagnosing aortic dissection using NCE-CT images, the developed algorithm demonstrated an accuracy of 93.8% [95% confidence interval (CI): 89.8-98.3%], a sensitivity of 91.6% (95% CI: 86.7-95.8%), and a specificity of 95.6% (95% CI: 91.2-99.3%). In contrast, the radiologists achieved an accuracy of 88.8% (95% CI: 83.5-94.1%), a sensitivity of 90.6% (95% CI: 83.5-94.1%), and a specificity of 94.1% (95% CI: 72.9-97.6%). There was no significant difference between the algorithm's performance and radiologists' mean performance in accuracy, sensitivity, or specificity (P>0.05). Conclusions: The algorithm proficiently segments the true and false lumens in aortic NCE-CT images, exhibiting diagnostic capabilities comparable to those of radiologists in detecting aortic dissection. This suggests that the algorithm could reduce misdiagnoses in clinical practice, thereby enhancing patient care.

Background: The prognosis of aortic intramural hematoma (IMH) is unpredictable, but computed tomography angiography (CTA) plays an important role of high diagnostic performance in the initial diagnosis and during follow-up of patients. In this study, we investigated the value of a radiomics model based on aortic CTA for predicting the prognosis of patients with medically treated IMH. Method: A total of 120 patients with IMH were enrolled in this study. The follow-up duration ranged from 32 to 1,346 days (median 232 days). Progression of these patients was classified as follows: destabilization, which refers to deterioration in the aortic condition, including significant increases in the thickness of the IMH, the progression of IMH to a penetrating aortic ulcer (PAU), aortic dissection (AD), or rupture; or stabilization, which refers to an unchanged appearance or a decrease in the size or disappearance of the IMH. The patients were divided into a training cohort (n=84) and a validation cohort (n=36). Six different machine learning classifiers were applied: random forest (RF), K-nearest neighbor (KNN), Gaussian Naive Bayes, decision tree, logistic regression, and support vector machine (SVM). The clinical-radiomics combined nomogram model was established by multivariate logistic regression. The area under the receiver operating characteristic (ROC) curve (AUC) was implemented to evaluate the discrimination performance of the models. The calibration curves and Hosmer-Lemeshow test were used for evaluating model calibration. DeLong's test was performed to compare the AUC performance of models. Results: Among all of the patients, 60 patients showed destabilization and 60 patients remained stable. A total of 12 radiomic features were retained after application of the least absolute shrinkage and selection operator (LASSO). These features were used for the machine learning model construction. The SVM-radial basis function (SVM-RBF) model obtained the best performance with an AUC of 0.765 (95% CI, 0.593-0.906). In the validation cohort, the combined clinical-radiomics model [AUC =0.787; 95% confidence interval (CI), 0.619-0.923] showed a significantly higher performance than did the clinical model (AUC =0.596; 95% CI, 0.413-0.796; P=0.021) and had a similar performance to the radiomics model (AUC =0.765; 95% CI, 0.589-0.906; P=0.672). Conclusions: A quantitative nomogram based on radiomic features of CTA images can be used to predict disease progression in patients with IMH and may help improve clinical decision-making.

PURPOSE:The aim of this study was to investigate the effects of maternal pulmonary arterial hypertension (PAH) on fetal hemodynamics in the third trimester and to identify hemodynamic indicators associated with adverse maternal and fetal outcomes. METHODS:We recruited 48 pregnant women with PAH in the third trimester and 32 women with normal pregnancies as controls matched for age and gestational week. Fetal growth and hemodynamic parameters were assessed by two-dimensional and color Doppler. All cases were followed up until delivery and maternal and fetal outcomes were collected. High throughput sequencing method was used to determine differential miRNA patterns in plasma exposed to pulmonary arterial hypertension (PAH) in pregnant women. We then performed the validated of key differentially expressed miRNAs by real-time PCR. RESULTS:Compared with the normal and mild PAH groups, resistance index (RI), pulsatility index (PI) of the fetal umbilical artery (UA) and quantitative ductus venosus (QDV) blood flow were increased in subjects with moderate to severe PAH, while PI and the ratio of peak systolic velocity (PSV) to end-diastolic velocity (EDV) (S/D) of the middle cerebral artery (MCA) were decreased. Compared with the normal group, subjects in the mild and moderate PAH groups had lower neonatal weight, shorter neonatal height, and higher preterm birth rates. In addition, miRNA sequencing data showed that PAH affected the levels of 23 miRNAs in plasma. At the same time, we showed that PAH significantly decreased the level of miR-1255a and increased the level of miR-548ar-3p by real-time PCR. CONCLUSION:In the group of pregnant women with moderate to severe pulmonary hypertension, there was a higher proportion of preterm births and low birth weight babies. Hemodynamic changes in the fetal UA, MCA, and ductus venosus (DV) during late pregnancy were associated with adverse fetal outcomes. At the same time, miRNA sequencing results showed that miR-1255a and miR-548ar-3p may play an important role in the development of PAH.

PURPOSE:Regardless of whether there are morphological abnormalities of right ventricle in hypertrophic cardiomyopathy (HCM) patients, the exact contribution of right ventricular (RV) global strains remains unresolved. We aimed to study the prognostic value of RV global strains in HCM patients with and without RV hypertrophy (RVH). METHOD:A total of 358 HCM patients who underwent the CMR examination and carried out the follow-up were finally included in this retrospective study. The endpoint was a composite of all-cause mortality, aborted SCD, and heart failure readmission. RV hypertrophy (RVH) was defined as maximal RVWT ≥ 5 mm at end-diastole. RV global strains (RV global longitudinal strain (GLS) and RV global circumferential strain (GCS) were measured in HCM patients by cardiac MRI feature tracking technique. The intraobserver and interobserver reproducibility were evaluated. Receiver-operating characteristic curves and Kaplan-Meier curves, cox proportional hazards regression, Likelihood ratio test and Integrated Discrimination Improvement (IDI) analysis were performed. P-value were corrected for multiple testing when using many covariables by a false discovery rate adjustment. RESULTS:Over a median follow-up of 25 (range 3-54) months, 49 patients reached the composite endpoints. HCM patients were divided into the RVH group and non-RVH groups. In the multivariate cox proportional hazards regression, after adjusting multiple clinical and imaging variables, RV GLS and RV GCS were independently associated with the composite endpoints in the RVH group (HR: 1.123; 95 % CI: 1.048-1.205; P = 0.002) and non-RVH group (HR: 1.174; 95 % CI: 1.031-1.337; P = 0.015), respectively. And The IDI index of models improved when adding RV GLS (IDI = 0.030, p < 0.001) and RV GLS (IDI = 0.056, p = 0.020), respectively. CONCLUSIONS:RV GLS and RV GCS are independent predictors of HCM with RVH and without RVH, respectively. RV GLS in the RVH group and RV GCS in the non-RVH group provide additional values for predicting the risk of adverse events.