The prognostic role of high-risk plaque (HRP) features, including high coronary calcium scores detected by CT, beyond traditional cardiovascular risk factors and obstructive coronary artery disease (CAD), remains uncertain. This study evaluated the prognostic value of a combined HRP definition in stable chest pain patients with low-to-intermediate pretest probability of CAD. This prespecified analysis included participants randomized to the CT arm of the pragmatic, prospective 26-center European DISCHARGE trial (NCT02400229). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, nonfatal myocardial infarction, or stroke); the secondary endpoint was expanded MACE (transient ischemic attack and major procedure-related complications). Our combined HRP definition was any coronary plaque with positive remodeling, napkin-ring sign, low attenuation, or total calcium score ≥ 400 Agatston units. Among 1745 participants (age: 60 ± 10 years, 990 female), 35 MACE and 47 expanded MACE occurred at a median follow-up of 3.5 years (IQR: 2.9–4.2). After risk factor adjustment, the combined HRP definition was associated with a higher risk of MACE (HR: 3.81; 95

INTRODUCTION:Inflammatory myopathies (IM) are a heterogeneous group of systemic disorders characterized by chronic muscle inflammation. Cardiac involvement has historically been underrecognized, partially because of its subclinical presentation, and is associated with a poor prognosis, underscoring the urgent need for effective diagnostic strategies and therapeutic approaches. Cardiac magnetic resonance and its new mapping techniques appear as one of the most valuable instruments to detect myocardial involvement, thereby limiting the need for an endomyocardial biopsy when the underlying cause of cardiac dysfunction is unclear or when noninvasive imaging is inconclusive. Evidence-based data remains lacking regarding treatment strategies, and nowadays, immunosuppressive therapy constitutes the cornerstone of treatment. AREAS COVERED:In this review, we provide a summary of the current literature on myocarditis in the context of IM, with a focus on clinical manifestations, underlying pathophysiological mechanisms, diagnostic methods, and therapeutic strategies. EXPERT OPINION:We are currently in a privileged moment regarding IM, as there has never been a time with so many ongoing clinical trials. With growing awareness of cardiac involvement in IM, now is the time to focus research efforts on cardiac involvement in IM to address this underrecognized manifestation that carries significant morbidity and prognostic implications in patients with IM.

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. 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. 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

Infective endocarditis (IE) remains a complex and life-threatening condition, often posing diagnostic challenges despite advances in the field. Accurate identification of pathogens and comprehensive detection of both cardiac and extracardiac lesions are essential. Echocardiography remains the cornerstone first-line imaging modality for evaluating valve lesions and functional impairment, with its findings constituting major diagnostic criteria. However, advanced imaging techniques-including computed tomography, nuclear imaging, and magnetic resonance imaging-have become valuable tools for resolving challenging cases, confirming or ruling out the endocarditis itself and detecting distant lesions that may allow achieving a definite diagnosis. These modalities are now integrated into a multimodal imaging strategy and evidence-based diagnostic algorithms tailored to the most common clinical scenarios. Recent 2023 updates to international guidelines have refined diagnostic criteria for IE. The European Society of Cardiology Guidelines and the Duke-International Society for Cardiovascular Infectious Diseases criteria emphasize a multimodal imaging approach, assigning equal diagnostic value to evidence of IE lesions detected across various imaging modalities. This approach has broadened the diagnostic possibilities for the heterogeneous population of patients with IE, thereby improving case interpretation and clinical decision making by multidisciplinary endocarditis teams. Validation studies demonstrated improvement of the diagnostic accuracy with these updated criteria: an important advancement for this severe disease. This review summarizes current evidence-based imaging recommendations, highlighting a rational and effective multimodal imaging strategy.

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. 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. 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). 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. * 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 * 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.

The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown. To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina. The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024. Random assignment to CT or ICA. Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale–anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale–anxiety subscale (HADS-D) were also evaluated. Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = −0.2; 95% CI, −0.4 to 0; P = .04; ICA = −0.2; 95% CI, −0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (−1.9; 95% CI, −3.4 to −0.5; P = .009), SF-12-PCS (−1.4; −2.1 to −0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007). Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences. ClinicalTrials.gov Identifier: NCT02400229

Importance The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown. Objective To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina. Design, Setting, and Participants The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024. Interventions Random assignment to CT or ICA. Main Outcomes and Measures Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated. Results Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95% CI, -0.4 to 0; P = .04; ICA = -0.2; 95% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007). Conclusions and Relevance Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences. Trial Registration ClinicalTrials.gov Identifier: NCT02400229

BACKGROUND:Metabolic dysfunction-associated steatotic liver disease (MASLD) often leads to hepatic insulin resistance (IR), yet its link to liver-specific insulin-mediated glucose uptake (IGLU) in type 2 diabetes (T2D) remains unclear. We aimed to explore this MASLD-T2D relationship, addressing organ-specific IR for personalized management and risk prevention. METHODS:This cross-sectional study included 41 T2D participants enrolled in a clinical trial (NCT02248311) undergoing biochemical analyses, anthropometric measurements and [18F]FDG-PET/CT imaging before and after hyperinsulinemic euglycemic clamp (HEC). FINDINGS:Two MASLD-T2D phenotypes were identified according to their IGLU patterns, that is, with low (HepGluc[+], n = 21) and with high (HepGluc[-], n = 20) hepatic response to insulin. HepGluc[+] participants exhibited increased systemic IR (HOMA-IR, p = .012), inflammation (interleukin 6, p = .005); alanine and aspartate aminotransferase ALT, AST (p = .015 and p = .007); gamma-glutamyl transferase GGT (p = .019) and steatosis markers (liver volume, p = .006); NAFLD liver fat score, p = .0017; hepatic steatosis index, p = .02; fatty liver index, p = .008; liver stiffness measurements (LSM) (p = .049). No statistical differences in serum-based liver fibrosis scores were shown. To identify MASLD-T2D phenotypes in a friendly manner, the MASLD-T2D score based on support vector machines was developed using AST, ALT and GGT (AUC = .83), as well as with MASLD indices including LSM and NAFLD liver fat score (AUC = .90). IMPLICATIONS:Two new MASLD-T2D phenotypes have been identified, HepGluc[+] and HepGluc[-], according to IGLU patterns, with HepGluc[+] being more deleterious due to higher systemic IR, steatosis and inflammation. Phenotypes can be identified using a new function, the MASLD-T2D score.

Background The analysis of ventricular synchrony is important and complex in different cardiac diseases because it provides additional prognostic and diagnostic information. Insufficient information is available regarding the analysis of ventricular synchrony in patients diagnosed with systemic sclerosis (SSc) at a Nuclear Cardiology Unit. Purpose To assess the mechanical ventricular synchrony of patients with SSc. Methods Prospective cohort study of sixty-two patients (age 56.8 ± 12.9 years, men 12.9%) with SSc. All patients were studied with gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (gSPECT-MPI) and Emory Cardiac ToolboxTM program during rest, exercise and cold test. The normal cut-off value for the dyssynchrony parameters (standard deviation [SD] > 18.4º, bandwidth [BD] > 51º, skewness [S] ≤ 3.2 and kurtosis [K] ≤ 9.3) were previously published and validated as well as its degrees. Statistical analyses were performed using ANOVA with Bonferroni correction and logistic regression analysis (STATA 18. StataCorp, College Station, TX, USA). Results The prevalence of ventricular mechanical dyssynchrony (VMD) (SD > 18.4º and/or BD > 51ª) at rest was high (n=40, 64.5%) and a normal ventricular mechanical synchronization was detected in 22 (35.5%) patients. Of the patients with VMD (n=40), 3 (3/40: 7.5%) had slight VMD (degree 1) and 37 (37/40: 92.5%) had moderate-severe (degrees 2-4) VMD. There was no significant difference in BD (64.2 30, 62.3 36, 52.7 23) and SD (21.8 ± 12.6, 20.8 ± 9.6, 18.5 ± 7.6) between rest, exercise and cold test, respectively (ANOVA with Bonferroni correction). Only S (3.6 ± 0.8 vs 4 ± 0.9, p = 0.027) and K (14.8 ± 8 vs 18.7 ± 8.4, p = 0.033) were lower during exercise in comparison to rest, and the remainder combination without any significant difference. Patients with VMD at rest had lower peak filling rate (PFR) (1.8 ± 0.5 vs 2.2 ± 0.46, p = 0.025) and a higher summed thickening score (STS) at rest (4.6 ± 10 vs 1.7 ± 6, p = 0.045) compared with patients with normal mechanical synchronization. We have defined probable VMD when a patient had diastolic dysfunction (PFR<18) and/or abnormal ventricular motility (STS >0). By mean of logistic regression analysis we have created a model adjusted by age, gender and previous cardiac event (CE) with a good prediction for VMD (AUC ROC: 0.76 (95% CI: 0.62 to 0.88), standard error: 0.065). (Results Table). Conclusions VMD has an elevated prevalence in patients with SSc. No significant differences are observed in BD and SD parameters between rest, exercise and cold tests. Furthermore, this study explains how we can calculate the pretest probability of VMD in patients with SSc.

Abstract Background While not the primary mechanism or hallmark for the pathogenesis of all myocardial disease, coronary microvascular disease is acknowledged to play a crucial role in the diagnostic and prognosis of different diseases. PET is considered the non-invasive gold standard for evaluating myocardial blood flow, but SPECT-CZT cameras have become a promising and comparable tool for this purpose, more widespread in some countries. However, each SPECT-CZT trademark possesses different characteristics and each service adopts different protocols. This requires establishing specific cut-off values for our recently installed CZT SPECT camera. Purpose The aim of this study is to determine cut-off values of myocardial blood flow (MBF) using a cardiac-dedicated CZT SPECT in our population. Methods We prospectively analyzed 109 patients who underwent gated-SPECT using a cardiac-dedicated CZT SPECT. Of these, 43 (39.4%) subjects correspond to a control group (with normal myocardial perfusion in rest and stress, normal gated, normal coronary CT, without myocardial hypertrophy, diabetes or valvular heart disease, all subjects asymptomatic and in sinus rhythm) and 66 (60.6%) patients correspond to a pathological group (angina:10, diabetes: 23, dyspnea: 7, heart failure: 3, non-fatal myocardial infarction: 14, left ventricular ejection fraction <50%: 9, coronary artery disease: 14, coronary revascularization: 9, valvular heart disease: 8). The cut-off values for MBF at rest (MBF-rest), MBF during stress or hyperemic phase (MBF-stress), MBF reserve (MBF-reserve: defined as MBF-stress/MBF-rest), and MBF differences (MBF-differences: MBF-stress - MBF-rest) were investigated. Statistical analyses were performed with Receiver Operating Characteristics (ROC) curve analysis using STATA 18. StataCorp, College Station, TX, USA. Results In order to differentiate control group and pathological group, cut-off values were (Results Table): Conclusions Different cut-off values of MBF were observed between subjects and patients using a cardiac-dedicated CZT SPECT camera.Results Table

ImportanceThe effectiveness and safety of computed tomography (CT) and invasive coronary angiography (ICA) in different age groups is unknown.ObjectiveTo determine the association of age with outcomes of CT and ICA in patients with stable chest pain.Design, Setting, and ParticipantsThe assessor-blinded Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial was conducted between October 2015 and April 2019 in 26 European centers. Patients referred for ICA with stable chest pain and an intermediate probability of obstructive coronary artery disease were analyzed in an intention-to-treat analysis. Data were analyzed from July 2022 to January 2023.InterventionsPatients were randomly assigned to a CT-first strategy or a direct-to-ICA strategy.Main Outcomes and MeasuresMACE (ie, cardiovascular death, nonfatal myocardial infarction, or stroke) and major procedure-related complications. The primary prespecified outcome of this secondary analysis of age was major adverse cardiovascular events (MACE) at a median follow-up of 3.5 years.ResultsAmong 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 2360 (66.3%) were younger than 65 years, 982 (27.6%) were between ages 65 to 75 years, and 219 (6.1%) were older than 75 years. The primary outcome was MACE at a median (IQR) follow-up of 3.5 (2.9-4.2) years for 3523 patients (99%). Modeling age as a continuous variable, age, and randomization group were not associated with MACE (hazard ratio, 1.02; 95% CI, 0.98-1.07; P for interaction = .31). Age and randomization group were associated with major procedure-related complications (odds ratio, 1.15; 95% CI, 1.05-1.27; P for interaction = .005), which were lower in younger patients.Conclusions and RelevanceAge did not modify the effect of randomization group on the primary outcome of MACE but did modify the effect on major procedure-related complications. Results suggest that CT was associated with a lower risk of major procedure-related complications in younger patients.Trial RegistrationClinicalTrials.gov Identifier: NCT02400229

Abstract Aim To show the improvement in myocardial perfusion SPECT studies achieved in the year 2023 using a cardio-dedicated CZT gamma camera, compared to year 2021 when using an analogical SPECT/CT gamma camera. Methods We have collected data on nuclear cardiology care activity for the years 2021, 2022 and 2023, including patients treated in our institution. In 2021 myocardial perfusion imaging (MPI) studies were performed primarily on an analogical SPECT/CT gamma camera, which was replaced by a cardio-dedicated CZT in 2022. In 2023 MPI was carried out mainly in the new CZT gamma camera. For comparison we have selected the SPECT MPI studies performed in 2021 (one day protocol mainly with 18 + 12 minutes acquisition plus 10 minutes for in-out patient), and 2023 MPI studies (one day protocol mainly with 6 + 4 minutes acquisition plus 10 minutes for in-out patient). Results (Results Table) With the new CZT cardio-dedicated gamma camera, the number of stress SPECT increased by 442 (31%) and rest SPECT by 341 (23%), with a total annual increase of 783 SPECT studies (27%) in 2023 compared to 2021. Furthermore, the complexity of SPECT studies has increased in 2023, since part of the studies carried out (68) correspond to SPECT studies of myocardial blood flow, which are obtained in the same gamma camera simultaneously. In addition, the gamma camera acquisition time has reduced by 66% (from 30 to 10 minutes), and the patient total time has reduced by half (from 40 to 20 minutes). Counts in the cardiac area have increased on average more than 1000 times (14 million counts for a low dose study and 32 million for a high dose study). Conclusions The improvement achieved in SPECT studies for myocardial perfusion after upgrading to a cardio-dedicated CZT gamma camera has been an annual increase of 27% in number of SPECT studies, and a decrease in patient total time by half, which has allowed implementing more complex studies, such as evaluation of myocardial blood flow.

Objective There is an increasing interest in knowing whether patients with antisynthetase syndrome (ASSD) may have silent myocardial interstitial involvement. Mapping techniques in cardiac magnetic resonance (CMR) can detect subclinical myocardial involvement. The purpose of this study was to identify alterations in multiparametric CMR in ASSD patients without overt cardiac involvement. Methods Patients diagnosed with ASSD underwent a CMR along with the standard clinical workup, investigation of specific and associated myositis antibodies, and high-resolution chest CT. The CMR protocol includes routine morphologic, functional, and late gadolinium enhancement sequences in standard cardiac planes, as well as native T1 and T2 mapping sequences and extracellular volume (ECV) calculation. Results Twenty-five patients were included in this study (56% women; median age 56.3 years). Three patients were considered in the acute phase at the time of inclusion. Eight patients (32%) showed pathological findings in CMR (6 stable disease, 2 acute phase). Elevated T1, T2 and ECV mapping values were found in 20% (5/25), 17% (4/25) and 24% (6/25) of the group, respectively. Two patients in the acute phase had increased values of both T2 and ECV. Conclusion Subclinical myocardial involvement in ASSD is not rare (32%) although its clinical significance is uncertain. Myocardial oedema (T2) was the most frequent finding, followed by increased T1 and/or ECV values likely signalling interstitial fibrosis. Of note, patients in the acute phase showed elevated T2 values.

Abstract Background Partial thrombosis of the false lumen (FL) in patients with chronic aortic dissection (AD) of the descending aorta has been associated with faster aortic dilation. Four-dimensional phase-contrast cardiovascular magnetic resonance (4D flow CMR) studies analyzing flow dynamics and biomechanics in the FL and their relationship with partial thrombosis are lacking. This study aimed to compare FL flow dynamics and biomechanics between patients with a patent and partially thrombosed FL. Materials and methods Patients with a chronic, patent (no thrombus) or partially thrombosed FL in the descending aorta after an AD underwent an imaging follow-up including a magnetic resonance angiography (MRA) and a 4D flow CMR study. FL thrombosis was quantified as the ratio of thrombus volume and FL volume on MRA. FL flow dynamics was assessed in terms of forward flow, wall shear stress (WSS), maximum kinetic energy (KE) and acceleration, and flow stasis on 4D flow CMR. Aortic stiffness in the FL was quantified using pulse wave velocity (PWV). Results and conclusions Sixty-five patients with a complete imaging protocol were included in the study (patency in 34 patients, partial thrombosis in 31). Partial thrombosis of the FL was associated with a reduction in the amount and energy of flow in the FL (reduced forward systolic flow, KE and acceleration), and a more stagnated flow in the FL (increased flow stasis). Axial WSS showed a tendency to be lower in the partial thrombosis group compared to the patency group, while PWV were similar in both of them. Funding IJC2018-037349-I.

BACKGROUND Despite the absence of clinical complications after an acute aortic dissection (AD) with persistent patent false lumen (FL), a high risk for clinical events may persist. OBJECTIVES The aim of this study was to assess the natural evolution of noncomplicated AD and ascertain whether different FL flow patterns by magnetic resonance imaging (MRI) have independent prognostic value for AD-related events beyond established morphologic parameters. METHODS One hundred thirty-one consecutive patients, 78 with surgically treated type A dissections and 53 with medically treated type B dissections, were followed up prospectively after acute AD with persistent patent FL in the descending aorta. Maximum aortic diameter, true lumen compression, entry tear, and partial FL thrombosis by computed tomography were assessed. Systolic antegrade true lumen and FL flow volumes and diastolic antegrade and retrograde flows were analyzed by MRI during the first year after AD. RESULTS After a median follow-up period of 8.0 years (IQR: 4.6-10.9 years), 43 patients presented aorta-related events (25 died and 18 required endovascular treatment). FL systolic antegrade flow >= 30% with respect to total systolic antegrade flow and retrograde diastolic flow >= 80% with respect to total diastolic FL flow were predictors of aortic events. In multivariate analysis, aortic diameter >45 mm (HR: 2.91), type B dissection (HR: 2.44), and MRI flow pattern (HR: 16.87) were independent predictors of AD-related events. CONCLUSIONS High systolic antegrade flow volume in the FL with significant diastolic retrograde flow assessed by MRI and aortic diameter >45 mm identify patients with higher risk for complications in whom more aggressive management would be indicated. (C) 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.