RESULTS The study protocol was completed in 157 participants, and hemodynamically significant stenosis was detected in 76 of 157 patients (48%) and 112 of 442 vessels (25%). According to receiver-operating characteristic curve analysis, adding dynamic CTP to CTA significantly increased the area under the curve from 0.65 (95% CI: 0.57-0.72) to 0.74 (95% CI: 0.66-0.81; P 1/4 0.011) on the patient level, with decreased sensitivity (93% vs 72%; P < 0.001), improved specificity (36% vs 75%; P < 0.001), and improved overall accuracy (64% vs 74%; P < 0.001).

Feature tracking (FT) has become an established tool for cardiovascular magnetic resonance (CMR)-based strain analysis. Recently, the compressed sensing (CS) technique has been applied to cine CMR, which has drastically reduced its acquisition time. However, the effects of CS imaging on FT strain analysis need to be carefully studied. This study aimed to investigate the use of CS cine CMR for FT strain analysis compared to conventional cine CMR. Sixty-five patients with different left ventricular (LV) pathologies underwent both retrospective conventional cine CMR and prospective CS cine CMR using a prototype sequence with the comparable temporal and spatial resolution at 3 T. Eight short-axis cine images covering the entire LV were obtained and used for LV volume assessment and FT strain analysis. Prospective CS cine CMR data over 1.5 heartbeats were acquired to capture the complete end-diastolic data between the first and second heartbeats. LV volume assessment and FT strain analysis were performed using a dedicated software (ci42; Circle Cardiovasacular Imaging, Calgary, Canada), and the global circumferential strain (GCS) and GCS rate were calculated from both cine CMR sequences. There were no significant differences in the GCS (− 17.1% [− 11.7, − 19.5] vs. − 16.1% [− 11.9, − 19.3; p = 0.508) and GCS rate (− 0.8 [− 0.6, − 1.0] vs. − 0.8 [− 0.7, − 1.0]; p = 0.587) obtained using conventional and CS cine CMR. The GCS obtained using both methods showed excellent agreement (y = 0.99x − 0.24; r = 0.95; p < 0.001). The Bland–Altman analysis revealed that the mean difference in the GCS between the conventional and CS cine CMR was 0.1% with limits of agreement between -2.8% and 3.0%. No significant differences were found in all LV volume assessment between both types of cine CMR. CS cine CMR could be used for GCS assessment by CMR-FT as well as conventional cine CMR. This finding further enhances the clinical utility of high-speed CS cine CMR imaging.

Purpose : This study aimed to use gadolinium-enhanced cardiovascular magnetic resonance (LGE-CMR) scanning to examine the clinical feasibility of feature-tracking strain (FT-strain) analysis on compressed sensing (CS) cine cardiovascular magnetic resonance (CMR) imaging for detecting myocardial infarction (MI). Methods: We enrolled 37 patients who underwent conventional cine CMR, CS cine CMR, and LGE-CMR scanning to assess cardiovascular disease. FT-strain analysis was used to assess peak circumferential strain (p-CS) based on an 18-segment model in both cine CMR imaging modalities. Based on LGE-CMR imaging findings, myocardial segments were classified as remote, adjacent, subendocardial infarcted, and transmural infarcted. The diagnostic performance of p-CS for detecting MI was compared between CS cine CMR imaging and conventional cine CMR imaging using the receiver operating characteristic (ROC) curve analysis. Results: A total of 440 remote, 85 adjacent, 76 subendocardial infarcted, and 65 transmural infarcted segments were diagnosed on LGE-CMR imaging. There were significant between-group differences in p-CS on both conventional and CS cine CMR ( p <0.05 in each) imaging. The sensitivity and specificity of p-CS for identifying MI were 85% and 79% for conventional cine CMR imaging, and 82% and 77% for CS cine CMR imaging, respectively. There was no significant difference between conventional and CS cine CMR imaging in the area under the curve of p-CS (0.89 vs. 0.87, p = 0.15). Conclusion : FT-strain analysis of CS cine CMR imaging may help identify MI; it may be used alongside or instead of conventional CMR imaging.

Background Coronary magnetic resonance angiography (CMRA) is a promising technique for assessing the coronary arteries. However, a disadvantage of CMRA is the comparatively long acquisition time. Compressed sensing (CS) can considerably reduce the scan time. The aim of this study was to verify the feasibility of CS CMRA scanning during the waiting time between contrast injection and late gadolinium enhancement (LGE) scan in a clinical protocol. Methods Fifty clinical patients underwent contrast-enhanced CS CMRA and conventional CMRA on a 3 T CMR scanner. After contrast injection, CS CMRA was scanned during the waiting time for LGE CMR. A conventional CMRA scan was performed after LGE CMR. We assessed acquisition times and coronary artery image quality for each segment on a 4-point scale. Visible vessel length, sharpness and diameter of right (RCA), left anterior descending (LAD), and left circumflex (LCX) coronary arteries were also quantitatively compared among the scans. Results All CS CMRA scans were successfully performed within the LGE waiting time. The median total scan time was 207 s (163, 259 s) for CS and 785 s (698, 975 s) for conventional CMRA (p < 0.001). No significant differences were observed in image quality scores, vessel length measurements, sharpness, and diameter between CS and conventional CMRA. Conclusions We could achieve all CS CMRA scans within the LGE waiting time. Contrast-enhanced CS CMRA could considerably shorten the scan time while maintaining image quality compared with conventional CMRA.

Background: Late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) is a standard for imaging of myocardial infarction (MI). However, it has been reported the usefulness of quantification of the T1 relaxation time for the characterization of old MI. Our aim is to quantitatively assess myocardial injury and viability without contrast mediums in acute MI.Methods: Twenty patients with acute MI underwent CMR within 1 month after reperfusion therapy. We assessed the native and post-contrast T1 mappings, native T2 mappings, and LGE in cross section. MIs were classified as "transmural" (> 75% of the area was transmural) and "non-transmural" (< 75% of the area was transmural). Transmural MIs were further classified into endocardial or epicardial types, while non-transmural MIs were classified into infarcted, salvaged, and remote. We defined 50% on the epicardial side of the region with high T2-weighted imaging as epicardial 50% area.Result: In non-transmural MI, the native T1 and T2 values of the infarcted and salvaged areas were higher than the remote area. Additionally, native T1 value of the infarcted area was higher than the salvaged area. However, there was no significant difference between transmural MI types for any variables. Last, native T1 value of the epicardial 50% area was significantly prolonged in transmural MI than in non-transmural MI.Conclusion: Native T1 value is useful for myocardial injury evaluation. Furthermore, transmural and non-transmural MI could be detected by T1 mapping of epicardial 50% areas without contrast mediums in the acute phase of MI. Copyright (C) 2020, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

Introduction: Single-center studies indicated a high diagnostic accuracy of dynamic computed tomography perfusion (CTP) imaging in the diagnosis of hemodynamically significant coronary artery disease (CAD). However, no prospective multicenter study has assessed the performance of combined coronary computed tomography angiography (CTA) and dynamic CTP. Hypothesis: In this prospective multicenter study, we assessed the hypothesis that dynamic CTP can provide an incremental diagnostic value over CTA detecting hemodynamically significant CAD defined by invasive coronary angiography (ICA) with fractional flow reserve (FFR). Methods: Seven centers enrolled 165 patients with suspected or known CAD, who were clinically referred for ICA. CTA and dynamic CTP were performed using dual-source CT prior to ICA. FFR was done as part of ICA in case of 26-90% coronary diameter stenosis. Hemodynamically significant stenosis was defined as of FFR<0.8 or ≥90% stenosis on ICA. Three blinded independent core laboratories analyzed CTA, CTP and ICA. Results: The study protocol was completed in 157 participants and hemodynamically significant stenosis was detected in 112 of 442 vessels (25%) and 123 of 157 patients (78%). According to receiver operating characteristic curve analysis, CTA showed an area under the curve (AUC) of 0.81 (95% confidence interval [CI], 0.73-0.86) on the patient level and 0.80 (95% CI, 0.76-0.84) on the vessel level. Adding dynamic CTP to CTA significantly increased the AUC to 0.85 (95% CI, 0.78-0.90; p=0.027) on the patient level and to 0.84 (95% CI, 0.80-0.87; p=0.002) on the vessel level. In the subgroups of patients with 1-, 2- and 3-vessel disease by CTA, the addition of dynamic CTP to CTA significantly increased AUC from 0.80 to 0.84 (p=0.041) in 2-vessel disease and from 0.65 to 0.73 (p=0.022) in 3-vessel disease, but not in 1-vessel disease (from 0.84 to 0.87, p=0.265). Conclusion: In this first prospective multicenter study on dynamic CTP, the combination of anatomical assessment with coronary CTA and functional evaluation with dynamic CTP allowed more accurate detection of hemodynamically significant coronary artery stenosis. Improved diagnostic performance with dynamic CTP was mainly obtained when multivessel disease was suspected by CTA.

PURPOSE:This study aimed to compare the efficacy of compressed sensing (CS) and conventional coronary magnetic resonance angiography (CMRA) in detecting coronary artery stenosis. METHOD:Twenty-eight patients underwent 3 T contrast-enhanced CS and conventional CMRA; for late gadolinium enhancement (LGE) imaging, 0.1 mmol/kg gadolinium medium was infused. CS CMRA was scanned within the LGE waiting time. After the LGE image acquisition, conventional CMRA was performed. The diagnostic performance of both CMRA for the detection of significant stenosis was evaluated using coronary angiography as a reference. The analysis was conducted to examine the three main coronary artery vessels: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). These arteries were subdivided into 8 segments (LAD; main, proximal, and middle, LCX; proximal and distal, RCA; proximal, middle, and distal). Of these, hypoplastic segments and vessels after coronary stent implantation were excluded. The acquisition time of CS CMRA was compared with that of conventional CMRA. RESULTS:The coronary arteries were evaluated in 197 segments. The sensitivity, specificity, and accuracy of CS CMRA in detecting significant stenosis were 85.2 %, 82.5 %, and 83.2 %, respectively, on a per-segment basis. Those of conventional CMRA were 85.2 %, 86.7 %, and 86.3 %, respectively. The acquisition time was 207 s (range, 144-258 s) for CS and 975 s (range, 787-1226s) for conventional CMRA (p < 0.001). CONCLUSIONS:Similar to conventional CMRA, CS CMRA has shown potential for the detection of significant coronary artery stenosis.

Background: This study evaluated the diagnostic capability of on-site coronary computed tomography-derived computational fractional flow reserve (CT-FFR) determinations for detecting coronary artery disease (CAD), as assessed by invasive fractional flow reserve (FFR). Methods and Results: Seventy-four patients with coronary artery calcium scores <1,500 who underwent coronary CT angiography (CTA) and invasive FFR measurements within 90 days were retrospectively reviewed. CT-FFR was computed using a prototype machine-learning (ML) algorithm in 91 vessels; 47 vessels of 42 patients were determined to have significant CAD (FFR <= 0.8). Correlation between CT-FFR and FFR was good (r=0.786, P<0.001). Per-vessel area under the curve was significantly larger for CT-FFR (0.907, 95% confidence interval: 0.828-0.958) than for CTA stenosis >= 50% (0.595, 0.487-0.697) or >= 70% (0.603, 0.495-0.705) (both P<0.001). Standard coronary CTA classifications recommended further functional tests in 57 patients with moderate or worse stenosis on CTA. CT-FFR analysis (mean analysis time: 16.4 +/- 7.5 min) corrected the standard coronary CTA classification in 18 of 74 patients and confirmed it in 45 of 74 patients. Thus, the per-patient diagnostic accuracy of the classifications was improved from 66% (54-77%) to 85% (75-92%). Conclusions: On-site CT-FFR based on a ML algorithm can provide good diagnostic performance for detecting hemodynamically significant CAD, suggesting the high value of coronary CTA for selected patients in clinical practice.

Background: The comparative tolerability, efficacy, and safety of bisoprolol and carvedilol have not been established in Japanese patients with heart failure and reduced ejection fraction (HFrEF). Methods and Results: The CIBIS-J trial is a multicenter, open-label, non-inferiority randomized controlled trial of bisoprolol vs. carvedilol in 217 patients with HFrEF (EF <= 40%). The primary endpoint was tolerability, defined as reaching and maintaining the maximum maintenance dose (bisoprolol 5 mg/day or carvedilol 20 mg/day) during 48 weeks of treatment. The primary endpoint was achieved in 41.4% of patients in bisoprolol (n=111) and 42.5% in carvedilol (n=106) groups. The non-inferiority of tolerability of bisoprolol compared with carvedilol was not supported, however, neither beta-blocker was superior with regard to tolerability. Heart rate (HR) decreased in both groups and its decrease from baseline was significantly greater in the bisoprolol group (20.3 vs. 15.4 beats/min at 24 week, P<0.05). Plasma B-type natriuretic peptide (BNP) levels decreased in both groups and the decrease was significantly greater in the carvedilol group (12.4 vs. 39.0 % at 24 weeks, P<0.05). Conclusions: There were no significant differences between bisoprolol and carvedilol in the tolerability of target doses in Japanese HFrEF patients. The clinical efficacy and safety were also similar despite the greater reduction in HR by bisoprolol and plasma BNP by carvedilol.

BACKGROUND The vascular response, in terms of quality and quantity, of the second- and third-generation drug-eluting stents (2G- and 3G-DES, respectively) was assessed prospectively on coronary angioscopy (CAS).Methods and Results:The Multicenter study on Intra-Coronary AngioScopy After Stent (MICASA) is a multicenter CAS registry. A total of 107 DES (71 2G- and 36 3G-DES) were prospectively observed on CAS 8.7±2.7 months after percutaneous coronary intervention. Neointimal coverage (NC) grade was evaluated using a 4-point grading scale, from 0 (no coverage) to 3 (complete coverage). Plaque yellow color (YC) was also assessed using a 4-point grading system, from 0 (white) to 3 (bright yellow). Max-NC (2G-DES vs. 3G-DES: 2.14±0.68 vs. 2.44±0.73, P=0.023); min-NC (1.07±0.48 vs. 1.39±0.60, P=0.002), and dominant-NC (1.57±0.69 vs. 2.08±0.84, P=0.002) were significantly higher and the YC grade (1.23±0.82 vs. 0.86±0.76, P=0.031) significantly lower in the 3G-DES group than in the 2G-DES group. There was no significant difference in the presence of thrombus (28.2% vs. 22.2%, P=0.51) between the 2G- and 3G-DES groups. CONCLUSIONS The higher NC grade and lower YC grade in 3G-DES than in 2G-DES might be associated with better long-term clinical outcome, which remains to be determined in future studies.

Objectives: Whole-heart coronary magnetic resonance angiography (MRA) is a promising non-contrast, radiation-free technique for assessing the coronary artery. Yet, a disadvantage of coronary MRA is the relatively long acquisition time. The purpose of this study was to evaluate the scan time and image quality of compressed sensing (CS) coronary MRA compared with conventional coronary MRA. Materials and methods: Twenty healthy volunteers underwent navigator-gated coronary MRA with a CS prototype sequence and conventional navigator-gated coronary MRA on a clinical 3T MRI scanner without contrast medium. The spatial resolutions were 1.33 x 1.33 x 1.20 mm(3) for CS and 1.33 x 1.33 x 1.48 mm(3) interpolated to 0.70 x 0.70 x 1.20 mm(3) for conventional, respectively. We compared acquisition times, rated image quality on a 4-point scale (RCA; proximal, middle, and distal, LAD; main, proximal, middle, and distal, LCX; proximal and distal), and measured the visualized vessel lengths of three vessels. Results: The mean acceptance rates were 44.9% for CS coronary MRA and 48.7% for conventional coronary MRA (p = .39). The mean effective scan time was 3 min 45 s for CS coronary MRA and 15 min 6 s for conventional coronary MRA (p < 0.001). Image quality scores were significantly lower for CS coronary MRA than for conventional coronary MRA (3.4 +/- 0.7 for CS vs. 3.8 +/- 0.4 for conventional; p < 0.0001). Conventional coronary MRA images were scored > 3.4 in all segments on average, while CS coronary MRA images were scored > 3.2 (good quality for diagnosis) in almost all segments, with only the distal RCA segment graded 2.9 on average. The average visible vessel lengths for CS and conventional coronary MRA were as follows: 11.5 +/- 4.4 cm and 12.5 +/- 4.8 cm for the RCA, respectively (p < 0.05, 95% limits of agreement [LOA]; - 3.6 to 1.6 cm); 10.6 +/- 3.0 cm and 11.1 +/- 2.9 cm for the LAD, respectively (p = .15, 95% LOA - 4.0 to 2.8 cm); and 7.1 +/- 2.2 cm and 8.2 +/- 2.5 cm for the LCX, respectively (p < 0.05, 95% LOA - 4.0 to 1.7 cm). Conclusions: Non-contrast coronary MRA using CS could largely shorten acquisition time, compared with conventional navigator-gated coronary MRA, while maintaining acceptable visualization at 3T.

Introduction: Efficacy of SGLT2 inhibitors on cardiovascular death has been reported by the EMPA-REG study. Meanwhile, SGLT2 inhibitors have been proposed for recommendations on excessive dehydration and use in Flail cases. We report on the usefulness and side effects of Canagliflozin administered to 22 patients with heart failure with diabetes mellitus who has mild renal dysfunction and can not tolerate the increase in diuretic. Methods and Results: Twenty-two cases (16 males, average 77.8 ± 11.2 years) were administered Canagliflozin 100 mg every day for an average of 6 months. NYHA (2.5–2.1), body weight (56.6–55.1 kg), systolic blood pressure (131.6–128.9 mmHg), CTR in chest XP (59.7–56.6%), NTproBNP (881–563 pg/ml), creatinine (1.77–1.63 mg/dl) were significant improved. On the other hand, ejection fraction (EF) with echocardiography was not improved before and after treatment (45.3–42.2%), and extended disturbance improved (E/e', 12.43–8.79). There was also no rise in the heart rate frequently seen with diuretics. (81.2–78.4/min) There was no progression of dehydrated or flailed fears. Conclusion: In this study, the usefulness of SGLT2 inhibitor for heart failure patients with diabetes mellitus was suggested. In addition to the dose reduction of diuretic drugs in some of the cases, heart failure has improved despite the flatness of kidney function. Also, elderly people were included, suggesting that side effects could be minimized if used under careful management.

The aim of this study is to assess the effect of blood pressure (BP) on coronary computed tomography angiography (CTA) derived computational fractional flow reserve (CTA-FFR).

BACKGROUND Compressed sensing (CS) cine magnetic resonance imaging (MRI) has the advantage of being inherently insensitive to respiratory motion. This study compared the accuracy of free-breathing (FB) CS and breath-hold (BH) standard cine MRI for left ventricular (LV) volume assessment.Methods and Results:Sixty-three patients underwent cine MRI with both techniques. Both types of images were acquired in stacks of 8 short-axis slices (temporal/spatial resolution, 41 ms/1.7×1.7×6 mm3) and compared for ejection fraction, end-diastolic and systolic volumes, stroke volume, and LV mass. Both BH standard and FB CS cine MRI provided acceptable image quality for LV volumetric analysis (score ≥3) in all patients (4.7±0.5 and 3.7±0.5, respectively; P<0.0001) and had good agreement on LV functional assessment. LV mass, however, was slightly underestimated on FB CS cine MRI (median, IQR: BH standard, 83.8 mL, 64.7-102.7 mL; FB CS, 79.0 mL, 66.0-101.0 mL; P=0.0006). The total acquisition times for BH standard and FB CS cine MRI were 113±7 s and 24±4 s, respectively (P<0.0001). CONCLUSIONS Despite underestimation of LV mass, FB CS cine MRI is a clinically useful alternative to BH standard cine MRI in patients with impaired BH capacity.

BACKGROUND GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non-vitamin K antagonist oral anticoagulant (NOAC), became available.OBJECTIVES This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1.METHODS During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients' baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics.RESULTS Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA(2)DS(2)-VASc [ Congestive heart failure, Hypertension, Age >= 75 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score >= 2; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment.CONCLUSIONS The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [ GLORIA-AF]; NCT01468701) (C) 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Background: Little is known about the direct effect of diabetes mellitus (DM) on medium-term to long-term lesion characteristics in patients treated with different types of stents.

Cardiovascular cine magnetic resonance (CMR) accelerated by compressed sensing (CS) is used to assess left ventricular (LV) function. However, it is difficult for prospective CS cine CMR to capture the complete end-diastolic phase, which can lead to underestimation of the end-diastolic volume (EDV), stroke volume (SV), and ejection fraction (EF), compared to retrospective standard cine CMR. This prospective study aimed to evaluate the diagnostic quality and accuracy of single-breath-hold full cardiac cycle CS cine CMR, acquired over two heart beats, to quantify LV volume in comparison to multi-breath-hold standard cine CMR.