BACKGROUND:Right ventricle (RV) function and volumes assessment by cardiac MRI has emerged as a strong prognostic marker in patients with pulmonary hypertension (PH), but expert centers propose different thresholds, possibly explainable by methodologic differences. RESEARCH QUESTION:What is the impact of RV trabeculation exclusion on RV metrics in patients with PH? Which level of pulmonary artery (PA) flow assessment best estimates RV stroke volume (RVSV) using 4-dimensional (4D) flow MRI? STUDY DESIGN AND METHODS:Forty-two patients with PH were recruited prospectively in the Postoperative Right Heart Remodeling in Patients With Chronic Thromboembolic Pulmonary Hypertension After Endarterectomy, or Pulmonary Arterial Hypertension After Lung Transplantation, study and underwent right heart catheterization and cardiac MRI including 4D flow MRI. RVSV, RV ejection fraction (RVEF), RV end systolic volume index (RVESVi), and RV mass were assessed either including or excluding trabeculations from the RV volume. RVSV including trabeculations from the right ventricular volume (RVSV_Tin(v)) and excluding trabeculations from the right ventricular volume (RVSV_Tex(v)) then were compared with the PA forward flow (PAFF) measured at the mid-PA trunk (Mid_PAFF) and at the PA annular level (Ann_PAFF), using 4D flow MRI. Twenty-three patients were re-evaluated after surgery: patients with chronic thromboembolic PH underwent pulmonary endarterectomy, whereas patients with refractory pulmonary arterial hypertension underwent lung transplantation. RESULTS:Excluding trabeculations from RV volumes led to higher RVEF, RVSV, and RV mass median values (47.3% [interquartile range (IQR) 34.6%-54.6%] vs 40.9% [IQR, 29.6%-50.6%]; 69.5 mL [IQR, 62.5-80.6 mL] vs 59.3 mL [IQR, 50.9-74.8 mL]; and 54.5 g [IQR, 41-69 g] vs 37 g [IQR, 29.2-50 g], respectively; P < .001 for all), and lower RVESVi median values (44.5 mL/m2 [IQR, 29.5-63.7 mL/m2] vs 54.4 mL/m2 [IQR, 33.5-77.2 mL/m2]; P < .001), reclassifying 15 patients as low risk. Compared with the standard approach of associating Mid_PAFF flow measurement with RVSV_Tin(v), the association between Ann_PAFF and RVSV_Tex(v) was stronger (r = 0.66 and r = 0.85 respectively; P = .04). Longitudinal analysis demonstrated strong changes for RV mass, RVESVi, and RVEF. After surgery, excluding trabeculations showed much less impact on RV metrics, reflecting reverse remodelling. INTERPRETATION:Our results show that postprocessing methodologic differences using cardiac and 4D flow MRI significantly impacted RV measurements when applying guideline-recommended thresholds. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov; No.: NCT03205085; URL: www. CLINICALTRIALS:gov.

Background Coronary intramural hematoma (IMH) is a rare cause of acute coronary syndrome that may occur after blunt chest impact. Case Summary A 19-year-old competitive athlete presented with sudden retrosternal chest pain after intense exertion and direct ball-related impact to the chest during a football match. Troponin peaked at 20,400 ng/L. Coronary angiography showed a nonobstructive ostial left anterior descending artery (LAD) lesion. Cardiac magnetic resonance demonstrated near-transmural ischemic injury with microvascular obstruction in the basal-mid septum. Coronary computed tomography (CT) angiography revealed hyperdense mural thickening and positive remodeling of the proximal LAD, suggestive of IMH. Optical coherence tomography confirmed a focal subadventitial IMH in the proximal LAD, near the ostium of the first septal branch. Discussion This case illustrates traumatic IMH as a potential cause of myocardial infarction with nonobstructive coronary arteries in a young athlete and underscores the value of cardiac CT. Take-Home Messages Coronary IMH should be considered after blunt chest trauma. Noncontrast CT aids IMH diagnosis.

The distinction between idiopathic pulmonary arterial hypertension (iPAH) and pulmonary hypertension associated with lung disease remains increasingly challenging, particularly in patients with overlapping clinical features. In a timely study, Valentin and colleagues investigated whether cardiac magnetic resonance (CMR) native T1 mapping could improve phenotypic characterization in patients with classical iPAH, iPAH with a lung phenotype, and group 3 pulmonary hypertension (PH). While conventional CMR measures of right ventricular (RV) structure and function showed no significant differences between groups, native T1 values were significantly higher in classical iPAH, particularly at the interventricular septum and RV insertion points, suggesting more pronounced myocardial fibrosis and RV remodeling. Patients with lung phenotype iPAH exhibited T1 profiles closer to group 3 PH, supporting the concept of distinct underlying pathophysiology. Although the observed differences were modest and require validation across larger cohorts and 1.5 Tesla MRI platforms, these findings highlight the potential of myocardial tissue characterization as a complementary tool for integrated PH phenotyping. Beyond diagnostic classification, advanced CMR techniques may provide valuable biomarkers of RV adaptation, disease progression, and treatment response, contributing to a more personalized and mechanistically informed approach to pulmonary vascular disease.

OBJECTIVE:This study aimed to assess modifications of aortic secondary flow patterns following thoracic endovascular aortic repair (TEVAR) using four dimensional flow magnetic resonance imaging (4D flow MRI). METHODS:FASCAT is a French, prospective, observational, single centre study. All included patients underwent cardiac MRI, including aortic magnetic resonance angiography and 4D flow MRI acquisition, before and three months after TEVAR. Visual and quantitative aortic flow patterns were assessed using Tempus Pixel Cardio and cvi42 software. Basic 4D flow MRI metrics-such as aortic forward flow (AFF), aortic reverse flow (ARF), aortic net flow (ANF), and peak and mean velocities-were initially assessed. 4D flow MRI derived advanced metrics-such as pulse wave velocity (PWV) related to aortic stiffness, flow ejection angle, flow eccentricity (ECC), and mean systolic fraction of reverse flow (FRF)-and their duration over systole (FRFdsys and ECCdsys, respectively) were also measured on pre- and post-operative MRIs. RESULTS:The analysis was conducted on 15 TEVAR procedures in 14 patients (seven aneurysms and seven dissections). The median time between pre- and post-operative MRI was 122.8 days. PWV statistically significantly increased within the stented segment (17.8 ± 12.1 cm/s vs. 9.4 ± 8.5 cm/s; p = .005), while it statistically significantly decreased upstream of the graft (8.8 ± 9.1 cm/s vs. 4.9 ± 6.2 cm/s; p = .035) post TEVAR. No statistically significant changes were found in terms of mean AFF, ANF, velocities, or flow ejection angle pre to post TEVAR. Mean systolic FRF statistically significantly decreased post TEVAR (37%, 26%, and 48% at the sinotubular junction, mid ascending aorta, and TEVAR inlet, respectively). FRFdsys and ECCdsys also statistically significantly decreased post TEVAR. CONCLUSION:This pre to post TEVAR 4D flow MRI study found a statistically significant decrease in ARF and ECC upstream of the graft, suggesting improved upstream aortic flow fields post TEVAR.

Journal Article Dysphagia caused by a double aortic arch Get access Paul Le Corre, Paul Le Corre Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Le Plessis Robinson 92350, France Corresponding author. Email: plecorre29@gmail.com https://orcid.org/0009-0003-0318-8387 Search for other works by this author on: Oxford Academic PubMed Google Scholar Arshid Azarine, Arshid Azarine Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Le Plessis Robinson 92350, France https://orcid.org/0000-0003-4045-822X Search for other works by this author on: Oxford Academic PubMed Google Scholar Virgile Chevance Virgile Chevance Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Le Plessis Robinson 92350, France https://orcid.org/0000-0001-7102-5238 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, ehad752, https://doi.org/10.1093/eurheartj/ehad752 Published: 09 November 2023

Introduction L’utilisation de la classification CAD-RADS 2.0 est recommandée pour les comptes rendus de TDM cardiaques centrés sur les coronaires par plusieurs sociétés savantes. Données récentes Dans un premier temps, cet article rappelle les bases de la classification CAD-RADS 2.0 permettant son utilisation : la détection et la caractérisation des plaques, la quantification de la sévérité des sténoses et l’évaluation de la charge athéromateuse globale. Est ensuite présenté le rationnel scientifique qui sous-tend la nécessité de son utilisation pratique pour les imageurs ainsi que les arguments pour convaincre les médecins correspondants demandeurs de s’y intéresser afin qu’ils l’intègrent dans leur pratique clinique. Conclusion L’utilisation de la classification CAD-RADS comme moyen de communication cardiologue/radiologue est un outil utile pour améliorer la prise en charge des patients.

Background: Chronic parietal stress has been suggested as a possible mechanism to explain the unclear pathophysiology of outflow tract PVCs.Objectives: To assess wall shear stress (WSS) maps of the right ventricle outflow tract (RVOT) in patients with significant outflow tract premature ventricular contrac-tion (PVC).Methods: We evaluated prospectively in a 2-centre study 15 patients undergoing first time outflow tract PVC ablation. All patients underwent gadolinium-enhanced 4D-flow cardiovascular MRI (CMR) before ablation. Flow patterns were visually ana-lyzed in RVOT long axis for vorticity and cross-sectional view for eccentricity. Pa-tients were compared to a sex and age 2:1 matched control population without car-diac disease and arrhythmia. Results: Blood flow in the RVOT was often associated with eccentric systolic flow jet without any macroscopic vortex detected. RVOT WSS maps were heterogenous, with increased WSS zones suggesting areas of focal flow jet impingement, most of-ten localized in the posterior and posteroseptal walls. These abnormal areas corre-sponded in most of cases (66%) to the arrhythmogenic zones, as demonstrated by electrophysiological mapping. In control subjects, WSS was predominately in-creased in the same areas. Ventricular EGMs amplitude during sinus rhythm in in-creased WSS zones was non-significantly lower (1.4 ± 0.7 mV vs. 2.4 ± 1.9 mV, p=0.26) in patients with electrophysiological/fluid dynamics concordance.Conclusions: 4D-flow CMR-derived WSS was locally increased at the posterior and posteroseptal RVOT walls in patients with outflow tract PVCs, corresponding mainly to the arrhythmogenic areas as demonstrated by electrophysiological mapping. Our findings suggest an electrophysiological/fluid dynamics relationship in patients with outflow tract PVCs.

Introduction: Immune checkpoint inhibitors (ICI) have significantly improved cancer treatment outcomes, but cardiovascular complications such as ICI-associated myocarditis are a major concern. Diagnosing myocarditis requires integrating biomarkers, electrocardiogram (EKG), cardiac imaging, and endomyocardial biopsy. We present a case illustrating these diagnostic challenges, involving a female patient treated with pembrolizumab who developed fatal acute myocarditis mimicking infiltrative cardiomyopathy. Case report: A 54-year-old woman with mucosal melanoma, treated with pembrolizumab, was hospitalized in May 2023 due to dyspnea and elevated troponin levels. Initial cardiac workups were normal, but subsequent tests revealed borderline cardiac magnetic resonance imaging findings. In late May 2023, the patient was admitted with worsening dyspnea, elevated NT-pro-BNP, and severe hyperlactatemia. Imaging and endomyocardial biopsy confirmed acute myocarditis with atypical presentation, mimicking infiltrative cardiomyopathy. Despite aggressive immunosuppressive therapy, the patient’s condition deteriorated, resulting in cardiogenic shock and death seven days post-admission. Conclusion: This case underscores the diagnostic and management challenges of ICI-associated myocarditis, particularly with atypical presentations. It highlights the need for vigilant, comprehensive monitoring and further research to improve diagnostic and therapeutic strategies for managing these severe side effects in patients undergoing ICI therapy.

Journal Article Cardiac tamponade related oesophageal perforation Get access Sylvain Diop, Sylvain Diop Department of Anesthesiology, Marie Lannelongue Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France Corresponding author. Email: menes.diop@gmail.com https://orcid.org/0000-0002-6846-8254 Search for other works by this author on: Oxford Academic PubMed Google Scholar Virgile Chevance, Virgile Chevance Department of Radiology, Marie Lannelongue Hospital, Le Plessis Robinson, France https://orcid.org/0000-0001-7102-5238 Search for other works by this author on: Oxford Academic PubMed Google Scholar Maïra Gaillard Maïra Gaillard Department of Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, ehad600, https://doi.org/10.1093/eurheartj/ehad600 Published: 28 September 2023

Atrial fibrillation is the most common cause of arrhythmia which is responsible for over 15% of ischemic strokes, most of these being secondary to migration of a left atrial appendage (LAA) thrombus. In patient with contraindication to anticoagulant therapy, percutaneous closure system placement may be indicated. Cardiac computed tomography (CT) angiography plays a central role in the initial assessment as well as in the follow-up. The purpose of the pre-implantation cardiac CT angiography is to evaluate the anatomy of the LAA in order to select the most suitable prosthesis and check for any contraindication to device implantation. Image analysis is divided into four steps that include analysis of the approach; search for a thrombus in the LAA; investigation of the anatomy of the LAA (morphology of the LAA, dimensions of the LAA and choice of device) and cardiac and thoracic assessments. Follow-up involves CT examination to check for correct placement of the device and to detect any complications. On the basis of the results of currently available published research, a panel of experts has issued recommendations regarding cardiac CT angiography prior to percutaneous LAA closure device placement, which were further endorsed by the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV).

Background: Evaluate the impact of valvular calcifications measured on cardiac computed tomography (CCT) in patients with infective endocarditis (IE). Methods: Seventy patients with native IE (36 aortic IE, 31 mitral IE, 3 bivalvular IE) were included and explored with CCT between January 2016 and April 2018. Mitral and aortic valvular calcium score (VCS) were measured on unenhanced calcium scoring images, and correlated with clinical, surgical data, and 1-year death rate. Results: VCS of patients with mitral IE and no peripheral embolism was higher than those with peripheral embolism (868 (25–1725) vs. 6 (0–95), p < 0.05). Patients with high calcified mitral IE (mitral VCS > 100; n = 15) had a lower rate of surgery (40.0% vs.78.9%; p = 0.03) and a higher 1-year-death risk (53.3% vs. 10.5%, p = 0.04; OR = 8.5 (2.75–16.40) than patients with low mitral VCS (n = 19). Patients with aortic IE and high aortic calcifications (aortic VCS > 100; n = 18) present more frequently atypical bacteria on blood cultures (33.3% vs. 4.8%; p = 0.03) than patients with low aortic VCS (n = 21). Conclusion: The amount of valvular calcifications on CT was associated with embolism risk, rate of surgery and 1-year risk of death in patients with mitral IE, and germ’s type in aortic IE raising the question of their systematic quantification in native IE.

A 49-year-old patient consulted for abdominal pain and fever, 2 years after treatment of infective endocarditis on a dual-chamber pacemaker (PM) with favourable outcome at this time after treatment by partial surgical removal of the PM and antibiotic therapy. The lead tips were left in the right ventricle (RV) and in the left subclavian vein (thoracic radiography, Panel A, arrows). Abdominal computed tomography (CT) evidenced a thick-walled anterior abdominal fluid collection adjacent to the left liver lobe (Panel B, arrow) communicating with the infero-apical part of the RV on sagittal (Panel C, arrow) and oblique (Panel D, arrow) reconstructions. The residual fragment of the ventricular probe was no more detected within the RV. The collection contained a high-density metallic structure (Panels B and C, arrowhead), suggesting a migration of the RV probe’s fragment through the cardiac wall, the pericardium, and...

MR assessment of a post-traumatic ventricular septum defect using 4D flow in a patient with multiple knife-related injuries Virgile Chevance, Virgile Chevance APHP, CHU Henri Mondor, Service d’imagerie médicale, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France Corresponding author. Tel: +33 149812111, Email: virgile.chevance@gmail.com https://orcid.org/0000-0001-7102-5238 Search for other works by this author on: Oxford Academic PubMed Google Scholar Vincent Pelletier, Vincent Pelletier APHP, CHU Henri Mondor, Service d’imagerie médicale, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Annabelle Nguyen, Annabelle Nguyen APHP, CHU Henri Mondor, Service d’imagerie médicale, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Jean-François Deux Jean-François Deux APHP, CHU Henri Mondor, Service d’imagerie médicale, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France https://orcid.org/0000-0003-2928-1929 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 42, Issue 7, 14 February 2021, Page 799, https://doi.org/10.1093/eurheartj/ehaa933 Published: 15 December 2020 Article history Received: 24 October 2020 Editorial decision: 25 October 2020 Accepted: 29 October 2020 Published: 15 December 2020