Interest in atrial function continues to increase as it relates to cardiovascular outcomes in a variety of diseases ([1][1]). Cardiac resynchronization therapy (CRT) can have dramatic but variable effects in heart failure patients with reduced left ventricular (LV) ejection fraction and electric

About 1 in 3 patients with chronic heart failure (HF) has left bundle branch block (LBBB) ([1][1]), a ventricular conduction disorder causing a distinct pattern of electromechanical polarization in the left ventricular (LV) wall, characterized by a decrease of work load in the early activated septum

Patients with aortic stenosis (AS) and prior mediastinal radiotherapy (XRT) represent a challenging group ([1–3][1]). The detrimental effects due to the pressure overload associated with AS may be compounded by the presence of radiation heart disease. Echocardiographic speckle-tracking strain

OBJECTIVES The purpose of this study was to investigate how LBBB and CRT modify RV free wall function by direct ventricular interaction. BACKGROUND Right ventricular (RV) function influences prognosis in patients with left bundle branch block (LBBB) and cardiac resynchronization therapy (CRT). There is, however, limited insight into how LBBB and CRT affect RV function. METHODS In 24 patients with LBBB

In this issue of iJACC , Deferm et al. ([1][1]) reported on repeated analyses performed in a small cohort of patients with heart failure with reduced ejection fraction (HFrEF) (n = 31) with a mean EF of 20%. The patients were hospitalized for an acute heart failure syndrome. Invasive

Until recently, patients who presented with myocardial infarction and unobstructed coronary arteries (MINOCAs) were a diagnostic and therapeutic mystery. Optimal management of these patients was unclear because the underlying cause(s) remained undefined using routine testing with electrocardiography

About 5,400 heart transplantations are performed around the world annually. Survival in allograft recipients has improved substantially over the years with effective immunosuppressive therapy. However, acute cellular or antibody-mediated allograft rejection in the first 6 to 12 months remains a

Coronary artery disease remains the leading cause of cardiovascular morbidity and mortality. Invasive X-ray angiography and coronary computed tomography angiography are established gold standards for coronary luminography. However, they expose patients to invasive complications, ionizing radiation, and iodinated contrast agents. Among a number of imaging modalities, coronary cardiovascular magnetic

Current measures of anthracycline-induced cardiotoxicity, defined by decreases in left ventricular ejection fraction (LVEF), may become apparent only at a late stage when the myocardium has been significantly damaged, exceeding its ability to compensate ([1][1]). Our group has recently shown in a

Objectives The authors applied unsupervised machine-learning techniques for integrating echocardiographic features of left ventricular (LV) structure and function into a patient similarity network that predicted major adverse cardiac events (MACE) in an individual patient. Background Patient similarity analysis is an evolving paradigm for precision medicine in which patients are clustered or classified

Coronary artery disease (CAD) remains a leading cause of mortality and morbidity, despite decades of improvement in diagnostic investigations and therapeutic interventions ([1][1]). Noninvasive imaging for the investigation of patients with chest pain is endorsed by the major U.S. and European

OBJECTIVES The purpose of this study was to investigate the effect of the temporal and observer variability of cardiac magnetic resonance (CMR)-measured native T1, T2, and extracellular volume fraction (ECV) and serum biomarkers for the detection of cancer-therapeutics-related cardiac dysfunction (CTRCD). BACKGROUND Biomarkers and serial quantitative CMR tissue characterization may help identify early

Objectives The aim of this study was to compare echocardiographic methods of determining tricuspid regurgitation (TR) severity against TR regurgitant volume (TRRV) by cardiovascular magnetic resonance (CMR). Background TR is usually assessed using echocardiography, but it is not known how this compares with quantitative measurements of TR severity by CMR. Methods Echocardiographic and CMR methods were

There is controversy over the impact of moderate aortic stenosis (AS) on outcomes in patients with left ventricular (LV) systolic impairment. Van Gils et al. ([1][1]) found that patients with moderate AS and concomitant LV impairment are at high risk for clinical events. In contrast, Fougères et 

Cardiac troponin I (cTnI) concentrations above the upper reference limit (99th percentile) are indicative of myocardial injury ([1][1]). Marathon running can increase cTnI concentrations, but the underlying mechanisms remain unknown ([2][2]). Quantitative cardiac magnetic resonance (CMR) techniques

OBJECTIVES This study assessed the impact of right-atrial (RA) pacing on left-atrial (LA) physiology and clinical outcome. BACKGROUND Data for the effects of RA pacing on LA synchronicity, function, and structure after cardiac resynchronization therapy (CRT) are scarce. METHODS The effect of RA pacing on LA function, morphology, and synchronicity was assessed in a prospective imaging cohort of heart

Aortic root replacement (ARR) can be complicated by graft infection in 1% to 5% of cases, which is associated with 7% to 21% mortality ([1][1]). Although numerous studies have assessed the feasibility of fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in vascular

Objectives To examine prognostic value of T1- and T2-mapping techniques in heart transplant patients. Background Myocardial characterization using T2 mapping (evaluation of edema/inflammation) and pre- and post-gadolinium contrast T1 mapping (calculation of extracellular volume fraction [ECV] for assessment of interstitial expansion/fibrosis) are emerging modalities that have been investigated in various

Nonalcoholic fatty liver disease (NAFLD) is a strong predictor of the incidence of cardiovascular (CV) disease independent of established CV risk factors ([1][1]). Some studies have reported a significant association between NAFLD and the prevalence of computed tomographic angiography (CTA)–

OBJECTIVES The aim of this study was to assess the diagnostic yield of cardiac magnetic resonance (CMR) including high-resolution (HR) late gadolinium enhancement (LGE) imaging using a 3-dimensional respiratory-navigated method in patients with myocardial infarction with nonobstructed coronary arteries (MINOCA). BACKGROUND CMR plays a pivotal role for the diagnosis of patients with MINOCA. However

Originally associated with the 18th-century mathematician Leonhard Euler, topology is a discipline in mathematics that studies shapes. One of the key ideas in topology is that the properties of shapes are invariant (i.e., unchanging) when deformed (e.g., a circle, an ellipse, and a hexagon are all

Objectives The purpose of this retrospective cohort study was to compare remodeling of left ventricular (LV) structure and function after transcatheter stent therapy with remodeling of LV structure and function after surgical therapy for COA. Background Transcatheter stent therapy is as effective as surgery in producing acute hemodynamic improvement in patients with coarctation of aorta (COA). However

Large randomized controlled trials demonstrated that adding anti–proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to statins improved clinical outcomes. Compared with statin monotherapy, the use of PCSK9 inhibitors with statins significantly reduced the incidence of acute

OBJECTIVES The aim of this study was to assess the effect of congestion and decongestive therapy on left atrial (LA) mechanics and to determine the relationship between LA improvement after decongestive therapy and clinical outcome in immediate or chronic heart failure with reduced ejection fraction (HFrEF). BACKGROUND LA mechanics are affected by volume/pressure overload in decompensated HFrEF. METHODS

OBJECTIVES This study assessed whether adenosine stress-only perfusion cardiac magnetic resonance (CMR) following a positive coronary artery calcium (CAC) score improved the diagnostic yield of invasive coronary angiography (CAG) in patients with stable chest pain. The study also established the association between positive CAC scores and stress-induced myocardial ischemia. BACKGROUND The diagnostic

Atherosclerotic comorbidities are risk factors for descending aortic aneurysm, but this relationship is unknown for ascending aneurysm in the context of unstandardized size criteria and imaging modalities used in prior studies ([1][1]). Known risk factors for abdominal aortic aneurysms may not apply

Background Recent efforts in collecting multi-omics data open numerous oppurtunities for comprehensive integration of highly heterogenous data to classify a patient's cardiovascular state, eventually leading to tailored therapies. We present a method that focuses on cohort matching algorithms for performing patient-to-patient comparisons along multiple echocardiographic parameters for predicting meaningful

Background Previous pathology studies demonstrated that thin-cap fibroatheroma (TCFA) is localized in specific segments of the epicardial coronary arteries. A detailed description of in vivo coronary plaques of various phenotypes has not been reported. Objectives We performed a comprehensive analysis on the distribution of coronary plaques with different phenotypes from our 3-vessel optical coherence

Since its inception in 2007, The Journal of the American College of Cardiology: Cardiovascular Imaging (iJACC) has served as the top publication for all contemporary aspects of cardiovascular imaging. Understanding the dissemination trends in cardiovascular imaging has traditionally been assessed through citations which assesses impact in the research community. Recently, social media, alternative

The most common complication of patients with bicuspid aortic valve (BAV) is aortic valve surgery ([1][1]). Hemodynamically significant (moderate-severe to severe) aortic regurgitation (AR) is more common in younger men with BAV ([1][1]) and is classified as Stage C (asymptomatic) or D (symptomatic

One of the observations from the Human Genome Project argued that merely the number of genes did not reflect the biological complexity of organisms, but the number of relevant interactions among pathophysiological variables could explain the varied disease phenotypes and presentations. This led to

OBJECTIVES The authors investigated ideal acoustic conditions on a clinical scanner custom-programmed for ultrasound (US) cavitation-mediated flow augmentation in preclinical models. We then applied these conditions in a first-in-human study to test the hypothesis that contrast US can increase limb perfusion in normal subjects and patients with peripheral artery disease (PAD). BACKGROUND US-induced

Therapeutic focused ultrasound offers a noninvasive approach to targeted delivery of ablative acoustic energy to structures within the body. High-intensity focused ultrasound is one form of therapeutic ultrasound that capitalizes on the conversion of focused acoustic energy into thermal energy to

OBJECTIVES This study investigated the relationship between plasma angiotensin-converting enzyme 2 (ACE2) activity levels and the severity of stenosis and myocardial remodeling in patients with aortic stenosis (AS) and determined if plasma ACE2 levels offered incremental prognostic usefulness to predict all-cause mortality. BACKGROUND ACE2 is an integral membrane protein that degrades angiotensin II

Calcific aortic stenosis (AS) is one of the most common valvular heart diseases today; its prevalence increases with age and usually manifests after the seventh decade of life ([1][1],[2][2]). Traditionally, it was thought that the calcification of a tricuspid aortic valve resulting in AS was

Objectives This study assessed changes in myocardial native T1 and T2 values after supine exercise stress in healthy subjects and in patients with suspected ischemia as potential imaging markers of ischemia. Background With emerging data on the long-term retention of gadolinium in the body and brain, there is a need for an alternative noncontrast cardiovascular magnetic resonance (CMR)−based myocardial

The clinical workup of angina using noninvasive cardiac imaging techniques is a foundational layer on the spectrum of coronary care, and this is an area that has a long history of “battle of the tests” in cardiology. The quadrimodal tug of war among stress echocardiography, nuclear myocardial

Objectives This study sought to develop a fully automated framework for cardiac function analysis from cardiac magnetic resonance (CMR), including comprehensive quality control (QC) algorithms to detect erroneous output. Background Analysis of cine CMR imaging using deep learning (DL) algorithms could automate ventricular function assessment. However, variable image quality, variability in phenotypes

Almost 3 decades ago, Atkinson and Edelman ([1][1]) described a then-new magnetic resonance imaging (MRI) technique that segmented the acquisition of the raw k-space data across multiple heartbeats within a short patient breath-hold. This approach effectively eliminated respiratory artifacts in

Objectives The aim of this study was to assess the effect of sex on myocardial fibrosis as assessed by using cardiac magnetic resonance (CMR) imaging in aortic stenosis (AS). Background Previous studies reported sex-related differences in the left ventricular (LV) remodeling response to pressure overload in AS. However, there are very few data regarding the effect of sex on myocardial fibrosis, a key

The writing of John Gray [(1)][1] that “not only do men and women communicate differently, but they think, feel, perceive, react, respond, love, need, and appreciate differently” is also pertinent to sex differences in their cardiac response to various stimuli and medications. Women’s hearts

OBJECTIVES This study sought to determine the agreement between cardiac magnetic resonance (CMR) imaging and invasive measurements of fractional flow reserve (FFR) in the evaluation of nonculprit lesions after ST-segment elevation myocardial infarction (STEMI). In addition, we investigated whether fully quantitative analysis of myocardial perfusion is superior to semiquantitative and visual analysis

One-third to one-half of patients with acute ST-elevation myocardial infarction (STEMI) have multivessel coronary artery disease (CAD). Their worse prognosis is possibly associated with additional plaque instability, impaired epicardial and microvascular myocardial perfusion, and cardiogenic shock.

Objectives The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background Diagnostic

It remains hotly debated, whether anatomical or functional investigation of patients with coronary artery disease is superior [(1)][1]. Although trials in patients with low prevalence of disease have not been able to demonstrate differences [(2)][2], the question has less frequently been studied in

Objectives The current substudy of the PACIFIC (Prospective Comparison of Cardiac PET/CT, SPECT/CT Perfusion Imaging and CT Coronary Angiography With Invasive Coronary Angiography) trial explores the impact of computed tomography (CT)–derived unfavorable plaque features on both hyperemic and non-hyperemic flow indices. Background Next to lesion severity, plaque vulnerability as assessed using coronary

Clinical studies involving thousands of patients consistently demonstrate a near-linear relationship between the extent of coronary atherosclerotic disease burden and risk of myocardial infarction and death [(1)][1]. Studies also strongly suggest that actively progressing atheroma is associated with

Objectives This study was conducted to investigate the influence of coronary artery calcium (CAC) score on the diagnostic performance of machine-learning–based coronary computed tomography (CT) angiography (cCTA)–derived fractional flow reserve (CT-FFR). Background CT-FFR is used reliably to detect lesion-specific ischemia. Novel CT-FFR algorithms using machine-learning artificial intelligence techniques

Coronary computed tomography angiography (CTA) is a reliable modality for noninvasive assessment of coronary stenosis [(1)][1]. Recent advances in computational fluid dynamics (CFD) have enabled patient-specific modeling of coronary blood flow and pressure from standard CTA images, without the need

Objectives This study compared the ability of automated myocardial perfusion imaging analysis to predict major adverse cardiac events (MACE) to that of visual analysis. Background Quantitative analysis has not been compared with clinical visual analysis in prognostic studies. Methods A total of 19,495 patients from the multicenter REFINE SPECT (REgistry of Fast Myocardial Perfusion Imaging with NExt

Although quantitative techniques for assessing noninvasive and invasive cardiac imaging have been available for years, the cardiology community has been relatively slow to embrace these techniques. The subjective interpretation of images remains the most commonly applied standard in clinical

OBJECTIVES The aims of this first-in-human pilot study of intravascular polarimetry were to investigate polarization properties of coronary plaques in patients and to examine the relationship of these features with established structural characteristics available to conventional optical frequency domain imaging (OFDI) and with clinical presentation. BACKGROUND Polarization-sensitive OFDI measures birefringence

Intracoronary imaging techniques provide unique insights into the pathobiology and treatment of human coronary artery disease (CAD) ([1–5][1]). The “holy grail” of intracoronary imaging is to identify high-risk, or “vulnerable,” plaques that are associated with an inevitable future

Objectives The purpose of this study was to derive a biomechanical stress metric that was based on the multifactorial assessment of coronary plaque morphology, likely related to the propensity of plaque rupture in patients. Background Plaque rupture, the most frequent cause of coronary thrombosis, occurs at locations of elevated tensile stress in necrotic core fibroatheromas (NCFAs). Finite element

The past few decades have witnessed extensive investigations to risk-stratify individual coronary artery plaques in an effort to identify plaques likely to progress, destabilize, and cause a new major adverse cardiac event, so that potentially life-saving intervention strategies could be

Functional mitral regurgitation (MR) in patients with atrial fibrillation (AF) without left ventricular dysfunction, namely, atrial functional MR, has been increasingly recognized. Whether mitral annular dilatation causes MR in patients without left ventricular dysfunction has remained controversial; however, recent studies using novel imaging technologies, including 3-dimensional echocardiography

Clinical trials of transcatheter mitral valve and tricuspid valve repair and replacement devices have begun in earnest, with the ultimate goal of providing definitive, nonsurgical treatment for the millions of patients with severe, symptomatic regurgitation, many of whom are too high risk or inoperable for a surgical approach. Computed tomography (CT) angiography offers the potential for detailed anatomic

Recent technological advances in cardiac imaging allow the visualization of anatomic details up to millimeter size in 3-dimensional format. Thus, it is not surprising that electrophysiologists increasingly rely upon cardiac imaging for the diagnosis, treatment, and subsequent management of patients affected by various arrhythmic disorders. Cardiac imaging methods reviewed in the present work involve:

The evaluation of valvular heart disease (VHD) is challenging when there is disagreement between objective hemodynamic metrics of severity and subjective findings of symptomatology. Stress echocardiography is recommended for the evaluation of these discordant cases because exertion can unmask

The most direct metric of the systolic performance of the heart is the quantity of blood ejected by the left ventricle during a single systole (i.e., the stroke volume). The stroke volume adapts rapidly to both internal homeostatic requirements and external stresses. If ventricular filling were