Risultati per: L'imaging nella urolitiasi

Circulation, Volume 148, Issue Suppl_1, Page A18850-A18850, November 6, 2023. Background:Intravascular imaging (IVI) namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), presents as a promising imaging modality for drug-eluting stent (DES) implantation compared to the gold-standard conventional two-dimensional angiography. IVI provides detailed information on vessel lumen, lesion length, and degree of calcification. For this purpose, we conducted a meta-analysis by pooling recently conducted randomized control trials (RCTs) to compare IVI with angiography for DES implantation.Hypothesis:IVI is associated with a significant reduction in CV events for DES implantation.Methods:Fourteen RCTs reporting CV outcomes with IVI versus angiography-guided stent implantation in CAD patients undergoing PCI were included in MEDLINE, and Scopus databases (Inception till May 2023). The primary outcome of interest was target-lesion revascularization (TLR). The outcome measures were summary random effects risk ratio (RR) with 95% confidence intervals.Results:A total of 8,946 patients (IVI 4,751 vs. angiography 4,195; mean age 61.7 years) were included. Over a median follow-up of 15 months (12-24.3), IVI was associated with significantly reduced TLR (RR 0.63 [0.49, 0.79]; Figure 1), target vessel revascularization (RR 0.66 [0.53, 0.83]), and major adverse cardiovascular events (MACE) (RR 0.69 [0.58, 0.78]) vs. conventional angiography for PCI. However, no significant difference was observed in all-cause mortality between the two imaging modalities (RR 0.85 [0.63, 1.15]). Meta-regression analysis showed no significant impact of follow-up duration, baseline comorbidities such as hypertension, smoking status, previous myocardial infarction, and stent length on TLR incidence.Conclusion:IVI was associated with improved CV outcomes in terms of reduced TLR, TVR, and MACE incidence when compared with traditional angiography in CAD patients for stent implantation.

Circulation, Volume 148, Issue Suppl_1, Page A17405-A17405, November 6, 2023. Introduction:Activation of matrix metalloproteinase (MMPs) post myocardial infarction (MI) predicts post-MI remodeling. MMP activation in the heart can be detected using 99mTc-RP805 a radiolabel peptidomimetic that binds to the catalytic site. The purpose of this study was to evaluate the biodistribution, dosimetry, and specificity of clinical grade 99mTc-RP805 for first-in-human studies.Methods:Male and female rats (n=24) were injected with99mTc-RP805 and euthanized at 1, 3, 7 or 12 hr post injection to determine biodistribution and estimate human dosimetry. Organ activity (%ID/g) was used to estimate whole body and organ effective dose using OLINDA. MI was induced in rats by LAD ligation (n=19) and injected with99mTc-RP805 3 days post MI, and rats were euthanized 3 hr after injection in absence (n=9) or presence (n=10) of a 100 x blocking dose of RP805 (257 ug/kg) 30 min prior to radiotracer injection to establish specificity. In vivo SPECT/CT imaging was performed with GMP grade99mTc-RP805 in rats post-MI (n=4).Results:The %ID/g for each organ is presented per time point (Fig 1 A). The highest radiation dose was found in male kidneys at 3 hr (%ID/g: 6.11 ± 0.54), female kidneys at 1hr (%ID/g: 6.31 ± 0.88). The estimated total body dose for human males was calculated at 0.172 mSv/mCi and 0.283 mSv/mCi for females, equaling a dose of 3.4 mSv and 5.7 mSv for a 30 mCi injection in males and females, respectively. There is 4 fold increase 99mTc-RP805 uptake in the infarct area compared to the normal LV (Fig 1B) and uptake was blocked with cold compound (ANOVA, p

Circulation, Volume 148, Issue Suppl_1, Page A16985-A16985, November 6, 2023. Background:Non-invasive identification of the site of origin (SOO) of ventricular arrhythmias is vital in informing ablation strategy. ECGi is an established method to generate 3D activation maps with a multielectrode vest combined with cardiac CT. EWI is an emerging echocardiography based modality that provides a low cost & non-ionizing mapping alternative.Hypothesis:EWI more precisely localises SOO of Complex Ventricular Ectopy (VEs) & intramural location than commercial ECGi.Aim:Compare spatial accuracy of EWI and ECGi to estimate SOO and validate against contact mapping.Methods:VE-ablation patients underwent preprocedural EWI & ECGi to estimate SOO on the AHA segment-model. A commercial ECGi system with cardiac CT was used for reconstruction of epicardial VE activation maps. EWI was performed using a research ultrasound acquiring B-mode and high frame rate (2000fps) images with simultaneous ECG. Local electromechanical activation was defined as time-point of the downward zero-crossing on the incremental axial strain curve (250 strain curves/view) and displayed on 3D rendered maps. The site of earliest activation & successful VE ablation was defined as ground truth for VE SOO.Results:10 patients were enrolled: 50% male, age 40.8 +/- 18.1 years, LV EF 41+/-15%, 50% with scar on MRI. CT ECGi correctly identified the VE AHA segment in 8/10 (80%) cases (misclassified 2 papillary muscle (PM) VEs) but did not afford transmural localization. After excluding 1 patient with insufficient VE’s for EWI, EWI correctly identified the VE-SOO segment in 8/9 (88%) cases locating 2 subepicardial, 2 septal intramural & 3 VEs at the base or intramural segment adjacent to a PM. It misclassified 1 PM VE.ConclusionBoth EWI & ECGI identified the VE-SOO segment in at least 80% of cases irrespective of presence of scar. EWI also correctly determined the transmural VE origin which cannot be located using commercial ECGI. This has important implications in planning ablation procedures.

Circulation, Volume 148, Issue Suppl_1, Page A16201-A16201, November 6, 2023. Introduction:Several predictive heart failure (HF) models exist to determine incident HF. We aimed to create a model that uses cardiac CT imaging biomarkers to improve discrimination scores of incident HF.Hypothesis:Cardiac CT variables increase predictive abilities of the Pooled Cohort Equations to Prevent HF (PCP-HF) score (a validated 10-year risk of new-onset HF prediction model) in all HF, HFrEF, and HFpEF.Methods:MESA participants aged 45-84 years old and free of clinical CVD who completed a cardiac CT were included for study analysis. The outcome of interest was new-onset HF. Clinical risk factors were obtained. Cardiac CT variables analyzed included left ventricular size index (LVSi) and calcifications of coronary arteries (CAC), aortic valve (AVC), mitral valve (MVC), and thoracic aorta (TAC).Results:Among 6,667 MESA study participants who underwent cardiac CT, 426 events of new-onset HF occurred during the follow-up period. Among the 426 events, 173 (40.6%) were categorized as HFrEF, 193 (45.3%) were categorized as HFpEF, and 60 (14.1%) had missing ejection fraction data. The reported data is based on the Cox model adjusted for all CT variables in one model with log(PCP-HF). For all incident HF (preserved and reduced), CAC (HR 1.10 95% CI 1.05-1.15, p

Circulation, Volume 148, Issue Suppl_1, Page A14402-A14402, November 6, 2023. Introduction:Gated CTs are used to quantify coronary artery calcium (CAC), a strong predictor of cardiovascular risk across diverse populations. However, inequities in access to gated CTs, typically not covered by insurance, exacerbate health disparities in atherosclerotic cardiovascular disease (ASCVD) risk assessment. Artificial intelligence can quantify CAC on non-gated chest CTs.Objective:We sought to determine sociodemographic differences in utilization of gated CAC scans vs non-gated chest CTs to identify opportunities to improve health equity in ASCVD risk assessment.Methods:We extracted electronic health record data on all gated CAC scans and non-gated chest CTs from 1/1/2021 – 12/31/2022 performed at Stanford Health Care. We excluded all patients with a history of ASCVD based on ICD codes and without any primary care encounters. Statistical analyses were performed using Pearson’s chi-squared test and t-test.Results:Out of 32,369 total CTs in our study, 5,300 (16%) were gated CAC scans and 27,069 (84%) were non-gated chest CTs. Compared with patients who received CAC scans, those who received non-gated CTs were more likely to be older, female, Hispanic, Black, have interpreter needs, and have Medicaid insurance (Table). They had a greater burden of comorbidities and were more likely to have visited the emergency department (16% vs. 5%) and been hospitalized (29% vs. 2%) in the prior year. Patients who underwent non-gated CTs had higher 10-year ASCVD risk scores as compared with those who underwent CAC scans (20% vs. 11%), yet only 24% were on statins.Conclusions:There are significant sociodemographic differences in patients who receive CAC scans vs non-gated chest CTs, highlighting opportunities to improve equity in access to tools for cardiovascular risk assessment through quantification of CAC on non-gated CTs. This supplemental approach can identify more diverse populations with higher ASCVD risk who may benefit from preventive therapies.

Circulation, Volume 148, Issue Suppl_1, Page A16462-A16462, November 6, 2023. Introduction:Polyvascular disease (PolyVD) is a high-risk atherosclerotic phenotype presenting worse cardiovascular outcomes. However, its atherosclerotic features remain to be fully elucidated yet. Near-infrared spectroscopy (NIRS) imaging quantifies lipidic plaque associated with clinical outcome.Hypothesis:Given a clustering of atherogenic risks in PolyVD, PolyVD may exhibit a distinct plaque phenotype, which accounts for their outcome.Methods:224 culprit lesions in 203 CAD patients receiving PCI were evaluated by NIRS imaging. PolyVD was defined as those with additional ASCVD (stroke and/or LEAD). NIRS-derived lipidic plaque feature (maxLCBI4mm) and clinical outcome (all-cause death+non-fatal MI+stroke) were compared in PolyVD and non-PolyVD subjects.Results:28.6% of study subjects exhibited PolyVD. They were older (77 v. 71 years, p=0.02) with a greater frequency of CKD (61 v. 45%, p=0.03). Under the use of statin (81 v. 71%, p=0.15) and ezetimibe (32 v. 21%, p=0.09), PolyVD patients had a lower LDL-C level (73 v. 84 mg/dL, p=0.01). Despite their LDL-C control, maxLCBI4mmdid not differ in two groups (median: 458 v. 576, p=0.19). Moreover, 64% of PolyVD patients still showed maxLCBI4mm≧400 (69% in non-PolyVD, p=0.44). On multivariate analysis, ACS independently predicted maxLCBI4mm≧400 (Figure) in PolyVD patients. Of note, PolyVD presenting ACS had a higher maxLCBI4mm(790 v. 411, p=0.001) compared to those without ACS, whereas this relationship did not exist in non-PolyVD (622 v. 561, p=0.19, Figure). During the 3-year observational period, PolyVD was associated with an elevated risk of MACE (p=0.002).Conclusions:Despite lowering LDL-C levels, PolyVD harbored a large amount of lipidic materials, accompanied by worse cardiovascular outcomes. Given the relationship of ACS with maxLCBI4mmin PolyVD, additional therapies which modulates ACS-related inflammatory activity may be warranted to alter their disease substrate and outcomes.

Circulation, Volume 148, Issue Suppl_1, Page A12853-A12853, November 6, 2023. Introduction:Inflammation and angiogenesis are central to development of atherosclerosis. [64Cu]Cu-DOTATATE and [68Ga]Ga-NODAGA-E[c(RGDyK)]2 (RGD) are PET tracers that can non-invasively visualize somatostatin receptor subtype 2 (SSTR2) and αvβ3integrin expression that represent inflammation and angiogenesis respectively.Hypothesis:Whether an imaging tracer of inflammation can be compared with a tracer of angiogenesis for detection and quantification of the atherosclerotic process in patients from a Phase II cancer trial cohort.Methods:A cohort of patients from Phase II trial were divided in three groups as controls (N=7), at risk (N=6) & diseased (N=7). PET/CT scans with two different tracers were performed in all subjects. The scans were retrospectively analyzed, and tracer uptake (mean of maximum target-to-background ratios (mTBRmax)) were determined in 6 arterial segments. In addition, plaques from patients (N=7) undergoing carotid endarterectomy (CEA) were studied with autoradiography and immunohistochemistry.Results:[64Cu]Cu-DOTATATE uptake in the disease group was significantly higher compared to the control group in the abdominal aorta (4.4 vs 2.1, p=0.02), thoracic aorta (3.0 vs 2.2, p=0.02), aortic arch (2.8 vs 2.2, p=0.03), left carotid artery (2.2 vs 1.3, p=0.02) and the average of all six aortic segments (2.7 vs 2.0, p=0.01) whereas all aortic segments in the disease group showed a higher but a non-significant difference compared to the control group with RGD uptake. A moderate correlation was found between the mean aortic uptake of [64Cu]Cu-DOTATATE & RGD (r=0.41, p=0.01) in patients from the disease group. SSTR2and αvβ3expression was confirmed on ex vivo plaques along with tracer binding.Conclusions:An in vivo imaging marker of inflammation was superior to a marker of angiogenesis in discriminating levels of atherosclerosis. The two markers were weakly correlated in patients with known cardiovascular disease.

Circulation, Volume 148, Issue Suppl_1, Page A17441-A17441, November 6, 2023. Background:Similarities in peripheral vascular anatomy between swine and humans make this animal an ideal model for evaluating the effects of lower extremity angioplasty procedures commonly performed to improve limb blood flow in peripheral artery disease (PAD).Hypothesis:We hypothesized that PET/CT imaging would provide a non-invasive strategy for quantifying the inflammatory response to balloon overdilation injury in a swine model of peripheral angioplasty.Methods:Five Yorkshire pigs (weight = 25 kg) underwent overdilation of the right femoral artery. A balloon catheter (7 mm x 40 mm) was introduced via the carotid artery and guided to the femoral artery under fluoroscopy. The balloon was then inflated to a pressure 1.5 times greater the recommended nominal pressure to induce arterial injury.18F-fluorodeoxyglucose (FDG) PET/CT imaging was performed 14 days after angioplasty to quantifyin vivoinflammation in the injured and control femoral arteries, which was expressed as the maximum standardized uptake value (SUVmax). Pigs were euthanized 14 days post-angioplasty and arteries were harvested and sectioned for gamma counting (18F-FDG uptake), and stained with hematoxylin and eosin histology (H&E), Masson’s trichrome, and alpha-smooth muscle actin (α-SMA) for evaluation of intimal remodeling and smooth muscle cell proliferation.Results:18F-FDG PET/CT imaging quantified a significant increase in inflammation for the injured versus control femoral artery 14 days post-angioplasty (p=0.04). Gamma counting confirmed a significant increase in18F-FDG uptake in the injured artery (p=0.02). H&E revealed a significant increase in intimal thickening in the injured artery (p=0.03). α-SMA expression was also significantly increased in the injured versus control femoral artery (p=0.01), demonstrating an increase in smooth muscle cell proliferation.Conclusions:18F-FDG PET/CT quantifies arterial inflammation resulting from overdilation injury that is associated with intimal remodeling and smooth muscle cell proliferation. PET/CT imaging may provide a non-invasive strategy forin vivotesting of the efficacy of emerging drug-coated endovascular peripheral devices.

Circulation, Volume 148, Issue Suppl_1, Page A13286-A13286, November 6, 2023. Background:Cardiac sarcoidosis (CS) diagnostic guidelines updated in 2006 and in 2017 now include imaging findings of left ventricular (LV) dysfunction (LV EF < 50%) on cardiac MRI and echocardiography as major diagnostic criterion. Limited data is available with regards to co-morbidities clustering in sarcoidosis and CS according to the 2017 updated guideline diagnostic criteria.Methods:A case control, single tertiary medical center study included 558 sarcoidosis patients with documented extracardiac sarcoidosis and completed electrocardiogram and/or cardiac MRI imaging. CS 2006 and 2017 diagnostic criteria and co-morbidity data were extracted from electronic charts and were available for comparison in 540 patients.Results:The total study population was composed of 52.7% (281/540) females, aged 58.9+/-12.6 years old, with diabetes mellitus (DM) present in 29.6% (160/540), HTN in 51.7% (279/540), CAD in 13.3% (72/540), moderate to severe aortic, mitral, or tricuspid valvular disease in 14.8% (80/540), ESRD in 2.4% (13/540), and COPD or asthma in 21.9% (118/540). There was a significant clustering of co-morbidities according to the imaging CS diagnostic criteria. Patients meeting the 2017 CS imaging criteria were found to be older (61.4+/-11.3 vs 58.8+/-12.8 years old in patients not meeting criteria, p=0.085), predominantly male (69.2%, (54/78) vs. 44.4%, (205/462), p

Circulation, Volume 148, Issue Suppl_1, Page A11536-A11536, November 6, 2023. Introduction:Rilonacept treatment in RHAPSODY resolved active pericarditis recurrences, and long-term treatment led to sustained risk reduction. Prior analysis linked greater baseline Late Gadolinium Enhancement (LGE), with more rapid recurrence upon rilonacept suspension after 12 weeks of treatment. Serial cardiac magnetic resonance (CMR) imaging (T2-STIR, LGE) enabled longitudinal assessment for tracking clinical improvement, guiding decision-making, and predicting patient outcomes after treatment cessation.Methods:At the long-term extension (LTE) 18-month decision milestone (18MDM), investigators chose, based on clinical status, to continue rilonacept, suspend rilonacept/observe, or discontinue the LTE. An imaging core lab blinded to clinical data measured pericardial thickness and graded pericardial edema (T2-STIR) and LGE at baseline and 18MDM. Pericarditis recurrence was assessed clinically following rilonacept suspension.Results:Baseline and 18MDM CMRs were available for 13 patients. Reductions in pericardial thickness, T2-STIR, and LGE from baseline to 18MDM while on treatment are provided inFigure. CMRs were obtained in 7/8 patients suspending rilonacept at 18MDM: LGE was none/trace, and T2-STIR was negative; yet, 5/7 (71%) had pericarditis recurrence within 1-4 months of rilonacept suspension despite prophylactic colchicine (n=2).Conclusions:Continued clinical improvement during prolonged rilonacept treatment corresponded with improvement on CMR, including reduced pericardial thickness, resolution of pericardial edema on T2-STIR, and resolution of LGE. Negative/trace LGE at 18MDM while on treatment did not predict absence of pericarditis recurrence upon subsequent rilonacept suspension in this size-limited subgroup. Larger prospective studies examining CMR parameters in guiding RP treatment duration decisions and informing associated clinical outcomes are warranted.

Circulation, Volume 148, Issue Suppl_1, Page A17749-A17749, November 6, 2023. Introduction:Ablation of non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation (PVI) may reduce atrial fibrillation (AF) recurrence. Localizing a trigger which initiates AF after a single atrial ectopic beat is challenging, especially in the scenario when the trigger P wave is obscured by preceding QRS-T complex.Aim:To evaluate the potential for noninvasive electrocardiographic imaging (ECGi) to localize NPVTs when the P wave morphology is superimposed on the T wave of the previous beat.Methods:We developed an algorithm which overlays and subtracts the preceding QRS-T wave complex from the QRS-T wave complex which is obscuring the P wave of interest, thus revealing the P wave morphology (Figure 1A). Resultant unobscured P waves (from multiple body surface electrodes) are then used for ECGi computation. In five patients undergoing AF ablation, after PVI, we paced from 15 atrial sites where NPVTs commonly arise, and evaluated the epicardial activation maps generated by ECGi both when pacing was timed to ensure an unobscured P wave and when timed to coincide with preceding QRS-T complex. Co-registration of CT-based ECGi activation maps with invasive electroanatomic map (EAM) allowed comparison of the earliest activation site on ECGi map from both the obscured P waves after QRS-T subtraction and unobscured P waves with true pacing locations on EAM (Figure 1B).Results:From 146 pacing sites in our patient cohort, for the unobscured P waves, median distance between earliest site on ECGi map and EAM pacing location was 16 mm (10-21 mm), and for obscured P waves after QRS-T subtraction, median distance was also 16 mm (12-23 mm) (Figure 1C).Conclusion:Using a QRS-T subtraction algorithm, ECGi can approximate origin of paced P waves whether P wave is unobscured or obscured by the preceding QRS-T complex. Spontaneous NPVT P waves are commonly obscured by the QRS-T wave and the ability to rapidly localize an early coupled P wave may facilitate NPVT mapping and ablation.

Circulation, Volume 148, Issue Suppl_1, Page A13313-A13313, November 6, 2023. Background:Despite some shared risk factors, aortic aneurysms and atherosclerosis manifest differently across the aorta. While atherosclerosis commonly co-exists with descending and abdominal aortic aneurysms, some observations suggested a decreased risk of atherosclerosis in patients with ascending aortic aneurysms. This has led to the suggestion that drivers of ascending aortic aneurysms may be anti-atherogenic.Aim:Using carotid intima-media thickness (cIMT) as a surrogate for atherosclerosis and deep learning-derived estimates of aortic diameter, this study examines whether ascending aortic aneurysms are protective against atherosclerosis in a longitudinal analysis of UK Biobank participants.Methods:Individuals who underwent both carotid ultrasound and cardiovascular MRI in the UK Biobank (N=40,479) were identified. We derived ascending and descending aortic measurements from a previously developed deep learning model that was trained to quantify dimensions in >4 million MRI images and extract diameter during ventricular systole. Measures of mean cIMT at 2 standardized angles for bilateral carotid arteries were utilized. The relationship between cIMT and aortic diameter was assessed using univariable and multivariable linear regression. β was calculated as μm change in cIMT per cm of aortic diameter.Results:In individuals with an aneurysmal ascending aorta ( >4.5cm), there was no significant association between aortic diameter and cIMT after accounting for age, sex, height, and weight (adjusted β=-15.4, P=0.26). There was also no significant correlation between ascending aortic diameter at baseline and cIMT progression in follow-up (adjusted β=-2.5; P=0.48). In the entire cohort, larger ascending aortic size was nominally associated with greater cIMT (adjusted β=5.0; P=0.005). As expected, larger diameter in the descending thoracic aorta was associated with higher cIMT (adjusted β=23.9; P=1.9×10-16).Conclusion:Based on multi-modal imaging data from over 40K individuals, we find no evidence of an inverse relationship between ascending aortic aneurysmal disease and atherosclerosis.

Circulation, Volume 148, Issue Suppl_1, Page A17817-A17817, November 6, 2023. Introduction:Our previous work led to developing a deep learning algorithm for retinal images, Reti-CVD, which effectively predicted cardiovascular disease (CVD) events in individuals without CVD history, leveraging coronary artery calcium (CAC) scores for algorithm training.Hypothesis:This study aims to assess the capability of deep learning-assisted retinal imaging to predict CVD events among prediabetic and diabetic patients using the data from the UK Biobank.Methods:Our study included prediabetic and diabetic patients from the UK Biobank. Reti-CVD scores were calculated and categorized into three risk groups – low (n=550), moderate (n=276), and high (n=275), based on the 50th and 75th percentiles, following a 2:1:1 ratio. To assess the Reti-CVD’s ability in predicting fatal and non-fatal CVD events, we performed a survival analysis on the longitudinal data from the UK Biobank using Cox proportional-hazards models and hazard ratios (HRs).Results:Among the 1101 prediabetic or diabetic patients at the onset, 138 (12.5%) experienced CVD events. According to Reti-CVD scores, these events were found as 8.2% (45/550), 15.2% (42/276), and 18.5% (51/275) in the low, moderate, and high-risk groups over a median follow-up period of 11 years, respectively. After adjusting for factors such as age, gender, hypertensive medication use, statin use, and smoking history, a significant association was observed between the Reti-CVD and the incidence of CVD events (HR=1.57, 95% CI, 1.00-2.47 for the moderate-risk group; HR=1.88, 95% CI, 1.19-2.98 for the high-risk group compared to the low-risk group). An increasing HR trend of 1.36 (95% CI, 1.09-1.70) was observed across risk groups in the prediction of CVD events.Conclusions:The Reti-CVD offers a valuable tool for risk stratification among prediabetic and diabetic patients, indicating its potential in managing these high-risk groups.

Circulation, Volume 148, Issue Suppl_1, Page A16140-A16140, November 6, 2023. Introduction:Cardiovascular magnetic resonance (CMR) imaging is recommended for surveillance and risk stratification in patients with hypertrophic cardiomyopathy (HCM), but the role of CMR findings in clinical decision making has not been described in a pediatric population.Methods:In this single center retrospective study we identified all patients with HCM who underwent CMR. We then determined if there was a clinical management change based on CMR findings.Results:We identified 136 patients with an HCM diagnosis from 2005-2022. Of these, 55 patients (40%) underwent 76 CMR studies. The HCM etiology was genetic or familial in 31 (56%), idiopathic in 21 (38%), and syndromic in 3 (5%); 34% of patients were female; and the median age (and IQR) of included patients at first CMR was 12 (9-15) years old. Ten patients underwent more than one CMR. Both awake and sedated CMRs were included and there were no complications. Management changes included confirmation of HCM diagnosis in 9 patients (16%), change in medical therapy for 3 (5%), myectomy recommendation in 1 (2%), and implantable cardioverter defibrillator (ICD) placement recommendation in 11 (20%). Of those recommended for ICD placement, 8 were a result of new late gadolinium enhancement and 3 had massive septal hypertrophy (median Z-score 30) discovered or confirmed by CMR. To date, no ICDs have discharged any shocks. Altogether, changes in clinical management were made based on CMR findings for 22 patients (40%), representing a change in management as a result of 29% of the total CMRs performed.Conclusion:CMR is an important contributor to clinical decision making in the management of children and adolescents with HCM. Specifically, CMR in this population was especially useful in defining the diagnosis of HCM in the presence of an equivocal echocardiogram and deciding to place an ICD. Fewer CMRs contributed to decision making regarding medical therapy and septal myectomy.

Circulation, Volume 148, Issue Suppl_1, Page A13430-A13430, November 6, 2023. Introduction:Precise risk assessment is essential for accurate management of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to assess the prognostic implications of cardiovascular magnetic resonance (CMR)-derived imaging biomarkers in a large cohort of AS patients.Methods:145 patients with severe AS underwent CMR imaging before TAVR. Image analyses included myocardial volumes, CMR-feature-tracking derived left and right atrial (LA & RA) as well as left and right ventricular (LV & RV) strain, myocardial T1 mapping as well as late gadolinium enhancement analyses. Cardiovascular (CV) mortality was defined as primary clinical endpoint.Results:Patients with CV death during follow-up had significantly enlarged RV enddiastolic volumes (82.9ml/ml2[70.8-96.0] vs. 62.8ml/ml2[54.7-76.0], p

Circulation, Volume 148, Issue Suppl_1, Page A13918-A13918, November 6, 2023. Introduction:PAH is a deadly disease without cure. Formalized risk stratification allows therapeutic adjustments that optimize drug utilization. Risk scores, like REVEAL 2.0 recommended by PAH guidelines only offer good discrimination. Our goal was to create risk models with excellent discrimination (C-Index over 0.8), using modern statistical techniques and expanded variable pools including imaging and genomics. The AIM of this study was to demonstrate the improved performance with the addition of cardiac MRI variables.Methods:PAH patients from the ASPIRE cardiac MRI database were analyzed. Imaging variable (IMV) selection was performed using three machine learning methods: logistic regression, Lasso, and Random Forest. Rankings of the IMVs from these sources were aggregated to arrive at a consensus list. The selected IMVs were added to the set of variables for deriving the REVEAL 2.0 composite score. Bayesian networks (BN) were then built to predict 1-year survival based on the Tree-Augmented naïve Bayes (TAN) algorithm. Five-fold cross-validation was performed to assess the improvement in survival prediction from adding the selected imaging variables.Results:A total of 343 PAH previously diagnosed subjects were included in this analysis. The rank aggregation algorithm identified several IMV, including LVSVI, RVCO, LVEDVI, and RVESVI, that were predictive of survival but not the REVEAL 2.0 composite score. Adding these IMV to the REVEAL 2.0 variables, we built a BN model that depicts the non-linear relationships among the predictors and one-year survival (Fig 1). We obtained an average AUC of 0.83 over the five cross-validation test sets, an improvement over the AUC of 0.78 using only the REVEAL 2.0 variables. A Mann-Whitney non-parametric test shows the improvement is statistically significant at the 0.1 level.Conclusion:Advanced statistical models that include cardiac IMVs improve performance of PAH risk assessment models.