Risultati per: L'imaging nella urolitiasi

Circulation, Volume 150, Issue Suppl_1, Page A4140983-A4140983, November 12, 2024. Background:Sarcoidosis is a systemic non-caseating granulomatous disease that can involve numerous organs, classically lung and lymph node. Patients with cardiac involvement typically have poorer outcomes, with left ventricular ejection fraction (LVEF) predicting mortality. There is little contemporary data evaluating the relationship of baseline LVEF at time of active cardiac sarcoidosis (CS) involvement or change in LVEF over time in patients with abnormal cardiac positron emission tomography (CPET) or cardiac magnetic resonance (CMR).Hypothesis:Abnormal CPET or CMR findings suggestive of CS will be associated with concurrently lower LVEF, as well as progressive decline in LVEF over long-term follow-up in those with CS.Methods:At a major sarcoidosis referral center, a retrospective analysis was performed on 1,901 biopsy-proven sarcoidosis patients and 358 probable CS patients by 2014 HRS Expert Consensus on Diagnosis. All echocardiograms, CPET, and CMR data were compiled. LVEF at time of positive and negative CMR and CPET within 6 months of each other, as well as LVEF change on long-term follow-up were analyzed by t-test and Tukey’s Studentized Range Test.Results:CPET and CMR positive findings did not correlate with lower LVEF at time of abnormal findings. Over an average of 4.98 years (range 0.25 to 11.68 years), LVEF by echocardiogram did not significantly change in patients with positive, negative, or discordant CPET/CMR imaging.Conclusions:Structural abnormalities by echocardiogram do not correlate with positive or negative CPET/CMR and are of little utility in early detection of cardiac sarcoidosis. These data suggest that combined CPET/CMR protocols increase the sensitivity of identifying early cardiac involvement of sarcoidosis. A normal echocardiogram should not be reassuring to the clinician against possible cardiac involvement of sarcoidosis.

Circulation, Volume 150, Issue Suppl_1, Page A4143328-A4143328, November 12, 2024. Background:Direct current cardioversion (DCCV) carries a risk of stroke in atrial fibrillation (AF) patients. Hence, published guidelines for mitigating this risk with oral anticoagulation (OAC). There is no consensus agreement on the safest approach when cardioverting patients with left atrial appendage occlusion device in situ.Aims:We aimed to compare association of pre-DCCV imaging with safety and outcomes in patients with WATCHMAN™ undergoing elective DCCV for atrial arrhythmias (AA)Methods:This was a retrospective cohort study of patients who received DCCV for AA during follow up after LAAO procedure from 2016-2024 within a large health care system. Safety endpoint was freedom from stroke, all-cause mortality, device embolism, and systemic embolism within 30-days post DCCV. Significant peri-device leak (PDL) was defined as > 5mm on cardiac imaging.Results:A total of 119 patients were included, more females 70 (59%), with more than half (64 (54%)) receiving a first-generation WATCHMAN™ 2.5, while the rest had WATCHMAN FLX™. Median age at presentation was 77 years (72,82), BMI of 31 kg/m2 (26,37), average CHADSVASC score of 4.5 and HASBLED score of 3. There was a median duration of 10 months (3,21) between LAAO to presentation for DCCV .Forty-four (37%) patients had pre-DCCV imaging, while 75 patients did not receive pre-procedural imaging. Between the two groups, there was no significant difference in OAC (VKA-antagonist/DOAC) usage prior to presentation (8 (18.6%) vs 12 (16.4%), P=0.9), with single antiplatelet therapy was the prevalent anti-thrombotic regimen. There was no significant difference in CHADSVASC, HASBLED, age, LVEF, or timing of presentation relative to the LAAO procedure. Higher percentage of patients were discharged on OAC post DCCV in the imaging cohort (13 (30.2%) vs 14 (19.4%), p=0.27), the difference was not significant. No Device related thrombus (DRT) nor significant PDL was detected on imaging. But non-significant PDL ranging from 2mm-4.7mm was found in 8 (18.1%) out of 44 patients who had imaging prior to DDCV. Safety endpoint was achieved in both cohorts with zero adverse events occurring during the 30 day follow up period post-DCCV.Conclusion:Elective cardioversion for atrial arrhythmias is safe in patients with WATCHMAN™. There were no post-DCCV stroke events in the overall cohort and no DRT identified in the pre-DCCV imaging subgroup. Further studies are needed to determine when pre-DCCV imaging is warranted in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4125497-A4125497, November 12, 2024. Background:Differentiating between causes of non-ischemic cardiomyopathy is important for disease-directed treatment. Cardiac MRI (CMR) and the use of late gadolinium enhancement (LGE) have proven useful for enhancing diagnostic accuracy. Definitive assessment of cardiomyopathy etiology by explant pathology facilitates direct evaluation of CMR utility.Hypothesis:We hypothesized direct comparison between pre-transplant (Tx) CMR and explant pathology will improve the characterization of undifferentiated cardiomyopathy through examination of cases where pre- and post-Tx diagnoses were discordant.Aims:To evaluate discrepant cases to describe imaging patterns in relation to post-Tx diagnosis.Methods:Institutional Tx recipients between 2000 and June 2023 were queried for pre-Tx MRI (n=122). Discrepant cases were identified (n=8). Pre-Tx diagnostic modalities, including CMR, were reviewed, and CMR patterns were evaluated in association with ultimate explant diagnosis.Results:Of the eight patients with discrepant diagnoses, five carried clinical diagnosis of dilated cardiomyopathy, one hypertrophic cardiomyopathy, one peripartum cardiomyopathy, and one congenital heart disease having undergone tricuspid valve and ASD repair. Pathologic evaluation most frequently identified biventricular or left ventricular arrhythmogenic cardiomyopathy (ARVC) (n=6), where CMR disclosed a diffuse pattern of subepicardial LGE and pre-Tx diagnosis of DCM was most common. Two of these pathologic descriptions represented a different disease on genetic evaluation: one patient had Danon disease, another had a LMNA pathogenic variant. The presumed peripartum cardiomyopathy was identified as Fabry’s disease on pathology (however, genetic testing consistent with Danon disease). Both Danon disease patients had primarily subendocardial LGE on CMR. One patient with a DCM phenotype had HCM pathologically. Results summarized in Table 1.Conclusions:Cardiac MRI can be a useful modality for the evaluation of underlying cardiomyopathy and should prompt appropriate genetic testing. Diffuse subepicardial LGE frequently accompanied the diagnosis of ARVC whereas a non-subepicardial pattern reflected alternative etiologies identified only through genetic testing.

Circulation, Volume 150, Issue Suppl_1, Page A4139380-A4139380, November 12, 2024. Background:Imaging of conventional PM’s and ICDs are infrequently performed via MRI. While many studies, including theMagnaSafeTrialhave unequivocally supported MRI safety in patients with such devices, theaddedclinical value has rarely been considered. Accordingly, we performed an observational, IRB-approved, prospective study to determine the ‘Additive Value’beyondsafety for patients with conventional PM/ICD’s undergoing clinical MRI.Wehypothesizethat MRI in PM/ICD patients is critical to an existing diagnosis and often markedly alters diagnosis and subsequent downstream patient management.Methods:An MRI Device exam (GE 1.5T,WI) pioneered by cardiologists ( >90% over 10 yrs; 100% over 20 years) was performed. Subsequently, a series of prospective defining questions using Boolean Logic Construct were answered within 1 week of MRI by both MRI technologist and MRI physicians.Questions:1) Did the primary diagnosis change?2) Did the MRI provide additional information to existing diagnosis?3) Was the pre-MRI (tentative) diagnosis confirmed?4) Did subsequent patient management change?If ‘Yes’ was answered to any of the above questions, it was considered that MRI was of value to pt diagnosis and/or impending therapy.Results:Average MRI: 25±14min for 2,008 consecutive patients of which 1,526 (76%) were neuro/neurosurgery, 141 (7%) were musculoskeletal and 341(17%) were CV cases. Upon review: of the Neuro/neurosurgeryMRIs, 1,376 (89%) provided additional information.The diagnosis changed in 1018 (74%), while medical therapy changed in 977 (71%). In only 124 (9%) did MRI simply confirm original diagnosis. ForCardiacpatients, MRI changed the original diagnosis in 235 (69%). MRI did not contribute in 42 (12%) as it was uninterpretable (ICD artifact), while in 64 pts, the diagnosis did not change. Finally, in 146Orthopedicpts, MRI provided additional information in 143 (98%) and in 130 (89%), changed pt care, and in 4 pts (3%), simply confirmed the diagnosis. Importantly, with careful attention to device reprogramming and scanner sequences, no safety or device issues were encountered in any patient all with tracking for >1 year.Conclusion:Via a dedicated program of MRI in PM/ICD patients adds substantial clinical value to diagnosis and subsequent management justifying ant inherent risk(s). Herein, we propose that yet another impediment to the advancement of CMR-PM/ICD strategies can become routine and often life-changing.

Circulation, Volume 150, Issue Suppl_1, Page A4142247-A4142247, November 12, 2024. Background:Cardiac transplantation remains the single most effective treatment for end-stage heart failure. Despite the routine use of anti-rejection drugs in clinical practice, approximately 40% of cardiac transplant patients still experience unavoidable rejection. Timely diagnosis of early acute rejection (AR) is essential to prevent further tissue damage. Transplant rejection and graft damage is primarily mediated by recipient cytotoxic CD8+T cells, which attack allografts by releasing perforin and granzyme B (GzmB).Aim:This study aimed to evaluate whether GzmB-targeted positron emission tomography (PET) imaging agent (68Ga-grazytracer) can characterize T lymphocyte infiltration in AR.Method:Mice were subjected to GzmB-targeted PET/CT on POD 3, 5, and 7. Autoradiography, Masson staining, immunohistochemistry, and flow cytometry were performed to verify the inflammatory infiltration and graft damage . Allograft-bearing mice were intraperitoneally administered with tacrolimus (2 mg kg−1) daily from operative day to post-operative day (POD) 7.Result:The uptake of68Ga-grazytracer was observed increased with the extension of rejection time(SUVmax:0.54 ± 0.07 vs. 0.19 ± 0.05 at POD 7 days, P

Circulation, Volume 150, Issue Suppl_1, Page A4131796-A4131796, November 12, 2024. Introduction:In recent years, the development of wearable devices and bioinformation analysis applications utilizing smartphone sensors has seen significant advancements. Despite these technological strides, their adoption and sustained use remain limited to health-conscious individuals. The general populace, particularly those indifferent to health management, stands to miss out on the potential benefits of wearable technologies due to a lack of engagement. This disconnect underscores the necessity for more accessible health monitoring solutions.Research Questions and Goals:This study aims to bridge the gap in health monitoring accessibility by introducing a system capable of non-invasive, non-contact acquisition of biometric information. Such a system seeks to democratize the early detection and prevention of diseases across various demographics.Methods and Results:A prospective cohort clinical study was conducted in a hospital setting with approximately 200 consenting patients and healthy controls. Images of the subjects’ faces and hands were captured with a high-speed camera, and blood pressure measurements were taken simultaneously for correlation.A machine learning algorithm was developed to analyze skin blood flow and spectral features from these images to identify potential diseases. The study specifically focused on early detection of hypertension and diabetes. Hypertension was categorized for individuals with systolic blood pressure ≥115 mmHg or diastolic blood pressure ≥75 mmHg. Diabetes was identified in subjects with HbA1c levels ≥6.5 or those previously diagnosed.The algorithm’s performance in detecting hypertension showed a 94.2% in alignment with the AHA guidelines for stage1 hypertension, based on pulse wave features. For a subset including 40% early hypertension cases, accuracy rates were 86.2% for 30-second data segments and 80.9% for 5-second segments.For diabetes detection, the application of the algorithm to video data achieved a 75.3%, utilizing blood flow patterns as markers. Hypertension and diabetes were analyzed using different features.Conclusions:The integration of AI algorithms with video data analysis of skin and blood vessels demonstrates a promising avenue for the non-contact, early detection of hypertension and diabetes. This approach not only offers a viable non-contact monitoring technology, but also represents a significant leap towards inclusive, accessible health care prevention and management strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4142540-A4142540, November 12, 2024. Background:Three-dimensional speckle tracking deformation STE (3D-STE) can overcome some limitations of 2D imaging. This study aims to verify the feasibility of using 3D-STE to quantify replacement fibrosis against enhanced cardiac magnetic resonance imaging (CMR-LGE).Method:3D-STE and the extent of LGE (%LGE) were prospectively measured in a large cohort of HCM patients, with an interval ≦ of 72 hours.Results:511 HCM patients (age 49.0 ± 14.3 years; 66.5% male) were enrolled. Three-dimensional global longitudinal strain (GLS-3D) moderately correlated with GLS-2D (r=0.622, p=0.000). GLS-3D showed the strongest correlation with %LGE (r = 0.699, p < 0.001). A quadratic model (R2=0.448, p=0.000) for the relationship between GLS-3D and %LGE performed better than a linear model. GLS-3D (OR = 0.632, p < 0.001) was independently associated with extensive LGE (%LGE≧15%). GLS-3D exhibited the highest area under the curve (AUC 0.894, p < 0.001) for detecting extensive LGE With a cutoff of -15.25%, sensitivity 87.3%, specificity 78.3%.Conclusion:GLS-3D is the most strongly correlated with %LGE among all strain parameters, demonstrating potential as a surrogate marker for LGE in HCM.

Circulation, Volume 150, Issue Suppl_1, Page A4115015-A4115015, November 12, 2024. Background:Coronary Artery Disease (CAD) is a significant global health issue, necessitating improved diagnostic tools for visualizing cardiac energetics. Traditional imaging methods such as PET and dobutamine stress echocardiography do not directly assess mitochondrial metabolism. Hyperpolarized Carbon-13 metabolic magnetic resonance imaging (HP-13C MRI) offers a promising non-invasive method for investigating mitochondrial function in CAD. This study utilizes HP-13C MRI to detect changes in mitochondrial metabolism in patients undergoing Coronary Artery Bypass Graft (CABG) surgery (Fig.1).Methods:We conducted HP-13C MRI examinations on two patients with advanced CAD before and (~4-6 months after CABG surgery and one healthy subject (Fig. 2 A,B). Participating subjects provided informed consent according to a protocol approved by the Institutional Review Board and Protocol Review Committee. Baseline blood samples were analyzed for pyruvate, triglycerides, free fatty acids, and insulin levels. Post-glucose load, patients received an intravenous injection of an IND-approved metabolic probe, [1-13C] pyruvic acid, prepared under Good Manufacturing Practice regulations. The HP solution was administered after polarization in a clinical polarizer (SPINlab™, GE Healthcare). Imaging was performed using a GE MR750 MR system with a Helmholtz loop-pair13C coil (PulseTeq Limited, UK). Data were reconstructed and analyzed with MATLAB scripts.Results and Discussion:Baseline blood measurements were normal for the healthy subject, but those with advanced CAD showed variable and abnormal values (Fig. 2C). HP-13C MRI safely assessed cardiac metabolism in patients with advanced CAD. Patients with advanced CAD exhibited reduced pyruvate metabolism compared to healthy controls, shown by lower myocardial bicarbonate/(bicarbonate+lactate) ratios (Bic/(Bic+Lac)). Following CABG, only Patient 2 showed improved Bic/(Bic+Lac), while Patient 1 did not (Fig. 3A-B). This variability may be influenced by differences in nutrition, hormonal status, medication regimens, or other factors. Changes in % Bic/(Bic+Lac) across different coronary artery segments were observed post-CABG in CAD patients (Fig. 3C).Conclusion:HP-13C MRI non-invasively assesses cardiac metabolism in CAD patients, demonstrating the potential to evaluate post-CABG metabolic changes. Our efforts continue to recruit large cohort to understand individual variability.

Circulation, Volume 150, Issue Suppl_1, Page A4143835-A4143835, November 12, 2024. Background:Cardiac magnetic resonance (CMR) is increasingly used for rejection surveillance in pediatric heart transplant recipients (PHTR). It is unclear if CMR-derived tissue characterization and myocardial perfusion correlate with functional status, i.e. VO2peakas derived by cardiopulmonary exercise testing (CPET). Lower VO2peakhas been associated with poor cardiometabolic health and development of coronary artery vasculopathy in PHTR.Aim:Our aim was to evaluate the correlation between CMR derived variables and CPET outcomes.Methods:PHTR who underwent CMR within 1 year of CPET were retrospectively reviewed. Those with submaximal effort on CPET (RER

Circulation, Volume 150, Issue Suppl_1, Page A4144999-A4144999, November 12, 2024. Obesity is associated with increased cardiovascular risk and adverse cardiac changes such as left ventricular hypertrophy (LVH) and in TOF higher body mass index (BMI) contributed to increase risk. Previous multicenter study concluded that right ventricular (RV) dysfunction contributed to cardiovascular event. Current recommendations for pulmonary valve replacement (PVR) in TOF patients use indexed RV endiastolic volume (RVEDVi) to determine timing of PVR. In the presence of obesity, RVEDVi may underestimate the severity of RV volume load. We sought to determine both diastolic (RVEDV) and systolic (REVSV) volume in obese and non-obese patients and the impact of the volume on right ventricular ejection fraction (RVEF).We conducted a retrospective study of adult TOF patients > 18 years age in obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) patients with a cardiac magnetic resonance imaging (CMR) prior to PVR for pulmonary regurgitation (PR). CMR database and electronic records were reviewed to compare anthropometric, demographic, and CMR variables between obese and non-obese patients.Table 1 shows demographic and CMR results between non-obese (n = 57) and obese (n = 32) patients. Indexed ventricular volume were smaller in obese compared to non-obese patients (LVEDVi 78.7±12.1 vs 84.3±14.9 mL/m2, p=0.04; RVEDVi 157.4±21.5 vs 169.4±32.7 mL/m2, p=0.03), in contrast the non-indexed volume were significantly larger (LVEDV, 166.7±32.9 vs 148.8±30.5 mL, p=0.006; RVEDV 333.1±61.3 vs RVEDV 297.6±56.6 mL, p=0.004). There is an association with ventricular volume with lower RVEF. In both groups the mean RVEF was abnormal but not different (43.2±8.7 vs 43.8±8.4%, P=NS). Patients with lower RVEF trended towards a lower LVEF especially in the obese group (Figure 1A-F).Our study showed that indexed ventricular volume was smaller in obese patients and may lead to false reassurance suggesting underestimation of the volume load from the PR. Our patients have lower RVEF which correlated with larger volume and evidence of ventricular-ventricular interaction with lower LVEF in patients with lower RVEF. When assessing timing of PVR in asymptomatic TOF patients, other parameters beyond indexed volume in those with elevated BMI should be considered including ejection fraction and different methods of indexing RV volume similar to LVM. Future larger and longitudinal studies are needed to determine if delayed repair in obese patients lead worse remodeling and outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4142430-A4142430, November 12, 2024. Background:Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality following heart transplantation (OHT). Noninvasive methods to detect CAV and risk stratify OHT patients are needed. The value of fully quantitative stress cardiac magnetic resonance imaging has been recently validated and may be a promising technique for OHT surveillance. We aimed to evaluate the feasibility of quantitative stress CMR after OHT.Methods:We enrolled asymptomatic OHT recipients without coronary artery disease to undergo regadenoson stress CMR (1.5T GE HealthCare) with cine imaging, tissue mapping, and late gadolinium enhancement (LGE) imaging for routine CAV surveillance. Using the dual sequence technique, quantitative perfusion values were determined using Fermi deconvolution. Myocardial perfusion reserve (MPR) was calculated as the ratio of stress to rest myocardial blood flow (MBF).Results:Fifty-three subjects (mean age 47.06 ± 17.14 years) were included. OHT recipients (n=11, mean 6.77 ± 4.34 years post-transplant) were compared with healthy controls (n=43). No life-threatening adverse events, brief or prolonged atrioventricular block or other arrhythmias occurred with regadenoson. Coronary angiography was performed in 9 OHT patients before CMR, with an average of 1.99 ± 2.05 years between studies. No visual inducible ischemia was reported. Post OHT, rest MBF was significantly higher (1.69 ± 0.52 mL/g/min vs 1.01 ± 0.24 mL/g/min, p=0.004) and stress MBF was lower (2.33 ± 0.69 mL/g/min vs 2.95 ± 0.88 mL/g/min, p=0.02) compared to controls. MPR was significantly lower in OHT recipients compared to controls (1.46 ± 0.51 vs 3.11 ± 1.12, p

Circulation, Volume 150, Issue Suppl_1, Page A4139718-A4139718, November 12, 2024. Background:Paclitaxel-coated balloon (PCB) has been used for the treatment of coronary artery disease in the small native coronary artery and its safety and efficacy have been reported in clinical trials.Research Questions:The real-word long-term outcomes after intravascular imaging device-guided percutaneous coronary intervention (PCI) with PCB have not fully elucidated.Aims:To elucidate the long-term outcome after PCB treatment.Methods:This was a single-center, retrospective and observational study. We enrolled 1226 lesions from 713 patients which were treated by intravascular imaging device-guided PCI with PCB (342 lesions from 211 patients) or durable-polymer everolimus-eluting stent (DP-EES, 784 lesions from 502 patients) which diameter was less than 3.0 mm in the native coronary arteries. Long-term clinical outcomes were compared between PCB and DP-EES. Primary outcome was major adverse cardiac event (MACE) defined as a composite of cardiac death (CD), myocardial infarction (MI), target vessel revascularization (TVR) and device thrombosis. Secondary outcomes were all-cause death, CD, MI, target lesion revascularization (TLR), TVR and device thrombosis. Cumulative incidences of clinical outcomes were estimated by the Kaplan-Meier method and compared by the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) of PCB relative to DP-EES for MACE were estimated through a multivariable Cox model and an inverse probability weighted (IPW).Results:Cumulative 5-year incidence of MACE was similar between PCB and DP-EES (18.5% vs. 20.7%, P=0.78, Figure). Cumulative 5-year incidences of all-cause death (23.2% vs. 16.8%, P=0.12), CD (8.0% vs. 7.0%, P=0.81), MI (2.2% vs. 2.5%, P=0.97), TLR (5.9% vs. 8.9%, P=0.35), TVR (12.6% vs. 14.4%, P=0.90) and device thrombosis (0% vs. 0.6%, P=0.20) were also similar between PCB and DP-EES. Even after adjustment for baseline characteristics, cumulative 5-year incidence of MACE was similar between PCB and DP-EES (multivariate and IPW adjusted HRs 0.72 [95% CI: 0.37-1.39], P=0.33 and 0.67 [95% CI: 0.21-2.07], P=0.48, respectively).Conclusion:PCB demonstrated comparable 5-year clinical outcomes with intravascular imaging device-guided PCI compared to DP-EES.

Circulation, Volume 150, Issue Suppl_1, Page A4113716-A4113716, November 12, 2024. Background:Current conventional echocardiographic assessment of diastolic function relies on predicting left ventricular (LV) filling pressure as a surrogate of diastolic function. High frame rate (HFR) Shear wave (SW) imaging is emerging as an innovative parameter for assessing myocardial stiffness, a key determinant of diastolic function. Natural SW are induced by valve closure (i.e. mitral valve closure (MVC)). Little is known so far, to which extent SWs could reflect changes in diastolic LV filling pressures.Purpose:We aimed at investigating the relationship between natural SW after MVC and LV diastolic pressures in an attempt to set up a cut-off value beyond which, elevated LV pressure can be suspected indicating diastolic dysfunction.Methods:Thirty patients (mean age 68.4±9.9 years) scheduled for clinically indicated left heart catheterization were prospectively recruited. Left ventricular end-diastolic pressure (LVEDP) was measured during the catheterization. Immediately afterwards, conventional as well as HFR (1167 ±86 Hz) echocardiography was performed. We drew an anatomical M-mode along the anteroseptal wall in the parasternal long axis view from base to apex and the display was colour coded for tissue acceleration. SWs appeared immediately after MVC as tilted green bands and their propagation velocity was measured semi-automatically(Figure 1).Results:LVEDP in our cohort ranged from 7.5 to 29.5 mmHg. From conventional echocardiographic parameters, only mitral inflow to mitral relaxation velocity ratio (E/e’) correlated moderately with LVEDP (r=0.51, p=0.006). SW velocities after MVC showed strong positive correlation with LVEDP (r=0.78, p

Circulation, Volume 150, Issue Suppl_1, Page A4136597-A4136597, November 12, 2024. Background:Collagen is the major extracellular matrix that imparts mechanical strength to fibrous caps covering fibroatheromas. Intracoronary polarimetry with polarization-sensitive (PS) optical frequency domain imaging (OFDI) measures polarization properties, such as birefringence and depolarization (Figure 1). Birefringence is elevated in collagen and collagen-synthesizing smooth muscle cells, while depolarization is increased by the presence of macrophages and lipid/necrotic cores.Purpose:This study aimed to investigate polarimetric signatures of coronary lesions with healed coronary plaques (HCP) in patients with ACS and chronic coronary syndrome (CCS). Furthermore, we aimed to investigate diagnostic value for birefringence and depolarization of ACS culprit lesions discriminating from CCS target lesions.Methods:We conducted a single center prospective registry of intracoronary PS-OFDI imaging in patients with coronary artery disease (n = 50). A total of 862 OFDI frames selected from culprit or target lesions were analyzed. Coronary plaque phenotypes were assessed using conventional OFDI imaging. HCP was defined as plaques with one or more layers of different optical density and a clear demarcation from underlying components on intensity images. Birefringence and depolarization of the newer intima was measured in cross-sectional images. Birefringence and depolarization of ACS- and CCS-lesions were compared using a generalized estimating equation model. Receiver operating characteristic (ROC) analysis was used to investigate the diagnostic performance of polarimetric signatures for identifying ACS-lesions.Results:Compared to CCS-lesions, ACS-lesions featured significantly higher lipid-burden index and maximum lipid arc (both p < 0.05). Compared to the CCS-lesions, ACS-lesions exhibited significantly lower birefringence (p < 0.05) and higher depolarization (p < 0.05). In the ROC analysis for differentiating ACS-lesions from CCS-lesions, area under the curves (AUC) for birefringence and depolarization were 0.712 and 0.672, respectively. In the multivariable ROC analysis in diagnosing ACS lesions, combination of birefringence with depolarization improved the AUC to 0.755 (p ＝ 0.025).Conclusions:Intracoronary polarimetry provides quantitative assessment of plaque composition in patients. Further research is warranted to investigate whether birefringence can serve as a marker of healing failure following plaque rupture and erosion.

Circulation, Volume 150, Issue Suppl_1, Page A4146142-A4146142, November 12, 2024. Clinical Presentation:A 62-year-old male with a complex medical history, including pulmonary sarcoidosis, diabetes, constrictive pericarditis post partial pericardial stripping, cirrhosis, and congestive heart failure, presented with signs and symptoms of volume overload. Despite increasing diuretics and previous paracentesis, his condition continued to deteriorate. There were raising concerns for constrictive pericarditis due to cardiac sarcoidos. Echocardiography (TEE) showed pericardial thickening and calcification adjacent to the left ventricle and dilated IVC 2.4 cm (TTE). Cardiac magnetic resonance imaging (CMR) demonstrated conical deformity of the ventricles, thickened pericardium with signal void suggestive of calcification. Computed Tomography (CT) showed significant near circumferential pericardial calcifications. Subsequent catheterization confirmed constriction and identified a right coronary artery lesion. Following this, the patient underwent a redo pericardiectomy and coronary artery bypass grafting, at the Cleveland Clinic. However, his post-operative course was marked by complex challenges, including multi-organ dysfunction, the need for tracheostomy, feeding tube, renal replacement therapy, and recurrent ascites. Despite intensive care, his condition did not improve, leading to a transition to comfort care and eventually the patient passed away in December 2023.Discussion:This case highlights the intricate management of a patient with a myriad of underlying health issues. While multimodality imaging is pivotal in ensuring accurate preoperative diagnosis and guiding surgical interventions, it is important to acknowledge that challenges may persist in the postoperative phase. This case study underscores the vital role of multimodality imaging, irrespective of post-surgical outcomes, in facilitating precise diagnosis and delivering optimal patient care. The subsequent referral to the Cleveland Clinic for redo surgery, followed by a challenging and ultimately palliative care journey, shows the complexity of her clinical course and the importance of multimodality imaging and comprehensive care strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4143721-A4143721, November 12, 2024. Background:People with established cardiovascular disease (CVD) are at risk of early cognitive decline, and neurodegenerative diseases such as dementia. White matter hyperintensities (WMH) of presumed vascular origin are associated with progressive cerebrovascular disease and risk factors for CVD. The shared risk factors include blood pressure, sedentary lifestyle, genomic risk factors likeAPOE4mutations. The extent to which common risk factors explain the co-occurrence of CVD and neurological diseases is unclear.Purpose:To determine the extent of which CMR measurements associated with WMH independent of known cerebrovascular risk factors.Methods:Cardiac and brain MRI images were analysed for 33,198 UK biobank participants. WMH analysis included 5 brain regions (Frontal, Parietal, Temporal, Occipital, Basal Ganglia and Thalami) and total brain WMH volume. Cardiac traits included stroke volumes, atrial volumes, ejection fractions (EF) of right and left chambers, left ventricular (LV) strain, LV wall thickness and aortic areas.Multivariable regression analysis was carried out, where each cardiac trait was regressed on each brain region and adjusted for demographics, cardiac risk factors, family history of disease and socioeconomic factors. Results were evaluated against a multiple testing correct p-value threshold of 0.05, reflecting the number of principle components(n=10) necessary to explain at least 90% of the cardiac trait variability.Results:Higher values of 7 cardiac traits (LV end stroke volume, aortic areas, mid and basal wall thickness) associated with higher WMH volumes for all brain regions. Conversely three traits (LV ejection fraction, descending aorta distensibility and RV ejection fraction) associated positively with lower WMH volumes for all brain regions. LV cardiac output and maximum LAV only associated with frontal lobe WMH volumes. Associations onAPOE- ε4 carriership, a known risk factor of Alzheimer’s disease, showed negative association in homozygous carriers between aortic distensibility of the ascending and descending aorta and higher WMH volumes in the frontal and occipital lobes.Conclusions:This study offers insight into WMH burden in a large population of adults. Using cardiac traits as surrogate markers of different cardiac disease could explain how cardiac functionality defines WMH volume distribution and subsequently the wider relationship between cardiovascular and cerebrovascular disease.