Risultati per: L'imaging nella urolitiasi

Stroke, Volume 56, Issue 1, Page 170-182, January 1, 2025. BACKGROUND:Ischemic stroke is a common cause of death worldwide and a main cause of morbidity. Presently, laser speckle contrast imaging, x-ray computed tomography, and magnetic resonance imaging are the mainstay for stroke diagnosis and therapeutic monitoring in preclinical studies. These modalities are often limited in terms of their ability to map brain perfusion with sufficient spatial and temporal resolution, thus calling for development of new brain perfusion techniques featuring rapid imaging speed, cost-effectiveness, and ease of use.METHODS:We report on a new preclinical high-resolution angiography technique for murine ischemic stroke imaging based on large-field high-speed multifocal illumination fluorescence microscopy. We subsequently showcase the proposed method by monitoring therapeutic effects of thrombolysis in stroke (n=6), further performing cross-strain comparison of perfusion dynamics (n=6) and monitoring the therapeutic effects of sensory stimulation–based treatment (n=11).RESULTS:Quantitative readings of hemodynamic and structural changes in cerebral vascular network and pial vessels were attained with 14.4-µm spatial resolution at 80-Hz frame rate fully transcranially. The in vivo perfusion maps accurately delineated the ischemic core and penumbra, further exhibiting a strong correlation (86.1±4.5%) with ex vivo triphenyl tetrazolium chloride staining, significantly higher than for the conventional laser speckle contrast imaging method. Monitoring of therapeutic effects of thrombolysis confirmed that early recanalization could effectively save the penumbra while reducing the infarct area. Cross-strain comparison of perfusion dynamics affirmed that C57BL/6 mice feature a larger penumbra and smaller infarct core as compared with BALB/c mice, which have few or no collaterals. Sensory stimulation–based treatment could effectively enhance blood flow and abolish perfusion deficits in the ischemic core and penumbra regions.CONCLUSIONS:A high-speed fluorescence-based angiography method for transcranial stroke imaging in mice is introduced, which is capable of localizing brain perfusion changes and accurately assessing the ischemic penumbra. Compared with the whole-brain x-ray computed tomography and magnetic resonance imaging methods, which are conventionally used for stroke diagnosis and therapeutic monitoring, the new approach is simple and cost-effective, further offering high resolution and speed for in vivo studies. It thus opens new venues for brain perfusion research under various disease conditions such as stroke, neurodegeneration, or epileptic seizures.

Stroke, Ahead of Print. BACKGROUND:A potential benefit of mechanical thrombectomy for patients with distal medium vessel occlusions is currently being investigated in randomized trials. Computed tomography perfusion imaging has not yet been tested as a method to guide mechanical thrombectomy for distal medium vessel occlusions. The purpose of this study was to assess penumbral imaging as an imaging-based method for triaging patients with ischemic stroke and acute M2-middle cerebral artery occlusion.METHODS:This observational retrospective study of M2-middle cerebral artery patients with ischemic stroke triaged by multimodal computed tomography undergoing mechanical thrombectomy at a high-volume stroke center between January 2015 and January 2023. The effect of recanalization was analyzed according to computed tomography perfusion-derived lesion volumes (defined using relative cerebral blood flow 6 seconds) using logistic regression analysis, and interaction terms between the independent variables and recanalization were tested. The primary end point was functional independence at day 90, defined using modified Rankin Scale scores of 0 to 2.RESULTS:A total of 140 patients with M2-middle cerebral artery occlusion were included. In multivariable logistic regression analysis, recanalization was not associated with better functional outcome (adjusted odds ratio, 1.85 [95% CI, 0.87–3.90];P=0.11). After including interaction terms, a significant treatment effect between recanalization and computed tomography perfusion-derived lesion volumes was observed in patients with >150 mL hypoperfusion volume (adjusted odds ratio, 1.02 [95% CI, 1.00–1.03];P=0.007) or >125 mL penumbral volumes (adjusted odds ratio, 1.02 [95% CI, 1.01–1.03];P=0.005), as well as for baseline ischemic core volume within the range of 15 to 40 mL (adjusted odds ratio, 1.11 [95% CI, 1.01–1.22];P=0.03).CONCLUSIONS:Penumbral imaging might serve as a useful tool for treatment decision-making in distal medium vessel occlusions, particularly in cases of suspected non- or codominant M2-middle cerebral artery vessel occlusions. A hypoperfusion volume threshold of >150 mL emphasizes the potential value of computed tomography perfusion as a standardized tool directly showing the volumetric relevance in distal medium vessel occlusion cases.

Circulation, Volume 150, Issue 23, Page 1885-1897, December 3, 2024. Conventional forms of noninvasive cardiovascular imaging that evaluate morphology, function, flow, and metabolism play a vital role in individual treatment decisions, often based on guidelines. Innovations in molecular imaging have enhanced our ability to spatially quantify the expression of a wider array of disease-related proteins, genes, or cell types, or the activity of specific pathogenic pathways. These techniques, which usually rely on design of targeted imaging probes, have already been used extensively in cancer medicine and have now become part of cardiovascular care in conditions such as amyloidosis and sarcoidosis. The recognition that common cardiovascular conditions are caused by a substantial diversity of pathobiologic pathways and the diversity of therapies available for use have rekindled interest in expanding the role of molecular imaging of tissue phenotype to improve precision in diagnosis and therapeutic decision-making. The intent of this article is to raise awareness and understanding of approaches to molecular or cellular imaging of phenotype with targeted probes, and their potential to promote the principles of precision medicine. Also addressed are the diverse roles of molecular imaging to improve precision and efficiency of new drug development at the stages of candidate identification, preclinical testing, and clinical trials.

Introduction
Perianal fistulising Crohn’s disease (pfCD) is a distinct and debilitating phenotype seen in around one-third of patients with CD. Clinical trials in pfCD are increasingly using magnetic resonance imaging (MRI) criteria as a primary endpoint, but there is heterogeneity in the radiological definition of a healed perianal fistula that currently limits our ability to perform meaningful meta-analyses of studies. Our aim is to standardise outcomes through the generation of an international consensus definition of a radiologically healed fistula.

Methods and analysis
This international Delphi consensus study employs a two-part strategy.
The first is a systematic review to identify a longlist of variables used to define radiological healing in pfCD. MRI-based indices used to score fistula severity and healing will be assessed for their methodological quality using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). The systematic review protocol will be conducted using COSMIN methodology and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
The second part will be an online Delphi consensus, guided by the results of the systematic review. Radiologists, gastroenterologists and colorectal surgeons with expertise in the management of pfCD will be invited to take part in two to three rounds of online surveys. Once an a priori threshold of >80% agreement is reached on individual radiological components used to define ‘healing’ and ‘healed’, a final meeting of key stakeholders will be organised to generate a consensus definition of a healed fistula.

Ethics and dissemination
The study has been deemed exempt from a formal Research Ethics Committee review as no patients will participate directly in the consensus process, given the technical nature of the research question. The study is registered with the local R&D department (Reference RD24/007). Publication of this study will help standardise radiological endpoint measurement in clinical trials of pfCD and improve the synthesis and meta-analysis of comparative studies.

PROSPERO registration number
CRD42024504334.

This meta-analysis investigates the association of various cardiac MRI–derived measurements with adverse clinical outcomes in patients with nonischemic dilated cardiomyopathy for the purpose of risk stratification.

Circulation, Volume 150, Issue Suppl_1, Page ASa1106-ASa1106, November 12, 2024. Introduction/Background:Computed tomography (CT) imaging is a promising method for diagnosing patients after return of spontaneous circulation (ROSC) from cardiac arrest. CT information could alter management, improving patient outcomes. There are data supporting use after out-of-hospital arrests, but use and impact of CT imaging after in-hospital-cardiac arrest (IHCA) has not been investigated.Research Question/Hypothesis:We hypothesize that CT imaging will identify acute pathology, resulting in a change in management.Goals/Aims:Our aim is to describe the rates of use, findings, and consequences of CT imaging after IHCA.Methods/Approach:We screened for the first IHCA on admission between 1/26 2023, and 1/302024 at 3 hospitals. Patients 18 years of age or older who achieved ROSC were included. Information was collected on demographics, type of imaging performed, imaging findings, and whether the findings acutely changed management. A change in management was defined as a subsequent change in medications, procedures, or consultations that would not have otherwise occurred and was specifically performed to reverse, mitigate, or treat the imaging finding, based on review of chart documentation by critical care fellows and medicine residents. Results are reported as counts and percentages.Results:We screened 638 IHCA at 3 hospitals. Of the 201 patients meeting inclusion criteria, 72 (35.8%) died within 24 hours after ROSC. Of those who survived 24 hours, 58 of 129 (45.0%) received CT imaging in the 48 hours after ROSC, 53 (41.1%) received a head CT, 26 (20.2%) received a chest CT, 19 (14.7%) received an abdomen/pelvis CT, and 4 (3.1%) received a CT that was not head, chest, or abdomen/pelvis. The most common findings were ischemic stroke (15), pulmonary airspace opacities (23), and pleural effusion (15). An acute finding (previously unknown) was identified in 32 of 58 scans (55.2%), and there was an acute change in management because of the acute finding in 21 (65.6%) of those patients. For 8 patients (13.8%), the scan identified an acute finding thought to have contributed to the cardiac arrest. Of the 58 patients who received CT imaging, 2 of them (3.4%) suffered cardiac arrest while receiving the CT scan.Conclusions:CT imaging within 48 hours after IHCA frequently identified acute pathology, resulting in a change in management. Complications were seen, although we do not know if these were a result of the CT imaging, related transportation, or other causes.

Circulation, Volume 150, Issue Suppl_1, Page A4140123-A4140123, November 12, 2024. Background/Introduction:Microvascular obstruction (MVO), due to damage to the coronary microvasculature, is a key determinant of infarct size, heart failure and poor outcomes following acute myocardial infarction, and there is currently no treatment for preventing MVO. Real-timein vivoimaging of MVO in the beating rodent heart is challenging due to the limited spatial and temporal resolution from movement artifacts. Here, we apply, for the first time, fiber-optic confocal laser endomicroscopy (CLM) for real-time imaging of the microvasculature in a beating murine heart with acute ischemia/reperfusion injury (IRI), and then monitoring the development of MVO.Methods:Anin vivomurine acute myocardial IRI model (45 min ligation of left coronary artery (LCA) and 30 min reperfusion) was applied. At 10 min prior to ischaemia, 150 µl Dextran-FITC (150 kDa, 10 mg/ml) was injected retro-orbitally, and then CLM imaging with a flexible miniprobe (ProFlex S-1500 with CellVizio system) was applied to the epicardial surface at multiple sites at 5 min post-injection (baseline), 30 min post-ischemia and 30 min post-reperfusion. A nitric oxide donor(NO) nanoparticle (NONP) was synthesized and IV bolus injected into IRI mice 5min prior to reperfusion to prevent MVO.Results:We confirmed visualization of the macro- and microvasculature at various sites on the epicardial surface of the beating heart. Next, we observed reduced microvasculature blood flow below LCA ligature as evidenced by reduced or even totally absence of FITC within the vessels at 30min post-ischemia. The microvasculature at the non-ischemic myocardium was unaffected. Furthermore, at 30 min post-reperfusion, we visualised patchy areas of reduced FITC signal suggesting MVO, and damaged microvasculature as evidenced by leakage of FITC outside the vessel. Interestingly, NONP treatment preserved the microvascular network and prevented MVO at 30 min post-reperfusion with even greater FITC, suggesting increased microvascular blood flow and penetration into cardiac tissue because of the vasodilatory effect of NO in the ischemic area.Conclusion:With CellVizio CLM system, we have demonstrated the MVO development during IRI, and damage to the microvasculature with leakage of dye from vessels into cardiac interstitium, thereby providing a pre-clinical platform to test novel therapeutic agents for preventing MVO. Importantly, we have shown an effective MVO prevention with NO-donor nanoparticle following IRI in mice.

Circulation, Volume 150, Issue Suppl_1, Page A4139198-A4139198, November 12, 2024. Introduction:Cardiovascular radiology reports contain valuable diagnostic information linked to images, but the unstructured text format makes feature extraction difficult on a large scale. Large language models (LLMs) allow for feature extraction where string parsing alone is insufficient, but require careful prompting for accurate results.Hypothesis:We hypothesize that a systematic prompting approach using LLMs can expedite the extraction of features from unstructured text in transesophageal echocardiography (TEE) reports.Methods:The data consisted of 7106 intraoperative TEE reports, 600 of which were manually reviewed to obtain pre- and post-intervention ground truth values for left ventricular ejection fraction (LVEF), right ventricular systolic function (RVSF), and tricuspid regurgitation (TR). Reports are paired with an imaging study consisting of 50-200 clips. For each feature considered, 100 of the 600 labeled reports were used to engineer a prompt in Llama-2 that maximized feature extraction accuracy.Results:We found that using multiple, shorter prompts yielded higher accuracy than did fewer, longer prompts. Additionally, when imposing semantic information onto a numerical scale, prompt engineering in combination with string parsing (Figure 1) gave the best results. When evaluated on the 500 labeled reports withheld for testing, the finalized prompts had accuracies of 94.1%, 94.8%, and 91.3% for LVEF, RVSF, and TR, respectively. Using this strategy, 5000 intraoperative TEE reports were analyzed and used to train and evaluate a regression model for LVEF estimation from TEE clips (Figure 2).Conclusion:We have shown that performing prompt engineering on Llama-2 can be used to extract features from unstructured TEE reports in an accurate manner. As an extension of these methods, automated feature prediction from echocardiograms can be used to create rapid, low-cost, and accessible cardiac assessments.

Circulation, Volume 150, Issue Suppl_1, Page A4146225-A4146225, November 12, 2024. Introduction:Patients who underwent arterial switch operation (ASO) for d-transposition of the great arteries (TGA) are at increased risk for early myocardial ischemia. Stress perfusion cardiac MR (SPCMR) is used as a non-invasive tool for risk stratification but interpretation is often challenging.Hypothesis:There is significant interobserver variability in SPCMR image interpretation in patients with repaired TGA.Aims:1. Determine incidence and severity of adverse effects of stress agents.2. Evaluate incidence of positive SPCMR.3. Assess agreement amongst reviewers in image interpretation.Methods:Patients with repaired TGA with SPCMR imaging from 2013 to 2024 were reviewed. Three patients with previous coronary intervention and one with severe chest pain after adenosine, unable to complete SPCMR, were excluded. 61 studies were performed in 56 patients. Images were independently reviewed by two investigators blinded to initial interpretation and clinical outcome. Perfusion defects were displayed on a circumferential polar plot using standard LV segmentation.Results:Median (IQR) age was 15 (11-17) years, weight 55 (36-68) kg, and BSA 1.6 (1.2-1.8) m2. Max heart rate was 110 (100-125) and systolic BP 127 (116-138). Eleven (20%) patients had cardiac symptoms, chest pain in 9 (16%), syncope in 1 (2%), pallor and distress in 1 (2%) infant. Adverse effects from SPCMR in 8/52 (15%) adenosine, 2/4 (50%) dobutamine, and 0/6 (0%) regadenoson were minor and resolved on stress completion. Six (10%) studies were initially interpreted as suspicious (n=5) or definitive (n=1) perfusion defect (Figure). No LGE was detected. Original interpretation did not match blinded reviews for 6 cases (Figure). Blinded reviewers agreed on 3 negative cases but interpretation differed in the other 3 cases (Figure).Conclusions:SPCMR is safe and feasible. Significant interobserver variability highlights the challenges in qualitative SPCMR interpretation for TGA. Quantitative perfusion may reduce interobserver variability. Larger multicenter studies would be helpful in further elucidating the risk profile of patient characteristics and coronary artery arrangements to determine whether routine use of SPCMR is warranted for TGA patients.

Circulation, Volume 150, Issue Suppl_1, Page A4119189-A4119189, November 12, 2024. Background:Direct current cardioversion (DCCV) carries a risk for stroke in AF patients, for that reason there are guidelines for mitigating this risk in AF patients on oral anticoagulation (OAC). Meanwhile, no consensus on the best approach for cardioverting patients with an appendage occlusion device in situ. This led to a very wide variation in pre and post DCCV practices in these patients.Aims:We aim to explore different factors that might be associated with the variation seen in pre-DCCV imaging practices in patients presenting post- percutaneous LAAO.Methods:This was a multi-center retrospective cohort study of patients who received DCCV for AF or AFL during follow up after LAAO procedure within a single healthcare system from 2016-2024.Results:A total of 119 patients were included, there were 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. A median duration of 10 months (3,21) between LAAO to presentation for DCCV . Forty-four (37%) patients had pre-DCCV imaging (imaging cohort). Number of males was significantly higher in the imaging cohort (24 (54.5%) vs 25 (33.3%), p=0.038), compared to those without imaging. There was a significant difference (p

Circulation, Volume 150, Issue Suppl_1, Page A4146737-A4146737, November 12, 2024. Introduction:Whole-body scintigraphy (WBS) is frequently performed for oncological indications but also has high sensitivity for incidental detection of transthyretin amyloid cardiomyopathy (ATTR-CM), which may be overlooked.Goal:Develop an algorithm that combines chest computed tomography (cCT) and WBS to identify incidental ATTR-CM in a large healthcare system.Methods:We included 3 cohorts: 1) 77 patients from Brigham and Women’s Hospital with high prevalence of patients positive for ATTR-CM (BWHC), 2) 982 continuous cohort of patients imaged with WBS at PennMedicine for oncological indications from 2010-2020 (PennC), and 3) 5 patients with proven ATTR-CM uptake on WBS when imaged for oncologic indications from 2021-2024 (PennC+). Using a U-Net model trained with Dice score, the AmyNet algorithm automatically segmented cCTs with regions of interest (ROIs) around the entire heart (ventricles, atria, blood pool). Maximal intensity projections of cCTs in the coronal plane were registered to WBS using rigid transformations from the ANTs library. Multiple template reconstructions of only BWHC projections augmented registration due to limited field of view of cCT by providing an initial alignment to the thorax. Transformations were applied to heart ROIs to identify the location on WBS. A modified contralateral ratio was calculated by taking the lateral 1/3 and inferior 2/3 region to avoid sternum and atria and reflecting it across the vertical axis. A cutoff ratio of 1.15 was established as positive for ATTR-CM.Results:Machine-generated and expert volumes were comparable (1071vs1087mL; p=0.74) with a Dice similarity index of 0.92±0.07. AmyNet had a 94% accuracy with 100% sensitivity and 90% specificity in detecting ATTR-CM in BWHC with positive patients having higher contralateral ratios (1.57±0.49 vs 1.01±0.18, p

Circulation, Volume 150, Issue Suppl_1, Page A4142721-A4142721, November 12, 2024. Backround:Patients with Ischemia with non-obstructive coronary artery (INOCA) have symptoms of chronic myocardial ischemia without comorbid obstructive coronary artery disease. As a result, they often fail to receive timely diagnosis and treatment, increasing the risk of poor prognosis. Hyperspectral imaging (HSI), developed on the basis of multispectral remote sensing, can provide information on the spatial distribution of various tissue structures, analyze the chemical composition and physical characteristics of different diseases.Objective:In this study, we attempted to analyze the functional status of peripheral microvessels by HSI and thus identify patients with INOCA.Methods:This study was an observational cross-sectional study. The study included 500 patients with chest pain who underwent coronary angiography from December 2023 to May 2024 at Renmin Hospital of Wuhan University. We acquire HSI of the patient’s face, palms and ears prior to coronary angiography. Patients were divided into a control group, an INOCA group, and a coronary artery blockage group according to guideline diagnostic criteria.Results:1. The data model (Model 1) was built by deep learning the waveband and texture data of HSI, and it showed good sensitivity and specificity for recognizing INOCA patients;2. The image model (Model 2) is built after deep learning of HSI features, and it also has good sensitivity and specificity for the diagnosis of INOCA patients. The specificity of the image model is higher than the data model, but the sensitivity is slightly worse;3. We constructed the composite model (Model 3) by fusing the data model with the image model. Compared to the data model and image model, the composite model showed higher sensitivity and specificity in the identification of INOCA patients.Conclusion:The model constructed based on deep learning of peripheral microvascular HSI can diagnose INOCA patients with high sensitivity and specificity.

Circulation, Volume 150, Issue Suppl_1, Page ASu902-ASu902, November 12, 2024. Background:Brain magnetic resonance imaging (MRI) has been examined for neuroprognostication (NP) after out-of-hospital cardiac arrest (OHCA). However, studies have focused on predicting poor outcomes of non-awakening and/or death. Recommendations for utilization of brain MRI in NP remain weak due to its subjective interpretation.Aim:We modified a previously published brain MRI score and examined our quantitated NP scores’ ability to predict good functional outcomes in OHCA survivors.Methods:We screened OHCA cases (2017-2023, Seattle Medic One registry) for patients who survived to hospital discharge and had brain MRIs performed 25 hours-7 days after arrest. Each MRI was reviewed by two adjudicators; a third reviewer served as tie-breaker. Reviewers were blinded to patient outcomes. Diffusion Weighted Imaging and Fluid Attenuated Inversion Recovery sequences were reviewed to score 35 neuroanatomical regions. Graded severity for estimated affected area (0 = zero; 1= < 25%; 2 = 25-50%; 3 = 50-75%; 4 = >75%) and binary (0 = not affected, 1 = affected) scores were tallied. Points were summed for a composite brain MRI score, “NP score”, possible range 0-214. Primary outcome was Cerebral Performance Categories (CPC) at hospital discharge (1-2: “independent”, 3: “dependent”, 4: “vegetative state”). Computational modeling employed folded normal distributions and Maximum Likelihood Estimation. Statistical analyses were Pearson’s, Spearman’s, ANOVA, Fisher LSD, t-tests.Results:Forty-two (42) adult patients were included (74% men, 55% Caucasian). Median NP score was 11.5 (IQR 41.5, n=42) overall, 2 (IQR=10, n=21) for independent versus 25.5 (IQR 36.5, n=10) for dependent patients, and 92 (IQR=81, n=11) for those in a vegetative state. NP scores strongly correlated with CPC [rs(40) = .69,p< .001], and were significantly different between CPC groups [F(2,39) = 32.66,p< 0.001]. Interrater concordance for NP score was high (Pearson)r= .88 [r = .96; .95; .90; .71].Conclusions:Our NP score correlated well with good functional outcomes in OHCA survivors, and (1) identified distinct thresholds that well-separate functional outcome groups and (2) had very strong concordance rate among four pairs of adjudicators. NP score-based predictive modeling differentiates functional outcomes beyond good versus poor dichotomy and may help providers and family anticipate recovery potential.

Circulation, Volume 150, Issue Suppl_1, Page A4144487-A4144487, November 12, 2024. Introduction:T2* cardiac MRI (CMR) is the standard for detecting hemorrhagic myocardial infarction (MI). However, the conventional T2* CMR (2D breath-held, ECG-gated, multi-gradient-echo T2*) can suffer from limited spatial resolution and multiple motion artifacts. We developed a time-efficient, fully ungated, free breathing, 3D T2* mapping method for detecting and characterizing hemorrhagic MI (hMI).Methods:Our approach, developed using a low-rank tensor framework, was tested in a canine model with reperfused hMI. Animals (n=5) underwent CMR 3 days after reperfusion. Short-axis, conventional 2D and proposed 3D T2*-w images, and the corresponding LGE images were acquired in a 3T CMR system. T2* maps (8 echoes, 1.41-15.44 ms) were constructed using mono-exponential fitting. IMH extent was determined by measuring the weighted sum of the imaging slices with hypointense regions (based on ‘mean-2SD’ criterion) within the LGE positive territories. Image quality was assessed by two CMR experts using a Likert scale (1 – poor; and 5 – excellent).Results:Figure 1 shows representative conventional 2D, proposed 3D T2* images, along with LGE image for reference. T2* image scores were higher with the proposed than the conventional approach: 3.5 ± 0.5 (conventional) vs 3.8 ± 0.3 (proposed), p

Circulation, Volume 150, Issue Suppl_1, Page A4143303-A4143303, November 12, 2024. Introduction:Preeclampsia is a hypertensive disorder of pregnancy associated with cardiovascular disease. Systemic peripartum microvascular alternations have been implicated in pregnancies complicated by preeclampsia. Whether coronary microvascular dysfunction is a potential mediator of preeclampsia-associated cardiovascular risk is unknown. We aimed to determine whether individuals with a history of preeclampsia have coronary microvascular dysfunction measured by cardiac magnetic resonance imaging (CMR) at least 5 years postpartum.Methods:Women with singleton pregnancies complicated by preeclampsia and a comparator group with uncomplicated, normotensive deliveries were identified and prospectively enrolled to undergo regadenoson stress perfusion CMR (1.5T Signa Artist GE HealthCare) at least 5 years postpartum. Using the dual sequence technique, fully 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:Twenty-three subjects (41.0 ± 6 years, 12.7 ± 5 years post-partum) were included. Women with a history of preeclampsia (n=11) were compared to a control group of women with prior normotensive pregnancy (n=12) (Figure 1A). Obesity and diabetes were more common with preeclampsia, but there was no significant difference in the presence of hypertension between the groups (Table 1A). There was no difference in stress MBF. However, preeclampsia was associated with higher rest MBF (1.47 ± 0.54 mL/g/min vs. 1.19 ± 0.29 mL/g/min; p=0.07) and MPR (1.96 ± 0.46 vs 2.66 ± 1.0; p=0.02) compared to normotensive pregnancy (Figure 1). Similarly, corrected MPR remained significantly lower with prior preeclampsia versus uncomplicated pregnancy (2.36 ± 1.0 vs 3.36 ± 1.46; p=0.03).Conclusions:In this study, we observed significantly reduced coronary microvascular function following a pregnancy complicated by preeclampsia at least 5 years postpartum. Heightened cardiovascular risk factors may attenuate this association; however, these observations indicate that systemic microvascular dysfunction in preeclampsia also involves the coronary microcirculation. Further research is needed to better understand the timing and association of these microvascular changes concerning preeclampsia and later heart disease.

Circulation, Volume 150, Issue Suppl_1, Page A4136136-A4136136, November 12, 2024. Background:The optimal clinical management and timing of intervention are less well defined in paradoxical low-flow, low-gradient severe aortic stenosis (PLFLG AS). Left ventricular global longitudinal strain (LV-GLS) has been shown to predict outcomes in high flow severe AS, but there is lack of data in patients with PLFLG AS. Given the exaggerated LV hypertrophy and remodeling pattern in PLFLG AS, LV-GLS may be a mechanistic imaging marker for worse outcomes.Hypothesis:In patients with PLFLG AS, LV-GLS is associated with adverse clinical outcomes by detecting subclinical myocardial fibrosis resulting from myocardial remodeling due to LV pressure overload.Methods:We examined patients with PLFLG AS defined as AVA