Risultati per: L'imaging nella urolitiasi

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 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 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 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

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 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 A4139978-A4139978, November 12, 2024. Background:Discrepant transthoracic echocardiography (TTE) parameters are not infrequently observed in patients with significant aortic stenosis (AS), however, there is limited literature regarding their computed tomography (CT) characteristics and prognostic implications.Aims:We compared the multi-modality imaging characteristics and outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) by AS subtype.Methods:Patients with severe AS (defined as aortic valve area

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 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 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 A4138112-A4138112, November 12, 2024. Background:Mitral annular calcification (MAC) is a common incidental finding associated with advanced renal dysfunction, hyperlipidemia, hypertension, or abnormal calcium metabolism. Caseous mitral annular calcification (CMAC) is a less common MAC variant involving central liquefaction necrosis, which results in a paste-like substance consisting of calcium, fatty acids, and cholesterol.Case description:A 64-year-old female presented to clinic with chronic shortness of breath and fatigue that started after COVID-19 pneumonia in 2021. As part of the initial evaluation, a transthoracic echocardiogram (TTE) was done, which revealed moderate annular calcification, 3+ mitral valve regurgitation, and a 1.8×1.5 cm echogenic mass on the posterior mitral annulus, concerning for possible fungal vegetation. Further multimodality imaging was pursued. Transesophageal echocardiogram confirmed the presence of a 2.0×1.7 cm cystic mass but demonstrated normal mitral valve function. Cardiac MR further identified a 1.2×0.8×1.5 cm hypointense mass, with surrounding late gadolinium enhancement, suggesting an associated inflammatory/degenerative process. Gated cardiac CT scan showed a mass with ring-like dense peripheral calcification and low central attenuation. Overall, findings from multimodality imaging were most consistent with CMAC. In the present case, the patient was monitored conservatively, as her symptoms of shortness of breath improved, and she did not experience any associated complications.Discussion:The present case demonstrates an incidental finding of an echogenic mass on the posterior mitral annulus, later identified as CMAC. Initial imaging with TTE helps evaluate for CMAC. However, on TTE alone, CMAC is often misdiagnosed with other conditions, including intracardiac tumors, abscesses, vegetations, or thrombi, and more advanced imaging is often recommended. On cardiac MR, CMAC is usually hypointense due to the elevated calcium content and may have surrounding late gadolinium enhancement due to associated inflammation. On gated cardiac CT, CMAC presents with a hyperintense rim due to calcification and a hypointense center consistent with central necrosis. As in this patient, CMAC is usually a benign condition that can be monitored conservatively. Indications for invasive intervention include significant valvular dysfunction, embolization, or conduction abnormalities. Multimodal imaging can aid in appropriate diagnosis to mitigate unnecessary interventions.

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 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 A4142182-A4142182, November 12, 2024. Introduction:Since pulmonary vein isolation (PVI) is often insufficient for persistent atrial fibrillation (PsAF) treatment, rotor ablation targeting AF drivers/substrates has been conducted as potential effective strategy. Recently, substrate location capable of attracting rotor (LR) has been reported to be associated with local fibrosis features. Meanwhile, epicardial adipose tissue (EAT) has been shown to be linked to developing fibrosis and arrhythmogenic substrates. Currently it is not well understood how EAT is related to the LR, and local fibrosis features. Personalized LGE-MRI-based digital twins (DTs) and cardiac CCT can be employed to investigate this.Hypothesis:EAT detected in CCT is correlated with LRs having specific local fibrosis features.Aim:To investigate the correlation between EAT, LRs, and the corresponding local fibrosis features using the merging of LGE-MRI-based DTs and CCT.Methods:Both LGE-MRI and CCT were acquired in 19 consecutive PsAF patients. Bi-atrial DTs incorporating the fibrosis distribution were created, wherein, following virtual PVI, LRs were identified by rapid pacing from 40 bi-atrial sites near fibrosis. In silico ablation was repeated until non-inducibility of rotors (Fig). EAT segmented from CCT and DT were compared after merging them using the bi-atria and 4 PVs as reference points. The distance from each tissue type in DT to the closest EAT (DCE) was calculated. The correlation between local fibrosis density feature (FD) and the median DCE at LRs was analyzed. For each LR, both volumetric FD (vFD) and endo-epi surface FD (sFD), subtracting epicardial surface FD from the endocardial surface FD to measure the dissociation of Endo-Epi surface FDs, were calculated.Results:Among 17 DTs excluding 2 without qualified CCT images, 15 DTs had 95 extra-PVI LRs in total. The DCE of fibrotic tissues (16%) was significantly shorter than that of normal tissues (84%) (p

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