Objectives:To investigate the relationship between epicardial adipose tissue(EAT)(including pericoronary adipose tissue[PCAT])with left ventricular remodeling and myocardial fibrosis in heart failure with reduced ejection fraction(HFrEF)patients.Methods:Consecutive patients diagnosed with HFrEF who underwent coronary computed tomography angiography(CCTA)and cardiac magnetic resonance imaging(CMR)examination at the First Affiliated Hospital of Air Force Medical University between May 2021 and January 2024 were included in this study(n=34).EAT CT attenuation,volume and PCAT CT attenuation of left anterior descending artery(LAD)and right coronary artery(RCA)were measured based on CCTA images.Left ventricular function parameters,late gadolinium enhancement(LGE),and extracellular volume(ECV)were evaluated based on CMR images.The correlations between EAT and PCAT with ventricular remodeling and myocardial fibrosis were evaluated in patients with HFrEF using Spearman analysis.Results:Spearman analysis showed that EAT volume were positively correlated with left ventricular end diastolic volume(LVEDV),left ventricular stroke volume(LVSV)and LGE(all P<0.05).EAT CT attenuation were positively correlated with LVEDV and left ventricular end systolic volume(LVESV),and negatively correlated with left ventricular remodeling index(LVRI),left ventricular ejection fraction(LVEF),left ventricular cardiac output(LVCO)and LGE(all P<0.05).LAD PCAT CT attenuation was positively correlated with LVESV,and negatively correlated with left ventricular maximal wall thickness,LVSV,LVEF,LVCO and LGE(all P<0.05).RCA PCAT CT attenuation were positively correlated with LVEDV and LVESV,and negatively correlated with LVEF and LGE(all P<0.05).EAT CT attenuation,volume and PCAT CT attenuation were not significantly correlated with ECV(all P>0.05).Conclusions:In HFrEF patients,both EAT and PCAT were associated with left ventricular remodeling and myocardial fibrosis.

Objectives:To investigate the relationship between epicardial adipose tissue(EAT)(including pericoronary adipose tissue[PCAT])with left ventricular remodeling and myocardial fibrosis in heart failure with reduced ejection fraction(HFrEF)patients.Methods:Consecutive patients diagnosed with HFrEF who underwent coronary computed tomography angiography(CCTA)and cardiac magnetic resonance imaging(CMR)examination at the First Affiliated Hospital of Air Force Medical University between May 2021 and January 2024 were included in this study(n=34).EAT CT attenuation,volume and PCAT CT attenuation of left anterior descending artery(LAD)and right coronary artery(RCA)were measured based on CCTA images.Left ventricular function parameters,late gadolinium enhancement(LGE),and extracellular volume(ECV)were evaluated based on CMR images.The correlations between EAT and PCAT with ventricular remodeling and myocardial fibrosis were evaluated in patients with HFrEF using Spearman analysis.Results:Spearman analysis showed that EAT volume were positively correlated with left ventricular end diastolic volume(LVEDV),left ventricular stroke volume(LVSV)and LGE(all P<0.05).EAT CT attenuation were positively correlated with LVEDV and left ventricular end systolic volume(LVESV),and negatively correlated with left ventricular remodeling index(LVRI),left ventricular ejection fraction(LVEF),left ventricular cardiac output(LVCO)and LGE(all P<0.05).LAD PCAT CT attenuation was positively correlated with LVESV,and negatively correlated with left ventricular maximal wall thickness,LVSV,LVEF,LVCO and LGE(all P<0.05).RCA PCAT CT attenuation were positively correlated with LVEDV and LVESV,and negatively correlated with LVEF and LGE(all P<0.05).EAT CT attenuation,volume and PCAT CT attenuation were not significantly correlated with ECV(all P>0.05).Conclusions:In HFrEF patients,both EAT and PCAT were associated with left ventricular remodeling and myocardial fibrosis.

Objective To investigate the combined effect of coronary artery calcification score(CACS)progression and sleep structure on major adverse cardiovascular events(MACE).Methods Data from the Multi-Ethnic Study of Atherosclerosis(MESA)were used to analyze participants and assess the interaction impact of CACS progression and different sleep stages on predicting MACE.Polysomnography(PSG)record provide an objective measure of sleep structure.Results The results of this study confirmed the dose-response relationship between CACS progression and MACE.ΔCACS 10-99 hazard ratio(HR)was 6.913(P＜0.001),ΔC ACS 100-199 HR was 22.098(P＜0.001),ΔCACS＞200 HR was 20.608(P＜0.001),reinforcing the notion that the rate of CACS development significantly affects cardiovascular risk.In addition,the study found that participants who showed lower rapid eye movement(REM)sleep and progression of CACS had the greatest risk of developing MACE,while participants who showed higher REM sleep but no progression of CACS had the lowest risk of developing MACE(P＜0.001).Conclusion Decreased REM sleep increases the risk of MACE in CACS patients,and maintaining adequate REM sleep may reduce this risk,emphasizing the protective effect of REM sleep on cardiovascular disease.

Objective To investigate the combined effect of coronary artery calcification score(CACS)progression and sleep structure on major adverse cardiovascular events(MACE).Methods Data from the Multi-Ethnic Study of Atherosclerosis(MESA)were used to analyze participants and assess the interaction impact of CACS progression and different sleep stages on predicting MACE.Polysomnography(PSG)record provide an objective measure of sleep structure.Results The results of this study confirmed the dose-response relationship between CACS progression and MACE.ΔCACS 10-99 hazard ratio(HR)was 6.913(P＜0.001),ΔC ACS 100-199 HR was 22.098(P＜0.001),ΔCACS＞200 HR was 20.608(P＜0.001),reinforcing the notion that the rate of CACS development significantly affects cardiovascular risk.In addition,the study found that participants who showed lower rapid eye movement(REM)sleep and progression of CACS had the greatest risk of developing MACE,while participants who showed higher REM sleep but no progression of CACS had the lowest risk of developing MACE(P＜0.001).Conclusion Decreased REM sleep increases the risk of MACE in CACS patients,and maintaining adequate REM sleep may reduce this risk,emphasizing the protective effect of REM sleep on cardiovascular disease.

Purpose To investigate the diagnostic value of multimodal imaging in cardiac lipoma.Materials and Methods The clinical symptoms,echocardiography,CT and cardiac magnetic resonance images of 14 patients with cardiac lipoma diagnosed in Xijing Hospital of Air Force Military Medical University from July 2016 to November 2022 were retrospectively analyzed.Results Five patients with lipoma had symptoms of chest tightness and shortness of breath.A total of 18 lesions were found in 14 cases with cardiac lipoma.The locations of cardiac lipomas were widely distributed in the heart,of which 9 were located under the inner lining of the ventricular lumen(6 in the left ventricle,3 in the right ventricle),5 in the myocardium(4 in the left ventricle wall,1 in the right ventricle wall),3 in the pericardium,and 1 in the right ventricle.Echocardiography of 12 cases showed strong echoic mass image,and CT of 7 cases showed uniform low-density mass image.All patients cardiac magnetic resonance showed high signal of T1WI,and the tumor signal of lipid-pressure sequence decreased significantly.T2WI showed high signal and low signal ring around the tumor,indicating a chemical shift artifact.In the film sequence of heart,the mass could be seen to wobble gently and change in the shape of spontaneous motion cycle.The first perfusion scan did not show perfusion elevation.No enhancement was observed on the delayed enhanced scan.Native T1 mapping showed that the T1 value of mass was significantly lower than that of normal myocarda[(255.9±48.4)ms vs.(994.2±66.4)ms],and the difference was statistically significant(t=-32.5,P<0.001).Conclusion Multimodal imaging can provide objective evidence for clinical diagnosis of cardiac lipoma.Lipomas with extremely low T1 values were found,which is helpful to assist in the diagnosis of cardiac lipoma,clearer observation of the lesions,accurate localization,and strong ability to detect small lesions.Therefore,when cardiac lipoma is suspected,T1 mapping can be used as a routine examination method for the diagnosis and differential diagnosis of cardiac masses.

Objective To investigate the relationship between sleep fragmentation(SF)parameters and left ventricular structure in a community-based elderly population using data collected from the Multi-Ethnic Study of Atherosclerosis(MESA)cohort.Methods A total of 1 404 participants from the MESA cohort who underwent polysomnography(PSG)and cardiac magnetic resonance(CMR)were included.PSG was used to assess SF parameters,including wake after sleep onset(WASO),arousal index-total(ArI-total),arousal index-rapid eye movement(ArI-REM),and arousal index-non-rapid eye movement(ArI-NREM).Left ventricular end-diastolic mass(LVEDM)was measured via CMR.Linear regression was employed to analyze the relationship between SF parameters and left ventricular mass to height ratio(LVHi).Results Univariate linear regression analysis showed that WASO[β 0.134;95％confi-dence interval(CI)0.023-0.052;P＜0.001],ArI-total(β 0.184;95％CI 0.203-0.362;P＜0.001),ArI-REM(β 0.116;95％CI 0.100-0.260;P＜0.001)and ArI-NREM(β 0.175;9 5％CI 0.176-0.323;P＜0.001)were positively correlated with LVHi.After adjust-ment for confounding factors in multivariate linear regression analysis,WASO(β 0.045;95％CI 0.001-0.024;P=0.033)was positively correlated with LVHi.WASO(β 0.089;95％CI 0.006-0.034;P=0.006)was significantly associated with increased LVHi in the female group but not in the male group.Conclusion In an ethnically diverse cohort,WASO is significantly associated with increased LVHi after adjustment for potential confounders,especially in the female elderly population.

Objective To explore the computed tomography angiography(CTA)and clinical features of Takayasu's arteritis(TA)with peripheral artery involvement.Methods In this retrospective study,CTA scan was performed in a total of 184 TA patients.TA patients were divided into two groups:60 patients within peripheral artery involvement(peripheral artery involvement group)and 124 patients without peripheral artery involvement(peripheral artery non-involvement group).The difference in comparison of clini-cal data and CTA findings were analyzed.Results A total of 194 peripheral arteries were involved in 60 patients.The most suscep-tible peripheral artery were axillary artery(52,26.8％),middle cerebral artery(26,13.4％)and femoral artery(22,11.3％).In the peripheral artery involvement group,the most common CTA manifestation was luminal stenosis(141,72.7％).The lumen dilata-tion,lumen stenosis with dilatation and wall calcification were not easy to be observed.The age and duration of disease in peripheral artery involvement group were significantly greater than those in peripheral artery non-involvement group(P＜0.05).The proportion of the peripheral artery involvement group in the active phase was significantly lower than that of the peripheral artery non-involvement group(P＜0.05).The incidence of pain in the limbs in peripheral artery involvement group was significantly higher than that in peripheral artery non-involvement group(P＜0.05).The utilization rate of tocilizumab in the peripheral artery involvement group was significantly higher than that in the peripheral artery non-involvement group(P＜0.05).Conclusion TA involving peripheral arteries is more common in patients with a long course of disease and in the inactive phase.Patients are prone to pain in their limbs.The CT A manifestations of these patients are also special,that is,the involved peripheral arteries are not prone to lumen dilatation and wall calcification.

Objective To evaluate the change of cardiac structure and function in patients with hypertrophic obstructive cardiomyopathy(HOCM)after ultrasound-guided percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)via cardiac magnetic resonance(CMR).Methods Patients with HOCM who underwent PIMSRA,echocardiography and CMR preoperative scanning and one year after surgery were analyzed retrospectively.Myocardial structural and functional parameters were measured by Circle cardiovascular imaging post-processing software.The changes of myocardial parameters before and after surgery were compared by using paired sample t-test and Chi-square test.Results Compared with the preoperative assessment,patients'clinical symptoms and the cardiac function were significantly improved one year after surgery.The left ventricular outflow tract pressure gradient(LVOT-PG)was significantly decreased and length of mitral regurgitation was shortened one year after surgery compared with before surgery via ultrasound(P<0.05).Compared with the preoperative assessment,CMR showed that patients with end-systolic volume of left atrium,minimum volume of left atrium,transverse diameter of left atrium,thickness of ventricular septum and free wall of left ventricular at end-systolic section were significantly reduced,and left ventricular mass(LVM)was significantly decreased one year after surgery,with statistical significance between before and after surgery(P<0.001).One year after surgery,the left atrium ejection fraction(LAEF)was significantly increased(P<0.05),the maximum slope and the maximum signal intensity of the ventricular septum and the left ventricular free wall of the papillary muscle were significantly increased(P<0.001),and the peak time was significantly decreased(P<0.001)compared with before surgery.Conclusion After PIMSRA treatment,the systolic function of left atrium in HOCM patients is improved,and the microcirculation perfusion of left ventricular is significantly improved.

Objective:To construct a porcine model of ischemia with non-obstructive coronary artery (INOCA) and explore the diagnostic value of a one-stop noninvasive method including CT myocardial perfusion imaging (CT-MPI) and coronary CT angiography (CCTA).Methods:Twelve swines were divided into the experimental group (9) and the normal group (3). Coronary microvascular dysfunction (CMD) porcine model was constructed in the experimental group by inducing diabetes mellitus, chronic kidney disease, and hypercholesterolemia. Invasive coronary angiography (ICA) and functional examination were performed on all 7+3 trial swines to clarify the INOCA diagnosis after completion of the modeling. Then, CT-MPI and CCTA were performed on all individuals to explore the CT-MPI and CCTA characteristics of INOCA porcine models. CT-MPI parameters, including myocardial blood flow (MBF), and myocardial blood volume (MBV) in rest and stress conditions, and CCTA parameters, including severity of stenosis and CAD-RADS, were analyzed.Results:ICA and functional tests showed that all swines in the experimental group met the diagnostic criteria for INOCA, which meant that INOCA porcine model was constructed successfully. CCTA results confirmed that there was no obstructive coronary stenosis in all 10 swines which were examined, which was consistent with ICA findings. CT-MPI results demonstrated that the mean MBF values, as well as the mean MBV values, in the rest and stress condition of each swines in the experimental group were lower than those of the control group. In contrast to the control group, the mean MBF and MBV values of swines in the experimental group in stress condition were generally lower than those in resting condition.Conclusions:In this study, a porcine model of CMD is successfully constructed by inducing hypercholesterolemia+diabetes mellitus+chronic kidney disease. ICA and invasive functional tests show that this CMD model meet the diagnostic criteria for INOCA. It has been confirmed that one-stop CT multimodality examination including CT-MPI and CCTA can be used for the diagnosis of INOCA as a noninvasive diagnostic method.

Objective:To explore the difference of the vessel and plaque characteristics, myocardial perfusion and cardiac function between patients with ischemia with non-obstructive coronary artery disease (INOCA) and obstructive coronary artery disease (CAD).Methods:From July 2021 to June 2022, 101 patients with angina were referred to dynamic computed tomography myocardial perfusion (CTP) and coronary computed tomography angiography (CCTA) and retrospectively included in our hospital. Based on the results of CTP and CCTA, patients were divided into INOCA (27 cases), moderate obstructive CAD (26 cases) and severe obstructive CAD (48 cases). The anatomical coronary artery stenosis, plaque characteristics and myocardial perfusion features of all patients were analyzed. Furthermore, left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained on full-phase reconstruction CCTA image by using Medis Suite 3.2 postprocessing software. Multigroup analysis used one way ANOVA or Kruskal Wallis H test. Results:Patients with INOCA were younger than patients with moderate and severe obstructive CAD ( P<0.001). INOCA patients (7.4%, 2/27) had lower rate of positive remodeling than both moderate (57.7%, 15/26, P<0.001) and severe obstructive CAD patients (33.3%, 16/48, P=0.017). The percentage of ischemic myocardium volume in patients with INOCA were similar with those in patients with severe CAD (all P>0.05), but significantly higher than those in patients with moderate CAD (all P<0.05). No significant difference in terms of GLS was detected between patients with INOCA [-17.4% (-21.6%, -11.6%)] and severe CAD [-17.6% (-21.9%, -14.8%), P=0.536], however, patients both with INOCA and severe CAD also had higher GLS than patients with moderate obstructive CAD [-22.3% (-29.8%, -19.0%), all P<0.05]. Conclusions:Based on"one-stop-shop"CTP combined with CCTA imaging, early cardiac functional changes including abnormal myocardial perfusion and myocardial strain in INOCA patients were similar to those in patients with severe obstructive CAD and more severe than those in patients with moderate obstructive CAD.