Daily Cardiology Research Analysis

AIMS: Percutaneous mitral commissurotomy (PMC) is the reference treatment for rheumatic mitral stenosis (MS). In high-income countries, mitral valve calcification is frequent. Computed tomography (CT) enables Mitral Valve Calcium Scoring (MVCS), but its prognostic value in rheumatic MS has not been prospectively evaluated. The CALCIMIT study assessed the reproducibility and prognostic value of the MVCS by CT on immediate and long-term outcomes after PMC. METHODS AND RESULTS: In this prospective multicenter study, patients underwent non-contrast cardiac CT before PMC. MVCS was quantified using Agatston's method. The primary endpoint was good immediate result (GIR), defined as final mitral valve area ≥1.5 cm² with ≥50% increase and ≤2/4 mitral regurgitation (MR). The secondary endpoint was long-term event-free survival (death or mitral reintervention). Between 2016 and 2019, 172 consecutive patients (mean age 56±15 years; 78% women) were included. According to CT, 113 patients (66%) had mitral calcification. GIR of PMC was achieved in 54.7% of patients. Independent predictors of GIR included lower CT-based MVCS, lower NYHA class, and lower baseline MR grade. MVCS was also independently associated with long-term survival free of mitral reintervention (HR 1.54, 95% CI 1.07-2.21; p=0.019). A threshold of 385.5 Agatston Units predicted both immediate and late outcomes. Interobserver reproducibility was excellent (calcification detection: Kappa 0.987; MVCS correlation: r=0.999). CONCLUSIONS: CT-derived MVCS provides independent, reproducible prognostic information for immediate and long-term outcomes after PMC, beyond conventional echocardiographic scores. Integrating MVCS into preprocedural assessment may improve patient selection for PMC.

IMPORTANCE: Selection of patients with a bicuspid aortic valve and aortopathy for prophylactic aortic surgery remains challenging. In thoracic aortopathy, aortic medial elastin fiber fragmentation initially leads to microcalcification but later declines with progressive loss of elastin content and reduced structural integrity. OBJECTIVE: To determine whether aortic microcalcification detected using fluorine F 18-labeled [18F]-sodium fluoride positron emission tomography (PET) is associated with future aortic diameter expansion. DESIGN, SETTING, AND PARTICIPANTS: This prospective longitudinal cohort study was conducted in tertiary care centers across Scotland from April 4, 2019, to September 15, 2023. Participants included patients with a bicuspid aortic valve. Data analysis was performed from May 21, 2024, to March 4, 2025. EXPOSURES: Hybrid [18F]-sodium fluoride PET and computed tomography. MAIN OUTCOMES AND MEASURES: Baseline ascending aortic [18F]-sodium fluoride uptake was measured as mean tissue to background ratio. The primary outcome was ascending aortic diameter expansion during 24 months on cardiac magnetic resonance imaging (MRI). RESULTS: Seventy-six patients with a bicuspid aortic valve (mean [SD] age, 52.6 [7.5] years; 57 [75.0%] male) underwent baseline [18F]-sodium fluoride PET and MRI. Fifty-six patients underwent follow-up MRI after a median of 723 (IQR, 515-787) days. There was an inverse correlation between baseline ascending aortic [18F]-sodium fluoride uptake and annual change in diameter (Pearson r = -0.37; P = .005), which remained after adjustment for confounders in multivariable regression analysis. Ascending aortic [18F]-sodium fluoride was not correlated with baseline diameter (Pearson r = 0.08; P = .50) but was moderately correlated with baseline ascending aortic stiffness index (Pearson r = 0.38; P < .001). CONCLUSION AND RELEVANCE: In this cohort study of patients with a bicuspid aortic valve, the most rapid aortic growth was seen in those with low [18F]-sodium fluoride ascending aortic uptake, indicating reduced aortic wall integrity. High ascending aortic [18F]-sodium fluoride uptake was associated with a stiffer and slow-growing ascending aortic phenotype. These findings suggest that [18F]-sodium fluoride PET imaging represents a promising new noninvasive approach to identify a microcalcified disease phenotype in thoracic aortopathy among patients with a bicuspid aortic valve.

Timely diagnosis of non-ST-elevation myocardial infarction (NSTEMI) remains challenging, as current protocols rely on serial high-sensitivity cardiac troponin (hs-cTn) tests that may delay decisions and overcrowd emergency departments. We retrospectively analyzed 54,636 patients receiving hs-cTn testing at emergency departments across Taiwan (May 2016-Dec 2021). Excluding STEMI and incomplete cases, we developed a machine learning (ML) model using demographics and 23 routine lab tests from the initial blood draw to enable early NSTEMI risk stratification. An actionable clinical decision supporting algorithm was also created based on ML-derived risk scores. A total of 15,096 eligible patients (mean age 69.94 ± 15.66 years; 42.2% female) were included in model training and evaluation. The ML model outperformed hs-cTn alone in both internal and external validation sets in terms of area under the receiver-operating characteristic curve. Beyond model development, a clinically actionable decision algorithm using risk score was established. Thresholds (<1.8 and ≥38.5) to define low- and high-risk groups, the model achieved a negative predictive value (NPV) of 98.8% (98.5-99.1%) for rule-out and a positive predictive value (PPV) of 78.1% (73.2-82.4%) for rule-in, encompassing 48.3% and 2.6% of patients, respectively. When combined with the established 0 h/1 h algorithm, the ML model further enhanced early decision-making, safely ruling in/out 85.3% of patients within 1 hour, with PPV and NPV reaching 84.9% (79.5-87.7%) and 100% (99.6-100%), respectively. In conclusion, this ML-based approach offers not only accurate prediction but also an actionable guide to support rapid, safe NSTEMI triage in emergency care.