Journal of Cardiovascular Echography最新文献

Apical hypertrophic cardiomyopathy (ApHCM) is a less common variant of hypertrophic cardiomyopathy, characterized by predominant thickening of the left ventricular apex. We describe a 64-year-old man presenting with dyspnea and T-wave inversions in the lateral precordial leads. Although initial echocardiography was reported as normal, further imaging revealed an "ace of spades" configuration on ventriculography and an anechoic apical area on off-axis views. Contrast echocardiography confirmed apical wall thickening with systolic obliteration. Cardiac magnetic resonance imaging showed patchy late gadolinium enhancement, and Holter monitoring excluded sustained arrhythmias. This case highlights the role of multimodality imaging in ApHCM.

Complex cardiac damage caused by ankylosing spondylitis (AS) is relatively rare in clinical practice. Although the first clear association between AS and aortic regurgitation (AR) was established in 1958, and subsequent case reports have been published, previous studies have not proposed effective, minimally invasive surgical treatment options. This report describes a patient with AS, AR, and mitral regurgitation who experienced frequent premature ventricular contractions, posing an extremely high risk of sudden death. We used a combination of multimodal imaging techniques to perform transcatheter aortic valve replacement on the patient. The patient recovered well after the procedure, with improved cardiac function. This case serves as a reference for treating patients with similar conditions.

Left atrial appendage closure (LAAC) has emerged as a crucial alternative for stroke prevention in patients with atrial fibrillation ineligible for long-term anticoagulation. While echocardiography, particularly transesophageal echocardiography (TEE), remains fundamental for procedural planning and guidance, the integration of multimodal imaging is increasingly shaping contemporary practice. This review explores the evolving landscape of imaging for LAAC, highlighting their complementary roles, technological advancements, and future directions in optimizing procedural outcomes. TEE is the standard imaging modality for LAAC, providing comprehensive anatomical and functional assessment across all procedural phases. However, advanced cardiac imaging techniques, including cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR), are gaining prominence. CCT offers detailed anatomical characterization of the left atrial appendage (LAA) and surrounding structures, aiding in device sizing and excluding thrombus. CMR provides superior tissue characterization and can be an alternative when TEE is not feasible. Intracardiac echocardiography may be a valid alternative to TEE ti guide device deployment and assessment. This review critically evaluates the strengths and limitations of each imaging modality in the LAAC procedure, from pre-procedural planning and patient selection to intraprocedural guidance and post-procedural assessment for complications like device leaks and device-related thrombosis. The evolving role of three-dimensional imaging and potential future applications, such as artificial intelligence-assisted image analysis, are also considered. Understanding the complementary roles of these imaging modalities is crucial for optimizing patient care in the modern era of LAAC. LAAC has emerged as a crucial alternative for stroke prevention in patients with atrial fibrillation who are ineligible for long-term anticoagulation. While echocardiography remains the cornerstone of procedural planning and guidance, the expanding role of multimodal imaging is reshaping current practice. Advanced cardiac imaging techniques, including CCT and CMR, are increasingly integrated into patient selection, device sizing, and post-procedural assessment, enhancing safety and efficacy. This review explores the evolving landscape of imaging modalities in LAAC, highlighting their complementary roles, recent technological advances, and future directions in optimizing procedural outcomes.

Background: Left ventricular (LV) dysfunction is a critical global health concern, usually assessed using parameters such as global longitudinal strain (GLS) and LV ejection fraction (LVEF) by Simpson's method. However, these methods can be resource-intensive and reliant on high-quality imaging. Mitral annular plane systolic excursion (MAPSE) offers a simpler, more accessible bedside alternative for evaluating LV function.

Objective: This study explored how MAPSE correlates with key echocardiographic parameters, such as GLS and LVEF, to establish its role as a practical and reliable tool for assessing LV systolic longitudinal function.

Methods: We conducted a single-center cross-sectional study with 80 patients diagnosed with LV dysfunction (LVEF <50%). Echocardiographic assessments measured were MAPSE, GLS, and LVEF. Statistical analyses examined the relationships between these parameters.

Results: MAPSE showed a strong correlation with GLS (r = 0.535, P < 0.0001) and a moderate correlation with LVEF (r = 0.324, P < 0.0001). Patients with more severe LV dysfunction (ejection fraction [EF] <40%) had lower mean MAPSE values (11.1 ± 0.4 mm) than those with milder dysfunction (EF >40%, MAPSE 12.4 ± 0.4 mm). MAPSE also correlated inversely with LV filling pressures (E/e' >14, P < 0.0001) and LV end-systolic dimensions (r = -0.254, P = 0.022). Interestingly, its positive association with tricuspid annular plane systolic excursion (P = 0.0046) highlighted its role in possibly reflecting biventricular function and ventricular interdependence.

Conclusion: MAPSE is a simple yet powerful tool for assessing LV function, offering strong correlations with GLS and insights into systolic and diastolic performance. Even with suboptimal imaging, its ease of use makes it an invaluable option for cardiac evaluation, particularly in time-sensitive or resource-constrained clinical settings.

Transcatheter mitral valve repair using the mitral transcatheter edge-to-edge repair (M-TEER) technique is a well-established therapeutic option for patients with severe mitral regurgitation. However, postprocedural complications can pose diagnostic and therapeutic challenges. We report the case of an 80-year-old woman with multiple comorbidities, including essential thrombocythemia, and a newly diagnosed bladder neoplasm, who recently underwent M-TEER. During routine follow-up, a mass was detected on the atrial surface of the mitral clip. The initial suspicion was thrombus. Transesophageal echocardiography confirmed a mass on the mitral clip. 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed focal uptake at the mitral valve level. Based on the modified Duke criteria and European Society of Cardiology 2023 guidelines, the diagnosis was considered "possible infective endocarditis." However, the concurrent neoplastic condition and lack of typical pathogens raised the alternative hypothesis of nonbacterial thrombotic endocarditis (NBTE). The patient was treated with intravenous anticoagulation and antibiotics. Serial imaging demonstrated a reduction in the size of the mass, but surgical intervention was precluded due to frailty. A definitive diagnosis could not be established.

Background: Acute pulmonary embolism (APE) is a cardiovascular emergency with considerable morbidity and mortality. Echocardiography has been an essential tool for risk stratification in high-risk patients. However, its prognostic utility in low-to-intermediate risk cases remains underexplored. Electrocardiographic (ECG) findings may provide additional prognostic information but are infrequently assessed alongside echocardiography.

Objective: To assess the prognostic value of baseline echocardiographic parameters in low-to-intermediate risk APE and to examine ECG findings as complementary tools in risk stratification.

Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Literature searches were performed in Medline, Scopus, Google Scholar, and Semantics up to December 2024. Studies enrolling adult patients with confirmed APE categorized as low-to-intermediate risk classification were included. Primary outcomes were in-hospital mortality or clinical deterioration. Pooled estimates were analysed using fixed-or random-effects models, or analysis of P values.

Results: Thirteen studies (n = 3073) were included. Echocardiographic parameters significantly associated with adverse outcomes included reduced tricuspid annular plane systolic excursion, RV fractional area change, and elevated pulmonary artery systolic pressure and tricuspid regurgitation velocity. ECG findings of T wave inversion and ischemic ST changes are strongly correlated with RV dysfunction and increased pulmonary pressures, supporting their adjunctive prognostic value.

Conclusion: In low-to-intermediate risk APE, echocardiographic indicators of RV dysfunction and pulmonary pressure are predictive of adverse outcomes. ECG findings were correlated with echocardiographic abnormalities and may enhance risk stratification, especially in resource-limited settings.

Background: Chronic coronary syndrome (CCS) constitutes 20%-30% of cardiac causes of chest pain. Deformation/Strain imaging is a sensitive marker of coronary artery disease (CAD) which detects subtle forms of ischemia in the form of strain. We aim to correlate global longitudinal and segmental strain with angiographic profile by using two-dimensional speckle tracking echocardiography (2D-STE).

Materials and methods: A prospective observational study was carried out on 150 subjects satisfying the inclusion criteria. Routine blood investigations, electrocardiogram, 2D echocardiography, and 2D-STE were performed. All subjects underwent coronary angiogram (CAG), and the severity of CAD was assessed by modified Gensini score (mGS). Global longitudinal strain (GLS) and segmental strain were correlated with mGS.

Results: Mean age was 55.28 ± 8.94 years. Males constituted 67.3% of the study population. The most common symptom was angina (54%), and the most common risk factor was type 2 diabetes mellitus (37%). Mean left ventricular ejection fraction (LVEF) was 58.6%. The mean GLS in the Significant CAD group was -13.8% and in the Insignificant CAD group was -17.7% (P < 0.01). The Pearson correlation analysis between GLS and segmental strain had a strong negative correlation (P < 0.01). GLS cutoff for significant single vessel disease was -18.8 (sensitivity 98%, specificity 86%, area under the curve 0.93; P = 0.03).

Conclusion: This study emphasizes the role of a simple, noninvasive transthoracic echocardiographic marker in predicting subclinical ischemia in CCS who have apparently normal LVEF. GLS correlates with the angiographic severity in CCS. The myocardial segmental strain correlates with angiographic territorial involvement. It is an independent predictor of significant CAD with good sensitivity and specificity.