Journal of Cardiovascular Echography最新文献

Mitral regurgitation (MR) is the second most prevalent valvular heart disease, classified as primary (degenerative) or secondary (functional) based on its underlying etiology. Accurate assessment of MR severity, mechanism, and prognosis is crucial for guiding therapeutic decision-making, including surgical and transcatheter interventions. Cardiac imaging plays a pivotal role in this evaluation, wherein transthoracic and transesophageal echocardiography is considered the first-line modality. Advancements in three-dimensional echocardiography and cardiac magnetic resonance imaging allowed to refine the quantification and characterization of MR, enhancing diagnostic accuracy and risk stratification. This review aims to provide an overview of multimodal cardiac imaging and the most relevant parameters to assess MR, highlighting key milestones, novel techniques, and their implications in clinical practice.

Background: One of the most common complications associated with dobutamine stress echocardiography (DSE) is abnormal blood pressure (BP) responses.

Aims and objectives: The current investigation aimed to examine the blood pressure responses during DSE and its potential implications on cardiovascular outcomes.

Methods: The study enrolled patients who lacked a history of hypertension and diabetes but demonstrated hypertensive response during DSE (n = 62). An equal number of patients who did not exhibit an increase in BP during the DSE were selected as the control group (n = 55). Throughout the 4-year clinical follow-up, we monitored the incidence of hypertension, myocardial infarction (MI), hospitalization due to heart disease, death, and stroke.

Results: Among those who demonstrated a hypertensive response during DSE, baseline systolic BP (P = 0.002) and diastolic BP (P = 0.002) were notably higher compared to the nonhypertensive group. In addition, the hypertensive group received a significantly elevated dosage of dobutamine in comparison to the controls (P = 0.010). However, no statistically significant variances were observed between the two groups concerning death (P = 0.600), acute MI (P > 0.999), chronic hypertension (P = 0.063), diabetes mellitus (P = 0.513), and hospitalization (P = 0.472).

Conclusion: In light of our findings, hypertensive responses in patients undergoing DSE do not correlate with subsequent adverse outcomes. While our investigation did not identify a statistically significant difference in hypertension rates, it is essential to note that significance may be achieved with future research involving a larger sample size.

Clear renal cell carcinoma (RCC) represents the most prevalent type of kidney cancer, with a tendency for venous migration and extension into the inferior vena cava (IVC) in 4%-10% of the cases. Herein, we present a case report of a patient with acute coronary syndrome and an incidental echocardiographic finding of a thrombus in the IVC, which contributed to the diagnosis of the RCC. A 67-year-old male patient was transferred to our clinic with high troponin levels and electrocardiogram changes suggestive of myocardial ischemia. Coronary angiography revealed occlusion of the right coronary artery and left anterior descending with normal flow through the graft. During the two-dimensional transthoracic echocardiographic examination, in the subcostal view, a thrombotic formation in the IVC was observed. A computed tomography of the abdomen showed an oval mass on the upper pole of the left kidney. The patient underwent an open radical nephrectomy. Pathological examination confirmed the diagnosis of clear RCC. The patient consulted the oncology department, where no specific oncological therapy was indicated. After a 2-year follow-up, ultrasound of the abdomen was normal, without relapse or metastatic dissemination of the RCC. Detailed echocardiographic assessment can reveal pathological changes even in the surrounding structures, which helps in the timely diagnosis and initiation of treatment in the early stages of the disease.

Context: Although computed tomography pulmonary angiography (CTPA) can confirm a diagnosis of acute pulmonary thromboembolism (PTE), its use may not be feasible in hemodynamically unstable patients. Transthoracic echocardiography (TTE) is useful to diagnose such cases but lacks specific, easily identifiable signs for differentiating acute PTE from other causes of right heart strain.

Aims: We investigated the effectiveness of the "SRC" sign, a nondilated main pulmonary artery with a dilated right atrium (RA) and right ventricle (RV), for diagnosing acute PTE.

Settings and design: This was an observational, retrospective, single-center study.

Subjects and methods: Patients with acute dyspnea and dilated RA and RV, with or without dilated pulmonary artery (PA), and those suspected of PTE according to the Wells criteria were included. Blood tests, electrocardiography, and CTPA were performed to confirm PTE diagnosis. Patients were divided into a nondilated PA and dilated RA and RV group and a dilated PA, RA, and RV group.

Statistical analysis used: Chi-square test with Yates's correction was used for statistical analysis.

Results: Forty-one patients (27 men) with suspected PTE were included, with 36 showing a dilated RA and RV on echocardiography. The SRC sign was present in 22 patients, all of whom were confirmed via CTPA to have acute PTE. The SRC sign demonstrated 100% specificity, 100% positive predictive value, and 92.86% negative predictive value.

Conclusions: TTE is valuable for assessing patients with acute dyspnea. Although RA and RV dilatation may indicate acute PTE, they are insufficient for diagnosis confirmation. The SRC sign shows high specificity for major acute PTE and may aid in decision-making.

Tuberous sclerosis complex has an autosomal dominant pattern of inheritance. Hamartomas are seen in various organs in tuberous sclerosis. Tuberous sclerosis is linked to cardiac rhabdomyomas, which is one of the common heart tumors in children. We present a full-term neonate who was suspected to have the congenital disease due to the presence of pansystolic murmur on examination. Echocardiography revealed multiple rhabdomyomas in the right ventricular (RV) and LV wall and interventricular septum of varying sizes and shapes. The largest rhabdomyoma arising from the lateral wall of RV measuring 16 mm × 18 mm. There was 6 mm × 8 mm rhabdomyoma protruding in the left ventricular outflow tract in nonobstructive manner. There was no inflow or outflow obstruction. Small apical muscular ventricular septal defect noted. Mother had numerous papulonodular lesions on both cheeks, nose, and forehead (adenoma sebaceum). No other neurocutaneous markers were present. Mother had no systemic involvement. In babies born to mothers with suspected tuberous sclerosis, a high degree of suspicion is required to rule out cardiac tumors.

Background: Coronary artery disease (CAD) is a major contributor to global morbidity and mortality. Aortic elasticity indices (AEI) have emerged as potential indicators for evaluating risk in CAD. This research aimed to explore the association between AEI and the severity of CAD, as measured by the modified Gensini score (mGS).

Materials and methods: A total of 225 individuals were screened, out of which 100 eligible individuals undergoing elective coronary angiography for suspected CAD were enrolled. These participants were divided into two groups: Group I, with normal or insignificant angiographic findings (31%) and Group II, with significant CAD (69%), for whom the mGS was calculated. Echocardiographically derived AEI were obtained for all participants.

Results: The mean age was 55.26 ± 8.94 years, predominantly males (63%). Unstable angina was the most prevalent presentation (70%), and dyslipidemia was identified as the most predominant (89%) risk factor. The analysis revealed that patients with significant CAD exhibited lower aortic distensibility (AD) (<4.85 cm²/dyn/10³) and aortic strain (<9.6%) than those without significant CAD with P = 0.03 and P = 0.04, respectively. Furthermore, AD was identified as the strongest predictor of the severity and complexity of CAD, particularly in cases with intermediate-high mGS tertiles.

Conclusion: This study underscores AD as the most reliable AEI for assessing CAD severity. Integrating these indices into routine clinical practice could significantly enhance risk stratification, guide treatment decisions, and ultimately improve outcomes for CAD patients.

Echocardiography is vital in diagnosing and managing congenital heart disease (CHD), particularly in the pediatric population, necessitating detailed structural and functional assessments. Artificial intelligence (AI) has revolutionized echocardiographic analysis, particularly in functional assessments and the detection of valvular lesions. While convolutional neural networks (CNNs) dominate image-based tasks, emerging vision language models (VLMs) are transforming report generation by integrating multimodal data. This review explores the current state of AI in echocardiography, emphasizing the potential of VLMs to provide comprehensive reports and image-specific diagnoses. Despite significant advancements, several challenges hinder the development of holistic AI software for diagnosing complex CHD (CXCHD). These challenges include the heterogeneity of CHD, limited access to high-quality labeled datasets, variability in imaging techniques, and the need for expertise in image annotation. This review highlights the necessity for robust algorithms, standardized protocols, and diverse training datasets to fully realize the potential of AI in CXCHD diagnosis.