Journal of Cardiovascular Echography最新文献

Background: Peripheral arterial disease shares common pathophysiological mechanisms with coronary artery disease (CAD), including inflammation and atherosclerosis. Carbohydrate antigen 125 (CA-125), previously known as a tumor marker, has been suggested to be elevated in patients with heart failure and CAD.

Aim: The aim of this study was to assess the correlation of serum tumor marker carbohydrate antigen 125 with ankle-brachial index (ABI) in patients with CAD.

Materials and methods: A prospective study was conducted on 60 CAD patients. Based on ABI, they were grouped into low ABI (≤0.9) and normal ABI (1-1.4). Serum CA-125 and high-sensitivity C-reactive protein (hs-CRP) were measured, and transthoracic echocardiographic parameters were evaluated.

Results: CA-125 was significantly higher in patients with low ABI compared to those with normal ABI (13.17 ± 4.48 vs. 10.03 ± 3.18 U/ml, P = 0.003). CA-125 was negatively correlated with ABI (r = -0.887, P < 0.001) and positively with hs-CRP (r = 0.696, P < 0.001).

Conclusion: Serum CA-125 is a readily available biomarker that may have utility as a supplementary indicator of atherosclerotic burden and vascular risk in patients with CAD.

Atrial fibrillation can arise from a range of underlying mechanisms, including electrical triggers, structural remodeling, metabolic influences, and inflammatory substrates, each of which requires a tailored therapeutic strategy. Understanding the specific atrial substrate responsible for the arrhythmia is therefore essential to guide appropriate management. In this context, echocardiography serves not only as a diagnostic tool but also as a key decision-making instrument, enabling clinicians to noninvasively evaluate the structural, mechanical, and electrical properties of the left atrium. Parameters such as left atrial strain, conduction time (PA-tissue Doppler imaging), and left atrial volume index provide valuable insights into the extent of atrial remodeling and fibrosis, which directly influence therapeutic choices and expected outcomes. While the diagnostic role of echocardiography in atrial fibrillation is well recognized, its integration into therapeutic decision-making, particularly in guiding rhythm control strategies, remains underutilized. This case series aims to address that gap by illustrating how echocardiographic findings can inform the selection, timing, and modality of interventional versus conservative treatment. We present three patients with distinct clinical backgrounds: one with structurally normal atria, one with atrial remodeling due to epicardial adipose tissue infiltration, and one elderly patient with moderate substrate alteration, where comorbidities and minimal symptom burden led to a conservative management decision. Each case highlights how advanced echocardiographic assessment can support individualized treatment planning, from catheter ablation to optimal medical therapy, in alignment with precision medicine principles.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a working diagnosis encompassing a wide spectrum of ischemic and non-ischemic conditions. We report the case of a 57-year-old male admitted for exertional chest pain and elevated troponin levels, initially managed as suspected MINOCA. Coronary angiography excluded obstructive coronary artery disease, while subsequent multimodality imaging unexpectedly revealed Scimitar syndrome, a rare congenital heart disease. This case underscores the diagnostic complexity of MINOCA and the crucial role of advanced imaging in uncovering alternative, non-ischemic etiologies.

We report a unique case of left-sided scimitar syndrome associated with horseshoe lung (HL) in a newborn with a prenatal diagnosis, confirmed at birth, of complex congenital heart disease (CHD). The cardiac anomalies included right atrial isomerism, persistent left superior vena cava, unbalanced complete atrioventricular (AV) atrial septal defect with atresia of the left component of the AV valve and a hypoplastic left ventricle, double outlet right ventricle, malposition of the great arteries, and anomalous origin of left pulmonary artery (AOLPA) from the perihilar portion of the right pulmonary artery. The combination of echocardiography, cardiac computed tomography, three-dimensional virtual reconstruction, and diagnostic heart catheterization provided complementary insights, each contributing critically to the final diagnosis. This case represents the first reported association of HL with left-sided scimitar syndrome and pseudo-pulmonary sling in a neonate with complex CHD, emphasizing the role of multimodality imaging for accurate diagnosis and clinical decision-making.

Purpose: This study aims to retrospectively utilize the echocardiographic analysis to assess the changes in the left ventricle (LV) and right ventricle (RV) size and function after 1 year of repair, in patients who underwent successful mitral transcatheter edge-to-edge repair (M-TEER), stratified by their baseline RV function.

Methods: A total of 112 patients were enrolled. Sixteen patients (14.2%) died during the 1^st year postprocedure, so that they were excluded from the study due to the nonavailability of follow-up echocardiography. Ninety-six patients were included in a single-center, observational study with 67 (69.7%) males and a mean age of 61 ± 14 years. All patients who were selected (n = 96) had completed a 1-year follow-up after M-TEER therapy. Patients were stratified into two groups: right ventricular dysfunction (RVdysf) group (Tricsupid annular plane systolic excursion [TAPSE] <17 mm, [n = 59]) and No-RVdysf group (TAPSE < 17 mm, [n = 37]).

Results: Procedural success was reported in 94.8% and at baseline RV-dysf group showed greater LV end-systolic dimension (left ventricular end-systolic diameter 53 mm vs. 48 mm, P = 0.022), LV end-systolic volume (LVESV 142 ml vs. 89 ml, P = 0.028), and significantly lower LV ejection fraction (LVEF 29.7% vs. 35.8%, P = 0.038). In the RVDysf group, RV dimensions did not change significantly at follow-up but TAPSE showed improvement in RV function after mitral TEER therapy (TAPSE at baseline 14 vs. follow-up 16 mm, P = 0.010). The right ventricular systolic pressure (RVSP) also decreased significantly in the RVdysf group (RVSP 55 vs. 42.5 mmHg, P = 0.000). The left atrial volume decreased significantly (54 ml/m² vs. 47 ml/m², P = 0.002), but no significant change was seen in the right atrial volume in this group of patients. When comparing the median differences of both groups at baseline and follow-up, some parameters show slight numerical differences between the groups, the P values generally indicate a lack of statistically significant differences.

Conclusions: Patients with preexistent RV dysfunction showed greater biventricular enlargement and impaired systolic function compared to those with normal RV function. At 1-year follow-up, the M-TEER therapy resulted in positive left ventricular remodeling and improvement in right ventricular systolic function in patients with baseline RV dysfunction, but the magnitude of these improvements was not statistically different from those observed in patients with normal RV function.

Mitral regurgitation (MR) is a valvular heart disease with high morbidity and mortality. Transcatheter edge-to-edge repair (TEER) presents a viable treatment option for severe MR in high-risk surgical patients. This review aims to assess the prognostic significance of speckle-tracking echocardiography (STE) in predicting outcomes after TEER and its potential role in patient management. A systematic literature review was done on PubMed for studies until November 2024. The search incorporated keywords of STE and TEER, including original research on STE's predictive value in TEER patients. Studies concerning surgical mitral valve repair or unrelated imaging techniques were excluded. Twenty-nine articles were included, indicating that STE metrics, especially global longitudinal strain (GLS), correlate with clinical outcomes like heart failure progression and mortality. Baseline GLS was determined as predictive of hospitalization and mortality, while post-TEER GLS improvements were associated with better functional capacity. Furthermore, left atrial function metrics were significant in predicting arrhythmia recurrence. This study highlights the utility of STE in predicting outcomes for TEER patients. While findings are encouraging, additional research is essential to elucidate the long-term effects of TEER on cardiac function, thereby enhancing patient selection and management approaches. This review highlights the relevance of STE in prognosticating outcomes for patients undergoing TEER. Further investigations are essential to clarify the long-term repercussions of TEER on cardiac functionality, thereby refining patient selection and management strategies.

We report the case of a complex congenital heart disease that accounts for unusual clinical presentation: subtle cyanosis and absence of murmur in a pediatric patient with double-outlet right ventricle, subaortic ventricular septal defect and severe pulmonary stenosis. Echocardiography revealed a large aorto-pulmonary window supplying the pulmonary arteries at systemic pressure.

Ostium secundum atrial septal defect (ASD) is the most common form of interatrial shunt, and its management depends on defect size, shunt direction, and adequacy of surrounding rims. Device closure is not feasible when inferior vena cava (IVC) or posterior rims are deficient, and such cases require surgical repair. We describe a 19-year-old female with a 28 mm ostium secundum ASD, deficient IVC and posterior rims, and right heart chamber dilation who was scheduled for minimally invasive surgical closure. Intraoperative transesophageal echocardiography (TEE) revealed a linear band within the left atrium adjacent to the deficient septum. Surgical inspection confirmed an interatrial band traversing the defect from the coronary sinus to the superior vena cava. Partial excision of the band was carried out along with ASD repair. The postoperative recovery was uneventful, with no arrhythmias or conduction disturbances, and the patient was discharged in stable condition. This case underscores the value of intraoperative TEE in delineating both expected anatomy and rare anomalies such as interatrial septal bands, which may influence surgical planning and outcomes.

The interventional echocardiographer (IE) plays a crucial role in structural heart interventions, yet faces significant risks from ionizing radiation, often greater than those encountered by the primary interventional cardiologist (IC). This elevated exposure is due to the IE's close proximity to the patient's head and, consequently, to the X-ray source, combined with a general lack of dedicated protective equipment designed for their position. Despite growing awareness of radiation safety in the catheterization lab, the specific protection needs of IEs remain under-recognized. Recent studies have shown that IEs can receive up to 11 times more radiation than ICs during procedures guided by transesophageal echocardiography (TEE), such as transcatheter edge-to-edge repair or left atrial appendage closure. These findings, together with the recent reduction in recommended dose thresholds for deterministic effects like cataract formation, emphasize the urgent need to implement effective protective measures. Radiation exposure can be significantly reduced by following the core principles of radiation safety: time, distance, and shielding. Key strategies include optimizing the IE's position based on expected fluoroscopic projections, using dedicated mobile or ceiling-mounted shields, adopting lightweight personal protective equipment, and encouraging the use of low-dose imaging protocols. Ongoing education and training, targeted not only at IEs but also at ICs, is essential to reinforce safe practices and promote a culture of radiation awareness. Technological innovations offer promising solutions. New shielding systems like the Eggnest® and Rampart^® have demonstrated effective protection for staff near the patient's head. Disposable radiation-reducing drapes and the development of robotic systems for remote TEE manipulation may further enhance safety without compromising workflow or image quality. Advances in imaging hardware and software also support dose reduction without sacrificing clinical effectiveness. Finally, computational dosimetry methods may soon allow for more accurate and individualized exposure monitoring, overcoming the limitations of conventional dosimeters. In summary, improving radiation protection for IE must become a priority. A combination of strategies is necessary to ensure long-term safety and sustainability in this rapidly evolving field.

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.