Journal of Cardiovascular Echography最新文献

Artificial intelligence (AI) is transforming cardiovascular imaging (CVI), enhancing accuracy, efficiency, and diagnostic capability across echocardiography (Echo), cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR). In Echo, AI improves image acquisition, segmentation, quantification of chamber function, and detection of wall motion abnormalities, supporting diagnosis and prognosis in various diseases. Automated two-dimensional and three-dimensional (3D) analysis allows rapid, reproducible assessments of ventricular volumes and EF. In valvular heart disease, AI assists in measurement, procedural planning, and integration with 3D printing. CCT benefits from AI at every workflow stage, from image acquisition to disease assessment. AI optimizes scanning protocols, reduces radiation exposure, and enhances coronary artery calcium scoring, plaque analysis, and ischemia evaluation. Algorithms enable rapid segmentation and functional assessment, while ongoing studies support its utility in risk prediction and plaque characterization. In CMR, AI accelerates acquisition, reduces artifacts, and automates segmentation and tissue characterization. Deep learning (DL) models accurately detect fibrosis, scar, and functional parameters, positively influencing prognosis prediction in every cardiac disease. AI-driven tools also streamline report generation, enhance Telemedicine workflow, and guide less experienced users in image acquisition. Despite these advances, challenges remain. Robust and diverse datasets, explainable AI models, regulatory approvals, and ethical considerations are critical for safe and widespread adoption. AI's "black box" nature hinders clinician trust, making interpretability essential. As these barriers are addressed, AI is expected to become an essential tool in every aspect of CVI, enabling personalized medicine, improving patient care, and optimizing clinical workflows in the coming decades.

Background: Metabolic syndrome (MS) prevalence remains linked to elevated risk for cardiovascular morbidity and mortality, making it a critical public health issue. Two-dimensional speckle-tracking echocardiography (2D-STE) facilitates early detection of subclinical left ventricular (LV) dysfunction, enabling preventing or postponing cardiovascular disease development.

Objective: The objective of this study was to assess LV systolic function among MS cases by 2D-STE.

Patients and methods: Our case-control study included 80 cases of both genders, aged between 30 and 56 years, divided into two groups: patient group (n = 50): cases Developing MS characteristics and control group (n = 30): healthy volunteers. All subjects underwent conventional echocardiographic examination and assessment of LV systolic function utilizing 2D-STE.

Results: LV systolic function, assessed by global longitudinal strain (GLS), showed significant impairment in MS cases compared to normal subjects (-12.9 to -20.8 vs. -17 to 23.3, P < .001), with a higher proportion of females exhibiting impaired GLS than males (31 cases, 70.4% vs. 8 cases, 18.8%) and a dose-dependent correlation between an increased number of MS components and LV systolic dysfunction. Furthermore, the prevalence of LV diastolic dysfunction showed an increase within the MS group as opposed to control subjects. There was a clear strong negative correlation between global strain and waist circumference and triglyceride level (P < 0.05).

Conclusions: There is a correlation between MS and impaired LV systolic and diastolic function among middle-aged adults who do not exhibit any prevalent heart conditions that could be detected by speckle-tracking echocardiography.

1. LVADs have emerged as destination therapy for advanced heart failure, however, these are still limited by many potential complications after implant, such as right heart failure, aortic regurgitation, thrombosis, infections 2. A seriate and accurate echocardiographic evaluation is needed in LVAD carriers but may sometimes be challenging, due to artifacts or poor acoustic windows due to the device 3. Left ventricular unloading is the main feature to consider to evaluate and adjust device function and requires many echocardiographic parameters to be assessed 4. Ramp test during echocardiography may be of additional value to optimize device speed and to early identify pump dysfunction.

Patent foramen ovale (PFO) is a congenital cardiac defect present in approximately 30% of the general population. While often asymptomatic, it is associated with cryptogenic stroke and paradoxical embolism. Percutaneous closure using atrial septal defect occluder is an effective preventive strategy, but these devices carry a risk of rare complications, including infective endocarditis. Device-associated infective endocarditis is often linked to transient bacteremia following invasive procedures, highlighting the importance of antibiotic prophylaxis. However, the clinical presentation can be variable, requiring a high index of suspicion and advanced imaging for the diagnosis. We describe the case of a 55-year-old woman with hypertension, obesity, and a history of PFO closure with an Amplatzer occluder, who developed infective endocarditis weeks after a dental procedure. She presented with fever, vomiting, and confusion, initially misdiagnosed with encephalitis. Transesophageal echocardiography revealed large filamentous vegetation on the Amplatzer occluder, causing functional mitral regurgitation. Blood cultures identified Staphylococcus aureus and Streptococcus pneumoniae, confirming a mixed bacterial infection. The patient underwent surgical removal of the infected device and mitral valve repair. Postoperatively, she improved significantly and was discharged with a complete course of antibiotics. This case underscores the need for vigilance in patients with intracardiac devices, particularly following bacteremia-inducing procedures. Early diagnosis using echocardiography and prompt surgical intervention are essential to managing device-related infective endocarditis. While antibiotic prophylaxis may reduce the risk of bacteremia-related infections, the lack of high-quality evidence necessitates further research to guide preventive strategies. Multidisciplinary care and strict adherence to diagnostic and therapeutic protocols remain pivotal to improving patient outcomes.

Background: The major cause of re-intervention in Fallot patients (tetralogy of Fallot [TOF]) is pulmonary regurgitation. Current cutoffs for pulmonary valve replacement (PVR) are all cardiac magnetic resonance (CMR) derived, based on the regurgitant fraction (RF) and/or right ventricular end-diastolic volume index. In this study, we aimed at determining if three-dimensional (3D)-derived right ventricular indices, notably RV global longitudinal strain (GLS), can act as a predictor for RF and hence facilitate the decision-making and timely referral of such patients.

Methodology: For this purpose, 3D volumetry and speckle tracking echocardiography has been performed on Fallot patients, with recent CMR in the past 6 months, 42 controls were included to benchmark echocardiographic results. Echocardiography-derived left ventricle (LV) and right ventricle (RV) volumes as well as longitudinal strain were calculated and tested for diagnostic accuracy to predict RF.

Results: Bland-Altmann analyses showed a good correlation between volumes obtained by CMR and those obtained by echocardiography, differences in volumes between CMR and echocardiography derived volumes were less evident in the LV compared to the RV, RV GLS <11% was sensitive and specific in predicting severe pulmonary regurge.

Conclusion: The study of strains, particularly RV strains in repaired TOF patients, is not new to the literature. However, to our knowledge, previous studies did not attempt to determine a cutoff of RV GLS in predicting severe PR and subsequent need for PVR, the findings of this study are limited by a small sample size, but they open new horizons in the diagnostics of repaired TOF patients.

Background: Obesity impairs vascular compliance and myocardial functions; however, the intricate pathogenesis of this dysfunction is still elusive. There is conflicting evidence on serum nitric oxide (NOx) regulation in obesity, and some reports state that its bioavailability is reduced, while some others claim that it is upregulated. This study aimed to measure NOx status in obesity, to correlate it to vascular function, and to determine if myocardial function is tied to vascular dysfunction or not.

Patients and methods: For this purpose, 20 obese patients underwent serum NOx testing, serum testing of postprandial C-peptide to glucose ratio (PCPRI), vascular function testing using conventional flow-mediated dilation (FMD) of brachial artery, and the advanced aortic strain rate (ASR), in addition to myocardial functions using speckle tracking echocardiography. The latter in addition to serum NO was benchmarked against 16 healthy controls.

Results: Serum NOx was significantly higher in cases compared to controls (obesity group: 106 ± 14 vs. control group: 62 ± 9). The higher the insulin resistance (evidenced by high PCPRI), the higher was the NO level, denoting possibly a state of insulin-induced NO resistance. This NOx resistance was correlated with measures of vascular function, with ASR being more intimately related to serum NOx (r = 0.86 compared to an r = 0.66 with FMD). Lower ASR was tied to lower myocardial functions as expressed by global longitudinal strain, notably the subendocardial layer (r = 0.56 and r = 0.77, respectively).

Conclusion: Vascular dysfunction seen in obesity is probably orchestrated by a state of resistance to nitric oxide, induced by hyperinsulinemia. This vascular dysfunction seems to play a major role in reducing myocardial functions, especially the subendocardial component, which is known to be affected by impaired blood supply.

We present a case of a 48-year-old man with an atypical type 2 myocardial infarction (MI)/myocardial infarction with nonobstructive coronary arteries, caused by a coronary embolism originating from the inferior vena cava and passing through a patent foramen ovale (PFO). The patient presented to the emergency department with oppressive retrosternal chest pain. His medical history included papillary renal cell carcinoma and seminoma with recent abdominal lymph node recurrence. The electrocardiogram indicated an inferolateral ST-segment elevation (STE), prompting emergency coronary angiography, that revealed distal occlusion of the circumflex artery and the obtuse marginal branch, suggesting an embolic etiology. Stent placement was deferred, and the management approach involved thromboaspiration and unfractionated heparin infusion. Abdominal imaging identified a thrombotic formation in the inferior vena cava and a transesophageal echocardiogram revealed a PFO with a right-to-left shunt, supporting the diagnosis of a paradoxical embolism. Follow-up coronary angiography showed vessel patency, and the patient was then treated with low-molecular-weight heparin. This case underscores the importance of considering alternative etiologies for STE myocardial infarction beyond acute plaque rupture, highlighting the need for individualized management strategies, particularly in patients with complex medical histories, and given the lack of standardized treatment guidelines for coronary embolism.

Spontaneous coronary artery dissection (SCAD) is an acute coronary syndrome. SCAD can be iatrogenic or can rely on a variety of conditions. Here, we present a rare case of ST-elevation myocardial infarction due to the left main coronary artery dissection in the context of a drug withdrawal crisis in a 47-year-old male.