Journal of Cardiovascular Echography最新文献

Objectives: Right ventricle (RV) function is a recognized independent determinant of morbidity and mortality in heart failure (HF), encompassing various etiologies such as congenital heart disease, pulmonary hypertension, and coronary artery disease. The prognostic significance of RV dysfunction in different HF subtypes - HF with preserved ejection fraction (HFpEF), mid-range EF (HFmrEF), and reduced EF (HFrEF) - continues to gain attention. This study aimed to assess RV dysfunction, quantified by global longitudinal strain (RV GLS), as an early and sensitive predictor of outcomes in HF patients categorized by EF.

Materials and methods: A prospective study of 100 HF patients categorized into HFpEF (left ventricular EF [LVEF] >50%, n = 16), HFmrEF (LVEF 40%-50%, n = 47), and HFrEF (LVEF < 40%, n = 37). Echocardiographic assessments, including RV GLS, were performed using a standardized protocol on the Philips EPIC 7C system. RV GLS was analyzed as a sensitive marker for poor outcomes, defined by major adverse cardiac events (MACE) and worsening functional status.

Results: RV GLS demonstrated significant variation among the groups. Patients in Group C (HFrEF, LVEF < 40%) exhibited markedly lower RV GLS compared to Group A (HFpEF, LVEF > 50%) (-13.5 ± 5.24 vs. -16.8 ± 4.21; P = 0.006). In addition, a significant difference was noted between Group C and Group B (HFmrEF, LVEF 40-50%) (-13.5 ± 5.24 vs. -14.6 ± 4.15; P = 0.047). The predictive value of RV GLS for poor outcomes in HF patients was supported by a sensitivity of 75% and specificity of 69.12%, with a cutoff threshold of - 14.7%.

Conclusions: RV GLS serves as a dependable marker for predicting poor outcomes in HF patients, with a defined cutoff value of -14.7%. This metric holds substantial clinical promise for effective risk stratification and timely intervention, demonstrating a sensitivity of 75% and a specificity of 69.12%.

Background: Transcatheter aortic valve replacement (TAVR) is a well-established therapeutic option for all risk patients with symptomatic severe aortic stenosis (AS). While TAVR primarily addresses AS, its benefits extend beyond the valve itself. Recent studies suggest possible restoration of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) following TAVR. This study aims to assess changes in LV GLS in patients undergoing TAVR, which may serve as a subclinical indicator of improved LV mechanics.

Materials and methods: This retrospective study included patients with severe AS who underwent TAVR at the American University of Beirut Medical Center from January 2017 to January 2023. Baseline and 1-year echocardiography parameters were compared, and GLS was calculated to assess the impact of TAVR on LV function.

Results: A total of 80 patients (mean age: 81.3 ± 7.8 years; 38.8% of women; 88.8% hypertensive) who underwent TAVR for severe AS were included in the final analysis. One-year post-TAVR, echocardiographic studies showed a significant reduction in interventricular septum diameter (13.3 ± 2.3 mm vs. 12 ± 1.8 mm, P < 0.001) and LV mass index (LVMI) (113.6 ± 26.6 g/m² vs. 96 ± 30.3 g/m², P < 0.001). LVEF showed a modest improvement (59.2 ± 12.3% vs. 62.1 ± 7.6%, P < 0.01). LV GLS significantly improved from -16.8 ± 4.6% to -19.2 ± 3.3% (P < 0.001). Baseline LVMI, LVEF, and GLS correlate with the GLS change (ΔGLS) post-TAVR.

Conclusion: GLS significantly improves 1 year after TAVR, indicating an overall improvement in LV performance. The degree of improvement in GLS correlates with baseline LVMI and systolic function.

Papillary muscle rupture (PMR) is a cardiac surgical emergency, and early treatment is associated with better short- and long-term survival outcomes. The sensitivity of the transthoracic echocardiogram for PMR is rather low (65%), and in acute, the diagnosis could be difficult given the clinical, laboratory, and radiological aspects not specific for the disease. We report a case of incomplete anterolateral PMR in a patient admitted to intensive care with bilateral pneumonia and septic shock. Transesophageal echocardiogram was fundamental for a better visualization of mitral subvalvular apparatus, allowing a correct diagnosis and a tempestive treatment.

Tricuspid regurgitation (TR) is characterized by the backward flow of blood from the right ventricle to the right atrium during systole. It can be primary, involving intrinsic valve abnormalities, or secondary, due to deformation of the valve apparatus. This case is notable for severe TR following previously unreported chest trauma, emphasizing the importance of detailed medical history in diagnosing valvular conditions. A 62-year-old patient with right atrial and ventricular dilation was diagnosed with severe TR during a routine checkup. Echocardiography showed a prolapsed posterior tricuspid leaflet and annular dilation. Later, a prior chest trauma from a car accident was identified as the likely cause. This case highlights the need for a detailed history and echocardiography to assess TR severity, especially after chest trauma, to prevent right dysfunction and worsening outcomes.

Risk stratification for sudden cardiac death (SCD) is a multiparametric process that integrates the data from family history, clinical evaluation, electrocardiographic findings, arrhythmic burden, and cardiovascular imaging. Echocardiography is the first-line imaging modality for both diagnosis and risk stratification of cardiovascular diseases associated with SCD. Advances in echocardiography and multimodality imaging have identified a number of parameters with proven prognostic value in SCD risk stratification. CMR = Cardiac magnetic resonance, CT = Computed tomography, ECG = Electrocardiogram, ECHO = Echocardiography.

Background: While pulmonary hypertension (HTN) is more common in individuals with chronic renal disease, there is a dearth of information about the development of right ventricular failure. The purpose of this study was to evaluate RV systolic function using tissue Doppler and conventional echocardiography in individuals with chronic renal impairment.

Subjects and methods: One hundred participants of both sexes who were above the age of 18 years old were included in this study. They were divided into four equal groups: Groups 1 and 2 comprise individuals with chronic renal disease at Stages 4 and 5, respectively. Group 3 is end-stage renal disease on hemodialysis (HD). Group 4 is a control group consisting of healthy, age-matched, nonrenal subjects who are normotensive, nondiabetic, and do not have any other comorbid conditions.

Results: Right ventricular basal diameter was significantly higher in groups chronic kidney disease (CKD) V and HD than control. Right ventricle tricuspid annular plane systolic excursion (RV TAPSE) and RV tissue Doppler imaging(S') were significantly lower in CKD Group V than HD and control group. Pulmonary HTN is present in 22% of renal patients with significantly higher prevalence in HD group. There was a positive correlation between the estimated glomerular filtration rate (eGFR) and RV TAPSE and between eGFR and RV (S') of CKD IV and CKD V groups. There was a negative correlation between RV TAPSE and pulmonary arterial systolic pressure by echocardiogram of the studied groups. There was a positive correlation between RV TAPSE and RV (S') of the studied groups.

Conclusions: HD patients showed better RV systolic indices than CKD Stage 5 patients. Pulmonary HTN, although present in all stages of CKD, showed higher prevalence in HD patients.

Background: Heart failure (HF) is a clinical syndrome that often leads to the complications such as pulmonary arterial hypertension (PAH), particularly Group 2 PAH secondary to left heart disease (PH-LHD). Echocardiography, a noninvasive tool, is used to assess the hemodynamic changes such as left ventricular ejection fraction (EF) and filling pressures. While most existing studies focused on PAH in HF with preserved EF, this study examines the incidence and hemodynamic impact of PAH in heart failure with reduced ejection fraction (HFrEF), addressing a critical gap in understanding.

Methodology: A retrospective, analytical cohort study was conducted using the patient details retrieved from the electronic medical records of the HF clinic. Data were collected for the period between January 2018 and December 2021. The convenience sampling was used to identify the patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and secondary PAH based on echocardiographic assessments.

Results: Among the cohort, 54% of patients exhibited secondary PAH with HFrEF. The significant correlations were found between PAH and left ventricular (LV) hemodynamic changes, including reduced EF, elevated filling pressures, and valve regurgitations such as mitral, tricuspid, and pulmonic regurgitation.

Conclusion: Despite limitations described, this research demonstrates a robust association between PAH and LV dysfunction in HFrEF patients. The study's strengths include its adequate sample size and the application of validated echocardiographic methods to assess the hemodynamic changes.

Infective endocarditis (IE) is a rare disease, but its impact is significant as it affects 3-10/100,000 per year in the population. According to the current guidelines ESC 2023, the evidence of lesions characteristic of IE is a major diagnostic criterion. Echocardiography is the first-line imaging technique to diagnose IE and to assess the structural and functional damage of cardiac structures. Transesophageal echocardiography (TEE) is recommended in patients with an inconclusive or negative TTE, in patients with high suspicion of IE, as well as in patients with a positive TTE, to document local complications. Other imaging modalities, such as cardiac computed tomography and nuclear imaging, are needed to confirm or exclude the diagnosis of IE, to characterize the extent of the cardiac lesions, and to diagnose cardiac complications. The aim of this article was to review the potential role of cardiac imaging, especially of TEE and cardiac CT in evaluating IE perivalvular complications.

Background: Pressure and volume loads are vital components of every congenital heart disease. Numerous studies have concentrated on investigating myocardial remodeling under varying loading conditions in animal models. The objective of this study was to compare myocardial responses in lesions with volume overload, specifically ventricular septal defects (VSD), and lesions with pressure overload, such as coarctation.

Methodology: For this purpose, three study groups have been involved: a VSD group (n = 19), a coarctation (CoA) group (n = 20), and healthy age- and sex-matched controls (n = 21). The severity of VSD has been measured by its size. In contrast, the severity of discrete CoA was quantified by the pressure gradient across the coarcted segment. The parasternal long axis assessed septal hypertrophy and left ventricular (LV) dilatation-systolic myocardial LV velocities using tissue Doppler imaging. The global longitudinal strain was performed to assess LV function accurately.

Results: The CoA groups displayed significant septal hypertrophy compared to the other two study groups: IVSd (CoA: 8 ± 1.6 vs. VSD 5.7 ± 0.9). LV dilatation was more marked in the VSD group: LV end-diastolic dimension (CoA: 30 ± 3 vs. 25 ± 1.7). Systolic septal and mitral annular velocities were reduced in the CoA group and intriguingly exaggerated in the VSD group: Septal basal systolic myocardial velocity: (VSD: 9 ± 2 vs. CoA: 5 ± 1 vs. Controls: 7 ± 0.8). Myocardial GLS was markedly reduced in the CoA group.

Conclusions: Besides the well-known eccentric-concentric hypertrophy paradigm in volume-pressure loading of the myocardium, pressure load seems to reduce myocardial velocities and LV function to a greater extent than volume loading. This is putatively mediated via myosin class switching, reduced myofilament sensitivity to calcium, and disrupted mechanical-electrical synchrony.