Journal of Cardiovascular Echography最新文献

Context: Minimally invasive mitral valve repair (MIMVr) has emerged as a promising alternative to conventional surgery procedures for addressing severe degenerative mitral regurgitation (MR). It provides early benefits such as reduced morbidity, shorter hospital stays, quicker recovery, and consistent long-term safety and efficacy. Exercise stress echocardiography (ESE) is essential for evaluating MR and pulmonary pressures during peak exercise, especially in patients with discordant symptoms and regurgitation grades at rest. ESE helps assess dynamic changes in hemodynamics and guide treatment strategies.

Aims: This study evaluates the hemodynamic impacts and clinical outcomes of MIMVr using ESE at 2 years posttreatment.

Settings and design: It is a retrospective study of patients who underwent MIMVr between 2020 and 2021 and ESE-evaluated at 2 years posttreatment.

Materials and methods: In this retrospective cohort study, we compared 13 patients with 13 age-matched healthy controls. All patients underwent resting and stress echocardiography using a semi-supine bicycle ergometer, Bruce, and SIECVI protocols for MR stress-echo.

Results: Preoperatively, most subjects were NYHA class II/III, with a shift to class I by 2 years postsurgery. ESE showed significant improvements in ejection fraction (61.4%-73.5%, P < 0.001) and decreased LV filling pressure (E/e' ratio from 14.4 to 10.1, P = 0.01). MIMVr patients showed reduced heart rate, double product during stress, and no stress-induced ischemia or significant arrhythmias.

Conclusions: This pilot study suggests that MIMVr provides meaningful 2-year improvements in cardiac function, approaching normal parameters. However, given the small, single-center design, these findings are primarily hypothesis-generating and warrant confirmation in larger prospective trials.

Objectives: We evaluated the role of speckle tracking derived territorial longitudinal strain (TLS) to predict the culprit artery in non-ST elevation myocardial infarction (NSTEMI).

Methods: We evaluated 211 NSTEMI patients scheduled for invasive coronary angiography. Transthoracic conventional and speckle tracking echocardiography was done to assess the left ventricular systolic function, wall motion score index (WMSI), territorial WMSI, and TLS. Coronary angiography within 24 h of hospital admission was used to evaluate the culprit vessel.

Results: The culprit vessel was most commonly left anterior descending (LAD) "36.5%" and left circumflex (LCX) "35.1%" followed by right coronary (RCA) "28.4%." Multivessel disease patients had higher WMSI and lower global longitudinal strain (GLS) compared to single- and 2-vessel disease (P < 0.001). TLS was significantly lower in the culprit vessel territory than in normal and stenosed nonculprit vessels. Moreover, TLS-LCX and TLS-RCA were markedly lower in the stenosed nonculprit territory than normal vessels. Adding TLS to WMSI significantly improved the prediction of the culprit vessel (P < 0.001). TLS-LAD, TLS-LCX, and TLS-RCA were independent predictors of the culprit vessel. The optimal cutoff value of TLS-LAD, TLS-LCX, and TLS-RCA was -15.65% (96.1% sensitivity and 100% specificity), -15.65% (94.6% sensitivity and 98.5% specificity), and -16.6% (100% sensitivity and 98.7% specificity), respectively.

Conclusions: TLS is an independent predictor for identifying the culprit vessel in patients with NSTEMI. Therefore, it should be evaluated during echocardiographic assessment of those patients.

Peripartum cardiomyopathy (PPCM) is a condition of myocardial systolic dysfunction with dilated cardiomyopathy phenotype which occurs in the last months of pregnancy to several months postpartum period. There are several predictors of poor recovery in PPCM, especially severe left ventricular (LV) systolic dysfunction at initial presentation. We reported a case of a 41-year-old woman with late presenter PPCM and the presence of poor predictors of recovery from echocardiographic parameters. Echocardiography showed severely reduced ventricular function and global hypokinetic LV with severe tricuspid regurgitation. After 6 months of guideline-directed medical treatment (GDMT) for heart failure (HF) with reduced ejection fraction, complete ventricular reverse remodeling which evaluated by conventional echocardiography parameters. In addition to that, global longitudinal strain and myocardial work index assessment by echocardiographic evaluation also showed progressive myocardial recovery. This case highlights the role and efficacy of HF GDMT in late presenter PPCM and emphasizes the importance of meticulous echocardiographic evaluation with the purpose to track the therapeutic response in the presence of poor prognostic factors in patients.

Myxoma is a rare benign primary cardiac tumor and the most common intracardiac tumor at all. It is usually asymptomatic or it may present gradually related to the increasing size. The clinical features and manifestations can be subtle, misdiagnosed, and not attributed to atrial myxoma (AM) due to the overlapping signs and symptoms with other pathological disorders such as neurological diseases. The reported case concerns a patient with a history of epilepsy presenting to the emergency department for an episode of syncope and seizures not responding to medical treatments. A complete cardiac evaluation with electrocardiogram, transthoracic echocardiography, and cardiological first-line assessment through laboratory and radiological tests is needed in order not to delay AM diagnosis.

The right atrium (RA) plays a vital role for cardiovascular performance. Recent data have demonstrated the utility of the RA functional assessment as a powerful biomarker for adverse outcomes in various physiological and pathological cardiovascular conditions. Evaluating RA size and function throughout the cardiac cycle (reservoir, conduit, and booster pump) helps for a better understanding of RA response to pressure and volume loading conditions. Basic and advanced echocardiographic modalities provide qualitative and quantitative assessment of the RA size and function. Two-dimensional speckle-tracking echocardiography-derived analysis of RA strain offers a window on all the phases of RA function. The available data are promising for using RA strain in routine echo assessment for the diagnostic and prognostic purposes. For example, in heart failure and pulmonary hypertension, RA strain has a range of 78%-80% sensitivity and 72%-88% specificity. In other indications such as cardiomyopathy and coronary artery disease, RA strain showed moderate accuracy. This review article aims to summarize the current published data on the feasibility and clinical value of RA strain, which may guide its use in a wide scale of patients with various cardiac abnormalities.

Background: Effective hygiene practices are crucial to mitigate infection risks in echocardiographic procedures. We conducted a nationwide survey to assess real-world disinfection standards in Italian echocardiography laboratories, measure adherence to core hygiene indicators, and identify structural determinants of compliance.

Methods: A 35-item questionnaire was distributed to 331 accredited centers. Compliance was defined as adherence to ≥5 of 7 core hygiene indicators. Multivariable logistic regression identified predictors of high compliance.

Results: Glove use (92.7%) and probe sheathing (34%-38%) were common, but high-level disinfection (HLD) remained underused (38.2% for surface probes and 64.7% for transesophageal echocardiography [TEE] probes). Only 48.3% of centers had traceability for TEE probe cleaning. Overall, 43.8% of centers achieved high compliance. Independent predictors included female gender (odds ratio [OR]: 2.37, 95% confidence interval [CI]: 1.49-3.75), hospital setting (OR: 2.50, 95% CI: 1.22-5.12), and high procedural volume (OR: 2.32, 95% CI: 1.45-3.71). Compliance varied by care setting, with outpatient clinics generally showing better adherence than emergency and intensive care units.

Conclusions: Significant heterogeneity exists in disinfection practices across Italian echo laboratories, with persistent gaps in HLD, traceability, and environmental hygiene. Compliance was driven by operator characteristics and center-level factors rather than general institutional policies. These findings call for workflow-integrated protocols and targeted training to ensure standardized practice.

Septic cardiomyopathy (SCM) is an acute, reversible myocardial dysfunction occurring in the context of sepsis, independent of ischemic heart disease. Despite its frequent occurrence in critically ill patients, SCM remains poorly defined and underdiagnosed. This article provides clinicians with a practical guide for the recognition and management of SCM, with particular attention to the role of bedside echocardiography. Echocardiography is emphasized as both a diagnostic and hemodynamic monitoring tool to optimize treatment strategies in patients with sepsis and septic shock. Advanced techniques such as speckle-tracking echocardiography enhance sensitivity for detecting subclinical myocardial impairment and support differential diagnosis. Real-time echocardiographic assessment allows tailored therapy and may improve patient outcomes. Key elements include the recognition of characteristic echocardiographic patterns, integration of global longitudinal strain analysis, and the use of echocardiographic findings to guide hemodynamic management decisions.

Epigastric pain could be associated with typical thoracic syndromes such as myocardial infarction (MI), aortic dissection (AD), or pulmonary embolism (PE) but, in certain cases, it could be more often linked to gastric disorders such as gastroesophageal reflux disease, hiatal hernia, or other gastric disorders. The key point of the differential diagnosis could be the collection of anamnestic data performed by the clinician and the performing of laboratory blood sample tests, radiological examinations and echography in Emergency Department; still a diagnostic challenges, especially in elderly patients where symptoms could be nonspecific or overlap with previous comorbidities. It's important to maintain a high index of clinical suspicion in the face of vague symptoms in multimorbid patients and to rely on a multidisciplinary approach in an emergency setting: The early use of echocardiography is fundamental for its diagnostic value, therapeutic guidance, and evolutionary monitoring of the condition. The reported case concerns an elderly patient presenting to the Emergency Department for a suspected episode of loss of consciousness following epigastric pain with a completely unexpected and never seen before ultrasound finding.

The diagnosis and management of cardiac masses, particularly in the emergent settings, present significant clinical challenges due to their varied etiologies and presentations. This case report describes a 74-year-old male with a history of bioprosthetic mitral valve replacement, presenting with acute heart failure and severe mitral stenosis initially presumed to be thrombosis. However, advanced histopathological and microbiological analysis of the explanted valve identified the underlying cause as early fungal bioprosthetic valve endocarditis caused by Rhizopus oryzae. The authors emphasize the importance of early recognition, multidisciplinary management, and advanced diagnostic tools to optimize the outcomes in such rare and fatal conditions.

Background: Differentiating the two main causes of chronic heart failure, is crucial for proper management. Since, in idiopathic dilated cardiomyopathy (DCM), both ventricles are affected, whereas the left ventricle is involved mainly in ischemic cardiomyopathy (ICM), assessment of right ventricle (RV) function may be beneficial in such differentiation. Strain imaging is a handy tool that can be used for such differentiation.

Aim: The aim of this study was to differentiate between DCM and ICM using RV two-dimensional strain imaging.

Materials and methods: One hundred and fifty patients were included in the study; according to the result of the echo-Doppler study and coronary angiography, they were divided into three equal groups: ICM group, DCM group, and a control group, matched in age and sex.

Results: There was a statistically significant higher tricuspid annular plane systolic excursion (14.3 ± 3.5 mm vs. 12.62 ± 3.5 mm, P = 0.006) and tricuspid annular systolic velocity (Sa) (0.96 ± 0.02 m/s vs. 0.67 ± 0.02 m/s, P = 0.001) in the ICM group compared with the DCM group. GRVLS was statistically significantly lower in the DCM group compared to the ICM group (-14.23% ± 4.11) versus (-16.64% ±5.99) (P = 0.006). According to the receiver operating characteristic (ROC) curve analysis, tricuspid annular (S) velocity with cutoff value >0.09 m/s with 84% sensitivity and 70% specificity and GRVLS >-18%, with 88% sensitivity and 74% specificity can be used to distinguish ischemic etiology.

Conclusion: RV dysfunction is more evident in patients with idiopathic cardiomyopathy than in patients with ICM as proved by tissue Doppler imaging and RV strain imaging.