Journal of Cardiovascular Echography最新文献

Sarcoidosis is a chronic inflammatory condition of uncertain origins, affecting multiple organs and characterized by the formation of granulomas. Cardiac involvement, known as cardiac sarcoidosis (CS), occurs in 5%-10% of cases and can lead to heart failure, arrhythmias, and sudden death. Distinguishing CS from other heart conditions poses a significant challenge. However, improved diagnostic techniques such as cardiac magnetic resonance (CMR) and positron emission tomography combined with computed tomography (CT) have enhanced recognition rates, replacing invasive procedures like endomyocardial biopsy. Clinical guidelines have further facilitated diagnosis. This case report underscores the diagnostic complexity of CS and highlights the emerging role of contrast-enhanced cardiac CT as a viable alternative to CMR, particularly in patients with contraindications to CMR.

Critically ill patients in the intensive care unit (ICU) require continuous hemodynamic monitoring to guide therapeutic decisions and prevent clinical deterioration. Echocardiography has emerged as a cornerstone for noninvasive hemodynamic assessment, offering real-time, bedside evaluation of key parameters such as venous congestion, pulmonary pressures, left atrial pressure (LAP), systemic vascular resistances, cardiac output, and ventricular-arterial coupling. Systemic venous congestion and right atrial pressure (RAP) can be assessed through inferior vena cava diameter measurement and respiratory variation, with additional accuracy provided by the VeXUS score, which incorporates hepatic, portal, and renal vein Doppler profiles. Internal jugular vein assessment and left ventricular (LV) stroke volume variability further refine RAP estimation. Pulmonary hypertension (PH) and right ventricular dysfunction can be evaluated through echocardiographic markers that differentiate precapillary from postcapillary PH, enabling tailored treatment strategies. In addition, echocardiography is fundamental for detecting right ventricular failure, particularly in PH and cardiogenic shock. LAP and systemic hemodynamics are integral to assessing LV diastolic and systolic dysfunction, which are pivotal in heart failure and cardiogenic shock management. Echocardiography also provides insights into vascular system properties and their interaction with cardiac performance, while lung ultrasound aids in detecting interstitial edema of cardiac origin. As a fast, reliable, and reproducible tool, echocardiography is the gold standard for noninvasive hemodynamic assessment in ICU patients, facilitating prompt and precise therapeutic decisions.

Accurate selection of patients referred for LVADs is essential to prevent peri- and postoperative complicationsEchocardiography is the first line imaging modality for the evaluation of LVAD candidatesStudy of RV geometry and function is mandatory to detect subclinical RV dysfunction which could cause RV failure after-LVAD implantation, a frequent and potentially life-threatening complicationSevere valvular heart disease, ascendant aorta and possible intracardiac thrombi or shunts should be carefully evaluated, since these may represent some limit to LVAD implantation.

Context: Aortic stenosis (AS) induces ventricular remodeling. After surgical aortic valve replacement (SAVR), there is reverse remodeling (RR) that might impact patients' prognosis.

Aims: This study aims to characterize cardiac RR post-SAVR, determine possible explanatory factors of this phenomenon, and assess its prognostic impact.

Methods: A retrospective observational study of 114 patients with severe AS who underwent SAVR between 2017 and 2021 and had echocardiographic follow-up 1 year after. A descriptive analysis of baseline characteristics of the patients was carried out, pre- and post-surgical comparisons. Factors associated with left ventricular RR (LVRR) and time to the occurrence of a major adverse cardiac event (MACE) were assessed.

Results: A total of 114 patients were included, with a median age of 72 years. One-year post-SAVR the left ventricle mass index (LVMi) decreased 16.9% (P < 0.01), the functional class improved (patients in New York Heart Association (NYHA) class I post-SAVR 57, 9% vs. patients in NYHA class I pre-SAVR 11, 4%; P < 0.01) and electrocardiographic criteria for hypertrophy were less common (19% post-SAVR vs. 43% pre-SAVR, P < 0.01). Basal LVMi was the only independent predictor of LVMi 1-year post-SAVR (B = 0.51 IC95% (0.34-0.68); P < 0.01). In the multivariate analysis, only age was associated with the occurrence of a MACE, hazard ratio = 1.11 (P = 0.026).

Conclusions: Results suggest that 1-year post-SAVR there is LVRR and basal LVMi is the only independent predictor of this phenomenon. Age is the only identified risk factor associated with the occurrence of a MACE, while no association was found between the latest and LVRR.

Context: Postoperative right heart failure is a poor prognostic factor after cardiac surgery. However, the factors that influence perioperative right ventricular (RV) function remain unknown. This study investigated whether preoperative pulmonary hypertension (PH) affects changes in RV systolic function during the perioperative period.

Aims: This study aimed to determine the effect of preoperative PH on changes in RV systolic function in patients undergoing aortic or mitral valve surgery.

Settings and design: This was a retrospective review of three-dimensional echocardiographic datasets of 157 patients undergoing aortic or mitral valve surgery.

Materials and methods: Patients were classified into the PH (n = 105) or non-PH (n = 51) group based on preoperative right heart catheterization findings. RV ejection fraction and RV longitudinal strain (RVLS) of the free wall and septum were calculated using semiautomated image analysis software at four time points: before surgery, end of surgery, 3 months after surgery, and 1 year after surgery.

Statistical analysis used: A mixed-effects model was used to compare changes in RV function between groups.

Results: Over 1 year, no significant differences in trends were observed between groups for any of the parameters. However, a significant deterioration in free wall RVLS was observed in the non-PH group when focusing on the change from baseline to 1 year (P value for interaction = 0.013).

Conclusions: In patients undergoing valvular surgery, the presence of preoperative PH did not significantly influence changes in RV function throughout the perioperative period.

The precise evaluation of pulmonary artery, right atrial, and ventricular pressures is essential for the diagnosis, ongoing management, and therapeutic decision-making in a wide range of cardiovascular conditions, including pulmonary hypertension. Since the early 1980s, the accuracy and consistency of echocardiography in estimating pulmonary artery pressure have been a subject of debate, with multiple formulas developed over time to improve reliability. Despite initial concerns, echocardiography has now been widely accepted as a noninvasive, safe, and readily available alternative to the more invasive right heart catheterization, which remains the gold standard. The growing recognition of echocardiography's role in clinical practice has led to significant advancements in its methodology. This review explores the contribution of echo-Doppler techniques to the assessment of right heart hemodynamics, highlighting their importance in daily practice. It also examines the historical milestones that have facilitated the standardization of various formulas and paved the way for the development of current guidelines. By tracing these developments, the review underscores the relevance of echocardiography in modern cardiology and the importance of continuing to refine its application to ensure accurate and reliable assessments.

Background: Despite its potential, pediatric three-dimensional (3D) transesophageal echocardiography (TEE) faced technical limitations due to the size and rigidity of early probes designed for adults.

Aim: In this paper, we present our experience in using the new pediatric 3D TEE probe in complex congenital heart disease (CHD).

Methods: Recent advancements in the field of miniaturization have led to the development of a new pediatric 3D TEE probe, specifically designed for young children (weight ≥4.5 kg). This probe features a smaller, flexible design and high-spatial and temporal resolution, enabling detailed views of intracardiac structures and real-time imaging crucial for complex diagnosis, planning interventional and surgical procedures. We used this new probe in pediatric cases (weight between 4.5 and 6 kg) with complex congenital heart disease.

Results: In double-outlet right ventricle or in Taussig Bing anomaly the new 3D TEE probe enabled detailed assessment of ventricular septal defect and its relations with tricuspid valve apparatus, and provided details of mitral valve leaflets not detectable by the transthoracic approach, even in small children.

Conclusions: These cases highlight the probe's ability to provide detailed anatomical information, enhancing surgical planning and outcomes. The pediatric 3D TEE probe has the potential to be a game changer in defining intracardiac anatomy in complex CHD.

Background: Transthoracic echocardiography remains a crucial diagnostic tool for the identification of pulmonary arterial hypertension (PAH). We eagerly await the novel noninvasive techniques development that significantly advances our knowledge of the pulmonary circulation and right ventricle.

Objective: The objective of this study was to assess pulmonary arterial hemodynamics using pulmonary pulse transit time (pPTT) following balloon mitral valvuloplasty (BMV).

Patients and methods: Thirty-three patients with moderate-to-severe mitral stenosis (MS) with varying pulmonary hypertension degree who were presented to the National Heart Institute to do percutaneous mitral balloon valvuloplasty. Participants were evaluated for their echocardiographic variables including the pPTT, and they were followed up immediately, 1 week, 1 month, and 6 months after BMV.

Results: The study demonstrated a significant and progressive improvement in the right ventricular fractional area change and the tricuspid annular plane systolic excursion (TAPSE) following BMV; on the other hand, the pulmonary artery systolic pressure demonstrated a significant decrease postprocedure and during the follow-up period. On analysis, we found a significant change observed in pPTT values postprocedure (P < 0.001). This value showed a significant reduction immediately following the procedure and the decline continued over the subsequent follow-up periods. Each of these postprocedure measurements showed a significant decrease from the baseline (P < 0.001).

Conclusion: The pPTT was high in postcapillary pulmonary hypertension (in MS patients) and reduced after correction of causative pathology; the pPTT is a valid measure to assess the improvement in PAH after BMV.

Introduction: Tricuspid regurgitation (TR) is associated with high rate and poor prognosis in patient undertreated. In recent years, transcatheter tricuspid valve interventions (TTVI) appears like a valuable option in high risk surgical candidates in presence of suitable anatomy. Screening phase with transthoracic, thansoesophageal echocardiography, and cardiac computed tomography (CT) are necessary select patients.

Purpose: The aim of the study is to compare different imaging modalities as three-dimensional (3D) transthoracic echocardiography (TTE), transesophageal echocardiography (TOE) and ECG-gated cardiac CT for the definition of tricuspid valve (TV) function and geometry assessment.

Materials and methods: Twenty-one (age 79 ± 7 years, female 72%) patients under screening for transcatheter treatment of TR were prospectively enrolled in the study and underwent TTE, TOE, and cardiac CT. All measurements were performed in double blind by three different operators and compared.

Results: In the comparison between 2D/3D TTE and 2D/3D TOE, no statistically significant differences were found regarding the evaluation of the valve anatomy, the site of regurgitation, and the underlying mechanism (TTE vs. TOE: 3D septo-lateral diam 45.8 ± 4,92 vs. 45.87 ± 4,98 mm, P = 0.87; 3D antero-posterior diam 43.5 ± 4,58 vs. 43.5 ± 4,53 mm, P = 0.59; Circularity index 0,75 ± 0,08 vs. 0,76 ± 0,08, P = 0.98). When comparing 3D TTE and cardiac CT, no differences were recorded in terms of TV area 17.58 ± 3 versus 17.71 ± 4,3 cm², P = 0.1; perimeter 14.89 ± 1,6 versus 14.29 ± 1 cm, P = 0.5 and diameters. Similarly, in the study of right ventricular dimensions, obtained through 3D volumetric reconstruction, TTE was not statistically different to Cardiac CT.

Conclusions: The present series shows how a lone 3D TTE has a good reliability in the definition of TV function, leaflet characteristics, and geometry when compared with second level imaging modalities and may be safely used to select optimal candidates for complex TTVI.

The latest ESC guidelines advocate for a multimodality imaging approach in diagnosing infective endocarditis, incorporating echocardiography, computed tomography (CT), magnetic resonance imaging, positron emission tomography/CT, and single-photon emission CT/CT to enhance diagnostic accuracy. This case study examines the limitations of this approach in a patient with suspected prosthetic valve endocarditis, suggesting that while multimodality imaging is valuable, a clinically oriented strategy may be more effective in certain situations.