Journal of Cardiovascular Echography最新文献

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, and traditional preventive measures focus on lifestyle modifications, pharmacologic interventions, and risk stratification. Recently, imaging has emerged as an interesting tool in cardiovascular prevention. This review explores the role of various imaging modalities in early detection, risk assessment, and disease monitoring. Noninvasive techniques such as carotid ultrasound, arterial stiffness assessment, echocardiography, and coronary artery calcium scoring enable the identification of subclinical atherosclerosis and ventricular dysfunction, providing insights that complement conventional risk factors. Coronary computed tomography angiography and cardiac magnetic resonance offer high-resolution visualization of vascular and myocardial pathology, contributing to refined risk stratification. Furthermore, emerging markers such as epicardial adipose tissue and hepatic steatosis are gaining recognition as potential predictors of cardiovascular risk. Advancements in artificial intelligence (AI) are revolutionizing cardiovascular imaging by enhancing image interpretation, automating risk prediction, and facilitating personalized medicine. Future research should focus on optimizing the integration of imaging into clinical workflows, improving risk prediction models, and exploring AI-driven innovations. By exploiting imaging technologies, clinicians could enhance primary and secondary prevention strategies, ultimately reducing the global burden of CVDs.

Aims: Athlete's heart has been extensively studied, particularly regarding global myocardial remodeling in normal systodiastolic function and supernormal deformation reserve. Based on specific morphological characteristics, it is commonly classified as eccentric and concentric remodeling; however, the recent interest in echocardiography lies in the dynamicity of the vorticity flow inside the LV chamber, primarily correlated with diastolic function. This study aims to verify the potential additional contribution of vortex analysis in characterizing the athlete's heart.

Methods and results: A group of 23 highly trained athletes was studied using two-dimensional standard and deformation echo parameters and vortex examination. A dedicated software (HyperDoppler-ESAOTE) defined geometrical and dynamic vortex parameters (area, length, depth, energy dissipation [ED], vorticity fluctuation, and kinetic energy fluctuation). The data obtained were compared with a group of 26 active nonathletes and a group of 23 normal subjects. Body mass index differed among the three groups, with higher values in normal subjects (normal = 27.2 ± 5.7; active = 22.9 ± 2.6; triathletes = 22.1 ± 1.8; P = 0.01). Indexed left ventricle mass was significantly higher in triathletes (triathletes = 96.9 ± 14.9; active = 87.6 ± 15; normal = 79.5 ± 15.7; P = 0.003) as twist (triathletes = 12.3 ± 3.9; active = 9.8 ± 3.7; normal = 8.1 ± 3.1; P = 0.001), expressing a supernormal apical reserve. Diastolic function was normal in both groups. In the presence of normal geometrical vortex data, vortex energetic parameters were significantly higher in triathletes (ED = 1.10 ± 0.41, P < 0.001; vorticity fluctuation = 0.89 ± 0.04, P < 0.001; kinetic energy fluctuation = 1.01 ± 0.08, P < 0.001).

Conclusions: Vortex analysis complements the morphological remodeling of the athlete's heart. It can contribute to defining the effects of training intensity and energy consumption. Future research will focus on potential modifications in different sports.

Background: Left ventricular global longitudinal strain (LV GLS) has shown to allow for risk stratification in heart failure (HF) patients with greater accuracy than LV ejection fraction (LVEF). However, previous studies included only few patients in New York Heart Association (NYHA) functional class I and rarely assessed clinical stability. The aim of this study was to determine the predictive value of LV GLS, as compared to LVEF, for short-term disease progression in asymptomatic stable HF patients.

Methods: This is a retrospective study including consecutive HF patients with LVEF <50%, in NYHA I, with no history of decompensation within the previous 6 months. The primary endpoint was the composite of cardiovascular death, hospitalization, and need for intensification of HF treatment within a 12-month follow-up period.

Results: Out of 153 patients, 17.8% showed disease progression. Receiver operating characteristic curves identified GLS as the most accurate predictor for clinical progression (area under the curve [AUC]: 0.883 (95% confidence interval [CI]: 0.811-0.954), cutoff: -9.0%, sensitivity: 88.5%, and specificity: 88.5%). LVEF performed less precisely (AUC: 0.654 [95% CI: 0.527-0.782], cutoff: 42%, sensitivity: 70.4%, and specificity: 54%). Depressed GLS was a strong and significant predictor for disease progression (hazard ratio [HR]: 16.7 (95% CI: 6.2-35.1), P < 0.001). Reduced LVEF showed to be a less reliable predictor (HR: 2.4 [95% CI: 1.1-5.2]).

Conclusions: GLS reliably predicts clinical progression in asymptomatic stable HF patients, with greater accuracy than LVEF. Its implementation in the risk stratification of these patients could help to identify those patients who are at greatest risk and may benefit from an intensification of their follow up and/or HF treatment.

Infective endocarditis (IE) is a potentially life-threatening condition characterized by infection of the heart valves or endocardial surface, leading to significant morbidity and mortality. This case series explores four unusual presentations of IE, highlighting the diverse etiologies and complex multisystem complications that can arise from this condition. The clinical manifestations of IE can vary widely, ranging from systemic embolization to acute heart failure, reflecting the varied spectrum of pathogens involved and the patient's underlying health status. Key risk factors include preexisting valvular heart disease, intracardiac devices, intravenous drug use, and immunocompromised states. Prompt and accurate diagnosis is crucial for effective management, with echocardiography serving as the gold standard imaging modality and playing a key role as the first-line tool. Both transthoracic and transesophageal echocardiography are invaluable in identifying vegetations, evaluating valve function, and detecting potential complications such as abscesses, valve perforation, and intracardiac fistulas. The high sensitivity and specificity of echocardiography allow for early detection, even in cases with subtle or atypical presentations, ensuring that timely medical or surgical interventions are initiated. In addition, echocardiography is essential in monitoring treatment response, guiding clinical decisions, and determining the need for surgical valve replacement when severe damage or persistent infection is evident. This series emphasizes the importance of a multidisciplinary approach to treatment, which may include both medical and surgical interventions, tailored to the patient's specific clinical scenario. A heightened awareness of atypical presentations and the need for timely intervention are critical for improving patient outcomes, particularly in high-risk populations.

Over the past decade, stress echocardiography has evolved from a test for assessing epicardial artery stenosis to a comprehensive functional test, targeting multiple cardiovascular parameters. The new approach includes several structured steps: (a) evaluating regional wall motion abnormalities to detect epicardial artery stenosis or vasospasm; (b) assessing pulmonary congestion and diastolic function via B-lines with lung ultrasound; (c) gauging preload and contractile reserve with volumetric echocardiography; (d) measuring coronary microvascular reserve using Doppler-based coronary flow velocity in the middistal left anterior descending artery; and (e) determining cardiac sympathetic reserve by tracking heart rate reserve on an ECG. This evolution was supported extensively by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), which played a key role in five areas: (1) developing the initial, curiosity-driven project; (2) disseminating protocols and results at national and international conferences, supporting logistic infrastructure and publication expenses; (3) establishing a digital platform (customized Redcap) for data entry and storage; (4) facilitating patient recruitment across 19 Italian centers; and (5) offering formal endorsement through six presidencies, adding credibility and reach beyond any single institution. The protocol quickly advanced from concept to high-impact publications, earning inclusion in 2024 specialty guidelines. Initially Italian-led, the study now includes 50 centers across 20 countries (e.g. USA and China). Beyond the 50 peer-reviewed papers published in 2016-2024, this study offers a novel, sustainable approach to cardiac stress testing, providing more information at lower costs, with zero radiation and minimal environmental impact. SIECVI's endorsement was instrumental in amplifying the study's rigor and outreach.

A 53-year-old woman was evaluated for left ventricular hypertrophy. Transthoracic echocardiography showed a mobile linear density in the ascending aorta and eccentric aortic insufficiency, raising the concern of aortic dissection. Transesophageal echocardiography and cardiac computed tomography (CT) found complex bands of tissue extending from the commissure to the aortic wall, confirming aortic valve tendon. It is an extremely rare malformation of aortic valve associated with aortic regurgitation that mimics aortic dissection. Although preoperative diagnosis has been challenging, three-dimensional echocardiography and CT reformatting aided the visualization of the spatially complex structure.

Strongyloides stercoralis is a nematode commonly known as roundworm. Humans are the primary host for the parasite and are infected when bare skin is exposed to contaminated soil. Once in the skin of the human host, the larvae migrate to the heart through the blood and then to the alveoli of the lungs, subsequently ending up in the trachea where the larvae are coughed up and swallowed. Clinically, this infection may be asymptomatic as well as present as an acute or chronic gastrointestinal discomfort, hyperinfection syndrome, or disseminated disease with the involvement of different organs. Myocarditis and vasculitis have been described. Here, we describe the case of a patient with a history of dilated cardiomyopathy and the novel finding of common iliac artery aneurysm in whose Strongyloides infection might be the trait d'union of these two conditions.

Left ventricular thrombosis (LVT) in stress cardiomyopathy or Takotsubo syndrome (TTS) is a moderately frequent complication. However, cardioembolic events are not frequently reported. Herein, we present a case report of 80-year-old patient admitted for chest pain at rest, started few days earlier following a violent argument. Her medical history included arterial hypertension and recent surgery of descending colon adenocarcinoma. Electrocardiogram showed sinus rhythm, negative T waves from V1 to V6, in D2, D3, AVF, and long QTc. Laboratory examinations documented an increased high sensitivity Troponin I, myoglobin, creatine kinase-MB, and B-type natriuretic peptide. Transthoracic echocardiography (TTE) showed a reduced left ventricular (LV) ejection fraction, "apical ballooning" with hyperkinesis of the basal segments of LV, suggestive for stress cardiomyopathy. A large thrombus in LV apex (3.3 cm × 2.1 cm) was found. Coronary angiogram showed normal coronary arteries. Anticoagulant therapy with Warfarin was quickly started, bridging with unfractionated heparin. Cardiac surgery was excluded for high-risk surgical patient. Daily TTE monitoring was done with evidence of slight reduction of the LVT. After 7^th day from admission, the patient complained an intense and sudden pain in lower extremities bilaterally. An acute occlusion of the descending aorta just above the bifurcation in the common iliac arteries was found. Interventional radiology procedure of recanalization of the bis-iliac carrefour was successfully performed. However, few hours after the procedure, the patient's hemodynamic conditions worsened until the exitus.

Background: The diagnosis of atrial tachyarrhythmias might be challenging at times. Assessing Doppler flow patterns of the left atrial appendage (LAA) using echocardiography, mainly transesophageal echocardiography, represents a valuable tool for establishing the diagnosis of atrial tachyarrhythmias, especially when the diagnosis remains unclear.

Result: Despite its effectiveness and simplicity, this technique is often underused in routine clinical practice.

Conclusion: This paper aims to underscore the effectiveness of using LAA flow in conjunction with electrocardiograms for diagnosing atrial tachyarrhythmias in complex cases, particularly atrial flutter, and to encourage physicians to adopt this approach to better identify patients at risk for the recurrence of atrial tachyarrhythmias and LAA thrombus formation.

Background: Cardiac remodeling in response to hemodynamic and neurohormonal factors is the primary driver of heart failure progression. Angiotensin receptor-neprilysin inhibitor (ARNI) has superior beneficial effects on mortality and quality of life compared to angiotensin-converting enzyme inhibitor (ACEI). Speckle-tracking echocardiography can detect early subtle changes in cardiac structure in numerous cardiac diseases. The study was conducted to evaluate the possible impact of ARNI therapy compared to ACEI on cardiac remodeling using echocardiographic parameters, including global longitudinal strain (GLS) in heart failure with reduced left ventricular ejection fraction (HFrEF) patients.

Methods: This prospective observational study included eighty recently diagnosed HFrEF patients with left ventricular ejection fraction (LVEF) ≤35%, prescribed the four pillars of guideline-directed medical therapy, and uptitrated to the maximally tolerated doses. The study included two groups: the ARNI group included forty patients prescribed ARNI, and the ACEI group included forty patients prescribed ACEI. All patients underwent two- and three-dimensional (2D and 3D) echocardiography to assess baseline parameters, including indexed left ventricular (LV) volumes and 2D and 3D GLS, at baseline and after a 6-month follow-up period.

Results: Both groups had no significant differences regarding demographic data and echocardiographic findings at baseline. After a 6-month follow-up period, there was a significant reduction in LV-indexed volumes in the ARNI group (P < 0.001) and indexed left atrial volumes (P = 0.013) compared to the ACEI group. There was a significant improvement in the ARNI group regarding LVEF (P = 0.011), 2D GLS (P < 0.001), and 3D GLS compared to the ACEI group, but no significant change in the LV mass index. Multivariate regression analysis showed that the use of ARNI, absence of diabetes mellitus, and a higher baseline GLS (above-9.1%) are independent predictors for the occurrence of reverse remodeling (defined as an increase in LVEF ≥5%).

Conclusion: The inclusion of ARNI in the pharmacotherapy of HFrEF patients is an independent predictor of LV reverse remodeling, as observed in a significant improvement in both 2D and 3D volumetric echocardiographic parameters, improved LVEF and longitudinal LV systolic function, represented in 2D and 3D GLS. Baseline 3D GLS and not LVEF or 2D GLS can help predict the occurrence of reverse remodeling in HFrEF patients.