Echo Research and Practice最新文献

Background: Cavity dilatation is occasionally observed during supine bicycle exercise stress echocardiography (SBSE). The underlying mechanisms are poorly understood.

Aims: This study aimed to characterise patients with left ventricle (LV) cavity dilatation and a decrease in the left ventricular ejection fraction (LVEF) during SBSE.

Methods: A total of 653 patients who underwent SBSE were evaluated. Those with exercise-induced cavity dilatation (defined as increased cavity size and a decrease in LVEF) were evaluated (n = 29). A control group (n = 37) of patients with a hypertensive response and a normal ESE was also evaluated.

Results: A total of 33/653 (5.1%) patients had an abnormal LV cavity response to exercise, with 15/29 (51.7%) having significant underlying coronary artery disease (CAD). Comparisons were made between patients with CAD (n = 15) and those with nonobstructive coronary arteries (NCAs, n = 14). NCA patients had significantly higher peak diastolic blood pressure (DBP) (NCA-CD 109 ± 17 mmHg vs. CAD-CD 96 ± 16 mmHg, p = 0.044) and rate-pressure product (RPP) (NCA-CD 28,623 ± 4474 vs. CAD-CD 23,649 ± 4763, p = 0.007). There was a trend toward increased dyspnoea at peak exercise in NCA (NCA-CD 35.7% vs. CAD-CD 6.7%, p = 0.080), and CAD patients showed a higher observed frequency of severe chest pain (CAD 53.3% vs. NCA 14.3%, p = 0.050). When patients with NCA and cavity dilatation were compared with a control group of patients with a hypertensive response to exercise but no cavity dilatation, no significant differences were observed.

Conclusion: Cavity dilatation is observed in 5% patients undergoing SBSE and is attributable to significant CAD in approximately half of patients. NCA cavity dilatation is associated with increased RPP and DBP at peak exercise, with a trend toward increased dyspnoea. Severe chest pain at peak exercise was observed more frequently in CAD patients.

Background: Global longitudinal strain (GLS) and left atrial strain metrics, including reservoir (LAr), contraction (LAct), and conduit strain (LAcd), have emerged as key indicators of left ventricular (LV) function and filling pressures. However, the prognostic value of these markers for risk stratification in acute heart failure (HF) remains uncertain, particularly in identifying patients at elevated risk of rehospitalization and mortality.

Results: In the prospective HARVEST cohort study, LA strain and GLS measurements were obtained retrospectively in 141 patients (mean age 71 ± 13, 25% women). Strain values are reported as absolute values reflecting the magnitude of deformation regardless of sign. Multivariable adjusted Cox regression was used to test whether GLS, LAr, LAct, and LAcd were associated with all-cause mortality and HF rehospitalization. Hazard ratios were calculated per 1% decrease in strain values. During a median follow-up time of 39 (IQR 14-66) months (490 patient-years) for mortality analyses and 22 (IQR 4-51) months (354 patient-years) for HF rehospitalization 62 (44%) patients died, and 62 (44%) were rehospitalized. Higher GLS, LAr, and LAcd were associated with a lower risk of mortality (HR:0.94, 95%CI:0.89-0.99, p = 0.045; HR:0.93, 95%CI:0.89-0.98, p = 0.009; and HR:0.94, 95%CI:0.88-0.99, p = 0.039, respectively), and higher LAr and LAct were associated with reduced risk of HF rehospitalization (HR:0.93, 95%CI:0.88-0.98, p = 0.004; and HR:0.85, 95%CI:0.77-0.94, p = 0.002, respectively).

Conclusion: In patients with acute HF, strain parameters predict prognosis, with poorer outcomes. Notably, decreasing LAr was associated with increased risk of both death and rehospitalization for HF, whereas decreasing GLS was only associated with higher mortality risk.

Background: Tiger stripes, parallel bands within regurgitant Doppler spectra, are often ascribed to oscillating intracardiac structures. Their frequency and clinical relevance are unclear.

Methods: We retrospectively reviewed 4,567 transthoracic echocardiograms (TTEs) in adults between 18 and 65 years of age for tiger stripes on pulsed-wave (PW)/continuous-wave (CW) Doppler and correlated with valve pathology, presence of oscillating masses, and clinical findings.

Results: Tiger stripes occurred in 5.4% of studies (95% CI 4.8-6.1%), predominantly with mitral and aortic regurgitation jets (MR/AR) and high-velocity tricuspid regurgitation (TR) jets. Stripes were not seen when oscillating masses were present, and were more conspicuous in mild-moderate jets and higher-velocity Doppler spectra. Audible Doppler cooing sound was common; no association with clinical musical murmurs.

Conclusions: Tiger stripes may represent a benign spectral Doppler artifact. In isolation, they should not prompt additional imaging for oscillating masses or be used to grade regurgitation severity.

Background: This study aimed to assess the utility of end-diastolic flow reversal in the upper descending aorta (EFR) for echocardiographic grading of aortic regurgitation (AR) severity, using cardiac magnetic resonance imaging (CMRI) as the reference. Additionally, we evaluated the role of EFR in predicting the need for aortic valve (AV) surgery during mid-term follow-up.

Methods: Sixty-six patients (mean age 53 ± 15.0 years, 73% men) underwent echocardiographic assessment, including (semi-)quantitative parameters such as proximal isovelocity surface area (PISA), effective regurgitation orifice area (EROA), AR volume (AR-Vol), vena contracta (VC) and EFR, compared against CMR-derived regurgitant fraction (RF). Multivariable regression analysis was applied evaluating predictors for severe AR and AV surgery.

Results: According to CMRI, 13 patients had no, 16 mild, 18 moderate and 19 severe AR. All echocardiographic parameters demonstrated good diagnostic accuracy (AUC: EFR 0.84, VC 0.82, PISA 0.84, EROA 0.83, AR-Vol 0.86; all p < 0.001). Logistic regression identified EFR (p = 0.022) and VC (p = 0. 015) as significant predictors of severe AR. During 62 months follow-up, 16 of 53 patients (24%) underwent AV surgery. All echocardiographic parameters, except PHT, were significantly different between patients receiving AV surgery compared to patients without surgery (PISA, EROA, AR-Vol and VC p < 0.001, EFR p = 0.043). However, VC remained the only parameter significantly associated with time to AV surgery (Cox-regression analysis, p = 0.024).

Conclusions: EFR is a robust and reliable parameter for AR assessment, particularly in distinguishing moderate from severe AR, and should be incorporated into comprehensive echocardiographic assessment. However, VC demonstrated stronger prognostic relevance for predicting surgical intervention.

Background: Polyethelene glycol (PEG) is a key component of several ultrasound enhancing agents (UEA) but has been recognized as contributing to anaphylactoid reactions, resulting in new contraindications to use in those with known or suspected PEG allergy. Despite these recommendations, no clinical tools currently exist to screen for those with suspected PEG-allergy in echocardiography laboratories.

Methods: We developed a screening survey to identify patients with potential PEG allergy and prospectively implemented it in a pilot study involving 8 patients with confirmed PEG allergy by skin prick testing and 50 prospectively enrolled patients undergoing clinically-indicated echocardiography without known PEG allergy, June - July 2025.

Results: All patients completed the survey. A positive response to at least 2 of the first 4 questions on the screening survey had a sensitivity of 100% (95% CI 67.6-100%), specificity of 100% (95% CI 92.9-100%), positive predictive value of 100% (95% CI 67.6-100%), and a negative predictive value of 100% (95% CI 92.9-100%) to identify individuals with known PEG allergy.

Conclusions: In this pilot multicenter study, a brief screening survey identified all patients with proven allergy to PEG, suggesting possible utility to its use to identify those with potential PEG allergy who would benefit from a non-PEGylated UEA, though further clinical validation is needed.