Echo Research and Practice最新文献

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.

The increasing demand for adult congenital heart disease (ACHD) services requires innovative solutions to reduce waiting times and optimise patient care. This paper presents the implementation and development of an ACHD Scientist-led clinic at Guy's and St Thomas' NHS Foundation Trust, providing an alternative, cost-effective, and efficient service model. A comprehensive service audit identified challenges related to patient backlogs, clinic efficiency, and administrative coordination. Subsequent restructuring efforts, including an expanded appointment system, improved referral pathways, and enhanced clinical governance, led to a significant reduction in overdue appointments from 15% to 2%, despite an overall increase in patient numbers. Comparative cost analysis demonstrated that the Clinical Scientist-led model is more cost-effective than the traditional models. Additionally, patient satisfaction surveys and Consultant evaluations confirmed this model's high quality and safety. These findings highlight the potential for broader adoption of Clinical Scientist-led clinics within the ACHD networks to improve accessibility, efficiency, and sustainability of care.

Background: Rheumatic mitral stenosis (MS) is characterised by structural alterations that reduce the size of the valvular orifice. In addition, changes in valve geometry may have haemodynamic consequences that extend beyond the narrowed orifice, influencing the overall clinical presentation of MS. The aim of this study was to develop an index to assess the haemodynamic severity of the stenosis.

Methods: A total of 186 patients with rheumatic MS who underwent comprehensive three-dimensional (3D) transoesophageal echocardiographic assessment were included. Dedicated software was used to extract a range of morphological variables to evaluate mitral valve geometry, including diameter, area, height, volume, and the aortic-mitral angle. To quantify the volume enclosed within the stenotic structure, we developed the 3D Doming Index (DI), calculated by dividing the valvular volume (tenting volume) by the theoretical volume of a cylinder generated by the mitral annulus and valvular height (tenting height). Linear regression models were employed to identify determinants of the mean pressure gradient.

Results: The 3D Doming Index demonstrated a significant association with the transmitral pressure gradient in the multivariate model, after adjusting for confounders including age, sex, heart rate, pulmonary artery systolic pressure, net atrioventricular compliance (C_n), and left atrial volume. Incorporation of the 3D Doming Index into the model improved overall performance.

Conclusions: The geometric configuration of the mitral valve contributes to the haemodynamic burden of obstruction in rheumatic MS. The 3D Doming Index offers valuable insight into the relationship between valve anatomy and the resultant haemodynamic impact of the stenosis.

Introduction: Accurate chamber quantification in transthoracic echocardiography (TTE) is important for guiding clinical decision-making. We aimed to assess the accuracy and reliability of patients' self-reported height and weight compared to measured height and weight, and how any differences in the calculated body surface area (BSA) may affect TTE parameter classification.

Methods: Consecutive patients attending for out-patient TTE were prospectively recruited at a large NHS Trust as part of a service evaluation. Height and weight were initially self-reported and then measured. TTE parameters were subsequently indexed to BSA or height based on both self-reported and measured values and compared.

Results: 698 patients participated. Self-reported and measured height, weight, and BSA were strongly correlated (r > 0.90). There was a difference between the mean self-reported and measured height (self-reported being 1.1 cm higher, p < 0.001) and weight (self-reported being 1.6 kg lower, p < 0.001) as well as the resulting BSA (self-reported being 0.01m² lower, p = 0.008). Indexing TTE parameters to self-reported (rather than measured) values resulted in changes to the indexed left ventricular end-diastolic volume, left ventricular end-systolic volume, Sinuses of Valsalva diameter and proximal ascending aorta diameter (all p < 0.05), although the effect sizes were small.

Conclusion: Compared to measured height, weight and calculated BSA, self-reported values are statistically different but result in little clinically important change to TTE parameters in out-patients attending for TTE. However, given the possible impact on clinical decision-making, TTE conclusions based on self-reported height and weight should be interpreted with care, particularly indexed left ventricular volumes and aorta dimensions. Echocardiographers should be vigilant in identifying rare cases where individuals significantly misreport their height or weight.