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Assessment of myocardial work in sarcomere gene mutation carriers, healthy controls and overt nonobstructive hypertrophic cardiomyopathy.
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-26 DOI: 10.1186/s44156-025-00073-4
Carla Marques Pires, George Joy, Miltiadis Triantafyllou, Ricardo Prista Monteiro, Ana Ferreira, Konstantinos Savvatis, Luis Rocha Lopes

Background: Hypertrophic cardiomyopathy (HCM) is defined by unexplained hypertrophy and often characterized by diastolic and systolic dysfunction. HCM patients are known to have impaired left ventricular (LV) myocardial work (MW), a more load-independent parameter compared to global longitudinal strain (GLS). We hypothesized that impaired MW might occur in sarcomere mutation carriers without LV hypertrophy.

Methods and results: A single centre study with a case-control design. Patients with overt nonobstructive HCM and a causal sarcomere gene variant (n = 44), carriers (n = 51) and age and sex matched (to the carriers) healthy controls (n = 32) underwent a transthoracic echocardiogram including myocardial deformation analysis to calculate GLS and MW. Global work index (GWI) (1695 ± 332mmHg% vs. 1881.50 ± 490mmHg%, p = 0.001) and global constructive work (GCW) (2017.78 ± 323.05mmHg% vs. 2329.31 ± 485.44 mmHg%, p = 0.002) were lower in sarcomere mutation carriers compared to controls. LV ejection fraction and GLS were similar between these two groups. GWI (1209 ± 735mmHg% vs. 1695 ± 332mmhg%, p < 0.001), GCW (1456 ± 703mmHg% vs. 1993 ± 389mmHg%, p < 0.001), global wasted work (GWW) (117 ± 148mmHg% vs. 96 ± 69mmHg%, p = 0.006) and global work efficiency (GWE) (89 ± 7% vs. 95 ± 3%, p < 0.001)] were worse in overt non-obstructive HCM patients.

Conclusion: We show for the first time that MW indexes were significantly worse in sarcomere mutation carriers compared to controls, suggesting that MW is more sensitive to early changes than GLS and could have a significant role in the evaluation and follow-up of carriers.

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引用次数: 0
Multi-societal expert consensus statement on the safe administration of ultrasound contrast agents.
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-21 DOI: 10.1186/s44156-024-00068-7
Jordan B Strom, Andrew Appis, Richard G Barr, Maria Cristina Chammas, Dirk-André Clevert, Kassa Darge, Linda Feinstein, Steven B Feinstein, J Brian Fowlkes, Beverly Gorman, Pintong Huang, Yuko Kono, Juan Lopez-Mattei, Andrej Lyshchik, Michael L Main, Wilson Matthias, Christina Merrill, Sharon L Mulvagh, Petros Nihoyannopoulos, Joan Olson, Fabio Piscaglia, Thomas Porter, Arnaldo Rabischoffsky, Roxy Senior, Jessica L Stout, Maria Stanczak, Stephanie R Wilson

Contrast enhanced ultrasound (CEUS) offers a safe, reliable imaging option to establish a clinical diagnosis across a variety of multidisciplinary settings. This Expert Consensus Statement serves to outline expert opinion on what constitutes appropriate supervision and the essential components of safe CEUS practice. The purpose of this document is to empower institutions to allow sonographers, along with other trained medical professionals, to administer UCAs at the point of care, consistent with the updated scope of practice documentation and within the broad parameters of an individual's training and licensure, while subject to appropriate supervision and meeting or exceeding minimum safety standards. This guidance was developed by the International Contrast Ultrasound Society and endorsed by the following organizations that represent ultrasound professionals: the British Society of Echocardiography, the Canadian Society of Echocardiography, the Society of Diagnostic Medical Sonography, the Society for Pediatric Radiology, the World Federation of Ultrasound in Medicine and Biology, the Brazilian College of Radiology, the Joint Review Committee for Diagnostic Medical Sonography, the Chinese Ultrasound Doctors Association, and the American Society of Neuroimaging. Additionally, this guidance document was affirmed or supported by the American Society of Echocardiography, the Association for Medical Ultrasound, and the Society for Vascular Ultrasound.

造影剂增强超声(CEUS)提供了一种安全可靠的成像选择,可在各种多学科环境中确定临床诊断。本《专家共识声明》概述了专家对什么是适当的监督以及 CEUS 安全操作的基本要素的看法。本文件旨在授权医疗机构允许超声技师与其他训练有素的医疗专业人员一起,根据最新的执业范围文件,在个人培训和执照的广泛范围内,在护理点实施 UCA,同时接受适当的监督并达到或超过最低安全标准。本指南由国际对比超声学会制定,并得到了以下代表超声专业人员的组织的认可:英国超声心动图学会、加拿大超声心动图学会、医学超声诊断学会、儿科放射学会、世界医学和生物学超声联合会、巴西放射学会、医学超声诊断联合审查委员会、中国超声医师协会和美国神经影像学会。此外,本指导文件还得到了美国超声心动图学会、医学超声协会和血管超声学会的肯定或支持。
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引用次数: 0
Echocardiographic assessment of aortic regurgitation: a practical guideline from the British Society of Echocardiography.
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-27 DOI: 10.1186/s44156-024-00067-8
Kelly Victor, Liam Ring, Vasiliki Tsampasian, David Oxborough, Sanjeev Bhattacharyya, Rebecca T Hahn

Aortic regurgitation is the third most common valve lesion with increasing prevalence secondary to an ageing population. Transthoracic echocardiography plays a vital role in the identification and assessment of aortic regurgitation and proves essential in monitoring severity and determining the timing of intervention. Building on the foundations of previous British Society of Echocardiography (BSE) recommendations, this BSE guideline presents an update on how to approach an echocardiographic assessment of aortic regurgitation. It provides a practical, step-by-step guide to facilitate a comprehensive, high-quality echocardiographic assessment of aortic regurgitation. It discusses commonly encountered echocardiography-based challenges with suggestions regarding how this information is relevant in the interpretation and grading of regurgitation severity. Additionally, the value of other cardiac imaging modalities is discussed. The guideline concludes with an overview of aortic regurgitation in the clinical context, addressing chronic versus acute aortic regurgitation, which features prompt referral for intervention, and the consequences of combined valve disease.

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引用次数: 0
Sex differences in ventricular-vascular interactions associated with aerobic capacity. 与有氧能力相关的心室-血管相互作用的性别差异。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-20 DOI: 10.1186/s44156-024-00066-9
Barbara N Morrison, Peter M Mittermaier, Garth R Lester, Michael E Bodner, Anita T Cote

Background: Aerobic capacity measured by maximal oxygen uptake (VO2max) is related to functional capacity and is a strong independent predictor of all-cause and disease-specific mortality. Sex-specific cardiac and vascular responses to endurance training have been observed, however, their relative contributions to VO2max are less understood. The purpose of this study was to evaluate sex-specific ventricular-vascular interactions associated with VO2max in healthy males and females.

Methods: Sixty-eight males and females (38% females, 35 ± 10y) characterised as recreational exercisers to highly trained endurance athletes, and free of chronic disease underwent a cycle ergometer to assess VO2max. Resting arterial compliance and echocardiographic evaluation of left ventricular (LV) structure and function were measured and indexed to body surface area.

Results: VO2max was similar between groups (54 ± 6 vs. 50 ± 7 ml/kg/min, p = 0.049). Indexed LV mass (LVMi) was higher (96 ± 15 vs. 81 ± 11, p = 0.001) in males versus females, respectively. Linear regression analysis revealed two models that were significantly associated with VO2max in males and females. In males, the two models included (1) longitudinal diastolic strain rate and LVMi (r2 = 0.31, p = 0.003) and (2) indexed end-diastolic volume (EDVi) and longitudinal diastolic strain rate (r2 = 0.34, p < 0.001). In females, the linear regression models included (1) LVMi, large arterial compliance, longitudinal systolic strain rate, and age (r2 = 0.69, p < 0.001) and (2) EDVi, large arterial compliance, longitudinal systolic strain rate, and age (r2 = 0.52, p = 0.003).

Conclusion: These findings reveal that while in both sexes, LVMi and LVEDVi are associated with VO2max, arterial compliance was also found to contribute to the variance in VO2 max in females, but not in males. Further, ventricular relaxation was a significant factor in aerobic capacity in males, while in females ventricular contraction was a significant factor.

背景:由最大摄氧量(VO2max)测量的有氧能力与功能能力相关,是全因死亡率和疾病特异性死亡率的一个强有力的独立预测指标。性别特异性的心脏和血管对耐力训练的反应已经被观察到,然而,它们对最大摄氧量的相对贡献还不太清楚。本研究的目的是评估健康男性和女性中与VO2max相关的性别特异性脑室-血管相互作用。方法:68名男性和女性(38%女性,35±10岁),从休闲锻炼者到训练有素的耐力运动员,无慢性疾病,采用循环测力仪评估VO2max。静息动脉顺应性和超声心动图评价左心室(LV)的结构和功能,并与体表面积指数。结果:两组VO2max差异无统计学意义(54±6 vs 50±7 ml/kg/min, p = 0.049)。索引左室质量(LVMi)男性高于女性(96±15比81±11,p = 0.001)。线性回归分析显示两个模型与男性和女性的最大摄氧量显著相关。在男性中,两种模型包括(1)纵向舒张应变率和LVMi (r2 = 0.31, p = 0.003)和(2)指数舒张末期容积(EDVi)和纵向舒张应变率(r2 = 0.34, p 2 = 0.69, p 2 = 0.52, p = 0.003)。结论:这些研究结果表明,尽管在两性中,LVMi和LVEDVi与VO2max有关,但动脉顺应性也被发现有助于女性VO2max的变化,但在男性中没有。此外,男性心室舒张是有氧能力的重要因素,而女性心室收缩是有氧能力的重要因素。
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引用次数: 0
Diagnostic value of selected fetal echocardiographic parameters in the prenatally suspected bicuspid aortic valve. 胎儿超声心动图参数对产前怀疑为二尖瓣主动脉瓣的诊断价值。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-06 DOI: 10.1186/s44156-024-00065-w
Min Zheng, Yanping Ruan, Lin Sun, Xiaowei Liu, Jiancheng Han, Yihua He

Objective: To explore the diagnostic value of crucial parameters of echocardiography for fetal bicuspid aortic valve (BAV) and improve diagnostic accuracy.

Methods: Fetuses with a prenatal suspected diagnosis of BAV were followed, and confirmed and misdiagnosed cases were obtained. Prenatal echocardiography was reviewed and analyzed. ROC curves were plotted to evaluate the diagnostic capabilities of different echo signs.

Results: 14 cases were confirmed, and 7 patients were misdiagnosed. Some abnormal ultrasound signs were observed in both groups, including direct ultrasound signs of the aortic valve: Two commissures and a "fish-mouth" opening; Thickening, hyperechogenicity, or the presence of a raphe; Restricted motion or opening; Eccentric or a-linear valve leaflet closure line and indirect ultrasound signs: Increased supra-aortic valve velocity; Post-stenotic widening of the ascending aorta. The combination of "Increased supra-aortic valve velocity" and "Two commissures and a 'fish-mouth' opening" had the highest AUC (AUC: 0.893, 95%CI: 0.752-1.000, Sensitivity: 0.786, Specificity: 1.000).

Conclusions: We first found that the combination of "Increased supra-aortic valve velocity" and "Two commissures and a 'fish-mouth' opening" had the best diagnostic capability and could reduce the rate of misdiagnosis. Fetuses with BAV should be followed up prenatally for the aortic valve and ascending aorta as they progressively deteriorate with gestational age.

目的:探讨超声心动图关键参数对胎儿双尖瓣主动脉瓣(BAV)的诊断价值,提高诊断准确率。方法:对产前疑似BAV的胎儿进行随访,收集确诊和误诊病例。对产前超声心动图进行回顾和分析。绘制ROC曲线,评价不同回声征象的诊断能力。结果:确诊14例,误诊7例。两组均观察到超声异常征象,包括主动脉瓣的直接超声征象:两个相交和一个“鱼嘴”开口;增厚:增厚、高回声性或裂口的存在;受限的运动或开口;瓣叶闭合线偏心或a型线状,超声间接征象:主动脉上瓣速度增加;升主动脉狭窄后扩大。“主动脉上瓣速度增加”和“双相交+一个‘鱼嘴’开口”组合的AUC最高(AUC: 0.893, 95%CI: 0.752-1.000,敏感性:0.786,特异性:1.000)。结论:我们首先发现“主动脉瓣上瓣速度加快”和“双相交+一个‘鱼嘴’开口”的组合诊断能力最好,可降低误诊率。BAV胎儿应在产前随访主动脉瓣和升主动脉,因为它们随着胎龄逐渐恶化。
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引用次数: 0
Feasibility of three dimensional and strain transthoracic echocardiography in a single-centre dedicated NHS cardio-oncology clinic. 三维和应变经胸超声心动图在英国国家医疗服务系统(NHS)心脏肿瘤专科门诊单中心的可行性。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-16 DOI: 10.1186/s44156-024-00063-y
Patrick O'Driscoll, David Gent, Liam Corbett, Rod Stables, Rebecca Dobson

Background: Following the publication of international cardio-oncology (CO) imaging guidelines, standard echocardiographic monitoring parameters of left ventricular systolic function have been endorsed. Recommendations highlight that either two-dimensional (2D) or three-dimensional (3D) left ventricular ejection fraction (LVEF), alongside global longitudinal strain (GLS) should be routinely performed for surveillance of patients at risk of cancer therapy-related cardiac dysfunction (CTRCD). We studied the feasibility of 3D-LVEF, 2D-GLS and 2D-LVEF in a dedicated CO service.

Methods: This was a single-centre prospective analysis of consecutive all-comer patients (n = 105) referred to an NHS CO clinic. Using a dedicated Philips EPIQ CVx v7.0, with X5-1 3D-transducer and 3DQA software, we sought to acquire and analyse 2D- and 3D-LVEF and 2D-GLS, adhering to the British Society of Echocardiography (BSE) and British Cardio-Oncology Society (BCOS) transthoracic echocardiography protocol.

Results: A total of 105 patients were enrolled in the study; 5 were excluded due to carcinoid heart disease (n = 5). Calculation of 3D-LVEF was achieved in 40% (n = 40), 2D-GLS in 73% (n = 73), and 2D-LVEF in 81% (n = 81). LV quantification was not possible in 19% (n = 19) due to poor myocardial border definition. Strong correlation existed between 2D-LVEF and 3D-LVEF (r = 0.94, p < 0.0001). Bland-Altman plot demonstrated no statistical differences in that the mean deviation between 2D-LVEF and 3D-LVEF were consistent throughout a range of LVEF values. The most persistent obstacle to 3D-LVEF acquisition was insufficient myocardial border tracking (n = 30, 50%).

Conclusion: This study demonstrates the high feasibility of 2D-GLS and 2D-LVEF, even in those with challenging echocardiographic windows. The lower feasibility of 3D-LVEF limits its real-world clinical application, even though only a small difference in agreement with 2D-LVEF calculation was found when successfully performed.

背景:随着国际心脏肿瘤学(CO)成像指南的出版,左心室收缩功能的标准超声心动图监测参数已得到认可。建议强调,无论是二维(2D)或三维(3D)左心室射血分数(LVEF),以及整体纵向应变(GLS)应常规监测癌症治疗相关心功能障碍(CTRCD)风险的患者。我们研究了3D-LVEF、2D-GLS和2D-LVEF在专门CO服务中的可行性。方法:这是一项单中心前瞻性分析,涉及到NHS CO诊所的连续所有患者(n = 105)。使用专用的飞利浦EPIQ CVx v7.0, X5-1 3d传感器和3DQA软件,我们试图获取和分析2D和3D-LVEF和2D- gls,遵循英国超声心动图学会(BSE)和英国心脏肿瘤学会(BCOS)经胸超声心动图协议。结果:共纳入105例患者;5例因类癌性心脏病被排除(n = 5)。3D-LVEF计算率为40% (n = 40), 2D-GLS计算率为73% (n = 73), 2D-LVEF计算率为81% (n = 81)。19% (n = 19)患者由于心肌边界定义不清而无法进行左室定量。2D-LVEF和3D-LVEF之间存在很强的相关性(r = 0.94, p)。结论:本研究证明了2D-GLS和2D-LVEF的高度可行性,即使在超声心动图窗口困难的患者中也是如此。3D-LVEF较低的可行性限制了其在现实世界的临床应用,即使在成功执行时发现与2D-LVEF计算只有很小的差异。
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引用次数: 0
The implementation of speckle tracking echocardiography for cardiac resynchronization therapy optimisation. A rotational myocardial mechanics interpretation. 斑点跟踪超声心动图在心脏再同步化治疗优化中的应用。旋转心肌力学解释。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-02 DOI: 10.1186/s44156-024-00062-z
Alexandros Stefanidis, Paraskevi Korlou, Panagiotis Margos, Ignatios Ikonomidis, Ioannis Paraskevaidis, Konstantinos Gatzoulis, Evmorfia Aivalioti, Konstantinos Kostopoulos

Background: Cardiac resynchronization therapy (CRT) has an additive therapeutic influence on left ventricular function in heart failure patients, but the underlying mechanisms through which it works are not completely explained. Our aim was to further elucidate the role of this intervention via rotational mechanics using 2D speckle tracking echocardiography (2D-STE).

Results: We investigated 46 patients (65 ± 9 years) who received CRT. All enrolled patients were assessed on admission by 2D-STE and 6 min walk test (6 min WT) and followed in the outpatient device clinic by 2D-STE (at 1 week and 6 months post-implantation) and 6 min WT (at 6 months post-implantation). On their first appointment all biventricular systems were optimised by atrioventricular delay optimisation and by changing the temporal activation of ventricular electrodes aiming to reach the highest left ventricular effective stroke volume across all activation options. A new 2D-STE based index (twist integral) targeting to assess the rotational mechanics of the whole cardiac cycle was also measured to further explain the CRT response. Twenty-two (48%) patients were responders at 6-month follow-up and most of them had dilated cardiomyopathy. The commonest selected mode that was related with the greatest left ventricular performance response was the simultaneous activation of the 2 ventricular leads (39%). The strongest predictor of CRT response was the improvement of effective stroke volume between admission and first appointment at clinic, followed by the improvement of twist integral, the absence of coronary artery disease, and the improvement of peak systolic twist.

Conclusions: Additional CRT optimisation via changing the temporal activation of ventricular electrodes is beneficial for left ventricular performance in heart failure patients. The success of biventricular pacing may also be explained by the improvement of left ventricular rotational mechanics.

背景:心脏再同步化治疗(CRT)对心力衰竭患者的左心室功能具有附加治疗作用,但其作用的潜在机制尚未完全解释。我们的目的是通过使用二维散斑跟踪超声心动图(2D- ste)的旋转力学进一步阐明这种干预的作用。结果:本组患者46例(65±9岁)接受CRT治疗。所有入组患者在入院时通过2D-STE和6分钟步行测试(6分钟WT)进行评估,并在门诊设备诊所进行2D-STE(植入后1周和6个月)和6分钟WT(植入后6个月)。在他们的第一次预约中,通过房室延迟优化和通过改变心室电极的时间激活来优化所有双心室系统,旨在达到所有激活选项中最高的左心室有效脑卒中容积。我们还测量了一种新的基于2D-STE的指标(扭转积分),旨在评估整个心脏周期的旋转力学,以进一步解释CRT反应。22例(48%)患者在6个月的随访中有反应,其中大多数患有扩张型心肌病。与最大左心室表现反应相关的最常见的选择模式是同时激活2个心室导联(39%)。CRT反应的最强预测因子是入院至首次预约之间有效脑卒中容量的改善,其次是扭转积分的改善、冠状动脉疾病的消失和收缩扭转峰值的改善。结论:通过改变心室电极的时间激活来优化额外的CRT有利于心力衰竭患者的左心室功能。双心室起搏的成功也可以通过左心室旋转力学的改善来解释。
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引用次数: 0
Visual grading of valvular regurgitation is inferior to measurement - results from the VIAVA-study (VIsual Assessment of VAlvular Regurgitation). 瓣膜返流的视觉分级不如测量--VIAVA(瓣膜返流的视觉评估)研究的结果。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-11 DOI: 10.1186/s44156-024-00061-0
Ozan Demirel, Paolo Di Stefano, Elke Boxhammer, Thomas Wuppinger, Christina Granitz, Björn Goebel, Uta C Hoppe, Michael Lichtenauer, Moritz Mirna

While the visual estimation of systolic left ventricular function by experienced examiners closely aligns with quantitative methodologies, the accuracy of visual estimation in determining the severity of valvular regurgitation using colour flow Doppler assessment of native heart valves remains largely unexplored. This study analysed the ability of 262 physicians to visually estimate the severity of 12 native valve regurgitations by grading colour Doppler transthoracic echocardiography loops in an online questionnaire. The assessments of the participants were compared to standardized quantitative evaluations conducted by certified echocardiography experts. Of the three valves to assess, evaluations by the participants showed the best correlation (Rs = 0.75, p < 0.0001) and agreement (percent agreement: 66.4%) with those of the experts in mitral valve regurgitation (MR). High agreement was observed for mild regurgitation across all valves (MR 94.5%, AR 80.3% and TR 88.7%), while consensus diminished in moderate (MR 55.9%, AR 49.5% and TR 55.0%) and severe regurgitation (MR 57.6%, AR 67.4%, TR 14.6%). The study underscores the potential utility of visual estimation of valvular regurgitation in clinical settings for identifying clinically relevant regurgitations. However, our findings also highlight the importance of integrating visual estimation with quantitative methods, particularly in moderate and severe cases of regurgitation.

虽然经验丰富的检查人员对左心室收缩功能的目测与定量方法密切相关,但使用彩色多普勒血流评估原发性心脏瓣膜来确定瓣膜返流严重程度的目测准确性在很大程度上仍未得到探讨。本研究分析了 262 名医生通过在线问卷对彩色多普勒经胸超声心动图环路进行分级,从而目测 12 个原发性瓣膜返流严重程度的能力。参与者的评估结果与认证超声心动图专家进行的标准化定量评估结果进行了比较。在需要评估的三个瓣膜中,参与者的评估结果显示出最佳的相关性(Rs = 0.75,P
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引用次数: 0
A proposal of a simplified grading and echo-based staging of aortic valve stenosis to streamline management. 建议对主动脉瓣狭窄进行简化分级和基于回声的分期,以简化管理。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-04 DOI: 10.1186/s44156-024-00064-x
Attila Kardos, Mani A Vannan

In this paper we discuss the relevance of continuity equation based aortic valve area (AVA) calculation as a robust parameter suitable for accurate grading of aortic stenosis (AS) irrespective of flow conditions. Combining the AVA-based grading and echocardiography-based staging, can provide with the most comprehensive clinical assessment of patients with AS and preserved left ventricular systolic function to streamline management decisions.

在本文中,我们讨论了基于连续性方程的主动脉瓣面积(AVA)计算的相关性,它是一个稳健的参数,适合对主动脉瓣狭窄(AS)进行准确分级,而不受血流条件的影响。将基于 AVA 的分级与基于超声心动图的分期相结合,可对保留左室收缩功能的主动脉瓣狭窄患者进行最全面的临床评估,从而简化管理决策。
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引用次数: 0
Left atrial volume assessed by echocardiography identifies patients with high risk of adverse outcome after acute myocardial infarction. 通过超声心动图评估左心房容积,确定急性心肌梗死后不良预后风险高的患者。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-21 DOI: 10.1186/s44156-024-00060-1
Jorun Tangen, Thuy Mi Nguyen, Daniela Melichova, Lars Gunnar Klaeboe, Marianne Forsa, Kristoffer Andresen, Adrien Al Wazzan, Oyvind Lie, Fatih Kizilaslan, Kristina Haugaa, Helge Skulstad, Harald Brunvand, Thor Edvardsen

Background: The left atrial (LA) volume has been demonstrated to be an important predictor of adverse outcome in patients with various cardiac conditions, including acute myocardial infarction (AMI). However, new treatment strategies in patients with AMI have led to better patient outcomes. We hypothesised that increased LA size could still predict mortality in patients with AMI despite improved treatment strategies.

Methods: We included patients with AMI in a prospective multicenter cohort study and the study patients were enrolled from 2014 to 2022. We recorded echocardiographic and clinical data during their index hospitalisation. Indexed LA volume (LAVi) was assessed in all patients and was used as a continuous variable in the univariate and multivariate Cox regression analysis. The study took place over a period of five years and median follow-up time was 3.8 years (range 3.1 to 5.0 years). The primary study outcomes were all-cause mortality and major adverse cardiac events (MACE). MACE was defined as hospital readmission due to myocardial infarction, cardiac arrest, stroke, heart failure, or onset of new atrial fibrillation.

Results: We included 487 patients (69 ± 12 years old, 26% female) with AMI. During the follow-up period all-cause mortality was 50 (10.3%) and patients who reached the primary outcomes were 153 (31.4%). The deceased patients had higher LAVi compared to survivors (40.0 ± 12.9 mL/m2 vs. 29.7 ± 11.2 mL/m2, p < 0.001). Factors associated with all-cause mortality and MACE were age, year of enrollment, left ventricular (LV) ejection fraction, LV global longitudinal strain (GLS), LV filling pressure, moderate or severe mitral regurgitation and LAVi. GLS and EF were segregated into two distinct models due to their moderately high correlation (r = 0.57, p < 0.001). LAVi remained as an independent echocardiographic predictor of primary outcomes after adjusting for the covariates above in two separates multivariable Cox regression models (hazard ratio 1.02/1.02 mL/m2 [95% CI 1.01-1.03/1.01-1.03], p = 0.006/0.003).

Conclusions: Our study demonstrated that LA dilatation is an independent echocardiographic predictor of mortality and MACE in patients with AMI despite improved treatment strategies. This finding highlights the potential of using LAVi as a marker for prognostication in these patients.

背景:左心房(LA)容积已被证实是预测包括急性心肌梗死(AMI)在内的各种心脏病患者不良预后的重要指标。然而,针对急性心肌梗塞患者的新治疗策略已为患者带来了更好的预后。我们假设,尽管治疗策略有所改进,但 LA 的增大仍能预测 AMI 患者的死亡率:我们在一项前瞻性多中心队列研究中纳入了急性心肌梗死患者,研究患者的入组时间为 2014 年至 2022 年。我们记录了患者住院期间的超声心动图和临床数据。我们评估了所有患者的指数 LA 容积(LAVi),并将其作为单变量和多变量 Cox 回归分析中的连续变量。研究历时五年,中位随访时间为 3.8 年(3.1 至 5.0 年)。主要研究结果为全因死亡率和主要心脏不良事件(MACE)。MACE的定义是因心肌梗死、心脏骤停、中风、心力衰竭或新发心房颤动而再次入院:我们纳入了 487 名急性心肌梗死患者(69 ± 12 岁,26% 为女性)。随访期间,全因死亡率为 50 例(10.3%),达到主要结果的患者为 153 例(31.4%)。与幸存者相比,死亡患者的 LAVi 较高(40.0 ± 12.9 mL/m2 vs. 29.7 ± 11.2 mL/m2,P 2 [95% CI 1.01-1.03/1.01-1.03],P = 0.006/0.003):我们的研究表明,尽管治疗策略有所改善,但LA扩张仍是预测AMI患者死亡率和MACE的独立超声心动图指标。这一发现凸显了将 LAVi 作为这些患者预后标志物的潜力。
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Echo Research and Practice
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