Echo Research and Practice最新文献

Background: Left ventricular thrombus (LVT) is a recognized complication of severe left ventricular (LV) systolic dysfunction. While cardiac magnetic resonance (CMR) Imaging is considered the gold standard due to its high sensitivity and specificity for detecting LVT, its availability remains limited in Sub-Saharan Africa. In contrast, 2D transthoracic echocardiography (TTE) is more accessible and commonly used in clinical practice. This study aimed to determine the incidence of LVT in patients with a left ventricular ejection fraction (LVEF) of less than 35% from any etiology, and to compare the diagnostic accuracy of TTE against CMR for its detection.

Methods: This prospective, cross-sectional study was conducted at the Aga Khan University Hospital Nairobi (AKUH, N). The study included patients aged 18 years and above with new onset heart failure symptoms and severely reduced LVEF of ≤ 35%. The study was conducted between January 2021 and December 2023. Patients underwent non-contrast 2D TTE and CMR within a 14-day interval. Diagnostic accuracy of 2D TTE was assessed using sensitivity, specificity, and predictive values.

Results: A total of 100 patients were included in the final analysis. The median age of participants was 58.0 years (IQR: 47.0-67.0). The median LVEF was 30% (IQR: 20-33). The median time between 2D echocardiography and cardiac MRI was 10 days (IQR: 1-12). LVT was detected in 11 patients (11%) on CMR. A significantly higher proportion of those with LVT had an ischemic etiology (n = 10, 90.9%) (p < 0.05). Participants with LVT had a lower LVEF (19%, IQR: 14-31) and larger left ventricular internal diameters (IQR 62 mm, IQR: 55-77.5) (p- value < 0.05). Among those with LVT, 73% (n = 8) had it detected by both diagnostic modalities. The 2D TTE's sensitivity and specificity for detecting LVT were 0.72 and 0.78, respectively, with an excellent negative predictive value of 0.98.

Conclusion: 11% of patients were found to have LVT on CMR. Patients with ischemic cardiomyopathy, significantly reduced LVEF, and a dilated LV, were identified as being at the highest risk for developing LVT. 2D TTE showed an excellent negative predictive value in excluding the presence of LVT.

Background: In this study, we evaluated the utility of the continuous wave (CW) Doppler pre-attenuation velocity envelope as a potential surrogate for pulsed-wave (PW) Doppler-based interrogation of left ventricular outflow tract (LVOT) flow in patients with moderate or severe aortic stenosis.

Methods: In a retrospective analysis, we examined 92 patients with moderate or severe aortic stenosis. Pulsed-wave Doppler was employed to acquire LVOT velocity and velocity time integral (VTI) in the 5-chamber view. CW Doppler recordings were scrutinized across multiple views with a specific focus on identifying a discernible pre-attenuation velocity envelope. Through manual tracing, we extracted peak velocity and VTI across the aortic valve as well as the pre attenuated velocity, which was used as a surrogate for LVOT assessment and substitute in the continuity equation in the evaluation of aortic valve stenosis.

Results: The pre-attenuation velocity envelope was distinctly discernible in 83 (90%) of patients. PW Doppler of the LVOT velocity significantly correlated with pre-attenuation velocity from the 5-chamber view (r = 0.75, p-value < 0.001) but showed a weaker correlation when obtained from other windows (r = 0.46, p-value < 0.001). Bland-Altman analyses indicated high levels of agreement between pre-attenuation velocities from the 5-chamber view and PW Doppler derived LVOT velocities, while weaker levels of agreement were observed between pre-attenuation velocities from other windows and PW Doppler derived LVOT velocities.

Conclusions: The pre-attenuation velocity envelope is attainable in the majority of patients with aortic stenosis. The pre-attenuation velocity envelope recorded from the 5-chamber view exhibits a noteworthy correlation and agreement with PW Doppler LVOT velocity. This observation positions pre-attenuation velocity envelope as a promising alternative and plausibility check for hemodynamic assessment in patients with aortic stenosis.

Background: Stress echocardiography is a key imaging modality for assessing coronary artery disease in the UK. Traditionally, stress echo services were led by consultant cardiologists, but evolving workforce models have increased the involvement of cardiac physiologists and scientists. This study, as part of the National Review of Stress Echocardiography Practice (BSE N-STEP), aimed to evaluate current stress echo workforce structures and test outcomes across a group of UK hospitals to inform future workforce planning.

Results: Data were analysed from 8506 stress echocardiograms, conducted between September 2020 and June 2023 across 34 UK hospitals. Based on the supervising workforce, stress echocardiograms were allocated into either a doctor-led (DL) or cardiac physiologist/scientist and nurse-led (CNL) model. 56.9% of stress echocardiograms were DL, while 42.7% were conducted under a CNL model. Physiologists/scientists were the most frequently involved staff (81.9%). The primary indication for stress echocardiography was ischaemia evaluation (89.4%). Dobutamine stress echocardiography was more common in DL services (63.0 vs. 56.3%, p < 0.001), while CNL services performed more exercise stress echocardiography (42.8 vs. 36.4%, p < 0.001). Test positivity rates were similar between DL and CNL models (17.1 vs. 17.7%, p = ns), though the CNL group had a lower complication rate (2.2 vs. 5.3%, p < 0.001). Reporting of stress echocardiograms remained consultant-led in 82% of cases, but physiologist/scientist-led reporting showed an increase over time. Training was primarily provided to registrars/fellows (60.2%), with physiologist/scientist trainees accounting for 32.4%.

Conclusions: This study provides a contemporary overview of stress echocardiography workforce models in the UK, highlighting the increasing role of cardiac physiologists and scientists in supervising and reporting stress echocardiography. Despite these shifts, consultant cardiologists remain central to stress echo reporting. The findings support the integration of multidisciplinary workforce models to enhance service efficiency. These insights will aid in future workforce planning and training strategies to optimise stress echocardiography service provision across the NHS.

Background: Myocardial strain measurements are increasingly used in research and clinical practice. However, there are limited data on inter-modality agreement and reproducibility. We aimed to investigate the inter-technique agreement of transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) imaging derived left atrial (LA) and left ventricular (LV) deformation parameters.

Methods: Subjects with or without cardiovascular disease were prospectively recruited and had TTE and CMR on the same day. Ten subjects with type 2 diabetes (T2D) had both scans repeated within two weeks for test-retest reproducibility assessment. Myocardial deformation analyses were undertaken including LA strain (LAS) corresponding to LA reservoir, conduit and booster pump phases, LV global longitudinal strain (GLS) and peak early/late diastolic strain rate (PE/PLDSR) and LV mid-circumferential strain (Mid-CS) and strain rates.

Results: 222 participants (T2D (n = 87); severe aortic stenosis (n = 78) and healthy volunteers (n = 57)) were included. There were no significant differences between TTE and CMR measured LAS parameters, with moderate agreement between imaging modalities (ICC = 0.55-0.69). LV parameters were significantly higher on CMR except for Mid-CS which was higher on TTE (-19.3 ± 3.19 vs. -23.0 ± 4.37; p < 0.001). Inter-technique agreement was poor for all LV deformation parameters, except PLDSR with modest agreement (ICC = 0.52-0.66). CMR test-retest reproducibility was good to excellent for LAS and LV strain rate parameters (ICC = 0.73-0.90). TTE test-retest reproducibility was good for conduit LAS and LV_PEDSR (ICC = 0.80).

Conclusion: There is modest agreement between TTE and CMR for LAS and poor agreement for LV strain assessment, suggesting that these techniques cannot be used inter-changeably. In a small subset of participants CMR test-retest reproducibility was overall better than TTE.

Background: Aortic stenosis (AS) is a common valvular heart disease where aortic valve replacement (AVR) is the only treatment. A novel staging system based on cardiac damage was developed to assess the pathophysiological consequence of AS and this has been shown to be associated with outcomes post AVR.

Methods: We conducted a systematic review of studies which evaluated cardiac damage in patients with AS. A search of MEDLINE and EMBASE was performed with data being extracted from relevant studies. The main outcome of interest were proportion of AS patients with signs of cardiac damage, all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.

Results: A total of 18 studies were included with 21,876 patients (mean age 79 years, 52.7% males). Pooled analysis indicated 76% of symptomatic severe AS patients and 88% of asymptomatic moderate/severe AS patients had signs of cardiac damage, with stage two being the most commonly reported (25.1% and 32.3% respectively). For symptomatic severe AS patients, the pooled all-cause mortality and cardiovascular mortality rates increased along an increase in cardiac damage stage from 9.4% to 2.0% respectively for stage 0 to 24.2% and 36.1% respectively for stage 4. In patients with asymptomatic moderate / severe AS, all-cause mortality ranged from 30.0% in stage 0 to 51.2% in stage 3/4. In patients with symptomatic severe AS undergoing AVR, meta-analysis indicated an increase in odds of cardiovascular related mortality for stage 4 cardiac damage only (OR 6.89, 95% CI: 3.04,15.61, p = 0.003). An increased odds of all-cause mortality was seen in for cardiac damage stages 1, 3 and 4 (OR 1.4, 95%CI: 1.10,1.77, p = 0.01, OR 2.27, 95%CI: 1.76,2.92, p = 0.0002 and OR 2.94, 95%CI: 1.97,4.38, p = 0.0006 respectively).

Conclusions: Cardiac damage is a common finding amongst patients with AS irrespective of AS severity or symptomatic status. Mortality rates appear to increase alongside an increase in cardiac damage staging. Cardiac damage may provide prognostic valve when considering the timing of AVR with left ventricular and right ventricular abnormalities being associated with increased odds of mortality.

Clinical trial number: Not applicable.

Ventricular arrhythmia (VA) is one of the common complications of many heart diseases in clinical practice, even some of its clinical symptoms are mild and non-specific, but the other may lead to sudden cardiac death (SCD) and most life-threatening VA is associated with ischemic cardiomyopathy (ICM). Nowadays, the developments in imaging techniques have provided clues to identify these highly variable VAs, which make clinicians identify patients with VA early and effectively who may have fatal consequences. Thereafter, it is beneficial to manage the risk stratification of patients, optimize their follow-up treatment, and improve clinical outcomes. This article reviews current ultrasound and magnetic resonance imaging techniques that can aid in diagnosis, treatment and prognosis, and provides clinicians with practical imaging and analytical recommendations to further identify patients with ICM who may develop VA. Clinical trial number Not applicable.

Background: Post-systolic shortening (PSS) has emerged as a method for evaluating left ventricular dysfunction. We aimed to determine whether pathological PSS, alone or in combination with global longitudinal strain (GLS), is a prognostic factor for major adverse cardiovascular events (MACEs) in patients with type 2 diabetes. We prospectively investigated 364 patients with type 2 diabetes aged 55-65 years in the CARDIPP study. All patients underwent echocardiography between 2005 and 2009. PSS, measured by speckle tracking echocardiography, was defined as myocardial contraction after aortic valve closure. Pathological PSS was defined as a post-systolic index > 5% and was calculated as follows: [(maximum longitudinal strain - peak systolic longitudinal strain)/(maximum longitudinal strain)]. The endpoint was any MACE, defined as hospitalization or death due to heart failure, myocardial infarction, or stroke. Cox proportional hazard ratios (HR) with 95% confidence intervals (CI) were calculated and adjusted for sex, age, body mass index, hypertension, smoking, previous cardiovascular events, and HbA1c level. The mean follow-up time was 11.2 ± 2.3 years.

Results: Pathological PSS was associated with an increased risk of MACEs after adjustment for other cardiovascular risk factors (HR 2.20, 95% CI 1.11-4.37). Subjects with reduced GLS, PSS and GLS combined in a risk prediction model, had an adjusted HR for MACEs of 2.94 (95% CI 1.33-6.52).

Conclusions: Our results suggest that PSS may provide additional prognostic information for patients with T2D when used alone or in combination with GLS.

Echocardiography has established itself as a vital component in the diagnosis and management of cardiovascular disease, evolving alongside advancements in imaging technology and clinical research methodologies. Since its inception in the 1950s, echocardiographic research has progressed from small-scale, observational studies to large cohort investigations and randomised controlled trials. This evolution has paralleled advancements in disease diagnosis and facilitated the use of echocardiography as an important player in other disciplines such as cardio-oncology and interventional cardiology. Echocardiography research has made great progress, with new developments rapidly shaping the field. This continued innovation underscores the singular focus of improving patient care. As digital and technological advancements accelerate, the potential for research in echocardiography to enhance diagnostic precision, guide personalised treatment, and improve outcomes on a global scale is greater than ever. Collaborative efforts and sustained investment in research will be key to realising these goals and advancing the care of patients with cardiovascular disease. This review explores the historical and ongoing contributions of echocardiography research to better understanding cardiac disease, emphasising the pivotal roles of early feasibility studies and large-scale trials in refining techniques and establishing clinical utility. Key infrastructure requirements for advancing echocardiography research are identified, including workforce development, academic and healthcare collaborations, clinical trial support, and access to big data and computational expertise. Emerging technologies, such as advanced imaging techniques, handheld devices, and AI-driven analytics, are highlighted as transformative tools poised to address current limitations in clinical practice.