Echo Research and Practice最新文献

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.

Background: Transthoracic echocardiography (TTE) is used to assess aortic stenosis (AS) severity and track disease progression. As the field moves to study medical therapies to halt disease progression, reliable non-invasive imaging markers that are sensitive to small changes in disease progression are needed to enable efficient trial designs. The signal-to-noise ratio of commonly obtained TTE-based measures of progressive (non-severe) AS severity is unknown.

Methods: This is a retrospective study of TTEs done at a tertiary referral centre (Tufts Medical Center, Boston MA). A cohort of patients with progressive AS who had two TTEs done within 30 days (in the absence of valve intervention) and a cohort of progressive AS patients with TTEs ≥ 1 year apart, also without valvular intervention, were assembled. Limits of agreement (LOA) and intraclass correlation (ICC) were calculated for aortic valve area (AVA) by continuity equation, peak velocity, and mean gradient. Cohen's d-statistic (d) was calculated for each hemodynamic assessment and a composite marker to assess sensitivity for detecting disease progression normalised to measurement variability.

Results: The reproducibility cohort included 24 patients. The progression cohort included 35 patients. The median age was 70 years (interquartile range [IQR] 13). 22 patients (37.3%) were female. In the progression cohort, the median time between TTEs was 2.2 years (IQR 3.1 years). In the reproducibility cohort, AVA LOA were -0.7 to 0.8, ICC = 0.61; peak velocity LOA were -149.0 to + 126.7, ICC = 0.29; and mean gradient LOA were -16.2 to 12.2, ICC = 0.06. The d-statistic for annualised change in AVA was -0.29, the d-statistic for annualised change in maximum velocity was 0.46, the d-statistic for mean gradient was 0.55. The d-statistic for a composite, including all three hemodynamic markers, was 0.45.

Conclusions: Standard TTE markers of AS severity have variable sensitivity for detecting AS progression. For patients with progressive (non-severe) AS, mean gradient has the highest signal-to-noise ratio and may be the most reliable TTE-based assessment of disease progression.

Background: Epicardial adipose tissue has been identified as a significant marker in the assessment of coronary artery disease (CAD), with a possible impact on the development of acute coronary events including ST-elevation myocardial infarction (STEMI).

Aim: To assess the association and predictability of echocardiographic-measured epicardial fat thickness (EFT) for the severity of CAD and mortality risk among STEMI patients.

Methods: This study included 159 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) and survived the in-hospital duration. Anthropometric measurements, lipid profiles, and angiographic data were recorded. The correlations between echo-measured EFT and CAD severity indicated by the syntax score (SS) were assessed. In-hospital and 6-month major adverse cardiovascular events (MACE) were reported, and mortality risk was evaluated using the Grace score.

Results: Among the study population, 104 patients (65.4%) had low SS, 45 patients (28.3%) had moderate SS, and 10 patients (6.3%) had high SS. STEMI patients with moderate/high SS had significantly larger EFT. EFT showed a significant correlation with BMI (r = 0.57), fat mass (kg) (r = 0.44), LDL (r = 0.40), the syntax score (r = 0.74), and the Grace score (r = 0.68), (p < 0.001 for all). Our ROC-derived cutoff value of EFT ≥ 5.45 mm significantly discriminated STEMI patients with moderate/high-SS, high coronary thrombus burden, 6-months high mortality risk, and 6-months MACE with reasonable respective sensitivity and specificity. Increased EFT independently predicted moderate/high-SS and high mortality risk on multivariable regression analysis.

Conclusion: Echo-measured EFT ≥ 5.45 mm might be a reliable non-invasive marker for predicting CAD severity, high coronary thrombus burden, 6-months high mortality risk, and 6-months MACE among STEMI patients.

Objectives: The study aimed to evaluate differences in conventional, tissue Doppler imaging (TDI) and speckle-tracking echocardiographic (STE) parameters of all cardiac chambers between SSc patients and healthy controls.

Methods: A study search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. MEDLINE, Scopus and Web of Science were searched using the following keywords: "speckle tracking", "global strain", "longitudinal strain", "circumferential strain", "radial strain", "atrial strain", "right ventricular strain", or "left ventricular strain" and "systemic sclerosis". Primary pooled analyses were performed on each cardiac parameter independently to determine the weighted mean difference (WMD) between SSc and controls. Further independent subgroup analyses were performed to compare symptomatic vs asymptomatic SSc and diffuse vs limited SSc.

Results: The systematic review and meta-analysis included 41 case-control eligible reports studies with a pooled sample size of 2497 SSc cases and 1439 controls. Significant weighted mean differences (WMD) between SSc patients and healthy controls were identified in septal S' wave (WMD 0.343 cm/s, CI [- 0.540-0.145], I²: 36%, p = 0.001), lateral S' wave (WMD 0.795 cm/s, CI [- 1.394-0.197], I²: 0%, p = 0.009), tricuspid S' wave (WMD 1.137 cm/s, CI [- 1.784-0.489], I²: 84%, p = 0.001), septal e' wave (WMD 1.398 cm/s, CI [- 2.272-0.523], I²: 82%, p = 0.002) and lateral e' wave (WMD 3.545 cm/s, CI [- 4.990-2.100], I²: 71%, p < 0.001) velocities. STE parameters were attenuated in patients with SSc, with impairment of left ventricular global longitudinal (WMD 2.765%, CI [- 3.482-2.049], I²: 91%, p < 0.001), circumferential (WMD 3.145%, CI [- 4.181-2.109], I²: 79%, p < 0.001), and radial (WMD 4.044%, CI [- 6.199-1.889], I²: 0%, p < 0.001) strain, right ventricular free wall (WMD 4.492%, CI [- 6.048-2.937], I²: 76%, p < 0.001) and right ventricular global longitudinal strain (WMD 2.843%, CI [- 3.290-2.396], I²: 32%, p < 0.001), as well as left (WMD - 8.317%, CI [- 11.873-4.761], I²: 82%, p < 0.001) and right (WMD 7.346%, CI [- 10.536-4.156], I²: 26%, p < 0.001) atrial reservoir strain.

Conclusion: SSc is associated with significantly impaired cardiac function and mechanics compared to healthy individuals, even in the absence of symptoms or pulmonary hypertension.

Background: GLS is a non-invasive imaging test that can be useful in the selection of patients highly suspected of CCS for coronary angiogram.

Aims: This study aimed to evaluate the diagnostic performance of rest 2D speckle tracking echocardiography (2D-STE) for detecting obstructive coronary artery disease (CAD) in patients with high clinical probability of chronic coronary syndrome (CCS) and preserved left ventricular ejection fraction (LVEF).

Methods: A prospective study enrolled 52 patients referred for coronary angiography due to highly suspected CCS. Participants were divided into CAD+ (significant stenosis) and CAD- (normal or non-significant stenosis). Transthoracic echocardiography (TTE), exercise EKG, 2D-STE, and coronary angiography were performed. Global longitudinal peak systolic strain (GLS) was calculated using 2D-STE, with a cut-off value of -18% for normal GLS. Reproducibility was assessed with intraclass correlation.

Results: The mean age of participants was 62.5 ± 11.9 years, and 63.5% were male. The CAD + group (51.9%) had significantly higher rates of hypertension, diabetes, dyslipidemia, and typical angina. GLS was significantly lower in the CAD + group (-15.89 ± 2.07%) compared to the CAD- group (-18.99 ± 2.37%, p = 0.0001). The optimal GLS cut-off for detecting significant coronary lesions was - 16.9%, with 74% sensitivity, 76% specificity, and an area under the curve (AUC) of 0.83 (95% CI 0.73-0.94). GLS correlated with the number of diseased vessels (p = 0.0001) but not with lesion complexity (SYNTAX score, p = 0.18). Regional strain was significantly reduced in patients with obstructive lesions in the left anterior descending (LAD) and circumflex arteries (CX), with optimal cut-offs at -19.2% and - 15.8%, respectively. GLS showed excellent inter-operator reproducibility (ICC = 0.94, p < 0.0001).

Conclusion: GLS demonstrates good diagnostic performance in detecting obstructive CAD in patients with a high pre-test probability of CCS and preserved LVEF. It serves as a reliable, reproducible indicator of significant coronary lesions, with promising clinical utility for non-invasive CAD assessment, particularly in resource-limited settings.

Background: The number of patients referred for and requiring a transthoracic echocardiogram (TTE) has increased over the years resulting in more cardiac sonographers reporting work related musculoskeletal pain. We sought to determine if a scanning protocol that replaced conventional workflows with advanced technologies such as multiplane imaging, artificial intelligence (AI) and automation could be used to optimise conventional workflows and potentially reduce ergonomic risk for cardiac sonographers. The aim was to assess whether this alternate protocol could reduce active scanning time as well as interaction with the ultrasound machine compared to a standard echocardiogram without a reduction in image quality and interpretability.

Method and results: Volunteer participants were recruited for a study that comprised of two TTE's with separate protocols. Both were clinically complete, but Protocol A combined automation, AI assisted acquisition and measurement, simultaneous and multiplane imaging whilst Protocol B reflected a standard scanning protocol without these additional technologies. Keystrokes were significantly reduced with the advanced protocol as compared to the typical protocol (230.9 ± 24.2 vs. 502.8 ± 56.2; difference 271.9 ± 61.3, p < 0.001). Furthermore, there was a reduction in scan time with protocol A compared to protocol B the standard TTE protocol (13.4 ± 2.3 min vs. 18.0 ± 2.6 min; difference 4.6 ± 2.9 min, p < 0.001) as well as a decrease of approximately 27% in the time the sonographers were required to reach beyond a neutral position on the ultrasound console.

Conclusions: A TTE protocol that embraces modern technologies such as AI, automation, and multiplane imaging shows potential for a reduction in ultrasound keystrokes and scan time without a reduction in quality and interpretability. This may aid a reduction in ergonomic workload as compared to a standard TTE.