Journal of the American Society of Echocardiography最新文献

Background: Mid-apical obstruction in hypertrophic cardiomyopathy (HCM) represents a distinct anatomical and hemodynamic phenotype. However, standardized echocardiographic criteria for its identification remain limited, and its pathophysiological and prognostic implications are incompletely defined.

Methods: We studied 606 consecutive patients with HCM, stratified by the presence or absence of a midsystolic Doppler signal void, defined as a continuous-wave Doppler manifestation of systolic cavity obliteration. Left ventricular morphology, intracavitary flow characteristics, the prevalence of apical aneurysm, circulating cardiac troponin I (cTnI) levels, and left ventricular global longitudinal strain (LV-GLS) were systematically assessed.

Results: A midsystolic Doppler signal void was present in 142 patients (23.4%). Compared with patients without signal void, these patients exhibited more pronounced mid-apical hypertrophy, papillary muscle hypertrophy, smaller indexed LV end-diastolic volumes, and higher peak mid-apical Doppler gradients. They also had a higher prevalence of apical aneurysm, higher cTnI levels, and lower absolute LV-GLS (|GLS|). In multivariable analysis, apical aneurysm (OR 17.27, 95% CI 2.30-129.60; P = 0.006) and lower |GLS| (OR 0.71, 95% CI 0.58-0.89; P = 0.002) remained independently associated with Doppler signal void.

Conclusions: Midsystolic Doppler signal void identifies a distinct mid-apical obstructive phenotype in hypertrophic cardiomyopathy and may complement conventional gradient-based assessment by identifying patients with adverse structural remodeling and high-risk features.

Background: The 2025 American Society of Echocardiography (ASE) diastolic guideline updates the 2016 ASE/EACVI algorithm by incorporating outcome-anchored thresholds and left atrial (LA) strain, which may alter diastolic grading and prognostic classification.

Objectives: To quantify reclassification between the 2016 and 2025 ASE diastolic algorithms and compare outcomes-based risk stratification for 1-year heart failure (HF) hospitalization and all-cause mortality across diastolic grades and filling-pressure categories.

Methods: Using structured echocardiographic variables from Mayo Database Explorer pooled across three U.S. Mayo Clinic sites, we applied both guidelines to the same index transthoracic echocardiogram. The analytic cohort required complete parameters to operationalize both algorithms on the same study and included only sinus-rhythm examinations. Reclassification was summarized using cross-tabulation and a Sankey diagram. Outcomes were 1-year HF hospitalization and 1-year all-cause mortality. Associations were evaluated with Kaplan-Meier methods and unadjusted Cox models; discrimination for HF hospitalization was quantified using the C-index for filling-pressure classification.

Results: Of 20,000 screened index echocardiograms, sequential exclusions yielded 5,907 patients. Under the 2016 guideline, classifications were Normal 4,050 (68.6%), Indeterminate 1,111 (18.8%), Grade 1 204 (3.5%), Grade 2 400 (6.8%), and Grade 3 142 (2.4%). Under the 2025 guideline, classifications were Normal 4,219 (71.4%), Grade 1 546 (9.2%), Grade 2 931 (15.8%), and Grade 3 211 (3.6%), eliminating the indeterminate category. For HF hospitalization, 2025 high versus low filling pressure was associated with higher risk (HR 3.80, 95% CI 3.36-4.31; C-index 0.64), with comparable discrimination under the 2016 framework (HR 5.73, 95% CI 4.96-6.62; C-index 0.65). For mortality, high versus low filling pressure was also associated with increased risk in both frameworks (2025 HR 1.88, 95% CI 1.36-2.60; 2016 HR 2.10, 95% CI 1.39-3.18).

Conclusions: The 2025 ASE algorithm removes the indeterminate category and yields clear, stepwise risk stratification; however, overall prognostic discrimination for clinical outcomes using filling-pressure classification is similar to the 2016 framework.