Journal of the American Society of Echocardiography最新文献

英文中文

Utility of the Ratio Between the Size of the Right Atrium and the Right Ventricle at End-Systole to Diagnose Atrial Secondary Tricuspid Regurgitation 应用收缩期末右心房与右心室大小之比诊断心房继发性三尖瓣反流。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.11.012

Alexandra Clement MD , Denisa Muraru MD, PhD , Samantha Fisicaro RDCS , Marco Penso BME , Michele Tomaselli MD , Noela Radu MD , Caterina Delcea MD, PhD , Alexandra S. Buta MD , Valeria Rella MD, PhD , Radu Sascau MD, PhD , Luigi P. Badano MD, PhD

Background

In the multiparametric framework for diagnosing atrial secondary tricuspid regurgitation (A-STR), an end-systolic (ES) right atrial (RA)–to–right ventricular (RV) volume or area ratio ≥1.5 supports the diagnosis of A-STR over the ventricular secondary tricuspid regurgitation phenotype (V-STR). However, this threshold value has never been tested.

Methods

A single-center study was conducted, prospectively enrolling consecutive patients with secondary tricuspid regurgitation who underwent two- and three-dimensional echocardiography.

Results

A total of 350 patients were enrolled (mean age, 75 ± 13 years; 65% women). Although patients with A-STR and V-STR presented similar degrees of secondary tricuspid regurgitation and comparable RA size, the ES RA/RV volume ratio was significantly larger in A-STR than in V-STR (1.75 [interquartile range, 1.35-2.45] vs 1.18 [interquartile range, 0.81-1.66], respectively; P < .001). On receiver operating characteristic analysis, the ES RA/RV volume ratio showed a significantly higher predictive power for A-STR (area under the curve [AUC], 0.73; 95% CI, 0.68-0.78) compared with RA maximum volume (AUC, 0.6; 95% CI, 0.54-0.66; P = .01), RA minimum volume (AUC, 0.59; 95% CI, 0.53-0.65; P = .007), and ratio of RA minimum volume to RV end-diastolic volume (AUC, 0.57; 95% CI, 0.51-0.63; P < .001). However, the predictive power of the ES RA/RV volume ratio (AUC, 0.73; 95% CI, 0.68-0.78) and the ES RA/RV area ratio (AUC, 0.76; 95% CI, 0.71-0.81) for the diagnosis of A-STR was similar (P = .58). The threshold value for ES RA/RV volume ratio that best distinguished between A-STR and V-STR was 1.40 (AUC, 0.68; 95% CI, 0.63-0.73), whereas for ES RA/RV area ratio, it was 1.6 (AUC, 0.64; 95% CI, 0.59-0.69). A multivariable model that included either ES RA/RV volume ratio or ES RA/RV area ratio, along with LV ejection fraction, RV ejection fraction, RV ES volume, and pulmonary artery systolic pressure, resulted in an AUC of 0.97 for differentiating between A-STR and V-STR.

Conclusions

ES RA/RV volume ratio ≥ 1.4 and ES RA/RV area ratio ≥ 1.6 support the diagnosis of A-STR over V-STR.

背景：在诊断心房继发性三尖瓣反流（A-STR）的多参数框架中，收缩末期（ES）右心房（RA）与右心室（RV）体积或面积比≥1.5支持A-STR的诊断，而不是心室STR表型（V-STR）。然而，这个阈值从未被测试过。方法：单中心前瞻性纳入连续接受二维和三维超声心动图检查的STR患者。结果：我们纳入了350例患者（75±13岁，65%为女性）。虽然A-STR和V-STR患者的STR程度和RA大小相似，但A-STR患者的ES RA:RV体积比明显大于V-STR患者(1.75[四分位间距（IQR） 1.35-2.45]比1.18 [IQR 0.81-1.66]；结论：ES RA:RV体积比≥1.4、ES RA:RV面积比≥1.6支持A-STR优于V-STR的诊断。

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引用次数: 0

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IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/S0894-7317(25)00067-7

引用次数: 0

The Prognostic Value of Right Ventricular Dysfunction in Dilated Cardiomyopathy: Superiority of Three-Dimensional Right Ventricular Ejection Fraction Over Conventional Parameters and Over Right Ventriculoarterial Coupling 扩张型心肌病右室功能障碍的预后价值：三维右室射血分数优于传统参数和右室-动脉耦合。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.11.013

Aura Vîjîiac MD, PhD, Sebastian Onciul MD, PhD, Alina Scărlătescu MD, PhD, Cristian Vîjîiac MD, Maria Dorobanţu MD, PhD, Radu Vătășescu MD, PhD

引用次数: 0

In Memory of James N. Kirkpatrick, MD, FASE

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2025.01.013

Susan E. Wiegers MD, FASE

引用次数: 0

Are New Thresholds Required for the Assessment of Right Ventricular Function in Patients With and Without Tricuspid Regurgitation? 有三尖瓣反流和无三尖瓣反流患者的右心室功能评估是否需要新的阈值？

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.12.001

Xavier Galloo MD , Nina Ajmone Marsan MD, PhD

引用次数: 0

Impact of Length Indexing of Deformation in Echocardiographic Evaluation of Right Ventricular Function 形变长度索引在超声心动图评价右心室功能中的影响。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.11.011

Weiting Huang MD , James Hodovan RDCS, PhD , Avneesh Sharma MD , Matteo Morello MD , Onur Varli MD , Bethany Gholson RCS, ACS , Jonathan R. Lindner MD

Background

When assessing right ventricular (RV) function by echocardiography, some discordance between the deformational indices is predicted on the basis of the influence of RV length. RV free wall longitudinal strain (RVFWS) is relatively independent of RV length, whereas tricuspid annular plane systolic excursion (TAPSE) reflects the strain-length product. Systolic annular velocity (s′; distance over time) is also likely to be influenced by length. The aim of this study was to test the hypothesis that indexing TAPSE and s′ to RV length would lead to better congruency with RVFWS.

Methods

Two separate cohorts were identified from retrospective data: (1) subjects with normal cardiac function (n = 75) and (2) a cohort with high likelihood of potential RV dysfunction determined by the study indication of either pulmonary hypertension or pulmonary embolism (n = 50). RV functional indices of TAPSE, RV s′, RVFWS, and fractional area change were verified and remeasured by an expert. Correlations and concordance maps between RVFWS and either TAPSE or RV s′ were made with and without indexing the latter measurements to RV length. Predictive accuracy for detecting abnormal RVFWS were made using receiver operating characteristics analysis.

Results

In normal subjects, indexing either TAPSE or RV s′ to RV length led to an improvement in the correlation coefficient (from 0.59 to 0.68 for TAPSE, from 0.41 to 0.58 for RV s′) and the variance (F statistic from 64.9 to 105.3 for TAPSE from 24.7 to 63.9 for RV s′) for correlations with RVFWS. In all subjects, categorical concordance with RVFWS was improved by indexing TAPSE and s′ to RV length primarily because of correction of underperformance to detect abnormal RVFWS in subjects with long RV length and better discrimination as normal for subjects with short RV length. Indexing to RV length improved the C statistic for detecting abnormal RVFWS for both TAPSE (0.80 vs 0.87, P = .03) and RV s′ (0.65 vs 0.77, P = .002).

Conclusions

Indexing TAPSE and RV s′ to RV length improves concordance of these deformational measurements with RVFWS and their ability to classify those with RV dysfunction according to RVFWS. Indexing TAPSE and RV s′ to length is particularly effective for interpreting paradoxical information such as low TAPSE and s′ in normal patients with short RV length and those with increased RV length who have normal TAPSE and s′ values but other evidence of RV dysfunction.

背景：通过超声心动图评估右心室（RV）功能时，根据 RV 长度的影响，可以预测变形指数之间存在一定的不一致性。RV 游离壁纵向应变（RVFWS）与 RV 长度相对无关，而三尖瓣瓣环平面收缩期偏移（TAPSE）则反映了应变与长度的乘积。收缩瓣环速度（s'）（随时间变化的距离）也可能受到长度的影响。我们假设将 TAPSE 和 s' 与 RV 长度挂钩将使 RVFWS 更为一致：从回顾性数据中确定了两个独立的队列：(a) 心功能正常的受试者（75 人），(b) 根据肺动脉高压或肺栓塞的研究指征确定的潜在 RV 功能障碍可能性较高的队列（50 人）。由专家对 TAPSE、RV s'、RVFWS 和分数面积变化 (FAC) 等 RV 功能指数进行验证和重新测量。在将 RVFWS 与 TAPSE 或 RV s'的测量值与 RV 长度挂钩或不挂钩的情况下，绘制了 RVFWS 与 TAPSE 或 RV s'之间的相关性和一致性图。通过接收操作者特征（ROC）分析得出了检测异常 RVFWS 的预测准确性：在正常受试者中，将 TAPSE 或 RV s' 与 RV 长度挂钩可提高与 RVFWS 的相关系数（TAPSE 为 0.59 至 0.68；RV s' 为 0.41 至 0.58）和方差（TAPSE 的 F 统计量为 64.9 至 105.3；RV s' 为 24.7 至 63.9）。在所有受试者中，TAPSE 和 s'与 RVFWS 的分类一致性通过将 TAPSE 和 s'与 RV 长度进行指数化而得到改善，这主要是由于纠正了 RV 长度长的受试者在检测异常 RVFW 时表现不佳的情况，以及将 RV 长度短的受试者区分为正常受试者的效果更好。对 TAPSE（0.80 vs 0.87，p=0.03）和 RV s'（0.65 vs 0.77，p=0.002）而言，将 RV 长度指数化可提高检测异常 RVFWS 的 C 统计量：结论：将 TAPSE 和 RV s' 与 RV 长度挂钩可提高这些变形测量值与 RVFWS 的一致性，并提高根据 RVFWS 对 RV 功能障碍患者进行分类的能力。将 TAPSE 和 RV s'与长度挂钩尤其有助于解释一些矛盾的信息，如 RV 长度较短的正常患者 TAPSE 和 s'较低，或 RV 长度增加但 TAPSE 和 s'值正常但有其他 RV 功能障碍证据的患者。

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引用次数: 0

Mortality-Based Right Ventricle Functional Echocardiographic Cutoffs in Patients With Compared to Without Tricuspid Regurgitation 三尖瓣反流患者与无三尖瓣反流患者基于右心室功能超声心动图的死亡率临界值对比。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.10.012

Lior Zornitzki MD , Ophir Freund MD , Shir Frydman MD , Zach Rozenbaum MD , Yoav Granot MD , Shmuel Banai MD , Yan Topilsky MD

Background

Tricuspid annular plane systolic excursion (TAPSE) and peak lateral tricuspid annular systolic velocity (S’) are echocardiographic indices of right ventricle function. The abnormality thresholds for these parameters are based on data obtained from healthy adults rather than outcome data.

Objectives

We aimed to reexamine the abnormality thresholds for these parameters based on their association with mortality in consecutive patients, stratified to with or without significant tricuspid regurgitation (TR).

Methods

We performed a retrospective analysis of consecutive patients undergoing echocardiography between 2011 and 2021. Tricuspid regurgitation was assessed using a semiquantitative method. Cutoff values associated with excess mortality were assessed using spline curves in univariate and multivariate Cox analyses.

Results

A total of 24,717 subjects were included in the current analysis. A total of 1,143 (4.6%) subjects had clinically significant (moderate or more) TR. In the entire cohort, TAPSE <20.9 mm and S’ <10.9 cm/sec were associated with excess mortality. In subgroup analysis, among subjects with significant TR, TAPSE <18.0 mm and S' <10.0 cm/sec were the cutoffs associated with excess mortality, while subjects without TR had a higher cutoff of TAPSE <21.5 mm and S' <10.9 cm/sec. In a multivariate model adjusted for the presence of TR and baseline characteristics, TAPSE <20.9 mm (hazard ratio = 1.16; 95% CI, 1.10-1.23; P < .001) and S’ <10.9 cm/sec (hazard ratio =1.09; 95% CI, 1.04-1.20; P = .01) were independently associated with mortality.

Conclusions

The TAPSE and S’ thresholds associated with excess mortality are higher than those reported in healthy adults. The TAPSE and S′ cutoffs associated with excess mortality were lower in patients with significant TR compared to patients without, suggesting that a personalized approach for their interpretation is needed.

背景：三尖瓣-环状面-收缩期-扩张（TAPSE）和峰值-侧三尖瓣-环状面-收缩期-速度（S'）是右心室（RV）功能的超声心动图指标。这些参数的异常阈值是基于健康成人的数据，而不是结果数据：我们的目的是根据这些参数与连续患者死亡率的关系重新研究这些参数的异常阈值，并将患者分为有或无明显三尖瓣反流（TR）的分层：我们对 2011-2021 年间接受超声心动图检查的连续患者进行了回顾性分析。采用半定量方法对三尖瓣反流进行评估。在单变量和多变量 Cox 分析中，使用样条曲线评估了与超额死亡率相关的临界值：本次分析共纳入 24717 名受试者。1143名受试者（4.6%）具有临床意义（≥中度）的TR。在整个队列中，TAPSEC结论：与超额死亡率相关的 TAPSE 和 S'阈值高于健康成人中报告的阈值。与无明显TR的患者相比，有明显TR的患者与超额死亡率相关的TAPSE和S'临界值较低，这表明需要采用个性化的方法来解释它们。

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引用次数: 0

Incremental Prognostic Value of Right Ventricular–Pulmonary Artery Coupling to a Clinical Risk Score in Tricuspid Regurgitation: The TRIO-RV Score 右心室-肺动脉耦合对三尖瓣反流临床风险评分的增量预后价值：TRIO-RV评分。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.11.006

Sirichai Jamnongprasatporn MD , Kyla M. Lara-Breitinger MD , Sorin V. Pislaru MD, PhD , Patricia A. Pellikka MD , Garvan C. Kane MD, PhD , Ratnasari Padang MBBS, PhD , Vidhu Anand MBBS , Jwan A. Naser MBBS , Vuyisile T. Nkomo MD, MPH , Mackram F. Eleid MD , Mohamad Alkhouli MD , Kevin L. Greason MD , Jeremy J. Thaden MD

Objectives

There are limited data evaluating the echocardiographic parameters of risk in tricuspid regurgitation (TR) patients. We sought to evaluate the incremental prognostic value of quantitative right ventricle (RV) function and RV–pulmonary artery (RV-PA) coupling to an established clinical risk score in TR patients.

Methods

We retrospectively identified patients with moderate or greater TR from January 1, 2019, to June 30, 2019. Univariable and multivariable Cox proportional hazards regressions were used to test the association of right ventricular free wall strain (RVFWS), RVFWS indexed to right ventricular systolic pressure (RVSP), and the Tricuspid Regurgitation Impact on Outcomes (TRIO) risk score with mortality. A novel TRIO-RV risk score was developed by incorporating RVFWS/RVSP into the clinical TRIO risk score.

Results

Among 417 patients, age 73 ± 11.5 years, 47% female, the TRIO score was 3.5 ± 2. The TRIO score was low risk in 213 (51%), intermediate risk in 162 (39%), and high risk in 42 (10%). During a median follow-up of 3.96 years (interquartile range, 1.66-4.34 years), death occurred in 157 patients (38%). The baseline TRIO risk category was associated with mortality (P < .001). After adjustment by TRIO risk score, both RVFWS <18.6% (adjusted hazard ratio, 3.08; 95% CI, 2.01-4.72; P < .001) and RVFWS/RVSP <0.43 %/mm Hg (adjusted hazard ratio, 2.76; 95% CI, 1.75-4.35, P < .001) remained significantly correlated with mortality. With the addition of RVFWS/RVSP, 151 (40%) patients with low- and intermediate-risk TRIO scores were reclassified to a higher-risk TRIO-RV score. The chi-square value increased in sequential models predictive of mortality for the TRIO score alone, the TRIO score plus RVFWS <18.6%, and the TRIO score plus RVFWS/RVSP <0.43 %/mm Hg (model chi-square 38.3, 72.2, and 82.3, respectively).

Conclusions

Quantitative parameters of RV function are associated with mortality in TR patients even after correction for an existing clinical risk score. Incorporating RVFWS/RVSP into the TRIO clinical risk score, the TRIO-RV score, reclassifies a substantial number of low- and intermediate-risk patients into higher-risk categories and improves risk stratification.

目的：评估三尖瓣反流（TR）患者的超声心动图参数风险的数据有限。我们试图评估定量右心室（RV）功能和RV-肺动脉（RV- pa）耦合对TR患者临床风险评分的增量预后价值。方法：回顾性筛选2019年1月1日至2019年6月30日期间≥中度TR的患者。采用单变量和多变量cox比例风险回归检验右心室游离壁应变（RVFWS）、与右心室收缩压（RVSP）相关的RVFWS以及TRIO风险评分与死亡率的关系。通过将RVFWS/RVSP纳入临床TRIO风险评分，开发了一种新的TRIO- rv风险评分。结果：417例患者中，年龄73±11.5岁，女性占47%，TRIO评分为3.5±2。TRIO评分为低危213例（51%），中危162例（39%），高危42例（10%）。中位随访3.96年（IQR 1.66-4.34年），157例（38%）患者死亡。结论：即使校正了现有的临床风险评分，RV功能的定量参数仍与TR患者的死亡率相关。将RVFWS/RVSP纳入TRIO临床风险评分，即TRIO- rv评分，将大量低危和中危患者重新分类为高风险类别，并改善了风险分层。

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引用次数: 0

Supine Bicycle Stress Echocardiography at Low Altitude for Identification of Susceptibility to Acute Mountain Sickness 在低海拔地区进行仰卧位自行车负荷超声心动图检查，以确定急性登山病的易感性。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.12.007

Yi Wang MD, PhD , Qingfeng Zhang MD , Kai Wang MD , Sijia Wang MD , Yong Jing MD , Shiyin Chen MD , Lan Shang MD , Chunmei Li MD , Yan Deng MD , Yun Xu MD , Lixue Yin MD, PhD

Background

Exposure to high altitude may unpredictably lead to acute mountain sickness (AMS). The purpose of this study was to identify the predictors of AMS at low altitude using exercise stress echocardiography (ESE).

Methods

A total of 40 healthy adults were enrolled and underwent comprehensive supine bicycle ESE at low altitude, including pulmonary vascular resistance (PVR), right ventricular area index at the end of diastole, B-lines, and inferior vena cava (IVC) diameter. All subjects ascended to 3,600 m within 24 hours. The risk factors for AMS were screened using least absolute shrinkage and selection operator regression analysis. A novel nomogram model was then established using multivariable logistic regression analysis, and a clinical impact curve was constructed.

Results

At the altitude of 3,600 m, 20 of 40 subjects had AMS (AMS group). On least absolute shrinkage and selection operator regression analyses, PVR, IVC, and B-lines at peak exercise were all independent factors influencing AMS. The nomogram built on the basis of these factors predicted AMS with sensitivity of 0.950 and specificity of 0.804, which outperformed the individual predictive C indexes of each indicator (nomogram: cutoff, 59.3; area under the curve [AUC], 0.90 [95% CI, 0.80-1.00]; PVR at peak exercise: cutoff, 1.55; AUC, 0.81 [95% CI, 0.70-0.91]; B-lines at peak exercise: cutoff, 1; AUC, 0.78 [95% CI, 0.69-0.92]; IVC at peak exercise: cutoff, 13.8; AUC, 0.74 [95% CI, 0.65-0.87]). The established model was validated by plotting the clinical decision curve analysis and clinical impact curve.

Conclusions

Supine bicycle ESE is a useful technique to identify subjects susceptible to AMS. This study established a nomogram to predict the development to AMS with high discrimination and accuracy.

背景：暴露于高海拔可能导致急性高原反应（AMS）。本研究的目的是通过运动应激超声心动图（ESE）确定低空AMS的预测因素。方法：选取40例健康成人，进行低空仰卧自行车综合心电图检查，包括肺血管阻力（PVR）、舒张末期右心室（RV）面积指数（RVEDAi）、b线、下腔静脉（IVC）内径。所有受试者在24小时内上升至3600米。采用最小绝对收缩和选择算子（LASSO）回归分析筛选AMS的危险因素。通过多变量logistic回归分析，建立了新的nomogram模型，并构建了临床影响曲线（CIC）。结果：海拔3600 m时，40例受试者中有20例发生AMS （AMS组）。通过LASSO回归分析，PVR、IVC和运动高峰b线均为AMS的独立影响因素。基于这些因素构建的nomogram预测AMS的灵敏度为0.950，特异性为0.804，优于各指标的单项预测c指标(nomogram: cutoff, 59.3， AUC, 0.90 (95% CI, 0.80-1.00), pvra -peak: cutoff, 1.55， AUC, 0.81 (95% CI, 0.70-0.91), B line-peak: cutoff, 1， AUC, 0.78 （95% CI, 0.69-0.92), ivc peak: cutoff, 13.8， AUC, 0.74 (95% CI, 0.65-0.87)）。通过绘制临床决策曲线分析（DCA）和临床影响曲线（CIC）对所建立的模型进行验证。结论：仰卧位自行车电刺激是鉴别AMS易感对象的有效方法。建立了一种判别率高、准确度高的nomogram预测AMS的发展趋势。

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引用次数: 0

Quantification of Lung Perfusion by a Novel Echocardiographic Approach in Pediatric Pulmonary Vein Stenosis 一种新的超声心动图方法在儿童肺静脉狭窄中的肺灌注量化。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.11.016

Joseph M. Stidham MD, Sarah LaBarge DNP, Jennifer H. Huang MD, Lars Grosse-Wortmann MD, Patrick D. Evers MD, MBA, MSc

引用次数: 0

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