Journal of the American Society of Echocardiography最新文献

Left atrial strain (LAS) is a sensitive marker of early atrial dysfunction and left ventricular diastolic abnormalities in pediatric heart disease, yet clinical integration remains limited. Evidence from 57 studies (2015-2024) including >5,300 patients <21 years of age demonstrates that healthy pediatric patients have higher LAS values, particularly left atrial conduit strain, than neonates and adults. Reduced left atrial reservoir and conduit strain is consistently reported in congenital heart disease and is associated with adverse outcomes across single-ventricle palliation stages. In pediatric cardiomyopathy, LAS impairment parallels worsening diastolic function. Among heart transplant recipients, left atrial reservoir strain correlates more strongly with invasive filling pressures than conventional noninvasive metrics. LAS also predicts myocardial injury in multisystem inflammatory syndrome in children, ischemic risk in diabetes, and early left ventricular dysfunction from chemotherapy. Despite its potential for diastolic function assessment, variability in acquisition and analysis remains substantial. Standardized protocols and larger prospective studies are needed to establish normative values and define clinical thresholds.

Background: The 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging diastolic function guideline often classified patients as "indeterminate" and provided inconsistent risk stratification. The 2025 update introduced a stepwise algorithm designed to minimize indeterminate cases. We examined whether the new guideline reduced indeterminate classifications and improved prognostic stratification compared with the 2016 standard.

Methods: We retrospectively evaluated 156 patients hospitalized with heart failure (HF) who underwent predischarge echocardiography. Diastolic function was graded according to the 2016 and 2025 algorithms. The primary end point was HF hospitalization or all-cause mortality. To explore applicability in earlier HF stages, we also analyzed 300 consecutive outpatients who underwent echocardiography during routine care.

Results: The 2025 algorithm eliminated indeterminate cases (23 reduced to 0) and redistributed classifications (normal increased from 24 to 46, grade I decreased from 45 to 24, grade II increased from 43 to 64, and grade III increased from 21 to 22). Brain natriuretic peptide levels and clinical outcomes demonstrated a clearer stepwise increase across risk categories with the 2025 criteria, whereas the 2016 definition showed less consistent separation between groups. During a median 3.7-year follow-up, 41 patients were readmitted for HF and 27 died. Elevated left atrial pressure defined by the 2025 algorithm was independently associated with adverse outcomes in multivariable models (hazard ratio, 3.56; 95% CI, 1.64-7.73; P = .001). Adding elevated left atrial pressure to the HOSPITAL score improved discrimination (c statistic changed from 0.63 to 0.73; P = .003). An exploratory outpatient cohort showed similar physiological stratification of brain natriuretic peptide across grades, although without longitudinal outcomes.

Conclusions: Stepwise application of the 2025 diastolic algorithm at discharge eliminated indeterminate classifications, enhanced prognostic stratification, and improved discrimination beyond a clinical risk score in hospitalized HF. Exploratory outpatient findings suggest potential applicability in earlier HF stages, although prospective validation across the full HF spectrum is needed.

Background: Limited evidence exists concerning the novel right ventricular (RV) coupling to pulmonary artery (RV-PA coupling) in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). We aimed to evaluate the prognostic value of this RV-PA coupling in patients after TAVR.

Methods: RV-PA coupling was defined as the ratio of RV free wall longitudinal strain (RVFWLS) to pulmonary artery systolic pressure (PASP), measured by echocardiography in AS patients undergoing TAVR between April 2012 and November 2022. The endpoints were all cause death, cardiovascular rehospitalization, stroke, and a composite of these.

Results: At a median follow-up time of 3.4 years, 352 (28.8%) patients in 1221 patients had composite clinical events. Patients with higher RVFWLS/PASP ratio were predominantly male, had lower body mass index, more comorbidities, higher Society of Thoracic Surgeons score, more New York Heart Association IV and worse laboratory data, alongside worse cardiac function compared to those with lower RVFWLS/PASP ratio. The fully adjusted multivariable hazard ratios of RVFWLS/PASP ratio and the tertile 3 of RVFWLS/PASP ratio were 2.228 (95% CI, 1.441-3.446) and 2.571 (95% CI, 1.633-4.047). In addition, Kaplan-Meier analyses revealed robust graded association between the RV-PA coupling and clinical outcomes (P <0.001).

Conclusions: The RV-PA coupling (RVFWLS/PASP ratio) is independently and robustly associated with adverse clinical events in patients undergoing TAVR. These data suggest that the RVFWLS/PASP ratio can serve as a risk stratification tool for patient selection and prognostication following TAVR.

Aims: Left ventricular (LV) strain derived by three-dimensional (3D) speckle tracking echocardiography (STE) has been demonstrated to be correlated with myocardial fibrosis (MF). However, whether 3D-STE parameters provided a similar estimation of LV MF compared with 2D-STE indices and late gadolinium enhancement (LGE) of cardiac magnetic resonance (CMR) imaging against histological MF remains unknown. The aim of this study was to determine whether 3D-STE parameters were similar to 2D-STE indices and LGE-CMR in assessing LV MF in patients with end-stage heart failure (HF) against histological MF.

Methods: STE and CMR were performed in 109 patients with end-stage HF who underwent heart transplantation. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained from two-dimensional (2D) and 3D-STE. The degree of MF was assessed using LGE-CMR and Masson's staining of the LV myocardial samples. One hundred and nine patients were divided into 3 groups based on the tertiles of histologic MF.

Resuilts: MF was strongly correlated with 3D-GLS (r = 0.70, P < 0.001), moderately correlated with LGE extent and 2D-GLS (r = 0.64, r = 0.58; P < 0.001 for each), and weakly correlated with 3D-GRS, 3D-GCS, 2D-GRS and 2D-GCS (r = -0.40, r = 0.29, r = -0.38, r = 0.25; P < 0.01 for each). The correlation of 3D-GLS with LV MF was similar to that of LGE with LV MF (0.70 vs 0.64; P = 0.427). The correlations of segmental 3D-LS with regional MF were similar to that of segmental LGE with regional MF for both ventricular septum and lateral wall (r = 0.68 vs 0.57, r = 0.71 vs 0.62, P > 0.05 for both). The positive and negative predictive values, as well as the area under the curve for identifying severe MF, were comparable among 3D-GLS, 2D-GLS, and LGE. The model with 3D-GLS (R² = 0.53, P < 0.001; Akaike information criterion [AIC] = 413) was similar to that with LGE (R² = 0.50, P < 0.001; AIC = 418) for reflecting the degree of LV MF.

Conclusions: 3D-GLS can be considered a novel functional parameter that may correlate with the extent of LV MF in patients with end-stage HF, demonstrating accuracy comparable to that of 2D-GLS and LGE-CMR in identifying severe MF.

Background: Periarterial echogenicity in the proximal coronary arteries (CAs) increases in the acute phase of Kawasaki disease (KD). However, some studies have questioned the diagnostic value of periarterial echogenicity in differentiating KD from other febrile diseases (non-KD) because of its relatively low specificity. In this study, the authors quantitatively assessed the degree of echogenicity in the proximal and mid segments of both CAs to determine its additional diagnostic value in patients with clinically suspected KD.

Methods: A total of 109 consecutive children (median age, 21 months; interquartile range, 11.0-47.8 months) who underwent transthoracic echocardiography for suspected KD (April 2021 to March 2023) were retrospectively examined. Two-dimensional echocardiographic images in the proximal and mid segments of both CAs were digitally stored and transferred to an offline image analysis system. The mean pixel value of the arterial wall was calculated in grayscale ranging from 0 to 255 (corrected for the intracardiac blood pool adjacent to the target site).

Results: A total of 109 patients were included, 87 (80%) ultimately diagnosed with KD (including 18 with incomplete KD) and 22 (20%) ultimately diagnosed with non-Kawasaki febrile diseases. Although the KD group generally showed higher CA wall echogenicity than the non-KD febrile group, there was no significant difference in the mean pixel values at the proximal segment (P = .34 for each). The KD group showed significantly higher echogenicity in the mid segments of both CAs than the non-KD febrile group (mid right coronary artery, P = .0049; mid left anterior descending coronary artery, P = .011). Similar results were observed in a small prospective cohort of 31 children examined under rigorously standardized ultrasound settings.

Conclusions: CA echogenicity in the mid segments may have potential diagnostic value in the early evaluation of suspected KD, possibly reflecting the characteristic diffuse involvement of the CAs in the acute phase.