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IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/S0894-7317(24)00477-2

引用次数: 0

Left Atrioventricular Coupling Index: A Novel Diastolic Parameter to Refine Prognosis in Heart Failure 左心房-心室耦合指数：完善心力衰竭预后的新型舒张参数

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.06.013

Background

Left atrioventricular coupling index (LACI), an index coupling left atrial to left ventricular (LV) volume at end-diastole, has been shown to be associated with prognosis in different clinical settings. However, the relation between LACI and LV diastolic dysfunction (DD) remains to be established. The aims of the present study were to investigate the association between LACI and LV DD and to assess its prognostic value in patients with heart failure (HF).

Methods

A total of 1,158 patients with HF in stable condition, on optimal medical therapy, were retrospectively analyzed (derivation cohort). Clinical and echocardiographic features were characterized across LACI tertiles. The independent prognostic value of LACI (end point: all-cause death or HF hospitalization) was assessed using Cox regression. Results were validated in an external cohort of 242 patients with HF.

Results

In the derivation cohort, the median LACI value was 0.29 (interquartile range, 0.19-0.42). Patients in the third tertile (LACI > 0.36) were older and presented with more advanced HF symptoms. Although the prevalence of grade 1 DD (American Society of Echocardiography/European Association of Cardiovascular Imaging classification) progressively decreased across LACI tertiles, the prevalence of grade 3 DD significantly increased (8%, 23%, and 46%, respectively; P < .0001). A cutoff value of ≥0.26 identified moderate to severe DD with an area under the curve of 0.75. During follow-up (median, 28 months; interquartile range, 11-53 months), 407 patients (35%) reached the end point. On multivariable analysis, LACI was independently associated with outcomes (hazard ratio for a 1-SD increase, 1.16; 95% CI, 1.06-1.28; P = .002), showing incremental predictive value over the DD grading system (net reclassification improvement = 0.150, P < .0001). The prognostic value of LACI was consistent in the external validation cohort.

Conclusions

LACI is associated with DD severity and is an independent predictor of outcomes in patients with HF.

背景：左房室耦合指数（LACI）是舒张末期左心房（LA）与左心室（LV）容积的耦合指数，在不同的临床环境中显示与预后有关。然而，LACI 与左心室舒张功能障碍（DD）之间的关系仍有待确定。本研究旨在调查 LACI 与左心室舒张功能障碍之间的关系，并评估其在心力衰竭（HF）患者中的预后价值：我们回顾性分析了1158名接受最佳药物治疗的稳定型心力衰竭患者（衍生队列）。临床和超声心动图特征体现在不同的 LACI 分层中。通过 Cox 回归评估了 LACI 的独立预后价值（终点：全因死亡/房颤住院）。结果在一个由 242 名高频患者组成的外部队列中得到验证：在衍生队列中，LACI 的中位值为 0.29（IQR:0.19-0.42）。第三个三分位数（LACI>0.36）的患者年龄较大，并伴有较严重的心房颤动症状。虽然 1 级 DD（ASE/EACVI 分级）的患病率在 LACI 三等分中逐渐降低，但 3 级 DD 的患病率却显著增加（分别为 8%、23% 和 46%，PC 结论：LACI 与 DD 严重程度相关，是预测高血压患者预后的独立指标。

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引用次数: 0

Advances in the Assessment of Patients With Tricuspid Regurgitation: A State-of-the-Art Review on the Echocardiographic Evaluation Before and After Tricuspid Valve Interventions 三尖瓣反流患者评估的进展：三尖瓣置换术前后超声心动图评估的最新进展》。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.07.008

Luigi P. Badano MD, PhD , Michele Tomaselli MD , Denisa Muraru MD, PhD , Xavier Galloo MD , Chi Hion Pedro Li MD , Nina Ajmone Marsan MD, PhD

Tricuspid regurgitation (TR) can have a significant impact on the health and mortality of a patient. Unfortunately, many patients with advanced right-sided heart failure are not referred for isolated tricuspid valve (TV) surgery in a timely manner. This delayed referral has resulted in a high in-hospital mortality rate and significant undertreatment. Fortunately, transcatheter TV intervention (TTVI) has emerged as a safe and effective alternative to surgery, successfully reducing TR severity and improving patients’ quality of life. Current guidelines emphasize the importance of assessing TR severity and its impact on the right heart chambers for selecting the appropriate intervention. However, the echocardiographic assessment of both right chambers and TV anatomy, along with TR severity, poses specific challenges, leading to the underestimation of TR severity. Recently, three-dimensional echocardiography has become crucial to enhance the characterization of TR severity. Moreover, it is essential to evaluate residual TR after TTVI to gauge the intervention’s success and predict the patient’s prognosis. This review provides a thorough evaluation of the echocardiographic parameters used to assess TR severity before and after TTVI. It presents a critical analysis of the accuracy and reliability of these parameters, highlighting their strengths and limitations to establish standardized diagnostic criteria and treatment protocols for TR, which will inform clinical decision-making and improve patient outcomes.

三尖瓣反流（TR）会对患者的健康和死亡率产生重大影响。遗憾的是，许多右侧心力衰竭晚期患者没有及时转诊接受孤立三尖瓣（TV）手术。这种延迟转诊导致了较高的院内死亡率和严重的治疗不足。幸运的是，经导管三尖瓣介入治疗（TTVI）已成为手术的一种安全有效的替代方法，成功降低了三尖瓣狭窄的严重程度，改善了患者的生活质量。目前的指南强调，评估 TR 的严重程度及其对右心腔的影响对于选择适当的介入治疗非常重要。然而，超声心动图对右心腔和TV解剖以及TR严重程度的评估存在特殊挑战，导致对TR严重程度的低估。近来，三维超声心动图对提高 TR 严重程度的定性至关重要。此外，评估 TTVI 后的残余 TR 对衡量介入治疗的成功率和预测患者的预后也至关重要。本综述全面评估了 TTVI 前后用于评估 TR 严重程度的超声心动图参数。它对这些参数的准确性和可靠性进行了批判性分析，强调了它们的优势和局限性，以建立 TR 的标准化诊断标准和治疗方案，为临床决策提供依据并改善患者预后。

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引用次数: 0

Watching the Reimbursement Tide Roll In (and Out) – ASE, Advocacy, and the Economics of CV Ultrasound 关注报销潮的涌入（和涌出）--ASE、宣传和 CV 超声波的经济学。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.09.008

Dermot Phelan MD, PhD, Susan Mayer MD, Katherine Stark, Denise Garris

引用次数: 0

Continuing Education and Meeting Calendar 继续教育和会议日历

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.08.010

引用次数: 0

Dobutamine Stress Echocardiography in Low-Gradient Aortic Stenosis 低梯度主动脉瓣狭窄的多巴酚丁胺应激超声心动图检查

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.06.017

Importance

Guidelines recommend the use of dobutamine stress echocardiography (DSE) in patients with low-gradient aortic stenosis (AS) and left ventricular ejection fraction (LVEF) <50%. However, a paucity of DSE data exists when LVEF >35%.

Objective

To examine the diagnostic accuracy of DSE in patients with low-gradient AS with a wide range of LVEF and to examine the interaction between the diagnostic accuracy of DSE and LVEF.

Design, Setting, and Participants

Patients with mean gradient <40 mm Hg, aortic valve area <1.0 cm², and stroke volume index ≤35 mL/m² undergoing DSE and cardiac computer tomography (C-CT) were identified from 3 prospectively collected patient cohorts and stratified according to LVEF: LVEF<35%, LVEF 35% to 50%, and LVEF>50%.

Exposure

Dobutamine stress echocardiography and C-CT were performed on patients with low-gradient AS.

Main Outcomes and Measures

Severe AS was defined as aortic valve calcification score ≥2,000 arbitrary units (AU) among men and ≥1,200 AU for women on C-CT.

Results

Of 221 patients included in the study, 78 (35%) presented with LVEF <35%, 67 (30%) with LVEF 35% to 50%, and 76 (34%) with LVEF >50%. Mean-gradient and aortic valve peak velocity during DSE showed significant diagnostic heterogeneity between LVEF groups, being most precise when LVEF <35% (both areas under the curve [AUC] = 0.90), albeit with optimal thresholds of 30 mm Hg and 377 cm/sec and a limited diagnostic yield in patients with LVEF ≥35% (AUC = 0.67 and 0.66 in LVEF 35% to 50% and AUC = 0.65 and 0.60 in LVEF ≥50%). Using guideline thresholds led to a sensitivity/specificity of 49%/84% for all patients with LVEF <50%.

Conclusion and Relevance

While DSE is safe and leads to an increase in stroke volume in patients with low-gradient AS regardless of LVEF, the association between DSE gradients and AS severity assessed by C-CT demonstrates important heterogeneity depending on LVEF, with the highest accuracy in patients with LVEF <35%.

重要性：指南建议在低梯度主动脉瓣狭窄（AS）和左室射血分数（LVEF）为35%的患者中使用多巴酚丁胺应激超声心动图（DSE）：研究低梯度主动脉瓣狭窄（AS）且左心室射血分数（LVEF）范围较宽的患者的 DSE 诊断准确性，并研究 DSE 诊断准确性与 LVEF 之间的相互作用：从三个前瞻性收集的患者队列中识别出平均梯度2、卒中容积指数≤35 mL/m2、接受DSE和心脏计算机断层扫描（C-CT）的患者，并根据LVEF进行分层；LVEF50%：主要结果和测量指标：重度强直性脊柱炎的定义是：C-CT上男性的AVC评分≥2000 AU，女性的AVC评分≥1200 AU：在纳入研究的 221 名患者中，78 人（35%）的 LVEF 为 50%。DSE 期间的平均梯度和 Vmax 在 LVEF 组间显示出明显的诊断异质性，在 LVEFC 时最为精确：虽然 DSE 是安全的，而且无论 LVEF 如何，都能增加低梯度 AS 患者的搏出量，但 DSE 梯度与 C-CT 评估的 AS 严重程度之间的关联显示出重要的异质性，这取决于 LVEF，其中 LVEF 为 50% 的患者的诊断准确性最高。

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引用次数: 0

Evaluating Discrepancies in Mitral Valve Area and Pressure Gradient: Implications for Diagnosing Severe Mitral Stenosis Under the 2023 Revised American Society of Echocardiography Recommendations 评估二尖瓣面积和压力梯度的差异：根据 2023 年修订的美国超声心动图学会建议诊断严重二尖瓣狭窄的意义。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.06.015

引用次数: 0

Guidelines Reinforce Treatment Disparities for Patients with Aortic Stenosis 指南强化了主动脉瓣狭窄患者的治疗差异。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.07.002

引用次数: 0

The Areas and Gradients in Rheumatic Mitral Stenosis: A Tale of Highs and Lows 风湿性二尖瓣狭窄的面积和梯度：高低起伏的故事。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.09.004

Jin Kyung Kim MD, PhD , Anita Sadeghpour MD , Natesa G. Pandian MD

引用次数: 0

Effectiveness of Negative Pressure Booths in Mitigating Airborne Infection Risk During Transesophageal Echocardiography 负压室在经食道超声心动图检查过程中降低空气传播感染风险的效果。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-11-01 DOI: 10.1016/j.echo.2024.07.005

引用次数: 0

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