This document will focus on the elements of performing a comprehensive duplex ultrasound imaging protocol for evaluation of the carotid and vertebral arteries. Two-dimensional imaging, Doppler and measurement techniques are presented. A review of plaque grading and classification, as it pertains to the comprehensive carotid duplex examination, are also presented.
{"title":"Practical Approach to Performing the Comprehensive Carotid Duplex Examination","authors":"Carol Mitchell PhD, ACS, RDMS, RDCS, RVT, RT(R) , Stavros Agorastos MHA, RDCS, RVT , Clark Garcia BA, RCS, RVS , Rebecca LeLeiko MD , Brad Mehl MHA, ACS, RDCS, RVT, RDMS, RT(R) , Melissa Warren MHSc, RVT, RVS, RPhS , Connor J. DeLorme BS , Matthew Vorsanger MD","doi":"10.1016/j.echo.2025.08.032","DOIUrl":"10.1016/j.echo.2025.08.032","url":null,"abstract":"<div><div>This document will focus on the elements of performing a comprehensive duplex ultrasound imaging protocol for evaluation of the carotid and vertebral arteries. Two-dimensional imaging, Doppler and measurement techniques are presented. A review of plaque grading and classification, as it pertains to the comprehensive carotid duplex examination, are also presented.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Pages 261-279"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-22DOI: 10.1016/j.echo.2025.11.010
Thais Coutinho MD
{"title":"Proximal Aortic Dilatation and Mortality: Insights, Bias, and a Path Forward","authors":"Thais Coutinho MD","doi":"10.1016/j.echo.2025.11.010","DOIUrl":"10.1016/j.echo.2025.11.010","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Pages 258-260"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-28DOI: 10.1016/j.echo.2025.11.011
Faysal Massad MD, Shriya Bavishi MD, Izhan Hamza MD, Patricia A. Pellikka MD
{"title":"Reply to “Methodological Considerations of Stroke Volume Index in Cardiac Amyloidosis Risk Stratification”","authors":"Faysal Massad MD, Shriya Bavishi MD, Izhan Hamza MD, Patricia A. Pellikka MD","doi":"10.1016/j.echo.2025.11.011","DOIUrl":"10.1016/j.echo.2025.11.011","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Pages 321-322"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reply to “Utility of Pulmonic Regurgitation Velocity in Suspected Pulmonary Arterial Hypertension”","authors":"Valentina Mercurio MD, PhD, Monica Mukherjee MD, MPH","doi":"10.1016/j.echo.2025.10.011","DOIUrl":"10.1016/j.echo.2025.10.011","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Pages 325-326"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Methodological Considerations of Stroke Volume Index in Cardiac Amyloidosis Risk Stratification","authors":"Chuanwei Zhao, Chenxuan Gao, Yun Lou, Yunfang Xiang","doi":"10.1016/j.echo.2025.09.013","DOIUrl":"10.1016/j.echo.2025.09.013","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Page 321"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-22DOI: 10.1016/j.echo.2025.11.009
Jonathan M. Wong MD , Everett Lai MD , Bruce N. Brent MD , Nelson B. Schiller MD , Richard E. Shaw PhD , Andrew S. Rosenblatt MD
Introduction
Studies that directly and simultaneously compare each echocardiographic method of estimating mean pulmonary artery pressure (mPAP) to that of right heart catheterization (RHC) in the same population are limited. The purpose of this study was to compare the yield and agreement of each echocardiographic method for estimating mPAP to RHC in a real-world cohort.
Methods
We screened 122 consecutive patients scheduled to undergo RHC at California Pacific Medical Center. All volunteers underwent resting transthoracic echocardiogram within 24 hours of completing RHC. We compared 6 distinct noninvasive methods for estimating mPAP to RHC. We performed scatter plots with linear regression and Bland-Altman analyses. We analyzed the diagnostic performance of various combinations of noninvasive parameters for the diagnosis of pulmonary hypertension (mPAP >20 mm Hg).
Results
By invasive investigation, the mean right atrial pressure (mRAP) was 11.4 ± 5.9 mm Hg, the mPAP was 33.1 ± 11.1 mm Hg, and the pulmonary vascular resistance (PVR) was 2.8 ± 1.6 Wood units. The noninvasive mPAP method using peak tricuspid regurgitation (TR) and end-diastolic pulmonary regurgitation (PR) gradients was most closely correlated with invasive mPAP (r = 0.70), while the method using pulmonary acceleration time was the least closely correlated with RHC mPAP (r = 0.33). Models using combined noninvasive TR and PR variables were better correlated with invasive mPAP (R2 = 0.60) compared with using noninvasive TR or PR variables alone (R2 = 0.48 and 0.47, respectively). The volunteers with an incomplete TR envelope had a more pronounced underestimation of systolic pulmonary artery pressure (52 vs 40 mm Hg, P < .001) compared wth ivolunteers with a complete TR envelope (55 vs 49 mm Hg). The utilization of multiple echocardiographic parameters improved the diagnostic accuracy of mean pulmonary hypertension (mPAP > 20 mm Hg) compared to RHC.
Conclusion
Noninvasive methods using the TR signal with inferior vena cava assessment were the most strongly correlated with invasive mPAP. The utilization of multiple echocardiographic parameters improved the diagnostic accuracy of mean pulmonary hypertension (mPAP > 20 mm Hg).
{"title":"Noninvasive Assessment of Mean Pulmonary Artery Pressure: A Comparison of Doppler Echocardiographic Methods","authors":"Jonathan M. Wong MD , Everett Lai MD , Bruce N. Brent MD , Nelson B. Schiller MD , Richard E. Shaw PhD , Andrew S. Rosenblatt MD","doi":"10.1016/j.echo.2025.11.009","DOIUrl":"10.1016/j.echo.2025.11.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Studies that directly and simultaneously compare each echocardiographic method of estimating mean pulmonary artery pressure (mPAP) to that of right heart catheterization (RHC) in the same population are limited. The purpose of this study was to compare the yield and agreement of each echocardiographic method for estimating mPAP to RHC in a real-world cohort.</div></div><div><h3>Methods</h3><div>We screened 122 consecutive patients scheduled to undergo RHC at California Pacific Medical Center. All volunteers underwent resting transthoracic echocardiogram within 24 hours of completing RHC. We compared 6 distinct noninvasive methods for estimating mPAP to RHC. We performed scatter plots with linear regression and Bland-Altman analyses. We analyzed the diagnostic performance of various combinations of noninvasive parameters for the diagnosis of pulmonary hypertension (mPAP >20 mm Hg).</div></div><div><h3>Results</h3><div>By invasive investigation, the mean right atrial pressure (mRAP) was 11.4 ± 5.9 mm Hg, the mPAP was 33.1 ± 11.1 mm Hg, and the pulmonary vascular resistance (PVR) was 2.8 ± 1.6 Wood units. The noninvasive mPAP method using peak tricuspid regurgitation (TR) and end-diastolic pulmonary regurgitation (PR) gradients was most closely correlated with invasive mPAP (<em>r</em> = 0.70), while the method using pulmonary acceleration time was the least closely correlated with RHC mPAP (<em>r</em> = 0.33). Models using combined noninvasive TR and PR variables were better correlated with invasive mPAP (<em>R</em><sup>2</sup> = 0.60) compared with using noninvasive TR or PR variables alone (<em>R</em><sup>2</sup> = 0.48 and 0.47, respectively). The volunteers with an incomplete TR envelope had a more pronounced underestimation of systolic pulmonary artery pressure (52 vs 40 mm Hg, <em>P</em> < .001) compared wth ivolunteers with a complete TR envelope (55 vs 49 mm Hg). The utilization of multiple echocardiographic parameters improved the diagnostic accuracy of mean pulmonary hypertension (mPAP > 20 mm Hg) compared to RHC.</div></div><div><h3>Conclusion</h3><div>Noninvasive methods using the TR signal with inferior vena cava assessment were the most strongly correlated with invasive mPAP. The utilization of multiple echocardiographic parameters improved the diagnostic accuracy of mean pulmonary hypertension (mPAP > 20 mm Hg).</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Pages 294-303"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-03-03DOI: 10.1016/j.echo.2026.01.001
Purvi Parwani MBBS, MPH, FASE, David H. Wiener MD, FASE
{"title":"Women in Echo: A Community Where We Belong","authors":"Purvi Parwani MBBS, MPH, FASE, David H. Wiener MD, FASE","doi":"10.1016/j.echo.2026.01.001","DOIUrl":"10.1016/j.echo.2026.01.001","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Pages A9-A10"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-10DOI: 10.1016/j.echo.2025.09.019
Mengxuan Yuan MD
{"title":"Transaortic Flow Rate and Risk Stratification in Moderate Aortic Stenosis","authors":"Mengxuan Yuan MD","doi":"10.1016/j.echo.2025.09.019","DOIUrl":"10.1016/j.echo.2025.09.019","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Page 322"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-14DOI: 10.1016/j.echo.2025.11.008
James Nadel MBBS, MMed, PhD , Avan Suinesiaputra PhD , Elizabeth D. Paratz MBBS, PhD , Julie Humphries MBBS, BHMS(Ed)(Hon I) , Alistair Young PhD , Rene Botnar PhD , David S. Celermajer MBBS, PhD , Geoff Strange MBBS, PhD , David Playford MBBS, PhD
Background
Aortic diameter remains the most utilised criterion for considering surgical correction of thoracic aortic aneurysm (TAA). In uncomplicated cases, guidelines do not differentiate between the sizes of aneurysms at the root and the ascending aorta (AscAo). To improve practice, greater understanding of site-specific TAA is needed. A nationwide echocardiographic data set linked to mortality outcomes was examined to determine how TAA affects cardiovascular disease (CVD) mortality.
Methods
The National Echo Database Australia (NEDA) was examined for aortic dimensions at the sinuses of Valsalva, sinotubular junction, and AscAo. Patients were stratified according to absolute aortic diameters and grouped as normal (<4 cm) or mildly (≥4 to <4.5 cm), moderately (≥4.5 to <5 cm), or severely (≥5 cm) dilated at the prescribed thoracic aortic sites. Mortality data were linked from the National Death Index.
Results
A total of 477,501 echocardiograms from 175,158 patients with 2,897,357 patient-years of follow-up were included. Severe TAA at any site increased the likelihood of 10-year CVD mortality compared with normal aortic diameters (31% vs 14%, P < .0001), with incremental increase in the probability of CVD death when moving from the proximal to the distal AscAo; CVD mortality at the sinuses of Valsalva was 30% (hazard ratio [HR], 1.79; 95% CI, 1.2-2.67; P = .004), at the sinotubular junction was 41% (HR, 1.91; 95% CI, 1.11-3.29; P = .002), and at the AscAo was 45% (HR, 3.96; 95% CI, 2.06-7.64; P < .001).
Conclusions
Severe TAA increases the probability of cardiovascular mortality. Given the low event rate of aortic death (0.2%) this is not explained solely by increased dissection risk. Interestingly, there is a doubling of CVD mortality likelihood when moving from the proximal to the distal AscAo. These results suggest that patients with severe ascending aortic dilatation may be at higher CVD risk compared with those with aortic root aneurysms, identifying new considerations for risk stratification and surgical management.
背景：主动脉直径仍然是考虑手术矫正胸主动脉瘤（TAA）最常用的标准。在不复杂的病例中，指南没有区分根动脉瘤和升主动脉（AscAo）的大小。为了改进实践，需要更好地了解特定地点的TAA。一项与死亡率结果相关的全国性超声心动图数据集被检查，以确定TAA如何影响心血管疾病（CVD）死亡率。方法：通过澳大利亚国家回声数据库（NEDA）检查Valsalva、窦管交界处和AscAo窦处的主动脉尺寸。根据主动脉绝对直径对患者进行分层并按正常分组（结果：共纳入175,158例患者的477,501张超声心动图，随访2,897,357例患者-年）。与正常主动脉直径相比，任何部位的严重TAA都增加了10年CVD死亡率的可能性（31% vs 14%, P < 0.0001），当从AscAo近端转移到远端时，CVD死亡的可能性增加；Valsalva鼻窦的心血管疾病死亡率为30%（危险比[HR]， 1.79; 95% CI, 1.2-2.67; P = 0.004），窦管交界处的心血管疾病死亡率为41%（危险比，1.91;95% CI, 1.11-3.29; P = 0.002）， AscAo的心血管疾病死亡率为45%（危险比，3.96;95% CI, 2.06-7.64; P < 0.001）。结论：严重的TAA会增加心血管疾病的死亡率。考虑到主动脉死亡发生率较低（0.2%），这不能仅仅解释为夹层风险增加。有趣的是，当从AscAo近端转移到远端时，心血管疾病死亡率的可能性增加了一倍。这些结果表明，与主动脉根部动脉瘤患者相比，严重升主动脉扩张患者可能有更高的心血管疾病风险，确定了风险分层和手术治疗的新考虑因素。
{"title":"Site-Specific Analysis of Thoracic Aortic Aneurysm and Cardiovascular Mortality: Insights From the National Echo Database Australia","authors":"James Nadel MBBS, MMed, PhD , Avan Suinesiaputra PhD , Elizabeth D. Paratz MBBS, PhD , Julie Humphries MBBS, BHMS(Ed)(Hon I) , Alistair Young PhD , Rene Botnar PhD , David S. Celermajer MBBS, PhD , Geoff Strange MBBS, PhD , David Playford MBBS, PhD","doi":"10.1016/j.echo.2025.11.008","DOIUrl":"10.1016/j.echo.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Aortic diameter remains the most utilised criterion for considering surgical correction of thoracic aortic aneurysm (TAA). In uncomplicated cases, guidelines do not differentiate between the sizes of aneurysms at the root and the ascending aorta (AscAo). To improve practice, greater understanding of site-specific TAA is needed. A nationwide echocardiographic data set linked to mortality outcomes was examined to determine how TAA affects cardiovascular disease (CVD) mortality.</div></div><div><h3>Methods</h3><div>The National Echo Database Australia (NEDA) was examined for aortic dimensions at the sinuses of Valsalva, sinotubular junction, and AscAo. Patients were stratified according to absolute aortic diameters and grouped as normal (<4 cm) or mildly (≥4 to <4.5 cm), moderately (≥4.5 to <5 cm), or severely (≥5 cm) dilated at the prescribed thoracic aortic sites. Mortality data were linked from the National Death Index.</div></div><div><h3>Results</h3><div>A total of 477,501 echocardiograms from 175,158 patients with 2,897,357 patient-years of follow-up were included. Severe TAA at any site increased the likelihood of 10-year CVD mortality compared with normal aortic diameters (31% vs 14%, <em>P</em> < .0001), with incremental increase in the probability of CVD death when moving from the proximal to the distal AscAo; CVD mortality at the sinuses of Valsalva was 30% (hazard ratio [HR], 1.79; 95% CI, 1.2-2.67; <em>P</em> = .004), at the sinotubular junction was 41% (HR, 1.91; 95% CI, 1.11-3.29; <em>P</em> = .002), and at the AscAo was 45% (HR, 3.96; 95% CI, 2.06-7.64; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Severe TAA increases the probability of cardiovascular mortality. Given the low event rate of aortic death (0.2%) this is not explained solely by increased dissection risk. Interestingly, there is a doubling of CVD mortality likelihood when moving from the proximal to the distal AscAo. These results suggest that patients with severe ascending aortic dilatation may be at higher CVD risk compared with those with aortic root aneurysms, identifying new considerations for risk stratification and surgical management.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 3","pages":"Pages 246-257"},"PeriodicalIF":6.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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