Pub Date : 2026-02-01DOI: 10.1016/j.echo.2025.09.005
Davide Genovese MD, PhD , Marco Previtero MD , Giacomo Prete MD , Michele Strosio MD , Carlo Cernetti MD , Luigi Paolo Badano MD, PhD , Denisa Muraru MD, PhD , Chiara Palermo RDCS , Giuseppe Tarantini MD, PhD , Martina Perazzolo Marra MD, PhD
Background
Evaluating right atrial pressure (RAP) is essential for managing cardiac diseases. Right heart catheterization (RHC) measures RAP directly but is invasive. In contrast, transthoracic echocardiography (TTE) provides a noninvasive estimate of RAP through inferior vena cava (IVC) assessment despite some limitations. The right atrial expansion index (RAEI) reflects right atrial compliance by measuring the relative increase in volume during the reservoir phase. This study aimed to validate RAEI as a noninvasive parameter for estimating RAP.
Methods
We retrospectively enrolled 1,020 patients (728 in the derivation and 292 in the validation cohort) with various chronic cardiac diseases who underwent clinically indicated RHC and TTE within 24 hours. Right atrial pressure was measured during the RHC and defined as elevated when above 10 mm Hg. Right atrial expansion index and other TTE parameters were measured offline and blinded to RHC results.
Results
In the derivation cohort, RAEI showed a logarithmic correlation with RAP (lnRAEI-RAP: r = −0.65, P < .001). The natural log of RAEI was an independent and additive predictor of RAP, outperforming clinical, hemodynamic, and echocardiographic parameters, including IVC assessment. The natural log of RAEI was more accurate than IVC assessment for identifying RAP ≥10 mm Hg (area under the curve lnRAEI, 0.840,;P < .001; optimal cutoff, lnRAEI <3.53); this finding was replicated in the validation cohort (area under the curve lnRAEI, 0.826; P < .001). Furthermore, lnRAEI <3.53 was confirmed as an optimal cutoff for identifying RAP ≥10 mm Hg in the validation cohort as well (sensitivity, 74%; specificity, 79%; accuracy, 78%). Finally, the equation RAP = 19.3 – (3.29 × lnRAEI) derived from the derivation cohort estimated RAP more accurately (−0.2 ± 3.1 mm Hg) than IVC assessment (1.5 ± 4.2 mm Hg) in the validation cohort.
Conclusions
In this patient cohort, lnRAEI was more accurate than IVC assessment for noninvasive RAP estimation.
{"title":"Comparison of the Right Atrial Expansion Index with Inferior Vena Cava Assessment for Echocardiographic Estimation of the Right Atrial Pressure","authors":"Davide Genovese MD, PhD , Marco Previtero MD , Giacomo Prete MD , Michele Strosio MD , Carlo Cernetti MD , Luigi Paolo Badano MD, PhD , Denisa Muraru MD, PhD , Chiara Palermo RDCS , Giuseppe Tarantini MD, PhD , Martina Perazzolo Marra MD, PhD","doi":"10.1016/j.echo.2025.09.005","DOIUrl":"10.1016/j.echo.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Evaluating right atrial pressure (RAP) is essential for managing cardiac diseases. Right heart catheterization (RHC) measures RAP directly but is invasive. In contrast, transthoracic echocardiography (TTE) provides a noninvasive estimate of RAP through inferior vena cava (IVC) assessment despite some limitations. The right atrial expansion index (RAEI) reflects right atrial compliance by measuring the relative increase in volume during the reservoir phase. This study aimed to validate RAEI as a noninvasive parameter for estimating RAP.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled 1,020 patients (728 in the derivation and 292 in the validation cohort) with various chronic cardiac diseases who underwent clinically indicated RHC and TTE within 24 hours. Right atrial pressure was measured during the RHC and defined as elevated when above 10 mm Hg. Right atrial expansion index and other TTE parameters were measured offline and blinded to RHC results.</div></div><div><h3>Results</h3><div>In the derivation cohort, RAEI showed a logarithmic correlation with RAP (lnRAEI-RAP: <em>r</em> = −0.65, <em>P</em> < .001). The natural log of RAEI was an independent and additive predictor of RAP, outperforming clinical, hemodynamic, and echocardiographic parameters, including IVC assessment. The natural log of RAEI was more accurate than IVC assessment for identifying RAP ≥10 mm Hg (area under the curve lnRAEI, 0.840,;<em>P</em> < .001; optimal cutoff, lnRAEI <3.53); this finding was replicated in the validation cohort (area under the curve lnRAEI, 0.826; <em>P</em> < .001). Furthermore, lnRAEI <3.53 was confirmed as an optimal cutoff for identifying RAP ≥10 mm Hg in the validation cohort as well (sensitivity, 74%; specificity, 79%; accuracy, 78%). Finally, the equation RAP = 19.3 – (3.29 × lnRAEI) derived from the derivation cohort estimated RAP more accurately (−0.2 ± 3.1 mm Hg) than IVC assessment (1.5 ± 4.2 mm Hg) in the validation cohort.</div></div><div><h3>Conclusions</h3><div>In this patient cohort, lnRAEI was more accurate than IVC assessment for noninvasive RAP estimation.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 167-178"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087982","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 : 2026-02-01DOI: 10.1016/j.echo.2025.09.002
Giuseppe Di Gioia MD , Armando Ferrera MD , Maria Rosaria Squeo MD , Francesco Raffaele Spera MD , Viviana Maestrini MD, PhD , Sara Monosilio MD , Federica Mango MD , Giulia Paoletti DMS , Andrea Serdoz MD , Antonio Pelliccia MD
Introduction
Physiological cardiac remodeling in elite athletes has been extensively described for the ventricles, but less is known regarding atrial function and its relationship with cardiorespiratory fitness.
Objectives
This study aimed to evaluate right (RA) and left atrial (LA) strain in Olympic athletes, exploring sex and sport-specific differences and correlations with VO2 max.
Methods
We enrolled 657 Olympic athletes (mean age, 25.5 ± 5.3 years; 51.7% male). All athletes underwent transthoracic echocardiography, including atrial strain analysis by two-dimensional speckle-tracking echocardiography and cardiopulmonary exercise test. Atrial reservoir (S_R), conduit (S_Cd) and contraction (S_Co) strain were measured. Athletes were grouped by sport discipline (skill, power, mixed, endurance).
Results
Endurance athletes exhibited the largest atrial dimensions and the highest VO2 max (P < .0001) and showed reduced RA S_R (34.9% ± 9.1%, P < .0001), S_Cd (−25.7% ± 8.1%, P = .0001), S_Co (−9%±4.4%, P = .0006), and LA S_R (38% ± 7.5%, P = .048) compared to skill, power, and mixed. No differences in LA S_Cd (P = .07) and S_Co emerged (P = .111). Right atrial strain inversely correlated with VO2 max (P < .0001), while no such relationship was observed for LA. Sex differences were observed, with male athletes displaying larger atria (LA volume index 23.9 ± 7.8 mL/m2 vs 22.3 ± 6.3 mL/m2, P = .004) but lower S_R and S_Cd compared to female athletes (P < .05).
Conclusions
Functional atrial indexes (S_R, S_Cd, and S_Co) appear more markedly altered in the atria of the less remodeled ventricles (more in skill than in endurance athletes) and even more in RA than in LA. Furthermore, male athletes demonstrated higher reservoir and conduit strain values, while female athletes exhibited enhanced contractile function. Our results should be viewed in conjunction with the extent of ventricular remodeling, that is, the more enlarged and performant (suction and contraction) the ventricular cavity is, the less relevant the atrial contribution to filling is.
导读：关于优秀运动员心室的生理性心脏重构已经有了广泛的报道，但关于心房功能及其与心肺健康的关系却知之甚少。目的：本研究旨在评估奥运会运动员右心房（RA）和左心房（LA）劳损，探讨性别和运动特异性差异及其与VO2 max的相关性。方法：入选657名奥运会运动员，平均年龄25.5±5.3岁，男性51.7%。所有运动员都接受了经胸超声心动图检查，包括2D-STE心房应变分析和心肺运动试验（CPET）。测量心房贮液（S_R）、导管（S_Cd）和收缩（S_Co）应变。运动员按运动项目（技术、力量、混合、耐力）分组。结果：耐力运动员表现出最大的心房尺寸和最高的VO2 max (p2 max (p2 vs. 22.3±6.3 ml/m2, p=0.004)，但与女性相比，S_R和S_Cd更低(p结论：功能心房指数（S_R， S_Cd和S_Co）在心室重构较少的心房中表现出更明显的变化（技能运动员比耐力运动员更明显），RA比LA更明显。此外，男性运动员表现出更高的水库和管道应变值，而女性运动员表现出增强的收缩功能。我们的研究结果应该与心室重构的程度结合起来看，即，心室腔越大、表现越好（吸引和收缩），心房对充盈的贡献就越小。
{"title":"Right and Left Atrial Strain by Speckle-Tracking Echocardiography: Sex Differences and Correlation with Cardiorespiratory Fitness in Olympic Athletes","authors":"Giuseppe Di Gioia MD , Armando Ferrera MD , Maria Rosaria Squeo MD , Francesco Raffaele Spera MD , Viviana Maestrini MD, PhD , Sara Monosilio MD , Federica Mango MD , Giulia Paoletti DMS , Andrea Serdoz MD , Antonio Pelliccia MD","doi":"10.1016/j.echo.2025.09.002","DOIUrl":"10.1016/j.echo.2025.09.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Physiological cardiac remodeling in elite athletes has been extensively described for the ventricles, but less is known regarding atrial function and its relationship with cardiorespiratory fitness.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate right (RA) and left atrial (LA) strain in Olympic athletes, exploring sex and sport-specific differences and correlations with VO<sub>2</sub> max.</div></div><div><h3>Methods</h3><div>We enrolled 657 Olympic athletes (mean age, 25.5 ± 5.3 years; 51.7% male). All athletes underwent transthoracic echocardiography, including atrial strain analysis by two-dimensional speckle-tracking echocardiography and cardiopulmonary exercise test. Atrial reservoir (S_R), conduit (S_Cd) and contraction (S_Co) strain were measured. Athletes were grouped by sport discipline (skill, power, mixed, endurance).</div></div><div><h3>Results</h3><div>Endurance athletes exhibited the largest atrial dimensions and the highest VO<sub>2</sub> max (<em>P</em> < .0001) and showed reduced RA S_R (34.9% ± 9.1%, <em>P</em> < .0001), S_Cd (−25.7% ± 8.1%, <em>P</em> = .0001), S_Co (−9%±4.4%, <em>P</em> = .0006), and LA S_R (38% ± 7.5%, <em>P</em> = .048) compared to skill, power, and mixed. No differences in LA S_Cd (<em>P</em> = .07) and S_Co emerged (<em>P</em> = .111). Right atrial strain inversely correlated with VO<sub>2</sub> max (<em>P</em> < .0001), while no such relationship was observed for LA. Sex differences were observed, with male athletes displaying larger atria (LA volume index 23.9 ± 7.8 mL/m<sup>2</sup> vs 22.3 ± 6.3 mL/m<sup>2</sup>, <em>P</em> = .004) but lower S_R and S_Cd compared to female athletes (<em>P</em> < .05).</div></div><div><h3>Conclusions</h3><div>Functional atrial indexes (S_R, S_Cd, and S_Co) appear more markedly altered in the atria of the less remodeled ventricles (more in skill than in endurance athletes) and even more in RA than in LA. Furthermore, male athletes demonstrated higher reservoir and conduit strain values, while female athletes exhibited enhanced contractile function. Our results should be viewed in conjunction with the extent of ventricular remodeling, that is, the more enlarged and performant (suction and contraction) the ventricular cavity is, the less relevant the atrial contribution to filling is.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 125-135"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066308","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":"2025 American Society of Echocardiography Recommendations for Evaluation of Left Ventricular Diastolic Function: Rearranging the Algorithms and Unshuffling the Patients","authors":"Vinicius Leite Gonzalez MD, MSc, Angela Barreto Santiago Santos MD, PhD, Murilo Foppa MD, PhD","doi":"10.1016/j.echo.2025.10.013","DOIUrl":"10.1016/j.echo.2025.10.013","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 233-234"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423317","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 : 2026-02-01DOI: 10.1016/j.echo.2025.11.007
Thomas Meredith BMed, MD, MClinTRes , Michael H. Picard MD , Timothy W. Churchill MD , Samuel Bernard MD , Philippe B. Bertrand MD, PhD , Danita M.Y. Sanborn MD, MMSc , Mayooran Namasivayam MBBS, PhD
Background
Arrhythmogenic cardiomyopathy (ACM) is a genetic disorder marked by fibrofatty myocardial replacement, leading to ventricular dysfunction and life-threatening arrhythmias. Historically identified as a right ventricular disease, advances in cardiac magnetic resonance imaging (CMR) have revealed left ventricular involvement in some cases, underscoring the need for refined diagnostic criteria. Conventional echocardiographic methods lack sensitivity, particularly for early disease detection, while strain imaging holds promise for identifying subclinical dysfunction.
Objective
This review explores the advancements in echocardiographic strain imaging techniques for ACM diagnosis and prognosis, focusing on recent developments in right and left ventricular assessment, differentiation from athletic remodeling, and integration with CMR findings.
Methods
An extensive review of contemporary literature was conducted that analyzed diagnostic thresholds, prognostic significance, and the utility of echocardiographic strain imaging compared to standard measures.
Findings
Echocardiographic right ventricular strain assessment offers enhanced diagnostic sensitivity, identifying ACM in cases that fail to meet traditional echocardiographic criteria. Strain provides superior prognostic discrimination, correlating with the risk of ventricular arrhythmias and disease progression. Left ventricular strain, particularly global longitudinal strain, detects subclinical dysfunction and predicts adverse outcomes, emphasizing its importance in left-dominant ACM phenotypes. Strain-based mechanical dispersion metrics also facilitate early disease detection and risk stratification.
Conclusion
Echocardiographic strain imaging is a valuable, noninvasive tool for ACM, addressing gaps in traditional echocardiographic diagnostic criteria. Standardization of thresholds and broader integration into clinical practice are required to maximize its utility. Future directions include leveraging machine learning and multimodal imaging for comprehensive ACM characterization.
{"title":"State-of-the-Art in Echocardiographic Strain Imaging of Arrhythmogenic Cardiomyopathy","authors":"Thomas Meredith BMed, MD, MClinTRes , Michael H. Picard MD , Timothy W. Churchill MD , Samuel Bernard MD , Philippe B. Bertrand MD, PhD , Danita M.Y. Sanborn MD, MMSc , Mayooran Namasivayam MBBS, PhD","doi":"10.1016/j.echo.2025.11.007","DOIUrl":"10.1016/j.echo.2025.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Arrhythmogenic cardiomyopathy (ACM) is a genetic disorder marked by fibrofatty myocardial replacement, leading to ventricular dysfunction and life-threatening arrhythmias. Historically identified as a right ventricular disease, advances in cardiac magnetic resonance imaging (CMR) have revealed left ventricular involvement in some cases, underscoring the need for refined diagnostic criteria. Conventional echocardiographic methods lack sensitivity, particularly for early disease detection, while strain imaging holds promise for identifying subclinical dysfunction.</div></div><div><h3>Objective</h3><div>This review explores the advancements in echocardiographic strain imaging techniques for ACM diagnosis and prognosis, focusing on recent developments in right and left ventricular assessment, differentiation from athletic remodeling, and integration with CMR findings.</div></div><div><h3>Methods</h3><div>An extensive review of contemporary literature was conducted that analyzed diagnostic thresholds, prognostic significance, and the utility of echocardiographic strain imaging compared to standard measures.</div></div><div><h3>Findings</h3><div>Echocardiographic right ventricular strain assessment offers enhanced diagnostic sensitivity, identifying ACM in cases that fail to meet traditional echocardiographic criteria. Strain provides superior prognostic discrimination, correlating with the risk of ventricular arrhythmias and disease progression. Left ventricular strain, particularly global longitudinal strain, detects subclinical dysfunction and predicts adverse outcomes, emphasizing its importance in left-dominant ACM phenotypes. Strain-based mechanical dispersion metrics also facilitate early disease detection and risk stratification.</div></div><div><h3>Conclusion</h3><div>Echocardiographic strain imaging is a valuable, noninvasive tool for ACM, addressing gaps in traditional echocardiographic diagnostic criteria. Standardization of thresholds and broader integration into clinical practice are required to maximize its utility. Future directions include leveraging machine learning and multimodal imaging for comprehensive ACM characterization.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 206-219"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534711","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 : 2026-02-01DOI: 10.1016/j.echo.2025.09.024
Filippo Sanfilippo MD, PhD , Michelle S. Chew MBBS, PhD, Michel Slama MD, PhD, Jonathan Aron MBBS, BSc, Florence Boissier MD, PhD, Bernard Cholley MD, PhD, David Cloete MD, MSc, MMED, Fernando Clau-Terré MD, PhD, Daniel De Backer MD, PhD, Ghislaine Douflé MD, MME, Jennifer Hastings MD, Antoine Herpain MD, Stephen Huang PhD, Oliver Hunsicker MD, Kateřina Jiroutková MD, PhD, Paul Mayo MD, Armand Mekontso Dessap MD, PhD, Sam Orde MBBS, PhD, Susanna Price MD, PhD, Chiara Robba MD, PhD, Martin Balik MD, PhD
{"title":"Caution Is Warranted When Applying Algorithms for Assessing Left Ventricular Diastolic Dysfunction and Filling Pressure in Critically Ill Patients","authors":"Filippo Sanfilippo MD, PhD , Michelle S. Chew MBBS, PhD, Michel Slama MD, PhD, Jonathan Aron MBBS, BSc, Florence Boissier MD, PhD, Bernard Cholley MD, PhD, David Cloete MD, MSc, MMED, Fernando Clau-Terré MD, PhD, Daniel De Backer MD, PhD, Ghislaine Douflé MD, MME, Jennifer Hastings MD, Antoine Herpain MD, Stephen Huang PhD, Oliver Hunsicker MD, Kateřina Jiroutková MD, PhD, Paul Mayo MD, Armand Mekontso Dessap MD, PhD, Sam Orde MBBS, PhD, Susanna Price MD, PhD, Chiara Robba MD, PhD, Martin Balik MD, PhD","doi":"10.1016/j.echo.2025.09.024","DOIUrl":"10.1016/j.echo.2025.09.024","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 237-238"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410662","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 : 2026-02-01DOI: 10.1016/j.echo.2025.10.014
Iksung Cho MD, PhD , Seonhwa Lee MD , In-Cheol Kim MD, PhD , Dae-Young Kim MD , Kang-Un Choi MD, PhD , Jang-Won Son MD, PhD , Jiwon Seo MD , Hee-Jung Lee MD , Kyu-Yong Ko MD , Kyu Kim MD , Seo-Yeon Gwak MD , Hyun-Jung Lee MD, PhD , Hojeong Kim MS, RDCS , William Dowon Kim MD , Chi Young Shim MD, PhD , Jong-Won Ha MD, PhD , Hyungseop Kim MD, PhD , Geu-Ru Hong MD, PhD , Jagat Narula MD, PhD
Aims
Stroke and systemic embolism are important complications of rheumatic mitral stenosis (MS) even if sinus rhythm (SR) is maintained. We sought to identify the risk factors for these events and to assess the predictive potential of left atrial (LA) mechanics using LA strain in patients with rheumatic MS in SR.
Methods and results
We analyzed 875 patients with rheumatic MS and SR. The primary outcome was defined as a composite of stroke, transient ischemic attack, and noncentral nervous system embolism. Systemic embolic events developed in 124 (14.1%) of 875 patients at a rate of 4.0 per 100 patient-years (95% CI, 2.5-5.5), during a mean follow-up period of 96.4 ± 61.1 months. Patients with systemic embolic events had a higher prevalence of hypertension and old age than those who did not experience such events, without significant differences in LA size. Left atrial reservoir strain (LASr) was impaired in patients with systemic embolic events (18.8 ± 6.8 vs 14.4 ± 5.3; P < .001). Left atrial reservoir strain was an independent predictor of systemic embolic events (hazard ratio, 0.84; 95% CI, 0.80-0.88; P = .001), after adjusting for confounding factors. The optimal LASr cutoff of 16.6%, derived from receiver operating characteristic analysis, identified subgroups with markedly different risks: patients with LASr ≤16.6% showed a 9.5%/year incidence rate (95% CI, 5.9-12.4) of events, while those with LASr >16.6% had a 2.5%/year (95% CI, 1.6-4.1; P < .001).
Conclusions
Impaired LA strain is associated with systemic embolism in patients with rheumatic MS and SR. A targeted anticoagulation approach may be warranted for those with impaired LA strain.
{"title":"Prognostic Value of Left Atrial Strain for Systemic Embolism in Rheumatic Mitral Stenosis with Sinus Rhythm: Implications for Anticoagulation Strategy","authors":"Iksung Cho MD, PhD , Seonhwa Lee MD , In-Cheol Kim MD, PhD , Dae-Young Kim MD , Kang-Un Choi MD, PhD , Jang-Won Son MD, PhD , Jiwon Seo MD , Hee-Jung Lee MD , Kyu-Yong Ko MD , Kyu Kim MD , Seo-Yeon Gwak MD , Hyun-Jung Lee MD, PhD , Hojeong Kim MS, RDCS , William Dowon Kim MD , Chi Young Shim MD, PhD , Jong-Won Ha MD, PhD , Hyungseop Kim MD, PhD , Geu-Ru Hong MD, PhD , Jagat Narula MD, PhD","doi":"10.1016/j.echo.2025.10.014","DOIUrl":"10.1016/j.echo.2025.10.014","url":null,"abstract":"<div><h3>Aims</h3><div>Stroke and systemic embolism are important complications of rheumatic mitral stenosis (MS) even if sinus rhythm (SR) is maintained. We sought to identify the risk factors for these events and to assess the predictive potential of left atrial (LA) mechanics using LA strain in patients with rheumatic MS in SR.</div></div><div><h3>Methods and results</h3><div>We analyzed 875 patients with rheumatic MS and SR. The primary outcome was defined as a composite of stroke, transient ischemic attack, and noncentral nervous system embolism. Systemic embolic events developed in 124 (14.1%) of 875 patients at a rate of 4.0 per 100 patient-years (95% CI, 2.5-5.5), during a mean follow-up period of 96.4 ± 61.1 months. Patients with systemic embolic events had a higher prevalence of hypertension and old age than those who did not experience such events, without significant differences in LA size. Left atrial reservoir strain (LASr) was impaired in patients with systemic embolic events (18.8 ± 6.8 vs 14.4 ± 5.3; <em>P</em> < .001). Left atrial reservoir strain was an independent predictor of systemic embolic events (hazard ratio, 0.84; 95% CI, 0.80-0.88; <em>P</em> = .001), after adjusting for confounding factors. The optimal LASr cutoff of 16.6%, derived from receiver operating characteristic analysis, identified subgroups with markedly different risks: patients with LASr ≤16.6% showed a 9.5%/year incidence rate (95% CI, 5.9-12.4) of events, while those with LASr >16.6% had a 2.5%/year (95% CI, 1.6-4.1; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Impaired LA strain is associated with systemic embolism in patients with rheumatic MS and SR. A targeted anticoagulation approach may be warranted for those with impaired LA strain.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 136-145"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432865","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 : 2026-02-01DOI: 10.1016/j.echo.2025.10.012
Heayoung Shin MD , Jihoon Kim MD, PhD , David Hong MD , Minjung Bak MD, PhD , Darae Kim MD, PhD , Jin-Oh Choi MD, PhD , Yang Hyun Cho MD, PhD , Joong Hyun Ahn MS , Jeong Hoon Yang MD, PhD
Aims
Previous studies on echocardiographic predictors for weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) have explored various left ventricular systolic function parameters. Therefore, we investigated whether change in left atrial (LA) strain during the weaning trial was associated with successful weaning from VA-ECMO.
Methods
A total of 120 patients with cardiogenic shock who received VA-ECMO between March 2016 and March 2024 were analyzed using a single-center prospective registry. During the weaning trial, flow gradually decreased by 30% to 50% of baseline flow. We assessed conventional echocardiographic parameters and LA reservoir strain (LARS) both at baseline and at minimal flow after flow reduction. The primary outcome was successful ECMO weaning.
Results
Sixty-six patients (55.0%) were successfully weaned from VA-ECMO. At minimal flow, conventional echocardiographic parameters were higher in the weaning success group compared to the failure group, including left ventricular outflow tract velocity-time integral, left ventricular ejection fraction, and mitral annular systolic velocity (all P < .001). During the weaning trial, the percentage relative increase in LARS was significantly higher in the success group than in the failure group (median 39.5% vs −1.2%; P < .001). The percentage relative increase in LARS was independently associated with weaning success (per +1%, adjusted odds ratio 1.02; 95% CI, 1.01-1.03; P = .003). Adding the percentage relative change in LARS to conventional criteria improved discrimination between weaning success and failure (area under the curve from 0.75 to 0.83; P = .010).
Conclusions
Left atrial reservoir strain improvement during ECMO weaning trial might be useful as a predictor of successful weaning from VA-ECMO when combined with conventional echocardiographic parameters.
{"title":"Clinical Significance of Change in Left Atrial Strain during Weaning from Venoarterial Extracorporeal Membrane Oxygenation","authors":"Heayoung Shin MD , Jihoon Kim MD, PhD , David Hong MD , Minjung Bak MD, PhD , Darae Kim MD, PhD , Jin-Oh Choi MD, PhD , Yang Hyun Cho MD, PhD , Joong Hyun Ahn MS , Jeong Hoon Yang MD, PhD","doi":"10.1016/j.echo.2025.10.012","DOIUrl":"10.1016/j.echo.2025.10.012","url":null,"abstract":"<div><h3>Aims</h3><div>Previous studies on echocardiographic predictors for weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) have explored various left ventricular systolic function parameters. Therefore, we investigated whether change in left atrial (LA) strain during the weaning trial was associated with successful weaning from VA-ECMO.</div></div><div><h3>Methods</h3><div>A total of 120 patients with cardiogenic shock who received VA-ECMO between March 2016 and March 2024 were analyzed using a single-center prospective registry. During the weaning trial, flow gradually decreased by 30% to 50% of baseline flow. We assessed conventional echocardiographic parameters and LA reservoir strain (LARS) both at baseline and at minimal flow after flow reduction. The primary outcome was successful ECMO weaning.</div></div><div><h3>Results</h3><div>Sixty-six patients (55.0%) were successfully weaned from VA-ECMO. At minimal flow, conventional echocardiographic parameters were higher in the weaning success group compared to the failure group, including left ventricular outflow tract velocity-time integral, left ventricular ejection fraction, and mitral annular systolic velocity (all <em>P</em> < .001). During the weaning trial, the percentage relative increase in LARS was significantly higher in the success group than in the failure group (median 39.5% vs −1.2%; <em>P</em> < .001). The percentage relative increase in LARS was independently associated with weaning success (per +1%, adjusted odds ratio 1.02; 95% CI, 1.01-1.03; <em>P</em> = .003). Adding the percentage relative change in LARS to conventional criteria improved discrimination between weaning success and failure (area under the curve from 0.75 to 0.83; <em>P</em> = .010).</div></div><div><h3>Conclusions</h3><div>Left atrial reservoir strain improvement during ECMO weaning trial might be useful as a predictor of successful weaning from VA-ECMO when combined with conventional echocardiographic parameters.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 146-155"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410632","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 : 2026-02-01DOI: 10.1016/j.echo.2025.10.009
Madiha Saiedi BSc, Liza Thomas MBBS, PhD, Mark Thomas MBBS, Nikola Stoyanov MBBS, Kotaro Nochioka MD, PhD, MPH, Rebecca Kozor BSc (Med), MBBS, PhD, Geu Ru Hong MD, PhD, Ian Chapman MBBS, PhD, Rebecca Perry BSc, PhD, Joseph B. Selvanayagam MBBS (Hons), DPhil
{"title":"Differentiating Anderson-Fabry Disease from Other Causes of Left Ventricular Hypertrophy: Novel Insights from Left Atrial Strain Imaging","authors":"Madiha Saiedi BSc, Liza Thomas MBBS, PhD, Mark Thomas MBBS, Nikola Stoyanov MBBS, Kotaro Nochioka MD, PhD, MPH, Rebecca Kozor BSc (Med), MBBS, PhD, Geu Ru Hong MD, PhD, Ian Chapman MBBS, PhD, Rebecca Perry BSc, PhD, Joseph B. Selvanayagam MBBS (Hons), DPhil","doi":"10.1016/j.echo.2025.10.009","DOIUrl":"10.1016/j.echo.2025.10.009","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 222-225"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402690","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 : 2026-02-01DOI: 10.1016/j.echo.2025.09.014
Jaehyun Lim MD, Soongu Kwak MD, Min-Ha Jeong MD, Jae Yeong Cho MD, PhD, ChanSoon Park MD, PhD, Jiesuck Park MD, Hong-Mi Choi MD, Ga Hui Choi MD, Jihoon Kim MD, Jin-Oh Na MD, PhD, Sun Hwa Lee MD, PhD, Mi-Hyang Jung MD, PhD, Hae Ok Jung MD, PhD, Sang-Chol Lee MD, PhD, Hyung-Kwan Kim MD, PhD, Kye Hun Kim MD, PhD, Goo-Yeong Cho MD, PhD
{"title":"The Effect of Mavacamten on Left Atrial Strain Dynamics in Obstructive Hypertrophic Cardiomyopathy","authors":"Jaehyun Lim MD, Soongu Kwak MD, Min-Ha Jeong MD, Jae Yeong Cho MD, PhD, ChanSoon Park MD, PhD, Jiesuck Park MD, Hong-Mi Choi MD, Ga Hui Choi MD, Jihoon Kim MD, Jin-Oh Na MD, PhD, Sun Hwa Lee MD, PhD, Mi-Hyang Jung MD, PhD, Hae Ok Jung MD, PhD, Sang-Chol Lee MD, PhD, Hyung-Kwan Kim MD, PhD, Kye Hun Kim MD, PhD, Goo-Yeong Cho MD, PhD","doi":"10.1016/j.echo.2025.09.014","DOIUrl":"10.1016/j.echo.2025.09.014","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 220-222"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182284","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 : 2026-02-01DOI: 10.1016/j.echo.2025.09.023
Jorge Eduardo Assef PhD, MD, Gustavo Nishida PhD
{"title":"Systematizing Diastolic Function Evaluation: From Algorithms to Practical Approach—Are We Finally Reaching Diagnostic Consistency?","authors":"Jorge Eduardo Assef PhD, MD, Gustavo Nishida PhD","doi":"10.1016/j.echo.2025.09.023","DOIUrl":"10.1016/j.echo.2025.09.023","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 235-236"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410678","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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