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}
Pub Date : 2026-02-01DOI: 10.1016/j.echo.2025.10.002
Yohei Masuda MD, Fumio Otsuka MD, PhD
{"title":"Implementation of Modified Venous Excess Ultrasound in Clinical Practice","authors":"Yohei Masuda MD, Fumio Otsuka MD, PhD","doi":"10.1016/j.echo.2025.10.002","DOIUrl":"10.1016/j.echo.2025.10.002","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 229-230"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276396","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.2025.09.011
Edith L. Posada-Martinez MD, Juan B. Ivey-Miranda MD, PhD
{"title":"Reply to “Intraoperative Factors Should Be Considered in Assessing the Association between Three-Dimensional Right Ventricular Ejection Fraction and Early Postoperative Outcomes”","authors":"Edith L. Posada-Martinez MD, Juan B. Ivey-Miranda MD, PhD","doi":"10.1016/j.echo.2025.09.011","DOIUrl":"10.1016/j.echo.2025.09.011","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 232-233"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180333","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.2025.10.015
Giorgia Benzoni MD , Michele Tomaselli MD, PhD , Noela Radu MD , Alexandra Clement MD , Marco Penso BME , Paolo Springhetti MD , Daniel Ignacio Conforme Torres MD , Tommaso Rinforzi MD , Carlotta Tosi MD , Alexandra Buta MD , Yuka Kawada MD , Denisa Muraru MD, PhD , Luigi P. Badano MD, PhD
Background
Three-dimensional echocardiographic planimetry of vena contracta area (VCA), which avoids geometric assumptions about the regurgitant orifice, has emerged as a promising method for grading secondary tricuspid regurgitation (STR). The aims of this study were to (1) define VCA threshold values to grade the severity of STR using a five-grade system, (2) identify the VCA cutoff value associated with adverse clinical outcomes, and (3) assess the incremental prognostic value of VCA compared with conventional quantitative parameters of tricuspid regurgitation severity.
Methods
Three-dimensional echocardiography was used to obtain VCA from 204 outpatients (mean age, 77 ± 12 years; 44% men) with mild to torrential STR (52% with severe or greater STR) according to current guidelines, and its association with a composite outcome of all-cause death and hospitalization for heart failure was assessed.
Results
The VCA threshold values for STR severity were <0.43 cm2 for mild, 0.43 to 0.67 cm2 for moderate, 0.68 to 0.88 cm2 for severe, 0.89 to 1.26 cm2 for massive, and >1.26 cm2 for torrential STR. Spline curve analysis identified a VCA threshold of 0.65 cm2 as the optimal cutoff associated with an increased risk for experiencing the composite end point. Although not yet severe, patients with VCA > 0.65 cm2 experienced an exponential increase in their risk. VCA > 0.65 cm2 was associated with a threefold risk increase for the composite end point regardless of effective regurgitant orifice area (EROA; log-rank P = .00068). In multivariate analysis, VCA remained independently associated with the composite end point (adjusted hazard ratio, 1.06; 95% CI, 1.02-1.10; P = .004). Adding VCA to baseline models incorporating clinical and echocardiographic variables, including either EROA or regurgitant volume, significantly improved the prognostic performance of the model (P = .007 and P = .018, respectively).
Conclusions
VCA obtained from color Doppler three-dimensional echocardiography is a robust parameter to grade STR severity, showing incremental prognostic value in comparison with both EROA and regurgitant volume.
{"title":"Threshold Values of Vena Contracta Area for Grading Secondary Tricuspid Regurgitation and its Association with Outcomes","authors":"Giorgia Benzoni MD , Michele Tomaselli MD, PhD , Noela Radu MD , Alexandra Clement MD , Marco Penso BME , Paolo Springhetti MD , Daniel Ignacio Conforme Torres MD , Tommaso Rinforzi MD , Carlotta Tosi MD , Alexandra Buta MD , Yuka Kawada MD , Denisa Muraru MD, PhD , Luigi P. Badano MD, PhD","doi":"10.1016/j.echo.2025.10.015","DOIUrl":"10.1016/j.echo.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Three-dimensional echocardiographic planimetry of vena contracta area (VCA), which avoids geometric assumptions about the regurgitant orifice, has emerged as a promising method for grading secondary tricuspid regurgitation (STR). The aims of this study were to (1) define VCA threshold values to grade the severity of STR using a five-grade system, (2) identify the VCA cutoff value associated with adverse clinical outcomes, and (3) assess the incremental prognostic value of VCA compared with conventional quantitative parameters of tricuspid regurgitation severity.</div></div><div><h3>Methods</h3><div>Three-dimensional echocardiography was used to obtain VCA from 204 outpatients (mean age, 77 ± 12 years; 44% men) with mild to torrential STR (52% with severe or greater STR) according to current guidelines, and its association with a composite outcome of all-cause death and hospitalization for heart failure was assessed.</div></div><div><h3>Results</h3><div>The VCA threshold values for STR severity were <0.43 cm<sup>2</sup> for mild, 0.43 to 0.67 cm<sup>2</sup> for moderate, 0.68 to 0.88 cm<sup>2</sup> for severe, 0.89 to 1.26 cm<sup>2</sup> for massive, and >1.26 cm<sup>2</sup> for torrential STR. Spline curve analysis identified a VCA threshold of 0.65 cm<sup>2</sup> as the optimal cutoff associated with an increased risk for experiencing the composite end point. Although not yet severe, patients with VCA > 0.65 cm<sup>2</sup> experienced an exponential increase in their risk. VCA > 0.65 cm<sup>2</sup> was associated with a threefold risk increase for the composite end point regardless of effective regurgitant orifice area (EROA; log-rank <em>P</em> = .00068). In multivariate analysis, VCA remained independently associated with the composite end point (adjusted hazard ratio, 1.06; 95% CI, 1.02-1.10; <em>P</em> = .004). Adding VCA to baseline models incorporating clinical and echocardiographic variables, including either EROA or regurgitant volume, significantly improved the prognostic performance of the model (<em>P</em> = .007 and <em>P</em> = .018, respectively).</div></div><div><h3>Conclusions</h3><div>VCA obtained from color Doppler three-dimensional echocardiography is a robust parameter to grade STR severity, showing incremental prognostic value in comparison with both EROA and regurgitant volume.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"39 2","pages":"Pages 156-166"},"PeriodicalIF":6.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432841","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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