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Sex-Specific Differences in Echocardiographic Parameters of Risk Stratification in Pulmonary Arterial Hypertension 肺动脉高压危险分层超声心动图参数的性别差异。
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.11.015
Nicola Benjamin Dr Sc Hum , Veronika Schiffer , Carolin Resag , Panagiota Xanthouli MD , Moritz Braun , Satenik Harutyunova MD , Christina A. Eichstaedt PhD , Benjamin Egenlauf MD , Alberto M. Marra MD , Eduardo Bossone MD , Antonio Cittadini MD , David G. Kiely MD , Ekkehard Grünig MD

Background

In healthy subjects, sex differences in right heart function have been detected for various echocardiographic parameters. The objective of this study was to investigate sex differences in echocardiographic European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk stratification parameters and their impact on survival estimation in patients with pulmonary arterial hypertension (PAH).

Methods

In this retrospective, cross-sectional study with a mean follow-up time of 3.2 ± 2.65 years (median, 2.78 years), clinical parameters including right atrial (RA) area, right ventricular area, and tricuspid annular plane systolic excursion (TAPSE) divided by systolic pulmonary artery pressure (sPAP) were assessed. Thresholds of ESC/ERS risk stratification were compared using multivariable Cox regression analysis.

Results

Of 748 patients with PAH (mean age, 65 ± 15 years; 63% women), men had significantly larger right heart size than women (RA area 21.76 ± 7.64 vs 17.65 ± 6.82 cm2, P < .001; right ventricular area 24.02 ± 7.15 cm2 vs 18.41 ± 5.75 cm2, P < .001). This difference was consistent throughout all World Health Organization functional classes and cardiac index risk groups, except for the RA area in the cardiac index high-risk group and World Health Organization functional class IV. On multivariable analysis, indexed values showed more pronounced differences for age-adjusted survival analysis compared with ESC/ERS risk stratification thresholds. TAPSE/sPAP showed no significant sex differences, which makes this parameter a robust prognostic predictor.

Conclusions

This is the first study focusing on sex differences in right heart size obtained by echocardiography in patients with PAH. For risk stratification indexing RA area to body surface area could be more reflective of body composition. In contrast, TAPSE/sPAP values were not sex dependent and were a robust prognostic factor in patients with PAH.
背景:在健康受试者中,各种超声心动图参数已经检测到右心功能的性别差异。研究问题:本研究的目的是探讨肺动脉高压(PAH)患者超声心动图ESC/ERS风险分层参数的性别差异及其对生存估计的影响。研究设计和方法:在这项回顾性横断面研究中,平均随访时间为3.2±2.65(中位2.78)年,评估临床参数,包括右心房(RA)、右心室(RV)面积和三尖瓣环平面收缩偏移(TAPSE),并以收缩期肺动脉压(sPAP)划分。采用多变量Cox回归分析比较ESC/ERS风险分层阈值。结果:748例PAH患者(平均年龄65±15岁,63%为女性),男性右心尺寸明显大于女性(RA面积21.76±7.64 cm2 vs. 17.65±6.82 cm2, p2 vs. 18.41±5.75 cm2)。结论:本研究首次关注超声心动图在PAH患者右心尺寸的性别差异。对于风险分层,ra面积与体表面积的指标化更能考虑到身体成分。相比之下,TAPSE/sPAP值与性别无关,是PAH的一个可靠的预后因素。
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引用次数: 0
The Forgotten Truth About Proximal Isovelocity Surface Area Correction in Tricuspid Regurgitation 关于三尖瓣反流的PISA纠正被遗忘的真相。
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-01 DOI: 10.1016/j.echo.2024.11.007
Ratnasari Padang MBBS, PhD, Jeremy J. Thaden MD
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引用次数: 0
Mechanical adaptation of the right ventricle to secondary tricuspid regurgitation, and its association with patients' outcomes.
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-22 DOI: 10.1016/j.echo.2025.02.011
Zsuzsanna Ladányi, Bálint Károly Lakatos, Alexandra Clement, Michele Tomaselli, Alexandra Fábián, Noela Radu, Tímea Katalin Turschl, Andrea Ferencz, Béla Merkely, Elena Surkova, Attila Kovács, Denisa Muraru, Luigi P Badano

Background: Data regarding the right ventricular (RV) mechanical adaptation to secondary tricuspid regurgitation (STR) is scarce.

Objectives: We investigated the changes in RV contraction pattern in patients with different STR severity and etiology, and their association with outcomes.

Methods: We enrolled 205 patients with STR (60% female, age: 77±12 years), in a single-center prospective observational study. We used three-dimensional echocardiography to measure RV ejection fraction (RVEF), the absolute contribution of the RV longitudinal (LEF), radial (REF), and anteroposterior (AEF) ejection fraction components, and their relative contribution by indexing to global RVEF (LEF/RVEF; REF/RVEF; AEF/RVEF). The patients were followed for a median of 9 months. The primary outcome was defined as heart failure hospitalization or all-cause death.

Results: Patients with different STR severity did not differ in terms of RVEF (mild vs. moderate vs. severe, RVEF: 50±11 vs. 49±9 vs. 50±10%, respectively, p=0.085). However, LEF/RVEF was significantly lower in severe STR (0.39±0.08 vs. 0.39±0.09 vs. 0.35±0.10, respectively, p=0.049). Patients with ventricular STR had lower global RVEF (48±10% vs. 53±8%, p=0.001), LEF (18±6% vs. 20±5 %, p=0.043), REF (23±9% vs. 28±8%, p=0.002), and REF/RVEF (0.48±0.012 vs. 0.52±0.09; p=0.040) than patients with atrial STR. In a multivariable Cox regression model, REF/RVEF was a significant and independent predictor of outcomes in the entire cohort (hazard ratio, 0.980 [CI, 0.961-1.000] per 0.01 unit change, p=0.047), while global RVEF was not.

Conclusions: Patients with STR demonstrate significant functional RV remodelling. Patients with severe STR show a significant decrease in the RV longitudinal shortening. Apart from STR severity, STR etiology also influences the RV contraction pattern, which was associated with outcomes in our cohort.

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引用次数: 0
Association Between Three-Dimensional Right Ventricular Ejection Fraction and In-Hospital Outcomes in Patients Undergoing Cardiac Surgery: A Multicenter Study.
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-19 DOI: 10.1016/j.echo.2025.02.008
Edith L Posada-Martinez, Juan B Ivey-Miranda, Xochitl A Ortiz-Leon, Jose A Arias-Godinez, Juan F Fritche-Salazar, Hugo G Rodriguez-Zanella, Maria E Ruiz Esparza-Dueñas, Diana Romero-Zertuche, Ivan I Silvestre-Flores, Julieta Morales-Portano, Arturo Orea-Tejeda, Jorge Rojas-Serrano, Robert L McNamara, Pedro A Reyes Lopez, Lissa Sugeng

Aims: Cardiac surgery is the cornerstone of treatment of several heart conditions, but accurate risk stratification is critical. Commonly used scores do not include right ventricular (RV) function. We aimed to evaluate whether three-dimensional (3D) RV ejection fraction (RVEF) predicts outcomes in patients undergoing cardiac surgery after adjusting for the EuroSCORE II.

Methods and results: This is a prospective multicenter study of adult patients undergoing cardiac surgery at 3 centers. Right ventricular function parameters were analyzed with transesophageal echocardiogram before the surgery. We evaluated the association of 3D RVEF with the primary outcome (composite of in-hospital mortality or need of temporary ventricular assist device) after adjusting for the EuroSCORE II. Exploratory end points were time on mechanical ventilation and time on inotropes. We included 248 patients (median age, 69 years; 43% female). Sixty-nine percent had normal RVEF (≥45%). Right ventricular function parameters (tricuspid annular plane systolic excursion, fractional area change, and RV free-wall longitudinal strain) were lower in the group of decreased RVEF (P < .001 for all). The primary outcome occurred in 28 patients (11%). After adjusting for the EuroSCORE II, decreased RVEF was independently associated with the primary outcome (hazard ratio = 2.46; 95% CI, 1.10, 5.50; P = .028). Importantly, 3D RVEF was superior to all other parameters of RV systolic function to predict the primary outcome (P = .006). At 30 days, survival free of the primary end point was 72% ± 8% versus 93% ± 3% (P < .001) in decreased versus normal RVEF, respectively. Right ventricular ejection fraction was associated with shorter time on mechanical ventilation (r = -0.27, P < .001) and shorter time on inotropes (r = -0.20, P = .01).

Conclusions: Among the RV function parameters, 3D RVEF is the strongest predictor of in-hospital mortality or need of temporary ventricular assist device in patients undergoing cardiac surgery. This multicenter study suggests that 3D RVEF should be included in the evaluation of patients undergoing surgery because it might improve stratification.

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引用次数: 0
Mitral Annular Dynamics After Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation: Comparison With Surgical Annuloplasty.
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-18 DOI: 10.1016/j.echo.2025.02.005
Mai Terada, Nobuyuki Kagiyama, Yuki Izumi, Ryosuke Higuchi, Mike Saji, Mitsunobu Kitamura, Itaru Takamisawa, Mamoru Nanasato, Tomohiro Iwakura, Mitsuaki Isobe
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引用次数: 0
Assessment of Diastolic Function: Is It Time to Relax? Rethinking Echocardiographic Approaches.
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-17 DOI: 10.1016/j.echo.2025.02.004
Thor Edvardsen, Lars Gunnar Klæboe
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引用次数: 0
The Elusive Nature of "Simple" D-Transposition During Perinatal Transition.
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-11 DOI: 10.1016/j.echo.2025.02.002
Rajesh Punn, Anita J Moon-Grady
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引用次数: 0
Are AI foundation models efficient for segmentation of echocardiograms?
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-08 DOI: 10.1016/j.echo.2025.02.001
Danielle L Ferreira, Rima Arnaout
{"title":"Are AI foundation models efficient for segmentation of echocardiograms?","authors":"Danielle L Ferreira, Rima Arnaout","doi":"10.1016/j.echo.2025.02.001","DOIUrl":"10.1016/j.echo.2025.02.001","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392357","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}
引用次数: 0
Extending the Mitral Annular Disjunction Phenotype: Anomalous Attachment of the Posterior Mitral Annulus to the Crest of the Left Ventricle.
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-03 DOI: 10.1016/j.echo.2025.01.014
Jeffrey J Silbiger, Raveen Bazaz
{"title":"Extending the Mitral Annular Disjunction Phenotype: Anomalous Attachment of the Posterior Mitral Annulus to the Crest of the Left Ventricle.","authors":"Jeffrey J Silbiger, Raveen Bazaz","doi":"10.1016/j.echo.2025.01.014","DOIUrl":"10.1016/j.echo.2025.01.014","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257256","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}
引用次数: 0
Application of Machine Learning Technology to Automate Thoracic Aorta Dimensions by Echocardiography 应用机器学习技术自动测量超声心动图胸主动脉尺寸。
IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 DOI: 10.1016/j.echo.2024.10.017
Hema Krishna MD, Carlos Dohse MD, Dale Smith PhD, Matthew Frost, Cyril Equilbec MEng, Glenda Chin BS, Michael Hill MD, Mary Carolina Rodriguez Ziccardi MD, Brody Slostad MD, Ashley Carter DNP, David Tiu BS, Dawood Darbar MBCHB, MD, Patricia A. Pellikka MD, Mayank Kansal MD
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Journal of the American Society of Echocardiography
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