Pub Date : 2025-02-01DOI: 10.1016/j.echo.2024.12.004
Annette Vegas MD, FRCPC, FASE, (Chair) , Bryan Wells MD, FASE, (Co-Chair) , Paul Braum BS, RDCS, RCS, FASE , Andre Denault MD, PhD, FASE , Wanda C. Miller Hance MD, FACC, FASE , Claire Kaufman MD , Mitalee Bremner Patel RDCS, FASE , Marcus Salvatori MD
Vascular access is a commonly performed procedure to facilitate patient care. This document provides expert consensus from diverse specialists on best practices and techniques for incorporating ultrasound (US) into vascular access procedures. This update replaces the 2011 American Society of Echocardiography guidelines for US-guided vascular cannulation. It includes recommendations for US-guided access to central and peripheral veins and arteries in adult and pediatric patients based on the strength of the scientific evidence present in the literature. The major roles of US during vascular access include (1) precannulation vessel assessment, (2) dynamic US guidance during cannulation, and (3) identification of local complications. This document discusses the general aspects of anatomic and US imaging of vessels, US-guided vascular cannulation techniques, and the identification of local vascular cannulation complications. Proper training should impart the cognitive knowledge and technical skills necessary to perform US-guided cannulation. There is an increasing body of literature indicating that US-guided vascular access improves success rates and reduces complications, although the quality of the evidence to date remains weak. A gap remains between the existing evidence and guidelines for the use of US in clinical practice. The availability of US equipment and clinical proficiency will more likely influence the role of US-guided vascular access as a standard of care than will future research studies.
{"title":"Guidelines for Performing Ultrasound-Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography","authors":"Annette Vegas MD, FRCPC, FASE, (Chair) , Bryan Wells MD, FASE, (Co-Chair) , Paul Braum BS, RDCS, RCS, FASE , Andre Denault MD, PhD, FASE , Wanda C. Miller Hance MD, FACC, FASE , Claire Kaufman MD , Mitalee Bremner Patel RDCS, FASE , Marcus Salvatori MD","doi":"10.1016/j.echo.2024.12.004","DOIUrl":"10.1016/j.echo.2024.12.004","url":null,"abstract":"<div><div>Vascular access is a commonly performed procedure to facilitate patient care. This document provides expert consensus from diverse specialists on best practices and techniques for incorporating ultrasound (US) into vascular access procedures. This update replaces the 2011 American Society of Echocardiography guidelines for US-guided vascular cannulation. It includes recommendations for US-guided access to central and peripheral veins and arteries in adult and pediatric patients based on the strength of the scientific evidence present in the literature. The major roles of US during vascular access include (1) precannulation vessel assessment, (2) dynamic US guidance during cannulation, and (3) identification of local complications. This document discusses the general aspects of anatomic and US imaging of vessels, US-guided vascular cannulation techniques, and the identification of local vascular cannulation complications. Proper training should impart the cognitive knowledge and technical skills necessary to perform US-guided cannulation. There is an increasing body of literature indicating that US-guided vascular access improves success rates and reduces complications, although the quality of the evidence to date remains weak. A gap remains between the existing evidence and guidelines for the use of US in clinical practice. The availability of US equipment and clinical proficiency will more likely influence the role of US-guided vascular access as a standard of care than will future research studies.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 2","pages":"Pages 57-91"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150230","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 : 2025-02-01DOI: 10.1016/j.echo.2024.09.012
Carlo Mannina MD , Kazato Ito MD , Zhezhen Jin PhD , Yuriko Yoshida MD , Cesare Russo MD , Koki Nakanishi MS, MD , Tatjana Rundek MS, MD, PhD , Shunichi Homma MD , Mitchell S.V. Elkind MD, MS , Marco R. Di Tullio MD
Background
Heart failure (HF) prevalence is increasing, especially among older adults. Left atrial (LA) dysfunction is often associated with HF, but it is unclear whether it may contribute to its development. We investigated whether measures of LA function can predict the development of HF in older adults without a history of cardiovascular events.
Methods and Results
Seven hundred ninety-five participants from a triethnic (white, Black, Hispanic) community-based cohort of adults age ≥55 without a history of cardiovascular events underwent standard, three-dimensional, and speckle-tracking echocardiography. Left atrial volumes, LA strain, LA stiffness, and LA coupling index (LACI) were measured. Longitudinal follow-up was conducted, and new-onset HF was ascertained through standardized interviews, in-person visits, and active hospital surveillance of admission and discharge ICD-9 codes. Risk analysis with a cause-specific hazards regression model was used to assess the association of LA variables with incident HF, adjusting for other HF risk factors. The mean age was 70.9 ± 9.2 years (297 men, 498 women). During a mean follow-up of 11.4 years, new-onset HF occurred in 345 participants (43.4%). All measures of LA morphology and function were associated with incident HF (all P < .05). In multivariable analysis, LA stiffness and LACI (adjusted hazard ratio = 2.06; 95% CI, 1.08-3.94; adjusted hazard ratio = 1.25; 95% CI, 1.09-1.43, respectively) remained associated with incident HF. After further adjustment for left ventricular global longitudinal strain, only LACI remained associated with incident HF (adjusted hazard ratio = 1.22; 95% CI, 1.05-1.42).
Conclusions
Left atrial coupling index is a stronger independent predictor for incident HF in older adults than LA volumes and strain and may improve HF risk stratification.
背景：心力衰竭（HF）的发病率越来越高，尤其是在老年人中。左心房（LA）功能障碍通常与心力衰竭有关，但目前尚不清楚它是否会导致心力衰竭的发生。我们研究了测量 LA 功能是否能预测无心血管事件史的老年人是否会患高血压。 方法和结果：来自三族（白人、黑人、西班牙裔）社区队列的 795 名年龄≥55 岁、无心血管事件史的成年人接受了标准、三维和斑点追踪超声心动图检查。测量了 LA 容量、LA 应变、LA 硬度和 LA 耦合指数 (LACI)。研究人员进行了纵向随访，并通过标准化访谈、亲自探访、医院对入院和出院 ICD-9 编码的主动监测来确定新发 HF。在调整其他心房颤动风险因素的基础上，采用病因特异性危险回归模型进行风险分析，以评估 LA 变量与心房颤动事件的相关性。平均年龄为 70.9±9.2（男性 297 人，女性 498 人）。在平均 11.4 年的随访期间，345 名参与者（43.4%）出现了新发高血压。LA形态和功能的所有指标均与新发心房颤动有关（所有p结论：与 LA 容积和应变相比，LACI 是老年人发生心房颤动的独立预测指标，可改善心房颤动风险分层。
{"title":"Left Atrial Function and Incident Heart Failure in Older Adults","authors":"Carlo Mannina MD , Kazato Ito MD , Zhezhen Jin PhD , Yuriko Yoshida MD , Cesare Russo MD , Koki Nakanishi MS, MD , Tatjana Rundek MS, MD, PhD , Shunichi Homma MD , Mitchell S.V. Elkind MD, MS , Marco R. Di Tullio MD","doi":"10.1016/j.echo.2024.09.012","DOIUrl":"10.1016/j.echo.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) prevalence is increasing, especially among older adults. Left atrial (LA) dysfunction is often associated with HF, but it is unclear whether it may contribute to its development. We investigated whether measures of LA function can predict the development of HF in older adults without a history of cardiovascular events.</div></div><div><h3>Methods and Results</h3><div>Seven hundred ninety-five participants from a triethnic (white, Black, Hispanic) community-based cohort of adults age ≥55 without a history of cardiovascular events underwent standard, three-dimensional, and speckle-tracking echocardiography. Left atrial volumes, LA strain, LA stiffness, and LA coupling index (LACI) were measured. Longitudinal follow-up was conducted, and new-onset HF was ascertained through standardized interviews, in-person visits, and active hospital surveillance of admission and discharge ICD-9 codes. Risk analysis with a cause-specific hazards regression model was used to assess the association of LA variables with incident HF, adjusting for other HF risk factors. The mean age was 70.9 ± 9.2 years (297 men, 498 women). During a mean follow-up of 11.4 years, new-onset HF occurred in 345 participants (43.4%). All measures of LA morphology and function were associated with incident HF (all <em>P</em> < .05). In multivariable analysis, LA stiffness and LACI (adjusted hazard ratio = 2.06; 95% CI, 1.08-3.94; adjusted hazard ratio = 1.25; 95% CI, 1.09-1.43, respectively) remained associated with incident HF. After further adjustment for left ventricular global longitudinal strain, only LACI remained associated with incident HF (adjusted hazard ratio = 1.22; 95% CI, 1.05-1.42).</div></div><div><h3>Conclusions</h3><div>Left atrial coupling index is a stronger independent predictor for incident HF in older adults than LA volumes and strain and may improve HF risk stratification.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 2","pages":"Pages 103-110"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401774","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 : 2025-02-01DOI: 10.1016/j.echo.2024.09.013
Kristen Westenfield MD, Steven M. Bradley MD, MPH, Larissa Stanberry PhD, Kevin M. Harris MD
Background
Understanding ascending aortic aneurysm growth and associated risk factors is critical to advising appropriate echocardiographic follow-up intervals for patients. The aim of this study was to identify aortic aneurysm growth rate on serial echocardiography as well as the clinical and demographic variables that contribute to baseline aortic size and subsequent aortic growth.
Methods
Patients identified with ascending aortic aneurysms and undergoing serial echocardiograms within 5 years were evaluated. Ascending aortic size was measured as part of routine echocardiographic examinations. Clinical and demographic variables including aortic valve type (trileaflet, bicuspid, or prosthetic) were evaluated for association with baseline aortic size as well as with aortic progression rate. Clinical events including aortic dissection and elective or emergent surgical repair were recorded.
Results
A total of 3,639 patients were identified (78% men; median age, 69 years), 175 (4.8%) with bicuspid valves and 206 (5.6%) with prior aortic valve replacement. Patients with larger aortas at baseline were older, with higher tobacco use and prior prosthetic valves. Over a mean of 2.4 years, aortic growth was observed and differed by valve type (trileaflet valve, 0.08 mm/y; bicuspid valve, 0.4 mm/y; P < .001). In six patients who developed aortic dissection, the estimated average annual growth rate was 0.98 mm/y.
Conclusions
In a large echocardiographic cohort, aortic aneurysm growth rate was 0.08 mm/y, though it was higher in patients with bicuspid valves (0.4 mm/y), but initial aortic size did not correlate with change in the aortic progression rate. These data may help inform recommended echocardiographic surveillance intervals.
{"title":"Rate of Ascending Aortic Enlargement in a Large Echocardiographic Cohort: Associated Risk Factors and Adverse Aortic Events","authors":"Kristen Westenfield MD, Steven M. Bradley MD, MPH, Larissa Stanberry PhD, Kevin M. Harris MD","doi":"10.1016/j.echo.2024.09.013","DOIUrl":"10.1016/j.echo.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Understanding ascending aortic aneurysm growth and associated risk factors is critical to advising appropriate echocardiographic follow-up intervals for patients. The aim of this study was to identify aortic aneurysm growth rate on serial echocardiography as well as the clinical and demographic variables that contribute to baseline aortic size and subsequent aortic growth.</div></div><div><h3>Methods</h3><div>Patients identified with ascending aortic aneurysms and undergoing serial echocardiograms within 5 years were evaluated. Ascending aortic size was measured as part of routine echocardiographic examinations. Clinical and demographic variables including aortic valve type (trileaflet, bicuspid, or prosthetic) were evaluated for association with baseline aortic size as well as with aortic progression rate. Clinical events including aortic dissection and elective or emergent surgical repair were recorded.</div></div><div><h3>Results</h3><div>A total of 3,639 patients were identified (78% men; median age, 69 years), 175 (4.8%) with bicuspid valves and 206 (5.6%) with prior aortic valve replacement. Patients with larger aortas at baseline were older, with higher tobacco use and prior prosthetic valves. Over a mean of 2.4 years, aortic growth was observed and differed by valve type (trileaflet valve, 0.08 mm/y; bicuspid valve, 0.4 mm/y; <em>P</em> < .001). In six patients who developed aortic dissection, the estimated average annual growth rate was 0.98 mm/y.</div></div><div><h3>Conclusions</h3><div>In a large echocardiographic cohort, aortic aneurysm growth rate was 0.08 mm/y, though it was higher in patients with bicuspid valves (0.4 mm/y), but initial aortic size did not correlate with change in the aortic progression rate. These data may help inform recommended echocardiographic surveillance intervals.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 2","pages":"Pages 92-98"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479304","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":"Refining the Prothrombotic State in Atrial Fibrillation With Left Atrial Appendage Three-Dimensional Echocardiography","authors":"Laurie Soulat-Dufour MD, PhD, Sylvie Lang PhD, Maharajah Ponnaiah PhD, Théo Simon MD, Stephane Ederhy MD, Saroumadi Adavane-Scheuble MD, Marion Chauvet-Droit MD, Elodie Capderou MD, Camille Arnaud MD, Eleonore Sotto MD, Raphael Cohen MD, Thibault d’Izarny Gargas MD, Aliocha Scheuble MD, Nadjib Hammoudi MD, PhD, Anne-Sophie Beraud MD, Karima Addetia MD, Franck Boccara MD, PhD, Roberto M. Lang MD, Ariel Cohen MD, PhD","doi":"10.1016/j.echo.2024.10.014","DOIUrl":"10.1016/j.echo.2024.10.014","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 2","pages":"Pages 137-140"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569583","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 : 2025-02-01DOI: 10.1016/j.echo.2024.10.018
Michelle D. Kelsey MD, Anita M. Kelsey MD, MBA
{"title":"Ascending Thoracic Aortic Aneurysm Screening Intervals and Rates of Expansion: A Growing Body of Literature","authors":"Michelle D. Kelsey MD, Anita M. Kelsey MD, MBA","doi":"10.1016/j.echo.2024.10.018","DOIUrl":"10.1016/j.echo.2024.10.018","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 2","pages":"Pages 99-102"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631309","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 : 2025-01-28DOI: 10.1016/j.echo.2025.01.012
Matthew Peters, Patrycja Galazka, McKenzie Schweitzer, Zaid Abood, M Fuad Jan, Renuka Jain, A Jamil Tajik
{"title":"Doppler Characterization of Left Anterior Descending Coronary Artery Diastolic Flow Profiles in Hypertrophic Cardiomyopathy.","authors":"Matthew Peters, Patrycja Galazka, McKenzie Schweitzer, Zaid Abood, M Fuad Jan, Renuka Jain, A Jamil Tajik","doi":"10.1016/j.echo.2025.01.012","DOIUrl":"10.1016/j.echo.2025.01.012","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068810","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 : 2025-01-28DOI: 10.1016/j.echo.2025.01.011
Federico Fortuni, Paolo Biagioli, Erberto Carluccio
{"title":"Reply to Unveiling the Left Atrioventricular Coupling Index: A Promising Marker for Diastolic Dysfunction and Prognosis.","authors":"Federico Fortuni, Paolo Biagioli, Erberto Carluccio","doi":"10.1016/j.echo.2025.01.011","DOIUrl":"10.1016/j.echo.2025.01.011","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068812","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 : 2025-01-28DOI: 10.1016/j.echo.2025.01.010
Jaiveer Singh, Samuel W Reinhardt, David J Hur, Lissa Sugeng, Emmanuel Akintoye, Bernardo Lombo, Lavanya Bellumkonda, Evgeny Shkolnik, Robert L McNamara, Kamil F Faridi
{"title":"Elevated Systolic Blood Pressure and Hemodynamic Parameters in Patients With Aortic Stenosis Undergoing Echocardiography in Real-World Practice.","authors":"Jaiveer Singh, Samuel W Reinhardt, David J Hur, Lissa Sugeng, Emmanuel Akintoye, Bernardo Lombo, Lavanya Bellumkonda, Evgeny Shkolnik, Robert L McNamara, Kamil F Faridi","doi":"10.1016/j.echo.2025.01.010","DOIUrl":"10.1016/j.echo.2025.01.010","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068811","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 : 2025-01-28DOI: 10.1016/j.echo.2024.12.014
Yong-Huai Wang, Yu Dong, Guang-Yuan Li, Chun-Yan Ma
{"title":"Unveiling the Left Atrioventricular Coupling Index: A Promising Marker for Diastolic Dysfunction and Prognosis.","authors":"Yong-Huai Wang, Yu Dong, Guang-Yuan Li, Chun-Yan Ma","doi":"10.1016/j.echo.2024.12.014","DOIUrl":"10.1016/j.echo.2024.12.014","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068997","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 : 2025-01-21DOI: 10.1016/j.echo.2025.01.008
Alexandra Clement, Michele Tomaselli, Luigi P Badano, Diana R Hadareanu, Noela Radu, Marco Penso, Sergio Caravita, Claudia Baratto, Samantha Fisicaro, Caterina Delcea, Alessandra Rota, Radu Sascau, Denisa Muraru
Background: In patients with secondary tricuspid regurgitation (STR), right ventricular ejection fraction (RVEF) may not accurately reflect the actual RV systolic performance since a considerable amount of the RV stroke volume (SV) is regurgitated back into the right atrium. To overcome this limitation, we explored the association with the outcome of the effective RVEF (eRVEF), which accounts for the tricuspid regurgitant volume (RegVol).
Methods: Five hundred thirteen patients with STR (mean age 75 ± 13 years, 39% atrial STR, 58% severe) underwent complete two-, three-dimensional, and Doppler echocardiography. The eRVEF was computed as RV forward SV/RV end-diastolic volume, where forward SV was obtained by subtracting the tricuspid RegVol from the total RVSV. The end point was a composite of all-cause death and heart failure hospitalization.
Results: After a mean follow-up of 18 ± 15 months, 195 patients (38%) reached the composite end point. At time-dependent receiver operating characteristic analysis, eRVEF (area under the curve [AUC] = 0.72; 95% CI, 0.68-0.77) showed a stronger association with outcome than RVEF (AUC = 0.65; 95% CI, 0.59-0.70; P = .006), tricuspid annular plane systolic excursion (AUC = 0.64; 95% CI, 0.59-0.69; P = .01), RV free-wall longitudinal strain (AUC = 0.63; 95% CI, 0.58-0.68; P = .003), and RV fractional area change (AUC = 0.55; 95% CI, 0.50-0.60; P < .001). The eRVEF cutoff associated with an excess event rate was 20% on spline curve modeling. Patients with eRVEF <20% demonstrated a higher rate of events at 2 years (65% ± 6%) than those having an eRVEF ≥20% (22% ± 7%, log-rank <0.0001). An eRVEF <20% was associated with a 3-fold increased risk of experiencing the composite end point (hazard ratio = 3.54 [2.61-4.79], P < .001). On different models of multivariable analysis, eRVEF as a continuous variable remained independently associated with the combined end point (hazard ratio = 0.96; 95% CI, 0.94-0.98; P < .001).
Conclusions: In patients with STR, eRVEF was more closely associated with all-cause mortality and heart failure hospitalizations than RVEF and other conventional echocardiographic indices of RV function.
{"title":"Association With Outcome of the Regurgitant-Volume Adjusted Right Ventricular Ejection Fraction in Secondary Tricuspid Regurgitation.","authors":"Alexandra Clement, Michele Tomaselli, Luigi P Badano, Diana R Hadareanu, Noela Radu, Marco Penso, Sergio Caravita, Claudia Baratto, Samantha Fisicaro, Caterina Delcea, Alessandra Rota, Radu Sascau, Denisa Muraru","doi":"10.1016/j.echo.2025.01.008","DOIUrl":"10.1016/j.echo.2025.01.008","url":null,"abstract":"<p><strong>Background: </strong>In patients with secondary tricuspid regurgitation (STR), right ventricular ejection fraction (RVEF) may not accurately reflect the actual RV systolic performance since a considerable amount of the RV stroke volume (SV) is regurgitated back into the right atrium. To overcome this limitation, we explored the association with the outcome of the effective RVEF (eRVEF), which accounts for the tricuspid regurgitant volume (RegVol).</p><p><strong>Methods: </strong>Five hundred thirteen patients with STR (mean age 75 ± 13 years, 39% atrial STR, 58% severe) underwent complete two-, three-dimensional, and Doppler echocardiography. The eRVEF was computed as RV forward SV/RV end-diastolic volume, where forward SV was obtained by subtracting the tricuspid RegVol from the total RVSV. The end point was a composite of all-cause death and heart failure hospitalization.</p><p><strong>Results: </strong>After a mean follow-up of 18 ± 15 months, 195 patients (38%) reached the composite end point. At time-dependent receiver operating characteristic analysis, eRVEF (area under the curve [AUC] = 0.72; 95% CI, 0.68-0.77) showed a stronger association with outcome than RVEF (AUC = 0.65; 95% CI, 0.59-0.70; P = .006), tricuspid annular plane systolic excursion (AUC = 0.64; 95% CI, 0.59-0.69; P = .01), RV free-wall longitudinal strain (AUC = 0.63; 95% CI, 0.58-0.68; P = .003), and RV fractional area change (AUC = 0.55; 95% CI, 0.50-0.60; P < .001). The eRVEF cutoff associated with an excess event rate was 20% on spline curve modeling. Patients with eRVEF <20% demonstrated a higher rate of events at 2 years (65% ± 6%) than those having an eRVEF ≥20% (22% ± 7%, log-rank <0.0001). An eRVEF <20% was associated with a 3-fold increased risk of experiencing the composite end point (hazard ratio = 3.54 [2.61-4.79], P < .001). On different models of multivariable analysis, eRVEF as a continuous variable remained independently associated with the combined end point (hazard ratio = 0.96; 95% CI, 0.94-0.98; P < .001).</p><p><strong>Conclusions: </strong>In patients with STR, eRVEF was more closely associated with all-cause mortality and heart failure hospitalizations than RVEF and other conventional echocardiographic indices of RV function.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030098","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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