Journal of the American Society of Echocardiography最新文献

英文中文

Are new thresholds required for the assessment of right ventricular function in patients with and without tricuspid regurgitation? 有三尖瓣反流和无三尖瓣反流患者的右心室功能评估是否需要新的阈值？

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-07 DOI: 10.1016/j.echo.2024.12.001

X Galloo, N Ajmone Marsan

引用次数: 0

Cardiac Elastography With External Vibration for Quantification of Diastolic Myocardial Stiffness. 体外振动心脏弹性成像定量测定舒张期心肌硬度。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-06 DOI: 10.1016/j.echo.2024.11.009

Tom Meyer, Brunhilde Wellge, Gina Barzen, Stefan Klemmer Chandia, Fabian Knebel, Katrin Hahn, Thomas Elgeti, Thomas Fischer, Jürgen Braun, Heiko Tzschätzsch, Ingolf Sack

Objectives: Heart failure is an increasing global health problem. Approximately 50% of patients with heart failure have heart failure with preserved ejection fraction (HFpEF) and concomitant diastolic dysfunction (DD), in part caused by increased myocardial stiffness not detectable by standard echocardiography. While elastography can map tissue stiffness, cardiac applications are currently limited, especially in patients with a higher body mass index. Therefore, we developed cardiac time-harmonic elastography (THE) to detect abnormal diastolic myocardial stiffness associated with DD.

Material and methods: Cardiac THE was developed using standard medical ultrasound and continuous external vibration for regionally resolved mapping of diastolic shear wave speed as a proxy for myocardial stiffness. The method was prospectively applied to 54 healthy controls (26 women), 10 patients with moderate left ventricular hypertrophy (mLVH; 5 women), and 45 patients with wild-type transthyretin amyloidosis (wTTR; 4 women), 20 of whom were treated with tafamidis. Ten healthy participants were reinvestigated after 2 to 6 months to analyze test-retest reproducibility by intraclass correlation coefficients.

Results: Myocardial shear wave speed was measured with good reproducibility (intraclass correlation coefficient = 0.82) and showed higher values in wTTR (3.0 ± 0.7 m/sec) than in mLVH (2.1 ± 0.6 m/sec) and healthy controls (1.8 ± 0.3 m/sec, all P < .05). Area under the curve values were 0.991 and 0.737 for discriminating wTTR and mLVH from healthy controls, respectively. Shear wave speed was reduced in patients after tafamidis treatment (2.6 ± 0.6 m/sec, P = .04), suggesting the potential value of THE for therapy monitoring. Shear wave speed was quantified in the septum, posterior wall, and an automatically masked region (here stated for the septal region).

Conclusions: Cardiac THE detects abnormal myocardial stiffness in patients with DD with high penetration depth, independent of body mass index and region selection. Based on standard ultrasound components, cardiac THE is cost-effective and has the potential to become a point-of-care method for stiffness-sensitive echocardiography.

心力衰竭是一个日益严重的全球性健康问题。大约50%的心力衰竭患者保留射血分数（HFpEF）和伴随的舒张功能障碍（DD），部分原因是标准超声心动图无法检测到心肌僵硬度增加。虽然弹性成像可以绘制组织刚度，但目前在心脏方面的应用有限，特别是在体重指数（BMI）较高的患者中。因此，我们开发了心脏时谐弹性成像（THE）来检测与dd相关的舒张期心肌僵硬度异常。材料和方法：心脏时谐弹性成像采用标准医学超声和连续外部振动，用于舒张期剪切波速度（SWS）的区域分辨制图，作为心肌僵硬度的代表。该方法前瞻性地应用于54例健康对照（HC）（26例女性）、10例中度左心室肥厚（mLVH）（5例女性）和45例野生型甲状腺素转淀粉样变（wTTR）（4例女性），其中20例采用他法底斯治疗。10名健康受试者于2-6个月后进行复试，通过类内相关系数（ICC）分析复试可重复性。结果：心肌SWS测量具有良好的重复性（ICC=0.82）， wTTR（3.0±0.7 m/s）高于mLVH（2.1±0.6 m/s）和hc（1.8±0.3 m/s）。结论：心肌THE在DD患者中检测异常心肌硬度具有高穿透深度，独立于BMI和区域选择。基于标准超声元件，心脏超声具有成本效益，有可能成为僵硬敏感超声心动图的护理点方法。

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引用次数: 0

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IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-01 DOI: 10.1016/S0894-7317(24)00534-0

引用次数: 0

Unraveling the Impact of Perivascular Amyloid Deposition on Cardiac Remodeling in AL Amyloidosis: A Call for Deeper Insights 揭示血管周围淀粉样蛋白沉积对 AL 淀粉样变性心脏重塑的影响：呼唤更深入的洞察力

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-01 DOI: 10.1016/j.echo.2024.08.014

Arif Albulushi MD, Mohammed Al-Mukhaini MD

引用次数: 0

Fetal Echocardiography From 10 to 15 Weeks of Gestation—Reliability, Genetic Associations, and Outcomes 妊娠 10 至 15 周胎儿超声心动图 - 可靠性、遗传关联和结果。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-01 DOI: 10.1016/j.echo.2024.08.012

Leila Rittey MBChB, MSc , Hannah Davidson MBBS , Lisa K. Hornberger MD , Luke Eckersley MBBS, PhD , Cleighton Boehme BSc, BEd , Angela McBrien MBBCh, MD

Introduction

There is increasing demand for accurate early fetal cardiac disease (FCD). We assessed the accuracy of early fetal echo (EFE) conducted in our high-volume fetal cardiac program and reviewed the spectrum of FCD, associated genetic anomalies, and outcomes encountered.

Methods

We identified all EFEs performed from 10⁺⁰ to 15⁺⁶ weeks of gestation from 2009 to 2021. We compared findings at EFE to fetal echo at ≥18⁺⁰ weeks or autopsy and documented genetic testing results for all FCD cases. For those with discrepancy between EFE and later exam, the discrepancy impact was reviewed. A score was used to quantify the anatomy assessed.

Results

A total of 1,662 EFEs were performed in 1,387 pregnancies; all but 41 were considered diagnostic. Fetal cardiac disease was diagnosed at EFE in 130, including 101 major, 12 minor, 13 other FCD, and 4 arrhythmias. In 14/130 with FCD, endovaginal imaging was undertaken, which increased the score (1.6/9 vs 3.5/9; P = .049). Thirty-five of 130 had repeat EFE, which increased the score (5.2/9 vs 7.4/9, P < .0001). Fetal loss occurred before confirmation of FCD in 16 and termination in 64, and 11 were lost to follow-up. Thirty-nine had autopsy and/or fetal echo ≥18⁺⁰: 35 had FCD confirmed, and 4 had resolution. Of the 35 confirmed FCD, 27 had no, 7 minor, and 1 major change. Of 1,489 with normal EFE, later echo demonstrated FCD in 14: 3 major and 11 minor. In 16, FCD evolved, including 4 arrhythmias and 12 with progressive FCD. Sensitivity, specificity, and positive and negative predictive values of EFE in identifying major FCD were 92.9%, 100%, 100%, and 99.7%, respectively. In cases with FCD, 85.4% had genetic testing, of whom 71% (60.8% of the total) had abnormal results.

Conclusions

In our experience, EFE permits accurate diagnosis and exclusion of most FCD. Endovaginal imaging and repeat EFE studies improved the ability to visualize structures adequately.

前言对早期胎儿心脏诊断（FCD）准确性的需求与日俱增。我们评估了在我们的高容量胎儿心脏项目中进行的早期胎儿回波（EFE）的准确性，并回顾了 FCD 的范围、相关遗传异常和遇到的结果：我们对 2009-2021 年间妊娠 10+0-15+6 周进行的所有 EFE 进行了鉴定。我们比较了 EFE 和≥18+0 周胎儿回声或尸检的结果，并记录了所有 FCD 病例的基因检测结果。对于EFE和后期检查结果有差异的病例，我们对差异的影响进行了审查。结果：结果：在 1387 例妊娠中进行了 1662 次 EFE；除 41 例外，其余均被认为是诊断性的。130 例 EFE 诊断为 FCD，包括 101 例重度 FCD、12 例轻度 FCD、13 例其他 FCD 和 4 例心律失常。14/130的FCD患者进行了EV成像，这增加了评分（1.6/9 vs 3.5/9 p=0.049）。35/130的患者进行了重复EFE检查，得分增加（5.2/9 vs 7.4/9，p< 0.0001）。16例在确认FCD前发生胎儿死亡，64例终止妊娠，11例失去随访机会。39例进行了尸检和/或胎儿回声≥18+0：35例确诊为FCD，4例得到解决。在 35 例确诊的 FCD 中，27 例无变化，7 例有轻微变化，1 例有较大变化。在 1489 例 EFE 正常的患者中，有 14 例在之后的回波中证实了 FCD：3 例大变化，11 例小变化。有 16 例 FCD 发生演变，其中包括 4 例心律失常和 12 例进行性 FCD。EFE 在识别主要 FCD 方面的敏感性、特异性、阳性预测值和阴性预测值分别为 92.9%、100%、100% 和 99.7%。在FCD病例中，85.4%进行了基因检测，其中71%（占总数的60.8%）检测结果异常：根据我们的经验，EFE 可以准确诊断和排除大多数 FCD。EV成像和重复EFE研究提高了充分观察结构的能力。

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引用次数: 0

Right Ventricular to Pulmonary Artery Coupling and Prognosis in Transthyretin Cardiac Amyloidosis 经淀粉样变性心脏淀粉样变性的右心室与肺动脉耦合和预后。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-01 DOI: 10.1016/j.echo.2024.08.013

Maria Chiara Meucci MD, Dorien Laenens MD, Rosa Lillo MD, Antonella Lombardo MD, Francesco Burzotta MD, Jan Stassen MD, Philippe Debonnaire MD, PhD, Mathias Claeys MD, PhD, Erwan Donal MD, PhD, Steven Droogmans MD, PhD, Bernard Cosyns MD, PhD, Ruxandra Jurcut MD, PhD, Fausto J. Pinto MD, PhD, Dulce Brito MD, PhD, Idit Yedidya MD, Caroline Van De Heyning MD, PhD, Nicole Sturkenboom MD, Francesca Graziani MD, PhD, Nina Ajmone Marsan MD, PhD

引用次数: 0

Noninvasive Imaging for Native Aortic Valve Regurgitation 原发性主动脉瓣反流的非侵入性成像。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-01 DOI: 10.1016/j.echo.2024.08.009

Vidhu Anand MBBS, Hector I. Michelena MD, Patricia A. Pellikka MD

Aortic regurgitation (AR) is associated with left ventricular (LV) volume and pressure overload, resulting in eccentric LV remodeling and enlargement. This condition may be well tolerated for years before the onset of myocardial dysfunction and symptoms. Echocardiography plays a crucial role in the diagnosis of AR, assessing its mechanism and severity, and detecting LV remodeling. The assessment of AR severity is challenging and frequently requires the integration of information from multiple different measurements to assess the severity. Recent data suggest that echocardiographically derived LV volumes (end-systolic volume index > 45 mL/m²), an ejection fraction threshold of <60%, and abnormal global longitudinal strain may help identify early dysfunction and may be used to improve clinical outcomes. Consequently, these parameters can identify candidates for surgery. Cardiac magnetic resonance imaging is emerging as a valuable tool for assessing severity when it remains unclear after an echocardiographic evaluation. This review emphasizes the importance of imaging, particularly echocardiography, in the evaluation of AR. It focuses on various echocardiographic parameters, including technical details, and how to integrate them for assessing the mechanism and severity of AR as well as LV remodeling.

主动脉瓣反流（AR）与左心室容量和压力超负荷有关，导致左心室（LV）偏心重塑和扩大。在出现心肌功能障碍和症状之前，这种情况可能会持续数年。超声心动图在诊断 AR、评估其机制和严重程度以及检测左心室重塑方面起着至关重要的作用。评估 AR 的严重程度具有挑战性，通常需要整合多种不同测量的信息来评估其严重程度。最近的数据表明，超声心动图得出的左心室容积（收缩末期容积指数 > 45 ml/m2）、射血分数阈值为

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引用次数: 0

Association of Glycemic Control With Right Ventricular Function Assessed by Two-Dimensional Speckle-Tracking and Three-Dimensional Echocardiography in Type 2 Diabetes Mellitus 通过二维斑点追踪和三维超声心动图评估 2 型糖尿病患者血糖控制与右心室功能的关系

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-01 DOI: 10.1016/j.echo.2024.09.002

Yanting Zhang MD, PhD , Yuman Li MD, PhD , Yixia Lin MD , Mingxing Xie MD, PhD , Li Zhang MD, PhD , Wei Sun MD, PhD , Wenhui Deng MD, PhD , Ruohan Zhao MD , Jiawei Shi MD, PhD , Wenqu Li MD , Lingyun Fang MD, PhD , Shukun He MD , Tianshu Liu MD, PhD , Yali Yang MD, PhD , Qing Lv MD, PhD , Jin Hu MD, PhD , Jing Wang MD, PhD

Background

Right ventricular (RV) involvement has been reported in type 2 diabetes mellitus (T2DM). The relationship between glycemic control and RV function remains unknown. We aimed to investigate the association between glycemic control and RV function assessed by two-dimensional speckle-tracking echocardiography and three-dimensional echocardiography in T2DM individuals.

Methods

This study prospectively enrolled 207 patients with T2DM and 84 individuals with normal glucose metabolism. The T2DM patients were divided into 2 subgroups according to glycated hemoglobin (HbA1c) level: controlled (HbA1c < 7.0%, n = 91) and uncontrolled subgroup (HbA1c ≥ 7.0%, n = 116). Right venticular free wall longitudinal strain (RVFWLS) was acquired by two-dimensional speckle-tracking echocardiography, and RV volumes and RV ejection fraction (RVEF) were assessed using three-dimensional echocardiography . Right ventricular coupling to pulmonary circulation was defined as the ratio of RVFWLS/pulmonary artery systolic pressure (PASP).

Results

Controlled and uncontrolled T2DM subgroups had impaired RV function as reflected by reduced RVFWLS and RVEF compared to the normal glucose metabolism group. The reduction in RVFWLS was more pronounced in the uncontrolled subgroup than in the controlled subgroup (P < .001), whereas no significant difference was found in RVEF between these 2 T2DM subgroups. Higher PASP and lower RVFWLS/PASP ratio were also noted in uncontrolled T2DM patients. Additionally, the incidence of RV dysfunction was significantly higher in the uncontrolled T2DM patients than in the controlled subgroup (43.1% vs 17.6%, P < .001). After adjustment for potential clinical confounders, PASP, and left ventricular parameters, HbA1c level was independently associated with RVFWLS (β = 0.290, P = .003) and RVFWLS/PASP ratio (β = 0.028, P = .006).

Conclusions

Subclinical RV myocardial dysfunction is present in T2DM patients and is more pronounced in patients with uncontrolled blood glucose. HbA1c level is independently associated with subclinical RV myocardial dysfunction, providing further insight into a possible link between poor glycemic control and diabetic cardiomyopathy.

背景：据报道，2 型糖尿病（T2DM）会累及右心室（RV）。血糖控制与右心室功能之间的关系仍然未知。我们旨在研究 T2DM 患者的血糖控制与二维斑点追踪超声心动图（2D-STE）和三维超声心动图（3DE）评估的 RV 功能之间的关系：这项研究前瞻性地纳入了 207 名 T2DM 患者和 84 名糖代谢正常 (NGM) 患者。根据糖化血红蛋白（HbA1c）水平将 T2DM 患者分为两个亚组：控制亚组（HbA1c < 7.0%，n = 91）和非控制亚组（HbA1c ≥ 7.0%，n = 116）。二维 STE 采集 RV 游离壁纵向应变（RVFWLS），三维 E 评估 RV 容量和 RV 射血分数（RVEF）。RV 与肺循环的耦合定义为 RVFWLS 与肺动脉收缩压（PASP）的比值：结果：与 NGM 组相比，受控和未受控 T2DM 亚组的 RV 功能受损，表现为 RVFWLS 和 RVEF 降低。与受控亚组相比，未受控亚组的 RVFWLS 降低更明显（P < 0.001），而这两个 T2DM 亚组之间的 RVEF 没有明显差异。未受控制的 T2DM 患者的 PASP 也较高，RVFWLS/PASP 比值较低。此外，未受控制的 T2DM 患者的 RV 功能障碍发生率明显高于受控亚组（43.1% vs 17.6%，P < 0.001）。在对潜在的临床混杂因素、PASP和左心室参数进行调整后，HbA1c水平与RVFWLS（β = 0.290，P = 0.003）和RVFWLS/PASP比值（β = 0.028，P = 0.006）独立相关：结论：T2DM 患者存在亚临床 RV 心肌功能障碍，在血糖未得到控制的患者中更为明显。HbA1c水平与亚临床RV心肌功能障碍有独立关联，进一步揭示了血糖控制不良与糖尿病心肌病之间可能存在的联系。

{"title":"Association of Glycemic Control With Right Ventricular Function Assessed by Two-Dimensional Speckle-Tracking and Three-Dimensional Echocardiography in Type 2 Diabetes Mellitus","authors":"Yanting Zhang MD, PhD , Yuman Li MD, PhD , Yixia Lin MD , Mingxing Xie MD, PhD , Li Zhang MD, PhD , Wei Sun MD, PhD , Wenhui Deng MD, PhD , Ruohan Zhao MD , Jiawei Shi MD, PhD , Wenqu Li MD , Lingyun Fang MD, PhD , Shukun He MD , Tianshu Liu MD, PhD , Yali Yang MD, PhD , Qing Lv MD, PhD , Jin Hu MD, PhD , Jing Wang MD, PhD","doi":"10.1016/j.echo.2024.09.002","DOIUrl":"10.1016/j.echo.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Right ventricular (RV) involvement has been reported in type 2 diabetes mellitus (T2DM). The relationship between glycemic control and RV function remains unknown. We aimed to investigate the association between glycemic control and RV function assessed by two-dimensional speckle-tracking echocardiography and three-dimensional echocardiography in T2DM individuals.</div></div><div><h3>Methods</h3><div>This study prospectively enrolled 207 patients with T2DM and 84 individuals with normal glucose metabolism. The T2DM patients were divided into 2 subgroups according to glycated hemoglobin (HbA1c) level: controlled (HbA1c < 7.0%, <em>n</em> = 91) and uncontrolled subgroup (HbA1c ≥ 7.0%, <em>n</em> = 116). Right venticular free wall longitudinal strain (RVFWLS) was acquired by two-dimensional speckle-tracking echocardiography, and RV volumes and RV ejection fraction (RVEF) were assessed using three-dimensional echocardiography . Right ventricular coupling to pulmonary circulation was defined as the ratio of RVFWLS/pulmonary artery systolic pressure (PASP).</div></div><div><h3>Results</h3><div>Controlled and uncontrolled T2DM subgroups had impaired RV function as reflected by reduced RVFWLS and RVEF compared to the normal glucose metabolism group. The reduction in RVFWLS was more pronounced in the uncontrolled subgroup than in the controlled subgroup (<em>P</em> < .001), whereas no significant difference was found in RVEF between these 2 T2DM subgroups. Higher PASP and lower RVFWLS/PASP ratio were also noted in uncontrolled T2DM patients. Additionally, the incidence of RV dysfunction was significantly higher in the uncontrolled T2DM patients than in the controlled subgroup (43.1% vs 17.6%, <em>P</em> < .001). After adjustment for potential clinical confounders, PASP, and left ventricular parameters, HbA1c level was independently associated with RVFWLS (β = 0.290, <em>P</em> = .003) and RVFWLS/PASP ratio (β = 0.028, <em>P</em> = .006).</div></div><div><h3>Conclusions</h3><div>Subclinical RV myocardial dysfunction is present in T2DM patients and is more pronounced in patients with uncontrolled blood glucose. HbA1c level is independently associated with subclinical RV myocardial dysfunction, providing further insight into a possible link between poor glycemic control and diabetic cardiomyopathy.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Pages 1156-1166"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Left Ventricular Diastolic Dysfunction in Patients With Heart Failure With a Higher Left Ventricular Ejection Fraction and Its Relation to Prognosis 左室射血分数较高的心力衰竭患者的左室舒张功能障碍及其与预后的关系

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-01 DOI: 10.1016/j.echo.2024.09.003

Nobuyuki Ohte MD, Shohei Kikuchi MD, Noriaki Iwahashi MD, Yoshiharu Kinugasa MD, Kaoru Dohi MD, Hiroyuki Takase MD, Katsuji Inoue MD, Takahiro Okumura MD, Kenta Hachiya MD, Emiyo Sugiura MD, Kenya Kusunose MD, Shuichi Kitada MD, Yoshihiro Seo MD

引用次数: 0

Echocardiographic Predictors of Readiness for Double Switch Operation and Postoperative Ejection Fraction in Patients With Congenitally Corrected Transposition of the Great Arteries Undergoing Left Ventricular Retraining 超声心动图预测接受左心室再训练的先天性大动脉错位患者接受双开关手术的准备程度和术后射血分数。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2024-12-01 DOI: 10.1016/j.echo.2024.08.011

Son Q. Duong MD, MS , Deborah Ho MD , Rajesh Punn MD , Danielle Sganga MD , Richard Mainwaring MD , Michael Ma MD , Frank L. Hanley MD , Kyong-Jin Lee MD , Shiraz A. Maskatia MD

<div><h3>Background</h3><div>In patients with congenitally corrected transposition of the great arteries (ccTGA), assessment of readiness for the double switch operation (DSO) after pulmonary arterial band (PAB) placement involves cardiac magnetic resonance imaging (cMRI) to measure left ventricular ejection fraction (LVEF) and mass and cardiac catheterization (catheterization) to assess the ratio of left ventricular to right ventricular pressure (LV:RVp). The aims of this study were to describe the relationships between echocardiographic and catheterization and cMRI measures of readiness for DSO and to develop risk factors for left ventricular (LV) dysfunction after DSO on the basis of echocardiographic measures of ventricular-arterial coupling (VAC).</div></div><div><h3>Methods</h3><div>Patients with ccTGA undergoing LV retraining at a DSO referral center were reviewed. LVEF measured by echocardiography was compared with that measured by cMRI, and LV:RVp measured by echocardiography was compared with that measured by catheterization using Bland-Altman analysis. The relationship between preoperative VAC markers and postoperative echocardiography was analyzed using ventricular end-systolic elastance (EES) and a novel marker consisting of the product of LVEF and LV:RVp (EFPR).</div></div><div><h3>Results</h3><div>Thirty-one patients with 56 evaluations for DSO were included, 24 of whom underwent DSO. Echocardiographic LVEF correlated well with cMRI LVEF (<em>r</em> = 0.79), and Bland-Altman analysis slightly overestimated cMRI LVEF (mean difference, +3%). Echocardiographic LVEF had a moderate ability to identify normal cMRI LVEF (area under the curve, 0.80) and at an optimal cut point of echocardiographic LVEF threshold of 61%, there was 71% sensitivity and 76% specificity to detect cMRI LVEF ≥ 55%. Echocardiographic LV:RVp correlated well with LV/RVp by catheterization (<em>r</em> = 0.77) and slightly underestimated the catheterization value (mean difference, −0.11). Echocardiographic LV:RVp had a good ability to identify adequate LV:RVp by catheterization (area under the curve, 0.95) and at an optimal echocardiography cut point of 0.75 had 100% sensitivity and 85% specificity to detect a catheterization LV:RVp >0.9. Echocardiography-based criteria for DSO readiness (echocardiographic LVEF of 61% and LV:RVp of 0.75) demonstrated specificity of 97% and positive predictive value of 96% for published criteria of DSO readiness (cMRI LVEF of 55% and catheterization LV:RVp of 0.9). EES and EFPR correlated with post-DSO LVEF (ρ = 0.72 and ρ = 0.60, respectively). EFPR of 0.51 demonstrated 78% sensitivity and 100% specificity for post-DSO LV dysfunction (LVEF < 55%). Age at first PAB also strongly correlated with post-DSO LVEF (ρ = 0.75). No patient with first PAB at <1 year of age exhibited post-DSO LV dysfunction.</div></div><div><h3>Conclusions</h3><div>Echocardiographic measures of LVEF and LV:RVp are reliable indicators of reference standar

背景：在先天性大动脉转位（ccTGA）患者中，评估肺动脉带（PAB）置入术后双转流手术（DSO）的准备程度需要通过心脏核磁共振成像（cMRI）测量左心室射血分数（EF）和质量，并通过心导管检查（cath）评估左心室：RV压力比（LV:RVp）。我们描述了超声心动图和 cath/cMRI 测量 DSO 准备程度之间的关系，并根据超声心动图测量的心室动脉耦合（VAC）制定了 DSO 后左心室功能障碍的风险因素：我们回顾了在 DSO 转诊中心接受左心室再训练的 ccTGA 患者。我们通过布兰-阿尔特曼（Bland-Altman，BA）分析比较了回声与 cMRI 测量的 EF 值，以及回声与心电图测量的 LV:RVp 值。我们使用收缩末期弹性（EES）和一种由 EF 与 LV:RVp 的乘积（EFPR）组成的新型标记物分析了术前 VAC 标记物与术后超声心动图之间的关系：我们对 31 名患者进行了 56 次 DSO 评估，其中 24 人接受了 DSO。回波 EF 与 cMRI 的相关性良好（r= 0.79），BA 略微高估了 cMRI（平均差 +3%）。回波 EF 识别正常 cMRI EF 的能力适中（AUC 为 0.80），在回波 EF 临界值为 61% 的最佳切点上，检测 cMRI LVEF >=55% 的敏感性为 71%，特异性为 76%。回波 LV:RVp 与心电图相关性良好（r=0.77），但略微低估了心电图（平均差为-0.11）。回波 LV:RVp 有很好的能力通过心导管识别足够的 LV:RVp（AUC=0.95），在最佳回波切点 0.75 时，检测心导管 LV:RVp 超过 0.9 的灵敏度为 100%，特异度为 85%。基于回声的 DSO 准备就绪标准（回声 EF 为 61%，LV:RVp 为 0.75）的特异性为 97%，对已公布的 DSO 准备就绪标准（cMRI EF 为 55%，导管 LV:RVp 为 0.9）的阳性预测值为 96%。EES 和 EFPR 与 DSO 后 EF 相关（rho= 0.72 和 0.60）。0.51 的 EFPR 对 DSO 后左心室功能障碍（EF < 55%）的敏感性为 78%，特异性为 100%。首次 PAB 的年龄也与 DSO 后 EF 密切相关（rho=0.75）。首次 PAB 患者年龄小于 1 岁的患者均未表现出 DSO 后左心室功能障碍：超声心动图测量的 EF 和 LV:RVp 是参考标准模式的可靠指标，可指导再训练期间的管理。术前 VAC 指标 EES 和 EFPR 可能是手术后左心室功能障碍的有用指标。回声 LV:RVp > 0.75 可能符合 DSO 的压力生成标准，应考虑转诊进行 DSO 的心导管和 cMRI 评估。在 1 岁前置入 PAB 可优化考虑 DSO 患者的左心室预后。

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