Journal of the American Society of Echocardiography最新文献

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Association of Preoperative Cardiac Magnetic Resonance and Echocardiography with Postoperative Left Ventricular Dysfunction in Primary Mitral Regurgitation 术前心脏磁共振和超声心动图与原发性二尖瓣反流术后左心室功能障碍的关系。

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01 DOI: 10.1016/j.echo.2025.09.015

Alexandre Altes MD , Valentine Pécriaux MSc , Paulin Hanvi MSc , Vincent Hanet MD , Inès Belhakia MD , Noémie Selin MD , David Vancraeynest MD, PhD , Agnès Pasquet MD, PhD , François Delelis MD , Manuel Toledano MD , Valentina Silvestri MD , Bernhard L. Gerber MD, PhD , Sylvestre Maréchaux MD, PhD

Background

We evaluated the relationship between preoperative left ventricular (LV) structural and functional characteristics assessed by echocardiography (Echo) and cardiac magnetic resonance (CMR) and the risk of postoperative LV dysfunction in patients with primary mitral regurgitation (MR) undergoing mitral valve (MV) repair surgery.

Methods

We retrospectively studied 223 patients (median age, 60 years; 21% women) with chronic primary MR who underwent preoperative Echo and CMR before MV repair surgery. The primary end point was postoperative LV dysfunction, defined as LV ejection fraction (LVEF) <50% on follow-up Echo.

Results

Postoperative LV dysfunction occurred in 41 patients (18%) after a median follow-up of 8.7 (interquartile range, 6.7-12.5) months. These patients had higher absolute and indexed (ind-) LV end-systolic diameters (LVESDs) and volumes (LVESVs; all P ≤ .009), lower CMR LV ejection fraction (LVEF; P = .003), and a trend toward lower Echo LVEF (P = .072). Individually, Echo and CMR parameters showed modest discriminative ability (areas under the curve from 0.59 [0.49-0.68] for Echo LVEF to 0.70 [0.61-0.78] for Echo-indLVESD). Strain imaging, whether assessed by Echo or CMR, did not improve risk stratification. Echo indLVESD and CMR LVEF were the most contributive LV characteristics. A 2-step approach based on Echo indLVESD < or ≥18 mm/m², followed by CMR LVEF > or ≤56% in patients with Echo indLVESD ≥18 mm/m², identified 3 subgroups with distinct rates of postoperative LV dysfunction (9%, 20%, and 41%, respectively).

Conclusion

In patients with primary MR undergoing MV surgery, preoperative LV characteristics assessed by Echo and CMR showed only moderate ability to identify those at higher risk of postoperative LV dysfunction. A stepwise approach using Echo indLVESD followed by CMR LVEF may help identify subgroups at differing risk levels. These exploratory findings require confirmation in larger prospective studies.

背景：我们评估了超声心动图（Echo）和心脏磁共振（CMR）评估的术前左心室（LV）结构和功能特征与二尖瓣（MV）修复手术的原发性二尖瓣返流（MR）患者术后左心室（LV）功能障碍风险之间的关系。方法：我们回顾性研究了223例慢性原发性MR患者（中位年龄60岁，21%为女性），这些患者在MV修复手术前接受了术前超声和CMR检查。主要终点为术后左室功能障碍，定义为左室射血分数(EF) < 50%。结果：41例（18%）患者在中位随访8.7个月（IQR: 6.7-12.5）后出现左室功能障碍。这些患者有较高的左室收缩期终末直径（ESD）和容积（ESV）（均p≤0.009），较低的CMR-LVEF （p=0.003）和较低的Echo-LVEF （p=0.072）。Echo和CMR参数分别表现出适度的区分能力（Echo- lvef -的曲线下面积为0.59 [0.49-0.68]，Echo- indlvesd的曲线下面积为0.70[0.61-0.78]）。应变成像，无论是用Echo还是CMR评估，都不能改善风险分层。Echo-indLVESD和CMR-LVEF是最重要的LV特征。基于Echo-indLVESD <或≥18mm /m2的两步方法，其次是在Echo-indLVESD≥18mm /m2的患者中CMR-LVEF >或≤56%，确定了三个亚组具有不同的术后左室功能障碍发生率（分别为9%，20%和41%）。结论：在接受MV手术的原发性MR患者中，通过Echo和CMR评估的术前左室特征仅显示出中等程度的识别术后左室功能障碍高风险的能力。采用Echo-indLVESD和CMR-LVEF的逐步方法可能有助于确定不同风险水平的亚组。这些探索性的发现需要在更大的前瞻性研究中得到证实。

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引用次数: 0

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01

引用次数: 0

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01

引用次数: 0

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01

引用次数: 0

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01

引用次数: 0

Quantitative Doppler Shape Analysis in Functional Tricuspid Regurgitation 功能性三尖瓣反流的定量多普勒分析。

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01 DOI: 10.1016/j.echo.2025.08.018

Arthur Iturriagagoitia MD , Simon Calle MD, PhD , Thomas Van Overmeiren MD , Marc De Buyzere MSc , Erwan Donal MD, PhD , Frank Timmermans MD, PhD

Background

The shape of the continuous-wave Doppler (CWD) envelope in functional tricuspid valve regurgitation (fTR) results from the dynamic interplay between flow, pressure gradient, and impedance. Although the v-wave cutoff shape in fTR is a well-recognized feature of severe tricuspid regurgitation (TR), the complete spectrum of TR CWD shapes across the different fTR severity ranges has not been thoroughly explored, which is the scope of the present study.

Methods

In 245 patients with fTR, TR was graded with transthoracic echocardiography using the corrected proximal isovelocity surface area method, and CWD shapes were scored, both qualitatively (using visual scoring into parabolic, triangular, or v-wave cutoff categories) and quantitatively (using a novel Vmax/Vmean parameter and time-to-peak velocity corrected for TR duration [TTP/TRD]). Linear regression analysis was performed to identify associations of Vmax/Vmean and TTP/TRD. Vmax/Vmean was categorized into tertiles to assess its association with the composite end point of death and heart failure hospitalization. Survival analysis consisted of Kaplan-Meier curves with log-rank tests and a multivariate Cox regression model.

Results

The Vmax/Vmean ratio as a surrogate value for fTR CWD shapes increases from a parabolic shape (1.26 ± 0.07) toward a more triangular shape without v-wave (1.32 ± 0.10) and eventually the v-wave cutoff sign (1.42 ± 0.14, P < .001) in most severe fTR. The Vmax, effective regurgitant orifice area, and right ventricular function parameters are significantly associated with Vmax/Vmean and TTP/TRD. Vmax/Vmean is independently associated with the occurrence of the composite end point (adjusted hazard ratio = 1.32; 95% CI, 1.09-1.60 [P = .004], log rank P = .004 between the second [1.27-1.33] and third tertile [>1.33]). Hierarchical Cox models show no incremental value on top of effective regurgitant orifice area (P = .2), whereas TTP/TRD was not associated with outcome.

Conclusion

Vmax/Vmean reflects the hydraulic severity of fTR and is independently associated with adverse clinical outcomes, providing a simple tool for improved risk stratification in patients with fTR.

背景：功能性三尖瓣返流（fTR）的连续波多普勒（CWD）包络的形状是血流、压力梯度和阻抗之间动态相互作用的结果。虽然fTR中的v波截止形状是严重TR的一个公认特征，但在不同fTR严重范围内的TR CWD形状的完整谱尚未被彻底探索，这是本研究的范围。方法：在245例fTR患者中，经胸超声心动图采用校正的近端等速表面积法对TR进行分级，并对CWD形状进行定性评分（使用视觉评分分为抛物线，三角形或v波截止类别），并使用新的Vmax/Vmean参数和校正TR持续时间的峰值时间速度（TTP/TRD）进行定量评分。线性回归分析Vmax/Vmean与TTP/TRD的相关性。将Vmax/Vmean分为几组，以评估其与死亡和心力衰竭住院治疗的复合终点的相关性。生存分析包括Kaplan-Meier曲线、log-rank检验和多变量Cox回归模型。结果：作为fTR CWD形状的替代值，Vmax/Vmean比值从抛物线形状（1.26±0.07）增加到更三角形的无v波形状（1.32±0.10），最终v波截止符号（1.42±0.14,P1.33）。分层Cox模型显示EROA上没有增加值（P = 0.2），而TTP/TRD与结果无关。结论：Vmax/Vmean反映了fTR的水力严重程度，并与不良临床结局独立相关，为改善fTR患者的风险分层提供了一种简单的工具。

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引用次数: 0

Sex-Based Differences in Mitral Annular Disjunction Severity and Arrhythmic Risk in Mitral Valve Prolapse 二尖瓣脱垂患者二尖瓣环分离严重程度及心律失常风险的性别差异。

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01 DOI: 10.1016/j.echo.2025.08.026

Luca Cristin MD, Lionel Tastet PhD, Rohit Jhawar BA, Amy B. Rich BA, Janet J. Tang PhD, Dwight Bibby RDCS, Qizhi Fang MD, Farzin Arya MD, Francesca N. Delling MD, MPH

Background

Arrhythmic mitral valve prolapse (AMVP), a condition with known female predominance, has been linked to mitral annular disjunction (MAD), yet the relationship between MAD, sex, body size, and arrhythmic events remains unclear.

Objectives

To determine whether MAD exhibits sex-based differential effects on arrhythmic risk and explore the implications of indexing MAD measurements.

Methods

We examined 682 consecutive MVPs at the University of California San Francisco (2013–23) with detailed clinical, rhythmic, and echocardiographic data. Mitral annular disjunction was indexed to body surface area, resulting in the identification of 3 distinct groups: no MAD and indexed MAD (iMAD) below and iMAD above the median. Arrhythmic mitral valve prolapse was defined as MVP with frequent and/or complex ventricular ectopy, including severe arrhythmic events such as sustained ventricular tachycardia, ventricular fibrillation/sudden cardiac arrest, or death.

Results

Among 682 MVP patients (48% women, mean age 58 ± 17 years), 35% had AMVP and 41% had MAD, with a median iMAD of 4 mm. Compared to women, men had greater absolute MAD length (9.0 ± 3.2 mm vs 7.3 ± 2.6, P < .001). Sex-based differences in MAD length were no longer appreciated after indexing for body surface area (P = .33). In multivariable analyses, iMAD >4 mm was significantly associated with arrhythmic events in men but not in women (P = .02 vs P = .63). Bileaflet MVP had a direct effect on severe arrhythmic events in women (P = .04 for MVP, P = .39 in mediation analysis), but in men this association was mediated by iMAD length (P = .03).

Conclusion

In a large MVP cohort, men exhibit greater MAD length and a stronger association between iMAD length and arrhythmic events. In contrast, iMAD length in women may be less important for arrhythmic risk stratification compared to other imaging parameters such as bileaflet involvement. Further studies are needed to confirm alternative mechanisms beyond localized MAD-related myocardial traction in women with MVP.

背景：心律失常二尖瓣脱垂（AMVP）是一种已知的女性常见病，与二尖瓣环分离（MAD）有关，但MAD、性别、体型和心律失常事件之间的关系尚不清楚。目的：确定MAD是否表现出基于性别的对心律失常风险的差异影响，并探讨索引MAD测量的意义。方法：我们对加州大学旧金山分校（2013-2023）682名连续的mvp进行了详细的临床、节律和超声心动图数据检查。MAD以体表面积为指标，分为无MAD、指数MAD （iMAD）低于中位数和iMAD高于中位数3组。AMVP被定义为伴有频繁和/或复杂心室异位的MVP，包括严重的心律失常事件，如持续性室性心动过速、心室颤动/心脏骤停或死亡。结果：682名mvp（女性48%，平均年龄58±17岁）中，35%有AMVP， 41%有MAD，中位iMAD为4 mm。与女性相比，男性的绝对MAD长度更大（9.0±3.2 mm vs 7.3±2.6 mm），男性的p4 mm与心律失常事件显著相关，而女性的p4 mm与心律失常事件无关（p=0.02 vs p=0.63）。双小叶MVP对女性严重心律失常事件有直接影响（MVP的p=0.04，中介分析的p= 0.39），但在男性中，这种关联是由iMAD长度介导的（p=0.03）。结论：在一个大型MVP队列中，男性表现出更大的MAD长度，并且iMAD长度与心律失常事件之间的关联更强。相比之下，女性iMAD长度对于心律失常风险分层的重要性可能不如其他成像参数（如双小管受损伤）。在女性MVP患者中，除了局部mad相关的心肌牵引外，还需要进一步的研究来证实其他的机制。

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引用次数: 0

A Revised Grading Scheme for Secondary Tricuspid Valve Regurgitation 修订后的三尖瓣二次反流分级方案。

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01 DOI: 10.1016/j.echo.2025.09.010

Xi Zhang MD , Yuxin Zhang MD , Bijun Tan MD , Han Li MD , Ying Hou MD , Pingan Zhou MD , Lijun Yuan MD, PhD , Changyang Xing MD, PhD

Background

The conventional 3-grade scheme recommended by American Society of Echocardiography (ASE) for secondary tricuspid regurgitation (STR) is limited by the frequent disagreement between multiparametric and single-parameter classifications and heterogeneous prognosis within the moderate group. We tested the hypothesis that the expert-recommended 4-grade scheme has better inherent agreement compared to the ASE scheme and further improved it as a revised 4-grade scheme using the corrected proximal isovelocity surface area (PISA) method to calculate effective regurgitant orifice area (EROA) and regurgitant volume (RegVol), along with the integration of other quantitative parameters.

Methods

A total of 178 patients with STR were included. The moderate grade according to the 3-grade ASE-recommended scheme was split into mild-moderate and moderate-severe grades following recent expert suggestions. The agreement between the multiparametric and single-parameter grading in TR severity was analyzed using the weighted kappa test. The structure and function of tricuspid valve and right heart, including the conventional parameters, strains, and the right ventricular‒pulmonary artery (RV-PA) coupling, were compared across grade severities. The partition values of quantitative regurgitation parameters were further determined by receiver operating characteristic curve analyses to develop the revised 4-grade scheme with involvement of corrected PISA method.

Results

The expert-recommended 4-grade scheme demonstrated better multiparametric and single-parameter agreement of RegVol (к = 0.901) in TR grading compared to the ASE-recommended 3-grade scheme (к = 0.506). Both RV strain and RV-PA coupling were significantly lower in patients with moderate-severe STR compared to those with mild-moderate STR (P < .05). The new cutoff values of EROA (0.34 cm²; area under the curve = 0.945) and RegVol (35 mL; area under the curve = 0.958), obtained using the corrected PISA method, demonstrated excellent accuracy in distinguishing mild-moderate from moderate-severe STR.

Conclusions

The revised 4-grade scheme for STR severity exhibited better inherent agreement than the ASE-recommended scheme as well as matching with the right heart functional variations.

背景：美国超声心动图学会（ASE）推荐的继发性三尖瓣反流（STR）的常规三级方案受到多参数和单参数分类频繁分歧以及中度组预后异质性的限制。我们检验了专家推荐的四级方案与ASE方案相比具有更好的内在一致性的假设，并使用校正的近端等速表面积（PISA）方法进一步将其改进为修订的四级方案，以计算有效孔面积（EROA）和反流体积（RegVol），以及其他定量参数的整合。方法：共纳入178例STR患者。根据最近专家的建议，将三级ase推荐方案中的中度分为轻度-中度和中度-重度。采用加权Kappa检验分析多参数分级与单参数分级在TR严重程度上的一致性。比较三尖瓣和右心的结构和功能，包括常规参数、应变和右心室-肺动脉（RV-PA）耦合。通过ROC曲线分析进一步确定定量反流参数的划分值，以制定涉及校正近端等速表面积（PISA）方法的修订四级方案。结果：专家推荐的4级方案与ase推荐的3级方案相比，RegVol在TR分级中的多参数和单参数一致性更好（χ =0.901）。中重度STR患者RV菌株和RV- pa偶联均显著低于轻中度STR患者（P < 0.05）。使用修正后的PISA方法获得的EROA （0.34 cm2, AUC = 0.945）和RegVol （35 mL, AUC = 0.958）的新临界值在区分轻度-中度和中度-重度STR方面显示出极好的准确性。结论：修订后的STR严重程度四级方案比ASE推荐方案具有更好的内在一致性，并且与右心功能变化相匹配。

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引用次数: 0

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01 DOI: 10.1016/j.echo.2025.11.002

Maria Chiara Meucci MD

引用次数: 0

Resolve to Up Your Echo Education Game in 2026 with ASE 在2026年与日月光一起提升你的回声教育游戏

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography

Pub Date : 2026-01-01 DOI: 10.1016/j.echo.2025.11.003

David H. Wiener MD, FASE

引用次数: 0

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