Journal of the American Society of Echocardiography最新文献

Background: Limited evidence exists concerning the novel right ventricular (RV) coupling to pulmonary artery (RV-PA coupling) in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). We aimed to evaluate the prognostic value of this RV-PA coupling in patients after TAVR.

Methods: RV-PA coupling was defined as the ratio of RV free wall longitudinal strain (RVFWLS) to pulmonary artery systolic pressure (PASP), measured by echocardiography in AS patients undergoing TAVR between April 2012 and November 2022. The endpoints were all cause death, cardiovascular rehospitalization, stroke, and a composite of these.

Results: At a median follow-up time of 3.4 years, 352 (28.8%) patients in 1221 patients had composite clinical events. Patients with higher RVFWLS/PASP ratio were predominantly male, had lower body mass index, more comorbidities, higher Society of Thoracic Surgeons score, more New York Heart Association IV and worse laboratory data, alongside worse cardiac function compared to those with lower RVFWLS/PASP ratio. The fully adjusted multivariable hazard ratios of RVFWLS/PASP ratio and the tertile 3 of RVFWLS/PASP ratio were 2.228 (95% CI, 1.441-3.446) and 2.571 (95% CI, 1.633-4.047). In addition, Kaplan-Meier analyses revealed robust graded association between the RV-PA coupling and clinical outcomes (P <0.001).

Conclusions: The RV-PA coupling (RVFWLS/PASP ratio) is independently and robustly associated with adverse clinical events in patients undergoing TAVR. These data suggest that the RVFWLS/PASP ratio can serve as a risk stratification tool for patient selection and prognostication following TAVR.

Aims: Left ventricular (LV) strain derived by three-dimensional (3D) speckle tracking echocardiography (STE) has been demonstrated to be correlated with myocardial fibrosis (MF). However, whether 3D-STE parameters provided a similar estimation of LV MF compared with 2D-STE indices and late gadolinium enhancement (LGE) of cardiac magnetic resonance (CMR) imaging against histological MF remains unknown. The aim of this study was to determine whether 3D-STE parameters were similar to 2D-STE indices and LGE-CMR in assessing LV MF in patients with end-stage heart failure (HF) against histological MF.

Methods: STE and CMR were performed in 109 patients with end-stage HF who underwent heart transplantation. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained from two-dimensional (2D) and 3D-STE. The degree of MF was assessed using LGE-CMR and Masson's staining of the LV myocardial samples. One hundred and nine patients were divided into 3 groups based on the tertiles of histologic MF.

Resuilts: MF was strongly correlated with 3D-GLS (r = 0.70, P < 0.001), moderately correlated with LGE extent and 2D-GLS (r = 0.64, r = 0.58; P < 0.001 for each), and weakly correlated with 3D-GRS, 3D-GCS, 2D-GRS and 2D-GCS (r = -0.40, r = 0.29, r = -0.38, r = 0.25; P < 0.01 for each). The correlation of 3D-GLS with LV MF was similar to that of LGE with LV MF (0.70 vs 0.64; P = 0.427). The correlations of segmental 3D-LS with regional MF were similar to that of segmental LGE with regional MF for both ventricular septum and lateral wall (r = 0.68 vs 0.57, r = 0.71 vs 0.62, P > 0.05 for both). The positive and negative predictive values, as well as the area under the curve for identifying severe MF, were comparable among 3D-GLS, 2D-GLS, and LGE. The model with 3D-GLS (R² = 0.53, P < 0.001; Akaike information criterion [AIC] = 413) was similar to that with LGE (R² = 0.50, P < 0.001; AIC = 418) for reflecting the degree of LV MF.

Conclusions: 3D-GLS can be considered a novel functional parameter that may correlate with the extent of LV MF in patients with end-stage HF, demonstrating accuracy comparable to that of 2D-GLS and LGE-CMR in identifying severe MF.

Background: Periarterial echogenicity in the proximal coronary arteries (CAs) increases in the acute phase of Kawasaki disease (KD). However, some studies have questioned the diagnostic value of periarterial echogenicity in differentiating KD from other febrile diseases (non-KD) because of its relatively low specificity. In this study, the authors quantitatively assessed the degree of echogenicity in the proximal and mid segments of both CAs to determine its additional diagnostic value in patients with clinically suspected KD.

Methods: A total of 109 consecutive children (median age, 21 months; interquartile range, 11.0-47.8 months) who underwent transthoracic echocardiography for suspected KD (April 2021 to March 2023) were retrospectively examined. Two-dimensional echocardiographic images in the proximal and mid segments of both CAs were digitally stored and transferred to an offline image analysis system. The mean pixel value of the arterial wall was calculated in grayscale ranging from 0 to 255 (corrected for the intracardiac blood pool adjacent to the target site).

Results: A total of 109 patients were included, 87 (80%) ultimately diagnosed with KD (including 18 with incomplete KD) and 22 (20%) ultimately diagnosed with non-Kawasaki febrile diseases. Although the KD group generally showed higher CA wall echogenicity than the non-KD febrile group, there was no significant difference in the mean pixel values at the proximal segment (P = .34 for each). The KD group showed significantly higher echogenicity in the mid segments of both CAs than the non-KD febrile group (mid right coronary artery, P = .0049; mid left anterior descending coronary artery, P = .011). Similar results were observed in a small prospective cohort of 31 children examined under rigorously standardized ultrasound settings.

Conclusions: CA echogenicity in the mid segments may have potential diagnostic value in the early evaluation of suspected KD, possibly reflecting the characteristic diffuse involvement of the CAs in the acute phase.

Background: Transthoracic echocardiography is recommended for the initial evaluation of patients with suspected pulmonary hypertension (PH), while right heart catheterization (RHC) is indicated to measure mean pulmonary artery pressure (mPAP). Although different echocardiographic algorithms have been proposed to estimate mPAP, these are based on limited validation, often in small or selected populations, and all predate the revised PH diagnostic threshold (mPAP >20 mmHg). This study aimed to evaluate and compare the diagnostic performance of five echocardiographic formulas for estimating mPAP in a large cohort of patients referred to RHC.

Methods: Consecutive patients undergoing clinically indicated RHC and transthoracic echocardiograph within 7 days were prospectively enrolled from a PH referral center over a 10-year period. Echocardiographic mPAP estimates were calculated using five previously proposed formulas derived from tricuspid regurgitation (TR), pulmonary regurgitation (PR), and pulmonary flow acceleration time. Diagnostic accuracy was assessed through correlation analysis, Bland-Altman plots, and receiver operating characteristic (ROC) curves, applying the updated PH definition (mPAP >20 mmHg).

Results: Out of 571 patients included (aged 68 ± 13 years, 50% male), 450 (79%) were diagnosed with PH. All echocardiographic formulas showed significant correlation with invasive mPAP (p <0.001). The formula based on minimal end-diastolic PR pressure showed the best correlation (mPAP_DPmin; R 0.92), and diagnostic accuracy (AUC 0.96 [0.95-0.98]), outperforming mPAP derived from TR velocity (AUC 0.91 [0.89-0.93]) and other formulas (all p < 0.001). mPAP_DPmin also showed minimal bias (+1.21 mmHg) with narrow limits of agreement (-7.14 to +9.56 mmHg), and high accuracy at the fixed 20 mmHg threshold (sensitivity 99%, specificity 82%).

Conclusions: Echocardiographic estimation of mPAP using the mPAP_DPmin formula provides excellent diagnostic accuracy for PH, outperforming other established echocardiographic algorithms.

Background: Quantifying tricuspid regurgitation (TR) severity by conventional Doppler echocardiography is challenging.

Objectives: We sought to validate right ventricular (RV) stroke volumes (SV_3DE) and tricuspid regurgitant volumes (RegVol_3DE) measured by three-dimensional echocardiography (3DE). Then we compared the quantitative metrics used to assess TR severity obtained by 3DE and by both the conventional and the corrected PISA methods.

Methods: Three-dimensional echocardiography RV and left ventricular (LV) SV were collected simultaneously with direct Fick measurements at right heart catheterization (RV SV_RHC) in 45 patients (66 ± 14 years, 76% women) with no or trivial TR and in 57 consecutive patients (73 ± 13 years, 61% women) with mild to torrential (14% mild, 37% moderate, 26% severe, 16% massive, and 7% torrential) TR and mild or no mitral or aortic regurgitation. In the latter group, RHC and 3DE were combined to derive TR regurgitant volume (RegVol_3DE-RHC = RV SV_3DE - RV SV_RHC) and compared to the 3DE volumetric RegVol (RegVol_3DE = RV SV_3DE - LV SV_3DE). Effective regurgitant orifice area (EROA) and regurgitant fraction (RegFr) were calculated from RegVol_3DE, as well as through conventional and corrected PISA methods.

Results: The feasibility of RV SV_3DE was 74%. Among patients with no or trivial TR, RV SV_3DE and RV SV_RHC showed a strong correlation (R² = 0.916, P < .0001), with a minimal bias (3.7 mL) and reasonable precision (limits of agreement, -10 mL; 18 mL). In those with mild to torrential TR, RegVol_3DE correlated with RegVol_3DE-RHC (R² = 0.918, P < .0001) and was accurate (bias = -1.3 mL, limits of agreement, -17.9 mL; 15.2 mL). The EROA, RegVol, and RegFr derived from conventional PISA (0.48 ± 0.4 cm², 38 ± 20 mL, and 36% ± 18%, respectively) were significantly smaller (P < .05) than those obtained from corrected PISA (0.61 ± 0.5 cm², 48 ± 24 mL, and 46% ± 24 %, respectively) and volumetric 3DE (0.62 ± 0.5 cm², 46 ± 25 mL, and 42% ± 18%, respectively).

Conclusions: Right ventricular SV measured by 3DE is accurate (minimal bias, acceptable imprecision) when compared to direct Fick RV SV_RHC.

Aims: The association between left ventricular (LV) systolic dysfunction and adverse outcomes in pediatric cardiomyopathies (CM) has been well-established, but little is known about the prognostic value of the diastolic function in this population. This study aims to evaluate the association between left atrial (LA) function, assessed through 2D-speckle tracking echocardiography (2D-STE), and adverse outcomes in pediatric CM patients.

Methods and results: A retrospective study of 138 pediatric CM patients (dilated, hypertrophic, and restrictive CMs) and 45 controls from three Institutions was conducted. Echocardiographic parameters, including LA reservoir strain (LAS), were measured from each patient's oldest complete echocardiogram at each Institution. The primary composite endpoint was cardiovascular death or aborted death, the need for a ventricular assist device (VAD), or cardiac transplantation. Associations between LAS and outcomes were assessed using Cox proportional hazards models and Kaplan-Meier analysis; complementary receiver-operating-characteristic (ROC) curves were computed after adjustment for follow-up duration. During a median follow-up of 78.8 months, 25 patients experienced the composite endpoint. Lower LAS (p<0.001), impaired global longitudinal strain (GLS) (p=0.003), reduced LV ejection fraction (LVEF) (p=0.003), increased LA volume index (LAVi) (p=0.027) and E/e' (p=0.024) were significantly associated with adverse outcomes. Multivariable Cox analysis demonstrated that LAS (HR 0.90, [0.84 - 0.96], p=0.001) is independently associated with the combined endpoint in model A adjusted for E/A and E/e', in model B (HR 0.94, [0.89 - 0.99], p=0.018) adjusted for LAVi and LVEF, in model C (HR 0.91, [0.87 - 0.95], p<0.001) adjusted for GLS and LVEF. LAS performed better than LAVi in determining the association with outcomes, with an Area Under the Curve (AUC) of 0.739 (p < 0.001) and a cutoff of 15.3% (sensitivity 0.58; specificity 0.86).

Conclusion: LAS showed an adjusted association with adverse outcomes in pediatric patients within the specified models, providing incremental information beyond conventional echocardiographic parameters. Incorporating LAS into routine evaluations may improve risk stratification and guide early interventions in pediatric CM.