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Predicting the Need for Pulmonary Venous Reintervention in Total Anomalous Pulmonary Venous Connection: The Role of Preoperative Echocardiographic Metrics
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-06 DOI: 10.1111/echo.70124
Helen M. Stanley, Jennifer A. Faerber, Meryl S. Cohen, Ryan Callahan, Stephanie M. Fuller, Brian R. White

Purpose

Development of postoperative obstruction in total anomalous pulmonary venous connection (TAPVC) is a major cause of morbidity and mortality. Although preoperative echocardiography has often been cited as prognostic of postoperative outcome, its predictive value has not been fully evaluated. Pulmonary venous variability index (PVVI) is an echocardiographic metric developed at our center and previously shown to correlate with preoperative clinical markers and catheterization findings of obstruction. We hypothesized that preoperative PVVI would be superior to maximum and mean velocity for prediction of postsurgical outcome in TAPVC.

Methods

We performed a retrospective review of TAPVC patients repaired at our center. Preoperative echocardiograms were reviewed for clinical read, and measures of pulmonary venous obstruction including maximum, mean, and minimum velocity and PVVI ([maximum velocity−minimum velocity]/mean velocity) were calculated from spectral Doppler of the pulmonary venous pathway. The outcome was time to surgical or catheter-based pulmonary vein reintervention.

Results

In total, 162 patients were included and 33 (20%) underwent reintervention. On univariate Cox proportional hazards model, single ventricle status, mixed-type TAPVC, and PVVI ≤ 0.5 were predictive of reintervention (hazard ratios of 2.7, = 0.01; 3.2, = 0.01; and 2.2, = 0.03, respectively). Absolute echocardiographic velocities were not associated with the outcome. On multivariate analysis, single ventricle status and mixed-type TAPVC remained significant predictors of reintervention, while PVVI did not.

Conclusions

Though preoperative PVVI was associated with an increased risk of postoperative reintervention in TAPVC by univariate analysis, multivariate analysis suggests that single ventricle status and TAPVC subtype are the strongest drivers of postoperative outcomes. Preoperative velocities are not predictive of outcome in TAPVC.

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引用次数: 0
Top reviewers 2024 echo
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-06 DOI: 10.1111/echo.70123
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引用次数: 0
Echocardiographic Parameters of Right Ventricular Size and Function Associated With Right Heart Failure After Durable Left Ventricular Assist Device Implantation—A Systematic Review and Meta-Analysis
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-04 DOI: 10.1111/echo.70119
Jia Cheng Kevyn Chai, Jia Le Chew, Anjalee Amarasekera, Hatem Soliman Aboumarie, Timothy C. Tan

Background

Late-onset Right Ventricular (RV) failure is an established complication of Durable Left-Ventricular Assist Device (D-LVAD) implantation. Transthoracic echocardiography (TTE) remains the primary imaging modality for serial monitoring in this population, but its interpretation remains challenging due to device-related changes in RV size and function and a lack of guidelines addressing this impact. This study aims to examine the diagnostic and prognostic utility of TTE parameters of RV size and function in the detection of late-onset RV failure post-implantation.

Methods and Results

A systematic literature search of medical databases was performed to identify all relevant studies assessing TTE parameters in adult patients with D-LVADs (January 2003–August 2023; English only). Of the 350 studies identified, nine studies with a pooled cohort of 627 patients and three studies with a pooled cohort of 175 patients (40 Cases and 135 controls) were meta-analyzed across a range of structural and functional TTE parameters. Compared to World Alliance Societies of Echocardiography (WASE) reference values, this population had dilated RV size (as quantified by RVEDD) and reduced systolic function (as quantified by TAPSE, RVFAC, and RVEF). TAPSE was positively associated with the non-RVF group, while RVEDD was negatively associated with the non-RVF group.

Conclusions

Based on the available studies, there was baseline RV dilatation and reduced systolic function in patients with D-LVADs. Additionally, TAPSE and RVEDD demonstrated a statistically significant association with the development of RVF post-implantation, indicating a potential role as prognostic markers. Further studies should also be conducted to establish post-implantation TTE reference values.

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引用次数: 0
Myocardial Dysfunction and Risk of Long COVID in Patients Recovered From Mild and Moderate COVID-19
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-03 DOI: 10.1111/echo.70120
Binyu Zhou, Yiran Zhang, Shuang Han, Jiqing Zhang, Lin Song, Haiyan Wang

Purpose

Numerous recovered COVID-19 patients exhibit persistent cardiovascular symptoms. However, the degree of myocardial dysfunction and its associated risk factors remain unclear. This study aims to evaluate myocardial dysfunction in recovered patients and pinpoint predictors of persistent cardiovascular symptoms.

Methods

We reviewed the echocardiograms of patients who recovered from mild or moderate COVID-19 and presented with cardiovascular symptoms during the Omicron surge. Myocardial strain was analyzed in 546 patients before and after infection, and in 351 prepandemic healthy controls. Clinical follow-up at 12 months post-infection was used to evaluated symptom persistence, and multivariable logistic regression was used to identify independent predictors.

Results

Baseline characteristics showed no significant differences between patients and controls (all p > 0.05). Although the left ventricle global longitudinal strain (LVGLS) remained stable post-infection, significant reductions emerged in regional left ventricle longitudinal strains (LVLS) and all left atrial strains (LAS) (all p < 0.05). Persistent cardiovascular symptoms affected 16.5% (90/546) of patients at 1-year follow-up. Multivariate analysis showed that only LA conduit strain (OR = 0.919, 95% CI: 0.857, 0.985, p = 0.017) and basal inferoseptal LVLS (OR = 0.883, 95% CI: 0.792, 0.986, p = 0.026) correlated with persisting cardiovascular symptoms.

Conclusion

Our findings demonstrate that subclinical but persistent COVID-19-associated myocardial dysfunction is characterized by regional LVLS impairment and LAS reduction. The identified strain parameters (LAScd and basal inferoseptal LVLS) serve as novel imaging markers for stratifying patients at risk of persistent cardiovascular symptoms. These results advocate for targeted echocardiographic surveillance and early intervention strategies in post-COVID care pathways.

Trial Registration

ClinicalTrials.gov identifier: NCT06170307

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引用次数: 0
Total Anomalous Pulmonary Venous Drainage Caused by Malposition of Septum Primum in Adults
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-03 DOI: 10.1111/echo.70118
Shanshan Cheng, Min Hu, Fangfang Feng, Shubao Wang

• MSP has primarily been reported in fetuses or children, with only one case of adult MSP with PAPVD previously reported in 2022.

The case we report is about an adult with TAPVD which caused by MSP. There are no similar reports so far.

.

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引用次数: 0
Afterload Mismatch After Mitral Valve Edge-to-Edge Repair: Echocardiographic Evaluation and Clinical Implications
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-03 DOI: 10.1111/echo.70121
Sergio Suma, Francesco Mangini
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引用次数: 0
Multimodality Imaging and Immune-Related Adverse Events During Immune Checkpoint Inhibitors Treatment: Where Do We Stand?
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-03 DOI: 10.1111/echo.70115
Stephanie Crosio, Giorgio Treglia, Martina Imbimbo, Patrizia Froesch, Lorenzo Grazioli Gauthier, Dimitri Arangalage, Luca Bergamaschi, Sándor A. Györik, Giacomo Maria Viani, Alessandro Caretta, Laura Anna Leo, Giovanni Pedrazzini, Giorgio Moschovitis, Anna Giulia Pavon

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, significantly improving survival across various malignancies. However, these therapies are associated with various types of immune-related adverse events (irAEs), including cardiotoxicity, a spectrum of rare but potentially life-threatening complications impacting significantly morbidity and mortality. Cardiovascular imaging has become key in cardio-oncology, providing essential diagnostic tools for early detection and monitoring. This review synthesizes current evidence and underlines the pivotal role of early and tailored imaging strategies in managing ICI-induced cardiotoxicity. By bridging the knowledge gap, it aims to provide targetable insights to optimize the clinical management in patients undergoing immunotherapy.

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引用次数: 0
Advancements in Computed Tomography Angiography for Pulmonary Embolism Assessment
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-03 DOI: 10.1111/echo.70116
Ludovica R. M. Lanzafame, Claudia Gulli, Christian Booz, Thomas J. Vogl, Luca Saba, Riccardo Cau, Patrizia Toia, Giorgio Ascenti, Michele Gaeta, Silvio Mazziotti, Tommaso D'Angelo

Pulmonary embolism (PE) is a critical condition stemming from venous thromboembolism, with potentially fatal outcomes. Computed tomography pulmonary angiography (CTPA) serves as the gold standard for diagnosing PE, offering unparalleled diagnostic accuracy, accessibility, and speed. Recent innovations, such as spectral CT systems and artificial intelligence (AI)-driven algorithms, have enhanced the diagnostic and prognostic capabilities of CTPA, enabling precise anatomical and functional assessments. This review highlights these technological advancements and their clinical implications.

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引用次数: 0
Diagnostic and Prognostic Value of RV Strain Defined as RV/LV Ratio on Chest CT in Acute Pulmonary Embolism: A Systematic Review
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-03 DOI: 10.1111/echo.70107
Ankit Hanmandlu, Aniruddh Mannari, Aiden Abidov

Background

Pulmonary embolism (PE) is a common cause of acute RV enlargement (often described as RV strain or RV-S), with significant associated mortality and morbidity. Chest CT pulmonary angiography is a widely available diagnostic modality to rule out PE and assess for RV-S, if positive for PE. Frequently, RV-S is assessed by measuring the right ventricular (RV) to left ventricular (LV) ratio (RV/LV ratio); however, there is no standardized technique for measuring CT RV/LV ratio, and the prognostic value of this marker is not well-defined.

Methods

PubMed and EMBASE databases were searched from inception to December 2023. A total of 35 studies were eligible for data collection based on relevance, completeness, and quality of data.

Results

The most common clinically effective cutoffs of the RV/LV ratio used were 0.9 and 1.0, and the most common methodology involved measuring RV and LV diameters within the same axial slice on both 2D (axial) and reconstructed 4-Chamber (4-Ch) views. Although 4-Ch and axial views had different RV/LV ratio predictability regarding specific outcomes such as 30-day death, there was no significant overall difference in the prognostic value across the different cutoffs used.

Conclusions

Our study demonstrates a lack of definite standardization in measuring CT RV/LV ratio in acute PE. Based on our review, we propose an RV strain defined as CT RV/LV ratio >1.0 measured on a single axial CT slice as an easily measurable and reliable marker of RV dysfunction in acute PE, with associated significant prognostic value in predicting adverse outcomes.

{"title":"Diagnostic and Prognostic Value of RV Strain Defined as RV/LV Ratio on Chest CT in Acute Pulmonary Embolism: A Systematic Review","authors":"Ankit Hanmandlu,&nbsp;Aniruddh Mannari,&nbsp;Aiden Abidov","doi":"10.1111/echo.70107","DOIUrl":"https://doi.org/10.1111/echo.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary embolism (PE) is a common cause of acute RV enlargement (often described as RV strain or RV-S), with significant associated mortality and morbidity. Chest CT pulmonary angiography is a widely available diagnostic modality to rule out PE and assess for RV-S, if positive for PE. Frequently, RV-S is assessed by measuring the right ventricular (RV) to left ventricular (LV) ratio (RV/LV ratio); however, there is no standardized technique for measuring CT RV/LV ratio, and the prognostic value of this marker is not well-defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed and EMBASE databases were searched from inception to December 2023. A total of 35 studies were eligible for data collection based on relevance, completeness, and quality of data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The most common clinically effective cutoffs of the RV/LV ratio used were 0.9 and 1.0, and the most common methodology involved measuring RV and LV diameters within the same axial slice on both 2D (axial) and reconstructed 4-Chamber (4-Ch) views. Although 4-Ch and axial views had different RV/LV ratio predictability regarding specific outcomes such as 30-day death, there was no significant overall difference in the prognostic value across the different cutoffs used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study demonstrates a lack of definite standardization in measuring CT RV/LV ratio in acute PE. Based on our review, we propose an RV strain defined as CT RV/LV ratio &gt;1.0 measured on a single axial CT slice as an easily measurable and reliable marker of RV dysfunction in acute PE, with associated significant prognostic value in predicting adverse outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Functional Mitral Valve Regurgitation, Pathophysiology, Leaflet ReModeling, and the Role of Imaging
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-25 DOI: 10.1111/echo.70101
Francesco Fulvio Faletra, Eluisa La Franca, Massimiliano Mulè, Alessandra Carvelli, Francesca Parisi, Giovanni Di Stefano, Rita Laura Borrello, Vincenzo Nuzzi, Paolo Manca, Manlio Cipriani

Functional mitral regurgitation (FMR) is a complex left ventricle (LV) and left atrium (LA) disorder in which mitral valve regurgitation is just the “tip of the iceberg.” Unlike primary mitral cvalve regurgitation, in which regurgitation occurs due to anatomic abnormalities of the valve itself, the etiology of FMR is multifactorial. Regional and global LV dysfunction, extent and location of fibrotic myocardium (subendocardial/transmural scar), and annulus enlargement are the leading causes of valve regurgitation. A comprehensive understanding of the causes, mechanisms, severity, and clinical consequences of FMVR relies primarily on noninvasive imaging techniques. Echocardiography is the first-line and most commonly used imaging technique. Cardiac magnetic resonance (CMR) has gained growing consensus mainly because it can precisely identify the extent and location of fibrotic myocardium. This review aims to: (a) describe the pathophysiology of the most common phenotypes of FMR, (b) challenge the paradigm that mitral leaflets are structurally normal in FMR, and (c) illustrate the critical role of both echocardiography and CMR in the comprehensive assessment of FMR.

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引用次数: 0
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Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques
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