Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques最新文献

Chronic coronary syndrome (CCS), encompassing a wide range of phenotypes and clinical scenarios, remains the leading global cause of disability and premature death. Advanced non-invasive imaging modalities, such as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR), play a pivotal role in enhancing diagnostic accuracy and guiding tailored management strategies for CCS patients. CCTA offers detailed insights into the presence, extent, and severity of coronary atherosclerotic plaques. In addition to detecting coronary stenoses, it enables the characterization of plaque phenotypes and the evaluation of additional prognostic biomarkers, such as perivascular adipose tissue (PVAT) attenuation, allowing for more comprehensive risk stratification. Recent technological advancements have further expanded CCTA's capabilities, enabling the integration of anatomical assessment with hemodynamic evaluation through non-invasive fractional flow reserve computation (FFR-CT) or stress myocardial perfusion analysis. With its superior three-dimensional spatial resolution, CCTA enhances pre-procedural planning for complex coronary revascularization, enabling the selection of optimal interventional strategies and improving patient selection. CMR is considered the gold standard for functional assessment of cardiac function, myocardial viability, quantitative flow evaluation, and tissue characterization, offering excellent soft-tissue contrast. CMR perfusion imaging can accurately assess myocardial ischemia, quantify myocardial blood flow (MBF), and detect microvascular dysfunction, thanks to its high temporal and spatial resolution with the advantage of no radiation exposure. This review highlights the evolving role of CCTA and CMR in managing patients with CCS, focusing on their current applications according to the most recent 2024 ESC guidelines, prognostic value, and recent technological advancements.

This review focuses on the key noninvasive cardiac imaging techniques, including coronary computed tomographic angiography (CCTA) and cardiac magnetic resonance imaging (CMR). It highlights essential publications pertinent to clinicians managing ischemic and nonischemic cardiomyopathy. CCTA provides an anatomical assessment that offers superior diagnostic accuracy compared to functional tests. It is a valuable tool for understanding the impact of nonobstructive coronary artery disease on patient outcomes. Additionally, CCTA is beneficial in defining the morphology of vulnerable plaque, which closely aligns with IVUS findings. It also demonstrates safety advantages, including reduced contrast volume and radiation dose and a lower risk of contrast-induced nephropathy when used in post-CABG besides conventional coronary angiograms. CMR provides invaluable insight into MI size and microvascular obstruction, critical for understanding a patient's prognosis. The assessment of scar tissue with CMR has become an essential tool for risk stratification and informs therapeutic decisions regarding the implantation of ICD.

Arrhythmogenic right ventricular cardiomyopathy is a condition characterized by fibro-fatty replacement, primarily affecting the right ventricle (RV), with variable involvement of the left ventricle, characterized by an increased risk of ventricular arrhythmias and sudden cardiac death. In addition to tissue characterization, which is not the subject of this review, dilation, global systolic dysfunction, and regional kinetic abnormalities of the RV are important components of the diagnostic process for this disease, serving as essential diagnostic criteria. Cardiac magnetic resonance, a central examination in the evaluation of cardiomyopathies, has gained progressive importance because of its greater diagnostic accuracy than echocardiography in detecting morphological volumetric and functional abnormalities, especially of the RV. However, the accurate assessment of morphological abnormalities of the RV using cardiac magnetic resonance imaging remains challenging, because of variability in the interpretation of individual structural anomalies. Besides, several elements come into play in the differential diagnosis of morphological anomalies of the RV, which often mislead the operator and lead to false positive results. The purpose of this review is to illustrate the use of cardiac magnetic resonance in the morphological, volumetric, and functional evaluation of the RV in this disease.

The paper provides a step-by-step guide in editing 3D transesophageal echocardiographic datasets. It reiterates the importance of editing as an added value of optimizing echocardiographic images in order to achieve a correct diagnosis and avoid unnecessarily lengthening an invasive examination such as transesophageal imaging.

In particular, the process begins with acquiring a comprehensive 3D dataset, optimizing image cropping, and adjusting gain to enhance visualization. Techniques such as rotation, cropping, dual view, and multiplanar reconstruction (MPR) allow for detailed exploration of cardiac structures, facilitating better understanding of conditions such as mitral regurgitation and stenosis. Advanced visualization tools, like photorealistic and glass effects, improve anatomical realism and help accentuate important features for diagnosis. Furthermore, transillumination techniques enhance visualization, making subtle anatomical details more apparent. To conclude, optimizing 3D datasets is essential for accurate anatomical representation and understanding of cardiac pathology, emphasizing the need for careful acquisition and editing during transesophageal echocardiography.

A 59-year-old male who underwent the Bentall procedure developed a newly identified echogenic mass in the right heart, detected via intraoperative transesophageal echocardiography (TEE). Thrombectomy under TEE guidance successfully removed the thrombus, and the patient recovered well. TEE was crucial for the real-time detection and management of this rare complication.