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

Background: Myocardial work is a novel measure of potential value for diagnosing coronary artery disease (CAD). It may therefore be useful in patients with chronic kidney disease (CKD), in whom the diagnostic work-up can be challenging.

Methods: This was a cross-sectional study of patients with CKD (G1-5, nondialysis-dependent). Cardiac computed tomography was performed to quantify coronary artery calcium score (CACS). Pressure-strain loop analysis was performed to obtain global and territorial work index (GWI and TWI, respectively). Logistic regression was applied to investigate the association between work measures and high CACS (>400).

Results: We included 455 patients (age: 57 years, 60% men, 8% with previous CAD, and eGFR of 43 mL/min/1.73 m²). High CACS across all coronary arteries was observed in 77 (17%), with 53 (12%) in the left anterior descending (LAD) artery, 28 (6%) in the right coronary artery (RCA), and 17 (4%) in the circumflex (Cx) artery. No difference in GWI was observed for overall high versus non-high CACS (1861 vs. 1937 mmHg%, p = 0.14). TWI was reduced in patients with high versus non-high CACS in the LAD (1772 vs. 1956 mmHg%, p = 0.003) and in the Cx (1556 vs. 1934 mmHg%, p = 0.001), but not in the RCA (p = 0.68). After multivariable regression, TWI remained significantly associated with high CACS in the LAD and Cx in patients with no history of CAD, but not in the RCA.

Conclusion: In patients with CKD, GWI was not associated with an overall high CACS. TWI was, however, associated with a high CACS in specific coronary arteries, although the findings were inconsistent.

Objectives: To investigate the clinical value of fetal heart quantification (fetal HQ) in the evaluation of normal fetal heart size, morphology, and cardiac function at different gestational weeks.

Materials and methods: A total of 101 pregnant women diagnosed with a healthy fetus by fetal echocardiography from September 2021 to December 2023 were selected and classified into four different periods of gestational weeks: 20-28 weeks (25 cases), 29-32 weeks (26 cases), 33-36 weeks (26 cases), and 37-40 weeks (24 cases). Quantitative analyses were performed by automatically tracking the endocardium using fetal HQ software that comes with the Voluson E10 from GE. To investigate the correlation between four-chambered vesicle length end-diastolic (4CV LED), four-chambered vesicle transverse width end-diastolic (4CV TWED), global sphericity index (GSI), ejection fraction (EF), stroke volume (SV), cardiac output (CO), and gestation age (GA), and the variability of normal fetal cardiac morphology and cardiac function at different gestational weeks.

Results: A statistically significant difference was observed between 4CV LED and 4CV TWED in normal fetuses at different gestational weeks (p < 0.05), which exhibited a positive correlation with gestational week. Conversely, no significant correlation was identified between GSI and gestational week (p > 0.05). The mean GSI of 101 normal fetuses was found to be 1.25 ± 0.09. A comparative analysis of EF, SV, and CO in normal fetuses at different gestational weeks revealed statistically significant differences in SV and CO (p < 0.05), which gradually increased with gestational weeks, whereas there was no statistically significant difference in EF (p > 0.05).

Conclusions: Fetal HQ represents a straightforward and dependable method for evaluating GSI and 24-segment SI of the left and right ventricles, which can provide a certain theoretical basis for the clinical quantitative evaluation of fetal cardiac geometry and cardiac function.

Purpose: This study aims to investigate the relationship between epicardial adipose tissue (EAT) and left atrial function in patients with preserved ejection fraction heart failure (HFpEF).

Methods: We conducted a cross-sectional study involving 113 patients diagnosed with HFpEF and 48 control subjects without heart failure. Echocardiography was performed to assess EAT thickness and left atrial function was quantified using Autostrain left atrium (LA), including left atrial strain during reservoir phase (LASr), left atrial strain during conduit phase (LAScd), and left atrial strain during contraction phase (LASct). Clinical and biochemical parameters were correlated with EAT and LA strain using regression analyses and generating receiver operating characteristic (ROC) curves for left atrial strain parameters.

Results: EAT thickness was significantly greater in the HFpEF group (8.0 ± 1.0 mm) compared to the control group (5.0 ± 0.7 mm). HFpEF group exhibited poorer left ventricle diastolic function, indicated by lower e' velocity, E/A ratio, and higher E/e' values. Left atrial strain parameters, including LASr (22.4 ± 9.1%), LAScd (11.9 ± 6.9%), and LASct (10.5 ± 3.9%), were all lower in the HFpEF. EAT thickness was positively correlated with NT-proBNP, triglycerides, and fasting blood glucose. Multivariate analysis revealed significant associations between EAT and LA strain parameters even after adjusting for potential confounders. ROC curve analysis indicated that LASr had the highest diagnostic accuracy for HFpEF. Additionally, left atrial strain parameters were strongly correlated with left ventricular diastolic function.

Conclusion: Patients with HFpEF exhibit increased EAT thickness and reduced left atrial function. The thickening of EAT is associated with a decrease in left atrial strain. LA strain, particularly LASr, may serve as a sensitive indicator for early detection of left ventricular diastolic dysfunction in HFpEF.

A 43-year-old woman presented with dyspnea and cough, initially misdiagnosed as respiratory syncytial virus. Persistent symptoms led to pulmonary thromboembolism treatment, but worsening issues revealed recurrent pericardial effusion. Imaging and biopsy confirmed pulmonary artery intimal sarcoma, mimicking thromboembolism, and autoimmune disease, underscoring diagnostic challenges. Contrast-enhanced angiotomography showing filling defects suggestive of pulmonary thromboembolism. Echocardiogram with severe pericardial effusion. T2-weighted MRI with two heterogeneous masses on the right side and another adjacent to the left atrium. Biopsy confirming pulmonary artery intimal sarcoma.

Purpose: This study explores the effects of anthracycline chemotherapy (AC) on breast cancer patients, focusing on changes in body composition, advanced echocardiographic parameters at rest and during exercise, and biomarkers; and subsequently assesses whether these parameters are associated with impaired cardiorespiratory fitness (CRF).

Methods: In this prospective study, we evaluated women with early-stage breast cancer undergoing AC at three visits: before AC, 1 month after, and 6 months post-AC.

Results: The study included 32 women with breast cancer, with functional disability increasing from 9.0% pre-AC to 43.8% at 1 month and 53.1% at 6 months post-AC. At 1 month, patients with functional disability exhibited higher rates of cancer therapy-related cardiac dysfunction (CTRCD) (85.7% vs. 55.5%) and, during exercise, showed lower left ventricular ejection fraction (LVEF), reduced contractile reserve and stroke volume (SV); along with elevated IL-6, PlGF, and MPO levels. By 6 months, these patients maintained higher CTRCD rates (35.3% vs. 0%), lower SV and cardiac output (CO), reduced global longitudinal strain (GLS), and decreased global work index (GWI). During exercise, they had lower SV; additionally, they exhibited higher MPO levels and increased body and visceral fat. In our multivariable model: age, body fat, resting GWI, exercise LVEF, and CO were independently associated with VO₂peak.

Conclusion: Significant and persistent CRF reductions are common in breast cancer patients post-AC. While resting LVEF and GLS were not linked to VO₂peak, resting MWI and exercise LVEF and CO were, potentially identifying patients at increased long-term heart failure risk who would benefit from cardioprotective strategies like cardio-oncology rehabilitation. It is important to recognize that impaired CRF is multifactorial, as demonstrated by age and body fat being independently associated with VO₂peak, and the impact of non-cardiac factors should be better studied. Our findings highlight the need for further research on CTRCD definition, suggesting that CPET and advanced exercise echocardiography could enhance risk stratification.

First echocardiographic detection of esophageal stent.

Optimal management of adult congenital heart disease (ACHD) requires a multidisciplinary team (MDT) approach, fostering a collaborative culture over an individualistic approach. Within this framework, subspecialty-trained radiologists provide crucial imaging expertise, supporting cardiologists, surgeons, and interventional cardiologists in diagnoses, treatment planning, and follow-up evaluations. Advanced imaging tools and a nuanced understanding of surgical and interventional procedures enable radiologists to provide valuable insights to clinicians. In this review, we discuss the structure of ACHD MDT meeting at a quaternary center, briefly review the general principles of interventions in ACHD and the subsequent complications encountered in adulthood, formulate an approach to imaging and reporting such complex repaired cases, and review the key information to be mentioned in the report for further surgery/intervention. In this review, we use the format of eight key take-home lessons from an MDT management practice in ACHD.

Transcatheter aortic valve implantation (TAVI) is the main treatment option for patients with severe aortic stenosis (AS) and older age. Improved imaging techniques have enabled better patient selection, and the main role is played by echocardiography. Methods more sensitive than LVEF in assessing cardiac function, such as global longitudinal strain (GLS) and myocardial work (MW), have become widespread, and other methods, like hemodynamic forces (HDFs), might be promising. The aim of this paper is to systematically review the parameters of GLS, MW, and HDF as predictors of reverse remodeling and their association with outcomes in patients with AS undergoing TAVI. In particular, the focus will be on the examination of the influence of TAVI on left atrial and ventricular function and right ventricular function.