This manuscript presents a rare case of a ruptured non-coronary sinus of Valsalva aneurysm into the right atrium, forming a giant migratory sac that caused dynamic tricuspid valve obstruction via a diastolic ball-valve mechanism. Transthoracic echocardiography raised the initial suspicion, cardiac computed tomography excluded dissection and visualized its mobility, and transesophageal echocardiography definitively characterized the rupture site and captured the real-time obstructive pathophysiology. This multimodality imaging approach was pivotal in guiding urgent surgical intervention.
Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular (CV) events. Myocardial work indices represent novel echocardiographic measures that may reveal subtle but important abnormalities of left ventricular (LV) function.
Patients with CKD were included prospectively and underwent echocardiography, including pressure-strain loop analyses to acquire myocardial work indices. These included the global work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE). Their association to major adverse cardiovascular events (MACE) – defined as heart failure (HF) and ischemic heart disease – were investigated by Cox regression. Competing risk regression was performed to account for all-cause death as a competing event.
We included 697 patients with CKD (mean age: 57 years, 60% men, median estimated glomerular filtration rate of 43 mL/min/1.73 m2), of whom 42 (6%) experienced MACE during a median follow-up of 3.9 (IQR: 3.4–4.5) years. In univariable analyses, all myocardial work indices were significantly associated with MACE. After multivariable adjustments, only GCW, GWW, and GWE remained significantly associated with MACE (GCW: HR 1.08 (1.00–1.17), per 100 mmHg% decrease; GWW: HR 1.05 (1.01–1.08), per 10 mmHg% increase; GWE: 1.15 (1.08–1.22), per 1% decrease), but only GWW and GWE were associated with MACE in multivariable competing risk regression. Notably, myocardial work indices were only associated with HF and not ischemic heart disease.
In patients with non-dialysis dependent CKD, wasted work and work efficiency were independently associated with MACE. These findings were driven by their association with HF.
A 15-year-old adolescent with complex congenital heart disease (CHD), previously diagnosed with anomalous origin of the right pulmonary artery from the ascending aorta and patent ductus arteriosus (PDA), presented with chest tightness. Transthoracic echocardiography (TTE) revealed moderate pulmonary artery stenosis (29 mmHg gradient), but computed tomography angiography (CTA) confirmed severe stenosis at the right pulmonary artery origin, and invasive angiography quantified a 32-mmHg systolic pressure gradient. Following successful pulmonary artery stenting, the gradient decreased to 5 mmHg, with complete symptom resolution. This case underscores the critical role of multimodal imaging in diagnosing postoperative pulmonary artery stenosis, guiding interventional timing, and preventing irreversible complications such as pulmonary hypertension and vascular remodeling in high-risk CHD populations.
Diabetes mellitus has been increasingly recognized as a contributor to subclinical atrial dysfunction, particularly in hypertensive patients with preserved left ventricular ejection fraction. In our study, we demonstrated an association between diabetes and impaired left atrial mechanics assessed by two-dimensional speckle-tracking echocardiography. Although the cross-sectional design does not allow causal inference, our findings support the hypothesis that diabetes may adversely affect atrial strain independent of overt cardiovascular disease. We adjusted for relevant clinical and echocardiographic variables, though residual confounding cannot be excluded. Patients with known atrial fibrillation were excluded, and although prolonged rhythm monitoring was not performed, this limitation reflects the real-world challenges of detecting silent paroxysmal arrhythmias. Echocardiography was chosen for its accessibility and widespread applicability, and reproducibility analyses confirmed good intra- and inter-observer agreement. Validation against other modalities such as cardiac magnetic resonance imaging was beyond the scope of the present study.
Cardiomyopathies represent a heterogeneous group of myocardial diseases characterized by structural and functional abnormalities that can lead to heart failure, arrhythmias, and sudden cardiac death. Echocardiography remains the first-line, non-invasive imaging modality for the evaluation of cardiomyopathies, owing to its broad availability, safety profile, and diagnostic versatility. This review comprehensively outlines the echocardiographic features associated with the major morphofunctional subtypes of cardiomyopathy: dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive cardiomyopathy (RCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and left ventricular non-compaction cardiomyopathy (LVNC). Emphasis is placed on both adult and pediatric populations, with attention to age-specific diagnostic criteria and measurement standards. The article also includes structured tabular summaries to facilitate clinical interpretation and application across diverse patient settings. Through an integrated and standardized echocardiographic approach, this review aims to support accurate diagnosis, effective monitoring, and informed therapeutic decision-making in the management of cardiomyopathies.
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