Coronary microvascular dysfunction is a clinical condition very diffuse in many different settings. Often the diagnosis can be very tricky, and choosing the proper diagnostic strategy can be fundamental for reaching the goal. The aim of this review is to evaluate the properties and the feasibility of our tests in specific scenarios by looking at the performances of each methodology reported in the literature.
All structural and functional alterations the heart experiences due to intense sports training are collectively called the “athlete's heart” (AH). One of the main diagnostic dilemmas of today's sports cardiology is the so-called “gray zone”—the structural and functional overlap between the physiological adaptation of the AH and the pathological process of cardiomyopathy. The importance of accurate differentiation between these two entities cannot be highlighted enough—it is estimated that half of the cases of sudden cardiac death in young athletes aged 19–29 are caused by cardiomyopathies, primarily hypertrophic cardiomyopathy (HCM). In the last few years, cardiac magnetic resonance imaging (MRI) has positioned itself as the gold standard for diagnosing structural heart disease, emphasizing the role of the cardiac imaging expert. This brief literature review provides the cardiac MRI findings and techniques that aid in distinguishing the AH from the most common cardiomyopathy—HCM. We will discuss the contributions, as well as current challenges and limitations of each technique, hoping to assist imaging experts and clinicians in solving one of the biggest dilemmas of sports cardiology.
Mitral valve prolapse (MVP) has been associated with left heart remodeling. This study explored cardiac remodeling in patients with MVP without significant regurgitation, focusing on the right heart.
This single-center study enrolled consecutive patients referred to trans-thoracic-echocardiography (TTE) with MVP, excluding those with significant regurgitation or known cardiovascular or pulmonary diseases. A group of healthy controls was included.
Forty-nine patients with MVP and 54 controls were finally selected (mean age of 62, 52–71; 52% males), and echocardiographic parameters were compared among groups. Twenty-nine (41%) patients with MVP showed tricuspid valve prolapse (TVP). Patients with MVP, irrespective of TVP, showed greater tricuspid annulus (systolic annulus: 31±6 vs. 32±5 vs. 27±3 mm for MVP+/TVP−, MVP+/TVP+, and controls, respectively; all p < 0.01) and greater minimum right atrial volume indexed (13, 12–15 mL/m2 vs. 15, 12–20 mL/m2 vs. 11, 10–14 mL/m2; all p < 0.05). Right ventricular dimensions and systolic indexes did not differ among groups, except TAPSE, which was significantly greater in MVP+/TVP+ patients compared to controls (25±4 vs. 22±3 mm, p = 0.004). A significant correlation (ρ = 0.43; p < 0.001) and an independent association at multivariate analysis (ß = 0.28; 95% CI 0.09–0.47; p = 0.004) were observed between end-systolic tricuspid diameter and TAPSE.
In patients with MVP with less-than-moderate mitral or tricuspid regurgitation, dilation of the right atrium and tricuspid annulus was found. The latter finding was associated with increased values of TAPSE, which should then be used with caution, while other indexes may be preferred when assessing the systolic function of these patients.
Atrial septal defect (ASD) is a prevalent congenital heart condition in adults, which finally leads to pulmonary hypertension and right heart failure if left untreated. Right heart catheterization (RHC), the current gold standard for determining ASD closure feasibility, is invasive. Thus, a noninvasive prescreening tool is urgently needed.
In a multicenter, retrospective study, we assessed 924 ASD patients (2012–2022) to determine their suitability for ASD closure. Using LASSO regression, we identified predictors for a correctable shunt, enabling us to create the ASD model. The ASD model, comprising of estimated pulmonary artery systolic pressure (ePASP), peak velocity through the pulmonary valve (PV), peak E-wave velocity through the tricuspid valve (TVE), and right atrial longitudinal dimension (RA) by echocardiography, was constructed and exhibited favorable discriminative capability with an area under the curve (AUC) of 0.941 (95% CI: 0.920–0.961) in the derivation group. The model also demonstrated good calibration and discriminative abilities in the validation cohort. When juxtaposed with the earlier congenital heart disease (CHD) model, the newly developed ASD model demonstrated superior predictive capabilities for correctable shunt, supported by the net reclassification index (NRI) [0.063 (95% CI: 0.001–0.127, p = 0.047)] and integrated discrimination improvement (IDI) [0.023 (95% CI: 0.011–0.036, p < 0.001)].
In summary, our research advocates the ASD model as a superior tool for screening suitable ASD defect closure candidates.
This study aimed to assess alterations in right ventricular (RV) function following percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes utilizing three-dimensional speckle tracking echocardiography (3D-STE).
A prospective study was conducted involving 136 patients diagnosed with chronic coronary syndromes undergoing PCI, constituting the study group, alongside 110 age- and gender-matched healthy volunteers serving as the control group. Echocardiographic evaluations, including both conventional and three-dimensional assessments, were performed on all study participants at 1-week, 6, and 12 months post-PCI. Parameters such as tricuspid annular plane systolic excursion (TAPSE) were derived from conventional echocardiography, while tricuspid lateral annular systolic velocity (S') was measured via tissue Doppler imaging. 3D-STE was utilized to quantify metrics including right ventricular fractional area change (RVFAC), right ventricular free wall longitudinal strain (RVFWLS), right ventricular global longitudinal strain (RVGLS), right ventricular stroke volume (RVSV), and right ventricular ejection fraction (RVEF).
TAPSE, S', RVFAC, RVFWLS, RVGLS, RVSV, and RVEF exhibited significant increases from 1-week to 6 months post-PCI (p < 0.05). However, from 6 to 12 months post-PCI, RVFAC, RVGLS, RVSV, and RVEF demonstrated no notable changes (p > 0.05). Meanwhile, TAPSE, S', and RVFWLS sustained significant elevations: TAPSE (19.63 ± 3.253% to 22.603 ± 2.885%, p < 0.001); S' (10.57 ± 2.643 to 12.61 ± 2.189 cm/s, p < 0.001); RVFWLS (18.64 ± 2.745% to 19.926 ± 3.291%, p = 0.002). At 12 months post-PCI, S', RVFAC, RVGLS, RVSV, and RVEF remained lower than those of the healthy control group, but the differences were not statistically significant (p > 0.05). However, RVFWLS was significantly lower compared to the healthy control group (19.926 ± 3.291% vs. 22.10 ± 1.994%, p < 0.001).
Following PCI, right ventricular systolic function in patients with chronic coronary syndromes improves significantly over time. However, even at the 12-month post-PCI mark, RVFWLS remains lower than that of the control group. Notably, 3D-STE emerges as a noninvasive method for quantifying right ventricular systolic function post-PCI in chronic coronary syndrome patients.
Cardiovascular magnetic resonance imaging (MRI) in patients with cardiac implants, such as pacemakers and defibrillators, has gained importance in recent years with the development of modern cardiac implantable electronic devices. The increasing clinical need to perform MRI examinations in patients with cardiac implants has driven the development of new advanced MRI sequences to mitigate image artifacts associated with cardiac implants. More specifically, advances in imaging techniques, such as wideband late gadolinium enhancement imaging, wideband T1 mapping, and wideband perfusion, have been designed to improve image quality and examinations in patients with cardiac implants, enabling a comprehensive and more reliable diagnosis, which was previously unattainable in these patients. This review article explores recent developments and applications of wideband techniques in the field of cardiovascular MRI, offering insights into their transformative potential. Clinical applications of wideband cardiovascular MRI are highlighted, particularly in assessing myocardial viability, guiding ventricular tachycardia ablation, and characterizing myocardial tissue.
Left ventricular (LV) apical aneurysms (ApAn+) occur in 10%–15% of apical hypertrophic cardiomyopathy (ApHCM) patients and confer considerable morbidity. We hypothesized that ApAn+ adversely impact ventricular mechanics and mechano-energetic coupling in ApHCM.
Ninety-eight ApHCM patients were identified, of which nine (9%) had ApAn+ and were compared with 89 (91%) who did not (ApAn−). 2D speckle-tracking echocardiography assessed ventricular mechanics using LV global longitudinal strain (GLS) and torsion, and mechano-energetic coupling as myocardial work indices. Clinical events over follow-up were adjudicated.
Mean age was 64 ± 15 years, 46% were female, and 3% had an HCM family history, with similar clinical risk factors between groups. Of the nine ApAn+ patients, there were six small (<2 cm) and three moderate-sized (2-4 cm) aneurysms. There was no difference in LV ejection fraction (65 ± 15 vs. 67 ± 11%, p = 0.51) or GLS (−9.6 ± 3.3 vs. −11.9 ± 3.9%, p = 0.09) between ApAn+ versus ApAn−. ApAn+ patients had greater myocardial global wasted work (347 ± 112 vs. 221 ± 165 mmHg%, p = 0.03) and lower global work efficiency (GWE, 75 ± 5 vs. 82 ± 8%, p = 0.006). LV GLS (β = −0.67, p < 0.001), ApAn+ (β = −0.15, p = 0.04), and twist rate (β = −0.14, p = 0.04) were independently associated with GWE. At 3.9-year follow-up, cardiovascular mortality (4%) and heart failure hospitalization (14%) events were similar between groups.
ApHCM patients with ApAn+ are characterized by more impaired LV mechano-energetic coupling when compared with ApAn−. ApAn+ is independently associated with worse GWE.
This study aimed to identify the utility of global longitudinal strain (GLS) as a reliable parameter that can accurately forecast left ventricle reverse remodeling (LVRR) in patients undergoing valve replacement surgery for severe chronic primary mitral regurgitation (MR), thereby aiding in assessing mortality and morbidity risk.
This retrospective observational study involved severe primary MR patients who underwent valve replacement surgery between 2018 and 2023. Pre- and postsurgery echocardiography data were collected, with GLS measurements utilized to assess left ventricular function. Various echocardiography parameters, including MR severity and LV dimensions, were analyzed. Bivariate and multivariate analyses were performed to explore relationships between GLS and LVRR.
This study enrolled 103 patients (54.4% male; mean age 45.4 ± 13.6 years). Statistical analyses revealed GLS to be an independent predictor of LVRR, with a threshold of −16.25% showing 89% sensitivity and 50% specificity. Each 1% increase in GLS corresponded to a 1.14-fold (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.01–1.31; p < 0.05) increased likelihood of LVRR.
These findings highlight GLS's potential as a prognostic marker for postsurgical outcomes in severe MR patients.
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