Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques最新文献_第2页

2D Contour: A Simplified Approach for Left Atrial Reservoir Strain 二维轮廓线：左心房储层应变的简化方法。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-18 DOI: 10.1111/echo.70359

Giacomo Ingallina, Riccardo Colombi, Paola Cunsolo, Gabriele Paci, Davide Margonato, Francesco Ancona, Giorgio Fiore, Carlo Gaspardone, Claudia Palomba, Noemi Russo, Stefano Stella, Leone Giovanni Musci, Federico Biondi, Ludovica Bognoni, Vincenzo Rizza, Monica Barki, Francesco Maisano, Eustachio Agricola

Background

Left atrial strain reservoir (LASr) has emerged as a useful parameter in assessing diastolic dysfunction and heart failure with preserved ejection fraction. LASr is typically assessed using speckle-tracking echocardiography (STE), which was developed to measure strain in the left ventricle. Despite its strength demonstrated in several clinical studies, the application of STE to the left atrium presents well-known limitations: thin walls, anatomical discontinuities, far-field location, and inter-vendor variability. The present study aims to evaluate the efficacy of an alternative method for assessing LASr, based on the percentage shortening of the atrial wall contour, by directly comparing it with STE-derived LASr values.

Methods

We retrospectively analyzed 246 patients in sinus rhythm with severe organic mitral regurgitation. The 2D contour strain method quantifies changes in the length of the two-dimensional (2D) endocardial atrial wall contour between end-systolic and end-diastolic frames. The peak strain value is calculated as: (maximum perimeter length−minimum perimeter length)/maximum perimeter length × 100.

Results

2D contour strain measurements were feasible in all patients. A strong correlation was observed between STE-derived and 2D contour-derived LASr values, with an R-value of 0.93. On average, 2D contour strain measurements underestimated LA peak strain by approximately 1% compared to STE. The consistency of 2D contour LA strain measurements, as assessed by inter- and intra-observer reproducibility, was excellent.

Conclusion

These findings suggest that 2D contour LA strain is a feasible and reliable alternative to STE for assessing LASr. This approach is particularly valuable in echocardiography labs where STE software for LA is unavailable.

背景：左心房应变蓄水池（LASr）已成为评估保留射血分数的舒张功能障碍和心力衰竭的有用参数。LASr通常使用斑点跟踪超声心动图（STE）进行评估，该技术用于测量左心室的应变。尽管在一些临床研究中证明了STE的优势，但STE在左心房的应用存在众所周知的局限性：壁薄、解剖不连续性、远场位置和供应商之间的可变性。本研究旨在评估一种评估LASr的替代方法的有效性，该方法基于心房壁轮廓缩短的百分比，通过直接将其与ste衍生的LASr值进行比较。方法：回顾性分析246例窦性心律伴严重器质性二尖瓣反流的患者。二维轮廓应变法量化了收缩期末和舒张期末心内膜房壁二维轮廓长度的变化。峰值应变值计算为：（最大周长-最小周长）/最大周长× 100。结果：所有患者均可进行二维轮廓应变测量。ste衍生的LASr值与2D轮廓衍生的LASr值之间存在很强的相关性，r值为0.93。平均而言，与STE相比，2D轮廓应变测量低估了LA峰值应变约1%。2D轮廓LA应变测量的一致性，通过观察者之间和观察者内部的再现性来评估，是非常好的。结论：2D轮廓LA应变是一种可行、可靠的替代STE评估LASr的方法。这种方法在超声心动图实验室中特别有价值，因为STE软件无法用于LA。

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引用次数: 0

Right Aortic Arch With Bilateral Ductus Arteriosus, Aberrant Left Subclavian Artery, Interrupted Left Carotid Artery 右主动脉弓伴双侧动脉导管，左锁骨下动脉异常，左颈动脉中断。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-18 DOI: 10.1111/echo.70349

Cosimo Marco Campanale, Serena Ventrella, Luciano Pasquini, Alessandra Toscano

We show an exceptional case of a right aortic arch (RAA) in a patient with DiGeorge syndrome, breaking the rule that the first epiaortic vessel courses to the contralateral side of the aortic arch. This is a RAA with an aberrant left subclavian artery (ALSA) and an isolated left carotid artery (ILCA) arising from the left pulmonary artery (LPA) via a left anterior ductus arteriosus (LADA), along with bilateral ductus arteriosus. This unique case highlights educational pitfalls in using a simple rule to define arch sidedness. Although challenging, echocardiographic diagnosis of such vascular anomalies is feasible in expert hands. The color-flow and Doppler pattern of the epiaortic vessels provide important information about their arrangement and connection to the aortic arch. Bilateral ductus arteriosus is often a marker of complex vascular anomalies, which are frequently associated with genetic syndromes.

我们展示了一个特殊的情况下，右主动脉弓（RAA）的患者与迪乔治综合征，打破了规则，第一层主动脉血管流向主动脉弓的对侧。这是一个异常的左锁骨下动脉（ALSA）和孤立的左颈动脉（ILCA），由左肺动脉（LPA）通过左前动脉导管（LADA）和双侧动脉导管产生。这个独特的案例突出了使用一个简单的规则来定义弓侧度的教育陷阱。尽管具有挑战性，超声心动图诊断这种血管异常是可行的专家的手。主动脉血管的彩色血流和多普勒图提供了它们的排列和与主动脉弓连接的重要信息。双侧动脉导管通常是复杂血管异常的标志，这通常与遗传综合征有关。

引用次数: 0

Predictive Models of a Future Coronary Artery Calcium Score in a Black Cohort: The GENOA Study 在黑人队列中未来冠状动脉钙评分的预测模型：GENOA研究。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-14 DOI: 10.1111/echo.70388

Edmund K. Kerut, Ronald Horswell, Adebamike Oshunbade, Michael E. Hall, Filip To, Ervin Fox, Michael R. McMullan, Kenneth R. Butler

Objective

This retrospective study of a Black cohort sought to create predictive models to calculate the probability of a coronary artery calcium score (CACS) about one decade after obtaining cardiovascular risk measures.

Study Design and Setting

Participants (n = 656) in GENOA had CV risk variables measured (1995–2000) and a CACS about one decade later (2009–2011). Using multivariate regression, computer models were written to calculate the probability of a future CACS of zero, ≥ 10, and ≥ 100. ROC values were 0.78, 0.77, and 0.76, respectively. Machine learning models did not perform any better than multivariate regression.

Results

Age, height, smoking duration, sex, and hypertension were significant for all three models in predicting a future CACS. Height was inversely related to future CACS, but weight and BMI were not contributory to the models. Lipid-lowering medications and exercise were associated with an increased CACS, the so-called CACS “paradox.”

Conclusion

Predictive models of a future CACS such as these may help in identifying important risk factors for a future CACS. By identifying these risk factors and implementing early modification of CV risk factors, the development of CV disease may be slowed.

目的：这项对黑人队列的回顾性研究旨在建立预测模型，以计算获得心血管风险测量后约十年冠状动脉钙评分（CACS）的概率。研究设计和设置：GENOA的参与者（n = 656）在1995-2000年期间测量了CV风险变量，并在大约十年后（2009-2011年）测量了CACS。使用多元回归，编写计算机模型来计算未来CACS为0、≥10和≥100的概率。ROC值分别为0.78、0.77、0.76。机器学习模型的表现并不比多元回归更好。结果：年龄、身高、吸烟持续时间、性别和高血压是预测未来CACS的重要因素。身高与未来的CACS呈负相关，但体重和BMI对模型没有贡献。降脂药物和运动与CACS增加有关，即所谓的“CACS悖论”。“结论：诸如此类的未来CACS预测模型可能有助于识别未来CACS的重要危险因素。通过识别这些危险因素并实施心血管危险因素的早期修改，可以减缓心血管疾病的发展。

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引用次数: 0

Right Ventricular–Pulmonary Artery Coupling and Clinical Outcomes Following Mitral Transcatheter Edge-to-Edge Repair: A Systematic Review and Meta-Analysis 二尖瓣边缘到边缘修复后的右心室-肺动脉耦合和临床结果：系统回顾和荟萃分析。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-12 DOI: 10.1111/echo.70387

Panagiotis Theofilis, Athanasios Sakalidis, Paschalis Karakasis, Panayotis K. Vlachakis, Evangelos Oikonomou, Emmanouil Mantzouranis, Panagiotis Iliakis, Kyriakos Dimitriadis, Panteleimon Pantelidis, Konstantinos Pamporis, Konstantina Aggeli, Konstantinos Tsioufis, Dimitris Tousoulis

Background

Right ventricular–pulmonary artery (RVPA) coupling is an emerging prognostic marker in cardiovascular disease, but its predictive value in patients undergoing mitral transcatheter edge-to-edge repair (MTEER) remains uncertain.

Methods

We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched for studies evaluating the prognostic impact of RVPA coupling in patients undergoing MTEER, using tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) or related markers. Risk of bias was assessed with the ROBINS-I tool, and meta-analyses were used to evaluate associations with clinical outcomes, including all-cause mortality, major adverse cardiovascular events (MACE), and residual mitral regurgitation (MR).

Results

Nine studies involving 3281 patients were included. Baseline RVPA uncoupling was significantly associated with an increased incidence of MACE (risk ratio [RR] 1.75, 95% confidence interval [CI]: 1.40–2.19) and higher all-cause mortality (RR 1.82, 95% CI: 1.53–2.18). No significant association was observed with post-operative MR (RR 1.17, 95% CI: 0.83–1.63). Sensitivity analyses did not alter the direction of the findings.

Conclusion

RVPA uncoupling is associated with adverse outcomes after MTEER. Routine assessment may improve pre-procedural risk stratification. Further studies should refine diagnostic thresholds and evaluate potential therapeutic strategies in the setting of impaired RVPA coupling prior to MTEER.

背景：右心室-肺动脉（RVPA）耦合是一种新兴的心血管疾病预后标志物，但其在二尖瓣经导管边缘到边缘修复（MTEER）患者中的预测价值仍不确定。方法：我们按照PRISMA 2020指南进行了系统综述和荟萃分析。检索PubMed、Scopus和Web of Science，利用三尖瓣环平面收缩移位(TAPSE)/肺动脉收缩压（PASP）或相关标志物评估MTEER患者RVPA偶联对预后影响的研究。使用ROBINS-I工具评估偏倚风险，并使用荟萃分析评估与临床结果的相关性，包括全因死亡率、主要不良心血管事件（MACE）和残留二尖瓣反流（MR）。结果：纳入9项研究，共3281例患者。基线RVPA解耦与MACE发生率升高（风险比[RR] 1.75, 95%可信区间[CI]: 1.40-2.19）和全因死亡率升高（RR 1.82, 95% CI: 1.53-2.18）显著相关。与术后MR无显著相关性（RR 1.17, 95% CI: 0.83-1.63）。敏感性分析并没有改变研究结果的方向。结论：RVPA解耦与MTEER术后不良预后相关。常规评估可改善手术前风险分层。在MTEER前RVPA偶联受损的情况下，进一步的研究应该完善诊断阈值并评估潜在的治疗策略。

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引用次数: 0

Echocardiographic Analysis of Tricuspid Regurgitation and Other Hemodynamic Factors in Relation to Right Atrial Function in Patients With Chronic Thromboembolic Pulmonary Hypertension 慢性血栓栓塞性肺动脉高压患者三尖瓣反流及其他血流动力学因素与右心房功能的超声心动图分析。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-12 DOI: 10.1111/echo.70393

Jun Li, Pan Han, XinXin Zhao, Lan Lan, Qiao Li

Objective

Using echocardiography to evaluate tricuspid regurgitation (TR) caused by chronic thromboembolic pulmonary hypertension (CTEPH) and to investigate the impact of TR on right atrial function, thereby enabling early monitoring and intervention of TR to protect right atrial function.

Methods

Eighty patients diagnosed with CTEPH between October 2022 and October 2024 were included in this study. These patients were divided into three groups based on the quantitative grading method for TR: mild TR (29 cases), moderate TR (30 cases), and severe TR (21 cases). Meanwhile, 24 healthy individuals who underwent physical examinations and were matched with the case group in terms of age and gender were selected as the control group. Clinical data, echocardiographic parameters, and other relevant information of all study subjects were collected. The above data were subjected to statistical analysis to explore the effects of various factors, including TR, on the reservoir function, conduit function, and booster pump function of the right atrium.

Results

Univariate linear regression analysis showed that the related variables, including heart rate, WHO functional class, main pulmonary artery diameter, pulmonary artery systolic pressure (PASP), right ventricular basal diameter, right ventricular anterior wall thickness, right ventricular global function (RVGF), tricuspid annular diameter (TAD), tricuspid valve coaptation length (TVCL), and TR, exhibited a linear relationship with right atrial total ejection fraction (TotEF) and passive ejection fraction (PassEF), but no linear relationship with right atrial active ejection fraction (ActEF). Multivariate stepwise linear regression analysis revealed that PASP, RVGF, and TR severity were the main factors affecting right atrial TotEF and PassEF. Specifically, right atrial TotEF and PassEF gradually decreased with the increase in PASP, the decline in RVGF, and the aggravation of TR severity.

Conclusions

In patients with CTEPH, the reservoir function and conduit function of the right atrium gradually decrease with the aggravation of TR, the impairment of RVGF, and the elevation of PASP.

目的：应用超声心动图评价慢性血栓栓塞性肺动脉高压（CTEPH）所致三尖瓣反流（TR），探讨TR对右心房功能的影响，为早期监测和干预TR保护右心房功能提供依据。方法：本研究纳入了2022年10月至2024年10月期间诊断为CTEPH的80例患者。根据TR的定量分级方法将患者分为轻度TR（29例）、中度TR（30例）、重度TR（21例）三组。同时选取年龄、性别与病例组相匹配的健康体检者24人作为对照组。收集所有研究对象的临床资料、超声心动图参数及其他相关信息。对上述数据进行统计分析，探讨包括TR在内的各种因素对右心房储层功能、导管功能、增压泵功能的影响。结果:单因素线性回归分析显示，心率、WHO功能分类、肺动脉主动脉直径、肺动脉收缩压（PASP）、右心室基底直径、右心室前壁厚度、右心室全功能（RVGF）、三尖瓣环径（TAD）、三尖瓣瓣覆盖长度（TVCL）、TR、与右心房总射血分数（TotEF）、被动射血分数（PassEF）呈线性关系，与右心房主动射血分数（ActEF）无线性关系。多因素逐步线性回归分析显示，PASP、RVGF和TR严重程度是影响右心房TotEF和PassEF的主要因素。右心房TotEF、PassEF随PASP升高、RVGF下降、TR严重程度加重而逐渐降低。结论：CTEPH患者右心房的储血功能和导管功能随着TR的加重、RVGF的损害和PASP的升高而逐渐降低。

{"title":"Echocardiographic Analysis of Tricuspid Regurgitation and Other Hemodynamic Factors in Relation to Right Atrial Function in Patients With Chronic Thromboembolic Pulmonary Hypertension","authors":"Jun Li, Pan Han, XinXin Zhao, Lan Lan, Qiao Li","doi":"10.1111/echo.70393","DOIUrl":"10.1111/echo.70393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Using echocardiography to evaluate tricuspid regurgitation (TR) caused by chronic thromboembolic pulmonary hypertension (CTEPH) and to investigate the impact of TR on right atrial function, thereby enabling early monitoring and intervention of TR to protect right atrial function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty patients diagnosed with CTEPH between October 2022 and October 2024 were included in this study. These patients were divided into three groups based on the quantitative grading method for TR: mild TR (29 cases), moderate TR (30 cases), and severe TR (21 cases). Meanwhile, 24 healthy individuals who underwent physical examinations and were matched with the case group in terms of age and gender were selected as the control group. Clinical data, echocardiographic parameters, and other relevant information of all study subjects were collected. The above data were subjected to statistical analysis to explore the effects of various factors, including TR, on the reservoir function, conduit function, and booster pump function of the right atrium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Univariate linear regression analysis showed that the related variables, including heart rate, WHO functional class, main pulmonary artery diameter, pulmonary artery systolic pressure (PASP), right ventricular basal diameter, right ventricular anterior wall thickness, right ventricular global function (RVGF), tricuspid annular diameter (TAD), tricuspid valve coaptation length (TVCL), and TR, exhibited a linear relationship with right atrial total ejection fraction (TotEF) and passive ejection fraction (PassEF), but no linear relationship with right atrial active ejection fraction (ActEF). Multivariate stepwise linear regression analysis revealed that PASP, RVGF, and TR severity were the main factors affecting right atrial TotEF and PassEF. Specifically, right atrial TotEF and PassEF gradually decreased with the increase in PASP, the decline in RVGF, and the aggravation of TR severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with CTEPH, the reservoir function and conduit function of the right atrium gradually decrease with the aggravation of TR, the impairment of RVGF, and the elevation of PASP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960640","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

Case Series of the “Blueberry-on-Top" Phenomenon: A Recently Recognized Strain Pattern in Patients With Apical Variant Hypertrophic Cardiomyopathy “蓝莓上顶”现象的病例系列：最近在尖变型肥厚性心肌病患者中发现的一种菌株模式。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-12 DOI: 10.1111/echo.70368

Saed Alnaimat, Mariah Mascara, Yochitha Pulipati, Anantha S. Madgula, Jenna Li, Robert W. W. Biederman, Georgios Lygouris

Background

The “Blueberry-on-Top” phenomenon is a novel echocardiographic strain pattern that has been recently described in patients with apical variant hypertrophic cardiomyopathy (ApHCM). It is identified when there is impaired global longitudinal strain (GLS) with paradoxically advanced time to peak strain (TPS) in a hypertrophied apex with relative sparing of the basal segments. On a standard polar map, GLS will have a pale center while TPS will depict a more robust blue center.

Objectives

While the “Blueberry-on-Top” pattern has been observed in a few prior reports, its true prevalence in patients with ApHCM is currently unknown. We sought to examine the prevalence of this strain pattern among patients with ApHCM.

Methods

A series of patients diagnosed with ApHCM by cardiac MRI were included and compared to a series of normal controls. All patients underwent a standard transthoracic echocardiogram (TTE). For uniform reporting, all echocardiogram studies were post-processed using Tomtec, which is a vendor-independent speckle tracking analysis software.

Results

From a cohort of 340 patients with HCM, a total of 15 patients with ApHCM were identified and subsequently compared to 15 normal controls. The “Blueberry-on-Top” pattern was observed in 93% (n = 14) of patients with ApHCM, while none of the normal controls had a “Blueberry-on-Top” pattern. We identified a GLS ratio threshold of 1.26 and a normalized time to peak strain (NTPS) ratio threshold of 0.09. When both thresholds are met, the “Blueberry-on-Top” phenomenon has nearly 100% sensitivity and 93% specificity for the diagnosis of ApHCM. We suggest using these parameters as an adjunctive tool for making the clinical diagnosis of ApHCM and integrating them into a more comprehensive approach.

Conclusion

The newly recognized “Blueberry-on-Top” strain pattern is unique and can be used as a supportive diagnostic feature in ApHCM.

背景：“蓝莓上顶”现象是一种新的超声心动图应变模式，最近在顶端变异性肥厚性心肌病（ApHCM）患者中被描述。当有受损的全球纵向应变（GLS）与矛盾的提前时间到峰值应变（TPS）在一个肥大的尖端与相对节约的基段。在标准的极坐标地图上，GLS将有一个苍白的中心，而TPS将描绘一个更强大的蓝色中心。虽然在之前的一些报道中观察到“蓝莓上顶”模式，但其在ApHCM患者中的真实患病率目前尚不清楚。我们试图检查这种菌株模式在ApHCM患者中的流行程度。方法：选取一系列经心脏MRI诊断为ApHCM的患者，并与一系列正常对照进行比较。所有患者均行标准经胸超声心动图（TTE）检查。为了统一报告，所有超声心动图研究都使用Tomtec进行后处理，这是一种独立于供应商的斑点跟踪分析软件。结果：从340例HCM患者中，共鉴定出15例ApHCM患者，并将其与15例正常对照进行比较。在93% （n = 14）的ApHCM患者中观察到“蓝莓在顶部”模式，而正常对照中没有“蓝莓在顶部”模式。我们确定GLS比率阈值为1.26，标准化时间与峰值应变（NTPS）比率阈值为0.09。当两个阈值都满足时，“蓝莓上顶”现象诊断ApHCM的敏感性接近100%，特异性为93%。我们建议将这些参数作为临床诊断ApHCM的辅助工具，并将它们整合到更全面的方法中。结论：新发现的“蓝莓上顶”菌株模式是独特的，可作为ApHCM的辅助诊断特征。

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引用次数: 0

Right Atrial Stiffness: An Emerging Prognostic Marker in Cardiac Amyloidosis? 右心房僵硬：心脏淀粉样变性的新预后指标？

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-12 DOI: 10.1111/echo.70392

Kalliopi Keramida, Konstantinos Papadopoulos, Vasiliki Androutsopoulou, Andrea Stefanini, Matteo Cameli

引用次数: 0

Accuracy of Myocardial Speckle Tracking in Identifying the Culprit Vessel in Non-ST-Segment Elevation Acute Coronary Syndromes 心肌斑点追踪在非st段抬高急性冠脉综合征中识别罪魁祸首血管的准确性。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-08 DOI: 10.1111/echo.70390

Hejia Sun, Yuze Han, Lidong Zhu, Xiaoxu Gu, Xin Li, Zhiqing Cao, Bo Zhang

Purpose

This study analyzed the diagnostic efficacy of electrocardiogram (ECG), transthoracic echocardiography (TTE), and speckle tracking echocardiography (STE) in identifying the culprit vessel (CV) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). It explored the feasibility and accuracy of the noninvasive STE technique in providing clinicians with CV-related information for treatment decision-making.

Methods

One hundred and forty-two NSTE-ACS patients were retrospectively analyzed to evaluate the diagnostic efficacy of ECG, wall motion score index (WMSI) of TTE, and territorial longitudinal strain (TLS) of STE in identifying the CV before coronary angiography (CAG).

Results

STE demonstrated superior accuracy (87.3%, p < 0.05) for CVs identification versus ECG (23.2%) and TTE (47.9%). The sensitivities of ECG, TTE, and STE in identifying the left anterior descending artery as the CV were 35.7%, 58.9%, and 89.3%, respectively (p < 0.05), with specificities of 88.4%, 90.7%, and 95.3%. For the right coronary artery, sensitivities were 17.5%, 35.0%, and 75.0% (p < 0.05; specificities: 93.1%, 92.1%, and 98.0%). For the left circumflex artery, sensitivities were 13.0%, 52.2%, and 95.7% (p < 0.05; specificities: 96.9%, 88.5%, and 87.5%). The WMSI + TLS model outperformed WMSI alone (p < 0.001). In multivessel disease, epicardial TLS (Epi - TLS) independently predicted the CV (p < 0.001) and surpassed other myocardial layers in diagnostic performance.

Conclusion

This study demonstrated that STE showed superior accuracy to other noninvasive techniques in the identification of CV in NSTE-ACS patients before CAG. Epi-TLS offered unique value in discriminating the true CV among multivessel disease. STE offered practical bedside evaluation for NSTE-ACS patients before invasive procedures.

Trial Registration

Dalian Friendship Municipal Hospital, China: CTR2500108952

目的：本研究分析心电图（ECG）、经胸超声心动图（TTE）和斑点追踪超声心动图（STE）对非st段抬高急性冠脉综合征（NSTE-ACS）患者罪魁血管（CV）的诊断价值。探讨无创STE技术在为临床医生提供cv相关信息用于治疗决策方面的可行性和准确性。方法：回顾性分析142例NSTE-ACS患者，评价心电图、TTE壁运动评分指数（WMSI）、STE区域纵向应变（TLS）在冠状动脉造影（CAG）前对CV的诊断价值。结果：STE鉴别CVs的准确率（87.3%,p < 0.05）高于ECG（23.2%）和TTE（47.9%）。ECG、TTE、STE识别左前降支为CV的敏感性分别为35.7%、58.9%、89.3% (p < 0.05)，特异性分别为88.4%、90.7%、95.3%。对于右冠状动脉，敏感性分别为17.5%、35.0%和75.0% （p < 0.05；特异性分别为93.1%、92.1%和98.0%）。左旋动脉敏感性分别为13.0%、52.2%和95.7% （p < 0.05；特异性分别为96.9%、88.5%和87.5%）。WMSI + TLS模型优于单独使用WMSI （p < 0.001）。在多血管疾病中，心外膜TLS （Epi - TLS）独立预测CV (p < 0.001)，在诊断性能上优于其他心肌层。结论：本研究表明，在CAG前鉴定NSTE-ACS患者CV时，STE比其他无创技术具有更高的准确性。Epi-TLS在鉴别多血管疾病的真实CV方面具有独特的价值。STE在侵入性手术前为NSTE-ACS患者提供了实用的床边评估。试验注册：中国大连市友谊医院：CTR2500108952。

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引用次数: 0

Association of Early Left Ventricular Ejection Fraction Patterns With Functional Recovery and Outcomes After Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation 单纯主动脉反流经导管主动脉瓣置换术后早期左心室射血分数模式与功能恢复及预后的关系

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-08 DOI: 10.1111/echo.70391

Tailuo Liu, Zixuan Zhang, Qiyue Liao, Fei Chen, Mao Chen

Background

Early changes in left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR) in patients with pure aortic regurgitation (AR) may signal functional recovery potential and prognostic relevance, yet systematic evidence is lacking.

Methods

We retrospectively analyzed 128 consecutive patients with pure AR who underwent TAVR between 2018 and 2023 and experienced an acute postprocedural LVEF reduction (≥5%). LVEF was assessed using the Simpson's biplane method at discharge and at 1 month. Patients were categorized according to a 1-month LVEF change into Rebound pattern (≥10% increase) or Decliner pattern (<10% increase). The primary endpoint was major adverse cardiovascular events (MACE); secondary endpoints included 1-year LVEF normalization, cardiovascular mortality, and all-cause mortality. Group comparisons employed standard parametric or nonparametric tests. Predictors of 1-year LVEF normalization were assessed with multivariable logistic regression, while Kaplan–Meier and Cox models were used for time-to-event outcomes.

Results

A Rebound pattern was observed in 54.69% of patients and was strongly associated with LVEF normalization at 1 year (odds ratio, 1.88; 95% CI, 1.57–1.96). Over a median follow-up of 945 days (interquartile range, 514–1319), the Rebound group experienced significantly fewer MACE (log-rank p = 0.043) and remained an independent protective factor for MACE, cardiovascular mortality, and all-cause mortality in multivariable analyses.

Conclusions

In patients with pure AR and acute LVEF decline after TAVR, early postoperative LVEF trajectory within 1 month independently predicts long-term functional recovery and prognosis. Routine assessment of early LVEF patterns may enhance risk stratification and inform individualized post-TAVR management.

背景：单纯主动脉瓣反流（AR）患者经导管主动脉瓣置换术（TAVR）后左室射血分数（LVEF）的早期变化可能预示着功能恢复潜力和预后相关性，但缺乏系统证据。方法：我们回顾性分析了2018年至2023年间连续128例接受TAVR且术后急性LVEF降低（≥5%）的纯AR患者。出院时和1个月时采用Simpson双翼法评估LVEF。根据1个月LVEF变化将患者分为反弹模式（≥10%增加）或下降模式(结果：54.69%的患者观察到反弹模式，并且与1年LVEF正常化密切相关（优势比，1.88;95% CI, 1.57-1.96）。在中位945天的随访中（四分位数范围为514-1319），反弹组的MACE显著减少（log-rank p = 0.043），并且在多变量分析中仍然是MACE、心血管死亡率和全因死亡率的独立保护因素。结论：单纯AR合并TAVR后急性LVEF下降的患者，术后1个月内早期LVEF轨迹独立预测长期功能恢复和预后。早期LVEF模式的常规评估可以加强风险分层，并为tavr后的个体化管理提供信息。

{"title":"Association of Early Left Ventricular Ejection Fraction Patterns With Functional Recovery and Outcomes After Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation","authors":"Tailuo Liu, Zixuan Zhang, Qiyue Liao, Fei Chen, Mao Chen","doi":"10.1111/echo.70391","DOIUrl":"10.1111/echo.70391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early changes in left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR) in patients with pure aortic regurgitation (AR) may signal functional recovery potential and prognostic relevance, yet systematic evidence is lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 128 consecutive patients with pure AR who underwent TAVR between 2018 and 2023 and experienced an acute postprocedural LVEF reduction (≥5%). LVEF was assessed using the Simpson's biplane method at discharge and at 1 month. Patients were categorized according to a 1-month LVEF change into <b>Rebound pattern</b> (≥10% increase) or <b>Decliner pattern</b> (<10% increase). The primary endpoint was major adverse cardiovascular events (MACE); secondary endpoints included 1-year LVEF normalization, cardiovascular mortality, and all-cause mortality. Group comparisons employed standard parametric or nonparametric tests. Predictors of 1-year LVEF normalization were assessed with multivariable logistic regression, while Kaplan–Meier and Cox models were used for time-to-event outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A Rebound pattern was observed in 54.69% of patients and was strongly associated with LVEF normalization at 1 year (odds ratio, 1.88; 95% CI, 1.57–1.96). Over a median follow-up of 945 days (interquartile range, 514–1319), the Rebound group experienced significantly fewer MACE (log-rank <i>p</i> = 0.043) and remained an independent protective factor for MACE, cardiovascular mortality, and all-cause mortality in multivariable analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with pure AR and acute LVEF decline after TAVR, early postoperative LVEF trajectory within 1 month independently predicts long-term functional recovery and prognosis. Routine assessment of early LVEF patterns may enhance risk stratification and inform individualized post-TAVR management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935257","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

Linking Energetic Inefficiency to Ventriculoarterial Uncoupling in Pulmonary Hypertension 肺动脉高压患者能量低下与心室动脉分离的关系。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2026-01-07 DOI: 10.1111/echo.70389

Ashwin Venkateshvaran, Thomas Lindow, Raluca Jumatate, Attila Kovacs, Annika Ingvarsson, Per Lindqvist, Anna Werther Evaldsson

Background

Right ventricular–pulmonary arterial (RV–PA) uncoupling is central to prognosis in precapillary pulmonary hypertension (PH). While the tricuspid annular plane systolic excursion tosystolic pulmonary artery pressure (TAPSE/sPAP) ratio is an established bedside surrogate of RV–PA coupling, novel energetic markers such as three-dimensional (3D)–derived right ventricular (RV) global wasted work (GWW) may provide complementary insight into maladaptive RV remodeling.

Objectives

To contextualize the prognostic value of RV GWW relative to TAPSE/sPAP and clarify their mechanistic and clinical complementarity.

Methods and Results

Patients with elevated GWW (≥38 mmHg/%) exhibited evidence of RV–PA uncoupling, including a reduced RV end-systolic elastance to arterial elastance (E_es/E_a) ratio (0.47 [0.34–0.73] vs. 0.71 [0.50–0.91]; p = 0.007) and lower TAPSE/sPAP ratio (0.21 [0.18–0.32] vs. 0.34 [0.22– 0.45] mm/Hg; p = 0.003) compared with lower GWW. In secondary analyses, a TAPSE/sPAP ratio below the median was associated with increased risk of death or lung transplantation (hazard ratio [HR] 3.20; 95% CI: 1.45–7.08), remaining significant after adjustment for age and sex (adjusted HR 2.97; 95% CI: 1.27–6.94). Discrimination was modest and comparable for TAPSE/sPAP (C-statistic 0.63; 95% CI: 0.53–0.73) and GWW (C-statistic 0.61), with no significant difference between metrics (ΔC = −0.02; p = 0.68).

Conclusions

TAPSE/sPAP remains a robust and clinically valuable surrogate of macroscopic RV–PA coupling. However, GWW offers complementary information by quantifying myocardial inefficiency related to paradoxical and postsystolic deformation, capturing energetic consequences of afterload mismatch that may not be reflected by displacement-based indices alone. Integrating energetic and mechanical markers may enable a more granular assessment of RV performance, particularly in intermediate-risk PH, and warrants evaluation in larger multicenter studies.

背景：右心室-肺动脉（RV-PA）解耦对毛细前肺动脉高压（PH）的预后至关重要。虽然三尖瓣环形平面收缩偏移与收缩期肺动脉压（TAPSE/sPAP）比值是一种已建立的RV- pa耦合的床边替代指标，但新的能量标志物，如三维（3D）衍生的右室（RV）全局浪费功（GWW），可能为RV重构不良提供补充信息。目的：探讨RV GWW相对于TAPSE/sPAP的预后价值，并阐明其机制和临床互补性。方法和结果：GWW升高（≥38 mmHg/%）的患者表现出RV- pa解偶联的证据，包括与GWW较低的患者相比，RV收缩末期弹性与动脉弹性（Ees/Ea）比值降低（0.47[0.34-0.73]比0.71 [0.50-0.91],p = 0.007）和TAPSE/sPAP比值降低（0.21[0.18-0.32]比0.34 [0.22- 0.45]mm/Hg, p = 0.003）。在二级分析中，TAPSE/sPAP比低于中位数与死亡或肺移植风险增加相关（风险比[HR] 3.20; 95% CI: 1.45-7.08），在调整年龄和性别后仍然显著（调整后的风险比[HR] 2.97; 95% CI: 1.27-6.94）。TAPSE/sPAP （c -统计量0.63;95% CI: 0.53-0.73）和GWW （c -统计量0.61）的歧视程度适中，具有可比性，指标之间无显著差异（ΔC = -0.02; p = 0.68）。结论：TAPSE/sPAP仍然是一种可靠的、具有临床价值的宏观RV-PA耦合替代物。然而，GWW通过量化与矛盾和收缩后变形相关的心肌效率低下提供了补充信息，捕获了可能无法仅通过基于位移的指标反映的后负荷不匹配的能量后果。整合能量和机械标志物可以更细致地评估RV的表现，特别是在中等风险的PH中，并且需要在更大的多中心研究中进行评估。

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引用次数: 0