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.
{"title":"Right Ventricular–Pulmonary Artery Coupling and Clinical Outcomes Following Mitral Transcatheter Edge-to-Edge Repair: A Systematic Review and Meta-Analysis","authors":"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","doi":"10.1111/echo.70387","DOIUrl":"10.1111/echo.70387","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</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":"145960662","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}
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.
{"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}
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.
{"title":"Case Series of the “Blueberry-on-Top\" Phenomenon: A Recently Recognized Strain Pattern in Patients With Apical Variant Hypertrophic Cardiomyopathy","authors":"Saed Alnaimat, Mariah Mascara, Yochitha Pulipati, Anantha S. Madgula, Jenna Li, Robert W. W. Biederman, Georgios Lygouris","doi":"10.1111/echo.70368","DOIUrl":"10.1111/echo.70368","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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% (<i>n</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The newly recognized “Blueberry-on-Top” strain pattern is unique and can be used as a supportive diagnostic feature in ApHCM.</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":"145960672","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}
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
{"title":"Accuracy of Myocardial Speckle Tracking in Identifying the Culprit Vessel in Non-ST-Segment Elevation Acute Coronary Syndromes","authors":"Hejia Sun, Yuze Han, Lidong Zhu, Xiaoxu Gu, Xin Li, Zhiqing Cao, Bo Zhang","doi":"10.1111/echo.70390","DOIUrl":"10.1111/echo.70390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>STE demonstrated superior accuracy (87.3%, <i>p</i> < 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 (<i>p</i> < 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% (<i>p</i> < 0.05; specificities: 93.1%, 92.1%, and 98.0%). For the left circumflex artery, sensitivities were 13.0%, 52.2%, and 95.7% (<i>p</i> < 0.05; specificities: 96.9%, 88.5%, and 87.5%). The WMSI + TLS model outperformed WMSI alone (<i>p</i> < 0.001). In multivessel disease, epicardial TLS (Epi - TLS) independently predicted the CV (<i>p</i> < 0.001) and surpassed other myocardial layers in diagnostic performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Dalian Friendship Municipal Hospital, China: CTR2500108952</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":"145936041","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}
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}
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 (Ees/Ea) 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.
{"title":"Linking Energetic Inefficiency to Ventriculoarterial Uncoupling in Pulmonary Hypertension","authors":"Ashwin Venkateshvaran, Thomas Lindow, Raluca Jumatate, Attila Kovacs, Annika Ingvarsson, Per Lindqvist, Anna Werther Evaldsson","doi":"10.1111/echo.70389","DOIUrl":"10.1111/echo.70389","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To contextualize the prognostic value of RV GWW relative to TAPSE/sPAP and clarify their mechanistic and clinical complementarity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Patients with elevated GWW (≥38 mmHg/%) exhibited evidence of RV–PA uncoupling, including a reduced RV end-systolic elastance to arterial elastance (E<sub>es</sub>/E<sub>a</sub>) ratio (0.47 [0.34–0.73] vs. 0.71 [0.50–0.91]; <i>p</i> = 0.007) and lower TAPSE/sPAP ratio (0.21 [0.18–0.32] vs. 0.34 [0.22– 0.45] mm/Hg; <i>p</i> = 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; <i>p</i> = 0.68).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</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":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913878","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}
Zhang Aoyi, Zhou Chang, Shen Dian, Hu Wenshu, Li Xinyi, Hu Haotian, Zhu Runyu
<div> <section> <h3> Objectives</h3> <p>A novel index, termed the right ventricle (RV)-pulmonary artery (PA) index, was established by integrating the longitudinal strain of the right ventricular free wall (RVFWLS) and the right ventricular ejection fraction (RVEF), both evaluated using three-dimensional speckle-tracking echocardiography (3D-STE), with the stiffness of the pulmonary artery (PAS). This approach aims to enhance our understanding of the underlying mechanisms associated with heart failure with preserved ejection fraction (HFpEF).</p> </section> <section> <h3> Methods</h3> <p>The study comprised 80 patients diagnosed with HFpEF, 60 high-risk patients without clinical heart failure (HF), and 50 healthy controls. Clinical data and pulmonary stiffness measurements were collected, and right ventricular function was evaluated using 3D-STE. Furthermore, the corresponding RV-PA coupling parameters were established. Statistical analyses were conducted using SPSS version 26.0 and R software, employing one-way ANOVA, the Kruskal–Wallis H test, Pearson and Spearman correlation coefficients, multivariable linear regression, and receiver operating characteristic (ROC) curve analysis.</p> </section> <section> <h3> Results</h3> <p>Patients with HFpEF exhibited elevated levels of PAS, dilated right heart structures, and impaired right ventricular (RV) function when compared to both high-risk and control groups. PAS was identified as an independent risk factor for RV dysfunction. Stratified diagnostic analysis revealed that the novel coupling index, RVEF/PAS, demonstrated exceptional diagnostic performance during the initial screening phase (AUC = 0.813) and maintained robust discriminatory power during the differentiation stage of the high-risk population (AUC = 0.757). Both newly developed indices, RVEF/PAS and RVFWLS/PAS, exhibited significant positive correlations with tricuspid annular plane systolic excursion (TAPSE)/PASP (<i>r</i> = 0.536, <i>p </i>= 0.004; <i>r</i> = 0.449, <i>p </i>= 0.019). The proposed stratified diagnostic model, characterized by a “primary screening-refined discrimination” approach based on parameter characteristics, offers a novel strategy for the early detection of HFpEF.</p> </section> <section> <h3> Conclusions</h3> <p>The 3D-STE method reliably assesses right ventricular function in patients with HFpEF, while pulmonary arterial compliance is effectively evaluated through PAS. The novel RV-PA coupling indices, namely RVEF/PAS and RVFWLS/PAS, are developed by integrating these techniques, providing a stratified diagnostic strategy for the early detection of HFpEF. PAS is appropriate for initial screenin
目的：通过将右心室游离壁纵向应变（RVFWLS）和右心室射血分数（RVEF）与肺动脉刚度（PAS）相结合，建立了一种新的指标，称为右心室(RV)-肺动脉（PA）指数，这两种指标均使用三维斑点跟踪超声心动图（3D-STE）进行评估。该方法旨在增强我们对保留射血分数（HFpEF）心力衰竭相关潜在机制的理解。方法：本研究包括80例确诊为HFpEF的患者，60例无临床心力衰竭（HF）的高危患者和50例健康对照。收集临床资料和肺刚度测量，并使用3D-STE评估右心室功能。建立了相应的RV-PA耦合参数。采用SPSS 26.0和R软件进行统计分析，采用单因素方差分析、Kruskal-Wallis H检验、Pearson和Spearman相关系数、多变量线性回归和受试者工作特征（ROC）曲线分析。结果：与高危组和对照组相比，HFpEF患者表现出PAS水平升高、右心结构扩张和右心室（RV）功能受损。PAS被认为是右心室功能障碍的独立危险因素。分层诊断分析显示，新型耦合指数RVEF/PAS在早期筛查阶段表现出优异的诊断性能（AUC = 0.813），在高危人群分化阶段保持了强大的鉴别能力（AUC = 0.757）。RVEF/PAS和RVFWLS/PAS与三尖瓣环状平面收缩偏移(TAPSE)/PASP呈显著正相关（r = 0.536, p = 0.004; r = 0.449, p = 0.019）。所提出的分层诊断模型，其特点是基于参数特征的“初级筛查-精细鉴别”方法，为HFpEF的早期检测提供了一种新的策略。结论：3D-STE方法可可靠评估HFpEF患者的右心室功能，而PAS可有效评估肺动脉顺应性。通过整合这些技术，开发了新的RV-PA耦合指数，即RVEF/PAS和RVFWLS/PAS，为HFpEF的早期检测提供了分层诊断策略。PAS适用于初级保健机构的初始筛查，而RVEF/PAS则在医疗中心提供精确的诊断支持。总的来说，这些方法建立了一种新的非侵入性工具系统来评估右心和肺血管系统之间的相互作用。
{"title":"Assessment of Right Ventricular-Pulmonary Arterial Coupling in Heart Failure With Preserved Ejection Fraction Using Three-Dimensional Speckle-Tracking Echocardiography and Pulmonary Artery Stiffness","authors":"Zhang Aoyi, Zhou Chang, Shen Dian, Hu Wenshu, Li Xinyi, Hu Haotian, Zhu Runyu","doi":"10.1111/echo.70385","DOIUrl":"10.1111/echo.70385","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>A novel index, termed the right ventricle (RV)-pulmonary artery (PA) index, was established by integrating the longitudinal strain of the right ventricular free wall (RVFWLS) and the right ventricular ejection fraction (RVEF), both evaluated using three-dimensional speckle-tracking echocardiography (3D-STE), with the stiffness of the pulmonary artery (PAS). This approach aims to enhance our understanding of the underlying mechanisms associated with heart failure with preserved ejection fraction (HFpEF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study comprised 80 patients diagnosed with HFpEF, 60 high-risk patients without clinical heart failure (HF), and 50 healthy controls. Clinical data and pulmonary stiffness measurements were collected, and right ventricular function was evaluated using 3D-STE. Furthermore, the corresponding RV-PA coupling parameters were established. Statistical analyses were conducted using SPSS version 26.0 and R software, employing one-way ANOVA, the Kruskal–Wallis H test, Pearson and Spearman correlation coefficients, multivariable linear regression, and receiver operating characteristic (ROC) curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with HFpEF exhibited elevated levels of PAS, dilated right heart structures, and impaired right ventricular (RV) function when compared to both high-risk and control groups. PAS was identified as an independent risk factor for RV dysfunction. Stratified diagnostic analysis revealed that the novel coupling index, RVEF/PAS, demonstrated exceptional diagnostic performance during the initial screening phase (AUC = 0.813) and maintained robust discriminatory power during the differentiation stage of the high-risk population (AUC = 0.757). Both newly developed indices, RVEF/PAS and RVFWLS/PAS, exhibited significant positive correlations with tricuspid annular plane systolic excursion (TAPSE)/PASP (<i>r</i> = 0.536, <i>p </i>= 0.004; <i>r</i> = 0.449, <i>p </i>= 0.019). The proposed stratified diagnostic model, characterized by a “primary screening-refined discrimination” approach based on parameter characteristics, offers a novel strategy for the early detection of HFpEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 3D-STE method reliably assesses right ventricular function in patients with HFpEF, while pulmonary arterial compliance is effectively evaluated through PAS. The novel RV-PA coupling indices, namely RVEF/PAS and RVFWLS/PAS, are developed by integrating these techniques, providing a stratified diagnostic strategy for the early detection of HFpEF. PAS is appropriate for initial screenin","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893482","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}
{"title":"Right Ventricular Global Wasted Work and RV–PA Coupling: Implications for Pulmonary Hypertension","authors":"Alexandra Mihai","doi":"10.1111/echo.70384","DOIUrl":"10.1111/echo.70384","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893505","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}
Yuting Hu, Ruqian Fu, Dezhi Zeng, Hua Teng, Peng Luo, Linghao Ying, Shi Deng, Hao Yang, Jianli Ren
Objective
To develop and validate machine learning (ML) models integrating two-dimensional speckle tracking echocardiography (2D-STE) parameters with clinical variables for robust identification of severe coronary artery disease (sCAD).
Methods
In this retrospective cohort study, five distinct ML models (Random Forest [RF], Support Vector Machine [SVM], K-Nearest Neighbors [KNN], Multi-Layer Perceptron [MLP], and Extremely Randomized Trees [Extra Trees]) were constructed to identify sCAD on a cohort of 204 patients (80% training set, 20% independent test set). Within the independent test set, two junior sonographers' diagnostic performance for sCAD was compared first without and then with ML assistance over a 2-week interval. SHapley Additive exPlanations (SHAP) analysis was applied to visualize and interpret the models, identifying key features driving sCAD prediction accuracy, with results visualized through dependence diagrams and force plot. Furthermore, a clinical nomogram integrating key predictors identified by ML models was developed to enable individualized quantification of sCAD risk.
Results
Utilizing five features, the MLP demonstrated the best performance with an area under the curve (AUC) of 0.870 and a sensitivity of 0.944. The SHAP visualization analysis for this model indicated that “LV AP4 Endo Peak L. Time SD” significantly influenced its predictions. The MLP model (AUC = 0.870) outperformed both junior sonographers (AUC = 0.687) and a nomogram constructed from ML-selected features (AUC = 0.712). Additionally, the results revealed that junior sonographers achieved significantly improved performance when assisted by the ML models.
Conclusion
The developed ML models could differentiate patients with angiography-confirmed sCAD from those without. Importantly, these models significantly improved the diagnostic performance of junior sonographers when used as an assistive tool.
目的：建立并验证将二维散斑跟踪超声心动图（2D-STE）参数与临床变量相结合的机器学习（ML）模型，用于重症冠状动脉疾病（sCAD）的鲁棒识别。方法：在这项回顾性队列研究中，构建了五种不同的ML模型（随机森林[RF]，支持向量机[SVM]， k -近邻[KNN]，多层感知机[MLP]和极端随机树[Extra Trees]）来识别204例患者的sCAD（80%训练集，20%独立测试集）。在独立的测试集中，两名初级超声医师对sCAD的诊断性能进行比较，首先在没有ML辅助的情况下，然后在两周的间隔内进行ML辅助。SHapley加性解释（SHAP）分析用于可视化和解释模型，确定驱动sCAD预测精度的关键特征，并通过依赖性图和力图将结果可视化。此外，我们还开发了一个临床nomogram整合ML模型识别的关键预测因子，以实现sCAD风险的个体化量化。结果：综合5个特征，MLP的曲线下面积（AUC）为0.870，灵敏度为0.944。该模型的SHAP可视化分析表明，“LV AP4 Endo Peak L. Time SD”显著影响其预测结果。MLP模型（AUC = 0.870）优于初级超声（AUC = 0.687）和由ml选择的特征构建的nomogram （AUC = 0.712）。此外，结果显示，初级超声医师在ML模型的帮助下取得了显着提高的性能。结论：所建立的ML模型可以区分血管造影证实的sCAD患者和未确诊的sCAD患者。重要的是，当用作辅助工具时，这些模型显着提高了初级超声医师的诊断性能。
{"title":"Machine Learning Models Integrating Two-Dimensional Speckle Tracking Echocardiography and Clinical Variables for Diagnosis of Severe Coronary Artery Disease","authors":"Yuting Hu, Ruqian Fu, Dezhi Zeng, Hua Teng, Peng Luo, Linghao Ying, Shi Deng, Hao Yang, Jianli Ren","doi":"10.1111/echo.70377","DOIUrl":"10.1111/echo.70377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop and validate machine learning (ML) models integrating two-dimensional speckle tracking echocardiography (2D-STE) parameters with clinical variables for robust identification of severe coronary artery disease (sCAD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, five distinct ML models (Random Forest [RF], Support Vector Machine [SVM], K-Nearest Neighbors [KNN], Multi-Layer Perceptron [MLP], and Extremely Randomized Trees [Extra Trees]) were constructed to identify sCAD on a cohort of 204 patients (80% training set, 20% independent test set). Within the independent test set, two junior sonographers' diagnostic performance for sCAD was compared first without and then with ML assistance over a 2-week interval. SHapley Additive exPlanations (SHAP) analysis was applied to visualize and interpret the models, identifying key features driving sCAD prediction accuracy, with results visualized through dependence diagrams and force plot. Furthermore, a clinical nomogram integrating key predictors identified by ML models was developed to enable individualized quantification of sCAD risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Utilizing five features, the MLP demonstrated the best performance with an area under the curve (AUC) of 0.870 and a sensitivity of 0.944. The SHAP visualization analysis for this model indicated that “LV AP4 Endo Peak L. Time SD” significantly influenced its predictions. The MLP model (AUC = 0.870) outperformed both junior sonographers (AUC = 0.687) and a nomogram constructed from ML-selected features (AUC = 0.712). Additionally, the results revealed that junior sonographers achieved significantly improved performance when assisted by the ML models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The developed ML models could differentiate patients with angiography-confirmed sCAD from those without. Importantly, these models significantly improved the diagnostic performance of junior sonographers when used as an assistive tool.</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":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893469","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}
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